Publications by authors named "Makiko Tomida"

27 Publications

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Vasomotor symptoms, sleep problems, and depressive symptoms in community-dwelling Japanese women.

J Obstet Gynaecol Res 2021 Jul 18. Epub 2021 Jul 18.

Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan.

Aim: To assess prevalence and characteristics of vasomotor symptoms in community-dwelling Japanese women.

Methods: These were cross-sectional analyses using data from the National Institute for Longevity Sciences-Longitudinal Study of Aging. The main outcome measures were prevalence and severity of hot flashes and sweating. Associations between hot flashes/sweating (slight, moderate, or severe vs none) and sleep problems were explored using logistic regression, with and without adjustment for age, daily physical activity, and number of urinations/night. Associations between hot flashes/sweating and sleep problems, depressive symptoms, and dietary variables were explored in logistic regression models or general linear models.

Results: A total of 1152 women between 40 and 91 years of age were enrolled. Hot flashes were reported by 24.5% of participants; with prevalence and severity highest in those 50-54 years or 2-5 years postmenopause. Sleep problems were reported 15 percentage points more frequently by women who reported hot flashes than by those without hot flashes. Adjusted odds ratios [95% CI] for difficulty in falling asleep and difficulty in sleeping through were 2.09 [1.565-2.796] and 2.07 [1.549-2.763]), respectively. Also, hot flashes were associated with higher risk of depressive symptoms (adjusted odds ratio [95% CI]: 2.99 [2.07-4.32]) and lower life satisfaction, self-esteem, and self-rated health status. A similar pattern was observed in women with and without sweating. No associations were found between hot flashes and dietary factors.

Conclusions: Clear associations were found between hot flashes and sleeping problems, even after adjusting for potential confounding factors. Women who reported hot flashes also reported worse mental and physical health than those who did not report hot flashes.
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http://dx.doi.org/10.1111/jog.14937DOI Listing
July 2021

Green tea consumption is associated with annual changes in hippocampal volumes: A longitudinal study in community-dwelling middle-aged and older Japanese individuals.

Arch Gerontol Geriatr 2021 Sep-Oct;96:104454. Epub 2021 Jun 1.

National Center for Geriatrics and Gerontology, Aichi, Japan.

Background: To investigate the association between green tea consumption and the annual rate of change of gray matter (GM), white matter (WM), and hippocampal volumes in community-dwelling middle-aged and older Japanese individuals.

Methods: A prospective cohort study with two years of follow-up was conducted as part of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) project. A total of 1693 participants (862 men and 831 women, aged 40-89 years) were included. Green tea consumption (mL/day) data were collected with a 3-day dietary record. Volumes of GM, WM, and the hippocampus were estimated by T1-weighted brain magnetic resonance imaging and FreeSurfer software. The GM ratio, WM ratio, and hippocampal ratio (HR) were calculated as the percentages of total intracranial volume, respectively.

Results: The mean (SD) annual rate of change of hippocampal volume [(HR at baseline - HR at follow-up)/HR at baseline/follow-up years×100%] was 0.499 (1.128) (%). In the multivariable-adjusted general linear model, green tea consumption was negatively associated only with the annual rate of change of hippocampal volume (%) [β (95% CI) for each 1 mL/day increase in green tea consumption = -20.2E-5 (-35.0E-5 to -5.3E-5); P-value = 0.008]. No associations were observed for the annual rate of change of GM or WM volumes. The results remained significant when the analysis was limited to those with stable green tea consumption and were especially evident among individuals aged 65 years and older and among women.

Conclusions: In this study, higher green tea consumption was associated with less annual hippocampal atrophy, and each additional 100 mL/day of green tea intake was related to a reduction of approximately 5% in annual hippocampal atrophy. This association was especially evident among older individuals and among women. Further study in different settings is needed to confirm this association.
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http://dx.doi.org/10.1016/j.archger.2021.104454DOI Listing
September 2021

Differences in the mass and quality of the quadriceps with age and sex and their relationships with knee extension strength.

J Cachexia Sarcopenia Muscle 2021 Aug 19;12(4):900-912. Epub 2021 May 19.

National Center for Geriatrics and Gerontology, Obu, Japan.

Background: Although muscle quality evaluations are currently considered important for diagnosing sarcopenia, data from the general population are lacking. This study used mid-thigh computed tomography measurements to evaluate age-related and sex-related differences in quadriceps femoris muscle quality and mass and their relationships with knee extension strength (KES).

Methods: Cross-sectional data from 520 Japanese individuals (273 men and 247 women, mean age: 63.1 ± 10.6 years) were analysed. Mass and quality were assessed using quadriceps cross-sectional areas (CSAs) and computed tomography values (CTVs), respectively. The four constituent muscles, intermuscular adipose tissue, and entire quadriceps area (total quadriceps muscles + intermuscular adipose tissue) were assessed, and the data were stratified by five age groups and sex. To evaluate age-related decline, linear and quadratic equations were tested for fit according to the constituent muscles and sex. KES could be measured in 472 of the 520 participants (254 men and 218 women, mean age: 62.3 ± 10.3). Multiple linear regression analyses with age-adjusted models were then used for evaluating the relationships between KES and quadriceps measurements.

Results: All muscle CSAs and CTVs showed downward trends with age (men: P < 0.001 for all; women: vastus medialis CTV, P = 0.004; others, P < 0.001); the intermuscular adipose tissue CSA did not show any trend (men: P = 0.938; women: P = 0.139), although its percentage of the entire quadriceps area showed an upward trend in both sexes (P < 0.001). Men exhibited a quadratic decline in the CSAs for the entire quadriceps area (P = 0.016), total quadriceps muscles (P = 0.021), the vastus medialis (P = 0.010) and vastus lateralis (P = 0.038), and all CTVs (rectus femoris, P = 0.044; others, P < 0.001). Women exhibited a quadratic equation in the CTV for rectus femoris (P = 0.031), but a linear decline in the other variables (P < 0.001 for all). Both the total quadriceps muscles CSA and CTV were significantly associated with KES in both sexes (P < 0.001). For each muscle, the CSAs of the vastus medialis (P < 0.001) and vastus intermedius (P = 0.001) were significantly associated with KES in men, whereas the vastus medialis CSA (P < 0.001), vastus lateralis CSA (P = 0.006), rectus femoris CSA (P = 0.020), and vastus intermedius CTV (P = 0.025) were significantly associated with KES in women CONCLUSIONS: Age-related quadriceps femoris changes in mass and quality differed by sex and the constituent muscles. The constituent muscles contributing to KES differed between men and women. Quadriceps CSA and CTV measurements are useful for objectively assessing age-related and sex-related muscle deterioration and KES.
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http://dx.doi.org/10.1002/jcsm.12715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350198PMC
August 2021

Intake of isoflavones reduces the risk of all-cause mortality in middle-aged Japanese.

Eur J Clin Nutr 2021 Mar 12. Epub 2021 Mar 12.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, Aichi, Japan.

Background/objectives: To clarify the effects of intake of legumes and isoflavones on all-cause mortality in middle-aged and older Japanese.

Subject/methods: The subjects were 2136 randomly chosen community-dwelling Japanese men and women aged 40-79 years who participated in a first-wave survey (1997-2000; baseline). The subjects were followed from baseline to December 31, 2017 (mean period of 16.6 ± 4.2 years). Intake of legumes, soybeans, and isoflavones at baseline was assessed using a 3-day dietary record with photographs. The relationships of intake amounts of legumes and isoflavones to mortality were assessed using Cox proportional hazards regression controlling for age, sex, education, employment, body mass index, smoking habits, medical histories, drinking, and energy intake.

Results: There were 491 deaths during the follow-up period. We found inverse associations of the intake of total soy products and intake of each of the isoflavones with all-cause mortality (p for trend < 0.05) in subjects aged < 60 years: the multivariate-adjusted hazard ratios (95% confidence intervals) for all-cause mortality in the highest intake group (third tertile) of total soy products and total isoflavones were 0.32 (0.13-0.78) and 0.35 (0.17-0.73), respectively, compared with the reference group (first tertile). In contrast, there were no significant associations of intake amounts of legumes, soybeans, and isoflavones with all-cause mortality in subjects aged 60 years or older.

Conclusions: The findings suggest that a higher intake of isoflavones might decrease the risk of all-cause mortality, especially in middle-aged Japanese.
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http://dx.doi.org/10.1038/s41430-021-00890-wDOI Listing
March 2021

Dietary diversity is associated with longitudinal changes in hippocampal volume among Japanese community dwellers.

Eur J Clin Nutr 2021 06 2;75(6):946-953. Epub 2020 Sep 2.

National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Background/objectives: Dietary habits are known to affect health, including the rate of brain ageing and susceptibility to diseases. This study examines the longitudinal relationship between dietary diversity and hippocampal volume, which is a key structure of memory processing and is known to be impaired in dementia.

Subjects/methods: Subjects were aged 40-89 years (n = 1683, men: 50.6%) and participated in a 2-year follow-up study of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Dietary intake was calculated from 3-day dietary records, and dietary diversity was determined using the Quantitative Index for Dietary Diversity at baseline. Longitudinal changes in hippocampal and total grey matter volumes were estimated by T1-weighted brain magnetic resonance imaging and FreeSurfer software. Estimated mean brain volume change in relation to dietary diversity score quintiles was assessed by the general linear model, adjusted for age, sex, education, smoking status, alcohol intake, physical activity, and comorbidities.

Results: The mean (± standard deviation) % decreases in hippocampal and total grey matter volume during the 2-year follow-up were 1.00% (±2.27%) and 0.78% (±1.83%), respectively. Multivariate-adjusted decreases in total grey matter volume were associated with dietary diversity score (p = 0.065, p for trend = 0.017), and the % decrease in hippocampal volume was more strongly associated with the dietary diversity score: the estimated mean (± standard error) values were 1.31% (±0.12%), 1.07% (±0.12%), 0.98% (±0.12%), 0.81% (±0.12%), and 0.85% (±0.12%), according to dietary diversity quintiles in ascending order (p = 0.030, p for trend = 0.003).

Conclusions: Among community dwellers, increased dietary diversity may be a new nutritional strategy to prevent hippocampal atrophy.
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http://dx.doi.org/10.1038/s41430-020-00734-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189902PMC
June 2021

Subtypes of physical frailty and their long-term outcomes: a longitudinal cohort study.

J Cachexia Sarcopenia Muscle 2020 10 18;11(5):1223-1231. Epub 2020 Jun 18.

Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Background: Components of physical frailty cluster into subtypes, but it remains unknown how these might be associated with age-related functional declines and multimorbidities. This study aims to investigated associations of physical frailty subtypes with functional declines and multimorbidity in a 10 year longitudinal cohort survey.

Methods: Complementary longitudinal cohort study used group-based multitrajectory modelling to verify whether frailty subtypes discovered in Taiwan are presented in another aging cohort, then investigated associations of these subtypes with cognitive decline and multimorbidity. Participants aged ≥50 years were recruited from the third to sixth waves (May 2002 to July 2010) of the National Institute for Longevity Sciences-Longitudinal Study of Aging, in Japan. People with incomplete data, pre-frail/frail status before their index wave, and those with incomplete data or who died during follow-up, were excluded. Group-based trajectory analysis denoted five established physical frailty criteria as time-varying binary variables in each wave during follow-up. Incident frailty was classified as mobility subtype (weakness/slowness), non-mobility subtype (weight loss/exhaustion), or low physical activity subtype. General linear modelling investigated associations of these frailty subtypes with activities of daily living, digit symbol substitution test (DSST) and Charlson Comorbidity Index (CCI) at 2 year follow-up.

Results: We identified four longitudinal trajectories of physical frailty, which corroborated the distinct subtypes we discovered previously. Among 940 eligible participants, 38.0% were robust, 18.4% had mobility subtype frailty, 20.7% non-mobility subtype, and 20.1% low physical activity subtype. People with mobility subtype frailty were older than those with other frailty subtypes or robust status and had higher prevalence of hypertension, diabetes, and heart failure. In the multivariable-adjusted general linear models, mobility-subtype frailty was associated with a significantly lower DSST score (point estimate -2.28, P = 0.03) and higher CCI (point estimate 0.82, P < 0.01) than the other groups.

Conclusions: Mobility-subtype frailty was associated with functional declines and progression of multimorbidity; the long-term effects of physical frailty subtypes deserve further investigation.
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http://dx.doi.org/10.1002/jcsm.12577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567152PMC
October 2020

Dietary Diversity and All-Cause and Cause-Specific Mortality in Japanese Community-Dwelling Older Adults.

Nutrients 2020 Apr 10;12(4). Epub 2020 Apr 10.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.

We examined associations between dietary diversity and all-cause and cause-specific mortality in 386 men and 413 women (age range, 60-79 years at baseline) who took part in the National Institute for Longevity Sciences-Longitudinal Study of Aging study from 1997 to 2000. Dietary intake was assessed using three-day dietary records and photographs. The Quantitative Index for Dietary Diversity was used to determine the dietary diversity among thirteen food groups. Dietary diversity score and each food intake were examined by sex-stratified tertiles, and hazard ratios (HR) were calculated to compare the risk for all-cause and cause-specific deaths across tertiles, after controlling for age, sex, body mass index, alcohol intake, smoking status, education, physical activity, and disease history. During a mean follow-up of 15.7 years, 289 subjects (36.2%) died. Compared to the subjects in the lowest tertile, the multivariate-adjusted HR for all-cause and cancer mortality was 0.69 (95% confidence interval (CI): 0.51-0.94) and 0.57 (95% CI: 0.33-0.98), respectively (trend < 0.05), in subjects in the highest tertile of dietary diversity. There were no significant associations between dietary diversity score and death from cardiovascular or cerebrovascular disease. Eating a variety of foods might contribute to longevity in older Japanese community dwellers.
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http://dx.doi.org/10.3390/nu12041052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230563PMC
April 2020

<Editors' Choice> Association between green tea intake and risk of cognitive decline, considering glycated hemoglobin level, in older Japanese adults: the NILS-LSA study.

Nagoya J Med Sci 2019 Nov;81(4):655-666

Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu City, Japan.

Positive and negative associations with risk of cognitive decline have been reported for glycated hemoglobin (HbA1c) level and green tea (GT) intake, respectively. This study aimed to assess whether the reduction in the risk of cognitive decline with GT intake depended on HbA1c level. The participants were aged ≥60 years at baseline in the cohort study, wherein examinations were conducted biennially from 2000 to 2012. Subjects (n=1,304) who had no cognitive decline during the first survey and who had participated in the follow-up survey at least once were included. The follow-up end point was the first screening time point for cognitive decline (Mini-Mental State Examination score <27) or the last survey participation. With reference to the Japanese Diabetes Society guideline, the cut-off points for HbA1c level were set at 5.6%, 6.0%, and 6.5%, and lower and higher groups were assigned for each cut-off point. In a multiple Cox proportional hazard model, an interaction between GT intake and HbA1c groups for cognitive decline was observed only at HbA1c 6.0% (-value for interaction [with Bonferroni's correction] <0.05/3). Lower risks of cognitive decline were found for the HbA1c ≥5.6%, ≥6.0%, and <6.5% groups (hazard ratios: 0.59, 0.34, and 0.77; 95% confidence intervals: 0.41-0.88, 0.19-0.61, and 0.56-1.08 for "≥4 times a day" vs. "
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http://dx.doi.org/10.18999/nagjms.81.4.655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892664PMC
November 2019

Protein intake per day and at each daily meal and skeletal muscle mass declines among older community dwellers in Japan.

Public Health Nutr 2020 04 14;23(6):1090-1097. Epub 2019 Oct 14.

National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Objective: To examine associations between protein intake per day and at different meals and skeletal muscle mass declines.

Design: Two-year prospective cohort study among older community dwellers.

Setting: National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan.

Participants: Older men (n 292) and women (n 363) aged 60-87 years who participated in the baseline (2006-2008) and follow-up studies (2008-2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined.

Results: Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women.

Conclusions: High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.
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http://dx.doi.org/10.1017/S1368980019002921DOI Listing
April 2020

Green tea and coffee intake and risk of cognitive decline in older adults: the National Institute for Longevity Sciences, Longitudinal Study of Aging.

Public Health Nutr 2020 04 23;23(6):1049-1057. Epub 2019 Sep 23.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, Japan.

Objective: To examine the association between green tea and coffee intake and cognitive decline in older adults.

Design: A prospective cohort study. The average intake of green tea and coffee in the previous year was assessed through a dietitian interview using a dietary questionnaire. A Mini-Mental State Examination (MMSE) was conducted up to six times biennially. Cognitive decline was screened using the MMSE; its incidence was defined as the first time a score of <27 points was obtained in a biennial test from the baseline. Hazard ratios for incidence of cognitive decline were estimated according to the intake of the two beverages using multivariable Cox proportional hazard regression, controlling for sociodemographic and lifestyle factors.

Setting: The National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) in Japan.

Participants: Men (n 620) and women (n 685), aged 60-85 years, from the NILS-LSA.

Results: During a mean of 5·3 (sd 2·9) years of follow-up, 432 incident cases of cognitive decline were observed. Compared with participants who consumed green tea
Conclusions: The intake of green tea, but not coffee, was shown to reduce the risk of cognitive decline in older adults.
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http://dx.doi.org/10.1017/S1368980019002659DOI Listing
April 2020

A cross-sectional study of the associations between the traditional Japanese diet and nutrient intakes: the NILS-LSA project.

Nutr J 2019 07 30;18(1):43. Epub 2019 Jul 30.

Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.

Background: Although our previous study using a food frequency questionnaire simulated nutritional characteristics of the traditional Japanese diet, this issue has not been sufficiently evaluated. This study was conducted to examine the relationship between the traditional Japanese diet and nutrient density (ND).

Methods: A cross-sectional study employing the dietary record method was conducted among 2221 community-dwelling Japanese adults (40-88 years) living in Aichi Prefecture, Japan, in 2006-2008. Based on previous studies, a 9-component Japanese Diet Index (JDI) and a 12-component modified JDI (mJDI) were defined. To develop a new weighted index, a multiple linear regression model was used to select food components which were significantly associated with an ND score (integrated by 11 nutrient components) from the mJDI and weight them. Correlation analyses were performed between JDI, mJDI, the new weighted JDI score and the ND score and its 11 nutrient components. The findings were validated with data from 2008 to 2010 by assessing the associations between the JDIs scores and the ND score.

Results: Scores of the JDI and mJDI were positively correlated with the ND score (corresponding Spearman's ρ [95% confidence interval; CI], 0.34 [0.31, 0.38] and 0.44 [0.41, 0.48], respectively; P < 0.05 for both). Among the mJDI, 9 food components (rice, fish and shellfish, green and yellow vegetables, seaweed, green tea, beef and pork, soybeans and soybean foods, fruit, and mushrooms) significantly associated with the ND score. All of these 9 components were weighted and a new weighted JDI (wJDI) was developed. The wJDI score was also positively correlated with the ND score (Spearman's ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05). However, scores for all 3 indices were positively correlated with sodium intake. The wJDI score obtained using dietary record data from 2008 to 2010 was also positively correlated with the ND score (Spearman's ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05).

Conclusions-: Adhering to a traditional Japanese diet as defined by the JDI was associated with good ND. Furthermore, the modified indices (mJDI and wJDI) had a higher performance for ND. However, all of the indices were correlated with high sodium intake.
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http://dx.doi.org/10.1186/s12937-019-0468-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664518PMC
July 2019

Role of gait speed and grip strength in predicting 10-year cognitive decline among community-dwelling older people.

BMC Geriatr 2019 07 5;19(1):186. Epub 2019 Jul 5.

National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan.

Background: The gait speed and handgrip strength represented the core determinants of physical frailty and sarcopenia, which were reported to be associated with cognitive impairment and decline. Different physical measures might differentially affect cognitive changes, such as higher-level cognitive change and global cognitive decline. This study examined the differential associations of gait speed and handgrip strength with 10-year cognitive changes among community-dwelling older people.

Methods: Participants aged 60 years and over living in the community were invited for study. Gait speed and handgrip strength were classified into 5 groups based on quintiles at baseline. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and Digit Symbol Substitution Test (DSST) every 2 years from baseline for a period of 10 years. Linear mixed effects models were used to determine the role of gait speed and handgrip strength in the prediction of 10-year cognitive changes by adjusting covariates, including age, gender, education, depressive symptoms, marital status, smoking status, instrumental activities of daily life (IADL), Charlson Comorbidity Index (CCI), and body mass index (BMI) at baseline.

Results: A total of 1096 participants were enrolled in the study. The mean age was 69.4 ± 5.8 years and 50.9% were male. The slowest gait speed group showed a significantly greater decline in the DSST scores over 10 years than the highest group (estimate = 0.28 and P = 0.003), but not in the MMSE scores (estimate = 0.05 and P = 0.078). The lowest handgrip strength group showed a significantly greater decline in the MMSE scores than the highest group (estimate = 0.06 and P = 0.039) and in the DSST scores than the highest two quintiles (estimate = 0.20 and P = 0.033 for the fourth quintile; estimate = 0.20 and P = 0.040 for the highest quintile) over 10-year follow-up.

Conclusions: A slow gait speed could predict 10-year cognitive decline using DSST, and a low handgrip strength could predict 10-year cognitive decline using MMSE in addition to DSST. Thus both physical measures are lined to cognitive decline but there may be different mechanisms between brain and physical functions.
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http://dx.doi.org/10.1186/s12877-019-1199-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612180PMC
July 2019

Positive Effects of Openness on Cognitive Aging in Middle-Aged and Older Adults: A 13-Year Longitudinal Study.

Int J Environ Res Public Health 2019 06 12;16(12). Epub 2019 Jun 12.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.

The relationship between openness (a psychological trait of curiosity) and a cognitive change was examined in middle-aged and older adults. Participants were 2214 men and women (baseline age range: 40 to 81 years). They were tested up to seven times over approximately 13 years. Openness at the baseline was assessed by the NEO Five-Factor Inventory. Cognitive abilities were assessed at each examination using the Wechsler adult intelligence scale-revised short form, which includes information, similarities, picture completion, and digit symbol subscales. General linear mixed models comprised fixed effects of openness, age at the baseline, follow-up time, their interactions, and the covariates. The results indicated that the main effects of openness were significant for all scores. Moreover, the interaction term openness × age × time was significant for the information and similarities test scores, indicating that changes in the information and similarities scores differed depending on the level of openness and baseline age. The estimated trajectory indicated that the differences in slopes between participants with high and low openness were significant after 60 years of age for the information, and after 65 years of age for the similarities scores. It is concluded that openness has a protective effect on the decline in general knowledge and logical abstract thinking in old age.
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http://dx.doi.org/10.3390/ijerph16122072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617284PMC
June 2019

Fish and Meat Intake, Serum Eicosapentaenoic Acid and Docosahexaenoic Acid Levels, and Mortality in Community-Dwelling Japanese Older Persons.

Int J Environ Res Public Health 2019 05 21;16(10). Epub 2019 May 21.

Section of NILS-LSA (National Institute for Longevity Sciences-Longitudinal Study of Aging), National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.

The associations between meat/fish consumption, docosahexaenoic acid (DHA)/eicosapentaenoic acid (EPA) intakes, and blood DHA/EPA levels, and mortality in Japan were examined as part of the National Institute for Longevity Sciences-Longitudinal Study of Aging: 520 men and 534 women (60-79 years at baseline) were followed from 1997-2017. Nutritional intakes were assessed using a 3-day dietary record and fasting venous blood samples were collected. Serum EPA/DHA concentrations, the EPA/arachidonic acid (ARA) ratio, EPA/DHA intakes, and fish/meat intakes were examined in tertiles as indicator variables, and hazard ratios (HR) were calculated to compare the risk of death across tertiles controlling for sex, age, body mass index, smoking status, alcohol drinking, physical activity, education, employment, and history of diseases. During follow-up (mean 11.7 years), 422 subjects (40.4%) died. The multivariate-adjusted HR for all-cause mortality in subjects in the highest tertile of serum DHA and EPA/ARA ratio was 0.73 (95% confidence intervals (CI): 0.53-0.99) and 0.71 (95% CI: 0.53-0.96) compared with subjects in the lowest tertile, respectively (trend < 0.05). There were no significant associations between mortality and serum EPA/ARA and DHA/EPA intakes. An increased serum DHA level or EPA/ARA ratio might be recommended for longevity to Japanese community dwellers.
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http://dx.doi.org/10.3390/ijerph16101806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572518PMC
May 2019

Hemoglobin A1c and 10-year information processing speed in Japanese community dwellers.

Environ Health Prev Med 2019 Apr 23;24(1):24. Epub 2019 Apr 23.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan.

Background: Hyperglycemia is believed to be a risk factor for cognitive decline, but the longitudinal relationship between hyperglycemia and cognitive decline in the Japanese population is unclear. The present study aimed to clarify the association between blood glucose levels and information processing ability in middle-aged and older adults.

Methods: The subjects were 866 men and 815 women aged 40-79 years not taking medication for diabetes who participated in the first study wave (1997-2000) and then participated at least once in the subsequent six study waves (2000-2012) of the National Institute for Longevity Sciences-Longitudinal Study of Aging, Japan. Hemoglobin A1c (HbA1c) levels were categorized into four groups (< 5.6, 5.6 to < 6.0, 6.0 to < 6.5, ≥ 6.5%), and a mixed-effects model was used to evaluate the effects of the HbA1c level (four groups) on repeated measures of information processing speed. The models also included baseline age, body mass index, ethanol intake, smoking status, educational level, family income, and history of stroke, hypertension, heart disease, and dyslipidemia as covariates.

Results: Mean (standard deviation) HbA1c and follow-up time in participants were 5.2 (0.5) % and 10.0 (3.6) years, respectively. A linear mixed model showed that the main effect of the four HbA1c groups on information processing ability was not significant in either men or women, but the interaction of HbA1c and time with information processing speed in the higher HbA1c level groups (≥ 6.5% group in men, 6.0 to < 6.5% and ≥ 6.5% groups in women) was significant compared to the lower HbA1c level (< 5.6%) group (P < 0.05). When the slope of information processing speed by HbA1c level at baseline was examined, the slope of information processing speed in the higher HbA1c level (≥ 6.5%) group was higher than in the lower HbA1c level (< 5.6%) group, both in men (- 0.31/year) and in women (- 0.30/year), as well as in women with an HbA1c level of 6.0 to < 6.5% (- 0.40/year).

Conclusions: Higher baseline HbA1c was associated with greater subsequent decline in information processing ability in Japanese community dwellers, even with the pre-clinical HbA1c level (6.0 to < 6.5%) in women. The results suggest that good glycemic control or prevention of hyperglycemia may contribute to maintaining information processing ability.
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http://dx.doi.org/10.1186/s12199-019-0778-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480813PMC
April 2019

Daily Physical Activity Predicts Frailty Development Among Community-Dwelling Older Japanese Adults.

J Am Med Dir Assoc 2019 08 18;20(8):1032-1036. Epub 2019 Feb 18.

Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.

Objectives: This study examined the association between frailty development and physical activity including the number of steps, the time of light-intensity physical activity (LPA) with <3.0 metabolic equivalents (METs), and the time of moderate- to vigorous-intensity physical activity (MVPA) with ≥3.0 METs in community-dwelling older Japanese adults.

Design, Setting, And Participants: Study subjects were 401 older adults at the baseline examination (April 2000-May 2002) who participated at least once in the follow-up examination of the longitudinal study of aging. Their 1787 cumulative data points (mean number of repeat visits, 3.5) were used for analysis.

Measures: The number of steps, time of LPA, and time of MVPA were recorded at baseline using a uniaxial accelerometer. Frailty was defined according to 5 frailty criteria: shrinking, exhaustion, low physical activity, low grip strength, and slow gait speed.

Results: The fully adjusted odds ratio for frailty among subjects walking <5000 steps was 1.85 [95% confidence interval (CI), 1.10-3.11]. The fully adjusted odds ratio for frailty among subjects with MVPA for <7.5 minutes was 1.80 (95% CI, 1.05-3.09). No significant association was observed between frailty and LPA.

Conclusions And Implications: The risk for developing frailty was substantially lower in older people walking ≥5000 steps/d or exercising for at least 7.5 minutes/d at an intensity >3.0 METs. These data could be applicable to the community interventions that aim to prevent frailty.
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http://dx.doi.org/10.1016/j.jamda.2019.01.001DOI Listing
August 2019

Polypharmacy is associated with frailty in Japanese community-dwelling older adults.

Geriatr Gerontol Int 2018 Oct 30;18(10):1497-1500. Epub 2018 Aug 30.

Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan.

Aim: The association between polypharmacy and the development of frailty is unknown. The present study assessed the longitudinal relationship between polypharmacy and frailty risk in Japanese community-dwelling older adults.

Methods: Participants included 299 non-frail older Japanese adults aged 65-81 years who participated in both baseline and follow-up examinations of a longitudinal study of aging (mean duration 6.2 years). At baseline examination, all prescribed and non-prescribed medications used during the previous 2 weeks were confirmed and coded by physicians. Frailty was diagnosed according to frailty criteria, and included shrinking, exhaustion, low activity, low grip strength and low gait speed. The relationship between frailty and the number of medications was assessed using multiple logistic regression analysis. The logistic regression model was used to control for potential confounders, including age at baseline, sex, body fat, total physical activity, education, employment, current smoking and number of comorbidities.

Results: The percentage of participants who developed frailty during follow up was 5.1% in those taking five or fewer medications, and 22.5% in those taking six or more medications. The fully adjusted odds ratio for frailty among participants taking six or more medications was 5.55 (95% confidence interval 2.17-14.22).

Conclusions: Polypharmacy appears to be a significant risk factor for the development of frailty in older Japanese adults. Geriatr Gerontol Int 2018; 18: 1497-1500.
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http://dx.doi.org/10.1111/ggi.13507DOI Listing
October 2018

Physical frailty and mortality risk in Japanese older adults.

Geriatr Gerontol Int 2018 Jul 2;18(7):1085-1092. Epub 2018 Apr 2.

Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan.

Aim: The association between frailty and increased mortality risk is unknown. The present study assessed the longitudinal relationship between frailty and mortality risk in Japanese community-dwelling older adults.

Methods: Participants included 841 randomly chosen community-dwelling Japanese individuals, including 175 older adults aged 65-88 years with incomplete data at the baseline examination (July 2006-July 2008). Participants were followed from baseline to 31 December 2015 (mean 7.9 years). Frailty was diagnosed according to frailty criteria, including unintentional weight loss (shrinking), exhaustion, low activity, low grip strength and low gait speed. Information on deaths was obtained from a population dynamics survey. The relationship between frailty and mortality was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression. The Cox proportional hazards model was used to control for potential confounders, including age at baseline, body fat, education, the Mini-Mental State Examination score, the Center for Epidemiologic Studies Depression Scale score, total physical activity, total caloric intake, alcohol intake, current smoking, household income and the number of current diseases.

Results: The fully adjusted hazard ratio for all-cause mortality in the frailty group was 2.63 (95% confidence interval, 1.28-5.39; P for trend <0.01). The age- and sex-adjusted hazard ratio for mortality of cancer in the frailty group was 3.33 (95% confidence interval, 1.15-9.62; P for trend <0.05).

Conclusion: Complications of frailty, which include shrinking, exhaustion, low activity, weakness, and slowness, appear to be significant risks for mortality in Japanese older adults. Geriatr Gerontol Int 2018; 18: 1085-1092.
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http://dx.doi.org/10.1111/ggi.13316DOI Listing
July 2018

Soy food and isoflavone intake reduces the risk of cognitive impairment in elderly Japanese women.

Eur J Clin Nutr 2018 10 18;72(10):1458-1462. Epub 2018 Jan 18.

Section of NILS-LSA, National Center for Geriatrics and Gerontology, Aichi, Japan.

Data were derived from the National Institute for Longevity Sciences-Longitudinal Study of Aging. Subjects comprised 403 men and 373 women aged 60-81 years at baseline who participated in the follow-up study at least once. Bean, soy product and soy isoflavone intake was assessed using a 3-day dietary record at baseline. Cognitive function was assessed by the Mini-Mental State Examination (MMSE). MMSE scores of ≤23 were used to define cognitive impairment. The relationship between bean, soy product and soy isoflavone intake and cognitive impairment was assessed using a generalized estimating equation. Multivariate-adjusted odds ratios (95% confidence intervals) for cognitive impairment with a 1 s.d. increase in total bean, total soybean and total soy isoflavone intakes were 0.48 (0.28-0.81; p = 0.006), 0.51 (0.32-0.83; p = 0.007), and 0.55 (0.32-0.93; p = 0.026), respectively, in women. Total soybean and soy isoflavone intake might decrease the risk of cognitive impairment in elderly Japanese women.
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http://dx.doi.org/10.1038/s41430-017-0061-2DOI Listing
October 2018

What is the best adjustment of appendicular lean mass for predicting mortality or disability among Japanese community dwellers?

BMC Geriatr 2018 01 5;18(1). Epub 2018 Jan 5.

Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan.

Background: Age-related declines in skeletal muscle mass and strength, representing "sarcopenia," are a growing concern in aging societies. However, the prevalence of low muscle mass based on the height-adjustment has been shown to be extremely low, and a more appropriate definition of low muscle mass is needed, particularly for Asian women. The aim of this study was to explore the most appropriate adjustment of appendicular lean mass (ALM) for predicting mortality or disability risk using ALM or any of 5 adjustments of ALM among community-dwelling Japanese.

Methods: Subjects comprised 1026 men and 952 women between 40 and 79 years old at baseline (1997-2000) who participated in the National Institute for Longevity Sciences - Longitudinal Study of Aging, Japan. ALM (kg) and 5 adjusted indices of ALM (ALM/leg length, ALM/height, ALM/height, ALM/weight, and ALM/body mass index [BMI]) were assessed at baseline. Disability was defined by long-term care insurance certification based on responses to a survey mailed in 2013, and death records were obtained as vital statistics until December 2014. Crude and adjusted Cox proportional hazard models were used to estimate hazard ratios for mortality or disability by sex-stratified quintiles of each ALM index (ALM and adjusted ALM) or sarcopenia-related indices. The area under the curve (AUC) was calculated with the multivariate-adjusted logistic regression model. Additionally, mixed-effects analyses were used to clarify the age-related ALM indices decline over 12 years (n = 1838).

Results: Crude Cox proportional hazard models and multivariate-adjusted logistic model (AUC) indicated that higher ALM and ALM/BMI in women, and higher ALM, ALM/leg length, ALM/height, and ALM/BMI in men were associated with lower risks for mortality or disability than ALM/height. The mixed effect model indicated all ALM indices in men, and ALM, ALM/leg length, and ALM/height in women could better predict age-related lean muscle mass decline.

Conclusions: Unadjusted ALM in women, and ALM/leg length, ALM/height, ALM/BMI, and ALM in men may be more appropriate for predicting future mortality or disability than ALM/height. Considering the age-related muscle mass decline, unadjusted ALM would be the first variable to assess, regardless of sex, in this Japanese cohort study.
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http://dx.doi.org/10.1186/s12877-017-0699-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756439PMC
January 2018

The effect of modifiable healthy practices on higher-level functional capacity decline among Japanese community dwellers.

Prev Med Rep 2017 Mar 28;5:205-209. Epub 2016 Dec 28.

National Center for Geriatrics and Gerontology, Aichi, Japan; Institute of Gerontology, Oberlin University, Tokyo, Japan.

This study aimed to clarify the effects of the accumulation of 8 modifiable practices related to health, including smoking, alcohol drinking, physical activity, sleeping hours, body mass index, dietary diversity, (life worth living), and health checkup status, on higher-level functional capacity decline among Japanese community dwellers. Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Subjects comprised 1269 men and women aged 40 to 79 years at baseline (1997-2000) who participated in a follow-up postal survey (2013). Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (total score and 3 subscales: instrumental self-maintenance, intellectual activity, and social role). The odds ratio (OR) and 95% confidence interval (CI) for a decline in higher-level functional capacity in the follow-up study according to the total number of healthy practices were analyzed using the lowest category as a reference. Multivariate adjusted ORs (95% CIs) for the total score of higher-level functional capacity, which declined according to the total number of healthy practices (0-4, 5-6, 7-8 groups) were 1.00 (reference), 0.63 (0.44-0.92), and 0.54 (0.31-0.94). For the score of social role decline, multivariate adjusted ORs (95% CIs) were 1.00 (reference), 0.62 (0.40-0.97), and 0.46 (0.23-0.90), respectively (P for trend = 0.04). Having more modifiable healthy practices, especially in social roles, may protect against a decline in higher-level functional capacity among middle-aged and elderly community dwellers in Japan.
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http://dx.doi.org/10.1016/j.pmedr.2016.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219638PMC
March 2017

Personality and global cognitive decline in Japanese community-dwelling elderly people: A 10-year longitudinal study.

J Psychosom Res 2016 12 14;91:20-25. Epub 2016 Oct 14.

Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan; Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan.

Objectives: To examine the longitudinal associations between the big five personality and changes in global cognitive function among community-dwelling elderly people involved in the National Institute for Longevity Sciences - Longitudinal Study of Aging.

Methods: The participants were 594 individuals (age range 60-81years) and followed for 10years and tested six times. Personality was assessed by the Japanese version of NEO five factor inventory at baseline. Cognitive function was assessed by the Japanese version of Mini Mental State Examination (MMSE) at all visits. For participants with a baseline MMSE score≥28, logistic generalized estimating equation models estimated the odds ratio (OR) and 95% confidence interval (CI) for MMSE score≤27 at each follow-up visit, according to a 1-SD increase of the baseline personality score. Post hoc analyses were performed for mild cognitive deficits, baseline MMSE score≥24 and ≤27, to estimate the OR and CI for MMSE score≤23.

Results: The adjusted OR for MMSE score≤27 was 0.78 (95% CI, 0.69-0.88), with a 1-SD increase in Openness to Experience score. In post hoc analyses, the adjusted OR for MMSE score≤23 was 0.50 (95% CI, 0.35-0.72) with a 1-SD increase in Conscientiousness score. Relationships between other personality traits and the decline in MMSE score were not significant.

Conclusions: Higher Openness to Experience was associated with a reduction in risk for cognitive decline in community-dwelling older adults. Higher Conscientiousness might also predict lower risk for severe cognitive decline, especially for individuals with mild cognitive deficits.
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http://dx.doi.org/10.1016/j.jpsychores.2016.10.004DOI Listing
December 2016

Cognitive abilities predict death during the next 15 years in older Japanese adults.

Geriatr Gerontol Int 2017 Oct 17;17(10):1654-1660. Epub 2016 Nov 17.

Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan.

Aim: The longitudinal relationship between cognitive abilities and subsequent death was investigated among community-dwelling older Japanese adults.

Methods: Participants (n = 1060; age range 60-79 years) comprised the first-wave participants of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Participants' cognitive abilities were measured at baseline using the Japanese Wechsler Adult Intelligence Scale-Revised Short Form, which includes the following tests: Information (general knowledge), Similarities (logical abstract thinking), Picture Completion (visual perception and long-term visual memory) and Digit Symbol (information processing speed). By each cognitive test score, participants were classified into three groups: the high-level group (≥ the mean + 1SD), the low-level group (≤ the mean - 1SD) and the middle-level group. Data on death and moving during the subsequent 15 years were collected and analyzed using the multiple Cox proportional hazard model adjusted for physical and psychosocial covariates.

Results: During the follow-up period, 308 participants (29.06%) had died and 93 participants (8.77%) had moved. In the Similarities test, adjusted hazard ratios (HR) of the low-level group to the high-level group were significant (HR 1.49, 95% CI 1.02-2.17, P = 0.038). Furthermore, in the Digit symbol test, the adjusted HR of the low-level group to the high-level group was significant (HR 1.62, 95% CI 1.03-2.58, P = 0.038). Significant adjusted HR were not observed for the Information or Picture Completion tests.

Conclusions: It is suggested that a lower level of logical abstract thinking and slower information processing speed are associated with shorter survival among older Japanese adults. Geriatr Gerontol Int 2017; 17: 1654-1660.
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http://dx.doi.org/10.1111/ggi.12952DOI Listing
October 2017

Dietary diversity decreases the risk of cognitive decline among Japanese older adults.

Geriatr Gerontol Int 2017 Jun 5;17(6):937-944. Epub 2016 Jul 5.

Section of National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan.

Aim: To clarify the effectiveness of dietary diversity, calculated by dietary records, on cognitive decline.

Methods: Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Participants comprised 298 men and 272 women aged 60-81 years at baseline (second wave) who participated in the follow-up study (third to seventh wave) at least once. Cognitive function was assessed with the Mini-Mental State Examination in all study waves. Dietary diversity was determined using the Quantitative Index for Dietary Diversity based on a 3-day dietary record in the second wave. Cumulative data among participants with a Mini-Mental State Examination score >27 in the second wave were analyzed using a generalized estimating equation. Multivariate adjusted odds ratios and 95% confidence intervals for Mini-Mental State Examination scores ≤27 in each study wave according to a 1 standard deviation (increase), or quartiles of the Quantitative Index for Dietary Diversity at baseline, were adjusted for sex, age, follow-up time, baseline Mini-Mental State Examination score, education, body mass index, annual household income, current smoking status, energy intake and disease history.

Results: Multivariate adjusted odds ratio for a decline in Mini-Mental State Examination score was 0.79 (95% CI 0.70-0.89; P < 0.001) with a 1 SD increase in dietary diversity score, or 1.00 (reference), 0.99 (95% CI 0.70-1.43), 0.68 (95% CI 0.46-0.99) and 0.56 (95% CI 0.38-0.83) according to the lowest through highest quartiles of dietary diversity score, respectively (trend P = 0.001).

Conclusions: Daily intake of various kinds of food might be a protective factor against cognitive decline in community-dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 937-944.
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http://dx.doi.org/10.1111/ggi.12817DOI Listing
June 2017

Dietary diversity and 14-year decline in higher-level functional capacity among middle-aged and elderly Japanese.

Nutrition 2016 Jul-Aug;32(7-8):784-9. Epub 2016 Feb 19.

National Center for Geriatrics and Gerontology, Aichi, Japan; Institute of Gerontology, Oberlin University, Tokyo, Japan.

Objectives: This study aimed to clarify the effects of dietary diversity on a decline in higher-level functional capacity among middle-aged and elderly subjects in Japan.

Methods: Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Subjects comprised 1317 men and women aged 40 to 79 at baseline (1997-2000) who participated in a follow-up postal survey (2013). Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology index of competence (total score and 3 subscales). Dietary intake was assessed using a 3-d dietary record, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The odds ratios and 95% confidence intervals (CI) for a decline in higher-level functional capacity in the follow-up study according to quartiles of QUANTIDD at baseline were estimated, controlling for age, sex, higher-level functional capacity scores at baseline, body mass index, alcohol consumption, physical activity, depressive score, household income, education, smoking, and disease history.

Results: A total of 214 (16%), 145 (11%), 70 (5%), and 136 (10%) subjects showed a decline in total score for higher-level functional capacity (≥2), instrumental self-maintenance (≥1), intellectual activity (≥2), and social role (≥2), respectively. Multivariate-adjusted odds ratios (95% confidence intervals) for the score for intellectual activity decline according to the lowest through highest quartiles of QUANTIDD were 1.00 (reference), 0.47 (0.23-0.95), 0.44 (0.22-0.90), and 0.41 (0.20-0.83), respectively (P for trend = 0.06).

Conclusions: Daily intake of various foods may protect against a decline in intellectual activity among middle-aged and elderly community dwellers in Japan.
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http://dx.doi.org/10.1016/j.nut.2016.01.022DOI Listing
March 2017

Higher gait speed and smaller sway area decrease the risk for decline in higher-level functional capacity among middle-aged and elderly women.

Arch Gerontol Geriatr 2015 Nov-Dec;61(3):429-36. Epub 2015 Aug 13.

Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan.

Objective: This study assessed whether physical function can indicate a risk of decline in higher-level functional capacity.

Methods: Data were derived from the National Institute for Longevity Sciences-Longitudinal Study of Aging. Subjects comprised 466 men and 495 women aged 40-79 years at baseline (1997-2000), whose total score for the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) at baseline was ≥11 and who participated in the follow-up survey. Baseline physical function examination included grip strength, comfortable gait speed, and sway area with eyes open. A decline in higher-level functional capacity was defined as a ≥2-point decrease in the TMIG-IC score after 14 years. The odds ratios (OR) and 95% confidence intervals (CI) for decline in the TMIG-IC score for 14 years according to a 1-standard deviation (SD) increase in physical function measurements at baseline were estimated.

Results: Subjects with decreased TMIG-IC scores included 78 (16.7%) men and 80 (16.2%) women. In women, the multivariate-adjusted OR (95% CI) for a TMIG-IC score decrease with a 1-SD increase in comfortable gait speed was 0.68 (0.50-0.92; p=0.013), and that with a 1-SD increase in sway area with eyes open was 1.49 (1.17-1.90; p=0.001). Grip strength was not associated with TMIG-IC score decline. None of the physical performance measures affected TMIG-IC score declines in men.

Conclusion: These results suggest that gait speed decreases and sway area increases might predict a risk of decline in higher-level functional capacity among middle-aged and elderly women.
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http://dx.doi.org/10.1016/j.archger.2015.08.001DOI Listing
January 2016

[Construction of a scale of attitude toward death in the middle-aged and elderly and its validity and reliability].

Nihon Ronen Igakkai Zasshi 2013 ;50(1):88-95

Department for Development of Preventive Medicine, National Center for Geriatrics and Gerontology.

Aim: The purpose of this study was to construct a scale that measures multidimensional attitudes regarding death in the middle-aged and elderly, using scale items for adolescents, and to examine its reliability and validity.

Methods: Twenty-nine items which were selected from the scale of Attitudes toward Death (Tange, 1999) were administered to subjects, consisting of 2,223 community-living Japanese men and women aged 40-79 years. Both exploratory factor analysis and confirmatory factor analysis were performed to examine the factor structures. The reliability and validity of the scale were examined.

Results: Exploratory factor analysis was performed to examine the factor structures of death attitudes, using the data from half of the subjects, indicated 5 factors. Confirmatory factor analysis, using the data from the remaining half, supported the goodness of fit of that model. Using this structure, the attitude toward death scale for the middle-aged and elderly (ATDS-A; five subscales) was constructed; "fear of death", "belief in existence of afterlife", "intention to live out own life", "meaning of death for life", "approval of death with dignity". For these subscales, the alpha coefficients ranged from 0.59-0.87. The validity of the subscales was suggested through the relation with the ego integration score.

Conclusions: This study suggested that the ATDS-A was reliable and valid, and was useful for the measurement of death attitudes in the middle-aged and elderly.
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http://dx.doi.org/10.3143/geriatrics.50.88DOI Listing
March 2014
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