Faculty Profiles - NAKAMURA Kazutoshi

Papers - NAKAMURA Kazutoshi

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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

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

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 < 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.

DOI： 10.1007/s12199-016-0542-2

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

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

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.

DOI： 10.1007/s12199-016-0572-9

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

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN EPIDEMIOLOGICAL ASSOC

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.

DOI： 10.2188/jea.JE20150064

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

Language：English Publishing type：Research paper (scientific journal) Publisher：TOHOKU UNIV MEDICAL PRESS

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.

DOI： 10.1620/tjem.239.95

【災害と自殺予防】新潟県中越地震被災地における住民の心の健康の推移

中村和利, 北村香織

自殺予防と危機介入 36 ( 2 ) 8 - 12 2016.3

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

Language：English Publishing type：Research paper (scientific journal) Publisher：S. Karger AG

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.

DOI： 10.1159/000442585

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

Language：English Publishing type：Research paper (scientific journal) Publisher：S. Karger AG

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.

DOI： 10.1159/000447963

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

Language：English Publisher：WILEY-BLACKWELL

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 (<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.

DOI： 10.1111/obr.12309

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

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS

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.

DOI： 10.1093/pubmed/fdu052

The Interaction Between β-3 Adrenergic Receptor and Peroxisome Proliferator-Activated Receptor Gamma Gene Polymorphism to Periodontal Disease in Community-Dwelling Elderly Japanese. Reviewed International journal

Akihiro Yoshihara, Noriko Sugita, Masanori Iwasaki, Yanming Wang, Hideo Miyazaki, Hiromasa Yoshie, Kazutoshi Nakamura

Journal of periodontology 86 ( 8 ) 955 - 63 2015.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: It has been hypothesized that β-3 adrenergic receptor and peroxisome proliferator-activated receptor gamma (PPARγ) might have gene-environmental and gene-gene interactions in periodontal disease. The purpose of this study is to elucidate the interaction between β-3 adrenergic receptor and PPARγ gene polymorphism with periodontal disease. METHODS: Three hundred thirty-two postmenopausal females were enrolled, and their serum high-sensitivity C-reactive protein (hsCRP) and hemoglobin A1c (HbA1c) were examined. β-3 adrenergic receptor and PPARγ genotypes were then determined. An oral examination was performed. The number of remaining teeth was counted, and the probing depth (PD) and clinical attachment level (CAL) were measured. Prevalence-rate ratios (PRRs) were calculated by multiple Poisson regression analyses to evaluate the relationship among periodontal disease markers, such as the number of sites with CAL 4 to 5 or ≥6 mm or PD 4 to 5 or ≥6 mm, and β-3 adrenergic receptor polymorphisms, PPARγ polymorphisms, and the interaction term adjusted by age, hsCRP, and HbA1c, after converting the number of remaining teeth (n) to an offset variable. RESULTS: In the participants with body mass index (BMI) ≥25, PRRs of β-3 adrenergic receptor genotype (Trp/Arg and Arg/Arg) for periodontal disease markers were 0.13 to 0.70 (P <0.0001 to 0.74), those of PPARγ genotype (Pro/Pro) were 0.66 to 3.14 (P = 0.01 to 0.68), and those of the interaction term for the two genotypes were 1.69 to 12.61 (P <0.0001 to 0.33). However, in the participants with BMI <25, a constant tendency was not observed. CONCLUSION: The results confirmed a positive relationship between the interaction term for β-3 adrenergic receptor genotype and PPARγ genotype and various periodontal markers in obese elderly females.

DOI： 10.1902/jop.2015.140472

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

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

Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: The Japan Public Health Center-based Prospective Study Reviewed

K. Nakamura, K. Kitamura, M. Inoue, N. Sawada, S. Tsugane

OSTEOPOROSIS INTERNATIONAL 25 ( 11 ) 2565 - 2571 2014.11

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER LONDON LTD

This study assessed the effects of physical activity on a 10-year incidence of self-reported vertebral fractures in adult women of a large Japanese cohort. Medium levels of strenuous activity and long-duration sedentary activity were associated with a lower incidence of vertebral fractures; association patterns appear to be different from hip fractures.
Physical activity helps prevent hip fracture, but little is known about the longitudinal association between physical activity and vertebral fractures. The purpose of this study was to evaluate the effects of physical activity on the 10-year incidence of symptomatic vertebral fractures using data from the Japan Public Health Center-based Prospective Study.
Baseline studies were conducted in 1993-1994, and the follow-up study was conducted 10 years later. We analyzed 23,757 women aged 40-69 years. At baseline, physical activity was assessed as a predictor by using a questionnaire. Subjects were asked to report vertebral fractures that occurred during the 10-year follow-up period. Relative risks (RRs) adjusted for confounders were estimated by multiple logistic regression analysis.
The 10-year cumulative incidence of vertebral fractures was 0.67 %. Those who engaged in strenuous physical activity of < 1 h/day had a significantly lower incidence of vertebral fractures than those who did not engage in such activity (RR = 0.52, 95 % CI 0.28-0.97), while those engaged in such activity a parts per thousand yen1 h/day did not (RR = 0.82, 95 % CI 0.58-1.14). Long-duration sedentary activity was associated with a low incidence of vertebral fractures (P for trend = 0.0002), but the frequencies of sports activities and metabolic equivalents were not (P for trend = 0.0729 and 0.4341, respectively).
Strenuous activity and sedentary activity are associated with the incidence of vertebral fractures, although the association may not be linear. The pattern of association between physical activity and vertebral fractures appears to be different from that of hip fractures.

DOI： 10.1007/s00198-014-2770-x

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

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN EPIDEMIOLOGICAL ASSOC

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 < 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.

DOI： 10.2188/jea.JE20130097

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

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER LONDON LTD

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<0.001 and =0.002, respectively) and femoral neck (P for trend=0.026 and <0.001, respectively); low BMI was associated with a decrease in lumbar spine BMD (P for trend<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.

DOI： 10.1007/s11657-013-0153-0

Association between low bone mineral density and clinical attachment loss in Japanese postmenopausal females Reviewed

Masanori Iwasaki, George W. Taylor, Kazutoshi Nakamura, Akihiro Yoshihara, Hideo Miyazaki

Journal of Periodontology 84 ( 12 ) 1708 - 1716 2013.12

Language：English Publishing type：Research paper (scientific journal)

Background: Previous studies have shown conflicting results as to whether low bone mineral density (BMD) is associated with severe clinical attachment loss (AL). The effect of dental restoration on AL was not considered in most studies. In addition, studies of this association in Japanese individuals are limited. The aim of this crosssectional study is to evaluate the possible association between BMD and AL with dental restoration information in Japanese community-dwelling postmenopausal females. Methods: The participants were 397 females (average age: 68.2 years). BMDs of the lumbar spine and right proximal femur were measured by the dual-energy x-ray absorptiometry method. Based on lower BMD/young adult mean (YAM) among the two sites measured, participants were classified into three groups: 1) normal: BMD = 80% YAM or higher (n = 161)
2) osteopenia: BMD = 70% to 80% YAM (n = 136)
and 3) osteoporosis: BMD = &lt
70% YAM (n = 100). Multivariable analyses of the differences in AL values among three BMD groups was conducted using general linear models. Adjustments for the percentage of teeth restored and other covariates were considered. Results: Individuals with osteopenia had significantly higher average AL than individuals with normal BMD (P = 0.022). Additionally, the osteoporosis group displayed significantly higher average AL (P = 0.003) and higher percentages of sites with AL ≥4 mm (P = 0.007). Conclusion: The results of the present study indicate that low systemic BMD was associated with severe AL in Japanese community-dwelling postmenopausal females.

DOI： 10.1902/jop.2013.120613

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

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

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 (< 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 < 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.

DOI： 10.1007/s12199-013-0351-9

加齢性運動器疾患の分子疫学コホート研究(村上鮭で元気プロジェクト)

中村和利, 高地リベカ, 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, 伊木雅之

日本公衆衛生学会総会抄録集 72回 272 - 272 2013.10

地域住民における血中25-hydroxyvitamin Dレベル村上コホート研究

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

Osteoporosis Japan 21 ( Suppl.1 ) 219 - 219 2013.9

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

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN EPIDEMIOLOGICAL ASSOC

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 <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.

DOI： 10.2188/jea.JE20110153

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