Objective In order to encourage medical consultations, the characteristics of subjects requiring medical consultation due to hyperglycemia were investigated using health check records at Tokai University Hospital (Survey 1). Among the examinees who underwent annual health checkups for two consecutive years and required a medical consultation at the first visit, we investigated how many of those subjects were treated at the second visit (Survey 2).
Methods Survey 1: 13,474 subjects (7,554 men and 5,920 women) who underwent health checkups at Tokai University Hospital in fiscal 2015 were enrolled. Survey 2: Among 13,765 subjects who underwent health checkups in fiscal 2014, 10,780 (78.3%, 6,157 men and 4,623 women) who also visited the next year were enrolled. The numbers of diabetic and/or hyperglycemic subjects and their A1c levels were analyzed by sex and age.
Results Survey 1: The percentage of subjects receiving diabetes treatment was 7.1% in men and 3.3% in women. The percentage requiring medical consultation due to hyperglycemia was 1.9% in men and 0.9% in women. Although the overall average A1c was 7.3% in those requiring medical consultation due to hyperglycemia, A1c levels were higher in younger productive subjects than in elderly retired subjects. Survey 2: Among the subjects requiring medical consultation due to hyperglycemia in the first year, 51.5% of men and 58.3% of women were receiving diabetes treatment the next year. In particular, most of the younger subjects with higher A1c were found to be receiving treatment at the next visit.
Conclusion The key role of health checkups is early detection of disease, so it is particularly important for examinees to receive medical consultation immediately after the checkup. The subjects requiring medical consultation due to hyperglycemia were successfully encouraged to start diabetes treatment through explanation of the results by doctors on the day of the health checkup.
[Purpose] It is known that the loss of muscle mass as the characteristic of sarcopenia cannot be simply evaluated based on a decrease in the body mass index (BMI). This study was performed to determine whether a decrease in the percent vital capacity (%VC), which indicates a decrease in the respiratory muscle mass, can be used as a predictor of sarcopenia in non-obese non-smoking middle-aged females.
[Methods] The subjects consisted of 280 non-smoking females aged 40-44 years who underwent respiratory function tests in our institution between April 2012 and March 2017. The exclusion criteria were height <145 cm and forced expiratory volume in one second percentage <70. The subjects were classified according to the BMI quartile into groups Q1-Q4, and %VC was compared among the 4 groups. In addition, to obtain %VC estimated from BMI, the mean BMI and %VC in each of 8 BMI segments (S1-S8 in ascending order) were calculated.
[Results] The mean %VC was significantly lower in the low BMI groups (group Q1, 93.81 ± 12.19) than in the average BMI group (group Q2, 98.60 ± 10.14; group Q3, 100.37 ± 11.50) (Q3 vs. Q1: p = 0.0014; Q2 vs. Q1: p = 0.013), but did not differ between the high (group Q4, 98.53 ± 8.86) and average groups (Q3 vs. Q4: p = 0.29). Graphical representation of %VC estimated from BMI revealed an accelerated decrease in %VC with a reduction in BMI in the underweight females, but a gentle decrease in %VC with a reduction in BMI in the overweight females.
[Discussion] Since the forced expiratory volume reflects the muscle mass of the entire body, there is a possibility that a decrease in %VC reflects "a state of decreased muscle mass and strength" as the pre-sarcopenia stage. When a decrease in %VC is observed in non-obese middle-aged females, appropriate nutritional guidance and muscle strength training may be necessary.
[Conclusion] This study suggested that a decrease in %VC in non-obese non-smoking middle-aged females may be a predictor of sarcopenia.
The quality management survey by the Japan Society of Health Evaluation and Promotion currently has approximately 360 registered facilities. A majority of the data has been assessed without any issues. However, on blood analysis, differences in quality control samples (quality control blood cells) have severely deterred the equal assessment of manufacturers and devices. Consequently, it has become necessary to use different quality control blood cells for each manufacturer. To resolve this issue, in conformance with the 3rd survey in 2016 and 2017, we requested all registered facilities to conduct measurements on a pilot basis, using novel quality control blood cells to demonstrate both a normal range and an abnormal range. Greater than 97% of registered facilities participated in both pilot trials. Some items for some manufacturers demonstrated a matrix effect, believed to have resulted from the measurement modality. Excluding these data and data suspected to have been input incorrectly, the coefficient of variance in all surveys of eight blood-cell related items was <10%, indicating that the data are accurate.
Specific health guidance' is a national policy in Japan aimed at preventing the occurrence of lifestyle diseases for people from 40–74 years old with visceral fat obesity. It consists of health guidance counseling and encouraging behavioral changes beneficial to health, such as appropriate diet and moderate exercise.
Locomotive Syndrome, or ‘Locomo', was proposed by the Japan Orthopedic Association when Japan statistically became a ‘super-aged' society. The term refers to restrictions in walking ability because of a dysfunction of locomotive organs. As the condition become worse, nursing care becomes necessary since people with no exercise habits, tend to suffer muscle weakness in the legs.
The Locomo risk test, consisting of two functional examinations, a stand-up test and a two-step test, enables people to know their own ability to move and need for training. LOCOTRA is locomotion training, including one-leg stands with eyes open to improve balance ability, and squats to strengthen the muscles. These exercises can be done safely and easily, even by elderly people.
Within the target population for the specific health guidance, 73 volunteers, who were not used to doing exercises, were registered. This study introduced Locomo risk testing and LOCOTRA under the health guidance program, and investigated whether participants could continue LOCOTRA, using a questionnaire after three and six months.
Results show that the older participants are, the more interest in LOCOTRA they have, and more than two thirds of participants over 50 years old could continue LOCOTRA. However, for those in their 40s, only a third could continue LOCOTRA. Some participants in their 70s had physical problems and did not continue the exercise.
In conclusion, the specific health guidance including the Locomo risk test and LOCOTRA could enable people with no exercise habits opportunities for regular exercise. Furthermore, these people should be encouraged to continue exercise through individual advice.
Cardiovascular diseases are the number causes of death for subjects aged 75 years old or more in Japan. To tackle this problem in advance, attention should be paid to subjects of young and middle working age. We conducted a prospective cohort study with a median follow-up of 8 years of a total of 30,636 healthy males aged 20–61 years who were not on medication. The adjusted hazard ratios (HR; 95% confidence interval) for total cardiovascular events (CVD) were 2.63 (1.32, 4.72), and those for death were 4.88 (2.95, 7.96) for subjects with metabolic syndrome. CVD events increased from an systolic blood pressure level of 120–129 mmHg (adjusted HR, 2.02; 1.15, 3.57) to 140–149 mmHg (7.91; 4.28–14.6), when BP 109/74 mmHg or less as references. CVD events increased as DBP increased. A DBP level of 90–94 mmHg was statistically significant (adjusted HR 10.1; 5.14, 19.2). The adjusted hazard ratios for CVD were 3.19 (1.66, 6.41) for heavy smokers (≥21/day) compared to never-smokers. heavy smokers (≥21/day) compared to never-smokers. Cumulative incidence of hypertension was significantly higher in subjects with proteinuria ≥+ and subjects with serum uric acid levels ≥7.0 mg/dL. In Japan, annual medical checkups are mandatory under the Industrial Safety and Health Law, and therefore we healthcare can provide young- and middle-aged workers with good opportunities to aware their health problems. To prevention for future cardiovascular disease, we should make good use of the results of medical checkup.
The leading cause of mortality in Japan is cancer. However, when cardiovascular disease, the second leading cause of mortality, and cerebrovascular disease, the fourth most common cause, are combined as vascular disease, they account for almost as many deaths as cancer. Thus, preventions of cancer and vascular disease are extremely important health-care priorities in Japan. Cerebrovascular disease and cerebral hemorrhage in particular became overwhelmingly widespread in Japan in the 1960s. Guidance for improving lifestyle habits, such as sodium intake restriction, was successful in markedly reducing blood pressure and mortality rates, a proud time in history for preventive medicine. However, in recent years, despite decreases in the main coronary risk factors, hypertension incidence and smoking rates, the mortality rate for heart disease continues to rise. Furthermore, the mortality rate for cerebral infarction has not decreased and in fact has surpassed that of cerebral hemorrhage to exhibit a Western disease pattern.
The Hisayama study in Japan, an ongoing epidemiological research, also suggests that obesity, diabetes, and dyslipidemia now contribute more to cerebrovascular disease risk compared to past two decades. Accordingly, it is well recognized that in addition to blood pressure, the management of obesity, diabetes, and dyslipidemia, as well as chronic kidney disease (CKD), is pivotal for the prevention of cerebro- and cardiovascular diseases in Japan. Thus, methods of treatment and treatment guidelines are frequently updated for these diseases and physician specialists are well informed about them. However, some inconsistencies in the expressions used in these guidelines have been reported by general physicians.
There has been a growing momentum for mainly academic societies to engage in scientific research on such risk factors to develop comprehensive cerebro- and cardiovascular disease management guidelines. Therefore, 11 societies including the Japanese Society for Internal Medicine agreed to participate in creating a "Comprehensive Risk Management for the Prevention of Cerebro- and Cardiovascular Diseases in Japan." The Japan Medical Association and the Japanese Association of Medical Sciences, which approved cooperative work, also participated in this project, thereby enabling the creation of this practical management chart for general practitioners. Although the basic aim was to improve risk factors (obesity, blood pressure, blood glucose, serum lipids, kidney function, etc.) by comprehensive management of lifestyle habits as the basic concept is indicated in Figure 1, the importance of comprehensive management, including drug intervention, is emphasized in the case of multiple risk factors involved in each disease. Physicians must also keep in mind that in cases with genetic factors or in secondary disease groups, specific pharmacotherapy for the underlying disease is necessary.
It is most anticipated that this management chart will be utilized in medical settings throughout Japan and that comprehensive management of the diverse range of risk factors observed in individual patients will improve the prevention of cerebro- and cardiovascular diseases, thereby leading to a healthier society.
Japan has one of the highest overall life expectancies and thus physicians must recognize that cerebro- and cardiovascular diseases are more likely to occur in elderly patients. Of course, management must also take into account functional declines specific to the elderly (decreased renal function and muscle weakness in particular), but careful management should also be implemented due to the greater risks of cerebro- and cardiovascular diseases in elderly individuals. We would like to introduce the comprehensive risk management chart for prevention of cerebro- and cardiovascular diseases.
The survey conducted by "Japan Society of Health Evaluation and Promotion" revealed that the re-examination rates for lipid values after the health checkup differed greatly among the health checkup facilities; the rates distributed from less than 5% to more than 65%. One of the reasons for this great difference among facilities would be that the re-examination threshold values for lipid parameters adopted by each facility are not uniform. Thus, it is necessary to standardize the re-examination threshold values for lipid parameters.
The factor which contributes to the difference in the re-examination rates would be the difference in the re-examination threshold values for triglycerides (TG) and LDL cholesterol (LDL-C). The TG levels in Japanese male are increasing year by year, and the threshold value of TG re-examination should affect the re-examination rates greatly. Regarding LDL-C threshold value, the adoption of uniform value might lead to over-screening as well as under-screening of the subject; the threshold value should be settled individually depending on the absolute cardiovascular risk factors.
In this article, after evaluating the threshold value for TG re-examination, utilization of "Suita Score", which was adopted in "Japanese Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Disease 2017", was proposed for the determination of LDL-C re-examination threshold. Further simulation following to the present proposal using the health check database hopefully would lead to better configuration of threshold values.