Objective: We prospectively examined the precision of four serum Helicobacter pylori (H. pylori) antibody measurement methods for diagnosing ‘currently infected’ vs. ‘uninfected’ and ‘currently infected+previously infected’ vs. ‘uninfected.’

Methods: Subjects included 326 patients who underwent esophagogastroduodenoscopy (EGD) in a comprehensive health checkup system. Serum H. pylori antibodies were measured using three latex-based methods, namely, L-type Wako H. pylori antibody, J (Hp-W); Latex ‘Seiken’ H. pylori antibody (Hp-D); and LZ test ‘Eiken’ H. pylori antibody (Hp-L), and the ELISA-based method, E plate ‘Eiken’ H. pylori antibody II (Hp-E). H. pylori infection status was determined from ¹³C-urea breath test results and EGD according to the Kyoto classification of gastritis. The accuracy of each kit was examined according to set cut-off values. Further, receiver operating characteristic (ROC) curve analysis was performed to examine the precision of serum H. pylori antibody findings.

Results: Accuracy analysis using set cut-off values showed that Hp-W and Hp-D were equivalent to Hp-E, whereas Hp-L was inferior. In ROC analysis of ‘currently infected’ vs. ‘uninfected’ status, areas under the curve (AUCs) were 0.9996 for Hp-W, 0.9988 for Hp-D, 0.9893 for Hp-L, and 1.0000 for Hp-E. However, in ROC analysis for ‘currently infected+previously infected’ vs. ‘uninfected,’ AUCs decreased to 0.9251, 0.9037, 0.8886, and 0.9478 for Hp-W, Hp-D, Hp-L, and Hp-E, respectively.

Conclusion: Although Hp-W and Hp-D had good precision comparable to that of Hp-E, the cut-off value for Hp-L needs to be changed. The impact of ‘previously infected’ cases on precision should also be considered.

Objective: To describe the prevalence and one-year incidence of retinal vein occlusion (RVO) and associated risk factors in a Japanese population at a medical checkup institution in Osaka.

Methods: Fundus photography was performed on 28,781 participants aged 19–93 from April 2019 to March 2020 as part of the medical checkup. We determined the prevalence of RVO, including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) by assessing the photographs, and analyzed the associated risk factors for RVO using medical checkup data.

Results: Of the 28,781 participants, RVO, BRVO, and CRVO were found in 334, 311, and 23 participants with 1.2%, 1.1%, and 0.08% prevalence, respectively. New RVO, BRVO, and CRVO were found in 57, 52, and 5 participants with a one-year incidence of 0.2%, 0.18%, and 0.02%, respectively. According to multivariate logistic regression analyses of subjects with and without RVO, there was a significant difference in the age, with an odds ratio (OR) of 1.03 (95% confidence interval [CI]=1.01–1.04); hypertension (OR=2.56, 95%CI=1.90–3.44); and AV nicking (mild: [OR=9.73, 95%CI=2.3–41.1]; moderate: [OR=298, 95%CI=73.6–1,210]; and severe: [OR=1,210, 95%CI=289–5,080]); respectively.

Conclusions: The prevalence of RVO was 1.2% and the one-year incidence of RVO was 0.2%. The strong correlation between RVO and the risk factors of hypertension and AV nicking suggests that blood pressure control and the prevention of arteriosclerosis would be associated with a lower incidence and prevalence of RVO.

Objective: Urinary glucose testing is simple, and has been used as a screening test. However, SGLT-2 inhibitors, drugs for diabetes, which promote massive urinary glucose excretion, are now commercially available, and the number of patients strongly positive for urinary glucose (4+) on health checkups has increased. In this study, we investigated the relationship between the urinary and fasting plasma glucose levels and their changes in persons who had undergone Ningen Dock during 5-year periods before and after SGLT-2 inhibitors became commercially available (2009–2013)(2014–2018).

Methods: The subjects were persons who had undergone health checkups. The fasting blood and urinary glucose levels were measured, and their relationship was investigated.

Results: In the diabetes treatment group, the mean rates of males and females with urinary glucose 4+ among those with a fasting plasma glucose level of <126 mg/dL during the 5 years before SGLT-2 inhibitors became commercially available (launching) were 0.8 and 0%, respectively. However, the percentages 5 years after launching were 25.7 and 16.1%, respectively, showing rapid increases. The specificity, false positive rate, and positive predictive value during the 5 years before launching were 99.4, 0.6, and 53.6%, respectively. The percentages 5 years after launching were 98.5, 1.5, and 21.2%, respectively.

Conclusions: Urinary glucose testing has been used for screening on health checkups. The launching of SGLT-2 inhibitors, which promote massive urinary glucose excretion, markedly influenced the specificity, false positive rate, and positive predictive value of urinary glucose testing.

Objective: Obesity, in particular abdominal obesity, often leads to a metabolic syndrome. Abdominal obesity is defined as a visceral fat area (VFA) >100 cm² using abdominal CT. Waist circumference (WC) is an alternative indirect and simple value for abdominal obesity. Among 191 countries, Vietnam has the lowest obesity rate (2.10%) as defined by body mass index (BMI) ≥30. The prevalence of obesity and metabolic syndrome has not been well studied in developing urban Vietnam, which is experiencing rapid changes in dietary patterns.

Methods: A total of 659 adult Vietnamese (373 males, ages 22 to 79, mean 48.9±0.5; and 286 females, ages 22 to 87, mean 49.9±0.7) underwent abdominal CT to measure VFA and physical examinations, including measurement of WC and BMI, at the HECI Center, Ho Chi Minh, Vietnam in 2019. The prevalence of obesity and metabolic syndrome, and the relationship among the three parameters were analyzed.

Results: The overall rate of obesity was 2.6% (males, 3.5%; females 1.4%), and overweight (BMI≥25 kg/m²) was 30.8% (males 41.0%; females 17.4%). Abdominal obesity (VFA≥100 cm²) was found in 44.3% (males 63.8%; females 18.9%) and metabolic syndrome using VFA≥100 cm² was found in 34.3% (males 49.9%; females 14.3%). VFA, WC and BMI values were positively correlated in both males and females.

Conclusion: In urban Vietnam, the prevalence of obesity (BMI≥30) is low, but being overweight and having metabolic syndrome with abdominal obesity were found in up to 40% of participants.

Objective: This study aimed to verify whether low-normal range serum thyroid hormone concentration is associated with carotid arteriosclerosis in men as they age.

Methods: This cross-sectional study included 1,087 men with a euthyroid state who had not been treated for or diagnosed with cardiovascular diseases and/or metabolic disorders in a comprehensive medical examination at Hidaka Hospital in Japan. Participants’ weight, blood pressure, plasma glucose, serum lipid profile, free thyroxine (FT₄), and thyrotropin were measured and they were interviewed about their smoking habit. Carotid maximum intima–media thickness (max IMT) was determined by ultrasonography.

Results: Max IMT increased with age and began to exceed 1.1 mm, an indicator of the presence of carotid artery plaque, at ≥50 years of age. Serum FT₄ concentrations were significantly lower in those with carotid plaque (p=0.001) and, in multivariate logistic regression analysis were independently associated with carotid plaque only in men aged ≥50 years (β=−1.800, p=0.002). Moreover, max IMT was significantly higher in men with serum FT₄ concentration values of <0.97 ng/dL than in those with ≥0.97 ng/dL. These differences were not observed in men aged <50 years.

Conclusion: Serum FT₄ concentration was independently associated with age-related increases in carotid max IMT in euthyroid Japanese men. A serum FT₄ concentration of <0.97 ng/dL in men aged ≥50 years may help determine their risk for early carotid arteriosclerosis.

Objectives: The aim of this study was to elucidate the effects of sleep habits on obesity in Japan.

Methods: We analyzed data from healthy people who underwent the “Ningen Dock” examination between 2012 and 2020. A total of 5,518 subjects (age: 57.5±13.1 years) were included in a cross-sectional analysis, and 1,515 (age: 58.2±11.9 years) were followed for 6 years in a longitudinal analysis.

Results: The mean sleep duration was 6.4±1.0 hours and was significantly longer in young and elderly people than in middle-aged people. Obesity prevalence was 25.6%, and 11.5% had obesity onset during the follow-up period. In both univariate and cross-sectional multivariate analyses, sleep was significantly associated with obesity. Other significant factors were age, current smoking in males, and habitual drinking and exercise in females. Compared to the 6-hour group, the odds ratio for obesity was significantly higher in males in the <6-hour sleep group and lower in the 7-hour and ≥8-hour groups. In females, there were tendencies towards higher obesity rates in the <6-hour group, and lower rates in the 7-hour group. In the longitudinal multivariate analysis, the odds ratio for sleep in relation to obesity onset tended to be higher in the <6-hour group and lower in the 7-hour group.

Conclusions: Short sleep duration was significantly correlated with obesity in males, and a similar tendency was found in females. Therefore, a sleep duration of approximately 7 hours may be advantageous in terms of obesity prevention in adults.

Objective: The Japan Society of Ningen Dock does not provide any criteria for determining whether changes from previous test values are within the range of natural biological variation or indicate clinical improvement or deterioration. Thus, when test values are classified into the same category as previously, deciding the significance of changes in the values has been left to the discretion of examiners. This study utilized data collected from participants to investigate new indices that would allow us to objectively determine whether changes in test values were significant within the respective criteria categories.

Methods: Participants comprised individuals who had undergone comprehensive health checkups (Ningen Dock) at the Jikei University School of Medicine for 25 years. Their data were used to calculate the level-specific, within-individual coefficient of variation (CV_I), and the reference change value (RCV) based on this CV_I. We then investigated significant changes in test values according to the criteria categories. Differences due to sex and age were also evaluated.

Results: Level-specific CV_I was estimated from measurements of 20,262 individuals with stable health status over time. We calculated RCV based on CV_I estimated without considering sex and age, and then classified RCV according to the criteria categories.

Conclusions: RCV estimation allows an objective evaluation of the significance of changes in test values, which helps determine whether the values have improved or deteriorated based on scientific evidence. RCV is expected to be widely used for Ningen Dock and in future clinical practice.

Objective: This study investigated the relationship between a coronary artery calcium score (CACS) ≥100 and mean intima-media thickness (IMT), and whether the discrimination ability of mean IMT for CACS≥100 differs from that of entire carotid artery (C-max) IMT and max IMT.

Methods: A total of 878 consecutive subjects without any history of cardiovascular disease who had undergone atherosclerosis dock were examined by logistic regression analysis to determine whether there is a significant association between mean IMT and CACS≥100. The analysis was adjusted for risk factors with quartile values that showed an IMT-positive likelihood ratio ≥2.0 for CACS≥100. The discrimination ability of each IMT parameter for CACS≥100 was compared using the area under the curve (AUC) as the index.

Results: The average age of the study subjects was 61.4±11.0 years, and the prevalence of CACS≥100 was 19.7%. Mean IMT values in the 75th percentile or higher (≥0.95 mm) showed a significant association with CACS≥100 (odds ratio: 2.28). The AUC of mean IMT in relation to CACS≥100 was 0.725, which was not significantly different from that of C-max IMT (0.729) or max IMT (0.728; p>0.05 for both).

Conclusions: The discrimination ability of mean IMT for CACS≥100 was not significantly different from that of C-max IMT or max IMT in Japanese subjects. Therefore, mean IMT may be as useful as max IMT for CAD risk stratification in this cohort.

Objective: People’s daily lives have changed during the coronavirus disease 2019 pandemic. Our study revealed several changes in metrics indicative of general health and well-being during the two years of the pandemic compared to the previous three years, based on annual health examinations. We explored time period-, sex-, and age-related changes in health status under pandemic-related circumstances.

Methods: We used a dataset of 56,368 participants aged 30–69 years who underwent health checkups between March 2017 and February 2022. Data were divided into five periods. Body weight, body mass index, waist circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and uric acid (UA) levels were measured. A three-way ANOVA was conducted to examine the effects of the time period, sex, and age.

Results: During the pandemic, SBP and DBP of the two sexes showed opposite trends. Women showed an increase throughout the five periods, whereas men showed a decrease. In all samples, FPG and HbA1c levels increased and then decreased during the pandemic, and UA levels increased before the pandemic but decreased in the first year of the pandemic.

Conclusions: SBP and DBP showed opposite trends in men and women, whereas other results showed no significant difference. However, prolongation of the pandemic could further impact societal behavior and lead to changes in future outcomes. We need to consider new methods to improve people’s lives through information-sharing and support tailored to the individual.

Objective: To evaluate the quality of a review by the Quality Evaluation for Ningen Dock and Health Screening Institute (QENDI), approved by the Japan Society of Ningen Dock, using examination findings.

Methods: We investigated the difference between QENDI and non-QENDI-reviewed hospitals affiliated with the same corporation using the rate at which an irregular heartbeat was indicated on auscultation as an index in patients with atrial fibrillation, a condition that is characterized by an irregular heartbeat.

Results: The indication rate in the QENDI-reviewed hospital was 88.0%, which was significantly higher than that in the non-QENDI-reviewed hospital (45.5%) (p<0.05). The rate at which an irregular heartbeat was indicated by non-Health Evaluation and Promotion Specialists (non-HEPSs) in the QENDI-reviewed hospital was 87.2%. This rate did not differ from that indicated by HEPSs (88.6%).

Conclusion: Diagnostic accuracy may depend more on certification by QENDI than examination by a HEPS. Thus, a review by QENDI may improve the standard of Ningen Dock institutes and the quality of clinical practice through continuing education.

Objective: To elucidate the relationship between colorectal adenoma and lifestyle-related diseases.

Methods: We enrolled 227 individuals who underwent a complete medical checkup at Tokyo Women’s Medical University between June 2016 and December 2017. Risk factors related to the development of colorectal adenoma were analyzed by contingency tables using multivariate logistic regression. Statistical significance was set at p<0.05.

Results: Colorectal adenoma was significantly related to metabolic syndrome that comprises three components, namely central obesity with hypertension, dyslipidemia, and impaired fasting glucose.

Conclusions: The presence of the three components of metabolic syndrome, hypertension, dyslipidemia, and impaired fasting glucose, significantly increases the risk of colorectal adenoma. Therefore, in addition to medication and lifestyle improvements (e.g., diet, exercise therapy), participants with metabolic syndrome with these three components should undergo screening for colorectal adenoma.

  The twelve-lead electrocardiographic (ECG) examination is used in various healthcare fields, and its automatic diagnosis functions play an important role in enabling the handling of a large number of ECGs in a short period of time. Incorrect placement of the ground electrode, while rare, can happen due to human error, and can impede the automatic diagnosis functions from identifying erroneous ECG recordings. This study assessed the ECG characteristics of incorrect ground electrode placement and its clinical implications in two patients. The results showed that (1) an isoelectrical line in either lead II or III is a simple way to identify incorrect electrode placement, and that two pairs of identical limb ECGs, or one pair of identical and one pair of polarity reversed symmetric limb ECGs additionally aid in identifying such a mistake; and (2) incorrect ground electrode attachment can result in the loss of electrocardiographic information corresponding to several frontal axis directions. All healthcare staff in charge of ECG examinations should to be aware of the unique characteristics of incorrect ground electrode placement to ensure proper recording of ECGs and improve the accuracy of ECG examinations.