Objective: The benefit of health literacy (HL) on adopting a healthy lifestyle is well established and enhancing HL as part of regular health checkups contributes to the prevention of lifestyle-related diseases. Tuned health advices requires preliminary assessment of HL. To balance evaluation precision and cumbersomeness, we aimed to find the most parsimonious questionnaire for our checkups.

 Methods: Participants (n = 714 with 55% female, 51.2 ± 10.9 years old) were recruited among the examinees who visited our checkups, and a cross-sectional survey was conducted by using the Japanese version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). Three short versions of HLS-EU-Q47 (HLS-Q12, HL-SF12, and HLS-EU-Q16), were explored using confirmatory factor analysis (CFA) to assess dimensionality and factorial validity together with Rasch analysis (RA) to provide detailed information at the item level.

 Results: Using likelihood-ratio tests, we found that all three short versions were better fit under a three-dimensional Rasch model (health care, disease prevention and health promotion) than one-dimensional one. All of them were above threshold for person separation reliability (PSR > 0.65), with only moderate loss of separation compared to HLS-EU-Q47. CFA supported the factor structure of the three domains, and HLS-Q12 has the best goodness-of-fit indices.

 Conclusions: Among the parsimonious questionnaire that we compared, HLS-Q12 is the best candidate, meeting the assumptions and the requirements of objective measurement while offering clinically feasible screening during regular checkups. In the next phase, we will evaluate the benefit of using individual's HL to tune life-style improvement advice.

 Objectives: Increase in lifestyle-related diseases with high BMI has been shown in numerous epidemiological studies. The present study was a comparative investigation of the effects of changes in BMI over two years on representative lifestyle-related disease onset and normalization.

Subjects: A total of 10,109 subjects (5,766 males and 4,343 females) who underwent annual health check-ups at Tokai University Hospital's Health Screening Center in 2014 and 2016 were included in this study.

 Methods: Based on the WHO classification of obesity, and standard weight according to the Japan Society of Obesity, in 2014 the subjects were divided into four groups, by BMI, and in 2016 each group was divided into four groups, by BMI, to make 16 groups in total. The new-onset and normalization rates for hypertension, diabetes and dyslipidemia during this two year period were compared between the groups, with classification by sex.

 Results: With both males and females, the hypertension new-onset rate increased with increasing BMI, but the new-onset rate also increased significantly in the groups showing BMI decrease. The diabetes new-onset rate increased with increasing BMI, but females who were slimmer than standard body type also showed increased normalization rate with BMI increase. With both males and females, the dyslipidemia new-onset rate increased with increasing BMI, and the normalization rate increased with decreasing BMI, but these relationships were weak with females.

 Conclusion: Changes in BMI are associated with new-onset and normalization rates, especially for dyslipidemia. Although hypertension and diabetes are associated with changes in BMI and new-onset and normalization rates, the involvement of other lifestyle-related factors must also be considered.