Today’s urbanized and industrialized social environment has a complex and integrated structure that affects human health, and cannot be discussed in simple context. Health issues are social challenge rather than individual, because well-being is influenced by various social environmental factors and daily living conditions, including those related to cultural backgrounds and human relationships.

In this session, circumstances and related situations in individual societies will be shared from an international aspect, particularly associated with life-style related disease and discussions will be conducted to identify issues and to get perspective for overcoming the challenges involved. Despite of drastic burst of human population on the earth, obesity is still prevailing worldwide. Additionally, obesity is not challenge of developed societies, but it involves developing societies. On the contrary, malnutrition has been observed not only in poor countries, but affluent countries in term of excess weight loss in yo. The event is open to all students and members of the public who are interested in urbanization, healthy lifestyles, health promotion, food and related issues.

高度な産業社会を擁する世界には、依然として飢餓と肥満が混在し、70億に達した世界人口の半数は都市に集中している。都市化により、都市は多様な利便性を提供する一方で健康リスクを集中させ、生活習慣病は途上国を含めて世界最大の死因となった。大量生産を背景に、大量消費を促す膨大な情報の流れは現代人の価値観に影響を及ぼし、生活習慣や生活態度は次世代に受け継がれる。都市化と産業化による複雑な社会環境は、人々の健康を左右する構造的連関を持っており、単眼的視点から解決できる可能性はない。韓国および中国から健康科学に関連する研究者を招へいし、北大の研究者とともに、各国の個別的課題および共通する東アジアの課題について情報交換を行い、克服の展望について議論する。都市化、および健康的な生活、衛生、食、等に興味がある学生、市民の参加を期待する。

1. Chronic Diseases, Behavior and Social Environment in China

Peiyu Wang,MD.,PhD

Professor of social medicine and health education, Peking University, China

During the past 20 years, the morbidity and mortality of CVD (heart disease and stroke) cancers and other chronic diseases in China are elevating continuously, while those in West European countries, America and Japan has steadily dropped down at same term. The crude death rate of CVD increased from 190 in 1990 to 260 per 100 000 population in 2009. Mortality of cancers rose from 120 in 1990 to 155 per 100,000 population in 2009. It is estimated that the number of the patients with CVD currently is 230 million, of which, 200 million are afflicted with hypertension, more than 7 million with stroke, 5 million with pulmonary heart disease, 2 million with myocardial infarction, and so on. One out of 5 adults is suffered from CVD. About 3 million Chinese die of CVD annually, which accounts for 41% of all death, the top reason of the death. Moreover chronic diseases were shown accelerated increase in the recent years. The prevalence of diabetes mellitus rose from 2.6-4.4% in 2002 up to 8.6-9.7% in 2008, that of hypertension was 18.8% in adults according to a National Survey in 2002 and reached approximately 25% in recent years in the investigation reports of some provinces and cities.

These are very serious state. If the chronic diseases could not be well controlled, the wealth and property created by the people will be largely offset. Further, the quality of living and happiness of the people will also be greatly reduced. Why did the chronic diseases rise continuously? One reason is the aging of population, which is inevitable and hard to intervene. However, the major reason is that health risk factors were violently increased and not well controlled. Therefore, how to reduce the health risk factors is the point for the prevention and control of chronic diseases.

The major risks for chronic diseases in China are unhealthy diets (over take of energy, fat and salt), physical inactivity, air pollution, smoking, excessive alcohol onsumption as well as mental stress and pressure. Behind these risk factors, there are complicated social, economic, environmental and personal reasons. Many researchers emphasized nutrition, physical activity, tobacco and alcohol, but I think the mental stress and psychological pressure are the more important for chronic diseases. The mental stress is easily ignored for it is difficult to measure. Currently, Chinese are one of the most tired, stressful, hard-working nations in the world. We have the longer working time, lower income and higher prices. People are now facing various stresses regardless of children, adolescents or adults. The stresses for children and adolescents mainly come from learning and employment, while the adults have living stress, working stress and traffic stress. The stress and psychological unbalance also come from disparities in income and society. The speeded rhythm in work and life, narrow space and low health awareness led to reduced physical activity (people do not have time and space to exercise); the extraordinarily increased cars accelerated physical inactivity and air pollution (Beijing has near 5 million cars, this is the double of Tokyo in spite of the similar population). The unhealthy diet is mainly due to the traditionally higher intake of salt, the rising consumption of fat/oil and meat which comes from improved economics, the fashion of fast food as well as poor knowledge on nutrition. The production and consumption of tobacco and alcohol increased triply during the recent 30 years. All these factors lead to the high prevalence of obesity, hypertension and dyslipidemia, which may further develop to coronary heart disease, stroke, diabetes and cancers.

To control the risk factors of the chronic diseases requires the efforts of individuals, society and government cooperatively. Every citizen should learn health knowledge, improve the health literacy and try to lead healthy life. The government and the society should create a healthy environment (both social and natural) and strengthen the health promotion, such as reforming the health care system and health services, increasing the public green area for exercise, limiting the excessive growth of automobile and alcohol, improving the traffic and air pollution, reinforcing tobacco control, relieving the mental stress of people. The most important issue is to set the final goal at the good health, better lives, social wellness and happiness, rather than economic growth or GDP only. Recently, Chinese government (also some local governments) actively promoted some healthy campaigns, such as “Health Beijing 10 Year Project”. However, it needs time to see the outcomes of these health promotion projects.

2.Nutrition-derived health impact in Japan-Diabetes, Metabolic Syndrome & DOHaD-

食生活に潜在する生活習慣病リスク－肥満と痩身－

Professor of Health Science, Hokkaido University Graduate School of Education

河口明人（北海道大学・大学院教育学研究院・教授）

環境健康科学研究教育センター　副センタ―長

Aging in Japan is becoming more serious at a speed and scale never seen before. On the parallel with it, chronic degenerative disease has been increasing constantly since the end of WWII.  Energy-enriched fat intake has been drastically increased by three times (20g to 60g a day) in these days along with emerging of lifestyle related disease, particularly diabetes and metabolic syndrome in male adult. Despite of no increase of total energy intake, why these diseases associated with deterioration of glucose metabolism have increased? It seems to be attributed to population aging, and another may be increasing of disproportionate fat intake. In our cohort study, share (%) of oleic acid among fatty acids on red blood cell membrane is strongly associated with increased serum triglyceride coupling with low HDL-cholesterol level and serum insulin level in asymptomatic population. Contrary to our expectation, it suggests that oleic acid is a significant determinant to induce insulin resistance in Japanese who have relatively high intake of fish oil.

Another nutrition-derived health impact is weight loss in young women with childbearing ages. A fifth of young adult women have BMI less than 18.5, diagnosed as excess weight loss that is well-known associated with delivering low birth baby (LBW<2,500g). Maternal birth weight and pre-pregnant body-weight are a significant predictor of her child’s birth weight. Accordingly LBW grow poorly become stunned girl who tends to give birth to LBW, which continues to the next generation as a vicious cycle, subsequently followed by life-style related disease. Sustainable development of society based on human health indicates that the present generation is responsible for the human reproduction.

世界的に例を見ない急速な高齢化を経験している我が国において、死因の6割以上を占める慢性疾患は加齢に連動し、したがって今後とも最大の健康課題である。およそこの10年間で、糖尿病患者は倍増(890万人)し、これに疑似症例（1,320万人）およびメタボリック・シンドローム症例(2,010万人)を含むと成人の過半数は、何らかの糖代謝異常のリスクに晒されている。摂取エネルギーの増加が観察されていないにも拘わらず、何故糖尿病患者やメタボリック・シンドローム患者が増加しているのか？一つには高齢化であり、もう一つには脂質摂取バランスが疑われる。我が国の脂質摂取量は、半世紀のあいだにおよそ20gから60gへと倍増し、コホート研究において赤血球膜脂肪酸分布からみた脂質の割合で、オレイン酸を主体とする一価不飽和脂肪酸は、いずれの飽和脂肪酸濃度よりも、トリグリセリド値上昇およびHDL-C濃度低下と密接に関連し、血清インスリン濃度とも有意な関連を示していた。魚油摂取量の多い我が国において、主に植物性油脂として摂取されるオレイン酸は、単体として摂取されることはほとんどないが、インスリン抵抗性の潜在的要因である可能性がある。

一方不適切な食生活は過食ばかりではなく、青年期女性の5人に1人が、BMI18.5未満の痩身とみなされ、母体の痩身は我が国でも上昇（10%）している低出生体重児(<2,500g)の原因的背景である可能性がある。母親の出生時体重および妊娠前体重が、新生児の体重の重要な規定因子であることが明らかとなっており、さらに低出生体重児は、将来的に生活習慣病の易発症病態であることが報告されている。若年時低体重は、高齢期の女性にとって最大のQOL阻害要因である骨粗鬆症の重要なリスクでもある。この世代を超えた食生活研究の推進と潜在リスクの改善は、健全な高齢者の社会参加を必須とする今後の我が国の極めて重要な課題である。

3. Metabolic syndrome and the life style modification to overcome it in the Korean population

Bo Kyung Koo,MD

Seoul National University, College of Medicine, Seoul, Korea

According to the Korean National Health and Nutritional Examination Surveys, the age-adjusted prevalence of metabolic syndrome was 24.9 % in 1998, which was significantly increased to 31.3% in the next 10 years. Metabolic syndrome is characterized by insulin resistance and epidemiologic studies in Korea elucidated that visceral fat and sarcopenia, the well-known causes of insulin resistance, increase the risk of metabolic syndrome in the Korean population. In addition, physical inactivity and increased meat and alcohol consumption, the characteristic life style in westernized and urbanized Korea, also increase the risk of metabolic syndrome in the Korean population. Furthermore, as the risk of abnormality in glucose metabolism, dyslipidemia, and hypertension is higher in the elderly, the increased average life span of the Koreans might accelerate the expansion of prevalence of metabolic syndrome.

Here I will describe the characteristics of metabolic syndrome in the Korean population and the intervention to overcome the risk of metabolic syndrome from the perspective of life style modification.

4.Obesity and low physical fitness among Asian children: current trends and mitigation strategies

肥満化・体力低下時代を生きるアジアの子どもたち：現状と緩和方策

Taro Yamauchi.,PhD

Associate Professor, Hokkaido University Faculty of Health Sciences

山内太郎(北海道大学・大学院保健科学研究院・准教授)

環境健康科学研究教育センター　兼務教員

日本では毎年10 月体育の日が近づくと、子どもの体力低下の話題がテレビや紙面をにぎわす。この30年間で子どもの身長や体重は増加し、体格はよくなっているものの肥満児割合も増加している。その一方で、体力テスト成績は下がり、歩数など運動量も減少している。

日本に限らず、世界の先進国でも子どもの体力低下と肥満化傾向が報告されている。欧米諸国はもちろんのこと、東アジア諸国でも報告が相次いでいる。私たちのフィールド調査からも中国、韓国、台湾、日本の都市部の小中学生に肥満化傾向と体力低下の兆候を見出した。さらに東南アジア、太平洋島嶼国においても都市部の子どもたちが急速に肥満化・体力低下している現象にも直面している。

約20年にわたりアジア、オセアニア、アフリカの農村および都市部、さらに狩猟採集民など伝統社会に暮らす人々の環境適応と健康について、住民の目線に立った調査を行ってきた。途上国農村部や自給自足的暮らしを営む伝統社会といった、自然に強く依存した生活世界に生きる子どもたちには、先進国の子どもにみられる異変は認められない。しかし、途上国農村部は現在、急速な都市化の渦中にあり、ライフスタイルが急激に変容している。途上国の農村に暮らす子どもの身体に異変が現れるのも時間の問題かもしれない。

一方、伝統社会は途上国と同様に経済のグローバル化の影響を受けて変化し始めているものの、子どものライフスタイルは基本的に変わらない。例えば狩猟採集民の子どもたちは森での遊びを通して生き抜くための智恵や技術を学んでいる。人類は長い時間を掛けて狩猟採集時代の生活環境に適応して進化してきたことを鑑みると、狩猟採集社会の生活の中に子どもの体力と健康のあるべき姿を見出すことができるかもしれない。

肥満・低体力と無縁な伝統社会に生きる子どもたちのライフスタイルと健康について考察し、アジアの子どもたちの体力向上と健康増進について考えてみたい。