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Takase H, Kawakatsu N, Hayashi K, Kin F, Isogaki T, Dohi Y. Urinary Na/K ratio is a predictor of developing chronic kidney disease in the general population. Hypertens Res 2024; 47:225-232. [PMID: 37714952 DOI: 10.1038/s41440-023-01399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/17/2023]
Abstract
Chronic kidney disease (CKD) is a major risk factor for cardiovascular diseases as well as end-stage kidney disease. Increased dietary sodium (Na) or decreased dietary potassium (K) deteriorates kidney function; however, findings regarding the association of dietary Na/K ratio with kidney function are limited and conflicting. Therefore, the present study investigated the impact of urinary Na/K ratio on the development of CKD, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, in the Japanese general population. In total, 14,549 subjects without CKD who participated in our medical checkup were enrolled. The urinary Na/K ratio was measured using a sample of overnight urine. The subjects were followed up until the endpoint (onset of CKD). During the median follow-up period of 61.4 months, CKD developed in 2096 participants (25.9 per 1000 person-years). The risk of developing CKD increased across the quartiles of baseline urinary Na/K ratio in the Kaplan-Meier analysis (log-rank, P < 0.001). In multivariate Cox proportional hazard regression analysis, urinary Na/K ratio was a significant predictor of new-onset CKD after adjustment for important factors including eGFR at baseline (hazard ratio, 2.013; 95% confidence interval, 1.658-2.445; p < 0.001). Moreover, baseline urinary Na/K ratio was found to be independently correlated with yearly decline in eGFR. Similar results were obtained in subgroups of participants with and without hypertension. Thus, urinary Na/K ratio is significantly associated with the development of CKD in the general population.
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Affiliation(s)
- Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan.
| | - Naomi Kawakatsu
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Kazusa Hayashi
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Fumihiko Kin
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Takeru Isogaki
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Yasuaki Dohi
- Division of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
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2
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Tabara Y. Sodium-to-potassium ratio and renal functional decline. Hypertens Res 2024; 47:245-246. [PMID: 37714955 DOI: 10.1038/s41440-023-01431-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Yasuharu Tabara
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, 420-0881, Japan.
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
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3
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Yamanaka N, Itabashi M, Fujiwara Y, Nofuji Y, Abe T, Kitamura A, Shinkai S, Takebayashi T, Takei T. Relationship between the urinary Na/K ratio, diet and hypertension among community-dwelling older adults. Hypertens Res 2023; 46:556-564. [PMID: 36522425 DOI: 10.1038/s41440-022-01135-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
The association between the urinary sodium (Na)/potassium (K) ratio and hypertension is well recognized. We investigated whether the urinary Na/K ratio might be associated with hypertension in community-dwelling older adults and whether the association was influenced by habitual dietary patterns. We enrolled a total of 684 older adults (mean age, 76.8 years) and conducted health examinations at Kusatsu, Japan, in 2021. The urinary Na/K ratio was found to be independently associated with systolic blood pressure (SBP) (p < 0.0001), years of education (p = 0.0027), number of cohabitants (p = 0.0175), estimated glomerular filtrate rate (eGFR) (p = 0.0244), and Geriatric Depression Scale short-version (GDS15) score (p = 0.0366). In addition, an unsupervised hierarchical clustering analysis revealed a spectrum of habitual dietary patterns for higher and lower values of the urinary Na/K ratio. The decision tree indicated that the urinary Na/K ratio was associated with the history of milk consumption. A positive history of daily milk consumption predicted a mean urinary Na/K ratio of 2.8, and a negative history of daily milk consumption predicted a mean urinary Na/K ratio of 3.3. Furthermore, the frequency of fruit and vegetable consumption also predicted the urinary Na/K ratio. The relationship between the urinary Na/K ratio and hypertension was influenced by the frequency of consumption of milk, fruits, and vegetables in the subjects. This finding might be due to the influence of education and/or depression. The results suggested the importance of nutritional education in the development of hypertension.
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Affiliation(s)
- Noriko Yamanaka
- Departments of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Mitsuyo Itabashi
- Departments of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yu Nofuji
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takumi Abe
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Takei
- Departments of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
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4
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Tanabe A, Hirata A, Kuwabara K, Kubo S, Higashiyama A, Hirata T, Sugiyama D, Nishida Y, Kubota Y, Kadota A, Nishikawa T, Miyamatsu N, Miyamoto Y, Okamura T. Association between visceral fat accumulation and decline in the estimated glomerular filtration rate based on cystatin C in the Japanese urban population: the KOBE study. Endocr J 2023; 70:97-106. [PMID: 36223945 DOI: 10.1507/endocrj.ej22-0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although metabolic syndrome, including visceral fat accumulation, causes kidney and cardiovascular diseases, the impact of visceral fat accumulation on mild decreased renal function remains unclear. This study examines the association between visceral fat area (VFA) measured by bioimpedance methods and the estimated glomerular filtration rate based on serum cystatin C (eGFRcys) in the Japanese urban population. This community-based cross-sectional study enrolled 952 individuals (287 men, 665 women) who participated in the second follow-up survey of the Kobe Orthopedic and Biomedical Epidemiological (KOBE) study. We compared the multivariate-adjusted means of eGFRcys among VFA quartile groups by gender using the analysis of covariance. Models were adjusted for age, high blood pressure, hypercholesterolemia, glucose intolerance, smoking, and alcohol use, and further adjusted for body mass index (BMI). The highest VFA quartile group had lower eGFRcys than the lowest VFA quartile group after adjusted for cardiometabolic risk factors, except for BMI (93.1 [95% confidence interval (CI), 90.1-96.2] vs. 82.1 [95% CI, 79.1-85.0] in men and 95.8 [95% CI, 94.1-97.5] vs. 89.4 [95% CI, 87.8-90.9] in women). Moreover, further adjustment for BMI revealed a similar result in men (93.5 [95% CI, 89.8-97.2] vs. 81.6 [95% CI, 77.9-85.3]), while no significant association was found in women. This study suggests a significant association between increased VFA levels and lower eGFRcys levels independent of cardiometabolic risk factors, such as glucose intolerance and hypercholesterolemia in men and women, as well as independent of BMI in men.
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Affiliation(s)
- Ayumi Tanabe
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Tokyo 140-0005, Japan
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kazuyo Kuwabara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Sachimi Kubo
- Department of Nutrition and Food Sciences, Tezukayama Gakuin University, Osaka 590-0113, Japan
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Hokkaido 060-8638, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, Keio University, Kanagawa 252-0883, Japan
| | - Yoko Nishida
- Osaka Institute of Public Health, Osaka 537-0025, Japan
| | - Yoshimi Kubota
- Department of Environmental and Preventive Medicine, School of Medicine, Hyogo Medical University, Hyogo 663-8501, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Tomofumi Nishikawa
- Faculty of Health Science, Kyoto Koka Women's University, Kyoto 615-0822, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
- Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation, Hyogo 650-0047, Japan
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5
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Ogata S, Akashi Y, Sakusabe T, Yoshizaki S, Maeda Y, Nishimura K, Maeda K, Nakai S. A multiple 24-hour urine collection study indicates that kidney function decline is related to urinary sodium and potassium excretion in patients with chronic kidney disease. Kidney Int 2021; 101:164-173. [PMID: 34774553 DOI: 10.1016/j.kint.2021.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
Multiple 24-hour urine collections are necessary to adequately assess sodium and potassium intake. Here, we assessed kidney function decline for four years after baseline in relation to seven-time averaged 24-hour urinary sodium and potassium excretion (UNaV, UKV), their UNaV/UKV ratio, and their categorical combination in outpatients with chronic kidney disease (CKD). This retrospective cohort study was based on 240 outpatients with baseline CKD stages 3-5, baseline age 20 years or more (median age 72.0 years), and a median follow-up (with interquartile range) of 2.9 (1.4-4.0) years. Outcome was the percentage change in annual slope of estimated glomerular filtration rate (delta eGFR per year). In linear mixed models, percentage changes in delta eGFR per year were -3.26% (95% confidence interval -5.85 to -0.60), +5.20% (2.34 to 8.14), and -5.20% (-7.64 to -2.69), respectively, per one standard deviation increase in the seven-time averaged UNaV and UKV, and their UNaV/UKV ratio. Additionally, percentage changes per year in delta eGFR per year were -16.27% (-23.57 to -8.27) in the middle-to-high UNaV and low UKV group, compared with the low UNaV and middle-to high UKV group. Thus, our study reinforces the observation of opposite associations between GFR decline and urinary excretion rates of sodium (positive) and potassium (negative), respectively. Whether changes in dietary sodium and potassium intake slow GFR decline still requires further study.
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Affiliation(s)
- Soshiro Ogata
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan; Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuumi Akashi
- Faculty of Nursing, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Takaya Sakusabe
- Faculty of Clinical Engineering, Fujita Health University School of Medical Sciences, Aichi, Japan
| | | | | | - Kunihiro Nishimura
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan; Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Shigeru Nakai
- Faculty of Clinical Engineering, Fujita Health University School of Medical Sciences, Aichi, Japan.
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6
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Association between the urinary sodium-to-potassium ratio and renal outcomes in patients with chronic kidney disease: a prospective cohort study. Hypertens Res 2021; 44:1492-1504. [PMID: 34480132 DOI: 10.1038/s41440-021-00741-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
A higher urinary sodium-to-potassium (UNa/K) ratio has been reported to be associated with high blood pressure and subsequent cardiovascular events. However, the association between the UNa/K ratio and renal outcomes remains uncertain. We prospectively investigated the association between the UNa/K ratio and renal outcomes in patients with chronic kidney disease (CKD). We enrolled 716 patients with CKD, and 24-h urinary sodium and potassium excretion were measured. Patients were divided into UNa/K ratio tertiles (T1-T3). Endpoints were defined as a composite of doubling of serum creatinine (SCr), end-stage kidney disease (ESKD), or death and a composite of doubling of SCr or ESKD (added as an alternative outcome). We investigated the association between the UNa/K ratio and renal outcomes using a Cox proportional hazards model. During a median follow-up of 2.3 years, doubling of SCr, ESKD, or death and doubling of SCr or ESKD occurred in 332 and 293 patients, respectively. After adjustment for covariates including potentially confounding variables such as plasma renin activity, plasma aldosterone concentration, and B-type natriuretic peptide, the hazard ratios (HRs) (95% confidence intervals [CIs]) for the composite of doubling of SCr, ESKD, or death for T2 and T3 were 1.44 (1.06-1.96) and 1.59 (1.14-2.21), respectively, compared with T1. Additionally, compared with T1, the highest tertile (T3) of the UNa/K ratio was associated with a composite of doubling of SCr or ESKD (HR 1.55, 95% CI 1.09-2.20). A higher UNa/K ratio was independently associated with poor renal outcomes in patients with CKD.
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7
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Sun Y, Zhang P, Li Y, He FJ, Wu J, Xu J, Zhang X, Li X, Song J. Association of Sodium, Potassium and Sodium-to-Potassium Ratio with Urine Albumin Excretion among the General Chinese Population. Nutrients 2021; 13:nu13103456. [PMID: 34684456 PMCID: PMC8539080 DOI: 10.3390/nu13103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
Mixed evidence was published regarding the association of sodium, potassium and sodium-to-potassium ratio (Na/K ratio) with renal function impairment. This study was conducted to further explore the relationship between sodium, potassium, NA/K ratio and kidney function in the general adult Chinese population. We performed a cross-sectional analysis using the baseline data from the Action on Salt China (ASC) study. 5185 eligible general adult participants from the baseline investigation of the ASC study were included in this analysis. Sodium, potassium and albumin excretion were examined from 24-h urine collection. Albuminuria was defined as albumin excretion rate (AER) greater than or equal to 30 mg/24-h. Mixed linear regression models, adjusted for confounders, were fitted to analyze the association between sodium, potassium and Na/K ratio, and natural log transformed AER. Mixed effects logistic regression models were performed to analyze the odds ratio of albuminuria at each quintile of sodium, potassium and Na/K ratio. The mean age of the participants was 49.5 ± 12.8 years, and 48.2% were male. The proportion of albuminuria was 7.5%.The adjusted mixed linear models indicated that sodium and Na/K ratio was positively associated with natural log transformed AER (Sodium: β = 0.069, 95%CI [0.050, 0.087], p < 0.001; Na/K ratio: β = 0.026, 95%CI [0.012, 0.040], p < 0.001). Mixed effects logistic regression models showed that the odds of albuminuria significantly increased with the quintiles of sodium (p < 0.001) and Na/K ratio (p = 0.001). No significant association was found between potassium and the outcome indicators. Higher sodium intake and higher Na/K ratio are associated with early renal function impairment, while potassium intake was not associated with kidney function measured by albumin excretion.
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Affiliation(s)
- Yuewen Sun
- The George Institute for Global Health at Peking University Health Science Centre, Beijing 100600, China; (Y.S.); (Y.L.); (X.L.)
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Centre, Beijing 100600, China; (Y.S.); (Y.L.); (X.L.)
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence: (P.Z.); (J.W.)
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Centre, Beijing 100600, China; (Y.S.); (Y.L.); (X.L.)
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Feng J. He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (F.J.H.); (J.S.)
| | - Jing Wu
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, The Chinese Center for Disease Control and Prevention, Beijing 100000, China;
- Correspondence: (P.Z.); (J.W.)
| | - Jianwei Xu
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, The Chinese Center for Disease Control and Prevention, Beijing 100000, China;
| | - Xiaochang Zhang
- Noncommunicable Disease and Aging Health Management Division, Chinese Center for Disease Control and Prevention, Beijing 100000, China;
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Centre, Beijing 100600, China; (Y.S.); (Y.L.); (X.L.)
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jing Song
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (F.J.H.); (J.S.)
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8
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Umemoto K, Kubo S, Nishida Y, Higashiyama A, Kawamura K, Kubota Y, Hirata T, Hirata A, Sata M, Kuwabara K, Miyazaki J, Kadota A, Iida M, Sugiyama D, Miyamatsu N, Miyamoto Y, Okamura T. Physique at Birth and Cardiovascular Disease Risk Factors in Japanese Urban Residents: the KOBE Study. J Atheroscler Thromb 2020; 29:188-199. [PMID: 33298666 PMCID: PMC8803564 DOI: 10.5551/jat.61069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
This study investigated the relationship between birth physique and cardiovascular risk factors in Japanese urban residents aged 40 years and more.
Methods:
A self-administered questionnaire on birth physique was performed among 624 individuals (165 men and 459 women) who participated in the KOBE study. We examined whether self-reported birth physique and available recorded birth weights matched for 72 participants. Then the association between birth physique and risk factors for all participants was examined by gender. Body size at birth in the questionnaire (large, medium, small) was set as an exposure and laboratory values from the baseline survey (2010-2011) were used as outcomes.
Results:
Mean (standard deviation) recorded birth weight of 72 participants was 3665 (318), 3051 (300), and 2653 (199) g, in the large, medium, and small group, respectively. In the analysis for all participants, odds ratio for having both hypertension and impaired glucose tolerance were significantly higher in the small versus large birth weight group, which was 7.42 (95% CI 1.75–31.50) for men and 4.44 (95% CI 1.14–17.30) for women after adjusting for age, body mass index, smoking/alcohol/exercise habits, and menstrual status in women. Similar results were observed in participants with recorded birth weight.
Conclusions:
The present study indicates that individuals with small physique at birth might be at higher risk for hypertension and impaired glucose tolerance in middle age compared to those with large birth weight.
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Affiliation(s)
- Kaori Umemoto
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Sachimi Kubo
- Department of Nutrition and Food Sciences, Tezukayama Gakuin University.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Yoko Nishida
- Osaka Institute of Public Health.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Kuniko Kawamura
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Yoshimi Kubota
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Department of Environmental and Preventive Medicine, Hyogo College of Medicine
| | - Takumi Hirata
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Department of Public Health, Hokkaido University Faculty of Medicine
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Mizuki Sata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Kazuyo Kuwabara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
| | - Junji Miyazaki
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Aya Kadota
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Miho Iida
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Daisuke Sugiyama
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Faculty of Nursing and Medical Care, Keio University
| | - Naomi Miyamatsu
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiro Miyamoto
- Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe.,Open Innovation Center, National Cerebral and Cardiovascular Center
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine.,Cohort Study Team, Center for Cluster Development and Coordination, Foundation for Biomedical Research and Innovation at Kobe
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