Objective: Since thyroid nodules are frequently found in Ningen Dock, a clinical guideline with lines of evidence is required to conduct efficient screening for those that should be treated. In this study, we analyzed the results of ultrasonographic examinations and the changes in their findings.
Methods: We carried out thyroid ultrasonography for all 21,856 people who underwent Ningen Dock from April, 2004 to March, 2009.
Results: Thyroid nodules were detected in 4,978 subjects (22.8%). Cytological diagnoses were as follows: class I or II (Group B) in 165 subjects, class III (Group B/M) in 20, and class IV or V (Group M) in 57. Between groups, there were no significant differences in percentages of each sex, age or nodule diameter. Changes in the nodule diameter were +0.2±0.3, +0.8±0.5, and +1.3±0.5 mm/year in Group B, B/M and M, respectively. The nodule diameter in Group M increased significantly faster than that in Group B. In Group M, there were no subjects with a decrease in nodule diameter of more than 1.0 mm/year M. Also, although all malignant nodules of 11 mm or more in diameter in this group grew by more than 1.0 mm/year, most malignant nodules of 10 mm or less in size exhibited no change in diameter.
Conclusions: The findings of this study suggest that it is important to make decisions on what to do about the thyroid nodules frequently found in ultrasonographic screening based on nodule diameter and subsequent observations.

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Objective: We investigated whether subjects with appendectomy in their history exhibited certain characteristics based on Ningen Dock results.
Methods: Our subjects were 10,093 men and 3,087 women who had undergone an annual health check-up. Exclusion criteria included medications for diabetes, hypertension, dyslipidemia, and hyperuricemia, and past history of cardio- and cerebrovascular diseases.
Results: The appendectomy rates in men and women were 6.6 and 5.6% overall and 2.5 and 2.7%, 4.0 and 4.8%, 6.6 and 6.6%, and 9.3 and 9.7%, for those in their twenties, thirties, forties, and fifties, respectively. Since there was a significant difference in average age between subjects with appendectomy in their history and those without, the Ningen Dock results of the 2 groups were compared after being adjusted for age. Total globulin was lower (men: 2.59 vs. 2.65 mg/dL (p=0.012), (women: 2.66 vs. 2.73 mg/dL (p=0.070)) in subjects who had undergone appendectomy, but there was no difference in blood pressure, pulse rate, blood cell count, hepatic and biliary enzymes, serum lipids, renal function, total protein, albumin, or CRP.
Conclusions: These findings suggest that appendectomy might affect immune function because total globulin includes immunoglobulin.

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Objective: To clarify which lifestyle habits are essentially associated with metabolic syndrome (MS).
Methods: A total of 14,762 subjects (8,441 males, 6,321 females, age: 23-80, mean 49.2) underwent Ningen Dock (comprehensive health examination) at our clinic from June 2008 to December 2008. Lifestyle habits associated with MS were analyzed by logistic regression. Associations with constituent factors of MS, such as hypertension, dyslipidemia and impaired fasting glucose, were also investigated.
Results: Among our subjects, 1,343 were assigned to an MS group and 12,109 to a non-MS group. Significant risk factors for MS were male gender, eating fast, dinner late at night, age, frequent dining out, drinking, and attempt to improve lifestyle. On the other hand, protective factors were light exercise, walking fast, regular meals and sufficient vegetable intake. There were some differences when lifestyle habits associated with constituent factors of MS, such as hypertension, dyslipidemia and impaired fasting glucose, were analyzed separately.
Conclusions: To improve MS, it would be effective to focus on the significant risk and protective factors indicated by this study. In addition, it would be possible to determine which lifestyle habits should be considered with priority depending on whether the problem is hypertension, dyslipidemia or impaired fasting glucose.

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Objective: Most chronic kidney disease (CKD) patients do not have proteinuria. We investigated risk factors of CKD without proteinuria and CKD progression in cases we had encountered.
Methods: Among 8,357 persons of 20 years and older who were examined at our health check-up center from 2002 onwards, we extracted those who had an eGFR (estimated glomerular filtration rate) of less than 60 mL/min/1.73m² and conducted multivariate logistic regression analysis regarding the risk factors of sex, age, urine tests, uric acid, BMI, hypertension, hyperlipidemia, diabetes and smoking. We examined the course of eGFR in CKD subjects without proteinuria for whom 3-5 years of follow-up was possible.
Results: Examinees of over 60 years at stage 3 CKD accounted for 15.76% of the total. Those with an eGFR of 50 or over but less than 60 accounted for 86% and those negative for proteinuria 86%. The risk factors for stage 3 CKD stage subjects overall in decreasing order of precedence were age, hyperuricemia, proteinuria, hypertension, and sex while those for CKD subjects without proteinuria in decreasing order were age, hyperuricemia, and hypertension. In 3-5 years (average 4.32 years) of follow-up, no significant decrease in eGFR was observed in subjects without proteinuria.
Conclusion: 86% of stage stage 3 CKD cases discovered in health check-ups, have an eGFR of 50 mL/min/1.73m² or above, the criterion for referral of patients for specialist examinations, and absence of proteinuria. Hyperuricemia is an important risk factor (odds ratio: 3.191) for CKD without proteinuria and interventions are considered necessary when it is present. We felt that proteinuria should be included as a stratified risk factor for CKD.

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Objective: To examine an association between regular exercise habit in terms of numbers of exercise units, and visceral fat, and determine the appropriateness of the guideline in Exercise Guide 2006 (MOHLW) stating that “At least 10 exercise (hereafter 10ex) per week is necessary to reduce visceral fat”
Methods: The subjects were 1,173 company personnel who underwent Ningen Dock at our center. After explaining the use of the exercise unit (ex) to measure their regular exercise habit, we had subjects enter exercise amounts in a questionnaire sheet and then classified them according to weekly exercise amounts into a less than 4ex group, a 4 to less than 10ex group and a 10 or more ex group. Visceral fat areas were calculated from cross-sectional abdominal CT scans at the level of the umbilicus. In addition to comparing the average visceral fat areas among the 3 regular exercise amount groups, after adjusting for confounding factors such as age, profession, smoking habit, drinking habit, dietary habits and subcutaneous fat area, we compared the odds ratios for a visceral fat area of 75 cm² or over among the groups.
Results: Compared to the less than 4ex group, the 10ex or more group exhibited significantly lower values for both average visceral fat area and odds ratio for visceral fat area of 75 cm² or over and though these values tended to be lower in the 4 to less than 10ex group, differences were not significant.
Conclusion: The government guideline of at least 10ex being necessary to reduce visceral fat is considered to be appropriate.

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Objective: It is commonly known that diabetes in combination with hypertension increases the risk of stroke and heart disease. It is therefore important to try and prevent the onset of diabetes in hypertensive patients. In the present study, we examined the effect of water-soluble olive polyphenol (OPDEX) on blood glucose levels in hypertensive patients with impaired glucose tolerance.
Methods: We had 15 hypertensive patients with impaired glucose tolerance take a supplement containing OPDEX for 12 weeks and conducted routine laboratory tests and measured oxidative stress indicators before and after taking the supplement.
Results: After 12 weeks of taking OPDEX, we observed a significant reduction in fasting glucose levels. Also, HOMA-β levels tended to be increased.For all other parameters, there were no significant differences with a placebo group for before and after taking the supplement.
Conclusion: OPDEX was clearly effective in reducing blood glucose levels in hypertensive patients with impaired glucose tolerance. The mechanism of action was considered to involve inhibition of α-glucosidase activity by OPDEX as well as its insulin secretion improving effect. Our findings suggested that OPDEX could help prevent or delay the onset of diabetes in hypertensive patients with impaired glucose tolerance.

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Objective: We examined the effect of Specific Health Guidance on subjectes with extremely high serum triglyceride (TG) levels.
Methods: We compared serum TG levels, waist circumference, weight and behavioral change scores between before and 3 months after receiving guidance in 19 males with extremely high serum TG levels (≧400 mg/dL) among persons receiving Specific Health Guidance between April 2008 and October 2009.
Results: Significant reductions in serum TG and waist circumference due to health guidance were observed (serum TG; from 523±112 mg/dL to 327±210 mg/dL, waist circumference; from 89.9±2.8 cm to 87.5±3.0 cm) and there was a significant positive correlation between the changes in the 2 parameters. There were significant improvements in behavioral change scores for dietary, exercise and drinking habits due to health guidance, and there was a clear correlation between improvement in serum TG and dietary and drinking habits.
Conclusion: Specific Health Guidance achieved a clear reduction in serum TG in most subjects. In order to improve serum TG it is important to focus on instructing people to reduce their waist circumference and improve their dietary and drinking habits in health guidance. Medical treatment should only be recommended for subjects in whom there is no improvement in serum TG with health guidance.

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Purpose: We previously reported on new ultrasound diagnostic criteria for fatty liver using an advanced ultrasound system equipped with differential tissue harmonic imaging. Using these criteria, we studied ALT levels for various degrees of hepatic steatosis and estimated healthy ranges of ALT for health check-up subjects by excluding the slightest degree of hepatic steatosis using ultrasound.
Subjects and Methods: 1,000 subjects were chosen at random from 17,069 people who underwent health check-ups at our clinic in 2009. A “healthy” group was established by excluding the following: ① positive HBsAg and/or HCVAb ② habitual alcohol ingestion regardless of amount of alcohol,③ any use of drugs,④ elevation of γ-GTP, ⑤ hepatic steatosis (regardless of degree ). Still images were recorded by five sonographers using a commercially available ultrasonoscope (Toshiba XARIO-XG) and later diagnosed by a certified fellow of JSUM based on our criteria.
Results: 381 subjects were determined to be “healthy” based on the above and the 95th percentile of ALT was 17.4±12.0 IU/L (5.4~29.4). The proportion of subjects in whom fatty liver was detected was 17.2% and two thirds of them had an elevated ALT level of over 30 IU/L. ALT levels for fatty steatosis increased gradually according to the degree of hepatic steatosis.
Conclusion: Healthy levels of ALT were estimated to be below 30 IU/L through exclusion of hepatic steatosis in establishing a “healthy population”. Cases of hepatic steatosis amongst the healthy population seemed to be the cause of the existing higher healthy range for ALT levels.

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We report on an asymptomatic glioblastoma found in Brain-Dock (brain check-up). In MRI, a very small lesion of about 9 mm in diameter was detected near the cortical surface of the right frontal lobe of a 53-year-old man. MRI performed 45 days later revealed that the lesion had increased in size rapidly. While there were still no symptoms, the patient was operated on, and the tumor was diagnosed as glioblastoma pathologically.
We also describe the procedures used in our hospital and how we explain the results of Brain-Dock to examinees.

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