Annual Health Checkup Research Articles

Association between proteinuria and retinal vein occlusion in individuals with preserved renal function: a retrospective cohort study.

To investigate the association between proteinuria and the incidenceof retinal vein occlusion (RVO) in individuals with preserved renal function. We conducted a retrospective cohort study from 2005 to 2020 using the JMDC Claims Database, a large database of health check-ups and administrative claims in Japan. Individuals who underwent annual health check-ups were included. Participants were classified into three groups based on the protein concentration in their urine: negative (≤10 mg/dl), trace (10-30 mg/dl) and positive (≥30 mg/dl). We estimated hazard ratios (HRs) for the development of RVO using Cox regression analyses with adjustment for baseline characteristics by the matching weights calculated from the multiple propensity scores. The cumulative incidence of RVO between the weighted groups was calculated using the Kaplan-Meier estimator. There were 1 635 212 eligible participants, among whom 2360 developed RVO. The mean follow-up period was 1036 ± 951 days. The adjusted HRs for RVO were 1.10 (95% confidence interval 0.92-1.33) and 1.46 (1.19-1.78) in the groups with trace and positive proteinuria compared with negative proteinuria respectively. The cumulative incidence rates of RVO at 7 years were 0.40%, 0.43% and 0.55% in the groups with negative, trace and positive proteinuria, respectively. Positive proteinuria was independently associated with an increased incidence of RVO in individuals with preserved renal function. Proteinuria may be a novel risk factor for RVO development.

MO129: Influence of Menstrual Situation on the Risk of Incident Microalbuminuria in School Workers: Miyagi Karoshi Prevention Study

Abstract BACKGROUND AND AIMS It has been recognized that menstrual situation impairs diagnostic accuracy of proteinuria. However, it is not fully understood how menstrual situation affects the degree of urinary albumin excretion, a well-known marker of endothelial damage. Moreover, there may be no report examining the dose–response relationship between contaminated blood and the risk of incident microalbuminuria. METHOD We studied 735 female school staffs (40.6 ± 11.2 years) who participated in the Miyagi Karoshi Prevention study. Urinary albumin excretion adjusted for creatinine (UAE) from morning spot urine sample was examined together with annual health check-up in 2019 and 2020. Menstrual situation was confirmed by a questionnaire at the time of examination. First of all, we examined the odds ratio for microalbuminuria of menstruation by means of logistic regression analysis using baseline data of 703 subjects with normo-albuminuria (NA) and 32 subjects with micro-albuminuria (MA). Next, we examined the dose–response relationship between urine blood category of − (n = 49), ± (n = 13 ), + (n = 22), 2+ (n = 13), 3+ (n = 47) and UAE or frequency of MA in 144 non-diabetic, non-hypertensive subjects without chronic kidney disease who were menstrual and non-menstrual situation in either year. RESULTS Age and BMI were similar between MA and NA groups, while frequency of menstruation (31.2 versus 15.4%, P < .05), hypertension, or BP ≧ 140/90 mmHg or use of antihypertensive medications (34.4 versus 10.0%, P < .001) and diabetes, or HbA1c ≧ 6.5% or use of antidiabetic medications (9.4 versus 2.3%, P < .05) was higher in MA than in NA group. Multivariate logistic regression analysis has shown that MA was significantly associated with menstruation (OR 2.65: 95% CI 1.17–53.99) and hypertension (OR 4.41: 1.69–11.51). UAE was dose-dependently increased with an increase in urine blood category (P < .001). Frequency of MA in each urine blood category was 0.0, 4.5, 0 and 17.0% (P = .001), respectively. CONCLUSION Contamination of blood into urine dose-dependently increases UAE in menstruated women. The diagnosis of MA may be possible even in menstrual situation if urine blood category is 2+ or lower.

Gender Differences in Insomnia and Role of Work Characteristics and Family Responsibilities Among Healthcare Workers in Taiwanese Tertiary Hospitals.

BackgroundInsomnia is common among healthcare workers (HCWs), especially those working in tertiary hospitals. This study aimed to clarify whether gender differences in insomnia could be explained by gender differences in work characteristics and family responsibilities among HCWs in tertiary hospitals in Taiwan.MethodsThis cross-sectional study was conducted in 22 departments of two tertiary hospitals in Northern Taiwan from December 2018 to March 2019. All data were obtained by a self-administered questionnaire given when participants underwent annual health check-ups. Insomnia was evaluated using the Chinese Athens Insomnia Scale. Work characteristics and family responsibilities were as follows: department, working hours, shift work, visual display terminals used at work, demand-control-support model, burnout level, breadwinner status, living conditions, and caregiver status. Data of 2,811 participants (317 men, 11.3%; 2,494 women, 88.7%) were analyzed (response rate: men, 85%; women, 88%). Logistic regression analysis examined howwork characteristics and family responsibilities explained gender differences in insomnia.ResultsThe prevalence of insomnia in women (61.7%) was significantly higher than that in men (52.7%), and gender differences strengthened after adjusting for work characteristics and family responsibilities [odds ratio: 1.45 (1.11–1.90) and 1.62 (1.18–2.22), p < 0.01]. Stratified analyses revealed that significant gender differences were found among HCWs with comparatively unfavorable work and family conditions. Furthermore, women had a higher association of insomnia owing to these factors.ConclusionThese results suggest that gender differences in insomnia among HCWs are mainly explained by gender differences in work characteristics and family responsibilities.

Association of domain-specific physical activity and sedentary behavior with cardiometabolic health among office workers.

Previous studies have reported opposite effects of occupational or non-occupational physical activity (PA) and sedentary behavior (SB) on health outcomes. However, no study has investigated the relationship between domain-specific movement behaviors and cardiometabolic health (CMH) among office workers, considering the compositional nature of time-use data. We investigated the associations of accelerometer-measured PA and SB for each domain (working time, non-working time on workday, and non-workday) with CMH indicators among office workers, using compositional data analysis. This cross-sectional study included 1258Japanese office workers. The time spent on SB, light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA) were assessed using an accelerometer. CMH indicators were retrieved from the annual health check-up data. Compositional multiple linear regression indicated that PA and SB during non-working time on workdays, but not working time or non-workdays, were significantly associated with CMH. In particular, during non-working time, time reallocations from SB to LPA and from SB to MVPA were associated with favorable changes in cardiometabolic risk score and lipid metabolism, respectively. Paradoxically, a greater proportion of LPA during non-working time was associated with favorable diastolic blood pressure (β=1.61; 95% confidence interval [CI]= 0.02, 3.19), whereas occupational LPA was detrimental (β=-2.48; 95% CI=-4.87, -0.09). Our results suggested that reducing SB and increasing PA during non-working time on workdays may be effective for managing CMH among office workers. Future longitudinal studies using compositional data analysis are required to confirm our results.

Sleep Satisfaction May Modify the Association between Metabolic Syndrome and BMI, Respectively, and Occupational Stress in Japanese Office Workers.

The association between obesity and psychological stress is ambiguous. The aim is to investigate the association between metabolic syndrome (MetS) and body mass index (BMI), respectively, with occupational stress among Japanese office workers. The study is a secondary analysis of the intervention group from a randomized controlled trial. There are 167 participants included in the analysis. Occupational stress is self-reported using the Brief Job Stress Questionnaire (BJSQ). BMI and the classification of MetS/pre-MetS was based on the participants’ annual health check-up data. The primary exposure is divided into three groups: no MetS, pre-MetS, and MetS in accordance with Japanese guidelines. The secondary exposure, BMI, remains as a continuous variable. Multiple linear regression is implemented. Sensitivity analyses are stratified by sleep satisfaction. Pre-MetS is significantly associated with occupational stress (7.84 points; 95% CI: 0.17, 15.51). Among participants with low sleep satisfaction, pre-MetS (14.09 points; 95% CI: 1.71, 26.48), MetS (14.72 points; 95% CI: 0.93, 28.51), and BMI (2.54 points; 95% CI: 0.05, 4.99) are all significantly associated with occupational stress. No significant associations are observed in participants with high sleep satisfaction. The findings of this study indicate that sleep satisfaction may modify the association between MetS and BMI, respectively, and occupational stress.

Positive relationships between annual changes in salt intake and plasma B-type natriuretic peptide levels in the general population without hypertension and heart diseases.

Excessive salt intake causes hypertension and heart diseases. B-type natriuretic peptide (BNP) is a surrogate marker of heart disease, and a slightly elevated BNP level is associated with a poor prognosis. Our previous cross-sectional study demonstrated that plasma BNP has a significant positive association with daily salt intake in the general population. However, the relationship between changes in salt intake and changes in plasma BNP remains unknown. We recruited 3051 participants without hypertension or electrocardiogram abnormalities who underwent annual health check-ups for two consecutive years. Clinical parameters, including plasma BNP, were obtained, and daily salt intake was evaluated using urinary samples. Annual changes in these parameters were calculated. The median plasma BNP level was 12.9 pg/mL, and the daily salt intake was 8.73 ± 1.89 g. The annual changes in plasma BNP and daily salt intake were 4.79 ± 36.38% and 2.01 ± 21.80%, respectively. Participants in the highest quartile of annual changes in daily salt intake showed the largest annual changes in plasma BNP. Annual changes in plasma BNP indicated a significant positive association with daily salt intake. Moreover, multiple linear regression analyses revealed that annual changes in plasma BNP showed a significant positive association with daily salt intake after adjustments. Our study showed a significant positive relationship between annual changes in plasma BNP and annual changes in daily salt intake. The suppression of plasma BNP is therefore induced by salt intake restriction. The monitoring of plasma BNP while reducing salt intake may therefore prevent heart diseases and lead to improved prognoses in the general population without heart diseases.

Associations between polycythemia and cardiometabolic risk factors in middle-aged men

BackgroundPolycythemia increases blood viscosity and causes thrombogenesis in cardiovascular disease. However, relationships between polycythemia and cardiometabolic risk factors in a general population remain to be determined. MethodsSubjects were middle-aged Japanese men (n = 11261) receiving annual health checkup examinations. Relationships of polycythemia, defined as hemoglobin concentrations of 16.5 g/dl or higher, with cardiometabolic risk factors, including obesity, hypertension, dyslipidemia and diabetes, were investigated. ResultsBoth in univariable analysis and multivariable analysis with adjustment for age, histories of smoking, alcohol drinking and regular exercise, and medication therapy for hypertension, dyslipidemia or diabetes, waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, LDL cholesterol, cardiometabolic index (CMI) and hemoglobin A1c were significantly higher and HDL cholesterol was significantly lower in the polycythemic group than in the non-polycythemic group. The above associations between polycythemia and cardiovascular risk factors were also found in the sub-analysis for nonsmokers (n = 4937). The odds ratios (ORs) of the polycythemic vs. non-polycythemic groups for high CMI and metabolic syndrome (MS) were significantly high when compared with the reference level in the multivariable analysis (OR with 95% confidence interval: high CMI, 2.18 [1.91 ∼ 2.50]; MS, 2.39 [2.02 ∼ 2.85]). ConclusionPolycythemia showed smoking-independent associations with cardiometabolic risk factors including visceral obesity, hypertension, dyslipidemia, diabetes and metabolic syndrome. Thus, polycythemia is a potential discriminator of cardiovascular risk in the general population.

Accumulated unhealthy behaviours and insomnia in Japanese dwellers with and without cardiovascular risk factors: a cross-sectional study

ObjectivesTo date, the association between accumulated unhealthy behaviours and insomnia in individuals stratified according to the presence or absence of major cardiovascular risk factors is unclear. This study aimed to...

Whisper Test – MasS Hearing Screening Programme

Aims and Objectives: To screen the school going mass for hearing loss and study its relationship with their academic performance and aptitude and compare it with pure tone audiometry and validate whisper test. Material and Methods: Procedure- Examiner stands arm distance (60cm) behind the patient. Mask the non-test ear by occluding the external auditory canal by continuously generating rubbing sound. The patient is explained to repeat the words. Test always started with consonants followed by vowels. If more than 80% were correct it was treated as passed. Results: In our study out of 86 students, 8 children failed in whisper test, but all passed in conversation test. In the present study performance was poor in failed students. The incidence of day dream, learning difficulty, inattentiveness was high with hearing impaired children. Conclusion: The whisper test is a simple effective diagnostic and mass hearing screening test which can predict an early hearing loss and if performed by a trained paramedical or social worker can differentiate in conductive, sensorineural, cochlear, and retrocochlear lesion. Since the whisper test does not require a qualified audiologist or otolaryngologist, it should be be a part of annual health check-up and national programme of prevention and control of deafness specifically hearing care in the elderly.

Association between circulating cystatin C and hyperuricemia: a cross-sectional study.

Circulating cystatin C has reportedly been related to cardiovascular disease, diabetes, and metabolic syndrome, apart from its traditional role in estimating the glomerular filtration rate. However, whether circulating cystatin C is related to hyperuricemia remains unclear. We included 2406 men and 1273 women who attended their annual health checkups in this study. Anthropometric and biochemical parameters were measured. Hyperuricemia was diagnosed as fasting serum uric acid > 420µmol/L in men and women. A total of 695 (18.9%) participants were diagnosed with hyperuricemia. Hyperuricemic patients had significantly higher serum cystatin C levels than healthy controls (0.91 (0.83-1.02) versus 0.82 (0.72-0.92) mg/L, P < 0.001). Serum cystatin C levels were positively related to the prevalence of hyperuricemia, which was 5.18%, 14.76%, 22.66%, and 31.24% in participants with serum cystatin C levels in the first, second, third, and fourth quartiles, respectively (P < 0.001 for trend). In stepwise multivariate logistic regression analysis, participants with serum cystatin C in the fourth quartile had a more than twofold increased risk of hyperuricemia (OR 2.262, 95% CI 1.495-3.422; P < 0.001) compared with those with serum cystatin C in the first quartile. In subgroup analyses, the fourth quartile of cystatin C was related to increased risks of hyperuricemia in both non-obese and obese participants (OR 4.405, 95% CI 1.472-13.184, P = 0.008; OR 1.891, 95% CI 1.228-2.911, P = 0.004, respectively), in non-metabolic syndrome participants (OR 3.043, 95% CI 1.692-5.473; P < 0.001) but not in metabolic syndrome participants (OR 1.689, 95% CI 0.937-3.045; P = 0.081), and in non-non-alcoholic fatty liver disease (non-NAFLD) (OR 2.128, 95% CI 1.424-3.180; P < 0.001, respectively) and young and middle-aged participants (OR 2.235, 95% CI 1.492-3.348, P < 0.001) but not in NAFLD and elderly participants. This study revealed a positive association of circulating cystatin C with hyperuricemia. Key Points • Serum cystatin C is associated with an increased risk of hyperuricemia. • Serum cystatin C is a useful biomarker in distinguishing patients at high risk of having hyperuricemia.

The Association Between Visceral Adiposity Index and Worsening Renal Function in the Elderly.

BackgroundVisceral adiposity index (VAI) is an indicator of visceral fat accumulation and dysfunction. However, little is known about whether VAI is associated with worsening renal function (WRF) in the elderly. Therefore, our study aimed to explore the association between VAI and WRF among the elderly population.MethodsIn total, 5,583 elderly participants (aged ≥ 65 years) who participated in the annual health checkups at least twice between January 2017 and July 2021 were enrolled and divided into four groups according to the VAI quartiles. The primary endpoint was incident chronic kidney disease (CKD), defined as incident estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. The secondary endpoint was rapid kidney function decline (RKFD), defined as decline in eGFR of 40%. To evaluate the association between VAI and WRF, three Cox regression models were conducted, where VAI was treated as a continuous variable and a categorical variable (Q1 as reference), respectively. Subgroup analysis in participants with different baseline characteristics was also performed.ResultsDuring a median of 2.46 year follow-up, 931 (16.68%) participants developed CKD. After fully adjusting for confounding factors, VAI was significantly associated with incident CKD (HR, 1.052; 95% CI: 1.029–1.076, p < 0.001), and RKFD (HR, 1.077; 95% CI: 1.041–1.114, p < 0.001). Moreover, compared to those with the lowest VAI quartiles, subjects with the highest quartiles had a higher risk of incident CKD (HR, 1.286; 95% CI: 1.033–1.601, p = 0.024), and RKFD (HR, 1.895; 95% CI: 1.086–3.307, p = 0.025). The risk of incident CKD also tended to increase with elevated VAI quartiles (all p-values for trend <0.05). This positive association remained consistent among participants with different genders, baseline weights, or kidney functions.ConclusionIn our study, elevated VAI was associated with increased risk of incident CKD and RKFD in the elderly population.

Dietary Patterns and Their Associations with Intermediate Age-Related Macular Degeneration in a Japanese Population.

This population-based cross-sectional study investigated the influence of dietary patterns on age-related macular degeneration (AMD) in a Japanese population. The Tsuruoka Metabolomics Cohort Study enrolled a general population aged 35–74 years from among participants in annual health check-up programs in Tsuruoka City, Japan. Eating habits were assessed using a food frequency questionnaire. Principal component analysis was used to identify dietary patterns among food items. The association between quartiles of scores for each dietary pattern and intermediate AMD was assessed using multivariate logistic regression models. Of 3433 participants, 415 had intermediate AMD. We identified four principal components comprising the Vegetable-rich pattern, Varied staple food pattern, Animal-rich pattern, and Seafood-rich pattern. After adjusting for potential confounders, higher Varied staple food diet scores were associated with a lower prevalence of intermediate AMD (fourth vs. first quartile) (OR, 0.63; 95% confidence interval [CI], 0.46–0.86). A significant trend of decreasing ORs for intermediate AMD associated with increasing Varied staple food diet scores was noted (p for trend = 0.002). There was no significant association between the other dietary patterns and intermediate AMD. In a Japanese population, individuals with a dietary pattern score high in the Varied staple food pattern had a lower prevalence of intermediate AMD.

Dermatitis in Greenhouse Farmers Caused by Acaricide Cyflumetofen - An Interview Study

Pesticides are essentially toxic to living things, and, as they are used openly, it is necessary to monitor them and to prevent their adverse effects. A self-administered questionnaire survey given to a group of the greenhouse farmers told us that some of them developed dermatitis from acaricide cyflumetofen, so we conducted an interview study on dermatitis caused by cyflumetofen. The participants were affiliated with a strawberry producing group, and were interviewed at their annual health checkups in the spring of 2016 and 2017. The questions covered the status of spraying, dermatitis from cyflumetofen, and visitations to clinics/hospitals. Of 108 farmers interviewed, 20 had subjective symptoms of dermatitis from cyflumetofen. Seven of them had visited clinics/hospitals. The most affected body part was the face, especially around the eyes, followed by the hands and forearms. The subjective symptoms varied from slight (rubor and itching) to serious (swelling with aching around the eyes). Three male farmers had visited clinics/hospitals for 3-4 weeks, and had stopped using cyflumetofen. We advised them to continue avoiding the use of cyflumetofen, considering the results of an animal test: a "pesticide abstract" stated that cyflumetofen had caused skin sensitization in guinea pigs. It is necessary, therefore, to mention this skin sensitization in the safety datasheet of cyflumetofen.

Branched chain and other amino acid intakes are inversely associated with sarcopenia among community elders in Qingdao, China.

The present study aimed to investigate the hypothesis that dietary amino acid intakes are associated with the risk of sarcopenia through a community-based observational study. A total of 1,140 participants (72.7±6.3 y) were recruited from an annual health check-up program in Qingdao, China. Skeletal muscle mass, muscle mass functions and biochemical parameters were measured by standard methods. Dietary intake was assessed by 3-day, 24-hour food records. The odds ratios (ORs) and 95% confidence intervals (CIs) of sarcopenic risk across quartiles of amino acid intakes were calculated using a multivariable- adjusted logistic regression model. Generalized linear models were used to assess the associations between dietary amino acid intakes and muscle mass functions. The prevalence of sarcopenia was 4.1%. Compared with the lowest category intake, the highest category of branched chain amino acids (BCAAs) (OR=0.11; 95% CI: 0.01, 0.90; p for trend=0.119), isoleucine (OR=0.11; 95% CI: 0.01, 0.89; p for trend=0.122) and tryptophan (OR=0.10; 95% CI: 0.01, 0.87; p for trend=0.176) was negatively correlated with sarcopenic risk with adjustment for potential confounding factors. Generalized linear model analysis showed that gait speed was positively correlated with dietary intakes of lysine, threonine, leucine, valine, tryptophan, BCAAs and aromatic amino acids (p<0.05). Higher intakes of BCAAs were associated with a lower risk of sarcopenia, which might beneficially protect against sarcopenia and improve physical function of the elderly.

Abstract EP53: The Association Of Oral Hypofunction/locomotive Syndrome And Increased Arterial Stiffness

Background: Frailty is associated with higher risk of cardiovascular disease (CVD). Recently, oral hypofunction, a disease in which the oral function is complexly reduced not only by ageing but also by a variety of factors, is regarded as a risk factor for frailty. Also, locomotive syndrome, which is defined as reduced mobility due to impaired locomotive organs, is reported to have close association with frailty and oral hypofunction. However, no studies evaluated the association of oral hypofunction / locomotive syndrome and arterial stiffness, a marker of CVD. The objective of this study is to evaluate the association of oral hypofunction / locomotive syndrome and arterial stiffness. Hypothesis: We hypothesized that subjects with oral hypofunction or locomotive syndrome have increased arterial stiffness compared to those without oral hypofunction and locomotive syndrome. Methods: Japanese Subjects above 50 years old who underwent annual health-checkup were enrolled in this cross-sectional study. Subjects with history of CVD and dementia were excluded. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Oral hypofunction was evaluated the methods based on the guidance by the Japanese Association for Dental Science. Seven oral factors, oral hygiene, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function were assessed. Oral hypofunction was diagnosed if more than 3 factors showed deterioration. Locomotive syndrome was evaluated by the questionnaires (GLFS-25) and physical performance tests consisted of those for quadriceps muscle strength, a two-step test, and a stand-up test according to the guidance by the Japanese Orthopedic Association. The association of oral hypofunction / locomotive syndrome and baPWV was assessed by multivariable linear regression analysis adjusted for conventional CVD risk factors. Results: Among 148 subjects (mean age: 59±7 years), 82 subjects (55%) had either oral hypofunction or locomotive syndrome (oral hypofunction: 33 subjects, locomotive syndrome: 65 subjects). BaPWV in subjects with either oral hypofunction or locomotive syndrome was significantly higher than subjects with none of them (mean baPWV: 1501±292 v.s. 1368±238cm/sec, p=0.003). Multivariable linear regression analysis revealed that the existence of either oral hypofunction or locomotive syndrome was significantly associated with increased arterial stiffness (β=100±39, p=0.01). Conclusion: The existence of either oral hypofunction or locomotive syndrome was associated with increased arterial stiffness. Further research on oral hypofunction / locomotive syndrome and CVD is warranted.

Fatty liver with metabolic disorder, such as metabolic dysfunction-associated fatty liver disease, indicates high risk for developing diabetes mellitus.

IntroductionNonalcoholic fatty liver disease (NAFLD) is diagnosed after excluding other liver diseases. The pathogenesis of NAFLD when complicated by other liver diseases has not been established completely. Metabolic dysfunction‐associated fatty liver disease (MAFLD) involves more metabolic factors than NAFLD, regardless of complications with other diseases. This study aimed to clarify the effects of fatty liver occurring with metabolic disorders, such as MAFLD without diabetes mellitus (DM), on the development of DM.Materials and MethodsWe retrospectively assessed 9,459 participants who underwent two or more annual health check‐ups. The participants were divided into the MAFLD group (fatty liver disease with overweight/obesity or non‐overweight/obesity complicated by metabolic disorders), simple fatty liver group (fatty liver disease other than MAFLD group), metabolic disorder group (metabolic disorder without fatty liver disease), and normal group (all other participants).ResultsThe DM onset rates in the normal, simple fatty liver, metabolic disorder, and MAFLD groups were 0.51, 1.85, 2.52, and 7.36%, respectively. In the multivariate analysis, the MAFLD group showed a significantly higher risk of DM onset compared with other three groups (P < 0.01). Additionally, the risk of DM onset was significantly increased in fatty liver disease with overweight/obesity or pre‐diabetes (P < 0.01).ConclusionsFatty liver with metabolic disorders, such as MAFLD, can be used to identify patients with fatty liver disease who are at high risk of developing DM. Additionally, patients with fatty liver disease complicated with overweight/obesity or prediabetes are at an increased risk of DM onset and should receive more attention.

Reference interval for serum concentration of small dense low-density lipoprotein cholesterol in the healthy Japanese population.

Small dense low-density lipoprotein a smaller and denser subfraction among whole low density lipoprotein particles is known to be highly atherogenic. The reference interval (RI) is not strictly defined for serum concentration of sdLDL-cholesterol (sdLDL-C) in Japan. The purpose of this study is to set the reference interval for sdLDL-C in healthy subjects. The population of this cross-sectional study was consisted of 40,862 individuals who had annual health checkups, and healthy subjects were extracted based on exclusion criteria such as medical history, social history, and blood sampling test results. Their serum sdLDL-C values were statistically analyzed and the RIs were set in men, premenopausal women, and postmenopausal women separately. The mean values of serum sdLDL-C in healthy subjects were 23.9mg/dL in men, 20.0mg/dL in premenopausal women and 23.7mg/dL in postmenopausal women, and the RIs were 12.6-45.3mg/dL in men, 11.4-35.1mg/dL in premenopausal women and 14.6-38.6mg/dL in postmenopausal women. Serum sdLDL-C values were significantly higher in men than in women. Besides, sdLDL-C values were significantly higher in postmenopausal women than in premenopausal women. In both genders, sdLDL-C values tended to increase with age. These results suggest that the RIs for sdLDL-C are recommended as follows: 13-45mg/dL in men, 11-35mg/dL in premenopausal women, and 15-39mg/dL in postmenopausal women, respectively. Aside from these RIs, it is also necessary to define clinical cutoff values graded according to individual risk levels for atherosclerotic cardiovascular diseases.

Effects of Body Weight Change on Development of Chronic Kidney Disease in Obese Metabolic Phenotypes

Introduction: Obesity is a risk factor for chronic kidney disease (CKD), but whether the reduction of body mass index (BMI) helps prevent CKD is controversial. Recently, obese metabolic phenotypes have raised considerable interest. We thus investigated the effect of BMI change on CKD development. Methods: We analyzed the data of 6,959 subjects who underwent annual health checkups in both 2013 and 2018. The subjects were categorized into five groups according to their BMI percentage change (ΔBMI) and classified into four obese metabolic phenotypes. By a multivariate logistic regression analysis, we investigated the association between BMI change and CKD development within the 5 years. Results: In total subjects, compared with the maintained BMI group (ΔBMI ≥0% but <2.5%), the odd ratios (ORs) and 95% confidence intervals (CIs) of CKD development were 0.70 (95% CI 0.54–0.91) for the severe BMI decrease group (ΔBMI <−2.5%), and 1.40 (95% CI 1.08–1.81) for the severe BMI increase group (ΔBMI ≥5%). In the metabolically healthy obese (MHO) phenotype, the risks of CKD development were significantly higher in the moderate BMI increase group (ΔBMI ≥2.5% but <5%) (OR 3.04, 95% CI 1.19–7.78) and a severe BMI increase group (OR 2.88, 95% CI 1.13–7.35). Regarding the metabolically unhealthy nonobese (MUNO) phenotype, the risks of CKD development were significantly lower in the severe BMI decrease group (OR 0.43, 95% CI 0.25–0.74) and the moderate BMI decrease group (ΔBMI ≥−2.5% but <0%) (OR 0.58, 95% CI 0.35–0.98). Conclusions: In the MHO phenotype, an increased BMI deteriorated CKD development, and a decreased BMI ameliorated CKD development in the MUNO phenotype.

Effect of Subclinical Hypothyroidism on the Association between Hemoglobin A1c and Reduced Renal Function: A Prospective Study.

Subclinical hypothyroidism (SCH) was reported to be associated with accelerating endothelial dysfunction, which is recognized as one of the upstream mechanisms that leads to glomerular injury (lower glomerular filtration rate (GFR)). SCH was also reported to be associated with hyperglycemia, which is associated with higher hemoglobin A1c (HbA1c) levels and induces endothelial dysfunction. Therefore, SCH status could influence the association between HbA1c and reduced eGFR. To clarify those associations, we conducted a prospective study of 1580 Japanese individuals who participated in an annual health check-up in 2014 with 2.8 years of follow-up. All participants had free triiodothyronine (T3) and free thyroxine (T4) levels in the normal range. Among study participants, 88 were diagnosed as having SCH. Even though no significant correlation was observed between HbA1c and annual change in estimated GFR among participants without SCH (multi-adjusted standardized parameter estimate (β) = 0.03, p = 0.250), a significant inverse association was observed among participants with SCH (β = −0.26, p = 0.014). When those analyses were performed among participants who were not taking glucose lowering medication, the observed associations were essentially the same: β = 0.03, p = 0.266 for participants without SCH and β = −0.32, p = 0.006 for participants with SCH, respectively. Therefore, SCH status could influence the association between HbA1c and renal function.

The Impact of Marital Transitions on Vegetable Intake in Middle-aged and Older Japanese Adults: A 5-year Longitudinal Study.

BackgroundMarital transitions are associated with adverse health events, such as mortality and cardiovascular disease. Since marital transitions (eg, becoming widowed) are unavoidable life events, it is necessary to identify modifiable intermediate outcomes. Thus, we examined the association between marital transitions and vegetable intake among middle-aged and older Japanese adults.MethodsThis longitudinal study included Japanese adults aged 40–79 years who received an annual health checkup between 2007 and 2011 (baseline) and 5 years later (follow-up). Marital transitions were classified as whether and what type of transition occurred during the 5-year period and comprised five groups: consistently married, married to widowed, married to divorced, not married to married, and remained not married. Changes in total vegetable, green and yellow vegetable, and light-colored vegetable intake from baseline to follow-up were calculated using the Food Frequency Questionnaire.ResultsData from 4,813 participants were analyzed (mean age, 59.4 years; 44.1% women). Regarding marital transitions, 3,960 participants were classified as “consistently married,” 135 as “married to widowed,” 40 as “married to divorced,” 60 as “not married to married,” and 529 as “remained not married.” Multivariable linear regression analysis revealed that compared to consistently married, married to widowed was inversely associated with the change in total vegetable intake (β = −16.64, SE = 7.68, P = 0.030) and light-colored vegetable intake (β = −11.46, SE = 4.33, P = 0.008).ConclusionOur findings suggest that being widowed could result in a reduced intake of vegetables. Hence, dietary counseling according to marital situation is necessary.