Rationale and Descriptive Analysis of Specific Health Guidance: the Nationwide Lifestyle Intervention Program Targeting Metabolic Syndrome in Japan

Abstract

Aim: All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database.

Methods: We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n=31,790) and nonparticipants (n=189,726) who were eligible for SHG in 2008.

Results: Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p＜0.01) and 2.25 vs 0.68 kg in women (p＜0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p＜0.01) and 1.53 vs 0.42 kg in women (p＜0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants.

Conclusion: Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

Keywords: Health Guidance; Health Policy; Health checkup; Metabolic Syndrome; National Data Base.

Fig. 1.

Participant classification for Specific Health Guidance (SHG) eligibility based on the “Standardized health examination and guidance program” of the Ministry of Health, Labor and Welfare. Specific Health Checkups participants are initially classified by obesity indicators (Step 1) and then by the number of additional metabolic risk factors and smoking status (Steps 2 and 3). Individuals who are on pharmacological therapy for diabetes, dyslipidemia, or hypertension are not eligible for SHG (Step 4).

Fig. 2.

Number of people who met the eligibility criteria for the Specific Health Guidance (SHG) in 2008, assignment of participants and nonparticipants, and follow-up rate a. The entire Japanese adult population aged 40–74 yr. b. People who did not have Specific Heath Check-ups (SHC) or their data were not correctly registered in the National Database were excluded. c. Participants of SHC were classified by the standard criteria (Fig. 1). d. We analyzed SHC/SHG data from 365 insurers who met specific performance requirements (data merging).

Fig. 3.

Change in clinical indicators (waist circumference, body weight, systolic blood pressure, hemoglobin A1c, triglyceride, and high-density lipoprotein cholesterol) from baseline (2008) to subsequent 3 yr (2009, 2010, and 2011) in participants and nonparticipants. (a) Men aged 40–64. (b) Women aged 40–64. *p < 0.05, **p < 0.01: differences between participants and the control.

Fig. 4.

Proportion of individuals who started pharmacological therapy in baseline and each follow-up year in the intensive Health Guidance (HG) and motivational HG aged 40–64 and 64–74. *p < 0.05, **p < 0.01: differences between participants and nonparticipants.