In our present world, both overnutrition and undernutrition are important issues that need to be addressed. Overnutrition increases the incidence of metabolic syndrome and lifestyle-related diseases, while undernutrition due to loss of appetite in the elderly or extreme weight-loss diets in young women leads to loss of skeletal muscle. Early detection of these risks followed by appropriate interventions are critical in preventing serious diseases like cardiovascular and cerebrovascular diseases as well as locomotive syndrome.
Several recent studies have reported that when there is the risk of future development of lifestyle-related diseases due to overnutrition, plasma amino acid profiles are altered in a certain way while malnutrition alters them in a different way. Based on such findings, in other studies, multivariable models using amino acid concentrations were developed for use as screening tests and their performance was evaluated. Among the screening tests focused on in these studies, we review the performance of AminoIndex_TM Lifestyle Related Diseases Risk Screening in detecting undernutrition and predicting the risk of developing diabetes within four years due to overnutrition.

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Objective: Yamagata Prefecture has the highest percentage of hypertensive patients in the whole of Japan and it has been known for some time that salt intake is particularly high in Northeast Japan where the Prefecture is located. Salt reduction is important in blood pressure management. At our hospital, we added salt intake to Ningen Dock health check-up tests in April 2015 and afterwards examined an association between salt intake and blood pressure in Ningen Dock examinees.
Methods: From among Ningen Dock examinees at our hospital between April 2015 and March 2016, 1,380 (1,034 men, 346 women; mean age 56±11 years) were enrolled as subjects, after excluding 39 who were taking diuretics. Salt intake was estimated from casual urine samples using a formula and an association of salt intake and blood pressure was investigated, dividing subjects into those not taking antihypertensive medication (non-medicated group) and those taking antihypertensive medication (medicated group). Associations between salt intake and obesity, weight and age were also examined.
Results: The mean salt intake for all examinees was 9.03±2.24 (men 9.14±2.24, women 8.71±2.23) g/day so only 26.8% (men 29.1%, women 19.9%) met the Ministry of Health Labour and Welfare recommendations of less than 8 g for men and less than 7 g for women. Although systolic and diastolic blood pressure significantly increased as salt intake increased in the non-medicated group, this association was not observed in the medicated group. Compared to the non-medicated group, salt intake was higher in the medicated group than in the non-medicated group for all age groups. Also, in the medicated group, salt intake increased with weight and was higher in obese persons.
Conclusion: Among the Ningen Dock examinees at our hospital, only around a quarter met the Ministry of Health Labour and Welfare recommendations for salt intake. Compared to the non-medicated group, salt intake was higher in the medicated group. In the non-medicated group, there was a significant association between salt intake and blood pressure, and our results suggested that salt reduction could be effective in reducing blood pressure even if a level of less than 6 g were not achieved.

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Objective: Based on a Ningen Dock customer satisfaction survey at Uji-Takeda Health Check-up Center during the period from 2012 to 2015 for all Ningen Dock customers, we investigated changes in satisfaction level and analyzed freely given opinions.
Methods: The level of satisfaction (i.e. excellent, good, poor and very poor) was investigated for each of 8 default question items. The opinions were classified into a content category and emotion category, and the relationship between two categories was studied.
Results: There were no changes in satisfaction level over 3 years in any of the 8 default items. Although the level of satisfaction regarding waiting times was still not very high in 2015 as they were long, an increase in the number of expressions of thanks and compliments concerning waiting time was noted in 2015.
Conclusion: In 2015, the improvement in evaluation of waiting time from the emotional aspect seems to be related to an increase in the number of staff nurses, giving our center many experienced staff, and further improvement in customer services due to our new leader nurse system.

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Objective: To investigate the effect of smoking on respiratory functions from health check-up data and determine a smoking index cutoff point encouraging people to stop smoking, with particular focus on analysis regarding smoking amount and gender differences.
Methods: Our subjects were 32,544 persons with analyzable data among 34,383 health check-up examinees at Omiya City Clinic from January to December 2016. By smoking history, they were divided into 3 groups: current smoker group, former smoker group and never smoker group and the mean FEV₁/FVC, %FEV₁ and smoking quantity index for each group were compared between men and women. In addition, we examined the prevalence of subjects with obstructive impairment among subjects with FEV₁/FVC less than 70% as well as an optimal cutoff point for the smoking quantity index for subjects with obstructive impairment.
Results: Significant differences in FEV₁/FVC were observed among all 3 groups. For %FEV₁, while no significant difference was found between the former smoker and never smoker group in women, significant differences were found for all other comparisons. The smoking quantity index was significantly higher in men than in women for both the smoker and former smoker groups. The optimal smoking quantity index cutoff point for subjects with obstructive impairment was 11.33 pack-years overall and 12.13 pack-years for men but a high cutoff point with predictive value for women could not be determined. The overall prevalence of obstructive impairment was 1.78%. The prevalence of obstructive impairment was 4.22% for the smoker group, 2.66% for the former smoker group and 1.11% for the never smoker group in men and 1.57%, 0.68% and 0.59% in women, respectively, so it was lower in women.
Conclusion: For male current smokers with a smoking quantity index of 12 pack-years or greater, education regarding COPD and actively instructing them to cease smoking were considered to be particularly important. Suggested reasons for the lower prevalence of obstructive impairment in women than in men are the lower smoking quantity index in women and the possibility that the effect of smoking on respiratory function differs between men and women.

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Objective: Based on multivariate analysis of plasma amino acid concentrations between cancer patients and healthy subjects, AminoIndex_TM Cancer Screening (AICS_TM) is used to evaluate the probabilities of people having seven types of cancer. In this study, we report annual changes in AICS ranks and cases of cancer detected in subjects determined to have changed to rank C in the annual screening by AICS.
Methods: Annual AICS rank changes were investigated in 216 subjects (115 Men, 101 Women) examined twice and in 139 subjects (81 Men, 58 Women) examined three times (average examination interval: 1.0±0.1 year). Numbers of cases of cancer detection among subjects determined to have changed to rank C in annual screening were investigated.
Results: The rank change rate results for A→C, B→C and C→C in the annual AICS screening were as follows. AICS (lung): 0.5%, 3.7%, 2.8%, AICS (gastric): 6.9%, 5.1%, 4.6%, AICS (colorectal): 6.0%, 1.9%, 0.9%, AICS (prostate): 4.3%, 8.7%, 11.3%, AICS (breast): 2.0%, 3.0%, 4.0%, AICS (uterine/ovarian): 2.3%, 1.1%, 0%, respectively. Among subjects examined twice, in an AICS (gastric) group with an annual change of B→C, 2 cases of gastric cancer were found. In an AICS (breast) group with a change result of C→C, 1 case of breast cancer was found. In an AICS (colorectal) group with a change of A→C, 1 case of GIST was found. Among subjects examined three times, in an AICS (prostate) group with annual changes of A→B→C, 1 case of prostate cancer was found. In an AICS (breast) group with annual changes of A→A→C, 1 case of breast cancer was found. The cancer detection rate by AICS was 1.7%.
Conclusion: Although the rate of change to rank C in the annual AICS screening was low, various cancers were discovered in subjects changing to rank C. These results suggest that annual AICS screening may lead to early detection of cancer.

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The patient was a previously healthy 54-year-old woman. There were no preceding cold-like symptoms. Ten days before being admitted to our hospital, she became aware of dry mouth, polydipsia, polyuria and weight loss and 7 days before, she had received a general health check-up at another hospital. Owing to a casual blood glucose level of 532 mg/dL and HbA1c of 6.6 %, she had been examined further at the other hospital 3 days before. Fasting blood glucose was 321 mg/dL, HbA1c 7.4 % and urinary ketone bodies 3+, and administration of vildagliptin 100 mg was started. On the day of admission to our hospital, the patient had earlier been referred to the diabetology outpatient department of the other hospital and due to the findings of a casual blood glucose level of 394 mg/dL, pH 7.314 and HCO₃^- of 17.4 mmol/L, fulminant type 1 diabetes with diabetic ketoacidosis (DKA) was suspected, and she was referred to our department for consultation. When she came, with a casual blood glucose level of 329 mg/dL, HbA1c of 7.9 %, a blood 3-hydroxy butyric acid level of 5,378 μmol/L, a venous blood pH of 7.335 and an HCO₃^- level of 17.4 mmol/L, she was considered to be developing DKA, continuous insulin infusion therapy was commenced and she was admitted. As anti-GAD antibodies, IA-2 antibodies and insulin autoantibodies were negative, the urinary C peptide level was 1.6 μg/day and in a glucagon stimulation test, the prestimulation serum C peptide level was 0.1 ng/mL and post stimulation serum C peptide level was 0.2 ng/mL, fulminant type 1 diabetes was diagnosed. Based on the present case, the chance noting of hyperglycemia symptoms in a medical interview and a low HbA1c level despite hyperglycemia should definitely bring type 1 fulminant diabetes to mind and serve as an urgent reminder of the importance of early referral to a specialist department.

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