Objectives It has been suggested that maternal smoking during pregnancy has an effect on childhood obesity. We previously clarified the association between maternal lifestyle habits practiced during pregnancy, including smoking, and childhood obesity and overweight at 9–10 years of age. In this study, we aimed to demonstrate this association through survival analysis.
Methods This study was based on an on-going community-based prospective cohort study initiated in the fetal stage called Project Koshu. The study population comprised of the participants of Project Koshu, who were children born in a rural Japanese area between 1991 and 1999 and their mothers. In this project, maternal smoking status during pregnancy was collected through a questionnaire and childhood anthropometric data were measured at annual medical check-ups from 3 years of age to 9–10 years of age. Using these data, we performed a survival analysis using the Kaplan-Meier method to compare the cumulative rate of childhood obesity and overweight between those with mothers who smoked during pregnancy and those who did not. Subsequently, we calculated the hazard ratio (HR) of the effect of maternal smoking during pregnancy on childhood obesity using the Cox proportional hazard model.
Results In the survival analysis of childhood obesity, we analyzed the data of 1428 children and their mothers (follow-up rate: 87.7%). Of these, 290 children (20.3%) became overweight and 92 children (6.4%) became obese between 3 years of age and 9–10 years of age. This shows that the cumulative rate of childhood obesity was significantly different between mothers with and without smoking habits (P<0.001).
  Using the Cox proportional hazard model, we analyzed the data of 1204 children and their mothers (follow-up rate: 74.0%). Of these, 255 children (21.2%) became overweight and 76 children (6.3%) became obese between 3 years of age and 9–10 years of age. Maternal smoking during pregnancy was found to be associated with childhood obesity (HR, 2.0; 95% confidence interval (CI): 1.04–4.0). However, there was no significant association between maternal smoking during pregnancy and childhood overweight.
Conclusion Our results suggest that the effect of fetal environmental factors on childhood obesity is more pronounced than that on childhood overweight. These results suggest that maternal smoking during pregnancy may be a significant factor in the association between fetal environment and post-delivery development.

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Objectives In order for activities preventing cognitive decline in the elderly and burdens of the caregiver to be effective and efficient, it is important to assess cognitive impairment and the behavioral and psychological symptoms of dementia (BPSD) in community-dwelling elderly people with cognitive impairment. The purpose of this study was to investigate differences in BPSD between assessment at home and assessment at an adult day-care facility, and to assess the relationship between BPSD and caregiver burden in disabled elderly people with and without mild cognitive impairment (MCI) or dementia.
Methods We studied 594 participants with activity limitations out of a target population of 917 community-dwelling elderly persons utilizing adult day-care service. Dementia and MCI were determined using a clinical history of dementia, the Clinical Dementia Rating scale, and/or the Mini-Mental State Examination (MMSE); 116 were diagnosed with dementia, 103 as having MCI, and 243 as cognitively normal controls (CN). BPSD were assessed at home and at the adult day-care facility with the Neuropsychiatric Inventory (NPI) and the Dementia Behavior Disturbance Scale (DBD). Activities of daily living (ADL) were evaluated using the Barthel index, and caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8).
Results People diagnosed with dementia were found to be significantly more impaired on the DBD, MMSE, BI, and J-ZBI_8, than CN or those with MCI. Those with MCI also showed significantly more impairments relative to CN. The scores on the NPI and DBD assessed at home were higher than that assessed at the adult day-care facility in each group. The differences of NPI and DBD scores between home assessment and assessment at the adult day-care facility were greater for people with dementia than for people with MCI or CN. Multiple regression analysis revealed that the best explanatory variables for J-ZBI_8 are home assessments of NPI and DBD, the MMSE for people with dementia, home assessment of DBD and MCI, and home assessment of NPI and BI for CN. Both NPI and DBD were not associated with the J-ZBI_8 when assessed at the adult day-care facility regardless of level of cognitive impairment.
Conclusion The scores of the BPSD and caregiver burden worsened with increasing severity of cognitive impairment, and the BPSD was more apparent when assessed at home compared to at the adult day-care facility. These findings suggest that the assessment of BPSD at home is important in determining MCI or dementia and to estimate caregiver burden in community-dwelling elderly people with basic ADL limitations.

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[in Japanese]

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[in Japanese]

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