Effectiveness of nationwide screening and lifestyle intervention for abdominal obesity and cardiometabolic risks in Japan: The metabolic syndrome and comprehensive lifestyle intervention study on nationwide database in Japan (MetS ACTION-J study)

Abstract

BackgroundLifestyle interventions can substantially improve obesity and cardiometabolic risks. However, evidence of long-term benefits of national intervention is sparse. We aimed to evaluate the long-term effectiveness of a nationwide program for abdominal obesity.MethodsA retrospective cohort study was performed using a longitudinal nationwide individual data in subjects aged 40–74 years who underwent checkups in fiscal year (FY) 2008. Lifestyle interventions were provided via interview in subjects with abdominal obesity and at least one cardiometabolic risk factor. Subjects who attended the lifestyle intervention (participants) were compared to those who did not attend (non-participants). Outcomes were waist circumferences (WC) and body mass index (BMI) reduction, reversal of metabolic syndrome (MetS), and changes in cardiometabolic risks. We used a three-step process with robust analytic approaches to account for selection bias that included traditional multivariate analysis, propensity-score matching and instrumental variable (IV) analyses.ResultsOf 19,969,722 subjects, 4,370,042 were eligible for analyses; 111,779 participants and 907,909 non-participants. A higher percentage of participants had ≥5% reductions in obesity profiles at year 3, compared to non-participants (WC, 21.4% vs 16.1%; BMI, 17.6% vs 13.6%; p<0.001 each). Participants also had higher reversal for MetS (adjusted odds ratio 1.31; 95% confidence interval: 1.29–1.33; p<0.001). Greater reductions in cardiometabolic risks were observed in participants. Those results were confirmed in analyses using a propensity score-matched cohort (n = 75,777, each) and IV analyses. Limitations of this work include the use of non-randomized national data in Japan to assess the effectiveness of the nationwide preventive program.ConclusionsIn the nationwide lifestyle intervention for abdominal obesity, the at-risk population achieved significant reductions in WC, BMI, and cardiometabolic risks in 3 years. This study provides evidence that the nationwide program effectively achieved long-term improvement in abdominal obesity and cardiometabolic risks.

Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men

“…The observed weight loss (ToT effect) of −2.2% (1.56 kg reduction) in our study was smaller than other lifestyle interventions for obesity, such as the 6.0% weight loss seen with the Diabetes Prevention Program. 24 This is probably because the threshold of waist circumference was relatively low; therefore, the population that received the intervention was relatively healthy. It may also be the case that the influence of an intervention for obesity implemented in the real world (effectiveness) may be smaller than what we find in randomized clinical trials (RCTs) (efficacy) because participants recruited in randomized clinical trials are usually self-selected, highly motivated individuals.…”

Risk and population attributable fraction of metabolic syndrome and impaired fasting glucose for the incidence of type 2 diabetes mellitus among middle‐aged Japanese individuals: Aichi Worker’s Cohort Study

“…The present findings imply that non-MetS individuals with IFG require vigorous interventions to prevent future type 2 diabetes mellitus development among the Japanese population. Health education support is an integral part of the Japanese MetS screening program 9,10 , which is provided to MetS individuals only. As lifestyle modification, such as strengthening physical activities or improving dietary habits, are reported to be effective in preventing the progression of hyperglycemia to type 2 diabetes mellitus 16,17 , such interventions should be provided to non-MetS individuals with IFG as well.…”

“…In this program, MetS is defined as either abdominal obesity plus two or more metabolic risk factors, or being overweight in the case of normal waist circumference plus three or more metabolic risk factors (Table 1) 7 . This program aims to improve abdominal obesity by modifying lifestyles, and eventually to prevent cardiovascular diseases and type 2 diabetes mellitus 9,10 . However, the current program does not include non-MetS individuals with impaired fasting glucose (IFG) as targets for the health education support.…”

Awareness of Locomotive Syndrome and Factors Associated with Awareness: A Community-Based Cross-Sectional Study

“…Looking back, in Japan, awareness of metabolic syndrome has dramatically increased since it was taken up as a basic medical examination item targeting middle-aged and older adult in 2008 [ 28 , 29 ]. According to this, incorporating locomotive syndrome into the health checkup items may be the most effective way to raise awareness.…”