Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Objective: Engaging in agriculture greatly affects workers’ lifestyles, particularly related to physical activity. This study aimed to clarify the prevalence of lifestyle-related chronic diseases among workers engaging and not engaging in agriculture in rural areas of Japan.Methods: A total of 4,666 consecutive participants aged ≥40 years (1,929 men and 2,737 women) were recruited during health examinations conducted from 2006 to 2014. For analysis, the participants were divided by sex and age into those engaging in agriculture and those not engaging in agriculture.Results: Engaging in agriculture may be contributing with a low prevalence of dyslipidemia, a constitutive factor of metabolic syndrome, in both sexes between the ages of 40 and 64 years. In the elderly aged ≥65 years, engaging in agriculture may influence the low prevalence of hypertension in men. Hypertension, a strong risk factor for stroke and cardiovascular disease, is very frequent among the Japanese elderly and, therefore, engaging in agriculture may have a significant impact on its prevention and control.Conclusion: In rural areas of Japan, engaging in agriculture may contribute to the control of lipid metabolism in middle-aged individuals and blood pressure in the elderly.

BACKGROUND/OBJECTIVE: Apolipoprotein A5 gene promoter region T-1131C polymorphism (APOA5 T-1131C) is known to be associated with elevated plasma TG levels, although little is known of the influence of the interaction between APOA5 T-1131C and lifestyle modification on TG levels. To investigate this matter, we studied APOA5 T-1131C and plasma TG levels of subjects participating in a three-month lifestyle modification program. SUBJECTS/METHODS: A three-month lifestyle modification program was conducted with 297 participants (Age: 57 +/- 8 years) in Izumo City, Japan, from 2001-2007. Changes in energy balance (the difference between energy intake and energy expenditure) and BMI were used to evaluate the participants' responses to the lifestyle modification. RESULTS: Even after adjusting for confounding factors, plasma TG levels were significantly different at baseline among three genotype subgroups: TT, 126 +/- 68 mg/dl; TC, 134 +/- 74 mg/dl; and CC, 172 +/- 101 mg/dl. Lifestyle modification resulted in significant reductions in plasma TG levels in the TT, TC, and CC genotype subgroups: -21.9 +/- 61.0 mg/dl, -20.9 +/- 51.0 mg/dl, and -42.6 +/- 78.5 mg/dl, respectively, with no significant differences between them. In a stepwise regression analysis, age, APOA5 T-1131C, body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), and the 18:1/18:0 ratio showed independent association with plasma TG levels at baseline. In a general linear model analysis, APOA5 T-1131C C-allele carriers showed significantly greater TG reduction with decreased energy balance than wild type carriers after adjustment for age, gender, and baseline plasma TG levels. CONCLUSIONS: The genetic effects of APOA5 T-1131C independently affected plasma TG levels. However, lifestyle modification was effective in significantly reducing plasma TG levels despite the APOA5 T-1131C genotype background.
Apolipoproteins* ; Asian Continental Ancestry Group* ; Body Mass Index ; Energy Intake ; Genotype ; Homeostasis ; Humans ; Japan ; Life Style* ; Linear Models ; Plasma* ; Promoter Regions, Genetic* ; Regression Analysis ; Triglycerides*

BACKGROUND/OBJECTIVES: Mulberry leaves contain quercetin derivatives, which have the effects of reducing obesity and improving lipid and glucose metabolism in mice with obesity. It is not clear whether or not mulberry leaves can directly affect metabolic disorders, in the presence of obesity, because of the interaction between obesity and metabolic disorders. The aim of the current study was to assess the direct action of quercetin derivatives on metabolic disorders in non-obese conditions in short-term high-fat diet fed mice. MATERIALS/METHODS: C57BL/6N mice were fed a high-fat diet, supplemented with either 0% (control), 1%, or 3% mulberry leaf powder (Mul) or 1% catechin powder for five days. Anthropometric parameters and blood biochemistry were determined, and hepatic gene expression associated with lipid and glucose metabolism was analyzed. RESULTS: Body and white fat weights did not differ among the four groups. Plasma triglycerides, total cholesterol, and free fatty acids in the 1%, 3% Mul and catechin groups did not differ significantly from those of the controls, however, plasma glucose and 8-isoprostane levels were significantly reduced. Liver gene expression of gp91phox, a main component of NADPH oxidase, was significantly down-regulated, and PPAR-alpha, related to beta-oxidation, was significantly up-regulated. FAS and GPAT, involved in lipid metabolism, were significantly down-regulated, and Ehhadh was significantly up-regulated. Glucose-metabolism related genes, L-PK and G6Pase, were significantly down-regulated, while GK was significantly up-regulated in the two Mul groups compared to the control group. CONCLUSIONS: Our results suggest that the Mul quercetin derivatives can directly improve lipid and glucose metabolism by reducing oxidative stress and enhancing beta-oxidation. The 1% Mul and 1% catechin groups had similar levels of polyphenol compound intake (0.4 x 10(-5) vs 0.4 x 10(-5) mole/5 days) and exhibited similar effects, but neither showed dose-dependent effects on lipid and glucose metabolism or oxidative stress.
Adipose Tissue, White ; Animals ; Biochemistry ; Blood Glucose ; Catechin ; Cholesterol ; Diet, High-Fat ; Fatty Acids, Nonesterified ; Gene Expression* ; Glucose* ; Lipid Metabolism ; Liver ; Metabolism* ; Mice* ; Morus* ; NADPH Oxidase ; Obesity ; Oxidative Stress ; Plasma ; Quercetin* ; Triglycerides ; Weights and Measures

BACKGROUND/OBJECTIVES: Mulberry leaves contain quercetin derivatives, which have the effects of reducing obesity and improving lipid and glucose metabolism in mice with obesity. It is not clear whether or not mulberry leaves can directly affect metabolic disorders, in the presence of obesity, because of the interaction between obesity and metabolic disorders. The aim of the current study was to assess the direct action of quercetin derivatives on metabolic disorders in non-obese conditions in short-term high-fat diet fed mice. MATERIALS/METHODS: C57BL/6N mice were fed a high-fat diet, supplemented with either 0% (control), 1%, or 3% mulberry leaf powder (Mul) or 1% catechin powder for five days. Anthropometric parameters and blood biochemistry were determined, and hepatic gene expression associated with lipid and glucose metabolism was analyzed. RESULTS: Body and white fat weights did not differ among the four groups. Plasma triglycerides, total cholesterol, and free fatty acids in the 1%, 3% Mul and catechin groups did not differ significantly from those of the controls, however, plasma glucose and 8-isoprostane levels were significantly reduced. Liver gene expression of gp91phox, a main component of NADPH oxidase, was significantly down-regulated, and PPAR-alpha, related to beta-oxidation, was significantly up-regulated. FAS and GPAT, involved in lipid metabolism, were significantly down-regulated, and Ehhadh was significantly up-regulated. Glucose-metabolism related genes, L-PK and G6Pase, were significantly down-regulated, while GK was significantly up-regulated in the two Mul groups compared to the control group. CONCLUSIONS: Our results suggest that the Mul quercetin derivatives can directly improve lipid and glucose metabolism by reducing oxidative stress and enhancing beta-oxidation. The 1% Mul and 1% catechin groups had similar levels of polyphenol compound intake (0.4 x 10(-5) vs 0.4 x 10(-5) mole/5 days) and exhibited similar effects, but neither showed dose-dependent effects on lipid and glucose metabolism or oxidative stress.
Adipose Tissue, White ; Animals ; Biochemistry ; Blood Glucose ; Catechin ; Cholesterol ; Diet, High-Fat ; Fatty Acids, Nonesterified ; Gene Expression* ; Glucose* ; Lipid Metabolism ; Liver ; Metabolism* ; Mice* ; Morus* ; NADPH Oxidase ; Obesity ; Oxidative Stress ; Plasma ; Quercetin* ; Triglycerides ; Weights and Measures

　　Health care plan has been established in each secondary medical area. Although health care plan should be focused on needs of people live in such units, studies with a view from residents’ perspective have not always been considered adequately. The aim of this study was to examine the factors that effect on utilization of health care facilities located outside of the secondary medical area in a rural region. The data included 515 patients with hypertension, 253 patients with hyperlipidemia, and 104 patients with diabetes. Factors relating utilization of health care facilities were assessed by age, sex, employment, number of diseases, body mass index (BMI), carotid plaque score, HbA1c, distance to the nearest clinic, and distance to the nearest bus stop. We conducted a logistic regression analyses of that data divided into two groups; car use and non car use. The result showed that sex, BMI, carotid plaque score and distance to the nearest bus stop were statistically significantly associated with the utilization of health care facilities located outside of the secondary medical area in patients with car use. Whereas, there were no statistically significantly associations in patients with non car use. Our findings suggested that it is important to consider health utilization of patients with lifestyle related diseases for making sustainable health care plan.

　　This study aimed at clarifying the effects of intervention with the composite Dementia Prevention Program. Subjects were 46 elderly people who had participated in the program. The study method included intervention trials to test the effects on the changes in BMI, physical function, and cognitive function of the program participants before and after the trial. Those aged 75 and up (old-old participants) had significantly stronger grip strength before the intervention than those below the age of 75 (young-old participants), but there was no difference in cognitive and physical functions between old-old and young-old participants. The average number of steps taken in the young-old group had significantly increased from approximately 4,000 steps before intervention to approximately 7,000 steps after intervention. When it comes to physical functions, the time taken for the 5-m walking exercise was significantly shortened from 3.8±0.8s to 3.5±0.5s in the young-old subjects; a change from 3.5±0.8s to 3.7±1.0s was observed for TUG in the young-old subjects and from 4.1±1.0s to 3.6±1.0s in old-old subjects. As regards cognitive function, episodic memory of the young-old subjects improved significantly, from 47.9±7.5 points before intervention to 56.5±8.8 points after intervention. The improvement in the old-old subjects was gradual. Episodic memory was improved without bearing on the changes shown in the 5-m walking tests (β＝-0.751, p＝0.020). The physical functions and episodic memory in cognitive function had both improved. This study suggested early intervention could increase the dementia prevention effect.

　　The establishment of a sustainable healthcare system based on residents’ needs is an urgent issue in a rural region. For this purpose, considering the structure of a healthcare system, such as the numbers of beds, doctors, and nurses is important. In addition, the study of healthcare utilization using the date gathered through geographic information systems (GIS) would be very helpful in building such a healthcare system. In Japan, however, there are few published studies available on how health services are utilized. The aim of this paper was to review articles of GIS research on healthcare utilization. We conducted a systematic search of published peer-reviewed literature on PubMed. We found 38 articles that satisfied our inclusions criteria for review. Of them, 12 articles had a map for understanding health needs or demands, 23 articles carried analyses of distance and time for health utilizations, and seven articles had a buffer or database for analyses of healthcare utilization. Most of these articles have dealt with pediatric care and emergency care. Given the aging population in a rural region, we concluded that a more evidence-based approach should be taken to rural health focussing on lifestyle-related diseases.

The anti-obesity effects of a hot water extract from wasabi (Wasabia japonica Matsum.) leaves (WLE), without its specific pungent constituents, such as allyl-isothiocyanate, were investigated in high fat-diet induced mice. C57J/BL mice were fed a high-fat diet (control group) or a high-fat diet supplemented with 5% WLE (WLE group). Physical parameters and blood profiles were determined. Gene expression associated with lipid metabolism in liver and white adipose tissue were analyzed. After 120 days of feeding, significantly lower body weight gain, liver weight and epididymal white adipose tissue weight was observed in the WLE group compared to the control group. In liver gene expression within the WLE group, PPARalpha was significantly enhanced and SREBP-1c was significantly suppressed. Subsequent downstream genes controlled by these regulators were significantly suppressed. In epididymal white adipose tissue of the WLE group, expression of leptin, PPARgamma, and C/EBPalpha were significantly suppressed and adiponectin was significantly enhanced. Acox, related to fatty acid oxidization in adipocytes, was also enhanced. Our results demonstrate that the WLE dietary supplement induces mild suppression of obesity in a high-fat diet induced mice, possibly due to suppression of lipid accumulation in liver and white adipose tissue.
Adipocytes ; Adiponectin ; Adipose Tissue, White ; Animals ; Body Weight ; Diet, High-Fat ; Dietary Supplements ; Gene Expression ; Leptin ; Lipid Metabolism ; Liver ; Mice ; Obesity ; PPAR alpha ; PPAR gamma ; Sterol Regulatory Element Binding Protein 1 ; Water

  Lifestyle-related diseases among the elderly have been brought to light by many investigaters. However, it remains unclear whether age-related frailty in the basic activities of daily living (ADLs) affects mortality independently of lifestyle. To clarify the relationship of lifestyle and frailty to elderly mortality, we conducted a three-year prospective study on 66 elderly people with reduced vital functions newly certified as requiring nursing care (frail elderly) and 72 elderly people living on their own (independent elderly) in Unnan City, Shimane Prefecture. The mortality rate for the frail elderly tended to be higher than for the independent elderly. However, this difference was not statistically significant. Gender was the only factor related to mortality in the frail elderly, who had advanced frailty. Furthermore, mortality rates were significantly higher for men than women. No relationship was observed between lifestyle and frailty. In the independent elderly, smoking and unstable gait, respectively, were significantly related to mortality. The present findings indicate that lifestyle and frailty are independently related to elderly mortality.