Trajectory Patterns of Three Lifestyle Behaviors and Subsequent Health Conditions in Japanese Adults: A Retrospective Longitudinal Study Using a Health Checkup Database

Introduction: Although the associations between lifestyle behavioral changes over time and the risks of cancer and cardiovascular diseases are documented worldwide, evidence specific to the Japanese population remains limited. This study aimed to elucidate the trajectories of lifestyle behaviors and their associations with health conditions. Methods: We analyzed health checkup data from the Japan Medical Data Center Claims Database from 2005 to 2019, specifically those of individuals who underwent 10 consecutive annual checkups. We focused on smoking, frequency of drinking alcohol, and regular exercise habits as the exposure factors. A group-based trajectory model was employed to estimate the patterns of single and multiple trajectories for three exposures. Furthermore, a linear mixed-effects model was used to assess the association between trajectory patterns and longitudinal changes in health conditions (body mass index, systolic blood pressure [sBP], LDL-cholesterol, and HbA1c). Results: This study included 51,064 Japanese subjects aged 20-59 years at their initial health checkup. We identified seven trajectory groups (Groups 1-7) that represented a high percentage of subjects in the following order: Group 3 (inactive, 31.0%), Group 5 (long-term smoking, 26.9%), and Group 2 (daily drinkers, 11.0%). The only lifestyle behavioral change observed was smoking cessation. Groups 3 and 5 exhibited higher sBP (Group 3: β = 1.18, standard error [SE] = 0.60, p = 0.05; Group 5: β = 1.33, SE = 0.61, p < 0.05) and LDL-cholesterol levels (Group 3: β = 3.80, SE = 1.36, p < 0.05; Group 5: β = 3.04, SE = 1.37, p < 0.05) than the nonsmoking, nondrinking, and regular exercise groups. Group 2 exhibited significantly high sBP (β = 2.43, SE = 0.62, p < 0.001), with an observed interaction effect over time (p < 0.05). Conclusions: Regular exercise and abstinence from smoking and drinking may be essential to avoid deterioration of health conditions.