永井 成美

Background We have previously reported that female patients with nontuberculous mycobacterial lung disease (NTM-LD) are thinner and eat less than healthy controls. Therefore, we hypothesized that their thinness is associated with body size misperception. The aim of this study was to clarify whether patients’ body size perception (BSP) is associated with body mass index (BMI) independent of potential confounders. Methods In this cross-sectional study, we assessed 81 outpatients for BSP using the Japanese version of Body Image Scale, body composition, dietary intake, and biochemical markers. As a control, we used BSP and self-reported anthropometric data from 111 healthy women collected via a web survey. First, BSP and BMI were compared between the patients and the controls. Second, patient data was compared between patients who overestimated their body size (OE, n = 31) and a control who did not (Non-OE, n = 50). Multiple regression analysis was performed to clarify the association between BSP (independent variable) and BMI (dependent variable), adjusting for potential confounders, such as age, disease duration, and nutritional factors. Results There was a negative correlation between body size distortion and BMI in both patients and controls (p < 0.001, both). In interpatient comparisons, the OE group had significantly lower BMI and body fat percentage (p < 0.001, both), normalized energy (p = 0.037), and protein (p = 0.013) intakes, and significantly greater weight loss from age 20 (p = 0.003) than the Non-OE group. Multiple regression analysis revealed that overestimation of body size was associated with lower BMI independent of confounders, such as longer disease history, longitudinal weight loss, and nutritional factors. Conclusion These findings suggest that body size distortion is an etiological factor for lower BMI in female patients with NTM-LD. Thus, it may be important to understand the patient’s body image when providing dietary advice.

Abstract Background In women, slender body habitus has been reported to be one of the predisposing factors underlying the development and poor prognosis of non-tuberculous mycobacterial lung disease (NTM-LD). Given the lack of nutritional data contributing to treatment strategies, we aimed to clarify the nutritional status of female patients with NTM-LD and its association with disease severity. Methods In this single-center observational study, we enrolled 81 female outpatients with NTM-LD. Data on healthy women of similar ages were selected from our previous survey data and categorized as controls. First, we compared anthropometric and dietary survey data between patients and controls. Second, after the patients were categorized into relatively mild (mild, n = 40) and relatively severe groups (severe, n = 41) based on pulmonary X-ray-image finding scores, body composition, nutritional intake, and biochemical markers were compared between the groups. To identify nutritional factors associated with disease severity, logistic regression analyses were performed. Results Compared with controls, patients with NTM-LD had significantly lower energy intake, body mass index, body fat, and skeletal muscle mass (all p < 0.001). Compared with the mild group, the severe group had significantly lower skeletal muscle mass (p = 0.037), albumin (p = 0.029), transthyretin (prealbumin) (p = 0.002), retinol-binding protein (p = 0.011), and hemoglobin (p = 0.001); however, no between-group differences were observed in energy or nutrient intake. Logistic analyses revealed that transthyretin (p = 0.025) and hemoglobin (p = 0.003) levels were independent factors associated with disease severity. Conclusions This is the first study to comprehensively report the association between NTM-LD severity and nutritional status, including body composition, nutrient intake, and biomarkers. The results suggest that initiating nutritional therapy from the mild stage of the disease to prevent undernutrition is warranted.

For athletes, it is important to acquire lean body mass (LBM) involving the skeletal muscle mass during their growth periods; however, the influence of chronotype on LBM gain remains unclear. We therefore aimed to investigate whether chronotype, sleep-wake cycle on weekdays (SWC-W), and their interaction contribute to LBM gain among adolescent male athletes in a 4-month intervention study. The participants were 45 male high-school baseball players. The intervention, including exercise menu (running and muscle strength training) and nutritional education, was conducted during a 4-month period of season-off training. The chronotype, body composition, lifestyle, and dietary intake were investigated before intervention (baseline) and after 4 months. Among the participants [Morningness (n = 14), Eveningness (n = 15), Intermediate (n = 16); ME score based on the Morningness/Eveningness Scale for Children (MES-C)], the midpoint of sleep on weekdays (MSW) was calculated in the "Morningness" and "Eveningness" participants, respectively. They were divided into 4 groups based on a match/mismatch with the chronotype: Type M-match (n = 8), Type M-mismatch (n = 6), Type E-match (n = 7), and Type E-mismatch (n = 8) groups. The data were compared among the 4 groups. Moreover, multiple regression analysis was conducted using an increase (kg) LBM gain as a response variable. When comparing the data between the "Morningness" and "Eveningness" participants, there were no differences in nutrient intake, the duration of training, or each parameter of body composition (per body weight) at baseline or after 4 months. There were also no differences in the rates of change in the body weight or each parameter of body composition. In groups in which the chronotype was consistent with the SWC-W (the Type M-match and Type E-match groups), the LBM gain were slightly greater than in the Type M-mismatch and Type E-mismatch groups (Type M-match: 3.5 ± 2.0 kg, Type M-mismatch: 1.6 ± 1.7 kg, Type E-match: 3.4 ± 2.2 kg, and Type E-mismatch: 1.2 ± 1.8 kg, p = .057). Multiple regression analysis revealed that an extent of the LBM gain was associated with a match between the chronotype and SWC-W (ß = 0.37, p = .030), independent of a long duration of training (ß = 0.52, p = .004). The results suggested that training-related LBM gain is associated with interactions between the chronotype and SWC-W in adolescent male athletes.Abbreviations: LBM: Lean body mass; SWC-W: Sleep-wake cycle on weekdays; ME score: Morningness-eveningness score; MES-C: Morningness/Eveningness Scale for Children; MSW: Midpoint of sleep on weekdays; MSF: Midpoint of sleep on free days; MSFsc: Midpoint of sleep on free days corrected for sleep debt accumulated through weekdays.

【目的】フィリピン共和国では、2016年の教育改革でカリキュラムに健康(栄養の内容を含む)が追加されたが、指導案や教材に乏しく栄養の授業は十分に行われていない。そこで同国の栄養の授業推進に資することを目的として、日本の栄養教諭課程学生3名が中心となり同国内関係者と協力して現地小学校で栄養の授業を実践した。【方法】PDCAサイクルに基づき実施した。(1)Plan:アセスメントで文献調査とフィリピン共和国ボホール州タグビララン市現地調査を行い、栄養課題抽出後「栄養バランスの是正」を優先課題に決定し、学習指導案と教材を英語で作成した。関係者と現地で協議し修正とスタッフ研修を行った。(2)Do:同市立A小学校2年生1クラス(32名)で、3G FOODS(3食品群)でバランスを学ぶ栄養の授業を単回実施した。(3)Check(経過・影響評価):授業終了時に、児童の授業満足度と理解度を質問紙とワークシートで調べた。同時に、授業参観者(現地教師・JICA隊員等)による授業評価(現地のカリキュラムや児童への適合度)を実施した。(4)Act:評価結果を関係者と共有した。【結果】児童の授業満足度(楽しかった)は100%、理解度(ワークシートの問題への正答率)は91%と高かった。授業参観者による授業評価では、授業、内容ともに同国の教育カリキュラムや児童の理解度等のレベルに適していると評価され、今後活用したいとの意見も得られた。【結論】結果より、フィリピン共和国の栄養の授業推進につながる実践ができたと考えられる。(著者抄録)

妊娠期栄養は胎児発育に加え,児の将来の生活習慣病予防の観点からもその重要性が見直されている。本研究は,単胎妊娠の日本人妊婦における妊娠前から妊娠中の食事要因と在胎不当過小児の関連を検討した。単胎妊娠の日本人妊婦702人に,妊娠前,初期,後期の米飯,肉料理,魚料理,野菜料理,緑黄色野菜,果物等の摂取頻度,葉酸サプリメントの利用,喫煙を調査した。児の出生体重は,在胎期間別出生時体格基準値の10パーセンタイル値未満を『在胎不当過小』(以下,過小)とした。過小児出生と母親の年齢,身長,妊娠前体格,妊娠中体重増加量,食物摂取頻度,葉酸サプリメントの利用,喫煙との関連をロジスティック回帰分析で検討した。解析の結果,過小児出生の低さには,妊娠前の緑黄色野菜の摂取頻度が高いこと[調整オッズ比:0.46,95%信頼区間(以下,CI):0.23-0.90],妊娠後期の野菜料理の摂取頻度が高いこと[調整オッズ比:0.49,95% CI:0.24-0.99],妊娠中体重増加量が多いこと[調整オッズ比:0.60,95% CI:0.38-0.97]が関連していた。また,妊娠前に野菜料理の摂取頻度が低かった母親の66.3%が,妊娠後期でも摂取頻度が低いままであった(p=0.042)。本研究結果から,妊娠前や妊娠後期における不足しがちな野菜の摂取に富む食生活と,妊娠中の適正な体重増加が,過小児出生の減少に関連する可能性が示唆された。また,妊娠前の食生活の一部は妊娠中も継続しやすかったことから,過小児予防の栄養教育は妊娠前からが望ましいと考えられた。(著者抄録)

OBJECTIVE: Low birth weight (LBW) is a major public health issue as it increases the risk of noncommunicable diseases throughout life. However, the genome-wide DNA methylation patterns of full-term LBW infants (FT-LBWs) are still unclear. This exploratory study aimed to analyze the DNA methylation differences in FT-LBWs compared with those in full-term normal birth weight infants (FT-NBWs) whose mothers were nonsmokers and had no complications. Initially, 702 Japanese women with singleton pregnancies were recruited. Of these, four FT-LBWs and five FT-NBWs were selected as references for DNA methylation analysis, and 862,260 CpGs were assessed using Illumina Infinium MethylationEPIC BeadChip. Gene ontology enrichment analysis was performed using DAVID v6.8 software to identify the biological functions of hyper- and hypomethylated DNA in FT-LBWs. RESULTS: 483 hyper-differentially methylated genes (DMGs) and 35 hypo-DMGs were identified in FT-LBW promoter regions. Hyper-DMGs were annotated to 11 biological processes; "macrophage differentiation" (e.g., CASP8), "apoptotic mitochondrial changes" (e.g., BH3), "nucleotide-excision repair" (e.g., HUS1), and "negative regulation of inflammatory response" (e.g., NLRP12 and SHARPIN). EREG was classified into "ovarian cumulus expansion" within the "organism growth and organization" category. Our data imply that LBW might be associated with epigenetic modifications, which regulate the immune system and cell maturation.

AIM: Small-for-gestational-age (SGA) status has negative health consequences in neonates and later life. Low socioeconomic status (SES) is a reported risk factor for adverse birth outcomes, such as SGA and preterm birth (PTB). The present study investigated whether maternal SES is associated with adverse outcomes in Japanese pregnant women. METHODS: Retrospective data were collected for 1970 Japanese women with singleton pregnancies who delivered between January 2007 and December 2011 at a single center: low SES group (n = 197); and controls (n = 1773). Low SES was defined according to the criteria of the Japanese pregnant-childbirth hospitalization support policy system. RESULTS: The low SES group included a significantly higher proportion of young women, women with single marital status, greater parity, pre-pregnancy smoking and a lack of regular employment (P < 0.001, respectively). The crude odds ratio (OR) for the association between low maternal SES and SGA was 1.80 (95% confidence interval [CI] 1.15-2.82, P = 0.010). After adjustment for baseline maternal age, parity, body mass index, smoking and gestational weight gain, the adjusted OR for the association between low maternal SES and SGA was 1.92 (95% CI 1.17-3.17, P = 0.010). No significant association was found between maternal SES and PTB. CONCLUSION: The present results suggest that low maternal SES is associated with SGA births in the Japanese population. Mitigation of low maternal SES could be urgent public health to prevent disadvantage birth outcome.

Being born with large birthweight is considered as a risk of non-communicable diseases later in life. However, it is not fully understood what kind of maternal dietary intake during pregnancy affect large birthweight. Therefore, we examined the association of dietary intakes and its changes during pregnancy with large-for-gestational-age (LGA) births in Japanese pregnant women. In the prospective study, 245 pregnant women who visited Kyoto Medical Center were enrolled. Nutrition survey using brief-type self-administered diet history questionnaire (BDHQ) at all trimester was completed in 171 pregnant women. Based on birthweight and gestational age, participants were divided into three groups, such as small-for-gestational-age (<10th, SGA, n=17), appropriate-for-gestational-age (≥10th and <90th, AGA, n=144), and LGA (≥90th, n=10) groups. Compared with those without LGA births, mothers with LGA births showed: 1) greater weight gain during pregnancy (LGA: 14.0±3.2 kg, AGA: 9.9±3.9 kg, SGA: 8.4±3.1 kg, p<0.05); 2) higher energy intake throughout pregnancy (LGA: 310±368 kcal, AGA: 7±490 kcal, SGA: -97±293 kcal, ptrend<0.05); 3) larger changes in plant oil and sucrose consumptions from the 1st to 2nd trimester, probably due to the results of greater consumption of bread, Western confectionery, Japanese confectionery, and mayonnaise and dressing during the same period (ptrend<0.05, respectively). Our results suggest that higher energy intake throughout pregnancy, as well as greater consumption of plant oil and sucrose from the first to second trimester could be associated with LGA births.

【目的】パタチン様ホスホリパーゼ3(PNPLA3)遺伝子多型(rs738409、C/G)は、非アルコール性脂肪性肝疾患(NAFLD)発症と病態悪化に関連することが知られている。小児期以降では、本遺伝子多型のGG型と食事中のn-6/n-3比との相互作用がNAFLD発症リスクとなるとの報告があるが、妊娠期における影響は不明な点が多い。そこで日本人妊婦において、PNPLA3遺伝子多型と食事中のn-6/n-3比の相互作用が妊娠中体重増加量に与える影響を検討した。【方法】日本人妊婦245人に、食物摂取頻度調査票を用いて妊娠初期、中期、後期の3回、食事調査を行った。基本情報や妊婦健診時の臨床・生化学データは診療録から得た。遺伝子多型解析は、TaqMan PCR法で行った。【結果】PNPLA3遺伝子多型の頻度はCC型0.232、CG型0.530、GG型0.238であった。GG型では、肝障害の指標であるALT値が妊娠後期時点でCG型より有意に高かった。またGG型において、妊娠後期のn-6/n-3比と妊娠中体重増加量が有意な正相関を示した。多変量解析から、妊娠後期のn-6/n-3比は、GG型の妊娠中体重増加量を規定する独立した因子であった。【結論】PNPLA3遺伝子GG型の日本人妊婦において、妊娠後期のn-6/n-3比が高い食事が妊娠中体重増加量を規定する要因の一つである可能性が示唆された。(著者抄録)

Maslinic acid, derived from olive fruit, reduces pro-inflammation cytokines, which are involved in muscle fiber atrophy. Therefore, the maslinic acid ingestion may enhance the muscular response to resistance training through anti-inflammatory action. We therefore conducted a parallel, double-blind, randomized, placebo-controlled trial that examined whether a combination of maslinic acid supplementation and resistance training improve mobility functions in community-dwelling elderly persons. Over a 12-week period, 36 participants underwent moderate resistance training and are assigned to the maslinic acid supplementation (n = 17, 60 mg/day) or the placebo (n = 19) group. At baseline and at 12-weeks, we assessed body composition, grip strength, walking speed, leg strength, mobility functions, and knee pain scores. Following the 12-weeks, skeletal muscle mass, segmental muscle mass (right arm, left arm, and trunk) and knee pain score of the right leg were significantly improved in the maslinic acid group, while there was no change or parameters had worsened in the placebo group. Grip strength of the better side significantly increased only in the maslinic acid group. These results suggest that maslinic acid supplementation combined with moderate resistance training may increase upper muscle mass and grip strength, and reduce knee pain, could be effective for preventing mobility-related disability in elderly persons. Clinical trial registration number: UMIN000017207.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder among reproductive-aged women. While PCOS is associated with an increased risk of obesity and insulin resistance, little is known regarding the prevalence of and risk factors for nonalcoholic fatty liver disease (NAFLD) among Japanese women with PCOS. We estimated the prevalence of and risk factors for elevated liver enzymes, as the index of NAFLD, in Japanese women with PCOS. Methods: We retrospectively reviewed 102 reproductive-aged women who visited the Department of Gynecology, Kyoto Medical Center in Japan from January 2000 to September 2016. Inclusion criterion was confirmed diagnosis of PCOS using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) codes. Exclusion criteria were women with a history of liver diseases, missing body mass index (BMI) and serum alanine aminotransferase (ALT) data, and pregnancy. Data regarding age; BMI; and levels of blood glucose, serum lipid, liver enzymes, and sex hormones were obtained from medical records. Elevated liver enzymes was defined as ALT > 19 IU/L. Optimal cutoffs for risk factors for elevated liver enzymes were calculated to determine predictors of elevated liver enzymes using area under the curve (AUC) by receiver-operating characteristics (ROC). Results: The prevalence of elevated liver enzymes was 33.3%. BMI was significantly higher in PCOS patients than in those without elevated liver enzymes (25.3 vs. 20.7 kg/m2, P < 0.05). ROC analyses were performed using BMI and blood glucose and testosterone levels because BMI and blood glucose showed differences between the groups and testosterone is related to fatty liver. AUC of the model including BMI and blood glucose and testosterone levels was 0.861 (sensitivity, 66.7%; specificity, 100%). Conclusions: These findings suggest that elevated liver enzymes are common in women with PCOS. An algorism using BMI and blood glucose and testosterone levels might be useful to determine elevated liver enzymes in women with PCOS. Our finding may be useful for the study of NAFLD among Japanese women with PCOS since several previous studies have indicated elevated liver enzymes to be related to the potential presence of NAFLD. Further examination, including abdominal ultrasonography and/or liver biopsy data, is required to confirm these results.

日本の若い女性は、全体として細身の体形へと変化してきており、エネルギー摂取量も経年減少している。このような体形や食べ方の変化の背景には、今よりもやせたい(理想体重との差は約4kg)という、強い「やせ」志向があることが知られている。この「やせ」志向が形成される要因のひとつに、メディアからの影響が挙げられる。メディアに登場する細身の体形の女性たちが他者からの賞賛や愛情、成功を獲得している姿は、やせた体形と社会的成功が結び付いているというメッセージとして視聴者に受け取られやすい。また、若い女性は他の年代の女性と比べて、体形において「他者との比較」に敏感であり、この傾向は人口規模の小さい地域より大都会で顕著にみられる。さらに、働く既婚女性において、良い妻、良い母でいると同時に、外見が魅力的で仕事でも成功することへのプレッシャーが、「やせ」に向かわせやすいことも指摘されている。栄養上の課題としては、若い女性の1日のエネルギー摂取量は減少し続けており、食事量そのものの減少を反映していると考えられる。その結果、微量栄養素や食物繊維の摂り方が十分ではなく、これらの供給源となる野菜や果物の摂り方も少ない。健康上の課題としては、ダイエット実施者での喫煙率の高さや、「やせ」志向者にみられる貧血および低い骨塩量などが挙げられる。容姿の美しさに価値が見出される社会では、女性は「今よりも細く、綺麗に」という願いを持ちやすく、IT機器の発達や巨大なソーシャルメディアによってその願いは拡散・増幅されやすい。さらに、身体活動量が少ない状態で食事を制限すると、除脂肪体重が減り不健康な「やせ」につながりやすい。しっかり食べてよく動くアクティブな生活を送ることや、体重のみでなく体組成にも関心を払うことの重要性について、より一層の情報提供や食育が行われることが望まれる。(著者抄録)

The color of food is known to modulate not only consumers' motivation to eat, but also thermal perception. Here we investigated whether the colors of hot soup can influence thermal sensations and body temperature, in addition to the food acceptability and appetite. Twelve young female participants consumed commercial white potage soup, modified to yellow or blue by adding food dyes, at 9 a.m. on 3 separated days. During the test, visual impression (willingness to eat, palatability, comfort, warmth, and anxiety) and thermal sensations were self-reported using visual analog scales. Core (intra-aural) and peripheral (toe) temperatures were continuously recorded 10 min before and 60 min after ingestion. Blue soup significantly decreased willingness to eat, palatability, comfort, and warmth ratings, and significantly increased anxiety feelings compared to the white and yellow soups. After ingestion, the blue soup showed significantly smaller satiety ratings and the tendency of lower thermal sensation scores of the whole body compared to the white and yellow soups. Moreover, a significantly greater increase in toe temperature was found with the yellow soup than the white or blue soup. In conclusion, this study provides new evidence that the colors of hot food may modulate postprandial satiety, thermal sensations and peripheral temperature. Such effects of color may be useful for dietary strategies for individuals who need to control their appetite.

PURPOSE: Smartphones are prevalently used among adolescents; however, nighttime exposure to blue-enriched light, through electric devices, is known to induce delays of the circadian rhythm phases and poor morning somatic conditions. We therefore investigated whether evening smartphone use may affect sleep-wake cycle and cardiac autonomic nervous system (ANS) activity after awaking in dormitory students. METHODS: The participants were high school students, living under dormitory rules regarding the curfew, study, meals, lights-out, and wake-up times. The students were forbidden from the use of both television and personal computer in their private rooms, and only the use of a smartphone was permitted. According to prior assessment of smartphone use, we chose age-, sex-, exercise time-matched long (n = 22, >120 min) and short (n = 14, ≤60 min) groups and compared sleep-wake cycle and physiological parameters, such as cardiac ANS activity, blood pressure, and intra-aural temperature. All measurements were performed during 6:30 to 7:00 a.m. in the dormitories. RESULTS: Compared with the short group, the long group showed a significantly lower cardiac ANS activity (2727 ± 308 vs. 4455 ± 667 ms2, p = 0.030) with a tendency toward a high heart rate, in addition to later bedtimes during weekdays and more delayed wake-up times over the weekend. Blood pressure and intra-aural temperature did not differ between the groups. CONCLUSIONS: In this population, evening smartphone use may be associated with altered sleep-wake cycle and a diminished cardiac ANS activity after awakening could be affecting daytime activities.

The 3111T/C single nucleotide polymorphism (SNP) of Circadian Locomotor Output Cycles Kaput (CLOCK) gene reportedly affects gastric motility before breakfast. It is of interest to know whether this SNP can affect the motility during the daytime. We investigated the association between the CLOCK 3111T/C SNP and several gastric motility parameters during the time period from 8:00 to 20:00 in 34 young women with scheduled meals. There were similar daytime fluctuations in gastric motility before and after the meals between the major (T/T) and minor (T/C) allele carriers. The CLOCK SNP may affect daytime gastric motility less than food stimulation.

We previously reported that carbonated water ingestion induced fullness and gastric motility. In order to determine whether such satiating effects occur through oral carbonic stimulation alone, we conducted modified sham-feeding (SF) tests (carbonated water ingestion (CW), water ingestion (W), carbonated water sham-feeding (CW-SF), and water sham-feeding (W-SF)), employing an equivalent volume and standardized temperature of carbonated and plain water, in a randomized crossover design. Thirteen young women began fasting at 10 p.m. on the previous night and were loaded with each sample (15ºC, 250 mL) at 9 a.m. on separate days. Electrogastrography (EGG) recordings were obtained from 20 min before to 45 min after the loading to determine the power and frequency of the gastric myoelectrical activity. Appetite was assessed using visual analog scales. After ingestion, significantly increased fullness and decreased hunger ratings were observed in the CW group. After the load, transiently but significantly increased fullness as well as decreased hunger ratings were observed in the CW-SF group. The powers of normogastria (2-4 cpm) and tachygastria (4-9 cpm) showed significant increases in the CW and W groups, but not in the CW-SF and W-SF groups. The peak frequency of normogastria tended to shift toward a higher band in the CW group, whereas it shifted toward a lower band in the CW-SF group, indicating a different EGG rhythm. Our results suggest that CO2-induced oral stimulation is solely responsible for the feeling of satiety. Moreover, different gastric-contraction rhythms (slow or fast) were induced by oral carbonic stimulation alone and carbonated water ingestion.