Positive Association Between Sleep Disturbance and Prevalence of Functional Dyspepsia in Japanese Young People

BACKGROUND

Evidence regarding the association between sleep disturbance and functional dyspepsia (FD) remains limited in the young population.

AIMS

This study aimed to investigate the association between sleep disturbance and FD including subgroups among Japanese young people.

METHODS

Study subjects were 8923 university students. FD was defined according to the Rome III criteria. Subjects with FD were further categorized as having postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS). Subjects completed a self-reported questionnaire assessing self-reported sleep duration, sleep disturbance, difficulty falling asleep, deep sleep disorder, nocturnal awakening, early awakening, and daytime sleepiness.

RESULTS

The prevalence of FD was 1.9%. After adjustment, all types of sleep disturbances were independently positively associated with FD (total sleep disturbance: OR 4.11 [95% CI: 2.89-5.78], difficulty falling asleep: OR 3.97 [95% CI: 2.53-6.01], deep sleep disorder: OR 4.85 [95% CI: 3.06-7.40], nocturnal awakening: OR 4.35 [95% CI: 1.90-8.67], early awakening: OR 4.50 [95% CI: 1.97-8.97], and daytime sleepiness: OR 2.83 [95% CI: 1.25-5.56]). While nocturnal awakening and daytime sleepiness were not associated with EPS, the other types of sleep disturbance were independently positively associated with EPS and PDS. No association between self-reported sleep duration and FD was found.

CONCLUSIONS

Sleep disturbance may be independently positively associated with the prevalence of FD among Japanese young people. Nocturnal awakening and daytime sleepiness were not associated with EPS; the other types of sleep disturbance were independently positively associated with EPS and PDS.

Association between menstrual pain and functional dyspepsia in a Japanese young population

BACKGROUND

Functional dyspepsia (FD) is a very common disease worldwide. Dysmenorrhea impairs quality of life among females of reproductive age. Although dysmenorrhea is associated with irritable bowel syndrome (IBS), no study has yet evaluated the association between dysmenorrhea and FD.

METHODS

This study's subjects consisted of 4693 female Japanese university students. We defined FD according to the Rome III criteria. Subjects completed a self-reported questionnaire regarding menstrual irregularity, menstrual pain, and medication for menstrual pain. Age, body mass index, drinking, smoking, exercise habit, anemia, and first-year student status were selected as potential confounding factors.

RESULTS

The prevalence of FD, epigastric pain syndrome (EPS), and postprandial distress syndrome (PDS) was 2.5%, 0.6%, and 2.1%, respectively. Heavy menstrual pain was independently positively associated with FD and PDS but not EPS (adjusted ORs: FD, 3.18 [95% CI: 1.60-6.89] and PDS, 2.93 [95% CI: 1.56-7.93] for heavy menstrual pain, p for trend = 0.001 and 0.004, respectively). Using medication for menstrual pain often was independently positively associated with FD, EPS, and PDS, respectively, (adjusted ORs: FD, 2.41 [95% CI: 1.50-3.83], EPS, 2.93 [95% CI: 1.04-7.93], PDS, 2.44 [95% CI: 1.46-4.01]). Irregular menstrual cycle was not associated with FD or with subtype of FD.

CONCLUSION

Among the young female Japanese population, menstrual pain might be independently positively associated with FD and PDS but not EPS. The use of medication for menstrual pain might be independently positively associated with FD including subtype of FD.

Frequency, Intensity, and Partner of Exercise Habit Is Inversely Associated with Functional Dyspepsia in Young Japanese Population

BACKGROUND

Functional dyspepsia (FD) has a high prevalence worldwide and reduces patients' quality of life. The etiology of FD is likely multifactorial. Although two studies showed an inverse association between exercise habits and FD, evidence regarding the association between exercise habits and FD remains scarce.

AIMS

This study aimed to investigate the association between exercise habits and FD among the young Japanese population, taking the presence or absence of an exercise partner as an additional variable.

METHODS

The study subjects consisted of 8923 Japanese university students. The definition of FD was based on the Rome III criteria. Information on exercise frequency, exercise intensity, and exercise partners was obtained from a self-administered questionnaire.

RESULTS

The prevalence of FD was 1.9% in this cohort. Low, moderate, and high frequency of exercise was independently inversely associated with FD (adjusted odds ratio [OR] was low: OR 0.69 [95% confidence interval (CI) 0.47-0.997], moderate: OR 0.53 [95% CI 0.34-0.81] and high: OR 0.53 [95% CI 0.30-0.88], p for trend p = 0.002). Moderate and high intensity of exercise was independently inversely associated with FD (moderate: OR 0.56 [95% CI 0.36-0.84] and high: OR 0.49 [95% CI 0.30-0.76], p for trend p = 0.001). Exercise with groups and with friends was independently inversely associated with FD whereas the association between exercising alone and FD was not significant (groups: OR 0.28 [95% CI 0.14-0.50] and friends: OR 0.44 [95% CI 0.24-0.74]).

CONCLUSION

Among the young Japanese population, frequency and intensity of exercise may be independently inversely associated with FD. Additionally, exercise with groups and with friends but not by oneself was inversely associated with exercise and FD, respectively.

The Association between Laughter and Functional Dyspepsia in a Young Japanese Population

The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population.

METHODS

This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire.

RESULTS

The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)).

CONCLUSION

In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

Association Between Body Mass Index and Functional Dyspepsia in Young Japanese People

Background/Aims

Evidence regarding the association between body mass index (BMI) and functional dyspepsia (FD) in the Asian population is limited. Further, no study has evaluated this issue in young people in Asian and Western populations. Thus, we aim to investigate this issue among young Japanese people.

Methods

The study subjects comprised of 8923 Japanese university students. BMI was divided into 4 categories (quartiles) on the basis of the study subjects’ distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, overweight, and obese was BMI < 18.5 kg/m², 18.5 ≤ BMI < 25 kg/m² (reference), 25 kg/m² ≤ BMI < 30 kg/m², and 30 kg/m² ≤ BMI, respectively. The definition of FD was based on the Rome III criteria.

Results

The prevalence of FD was 1.9% in this cohort. The lowest BMI was independently associated with FD after adjustment (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.46-3.67); P for trend = 0.001). The lowest BMI was independently associated with FD in women but not in men (OR, 2.94; 95% CI, 1.59-5.77; P for trend = 0.001). Leanness was independently associated with FD in total and in women but not in men (total adjusted OR, 2.01; 95% CI, 1.40-2.86) and women (OR, 2.19; 95% CI, 1.35-3.45). However, interaction analysis showed no significant difference for sex.

Conclusions

Among young Japanese people, BMI may be independently inversely associated with FD. Leanness may be an independent associated factor for FD in the young Japanese women.

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

Background

Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

Methods

In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose–response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

Findings

We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10.1 per 1000 participant-years) over a median follow-up of 7.1 years ([IQR 4.3–9.9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0.60 (95% CI 0.51–0.71) for quartile 2, 0.55 (0.49–0.62) for quartile 3, and 0.47 (0.39–0.57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000–8000 steps per day and among adults younger than 60 years until 8000–10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0.67 [95% CI 0.56–0.83]) and a peak of 60 min (0.67 [0.50–0.90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1.12 [0.96–1.32]) and 100 steps per min or faster (0.86 [0.58–1.28]).

Interpretation

Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

POSSIBILITY OF NEW LYMPHATIC PATHWAY CREATION THROUGH NEO-LYMPHANGIOGENESIS INDUCED BY SUBDERMAL DISSECTION

Surgical intervention and subsequent wound healing process are known to induce neo-lymphangiogenesis, but few studies have been reported to utilize this mechanism for lymphedema treatment. The aim of this study was to evaluate feasibility of subdermal dissection for neo-lymphangiogenesis induction (SDN) to treat lower extremity lymphedema (LEL). Medical records of secondary LEL patients who had undergone ICG lymphography and SDN procedure were reviewed. SDN was performed by dissecting fat tissues just below the dermis from the most proximal area showing dermal backflow through abdominal-toaxillary lymphatic pathways. Perioperative lymphedematous conditions were evaluated with lymphedema quality of life score (LeQOLiS) and LEL index. Seventeen female patients were included. SDN could be performed in 10 minutes on average without postoperative complication. Postoperative ICG lymphography showed new lymphatic pathways in 6 (35.3%) cases. Postoperative LeQOLiS ranged from 9 to 66, which was statistically lower than preoperative LeQOLiS (32.9 ± 19.2 vs. 36.6 ± 19.3, p = 0.048), whereas there was no statistically significant difference between pre- and post-operative LEL index (275.2 ± 23.3 vs. 270.5 ± 20.8, P = 0.073). Subdermal dissection, although its probability is not high, has a potential to induce neo-lymphangiogenesis. Further studies are required to improve and demonstrate efficacy of the procedure for new lymphatic pathway creation.

Association of Neighborhood Food Environment and Physical Activity Environment With Obesity: A Large-Scale Cross-Sectional Study of Fifth- to Ninth-Grade Children in Japan

Objective: This study examined the relationship between neighborhood food and physical activity environment, and obesity among elementary and junior high school students in Japan. Methods: The participants were fifth- to ninth-grade children (n=7277), who were attending municipal schools in Japan. Percent overweight (POW) was calculated using their age, gender, height, and weight, which were collected through a questionnaire. A POW of < 20% was considered non-obese, while ≥ 20% was considered obese. Furthermore, using a geographic information system, we investigated the density of convenience stores, fast-food stores, casual restaurants, supermarkets and department stores, parks, sports facilities, stations, and intersections in the school district. Additionally, from the census, we obtained information regarding the population density of the municipality where the participants' schools were located. Multiple logistic regression analysis was used to examine the relationship between obesity and food environment (the food environment model), between obesity and physical activity environment (the physical activity environment model), and among obesity, food, and physical activity environment (the food and physical activity environment model). Results: In the food environment model and the food and physical activity environment model, the density of convenience stores showed a significant positive association. In the physical activity environment model, the density of stations showed a significant negative association. Conclusion: This study's findings can contribute to the development of appropriate community interventions for improving children's health in Japan and similar areas.

The effects of dietary licorice flavonoid oil supplementation on body balance control in healthy middle-aged and older Japanese women undergoing a physical exercise intervention: a randomized, double-blind, placebo-controlled trial

AIMS

In this study, the effects of licorice flavonoid oil (LFO) supplementation on mobility functions were evaluated in middle-aged and older women who underwent daily physical exercise.

METHODS

The 73 women aged 59-85 years (71.2 ± 5.2 years) were randomly assigned to the LFO group (n = 37) or the placebo group (n = 36). For 16 weeks, the LFO group consumed a daily capsule containing 300 mg of LFO, while the placebo group consumed a placebo capsule. All participants were instructed to complete a strength training program during the 16 weeks and to increase their daily step count by 1000. 10-m walking speed (with/no obstruction), one-leg standing time with eyes open, handgrip strength, isometric knee extension strength, and body composition were evaluated at baseline and every eight weeks.

RESULTS

In the 10-m walking speeds (with/no obstruction), LFO supplementation did not show significant improvements. One-leg standing time was significantly prolonged with LFO intake (LFO: baseline 73.9 s vs 16 weeks 93.5, placebo: baseline 82.8 vs 16 weeks 87.1, p = 0.03). In addition, a significant decrease in BMI and body fat percentage with LFO was found (p = 0.01, p = 0.03, respectively).

DISCUSSION

Since a lower BMI corresponds to a lighter physical load on the lower limb, in addition, since LFO might improve skeletal muscle function by antioxidant activity, participants could stand longer and body balance control was improved.

CONCLUSION

LFO supplementation improved body balance control and may contribute to fall prevention in healthy middle-aged and older women having daily physical exercise.

TRIAL REGISTRATION

UMIN Clinical Trial Registry No. 000029712.

Predictive value of QRS duration normalized to left ventricular volume for responding to cardiac resynchronization therapy in patients with mid-QRS duration enrolled in the multicenter registry

Background

For cardiac resynchronization therapy (CRT), patients with chronic heart failure (HF) and wide (&gt;150msec) QRS duration (QRSd) received class I/A indication. However, its beneficial effect seemed to be limited for those with mid- (120–150msec) QRSd. Recent studies demonstrated that QRSd normalized to left ventricular end-diastolic volume (QRSd/ LVEDV) improved prediction of clinical outcome in patients with CRT. Therefore, we sought to investigate predictive value of QRSd/LVEDV for responding to CRT in patients with mid-QRSd.

Methods

This was retrospective multi-center observational cohort study. A total 506 consecutive patients who underwent CRT implantation in Tohoku University Hospital and National Cerebral and Cardiovascular Center were evaluated. Exclusion criteria were QRSd less than 120ms, upgrade procedures from other implanted non-CRT devices and bradycardia requiring pacing. We evaluated clinical variables, data of electrocardiogram and transthoracic echocardiography at baseline and 6 months after CRT implantation. Primary endpoint was a HF hospitalization after CRT implantation. Distribution of free from HF hospitalization during follow-up was calculated using Kaplan-Meier curves, and the effects of covariate on the time to endpoint were investigated using a Cox proportional hazards model.

Results

After 199 patients were excluded based on exclusion criterion, remaining 307 patients were included for the analysis. Mean age was 62±14 [SD] years, and 238 (77%) were male. Mean LVEF and LVEDV were 25±9% and 234±82ml, respectively, and 24% of patients had ischemic etiology of HF. During the median 948 days of follow-up, CRT patients with mid QRSd (n=126; 136±10msec), as compared with those with wide QRSd (n=181; 174±17msec), tended to have higher incidence of HF hospitalization (Wilcoxon p=0.03). Multivariate analysis showed that QRSd and QRSd/LVEDV were significant predictors for HF hospitalization in CRT patients with mid QRSd, and cut-off values (137msec of QRSd and 0.65 of QRSd/LVEDV), which was calculated by receiver operative curve analysis, was used for risk stratification. QRSd&lt;137msec was significant negative predictors for HF hospitalization (p=0.005), and Mid-QRSd patients with QRSd≥137msec demonstrated equivalent clinical outcome with those with wide QRSd. Moreover, patients with QRSd/LVEDV≥0.65 tended to have lower incidence of HF hospitalization as compared with those without it among patients with QRSd&lt;137msec (n=64, Figure).

Conclusion

The present study demonstrates that QRSd normalized to left ventricular end-diastolic volume (QRSd/ LVEDV) could be clinical value in predicting outcome in CRT patients with mid-QRSd. These findings indicate normalized QRSd reflects myocardial conduction properties and contribute to risk stratification.

Funding Acknowledgement

Type of funding sources: None.