Objective: Accumulation of visceral fat plays a key role in the development of metabolic syndrome (MS) which is a serious health problem worldwide. Although computed tomography (CT) is considered to be the gold standard for the diagnosis of MS, its application to screening for MS is problematic.
Methods: We evaluated the usefulness of visceral fat area (VFA) estimated by bioelectrical impedance analysis (BIA) by studying its relationships with clinical parameters related to metabolic syndrome.
Results: Serum triglyceride levels, GOT, GPT and γ-GTP were significantly higher in subjects with VFA≧100cm² than those with VFA<100cm². Blood pressure, blood tests and many other parameters were correlated with percentage of body fat (%BF) and VFA. The relationship between %BF and VFA was not linear with the increase in VFA being much greater in those with %BF≧20 than in those with %BF<20. VFA measurement by BIA was therefore considered to be advantageous in that it closely reflected clinical parameters and allowed visceral fat accumulation to be more accurately estimated than by %BF. When subjects were categorized into four groups according to their VFA, a dose-response relationship was evident between the above parameters and VFA.
Conclusion: VFA measurement by BIA could be a good alternative to CT in screening for MS

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Objective: We examined the utility of lipoprotein profiling by gel permeation HPLC in screening for metabolic syndrome (MS) and lifestyle diseases in medical examinations.
Subjects and Methods: Our subjects were 100 males (aged 53±7) who underwent health check-ups at Shizuoka Medical Center. Cholesterol levels in lipoprotein subclasses were measured on an analytical service provider’s HPLC system (^®LipoSEARCH) at Skylight Biotech Inc. (Akita, Japan). We examined the usefulness of the lipoprotein index for distinguishing the MS group through correlation analysis between HPLC lipoprotein profiles and 80 health evaluation items, ROC analysis and 2×2 contingency tables.
Results: Obesity, high blood pressure, glucose intolerance, liver dysfunction and inflammation were significantly positively correlated with large and medium VLDL-C, very small LDL-C, very small HDL-C, and significantly negatively correlated with large HDL-C. On the other hand, adiponectin was inversely correlated with these lipoprotein subclasses. In discriminating the moderate MS group with 2 or more risk factors from no MS risk group, the HPLC index very small LDL-C/large HDL-C ratio (cut-off value 2.7, average + 1SD of no MS risk group) was superior to the conventional index LDL-C/HDL-C ratio (cut off value 2.5), odds ratio (5.71 vs 3.66 ) and had greater sensitivity (0.57 vs 0.46). In case of the MS group with 3 or more risk factors (the active support group), the HPLC index was superior to the conventional index in sensitivity (0.75 vs 0.64).
Conclusion: We found HPLC lipoprotein profiling to be very useful in making the assessment of “mibyou”, (illness-free clinical state) as well as in health check-ups focused on MS. This was because of the specific and characteristic correlations observed between HPLC profiles and lifestyle factors such as drinking, smoking and eating habits, as well as MS risk markers.

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Objective: Normal tension glaucoma(NTG) is more prevalent in Japan than in other countries. It has been reported that glaucoma affects 5.78% of Japanese people over the age of 40 years and NTG comprises two-thirds of Japanese glaucoma cases. Glaucoma is the main cause of blindness in Japan because patients with NTG are usually asymptomatic in the early stage. As fundus photography performed during general health check-up seems to be inadequate for detecting NTG, our objective was to evaluate the usefulness of frequency doubling technology (FDT) perimetry in screening for NTG.
Methods: Two hundred thirty-eight employees (88 males, 150 females) of our hospital underwent FDT perimetry, fundus photography with a non-mydriatic camera and non-contact tonometry. Their ages ranged from 22 to 72 years (mean, 43.0 years).
Results: FDT detected visual field abnormalities (VFA) in 30 subjects. Among them, 10 subjects underwent ophthalmologic diagnosis and 7 (70.0%) were diagnosed with glaucoma {6 with NTG [4 with early NTG who did not have VFA using Humphrey Field Analyzer, and 2 almost free from fundus abnormalities (FA)]}. On the other hand, fundus photography detected FA in 12 subjects who did not have VFA in FDT perimetry. Among them, 8 subjects underwent ophthalmologic diagnosis and only 1 subject (12.5%) was suspected of having NTG.
Conclusions: FDT may be useful in mass screening for early detection of NTG but it would be even more useful to use FDT together with fundus photography.

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Objective: Various difficulties were anticipated following the implementation of specific health guidance in April 2008, such as in the preparation of support plans and provision of continuous support to those receiving guidance as well as in administrative aspects such as management of health guidance evaluation points and data. In view of this, together with Honest Co., Ltd, we created an integrated support system covering everything from the initial interview to reporting, with public health nurses and nationally registered dieticians involved in specific health guidance playing a central role.
Methods: The system was developed by cardiovascular specialists, public health nurses, nationally-registered dieticians, data management staff and Honest Co., Ltd. systems engineers (SE) during the period 9 April 2007 to 31 March 2008. PowerPoint slides prepared by the public health nurses and nationally registered dieticians were made into a system of screens by the SE and through repeated checks and amendments, the content of each screen was finalized.
Results: The major features of the system are as follows: initial interview screen using movies and graphics, health guidance given in a fun way that will keep people’s interest, effective use of limited time for support, simplified reciprocal calorie conversion of food and exercise using 100 kcal cards, automatic preparation of 6-month continuous support schedules, integrated management of daily support schedules and data/health guidance evaluation points, timely sharing of support information among staff and all support information in digital form. The system was used in giving specific health guidance to consenting eligible examinees among those undergoing ningen dock-type health check-ups and health check-ups by means of mobile facilities conducted by 12 contracted bodies (9 municipal national health insurance associations and 3 other health insurance associations). Up to the end of December 2008, a total of 1,653 persons underwent specific health guidance (initial interview) consisting of 567 ningen dock and 1,086 mobile health check-up examinees. This was 88.8% of all examinees.
Conclusion: We consider our support system to be indispensable to a staff consisting of only 12 public health nurses, 4 nationally-registered dieticians, and 6 health exercise instructors in conducting specific health guidance for over 1,500 people annually. Next fiscal year, we will evaluate the results in consideration of efforts made to address shortcomings in the current year and further improve the system.

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Objective: We provide radiography, conventional endoscopy (CE) and transnasal endoscopy (TNE) examinations at our health evaluation center for the same charge. In this study we evaluated the usefulness of TNE by investigating the trend in examinee preference for TNE following its introduction in 2004.
Methods: We analyzed the results of 34,914 upper gastrointestinal (UGI) examinations which were performed from April 2001 to August 2008 in our unit and conducted a questionnaire survey of patients who underwent TNE .
Results: The results of the questionnaire showed that 95% of examinees felt at ease about TNE and 96% wished to have their next examination performed by this means. Since the introduction of TNE the number of examinees who prefer it has been rapidly increasing. In 2007 TNE accounted for 44% of UGI examinations and in 2008 (April to August), it accounted for 62%.
Conclusions: TNE is preferred by almost all examinees and will be the first choice for UGI examinations at our health evaluation center in the future, from the risk management and medical economics viewpoints. However, we should conduct a further investigation to fully determine the diagnostic capabilities of ultrathin endoscopes.

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Background: Owing to an increase in the quantity of insulin measurements to evaluate subjects undergoing health check-ups according to the Homeostasis model assessment for insulin resistance (HOMA-R), more rapid and simple assay systems are necessary. With this in mind, we evaluated a newly developed insulin assay involving the use of a latex turbidimetric immunoassay with a chemistry autoanalyzer.
Methods: The “Cias INSULIN” kit was used on a TBA-200FR autoanalyzer and the assay procedure followed the manufacturer’s instructions.
Results: The within-run CVs ranged from 2.9 % to 5.5 % , and between-run CVs were 2.6 % - 7.6 %. An assay range of 100μU/mL was obtained. Neither bilirubinemia nor chylomicronemia in samples or those with high concentrations of rheumatoid factor adversely affected assays, and no cross reactivity with c-peptide was detected up to a concentration of 1,000 ng/mL. In comparison with a chemiluminescent method, a linear regression equation of y=0.915x+2.2, r=0.995 was obtained, and insulin values in serum and NaF plasma samples produced an equation of y=0.903x+0.2, r=0.996. A recovery test with insulin analogues yielded 80 - 120% of the expected concentrations. The mean (±SD) fasting serum insulin values were 5.9±3.0μU/mL in healthy men, and 5.8±2.8μU/mL in women. The HOMA-R values were 1.42±0.80 and 1.35±0.73, respectively.
Conclusion: This method demonstrated good basic performance and would be useful for measuring insulin in routine practice, health check-ups, and ningen dock.

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Aim: Though metabolic syndrome (MS) has been reported to be associated with chronic kidney disease (CKD) in several studies, the relationships between CKD and metabolic risk factors are complex. The aim of our study was therefore to analyze these complex relationships.
Methods: CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m² and/or proteinuria. MS was defined in accordance with the revised National Cholesterol Education Program criteria for Japanese, and the definition of Japanese metabolic syndrome (JMS) was in accordance with that of the Examination Committee for Criteria of Metabolic Syndrome. Metabolic risk factors and frequency of CKD were compared for MS and non-MS subjects using medical check-up data from 2290 men and 1360 women. Areas under the receiver operating characteristic curve (AUC) for diagnosing CKD were calculated and logistic regressions were performed. Excluding diabetic patients and subjects taking antihypertensive or antidyslipidemic medication, Spearman’s correlation coefficients were calculated.
Results: The prevalence of CKD was higher in MS than in non-MS subjects. In logistic regressions, age, MS, body mass index (BMI), and low-density lipoprotein cholesterol (LDLc) were independently related with CKD in men, and age, MS and body fat% were independently related with CKD in women. JMS was not independently related with CKD. eGFR was significantly negatively correlated with age, BMI, waist circumference (WC), systolic blood pressure, diastolic blood pressure (DBP), fasting glucose, LDLc, hemoglobin A1c (HbA1c) and % vital capacity (%VC), and significantly positively correlated with gamma glutamyltransferase (GGT) and heart rate in men, and significantly negatively correlated with age, BMI, WC, DBP, triglycerides, high-sensitive C-reactive protein, GGT, alanine aminotransferase, LDLc, HbA1c and %VC, and significantly positively correlated with heart rate in women.
Conclusions: Though JMS was related with CKD, in logistic regressions, it was not independently associated with CKD. Among metabolic risk factors, those independently associated with CKD were MS, BMI and LDLc in men and age, MS and body fat % in women.

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Aim: LDL cholesterol is associated with metabolic syndrome (MS) but is not generally considered to be a component of MS. The aim of the present study was to examine the association between LDL cholesterol and MS.
Methods: Prevalence of MS was compared among quartiles of serum LDL cholesterol levels using data from 2,082 Japanese men and 1,217 Japanese women not taking antihyperlipidemic medication. Areas under the receiver operating characteristic curve (AUC) of LDL cholesterol for diagnosing MS and Spearman’s correlation coefficients among risk factors were calculated.
Results: The prevalence of MS increased as serum levels of LDL cholesterol increased both in men and women. The slope of the increase was steeper in women than in men. The AUC (95% confidence interval) of LDL cholesterol for diagnosing MS was 0.579 (0.543-0.615) in men and 0.715 (0.658-0.772) in women. The correlations between LDL cholesterol and systolic blood pressure, diastolic blood pressure, fasting glucose, triglycerides, and gamma glutamyltransferase were significantly stronger in women than in men. The correlation between LDL cholesterol and blood pressure was significant in women but not in men.
Conclusions: In Japanese subjects, LDL cholesterol was closely associated with MS and the association was stronger in women than in men.

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