[in Japanese]

View full abstract

Objective: A study on persons receiving Specific Health Guidance reported that a reduction in weight of at least 3% improved clinical test results. In the present study, we aimed to determine lifestyle habits making it easier for large numbers of people receiving Specific Health Guidance to achieve a decrease in weight. The participants were men receiving active support and we carried out an investigation to see if there was an association between lifestyle habits at the time of the initial specific health check-up and presence or absence of a decrease in weight thereafter.
Methods: We used data from 155 medical insurer facilities that consented to participate in the present study. The subjects were 4,266 men ranging in age from 40 to 64 years who in 2011 had been determined to require active support and had completed the course of health guidance from among 969,777 individuals who underwent specific health check-up in fiscal 2011, 2012 and 2013. To be determined as “achieved weight reduction” participants had to have a reduction of at least 3%. We examined associations between lifestyle habits determined by the medical interview during the specific health check-up in 2011 and achievement of weight reduction over 2 years using logistic regression analysis.
Results: After 1 and 2 years 33.2% and 35.4% had achieved a reduction in weight, respectively. A reduction in both years was achieved by 23.2% and those not achieving a reduction accounted for 54.5%. Among lifestyle habits, there was a significant association between “Don’t eat dinner in the 2 hours before going to bed” and achievement of weight reduction over 2 years (p=0.006).
Conclusion: Our findings suggested the possibility that achievement of weight reduction would be enhanced if men receiving Specific Heath Guidance could be persuaded not to eat dinner in the 2 hours before going to bed as a start.

View full abstract

Objective: To investigate variation in lung age with difference in smoking habit and study the usefulness of lung age.
Methods: The subjects were 18,975 men from among 33,052 people who underwent health check-ups at Omiya City Clinic from January to December 2015. Based on their smoking history, subjects were assigned to one of 3 groups: Current Smoker Group, Ex-Smoker Group and Never Smoked Group. and were investigated regarding their age, pulmonary function test results, and chest X-ray findings. Lung age was calculated using the formula stipulated by The Japanese Respiratory Society and a comparative examination carried out according to lung age difference = lung age - real age. We examined temporal changes in lung age difference in subjects who had continuously undergone health check-ups for 20 years.
Results: Lung ages were 61.5 years (±17.4), 61.7 years (±14.7) and 56.2 years (±14.9) in the Current Smoker, Ex-Smoker and Never Smoked Groups, respectively, and lung age differences were +12.7 years (±14.6), +8.9 years (±11.1) and +8.2 years (±12.1), respectively, and the lung age difference was significantly greater in the Current Smoker Group. Also, at 4.4%, the prevalence of emphysematous lesions observed in X-rays in the Current Smoker Group was significantly greater than in the other 2 groups. The lung age difference in the Ex-Smoker Group tended to become smaller. The lung age difference in the Ex-smoker Group tended to become smaller the longer the period since stopping smoking. While there had been no significant difference in lung age among the 3 groups 20 years ago, at the time of the study, lung age in the current smokers was higher and the lung age difference was significantly greater. No significant difference was observed between the Ex-Smoker and Never Smoked Groups.
Conclusion: Lung age difference increases due to smoking. It can be decreased by stopping smoking and is an indicator that is well correlated with smoking habit. The effect of stopping smoking at an early date is soon reflected as a change in lung age and as it is readily available to the examinee, lung age is effective in the early discovery and prevention of COPD.

View full abstract

Objective: In high-density breasts, the detection sensitivity for lesions is low with mammography (MG) but more effective screening can be expected if it is combined with ultrasonography (US). In the present study, we examined the results of breast density-focused screening combining mammography and US.
Methods: The subjects were 6,603 persons in whom an overall evaluation of screening combining MG and US was conducted between January 2013 and December 2014. They were divided into a high-density breast group (extremely dense/heterogeneously dense) and a non-high-density breast group (scattered fibroglandular densities/almost entirely fat) and examined regarding number of cancers discovered (rate), number requiring secondary testing (rate) and positive predictive value.
Results: Among the 6,603 subjects, there were 3,492 with high-density breasts (52.9%) and 3,111 (47.1%) with non-high-density breasts. In high-density breasts, the number of cancers discovered assuming screening by MG alone was 12 (0.34%) and combination with US increased it to 20 (0.57%). For non-high density breasts, the number of cancers discovered by MG alone was 11 (0.35%) but combination with US only increased it slightly to 13 (0.42%). In addition, before the overall evaluation, the number requiring secondary testing was 539 (8.2%), but this had decreased to 454 (6.9%) after it. However, compared with MG alone, the positive predictive value for combination screening was lower (8.13% vs. 7.27%), even after the overall evaluation. Examination according to breast density produced a similar result.
Conclusion: Combination with US increased the cancer discovery rate, particularly for high-density breasts, and our findings suggested that combination could raise the efficiency of breast cancer screening. Issues for the future were considered to be reducing unnecessary secondary testing as much as possible in the overall evaluation and raising the positive predictive value.

View full abstract

Objective: We examined whether a positive result for proteinuria in dipstick urinalysis was affected by the use of first morning void or spot urine specimens.
Methods: The sample population consisted of individuals who received a general health check-up at Kameda Medical Center. Urinalysis was conducted for 2,619 individuals who visited our hospital between June and October 2012 using spot urine specimens and for 2,512 individuals who visited our hospital between June and October 2013 using first morning void specimens. Patients who were menstruating, being treated for diabetes, being treated or observed for nephritis, or had either nephrosis or severe kidney disease were excluded. As a primary endpoint, we examined changes in the proteinuria positivity rate and investigated factors affecting this rate by performing logistic regression analysis. As a secondary endpoint, we examined changes in the occult hematuria positivity rate.
Results: The proteinuria positivity rate with the spot urine test was 3.9% (102/2,619) and that with first morning void urine was 1.8% (45/2,512), and the difference was statistically significant (p<0.001). Logistic regression analysis confirmed that the first morning void was independently associated with the reduced proteinuria positivity rate. The occult hematuria positivity rate with the spot urine test was 6.2% (162/2,619) and that with first morning void urine was 1.8% (45/2,512) and the difference was statistically significant (p<0.001).
Conclusions: Use of first morning void urine can lead to lower proteinuria and occult hematuria positivity rates than for spot urine.

View full abstract

Objective: We showed before in a cross-sectional study that both nonalcoholic fatty liver disease (NAFLD) and nephrolithiasis were associated with lifestyle-related diseases (LD) and metabolic syndrome (MetS). However, NAFLD was more strongly associated with them than nephrolithiasis. Furthermore, the combined presence of NAFLD and nephrolithiasis could enhance the progression of atherosclerosis. The present study had a longitudinal retrospective design.
Methods: The subjects were 756 persons who underwent ultrasonography at our center during the period from October 2007 to September 2010 as well as five years after baseline. Those with an alcohol intake of > 20g/day were excluded. Five hundred thirty persons without NAFLD at baseline were divided into a group with NAFLD and a group without NAFLD five years later. The change in LD and MetS was compared between the 2 groups. Seven hundred two persons without nephrolithiasis at baseline were also analyzed. Independent predictors of NAFLD and nephrolithiasis development were determined by multivariate logistic regression. Furthermore, according to NAFLD and nephrolithiasis development, 490 persons without NAFLD or nephrolithiasis at baseline were divided into four groups (neither NAFLD nor nephrolithiasis development, development of only NAFLD, development of only nephrolithiasis, development of both NAFLD and nephrolithiasis) and compared.
Results: Changes in LD and MetS in the group with NAFDL were significantly worse compared with the group without NAFLD. The independent predictors of NAFLD development were obesity, dyslipidemia, treatment for hyperuricemia, and absence of exercise habit. Although the predictors of nephrolithiasis development could not be clarified, in the comparison of the four groups, frequencies of LD and MetS in the group with NAFLD and nephrolithiasis were higher than in the other three groups.
Conclusions: Our study suggested that LD and MetS could be involved in the development of not only NAFLD but also nephrolithiasis in the near future.

View full abstract

Objective: Calculating statistics for each year of health check-up results, we examined historical changes in the frequency of NAFLD and check-up results.
Methods: We calculated mean ages and NALFD frequencies for each year for persons undergoing the general health check-up center at our hospital from 1996 to 2015 and examined changes over the 20 years. The health check-up results for examinees with NAFLD were divided into a first period (1996 - 2005) and a second period (2006 - 2015) and compared.
Results: The total number of examinees for 1996 - 2015 was 180,248 and there were 39,627 with NAFLD (frequency 22.0%). The frequencies of NAFLD by gender were 28.6% vs. 11.1% for men and women, respectively and that for men was significantly higher. The frequencies by age and gender were as follows: Up to 39 years (men vs. women: 25.5 vs. 4.1%), 40 - 49 years (30.6% vs. 7.9%), 50 - 59 years (29.0% vs. 16.0%), 60 years or over (25.6% vs. 19.7%). For men, the frequency was significantly lower for up to 39 years old and significantly higher for men in their 40s and 50s. For women, the frequency of NAFLD increased with age and at 60 years or above it was significantly higher. NAFLD frequencies for the first and second period were 19.0% and 23.8%, respectively, with the increase in frequency being significant. Comparing health check-up results in those with NAFLD between the first and second periods, AST, ALT and TG were significantly higher in the first period and age, BMI, HDL-C, fasting blood glucose, HbA1c and FIB-4 index were significantly higher in the second period. Regarding frequencies of abnormal results, those for AST, ALT and dyslipidemia were significantly higher in the first period while those for hypertension, high blood glucose and high BMI were significantly higher in the second period.
Conclusion: Health check-up examinees with NAFLD continue to increase steadily. In those with NAFLD, health check-up results for BMI and glucose tolerance have increased in recent years. Also, changes in the FIB4-index measurements over time in this study suggest that the number of NAFLD patients with progressive liver fibrosis at the time of health check-ups could be increasing.

View full abstract

Objective: The aim of this study was to analyze factors associated with decline in renal function in elderly patients with type 2 diabetes.
Methods: Averages of body weights, body mass indexes (BMI), blood pressures, and laboratory test results between 1995 and 1999 were used as explanatory variables. We calculated average estimated glomerular filtration rates (eGFRs) for 1995-1999 and 2010-2014, and regarded the difference between the two as decline in renal function. We enrolled patients who met the following criteria: (1) patient who visited our hospital more than three times a year from January 1995 to January 2014, (2) who was diagnosed as having type 2 diabetes before 1995 and whose average HbA1c was higher than 6.5% between 1995 and 1999, (3) who was born before 1950, and (4) whose average eGFR for 1995-1999 was higher than 70 mL/min/1.73m². We used Spearman’s rank correlation coefficients to investigate relationships between the decline in eGFR and the averages of parameters between 1995 and 1999, and conducted multiple linear regression analysis using the decline in eGFR as the objective variable.
Results: Based on correlation analysis, history of cardiovascular diseases, fatty liver, BMI, systolic blood pressure, blood glucose, gammma-glutamyltransferase (GGT), uric acid, high-density lipoprotein cholesterol, and urine albumin were all strongly correlated with decline in eGFR. Multiple linear regression showed that GGT and urine albumin were significantly correlated with the decline in eGFR.
Conclusion: In elderly patients with type 2 diabetes, higher urine albumin and higher GGT were associated with decline in eGFR.

View full abstract

Objective: In a total of 28,941 health check-ups performed on 10,854 persons at our center between April 2009 and December 2015, 5 cases of congenital heart disease were discovered. The objective of the present study was to examine an effective method of screening for congenital heart disease in adult health check-ups from the characteristics of these cases.
Methods: We investigated the 5 patients diagnosed with congenital heart disease at our center with respect to subjective symptoms, history of pregnancy and childbirth, chest auscultation findings, ECG exams, chest X-ray exams, number of health check-ups up to diagnosis, and prognosis.
Results: The congenital heart disease comprised 3 cases (all women) of atrial septal defect (ASD) and 2 cases (1 woman, 1 man) of patent ductus arteriosus (PDA). The abnormal findings were heart murmur only in 2 ASD patients and 2 PDA patients and ECG abnormalities and abnormal second heart sound in chest auscultation in 1 ASD patient. No patient had subjective symptoms and for 2 women who had experienced childbirth, there had been no abnormalities during pregnancy or at childbirth. Based on the chest X-ray exam, no patient was determined to require secondary testing. For 1 patient with ASD and 1 patient with PDA, the diagnosis of congenital heart disease had been made at the first health check-up but it had taken several check-ups for the diagnosis to be made in the other 3 patients. Catheter treatment was applied for 3 ASD patient and 1 PDA patient.
Conclusion: Congenital heart disease is an important disease that should be screened for in adult health check-ups but there are many cases of difficulty in diagnosis due to lack of characteristic findings. Chest auscultation is important in such cases.

View full abstract

Objective: We examined the effectiveness of utilization of the web health service “QUPiO for SEIREI” that we introduced in August 2013 whose objective was improving self-care ability.
Methods: Among 18,248 health check-up examinees who had a health check-up continuously over three years, 1196 (6.6%) were registered in the system in 2013 and used the record function, and 17,049 subjects (93.4%) were not registered. Body weight, BMI, waist circumference, blood pressure, blood data (triglycerides, HDL cholesterol, LDL cholesterol, fasting blood sugar, HbA1c, AST, ALT, γ-GTP) and lifestyle-related interview data were compared between the groups
Results: The age of those registered for the web service ranged widely, from 21 years old to 83 years, and more than half recorded their weight and step counts. In comparison, the age of non-registered group was younger and their weight was greater. In the subgroup with the highest usage, compared to those with low usage of less than once a month, body weight and BMI were significantly lower (p<0.01). In the group that used the web 0-1 times pre month or more, AST and ALT were significantly lower than in the non-registered group (p<0.01). Two years after registration, while walking or equivalent physical activity increased based on information from the lifestyle interview for all groups, the rate of increase was higher for the group that used the record service at least once a week.
Conclusion: The active use of the web service significantly improved the results of some check-up results suggesting that it would be an effective support tool. It also raised self-care ability.

View full abstract

Objective: In recent years, due to the westernization of the Japanese diet and other factors, increasing tendencies have been observed for reflux esophagitis and esophageal herniation over a wide age range from young people to the elderly. We report the findings of a study on health check-up examinees whose objective was to examine associations between these diseases and check-up results and diet.
Methods: The subjects were 1,060 persons who underwent upper gastrointestinal endoscopy in a health check-up at our association from April-December 2014. Defining reflux esophagitis as mucosal damage such as reddening and erosion in the lower esophagus, we calculated relative risk rates by the proportional hazards model for the health check-up items of obesity, fatty liver, LDL-C, triglycerides and HbA1c as well as the medical interview items of nocturnal eating habit, taking a meal before going to bed, drinking habit and alcohol amount, considering p<0.05 to indicate significance.
Results: There was much reflux esophagitis and esophageal herniation in men and by age group, reflux esophagitis was most frequent in the 70s (23.8%), followed by 39 years or younger (22.7%) and the 50s (18.1%). There was no significant difference by age group for esophageal herniation. The risk factors for developing reflux esophagitis were obesity, fatty liver, LDL-C, triglycerides, nocturnal eating habit, taking a meal before going to bed, drinking habit, and alcohol amount (large) but in the present study, the check-up item of HbA1c and the medical interview item of (alcohol amount <360 mL) were not risk factors according to the analysis. The risk factors for esophageal herniation were fatty liver, triglycerides and nocturnal eating habit.
Conclusion: The results of the present analysis suggested that there were close associations between reflux esophagitis and esophageal herniation and diet and eating habits. In the future it will be necessary provide dietary guidance not only to prevent lifestyle-related diseases but also the development of these esophageal diseases.

View full abstract

Objective: Shinkokai Sendai Medical Clinic changed the procedure of cervical brush cytology from conventional cytology to liquid based cytology (LBC) by the ThinPrep method in April, 2014, in order to improve the accuracy of cervical cancer screening. In this study, we compared the detection rates for conventional cytology and LBC, and reported on the effectiveness of LBC.
Methods: In this this study at our clinic, 20,341 instances of conducting cervical brush cytology by conventional cytology in 2013 (Jan - Dec) and 21,690 instances of conducting it by LBC in 2015 (Jan - Dec) were investigated. We compared the appearance rates of unacceptable specimens and the detection rates of atypical cells. The specimens for LBC were made using the ThinPrep system (autoloader).
Results: The appearance rates of unacceptable specimens were 0.39% for conventional cytology and 0.1% for LBC. The detection rates of atypical cells were given in the following. ASC-US: 0.84% for conventional cytology and 0.77% for LBC, ASC-H: 0.01% for conventional cytology and 0.03% for LBC, LSIL: 0.3% for conventional cytology and 0.6% for LBC, HSIL: 0.22% for conventional cytology and 0.29% for LBC.
Discussion: Compared to conventional cytology, the appearance rate of unacceptable specimens decreased with LBC. For LBC, the advantages are considered to be that it can maintain a high cell recovery rate and that it is not affected by level of skill of the cytotechnologist in the preparation of specimens. However, we consider that the burden of screeners in the microscopy process needs to be further reduced and that training in cell observation is required when switching to LBC. Some disadvantages of LBC are the high initial investment, increased running costs and the complicated pretreatment process.
Conclusion: We consider that the switch to LBC led to a reduction in unacceptable specimens and improvement in the atypical cell detection rate as well as a decrease in the burden of cytotechnologists.

View full abstract

Objective: To examine whether breath acetone concentration (BrAce) is a useful indicator of fat loss during weight reduction.
Methods: The study included 45 healthy women who took the Tokyo Adventist Hospital Weight Reduction Class between January 2011 and July 2014. They took the class once a week 6 times and blood was taken at the first and the end of the course. BrAce was measured by gas chromatography.
Results: Body weight and body fat as well as blood pressure, blood glucose, lipids, and liver function improved significantly. This was accompanied by improvements in lifestyle behavior as assessed by a behavior change checklist. Total ketone body in blood had increased significantly at the end of the 6-week course (total ketone body: beginning 73.6 ± 59.2 μmol/L, end 240.5 ± 193.8 μmol/L, p < 0.001). BrAce increased gradually in conjunction with decreases in body weight and body fat and it increased significantly from the 5th class. The increase in BrAce was significant at the end of the course (BrAce: beginning 529.2 ± 150.8 ppb, end 1156.6 ± 590.9 ppb, p < 0.001).
Conclusions: Breath acetone measurement is a non-invasive, useful means of monitoring fat burning and can be a good motivator to lose weight.

View full abstract

Objective: Detection rate is one of the criteria used to evaluate the quality of gastric cancer screening programs that use esophagogastroduodenoscopy. However, the detection rate is biased by the age distribution and sex ratio of the population undergoing endoscopy. Therefore, we assessed the quality of our screening program using a standardized detection ratio adjusted for age and sex.
Methods: Between January 4 and December 28, 2016, 4,927 persons who underwent a health check-up including ultra-slim endoscopy at our clinic, MedCity21, were enrolled in this study. We determined standardized detection ratios and gastric cancer detection rates.
Results: Gastric cancer was detected in 13 male subjects and the value of the standardized detection ratio was 3.74. In contrast, gastric cancer was only detected in one female subject and the value of the standardized detection ratio was 0.89. Among all subjects, the value of the standardized detection ratio was 3.04 and the gastric cancer detection rate was 0.28%.
Conclusions: Gastric cancer was detected successfully in our health check-ups based on assessment using the standardized detection ratio.

View full abstract

Objective: A difference in opinion remains regarding appropriate criteria for diagnosing prediabetes. We examined the risk for incident diabetes in prediabetes using HbA1c and FPG.
Methods: In the period 2007-2010, 4,698 subjects from the Takaoka Health Care Center who had no history of diabetes (HbA1c < 6.5% and FPG < 126mg/dL) were followed up for an average of 6.4 years. They were divided into seven groups according to the results of baseline diagnosis of prediabetes. Diabetes was diagnosed by JDS criteria (FPG ≥ 126 mg/dL and HbA1c ≥ 6.5% or clinician-diagnosed diabetes).
Results: Optimal cutoff points for incident diabetes by receiver operating characteristic curve analysis were FPG 103 mg/dL and HbA1c 5.65%. Multivariate-adjusted hazard ratios for incident diabetes were 2.87 (95% CI 0.86-9.63) in those with FPG 100-125 mg/dL and HbA1c ≤ 5.5%, 8.26 （2.31-29.47）in those with FPG ≤99 mg/dL and HbA1c 5.6-6.4%, 11.26 （3.62-34.97）in those with FPG 100-109 mg/dL and HbA1c 5.6-5.9%, 52.12（15.93-170.52）in those with FPG 100-109 mg/dL and HbA1c 6.0-6.4%, 49.00（15.83-151.65）in those with FPG 100-125 mg/dL and HbA1c 5.6-5.9% and 99.95 （32.75-298.93）in those with FPG 110-125 mg/dL and HbA1c 6.0-6.4%, compared with normoglycemic individuals.
Conclusions: The combination of FPG 100-125 mg/dL and HbA1c 5.6-6.4% was effective in screening for very high risk prediabetes subjects requiring interventions.

View full abstract