Masanori Nagao

Background: Large-scale disasters may increase cardiovascular disease (CVD) risk through psychological distress, disrupted healthcare access, and lifestyle changes, but existing CVD risk scores may not adequately capture disaster-related vulnerability.Methods: We analysed data from 23,452 participants aged 30–79 years in the Fukushima Health Management Survey after the 2011 Great East Japan Earthquake and Fukushima Daiichi nuclear accident. Incident CVD, defined as stroke or myocardial infarction, was monitored during follow-up. LASSO logistic regression and XGBoost were used only as exploratory screening tools, and predictors selected by both approaches were incorporated into a Cox proportional hazards model to develop the Questionnaire-based Post-Disaster Cardiovascular Risk Score Incorporating Psychological Distress (Q-DISC). Performance was assessed using C-statistics, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and calibration analyses.Findings: During a median follow-up of 8.0 years, 1,368 participants developed incident CVD. Psychological distress assessed using the Kessler-6 Psychological Distress Scale (K6) was selected by both screening approaches and was independently associated with incident CVD. Adding K6 improved discrimination, NRI, and IDI across established CVD risk models. In the test dataset, Q-DISC showed acceptable discrimination (C-statistic, 0.770 [95% CI 0.745–0.800]) and calibration, with performance comparable to established laboratory- and non-laboratory-based models.Interpretation: Psychological distress provided prognostic information beyond conventional cardiovascular risk factors after a large-scale disaster. Q-DISC may support preliminary questionnaire-based cardiovascular risk stratification when laboratory testing or physical measurements are unavailable. External validation and, if necessary, recalibration are required before clinical implementation.

Aim: There is limited research on the relationship between exercise habits during early adulthood and their continuation into later life, as well as the impact on physical function in older adults. Methods: The study involved community‐dwelling residents aged 60–79 years who participated in health examinations, physical function tests and questionnaire surveys in 2020 and 2021. After excluding duplicates, 862 participants (400 men and 462 women) were included. Exercise habits were defined as regular physical activity between ages 18 and 22 years, and from age 22 years to the present. Prefrailty and frailty were assessed using the revised Japanese Cardiovascular Health Study criteria. Results: Among participants, 53.9% were prefrail and 2.8% were frail. Those with exercise habits between ages 18 and 22 years tended to have a lower probability of prefrailty/frailty compared with those without, with a multivariate‐adjusted odds ratio (OR) of 0.77 (95% confidence interval [CI] 0.57–1.04). Similarly, those who exercised after age 22 had a lower probability, with ORs of 0.61 (95% CI 0.42–0.88) for 1–10 years, 0.51 (95% CI 0.32–0.82) for 11–20 years, 0.55 (95% CI 0.32–0.96) for 21–30 years and 0.32 (95% CI 0.20–0.51) for >30 years of exercise. Conclusions: Exercise experience during young adulthood, particularly the continuation of regular physical exercise from age 22 years onward, might reduce the probability of prefrailty and frailty later in life. Encouraging lifelong exercise might be a key preventive strategy against frailty. Geriatr Gerontol Int 2025; 25: 1495–1502 .

The ectopic intrathyroidal thymus (EIT) is located anywhere in the thyroid gland along the developmental pathway of thymic descent due to thymic migration during embryogenesis. Ultrasonographic findings of papillary thyroid carcinoma (PTC) resemble those of EIT, which is frequently found in children. We comprehensively evaluated the clinical factors associated with EIT to understand its physiological implications and to explore helpful information for clinical discrimination between EIT and PTC. Approximately 320,000 datasets of thyroid ultrasound examinations conducted in the Fukushima Health Management Survey were systematically analyzed. Trend analyses were performed following stratification into groups of the age-sex-adjusted standard deviation score (SDS) for body mass index (BMI-SDS) and body surface area-sex-adjusted SDS for both the width and thickness of the area (BWTAR) as an indicator of thyroid volume (BWTAR-SDS). The prevalence of EIT was 3.2% in the study. Compared with negative EIT, the age- and sex-adjusted odds ratios (95% confidence intervals) for the BMI-SDS, BWTAR-SDS, and presence of diffuse goiter, cysts, and nodules were 0.919 (0.901–0.939), 0.976 (0.957–0.996), 0.821 (0.602–1.121), 0.892 (0.853–0.932), and 1.602 (1.302–1.972), respectively. EIT was not associated with the presence of diffuse goiter but was independently associated with male sex, young age, small thyroid volume, low BMI, absence of cysts, and presence of nodules. The series of clinical factors related to EIT shown in the study might provide complementary information in addition to ultrasonographic findings in cases with asymptomatic thyroid nodules resembling PTC found in young patients.

Context: Examining how overweight/obesity impacts thyroid nodule development in children and adolescents by sex and age allows speculation on the mechanism. Objective: We examined whether overweight/obesity in children and adolescents is associated with thyroid nodule development by sex and age. Methods: Approximately 300 000 participants who underwent thyroid ultrasonography in the Fukushima Health Management Survey after a nuclear accident were enrolled. Those without nodules in the initial 2 examinations (1-3 and 4-5 years postaccident) were prospectively assessed for nodule development in the third examination (6-7 years postaccident) relative to baseline overweight status, with an average follow-up of 4.2 years. This was a population-based prospective cohort study. The first and second thyroid examinations involved 299 939 and 237 691 participants, respectively, excluding those with thyroid nodules. After the third examination, 184 519 participants were finalized for analysis. Multivariable adjusted odds ratios of new detected thyroid nodules for overweight participants were compared with normal-weight participants. Results: New thyroid nodules were detected in 660 participants. Being overweight was positively associated with thyroid nodules. The adjusted odds ratio (95% CI) of thyroid nodules for overweight participants compared with other participants was 1.27 (1.04-1.57). Additionally, the multivariable adjusted odds ratios for overweight males and females were 1.21 and 1.32, respectively, and those for different age groups (0-9, 10-14, and 15-19 years) ranged from 1.17 to 1.75. Conclusion: Being overweight was associated with thyroid nodules in children and adolescents, mostly adolescent females, regardless of their proximity to the nuclear power plant.

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives’ houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

Background: Dietary patterns may be linked to the incidence of type 2 diabetes mellitus (T2DM) after disasters. We investigated the association between dietary patterns and new-onset T2DM in evacuees of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Methods: Among the 22,740 non-diabetic participants aged 20–89 years who completed the dietary assessment in the Fukushima Health Management Survey between July 2011 and November 2012, the incidence of T2DM was evaluated until 2018. Principal component analysis with varimax rotation was applied to derive dietary patterns based on a validated, short-form food frequency questionnaire. The identified dietary patterns were categorized as typical Japanese, juice, and meat. Results: The cumulative incidence of T2DM was 18.0 and 9.8 per 1000 person-years in men and women, respectively, during the follow-up period. The multiple-adjusted hazard ratio (95% confidence interval) of the highest vs. lowest quartile of the typical Japanese pattern scores for T2DM was 0.80 (0.68, 0.94; P for trend = 0.015) in total, 0.85 (0.68, 1.06; P for trend = 0.181) in men, and 0.76 (0.60, 0.95; P for trend = 0.04) in women. Conclusions: A typical Japanese dietary pattern may be associated with a reduced new-onset T2DM risk in evacuees, especially women, after the Great East Japan Earthquake and the FDNPP accident.

A novel healthy diet index for dietary quality can be used to assess food intake. After the Great East Japan Earthquake in 2011, the Fukushima Health Management Survey collected dietary data using a short-form food frequency questionnaire (FFQ). The current study included eligible participants (n = 64,909) aged 16–84 years who answered the FFQ in 2011. The year- and sex-specific dietary patterns were determined via principal component analysis. Based on the typical Japanese, juice/dairy, and meat patterns, healthy diet index (HDI) scores were assigned for food items, resulting in Spearman’s correlation coefficients of 0.730, −0.227, and −0.257, respectively. The mean (standard deviation) of the HDI scores (range: 1–18) were 9.89 (2.68) in men and 9.96 (2.58) in women. Older individuals, women, nonsmokers, those in good health and with regular physical exercise, and those who did not transfer residences had a high HDI score. In the confirmatory analysis, the adjusted odds ratio (95% confidence interval) of the highest vs. the lowest quartiles of HDI scores was 0.87 (0.80, 0.94) for overweight, 0.89 (0.81, 0.97) for large waist circumference, and 0.73 (0.66, 0.80) for dyslipidemia. The HDI score obtained using the FFQ can be applied to evaluate dietary profiles.

This study aimed to clarify the relationship between the onset of low-density lipoprotein hypercholesterolemia (hyper-LDLemia), high-density lipoprotein hypocholesterolemia (hypo-HDLemia), and hyper-triglyceridemia (hyper-TGemia) and lifestyle/socio-psychological factors among Fukushima evacuation area residents after the Great East Japan Earthquake. Participants included 11,274 non-hyper-LDLemia, 16,581 non-hypo-HDLemia, and 12,653 non-hyper-TGemia cases in the Fiscal Year (FY) 2011. In FY2011, these participants underwent a health checkup and responded to a mental health and lifestyle survey. The onset of each disease was followed through FY2017. The evacuation experience was positively associated with the risk of hyper-LDLemia, hypo-HDLemia, or hyper-TGemia. Conversely, the middle high dietary diversity score was negatively associated with the onset of hyper-TGemia. Moreover, low sleep satisfaction was positively associated with hypo-HDLemia and hyper-TGemia. The “almost never” exercise habit was positively associated with hypo-HDLemia. Current smoking and audible nuclear power plant explosions were positively associated with the risk of hyper-TGemia. Drinking habits exhibited a negative association with the onset of hyper-LDLemia, hypo-HDLemia, and hyper-TGemia. The results of this study indicate the need for continuous improvement in lifestyle, as well as efforts to eliminate the impact of disasters to prevent the onset of dyslipidemia among disaster evacuees.