Objective: A limited number of epidemiological studies have attempted to assess thyroid function and coronary artery disease (CAD) risk factors in the general population. We attempted to clarify relationships between underlying thyroid dysfunction and serum low-density lipoprotein cholesterol (LDL-C) levels in subjects undergoing annual health examination in Japan.
Methods: Of 2,727 subjects who visited Tokai University Hachioji Hospital for annual health examination, 1,434 men and 1,065 women were included in this study. Subjects on medication for dyslipidemia, and those with a prior history of thyroid disease or CAD were excluded. We classified thyroid function based on serum thyrotropin (TSH) concentrations.
Results: LDL-C levels in subjects with low TSH were lower than those in subjects with normal TSH. On the other hand, no difference in LDL-C levels was observed in subjects with high TSH. In females aged 55 and above, more than 40% had high LDL-C levels, and more than 10% had a high TSH concentration. Moreover, for this subject group, the percentage achievement of treatment goals gradually declined in pace with increasing TSH levels, going from low, through normal, to high. Specifically, more than half of the female subjects in this age group with high TSH did not achieve their treatment goals.
Conclusion: The results of our study to assess whether high LDL-C is due to thyroid dysfunction suggest that female subjects aged 55 years and above with LDL-C ≥140 mg/dL should receive thyroid function tests.

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Objective: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease, and elevated serum uric acid (SUA) has been reported to be associated with the progression of CKD. We therefore examined the prevalence of CKD and whether higher SUA decreased the estimated glomerular filtration rate (eGFR) after 10 years.
Methods: The subjects were 5,629 men and 3,711 women who visited our hospital for a health check-up in 2008. The prevalence of CKD and the relationship between SUA and eGFR were investigated. Subjects who had participated our ‘human dry dock’ program in both 2008 and 1998 and had no renal dysfunction (60≤ eGFR <90) in 1998 were divided into 2 groups: no remaining renal dysfunction group (N-group) and renal dysfunction group (D-group). We compared the changes in their eGFR and SUA after the 10-year interval.
Results: The proportion of subjects with CKD was 13.9%. SUA in 1998 was correlated negatively with eGFR 10 years later (men: r=-0.17, p<0.01, women: r=-0.13, p<0.01). SUA was already higher in the D-group than that in the N-group in 1998. SUA increased after 10 years in the D-group and in N-group females, and decreased in N-group males. Urine pH increased only in N-group males, so it was higher than in D-group males in 2008.
Conclusion: SUA was correlated negatively with eGFR after 10 years, and higher SUA levels appeared to be related to the decrease in eGFR suggesting that SUA may be a predictive parameter for CKD.

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Objective: Metabolic syndrome enhances coronary heart disease and cerebral stroke. However, few longitudinal studies have been conducted on the incidence of coronary heart disease and cerebral stroke in Japanese patients with non-alcoholic fatty liver disease (NAFLD) and the risk factors for its development.
Methods: A total of 1,798 NAFLD patients with an age of ≥60 years were enrolled. The primary event was the first onset of coronary heart disease or cerebral stroke. Independent factors associated with the incidence rate of such events were analyzed by the Kaplan-Meyer method and the Cox proportional hazard model. The mean observation period was 7.5 years.
Results: The number of cases of coronary heart disease or cerebral stroke that developed was 137. The 10th year cumulative development rate was 11.7% in the NAFLD patients. Cox proportional hazards analysis revealed the following: 1) Coronary heart disease occurred with statistical significance when patients had poor control of blood pressure, smoking, low high density lipoprotein level, and high glucose level. 2) Ischemic stroke occurred with statistical significance when patients had poor control of blood pressure, an age of ≥70 years, and high glucose level. 3) Hemorrhagic stroke occurred with statistical significance when patients had poor control of blood pressure, age ≥70 years, low albumin level of <3.9 g/dL and high aspartate aminotransferase to platelet ratio index.
Conclusion: Our study indicates that the risk factors for the development of vascular disease are different for coronary heart disease, ischemic stroke and hemorrhagic stroke in Japanese elderly patients with NAFLD.

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Background: Carcinoma of the prostate continues to be a major health problem in Japan. The incidence of prostate cancer is increasing. The degree of variability in PSA measurements is important for interpreting the results of this test in screening programs, particularly for interpreting the significance of changes in repeated tests. There is also the issue of how we should manage cases of abnormal PSA values within a health check-up.
Subjects and Methods: Serum prostate-specific antigen (PSA)-based prostate cancer screening was conducted on healthy Japanese seamen between 2005 and 2007. To determine the long-term intra-individual variation in PSA in healthy men, we analyzed the annual changes in PSA levels in 164 men who underwent PSA measurement continuously for three years.
Results: The levels of serum PSA in this group were relatively low, and the PSA levels in each person with a level less than 2.0ng/mL at the first measurement (baseline PSA) remained steady for 3 years.
Conclusion: Individuals with a PSA level of more than 4.0 ng/mL and those in whom there is an increase in PSA level of more than 2.0 ng/mL at the second round of screening in a health check-up should be further evaluated by specialists.

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Objective: In recent years, as the incidence of pulmonary tuberculosis has been continually declining, the usefulness of chest radiographs in health check-ups has been questioned. We evaluated cases of pulmonary tuberculosis detected in our health check-ups, and discuss the necessity of chest radiography in them.
Methods: A total of 12,581 examinees were screened by chest radiography at our health care center from July 2009 to March 2011 and we report on cases of pulmonary tuberculosis diagnosed from abnormal findings in the chest radiographs taken.
Results: Four of the 12,581 examinees were diagnosed with pulmonary tuberculosis, and the detection rate was 0.03%. It could be detected in all 4 cases in spite of shadows on chest radiographs only indicating slight symptoms. Two of the examinees with abnormal findings delayed in consulting a doctor.
Conclusion: Health check-ups play an important role in this regard because patients tend to avoid seeing a doctor if their symptoms are only slight. Health check-ups are particularly effective for discovering pulmonary tuberculosis in areas of high prevalence, so it is necessary to educate persons in charge of company health care departments in such areas to make plans for employees to have health check-ups. In addition, the present study reconfirms the importance of consulting a doctor soon after a health check-up so that treatment can be started as early as possible.

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Objective: To qualify gastric cancer screening with ultrathin transnasal endoscopy in our facility.
Methods: We compared the detection rate of gastric cancer by transnasal endoscopy to that using regular-sized endoscopy. We examined 12,021 and 9,819 male health check-up subjects by transnasal ultrathin endoscopy and regular-sized endoscopy, respectively, from April 1995 to March 2011.
Results: Gastric cancer was detected in 34 subjects in the transnasal endoscopy group, and the detection rate was 0.28%. The results were not inferior to those for the regular-sized oral endoscopy group (31 subjects and 0.32%). The clinicopathological findings for the cancer cases indicated an early cancer rate of 85.3% in the transnasal endoscopy group, and 38.2% of the cancer cases were treated by endoscopic resection. These results were not significantly different from those for the regular-sized endoscopy group. In the transnasal endoscopy group, lesions located at the U regions were more frequent than in the regular-sized endoscopy group, and those of less than 20 mm in diameter were also more frequent.
Conclusion: These results show that transnasal endoscopy is not inferior to regular-sized endoscopy for gastric cancer screening. For further investigation, we need to conduct a multi-center prospective study using a standardized observation method.

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Objective: Using findings from health check-ups, we investigated longitudinally whether there are any factors influencing the worsening of glucose tolerance in non-diabetic Japanese.
Methods: Subjects were taken from among persons undergoing annual health check-ups in both 2004 and 2010, and informed consent was obtained from them. In total, 390 Japanese male and 147 female teachers and other workers of 25-60 years of age at baseline were enrolled in this study. Subjects diagnosed as having diabetes mellitus (DM) at baseline were excluded. Height, weight, blood pressure, fasting plasma glucose (FPG), HbA1c, serum lipids, insulin and high-molecular-weight (HMW)-adiponectin levels were measured after an overnight fast. Subjects were divided into 3 groups in 2004 and 2010: DM, Pre-DM and normal glucose tolerance. Serum insulin concentrations were measured by EIA and serum HMW-adiponectin by ELISA.
Results: After the 6 years, glucose tolerance had improved in 2 subjects, was unchanged in 347 and worsened in 41 for males, while the figures for females were 0, 133 and 14, respectively. Baseline factors correlating significantly with status ［No change = 0 / Worsened = 1］ were age, BMI, plasma glucose, TG, LDL-cholesterol, ALT, γ-GTP, HOMA-IR and HMW-adiponectin. No correlations were observed with baseline smoking, alcohol consumption or exercise status. Stepwise multiple regression analysis of ［No change / Worsened］ as a dependent variable showed that there were significant independent correlations for baseline glucose, HMW-adiponectin (F = 11.5, r’ = -0.165) and age in males (P< 0.0001, R²= 0.156).
Conclusions: The findings of this 6-year longitudinal study suggested that low baseline HMW-adiponectin, together with baseline glucose level and age, are predictive of worsening glucose tolerance in non-diabetic Japanese men.

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Objective: Early detection of dementia is very important because patients can experience some recovery and improvement if they are treated in the early stages of the disease. The kana-picking test (Japanese character picking test) is considered to be useful for detecting preclinical dementia and it has been recently reported that Computed Tomography linear measurements are also effective. We examined whether these methods can be used as screening tests for the early stages of dementia in Ningen dock.
Methods: A total of 107 subjects undergoing routine health check-ups who selected “early screening tests for dementia”, an optional service provided by our Ningen Dock, from April 2010 to March 2011 were enrolled. After practicing for the kana-picking test, they underwent the test and their brain CT scans were evaluated by a radiologist. A series of CT linear measurements were also obtained from brain CT and we examined for a relationship between them and scores in the kana-picking test.
Results: A 70-year-old male subject scored less than borderline in the kana-picking test and the radiologist reported temporal lobe atrophy in this subject's brain CT. A strong correlation was noted between kana-picking test scores and CT linear measurements.
Conclusion: We confirmed that the kana-picking test is useful for detecting preclinical dementia in Ningen Dock because it allowed us to identify an asymptomatic subject with brain atrophy. The findings of our study suggest that CT linear measurements may help raise the effectiveness of screening for preclinical dementia.

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Objective: In our center, we determine the possibility of conducting upper gastrointestinal tract contrast examinations (hereafter MDL) after examining and interviewing examinees. In cases in which MDL is considered inapplicable at the time, the examination details are amended, either changing to endoscopy or conducting MDL at a later date. As it was considered important to have a system for ensuring the safety of examinations, we examined amendments that had been made to examination details in order to develop such a system.
Methods: From a list of examinees, we selected those in whom there had been amendments to MDL or it had been canceled, and classified the amendments according to 6 categories of reasons for amendment, by gender, age and number of examinations undertaken, and conducted a comparison.
Results: The examination was amended or canceled for 230 examinees, 0.9% of the total. Males accounted for 43% and females 57%; their average age was 55.6±11.8 years; by age group 72 were in their 50s (31.3%), 61 in their 60s (26.5%), 42 in their 40s (18.3%) and 24 in their 70s (10.5%). As reasons for amdendment or cancellation, there were 63 cases of poor physical condition (27.4%), 31 cases of postoperative adhesion (13.5%), 30 cases of severe constipation (13.0%), 17 cases of feeling of disgust, allergy, etc. (7.4%) and 82 cases of unspecified reason (35.7%). The number of examinations undertaken was 2-5 for 101 examinees (43.9%) and one for 73 (31.8%). The details of amendment were change to endoscopy in 125 cases (54.4%), MDL at later date in 61 cases (26.5%) and GI examination cancellation in 44 cases (19.1%).
Conclusion: Amendment was particularly frequent in women with poor physical condition, with constipation and feeling of disgust as major reasons. Important points in conducting MDL safely and efficiently were considered to be information collection procedures and capabilities, developing a system for sharing information, risk management and examinee education including instruction.

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Objective: The purpose of this retrospective cohort study was to evaluate an association between hyperuricemia and plasma glucose (PG) and immunoreactive insulin (IRI) during a 75 g oral glucose tolerance test (OGTT) in subjects with normal and borderline OGTT patterns.
Methods: Out of 1175 subjects who underwent the OGTT, 1007 with normal or borderline OGTT patterns were enrolled in the present study. The enrolled subjects were divided into 2 groups: high uric acid (UA) level group with UA > 7.0mg/dl; normal UA level group with UA ≤ 7.0mg/dl. They were also classified into 25,50,75 and 100 percentiles.
Results: High UA group had a higher plasma IRI response pattern; High UA group had higher rate of fatty liver than normal UA group; Subjects in high UA group had higher rate of delayed IRI response pattern than subjects in normal UA group.
Conclusion: The present study indicates a relationship between hyperuricemia and hyperinsulinemia.

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Objective: It has been known that gallbladder stones are associated with obesity or dyslipidemia for some time. In the present study, we investigated to see if there is an association between gall bladder stones and lifestyle habits or metabolic syndrome.
Methods: We selected 18,540 persons (10,911 males, 7,629 females) who had been examined at the general health center of our hospital between 2004 and 2010 and consented to take part in the study as our subjects. Persons with viral hepatitis and other chronic liver diseases as well as those who had undergone cholecystectomy were first eliminated.
Results: Gallbladder stones were noted in 602 subjects (3.2%). For those with gallbladder stones, age, BMI, waist circumference, blood pressure, fasting blood sugar, HbA1c and tryglycerides were all significantly higher than in those without, while HDL levels were significantly lower. The incidences of fatty liver and MS were also significantly higher. As for lifestyle habits, no association was seen for coffee consumption or smoking but the frequency of gallbladder stones was lower in those who drank alcohol. Multivariate analysis indicated that independent risk factors for gallbladder stones were age and large BMI for both men and women, and MS was an independent risk factor for men alone. On the other hand, alcohol consumption was found to be a inhibitory factor.
Conclusion: We consider that gallbladder stones are a lifestyle disease associated with individual factors of MS and that interventions such as lifestyle improvement guidance are necessary to prevent them.

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Objective: The purpose of this study was to examine relationships between personality traits and subjective stress symptoms in persons who underwent stress check-ups at our healthcare center. In this study, we called stress check-ups “Stress-Dock”.
Methods: The subjects were 46 adults (26 men and 20 women) who underwent stress check-ups between April 2009 and March 2011. Questionnaires used were the Yatabe-Guilford Personality Inventory(YG) and the Cornell Medical Index-Health Questionnaire(CMI). In this study, we defined the subjective symptoms in CMI used for neurosis screening as subjective stress symptoms.
Results: Emotional instability personality and obedience personality were significantly correlated with all subjective stress symptoms except cardio-vascular system-related symptoms. Aggressiveness was significantly correlated with sensitivity and anger. There were significant correlations between subjectivity and all subjective stress symptoms. Rhathymia was not significantly correlated with any subjective stress symptom.
Conclusion: Our study revealed that the manifestation of subjective stress symptoms differed with personality traits. Inferiority complex, over-adaptation and type A personality were focused on because they are considered to be personality traits conducive to stress. The findings of the present study should help improve the accuracy of stress check-ups as well as stress reports to examinees.

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Objective: In Specific Health Guidance, it may not be possible to provide continuous follow-up up to the final guidance session for various reasons. The reasons for high non-completion rates for Specific Health Guidance at other facilities and the factors behind non-completion were unclear. Our objective was therefore to investigate the reasons for persons not completing Specific Health Guidance at Seirei Numazu Hospital and to determine effective methods for continuous follow-up.
Methods: Among 12 persons conducting Specific Health Guidance at Seirei Numazu Hospital, we conducted group interviews of 6 who were in charge of 17 persons who did not complete Specific Health Guidance in fiscal 2009, and performed qualitative analysis of the findings.
Results: The analysis of 171 code items enabled us to determine the causes of non-completion and effective methods for continuous follow-up.
Conclusion: The findings suggested that the factors behind non-completion were those related to the persons receiving guidance (hereafter subjects) and those related to the persons in charge of guidance and the operation of the facility giving it. We determined that there were 2 effective ways of ensuring continuous follow up which were enhancement of guidance techniques and refinement of follow-up procedures. Listening to the opinions of the persons in charge of guidance provided a good opportunity to consider the causes of non-completion, effective ways for ensuring continuous support and factors interfering with follow-up. However, due to the small number of subjects and the fact that opinions were those of persons in charge of guidance rather than those not completing it, there is a potential bias in the results. We aim to study the issue of non-completion further in the future.

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