Chronic kidney disease (CKD) causes not only end-stage kidney disease, which requires dialysis therapy, but also cardiovascular disease. As a cause of CKD, the prevalence of lifestyle-related diseases, such as diabetes mellitus and hypertension, has been increasing, although that of chronic glomerulonephritis has been decreasing. Risk factors of CKD include obesity, metabolic syndrome, hyperuricemia, dyslipidemia, and smoking. Early detection of CKD by Ningen Dock followed by dietary and lifestyle guidance is important in suppressing the progression of CKD for prevention of end-stage kidney disease and cardiovascular disease.

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Objective: We investigated the situation of hematuria in health check-up examinees.
Methods: We collected hematuria data for 16,018 subjects (10,841 males, 5,177 females) who underwent a health check-up at the Health Management Center of Toranomon Hospital during a one-year period from February 2011, and examined differences by sex and age.
Results: 10.9% of males and 26.8% of females (excluding those who were menstruating) were positive for hematuria (1+ or greater) and the positive rate tended to increase with age.
Conclusions: Positive rates for hematuria in health check-ups were higher than previous reports and there were clear differences between the sexes and age groups. In addition, positive rates for hematuria in our facility had risen between 2004 and 2011, and 2012. Hematuria testing was standardized in Japan in 2006 and while the influence of this is unknown, we considered that hematuria could be increasing over time.

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Objective: We investigated the clinical significance of hematuria in health check-up examinees.
Methods: We collected hematuria data for 16,018 subjects (10,841 males, 5,177 females) who underwent a health check-up (Ningen Dock) at the Health Management Center of Toranomon Hospital during a one-year period from February 2011, and investigated an association between hematuria and estimated glomerular filtration rate (eGFR). Next, in 58,337 subjects (48,141 males, 18,152 females) who underwent Ningen Dock in the 4-year period from 2008 to 2011, the results for hematuria at the time of Ningen Dock were examined for those who had later been diagnosed with renal cell carcinoma and bladder cancer on the basis of kidney and ureteral stones in abdominal ultrasonography and further examinations.
Results: In multivariate analysis including age, there was no significant association between hematuria and low eGFR. Also, the positive rate for hematuria in those in whom kidney stones were observed in ultrasonography was just 18.5%. In addition, only 8.3% of those with renal cell carcinoma and 28.6% of those with bladder cancer had been positive for hematuria.
Conclusions: While positive rates for hematuria in Ningen Dock were higher than previous reports, we considered that our findings did not suggest that being positive for hematuria in a single urine test would be an effective predictor of CKD or other urological diseases. In the future, it will desirable to have new guidelines, which also include a consideration of health economics, for determining the validity of examining those positive for hematuria further.

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Objective: Prostate cancer is a typical cancer in older age men and in Japan, it is expected to be the first-ranking male cancer in 2020. Japan introduced a medical care insurance system for late-aged persons in April 2008 and under it, “late-aged persons” are defined as men and women aged 75 years or older. In this study, we investigated the characteristics of prostate cancer in late-aged men.
Methods: Prostate cancer was discovered in 612 patients at Kurosawa Hospital from January 2002 to December 2012. Among them, 436 were analyzed regarding prognostic grouping of prostate cancer and 472 were analyzed regarding pathological classification. UICC classification (7th edition, 2009) was used as the prognostic classification and for the pathological classification, the Gleason score was used.
Results: In the late-aged men, the rate for infiltrating cancer plus metastatic cancer (III + IV) was 33.3% in the screening group and 47.1% in the outpatient clinic group. On the other hand, in men under 75 years of age, the rate for infiltrating and metastatic cancer (III + IV) was 18.4% in the screening group and 33.6% in the outpatient group. Thus, in the outpatient group, the rate for III+IV stage cancer in the late-aged men was significantly higher than that in men under 75 years of age (p<0.05). Regarding subjects in whom the PSA measurement was under 50 ng/mL, the Gleason score in the late-aged men was significantly higher than that in men under 75 years of age (p<0.05).
Conclusion: Our findings demonstrated the significance of prostate cancer screening in the late-aged men as well as in men under 75 years of age in Japan.

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Objective: At our center, we carry out retinal nerve fiber layer analysis by optical coherence tomography (hereafter OCT) as an optional examination item. We reexamined its usefulness for glaucoma.
Methods: For 6,443 (3,698 males, 2,745 females) average age 49.4 ± 9.4 (18-82) who underwent fundus camera (no mydriasis eyeground photography), intraocular pressure (non-contact), or OCT (retinal nerve fiber layer analysis) examinations from April, 2011 to March, 2014, we carried out an investigation of the positive rates of each inspection, agreement rate using kappa, and examination route used by the glaucoma diagnostician making the diagnosis.
Results: The glaucoma positive rates for each examination were fundus camera 7.5%, OCT 22.3%, and intraocular pressure 1.3%. There was a 73.2% correlation between OCT and fundus camera, indicating close agreement. In 14 cases in which there was no agreement, 6 of pre-glaucoma were included. Low agreement was seen for fundus camera and intraocular pressure, OCT and intraocular pressure. For patients determined to be positive in examinations, the rates for routes which finally led to a diagnosis of glaucoma were fundus camera 95.6%, OCT 15.6%, and intraocular pressure 4.4%.
Conclusions: The level of agreement between OCT and fundus camera, the most effective detection route, was high, and OCT was also able to detect pre-glaucoma. These results reconfirmed its usefulness in Ningen Dock.

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Objective: The standard cookie test, an existing challenge diet, is characterized by the difficulty of completely ingesting all the cookies within a particular time frame. We devised an improved challenge diet in which the number of cookies is decreased and an amount of powdered sugar equivalent to the reduction in carbohydrate content is dissolved in sugar-free tea. We evaluated the effectiveness of our improved challenge diet by comparing its glycemic pattern with existing challenge diets, as well as from the responses of subjects to a questionnaire.
Methods: We recruited ten volunteers who had not been previously diagnosed with diabetes and whose fasting blood glucose level was ≥ 90 mg/dL at the most recent health check-up. Trelan-G^®, a cookie test, and our improved challenge diet were administered at 1-week intervals. Blood sampling was performed at 0, 30, 60, and 120 minutes after administration to measure parameters related to sugar and lipid metabolism.
Results: Blood sugar and insulin patterns following administration of our new challenge diet were similar to those of Trelan-G and glucose intolerance could also be detected using 1-hour plasma glucose with the new diet (concordance rate: 9/9). Blood lipid levels increased after the new diet and the questionnaire revealed that the difficulty of subjects in complying with it was reduced compared with the cookie test.
Conclusion: We confirmed that our new challenge diet maintained a constant level of performance and that it reduced the burden on subjects. This challenge diet could be useful for the early detection of glucose intolerance and/or postprandial hyperlipidemia during a routine health check-up.

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Objective: We examined the efficacy of Shakuyakukanzoto, a Chinese herbal medicine, when used as premedication against peristalsis in upper gastrointestinal endoscopy.
Methods: Seventy-eight subjects underwent upper gastrointestinal endoscopy. Each was given a premedication containing Gascon^TM (dimethicone), with or without Shakuyakukanzoto. The peristaltic activity at the antrum was estimated by examiners according to the Niwa criteria. It was also independently estimated later by a physician using DVD records. The extent of any problems due to peristalsis during the examination was evaluated using the Visual Analogue Scale.
Results: The subjects who had been given a premedication containing Shakuyakukanzoto showed less peristaltic activity than the others, although the difference was not statistically significant.
Conclusion: The present study suggests that, when used as a premedication, Shakuyakukanzoto could reduce peristaltic activity in upper gastrointestinal endoscopy during health check-ups.

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Objective: To extend healthy life expectancy, the prevention of fractures due to reduced bone density is important because they are a major cause of elderly people becoming bedridden. However, at our center, only about 2% of males and 25% of females underwent bone density examinations. In order to encourage people to have these examinations, we studied association between arteriosclerosis-related items and bone density, and determined the high-risk items.
Methods: Our subjects were 321 women who underwent bone density examinations for the first time and internal abdominal fat measurements by CT in health check-ups between April 1 2008 and January 31 2014. Using statistical methods, we studied possible association between examination date, lifestyle habit items and decreased bone density.
Results: The t test revealed significant differences in the following items, with p<0.001 for age at examination and hypertension; p<0.01 for HbA1c value and p<0.05 for visceral fat, BMI and drinking. Also, the χ² test revealed significant differences in the following items, with p<0.001 for menopause and hypertension and p<0.05 for visceral fat and BMI. Further, in a logistic regression analysis model with age at examination, subcutaneous fat area, HbA1c value, total cholesterol and smoking as explanatory variables, the accuracy rate was 83.4%, and in the Hosmer-Lemeshow test, the value of χ² was 8.060 and that of p was 0.428 (greater than significance level of 0.05). This indicated that results were optimal and demonstrated the usefulness of these variables in predicting reduction in bone density.
Conclusion: While an association with smoking was not immediately obvious in the χ² test and t test, its addition to the explanatory variables for logistic regression analysis had a major impact on predicting osteoporosis. While there is a tendency to focus on association with single item, we think it is necessary to consider association between multiple items and reflect this in lifestyle guidance.

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Objective: As vasovagal reaction (VVR) is a major adverse effect due to blood drawing, it is necessary to have measures to prevent VVR and procedures to take if it occurs at the time of blood withdrawal. We investigated the current status of subjects developing VVR at our center.
Methods: VVR occurred in 29 of 41,076 men (average age: 45.7 ± 11.3yrs) and 18 of 22,217 women (44.0 ± 12.3yrs) who had blood drawn at our center from December 2012 to September 2014. We investigated the cases of VVR with regard to age, gender, BMI, sleep length, severity and recovery process.
Results: Nineteen of the 47 people who suffered VVR were 29 years old or younger (prevalence: 0.30%). Risk factors were short sleep time, female gender and being thin. Most cases were not severe and subjects recovered by resting on a bed with their legs up.
Conclusion: It is important to improve the blood drawing environment to reduce the VVR risk. We need to pay attention to subjects at high risk, including those lacking sleep. We should also recommend that people lie down during blood drawing, and communicate with them to relieve any concerns.

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Objective: Both nonalcoholic fatty liver disease (NAFLD) and nephrolithiasis are considered to be associated with lifestyle-related diseases and metabolic syndrome (MetS). We analyzed an association between NAFLD and nephrolithiasis.
Methods: Subjects were 2,227 persons who underwent ultrasonography at our Center from June 2011 to December 2013. Those with past history of liver diseases and/or alcohol intake of > 20g/day had been excluded. Subjects were divided into a group with NAFLD and a group without NAFLD by gender. Age, presence of life-style related diseases, therapeutic situation, frequency of MetS, and lifestyle were compared between the 2 groups. The same factors were also compared between groups with nephrolithiasis and groups without nephrolithiasis. According to presence or absence of NAFLD, we divided subjects into two groups, and compared the frequency of nephrolithiasis, and according to presence or absence of nephrolithiasis we divided subjects into two groups and compared the frequency of NAFLD. Furthermore, according to presence or absence of NAFLD and nephrolithiasis we divided them into to four groups (neither NAFLD nor nephrolithiasis, only nephrolithiasis, only NAFLD, both nephrolithiasis and NAFLD) and compared them.
Results: In multivariate analysis, a significant association with NAFLD was observed for obesity, dyslipidemia, and impaired glucose tolerance, but only in males for hyperuricaemia. A significant association with nephrolithiasis was observed for hypertension and dyslipidemia in males. There was an association between presence of NAFLD and that of nephrolithiasis. In the comparison of four groups, frequencies of life-style related diseases and MetS in the group with both NAFLD and nephrolithiasis were higher than in the other three groups.
Conclusions: Our study suggested that both NAFLD and nephrolithiasis were related to life-style related diseases and MetS, and the pathological mechanisms of NAFLD and nephrolithiasis were similar. However, NAFLD was more strongly associated with life-style related diseases and MetS than nephrolithiasis. The combined presence of NAFLD and nephrolithiasis could enhance the progression of atherosclerosis.

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Objective: In order to demonstrate the effectiveness of colorectal cancer screening, we divided colorectal cancer patients into groups by means of discovery and carried out a comparison of disease progression status and medical costs.
Methods: Our subjects were 133 patients of less than 80 years in age diagnosed with colorectal cancer from April 2010 - March 2011, Disease progression status was obtained from hospital cancer records. Medical costs were determined for a period of one year from the date of diagnosis from medical treatment fees data. Analyses were also carried out by cancer stage and treatment method.
Results: Patients were divided into a screening group, with 48 subjects, and a hospital group (patients who were examined in hospital after symptoms were observed), with 85 subjects. For cancer stage 0, there were 28 subjects in the screening group (58.3%) and 28 subjects in the hospital group (32.9%). For early cancer at Stage 0 and Stage I, there were 38 subjects (79.2%) in the screening group and 37 subjects in the hospital group (43.5%). Endoscopic treatment on an outpatient basis was conducted in 25 subjects in the screening group (52.1%) and 14 subjects in the hospital group (16.5%). Treatment by endoscopic surgery or surgical operations had been completed in 38 subjects in the screening group (79.2%) and 45 subjects in the hospital group (52.9%). The median annual medical costs per person for the screening group was ￥229,495 (mean ￥741,504±￥752,431) and that for the hospital group was ￥1,753,790 (mean ￥1,927,710±￥1,698,447) for the hospital group.
Conclusion: Colorectal cancer screening would not only enable cancer to be discovered at an early stage, it would also help to keep medical costs down.

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Objective: We conducted a written questionnaire survey concerning health guidance skills in order to determine the necessary requirements for supporting lifestyle modification.
Methods: The subjects were 842 (351 doctors, 305 public health nurses, 186 registered dietitians) of 982 attendees of the 2014 Skill Enhancement Workshop for Ningen Dock Health Support Advisors from whom valid responses to a written questionnaire concerning skill proficiency levels of health support advisors were obtained. Using the questionnaire, attendees rated their proficiency levels at the beginning of the workshop according to 4 grades. The results were analyzed by proficiency level for individual items for the respondents overall and by occupational category. For some public health nurses, results were also analyzed by number of years of experience in health guidance.
Results: Overall, proficiency levels were high for items concerning individual support but low for items concerning group support. Scores for items relating to specific support for reducing alcohol consumption and smoking cessation based on the AUDIT and the ABC/ABR approach were low. While scores for proficiency in exercise risk management were high for doctors, those for public health nurses and registered dietitians were low. Scores for items relating to the specific health guidance system were high for public health nurses and registered dietitians. Scores for diet-related items were high for registered dietitians but low for doctors and public health nurses. For public health nurses with many years of experience in health guidance, scores were significantly higher for items regarding the specific health guidance system and its evaluations, items regarding physical activity and those regarding an association between drinking and smoking and lifestyle-related diseases.
Conclusion: In order to raise the effectiveness of health guidance, workshop content should be more focused on skills with low proficiency levels and there should be greater cooperation among the various health professionals involved so that they can complement each other's skills.

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