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. 2018 Jan 9;13(1):e0190862.
doi: 10.1371/journal.pone.0190862. eCollection 2018.

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)

Yoko M Nakao  1 , Yoshihiro Miyamoto  1 , Kenji Ueshima  2 , Kazuhiro Nakao  3 , Michikazu Nakai  4 , Kunihiro Nishimura  4 , Shinji Yasuno  2 , Kiminori Hosoda  5 , Yoshihiro Ogawa  6 , Hiroshi Itoh  7 , Hisao Ogawa  8 , Kenji Kangawa  8 , Kazuwa Nakao  9
Affiliations

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)

Yoko M Nakao et al. PLoS One. .

Abstract

Background: Lifestyle 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.

Methods: A 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.

Results: Of 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.

Conclusions: In 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.

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Conflict of interest statement

Competing Interests: This work was supported Japan Agency for Medical Research and Development (https://www.amed.go.jp) and the Clinical and Epidemiologic Research of the Joint Project of Japan Heart Foundation and the Japanese Society of Cardiovascular Disease Prevention sponsored by AstraZeneca (http://www.jhf.or.jp/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study flow chart.
FY, fiscal year.
Fig 2
Fig 2. Categorical waist and weight reduction.
WC, waist circumference; BMI, body mass index.
Fig 3
Fig 3. Beta-coefficients of each cardiometabolic risk factors using linear regression and instrumental variable methods.
SBP, systolic blood pressure; DBP, diastolic blood pressure; PS, propensity score; IV, instrumental variable.
See this image and copyright information in PMC

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