『保健医療科学』 2025 第74巻 第3号 p.283-292（2025年8月）
＜原著＞
特定保健指導後の腹囲体重減少達成状況別の生活習慣病発症リスクの検証 ―LIFE Study―
佐藤有希子，村田典子，前田恵，福田治久，
九州大学大学院医学研究院医療経営・管理学講座
Evaluating the risk of developing lifestyle-related diseases based on achievement status of abdominal circumference and body weight reduction
after specific health guidance: The LIFE Study
SATO Yukiko，MURATA Fumiko，MAEDA Megumi， FUKUDA Haruhisa
Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences
＜抄録＞
目的： 2024 年度から腹囲 2㎝・体重 2kg減を達成すれば特定保健指導の介入量を問わず特定保健指導終了とする新たなアウトカム評価が導入された．本研究では基準達成群，未達成群，脱落群を比較し，短期的アウトカムと中長期的アウトカムの新規発症の差の有無を明確にする．
方法：本研究は，LIFE Studyの 15 自治体における 2012 年度～ 2022 年度の国民健康保険加入者の医療レセプトデータおよび特定健康診査・特定保健指導データを用いた．特定保健指導後の腹囲 2㎝かつ体重 2㎏減少の達成群，未達成群，保健指導途中終了の脱落群の 3群に分類し，短期的アウトカム（高血圧，糖尿病，脂質異常症の発症）および中長期的アウトカム（虚血性心疾患，脳血管疾患の発症）を評価した．Kaplan-Meier法を使用し生存曲線を描き，Log-rank検定を行った．3 群間における交絡因子の影響を調整するためCox比例ハザードモデルによる多変量解析を行った．さらに，自治体のクラスターを考慮し標準誤差を補正した感度分析を実施した．
結果：短期的アウトカムの発症率は，達成群 88 人（ 22.8％），未達成群 423 人（ 36.3％），脱落群 647人（ 30.3％），中長期的アウトカムは達成群 23 人（ 6.0％），未達成群 84 人（ 7.2％），脱落群 116 人（ 5.4％）であった．Kaplan-Meier法による生存時間分析とLog-rank検定では，短期的アウトカムにおいて 3群間で有意差を認めた．ハザード比は，短期的アウトカムで未達成群 1.50（ 1.19-1.89），脱落群1.23（ 0.98-1.54），中長期的アウトカムでは，未達成群 0.98（ 0.62-1.57），脱落群 0.77（ 0.49-1.21）であった．自治体のクラスターを考慮した感度分析の結果，短期的アウトカムは未達成群 1.50（ 1.29-1.75, p< 0.001）と有意差を認め，中長期的アウトカムでは有意差が認めなかった．
結論：短期的アウトカムでは，達成群と比較した未達成群のみ統計的な有意差を認めた．自治体間の影響を考慮した感度分析においても，同様の結果であった．一方，中長期的アウトカムでは，統計的有意差は認められなかった．動脈硬化性疾患の進行は長期間を要するため，今後の特定保健指導においては特定健康診査を継続的に受診し，減量効果を維持することが重要である．
キーワード：特定健康診査，特定保健指導，体重減少，アウトカム評価，生活習慣病の発症
Abstract
Objectives: From FY2024, Japanʼs Specific Health Guidance system introduced a new outcome-based assessment, allowing participants to complete the program upon achieving a reduction of at least 2 cm in abdominal circumference and at least 2 kg in body weight, regardless of the intervention volume. This study examined whether there were differences in the incidence of short-term and medium/long-term health outcomes among individuals who achieved these targets, those who did not, and those who dropped out of Specific Health Guidance.
Methods: This study utilized medical claims data and specific health check-up and guidance data from FY2012 to FY2022 across 15 municipalities participating in the LIFE Study. Participants were classified into achievement, non-achievement, and dropout groups based on whether they achieved ≥ 2 cm abdominal circumference and ≥ 2 kg weight reduction after Specific Health Guidance. Short-term outcomes were defined as the incidence of hypertension, diabetes, and dyslipidemia, while medium/long-term outcomes were defined as ischemic heart disease and cerebrovascular disease. Kaplan-Meier survival curves were generated, and log-rank tests were used to assess inter-group differences. Multivariable Cox proportional hazards models were applied to estimate hazard ratios (HRs), adjusting potential confounders. Additionally, sensitivity analyses were conducted, accounting for municipal clustering and adjusting standard errors.
Results: The incidence of short-term outcomes was 88 (22.8%) in the achievement group, 423 (36.3%) in the non-achievement group, and 647 (30.3%) in the dropout group. The incidence of medium/long-term outcomes was 23 (6.0%), 84 (7.2%), and 116 (5.4%), respectively. Kaplan-Meier analysis showed significant differences in short-term outcomes. Using the achievement group as the reference, the HRs for shortterm outcomes were 1.50 (95% confidence interval [CI]: 1.19–1.89) in the non-achievement group and 1.23 (95% CI: 0.98–1.54) in the dropout group. For medium/long-term outcomes, the HRs were 0.98 (95% CI: 0.62–1.57) in the non-achievement group and 0.77 (95% CI:0.49–1.21) in the dropout group. Sensitivity analysis, accounting for municipal clustering, showed a significant difference in the short-term outcome for the non-achievement group (HR: 1.50, 95% CI: 1.29–1.75, p < 0.001), but no significant difference in medium/long-term outcomes.
Conclusion: For short-term outcomes, only the non-achievement group had a significantly higher risk than the achievement group, even after accounting for municipal clustering in the sensitivity analysis. In contrast, no significant differences were observed for medium/long-term outcomes. Given the prolonged progression of atherosclerotic diseases, it is important to continue undergoing Specific Health Check-ups and maintaining weight reduction through ongoing Specific Health Guidance.
keywords : Specific health check-ups, specific health guidance, weight reduction, outcome evaluation, development of lifestyle-related diseases