{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:03:24Z","timestamp":1779289404214,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T00:00:00Z","timestamp":1647216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>We conducted a longitudinal examination to assess the relationship between lifestyle habits, including exercise habits, and the incidence of undernutrition after the Great East Japan Earthquake in March 2011. Of the 31,411 participants aged \u226560 years who lived in the municipalities\u2019 evacuation areas before the disaster and had undergone health examinations, 17,622 persons with a body mass index of 20\u201325 kg\/m2 were followed up through the FY 2017 (a mean follow-up of 6.9 years). The analysis involved 13,378 individuals who could be followed. The associations between undernutrition after the disaster and lifestyle factors were estimated via multivariable-adjusted analysis using the Cox proportional hazard regression model. The dependent variable was the proportion of undernutrition after the disaster, whereas independent variables included evacuation, exercise habits\/physical activity, alcohol consumption, smoking, meals before bedtime, gastrointestinal surgery history, history of lifestyle-related diseases, and two or more subjective symptoms. In total, 1712 of the 13,378 participants were newly undernourished after the disaster. The statistically significant variables influencing the occurrence of undernutrition were non-evacuation (hazard ratio (HR), 1.31; 95% confidence index (CI) 1.17\u20131.47), poor exercise habits (HR, 1.14; 95% CI 1.03\u20131.50), and poor physical activity (HR, 1.12; 95% CI 1.01\u20131.25). Other significant related variables were drinking habits, surgical history, lifestyle-related diseases, and two or more subjective symptoms. These results suggest that regular exercise and\/or physical activity might be important in preventing undernutrition following a disaster, regardless of sex, other lifestyle habits, or past medical history.<\/jats:p>","DOI":"10.3390\/ijerph19063399","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T03:06:10Z","timestamp":1647313570000},"page":"3399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Lifestyle Factors Associated with Undernutrition in Older People after the Great East Japan Earthquake: A Prospective Study in the Fukushima Health Management Survey"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8487-712X","authenticated-orcid":false,"given":"Kanako","family":"Okazaki","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Fukushima Medical University School of Medical Sciences, Fukushima 960-8516, Japan"},{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-7165","authenticated-orcid":false,"given":"Tetsuya","family":"Ohira","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0128-8395","authenticated-orcid":false,"given":"Akira","family":"Sakai","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michio","family":"Shimabukuro","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichiro J.","family":"Kazama","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0568-8361","authenticated-orcid":false,"given":"Atsushi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3783-2914","authenticated-orcid":false,"given":"Hironori","family":"Nakano","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6888-6640","authenticated-orcid":false,"given":"Fumikazu","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9382-8023","authenticated-orcid":false,"given":"Masanori","family":"Nagao","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-2840","authenticated-orcid":false,"given":"Seiji","family":"Yasumura","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Ohto","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,14]]},"reference":[{"key":"ref_1","first-page":"59","article-title":"Concept of science and society in the age of longevity","volume":"80","author":"Akiyama","year":"2010","journal-title":"Kagaku"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1093\/gerona\/63.9.984","article-title":"Initial manifestations of frailty criteria and the development of frailty phenotype in the women\u2019s health and aging study II","volume":"63","author":"Xue","year":"2008","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_3","unstructured":"Hazzard, W.R., Blass, J.P., Ettinger, W.H., Halter, J.B., and Ouslander, J. (1998). Frailty and failure to thrive. Principles of Geriatric Medicine and Gerontology, McGraw Hill."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jamda.2013.03.010","article-title":"Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people","volume":"14","author":"Shimada","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.je.2016.09.008","article-title":"Prevalence of frailty in Japan: A systematic review and meta-analysis","volume":"27","author":"Kojima","year":"2017","journal-title":"J. Epidemiol."},{"key":"ref_6","unstructured":"Ministry of Health, Labor and Welfare (2019, September 11). Summary of the Results of the 2017 National Health and Nutrition Survey, Available online: https:\/\/www.mhlw.go.jp\/content\/10904750\/000351576.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29S","DOI":"10.1177\/1010539516687022","article-title":"Fukushima health management survey and related issues","volume":"29","author":"Yasumura","year":"2017","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_8","unstructured":"Utsukushima Fukushima Future Support Center (2019, October 28). Report on the Survey and Research Project on the Necessary Support by Analyzing the Causes of the Increase in the Number of People Certified as Needing Long-Term Care in Fukushima Prefecture, Available online: https:\/\/www.mhlw.go.jp\/file\/06-Seisakujouhou-12300000-Roukenkyoku\/0000140299.pdf."},{"key":"ref_9","first-page":"59","article-title":"The elderly people and the Great East Japan disaster of March 11, 2011","volume":"62","author":"Shimizu","year":"2013","journal-title":"Bull. Nara Univ. Educ."},{"key":"ref_10","unstructured":"Tanba, F. (2019, December 20). Current Status and Issues of Evacuees in the Accident at TEPCO\u2019s Fukushima Daiichi Nuclear Power Plant. 32nd Atomic Energy Commission: Document 1\u20133. Available online: http:\/\/www.aec.go.jp\/jicst\/NC\/iinkai.teirei\/siryo2013\/siryo32\/siryo1-3.pdf."},{"key":"ref_11","first-page":"629","article-title":"The effect of lunch box provision and mass feeding on energy and nutrient supply at emergency shelters after the Great East Japan Earthquake","volume":"66","author":"Mihara","year":"2019","journal-title":"Nihon Koshu Eisei Zasshi"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.amepre.2015.10.008","article-title":"Effect of evacuation on body weight after the Great East Japan Earthquake","volume":"50","author":"Ohira","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1161\/HYPERTENSIONAHA.116.07499","article-title":"Evacuation and risk of hypertension after the Great East Japan Earthquake: The Fukushima Health Management Survey","volume":"68","author":"Ohira","year":"2016","journal-title":"Hypertension"},{"key":"ref_14","first-page":"627390","article-title":"Evacuation after the Fukushima Daiichi nuclear power plant accident is a cause of diabetes: Results from the Fukushima health management survey","volume":"2015","author":"Satoh","year":"2015","journal-title":"J. Diabetes Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.2169\/internalmedicine.55.6030","article-title":"Hypo-high-density lipoprotein cholesterolemia caused by evacuation after the Fukushima Daiichi nuclear power plant accident: Results from the Fukushima Health Management Survey","volume":"55","author":"Satoh","year":"2016","journal-title":"Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"327","DOI":"10.5551\/jat.35824","article-title":"Influence of Post-disaster Evacuation on Incidence of Metabolic Syndrome","volume":"24","author":"Hashimoto","year":"2017","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.je.2016.05.006","article-title":"Effect of evacuation on liver function after the Fukushima Daiichi Nuclear Power Plant accident: The Fukushima Health Management Survey","volume":"27","author":"Takahashi","year":"2017","journal-title":"J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.je.2016.08.002","article-title":"Evacuation after the Great East Japan Earthquake was associated with poor dietary intake: The Fukushima Health Management Survey","volume":"27","author":"Zhang","year":"2017","journal-title":"J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Tsubota-Utsugi, M., Yonekura, Y., Tanno, K., Nozue, M., Shimoda, H., Nishi, N., Sakata, K., Kobayashi, S., and RIAS Study (2018). Association between health risks and frailty in relation to the degree of housing damage among elderly survivors of the great East Japan earthquake. BMC Geriatr., 18.","DOI":"10.1186\/s12877-018-0828-x"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/MCO.0b013e3282fba5d7","article-title":"Subjective and objective nutritional assessment methods: What do they really assess?","volume":"11","year":"2008","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"417","DOI":"10.2188\/jea.JE20100180","article-title":"Body Mass Index and Mortality from All Causes and Major Causes in Japanese: Results of a Pooled Analysis of 7 Large-Scale Cohort studies","volume":"21","author":"Sasazuki","year":"2011","journal-title":"J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1080\/03014460.2019.1662943","article-title":"Nutrition intake among the Japanese elderly: An intergenerational comparison based on national health and nutrition survey scores","volume":"46","author":"Yokoyama","year":"2019","journal-title":"Ann. Hum. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1079\/PNS2005437","article-title":"Use of BMI in the assessment of undernutrition in older subjects: Reflecting on practice","volume":"64","author":"Cook","year":"2005","journal-title":"Proc. Nutr. Soc."},{"key":"ref_24","first-page":"33","article-title":"Dietary intake and nutritional status among Japanese elderly participants in the National health and nutritional survey Japan 2003\u20132011","volume":"12","author":"Yokoyama","year":"2018","journal-title":"J. Jpn. Soc. Shokuiku"},{"key":"ref_25","unstructured":"Japan Geriatrics Society (2019, December 03). Statement of the Japan Geriatrics Society on Frailty. Available online: https:\/\/www.jpn-geriat-soc.or.jp\/info\/topics\/pdf\/20140513_01_01.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_27","first-page":"718","article-title":"Unintentional weight loss in older adults","volume":"89","author":"Gaddey","year":"2014","journal-title":"Am. Fam. Physician"},{"key":"ref_28","unstructured":"Ministry of Health, Labor and Welfare (2020, January 04). Standard health screening and health Guidance Program. Final Version. Part 2 Medical Examination Attachment 3 Standard Questionnaire, Available online: https:\/\/www.mhlw.go.jp\/bunya\/kenkou\/seikatsu\/pdf\/02.pdf."},{"key":"ref_29","unstructured":"Ministry of Health, Labor and Welfare (2020, January 10). Physical Activity Reference for Health Promotion 2013, Available online: https:\/\/www.mhlw.go.jp\/content\/000306883.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"734267","DOI":"10.3389\/fnut.2021.734267","article-title":"The effects of exercise on appetite in older adults: A systematic review and meta-analysis","volume":"8","author":"Hubner","year":"2021","journal-title":"Front. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gianfredi, V., Blandi, L., Cacitti, S., Minelli, M., Signorelli, C., Amerio, A., and Odone, A. (2020). Depression and objectively measured physical activity: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103738"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.7326\/0003-4819-131-1-199907060-00005","article-title":"Walking to work and the risk for hypertension in men: The Osaka Health Survey","volume":"131","author":"Hayashi","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3396","DOI":"10.1158\/1055-9965.EPI-08-0497","article-title":"Effect of physical activity on breast cancer risk: Findings of the Japan collaborative cohort study","volume":"17","author":"Suzuki","year":"2008","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/01.cej.0000236249.63489.05","article-title":"Time spent walking and risk of colorectal cancer in Japan: The Miyagi Cohort study","volume":"16","author":"Takahashi","year":"2007","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1136\/bjsports-2011-090466","article-title":"Is exercise effective in promoting mental well-being in older age? A systematic review","volume":"45","author":"Rosenbaum","year":"2011","journal-title":"Br. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/JES.0b013e3181b7b57b","article-title":"Exercise and respiratory tract viral infections","volume":"37","author":"Martin","year":"2009","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Cameron, I.D., Fairhall, N., Langron, C., Lockwood, K., Monaghan, N., Aggar, C., Sherrington, C., Lord, S.R., and Kurrle, S.E. (2013). A multifactorial interdisciplinary intervention reduces frailty in older people: Randomized trial. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-65"},{"key":"ref_38","first-page":"724","article-title":"Current status of diets and nutritional issues in disaster areas: Report on the areas affected by the Great East Japan Earthquake (Kesennuma City, Miyagi Prefecture)","volume":"54","author":"Kazuhiro","year":"2011","journal-title":"J. Jpn. Diabetes Soc."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ishida, Y., Yoshida, D., Honda, T., Hirakawa, Y., Shibata, M., Sakata, S., Furuta, Y., Oishi, E., Hata, J., and Kitazono, T. (2020). Influence of the accumulation of unhealthy eating habits on obesity in a general japanese population: The Hisayama study. Nutrients, 12.","DOI":"10.3390\/nu12103160"},{"key":"ref_40","first-page":"1","article-title":"Reasons for not receiving the specific health examination and health attitudes of those who have not received the examination in Hanamaki City, Iwate Prefecture","volume":"57","author":"Kubota","year":"2021","journal-title":"J. Health Welf. Stat."},{"key":"ref_41","first-page":"34","article-title":"Factors and Countermeasures for undiagnosed patients based on questionnaire survey of undiagnosed patients for specific health examination","volume":"58","author":"Goto","year":"2022","journal-title":"Indic. Health Welf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:36:02Z","timestamp":1760135762000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,14]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19063399"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19063399","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,14]]}}}