Glycative Stress Research
Online edition : ISSN 2188-3610
Print edition : ISSN 2188-3602
Received : April 11, 2016
Accepted : September 12, 2016
Published online : September 30, 2016

Original article

Significance evaluation of Anti-Aging QOL Common Questionnaire

Yuko Oguma 1), Kenji Iida 2), Yoshikazu Yonei 3), Toshihiko Satoh 4)1) Sports Medicine Research Center, Keio University, Kanagawa, Japan
2) Keio Research Institute at SFC, Keio University, Kanagawa, Japan3) Anti-Aging Medical Research Center, Doshisha University, Kyoto, Japan
4) Graduate School of Social Informatics, Aoyama Gakuin University, Kanagawa, Japan

Abstract

Objective: Questionnaires are used for a broad range of purposes, including the collection of inference materials for disease
screening and diagnostic processes, the verification and interpretation of test results, and the choice of post-diagnostic
interventions, as well as for the evaluation of the severity of certain diseases. The Japanese Society for Anti-Aging Medicine
provides its members with the “Anti-Aging QOL Common Questionnaire” (hereinafter referred to as the “AAQOLQuestionnaire”) so as to help improve the quality of anti-aging medical checkups. The present study was conducted to verify
the validity and efficacy of the AAQOL Questionnaire using data obtained using the questionnaire and the functional age
data calculated through various tests, and to prepare for future revisions for more effective utilization.
Methods and results: An analysis of data from 5,827 persons (3,364 men, mean age 55.4 ± 12.9 years; 2,463 women,
54.8 ± 13.7 years) who underwent anti-aging medical checkups for the first time at 30 facilities in Japan identified that thefollowing items that tended to increase with aging in both sexes: 7 of 33 “physical symptom” items (palpitations, shortness ofbreath, gray hair, hair loss, tinnitus, arthralgia, and frequent urination) and 3 of 21 “mental symptom” items (shallow sleep,
difficulty in falling asleep and lapse of memory). A factorial analysis of physical and mental symptoms, when the numberof factors prescribed in 5, revealed that the former converged to 12 items, and the latter to 21 items. A Structural Equation
Modeling (SEM) including four additional lifestyle factors (amount of smoking, amount of exercise, sleeping hours, andVDT screen gazing time) suggested that lifestyle-related items influence the body, and in turn influence mentality. Amountof exercise was identified as the most influential lifestyle item. An analysis for correlations between each of the five “physicalsymptom” and the five “mental symptom” factors and the five functional ages showed that the partial correlation coefficient
was generally not so high, suggesting that it is difficult to estimate the functional ages only from the results obtained using
the AAQOL Questionnaire. However, it is interesting to note that a relatively high correlation was found between hormone
age / blood vessel age and some physical and mental symptom items and overall score; it is hoped that further investigations
will yield new findings.
Conclusion: The results from the present study suggested that the AAQOL Questionnaire is worth using in the field ofantiaging medicine but has some points to modify. For further research, it will be necessary to set a definite goal and selectitems to focus on, and, if aiming to evaluate the influence of aging on QOL, it will also be necessary to consider the adoptionof other health-related QOL rating scales.

KEY WORDS: questionnaire, sign prevalence rate, functional age, correlation, aging, quality of life (QOL)
Introduction

Questionnaires are used for a broad range of purposes,
including the collection of inference materials for disease
screening and diagnostic processes, the verification andinterpretation of test results, and the choice of post-diagnostic
interventions, as well as the evaluation of the severity ofcertain diseases 1 - 8). The Japanese Society for Anti-Aging
Medicine provides its members with the “Anti-Aging QOL
Corresponding to: Toshihiko Satoh, MD, PhD, MPH
Graduate School of Social Informatics, Aoyama Gakuin University,
Address: 5-10-1 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, Japan
TEL: +81-42-759-6115 E-mail: t_satoh@si.aoyama.ac.jp
Co-authors: Oguma Y, yoguma@keio.jp; Iida K, keniida@sfc.keio.ac.jp;
Yonei Y, yyonei@mail.doshisha.ac.jp

Common Questionnaire” (AAQOL Questionnaire) so as tohelp improve the quality of anti-aging medical checkups. The
current version of the AAQOL Questionnaire consists of 33
questions items concerning physical symptoms, 21 questions
items concerning mental symptoms (each evaluated on a 5point scale), and lifestyle-related questions, such as sleep habits,
exercise habits, smoking, and drinking. When questionnaire
was made, items are arranged in consideration of the Theory_ 17 7 _Glycative Stress Research 2016; 3 (3): 177- 185(c) Society for Glycative Stress ResearchEvaluation of Anti-Aging QOL Common Questionnaireof Yin-Yang and the Five Elements.
The term anti-aging medical checkup refers to “a complete
medical check-up focusing on assessing the degree of aging
and an advanced form of the conventional ningen dock(annual health check-up)” 9, 10), including tests for the early
detection of signs and risk factors of senescence. Therefore,
the AAQOL Questionnaire should be evaluated in terms of
its associations with test data on the degree of senescence,i.e., blood vessel age, hormone age, muscle age, bone age,and other age parameters, as well as findings related tosenescence risk factors, such as oxidative stress, mental andphysical stress, immune function, glycative stress, lifestyle,and harmful heavy metal contents.
The present study was conducted by descriptive statistics
to summarize the results of the AAQOL Questionnaire using
data obtained via the questionnaire and functional age data
calculated through various tests, to verify its adequancy andefficacy, and to prepare for future revisions for more effective
utilization.

Methods
Subjects

The study population comprised 5,827 effective
respondents (3,364 men, 55.4 ± 12.9 years [mean ± standard
deviation]; 2,463 women, 54.8 ± 13.7 years) out of 6,016
persons (3,364 men and 2,652 women) who underwent antiaging medical checkups for the first time at 30 facilities
in Japan. Analysis data were handled with unlinkableanonymization.

Analytical procedures

1. Evaluation of sign prevalence rates by item- and age-related
increasing tendencies
The AAQOL Questionnaire consists of 33 “physicalsymptom” items, 21 “mental symptom” items, and six“lifestyle” items 11,12). For all symptom-related items, subjects
were asked to answer questions on a 5-point scale (1. None,
2. Little, 3. Mild, 4. Moderate, 5. Severe). The proportion of
respondents who answered 4 or 5 for each item was calculated
as “sign prevalence rate” by sex and analyzed by chi-square
test. Thereafter, the ratio was calculated by sex and age
stratum (every 10 years) to examine for a tendency for theratio to increase with aging by trend test for proportion.
2. Correlations between “physical symptom” items and “mental
symptom” items
Correlations between the 33 “physical symptom” items
and the 21 “mental symptom” items were evaluated foreach pair with a bivariate analysis using partial correlation
coefficient with age as the control variable.
3. Categorization of symptoms
A factorial analysis was performed on the 33 “physicalsymptom” items and the 21 “mental symptom” items tocategorize these question items. Factors were identified
using the maximum likelihood method in combination withvarimax rotation. The extraction factor was set as 5 factors
being conscious of the Theory of Yin-Yang and the Five

Elements. When any of factor loading amounts was less than0.4, data were eliminated and a re-analysis was conducted
repeatedly.
4. Evaluation of causality for each category
Relationships between the “physical symptom” and“mental symptom” factors identified by factorial analysis andfour lifestyle-related items, i.e., amount of smoking (/day),amount of exercise (day/week), sleeping hours (hour/day),and visual display terminal (VDT) screen gazing time(hour/day) were analyzed using a covariance structure
analysis known as structural equation modeling (SEM). As
a results of preliminary analysis, “water intake” and “alcohol
drinking amounts” were excluded from lifestyle-related itemsof the questionnaire. Model fitting was determined using thecomparative fit index (CFI), goodness of fit index (GFI),
degree of freedom-adjusted goodness of fit index adjusted
GFI (AGFI), and root mean error of approximation (RMSEA).
The model was judged as being fitting when the following
criteria were met: CFI, (GFI), and AGFI > 0.90 and RMSEA< 0.05. The notation of each index is as follows. CFI: An
index combining the Bentler-Bonett normed fit index (NFI)(influenced by the number of cases) and the Tucker-Levis
index (TLI) (sometimes deviating from the range 0-1) withcorrections of their drawbacks; the goodness increases as
this index approaches 1. GFI/AGFI: An index that can beinterpreted like R2 (coefficient of determination) in regression
analysis. The GFI ranges from 0 to 1, and is desirably not
lower than 0.9. AGFI can be interpreted like adjusted R 2 inregression analysis, working to correct GFI drawbacks andexert penalties on complex models with multiple parameters.
Although the AGFI is smaller than GFI, GFI and AGFI have
similar values if the model is not complex. RMSEA is anindex of the difference between the model distribution andtrue distribution taking into account model complexity. The
fit is good if this index is not higher than 0.05, and the fit ispoor if this index is not lower than 0.1 13).
5. Associations between questionnaire items and functional
ages
Associations between various questionnaire items andthe scores for the five “physical symptom” factors and thefive “mental symptom” factors and differences of fivefunctional ages (blood vessel age, muscle age, hormone age,bone age, and nerve age calculated through various tests)
from actual age 14, 15) were evaluated by means of partial
correlation coefficient with age as a control variable. Functional
age was calculated using Age Management Check R (Ginga
Kobo, Nagoya, Aichi, Japan) 16).
Data were statistically processed using IBM SPSS
Statistics 19 and Amos 19 (IBM, New York, NY, USA) except
for the trend test of aging effect on symptoms; R version 3.1.2(R Foundation for Statistical Computing, Vienna, Austria)
was used for these analysis. A significance level of 5% ( p <0.05) was set in each analyses.

Ethical Considerations

The present study was conducted after examination andapproval for the ethics and appropriateness of the study ata meeting of the Doshisha University Ethics Committee for_ 178 _Glycative Stress Research

Scientific Research Involving Human Subjects (Application
Numbers: #0832 and #14089).

Results

Table 1 shows data on the proportion of subjects withsubjective symptoms by item and the presence/absence of
aging-related increasing symptom tendency. For most of the33 “physical symptom” items, a sex-related difference wasobserved. The items ranked highest in terms of sign prevalence
rate were hair loss (41.4%), stiff shoulder (38.7%), and tendency
to gain weight (32.0%) in men, and stiff shoulder (57.7%),
hair loss (48.9%), and tendency to gain weight (43.7%) in
women. The three highest ranked items were constant between
the two sexes, although the ranking order differed. The lowest
ranked items were anorexia (1.2%), hot flash (2.3%), andweight loss / thin (2.6%) in men, and anorexia (2.0%), weightloss / thin (3.2%), and diarrhea (5.4%) in women. An agingrelated increasing tendency in symptoms was found in 11
items in men and 10 items in women, with the following 7
items found in both sexes: palpitations, shortness of breath,gray hair, hair loss, tinnitus, arthralgia, and frequenturination.
For the majority of the 21 “mental symptom” items, a
sex-related difference was observed in sign prevalence rate.
The highest ranked items in terms of sign prevalence rate
were lapse of memory (22.8%), shallow sleep (17.7%), andirritability (15.7%) in men, and lapse of memory (28.1%),
shallow sleep (17.7%), and irritability (14.8%) in women, withthe three top ranked items shared by both sexes. On the other
hand, the sign prevalence rate was lowest for vague feelingof fear (2.1%), feeling of uselessness (2.4%), and depressed(2.5%) in men, and vague feeling of fear (3.8%), reluctanceto talk with others (4.2%), and depressed (4.6%) in women.
An aging-related increasing symptom tendency was foundin only a few items with shallow sleep, difficulty in falling
asleep and lapse of memory identified as such items in both
sexes.
Table 2 shows combinations of items with high associations
between the 31 “physical symptom” items and the 22 “mental
symptom” items according to sex in descending order,
excluding those associated with no feeling of good healthand lethargy at a correlation coefficient of 0.4 or lower.
A partial correlation coefficient > 0.4 was found for the
combination of no feeling of good health and lethargy in both
sexes. Other “physical symptom” items with high correlations(partial correlation coefficient > 0.34) were hot flash, anorexia,
early satiety, and tired eyes in men, and thirst alone in women.
Thereafter, a factorial analysis was performed on the 33“physical symptom” items and the 21 “mental symptom”
items to identify five factors for each category. Whereas allof the 21 items of the latter were categorized in five factors,
only 12 of the 33 items of the former were incorporated
in various factors. The five factors of “body” consisted ofi) ocular symptoms (tired eyes, blurry eyes, and eye pain),ii) palpitations / shortness of breath, iii) gastrointestinal
problems (anorexia, early satiety, and epigastralgia), iv)
stiffness (stiff shoulder and muscular pain / stiffness), and v)
weight problems (tendency to gain weight and weight loss /thin). The five factors of “mind” consisted of i) depression,ii) mental anxiety, iii) mental confusion, iv) insomnia, and v)
irritation.

Of the 6 “lifestyle” items, 2 were excluded because of
the absence of a significant influence found in preliminary
analysis. The remaining 4 items, amount of smoking, amountof exercise, sleeping hours, and VDT screen gazing time, wereused (data on amount of exercise and sleeping hours were
input in reversion) for covariance structure analysis. Fig. 1
shows a hypothetical model on the relationship between
lifestyles and physical and mental health. A preliminary
analysis based on a hypothetical model revealed significancefor the path from lifestyles to “body” but did not show
significance for the path to “mind.” Therefore, data were reanalyzed using a model modified to remove the path from“ lifestyles” to “mind,” and to newly include a path from“ body” to “mind.” The analytical results from the modified
model are shown in Fig. 2.
The results suggested that “lifestyles” characterized byhigh scores for amount of smoking and VDT screen gazingtime and low scores for amount of exercise and sleeping
hours influence “body” problems, which in turn influence“mind” illness. The goodness of the modified model was
determined to be GFI = 0.97, AGFI = 0.96, CFI = 0.95, and
RMSEA = 0.049, showing good applicability to the data.
Table 3 shows the questionnaire items and the partial
correlation coefficients for the scores of the five “physicalsymptom” factors and the scores of the five “mental
symptom” factors and the differences between the various
functional ages (blood vessel age, muscle age, hormone age,bone age, nerve age) and actual ages. Although no factor
showed a high correlation, a relatively high correlation
was found between stiffness and muscle age in women (r= 0.283). The all-item score was found to have a relatively
high correlation with hormone age and blood vessel age (r =0.142 to 0.165) in both sexes. Muscle age in women was also
found to have a relatively high correlation (r = 0.133).

Discussion

First, the background for the establishment of the AAQOLQuestionnaire is described here. In 2000, a review committee
for developing a common questionnaire was organized in theJapan Society of “Ningen Dock” (annual health check-up),
with the aim of formulating a common questionnaire to be
used in annual health check-ups in Japan. At that time, thecommittee advised the Japan Society of Ningen Dock to adopt
the AAQOL Questionnaire as their common questionnaire.
However, the proposal was not accepted. To date, no suchquestionnaire has been developed in the Japan Society of
Ningen Dock.
To date, a variety of common questionnaires have been
proposed, including “SF-36” 17- 21), which is commonly usedworldwide as a rating scale for health-related QOL, the“home healthcare score” and “regional healthcare capacity
score” developed through the Ministry of Health andWelfare Integrated Research for Aging and Health Scienceby the “Research group for the Development of Home
Healthcare Systems and Techniques” 21), the “Quality of Life
Questionnaire for Cancer Patients Treated with Anticancer
Drugs” developed by the Kurihara Group in the Ministry of
Health and Welfare 22), the WHO/QOL-26 developed by theWorld Health Organization (WHO), the EuroQol (EQ-5D)
Health Scores 23, 24), the Occupational Health Surveillance
Form 25, 26), and the Climacteric and Senescence Scores forJapanese Subjects 27). Although these questionnaires appear_ 179 _

_ 18 0 _

Women

36.0
18.2
7.2
57.7
33.8
5.6
5.6
33.7
3.2
17.8
14.6
10.3
13.6
2.0
7.5
6.3
7.3
7.5
5.4
21.1
11.6
48.9
16.4
7.1
8.1
30.4
17.0
17.6
20.8
13.7
7.4
33.9

Men

25.3
14.6
4.2
38.7
25.8
4.7
5.2
32.0
2.6
13.6
11.1
8.9
7.3
1.2
6.0
3.8
5.5
11.4
10.6
7.7
13.7
41.4
6.5
3.6
11.0
29.7
12.2
6.1
26.4
17.8
2.3
10.1

< 0.001< 0.001< 0.001< 0.001< 0.001
n.s.
n.s.
n.s.
n.s.
< 0.001< 0.001n.s.
< 0.0010.017
0.025< 0.001
0.003< 0.001< 0.001< 0.0010.020< 0.001< 0.001< 0.001< 0.001n.s.
< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001

1. None, 2. Little, 3. Mild, 4. Moderate, 5. Severe; n.s., not significant.

Physical symptoms
Tired eyes
Blurry eyes
Eye pain
Stiff shoulders
Muscular pain / stiffness
Palpitations
Shortness of breath
Tendency to gain weight
Weight loss; thin
Lethargy
No feeling of good healthThirstSkin problems
Anorexia
Early satiety
Epigastralgia
Liable to catch cold
Coughing and sputum
Diarrhea
Constipation
Gray hair
Hair loss
HeadacheDizziness
Tinnitus
LumbagoArthralgia
Edematous
Easily breaking into a sweat
Frequent urination
Hot flashCold skin

Question item

n.s.
n.s.
n.s.
n.s.
n.s.
< 0.001< 0.001
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
0.020
n.s.
< 0.001
0.004< 0.001n.s.
n.s.
< 0.001n.s.
< 0.001n.s.
n.s.
< 0.0010.016< 0.001

Men

n.s.
0.020
n.s.
n.s.
n.s.
0.003
< 0.001
n.s.
n.s.
n.s.
n.s.
0.009
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
< 0.001< 0.001n.s.
n.s.
< 0.001n.s.
< 0.001n.s.
n.s.
< 0.001
n.s.
n.s.

Women

Aging-related
Proportion (%) of
respondents with scoreincreasing symptom
Sex-related
4 or 5tendency
difference

Men

Mental symptoms
Irritability
15.7
Easily angered
13.9
Loss of motivation
6.1
No feeling of happiness
4.3
Nothing to look forward to in life
4.2
Daily life is not enjoyable
3.7
Loss of confidence
2.9
Reluctance to talk with others
3.1
Depressed
2.5
Feeling of usefulness
2.4
Shallow sleep
8.0
Difficulty in falling asleep
10.4
Pessimism
5.7
Lapse of memory
22.8
Inability to concentrate
7.2
Inability to solve problems
2.6
Inability to make judgments readily
3.0
Inability to sleep because of worries
5.4
A sense of tension
11.0
Feeling of anxiety for no special reason
3.8
Vague feeling of fear
2.1

Question item

Women

14.8
11.0
10.4
6.1
6.1
5.4
7.2
4.2
4.6
4.7
10.5
14.5
11.0
28.1
11.0
6.1
6.4
8.3
11.9
6.4
3.8
n.s.
0.001
< 0.001
0.002
0.001
0.001
< 0.0010.026< 0.001< 0.001
0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001

Proportion (%) of
respondents with score
Sex-related
4 or 5difference

Table 1. Proportion of subjects with physical / mental symptoms by item in the Anti-Aging QOL Common Questionnaire andpresence/absence of aging-related increasing symptom tendency

n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
< 0.001
0.003
n.s.
< 0.001
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.

Men

n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
< 0.001< 0.001n.s.
< 0.001
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.
n.s.

Women

Aging-related
increasing symptom
tendency

Evaluation of Anti-Aging QOL Common QuestionnaireGlycative Stress Research

Table 2. Associations between “physical symptom” items and “mental symptom” items controlled by age.
Partialcorrelation
coefficient

Men

Women

> 0.5
> 0.4

No feeling of good health-loss of motivation (0.501)
No feeling of good health-pessimism (0.463)

Lethargy-loss of motivation (0.463)

Lethargy-loss of motivation (0.448)

No feeling of good health-depressed (0.432)

Lethargy-Inability to concentrate (0.433)

Lethargy-irritability (0.427)

Lethargy-irritability (0.435)

No feeling of good health-daily life is not enjoyable (0.431)

No feeling of good health-Inability to concentrate (0.422)

No feeling of good health- no feeling of happiness (0.421)

Lethargy-depressed (0.414)

No feeling of good health-depressed (0.409)

No feeling of good health-pessimism (0.411)

Hot flash-vague feeling of fear (0.362)

Thirst-Inability to concentrate (0.341)

No feeling of good health-daily life is not enjoyable (0.401)> 0.34*

No feeling of good health- no feeling of happiness (0.415)

Hot flash-Inability to concentrate (0.351)
Anorexia-depressed (0.349)

Early satiety-vague feeling of fear (0.348)
Hot flash-depressed (0.345)

Early satiety-inability to concentrate (0.343)
Tired eyes-irritability (0.343)*; Correlations with lethargy or no feeling of good health are excluded.

Lifestyle	

Body	

Mind	

A hypothetical model of relationship between lifestyles and physical and mental health.
Fig. 1.Fig.A1.hypothetical
modelof relationshipbetweenlifestyles
A structural model alone
is represented,
with observed variables
and error variables
omitted.and mental and physicalhealth.
A structural model alone is represented, with observed variables and error variables_ 181 _
omitted.

Evaluation of Anti-Aging QOL Common Questionnaire

Amount of
exerciseAmount of smoking

0.12

Sleeping hours
0.91

0.07

VDT gaze time

0.12

Lifestyle

Ocularsymptoms
Palpitations /shortness of breath
Gastrointestinal
problems

Stiffness

Weightproblems

Depression
0.19

0.63

0.81
0.85

Mental anxiety

0.59
0.63

0.77

0.73
Body

Mind

0.66

Mentalconfusion

0.56
0.58

0.40

Indexes of goodness
GFI
0.97
AGFI
0.96
CFI
0.95
RMSEA 0.049

Fig. 2. Modified model of causality of lifestyle to physical and mental parameters.

Insomnia

Emotional
anxietyp<0.05* Root Mean Square Error of Approximation (RMSEA); an index of model goodness. Generally, it is considered that the fit
is good if this index is 0.05 or lower, and that the fit is poor if this index is 0.1 or higher. VDT, visual display terminals; GFI,
goodness of fit index; AGFI, degree of freedom-adjusted GFI; CFI, comparative fit index.

_ 18 2 _Glycative Stress Research

Table 3. Partial correlation coefficients between physical and mental symptom factors and functional ages controlled by age.

Men

The 5 physicalfactors

The 5 mental
factors

TOTAL SCORE

Ocular symptoms
Palpitations / shortnessof breath
Gastrointestinal
problems
Stiffness
Weight problems
SUBTOTAL SCORE
Depression
Mental anxiety
Mental confusion
Insomnia
Emotional anxiety
SUBTOTAL SCORE

Women
The 5 physicalfactors

The 5 mental
factors

TOTAL SCORE

Ocular symptoms
Palpitations / shortnessof breath
Gastrointestinal
problems
Stiffness
Weight problems
SUBTOTAL SCORE
Depression
Mental anxiety
Mental confusion
Insomnia
Emotional anxiety
SUBTOTAL SCORE

Muscle age

Bone age

Hormone age

0.032- 0.005

0.120

0.071

0.034

0.114

Nerve age Blood vessel age
0.060

0.087

0.085

0.025

0.096

0. 053

0.113

0.063

0.183

0.162

0. 001

0.082

0.066

0.110

0.039

0.035
0.079
0.051
0.031
0.053
0.068
0.095

0.113

0.143

0.077

0.083

0.100

0.013
0.048
0.037
0.031
0.044
0.047
0.037

0.059
0.128
0.099
0.086
0.102
0.125
0.143

0.066
0.081
0.043
0.062
0.082
0.085
0.086

0.116
0.062
0.056
0.068
0.085
0.089
0.158

Muscle age

Bone age

Hormone age

0.056

0.031

0.149

0.055

0.283
- 0.009-0.050

0.026

0.092

0.072

0.061
0.045
0.019
0.030
0.143
0.054
0.133

0.070
0.066
0.063
0.040
0.037
0.073
0.052

0.085
0.112
0.073
0.085
0.147
0.107
0.165

0.057
0.049
0.066
0.066
0.087
0.073
0.073

0.046

0.033

0.094

0.039

0.041

0.054

0.089

0.105

0.164

Nerve age Blood vessel age
0.044

0.086

0.111

0.069

0.092

0.126

0.077

0.183

0.030

0.144

0.065

0.078

0.058
0.076

0.078

0.053
0.051
0.041
0.075
0.161
0.070
0.142

Bold type; p < 0.05.

in scientific papers, they have not been widely used in theclinical setting largely because of the difficulty of use.
Another reason seems to be the fixed method of calculatingscores 11). Hence, the manner of interpreting and weighing
individual items varies widely among different studies. With
regard to the handling of health status QOL scores, it isnecessary to collect data for a sufficient number of samples,
and to have fair and highly transparent arguments involving
a large number of researchers.
Records indicate that the AAQOL Questionnaire
was developed with reference to the aforementioned
questionnaires 11,28), with a focus on the items pational healthsurveillance form that largely reflects health status changes
in healthy persons aged 20 to 80 years 25,26). It is characterizedby two aspects: symptoms are classified into two categories,“physical symptoms” and “mental symptoms”, and the items
that are most commonly found in the field of occupational

hygiene 26) are included.
The Japanese Society for Anti-Aging Medicine is joined
not only by those in a broad range of medical and surgicalfields, but also by many people in the fields of dentistry andOriental medicine. Although there is some concern about thelack of order for presentation of the contents and discussions,“the Anti-Aging QOL Common Questionnaire” was expected
to serve as a standard leader. The AAQOL Questionnaire isavailable for download from the Japanese Society for AntiAging Medicine (http://www.anti-aging.gr.jp/), Society for
Glycation Stress Research (http://www.toukastress.jp), andthe Laboratory of Anti-Aging Medicine at the Faculty ofLife and Medical Sciences, Doshisha University (http://
www.yonei-labo.com).
In addition to the Japan Society of Ningen Dock, currently,
a broad range of facilities, including clinical studies, labor
health, and other areas related to foods, cosmetics, and exercise_ 18 3 _Evaluation of Anti-Aging QOL Common Questionnaire
devices, both in Japan and abroad, have been encouraged touse the AAQOL Questionnaire. It is also used at clinics in
Taiwan and Switzerland. In addition, items are arranged inconsideration of the Theory of Yin-Yang and the Five
Elements to allow oriental medical professionals to readily
accept the items, and to enable clinical studies on “kampo”(traditional Chinese herbal) medicines, herbs, acupuncture
and moxibustion, qigong, and other alternative medicines.
First, to evaluate the adequacy of the contents of the
AAQOL Questionnaire, sex- and age-related quantitative
differences were evaluated in terms of the sign prevalence rate
for each item. The results identified hair loss, stiff shoulder,
and tendency to gain weight as the top three highest ranked“physical symptom” items in terms of sign prevalence rate
in both sexes. According to the 2013 Comprehensive Surveyof Living Conditions 3), lumbago (on the order of 10-20%,
increased with aging), stiff shoulder (10% to 20%, no tendency
to increase with aging), dullness (approximately 5%, common
in the middle-aged), and arthralgia (5% to 20%, increased withaging) were subjective symptom items of high prevalencein the middle-aged and older subjects. When limiting the
population to elderly persons aged 70 years or older, “Havea Desire to Urinate”, “Hard to Hear”, “Dimness of Sight”,“Forget Things”, and other types of symptoms were prevalent.
Although “hair loss”, an item characteristic of the AAQOLQuestionnaire used in the present survey, was not includedin the Comprehensive Survey of Living Conditions, there wasa consistency between the two surveys that the sign prevalence
rate of “stiff shoulder” was high but did not tend to increase
with aging.
A total of 7 “physical symptom” items tended to increase
with aging in both sexes: palpitations, shortness of breath,gray hair, hair loss, tinnitus, arthralgia, and frequent urination.
Four items tended to increase with aging in men only:
coughing and sputum constipation, hot flash, and cold skin.
The absence of a tendency to increase with aging in womenis attributable to the fact that all these items are subjective
symptoms that are commonly experienced by middle-aged
women. Although the proportions were low, it is of interest
that hot flash and cold skin increased with aging in men.
Three “mental symptom” items tended to increase withaging: shallow sleep, difficulty in falling asleep and lapseof memory, and this finding for these 3 items was well
anticipated as it was consistent with a previously reported
study 4). Interestingly however, it was a new finding thatmany other “mental symptoms” did not tend to increase withaging.
Factorial analysis revealed that only 12 of the 33 “physicalsymptom” items were adopted, and that the 33 physicalsymptom items were composed of diverse and independent
symptoms. It seems to be compatible with the original purposeof this questionnaire that completely includes items withhigh frequencies in the field of the occupational health 26).
On the other hand, all “mental symptom” items wereassigned to any of the five factors; many “mental symptoms”
were found to have higher mutual associations than“physical symptoms.” A covariance structure analysis forthe relationships between lifestyles and the five “physicalsymptom” factors and five “mental symptom” factors
identified by factorial analysis showed that lifestyles influence
the body, demonstrating the applicability of a model inwhich “physical symptoms” influence “mental symptoms.”
In addition, when comparing path coefficients, the lifestyle

item amount of exercise was ranked distinguishedly highest
among the four items with a path coefficient of 0.91, suggesting
the greatest influence of “amount of exercise.” In addition,
while the path coefficient for “lifestyles” to “body” was 0.19,
the path coefficient for “body” to “mind” was 0.73, a nearly
4-fold higher level; the latter linkage was stronger than theformer.
In the present study, the lifestyle items “alcohol
consumption” and “water intake” were not adopted. Eachlifestyle item is prepared by the system on which thenumerical value is input as a continuous variable. Individual
variability in an answer is supposed not to be small and apossibility of misclassification is high.
Especially in items ”alcohol consumption” and “water
intake,” their values were widely variable by individual
respondents and it is highly possible that the questionnaireauthor cannot get correct answers as originally expected. It
is needed to re-consider for improving the questionnaire, i.e.,
by adding the question items for which the validity has been
secured or objective evaluation especially to lifestyle items.
It should also be taken up in the question item about eating
habit.
An analysis for correlations between each of the various
physical and mental symptom factors and the five functional
ages revealed partial correlation coefficients that were in
general not too high, suggesting that it is difficult to estimate
the functional ages only from the results of the AAQOLQuestionnaire. However, it is interesting to note that a
relatively high correlation was found between hormone age /blood vessel age and some items and overall score of mental
and physical symptoms; it is hoped that further investigations
will provide new findings.
As stated at the beginning of this article, questionnaires
are used for a wide variety of purposes. Given that the AAQOLQuestionnaire is essentially intended to evaluate the physicaland mental effects of aging, only the items showing agingrelated increasing symptom tendencies, as shown in Table 1,
may be adopted. It seems, however, that the AAQOLQuestionnaire is actually also used to provide basic data for
estimations in disease screening and diagnostic processes,
and information for health advice for care seekers. In thisregard, the AAQOL Questionnaire must include a broad
range of items.

Conclusion

Data from 5,827 effective respondents (3,364 men and2,463 women) out of 6,016 persons (3,364 men and 2,652
women) who underwent Anti-Aging Medical Checkups wereanalyzed for associations between the findings in a survey
using the Anti-Aging QOL (AAQOL) Common Questionnaire
and lifestyles and functional ages. The results suggested thevalidity of the AAQOL Questionnaire and some points tomodify. For further research, it will be necessary to set a
definite goal and select items upon which to focus, and, if
a future aim is the relationship between aging and QOL, it
will be important to consider including other health-related
QOL rating scales.

_ 18 4 _Glycative Stress Research

Acknowledgements

This work was supported by the Clinical Research
Promotion Committee of the Japanese Society for Anti-Aging
Medicine. An abstract of this study was presented at the 16th
Meeting of the Japanese Society for Anti-Aging Medicine on
June 10th, 2016 at Yokohama, Japan.

Conflict of Interest Statement

The authors state that the performance of this study
entailed no issues representing a conflict of interest.

References
1) Yashima N, Kawamura K, Chiba K, et al. The summary

report of Ningen Dock (medical checkups) in 1998. Medical
Journal of Sendai Red Cross Hospital. 2000; 9: 95-99. (inJapanese)
2) Takenaka M, Maekawa C, Kudo T, et al. Effects andproblems of questionnaire use: (Second report) Healthguidance sharing the goal with examinees. Journal of the
Hokkaido Association of Rural Medicine. 2001; 34: 4647. (in Japanese)3) Shibukawa E, Seta S, Okada F, et al. Hope for medical
checkups from a stand point of a public health nurse.
The Journal of Pediatric Practice. 2001; 64: 470-474. (inJapanese)
4) Yanagawa Y. The purpose and process of health checkups:
Checkups for the heart. The Journal of Therapy (Chiryo).
2002; 84: 2132-2136. (in Japanese)5) Yoshida H, Fujii K, Nakamura K, et al. Influence of longhour working on lifestyle: Significance of our questionnaire.
Kenko Igaku (Ningen Dock). 2004; 19: 61-65. (in Japanese)
6) Tamura Y, Yoshida H, Arai S, et al. An approach for healthmanagement for middle-aged working women using thequestionnaire of Ningen Dock. Ningen Dock. 2006; 21:708-712. (in Japanese)
7) Wada T. Actual practice and problems in what is called“Metabo Health Checkup”: Guidance for obesity. Adult
Diseases and Lifestyle-related Diseases (Seijinbyo To
Seikatsu Shukanbyo). 2009; 39: 556-560. (in Japanese)
8) Kawamura M. Difference of medical record check sheet
between health check and medical examination (Human
Dry Dock). Journal of the Association of Insurance
Medicine of Japan. 2011; 109: 162-169. (in Japanese)9) Yonei Y, Yoshino M. The human dock of tomorrow: Annual
health check-up for anti-aging. Ningen Dock. 2006: 19:
5-8.
10) Yonei Y, Takabe W. Aging assessment by anti-aging medical
checkup. Health Evaluation and Promotion. 2015; 42: 459464.
11) Yonei Y, Inagaki Y, Iwaita Y, et al. Report of anti-aging
medical checkups. Journal of Kawasaki City Medical
Association. 2003; 20: 65-71. (in Japanese)12) Yonei Y, Takahashi Y, Watanabe M, et al. Effects on thehuman body of a dietary supplement containing l-carnitine
and Garcinia cambogia extract: A study using double-blind
tests. J Clin Biochem Nutr. 2008; 42: 89-103.
13) Tabei A. Perfect method for utilizing SPSS: Questionnaire
processing by covariance structure analysis (Amos). Tokyo
Tosho, Tokyo, 2011. (in Japanese)
14) Yabukita H, Miyazaki R, Nomoto K, et al. Characteristicsof physical functions in elderly people requiring support.
Anti-Aging Medicine. 2013; 10: 16-20.

15) Yonei Y. Significance of anti-aging medical checkups forthe elderly. Nihon Ronen Igakkai Zasshi. 2013; 50: 780783. (in Japanese)16) Ito H. The Age Management Check R supporting system
for anti-aging medical checkups. Modern Physician 26:
605-608, 2006. (in Japanese)17) Ware, JE. SF-36 Health Survey manual and interpretation
guide. The Health Institute, New England Medical Centre,
Boston, MA, USA, 1993.
18) Fukuhara S. et al. Psychometric and clinical tests of validityof the Japanese SF-36 Health Survey. J Clin Epidemiol.
1998; 51: 1045-1053.
19) Ministry of Health, Labour and Welfare. Fromcomprehensive survey of living conditions: 2013 Graphicalreview of Japanese household. http://www.mhlw.go.jp/
toukei/list/dl/20-21-h25.pdf, cited on April 3, 2016.
20) Pace-Schott EF, Spencer RM. Age-related changes in the
cognitive function of sleep. Prog Brain Res. 2011; 191:
75-89.
21) Okajima S. Study of evaluation system for nursing careability and care management for high-risk cases. Integrated
Research for Aging and Health Science (Choju Kagaku
Sogo Kenkyu). 1998; 1997: 267-269. (in Japanese)
22) Kurihara M, Nakamura H, Matsukawa M, et al. Evaluation
using the Quality of Life Questionnaire for Cancer Patientstreated with anticancer drugs. Japanese Journal of Cancer
and Chemotherapy. 1994; 21: 379-387. (in Japanese)23) EuroQoL Group. EuroQoL: A new facility for themeasurement of health-related quality of life. Health
Policy. 1990; 16: 199-208.
24) Ikeda S. et al. Developing a Japanese version of the EQ5D-5L value set. J Natl Inst Public Health. 2015; 64: 4755.
25) Araki Y. Health support system for female workers. HealthCare (Kenko Kanri). 1999; 3: 3-23. (in Japanese)
26) Uno B. Effective utilization of questionnaires in regular
medical checkups. Occupational Health Management(Rodo Eisei Kanri). 2001; 12: 45-51. (in Japanese)27) Honjo H, Ohama K, Aso T, et al. Report of the Reproduction
and Endocrinology Committee “The Investigation Board
for Japanese Menopausal and Aged Woman Evaluation
Score and HRT Side Effects”: Questionnaire for evaluating
menopause symptoms in Japanese women. Acta Obstetrica
et Gynaecologica Japonica. 2001; 53: 883-888. (in Japanese)28) Yonei Y, Mizuno Y, Orimo H, et al. Effect of electropotential therapy on symptoms associated with QOL andaging. Anti-Aging Medicine. 2003; 2: 16-23. (in Japanese)_ 18 5 _