Annual Health Checkup Research Articles

Associations between glycemic status and the ratio of γ-glutamyl transferase to HDL-C in middle-aged women.

The ratio of γ-glutamyl transferase to HDL-C (GGT/HDL-C) has been proposed as a discriminator of metabolic syndrome. The purpose of this study was to elucidate the relationship between GGT/HDL-C and glycemic status in women. The subjects were 18,218 middle-aged women who had received annual health checkups in their workplaces. They were divided by habitual alcohol intake into nondrinkers, occasional drinkers, regular light drinkers, and regular heavy drinkers. In overall subjects, hemoglobin A1c level and prevalence of diabetes tended to be higher in subjects with higher GGT/HDL-C, and GGT/HDL-C tended to be higher with an increase of alcohol intake. The odds ratio for hyperglycemia in subjects with vs. subjects without high GGT/HDL-C tended to be lower with an increase of alcohol intake, and the association between high GGT/HDL-C and hyperglycemia was significantly weaker in regular heavy drinkers than in nondrinkers. In middle-aged women, there were positive associations of GGT/HDL-C with alcohol intake and glycemic status, and the association between GGT/HDL-C and glycemic status tended to be weaker with an increase of alcohol intake. Thus, alcohol use should be taken into account when GGT/HDL-C is used as a discriminator of diabetes.

Association of body indices with mortality in older population: Japan Specific Health Checkups (J-SHC) Study.

Obesity indices reflect not only fat mass but also muscle mass and nutritional status in older people. Therefore, they may not accurately reflect prognosis. This study aimed to investigate associations between a body shape index (ABSI), body mass index (BMI), and mortality in the general older population. This nationwide observational longitudinal study included individuals aged between 65 and 74 years who underwent annual health checkups between 2008 and 2014. Exposures of interest were ABSI and BMI, and the primary outcome was all-cause mortality. Association between the ABSI and BMI quartile (Q1-4) and mortality was assessed using Cox regression analysis. A restricted cubic spline was also used to investigate nonlinear associations. The missing values were imputed using multiple imputation by chained equations. Among 315,215 participants, 5074 died during a median follow-up period of 42.5 (interquartile range: 26.2-59.3) months. Compared with ABSI Q1, ABSI Q3 and Q4 were associated with increased risk of mortality, with the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.13 (1.05-1.22) and 1.23 (1.13-1.35), respectively. Compared with BMI Q3, BMI Q1 and Q2 were associated with an increased risk of mortality, with aHRs and 95% CIs of 1.51 (1.39-1.65) and 1.12 (1.03-1.22), respectively. The impacts of these indices were greater in male than in female. The heatmap of the aHR for mortality by continuous ABSI and BMI showed that higher ABSI was consistently associated with higher mortality risk regardless of BMI, and that the combination of low BMI and high ABSI was strongly associated with increased mortality risk. High ABSI and low BMI are additively associated with the risk of all-cause mortality in the general older population in Japan. Combination of ABSI and BMI is useful for evaluating mortality risk in older people.

Serum Osmolality as a Predictor of Renal Function Decline: A Retrospective Cohort Study.

Background and Aims: Dehydration is a prevalent and costly healthcare concern, linked to heightened risks of acute kidney injury and in-hospital mortality. Despite its significance, limited evidence exists regarding its prevalence and correlation with renal function decline in apparently healthy individuals. This retrospective cohort study aimed to investigate the prevalence and association of dehydration with renal function decline and the development or progression of chronic kidney disease (CKD) in the general population. Methods: The medical records of subjects undergoing annual health check-ups from 2016 to 2019 at a single center in Taiwan were analyzed, and those with CKD stage V, insufficient data, or an increased estimated glomerular filtration rate (eGFR) were excluded. Serum osmolality, eGFR, and relevant parameters were measured. Logistic regression and Kaplan-Meier analyses were used to assess associations between osmolality and CKD-related outcomes. Results: Among the 4449 eligible subjects, those in the higher osmolality quartiles had an elevated risk of CKD or CKD progression. Multivariate analyses identified age, systolic blood pressure, serum osmolality, uric acid, proteinuria, and a history of diabetes as independent risk factors, with high-density lipoprotein being protective. Cumulative incidence curves demonstrated a significant increase in the risk of CKD with increasing osmolality levels. Restricted cubic spline analyses confirmed a nonlinear relationship between osmolality and CKD risk. Conclusions: Elevated serum osmolality independently predicted renal function decline and CKD development in apparently healthy individuals, and this effect persisted after adjusting for established risk factors. Our findings underscore the importance of addressing dehydration as a modifiable risk factor for CKD.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Metabolically healthy obesity and cardiovascular outcomes

Abstract Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged <65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality. Key messages • Metabolically healthy obesity did not increase cardiovascular disease risks. • Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.

Prediction of subsequent CKD according to eGFR decline slope varies by the presence of hypertension

Abstract Background We reported that a declining slope in eGFR evaluated from 3-year observation could predict subsequent CKD among the relatively healthy population, even adjusted for baseline eGFR. However, its certainty may vary depending on the presence of comorbidities such as diabetes and hypertension, which are also recognized as the risk factors of CKD. Methods Annual health check-up data from a Japanese company spanning from 2009 to 2022 was used. The analyses included participants having 4 times continuous eGFR measurements for 3 years, undergoing health checkups at least once during a follow-up period, with negative for urinary protein (UP), and non-diabetic. Individual ‘eGFR slopes’ were calculated by the regression line with 4 times eGFR measurements. Participants with slopes of < -5 per year were categorized as the “decreased” group and -5 or more were categorized as the “stable” group. The cases of positive UP or less than 45mL/min/1.73m2 in eGFR during a follow-up period were defined as CKD. Cox regression analyses adjusted for sex, age, and eGFR at baseline were performed to calculate the hazard ratios and 95% CIs for CKD in the decreased group (reference; stable), stratified by hypertension. Results Out of 5598 study participants(men 36%, mean age 48.2±10.1years, mean follow-up period 4.3 years), 260 CKD cases (4.6%) were observed. CKD cases accounted for 4.5% (235/5218) in the stable group and 6.6% (25/380) in the decreased group. Multivariate-adjusted hazard ratios [95%CIs] of CKD by eGFR decline was 1.50[0.99-2.27]. The eGFR decline increased the risk of CKD only in participants with hypertension (2.09[1.09-4.04]), but not in those without hypertension (1.25[0.73-2.13]). After excluding individuals with eGFR slopes exceeding 10 per year to consider for hyperfiltration of eGFR, the results were consistent. Conclusions The eGFR decline over a 3-year observation may predict subsequent CKD only in individuals with hypertension. Key messages • With a relatively short-term evaluation period of three years, eGFR decline can predict subsequent CKD only in hypertensive individuals. • In middle-aged hypertensive patients, it would be important for the prevention of CKD to pay attention not only to low eGFR but also to the progression of eGFR decline.

Patterns of trajectories of glycated hemoglobin, fasting plasma glucose, and body mass index until the first clinic visit: the real-world history of type 2 diabetes using repeated health checkup data of Japanese workers

Abstract Background There is a lack of evidence regarding the trajectories of type 2 diabetes until the first clinic visit, including the untreated period after diagnosis. Objective We aimed to determine the real-world history of type 2 diabetes until the first clinic visit, including the untreated duration, and to assess the effective timing of the therapeutic intervention. Methods A total of 23,622 nondiabetic Japanese workers with a mean (SD) age of 38.8 (11.5) years were retrospectively followed from 2008 to 2022 for annual health checkups. The trajectories of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body mass index (BMI) until the first clinic visit in diabetes individuals were determined. ROC analysis was performed to assess the contribution of each measure to the first visit. Results During a median follow-up of 12.0 years, 1,725 individuals developed type 2 diabetes, of whom 532 individuals visited clinics. HbA1c and FPG trajectories steeply rose in the year before the first clinic visit after their progressive upward trends. ROC analysis showed cutoff values for each measure. As the untreated duration increased, glycemia increased and BMI decreased among individuals who visited clinics. Conclusions To prevent the initial worsening of diabetes, early therapeutic intervention is necessary during the increasing trends before the steep rise in glycemia, regardless of the degree of obesity. HbA1c ≥6.5% (47.5 mmol/mol) and an HbA1c ≥0.2% (2.2 mmol/mol)/year increase may be an effective timing for therapeutic intervention.

Impact of the COVID-19 pandemic on the incidence of cardiometabolic risk factors among workers: results from the Japan Epidemiology Collaboration on Occupational Health study

BackgroundThe COVID-19 pandemic and associated restrictions on human activities have greatly changed lifestyles, which might have deteriorated the cardiometabolic profile.ObjectiveThis study aimed to examine the effect of the COVID-19 pandemic...

Handgrip Strength Is Inversely Associated With the Progression of Kidney Damage in a General Japanese Population: A Prospective Cohort Study.

Background Handgrip strength is an indicator of muscle function and a predictor of health outcomes. However, only a few studies have examined the association between handgrip strength and the development of kidney damage. This study aimed to investigate the longitudinal association of handgrip strength with kidney damage in a general Japanese population. Methods This prospective cohort study enrolled participants with normal kidney function who attended annual health check-ups in Ibaraki Prefecture, Japan, between April 2016 and March 2020. Clinical information, including data from blood and urine tests, physiological examinations, and handgrip strength tests, was collected at enrollment. Lifestyle information was also collected via a self-administered questionnaire. The study participants were followed up for the progression of kidney damage until March 2023. Relative handgrip strength was calculated by dividing the handgrip strength by the body mass index to adjust for differences in body mass. A Cox proportional hazards model was used to examine the relationship between relative handgrip strength and the progression of kidney damage. Results A total of 4304 participants with normal kidney function were enrolled in this study. During the mean follow-up period of approximately 4 years (SD 1.8 years), 15.4% of the participants developed kidney damage. After adjusting for covariates, higher relative handgrip strength was associated with a lower risk of kidney damage in men (HR = 0.63, 95% CI: 0.43 - 0.90; p = 0.012), but no significant association was observed in women. Conclusions Higher relative handgrip strength is associated with a lower risk of kidney damage in men. This finding highlights the importance of muscle strength in preventing kidney damage.

Association of psychological and physical stress response with weight gain in university employees in Japan: a retrospective cohort study.

To clarify the association of job stressor score (A score), psychological and physical stress response score (B score), and social support (C score), with the incidence of ≥10% weight gain. This study included 10,036 university employees who completed the brief job stress questionnaire (BJSQ) and annual health checkups between 2016 and 2021. The incidence of ≥10% weight gain from baseline weight was measured. Participants were classified into four categories based on their BJSQ dimension scores. B score was significantly associated with the incidence of weight gain, whereas A and C scores were not. Participants of Q75-89, and Q90-100 categories of B score were at significantly high risk of the incidence of ≥10% weight gain. Psychological and physical stress response had an increasing risk of weight gain.

Association between internet use and annual health checkups among older Japanese adults: propensity score-matched analysis, Japan gerontological evaluation study cross-sectional study 2016

BackgroundThe integration of the Internet into daily life has potential implications for public health, especially in promoting preventive healthcare measures like annual health checkups. This study explores the association between Internet use and the likelihood of participating in these checkups among older Japanese citizens.MethodsParticipants aged 65 and older were randomly selected from 37 municipalities in Japan, ensuring they required no long-term care. Out of 24,313 responses to a postal questionnaire, 11,495 participants were deemed eligible for analysis, achieving a valid participation rate of 70.1%. We applied propensity score matching to balance Internet users and non-users, resulting in 6,504 matched cases. Poisson regression analysis was then used to adjust for demographic, socioeconomic, and behavioral variables that could act as potential confounders.ResultsOur findings show that 55.1% of participants used the Internet several times a month, and among these, 63.5% had attended an annual health checkup in the preceding year. After adjusting for potential confounders, Internet users were found to be 9% more likely to participate in annual health checkups compared to non-users (95% Confidence Interval: 1.02–1.15).ConclusionsThis study concludes that there is a positive association between Internet use and participation in annual health checkups among older individuals in Japan. The results suggest that Internet use may serve as a tool to promote preventive healthcare practices in older populations. However, the study underscores the need for further investigation to understand the underlying mechanisms of this association and to establish a causal relationship.

Meat intake and type 2 diabetes among Japanese workers: a prospective study.

Red meat and processed meat intake has been linked to increased risk of type 2 diabetes; however, evidence from Asia is limited and inconsistent. We prospectively examined the association of intake of total meat and its subtype with type 2 diabetes in a Japanese working population. Participants were 2709 workers aged 18-78 years who reported no history of diabetes when they responded to a health survey for the first time between 2012 and 2019. Dietary intake was assessed using a validated self-administered diet history questionnaire. The incidence of type 2 diabetes was assessed via annual health checkups from baseline through March 2023. Type 2 diabetes was defined as fasting blood glucose ≥ 126 mg/dl, casual blood glucose ≥ 200 mg/dl, HbA1c ≥ 6·5 %, self-report of diabetes or current use of anti-diabetic drugs. Hazard ratios according to tertile of meat intake were estimated using Cox proportional hazards regression. During 16119 person-years of follow-up, 135 (5·0 %) workers developed type 2 diabetes. Intakes of total meat, red meat, processed meat and poultry were not associated with risk of type 2 diabetes. After adjustment for covariates, hazard ratios for the highest v. lowest tertile of meat intake were 1·01 (95 % CI 0·63, 1·62) for total meat, 1·02 (95 % CI 0·66, 1·58) for red meat, 0·99 (95 % CI 0·65, 1·49) for processed meat and 1·13 (95 % CI 0·71, 1·80) for poultry. Our findings suggest that meat intake is not associated with the risk of type 2 diabetes among Japanese workers.

Associations between income/employment status and diabetes care processes, health behaviors, and health outcomes in Japan: A cross-sectional study using claims data linked to a questionnaire survey.

We aimed to explore the associations between income/employment status and diabetes care processes, health behaviors and health outcomes. This cross-sectional study used health insurance claims data between April 2021 and March 2022, and a questionnaire survey between December 2022 and January 2023 in Tsukuba City. The study analyzed the participants with diabetes (other than type 1) from those selected by stratified random sampling. We evaluated diabetes care processes, health behaviors and health outcomes by calculating weighted proportions among the groups. We also assessed the associations between income/employment status and these variables using multivariable modified Poisson regression models. Of the 264 identified participants, 161 (64.2%) were men and 168 (72.8%) were aged ≥65 years old. Compared with the low-income groups, the high-income group had a higher proportion of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists use (adjusted risk ratio [aRR] 1.70, 95% confidence interval (CI) 1.07-2.72), a higher proportion of attendance to annual health checkups for ≥2 years (aRR 1.68, 95% CI 1.07-2.64) and a lower proportion of all-cause hospitalization (aRR 0.15, 95% CI 0.04-0.48); additionally, the middle-income group had a lower proportion of high total outpatient medical expenses (aRR 0.57, 95% CI 0.35-0.92). Compared to the no work time group, the full-time work group had a lower proportion of exercise habits (aRR 0.59, 95% CI 0.35-0.99) and a higher proportion of good self-reported health (aRR 2.08, 95% CI 1.22-3.55). Several variables were associated with income/employment status. Policy intervention should focus on high-risk groups identified by considering these associations.

Annual variation of estimated glomerular filtration rate in health check-ups associated with end-stage kidney disease

Estimated glomerular filtration rate (eGFR) variation is associated with end-stage kidney disease (ESKD) development in patients with chronic kidney disease; whether annual variations in eGFR at health check-ups is associated with ESKD risk in the general population is unclear. We conducted a retrospective cohort study using Japanese national medical insurance claims from 2013 to 2020. Individuals who had their eGFR levels measured three times in annual health check-ups were included (N = 115,191), and the coefficient of variation of eGFR (CVeGFR) was calculated from 3-point eGFR. The end-point was ESKD as reported in the claims data. We analyzed the association between CVeGFR and ESKD incidence after adjusting for conventional ESKD risk factors. The CVeGFR median distribution was 5.7% (interquartile range: 3.5–8.5%). During a median follow-up period of 3.74 years, 164 patients progressed to ESKD. ESKD incidence was significantly higher in the highest quartile group (CVeGFR ≥ 8.5%) than in the other groups (P < 0.0001). After adjusting for risk factors, individuals with CVeGFR ≥ 8.5% had a significantly high ESKD incidence (adjusted hazard ratio: 3.01; 95% CI 2.14–4.30). High CVeGFR in annual health check-ups was associated with high ESKD incidence, independent of its other conventional risk factors, in the general population.

The serum uric acid to serum creatinine ratio is an independent risk factor for type 2 diabetes in community-dwelling elderly: A longitudinal analysis

Background and aimElevated serum uric acid (SUA) levels are an important marker of metabolic disorders. However, SUA levels largely depend on renal clearance function. This study aims to investigate the relationship between renal function-normalized SUA [SUA to serum creatinine (SCr) ratio] and the risk of developing type 2 diabetes in a community-dwelling elderly population. Methods and resultsA retrospective cohort study was conducted on elderly, non-diabetic individuals from the Kunshan community in China, who participated in annual health check-ups between January 2018 and December 2023. The relationship between the baseline SUA/SCr ratio and the risk of type 2 diabetes was examined using Cox regression models, restricted cubic splines (RCS), and subgroup analyses. After a median follow-up of 3.88 years, 778 cases of type 2 diabetes were identified among 7671 elderly non-diabetic individuals. Adjusting for confounding variables, the baseline SUA/SCr ratio was significantly linked to type 2 diabetes risk (P < 0.001). Individuals in the highest SUA/SCr ratio quartile had a 1.323 times higher risk of developing type 2 diabetes compared to those in the lowest quartile (HR = 1.323, 95% CI 1.053–1.661, P = 0.016). RCS analysis further confirmed this positive association. Additionally, subgroup analyses suggested that this relationship was particularly pronounced in female individuals. ConclusionsIn Chinese elderly community residents, the baseline SUA/SCr ratio is linked to the risk of type 2 diabetes. Monitoring this ratio could aid in predicting and assessing the risk of type 2 diabetes.

Association between Helicobacter pylori infection and type 2 diabetes mellitus: a retrospective cohort study and bioinformatics analysis

PurposeThis study aimed to preliminarily investigate the association and possible mechanisms between Helicobacter. pylori (H. pylori) infection and type 2 diabetes mellitus (T2DM) through data collection, statistical analysis, and bioinformatics analysis.MethodsA retrospective cohort study, including a total of 4406 participants who attended annual health checkups at Xian GEM Flower Changqing Hospital, was conducted to explore the correlation between the incidence of T2DM and H. pylori infection. To uncover the potential mechanisms underlying the interaction between the two diseases, differentially expressed genes (DEGs) common to T2DM and H. pylori infection were identified using the GEO database and Venn diagrams. These DEGs were then analyzed through Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, and protein-protein interaction (PPI) analysis.ResultsIn total, 2053 participants were classified into the H. pylori-positive group and 2353 into the H. pylori-negative group. H. pylori infection was associated with a higher risk of T2DM occurrence (adjusted HR 1.59; 95% CI 1.17–2.15, P = 0.003). The average disease-free survival time was 34.81 months (95% CI 34.60-35.03 months) in the H. pylori positive group and 35.42 months (95% CI 35.28–35.56 months) in the H. pylori negative group. Multivariate analysis and subgroup analyses also showed that H. pylori infection increased the risk of developing T2DM. A total of 21 DEGs between T2DM and H. pylori infection were identified and enriched in 7 signaling pathways, indicating specific protein interactions.ConclusionsThe prevalence of T2DM was associated with H. pylori infection. T2DM and H. pylori infection may interact with each other through metabolic and immune pathways.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension.

Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension. This cohort study analysed data from 30152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension. During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users. Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Risk of incident type 2 diabetes in male NAFLD and NAFLD-free smokers: a 7-year post-cessation study

BackgroundWe aimed to investigate the post-cessation T2DM risk in male NAFLD and NAFLD-free smokers in a 7-year cohort study.MethodsThe study population was male adults who underwent annual health checkups in a 7-year cohort study. Recent quitters were categorized into four groups based on their weight gain during follow-up: < 0 kg, 0–1.9 kg, 2.0–3.9 kg, and ≥ 4.0 kg. Cox proportional hazard models, adjusted for various variables, were used to estimate hazard ratios (HRs) for the association between post-cessation weight gain and incident T2DM in NAFLD and NAFLD-free individuals.ResultsAt baseline, we included 1,409 NAFLD and 5150 NAFLD-free individuals. During a total of 39,259 person-years of follow-up, 222 (15.8%) NAFLD patients and 621 (12.1%) NAFLD-free participants quit smoking, with the corresponding means (standard deviations) of post-cessation weight gain being 2.24 (3.26) kg and 1.15 (3.51) kg, respectively. Among NAFLD individuals, compared to current smokers, the fully adjusted HRs (95% CI) for incident T2DM were 0.41 (0.06–3.01), 2.39 (1.21–4.70), 4.48 (2.63–7.63), and 6.42 (3.68–11.23) for quitters with weight gains < 0 kg, 0.0–1.9 kg, 2.0–3.9 kg, and ≥ 4.0 kg, respectively. For NAFLD-free individuals, we only observed a significant association between post-cessation weight gain ≥ 4.0 kg and the risk of incident T2DM (P < 0.001). Further analysis revealed that the impact of post-cessation weight gain on T2DM risk was not affected by alcohol consumption or obesity status at baseline.ConclusionsMild post-cessation weight gain significantly increased the risk of T2DM in male NAFLD patients but not in male NAFLD-free individuals. Therefore, it is recommended that individuals with NAFLD manage their weight after quitting smoking.

Prevalent and new use of common drugs for the incidence of community-acquired acute kidney injury: cohort and case-crossover study

Although community-acquired acute kidney injury (CA-AKI) represents a significant subset of all AKI incidence, evidence is limited due to the lack of comprehensive data prior to diagnosis. Here, we examined the risk of drug use for CA-AKI by using exhaustive pre-diagnostic prescription data. We included 78,754 working-age healthy individuals who underwent an annual health checkup program. We conducted a cohort study to assess the association between prevalent drug use and subsequent CA-AKI incidence using the Cox proportional hazard model. Subsequently, we conducted a case-crossover study to compare the new drug use in the case period directly before the CA-AKI incidence (− 3 to 0 months) with that in the control period far before the CA-AKI incidence (− 15 to − 12 months and − 9 to − 6 months) using the conditional Poisson regression model. The prevalent use of renin–angiotensin–aldosterone system (RAAS) inhibitors was associated with an increased CA-AKI incidence, but the new use was not. The new use of diuretics, anti-infectious drugs, and contrast medium was also associated with an increased CA-AKI incidence. These results suggest we need to pay attention for the incidence of AKI among the general population taking those common drugs.

Validity of the Chinese multimorbidity-weighted index in measuring disease burden using health check-ups data in primary care

BackgroundAs multimorbidity becomes common that imposes a considerable burden to patients, but the extent to which widely-used multimorbidity indexes can be applied to quantify disease burden using primary care data in China is not clear. We applied the Chinese Multimorbidity-Weighted Index (CMWI) to health check-ups data routinely collected among older adults by primary care, to examine its validity in measuring multimorbidity associated risks of disability and mortality in annual follow-ups.MethodsThe study utilized data from annual health check-ups of older adults, which included information on individual age, sex, and 14 health conditions at primary care in a district of Guangzhou, Guangdong, China. The risk of CMWI for mortality was analysed in a total sample of 45,009 persons 65 years and older between 2014 and 2020 (average 2.70-year follow-up), and the risk for disability was in a subsample of 18,320 older adults free of physical impairment in 2019 and followed-up in 2020. Risk of death and disability were assessed with Cox proportional hazard regression and binary logistic regression, respectively, with both models adjusted for age and sex variables. The model fit was assessed by the Akaike information criterion (AIC), and C-statistic or the area under the receiver operating characteristic curve (AUC).ResultsOne unit increase in baseline-CMWI (Median= 1.70, IQR: 1.30-3.00) was associated with higher risk in subsequent disability (OR = 1.12, 95%CI = 1.05,1.20) and mortality (OR = 1.18, 95%CI = 1.14, 1.22). Participants in the top tertile of CMWI had 99% and 152% increased risks of disability and mortality than their counterparts in the bottom tertile. Model fit was satisfied with adequate AUC (0.84) or C-statistic (0.76) for both outcomes.ConclusionsCMWI, calculated based on primary care’s routine health check-ups data, provides valid estimates of disability and mortality risks in older adults. This validated tool can be used to quantity and monitor older patients’ health risks in primary care.