About a year has passed since the criteria for defining and diagnosing of metabolic syndrome (MetS) in the Japanese were establishedl. There are several differences between these criteria and other commonly used definitions of MetS, such as those of the World Health Organization (WHO) and the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATPIII). In some ways this is not surprising because the criteria might be expected to differ for different ethnic populations. On the other hand, it is important to understand why we should identify subjects with MetS. In this paper, we would like to discuss how and why it is necessary to diagnose MetS.

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Background and Methods Changes in serum total cholesterol levels associated with aging in young adults were compared with those in the elderly. Changes in serum total cholesterol levels in 117 patients aged less than 35 years old and 38 patients at least 55 years old who underwent physical examinations in 1992 were compared over 10 years until 2002.
Results Serum total cholesterol in the group of young adults with normal cholesterol levels of 220 mg/dl or less in 1992 rose significantly, while it remained high in the group with high cholesterol levels of 221 mg/dl or more. However, serum total cholesterol levels did not change in the elderly group with normal cholesterol levels, while the levels in the high cholesterol group tended to decrease.
Conclusion These results suggest that young adults with high serum total cholesterol are exposed to a condition of continued hypercholesterolemia over the long term, indicating that active health education is important from an early age.

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Aim To investigate the correctness of electrocardiogram (ECG)-gated angiography in the detection of bleb in unruptured aneurysm.
Methods In the year of 2004,15 unruptured aneurysm patients received ECG-gated angiography examination. Ten of them had bleb and the bleb was detected as the pulsation site in ECG-gated angiogram. Surgically excised specimen were stained and histological investigation revealed that there were partial or complete absence of tunica media smooth muscle and the internal elastic lamina layer in the aneurysm wall in all 15 cases. A sudden reduction of collagen layer was noted in 10 cases with bleb.
Conclusion ECG-gated angiography can be used in the bleb detection of unruptured aneurysms, its correctness can be verified by histological examination.

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Background The 2004 Japanese Society of Hypertension guideline for the management of hypertension calls for lifestyle modifications as the initial therapy. If the blood pressure (BP) goal is not achieved by lifestyle modification, pharmacological treatment should be used as a second therapy. Although optimizing dosages or adding additional drugs is recommended until the BP goal is achieved, lifestyles that should be modified during the further drug therapy are not described. This study was conducted to determine the risk factors relating to uncontrolled hypertension in pharmacological therapy before optimizing dosages or adding additional drugs.
Methods This cross-sectional study was of 1064 treated hypertensive subjects (785 men and 279 women, mean age,59.1 years) visiting the Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital. Logistic regression was used to assess the odds ratio (OR) between having controlled office BP and clinical characteristics. Obesity and 8 lifestyles were put into a multivariate logistic regression model to obtain adjusted ORs and 95% confidence intervals.
Results Five hundred ninety-one (55.5%) of subjects did not reach their target BP level. Multivariate analysis indicated that inadequate BP control was associated with obesity, irregular meal times, and drinking of alcohol every day. OR of obesity was significantly increased according to the cutoff value of body mass index (BMI) of 23 kg/m². However, OR of irregular meal times and drinking alcohol everyday were not changed by BMI.
Conclusion Dosages should be optimized or additional antihypertensive drugs added after lifestyle modifications such as weight reduction, alcohol intake reduction, and scheduling regular mealtimes for subjects with inadequate BP control.

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Background Leptin, a product of the obese (ob) gene, is released from adipocytes. Plasma leptin is correlated with both obesity and plasma insulin (immunoreactive insulin, IRI), and at the same body mass index (BMI) there is considerable variation in plasma leptin concentrations. However, it is not clear whether plasma leptin is correlated with plasma insulin at the same BMI. This study was designed to determine the relationship between plasma leptin and insulin resistance after adjustment for BMI.
Methods A cross-sectional study was carried out using 423 healthy overweight people aged 40-65 years (342 men and 81 women, BMI≥22 kg/m2). Subjects were divided into three groups by plasma leptin concentrations (<25 percentile,25-<75 percentile, ≥75 percentile) after adjusting for BMI. Weight, height, leptin, IRI, and blood pressure were studied after an overnight fast. Insulin sensitivity was modeled according to a homeostasis model assessment of insulin resistance (HOMA-IR). Analysis of variance (ANOVA) with Dunnett's t-test were used to compare results between groups.
Results Eighty men and 18 women belonged to the low group (<25 percentile),173 men and 40 women to the middle group (25-<75 percentile), and 89 men and 23 women to the high group (≥75 percentile). The results were evaluated using one-way ANOVA and Dunnett's t-test (vs. the middle group). HOMAIR, fasting IRI, and systolic and diastolic blood pressure were higher only among men, in the high group compared to those in the middle group.
Conclusion A relatively high plasma leptin concentration after adjustment for BMI might indicate insulin resistance in men.

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Background The concept of stages of change is widely used in smoking cessation interventions. We aimed to elucidate the relationship between stages of change and advice to quit smoking from family and medical physicians.
Methods A cross-sectional study of 3803 smokers visiting the Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Tokyo, Japan was conducted between November 2000 and January 2005.
Result Multivariate logistic regression analysis revealed that male smokers who were strongly recommended to quit from either a family member or a physician and female smokers who were strongly recommended by a family member only had a significantly higher probability to be in the preparation stage than those who were not recommended by a family member and a physician.
Conclusion Medical physicians in health examination centers should make recommendations not only to smokers but also to their spouses.

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Background The relationships between diastolic blood pressure (DBP) and biosocial factors including sleep status have not been extensively studied.
Methods One hundred and one Japanese subjects (male: female=73: 28, aged 30 to 59, mean age 50.9years) with more than 90 mmHg DBP levels, regardless of systolic blood pressure (SBP) levels, were recruited. We cross-sectionally investigated the influence of biosocial correlates, such as age, body mass index (BMI), smoking, alcohol use, preference for salty taste, exercise and self-reported sleep status, on DBP levels.
Results Univariate and multiple regression analysis, adjusted for biosocial correlates, revealed that BMI and lack of sleep were significantly correlated with DBP levels, respectively.
Conclusion Our results suggest that sleep status had significant effects on DBP levels, showing that we should note the necessity of a consideration of sleep status, in addition to BMI, in the setting of human dry dock, for subjects with more than 90 mmHg of DBP levels.

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Objective This study was aimed to clarify differences in the medical examination data of ex-smokers in reference to those of smokers and non-smokers.
Methods From 19410 males who underwent medical check-ups at Kasugai City Medical Care Center between April 1994 and March 2002, an ex-smoker group (93 subjects), a smoker group (135 subjects) and a non-smoker group (120 subjects) were defined. The following data were recorded for people in each of the three groups in four consecutive annual examinations body weight, body mass index, body fat percentage, blood pressure, total cholesterol, HDL cholesterol and triglyceride concentration. Changes in these measurements over time were calculated for each group and their differences were compared.
Results The body weight, body mass index, body fat percentage, blood pressure, total cholesterol and HDL cholesterol remained roughly the same or increased slightly for the smoker and non-smoker groups. No remarkable differences were observed in any data categories for the ex-smoker group between the year prior to smoking cessation and the year after cessation. However, significant increases were measured after 1 year in the following 1.3 kg in body weight,0.5 kg/m2 in body mass index,0.7% in body fat percentage,1.7 mmHg in both systolic and diastolic blood pressure,8.6 mg/dl in total cholesterol and 2.9 mg/dl in HDL cholesterol. Increased blood pressure and total cholesterol were correlated strongly with increased body fat.
Conclusion It appears necessary for medical practitioners to advise clients to quit smoking and provide guidance regarding the importance of minimizing gains in body weight and body fat which lead to hypertension or hyperlipidemia after quitting smoking.

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