Updated on 2022/12/01

写真a

 
NAKAMURA Kazutoshi
 
Organization
Academic Assembly Institute of Medicine and Dentistry IGAKU KEIRETU Professor
Faculty of Medicine School of Medicine Professor
Graduate School of Medical and Dental Sciences Community Disease Control Community Preventive Medicine Professor
Title
Professor
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Degree

  • 医学博士 ( 1994.3   福島県立医科大学 )

  • 公衆衛生学修士 ( 1992.12   ミシガン大学 )

Research Interests

  • 疫学

  • 予防医学

  • Epidemiology

  • Preventive Medicine

Research Areas

  • Life Science / Hygiene and public health (non-laboratory)

  • Life Science / Hygiene and public health (laboratory)

Research History (researchmap)

  • Niigata University   Graduate School of Medical and Dental Sciences   Professor

    2011

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  • Niigata University Graduate School of Medical and Dental Sciences, Course of Community Disease Control, Department of Community Preventive Medicine, Dvision of Social and Environmental Medicine   Professor

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Research History

  • Niigata University   Graduate School of Medical and Dental Sciences Community Disease Control Community Preventive Medicine   Professor

    2011.1

  • Niigata University   Faculty of Medicine School of Medicine   Professor

    2011.1

  • Niigata University   Graduate School of Medical and Dental Sciences Community Disease Control   Associate Professor

    2004.4 - 2010.12

  • Niigata University   Faculty of Medicine   Research Assistant

    1996.4 - 2000.3

Professional Memberships

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Committee Memberships

  • 衛生学会   評議員  

       

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    Committee type:Academic society

    衛生学会

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Papers

  • Leisure-Time and Non-Leisure-Time Physical Activities are Dose-Dependently Associated With a Reduced Risk of Dementia in Community-Dwelling People Aged 40-74 Years: The Murakami Cohort Study. International journal

    Kaori Kitamura, Yumi Watanabe, Keiko Kabasawa, Akemi Takahashi, Toshiko Saito, Ryosaku Kobayashi, Ribeka Takachi, Rieko Oshiki, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki, Kei Watanabe, Kazutoshi Nakamura

    Journal of the American Medical Directors Association   23 ( 7 )   1197 - 1204   2022.7

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    OBJECTIVE: Although physical activity (PA) in late life is considered a preventive factor for dementia, effects of different types of PAs on the development of dementia in early old age are unclear. This study aimed to determine the effect of leisure-time and non-leisure-time PAs on dementia risk in middle-aged and older adults during an 8-year follow-up. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Participants were 13,773 community-dwelling individuals aged 40-74 years who completed the baseline self-administered questionnaire survey of the Murakami cohort study in 2011-2013. METHODS: Main predictors were leisure-time and non-leisure-time (commute, occupational work, and housework) PAs as assessed by MET score (MET-hour/d). The outcome was newly developed dementia determined using a long-term care insurance database. Covariates included demographics, lifestyle, body size, disease history, and PA level. Hazard ratios (HRs) were calculated using Cox proportional hazards models. RESULTS: Mean age of participants was 59.0 (SD 9.3) years. Higher levels of leisure-time PA were associated with lower HRs (adjusted P for trend <.001), with all tertiles having significantly lower HRs (low: 0.71, 95% CI 0.51-0.99; medium: 0.59, 95% CI 0.43-0.81; high: 0.55, 95% CI 0.41-0.75) relative to the reference (zero). Higher quartiles of non-leisure-time PA were associated with lower adjusted HRs for dementia (adjusted P for trend < .001), with the second-fourth quartiles having significantly lower HRs (second: 0.73, 95% CI 0.54-0.98; third: 0.59, 95% CI 0.43-0.81; fourth: 0.55, 95% CI 0.41-0.75) relative to the lowest quartile. These associations were robust regardless of sex and age group. CONCLUSIONS AND IMPLICATIONS: Both leisure-time and non-leisure-time PAs are independently and robustly associated with a reduced risk of dementia.

    DOI: 10.1016/j.jamda.2022.01.053

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  • Association between Sarcopenia and Depressive Symptoms in Community-Dwelling People Aged 40 Years and Older.

    Alena Zakharova, Keiko Kabasawa, Yumi Ito, Junta Tanaka, Aya Hinata, Kaori Kitamura, Yumi Watanabe, Shoichiro Tsugane, Kazutoshi Nakamura, Ichiei Narita

    The Tohoku journal of experimental medicine   257 ( 2 )   117 - 125   2022.6

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    Several studies have reported an association between sarcopenia and depression. Their results, however, are inconsistent, partly due to small sample sizes and lack of consideration of important confounders. The present study aimed to cross-sectionally examine this association in community-dwelling people in Japan. This study used baseline data from the Yuzawa cohort study (age ≥ 40 years), with the final analysis population comprising 2,466 participants. A self-administered questionnaire was used to elicit information related to sarcopenia, depressive symptoms, demographic characteristics, anthropometrics, disease history, and lifestyles. Sarcopenia was diagnosed using SARC-F, a validated questionnaire including components of Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falls. Depressive symptoms were assessed using the 11-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). For depressive symptoms, prevalence ratios (PRs) were calculated, and odds ratio (ORs) were obtained using simple and multiple logistic regression analyses. Mean age of participants was 61.7 years (standard deviation = 11.8), and 10.5% and 34.7% had sarcopenia and depressive symptoms, respectively. Sarcopenic individuals had a significantly higher PR (2.00), unadjusted OR (3.67), and adjusted OR (4.96) compared to non-sarcopenic individuals, with an estimated adjusted PR of 2.7. There was a significant dose-dependent association between SARC-F scores and depressive symptoms in sarcopenic individuals (adjusted P for trend = 0.0028). In conclusion, sarcopenia and depressive symptoms were robustly associated in community-dwelling, middle-aged and older people in Japan. However, the direction of this association is unclear, and a future cohort study will be needed to determine causality.

    DOI: 10.1620/tjem.2022.J024

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  • Secular changes in bone mineral density of adult Japanese women from 1995 to 2013.

    Hiroaki Watanabe, Yasuko Minagawa, Ichiro Suzuki, Kaori Kitamura, Yumi Watanabe, Keiko Kabasawa, Kseniia Platonova, Aya Hinata, Kazutoshi Nakamura

    Fukushima journal of medical science   67 ( 3 )   128 - 134   2021.12

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    INTRODUCTION: Secular changes in hip fracture incidence have been reported in the last few decades in Japan, but whether long-term bone mineral density (BMD) is also changing is unclear. This study aimed to determine whether BMD of Japanese women has changed over time. METHODS: Subjects were 10,649 adult women who underwent BMD measurement in a health check-up population in Niigata, Japan, between 1995 and 2013. BMD of the distal, non-dominant forearm was measured by dual-energy X-ray absorptiometry. Demographic information and BMI were also obtained. Secular trends were determined by linear regression analysis. RESULTS: BMD of subjects in their 40's decreased significantly in the age-adjusted model (P for trend=0.0162), but not in the age- and BMI-adjusted model (P for trend=0.2171). BMD of subjects in their 50's decreased marginally in the age-adjusted model (P for trend=0.0535), but not in the age- and BMI-adjusted model (P for trend=0.6601). BMDs of subjects in their 30's and 60's did not significantly change, while BMIs of subjects in their 40's-60's decreased significantly. CONCLUSIONS: A secular decrease in BMD, partly attributed to decreases in BMI, was observed in middle-aged Japanese women from 1995 to 2013. Measures to help maintain suitable BMI will be necessary to prevent a decrease in BMD among women.

    DOI: 10.5387/fms.2021-10

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  • Serum 25-hydroxyvitamin D levels are not associated with impaired postural sway in community-dwelling older women: a 6-year follow-up study. International journal

    Kazutoshi Nakamura, Toshiko Saito, Akemi Takahashi, Ryosaku Kobayashi, Rieko Oshiki, Kaori Kitamura, Yumi Watanabe

    Journal of musculoskeletal & neuronal interactions   21 ( 4 )   501 - 508   2021.12

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    OBJECTIVES: A positive association between levels of blood 25-hydroxyvitamin D (25[OH]D), an index of vitamin D status, and physical balance has been reported from cross-sectional studies, but longitudinal studies are rare. The present study aimed to test the hypothesis that low serum 25(OH)D levels are longitudinally associated with impaired postural sway over a 6-year follow-up period in older women. METHODS: The present cohort consisted of 392 community-dwelling Japanese women aged ≥69 years. Baseline examinations included serum 25(OH)D and physical performance tests, including postural sway velocity. Standing postural sway was evaluated by measuring gravity-center sway velocity. Follow-up physical performance tests were conducted 6 years later. RESULTS: Mean subject age and serum 25(OH)D levels were 73.3 years (SD 3.7) and 61.0 nmol/L (SD 16.9), respectively. No significant association was found between 25(OH)D levels and changes in postural sway velocity (adjusted P for trend=0.72). Women with 25(OH)D <30 nmol/L tended to have lower Δpostural sway velocity than those with 25(OH)D ≥30 nmol/L (mean, -0.59 vs 0.37 cm/s, respectively; adjusted P=0.13). CONCLUSIONS: Vitamin D levels are not longitudinally associated with impaired postural sway in older women. Further longitudinal studies are needed to corroborate the results of this study.

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  • Short daytime napping reduces the risk of cognitive decline in community-dwelling older adults: a 5-year longitudinal study

    Kaori Kitamura, Yumi Watanabe, Kazutoshi Nakamura, Chikako Takano, Naomi Hayashi, Hisami Sato, Toshiyuki Someya

    BMC Geriatrics   21 ( 1 )   2021.12

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    <title>Abstract</title><sec>
    <title>Background</title>
    Beneficial effects of napping on cognition have been suggested in cross-sectional studies. This study aimed to clarify longitudinal associations between cognitive decline and sleep characteristics, particularly daytime napping, over a 5-year period in older adults.


    </sec><sec>
    <title>Methods</title>
    Study participants were 389 community-dwelling individuals aged ≥65 years living in Ojiya City, Niigata, Japan. Baseline and follow-up examinations were conducted in 2011–2013 and 2016–2018, respectively. Trained nurses visited and interviewed participants to collect the following information at baseline and follow-up: demographic characteristics, disease history, lifestyle habits including bedtime, sleeping hours, and daytime nap duration, and cognitive function. The assessment of cognitive function was performed using the revised Hasegawa’s dementia scale (HDS-R), with cognitive decline defined as a change in the HDS-R of ≤ − 3 over 5 years. Odds ratios (ORs) for cognitive decline were calculated using multiple logistic regression analysis.


    </sec><sec>
    <title>Results</title>
    Mean age of participants was 74.6 years (SD 6.4), and the cumulative incidence of cognitive decline was 106/389 (27.3%). The adjusted OR for 1–29 min daytime napping was significantly lower compared to that for no napping (OR = 0.47, 95%CI: 0.23–0.96). Earlier bedtime was associated with cognitive decline (adjusted P for trend = 0.0480).


    </sec><sec>
    <title>Conclusion</title>
    Short daytime napping (&lt; 30 min) reduces the risk of cognitive decline over 5 years for community-dwelling older people. A future study will be necessary to confirm the effect of short napping on the reduction of risk for clinically diagnosed dementia.


    </sec>

    DOI: 10.1186/s12877-021-02418-0

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    Other Link: https://link.springer.com/article/10.1186/s12877-021-02418-0/fulltext.html

  • Education, household income, and depressive symptoms in middle-aged and older Japanese adults. International journal

    Aya Hinata, Keiko Kabasawa, Yumi Watanabe, Kaori Kitamura, Yumi Ito, Ribeka Takachi, Shoichiro Tsugane, Junta Tanaka, Ayako Sasaki, Ichiei Narita, Kazutoshi Nakamura

    BMC public health   21 ( 1 )   2120 - 2120   2021.11

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    BACKGROUND: Income inequality has dramatically increased worldwide, and there is a need to re-evaluate the association between socio-economic status (SES) and depression. Relative contributions of household income and education to depression, as well as their interactions, have not been fully evaluated. This study aimed to examine the association between SES and depressive symptoms in Japanese adults, focusing on interactions between education and household income levels. METHODS: This cross-sectional study used data from baseline surveys of two cohort studies. Participants were 38,499 community-dwelling people aged 40-74 years who participated in baseline surveys of the Murakami cohort study (2011-2012) and Uonuma cohort study (2012-2015) conducted in Niigata Prefecture, Japan. Information regarding marital status, education level, household income, occupation, activities of daily living (ADL), and history of cancer, myocardial infarction, stroke, and diabetes was obtained using a self-administered questionnaire. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression analysis was used to obtain odds ratios (ORs). Covariates included age, sex, marital status, education, household income, occupation, ADL, and disease history. RESULTS: Individuals with higher education levels had lower ORs (adjusted P for trend = 0.0007) for depressive symptoms, independently of household income level. The OR of the university-or-higher group was significantly lower than that of the junior high school group (adjusted OR = 0.79). Individuals with lower household income levels had higher ORs (adjusted P for trend< 0.0001) for depressive symptoms, independently of education level. The type of occupation was not associated with depressive symptoms. In subgroup analyses according to household income level, individuals with higher education levels had significantly lower ORs in the lowest- and lower-income groups (adjusted P for trend = 0.0275 and 0.0123, respectively), but not in higher- and highest-income groups (0.5214 and 0.0915, respectively). CONCLUSIONS: Both education and household income levels are independently associated with the prevalence of depressive symptoms, with household income levels showing a more robust association with depressive symptoms than education levels. This suggests that a high household income level may offset the risk of depressive symptoms from having a low education level.

    DOI: 10.1186/s12889-021-12168-8

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  • Association of coffee, green tea, and caffeine with the risk of dementia in older Japanese people. International journal

    Nana Matsushita, Yuta Nakanishi, Yumi Watanabe, Kaori Kitamura, Keiko Kabasawa, Akemi Takahashi, Toshiko Saito, Ryosaku Kobayashi, Ribeka Takachi, Rieko Oshiki, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki, Kei Watanabe, Kazutoshi Nakamura

    Journal of the American Geriatrics Society   2021.10

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    OBJECTIVES: Coffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle-aged and older people. METHODS: This was a cohort study with an 8.0-year follow-up. Participants were community-dwelling individuals (n = 13,757) aged 40-74 years. A self-administered questionnaire survey was conducted in 2011-2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long-term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry. RESULTS: The number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend = 0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30-0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend = 0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2-2.9 cups/day and ≥3 cups/day of coffee had lower HRs (0.69, 95% CI: 0.48-0.98 and 0.53, 95% CI: 0.31-0.89, respectively) than those who consumed 0 cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend = 0.0146) only in the 60-69 years age subgroup. CONCLUSIONS: High levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose-dependent manner, especially in men. Moreover, coffee consumption of ≥3 cups/day was associated with a 50% reduction in dementia risk.

    DOI: 10.1111/jgs.17407

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  • Menstrual and reproductive factors and limitations in activities of daily living: A case-control study within the Japan Public Health Center-based Prospective Study. Reviewed International journal

    Kazutoshi Nakamura, Norie Sawada, Kaori Kitamura, Yumi Watanabe, Shoichiro Tsugane

    The journal of obstetrics and gynaecology research   47 ( 11 )   3903 - 3912   2021.9

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    AIM: Although menstrual/reproductive factors are known to be associated with physical disability, little is known about these associations in relation to activities of daily living (ADL). This study aimed to clarify associations between menstrual/reproductive factors and ADL limitations in peri- and postmenopausal women. STUDY DESIGN: A nested case-control study of the Japan Public Health Center-based Prospective (JPHC) Study. METHODS: The main outcome measure was self-reported ADL levels in the 10-year follow-up questionnaire survey of the JPHC Study conducted between 2000 and 2004 (N = 36 460). Women who "live inside almost independently, but go out with assistance" or had a lower level of activity were considered to have ADL limitations ("cases"), and all others served as controls. Candidate menstrual/reproductive predictors were as follows: menarcheal age, menopausal status, menopausal age, regularity of menses, menstrual cycle, number of pregnancies, age at first pregnancy, number of deliveries, age at first delivery, and breast feeding. Multiple logistic regression analyses were conducted, and odds ratios adjusted for age and past lifestyle were calculated. RESULTS: Mean ages of cases (N = 592) and controls (N = 38 656) were 68.3 (SD = 7.6) and 61.1 (SD = 7.7) years, respectively. With respect to menopausal age, groups aged <45 and ≥55 years had significantly higher adjusted ORs (1.44, 95% CI: 1.09-1.90 and 1.55, 95%CI: 1.09-2.18, respectively) than the reference group (50-54 years). Multiparous women had significantly lower ORs than nulliparous women. CONCLUSION: Our findings suggest that menopausal age and parity may predict future ADL limitations in women.

    DOI: 10.1111/jog.14959

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  • Body mass index and risk of recurrent falls in community-dwelling Japanese aged 40-74 years: The Murakami cohort study.

    Kazutoshi Nakamura, Kaori Kitamura, Yumi Watanabe, Keiko Kabasawa, Akemi Takahashi, Aya Hinata, Toshiko Saito, Ryosaku Kobayashi, Rieko Oshiki, Ribeka Takachi, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki, Kei Watanabe

    Geriatrics & gerontology international   21 ( 6 )   498 - 505   2021.6

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    AIMS: A prior meta-analysis found that obesity (body mass index [BMI] ≥ 30 kg/m2 ) was associated with a high fall risk, while being overweight (BMI≥25, <30 kg/m2 ) was associated with the lowest fall risk. However, whether these associations hold true for East Asians is unknown. This study aimed to assess the association between BMI and incidence of recurrent falls in Japanese aged 40-74 years. METHODS: This 5-year follow-up cohort study involved 7538 community-dwelling individuals who did not experience recurrent falls in the year before the baseline study. Information on demographics, body size, lifestyle, and disease history was obtained using a self-administered questionnaire. BMI was categorized as <18.5 (underweight), 18.5-20.6 (low-normal), 20.7-22.7 (mid-normal, reference), 22.8-24.9 (high-normal), and ≥ 25.0 kg/m2 (overweight). The outcome was recurrent falls reported, and fall history in the previous year was recorded as none, once, or twice or more (recurrent falls). RESULTS: Mean BMI was 23.5 kg/m2 (SD 2.9) for men and 22.7 kg/m2 (SD 3.2) for women. The adjusted odds ratio (OR) for recurrent falls in the BMI ≥25 group was significantly higher (1.41, 95%CI: 1.02-1.93) than that in the reference group. The adjusted OR in the BMI ≥25 group was significantly higher than that in the reference group for the age ≥ 60 subgroup (1.62, 95%CI: 1.09-2.40), but not for the age < 60 subgroup (OR = 1.04, 95%CI: 0.60-1.80). CONCLUSIONS: Being overweight may be a risk factor for recurrent falls in community-dwelling older Japanese. Further studies are needed to determine the underlying mechanism. Geriatr Gerontol Int 2021; 21: 498-505.

    DOI: 10.1111/ggi.14167

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  • Alterations in Glycerolipid and Fatty Acid Metabolic Pathways in Alzheimer's Disease Identified by Urinary Metabolic Profiling: A Pilot Study. Reviewed International journal

    Yumi Watanabe, Kensaku Kasuga, Takayoshi Tokutake, Kaori Kitamura, Takeshi Ikeuchi, Kazutoshi Nakamura

    Frontiers in neurology   12   719159 - 719159   2021

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    An easily accessible and non-invasive biomarker for the early detection of Alzheimer's disease (AD) is needed. Evidence suggests that metabolic dysfunction underlies the pathophysiology of AD. While urine is a non-invasively collectable biofluid and a good source for metabolomics analysis, it is not yet widely used for this purpose. This small-scale pilot study aimed to examine whether the metabolic profile of urine from AD patients reflects the metabolic dysfunction reported to underlie AD pathology, and to identify metabolites that could distinguish AD patients from cognitively healthy controls. Spot urine of 18 AD patients (AD group) and 18 age- and sex-matched, cognitively normal controls (control group) were analyzed by mass spectrometry (MS). Capillary electrophoresis time-of-flight MS and liquid chromatography-Fourier transform MS were used to cover a larger range of molecules with ionic as well as lipid characteristics. A total of 304 ionic molecules and 81 lipid compounds of 12 lipid classes were identified. Of these, 26 molecules showed significantly different relative concentrations between the AD and control groups (Wilcoxon's rank-sum test). Moreover, orthogonal partial least-squares discriminant analysis revealed significant discrimination between the two groups. Pathway searches using the KEGG database, and pathway enrichment and topology analysis using Metaboanalyst software, suggested alterations in molecules relevant to pathways of glycerolipid and glycerophospholipid metabolism, thermogenesis, and caffeine metabolism in AD patients. Further studies of urinary metabolites will contribute to the early detection of AD and understanding of its pathogenesis.

    DOI: 10.3389/fneur.2021.719159

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  • 地域在住高齢者の認知機能低下予防プログラムの開発

    北村 香織, 佐藤 久美, 林 直美, 渡邊 裕美, 中村 和利

    木村看護教育振興財団看護研究集録   ( 27 )   36 - 60   2020.11

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    Language:Japanese   Publisher:(公財)木村看護教育振興財団  

    地域高齢者の認知機能低下に関わる要因を明らかにするため、小千谷市の3地区に在住する高齢者で要支援・要介護認定を受けていない592名に面接調査を行い、その結果をもとに、科学的根拠に基づく認知機能低下予防プログラムを開発した。同プログラムを用いて認知機能低下予防教室を開催し、そのさい教育媒体として「生活習慣チェック用紙」を使用するとともに、面談時に「K10調査票」を用いてストレスの評価を行うこととした。さらに、教室終了後に面談結果をスタッフ間で検討することでハイリスク者を抽出し、個別支援を継続的に実施することとした。

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  • Predictors of decline in vitamin D status in middle-aged and elderly individuals: a 5-year follow-up study. Reviewed International journal

    Kazutoshi Nakamura, Kaori Kitamura, Yumi Watanabe, Toshiko Saito, Akemi Takahashi, Ryosaku Kobayashi, Rieko Oshiki, Keiko Kabasawa, Ribeka Takachi, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Kei Watanabe

    The British journal of nutrition   1 - 7   2020.5

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    Little is known about predictors of decline in vitamin D status (vitamin D decline) over time. We aimed to determine demographic and lifestyle variables associated with vitamin D decline by sufficiently controlling for seasonal effects of vitamin D uptake in a middle-aged to elderly population. Using a longitudinal study design within the larger framework of the Murakami Cohort Study, we examined 1044 individuals aged between 40 and 74 years, who provided blood samples at baseline and at 5-year follow-up, the latter of which were taken on a date near the baseline examination (±14 d). Blood 25-hydroxyvitamin D (25(OH)D) concentrations were determined with the Liaison® 25OH Vitamin D Total Assay. A self-administered questionnaire collected demographic, body size and lifestyle information. Vitamin D decline was defined as the lowest tertile of 5-year changes in blood 25(OH)D (Δ25(OH)D) concentration (<6·7 nmol/l). Proportions of those with vitamin D decline were 182/438 (41·6 %) in men and 166/606 (27·4 %) in women (P < 0·0001). In men, risk of vitamin D decline was significantly lower in those with an outdoor occupation (P = 0·0099) and those with the highest quartile of metabolic equivalent score (OR 0·34; 95 % CI 0·14, 0·83), and higher in those with 'university or higher' levels of education (OR 2·92; 95 % CI 1·04, 8·19). In women, risk of vitamin D decline tended to be lower with higher levels of vitamin D intake (Pfor trend = 0·0651) and green tea consumption (Pfor trend = 0·0025). Predictors of vitamin D decline differ by sex, suggesting that a sex-dependent intervention may help to maintain long-term vitamin D levels.

    DOI: 10.1017/S0007114520001580

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  • Dietary calcium and vitamin K are associated with osteoporotic fracture risk in middle-aged and elderly Japanese women, but not men: the Murakami Cohort Study. Reviewed International journal

    Kseniia Platonova, Kaori Kitamura, Yumi Watanabe, Ribeka Takachi, Toshiko Saito, Keiko Kabasawa, Akemi Takahashi, Ryosaku Kobayashi, Rieko Oshiki, Aleksandr Solovev, Masayuki Iki, Shoichiro Tsugane, Ayako Sasaki, Osamu Yamazaki, Kei Watanabe, Kazutoshi Nakamura

    The British journal of nutrition   1 - 25   2020.5

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    Although dietary calcium, vitamin D, and vitamin K are nutritional factors associated with osteoporosis, little is known about their effects on incident osteoporotic fractures in East Asian populations. This study aimed to determine whether intakes of these nutrients predict incident osteoporotic fractures. We adopted a cohort-study design with a 5-year follow-up. Subjects were 12,794 community-dwelling individuals (6,301 men and 6,493 women) aged 40-74 years. Dietary intakes of calcium, vitamin D, and vitamin K were assessed with a validated food frequency questionnaire. Covariates were demographic and lifestyle factors. All incident cases of major osteoporotic limb fractures, including those of the distal forearm, neck of humerus, neck or trochanter of femur, and lumbar or thoracic spine were collected. Hazard ratios (HRs) for energy-adjusted calcium, vitamin D, and vitamin K were calculated with the residual method. Mean age was 58.8 years (SD=9.3). Lower energy-adjusted intakes of calcium and vitamin K in women were associated with higher adjusted HRs of total fractures (P for trend=0.005 and 0.08, respectively). When vertebral fracture was the outcome, P for trend values for calcium and vitamin K were 0.03 and 0.006, respectively, and HRs of the lowest and highest (reference) intake groups were 2.03 (95%CI:1.08-3.82) and 2.26 (95%CI:1.19-4.26), respectively. In men, there were null associations between incident fractures and each of the three nutrient intakes. Lower intakes of dietary calcium and vitamin K were independent, lifestyle-related risk factors for osteoporotic fracture in women but not men. These associations were robust for vertebral fractures, but not for limb fractures.

    DOI: 10.1017/S0007114520001567

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  • Total physical activity and risk of chronic low back and knee pain in middle-aged and elderly Japanese people: The Murakami cohort study. Reviewed International journal

    Aleksandr Solovev, Yumi Watanabe, Kaori Kitamura, Akemi Takahashi, Ryosaku Kobayashi, Toshiko Saito, Ribeka Takachi, Keiko Kabasawa, Rieko Oshiki, Kseniia Platonova, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki, Kei Watanabe, Kazutoshi Nakamura

    European journal of pain (London, England)   24 ( 4 )   863 - 872   2020.4

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    BACKGROUND: Specific components of physical activity, such as vigorous exercise and heavy occupational work, are known to increase the risk of chronic low back pain (CLBP) and chronic knee pain (CKP), but impacts of other components are less known. This study aimed to assess the relationship between total physical activity and risk of CLBP and CKP from a public health perspective. METHODS: Participants were 7,565 individuals, aged 40-74 years, who did not have CLBP or CKP, and who participated in the 5-year follow-up survey. A self-administered questionnaire was used to obtain information on demographics, body size and lifestyle (including physical activity) in the baseline survey in 2011-2013, and on CLBP and CKP using Short Form 36 (SF-36) in the follow-up survey. Sitting, standing, walking and strenuous work for occupational activity were assessed for total physical activity, and walking slowly, walking quickly, light to moderate exercise and strenuous exercise were assessed for leisure-time physical activity using metabolic equivalent hours/day (METs score). RESULTS: Mean age of participants was 60.1 years (SD, 8.8). Participants with higher METs scores had a significantly higher risk of CKP (p for trend = 0.0089, OR of 4th quartile = 1.29, 95% CI: 1.04-1.59 vs. 1st quartile), but not CLBP. An intermediate leisure-time METs score was associated with a lower risk of CLBP (OR = 0.75, 95%CI: 0.61-0.92 vs. 0 METs-group). CONCLUSIONS: A high level of total physical activity may increase the risk of CKP, whereas an intermediate level of leisure-time physical activity may decrease the risk of CLBP, in middle-aged and elderly individuals. SIGNIFICANCE: Evidence on the longitudinal association between total physical activity and CLBP and CKP in middle-aged and elderly people is lacking. We conducted a cohort study to assess this association, and found that high levels of total physical activity increased risk of CKP, and intermediate levels of leisure-time physical activity decreased risk of CLBP. This suggests that the effect of physical activity on chronic pain differed by pain site.

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  • Psychological distress as a risk factor for dementia after the 2004 Niigata-Chuetsu earthquake in Japan. Reviewed International journal

    Kazutoshi Nakamura, Yumi Watanabe, Kaori Kitamura, Keiko Kabasawa, Toshiyuki Someya

    Journal of affective disorders   259   121 - 127   2019.12

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    BACKGROUND: A large earthquake can cause extreme stress and may adversely affect cognitive function in humans. We aimed to examine a possible association between psychological distress and incident dementia after the 2004 Niigata-Chuetsu earthquake in Japan. METHODS: This is a retrospective cohort study followed participants for 10-12 years. Subjects were 6,012 residents in 2005, 5,424 in 2006, and 5,687 in 2007 (age ≥40 years) living in Ojiya city who participated in the annual health check examinations after the 2004 Niigata-Chuetsu earthquake. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10), and individuals with a K10 score ≥10 were considered to have psychological distress. Incident dementia cases were identified from a long-term care insurance database of the local government during the follow-up period. We evaluated hazard ratios (HRs) of psychological distress for incident dementia in each year, unadjusted and adjusted for covariates, including sex, age, occupation, BMI, and property damage of residential area. RESULTS: The average age of the subjects was 64.6 years in 2005, 64.6 in 2006, and 65.2 in 2007. Adjusted HRs were significantly higher (HR = 1.20-1.66) in the psychological distress group than in the reference group in each year. In particular, adjusted HR was high (HR = 2.89) in those with psychological distress in all three years (2005-2007). CONCLUSION: Psychological distress, especially persistent distress, is a risk factor for incident dementia in victims of large disasters.

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  • Modifiable factors associated with symptomatic knee osteoarthritis: The Murakami cohort study. Reviewed International journal

    Ryoya Takiguchi, Rintaro Komatsu, Kaori Kitamura, Yumi Watanabe, Akemi Takahashi, Ryosaku Kobayashi, Rieko Oshiki, Toshiko Saito, Keiko Kabasawa, Ribeka Takachi, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki, Kazutoshi Nakamura

    Maturitas   128   53 - 59   2019.10

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    OBJECTIVES: Modifiable risk factors for knee osteoarthritis (OA) have not been studied in detail. This study aimed to determine lifestyle-related modifiable factors of symptomatic knee osteoarthritis in an East Asian population. STUDY DESIGN: This 5-year cohort study involved 11,091 individuals (age range 40-72 years) living in the Murakami region of Niigata, Japan, who did not have a history of knee OA. At baseline, information on sociodemographic characteristics, body size, lifestyle, and living condition was obtained using a self-administered questionnaire. MAIN OUTCOME MEASURES: Incident symptomatic knee OA observed at hospitals and orthopaedic clinics in the five years to 2016. Clinical grades of knee OA were based on the Kellgren-Lawrence scale. P for trend was assessed to examine linear associations between predictors and the outcome in multiple logistic regression analysis. RESULTS: The mean age of participants was 58.1 (SD 9.3) years. The number of cases of grade 2 or more incident knee OA was 429. In men, older age (P for trend < 0.0001), higher BMI (P for trend < 0.0001), higher METs score (P for trend = 0.0150), less smoking (P for trend = 0.0249), and lower green tea consumption (P for trend = 0.0437) were associated with incident knee OA. In women, older age (P for trend < 0.0001), higher BMI (P for trend < 0.0001), and alcohol consumption (P = 0.0153) were associated with incident knee OA. CONCLUSIONS: Several lifestyle-related factors were found to be associated with incident knee OA and exhibited sex-dependent differences. In particular, higher consumption of green tea was associated with a lower incidence of knee OA in men.

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  • Low serum 25-hydroxyvitamin D is associated with low grip strength in an older Japanese population. Reviewed

    Kitsu T, Kabasawa K, Ito Y, Kitamura K, Watanabe Y, Tanaka J, Nakamura K, Narita I

    Journal of bone and mineral metabolism   2019.8

  • Physical activity modifies the effect of calcium supplements on bone loss in perimenopausal and postmenopausal women: subgroup analysis of a randomized controlled trial. Reviewed

    Nakamura K, Saito T, Kobayashi R, Oshiki R, Kitamura K, Watanabe Y

    Archives of osteoporosis   14 ( 1 )   17   2019.2

  • Molecular Network Analysis of the Urinary Proteome of Alzheimer's Disease Patients. Reviewed

    Watanabe Y, Hirao Y, Kasuga K, Tokutake T, Semizu Y, Kitamura K, Ikeuchi T, Nakamura K, Yamamoto T

    Dementia and geriatric cognitive disorders extra   9 ( 1 )   53 - 65   2019.1

  • Food frequency questionnaire reproducibility for middle-aged and elderly Japanese. Reviewed International journal

    Koutatsu Maruyama, Ai Ikeda, Junko Ishihara, Ribeka Takachi, Norie Sawada, Taichi Shimazu, Kazutoshi Nakamura, Junta Tanaka, Taiki Yamaji, Motoki Iwasaki, Hiroyasu Iso, Shoichiro Tsugane

    Asia Pacific journal of clinical nutrition   28 ( 2 )   362 - 370   2019

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    BACKGROUND AND OBJECTIVES: The aim of this study was to examine the reproducibility of a self-administered food frequency questionnaire (FFQ) originally developed for the Japan Public Health Center-Based Prospective Study (JPHC study) and modified for use in the Next Generation (JPHC-NEXT) study. METHODS AND STUDY DESIGN: Participants included 98 men and 142 women aged 40-74 years from the five areas included in the JPHCNEXT protocol. In November 2012, participants were recruited and asked to complete the first nutrition survey. The second nutrition survey was completed after 1 year. RESULTS: We estimated daily energy as well as 53 nutrient and 29 food group intakes using the FFQ. To assess reproducibility, we calculated Spearman correlation coefficients between both FFQs, which showed mostly intermediate-to-high values. Median (range) correlation coefficients and quartile distribution in the same and adjacent categories for energy-adjusted nutrient intakes were 0.55 (0.42-0.84) and 84.7% (76.5%-98.0%) in men and 0.54 (0.35-0.80) and 84.5% (76.1%-94.4%) in women. The respective values for energy-adjusted food group intakes in men and women were also mostly intermediate to high: 0.54 (0.39-0.79) and 83.7% (75.5%-90.8%) in men and 0.57 (0.40-0.83) and 84.5% (77.5%-93.7%) in women. CONCLUSIONS: The FFQ developed for the JPHC-NEXT study has reasonable reproducibility. Because this FFQ has also been validated in a previous study, it can be considered a useful dietary assessment tool to examine associations between dietary consumption and lifestyle-related diseases.

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  • Menstrual and reproductive factors and risk of vertebral fractures in Japanese women: the Japan Public Health Center-based prospective (JPHC) study. Reviewed

    Shimizu Y, Sawada N, Nakamura K, Watanabe Y, Kitamura K, Iwasaki M, Tsugane S, JPHC Study group

    Osteoporos Int   2018.8

  • The Murakami Cohort Study of vitamin D for the prevention of musculoskeletal and other age-related diseases: A study protocol Reviewed

    Kazutoshi Nakamura, Ribeka Takachi, Kaori Kitamura, Toshiko Saito, Ryosaku Kobayashi, Rieko Oshiki, Yumi Watanabe, Keiko Kabasawa, Akemi Takahashi, Shoichiro Tsugane, Masayuki Iki, Ayako Sasaki, Osamu Yamazaki

    Environmental Health and Preventive Medicine   23 ( 1 )   28   2018.6

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    Background: Age-related musculoskeletal diseases are becoming increasingly burdensome in terms of both individual quality of life and medical cost. We intended to establish a large population-based cohort study to determine environmental, lifestyle, and genetic risk factors of musculoskeletal and other age-related diseases, and to clarify the association between vitamin D status and such diseases. Methods: We targeted 34,802 residents aged 40-74 years living in areas of northern Niigata Prefecture, including Sekikawa Village, Awashimaura Village, and Murakami City (Murakami region). The baseline questionnaire survey, conducted between 2011 and 2013, queried respondents on their lifestyle and environmental factors (predictors), and self-reported outcomes. Plasma 25-hydroxyvitamin D (25[OH]D) concentration, an indicator of vitamin D status, was determined with the Liaison® 25OH Vitamin D Total Assay. The primary outcome of this study was osteoporotic fracture
    other outcomes included age-related diseases including knee osteoarthritis, perception of chronic pain, dementia, and long-term care insurance use. Mean ages of men and women were 59.2 (SD = 9.3, N = 6907) and 59.0 (SD = 9.3, N = 7457) years, respectively. From the blood samples provided by 3710 men and 4787 women, mean 25(OH)D concentrations were 56.5 (SD = 18.4) nmol/L (22.6 ng/mL) and 45.4 (SD = 16.5) nmol/L (18.2 ng/mL), respectively. Discussion: Follow-up surveys are planned every 5 years for 15 years, and incident cases of our targeted diseases will be followed at hospitals and clinics in and nearby the cohort area. We anticipate that we will be able to clarify the association between vitamin D status and multiple disease outcomes in a Japanese population.

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  • Low serum 25-hydroxyvitamin D increases cognitive impairment in elderly people. Reviewed

    Sakuma M, Kitamura K, Endo N, Ikeuchi T, Yokoseki A, Onodera O, Oinuma T, Momotsu T, Sato K, Nakamura K, Narita I

    Journal of bone and mineral metabolism   2018.6

  • Effect of monitoring salt concentration of home-prepared dishes and using low-sodium seasonings on sodium intake reduction. Reviewed

    Nakadate M, Ishihara J, Iwasaki M, Kitamura K, Kato E, Tanaka J, Nakamura K, Ishihara T, Shintani A, Takachi R

    European journal of clinical nutrition   72 ( 10 )   1413 - 1420   2018.1

  • Epidemiological profiles of chronic low back and knee pain in middle-aged and elderly Japanese from the Murakami cohort. Reviewed

    Takahashi A, Kitamura K, Watanabe Y, Kobayashi R, Saito T, Takachi R, Kabasawa K, Oshiki R, Tsugane S, Iki M, Sasaki A, Yamazaki O, Nakamura K

    Journal of pain research   11   3161 - 3169   2018

  • Association between dialysis treatment and cognitive decline: A study from the Project in Sado for Total Health (PROST), Japan Reviewed

    Yumi Watanabe, Kaori Kitamura, Kazutoshi Nakamura, Kazuhiro Sanpei, Minako Wakasugi, Akio Yokoseki, Keiko Kabasawa, Osamu Onodera, Takeshi Ikeuchi, Ryozo Kuwano, Takeshi Momotsu, Ichici Narita, Naoto Endo

    GERIATRICS & GERONTOLOGY INTERNATIONAL   17 ( 10 )   1584 - 1587   2017.10

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    Aim: Evidence for the association between dialysis treatment and cognitive decline is limited. The present study aimed to determine whether dialysis treatment is associated with cognitive decline in adult outpatients of a general hospital in Japan.
    Methods: This was a cross-sectional substudy of the Project in Sado for Total Etealth (PROST). Total Etealth PROST targeted adult outpatients of a general hospital in Sado City, Niigata, Japan. Among 753 patients (mean age 68.1 11.6 years) analyzed, 66 received dialysis. Cognitive state was evaluated using the Mini-Mental State Examination, and those with a Mini-Mental State Examination score &lt;24 were considered "cognitively declined." The prevalence of cognitive decline was compared by odds ratios calculated with multiple logistic regression analysis. Variables included in the analyses were dialysis, age, sex and self-reported histories of hypertension, diabetes, stroke and ischemic heart disease.
    Results: Of the 66 dialysis patients, 24 (36.4%) showed cognitive decline, whereas 172 (25.0%) of 687 non-dialysis patients showed cognitive decline. The age and sex-adjusted odds ratio for cognitive decline in dialysis patients was 2.57 (95% confidence interval 1.43-4.61), relative to non-dialysis patients. The odds ratio remained significant (odds ratio 2.69, 95% confidence interval 1.49-4.88) even after adjusting for all covariates.
    Conclusion: The prevalence of cognitive decline was high in dialysis patients relative to non-dialysis patients among outpatients of a general hospital in Japan..

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  • Weight loss from 20 years of age is associated with cognitive impairment in middle-aged and elderly individuals Reviewed

    Kaori Kitamura, Yumi Watanabe, Kazutoshi Nakamura, Akemi Takahashi, Ribeka Takachi, Rieko Oshiki, Ryosaku Kobayashi, Toshiko Saito, Shoichiro Tsugane, Ayako Sasaki

    PLOS ONE   12 ( 10 )   e0185960   2017.10

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    Background
    Few empirical studies have been conducted to identify modifiable factors that may affect cognitive impairment in Japanese individuals. The present study aimed to clarify whether body mass and lifestyle are associated with cognitive impairment in Japanese middle-aged and elderly individuals.
    Methods
    Subjects were 1814 community-dwelling individuals aged 44-79 years, all of whom were participants of the Murakami Cohort Study baseline survey conducted in 2011-2013. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) in 2014-2016, and cognitive impairment, the outcome measure, was defined as an MMSE score &lt;24. Predictor variables were body mass index (BMI), long-term weight changes from 20 years of age, and lifestyle factors, such as smoking, drinking, and physical activity levels, which were obtained from a self-administered questionnaire in the baseline survey. Covariates were sex, age, education level, and histories of stroke and diabetes. Multiple logistic regression analysis was used to calculate the adjusted odds ratios (ORs).
    Results
    The prevalence of overall cognitive impairment was 6.2%. The adjusted ORs of cognitive impairment in the lowest (&lt;[-4] kg) (OR = 2.70, 95% CI, 1.18-6.20) and second ([-4]-[0] kg) (OR = 2.37, 95% CI, 1.04-5.37) quintiles for long-term weight change were significantly higher than the reference 4th quintile ([+4]-[+7] kg). The adjusted OR in the highest quintile &gt;=[+8] kg) was 2.24 (95% CI, 0.99-5.04). Current BMI was not associated with cognitive impairment.
    Conclusions
    Long-term weight loss is associated with cognitive impairment in Japanese middle-aged and elderly individuals. Because the present study was retrospective in nature, prospective studies should also be conducted for further characterization of this association.

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  • Online version of the self-administered food frequency questionnaire for the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT) protocol: Relative validity, usability, and comparison with a printed questionnaire Reviewed

    Erika Kato, Ribeka Takachi, Junko Ishihara, Yuri Ishii, Shizuka Sasazuki, Norie Sawada, Motoki Iwasaki, Yurie Shinozawa, Jun Umezawa, Junta Tanaka, Yuta Yokoyama, Kaori Kitamura, Kazutoshi Nakamura, Shoichiro Tsugane

    JOURNAL OF EPIDEMIOLOGY   27 ( 9 )   435 - 446   2017.9

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    Background: Online dietary assessment tools offer advantages over printed questionnaires, such as the automatic and direct data storage of answers, and have the potential to become valuable research methods. We developed an online survey system (web-FFQ) for the existing printed FFQ used in the JPHC-NEXT protocol, the platform of a large-scale genetic cohort study. Here, we examined the validity of ranking individuals according to dietary intake using this web-FFQ and its usability compared with the printed questionnaire (print-FFQ) for combined usage.
    Methods: We included 237 men and women aged 40-74 years from five areas specified in the JPHCNEXT protocol. From 2012 to 2013, participants were asked to provide 12-day weighed food records (12d-WFR) as the reference intake and to respond to the print-and web-FFQs. Spearman's correlation coefficients (CCs) between estimates using the web-FFQ and 12d-WFR were calculated. Crossclassification of intakes was compared with those using the print-FFQ.
    Results: Most participants (83%) answered that completing the web-FFQ was comparable to or easier than completing the printed questionnaire. The median value of CCs across energy and 53 nutrients for men and women was 0.47 (range, 0.10-0.86) and 0.46 (range, 0.16-0.69), respectively. CCs for individual nutrient intakes were closely similar to those based on the print-FFQ, irrespective of response location. Cross-classification by quintile of intake based on two FFQs was reasonably accurate for many nutrients and food groups.
    Conclusion: This online survey system is a reasonably valid measure for ranking individuals by intake for many nutrients, like the printed FFQ. Mixing of two FFQs for exposure assessments in epidemiological studies appears acceptable. (C) 2017 Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

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  • Comparison of weighed food record procedures for the reference methods in two validation studies of food frequency questionnaires Reviewed

    Yuri Ishii, Junko Ishihara, Ribeka Takachi, Yurie Shinozawa, Nahomi Imaeda, Chiho Goto, Kenji Wakai, Toshiaki Takahashi, Hiroyasu Iso, Kazutoshi Nakamura, Junta Tanaka, Taichi Shimazu, Taiki Yamaji, Shizuka Sasazuki, Norie Sawada, Motoki Iwasaki, Haruo Mikami, Kiyonori Kuriki, Mariko Naito, Naoko Okamoto, Fumi Kondo, Satoyo Hosono, Naoko Miyagawa, Etsuko Ozaki, Sakurako Katsuura-Kamano, Keizo Ohnaka, Hinako Nanri, Noriko Tsunematsu-Nakahata, Takamasa Kayama, Ayako Kurihara, Shiomi Kojima, Hideo Tanaka, Shoichiro Tsugane

    JOURNAL OF EPIDEMIOLOGY   27 ( 7 )   331 - 337   2017.7

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    Background: Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes.
    Methods: WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra-and inter-individual variation in nutrient intakes caused by the difference in procedures.
    Results: General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra-and inter-individual variation in nutrient intakes were similar between the two studies.
    Conclusion: Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar. (C) 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

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  • Cognitive function is maintained in noninstitutionalized elderly Japanese requiring care with high levels of health-related quality of life Reviewed

    Kaori Kitamura, Kazutoshi Nakamura, Kimiko Ueno, Tomoko Nishiwaki

    ENVIRONMENTAL HEALTH AND PREVENTIVE MEDICINE   21 ( 6 )   585 - 590   2016.11

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    Health-related quality of life (HRQOL) has been reported to be associated with cognitive function; however, whether or not this relationship involves causality is uncertain. This study aimed to determine whether HRQOL levels are associated with subsequent changes in cognitive function in elderly people requiring care.
    Participants were 74 community-dwelling elderly people utilizing the long-term care service (69 % women) who underwent physical and psychological examinations at baseline and follow-up. The outcome was 2-year changes in Mini-Mental State Examination (a dagger MMSE) score. The potential predictor was HRQOL level assessed by the EuroQol 5 dimension (EQ-5D) score (utility value) at baseline; other variables were body mass index (BMI), Barthel index, grip strength, Geriatric Depression Scale, serum albumin, and serum hemoglobin. Associations between EQ-5D and a dagger MMSE scores were assessed using correlation analysis, regression analysis, and analysis of covariance (ANCOVA).
    Mean age, BMI, and Barthel index at baseline were 81.6 years [standard deviation (SD) 8.2], 21.1 kg/m(2) (SD 4.0), and 79 (SD 20), respectively; the mean a dagger MMSE score was -2.2 (SD 5.1). EQ-5D was significantly correlated with a dagger MMSE (partial r = 0.375, P = 0.0012). The mean a dagger MMSE values of the 1st, 2nd, and 3rd EQ-5D quartiles were -4.2 (adjusted P = 0.0050), -2.6 (adjusted P = 0.0476), and -2.4 (adjusted P = 0.0298), respectively, which were lower than the -0.1 of the reference 4th quartile.
    HRQOL as assessed by EQ-5D is associated with longitudinal cognitive decline in frail elderly people, and cognitive function may be maintained in individuals with high HRQOL levels.

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  • Rural-urban differences in the prevalence of cognitive impairment in independent community-dwelling elderly residents of Ojiya city, Niigata Prefecture, Japan Reviewed

    Kazutoshi Nakamura, Kaori Kitamura, Yumi Watanabe, Hiroko Shinoda, Hisami Sato, Toshiyuki Someya

    ENVIRONMENTAL HEALTH AND PREVENTIVE MEDICINE   21 ( 6 )   422 - 429   2016.11

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    This study aimed to examine rural-urban differences in the prevalence of cognitive impairment in Japan.
    We targeted 592 residents aged 65 years and older who did not use long-term care insurance services in one rural and two urban areas in Ojiya City, Japan. Of these, 537 (90.7 %) participated in the study. The revised Hasegawa's dementia scale (HDS-R) was used to assess cognitive function, and cognitive impairment was defined as a HDS-R score aecurrency sign20. Lifestyle information was obtained through interviews. The prevalence of cognitive impairment was compared according to the levels of predictor variables by odds ratios (ORs) calculated by a logistic regression analysis.
    Mean age of participants was 75.7 years (SD 7.0). The prevalence of cognitive impairment was 20/239 (8.4 %) in the rural area and 6/298 (2.0 %) in the urban areas, for a total of 26/537 (4.8 %) overall. Men tended to have a higher prevalence of cognitive impairment (P = 0.0628), and age was associated with cognitive impairment (P for trend &lt; 0.0001). The rural area had a significantly higher prevalence of cognitive impairment (age- and sex-adjusted OR = 4.04, 95 % CI: 1.54-10.62) than urban areas. This difference was significant after adjusting for other lifestyle factors.
    The prevalence of cognitive impairment was higher in the rural area relative to urban areas in Ojiya city. This regional difference suggests the existence of potentially modifiable factors other than lifestyle in relation to cognitive impairment.

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  • Validity of Short and Long Self-Administered Food Frequency Questionnaires in Ranking Dietary Intake in Middle-Aged and Elderly Japanese in the Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) Protocol Area Reviewed

    Yuta Yokoyama, Ribeka Takachi, Junko Ishihara, Yuri Ishii, Shizuka Sasazuki, Norie Sawada, Yurie Shinozawa, Junta Tanaka, Erika Kato, Kaori Kitamura, Kazutoshi Nakamura, Shoichiro Tsugane

    JOURNAL OF EPIDEMIOLOGY   26 ( 8 )   420 - 432   2016.8

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    Background: Longitudinal epidemiological studies require both the periodic update of intake information via repeated dietary survey and the minimization of subject burden in responding to questionnaires. We developed a 66-item Food Frequency Questionnaire (short-FFQ) for the Japan Public Health Center-based prospective Study for the Next Generation (JPHC-NEXT) follow-up survey using major foods from the FFQ developed for the original JPHC Study. For the JPHC-NEXT baseline survey, we used a larger 172-item FFQ (long-FFQ), which was also derived from the JPHC-FFQ. We compared the validity of ranking individuals by levels of dietary consumption by these FFQs among residents of selected JPHC-NEXT study areas.
    Methods: From 2012 to 2013, 240 men and women aged 40-74 years from five areas in the JPHC-NEXT protocol were asked to respond to the long-FFQ and provide 12-day weighed food records (WFR) as reference; 228 also completed the short-FFQ. Spearman's correlation coefficients (CCs) between estimates from the FFQs and WFR were calculated and corrected for intra-individual variation of the WFR.
    Results: Median CC values for energy and 53 nutrients for the short-FFQ for men and women were 0.46 and 0.44, respectively. Respective values for the long-FFQ were 0.50 and 0.43. Compared with the long-FFQ, cross-classification into exact plus adjacent quintiles with the short-FFQ ranged from 68% to 91% in men and 58% to 85% in women.
    Conclusions: Similar to the long-FFQ, the short-FFQ provided reasonably valid measures for ranking middle-aged and elderly Japanese for many nutrients and food groups. The short-FFQ can be used in follow-up surveys in prospective cohort studies aimed at updating diet rank information.

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  • Association between Dietary Intake and Bone Mineral Density in Japanese Postmenopausal Women: The Yokogoshi Cohort Study Reviewed

    Harumi Hirata, Kaori Kitamura, Toshiko Saito, Ryosaku Kobayashi, Masanori Iwasaki, Akihiro Yoshihara, Yumi Watanabe, Rieko Oshiki, Tomoko Nishiwaki, Kazutoshi Nakamura

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE   239 ( 2 )   95 - 101   2016.6

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    Diet and food intake play an important role in the development of osteoporosis. However, apart from calcium and vitamin D, how nutrients affect bone status is not fully understood. The purpose of this study was to determine cross-sectional and longitudinal associations between dietary intake and bone mineral density (BMD) in Japanese postmenopausal women. This 5-year cohort study included 600 community dwelling women aged 55-74 years at baseline in 2005. Information on demographics, nutrition, and lifestyle was obtained through interviews, and nutritional and dietary intake was assessed using a validated food frequency questionnaire. BMD measurements were performed by dual energy X-ray absorptiometry. In 2010, 498 women underwent follow-up BMD examinations. Multiple linear regression analysis was performed to determine associations of predictor variables with BMD, adjusting for confounders. In cross-sectional analyses, coffee or black tea consumption was positively associated with lumbar spine (P = 0.004) and total hip (P = 0.003) BMD, and alcohol intake was positively associated with femoral neck (P = 0.005) and total hip (P = 0.001) BMD. In longitudinal analyses, vitamin K (P = 0.028) and natto (fermented soybeans) (P = 0.023) were positively associated with lumbar spine BMD, and meat or meat product consumption was inversely associated with total hip (P = 0.047) BMD. In conclusion, dietary factors other than calcium and vitamin D intake are predictors of bone mass and bone loss in Japanese postmenopausal women. In particular, natto intake is recommended for preventing postmenopausal bone loss on the basis of current evidence.

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  • Elevated C-Reactive Protein is Associated with Cognitive Decline in Outpatients of a General Hospital: The Project in Sado for Total Health (PROST) Reviewed

    Yumi Watanabe, Kaori Kitamura, Kazutoshi Nakamura, Kazuhiro Sanpei, Minako Wakasugi, Akio Yokoseki, Osamu Onodera, Takeshi Ikeuchi, Ryozo Kuwano, Takeshi Momotsu, Ichiei Narita, Naoto Endo

    Dementia and Geriatric Cognitive Disorders Extra   6 ( 1 )   10 - 19   2016

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    Background/Aims: We aimed to determine whether the concentration of serum C-reactive protein (CRP) is associated with cognitive function in an adult Japanese population. Methods: Participants of this cross-sectional study were from a subgroup of the Project in Sado for Total Health (PROST
    n = 454
    mean age, 70.5 years). The cognitive state was evaluated using the Mini-Mental State Examination (MMSE), and those with an MMSE score &lt
    24 were considered 'cognitively declined'. Concentrations of serum high-sensitivity CRP were measured. Multiple logistic regression analysis was used to calculate odds ratios (ORs) for cognitive decline, adjusting for the covariates of age, sex, BMI, disease history, and APOE allele. Results: Of the 454 participants, 94 (20.7%) were cognitively declined. Relative to the lowest (first) quartile of CRP concentration, adjusted ORs were 1.29 (95% CI 0.61-2.75) for the second, 1.78 (95% CI 0.82-3.86) for the third, and 3.05 (95% CI 1.45-6.42) for the highest (fourth) quartiles (p for trend = 0.018). When data were stratified by sex, the association between CRP concentration and cognitive decline was observed only in women. Conclusion: Our findings suggest an association between higher CRP concentration and lower cognitive function. Chronic inflammation may affect cognitive function in adults, in particular women.

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  • Modifiable Factors Associated with Cognitive Impairment in 1,143 Japanese Outpatients: The Project in Sado for Total Health (PROST) Reviewed

    Kaori Kitamura, Yumi Watanabe, Kazutoshi Nakamura, Kazuhiro Sanpei, Minako Wakasugi, Akio Yokoseki, Osamu Onodera, Takeshi Ikeuchi, Ryozo Kuwano, Takeshi Momotsu, Ichiei Narita, Naoto Endo

    Dementia and Geriatric Cognitive Disorders Extra   6 ( 2 )   341 - 349   2016

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    Background/Aims: Evidence on modifiable factors associated with cognitive impairment in Japanese patients is scarce. This study aimed to determine modifiable factors for cognitive impairment in a Japanese hospital-based population. Methods: Subjects of this cross-sectional study were 1,143 patients of Sado General Hospital (Niigata, Japan) registered in the Project in Sado for Total Health (PROST) between June 2008 and September 2014. We assessed disease history, body mass index (BMI), leisure time physical activity, walking time, smoking and drinking habits, and consumption of vegetables, fruits, and green tea as predictors, with cognitive impairment defined by the Mini-Mental State Examination (score &lt
    24) as an outcome. Multiple logistic regression analysis was performed to calculate odds ratios (ORs) for cognitive impairment. Results: The mean subject age was 68.9 years, and the prevalence of cognitive impairment was 21.5%. Multivariate analysis revealed that age (p &lt
    0.001), low BMI (&lt
    21.1
    OR 1.39, 95% CI 1.12-1.72), a history of stroke (p = 0.003), a history of myocardial infarction (p = 0.038), low fruit consumption (p for trend = 0.012), and low green tea consumption (p for trend = 0.032) were independently associated with a higher prevalence of cognitive impairment. Conclusions: Modifiable factors, such as low BMI, low fruit consumption, and low green tea consumption, are associated with cognitive impairment. Longitudinal studies will be needed to confirm these findings.

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  • Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects Reviewed

    N. Veronese, E. Cereda, M. Solmi, S. A. Fowler, E. Manzato, S. Maggi, P. Manu, E. Abe, K. Hayashi, J. P. Allard, B. M. Arendt, A. Beck, M. Chan, Y. J. P. Audrey, W. -Y. Lin, H. -S. Hsu, C. -C. Lin, R. Diekmann, S. Kimyagarov, M. Miller, I. D. Cameron, K. H. Pitkala, J. Lee, J. Woo, K. Nakamura, D. Smiley, G. Umpierrez, M. Rondanelli, M. Sund-Levander, L. Valentini, K. Schindler, J. Torma, S. Volpato, G. Zuliani, M. Wong, K. Lok, J. M. Kane, G. Sergi, C. U. Correll

    OBESITY REVIEWS   16 ( 11 )   1001 - 1015   2015.11

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    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (&lt;18.5, 18.5-24.9, 25-29.9, 30kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI=1.26-1.58) for underweight, 0.85 (95% CI=0.73-0.99) for overweight and 0.74 (95% CI=0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR=1.65 [95% CI=1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

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  • Property damage and long-term psychological distress after the 2004 Niigata-Chuetsu earthquake in Ojiya, Japan: a community-based study Reviewed

    Kazutoshi Nakamura, Kaori Kitamura, Yoshiharu Kim, Toshiyuki Someya

    JOURNAL OF PUBLIC HEALTH   37 ( 3 )   398 - 405   2015.9

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    Background This study aimed to assess psychological distress (PD) in earthquake-stricken communities with regard to the extent of property damage for 3 years following the 2004 Niigata-Chuetsu earthquake in Japan.
    Methods Subjects were participants of health check examinations in a community near the epicentre, and included 7097 residents (a parts per thousand yen18 years) in 2005, 6586 in 2006 and 6698 in 2007. Interviews assessed PD symptoms and lifestyles. The Kessler Psychological Distress Scale (K10) was used, with scores a parts per thousand yen20 considered as PD. The 137 subdistricts were divided into quartiles according to the proportion of half-completely destroyed houses at cut-offs of 18.9, 30.5 and 66.7%.
    Results The PD prevalence was 17.0% in 2005, 13.2% in 2006 and 11.8% in 2007. In 2005, the more and most heavily damaged groups had significantly higher PD prevalence (OR = 1.5 and 1.4, respectively) than that of the least damaged group with a dose-dependent relationship (P = 0.0005). This association was weaker in 2006 (P = 0.0413) and in 2007 (P = 0.1816).
    Conclusions Psychological distress prevalence was high in highly damaged areas, and the prevalence difference between areas with high versus low damage decreases with time. Extensive mental health care in communities with substantial damage should be expected to last 2 years after an earthquake.

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  • Prolonged occupational activity and 6-year changes in postural sway in elderly women. Reviewed

    Nakamura K, Kitamura K, Oshiki R, Kobayashi R, Saito T, Nishiwaki T

    Journal of musculoskeletal & neuronal Interactions.   15 ( 1 )   78 - 82   2015.3

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  • Impact of demographic, environmental, and lifestyle factors on vitamin D sufficiency in 9084 Japanese adults. Reviewed

    Nakamura K, Kitamura K, Takachi R, Saito T, Kobayashi R, Oshiki R, Watanabe Y, Tsugane S, Sasaki A, Yamazaki O

    Bone   74   10 - 17   2015.1

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  • Psychological Recovery 5 Years After the 2004 Niigata-Chuetsu Earthquake in Yamakoshi, Japan Reviewed

    Kazutoshi Nakamura, Kaori Kitamura, Toshiyuki Someya

    JOURNAL OF EPIDEMIOLOGY   24 ( 2 )   125 - 131   2014.3

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    Background: The 2004 Niigata-Chuetsu earthquake of Japan caused considerable damage. We assessed long-term changes in psychological distress among earthquake victims during the period 5 years after the earthquake.
    Methods: The participants were people aged 18 years or older living in Yamakoshi, a community in Niigata Prefecture near the epicenter. A self-administered questionnaire survey was conducted annually for 5 consecutive years after the earthquake. Response rates were 1316/1841 (71.5%) in 2005, 667/1381 (48.3%) in 2006, 753/1451 (51.9%) in 2007, 541/1243 (43.5%) in 2008, and 814/1158 (70.3%) in 2009. The questionnaire asked about demographic characteristics, including sex, age, employment status, social network, and psychological status. Psychological distress was assessed using the 12-item General Health Questionnaire and was defined as a total score of 4 or higher.
    Results: The overall prevalence of psychological distress decreased (P &lt; 0.0001) gradually from 2005 (51.0%) to 2008 (30.1%) but tended to increase from 2008 to 2009 (P = 0.1590). Subgroup analyses showed that prevalence did not decrease over the 5-year study period among participants with poor social contact (P = 0.0659). From 2008 to 2009 prevalence increased in women (+7.5%, P = 0.0403) and participants aged 65 years or older (+7.2%, P = 0.0400).
    Conclusions: The prevalence of psychological distress in Yamakoshi people decreased steadily during the 4 years immediately after the earthquake but appeared to increase thereafter. The earthquake victims are still reestablishing their lives. Thus, continued attention should be focused on maintaining and further assessing their mental health.

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  • High serum 25-hydroxyvitamin D levels do not retard postmenopausal bone loss in Japanese women: the Yokogoshi study Reviewed

    Kaori Kitamura, Kazutoshi Nakamura, Toshiko Saito, Ryosaku Kobayashi, Rieko Oshiki, Tomoko Nishiwaki, Masanori Iwasaki, Akihiro Yoshihara

    ARCHIVES OF OSTEOPOROSIS   8 ( 1-2 )   153   2013.12

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    We conducted a cohort study exploring an association between serum 25-hydroxyvitamin D (serum 25(OH)D) and parathyroid hormone (PTH) levels and 5-year changes in bone mineral density (BMD) in 482 postmenopausal women. High serum 25(OH)D levels do not retard postmenopausal bone loss within the lumbar spine or femoral neck, and high PTH levels potentially increase hip bone loss.
    Purpose The aim of this study was to explore an association between serum 25(OH)D levels and 5-year changes in BMD in postmenopausal women.
    Methods This 5-year cohort study included 482 women between 55 and 74 years of age who lived in a community in Japan. Medical examinations were conducted in 2005 and 2010. Data were obtained on baseline serum 25(OH)D and intact parathyroid hormone (iPTH) levels. Outcomes of this study were 5-year changes in BMDs of the lumbar spine and femoral neck. Covariates included years since menopause, body mass index (BMI), lifestyle factors, and weight change. Changes in BMDs among quartiles of serum 25(OH)D were compared with analysis of covariance.
    Results The mean age of subjects was 63.1 years, and mean serum25(OH)D levelswere 56.0 nmol/L. Age and decrease in weight were significantly associated with decreases in BMDs of both the lumbar spine (P for trend&lt;0.001 and =0.002, respectively) and femoral neck (P for trend=0.026 and &lt;0.001, respectively); low BMI was associated with a decrease in lumbar spine BMD (P for trend&lt;0.001). No significant associations were found between serum 25(OH)D levels and changes in BMDs. High serum iPTH levels were associated with a greater decrease in femoral neck BMD (P for trend=0.026).
    Conclusions High serum 25(OH)D levels do not retard postmenopausal bone loss within the lumbar spine or femoral neck, and high PTH levels potentially increase hip bone loss.

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  • Association between body mass index and mortality among institutionalized elderly adults in Japan Reviewed

    Akemi Nakazawa, Kazutoshi Nakamura, Kaori Kitamura, Yoshiaki Yoshizawa

    ENVIRONMENTAL HEALTH AND PREVENTIVE MEDICINE   18 ( 6 )   502 - 506   2013.11

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    The purpose of this study is to assess the association between body mass index (BMI) and mortality among nursing home residents in Japan.
    A one-year prospective cohort study was conducted with 8,510 elderly individuals across 140 nursing homes. Baseline measurements included age, sex, height, weight, BMI, activities of daily living (ADL) (Barthel Index), and degree of dementia. Information regarding dates of discharge and mortality were also obtained to calculate person-years. Cox's proportional hazards model was used to estimate hazard ratios.
    Mean age and BMI were 84.3 [standard deviation (SD) 8.1] years and 20.6 (SD 3.8) kg/m(2), respectively. Hazard ratios of mortality adjusted for sex, age, ADL, degree of dementia, and type of home were 2.4 [95 % confidence interval (CI): 1.9-3.1] for the 1st quintile of BMI (&lt; 17.3 kg/m(2)), 1.7 (95 % CI: 1.3-2.3) for the 2nd quintile (17.3-19.2 kg/m(2)), 1.5 (95 % CI: 1.2-2.0) for the 3rd quintile (19.3-21.1 kg/m(2)), and 1.2 (95 % CI: 0.9-1.6) for the 4th quintile (21.2-23.5 kg/m(2)) (P for trend &lt; 0.001), compared with the reference 5th quintile (23.6a parts per thousand currency sign kg/m(2)).
    There was a clear inverse dose-dependent relationship between BMI and mortality. Future studies should be conducted to determine the effects of nutritional intervention on mortality in institutionalized elderly adults.

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  • Association Between Activities of Daily Living and Mortality Among Institutionalized Elderly Adults in Japan Reviewed

    Akemi Nakazawa, Kazutoshi Nakamura, Kaori Kitamura, Yoshiaki Yoshizawa

    JOURNAL OF EPIDEMIOLOGY   22 ( 6 )   501 - 507   2012.11

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    Background: We assessed the association between activities of daily living (ADL) and mortality among nursing home residents in Japan.
    Methods: This I-year prospective cohort study investigated 8902 elderly adults in 140 nursing homes. Baseline measurements included age, sex, height, weight, body mass index (BMI), ADL, and dementia level. ADL levels were obtained by caregivers, using the Barthel Index (BI), after which total BI scores were calculated (higher scores indicate less dependence). Information on dates of discharge and mortality was also obtained to calculate person-years. The Cox proportional hazards model was used to estimate hazard ratios (HRs).
    Results: Mean age was 84.3 years, and mean total BI score was 38.5. The HRs of mortality adjusted for sex, age, BM I, and type of nursing home were 7.6 (95% CI: 3.3-17.8) for those with a BI score of 0 (totally dependent), 3.9 (1.7-9.0) for those with a score of 1 to 10, 3.5 (1.4-8.7) for those with a score of 11 to 40, 2.7 (1.4-5.1) for those with a score of 41 to 70, and 1.3 (0.7-2.4) for those with a score of 71 to 99 (P for trend &lt;0.001), as compared with those with a score of 100. Multivariate analysis revealed that BI, sex, age, and BMI were significantly associated with mortality rate.
    Conclusions: There was a clear inverse association between ADL level and mortality. In conjunction with other risk factors, ADL level might effectively predict short-term mortality in institutionalized elderly adults.

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  • Effect of Low-Dose Calcium Supplements on Bone Loss in Perimenopausal and Postmenopausal Asian Women: A Randomized Controlled Trial Reviewed

    Kazutoshi Nakamura, Toshiko Saito, Ryosaku Kobayashi, Rieko Oshiki, Kaori Kitamura, Mari Oyama, Sachiko Narisawa, Mitsue Nashimoto, Shunsuke Takahashi, Ribeka Takachi

    JOURNAL OF BONE AND MINERAL RESEARCH   27 ( 11 )   2264 - 2270   2012.11

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    Current standard-dose calcium supplements (eg, 1000 mg/d) may increase the risk for cardiovascular events. Effectiveness of lower-dose supplements in preventing bone loss should thus be considered. This study aimed to assess whether calcium supplements of 500 or 250 mg/d effectively prevent bone loss in perimenopausal and postmenopausal Japanese women. We recruited 450 Japanese women between 50 and 75 years of age. They were randomly assigned to receive 500 mg of calcium (as calcium carbonate), 250 mg of calcium, or placebo daily. Medical examinations conducted three times over a 2-year follow-up period assessed bone mineral density (BMD) of the lumbar spine and femoral neck. One-factor repeated measures ANOVA was used for statistical tests. Subgroup analyses were also conducted. Average total daily calcium intake at baseline for the 418 subjects who underwent follow-up examinations was 493 mg/d. Intention-to-treat analysis showed less dramatic decreases in spinal BMD for the 500-mg/d calcium supplement group compared to the placebo group (1.2% difference over 2 years, p = 0.027). Per-protocol analysis (&gt;= 80% compliance) revealed that spinal BMD for the 500 mg/d and 250-mg/d calcium supplement groups decreased less than the placebo group (1.6%, p = 0.010 and 1.0%, p = 0.078, respectively), and that femoral neck BMD for the 500-mg/d calcium supplement group decreased less relative to the placebo group (1.0%, p = 0.077). A low-dose calcium supplement of 500 mg/d can effectively slow lumbar spine bone loss in perimenopausal and postmenopausal women with habitually low calcium intake, but its effect on the femoral neck is less certain. Calcium supplementation dosage should thus be reassessed. (Clinical Trials Registry number: UMIN000001176). (C) 2012 American Society for Bone and Mineral Research.

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  • Effect of low-dose calcium supplements on bone loss in perimenopausal and postmenopausal Asian women: a randomized controlled trial. Reviewed

    Nakamura K, Saito T, Kobayashi R, Oshiki R, Kitamura K, Oyama M, Narisawa S, Nashimoto M, Takahashi S, Takachi R

    J Bone Miner Res   27 ( 11 )   2264 - 2270   2012.11

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    Current standard-dose calcium supplements (eg, 1000 mg/d) may increase the risk for cardiovascular events. Effectiveness of lower-dose supplements in preventing bone loss should thus be considered. This study aimed to assess whether calcium supplements of 500 or 250 mg/d effectively prevent bone loss in perimenopausal and postmenopausal Japanese women. We recruited 450 Japanese women between 50 and 75 years of age. They were randomly assigned to receive 500 mg of calcium (as calcium carbonate), 250 mg of calcium, or placebo daily. Medical examinations conducted three times over a 2-year follow-up period assessed bone mineral density (BMD) of the lumbar spine and femoral neck. One-factor repeated measures ANOVA was used for statistical tests. Subgroup analyses were also conducted. Average total daily calcium intake at baseline for the 418 subjects who underwent follow-up examinations was 493 mg/d. Intention-to-treat analysis showed less dramatic decreases in spinal BMD for the 500-mg/d calcium supplement group compared to the placebo group (1.2% difference over 2 years, p = 0.027). Per-protocol analysis (&gt;/=80% compliance) revealed that spinal BMD for the 500-mg/d and 250-mg/d cal

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  • Nutritional and biochemical parameters associated with 6-year change in bone mineral density in community-dwelling Japanese women aged 69 years and older: The Muramatsu Study Reviewed

    Kazutoshi Nakamura, Mari Oyama, Toshiko Saito, Rieko Oshiki, Ryosaku Kobayashi, Tomoko Nishiwaki, Mitsue Nashimoto, Yasuo Tsuchiya

    NUTRITION   28 ( 4 )   357 - 361   2012.4

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    Objective: Predictors of bone loss in elderly Asian women have been unclear. This cohort study aimed to assess lifestyle, nutritional, and biochemical predictors of bone loss in elderly Japanese women.
    Methods: Subjects included 389 community-dwelling women aged 69 y and older from the Muramatsu cohort initiated in 2003; follow-up ended in 2009. We obtained data on physical characteristics, osteoporosis treatment (with bisphosphonates or selective estrogen receptor modulators), physical activity, calcium intake, serum 25-hydroxyvitamin D. undercarboxylated osteocalcin, serum albumin, and bone turnover markers as predictors. The outcome was a 6-y change in forearm BMD (Delta BMD). Osteoporosis treatment was coded as 0 for none, 1 for sometimes, and 2 for always during the follow-up period. Stepwise multiple linear regression analysis was used to identify independent predictors of Delta BMD.
    Results: Mean age of the subjects was 73.3 y. Mean values of Delta BMD and Delta weight were 0.019 g/cm(2) (-5.8%) and -2.2 kg, respectively. Stepwise multiple linear regression analysis revealed baseline BMD (beta = 0.137, P &lt; 0.0001), osteoporosis treatment beta = 0.0068, P = 0.0105), serum albumin levels (beta = 0.0122, P = 0.0319), and Delta weight (beta = 0.0015, P = 0.0009) as significant independent predictors of Delta BMD. However, none of the other nutritional or biochemical indices were found to be significant predictors of Delta BMD.
    Conclusions: Our findings indicate that adequate general nutrition and appropriate osteoporosis medication, rather than specific nutritional regimens, may be effective in preventing bone loss in elderly women. (C) 2012 Elsevier Inc. All rights reserved.

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  • Determination of whether the association between serum albumin and activities of daily living in frail elderly people is causal Reviewed

    Kaori Kitamura, Kazutoshi Nakamura, Tomoko Nishiwaki, Kimiko Ueno, Akemi Nakazawa, Mariko Hasegawa

    Environmental Health and Preventive Medicine   17 ( 2 )   164 - 168   2012.3

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    Objectives Serum albumin and activities of daily living (ADL) are associated with each other, but whether the association is causal is not known. The purpose of this study was to determine whether a causal association exists between serum albumin and ADL levels. Methods The subjects were 116 frail elderly individuals (34 men and 82 women
    mean age 83.0 years). Demographic characteristics, serum albumin, ADL, and handgrip strength were measured at a baseline examination and at a follow-up examination 2 years later. Levels of ADL were assessed with the Barthel Index. Pearson's correlation coefficients were calculated for serum albumin, ADL, and handgrip strength for baseline values and for their 2-year changes (Δ). Results At baseline, the mean serum albumin concentration was 4.0 g/dL and the total score of the Barthel Index (baseline Barthel Index) was 71.1. The baseline serum albumin level correlated significantly with the baseline Barthel Index (r = 0.287) and baseline handgrip strength (r = 0.315), but not with Δ Barthel Index (r = 0.096) or Δ handgrip strength (r = - 0.058). The Δ serum albumin correlated significantly with Δ Barthel Index (r = 0.296), but not with Δ handgrip strength (r = 0.182), baseline Barthel Index (r = - 0.044), or baseline handgrip strength (r = 0.047). Conclusions This 2-year cohort study has demonstrated that a decrease in serum albumin levels is associated with a decrease in ADL levels. A third factor may play a role in adversely affecting both serum albumin and ADL levels in frail elderly people. © The Japanese Society for Hygiene 2011.

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  • Determination of whether the association between serum albumin and activities of daily living in frail elderly people is causal Reviewed

    Kitamura K, Nakamura K, Nishiwaki T, Ueno K, Nakazawa A, Hasegawa M

    Environ Health Prev Med   17 ( 2 )   164 - 168   2012.3

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    OBJECTIVES: Serum albumin and activities of daily living (ADL) are associated with each other, but whether the association is causal is not known. The purpose of this study was to determine whether a causal association exists between serum albumin and ADL levels. METHODS: The subjects were 116 frail elderly individuals (34 men and 82 women; mean age 83.0 years). Demographic characteristics, serum albumin, ADL, and handgrip strength were measured at a baseline examination and at a follow-up examination 2 years later. Levels of ADL were assessed with the Barthel Index. Pearson&#039;s correlation coefficients were calculated for serum albumin, ADL, and handgrip strength for baseline values and for their 2-year changes (Delta). RESULTS: At baseline, the mean serum albumin concentration was 4.0 g/dL and the total score of the Barthel Index (baseline Barthel Index) was 71.1. The baseline serum albumin level correlated significantly with the baseline Barthel Index (r = 0.287) and baseline handgrip strength (r = 0.315), but not with Delta Barthel Index (r = 0.096) or Delta handgrip strength (r = - 0.058). The Delta serum albumin correlated significantly with Delta Barthel Index (r = 0.296),

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  • Physical activity and 5-year changes in physical performance tests and bone mineral density in postmenopausal women: The Yokogoshi Study Reviewed

    Kaori Kitamura, Kazutoshi Nakamura, Ryosaku Kobayashi, Rieko Oshiki, Toshiko Saito, Mari Oyama, Shunsuke Takahashi, Tomoko Nishiwaki, Masanori Iwasaki, Akihiro Yoshihara

    MATURITAS   70 ( 1 )   80 - 84   2011.9

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    Objective: The effect of physical activity on musculoskeletal health in older adults is not completely understood. The aim of this study was to determine the relationship between physical activity and 5-year changes in physical performance tests and bone mineral density (BMD) in postmenopausal women.
    Study design: The design was a 5-year cohort study.
    Main outcome measures: Subjects were 507 women (55-74 years old) living in a rural community in Japan. Physical activity assessed included housework, farm work, and moderate leisure-time physical activity within the previous week. Measurements at baseline included handgrip strength, walking time (timed "Up & Go" test) and BMD of the femoral neck and vertebrae. Five-year changes in these measures (outcome variables) were compared among groups with different levels of physical activity by analysis of covariance.
    Results: Women who did not do housework performed worse in changes in handgrip strength (difference = 2.22 kg, P = 0.0201) and worse in changes in the walking time (difference = 0.54 s, P = 0.0072) than those who did housework alone. Women who spent at least 9 h per week (median = 24) doing farm work performed better in changes in handgrip strength (difference = 0.28 kg, P= 0.0334), but worse in changes in the walking time (difference = 0.66 s, P&lt;0.0001) than those who did not do farm work. However, leisure-time activity was not associated with changes in any outcome variable, and none of the physical activities predicted BMD changes.
    Conclusions: Engaging in housework and farm work are determinants of physical function in postmenopausal women, which may help them maintain independence in daily living. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

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  • Positive predictive values for self-reported fractures in an adult Japanese population Reviewed

    Kazutoshi Nakamura, Manami Inoue, Yoshikazu Kaneko, Shoichiro Tsugane

    Environmental Health and Preventive Medicine   16 ( 2 )   129 - 132   2011.3

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    Objectives: Self-reporting provides useful information for assessing the risk factors of osteoporotic fractures in large cohort studies. However, to data, no studies in Japan have confirmed the accuracy of this approach in this context. The aim of the study reported here was to determine the positive predictive value (PPV) for the self-reporting of fractures. Methods: A total of 133 participants of the Oguni cohort in the Japan Public Health Center-based Prospective Study who reported a vertebral, upper limb, or hip fracture on the 15-year follow-up questionnaire survey were evaluated. The accuracy of fractures was confirmed by cross-referencing medical records. Results: The average age of the participants was 72.4 (standard deviation 7.9) years. The PPV for vertebral fracture in the last 15 years was 17/20 (85.0%) for women and 2/9 (22.2%) for men, for a total of 19/29 (65.5%). PPVs for upper limb and hip fractures were as low as 30/68 (44.1%) and 12/22 (54.5%), respectively. Conclusion: Female self-reporting provided PPVs suitable for symptomatic vertebral fracture over 15 years and can be used as an outcome measure in large cohort studies in Japan. © 2010 The Japanese Society for Hygiene.

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  • Postural sway velocity predicts osteoporotic fracture in community-dwelling elderly Japanese women: the Muramatsu Study Reviewed

    Kazutoshi Nakamura, Rieko Oshiki, Ryosaku Kobayashi, Mari Oyama, Toshiko Saito, Tomoko Nishiwaki, Mitsue Nashimoto, Yasuo Tsuchiya

    AGE AND AGEING   40 ( 1 )   132 - 135   2011.1

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  • Low Body Mass Index and Low Serum Albumin Are Predictive Factors for Short-Term Mortality in Elderly Japanese Requiring Home Care Reviewed

    Kaori Kitamura, Kazutoshi Nakamura, Tomoko Nishiwaki, Kimiko Ueno, Mariko Hasegawa

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE   221 ( 1 )   29 - 34   2010.5

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    Japan has a rapidly growing elderly population requiring care. This study aimed to clarify risk factors for two-year mortality in such people. Subjects included 205 community-dwelling elderly people, who were approved for care in the 2003 Yamato Study, an epidemiologic study of individuals utilizing the long-term care service system. Demographic characteristics, Barthel index (measuring activities of daily living), grip strength, thigh muscle volume, psychological evaluation, and blood values including hemoglobin, serum albumin, and serum 25-hydroxyvitamin D levels were investigated at baseline. The average age of subjects was 83.6 (S.D., 8.0) years. Of the 205 subjects, 42 died during the follow-up period. Bivariate analysis showed that older age (p = 0.0015), lower weight (p = 0.0087), lower body mass index (BMI) (p = 0.0001), lower Barthel index (p = 0.0017), lower hemoglobin (p = 0.0180), and lower serum albumin (p = 0.0001) were associated with mortality, but that sex was not (p = 0.1248). Stepwise multiple logistic regression analysis showed that BMI &lt; 17.1 kg/m(2) (adjusted OR = 4.0, p = 0.0007), age &gt;= 90 years (adjusted OR = 3.3, p = 0.0033), and lower serum albumin levels (adjusted OR = 0.86, p = 0.0007) were independently associated with mortality. We conclude that low BMI and low serum albumin are strong predictors of 2-year mortality in frail elderly individuals, and that nutritional risk should appropriately be evaluated for elderly people requiring home care.

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  • Long-Term Suicide Mortality Rates Decrease in Men and Increase in Women after the Niigata-Chuetsu Earthquake in Japan Reviewed

    Keiko Hyodo, Kazutoshi Nakamura, Mari Oyama, Osamu Yamazaki, Izumi Nakagawa, Kazuo Ishigami, Yasuo Tsuchiya, Masaharu Yamamoto

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE   220 ( 2 )   149 - 155   2010.2

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    A devastating earthquake causes psychological distress, and may increase suicide mortality thereafter, yet previous studies have made inconsistent conclusions regarding this issue. The purpose of the present study was to determine whether the 2004 Niigata-Chuetsu earthquake in Japan affected long-term mortality from suicide. We conducted a comparative study of suicide mortality rates during the 5-year period preceding and the 3-year period following the earthquake in the disaster area and a control area in Niigata Prefecture, by analyzing death certificate data from October 1, 1999, to September 30, 2007. In men, baseline suicide mortality rates (5 years preceding the earthquake) were 48.4 per 100,000 person-years in the disaster area and 46.1 in the control area, and suicide mortality rates during the 3-year period following the earthquake were 46.0 and 45.1, respectively. In women, baseline suicide mortality rates were 22.3 in the disaster area and 18.7 in the control area, and post-earthquake suicide mortality rates were 20.2 and 15.3, respectively. In consequence, the decrease in suicide mortality rate during the 3 years post-earthquake was significantly higher in the disaster area (2.5) than in the control area (1.0) (p = 0.0013) in men, whereas the decrease in suicide mortality rate was 2.1 in the disaster area and 3.0 in the control area (p = 0.1246) in women. We have concluded that the long-term mortality from suicide after the earthquake decreases in men and increases in women, suggesting that post-earthquake suicide mortality is sex-dependent. Post-earthquake suicide prevention strategies should more aggressively target women.

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  • Intake of dairy products and bone ultrasound measurement in late adolescents: a nationwide crosssectional study in Japan Reviewed

    Kazuhiro Uenishi, Kazutoshi Nakamura

    ASIA PACIFIC JOURNAL OF CLINICAL NUTRITION   19 ( 3 )   432 - 439   2010

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    Introduction: There is little evidence regarding the effects of dairy product intake on bone mineralization among late adolescents, especially in Asians. The aim of this study was to determine the association between dairy product intake and bone strength as measured by quantitative ultrasound (QUS) in a large Japanese population. Methods: Subjects were 38,719 high school students (14,996 males and 23,723 females) across 33 prefectures in Japan. Bone stiffness of the calcaneus was measured by QUS densitometry (AOS-100, Aloka). Subjects were given a self-administered questionnaire, which included questions on gender, age, height, weight, consumption of dairy products, and levels of physical activity. Intake of milk and yogurt were classified as none, 1-99, 100199, 200-399, and &gt;= 400 ml/day. Results: The proportion of subjects who consumed milk 400 ml/day or more was 21% in males and 7.3% in females, while 24% of males and 41.1% of females did not consume milk. After adjusting for physical activity, weight, gender, age, and area of residence, milk intake (R(2)=2.8%, p&lt;0.001) and yogurt intake (R(2)=0.1%, p&lt;0.001) were independently associated with the QUS measurement. Similar associations were found in males and females when a gender-stratified analysis was conducted. Conclusion: We found a positive dose-effect relationship between milk intake and bone strength in late adolescents, to whom we recommend milk intake of 400 ml/day or more to obtain greater bone mass.

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  • Low calcium intake is associated with increased bone resorption in postmenopausal Japanese women: Yokogoshi Study Reviewed

    Kazutoshi Nakamura, Toshiko Saito, Akihiro Yoshihara, Miki Ishikawa, Yasuo Tsuchiya, Rieko Oshiki, Ryosaku Kobayashi, Keiko Maruyama, Keiko Hyodo, Mitsue Nashimoto, Naoko Tsugawa, Toshio Okano, Mari Oyama, Masaharu Yamamoto

    PUBLIC HEALTH NUTRITION   12 ( 12 )   2366 - 2370   2009.12

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    Objective: Low Ca intake is common among Japanese women, but its effect Oil bone metabolism has not been fully elucidated. The aim Of the present study was to determine the relationship between Ca intake and serum markers of bone turnover ill postmenopausal Japanese women.
    Design: A cross-sectional study.
    Setting: A community setting.
    Subjects: Subjects were 595 home-dwelling postmenopausal Japanese women. Ca intake was assessed by a validated FFQ, Serum type I collagen cross-linked N-telopeptides (NTX) and osteocalcin Were measured as markers of bone turnover. The relationships between demographic characteristics, lifestyles, serum Ca, vitamin D and intact serum parathyroid hormone and bone turnover were also assessed.
    Results: The average age of the subjects was 64.5 (SD 5.8) years and the mean Ca intake was 527 (SD 160) mg/d. Ca intake was significantly associated with serum NTX (P=0.0104); but not with serum osteocalcin. Mean serum NTX concentration in the lowest quartile of Ca intake (&lt;417 mg/d) was significantly higher than in the fourth, referent quartile. Among these Japanese postmenopausal women, very low Ca intake (less than similar to 400 mg/d) was associated with increased bone resorption but not one formation.
    Conclusions: Increased bone resorption may be one mechanism by which this Ca-depleted population normalizes bone metabolism and prevents osteoporosis.

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  • Incidence and risk factors associated with hip fracture in institutionalised elderly people in Japan Reviewed

    Kazutoshi Nakamura, Shunsuke Takahashi, Mari Oyama, Mitsue Nashimoto, Toshiko Saito, Yasuo Tsuchiya, Yoshiaki Yoshizawa, Masaharu Yamamoto

    AGE AND AGEING   38 ( 4 )   478 - 482   2009.7

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  • Microscopic hematuria is associated with low bone mineral density in aged women and men Reviewed

    Kazutoshi Nakamura, Junichiro James Kazama, Yoshifumi Tanaka, Keiko Makabe, Mari Oyama, Yasuo Tsuchiya, Masaharu Yamamoto

    JOURNAL OF BONE AND MINERAL METABOLISM   27 ( 2 )   251 - 254   2009.3

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    Little is known concerning renal or urological risk factors for osteoporosis. The aim of this study was to explore an association between urinalysis and bone mineral density (BMD) in 4,835 Japanese adults. Participants were 4,835 individuals (female 3,683; male 1,152) aged 50 years and over who received a health check-up between January 1995 and March 2006 in Japan. BMD of the distal radius and ulna of the non-dominant forearm was measured by the dual-energy X-ray absorptiometry (DXA) method using a DTX-200 Dexacare osteometer (Osteometer MediTech A/S, Rodovre, Denmark). Urine variables were protein, and red blood cells (RBCs) and white blood cells (WBCs) in urine sediment (categorized as &lt; 1, 1-4, 5-9, or a parts per thousand yen10 cells per high-power microscopic field). Average age was 58.9 years (SD 5.6) in women, and 60.5 years (SD 6.2) in men. Simple linear regression analysis showed that urinary RBCs were associated with BMD in women (beta = -5.88 x 10(-3), R (2) = 0.004, p &lt; 0.0001) and men (beta = -1.34 x 10(-2), R (2) = 0.013, p = 0.0001). These associations held when possible confounders were adjusted (beta = -2.05 x 10(-3), R (2) = 0.001, p = 0.0338 for women and beta = -5.67 x 10(-3), R (2) = 0.006, p = 0.0163 for men). Microscopic hematuria is associated with forearm BMD in women and men aged 50 years and over. Further studies should be conducted to determine the mechanisms underlying this association.

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  • Calcium intake and the 10-year incidence of self-reported vertebral fractures in women and men: The Japan Public Health Centre-based Prospective Study Reviewed

    Kazutoshi Nakamura, Norie Kurahashi, Junko Ishihara, Manami Inoue, Shoichiro Tsugane

    BRITISH JOURNAL OF NUTRITION   101 ( 2 )   285 - 294   2009.1

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    The purpose of this study was to evaluate the effect of low Ca intake on the 10-year incidence of vertebral fractures in cohorts I and 11 of the Japan Public Health Centre-based Prospective Study. The baseline studies were conducted in 1990-1994, with the follow-up studies conducted after 10 years. We analysed 33 970 subjects aged 40-59 years in cohort I and 41664 subjects aged 40-69 years in cohort II. At baseline, the intake of Ca was assessed as a predictor, using validated FFQ. A meta-analysis was performed to estimate a summary relative risk (RR) for the two cohort studies. The 10-year cumulative incidences of self-reported vertebral fractures were 0.38% for cohort I and 0.56% for cohort II. In women, lower Ca intake was associated with a higher incidence of vertebral fractures (P for trend=0.001), with the lowest quartile of Ca intake having a significantly higher incidence (0.89/1000 persons per year or RR 2.10 (95% CI 1.25, 3.55)) than that (0.42/1000 persons per year) of the highest. In addition, the RR calculated using energy-adjusted Ca intake (by the residual method) as an outcome was 1.92 (95% Cl 1.28, 2.88). However, no such association was observed in men. An increase of Ca intake should be considered as a preventive strategy for vertebral fractures in peri-and post-menopausal women with a low Ca intake.

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  • Development of a simple food frequency questionnaire to estimate intakes of calcium and other nutrients for the prevention and management of osteoporosis Reviewed

    Kazuhiro Uenishi, Hiromi Ishida, Kazutoshi Nakamura

    JOURNAL OF NUTRITIONAL SCIENCE AND VITAMINOLOGY   54 ( 1 )   25 - 29   2008.2

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    There have been no simple methods to estimate dietary nutrient intakes for the prevention and management of osteoporosis. The aim of this study was to develop and validate a new, simple food frequency questionnaire (FFQ) for dietary intake of calcium and other nutrients relevant to the bone health of adult Japanese women. We developed a 28-item FFQ. To validate this, 208 and 72 adult women aged between 18 and 69 y were recruited for testing reliability and reproducibility, respectively. In the 208 women, moderate-to-high Spearman's correlation coefficients between our FFQ and the conventional diet record method were found in intakes of calcium (r=0.668), sodium chloride (NaCl) (r=0.475), vitamin A (r=0.501), vitamin D (r=0.413), vitamin K (r=0.649), and energy (r=0.471). In the 72 women, coefficients of variance of the four repeated measurements of intakes throughout a year were 14.1% for calcium, 7.3% for NaCl, 21.2% for vitamin A, 13.6% for vitamin D, 36.8% for vitamin K, and 9.6% for energy In conclusion, the FFQ we developed is a useful tool to evaluate the intake of dietary calcium of adult Japanese women.. Although it can also measure intakes or dietary vitamin A, vitamin D, vitamin K, NaCl, and energy, further improvement is needed to measure intakes of these nutrients and energy.

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  • Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study Reviewed

    Kazutoshi Nakamura, Naoko Tsugawa, Toshiko Saito, Miki Ishikawa, Yasuo Tsuchiya, Keiko Maruyama, Rieko Oshiki, Ryosaku Kobayashi, Mitsue Nashimoto, Akihiro Yoshihara, Reo Ozaki, Toshio Okano, Masaharu Yamamoto

    BONE   42 ( 2 )   271 - 277   2008.2

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    Little has been understood about vitamin D status in relation to bone health in Asian women. The purpose of this study was to identify how the serum 25-hydroxyvitamin D (25[OH]D) concentration is associated with bone mass and bone metabolism. This cross-sectional, community-based epidemiologic study was conducted among 600 ambulatory postmenopausal women. The serum 25(OH)D concentration was measured with radioimmunoassay. Other blood biochemical measurements were intact parathyroid hormone and markers of bone turnover, including osteocalcin and type I collagen cross-linked N-telopeptides. Bone mineral density (BMD) of the lumbar spine and right femoral neck were measured with the dual-energy X-ray absorptiometry method using a QDR4500a. The mean serum 25(OH)D concentration was 55.6 nmol/L (SD 14.6). Serum 25(OH)D concentration was linearly associated with BMD of the femoral neck (R-2=0.020, P=0.003), but not with BMD of the lumbar spine. Odds ratios (ORs) for low BMD (defined as t score &lt;= -2.5 SD) were calculated for strata defined by 25(OH)D concentration. The prevalence of low BMD of the lumbar spine was significantly higher in the 40- to 50-nmol/L 25(OH)D group (adjusted OR=3.0, 95% CI: 1.3-7.0) compared to the reference group (&gt;= 70 nmol/L). Prevalence of low BMD for the femoral neck was significantly higher in the 30- to 40-nmol/L (adjusted OR=3.6, 95% CI: 1.1-12.1) and the 40- to 50-nmol/L (adjusted OR=7.6, 95% CI: 2.5-23.2) groups compared to the reference group (&gt;= 70 nmol/L). The mean serum concentration of intact PTH was significantly higher in subjects with serum 25(OH)D &lt; 50 nmol/L compared to those with serum 25(OH)D &gt;= 50 nmol/L. The present study suggests that higher serum 25(OH)D concentrations are associated with increased BMD of the femoral neck, and that a serum 25(OH)D concentration of at least 70 nmol/L is needed to obtain high BMD of the femoral neck, and that of at least 50 nmol/L is needed to achieve normal PTH levels and prevent low BMD in home-dwelling postmenopausal Japanese women. (c) 2007 Elsevier Inc. All rights reserved.

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  • Age-related decrease in serum 25-hydroxyvitamin D concentrations in the frail elderly: a longitudinal study Reviewed

    Kazutoshi Nakamura, Tomoko Nishiwaki, Kimiko Ueno, Masaharu Yamamoto

    JOURNAL OF BONE AND MINERAL METABOLISM   25 ( 4 )   232 - 236   2007.7

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    Several cross-sectional studies have demonstrated an age-related decrease in serum 25-hydroxyvitamin D [25(OH)D] concentrations. No prospective studies, however, have been conducted to examine this correlation to date. The objectives of this study were to measure age-related changes in serum 25(OH)D concentrations and to identify predictors of change in serum 25(OH)D concentrations in the frail elderly during a 2-year follow-up period. Eighty elderly subjects (48 women and 32 men) were selected from people utilizing the long-term care insurance system in a community in Japan. All subjects participated in both the baseline and follow-up (2 years later) medical examinations. Baseline measurements included age, height, body mass index, and weight. Additionally, levels of activities of daily living (Barthel index), grip strength, lifestyle, serum 25(OH)D, intact parathyroid hormone (PTH), albumin, total protein, and creatinine concentrations were also determined at baseline. The average age of the subjects was 82.1 years (SD, 8.8). The 2-year decrease in serum 25(OH)D concentrations was calculated to be 6 nmol/l. Multiple linear regression analyses found that the 2-year change (Delta) in the log-transformed 25(OH)D was associated with oalbumin (beta = 0.503, R-2 = 0.288, P &lt; 0.0001), and Delta log-transformed intact PTH was associated with baseline creatinine (beta = 0.453, R-2 = 0.142, P = 0.0006) and Delta log-transformed 25(OH)D (beta = -0.512, R-2 = 0.103, P = 0.0037). In conclusion, serum 25(OH)D concentrations decreased in the 2-year follow-up. This information is useful for the maintenance of vitamin D status and prevention of vitamin D insufficiency in the frail elderly.

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  • Threshold value of serum 25-hydroxyvitamin D concentration in relation to elevated serum parathyroid hormone concentrations in elderly Japanese women Reviewed

    Kazutoshi Nakamura, Mitsue Nashimoto, Yasuo Tsuchiya, Toshiko Saito, Tomoko Nishiwaki, Kimiko Ueno, Yoko Okuda, Rieko Oshiki, Masaharu Yamamoto

    JOURNAL OF BONE AND MINERAL METABOLISM   24 ( 5 )   395 - 400   2006.9

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    This study was designed to determine the threshold value for 25-hydroxyvitamin D [25(OH)D] concentration in relation to elevated serum parathyroid hormone (PTH) concentrations in elderly Japanese women. The subjects were 582 noninstitutionalized, ambulant women who lived in a community in Japan. Serum 25(OH)D concentrations were determined using the Nichols Advantage chemiluminescent assay, and serum intact PTH concentrations were determined with a two-site immunoradiometric assay. Demographic characteristics, calcium intake, and serum 1,25(OH)(2)D levels were also determined. The average age, body mass index (BMI), and calcium intake of the subjects were 74.5 years (SD 4.5), 23.3kg/m(2) (SD 3.4), and 579mg/day (SD 248), respectively. The serum log-transformed intact PTH concentration was significantly predicted by the serum 25(OH)D concentration (r = -0.147, P = 0.0004), but not by age, BMI, the serum log-transformed 1,25(OH)(2)D concentration, or the log-transformed calcium intake. Analysis of variance with Dunnett's multiple comparisons showed that mean serum intact PTH concentrations with serum 25(OH)D concentrations less than 30nmol/l (mean intact PTH = 5.89pmol/l, P &lt; 0.0001) and in the range 30-39nmol/l (mean intact PTH = 4.54pmol/l, P = 0.0067) were significantly higher than mean intact PTH concentrations for serum 25(OH)D concentrations greater than 50nmol/l (mean intact PTH = 3.65pmol/l, the baseline level), but the mean serum intact PTH concentration for 25(OH)D concentrations in the range 40-49nmol/l (mean intact PTH = 3.70pmol/l, P = 0.9975) was not. We conclude that serum 25(OH)D for ambulant elderly Japanese women should be maintained at 40nmol/l or higher.

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  • Vitamin D insufficiency in Japanese populations: from the viewpoint of the prevention of osteoporosis Reviewed

    K Nakamura

    JOURNAL OF BONE AND MINERAL METABOLISM   24 ( 1 )   1 - 6   2006.1

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    Low levels of vitamin D nutrition (i.e., vitamin D insufficiency), which potentially cause osteoporosis, have been recognized as a common health problem for elderly people in European and North American countries, but there have been no studies on the prevalence of vitamin D insufficiency in Japan until recently. The aim of this article was to review descriptive features of serum 25-hydroxyvitamin D [25(OH)D] levels and vitamin D insufficiency in Japanese subjects. Reviewing 15 studies pertaining to vitamin D nutritional status recently published for various Japanese populations revealed that: (1) the prevalence of vitamin D insufficiency in active elderly people was as low as 5% or less; (2) the prevalence of vitamin D insufficiency was much higher (up to about 50%) in inactive elderly people than in active elderly people, depending on activities of daily living (ADL); (3) frequent fish consumption helps increase serum 25(OH)D concentrations, especially in winter; and (4) vitamin D nutrition in young women was poorer than people in middle and advanced ages, which may adversely affect bone metabolism. Future studies should focus on the effects of low vitamin D status on bone mass and fractures in Japanese subjects.

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  • Efficacy of optimization of vitamin D in preventing osteoporosis and osteoporotic fractures: A systematic review Reviewed

    Kazutoshi Nakamura, Iki Masayuki

    Environmental Health and Preventive Medicine   11 ( 4 )   155 - 170   2006

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    Increased intake or supplementation of vitamin D is often recommended for normal bone health
    however, its preventive effect on osteoporosis has not been fully evaluated. The aim of this review is to gather evidence of the efficacy of the optimization of vitamin D nutrition in preventing osteoporosis and osteoporotic fractures. PubMed was used for searching the relevant literature using the MeSH terms "Bone Density (limited to "human", "female", and "English" literature)" or "Fractures (limited to "human", "age ≥45 years", and "English" literature)", and "Vitamin D". The searches yielded 19 randomized controlled trials (RCTs), nine cohort studies, 19 case-control studies, 19 cross-sectional studies, and one meta-analysis. We attempted to answer three questions: 1) does increased vitamin D intake prevent bone loss in peri- and postmenopausal women?, 2) does increased vitamin D intake prevent osteoporotic fractures in the elderly?, and 3) does increased vitamin D intake positively affect peak bone mass attainment in young women? The answer to questions 1 and 2 is that a vitamin D intake of 10-17.5 μg/day (400-700 IU/day) or more is effective in preventing bone loss in late postmenopausal women and an intake of 17.5-20 μg/day (700-800 IU/day) or more together with a calcium supplement reduces the risk of osteoporotic fractures. For question 3, some lines of evidence support the negative effect of low vitamin D nutrition on the attainment of peak bone mass in young women. Further studies are needed to clarify the effect of vitamin D in this age group.

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  • Vitamin D and prevention of osteoporosis: Japanese perspective Reviewed

    Kazutoshi Nakamura

    Environmental Health and Preventive Medicine   11 ( 6 )   271 - 276   2006

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    Vitamin D insufficiency, or a low vitamin D status, is a prevalent condition worldwide. However, there have been no studies addressing this public health issue until recently. In this review article, a summary of a series of studies conducted by the author and his colleagues to determine whether the vitamin D status of Japanese people is adequate and how their vitamin D status affects bone mass and bone metabolism is presented. The observational studies conducted by our group revealed that vitamin D insufficiency does not seem to be a serious problem among active elderly people, but that elderly people with a low level of activities of daily living (ADL) are at a very high risk of vitamin D insufficiency. In young adults, a high intact PTH concentration due to vitamin D insufficiency, which adversely affects their bone mass, is common, suggesting that vitamin D nutrition, as well as dietary calcium intake, should be improved. However, the effects of vitamin D insufficiency among elderly Japanese on bone metabolism, bone mass, and fractures have not been clarified, and should be studied further to determine whether specific preventive strategies, such as vitamin D supplementation, are required for this high-risk group. Intervention studies targeting Japanese populations are required to further address this issue.

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  • Serum 25-hydroxyvitamin D levels and activities of daily living in noninstitutionalized elderly Japanese requiring care Reviewed

    K Nakamura, T Nishiwaki, K Ueno, M Yamamoto

    JOURNAL OF BONE AND MINERAL METABOLISM   23 ( 6 )   488 - 494   2005.11

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    To date, no study has investigated the nutritional status of vitamin D in frail elderly people living at home. The purposes of this study were to assess serum 25-hydroxyvitamin D ( 25[ OH] D) levels and associated factors in noninstitutionalized elderly people who had various levels of physical disability, and to propose an adequate vitamin D nutritional status for the elderly by interpreting the serum 25( OH) D levels in relation to serum parathyroid hormone ( PTH) levels in this population. Health examinations were conducted in the winter and summer of 2003. The subjects were 143 elderly people in the winter, and 120 elderly people in the summer, who all used the long- term care insurance system at home. Serum 25( OH) D concentrations were determined with a chemiluminescence proteinbinding assay, and serum intact PTH concentrations were determined with an immunoradiometric assay. The subjects' disease histories and lifestyle information were obtained through an interview. Activities of daily living (ADL) levels were evaluated using the Barthel index, and grip strength was measured with a digital hand dynamometer. Average serum 25( OH) D levels in the winter and summer were 54.2 nmol/l (SD 29.0) and 53.3 nmol/l ( SD 32.3), respectively, and intact PTH concentrations in the winter and summer were 4.2 pmol/ l ( SD 1.8) and 4.3 pmol/ l ( SD 1.8), respectively. The proportion of people who had a low 25( OH) D (&lt; 30 nmol/l) and high intact PTH levels (&gt; 6.9 pmol/l) were 15% - 20% and 8%, respectively. Significant predictors of low serum 25( OH) D concentrations were low ADL levels, female sex, and low fish consumption in both seasons. Serum 25( OH) D concentrations of less than 50 nmol/l were associated with elevated serum intact PTH concentrations. In conclusion, elderly people requiring care at home are at high risk of hypovitaminosis D, and their low serum 25( OH) D levels are mainly associated with low ADL levels. In addition, maintenance of serum 25( OH) D concentrations above 50 nmol/ l may prevent hypovitaminosis D-induced hyperparathyroidism.

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  • Nutrition, mild hyperparathyroidism, and bone mineral density in young Japanese women Reviewed

    K Nakamura, K Ueno, T Nishiwaki, Y Okuda, T Saito, Y Tsuchiya, M Yamamoto

    AMERICAN JOURNAL OF CLINICAL NUTRITION   82 ( 5 )   1127 - 1133   2005.11

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    Background: The adverse effects of poor nutrition on the bones of young Asian women have not been fully elucidated.
    Objective: The purpose of this study was to investigate possible associations of vitamin D nutrition, calcium intake, and other nutrients with bone metabolism and bone mass in young Japanese women.
    Design: The subjects were 108 female college students aged 19-25 y. Dietary nutrients were measured by using the duplicate sampling method on 3 weekdays. Serum 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone, and bone turnover markers were also measured. Bone mineral density (BMD) of the spine and femur was measured by dual-energy X-ray absorptiometry.
    Results: The proportions of the subjects with low 25(OH)D (&lt;30 nmol/L) and high intact parathyroid hormone (&gt;= 6.9 pmol/L) concentrations were 32.4% and 15.7%, respectively. Serum 25(OH)D concentrations (P = 0.0265) and calcium intake (P = 0.0103) were inversely associated with serum intact parathyroid hormone. In addition to weight and physical activity, the presence of mild hyperparathyroidism was associated with a low BMD of the lumbar spine (P = 0.0062) and the femoral neck (P = 0.0250), and a low calcium intake was associated with a low BMD of the femoral neck (P 0.0044).
    Conclusions: Low calcium intake (based on low BMD of the femoral neck only) and mild hyperparathyroidism (based on low BMD of both the femoral neck and lumbar spine), partly explained by low vitamin D nutrition and a low calcium intake, are important predictors of low BMD in young Japanese women. Effects of poor nutrition and mild hyperparathyroidism on bone peak bone mass in young women should be further investigated in longitudinal studies.

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  • Intakes of calcium and other nutrients related to bone health in Japanese female college students: A study using the duplicate portion sampling method Reviewed

    K Ueno, K Nakamura, T Nishiwaki, T Saito, Y Okuda, M Yamamoto

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE   206 ( 4 )   319 - 326   2005.8

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    UENO, K., NAKAMURA, K., NISHIWAKI, T., SAITO, T., OKUDA, Y. and YAMAMOTO, M. Intakes of Calcium and Other Nutrients Related to Bone Health in Japanese Female College Students: A Study Using the Duplicate Portion Sampling Method. Tohoku J. Exp. Med., 2005, 206 (4), 319-326 - The purposes of this study were to determine intakes of nutrients related to bone health, such as calcium (Ca), phosphorus (P), sodium (Na), potassium (K), and protein, in Japanese female college students, using the duplicate portion sampling method, and to identify possible lifestyle factors explaining their calcium intakes. Subjects were 106 Japanese female college students aged 19-23 years. All foods in the duplicate portions, as eaten by the subjects during a three-weekday period, were collected. The minerals and protein in the food samples were analyzed. Life-style information was obtained by interview. Levels of cognitive eating restraint (CER) were assessed by the Three-Factor Eating Inventory. Average intakes of dietary Ca, P, Na, K, and protein were 380 (SD 209) mg/day, 649 (SD 212) mg/day, 2,535 (SD 847) mg/day, 1,108 (SD 429) mg/day, and 41.7 (SD 12.6) g/day, respectively. Ca intake was significantly associated with the frequency of milk intake (R-2 = 0.278, p &lt; 0.001), intake of other dairy products (R-2 = 0.338, p &lt; 0.001), and meal skipping (R-2 = 0.161, p &lt; 0.001), but not with CER score (p = 0.378). Female college students are at high risk for poor Ca nutrition. Low intake of nutrients relevant to bone health is considered to adversely affect bone metabolism in young women. bone health; dietary calcium; duplication sampling method; female college student; minerals. (c) 2005 Tohoku University Medical Press.

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  • Health characteristics of elderly Japanese requiring care at home Reviewed

    T Nishiwaki, K Nakamura, K Ueno, K Fujino, M Yamamoto

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE   205 ( 3 )   231 - 239   2005.3

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    The number of elderly subjects requiring care is rapidly increasing, however, their health status has not been well studied. The purposes of this study were to describe the health characteristics of the elderly at home who were using long-term care insurance, and to clarify factors that influence dependence for activities of daily living (ADL). The subjects were 194 elderly people living at home, who were approved for care. The items surveyed were the demographic characteristics, care level (or level of dependence for ADL), Barthel index, grip strength, thigh muscle volume, cognitive impairment using the mini-mental state examination (MMSE), depressed mood using the geriatric depression scale (GDS-15), and serum albumin and hemoglobin levels. The grip strength (p = 0.0001), thigh muscle volume (P = 0.0030), MMSE score (p = &lt; 0.0001) and serum albumin level (p = &lt; 0.0001) decreased, while the GDS-15 score (p = 0.0142) increased with deteriorating care levels. The proportion of subjects not requiring assistance for the items "bathing" and "stair-climbing" in the Barthel index was markedly low in the subjects belonging to the relatively low (mild) care levels. The logistic regression analysis showed that factors associated with dependence for "bathing" and "stair-climbing" were the use of day-services, male sex, decline of grip strength, and a high GDS-15 score. In conclusion, it is important to strengthen the muscles of the upper half of the body, and to correct depressed moods for maintaining levels of ADL in the elderly requiring care at home.

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  • Weight gain in childhood and bone mass in female college students Reviewed

    T Saito, K Nakamura, Y Okuda, M Nashimoto, N Yamamoto, M Yamamoto

    JOURNAL OF BONE AND MINERAL METABOLISM   23 ( 1 )   69 - 75   2005.1

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    The attainment of maximal peak bone mass early on in life is one of the most important strategies for the prevention of osteoporosis in women. The aim of this study was to clarify the correlation between gains in body size in all growth phases in childhood and adult bone mass in women. The subjects were 86 female first-year university students, aged 18-21 years. We measured the subjects' bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine and the left hip, including the femoral neck, with dual energy X-ray absorptiometry. Each subject was measured for current height and weight. Height and weight at birth, and at 1.5, and 3 years were obtained from each maternity record book, and those between 6 and 18 years were obtained from their school health records. Other information, including physical activity and calcium intake, was obtained through an interview. Bivariate analysis showed that weight gains during the periods from birth to 1.5 years and from 9 to 12 years significantly correlated with both BMC and BMD values at any site. The stepwise method of multiple regression analysis showed that a weight gain during the period from birth to 1.5 years was significantly associated with BMC at the lumbar spine (P=0.0001) and at the femoral neck (P=0.0290) and with BMD at the lumbar spine (P=0.0387). Birth weight was significantly associated with BMC at the lumbar spine (P=0.0474) and the total hip (P=0.0352), and weight gain during the period from 9 to 12 years was significantly associated with BMC at the femoral neck (P=0.0376). In conclusion, birth weight and weight gain in infancy are important determinants of bone mass in young women. Additionally, a girl's prepubertal growth spurt is likely to be a key phase for the acquisition of bone mass in relation to body weight. Our findings suggest that osteoporosis prevention programs may need to start very early in the life cycle.

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  • Dietary calcium, sodium, phosphorus, and protein and bone metabolism in elderly Japanese women: A pilot study using the duplicate portion sampling method Reviewed

    K Nakamura, Y Hori, M Nashimoto, Y Okuda, H Miyazaki, Y Kasai, M Yamamoto

    NUTRITION   20 ( 4 )   340 - 345   2004.4

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    OBJECTIVES: Associations between dietary factors and bone metabolism in Asians have not been thoroughly investigated. The purpose of this study was to determine the effect of dietary intake of calcium (Ca), phosphorus (P), sodium (Na), and protein on bone metabolism in elderly Japanese women by the duplicate portion sampling method.
    METHODS: The subjects were 43 healthy female volunteers (mean age, 68.3 y; standard deviation, 6.8). Dietary nutrients were directly determined by using a 24-h duplicate meal portion. Serum osteocalcin and bone alkaline phosphatase and urinary deoxypyridinoline (DPD) and type I collagen cross-linked N-telopeptides (NTX-I) were measured as markers of bone turnover. Hormones related to bone metabolism, including serum 25-hydroxyvitainin D-3, 1,25-dihydroxyvitamin D-3, and intact parathyroid hormone also were determined. Urinary parameters were corrected for urinary creatinine concentration.
    RESULTS: The mean (standard deviation) daily dietary intakes of Ca, P, Na, and protein were 660 (195) mg, 996 (208) mg, 4080 (1142) mg, and 63.9 (15.5) g, respectively. Dietary Ca was negatively correlated with urinary DPD (r = -0.417, P = 0.005) and NTX-I (r = -0.324, P = 0.034), and dietary P was negatively correlated with urinary DPD (r = -0.307, P = 0.045). Multiple regression analysis showed that only dietary Ca was associated with urinary DPD and NTX-I. Dietary Ca intake was significantly associated with bone resorption markers, but no other dietary factors were associated with any of the biochemical markers.
    CONCLUSION: The major factor having an adverse effect on the bone health of the elderly Japanese women is low Ca intake and not other dietary minerals or protein.

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  • Nutritional covariates of dietary calcium in elderly Japanese women: Results of a study using the duplicate portion sampling method Reviewed

    K Nakamura, Y Hori, M Nashimoto, Y Okuda, H Miyazaki, Y Kasai, M Yamamoto

    NUTRITION   19 ( 11-12 )   922 - 925   2003.11

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    OBJECTIVES: The purposes of this study were to determine the intake of nutrients related to bone health, including calcium (Ca), phosphorus (P), sodium (Na), potassium (K), protein, and vitamin D, in elderly Japanese women and to examine possible intercorrelations between Ca intake and other nutrients.
    METHODS: Fifty-three elderly women in a rural community in Japan participated by supplying duplicate meat samples of everything they ate during a 24-h period. Dietary Ca, P, Na, K, protein, and vitamin D intakes were examined. The mean (standard deviation) age of the 53 women was 68.2 y (6.4 y).
    RESULTS: The mean (standard deviation) intakes of dietary Ca, P, Na, K, protein, and vitamin D were 670 (219) mg/d, 1019 (267) mg/d, 4203 (1341) mg/d, 2752 (844) mg/d, 65.2 (18.3) g/d, and 9.90 (8,89) mug/d, respectively. Dietary Ca was significantly correlated with dietary P (r = 0.732, P &lt; 0.0001), Na (r = 0.336, P = 0.0140), K (r = 0.571, P &lt; 0.0001), and protein (r = 0.563, P &lt; 0.0001), but not with vitamin D. After adjusting the data to reflect the total dry weight, dietary Ca was still correlated with P (r = 0.696, P &lt; 0.0001), K (r = 0.423, P = 0.0018), and protein (r = 0.405, P = 0.0029).
    CONCLUSIONS: The intake of dietary nutrients relevant to bone health in ambulatory Japanese elderly women was examined and documented. The potential confounding effects of these nutrients, especially P, K, and protein, should be taken into account when evaluating the effects of dietary Ca on bone health in observational studies. (C) Elsevier Inc. 2003.

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  • Correlates of bone mineral density in elderly women living in nursing homes for the disabled in Japan Reviewed

    K Nakamura, M Nashimoto, S Matsuyama, M Hatakeyama, M Yamamoto

    AGING CLINICAL AND EXPERIMENTAL RESEARCH   14 ( 6 )   485 - 490   2002.12

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    Background and aims: Characteristics of bone aging in the institutionalized elderly are not well known. The aim of this study was to determine the factors correlated with the forearm bone mineral density (BMD) in elderly women with disability. Methods: Of 175 female residents living in nursing homes for the disabled in Niigata, Japan, 119 agreed to participate and underwent medical examinations in 1999; 107 (age range, 66-100) met our inclusion criteria. We measured forearm BMD by dual-energy X-ray absorptiometry (DXA), and the serum concentrations of 25-hydroxyvitamin D-3, 1,25-dihydroxyvitamin D-3, intact parathyroid hormone, albumin, total protein, and creatinine. Body weight, score of activities of daily living, and history of femoral neck fractures were also recorded. Results: Forearm BMD decreased with age, and the regression equation was BMD=0.9035exp, (-0.0179Age) (R-2=0.170, p&lt;0.0001). Multiple linear regression analysis revealed that only age (R-2=0.178, p&lt;0.0001), and serum creatinine (R-2=0.153, p&lt;0.0001) and albumin (R-2=0.051, p=0.005) concentrations were independently associated with log-BMD. Twenty-five of the 107 subjects had a history of femoral neck fracture, and only serum albumin concentration (p=0.031) was shown to be associated with fracture history. Conclusions: Forearm BMD was associated with age, serum creatinine and albumin, which may be useful parameters for assessing the bone health of elderly women with disability.

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  • Fish as a major source of vitamin D in the Japanese diet Reviewed

    K Nakamura, M Nashimoto, Y Okuda, T Ota, M Yamamoto

    NUTRITION   18 ( 5 )   415 - 416   2002.5

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    OBJECTIVES: We investigated the amount and sources of vitamin D in the Japanese diet by analyzing diet records collected over a 4-mo period.
    METHODS: Dietary data for this study were provided by a nursing home in Niigata, Japan. Diet records, written by the nursing home's dietitian, for 122 consecutive days between September and December 1999, were used. The amount of food for an individual was weighed before cooking and recorded on the diet record. Vitamin D-containing foods, including fish, eggs, meat, and mushrooms, were selected from the diet records, and their vitamin D (vitamin D2 plus D3) per day was calculated by referring to the Standard Tables of Food Composition in Japan.
    RESULTS: The overall average vitamin D intake per day was 7.10 mug (284 IU), which is about 70% of the recommended dietary allowance of 10 mug (400 IU). There were no significant differences in vitamin D values over the 4 mo (P = 0.822). Overall, the contribution of vitamin D from fish to total vitamin D intake was 90.7%, followed by mushrooms (4.4%), eggs (3.2%), and meat (1.7%).
    CONCLUSIONS: Frequent fish intake appears to be an advisable health practice in terms of preventing vitamin D insufficiency in the elderly. (C)Elsevier Science Inc. 2002.

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  • Hypovitaminosis D and hyperparathyroidism in physically inactive elderly Japanese living in nursing homes: Relationship with age, sunlight exposure and activities of daily living

    M Nashimoto, K Nakamura, S Matsuyama, M Hatakeyama, M Yamamoto

    AGING CLINICAL AND EXPERIMENTAL RESEARCH   14 ( 1 )   5 - 12   2002.2

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    Background and aims: The purposes of this study were to investigate the prevalences of hypovitaminosis D and hyperparathyroidism in physically inactive elderly people living in Japanese nursing homes and determine any correlations with demographic, environmental and/or life-style factors. Methods: We targeted 220 elderly people living in nursing homes for the physically disabled in Japan. Of these, 133 (women, 113; men, 20) subjects who agreed and met our inclusion criteria were studied. The average age of the subjects was 84.6 years (SD 8.2). Serum 25-hydroxyvitamin D-3(25[OH]D-3), intact parathyroid hormone (intact PTH), creatinine, and albumin concentrations were measured in each subject. Total hours of sunshine during the previous 5 weeks, activities of daily living (ADL) levels, and dietary vitamin D intake were also measured. ADL levels were evaluated using the Physical Self-Maintenance Scale (5-point scale). The examinations were performed between October and December, 1999. Results: The average concentrations of serum 25(OH)D-3 and intact PTH were 29.9 nmol/L (SD 13.1) and 5.04 pmol/L (SD 2.27), respectively. The prevalences of hypovitaminosis D (25[OH]D-3&lt;30 nmol/L) and hyperparathyroidism (intact PTH&gt;6.90 pmol/L) were 771133 (57.9%) and 21/133 (15.8%), respectively. Serum 25(OH)D-3 concentrations were positively associated with hours of sunshine (R-2=0.371, p&lt;0.001) and serum albumin concentrations (R-2=0.086, p&lt;0.001), but not with age (p=0.075) or total ADL score (p=0.527). A negative association between serum intact PTH and 25(OH)D-3 levels was found in subjects who were 80 years or older (p&lt;0.001) but not in subjects under the age of 80 years. Conclusions: Hypovitaminosis D and hyperparathyroidism are commonly seen in elderly Japanese with low ADL levels. Hypovitaminosis D seems to adversely affect PTH levels, especially in the very elderly.

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  • Low serum concentrations of 25-hydroxyvitamin D in young adult Japanese women: A cross sectional study

    K Nakamura, M Nashimoto, S Matsuyama, M Yamamoto

    NUTRITION   17 ( 11-12 )   921 - 925   2001.11

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    OBJECTIVES: The vitamin D nutrition status of young adult women is unclear, but a recent preliminary report suggested that they may have vitamin D insufficiency. This study assessed the serum concentrations of 25-hydroxyvitamin D (25[OH]D), an index of vitamin D nutrition status, in young adult Japanese women in comparison with those in older women and investigated whether serum 25(OH)D concentrations are associated with other calcium-related hormones and bone mass.
    METHODS: A cross sectional study of 77 healthy women, age 19 to 66 y, working in nursing homes in Japan was conducted in the winter of 1999 and 2000. The investigation included blood tests, forearm bone mass measurements, and a lifestyle questionnaire,
    RESULTS: The mean serum 25(OH)D concentration in women younger than 30 y was 34.0 nmoL/L (standard deviation [SD] = 11.0) and significantly lower than that in women 30 y and older (50.0 nmol/L, SD = 14.4). The proportion of subjects younger than 30 y who had serum 25(OH)D concentrations less than 30 nmol/L was 42.1% and was significantly higher (P &lt; 0.001) than the proportion of those 30 y and older (10.3%). There was a weak but significant linear association between serum 25(OH)D concentrations and forearm bone, mineral content (R-2 = 0.114, P = 0.0052) but not between serum 25(OH)D concentrations and bone mineral density. The association held after adjusting for body weight (R2 = 0.139, P = 0.0111). Serum intact parathyroid hormone concentrations were within the normal range and not associated with serum 25(OH)D concentrations.
    CONCLUSIONS: Serum 25(OH)D concentrations in young adult Japanese women (&lt; 30 y old) are lower than those of older adult women (30 to 66 y), and lower serum 25(OH)D concentrations are likely associated with lower forearm bone mineral content. (C) Elsevier Science Inc. 2001.

    DOI: 10.1016/S0899-9007(01)00662-1

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  • Serum 25-hydroxyvitamin D concentrations and related dietary factors in peri- and postmenopausal Japanese women

    K Nakamura, M Nashimoto, Y Hori, M Yamamoto

    AMERICAN JOURNAL OF CLINICAL NUTRITION   71 ( 5 )   1161 - 1165   2000.5

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    Background: Few studies of vitamin D nutrition in Asian populations have been conducted.
    Objective: The objective was to assess 25-hydroxyvitamin D [25(OH)D] concentrations in healthy elderly Japanese women during the winter and to determine whether 25(OH)D concentrations are associated with lifestyle.
    Design: We investigated 151 women aged 66.5 +/- 6.7 y ((x) over bar +/- SD) living in a rural community in February 1999. Serum 25(OH)D and intact parathyroid hormone were measured by using HPLC and an immunoradiometric assay, respectively. Information on lifestyle factors, including sunshine exposure and the consumption of vitamin D-rich foods, was also obtained through an interview.
    Results: The mean (+/- SD) 25(OH)D concentration was 59.9 +/- 17.0 nmol/L. Vitamin D insufficiencies (&lt;30 nmol/L) were found in 4.6% of the women, a value lower than that found in white populations. No correlation was found between age and 25(OH)D concentrations (r = 0.004, P = 0.957). The 25(OH)D concentration of subjects who consumed fish frequently (greater than or equal to 4 times/wk) was 10.1 nmol/L higher (P &lt; 0.001) than that of subjects with a moderate consumption of fish (1-3 times/wk). Additionally, those who did not consume eggs had significantly lower 25(OH)D concentrations than did those who consumed eggs greater than or equal to 1 time/wk (P &lt; 0.05).
    Conclusions: The nutritional status of vitamin D in Japanese populations seems to be better than that in most Western populations. Frequent fish consumption is believed to help maintain adequate concentrations of serum 25(OH)D in elderly Japanese women during the winter.

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  • Age and sex differences in the bone mineral density of the distal forearm based on health check-up data of 6343 Japanese

    K Nakamura, Y Tanaka, K Saitou, M Nashimoto, M Yamamoto

    OSTEOPOROSIS INTERNATIONAL   11 ( 9 )   772 - 777   2000

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    Bone mineral density (BMD) predicts osteoporotic fractures. The incidence of osteoporotic fractures in Japan is lower than among Caucasians, but fewer data on the BMD of Asians have been reported. This study attempted to clarify the age and sex differences in the forearm BMD of healthy adult to assess racial differences between Japanese and Caucasians. The subjects were 6343 healthy adult Japanese (5281 females, 1062 males) who underwent a health check-up at a health care service center between February 1995 and August 1999. Subjects' age ranged from 15 to 80 years. The BMD of the distal radius and ulna of the non dominant forearm was measured by dual-energy X-ray absorptiometry. Overall, the forearm BMD of men was greater than that of women in all age groups. Peak BMD was 0.484 g/cm(2) in the 40-44 year age group of women and 0.590 g/cm(2) in the 30-34 year age group of men. The forearm BMD of women under 50 years of age (the average age at menopause) increased slightly with age (2.0%/decade, p&lt;0.0001), but it did not among their male counterparts. After 50 years of age, BMD of the women decreased linearly (-1.6%/year, p&lt;0.0001) with age, the rate of decrease being 1.7-fold faster than in their male counterparts. Rates of gain and loss of forearm BMD differ between the sexes. In comparison with data previously reported, we did not find any evidence of racial differences in BMD as an explanation for the lower incidence of osteoporotic fractures in Japan.

    DOI: 10.1007/s001980070056

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  • 新潟大学のコホート研究・臨床疫学研究の進捗状況と今後の展望 村上コホート研究

    中村 和利, 北村 香織, 渡邊 裕美

    新潟医学会雑誌   132 ( 4 )   127 - 130   2018.4

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    私たちは、健康寿命延伸とビタミンDの加齢性疾患予防効果の解明を目的として、加齢性運動器疾患、認知症、その他の疾患のリスク要因や予防要因を包括的に解明する地域住民コホート研究を2011年に新潟県村上保健所管内で開始した。エンドポイントは、死亡と疾患罹患率であり、対象疾患は、骨粗鬆症性骨折、変形性膝関節症、認知症、慢性疼痛、その他である。健康調査票によるベースライン調査に同意した参加者(n=14,364)の平均年齢は、男性59.2歳(SD=9.3、n=6,907)、女性59.0歳(SD=9.3、n=7,457)であった。また、血液検体のある参加者(n=8,497)の平均年齢は、男性56.5歳(SD=18.4、n=3,710)、女性45.4歳(SD=16.5、n=4,787)であった。調査票による5年後フォローアップ調査を2016〜2017年に行い(回収率61%)、疾患追跡を順調に進めている。(著者抄録)

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  • 尿プロテオミクスによるアルツハイマー病バイオマーカー探索

    渡邊 裕美, 平尾 嘉利, 春日 健作, 徳武 孝允, 池内 健, 中村 和利, 山本 格

    Dementia Japan   31 ( 4 )   611 - 611   2017.10

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  • Comparison of weighed food record procedures for the reference methods in two validation studies of food frequency questionnaires Reviewed

    Ishii Y, Ishihara J, Takachi R, Shinozawa Y, Imaeda N, Goto C, Wakai K, Takahashi T, Iso H, Nakamura K, Tanaka J, Shimazu T, Yamaji T, Sasazuki S, Sawada N, Iwasaki M, Mikami H, Kuriki K, Naito M, Okamoto N, Kondo F, Hosono S, Miyagawa N, Ozaki E, Katsuura-Kamano S, Ohnaka K, Nanri H, Tsunematsu-Nakahata N, Kayama T, Kurihara A, Kojima S, Tanaka H, Tsugane S

    J Epidemiol   27 ( 7 )   331-337   2017.7

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    DOI: 10.1016/j.je.2016.08.008

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  • 簡易版食物摂取頻度調査票開発のための予備的検討 食品群・栄養素等の摂取量推定・妥当性検証

    横山悠太, 高地リベカ, 石原淳子, 岩崎基, 澤田典絵, 笹月静, 加藤恵梨香, 中村和利, 津金昌一郎

    J Epidemiol   24 ( Supplement 1 )   88   2014.1

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    J-GLOBAL

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  • 村上コホート研究について

    髙地 リベカ, 中村和利, 髙地リベカ, 北村香織, 斎藤トシ子, 小林量作, 押木利英子, 佐々木綾子, 山崎理

    新潟県医師会報   740   2 - 5   2011

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Research Projects

  • 加齢性運動器疾患の大規模分子疫学コホート研究10年後フォローアップ

    2019.4 - 2023.3

    JSPS  科学研究費補助金基盤研究B 

    中村 和利

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    Authorship:Principal investigator  Grant type:Competitive

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  • 加齢性運動器疾患の大規模分子疫学コホート研究5年後フォローアップ

    2015.4 - 2019.3

    JSPS  科学研究費補助金基盤研究B 

    中村 和利

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  • 加齢性運動器疾患の分子疫学コホート研究

    2011.4 - 2015.3

    JSPS  科学研究費補助金基盤研究A 

    中村 和利

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  • 骨折をアウトカムとして行う骨粗鬆症の遺伝および環境リスク要因の解明

    2005.4 - 2008.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

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    Grant amount:\2900000 ( Direct Cost: \2900000 )

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Teaching Experience

  • 医学序説 I

    2022
    Institution name:新潟大学

  • 臨床医学講義(集中)

    2022
    Institution name:新潟大学

  • 医学序説 II

    2021
    Institution name:新潟大学

  • 医学序説 I

    2020
    Institution name:新潟大学

  • 医学と社会

    2014
    Institution name:新潟大学

  • 医科学研究特論

    2014
    Institution name:新潟大学

  • 病気と遺伝学

    2013
    Institution name:新潟大学

  • 疫学

    2009
    Institution name:新潟大学

  • 環境医学

    2009
    Institution name:新潟大学

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