【Background】 It is well known that hyperinsulinemia is improved by physical activity, but the effective amount of walking remains unclear. 【Methods】 In the present study, we examined the walking time during fast walking（6km/h） required for insulin-sparing action using urinary C-peptide excretion as an index. Six healthy adult females participated in Study 1, and another 6 healthy adult females participated in Study 2. Four experiments consisted of control, walking at 6 km/h for 1 or 2 or 3 hours. Walking was divided equally between morning and afternoon. After urine samples were collected before walking（6:00 to 8:00），daytime（8:00 to 20:00）and nighttime（20:00 to 8:00 the next day） urine samples were collected in Study 1. On the other hand, daytime urine samples were collected separately（8:00 - 12:00, 12:00 - 16:00, 16:00 - 20:00）in Study 2. 【Results】 In both the Study 1 and Study 2, the urinary C-peptide excretion levels during the daytime were significantly lower in all the 1-hour, 2-hour and 3-hour walking experiments than in the control. In the Study 2 and when the results of the both studies were aggregated, the urinary C-peptide excretion levels during the daytime were tended to be lower in walking for 2 hours and significantly lower in walking for 3 hours than in walking for 1 hour. No significant differences were observed between walking for 2 hours and 3 hours. 【Conclusions】 Walking at 6 km/h for 1 hour/day or more is expected to reduce urinary C-peptide excretion and induce insulin-sparing effects.

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[in Japanese]

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Total parenteral nutrition　（TPN），which includes vitamins and trace elements, is used for the delivery of nutritional products to patients who require long-term intravenous nutritional management. Given that the metabolism of trace elements differs depending on the patient’s condition, concentrations of trace elements in the blood are checked and adjusted as needed. However, the only drug prescribed for supplementation of trace elements in Japan is a mixed drug; thus, adjustment of each trace element, except for selenium, is difficult. We observed an unexpected accumulation of manganese　（Mn） in patients receiving TPN in addition to a mixed trace element drug owing to low serum levels of trace elements. The daily dose of Mn in the TPN was 0.5 μmol, and the addition of the mixed trace element drug increased the daily dose of Mn to 1.5 μmol. However, the serum Mn concentrations of the patients increased to approximately nine times the upper reference limit within one month after the mixed trace element drug was added to the TPN. When the mixed trace element drug was changed to an Mn-free drug, the serum Mn concentrations of the patients decreased below the quantitation limit within 3 months. In this study, we report two cases of extremely high serum Mn concentrations due to the addition of a mixed trace element drug to long-term TPN therapy. Mn accumulation is known to cause cranial nerve disease; therefore, caution should be exercised when administering additional trace element drugs to patients undergoing long-term TPN.

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[in Japanese]

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