李 媛英

Background: To examine the association of intrahepatic fat with homeostasis model assessment-insulin resistance (HOMA-IR), a marker of insulin resistance, in Japanese adults, and whether intrahepatic fat is associated with insulin resistance independent of waist circumference and other measures of obesity.Methods: Fifty-three individuals aged 37-69 were studied. Spectrum obtained using a 3-T magnetic resonance imager was analysed with LC Model to quantify intrahepatic fat. Blood levels of insulin, glucose and other biochemical markers were obtained after 8 h or more fasting. Percent body fat was estimated by a bioelectrical impedance analyzer. HOMA-IR and intrahepatic fat content were log-transformed in the analysis.Results: We found a positive correlation between intrahepatic fat and HOMA-IR, which was independent of the anthropometric measures of obesity. In contrast, significant and positive correlations of body mass index, percent body fat, and waist circumference with HOMA-IR were largely explained by their associations with intrahepatic fat. Intrahepatic fat was positively associated with alanine transaminase and triglyceride seven after adjustment for HOMA-IR.Conclusion: Intrahepatic fat was associated with insulin resistance independent of age, sex, and measures of obesity in Japanese adults. Hypertriglyceridemia and liver injury may directly occur subsequent to intrahepatic fat accumulation. (C) 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Background: This study aimed to investigate associations between central aortic pressure (CAP) and subclinical organ damage of the heart amongst the general population. Methods: We conducted a cross-sectional study in a community-based population, consisting of 3002 men and women aged between 40 and 79 years. The CAP was measured using the HEM-9000AI device, an automated tonometer. Electrocardiograms (ECG) were read according to the Minnesota Code. Subclinical organ damage in the heart was defined as measurable left high amplitude R waves (LHAR), major and minor ST-T abnormalities, and left ventricular hypertrophy (LVH). Results: Age-and sex-adjusted prevalence of LHAR, major and minor ST-T abnormalities, and LVH was higher for subjects in the highest tertile of CAP levels than those in the lowest tertile. After further adjustments for other cardiovascular risk factors, these associations did not change substantially. The multivariable odds ratios (ORs) (95% CI) of LHAR, major and minor ST-T abnormalities, and LVH for the highest tertile of CAP levels compared to the lowest tertile were 2.7(1.9-3.9), 1.8(1.1-2.9), 1.7(1.3-2.3) and 3.2(1.3-8.1), respectively. The positive associations with LHAR and minor ST-T abnormalities were observed primarily among non-hypertensive subjects. The respective corresponding ORs were 2.8(1.7-4.6) and 1.7(1.2-2.4) for non-hypertensive subjects, and 1.7(0.9-3.3) and 1.1(0.7-1.8) for hypertensive subjects. Conclusion: CAP levels were associated with subclinical organ damage of the heart independent of cardiovascular risk factors, and these associations were primarily seen in non-hypertensive subjects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Background: Elevated high-sensitivity C-reactive protein (hs-CRP), a marker of low-grade systemic inflammation, may be involved in the etiology of type 2 diabetes mellitus (T2DM). However, whether inflammation precedes development of T2DM independent of cigarette smoking and obesity remains to be confirmed. Methods: We studied 4213 civil servants in a local government in Japan aged 35-66years at baseline in 2002, who donated blood samples and were followed 6years. Hazard ratios (HR) of T2DM according to the hs-CRP quartiles [range Q1: 0.02-0.18 (reference), Q2: 0.18-0.33, Q3: 0.33-0.67 and Q4: 0.67-9.62mg/L) were estimated by Cox proportional hazards model adjusted for gender, age, body mass index, alcohol intake, smoking status (current, past and never), number of cigarettes per day, physical activity, family history of diabetes (Model 1) and variables in Model 1+glucose (Model 2). Results: The geometric mean [95% confidence interval (CI)] of hs-CRP was 0.36mg/L (0.34-0.37). During the follow-up, 156 new T2DM cases were confirmed. In total sample, Model 2 HRs (95% CIs) for hs-CRP quartiles Q2-Q4 compared with Q1 were 0.69 (0.36-1.26), 1.47 (0.91-2.39) and 1.78 (1.10-2.88), respectively (p for linear trend=0.014). Stratified analysis revealed that a statistically significant association was observed only in normal weight non-current smokers with Model 2 HRs (CIs) being 0.79 (0.29-2.17), 2.63 (1.25-5.56) and 3.19 (1.49-6.86) for Q2-Q4 compared with Q1, respectively (p for linear trend=0.0006). The relationship did not change materially after further adjusting for log-homeostasis model assessment or exclusion of past smokers. Conclusions: These findings imply that higher hs-CRP itself or existence of chronic systemic inflammation precedes onset of T2DM independent of obesity and smoking. © 2013 John Wiley &amp Sons, Ltd.

Background: We investigated the association of baseline body mass index (BMI) and weight change since age 20 years with liver cancer mortality among Japanese. Methods: The data were obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 31 018 Japanese men and 41 455 Japanese women aged 40 to 79 years who had no history of cancer were followed from 1988 through 2009. Results: During a median 19-year follow-up, 527 deaths from liver cancer (338 men, 189 women) were documented. There was no association between baseline BMI and liver cancer mortality among men or men with history of liver disease. Men without history of liver disease had multivariable hazard ratios (HR) of 1.95 (95%CI, 1.07-3.54) for BMI less than 18.5 kg/m2 and 1.65 (1.05-2.60) for BMI of 25 kg/m2 or higher, as compared with a BMI of 21.0 to 22.9 kg/m2. BMI was positively associated with liver cancer mortality among women and women with history of liver disease. Weight change since age 20 years was positively associated with liver cancer mortality among women regardless of history of liver disease. Women with history of liver disease had a multivariable HRs of 1.96 (1.05-3.66) for weight gain of 5.0 to 9.9 kg and 2.31 (1.18-4.49) for weight gain of 10 kg or more, as compared with weight change of -4.9 to 4.9 kg. Conclusions: Both underweight (BMI &lt 18.5 kg/m2) and overweight (BMI &gt 25 kg/m2) among men without history of liver disease, and weight gain after age 20 (weight change =5 kg) among women with history of liver disease, were associated with increased mortality from liver cancer. © 2013 Japan Epidemiological Association.

Objective. To investigate an effect of smoking cessation on chronic obstructive pulmonary disease (COPD) mortality in Asians. Methods. The data was obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 41465 Japanese men and 52662 Japanese women aged 40-79 years who had no history of COPD, asthma, other chronic lung diseases, cardiovascular disease or cancer were followed between 1988 and 2008. Results. During median 18-year of follow-up, there were 285 (251 men and 34 women) documented deaths from COPD. Multivariable-adjusted hazard ratios with 95% confidence intervals of COPD death were 4.46 (2.72-7.29) and 9.26 (4.19-20.5), respectively for current male and female smokers when compared to never smokers. Compared with current smokers, the multivariable HRs for 5-9 years and 10 years or more smoking cessation prior to baseline were 0.44 (0.22-0.87) and 0.36 (0.22-0.58) in men, respectively while the HR for never smokers was 0.30(0.16-0.57). There were an insufficient number of COPD deaths in women to clarify this association. Conclusion. Smoking cessation for ten years or more prior to enrollment reverses the excess risk of COPD mortality to a level similar to that observed among never smokers in men. 2012 Published by Elsevier Inc.

Background It was suggested that inflammation may mediate or modify biological effects of adiponectin. Few studies examined the association between circulating adiponectin levels and type 2 diabetes (T2DM) while controlling for variables related to inflammation. In addition, East Asians were reported to have lower adiponectin levels but higher diabetes prevalence at a given degree of obesity than Caucasians, raising some possibility that the adiponectindiabetes association may differ by race. Therefore, we prospectively investigated the associations with a number of covariates including C-reactive protein and smoking status in a cohort of Japanese workers aged 3566?years. Methods Serum adiponectin concentration and other covariates were obtained in 2002 for 3008 civil servants free of T2DM at baseline in urban/suburban Japan. T2DM incidence was defined as the year when annually assessed fasting blood glucose level first exceeded 126?mg/dL or self-reported initiation of medication through 2007. T2DM incidence was examined in relation to the adiponectin quintile. Results Age- and sex-adjusted homeostasis model assessment insulin resistance was inversely associated with adiponectin quintiles at baseline. During six years of follow-up, 164 individuals developed T2DM. In a fully adjusted model, hazard ratios (95% confidence intervals) of T2DM in Q2 to Q5 compared with that in Q1 were 0.62 (0.410.94), 0.44 (0.250.77), 0.40 (0.200.78) and 0.85 (0.481.49), respectively. Conclusions Low adiponectin was related to increased incidence of T2DM independent of baseline levels of blood glucose, insulin and C-reactive protein as well as other confounding variables in middle-aged Japanese. Whether high adiponectin is linearly associated with decreased T2DM risk needs further investigation. Copyright (C) 2012 John Wiley & Sons, Ltd.

Objective. To examine a combination of healthy lifestyles on the risk of metabolic syndrome (MetS) to inform future interventions. Methods. A total of 1897 men aged 35-60 years participated in an annual health check-up in 2002 and 2005. MetS was defined by AHA/NCEP criteria. Logistic regression analyses were used to estimate age- and BMI-adjusted odds ratios (ORs) of MetS incidence for each healthy lifestyle (regular physical activity, adherence to healthy eating behaviors, not current smoking, and maintaining a stable weight since one's mid-twenties), separately (Model 1) and simultaneously (Model 2). A points system was developed to derive 3-year risk of MetS incidence by assigning a specific point to each healthy lifestyle. Results. MetS developed in 285 (15.0%) subjects after the follow-up. The ORs of MetS for each healthy lifestyle ranged from 0.42 to 0.64 (Model 2). Three-year risk of MetS incidence was predicted to differ from 1% to 60% according to the individual point total of the points system. The population-attributable fraction of MetS in subjects whose point total was not in the highest quartile was 71%. Conclusion. Adherence to healthy lifestyles was associated with a lower risk of MetS among apparently healthy middle-aged Japanese male workers. (C) 2010 Elsevier Inc. All rights reserved.

Objective. To investigate the associations between dietary intake of n-3 polyunsaturated fatty acids (plant-derived alpha-linolenic acid: ALA, and marine-derived eicosapentaenoic and docosahexaenoic acid: EPA + DHA) and insulin resistance (IR) in a lean population with high n-3 PUFA intake.Method. We cross-sectionally studied 3383 Japanese local government workers aged 35-66 in 2002. IR was defined as the highest quartile of homeostasis model assessment, and nutrient intake was estimated from a diet history questionnaire. The odds ratios (ORs) of IR taking the lowest quartile of ALA or EPA + DHA intake as the reference were calculated by logistic regression analysis.Results. Mean age, body mass index (BMI), and dietary ALA, and median of dietary EPA + DHA were 47.9 years, 22.9 kg/m(2), and 1.90 g/day (0.88%E) and 0.77 g/day (0.36%E), respectively. The ORs of IR decreased across the quartiles of ALA intake (multivariate-adjusted OR for Q4 versus Q1 = 0.74, P for trend = 0.01) and the association was observed only in subjects with a BMI of <25 kg/m(2) (P for interaction = 0.033). However EPA + DHA showed no such associations consistently.Conclusion. Higher ALA intake was significantly associated with a lower prevalence of IR in normal weight individuals of middle-aged Japanese men and women. (C) 2010 Elsevier Inc. All rights reserved.

A 6-month, twice weekly, well-rounded exercise program (47 sessions in total) comprised of a combination of aerobic, resistance and flexibility training was provided for institutionalized older adults aged 60 to 93. We analyzed the data of 18 older adults who could stand and had attended more than 10% of the classes (mean participation rate: 54%) to examine changes in activities of daily living (ADL), physical fitness tests and depressive moods. The mean (+/- standard deviation, range) age of the participants was 71.3 (+/- 15.6, 60-93) in men and 85.9 (+/- 5.8, 72-93) in women. Significant improvement in ADL of the hand manipulation domain and borderline significant improvement in ADL of the mobility domain were observed (McNemar test p=0.011 and 0.072, respectively). A 6-minute walk distance increased significantly from 151.6 m to 236.6 m (p=0.01, paired t-test), and the result of the Soda Pop test, which tests hand-eye coordination, also improved significantly from 35.2 sec to 25.3 sec (p=0.01, paired t-test). These findings suggest that such a program could be effective in improving the ADL and physical fitness of the elderly.