Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Clinical Research Promotion Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Prev Med. 2020 Dec;141:106301. doi: 10.1016/j.ypmed.2020.106301. Epub 2020 Oct 24.
The Japanese government launched a nationwide health screening and lifestyle intervention program in 2008 to prevent and reduce metabolic syndrome in at-risk individuals. This study examined the longitudinal effects of the program's lifestyle interventions on metabolic outcomes using health insurance data from one prefecture. The study population comprised 16,317 individuals aged 40-74 years who met the recommendation criteria for the interventions between 2009 and 2015. Participants were categorized into an overall intervention group (comprising a single-session motivational intervention group and a multi-session intensive intervention group) and a non-intervention group. We evaluated the interventions' effects on the initiation of medications for metabolic disorders (hyperlipidemia, hypertension, and hyperglycemia) and metabolic syndrome incidence for 6 years using discrete hazard models that adjusted for sex, age, health screening measurements, and smoking habit. The longitudinal effects on health screening measurements were also evaluated using regression models for repeated measures. The adjusted hazard ratios (aHRs) (95% confidence interval [CI]) for initiation of medications were 0.83 (0.77-0.90), 0.77 (0.71-0.84), and 0.66 (0.57-0.77) for overall, motivational, and intensive interventions, respectively. The aHRs (95%CI) for metabolic syndrome incidence were 0.84 (0.75-0.94), 0.80 (0.71-0.91), and 0.67 (0.51-0.89) for overall, motivational, and intensive interventions, respectively. The interventions reduced body mass index and waist circumference, but had modest effects on blood lipids, blood glucose, and hemoglobin A1c levels; blood pressure was unaffected. These interventions represent an effective strategy to prevent the progression of preclinical metabolic syndrome, but further studies are needed to evaluate their long-term preventive effects on cardiovascular disease and diabetes.
日本政府于 2008 年启动了一项全国性的健康筛查和生活方式干预计划，以预防和减少高危人群的代谢综合征。本研究利用一个县的医疗保险数据，考察了该计划生活方式干预对代谢结果的纵向影响。研究人群包括 2009 年至 2015 年符合干预推荐标准的 16317 名 40-74 岁个体。参与者分为总体干预组（包括单次动机干预组和多次强化干预组）和非干预组。我们使用离散风险模型，根据性别、年龄、健康筛查测量值和吸烟习惯，评估了 6 年内代谢障碍（血脂异常、高血压和高血糖）药物治疗开始和代谢综合征发病率的干预效果。还使用重复测量的回归模型评估了对健康筛查测量值的纵向影响。药物治疗开始的调整后危险比（aHR）（95%置信区间[CI]）分别为 0.83（0.77-0.90）、0.77（0.71-0.84）和 0.66（0.57-0.77），对应于总体、动机和强化干预。代谢综合征发病率的 aHR（95%CI）分别为 0.84（0.75-0.94）、0.80（0.71-0.91）和 0.67（0.51-0.89），对应于总体、动机和强化干预。这些干预措施降低了体重指数和腰围，但对血脂、血糖和血红蛋白 A1c 水平的影响较小；血压不受影响。这些干预措施代表了预防临床前代谢综合征进展的有效策略，但需要进一步研究来评估它们对心血管疾病和糖尿病的长期预防效果。
