論文 - 宮川　尚子

Six random specimens of daytime casual urine on different days are sufficient to estimate daily sodium/potassium ratio in comparison to 7-day 24-h urine collections.

Iwahori T, Ueshima H, Miyagawa N, Ohgami N, Yamashita H, Ohkubo T, Murakami Y, Shiga T, Miura K

Hypertension research : official journal of the Japanese Society of Hypertension （NATURE PUBLISHING GROUP）  37 （ 8 ） 765 - 71 2014年08月

研究論文（学術雑誌）, 査読有り,  ISSN  0916-9636

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The objective of this study was to determine the optimal number and type of casual (spot) urine specimens required to estimate an individual's urinary sodium/potassium (Na/K) ratio. A total of 48 participants, 25 men and 23 women, aged between 25 and 59 years, was recruited from healthy volunteers. The Na/K ratio in each casual urine and 7-day 24-h urine sample was measured. Correlation analysis and the quality of agreement by the Bland and Altman method between casual urine and 24-h urine were analyzed. The mean Na/K ratio of 7-day 24-h urine was 4.3. The mean Na/K ratio of six random specimens of daytime (collected between 09 and 17 hours) casual urine correlated most strongly with the Na/K ratio of 7-day 24-h urine (r=0.87). The bias for the mean Na/K ratio between 7-day 24-h urine and daytime casual urine was almost negligible (0.03), and the quality of agreement for the mean of the six random, daytime casual urine specimens on different days was similar to that of the 2-day 24-h urine samples for estimating 7-day 24-h values. Our findings show that the mean Na/K ratio of six random daytime casual urine specimens on different days was a good substitute for the 2-day 24-h urine Na/K ratio.

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レセプト情報・特定健診等情報データベースを利用した滋賀県における循環器疾患危険因子の有病率、治療率、コントロール率

宮川 尚子, 村上 義孝, 岡山 明, 角野 文彦, 三浦 克之

日本公衆衛生雑誌 （日本公衆衛生学会）  61 （ 7 ） 333 - 341 2014年07月

研究論文（学術雑誌）, 筆頭著者, 査読有り,  ISSN  0546-1766

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目的 生活習慣病の予防戦略立案において、循環器疾患危険因子の有病率、治療率およびそのコントロール率を性・年齢別に詳細に実態把握することは公衆衛生上重要である。高齢者の医療の確保に関する法律に基づく「レセプト情報・特定健診等情報データベース」の研究利用が可能になったことに伴い、滋賀県の特定健診全受診者における高血圧、糖尿病および高LDLコレステロール血症の有病率、治療率およびコントロール率を明らかにする。方法 滋賀県在住の平成20年度特定健診受診者全員を対象者とし、本データベースにおける特定健診に関する提供データを用い、性・年齢別(5歳階級)に高血圧、糖尿病、高LDLコレステロール血症の有病率、治療率、コントロール率およびその95%信頼区間を算定した。コントロール率は、高血圧、糖尿病、高LDLコレステロール血症治療者のうち、検査値が基準値未満の者の割合とした。結果 滋賀県在住の平成20年度特定健診受診者は211,976人であった。高血圧では男女ともに有病率(男性16〜60%、女性6〜58%)と治療率(男性23〜71%、女性24〜71%)は年齢上昇に伴い増加したが、コントロール率は約55%で年齢による違いがなかった。糖尿病では、男女の有病率(男性3〜15%、女性1〜10%)と男性の治療率(44〜62%)は年齢上昇に伴い増加し、コントロール率も男性で43〜51%、女性で32〜50%と緩やかに増加した。高LDLコレステロール血症では女性の有病率(16〜57%)と男女の治療率(男性6〜44%、女性6〜51%)、コントロール率が年齢上昇に伴い増加し、コントロール率は男性で63〜80%、女性で64〜77%と高い値を示した。結論 レセプト情報・特定健診等情報データベースの特定健診データの活用により循環器疾患危険因子の有病率、治療率の詳細把握が可能になるとともに、これまで報告がなかったコントロール率が明らかとなり、本データベースは生活習慣病の実態把握に有効に利用できることが示された。(著者抄録)

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滋賀県野洲市における特定健診未受診理由を踏まえた特定健診受診勧奨手法の開発と受診率向上への効果

宮川 尚子, 門田 文, 清水 めぐみ, 山澤 幸子, 宇野 裕子, 大黒 清夏, 今堀 初美, 山下 亜希代, 櫻井 真汐, 駒井 文昭, 吉田 和司, 門脇 崇, 上島 弘嗣, 三浦 克之, 岡村 智教

厚生の指標 （(一財)厚生労働統計協会）  61 （ 4 ） 28 - 34 2014年04月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り,  ISSN  0452-6104

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目的 平成20年度より開始された特定健診の平均受診率は市町村国保で31%前後であり,参酌標準の65%と大きく乖離している。健診受診率に影響を及ぼす要因について,受診勧奨施策の受診率への効果を検討した報告は少ない。本研究では,滋賀県野洲市において特定健診未受診者の未受診理由を明らかにし,得られた未受診理由を踏まえた健診受診勧奨手法を開発して,その効果について検討した。方法 滋賀県野洲市の国保加入者を対象として,平成21年度に,前年度(平成20年度)の特定健診未受診者4,122人のうち無作為抽出した1,579人に郵送にて特定健診未受診の理由を尋ねる質問紙調査を実施し,760人(48.1%)から回答を得た。特定健診未受診理由に基づき,未受診理由を踏まえた受診勧奨手法を開発し,平成22年度に受診率向上のための対策を実施した。勧奨手法の効果は,健診実施期間が平成22年度と同じであった平成20年度の健診受診率との比較により評価した。結果 健診未受診理由調査の結果,年齢層に関わらず「病院などにかかっている」「事業所健診等を受けている」「たまたま受け忘れた」「健康だから」が多く,中壮年層では加えて「受ける時間がない」も多かった。これらの未受診理由を踏まえて,個人と集団,それぞれへのアプローチを組み合わせた受診勧奨手法を開発した。個人へのアプローチとしては健診開始時に受診券と一緒に受診勧奨チラシを対象者全員に個別送付し,また健診期間の中間時点に,その時点の未受診者全員に再度,受診勧奨チラシと健診実施機関一覧表を個別送付した。集団に対するアプローチとしては同じく健診期間の中間時点で,「健康で自覚症状のない時の受診の重要性」をテーマにした記事の広報掲載とポスターの掲示を行った。この受診勧奨手法を用いた平成22年度の特定健診受診率は,用いていない平成20年度に比べて7.2%有意に上昇し,これは年齢層に分けても同様の結果であった。受診のきっかけを調査したところ,今回の受診勧奨手法をあげた者の割合は,ほぼ受診率の増加分に相当する660人(受診率8%相当)であった。結語 特定健診未受診理由を踏まえた受診勧奨手法を開発し,その効果を評価した。タイミングを見計らった個別通知や,健診受診の意義を伝える勧奨を,集団および個人を対象に実施したことにより,高年層,中壮年層ともに健診受診率は大きく上昇し,本受診勧奨手法の有用性が示された。(著者抄録)

Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80.

Miyagawa N, Miura K, Okuda N, Kadowaki T, Takashima N, Nagasawa SY, Nakamura Y, Matsumura Y, Hozawa A, Fujiyoshi A, Hisamatsu T, Yoshita K, Sekikawa A, Ohkubo T, Abbott RD, Okamura T, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Atherosclerosis （ELSEVIER IRELAND LTD）  232 （ 2 ） 384 - 9 2014年02月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り,  ISSN  0021-9150

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Background: Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake.
Objective: To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population.
Methods: We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake.
Results: During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37% kcal (0.86 g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P = 0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline).
Conclusion: LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

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Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan.

Liu L, Miura K, Fujiyoshi A, Kadota A, Miyagawa N, Nakamura Y, Ohkubo T, Okayama A, Okamura T, Ueshima H

The American journal of cardiology （EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC）  113 （ 1 ） 84 - 9 2014年01月

研究論文（学術雑誌）, 査読有り,  ISSN  0002-9149

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The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES 111; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan. (C) 2014 Elsevier Inc. All rights reserved.

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Interaction between dietary marine-derived n-3 fatty acids intake and J-point elevation on the risk of cardiac death: a 24-year follow-up of Japanese men.

Hisamatsu T, Miura K, Ohkubo T, Yamamoto T, Fujiyoshi A, Miyagawa N, Kadota A, Takashima N, Okuda N, Matsumura Y, Yoshita K, Kita Y, Murakami Y, Nakamura Y, Okamura T, Horie M, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Heart (British Cardiac Society) （BMJ PUBLISHING GROUP）  99 （ 14 ） 1024 - 9 2013年07月

研究論文（学術雑誌）,  ISSN  1355-6037

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Objective Higher marine-derived n-3 fatty acids (MDn3FAs) intake reduces the risk of sudden cardiac death via antiarrhythmic effects. The article evaluates whether MDn3FAs intake attenuates the increased risk of cardiac death associated with J-point elevation (JPE), characterised by an elevation of QRS-ST junction (J-point) >= 0.1 mV on electrocardiography.
Design A prospective population-based cohort study.
Setting The National Survey on Circulatory Disorders and the National Nutrition Survey of Japan.
Participants A total of 4348 community-dwelling men (mean age 49.3 years), without cardiovascular diseases at baseline, from randomly selected areas across Japan.
Main outcome measures Cardiac death (200 men) during the 24-year follow-up.
Results Dietary MDn3FAs intake was assessed using a dietary method to estimate individual intake of household-based weighed food records for 3 days. Cox models were used to calculate HRs and 95% CIs adjusted for possible confounding factors. JPE was present in 340 participants (7.8%). The median daily intake of MDn3FAs was 0.35% kcal (0.92 g/day). The risk of cardiac death was significantly higher in participants with JPE than in those without JPE in the low intake group (<0.35% kcal; adjusted HR 3.51; 95% CI 1.84 to 6.73; p<0.001), but not in the high intake group (>= 0.35% kcal; adjusted HR 1.09; 95% CI 0.56 to 2.16; p=0.795). The interaction between dietary MDn3FAs intake and JPE on the risk of cardiac death was statistically significant (p=0.006).
Conclusions The increased risk of cardiac death associated with JPE may be attenuated by higher dietary MDn3FAs intake.

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Association between J-point elevation and death from coronary artery disease--15-year follow up of the NIPPON DATA90.

Hisamatsu T, Ohkubo T, Miura K, Yamamoto T, Fujiyoshi A, Miyagawa N, Kadota A, Takashima N, Nagasawa SY, Kita Y, Murakami Y, Okayama A, Horie M, Okamura T, Ueshima H, NIPPON DATA90 Research Group.

Circulation journal : official journal of the Japanese Circulation Society 77 （ 5 ） 1260 - 6 2013年

研究論文（学術雑誌）, 査読有り,  ISSN  1346-9843

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Background: An early repolarization pattern, characterized by an elevation of the QRS-ST junction (J-point) on 12-lead electrocardiography (ECG) is associated with cardiac and sudden death. However, little is known about the prognostic significance of J-point elevation for various disease-specific cardiovascular outcomes, including coronary artery disease (CAD). Methods and Results: To investigate the association between the presence of J-point elevation ≥0.1 mV and various disease-specific cardiovascular outcomes, we conducted a 15-year prospective study in a representative general Japanese population of 7,630 individuals (41% men, mean age 52.4 years) who participated in the National Survey of Circulatory Disorders. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. J-point elevation was present in 264 individuals (3.5%) and was associated with an increased risk of cardiac death (adjusted HR, 2.54
95% confidence interval [CI] 1.40-4.58
P=0.002) and death from CAD (adjusted HR, 4.66
95% CI 2.30-9.46
P&lt
0.001). In a subgroup analysis by age, the association between J-point elevation and cardiovascular outcomes was more remarkable in middle-aged (&lt
60 years) than in older individuals (≥60 years) (all P for interaction &lt
0.05). Conclusions: J-point elevation on standard 12-lead ECG was an independent predictor of cardiac death and death from CAD in a representative sample of the general Japanese population, particularly among the middle-aged.

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Fatty acid intakes and coronary heart disease mortality in Japan: NIPPON DATA90, 1990-2005

Yasuyuki Nakamura, Yutaka Kiyohara, Nagako Okuda, Tomonori Okamura, Aya Higashiyama, Makoto Watanabe, Aya Kadota, Shin-ya Nagasawa, Naoko Miyagawa, Takayoshi Ohkubo, Yoshikuni Kita, Katsuyuki Miura, Akira Okayama, Hirotsugu Ueshima

Current Nutrition and Food Science 9 （ 1 ） 26 - 32 2013年

ISSN  1573-4013

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Associations between dietary fatty acid intakes and risk of coronary heart disease (CHD) are not entirely consistent in prospective studies in the U.S. and Europe. Such studies in Japan are rare. The objective of this study was to examine the association between dietary total, saturated (SFA), and polyunsaturated (PUFA) fatty acids, cholesterol intake and CHD mortality using the dataset of NIPPON DATA90. At the baseline in 1990, we performed blood biochemical measurements and a nutritional survey on participants from 300 randomly selected districts. After exclusion of participants with a history of CHD and/or stroke at the baseline, we followed 7,819 community residents (3,254 men and 4,565 women, age ≥ 30) for 15 years. We estimated individual nutrient intakes among family members by weighed food records in three consecutive representative days. During the follow-up, there were 42 CHD deaths in men and 30 in women. Mean daily SFA and PUFA % calorie intakes were 5.90±1.36%, and 5.59±1.30%, respectively in men, and 6.48±1.53%, and 6.08±1.14% in women. A Cox analysis adjusted for age, vegetable and fruit intakes, and other confounders in women found that SFA intake was significantly associated with CHD mortality (hazards ratio per one quintile increment=1.34, 95% confidence intervals: 1.02-1.74, P=0.03), while no such association was noted in men. No associations were found between other fat intakes and CHD mortality in men or women. In conclusion, SFA intake was positively associated with CHD mortality independent of confounders in women, but not in men. © 2013 Bentham Science Publishers.

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Long-term risk of BP values above normal for cardiovascular mortality: a 24-year observation of Japanese aged 30 to 92 years.

Takashima N, Ohkubo T, Miura K, Okamura T, Murakami Y, Fujiyoshi A, Nagasawa SY, Kadota A, Kita Y, Miyagawa N, Hisamatsu T, Hayakawa T, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Journal of hypertension （LIPPINCOTT WILLIAMS & WILKINS）  30 （ 12 ） 2299 - 306 2012年12月

研究論文（学術雑誌）, 査読有り,  ISSN  0263-6352

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Objective: In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population.
Methods: We followed up a nationwide sample of 8592 Japanese, aged 30 years or above without a history of CVD and antihypertensive medication at baseline, for 24 years. Hazard ratios for CVD mortality in BP categories defined according to JCN7 criteria were estimated using Cox model adjusted for potential confounding factors with normal BP treated as the reference category.
Results: We observed 689 CVD deaths. Hazard ratios for CVD mortality were progressively and significantly increased from the category of prehypertension. Population-attributable fraction (PAF) demonstrated that 43 and 48% of CVD and stroke deaths were explained by non-normal BP at baseline. Hazard ratios and PAF were remarkably higher in younger participants (aged 30-59 years) than those in the elderly (aged 60 years or above). Particularly, in younger men, 81% of CVD deaths were explained by non-normal BP. In sensitivity analysis, participants with antihypertensive medication showed the highest hazard ratio for CVD morality compared with the other categories.
Conclusions: BP levels above normal at baseline retained significant relative and absolute risks of CVD and stroke mortality during 24 years. Long-lasting burden of non-normal BP particularly in younger individuals suggests the importance of primary prevention of high BP from younger generation.

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