Received Health Check-ups Research Articles

Aspartate/alanine aminotransferase ratio and development of chronic kidney disease in non-diabetic men and women: a population-based longitudinal study in Kagawa, Japan.

The relationship between serum aspartate/alanine aminotransferase ratio (AST/ALT) and subsequent development of chronic kidney disease (CKD) in non-diabetic Asian adults has not yet been fully investigated in longitudinal studies. The study included all middle-aged and older non-diabetic Japanese citizens who received health check-ups in Zentsuji, Kagawa, Japan (1998-2023). AST/ALT was classified into three categories: < 1.0 (reference), 1.0- < 1.5, and ≥ 1.5. CKD was defined as an estimated glomerular filtration rate of < 60mL/min/1.73 m2. The Weibull accelerated failure time model was used to examine the association between AST/ALT categories and subsequent CKD onset because the proportional hazards assumption was violated. Of 6309 men and 9192 women, 2966 men and 4395 women remained in the final cohort. After a mean follow-up of 7.50years for men and 8.34years for women, 33.7% of men and 34.0% of women developed CKD. Women had higher AST/ALT than men. In women, a dose-response relationship was observed, with a 9% shorter survival time to CKD onset for AST/ALT ≥ 1.5 compared with AST/ALT < 1.0. In contrast, men had a shorter survival time to CKD onset by point estimates, but the 95% confidence intervals crossed 1 in all models. In this study comparing the risks of CKD development in non-diabetic men and women by AST/ALT levels, a dose-response relationship was only observed in women. Differences in the distribution of AST/ALT by sex may have affected the results. Therefore, in non-diabetic Japanese women, AST/ALT may be used as an indicator of future CKD development.

Relationship between triglyceride-to-glucose index in addition to waist circumference as a marker of insulin resistance and mean arterial pressure

Abstract Background Blood pressure is one of the criteria for detecting metabolic syndrome in Japan as follows: systolic blood pressure(SBP) ≥ 130mmHg or diastolic blood pressure (DBP) ≥ 85mmHg, and mean arterial pressure(MAP) is related to atherosclerosis of small artery and insulin resistance is the risk facor of it. Recent experts propose that triglyceride-to-glucose (TyG) index and in addition to waist circumference (WC) are alternative method to predict insulin resistance. Methods and Results 27939 individuals under 65 years old who received health check-up were eligible for the present study. MAP is calculated as follow: (SBP - DBP)/3 + (DBP). TyG index is calculated as follow: Ln(triglyceride x glucose/2). TyG-WC index is calculated as follow: (TyG index) x (WC). Mean triglyceride, glucose, TyG index and TyG-WC index were 103.9, 94.2, 9.02 and 733.6, respectively. Receiver operating characteristics (ROC) curve showed the cut-off value of MAP ≥ 96.33mmHg as high blood pressure. Using this cut-off value, ROC curves of TyG index and TyG-WC index for predicting high MAP shows 9.06 (AUC 0.66) and 734.8 (AUC 0.70), respectively. Conclusions TyG index and TyG-WC index as markers of insulin resistance were significantly correlated with MAP. TyG-WC index was better marker of insulin resistance then TyG index and it might be useful for predicting hypertension and metabolic syndrome.

Effects of MAFLD defined by fatty liver index or ultrasonography on kidney function decline in the general population

This study aimed to investigate whether metabolic dysfunction-associated fatty liver disease (MAFLD) defined by the fatty liver index (FLI) affects the decline in kidney function and whether this relationship is still observed in MAFLD defined by ultrasonography (USG). A retrospective cohort study was conducted using de-identified data from participants who received health checkups at Samsung Changwon Hospital between 2002 and 2018. The primary and secondary exposures were the presence of FLI- and USG-defined MAFLD, respectively. The primary outcome was 5-years slope of eGFR. The secondary outcome was a rapid decline in kidney function, defined as a 5-years slope of estimated glomerular filtration rate (eGFR) of less than − 3 mL/min/1.73 m2 per year. A total of 37,500 participants were included in the analysis. Participants with FLI-defined MAFLD had a larger decline in 5-year eGFR slope than those without FLI-defined MAFLD (beta coefficients − 0.11; 95% CI − 0.14 to − 0.08). Participants with FLI-defined MAFLD had a higher risk of rapid kidney function decline than those without FLI-defined MAFLD (odds ratio 1.33; 95% confidence intervals (CIs) 1.05–1.69). However, USG-defined MAFLD was less related to kidney function decline. In conclusion, the presence of FLI-defined MAFLD was associated with larger and faster kidney function decline.

The Clinical Implication of Nocturia in Predicting Hypertension Among Working-Aged Koreans.

Evidence has indicated that nocturia is a clinical manifestation of adverse health conditions, including cardiovascular diseases and metabolic disorders. However, previous studies are less available for the clinical implication of nocturia on the development of hypertension. Study participants were 32,420 working-aged Koreans (21,355 men and 11,065 women) who periodically received health checkups. They were categorized into 4 groups by the frequency of nocturia (never, <1, 1-2, and ≥3/week). We used Cox proportional hazards models to analyze the multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CIs) for incident hypertension (multivariable-adjusted HR [95% CI]) in relation to the frequency of nocturia. Subgroup analysis was conducted by gender and sleep quality (good and poor sleep quality). In women, nocturia was associated with an increased risk of hypertension, compared with never nocturia (HR [95% CI]; never: reference, <1/week: 1.33 [1.10-1.60], 1-2/week: 1.26 [1.00-1.58], and ≥3/week: 1.34 [1.05-1.72]). This association was not observed in men (HR [95% CI]; never: reference, <1/week: 1.00 [0.93-1.08], 1-2/week: 1.00 [0.88-1.12], and ≥3/week: 1.06 [0.94-1.23]). In subgroup analysis by sleep quality, only women with good sleep quality showed an association between nocturia and the risk of hypertension. However, women with poor sleep quality and men did not show an association between the frequency of nocturia and the risk of hypertension. Nocturia is a potential risk factor for incident hypertension in working-aged women with good sleep quality.

Elevated remnant cholesterol was associated with the increased metabolically unhealthy obesity risk in Chinese youth.

Metabolically unhealthy obesity is characterized by the presence of cardiovascular metabolic risks such as hypertension, dyslipidemia, and hyperglycemia. Research has shown a correlation between remnant cholesterol (RC) concentrations and abdominal obesity in children. However, the effect of RC concentration on metabolically unhealthy obesity remains unclear. This study included 3114 Chinese adolescents who received health check-ups. We used logistic regression models and receiver operating characteristic analysis to evaluate the correlation between RC concentration and metabolically unhealthy obesity in a cross-sectional design. After controlling for possible confounding variables, we found that individuals in the top and fourth quintiles of RC concentrations had a significantly higher likelihood of developing metabolically unhealthy obesity compared to those in the bottom quintile (ORs, 4.810 and 1.836; 95% CIs, 3.209-7.212 and 1.167-2.890, respectively). The risk of metabolically unhealthy obesity tended to increase with RC concentration (ptrend<0.001). In addition, boys showed positive associations between RC concentration and both BMI (r = 0.305, p<0.001) and waist circumference (r = 0.306, p<0.001). According to the analysis, the predictive accuracy of metabolically unhealthy obesity was 0.736 (95% CI, 0.690-0.781) for boys and 0.630 (95% CI, 0.573-0.687) for girls. The ideal prediction threshold was 0.66 for boys and 0.59 for girls. Our findings indicate that elevated RC concen-tration is linked to a higher likelihood of developing metabolically unhealthy obesity in young individuals, regardless of other known risk factors.

Increased Waist Circumference after One-Year Is Associated with Poor Chewing Status.

This study aimed to investigate the relationship between an increase in waist circumference (WC) after 1 year and self-reported chewing status in 10,870 Japanese adults who had received health checkups. Subsequently, 8068 participants were included in the final analysis. We defined an increase in WC ≥ 5 cm after 1 year as an unhealthy increase; in total, 613 (7.5%) respondents met this criterion. Chewing status was evaluated using a self-reported questionnaire at baseline; 1080 (13%) respondents were diagnosed with poor chewing status. After adjusting for age, gender, WC, body mass index (BMI), and chewing status, an increase in WC ≥ 5 cm was found to be positively associated with gender (females: odds ratios [ORs]: 1.206; 95% confidence intervals [CIs]: 1.008-1.443), WC (ORs: 0.967; 95% CIs: 0.954-0.981), BMI (≥25 kg/m2; ORs: 2.194; 95% CIs: 1.715-2.808), and chewing status (poor; ORs: 1.356; 95% CIs: 1.084-1.697). These findings suggest that increased WC after 1 year was associated with self-reported poor chewing status in Japanese adults.

Visceral Adipose Tissue Reduction Measured by Deep Neural Network Architecture Improved Reflux Esophagitis Endoscopic Grade.

Visceral obesity is a risk factor for reflux esophagitis (RE). We investigated the risk of RE according to visceral adipose tissue (VAT) measured by deep neural network architecture using computed tomography (CT) and evaluated the longitudinal association between abdominal adipose tissue changes and the disease course of RE. Individuals receiving health checkups who underwent esophagogastroduodenoscopy (EGD) and abdominal CT at Seoul National University Healthcare System Gangnam Center between 2015 and 2016 were included. Visceral and subcutaneous adipose tissue areas and volumes were measured using a deep neural network architecture and CT. The association between the abdominal adipose tissue area and volume and the risk of RE was evaluated. Participants who underwent follow-up EGD and abdominal CT were selected; the effects of changes in abdominal adipose tissue area and volume on RE endoscopic grade were investigated using Cox proportional hazards regression. We enrolled 6,570 patients who underwent EGD and abdominal CT on the same day. RE was associated with male sex, hypertension, diabetes, excessive alcohol intake, current smoking status, and levels of physical activity. The VAT area and volume increased the risk of RE dose-dependently. A decreasing VAT volume was significantly associated with improvement in RE endoscopic grade (hazard ratio: 3.22, 95% confidence interval: 1.82-5.71). Changes in subcutaneous adipose tissue volume and the disease course of RE were not significantly correlated. Visceral obesity is strongly associated with RE. VAT volume reduction was prospectively associated with improvement in RE endoscopic grade dose-dependently. Visceral obesity is a potential target for RE treatment.

Evaluation of bi-directional causal association between periodontitis and benign prostatic hyperplasia: epidemiological studies and two-sample mendelian randomization analysis.

Background: Periodontitis and benign prostatic hyperplasia (BPH) are all common chronic diseases with higher incidence in middle-aged and old men. Several studies have indicated a potential association between periodontitis and BPH, although the findings remain inconclusive. However, there is no mendelian randomization (MR) studies to assess this association. Methods: The 40 men who had received health check-ups were included in an epidemiological study. Genetic data of BPH (13118 cases and 72799 controls) and periodontitis (3046 cases and 195395 controls) from FinnGen project was used to perform two-sample MR analysis. The inverse-variance weighted (IVW) model was identified as the primary analytical method, with MR Egger, weighted median, simple mode, and weighted mode serving as additional approaches. Results: The epidemiological analysis demonstrated a lack of statistically significant differences in the prevalence of clinical BPH between severe periodontitis group and non-severe periodontitis group. Similarly, no statistically significant differences were found in the prevalence of severe periodontitis among individuals with clinical BPH compared to those without. Additionally, Among the five models utilized in MR analysis, including the IVW model, no evidence of a causal link between periodontitis and BPH was observed. Conclusion: The findings from our epidemiological investigation and MR analysis do not provide support for a causal relationship between periodontitis and BPH.

Associations between mothers' economic insecurity and mood and thoughts on life with children at infants' 3-month check-ups: A cross-sectional study using data from infant health check-ups

Objectives We aimed to clarify the relationship between economic insecurity and the psychological profiles of mothers raising infants by analyzing data from three-month health check-ups in relation to the birth population in order to generate basic data that can be used to consider support for families facing economic insecurity.Methods The study area was a neighborhood in a major Japanese city. The survey focused on 1013 mothers who had received health check-ups for children aged 18 months between November 2017 and October 2019. The data included in the analysis were data from the children's three-month health check-ups and survey data from 908 mothers who responded to the questionnaire and consented to the use of their health check-up data. After excluding data from potential participants who were not mothers or had multiple births, data from 847 participants were analyzed (valid response rate: 93.3%). The objective variables were mothers' mood and thoughts about life with their children at the time of the three-month check-up as the mothers' psychological profiles. The explanatory variable was the presence or absence of maternal economic insecurity, and logistic regression analysis was conducted, adjusted for the children's sex and birth order, presence or absence of maternal counselors, and the mothers' educational attainment.Results A total of 60 (7.1%) mothers were economically insecure. Of the mothers' moods, 122 (14.4%) reported feeling anxious, followed by 36 (4.3%) who reported feeling lonely. Of their thoughts on life with their children, 776 (91.6%) mothers reported that they enjoyed it, and 567 (66.9%) reported that they were happy to be parents. On the other hand, 157 (18.5%) reported feeling frustrated, and 75 (8.9%) reported that the lack of time for themselves was painful. Economically insecure mothers had an odds ratio of 5.59 (95% confidence interval, 2.49-12.55) for feeling lonely, 4.77 (2.67-8.54) for feeling anxious, and 2.70 (1.50-4.86) for feeling frustrated, all significantly higher than in mothers not facing economic insecurity.Conclusion Economic insecurity among mothers at the time of the three-month check-up was associated with the psychological states of loneliness, anxiety, and frustration about living with their children. It was suggested that to solve economically insecure mothers' problems, they need support, including connecting them with social welfare services, so that they will be able to raise their children in a more stable environment.

Effect of sunlight on vitamin D and hemoglobin levels among the residents of Ningbo, China.

Objective: this study investigated the effect of sunlight on vitamin D and hemoglobin levels among the residents of Ningbo, China. The impact of gender, age, and season on vitamin D and hemoglobin levels was also explored. Methods: a total of 8,481 research subjects, including 5,146 men and 3,335 women, who were permanent residents of Ningbo and received health checkups at Ningbo Second Hospital, were included in the study. Ningbo City climate bulletin data from 2019 to 2022 was also included. Results: the study subjects received an average of 132.20 ± 40.05 h of sunlight exposure per month and had average vitamin D levels of 19.63 ± 6.61 ng/ml. Hemoglobin levels were adequate in 85.4 % of the participants and deficient in 14.6 %. Sunlight exposure correlated positively with vitamin D and negatively with hemoglobin levels. Regression analysis indicated that gender, age, and season affected vitamin D and hemoglobin levels to different degrees. Conclusion: in Ningbo, vitamin D deficiency was common in adults while hemoglobin levels were mostly normal. The amount of sunlight exposure had a significant effect on vitamin D and hemoglobin levels and this relationship was impacted by gender, age, and season.

Association between the Suita Score and Body Composition in Japanese Adults: A Large Cross-Sectional Study.

The purpose of this study was to clarify the relationship between the Suita score (a prediction model for the development of cardiovascular disease) and body composition in Japanese health check-up subjects (6873 men and 8685 women). The Suita score includes 8 items (age, gender, smoking, diabetes, blood pressure, low-density lipoprotein, high-density lipoprotein, and chronic kidney disease). Factors associated with the Suita score within body composition-related parameters (body mass index (BMI), waist circumference (WC), fat mass index, fat-free mass index, fat mass to fat-free mass ratio (F-FF ratio), and water mass index) as assessed by bioelectrical impedance analysis were examined. The mean age of subjects was 54.8 years in men and 52.8 years in women (p < 0.0001). The mean BMI was 23.9 kg/m2 in men and 21.8 kg/m2 in women (p < 0.0001). Diabetes mellitus was found in 1282 subjects (18.7%) among men and 816 subjects (9.4%) among women (p < 0.0001). The mean Suita score was 42.0 in men and 29.6 in women (p < 0.0001). In multivariate analysis, WC (p < 0.0001), F-FF ratio (p < 0.0001), and water mass index (p < 0.0001) were independent factors linked to the Suita score for both genders. In conclusion, body composition can be associated with the Suita score in Japanese adults receiving health check-ups.

Effect of overweight/obesity and metabolic syndrome on frailty in middle-aged and older Japanese adults.

The potential for developing frailty exists in middle-aged and older adults. While obesity and metabolic syndrome (MetS) increase the risk of frailty in older adults, this relationship remains unclear in middle-aged adults, who are prone to developing lifestyle-related diseases. To examine the effect of overweight/obesity and MetS on frailty development in middle-aged and older Japanese adults using real-world data. This nationwide cohort study used exhaustive health insurance claims data of 3,958,708 Japanese people from 2015 to 2019 provided by the Japan Health Insurance Association. Participants aged ≥35 and<70years who received health checkups in 2015 were included. Multivariate logistic regression was used to assess the effect of body mass index (BMI) and MetS or MetS components (i.e., diabetes, hypertension, and dyslipidemia) in 2015 on frailty risk assessed using the hospital frailty risk score in 2019. Additionally, a subgroup analysis was performed to examine the interaction effects of MetS components and 4-year weight change (%) on frailty risk among participants who were overweight and obese (BMI ≥25kg/m2). In 2019, 7204 (0.2%) and 253,671 (6.4%) participants were at high and intermediate frailty risks, respectively. Obesity and MetS were independently associated with intermediate/high frailty risk (odds ratio (OR) 1.36, p<0.05; OR 1.23, p<0.05, respectively) and high frailty risk (OR 1.80, p<0.05; OR 1.37, p<0.05, respectively) in all participants. Although all MetS components were frailty risk factors, these effects diminished with age in both sexes. Subgroup analysis of patients with diabetes revealed that 5%-10% weight loss was associated with reduced frailty risk in both sexes. Obesity, MetS, and MetS components were independent frailty risk factors in middle-aged and older Japanese adults. Weight loss of up to 10% over 4years prevented frailty in patients with diabetes who were overweight and obese.

Severity of fatty liver is highly correlated with the risk of hypertension and diabetes: a cross-sectional and longitudinal cohort study.

Fatty liver disease (FLD) is associated with several metabolic derangements. We conducted a retrospective cross-sectional and longitudinal study to evaluate the role of FL severity in the risk of new-onset and co-existing hypertension (HTN) and diabetes mellitus (DM). The cross-sectional cohort consisted of 41,888 adults who received health checkups in a tertiary hospital of Taiwan from 1999 to 2013. Of them, 34,865 without HTN and/or DM at baseline and within 1year after enrollment were included as a longitudinal cohort (mean, 6.45years for HTN; 6.75years for DM). FL severity based on the degree of hepatic steatosis was assessed by ultrasound sonography. In cross-sectional cohort, 22,852 (54.6%) subjects had FL (18,203 [43.46%] mild FL and 4,649 [11.10%] moderate/severe FL); 13.5% (n = 5668) had HTN; and 3.4% (n = 1411) had DM. Moderate/severe FL and mild FL had significantly higher risks of existing HTN (adjusted odds ratio/95% confidence interval [CI] 1.59/1.43-1.77 and 1.22/1.13-1.32, respectively). In longitudinal cohort, 3,209 and 822 subjects developed new-onset HTN and DM, respectively (annual incidence, 14.3 and 3.5 per 1000 person-years; 10-year cumulative incidence, 14.35% and 3.89%, respectively). Moderate/severe and mild FL had significantly higher risks of new-onset HTN (adjusted hazard ratio [aHR]/CI 1.54/1.34-1.77 and 1.26/1.16-1.37, respectively) and DM (aHR/CI 5.88/4.44-7.81 and 3.22/2.56-4.07, respectively). Resolved FL during follow-up decreased the risk of HTN and/or DM. Patients with FL are at high risk of prevalent and incident HTN and/or DM. The risk increases with the severity of FL.

Combinatorial Use of Machine Learning and Logistic Regression for Predicting Carotid Plaque Risk Among 5.4 Million Adults With Fatty Liver Disease Receiving Health Check-Ups: Population-Based Cross-Sectional Study.

Carotid plaque can progress into stroke, myocardial infarction, etc, which are major global causes of death. Evidence shows a significant increase in carotid plaque incidence among patients with fatty liver disease. However, unlike the high detection rate of fatty liver disease, screening for carotid plaque in the asymptomatic population is not yet prevalent due to cost-effectiveness reasons, resulting in a large number of patients with undetected carotid plaques, especially among those with fatty liver disease. This study aimed to combine the advantages of machine learning (ML) and logistic regression to develop a straightforward prediction model among the population with fatty liver disease to identify individuals at risk of carotid plaque. Our study included 5,420,640 participants with fatty liver from Meinian Health Care Center. We used random forest, elastic net (EN), and extreme gradient boosting ML algorithms to select important features from potential predictors. Features acknowledged by all 3 models were enrolled in logistic regression analysis to develop a carotid plaque prediction model. Model performance was evaluated based on the area under the receiver operating characteristic curve, calibration curve, Brier score, and decision curve analysis both in a randomly split internal validation data set, and an external validation data set comprising 32,682 participants from MJ Health Check-up Center. Risk cutoff points for carotid plaque were determined based on the Youden index, predicted probability distribution, and prevalence rate of the internal validation data set to classify participants into high-, intermediate-, and low-risk groups. This risk classification was further validated in the external validation data set. Among the participants, 26.23% (1,421,970/5,420,640) were diagnosed with carotid plaque in the development data set, and 21.64% (7074/32,682) were diagnosed in the external validation data set. A total of 6 features, including age, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), total cholesterol, fasting blood glucose, and hepatic steatosis index (HSI) were collectively selected by all 3 ML models out of 27 predictors. After eliminating the issue of collinearity between features, the logistic regression model established with the 5 independent predictors reached an area under the curve of 0.831 in the internal validation data set and 0.801 in the external validation data set, and showed good calibration capability graphically. Its predictive performance was comprehensively competitive compared with the single use of either logistic regression or ML algorithms. Optimal predicted probability cutoff points of 25% and 65% were determined for classifying individuals into low-, intermediate-, and high-risk categories for carotid plaque. The combination of ML and logistic regression yielded a practical carotid plaque prediction model, and was of great public health implications in the early identification and risk assessment of carotid plaque among individuals with fatty liver.

Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.

Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. Study participants were 26,673 diabetic men who received health check-up both in 2003-2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003-2004 and 2009, changes in smoking status were categorised into 7 groups (never - never, never - quitting, never - current, quitting-quitting, quitting-current, current-quitting and current-current). Smoking amount was categorised into never, light (0-10 pack years), moderate (10-20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed-up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. Current-quitting (1.271 [1.050-1.538]), current-current (1.243 [1.070-1.444]) and heavy smoking (1.238 [1.078-1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current-current smoking (1.429 [1.098-1.860]) and heavy smoking (1.357 [1.061-1.734]). An increased risk of neuropathy was observed in current-quitting smoking (1.360 [1.076-1.719]), current-current smoking (1.237 [1.025-1.492]) and heavy smoking (1.246 [1.048-1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients.

Factors Associated with Refraining from Health Checkups during the COVID-19 Pandemic in Japan.

This study aimed to determine the characteristics of people who refrained from having regular checkups due to the spread of the novel coronavirus 2019 (COVID-19) infection and the factors associated with this behavior. We conducted a nationwide internet survey of 4593 males and females aged 20-69 in Japan regarding their health checkups from April 2020 to March 2021, when COVID-19 was widespread. Individuals who received checkups during this time were "the receiving group"; those who did not were "the refraining group". Personal attributes, responses to a health questionnaire and other items were used to compare the groups. The analysis showed that males over 53 refrained from having health checkups compared to those younger. On the other hand, males with higher personal incomes who never skipped breakfast received health checkups. Females with children under 18 years were less likely than those without to receive health checkups. For males, the characteristic factors were economic and health awareness and literacy. Females were less aware of medical checkups. Moreover, they demonstrated an inability to maintain an everyday rhythm. No factors were common to males and females, indicating the need to consider separate strategies for encouraging males and females to obtain annual health checkups.

Associations of accelerometer-measured sedentary behavior and physical activity with sleep in older adults

Few studies have examined the non-linear relationships of objectively-measured sedentary behavior and physical activity with insomnia symptoms in older adults. We investigated such relationships of sedentary and physically-active behaviors with total sleep time and nocturnal wakefulness. We recruited adults aged 60 years and above who have received health check-ups or been to geriatric outpatient services from a hospital setting. Sedentary and physically-active behaviors, total sleep time, and wakefulness time after sleep onset were measured by Actigraphy, and their relationships were estimated using generalized additive models. The 157 older adults receiving health-related services slept 7.5h (20.8min awake) on average per day. Total sleep time was negatively associated with sedentary and physically-active behaviors. By contrast, a U-shape relationship was found between sedentary behavior and wakefulness time after sleep onset, with a turning point at a daily sedentary time of 10.9h. Longer high-intensity physical activity time was related to a shorter wakefulness time after sleep onset. By contrast, daily sedentary time longer than 10.9h was related to shorter total sleep time but more nocturnal wakefulness time. Future nonpharmacological strategies for sleep improvement should consider the sedentary threshold.

The correlation between NAFLD and serum uric acid to serum creatinine ratio.

With the prevalence of non-alcoholic fatty liver disease (NAFLD) increasing worldwide, many noninvasive techniques have been used to improve its diagnosis. Recently, the serum uric acid/creatinine (sUA/sCr) ratio was identified as an indicator of fatty liver disease. Therefore, we examined the relationship between sUA/sCr levels and ultrasound-diagnosed NAFLD in Korean adults. This study included 16,666 20-year-olds or older who received health checkups at a university hospital's health promotion center from January to December 2021. Among them, 11,791 non-patients with and without NAFLD were analyzed, excluding those without abdominal ultrasound, those without data on fatty liver, cancer, or chronic kidney disease severity, those with a history of alcohol abuse, and those with serum hs-CRP <5 mg/L. The odds ratio (OR) and 95% confidence interval (CI) of the sUA/sCr ratio according to the presence or absence of fatty liver disease and severity were calculated after correcting for confounding variables using logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) of the sUA/sCr ratio confirmed and compared the sensitivity and specificity of NAFLD and serum uric acid. sUA/sCr increased with fatty liver severity, and the post-correction OR in the NAFLD group was 1.183 (95% CI: 1.137-1.231) compared to the group without NAFLD. Concerning the fatty liver severity, the post-correction OR in the mild NAFLD group increased to 1.147 (95% CI: 1.099-1.196), and that in the moderate-to-severe NAFLD group increased to 1.275 (95% CI: 1.212-1.341) compared to the group without NAFLD. The sensitivity of sUA/sCr to fatty liver severity was 57.9% for the non-NAFLD group, 56.7% for the mild NAFLD group, and 59.0% for the moderate-to-severe NAFLD group; the specificity of sUA/sCr to fatty liver severity 61.4% for the non-NAFLD group, 57.3% for the mild NAFLD group, and 65.2% for the moderate-to-severe NAFLD group. NAFLD severity is associated with sUA/sCR.

Associated Factors with Changes of Metabolic Abnormalities among General Population in COVID-19 Pandemic

The coronavirus disease-2019 (COVID-19) pandemic has led to restrictions on daily living including social distancing. These restrictions had an impact on the individual's healthy lifestyle and health status. We investigated the associated factors with changes of metabolic abnormalities among general population in COVID-19.The participants were 43,639 people who received health check-ups twice in 2019 and 2021 during COVID-19 pandemic, at 16 health promotion centers. Metabolic abnormalities were identified according to the third report of the cholesterol education program criteria. Multiple logistic regression analysis was performed to confirm the factors related to changes of metabolic abnormalities during COVID-19.Metabolic syndrome and metabolic abnormalities increased overall during the COVID-19 pandemic. This increase was mostly appeared in males. The occurrence of metabolic syndrome during COVID-19 was associated with 50s and older age (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.019-1.254), attempt to quit smoking (OR, 1.467; 95% CI, 1.171-1.839), start smoking (OR, 1.251; 95% CI, 1.110-1.412), decrease in aerobic exercise (OR, 1.328; 95% CI, 1.162-1.517), and increase in strength exercise (OR, 0.704; 95% CI, 0.592-0.838).The metabolic syndrome is closely related to smoking experience and lack of exercise during COVID-19.

Exploring the Link between Chronic Kidney Disease and Alzheimer's Disease: A Longitudinal Follow-Up Study Using the Korean National Health Screening Cohort.

Chronic kidney disease (CKD) and Alzheimer's disease (AD) are common chronic diseases in the elderly population. Although a relationship between CKD and the occurrence of AD has been proposed, previous research results have been disputed, and further investigation is necessary to confirm this relationship. In this longitudinal follow-up study, we examined data from the Korean National Health Insurance Service-Health Screening Cohort, consisting of 15,756 individuals with CKD and 63,024 matched controls aged ≥40 years who received health check-ups between 2002 and 2019. Overlap-weighted Cox proportional hazard regression models were exploited to calculate hazard ratios (HRs) for the association between CKD and AD. During the monitoring period, individuals with CKD had a greater incidence of AD than those without CKD (15.80 versus 12.40 per 1000 person years). After accounting for various factors, CKD was significantly associated with a 1.14-fold increased likelihood of developing AD, with a 95% confidence interval ranging from 1.08 to 1.20. In subgroup analysis, this relationship persisted irrespective of age (≥70 or <70), sex, income, smoking status, alcohol consumption, place of residence, or fasting blood glucose level. Additionally, the association between CKD and AD was still evident among patients who were overweight or obese, those with normal blood pressure or cholesterol levels, and those without any other health conditions or with a CCI score of ≥2. These results suggest that CKD could increase the probability of developing AD in the Korean adult population irrespective of demographic or lifestyle conditions. This may make it challenging to predict AD in patients with CKD, emphasizing the importance of frequent AD screening and management.