[in Japanese]

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 Objective: To evaluate five different types of health checkup reports for understanding consumer preferences.
 Methods: The following health checkup report samples were prepared: sample A- mark abnormal findings and give advice at the end; sample B-grade each item using the alphabet coding system; sample C-grade each item using the Japanese coding system; sample D-present a list of item grades; and sample E-indicate the overall risk level at the beginning and give advice in order of descending priorities. A web-based survey was conducted among 424 Japanese adults aged 35-59 years. Participants, randomly divided into four groups, were asked to evaluate two of the health checkup report samples in terms of intelligibility, comprehensibility, and design quality (information volume, organization, attractiveness, helpfulness, tone, size, and spacing).
 Results: Regardless of the type of health checkup report, less than 40% of participants could point out all abnormal findings in the health checkup report. Compared with the sample A, the sample B rated higher in intelligibility, comprehensibility, and the four design quality items (information volume, organization, attractiveness, tone, and size). Compared with the sample B, the sample C rated higher in intelligibility, comprehensibility, and the four design quality items (information volume, organization, attractiveness, and helpfulness). Compared with the sample B, the sample D rated higher in the two design quality items (information volume and size), but no significant differences were found in intelligibility or comprehensibility. Compared with the sample C, the sample E rated higher in intelligibility, comprehensibility, and all design quality items. More than 80% of participants given the sample E agreed that they should take risk reduction measures as soon as possible.
 Conclusion: The sample E topped the overall rating, followed in the order of the samples C, B, D, and A. According to the results of this study, health checkup reports had better satisfy the following conditions: indicate the overall risk level at the beginning; give advice in order of descending priorities; and grade each item using the Japanese coding system.

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 We built the system to collect and standardize the data of health checkup of residents of municipalities in Chiba prefecture. We asked all medical laboratories to participate in the same external quality control, and the standardization of measurements with the same standard material was executed. For the judgment of abnormalities of data, the circulatory organs judgment division table of the Ministry of Health, Labor and Welfare was used. We collected data from 22 municipalities through 2002 to 2006.There were 366,862 (111,877 men, 254,985 women) data collected from 22 municipalities for five years in total. We noticed that there were significant sex and age differences in the data of health check-up. In men, the risks of cardiovascular disease as BMI, T-Chol & TG were the highest for those 40-49 years of age and decreased gradually with age. The mean HDL-Chol of men was 55mg/dL for all age groups and lower than that of women. SBP & BS were higher for all age groups of men compared with women. In women, BMI, T-Chol & TG were significantly low before menopause and rapidly increased with age after menopause to overtake those of men at the age of 70 years. The mean HDL-Chol of women was 65-70mg/dL for those 35-59 years of age and gradually decreased. BMI, SBP, TG and BS became almost same between men and women at the age of 70 years.
 It may be indispensable to consider sex and age differences of health check-up data for the better health education.

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 The body mass index (BMI) is widely used in clinical practice and medical examinations to evaluate the body size. People are considered obese when their BMI exceeds 25kg/m² in Japan. Along with a recent increase in the prevalence of obesity in developed countries, health checkups and health care advice with a particular focus on metabolic syndrome were started in Japan a few years ago. As a result, people started to become aware of metabolic syndrome as well as the health risks of obesity, showing the success of such health care advice. On the other hand, it is not well-known that the number of people who are underweight with a BMI of less than 18.5 is increasing among Japanese women in their 20-40s. However, no common framework for underweightness has been established. Does being underweight have negative effects on our health? It is known that BMI has a U-shaped relationship with the mortality rate. In Asia, Zheng et al. reported the impact of a low BMI on mortality in 2011 involving more than 1 million people. In Japan, Tamakoshi et al. and Nagai et al. also reported a relationship between underweightness and high mortality rates. Other than reports on relationships with mortality rates, many reports indicated health damage caused by being underweight. These reports suggest that being underweight is associated with health risks. Thus, in this study, we investigated 13,499 subjects (males: 10,917, 81.2%, mean age: 47.4±10.6 years) who underwent a comprehensive medical examination, and reported the prevalence of diseases and results of the examination according to their body size. We also discussed issues regarding medical examinations when examining a person who is underweight based on the above results and previous studies.

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 In order to maintain the homeostasis of life, kidney receives 20% of blood flow (1L/min) in cardiac output. Despite of blood pressure changing, the glomerular filtration rates are kept at 100mL / min. Proximal tubules reabsorb more than 99% of fluid and biogenic substances in solute (i.e. glucose, amino acid and so on) those are essential for maintenance of homeostasis. Complex anatomical structures of kidney contribute to this mechanism that is likely to ultimate recycling system of fluid as well as the efficient waste removal.
 Chronic kidney disease (CKD) has been recognized as the great risk factor for cardiovascular events. The interaction so-called “cardio-renal association” may be related to “strain vessel theory” that is based on the anatomical similarity of special vascular structures among brain, heart and kidney. Therefore, the existence of proteinuria suggests impairment of glomeruli as well as cerebra-cardiac vascular damages except cases involving in immunological nephritis. In the guideline of CKD 2012, both estimated Glomerular filtration rate (eGFR) and urinary protein excretion are recognized as risk factor for cardiovascular events. However, the first line therapy for controlling blood pressure changed in CKD patients without proteinuria. The combination of long acting calcium channel blockers with other anti-hypertensive agents are also recommended for CKD patients instead of blind prescription of inhibitors for renin angiotensin system.
 To evaluate accurate renal functions is important for appropriate drug therapies in CKD patients. In general, the estimation of eGFR using serum creatinine by MDRD formula is popular but is not always correct. The patients with less muscle mass such as elderly, women, children and bedridden people show lower levels of serum creatinine than we speculate. Therefore, the estimation using serum cystatin C is better for estimation of eGFR, which may be allowed in every 3 month in outpatients.

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