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Identifying progressive early chronic kidney disease (CKD) patients at a health checkup is a good opportunity to improve their prognosis. However, it is difficult to identify them using common health tests. This worksite-based cohort study for 7 years in Japan (n = 7465) was conducted to evaluate the progression of CKD. The outcome was aggravation of the KDIGO prognostic category of CKD 7 years later. The subjects were male, 59.1%; age, 50.1 ± 6.3 years; and eGFR, 79 ± 14.4 mL/min/1.73 m 2 . The number of subjects showing CKD progression started to increase from 3 years later. Vector analysis showed that CKD stage G1 A1 was more progressive than CKD stage G2 A1. Bayesian networks showed that the time-series changes in the prognostic category of CKD were related to the outcome. Support vector machines including time-series data of the prognostic category of CKD from 3 years later detected the high possibility of the outcome not only in subjects at very high risks but also in those at low risks at baseline. In conclusion, after the evaluation of kidney function at a health checkup, it is necessary to follow up not only patients at high risks but also patients at low risks at baseline for 3 years and longer.

Although the economic burden of multimorbidity is a growing global challenge, the contribution of multimorbidity in patients with high medical expenses remains unclear. We aimed to clarify multimorbidity patterns that have a large impact on medical costs in the Japanese population. We conducted a cross-sectional study using health insurance claims data provided by the Japan Health Insurance Association. Latent class analysis (LCA) was used to identify multimorbidity patterns in 1,698,902 patients who had the top 10% of total medical costs in 2015. The present parameters of the LCA model included 68 disease labels that were frequent among this population. Moreover, subgroup analysis was performed using a generalized linear model (GLM) to assess the factors influencing annual medical cost and 5-year mortality. As a result of obtaining 30 latent classes, the kidney disease class required the most expensive cost per capita, while the highest portion (28.6%) of the total medical cost was spent on metabolic syndrome (MetS) classes, which were characterized by hypertension, dyslipidemia, and type 2 diabetes. GLM applied to patients with MetS classes showed that cardiovascular diseases or complex conditions, including malignancies, were powerful determinants of medical cost and mortality. MetS was classified into 7 classes based on real-world data and accounts for a large portion of the total medical costs. MetS classes with cardiovascular diseases or complex conditions, including malignancies, have a significant impact on medical costs and mortality.

This study aimed to clarify the trajectory of BMI alongside age-related changes in height and weight among Japanese adults. Data from annual health checkups between 2015 and 2020 by the Japan Health Insurance Association were retrospectively analyzed. A total of 4,777,891 men and 3,378,003 women (age 35-69 years) were stratified into 14 subgroups based on sex and 5-year age categories. We used linear mixed-effects model to estimate values for each outcome, with six-time points (2015-2020) as the independent variable. Mean BMI changes were positive across all subgroups, indicating a trend of increasing BMI (men, 0.02 to 0.14 kg/m /year; women, 0.05 to 0.16 kg/m /year). In younger subgroups, the changed were relatively large, with the weight transitions mirroring those of BMI. However, the mean changes were negative (men, -0.06 kg/year; women, -0.01 kg/year) in the oldest subgroups. Height reduction increased with age across subgroups (men, -0.14 to -0.03 cm/year; women, -0.18 to -0.01 cm/year). In conclusion, BMI tended to increase with age in both sexes across all age groups of Japanese adults. The increase in BMI appeared to be influenced by weight gain in young to middle age, whereas height reduction influenced increased BMI in older age groups.

The SARC-F is a 5-item questionnaire screening for patients at risk of sarcopenia. The electrical properties of tissues derived from bioelectrical impedance spectroscopy (BIS), including phase angle (PhA) and intracellular-extracellular water ratio (ICW/ECW) indices, are biomarkers of age-related loss of skeletal muscle quantity and quality. The purpose of the current study was to examine the association between SARC-F and muscle mass, strength, muscle-specific strength, and muscle quality as assessed by BIS and hand grip strength (HGS). Sarcopenia risk was assessed using the SARC-F questionnaire. BIS was used to obtain skeletal muscle mass (SMM) and skeletal muscle mass index (SMI), PhA, ICW/ECW index, membrane capacitance (Cm) and characteristic frequency (fc) for assessing muscle quantity and quality. HGS was evaluated, and muscle-specific strength (HGS/SMM) was calculated. The Pearson correlation coefficient was used to examine the associations between SARC-F scores and each muscle parameter. A total of 205 older adults aged 65–99 years were included in the current cross-sectional analysis. Of those, 142 were community-dwelling healthy older adults (110 women and32 men) and 63 were the older adults living in special nursing homes for the older adults (45 women and 18 men). SARC-F was significantly correlated with SMM, SMI, HGS, and HGS/SMM in both men and women ( p  < 0.05). SARC-F was also correlated with PhA, ICW/ECW index, Cm, and fc in both men and women ( p  < 0.001). The SARC-F score was associated with SMM, HGS, HGS/SMM, PhA, ICW/ECW index, Cm, and fc independently of age, sex, height, and BMI. SARC-F is a subjective yet simple assessment tool for muscle mass, strength, and quality relevant to sarcopenia.

Background Physical inactivity due to cachexia and muscle wasting is well recognized as a sign of poor prognosis in chronic obstructive pulmonary disease (COPD). However, there have been no reports on the relationship between trunk muscle measurements and energy expenditure parameters, such as the total energy expenditure (TEE) and physical activity level (PAL), in COPD. In this study, we investigated the associations of computed tomography (CT)-derived muscle area and density measurements with clinical parameters, including TEE and PAL, in patients with or at risk for COPD, and examined whether these muscle measurements serve as an indicator of TEE and PAL. Methods The study population consisted of 36 male patients with (n = 28, stage 1–4) and at risk for (n = 8) COPD aged over 50 years. TEE was measured by the doubly labeled water method, and PAL was calculated as the TEE/basal metabolic rate estimated by the indirect method. The cross-sectional areas and densities of the pectoralis muscles, rectus abdominis muscles, and erector spinae muscles were measured. We evaluated the relationship between these muscle measurements and clinical outcomes, including body composition, lung function, muscle strength, TEE, and PAL. Results All the muscle areas were significantly associated with TEE, severity of emphysema, and body composition indices such as body mass index, fat-free mass, and trunk muscle mass. All trunk muscle densities were correlated with PAL. The product of the rectus abdominis muscle area and density showed the highest association with TEE (r = 0.732) and PAL (r = 0.578). Several trunk muscle measurements showed significant correlations with maximal inspiratory and expiratory pressures, indicating their roles in respiration. Conclusions CT-derived measurements for trunk muscles are helpful in evaluating physical status and function in patients with or at risk for COPD. Particularly, trunk muscle evaluation may be a useful marker reflecting TEE and PAL.

Physical inactivity is associated with comorbidities and mortality in chronic obstructive pulmonary disease (COPD) patients. Although non-exercise activity thermogenesis (NEAT) is important for evaluating the physical activity level (PAL) of patients with chronic diseases, it has not yet been assessed in COPD patients. This study included male patients with COPD (n=28) and high risk for COPD (n=8). Total energy expenditure (TEE) and basal metabolic rate (BMR) were measured using the doubly labeled water (DLW) method and indirect calorimetry, respectively. PAL was calculated as TEE/BMR, while the NEAT was obtained from a questionnaire. Physical activity was also assessed using an accelerometer. The total NEAT score was correlated with PAL (r=0.534, 𝑃 < 0.001), while PAL was correlated more strongly with the non-locomotive NEAT score (r=0.548, 𝑃 < 0.001) than the locomotive NEAT score (r =0.278, 𝑃 = 0.10). Regarding accelerometer-obtained data, this questionnaire mainly reflected steps/day and the duration of light locomotive and non-locomotive daily activities. The NEAT score is a possible option for evaluating PAL in daily clinical practice. The present results indicated that non-locomotive activity may have a greater impact on PAL than locomotive activity in COPD patients.

Background: Subjective well-being (SWB) is an essential indicator of successful aging. Although social connections enhance SWB among older adults, few interventions have integrated community-based approaches with information and communication technology (ICT). This study evaluated the Chofu–Digital–Choju (CDC) project, a multi-component community intervention fostering in-person and online social connections among community-dwelling older adults in urban Japan. Methods: This quasi-experimental study (January 2022 to March 2024) included community-dwelling older adults aged 65–84 years in Chofu City, Tokyo, Japan. The intervention consisted of online classes, community hubs as local third places, and community events. Baseline and follow-up data were collected using self-administered questionnaires. Propensity score matching (1:1) was used to reduce selection bias, and generalized estimating equations were applied to evaluate the intervention effects. The primary outcome was SWB (Cantril Ladder). The secondary outcomes included social isolation, neighborhood relationships, social participation, health literacy, psychological health, physical activity, and ICT use. Results: Among the 1599 participants who completed both surveys, 209 (13.1%) participated in at least one CDC intervention component. After propensity score matching, 195 pairs were analyzed. No significant interaction effect was observed for SWB (β = 0.08, 95% confidence interval [CI]: −0.20, 0.37; p = 0.565). However, a significant interaction effect favored the intervention group for Internet usage frequency (odds ratio = 1.53, 95% CI: 1.08, 2.16; p = 0.016). A significant borderline interaction was also observed in health literacy (β = 0.13, 95% CI: −0.00, 0.26; p = 0.056), which reached significance in covariate-adjusted sensitivity analysis (p = 0.044). Subgroup analyses revealed that community hub participants showed significant interaction effects in health literacy (p = 0.021) and a trend toward reduced depressive symptoms (p = 0.084). Conclusions: The CDC intervention did not improve SWB over 2 years but enhanced Internet use and supported health literacy and depressive symptoms, particularly among hub participants. Community-based, multi-component interventions that integrate online and in-person activities may foster digital inclusion and specific health behaviors. Although SWB did not change in this study, these proximal gains may serve as foundational steps for long-term improvement. The study protocol was preregistered in the UMIN Clinical Trials Registry (UMIN000051393; Registered on 21 June 2023).

Left ventricular (LV) enlargement has been linked to sudden cardiac death among young athletes. This study aimed to model the effect of long-term incessant endurance training on LV dimensions in female adolescent runners. Japanese female adolescent competitive distance runners (n = 36, age: 15 years, height: 158.1 ± 4.6 cm, weight: 44.7 ± 6.1 kg, percent body fat: 17.0 ± 5.2%) underwent echocardiography and underwater weighing every 6 months for 3 years. Since the measurement occasions varied across subjects, multilevel analysis was used for curvilinear modeling of changes in running performance (velocities in 1500 m and 3000 m track race), maximal oxygen uptake (VO2max), body composition, and LV dimensions. Initially, LV end-diastolic dimension (LVEDd) and LV mass were 47.0 ± 3.0 mm and 122.6 ± 15.7 g, respectively. Running performance and VO2max improved along with the training duration. The trends of changes in fat-free mass (FFM) and LVEDd were similarly best described by quadratic polynomials. LVEDd did not change over time in the model including FFM as a covariate. Increases in LV wall thicknesses were minimal and independent of FFM. LV mass increased according to a quadratic polynomial trend even after adjusting for FFM. FFM was an important factor determining changes in LVEDd and LV mass. Although running performance and VO2max were improved by continued endurance training, further LV cavity enlargement hardly occurred beyond FFM gain in these adolescent female runners, who already demonstrated a large LVEDd.

The association between patterns of internet use for older adults’ well-being is unclear. We examined the association between the frequency and purpose of internet use and subjective well-being in older Japanese adults. We analyzed cross-sectional data from 2343 community-dwelling older adults (aged 65–84 years). Subjective well-being was measured using the World Health Organization Well-Being Index as a continuous score, and internet use was categorized by frequency and purpose. Hierarchical linear regression analysis was controlled for sociodemographic and health-related covariates. After full adjustment, only daily (B = 1.04, 95% CI [0.53, 1.56]) and dual-purpose use (i.e., for both practical and social communication purposes; B = 0.80, 95% CI [0.28, 1.31]) were independently associated with higher well-being. The analysis of the combined patterns further suggested that daily use was the primary factor. For older adults, regularity of internet use was more strongly associated with well-being than diversity of purpose. Daily integration appears to be a key factor for realizing benefits, suggesting that sustained practice is the foundational step in building the digital capital necessary for a flourishing later life. Longitudinal studies are needed to confirm these findings and untangle the causal relationship between sustained internet use and improved well-being among older adults.

Background The potential for developing frailty exists in middle‐aged and older adults. While obesity and metabolic syndrome (MetS) increase the risk of frailty in older adults, this relationship remains unclear in middle‐aged adults, who are prone to developing lifestyle‐related diseases. Objective To examine the effect of overweight/obesity and MetS on frailty development in middle‐aged and older Japanese adults using real‐world data. Methods This nationwide cohort study used exhaustive health insurance claims data of 3,958,708 Japanese people from 2015 to 2019 provided by the Japan Health Insurance Association. Participants aged ≥35 and < 70 years who received health checkups in 2015 were included. Multivariate logistic regression was used to assess the effect of body mass index (BMI) and MetS or MetS components (i.e., diabetes, hypertension, and dyslipidemia) in 2015 on frailty risk assessed using the hospital frailty risk score in 2019. Additionally, a subgroup analysis was performed to examine the interaction effects of MetS components and 4‐year weight change (%) on frailty risk among participants who were overweight and obese (BMI ≥25 kg/m2). Results In 2019, 7204 (0.2%) and 253,671 (6.4%) participants were at high and intermediate frailty risks, respectively. Obesity and MetS were independently associated with intermediate/high frailty risk (odds ratio (OR) 1.36, p < 0.05; OR 1.23, p < 0.05, respectively) and high frailty risk (OR 1.80, p < 0.05; OR 1.37, p < 0.05, respectively) in all participants. Although all MetS components were frailty risk factors, these effects diminished with age in both sexes. Subgroup analysis of patients with diabetes revealed that 5%–10% weight loss was associated with reduced frailty risk in both sexes. Conclusions Obesity, MetS, and MetS components were independent frailty risk factors in middle‐aged and older Japanese adults. Weight loss of up to 10% over 4 years prevented frailty in patients with diabetes who were overweight and obese. Obesity and metabolic syndrome are independent frailty risk factors in middle‐aged and older adults; however, the influence of metabolic syndrome components (i.e., diabetes, hypertension, and dyslipidemia) diminishes with age. Weight loss of up to 10% over a period of 5 years prevented the development of frailty in the population with overweight/obesity and diabetes.