Yukako Tani

Oral Health and Incident Depressive Symptoms: JAGES Project Longitudinal Study in Older Japanese

To determine whether oral health status predicts depressive symptoms in older Japanese people.

Maternal vegetable intake in early pregnancy and wheeze in offspring at the age of 2 years

Background/objectivesVegetable intake during childhood may reduce the risk of subsequent asthma. We verified the effect of maternal intake during pregnancy on asthma risk in offspring, which has rarely been studied.Subjects/methodsIn a hospital-based birth cohort study conducted in Tokyo, we administered a food frequency questionnaire at two periods during the respondents’ pregnancy: early and mid to late periods. In addition, a questionnaire including the International Study of Asthma and Allergies in Childhood questionnaire was conducted when the offspring were 2 years old. Multivariate Poisson regression adjusting for maternal baseline demographics was used to elucidate the association between maternal vegetable intake and the incidence of wheeze in the offspring.ResultsAmong 310 singletons, 82 (26.5%) experienced wheeze at 2 years of age. Women with the highest intake of cruciferous, and folate-rich vegetables during early pregnancy reported a significantly lower prevalence of wheeze in their child at 2 years of age in comparison with those who reported the lowest intake (adjusted risk ratio: 0.48 and 0.47, 95% confidence interval: 0.26–0.89, and 0.25–0.87, respectively). In trend analysis, a higher maternal intake of cruciferous, folate-rich vegetables, and total vegetables during early pregnancy was less likely to be associated with wheeze in the offspring at 2 years old (p for trend: 0.038, <0.001, and 0.028, respectively). Maternal vegetable intake during mid to late pregnancy was not associated with wheeze in the offspring.ConclusionsMaternal vegetable intake during early pregnancy may have a protective effect against asthma in offspring at 2 years of age.

Eating Alone Yet Living With Others Is Associated With Mortality in Older Men: The JAGES Cohort Survey

Abstract Objectives Eating by oneself may be a risk factor for poor nutritional and mental statuses among older adults. However, their longitudinal association with mortality in relation to coresidential status is unknown. Method We conducted a 3-year follow-up of participants in the Japan Gerontological Evaluation Study, a population-based cohort of 65 years or older Japanese adults. We analyzed mortality for 33,083 men and 38,698 women from 2010 to 2013 and used. Cox regression models were used to estimate hazard ratios (HR) for mortality. Results A total of 3,217 deaths occurred during the follow-up. Compared with men who ate and lived with others, the HRs after adjusting for age and health status were 1.48 (95% confidence intervals [CI]: 1.26–1.74) for men who ate alone yet lived with others and 1.19 (95% CI: 1.01–1.41) for men who ate and lived alone. Among women, the adjusted HR was 1.18 (95% CI: 0.97–1.43) for women who ate alone yet lived with others and 1.10 (95% CI: 0.93–1.29) for women who ate and lived alone. Discussion A setting in which older adults eat together may be protective for them. Promotion of this intervention should focus on men who eat alone yet live with others.

Long-term Impact of Childhood Disadvantage on Late-Life Functional Decline Among Older Japanese: Results From the JAGES Prospective Cohort Study

Background Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study. Methods Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years). Results A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group. Conclusions These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context.

Adverse Childhood Experiences and Higher-Level Functional Limitations Among Older Japanese People: Results From the JAGES Study

Background A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people. Methods Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status. Results Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27). Conclusions ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people.

Living Alone or With Others and Depressive Symptoms, and Effect Modification by Residential Social Cohesion Among Older Adults in Japan: The JAGES Longitudinal Study

Background There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan. Methods We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level. Results Among men (but not women), living alone (OR 1.43; 95% confidence intervals [CI], 1.18–1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09–1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion. Conclusions Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.

Community Social Capital, Built Environment, and Income-Based Inequality in Depressive Symptoms Among Older People in Japan: An Ecological Study From the JAGES Project

Background Although reducing socioeconomic inequalities in depression is necessary, their associated factors have rarely been studied. This study aimed to screen the potential contextual factors associated with income-based inequality in older adults’ depression. Methods Using data from the Japan Gerontological Evaluation Study (JAGES) of 2013, we conducted an ecological study covering 77 communities in Japan. Our measures of socioeconomic inequalities in depression were the slope index of inequalities (SII) and the relative index of inequalities (RII) of the prevalence of depressive symptoms across three income levels. We categorized available community-level factors, including socio-demographic factors, social participation, social relationships, subjective changes in the residential area, and the built environment. These indicators were aggregated from individual responses of 51,962 and 52,958 physically independent men and women, respectively, aged 65 years or more. We performed multiple linear regression analyses to explore factors with statistical significance of a two-tailed P-value less than 0.05. Results Factors associated with shallower gradients in depression for men included higher participation in local activities and reception or provision of social support, which did not show significant association among women. Perceived increases in unemployment and economic inequalities were positively associated with larger inequalities in both genders (P < 0.05). The built environment did not indicate any significant association. Conclusions A community environment fostering social activities and relationships might be associated with smaller income-based inequalities in depression. There is a need for more deterministic studies for planning of effective community interventions to address socioeconomic inequalities in depression.

Dietary n-3 Polyunsaturated Fatty Acids in Late Pregnancy and Postpartum Depressive Symptom among Japanese Women

Background The use of n-3 polyunsaturated fatty acids (n-3PUFA) in preventive or therapeutic modalities for postpartum depression, especially long-chain types such as eicosapentaenoic acid (EPA) and a docosahexaenoic acid (DHA), is of considerable interest. High n-3PUFA consumption has been reported among pregnant Japanese women. Therefore, analysis of this group could provide important insights into the relationship between postpartum depression and dietary n-3PUFA consumption. To further examine the relationship between the risk of postpartum depression and n-3PUFA consumption, we conducted a prospective hospital-based birth cohort study in Japan. Design and methods Our prospective birth cohort study was performed at the National Center for Child Health and Development (NCCHD) in suburban Tokyo, Japan. Dietary n-3PUFA intake during late pregnancy was assessed by a semi-quantitative food questionnaire and participants were categorized by quintile distributions of n-3PUFA intake. A Japanese translation of the Edinburgh Postnatal Depression Scale was used to screen women for postpartum depression at 1 month after delivery (967 women) and at 6 months after delivery (710 women). We performed logistic regression analysis to examine the relationship between the risk of postpartum depression and n-3PUFA consumption after adjusting for confounding factors. Results Significant associations between EPA, DHA, and n-3PUFA intakes in late pregnancy and postpartum depression at both 1 and 6 months after delivery were not observed. Conclusion This prospective study indicated that EPA, DHA, and n-3PUFA intake during late pregnancy was not associated with the risk of postpartum depression.

Does Type of Residential Housing Matter for Depressive Symptoms in the Aftermath of a Disaster? Insights From the Great East Japan Earthquake and Tsunami

Abstract The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents’ mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

Exploring 2.5-Year Trajectories of Functional Decline in Older Adults by Applying a Growth Mixture Model and Frequency of Outings as a Predictor: A 2010–2013 JAGES Longitudinal Study

Background We explored the distinct trajectories of functional decline among older adults in Japan, and evaluated whether the frequency of outings, an important indicator of social activity, predicts the identified trajectories. Methods We analyzed data on 2,364 adults aged 65 years or older from the Japan Aichi Gerontological Evaluation Study. Participants were initially independent and later developed functional disability during a 31-month follow-up period. We used the level of long-term care needs certified in the public health insurance system as a proxy of functional ability and linked the fully tracked data of changes in the care levels to the baseline data. A low frequency of outings was defined as leaving one’s home less than once per week at baseline. We applied a growth mixture model to identify trajectories in functional decline by sex and then examined the association between the frequency of outings and the identified trajectories using multinomial logistic regression analysis. Results Three distinct trajectories were identified: “slowly declining” (64.3% of men and 79.7% of women), “persistently disabled” (4.5% and 3.7%, respectively), and “rapidly declining” (31.3% and 16.6%, respectively). Men with fewer outings had 2.14 times greater odds (95% confidence interval, 1.03–4.41) of being persistently disabled. The association between outing frequency and functional decline trajectory was less clear statistically among women. Conclusions While the majority of older adults showed a slow functional decline, some showed persistent moderate disability. Providing more opportunities to go out or assistance in that regard may be important for preventing persistent disability, and such needs might be greater among men.