Kazue Yamaoka

Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis

BackgroundTo evaluate the effect of lifestyle modifications on metabolic syndrome (MetS) as assessed by its resolution and improved values for its components.MethodsThis was a systematic review and meta-analysis. Searches were performed of MEDLINE and the Cochrane Database from January 1966 to October 2011 to identify randomized controlled trials (RCTs) related to the study objective. The included studies were RCTs restricted to the English language, with a follow-up period of 6 months or more, which reported overall resolution of MetS or values of MetS components (fasting blood glucose, waist circumference, high-density lipoprotein (HDL), triglycerides, and systolic and diastolic blood pressure (SBP, DBP)). Two investigators independently assessed study eligibility. The effect sizes were the relative proportion of patients with resolved MetS and mean differences in MetS component values from baseline to 1-year follow-up in a lifestyle-modification intervention (LMI) group versus a control (conventional lifestyle education or no treatment) group. Meta-analyses were conducted using a random-effects model.ResultsEleven interventions in eight RCTs were used for the meta-analyses. The relative proportion of patients with resolved MetS in the intervention group was approximately 2.0 (95% CI 1.5 to 2.7) times greater in the intervention group compared with the control group (7 interventions, n = 2.839). LMI (5 interventions, n = 748) significantly reduced mean values for SBP by -6.4 mmHg (95% CI -9.7 to -3.2), DBP by -3.3 mmHg (95% CI -5.2 to -1.4), triglycerides by -12.0 mg/dl (95% CI -22.2 to -1.7), waist circumference by -2.7 cm (95% CI -4.6 to -0.9), and fasting blood glucose by -11.5 mg/dl (95% CI -22.4 to -0.6) (5 interventions), but reductions were not significant for HDL (1.3 mg/dl; 95% CI -0.6 to 3.1).ConclusionsThe LMI was effective in resolving MetS and reducing the severity of related abnormalities (fasting blood glucose, waist circumference, SBP and DBP, and triglycerides) in subjects with MetS.

Health-related quality of life varies with personality types: a comparison among cancer patients, non-cancer patients and healthy individuals in a Japanese population

In an attempt to examine differential effects of personality on health-related quality of life (HRQoL) without regard to disease type, we used the HRQoL-20, a general questionnaire (Japanese original scale) we developed (comprising 20 questions related to physiological, psychological or social HRQoL) and the Eysenck Personality Questionnaire (EPQ), which measures personality traits of extraversion (E), neuroticism (N) and psychoticism (P). The subjects (399 males and 429 females), stomach cancer patients, non-cancer patients (who had received acupuncture or moxibustion treatment) and healthy controls, were classified into three personality types. The results indicated that the HRQoL score of the tolerable/tolerant type (high E, low N and high P scorers) was greater than the intolerable/intolerant type (low E, high N and low P scorers) and also the unclassified type (neither of above scorers). The HRQoL correlated positively with the E and P scales and negatively with the N scale, in the case of all subjects, with the exception of N in male cancer patients and E in male non-cancer patients. The results supported the hypothesis that the HRQoL varies with personality variables, in that each patient, in different treatment settings, strives for the situation that is congruent with his/her personality to attain a better HRQoL.

The impact of subjective and objective social status on psychological distress among men and women in Japan

From around 1990s, social disparity issues and their effects on mental health have been gaining increasing attention in Japanese society. Findings from previous studies on socioeconomic status (SES) and mental health in Japan are inconsistent. Subjective Social Status (SSS) has been proposed and tested as a stronger predictor of mental health than measures such as education, income and occupation in the UK and US, but this has not been tested enough in countries with a different social and cultural background such as Japan. In the present study, a cross-sectional questionnaire survey was conducted in 2006 among a nationally representative community-based random sample of residents in Japan aged 20-74 years. A total of 1237 participants completed the questionnaire, with the overall response rate of 61.9%. After excluding 42 respondents, data from 1195 respondents (574 men and 621 women) were analyzed. SSS, household income, and education level of respondents were measured using single-item questions. Those with a K6 score of 5 or greater were defined as having psychological distress. A multiple logistic regression model was used to examine the effects of SSS, household income, and education on psychological distress. Among men, the prevalence of psychological distress, after adjusting for age and marital status, differed significantly across groups classified based on SSS, household income, and education. Among women, only SSS was significantly associated with psychological distress after adjusting for age and marital status. However, when all three variables were simultaneously entered into the model, SSS and household income were significantly associated with psychological distress, with the low SSS group having a higher odds ratio of psychological distress. In summary, SSS seems to be a stronger predictor of psychological distress among both men and women in the Japanese community than traditional measures of SES.

Test validity of periodic liver function tests in a population of Japanese male bank employees

The validity (sensitivity and specificity) of annual liver function tests, determined by assaying blood levels of aspartate aminotransferase, alanine aminotransferase and gammaglutamyl transpeptidase, was evaluated using the results of health checkups of male bank workers. The specificity of each liver function test to detect persons with fatty liver, excess alcohol users, and hepatic virus carriers, diagnosed respectively by ultrasound, detailed inquiry, and virus marker tests, was always higher than 80%, except for alanine aminotransferase in excess alcohol users (63.5%). However, the highest sensitivity to detect virus carriers was alanine aminotransferase to detect HCV antibody-positive workers, but it was only 45.5%. The highest sensitivity of the liver function tests to detect excess alcohol users in obese subjects was only 33.3%. The highest sensitivity by liver function tests to detect fatty liver was 35.7% which was inferior to that of the body mass index. These results indicate that the liver function tests mandated in the workplace periodic health checkups in Japan exhibit very low sensitivity for the detection of any of the proposed target clinical conditions.

Illness perceptions and quality of life in Japanese and Dutch patients with non-small-cell lung cancer

This study examined quality of life (QOL) and illness perceptions in Dutch and Japanese patients with non-small-cell lung cancer, thereby extending the body of knowledge on cultural differences and psychosocial aspects of this illness. 24 Dutch and 22 Japanese patients with non-small-cell lung cancer filled out questionnaires on three occasions: immediately before chemotherapy, 1 week later, and 8 weeks after the initial chemotherapy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) assessed QOL, and the Brief Illness Perception Questionnaire (B-IPQ) illness perceptions. Scores on several QOL measures indicated (a) major impact of first chemotherapy sessions, and (b) some tendency to returning to baseline measures at 8 weeks. Differences between Japanese and Dutch samples were found on five EORTC QLQ-C30 dimensions: global health status, emotional functioning, social functioning, constipation, and financial difficulties, with the Dutch patients reporting more favorable scores. Regarding illness perceptions, Japanese patients had higher means on perceived treatment control and personal control, expressing a higher sense of belief in the success of medical treatment than Dutch patients. In both Japanese and Dutch patients, impact of chemotherapy on QOL was evident. Some differences in illness perceptions and QOL between the two samples were observed, with implications for integral medical management. Both samples reported illness perceptions that reflect the major consequences of non-small-cell lung cancer. Incorporating symptom reports, illness perceptions, and QOL into medical management may have positive consequences for patients with non-small-cell lung cancer.

Social determinants of self-reported sleep problems in South Korea and Taiwan.

OBJECTIVE To clarify the social determinants of insomnia in South Korea and Taiwan. METHODS Cross-sectional surveys were conducted in South Korea (n=1007) and Taiwan (n=785) in 2003. Nationwide samples of people completed a structured questionnaire, based on face-to-face interviews. Outcome measures were self-reported sleep problems, defined by at least one of three sleep symptoms on a nightly basis for more than 2 weeks: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning waking (EMW). Explanatory variables investigated were demographic characteristics (gender, age), socioeconomic factors (income, education), and social capital, including norms of reciprocity, interpersonal trust, civic association, and social support (i.e., the availability of persons to consult regarding personal problems and important matters). RESULTS The prevalence of sleep problems was 8.2% in South Korea and 9.3% in Taiwan. Stepwise logistic regression showed that, in South Korea, sleep problems were significantly associated with increasing age (P<.05), low income (P<.01), and having few persons with whom to consult compared to having a spouse/partner (P<.05); in Taiwan, sleep problems were significantly associated with being female (P<.05), increasing age (P<.001), and having family members vs. a spouse/partner to consult (P<.05). CONCLUSION Self-reported sleep problems in two northeast Asian countries were associated with certain demographic characteristics and socioeconomic factors, which is consistent with previous results in Western countries. In addition, the results of this study suggested that sleep problems may also be associated with social support.

Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial

BackgroundThe prevalence of type 2 diabetes is rising worldwide, as has been the global mean fasting plasma glucose level. This study aimed to evaluate the effectiveness of a structured individual-based lifestyle education (SILE) program to reduce the hemoglobin A1c (HbA1c) level in type 2 diabetes patients delivered by registered dietitians in primary care clinical settings.MethodsThis was a 6-month prospective cluster randomized controlled trial in a primary care setting with randomization at the practice level. Twenty general practitioners in 20 clinics in Kanagawa prefecture, Japan, were involved. 193 adults (51% men, mean age 61.3 years) with type 2 diabetes and HbA1c ≥6.5% who received treatment in medical clinics were the participants. A SILE program was implemented through 4 sessions with trained registered dietitians during the 6-month study period. Results were compared with those of a control group who received usual care. The primary endpoint was the change in HbA1c levels at 6 months from baseline. Secondary endpoints were the changes at 6 months from baseline in fasting plasma glucose, lipid profile, blood pressure, BMI, energy, and nutrient intakes (whole day and each meal). Intention-to-treat analysis was conducted. Mixed-effects linear models were used to examine the effects of the treatment.ResultsThe mean change at 6 months from baseline in HbA1c was a 0.7% decrease in the intervention group (n = 100) and a 0.2% decrease in the control group (n = 93) (difference −0.5%, 95%CI: -0.2% to −0.8%, p = 0.004). After adjusting for baseline values and other factors, the difference was still significant (p = 0.003 ~ 0.011). The intervention group had a significantly greater decrease in mean energy intake at dinner compared with the control group and a greater increase in mean vegetable intake for the whole day, breakfast, and lunch as shown in crude and adjusted models. A tendency toward improvement was observed in the other secondary endpoints but the improvement was not statistically significant. These results were confirmed by several sensitivity analyses.ConclusionsThe SILE program that was provided in primary care settings for patients with type 2 diabetes resulted in greater improvement in HbA1c levels than usual diabetes care and education.Trial registrationhttp://UMIN000004049

Illness perceptions and quality of life in Japanese and Dutch women with breast cancer.

Knowledge on cross-cultural quality of life (QOL) and illness perceptions may help women with breast cancer cope more effectively. The self regulation model (SRM) guided the current exploratory longitudinal pilot-study. Central to SRM is the perception of health threats and their effects on QOL. Illness perceptions and QOL were assessed in 22 Dutch and 21 Japanese patients with breast cancer who filled out questionnaires before, 1 week, and 8 weeks after the first chemotherapy course. The questionnaires assessed QOL and illness perceptions. Patients’ scores were compared with groups of patients with other chronic somatic illnesses (asthma, diabetes). Patients in both samples reported major impact of chemotherapy on global health status, physical functioning, role functioning, emotional functioning, constipation and diarrhea. Differences between Japanese and Dutch patients were limited to social functioning and financial problems. Japanese patients expressed stronger concerns about their illness than Dutch patients. Results of the Japanese and Dutch patients with breast cancer differed from data in patients with asthma on consequences, timeline, concern and emotional response. Results of Japanese patients differed from patients with type 2 diabetes on timeline and concern, whereas Dutch patients differed on timeline and consequences. Japanese and Dutch breast cancer patients have—overall—similar illness perceptions and QOL responses and are aware of the typical characteristics of their disease. The results support the feasibility of cross-cultural psychosocial research in oncology and offer implications for clinical interventions which impact on self-efficacy to empower patients with breast cancer.

Social Ties May Play a Critical Role in Mitigating Sleep Difficulties in Disaster-Affected Communities: A Cross-Sectional Study in the Ishinomaki Area, Japan

STUDY OBJECTIVES We examined the association between social factors and sleep difficulties among the victims remaining at home in the Ishinomaki area after the Great East Japan Earthquake and Tsunami and identified potentially modifiable factors that may mitigate vulnerability to sleep difficulties during future traumatic events or disasters. DESIGN A cross-sectional household survey was conducted from October 2011 to March 2012 (6-12 mo after the disaster) in the Ishinomaki area, Japan. Univariate and multivariate logistic regression models were used to examine associations between social factors and sleep difficulties. PARTICIPANTS We obtained data on 4,176 household members who remained in their homes after the earthquake and tsunami. INTERVENTIONS N/A. RESULTS Sleep difficulties were prevalent in 15.0% of the respondents (9.2% male, 20.2% female). Two potentially modifiable factors (lack of pleasure in life and lack of interaction with/visiting neighbors) and three nonmodifiable or hardly modifiable factors (sex, source of income, and number of household members) were associated with sleep difficulties. Nonmodifiable or hardly modifiable consequences caused directly by the disaster (severity of house damage, change in family structure, and change in working status) were not significantly associated with sleep difficulties. CONCLUSIONS Our data suggest that the lack of pleasure in life and relatively strong networks in the neighborhood, which are potentially modifiable, might have stronger associations with sleep difficulties than do nonmodifiable or hardly modifiable consequences of the disaster (e.g., house damage, change in family structure, and change in work status).

Effects of lifestyle education program for type 2 diabetes patients in clinics: study design of a cluster randomized trial

BackgroundThe number of patients with type 2 diabetes is drastically increasing worldwide. It is a serious health problem in Japan as well. Lifestyle interventions can reduce progression from impaired glucose tolerance to type 2 diabetes, and glycemic control has been shown to improve postprandial plasma glucose levels. Moreover, several studies have suggested that continuous interventions (combined diet and exercise) can improve the plasma glucose level and reduce dosage of hypoglycemic agents.Although many interventional studies of lifestyle education for persons with diabetes in hospitals have been reported, only a few have been clinic-based studies employing an evidence-based lifestyle education program. This article describes the design of a cluster randomized controlled trial of the effectiveness of lifestyle education for patients with type 2 diabetes in clinics by registered dietitians.Methods/DesignIn Japan, general practitioners generally have their own medical clinics to provide medical care for outpatients in the community, including those with type 2 diabetes. With the collaboration of such general practitioners, the study patients were enrolled in the present study. Twenty general practitioners were randomly allocated to each provide patients for entry into either an intervention group (10) or a control group (10). In total, 200 participants will be included in the study. The intervention group will receive intensive education on lifestyle improvement related to type 2 diabetes by registered dietitians in clinics. Lifestyle education will be conducted several times during the study period. The control group will receive information on dietary intake and standard advice on glycemic control by registered dietitians. The primary endpoint is the change from the baseline value of HbA1c at 6 months. Data on health behavior and related issues will be gathered continuously over a 6-month period.DiscussionThis is the first study to evaluate lifestyle education in clinics by a cluster randomization trial in Japan. The proposed study will provide practical information about the usefulness of the intensive lifestyle improvement education program in primary care settings. The study was started in September 2007 and entry of subjects was completed in December 2010. Data on the effect evaluation will be available in 2011.Trial RegistrationUMIN000004049