Objective: Individuals with metabolic syndrome (MetS) undergoing the specific health guidance program in Japan are screened based on the criteria of abdominal (abd.) circumference and/or body mass index (BMI). However, non-obese individuals not selected on the basis of these criteria may have other factors related to MetS, such as high blood pressure, high glucose levels, and abnormal lipid profiles, and might require instruction for prevention of cardiovascular diseases. We studied the relationships between obesity and metabolic abnormalities in subjects who underwent a complete medical examination at our center for the future management of such individuals.
Methods: We investigated 13,684 subjects (7,136 males, 6,548 females) who visited our center from April 2008 to March 2009, and used data from them regarding abd. circumference, BMI, blood pressure, plasma glucose levels, glycohemoglobin levels, serum triglyceride levels, and HDL-cholesterol levels for our analysis.
Results: Nearly half of the males (47.4%) were determined to be obese based on abd. circumference and/or BMI. There were significant relationships between abd. circumference and the number of other composition factors, with each additional 3.5 cm of abd. circumference adding another composition factor. However, 31.5% of males and 64.4% of females who had three composition factors did not fulfill the criteria of obesity, and thus did not receive instruction regarding MetS as part of the specific health guidance program.
Conclusions: Screening for obesity, especially visceral obesity, is necessary for better prevention of risk factors related to cardiovascular diseases. With the present criteria, many non-obese persons with multiple composition factors for MetS do not benefit from the specific health guidance program.

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Objective: In order to discover early esophageal cancer, fine mucosal cancer lesions must be clearly visible and institutions refine the contrast technique in various ways to achieve this. In our clinic, we previously had examinees raise their chins, and administered the contrast medium and air at the same time (hereafter open method) but they often suffered aspiration. Currently, we administer the contrast agent and air in the normal way and achieve double contrast at the optimum time (hereafter non-open method). In this study, we conducted a comparison of the open and non-open methods.
Subjects: The subjects were 573 patients who underwent examination by both the open and non-open methods.
Methods: We scored contrast agent attachment, mucosa visibility, air bubble formation (upper and lower areas) and cardia visibility according to 3 grades: good, acceptable and not acceptable. The maximum overall score was 21 and we made overall evaluations according to the same 3 grades as follows:17-21 good, 12-16 acceptable, 7-11 not acceptable.
Results: Mucosa visibility of the lower esophagus was judged to be unacceptable in significantly less patients in the non-open method group (5 patients, 0.9%) than in the open method group (17 patients, 3%). For air bubble formation, significantly more patients in the non-open group (212, 37%) were evaluated as good than in the open group (165, 28.8%). In the overall image evaluation, the non-open method was also superior, rated as good in 316 patients (55.2%) as opposed to 277 patients (48.3%) in the open method group.
Conclusion: The open method was previously considered to be a good way of enhancing mucosa visibility but the present results showed that the non-open method was superior to it in terms of overall image quality.

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Objective: Nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with insulin resistance. However, the causal relationship between these two pathological states and its molecular mechanism remain largely unclear.
Methods: We analyzed the relationship between insulin resistance and NAFLD in nondrinkers (521 men and 575 women) who visited our center for health check-ups and were not taking any medication for hyperlipidemia and diabetes mellitus.
Results: The data obtained in this study indicate that the incidence of NAFLD was positively correlated with HOMA-R levels. In addition, the result for serum triglyceride to HDL cholesterol ratios, which are used as a lipid marker for insulin resistance, was similar to that obtained for HOMA-R.
Conclusions: In view of a recent study finding that patients with an insulin receptor defect had a low triglyceride to HDL-cholesterol ratio and a high HOMA-R, the data presented here can be interpreted as an indication that the defective insulin signaling in patients with NAFLD occurs at post-receptor levels.

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Objective: The purpose of this retrospective cohort study was to clarify the differences between hepatocellular carcinoma (HCC) detected in Ningen Dock when there are no symptoms and that diagnosed after the onset of symptoms.
Methods: Inclusion criteria were HCC and no history of malignant tumor. Our subjects were 87 patients diagnosed with HCC in Ningen Dock when they had no symptoms (Ningen Dock group) and 167 patients who were diagnosed with it after the onset of symptoms (Symptom group). We studied the differences between the Ningen Dock group and Symptom group regarding clinical backgrounds, cancer staging, and survival probability, evaluating differences in clinical backgrounds and cancer staging by the Mann-Whitney test or Kruscal/Wallis1 method. Survival probability was assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis.
Results: 1.Clinical backgrounds: The indocyaningreen retention test at 15 min was 31.9 in the Symptom group and 27.2 in Ningen Dock group (P = 0.011). Stage 1 and 2 accounted for about 30% in the Symptom group, whereas they accounted for about 80% in the Ningen Dock group 2. Survival probability: Survival probability in Symptom group was 60.2% at one year, 31.5% at three years, and 14.4% at five years while that in the Ningen Dock group was 94.6% at one year, 76.2% at three years, and 64.8% at five years. Survival probability in the Ningen Dock group was therefore markedly higher than in the Symptom group.
Conclusion: Evaluation in Ningen Dock enhances the rate of early diagnosis of hepatocellular carcinoma.

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Objective: Chronic obstructive pulmonary disease is often present in elderly Japanese. The aim of this retrospective cohort study was to assess the predictive factors of chronic obstructive pulmonary disease in Japanese subjects.
Methods: A total of 1336 men and women examined annually from 1997 to 2006 in our health check-up division by means of the respiratory function test were enrolled. The average decrease in FEV1.0 based on several factors was evaluated using the Mann-Whitney test or Kruskal-Wallis test.
Results: The total average decrease in FEV1.0 was -0.38L. The average decrease in males was significantly larger than in females (-0.40L and -0.32L, respectively). As for differences among age groups, the decrease from the 1997 average for subjects over 55(-0.36L) was significantly smaller than that for under 45(-0.39L) and between 45 and 55(-0.39L). The average decrease in FEV1.0 for subjects with a BMI between 20 and 25 was significantly larger than for subjects with a BMI of less than 20 and those with a BMI of over 25. As for smoking history, the average decrease for current smokers (-0.41L) was significantly larger than for non-smokers(-0.37L) and ex-smokers (-0.39L). When examined by FEV1.0 in 1997, the average decrease was significantly greater the larger the baseline FEV1.0 (under 3.0:-0.33L, between 3.0 and 3.5:-0.39L, over 3.5:-0.46).
Conclusions: As a smoking habit enhances the decline in FEV1.0, stopping smoking is necessary to prevent the appearance of obstructive pulmonary function.

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Objective: Gastrointestinal stromal tumors(GIST)develop as submucosal tumors within the gastrointestinal tract. We describe a case in which ultrasound revealed duodenal GIST that had been undetected by upper gastrointestinal imaging in an asymptomatic 46-year-old male patient.
Case: The ultrasound showed a circular tumor 3 cm in diameter with well-defined margins, originating from the duodenum and located posterior to the body of the gallbladder and near the head of the pancreas. Ultrasonic images of the tumor were mottled and isoechoic with hyperechoic regions compatible with normal liver parenchyma. Color doppler indicated very little blood flow at the tumor periphery. CT and MRI positioned the tumor in the second portion of the duodenum. The tumor appeared heterogeneous on contrast-enhanced CT. MRI showed a slight low-signal-intensity area on the T1-weighted image, and dynamic MRI showed heterogeneous contrast enhancement in the early phase. Partial duodenectomy was performed, and the tumor was diagnosed as a low-risk duodenal GIST on the basis of histopathologic findings.
Conclusions: Owing to Because of the exoenteric growth pattern, the tumor was not observed in upper gastrointestinal imaging, but was readily detected by ultrasound since there was no interference from abdominal gas. Ultrasound can provide real-time identification of tumor location, and has applications in the detection of submucosal tumors.

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Objective: We investigated a relationship between the serum LDL cholesterol to HDL cholesterol ratio (L/H ratio) and coronary risk factors in a Japanese population.
Methods: Our subjects were 3,717 individuals who underwent a general health examination in 2004. We estimated their L/H ratios and determined if there was a correlation between them and other cardiovascular risk factors.
Results: The L/H ratio of participants without treatments for diabetes mellitus, hypertension, or dyslipidemia was 2.24 (SD 0.88), and that of subjects with no traditional cardiovascular risk factors (BMI, blood pressure, and fasting blood glucose, HbA1c, LDL cholesterol, HDL cholesterol, triglyceride, and uric acid levels were below ideal levels in Ningen Dock criteria) was 1.46 (SD 0.42). The 90 percentile of the L/H ratio in this group was 2.02 (male/female 2.25/1.77). The L/H ratio was higher in male subjects in both groups. In the group that had a relatively low LDL level (below 139 mg/dl), HDL cholesterol was more strongly correlated with the L/H ratio than LDL cholesterol. In subjects with LDL levels below 139 mg/dl, the high L/H ratio was related to a higher level of high sensitive CRP.
Conclusions: In this Japanese population, the 90 percentile of the L/H ratio of individuals whose BMI, blood pressure, and other metabolic factors meet the ideal Ningen Dock criteria was 2.02. In individuals with a relatively low LDL level, a high L/H ratio might indicate the presence of more severe cardiovascular risk factors.

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Objective: The objective was to clarify the effects of continuous health guidance focusing on metabolic syndrome through changes in weight.
Methods: We compared numbers of persons gaining or losing weight and changes in average weight in 233 persons aged 40-69 undergoing a 2-day health check-up at our center continuously over 5 years from April 2004 to March 2009 for 2 periods - Period 1: 2004-2006; Period 2: 2006-2008 (weights in 2004 and 2006 used for Period 1 evaluation; weights in 2006 and 2008 used for Period 2 evaluation). For Period 1, a doctor explained the results to subjects and then gave them health guidance for about 10 minutes concerning abnormal measurements. For Period 2, in addition to taking abdominal girth measurements and conducting body composition tests, we organized a health class having health targets.
Results: In Period 1, the numbers of people whose weight increased by over 3 kg and between 1 and 3 kg were 23 and 53, respectively and the numbers of people whose weight decreased by more than 3 kg and between 1 and 3 kg were 26 and 41, respectively. There was no weight change in 89 people. In Period 2, the numbers of people whose weight increased by over 3 kg and between 1 and 3 kg were 14 and 23, respectively and the numbers of people whose weight decreased by more than 3 kg and between 1 and 3 kg were 53 and 61, respectively. There was no weight change in 82 people. Compared to Period 1, there was a significant increase in the number of people losing weight in Period 2 and there was a decrease in the number of people gaining weight (p<0.001). Regarding changes in average weight, in Period 1, there was an increase of 0.11 kg whereas there was a decrease of 1.25 kg in Period 2. The decrease in weight in Period 2 was significant (p<0.001).
Conclusion: Continuous health guidance focusing on metabolic syndrome was effective in achieving weight reduction.

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Objective: According to specific health guidance which was established by the Ministry of Health, Labour and Welfare in 2008, we need to give people guidance to improve metabolic syndrome since it causes obesity. However, as decreases in measurements are not very large in many cases, we determined changes in laboratory data for a 3 kg loss in weight and 3 cm loss in waist circumference.
Method: We selected 47 men and women in the “active support” category and gave them health guidance and a blood test. We gave them the objectives of achieving a decrease of 3 kg in weight and a 3 cm decrease in waist circumference. Based on the results, we divided them into 4 groups : a group that was successful in achieving the decreases in both weight and waist circumference, a group that was successful in only achieving the decrease in waist circumference, a group that was successful in only achieving the decrease in weight, and one that was not successful in achieving either of the objectives. We then gave them another blood test and compared the new blood test data with the previous data.
Results: Significant decreases in triglyceride, ALT, and γ-GTP were noted in the group accomplishing both objectives.
Conclusion: In the group achieving both a decrease of 3 cm in waist circumference and a decrease of 3 kg in weight, there was a marked improvement in laboratory data compared to the other groups.

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Objective: In specific health guidance program, supports which motivate people themselves to make behavior modifications are required. However, it is still not clear whether such health guidance focusing on self-care is effective in improving lifestyle habits or laboratory tests. Lifestyle guidance is used as a first choice strategy for people with hyperuricemia. We therefore compared changes in lifestyle habits and laboratory data in individuals with hyperuricemia between both for those who underwent special health guidance and those who did not.
Methods: Among the employees of a certain company who underwent health check-ups from 2000-2007, we focused on those considered to require lifestyle guidance due to hyperuricemia (determined on the basis of a uric acid level of 7.0-8.9 mg/dL without complications and 7.0-7.9 mg/dL with any complications). Lifestyle habits and laboratory data after a year of those who had received the health guidance were compared with those who had not .
Results: Among 272 males with hyperuricemia, 91 received the health guidance (guidance group). After a year, uric acid levels had returned to normal in 118 people and a significantly high percentage of them were from the guidance group. While the uric acid level decrease both in the guidance and in no guidance groups, the degree of the decrease was significantly greater in the guidance group. There was no difference between the guidance and no guidance groups as regards improvement rates in smoking and exercise habits. However, in the guidance group, the rate of drinking alcohol every day dropped off greater, and tendency for γ-GTP to increase was slight.
Conclusion: The results suggest that health guidance focusing on self-care conducted at this company was effective in improving hyperuricemia.

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Objective: The subject of breast cancer examinations has been gaining attention in recent years due to the increasing number of breast cancer sufferers, and more and more patients are undergoing such examinations every year. As a result, there has also been an increase in the number of examinees requiring secondary examinations. We carried out an investigation of ultrasound observations at our institution to review criteria for secondary examinations.
Methods: 3,952 examinees who underwent ultrasound mammary gland examinations during the period from June 2005 to the end of March 2009 were selected as subjects. Diagnostic images from both initial and secondary examinations were evaluated based on comments from the radiologists who actually conducted the examinations with the consent of two medical specialists. We carried out the investigation of secondary examination cases by comparing the images and observations from the initial examinations with those from the secondary examinations.
Results: Of the total of 3,952 subjects who underwent ultrasound mammary gland examinations, 341 (8.6%) were categorized as C2. A total of 122 subjects underwent secondary examinations. Details of the observations are as follows: Fibroadenoma (96 cases), intraductal papilloma (14 cases), suspected low echo nodule (9 cases), suspicious low echo area (1 case), cyst (1 case), mastopathy (1 case). The prognosis for 106 subjects remained unchanged after the secondary examination while the prognosis for 10 subjects was revised to a less serious level and for 6 subjects to a more serious level.
Conclusion: The prognosis for most of the subjects who underwent secondary examinations was fibroadenoma with no changes in size or form. Based on these results, we believe that if secondary examination criteria were reviewed and typical fibroadenoma removed from them, this would not only improve the accuracy of examinations but also help to alleviate the psychological trauma suffered by patients and reduce medical expenses. It is also our view that continued investigation of secondary examination cases will further enhance the accuracy of examinations.

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Objective: Our objective was to clarify who should undergo screening for colorectal neoplasm (colorectal polyp and cancer) by total colonoscopy in ningen dock.
Methods: 304 of 3,055 ningen dock patients underwent optional total colonoscopy screening for colorectal neoplasm at our hospital from January 2003 to December 2007. First, we investigated an association between fecal occult blood test and colonoscopy findings. We also determined the risk factors of colorectal neoplasm among the clinical factors of age, family history, past history, smoking history, drinking history, hypertension, diabetes mellitus, dyslipidemia, hyperuricemia and body mass index. Statistical analysis was performed using multivariate analysis (multiple logistic regression analysis) with p<0.05 regarded as significant.
Results: The fecal occult blood test revealed 2 of 4 cases of colon cancer (including 1 case of advanced colon cancer), missing 2 cases of early colon cancer. The independent risk factors were past history (odds ratio 1.882, 95% CI: 1.104-3.209) and drinking history (odds ratio 1.912, 95% CI: 1.120-3.266). Furthermore, patients who had more than two factors among hypertension, dyslipidemia, family history, obesity (BMI≧25), hyperuricemia, age (over 50 years) and smoking history, were considered to have a significantly high risk of colorectal neoplasm.
Conclusions: Patients who have a past history of colorectal neoplasm or drinking history or more than 2 factors among hypertension, dyslipidemia, hyperuricemia, age (over 50 years) and smoking history should be encouraged undergo total colonoscopy for screening for colorectal neoplasm in ningen dock.

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Objective: The nicotine patch has been approved for tobacco dependence in Japan since June 2006. We evaluated the smoking cessation success rate (SR) of the smoke free program (SFP) in our smoking cessation clinic.
Methods: A total of 100 patients were treated in the SFP from15 June 2006 to 14 October 2007. We evaluated the smoking cessation SR in the total number of patients who completed the program. We also compared BP, BW, vital capacity (VC) and inspiratory volume (IC) measurements and followed up successful patients to see if they were still not smoking 6 and 12 months after completing the program.
Results: The total number of patients treated in the program was 100 (78 males, 22 females), having an average age of 54. The smoking cessation SR for all patients was 52% (males 55%, females 50%). Those who stopped smoking gained 1.8 kg in weight. There was no change in BP but there was tendency for VC and IC to increase. Sixty-eight percent of the patients completed the program and the smoking cessation SR for these patients was 76%. Patients who could not complete the program had a high TDS. Among the patients who stopped smoking, 83% and 74% were still not smoking 6 and 12 months after completing the program, respectively.
Conclusion: cooperative team intervention involving a doctor, nurse, and pharmacist, and close contact with patients are key factors in achieving a high SR for smoking cessation.

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