Table 1. Nationwide preventive program: Screening and lifestyle intervention features.

Health checkups

Subjects     - All individuals or their family members aged 40–74 years, who are covered as primary beneficiaries under the health insurance system in Japan.     - Pregnant women, prisoners, individuals living overseas, and long-term inpatients were excluded. Exams     - Exams included questionnaires, physical examinations, waist circumference, height, weight, blood pressure, blood samples, and urinalyses.     - All exams were conducted under an article prescribed by an ordinance of the Ministry of Health, Labour and Welfare. Results & Information Supply     - Regardless of the presence/absence of cardiometabolic risks, information was given to all subjects simultaneously, with notification of the checkup results annually or more frequently.

Lifestyle interventions

- Individuals with a waist circumference ≥85 cm (men)/≥90 cm (women) or <85 cm (men)/<90 cm (women) with a body mass index ≥25 kg/m2, with at least one of the following: (1) high glucose tolerance (fasting blood glucose ≥100 mg/dl or hemoglobin A1c ≥5.6%), (2) dyslipidemia (triglyceride ≥150 mg/dl or high-density lipoprotein-cholesterol <40 mg/dl), (3) high blood pressure (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg) were considered at risk.     - Individuals taking medications for hypertension, dyslipidemia, or diabetes mellitus were excluded. Interventions     - Interventions were provided for 20 minutes or more to each individual separately or for 80 minutes or more to a group by a physician, public health nurse, or registered dietician.     - The facilitator explained the necessity of lifestyle improvement, the relationship between lifestyle and the specific health checkup data, the patient’s lifestyle, knowledge about metabolic syndrome and lifestyle-related chronic diseases, and the influence of these factors on the daily lives of the individuals receiving the motivational support.     - Explanation was given about the advantages of lifestyle improvement and the disadvantages of failing to improve lifestyle.     - The facilitator suggested changes needed to improve the lifestyle (e.g., diet and exercise).     - The facilitator set goals for actions and the timing of the outcome evaluation, accompanied by presentation of the social resources needed for lifestyle improvement and support for their effective utilization.     - The facilitator showed how to measure body weight and abdominal circumference.     - Goals for actions and the action plan were prepared by the individual receiving the motivational support under guidance via interview.     - A follow-up interview was performed based on the risks.     - The evaluation was made via interview or telecommunication (telephone, e-mail, etc.), 6 months after the first session.