Objective　The interim evaluation of Health Japan 21(second term), a national health promotion plan, suggested that improvements in the food environment did not lead to improvements in individual dietary habits. The present study aimed to evaluate the relationship between the dietary behavior targets of Health Japan 21 (second term) and perceived food environment and health literacy.

Method　We conducted an online cross-sectional survey in March 2019 among adults aged 20-64 years. From the 9,667 registered monitors of the research firm, we collected 2,851 responses (29.5% response rate). The perceived food environment (how people perceive the local food environment) was estimated using the following six questions, namely, availability: easy access to nutritionally balanced meals, accessibility: no inconvenience in daily shopping, affordability: access to nutritionally balanced meals at reasonable prices, accommodation: easy access to food services within business hours, acceptability: satisfaction with the quality of food ingredients, and another form of acceptability: adequate food safety. Health literacy was evaluated using five questions related to information gathering, information selection, information transfer, information judgment, and self-determination. Last, we asked the respondents about two dietary behaviors, namely, the frequency of a balanced diet (defined as comprising the staple food, a main dish, and a side dish) and the quantity of vegetable intake, along with sociodemographic information. The analysis included 2,111 respondents, excluding those whose socioeconomic status was unknown. Multiple logistic regression analyses were performed to determine the relationship between perceived food environment and health literacy on dietary behaviors, while adjusting for sociodemographic factors.

Result　A balanced diet was associated with the following perceptions of the food environment: “access to nutritionally balanced meals at reasonable prices” (adjusted odds ratio [95% confidence interval] = 1.37 [1.02, 1.82]; women), and “adequate food safety” (1.54 [1.19, 1.98]; men), and health literacy: “information gathering” (0.84 [0.73,0.97]; men) and “self-determination” (1.28 [1.10,1.50], 1.37 [1.14,1.63]; men, women). The quantity of vegetable intake was associated with the following perceptions of the food environment: “easy access to nutritionally balanced meals” (1.54 [1.15,2.06]; men), and “no inconvenience in daily shopping” (1.55 [1.12,2.15]; women), and health literacy: “information transfer” (1.30 [1.10,1.54]; men), and “self-determination” (1.67 [1.38,2.02]; women)).

Conclusion　To achieve a balanced diet and increased vegetable intake in a population, it is necessary to promote both the acquisition of a higher level of “self-determination” (rather than “information gathering”) in health literacy and the creation of a heathy food environment.

Objectives　The study aimed to clarify the association among health check-up results, death, and occurrence of the need for nursing care among Japanese older adults.

Methods　The participants were 24,909 males and 28,742 females. A medical system for late-stage older adults in the Tochigi Prefecture (Japan) insured, not qualified for long-term care insurance certification, and participated in health check-ups from April 2020 to March 2021. We recorded the occurrence of death and loss of independence from the date of health check-ups through the end of August 2021. Furthermore, we divided the participants into two groups based on the judgment value of medical consultation recommendations for the specified medical check-ups. In addition, we calculated 1-year survival and independence rates using the Kaplan-Meier method and estimated hazard ratios (HRs) of death and loss of independence using the Cox's proportional hazard model.

Results　During the follow-up, 424 cases of deaths (281 males and 143 females) and 1,011 cases of loss of independence (529 males and 482 females) were identified. In addition, 1-year survival and independence rates for low serum albumin were 0.920-0.958, with the lowest in both the sexes. The Cox's proportional hazards model after adjusting for age, body mass index, and responses to the late-stage older adult questionnaire revealed that HRs of death (3.05 [2.00-4.64]) and loss of independence (2.58 [1.87-3.56]) for low hemoglobin were the highest in males, and those of death (5.87 [2.45-14.07]) and loss of independence (3.00 [1.70-5.29]) for low serum albumin were particularly high in females. In a previous study analyzing the loss of independence among older adults who participated in health check-ups, HRs of death for low serum albumin and hemoglobin were 2.7 [1.2-6.0] and 1.8 [1.1-2.9], respectively, and the current study results showed a higher tendency than that in the previous study. In addition, previous studies showed an association between low serum albumin and stroke and low hemoglobin and death. However, in the current study, HRs for low serum albumin and hemoglobin could be particularly high because the Tochigi Prefecture has a high age-adjusted mortality rate for cerebrovascular and cardiac diseases, in addition to low nutrition among individuals with risk factors for these diseases.

Conclusion　This study found that low nutrition among older adults in the Tochigi Prefecture was highly associated with the occurrence of death and the need for nursing care. In addition, the trends in mortality and the risk of loss of independence among older adults differed by region.

Objectives　Recent studies have shown a bidirectional association between diabetes and periodontal disease. However, the longitudinal association between periodontal pocket depth and new onset of diabetes remains controversial. Therefore, this study aimed to examine the association between periodontal pocket depth and new onset of diabetes using dental check-up data in a community-based population.

Methods　The study comprised 5,163 participants aged≥20 years (mean age±standard deviation, 57.4±13.9 years; women, 66.3%) who underwent dental check-ups between April 2016 and March 2019 in a Tokyo ward. We classified the participants into three groups using community periodontal index codes from dental check-ups: healthy periodontal pocket group, periodontal pocket 4-5 mm group, and periodontal pocket ≥6 mm group. The participants were followed until the end of March 2020. Additionally, data on individuals who developed diabetes in the same ward were acquired from the National Health Insurance and Latter-Stage Older Persons Health Care System using ICD-10 codes. As the study outcome, we identified individuals who developed diabetes after the dental check-up date. Diabetes incidence rates were compared using the log-rank test and Cox regression analysis. Additionally, we performed a sensitivity analysis using a similar framework.

Results　The log-rank test showed that the cumulative incidence of diabetes between the three groups was significantly different (P<0.01). A Cox regression analysis model adjusted for sex, age, smoking habits, number of teeth present, and oral hygiene status showed that the diabetes development hazard ratio (HR) for the periodontal pocket ≥6 mm group was 1.44 (95% confidence interval [CI]; 1.04-2.00) when compared with that of the healthy periodontal pocket group. In the sensitivity analysis of individuals aged ≥40 years, the HR for the periodontal pocket ≥6 mm group was 1.55 (95% CI; 1.11-2.16) when compared with that of the healthy periodontal pocket group. Similarly, among men aged ≥40 years, the HR for the periodontal pocket ≥6 mm group was 1.72 (95% CI; 1.04-2.85) when compared with that of the healthy periodontal pocket group. However, no significant association between new onset of diabetes and periodontal pocket depth was found for women aged ≥40 years (HR=1.39, 95% CI; 0.89-2.18).

Conclusion　This The study suggests a longitudinal association between periodontal pocket depth and new onset of diabetes. The association was particularly pronounced in men aged ≥40 years. Therefore, men aged <40 years should maintain good oral health through appropriate dental health guidance to prevent the future development of diabetes.