Association of High-Density Lipoprotein Subclasses Levels with Sleep Duration and Other Lifestyles in Middle-Aged and Elderly Women: Cross-Sectional Study

Objective: We aimed at investigating the association of high-density lipoprotein subclasses (HDL2-C and HDL3-C) levels with sleep duration, in comparison to other lifestyles in middle-aged and elderly women. Materials and Methods: A total of 69 women aged older than 40 who underwent "Anti-aging Health Checkups" were enrolled in the study. The analyses were conducted for all the subjects using personal data regarding clinical characteristics and lifestyle. Sleep duration was categorized into two groups of less than or more than 6 hrs. First, an analysis was performed to assess the correlation of two major HDL subclasses with various factors. Next, a multiple regression analysis was conducted to identify the association for each HDL2-C and HDL3-C with lifestyles such as sleep duration, daily breakfast, dinner time, habitual exercise, and drinking. Moreover, we examined the associations between HDL2-C and sleep duration combined with other lifestyle factors such as dinner time, daily breakfast, habitual exercise, and drinking. Results: In comparison to lifestyles, sleep duration had a strong association with only HDL2-C after adjustment for confounders. The "less 6 hrs sleep" group in combination with the "no exercise habit" or the "routine drinking habit" significantly decreased HDL2-C levels more than the assumed reference group. Regarding breakfast, there is a significant association between the "less than 6 hrs sleep with no daily breakfast" and the "more than 6 hrs sleep with daily breakfast." Conclusion: The results of this study may suggest that sufficient sleep might be significant for maintaining appropriate HDL2-C levels in middle-aged and elderly women under the condition that lifestyle might change during the ongoing COVID-19 pandemic.

Analysis of Comorbidity for Patients with Pancreatic Cysts in Medical Checkup Screening

OBJECTIVES

We investigated whether there is a difference in the frequency of comorbidity between patients with pancreatic cysts and those without pancreatic cysts by abdominal ultrasonography in patients undergoing medical checkup screening.

METHODS

The subjects were 6,627 patients who underwent abdominal ultrasonography at Tokai University Hachioji Hospital's Health Screening Center between April 2019 and March 2020.

RESULTS

Of the total 6,627 patients, 158 (2.4%) were pointed out to have pancreatic cysts. Multivariate analysis revealed that the related factors were female sex, age 60 years or older, diabetes, lung cancer, and uterine/ovarian cancer.

CONCLUSION

Unlike pancreatic cancer, pancreatic cysts are more common in women. In addition, it is known that pancreatic cysts have a high complication rate of cancers of other organs; lung cancer and uterine/ovarian cancer were identified as high-risk factors in this study.

Estimated Elovl6 and delta-5 desaturase activities might represent potential markers for insulin resistance in Japanese adults

Purpose

Results from a recent study indicated that lower stearic acid/palmitic acid (SA/PA) and arachidonic acid/dihomo-γ-linolenic acid (AA/DGLA) ratios were associated with metabolically unhealthy obesity. However, this has not been extensively studied in the Japanese population.

Methods

We recruited 291 Japanese subjects with serum free fatty acid profiles undergoing health examinations. Whole serum desaturase activity was estimated as the product: precursor ratio -SA/PA ratio for elongation of long-chain fatty acid family member 6 (Elovl6) and AA/DGLA for delta-5 desaturase (D5D). The determinants of Elovl6 and D5D activity were investigated using multiple regression analyses.

Results

The Elovl6 and D5D activities exhibited a negative correlation with the logmatic-transformed TG/HDL-C ratio and TyG index. Multiple regression analyses revealed that the TG/HDL-C ratio and TyG index were negatively associated with Elovl6 and D5D activities. Most atherogenic markers were worse in the low Elovl6 or D5D activity group than in the high Elovl6 or D5D activity group. When study subjects were further stratified by TG levels, most atherogenic markers were the worst in the highest TG group in either the lowest Elovl6 or lowest D5D activity groups.

Conclusion

The estimated Elovl6 and D5D activities might be useful markers of insulin resistance in Japanese subjects.

Usefulness of Triglyceride to High-Density Lipoprotein Ratio and Alanine Aminotransferase for Predicting Insulin Resistance and Metabolic Syndrome in the Japanese Population

Background: Considering the fact that both alanine aminotransferase (ALT) and the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio are useful markers for cardiovascular disease, insulin resistance (IR), and metabolic syndrome (MetS), the possible association of ALT and TG/HDL-C ratio is conceivable, but the association is not well studied. Moreover, assessment of IR and MetS by a combination lipid and liver biomarkers has rarely been carried out. Methods: A total of 11,808 Japanese subjects who underwent an annual health examination and who were not taking medications were recruited. The association between TG/HDL-C ratio and ALT level was investigated using correlation and multiple linear regression analyses. Homeostasis model assessment of insulin resistance (HOMA-IR) and the number of MetS components were evaluated after subjects were stratified by TG/HDL-C ratio and ALT levels. Results: Correlation analysis revealed that ALT levels were positively associated with TG/HDL-C ratio. Moreover, multiple linear regression analysis revealed that TG/HDL-C ratio was positively associated with ALT levels, and the association was attenuated but persisted in both men and women after additional adjustment for visceral adiposity (body mass index, waist circumference, or fatty liver) and IR (HOMA-IR). HOMA-IR and MetS component number increased with either ALT or TG/HDL-C ratio in both men and women. HOMA-IR and MetS component number were particularly high (HOMA-IR: men 2.82, women 3.22, MetS component number: men 2.6, women 2.1) in subjects with highest ALT level and TG/HDL-C ratio. Conclusions: TG/HDL-C ratio showed a positive association with ALT levels in both sexes. Assessments of IR and MetS can become more precise by evaluating TG/HDL-C ratio and ALT, simultaneously.

The Association between the Triglyceride to High-density Lipoprotein Cholesterol Ratio and Low-density Lipoprotein Subclasses

Objective The triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is related to insulin resistance (IR). However, information about whether or not the TG/HDL-C ratio is associated with low-density lipoprotein (LDL) subclasses in the Japanese population is limited. Methods In total, 1,068 Japanese subjects who underwent an annual health examination and who were not taking medications were recruited. The association between the TG/HDL-C ratio and LDL subclasses was investigated using correlation, multiple regression, and receiver operating characteristic analyses. Results A correlation analysis revealed that both malondialdehyde-modified low-density lipoprotein (MDA-LDL) and small dense low-density lipoprotein cholesterol (sdLDL-C) were positively associated with the TG/HDL-C ratio. Furthermore, a multiple linear regression analysis revealed that the TG/HDL-C ratio was positively associated with MDA-LDL and sdLDL-C in both men and women. The multiple logistic regression analysis also revealed that the TG/HDL-C ratio was positively associated with the upper tertile of MDA-LDL and sdLDL-C in men and women. The LDL-C levels increased with the increasing TG/HDL-C ratio. The MDA-LDL and sdLDL-C are known to be positively associated with LDL-C. However, within the same LDL-C range, both MDA-LDL and sdLDL-C levels increased with the TG/HDL-C ratio, except for MDA-LDL levels in the LDL-C <112 mg/dL group in women. These results further supported the notion that the TG/HDL-C ratio was positively associated with the MDA-LDL and sdLDL-C levels, especially in the higher LDL-C range, in both men and women. The optimal cut-off points of the TG/HDL-C ratio for the upper tertile of MDA-LDL and sdLDL-C were 1.85 and 2.03 in men and 0.88 and 1.30 in women, respectively. Conclusion The TG/HDL-C ratio is positively associated with MDA-LDL and sdLDL-C in Japanese subjects. The relationship was particularly notable in subjects with high LDL-C levels.

Oleic acid to stearic acid ratio might be a potential marker for insulin resistance in non-obese Japanese

Results from a recent study indicate that a higher level of oleic acid/stearic acid ratio was associated with metabolically unhealthy obesity. This was further validated in cross-sectional and interventional studies; however, this was not extensively studied in a non-obese population. We recruited 260 Japanese subjects with serum free fatty acid profiles undergoing anti-aging health examinations. The determinants for oleic acid/stearic acid ratio were investigated using multiple regression analyses. To compare different markers, the subjects were classified based on oleic acid/stearic acid ratio and the combination of oleic acid/stearic acid ratio and triglyceride levels. The oleic acid/stearic acid ratio exhibited a positive correlation with the logmatic transformed triglyceride/high-density lipoprotein cholesterol ratio and the fasting triglycerides-glucose index, both of which were used as markers for insulin resistance. Multiple regression analyses revealed that the triglyceride/high-density lipoprotein cholesterol ratio and fasting triglyceride-glucose index were positively associated with the oleic acid/stearic acid ratio. Most markers were the worst in the highest triglyceride group in both oleic acid/stearic acid groups. In addition, most markers were worse in high oleic acid/stearic acid ratio group than low group. In conclusion, oleic acid/stearic acid ratio might be a useful marker for insulin resistance in non-obese Japanese subjects.

Associations Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Metabolic Syndrome, Insulin Resistance, and Lifestyle Habits in Healthy Japanese

Background: The triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is related to insulin resistance (IR). However, little information is available on whether TG/HDL-C is associated with IR and components of metabolic syndrome (MetS) and how lifestyle habits affect TG/HDL-C in the healthy Japanese population. Methods: In total, 1068 Japanese subjects who had undergone an annual health examination and who were not receiving medication were recruited. Determinants for TG/HDL-C ratio were investigated using multiple regression analyses. The subjects were divided into three groups by lifestyle habits (i.e., smoking, exercise, and physical activity), homeostasis model assessment of IR (HOMA-IR), and fasting plasma glucose, four groups by alcohol intake, and five groups by numbers of MetS components to compare TG/HDL-C values. All analyses were done separately by sex. Results: Multiple regression analyses revealed that waist circumference and smoking were positively associated with TG/HDL-C in both men and women, whereas physical activity was negatively associated with TG/HDL-C ratio in women. TG/HDL-C increased with increasing number of MetS in both men and women. TG/HDL-C increased as HOMA-IR increased in both men and women, when subjects were stratified according to HOMA-IR. TG/HDL-C values were lower in both men and women who exercised regularly, had high physical activity, or were nonsmokers. Independent of exercise and physical activity, TG/HDL-C was higher in smokers than in nonsmokers for both men and women. The relationship between TG/HDL-C and alcohol intake was not statistically significant in both men and women. Conclusions: The TG/HDL-C ratio is associated with IR, components of MetS, exercise, physical activity, and smoking, but not alcohol intake, in healthy Japanese subjects.

The Association Between the Serum Uric Acid to Creatinine Ratio and Metabolic Syndrome, Liver Function, and Alcohol Intake in Healthy Japanese Subjects

Background: In patients with diabetes mellitus, the serum uric acid (UA) to creatinine (Cr) ratio (UA/Cr) has been reported to be associated with a higher risk of metabolic syndrome (MetS). In healthy subjects, however, this relationship and a possible association with pathological conditions remain undetermined. Methods: In total, 9104 Japanese subjects who had undergone an annual health examination and who were not receiving medication were divided into four groups based on UA/Cr values, and various markers were compared. Results: Anthropometric measures, blood pressure, glycemic state, lipids [except high-density lipoprotein cholesterol (HDL-C)], renal function, transaminases, and numbers of MetS components increased, according to UA/Cr quartiles, as the UA/Cr increased. In contrast, HDL-C and Cr decreased as the UA/Cr increased. UA/Cr values increased as the number of MetS increased. When UA/Cr values within each alcohol consumption group were investigated, the overall metabolic profile was the worst in subjects who consumed ≥75 grams ethanol a day with a UA/Cr of ≥6.8, except for fasting immunoreactive insulin (FIRI), homeostasis model assessment of insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), and HDL-C values. Subjects who did not consume alcohol with a UA/Cr of ≥6.8 showed the highest FIRI, HOMA-IR, and LDL-C values. Conclusions: The UA/Cr was associated with components of MetS, liver function, and alcohol intake in healthy Japanese subjects. The UA/Cr might be a useful marker to distinguish subjects with high IR and dyslipidemia who do not consume alcohol.

Low-density Lipoprotein Subclasses are Associated with Serum Uric Acid Levels

BACKGROUND

Levels of uric acid (UA) and low-density lipoprotein (LDL) subclasses are both associated with coronary heart disease and metabolic syndrome (MetS). However, the relationship between UA and LDL subclasses is not well understood.

METHODS

Subjects included 633 Japanese subjects not receiving medication for hyperuricemia, diabetes mellitus, dyslipidemia, or chronic renal disease who underwent an annual health examination that included determination of small, dense low-density lipoprotein cholesterol (sdLDL-C) and malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels.

RESULTS

Serum UA exhibited a positive correlation with both sdLDL-C and MDA-LDL (r = 0.335 and 0.339, respectively). Since sdLDL-C and MDA-LDL show strong positive association, sdLDL-C and MDA-LDL were used as separate explanatory variables in multiple linear regression analysis. Male gender, waist circumference (WC), high-density lipoprotein cholesterol (HDL-C), logarithmic transformed triglyceride (TG) [ln(TG)], and MDALDL as a group were associated with serum UA. Similarly, male gender, body mass index (BMI), ln(TG), and sdLDL-C as a group were associated with serum UA. These results further supported that both MDA-LDL and sdLDL-C levels were positively correlated with serum UA levels. Evaluation of subjects' characteristics according to tertile UA values (tertile 1, < 5.0 mg/dL; tertile 2, 5.0 - < 6.3 mg/dL; tertile 3, ≥ 6.3 mg/dL) indicated that MDALDL and sdLDL-C levels gradually increased with increasing UA levels. Additionally, the upper third UA tertile was associated with the worst metabolic profile based on BMI, WC, blood pressure, fasting plasma glucose, fasting immunoreactive insulin, homeostasis model assessment insulin resistance, TG, HDL-C, and the number of MetS components.

CONCLUSIONS

Both LDL particle size and oxidized LDL were associated with serum UA levels in Japanese subjects.

Evaluation of Malondialdehyde Low-Density Lipoprotein Stratified by Low-Density Lipoprotein Cholesterol

BACKGROUND

Malondialdehyde low-density lipoprotein (MDA-LDL) is a major form of oxidized LDL and considered to be more atherogenic than LDL. Information on major determinants of MDA-LDL and their association in subjects who are not under treatment for diabetes mellitus and dyslipidemia is limited.

METHODS

This study included 778 Japanese subjects who were not taking medication for diabetes mellitus and dyslipidemia. All subjects underwent an annual health examination that included MDA-LDL analysis. Study subjects were divided into four groups according to mean values of LDL-C and MDA-LDL, and the metabolic profile was compared.

RESULTS

LDL cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were mainly associated with MDA-LDL. When subjects were stratified based on LDL-C levels, small dense LDL-C and MDA-LDL levels increased as LDL-C levels increased. Comparison of the characteristics of study subjects in the same LDL-C level group revealed that subjects with high MDA-LDL showed high metabolic risk in all LDL-C groups, particularly notable in the group with LDL-C levels < 120 mg/dL.

CONCLUSIONS

Our data indicated that high LDL-C and low HDL-C levels were independently associated with high MDA-LDL. To prevent high MDA-LDL, it is important to lower LDL-C level as well as to increase HDL-C even in subjects with low LDL-C level by lifestyle modification.

Non-HDL Cholesterol is a More Superior Predictor of Small-Dense LDL Cholesterol than LDL Cholesterol in Japanese Subjects with TG Levels ＜400 mg/dL

Aim: The Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and treatment of hyperlipidemia in Japanese adults recommend using low-density lipoprotein cholesterol (LDL-C) calculated by Friedewald formula (F_LDL-C) for subjects with triglyceride (TG) levels <400 mg/dL and non-high-density lipoprotein cholesterol (non-HDL-C) levels for subjects with TG levels ≥400 mg/dL. Because small-dense LDL particles are more atherogenic than large LDL particles, we sought the better lipid parameter which was more reflective of the high small-dense LDL-C (sdLDL-C) levels in subjects with TG levels <400 mg/dL.

Methods: This study included 769 Japanese subjects who met our inclusion criteria and underwent an annual health examination, including sdLDL-C analyses.

Results: The correlation coefficient of non-HDL-C for sdLDL-C (r = 0.760) was significantly higher than that of F_LDL-C (r = 0.601). The area under the curve (95% confidence interval) was 0.771 (0.731, 0.811) for F_LDL-C and 0.871 (0.842, 0.901) for non HDL-C, which showed significantly higher predictive value for more than fourth quartile value of sdLDL-C (46 mg/dL). The optimal cut-off point of non-HDL-C was 158 mg/dL. Even in subjects stratified by waist circumstance, homeostasis model assessment of insulin resistance, TG, and F_LDL-C levels and non-HDL-C showed stronger relationships with sdLDL-C than F_LDL-C. Moreover, non-HDL-C showed a better relationship with sdLDL-C than total cholesterol (TC), TC/HDL-C, and non-HDL-C/HDL-C.

Conclusion: Our data suggested that non-HDL-C is superior to F_LDL-C and one of the reliable surrogate lipid markers of sdLDL-C in Japanese subjects with TG levels <400 mg/dL.

HDL2/HDL3 Ratio Changes, Metabolic Syndrome Markers, and Other Factors in a Japanese Population

AIM AND METHODS

The high-density lipoprotein 2 cholesterol (HDL2-C) to HDL3-C ratio is associated with insulin resistance, high-molecular-weight adiponectin (HMW-Ad), and metabolic syndrome (MetS) components and is useful for evaluating MetS in Japanese individuals. We investigated potential associations between changes in HDL2-C/HDL3-C and changes in MetS components, insulin resistance, adipocytokine, lipids, and lifestyle habits in 892 Japanese subjects who underwent annual health examinations twice at a mean interval of 1.1 years. Study subjects were divided into three groups on the basis of HDL2-C/HDL3-C changes.

RESULTS

Average changes in waist circumference (WC) and HDL-C were significantly lower and higher, respectively, in the 0 to ＜0.5 and ≥0.5 HDL2-C/HDL3-C change groups compared with those in the reference group (＜0 HDL2-C/HDL3-C change). Among MetS components, average changes in HDL2-C/HDL3-C were associated with changes in WC and HDL-C. Average changes in HMW-Ad and the homeostasis model assessment of insulin resistance were significantly higher and lower, respectively, in the ≥0.5 HDL2-C/HDL3-C change group compared with those in the reference group. In addition, the average low-density lipoprotein cholesterol (LDL-C) gradually decreased as HDL2-C/HDL3-C increased. The average change in LDL-C was significantly lower in the 0 to ＜0.5 and ≥0.5 HDL2-C/HDL3-C change groups than in the reference group. Moreover, a ≥0.5 HDL2-C/HDL3-C change positively correlated with good lifestyle statuses in terms of smoking, physical activity, and alcohol consumption.

CONCLUSION

Changes in HDL2-C/HDL3-C inversely correlated with changes in WC, insulin resistance, and LDL-C and positively correlated with HMW-Ad and good lifestyle habits. Therefore, HDL2-C/HDL3-C changes comprise a useful marker for both MetS and atherogenic conditions in Japanese population.

HDL2-cholesterol/HDL3-cholesterol ratio was associated with insulin resistance, high-molecular-weight adiponectin, and components for metabolic syndrome in Japanese

AIMS

Recent data have suggested a relationship between the high-density lipoprotein (HDL) subclass ratio and metabolic syndrome (MetS). However, limited information is available regarding the relationships between the HDL subclass ratio and insulin resistance, associated adipocytokine levels, and MetS components. The associations of the high-density lipoprotein 2 cholesterol (HDL2-C) to high-density lipoprotein 3 cholesterol (HDL3-C) ratio with the homeostasis model assessment of insulin resistance (HOMA-IR) index, high-molecular-weight adiponectin (HMW-Ad) levels, and MetS components were examined.

METHODS

The study included 1155 Japanese subjects who met our inclusion criteria and underwent an annual health examination that included an HDL subclass analysis.

RESULTS

The HDL2-C/HDL3-C ratio and the HMW-Ad level gradually decreased as the number of MetS components increased. In contrast, HOMA-IR gradually increased as the number of MetS components increased. The HDL2-C/HDL3-C ratio correlated inversely with HOMA-IR and positively with the HMW-Ad level. A strong positive correlation was observed between the HDL2-C/HDL3-C ratio and the HDL-C level. The HDL2-C/HDL3-C ratio exhibited moderate negative correlations with the body mass index, waist circumference, and triglyceride level. Weak negative correlations were observed for the HDL2-C/HDL3-C ratio with the systolic and diastolic blood pressure and fasting plasma glucose levels.

CONCLUSIONS

Our data indicated that the HDL2-C/HDL3-C ratio was associated with insulin resistance, the HMW-Ad level, and MetS components, and it was useful for evaluating MetS in Japanese individuals.

Relationship between Hb and HbA1c in Japanese adults: an analysis of the 2009 Japan Society of Ningen Dock database

We investigated the effect of Hb on HbA1c levels in 265,427 Japanese individuals. The divergence between fasting plasma glucose (FPG) and HbA1c levels increased with lower Hb, resulting in HbA1c levels that were higher in relation to than the FPG levels. Similarly, the correlation between FPG and HbA1c levels, stratified by Hb, weakened as Hb decreased.

Lifestyle and glycemic control in Japanese adults receiving diabetes treatment: an analysis of the 2009 Japan Society of Ningen Dock database

We investigated the level of glycemic control in 7020 patients treated with diabetes medications. We found that the overall mean HbA1c was 7.3% (56 mmol/mol). Over half had HbA1c levels ≥7.0% (53 mmol/mol) and poorer glycemic control was associated with unhealthy lifestyle habits.

Status of diabetes treatment in Japanese adults: an analysis of the 2009 Japan Society of Ningen Dock database

OBJECTIVE

The Japan Diabetes Society (JDS) has recommended target levels of glycemic control based on guidelines for the management of diabetes mellitus (DM). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations nationwide. Using this database, we evaluated the efficacy of current treatment for patients with DM based on the JDS recommendations.

METHODS

This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. In order to assess the level of glycemic control in the Japanese population, we analyzed previously obtained measurements of HbA1c in 7,180 patients 20 to 79 years of age (mean age: 57.9 ± 8.7 years, 6,007 men and 1,173 women) taking DM medications.

RESULTS

According to the JDS guidelines, 44.7% of the patients fell into the good glycemic control group, with an HbA1c level of <7.0% while 22.4% were classified into the poor glycemic control group, with an HbA1c level of ≥ 8.0%. The control of other arteriosclerosis risk factors deteriorated as the glycemic control deteriorated. Lifestyle factors were strongly found to be associated with glycemic control in the patients receiving DM treatment.

CONCLUSION

Aggressive lifestyle modification is needed to improve glycemic control in patients with DM.

Status of lipid management using lifestyle modification in Japanese adults: an analysis of the 2009 Japan Society of Ningen Dock database

OBJECTIVE

The Japan Atherosclerosis Society (JAS) has recommended serum lipid management goals (SLMGs) based on the coronary heart disease (CHD) risk classification included in its 2007 guidelines for the diagnosis and prevention of atherosclerotic cardiovascular disease in the Japanese population (JAS GL 2007). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations. Using this database, we evaluated the lifestyles of patients with dyslipidemia by identifying risk factors for CHD development based on the JAS recommendations.

METHODS

A total of 223,407 adults (men: 138,435; women: 84,972) aged between 20 and 79 years were enrolled in the analysis. Those who were already being treated for dyslipidemia and had a history of CHD were excluded. CHD risk factors in the JAS GL 2007, such as an advanced age, hypertension, diabetes mellitus, smoking habits, a family history of coronary artery disease, and low high-density lipoprotein cholesterol levels, were used for the evaluation. The subjects were categorized into three groups (Categories I, II and III) according to the number of risk factors other than the low-density lipoprotein cholesterol (LDL-C) level. We evaluated the percentage of goals met during primary prevention in each group. The serum LDL-C levels were calculated using the Friedewald formula. The LDL-C levels were measured using a direct homogeneous assay if the triglyceride level was ≥400 mg/dL.

RESULTS

Overall, 72.9% of the subjects achieved their SLMGs. Most subjects (>90%) with no CHD risk factors other than the LDL-C level in Category I achieved their SLMGs, while less than half of the subjects in Category III achieved their goal.

CONCLUSION

Smoking cessation and medication administration should be considered in patients in Categories II and III.

Status of dyslipidemia treatment in Japanese adults: an analysis of the 2009 Japan Society of Ningen Dock database

OBJECTIVE

The Japan Atherosclerosis Society (JAS) has recommended serum lipid management goals (SLMGs) based on the coronary heart disease (CHD) risk classification included in its 2007 guidelines for the diagnosis and prevention of atherosclerotic cardiovascular disease in the Japanese population (JAS GL 2007). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations at 21 institutes nationwide. Using this database, we evaluated the efficacy of current treatment for patients with dyslipidemia by identifying risk factors for CHD development, based on the JAS recommendations.

METHODS

This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. 17,991 adults taking dyslipidemia medications were enrolled. The JAS GL 2007 was used for evaluation. Since the guideline indicated separate goals (secondary prevention for subjects with a prior history of CHD and primary prevention for those with other CHD risk factors), we evaluated the percentages of goals met. The serum low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald formula. The LDL-C level was measured using a direct homogeneous assay if the triglycerides (TG) level was 400 mg/dL or higher.

RESULTS

The achievement rates of the SLMGs were as follows: LDL-C, 72.3%; high-density lipoprotein cholesterol (HDL-C), 94.6%; and TG, 69.7%.

CONCLUSION

Our results regarding Japanese patients receiving dyslipidemia treatment for CHD prevention identified insufficient reductions in the levels of LDL-C and TG in those at high risk for CHD and suggest the need for more aggressive lipid-lowering therapy.

Prediction of homeostasis model assessment of insulin resistance in Japanese subjects

OBJECTIVE

In our previous study, multivariate analysis showed that body mass index (BMI), triglycerides (TG) levels, and systolic blood pressure (SBP), in addition to fasting plasma glucose (FPG) levels, significantly correlated with homeostasis model assessment of insulin resistance (HOMA-IR). Our aim was to develop a predictive tool for HOMA-IR using tests of the specific health examinations.

METHODS

We enrolled 7,248 Japanese adults (3,793 men, and 3,455 women) in this cross-sectional study. A multiple regression model for predicting HOMA-IR was created using laboratory tests and lifestyle habits in the specific health examination.

RESULTS

HOMA-IR prediction index was developed using routinely measured parameters (BMI; levels of FPG, TG, and high-density lipoprotein cholesterol; BP; exercise; and physical activity), and did not require measurement of immunoreactive insulin levels. The prediction accuracy of the model was considered good, as indicated by R2 values (men, 0.465; women, 0.405).

CONCLUSION

The predictive tool for HOMA-IR using specific health examination tests allows healthcare professionals to estimate an individual's overall risk of metabolic syndrome (MetS). We propose that this tool can be used as an aid in health guidance for MetS.

Relationship between transitions in self-rated health and health indicators in Japanese workers

OBJECTIVE

Self-rated health (SRH) reflects lifestyle habits, chronic disease, and psychosocial conditions. The aim of this study was to examine the relationship between transitions in SRH and health indicators among Japanese white-collar workers.

METHODS

Three-year medical examination data from an occupational field was used. The distribution of data related to SRH, lifestyle habits, treatment of chronic disease, laboratory data abnormalities, job stress, and sickness absences were compared using ridit analysis, and the odds ratios and 95% confidence intervals were calculated using the first year of observation as a reference.

RESULTS

During the observation period, the proportion of workers with poor SRH, self-rated lifestyle habits, sleep, dietary habits, and body mass index increased. Particularly, high job stress (heavy job burden and low job control) and few sickness absences were strongly related to poor SRH.

CONCLUSIONS

Unfavorable lifestyles and work-related conditions worsened as SRH declined among workers. The results suggest that health indicators related to SRH are different according to the population. Tracking changes in SRH using indices related to SRH is useful for evaluating the health status in a target group.

Risk assessment chart for predicting fatty liver in Japanese subjects

OBJECTIVE

The diagnosis of fatty liver is done mainly by ultrasonography, which it is not included in the usual health checkup examinations. The aim of this study was to develop an index to predict the existence of fatty liver using tests that are part of specific health examinations.

METHODS

A total of 7,305 Japanese (4,042 men; 3,263 women) who underwent annual health checks were enrolled. Body mass index (BMI), Waist circumference (WC), blood pressure, and levels of triglyceride (TG), high-density lipoprotein cholesterol, fasting plasma glucose (FPG), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase were used to predict fatty liver, and a stepwise procedure was used to select an optimal subset of dummy regressors. The probabilities for predicting fatty liver were calculated from the logistic regression equation using the constant and coefficients for each variable.

RESULTS

Risk assessment charts for predicting the probability of fatty liver were developed. These probabilities were displayed in a color-coded manner by combining BMI, TG, FPG, ALT, and WC.

CONCLUSION

Our fatty liver-predicting index consisted of the components of metabolic syndrome (MetS) and ALT, thus indicating a close relationship of fatty liver and MetS. The use of this index enables quantitative assessments of the severity of MetS.

Evaluation of high-density lipoprotein cholesterol levels in Japanese women

OBJECTIVE

The aim of the present study was to clarify the significance of high levels of high-density lipoprotein cholesterol (HDL-C) in Japanese women receiving an annual health check-up.

METHODS

A total of 1879 women who were not taking medication for hypertension, diabetes or dyslipidemia, with no prior history of ischemic heart disease, cerebrovascular disease or chronic renal failure were analyzed. First, the association between HDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) was studied. Next, the association between HDL-C and the number of metabolic syndrome (MetS) risk factors, including HOMA-IR, was determined. In addition, clinical parameters including HOMA-IR, number of MetS risk factors, smoking, exercise, and alcohol consumption habits were compared according to HDL-C level.

RESULTS

HOMA-IR was lower in subjects with elevated HDL-C. Additionally, a lower body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides (TG) were observed in subjects with higher HDL-C. Moreover, the proportion of subjects who were obese, or those who had high FPG, high TG, and a high number of MetS risk factors was lower in subjects with higher HDL-C. Both obesity and smoking were associated with reduced HDL-C levels. Increasing levels of alcohol consumption, from < 25 g/day, to 25 -< 50 g/day, to 50 -< 75 g/day, were associated with a progressive increase in HDL-C level, but a progressive reduction in HOMA-IR. However, this apparent benefit of alcohol intake on HDL-C and HOMA-IR disappeared in subjects who drank ≥ 75 g/day.

CONCLUSIONS

Female subjects who were not obese, did not smoke, and drank < 75 g alcohol/day had elevated HDL-C levels, which were associated with improved insulin sensitivity. Drinking alcohol in excess of 75 g/day appeared to provide no advantages in terms of HDL-C or HOMA-IR levels. Thus, it might be important for females to keep their alcohol intake below 75 g/day.

Optimal cut-off point for homeostasis model assessment of insulin resistance to discriminate metabolic syndrome in non-diabetic Japanese subjects

We have recently established a 'health-associated' reference interval of homeostasis model assessment of insulin resistance (HOMA-IR) between 0.4 and 2.4. In the present study, the aim was to establish a 'decision-based' limit of HOMA-IR for the discrimination of metabolic syndrome (MetS) in non-diabetic Japanese subjects. The receiver-operating characteristic curve of HOMA-IR for detecting MetS was developed using data from 6868 non-diabetic subjects (3727 men, 3141 women). The optimal cut-off point was determined based on the point that yielded the minimum value of the square root of [(1 - sensitivity)(2) + (1 - specificity)(2)]. HOMA-IR = 1.7 was determined as the optimal cut-off value, with a sensitivity and specificity of 73.4% and 70.5% for men, and 81.5% and 77.0% for women, respectively. In conclusion, the optimal cut-off value for HOMA-IR to discriminate MetS in non-diabetic Japanese subjects appears to be 1.7. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00194.x, 2012).

Association between insulin resistance and metabolic syndrome risk factors in Japanese

Aims/Introduction:  It is important to identify individuals at risk of metabolic syndrome (MetS), namely those with insulin resistance. Therefore, the aim of the present study was to find anthropometric and metabolic parameters that can better predict insulin resistance.

SUBJECTS AND METHODS

  We selected 3899 individuals (2058 men and 1841 women), excluding those with fasting plasma glucose (FPG) ≥126 mg/dL, on medication for hypertension, dyslipidemia or diabetes, and those with a history of advanced macrovascular disease. Using multivariate analyses, we selected components for obesity, lipids, and blood pressure based on the strength of their association with the homeostasis model assessment of insulin resistance (HOMA-IR).

RESULTS

  In multiple linear regression analysis, body mass index (BMI), waist circumference (WC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and systolic blood pressure (SBP) were selected in men and women, and the effect of BMI on HOMA-IR outweighed that of WC. In multiple logistic regression analysis, BMI, TG, and SBP were significantly associated with HOMA-IR ≥2.5 in both genders, but WC and HDL-C were only selected in men. Combinations of BMI, TG, SBP, and FPG showed higher HOMA-IR values than those of the existing MetS components, considered useful for the identification of individual with higher insulin resistance.

CONCLUSIONS

  Body mass index, TG and SBP were selected as components significantly related to insulin resistance. The selected components were fundamentally adherent to the existing MetS criteria, the only difference being the measure of obesity, in which a stronger association with insulin resistance was observed for BMI than WC. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00162.x, 2011).

Self-rated health as a comprehensive indicator of lifestyle-related health status

OBJECTIVES

To evaluate the usefulness of self-rated health (SRH) as a comprehensive indicator of lifestyle-related health status by examining the relationships between SRH and: (1) history of cancer and cardiovascular disease; (2) treatment of hypertension, diabetes, and dyslipidemia; (3) abnormalities in clinical parameters including blood pressure, fasting glucose, and lipids; and (4) lifestyle habits.

METHODS

3744 health-check examinees at Tokai University Hachioji Hospital seen between April 2009 and March 2010 were enrolled. SRH was graded as "good," "relatively good," "relatively poor," or "poor." For statistical comparison, the differences among "healthy" (=good), "relatively healthy" (=relatively good), and "unhealthy" (=relatively poor plus poor) groups were examined. Mantel-Haenszel odds ratios were calculated to remove the confounding effect of age, using the healthy group as the reference. The Mantel-extension method was used as a trend test.

RESULTS

1049 subjects rated their health as good, 2194 as relatively good, 428 as relatively poor, and 73 as poor. The prevalence of all diseases showed significant odds ratios and trends as SRH deteriorated. Obesity, blood pressure, glucose metabolism, and lipids deteriorated significantly as SRH became poorer, and a trend was observed in all parameters. Weight change, exercise, smoking, and rest showed significant odds ratios and trends as SRH deteriorated.

CONCLUSION

SRH appears useful as a comprehensive indicator of lifestyle-related health status.

Long-term detraining increases the risk of metabolic syndrome in Japanese men

OBJECTIVE

The aim of the present study was to examine the effect of long-term detraining on metabolic syndrome (MetS).

METHODS

1109 Japanese men were categorized by their exercise habits. Clinical data, number of MetS risk factors, and differences in lifestyle-related behaviors of the non-training group (n = 233) and the detraining group (n = 483) were compared with those of the training group (n = 87).

RESULTS

Waist circumference and body mass index were significantly higher in the non-training group and the detraining group than in the training group, and also higher in the detraining group than in the non-training group. High-density lipoprotein cholesterol (HDL-C) was lower and low-density lipoprotein cholesterol (LDL-C) was higher in the non-training group and the detraining group than in the training group. Both the non-training group and the detraining group had more MetS risk factors than the training group. The odds ratio for smoking was higher in the detraining group than in the training group.

CONCLUSIONS

Detraining results in similar degrees of obesity, low HDL-C, high LDL-C, and high MetS risk as non-training. To prevent lifestyle-related diseases, it is particularly important not only to encourage adults to become physically active, but also discourage active young people from discontinuing physical exercise.