Background: Smoking cessation is associated with unfavorable weight gain, and HDL cholesterol (HDL-C) favorably increases. However, the long term effects of changes in smoking habit on waist circumference (WC), body weight (BW) and HDL-C are not clear. The purpose of this study was to examine the effects of changes in smoking habits on HDL-C and BW over 4 years. Methods: Subjects were 18,289 men (20-64 years of age) who had annual medical check-ups consecutively for 4 years from April 1 2008 to March 31, 2011. They were divided into 4 groups based on the smoking habits change from the 1st year compared to the next 2 years: “non-smoking”, “smoking cessation”, “smoking” and “smoking initiation”. The changes in WC, BW and HDL-C over 4 years were analyzed using the analysis of variance. Results: From 2008 to 2009, WC and BW significantly increased in the smoking cessation group (+1.30 cm,+0.87 kg) and BW decreased (-0.54 kg), but WC did not change significantly in the smoking initiation group. HDL-C also increased in the non-smoking group (+2.9 mg/dL) but did not change significantly in the smoking initiation group. Over 4 years, the increase in WC, BW and HDL-C was largest in the smoking cessation group (+1.43 cm,+1.57 kg and +4.7 mg/dL, respectively). In the smoking and non-smoking groups, WC, BW and HDL-C slightly increased but no significant change was observed in the smoking initiation group. The effects of changes in smoking habits on WC, BW and HDL-C were largest during the first year and then gradually declined during the next 3 years. Conclusion: The usual HDL-C reduction accompanying weight gain was not observed after the cessation of smoking. In the smoking cessation group, WC and weight gain continued over the 4 years, but HDL-C also improved. It is suggested that continuing smoking cessation for several years would contribute to the improvement of the atherosclerotic risk factor.
Background: The usefulness of lung age is expected by the Japanese Respiratory Society. They pointed out the problem of smoking, which may induce chronic obstructive pulmonary disease (COPD), and promoted smoking cessation because of the recent increase of COPD patients. Early detection and treatment of COPD are required. In our hospital, lung age was measured by pulmonary function tests, and its determination is becoming more common for our patients. We expect that the difference in lung age will be influenced by the smoking situation of patients at our hospital. In addition, we have another purpose. The lung age may be influenced by factors related to lifestyle-related disease. Subjects: All subjects were recruited in St. Luke’s International Hospital who attended an annual comprehensive medical checkup with the exclusion of those who did not have data from pulmonary function tests. We referred to the most recent data if they came into the hospital multiple times. Methods: We calculated the difference between lung age and real age (as the lung age difference). First, we divided the patients in three groups according to their smoking history—current smokers, ex-smokers, and non-smokers—for comparison of the lung age difference. Second, we divided the patients into subgroups based on the smoking index of 600 and the interval of every 20 years for the smoking duration. Each group was assessed in relation to lifestyle-related diseases and lung age difference based on blood tests (triglyceride, HDL cholesterol, LDL cholesterol), waist circumference and blood pressure, with each quartile based on a lower lung age difference. Results: In the three groups of patients who were separated according to the smoking index, male current smokers had the largest lung age difference compared with the ex-smokers and non-smokers, and female current smokers had a larger number than non-smokers. The large lung age difference in men depended on a high smoking index. The group with a smoking duration of 21 to 40 years had a larger lung age difference than the male group with a duration of 1 to 20 years, and the group with a duration of over 41 years had a larger number than the female group with a duration of 1 to 20 years. In particular, the level of triglyceride was higher in men with a large lung age difference. Discussion: This study showed that the lung age may be influenced by smoking history and duration of smoking, and obesity may be affected by the risk factors for lifestyle-related diseases, due to a reduced pulmonary function.
In patients with thyroid nodules, there are no other symptoms except nodules and their thyroid function is usually normal, except in the case of autonomously functioning thyroid nodules (AFTN). Ultrasonographic study (US) is the most simple and useful method for the detection and evaluation of thyroid nodules. The aim of this study was to detect thyroid nodules using US and to select patients who need to undergo US-guided fine needle aspiration biopsy (FNAB) and to refer them to a thyroid specialist for treatment and management. We performed a retrospective study of 3,783 subjects (1,418 males and 2,365 females) who had received US of the thyroid at the Health Service Association Clinic (Kenko Life Plaza) between 2003 and 2013. Thyroid nodules were evaluated by using the US classification system (USC1 - USC5) of Yokozawa et al. Thyroid nodules were found in 1,478 (39.1%) and thyroid cysts were found in 918 (24.3%) of the 3,783 subjects. We referred 566 patients to a thyroid specialist and received 401 referral reply letters from the hospital. Of the 401 patients, 74 had malignant nodules and 327 had benign thyroid nodules. Of the 74 malignant nodules, 71 were PC and 3 were follicular thyroid carcinoma (FC). Thirty of the 71 PC (42.3%) had thyroid papillary microcarcinoma (MC). Of the 74 patients, 55 (52 PC and 3 FC) were operated and 19 with low-risk MC have been observed without surgery. Hashimoto’s disease was concomitantly seen in 5 (6.8%) of the 74 patients with malignant nodules and in 53 (16.2%) of the 327 with benign nodules. Polycystic thyroid disease was present in 28 (0.74%) of the 3,783 subjects who underwent US. From these research findings, we devised a flowchart for the early diagnosis and management of thyroid nodules.
To evaluate the health status and to find high risk individuals to be treated, various kinds of studies have been conducted. There are 2 methods to give the meaning of the measured data from health examination. One is the method based on the product management procedure to find irregular products and gives relative position in the population. It is clear to understand the image of relative health status. However, relative position does not mean the risk itself. If the population is at the high risk, individuals are also at the high risk for diseases. The latter method is based on epidemiological evidences. After following population at risk for more than 10 years, study participants are divided into control group and exposure groups. Mortality or incidence rates were calculated for these groups and estimated relative risk for exposure. Using relative risks and absolute risks derived from prospective studies. Recent Japanese guidelines are based on epidemiological evidences. Combinations of risk factors are also useful to find high risk individuals. It is clear that the method to identifying risk for disease should be based on epidemiological evidences.
Blood pressure (BP) values of a population usually show a normal distribution, and the distribution differs largely by areas and periods, which means BP is a kind of nutritional biomarkers. On the other hand, many epidemiological studies (mainly cohort studies) showed that BP values strongly relate to the future risk of cardiovascular diseases (CVD) and are established CVD risk factors. The relationship is continuous and log-linear and there is no threshold. Therefore, the cut-off point to define “hypertension” is artificial, but it cannot be determined by the cross-sectional data of BP distribution. Now, most of BP treatment guidelines in the world define “hypertension” as BP 140/90 mmHg or over and “optimal BP” as BP less than 120/80 mmHg. The cut-off value of “hypertension” does not mean the implication of drug treatment; however, that of “optimal BP” means the necessity of lifestyle modification. The cut-off BP values reported by the Japan Society of Ningen Dock in 2014 should be retracted because there are many problems and great mistakes.
Japan Atherosclerosis Society (JAS) published the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2012. Since then, these guidelines have been used as a clinical standard for prevention of atherosclerotic cardiovascular diseases in Japan. JAS guidelines were based upon the data of NIPPON DATA80 to evaluate the 10-year probability (absolute risk) of coronary artery disease death. However, in the April of 2014, the Japan Society of Ningen Dock announced at a press conference a “reference range” based upon the 95% distribution of clinical and laboratory examination data of so-called supernormal healthy subjects without any prospective data for predicting the development of coronary artery disease. This announcement resulted in a nation-wide confusion among health care providers in terms of the management and treatment of a variety of life-style related diseases. This “reference range” cannot be used for the diagnosis of diseases, estimation of future development of atherosclerotic cardiovascular diseases, and establishment of treatment targets. In contrast, the criteria for the diagnosis and treatment of dyslipidemia in the JAS guidelines are based upon the future risk estimation and prompt us to initiate life-style modification as well as diet, exercise and drug therapies. Thus, clinical judgment values as used in a variety of clinical guidelines are very important and should be used as the only standard in the clinical settings.
Diabetes mellitus is defined as a state of continuous hyperglycemia due to a lack of insulin action and develops various chronic complications if patients have not been received suitable treatment. Increasing numbers of the patients with diabetes mellitus have been a social problem. It is thus significant to make diagnosis as having diabetes in a positive manner at a chance of such as healthy checkup. This manuscript reviewed how to give a diagnosis for this disease according to the opinion of Japan Diabetes Society. Essential for making diagnosis of diabetes is to make sure that the patients have continuous hyperglycemia. Important laboratory tests for clinical diagnosis of diabetes are plasma glucose and HbA1c. If the results of plasma glucose (①, ② or ③) or HbA1c (④) implement the following 4 criteria, the patient is diagnosed as having “diabetic type” ① Fasting plasma glucose equal or more than 126 mg/dL ② Random plasma glucose equal or more than 200 mg/dL ③ 120 minute plasma glucose during 75g OGTT equal or more than 200 mg/dL ④ HbA1c (NGSP) equal or more than 6.5% Diagnosis of diabetes has be done if the patient has both “diabetic type” determined at the two different days except for two successive determination of HbA1c, or simultaneously measured plasma glucose and HbA1c are both “diabetic type”. Diagnosis of diabetes is also done if the patients with one “diabetic type” have typical clinical symptoms for hyperglycemia or reliable diabetic retinopathy.
Obesity is an important pathological basis of major risk factors for atherosclerosis including type 2 diabetes mellitus, dyslipidemia and hypertension. Obesity is also associated with a variety of health problems such as non-alcoholic fatty liver diseases, hyperuricemia or proteinuria. It is thus important how to diagnose obesity and how to determine therapeutic subjects among obese people. Although the number of severe obese subjects in Japan is smaller than those in Western counties, the prevalence of obesity-related diseases is comparable; it therefore appears to be reasonable to diagnose obesity with smaller BMI in Japan. Japan Society for the Study of Obesity (JASSO) defines 18.5 ≤ BMI < 25 as normal weight, 18.5 > BMI as underweight and 25 < BMI as obese on the basis of a number of epidemiological studies. Among obese subjects, JASSO defines subjects who need weight reduction from medical reason as “obesity disease”. Important point is that “obesity disease”includes not only subjects who currently possess obesity-related health problems but also subjects who will develop the health problems with high probability. It is widely accepted that visceral obesity is such high-risk obesity. To diagnose visceral obesity, JASSO recommends the evaluation of visceral fat area (VFA) by CT scan after the screening by waist circumference measurements. Japan Society of Ningen Dock (JSND) released a new reference interval for health checkup, which was determined by clinical and laboratory data of subjects who were free from certain diseases as well as from certain medical treatments. A large number of subjects with visceral obesity who needs weight reduction from medical reason fall in this newly-released reference interval for BMI (< 27.7). Health professionals who engage in health checkups should understand the difference of the scientific basis as well as the objective of the criteria of obesity by JASSO and the reference interval of JSND.
Serum AST, ALT, γ-GTP and PLT count have been used for the screening of liver injury in health evaluation and promotion in Japan. The judgment of normal, mildly abnormal, necessity of follow-up or necessity of therapy in liver condition have been done based on the serum levels of these blood chemistries. However, the ranges of upper limit of serum ALT is distributed from less than 25IU/L to 48IU/L among 78 affiliated university hospitals in Japan. Recently it was reported that healthy ranges for serum ALT levels were less than 30IU/L in men and less than 19IU/L in women from Italy. In proportion to the progression of liver fibrosis, serum AST/ALT is getting increased and PLT count is getting decreased. These results indicate that the judgment of normal, mildly abnormal, necessity of follow-up or necessity of therapy in liver injury should be done based on not only serum levels of AST and ALT but also AST/ALT and PLT count. It is necessary to reconsider the upper limits of serum AST, ALT and PLT count in Japanese population.