掲載種別：研究論文（学術雑誌）  

DOI： 10.18332/tid/175632

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction An elevated ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) not only independently affects aging-related health but also plays a critical role in mortality. However, there is limited predictive data on all-cause mortality, particularly in the context of community-dwelling individuals in Japan. This study examined the association between the AST/ALT ratio and survival prognosis in a cohort study using two follow-up studies based on 19-year and 7-year intervals. Methods The study included 1,573 male (63 ± 14 years; range, 20-90 years) and 1,980 female participants (65 ± 12 years; range, 19-89 years). The participants were those involved in a Nomura cohort study conducted in 2002 (first cohort) and 2014 (second cohort) that continued to participate throughout the follow-up periods (follow-up rates were 90.3% and 97.4% for each cohort). A Cox proportional hazards model was adopted to calculate the multivariate-adjusted hazard ratios (HRs) of death from the baseline health check-up to the follow-up periods while controlling for potential confounding factors. Results The follow-up survey revealed that there were 473 male deaths (30.1% of total male participants) and 432 female deaths (21.8% of total female participants). The univariate Cox regression analysis showed that HRs for all-cause mortality were greater for participants in higher AST/ALT ratio quartiles (p < 0.001). The multivariate Cox regression analysis with adjusted variables showed a significant association between those in the fourth AST/ALT ratio quartile (HR: 1.83, 95% confidence interval, 1.46-2.29) and the risk of all-cause mortality. This association holds irrespective of gender, age, and elevated gamma-glutamyl transpeptidase, particularly in the case of participants with a body mass index < 25 kg/m2 without a history of cardiovascular disease or diabetes. Conclusions Our results reveal that an elevated AST/ALT ratio is an independent factor that can predict the risk of all-cause mortality among community-dwelling individuals.

DOI： 10.7759/cureus.52224

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Smoking status is known to be an independent and significant predictor of health outcomes related to aging and plays a crucial role in overall mortality rates. This cohort study investigated the relationship between smoking status and survival outcomes over follow-up periods of 9 and 21 years. Methods: The sample consisted of 3526 participants with a mean age of 64 ± 12 years, 44.1% of whom were male. The median follow-up duration was 6315 days, with an interquartile range of 3441 to 7727 days. Smoking status [i.e., Brinkmann index (BI)] was calculated by multiplying the number of years smoked by the number of cigarettes smoked daily. Based on this, participants were categorized into non-smokers, former smokers, and current smokers. The data were analyzed using Cox regression, employing age as the time variable and accounting for various risk factors. Results: A total of 1111 participants (49.2%) were confirmed to have died. Among these, 564 were male (36.2% of all male participants), and 547 were female (27.8% of all female participants). The multivariate-adjusted odds ratio (95% confidence interval) for all-cause mortality compared with never-smokers was 1.51 (1.17-1.96) for former smokers with BI > 800, 1.61 (1.20-2.17) for current smokers with BI of 400-799 and 1.62 (95% CI, 1.24-2.10) with BI of ≥800 (P for trend <0.001). Participants who died within three years of follow-up were excluded to avoid the possibility of reverse causation, but the results were essentially unchanged. Conclusion: We found that the BI is a valid predictor of future mortality risk and that BI 800 for former smokers and BI 400 for current smokers were useful cutoff values. Efforts to control smoking should focus not only on current smokers but also on former smokers to reduce the risk of premature death associated with smoking.

DOI： 10.1177/1179173X241275881

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Rural career preference is known to be affected by rural self-efficacy. This study aims to explore whether the presence of a physician role model and having a medical department of interest influence rural self-efficacy among medical students. The study sample comprised 813 students (464 male and 349 female). We assessed rural self-efficacy using a validated scale that comprised 15 questions. The effect of the presence of a physician role model and the choice of medical department on rural self-efficacy score was examined. Multivariable-adjusted regression analysis showed that the presence of a physician role model was significantly associated with the rural self-efficacy score (β = 0.236, p < 0.001), as were gender (β = -0.096, p = 0.004), admission while living in hometown (β = 0.077, p = 0.041), receiving a scholarship for regional duty (β = 0.079, p = 0.025), admission based on school recommendation (β = 0.077, p = 0.031), and subjective difficulty with living in a rural area (β = -0.201, p < 0.001). Moreover, a higher rural self-efficacy score was significantly associated with students who listed general medicine/family medicine (β = 0.204, p < 0.001), pediatrics (β = 0.098, p = 0.004), or obstetrics and gynecology (β = 0.108, p = 0.002) as their department of choice, while anesthesiology (β = -0.075, p = 0.023) was significantly associated with a lower rural self-efficacy score. These relationships were consistent for both males and females. The presence of a physician role model and the choice of medical department are important factors for higher rural self-efficacy scores.

DOI： 10.7759/cureus.46174

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記述言語：日本語   出版者・発行元：(一社)日本医学教育学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Many of the existing research studies have shown that serum uric acid (SUA) is a predictor of renal disease progression. More recently, studies have suggested an association between renal function-normalized SUA and all-cause mortality in adults. This study aims to examine the association between the ratio of SUA to creatinine (SUA/Cr) and all-cause mortality with a focus on hypertensive patients. METHODS: This study is based on 2,017 participants, of whom 916 were male (mean age, 67 ± 11 years) and 1,101 were female (mean age, 69 ± 9 years). All participants were part of the Nomura Cohort Study in 2002 (cohort 1) and 2014 (cohort 2), as well as the follow-up period (2002 follow-up rate, 94.8%; 2014 follow-up rate, 98.0%). We obtained adjusted relative risk estimates for all-cause mortality from a basic resident register. In addition, we employed a Cox proportional hazards model and adjusted it for possible confounders to determine the hazard ratio (HR) and 95% confidence interval (CI). RESULTS: Of the total participants, 639 (31.7%) were deceased; of these, 327 (35.7%) were male and 312 (28.3%) were female. We found an independent association between a higher ratio of SUA/Cr and a higher risk of all-cause mortality in female participants only (HR, 1.10; 95% CI, 1.02-1.18). The multivariable-adjusted HRs (95% CI) for all-cause mortality across quintiles of baseline SUA/Cr were 1.28 (0.91-1.80), 1.00, 1.38 (0.95-1.98), 1.37 (0.94-2.00), and 1.57 (1.03-2.40) for male participants, and 0.92 (0.64-1.33), 1.00, 1.04 (0.72-1.50), 1.56 (1.06-2.30), and 1.59 (1.06-2.38) for female participants. When the data were further stratified on the basis of age (< 65 or ≥ 65 years), body mass index (< 22.0 or ≥ 22.0 kg/m2), estimated glomerular filtration rate (< 60 or ≥ 60 mL/min/1.73 m2), and presence of SUA-lowering medication, trends similar to those of the full population were found in all groups. CONCLUSION: Baseline SUA/Cr is independently and significantly associated with future all-cause mortality among hypertensive patients.

DOI： 10.1186/s40885-023-00235-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Uric acid is both a pro-oxidant and an antioxidant. This study examined whether serum uric acid (SUA) is associated with all-cause mortality and cardiovascular biomarkers in members of the general population who had varying levels of handgrip strength (HGS). METHODS: The analysis is based on 1736 participants, of whom 785 were male (69 ± 11 years old) and 951 were female (69 ± 9 years old). We obtained adjusted relative risk estimates for all-cause mortality from the Japanese Basic Resident Registry and used a Cox proportional hazards model (adjusted for possible confounders) to determine the hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: The results indicated a significant interaction between the effects of SUA levels and HGS on all-cause mortality risk. Among participants with low HGS (<30.0 kg in males, <20.0 kg in females), low SUA levels (<3.5 mg/dL in males, <3.0 mg/dL in females; HR: 2.40; 95% CI: 1.07-5.40) and high SUA levels (≥8.0 mg/dL in males, ≥7.0 mg/dL in females; HR: 3.05; 95% CI: 1.41-6.59) were associated with a significantly higher HR for all-cause mortality than medium SUA levels (3.5-7.9 mg/dL in males, 3.0-6.9 mg/dL in females). Among participants with high HGS (≥30.0 kg in males; ≥20.0 kg in females), there was no difference between the HR for all-cause mortality between the three SUA-category groups. CONCLUSIONS: The association between SUA and the risk of all-cause mortality was U-shaped for this population of community-dwelling adults. This was primarily true for those with low HGS.

DOI： 10.1016/j.metop.2022.100227

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There is limited research on the association between longitudinal variability in serum uric acid (SUA) and all-cause mortality in the general population, although recent studies have suggested that changes in SUA are associated with all-cause mortality in adults. This study aims to examine the association between percentage change in SUA (%dSUA = 100 × (cohort 2 SUA - cohort 1 SUA)/(time × cohort 1 SUA) and all-cause mortality. This study is based on 1,301 participants, of whom 543 were male (63 ± 11 years) and 758 were female (63 ± 9 years). We obtained adjusted relative risk estimates for all-cause mortality and used a Cox proportional hazards model, adjusted for possible confounders, to determine the hazard ratio (HR) and 95% confidence interval (CI) of %dSUA. Of all the participants, 79 (6.1%) were deceased, and of these, 45 were male (8.3%) and 34 were female (4.5%). The multivariable-adjusted HRs (95% CI) for all-cause mortality for the first, second to fourth (reference), and fifth %dSUA quintiles were 3.79 (1.67-8.48), 1.00, and 0.87 (0.29-2.61) for male participants and 4.00 (1.43-11.2), 1.00, and 1.19 (0.46-3.05) for female participants, respectively. Participants with a body mass index of <22 kg/m2 had a significantly higher HR, forming a U-shaped curve for the first (HR, 7.59; 95% CI, 2.13-27.0) and fifth quintiles (HR, 2.93; 95% CI, 1.05-8.18) relative to the reference. Percentage change in SUA is independently and significantly associated with future all-cause mortality among community-dwelling persons.

DOI： 10.1155/2023/7382320

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Anthropometric evaluation is a simple yet essential indicator of muscle and fat mass when studying life prognosis in aging. This study aimed to investigate the contributions of anthropometric measurements, independent of body mass index, to measures of all-cause mortality. We examined data for 1,704 participants from the 2014 Nomura Cohort Study who attended follow-ups for the subsequent eight years (follow-up rate: 93.0%). Of these, 765 were male (aged 69 ± 11 years) and 939 were female (aged 69 ± 9 years). The Japanese Basic Resident Registry provided data on adjusted relative hazards for all-cause mortality. The data were subjected to a Cox regression analysis, wherein the time variable was age and the risk factors were gender, age, anthropometric index, smoking habits, drinking habits, exercise habits, cardiovascular history, hypertension, lipid levels, diabetes, renal function, and serum uric acid. Of the total number of participants, 158 (9.3%) were confirmed to have died, and of these, 92 were male (12.0% of all male participants) and 66 were female (7.0% of all female participants). The multivariable Cox regression analysis revealed that a smaller thigh-hip ratio predicted eight-year all-cause mortality in male participants, but only baseline body mass index was associated with all-cause mortality in female participants. Thigh-hip ratio is a useful predictor of death in Japanese community-dwelling men.

DOI： 10.1371/journal.pone.0292287

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Epidemiological evidence regarding the relationship between fish and fatty acid intake and carotid intima-media thickness (CIMT) has been limited and inconsistent. The current cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study. METHODS: Study subjects were 2024 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value ＞1.0 mm. RESULTS: The prevalence of carotid wall thickening was 13.0%. In men, intake of n-3 polyunsaturated fatty acids (PUFA) was independently positively related to the prevalence of carotid wall thickening, while no associations were found between intake of fish and the other fatty acids and carotid wall thickening or maximum CIMT. In women, intake levels of fish, n-3 PUFA, eicosapentaenoic acid, docosahexaenoic acid, and arachidonic acid were independently inversely associated with carotid wall thickening and intake levels of fish, n-3 PUFA, α-linolenic acid, n-6 PUFA, and linoleic acid were independently inversely associated with the maximum CIMT. No significant relationships were found between intake of total fat, saturated fatty acids, or monounsaturated fatty acids and carotid wall thickening or maximum CIMT regardless of sex. CONCLUSIONS: In women, higher intake of fish and n-3 and n-6 PUFA may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT.

DOI： 10.5551/jat.63781

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病合併症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The relationship between alanine-glyoxylate aminotransferase 2 (AGXT2) single-nucleotide polymorphisms (SNPs) and diabetes mellitus (DM) has not been investigated. Therefore, we performed a case-control study to examine this relationship. METHODS: The study subjects included 2,390 Japanese men and women aged 34 to 88 years. In total, 190 cases were defined as having a fasting plasma glucose level ≥126 mg/dL, having a glycated hemoglobin ≥6.5% or currently using diabetic medication. The 2,200 remaining participants served as control subjects. RESULTS: Compared with study subjects with the CC genotype of AGXT2 SNP rs37369, those with the TT, but not CT, genotype had a significantly increased risk of DM: the adjusted odds ratio (OR) for the TT genotype was 1.83 (95% confidence interval [CI], 1.04 to 3.47). AGXT2 SNPs rs37370 and rs180749 were not significantly associated with the risk of DM. The CTA haplotype of rs37370, rs37369 and rs180749 was significantly positively associated with the risk of DM (crude OR, 1.25; 95% CI, 1.01 to 1.56), whereas the CCA haplotype was significantly inversely related to DM (crude OR, 0.53; 95% CI, 0.27 to 0.95). The multiplicative interaction between AGXT2 SNP rs37369 and smoking status with regard to the risk of DM was not significant (p=0.32 for interaction). CONCLUSIONS: This is the first study to show significant associations between AGXT2 SNP rs37369, the CTA haplotype, and the CCA haplotype and DM. No interaction with regard to the risk of DM was observed between rs37369 and smoking.

DOI： 10.1016/j.jcjd.2022.06.004

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jcla.24445

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担当区分：筆頭著者,　最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.metop.2022.100186

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Epidemiological evidence for the relationship between education and income and carotid intima-media thickness (CIMT) has been limited and inconsistent. The present cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study. METHODS: Study subjects were 2012 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value > 1.0 mm. RESULTS: The prevalence of carotid wall thickening was 13.0%. In participants under 60 years of age (n = 703) and in those aged 60 to 69 years (n = 837), neither education nor household income was associated with carotid wall thickening or with maximum CIMT. Among those aged 70 years or older (n = 472), however, higher educational level, but not household income, was independently related to a lower prevalence of carotid wall thickening: the multivariate-adjusted odds ratio for high vs. low educational level was 0.43 (95% confidence interval 0.21-0.83, p for trend = 0.01). A significant inverse association was observed between education, but not household income, and maximum CIMT (p for trend = 0.006). CONCLUSIONS: Higher educational level may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT only in participants aged 70 years or older.

DOI： 10.1186/s12199-021-01011-6

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAIWAN SOC GERIATRIC EMERGENCY & CRITICAL CARE MEDICINE-TSGECM  

Background: The incidence of hypertension is increasing worldwide, and handgrip strength (HGS) is an easily obtainable measure of physical health and muscle function. However, there is limited data available on the relationship between HGS and hypertension among community-dwelling persons in Japan. Therefore, we performed a population-based cohort study to examine whether relative HGS, defined by HGS/body mass index (BMI) ratio, was associated with hypertension.Methods: A follow-up cohort study included 257 men aged 66 +/- 9 years and 369 women aged 67 +/- 8 years from a rural village (Nomura Cho, Seiyo City, in Ehime prefecture, Japan). Logistic regression models were used to evaluate the relative HGS as a significant predictor of hypertension.Results: The median HGS was 36.4 (interquartile range: 31.3-40.7) kg in men and 21.9 (19.8-24.7) kg in women, while the mean HGS/BMI ratio was 1.62 +/- 0.33 m(2) in men and 1.04 +/- 0.21 m(2) in women. Of the participants, 120 men (46.7%) and 137 women (37.1%) had hypertension. The prevalence of hypertension was significantly decreased in relation to an increasing baseline relative HGS only among men. After adjustment for confounding factors, the respective odds ratios (95% confidence interval) of the three tertiles of the gender-specific relative HGS for hypertension were 1.00, 0.65 (0.35-1.22), and 0.27 (0.14-0.54) in men, and 1.00, 0.71 (0.42-1.19), and 0.56 (0.33-0.95) in women.Conclusion: These results suggest that the relative HGS is significantly and negatively associated with an increased risk of hypertension in Japanese-community dwelling persons. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

DOI： 10.6890/IJGE.202107_15(3).0014

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記述言語：日本語   出版者・発行元：愛媛医学会  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Serum uric acid (SUA) is a key risk factor contributing to renal failure, a serious public health problem. However, few studies have examined whether the interactive relationship between alcohol consumption and SUA is independently associated with the estimated glomerular filtration rate (eGFR). METHODS: Our sample comprised 742 men aged 69 ± 11 years (mean ± standard deviation) and 977 women aged 69 ± 10 years from a rural area. We cross-sectionally examined the relationships between the confounding factors of alcohol consumption and SUA with renal function denoted by eGFR estimated using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations modified by a Japanese coefficient. RESULTS: In both genders, eGFR increased with a rise in alcohol consumption. This tendency was more pronounced in participants with hyperuricemia, where SUA was greater than 7.0 mg/dL in men and greater than 6.0 mg/dl in women (men: F = 41.98, p < 0.001; women: F = 41.98, p < 0.001). A multiple linear regression analysis showed that alcohol consumption (men: β = 0.112, p < 0.001; women: β = 0.060, p = 0.011) and SUA (men: β = -0.282, p < 0.001; women: β = 0.317, p < 0.001) were significantly and independently related to eGFR. Further, the interactive relationship between alcohol consumption and SUA (men: F = 6.388, p < 0.001; women: F = 5.368, p < 0.001) was a significant and independent indicator of eGFR. CONCLUSIONS: These results suggested that alcohol consumption and SUA were synergistically associated with renal dysfunction among community-dwelling persons.

DOI： 10.1002/jcla.23812

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記述言語：日本語   出版者・発行元：(一社)日本プライマリ・ケア連合学会  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: In addition to playing a critical role in cardiovascular health, muscle mass and strength independently impact aging-related health outcomes in adults. There are limited predictive data for all-cause mortality, particularly for community-dwelling persons in Japan. This study examined whether handgrip strength (HGS) and thigh circumference are related to survival prognosis based on a 6-year follow-up period. METHODS: Participants were 787 men (aged 69 ± 11 years) and 963 women (aged 69 ± 9 years) who took part in a Nomura cohort study conducted in 2014 and who continued with follow-ups for the subsequent 6 years (follow-up rate: 95.5%). We obtained adjusted relative hazards of all-cause mortality from the basic resident register. The data were subjected to a Cox regression with age as the time variable and gender, age, anthropometric index, smoking habits, drinking habits, exercise habits, cardiovascular history, blood pressure, lipid levels, diabetes, renal function, and serum uric acid as risk factors. RESULTS: Of the 1750 participants, a total of 97 (5.5%) were confirmed to have died, of which 56 were men (7.1% of all male participants), and 41 were women (4.3% of all female participants). The multivariable Cox regression analysis revealed that smaller thigh circumference and lower HGS in men were found to predict 6-year all-cause mortality, but in women only baseline HGS was associated with all-cause mortality. CONCLUSION: Thigh circumference and HGS are useful predictors of death in Japanese community-dwelling men.

DOI： 10.1007/s41999-021-00515-2

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) independently impacts aging-related health outcomes and plays a critical role in cardiovascular diseases (CVDs). However, there are limited predictive data on all-cause mortality, especially for the Japanese community population. In this study, it was examined whether LDL-C is related to survival prognosis based on 7 or 10 years of follow-up. METHODS: Participants included 1610 men (63 ± 14 years old) and 2074 women (65 ± 12 years old) who participated in the Nomura cohort study conducted in 2002 (first cohort) and 2014 (second cohort) and who continued throughout the follow-up periods (follow-up rates: 94.8 and 98.0%). Adjusted relative risk estimates were obtained for all-cause mortality using a basic resident register. The data were analyzed by a Cox regression with the time variable defined as the length between the age at the time of recruitment and that at the end of the study (the age of death or censoring), and risk factors including gender, age, body mass index (BMI), presence of diabetes, lipid levels, renal function, serum uric acid levels, blood pressure, and history of smoking, drinking, and CVD. RESULTS: Of the 3684 participants, 326 (8.8%) were confirmed to be deceased. Of these, 180 were men (11.2% of all men) and 146 were women (7.0% of all women). Lower LDL-C levels, gender (male), older age, BMI under 18.5 kg/m2, and the presence of diabetes were significant predictors for all-cause mortality. Compared with individuals with LDL-C levels of 144 mg/dL or higher, the multivariable-adjusted Hazard ratio (and 95% confidence interval) for all-cause mortality was 2.54 (1.58-4.07) for those with LDL-C levels below 70 mg/dL, 1.71 (1.15-2.54) for those with LDL-C levels between 70 mg/dL and 92 mg/dL, and 1.21 (0.87-1.68) for those with LDL-C levels between 93 mg/dL and 143 mg/dL. This association was particularly significant among participants who were male (P for interaction = 0.039) and had CKD (P for interaction = 0.015). CONCLUSIONS: There is an inverse relationship between LDL-C levels and the risk of all-cause mortality, and this association is statistically significant.

DOI： 10.1186/s12944-021-01533-6

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Digital clubbing has been regarded as an important sign in medicine. A 33-year-old woman with no history of hepatic, pulmonary, or malignant disease was referred to our hospital. She had been taking lubiprostone every day for three years for constipation. Clubbing in her upper and lower limb digits began gradually about two years ago. The results of laboratory investigations were almost normal. We suspected the clubbed digits were a side effect of lubiprostone and confirmed that the levels of urinary prostaglandin E2 (PGE2), which can cause clubbed digits, were elevated. Thus, we instructed the woman to stop taking lubiprostone and monitored this lab value. However, the value continued to rise over 2 months to 41.9 mu g/g Cr. During that time, she had been taking sennoside A B calcium instead of lubiprostone for constipation. Since sennoside A B calcium also has the effect of increasing PGE2, we ordered the discontinuation. Her urinary PGE2 to creatinine level normalized, and the clubbing improved after the discontinuation of these two medications.

DOI： 10.2169/internalmedicine.6104-20

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記述言語：英語  

A 62-year-old woman presented with a dry cough lasting 18 months. She had previously been examined by multiple doctors, but no abnormalities were observed. Several medications such as rabeprazole and inhaled corticosteroids were administered as test treatments without any improvement. Therefore, the possibility of biological disease, including acid reflux, had been mistakenly ruled out. We examined the sputum gram stain. The result showed phagocyted normal bacterial flora, suggesting aspiration. Laryngoscopy revealed edema of the arytenoid cartilage. The patient was finally diagnosed with laryngopharyngeal reflux and silent aspiration. This case suggested that the ineffectiveness of proton-pump inhibitors cannot always exclude the presence of reflux disease and the usefulness of gram stain examination to detect silent aspiration.

DOI： 10.1002/jgf2.348

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Body mass index (BMI) is a simple index of weight-to-height that is commonly used to classify people as underweight, overweight or obesity, and high BMI has been clearly linked to increased risk of illness in adults. However, few studies have examined the significance of upper normal weight as a risk factor for the development of chronic kidney disease (CKD) in the general Japanese population. METHODS: We conducted a prospective cohort study designed as part of the Nomura study. We recruited a random sample of 421 men aged 67 ± 10 (mean ± standard deviation; range 24-95) years and 565 women aged 68 ± 9 (22-84) years during their annual health examination in a single community. We examined the relationship between quartiles of baseline BMI and renal dysfunction after a 3-year evaluation based on estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations modified by the Japanese coefficient. CKD was defined as having dipstick-positive proteinuria (≥ 1 +) or a low eGFR (< 60 mL/min/1.73 m2). RESULTS: Of the 986 participants, a total of 134 (13.6%) participants, including 72 (17.1%) men and 62 (11.0%) women, received a new diagnosis of CKD during the study period, and 25 (9.7%), 19 (8.0%), 47 (19.0%), and 43 (17.8%) diagnoses were received in the BMI-1 (BMI, < 20.7 kg/m2), BMI-2 (BMI, 20.7 to 22.5 kg/m2), BMI-3 (BMI, 22.6 to 24.4 kg/m2), and BMI-4 (BMI ≥ 24.5 kg/m2) groups, respectively. Using BMI-2 as the reference group, the non-adjusted odds ratio (OR) (95% confidence interval) for CKD was 2.70 (1.53-4.75) for BMI-3 and 2.49 (1.40-4.42) for BMI-4, and the multivariable-adjusted OR was 2.52 (1.40-4.56) for BMI-3 and 2.30 (1.26-4.22) for BMI-4. CONCLUSIONS: Increased BMI from upper normal weight is strongly associated with the development of CKD in community-dwelling persons.

DOI： 10.1007/s11255-020-02501-2

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担当区分：筆頭著者   記述言語：英語  

DOI： 10.5116/ijme.5eb6.81cb

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic kidney disease (CKD) is a major public health concern. Baseline serum uric acid (SUA) levels were independently associated with incident renal dysfunction, but whether baseline and changes in SUA produce an interactive effect on renal dysfunction remains unclear. METHODS: The subjects comprised 460 men aged 68 ± 10 (mean ± standard deviation) years and 635 women aged 68 ± 9 years from a rural village. We have found participants who underwent a similar examination 3 years later, and analyzed the relationship between baseline SUA, changes in SUA, and a 3-year follow-up renal function evaluated by estimated glomerular filtration rate (eGFR). RESULTS: A total of 93 (20.2%) men and 76 (12.0%) women had hyperuricemia (men: SUA ≥ 7.0 mg/dL and women: SUA ≥ 6.0 mg/dL) at baseline. Multiple regression analysis using changes in eGFR as objective variable, adjusted for risk factors as explanatory variables, showed that the baseline SUA and changes in SUA were linearly associated with changes in eGFR (β = －0.115, P < .001 and β = －0.431, P < .001, respectively). In both normal SUA group and hyperuricemia group, changes in SUA significantly associated with changes in eGFR (β = －0.473, P < .001 and β = －0.197, P = .009, respectively). Participants with increased SUA from normal to hyperuricemia group had greater eGFR decline over the follow-up period, and their multivariate-adjusted 3-year follow-up eGFR was significantly lower than in other groups (P < .001). CONCLUSION: Our data demonstrated that baseline and longitudinal changes in SUA were independently and interactively associated with the renal function decline among community-dwelling persons.

DOI： 10.1002/jcla.23166

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担当区分：最終著者,　責任著者   記述言語：英語  

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) has been widely evaluated as a biomarker in various medical and surgical prognoses, but its usefulness in diabetic kidney disease is not yet known. METHODS: This prospective observational study included outpatients, comprised of 184 men aged 73 ± 11 (mean ± standard deviation) years and 174 women aged 76 ± 10 years at baseline, from a rural hospital. We examined the relationship between baseline NLR calculated by analyzing the differential leukocyte counts in the complete blood count and the 2-year estimated glomerular filtration rate (eGFR) decline rate (i.e. 2-year eGFR-baseline eGFR) ∗100/baseline eGFR. Rapid eGFR decline rate was defined as a value < -25%. RESULTS: Multiple linear regression analysis using rapid eGFR decline rates as objective variables, adjusted for confounding factors as explanatory variables, showed that NLR (β = 0.138, p = 0.007) as well as presence of antidyslipidemic medication, hemoglobinA1c, and urinary albumin excretion stage were significantly and independently associated with a rapid eGFR decline rate. The multivariate-adjusted odds ratios (95% confidence interval) of the 2nd and 3rd tertiles of baseline NLR for rapid eGFR decline rate were 3.62 (0.70-18.7) and 8.03 (1.54-41.9), respectively. Multivariate-adjusted mean eGFR (95% confidence interval) values after 2 years categorized by tertile of baseline NLR were: 1st, 63.9 (61.8-66.1); 2nd, 60.8 (58.7-62.9); and 3rd, 58.9 (56.8-61.0). CONCLUSIONS: These results suggest that baseline NLR might be a useful biomarker for renal function decline in outpatients with diabetes.

DOI： 10.1016/j.dsx.2020.04.029

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記述言語：日本語  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The risk associated with serum uric acid (SUA) levels when within the normal range is unknown. This study aims to examine whether SUA within the normal range is a predictor of hypertension. Methods: The subjects comprised 704 men aged 71 ± 9 (mean ± standard deviation) years and 946 women aged 70 ± 8 years recruited for a survey at the community based annual medical check-up. The main outcome was the presence of hypertension (antihypertensive medication and/or having SBP ≥140 mmHg and/or DBP ≥90 mmHg). Results: At baseline, 467 (66.3%) men and 608 (64.3%) women had hypertension. Comparing to lowest quartile in women (SUA-1, uric acid < 4.1 mg/dL), the unadjusted odds ratios (ORs) [95% confidence interval (CI)] for hypertension of SUA-2 (4.1 to 4.7 mg/dL), SUA-3 (4.8 to 5.4 mg/dL), and SUA-4 (≥5.5 mg/dL) were 1.11 (0.78-1.59), 1.75 (1.20-2.55), and 1.89 (1.30-2.77), respectively. These associations were apparent even after adjustments for age, but ORs were attenuated after adjusting for all confounding factors. During a follow-up of 3.0 years, there were 35 (24.0%) hypertension cases in men and 51 (20.8%) in women. In women only, a significant association between increased SUA categories and incidence of hypertension was observed, and the multivariate-ORs (95% (CI) for incident hypertension of SUA-3 (4.5-5.2 mg/dL) and SUA-4 (≥5.3 mg/dL) were 2.23 (0.81-6.11) and 3.84 (1.36-10.8), respectively. Conclusions: These results suggest that baseline SUA within the normal range could be an important predictor for incidence of hypertension in Japanese community-dwelling elderly women.

DOI： 10.1186/s40885-020-00155-x

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The incidence of hypertension is increasing worldwide and obesity is one of the most significant risk factors. Obesity can be defined by various anthropometric indices such as body mass index (BMI), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR). This study examined a range of anthropometric indices and their relationships with hypertension. Methods: This study included 768 men aged 70 ± 10 years and 959 women aged 70 ± 8 years from a rural village. The relationship between anthropometric indices (BMI, WHpR, and WHtR) and hypertension was examined using cross-sectional (baseline, N = 1727) and cohort data (follow-up, N = 419). Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in both genders. Logistic regression models were used to evaluate WHtR as a significant predictor of hypertension. Results: In the cross-sectional study, WHtR, BMI, and WHpR showed significant predictive abilities for hypertension in both genders, with WHtR showing the strongest predictive ability. Also, in the cohort study, WHtR showed a significant predictive ability for incident hypertension in both genders, and, for women, BMI as well as WHtR had also predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.53 (sensitivity, 44.3%; specificity, 80.2%) for men and 0.54 (sensitivity, 60.9%; specificity, 68.6%) for women. In the cohort study, the optimal WHtR values were 0.47 (sensitivity, 85.4%; specificity, 39.8%) for men and 0.51 (sensitivity, 66.7%; specificity, 58.2%) for women. Conclusions: The results suggest that WHtR is a useful screening tool for hypertension among Japanese middle-aged and elderly community-dwelling individuals.

DOI： 10.1186/s40885-020-00142-2

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Metabolic syndrome (MetS) is increasing worldwide with the continuous increase in obesity prevalence. Chronic kidney disease (CKD) is also a major public health problem, but there is controversy over whether baseline MetS is a predictor of decreased renal function among Japanese community-dwelling middle-aged and elderly Japanese. METHODS: We conducted a prospective cohort study designed as part of the Nomura study. We recruited a random sample of 410 men aged 68 ± 8 (mean ± standard deviation; range, 50-95) years and 549 women aged 69 ± 7 (50-84) years during their annual health examination in a single community. We examined the relationship between baseline MetS and renal dysfunction after a 3-year evaluation based on estimated glomerular filtration rate (eGFRCKDEPI) using the CKD-EPI equations modified by the Japan coefficient. CKD was defined as dipstick-positive proteinuria (> or = 1 +) or a low eGFRCKDEPI (< 60 mL/min/1.73 m2). RESULTS: Of the 959 participants, 413 (43.1%) had MetS at baseline. Annual eGFR decline rate was significantly greater in those with MetS than in those without MetS, and the annual eGFR decline rate of < - 1.2 mL/min/1.73 m2/year increased significantly in relation to presence of baseline MetS, especially low HDL cholesterol (HDL-C). Moreover, the incidence rate of CKD after 3 years was 13.5% and increased significantly in relation to presence of baseline MetS, especially its components such as elevated HbA1c. The multivariate-adjusted odd ratio (OR) for CKD in participants with MetS versus those without MetS was 1.55 (0.99-2.43). The multivariate-adjusted ORs for rapid annual eGFR decline rate were significantly high in patients aged ≥ 65 years and presence of medication, regardless of gender and eGFR value. CONCLUSIONS: Low HDL-C and elevated HbA1c levels correlated significantly with eGFR decline in a short period of 3 years. MetS also showed a significant association with eGFR decline. This study suggests the importance of low HDL-C and elevated HbA1c in the effect of MetS on eGFR decline rather than obesity among Japanese community-dwelling middle-aged and elderly Japanese without CKD.

DOI： 10.1007/s11255-019-02320-0

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1089/met.2018.0055

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s11255-018-02065-2

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担当区分：筆頭著者  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0216069

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担当区分：最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intraductal papillary mucinous neoplasms (IPMNs) are cystic neoplasms with the potential for progression to pancreatic cancer. Accurate prediction of the malignant potential is challenging and a proper treatment strategy has not been well established. Preoperative neutrophil-to-lymphocyte ratio (NLR) is a biomarker of the malignant potential in patients with several types of malignancy. We explored malignant potential in patients with IPMN. The present study included 56 patients aged of 73 ± 9 years (mean ± standard deviation) who underwent curative resection for IPMN from 1996 to 2017. We analyzed the relationship between the characteristics including NLR and malignant component for predicting pathological results. The nonmalignant IPMN group (N = 21) included patients with low-grade dysplasia (LGD) and intermediate-grade dysplasia (IGD), and the malignant IPMN group (N = 35) included patients with high-grade dysplasia (HGD) and invasive carcinoma. In a univariate analysis, NLR ⩾ 2.2 (P = .001), prognostic nutritional index (PNI) < 45 (P = .016), CA 19-9 > 37 U/mL (P = .039), and cystic diameter ⩾ 30 mm (P = .010), and mural nodule (P = .010) were significantly different between the malignant IPMN and the nonmalignant IPMN groups. Multivariate analysis showed that high NLR (⩾2.2) (odds ratio 9.79; 95% confidence interval: 2.06-45.6), cystic diameter ⩾ 30 mm (4.65; 1.14-18.9), and mural nodule (4.91; 1.20-20.1) were independently predictive of malignant IPMN. These results suggest that preoperative NLR is a useful predictive biomarker for evaluating malignant potential in patients with IPMN.1.

DOI： 10.1177/1177271919851505

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s40618-017-0760-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.22605/RRH4791

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer International Publishing  

Introduction: Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased serum uric acid (SUA) levels are associated with MetS and its components. However, whether baseline and changes in SUA predict incidence of MetS and its components remains unclear. Methods: The subjects comprised 407 women aged 71 ± 8 years from a rural village. We have identified participants who underwent a similar examination 11 years ago, and examined the relationship between baseline and changes in SUA, and MetS based on the modified criteria of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP) III report. Results: Of these subjects, 83 (20.4%) women at baseline and 190 (46.7%) women at follow-up had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS
both baseline and changes in SUA as well as history of cardiovascular disease, low-density lipoprotein cholesterol, and estimated glomerular filtration ratio (eGFR) were independently and significantly associated with the number of MetS components during an 11-year follow-up. The adjusted odds ratios (ORs) (95% confidence interval) for incident MetS across tertiles of baseline SUA and changes in SUA were 1.00, 1.47 (0.82–2.65), and 3.11 (1.66–5.83), and 1.00, 1.88 (1.03–3.40), and 2.49 (1.38–4.47), respectively. In addition, the combined effect between increased baseline and changes in SUA was also a significant and independent determinant for the accumulation of MetS components (F = 20.29, p &lt
0.001). The ORs for incident MetS were significant only in subjects with age ≥ 55 years, decline in eGFR, and no baseline MetS. Conclusions: These results suggested that combined assessment of baseline and changes in SUA levels provides increased information for incident MetS, independent of other confounding factors in community-dwelling women.

DOI： 10.1007/s40618-017-0822-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Nature  

Background: Few data is available on the association between body mass index (BMI), serum uric acid (SUA) levels and blood pressure (BP) categories in the disease continuum, when efforts for its prevention may be applicable. Methods: We performed a cross-sectional study to examine the association between BMI, SUA and BP in a community-dwelling sample of Japanese men. Individuals not on antihypertensive and uric acid lowering medications, and aged 50 to 90 years [817men aged 66 ± 9 (mean ± standard deviation) years] were recruited for the survey during a community based annual medical check-up. The main outcome was the presence of prehypertension [systolic BP (SBP) 120-139 mmHg and/or diastolic BP (DBP) 80-89 mmHg] and hypertension [SBP ≥ 140 and /or DBP ≥ 90]. Results: In participants with a BMI of < 21.0 kg/m2, increased SUA levels were positively associated with SBP and DBP, but in those with a BMI of ≥ 21.0 kg/m2, increased SUA levels were negatively associated with SBP and DBP. The interaction between BMI and SUA as well as BMI and SUA was a significant and independent determinant for both SBP (β = - 1.125, p = 0.001) and DBP (β = - 0.995, p = 0.005). Among participants, the respective prevalence of normotension, prehypertension, and hypertension was 19.5% and 53.7%, and 19.8%. The prevalence of normotension and prehypertension decreased with increasing BMI and the prevalence of hypertension increased with increasing BMI. In participants with a BMI ≥ 21.0 kg/m2, the adjusted-odds ratio of SUA for hypertension was 0.75 (95% CI, 0.59-0.95) compared with normotension and 0.82 (0.70-0.96) compared with prehypertension. In those with a BMI of < 21.0 kg/m2, these associations were not shown. Conclusion: BMI may modify the association between SUA and blood pressure status among community-dwelling men.

DOI： 10.1186/s40885-018-0087-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier (Singapore) Pte Ltd  

Background: Alcohol consumption is an important lifestyle factor for a variety of health problems, we investigated whether alcohol consumption is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling persons. Methods: The present study included 764 men aged 70 (69–70) years and 955 women aged 70 (69–70) years from a rural village. Daily alcohol consumption was measured using the Japanese liquor unit in which a unit corresponds to 22.9 g of ethanol, and the participants were classified into never drinkers, occasional drinkers, daily light drinkers (1–2 units/day), and daily moderate drinkers (2–3 units/day). Results: HGS were significantly correlated with age in both men and women. HGS increased significantly with increased daily alcohol consumption in both genders, and in men HGS in daily moderate drinkers were significantly greater than those in never, occasional, and daily light drinkers. In women, HGS in daily light and moderate drinkers were significantly greater than those in never drinkers. In men, Multivariate-adjusted HGS were significantly greater in daily light {mean: 33.4 (95% confidence interval: 32.3–34.5) kg} and moderate drinkers {33.6 (32.8–34.0) kg} than in never drinkers {31.7 (30.8–32.7) kg}, and in women multivariate-adjusted HGS in occasional drinkers {21.5 (21.0–22.1) kg} was significantly greater in never drinkers {20.7 (20.5–21.0) kg}. Conclusion: These results suggest that alcohol consumption may have a protective role in aging-associated decline in muscle strength in community-dwelling persons.

DOI： 10.1016/j.ijge.2018.03.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Elevated serum uric acid (SUA) levels are associated with glucose control. However, whether baseline and changes in SUA predict long-term follow-up glucose control [e.g., glycated hemoglobin (HbA1c)] remains unclear. Methods: The subjects comprised 393 women aged 71 ± 8 years and 279 men aged 71 ± 10 years from a rural village. We have identified participants who underwent a similar examination 11 years prior, and subjects were divided into four groups based on the tertiles of baseline and changes in SUA, and examined the relationship between baseline and changes in SUA, and glucose control evaluated by follow-up HbA1c after 11-years. Results: In both genders, follow-up SUA were significantly higher in Group 4 (i.e., women: Group 4, baseline SUA ≥ 4.0 mg/dL and changes in SUA ≥ 0.8 mg/dL; men: Group 4, ≥ 5.3 mg/dL and ≥ 0.4 mg/dL) than in the other Groups, but eGFR was significantly lower. Only in women, there were significant differences among the four groups regarding follow-up HbA1c, and follow-up HbA1c was highest in Group 4. In addition, the interaction between baseline and changes in SUA (F = 5.391, p = 0.021) as well as baseline low-density lipoprotein cholesterol (LDL-C) (F = 13.793, p < 0.001), estimated glomerular filtration ratio (F = 10.715, p = 0.001), HbA1c (F = 118.285, p < 0.001), SUA (F = 9.457, p = 0.002), and changes in SUA (F = 7.757, p = 0.006) was a significant and independent determinant of follow-up HbA1c. Multivariate-adjusted follow-up HbA1c (p = 0.002) were significantly higher in Group 4 than the other groups. Conclusions: These results suggested that combined assessment of baseline and changes in SUA provides increased information for long-term predictive glucose control, independent of other confounding factors in community-dwelling women.

DOI： 10.1186/s13098-018-0356-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

BACKGROUND: Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Alanine aminotransferase (ALT) at high levels and total bilirubin (T-BiL) at low levels were oxidative potentials, but it was uncertain whether ALT and T-BiL had an additive interaction for the risk of MetS. METHODS: From a single community, we recruited 864 women (70 ± 8 years) during their annual health examination. We cross-sectionally investigated whether ALT and T-BiL are associated with MetS and its components based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report. RESULTS: Of these subjects, 415 women (48.0%) had MetS. Participants with MetS had a higher ALT and lower T-BiL level than those without MetS. The adjusted-odds ratios (OR) (95% confidence interval [CI]) for MetS across tertiles of ALT and T-BiL were 1.00, 1.19 (0.78-1.81), and 1.86 (1.24-2.80) and 1.00, 0.96 (0.65-1.43), and 0.54 (0.36-0.81), respectively. When ALT and T-BiL were categorized into three binary characteristics by tertiles of ALT and T-BiL, high T-BiL was associated with decreased risk for MetS in a multivariable model (OR: 0.55, 95% CI: 0.37-0.82), especially among those with 1st tertile ALT. Similarly, high ALT was also associated with increased risk for MetS in a multivariate model (OR: 1.81, 95% CI: 1.20-2.71), especially among those with 2nd & 3rd tertiles of T-BiL. In the formal testing of addictive interaction between ALT and T-BiL for MetS, presence of T-BiL <0.72 mg/dL (1st and 2nd tertile) alone was not associated with increased risk of MetS in a multivariate analysis, and presence of ALT ≥16 IU/L (2nd and 3rd tertile) alone was not associated with increased risk of MetS. CONCLUSIONS: These results suggested that higher ALT and lower T-BiL levels were synergistically associated with MetS, independent of other confounding factors among Japanese women.

DOI： 10.1089/met.2017.0064

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

PURPOSE: Chronic kidney disease is a major public health concern. Serum uric acid (SUA) at high levels was oxidative stress agents, and total bilirubin (T-BiL) at mildly increased levels was potent antioxidants, but whether SUA and T-BiL produce an additive interaction for the risk of renal dysfunction remains unclear. METHODS: The subjects comprised 567 men aged 71 ± 8 (mean ± standard deviation) years and 853 women aged 70 ± 8 years from a rural village. We examined the relationship between SUA and T-BiL, and renal function was evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. RESULTS: Stepwise multiple regression analysis using eGFR as an objective variable, adjusted for risk factors as explanatory variables, showed that SUA (β = -0.358, p < 0.001) as well as age (β = -0.534, p < 0.001), drinking status (β = 0.119, p < 0.001), and the presence of antihypertensive medication (β = -0.058, p = 0.005) were significantly and independently associated with eGFR, but T-BiL was not associated with eGFR. While in the group with the highest tertile of SUA, T-BiL (β = 0.081, p = 0.032) was significantly and independently associated with eGFR, and in the group with the lowest to middle tertile of SUA, T-BiL was not associated with eGFR. In addition, interaction between SUA and T-BiL (F = 8.512, p = 0.004) as well as age, drinking status, the presence of antihypertensive medication, SUA, and T-BiL was a significant and independent determinant for eGFR. CONCLUSIONS: Our data demonstrated that low T-BiL could be important as a potential risk factor for renal dysfunction in those with high SUA.

DOI： 10.1007/s11255-017-1633-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Context: We previously reported that single nucleotide polymorphism (SNP)-420 C>G (rs1862513) in the promoter region of RETN was associated with type 2 diabetes. Plasma resistin was tightly correlated with SNP-420 genotypes. SNP-420 is a CpG-SNP affecting the sequence of cytosine-phosphate-guanine dinucleotides. Objective: To examine whether methylation at SNP-420 affects plasma resistin, we analyzed plasma resistin and methylation at RETN SNP-420. Design and Methods: Genomic DNA was extracted from peripheral white blood cells in 2078 Japanese subjects. Quantification of the methylation was performed by pyrosequencing after DNA bisulfite conversion. Results: Methylation at SNP-420 was highest in the C/C genotype (36.9 ± 5.7%), followed by C/G (21.4 ± 3.5%) and G/G (2.9 ± 1.4%; P < 0.001). When assessed in each genotype, methylation at SNP-420 was inversely associated with plasma resistin in the C/C (β = -0.134, P < 0.001) or C/G (β = -0.227, P < 0.001) genotype. In THP-1 human monocytes intrinsically having the C/C genotype, a demethylating reagent, 5-aza-dC, decreased the methylation at SNP-420 and increased RETN messenger RNA. SNP+1263 (rs3745369), located in the 3' untranslated region of RETN, was also associated with methylation at SNP-420. In addition, highly sensitive C-reactive protein was inversely associated with methylation at SNP-420 in the C/C genotype, whereas body mass index was positively associated. Conclusions: Plasma resistin was inversely associated with the extent of methylation at SNP-420 mainly dependent on the SNP-420 genotype. The association can also be explained partially independent of SNP-420 genotypes. SNP-420 could have dual, genetic and epigenetic effects on plasma resistin.

DOI： 10.1210/jc.2016-2417

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications Ltd  

Abnormally high glycated hemoglobin (Hb) (HbA1c) is significantly associated with oxidative stress and an increased risk of cardiovascular disease (CVD). Serum total bilirubin (T-B) may have a beneficial role in preventing oxidative changes and be a negative risk factor of CVD. Limited information is available on whether serum T-B is an independent confounding factor of HbA1c. The study subjects were 633 men aged 70± 9 (mean ±standard deviation (SD)) years and 878 women aged 70 + 8 years who were enrolled consecutively from among patients aged ≥40 years through a community-based annual check-up process. We evaluated the relationship between various confounding factors including serum T-B and HbA1c in each gender. Multiple linear regression analysis pertaining to HbA1c showed that in men, serum T-B (β=0.139) as well as waist circumference (β = 0.099), exercise habit (β = 0.137), systolic blood pressure (SBP) (β = 0.076), triglycerides (β = 0.087), and uric acid (β=0.123) were significantly and independently associated with HbA1c, and in women, serum T-B (β=0.084) as well as body mass index (β = 0.090), smoking status (β = - 0.077), SBP (β = 0.117), diastolic blood pressure (DBP) (β = - 0.155), low-density lipoprotein cholesterol (β = 0.074), prevalence of antidyslipidemic medication (β = 0.174), and uric acid (β = 0.090) were also significantly and independently associated with HbA1c. Multivariateadjusted serum HbA1c levels were significantly high in subjects with the lowest serum T-B levels in both genders. Serum T-B is an independent confounding factor for HbA1c among community-dwelling middle-aged and elderly persons.

DOI： 10.1177/1849454417726609

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier B.V.  

Background/Purpose Oxidative stress is thought to be involved in the development of vascular dysfunction. Arterial stiffness is one of the most significant manifestations of aging and vascular disease. We investigated whether increased malondialdehyde-modified low-density lipoprotein (MDA-LDL), which is responsible for oxidative stress, was associated with increased arterial stiffness, independent of confounders of cardiovascular disease. Methods The participants comprised 10 men aged 70 ± 7 years (range, 61–82 years) and 86 women aged 67 ± 7 years (range, 53–81 years). Peripheral arterial stiffness was evaluated by the mean of the right and left brachial to ankle pulse wave velocity (baPWV). Results and conclusion Both right and left baPWV values of Tertile-2 (61–81 U/L) and Tertile-3 (82–218 U/L) categorized by tertiles of the MDA-LDL level were significantly higher than those of Tertile-1 (34–60 U/L
p = 0.022 and p = 0.018, respectively). The multivariate-adjusted baPWV increased significantly from the lowest to the highest MDA-LDL group. Both baPWV values of Tertile-2 (61–81 U/L) and Tertile-3 (82–218 U/L) were significantly higher than those of Tertile-1 (34–60 U/L) (p = 0.044 and p = 0.044, respectively). To further investigate whether MDA-LDL can explain baPWV levels independent of other known confounding factors, multiple linear regression analyses for baPWV were conducted, which showed that MDA-LDL levels (β = 0.164, p = 0.037) were independently and significantly associated with baPWV as well as gender, age, and presence of raised blood pressure. In addition, we found that a slightly high–normal MDA-LDL level within a normal range is significantly associated with a higher baPWV. MDA-LDL levels are associated with an increased risk of arterial stiffness in community-dwelling persons.

DOI： 10.1016/j.jcgg.2016.05.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Physiological Society  

Resistin is a cytokine inducing insulin resistance in mice. We previously identified single nucleotide polymorphisms (SNPs) at -420 (rs1862513) and -358 (rs3219175) located in the human resistin gene (RETN) promoter as strong determinants for circulating resistin in the Japanese population. The objective was to identify additional functional variants for circulating resistin. We conducted a genome-wide association study in 448 Japanese subjects. A peak association signal was found on chromosome 19 where RETN is located. The top-hit SNP was SNP -358 G&gt
A, followed by rs1423096 C&gt
T, SNP -420 C&gt
G, and rs10401670 C&gt
T (P = 5.39�10-47, 1.81�10-22, 2.09�10-16, and 9.25�10-15, respectively). Meta-analysis including another two independent general Japanese populations showed that circulating resistin was most strongly associated with SNP-358, followed by SNP-420, rs1423096, and rs10401670. Rs1423096 and rs10401670 were located in the 3′-region of RETN and were in strong linkage disequilibrium. Although these SNPs were also in linkage disequilibrium with the promoter SNPs, conditional and haplotype association analyses identified rs1423096 and rs10401670 as independent determinants for circulating resistin. Functionally, nuclear proteins specifically recognized T but not C at rs10401670 as evidenced by an electrophoretic mobility shift assay. The promoter activity of a luciferase reporter with T at either rs1423096 or rs10401670 was lower than that with C in THP-1 human monocytes. Therefore, rs1423096 and rs10401670, in addition to SNP-420 and SNP-358, were identified as possible functional variants affecting circulating resistin by the genome-wide search in the Japanese population.

DOI： 10.1152/physiolgenomics.00040.2016

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

BACKGROUND: In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students. METHODS: A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18-34) years and 227 men aged 22 ± 4 (range, 18-44) years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons). RESULTS: Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR) of "technical & research specialty" and a low OR for "personal reasons" were associated with preference for surgery. "Technical & research specialty" was positively associated with preference for special internal medicine and negatively for pediatrics. "Work-life balance" was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, "technical & research specialty" was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and "job security" was positively associated for general medicine/family medicine and negatively for psychology. Among men only, "educational experience" and "personal reasons" were positively, and "job security" was negatively associated with preference for pediatrics. For both genders, "work-life balance" was positively associated with preference for controllable lifestyle specialties. CONCLUSION: We must acknowledge that Japanese medical students have dichotomized some motivations for their specialty preference based on gender. Systematic improvements in the working environment are necessary to solve these issues.

DOI： 10.1186/s12909-016-0811-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Handgrip strength (HGS) is a useful measure of health-related quality of life and general muscle strength. Serum total bilirubin (T-B) may present potential beneficial effects in preventing oxidative changes which are associated with a risk of metabolic syndrome and the development of cardiovascular disease. Limited information is available regarding whether HGS is an independent confounding factor for serum T-B. The study participants were 214 men aged 71 ± 8 (mean ± standard deviation) years and 302 women aged 71 ± 7 years that were enrolled consecutively from among paticipants aged ≥ 50 years through an annual check-up process. We evaluated the relationship between serum T-B and confounding factors within each sex. HGS related significantly with serum T-B in both men (r = 0.156, p = 0.023) and women (r = 0.173, p = 0.003). Multiple linear regression analysis showed that in men, HGS (β = 0.173) as well as smoking status (β = -0.147), exercise habit (β = 0.138), low-density lipoprotein cholesterol (β = 0.146), and hemoglobin A1c (HbA1c) (β = -0.198) were significantly and independently associated with serum T-B. In women, HGS (β = 0.159) as well as smoking status (β = -0.116), high-density lipoprotein cholesterol (β = 0.159), and HbA1c (β = -0.161) were significantly and independently associated with serum T-B. Multivariate-adjusted serum T-B levels were significantly lower in subjects with the lowest HGS level in both sexes. Increased HGS is strongly associated with increased serum T-B, independent of confounding factors in both sexes.

DOI： 10.1620/tjem.240.221

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS INC  

Introduction: Serum uric acid (SUA) and triglyceride (TG) levels are strongly correlated with insulin resistance; however, the association after a walking exercise program in community-dwelling older women has not been investigated. Methods: The present study included 100 postmenopausal women (mean +/- standard deviation, 68 +/- 7 years) from a rural village in Japan. The Nordic walking program of 120 min per week was performed for 12 weeks. Before and after the intervention, SUA, TG, various relevant factors and homeostasis model assessment of insulin resistance (HOMA-IR) were measured. Results and conclusions: Multivariate linear regression analysis showed that baseline TG and -glutamyltransferase (GGT) were significantly associated with baseline HOMA-IR. After the 12-week training program, changes in TG, SUA and GGT were significantly associated with changes in HOMA-IR. In addition to their direct associations, we observed a synergistic association between changes in TG and SUA and changes in HOMA-IR. Participants were divided into three groups (tertiles) according to changes in TG and SUA. The tertiles of changes in SUA correlated significantly with changes in HOMA-IR in participants in the tertile with the greatest decrease in TG (r = 0.525, p = 0.001), but not in the other two tertiles of change in TG (r = 0.049, p = 0.699). There was a significant interaction between SUA and TG for changes in HOMA-IR ( = 0.281, p = 0.005). These results suggest that changes in TG and SUA are synergistic factors associated with changes in insulin resistance after a 12-week walking exercise program in community-dwelling older women.

DOI： 10.3109/07435800.2015.1094085

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Serum uric acid (UA) has strong anti-oxidant properties. Muscle strength and mass decrease with age, and recently, this decrease has been defined as sarcopenia. Sarcopenia may be triggered by oxidative stress. We investigated whether serum UA is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling elderly persons. The present study included 602 men aged 72 +/- 7 years and 847 women aged 71 +/- 6 years from a rural village. We examined the cross-sectional relationship between serum UA and HGS. In both genders, HGS increased significantly with increased serum UA levels. A multiple linear regression analysis using HGS as an objective variable and various confounding factors as explanatory variables showed that in men age, drinking status, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and estimated glomerular filtration ratio (eGFR(CKDEPI)) were independently and significantly associated with HGS, and in women, serum UA as well as age, body mass index, drinking status, diastolic blood pressure, and eGFR(CKDEPI) were independently and significantly associated with HGS. In women, age and multivariate-adjusted HGS were significantly higher in the Quartile-3 (4.8-5.4 mg/dL) and Quartile-4 groups (5.5-9.3 mg/dL) of serum UA than in the lower groups (0.7-4.7 mg/dL). These results suggest that serum UA may have a protective role in aging-associated decline in muscle strength in community-dwelling elderly women.

DOI： 10.1371/journal.pone.0151044

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS INC  

The association of low muscle strength with cardio-metabolic risks remains controversial. The present study included 742 men aged 70 +/- 9 years and 937 women aged 70 +/- 8 years from a rural village. We examined the cross-sectional relationship between relative muscle strength defined by handgrip strength (HGS)/body weight (BW) ratio, and metabolic syndrome (MetS) based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report and its components. Of these, 203 men (27.4%) and 448 women (47.8%) had MetS. In men, increasing quartile of HGS/BW ratio was significantly and independently associated with high waist circumference {odds ratio, 0.31; 95% confidence interval (CI), 0.24-0.41} and elevated triglyceridemia (0.71, 0.59-0.86). In women, it was also significantly and independently associated with high waist circumference (0.41; 0.36-0.48), high blood pressure (0.78; 0.66-0.92), Low HDL-cholesterolemia (0.84; 0.73-0.98) and elevated triglyceridemia (0.65; 0.53-0.79). In both genders, the prevalence of MetS significantly decreased in relation to increasing HGS/BW ratio. After adjustment for age, smoking status, drinking status, LDL-C, estimated glomerular filtration ratio (eGFR), and medication, the respective odds ratio (95% CI) for the quartile of HGS/BW ratio for MetS was 1.00, 0.54 (0.34-0.85), 0.32 (0.19-0.53), and 0.16 (0.09-0.29) in men, and 1.00, 0.76 (0.50-1.16), 0.33 (0.22-0.51), and 0.16 (0.10-0.25) in women. These results suggest that HGS/BW ratio was significantly and negatively associated with an increased risk of cardio-metabolic disorders in Japanese-community dwelling persons.

DOI： 10.3109/10641963.2015.1081232

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記述言語：日本語   掲載種別：研究論文（研究会，シンポジウム資料等）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS INC  

Diabetes is strongly associated with several mechanisms of tissue damage such as oxidative stress. Serum bilirubin may have a beneficial role in preventing oxidative changes in cardiovascular disease (CVD). Limited information is available on whether serum bilirubin is an independent confounding factor for carotid atherosclerosis among elderly persons with type 2 diabetes. The study subjects were 169 men aged 79 +/- 8 (mean +/- SD) years and 205 women aged 81 +/- 8 years that were enrolled consecutively from patients in the medical department. Carotid intima-media thickness (IMT) and plaque were derived via B-mode ultrasonography. Multiple linear regression analysis showed that serum total bilirubin (=-0.160) was significantly associated with carotid IMT. Compared to subjects with a serum total bilirubin of tertile-1 (0.13-0.58mg/dL), the multivariate-adjusted odds ratio (95% confidence interval) of carotid IMT 1.0mm including plaque and carotid plaque was 0.46 (0.23-0.93) and 0.32 (0.17-0.60) in the Tertile-3 group (0.87-1.93mg/dL), respectively. Next, data were further stratified by gender, age, smoking status, medication and prevalence of CVD. There were no significant differences in serum total bilirubin levels between selected subgroups. Our data demonstrated a negative association between serum total bilirubin and carotid atherosclerosis among elderly persons with type 2 diabetes.

DOI： 10.3109/10641963.2015.1060990

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS LTD  

Background: In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career.
Methods: The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables.
Results: Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (beta = 0.189, P = 0.001), 'Student preparing for the entrance exam' (beta = 0.172; P = 0.001), 'Intent for rural practice' (beta = 0.123, P = 0.016), and 'Work-life balance' (beta = 0.126, P = 0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (beta = -0.107, P = 0.037) and 'Scientific orientation' (beta = -0.125, P = 0.013).
Conclusions: Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.

DOI： 10.3402/meo.v21.29448

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Co-Action Publishing  

Background: In Japan, there is a shortage of young physicians in various specialties
the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods: The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients
biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Results: Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (β=0.189, P=0.001), 'Student preparing for the entrance exam' (β=0.172
P=0.001), 'Intent for rural practice' (β=0.123, P=0.016), and 'Work-life balance' (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (β=-0.107, P=0.037) and 'Scientific orientation' (β=-0.125, P=0.013). Conclusions: Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.

DOI： 10.3402/meo.v21.29448

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier  

Introduction Nordic walking, characterized by the use of two walking poles, is becoming increasingly popular. The aim of this study was to analyze the effects produced by a 12-week Nordic walking training program on functional abilities and metabolic profiles, specifically walk distance and insulin resistance, among elderly women. Methods The present study included 74 women (68 ± 7 years). The Nordic walking training program of 120 minutes per week was performed for 12 weeks. Before and at the end of the 12-week intervention, 6-minute walking distance (6MWD) and the homeostasis of the model assessment of insulin resistance (HOMA-IR) were measured. Results and conclusions After the 12-week Nordic walking training program, 6MWD increased significantly (p &lt
0.001). HOMA-IR improved significantly from a median (interquartile range) of 2.01 (1.31-2.59) to 1.32 (0.86-2.08) after intervention. Stepwise multiple linear regression analyses for changes in HOMA-IR showed that changes in the body mass index (BMI
β = 0.255, p = 0.019), triglycerides (TG
β = 0.266, p = 0.015), and uric acid (β = 0.279, p = 0.009) were independently and significantly associated with changes in HOMA-IR. The increased 6MWD correlated significantly with improved HOMA-IR in participants with baseline gamma-glutamyl transferase (GGT) ≥ 26 IU/L (r = -0.682, p = 0.005), but not in those with baseline GGT &lt
26 IU/L (r = -0.127, p = 0.338). Analysis of covariance showed that two regression lines in each graph were significantly different (F = 5.64, p = 0.020). These results suggest that increased 6MWD predicts improvement in insulin resistance after a 12-week Nordic walking training program in participants with elevated GGT.

DOI： 10.1016/j.jcgg.2015.03.005

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記述言語：英語   出版者・発行元：AMER DIABETES ASSOC  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HUMANA PRESS INC  

Nordic walking (NW), characterized by the use of two walking poles, has positive effects on several muscle groups. Muscle strength and mass decrease with age, and recently, this decrease is defined as sarcopenia. Sarcopenia may be triggered by oxidative stress. We investigated whether changes in the oxidative stress marker, malondialdehyde-modified low-density lipoprotein (MDA-LDL)/LDLcholesterol (LDL-C) ratio are associated with change in handgrip strength (HGS), which is a useful indicator of sarcopenia, by a 12-week NW exercise among Japanese community-dwelling persons. The present study included 65 women aged 67 +/- 7 years and 9 men aged 71 +/- 8 years from a rural village. NW exercise of 120 min per week was performed for 12 weeks. Before and at the end of the 12-week intervention, various confounding factors and HGS were measured. 12-week changes in various factors were calculated by subtracting the baseline values from the 12-week values. Changes in HGS and follow-up HGS increased progressively with decreased changes in the MDA-LDL/LDL-C ratio after the 12-week walking exercise (r = -0.32, P = 0.006 and r = -0.35, P = 0.002, respectively). Multiple linear regression analysis showed that changes in HDL-C (beta = 0.26, P = 0.019) and MDALDL/LDL-C ratio (beta = -0.32, P = 0.004) were significantly and independently associated with changes in HGS. When the data were further stratified by gender, change in the MDA-LDL/LDL-C ratio was significantly and similarly associated with change in HGS in women only. These results suggest that change in MDA-LDL/LDL-C ratio may be a predictor for HGS after a 12-week NW exercise in community-dwelling persons.

DOI： 10.1007/s12020-014-0360-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AUSTRALIAN RURAL HEALTH EDUC NETWORK  

Introduction: In Japan, the maldistribution of physicians between urban and rural areas is increasing. It is important to know the practice location expectations of future physicians.
Methods: The study was designed as a cross-sectional survey. In 2009-2013, students at a medical school in Japan completed a questionnaire containing 50 items with four-point Likert scales. The students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to state their intention to practice in a rural area.
Results: The study sample consisted of 368 students (88.2% response rate). Significant variables that were associated with a positively motivated intent for rural practice were 'presence of a role model' (odds ratio (OR), 5.42; 95% confidence interval (CI), 1.58-18.5), 'admission by school recommendation' (OR, 7.68; 95% CI, 2.14-27.6), 'growing up in a rural area' (OR, 6.16; 95% CI, 1.01-37.6), 'general medicine/family medicine as the first career choice' (OR, 5.88; 95% CI, 2.43-14.2), 'interest in the targeted population' (OR, 16.7; 95% CI, 3.97-69.9), 'memorable experience at a class or clinical rotation' (OR, 3.94; 95% CI, 3.73-416), and 'location of their medical school' (OR, 11.4; 95% CI, 2.79-46.2).
Conclusions: The present study suggests that medical schools might recruit students with characteristics associated with intention for rural practice.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Arterial stiffness represents the cumulative effects of cardiovascular risk factors, including aging, on the arterial wall, and has been found to be a surrogate marker of cardiovascular disease. However, it remains unknown whether baseline arterial stiffness is independently associated with improvement in functional abilities after exercise training. The subjects were 72 adults (9 men and 63 women) aged 67 +/- A 7 years from a rural village. Before and at the end of a 12-week Nordic walking program, 6-min walk distance (6MWD) as functional abilities, metabolic characteristics, and the mean of the right and left brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness were measured. Higher baseline mean baPWV levels correlated significantly with shorter baseline 6MWD (P &lt; 0.001), and also with the follow-up 6MWD (P &lt; 0.001) and change rate (P = 0.019) in 6MWD after the 12-week training program. Multivariate linear regression analysis was employed to evaluate the contribution of baseline mean baPWV for 6MWD parameters showing that baseline mean baPWV values were significantly and independently associated with follow-up 6MWD (beta = -0.523, P &lt; 0.001) and change rate in 6MWD (beta = -0.399, P &lt; 0.001) as well as baseline 6MWD (beta = -0.522, P &lt; 0.001), but was not associated with change after the 12-week training program. Higher baPWV, a measurement of arterial stiffness, might be a predictor of functional abilities after exercise training, independent of confounding factors, in the general population.

DOI： 10.1007/s40520-014-0262-7

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Geriatrics Society  

Aim: In Japan, the imbalance in the medical workforce has caused a deterioration of rural medicine. We explored the differences in speciality preferences and career determinant factors among students to identify keys to increase the recruitment of physi¬cians to rural areas. Methods: We conducted a survey of first- and fifth-year medical students, using a questionnaire enquiring about their specialty preference and career determinant factors. The data were analyzed with a chi-square test. Results: A higher percentage of first-year students preferred to be basic medicine scientists, while fifth-year students considered internal medicine subspecialities, obstetrics and gynecology, anesthesia, and ophthalmology to be the most desirable. The factor analysis yielded five factors responsible for these findings
high social approval of the specialty, working hours, income, advice from senior classmates and doctors, and the work environment. The percentage of students who considered rural practice as a choice for thier future plan and had an awareness of the collapse of rural medicine was lower in the fifth-year students than in the first-year students. Conclusion: To increase the medical work force in provincial areas, it is necessary to strengthen not only the medical system with regard to general medicine, but also to offer better medical education in rural areas. More information about rural practice should therefore be transmitted to medical students.

DOI： 10.3143/geriatrics.52.48

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本プライマリ・ケア連合学会  

<b>目的</b> : 近年, 高齢化が進む我が国で, 単に疾患の治療だけではなく生活の質を高めることが重要視されている. 今回, 地域在住者を対象として主観的健康感と平均3.8年後の死亡との関係を検討した.<br><b>方法</b> : 2008年度に地域在住の2657名を対象に自記式アンケート調査を郵便法にて実施し, 住民基本台帳を基に平均3.8年後の死亡との関係について検討した. 調査項目は, 死亡に関わる背景因子として, 性別, 年齢, 健康状況 (心脳血管疾患既往歴, うつ状態, 主観的幸福感, 主観的健康感) , 基本的日常生活動作 (BADL : 歩行, 食事, 排泄, 入浴, 整容, 移動を全介助から完全自立まで4段階で評価) , ライフスタイルとして老研式活動能力指標 (TMIG : 手段的自立, 知的能動性, 社会的役割) を用いた.<br><b>結果</b> : 1825名, 男性767名 (平均年齢 : 67&plusmn;13歳) , 女性1058名 (平均年齢 : 68歳&plusmn;11歳) が分析可能であり, 2008年から2012年までに91名 (5.0%) の死亡が確認された. 主観的健康感に影響する背景因子について検討したところ, 年齢, 心脳血管疾患既往歴, うつ状態, 知的能動性, 主観的幸福感が有意な関係を示した. さらに主観的健康感はロジスティック回帰分析より死亡の有意な独立説明変数であることが示された.<br><b>結論</b> : 自分の健康状態に対してどのように感じているのか, どう認識しているのかは大切であり, 物理的に目に見えないものではあるが, 予後を予測する指標の1つとして考えられる.

DOI： 10.14442/generalist.38.214

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DOI： 10.1155/2015/480418

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Serum bilirubin may have a beneficial role in preventing oxidative changes in atherosclerosis. Limited information is available on whether serum total bilirubin is an independent confounding factor for carotid atherosclerosis {for example, intima-media thickness (IMT), plaque} measured noninvasively by B-mode ultrasonography only among elderly persons. The study subjects were 325 men aged 79 +/- 8 (mean +/- standard deviation) years and 509 women aged 81 +/- 8 years that were enrolled consecutively from patients aged &gt;= 60 years in the medical department. Carotid IMT and plaque were derived via B-mode ultrasonography. Multiple linear regression analysis showed that in men age (beta=0.199, p=0.002), smoking status (beta=0.154, p=0.006), GGT (beta=-0.139, p=0.039), and GGT (beta=-0.133, p=0.022) were significantly and independently associated with carotid IMT, and in women age (beta=0.186, p&lt;0.001), systolic blood pressure (beta=0.104, p=0.046), diastolic blood pressure (beta=-0.148, p=0.004), prevalence of antihypertensive medication (beta=0.126, p=0.004), fasting plasma glucose (beta=0.135, p=0.003), GGT (beta=-0.104, p=0.032), estimated glomerular filtration rate, serum bilirubin (beta=-0.119, p=0.006), and prevalence of cardiovascular disease (CVD) (beta=0.103, p=0.017) were also independently associated with carotid IMT. The odds ratios (ORs) {95% confidence interval (CI)} of increasing serum bilirubin category were negatively associated with carotid IMT &gt;= 1.0 mm and plaque in both genders. Compared to subjects with a serum bilirubin of Quartile-1, the multivariate-OR (95% CI) of carotid plaque was 0.25 (0.11-0.57) in the Quartile-4 male group, and 0.41 (0.21-0.78) in the Quartile-2 female group, 0.51 (0.26-0.98) in the Quartile-3 female group, and 0.46 (0.24-0.89) in the Quartile-4 female group. Our data demonstrated an independently negative association between serum bilirubin and carotid atherosclerosis in both genders.

DOI： 10.1371/journal.pone.0114281

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Chronic kidney disease (CKD) is a major public health problem. However, few studies have examined the significance of serum bilirubin as a risk factor for the development of CKD in the general Japanese population. The subjects comprised 413 men (mean age: 79 +/- 9 years; (range, 60-100 years) and 637 women (mean age: 81 +/- 8 years; range, 60-106 years) who visited the medical department of Seiyo Municipal Nomura Hospital. We examined the relationship between increased serum bilirubin and renal function that was evaluated by estimated glomerular filtration rate (eGFR) using CKD-EPI equations modified by a Japanese coefficient. Stepwise multiple regression analysis with eGFR as the objective variable, and adjusted risk factors as the explanatory variables, showed that serum bilirubin (beta=0.11, P&lt;0.001) was significantly and independently associated with eGFR, in addition to gender, age, prevalence of antihypertensive medication, triglycerides, prevalence of antidiabetic medication, and serum uric acid. Compared with stages 1+2 (eGFR &gt;= 60.0 ml/min/1.73 m(2)), mean multivariate-adjusted odds ratio {95% (confidence interval (CI)} for hypobilirubinemia (first quartile, &lt;0.52 mg/dL) was 3.52 (range: 1.88-6.59). Next, to control potential confounding factors, data were further stratified by gender, age, medication (antihypertensive, antidyslipidemic, and antidiabetic agents), and prevalence of cardiovascular disease. The standardized coefficient for eGFR was significant in both groups, and there was no interaction between the groups. Our data demonstrated an independent positive association between serum bilirubin and eGFR in both genders. Low serum bilirubin level would be useful as a potential risk factor for renal function.

DOI： 10.1371/journal.pone.0115294

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Central blood pressure (BP) has been shown to strongly associate with cardiovascular disease and outcome. Recent studies have demonstrated a relationship between changes in body size by exercise training and peripheral BP; however, the effect on changes in central BP is unknown. The aim of this study was to assess whether changes in body size are independently related to changes in central BP in the elderly. The subjects were 11 men (mean age, 68 +/- 6 years) and 84 women (68 +/- 7 years) from a rural village. Before and at the end of the 12-week training program, metabolic variables, and first peak radial systolic BP (SBP1) and second peak radial SBP (SBP2) as estimates of central SBP, were obtained. Radial augmentation index (AI) was calculated as follows: ((SBP2 -diastolic BP (DBP))/(SBP1 -DBP)) x 100 (%) and we used AI corrected at heart rate 75 per min (AI@75). After the 12-week training program, weight loss correlated strongly with reduction in brachial mean arterial pressure (MAP), radial SBP1, SBP2 and AI@75. After adjusting for confounding factors, weight loss was significantly and independently associated with each reduction in brachial MAP (beta = 0.34, P = 0.001), radial SBP1 (beta = 0.31, P = 0.002), SBP2 (beta = 0.37, P &lt; 0.001) and AI@75 (b = 0.36, P = 0.001). These findings suggest that weight loss by a 12-week training program may be an effective strategy to improve central BP parameters among Japanese elderly persons.

DOI： 10.1038/hr.2014.108

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Blood levels of adiponectin, an adipocyte-secreted protein correlated with metabolic and cardiovascular risks, are highly heritable. Genome-wide association (GWA) studies for adiponectin levels have identified 14 loci harboring variants associated with blood levels of adiponectin. To identify novel adiponectin-associated loci, particularly those of importance in East Asians, we conducted a meta-analysis of GWA studies for adiponectin in 7827 individuals, followed by two stages of replications in 4298 and 5954 additional individuals. We identified a novel adiponectin-associated locus on chromosome 10 near WDR11-FGFR2 (P = 3.0 × 10-14) and provided suggestive evidence for a locus on chromosome 12 near OR8S1-LALBA (P = 1.2 × 10-7). Of the adiponectinassociated loci previously described, we confirmed the association at CDH13 (P = 6.8 × 10-165), ADIPOQ (P = 1.8 × 10-22), PEPD (P = 3.6 × 10-12), CMIP (P = 2.1 × 10-10), ZNF664 (P = 2.3 × 10-7) and GPR109A (P = 7.4 × 10-6). Conditional analysis at ADIPOQ revealed a second signal with suggestive evidence of association only after conditioning on the lead SNP (Pinitial = 0.020
Pconditional = 7.0 × 10-7). We further confirmed the independence of two pairs of closely located loci (&lt
2 Mb) on chromosome 16 at CMIP and CDH13, and on chromosome 12 at GPR109A and ZNF664. In addition, the newly identified signal near WDR11-FGFR2 exhibited evidence of association with triglycerides (P = 3.3 × 10-4), high density lipoprotein cholesterol (HDL-C, P = 4.9 × 10-4) and body mass index (BMI)-adjusted waist-hip ratio (P = 9.8 × 10-3). These findings improve our knowledge of the genetic basis of adiponectin variation, demonstrate the shared allelic architecture for adiponectin with lipids and central obesity and motivate further studies of underlying mechanisms. © The Author 2013. Published by Oxford University Press. All rights reserved.

DOI： 10.1093/hmg/ddt488

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DOI： 10.2337/dc13-1658

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

There are few data available on the association between serum uric acid (SUA) levels and blood pressure (BP) categories earlier in the disease continuum, when efforts for its prevention may be applicable. We performed a cross-sectional study to examine the association between SUA and prehypertension in a community-dwelling sample of Japanese adults. Study participants without hypertension aged 19 to 90 years [567 men aged 56 +/- 15 (mean +/- standard deviation) years and 808 women aged 58 +/- 13 years] were recruited for a survey at the community based annual medical check-up. The main outcome was the presence of prehypertension [systolic BP (SBP) 120-139 mmHg and/or diastolic BP (DBP) 80-89 mmHg]. After adjustments by gender and age, both SBP (p &lt; 0.001) and DBP (p &lt; 0.001) increased significantly and progressively with increasing SUA and triglycerides (TG) as well as body mass index, LDL cholesterol, and fasting plasma glucose (FPG). Compared to those with normotension, the multivariate-adjusted odds ratio (95% confidence interval) for participants with prehypertension was 1.15 (1.05-1.26) for SUA and 3.19 (1.66-6.14) for TG. The interaction between increased SUA and TG was a significant and independent determinant for SBP (beta = -2.474, p = 0.008), but not for DBP (beta = -0.608, p = 0.349). Higher SUA levels are associated with prehypertension in participants without hypertriglyceridemia (&lt; 150 mg/dL), but not in participants with hypertriglyceridemia (&gt;= 150 mg/dL). TG levels may modify the association between SUA and prehypertension.

DOI： 10.3109/10641963.2013.789043

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Variants in the CDH13 gene have been identified as determinants of blood levels of adiponectin, an insulin-sensitizing adipokine. However, their association with other metabolic risk factors remains unclear. We examined variants at CDH13 in relation to total and high-molecular-weight (HMW) adiponectin using data from a genome-wide association study performed in 2,434 Singaporean Chinese with replication in up to 3,290 Japanese and 1,610 Koreans. The top signal rs4783244 in CDH13 showed strong associations with total adiponectin (standardized b [b] = 20.34, 95% CI 20.38 to 20.30, P = 2.0 3 10270), HMW adiponectin (b = 20.40, 95% CI 20.43 to 20.36, P = 1.1 3 102117), and the HMW-to-total adiponectin ratio (b = 20.44, 95% CI 20.49 to 20.40, P = 3.2 3 10283). In the replication study, this single nucleotide polymorphism explained 4.1% of total and 6.5% of HMW adiponectin levels. No association was observed between rs4783244 and metabolic traits associated with insulin resistance before adjustment for HMW adiponectin levels. After adjustment for HMW adiponectin levels, the minor allele was associated with lower BMI (b = 20.15, 95% CI 20.19 to 20.11, P = 3.5 3 10214), homeostasis model assessment-insulin resistance index (b = 20.16, 95% CI 20.20 to 20.12, P = 9.2 3 10216), and triglycerides (b = 20.16, 95% CI 20.19 to 20.12, P = 1.3 3 10216) and with higher HDL (b = 0.16, 95% CI 0.12 to 0.19, P = 2.1 3 10217). CDH13 variants strongly influence plasma total and HMW adiponectin levels in East Asian populations but appear to alter adiponectin sensitivity, resulting in better metabolic health than expected based on circulating adiponectin levels. © 2013 by the American Diabetes Association.

DOI： 10.2337/db13-0129

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS LTD  

Impaired fasting glucose (IFG) in diabetes is a risk factor for arterial stiffness and cardiovascular disease (CVD), but the impact of a slightly high-normal glucose level remains controversial. We investigated whether slightly high-normal fasting plasma glucose (FPG) was independently associated with arterial stiffness in non-diabetic community-dwelling persons. We recruited 114 men aged 69 +/- 9 years (range 40-89) and 208 women aged 68 +/- 7 years (range 36-84) during their annual health examination in a single community. Arterial stiffness was evaluated by the mean of the right and left brachial-ankle pulse wave velocity (ba-PWV). Age-adjusted ba-PWV increased significantly from the lowest to the highest FPG group (p &lt; 0.001). Multiple linear regression analyses for ba-PWV revealed that FPG levels (=0.154, p &lt; 0.001) were independently and significantly associated with ba-PWV. The multivariate-adjusted ba-PWV value of the high-normal glucose group (Group 3: 95-100 mg/dL) was significantly higher than that of the lowest normal glucose group (Group 1: 52-89 mg/dL) (p=0.021), and the ba-PWV value in the IFG group (Group 4: 101-125 mg/dL) was significantly higher than those of the normal glucose groups (Group 1: &lt;90 mg/dL; Group 2: 90-94 mg/dL) (p&lt;0.001 and p=0.009, respectively). Slightly high-normal glucose levels were associated with arterial stiffness in Japanese community-dwelling persons.

DOI： 10.1177/1358863X13503192

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS INC  

Background: High sensitivity C-reactive protein (hsCRP) is an acute phase reactant and a sensitive marker of inflammation. Age and adiposity can potentially promote the production of C-reactive protein (CRP). However, only a few studies have investigated any interaction between age and adiposity on hsCRP concentrations.
Methods: We recruited 822 men (mean age, 61 +/- 14 years) and 1097 women (63 +/- 12 years) during their annual health examination from a single community. We cross-sectionally examined whether age, body mass index (BMI), and the interaction are significantly associated with hsCRP concentrations, independent of confounding factors.
Results: Multiple linear regression analyses for hsCRP showed that in men, age (=0.169, P&lt;0.001) and BMI (=0.114, P=0.004) as well as smoking status, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), uric acid, and gamma-glutamyl transferase (GGT) were significantly associated with hsCRP; and in women, age (=0.203, P&lt;0.001) and BMI (=0.225, P&lt;0.001) as well as HDL-C, fasting plasma glucose (FPG), uric acid, GGT and high-molecular weight adiponectin were significantly associated with hsCRP. In addition to their direct associations, the interaction between age and BMI was also a significant and independent determinant for hsCRP in both men (F=4.407, P=0.036) and women (F=5.487, P=0.019). In participants aged&lt;75 years, overweight (BMI 25.0kg/m(2)) persons were more likely to have a prevalence of elevated hsCRP concentrations (1.00 mg/L) compared with the normal-weight (BMI &lt;22.0kg/m(2)), but such an association was not observed in those aged 75 years.
Conclusions: Adiposity promotes low-grade systemic inflammation in community-dwelling persons aged &lt;75 years.

DOI： 10.1177/0004563212473445

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HUMANA PRESS INC  

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased uric acid (UA) levels are associated with MetS and its components. High-sensitivity C-reactive protein (hsCRP) levels are also associated with MetS, and hsCRP levels could be modulated by UA. We investigated whether combining UA and hsCRP levels are independently associated with MetS and insulin resistance in Japanese community-dwelling women. From a single community, we recruited 1,097 women (63 +/- A 12 years) during their annual health examination, and examined the cross-sectional relationship between UA, hsCRP, and MetS and insulin resistance, which was evaluated by homeostasis of minimal assessment of insulin resistance. Of these subjects, 218 women (19.9 %) had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS and insulin resistance, both UA and hsCRP as well as age and alcohol consumption, were independently and significantly associated with MetS and insulin resistance. The adjusted-odds ratios (95 % confidence interval) for MetS across tertiles of UA and hsCRP were 1.00, 1.45 (0.95-2.22), and 2.61 (1.74-3.93), and 1.00, 1.80 (1.18-2.74), and 3.23 (2.15-4.85), respectively. In addition, the combination increased UA, and hsCRP was also a significant and independent determinant for MetS and insulin resistance. In direction associations, we also observed a synergistic effect between these two molecules (F = 2.76, P = 0.027). These results suggested that combined assessment of UA and hsCRP levels provides incremental information for risk stratification of patients with MetS, independent of other confounding factors in community-dwelling women.

DOI： 10.1007/s12020-013-9912-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Serum uric acid (SUA) levels are strongly correlated with aging, gender, renal function, obesity, and metabolic abnormality; however, whether SUA has a causative role in elevated blood pressure (BP) is still a matter of debate. From a single community, we recruited 1177 eligible women (mean age, 61 +/- 13 years) during their annual health examination. All subjects were divided into two groups according to their age (participants aged &gt;= 55 years and those aged &lt;55 years). We investigated whether age and SUA are synergistically associated with BP, independent of confounding factors. Of these subjects, SUA significantly correlated with both systolic BP (SBP; r = 0.236, P&lt;0.001) and diastolic BP (DBP; r = 0.263, P&lt;0.001) in female participants aged &lt;55 years but not in those aged &gt;= 55 years. The interaction between age and SUA on BP as well as age and body mass index, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, prevalence of antidiabetic medication and SUA was a significant and independent determinant of both SBP (beta = -0.106, P = 0.011) and DBP (beta = -0.070, P = 0.003). In participants aged &lt;55 years, the multivariate-adjusted odds ratio (95% confidence interval) for hypertension was 3.03 (1.13-8.11) for the highest tertile (4.8-10.8 mg dl(-1)) of SUA compared with the lowest tertile (0.7-3.8 mg dl(-1)) but was not significant in those aged &gt;= 55 years. These results suggested that age and SUA have a synergistic effect on BP status in community-dwelling women, independent of conventional cardiovascular risk factors.

DOI： 10.1038/hr.2013.5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Serum uric acid (SUA) levels are associated with metabolic syndrome (MetS) and its components such as glucose intolerance and type 2 diabetes. It is unknown whether there are gender-specific differences regarding the relationship between SUA levels, impaired fasting glucose (IFG) and newly detected diabetes. We recruited 1,209 men aged 60 +/- 15 (range, 19-89) years and 1,636 women aged 63 +/- 12 (range, 19-89) years during their annual health examination from a single community. We investigated the association between SUA levels and six categories according to fasting plasma glucose (FPG) level {normal fasting glucose (NFG), &lt;100 mg/dL; high NFG-WHO, 100 to 109 mg/dL; IFG-WHO, 110 to 125 mg/dL; IFG-ADA, 100 to 125 mg/dL; newly detected diabetes, &gt;= 126 mg/dL; known diabetes} SUA levels were more strongly associated with the different FPG categories in women compared with men. In women, the associations remained significant for IFG-WHO (OR, 1.23, 95% CI, 1.00-1.50) and newly detected diabetes (OR, 1.33, 95% CI, 1.03-1.72) following multivariate adjustment. However, in men all the associations were not significant. Thus, there was a significant interaction between gender and SUA level for newly detected diabetes (P = 0.005). SUA levels are associated with different categories of impaired fasting glucose in participants from community-dwelling persons, particularly in women.

DOI： 10.1371/journal.pone.0065886

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hematological parameters including red blood cell (RBC) count, hematocrit (Hct), and hemoglobin (Hgb) are independently associated with insulin resistance. The aim of this study was to determine whether hematological parameters are associated with metabolic syndrome (MetS), and its components, independent of gender, body mass index (BMI) and other confounders of cardiovascular disease. A total of 692 men [60 ± 14 (mean ± standard deviation)
20-89 (range) years] and 1,004 women (63 ± 12
21-88 years) participants without diabetes were recruited from a single community at the time of their annual health examination. We examined the relationship between hematological parameters and insulin resistance assessed by Homeostasis model assessment of insulin resistance (HOMA-IR), MetS, and its components. RBC count, Hct, and Hgb were all significantly associated with measures of HOMA-IR. Multiple linear regression analyses for HOMA-IR showed that RBC count, Hct, and Hgb were all shown to be independently and significantly associated with HOMA-IR as well as gender, BMI, alcohol consumption, current smoking status, γ-glutamyltransferase, high molecular weight adiponectin, and uric acid. Inclusion of hematological parameters into the model further increased the coefficient of determination (R 2). Compared to participants with the lowest quartile of Hct, multivariate-adjusted odds ratio for insulin resistance (HOMA-IR ≥ 1.74) was 2.27 [95 % confidence interval (CI), 1.55-3.31] for the third quartile, and 3.78 (95 % CI, 2.38-5.99) for the highest quartile. Hct was significantly and strongly associated with increased HOMA-IR levels. Hematological parameters were positively associated with insulin resistance and prevalence of MetS in Japanese dwelling-community persons. © 2013 Springer Science+Business Media, LLC.

DOI： 10.1007/s12020-012-9662-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Resistin is an adipokine secreted from adipocytes in mice. We previously reported that a single nucleotide polymorphism (SNP) -420 (rs1862513) in the human resistin gene (RETN), is correlated with plasma resistin. Decorin is a multifunctional proteoglycan, and its isoform, lacking 14 amino acids from the N terminal region of mature core decorin, recently was identified as a resistin receptor in mice. To examine whether SNPs in the vicinity of the human decorin gene (DCN) are associated with plasma resistin, we cross-sectionally analyzed six tag SNPs selected around DCN in the same linkage disequilibrium block in 2,078 communitydwelling Japanese subjects. Plasma resistin was associated with the rs7139228, rs7956537, rs516115, and rs3138167 genotypes in DCN. A multiple regression analysis revealed that the genotype of rs7308752 (G/G) or rs516115 (C/C) was associated with decreased plasma resistin after adjusted for age, sex, BMI, and the RETN SNP rs1862513. The effect of rs7139228 and rs1862513 seemed to be additive without synergistic interaction. Therefore, plasma resistin was associated with some tag SNPs around DCN in the general Japanese population. The possibility that human decorin is a human resistin receptor should be pursued. © 2013 by the American Diabetes Association.

DOI： 10.2337/db12-0058

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DOI： 10.1155/2013/979481

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HUMANA PRESS INC  

The aim of this article was that high-density lipoprotein cholesterol (HDL-C) reduces blood vessel injury through its antioxidant and anti-inflammatory functions. However, the effect of HDL-C on blood pressure may be controversial. Therefore, the aim of this study was to address whether HDL-C level is associated with blood pressure, and we examined cross-sectional data from community-dwelling persons. A total of 859 men [58 +/- A 15 (mean +/- A standard deviation); 20-89 (range) (years) and 1,169 women (61 +/- A 13; 19-88 years)] participants not on medication for hypertension were recruited from a single community at the time of their annual health examination. We examined the relationship between cardiovascular risk factors and blood pressure status. Multiple linear regression analysis using systolic blood pressure (SBP) and diastolic blood pressure (DBP) as an objective variable showed that HDL-C was significantly and independently associated with both SBP (beta = 0.138), and DBP (beta = 0.144). Compared to normotensive participants with the lowest quartile of HDL-C, multivariate-adjusted odds ratio (OR) for pre-hypertension was 1.72 (1.22-2.45) for the second quartile, 1.51 (1.07-2.15) for the third quartile, and 1.52 (1.04-2.22) for the highest quartile. Moreover, compared with normotensive participants with the lowest quartile, the multivariate-adjusted ORs for hypertension were 2.37 (1.63-3.45), 2.24 (1.54-3.28), 3.15 (2.10-4.74), respectively. There were no interactions between the two groups stratified by gender, age, BMI, drinking status, TG, FPG, and medication. Therefore, we concluded that HDL-C levels were positively associated with blood pressure in Japanese dwelling-community persons.

DOI： 10.1007/s12020-012-9625-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The aim of the present study was to examine how liver markers are associated with insulin resistance in Japanese community-dwelling adults.
Methods: This cross-sectional study included 587 men aged 58 +/- 14 (mean +/- standard deviation; range, 20-89) years and 755 women aged 60 +/- 12 (range, 21-88) years. The study sample consisted of 998 (74.4%) non-obese [ body mass index (BMI) &lt; 25.0 kg/m(2)] and 344 (25.6%) overweight (BMI &gt;= 25 kg/m(2)) subjects. Insulin resistance was defined by homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5, and HOMA-IR and potential confounders were compared between the groups. Areas under the curve (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum markers.
Results: In non-obese subjects, the best marker of insulin resistance was alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio of 0.70 (95% confidence interval (CI), 0.63-0.77). In overweight subjects, AUC values for the ALT/AST ratio and ALT were 0.66 (0.59-0.72) and 0.66 (0.59-0.72), respectively. Multiple linear regression analyses for HOMA-IR showed that ALT/AST ratios were independently and significantly associated with HOMA-IR as well as other confounding factors in both non-obese and overweight subjects. The optimal cut-off point to identifying insulin resistance for these markers yielded the following values: ALT/AST ratio of &gt;= 0.82 in non-obese subjects and &gt;= 1.02 in overweight subjects. In non-obese subjects, the positive likelihood ratio was greatest for ALT/AST ratio.
Conclusions: In non-obese Japanese adults, ALT/AST ratio may be the best reliable marker of insulin resistance.

DOI： 10.1186/1475-2840-11-117

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT INC  

Background: The role of resistin in the pathophysiology of insulin resistance in human is controversial and different in men and women. Thus, the discrepancy among previous reports may be resolved by gender-specific analysis of a large number of participants.
Methods: From a single community, we recruited 746 men (mean age, 60 +/- 14 years) and 1033 women (63 +/- 12 years) during their annual health examination. We investigated whether plasma resistin levels are associated with insulin resistance evaluated by homeostasis of model assessment of insulin resistance (HOMA-IR) according to gender.
Results: Resistin levels were significantly correlated with HOMA-IR in men, but not in women. Analysis of covariance showed that two regression lines were significantly different (F = 9.941, P = 0.002). Multiple linear regression analyses for resistin showed that the resistin levels (beta = 0.124, P &lt; 0.001) were independently and significantly associated with HOMA-IR as well as body mass index (BMI), alcohol consumption, smoking status, uric acid, gamma-glutamyltransferase (GGT), and high molecular weight (HMW) adiponectin only in men and not in women. The interaction between gender and resistin level (F = 11.50, P &lt; 0.001) was also a significant and independent determinant for HOMA-IR as well as gender, BMI, alcohol consumption, smoking status, uric acid, GGT, HMW adiponectin, and resistin.
Conclusions: These results suggest that plasma resistin levels are associated with insulin resistance in older Japanese men.

DOI： 10.1089/met.2012.0032

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1089/met.2011.0078

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: Carotid intima-media thickness (IMT) is an useful surrogate marker of cardiovascular disease. Associations between uric acid (UA), metabolic syndrome (MetS) and carotid IMT have been reported, but findings regarding the relationship have been inconsistent.
Methods: A total of 1,579 Japanese elderly subjects aged &gt;= 65 years {663 men aged, 78 +/- 8 (mean +/- standard deviation) years and 916 women aged 79 +/- 8 years} were divided into 4 groups according to UA quartiles. We first investigated the association between UA concentrations and confounding factors including MetS; then, we assessed whether there is an independent association of UA with carotid IMT and atherosclerosis in participants subdivided according to gender and MetS status.
Results: Carotid IMT was significantly increased according to the quartiles of UA in both genders without MetS and women with MetS. Multivariate logistic regression analysis showed that odds ratio (OR) {95% confidence interval (CI)} in men for carotid atherosclerosis was significantly increased in the third (OR, 1.75; 95% CI, 1.02-3.02), and fourth quartiles (OR, 2.01; 95% CI, 1.12-3.60) of UA compared with that in the first quartile of UA, and the OR in women was significantly increased in the fourth quartile (OR, 2.10; 95% CI, 1.30-3.39). Similarly, the ORs were significantly associated with increasing quartiles of UA in both genders without MetS, but not necessarily increased in those with MetS.
Conclusions: UA was found to be an independent risk factor for incidence of carotid atherosclerosis in both genders without MetS.

DOI： 10.1186/1475-2840-11-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Pulse wave velocity (PWV) is a simple and noninvasive method of measuring arterial stiffness for the assessment of cardiovascular disease in high-risk populations. This association may be further confounded by hemoglobin status, which is involved in the development of atherosclerosis. We randomly recruited 120 men and 223 women aged 69 +/- 9 and 68 +/- 7 years, respectively, during their annual health examination in a single community. Arterial stiffness was evaluated by brachial-ankle PWV (baPWV). The value of baPWV was different from men and women. In men, baPWV was not related to hemoglobin levels (r = 0.013, P = .886), but in women baPWV increased significantly and progressively with increased hemoglobin levels (r = 0.276, P &lt; .001). Stepwise multiple regression analysis using the baPWV as objective variables, adjusted for confounding factors as explanatory variables, showed that only in women, hemoglobin levels (beta = 0.165, P = .001) as well as age (beta = 0.268, P &lt; .001), body mass index (BMI; beta = -0.165, P &lt; .001), systolic blood pressure (SBP; beta = 0.429, P &lt; .001), prevalence of antihypertensive (beta = 0.154, P = .002), heart rate (HR; beta = 0.108, P = .017), and antilipidemic medication (beta = 0.094, P = .036), and estimated glomerular filtration rate (eGFR; beta = -0.147, P = .003) were significantly and independently associated with baPWV. Multivariate-adjusted baPWV was significantly higher in hemoglobin groups of &gt;= 12.7 g/dL (Group-2, Group-4) than in the lowest hemoglobin group (10.0-12.6 g/dL; P = .032). A slightly low hemoglobin level was beneficially associated with arterial stiffness in community-dwelling women but not men.

DOI： 10.3109/10641963.2011.618202

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aims: Resistin, secreted from adipocytes, causes insulin resistance in mice. We previously reported that the G/G genotype of a single-nucleotide polymorphism (SNP)-420 (rs1862513) in the human resistin gene (RETN) resulted in an increase in circulating resistin and susceptibility to type 2 diabetes (T2D). Whereas PPARG Pro12Ala Pro/Pro and RETN SNP-420 G/G genotypes were synergistically associated with plasma resistin, no other trans-acting SNPs associated with circulating resistin have been reported. Methods: We cross-sectionally analyzed the association between plasma resistin and SNPs recently reported to be associated with T2D in 2,038 community-dwelling Japanese individuals. These SNPs are located around the TCF7L2, KCNJ11, IGF2BP2, CDKN2A/B, SLC30A8, CDKAL1, GCKR, HHEX, KCNQ1, WFS1, TCF2, TSPAN8, CDC123, ADAMTS9, THADA, JAZF1, PANK1, IRS1, HK1, and MTNR1B genes. The SNPs were analyzed by TaqMan assays, and plasma resistin was determined by ensyme-linked immunosorbent assay (ELISA). Results: Plasma resistin was significantly associated with rs7578597 in THADA [C/C 6. 81, C/T 8. 64 ± 5. 26, T/T 11. 54 ± 6. 54 ng/ml
P = 0. 0159, analysis of variance (ANOVA)]. Plasma resistin appeared to be higher in individuals with the THADA T/T and RETN SNP-420 G/G genotypes. A multiple regression analysis revealed that plasma resistin was also associated with THADA after adjustment for age, gender, body mass index, and SNP-420 (β = 1. 89, P = 0. 036). A nominal association between plasma resistin and rs4607103 in ADAMTS9 disappeared after multivariate adjustment. Conclusions: Circulating resistin was associated with rs7578597 in THADA in the general Japanese population. In addition to the cis-acting effect of SNP-420 in the RETN promoter, circulating resistin could be affected by other trans-acting SNPs. © 2011 The Japan Diabetes Society.

DOI： 10.1007/s13340-011-0039-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recent genomewide association studies have successfully identified several genotypes susceptible to type 2 diabetes mellitus (T2DM). However, only a few studies have investigated whether these variations confer a risk of the future development of T2DM. We conducted a longitudinal genetic epidemiological study to clarify the prognostic significance of the T2DM-associated variants. The sample population consisted of 2037 middle-aged to elderly community residents. Personal health records were obtained from a clinical database administered by the local government. Genotype risk score was calculated by the following variants, namely, KCNQ1, TCF7L2, CDKAL1, HHEX, IGF2BP2, CDKN2AB, SLC30A8, KCNJ11, PPARG, and GCKR. Susceptibility of these variants in Japanese has been confirmed by association analysis. Among the 1824 subjects who did not have T2DM at baseline, 95 cases of T2DM were newly diagnosed during the 9.4-year follow-up period. Mean genotype risk score in these subjects was significantly higher than that in the subjects who remained nondiabetic (9.5 ± 1.8 vs 9.1 ± 2.0, P =.042). Although the initial mean body mass index (24.7 ± 3.2 vs 23.0 ± 2.8, P &lt
.001) and initial glucose (106 ± 18 vs 90 ± 13, P &lt
.001) were also significantly higher in those subjects who developed T2DM, the genotype risk score remained an independent determinant of the development of T2DM even after adjustment for these parameters and possible confounding factors. Per-allele odds ratio for the development of T2DM was 1.12 (95% confidence interval, 1.00-1.25
P =.049). Type 2 diabetes mellitus-susceptible genetic variants identified by a cross-sectional genomewide association study were significantly associated with the future development of T2DM in a general population sample. © 2011 Elsevier Inc.

DOI： 10.1016/j.metabol.2011.03.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: High sensitivity C-reactive protein (hsCRP) is an acute phase reactant and a sensitive marker of inflammation. Hyperglycemia can potentially promote the production of CRP. The aim of this study was to determine whether increased fasting plasma glucose (FPG) levels are associated with elevated hsCRP concentrations by gender.
Methods: We recruited 822 men (mean age, 61 +/- 14 years) and 1,097 women (63 +/- 12 years) during their annual health examination from a single community. We cross-sectionally examined whether FPG levels are associated with hsCRP concentrations, and whether this association is independent of gender, body mass index (BMI) and other components of the metabolic syndrome.
Results: In women only, hsCRP increased significantly and progressively with increasing FPG (r = 0.169, P &lt; 0.001). The stepwise multiple linear regression analysis using hsCRP as an objective variable, adjusted for confounding factors as explanatory variables, showed that FPG as well as age, BMI, systolic blood pressure, high-density lipoprotein cholesterol (HDL-C), uric acid, and high molecular weight adiponectin were significantly associated with hsCRP in women, but not in men. There was significant gender interaction, and an increase in hsCRP levels that was greater in women with BMI = 25 kg/m(2) and higher FPG than in men.
Conclusions: These results suggested that hsCRP levels increase continuously across the FPG spectrum starting from the lowest FPG in both men and women. However, increase in hsCRP levels was greater in women than men.

DOI： 10.1186/1475-2840-10-51

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: There are few studies to demonstrate the associations between newly addressed lipid profiles and metabolic syndrome (MetS)-associated variables.
Methods: Study participants without medications for hypertension, diabetes, or dyslipidemia {614 men aged 58 +/- 14 (mean +/- standard deviation; range, 20-89) years and 779 women aged 60 +/- 12 (range, 21-88) years} were randomly recruited from a single community at the time of their annual health examination. The association between lipid profiles (total cholesterol (T-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, T-C/HDL-C, TG/HDL-C, LDL-C/HDL-C ratio and MetS, Insulin resistance by homeostasis model assessment of insulin resistance (HOMA-IR), and serum HMW adiponectin were analyzed.
Results: In multiple linear regression analysis, TG/HDL-C and T-C/HDL-C ratios as well as TG showed significantly strong associations with all three MetS-associated variables in both men and women. In men, the ROC curve analyses showed that the best marker for these variables was TG/HDL-C ratio, with the AUC for presence of MetS (AUC, 0.82; 95% CI, 0.77-0.87), HOMA-IR (AUC, 0.75; 95% CI, 0.70-0.80), and serum HMW adiponectin (AUC, 0.67; 95% CI, 0.63-0.71), respectively. The T-C/HDL-C ratio, TG, HDL-C, LDL-C/HDL-C ratio, and non-HDL-C also discriminated these markers; however all their AUC estimates were lower than TG/HDL-C ratio. These results were similar in women.
Conclusion: In Japanese community-dwelling adults, lipid ratios of TG/HDL-C, T-C/HDL-C, LDL-C/HDL-C as well as TG and HDL-C were consistently associated with MetS, insulin resistance and serum HMW adiponectin. Lipid ratios may be used as reliable markers.

DOI： 10.1186/1476-511X-10-79

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Introduction. Serum high molecular weight (HMW) adiponectin, an adipocytokine, which is a protein secreted specifically by adipose tissue, improves insulin sensitivity and plays an important role in the development of metabolic syndrome and cardiovascular disease (CVD). Pulse wave velocity (PWV) is a noninvasive method of measuring arterial stiffness for the assessment of CVD in high-risk populations. We investigated whether serum HMW adiponectin is independently associated with arterial stiffness when evaluated using PWV. Methods. We randomly recruited 99 men aged 69 +/- 9 (mean +/- standard deviation) years and 170 women aged 68 +/- 7 years during their annual health examination in a single community. Peripheral arterial stiffness was evaluated by mean PWV determined at three points: from the heart to the carotid artery, to the brachial artery, and to the ankle. Results and conclusions. Age-adjusted PWV in all sites other than the heart to the carotid artery decreased progressively with increased serum HMW adiponectin. Age-adjusted mean PWV significantly decreased from the lowest to the highest serum HMW adiponectin group. Multiple linear regression analyses for mean PWV revealed that decreased serum HMW adiponectin levels were significantly associated with increased mean PWV as well as age, BMI, SBP, DBP, prevalence of antihypertensive medication, and eGFR. Inclusion of serum HMW adiponectin into the model further increased the coefficient of determination (R(2)). Multivariate-adjusted mean PWV was significantly lowest in the highest serum HMW adiponectin group.

DOI： 10.3109/07435800.2010.534754

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of a patient with incarcerated obturator hernia who presented with right thigh pain. An 88-year-old woman who had experienced right thigh pain for the previous 3 years was given a diagnosis of sciatica at the orthopedic department. In July 2009, she was hospitalized with the chief complaint of appetite loss. The day after admission she experienced increased right thigh pain and lower abdominal pain. Abdominal ultrasonography revealed a keyboard sign. Based on this finding, we diagnosed an ileus, which was alleviated by the insertion of an ileus tube. However, after the removal of the ileus tube, her right thigh pain recurred. Therefore, a diagnosis of hernia was considered. Contrast-enhanced computed tomography revealed an incarcerated bowel in the region between the pectineus muscle and muscle obturator. Laparotomy showed that the ileal part located about 15 cm from the terminal ileum was incarcerated in the right foramen obturatum
therefore, ileal resection and end-to-end anastomosis were performed. After the operation, her intestinal obstruction symptoms and right pain disappeared. If right pain and ileus symptoms of unknown cause occur in elderly persons, obturator hernia should be considered.

DOI： 10.3143/geriatrics.48.176

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Introduction. Serum gamma-glutamyl transferase (GGT) activity changes in response to oxidative stress. Little data are available on the association between serum GGT and the prevalence of impaired fasting glucose (IFG) and diabetes among Japanese community-dwelling persons. Methods. We recruited 871 men, aged 61 +/- 14 (range, 20-89) years, and 1,139 women, aged 63 +/- 12 (range, 21-88) years during their annual health examination from a single community. We performed a cross-sectional study to examine whether serum GGT was associated with IFG and diabetes. Results and conclusions. The levels of most confounding characteristics varied with increasing GGT activity. The prevalence of IFG and diabetes was significantly and linearly associated with increasing quartiles of serum GGT. After adjustment for sex, age, smoking status, drinking status, low-density lipoprotein cholesterol, uric acid, estimated glomerular filtration rate, and alanine aminotransferase, the odds ratio (OR) [95% confidence interval (CI)] for IFG compared with the participants with lowest quartile of serum GGT was 1.91 (1.31-2.78) for second quartiles, 2.41 (1.63-3.57) for third quartiles, and 3.24 (2.03-5.17) for highest quartiles. The multivariate-adjusted OR (95% CI) for diabetes was 1.91 (1.18-3.09) for second quartiles, 2.15 (1.30-3.54) for third quartiles, and 3.79 (2.11-6.82) for highest quartiles. Furthermore, the multivariate-adjusted ORs for IFG were also associated with increasing levels of serum GGT within subgroups of age, body mass index, drinking status, serum high-molecular-weight adiponectin levels, insulin resistance, and the presence of antihypertensive/antilipidemic medication. These results suggested that higher serum GGT within normal concentration range was significantly associated with IFG and diabetes in the general population.

DOI： 10.3109/07435800.2010.534756

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Atherosclerosis Society  

Aim: Serum high molecular weight (HMW) adiponectin improves insulin sensitivity, and a decreased level of serum HMW adiponectin has been reported as a risk factor for the development of diabetes and coronary heart disease. This association may be further confounded by the hemoglobin status, which is involved in the development of atherosclerosis. Methods: A cross-sectional study was carried out in 2002. Study participants, consisting of 897 men aged 61±14 (mean ± standard deviation) years and 1,148 women aged 63±12 years, were randomly recruited from a single community at the time of their annual health examination. Results: Serum HMW adiponectin levels were lowered dose-dependently with an increased hemoglobin level. Stepwise multiple linear regression analyses for serum HMW adiponectin revealed that the hemoglobin status was independently and significantly associated with serum HMW adiponectin levels as well as sex, age, body mass index (BMI), alcohol consumption, total cholesterol, triglycerides, high density lipoprotein cholesterol, antilipidemic medication, uric acid, serum gamma glutamyltransferase, and insulin resistance. Inclusion of hemoglobin levels in the model further increased the coefficient of determination. In stratified analysis, mean serum HMW adiponectin levels were significantly and similarly decreased as hemoglobin levels increased in men, ages ≥65 years, BMI &lt
23.0 kg/m2, alcohol drinkers, and lower insulin resistance, and there were significant interactions between the two groups for BMI, alcohol consumption and insulin resistance. Conclusion: Hemoglobin status is inversely associated with serum HMW adiponectin levels in community-dwelling persons, especially those aged ≥65 years, BMI &lt
23.0 kg/m2, alcohol drinkers, andlower insulin resistance groups.

DOI： 10.5551/jat.6379

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Adiponectin is one of the important molecules in the development of metabolic syndrome, and its concentration is decreased in obesity, type-2 diabetes, and cardiovascular disease. We aim to determine whether serum high-molecular weight (HMW) adiponectin, which is thought to represent the biological active form, was associated with a risk for the prevalence of prehypertension and hypertension. The cross-sectional study was carried out in 2002. A total of 614 men, aged 58 +/- 14 (range, 20-89) years, and 779 women, aged 62 +/- 12 (range, 21-88) years without medications for hypertension, diabetes, or dyslipidemia were recruited from a single community at the time of their annual health examination. In men, nonadjusted and age-adjusted mean serum HMW adiponectin were significantly lower in subjects with prehypertension and hypertension than those with normotension. In women, only nonadjusted values were higher in subjects with hypertension than those with normotension. Multiple linear regression analysis using systolic blood pressure (SBP) and diastolic blood pressure (DBP) as an objective variable, adjusted for risk factors as explanatory variables, showed that only in men, log serum HMW adiponectin were significantly and independently associated with SBP and DBP. In men, lower serum HMW adiponectin categories were positively associated with prehypertension and hypertension in an age-adjusted model, and hypertension in an age- and BMI-adjusted model. Serum HMW adiponectin concentrations were inversely associated with blood pressure (BP) in the general male population.

DOI： 10.3109/10641963.2010.531847

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Increased high-sensitivity C-reactive protein (hsCRP) levels are associated with MetS and its components. Changes in gamma-glutamyl transferase (GGT) levels in response to oxidative stress are also associated with MetS, and the levels could be modulated by hsCRP.
Methods: From a single community, we recruited 822 men (mean age, 61 +/- 14 years) and 1,097 women (63 +/- 12 years) during their annual health examination. We investigated whether increased hsCRP and GGT levels are synergistically associated with MetS and insulin resistance evaluated by Homeostasis of model assessment of insulin resistance (HOMA-IR).
Results: Of these subjects, 141 men (17.2%) and 170 women (15.5%) had MetS. Participants with MetS had a higher hsCRP and GGT level than those without MetS in both genders, and the HOMA-IR increased significantly in correlation with an increase in hsCRP and GGT. In men, the adjusted odds ratios (95% confidence interval) for MetS across tertiles of hsCRP and GGT were 1.00, 1.69 (1.01-2.80), and 2.13 (1.29-3.52), and 1.00, 3.26 (1.84-5.78) and 6.11 (3.30-11.3), respectively. In women, the respective corresponding values were 1.00, 1.54 (0.92-2.60), and 3.08 (1.885.06), and 1.00, 1.70 (1.04-2.79) and 2.67 (1.66-4.30). The interaction between increased hsCRP and GGT was a significant and independent determinant for MetS and insulin resistance in both genders.
Conclusions: These results suggested that higher CRP and GGT levels were synergistically associated with MetS and insulin resistance, independently of other confounding factor in the general population.

DOI： 10.1186/1475-2840-9-87

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The aim of the present study was to examine how lipid profiles are associated with insulin resistance in Japanese community-dwelling adults.
Methods: This cross-sectional study included 614 men aged 58 +/- 14 (mean +/- standard deviation; range, 20-89) years and 779 women aged 60 +/- 12 (range, 21-88) years. The study sample were 1,042 (74.8%) non-obese (BMI &lt; 25.0 kg/m(2)) and 351 (25.2%) overweight (BMI &gt;= 25 kg/m(2)) subjects. Insulin resistance was defined by homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5. The areas under the curve (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum markers.
Results: In non-obese subjects, the best marker of insulin resistance was low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio of 0.74 (95% confidence interval (CI), 0.66-0.80). The HDL-C, triglyceride (TG)/HDL-C ratio, and non-HDL-C also discriminated insulin resistance, as the values for AUC were 0.31 (95% CI, 0.24-0.38), 0.69 (95% CI, 0.62-0.75) and 0.69 (95% CI, 0.62-0.75), respectively. In overweight subjects, the AUC for TG and TG/HDL-C ratio were 0.64 (0.58-0.71) and 0.64 (0.57-0.70), respectively. The optimal cut-off point to identifying insulin resistance for these markers yielded the following values: TG/HDL-C ratio of &gt;= 1.50 and LDL-C/HDL-C ratio of &gt;= 2.14 in non-obese subjects, and &gt;= 2.20, &gt;= 2.25 in overweight subjects. In non-obese subjects, the positive likelihood ratio was greatest for LDL-C/HDL-C ratio.
Conclusion: In non-obese Japanese adults, LDL-C/HDL-C ratio may be the best reliable marker of insulin resistance.

DOI： 10.1186/1476-511X-9-138

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Lippincott Williams and Wilkins  

Hypertension is one of the most common complex genetic disorders. We have described previously 38 single nucleotide polymorphisms (SNPs) with suggestive association with hypertension in Japanese individuals. In this study we extend our previous findings by analyzing a large sample of Japanese individuals (n=14 105) for the most associated SNPs. We also conducted replication analyses in Japanese of susceptibility loci for hypertension identified recently from genome-wide association studies of European ancestries. Association analysis revealed significant association of the ATP2B1 rs2070759 polymorphism with hypertension (P=5.3×10
allelic odds ratio: 1.17 [95% CI: 1.09 to 1.26]). Additional SNPs in ATP2B1 were subsequently genotyped, and the most significant association was with rs11105378 (odds ratio: 1.31 [95% CI: 1.21 to 1.42]
P=4.1×10). Association of rs11105378 with hypertension was cross-validated by replication analysis with the Global Blood Pressure Genetics consortium data set (odds ratio: 1.13 [95% CI: 1.05 to 1.21]
P=5.9×10). Mean adjusted systolic blood pressure was highly significantly associated with the same SNP in a meta-analysis with individuals of European descent (P=1.4×10). ATP2B1 mRNA expression levels in umbilical artery smooth muscle cells were found to be significantly different among rs11105378 genotypes. Seven SNPs discovered in published genome-wide association studies were also genotyped in the Japanese population. In the combined analysis with replicated 3 genes, FGF5 rs1458038, CYP17A1, rs1004467, and CSK rs1378942, odds ratio of the highest risk group was 2.27 (95% CI: 1.65 to 3.12
P=4.6×10) compared with the lower risk group. In summary, this study confirmed common genetic variation in ATP2B1, as well as FGF5, CYP17A1, and CSK, to be associated with blood pressure levels and risk of hypertension. © 2010 American Heart Association, Inc.

DOI： 10.1161/HYPERTENSIONAHA.110.153429

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Recent genome-wide association studies have identified several genetic variants as susceptibility loci for serum uric acid (UA) levels. We also identified a common nonsense mutation, W258X, responsible for renal hypouricemia. Here, we investigated clinical implications of these genetic variants by cross-sectional and longitudinal genetic epidemiological analysis. Methods: The study enrolled 5,165 Japanese subjects aged 64 ± 12 years from the general population. Clinical parameters were obtained from the personal health records, evaluated at medical checkups. Results: Serum UA levels were significantly different between the SLC22A12 rs11231825 (CC/CT/TT: 4.5 ± 1.6, 5.0 ± 1.4, 5.3 ± 1.4 mg/dl
p = 7.6 × 10 -20), SLC2A9 rs1014290 (TT/TG/GG: 4.9 ± 1.4, 5.1 ± 1.4, 5.3 ± 1.4 mg/dl
p = 3.1 × 10-11) and ABCG2 rs2231142 (TT/TG/GG: 5.3 ± 1.5, 5.2 ± 1.4, 5.1 ± 1.4 mg/dl
p = 2.0 × 10-5) genotypes. During 9.4 years of follow-up, 87 new cases of hyperuricemia were diagnosed. Multiple logistic regression analysis identified the accumulation of risk alleles as a significant determinant of future development of hyperuricemia (OR = 7.94
95% CI: 1.97-53.6). In contrast, subjects with nonsense mutation predominantly showed lower UA levels (XX/XW/WW: 1.3 ± 1.7, 3.6 ± 1.0, 5.2 ± 1.4 mg/dl
p = 9.3 × 10-82). However, these subjects showed significantly reduced renal function (β = -0.111
p &lt
0.001) independently of possible covariates. Conclusion: Accumulation of risk genotypes was an independent risk factor for future development of hyperuricemia. Genetically developed hypouricemia was an independent risk factor for decreased renal function. Copyright © 2010 S. Karger AG, Basel.

DOI： 10.1159/000318943

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It was recently reported that GCKR rs780094 was associated with fasting plasma glucose (FPG) and triglyceride (TG) levels in various ethnic populations (A allele for low FPG and high TG). An association between GCKR rs780094 and type 2 diabetes mellitus (T2DM) (A allele for low risk) has also been reported. We examined the association between GCKR rs780094 and T2DM in Japanese subjects by analyzing 488 cases and 398 controls. A meta-analysis was performed involving two previous association studies. We also analyzed the association between the single-nucleotide polymorphism and clinical parameters in the general Japanese population (n=1854). In the case-control study, the A allele of GCKR rs780094 was associated with a reduced risk of T2DM (odds ratio=0.711 (95% confidence interval=0.589-0.859), P=4.2 × 10-4). A meta-analysis confirmed the association of GCKR rs780094 with T2DM susceptibility. In the general Japanese population, subjects with the A/A genotype had lower levels of FPG, fasting plasma insulin and homeostasis model assessment of insulin resistance than those with the G/G genotype. Conversely, subjects with the A/A genotype had higher levels of TG than those with the G/G genotype. We replicated GCKR rs780094 as a marker of T2DM susceptibility in Japanese subjects. This suggests that GCKR rs780094 is a common variant for T2DM susceptibility in various ethnic groups. © 2010 The Japan Society of Human Genetics. All rights reserved.

DOI： 10.1038/jhg.2010.75

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: There are few data focusing on the effect of insulin resistance on a new risk category of prehypertension (120-139 mmHg systolic and/or 80-89 mmHg diastolic blood pressure) recently established by The Seventh Report of the Joint National Committee on High Blood Pressure (JNC-7). We aimed to determine whether insulin resistance was associated with a risk for prehypertension and hypertension.
Methods: Of 3,164 (34.6% of 9,133 adults aged 19 to 90 years) adults at the community-based annual medical check-up, study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or renal failure (567 men aged 57 +/- 14 (mean +/- standard deviation); range, 20-84) years and 702 women aged 59 +/- 12; 21-88 years) were recruited. We examined the cross-sectional relationship between insulin resistance, which was evaluated by homeostasis of minimal assessment of insulin resistance (HOMA-IR) and normotension, prehypertension, or hypertension using the JNC-7 criteria.
Results: The HOMA-IR correlated significantly with systolic (r = 0.171) and diastolic (r = 0.170) blood pressures. Triglycerides &gt;= 150 mg/dL, HDL-C &lt; 40 mg/dL, metabolic syndrome, serum uric acid &gt;= 7.0 mg/dL, and HOMA-IR &gt;= 2.5 showed the highest crude odds ratio (OR) for progression from normotension to prehypertension, and &gt;= 65 years, FBG &gt;= 110 mg/dL, metabolic syndrome, and HOMA-IR = 2.5 showed the highest crude OR for progression from normotension to hypertension. Multivariate logistic regression analysis showed that HOMA-IR was independently associated with the presence of prehypertension and hypertension.
Conclusions: Insulin resistance was significantly associated with prehypertension as well as hypertension in the general population.

DOI： 10.5551/jat.2584

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Insulin resistance is a feature of type 2 diabetes. Resistin, secreted from adipocytes, causes insulin resistance in mice. We previously reported that the G/G genotype of single nucleotide polymorphism (SNP) at -420 (rs1862513) in the human resistin gene (RETN) increased susceptibility to type 2 diabetes by enhancing its promoter activity. Plasma resistin was highest in Japanese subjects with G/G genotype, followed by C/G, and C/C. In this study, we cross-sectionally analyzed plasma resistin and SNPs in the RETN region in 2,019 community-dwelling Japanese subjects. Plasma resistin was associated with SNP-638 (rs34861192), SNP-537 (rs34124816), SNP-420, SNP-358 (rs3219175), SNP+299 (rs3745367), and SNP+1263 (rs3745369) (P&lt
10-13 in all cases). SNP-638, SNP -420, SNP-358, and SNP+157 were in the same linkage disequilibrium (LD) block. SNP-358 and SNP-638 were nearly in complete LD (r2 = 0.98), and were tightly correlated with SNP-420 (r2 = 0.50, and 0.51, respectively). The correlation between either SNP-358 (or SNP-638) or SNP-420 and plasma resistin appeared to be strong (risk alleles for high plasma resistin
A at SNP-358, r2 = 0.5224, P = 4.94×10-324
G at SNP-420, r2 = 0.2616, P = 1.71×10-133). In haplotypes determined by SNP-420 and SNP-358, the estimated frequencies for C-G, G-A, and G-G were 0.6700, 0.2005, and 0.1284, respectively, and C-A was rare (0.0011), suggesting that subjects with A at -358, generally had G at -420. This G-A haplotype conferred the highest plasma resistin (8.24 ng/ml difference/allele compared to C-G, P&lt
0.0001). In THP-1 cells, the RETN promoter with the G-A haplotype showed the highest activity. Nuclear proteins specifically recognized one base difference at SNP-358, but not at SNP-638. Therefore, A at -358 is required for G at 2420 to confer the highest plasma resistin in the general Japanese population. In Caucasians, the association between SNP-420 and plasma resistin is not strong, and A at 2358 may not exist, suggesting that SNP-358 could explain this ethnic difference. © 2010 Onuma et al.

DOI： 10.1371/journal.pone.0009718

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Serum high molecular weight (HMW) adiponectin improves insulin sensitivity, and a decreased level of serum HMW adiponectin has been reported as a risk factor for the development of diabetes and coronary heart disease. This association may be further confounded by the alcohol drinking status, which is involved in the development of liver dysfunction. The aim of this study was to determine whether the alcohol drinking status is associated with serum HMW adiponectin levels in community-dwelling Japanese men.
Methods: A cross-sectional study was carried out in 2002. Study participants without a clinical history of diabetes (747 men aged 60 +/- 14 (mean +/- standard deviation) (range, 20-89) years) were randomly recruited from a single community at the time of their annual health examination. They were classified into never drinkers, light drinkers (&lt;1 unit/day), moderate drinkers (1-1.9 units/day), and heavy drinkers (&gt;= 2 units/day). We examined the effects of alcohol consumption on serum HMW adiponectin.
Results: Overall, mean serum HMW adiponectin levels were significantly lower in the group with higher alcohol consumption, and there were inter-group differences in the alcohol drinking status. Moreover, age-adjusted mean serum HMW adiponectin levels were significantly lower in the group with higher alcohol consumption. Multiple linear regression analysis showed that the alcohol drinking status was significantly and independently associated with serum adiponectin as well as age, smoking status, TG, HDL-C, LDL-C, serum ALT, and HOMA-IR. Multivariate-adjusted mean serum HMW adiponectin levels were also significantly lower in the group with higher alcohol consumption.
Conclusion: The alcohol drinking status is negatively associated with serum HMW adiponectin levels in Japanese community-dwelling men.

DOI： 10.5551/jat.4879

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Serum high molecular weight (HMW) adiponectin improves insulin sensitivity, and a decreased level has been reported as a risk factor for the development of diabetes and coronary heart disease. This association may be further confounded by smoking, which is involved in the development of insulin resistance. The aim of this study was to determine whether smoking status is associated with serum HMW adiponectin levels in community-dwelling males.
Methods: The cross-sectional study was carried out in 2002. Study participants without a clinical history of diabetes (724 men aged 60 +/- 14 (mean +/- standard deviation) (range, 20-89) years) were randomly recruited from a single community at an annual physical examination. They were classified into never-smokers, ex-smokers, light-smokers (&lt;30 pack . year), and heavy-smokers (&gt;= 30 pack . year).
Results: Mean serum HMW adiponectin levels were significantly lower in the current smokers than in the never-and ex-smokers but showed no significant difference between the light and heavy-smokers. Multiple linear regression analyses revealed that smoking status was significantly associated with HMW adiponectin levels, as were age, BMI, alcohol consumption, triglycerides, and high-density lipoprotein cholesterol. Multivariate-adjusted mean serum HMW adiponectin levels were lowest in the heavy-smokers, and significantly decreased in heavy-smokers compared with never-smokers and ex-smokers of an age &gt;= 60 years, BMI &gt;= 22 kg/m(2), alcohol consumption &gt;= 22.9 g of ethanol/day, and HOMA-IR &gt;= 1.6.
Conclusion: Smoking status is associated with serum HMW adiponectin levels in community-dwelling Japanese men.

DOI： 10.5551/jat.3681

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aims: Renal dysfunction is a major public health problem, but there have been few investigations of the relationship between serum high molecular weight (HMW) adiponectin and renal function in Japanese community-dwelling adults.
Methods: We randomly recruited a sample of 1,849 adult Japanese (793 men aged 60 +/- 14 (mean +/- standard deviation; range, 20-89) years and 1,056 women aged 62 +/- 12 (range, 21-88) years) during their annual health examination in a single community. Participants with an eGFR of &gt;= 60 mL/min/1.73 m(2) were divided into four groups based on quartiles of serum HMW adiponectin levels, and it was investigated whether serum HMW adiponectin is independently associated with eGFR.
Results: Mean eGFR was significantly higher in the highest quartile than the lowest quartile of serum HMW adiponectin levels. Stepwise multiple linear regression analysis using eGFR as an objective variable, adjusted for confounding factors as explanatory variables, showed that serum HMW adiponectin (beta = 0.068) as well as age (beta = -0.361), prevalence of antihypertensive medication (beta = -0.115), triglycerides (beta = -0.063), low-density lipoprotein cholesterol (beta = -0.094), and fasting plasma glucose (beta = 0.148) were independently associated with eGFR. The multivariate-adjusted odds ratio for mild renal dysfunction of an eGFR &lt;70 mL/min/1.73 m(2) was 0.62 (95% CI, 0.42-0.91) for the highest quartile compared with participants with the lowest serum adiponectin quartile.
Conclusions: We conclude that a higher serum HMW adiponectin level is associated with a reduced odds ratio of mild renal dysfunction in Japanese adults.

DOI： 10.5551/jat.5124

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The Ala allele of the Pro12Ala polymorphism (rs1801282) of peroxisome proliferator-activated receptor γ (PPARγ) is protective against type 2 diabetes (T2DM). Resistin, secreted from adipocytes, causes insulin resistance in rodents. Resistin gene expression is reduced by the PPARγ ligand. We previously reported that subjects with the G/G genotype of a resistin gene single nucleotide polymorphism (SNP) at -420 (rs1862513) had the highest circulating resistin levels, followed by C/G and C/C. The aim of this study was to determine the relationship among PPARγ Pro12Ala polymorphism, resistin SNP-420, and plasma resistin. Design, patients and measurements: We cross-sectionally analysed 2077 community-dwelling subjects attending an annual medical check-up. Genotypes were determined by TaqMan analysis. Fasting plasma resistin was measured using ELISA. Results: Plasma resistin appeared to be higher in subjects with the Pro/Pro genotype of PPARγ than those with Pro/Ala and Ala/Ala genotypes (mean ± SE, 11.6 ± 0.2 vs. 10.4 ± 0.5 μg/l). Multiple regression analysis, adjusted for age, gender, BMI, and resistin SNP-420, revealed that the Pro/Pro genotype was a positive predictor of plasma resistin (PPARγ, Pro/Pro vs. Pro/Ala + Ala/Ala, unstandardized regression coefficient (β) = 1.03, P = 0.0384). The effects of the Pro/Pro genotype of PPARγ (Pro/Pro vs. Pro/Ala + Ala/Ala) and the G/G genotype of resistin SNP-420 (G/G vs. C/C) on plasma resistin were synergistic (β = 4.76, P = 0.011). Conclusions: The PPARγ Pro12Ala Pro/Pro and resistin SNP-420 G/G genotypes were synergistically associated with plasma resistin, when adjusted for age, gender, and BMI, in the Japanese general population. © 2009 The Authors.

DOI： 10.1111/j.1365-2265.2008.03465.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Alcohol consumption is associated with a decreased risk of type 11 diabetes and cardiovascular diseases. However, there is a great deal of controversy concerning the relationship between alcohol consumption and insulin resistance. This association may be further confounded by an increase in body weight levels. The aim of this study was to determine whether alcohol consumption promotes insulin resistance according to body weight levels in community-dwelling men. Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina or diabetes were randomly recruited from a single community at the time of their annual health examination (678 men aged 59 14 years). They were classified into never drinkers, light drinkers [&lt; 1 unit (22.9 g ethanol)/day], moderate drinkers (1-1.9 unit/day), and heavy drinkers 2 unit/day), and further divided into underweight [body mass index (BMI) &lt; 23 kg/m(2)] or overweight (BMI &gt;= 23.0 kg/m(2)). Insulin resistance was estimated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-IR and potential confounders were compared between the groups. The confounders included age, BMI, smoking status, serum gamma glutamyltransferase, and high molecular-weight adiponectin. In the overall, HOMA-IR is significantly correlated with age, BMI, serum gamma glutamyltransferase, and high molecular-weight adiponectin. After adjustment for potential confounders, mean log HOMA-IR is significantly lower in the heavy drinkers irrespective of BMI categories. In conclusion, alcohol consumption is associated with decreased insulin resistance independent of BMI in Japanese community-dwelling men.

DOI： 10.1620/tjem.218.331

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE-The present study was conducted to confirm possible associations between candidate genes from genome-wide association studies and type 2 diabetes in Japanese diabetic patients and a community-based general population. A total of 11 previously reported single-nucleotide polymorphisms (SNPs) from the TCF7L2, CDKAL1, HHEX, IGF2BP2, CDKN2A/B, SLC30A8, and KCNJ11 genes were analyzed. RESEARCH DESIGN AND METHODS-Candidate SNPs were genotyped in 506 type 2 diabetic patients and 402 control subjects and meta-analyzed with six previous association studies in Japanese patients. Associations with fasting plasma insulin levels were investigated in a general population sample (n = 1,963, 61 ± 13 years). RESULTS-In our case-control subjects, susceptibility to type 2 diabetes was replicated in TCF7L2 (rs12255372), CDKAL1 (rs7756992, rs7754840), HHEX (rs7923837), IGF2BP2 (rs4402960 and rs1470579), CDKN2A/B (rs10811661), and SLC30A8 (rs13266634). In addition to these polymorphisms, meta-analysis confirmed the association of type 2 diabetes susceptibility with KCNJ11 rs5219, TCF7L2 rs7903146, and HHEX rs1111875. The TCF7L2 rs12255372 polymorphism showed the highest odds ratio (OR) for type 2 diabetes (OR 1.714 [1.298-2.263]). Odds ratio of other polymorphisms ranged from 1.13 to 1.41. The risk allele of CDKAL1 rs7756992 was significantly associated with lower insulin levels in type 2 diabetic patients after adjustment for other confounding factors. CONCLUSIONS-Type 2 diabetes susceptibility of seven candidate genes was confirmed in Japanese. Conservation of susceptible loci for type 2 diabetes was independent of ethnic background. © 2009 by the American Diabetes Association.

DOI： 10.2337/db07-1785

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective:Susceptibility of fat mass and obesity-associated (FTO) gene polymorphisms to obesity has been reported in various populations. Polymorphisms in the melanocortin 4 receptor (MC4R) gene were recently explored as another susceptible locus. However, prognostic significance of these genetic variations has not been fully elucidated. Here, we investigated the involvement of FTO rs9939609 and MC4R rs17782313 polymorphisms in the development of obesity. Association with type 2 diabetes mellitus (T2DM) was also investigated.Subjects: We analyzed 2806 community-dwelling middle-aged to elderly subjects (6114 years). Clinical parameters were obtained from the subjects' personal health records, evaluated at their annual medical check-up.Results:FTO genotype was significantly associated with current body mass index (BMI
TT 23.23.2, TA 23.73.2, AA 24.43.2 kg m 2, P2.5 × 10 6) and frequency of obesity (26.6, 32.0, 43.0% respectively, P2.0 × 10 4). Age-and sex-adjusted odds ratio for obesity was 1.30 (P0.004) in TA and 2.07 (P0.002) in AA genotype. During the 9.4 years comprising the follow-up period, 214 new cases of obesity were diagnosed among 1718 subjects whose retrospective data were available. A allele frequency of the FTO genotype was significantly higher in subjects who developed obesity (22.2, 15.8%, P0.001), Age-, sex-and initial BMI-adjusted odds ratio for the development of obesity was 1.46 (95% confidence interval, 1.04-2.04) (P0.031). However, association studies and meta-analysis of T2DM did not actively support the involvement of FTO genotype. No significant differences were observed between the MC4R genotype and BMI (P0.015), and the frequency of obesity (P0.284).Conclusion:FTO genotype is an independent risk factor for future development of obesity. © 2009 Macmillan Publishers Limited All rights reserved.

DOI： 10.1038/ijo.2009.161

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Serum gamma-glutamyl transferase (GGT) activity changes in response to oxidative stress. Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Few data are available on the association between serum GGT and the prevalence of MetS among community-dwelling individuals in Japan.
Methods: We recruited 793 men (mean age, 60 +/- 14 years), and 1,073 women (62 +/- 12 years), free from any history relating to cardiovascular disease during their annual health examination, from a single community. We performed a cross-sectional study to examine whether serum GGT was associated with MetS.
Results: The levels of most confounding characteristics varied with increasing GGT activity After adjustment for age, smoking status, drinking status, low-density lipoprotein cholesterol, uric acid, estimated glomerular filtration rate and alanine aminotransferase, the odds ratios (95% confidence interval) for MetS increased across serum GGT tertiles (1, 2.23 (1.22-4.07), and 2.32 (1.18-4.56) in men; and 1, 1.43 (0.81-2.51), and 2.64 (1.50-4.64) in women). After additional adjustment for insulin resistance markers (immuno-reactive insulin or homoeostasis model assessment of insulin resistance index), the association was attenuated and the linear relation no longer significant in both genders. Furthermore, serum GGT was significantly associated with the presence of individual components of MetS in both genders, except for dyslipidemia in men and hypertension in women.
Conclusions: These results suggested that higher serum GGT was significantly associated with MetS and its components in the general population. This association was related with insulin resistance but was independent of other confounding factors.

DOI： 10.5551/jat.No414

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Serum gamma-glutamyl transferase (GGT) activity changes in response to oxidative stress. Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Few data are available on the association between serum GGT and the prevalence of MetS among community-dwelling individuals in Japan.
Methods: We recruited 793 men (mean age, 60 +/- 14 years), and 1,073 women (62 +/- 12 years), free from any history relating to cardiovascular disease during their annual health examination, from a single community. We performed a cross-sectional study to examine whether serum GGT was associated with MetS.
Results: The levels of most confounding characteristics varied with increasing GGT activity After adjustment for age, smoking status, drinking status, low-density lipoprotein cholesterol, uric acid, estimated glomerular filtration rate and alanine aminotransferase, the odds ratios (95% confidence interval) for MetS increased across serum GGT tertiles (1, 2.23 (1.22-4.07), and 2.32 (1.18-4.56) in men; and 1, 1.43 (0.81-2.51), and 2.64 (1.50-4.64) in women). After additional adjustment for insulin resistance markers (immuno-reactive insulin or homoeostasis model assessment of insulin resistance index), the association was attenuated and the linear relation no longer significant in both genders. Furthermore, serum GGT was significantly associated with the presence of individual components of MetS in both genders, except for dyslipidemia in men and hypertension in women.
Conclusions: These results suggested that higher serum GGT was significantly associated with MetS and its components in the general population. This association was related with insulin resistance but was independent of other confounding factors.

DOI： 10.5551/jat.no414

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Hypertension and obesity are likely the most common disease in Japan. It has been reported that subjects with prehypertension (systolic blood pressure [SBP] 120-139 mmHg and/or diastolic blood pressure [DBP] 80-89 mmHg) have also an increased risk of cardiovascular disease; however, only limited data are available on the prevalence of prehypertension and its association with body weight. We performed a cross-sectional Study to examine whether the status of body weight was associated with prehypertension. Study participants aged 19 to 90 years [1,207 men aged 60 +/- 15 (mean standard deviation) years and 1,634 women aged 63 +/- 12 years] were randomly recruited for a Survey at the community-based annual medical check-up. The prevalence of prehypertension was 27.3% in men and 23.9% in women. The levels of SBP and DBP increased, as body mass index (BMI) increased in both genders. In a multivariate-adjusted model, increasing BMI categories were positively associated with prehypertension. Especially in men, compared to participants with BMI of &lt; 21.0 kg/m(2) (referent), the multivariate-odds ratio (95% CI) of prehypertension was 1.90 (1.17-3.09) in the 21.0-23.4 kg/m(2) group, 2.38 (1.31-4.34) in the 23.5-24.9 kg/m(2) group, and 3.79 (2.03-7.09) in the &gt;= 25.0 kg/m(2) group. In Conclusion, even subjects with mildly increased BMI (21.0-24.9 kg/m) had an increased risk of prehypertension in community-dwelling persons. It is time to pay more attention to excess bodyweight in preventing high blood pressure.

DOI： 10.1620/tjem.216.353

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Serum gamma-glutamyl transferase (GGT) activity is a general clinical marker of excessive alcohol consumption, and GGT reflects changes in oxidative stress and implicated in the progression of hypertension. Recent guidelines classify persons with above-optimal blood pressure (BP) but not clinical hypertension as having prehypertension for a systolic BP (SBP) of 120 to 139 mmHg and/or a diastolic BP (DBP) of 80 to 89 mmHg; however, only limited data are available on the association between serum GGT and this entity among community-dwelling men in Japan. We performed a cross-sectional study to examine whether serum GGT was associated with prehypertension. Study participants (754 men, age 56 15 years) without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or retial failure were recruited from a single community. Thirty-seven percent of participants had prehypertension and 39.3% had hypertension. Multiple regression analysis using SBP and DBP as objective variables, adjusted for risk factors as explanatory variables, showed that log GGT was significantly and independently associated with elevated SBP (beta = 0.109, P = 0.006) and DBP (beta = 0.238, P &lt; 0.001). Compared with participants in the lowest tertile of serum GGT (&lt; 29 IU/L), the multivariate-adjusted odds ratio (OR) (95% CI) for prehypertension was 1.73 (1.06-2.81) for the middle tertile (29-53 IU/L) and 2.37 (1.31-4.31) for the highest tertile (&gt; 53 IU/L). Moreover, the respective ORs for hypertension were 1.82 (1.04-3.18) and 3.11 (1.61-6.03). These results suggest that higher serum GGT levels are associated with prehypertension or hypertension in the general male population.

DOI： 10.1620/tjem.216.213

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Serum gamma-glutamyl transferase (GGT) activity is a general clinical marker of excessive alcohol consumption, and GGT reflects changes in oxidative stress and implicated in the progression of hypertension. Recent guidelines classify persons with above-optimal blood pressure (BP) but not clinical hypertension as having prehypertension for a systolic BP (SBP) of 120 to 139 mmHg and/or a diastolic BP (DBP) of 80 to 89 mmHg; however, only limited data are available on the association between serum GGT and this entity among community-dwelling men in Japan. We performed a cross-sectional study to examine whether serum GGT was associated with prehypertension. Study participants (754 men, age 56 15 years) without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or retial failure were recruited from a single community. Thirty-seven percent of participants had prehypertension and 39.3% had hypertension. Multiple regression analysis using SBP and DBP as objective variables, adjusted for risk factors as explanatory variables, showed that log GGT was significantly and independently associated with elevated SBP (beta = 0.109, P = 0.006) and DBP (beta = 0.238, P &lt; 0.001). Compared with participants in the lowest tertile of serum GGT (&lt; 29 IU/L), the multivariate-adjusted odds ratio (OR) (95% CI) for prehypertension was 1.73 (1.06-2.81) for the middle tertile (29-53 IU/L) and 2.37 (1.31-4.31) for the highest tertile (&gt; 53 IU/L). Moreover, the respective ORs for hypertension were 1.82 (1.04-3.18) and 3.11 (1.61-6.03). These results suggest that higher serum GGT levels are associated with prehypertension or hypertension in the general male population.

DOI： 10.1620/tjem.216.213

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE SOC HYPERTENSION  

Chronic kidney disease (CKD) is a major public health problem. However, few studies have examined the significance of body mass index (BMI) as a risk factor for the development of CKD in the general Japanese population. Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina or renal failure (754 men aged 56 +/- 15 [mean +/- SD] years and 962 women aged 59 +/- 13 years) were randomly recruited from a single community at the time of their annual health examination. We examined the relationship between increased weight (Le., BMI) and renal function evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. Increased BMI was consistently associated with reduced eGFR. Estimated GFR was lower in participants with upper normal body weight (BMI, 22.0 to 24.9 kg/m(2)) or who were overweight or obese (BMI &gt;= 25 kg/m(2)), compared with participants with lower normal body weight (BMI, 18.5 to 21.9 kg/m(2)). Stepwise multiple regression analysis using eGFR as an objective variable, adjusted for various risk factors as explanatory variables, showed that BMI (beta=-0.075) was significantly and independently associated with eGFR, in addition to age, log triglycerides, low-density lipoprotein cholesterol and log fasting blood glucose. Compared with those with lower normal body weight, multivariate-adjusted odds ratios for moderately reduced renal function, defined as an eGFR &lt;60 mL/min/1.73 m(2), were 1.86 (1.01-3.42) for upper normal weight and 2.02 (1.01-4.03) for overweight or obese individuals. In conclusion, increased BMI is strongly associated with decreased eGFR in community-dwelling healthy persons. (Hypertens Res 2008; 31: 1559-1564)

DOI： 10.1291/hypres.31.1559

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objective The c-Jun N-terminal kinase 1 (JNK1, mitogen-activated kinase 8; MAPK8) phosphorylates insulin receptor substrate-1 (IRS-1) at serine 307, which induces insulin resistance. MAPK8 activity is increased in obese insulin-resistant mice, whereas mapk8 (-/-) mice show decreased adiposity and improved insulin sensitivity. The aim of this study was to determine the relationship between single nucleotide polymorphisms (SNPs) of MAPK8 and type 2 diabetes (T2DM).
Design, patients and measurements Approximately 2 kb of 5&apos; flanking and the coding regions were initially sequenced in 24 Japanese T2DM subjects. Identified SNPs were genotyped in 204 T2DM cases and 201 nondiabetic controls. The function of promoter SNP-1066 (g.-1066G &gt; A, rs10857561) was analysed by electrophoretic mobility shift assay (EMSA) and luciferase assay. SNP-1066 was further genotyped in a total of 498 cases and 407 controls, and in 2075 subjects in the general population.
Results In 204 cases and 201 controls, 11 identified SNPs were not associated with T2DM. These SNPs were in the same linkage disequilibrium (LD) block. The tag SNP-1066 was not associated with T2DM in a total of 498 cases and 407 controls with the power &gt; 80% when the relative risk is &gt; 1.31. Functionally, transcription factor AP2 alpha specifically recognized G but not A at -1066. MAPK8 promoter activity was unchanged between G and A. In 2075 subjects, neither body mass index (BMI), fasting plasma glucose (FPG), homeostasis model assessment insulin resistance index (HOMA-IR), nor beta cell function index (HOMA-beta) was associated with SNP-1066.
Conclusions The G/G genotype of MAPK8 SNP-1066 did not affect T2DM susceptibility despite specific binding of AP2 alpha.

DOI： 10.1111/j.1365-2265.2007.03143.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Augmentation index (AI), the ratio of augmented pressure by the reflection pressure wave to the pulse pressure (PP), is an index of arterial stiffness and central blood pressure (BP). Although type 2 diabetes mellitus (DM) is a major risk factor for atherosclerosis, there is controversy with respect to how DM affects AI. In the present study, we investigated possible determinants of AI in 194 type 2 DM patients (mean age 67 +/- 9 years). AI was measured in the left radial artery using an automated tonometric method. In a simple correlation analysis, AI showed a positive association with age, and a negative association with body height, body weight, waist circumference, heart rate (HR), plasma glucose, and HbA1c. Women had significantly higher AI than men. Stepwise regression analysis revealed that mean BP (MBP) (beta = 0.260, p &lt; 0.001), HR (beta = -0.550, p &lt; 0.001) and body height (beta = -0.217, p &lt; 0.001) were independent determinants of radial Al. Similarly, the second peak of systolic BP (SBP2), an index of central aortic systolic BP (SBP), showed a positive association with age, BMI, waist circumference, MBP and Al, and a negative association with body height. In a separate analysis performed in diabetic patients with treated hypertension (n = 123), again, only MBP, HR and body height were significant determinants of radial Al. There was no difference in radial AI and SBP2 among the classes of antihypertensive drugs used. These findings indicate that tight BP control would be effective in reducing the reflection wave and aortic BP, which could independently relate to cardiovascular disease in type 2 diabetic patients.

DOI： 10.1291/hypres.31.493

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ENDOCRINE SOC  

Objective: In Western countries, one of the most important modifiable targets for the prevention of cardiovascular diseases is metabolic syndrome. Adiponectin is an adipose tissue-specific plasma protein that inversely associates with metabolic syndrome. Among several molecular isoforms, high-molecular-weight (HMW) complex is considered the active form. Increased serum high-sensitivity C-reactive protein (hsCRP) concentration also associates with metabolic syndrome, and adiponectin could modulate plasma C-reactive protein levels. Here, through cross-sectional investigation, we investigated whether reduced HMW adiponectin and increased hsCRP levels in plasma are synergistically associated with metabolic syndrome. Measurement of HMW complex of adiponectin is one of the novelties of this study.
Design: We analyzed 1845 community-dwelling middle-aged to elderly subjects ( 62 +/- 13 yr). Plasma HMW adiponectin levels were measured by ELISA. Clinical parameters were obtained from the subjects&apos; personal health records, evaluated at their annual medical check-up.
Results: Each component of metabolic syndrome, except for raised blood pressure, showed significantly lower plasma HMW adiponectin concentrations for both men and women ( P &lt; 0.001). In contrast, plasma hsCRP levels were significantly higher in subjects with metabolic disorders ( P &lt; 0.001). After adjusting for other confounding factors, HMW adiponectin [ log normalized, odds ratio 0.084 (95% confidence interval 0.050-0.142), P &lt; 0.001] and hsCRP [3.009 (2.175-4.163), P &lt; 0.001] were identified as independent determinants of metabolic syndrome. In addition to the direct associations, we also observed a synergistic effect between these two molecules ( F = 11.8, P &lt; 0.001).
Conclusions: Reduced HMW adiponectin and elevated hsCRP are synergistically associated with the accumulation of metabolic disorders. The combination of these markers would be useful for identifying at-risk populations.

DOI： 10.1210/jc.2007-0397

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Obesity is a complex trait reflecting numerous genetic and environmental factors. Recently, a common genetic polymorphism (rs7566605) associated with a higher BMI was found in proximity to the insulin induced protein 2 (INSIG2 ) gene, with replication in four unrelated populations living in Western countries. We investigated the susceptibility to the polymorphism amongst the general Japanese population (n 1976). The frequency of appearance of the single-nucleotide polymorphism (SNP) in the Japanese (G allele
0.652, C allele
0.348) was not different from that found in subjects of European origin as reported previously. However, the BMI levels in each of these genotypes did not differ significantly (GG
23 ± 3, GC
24 ± 3, CC
24 ± 3 kg/m2, P 0.906). In a separate analysis according to sex (male
P 0.462, female
P 0.879), age decade (40s
P 0.057, 50s
P 0.998, 60s
P 0.622, 70s
0.425, respectively), and tertiles of the BMI (1st
P 0.409, 2nd
P 0.088, 3rd
P 0.780), the differences did not achieve statistical significance. The frequency of obesity did not differ among the genotypes (25 kg/m2
30.3, 30.8, 28.2, P 0.729, 30 kg/m2
2.9, 3.8, 2.8, P 0.549). No associations were also observed for related plasma markers
high-molecular weight (HMW) adiponectin (P 0.510), high-sensitive C-reactive protein (P 0.788), resistin (P 0.937) and homeostasis of minimal assessment of insulin resistance (P 0.634). These results indicate a lack of association between SNP rs7566605 and being overweight among the Japanese (in the middle-aged and elderly population). © 2008 The Obesity Society.

DOI： 10.1038/oby.2007.25

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記述言語：英語  

DOI： 10.1097/01.ogx.0000320468.41659.f8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Chronic kidney disease (CKD) is a major public health problem, but there is controversy over whether or not CKD is an independent risk factor for peripheral arterial stiffness in community residents.
Patients and Methods We randomly recruited 107 men, aged 68 9 (mean standard deviation) years, and 203 women, aged 67 7 years during their annual health examination in a single community. Study subjects did not have a clinical history of cerebrovascular disease or current neurological abnormalities. Peripheral arterial stiffness was evaluated by mean pulse wave velocity (PWV) determined at three points: from heart to the carotid artery, to the brachial artery, and to the ankle, and CKD was evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation.
Results Estimated GFR was significantly correlated with mean PWV (r=-0.317, p&lt;0.001). Stepwise multiple linear regression analysis using mean PWV as an objective variable, adjusted by explanatory variables, showed that eGFR (beta,-0.171; p&lt;0.001) significantly contributed to mean PWV, along with age, body mass index, systolic blood pressure, diastolic blood pressure, and antihypertensive drug use, and improved multiple coefficient of determination in the model.
Conclusion Decreased eGFR is associated with an increased risk of arterial stiffness in community residents.

DOI： 10.2169/internalmedicine.47.0825

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Metabolic syndrome (MetS) is a major public health problem. However, few studies have examined the significance of MetS as a risk factor for the development of chronic kidney disease (CKD) in the general Japanese population.
Methods Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or renal failure (1,158 men, aged 61 +/- 15 years and 1,606 women, aged 63 +/- 12 years) were recruited from a single community. We examined the cross-sectional relationship between MetS and renal function as evaluated by estimated glomerular filtration rate (eGFR).
Results The presence of MetS was consistently associated with reduced eGFR, with the level of reduction proportional to the number of MetS components present. Multiple linear regression analysis using eGFR as an objective variable showed that BMI, DBP, antihypertensive drug use, high-density lipoprotein cholesterol, antilipidemic drug use and fasting blood glucose, which were components of MetS, were significantly and independently associated with eGFR, in addition to age and low-density lipoprotein cholesterol. Individuals with MetS showed a multivariate-adjusted odds ratio of 1.53 (95% confidence interval, 1.10-2.13) for CKD compared to those without MetS.
Conclusions MetS was significantly associated with decreased eGFR in the general population.

DOI： 10.2169/internalmedicine.47.1202

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Chronic kidney disease (CKD) is a major public health problem, but there is controversy over whether or not CKD is an independent risk factor for peripheral arterial stiffness in community residents.
Patients and Methods We randomly recruited 107 men, aged 68 9 (mean standard deviation) years, and 203 women, aged 67 7 years during their annual health examination in a single community. Study subjects did not have a clinical history of cerebrovascular disease or current neurological abnormalities. Peripheral arterial stiffness was evaluated by mean pulse wave velocity (PWV) determined at three points: from heart to the carotid artery, to the brachial artery, and to the ankle, and CKD was evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation.
Results Estimated GFR was significantly correlated with mean PWV (r=-0.317, p&lt;0.001). Stepwise multiple linear regression analysis using mean PWV as an objective variable, adjusted by explanatory variables, showed that eGFR (beta,-0.171; p&lt;0.001) significantly contributed to mean PWV, along with age, body mass index, systolic blood pressure, diastolic blood pressure, and antihypertensive drug use, and improved multiple coefficient of determination in the model.
Conclusion Decreased eGFR is associated with an increased risk of arterial stiffness in community residents.

DOI： 10.2169/internalmedicine.47.0825

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Chronic kidney disease (CKD) is a major public health problem. There is conflicting evidence concerning whether CKD is an independent risk factor for carotid intima-media thickness (IMT).
Patients and Methods The study subjects were 428 men aged 70 +/- 15 (mean +/- standard deviation) years and 582 women aged 75 +/- 12 years enrolled consecutively from patients in the Medical Department of Seiyo Municipal Nomura Hospital. Carotid IMT was derived via B-mode ultrasonography and CKD was evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation.
Results In men, age (p&lt;0.001), systolic blood pressure (p&lt;0.001), antihypertensive drug use (p&lt;0.001), HDL-C (p=0.006), LDL-C (p=0.004), prevalence of diabetes (p=0.035) and eGFR (p&lt;0.001) were significantly correlated with carotid IMT. In women, age (p&lt; 0.001),systolic blood pressure (p&lt; 0.001), antihypertensive drug use ( p&lt; 0.001), HDL-C (p=0.035), LDL-C (p=0.017) and eGFR (p&lt; 0.001) were significantly correlated with carotid IMT. Stepwise multiple linear regression analysis using IMT as an objective variable, adjusted by various factors as explanatory variables, showed that eGFR was a significant independent contributing factor along with known risk factors in men (beta, -0.096; p=0.018) and women (beta, -0.080; p=0.035).
Conclusions Our data suggested that eGFR was associated with an increased prevalence of carotid atherosclerosis independent of common cardiovascular risk factors in both men and women.

DOI： 10.2169/internalmedicine.47.0552

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective The association between obesity and atherosclerotic disease is controversial. We examined whether common carotid intima-media thickness (IMT), a precursor to preclinical atherosclerosis, was associated with total body fatness or the accumulation of fat mass in the abdominal region in middle-aged and older persons.
Methods Participants were consecutively enrolled from patients aged &gt;= 50 years, and were 623 men aged 73 +/- 10 (mean +/- standard deviation) years and 835 women aged 76 +/- 10 years. Demographic data were collected and maximal preperitoneal fat thickness (PFTmax) and carotid intima-media thickness (IMT) were evaluated on B-mode ultrasonography. Subjects were divided into 3 groups on the basis of body mass index (BMI), a marker of general obesity.
Results It was shown by multiple regression analysis for IMT that age, smoking status, hypertension and uric acid were significantly associated with IMT in subjects in the lowest BMI group (&lt; 20 kg/m(2)), and age, hypertension, dyslipidemia and uric acid in middle BMI group (20-22.9 kg/m(2)). Moreover, man sex, age, BMI, PFTmax, smoking status, hypertension and uric acid were significantly associated with IMT in subjects with highest BMI group (23 kg/m(2)). Analysis of covariance showed that interaction between BMI and visceral obesity (f = 7.202, p = 0.007) was significantly associated with IMT, in addition to age, visceral obesity, smoking status, hypertension, dyslipidemia and uric acid.
Conclusion The present study indicates a graded and independent association between general and visceral obesity and preclinical carotid artery changes in patients aged 50 years with a BMI 23 kg/m(2).

DOI： 10.2169/internalmedicine.47.0478

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Objective: To investigate the relationships between carotid atherosclerosis, age and metabolic syndrome (MetS), by ultrasonographically examining the carotid arteries of subjects who ranged from young adults to centenarians.
Methods: Carotid intima-media thickness (IMT) was evaluated by B-mode ultrasonography in 1540 patients (685 men, aged 70 +/- 15 years, and 855 women, aged 74 +/- 13 years) in the Medical Department of Seiyo Municipal Nomura Hospital. We investigated the association between carotid IMT as well as plaque, and confounding risk factors including MetS by using the 2005 Japanese criteria.
Results: MetS increased with age until the fifth to seventh decade of life but began to decrease in the more elderly subjects. Carotid IMT increased in a linear manner with age (r = 0.442, P &lt; 0.001) and occurrence of plaques also increased up to the ninth decade of life (P for trend &lt;0.001). Multiple logistic regression analysis for carotid IMT &gt;= 1.10 mm and plaque occurrence was performed using age, sex, smoking status, low-density lipoprotein cholesterol and MetS as variables. In subjects less than 80 years old, male sex and MetS were significant factors for carotid IMT &gt;= 1.10 mm. However, in subjects 80 years or older, MetS was not related to carotid IMT &gt;= 1.10 mm. The appearance of plaque was associated with age and smoking status, but not with MetS.
Conclusion: MetS confers an increased risk of cardiovascular morbidity in subjects aged less than 80 years, and its identification may thus be important in risk assessment and treatment of patients.

DOI： 10.1111/j.1447-0594.2007.00409.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE - Resistin, secreted from adipocytes, causes insulin resistance in rodents. We previously reported that the G/G genotype of a resistin gene promoter single nucleotide polymorphism (SNP) at -420 increases type 2 diabetes susceptibility by enhancing promoter activity. We report here on the relation between plasma resistin and either SNP -420 genotype or factors related to insulin resistance. RESEARCH DESIGN AND METHODS - We cross-sectionally analyzed 2,078 community-dwelling Japanese subjects attending a yearly medical checkup. The SNP -420 genotype was determined by TaqMan analysis. Fasting plasma resistin was measured using an enzyme-linked immunosorbent assay kit. RESULTS - Plasma resistin was associated with the SNP -420 genotype (P &lt
0.0001), which was highest in G/G followed by C/G and C/C. Plasma resistin was higher in elderly individuals, female subjects, nondrinkers, and subjects with high blood pressure (P &lt
0.001, 0.003, &lt
0.001, and 0.001, respectively). Simple regression analysis revealed that age, female sex, homeostasis model assessment of insulin resistance (HOMA-IR) index, systolic blood pressure, low HDL cholesterol, and high-sensitivity C-reactive protein (hs-CRP) were positively correlated with plasma resistin (P &lt
0.001, 0.003, &lt
0.001, 0.004, &lt
0.001, and 0.003, respectively). Multiple regression analysis adjusted for age, sex, and BMI revealed that plasma resistin was an independent factor for HOMA-IR, low HDL cholesterol, and hs-CRP (P = 0.001, &lt
0.001, and 0.006, respectively). CONCLUSIONS - Plasma resistin was associated with SNP -420 and was correlated with insulin resistance, low serum HDL cholesterol, and high hs-CRP in the Japanese general population. © 2007 by the American Diabetes Association.

DOI： 10.2337/dc06-1936

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease and is associated with cardiac events. We investigated cross-sectionally the association between carotid intima-media thickness (IMT), confounding risk factors, and metabolic syndrome (MetS) using the modified Japanese criteria.
Methods: Carotid IMT was evaluated on B-mode ultrasonography in 918 patients (394 men aged 66 +/- 15 years and 524 women aged 72 +/- 13 years).
Results: Among our 918 patients, 74 (8.1%) had no metabolic abnormalities, 478 (52.1%) had a metabolic abnormality with neither type 2 diabetes or MetS, and 127 had MetS without diabetes. Of the patients with type 2 diabetes, 132 (14.4%) did not have MetS and 107 (11.7%) had both type 2 diabetes and MetS. The carotid IMT values in the four groups with any metabolic abnormalities were significantly greater than the IMT of the group with neither condition (p=0.001), respectively. In syndrome model, type 2 diabetes was significantly associated with carotid atherosclerosis (p=0.006), but MetS was borderline significant. In the component model of MetS, there was a significant association with hypertension (p&lt;0.001) and dyslipidemia (p=0.006). Multiple logistic regression analysis for carotid atherosclerosis compared to neither condition demonstrated that subjects with both MetS and diabetes (OR, 5.58; 95% CI, 2.64-11.8), those with type 2 diabetes without MetS (OR, 3.00; 95% CI, 1.45-6.22), and those with MetS without type 2 diabetes (OR, 2.58; 75% CI, 1.24-5.39) showed a higher odds ratio after adjustment for covariates.
Conclusion: Even after taking into account each individual component of MetS, the clustering of visceral obesity with at least 2 of the 3 components, and diabetes are independently associated with increased carotid IMT. This suggests that the components of MetS and type 2 diabetes interact to affect vascular thickness synergistically.

DOI： 10.5551/jat.14.78

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Aim: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities and a predictor of both type 2 diabetes mellitus and adverse cardiovascular events. Whether there are gender differences in the association between early atherosclerosis and MetS has not yet been thoroughly elucidated.
Methods: The subjects consisted of 388 men aged 64 +/- 16 years and 480 women aged 70 +/- 13 years. Early atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography.
Results: Carotid IMT values were significantly greater in both male (P = 0.007) and female (P = 0.002) subjects with MetS. After adjusting for established risk factors, the difference persisted on a significant level in women (P = 0.003), but was weak in men (P = 0.013). Multiple regression analysis using IMT as an objective variable, with adjustment for various risk factors as explanatory variables, showed that MetS (P = 0.016) was a significant independent contributing factor along with known risk factors only in women. Among the components of MetS, hypertension (P = 0.036) and dyslipidemia (P = 0.008) had a strong impact on carotid IMT in men, whereas hypertension (P = 0.003) ranked first in women.
Conclusion: The effect of MetS in early carotid atherosclerosis is more pronounced in women than in men, and the impact of MetS components on carotid IMT differs between men and women.

DOI： 10.5551/jat.14.36

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 79-year-old woman had shown a decline of volition nine months before admission. Because she demonstrated a depressive state, she had been treated with an antidepressant for one month before admission. Thereafter, she became incontinent and showed a poor appetite since two days before admission. Plain computed tomography scan showed an extensive low density area in the right frontal lobe. Cerebral magnetic resonance imaging revealed a tumor with edema (3 cm in diameter), which showed heterogeneous enhancement. The solitary tumor was removed by craniotomy. Metastatic carcinoma was suspected on histological examination, but the primary cancer was not able to be detected by a whole body examination, except for colonoscopy, which was refused by her family. She demonstrated intestinal bleeding about five months after the craniotomy. Rectal cancer was discovered by colonoscopy and she underwent Hartman's procedure. Histological examination revealed poorly differentiated adenocarcinoma similar to resected brain tumor. The final solitary diagnosis was metastatic carcinoma from primary rectal cancer. Solitary brain metastasis from colon cancer is extremely rare, however, we should consider the possibility in cancers of the digestive tract.

DOI： 10.3143/geriatrics.44.122

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective To examine whether or not individuals with a normal body mass index (BMI) (18.5 kg/m(2)-24.9 kg/m(2)), but who also fulfill the criteria for the metabolic syndrome (MetS) class, can be associated with carotid atherosclerosis.
Methods The subjects were consecutive in-patients with a normal BMI (18.5 kg/m(2)-24.9 kg/m(2)) in the Medical Department of Seiyo Municipal Nomura Hospital enrolled between September 1996 and February 2006. The subjects were 452 men aged 69 +/- 15 (mean +/- standard deviation) years and 542 women aged 74 +/- 13 years. Carotid atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography.
Results Compared with men with BMI 18.5 kg/m(2) to 20.9 kg/m(2), the odds ratios of the MetS were 2.83 (95% confidence interval [CI], 1.69-4.76) for men with BMI 21 kg/m(2) to 22.9 kg/m(2) and 6.13 (95% CI, 3.57-10.5) for men with BMI 23.0 kg/m(2) to 24.9 kg/m(2) after controlling for age, smoking status, high low-density lipoprotein cholesterol, and uric acid. Using the same regression model and BMI categories in women, the odds ratios were 2.52 (95% CI, 1.42-2.83) and 4.38 (95% CI, 2.42-7.92), respectively. Multivariate-adjusted carotid IMT was significantly greater in men with than without MetS, especially in patients with BMI 23.0 kg/m(2) to 24.9 kg/m(2). Although in women, there were no inter-group differences in categories of normal BMI and MetS.
Conclusion Individuals in the upper normal BMI range have a relatively high prevalence and are at increased risk of having metabolic syndrome. Therefore, screening of individuals with normal or slightly elevated BMI is important in preventing atherosclerosis.

DOI： 10.2169/internalmedicine.46.0261

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Purpose. To determine optimal cutoff values for preperitoneal fat thickness measured by ultrasonography as indicators for obesity-related disorders.
Methods. We studied 276 men aged 60 +/- 13 years and 307 women aged 64 +/- 11 years. Participants were consecutively enrolled from inpatients aged &lt;= 75 years. Demographic data were collected and maximal preperitoneal fat thickness (PFTmax) and carotid intima-media thickness were evaluated on B-mode ultrasonography. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values for PFTmax.
Results. Multiple regression analysis using one or more obesity-related disorders as an objective variable showed that the tertile on the basis of PFTmax was a significant independent contributing factor in both men and women. Receiver operating characteristic curve analysis identified the cutoff points of 6.1 mm for PFTmax in men (sensitivity, 66.7%; specificity, 62.5%) and 8.7mm for PFTmax in women (sensitivity, 56.6%; specificity, 63.6%) as discriminator values corresponding to the presence of one or more obesity-related disorders. Using the new criteria to diagnose visceral obesity, we found that adjusted carotid intima-media thickness was significantly higher in men and women with visceral obesity and two or more obesity-related disorders than in those without them.
Conclusions. These findings suggested that PFTmax measured on ultrasonography was useful in screening for indicators of cardiovascular risk factors.

DOI： 10.1007/s10396-007-0137-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

Objective: Several cohort studies have shown a link between serum C-reactive protein (CRP) and subsequent cardiovascular disease; however, the role of CRP as an independent risk factor remains controversial. We therefore investigated the association between CRP and sclerotic lesions of common carotid atherosclerosis.
Patients and Methods: We evaluated sclerotic lesions of common carotid arterial intima-media thickness (IMT) by ultrasonography in 139 men aged 67 +/- 15 years and 201 women aged 75 +/- 10 years. To investigate the relation between CRP and various confounding factors, subjects were divided into four groups based on the quartile of CPR.
Results: Carotid IMT values were significantly higher in groups with higher CRP (p = 0.022). To identify the possible CRP level and risk factor interactions for IMT, multiple regression analysis for IMT was performed based on risk factors in subjects with a specific CRP level. It was shown that age, smoking status, systolic blood pressure (SBP) and LDL cholesterol were significantly associated with IMT in subjects in the lower CRP groups (CRP-1 similar to CRP-3), and age, SBP and presence of diabetes mellitus in the highest CRP group (CRP-4). To further investigate whether the interaction between CRP and conventional risk factors could influence IMT, a general linear model demonstrated that interaction between CRP and the presence of diabetes mellitus (F = 4.754 p = 0.030) was significantly associated with IMT, in addition to sex, age, SBP, antihypertensive drug use, LDL cholesterol and HDL cholesterol.
Conclusions: This finding indicates that the association between CRP and IMT significantly differed between subjects with and without diabetes mellitus.

DOI： 10.5551/jat.13.175

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective The aim of this study was to evaluate the influence of conventional cardiovascular risk factors on the degree of adaptive response of the carotid arterial wall to atherosclerotic disease.
Patients and Methods We evaluated the diameter and intima-media thickness ( IMT) of common carotid artery ( CCA) by ultrasonography in 351 men aged 70.3 ( range, 14-97) years and 474 women aged 75.6 ( range, 19-103) years in the medical department of Seiyo Municipal Nomura Hospital. We assessed cross-sectionally the relationships between CCA diameter and IMT and cardiovascular risk factors by gender.
Results In multiple linear regression analyses, after controlling for traditional cardiovascular risk factors, a significant correlation was found between CCA diameters and age ( p=0.034), body mass index ( BMI) ( p&lt;0.001), smoking status ( p=0.039), alcohol consumption (&lt;0.001) and uric acid ( UA) ( p=0.021) in men, and between CCA diameters and age (&lt;0.001), BMI ( p&lt;0.001), systolic blood pressure ( SBP) ( p=0.013) and antihypertensive drug use ( p=0.005) in women. Analysis of covariance showed that the two regression lines between carotid IMT and diameter in those with or without plaque were significantly different in both men ( F=16.4; p&lt;0.001) and women ( F=15.0; p&lt;0.001). After adjustment for carotid IMT and plaque, associations with carotid diameters still persisted for age ( p&lt;0.001), BMI ( p&lt;0.001), smoking status ( p=0.006), alcohol consumption ( p&lt;0.001) and SBP ( p=0.001) in men, and age ( p=0.005), BMI ( p&lt;0.001), SBP ( p=0.047) and UA ( p=0.001) in women.
Conclusion This study shows that the CCA diameters correlated with conventional cardiovascular risk factors including alcohol consumption. These findings suggest that the CCA diameters may reflect the ability of adaptive remodeling to the atherosclerosis before plaque formation and can be an important factor during the development of atherosclerosis.

DOI： 10.2169/internalmedicine.45.1575

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. Associations between hyperuricemia, metabolic syndrome and carotid IMT have been reported, but few of the studies have been conducted in a Japanese population.
Methods A total of 1,128 subjects (498 men aged, 68 +/- 14 years and 630 women aged 72 +/- 12 years) were divided into 4 groups according to serum uric acid (SUA) quartiles. We first investigated the association between SUA concentrations and metabolic syndrome; then, we assessed whether there is an independent association of SUA with carotid IMT in a population subdivided according to gender and metabolic syndrome status.
Results In women, the prevalence of visceral obesity and metabolic syndrome were significantly increased with increased SUA quartiles, but not in men. After adjusting for age, smoking status, LDL-cholesterol, creatinine and history of diabetes mellitus, the odds ratios (95% CI) of sex-specific quartiles of SUA for metabolic syndrome were 1.0, 1.37 (0.79-2.37), 1.37 (0.79-2.38), and 1.80 (1.03-3.15) in men, and 1.0, 1.04 (0.56-1.94), 2.35 (1.30-4.22), and 2.20 (1.16-4.20) in women. After adjusting for various known risk factors, the prevalence of carotid atherosclerosis (IMT. 1.0 mm) was higher in subjects in the second, third and fourth quartiles of SUA concentration with odds ratios (95% CI) of 2.41 (1.08-5.37), 3.33 (1.49-7.42), and 2.73 (1.17-6.35), respectively in men without metabolic syndrome but not in men with metabolic syndrome or in women with or without metabolic syndrome.
Conclusion The prevalence of metabolic syndrome was significantly increased according to SUA values only in women. In men without metabolic syndrome, SUA was found to be an independent risk factor for incidence of carotid atherosclerosis.

DOI： 10.2169/internalmedicine.45.1661

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記述言語：英語  

DOI： 10.1111/j.1447-0594.2006.00332.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. In addition to low-density lipoprotein cholesterol (LDL-C), metabolic syndrome has been linked to the pathogenesis of atherosclerosis. The present study investigated whether the clustering of multiple components of metabolic syndrome has a greater impact on vascular parameters than individual components of metabolic syndrome, and assessed the association between carotid IMT and LDL-C and metabolic syndrome.
Methods Carotid IMT was evaluated on B-mode ultrasonography in 760 patients (340 men aged 64 16 years and 420 women aged 69 13 years) in the Medical Department of Seiyo Municipal Nomura Hospital. The subjects did not demonstrate any clinical signs of cardiovascular disease. We investigated the association between carotid IMT and confounding risk factors including LDL-C and metabolic syndrome using the 2005 Japanese criteria.
Results Carotid IMT increased with increasing numbers of metabolic syndrome components (p for trend &lt; 0.001). Multiple regression models, including age, sex, body mass index, smoking status, LDL-C, diabetes mellitus as well as each individual component of metabolic syndrome as continuous variables, showed that both metabolic syndrome (beta=0.100; p=0.029) and LDL-C (beta=0.210, p &lt; 0.001) were independent determinants of carotid IMT. Metabolic syndrome amplified the LDL-C associated increases in carotid atherosclerosis.
Conclusions Even after taking into account each individual component of MS, the clustering of visceral obesity with at least 2 of the 3 components, and LDL-C are independently associated with increased carotid IMT. This suggests that the components of metabolic syndrome interact to synergistically impact vascular thickness.

DOI： 10.2169/internalmedicine.44.1232

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

It is not known whether subjects with metabolic syndrome and elevated blood pressure are at the same cardiovascular risk as subjects with metabolic syndrome but without elevated blood pressure. Using B-mode ultrasonography, carotid IMT was measured in 1,297 patients (593 men and 704 women) in the medical department of Seiyo Municipal Nomura Hospital between August 1996 and April 2005. The prevalence of metabolic syndrome was 32.5% among men and 35.9% among women. On comparing subjects with an equal number of components of metabolic syndrome, it was found that the prevalence of carotid atherosclerosis was significantly higher in subjects with elevated blood pressure than in those without, and increased with the number of components in the former group (p for trend = 0.0277), but not in the latter (P for trend = 0.5159). In a stepwise multiple logistic regression analysis, after adjustment for confounding factors, elevated blood pressure (OR, 1.771; 95% Cl, 1.246-2.519), low HDL-C (OR, 1.391; 95% Cl, 1.053-1.836) and number of components of metabolic syndrome (OR, 1.561; 95% Cl, 1.103-2.209) were significantly associated with carotid atherosclerosis. The diagnosis of metabolic syndrome per se might not adequately identify subjects at increased cardiovascular risk.

DOI： 10.5551/jat.12.268

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective To estimate the prevalence and risk of ischemic stroke associated with metabolic syndrome.
Methods and Patients In 197 stroke patients (80 cases of atherothrombotic infarction, 97 lacunar infarction, 16 cardioembolic infarction, 4 others) and 356 age- and sex-matched control subjects aged 65 years and older in Seiyo Municipal Nomura Hospital, we investigated the association between metabolic syndrome and risk factor-dependent augmentation of ischemic stroke in subjects with several risk factors for atherosclerosis. The diagnosis of cerebral infarction in each patient was confirmed by CT findings of the brain and metabolic syndrome was defined as at least 3 of the 5 following conditions: visceral obesity, hypertension (HT), hypertriglyceridemia, low HDL-cholesterol and diabetes mellitus (DM).
Results After adjustment for sex, age, and smoking, metabolic syndrome was significantly related to atherothrombotic infarction (odds ratio, 3.08; 95% confidence interval, 1.69-5.61). Of the individual components, visceral obesity, HT and DM were independent risk factors for atherothrombotic infarction. Increased risk for atherothrombotic infarction was also associated with increases in the 5 component conditions of the metabolic syndrome.
Conclusion The clustering of cardiovascular risk factors called metabolic syndrome increases the risk of cardiovascular morbidity, and its identification may thus be important in risk assessment and treatment of patients.

DOI： 10.2169/internalmedicine.44.922

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Several cohort studies have shown a link between serum uric acid (SUA) and subsequent cardiovascular disease. However, such an association did not remain significant after adjusting for concomitant risk factors for atherosclerosis in some studies. Thus, the role of SUA as an independent risk factor remains controversial. We therefore investigated the association between SUA and sclerotic lesions of common carotid atherosclerosis.
Patients and Methods We evaluated sclerotic lesions of the common carotid arterial intima-media thickness (IMT) by ultrasonography in 398 men aged 74 8 (range, 60-97) years and 521 women aged 75 8 (range, 60-104) years. To investigate the relation between SUA and various factors, all subjects were divided into three groups based on the tertile of SUA.
Results Stepwise multiple linear regression analysis using IMT as an objective variable, adjusted by various risk factors as explanatory variables showed that SUA [B, 0.0099; 95% confidence interval (0), 0.0022-0.01751 was a significant independent contributing factor along with known risk factors such as age, sex, smoking status, systolic blood pressure, diastolic blood pressure, antihypertensive drug use, HDL-cholesterol, and LDLcholesterol. Multiple logistic regression analysis for carotid IMT as a tertile of SUA and dependent variables showed that the adjusted odds ratio was 1.25 (95% CI, 0.87-1.78) for those in the middle tertile (4.2-5.5 mg/dl), and 1.66 (95% CI, 1.16-2.39) for those in the highest tertile (5.6-14.1 mg/dl) compared to that for subjects in the lowest tertile of SUA levels (0.51-4.1 mg/dl).
Conclusion We suggest that SUA is a risk factor or marker for ultrasonographically determined IMT.

DOI： 10.2169/internalmedicine.44.787

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

The aim of the present study was to evaluate sclerotic lesions of the common carotid artery by ultrasonography in 921 in-patients aged 65 years and older (77 +/- 7 years) and investigate whether lipid levels were associated with carotid atherosclerosis. In men, an increased risk for carotid atherosclerosis was associated with increased levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). Compared to men with the lowest tertile of LDL-C levels (&lt; 83.4 mg/dl), the adjusted odds ratio was 2.502 (95% confidence interval: 1.426-4.390) in those with the middle tertile (83.4-115.2 mg/dl), and 2.688 (1.509-4.790) in those with the highest tertile (&gt; 115.2 mg/dl). Like the LDL-C level, the non-HDL-C level showed a positive and linear relationship with carotid atherosclerosis. Compared to men with the lowest tertile of non-HDL-C levels (&lt; 101 mg/dl), the adjusted odds ratio was 2.881 (1.633-5.081) for those with the middle tertile (101-135 mg/dl), and 2.990 (1.651-5.415) for those with the highest tertile (&gt; 135 mg/dl). Similarly, in women, an increased risk for carotid atherosclerosis was also positively and linearly associated with LDL-C and non-HDL-C. The Non-HDL-C level is a potential predictor of risk for carotid atherosclerosis in the elderly.

DOI： 10.5551/jat.12.143

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

We tried to investigate whether accumulation of visceral fat, assessed by a simple but widely used ultrasonographic method, was associated with common carotid atherosclerosis in non-obese men ranging from 16 to 79 years old. The subjects were consecutive 297 male in-patients whose body mass index ranged from 18.5 kg/m(2) to 25 kg/m(2). An ultrasonographic evaluation using a 7.5 MHz linear type B-mode probe was performed by a specialist to determine the intima-media thickness (IMT) of the common carotid artery and the maximal thickness of peritoneal fat (Pmax) at the anterior surface of the liver and the minimal thickness of subcutaneous fat (Smin) of the abdomen. The Pmax/Smin ratio, which was termed the abdominal wall fat index (AFI), was then calculated. The mean age +/- standard deviation in this series was 65 +/- 13 (range, 15-79) years. Multiple regression analysis using IMT as an objective variable, adjusted by various risk factors as explanatory variables, showed that AFI [beta, 0.0538; 95% confidence interval (CI), 0.0116-0.0960] was a significant independent contributing factor along with known risk factors such as age, smoking status, systolic blood pressure, HDL-cholesterol and LDL-cholesterol. We found that AFI was useful in evaluating disorders of metabolism and atherosclerosis in non-obese men.

DOI： 10.5551/jat.12.85

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Plasma homocysteine (Hcy) concentration has been shown to be influenced by a mutation in the gene coding methylenetetrahydrofolate reductase (MTHFR). Although plasma Hcy has been shown to be related to atherosclerotic disorders, the association between MTHFR gene polymorphism and ischemic stroke remains controversial. In the present study we investigated the association between MTHFR gene polymorphism and risk factor-dependent augmentation for ischemic stroke in subjects with several risk factors for atherosclerosis, with special emphasis on the risk factor-gene interaction. The diagnosis of cerebral infarction in each patient was confirmed by computed tomography (CT) findings of the brain. MTHFR C677T polymorphism was genotyped with a conventional method. In 97 stroke patients (48 cases of atherothrombotic infarction, 38 cases of lacunar infarction, 9 cases of cardiac embolism, 2 others) and 241 age-and sex-matched healthy control subjects, the frequencies of the T allele were 0.44 and 0.39, respectively. In patients with CT-proven atherothrombotic infarction, the T allele frequency was 0.54 (P =. 033 vs controls). The adjusted odds ratio in subjects with TT genotype for atherothrombotic infarction was 3.87 (95% confidence interval = 1.27-11.8). A general linear model analysis showed that an interaction between the HDL-C and MTHFR genotype was significantly associated with atherothrombotic infarction (F = 5.695
P =. 018). These findings indicate that the T allele of the MTHFR gene is significantly associated with atherothrombotic infarction. Furthermore, the analysis of risk factor-gene interaction could be a useful tool for deriving specific predictive information about ischemic stroke in an elderly Japanese population. © 2005 by National Stroke Association.

DOI： 10.1016/j.jstrokecerebrovasdis.2004.12.003

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記述言語：英語  

The effect of genetic polymorphism of human organic anion transporting polypeptide C (OATP-C) on the lipid-lowering response to 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitors was assessed. A retrospective study was conducted on 66 patients who underwent treatment of hyperlipidemia with HMG-CoA reductase inhibitors in a municipal hospital in a community-based cohort of Ehime prefecture in the southern part of Japan. Plasma lipid concentrations before and after administration were analyzed in patients in relation to the 521T/C (Val-174-->Ala) polymorphism in the OATP-C gene (TT: n=44 (66.7%), TC: n=20 (30.3%), CC: n=0 (0.0%), undetermined: n=2 (3.0%)). Total cholesterol level was significantly lowered after treatment with HMG-CoA reductase inhibitors in all patients (p<0.001); moreover, subjects with the 521C allele showed an attenuated total-cholesterol-lowering effect compared with those homozygous for the 521T allele (-22.3+/-8.7% vs. -16.5+/-10.5%, p<0.05). These data suggest that the 521T/C polymorphism of the OATP-C gene modulates the lipid-lowering efficacy of HMG-CoA reductase inhibitors.

DOI： 10.2133/dmpk.19.375

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3143/geriatrics.41.92

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Chlamydia pneumoniae (Cp) is an important pathogen for infections of the respiratory tract; recently, also a number of reports suggesting its relation to atherosclerosis. This study was performed to clarify the relation between Cp infection and ischemic stroke.
Patients Forty elderly patients with ischemic stroke (age 75 +/- 6.6; male 57.5%) and 85 elderly control subjects without a history of ischemic stroke (age 74 +/- 8.1; male 43.5%) were investigated.
Methods Patients were divided into four groups according to clinical diagnosis: 1) atherothrombotic infarction, 2) lacunar infarction, 3) those with cardiac embolism, and 4) non-classifiable. Cp infection was determined by measuring the anti-Cp IgG specific antibody level (Cp IgG index) using enzyme-linked immunosorbent assay (ELIZA) method. Those below the 1.10 Cp IgG index were determined as seronegative and those above 1.10 as seropositive.
Results We found that 20 cases (87.0%) of atherothrombotic infarction, 6 (66.7%) of lacunar infarction, 3 (50.0%) others and 52 (61.2%) control were Cp seropositive. Cp seropositiveness, as adjusted by multiple regression analysis using various known risk factors, was a significant independent contributing factor for ischemic stroke (p=0.017) and was associated with an increased risk for atherothrombotic infarction (odds ratio, 12.6; 95% CI, 2.0-79.3).
Conclusion This suggests that Cp infection is also an important risk factor for ischemic stroke, particularly atherothrombotic infarction in elderly Japanese.

DOI： 10.2169/internalmedicine.42.571

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1365-2265.2008.03465.x

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記述言語：英語   出版者・発行元：Japan Atherosclerosis Society  

We investigated the relation between the serum concentration of HGF and carotid atherosclerosis. Serum concentrations of HGF were measured in 128 in-patients (mean age, 74 ± 11 years) free from cardiac, liver and renal diseases, in addition to lung diseases, in the Medical Department of Nomura Municipal Hospital between August, 2000 and June, 2001. Carotid intima-media thickness (IMT) was evaluated by ultrasonography with a 7.5 MHz linear type B-mode probe. The results showed a significantly positive correlation between serum age and HGF concentrations in patients with carotid atherosclerosis (IMT > 1.0 mm) (<I>r</I> = 0.391, <I>p</I> = 0.005). On the other hand, there was no significant correlation between age and serum HGF concentration in those without carotid atherosclerosis (IMT ≤ 1.0 mm) (<I>r</I> = 0.157, <I>p</I> = 0.173). A general linear model analysis for HGF adjusted with other risk factors showed that the age-carotid atherosclerosis interactions were significantly associated with serum HGF (<I>F </I>[1.114] = 6.193; <I>p</I> = 0.014), in addition to age, systolic blood pressure (SBP), aniti-hypertensive drug use, diabetes mellitus and carotid atherosclerosis. In contrast, multiple regression analysis showed that serum HGF (<I>β</I> = 0.160, <I>p</I> = 0.033) was independently associated with carotid atherosclerois, in addition to gender, age, SBP and HDL-cholesterol. These results suggest that increased serum HGF concentrations were associated with carotid atherosclerosis, independent of known risk factors for atherosclerosis.

DOI： 10.5551/jat.10.154

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その他リンク： http://search.jamas.or.jp/link/ui/2004082415

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE SOC HYPERTENSION CENT ACADEMIC SOC, PUBL OFFICE  

The insertion/deletion (I/D) polymorphism of the human angiotensin-converting enzyme (ACE) gene is a major determinant of circulating ACE activity, with the D allele being associated with higher ACE levels than the I allele. Thus, chronic exposure to high levels of circulating and tissue ACE may well predispose to vascular wall thickening and atherosclerosis. However, the effect of the ACE gene on carotid atherosclerosis remains controversial. We investigated the association between ACE gene I/D polymorphism and risk factor-dependent augmentation of carotid arterial remodeling in subjects with several risk factors for atherosclerosis. We evaluated sclerotic lesions of the common carotid artery with intima-media thickness (IMT) by ultrasonography in 184 patients (mean age+/-SD, 67+/-14 years old) and studied whether any risk factor-gene interactions were associated with carotid atherosclerosis. Out of the 184 subjects, 71 had the ACE II genotype, 87 the ID genotype and 26 the DD genotype. There was no significant difference in IMT among the three ACE genotypes. In total subjects, multiple regression analysis showed that age, total-cholesterol (T-C), and HDL-cholesterol (HDL-C) were significantly associated with IMT. However, the association between risk factors and IMT was genotype-specific. Systolic blood pressure (SBP) and HDL-C were significantly associated with IMT in ACE D carriers (DD+ID), but not in subjects with the ACE II genotype. Similarly, T-C was significantly associated with IMT only in subjects with the ACE II genotype. A general linear model of the interaction between the ACE genotype and the conventional risk factors showed that the SBP-ACE genotype interaction were significantly associated with IMT (F=7.915; p=0.005). This finding further supports the idea that analysis of risk factor-gene interaction could be a useful tool for deriving specific predictive information about the development of atherosclerosis.

DOI： 10.1291/hypres.25.875

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記述言語：英語   出版者・発行元：一般社団法人 日本動脈硬化学会  

The present study was performed to clarify the relation between plasma homocysteine and ischemic stroke. We studied the relationship between ischemic stroke and the known risk factors for atherosclerosis including plasma homocysteine in 91 in-patients (80.3&plusmn;6.8 years) in a medical ward. Those diagnosed with transient ischemic attack, cerebral infarction were placed in the disease group. Blood was drawn from in-patients in a fasting state for determination of plasma homocysteine. Plasma homocysteine concentrations were determined using a high-performance liquid chromatography assay. The odds ratio of ischemic stroke was higher in the second (10.0-13.9 &mu;mol/l) and third highest plasma homocysteine concentration groups (&ge;14.0 &mu;mol/l) than in the first group (<10.0 &mu;mol/l) by 5.18 and 4.42-fold, respectively. Logistic regression analysis using ischemic stroke as an object variable, adjusted by various risk factors including the plasma homocysteine concentration showed that the odds ratio on combining the second and third groups was 5.80 (95% confidence interval (Cl): 1.50-22.5) compared with the first group. The findings confirmed that the association between plasma homocysteine concentration and ischemic stroke in Western populations is also present among the elderly Japanese.

DOI： 10.5551/jat.9.121

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DOI： 10.5551/jat.9.213

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記述言語：英語  

DOI： 10.1046/j.1444-1586.2002.00024.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Homocysteine (Hey) is a sulfhydryl amino acid. Its precursor, the essential amino acid methionine, is derived from dietary protein; recently a number of studies have suggested its relation to atherosclerosis. The present study was performed to clarify the relation between the plasma Hey concentration and sclerotic lesions of the common carotid arteries.
Methods and Patients We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 120 elderly in-patients (77 9 years), and studied the relationship of the known risk factors for atherosclerosis including plasma Hey. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of the common carotid arteries. Blood was drawn from the patients while fasting for determination of plasma Hey. Plasma Hey concentrations were determined using a high-performance liquid chromatography assay.
Results Logistic regression analysis using IMT as an object variable, adjusted by various risk factors including the plasma Hey concentration, revealed that the relative risk in the group combining the second and the third highest Hey groups was 6.49 (95% confidence interval (0): 1.95-21.9) compared with the first group and the plaque presence showed a relative risk of 4.45 (95% CI: 1.53-12.9).
Conclusion The findings of this study confirmed that observations of an association between plasma Hey concentration and common carotid atherosclerosis in Western populations is also present among the elderly Japanese.

DOI： 10.2169/internalmedicine.40.1189

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Chlamydia pneumoniae (C. pneumoniae) is an important pathogen for infections of the respiratory tract, and there are recently also a number of reports suggesting its relation with atherosclerosis. This study was performed to clarify the relation between C. pneumoniae infection and sclerotic lesions of the common carotid arteries.
Methods and Patients We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 147 in-patients (mean age, 70 years; 95% confidence interval, 68-72) in the internal medicine ward, and studied the relation of the known risk factors for atherosclerosis including C. pneumoniae infection. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of common carotid arteries. C. pneumoniae infection was determined by measuring anti-C. pneumoniae IgG specific antibody level (IgG index) using enzyme-linked immunosorbent assay (ELISA) method with serum of fasting blood, which had been preserved at -70 degreesC.
Results IgG index (p=0.0263), from multiple regression analysis using various risk factors as explanatory variables, was a significant independent contributing factor (R-2=0.3465, p&lt;0.0001) along with known risk factors such as male (p=0.0289), age (p=0.0007), Brinkman index (p=0.0067), hypertension (p=0.0443) and T-Chol (p=0.0220).
Conclusion This study confirmed that the observations of an association between antibody against C. pneumoniae and common carotid atherosclerosis in Western nations is also present in Japan. Our results suggests that C. pneumoniae infection is also an important risk factor for common carotid atherosclerosis.

DOI： 10.2169/internalmedicine.40.208

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER-VERLAG TOKYO  

Plasma homocysteine (Hcy) concentration has been shown to be influenced by a mutation in the gene coding methylenetetrahydrofolate reductase (MTHFR). Although plasma Hcy is related to atherosclerotic disorders, conflicting results have been reported about the association between MTHFR gene polymorphism and sclerotic lesions of the common carotid arteries. The effect of age-gene interaction on carotid arterial remodeling was investigated in elderly subjects with several risk factors for atherosclerosis. We evaluated sclerotic lesions of the common carotid arteries by ultrasonography in 326 patients (mean age +/- standard deviation, 73 +/- 12 years) and studied relations among the known risk factors for atherosclerosis, including MTHFR gene polymorphism and its interactions with age and sex. Of the 326 subjects studied, 136 had MTHFR genotype CC, 136 genotype CT. and 54 genotype TT. The three groups did not differ with respect to background factors such as age, history of cigarette smoking, blood pressure, lipids or uric acid. or in the incidence of atherosclerotic diseases. Spearman's rank correlation revealed a significant relationship between gender. age, Brinkman index. systolic blood pressure, triglycerides, HDL-cholesterol (HDL-C). uric acid, and MTHFR gene polymorphism. Multiple regression analysis using intimamedia complex thickness (IMT) as a criterion variable and risk factors. including MTHFR gene polymorphism as explanatory variables showed that MTHFR gene polymorphism (P = 0.039) was a significant independent explanatory variable for IMT. along with gender (male) (P &lt; 0.001), age (P &lt; 0.001), systolic blood pressure (SBP) (P = 0.047), total cholesterol (T-C) (P &lt; 0.001), and HDL-C (P &lt; 0.001). Furthermore. a general linear model analysis revealed that interaction between age and MTHFR gene polymorphism was significantly associated with IMT, independently of age, SBP, T-C, and HDL-C in male subjects. However. age-gene interaction was not observed in female subjects. The findings of the present study confirm an association between MTHFR gene polymorphism and common carotid atherosclerosis in the Japanese population and further support the role of risk factor-gene interaction in common carotid atherosclerosis.

DOI： 10.1007/s100380170031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11213/tonyobyo1958.44.541

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DOI： 10.3143/geriatrics.37.479

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

対象は65歳以上の高齢者で,自記式アンケートの回答が分析可能であった1268人(男575人,女693人)である.このうち自宅で介護が必要とされる被介護者を有する者は,男性55人(9.6%),女性69人(10.0%)であった.精神的健康度について背景的特徴との関連をみたロジスティック回帰分析では,被介護者を有する者は有しない者と比較して有意に不良であった.その内容については,主観的介護負担感度が終日臥床,痴呆度が常時要介護で有意に不良であった.一方,被介護者を有する者のみでみると,地域行事への参加や高い情緒的支援が良好な精神的健康度と有意な関連を認めた.地域在住高齢者において,被介護者を有することは精神的健康に大きく影響していた

DOI： 10.3143/geriatrics.37.912

PubMed

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2000&ichushi_jid=J01214&link_issn=&doc_id=20001211400015&doc_link_id=10008505852&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10008505852&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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DOI： 10.3143/geriatrics.36.703

PubMed

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記述言語：日本語   出版者・発行元：日本プライマリ・ケア学会  

平成8年11月中に診療した急性気道感染症の新患連続20名に対する抗生剤処方の有無及びその背景について調査した.抗生剤の使用は,「感冒に抗生剤は有効」とする医師ほど,患者の訴えでは発熱・咽頭痛・痰・膿性痰の存在,身体所見では扁桃腺・リンパ節・胸部異常所見の存在にて有意に高かった.逆に,診療施設の立地条件がへき地型,患者の訴えでは頭痛の存在では処方率は有意に低かった.以上より,急性気道感染症に対する抗生剤処方には,患者の症状や所見以外に心理・社会的背景因子の関与が明らかにされた

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

主観的幸福感と背景因子との関係については,主観的幸福感は同居家族のいる人,配偶者のいる人,血圧の高くない人,脳卒中歴のない人,医師による定期的内服治療を受けていない人,運動習慣のある人,仕事をしている人ほど有意に大きかった.主観的幸福感と各種スコアーとの関係については,主観的幸福感はADL,情報関連機能,手段的・情緒的支援ネットワーク,健康状況,食欲状況,睡眠状況,記憶状況,家族関係,友人関係,経済状況の値が高いほど有意に大きかった.主観的幸福感を取り巻く背景因子を説明変数とする重回帰分析では,手段的支援ネットワーク,情緒的支援ネットワーク,健康状況,記憶状況などは有意な正の偏相関を示した

DOI： 10.3143/geriatrics.36.861

PubMed

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1999&ichushi_jid=J01214&link_issn=&doc_id=20000128210006&doc_link_id=10008486261&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10008486261&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：The Japan Geriatrics Society  

近年, 老人人口およびそれに伴う長期臥床患者や独居老人の増加に伴い, 在宅ケアの必要性が急速に高まっている. そうした中, 在宅ケアにおける患者 (以下被介護者) の健康に関する把握は従来よりなされているが, それを看る介護者の健康に関わる環境要因の把握は未だ十分ではない. 核家族化や介護者自身の高齢化が目立つ状況下, 介護者の負担をいかに軽減できるかも在宅ケアを進めていく上で重要な要因と考えられる. そこで介護者の負担度と主観的幸福感を調査し, それに及ぼす影響因子について検討した. 対象は, 当院で訪問診療・看護を受けている高齢者あるいは長期臥床患者の家族で, 1年以上常に患者の介護にあたっている介護者20名である. 方法では, 介護者については年齢, 性別, 被介護者との続柄や人間関係, 副介護者・職業・趣味活動の有無, 健康状況, 介護期間, さらに抑うつスコア, 社会的支援度, 介護負担度, 主観的幸福感を調査し, 被介護者については年齢, 基礎疾患, ADLの程度を調査した. その結果, 介護者の負担度については, 介護者側では女性ほど (p<0.05), 被介護者との人間関係や自身の健康状況が良くないほど (各々p<0.05), また手段的支援ネットワークや情緒的支援ネットワークでの点数が低いほど (各々p<0.005, p<0.05) 大きくなり, 被介護者側では年齢が高いほど (p<0.05), ADLでは離床が困難であるほど (p<0.05) 大きかった. 介護者の主観的幸福感については, 副介護者がいるほど (p<0.005), 手段的支援ネットワークや情緒的支援ネットワークでの点数が高いほど (各々p<0.05) 大きくなり, ADLでは情報の理解が可能であるほど (p<0.05) 小さかった. 本調査により, 介護者の負担度を軽減し, 主観的幸福感を失わずに介護を続けていくには, その手段的・情緒的支援ネットワークの充実を計ることの重要性が示唆された.

DOI： 10.3143/geriatrics.36.35

PubMed

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JALC/00086135306?from=CiNii

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

Objective. This study aimed to examine the factors affecting prescription of antibiotics for acute bronchitis in ambulatory care settings in Japan.
Method. A prospective study was conducted on 92 physicians engaged in primary care regarding their prescription behaviour for a series of 20 new patients with acute respiratory diseases seen during November 1996 and the background factors affecting the behaviour.
Results. A total of 1755 patients were registered during the study period, 302 (17.2 %) of whom were diagnosed with acute bronchitis and 1165 (66.4%) with upper respiratory tract infection. Independent background factors related to diagnosis of acute bronchitis included self-care prior to visit (odds ratio 1.93, 95% CI 1.33-2.80), complaints such as cough (8.80, 4.77-16.2), sputum (2.24, 1.59-3.14) and purulent sputum (6.47, 3.02-13.9). The odds ratio was high in patients with more severe findings of the chest (5.00, 3.64-6.85), given chest X-ray (2.68, 1.33-5.38) while it was low in those feeling cold (0.68, 0.48-0.96), and those with a sore throat (0.63, 0.45-0.90), nasal symptoms (0.75, 0.54-1.04) and more severe findings of the pharynx (0.74, 0.58-0.92). In those with an upper respiratory tract infection, the odds ratio was high for complaints such as feeling cold (1.51, 1.11-2.05) and nasal symptoms (1.39, 1.04-1.86), while it was low for complaints such as cough (0.67, 0.48-0.95), sputum (0.43, 0.30-0.62), purulent sputum (0.19, 0.08-0.44), wheeze (0.34, 0.13-0.92), in those with more severe findings of the tonsil (0.36, 0.29-0.44) and the chest (0.30, 0.19-0.47) and given chest X-rays (0.29, 0.12-0.66). For acute bronchitis, antibiotics were administered to 67.5% and symptomatic therapy concurrently given to 64.9%. As for independent background factors related to prescription of antibiotics for acute bronchitis, the odds ratio was higher in physicians denying the efficacy of antibiotics for treating a cold (4.58, 1.94-10.8), and the patients with complaints such as purulent sputum (22.9, 2.66-197.2), more severe findings of the pharynx (2.26, 1.34-3.79) and of the chest (2.73, 1.53-4.88), and those who had a body temperature measurement taken (4.42, 1.71-11.4) and a chest X-ray (6.11, 1.07-34.9), but was lower in those complaining of chills (0.16, 0.04-0.66) and diarrhoea (0.11, 0.01-1.11).
Conclusions. A majority of patients receiving medical care for acute bronchitis are given an unnecessary antibiotic prescription. The result of this study may be useful for the finding of appropriate forms of intervention for changing physicians' prescription behaviour.

DOI： 10.1093/fampra/15.3.244

Web of Science

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記述言語：日本語   出版者・発行元：The Japan Geriatrics Society  

安定した寝たきり患者に対する入浴の効果を検討するために, 町立野村病院内科入院中の寝たきり患者10名 (男性5名, 女性5名, 年齢78.9±10.5歳) を対象に入浴前後の血圧, 脈拍, 内分泌環境, さらに出浴後24時間の血圧と脈拍について検討した. その結果, 血圧は入浴により一過性に上昇し, 出浴後は急速に低下した. その後の24時間効果については入浴日は非入浴日と比べると, 収縮期血圧では12～16時間 (p<0.005) で有意に低く, 拡張期血圧でも同様に8～12時間 (p<0.01), 12～16時間 (p<0.001), 20～24時間 (p<0.001) で有意に低かった. 脈拍については入浴後0～4時間で有意に高かったが (p<0.01), 8～12時間 (p<0.001) と12～16時間 (p<0.001) では有意に低かった. また入浴前後で血漿レニン活性の有意な上昇を認めた (p<0.05). 以上, 入浴により交感神経刺激を介して一過性に血圧は上昇するものの出浴後は急速に低下し, その効果は数時間にわたり持続することが示唆された.

DOI： 10.3143/geriatrics.35.299

PubMed

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DOI： 10.3143/geriatrics.35.201

PubMed

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記述言語：英語   出版者・発行元：APPLETON & LANGE  

Web of Science

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記述言語：日本語  

CiNii Books

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 56-year-old man who had thirst and general malaise from July 13, 1996 was referred to this hospital at 4 : 35 am on the 16th as he did not improve after treatment given by a neighborhood doctor. At the time of admission, he was delirious and suffering from Kussmaul respiration and excessive dehydration. Tests revealed that his blood sugar level was 968 mg/dl, blood gas pH 7.135, HCO3- 3.4 mEq/l, serum CPK 8,250 U/l, myoglobin 21,000 ng/ml, and urinary ketone bodies, and he was diagnosed as having diabetes mellitus with ketoacidosis (DKA) accompanied by rhabdomyolysis. Transfusion and continuous administration of a small amount of insulin was started immediately, and his consciousness and electrolysis substantially returned to normal after 12 hours. CPK and myoglobin levels gradually decreased. On the evening of the 17th, however, he developed abdominal pain and mucous hematochezia, and was found by endoscopy of the colon to have ischemic enteritis with a partially necrosed sigmoid colon on the 18th. The necrosed ileocecum was removed by emergency surgery and colonostomy of the sigmoid colon. These abnormalities were attributed to abnormal metabolism and circulatory insufficiency with DKA. © 1997, THE JAPAN DIABETES SOCIETY. All rights reserved.

DOI： 10.11213/tonyobyo1958.40.355

Scopus

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DOI： 10.3143/geriatrics.33.835

PubMed

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DOI： 10.3143/geriatrics.31.38

PubMed

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.34.6_516_3

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.34.8_694_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.33.8_713_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.33.Abs_91_1

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.33.8_713_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.33.Abs_91_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.33.8_714_3

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記述言語：日本語   出版者・発行元：The Japanese Respiratory Society  

16歳女性. 7歳頃より気管支喘息に罹患. 喘鳴, 呼吸困難, 頸部・上胸部に皮下気腫を認め入院. 血液ガスではPa_O₂60.7torrと低酸素血症を認め, 胸・腹部X線写真では著明な縦隔気腫, 皮下気腫, 腹膜気腫, 胸部CT写真では硬膜外気腫がみられた. 酸素吸入, アミノフィリンの投与にて症状は次第に改善し, 検査成績も正常化した. 腹膜気腫や硬膜外気腫を合併した気管支喘息はまれであり興味ある症例と思われる.

DOI： 10.11389/jjrs1963.28.913

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(株)ジェフコーポレーション  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

CiNii Books

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記述言語：日本語   出版者・発行元：日本社会薬学会  

「医療専門職を志す学生がお互いの職種を理解し、質の高いチーム医療の基盤を形成する機会を持つ」ことを目的として、「多職種連携ワークショップ(WS)」を開催した。医療系学生31名(薬学生12名、医学生11名、看護学生8名)が参加し、医療専門職は医師4名、薬剤師1名、看護師1名、作業療法士1名が参加した。WSでは、「家族会議」、「多職種カンファレンス」、「各職種ができそうなこと」の3セッションについて、ロールプレイやグループワークを行った。アンケートは25名(薬学生10名、医学生7名、看護学生8名)より回答が得られ、「多職種連携に対する質問」では、WS前に比べてWS後には、薬学生・医学生・看護学生ともに調査した5項目全てに対して意識の向上がみられた。薬学生・看護学生は全項目、医学生は「他学部生との交流の重要性」、「他職種の業務内容の理解度」の2項目に対して、有意な上昇を確認した。薬学生は、WS後に医師・薬剤師・看護師の貢献度が低下し、その他の職種の貢献度が上昇した。医学生は、わずかに自身の職種の貢献度が低下し、薬剤師の貢献度が上昇した。

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床薬理学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

メタボリックシンドローム(MetS)は、コンポーネントである内臓脂肪型肥満(内臓脂肪蓄積)、高血圧、高中性脂肪血症、低HDLコレステロール血症、高血糖からなり、インスリン抵抗性を背景とした心血管疾患(CVD)危険因子の集まりである。血清尿酸の増加はMetSのコンポーネントと強い関わりをもち、しばしば肥満や血圧上昇、脂質異常、耐糖能異常、CVD危険因子集積に合併し、悪玉としての関与が指摘されている。高尿酸血症は約6割にインスリン抵抗性が認められ、MetSのない段階での総頸動脈硬化症の独立した危険因子でもある。また危険因子としては女性のほうが影響を受けやすいことも指摘されている。運動介入に伴うインスリン抵抗性の改善に対しては、血清尿酸の低下は中性脂肪の低下とともに他の交絡因子で補正後も有意な交互作用を示していた。血清尿酸はその上昇を早期に発見し介入することで動脈硬化の予防につながる指標としても注目されている。(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本社会薬学会  

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

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記述言語：日本語   出版者・発行元：(公社)地域医療振興協会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016308963

記述言語：日本語   出版者・発行元：(株)臨床評価刊行会  

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記述言語：日本語   出版者・発行元：日本体質医学会  

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：愛媛医学会  

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記述言語：日本語   出版者・発行元：(公社)地域医療振興協会  

2013年1月31日、愛媛県南予地域の小学校、E校(5、6年生)15名、2014年1月14日、S校(1〜6年生)11名の合計26名を対象に、禁煙を含めた薬物乱用防止教室を行った。授業は45分間で、教科書に準拠した覚醒剤や違法薬物、タバコの歴史やタバコ会社の宣伝や高校生の禁煙率について授業を行った。禁煙教室実施前後に、対象と家族の喫煙状況、禁煙教育が対象の喫煙に対する考え方に及ぼす影響について、加濃式社会的ニコチン依存度ワーキンググループが作成したKTSND標準版を用い調査した。調査の結果から、禁煙教育により、ニコチン依存度は低下し、対象者のニコチン依存度は低下し、禁煙教育は対象者のニコチン依存度を減らすには意義があり、喫煙の危険性を啓発する手段として有用であることが示唆された。

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016056151

記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：日本体質医学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER DIABETES ASSOC  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）   出版者・発行元：(株)尾島医学教育研究所  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015189755

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）   出版者・発行元：愛媛医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

目的:超高齢化社会の到来に備えて,次世代を担う学生にとって将来決定に重要な因子は何であるか,地域医療に従事する医師を増加させるためにどのような教育が必要とされるかを探る.対象と方法:平成24年度に愛媛大学医学部医学科1年生109名,5年生99名,うち回答者数は1年生89名(男性52名,女性37名),年齢19±1歳(平均年齢±標準偏差,範囲18〜21歳),回収率81.6%,5年生74名(男性48名,女性26名),年齢24±3歳(平均年齢±標準偏差,範囲22〜36歳),回収率74%であった.調査方法はアンケート方式で,パーソナルデータ,将来の進路決定に関する項目,勤務地の決定因子,地域医療や医師不足に関する項目について検討した.結果:将来希望する診療科は,臓器別専門医,産婦人科,麻酔科,眼科を志望する割合は5年生で有意に多く1年生で少なかった.基礎医学者,外科は5年生で有意に少なく,1年生で多かった.進路決定の重要因子では,収入,勤務形態,診療科の雰囲気,先輩の薦めといった現実的な項目を重要視する割合は5年生では有意に多く,1年生で少なかった.他方,入学前に得た知識や仕事のやりがいという漠然とした項目を重要視する割合は,5年生では有意に少なく,1年生で多かった.地域医療の崩壊や医師不足といった問題に危機感を抱き,高齢化の進む離島や医師不足地域での勤務を可能とする学生の割合は5年生よりも1年生で多く,その差は有意であった.考察:地域医療・老年医学に従事する医師数の増加を図るためには,医学生の志望する診療科の細分化を踏まえた上で,学生が進路を決定する上で重要視する背景因子が地域医療・老年医学の分野においてどのように受け止められているかを見極める事が重要である事が示唆された.また地域医療・老年医学に関する学生への情報発信,臨床実習時間の増加が急務である事が示唆された.(著者抄録)

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER DIABETES ASSOC  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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