Objective Uric acid (UA) and high-density lipoprotein (HDL) subclasses are associated with inflammation, coronary heart disease, and metabolic syndrome (MetS). However, the relation between UA and HDL subclasses is not well understood.
Methods Subjects included 848 Japanese men not taking medication for hyperuricemia, hypertension, diabetes mellitus, dyslipidemia, or chronic renal disease; they underwent an annual health examination that included HDL subclass analyses.
Results When subjects were stratified by HDL2-C or HDL3-C levels, UA level decreased as HDL2-C level increased, while UA levels increased as HDL3-C levels increased. In a multiple linear regression analysis, age, waist circumference (WC), diastolic blood pressure (BP), logarithmic transformed triglyceride ln(TG) and HDL3 cholesterol (HDL3-C), were associated with UA level. In a multiple logistic regression analysis for upper tertile of UA (≥ 6.8 mg/dL), WC, diastolic BP, ln(TG), HDL2-C and HDL3-C were associated. Since this analysis indicated that MetS components were determinants of UA level along with HDL-C subclass, possible synergistic effects of HDL-C subclass and MetS components to determine UA level were assessed. A combination of the number of MetS components and stratification of HDL3-C affected UA levels; the mean UA level increased in subjects with increased MetS components and HDL3-C level.
Conclusion HDL-C subclasses were associated with UA level; particularly, a high HDL3-C level was associated with high UA level related to MetS in Japanese men.
Objective Obesity occurs when energy intake consistently exceeds energy expenditure. Nonexercise activity thermogenesis (NEAT) is an important component of daily energy expenditure. It represents common daily activities, such as fidgeting, walking, and standing. To investigate the relationship of nutrient intake and energy expenditure with obesity, we compared lifestyle habits in obese and non-obese Japanese adults by estimating their nutritional intake and energy expenditure values, focusing on the role of NEAT in obesity.
Methods Forty-nine men who underwent anti-aging health checks at Tokai University Tokyo Hospital were enrolled in the study. A food frequency questionnaire (FFQg) was used to estimate nutrient intake and energy expenditure values.
Results There was no significant difference in nutrient intake values, and total daily energy expenditure, resting energy expenditure and exercise energy expenditure between the non-obesity and obesity groups. Physical activities excluding exercise were subdivided into the following six categories: sleeping, resting, sedentary activity, light physical activity, moderate physical activity and vigorous physical activity. It was found that the number of hours of light physical activity and moderate physical activity, corresponding to NEAT, was significantly less in the obesity group than in the non-obesity group.
Conclusion The present study showed that obesity in Japanese men was associated with decreased NEAT rather than excessive energy intake and/or decreased physical exercise. Approaches to enhance NEAT, for example, changes in posture and movement, could have a substantial impact on the prevention and reduction of obesity.
Objective. The aim of this study was to assess the relationship between sarcopenic obesity (SO) and osteopenia among Japanese elderly women.
Design. Cross-sectional observational study.
Setting. Comprehensive-health checkup center.
Participants. A total of 126 women (mean age 72.5±5.4 years) who underwent comprehensive health checkups and examinations both of whole-body composition and bone mineral density using dual-energy X-ray absorptiometry were enrolled. Sarcopenia was defined as a height-adjusted skeletal muscle mass <5.4 kg/m2. Obesity was defined as a total-body fat percentage ≥30%. Osteopenia was defined as a percentage of young adult mean <80%.
Main outcome and measures. Multivariate logistic regression analyses were performed to identify the risk factors for osteopenia associated with SO.
Results. The prevalence of sarcopenia, obesity, and SO were 17%, 36%, and 16%, respectively. More than half of the participants were regarded as having osteopenia. The prevalence of osteopenia was higher in sarcopenia and SO subjects and lower in obese subjects than in standard phenotype. Subjects with osteopenia showed characteristics of sarcopenia, i.e. a lower body mass index, lower skeletal muscle mass, and lower fat mass. Multivariate logistic regression analyses revealed that SO subjects were significantly associated with the prevalence of osteopenia (odds ratio and 95% confidence interval: 4.26, 1.10–16.4) after adjustment for age and visceral fat area. The association remained marginal after additive adjustments for smoking, drinking, and physical activity (odds ratio and 95% confidence interval: 3.77, 0.92–15.4).
Conclusions. SO was significantly associated with the prevalence of osteopenia among Japanese elderly women.
The National Health and Nutrition Survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2016 revealed that 21.1% of men and 24.8% of women showed high low-density lipoprotein cholesterol (LDL-C) levels (≥ 140 mg/dL), which indicated a higher mean cholesterol level in women than in men. Higher LDL-C values in women than in men have been noted for a long time, and it is speculated that menopause is one of the factors that affect elevated LDL-C levels in women. Despite elevated LDL-C in women, it is well recognized that women are not prone to developing arteriosclerotic lesions. The Japan Atherosclerosis Society has published "Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017" and provided risk stratification charts according to the Suita score system, which was developed in the Suita study. These risk charts were provided based on the lipid level and classical cardiovascular risk factors, and cardiovascular events have been set as end points with detailed treatment goals in the guidelines. Unfortunately, gender differences have not been considered in treatment goals in the guidelines, even though women carry a lower risk of cardiovascular events than men. In this sense, it might be a better idea to determine the adaptation of high LDL-C treatment by statins after using carotid artery ultrasound to check for the presence of atherosclerotic lesions, carotid intima-media thickness (IMT), or plaques. It has been reported that efficient high LDL-C therapy with statins reduces plaque development more effectively in women than in men. In addition, it is important for health care professionals who provide instructions regarding diet and nutrition to understand that dietary nutrients that affect LDL-C level are not cholesterol derived from food, but mainly the intake of saturated fatty acids and trans-unsaturated fatty acids.
The mortality rate caused by coronary artery disease for Japanese has remained extremely low compared with other developed countries, and this may be explained, at least in part, by differences in dietary habits. The Japan Diet, which is also referred as "the traditional Japanese diet," has been shown to contribute to the prevention of coronary artery disease in several studies. The Japan Atherosclerosis Society revised the guidelines for treatment of dyslipidemia to prevent atherosclerotic cardiovascular diseases in 2013. In the section on diet therapy in the guidelines, three items on how to advance diet therapy were recommended as follows: (1) provide patients with an atmosphere for approaching the diet therapy with a positive attitude; (2) correct issues on diet case by case; and (3) support patients to continue diet therapy comfortably for a long time. Since diet therapy also requires scientific evidence, diet therapy according to the latest guidelines for patients with dyslipidemia should be considered.
Pulmonary embolism (PE) is a clinical entity with a high mortality rate and hence requires accurate, urgent diagnosis and emergency therapy. We report a case of successful treatment of PE in a patient with renal cell carcinoma (RCC) with tumor thrombosis of the renal vein and the inferior vena cava (IVC). PE was diagnosed using electrocardiography (ECG), echocardiography, D-dimer level elevation and contrast-enhanced computed tomography. First, ECG showed a new sinus tachycardia and T wave flattening in the inferior leads (II, III, aVf) in contrast to routine ECG performed previously at a medical health check-up. Second, echocardiography revealed a dilated right ventricle, tricuspid regurgitation, and elevation of systolic pulmonary artery pressure. We emergently inserted a temporary IVC filter at the proximal end of the tumor thrombus under serial echocardiographic evaluation, followed by thrombolytic therapy and anticoagulation therapy. After 3 days, we performed radical nephrectomy and thrombectomy of the IVC. After surgery, the temporary IVC filter was removed, and the anticoagulation therapy was continued. The patient remained symptom free 3 years after surgery. For the diagnosis of PE, it is important to compare the previous ECG obtained on routine medical health check-up and the ECG results at diagnosis. In conclusion, during a medical health check-up in clinical practice, despite its rare occurrence, a life-threatening PE should be ruled out in a patient with risk factors, symptoms, and ECG findings such as tachycardia and ST-T change in the inferior leads and patients with such findings should be urgently referred to a cardiovascular specialist.