TY - JOUR
T1 - Longitudinal effects of a nationwide lifestyle intervention program on cardiometabolic outcomes in Japan
T2 - An observational cohort study
AU - Takeuchi, Yoshinori
AU - Kashiwabara, Kosuke
AU - Hosoi, Hiroki
AU - Imai, Hirohisa
AU - Matsuyama, Yutaka
N1 - Funding Information:
The authors would like to thank Dr. Yasuhiro Hagiwara, Dr. Gen Yamada, and Dr. Takuya Hirai for their kindness in providing technical assistance and advice. This study was approved by the Research Ethics Committee, Graduate School of Medicine and Faculty of Medicine, the University of Tokyo (Approval No. 12040). Because these analyses involved the secondary use of data that had been routinely collected as part of regular business operations of the Health Insurance Organization in Prefecture A, the need for individual informed consent was waived in accordance with the current ethical standards for medical and health research involving human participants in Japan. This study was supported by Grants-in-Aid for Support Program for Biostatisticians / Project Promoting Clinical Trials for Development of New Drugs and Medical Devices from the Japan Agency for Medical Research and Development (No grant number). The funding source has no role in the analysis and interpretation and in the writing of the manuscript. The SHC and SHG data used in this study are maintained by the Health Insurance Organization of Prefecture A (Japan). However, restrictions apply to the availability of data, which were used under permission for this study. Accordingly, these data are not publicly available. Hirohisa Imai received lecture fees from the Health Insurance Organization of Prefecture A. No other potential competing interest relevant to this study was reported.
Funding Information:
This study was supported by Grants-in-Aid for Support Program for Biostatisticians / Project Promoting Clinical Trials for Development of New Drugs and Medical Devices from the Japan Agency for Medical Research and Development (No grant number). The funding source has no role in the analysis and interpretation and in the writing of the manuscript.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/12
Y1 - 2020/12
N2 - The Japanese government launched a nationwide health screening and lifestyle intervention program in 2008 to prevent and reduce metabolic syndrome in at-risk individuals. This study examined the longitudinal effects of the program's lifestyle interventions on metabolic outcomes using health insurance data from one prefecture. The study population comprised 16,317 individuals aged 40–74 years who met the recommendation criteria for the interventions between 2009 and 2015. Participants were categorized into an overall intervention group (comprising a single-session motivational intervention group and a multi-session intensive intervention group) and a non-intervention group. We evaluated the interventions' effects on the initiation of medications for metabolic disorders (hyperlipidemia, hypertension, and hyperglycemia) and metabolic syndrome incidence for 6 years using discrete hazard models that adjusted for sex, age, health screening measurements, and smoking habit. The longitudinal effects on health screening measurements were also evaluated using regression models for repeated measures. The adjusted hazard ratios (aHRs) (95% confidence interval [CI]) for initiation of medications were 0.83 (0.77–0.90), 0.77 (0.71–0.84), and 0.66 (0.57–0.77) for overall, motivational, and intensive interventions, respectively. The aHRs (95%CI) for metabolic syndrome incidence were 0.84 (0.75–0.94), 0.80 (0.71–0.91), and 0.67 (0.51–0.89) for overall, motivational, and intensive interventions, respectively. The interventions reduced body mass index and waist circumference, but had modest effects on blood lipids, blood glucose, and hemoglobin A1c levels; blood pressure was unaffected. These interventions represent an effective strategy to prevent the progression of preclinical metabolic syndrome, but further studies are needed to evaluate their long-term preventive effects on cardiovascular disease and diabetes.
AB - The Japanese government launched a nationwide health screening and lifestyle intervention program in 2008 to prevent and reduce metabolic syndrome in at-risk individuals. This study examined the longitudinal effects of the program's lifestyle interventions on metabolic outcomes using health insurance data from one prefecture. The study population comprised 16,317 individuals aged 40–74 years who met the recommendation criteria for the interventions between 2009 and 2015. Participants were categorized into an overall intervention group (comprising a single-session motivational intervention group and a multi-session intensive intervention group) and a non-intervention group. We evaluated the interventions' effects on the initiation of medications for metabolic disorders (hyperlipidemia, hypertension, and hyperglycemia) and metabolic syndrome incidence for 6 years using discrete hazard models that adjusted for sex, age, health screening measurements, and smoking habit. The longitudinal effects on health screening measurements were also evaluated using regression models for repeated measures. The adjusted hazard ratios (aHRs) (95% confidence interval [CI]) for initiation of medications were 0.83 (0.77–0.90), 0.77 (0.71–0.84), and 0.66 (0.57–0.77) for overall, motivational, and intensive interventions, respectively. The aHRs (95%CI) for metabolic syndrome incidence were 0.84 (0.75–0.94), 0.80 (0.71–0.91), and 0.67 (0.51–0.89) for overall, motivational, and intensive interventions, respectively. The interventions reduced body mass index and waist circumference, but had modest effects on blood lipids, blood glucose, and hemoglobin A1c levels; blood pressure was unaffected. These interventions represent an effective strategy to prevent the progression of preclinical metabolic syndrome, but further studies are needed to evaluate their long-term preventive effects on cardiovascular disease and diabetes.
KW - Longitudinal analysis
KW - Metabolic syndrome
KW - Observational study
KW - Policy evaluation
KW - Population approach
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UR - http://www.scopus.com/inward/citedby.url?scp=85095417894&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2020.106301
DO - 10.1016/j.ypmed.2020.106301
M3 - Article
C2 - 33164885
AN - SCOPUS:85095417894
SN - 0091-7435
VL - 141
JO - Preventive Medicine
JF - Preventive Medicine
M1 - 106301
ER -
