Objectives: To clarify the association between metabolic syndrome (MetS; Metabolic Syndrome), comorbid physical decline, and mild cognitive impairment (MCI) in community-dwelling older adults.

Methods: A cross-sectional analysis of 554 community-dwelling older adults aged 65 years or older (mean age 73.7±6.2 years, 63.4% women) was conducted using data from the Tarumizu Study 2019. MetS was determined using the criteria of the International Diabetes Federation, and physical function decline was judged as applicable if either or both grip strength (<28 kg for men and <18 kg for women) and usual walking speed (<1.0 m/sec) were below the cutoff values. Based on the presence or absence of MetS and physical decline, patients were operationally classified into four groups: robust group, MetS alone group (MetS group), physical decline alone group (physical decline group), and MetS and physical decline coexisting group (coexisting group). MCI was assessed by the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) for memory, attention, executive function, and processing speed. Participants were considered to have MCI if they scored 1.5 SD or more below the norm, which takes into account age and education, on any of the tests. Logistic regression analysis was performed with MCI as the dependent variable and the four groups defined by the presence of MetS and physical decline as independent variables, with age, sex, educational history, and number of medications as covariates.

Results: Participants characteristics were 191 (34.5%) in the robust group, 218 (39.4%) in the MetS group, 62 (11.2%) in the physical decline group, and 83 (15.0%) in the coexisting group. Logistic regression analysis showed that, compared with the robust group, the physical decline group (odds ratio: 2.39, 95% confidence interval: 1.17-4.87) and the coexisting group (odds ratio: 2.41, 95% confidence interval: 1.21-4.79) each had a significant association with MCI. On the other hand, the MetS group showed no significant association with MCI compared with the robust group.

Conclusion: The presence of physical functional decline and the coexistence of MetS and physical decline are associated with MCI among community-dwelling older persons.

Objective: In Tama City in Tokyo, a 12-lead electrocardiogram (ECG) has been included as an essential examination in specific health checkups for the early detection of atrial fibrillation (AF) since 2008. This study aimed to clarify the secular trends of AF prevalence by sex and age for 14 years and the related factors for these trends in the general population from the TAMA MED Project-AF.

Methods: Study subjects were the subscribers of national health insurance aged 40-74 years who underwent annual specific health checkups in Tama City from 2008 (n=12,137) to 2021 (n=11,499). AF was diagnosed by a 12-lead ECG at each institution. The related factors for the trends of AF prevalence were identified by multiple regression analysis with stepwise forward method using factors with P<0.05 in simple regression analysis.

Results: AF was diagnosed in 101 subjects (men 85, women 16) in 2008 and 131 (men 105, women 26) in 2021. AF prevalence was 0.83% (men 1.68%, women 0.23%) in 2008 and 1.14% (men 2.22%, women 0.38%) in 2021 with the 1.4 (men 1.3, women 1.7)-fold increase compared to 2008. The AF prevalence for 14 years showed significant increasing trends in both men and women (P<0.001 and P=0.036 for trend, respectively). The increasing trend was observed markedly in men aged 65-75 years (2.0% to 2.8%, P<0.001 for trend) but has reached the ceiling at 2015. Although many factors such as age, systolic and diastolic blood pressure (BP), liver function, and the presence of hypertension, diabetes, heart disease, past history, and the therapeutic drug use were associated with the trend of AF prevalence in simple regression analysis, systolic BP, hypertension, and diabetes (systolic BP and hypertension in men, and history of stroke in women) were identified in multiple regression analysis.

Conclusion: The AF prevalence in the general population has certainly increased in both men and women since 2008, especially in men aged 65-75 years. Many factors were related to the trend of AF prevalence, in which BP values and hypertension would be particularly important factors.

Objective: Fatty liver is a phenotype of visceral fat accumulation in the liver, and excessive alcohol consumption is known to be a risk factor for fatty liver. In this study, we investigated the association between drinking habits and homeostatic model assessment for insulin resistance (HOMA-IR), a marker of insulin resistance, and higher levels of fatty liver index (FLI) in community residents.

Methods: We conducted a cross-sectional study using data from 1,078 participants in the baseline survey of the KOBE study, which included men and women aged 40-74 years who had no history of cardiovascular disease and were not receiving treatment for lifestyle-related diseases. Drinking habits were classified into 4 groups for men (none, <1 gou/day, 1-2 gou/day, and ≥2 gou/day) and 3 groups for women (none, <1 gou/day, and ≥1 gou/day) based on the amount of alcohol consumed per day, and higher FLI was defined as FLI 30 or higher, which is suspicious for the presence of fatty liver. The association between drinking habits, HOMA-IR, and higher FLI was examined by multivariate logistic regression analysis, and odds ratios and 95% confidence intervals were calculated.

Results: Among 1,078 subjects (323 men and 755 women, mean age 58.9 years), 172 (16.0%) had higher FLI. Regarding the association between drinking habits and FLI, there was a significant positive association with higher FLI prevalence in the 1-2 gou/day and ≥2 gou/day groups for men, and a significant positive association with higher FLI prevalence in the ≥1 gou/day group for women. HOMA-IR was also significantly positively associated with higher FLI in both men and women. Similar results were obtained in analyses restricted to non-obese individuals.

Conclusions: Current drinkers of ≥1 gou/day was significantly positively associated with higher FLI prevalence in both men and women in community residents, mainly among non-obese individuals. Even among non-obese individuals who drink heavily on a daily basis, moderation in alcohol consumption should be recommended because the increased insulin resistance associated with fatty liver may lead to the development of cardiovascular disease. In addition, FLI reflects insulin resistance even in non-obese individuals.

Objective: A health examination program targeting metabolic syndrome criteria, which includes abdominal obesity as a mandatory condition has been implemented to prevent cardiovascular diseases (CVD) in Japan. However, even non-obese individuals with risk factors are reportedly at a similarly increased risk of CVD. Since this group represents more in Japan than those meeting the aforementioned criteria, there is still a need to assess risk and population impact of risk factor accumulation in non-obese individuals to inform public health policy. Also, whether CVD risks according to the risk factor accumulation differ by the presence of obesity was mostly examined in community settings, leaving necessity for studies in urban employees, who may have different lifestyles and higher rates of coronary artery disease. This study aimed to estimate CVD risks and population-attributable fractions (PAFs) by the number of CVD risk factors, stratified by obesity status, in a cohort of local government employees.

Methods: This study included 7,179 participants from the Aichi Workers' Cohort Study recruited between 2002-2008 without histories of CVD and cancer or missing data at baseline and followed-up for at least one year. The participants were categorized into four groups (0, 1, 2, or ≥3) according to the number of the following risk factors: hypertension, diabetes, high LDL cholesterol, kidney disease and, smoking, which were further divided by obesity status. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and the 95% confidence intervals (CIs) as well as PAFs for CVD incidence.

Results: During follow-up, 99 developed CVD (66 non-obese and 33 obese). Among non-obese participants, compared to those with no risk factors, the HR for CVD incidence increased with the number of risk factors: 2.43 (95%CI: 1.14-5.21), 3.96 (95%CI: 1.79-8.74), and 4.75 (95%CI: 1.73-13.0) for one, two and three or more risk factors, respectively. In the obese group, the HRs compared to non-obese individuals with no risk factors increased similarly according to the number of risk factors: 4.31 (95%CI: 1.85-10.00), 3.75 (95%CI: 1.47-9.57), and 7.53 (95%CI: 2.86-19.8) for one, two, and three or more risk factors, respectively. The PAFs were 16.7%, 16.6%, and 5.6% in the non-obese group and 10.9%, 6.7%, and 7.0% in the obese group for one, two, and three or more risk factors, respectively.

Conclusion: Accumulation of risk factors was associated with increased CVD risk regardless of obesity status.