Nursing for the people withlifestyle- related diseases
in Japan
1. Current state of lifestyle-related diseases/ NCDs inJapan and actions taken

Japanese Nursing Association

1. Current state of lifestyle-relateddiseases/NCDs in Japan and actions
taken
2. Nursing for the people with lifestylerelated diseases: healthpromotion, prevention and living withthe diseases (to be issued soon)
3. Japanese Nursing Association in
Action (to be issued soon)

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The lifestyle-related diseases
It is a group of diseases the onset and progress ofwhich are concerned with lifestyle and behavior
factor(s) such as dietary habits, physicalactivities, rest, smoking, alcohol consumption, etc.
Examples: Diabetes, hypertension, heartdiseases, cerebrovascular diseases, cancers, etc.

The term “lifestyle-related diseases(Seikatsu-shukan-byo )” was proposed in 1996 by
the Ministry of Health and Welfare’s Council on Public Health.
In Japan the mortality rates of such diseases as cerebrovascular diseases, cancers
and heart diseases rapidly increased around the age of 40. The traditional
administrative term of “adult diseases (Seijin-byo)” was used because these diseases
were related with aging. However, as the prevention of such diseases requiredconsiderations based on the current state of one’s lifestyle and behavior factors suchas diet, physical activities, smoking and alcohol consumption as well as the issues
related to those, the concept of “lifestyle-related diseases” was introduced.
The lifestyle-related diseases are chronic diseases including cancer, heart diseases
and diabetes. It is also non-communicable diseases (NCDs) against which worldwide
actions are being taken.

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The principle causes of death among the Japanese havechanged from infections to lifestyle-related diseases such as
cancer, heart diseases and cerebrovascular diseases
300

Changes in mortality rates from principle causes of deathper 100,000 population
Tuberculosis
Malignantneoplasm

250

Diabetes

200

Hypertensive
diseasesheart diseases

150
Cerebrovascul
ar diseases

100

Pneumonia
Liver disease

50
Renal failure
Died of old age
1921
1925
1929
1933
1937
1941
1948
1952
1956
1960
1964
1968
1972
1976
1980
1984
1988
1992
1996
2000
2004
2008
2012

0

Source: 2012 Vital Statistics, Ministry of Health, Labour and Welfare(MHLW)Japan saw a rapid decline in tuberculosis- and pneumonia-related deaths in theearly 1950s. The leading causes of deaths was dramatically changed from
communicable diseases to the lifestyle-related diseases around this time.
Malignant neoplasm, cardiovascular diseases and cerebrovascular diseases havebeen the three major causes of death since 1958, currently making up
approximately 60% of all causes of death. Against this backdrop, emphasis is being
placed on the preventive measure of the lifestyle-related diseases.

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Approximately 30% of deaths among
Japanese people are caused by cancer
Cause specific mortality rate per 100,000 population

48.2
19.9 12.7

32.6 5.1

21 13.1

Malignant neoplasm
heart diseases
Cerebrovascular diseases
Diabetes

286.6

Hypertensive diseases
Pneumonia

98.4

Renal failure
Liver diseases
Died of old age

5.8
11.5

96.5

Non-traffic accident

157.9

Traffic accident
SuicideOther cause

Source: 2012 Vital Statistics, MHLWApproximately 60% of deaths among Japanese people are caused by lifestylerelated diseases; while approximately 30% are caused by cancers.
Research on preventable risk factors in the Japanese population identified the two
principle determinants of adult deaths due to NCDs or injuries in Japan in 2007 as
smoking and high blood pressure.1)

1) The issue of The Lancet featuring Japan (September 2011): Series Japan: Universal Health Careat 50 Years: What has made the population of Japan healthy? (Kenji Shibuya (representative);
Comprehensive assessment of risk factor interventions and prevention of disease burden; Grantin-Aid for Scientific Research from the Ministry of Health, Labour and Welfare (FY 2010–2012))

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The estimated number of patients
The estimated number of patients
Unit (1,000 persons)670.6
Hypertensive diseases
298.3

Malignant neoplasm
Cerebrovascular diseases

283.8
2935.6

Diabetes

232.4

Ischemic heart diseases
Others77.4

Source: 2011 Patients survey, MHLWApproximately a third of the estimated number of patients in Japan is suffering fromlifestyle-related diseases.
With regard to the hypertensive diseases, which rank at the top in the estimatednumber of patients list, the 2012 National Health and Nutrition Survey shows 55.5%
of males and 39.6% of females of 20 years or older are deemed to have ahypertensive diseases (systolic blood pressure of 140 mmHg or higher and/or
diastolic blood pressure of 90 mmHg or higher, or taking a antihypertensive drug).

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Cancers in the Japanese population
Number of cancer patients by site (2010)

Prostate

Male

Lung

StomachBreastFemale0100,000

200,000

300,000

400,000

500,000(persons)

oral cavity or pharynx
rectumlarynxuteruskidney or ureter
multiple myeloma

esophagus
liver
lungs
ovary
brain and/or CNS
leukemia

stomachgallbladder or bile duct
skin
prostatic glandthyroidcolon
pancreasbreastbladdermalignant lymphoma

Cancer has topped the causes of death list in Japan since 1981. The lifetime risk ofcancer in Japanese is one in two. The likelihood of dying from cancer is one in four
for males (26%) and one in six for females (16%). The mortality rate from cancer
start to increase in those in their 60s. The mortality rate is greater for males thanfemales in their 60s and older.
The national cancer screening rate in 2010 was extremely low. In males, thescreening rate of stomach cancer was 36.6%, colon cancer was 28.1%, and lungcancer was 26.4%. In females, the screening rate of stomach cancer was
28.3%, colon cancer was 23.9%, and lung cancer was 23.0%, breast cancer was
30.6% and uterine cancer was 28.7%
Source: Center for Cancer Control and Information Services, National Cancer Center, Japan
http://ganjoho.jp/public/statistics/pub/statistics01.html (accessed on 24 June 2014)

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Diabetes(10,000 persons)

1320

1400
1200

1100

1000
800

890

950

690 740(year)

880
680

600

1997
2002
2007

400

2012

200
0
Diabetes strongly suspected

Diabetes cannot be ruled out

Diabetes strongly suspected: persons with HbA1c (NGSP) of 6.5% or greater, and/or persons
who have been diagnosed with diabetes and received treatment
Diabetes cannot be ruled out: persons with HbA1c (NGSP) of 6.0% or greater, but less than
6.5%, and not strongly suspected to have diabetes

The estimated figure for the number of “diabetes cannot be ruled out” had shown an
increasing tendency before, but decreased in a Japanese government survey in 2012.
The percentage of the “diabetes strongly suspected” group was 15.2% for males and7.8% for females. Compared to the figures of previous survey in 2007, there were nochanges for males but an increase for females. Meanwhile the percentage of“diabetes cannot be ruled out” was 12.1% for males and 13.1% for females. In
comparison to the figures in the previous survey in 2007, there was no change formales but a decrease for the females.
Source: 2012 National Health and Nutrition Survey, MHLWJapanese Nursing Association

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Cerebrovascular diseases
Cerebrovascular diseases mortality rates(per 100,000 population)
200

180
160
140
120

All cerebrovascular disorders

100

Subarachnoid hemorrhage

80

Intracerebral hemorrhage

60

Cerebral infarction

40
20
2012

2011

2010

2005

2000

1995

1990

1985

1980

1975

1970

1965

1960

1955

1951

0
(year)
Source：2012 Vital Statistics, MHLWThe third highest cause of death among the Japanese is cerebrovascular diseases.
When cerebrovascular diseases occur, they also have a high risk to create a need forlong-term care.
The mortality rate of cerebrovascular diseases among the Japanese peaked around
1965, and then declined. The largest factor behind this change was a decline inintracerebral hemorrhage cases.
At present, cerebral infarction makes up
approximately 60% of cases in which cerebrovascular diseases cause death, and it isattributed to increasing dyslipidemia and diabetes. Although the exact incidence
rate of cerebral infarction is unknown, it is estimated to be between 100 and 200
cases per 100,000 population, and around 600 cases per 100,000 population of 40
years or older.1)
The estimated number of patients with cerebrovascular diseases in 2011 was
1,235,000.
Source: 1) Stroke management guideline 2009, by Stroke joint guideline committee

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Heart diseases
Estimated death due to ischemic heart disease andcerebrovascular disease per 100,000 population
160
140
120
100
80
60
40

20
0

Ischemic heart disease

Cerebrovascular disease

Source: WHO Global Health Observatory Data Repository, Disease and injury country estimates, 2008

Mortality rate of heart diseases among the Japanese is on the increase. In thepast, when compared to various overseas populations, the Japanese showed higher
mortality rate from cerebrovascular diseases and lower mortality rate from ischemic
heart disease. However the changes in lifestyle and diet of Japanese population havebrought an increase in metabolic diseases such as obesity, dyslipidemia and impaired
glucose tolerance. It is feared this trend may lead to an increased risk of ischemic
heart disease.
Reference:
Guidelines for the primary prevention of ischemic heart disease revised version(JCS 2012) by joint team from: The
Japanese Circulation Society, Japan Society of Nutrition and Food Science, The Japanese Society ofHypertension, The Japan Menopause Society (The Japan Society for Menopause and Women's Health), JapaneseSociety of Pediatric Cardiology and Cardiac Surgery, Japanese College of Cardiology, The Japanese Association of
Cardiac Rehabilitation, The Japan Diabetes Society, Japan Atherosclerosis Society and The Japan Geriatrics Society

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Obesity
Ratio of obese persons (BMI ≥ 25)

(%)

40.0

Males

In their 20s

30.0

In their 30s
In their 40s

20.0

In their 50s
In their 60s

10.0

70 years or older
0.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0

FemalesIn their 20s
In their 30s

In their 40s
In their 50s

2012

2010

2008

2006

2004

2002

2000

1998

1996

1994

1992

1990

1988

1986

1984

1982

1980

In their 60s
70 years or older(year)

Source: 2012 National Health and Nutrition Survey, MHLWThe WHO definitions are: a BMI greater than or equal to 25 is overweight while a BMI
greater than or equal to 30 is obesity.1)
The Japanese definition of obesity is a BMI greater than or equal to 25, while thosewith concurrent health issues or visceral fat area size of 100 cm2 or larger are deemedadiposity. Although the obesity-related diseases are on the rise in Japan, obese
Japanese mostly fall within a BMI range of 25 or more but less than 30. Since notmany fall in the WHO’s obese criterion of BMI of 30 or greater, Japan uses different
criteria from WHO.2)
According to the 2012 National Health and Nutrition Survey, 25.3% of males and 15.9%of females of 20 years or older fall in a BMI range of 25 or greater but less than30, while 3.8% of the males and 3.4% of the females have a BMI of 30 or greater.
There is an increasing tendency for obesity in males.
Sources:
1) World Health Organization (2014) Obesity and overweight Fact sheet No. 311, http://www.who.int/mediacentre/factsheets/fs311/en/# (accessed 19 June 2014)
2) Japan Society for the Study of Obesity (2011) Journal of Japan Society for the Study of Obesity, 17(50), pp1-2.

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Metabolic Syndrome
Metabolic syndrome diagnostic criteria
Additional risks
Abdominal girth i. blood glucose; ii. lipids;iii. blood pressure
Male≥ 85cm
Female≥ 90cm
i. blood glucose:ii. lipids:iii. blood pressure:

Diagnosis

Two or more apply

Metabolic syndrome

One applies

Potential

fasting blood glucose level of 110 mg/dL or higher
neutral fat level of 150 mg/dL or higher and/or HDL cholesterollevel of less than 40 mg/dL
Systolic blood pressure(BP) of 130 mmHg or higher and/or
diastolic BP of 85 mmHg or higher

It has become known that lifestyle-related diseases are strongly associated withobesity with excess visceral fat (visceral fat obesity). The visceral fat obesity increases
the risks for diabetes, dyslipidemia and hypertension, as well as progressive arterialsclerosis, which raises the risk for myocardial infarction (MI) and stroke. In
Japan, metabolic syndrome (visceral fat syndrome) is diagnosed when two of thethree indicators of blood glucose, lipids and blood pressure, exceed their respective
reference ranges. Those who fulfill the criteria need to manage the conditions byimproving their lifestyles.
The 2011 data of those who underwent metabolic syndrome-focused
screening, targeting those of 40 years or older, show that 14.6% were likely to havemetabolic syndrome while 12.1% were deemed in the “potential” category.1)
Source: 1) Data related to specified health examination and/or specified health guidance, MHLW
http://www.mhlw.go.jp/bunya/shakaihosho/iryouseido01/info02a-2.html (accessed on 25 June 2014)

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RISK FACTORSJapanese Nursing Association13

Although declining, salt intake level
among the Japanese is still high
(g)

15

10
Salt intake level

5

1975
1980
1985
1990
1995
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

0
(year)

Source: 2012 National Health and Nutrition Survey, MHLW

Dietary habits form one of the important factors that influence lifestyle-relateddiseases. Historically Japan had a higher prevalence of hypertension and deaths due
to stroke. One of the contributing factors was the high level of salt intake. On
average, the Japanese consume 10.4 g of salt/day (2012 data). Although WHO
recommends to limit the salt intake to 5 g/day, the target salt intake in Japan are lessthan 9 g/day for males and less than 7.5 g/day for females.
Sources:• 2012 National Health and Nutrition Survey, MHLW• Dietary reference intakes for Japanese (2010 edition), MHLW
• 2014 Hypertension management guideline by The Japanese Society of Hypertension

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Changing dietary structure of theJapanese
PFC balance changes
1961
1971
1980
1990
2000
Protein (P)2002

Fat (F)

2004

Carbohydrates (C)

2006
2008
2010
2012
0%

20%

40%

60%

80%

100%

Source: Sections 44, 45 and 46, “Current state of citizens’ nutrition” from 2012
National Health and Nutrition Survey by MHLWThe Japanese diet has seen major changes. Although the total calorific intake has notchanged much, the ratio of fat on an energy intake level is increasing while that ofcarbohydrates is on the decline.
Meat, eggs, dairy products and oils have become a larger source of fat intake, while
tubers and rice-based carbohydrate intake has decreased. Although the protein intake
level remains relatively stable over times, an increase in animal protein intake has been
observed (from 25.3 g in 1961 to 36.4 g in 2012) while the plant protein intake has
decreased.
“Kenko Nippon 21 (Health Japan 21)” suggests a daily intake target for vegetables andfruits of 350 g, though the 2012 survey showed adults’ average vegetable, etc., intake
remained 286.5 g.
Sources:“Current state of citizens’ nutrition” from 2012 National Health and Nutrition Survey , MHLW
“Shokuiku guidebook for parents and children” by Office of Shokuiku Promotion, Cabinet Office“aff” May 2008 issue by Ministry of Agriculture, Forestry and Fisheries (http://www.maff.go.jp/j/pr/aff/backnumber.html; accessed on June 11, 2014)

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Physical activities: Fewer steps aretaken per day on overage
Chronological changes in the average number of steps per day(steps/day)Males(steps/day)

10,00010,000

9,000

9,000

8,000

8,000

7,000

7,000

6,000

6,000

5,000

5,000

4,000

4,000

3,000

3,000

Females(year)(year)― age 20–29 ― age 30–39 ― age 40–49 ― age 50–59 ― age 60–69 ― age 70 and over
Source: 2012 National Health and Nutrition Survey , MHLW

According to WHO, physical inactivity is the fourth highest risk factor in terms of thenumber of deaths worldwide, following hypertension (13%), smoking (9%) andhyperglycemia (6%).1) Regular physical activity is deeply related to NCDs.
When looking at the mean number of steps taken per day by Japanese males andfemales under 60 years of age, a gradual declining trend is observed. When looking at
the number of persons who have continued an exercise habit at least twice a week at 30
minutes per session, the numbers among those in their 20s and 40s have fluctuated ataround 20%, while the figures for those in their 50s or older have shown increasing
trends.
Source: 1) Global recommendations on physical activity for health, Geneva, World Health Organization, 2010.

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Smoking(%)

Status of smoking in various countries (Cigarette)

60
50
40
30
Male

20

Female100Source: Global Tobacco Epidemic 2013, WHO

Tobacco(Cigarette) is one of the significant risk factors for lifestyle-related diseases suchas cancers, lung diseases, cardiovascular diseases and diabetes. Passive smoking also
has a major health impact.
In Japan, smoke cessation treatment is covered by insurance since 2006.
However, despite the tobacco tax was increased in 2010 in the interest ofhealth, researchers reported that based on the survey data of tobacco tax rate andsmoking, the effect on non-smoking, reducing smoking and/or preventing an increase insmoking was transient.1)
The smoking rates of Japanese was 34.1% for male and 9.0% for female according to the2012 data. Although the smoking rates among men had been on a decline after
1995, the trend has turned upward since 2010. 2)
Sources:
1) Compiled data from “National Survey on Changes in Work and Life Styles (Japanese Life Course Panel Survey for the Middle-aged) 2013” byInstitute of Social Sciences, The University of Tokyo; specific data in press release (http://ssjda.iss.u-tokyo.ac.jp/panel/PR/13PressRelease.pdf;
in Japanese; accessed on June 10, 2014)2) 2012 National Health and Nutrition Survey, MHLWJapanese Nursing Association

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Drinking alcoholic beverages(alcohol consumption)(%)

Ratio of persons with a drinking habit

50
45
40
35
30
25
20
15
10
5
0

age 20–29
age 30–39

age 40–49
age 50–59
age 60–69
age 70 and overMales

Females

Persons who answered they would drink at least three days a week and at least 180 mL of seishu(refined sake) or equivalent on the days when they drink
180 mL of seishu = approx. 500 mL of beer = 240 mL of wine
Source: 2012 National Health and Nutrition Survey, MHLW

There is a large difference between males and females concerning the drinking
habit.
The ratio of persons with a drinking habit that raises the risk for lifestyle-relateddiseases (daily alcohol intake of 40 g or more pure alcohol for males or 20 g ormore for females): 14.7% for males and 7.6% for females.

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Drinking alcoholic beverages(alcohol consumption)
Level of alcohol consumption
per adult

105(10,000
persons)
11,000100

10,500(L)

95

10,000

90
9,500
85
80

9,000

75

8,500

70

8,000

Level of alcohol
consumption perperson 20 years old orolder
Size of population 20
years or older(Year)
Size of population 20 years or older is based on “Annual demographic report (as of October 1, 2012)” of theStatistics Bureau, Ministry of Internal Affairs and Communications
Not including Okinawa Prefecture
Source: “Alcohol factsheet” (March 2014) by Alcohol Tax Division, Taxation Department, National Tax Agency
http://www.nta.go.jp/shiraberu/senmonjoho/sake/shiori-gaikyo/shiori/2014/pdf/100.pdf(accessed on 23 June 2014)

While the size of the population of 20 years or older increased, the level ofalcohol consumption per person showed a declining tendency.

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The necessity to make actions to control
lifestyle-related diseases:
The gap between average life
expectancy and healthy life expectancy(years)

90
80

70
60
50
40
30
20
10

Japan
Afghanistan
Argentina
Australia
BahamaBrazilCanadaCentral Africa
Denmark
FranceGreeceIndia
Kenia
Holland
New ZealandPhilippines
SwedenThailand
Tonga
UK
USA

0

Average life expectancy

Healthy life expectancy

Source: Global Health Observatory Data, World Health Organization
http://apps.who.int/gho/data/view.main.690?lang=en (Accessed on 2014/6/11)

The Japanese population boasts the world’s highest average life expectancy at birthof 80.21 years for men and 86.61 years for women(2013 data). On the other
hand, there is a large difference between the average life expectancy at birth andhealthy life expectancy : about 9 years for men and 12 years for women. Healthpromotion and disease prevention will play a major role to fill this gap.
Although various countries throughout the world show varying length of average life
expectancy, the gap between average life expectancy and healthy life expectancy
ranges from 7 to 10 years.
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The necessity to make actions to control
lifestyle-related diseases:
Ratio of healthcare expenditures used forthe lifestyle-related diseases
Ratio of medical care related healthcare expenditure by disease

Malignant neoplasm
Hypertensive diseases
Cerebrovascular diseases
Diabetes
Ischemic heart diseases
OthersTotal medical care related healthcare expenditure¥ 27812.9billion(about US$ 271billion)
Source: 2011 Estimates of national medical care expenditure, MHLW

A few lifestyle-related diseases account for up to almost 30% of the healthcare
expenditure.

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The necessity to make actions to control
lifestyle-related diseases:
Lifestyle-related diseases’ impact onlong-term care
Cerebrovascular diseases(stroke)
Cardiac diseases (heartdiseases)
Malignant neoplasm (cancer)

Total

Diabetes
Respiratory diseases

Male

Joint disorders
Dementia
Parkinson’s disease
Fall and/or fracture

FemaleAge-related debility

0%

20%

40%

60%

80%

100%

Others, unknown or unclear

Source: 2012 Comprehensive Survey of Living Conditions, MHLW

The four major lifestyle-related diseases, cerebrovascular diseases, cardiac
diseases, malignant neoplasm and diabetes, account for up to 30% of the maincauses for long-term care needs (44% in the male population and 27% in thefemale population).

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JAPANESE GOVERNMENTPOLICIES

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National Health Promotion Program
1978–

The First National Health Promotion Program:

1988–

The Second National Health Promotion Program:
Active 80 Health Plan

2000–

The Third National Health Promotion Program:
National Health Promotion in the 21st Century(Health Japan 21)

2013–2022

The Fourth National Health Promotion Program:
Phase 2 National Health Promotion in the 21stCentury (Health Japan 21 (Phase 2))

The Japanese Government has formulated and revised the policies to promotehealth of population for many years.

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Health Japan 21 Phase 2(1) To extend healthy life expectancy and to reduce healthdisparity(2) To thoroughly implement measures to prevent the onset
and/or exacerbation of lifestyle-related diseases(3) To maintain and improve the functions necessary for having asocial life (mental health, health of the next generations
and health of the elderly)(4) To improve the social environment to support and protect
health(5) To improve lifestyle and behavior and the social environment
Health Japan 21 (Phase 2) is a plan for the ten-year period from 2013. It wasformulated to set the policy direction among the socioeconomic changes in recent
years and the rapid population aging and fewer children, by focusing on the
demographic movement in the next ten years and clearly presenting, “What tostrive for.”
Altogether the plan sets 53 targets (excluding duplications) for health promotion of
population in numerical indicators to build an energetic society where people canlive healthy and spiritually content lives in each stage of their lives, and thus ensurethat social security systems are sustainable.
“To thoroughly implement measures to prevent the onset and/or exacerbation oflifestyle-related diseases,” specific targets for NCDs namely cancer, cardiovasculardiseases, diabetes and chronic obstructive pulmonary disease (COPD) are set. At
the same time, with regard to the objective, “To improve lifestyle and behavior andthe social environment,” specific lifestyle targets in relation to the lifestyle-relateddiseases are set (namely nutrition and diet, physical activities and exercise, rest,
alcohol consumption, smoking and dental and oral health).

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Health Japan 21 Phase 2:
To improve lifestyle and behavior andsocial environment (nutrition and diet)
•
•

•
•
•

Increase in the number of people maintaining optimal weight(fewer obesity or underweight persons)
Increase in the number of people taking adequate quantity andquality of meals (more meals with a combination of staple
carbohydrate, main protein dish and side vegetable dish, lesssalt intake and more intake of vegetables and fruit)
Increase in the number of people having meals in the company
of others (smaller ratio of children who eat meals alone)
Increase in the number of food companies and restaurants that
registered as tackling reduction of salt and fat in food
Increase in the proportion of specified meal catering facilities
that implement the plan, cooking and nutritional assessment ofmeals depending on the users they cater for* Specified meal catering facilities: facilities that provide at least 100 meals at once or at least 250
meals per day on an ongoing basis
Examples: meal catering facility at a childcare center, school, businessestablishment, hospital or aged care facility

To extend healthy life expectancy and improve the quality of life, targets are set for
prevention of main lifestyle-related diseases (cancers, cardiovascular diseases anddiabetes) based on scientific evidences. Due to the large ratio of underweightfemales in their 20s (29.0%) and for better nutrition and prevention of
malnourishment for the elderly, targets aimed to reduce underweight conditions arealso set, in addition to obesity-related targets.
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Health Japan 21 Phase 2:
To improve lifestyle and behaviors andsocial environment (physical activities)•••

Increase in the number of walking steps in the course of dailyliving (1200–1500 more steps)
Increase in the proportion of people who exercise regularly(approximately 10% more)
Increase in the number of local governments that commit tobuilding an exercise friendly town for residents and commit
to improving the environment for it

The government set the above targets in Health Japan 21 (Phase 2). As a part of theactions to promote Health Japan 21 (Phase 2), “Exercise and Physical Activity
Reference for Health Promotion 2013” was developed to present the importance ofphysical activities and exercise and a method to put them into practice.

By increasing the daily physical activity level, one can lower the risks of developing
lifestyle-related diseases including metabolic syndrome, the risk of dying from sucha condition and the risks of losing the functions for living due to aging, as well as therisk of developing mental disorders. Furthermore, regular practice of physicalactivity is expected to increase the preventative effects against those diseases, etc.,
will increase.
Source: Report by the committee on revision of Exercise and physical activity
reference and guideline, Ministry of Health, Labour and Welfare

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Health Japan 21 Phase 2:
To improve lifestyle and behavior andsocial environment (smoking)••••Reduction of the smoking ratio in adults
Eliminate underage smoking
Eliminate smoking in pregnant women
Reduction of the ratio of persons who are exposed to secondhand smoke (at home, in the workplace, restaurants,
government facilities and healthcare institutions.)

Smoking is the main risk factor of such diseases as cancer, stroke, ischemic
heart diseases and diabetes. Since both smoking and second-hand smoke areconsidered as a factor of many diseases in the Japanese population, its risk
shall be reduced.

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Health Japan 21 Phase 2:
To improve lifestyle and behavior andsocial environment (alcohol)•••

Reduction of the ratio of persons with a drinking habit thatraises the risk for lifestyle-related diseases (daily alcohol
intake of 40 g pure alcohol or more for males and 20 g ormore for females)
Eliminate underage drinking
Eliminate drinking in pregnant women

Health Japan 21 (Phase 2) sets the three above targets on alcohol.
Drinking also tends to increase consumption of accompanying food, and withthe calories of the alcohol, tends to increase the total energy intake. Since
cancer, hypertension, cerebral hemorrhage, dyslipidemia and such show a lineal
correlation with the average daily alcohol consumption, a target on the quantityof alcohol consumption has been set as a measure to prevent lifestyle-relateddiseases.
In addition, elimination of underage drinking was set as a target for healthy
physical development in underage persons (younger than 20 years
old), alongside the reduction of the ratio of pregnant women who drink from
8.7% in 2010 to zero, as the target to protect the fetus from the impact ofdrinking during pregnancy.
Source: Health Japan 21(Phase 2), MHLWJapanese Nursing Association

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Specified health examination andspecified health guidance•••

Target groups: those between 40 and 74 years of age
Costs: paid for by insurers of health insurance (except for apartial out-of-pocket contribution with some insurers)
Basic examination items:
Questionnaire

History of medication, smoking, etc.

Physicalmeasurement

Height, weight, BMI and abdominal girth

Blood pressure
measurement
Physicalscreening

Physical examination

Urinalyses

Glucose and protein in urine

Blood tests

Lipids: neutral fat, HDL cholesterol and LDL cholesterol
Blood glucose: fasting blood glucose or HbA1c
Liver function: GOT, GPT and γ-GTP*When the physician deems necessary, electrocardiogram, funduscopy and otherexamination(s)/test(s) may be conducted

To prevent lifestyle-related diseases, which cause approximately 60% of deaths in
the Japanese population, the health examination focusing on the metabolic
syndrome began in 2008.
It became mandatory for insurers to provide insured persons and their families withhealth examination and health guidance. However, the ratio of implementing
specified health examination in 2011 was 44.7%, which is not a high figure. Males
tend to show a lower screening ratio in the age groups older than 60 years, which is
the general retirement age.1)
Source: 1) “Specified health examination and specified health guidance: Status of implementation”
by MHLW

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Specified health guidanceSpecified health guidance target group
Additional risks
i. Abdominal girth& BMI

ii. blood glucose;iii. lipids;
iv. blood pressure

Male≥ 85cm

Two or more
applicable

Female≥ 90cm

One applicable

Above notapplicableAND
BMI ≥ 25 kg/m2

v. historyofsmokingYes

age 40–64

age 65–74

Proactive
supportMotivational
supportNot

Three applicable
Two applicable

Assessment

Yes
No

Proactive
supportMotivational
supportOne applicable

Based on the results of the specified health examination, specialized support in lifestyleand behavior review is offered by designated professionals including physicians, publichealth nurses, and/or registered dietitians to persons with a high risk of developing alifestyle-related disease, but more likely to benefit from lifestyle improvements toprevent the lifestyle-related diseases. Specified health guidance may be provided in theform of motivational support or proactive support, depending on the degree of the risks.
Those with higher risks receive proactive support.
Among those who underwent the 2011 specified health examination, 18.2% wereidentified as a specified health guidance target group. Specified health guidancecompletion rate in the specified health guidance target group was 15.0%. This rate has
increased every year since the introduction of specified health guidance in 2008.
Japanese Nursing Association31Effects of specified healthexamination and specified healthguidance
A working group at the Ministry of Health, Labour and Welfare reviewed theeffects of specified health guidance and published its findings as an interim report.
In those findings, among the specified health guidance target group, those who
received proactive support by public health nurses or other professionals in theform of telephone calls and interviews experienced a major reduction in
abdominal girth, BMI and body weight and improvement in such indicators as
blood glucose, blood pressure and lipid levels, in comparison to those without
support or those who did not continue. Furthermore, it was observed inapproximately 20–30% of the males and approximately 30–40% of the females in
the metabolic syndrome group or potential group had “graduated” from therespective groups at completion of the proactive support stage.
Source: Interim report by the working group for review of healthcare cost
optimization effects of specified health examination and specified healthguidance, MHLW, April 2014

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Basic Act on Food and Nutrition
Education and Basic Plan to Promote
Food and Nutrition Education
Fundamental policies concerning promotion of food andnutrition education(Shokuiku)•••

Promotion of food and nutrition education according toeach developmental stage throughout one’s life
Promotion of food and nutrition education that leads toprevention and improvement of the lifestyle-relateddiseases
Promotion of food and nutrition education for children
through having meals together with their families
Source: Basic Plan to Promote Food Education Phase 2, Cabinet Office(http://www8.cao.go.jp/syokuiku/about/plan/pdf/2kihonkaiteihonbun.pdf; accessed on 23 June 2014)

Against the backdrop of changing socioeconomic structure and diversifying
values, the traditional diet of eating a wide range of side dishes along the stapleof rice has changed, leading to unbalanced nutrition such as over-intake of lipids
and irregular eating habits such as skipping breakfast. In order to ensure thehealth of body and mind, and to live an active and full life, food and nutrition isextremely important. The Basic Act on Food and Nutrition Education wasestablished in 2005 for the purpose of facilitating children to acquire knowledge
on food and nutrition and the ability to choose food well, so that they can growhealthy diet habits. Actions to prevent lifestyle-related diseases and improve
one’s lifestyle are also under way by the Plan to Promote Food and Nutrition
Education.
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