Keigo Saeki

Reliability and Validity of the International Physical Activity Questionnaire (IPAQ) in Elderly Adults: The Fujiwara-kyo Study

Background The International Physical Activity Questionnaire (IPAQ) is a self-reported questionnaire for assessing physical activity and has been tested in 12 countries among adults aged 18 to 65 years. The present study evaluated the reliability and validity of the IPAQ among adults aged 65 years and older. Methods The study included 164 men and 161 women selected from participants of the Fujiwara-kyo Study, a prospective cohort of elderly Japanese adults. To examine test–retest reliability, the participants were asked to complete the IPAQ twice, 2 weeks apart. The criterion validity of the IPAQ was tested by using an accelerometer. Results Based on intraclass correlation coefficients, the reliability of the total IPAQ was 0.65 and 0.57 for men and women, respectively, aged 65 to 74 years and 0.50 and 0.56 for those aged 75 to 89 years. The Spearman correlation coefficients between total IPAQ score and total physical activity measured by accelerometer (TPA-AC) were 0.42 and 0.49 for men and women, respectively, aged 65 to 74 and 0.53 and 0.49 for those aged 75 to 89. Weighted kappa coefficients between total IPAQ score and TPA-AC were 0.49 and 0.39 for men and women, respectively, aged 65 to 74 and 0.46 and 0.47 for those aged 75 to 89. Conclusions The reliability of the IPAQ was not sufficient, but the validity was adequate. Although there were some limitations with regard to repeatability and agreement in classification, the IPAQ was a useful tool for assessing physical activity among elderly adults.

Exposure to light at night, nocturnal urinary melatonin excretion, and obesity/dyslipidemia in the elderly: a cross-sectional analysis of the HEIJO-KYO study.

CONTEXT Obesity and exposure to light at night (LAN) have increased globally. Although LAN suppresses melatonin secretion and disturbs body mass regulation in experimental settings, its associations with melatonin secretion, obesity, and other metabolic consequences in uncontrolled home settings remain unclear. OBJECTIVE The aim of this study was to determine the association of exposure to LAN in an uncontrolled home setting with melatonin secretion, obesity, dyslipidemia, and diabetes. DESIGN AND PARTICIPANTS A cross-sectional study was performed in 528 elderly individuals (mean age, 72.8 yr). MEASURES The intensity of LAN in the bedroom was measured at 1-min intervals during two consecutive nights, along with overnight urinary melatonin excretion and metabolic parameters. RESULTS Compared with the Dim group (average <3 lux; n = 383), the LAN group (average ≥3 lux; n = 145) showed significantly higher body weight (adjusted mean, 58.8 vs. 56.6 kg; P = 0.01), body mass index (23.3 vs. 22.7 kg/m(2); P = 0.04), waist circumference (84.9 vs. 82.8 cm; P = 0.01), triglyceride levels (119.7 vs. 99.5 mg/dl; P < 0.01), and low-density lipoprotein cholesterol levels (128.6 vs. 122.2 mg/dl; P = 0.04), and showed significantly lower high-density lipoprotein cholesterol levels (57.4 vs. 61.3 mg/dl; P = 0.02). These associations were independent of numerous potential confounders, including urinary melatonin excretion. Furthermore, LAN exposure is associated with higher odds ratios (ORs) for obesity (body mass index: OR, 1.89; P = 0.02; abdominal: OR, 1.62; P = 0.04) and dyslipidemia (OR, 1.72; P = 0.02) independent of demographic and socioeconomic parameters. In contrast, urinary melatonin excretion and glucose parameters did not show significant differences between the two groups. CONCLUSIONS Exposure to LAN in an uncontrolled home setting is associated with impaired obese and lipid parameters independent of nocturnal urinary melatonin excretion in elderly individuals. Moreover, LAN exposure is associated with higher ORs for obesity and dyslipidemia independent of demographic and socioeconomic parameters.

Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the fujiwara-kyo study

BackgroundThis cross-sectional study investigated the relationship between the number of remaining teeth to mild memory impairment (MMI), which is a preclinical stage of dementia, and to cognitive impairment.MethodsThe subjects were aged 65 years or older and were grouped according to their score for the Mini-Mental State Examination (MMSE), the three-word delayed recall test in the MMSE, and the Geriatric Depression Scale into the control group (n = 3,696), the MMI group (n = 121), and the low MMSE score (23 or lower) group (n = 214). We collected data on the number of remaining teeth, the length of the edentulous period, health-related lifestyle, medical history, blood pressure, height, and body weight. Fasting venous blood samples were also obtained.ResultsMultiple logistic regression analysis, adjusted for depressive symptoms, age, sex, length of education, and other explanatory variables, revealed that the odds ratios of 0-10 remaining teeth to 22-32 remaining teeth were 1.679 (95% CI 1.073-2.627) for MMI and 2.177 (95% CI 1.510-3.140) for a low MMSE score. A significant relationship was also found between the length of the edentulous period and the risk of a low MMSE score (odds ratio 3.102, 95% CI 1.432-6.720) (15 years or more/less than 15 years).ConclusionsOur findings suggest that tooth loss is associated with cognitive function.

Positive Effect of Daylight Exposure on Nocturnal Urinary Melatonin Excretion in the Elderly: A Cross-Sectional Analysis of the HEIJO-KYO Study

CONTEXT Melatonin is involved in a variety of diseases, including cancer, insomnia, depression, dementia, hypertension, and diabetes; its secretion is influenced by environmental light. Although daylight exposure increases nocturnal melatonin secretion in a controlled laboratory setting, whether it increases nocturnal melatonin secretion in an uncontrolled daily life setting remains unclear. OBJECTIVE We aimed to determine the association between daylight exposure in an uncontrolled daily life setting and urinary 6-sulfatoxymelatonin excretion. DESIGN AND PARTICIPANTS A cross-sectional study was conducted in 192 elderly individuals (mean age, 69.9 yr). MEASURES We measured ambulatory daylight exposure using a wrist light meter in two 48-h sessions; furthermore, we measured overnight urinary 6-sulfatoxymelatonin excretion, an index of melatonin secretion, on the second night of each session. RESULTS The median duration of daylight exposure of at least 1000 lux was 72 min (interquartile range, 37-124). Univariate linear regression analysis showed marginal to significant associations between log-transformed urinary 6-sulfatoxymelatonin excretion and age, current smoking status, benzodiazepine use, day length, log-transformed duration of daylight exposure of at least 1000 lux, and daytime physical activity. In a multivariate model, log-transformed duration of daylight exposure of at least 1000 lux was significantly associated with log-transformed urinary 6-sulfatoxymelatonin excretion (regression coefficient, 0.101; 95% confidence interval, 0.003-0.199; P = 0.043). Furthermore, an increase in the duration of daylight exposure of at least 1000 lux from 37 to 124 min (25th to 75th percentiles) was associated with a 13.0% increase in urinary 6-sulfatoxymelatonin excretion (6.8 to 7.7 μg). CONCLUSIONS Daylight exposure in an uncontrolled daily life setting is positively associated with urinary 6-sulfatoxymelatonin excretion in the elderly.

Working hours, occupational stress and depression among physicians

BACKGROUND Physicians report high prevalence of depression, work long hours and are exposed to many occupational stresses (OSs). AIMS To investigate the cross-sectional association between working hours, OS and depression among physicians. METHODS A self-administered questionnaire was mailed to 1902 alumni of a medical school. The questionnaire evaluated working hours in the previous week, OS assessed by the effort-reward imbalance model, social support and depression evaluated by the Center for Epidemiologic Studies Depression scale. The associations between these occupational factors and depression were analyzed using multiple logistic regression. RESULTS The questionnaire was returned by 795 alumni (response rate, 42%), and 706 respondents (534 men and 172 women) were suitable for analysis. The odds ratio (OR) of depression in the long working hours group (>70 h/week) was 1.8 (95% CI: 1.1-2.8) compared with the short working hours group (<54 h/week), adjusted for basic attributes. The adjusted ORs of depression in the upper effort-reward ratio (ERR) tertile versus the lower ERR tertile were 0.6 (0.2-1.8) in the short working hours group, 8.5 (3.0-24.0) in the middle working hours group and 9.9 (3.8-25.7) in the long working hours group. The adjusted ORs of depression stratified according to working hours and ERR tended to be higher in the groups with a higher ERR, but no association between working hours and depression was found. CONCLUSIONS This study indicates that the management of OS is needed as a countermeasure against depression among physicians.

Tooth loss is associated with mild memory impairment in the elderly: The Fujiwara-kyo study

It has been reported that tooth loss is associated with Alzheimers disease (AD) and dementia. The purpose of this study was to investigate the association between tooth loss and mild memory impairment (MMI) among the elderly. We examined 3,061 community residents aged 65 years or older who had a score of 24 or more on the Mini-Mental State Examination. The subjects were divided according to their score for the three-word delayed recall test into control (score: 3 or 2) and MMI (score: 1 or 0) subjects. The subjects underwent a dental examination, an interview to determine their medical history, a self-administered questionnaire (inclusive of higher-level functional capacity, drinking and smoking habits, and frequency of going out), and a 10-m walking test. Fewer remaining teeth, going out once a week or less frequently, and a slow walking speed on a 10-m walking test were found at a significantly higher prevalence in the MMI group (n=101) than in the control group (n=2,960), after adjustment for sex, age, and the level of education. Multiple logistic regression analysis using these items revealed that the odds ratio of 0-10 remaining teeth for MMI was 1.71 (95% CI 1.05-2.78), compared to individuals with 22-32 remaining teeth. A significant increase was also found in a trend test to examine the increasing odds ratios of 22-32, 11-21, and 0-10 remaining teeth. We consider that tooth loss is associated with MMI later in life.

Relationship between swallowing problems and tooth loss in community-dwelling independent elderly adults: the Fujiwara-kyo study.

To investigate the relationship between swallowing problems and the number of remaining teeth in healthy elderly people.

Exposure to light at night and risk of depression in the elderly

BACKGROUND Recent advances in understanding the fundamental links between chronobiology and depressive disorders have enabled exploring novel risk factors for depression in the field of biological rhythms. Increased exposure to light at night (LAN) is common in modern life, and LAN exposure is associated with circadian misalignment. However, whether LAN exposure in home settings is associated with depression remains unclear. METHODS We measured the intensities of nighttime bedroom light and ambulatory daytime light along with overnight urinary melatonin excretion (UME) in 516 elderly individuals (mean age, 72.8). Depressive symptoms were assessed using the Geriatric Depression Scale. RESULTS The median nighttime light intensity was 0.8lx (interquartile range, 0.2-3.3). The depressed group (n=101) revealed significantly higher prevalence of LAN exposure (average intensity, ≥ 5 lx) compared with that of the nondepressed group (n=415) using a multivariate logistic regression model adjusted for daytime light exposure, insomnia, hypertension, sleep duration, and physical activity [adjusted odds ratio (OR): 1.89; 95% confidence interval (CI), 1.10-3.25; P=0.02]. Consistently, another parameter of LAN exposure (duration of intensity ≥ 10 lx, ≥ 30 min) was significantly more prevalent in the depressed than in the nondepressed group (adjusted OR: 1.71; 95% CI, 1.01-2.89; P=0.046). In contrast, UME was not significantly associated with depressive symptoms. LIMITATION Cross-sectional analysis. CONCLUSION These results suggested that LAN exposure in home settings is significantly associated with depressive symptoms in the general elderly population. The risk of depression may be reduced by keeping nighttime bedroom dark.

Association between depressive symptoms and metabolic syndrome in Japanese community‐dwelling older people: a cross‐sectional analysis from the baseline results of the Fujiwara‐kyo prospective cohort study

Metabolic syndrome contains many risks for medical diseases such as cardiovascular disease and diabetes, which might precipitate depressive symptoms in the older people. However, the association between depressive symptoms and metabolic syndrome in Japanese community‐dwelling older people is unclear. This study was performed to answer this important question.

Stronger association of indoor temperature than outdoor temperature with blood pressure in colder months.

Background: Higher cardiovascular mortality in winter may be partly explained by increased blood pressure (BP) because of cold exposure. However, this winter excess mortality is higher in countries with moderate winter than those with severe winter climate. Objectives: Although higher BP in low outdoor temperatures has been reported, the magnitude of association of indoor temperature with ambulatory BP remained unclear. We aimed to compare the associations of indoor and outdoor temperature with ambulatory BP. Methods: From repeated measurements on two consecutive days during colder months (October–April) among 868 elderly individuals, we assessed the association of indoor and outdoor temperatures with ambulatory BP using multilevel analysis with random intercept for each individual. Results: Correlation between indoor and outdoor temperature got weak along with decreasing outdoor temperature. Outdoor temperature was not significantly associated with ambulatory BP. In contrast, a 1°C lower indoor temperature was significantly associated with 0.22 mmHg higher daytime SBP, 0.18% higher nocturnal BP fall, 0.34 mmHg higher sleep-trough morning BP surge independent of potential confounders including physical activity. The models with indoor temperature showed better fit of the model than those with outdoor temperature. Night-time SBP did not show significant association with indoor and outdoor temperature but with bed temperature. Discussion: Our results suggest the importance to assess the association of indoor temperature with cardiovascular mortality to determine whether improving housing thermal environment reduces winter excess mortality. Conclusion: Indoor temperature showed stronger association than outdoor temperature with BP in colder months.