Recently, both overnutrition and undernutrition have become social issues. Overnutrition has led to an increase in the number of individuals with metabolic syndrome and lifestyle-related diseases, while undernutrition due to loss of appetite in the elderly or severe weight-loss diets in young women may lead to loss of skeletal muscle. Early detection of these risks followed by appropriate interventions is critical for preventing the development of serious diseases such as cardiovascular and cerebrovascular diseases and locomotive syndrome.

  Recent studies have reported that future risks for developing lifestyle-related diseases include changes in plasma amino acid profiles and that malnutrition changes plasma amino acid profiles in a different manner from overnutrition. Based on these findings, other studies have developed and evaluated the performance of multivariable models based on plasma amino acid concentrations for use as screening tests. We reviewed one of these screening tests (AminoIndex_TM LifeStyle diseases) regarding the development of diabetes within four years as a result of overnutrition as well a status of undernutrition.

Objective: Recently, a decrease in skeletal muscle mass was found to be related to atherosclerosis risk. We investigated the relationship between skeletal muscle mass and atherosclerosis risk factors according to visceral fat accumulation status, using accurate, simple bioelectrical impedance methods.

Methods: The study included 1,161 middle-aged Japanese people (998 men and 163 women). The skeletal muscle was assessed using a bioelectrical impedance method between the upper and lower limbs, and visceral fat area (VFA) was measured using a dual bioelectrical impedance method. The subjects were divided into two groups according to VFA (VFA ≥100 cm² and VFA <100 cm²) by sex and the relationship between percentage of skeletal muscle of body weight (PSM) and the number of atherosclerosis risk factors in each group was investigated. Multiple linear regression analysis was performed to determine the relative contribution of explanatory variables (age, VFA, subcutaneous fat area, and PSM) to the response variable (number of risk factors).

Results: The mean PSM significantly decreased as the number of risk factors increased in both men and women. In men with VFA <100 cm², the number of risk factors was significantly correlated with PSM (B = -0.164, p < 0.001), whereas in men with VFA ≥100 cm², there was no correlation. In women, the number of risk factors was not correlated with PSM irrespective of VFA.

Conclusions: Skeletal muscle mass assessed using the present accurate, simple bioelectrical impedance methods may be a new index for assessing the possibility of atherosclerosis risk factors in men.

Objective: Blood exposure and subsequent blood-borne infections are major risk factors for acquired occupational diseases. Hepatitis B (HB) viral infection is among them, and it is well known that it causes cirrhosis and liver cancer in two or three decades. It can be prevented with HB vaccination, which is recommended for medical staff. However, the antibody titer for acquired immunization generally decreases with time. The authors investigated the time-dependent decrease in HB virus antibody titers after vaccination.

Methods: Three hundred and seventy-five (70 males and 305 females) hospital employees were immunized with HB vaccine at their workplace and thereafter when needed. HB virus surface antibody titers were measured in 2004, 2007, 2010 and 2015, using a semi-quantitative photo-hemagglutination assay. Measured titers were defined as negative for 8 times or less and positive for 16 times or more.

Results: Out of the total of 375 persons who had been injected with HB vaccine, there had been significant titer loss in 132 (35%) in five years. There was no significant statistical difference between two subgroups, one of them consisting of persons who had continued to have positive results and the other of persons who had newly obtained immunity. Conversion from a positive to a negative result was more likely in males than in females (50% vs 32%, p < 0.01).

Conclusions: The titers of approximately one-third of the subjects converted from positive to negative in five years. After HB vaccination, periodical antibody titer measurements and additional vaccination may be recommended for persons with negative results.

Objective: We investigated whether the lifestyle habits of males at the age of 35 influenced their blood lipids at the age of 40.

Methods: From among 2,583 males who underwent health check-ups at 35 and 40 years old in the period from 2008 to 2015, 1,655 without medication for dyslipidemia were selected. We retrospectively examined whether lifestyle habits at 35 years old influenced the occurrence of blood lipid disorders at 40 years old or not.

Results: We assigned 1,503 subjects with normal TG levels at 35 and 40 years old to a TG maintenance group. Also, we assigned 152 subjects with normal TG levels at 35 years old but levels outside the standard range at 40 years old to a TG aggravation group. In addition, 1,363 subjects were assigned to a LDL-C maintenance group and 292 to a LDL-C aggravation group, 1,622 to a HDL-C maintenance group and 33 to a HDL-C aggravation group, in a similar manner to that for TG data. Regarding lifestyle habits at 35 years old, skipping breakfast, smoking, and risky drinking were associated with TG aggravation and risky drinking was associated with HDL-C aggravation.

Conclusions: When there are poor lifestyle habits at 35 years old, we should determine risk factors for increases in lipid data to levels beyond the standard ranges at 40 years old even then the levels at the age of 35 are considered to be normal. Such data are no problem in youth but we still need to pay attention to them.

Objective: Hyperuricemia is an established risk factor of incident hypertension. However, the impact of renal function on the relationship between hyperuricemia and incident hypertension has not been fully elucidated. We investigated the relationship between hyperuricemia and incident hypertension stratified by estimated creatinine clearance (Ccr) or proteinuria using health check-up data.

Methods: We conducted a retrospective cohort study of 11,043 adult males who underwent health check-ups at our institutions and had no history of either chronic renal failure or cerebrocardiovascular diseases. Participants were divided into quartiles according to serum urate levels, and the fourth quartile was defined as the hyperuricemia group (serum urate level ≥ 6.9 mg/dL). We followed up the participants for five years using annual health check-up data.

Results: During 33,672 person-years of follow-up, 1,614 participants developed hypertension. The cumulative incidence of hypertension was significantly different among the quartiles (Log-rank test, p < 0.001). The multivariate Cox proportional hazard model revealed that hyperuricemia was significantly associated with incident hypertension (hazard ratio: 1.346, p < 0.001). In the analyses stratified by proteinuria or Ccr, hyperuricemia was associated with incident hypertension in the proteinuria-negative and proteinuria-positive groups, as well as in the Ccr-high and Ccr-low groups (divided by median of Ccr). Neither proteinuria nor Ccr had a significant interaction with the relationship between hyperuricemia and incident hypertension (likelihood ratio test: interaction p = 0.8747, 0.5638, respectively).

Conclusions: Hyperuricemia was significantly associated with incident hypertension in a healthy male population with no influence from proteinuria or creatinine clearance.

  Pulmonary pleomorphic carcinoma (PPC) is a subgroup of non-small cell lung cancer that contains both epithelial and mesenchymal (sarcomatoid) components. Because of its rarity and aggressiveness, there are few reports describing the early stage of PPC. In this report, we describe a case of PPC detected as a small shadow during optional low-dose computed tomography (CT) screening that was completely resected at the early stage after follow-up.

  During a health check-up for a 64-year-old man at our institution, optional low-dose chest CT screening revealed a small ground-glass opacity-like shadow in the peripheral area of the upper lobe of the right lung. Afterwards, the lesion was monitored using standard-dose CT. Although no remarkable changes had been observed up to 12 months, it had become enlarged by the 18-month follow-up. Further examinations did not provide a definitive diagnosis, so a surgical operation was performed for both diagnosis and treatment purposes. As the intraoperative rapid pathologic diagnosis revealed malignancy, a typical right upper lobectomy and mediastinal lymph node dissection were performed. Microscopic images of the tumor showed both epithelial and sarcomatoid components. The pathological diagnosis obtained using permanent sections was PPC resected completely at stage IA.

  Two cases of the long-term observation of pulmonary adenocarcinoma in situ (AIS) are reported. In case 1, the patient presented with an area of ground glass opacity (GGO) measuring 20 mm in diameter on chest computed tomography (CT) during a health check-up conducted at the age of 54 years. The GGO nodule was followed up with yearly CT scans and grew to 29 mm in diameter over 9 years. Thoracoscopic middle lobectomy was performed, and histopathological examination revealed AIS. In case 2, an area of GGO 7.7 mm in diameter was found when the patient was 49 years old. It was monitored via periodic CT examinations over 12 years. During this time, it grew to 19 mm in diameter. The surgical specimen exhibited AIS. In both cases, the tumor grew at a regular speed without showing any signs of invasion. The tumor doubling times for cases 1 and 2 were 1,878 and 1,071 days, respectively. However, cases in which GGO nodules grew rapidly and then developed into advanced adenocarcinoma have also been reported, so careful follow-up is mandatory for GGO lesions that are suggestive of AIS.