Objective The aim of this study was to evaluate the effects of health checkup and the health education "Hokenshido" program based on the concept that visceral fat accumulation causes metabolic syndrome (MetS), leading to cardiovascular disease (CVD). Methods and SubjectsBased on the Japanese definition of metabolic syndrome, in the annual health checkup for general subjects, the measurement of waist circumference and use of "Where am I?" chart on the way to develop atherosclerosis were introduced. The study group comprised 3,174 Japanese employees .2%, 14.4%, p< 0.001) and females (3.0%, 2.2%, 1.9%, p=0.359), respectively. Among subjects with MetS at baseline, the number of subjects with MetS significantly decreased in males (508, 287, 247, p<0.0001) and females (22, 8, 6, p<0.0001), respectively. Mean waist loss was 1.6 cm in males (<0.0001) and 1.5 cm in females (<0.001). Among subjects with metabolic syndrome at baseline, the mean waist loss was 2.5 cm in males (<0.0001) and 3.9 cm in females (<0.05). Fatal atherosclerotic vascular events were not recorded in this study period. Conclusion Health check-up and the "Hokenshido" program reduced the prevalence of the MetS, which might lead to prevention of CVD.

Background: It is uncertain whether health counselling after community-based health checkups for high-risk individuals of lifestyle-related disease enhances their referral to physicians. Methods: We performed a clustered randomized controlled trial of untreated high-risk individuals aged 40 to 74 years who were screened from the annual health checkup in 2014 and 2015 under the national health insurance in 43 municipalities around Japan, assigning 21 intervention and 22 usual care municipalities. The high-risk conditions were severe forms of hypertension, diabetes, dyslipidemia (for men), and proteinuria. For the intervention group, the theory-based health counselling was performed to enhance referrals to physicians, while each municipality performed its own standard counselling for the usual care group. Data on clinical visits and risk factors were collected systematically and anonymously from the databases of health insurance qualification, health insurance claims, and annual health checkups. Hypotheses are that the cumulative proportion of seeing physicians (clinical visits) is higher in the intervention than the usual care groups, and that those in the intervention group have lower cumulative incidence of composite outcomes associated with lifestyle-related diseases. Results: The numbers of subjects for the analyses were 8,977 in the intervention group and 6,733 in the usual care group. Among them, 6,758 had hypertension, 2,147 had diabetes, 2,861 had dyslipidemia, and 1,221 had proteinuria in the intervention group, with corresponding numbers of 4,833, 1,517, 2,262, and 845, respectively, in the usual care group. There were no material differences in mean levels and proportions of major cardiovascular risk factors between the two groups. Conclusions: We expect to provide scientific evidence on the effectiveness of health counselling.