Control of Diabetes Mellitus and Long-Term Prognosis in Stroke Patients: The Shiga Stroke and Heart Attack Registry

BACKGROUND: The relationship between diabetes control status and long-term prognosis after stroke incidence remains unclear. This study aimed to investigate the effect of diabetes status at admission on long-term survival in patients with first-ever stroke. METHODS: A retrospective cohort study was conducted based on the Shiga Stroke and Heart Attack Registry in Japan. Patients were classified according to their diabetes status and glycated hemoglobin (HbA1c) value at hospital admission into the following: (1) free of diabetes (no history of diabetes and HbA1c <6.5%); (2) good control (history of diabetes and HbA1c <7%; free of history and 6.5% ≤HbA1c <7%); and (3) poor control (with or without a history of diabetes and HbA1c ≥7%). Multivariable Cox regression models were used to evaluate the association between diabetes status and long-term survival from stroke onset. Additionally, we also evaluated the association between diabetes status and conditional survival, beginning 29 days after stroke onset. RESULTS: A total of 6, 331 first-ever stroke patients were eligible for this study. Among study patients, the mean (±SD) age was 72.85 ± 13.19 years, and the mean (±SD) follow-up year was 2.76 ± 1.66 years; additionally, 42.09% of patients were women. Among patients with all strokes, considering the free-of-diabetes group as the reference group, the adjusted hazard ratio (95% confidence interval) for mortality was 1.26 (1.10, 1.44) in the good control group and 1.22 (1.05, 1.41) in the poor control group. Among patients with ischemic stroke, the adjusted hazard ratio was 1.24 (1.06, 1.46) in good control group and 1.27 (1.08, 1.50) in poor control group. After excluding patients who died within 28 days, the adjusted hazard ratio for conditional mortality in the poor control group was 1.31 (1.12, 1.54) among all stroke patients and 1.29 (1.08, 1.54) among ischemic stroke patients. No significant associations were observed between diabetic status and long-term mortality in intracerebral hemorrhage patients. CONCLUSIONS: The findings suggest that first-ever stroke patients with diabetes exhibited a higher risk of all-cause mortality than those without diabetes, particularly in the overall stroke and ischemic stroke populations. Additionally, in stroke populations after 28 days of onset, high risk of long-term mortality was stated in stroke patients with poor HbA1c control

社会的要因を含む生活習慣病リスク要因の解明を目指した国民代表集団の大規模コホート研究：ＮＩＰＰＯＮ ＤＡＴＡ８０／９０／２０１０

厚生労働科学研究費補助金研究成果報告書研究区分: 厚生労働科学研究費補助金 疾病・障害対策研究分野 循環器疾患・糖尿病等生活習慣病対策総合研究課題番号: H25-循環器等（生習）-指定-022研究年度: 2013報告書区分: 総括文献番号: 201315063

社会的要因を含む生活習慣病リスク要因の解明を目指した国民代表集団の大規模コホート研究：ＮＩＰＰＯＮ ＤＡＴＡ８０/９０/２０１０

厚生労働科学研究費研究成果報告書研究区分: 厚生労働科学研究費補助金 疾病・障害対策研究分野 【補助金】 循環器疾患・糖尿病等生活習慣病対策総合研究課題番号: H25-循環器等(生習)-指定-022研究年度: 2014報告書区分: 総括文献番号: 201412057A研究代表者: 三浦 克之（滋賀医科大学・医学部・教授）研究分担者: 上島 弘嗣（滋賀医科大学・アジア疫学研究センター・特任教授）研究分担者: 門田 文（滋賀医科大学・アジア疫学研究センター・特任准教授）研究分担者: 藤吉 朗（滋賀医科大学・医学部・准教授）研究分担者: 宮松 直美（滋賀医科大学・医学部・教授

社会的要因を含む生活習慣病リスク要因の解明を目指した国民代表集団の大規模コホート研究：NIPPON DATA80/90/2010

厚生労働科学研究費研究成果報告書研究区分: 厚生労働科学研究費補助金 疾病・障害対策研究分野 循環器疾患・糖尿病等生活習慣病対策総合研究課題番号: H25-循環器等(生習)-指定-022研究年度: 2015報告書区分: 総括文献番号: 201508023A研究代表者: 三浦 克之（滋賀医科大学・医学部・教授）研究分担者: 上島 弘嗣（滋賀医科大学・アジア疫学研究センター・特任教授）研究分担者: 門田 文（滋賀医科大学・アジア疫学研究センター・特任准教授）研究分担者: 宮松 直美（滋賀医科大学・医学部・教授）研究分担者: 有馬 久富（滋賀医科大学・アジア疫学研究センター・特任教授）研究分担者: 高嶋 直敬（滋賀医科大学・医学部・助教

Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80.

In Asian countries, a major source of salt intake is from seasoning or table salt added at home. However, little is known about the adverse effects of salt intake evaluated according to household unit. We investigated the relationship between household salt intake level and mortality from all-cause and cardiovascular diseases (CVDs). Participants included 8702 individuals (56% women) who were living with someone else and who were aged 30-79 years and enrolled in the National Nutritional Survey of Japan in 1980 with a 24-year follow-up. Household nutrient intake was evaluated using a 3-day weighing record method in which all foods and beverages consumed by any of the household members were recorded. The household salt intake level was defined as the amount of salt consumed (g) per 1000 kcal of total energy intake in each household, and its average was 6.25 (2.02) g/1000 kcal. During the follow-up, there were 2360 deaths (787 CVD, 168 coronary heart disease [CHD], and 361 stroke). Cox proportional hazard ratios (HRs) for an increment of 2 g/1000 kcal in household salt intake were calculated and adjusting for sex, age, body mass index, smoking status, alcohol consumption status, self-reported work exertion level, household potassium intake, household saturated fatty acid intake, and household long-chain n-3 polyunsaturated fatty acid intake. The HRs (95% confidence intervals) were 1.07 (1.02, 1.12) for all-cause mortality, 1.11 (1.03, 1.19) for CVD, 1.25 (1.08, 1.44) for CHD, and 1.12 (1.00, 1.25) for stroke. The household salt intake level was significantly associated with long-term risk of all-cause, CVD, CHD, and stroke mortality in a representative Japanese population

Control of Diabetes Mellitus and Long-Term Prognosis in Stroke Patients : The Shiga Stroke and Heart Attack Registry.

Background:The relationship between diabetes control status and long-term prognosis after stroke incidence remains unclear. This study aimed to investigate the effect of diabetes status at admission on long-term survival in patients with first-ever stroke.Methods:A retrospective cohort study was conducted based on the Shiga Stroke and Heart Attack Registry in Japan. Patients were classified according to their diabetes status and glycated hemoglobin (HbA1c) value at hospital admission into the following: (1) free of diabetes (no history of diabetes and HbA1c <6.5%); (2) good control (history of diabetes and HbA1c <7%; free of history and 6.5% ≤HbA1c <7%); and (3) poor control (with or without a history of diabetes and HbA1c ≥7%). Multivariable Cox regression models were used to evaluate the association between diabetes status and long-term survival from stroke onset. Additionally, we also evaluated the association between diabetes status and conditional survival, beginning 29 days after stroke onset.Results:A total of 6,331 first-ever stroke patients were eligible for this study. Among study patients, the mean (±SD) age was 72.85 ± 13.19 years, and the mean (±SD) follow-up year was 2.76 ± 1.66 years; additionally, 42.09% of patients were women. Among patients with all strokes, considering the free-of-diabetes group as the reference group, the adjusted hazard ratio (95% confidence interval) for mortality was 1.26 (1.10, 1.44) in the good control group and 1.22 (1.05, 1.41) in the poor control group. Among patients with ischemic stroke, the adjusted hazard ratio was 1.24 (1.06, 1.46) in good control group and 1.27 (1.08, 1.50) in poor control group. After excluding patients who died within 28 days, the adjusted hazard ratio for conditional mortality in the poor control group was 1.31 (1.12, 1.54) among all stroke patients and 1.29 (1.08, 1.54) among ischemic stroke patients. No significant associations were observed between diabetic status and long-term mortality in intracerebral hemorrhage patients.Conclusions:The findings suggest that first-ever stroke patients with diabetes exhibited a higher risk of all-cause mortality than those without diabetes, particularly in the overall stroke and ischemic stroke populations. Additionally, in stroke populations after 28 days of onset, high risk of long-term mortality was stated in stroke patients with poor HbA1c control

Association between socioeconomic status and physical inactivity in a general Japanese population: NIPPON DATA2010.

Background:Lower socioeconomic status (SES) may be related to inactivity lifestyle; however, the association between SES and physical inactivity has not been sufficiently investigated in Japan.Methods:The study population is the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2,609 adults. Physical activity was assessed by physical activity index (PAI) calculated from activity intensity and time. The lowest tertile of PAI for each 10-year age class and sex was defined as physical inactivity. Multivariable logistic regression analyses were conducted to examine the association of SES (employment status, educational attainment, living status, and equivalent household expenditure (EHE)) with physical inactivity.Results:In the distribution of PAI by age classes and sex, the highest median PAI was aged 30-39 years among men (median 38.6), aged 40-49 years among women (38.0), and median PAI was decreased with increasing age. Multivariable-adjusted model shows that not working was significantly associated with physical inactivity after adjustment for age in all age groups and sexes. Not living with spouse for adult women and elderly men was significantly associated with physical inactivity compared to those who living with spouse. However, neither educational attainment nor EHE had any significant associations with physical inactivity.Conclusions:The result indicated that physical inactivity was associated with SES in a general Japanese population. SES of individuals need to be considered in order to prevent inactivity lifestyle

コウレイシャ テンカン ノ モンシンヒョウ ニヨル ソウキ ハッケン : ニンチショウ トノ カンレン ニオイテ

本研究の目的は高齢者てんかんを問診票の活用により、物忘れ外来を含む高齢者複合施設における高齢者てんかんの実態を明らかにすることにある。物忘れ外来を含む高齢者複合施設を調査期間中に利用した417名を対象に、高齢者てんかん問診票を用い、てんかん有病率を算出した。また、新規に高齢者てんかんと判定された者の特徴を記述した。その結果、すでにてんかんの診断ありが7名（1.7%）、問診票の回答内容からてんかんの疑いありは33名（7.9%）、その中から医師の診断により新規に高齢者てんかんが判定された者は14名（3.0%）であった。施設別有病率では、物忘れ外来7名（5.0%）、ショートステイ利用者、グループホーム入所者は2割前後であった。新規に高齢者てんかんと判定された者の問診項目では、意識減損がもっとも多かった。さらに、新規にてんかんが判明したすべての者が何らかの認知症を有していた。本研究により物忘れ外来を含む高齢者複合施設において、高齢者てんかんが潜在していることが明らかとなり、これらの早期発見のため高齢者てんかんの問診票の必要性が示された

Evaluation of the fall risk assessment tool among patients with neurological disease

科学研究費補助金研究成果報告書研究種目: 若手研究(スタートアップ)研究期間: 2007～2008課題番号: 19890269研究代表者: 荻田 美穂子（滋賀医科大学・医学部・助教）研究協力者: 宮松 直美（滋賀医科大学・医学部・教授）研究協力者: 盛永 美保（滋賀医科大学・医学部・講師