The Ministry of Health, Labour and Welfare (MHLW) published the Physical Activity and Exercise Guide for Health Promotion 2023 in January 2024 to promote initiatives in the field of physical activity and exercise under Health Japan 21 (the third term). This guide is formulated based on scientific knowledge and aims to advance initiatives in the field of physical activity. It is intended for professionals involved in health promotion (e.g., health fitness instructors, public health nurses, dietitians, and physicians), policymakers (e.g., in health promotion and urban planning departments), workplace managers, and other stakeholders supporting physical activity in the health, medical, and nursing care sectors. The eight new changes and additions in this guide are as follows;

　1) Name changed from ‘reference' to ‘guide'.

　2) Recommendations aimed at children are established.

　3) Recommendations for older people to undertake multicomponet physical activity at least 3 days/week.

　4) Introduces key points on physical activity for people with chronic diseases

　5) Recommends that all generations should be careful not to spend too much time sedentary.

　6) Recommends that adults and older people undertake muscle training 2 to 3 days/week

　7) Introduces tips for active living at the workplace

　8) Introduces the importance of developing a physical activity support environment

　The Dietary Reference Intakes for Japanese (2025 edition) (hereafter referred to as DRIs) is a basic and comprehensive guideline for healthy diets that is revised and published by the Ministry of Health, Labor and Welfare every five years. In the past, its use was limited to group-meal preparations, but recently, it has become widely used including in health checkup practices. The DRIs considers the amount of energy and 35 types of nutrients that should be consumed, and specifies the amount of energy and 33 types of nutrients. The DRIs is characterized as a quantitative guideline, but not as a qualitative guideline.

　For energy, estimated energy requirement and "target BMI range" are specified, and for nutrients, five types of indicators (estimated average requirement, recommended dietary allowance, adequate intake, tolerable upper limit, tentative dietary goal) are specified. Among these, tentative dietary goal set for the prevention of lifestyle-related diseases may be the most important indicator for those working in health checkups. In addition, the relationship between energy and nutrients is explained for hypertension, dyslipidemia, diabetes, chronic kidney disease, and osteoporosis. Although this chapter does not provide any indication of the amount of intake that should be achieved, and only provides a qualitative explanation, it is valuable in understanding the characteristics of lifestyle-related diseases. In addition, there is an explanation on the use of DRIs, and the PDCA cycle is introduced as a basis, emphasizing the importance of estimating habitual nutrient intakes (performing a dietary assessment that is feasible and has a sufficient degree of reliability) and comparing it with the amount of intake that should be achieved as set by the DRIs.

　The DRIs has already changed from simply providing numerical information to guideline that is "used" in its entirety. The (2025 edition) will be used for five years from April 2025. We hope it be used correctly and broadly.

　Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease (ASCVD), and its management is important for the prevention of ASCVD events. Since the publication of the Guidelines for the Treatment of Hyperlipidemia in 1997, the Japan Atherosclerosis Society (JAS) has revised the guidelines every five years in response to the accumulation of new knowledge from epidemiological studies and clinical trials, and in 2022 issued the latest version "Guidelines for the Prevention of ASCVD, 2022". Revisions from the previous version include the addition of atherothrombotic cerebral infarction to secondary prevention diseases, the addition of casual triglyceride levels to the diagnostic criteria for dyslipidemia, the adoption of the Hisayama-cho score as a risk stratification tool for primary prevention, and partial changes to the management targets ​​for diabetes. In Japan, health checkups are mandatory for employees, and specific health checkups are also conducted for family members, etc. These checkups are conducted by health checkup facilities, and depending on the data obtained, the examinees must be referred to medical institutions or sent for health guidance. Many health checkup facilities use the standard values based on the Ministry of Health, Labor and Welfare's "Standard Health Checkup and Health Guidance Program", but this standard differs slightly from the intent of the JAS guideline. In this article, after providing an overview of the "Guidelines for the Prevention of ASCVD, 2022", I will suggest how it can be used in health checkup facilities.

　Chronic kidney disease (CKD) is recognized not only as a leading cause of end-stage renal disease (ESRD) but also as a risk factor for the development and mortality of cardiovascular disease (CVD). In Japan, the number of chronic dialysis patients is higher compared to other countries, and the aging population is expected to further increase the prevalence of CKD, making it a critical healthcare issue. Clinical practice guidelines have played a pivotal role in the dissemination and promotion of CKD care. In 2002, the KDOQI (National Kidney Foundation's Kidney Disease Outcomes Quality Initiative) published guidelines on the diagnosis and management of CKD, which were later succeeded by KDIGO (Kidney Disease: Improving Global Outcomes).

　The Japanese Society of Nephrology (JSN) published the "CKD Clinical Guide" in 2007 as a tool for collaboration between primary care physicians and specialists. This guide was revised in 2009 and 2012. In 2009, JSN released the "Evidence-Based CKD Clinical Practice Guidelines" targeting nephrologists, and in 2013, a revised version adopting the CQ (clinical question)-based format was published. Subsequently, in 2018, the "CKD Clinical Practice Guidelines" were comprehensively revised with non-specialists in mind, and a "CKD Care Guide for Patients and Their Families" was also introduced.

　The "Evidence-Based CKD Clinical Practice Guidelines 2023" feature a significant update, combining text-based explanations that include expert opinions with CQ-based content. In response to concerns about the volume of information, simplified versions, namely the "CKD Clinical Guide 2024" for non-specialists and medical staff and the "CKD Care Guide 2024" for patients and their families, were also developed. These initiatives aim to clarify the role of the "CKD Clinical Practice Guidelines 2023," facilitating early detection of CKD, strengthening care coordination, and slowing disease progression. These efforts are expected to reduce the incidence of CVD and dialysis initiation while promoting public health.

　More than 10 million people are estimated to have diabetes and almost same number of people have impaired glucose tolerance in Japan. The diagnosis of diabetes is made by blood glucose levels and reference values are decided based on many clinical data. The development of diabetes drugs has recently progressed rapidly, and nine oral drugs and two injectable drugs are now available. The ACE inhibitors and ARBs were only two drugs with evidence of efficacy for diabetic nephropathy for long time, however, the evidence of SGLT2 inhibitors, GLP-1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist have recently reported.

　In this paper, diagnosis and treatment of diabetes based on recent evidences are described from the "Diabetes Care Guide 2024" and "Diabetes Care Guidelines 2024" published by the Japan Diabetes Society.

　Approximately 10,000 upper gastrointestinal contrast examinations are performed per year at our health management center. To prevent serious complications, measures must be taken to optimize barium excretion after the procedure.; In2022, two cases of gastrointestinal perforation requiring emergency surgery occurred at our hospital. These incidents prompted the introduction of new measures and changes to existing protocols. A questionnaire survey was administered patients undergoing checkups following upper gastrointestinal contrast examination to assess the effectiveness of the new protocols. The results showed that taking a laxative with 500 mL of water immediately after barium contrast examination accelerated barium excretion time. Viscosity measurements found that the viscosity of barium in the gastrointestinal tract was reduced to approximately 1/10 -1/16 of previous values. The reduction in viscosity promotes excretion without hardening the stool. This study also found that inter departmental cooperation is important -to provide consistent and detailed explanations to patients regarding drinking laxatives, water intake, and eating, -when undergoing barium contrast studies.