Association between serum uric acid levels and achievement of target blood pressure among Japanese community residents with hypertension.

The authors examined the sex-specific association between serum uric acid (SUA) levels and achievement of target blood pressure among Japanese patients with hypertension. This cross-sectional study was conducted between January 2012 and December 2015 and examined 17 113 eligible participants (6499 men; 10 614 women) with hypertension among 66 874 Japanese community residents who underwent voluntary health checkups. Multivariate analysis was used to estimate the association between high SUA level (≥7.0 mg/dL for men and ≥6.0 mg/dL for women) and "therapeutic failure" in achieving target blood pressure (BP) of 140/90 and 130/80 mmHg in both sexes. Multivariate analysis revealed that high SUA level was significantly associated with failure to achieve the 130/80 mmHg treatment goal among men (AOR = 1.24, 95% CI = 1.03-1.50, p = .03). Among women, high SUA level was significantly associated with failure to achieve both the 130/80 and 140/90 mmHg treatment goals (AOR = 1.33, 95% CI = 1.20-1.47, p < .01 and AOR = 1.17, 95% CI = 1.04-1.32, p < .01, respectively). Each increase in SUA quartile was positively associated with increases in systolic BP (SBP) and diastolic BP (DBP) (p < .01 for trend) in both sexes. SBP and DBP in each quartile (Q2-Q4) were also significantly higher compared with those of Q1 in both sexes (p < .01). Our data confirms the difficulties in maintain goal BP control in those with elevated SUA.

Efficacy and safety of semaglutide in glycemic control, body weight management, lipid profiles and other biomarkers among obese type 2 diabetes patients initiated or switched to semaglutide from other GLP-1 receptor agonists.

PURPOSE: Evidence of the efficacy and safety of semaglutide among patients with type 2 diabetes who were initiated on or were switched to semaglutide from other GLP-1 RAs remains limited. The objective of this study was to investigate the short-term effects of switching to semaglutide from other GLP-1 RAs. METHODS: This retrospective cohort study evaluated patients with type 2 diabetes who were initiated on or were switched to semaglutide due to poor diabetes control with other GLP-1 RAs or other medications, or obesity. HbA1c, body weight, serum creatinine, serum uric acid, parameters of lipid metabolism, and parameters of liver function were measured before and 6 months after administration of semaglutide. RESULTS: A total of 50 patients were registered in the study. After switching to semaglutide (n = 43), HbA1c and body weight significantly decreased (p < 0.01, p < 0.01), respectively. The same findings were observed in semaglutide-naïve patients (p = 0.04, p < 0.02) (n = 7). Serum uric acid, total cholesterol, triglycerides, and urinary albumin-creatinine ratio decreased significantly as well (p = 0.04, p = 0.04, p = 0.02, p = 0.04), whereas serum creatinine did not change significantly (p = 0.51). CONCLUSIONS: Semaglutide showed excellent efficacy, even in patients switched from other GLP-1 RAs. Semaglutide appears to be a promising agent for blood glucose and body weight control in obese type 2 diabetes mellitus patients and could be more potent in treating type 2 diabetes than existing GLP-1 RAs.

An association between subcutaneous fat mass accumulation and hypertension.

Evidence to assess relationships between subcutaneous fat area (SFA) and lifestyle-related diseases, including hypertension, remains limited. The aim of this study was to investigate the relationship between SFA and hypertension. This study was a single-institution, cross-sectional study of 1,899 eligible Japanese participants who underwent health checkups between December 2016 and December 2018. All patients were measured for SFA and visceral fat area (VFA) by abdominal computed tomography (CT). SFA was divided into quartiles by gender, and multivariate logistic regression analysis was performed to estimate associations between SFA quartiles (Q) and hypertension. Mean age and SFA were 60.9 9 (standard devastation [SD]:12.0) years and 123.0 (56.9) cm2 in men, and 60.6 (12.8) years and 146.6 (79.0) cm2 in women, respectively. Risk of hypertension from multivariate regression modeling compared with the lowest quartile (Q) in both sexes was as follows: for men Q2 [odds ratio (OR), 1; 95% confidence interval (CI), 0.55-1.51 ], Q3 (OR, 1.73; 95%CI, 1.17-2.56), and Q4 (OR, 1.96; 95%CI, 1.31-2.94); for women Q2 (OR, 0.87; 95%CI, 0.48-1.58), Q3 (OR, 1.73; 95%CI, 1.02-2.95), and Q4 (OR, 2.54; 95%CI, 1.51-4.28). The optimal SFA cutoff value at risk of hypertension was 114.7 cm2 in men and 169.3 cm2 in women. The prevalence of hypertension was positively associated with SFA quartiles in both genders. The present results may indicate the necessity of considering not only VFA, but also SFA for the primary and secondary prevention of hypertension.

Association between Visceral or Subcutaneous Fat Accumulation and B-Type Natriuretic Peptide among Japanese Subjects: A Cross-Sectional Study.

BACKGROUND: Some previous studies have shown reduced levels of plasma B-type natriuretic peptide (BNP) in individuals with obesity. We aimed to estimate the relationship between BNP and abdominal fat distribution, adjusted for confounding factors. METHODS: This cross-sectional study included 1806 Japanese individuals (981 men and 825 women) who underwent a medical health check-up. Analyzed data included age, sex, visceral fat area (VFA), and subcutaneous fat area (SFA) as obtained from computed tomography, blood pressure, and blood test results including BNP. Multiple linear regression analysis was used to examine the association between BNP, VFA, and SFA after adjusting for age, sex, comorbidities, and body mass index. RESULTS: In the models analyzed separately for VFA and SFA, BNP correlated independently with VFA in multiple linear regression analysis among all subjects and in both men and women, while SFA correlated inversely with BNP in all subjects and women but not in men. In the model that included both VFA and SFA, BNP correlated independently with VFA, but SFA and BNP were not correlated in any models. CONCLUSION: Higher VFA showed an independent, significant association with lower BNP. In addition, the inverse correlation with BNP was stronger for VFA than for SFA.

An association between visceral or subcutaneous fat accumulation and diabetes mellitus among Japanese subjects.

BACKGROUND: The impact of subcutaneous fat accumulation remains controversial. This study assessed the association between visceral or subcutaneous fat area (VFA and SFA, respectively) and diabetes mellitus (DM) among Japanese subjects. METHODS: This was a cross-sectional study involving 1907 eligible participants (men, 1050; women, 857) who participated in a voluntary health check-up conducted at Juntendo University Hospital from January 2017 to December 2018, in Tokyo, Japan. Associations between VFA or SFA quartiles and DM were identified using adjusted odds ratios (AORs) and 95% confidence intervals (CIs) with multivariable logistic regression analysis adjusted for confounders. Receiver operating characteristic (ROC) curve analysis was used to assess appropriate cut-off values of VFA or SFA. RESULTS: Multivariate analyses showed that Q4 (≥ 125 cm2) of VFA was significantly positively associated with DM compared to Q1 (< 65 cm2) (AOR = 1.94, 95% CI 1.02-3.71), whereas there was no association between SFA and DM in men. Among women, Q4 (≥ 85 cm2) of VFA was significantly positively associated with DM compared to Q1 (< 30 cm2) (Q4, AOR = 6.15, 95% CI 1.65-22.99). Also, Q3 and Q4 (≥ 135 cm2) of SFA were significantly positively associated with DM compared to Q1 (< 90 cm2) (Q3, AOR = 5.64, 95% CI 1.21-26.25; Q4, AOR = 7.81, 95% CI 1.71-35.65). The appropriate cut-off value of VFA in men was 101.5 cm2. Those of VFA and SFA in women were 72.5 cm2 and 165.3 cm2, respectively. CONCLUSIONS: Our results suggest the importance of considering SFA as well as VFA, especially in women, for primary and secondary prevention of DM.

Serum zinc concentrations and characteristics of zinc deficiency/marginal deficiency among Japanese subjects.

BACKGROUND: Studies that have examined serum zinc deficiency/marginal deficiency in developed countries, including Japan, are still limited. The aim of this study was to assess serum zinc concentrations and associated characteristics among Japanese subjects. METHODS: This cross-sectional study, conducted from September 2016 to December 2018, included 2056 eligible subjects who participated in a voluntary health checkup. Serum zinc concentration categories were defined as deficiency (<60 µg/dL), marginal deficiency (≥60 to <80 µg/dL), and normal (≥80 µg/dL). Serum zinc concentrations were compared between the first age category (<40 years) and other age categories with Dunnett's method. Trends in P-values were estimated using the Jonckheere-Terpstra test for continuous variables. RESULTS: The proportions of subjects with deficiency and marginal deficiency were 0.4% and 46.0% in men, and 0.6% and 38.4% in women, respectively. The deficiency/marginal deficiency group had significantly lower lipid profiles and nutritional status, and a significantly lower proportion were non-daily drinkers in both genders. Older age was significantly associated with lower serum zinc concentration only in men. CONCLUSIONS: Our findings clarified a high proportion of serum zinc deficiency/marginal deficiency, especially in men, and suggest a possible association between serum zinc levels and nutritional status and alcohol consumption. It may be necessary to manage nutritional status, including zinc intake.

Assessing lifestyle-related diseases with body and muscle mass using bioelectrical impedance analysis.

OBJECTIVES: To investigate the correlation between imbalance of muscle mass to body weight and lifestyle-related diseases using bioelectrical impedance analysis (BIA) among Japanese population. METHODS: This was a retrospective, cross-sectional study conducted at Juntendo University Hospital in Tokyo, Japan, from May 2015 to November 2017. Their muscle-to-weight ratio were stratified into "muscle-to-weight ratio" quartiles as follows: men, Q1 (≥0.79), Q2 (0.75 to <0.79), Q3 (0.72 to <0.75), and Q4 (<0.72); women, Q1 (≥0.73), Q2 (0.68 to <0.73), Q3 (0.63 to <0.68), and Q4 (<0.63). The primary outcome was prevalence of ≥2 lifestyle-related diseases, including hypertension, dyslipidemia, type 2 diabetes mellitus, and hyperuricemia. RESULTS: Data from 2009 individuals (men, 55%; mean age, 62 years) were analyzed. Compared to the lowest quartile, risk for the presence of ≥2 lifestyle-related diseases, in a multivariable regression model for men was as follows: Q2 (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.31-2.87), Q3 (OR, 2.85; 95% CI, 1.89-4.29), and Q4 (OR, 6.00; 95% CI, 4.07-8.84). For women, an increased risk was seen in Q2 (OR, 2.31; 95% CI, 1.20-4.46), Q3 (OR, 4.45; 95% CI, 2.40-8.26), and Q4 (OR, 12.6; 95% CI, 6.80-23.5). Cutoff values of muscle-to-weight ratio correlated with lifestyle-related diseases (≥2) were 0.76 for men and 0.68 for women. CONCLUSIONS: Our results showed that an imbalance of muscle mass to body weight confers an independent and stepwise increased risk for lifestyle-related diseases.

Achievement of Target Serum Uric Acid Levels and Factors Associated with Therapeutic Failure among Japanese Men Treated for Hyperuricemia/Gout.

Objective To assess the rate of successfully achieving treatment goals among Japanese men with hyperuricemia/gout and identify factors influencing the success rate. Methods This cross-sectional study, conducted from January to December 2012, examined the serum uric acid (SUA) levels and clinical characteristics of 2,103 men with hyperuricemia/gout selected from an initial population of 136,770 individuals who participated in a workplace health checkup. The success rates (defined as SUA ≤6.0 mg/dL) were calculated, and a multivariate analysis was used to identify factors associated with "therapeutic failure" to achieve target SUA levels. Results The rate of successfully achieving the target SUA level was 37.5%. The body mass index (BMI) was significantly associated with therapeutic failure [25.0≤ Category (C) 2<27.5, adjusted odds ratio (AOR) =1.35; 27.5≤C3<30.0, AOR=1.69; C4 ≥ 30.0, AOR=1.94; relative to C1<25.0]. A significant positive association was also observed between waist circumference (WC) and therapeutic failure (85≤C2<90, OR=1.29; 90≤C3<95, OR=1.41; 95≤C4, OR=2.28; relative to C1<85.0 cm). Those with higher BMI/WC measurements were significantly more likely to have higher SUA levels than those with lower such measurements. The ongoing intake of dyslipidemia medication was identified as a protective factor against therapeutic failure. Discussion Our findings suggest a possible association between obesity and therapeutic failure, underscoring the importance of maintaining lipid profiles as part of managing SUA levels. Better management of both obesity and dyslipidemia may prevent future cardiovascular disorders by ensuring healthier SUA levels.

Association between high cystatin C levels and carotid atherosclerosis.

AIM: To investigate the association between carotid atherosclerosis and cystatin C (CysC) and to determine the optimal CysC cut-off value. METHODS: One hundred twenty-eight subjects were included in this study. Atherosclerosis was defined as a maximum carotid plaque thickness (MCPT) of greater than 2 mm. A receiver operating characteristic curve analysis was used to determine the diagnostic value of serum CysC for atherosclerosis. The subjects were divided into two groups according to the CysC cut-off value. We screened for diabetes, hypertension, dyslipidemia, smoking status, alcohol consumption, and exercise behavior. The association between atherosclerosis and CysC levels was assessed using multivariate analysis. RESULTS: The subjects were then divided into two groups according to the CysC cut-off value (0.73 mg/L). The median age of the high CysC group was 72 years (85% males), whereas that of the low CysC group was 61 years (63% males). The CysC levels were significantly correlated with Cr and estimated glomerular filtration rate (eGFR) values. Body-mass index, visceral fat area, hypertension, diabetes mellitus, and MCPT were significantly higher in the high CysC group than in the low CysC group. Furthermore, the eGFR was significantly lower in the high CysC group. Regarding lifestyle habits, only the exercise level was lower in the high CysC group than in the low CysC group. Multivariate analysis, adjusted for age and sex, revealed that high CysC levels were significantly associated with an MCPT of ≥ 2 mm (odds ratio: 2.92; 95%CI: 1.13-7.99). CONCLUSION: Higher CysC levels were associated with an MCPT of ≥ 2 mm. The CysC cut-off value of 0.73 mg/L appears to aid in the diagnosis of atherosclerosis.

Bacteraemia predictive factors among general medical inpatients: a retrospective cross-sectional survey in a Japanese university hospital.

OBJECTIVES: The precise criteria for obtaining blood cultures have not been established; they depend on the physician's judgement. We examined clinical parameters to determine predictive factors of bacteraemia and the need for blood cultures among general medical inpatients. DESIGN: A retrospective cross-sectional survey. SETTING: A Japanese university hospital. PARTICIPANTS: All general inpatients who had blood cultures taken from 1 January 2011 to 31 December 2012. MAIN MEASURES: Clinical information at or just before blood culture sampling was extracted from medical charts. Factors potentially predictive of bacteraemia were analysed using Fisher's exact test, followed by multivariable logistic regression model analysis. MAIN RESULTS: A total of 200 patients (male: female=119:81, 64.3±19.1 years old) comprised this study; 57 (28.5%) had positive blood culture results. Multivariable logistic regression analysis revealed that age >60 years (OR=2.75, 95% CI 1.23 to 6.48, p=0.015), female sex (OR=2.21, 95% CI 1.07 to 4.67, p=0.038), pulse rate >90 bpm (OR=5.18, 95% CI 2.25 to 12.48, p<0.001) and neutrophil percentage >80% (OR=3.61, 95% CI 1.71 to 8.00, p=0.001) were independent risk factors for positive blood culture results. The area under the receiver operating characteristic curve analysis of this model was 0.796. CONCLUSIONS: Our results emphasise the importance of taking blood cultures if the pulse rate is >90 bpm, in elderly patients and in women, and for ordering a differential white cell count.

Association between health literacy and metabolic syndrome or healthy lifestyle characteristics among community-dwelling Japanese people.

BACKGROUND: Few studies have assessed the association between health literacy (HL) and healthy lifestyle characteristics among Japanese people, and reports on the association between HL and prevalence of metabolic syndrome are also scarce. METHODS: The present cross-sectional study included 1817 (781 men and 1036 women) Japanese individuals who participated in a medical health checkup at Bange Kosei General Hospital and Takada Kosei Hospital in Fukushima, Japan, from April 2013-2014. Information regarding HL and healthy lifestyle characteristics listed in Breslow's seven health practices was collected by self-administered questionnaire. RESULTS: In multivariate logistic analysis, higher HL (≥14) was positively associated with healthy lifestyle characteristics [odds ratio (OR) = 2.08, 95 % confidence interval (CI) = 1.33-3.23] and inversely associated with prevalence of metabolic syndrome (OR = 0.67, 95 % CI = 0.48-0.95) among men. Among HL items, the ability to make decisions based on health-related information was significantly associated with healthy lifestyle characteristics (OR = 2.04, 95 % CI = 1.34-3.10 for men, OR = 1.38, 95 % CI = 1.30-1.85 for women) and inversely associated with prevalence of metabolic syndrome (OR = 0.62, 95 % CI = 0.44-0.88 for men, OR = 0.68, 95 % CI = 0.49-0.95 for women) in both sexes. CONCLUSIONS: We found positive associations between HL and healthy lifestyle characteristics and an inverse association with prevalence of metabolic syndrome among men. Our findings also suggest that men and women are likely to engage in health-promoting behaviors and make decisions based on health-related information. These findings highlight the importance of comprehensive assessments, including HL, for health promotion in the community.

The Relationships between Metabolic Disorders (Hypertension, Dyslipidemia, and Impaired Glucose Tolerance) and Computed Tomography-Based Indices of Hepatic Steatosis or Visceral Fat Accumulation in Middle-Aged Japanese Men.

BACKGROUND: Most studies on the relationships between metabolic disorders (hypertension, dyslipidemia, and impaired glucose tolerance) and hepatic steatosis (HS) or visceral fat accumulation (VFA) have been cross-sectional, and thus, these relationships remain unclear. We conducted a retrospective cohort study to clarify the relationships between components of metabolic disorders and HS/VFA. METHODS: The participants were 615 middle-aged men who were free from serious liver disorders, diabetes, and HS/VFA and underwent multiple general health check-ups at our institution between 2009 and 2013. The data from the initial and final check-ups were used. HS and VFA were assessed by computed tomography. HS was defined as a liver to spleen attenuation ratio of ≤1.0. VFA was defined as a visceral fat cross-sectional area of ≥100 cm2 at the level of the navel. Metabolic disorders were defined using Japan's metabolic syndrome diagnostic criteria. The participants were divided into four groups based on the presence (+) or absence (-) of HS/VFA. The onset rates of each metabolic disorder were compared among the four groups. RESULTS: Among the participants, 521, 55, 24, and 15 were classified as HS(-)/VFA(-), HS(-)/VFA(+), HS(+)/VFA(-), and HS(+)/VFA(+), respectively, at the end of the study. Impaired glucose tolerance was more common among the participants that exhibited HS or VFA (p = 0.05). On the other hand, dyslipidemia was more common among the participants that displayed VFA (p = 0.01). CONCLUSIONS: It is likely that VFA is associated with impaired glucose tolerance and dyslipidemia, while HS might be associated with impaired glucose tolerance. Unfortunately, our study failed to detect associations between HS/VFA and metabolic disorders due to the low number of subjects that exhibited fat accumulation. Although our observational study had major limitations, we consider that it obtained some interesting results. HS and VFA might affect different metabolic disorders. Further large-scale longitudinal studies are needed to reveal the relationships between the components of metabolic disorders and HS/VFA.

Association Between Serum Uric Acid Levels/Hyperuricemia and Hypertension Among 85,286 Japanese Workers.

This cross-sectional study from January 2012 to December 2012 aimed to examine the sex-specific association between serum uric acid (SUA) levels/hyperuricemia and hypertension among Japanese patients. SUA level, medical histories, and lifestyle-related items were collected from 85,286 of 136,770 participants. Among those with hyperuricemia, the median age was 46 years and 97% were men, which was significantly different than those without hyperurecemia (44 years and 56%, respectively; P<.01). Hyperuricemia was 1.79 times more likely in hypertensive men than normotensive men and almost six times more likely in hypertensive women (odds ratio=5.92 and adjusted odds ratio=1.33 for men and adjusted odds ratio=1.81 for women) after multivariate analysis. SUA quartiles positively correlated with systolic and diastolic blood pressures in both sexes. Hyperuricemia and SUA levels were significantly associated with hypertension in both sexes. These findings underscore the importance of maintaining normal SUA levels to manage and prevent hypertension. Better management of SUA as well as blood pressure may have potential in preventing future cardiovascular disorders.

Achievement of Target Blood Pressure Levels among Japanese Workers with Hypertension and Healthy Lifestyle Characteristics Associated with Therapeutic Failure.

BACKGROUND: Few studies have examined Japanese with regard to the achievement rates for target blood pressure levels, or the relationship between these rates and healthy lifestyle characteristics in patients with hypertension as defined by the newly established hypertension management guidelines (JSH2014). The aim of this study was to elucidate achievement rates and examine healthy lifestyle characteristics associated with achievement status among Japanese. METHODS: This cross-sectional study, conducted in January-December 2012, examined blood pressure control and healthy lifestyle characteristics in 8,001 Japanese workers with hypertension (mean age, 57.0 years; 78.8% were men) who participated in a workplace health checkup. Data were collected from workplace medical checkup records and participants' self-administered questionnaires. We divided into 5 groups [G1; young, middle-aged, and early-phase elderly patients (65-74 years old) without diabetes mellitus or chronic kidney disease (CKD) (<140/90 mmHg), G2; late-phase elderly patients (≥75 years old) without diabetes mellitus or CKD (<150/90 mmHg), G3; diabetic patients (<130/80 mmHg), G4; patients with CKD (<130/80 mmHg), and G5; patients with cerebrovascular and/or coronary artery diseases (<140/90 mmHg)] according to JSH2014. And then, achievement rates were calculated in each group. Multivariate analysis identified healthy lifestyle characteristics associated with "therapeutic failure" of target blood pressure. RESULTS: Target blood pressures were achieved by 60.2% of young, middle-aged, and early-phase elderly patients (G1), 71.4% of late-phase elderly patients (G2), 30.5% of diabetic patients (G3), 33.4% of those with chronic kidney disease (G4), and 66.0% of those with cerebrovascular and/or coronary artery diseases (G5). A body mass index of 18.5-24.9 and non-daily alcohol consumption were protective factors, and adequate sleep was found to contribute to therapeutic success. DISCUSSION: We found low achievement rates for treatment goals among patients with chronic kidney disease and diabetes mellitus. Maintaining an ideal body weight and adequate alcohol consumption may help with blood pressure control. Lifestyle modification may be necessary for better management of hypertension.

Utility of 75-g oral glucose tolerance test results and hemoglobin a1c values for predicting the incidence of diabetes mellitus among middle-aged Japanese men -a large-scale retrospective cohort study performed at a single hospital.

OBJECTIVE: The aim of this study was to investigate the associations between the incidence of diabetes and the accumulation of markers of impaired glucose metabolism; i.e., pre-diabetes. METHODS: This retrospective cohort study recruited 1,631 men without diabetes at baseline who attended more than two routine health check-ups at our institution between 2006 and 2012. The participants were divided into four groups based on the number of markers of impaired glucose metabolism exhibited at the initial examination. The following markers of impaired glucose metabolism were defined as risk factors for diabetes: a fasting plasma glucose level of ≥110 mg/dL, 2-hour plasma glucose level of ≥140 mg/dL and glycated hemoglobin (HbA1c) value of ≥6.0% (42 mmol/moL). The risk of developing diabetes was assessed using a multivariate analysis. RESULTS: The median examination interval was 1,092 days. The incidence of diabetes rose in association with the number of markers. The subjects with two markers displayed a multivariate-adjusted odds ratio (OR) for diabetes of 19.43 [95% confidence interval (CI): 9.70-38.97] and the subjects with three markers displayed an OR of 48.30 (95% CI: 20.39-115.85) compared with the subjects with one or no markers. CONCLUSION: The present results demonstrate the impact of accumulating markers of impaired glucose metabolism on the risk of developing diabetes. Anti-diabetes intervention strategies should aim to comprehensively assess an individual's risk of developing diabetes at the pre-diabetes stage.

Global distribution of polymorphisms associated with delayed Plasmodium falciparum parasite clearance following artemisinin treatment: genotyping of archive blood samples.

The recent emergence and spread of artemisinin-resistant Plasmodium falciparum isolates is a growing concern for global malaria-control efforts. A recent genome-wide analysis study identified two SNPs at genomic positions MAL10-688956 and MAL13-1718319, which are linked to delayed clearance of parasites following artemisinin combination therapy (ACT). It is expected that continuous artemisinin pressure will affect the distribution of these SNPs. Here, we investigate the worldwide distribution of these SNPs using a large number of archived samples in order to generate baseline data from the period before the emergence of ACT resistance. The presence of SNPs in MAL10-688956 and MAL13-1718319 was assessed by nested PCR RFLP and direct DNA sequencing using 653 global P. falciparum samples obtained before the reported emergence of ACT resistance. SNPs at MAL10-688956 and MAL13-1718319 associated with delayed parasite clearance following ACT administration were observed in 8% and 3% of parasites, respectively, mostly in Cambodia and Thailand. Parasites harbouring both SNPs were found in only eight (1%) isolates, all of which were from Cambodia and Thailand. Linkage disequilibrium was detected between MAL10-688956 and MAL13-1718319, suggesting that this SNP combination may have been selected by ACT drug pressure. Neither of the SNPs associated with delayed parasite clearance were observed in samples from Africa or South America. Baseline information of the geographical difference of MAL10-688956 and MAL13-1718319 SNPs provides a solid basis for assessing whether these SNPs are selected by artemisinin-based combination therapies.

Body mass index and waist circumference are independent risk factors for low vital capacity among Japanese participants of a health checkup: a single-institution cross-sectional study.

OBJECTIVE: This study aimed to examine the associations between obesity and percentage vital capacity (%VC), as well as lifestyle-related disorders, among Japanese participants of a voluntary health checkup. METHODS: Subjects were 7,892 individuals who participated in a medical health checkup from January to December 2007. Multivariate logistic regression analysis was performed to assess associations between low %VC (<80) and body mass index (BMI) and waist circumference (WC), as well as lifestyle-related disorders. RESULTS: Medical histories of hypertension and dyslipidemia were more frequent in the low %VC group than in the normal %VC group in both sexes. In men, BMI was significantly associated with low %VC (25.0 ≤ C2 < 27.5, odds ratio (OR) = 2.10; 27.5 ≤ C3 < 30.0, OR = 2.23; C4 ≥ 30.0, OR = 3.46) relative to the first category (C1 < 25.0). A significant association was also observed between WC and low %VC (85 ≤ C2 < 90, OR = 1.40; 90 ≤ C3 < 95, OR = 1.55; 95 ≤ C4, OR = 2.51; relative to C1 < 85.0 cm). In women, BMI was significantly associated with low %VC in C3 and C4 (C3, OR = 2.05; C4, OR = 2.84), and WC was significantly associated with low %VC in C4 (C4, OR = 2.32). CONCLUSION: Our results suggest that obesity may be associated with restrictive pulmonary function and underscore the importance of maintaining ideal body weight for the prevention of restrictive pulmonary dysfunction.

Association between abdominal fat distribution and atherosclerotic changes in the carotid artery.

AIM: We aimed to evaluate the association between abdominal fat distribution (e.g., abdominal visceral fat area [VFA], subcutaneous fat area [SFA], and total fat area [TFA]), waist circumference (WC), or body mass index (BMI) and atherosclerotic changes in the carotid artery after adjusting for common risk factors. METHODS: The present study is a hospital-based, cross-sectional study. Study participants included 223 Japanese individuals who underwent a medical health checkup at Juntendo University Hospital, Tokyo, between December 2005 and August 2011. Multivariate logistic regression analysis was used to examine the association between abdominal VFA, SFA, TFA, the VFA/SFA ratio, WC, or BMI and intima-media thickness [IMT] (mean IMT≥1.1mm or maximum IMT≥1.2mm) as atherosclerotic changes in the carotid artery. RESULTS: Multivariate logistic regression analysis showed that VFA (OR for ≥150cm(2) versus <100cm(2), 3.88; 95% CI, 1.39-10.85), BMI (OR for ≥27.6kg/m(2) versus <25kg/m(2), 5.22; 95% CI, 1.69-16.16), and TFA (OR for 200-285cm(2) versus <200cm(2), 4.15; 95% CI, 1.34-12.86: OR for ≥285cm(2) versus <200cm(2), 5.53; 95% CI, 1.76-17.35) were significantly associated with atherosclerotic changes in men. After adjustment for BMI, only TFA (OR for ≥285cm(2) versus <200cm(2), 3.76; 95%CI, 1.03-13.79) in men was significantly associated with atherosclerotic changes in the carotid artery. CONCLUSIONS: Our results indicate that VFA, TFA, and BMI are independently associated with atherosclerotic changes in Japanese men. TFA may be considered as a valuable measure of atherosclerotic changes.

Age-specific effectiveness and safety of newly initiated insulin therapy in Japanese patients with uncontrolled diabetes.

INTRODUCTION: One consequence of population aging is an increase in the number of elderly patients with diabetes mellitus. These elderly patients often experience atherosclerotic complications, and diabetes prevention and management are strongly desired to promote health and reduce the financial burden on the healthcare system. In this study, we conducted an age-specific evaluation of the effectiveness and safety of comprehensive management with newly initiated insulin therapy over a 1-year period in elderly (≥65 years) compared with non-elderly (≤64 years) Japanese patients with uncontrolled diabetes [glycated hemoglobin (HbA1c) ≥ 8% for ≥ 3 months]. METHODS: This retrospective single-center cohort study was conducted in Japan. We screened all outpatients with diabetes mellitus who visited the clinic for diabetes treatment between December 2006 and March 2011. Of these patients, 132 with type 2 diabetes who were newly initiated on insulin therapy for continued poor glycemic control and undergoing comprehensive management through self-monitoring of blood glucose (SMBG) were registered to the study. RESULTS: Thirty-two of 132 registered patients were excluded from the analysis. Among the 100 patients (67 non-elderly, 33 elderly) included in the analysis, median age and proportion of male patients was 69 years and 66.7%, respectively, among the elderly, and 52 years and 68.7%, respectively, among the non-elderly patients. After initiation of insulin therapy, median HbA1c levels improved from 9.6% to 7.2% in elderly patients, and from 10.8% to 7.3% in non-elderly patients at baseline and 12 months. Severe hypoglycemic events were not observed in either patient group; however, uncontrolled diabetes was ongoing in 31.8% of non-elderly and 15.4% of elderly patients, and obesity was associated with poor glycemic control. CONCLUSION: Our results indicate that the effectiveness and safety of newly initiated insulin therapy are similar between elderly and non-elderly Japanese patients with uncontrolled diabetes, and highlight the importance of comprehensive management using SMBG to avoid hypoglycemia. Better glycemic control supported by adequate intensive management is required to improve mortality and morbidity.

Influence of smoking on HIV infection among HIV-infected Japanese men.

We performed a cross-sectional study that included 100 HIV-infected Japanese men without hemophilia to examine the influence of smoking on HIV infection. History of smoking was obtained using a questionnaire. The percentage of current smokers was 40 % and was the highest (50 %) among men in their forties. The mean Brinkman index (BI, number of cigarettes smoked per day multiplied by years of smoking) was 450. The percentage of patients with a BI ≥600 was significantly higher in patients with an AIDS-defining event than in those without an AIDS-defining event. A BI ≥600 was associated with an AIDS-defining event. Reducing smoking appears to be critical to enhancing disease management efforts in Japanese men with HIV.