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Aim: This study explored longitudinally the relationship between smoking and secondhand smoke and the incidence of physical frailty in community-dwelling Japanese older people., Methods: Data collected from the National Institute for Longevity Sciences-Longitudinal Study of Aging database from 2002 to 2012 (third to seventh wave) among older adults aged ≥65 years were analyzed. Participants with physical frailty at baseline, as determined by the Cardiovascular Health Study criteria, missing data or who failed to attend follow ups were excluded. Data on current cigarette smoking and secondhand smoke exposure were collected from the third wave results. The generalized estimating equation model was used to examine the longitudinal relationships between smoking, secondhand smoke and subsequent frailty., Results: The final analysis included 540 participants with a mean age of 71.4 years (standard deviation 4.6). The generalized estimating equation analysis showed that, compared with non-smokers, smokers were at significant risk of physical frailty (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.21-4.74) after adjustment for multiple covariates; especially men (OR 3.75, 95% CI 1.76-8.00) and older adults aged ≥75 years (OR 4.12, 95% CI 1.43-11.87). Participants exposed to both smoking and secondhand smoke had a higher risk of physical frailty (OR 3.47, 95% CI 1.56-7.73) than non-smokers without secondhand smoke exposure. Smokers exposed to secondhand smoke were associated with more risk of physical frailty (OR 9.03, 95% CI 2.42-33.77) compared with smokers without secondhand smoke exposure., Conclusions: Smoking, especially when combined with secondhand smoke exposure, is associated with future physical frailty among older adults. Geriatr Gerontol Int 2024; 24: 142-149., (© 2023 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Aim: The association between polypharmacy and the development of frailty is unknown. The present study assessed the longitudinal relationship between polypharmacy and frailty risk in Japanese community-dwelling older adults., Methods: Participants included 299 non-frail older Japanese adults aged 65-81 years who participated in both baseline and follow-up examinations of a longitudinal study of aging (mean duration 6.2 years). At baseline examination, all prescribed and non-prescribed medications used during the previous 2 weeks were confirmed and coded by physicians. Frailty was diagnosed according to frailty criteria, and included shrinking, exhaustion, low activity, low grip strength and low gait speed. The relationship between frailty and the number of medications was assessed using multiple logistic regression analysis. The logistic regression model was used to control for potential confounders, including age at baseline, sex, body fat, total physical activity, education, employment, current smoking and number of comorbidities., Results: The percentage of participants who developed frailty during follow up was 5.1% in those taking five or fewer medications, and 22.5% in those taking six or more medications. The fully adjusted odds ratio for frailty among participants taking six or more medications was 5.55 (95% confidence interval 2.17-14.22)., Conclusions: Polypharmacy appears to be a significant risk factor for the development of frailty in older Japanese adults. Geriatr Gerontol Int 2018; 18: 1497-1500., (© 2018 Japan Geriatrics Society.)

Aim: The association between frailty and increased mortality risk is unknown. The present study assessed the longitudinal relationship between frailty and mortality risk in Japanese community-dwelling older adults., Methods: Participants included 841 randomly chosen community-dwelling Japanese individuals, including 175 older adults aged 65-88 years with incomplete data at the baseline examination (July 2006-July 2008). Participants were followed from baseline to 31 December 2015 (mean 7.9 years). Frailty was diagnosed according to frailty criteria, including unintentional weight loss (shrinking), exhaustion, low activity, low grip strength and low gait speed. Information on deaths was obtained from a population dynamics survey. The relationship between frailty and mortality was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression. The Cox proportional hazards model was used to control for potential confounders, including age at baseline, body fat, education, the Mini-Mental State Examination score, the Center for Epidemiologic Studies Depression Scale score, total physical activity, total caloric intake, alcohol intake, current smoking, household income and the number of current diseases., Results: The fully adjusted hazard ratio for all-cause mortality in the frailty group was 2.63 (95% confidence interval, 1.28-5.39; P for trend <0.01). The age- and sex-adjusted hazard ratio for mortality of cancer in the frailty group was 3.33 (95% confidence interval, 1.15-9.62; P for trend <0.05)., Conclusion: Complications of frailty, which include shrinking, exhaustion, low activity, weakness, and slowness, appear to be significant risks for mortality in Japanese older adults. Geriatr Gerontol Int 2018; 18: 1085-1092., (© 2018 Japan Geriatrics Society.)

Aim: The longitudinal relationship between cognitive abilities and subsequent death was investigated among community-dwelling older Japanese adults., Methods: Participants (n = 1060; age range 60-79 years) comprised the first-wave participants of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Participants' cognitive abilities were measured at baseline using the Japanese Wechsler Adult Intelligence Scale-Revised Short Form, which includes the following tests: Information (general knowledge), Similarities (logical abstract thinking), Picture Completion (visual perception and long-term visual memory) and Digit Symbol (information processing speed). By each cognitive test score, participants were classified into three groups: the high-level group (≥ the mean + 1SD), the low-level group (≤ the mean - 1SD) and the middle-level group. Data on death and moving during the subsequent 15 years were collected and analyzed using the multiple Cox proportional hazard model adjusted for physical and psychosocial covariates., Results: During the follow-up period, 308 participants (29.06%) had died and 93 participants (8.77%) had moved. In the Similarities test, adjusted hazard ratios (HR) of the low-level group to the high-level group were significant (HR 1.49, 95% CI 1.02-2.17, P = 0.038). Furthermore, in the Digit symbol test, the adjusted HR of the low-level group to the high-level group was significant (HR 1.62, 95% CI 1.03-2.58, P = 0.038). Significant adjusted HR were not observed for the Information or Picture Completion tests., Conclusions: It is suggested that a lower level of logical abstract thinking and slower information processing speed are associated with shorter survival among older Japanese adults. Geriatr Gerontol Int 2017; 17: 1654-1660., (© 2016 Japan Geriatrics Society.)

Aim: The association between sarcopenia diagnosed according to the criteria of the Asian Working Group for Sarcopenia and increased mortality risk is currently unknown. The present study assessed the longitudinal relationship between sarcopenia and mortality risk in an elderly Japanese population., Methods: Participants were 720 community-dwelling Japanese individuals aged 65-79 years at baseline (November 1997 to April 2000). The participants were followed from baseline to 31 December 2014 (mean duration 11.0 years). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria, using extremity muscle mass assessed by dual-energy X-ray absorptiometry, grip strength and gait speed. A population dynamics survey was used to obtain information on deaths. The relationship between sarcopenia and mortality was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression. The Cox proportional hazards model was used to control for potential confounders, including age at baseline, body mass index, total caloric intake, alcohol intake, current smoking habits, leisure-time physical activity and the number of current diseases., Results: The fully adjusted hazard ratio for all-cause mortality among men in the sarcopenia group was 1.95 (95% confidence interval 1.04-3.67) compared with that in the normal group. No significant association between sarcopenia and all-cause mortality was observed among women., Conclusion: The complications of sarcopenia, including low muscle mass, low grip strength and low gait speed, appear to be significant risks for mortality in older Japanese men. Geriatr Gerontol Int 2017; 17: 1642-1647., (© 2017 Japan Geriatrics Society.)

Aim: To clarify the effectiveness of dietary diversity, calculated by dietary records, on cognitive decline., Methods: Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Participants comprised 298 men and 272 women aged 60-81 years at baseline (second wave) who participated in the follow-up study (third to seventh wave) at least once. Cognitive function was assessed with the Mini-Mental State Examination in all study waves. Dietary diversity was determined using the Quantitative Index for Dietary Diversity based on a 3-day dietary record in the second wave. Cumulative data among participants with a Mini-Mental State Examination score >27 in the second wave were analyzed using a generalized estimating equation. Multivariate adjusted odds ratios and 95% confidence intervals for Mini-Mental State Examination scores ≤27 in each study wave according to a 1 standard deviation (increase), or quartiles of the Quantitative Index for Dietary Diversity at baseline, were adjusted for sex, age, follow-up time, baseline Mini-Mental State Examination score, education, body mass index, annual household income, current smoking status, energy intake and disease history., Results: Multivariate adjusted odds ratio for a decline in Mini-Mental State Examination score was 0.79 (95% CI 0.70-0.89; P < 0.001) with a 1 SD increase in dietary diversity score, or 1.00 (reference), 0.99 (95% CI 0.70-1.43), 0.68 (95% CI 0.46-0.99) and 0.56 (95% CI 0.38-0.83) according to the lowest through highest quartiles of dietary diversity score, respectively (trend P = 0.001)., Conclusions: Daily intake of various kinds of food might be a protective factor against cognitive decline in community-dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 937-944., (© 2016 Japan Geriatrics Society.)

Aim: Sex- and age-related differences in mid-thigh composition and muscle quality remain unclear. The present study aimed to clarify these differences using computed tomography in middle-aged and elderly Japanese., Methods: A total of 2310 participants (age 40-89 years), who were randomly selected from the local residents, underwent computed tomography examination of the right mid-thigh. Thigh circumference and cross-sectional areas of the thigh, muscle, quadriceps, non-quadriceps, fat, and bone were measured. Knee extension strength and muscle quality index (knee extension strength/quadriceps cross-sectional area) were also assessed. Sex- and age-related differences in these indices were analyzed., Results: The thigh cross-sectional area in men and women decreased by 0.6% and 0.5%/year, respectively, because of a decrease in muscle cross-sectional area (men 75.2%, women 40.6%), fat cross-sectional area (men 24.4%, women 59.6%) and bone cross-sectional area (men 0.5%, women -0.2%). Muscle cross-sectional area in men and women decreased by 0.6% and 0.4%/year, respectively, because of a decrease in quadriceps cross-sectional area (men 65.6%, women 81.6%) and non-quadriceps cross-sectional area (men 34.4%, women 18.4%). Muscle quality in men and women decreased by 0.4% and 0.3%/year, respectively., Conclusion: Thigh cross-sectional area decreased with age mainly because of a decrease in muscle cross-sectional area in men and fat cross-sectional area in women. The rate of decrease in muscle cross-sectional area was 1.5-fold higher in men than in women. Muscle cross-sectional area decreased with age mainly because of a decrease in quadriceps cross-sectional area, especially in women. Decrease in muscle quality with age was similar in both sexes., (© 2014 Japan Geriatrics Society.)

Aim: Sarcopenia accelerates frailty syndrome, and adversely affects activities of daily living and quality of life. The aim of the present study was to assess longitudinal relationships between baseline androgen and muscle mass changes in Japanese women., Methods: Data were collected from 539 community-dwelling, Japanese women aged 40-79 years at baseline who participated in both baseline and follow-up examinations of a longitudinal study of aging (mean duration 8.3 years). Appendicular skeletal muscle mass was measured with dual-energy X-ray absorptiometry at baseline and follow-up examinations. The cut-off point for sarcopenia was a skeletal muscle index (appendicular skeletal muscle mass/height(2) ) <5.46 kg/m(2) . Participants with sarcopenia at baseline were excluded. Thus, 430 women were included. Total testosterone, free testosterone and dehydroepiandrosterone-sulphate were measured by radioimmunoassay at baseline. The androgens were categorized into three groups by serum levels. Multiple logistic regression models were fit to determine the associations between androgens and sarcopenia while controlling for baseline age, body mass index, leisure-time physical activity, nutritional intakes (total energy, total protein, vitamin D), serum C-reactive protein levels, medical histories (heart disease, osteoporosis, rheumatoid arthritis), menopause and smoking habit., Results: The fully adjusted odds ratio of sarcopenia for the low-free testosterone group (<0.7 pg/mL) compared with the high-free testosterone group (≥1.2 pg/mL) was 3.59 (95% confidence interval 1.25-10.34). Sarcopenia was not significantly related to total testosterone or dehydroepiandrosterone-sulphate., Conclusion: A low-free testosterone level appears to be a significant predictor of the risk for loss of appendicular muscle in Japanese women., (© 2014 Japan Geriatrics Society.)

Aim: Little is known about longitudinal changes of body composition measured by dual-energy X-ray absorptiometry (DXA) in middle-aged and elderly individuals. We evaluated longitudinal changes of body composition, and age and sex differences in appendicular skeletal muscle mass., Methods: Participants were 1454 community-dwelling Japanese men and women aged 40-79 years. Body composition at baseline and 6-year follow up was measured by DXA., Results: Fat increased significantly in men of all ages, and in women aged in their 40s and 50s. Among men, arm lean tissue mass (LTM) changed by 0.9%, -0.5%, -1.4% and -3.7%, respectively, for the 40s to the 70s, and decreased significantly in the 60s and 70s. Leg LTM in men changed by -0.4%, -1.3%, -1.7% and -3.9%, respectively, and decreased significantly from the 50s to the 70s. Compared with the preceding age groups, significant differences were observed between the 60s and 70s in arm and leg LTM change in men. Among women, arm LTM changed by 0.7%, 0.2%, 1.6% and -1.5%, respectively, which was significant in the 60s and 70s. Leg LTM decreased significantly in all age groups of women by -2.0%, -2.8%, -2.4% and -3.9%, respectively. With respect to sex differences, leg LTM loss rates were significantly higher in women than men at the 40s and 50s., Conclusions: Longitudinal data suggest that arm and leg LTM decreased markedly in men in their 70s, and leg LTM had already decreased in women in their 40s., (© 2013 Japan Geriatrics Society.)

Aim: The present study aimed to evaluate age-related changes in skeletal muscle mass among community-dwelling middle-aged and elderly Japanese., Methods: This 12-year longitudinal study of a community-dwelling population in Japan included 15,948 examinations of 1962 men and 1990 women. We assessed appendicular muscle mass (AMM) using dual X-ray absorptiometry and calculated the skeletal muscle index (SMI) using the AMM divided by height squared (kg/m(2) ). Low muscle mass was defined as muscle mass minus two standard deviations below the mean for young healthy adults. Leg extension power (watts) was measured as an index of muscle function. Longitudinal data of skeletal muscle mass were analyzed using a general linear mixed-effect model., Results: The prevalence of low muscle mass at the first wave of examinations was 27.1% in men and 16.4% in women. Longitudinal analysis showed that skeletal muscle mass decreased with aging during the 12-year study period except in middle-aged men, and to a greater extent in elderly men (P for trend, <0.001). Skeletal muscle mass decreased slightly, but significantly, in women. Although a cross-sectional analysis showed that SMI did not differ with age in women, leg extension power per leg muscle mass and grip strength per arm muscle mass as indices of muscle quality were significantly lower in older women (P for trend, <0.001 for both)., Conclusion: Age-related decreases in muscle mass were trivial, especially in women, but the quality of muscle decreased with aging in both sexes., (© 2014 Japan Geriatrics Society.)

Aims: To estimate the prevalence of lower urinary tract symptoms (LUTS) in Japanese people, and the relationships to aging and sex, we carried out the present population-based study., Methods: The present study included 1198 men aged 60.7 ± 12.5 years and 1218 women aged 60.8 ± 12.7 years who participated in a study of aging carried out at the National Center for Geriatrics and Gerontology between 2006 and 2008, using linguistically validated versions of the International Prostate Symptom Score (I-PSS) and International Consultation on Incontinence Questionnaire Short-form (ICIQ-SF)., Results: The prevalence of I-PSS ≥ 8 was 25.2% in men and 11.8% in women, that of two or more a week urinary incontinence was 3.3% and 6.6%, respectively, and that of I-PSS ≥ 8 and/or two or more a week urinary incontinence was 25.8% and 16.0%, respectively. The prevalence of the seven symptoms in I-PSS increased with aging. Just 9.1% of men and 4.6% of women who reported LUTS were medicated for LUTS., Conclusions: The results showed that the severity of LUTS in Japan was related to aging. The prevalence of LUTS with I-PSS ≥ 8 in Japan is similar to that in other countries., (© 2013 Japan Geriatrics Society.)

Aim: Sarcopenia-related falls and fractures are becoming an emerging problem as a result of rapid aging worldwide. We aimed to investigate the prevalence of sarcopenia by estimating the muscle mass of the arms and legs of patients with and without hip fracture., Methods: This cross-sectional study examined 357 patients immediately after a hip fracture (the HF group) and in 2511 patients from an outpatient clinic who did not have a hip fracture (the NF group) at single institution in Japan. We carried out whole-body dual energy X-ray absorptiometry to analyze body composition with skeletal muscle mass index (SMI; lean mass/height(2)) and bone mineral density (BMD). We carried out stepwise logistic regression analysis to determine the factors associated with a hip fracture., Results: Lower appendicular SMI (P < 0.001), leg SMI (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after controlling for age and sex. The arm SMI was similar in both groups (P > 0.95). In multivariate analysis, the presence of sarcopenia, older age and lower BMD were associated with the occurrence of a hip fracture (OR 1.476, P = 0.002; OR 1.103, P < 0.001; OR 0.082, P < 0.001; respectively)., Conclusion: This study showed a higher prevalence of sarcopenia and more reduced leg muscle mass in patients after a hip fracture than in the outclinic patients who did not have hip fractures. The results imply sarcopenia can be a risk factor for a hip fracture., (© 2012 Japan Geriatrics Society.)

Aim: The detection of the early stages in amnesic mild cognitive impairment (aMCI) is considered important in diagnosing progression to Alzheimer's disease. The current study sought to investigate differences in cognitive function between control subjects with no memory loss (control), and subjects in the early stage of aMCI (EMCI) and late stage of aMCI (LMCI)., Methods: A total of 100 community-dwelling older adults aged 65 years and over were recruited from 1543 potential subjects. Subjects were classified into three groups based on the degree of objective memory impairment; control (n=29), EMCI (n=34) and LMCI (n=37). Multiple neuropsychological tests were carried out to examine cognitive function., Results: The EMCI individuals showed lower cognitive function relative to controls; not only in logical memory, but also in letter fluency (P<0.05). There were no significant differences in neuropsychological scores between the EMCI and LMCI groups, except for category fluency and logical memory. In addition, the EMCI subjects' logical memory score showed a significant relationship with letter fluency, category fluency and digit span backward test performance (P<0.05)., Conclusions: These results suggest that the application of multiple neuropsychological tests might be useful in diagnosing older adults with EMCI and LMCI., (© 2012 Japan Geriatrics Society.)

Aim: To describe age- and sex-related differences in gait patterns of community-living men and women using 3-D gait analysis., Methods: Subjects (n=2006) aged 40-84 years participated in the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). Spatiotemporal components, including velocity, step length, step frequency, and double support time during a gait cycle, were calculated from 3-D coordinates and vertical force data. Velocity, step length and step frequency were normalized by leg length and acceleration due to gravity, and double support time was normalized to gait cycle duration., Results: Spatiotemporal walking variables of brisk velocity and step length were significantly greater in men than in women, while comfortable velocity and comfortable and brisk step frequencies and double support times were greater in women than in men. Age-related changes were marked at 70-84 years in most spatiotemporal variables in both sexes during comfortable walking. During brisk walking, age-related changes were observed from a younger age than during comfortable walking, and there were sex-related differences., Conclusion: The age-related gait alteration was obvious among those aged 70 years and older, and it accelerated markedly in women's brisk walking intensity., (© 2010 Japan Geriatrics Society.)

Aims: Most of the acetaldehyde, a recognized animal carcinogen, generated during alcohol metabolism is eliminated by liver mitochondrial aldehyde dehydrogenase 2 (ALDH2). More than 40% of Japanese people have the inactive form of ALDH2, and inactive ALDH2 is a risk factor for multiple cancer of the esophagus, as well as head and neck cancer. Possible associations between pancreatic cancer and ALDH2 gene polymorphism, as well as between colon cancer and ALDH2 gene polymorphism, in conjunction with smoking and/or drinking habits, were examined in a Japanese population., Methods: Patients with pancreatic cancer (n = 187) and with colon cancer (n = 49) were examined. The drinking (5 g ethanol consumption/day) and/or smoking habits as well as ALDH2 gene polymorphism were examined. The age-matched control subjects were recruited in the NILS Longitudinal Study of Aging (LSA)., Results: Aging, smoking and inactive ALDH2, but not alcohol, are independent risk factors for pancreatic cancer. The frequency of smoking habits tended to be higher in patients with colon cancer compared with the patients without cancer. However, age, body mass index or the distribution of ALDH2 genotypes did not differ significantly among the patients with colon cancer, colon polyps and others., Conclusions: Inactive ALDH2 is an independent risk factor for pancreatic cancer, but inactive ALDH2 might not be a risk for colon cancer.