Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease. Recently developed drugs and guidelines have improved the working ability and prognosis of RA patients. Survival in RA has been extended, and RA patients have increased opportunity to visit Preventive Health Care Centers to undergo the Comprehensive Health Checkup System, or Ningen Dock. The health problems experienced by patients with RA are characteristically similar to those of the general population without RA. These include frailty, sarcopenia and locomotive syndrome. Basically, cytokines which cause chronic inflammation play important roles in both arthritis and sarcopenia, including tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2). In addition, recent studies have recognized that RA is a risk factor for cardiovascular disease, as well as for bone fragility and refracture. Clinical care of these patients therefore includes explanations of exercise and diet, as recognized in the 2022 American College of Rheumatology (ACR) guidelines for exercise, rehabilitation, diet, and additional integrative interventions.

Objective: Urinary sediment is examined in Ningen Dock. We sought to evaluate the costs and diagnostic value associated with abnormal urinary sediment findings, in addition to estimated glomerular filtration rate (eGFR), urinary protein, and occult blood measurement, in Ningen Dock after 4 years.

Methods: In the patients who underwent Ningen Dock in 2015, urinalysis was performed using a fully-automated urinalysis system at the central laboratory of each hospital. Urine sediment was microscopically examined by laboratory technicians. Granular casts, epithelial casts, and tubular epithelium were defined as pathological findings. Seventy-six patients who showed these findings in 2015 and were re-examined in 2019. The eGFR, urinary protein, and occult blood were statistically analyzed.

Results: Pathological urinary sediment findings detected in 2015 spontaneously disappeared after 4 years in 91% of the patients. No significant change was observed in eGFR, urinary protein or occult blood in the patients who continued to have pathological findings after 4 years. At least \157 was spent per sample in supplies and personnel.

Conclusions: Almost the pathological urine sediment was disappeared after four years. The benefit of urine sediment examinations was small for the cost. The eGFR, urine protein and occult blood test are sufficient in the kidney function examinations in Ningen Dock.

Objective: Cardiovascular disease and osteoporosis are major public health problems that share common pathophysiological mechanisms besides aging. This study aimed to investigate the possible association between bone mineral density (BMD) and arterial stiffness measured by cardio-ankle vascular index (CAVI) in the Japanese general population without overt cardiac disease.

Methods: The study population was 1,242 consecutive participants who underwent cardiovascular health check-ups at the University of Tokyo Hospital. After excluding participants with coronary artery disease, peripheral arterial disease, atrial fibrillation/atrial flutter, decreased left ventricular systolic function, and pacemaker implantation, 1,169 men and women were analyzed. The calcaneus BMD was assessed by quantitative ultrasound methods. Cardiovascular functions were evaluated with CAVI, left ventricular global longitudinal strain (LVGLS), peak early diastolic transmitral velocity (E)/peak early diastolic mitral annular velocity(e′) (E/e′), and carotid intima-media thickness (IMT) measurements.

Results: In univariate analysis, BMD was associated with CAVI, E/e′ and IMT along with other cardiovascular risk factors except for diabetes (r=−0.162, p<0.001, r=−0.203, p<0.001, r=−0.113, p<0.001, respectively), whereas no association was identified between BMD and LVGLS. In multivariate analysis, after adjustment for pertinent confounding variables, only CAVI remained associated with low BMD (estimated coefficient=0.0050, p=0.004), but the direction of association was opposite and smaller in size compared to univariate analysis.

Conclusions: This study is the first to examine the relationship between BMD and multiple cardiovascular measurements in the Japanese general population without overt cardiovascular disease and has demonstrated the partial relationship of osteoporotic state and enhanced arterial stiffness, as evaluated by CAVI.

Objective: This study aimed to identify predictive factors for diabetes development in Ningen Dock examinees with very mild glucose intolerance.

Methods: We retrospectively analyzed medical records, interview responses, and Ningen Dock results of 11,313 examinees from April 2015 to March 2016 and followed them until March 2021.

Results: Over five years, 2.6% of examinees were newly diagnosed with diabetes. Those who developed diabetes had statistically significantly higher median age, body weight, and BMI compared to those who did not develop diabetes (p<0.001). Almost all laboratory values, including FPG and HbA1c, were worse in the former group. When their FPG and HbA1c levels were not high (Ningen Dock category A or B), their incidence rate of developing diabetes over the next five years was extremely low (0.09–0.7%). We conducted multivariate analysis regarding predictive factors for the development of diabetes among examinees in Ningen Dock category B, which identified BMI ≥25 kg/m² (OR 5.356, p<0.001), LDL-C ≥140 mg/dL (OR 2.415, p=0.023), smoking (OR 2.320, p=0.042), and family history of diabetes (OR 2.510, p=0.016) as significant predictive factors. The incidence rate of developing diabetes over the next five years increased from 0.7% to 12.5% when these predictive factors were present.

Conclusions: FPG and HbA1c levels are the most important variables in predicting the development of diabetes. However, individuals with multiple risk factors should be carefully monitored for the development of diabetes, even if their FPG and HbA1c levels are not high.

Objective: It has been nearly 30 years since Helicobacter pylori (Hp) was identified as a class I carcinogen for gastric cancer (GC). However, only a small percentage of Hp-infected patients develop cancer. Although eradication therapy is considered the most effective for preventing GC, various cases of GC have been observed after eradication. This study aimed to analyze the factors preventing GC based on health examination data.

Methods: A total of 19,278 health checkup subjects (12,916 males and 6,362 females; mean age, 51.9±11.3 years) who underwent physical examinations at our health checkup center from 2012 to 2018 were included. Patients with a history of GC were excluded. Multiple logistic regression analysis was used to analyze the association between GC and background factors (age, sex, smoking history, alcohol consumption history, and family history of GC), lifestyle factors (dietary preferences, exercise, and sleep), and lifestyle-related disease factors (body-mass index, metabolic syndrome, abdominal circumference, visceral fat, body fat, lipids, glucose tolerance, liver function, and fatty liver). We also compared GC incidence between Hp-infected and post-Hp eradication patients.

Results: Age and salt intake were significantly associated with GC (p=0.001 and 0.003, respectively). GC incidence was 1.53% among Hp-infected patients and 0.52% among post-Hp eradication patients, approximately one-third of that in those who did not undergo eradication.

Conclusion: Aging and a high salt intake may be associated with GC, suggesting that a low-sodium diet can prevent GC, especially among the elderly. The results of this study also suggest that Hp eradication therapy is effective in preventing GC.

Objective: To evaluate the effect of a continuous glucose monitoring (CGM) device, the FreeStyle Libre^TM, on blood glucose (BG) fluctuation in elderly people with untreated glucose intolerance.

Methods: Sixty participants aged 60 years or older with glucose intolerance (6.5%≤HbA1c or 125 mg/dL≤BG) who were not receiving any treatments for diabetes were enrolled in the study. They were placed on the CGM device for 14 days. During these 14 days, they were asked to keep a detailed diary regarding daily events, focusing on diet and exercise. On the 7th day, an educational review session was performed to assess a weekly summary of their BG levels and daily events. On the 14th day, the BG results were summarized. Fifty-five participants completed the trial, and their response to a questionnaire was obtained.

Results: Even with glucose intolerance (HbA1c 6.7±0.48), large diurnal blood glucose fluctuations and frequent hyperglycemia were observed during the first week of the study period. The mean daily BG level significantly improved from 129.9±7.5 mg/dL in the first week to 119.1±6.18 mg/dL in the second week (p<0.01). The number of hyperglycemic events exceeding 180 mg/dL decreased, from 6.8±5.8 in the first week to 4.3±4.0 in the second week (p<0.01). The peak BG level also decreased, from 236±73.6 mg/mL in the first week to 218±67.8 mg/dL in the second week (p<0.01). Twenty-five of 55 participants (45%) lost more than 1 kg of weight. Forty-nine participants (89%) positively responded to CGM use as effective in the post-enrollment survey. For 47 (85%), review on the 7th day was needed. Fifty participants (91%) wanted to continue using CGM. The majority of participants stated that the CGM system helped them understand the importance of dietary carbohydrate intake, which subsequently improved their glycemic control after the review session and counseling.

Conclusion: In elderly people with untreated glucose intolerance, various patterns of elevated BG were observed. However, the CGM universally improved their hyperglycemia and glucose fluctuations, regardless of the cause. The CGM system may become a valuable tool in improving untreated glucose intolerance in elderly people, who are highly motivated to restore and maintain their health status.

Objectives: A prospective collaborative study was conducted on subjects who underwent consecutive comprehensive health checkup system (Ningen Dock) at six health checkup facilities. This study aimed to achieve the following objectives:

  1) To examine the correlation between Brachial-ankle Pulse Wave Velocity (baPWV) values and atherosclerosis risk factors.

  2) To investigate the secular changes in baPWV values in subjects who underwent Ningen Dock for three consecutive years.

  3) To assess the association between baPWV values and atherosclerotic disease risk scores (Suita score, Hisayama score).

Methods: A total of 14,933 subjects were enrolled in 2019, and cross-sectional analysis was conducted. Additionally, longitudinal analysis was carried out on 4,578 subjects who had baPWV measurements for three consecutive years (2019–2021).

Results: Regarding the relationship between atherosclerosis risk factors and baPWV values, the strongest correlation was found with four factors: hypertension, glucose metabolism abnormalities, lipid abnormalities (excluding LDL-C), and obesity. These factors remained independent variables in multiple regression analysis. baPWV values increased significantly in both males and females annually. Among 4,249 subjects (40 to 80 years old during the three-year study period), baPWV values increased significantly as each risk score classification elevated, despite each risk score remained unchanged.

Conclusion: baPWV values were robustly correlated with the clustering of atherosclerosis risk factors and risk scores for atherosclerotic disease. Furthermore, baPWV values increased annually even when risk scores remained unchanged, suggesting the importance of continuous baPWV measurement for monitoring the progression of atherosclerosis.

Objective: Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a newly defined disease entity. Although high-density lipoprotein cholesterol (HDL-C) is one of the diagnostic criteria for MAFLD, it is uncertain how HDL subclasses are associated with MAFLD in Japanese.

Methods: Among subjects who underwent a health examination at our hospital, 1,879 subjects (men: 1,238, women: 641) who participated in HDL2-C and HDL3-C evaluation were included in this cross-sectional study. The association between HDL2-C, HDL3-C, HDL2-C/HDL3-C ratio and MAFLD was investigated using multiple logistic regression analysis.

Results: HDL2-C, HDL3-C, and HDL2-C/HDL3-C ratio were significantly lower in MAFLD subjects in men, while HDL2-C and HDL2-C/HDL3-C ratio were significantly lower and HDL3-C was significantly higher in MAFLD subjects in women. Further, as the number of MAFLD diagnostic components increased, all indices decreased in men, while HDL2-C and HDL2-C/HDL3-C ratio decreased as the number of MAFLD diagnostic components increased in women. In multiple logistic regression analysis, HDL2-C and HDL2-C/HDL3-C ratio was negatively associated with MAFLD in both men and women, while HDL3-C was positively associated.

Conclusion: Our results indicate that HDL2-C and the HDL2-C/HDL3-C ratio are negatively associated with MAFLD, while HDL3-C is positively associated with MAFLD in both men and women. The associations between these indices and MAFLD vary between genders and with the number of MAFLD diagnostic components.

  An asymptomatic 69-year-old woman exhibited slight ST-segment depression in the inferior leads on an electrocardiogram during a health check-up. Echocardiography revealed a small mobile tumor originating from the anterolateral papillary muscle of the left ventricle. As brain computed tomography revealed a cerebral infarction, urgent surgery was performed. The resected tumor was histologically diagnosed as a papillary fibroelastoma (PFE). The postoperative course was uneventful with no tumor recurrence two years post-surgery. It is extremely rare to find PFE during a health check-up. We emphasize that even minor abnormal findings during health check-ups should be monitored vigilantly.