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Objectives: This study examined the impact of the Center of Healthy Aging Program (CHAP) on the cognitive function and economic burden associated with dementia., Methods: This observational study utilised Iwaki cohort data. We included participants with mini-mental state examination (MMSE) scores and categorised them into pre- and post-CHAP groups based on their year of entry into the cohort (before 2013 or after) (index year). We defined participants with suspected severe cognitive impairment and suspected mild cognitive impairment using their MMSE scores, with their incidence being the first observation meeting these definitions during the follow-up period. We compared the incidence rates between the pre- and post-CHAP groups using Cox proportional hazard analysis. Medical and caregiving costs were estimated based on the projected number of residents in Iwaki area with suspected mild cognitive impairment and sSCI during hypothetical 10 years of the CHAP implemented or not and compared., Results: Of the 2,569 participants, 1716 and 853 were included in the pre- and post-CHAP groups, respectively. The incidence rate of suspected mild cognitive impairment was significantly lower in the post-CHAP group even after adjusted known factors associated with cognitive disorders. No cases of suspected severe cognitive impairment occurred in the post-CHAP group during the follow-up period. Estimated costs of JPY 1,628,450 (USD 11562.00 or EUR 10259.24, JPY 100  =  USD 0.71 or EUR 0.63) and JPY 789,560 (USD 5605.88 or EUR 4974.23) per person per year were projected after 10 years with and without the CHAP, respectively., Conclusions: We demonstrated a reduction in the incidence rate of suspected mild cognitive impairment among residents who participated in the CHAP and a decrease in the medical and caregiving costs associated with suspected severe cognitive impairment., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AS was an employee of Medilead, Inc. and serves as a director of Healthcare Consulting, Inc. KK holds the position of Executive Vice President of Integrated Clinical Care Informatics, Inc. AI received grants from Abbott Japan Inc., Abbvie G.K., Becton, Dickinson and Company, Creative-Ceuticals Inc., Eli Lilly Japan K.K., Gilead Sciences K.K., Intuitive Surgical G.K., Milliman Inc., Pfizer Inc., Sanofi Pasteur Inc., and Terumo Corporation, and personal fees from Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., CSL Behring Japan Inc., FUJIFILM Corporation, Sanofi K.K., and Takeda Pharmaceutical Co., Ltd. outside the submitted work., (Copyright: © 2024 Shoji et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To promote health awareness and improve life expectancy in Hirosaki, a Japanese rural area, the Center of Healthy Aging Program (CHAP) was founded in 2013. The most important characteristic of CHAP is a personalized interview just after the checkup to discuss individual results. We evaluated the clinical and economic effects of CHAP by analyzing the cohort data of voluntary participants from annual health checkups since 2005 in the Iwaki district of Hirosaki. We calculated 10-year incidence risk scores for coronary heart diseases (CHDs) and stroke, and compared the risk-score trend before and after the start of CHAP by adjusting other risk factors using multivariate generalized linear regression analyses. We also predicted the 10-year incidences of CHDs and stroke based on the risk scores, for future scenarios of the two conditions, with and without CHAP, and compared them to their treatment costs between scenarios. The number of participants ranged between 808 and 1,167, from 2008 to 2016. The mean age (55 years) and proportion of women (60%) did not significantly change throughout the period. After adjusting for sex, age, outside temperature on the checkup date, the preparation effect of CHAP in 2012, and risk scores in the previous year, the annual increases in risk scores of CHDs and stroke were significant even after CHAP (+0.413, p <0.001; +0.169, p <0.001, respectively), but slightly less compared to before CHAP (+2.638, p <0.001; +1.155, p <0.001, respectively). Assuming the trend continued until 2021, the 10-year incidences of CHDs and stroke have decreases by 22,486 and 9,603, respectively, and treatment costs decreased by JPY 21,973 and 16,056 million, respectively. CHAP contributes to a significant decrease in the incidences of CHDs and stroke, and reduces economic burden on the local government., Competing Interests: The potential competing interests of authors (if any) are otherwise summarized in the following sentences. AS is employee of Medilead Inc. KK is COE of Integrated Clinical Care Informatics, Inc. AI has received grants from Abbott Japan Inc., Abbvie G.K., Becton, Dickinson and Company, Creative-Ceuticals Inc., Eli Lilly Japan K.K., Gilead Sciences K.K., Intuitive Surgical G.K., Milliman Inc., Pfizer Inc., Sanofi Pasteur Inc., and Terumo Corporation, and personal fees from Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., CSL Behring Japan Inc., FUJIFILM Corporation, Sanofi K.K., and Takeda Pharmaceutical Co., Ltd. outside the submitted work. These do not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2022 Shoji et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Several studies have reported that obesity is associated with influenza infection; however, the role of visceral fat remains unclear. The aim of this study was to investigate the association between visceral fat and influenza infection in community-dwelling Japanese adults., Methods: A cross-sectional study was performed using data from an annual community-based health check-up conducted from May to June in 2019. In total, 1,040 Japanese adults aged 20-89 years were enrolled in this study. Influenza infection status was determined by participants' responses to a self-administered questionnaire. The visceral fat area (VFA) was measured using a bioimpedance-type visceral fat meter. Participants were classified into four groups using the following cut-off points: VFA < 100 cm2 was set as the reference category according to the Japanese criteria, 100 ≤ VFA < 150 cm2, 150 ≤ VFA < 200 cm2, and 200 cm2 ≤ VFA. Logistic regression models were used to assess the association between VFA and influenza infection., Results: In total, 119 participants had influenza infections in the past year. In the multivariate adjusted model, a higher VFA was significantly associated with increased influenza infection; the adjusted odds ratio for 200 cm2 ≤ VFA was 5.03 [95% confidence interval (CI): 1.07-23.6], that for 150 ≤ VFA < 200 cm2 was 1.97 (95% CI: 0.71-5.45), and that for 100 ≤ VFA < 150 cm2 was 1.62 (95% CI: 0.84-3.12), compared with that for VFA < 100 cm2 (p for trend = 0.049). These findings were confirmed in the same cohort the following year., Conclusions: Our results suggest that visceral fat accumulation is associated with influenza infection. Large-scale prospective studies using diagnostic information for influenza infection are required to confirm this association., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: authors K.K., N.O., T.Y., K.M., and Y.K. are employees of Kao Corporation (Tokyo, Japan). All other authors declare no potential competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Owing to increasing medical expenses, researchers have attempted to detect clinical signs and preventive measures of diseases using electronic health record (EHR). In particular, time-series EHRs collected by periodic medical check-up enable us to clarify the relevance among check-up results and individual environmental factors such as lifestyle. However, usually such time-series data have many missing observations and some results are strongly correlated to each other. These problems make the analysis difficult and there exists strong demand to detect clinical findings beyond them. We focus on blood test values in medical check-up results and apply a time-series analysis methodology using a state space model. It can infer the internal medical states emerged in blood test values and handle missing observations. The estimated models enable us to predict one's blood test values under specified condition and predict the effect of intervention, such as changes of body composition and lifestyle. We use time-series data of EHRs periodically collected in the Hirosaki cohort study in Japan and elucidate the effect of 17 environmental factors to 38 blood test values in elderly people. Using the estimated model, we then simulate and compare time-transitions of participant's blood test values under several lifestyle scenarios. It visualizes the impact of lifestyle changes for the prevention of diseases. Finally, we exemplify that prediction errors under participant's actual lifestyle can be partially explained by genetic variations, and some of their effects have not been investigated by traditional association studies., Competing Interests: The authors have declared that no competing interests exist.