Hiroshi Yokomichi

Evaluation of the associations between changes in intraocular pressure and metabolic syndrome parameters: a retrospective cohort study in Japan

Objective The contributions of highly correlated cardiovascular risk factors to intraocular pressure (IOP) are not clear due to underlying confounding problems. The present study aimed to determine which metabolic syndrome parameters contribute to elevating IOP and to what extent. Design Retrospective cohort study. Setting A private healthcare centre in Japan. Participants Individuals who visited a private healthcare centre and underwent comprehensive medical check-ups between April 1999 and March 2009 were included (20u2005007 in the cross-sectional study and 15u2005747 in the longitudinal study). Primary and secondary outcome measures Changes in IOP were evaluated in terms of ageing and changes in metabolic syndrome parameters. Pearsons correlation coefficients and mixed-effects models were used to examine the relationship of changes in IOP with ageing and changes in metabolic syndrome parameters in cross-sectional and longitudinal studies, respectively. Results In the cross-sectional study, IOP was negatively correlated with age and positively correlated with waist circumference, high-density lipoprotein cholesterol (HDL-C) levels, triglyceride levels, systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting plasma glucose (FPG) levels. In the longitudinal multivariate analysis, the associated IOP changes were −0.12 (p<0.0001) mmu2005Hg with male sex; −0.59 (p<0.0001) mmu2005Hg with 10u2005years of ageing; +0.42 (p<0.0001) mmu2005Hg with 1u2005mmol/L increase in HDL-C levels; +0.092 (p<0.0001) mmu2005Hg with 1u2005mmol/L increase in triglyceride levels; +0.090 (p<0.0001) mmu2005Hg with 10u2005mmu2005Hg increase in SBP; +0.085 (p<0.0001) mmu2005Hg with 10u2005mmu2005Hg increase in DBP; and+0.091 (p<0.0001) mmu2005Hg with 1u2005mmol/L increase in FPG levels. Conclusions Elevation of IOP was related to longitudinal worsening of serum triglyceride levels, blood pressure and FPG and improvement in serum HDL-C levels.

Impact of the great east Japan earthquake on the body mass index of preschool children: a nationwide nursery school survey

Objective To evaluate the impact of the 2011 great east Japan earthquake on body mass index (BMI) of preschool children. Design Retrospective cohort study and ecological study. Setting Affected prefectures (Fukushima, Miyagi and Iwate) and unaffected prefectures in northeast Japan. Participants The cohort study assessed 2033 and 1707 boys and 1909 and 1658 girls in 3 affected prefectures and unaffected prefectures, respectively, all aged 3–4u2005years at the time of the earthquake. The ecological study examined random samples of schoolchildren from the affected prefectures. Primary and secondary outcome measures The cohort study compared postdisaster changes in BMIs and the prevalence of overweight and obese children. The ecological study evaluated postdisaster changes in the prevalence of overweight children. Results 1u2005month after the earthquake, significantly increased BMIs were observed among girls (+0.087u2005kg/m2 vs unaffected prefectures) in Fukushima and among boys and girls (+0.165 and +0.124u2005kg/m2, respectively vs unaffected prefectures) in Iwate. 19u2005months after the earthquake, significantly increased BMIs were detected among boys and girls (+0.137 and +0.200u2005kg/m2, respectively vs unaffected prefectures) in Fukushima, whereas significantly decreased BMIs were observed among boys and girls (−0.218 and −0.082u2005kg/m2, respectively vs unaffected prefectures) in Miyagi. 1u2005month after the earthquake, Fukushima, Miyagi and Iwate had a slightly increased prevalence of overweight boys, whereas Fukushima had a slightly decreased prevalence of overweight girls, compared with the unaffected prefectures. The ecological study detected increases in the prevalence of overweight boys and girls in Fukushima who were 6–11 and 6–10u2005years of age, respectively. Conclusions These results suggest that in the affected prefectures, preschool children gained weight immediately after the earthquake. The long-term impact of the earthquake on early childhood growth was more variable among the affected prefectures, possibly as a result of different speeds of recovery.

Statin use and all-cause and cancer mortality: BioBank Japan cohort.

Background Statins are the first-line agents used to treat patients with high serum low-density lipoprotein cholesterol levels, thus reducing the risk of death from arterial sclerotic cardiovascular disease; however, little is known about the effects of non-statin pharmacological interventions on mortality as well as about the potential protective effects of statin use against cancer death. This work aimed to compare all-cause and cancer mortality among patients with hyperlipidaemia who did and did not receive statin treatment. Methods Between 2003 and 2007 fiscal years, we recruited Japanese patients diagnosed with hyperlipidaemia from 66 hospitals. Patients in our cohort were followed up for a maximum of 12 years to observe the causes of death. Kaplan–Meier estimates from the baseline were used to compare the mortality of patients based on the administered medicine. All-cause mortality were compared among patients with/without administration of statins and other agents; any-organ and colorectal cancer mortality were compared between patients with/without administration of statins. Results Our cohort included 41,930 patients with mean ages of 64–66 years and mean body mass indices of 24–25 kg/m2. Patients who received statin monotherapy and were treated with lifestyle modification exhibited nearly identical survival curves, whereas statin use represented a non-significant but potentially protective effect against colorectal cancer-related mortality. The lowest mortality in this cohort was associated with resin monotherapy. Conclusions Mortality rate has been similar for patients treated with statin monotherapy and lifestyle modification. Statin monotherapy could potentially reduce any-organ- and colorectal cancer-related mortality.

Improvement in glycemic control through changes in insulin regimens: findings from a Japanese cohort of children and adolescents with type 1 diabetes

Although insulin analogs have dramatically changed diabetes treatment, scarce evidence is available on those effects. We aimed to explore whether glycemic control had improved, the use of insulin analogs had been increased, and hypoglycemic events had decreased over time in Japanese pediatric patients with type 1 diabetes (T1D).

Longitudinal changes in body mass index of children affected by the Great East Japan Earthquake

Background:The evacuation and disruption in housing caused by the 2011 Great East Japan Earthquake and following nuclear radiation may have influenced child health in many respects. However, studies regarding longitudinal childhood growth are limited. Therefore, in this study we aimed to explore the influence of the earthquake on longitudinal changes in body mass index in preschool children.Methods:Participants were children from nursery schools who cooperated with the study in the Iwate, Miyagi and Fukushima prefectures. The exposed group consisted of children who experienced the earthquake during their preschool-age period (4–5 years old). The historical control group included children who were born 2 years earlier than the exposed children in the same prefectures. Trajectories regarding body mass index and prevalence of overweight/obesity were compared between the two groups using multilevel analysis. Differences in the changes in BMI between before and after the earthquake, and proportion of overweight/obesity was compared between the two groups. We also conducted subgroup analysis by defining children with specific personal disaster experiences within the exposed group.Results:A total of 9722 children were included in the study. Children in the exposed group had higher body mass indices and a higher proportion of overweight after the earthquake than the control group. These differences were more obvious when confined to exposed children with specific personal disaster experiences.Conclusions:Children’s growth and development-related health issues such as increased BMI after natural disasters should evoke great attention.

Do body mass index trajectories affect the risk of type 2 diabetes? A case–control study

BackgroundAlthough obesity is a well-studied risk factor for diabetes, there remains an interest in whether “increasing body mass index (BMI),” “high BMI per se,” or both are the actual risk factors for diabetes. The present study aimed to retrospectively compare BMI trajectories of individuals with and without diabetes in a case–control design and to assess whether increasing BMI alone would be a risk factor.MethodsUsing comprehensive health check-up data measured over ten years, we conducted a case–control study and graphically drew the trajectories of BMIs among diabetic patients and healthy subjects, based on coefficients in fitted linear mixed-effects models. Patient group was matched with healthy control group at the onset of diabetes with an optimal matching method in a 1:10 ratio. Simple fixed-effects models assessed the differences in increasing BMIs over 10xa0years between patient and control groups.ResultsAt the time of matching, the mean ages in male patients and controls were 59.3xa0years [standard deviation (SD)u2009=u20099.2] and 57.7xa0years (SDu2009=u200911.2), whereasxa0the mean BMIs were 25.0xa0kg/m2 (SDu2009=u20093.1) and 25.2xa0kg/m2 (SDu2009=u20092.9), respectively. In female patients and controls, the mean ages were 61.4xa0years (SDu2009=u20097.9) and 60.1xa0years (SDu2009=u20099.6), whereasxa0the mean BMIs were 24.8xa0kg/m2 (SDu2009=u20093.5) and 24.9xa0kg/m2 (SDu2009=u20093.4), respectively. The simple fixed-effects models detected no statistical significance for the differences of increasing BMIs between patient and control groups in males (Pu2009=u20090.19) and females (Pu2009=u20090.67). Sudden increases in BMI were observed in both male and female patients when compared with BMIs 1xa0year prior to diabetes onset.ConclusionsThe present study suggested that the pace of increasing BMIs is similar between Japanese diabetic patients and healthy individuals. The increasing BMI was not detected to independently affect the onset of type 2 diabetes.

Survival of macrovascular disease, chronic kidney disease, chronic respiratory disease, cancer and smoking in patients with type 2 diabetes: BioBank Japan cohort

Background The number of patients with diabetes is increasing worldwide. Macrovascular disease, chronic kidney disease, chronic respiratory disease, cancer and smoking frequently accompany type 2 diabetes. Few data are available related to mortality of Asians with diabetes associated with these serious comorbidities. The present study aimed to quantify the excess mortality risks of type 2 diabetic patients with comorbidities. Methods We analysed the available records of 30,834 Japanese patients with type 2 diabetes from the BioBank Japan Project between 2003 and 2007. Men and women were followed up for median 8.03 and 8.30 years, respectively. We applied Cox proportional hazard model and Kaplan–Meier estimates for survival curves to evaluate mortality in diabetic patients with or without macrovascular disease, chronic respiratory disease, chronic kidney disease, cancer and smoking. Results Adjusted hazard ratios (HRs) for mortality were 1.39 (95% CI, 1.09–1.78) for male sex, 2.01 (95% CI, 1.78–2.26) per 10-year increment of age. Adjusted HRs of primary interest were 1.77 (95% CI, 1.42–2.22), macrovascular disease; 1.58 (95% CI, 1.08–2.31), chronic respiratory disease; 2.03 (95% CI, 1.67–2.47), chronic kidney disease; 1.16 (95% CI, 0.86–1.56), cancer; and 1.74 (95% CI, 1.30–2.31), current smoking. Conclusions Diabetic patients with a past or current history of chronic kidney, macrovascular or respiratory diseases or smoking habit have exhibited the highest risk of mortality. Data were limited to those of survivors of comorbidities but we propose the need to improve comorbidities and terminate cigarette smoking for better prognosis in patients with diabetes.

Macrosomic Neonates Carry Increased Risk of Dental Caries in Early Childhood: Findings from a Cohort Study, the Okinawa Child Health Study, Japan

Background Although many studies have discussed health risks in neonates with a low birth weight, few studies have focused on the risks in neonates with a high birth weight. The objective of this study was to determine whether differences in the incidence of dental caries in early childhood are associated with birth weight status. Methods A total of 117,175 children born in Okinawa Prefecture, Japan from 1997 to 2007 were included in this study. Medical professionals collected information about birth records, growth and development, parental child-rearing practices and dental health at 3 months, 18 months and 3 years of age. The risk of dental caries among neonates with macrosomia (birth weight ≥4000 g) was compared with that among neonates with normal weight (2500–3999 g). Sensitivity analyses included ‘large for gestational age’ (LGA, birth weight above the 90th percentile for gestational age), which was relative to ‘appropriate for gestational age’ (birth weight between 10th and 90th percentiles). Relative risks and relative risk increases were estimated by multivariate Poisson regression. Results At 3 years of age, the relative risk increases for dental caries after adjusting for confounding factors were 19% [95% confidence interval (CI), 11%–28%, P < 0.001] for macrosomic neonates and 12% (95% CI, 9%–16%, P < 0.001) for LGA neonates. Conclusion Macrosomia and LGA were associated with an increased risk of dental caries in early childhood. Particular attention should be paid to abnormally large neonates.

Disease prevalence among nursery school children after the Great East Japan earthquake

Objective To investigate the relationship between personal experience of the Great East Japan Earthquake and various disease types among nursery school children. Design We conducted a nationwide survey of nursery school children born between 2 April 2006 and 1 April 2007. Nursery school teachers completed questionnaires if they agreed to join the study. Questionnaire items for children consisted of their birth year and month, sex, any history of moving into or out of the current nursery school, presence of diseases diagnosed by a physician at the age of 66–78u2005months and type of disaster experience. The survey was conducted from September 2012 to December 2012. Setting Japan, nationwide. Participants A total of 60u2005270 nursery school children were included in the analysis, 840 of whom experienced the disaster on 11 March 2011. Main outcome measures The health status of children 1.5u2005years after the disaster based on nursery school records. Results Experiencing the disaster significantly affected the prevalence of overall and individual diseases. Furthermore, there was a difference in disease prevalence between boys and girls. In boys, experiencing the tsunami (OR 2.53, 95% CI 1.22 to 5.24) and living in an evacuation centre (OR 2.92, 95% CI 1.46 to 5.83) were remarkably associated with a higher prevalence of atopic dermatitis, but these trends were not observed among girls. Instead, the home being destroyed (OR 3.50, 95% CI 2.02 to 6.07) and moving house (OR 4.19, 95% CI 2.01 to 8.71) were positively associated with a higher prevalence of asthma among girls. Conclusions Our study indicates that experiencing the disaster may have affected the health status of nursery school children at least up to 1.5u2005years after the disaster. Continuous monitoring of the health status of children is necessary to develop strategic plans for child health.

Diabetes screening intervals based on risk stratification.

BackgroundGuidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes.MethodsThis was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals based on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We adapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a linear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1.ResultsAmong 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48 (30–74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30–44 years old, HbA1c screening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMIu2009>u200930) years, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ≥20%) years. This trend was consistent in other age and risk groups as well; among obese 30–44 year olds, we found substantially shorter intervals compared to other groups.ConclusionHbA1c screening intervals for identification of DM vary substantially by risk factors. Risk stratification should be applied when deciding an optimal HbA1c screening interval in the general population to minimize overdiagnosis and overtreatment.