Adiponectin was discovered to be the most abundant transcript in human adipose tissue in 1996. Animal studies have revealed that administering adiponectin improves insulin resistance and blood glucose levels, and inhibits atherosclerosis. In this review, I re-assess the significance of measuring serum high-molecular-weight (HMW) adiponectin levels in health check-ups, ‘Ningen Dock’.

Cross-sectional studies using ELISA have revealed that the serum HMW-adiponectin concentration in healthy Japanese females was 1.9 times that of males and that there was a strong positive correlation between it and HDL-C but there were negative correlations with BMI and the homeostasis model assessment insulin resistance (HOMA-R). These studies also indicated that the serum HMW-adiponectin concentration was more strongly associated with HOMA-R and numbers of subjects with MetS than the total adiponectin concentration. Some subjects may inherit a lower serum adiponectin concentration and may have a higher risk of developing cardiovascular diseases (CVDs).

Our longitudinal study, a 6-year follow-up study of Japanese men, revealed that decreased HMW-adiponectin is a predictor of progression to MetS. In another study, on16 Japanese male subjects with MetS, lifestyle modification for 3 months induced a decrease in BMI and waist circumference and an increase in serum HMW-adiponectin but not total adiponectin.

A chemiluminescent enzyme immunoassay (CLEIA) developed for HMW-adiponectin is reportedly faster and more accurate than other assays. Also, serum levels are closely correlated with parameters related to MetS and CVDs and findings have suggested that HMW-adiponectin is a useful biomarker of MetS and related disorders in ‘Ningen Dock’.

Nonalcoholic fatty liver disease (NAFLD) has been increasing dramatically in Japan and many other nations over the past few decades. At present, according to Japanese annual health check-up reports, 10–40% of Japanese adults show evidence of NAFLD in ultrasonography. Also, 10–20% of these people with NAFLD have nonalcoholic steatohepatitis (NASH). Ultrasonography is more useful for detecting NAFLD than laboratory tests, such as liver enzymes. Physicians detecting NAFLD in their patients should evaluate its severity by imaging methods, histological scoring systems, and/or liver biopsy. They should also evaluate NAFLD-related complications in NAFLD patients, such as type 2 diabetes mellitus, vascular disease and hepatocellular carcinoma, as well as the factors involved in these complications.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. It is most frequently seen in rheumatic diseases. Recent advances in the treatment of RA can prevent bone/cartilage destruction and improve the prognosis of RA patients. In view of this situation, the concept of “T2T”, “Treatment to target”, has been established to administer appropriate treatment, such as that with methotrexate and newly developed biological agents, which will attain clinical remission as well as radiographic and functional remission. Such biological agents have direct effects against pro-inflammatory cytokines such as TNF-α and IL-6 in RA synovial tissues. Smoking is a risk factor for RA in association with genetic factors. Although morning stiffness is not specific to RA, joint swelling and/or tenderness reflects synovitis and is an important clinical feature. Pulmonary involvement should be investigated as an extra-articular manifestation. Laboratory examinations, which include acute-phase reactants such as CRP and erythrocyte sedimentation rate (ESR), evaluate disease activity. IgM RF is also tested as a diagnostic tool, although it is also detected in other diseases. Anti-citrullinated protein antibodies (ACPA) are a new marker for the diagnosis of RA and predict articular destruction. It is necessary to obtain a definite diagnosis through classification in order to start suitable treatment for RA patients in the early stage. As the previously published American College of Rheumatology (ACR) 1987 revised criteria were not useful for identifying RA patients in the early stage, the ACR and European League against Rheumatism (EULAR) proposed new criteria for the classification of RA in 2010.

Objective: The Japan Atherosclerosis Society (JAS) recommended that serum lipid management goals based on a coronary heart disease (CHD) risk factor classification be included in its 2007 guidelines (GL 2007) for the diagnosis and prevention of atherosclerotic cardiovascular disease in the Japanese population, which were revised in 2012 (GL 2012). Using the Japan Society of Ningen Dock database, we compared the distributions of the risk categories according to GL 2007 and GL 2012.

Methods: A total of 17,991 adults taking dyslipidemia medications were enrolled. The JAS GL 2007 and GL 2012 were used for evaluation. The guidelines have 2 different objectives (secondary prevention for subjects with a prior history of CHD and primary prevention for those with other CHD risk factors) and we compared the distributions of risk categories in a primary prevention group. Serum low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald formula.

Results: Of the patients in Category I according to GL 2007, 6.6% came under Category III according to GL 2012. Of the patients in Category II according to GL 2007, 37.1%, 38.5%, and 24.3% came under Categories I, II, and III according to GL 2012, respectively. Most subjects (81.1%) in Category III according to GL 2007 were still in the same category according to GL 2012, while 4.3% and 14.7% were in Categories I and II, respectively.

Conclusion: According to GL 2012, 43.7% of the primary prevention patients were assigned to categories different from those based on GL 2007.

Objective: The first aim of this study was to identify risk factors associated with osteoporosis and decreased bone mass in the general Japanese population. The second was to elucidate the relationship between bone mineral density and bone turnover markers.

Materials and Methods: We analyzed bone mineral density (BMD) and bone turnover markers - such as bone-specific alkaline phosphatase (BAP), urinary deoxypyridinoline (DPD) and N-terminal crosslinking telopeptide of type I collagen (NTX) - in 238 subjects who visited the Department of General Medicine, National Center for Global Health and Medicine from March 2005 through March 2007 for a Ningen Dock-style annual health check-up. Risk factors associated with osteoporosis and decreased bone mass were evaluated using multivariate logistic regression analysis, and the differences in BMD and bone turnover markers were examined between subjects with and without osteoporosis.

Results: Factors associated with osteoporosis were age, gender (female) and low BMI, and specifically in female subjects menopause, high serum level of total cholesterol and large alcohol intake (p<0.05). BMD was strongly correlated with bone turnover markers. (NTX : R= –0.44, p<0.0001, DPD: R= –0.42, p<0.0001).

Conclusion: Bone turnover markers were useful for estimating BMD. High serum level of total cholesterol and large alcohol intake were risk factors for osteoporosis.

Objective: The economic inequality gap in Japan has rapidly widened in recent years, and financial disparity has been reported to affect health status. The present study investigated a relationship between economic status and cancer knowledge, healthy behavior, and cancer check-up rates.

Methods: This cross-sectional study involved 6,004 residents of Yokohama City and Oyama City, Japan, randomly selected from the gender and age strata. Subjects aged between 35 and 65 were divided into 2 groups according to whether they perceived their economic status as affluent or not.

Results: Nearly 35% of the subjects answered that they did not consider themselves to be affluent. The subjects in this group had lower education levels and less regular employment, and fewer were married, compared with the affluent group. They also tended to have less knowledge about a healthy lifestyle, eat fewer vegetables, smoke, have an unhealthy body weight, and receive fewer cancer check-ups. We found strong correlations between relative economic satisfaction and cancer prevention knowledge, healthy lifestyle, and behaviors. People who did not perceive themselves as affluent tended to know less about cancer risks, have unhealthy diets and smoking habits, and receive fewer cancer check-ups.

Conclusion: A significant positive correlation exists between economic satisfaction and cancer prevention behaviors in Japan. Because economic dissatisfaction derives from a comparison with others, a reduction in social disparity may be necessary to increase cancer check-up rates and promote healthy lifestyles.

Objective: The aim of this study was to clarify relationships of high-density lipoprotein 2 cholesterol (HDL₂-C) and high-density lipoprotein 3 cholesterol (HDL₃-C) with lifestyle habit factors in Japanese adults.

Methods: A total of 1,461 qualified subjects who underwent annual health examination were analyzed. Relationships between HDL₂-C and HDL₃-C, and clinical parameters including obesity, smoking, exercise, and alcohol consumption were studied.

Results: Stepwise multiple linear regression analysis revealed that all independent variables excluding ex-smoker were selected for HDL₂-C level. However, only alcohol consumption was selected for HDL₃-C level. Both HDL₂-C and HDL₃-C levels increased together with higher alcohol consumption. HDL₂-C levels were decreased by obesity and current smoking and increased by exercise. HDL₂-C levels were higher in women than in men.

Conclusion: HDL₂-C levels were associated with alcohol consumption, waist circumference (WC), smoking and exercise, and a gender difference was observed. However, HDL₃-C levels were only associated with alcohol consumption. Our data provided a better understanding of HDL-C subclasses and lifestyle habit factors.

Objective: The aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and percent body fat (PBF) to predict incident diabetes.

Methods: Areas under receiver operating characteristic curves (AUCs) for these parameters were calculated for a Japanese population consisting of 1,704 men and 1,016 women to determine incident diabetes and hazard ratios (HRs) for each one SD increase in these parameters, and also when they were dichotomously defined.

Results: During 4 years of follow-up (mean 3.4 years), 54 men (3.2%) and 19 women (1.9%), of whom 69 (94.5%) were prediabetes at baseline, developed diabetes. The AUCs [95% confidence intervals (CIs)] for BMI, WC, WHtR and PBF were 0.69 (0.61–0.76), 0.68 (0.61–0.76), 0.70 (0.63–0.78) and 0.65 (0.59–0.71), respectively, in men and 0.74 (0.61–0.86), 0.75 (0.61–0.88), 0.76 (0.64–0.88) and 0.77 (0.65–0.88), respectively, in women. After adjusting for fasting glucose, hemoglobin A1c and other confounders, only BMI in men was significant [HR (95% CI): 1.49 (1.07–2.07), p=0.018] among continuous parameters, while only WC and PBF in women were significant [HRs (95% CIs): 5.22 (1.24–21.91), p=0.024 and 5.67 (1.33–24.20), p=0.019, respectively] among dichotomous parameters.

Conclusion: The abilities of these anthropometric parameters to predict incident diabetes were almost equal and limited when both fasting glucose and hemoglobin A1c were measured.

Objective: The Japanese Society of Hypertension (JSH) has recommended target levels of blood pressure (BP) control based on guidelines for the management of hypertension. The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations nationwide and using its data, we evaluated the efficacy of current treatment for hypertension patients based on the JSH recommendations as well as an association between adherence to lifestyle habits and BP control.

Methods: This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. To assess BP control in the Japanese population, we analyzed previously obtained measurements of conventional BP in 31,754 patients aged 40 to 79 years (mean age: 58.6 ± 8.3 years, 23,868 men and 7,886 women) taking hypertensive medications.

Results: The overall mean systolic BP in these patients was 129.7 ± 15.2 mmHg, and diastolic BP was 79.7±10.5 mmHg. According to the JSH2009 guidelines, the target office BP was achieved in 45.2% of all subjects; 36.2% of patients with diabetes mellitus, chronic kidney disease, or a history of coronary heart disease; 70.4% of elderly patients; 44.7% of nonelderly patients (younger than 65 years); and 76.2% of patients with cerebrovascular disease. When 140/90 mmHg were used as hypertension criteria for conventional BP measurements, the achievement rate was 69.8%. Undesirable lifestyle habits, except smoking, were associated with poor BP control.

Conclusion: Hypertension is considered to be insufficiently managed in more than half of patients and therefore strict management through lifestyle modification is necessary to reduce the complications rate.