Objective: We developed a new simple method of detecting overt thyroid dysfunction in patients using a set of routine tests and applied it in screening during the general health check-up called“Ningen Dock”to check its usefulness.
Methods: In the screening, a computer was used to evaluate the findings of routine tests based on recognition of common patterns in patients with confirmed thyroid dysfunction. The screening was applied to 2,379 Japanese people undergoing Ningen Dock at JR Sendai Hospital, inputting alkaline phosphatase (ALP), serum creatinine (S-Cr), total cholesterol (TC), lactate dehydrogenase (LDH) and red cell count (RBC) data into a personal computer.
Results: Based on a thyroid specialist’s consideration of computer evaluations together with additional data such as heart rate and body weight change, 51 persons (2.14%) were suspected of having thyroid dysfunction and recommended for further examination. Based on blood thyroid hormone measurements conducted when examinees consulted the thyroid specialist or during Ningen Dock, among 28 examinees, 6 were determined to have overt thyroid dysfunction and 1 subclinical thyroid dysfunction. None of these 7 people had complained of illness.
Conclusion: The usefulness of our new method for screening patients with latent thyroid dysfunction through the use of a set of routine tests conducted during a general health check-up without thyroid hormone measurement was confirmed. It would be useful for the general physician during hospital examinations or “Ningen Dock” and may contribute to improving patient QOL.

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Objective: Generally, abdominal ultrasonography (US) is conducted before the upper gastrointestinal series (UGI). Here, we evaluate the effects of UGI on US images.
Methods: US was conducted before and after UGI on 11 male and 9 female members of the staff of our facility. US images were compared before and after UGI for the organs of focus, which were the liver, gallbladder, common bile duct, pancreas, spleen and kidney. US images of the pancreas were evaluated for different periods of time from the end of UGI to the beginning of US.
Results: Almost equivalent US images were obtained for the liver and gallbladder for before and after UGI by varying the body position and scanning technique. Equivalent images were obtained for the common bile duct in all except 1 case. US images of the spleen and the kidney were not affected. For the pancreas, poor US images were obtained in 7 cases (35%) and equivalent images were obtained in 8 cases (40%) by changing the body position. The effect of gas produced by effervescent granules was small, but the clarity of US images was reduced by barium in several cases. For the pancreas, poor US images were obtained within 30 minutes of the end of UGI but there were no poor images after 30 minutes or more.
Conclusion: It is necessary to conduct US at least 30 minutes after UGI. Also, after UGI, it is possible to obtain US images equivalent to those obtained before it by changing the body position or scanning technique.

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Objective: Microalbuminuria has been established as an early marker of renal injury. However, to avoid orthostatic albuminuria, the use of first morning void samples is recommended. Since we usually use spot urine samples for subjects undergoing health check-ups, albuminuria could be over-diagnosed using an ordinary cut-off level. We therefore examined the validity of cut-off values for microalbuminuria in spot urine samples in consideration of sustained urinary albumin excretion.
Methods: We measured the urinary albumin-creatinine ratio (UACR) in spot morning urine samples obtained from Ningen Dock examinees, and compared baseline values with those obtained after one year.
Results: Among 609 subjects (average age 51.3 years, males 399), 550 (90.3 %) were normal (UACR<30 mg/g) for both measurements. In 48 subjects who had a UACR of more than 30 mg/g at baseline, in 33 (5.4 %), UACR was still high, and in 15 (2.5 %) it was normal after 1 year. In subjects who were normal at baseline, 11 (1.8 %) had a high UACR after 1 year. Assuming that persistent microalbuminuria indicates the presence of chronic renal injury, sensitivity was 0.75, and specificity 0.97 using an ordinary UACR cut-off value (30 mg/g). When the cut-off value was raised to 40, sensitivity and specificity increased to 0.84 and 0.98, respectively. However, further increases in the cut-off value did not enhance sensitivity any more.
Conclusion: A cut-off value of 40 mg/g for UACR in spot urine samples is optimal for predicting persistence of microalbuminuria over 1 year.

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Objective: The role of ALT and γ-GT as indicators for the diagnosis of metabolic syndrome (MetS) and its development was examined in relation to the homeostasis model assessment of insulin resistance (HOMA-R), a marker of early-stage MetS, and high-sensitive CRP (hsCRP), a marker of the development of cardiovascular risk.
Methods: Among 4,906 people who underwent their initial health check-ups at Tokai University Hachioji Hospital, we selected 1,687 subjects who were non-drinkers, not already being treated for hypertension, dyslipidemia, or diabetes, and did not have advanced macrovascular diseases or hepatitis viral infection. Stepwise multiple linear regression analyses were performed to find significant determinants of HOMA-R and hsCRP. We next divided subjects into those with and without MetS and liver enzyme abnormalities, and compared their clinical characteristics.
Results: FPG, BMI, ALT, SBP, and TG were significantly related to HOMA-R, and γ-GT, BMI and HDL-C were significantly related to hsCRP according to the results of stepwise multiple linear regression analyses. A group of subjects with a high HOMA-R could be distinguished on the basis of presence or absence of MetS and ALT abnormality, and a group with a high hsCRP on the basis of presence or absence of MetS and γ-GT abnormality. Further dividing those with MetS and an abnormal ALT based on presence or absence of γ-GT abnormality, allowed us to distinguish a group with a high HOMA-R and hsCRP.
Conclusion: Our findings show that ALT is closely related to HOMA-R and γ-GT to hsCPR. We therefore suggest that addition of ALT and γ-GT abnormalities to screening for MetS may be useful for diagnosis of early-stage MetS and for detection of cardiovascular risk development.

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Objective: Most cases of liver dysfunction, which is observed frequently in combination with obesity in annual health check-ups, are due to fatty liver. Fatty liver is considered to be a component of metabolic syndrome. However, as the significance of fatty liver in non-obese subjects has hardly been studied, we investigated the effects of fatty liver on clinical data and insulin resistance in non-obese subjects in comparison with obese subjects.
Methods: Our subjects were 936 healthy male office workers with similar workloads who visited our health institute for annual health check-ups. They were divided into 4 groups according to degree of obesity and the presence of fatty liver. Blood chemical data and HOMA-IR, an indicator of insulin resistance, were compared between subjects with and without fatty liver, and the relationship between fatty liver and HOMA-IR was investigated in non-obese and obese subjects.
Results: Both non-obese and obese subjects with fatty liver had higher titers for liver function tests, uric acid, serum lipids, and glucose, compared to those without fatty liver. In particular, HOMA-IR was very high in the former. Further, fatty liver was found to be more closely associated with insulin resistance in non-obese subjects than in obese subjects by logistic regression analyses.
Conclusion: Since fatty liver in the non-obese subjects indicated a higher degree of insulin resistance, compared to obese subjects, non-obese subjects with fatty liver also need to modify their lifestyles.

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Objective: We examined changes in various indicators due to Specific Health Guidance.
Methods: Subjects were 420 persons (236 men, 184 women) who received Specific Health Guidance and then underwent Specific Health Examinations the following year at the Kokura Medical Association Health Check-up Center. Changes in blood pressure, lipid metabolism and glucose metabolism with changes in body weight and abdominal circumference were examined.
Results: For the subjects overall, Specific Health Guidance achieved significant average reductions in body weight and abdominal circumference of 1.5 kg and 1.6 cm, respectively. Further, in the group of subjects in which there was a reduction in weight (n=236, average weight decrease 3.4 kg), there were decreases in both systolic blood pressure (133.7 to 129.8mmHg p<0.001) and diastolic blood pressure (78.3 to 76.3mmHg p=0.005). Regarding lipid metabolism, there was a decrease in tryglycerides (150.2 to 130.4mg/dL p<0.001)and an increase in HDL cholesterol (55.7 to 57.6mg/dL p<0.001) but there no significant change in glucose metabolism. On the other hand, in the group in which there was an increase in weight (n=66, average weight increase 2.3 kg), there was a tendency for tryglycerides to increase and HDL cholesterol to decrease and regarding glucose metabolism, there was a significant rise in HbA1c(JDS) (5.42 to 5.57 % p<0.001).
Conclusion: There was a significant decrease in body weight and abdominal circumference in the subjects overall following Specific Health Guidance. Furthermore, in around 5% of the group in which there was a reduction in weight, there was a drop in blood pressure and an improvement in lipid metabolism while in the group whose weight increased, there was deterioration in both lipid and glucose metabolism. We therefore consider that reductions in weight and abdominal circumference achieved by Specific Health Guidance and Specific Health Examinations are useful in the prevention of lifestyle diseases.

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Objective: The plasma free amino acid profile reflects the metabolic status of the body and has been reported to change in various pathologic conditions, including liver dysfunction and various cancers. To develop a novel diagnostic marker for the early detection and clinical treatment of prostate cancer, the diagnostic performance of "AminoIndex", a multiplexed model based on the plasma free amino acid profile was investigated.
Methods: Plasma amino acid levels in prostate cancer patients and healthy controls were measured. After univariate analysis, the multiplexed model based on the plasma amino acid profile was applied in multivariate analysis to evaluate its diagnostic performance in distinguishing patients from healthy controls. The performance of "AminoIndex" in distinguishing prostate cancer patients from healthy controls was evaluated using the area under the receiver operating characteristic curves (ROC_AUC) obtained from predicted index scores.
Results: Plasma alanine, histidine, asparagine and proline were increased, whereas tryptophan was decreased in patients as compared to the healthy controls. The ROC_AUC of the "AminoIndex" in distinguishing prostate cancer patients from healthy controls was 0.74 and it was also able to detect early-stage cancer. No significant correlation was observed between "AminoIndex" and PSA.
Conclusion: "AminoIndex" could be used independently of PSA as a novel diagnostic marker for prostate cancer. Combinational diagnosis with PSA would be a promising strategy.

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Objective: We compared MR-mammography, mammography (MMG) and ultrasound (US) and report our findings.
Methods: Subjects were 52 persons who underwent MRI examinations from July 1 2009 to March 31 2010 and we compared the results of MMG, US and MR-mammography for 18 patients with breast cancer.
Results: In 1 person in whom MMG had been negative, breast cancer was noted in US and multiple breast cancer was suspected based on MRI. Also in 3 subjects in whom images were difficult to obtain by US, tumors were observed in MMG and MRI, which were small-size cancers and DCIS (ductal carcinoma in situ). Furthermore, MRI was able to detect 4 satellite tumors which were not visible in US. It was thus considered to have high capability to detect such tumors. The results for measuring ADC values (10^-3mm²/sec) in diffusion weighted images for several subjects were 0.964 and 0.908 for breast cancer subjects and 2.359 and 2.097 for normal subjects and those with benign tumors.
Conclusion: MRI was considered to have high detection capability with respect to breast cancer as it was able to able to detect satellite tumors that are not easy to see in MMG and US, as well as DCIS. The measurement of ADC values in MRI DWI would be highly applicable in health check-ups and should raise diagnostic accuracy.

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Objective: While N-terminal pro-brain natriuretic peptide (NT-proBNP has been established as an important biomarker in the clinical setting where it is used in the diagnosis of cardiac failure, evaluation of the effectiveness of treatment and making prognoses, it still does not have a clear role in health check-ups. We therefore investigated the significance of NT-proBNP measurements in Ningen Dock.
Methods: Our subjects were 5,084 persons who underwent our association's Ningen Dock from January 15 to March 9 2009. Persons with renal failure (creatinine over 2 mg/dL) and those under treatment for cardiac disease and hypertension were eliminated leaving 4,225 as the subjects for our investigation. In them, we examined relationships between age, gender, blood pressure, blood chemical data, ECGs and NT-proBNP. Next, percentages of persons with high NT-proBNP levels (over 109 pg/mL) were examined with respect to hypertension and ECG abnormalities.
Results: Age, gender, systolic blood pressure, LDL-C, albumin, red blood cell count, fasting glucose, high-sensitive CRP, supraventricular extrasystole, ventricular extrasystole, left bundle branch block, atrial flutter/atrial fibrillation and left ventricular hypertrophy, independently, were significantly associated with NT-proBNP. The percentage of subjects with high NT-proBNP levels was 5% for subjects with normal blood pressure and no ECG abnormalities, while it was 10% for hypertension and left ventricular hypertrophy and 60% for atrial flutter/atrial fibrillation.
Conclusion: Based on the above findings, NT-proBNP measurement would be useful in Ningen Dock.

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Objective: Investigation of gastric cancer death rates and prognosis in persons undergoing stomach examinations and those not undergoing them to determine effectiveness of such examinations.
Methods: During the 5 years from 2005 to 2009, we examined gastric cancer death details in Fujieda in death certificates, such as age, sex, duration of illness and whether the person had undergone a stomach examination or not. The total number of was 136,664 and 50,301 had undergone such examinations.
Results: There were 214 gastric cancer deaths from 2005 to 2009, 131 males and 83 females. An average of 42.8 people died per year. By age, death rates were significantly higher for people in their 60s and 70s than those in their 40s and 50s (p<0.05). The proportion of persons in the non-examined group dying from gastric cancer ranged from 71-88% depending on age and the average was 82%. As for the prognosis of gastric cancer patients, 38% of those in the non-examined group died in a year, 43% in the next 1-3 years, and this information was not known for 22%. The figures for the examined group were 28% dying within a year, 58% in 1-3 years and time of death was unknown for 13%. The number of persons dying within a year in the examined group was significantly lower than that in the non-examined group (p<0.05).
Conclusion: Gastric cancer deaths in the non-examined group amounted to 82%, while the figure for the examined group was 18%(p<0.05). Persons in the examined group stayed alive for significantly longer than those in the non-examined group (p<0.05).

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Objective: In 2008, the Ministry of Health, Labour and Welfare of Japan launched a metabolic syndrome (MS) prevention program in which it requested all health insurers to provide Specific Health Examinations related to MS followed by Specific Health Guidance based on the findings to people of 40 years and over. The Kyoto Industrial Health Association provides a remote health guidance program combined with face-to-face guidance. This study was initiated to investigate the effectiveness of Specific Health Guidance with remote support in the prevention and treatment of MS.
Methods: The subjects of the study were 260 male workers, who had MS-related findings in health check-ups in 2008, and received Specific Health Guidance (HG group). Two hundred sixty male workers, who had similar findings in health check-ups but did not receive Specific Health Guidance were selected as controls (control group). The results of health check-ups in 2008 and 2009 were analyzed.
Results: In the HG group, BMI, waist circumference and hemoglobin A1c decreased (p<0.001), whereas hemoglobin A1c increased in the control group (p<0.01). Multiple regression analysis revealed that the reduction in BMI was positively associated with exercise practice (more than twice a week) and physical activity (1 hour or more per day) (r=0.196, p<0.01).
Conclusion: These findings show that the combination of face-to-face and remote health guidance is effective in preventing MS and mitigating it. An exercise habit might reinforce these effects.

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Objective: We have to discover people with early-stage metabolic syndrome during health check-ups and improve their dietary habits and other behavior in order to prevent them from developing lifestyle-related diseases in the future. We investigated whether dietary habits have an impact on metabolic-syndrome related laboratory data in Ningen Dock examinees.
Methods: Our subjects were 1,905 examinees aged 40 to 69 years (1,335 men and 570 women) who visited our center from April 2009 to March 2010. Dietary habits were investigated using an interview sheet with the title Dietary Habits Table, which requested 14 categories of dietary habit-related information. The responses obtained were compared statistically with body mass index (BMI), abdominal circumference, serum triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), fasting blood sugar (FBS) and blood pressure, using multiple logistic regression analyses.
Results: Many women selected "eating a balanced diet", "daily intake of fruit", "plant oil", "like sweets" and many men "salty foods" and "drink noodle soup". Significant associations were found in both men and women between "eating moderately" and normal BMI and abdominal circumference measurements; between "eating moderately" and "eating a balanced diet" and normal LDL-C level, and between "like sweets" and a high HbA1c level. Significant associations were also found in men between "daily intake of milk" and normal TG and HDL-C levels, and in women between "daily intake of milk" and high LDL-C level. In men, there were also associations between "eating out", "like salty food" and "no daily intake of fruit" and obesity or dyslipidemia.
Conclusion: We confirmed that there is a clear association between dietary habits and metabolic-syndrome related laboratory data and aim to use our findings in health guidance in the future.

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Objective: "Lung age", which is calculated from the height, sex and one second forced expiratory volume, is used as an index of respiratory function. Its main worsening factor is smoking. We investigated the lifestyle factors that worsen lung age in non-smokers because such factors had not been clarified.
Methods: 1,291 males (49.9±11.1 yrs) and 1,689 females (50.4±11.8 yrs) who had no respiratory disease and underwent Ningen Dock at the Shimbashi Medical Check-up Office of Jikei University Hospital were enrolled in this study. The influences of the following factors on the difference between lung age and real age were evaluated: exposure/non-exposure to second-hand smoke, body mass index, increase in body weight since 20 yrs old, ethanol intake (g/week), and whether subjects did at least one hour of hard exercise per week, at least one hour of walking per day or fast walking, or not.
Results: In the males, an increase in body weight since 20 yrs old and less than one hour of hard exercise per week worsened lung age. In the females, an increase in body weight since 20 yrs old and less than one hour of walking per day worsened lung age.
Conclusion: This study suggests that an increase in body weight and less physical activity are lifestyle factors that worsen lung age in non-smokers.

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Objective: We evaluated the clinical effectiveness of a novel procedure developed by us for barium enemas in improving the quality of X-ray images. A low-density barium sulfate suspension (2w/v%, referred to as LD barium) is first injected to flush the inside of the colon before performing the barium enema.
Methods: Between February 2010 and June 2010, 290 patients undergoing barium enema examinations were assigned to either a flushing group (group A) or non-flushing group (group B), and the deep colon (ascending colon and cecum) was examined to compare adhesion of barium, volume of remaining feces and visualization of FNP (fine network pattern) as endpoints using Barium Enema Imaging Evaluation Criteria. Twenty-seven patients (aged from 32 to 68, average age 50 years, male: female ratio 13:14) were assigned to group A, and 26 patients (aged from 27 to 76, average age 48 years, male: female ratio 10:16) were assigned to group B.
Results: Group A was superior to group B with respect to all endpoints in the ascending colon and cecum.
Conclusion: Flushing the inside of the colon with LD barium improved the quality of X-ray images of the deep colon.

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Objective: To compare the results of estimating %vital capacity (%VC) using a new formula and the %VC judgment grades in the 2008 revision (new standard) with estimation by formula of Baldwin's formula for this purpose and the 2002 judgment grades (former standard) in testing pulmonary function.
Methods: In a total of 118,733 persons undergoing pulmonary function tests, %VC was calculated by the new and former standards, and evaluation grades assigned according to them. In addition, temporal changes in vital capacity for subjects with restrictive ventilatory impairment who underwent repeated testing were examined according to the new standard.
Results: Incidence of less than 80% vital capacity (restrictive ventilatory impairment) was 7.5% by the former standard and 28.8% by the new standard. By the former standard, rates for the evaluation grades of A: no abnormality, C: follow-up required and D; treatment required were 92.5%, 7.2% and 0.3%, respectively. By the new standard, in which there is no Grade C, rates were 71.2% for grade A, and 28.8% for grade D. Furthermore, in a detailed examination of restrictive ventilatory impairment by the new standard, %VC ranged from 70 - 79% in 81.8% of cases, 60 - 69% in 15.8% and less than 60% in 3.1%. In subjects undergoing repeated testing, for those with a %VC in the range 70 - 79% in the initial test, the results of the final test showed an increase in %VC for 70.6% and a decrease for 28.7%. In subjects in whom the decrease occurred over 3 years or more, the average annual change in vital capacity was -0.78±0.89 percentage points.
Conclusion: According to the new standard, while there was a 3.8-fold increase in the number of subjects with restrictive ventilatory impairment, 80% of them were in the 70 - 79% %VC range and at about -0.8 percentage points per year, the average annual decrease in %VC was small, so such subjects could be the target of follow-up.

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