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Study design of the Saku Control Obesity Program (SCOP)
Abstract
BACKGROUND: The increasing number of patients with metabolic syndrome and resultant diabetes mellitus, hypertension, hyperlipidemia, and other lifestyle-related diseases are an urgent focus of the Ministry of Health, Labor and Welfare. Because obesity is a common basis of these diseases, the control of obesity is an important aim. METHODS: A cognitive-behavioral treatment is being employed in a randomized intervention trial at the Saku Health Dock Center. 976 people whose BMI in upper quintile were identified from the health checkup database, and 235 people participated in the Saku Control Obesity Program (SCOP). Various biomarkers (including lipokines and single nucleotide polymorphism SNPs), physical activity, personality type (measured by the NEO-FFI), and dietary habits and dietary intake behavior (measured by the SQ-DHQ) will be measured to clarify the multiple factors influencing obesity. Each participant will use a diary to record body weight, body fat, number of steps, physical activity energy expenditure (PAEE), and success in achieving the established plan; a dietary record and appropriate equipment are also provided. At 1, 3, 6, 9, and 12 months, each participant will be interviewed by a doctor and dietician and receive individual education regarding physical activity. Follow-up will occur 1 and 2 years after baseline measurements. RESULTS: A total of 116 men (52.9 ± 6.6 years) and 119 women (54.4 ± 6.5 years) are participating in the study. Average body weight (± SD) was 86.4 ± 11.8 kg in males and 75.2 ± 9.5 in females. BMI was 30.4 ± 3.5 in males and 31.1 ± 3.1 in females. Waist and visceral fat area were 101.5 ± 8.7 cm and 159 ± 54 cm2 in males and 103.7 ± 8.3 cm and 130 ± 47 cm2 in females, respectively. PAEE was 271 ± 127 kcal in males and 246 ± 102 kcal in females. Basal metabolic rate, measured in one-tenth of the participants, was 1659 ± 226 kcal in males and 1477 ± 210 kcal in females. CONCLUSION: The purpose of this study is to evaluate the effectiveness of a cognitive-behavioral treatment designed to help obese patients lose weight and to maintain their weight losses over time. SCOP has been started with a good participation rate.
... Since 1990, a population-based Japan Public Health Center cohort study, consisting of 40-59-year-old residents, has been conducted in Saku [11]. According to the prevention of MetS, we established a clinical study (Saku Control Obesity Program (SCOP)) and compared the efficacy of SCOP intervention (i.e., change in the rate of metabolic syndrome before and after the intervention) [12][13][14][15]. In Saku Health Dock Center each year, about 7000 examinees have come to the center for a health checkup, including an oral glucose tolerance test (OGTT) by 75 g glucose intake, endoscopy, and recently abdominal CT, in addition to the routine laboratory test and physical checkups. ...
Background
The prevention of metabolic syndrome (MetS) is a major public health concern in Japan. The effects of the relationship between eating behavior and nutritional intake on MetS remained unclear.
To evaluate nutrition’s role in preventing or exacerbating MetS, we examined the associations among eating behavior, nutritional intake, and MetS for the baseline study in the cohort subjects undergone health checkups.
Methods
Four thousand and four hundred forty-seven Japanese men and women were enrolled at the Saku Central Hospital. They received an anthropometric and clinical examination and were assessed for present illness, lifestyle factors such as physical activity, smoking, drinking, and dietary habits at the enrollment. Eating behavior was analyzed by the Sakata’s Eating Behavior Questionnaire. Dietary assessment was made using a brief self-administered diet history questionnaire. Two thousand and six hundred two men and 1844 women aged more than 20 were analyzed.
Results
The mean age in men and women were 59.2 and 58.4 years old and the mean body mass index (BMI) were 23.7 and 22.3 kg/m ² , respectively. The percentages of MetS were 20.6 in men and 6.1 in women. In some nutrients, significantly higher energy-adjusted intakes in subjects without MetS than with Mets appeared both in men and women after age adjustment. After adjusting by age, energy-adjusted intake beverages in men and cereals in women were significantly higher in subjects with MetS than those without MetS. The scores of all the categories in eating behavior were significantly worse in subjects with MetS than those without MetS.
Conclusions
The differences in dietary intake between subjects with Mets and without Mets were relatively small. The scores of all the categories in eating behavior were worse in subjects with MetS than without MetS. It was suggested that the problem lay in the quality of diet, not in the quantity, caused by bad eating habits. The potential influence of eating behavior and nutritional intake on MetS was presented in men and women.
... Participants. We studied participants in the Saku Control Obesity Program (SCOP) (10). All the 50-59 y-old obese men and women (n530) were selected for the present study and they were allocated to normal glucose tolerance (NGT) (n510), impaired glucose tolerance and/or impaired fasting glycemia (IGT/IFG: impaired glucose tolerance (n52), impaired fasting glycemia (n54), and a combination of impaired glucose tolerance and impaired fasting glycemia (n55)), and T2DM (n59) groups on the basis of their fasting serum glucose and serum glucose concentration at the 2-h time point of an oral glucose tolerance test (OGTT) performed at the start of the SCOP, the JDS criteria, or a diagnosis made by their doctor. ...
We determined the total energy expenditure (TEE) of healthy overweight or obese people, and those with impaired glucose tolerance and/or impaired fasting glycemia (IGT/IFG), or type 2 diabetes (T2DM) using the doubly-labeled water method. As a second purpose, we compared the measured TEE with the target energy intake recommended in the treatment guidelines for diabetes. The participants were normal glucose tolerance (NGT), and IGT/IFG (n=11) and T2DM (n=9) patients, who were 50-59 y and had a body mass index >25 kg/m². The median TEE/body mass (BM) values were 32.6, 33.3, and 34.4 kcal/kg BM and the TEE/target BM values (target BM: BM at a BMI of 22 kg/m²) were 43.7, 50.2, and 46.5 kcal/kg target BM for each group, respectively, and did not differ significantly among them. Obese Japanese participants with T2DM in this study had lower TEE/BM than previously studied in non-obese participants with T2DM. In IGT/IFG or T2DM patients, if 30 kcal/kg target BM was used as the energy coefficient, on the basis of the treatment guidelines, the difference between TEE and the target energy intake would be −1,174±552 kcal (−38±11%). When 35 kcal/kg target BM was used as the energy coefficient, the difference between TEE and the target energy intake would be −877±542 kcal (−27±13%). Thus, the energy coefficients used to estimate target energy intake during lifestyle modification in obese/overweight patients with T2DM are considered to be quite low during the first step of diet therapy.
... We also confirmed the WC of 85 cm for men and 90 cm for women was fit to 100 cm 2 visceral fat areas by CT scan in the SCOP study, and intervention to improve obesity was associated with the increase of adiponectin and decrease of leptin [8][9][10]. The inverse relationship of leptin and adiponectin during successful intervention supported the central role of abdominal fat in metabolic syndrome [11]. ...
The standardization of diagnostic criteria is important to compare the efficacy of intervention and prevention of diseases. It could be conclusive that the WC of Japanese criteria is appropriate avoiding both over-diagnosis and under-diagnosis. WC reflects both visceral fat and subcutaneous fat of the abdominal wall, women in middle age usually have more subcutaneous fat than visceral fat.
... We also confirmed the WC of 85 cm for men and 90 cm for women was fit to 100 cm 2 visceral fat areas by CT scan in the SCOP study, and intervention to improve obesity was associated with the increase of adiponectin and decrease of leptin [8][9][10]. The inverse relationship of leptin and adiponectin during successful intervention supported the central role of abdominal fat in metabolic syndrome [11]. ...
The concept of metabolic syndrome was proposed by several committees, although there had considerable disagreement over the definition and diagnostic criteria. The use of the definitions to conduct research into the metabolic syndrome resulted in wide ranging prevalence rates, inconsistencies and confusion, and spurred on the vigorous debate regarding how the metabolic syndrome should be defined
... 14 We developed a weight loss program based on a behavioral approach with dietary and exercise intervention (Saku Control Obesity Program (SCOP)) in Japan. [15][16][17] In this program, we emphasized individually-tailored counseling, instead of uniform class room teaching, and the diet and physical activity were designed for each participant. [18][19][20] Half participants succeeded to reduced more than 5% body weight, and to change to the good lifestyle. ...
... The research plan was approved by the Ethical Committee of the National Institute of Health and Nutrition and Saku Hospital. The details and design of this study have been described previously [17]. Individuals who underwent health check-ups at the center were registered in the database, and 976 members between the ages of 40 and 64 years old who ...
Background:
Quantitative evaluation of visceral fat mass and skeletal muscle mass is important for health promotion. Recently, some studies suggested the existence of adipocyte-myocyte negative crosstalk. If so, abdominal skeletal muscles may easily and negatively affected not only by the age but also the visceral fat because age-related reduction in abdominal region is greater compared with limbs.
Objective:
We cross-sectionally examined the existence of quantitative associations between visceral fat area and abdominal skeletal muscle distribution in overweight people.
Methods:
A total of 230 Japanese males and females who aged 40-64 years and whose body mass index (BMI) was 28.0-44.8kg/m2 participated in this study. The cross-sectional area (CSA) of the visceral fat, subcutaneous fat, and abdominal skeletal muscles, namely, the rectus abdominis, abdominal oblique, erector spinae, and iliopsoas muscles were measured by the computed tomography images.
Results:
Stepwise regression analyses revealed the existence of sex difference in the relation between visceral fat CSA and other morphological variables. In males, BMI was a positive, and the iliopsoas muscle group CSA was a negative contributor of the visceral fat CSA. In females, both age and BMI were selected as positive contributors.
Conclusion:
These data suggested that the visceral fat CSA may negatively associated with iliopsoas muscle group CSA in males. In females, the visceral fat CSA was not significantly related to the distribution of the abdominal skeletal muscle groups.
... The outline of SCOP has been described previously. 22 The SCOP study protocol initially included 235 Japanese obese subjects (116 men and 119 women) recruited from the database of medical checkup record of Saku Central Hospital Human Dock Center, Nagano, Japan. The study participants had medical checkups since 2000 and were aged 40-64 years old, with a body mass index (Body Mass Index (BMI): kg/m 2 )) greater than 28.3 (the upper 5 percentile of all examinees). ...
... This study is a cross-sectional analysis of a randomized controlled trial, the Saku Control Obesity Program (SCOP), examining the effect of behavioral treatment and exercise at the Saku Central Hospital Human Dock Center . The details and design of the study have been previously described elsewhere171819. Briefly, the program consisted of a randomized intervention trial using cognitive-behavioral treatment at the ...
Dietary glycemic index or load is thought to play an important role in glucose metabolism. However, few studies have investigated the relation between glycemic index (GI) or load (GL) and glycemia in Asian populations. In this cross-sectional analysis of a randomized controlled trial, the Saku Control Obesity Program, we examined the relation between the baseline GI or GL and glycemia (HbA1c and fasting plasma glucose [FPG] levels), insulin resistance (HOMA-IR), β-cell function (HOMA-β), and other metabolic risk factors (lipid levels, diastolic and systolic blood pressure, and adiposity measures).
The participants were 227 obese Japanese women and men. We used multiple linear regression models and logistic regression models to adjust for potential confounding factors such as age, sex, visceral fat area, total energy intake, and physical activity levels.
After adjustments for potential confounding factors, GI was not associated with HbA1c, but GL was positively associated with HbA1c. For increasing quartiles of GI, the adjusted mean HbA1c were 6.3%, 6.7%, 6.4%, and 6.4% (P for trend = 0.991). For increasing quartiles of GL, the adjusted mean HbA1c were 6.2%, 6.2%, 6.6%, and 6.5% (P for trend = 0.044). In addition, among participants with HbA1c ≥ 7.0%, 20 out of 28 (71%) had a high GL (≥ median); the adjusted odds ratio for HbA1c ≥ 7.0% among participants with higher GL was 3.1 (95% confidence interval [CI] = 1.2 to 8.1) compared to the participants with a lower GL (<median). Further, among 16 participants with FPG ≥ 150 mg/dL, 13 participants (81.3%) had a higher GL; the adjusted odds ratio for FPG ≥ 150 mg/dL among participants with a higher GL was 8.5 (95% confidence interval = 1.7 to 43.4) compared to those with a lower GL. In contrast, GI and GL were not associated with metabolic risk factors other than glycemia.
Our findings suggest that participants with poor glycemic control tend to have a higher GL in an obese Japanese population.
... The outline of SCOP has been described previously. 22 The SCOP study protocol initially included 235 Japanese obese subjects (116 men and 119 women) recruited from the database of medical checkup record of Saku Central Hospital Human Dock Center, Nagano, Japan. The study participants had medical checkups since 2000 and were aged 40-64 years old, with a body mass index (Body Mass Index (BMI): kg/m 2 )) greater than 28.3 (the upper 5 percentile of all examinees). ...
Reported effects of different soy products on blood pressure vary. This systematic review and meta-analysis was performed to clarify the effects of soy isoflavone extract supplements on systolic and diastolic blood pressure (SBP and DBP) in adult humans.
PubMed, CENTRAL, ICHUSHI, and CNKI were searched in June 2009 for relevant randomized placebo-controlled trials. Study data and indicators of methodological validity were independently extracted by two authors using predefined data fields. Meta-analysis was carried out in Review Manager 5.0.22.
Searches identified 3740 articles, of which 14 randomized controlled trials (789 participants) were included. Daily ingestion of 25-375 mg soy isoflavones (aglycone equivalents) for 2-24 weeks significantly decreased SBP by 1.92 mmHg (95% confidence interval -3.45 to -0.39; P = 0.01) compared with placebo (heterogeneity P = 0.39, fixed effect model) in adults with normal blood pressure and prehypertension. The effect was not lost on sensitivity analysis. Subgroup analyses suggest greater effects in studies longer than 3 months, in Western populations, at lower doses, and in studies at lower risk of bias. Soy isoflavones did not affect DBP [-0.13 (95% confidence interval -1.03 to 0.78) mmHg, P = 0.78; heterogeneity P = 0.20, fixed effect model].
Soy isoflavone extracts significantly decreased SBP but not DBP in adult humans, and no dose-response relationship was observed. Further studies are needed to address factors related to the observed effects of soy isoflavones on SBP and to verify the effect in hypertensive patients.
The prevalence of chronic kidney disease (CKD) is estimated to be 8–16% worldwide, and it is increasing. CKD is a risk factor for heart attack and stroke, and it can progress to kidney failure requiring dialysis or transplantation. Recently, diabetic nephropathy has become the most common cause of CKD. In Japan, the cumulative probability of requiring hemodialysis by the age 80 years is 1/50 in males and 1/100 in females. The number of patients under hemodialysis in Japan exceeded 320,000 in 2014, among which 38,000 were newcomers and 27,000 died.
The annual medical costs of hemodialysis are 1.25 trillion yen in Japan, representing 4% of the total national medical expenditures in 2014. A low-protein diet (less than 0.5 g/kg b.wt.) is a very effective intervention. Low-protein rice (1/10 to 1/25 of the normal protein contents) is helpful to control the consumption of proteins, decreasing at the same time the intake of potassium and phosphate.
Protein restriction is indicated as soon as the eGFR becomes lower than 60 ml/min/1.73 m² body surface, in order, to slow disease progression. The newly developed low-protein Indica rice is expected to help many CKD patients in China and Southeast Asia.
Purpose To examine the factors related to successful body weight reduction. Methods The subjects were 111 middle-aged men and women who participated in a one-year weight loss program by changing their lifestyle in 2006. The subjects were classified into two groups by the amount of body weight loss during the program: 1) moderate or no weight loss (MNWL) (loss of less than 5% body weight) group and 2) successful weight loss (SWL) (loss of more than 5% weight) group, and their eating behaviors, thoughts about losing weight, and the proportions of subjects who had obstacles to weight loss, stress and support at the start of the program were compared. Results The subjects showed significant loss of weight after the program (mean -5.6±5.7% from initial body weight). A total of 53 subjects were classified into the MNWL group and 58 were classified into the SWL group. The SWL group showed significantly lower scores of "irregularity of eating"and "perception gap about feeling of fullness and hunger" than the MNWL group. The proportions of subjects who stated that losing weight was important and that their health depended on themselves, and the subjects who did not think that this was going to end well were almost 100% in both groups. The proportions of the subjects who were confident about losing weight, who had some obstacles to losing weight and who could receive any support from people around them were also not significantly different between the groups. On the other hand, significantly more MNWL subjects felt stress in losing weight than SWL subjects. The main reasons for the stress were job-related for men, and related to surroundings (taking care of their family), job and food restrictions in women. Conclusion Less obesity-related eating behavior and less stress were suggested as key determinants of successful body weight reduction. Consideration of the life context of a participant before treatment might be important for enhancing a weight loss program's effect.
Preproghrelin gene polymorphisms (SNPs) are possible predisposing factors to obesity and metabolic syndrome. We analysed SNPs in obese Japanese individuals and studied the correlation with diabetes and metabolic syndrome. We recruited 235 subjects (BMI > 28.3) from individuals undergoing periodic medical check-up at Saku Central Hospital. Their SNPs were genotyped using PCR-RFLP method. Frequencies of 5 SNPs in the preproghrelin gene −1500C>G (rs3755777), −1062G>C (rs26311), −994C>T (rs26312), Leu72Met (+408C>A) (rs696217), and +3056T>C (rs2075356) were compared with healthy individuals (data from HapMap Project or Asian population studies). Associations between these SNPs and clinical parameters were investigated. The phenotypes evidently differed between men and women. In men, higher fasting glucose and HbA1c values were observed in the +3056C/C minor homozygotes without leptin or insulin accumulation. The +408C -- +3056C haplotype was more frequent in the diabetic subgroup, in which diagnosis was based on fasting glucose, 75gOGTT, and HbA1c values, than normal subgroup. In contrast, in women, a significant correlation was observed between fat metabolism and obesity. The −1062C/C minor homozygotes had higher values of C-peptide, insulin, total and visceral fat area, waist circumference and BMI. The 72Met/Met minor homozygotes showed reduced leptin, total, HDL and LDL cholesterol concentrations and increased value of visceral fat area. Further, in the other SNPs, the minor homozygotes showed a similar trend, and the heterozygotes had intermediate values. Preproghrelin gene polymorphisms in obese Japanese may be predisposing factors to diabetes mellitus in men and to obesity via aberrant fat metabolism in women.
BACKGROUND: Large errors may occur when predicting basal metabolic rate (BMR) based on physical characteristics in obese people. In addition, the contribution of abdominal visceral fat to BMR remains controversial. This study examined the accuracy of several predictive equations for BMR and the contribution of abdominal fat distribution to BMR in obese Japanese participants in the Saku Control Obesity Program (SCOP). METHODS: BMR was determined using a mask and Douglas bag in adult males (n = 12) and females (n = 11). We measured abdominal subcutaneous and visceral fat areas using computerized tomography.RESULTS: All the equations, with the exception of Bernstein’s, overestimated BMR in obese males. Some equations, including the Japan-Dietary Reference Intakes and the Food and Agriculture Organization of the United Nations/World Health Organization/United Nations University (FAO/WHO/UNU) equations, overestimated BMR in obese females, while the Harris-Benedict and Henry equations provided relatively accurate predictions of BMR in obese females. We found no correlation between abdominal visceral fat area and BMR when adjusted for sex, fat-free mass, and abdominal subcutaneous fat area (partial r =−0.022). Abdominal subcutaneous fat area correlated significantly with BMR when adjusted for sex, fat-free mass, and abdominal visceral fat area (partial r = 0.732), although this correlation was no longer significant after adjustment for total fat mass (partial r = 0.266).CONCLUSIONS: In obese Japanese subjects, most the predictive equations overestimated BMR in males, whereas some equations were relatively accurate for females. Our findings indicate abdominal fat distribution may not be independently related with BMR.
A reduction in adiposity may be associated with an improvement in insulin sensitivity and β-cell function as well as cardiovascular disease (CVD) risk factors; however, few studies have investigated these associations in a longitudinal setting.
To investigate these associations over a 1-year period, we conducted an observational analysis of 196 Japanese subjects with obesity in the Saku Control Obesity Program. We investigated the relations between changes in adiposity (body mass index [BMI], waist circumference, subcutaneous fat area [SFAT], and visceral fat area [VFAT]) and changes in HbA1c, fasting plasma glucose (FPG), insulin sensitivity index (ISI), the homeostasis model assessment β cell function (HOMA-β), lipids, and blood pressure.
All adiposity changes were positively associated with HbA1c and FPG changes. Reductions in BMI and VFAT were associated with HOMA-β reduction. Reductions in all adiposity measures were associated with an improvement in the ISI. Changes in most adiposity measures were positively associated with changes in blood pressure and lipid levels, except for LDL.
The present findings provide additional supportive evidence indicating that a reduction in adiposity may lead to an improvement in insulin sensitivity and the reduction of CVD risk factors in obese individuals.
Preproghrelin gene single-nucleotide polymorphisms are possible predisposing factors to obesity and other metabolic syndromes. To study the correlation between genotypes and obesity, we recruited 117 obese Japanese women (BMI, 25.0-41.1; average, 31.1). Minor homozygotes for 5 preproghrelin gene polymorphisms, namely, -1500C>G (rs3755777), -1062G>C (rs26311), -994C>T (rs26312) (promoter region), Leu72Met (rs696217) (exon 2), and +3056T>C (rs2075356) (intron 2), had high values of total and visceral fat areas, waist circumference, and BMI, indicating significant correlation of the polymorphisms with obesity and fat metabolism. Here, we studied the relationship between the genotypes and dietary tendency. Self-administered Diet History Questionnaire showed that total food intake, sugar, and dairy product intake were low in +3056C/C women. Their energy, protein, fat, and meat intake was also low. Energy balance calculation showed considerably reduced fat and protein consumption. Dietary habits were surveyed using Sakata's Questionnaire on Eating Behavior. Of the genotypes, -1062C/C women showed low scores for "motivation for eating" and "eating because of stress or something else." Thus, surprisingly, it was revealed that minor homozygotes for preproghrelin gene polymorphisms were light eaters, did not prefer fat or protein, and apparently had a poor appetite, although they were predisposed to obesity.
This study evaluated effects of a behavioral approach which placed emphasis on tailored behavior counseling, diet, weight loss and weight maintenance. A one-year randomized controlled trial was conducted among 235 overweight/obese adults in Japan. The intervention group (n=119) received individual-based counseling using a behavioral approach and the changes made in the diet and physical activity were dependent on each participant as much as possible. One year later, the intervention group lost significantly more weight than the control group (-5.0 kg vs. 0.1 kg for men and -3.9 kg vs. -0.2 kg for women). Compared to the control group, the male intervention group reduced overall energy, cereals and dairy products consumption significantly, while increasing green and yellow vegetable intake, and the female intervention group significantly reduced intake of dairy products. Regarding behaviors, both male and female intervention groups increased the number of walking steps and women improved their irregular eating habits compared to those in the control groups. Behavior changes were related to weight loss; participants who maintained the action/maintenance stage or moved to later stages lost significantly more weight than participants who remained in the pre-contemplation/contemplation/preparation stages or regressed to earlier stages. After one-year follow-up, the intervention group maintained significantly lower weights, lower energy intakes and improvements in irregular eating habits. Our behavioral approach led to diet and behavior modification, weight loss and maintenance. Because modified variables differed between men and women, gender-specific approaches may be necessary.
The objective of the present study was to investigate the relationship between the indices of body size such as BMI, fat-free mass index (FFMI, FFM/height2), fat mass index (FMI, FM/height2), and body fat percentage (%BF), and physical activities assessed by the doubly-labelled water (DLW) method and an accelerometer in free-living Japanese adult women. We conducted a cross-sectional study in 100 female subjects ranging in age from 31 to 69 years. Subjects were classified in quartiles of BMI, FFMI, FMI and %BF. Daily walking steps and the duration of light to vigorous physical activity were simultaneously assessed by an accelerometer for the same period as the DLW experiment. Only physical activity-related energy expenditure (PAEE)/FFM and PAEE/body weight (BW) decreased in the highest quartile of BMI. Physical activity level, PAEE/FFM and PAEE/BW decreased in the highest quartile of FMI and %BF, whereas they were not different among quartiles of FFMI. Daily walking steps and the duration of moderate- and vigorous-intensity physical activities decreased or tended to decrease in the highest quartile of FMI and %BF, but did not differ among quartiles of FFMI and BMI. These results clearly showed that Japanese adult women with higher fat deposition obviously had a low level of physical activities assessed by both the DLW method and accelerometry, but those with larger BMI had lower PAEE/FFM and PAEE/BW only. Our data suggest that the relationship between obesity and daily physical activities should be discussed using not only BMI but also FMI or %BF.
The prevalence of diabetes is increasing globally. In addition to established risk factors for diabetes, such as diet, inactivity, overweight and obesity, the involvement of persistent organic pollutants, including dioxins and polychlorinated biphenyls (PCBs), has also been suggested to be a possible, but controversial, cause of this epidemic. The present study investigated the association between blood PCB congener levels and the prevalence of diabetes among middle-aged, overweight and obese Japanese participants in the Saku Control Obesity Program. One hundred seventeen participants had their congener-specific PCB levels measured in addition to undergoing routine blood analyses at the time of a medical checkup. Prevalent diabetes was defined according to two methods: definite diabetes was defined as people with an HbA1c level ≥ 6.9% or who were taking medication for diabetes, and all diabetes was defined as people with an HbA1c level ≥ 6.5%, a fasting plasma glucose level ≥ 126 mg/dL, or a history of doctor-diagnosed diabetes. A multiple logistic regression analysis was performed to analyze the association between the PCB levels and the prevalence of diabetes, with adjustments for sex, age, body mass index and total lipids. As a result, PCB 146 and 180 were positively associated and PCB 163/164 and 170 were negatively associated with the prevalence of definite diabetes. The significance of the association of PCB 180 and 163/164 with the prevalence of diabetes persisted regardless of the definition of diabetes or adjustments for total lipids, suggesting the possibility that these parameters may modify the risk of diabetes.
BACKGROUND: Long-term weight loss is difficult to maintain, but recently cognitive behavioral therapy has been shown to be effective for long-term weight loss and maintenance. METHODS: The 119 participants, who had been assigned to program to lose weight, were interviewed by dieticians regarding their motivation for weight loss and psychological status and self-corrected problems with their eating activities and exercises, following recognition of problems, discussing solutions, and devising personal dietary plans and exercise plan to loose weight at 1.0-2.0 kg per month. RESULTS: In women, the prevalence of motivation to resolve the situation (n = 44, 84.6%) was significantly higher than that of men (n = 33, 67.3%; p < 0.05). In men, awareness of the need to keep healthy by oneself was significantly associated with the motivation to resolve the situation (p = 0.002) and the availability of support from others (p = 0.004). Thirty problems and 29 dietary goals were set by participants. The percentages of intake of alcohol (p < 0.05) and intake of sweets (p < 0.01) as the problems and decrease of intake in specified foods (p < 0.01) and snacks (p = 0.05) as dietary goals were significantly different between men and women. Women with BMI over 31 kg/m 2 set fewer additional steps as exercise goals than those with BMI under 29 kg/m 2 (p < 0.05). CONCLUSIONS: The characters of subjects such as psychological status and the problems and the target recognized by participants were different between gender and the degree of obesity.
The aim of this study was to describe the 20-year changes in body mass index (BMI; kgm(-2)) and the prevalence of overweight in Japanese adults. Cross-sectional annual nationwide surveys (National Nutrition Survey, Japan) were carried out with a large probability sample of the Japanese population. Data sets of the 1976-95 surveys, comprising 91983 men and 120822 women (> or =20 years of age), were used. The analyses were carried out in age and gender groups, and by residential area according to the size of the municipality (metropolitan areas, cities and small towns). The mean BMI increaseed in men with an increment of +0.44 kg m(-2) 10 years(-1) and slightly decreased in women, by -0.09 kg m(-2) 10 years(-1), after adjustment for age. A decreasing trend of mean BMI was most significant in the female 20-29 years age-group (-0.38 kg m(-2) 10 years(-1)), in contrast to an increasing trend observed in elderly women (60-69 and 70+ years age-groups). The prevalence of preobese (BMI: 25-29.9kg m(-2)) and obese (BMI > or = 30 kg m(-2)) men increased from 14.5% and 0.8%, respectively, in the time-period 1976-80 to 20.5% and 2.01% during 1991-95. The increasing trend was most evident in the youngest age-group (20-29 years) and in those from small towns. The overall prevalence of preobese and obese women did not change during the 20-year study period. The prevalence in younger women decreased, this trend being more prominent in metropolitan areas. Although the prevalence of overweight (BMI > or =25 kg m(-2)) in Japanese men and elderly women has increased in the last 20 years, the mean BMI in younger women, especially those in metropolitan areas, has decreased. A population approach to control obesity and prevent obesity-associated diseases should be mainly focused on men and women older than 40 years of age.