Objective: We reevaluate the waist circumference in the diagnostic criteria of metabolic syndrome in Japanese. Methods: We enrolled 3,332 subjects (1,921 men and 1,411 women)who consulted annual health check-up and Ningen dock in our center. The criteria were reevaluated by the receiver-operating characteristics (ROC) curve according to the accumulation of any two of the following three abnormalities: blood pressure, lipid level, and blood glucose level. In order to draw ROC curve, we hypothesized 10 different points of waist circumference from 72cm to 95cm, and calculated both sensitivity and specificity. We determined the most ideal waist circumference from the cut-off point of the ROC curve. We also drew ROC curves according to atherosclerotic findings based on eye fundus photograph, electrocardiogram, brain magnetic resonance image and magnetic resonance angiography, and echogram of the common carotid artery. Based on the newly detected waist circumference, we compared the pseudo-negative ratio of the atherosclerotic findings in the participants who were diagnosed as metabolic syndrome by the present criteria. Results: The ideal waist circumference was hypothesized as 85cm in men and 80cm in women. This new proposed waist circumference decreased the pseudo-negative ratio of metabolic syndrome in women. Conclusion: By using a new waist circumference proposed in this study, the diagnostic probability of metabolic syndrome in Japanese women is improved.

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Objective: To make-up effective program for colon cancer screening at young adult(aged under 40 years old), we researched two groups: occult blood(-)+Sigmoidoscopy(SCS) and occult blood(+) + Total colonoscopy(TCS). Among them we investigated what kind of sickness ware found. Metods: Between June 2004 and May 2006,8911 persons aged under 40 years old were done 2 times of occult blood test.210(who were negative at occult blood)were performed SCS.648 persons were positive at occult blood. Among them,94persons were done TCS. Results: There were no person who had cancer in SCS goroup. Only 9 persons had adenoma. But tumor size was only under 5mm except one person. But in TCS group, three persons had colon cancer and 12 persons had adenoma. of course these persons had no sympton. in addition,6 persons have ulcerlative colitis. Conclusion: We conclud that, first of all, we shuld check occult blood. If occult blood is negative, SCS is not ncesarry. but occult blood is positive, shuld take TCS for young adulut person such as under 40 years old.

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Objective: With an increase in the number of patients with diabetes mellitus, the number of people undergoing ningen dock is expected to rise. We evaluated the necessity of disorder screening in the presence of impaired glucose tolerance in ningen dock examinees by clarifying the tendency of complications other than those of diabetes mellitus detected by medical check in the diabetes clinic. Methods: The subjects were 659 patients with type 2 diabetes mellitus who visited the diabetes clinic due to hyperglycemia as the chief complaint between January and December 2006. General physical and screening examinations were performed, and the tendency of complications other than the 3 major complications of diabetes mellitus was evaluated. Results: There were 22 subjects (3.4%)with cancer, which was detected at the initial examination in 59.1% of them. The other disorders detected were amyotrophic lateral sclerosis, Parkinson's disease, spinocerebellar degeneration, mucin-producing cystic pancreatic tumor, chronic rheumatoid arthritis, pulmonary tuberculosis (2 patients), nephritis, pituitary meningioma, internal carotid artery stenosis indicated for bypass operation, asbestos-related pleural thickening, myoma indicated for surgery, and renal failure (3 patients). Conclusions: Due to the qualitative change of the population, i. e., a marked increase in patients with impaired glucose tolerance, screening in ningen dock and health check-up examinations require clinicians to pay attention to not only the 3 major complications of diabetes mellitus, but also malignant tumors, infections, and other systemic diseases. In addition, in the presence of diabetes mellitus as an underlying disease, we, as diabetes specialists, should recommend patients to actively undergo ningen dock and health check-up examinations in addition to routine treatment for the early detection of systemic complications.

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Objective: The inflammatory process is considered to be partly involved in the pathogenesis of type 2 diabetes. An increased level of high-sensitivity CRP (hs CRP) was investigated regarding whether this has any relation with abnormal glucose and insulin metabolism. Methods: 4354 subjects, who showed minimal variation in hs CRP from Jan.2002 through July 2005, were recruited and divided into three groups based on the hs CRP concentration: lower (<1. Omg/L), middle (1.0-1.99mg/L), and higher (>2.0mg/L) groups. Fasting blood glucose, insulin, and HbA1C were measured and HOMA-R was calculated. Results: In the higher hs CRP group, insulin, HOMA-R, glucose, and HbA1C were elevated. Adjusting BMI in the three groups, insulin, HOMA-R, glucose, and HbA1C were also elevated in the middle and higher groups compared to the lower group. Conclusion: Increased hsCRP levels are more effective to predict the development of future abnormal glucose metabolism than BMI.

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Objective: While excessive drinking promotes atherosclerosis, alcohol intake of an appropriate amount is known to reduce overall mortality and mortality due to cardiovascular diseases. In this study, the effects of habitual drinking on various risk factors of atherosclerosis were evaluated in males undergoing human dock health screening. Methods: The subjects were 996 males who underwent human dock health screening at our hospital. They were divided into 4 groups according to the level of alcohol consumption: None,26g/day or less,26-52g/day, and more than 52g/day. No significant difference was noted in age or body mass index(BMI) among the 4 groups. Tests associated with lifestyle-related diseases were performed, and insulin sensitivity and secretion ability were evaluated by calculating the HOMA-%S and HOMA-%β, respectively. High sensitivity C-reactive protein (CRP), which is an index of atherosclerosis, was also determined. Results: Drinking 26g/day or less significantly increased the blood pressure and serum HDL-cholesterol levels but significantly decreased serum LDL-cholesterol and high-sensitivity CRP levels compared with non-drinker. Drinking 26g/day or less did not significantlyaffect serum triglyceride, uric acid or fasting plasma glucose levels. Drinking more than 26g/day further increased blood pressure and also increased serum triglyceride, uric acid, and fasting plasma glucose levels. It also significantly increased high-sensitivity CRP levels compared with drinking 26g/day or less. While drinking increased insulin sensitivity, drinking more than 26g/day significantly reduced insulin secretion. Conclusions: Drinking 26g/day or less was suggested to have a suppressive effect on atherosclerosis. However, drinking more than 26g/day is considered to promote atherosclerosis by exerting adverse effects on multiple factors related to atherosclerosis.

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Objective: It is unclear which factors related to lifestyle are attributable to visceral and subcutaneous fat. In this study, we comprehensively assessed the individual health profiles including dietary habits, personal characters and behavior, and we investigated the relationship between these factors and visceral/subcutaneous fat area. Subjects and Methods: We measured visceral and subcutaneous fat areas by CT scan, and assessed 120parameters including those examined in a medical check-up, plasma adiponectin, dietary habits, and a lifestyle questionnaire in 281 men aged 30-79. The subjects whose visceral or subcutaneous fat area was beyond the range of mean± SD were selected for comparisons between the groups with higher and lower visceral/subcutaneous fat area. Results: Several lifestyle related factors are significantly different between the two groups with different visceral and/or subcutaneous fat area. Visceral obesity was associated with a consciousness of stress and disordered food habits such as eating late at night and urge for satiety. Subcutaneous obesity was associated with daily physical inactivity and unbalanced energy intake. The predisposition to both visceral /subcutaneous fat was associated with a westernized lifestyle such as preferences for foods rich in fat and strong tastes. The plasma adiponectin was more strongly associated with visceral fat than subcutaneous fat. The body weight, body mass index, body fat ratio and waist circumference were more strongly associated with subcutaneous fat area than visceral fat area. Conclusion: These results suggest that lifestyle related factors should be fully considered to effectively control different types of “obesity”.

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Clinical significance of plasma homocysteine levels in Japanese patients and its importance in ningen dock were studied. The subjects consisted of 80 Japanese patients who were suspected of having metabolic syndrome. Plasma homocysteine levels were measured by the established kit using an enzymatic assay. The plasma homocysteine level was 11.9±2.9 u mon, and 14 (18%) out of 80 patients were found to have a high plasma homocysteine concentration over 14.0 μmol/L. Significant differences were not observed among patients with high plasma homocysteine levels compared to those with a normal range in terms of age, gender, and atherosclerotic risk factors such as diabetes mellitus, hypertension, high levels of LDL-cholesterol, low levels of HDL-cholesterol, and high levels of triglycerides. However, atherosclerotic changes of multiple lacunar infarctions and/or asymptomatic cerebral infarctions were detected in 13 patients (93%) with high plasma homocysteine levels by brain MRI. This frequency was significantly (p<0.005) higher than that in patients with a normal range of plasma homocysteine(39%). In addition, serum lipoprotein (a) levels were also associated with atherosclerotic changes by brain MRI. The predictive value of these atherosclerotic changes in plasma homocysteine levels was similar to that in serum lipoprotein (a) levels. The above findings indicate that plasma homocysteine levels can be a new marker of atherosclerotic changes in Japanese patients, and should thus be measured in ningen dock.

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Objective: We assessed the relations of uric acid and urinary pH to metabolic syndrome (MetS) and its defining factors in a health screening population. Subjects and Methods: A total of 225,826 participants (168,042 men and 57,784 women) undergoing annual medical check-ups over 21 years from 1985 to 2005 at Toranomon Health Management Center were investigated to determine the relation ship of uric acid or urinary pH to MetS. MetS was defined according to the Japanese criteria, excluding waist circumference as the parameter of abdominal obesity; we had no data on waist circumference, so the BMI was used instead in this study. Results: Over the 21 years, elevation of the uric acid level occurred and the urinary pH decreased annually, while the prevalence of MetS increased annually. Urinary pH and uric acid were both related to most of the factors defining MetS, such as hypertension, fasting plasma glucose, BMI, hypertriglyceridemia, and a low HDL-cholesterol level, and were also related significantly to disease prevalence. During the follow-up of subjects with a normal BMI at the first medical check-up, the prevalence of MetS was significantly higher in the group with a uric acid level over 7.1 mg/dl or aciduria (urinary pH< 5.5). Conclusion: The results suggest that both uric acid and urinary pH are significant predictors of metabolic syndrome.

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Objective: In the mammary gland dock in our hospital, breast cancer screening is perfomed by mammography in combination with inspection/palpation. The positive rate and results of this screening were evaluated. Methods: The subjects were 4,525 females who underwent our mammary gland dock between January 2001 and December 2005. The screening was considered to be positive when abnormalities were detected by mammography and inspection/palpation. Mammograms were evaluated by 2 physicians. In all subjects with previously obtained films, the present films were compared with the previous ones. Subjects who were positive for the screening underwent close examination by techniques such as ultrasonography. Results: Of the 4,525 examinees,187 were positive (4.13%). Close examination showed abnormal findings in 3.07% and malignant tumors such as breast cancer in 0.29%. Conclusion: Our method of breast cancer screening including mammography showed relatively good results in terms of the positive rate and breast cancer detection rates.

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Objective: To reduce the risks of lifestyle related diseases, further stability of the improved lifestyle is necessary. Therefore, a scheduled health promotion program “Try 13 weeks” has been performed to help for improving inadequate life style. And the follow-up study was planned to the participants who were completed this program. Methods: Three hundred and towenty two program participants (160 men,162 women) from June 2002 to March 2006 were checked their laboratory examinations and the success rate of changing life style. For detailed analysis, follow up results were obtained by the repeated laboratory examination of the 42 participants (22 men,20 women) who were agreed and cooperated this program. The stability of lifestyle modification was analysed additionally about 70 participants comprised respondents of the questionnaires survey between 1 to 3 years later. Result: After 13-week program, significant improvements were obtained in 88% (187/214)of the participants with obesity,70% of those with hyperlipidemia and in 80% of those with impaired fasting glucose respectively. Detailed follow-up analysis and additional questionnaire survey revealed sufficient results, such as reduced calories intake in 92% and daily exercise habit in 78%. Furthermore, stabie lifestyle modification including lowered body weight and improvement of HDL-C have been maintained for 1 to 3 years after completion of the program. Conclusions: Individual continuous intervention throughout the program is necessary for the participants to notice that their daily life style directly links to the disease risk and that the risk could be modified by their own effort. However, further accumulation of program experience would certainly be necessary.

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Objective: Among patients who were positive for fecal occult blood test, we investigated the results of examination and lifestyle related factors in those who underwent colonoscopy to utilize our data in health guidance. Methods: We extracted the results of colonoscopy (CF)/histological diagnosis and the treatment course from medical records. We also extracted the body mass index (BMI), blood sugar/lipid levels, and liver function test/gastroscopy findings from reports on the results of a health check-up. We investigated the medical history including surgery, state of excretion, diet, and preference using a questionnaire. We examined the correlation of these factors with the results of CF. Results: CF revealed abnormal findings in 70.5% of 156 subjects; 21.8%,10.1%, and 41.8% of them had hemorrhoids, diverticula, and benignpolyps, respectively. With respect to age, the incidences of benign polyps in patients aged 60 to 69 years, those aged 50 to 59 years, and those aged 40 to 49 years were 40.5%,28.6%, and 26.5%, respectively. Malignant polyps were detected in 6.4% of the patients with abnormal CF findings. The incidence was higher in males. Fifty percent of the patients with abnormal CF findings were under follow-up or treatment. Furthermore,46.3%,27.3%, and 5.5% of them underwent a follow-up examination after 1 year, polypectomy, and surgery, respectively. We examined the correlation between abnormal CF findings and abnormal biochemical data. The odds ratios for total cholesterol and triglyceride were 1.48 and 1.47, respectively. However, in patients with hyperglycemia, the odds ratio was 3.25 (p<0.05). Conclusion: In this survey, there was an association between abnormal CF findings and hyperglycemia. In addition, lifestyle related factors such as diet, alcohol, and smoking were also involved.

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Objective: Not only most travelers are interested in vaccinations as international travel but also many reports are available in Western countries on the travelers vaccines particularly in hepatitis A and hepatitis B, however little information about them in Japan in spite of presence of 17 million overseas travelers. In this study, we analyzed the immunity to hepatitis A virus and hepatitis B virus in Japanese travelers at a travel clinic and evaluate to the necessity of vaccines against them for travelers who are going to endemic areas. Methods: A retrospective observational study included 428 Japanese travelers who visited our institutions for pre-travel health check-up during the period October 2005 through March 2006 and were tested for hepatitis A antibody (HAAb) and hepatitis B surface antibody (HBsAb). Results: History of vaccination against HA and HB was obtained. Of the 293 subjects who had not received HA vaccination,10.2% were positive for HAAb; 80% of these were more than 60 years of age, and 25% were less than 50 years of age. Of the 308 subjects who had not received HB vaccination,6.2% were positive for HBsAb. Conclusion: These results have aided our pre-travel advice for Japanese travelers planning to visit areas endemic for the HA and HB viruses. Elderly individuals may elect to have an HAAb titer check before receiving the HA vaccine.

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Objective: As gastroesophageal reflux disease (GERD) is a lifestyle-associated disease that can significantly impair a patient's quality of life (QOL), it has become more important for physicians conducting health checks to deal with this condition. In this report, we will present a trial in which we screened for GERD using the frequency scale for the symptoms of GERD (FSSG) questionnaire, and then collaborated with the treating physicians in the provision of lifestyle modification advice and medication. Methods: The subjects were 1405patients who attended this institution for health checks in January and February 2006. An FSSG score of 8 points or more was considered likely GERD, and dietary advice was given at the time of the health check. Patients with persistent discomfort, as evidenced by follow-up FSSG questionnaire 2-3 weeks later, underwent esophago-gastro-duodenoscopy, and were prescribed oral medication. Subjects prescribed proton pump inhibitors (PPIs)were reassessed 2 weeks later using the FSSG questionnaire. Endoscopic findings, barium meal findings, and diet were examined as possible factors influencing the FSSG results. Results: A total of 273 subjects (19%) were assessed as likely GERD. Of these,36 (2.6%)attended medical institutions for further investigation and treatment, and15 (1.1%)commenced oral medication. Of the 7 prescribed PPIs, the FSSG score after 2 weeks'treatment decreased in all subjects (mean16>7points). FSSG scores correlated with endoscopic findings and diet. Conclusions: The FSSG questionnaire was useful in facilitating collaboration between health check and treating teams, from screening for GERD through to treatment.

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Objective: The aim of this study was if the classification of chronic gastritis without local lesion would lead to improvement of gastric cancer diagnosis in upper gastrointestinal (GI)series. Methods: This study included 6,583 cases with advanced endoscopic diagnosis after upper GI series. The patients were divided into 2 groups: patients who had endoscopic diagnosis with gastric cancer after the radiographic findings of local lesion, and patients who had endoscopic diagnosis with gastric cancer after the radiographic classification of chronic gastritis. Then, we analyzed the diagnostic sensitivity, respectively. Results: A total of 44 patients were endoscopically diagnosed with gastric cancer after the radiographic findings of local lesion. The sensitivity was 0.74%. Eleven patients were diagnosed with gastric cancer in the advanced endoscopy after the radiographic classification of chronic gastritis. The sensitivity was 1.63%. Conclusion: We concluded that the classification of chronic gastritis leads to diagnostic improvement of gastric cancer in upper GI series.

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