In 1999, waist circumference (WC) as a basic item in the Ningen Dock was first introduced at the Jikei University in Japan. A WC of 85 cm in men and 90 cm in women equaling to visceral fat areas 100 cm². WC, which indicates the accumulation state of visceral fat, is easily measured. These data cutoff points were applied as criteria of the metabolic syndrome associated with cardiovascular disorders. Obesity is defined in Japan as a body mass index (BMI) ≥25 kg/m². The total number of subjects that underwent the Ningen Dock from 1999 to 2018 was 122,567 men and 54,267 women, aged 30-79 years old. The criterial data of WC and BMI were calculated by sex and age group every year. In order to clarify transitional changes, data were analyzed with linear approximation. In the 20-year period, both BMI and WC increased in the 55-69 years old groups of both sexes and decreased in the 30-39 years old group in men. In the 40-54 years old groups of both sexes and the 70-79 years old group in men, BMI increased, but WC decreased. In women, both BMI and WC decreased in the 30-34 years old group and the 65-69 years old group, and increased in the 50-64 years old group. The remaining age groups showed a decrease in BMI and an increase in WC. The two national publications on abdominal circumference are the Specific Health Report Survey and the National Health and Nutrition Survey. The data in this study were similar to the results of the former survey conducted in the large population.

 In recent years, there has been an increase in the number of patients with heart failure called as the "heart failure pandemic".

 The most common causes were ischemic heart disease, hypertension, and valvular disease. Recently, although the rate of ischemic heart disease has increased, the number of hypertensive HFpEF (heart failure with preserved left ventricular function) patients increases.

 To respond to this situation, we should recognize that heart failure is not as a single phase of disease but as a continuous and progressive disease. According to the recent guideline, patients with heart failure are identified as followings; Stage A: risk stage without organic heart disease, Stage B: risk stage with organic heart disease, Stage C: symptomatic heart failure stage, and Stage D: treatment-resistant stage. In patients with stage A/B, if it is a high-risk group without symptom, it should be treated to prevent the onset of heart failure. In patients with stage C/D, improvement of symptoms and prognosis, and prevention of progression/recurrence of heart failure should be achieved.

 Physical exercise plays a major role in the primary and secondary prevention of heart failure. In 2017, a standard program of cardiac rehabilitation for patients with heart failure was published. This program is a practical manual, and at the same time, specifies the essential items and the effort items for implementation.

 To improve the prognosis and quality of life of patients with heart failure, it is important to detect stage A/B patients at an early stage and to manage their lifestyle and intervene in their risk factors appropriately. The contribution of this Society in this area is expected.

 Elderly people, who made up only 7% of the population in 1970, had been more than 25% of the population in 2019, and one woman will have 1.42 children in her lifetime in Japan. Increasing in aging population with the declining birthrate in our country is progressing with an extremely rapid rate, and that the medical costs of the elderly will be close to 80% of the total medical costs after 2040 when the aging peaks. As the number of elderly people increases, the number of elderly patients with type 2 diabetes is also increasing. According to the 2018 National Nutrition Survey, 18.7% of men and 9.3% of women are HbA1c above 6.5% or under treatment of diabetes mellitus. At age 70 and over, 24.6% of men and 15.7% of women are living with diabetes and the numbers increase with age.

 Along with the aging of patients with diabetes, dementia, cancer, fracture, depression, periodontal disease and so on are major factors that lower the QOL of patients. Furthermore, in elderly diabetic patients, hyperglycemia itself causes not only vascular disorders but also senile syndromes such as sarcopenia, flail, malnutrition and heart failure. Age-related decline in renal function increases the risk of hypoglycemia during treatment.

 How to deal with elderly people with diabetes is not trivial. It is necessary to fully consider whether the preventive evidence shown in young adults and the elderly in the early period is appropriate for the elderly in the late stage and elderly patients requiring medical care. On top of that, it seems that the basic stance of properly prescribing a minimum of drugs and performing mild blood glucose control is important.

 Biliary tract cancer is not a rare cancer in Japan, with more than 20,000 cases diagnosed annually, with the eighth most common in men and the seventh most common in women. With the increase in the prevalence among elderly people, it is sometimes difficult to choose the treatment. There are various issues such as the invasiveness of surgery and the limited choice of anticancer drugs, the responsiveness of treatment, and when to determine palliative care based on prognosis.

 From the viewpoint of preventive medicine, it is urgently necessary to find out this disease as early as possible and to link it to treatment. Among the biliary tract cancers, gallbladder cancer is associated with risk factors such as gallbladder stones and pancreaticobiliary maljunction. Ultrasound plays a major role in medical examinations and is an essential test for the diagnosis of gallbladder cancer. On the other hand, risk factors for bile duct cancer include congenital biliary dilatation, intrahepatic calculi, ulcerative colitis, and a career in the printing industry. The only option is to pick up from ultrasonic abnormalities such as bile duct dilatation.

 When considering biliary tract cancer, you should understand the difference from other cancers and their specificity. Even gastroenterologists who treat the digestive diseases in general, the treatment for biliary tract cancer requires careful judgment, easy-to-understand explanations, and holistic care.

 Biliary tract cancer is mostly not found in the early stage even if undergoing regular medical examinations. I explain the current strategies and issues of biliary tract cancer prevention.

 Although the leading cause of death in Japan is malignant neoplasms, the combined numbers of death from heart disease and cerebrovascular disease are comparable to those of malignant neoplasms. In addition, medical expenses for lifestyle-related diseases account for around one quarter of national medical expenses. Therefore, prevention of lifestyle-related disease and vascular disease is extremely important not only to extend the average and healthy lifespans, but also to reduce national medical cost measures. Based on these circumstances, the "Basic Law for Countermeasures for Stroke and Cardiovascular Disease" has been enforced in December 2019.

 Many risk factors for cerebro-cardiovascular diseases have been clarified by epidemiological researches, and the importance for the management of these factors has been shown with large-scale inteventional studies; therefore, the guidelines for the management of these risk factors had been issued and revised as needed. Furthermore, the importance of comprehensive management of these risk factors is also shown as evidence, and the need for comprehensive management has been advocated.

 In response to these need, "Specific Health Check and Guidance" was started in 2008 by the Japanese government; and "Comprehensive risk management chart for the prevention of cerebrocardiovascular disease" was issued in 2015 by Japanese academic medical societies, and has been used as a comprehensive guideline in general clinical practice and occupational fields. Afterwards, the guidelines of each academic society were revised, and the need to formulate a chart for the elderly has increased. Accordingly, in May 2019, the "Comprehensive risk management chart for the prevention of cerebrocardiovascular disease 2019" was published.

 In this article, I will refer to the epidemiology in Japan up to the present, and summarize the revision of the "Comprehensive risk management chart for the prevention of cerebrocardiovascular disease 2019" from the 2015 edition.

 Recently, research based on self-organization has seen rapid worldwide development. The Self-Organizing Map (SOM) analysis technique, a practical application, has the benefit that it is not affected by distribution patterns as a non-linear regression method against complex system event data. Furthermore, SOM has the feature of outlining the entirety of the data while maintaining the mutual similarity relationship.

 Recent technical developments undertaken by the authors have allowed simultaneous on-screen display of the front and hidden rear sides of a spherical surface of SOM. This enables us to visually grasp the overall similarity relationships between components. In addition, the introduction of the DIM mode into SOM analysis, which calculates the degree of similarity between components, enables quantification of such similarity between components. This also allows for the comparison of strength among components. Through these processes, the SOM analysis technique has been improved. Such advancement facilitates development of an environment where it is feasible to apply data of the complex system analysis obtained from medical checkups with a wide range of variable factors to clinical practice.

 In this symposium, the authors examined data such as laboratory results, lifestyle interviews, and nutrient intake status in Japanese adults who received a medical checkup. Thereafter, we exhaustively calculated the degree of similarity by the latest SOM analysis method in all possible pairs between two components. We then searched the highest degree of similarity in aging between men and women among key components and the results were stored in the profiles. This enables us to dynamically understand the situation in which the strength of similarity between two components changes depending on aging in men and women. Additionally, in terms of clinical significance of the component-pairing, it can be used not only to predict the age at which symptoms often develop, and detect signs of symptoms without delay, but also to provide medical support and health guidance in a timely and appropriately manner.

 We evaluate the biological trend information of men and women associated with aging in detail based on our results and apply it to the health promotion system used for medical checkups. We believe that this will contribute to enabling more qualitative improvement of medical checkups.

 Health screening/Ningen Dock loses much of its value if the examinees simply undergo health-checks without reflecting on the results (for healthcare providers, if they simply provide health examinations without paying attention to the results). Routine examinations, not necessarily expensive ones, can provide a great deal of information that—depending on how the data is interpreted—can be meaningful to living a long healthy life. From acute to chronic diseases, including lifestyle-related diseases, front-line health care personnel require specific approaches to understanding the underlying pathophysiology and effectively utilizing this pathophysiological information in their clinical practice.

 Reference intervals are, in general, defined as intervals between the 2.5^th and 97.5^th percentiles of the reference distribution. When a clinical value is within the reference interval, the result is usually rated as "A". From a rating alone, an examinee may be moved from joy to sorrow, or a healthcare provider may consider an individual to be disease-free. It is important to closely observe the changes across ages when we interpret laboratory data. Regardless of the rating, healthcare providers must pay attention to the transitional change from the previous results. It is necessary to evaluate whether the value is reaching to the reference limit or whether it is rapidly worsening.

 In addition, we should be careful not to cling onto just one parameter. Disease risks are often evaluated using multiple factors, and we should not consider the results to reflect a disease-free status just because a parameter is within the reference interval. With advancing age, the parameters associated with lifestyle-related diseases such as hypertension, dyslipidemia, diabetes, and hyperuricemia tend to be rated as "needing close observation" or "needing re-evaluation". On the other hand, is it always necessary for all health-check parameters to remain within the reference intervals? There are healthy individuals for whom a certain value is above or below these reference intervals, and "personal reference intervals" should sometimes be taken into consideration.

 This paper provides several keys to the interpretation of clinical data: 1) careful observation of the changes across ages, 2) optimal determination using a combination of multiple factors, and 3) scientific speculation on the reasons for change.