Masako Sei Tokushima Health Screening Center Background; Tokushima Prefecture・・・ 背景:徳島県・・ Committee for Strategies to Prevent LifestyleRelated Diseases 生活習慣病予防対策委員会 Tracking of obesity among elementary and junior high school students 肥満のトラッキング Important period related to the risk of adolescent obesity 思春期肥満のリスクに関する重要な時期 Recent changes in the rate of obese children 最近の肥満児出現率の変化 Awa Odori, August 12-15 The Yoshino River Sudachi Food Awa Odori Poultry Naruto Kintoki sweet potatoes Sudachi kun Red Sea Bream Tokushima Prefecture Calculated from Annual Report of School Health Survey 2006, Ministry of Education, Culture, Sports, Science and Technology door to door by car Awa Odori, August 12-15 There is no electric train Carbohydrate and carbohydrate・・ Savory pancake Naruto Kintoki sweet potatoes Tokushima Ramen Noodles Scattered sushi 生活習慣病予防対策委員会 In 2000, the committee in order to “promote lifetime health development initiated during infancy” was established. 2000年、「小児期より生涯を通じた健康づくり」推進のために設立 The members of the committee comprise school doctors, school principals, directors of health centers, dietitians, and university person. 委員会の構成は学校医、学校長、保健所長、栄養士、大学等 生活習慣病予防対策委員会 組織図 Research Section 調査班 General Planning Section 総括班 High-riskapproach Section 個別アプローチ班 Population approach Section Public Relations Section 集団アプローチ班 社会資源利用班 Diabetes Prevention Section 糖尿病対策班 2006~ In 2000, a physical survey was performed for all students in elementary and junior high school (n=about 70,000). 体格調査開始 In 2001, the committee conducted a survey concerning measures taken against lifestylerelated diseases by each organization. 各機関の取り組み調査 In 2003, “Health management system for obesity in children” and “School urine examination system” were established. 個別アプローチ開始 In 2004 and 2011, lifestyle survey were performed 生活習慣調査 too thin やせすぎ 6 15 24 40 66 89 80 79 64 463 thin やせ 299 377 445 585 611 714 719 836 693 5279 overweight normal obese ふつう やや太りすぎ 太りすぎ 高度太りすぎ 3228 147 120 51 3148 192 143 53 2875 230 250 68 2747 291 252 84 2651 311 267 93 2565 291 317 102 2731 345 306 151 2979 259 261 135 2929 262 254 148 25853 2328 2170 885 Ｈ１４女子 学年 やせすぎ 小１ 9 小２ 24 小３ 23 小４ 46 小５ 100 小６ 185 中1 164 中2 130 中3 59 総計 740 男女計sum 1203 やせ 308 419 461 523 789 852 792 723 482 5349 10628 ふつう やや太りすぎ 太りすぎ 高度太りすぎ 3030 163 115 29 2888 184 122 29 2713 210 172 49 2620 240 200 39 2544 237 179 46 2445 188 168 55 2482 245 207 75 2754 279 225 92 2951 333 227 104 24427 2079 1615 518 50280 4407 3785 1403 Ｈ１４男子 学年 小１ 小２ 小３ 小４ 小５ 小６ 中1 中2 中3 総計 範囲外 3 1 1 1 1 4 11 範囲外 2 1 5 8 19 sum 総計 3854 3929 3893 3999 3999 4078 4333 4550 4354 36989 総計 3656 3666 3628 3668 3895 3893 3965 4204 4161 34736 71725 Health Management System for Obese Children Tertiary care 小児肥満健康管理システム ２００３～ medical center consult 受診 Obese children (obesity index 50%≦) 対象者(肥満度５０％以上等) obesity index 健診の通知，受診勧奨 School 各学校 exam/ support/treat 検査・指導・治療 consult 受診 exam/ support /treat 検査・指導・治療 Reports of results 報告書 Reports of all the members “Awakko” Reports of analysis Introduce (if necessary) School Physician, family clinic 校医・かかりつけ医 (二次検診) Reports of results 報告書 “The guide of obesity therapy” Lecture/workshop 肥満外来の手引き 研修会・講演会 Committee 生活習慣病予防対策委員会 学校検尿検診システム ２００３～ Urine test in School (once or twice) (proteinuria, occult blood, or glycosuria +) School Physician, family clinic exam/ diagnosis 検査・暫定診断 Introduce (if necessary) Tertiary care medical center 第１回 早朝尿 試験紙法（蛋白，潜血，糖） 糖 蛋白・潜血 （－） （±）～ （±） （＋）～ 食後尿＊２ 第２回＊１ 早朝尿 （－） （±）～ 学校・教委へ報告 学校から保護者へ連絡し 二次検診へ 二次検診＊３ 医療機関受診 蛋白・潜血 糖 早朝尿・来院時尿の尿検査 （2～3 回） 血液検査（BUN，クレアチニン， 総蛋白，ASO，CRP，血清補体成分 （C3）等） 学校・医師会へ報告 学校から教委へ連絡 空腹時の尿糖，尿ケトン体， 簡易経口ブドウ糖負荷試験， 負荷試験後の尿糖 高校生は HbA1c など 暫定診断・管理区分決定 蛋白尿・血尿の合併，高度の蛋白尿 （2+以上），尿所見の悪化，高血圧， むくみ，腎機能低下，血清補体価低値 三次（精密）検診 腎臓専門医療機関 糖尿病（疑），耐糖能異常（疑） 高校生は HbA1c5.2%以上など （小児）糖尿病専門医療機関 学校・医師会へ報告 （学校から市町村教委へ連絡） 確定診断・管理区分決定 医師会 地域保健 学校健診 医療機関検診 教育委員会 栄養士会 み ん な で 応 援 す る よ 大学 小児肥満健康管理シ ステ ム 徳島県医師会生活習慣病予防対策委員会 % n Hypercholesterolemia 13.6 49/361 Low serum HDL-C 11.3 40/353 Hypertriglyceridemia 37.7 136/361 Hyperuricemia 37.5 133/355 Hyperglycemia 4.2 15/359 Hyperinsulinemia 51.6 80/155 Liver dysfunction 45.9 166/362 Hypertention* 27.6 99/359 any metabolic abnormalities 80.4 295/367 Sei M et al, Pediatrics International (2007) 49, 545–552 year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 number of number of DM reports from from school clinic urine test 35 26 29 37 16 31 33 12 27 31 26 5 5 4 6 6 5 9 4 9 11 7 3,291 students in elementary and junior high school Consisted of 30 items such as physique, sleep, eating habits, diet, exercise, and free time The lifestyle survey in Tokushima did not identify any marked differences compared with nationwide values A marked association between eating meals with the family every day and good lifestyle habits Yuasa K et al, JMI (2008) 55, 71-77 Eating breakfast, everyday Eating vegetables, everyday Eating with family, everyday Watching television (average hours spent) Longitudinal weight and height data were collected annually from 9723 children aged 614 years (entered elementary schools in Tokushima, in the 2001-2002 school year) : 小１から中3まで、9年間の前向きコホート Based on the age specific BMI cut off values in IOTF BMI at age 6 y BMI at age 14y Age (years) Frequency, n (%) Underweight Normal weight Overweight Obese Total (N = 9723) 6 785 (8.1) 7447 (76.6) 1035 (10.6) 456 (4.7) 14 700 (7.2) 7631 (78.5) 1111 (11.4) 281 (2.9) 6 413 (8.3) 3853 (77.3) 465 (9.3) 252 (5.1) 14 341 (6.8) 3899 (78.2) 560 (11.2) 183 (3.7) 6 372 (7.8) 3594 (75.8) 570 (12.0) 204 (4.3) 14 359 (7.6) 3732 (78.7) 551 (11.6) 98 (2.1) Boys (n = 4983) Girls (n = 4740) 6y UW 8.1% OW 10.6% NW 76.6% OB 4.7% 14y UW 7.2% 0% OW 11.4% NW 78.5% 20% 40% OB 2.9% 60% 80% 100% Tracking of obesity （6y →14y） At age 14y classified as UW NW OW (exc. OB) OB OW (incl. OB) 154 (37.3%) 244 (59.1%) 13 (3.1%) 2 (0.5%) - NW OW (exc. OB) OB 184 (4.8%) 2 (0.4%) 1 (0.4%) 3353 (87.0%) 250 (53.8%) 52 (20.6%) 274 (7.1%) 166 (35.7%) 107 (42.5%) 42 (1.1%) 47 (10.1%) 92 (36.5%) OW (incl. OB) - - - - 412 (57.5%) 7 (1.9%) 244 (6.8%) 211 (37.0%) 89 (43.6%) 0 (0%) 20 (0.6%) 22 (3.9%) 56 (27.5%) Boys (n=4983) At age 6y classified as UW Girls (n=4740) At age 6y classified as UW NW OW (exc. OB) OB OW (incl. OB) 137 (36.8%) 228 (61.3%) 218 (6.1%) 3112 (86.6%) 3 (0.5%) 334 (58.6%) 1 (0.5%) 58 (28.4%) 378 (48.8%) Adolescent obesity risk in the non-obese subset at aged 6 years Dataset 4983 boys and 4740 girls n=9723 Obese at aged 6 years (248 boys and 237 girls) Non-obese subset 4735 boys and 4503 girls n=9238 Obese at aged 14 years n= 8968 Persistent non-obesity 4603 boys and 4365 girls Incident obesity 132 boys and 138 girls Kori H et al, Pediatrics International (2013) 55, 761–766 n= 270 Odds ratio of adolescent obesity in the non-obese subset Boys (n = 4735) Girls (n = 4503) Period (years of age) OR (95% CI)a Corrected Pvalueb OR (95% CI)a Corrected Pvalueb 6–7 1.82 (1.58–2.08) 2.1 × 10-16 1.90 (1.67–2.15) 1.6 × 10-22 7–8 1.84 (1.60–2.12) 7.2 × 10-16 1.60 (1.40–1.84) 2.2 × 10-10 8–9 1.39 (1.20–1.60) 8.8 × 10-5 1.63 (1.42–1.86) 1.5 × 10-11 9–10 1.61 (1.40–1.86) 4.5 × 10-10 1.56 (1.36–1.77) 8.5 × 10-10 10–11 1.66 (1.44–1.91) 1.6 × 10-11 1.62 (1.40–1.88) 2.1 × 10-9 11–12 1.70 (1.49–1.95) 7.2 × 10-14 1.90 (1.64–2.21) 5.4 × 10-16 12–13 2.06 (1.74–2.45) 2.1 × 10-15 1.61 (1.40–1.85) 1.4 × 10-9 13–14 2.57 (2.17–3.03) 4.2 × 10-27 1.99 (1.70–2.32) 4.0 × 10-17 aORs indicate the effects of the 1-SD increase in annual BMI gain from logistic regression models adjusted for sex and baseline BMI. bCorrected P-values were shown after Bonferroni correction. Kori H et al, Pediatrics International (2013) 55, 761–766 We obtained anthropometric data for schoolchildren in Tokushima, 2000-2011. The survey included approximately 70,000 children each year and covered all of the elementary schools and junior high schools in Tokushima Prefecture. The prevalence rates of both overweight and obesity decreased Trends in prevalence of obesity (elementary school) Tokushima, boys Tokushima, girls Japan, boys (Nation-wide data) Japan, girls Trends in prevalence of obesity (junior high school) Japan, boys (Nation-wide data) Tokushima, boys Tokushima, girls Japan, girls Obese children (obesity index 50%≦) 1500/71725 (2.09%) in 2002 →794/62128 (1.28%) in 2011 Overweight children (obesity index 20%≦) 10529/75196 (14.00%) in 2000 →6280/62128 (10.11%) in 2011 Twelve-year cross-sectional changes in the prevalence rates of overweight and obesity (obesity index 20~30%, 30~50%,50%≦) Boys (overall,6-14 years) Girls (overall,6-14 years) Activity of Diabetes Prevention Section (2004~) Lectures ( for general population, employers) Publicity (newspaper, television, posters ) “Declaration of a State of Emergency on Diabetes” Education of medical professionals Establishment of efficient links among healthcare providers Certifications of physicians with sufficient knowledge of diabetes Certifications of diabetic educators Preparation of a new walking diary Preparation of healthy menu AWA-ODORI Exercise Shima K et al, Diabetology International( 2013) 4, 23–33 Activity of Diabetes Prevention Section 2004~ “Declaration of a State of Emergency on Diabetes” AWA-ODORI Exercise 阿波踊り体操、ＤＶＤ http://www2.tokushima.med.or.jp/syuukanbyou/ 太い子が多いなあ・・ 太い大人が多いなあ・・ 糖尿病が多いなあ・・ 歩かないし、甘辛いの好きだし・・ 困ったなあ・・ Subjects Obese children Obese adult Diabetes 対策を継続できる組織を作ろう Organization Surveillance, Research ちゃんと肥満児を数えよう 生活習慣病 に対する 集団アプローチ Population approach System for consulting, High risk approach ハイリスクの子はちゃんと指導・医療へつなげよう 大人の糖尿病対策をがんばろう Diabetes Prevention for adult 高校生のハイリスクの子もちゃんと指導・医療へつなげよう Including high school students Map of obesity levels(%) by prefecture, among 5-17 years of age in 2013 Tokushima Prefecture Calculated from Annual Report of School Health Survey 2013, Ministry of Education, Culture, Sports, Science and Technology Cooperation in Tokushima 徳島県内の連携 Medical Association 県医師会 School Physician Family clinic 校医 Prefectural government 徳島県 All children and citizens こどもたち 県民 School 各学校 Board of education 教育委員会 Public health center 保健関係者 （保健所等） University, Researcher 各大学 Committee for Strategies to Prevent Lifestyle-Related Diseases 生活習慣病予防対策委員会 Dietetic association 県栄養士会 食育関係者 Health Fitness Association 健康運動 指導士会等
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