Objective: In this study, we investigated an association between BMI and subcutaneous and visceral fat obesity, as determined by abdominal CT, and the Japanese metabolic syndrome diagnostic criteria and liver function.
Methods: We analyzed data for 174 men and 63 women with mean ages of 46.6±11.3 and 49.2±12.4 years, respectively. The subjects were divided according to visceral fat area(VF) and BMI into a normal group (VF<100 cm², BMI<25), subcutaneous fat obesity group (VF<100 cm², BMI≥25), visceral fat accumulation non-obesity group (VF≥100 cm², BMI<25), and a visceral fat obesity group (VF≥100 cm², BMI≥25). The 4 groups were compared regarding their age, height, weight, BMI, systolic and diastolic blood pressures, and laboratory data for total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood glucose, HbA1c, AST, ALT, and γ-GTP. There were more women in the subcutaneous than in the visceral fat obesity group.
Results: An increase in visceral fat was related to high blood pressure and liver dysfunction in males. An increase in subcutaneous fat was related to a decrease in HDL cholesterol in both males and females and an increase in ALT in females. Increases in both visceral and subcutaneous fat were related to a decrease in HDL cholesterol and increases in HbA1c and γ-GTP.
Conclusions: Our findings suggested that in patients suspected of having metabolic syndrome, it is necessary to measure visceral and subcutaneous fat areas, analyze the results according to gender, and use the data obtained to devise preventive measures.

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Objective: The Ministry of Health, Labour and Welfare (MHLW) has introduced a specific health examination for metabolic syndrome (MS) using modified criteria of the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome (JCDMS). Examinees who satisfy the mandatory condition of obesity and are positive for at least 1 MHLW criterion may receive specific health guidance, but examinees who are on medication (EOnM) for hypertension, dyslipidemia, or diabetes may not because they are under the guidance of clinicians. We analyzed the medical check-up results for EOnM to see if their data were better than examinees with no medication (ENoM).
Methods: Our subjects were 6,642 men between 40 and 64 years old. Diagnosis was conducted for EOnM assuming that they were not on medication.
Results: EOnM had a significantly higher incidence of enlarged waist circumference and higher body mass index than ENoM. Also, the incidence of elevated fasting plasma glucose among EOnM for hypertension and/or dyslipidemia, and that of lipid abnormality among EOnM for diabetes and/or hypertension, was significantly higher in most cases than ENoM. EOnM for dyslipidemia and diabetes had a significantly higher incidence of elevated blood pressure than ENoM. When blood pressure was excluded in making a diagnosis for examinees taking only antihypertensives and ENoM, in the former, the incidence of those who should receive specific health guidance and that of those positive for at least one of the JCDMS criteria was significantly higher than in the latter. This was also the case with examinees taking only medicine for dyslipidemia.
Conclusions: The medical check-up results for examinees on medication were no better than those without medication.

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Objective: When our facility was made non-smoking, there was an increase in secret smoking among people undergoing our one-night-stay ningen dock because they could not cope with being unable to smoke for such a long time. With the objectives of mitigating the symptoms arising from being unable to smoke and giving people the incentive to cease smoking, we provided those who wished it with counseling on giving up smoking, which included the application of a nicotine patch and providing them with information on its use and smoking cessation. As people said things like "Using the patch made me feel OK" and "I ceased smoking afterwards", we decided to conduct a survey on the outcome of smoking cessation support centering on the use of a nicotine patch.
Methods: We conducted a questionnaire survey of 142 smokers who underwent a 1-night-stay ningen dock between January and June 2008, sending the questionnaire to them by mail.
Results: The questionnaire recovery rate was 33.8%. In the section on smoking cessation counseling, the responses "I could use the nicotine patch" and "I understood how to purchase nicotine patches" were ranked 1st and 2nd, respectively. Regarding interest in smoking cessation, 75% of respondents were between being interested in stopping smoking and preparing to do something about it, and 76% were using a nicotine patch. However, only 14.6% succeeded in stopping smoking and we considered that others who had wanted to stop but did not succeed were unable to cope with the stress and irritability.
Conclusions: Our smoking cessation counseling centering on the use of a nicotine patch is considered to have increased interest in smoking cessation by allowing people to experience the beneficial effects of the patch and gain a correct understanding of the merits of smoking cessation. The fact that only 14.6% succeeded in stopping smoking indicates that measures taken against the disappearance of smoking as a means of relieving stress and other aspects of psychological dependence on the smoking habit were insufficient. However, we noted that providing support for smoking cessation in this manner was a motivating force in changing smoking behavior.

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Objective: Hypertension is the one of the most important risk factors of stroke and other lethal diseases. Thus, it is essential to prevent the onset of hypertension in preventive medicine. Further, with changes in the Japanese lifestyle, the risk factors for the onset of hypertension are assumed to have also been changing. To determine risk factors for the onset of hypertension, we conducted a longitudinal analysis of data from subjects who had undergone annual health screening in recent years.
Methods: Our subjects were 1,701 people who had undergone annual health screening every year from 2003 to 2008. We excluded 396 subjects who presented hypertension or were taking medication for it, and subjected the data of the remaining 1,305 subjects to multivariate Cox regression analysis.
Results: During the 5 years, 139 subjects started medication for hypertension and 78 subjects presented hypertension. After adjusting for covariate factors, the multivariate cox regression analysis showed that age, body mass index (BMI), 1st-year blood pressure (BP) and parent hypertension were significant and independent risk factors for the onset of hypertension. Changes in BMI over the 5 years were significantly relevant to changes in BP over this period (p<0.0001). BMI was also correlated with the incidence of hypertension over 5 years. Furthermore, excluding the data of 38 subjects taking medication for diabetes mellitus from the analysis showed that HbA1c was also a significant and independent risk factor for the onset of hypertension.
Conclusions: Recently, our knowledge of the harmful effects of obesity on health has been growing. Our study showed that obesity is a risk factor for onset of hypertension and therefore body weight control is important for preventing it.

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Objective: Doctors and members of a co-medical team (nurses, public health nurses, national registered dieticians, pharmacists, physical therapists) have been making use of their individual coaching skills in giving guidance to patients matched to individual behaviour modification stages under a lifestyle disease improvement program conducted jointly in consultation with each other. In the last 3 years, behavioural modification was observed in all patients who completed this educational program and there was an improvement in laboratory data for 84% of them. This improvement rate was as good or better than that achieved in previous studies and we verified the achievement of such a high level of improvement.
Methods: We entered data for 100 patients (diabetes 86, hyperlipidemia 8, hypertension 6) who had completed a 3-month program during the period January 2007 - December 2009 on whether there had been changes in behavioural modification stage, changes in dietary and exercise habits or other behavioural changes between before and after undergoing the program into a database and analyzed it. We also analyzed changes in laboratory data.
Results: There was an improvement in the behavioural modification stage for all subjects, from "considering modification" to "making preparations for modification" or "actually modifying behaviour". The rates of improvement for dietary habits, exercise habits, other behavioural modification and laboratory data were 99%, 95%, 96% and 84%, respectively.
Conclusions: We consider that specialist counseling and expert coaching matched to individual behavioural modification stages in a lifestyle disease improvement program conducted by doctors and a comedical team in close consultation with each other was effective in achieving improvements in patients’ lifestyle habits and laboratory data. We felt that the methods used would also be useful in specific health guidance.

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Objective: The use of transnasal endoscopy is increasing in health check-ups and ningen dock since it is easy on the patient and safe to perform, and we are using it effectively in our hospital for screening purposes. We have also started using the world’s first transnasal endoscopy examination vehicle in a mobile ningen dock that includes endocopic screening of the upper gastric tract. We report the details in the following.
Methods: We dispatched our transnasal endoscopy vehicle and X-ray screening vehicle to business premises and conducted all of the examinations that are usually carried out in ningen dock at our hospital. An average of 12 persons was examined each time the vehicles went out. Staining tests were conducted during transnasal endoscopy but not biopsies. When necessary, biopsies were done at a later date in the hospital.
Results: Endoscopic examinations caused no accidental symptoms. Examinees rated the transnasal endoscopy examinations highly for the following reasons: 1) Endoscopy was conducted more safely with no sedative used, 2) It was easy on examinees, they could concentrate on explanations given during it and had a good understanding of what was happening and 3) Transnasal endoscopy was convenient because they could return to work immediately afterwards.
Conclusion: We consider the use of a transnasal endoscopy examination vehicle in our mobile ningen dock to be highly useful due to reductions in discomfort, examination time and costs.

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Objective: The aim of this study was to examine the relationship between metabolic syndrome (MetS) and anti-aging medical indicators such as functional age and oxidative stress markers.
Methods: The subjects were 175 persons who underwent an anti-aging evaluation. The functional age parameters considered were muscle age (weight bearing index), bone age (bone mineral density (BMD), hormone age (IGF-I, DHEA-s/cortisol ratio), blood vessel age (pulse velocity analysis, homocysteine and hsCRP), urine 8-OHdG and oxidative stress prevention potential index (OSPPI). Cross-sectional statistical analysis was performed on them.
Results: Fifteen men (age 67.2±8.1) and 7 women (age75.9±11.2) were assigned to a MetS (+) group and 55 men(age 62.9±11.8) and 80 women(age 63.8±12.1) to a MetS(-) group. In the MetS (+) group, muscle age tended to be higher. BMD was higher (P=0.009) in men but lower in women (P < 0.001). BMD was not significantly associated with smoking habit or other factors. In the MetS(+) group, DHEA-s was lower in men (P=0.048) and women had a significantly lower DHEA/cortisol ratio (P=0.013). In women in this group, homocysteine levels were higher (P=0.010), and hsCRP levels were also higher (P=0.019). Levels of 8-OHdG were higher in MetS (+)women (P=0.010) while serum LPO was higher in men in this group (P=0.028). The OSPPI was lower in the MetS(+)group, particularly in women (P=0.020).
Conclusion: Our data indicate that MetS can affect functional aging which is partially mediated by oxidative stress.

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Objective: With the aim of raising the accuracy of cervical cancer screening in ningen dock, in 2008, we introduced the HPV test, as an additional screening technique to conventional cytologic diagnosis for those who wished it. We investigated the status of cervical cancer screening at our center over a 6-year period.
Subjects and methods: Our subjects were a total of 41,459 persons who underwent cervical cancer screening during ningen dock in the 6 years from 2003 to 2008. Regarding the screening situation in 2008, our subjects were 1,908 persons undergoing the HPV test among 6,744 who had received cytologic diagnosis.
Results: In the above 6-year period 23 people were confirmed to have developed cancer through written replies (discovery rate 0.05%). A further 5 subjects were found to have cancer on undergoing ningen dock again. With the switch to the Bethesda system and the introduction of HPV screening, in 2008, cancer was discovered in 6 patients among 77 who required further testing in cytologic diagnosis (discovery rate: 0.09%). As for the 1,908 persons who also underwent HPV screening (28.3% of persons undergoing cervical cancer screening) 61 tested positive (positive rate: 3.2%), with the positive rate for subjects in their 20s at 11.1%.
Conclusions: With the revision of the Bethesda system, subjects with Class II ASC-US (atypical squamous cells of undetermined significance) became included in those requiring detailed testing, raising the proportion of such persons to 1.14% in 2008, an all-time high. With an increase in persons considered to be positive due to the introduction of HPV screening, there will be a further increase in the percentage of those requiring further detailed examination in the future.The introduction of the Bethesda system and HPV screening is expected to lead to the establishment of criteria for examinees considered to be at risk of precancerous lesions as well as to an increase in the discovery rate for cervical cancer in the future.

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Objective: We report on our "health check-up bra" a product to improve the environment for women who have a health check-up with both men and women present.
Method: The subjects of our survey were 595 women who had a health check-up at our hospital between December 1st, 2008 and February 20th, 2009. We sent a letter to women describing our survey beforehand and distributed the bra free on condition that participants answered questions concerning it.
Results: The size and the cut of the bra were evaluated quite highly but awareness of the bra and desire to purchase it were remarkably low. Some radiographs taken with it on showed a little distortion.
Conclusions: The bra was useful in improving our service to women who have a health check-up. It helps ensure reliability in examinations and it is useful for women during physical check-up. However, we found that having to change clothes took time and interrupted the workflow. It had almost no effect on the interpretation of chest radiographs. However, we are reconsidering the price of the bra due to the low desire to purchase it.

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Objective: The purpose of this study was to examine cut-off points for visceral fat area (VFA) and waist circumference (WC) in Japanese men and women, by studying a relationship between VFA and plasma adiponectin density.
Subjects and Methods: Our study population consisted of 8,470 men (47.3 ± 8.2 years) and 1,626 women (47.5 ± 4.7 years), who underwent a medical examination at TOYOTA Health Support Center WELPO. Using receiver operating characteristic [ROC] curve analysis, we determined the optimal cut-off points for VFA and WC - those fulfilling the presence of 2 or 3 factors from among hypertension, dyslipidemia, and hyperglycemia, which are related to metabolic syndrome (MetS). In addition, the gender-specific WC cut-off point equivalent to the VFA cut-off point, was determined using simple regression analysis between VFA and WC. Subjects were divided into groups according to VFA in 20 cm² intervals, and the mean density of plasma adiponectin was compared among them.
Results: ROC curve analysis showed that the optimal cut-off points for VFA and WC were 76.3 cm² & 84.2 cm in men and 47.3 cm² & 80.5cm in women, respectively. By regression analysis, WC values corresponding to the VFA cut-off point were 85.2cm in men and 80.1cm in women. In WC groups over 60-80 cm² in men and over 40-60 cm² over in women, there was no significant difference in the relationship between VFA and the mean density of plasma adiponectin. This result suggests that there would be a lower limit of adiponectin secretion for higher values of VFA.
Conclusion: It would be advisable to review the Japanese waist circumference criteria for MetS, especially in women.

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Objective: To investigate the use of urinary myoinositol (UMI) as a glucose intolerance marker in screening individuals for the 75 g oral glucose tolerance test (OGTT) in a routine health check-up.
Methods: Subjects (n=61) were volunteers selected from those undergoing a routine health check-up who had fasting plasma glucose levels of 110-125 mg/dL (determined during a preliminary routine medical examination). Subjects were classified according to the 1998 WHO criteria for diabetes mellitus, and those with normal glucose tolerance (NGT) and 1 h plasma glucose ≥ 180 mg/dL were further classified as pre-borderline (p-BD). Subjects gave written consent, and we measured UMI before loading and 2 h after the OGTT. The change in UMI was calculated using the ratio of myoinositol to creatinine at each time point.
Results: Of the 61 subjects, 30 (49.2%) were classified as NGT and therefore did not need to undergo the OGTT. In the remaining subjects, lower glucose tolerance was associated with a greater ΔUMI. ΔUMI was positive in 100% (7/7) of diabetes mellitus cases, 63.6% (7/11) of impaired glucose tolerance cases and 83.3% (5/6) of p-BD cases.
Conclusion: ΔUMI can be used to screen for subjects requiring OGTT as a secondary medical test during a routine health check-up.

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Objective: In calculating the estimated glomerular filtration rate (eGFR)，we compared serum creatinine values to the 2nd decimal place (Cr2) with those to the 1st decimal place (Cr1) after rounding off.
Methods: The criteria for CKD staging and equation for calculating GFR used were those published by the Japan Society of Kidney Disease. EGFRs calculated using Cr2 and Cr1 were designated eGFR(Cr2) and eGFR(Cr1), respectively. In this study, creatinine levels of 1,102 people (699 men and 403 women) were measured by the enzyme method and analyzed.
Results : No subjects were classified as stage 4(eGFR: 15-29) or 5(eGFR: less than 15). An eGFR(Cr2) having 1 to 4 at the second decimal place was lower than eGFR(Cr1), whereas an eGFR(Cr2) having 5 to 9 at the 2nd decimal place was higher than eGFR(Cr1). Numbers of subjects classified as CKD stages using eGFR(Cr2) and eGFR(Cr1) were indicated as eGFR(Cr2)/eGFR(Cr1). According to this system, in men, 28/30 subjects were stage 3(eGFR: 30-59), 427/442 were stage 2(eGFR; 60-89) and 244/227 were stage 1(eGFR; over 90). In women, 9/12 were stage 3, 207/202 were stage 2 and 187/189 stage 1. Therefore, the stagings determined by eGFR(Cr1) were different from those by eGFR(Cr2) and not correct. Eleven of 50 men with a Cr1 of 1.0mg/dL were classified as stage 3 but none of 51 women with a Cr1 of 0.7mg/dL was classified as stage 3, indicating that it is impossible to determine CKD stagings by Cr1 alone.
Conclusion : Since eGFR(Cr1) was different from and less reliable than eGFR(Cr2), Cr2 and eGFR(Cr2) should be used in health care center reports regarding healthy people and those with moderate hypofunction of the kidney.

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