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● このスライドの著作権は、講演の発表者本人に帰属します（図表等の引用箇所は除く）。如何なる国・地域においても、また紙媒体やインターネット・電子データなど形態に関わらず、スライドの全部または一部を無断で複製、転載、配布、送信、放送、貸与、翻訳、販売、変造、二次的著作物を作成すること等は、固く禁止します。
Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the Fukushima
Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited from other sources).
It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell, modify, and/or
create derivatives of any slides, in any physical or electronic medium anywhere in the world.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)
2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)March 2nd, 2024

Session 1-3

Lessons from 12 years of theComprehensive Health CheckSHIMABUKURO Michio, MD, PhD
Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University

Office of the Comprehensive Health Check and Health Promotion, Radiation Medical Science
Center for the Fukushima Health Management Survey, FMU

1Topics
1. Lessons from 12 years of theComprehensive Health Check
2. Possible mechanisms
3. Future perspective

2

FHMS includes 5 surveys① Basic Survey② Thyroid Ultrasound ExaminationCHC③Fukushima Med Univ

Fukushima Pref

④ Mental Health and Lifestyle Survey⑤ Pregnancy and Birth Survey

CHC: Comprehensive Health Check
FHMS: Fukushima Health Management Survey
From website of the Radiation Medical Science Center for the Fukushima HealthManagement Survey, Fukushima Medical University

3

Estimated radiation doses & NCD

Backgrounds• Basic survey in the FHMS
• Four months after 2011 Great East Japan Earthquake (GEJE)
and the subsequent accidents at the Fukushima Daiichi
Nuclear Power Plant (FDNPP) March 11, 2011 to July 11, 2011
• Estimated radiation doses were determined in all Fukushimaresidents (Yasumura S et al.,2012)

Purpose• To determine the relationship between estimated radiation doses
and NCD in residents who underwent CHC of the FHMS in 2011
• Sakai et al., J Epidemiol 2022:32 (Suppl_XII);S84.
CHC: Comprehensive Health Check
FHMS: Fukushima Health Management Survey
NCD: Non-communicable diseases

4Methods⚫Residents who had lived in the areasurrounding FDNPP and were forced to evacuateby government order after the disaster, andthose who have received CHC.
⚫Participants in CHC 2011, n=72,869（Men31,982、Women 40,887) (≥16y, 30.9％) 16-84y,54,087 (Men 22,599, Women 31,488).
⚫Of the above, 52.5% participated in theBasic Survey. For non-participants, radiation
doses were estimated with multiple imputation(age, sex, and areas).
⚫Residents were categorized to 0-1（≥0 and<1）, 1-2（≥1 and <2）, and ≥2 mSv/y groups.
⚫With 2011 as a baseline, onsets of NCS from2012 to 2017 as hazard ratios (95%
confidential intervals, CI).
⚫Hazard ratio (95% CI) were calculated as for
1 mSv/y as reference in a Cox proportional
hazards model.

Evacuation zone
on 2011 April 22,
Fukushima government HP

CHC: Comprehensive Health Check
FHMS: Fukushima Health Management Survey
NCD: Non-communicable diseases5

Results: estimated radiation doseｓ⚫Residents who participated in the Basic Survey (obtained
estimated radiation doses)(n=28,402、52.5%)<1 mSv：n=19,238（67.7％）
1-2 mSv：n=7,089（25.0％）≥2 mSv：n=2,075（7.3％）⚫Residents who did not participate in the BasicSurvey(47.5%)(calculated estimated doses with multipleimputation)<1 mSv：67.5%1-2 mSv：24.6%≥2 mSv：7.9%⚫Distribution: a similar tendency between the above two groups⚫Analyses were done for the Basic Survey + the non-Basic Survey
groups, and the Basic Survey group alone.
6

Increased NCD in estimated radiation doses ≥2mSv/y group
Adjusted forHypertension
Diabetes
Dyslipidemia
Chronic kidneydiseaseHyperuricemia

Liver dysfunction
Polycythemia
AnemiaThrombocytopenia
Lymphocytopenia
Neutropenia

Model 1Model 2aModel 2bModel 3Model 4Sex, AgeSex, Age, BMISex, Age,
Evacuation

Sex, Age, BMI,Evacuation

All parameters*

1.29

1.20

1.22

1.13

1.09

(1.16-1.44)(1.08-1.33)(1.09-1.36)(1.01-1.26)(0.98-1.22)

1.17

1.06

1.09

1.00

1.01

(1.02-1.36)(0.92-1.23)(0.94-1.27)(0.86-1.16)(0.87-1.18)

1.28

1.20

1.19

1.12

1.13

(1.04-1.57)(0.98-1.46)(0.95-1.47)(0.90-1.39)(0.91-1.40)

1.04

1.01

0.99

0.96

1.04

(0.95-1.13)(0.92–1.10)(0.90–1.08)(0.88–1.06)(0.95–1.14)

1.16

1.09

1.11

1.05

1.08

(1.04–1.29)(0.98–1.22)(0.99–1.24)(0.94–1.18)(0.96–1.20)

1.17

1.13

1.08

1.05

1.06

(1.06–1.29)(1.03–1.24)(0.98–1.19)(0.95–1.15)(0.96–1.17)

1.32

1.07

(1.02–1.71)(0.82–1.39)

0.88(0.77–1.01)

0.95(0.74–1.23)

0.91(0.73–1.15)*age, sex, current smoking,binge drinking, evacuation,
hypertention, diabetes,
dyslipidemia, and bloodbiochemical parameters atbaseline

1.14(0.99–1.31)

1.01(0.78–1.32)

0.95(0.75–1.20)

1.08

1.21(0.86–1.36)(0.96–1.53)

Numbers are hazard ratios (95% confidential interval) as values with 1 mSv/y as reference in a Cox
proportional hazards model7

Summary⚫Estimated doses (≥2 mSv/yr) were associated with increased hypertension,
diabetes, dyslipidemia, hyperuricemia, liver dysfunction, and polycythemia
in an age- and sex-adjusted model. However, the association disappeared
after adjustment for evacuation status and lifestyle-related factors.
⚫It is unlikely that the high estimated radiation doses of the evacuees
during the first four months after the accident were directly related to theonset of lifestyle-related diseases.
⚫Meanwhile, it is presumed that evacuation and lifestyle changes haveaffected the development of NCD among residents with higher estimatedradiation doses.

Limitations⚫Covered population low in the Basic Survey (30%) could not be representativeof the population as a whole. However, post-multiple completion data showed
the same results.
⚫Since CHC was initiated several months after the accident, they may notreflect the effects of radiation exposure during the acute phase.
⚫The maximum follow-up period for this study was 6 years; longer follow-up isneeded to determine the true effect of radiation on NCD.
⚫The effects of diet, physical activity, and psychological stress were notexamined in this study.

8Topics
1. Lessons from 12 years of theComprehensive Health Check
2. Possible mechanisms
3. Future perspective

9

How NCD Occurs
Socio-economic &environmental
risk factors

Behavioral
risk factors

NCD
Non-communicablediseasesComplications &comobididies

NCD-related
disabilities

Globalization
Urbanization
Air pollution
Poverty
Poor education
Inequality
StressDiscrimination

Smoking
Unhealthy dietPhysicalinactivity
Heavy alcohol
consumption

Obesity/Metabolic
syndrome
Hypertension
IGT/Diabetes
Dyslipidemia(LDL cholesterol,triglycerides)

Chronic kidneydiseaseStroke,Heart attack
Heart failure
Atrialfibrillation
DementiaCancer

Decline inphysical andmentalfunctions
Decline in QOL
Shortening in
healthy life
expectancy &life expectancy

Genetic & Epigenetic risk factors

Dans et al, Lancet 2021:377;680
Park et al, https://bit.ly/3HYhWHC
Modified by Shimabukuro

10

NCD after the nuclear accident: what we know in CHC≤15y: Children
A certain number of children presented with obesity,dyslipidemia, hyperuricemia, liver dysfunction, hypertension,and IGT. Obesity improved in the follow-up survey, but theimprovement of lipid abnormalities in boys was delayed.

≥16y• Increased: obesity, metabolic synd, IGT & diabetes, chronic
kidney disease, hyperuricemia, and polycythemia• Increased but improved: blood pressure, LDL-cholesterol(residents under treatment increased), liver dysfunction(decreased due to the improvements of daily physical activity
and frequency of breakfast intake)• No changes: WBC counts and fractions within the evacuatedareas: no direct effects observed
CHC: The Comprehensive Health Checkup
IGT: impaired glucose tolerance
Based on the report submitted to the 41st Prefectural Monitoring Committee
Meeting for Fukushima Health Management Survey

11Increased NCD after the diaster
≤15y

≥16y
Obesity

Obesity・Dyslipidemia

VisceralObesity

Obesity•Metabolic synd

High TG
Low HDL

Hypertension

IGT

Increased NCD+ Hyperuricemia

CKD, Stroke•Heart attack
Heart failure, AFib, Dementia, Cancer

SmokingIGT: impaired glucose tolerance
CKD: chronic kidney disease
Afib: atrial fibrillation

LDLchol

Tanabe ... Shimabukuro, Diabetes Res Clin Pract 2021

Hypertension

Diabetes

IGT
Non-Obese12

Lifestyle- and disaster-related factors and NCD risk:
CHC ≥40y、men 10,120, women 13,961↑ increase,↓decrease, empty notsignificant, – notanalyzedobesityleanness

Hypertention

Diabetes
mellitus

Dyslipidemia

MWMWMWM

WM↑↑

↓↑↑

↑↑↑↑
↓

Aging
Obesity––––↑↑

Leanness––––↓↓

MWMW↑↓↑↑↑↑↑↑↑↑↑↓↓↑↑↓↑ ↑↑

↑↑

↑

↑

↓

Sleep satisfaction↑↓

EtOH < 40g/d↑

EtOH ≥ 40g/d↑

Current smoking↑

↓↑↓

↓↓ ↓↓

↑
↑↑

↑

Evacuation

Change of jobs

CKDW

↓

Excersise ≥ 2x/w

Liverdysfunction↑↑↑

Depressive symptoms↑

PTSD symptoms
Radiation concerns↑

Participation inrecreation

↓

↓

↓

Based on the report submitted to the 41st Prefectural Oversight Committee Meeting for the FHMS↑
13Topics
1. Lessons from 12 years of theComprehensive Health Check
2. Possible mechanisms
3. Future perspective

14

NCD：Who and how to prevent it
NCD: Non-communicable diseases

Global levelUN、WHO⚫
⚫

⚫
⚫

Country level
Government, Ministry

Health policy⚫
development andimplementation
Supporting NCD
research
Monitoring of NCD ⚫
Support for⚫
national andinternational
cooperation

Community level Individual level
Local government, community,workplace, school, nongovernmental organization (NPO,NGO)

Budget for health ⚫
promotion system ⚫
(health screening
opportunities)
Research support ⚫
Develop sustained
primary healthcare system

Budreviciute et al. Front Public Health2020:574111 Modified by Shimabukuro（Privateopinion）

Offer healthy food
Offer places andtimes for physicalactivity
Creating systems tosupport NCD
prevention and careservices

Individual, Family⚫ Healthylifestyle⚫ Health literacy

Role of CHC
CHC: Comprehensive Health Check15

Increased NCD after the diaster： Evidence for Prevention andScientifically proven facts
Treatment
≤15y

≥16y

Unhealthy dietPhysicalinactivity
Obesity

Unhealthy dietPhysical inactivity

Obesity・Dyslipidemia◎Body weight reduction– Medication

Obesity•Metabolic synd

VisceralObesity

High TG
Low HDL

Hypertension

Evidence for Prev &Tr◎Effective△Almost not effective– Not effective

IGT+ Hyperuricemia△BW reduction◎Medication

Increased NCD

CKD, Stroke/Heart attack,Heart failure, AFib, Dementia, Cancer

Smoking– Medication◎Motivation

LDLchol

Hypertension

IGT–BW reduction –BW reduction◎Medication◎Salt restriction◎Medication

Tanabe ... Shimabukuro, Diabetes Res Clin Pract 2021

Diabetes

Diabetic
Microangiopathy(retinopathy,nephropathy &neuropathy)

Non-Obese

IGT: impaired glucose tolerance
CKD: chronic kidney disease
Afib: atrial fibrillation

16

Role of CHC in 10 years summary

Notification of individual results

Reports of the 41st Prefectural Monitoring Committee Meeting for FHMS 2011-2019

1.

Provide opportunities for health checkups••

2.

Secure the physical and mental health of residents who experienced majorchanges in their living environment after the earthquake.
Opportunities to receive checkups for people between 16-39y, who have few
opportunities by current health policy.

Preparation and sharing ofanalysis reports

Close cooperation with municipalities•3.

Sharing of residents health information via planning of health events andreports conference
Analysis of factors associated with physical and mental health after theearthquake•

4.

Clarification and sharing of factors associated with physical and mentalhealth• Academic papers: 48 Accepted thesis, 48 Submitted thesis (as of Jan, 2024
Impacts of feedback from CHC

Fiscal YearNumbers

2016

３M 11 times

495

2017

６M 42 times

2,379

An improvement in some risks (blood pressure and LDL cholesterol levels)
due to increased health awareness, corrected lifestyle, and higher
treatment rates• The results of health checkups were used for municipal health policy
Proposal from CHC

2018

６M 26 times

2,324

2019

６M 38 times

3,334

2020

３M 17 times

1,432

2021

３M 18 times

1,642

•2022

４M 25 times

2,028

2023
(Until the end of Dec.)

５M 47 times

2,157

•

5.

Health seminar

Proposal made to municipalities and local residents on the importance of(1) physical activity and healthy diet, (2) mental health care, and (3)promotion of social participation.

Visitors

17Summary
take home message

1. Lessons from 12 years of the Comprehensive Health Check⚫ Increased in adult, partially in children: obesity, metabolic synd, IGT & diabetes,
chronic kidney disease, hyperuricemia, and polycythemia.
⚫ Estimated doses were associated with increased NCD→ Presumably, evacuation andlifestyle changes may have affected the development of NCD among residents withhigher estimated radiation doses.

2. Possible mechanisms⚫ After the accident, evacuation and lifestyle changes → unhealthy diet, physicalinactivity, and smoking & drinking → mental problems→ obesity accompanying NCD are
NCD: Non-communicable diseases
increasing.

3. Future perspective⚫ Individuals and communities to learn true health literacy (=evidence) and commit
evidence-based prevention and treatment of NCD.
⚫ Sharing information among individuals, communities, municipalities, prefectures,countries, and global

18

Thank you for your attention

Fukushima Medical University gardens
photos by Shimabukuro19

● このスライドは、非営利かつ個人的な目的に限り閲覧することができます。
The following presentation slides are shared with symposium participants exclusively for personal, non-commercial,educational purposes.

● このスライドの著作権は、講演の発表者本人に帰属します（図表等の引用箇所は除く）。如何なる国・地域においても、また紙媒体やインターネット・電子データなど形態に関わらず、スライドの全部または一部を無断で複製、転載、配布、送信、放送、貸与、翻訳、販売、変造、二次的著作物を作成すること等は、固く禁止します。
Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the Fukushima
Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited from other sources).
It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell, modify, and/or
create derivatives of any slides, in any physical or electronic medium anywhere in the world.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)