Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990-1994

Characteristics of chronic fatigue syndrome in a Japanese community population : chronic fatigue syndrome in Japan

This study seeks to estimate the prevalence of chronic fatigue syndrome (CFS) and assess the characteristics of CFS in a community population in Japan using laboratory tests and questionnaires for lifestyle, fatigue states, and depression states. The design of this study is a cross-sectional observational study. The setting of this study is a medical health checkup program in a general hospital. This study was conducted with 1,430 Japanese (867 men and 563 women), 20 to 78 years of age. We classified participants who complained of fatigue according to the case definition of CFS proposed by the Centers for Disease Control and Prevention in the USA in 1994. Alcohol, caffeine, catechin and total polyphenol consumption, smoking status, sleep duration, and physical activity were evaluated using questionnaires. The prevalence of CFS was 1.0% (95% CI 0.5-1.6%) of a community population in Japan. Although various lifestyle factors of the participants with CFS were similar to those without chronic fatigue, average sleep duration was significantly shorter among the participants with CFS (5.5 ± 0.8 h) compared to those without chronic fatigue (6.3 ± 0.9 h, P < 0.001). Proportion at subjects having average sleep duration of less than 6 h was 64.3% among the participants with CFS in contrast to only 15.0% in those without chronic fatigue (P < 0.001). Among the eight case-defining symptoms, "Unrefreshing sleep" had high sensitivity and high specificity for screening CFS in Japanese population (92.9% and 87.8%, respectively). The average sleep duration was notably shorter in Japanese suffering from CFS. Further longitudinal study is needed to evaluate the possibility of extreme short sleep duration as a major cause of CFS in Japan.

Longitudinal study on white blood cell count and the incidence of metabolic syndrome

OBJECTIVE

Many studies have revealed that white blood cell count (WBC) is related to insulin resistance which is a central mechanism of metabolic syndrome (MetS). However, few cohort studies have examined the role of WBC in the development of MetS. We hypothesized that WBC is associated with the future development of MetS, and investigated the longitudinal incidence of MetS in healthy workers.

METHODS

WBC was measured in 5,073 workers (mean age 42.5 years) without MetS at baseline. The incidence of MetS was monitored over 7 years of follow-up, in relation to quartiles of WBC. During the follow-up, 925 participants were diagnosed as MetS.

RESULTS

Incidence of MetS was increased in participants with higher WBC: the rates of incidence of MetS were 22.6, 32.9, 42.9, and 57.5 per 1,000 person-years of follow-up in the 1st, 2nd, 3rd, and 4th quartiles of WBC, respectively. After adjustments for confounding factors, the adjusted hazards ratio (95% confidence interval) for MetS was 1.00 (reference), 1.22 (0.98 to 1.51), 1.52 (1.24 to 1.87), and 1.66 (1.35 to 2.04) through the quartiles of WBC, respectively, (p <0.001). This relationship was consistent among current smokers and never smokers, and among male and female genders, respectively.

CONCLUSION

WBC is useful in predicting the future development of MetS which leads to atherosclerotic diseases.

Prognostic factors associated with a subchondral insufficiency fracture of the femoral head

OBJECTIVE

The aim of this study was to identify the risk factors associated with the prognosis of a subchondral insufficiency fracture of the femoral head (SIF).

METHODS

Between June 2002 and July 2009, 25 patients diagnosed with SIF were included in this study. Sequential radiographs were evaluated for the progression of collapse. Clinical profiles, including age, body mass index, follow-up period and Singh's index, were documented. The morphological characteristics of the low-intensity band on T(1) weighted MRI were also examined with regards to four factors: band length, band thickness, the length of the weight-bearing portion and the band length ratio (defined as the proportion of the band length to the weight-bearing portion of the femoral head in the slice through the femoral head centre).

RESULTS

Radiographically, a progression of collapse was observed in 15 of 25 (60.0%) patients. The band length in patients with progression of collapse [22.5 mm; 95% confidence interval (CI) 17.7, 27.3] was significantly larger than in patients without a progression of collapse (13.4 mm; 95% CI 7.6, 19.3; p<0.05). The band length ratio in patients with progression of collapse (59.8%; 95% CI 50.8, 68.9) was also significantly higher than in patients without a progression of collapse (40.9%; 95% CI 29.8, 52.0; p<0.05). No significant differences were present in the other values.

CONCLUSION

These results indicate that the band length and the band length ratio might be predictive for the progression of collapse in SIF.

Association of obesity with diabetic retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS Report no. 8)

The aim of the study was to report the prevalence of obesity indices in individuals with diabetes and find out their association with diabetic retinopathy in the urban Indian population. Subjects (n = 1,414) were recruited from Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetics Study (SN-DREAMS-I), a cross-sectional study between 2003 and 2006. Anthropometric measurements were carried out, and all patients' fundi were photographed using 45 degrees four-field stereoscopic digital photography. The diagnosis of diabetic retinopathy was based on the modified Klein classification. Generalized obesity and abdominal obesity were defined using WHO Asia Pacific guidelines with the BMI (body mass index) cutoff as > or =23 kg/m(2), WC (waist circumference) cutoffs as > or =90 cm in men and > or =80 cm in women and WHO guidelines using WHR (waist-to-hip ratio) cutoffs as > or =0.90 for men and > or =0.85 for women. Prevalence of obesity defined by BMI and WC was more in women compared to men, and that defined by WHR was more in men compared to women (P < 0.001). The prevalence of isolated generalized obesity, isolated abdominal obesity and combined obesity were 5.4, 10.1 and 58% in men and 4.5, 10.8 and 74.4% in women, respectively. The prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy was more in the isolated abdominal obesity group (26.35 and 6.08%, respectively) than in other subgroups. On logistic regression analysis, isolated abdominal obesity (OR 2.02, 95% CI: 1.06-3.86) and increased WHR in women (OR 1.48 95% CI: 1.10-2.38) were associated with diabetic retinopathy; BMI > or = 23 (OR 0.66, 95% CI: 0.48-0.90) and combined obesity (OR 0.72, 95% CI: 0.53-0.99) had a protective role for any diabetic retinopathy in the overall group. In the urban south Indian population, isolated abdominal obesity and higher WHR in women were associated with diabetic retinopathy, but not with the severity of diabetic retinopathy.

MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head

OBJECTIVE

The purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI.

SUBJECTS AND METHODS

Between May 1998 and February 2009, we reviewed 30 consecutive hips in 30 patients, 60 years old or older at the time of onset of hip pain, with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available. Both clinical and radiologic appearances were investigated. The patients were divided into two groups according to the shape of low-intensity bands on T1-weighted images. The first group showed concavity of the articular surface, which is characteristic of osteonecrosis, and the second group showed an irregular convexity of the articular surface, which is characteristic of subchondral insufficiency fracture.

RESULTS

Sixteen hips (53.3%) showed evidence of osteonecrosis, and 14 (46.7%) showed evidence of subchondral insufficiency fracture, which was consistent with the corresponding histopathologic diagnoses. In all cases of osteonecrosis, the patient had a history of either corticosteroid intake or alcohol abuse. Among patients with subchondral insufficiency fracture, the proportion of women was significantly higher than that among patients with osteonecrosis. A crescent sign (subchondral fracture) was present radiographically in about half of all cases in both groups.

CONCLUSION

The results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis. In addition, among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse, a diagnosis of subchondral insufficiency fracture should be considered.

The effects of vigorous physical activity on intra-abdominal fat levels: a preliminary study of middle-aged Japanese men

AIM

To examine the effects of vigorous physical activity (PA) on intra-abdominal fat (IF) levels in obese men.

METHODS

Thirty-seven obese men (mean age: 47.6+/-8.6 years) engaged in a 12-week aerobic exercise program on a regular basis (3 days/week). We divided them into low volume of vigorous PA group (n=19) or high volume of vigorous PA group (n=18), based on the median time spent (34.3min/week) in vigorous PA (over 6.1 metabolic equivalents assessed by a single-axis accelerometer) throughout the program.

RESULTS

Regular exercise reduced IF levels (measured by computed tomography) from 188.1+/-53.9cm(2) to 170.3+/-46.6cm(2) for the low volume of vigorous PA group and from 167.9+/-44.3cm(2) to 137.9+/-40.6cm(2) for the high volume of vigorous PA group. Two-way (time x group) ANOVA revealed no significant interactions for the IF level. However, correlation analysis for all participants showed that time spent in vigorous PA throughout the program significantly correlated to IF reductions after adjusting for initial levels of IF, vigorous PA and weight changes (r=-0.42, P=0.02).

CONCLUSION

This study suggests that vigorous PA may affect IF reductions in obese men.

[Reflection about Japanese immigration to Brazil under the light of body adiposity]

Migrant populations represent a good opportunity to investigate the role of environmental factors for the genesis of obesity and its comorbidities. The Japanese-Brazilian Diabetes Study Group studied the prevalence of diabetes and related disorders in Japanese-Brazilians from Bauru, SP, in 1993. Using specific criteria for Asian, 22.4% of the Japanese-Brazilians were found as having overweight in this first phase of the study. In the second phase, in 2000, this prevalence increased to 44.2% and 50.3% had central obesity. This population also had high prevalence of type 2 diabetes, hypertension and dyslipidemia, components of the metabolic syndrome. The JBDS Group also showed the association between Occidentalized habits, mainly a rich saturated-fat-diet, and the occurrence of the metabolic syndrome. In 2005, motivated by these findings, the JBDS Group started the third phase of the study which was an intervention program based on healthy diet and physical activity recommendations, using resources that could be feasible in terms of public health in Brazil. After one year-intervention program, the JBDS Group observed a decrease in anthropometric parameters, blood pressure and plasma glucose and cholesterol levels. It will be necessary a longer follow-up to evaluate the maintainance of these benefits and their impact in the risk development of diabetes and cardiovascular events.

A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head

A 73-year-old female suffered from right hip pain without any history of antecedent trauma. The initial radiograph showed a slight narrowing of the joint space in the right hip. The patient was treated by non-weight bearing for 5 weeks. Radiographs obtained 3 months after the onset of pain showed the progression of both the joint-space narrowing and subchondral collapse at the superior portion. T1-weighted MR (magnetic resonance) images obtained 3 months after the onset revealed an irregular-shaped low-intensity area just beneath the articular cartilage as well as a low-intensity band, which was concave to the articular surface. A total hip replacement was performed. A histopathological examination revealed fracture callus and granulation tissue in the subchondral area. This subchondral fractured area was surrounded by vascular rich granulation tissue and fibrous tissue, which corresponded to the concave-shaped low-intensity band observed on the T1-weighted image.

PPARG genotype accounts for part of individual variation in body weight reduction in response to calorie restriction

Several studies indicate that expression of the peroxisome proliferator-activated receptor gamma (PPARG) gene is influenced by calorie restriction. The aim of this study was to investigate whether PPARG gene variations are associated with weight reduction and changes in coronary heart disease (CHD) risk factors in response to a 14-week calorie restriction. In total, 95 middle-aged, Japanese women (BMI>or=25 kg/m2) enrolled as subjects for 14 weeks and attended weekly dietary lectures instructing them on how to consume a nutritionally balanced diet of 1,200 kcal/day. Eight single-nucleotide polymorphisms (SNPs) in the PPARG gene (rs1801282 (Pro/Ala), rs2292101, rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were analyzed. Body weight decreased significantly (-7.7+/-3.1 kg; -11.3+/-4.4%) during the intervention. Six PPARG SNPs (rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were significantly associated with the weight reduction, with rs1175544 having the strongest association (P=0.004). No differences across the rs1175544 genotypes were observed in any of the blood analyses or in blood pressure. In a multiple regression analysis, the rs1175544 genotypes accounted for 7% of the total weight reduction variance. These data suggest that one SNP of the PPARG genotype accounted for a significant portion of the total body weight reduction variance in response to a short-term intervention consisting of calorie restriction; however, no relationship was found between these SNPs and the changes in CHD risk factors which accompanied weight loss.

Consumo alimentar e doença macrovascular em nipo-brasileiros: um estudo transversal

OBJETIVO: Descrever o hábito alimentar de nipo-brasileiros com e sem doença macrovascular (DMV). MÉTODOS: Definiu-se DMV, para 1.165 nipo-brasileiros, a partir de escores atribuídos ao histórico de saúde, eletrocardiograma e valores do índice tornozelo-braquial. Determinou-se o consumo alimentar habitual por meio de Questionário de Frequência do Consumo de Alimentos. RESULTADOS: A porcentagem de casos confirmados com DMV foi de 3,2%, sendo semelhante entre os sexos. Observou-se, de forma estatisticamente significante, maior frequência de indivíduos com DMV (confirmados ou suspeitos) entre aqueles de primeira geração, com idade > 60 anos, tabagistas, com hipertensão arterial, hipertrigliceridemia e diabetes. Nipo-brasileiros com DMV (confirmados ou suspeitos) apresentaram menor perímetro do quadril e maior idade, pressão arterial sistólica, triglicérides, glicemia, consumo de alimentos fonte de ferro e menor fonte de fibras de grãos. Encontrou-se diferença estatisticamente significante apenas para o consumo de gordura saturada (análise bruta: segundo terço versus primeiro terço). CONCLUSÕES: programas de educação nutricional devem ser incentivados neste grupo com alta prevalência de doenças crônicas não transmissíveis.

Effects of mild calorie restriction and high-intensity interval walking in middle-aged and older overweight Japanese

We investigated whether a combination of mild calorie restriction (MCR) and high-intensity interval walking (HIW) improved physical fitness more than HIW alone in middle-aged and older overweight Japanese (40-69years old, BMI23.6kg/m(2)). Forty-seven women and 16 men were divided into MCR+HIW and HIW groups. All subjects performed HIW: 5 sets of 3-min low-intensity walking (40% peak aerobic capacity for walking, VO(2peak)) and 3-min high-intensity walking (70% VO(2peak)) per day, 4days per week, for 16weeks while energy expenditure was monitored with a tri-axial accelerometer. The MCR+HIW group consumed meal replacement formula (240kcal): a mixture of low-carbohydrates and -fat and high-protein, for either lunch or dinner everyday and therefore, had approximately 87% of the energy intake of the HIW group during the intervention period. Although the HIW group showed improvements in BMI, blood pressure, and several blood chemicals, the MCR+HIW group had greater improvement. Moreover, the medical expenditure for the 6months including the intervention period was 59% lower in the MCR+HIW group than in the HIW group. Our strategy of a short-term combination of MCR and HIW may thus prevent lifestyle-associated diseases and improve health in middle-aged and older overweight Japanese.

Obesity and its associations with hypertension and type 2 diabetes among Chinese adults age 40 years and over

AIM

To investigate the prevalence of obesity in a Chinese community according to the World Health Organization recommended criteria for Asians in 2000 based on body mass index (BMI) and waist circumference (WC), and to examine the associations between obesity and the risk of hypertension and type 2 diabetes among adults age 40 years and over in Shanghai, China.

METHODS

A population-based survey was conducted in Youyi Community in Shanghai. Five thousand seventy-one subjects (1917 men and 3154 women) were included in this study. Standard questionnaires were used to collect baseline data of participants. Body weight, height, WC, blood pressure, and glucose in the blood were measured.

RESULTS

The prevalence of general obesity was 44.6% (46.4% for men and 43.6% for women) according to BMI and 36.1% (25.5% for men and 42.6% for women) for central obesity according to WC. The prevalence of obesity I was higher in men (41.6%) than in women (36.2%; chi(2) =14.8, P<0.05), although the rate was higher in women than in men for obesity II (7.4% versus 4.8%, chi(2) =13.6, P<0.01) or central obesity (42.6% versus 25.5%, chi(2) =152.1, P<0.01). Odds ratios of hypertension and type 2 diabetes were significantly higher in the obesity group compared with either the group with BMI 18.5-<23.0kg/m(2) or the group with WC<90cm for men or <80cm for women.

CONCLUSIONS

According to the criteria of obesity for Asians, the prevalence of obesity among Chinese adults age 40 years and over in Shanghai is high. Subjects with obesity have a significantly higher risk of hypertension and type 2 diabetes.

Association of body mass index with coronary plaque regression: 6-month prospective study

AIM

Obesity is a well known strong risk factor for coronary artery disease (CAD). We prospectively investigated the influence of body mass index (BMI) on the inhibitory effects of pravastatin against the development of coronary atherosclerosis.

METHODS

In 56 patients with stable CAD, 3-dimensional intravascular ultrasound was performed in matched coronary segments at the baseline and after 6-month treatment with pravastatin.

RESULTS

The plaque volume was significantly reduced by 11% after treatment (p<0.001 vs. baseline). The percent plaque volume was positively correlated with the baseline BMI (r=0.37, p<0.001), and negatively correlated with the serum total cholesterol / high-density lipoprotein cholesterol ratio (r=0.27, p<0.05) and total leukocyte count (r=0.27, p<0.05). Multivariate regression analysis showed that BMI was an independent predictor of the change in plaque volume (beta coefficient: 0.326; 95% CI: 0.003 to 0.037; p<0.05). No correlations were found between BMI and changes in the serum levels of any other lipids, apolipoproteins, or hs-CRP.

CONCLUSION

The present study demonstrated that an increase in BMI attenuated pravastatin-induced coronary atherosclerosis regression. The results may provide new insight into the framework for the treatment of obese patients with CAD.

Visceral and subcutaneous adiposity and adiponectin in middle-aged Japanese men: the ERA JUMP study

Adiponectin is reduced in obesity and has been suggested to play an important role in modulation of atherosclerosis. We studied the relationship between visceral (VAT) and subcutaneous (SAT) adipose tissue and serum adiponectin concentrations in Japanese men. Participants were 304 randomly selected community-based Japanese men aged 40-49 without a prior history of cardiovascular disease. Participants were grouped according to tertiles of serum adiponectin. In multiple linear regression analysis including age, pack years of smoking, and alcohol intake as covariates, log-transformed adiponectin was inversely associated with both VAT and SAT when these two obesity measures were included separately in the models. However, log-transformed adiponectin was inversely associated with VAT (standardized beta estimate=-0.465; P<0.0001) and positively associated with SAT (standardized beta estimate=1.277; P=0.03), when these were included concomitantly in the model. In conclusion, VAT and SAT had differential associations with serum adiponectin concentrations.

Obesity phenotype and intra-abdominal fat responses to regular aerobic exercise

AIM

To examine the effects of obesity phenotype on abdominal fat responses to regular aerobic exercise.

METHOD

Fifty-seven obese men aged 34-70 years were divided into two groups based on baseline intra-abdominal fat (IF) area measured by computerized tomography: moderate (<200 cm(2)) IF (MIF; n=33, age: 52.9+/-10.6 [SD] yr, body mass index [BMI]: 29.2+/-3.1 kg/m(2)) or high (>or=200 cm(2)) IF (HIF; n=24, age: 53.5+/-9.5 yr, BMI: 30.3+/-3.1 kg/m(2)). The 12-week exercise program consisted primarily of aerobic exercise and met 3 days per week for 90 min per session. Weight, BMI, body composition (by dual-energy X-ray absorptiometry), IF and subcutaneous fat (SF) areas were measured before and after the program.

RESULTS

Regular aerobic exercise reduced weight by 2.3+/-2.2 kg in MIF and 3.2+/-3.0 kg in HIF. HIF reduced significantly more IF area than MIF (15.1+/-26.0 cm(2) in MIF and 43.3+/-41.9 cm(2) in HIF), and the difference remained significant after adjusting for baseline fat mass, weight change and total energy intake during the 12-week aerobic exercise.

CONCLUSION

Exercise-induced IF reduction may be remarkably influenced by obesity phenotype.

Association of an abnormal blood glucose level and morning blood pressure surge in elderly subjects with hypertension

BACKGROUND

We previously reported that morning blood pressure (BP) surge (MBPS) was an independent risk factor for stroke. We evaluated the determinants of MBPS in hypertensive patients.

METHODS

We analyzed 24-h ambulatory BP monitoring (ABPM) records in 458 hypertensive patients (mean: 72.2 +/- 8.5 years). The MBPS was calculated as the mean systolic BP (SBP) over 2 h after waking minus mean SBP during the hour of sleep that included the lowest nighttime BP. The cutoff value for identifying the top decile (the MBPS group) was defined as > or =55 mm Hg.

RESULTS

The MBPS was associated with age, fasting plasma glucose, and 24-h SBP, and they were independent and significant determinants of MBPS in multivariate analysis (age, P = 0.01; fasting plasma glucose, P < 0.01; 24-h SBP, P = 0.04) after adjustment for confounding factors of gender, body mass index (BMI), and smoking status. The subjects in the MBPS group (n = 45) were older in age (76.4 years vs. 71.8 years, P < 0.01) and had higher fasting plasma glucose (97.6 mg/dl vs. 91.4 mg/dl, P = 0.04) than those in the non-MBPS group. In logistic regression analysis, the MBPS group was associated with older age (10 years older: odds ratio (OR) 1.85, 95% confidence interval (CI) 1.26-2.72, P < 0.01) and higher fasting plasma glucose (10-mg/dl increase: OR 1.16, 95% CI 1.01-1.33, P = 0.03).

CONCLUSION

In addition to older age and higher mean 24-h SBP, higher fasting plasma glucose was associated with MBPS.

Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head

INTRODUCTION

Subchondral insufficiency fracture of the femoral head (SIF) may be confused with osteonecrosis of the femoral head (ON) due to clinical and imaging similarities.

MATERIALS AND METHODS

Contrast-enhanced MR images in patients with SIF (ten hips in ten patients) were retrospectively reviewed and compared with those from patients with ON (ten hips in six patients).

RESULTS

Low-signal intensity bands on T1-weighted images were present within the femoral head in all hips examined. The segment proximal to the band was contrast-enhanced following IV gadolinium administration in nine of ten hips (90%) with SIF and in none of the 10 hips with ON.

CONCLUSION

These results suggest that the presence of contrast enhancement in the segment proximal to the low-signal intensity band in the femoral head may serve as a supplemental diagnostic measure for the differentiation of SIF from ON.

Glucose control in korean immigrants with type 2 diabetes

Despite the rising incidence of type 2 diabetes in Korean immigrants, little is known about glucose control in these individuals. This descriptive study examined factors influencing glucose control in Korean immigrants with type 2 diabetes. Participants were 143 Korean immigrants with type 2 diabetes who completed questionnaires, a finger stick blood test for glycosylated hemoglobin (HbA1c), and anthropometric measures. The mean HbA1c level was 7.6 % (SD = 1.5; range = 5.6 to 12.5). Less than half of the participants (41.3%) met the American Diabetes Association's goal of less than 7%. After adjusting for demographic and health variables, family diet support, waist-to-hip ratio (WHR), the duration of diabetes, the number of diabetic medications, and age significantly influenced glucose control. Findings support the positive role of family involvement in diabetes management. Patients with long-standing diabetes, higher WHR, and more diabetic medications deserve special attention because they tend to have higher HbA1c levels.

Daily exercise fluctuations and dietary patterns during training predict visceral fat regain in obese women

BACKGROUND

Visceral adiposity is an essential component of metabolic syndrome. Reduction of excessive visceral fat prevents metabolic syndrome and improves atherosclerotic diseases. This study aimed to identify dietary patterns and physical exercise during the training-education period that predict visceral adiposity regain during the follow-up period.

METHODS

One hundred one moderately obese Japanese women, 23 to 67 years of age, participated in 0- to 4-month training-education and 12-month follow-up periods. Dietary patterns of food groups during training-education were analyzed by principal components analysis, and 3 major dietary patterns were derived. The change in visceral fat over the follow-up, adjusted for 4-month visceral fat area (VFA) and 4- to 16-month body mass index change, was analyzed using stepwise multiple linear regression.

RESULTS

VFA and body weight decreased during training-education (P<0.001) and were maintained during follow-up. One major dietary pattern (of 3) (P=0.030) and standard deviations of daily exercise duration (P=0.012) during training-education predicted VFA regain during follow-up. This regain correlated negatively with combinations of bread, milk and dairy products, fruits, seeds and nuts, and mushrooms, but positively with combinations of rice, pickles, miso, alcohol, and meat. The large standard deviation of daily exercise duration during training-education showed greater VFA regain during follow-up than did the smaller standard deviation (P=0.023), but body mass index did not show a similar trend.

CONCLUSION

Our results revealed that daily exercise fluctuations and dietary patterns were useful predictors of visceral fat regain.

Projecting the probability of survival free from cancer and cardiovascular incidence through lifestyle modification in Japan

OBJECTIVES

To promote prevention strategies aimed at reducing the incidence of cancer or cardiovascular disease (CVD), we present a method to project the probability that a subject with given lifestyle risk factors will survive free from either of cancer or CVD.

METHODS

Projection models were developed from data from a cohort study conducted in Japan. During 1990-2003, 96,592 subjects were followed and 5797 cancer and 2591 CVD cases and 2395 deaths were identified. Smoking, alcohol intake and body mass index (BMI) were used as common risk factors in projection models.

RESULTS

According to the projection of individualized probability, avoidance of smoking, excess alcohol intake and high BMI increased 10-year disease-free survival probability from 81.4% to 92.9% and from 88.0% to 94.3% in 50- to 54-year-old men and women, respectively. In terms of population average risk, smoking cessation and avoidance of excess alcohol exerted a large impact, while decreasing BMI had a small impact due to the small at-risk population.

CONCLUSIONS

Current smoking, excess alcohol intake and obesity were suggested as common risk factors for cancer and CVD. Considering the distribution of risk factors in the Japanese population, smoking prevention/cessation and reduction of excess alcohol intake would prevent a large number of incident cases.

Exenatide exhibits dose-dependent effects on glycemic control over 12 weeks in Japanese patients with suboptimally controlled type 2 diabetes

This study assessed the dose-dependent efficacy and safety of exenatide over 12 weeks in Japanese patients with type 2 diabetes suboptimally controlled despite therapeutic doses of sulfonylurea (SU), SU plus biguanide, or SU plus thiazolidinedione. Patients were randomly assigned to placebo (N = 40), 2.5 microg (N = 38), 5 microg (N = 37), or 10 microg (N = 38) exenatide administered subcutaneously twice daily (BID). Patients randomly assigned to 10 microg exenatide received 5 microg BID for the first 4 weeks, with the dose escalated to 10 microg BID for the final 8 weeks. Patients were 60.3 +/- 9.7 years old, with body mass index 25.3 +/- 4.3 kg/m(2) and hemoglobin A1c (HbA1c) 8.0 +/- 0.8%. Baseline-to-endpoint HbA1c changes (%) were +0.02 +/- 0.1 (placebo), -0.9 +/- 0.1 (2.5 microg), -1.2 +/- 0.1 (5 microg), and -1.4 +/- 0.1 (10 microg) (all p < 0.001 vs. placebo). Of patients with baseline HbA1c -7%, 5.1% (placebo), 50.0% (2.5 microg), 71.4% (5 microg), and 79.4% (10 microg) achieved HbA1c <7% at endpoint (p < 0.001, trend test). Baseline-to-endpoint fasting plasma glucose changes (mg/dL) were +6.0 +/- 4.8 (placebo), -18.6 +/- 5.7 (2.5 microg), -25.0 +/- 7.0 (5 microg), and -28.9 +/- 5.9 (10 microg) (all p < or = 0.001 vs. placebo). Treatment-emergent adverse events were mostly mild; dose-dependent increases in incidence were observed for hypoglycemia, nausea, anorexia, decreased appetite, and diarrhea (all p < or = 0.044, trend test). Over 12 weeks, exenatide dose-dependently improved glycemic control in Japanese patients with type 2 diabetes.

Safety, tolerability, pharmacokinetics, and pharmacodynamics of exenatide once weekly in Japanese patients with type 2 diabetes

This randomized, placebo-controlled, double-blind, parallel study assessed the safety, tolerability, pharmacokinetics, and pharmacodynamics of exenatide once weekly (QW) in 30 Japanese patients with type 2 diabetes (T2D) suboptimally controlled by diet and exercise alone or combined with biguanide, sulfonylurea, thiazolidinedione, or combinations of these agents (58.6% male; 58+/-9 years; body mass index 26.3+/-2.9 kg/m(2); hemoglobin A(1c) [HbA(1c)] 7.4+/-0.8%; fasting plasma glucose [FPG] 156.1+/-29.1 mg/dL; duration of T2D 6+/-5 years; means +/- SD). Patients were randomized in a 1:1:1 ratio to subcutaneous placebo QW, exenatide QW 0.8 mg, or exenatide QW 2.0 mg for 10 weeks. All evaluable patients were analyzed (placebo QW, n=10; exenatide QW 0.8 mg, n=10; exenatide QW 2.0 mg, n=9), unless otherwise stated. Steady-state plasma exenatide concentrations were observed by Week 8 of the study. For the evaluable pharmacokinetic population, geometric mean (90% confidence interval) steady-state plasma concentrations (pg/mL) were 81.2 (68.3-96.4) and 344.5 (256.5-462.7) with exenatide QW 0.8 mg (n=8) and exenatide QW 2.0 mg (n=5), respectively. Baseline-to-Week 10 glycemic improvements with placebo QW, exenatide QW 0.8 mg, and exenatide QW 2.0 mg, respectively, were: HbA(1c) (%): -0.4+/-0.3, -1.0+/-0.7, and -1.5+/-0.7; FPG (mg/dL): -20.5+/-20.4, -25.2+/-10.9, and -50.8+/-27.8; and 2-hour postprandial plasma glucose excursions (mg/dL): -8.8+/-26.9, -50.0+/-41.1, and -59.7+/-26.8 (means +/- SD). No serious adverse events (AEs) were reported and no AEs led to study discontinuation in any group. The most frequent AE observed was mild-to-moderate injection site induration. No serious hypoglycemia was reported. Exenatide QW for 10 weeks was well tolerated and improved short-term glycemic control in Japanese patients with suboptimally controlled T2D.

A tale of two countries--the United States and Japan: are differences in health due to differences in overweight?

BACKGROUND

Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities.

METHODS

Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes.

RESULTS

The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men.

CONCLUSION

Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.

Age- and gender-specific BMI in terms of the lowest mortality in Japanese general population

OBJECTIVE

The primary purposes of our study were to establish age- and gender-specific BMIs in terms of lowest mortality (risk nadir BMIs) for the Japanese population, and to then compare those to (i) BMIs for whites as determined by similar studies and to (ii) the official BMI guidelines.

METHODS AND PROCEDURES

A total of 32,060 men and 61,916 women aged 40-79 years underwent health check-ups in Ibaraki prefecture, Japan, in 1993 and were followed through 2003. To determine the age- and gender-specific risk nadir BMIs, coefficients and the lowest point from a quadratic model with transformed BMI were calculated by a Cox proportional hazard model. This included the quadratic term of 1/BMI and adjusted values (age, alcohol intake, and smoking status).

RESULTS

For both age and both gender categories, the relationship between all-cause mortality risk and BMI categories are illustrated as U-shaped curves. The risk nadir BMIs for men in the age groups of 40-59 and 60-79 years were 23.4 and 25.3 kg/m(2), respectively. Similarly, in women, the risk nadir BMIs were 21.6 and 23.4 kg/m(2), respectively.

DISCUSSION

Among the general Japanese population, the risk nadir BMI for the age group of 60-79 years was higher compared to the age group of 40-59 years, which was similar to the study for whites, and the age-dependent risk nadir BMI differed from the official guidelines criteria. Our findings underscore the importance of weight control following appropriate indicators of body weight according to age.

Changes in body mass index by birth cohort in Japanese adults: results from the National Nutrition Survey of Japan 1956-2005

Background The National Nutrition Survey, Japan (NNS-J) provides annual anthropometric information for a whole nation over 50 years. Based on this survey, the mean body mass index (BMI) of Japanese men and elderly women has increased in recent decades, but that of young women has decreased. We examined the effect of birth cohort on this phenomenon.

Methods We analysed data from the NNS-J for subjects aged 20–69 years. BMI during 1956–2005 and the prevalence of overweight and obesity (BMI ≥ 25 kg/m²) during 1976–2005 were estimated.

Results The BMI increased with age in every birth cohort, with similar increments, and did not peak until 60–69 years of age. However, with cross-sectional age, the BMI usually peaked before 60–69 years of age. The differences among cohorts already existed at 20–29 years of age, and slightly increased in men between 20–29 and 30–39 years of age. The BMI in all male age groups increased from the 1891–1900 through 1971–80 cohorts. However, in women, the figure increased until the 1931–40 cohorts, but later decreased. Changes in prevalence were generally consistent with changes in BMI. The recent increase (decrease in young women) in the mean BMI is attributable to birth cohort, indicating that thinner (fatter) and less recent birth cohorts have been replaced by fatter (thinner) ones.

Conclusions A cohort effect was quantitatively demonstrated based on a repeated annual survey. In Japan, the differences in BMI among cohorts were already established by young adulthood.

A Comparison of Biological Risk Factors in Two Populations: The United States and Japan

Life expectancy is higher in Japan than in the United States. We compared the prevalence of clinically recognized risk factors in the two countries to explore the possibility that differences in these likely precursors to disease and death are linked to the paths to higher mortality for Americans. We found that American men and women have higher levels of total biological risk than the Japanese, particularly for risk factors included in the metabolic syndrome. A significant difference between the two countries is the higher prevalence of overweight among Americans. On the other hand, measured blood pressure appears more favorable among Americans. A larger proportion of Americans use prescription drugs, which results in lowered levels of measured biological risk. There are large differences in the prevalence of a number of risk factors between American and Japanese women less than age 40; this could mean that Americans develop biological risk earlier in life or that the differences are growing larger in more recent cohorts.

Health related quality of life measured by SF-36: a population-based study in Shanghai, China

BACKGROUND

Health related quality of life (HRQL) is a research topic that has attracted increasing interests around the world over the past two decades. The 36-item Short Form (SF-36) is a commonly used instrument for measuring HRQL. However, the information on Chinese adults' quality of life is limited. This paper reports on the feasibility of using the Mandarin version of SF-36 to evaluate HRQL in the population of Shanghai, China.

METHODS

A total of 1034 subjects were randomly sampled using a stratified multiple-stage sampling method in Shanghai. Demographic information was collected, and SF-36 was used to measure HRQL.

RESULTS

Internal reliability coefficients were greater than 0.7 in six of the eight SF-36 dimensions, except social function and mental health. Intraclass correlation coefficients ranged from 0.689 to 0.972. Split-half reliability coefficients were higher than 0.9 in five SF-36 dimensions. Validity was assessed by factor analysis and correlation analysis. Our results were basically in accordance with the theoretical construction of SF-36. The average scores of most SF-36 dimensions were higher than 80. The primary influencing risk factors of HRQL included chronic diseases, age, frequency of activities, and geographical region, which were identified using multivariate stepwise regression.

CONCLUSION

Overall, HRQL in the population of Shanghai is quite good. The Mandarin version of SF-36 is a valid and reliable tool for assessing HRQL.

Association of hypertension with changes in the body mass index of university students

BACKGROUND

There are few longitudinal studies on the associations of obesity with hypertension in young adults.

OBJECTIVES

To analyze longitudinally to what extent weight gain associates with hypertension in young adults.

METHODS

The subjects of this study consisted of 6,178 university students (male 4,098; female 2,080). The associations of hypertension with body type change were longitudinally examined by using the records of health examinations while at university. The prevalence ratios (PRs) for hypertension in their senior year were calculated on groups that changed toward obese against those that changed toward underweight. The logistic regression analyses were used to estimate odds ratios (ORs) for hypertension in their senior year of each factor. The analyses were conducted on (i) all subjects, (ii) non-hypertensive subjects in their freshman year, and (iii) by schools, in order to take into account physical activities.

RESULTS

The PRs of hypertension in subjects changed toward obese from their freshmen to seniors against ones toward underweight were 1.47 (95% CI; 1.00-2.15) for males and 3.50 (0.93-13.22) for females. In analyses limited to non-hypertensive subjects in their freshman year, results were similar to those of all subjects. The analyses by school also showed similar results to those including all subjects. In logistic regression analyses, although the factor most strongly associated with hypertension was body type in their senior year, the body type in their freshman still showed significant association with hypertension after the adjustment of senior year body type and hypertension in freshman year. The ORs for hypertension in obese subjects to normal weight ones in their senior year were 9.13 (95% CI; 5.77-14.45) for males and 22.59 (5.69-89.67) for females after adjusted by hypertension in freshman, body type in freshman and school.

CONCLUSIONS

These data suggest that the increase of BMI is linked to hypertension in university students.

Variations in the FTO gene are associated with severe obesity in the Japanese

Variations in the fat-mass and obesity-associated gene (FTO) are associated with the obesity phenotype in many Caucasian populations. This association with the obesity phenotype is not clear in the Japanese. To investigate the relationship between the FTO gene and obesity in the Japanese, we genotyped single nucleotide polymorphisms (SNPs) in the FTO genes from severely obese subjects [n = 927, body mass index (BMI) ≥ 30 kg/m²] and normal-weight control subjects (n = 1,527, BMI < 25 kg/m²). A case-control association analysis revealed that 15 SNPs, including rs9939609 and rs1121980, in a linkage disequilibrium (LD) block of approximately 50 kb demonstrated significant associations with obesity; rs1558902 was most significantly associated with obesity. P value in additive mode was 0.0000041, and odds ratio (OR) adjusted for age and gender was 1.41 [95% confidential interval (CI) = 1.22–1.62]. Obesity-associated phenotypes, which include the level of plasma glucose, hemoglobin A1c, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and blood pressure were not associated with the rs1558902 genotype. Thus, the SNPs in the FTO gene were found to be associated with obesity, i.e., severe obesity, in the Japanese.

Neither the presence of metabolic syndrome as defined by the IDF guideline nor an increased waist circumference increased the risk of microvascular or macrovascular complications in Japanese patients with type 2 diabetes

The aim of this study was to evaluate the relationship between the diagnosis of metabolic syndrome (MetS) or its components and the prevalence of microvascular and macrovascular complications in 130 Japanese type 2 diabetic patients. Out of the 130 patients, 58.5% satisfied the criteria of the MetS as defined by the IDF guideline. The results of logistic regression analysis with adjustment for three variables (age, gender and duration of diabetes) revealed that the presence of MetS as defined by the IDF guideline was not independently related to the presence of proliferative retinopathy, proteinuria, neuropathy, or macrovascular disease in the diabetic patients. The waist circumference per se was not associated with diabetic neuropathy, retinopathy, nephropathy, or macrovascular diseases. These results suggest that neither the presence of MetS, as defined by the IDF guideline, nor the waist circumference was associated with the presence of either microvascular or macrovascular complications in Japanese type 2 diabetic patients.

Nonalcoholic fatty liver disease in Japanese patients with severe obesity who received laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in comparison to non-Japanese patients

BACKGROUND

The number of patients with morbid obesity is increasing worldwide. However, the prevalence of morbid obesity is still low in Japan, and therefore few systematic investigations of liver dysfunction in this population have so far been carried out. This study aimed to investigate the clinical characteristics in severe obese Japanese patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB).

METHODS

Eighty-four patients with severe obesity, including 61 Japanese and 23 non-Japanese patients, were analyzed.

RESULTS

The mean body mass index (BMI) was 43.7 +/- 7.8 kg/m(2), and there was no difference between Japanese and non-Japanese patients. Nonalcoholic fatty liver disease (NAFLD) was observed in 45/59 (76.2%) of the Japanese patients. Although there were no differences in the BMI and body weight, serum ALT was higher in Japanese patients in comparison to non-Japanese patients (P < 0.05). The indices for insulin resistance were significantly higher in the Japanese patients in comparison to non-Japanese patients (P < 0.01). The liver/spleen computed tomography (CT) ratios were lower in Japanese patients (P < 0.05). The laboratory data and BMI significantly improved at 1 year after LRYGB in both groups.

CONCLUSIONS

Racial difference may exist difference may exist in NAFLD in patients with severe obesity. When the BMI is similar, liver dysfunction among Japanese patients with severe obesity tends to be higher than in non-Japanese patients. Japanese patients with severe obesity must therefore reduce their body weight to a greater degree in comparison to non-Japanese patients with the same BMI. LRYGB can achieve effective weight control and lower ALT levels in Japanese patients with severe obesity.

Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan

BACKGROUND

Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce.

METHODS

Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol.

RESULTS

Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women.

CONCLUSION

The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.

Association of single-nucleotide polymorphisms in MTMR9 gene with obesity

Genetic factors are clearly involved in the development of obesity, but the genetic background of obesity remains largely unclear. Starting from 62 663 gene-based single-nucleotide polymorphisms (SNPs) in three sequential case-control association studies, we identified a replicated association between the obesity phenotype (BMI > or =30 kg/m(2)) and a SNP (rs2293855) located in the myotublarin-related protein 9 (MTMR9) gene in the chromosomal segment 8p23-p22. P-values (minor allele dominant model) of the first set (93 cases versus 649 controls) and the second set (564 cases versus 562 controls) were 0.008 and 0.0002, respectively. The association was replicated in the third set [394 cases versus 958 controls, P = 0.005, odds ratio (95% CI) =1.40 (1.11-1.78)]. The global P-value was 0.0000005. A multiple regression analysis revealed that gender, age BMI and rs2293855 genotype (minor allele dominant model) were significantly associated with both systolic and diastolic blood pressures. MTMR9 was shown to be the only gene within the haplotype block that contained SNPs associated with obesity. Both the transcript and protein of MTMR9 were detected in the rodent lateral hypothalamic area as well as in the arcuate nucleus, and the protein co-existed with orexin, melanin concentrating hormone, neuropeptide Y and proopiomelanocortin. The levels of MTMR9 transcript in the murine hypothalamic region increased after fasting and were decreased by a high-fat diet. Our data suggested that genetic variations in MTMR9 may confer a predisposition towards obesity and hypertension through regulation of hypothalamic neuropeptides.

Adiponectin inversely correlates with high sensitive C-reactive protein and triglycerides, but not with insulin sensitivity, in apparently healthy Japanese men

Adiponectin, an antiatherogenic peptide, has diverse biological actions on insulin sensitivity, inflammation and lipid metabolism. To explore physiological and pathophysiological significance of adiponectin in the Japanese general population, we systematically analyzed the relationship between adiponectin and high sensitive CRP (hsCRP), lipids, insulin sensitivity, and anthropometric parameters in 166 consecutive adult male health examinees. By univariate analysis, serum adiponectin was positively correlated with age and HDL-cholesterol, and inversely correlated with fasting plasma glucose, fasting insulin, homeostasis model assessment insulin-resistance, waist, body mass index, triglycerides and hsCRP. However, multivariate analysis revealed that adiponectin independently correlated with triglycerides (r = -0.243, P = 0.0033) and hsCRP (r = -0.262, P = 0.0015) but not with all other variables. Adiponectin was lower and hsCRP higher in the subjects with metabolic syndrome (n = 22) than in those without it (n = 144) (adiponectin, 5.4 +/- 2.8 vs 7.5 +/- 4.2 microg/ml, p = 0.002; hsCRP, 832 +/- 605 vs 470 +/- 524 ng/ml, p = 0.0004). Current findings suggest that relative importance of hypertriglyceridemia and enhanced inflammation, rather than insulin resistance, as the downstream events of hypoadiponectinemia leading to atherosclerosis in the Japanese general population.

Correlation of hepatic steatosis with body mass index, serum ferritin level and hepatic fibrosis in Japanese patients with chronic hepatitis C

AIMS

The present study was aimed at determining the predictors of hepatic steatosis and fibrosis in Japanese patients with chronic hepatitis C.

METHODS

The relationship between the degrees of hepatic steatosis or fibrosis and several clinical parameters was evaluated using univariate and multivariate analyses.

RESULTS

Steatosis was observed in 117 out of 184 patients (64%), including 45 patients (25%) with grade 1 (<10% of hepatocytes affected), 56 patients (30%) with grade 2 (10-30%), 12 patients (7%) with grade 3 (30-50%), and four patients (2%) with grade 4 (>50%). In the multivariate analysis, body mass index (BMI) (P = 0.0038) and serum ferritin (P < 0.0001) were selected as independent predictors of hepatic steatosis. Six of the 184 patients (3%) had stage 0 fibrosis (no fibrosis), 87 patients (47%) had stage 1, 55 patients (30%) had stage 2 and 36 patients (20%) had stage 3. In the multivariate analysis, platelet count (P = 0.0012), aspartate aminotransferase (AST) (P = 0.0219), hyaluronic acid (P < 0.0001) and the grade of steatosis (P = 0.0008) were selected as independent predictors of hepatic fibrosis.

CONCLUSION

Obesity and iron storage, as evaluated by BMI and serum ferritin level, respectively, have important roles in the pathogenesis of hepatic steatosis, which is a factor responsible for the development of hepatic fibrosis in Japanese patients with chronic hepatitis C.

Functional single-nucleotide polymorphisms in the secretogranin III (SCG3) gene that form secretory granules with appetite-related neuropeptides are associated with obesity

CONTEXT

Genetic factors are important for the development of obesity. However, the genetic background of obesity still remains unclear.

OBJECTIVE

Our objective was to search for obesity-related genes using a large number of gene-based single-nucleotide polymorphisms (SNPs).

DESIGN AND SETTING

We conducted case-control association analyses using 94 obese patients and 658 controls with 62,663 SNPs selected from the SNP database. SNPs that possessed P < or = 0.02 were further analyzed using 796 obese and 711 control subjects. One SNP (rs3764220) in the secretogranin III (SCG3) gene showed the lowest P value (P = 0.0000019). We sequenced an approximately 300-kb genomic region around rs3764220 and discovered SNPs for haplotype analyses. SCG3 was the only gene within a haplotype block that contained rs3764220. The functions of SCG3 were studied.

PATIENTS

Obese subjects (body mass index > or = 30 kg/m(2), n = 890) and control subjects (general population; n = 658, body mass index < or = 25 kg/m(2); n = 711) were recruited for this study.

RESULTS

Twelve SNPs in the SCG3 gene including rs3764220 were in almost complete linkage disequilibrium and significantly associated with an obesity phenotype. Two SNPs (rs16964465, rs16964476) affected the transcriptional activity of SCG3, and subjects with the minor allele seemed to be resistant to obesity (odds ratio, 9.23; 95% confidence interval, 2.77-30.80; chi(2) = 19.2; P = 0.0000067). SCG3 mRNA and immunoreactivity were detected in the paraventricular nucleus, lateral hypothalamic area, and arcuate nucleus, and the protein coexisted with orexin, melanin-concentrating hormone, neuropeptide Y, and proopiomelanocortin. SCG3 formed a granule-like structure together with these neuropeptides.

CONCLUSIONS

Genetic variations in the SCG3 gene may influence the risk of obesity through possible regulation of hypothalamic neuropeptide secretion.

Medical costs of obese Japanese: a 10-year follow-up study of National Health Insurance in Shiga, Japan

BACKGROUND

For the Japanese population, a body mass index (BMI) of 25.0-29.9 is classified as obesity and is a risk factor for cardiovascular disorders such as hypertension.

METHODS

A cohort study to clarify obesity costs for a Japanese population was conducted utilizing baseline BMI and medical costs over a 10-year follow-up period. The participants were 4502 community dwelling Japanese National Health Insurance (NHI) beneficiaries aged 40-69 years. According to their baseline BMI values (kg/m(2)), participants were classified into the following three categories: BMI < 18.5, 18.5 < or = BMI < 25.0 and 25.0 < or = BMI. Medical costs per person per month were compared among the three categories. Excess medical costs attributable to the 25.0 < or = BMI category compared to the 18.5 < or = BMI < 25.0 category were estimated.

RESULTS

Approximately 20% of the Japanese population studied had a BMI of 25.0 or over. A J-shaped relationship between BMI and personal total medical costs was observed. Personal total medical costs per month determined from the 10-year follow-up in each category were 189 Euros (BMI < 18.5), 134 Euros (18.5 < or = BMI < 25.0) and 155 Euros (25.0 < or = BMI). A J-shaped pattern was observed after adjusting for age, sex, smoking and drinking habits, and excluding early deceased participants. Furthermore, smoking habit did not modify the J-shaped pattern of total medical costs. The estimated excess medical costs for the 25.0 < or = BMI category represented 3.1% of the total medical costs for the entire study population (634 105 Euros).

CONCLUSION

The Japanese NHI beneficiaries with a BMI of 25.0 or over showed increased medical costs compared to those with a BMI of 18.5-24.9.

Epidemic obesity and type 2 diabetes in Asia

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers

BACKGROUND

Performance parameters for double-balloon enteroscopy (DBE) have not been described.

OBJECTIVE

To determine the learning curve for DBE.

DESIGN

Prospective cohort study.

SETTING

Six U.S. tertiary centers.

PATIENTS

A total of 188 subjects undergoing 237 DBE procedures; 130 (69%) with obscure GI bleeding.

INTERVENTIONS

Performance parameters from each center's initial 10 cases were compared to the subsequent examinations.

MAIN OUTCOME MEASUREMENTS

Exam duration, depth of insertion, and findings on DBE examination.

RESULTS

DBE was introduced by mouth in 149 (63%) cases, by rectum in 77 (33%) cases, and through a stoma in 6 (2.5%) patients. The mean (+/-SD) duration was 109.1 +/- 44.6 minutes for the first 10 cases and 92.4 +/- 37.6 minutes for subsequent cases (P = .005) but did not change for rectal DBE procedures. There was no change in mean depth of insertion, but the mean fluoroscopy time declined significantly (P = .025). Diagnostic or therapeutic maneuvers were performed in 64% of cases; DBE led to a diagnosis in 81 (43%) patients. A total of 78% of patients had prior capsule endoscopy (CE) with significant agreement between DBE and CE (kappa = 0.74). One perforation occurred (0.4%). Per-rectal cases failed to reach the small bowel in 24 (31%) cases.

LIMITATIONS

All patients did not undergo initial CE. The therapeutic DBE scope was not available for the initial 8 months of the study.

CONCLUSIONS

There was a significant decline in overall procedural time and fluoroscopy time after the initial 10 DBE cases. There was no improvement in performance parameters when DBE was performed via the rectal approach despite increased, but limited, operator experience.

Effect of growth hormone treatment on trunk fat accumulation in adult GH-deficient Japanese patients: a randomised, placebo-controlled trial

OBJECTIVE

Patients with growth hormone deficiency (GHD), both Japanese and Caucasian, have an abnormal body composition with pronounced abdominal obesity. This study aimed to evaluate changes in trunk fat with GH treatment.

DESIGN

Double-blind, placebo-controlled study.

PATIENTS AND MEASUREMENTS

Sixty-one Japanese adult GH deficient patients (mean age 37 years) were randomised to either GH, titrated to 0.012 mg/kg/day, (n = 30) or placebo (n = 31) for 24 weeks. Body composition, by dual-energy X-ray absorptiometry (DXA), was evaluated at a central laboratory for trunk fat, total body fat and lean body mass. Serum lipid levels were also determined centrally.

RESULTS

At baseline, 26 (42.6%) patients had a body mass index (BMI) > or = 25 kg/m(2), the threshold for obesity-related complications for Japanese subjects. Median trunk fat mass (FM) was > or = 9.0 kg for each treatment and gender group, higher than the cut-off for increased age-adjusted risk for cardiovascular complications reported in the normal Japanese population. After 24 weeks of GH treatment, the change in percentage trunk FM was -3.4 +/- 0.6%, versus 0.4 +/- 0.6% with placebo (p < 0.001). Change in total body FM was -2.8 +/- 0.5% with GH and 0.0 +/- 0.5% with placebo, indicating that the decrease in trunk fat was more pronounced than for total body fat. Total and low density lipoprotein (LDL)-cholesterol were both significantly (p < 0.001) decreased compared with placebo. One patient discontinued due to a subdural haematoma and one had GH dose reduced due to hyperglycaemia.

CONCLUSIONS

Japanese patients with GHD have abnormal central fat accumulation, which is reduced by GH treatment over 24 weeks. This may reduce cardiovascular risk but the GH dose should be individualised to maintain IGF-I in the normal range.

A longitudinal study of the influence of smoking on the onset of obesity at a telecommunications company in Japan

OBJECTIVE

To clarify the influence of smoking on the onset of obesity. METHODS.: A 5-year follow-up study was carried out on 25,312 workers at the time of their annual health check-up from 1992 to 1997. Pooled logistic regression analyses by sex were performed with age, working conditions and lifestyle as independent variables and the onset of obesity (BMI> or =26.4) as a dependent variable adjusted for the time period.

RESULTS

In males, the following factors increased the risk of the onset of obesity: smoking equal to or more than 20 cigarettes per day (versus nonsmokers), monthly holidays fewer than 5 days (versus >7 days), one-way commute more than 90 min (versus< or =60 min), sleeping less than 5 h, moderate and high preference for fatty meals (versus little preference). In females, 30-39 years, 40-49 years and 50-59 years (versus 20-29 years), being an ex-smoker, smoking fewer than 20 cigarettes per day, smoking equal to or more than 20 cigarettes per day (versus nonsmokers, respectively) and high preference for fatty meals (versus little preference) increased the risk of the onset of obesity.

CONCLUSION

This study revealed that smoking independently increases the risk of the onset of obesity regardless of sex.

Visceral fat obesity contributes to the tortuosity of the thoracic aorta on chest radiograph in poststroke Japanese patients

Tortuosity of the thoracic aorta on chest radiographs is characteristic of atherosclerotic disease. Aging and hypertension are associated with the tortuosity, but little is known about the influence of other atherosclerotic risk factors on this abnormality. The purpose of this study was to examine which atherosclerotic risk factors are determinants for tortuosity of the thoracic aorta. Forty-five poststroke Japanese patients (31 men and 14 women, age range 41-78 years and mean 60.5+/-8.6) were studied. The distance factor, ie, the ratio of meandering vessel length to the straight-line distance between its end points, was used to measure arterial tortuosity. The hospital records were reviewed for clinical and biochemical variables. Tortuosity of the thoracic aorta had a significant positive relationship with body mass index (BMI) (r = 0.397, p < 0.01), waist circumference (r = 0.360, p < 0.05), and the cardiothoracic ratio (CTR) (r = 0.526, p < 0.001), and a significant negative relationship with ankle-brachial pressure index (ABPI) (r = -0.360, p < 0.05). Stepwise regression analysis showed that waist circumference and CTR were independently correlated with increased tortuosity, whereas ABPI was negatively correlated with it. These results suggest that visceral fat obesity is a novel contributor to tortuosity of the thoracic aorta, which may be as shortening of the distance between aortic tethering points due to elevation of the diaphragm by excessive intraabdominal fat and as a consequence of aortic elongation due to arteriosclerosis caused by obesity-related metabolic disorders.