Jin Fukumoto

Adiponectin and colorectal adenomas: Self Defense Forces Health Study

Adiponectin is an adipocyte‐derived protein with an insulin‐sensitizing action. Circulating levels of adiponectin are inversely correlated with obesity, especially abdominal obesity. Some studies have suggested that low levels of circulating adiponectin might be related to increased risk of colorectal cancer and adenomas. The present study examined the relationship between total and high‐molecular‐weight (HMW) adiponectin to colorectal adenomas in the Self Defense Forces (SDF) Health Study. The study subjects comprised 656 cases of colorectal adenomas and 648 controls with normal colonoscopy among men receiving a preretirement health examination at two Self Defense Forces hospitals. Total and HMW adiponectin were slightly lower in adenoma cases than in controls; geometric means of total adiponectin were 5.42 µg/mL in cases and 5.63 µg/mL in controls (P = 0.13), and the corresponding values of HMW adiponectin were 2.47 µg/mL and 2.57 µg/mL, respectively (P = 0.29). Regardless of adjustment for body mass index and other lifestyle factors, total adiponectin was unrelated to the risk of colorectal adenomas. Total adiponectin levels were inversely related to the risk of large adenomas (≥ 5 mm), but not of small adenomas, with a nearly statistically significant decreasing trend (P = 0.06). However, the inverse association was largely ascribed to body mass index and other lifestyle factors. HMW adiponectin showed no clear association with either overall or size‐specific risk of colorectal adenomas. The study provided suggestive evidence for a protective association between adiponectin and large adenomas, but did not indicate a protective association independent of adiposity. (Cancer Sci 2008; 99: 781–786)

Circulating vitamin D and colorectal adenomas in Japanese men

Accumulating evidence suggests that vitamin D has anticarcinogenic effects. However, it is unclear whether the nutrient is involved in the early stage of colorectal carcinogenesis. We examined the association between circulating vitamin D concentrations and colorectal adenomas in Japanese men. The study subjects comprised 656 cases of colorectal adenomas and 648 controls with normal colonoscopy among male self defense officials receiving a pre‐retirement health examination between 1997 and 2004. Plasma or serum levels of 25‐hydroxyvitamin D [25(OH)D] were measured using a radioimmunoassay method. Logistic regression analysis was used to obtain odds ratios (OR) and 95% confidence intervals (CI) with adjustment for potential confounding variables. Overall, there was no measurable association between circulating 25(OH)D concentrations and colorectal adenomas. When the analysis was restricted to subjects whose blood was taken during the winter season (November–April), the prevalence odds of colorectal adenomas for the highest versus lowest quartile of 25(OH)D was statistically significantly decreased (ORu2003=u20030.58; 95% CIu2003= 0.34–0.99). The reduction was more pronounced for the rectum (ORu2003=u20030.22) and distal colon (ORu2003=u20030.47) than for proximal colon (ORu2003=u20030.70). During the summer season (May–October), higher levels of 25(OH)D were associated with an increased odds of small, but not large, adenomas. The present study adds to evidence that high levels of circulating vitamin D measured during darker season is associated with decreased prevalence of adenomas in the distal sites of the colorectum. (Cancer Sci 2010)

C‐reactive protein and colorectal adenomas: Self Defense Forces Health Study

Chronic inflammation has been implicated in colorectal carcinogenesis. Several studies have investigated the relationship between C‐reactive protein (CRP), a biomarker of inflammation, and colorectal cancer and adenomas, resulting in inconsistent findings. The present study examined the relationship between circulating levels of high‐sensitivity CRP and colorectal adenomas. The study subjects comprised 646 cases of colorectal adenoma and 635 controls of normal total colonoscopy among men receiving a preretirement health examination at two hospitals of the Self Defense Forces. Statistical adjustment was made for cigarette smoking, alcohol use, body mass index, physical activity, and other potential confounders. The multivariate‐adjusted geometric means showed no measurable differences between adenoma cases and controls, but were higher among cases with larger adenomas (trend P = 0.03). Likewise, although the prevalence odds of colorectal adenomas did not differ according to CRP levels as categorized at the 30th, 60th, and 90th percentiles in the controls, higher levels of CRP were associated with a statistically significant increase in the prevalence odds of large adenomas (≥5 mm), but not of small adenomas (<5 mm). The multivariate‐adjusted odds ratios of large adenomas for the lowest to highest categories of CRP were 1.00 (referent), 1.81 (95% confidence interval 1.17–2.80), 1.61 (95% confidence interval 1.03–2.52), and 2.21 (95% confidence interval 1.28–3.84), respectively (trend P = 0.01). A positive association between CRP and prevalence odds of large adenomas was not modified by either smoking or overweight. These findings suggest that inflammation is linked to the growth of colorectal adenomas. (Cancer Sci 2009; 100: 709–711)

Linking lifestyle factors and insulin resistance, based on fasting plasma insulin and HOMA-IR in middle-aged Japanese men: A cross-sectional study

Abstract Objective. Insulin resistance (IR) is regarded as one of the earliest features of many metabolic diseases, and major efforts are aimed at improving insulin function to confront this issue. The aim of this study was to investigate the relationship of body mass index (BMI), cigarette smoking, alcohol intake, physical activity, green tea and coffee consumption to IR. Methods. We performed a cross-sectional study of 1542 male self defense officials. IR was defined as the highest quartile of the fasting plasma insulin (≥ 50 pmol/L) or the homeostasis model assessment-estimated IR (HOMA-IR ≥ 1.81). An unconditional logistic model was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between IR and influential factors. Stratified analysis by obesity status (BMI < 25 kg/m2, non-obese; ≥ 25 kg/m2, obese) was performed. Results. IR was significantly positively related to BMI and glucose tolerance, negatively related to alcohol use. Independent of obesity status, significant trends were observed between IR and alcohol use. Drinking 30 mL or more of ethanol per day reduced IR by less than 40%. Strong physical activity was associated with decreased risk of IR based on fasting plasma insulin only in the obese. Coffee consumption was inversely associated with the risk of IR based on HOMA-IR in the non-obese group. Conclusion. Higher coffee consumption may be protective against IR among only the non-obese. Further studies are warranted to examine the effect modification of the obesity status on the coffee-IR association.

Validity of a Diagnostic Scale for Acupuncture: Application of the Item Response Theory to the Five Viscera Score

In acupuncture therapy, diagnosis, acupoints, and stimulation for patients with the same illness are often inconsistent among between Traditional Chinese Medicine (TCM) practitioners. This is in part due to the paucity of evidence-based diagnostic methods in TCM. To solve this problem, establishment of validated diagnostic tool is inevitable. We first applied the Item Response Theory (IRT) model to the Five Viscera Score (FVS) to test its validity by evaluating the ability of the questionnaire items to identify an individuals latent traits. Next, the health-related QOL scale (SF-36), a suitable instrument for evaluating acupuncture therapy, was administered to evaluate whether the FVS can be used to make a health-related diagnosis. All 20 items of the FVS had adequate item discrimination, and 13 items had high item discrimination power. Measurement accuracy was suited for application in a range of individuals, from healthy to symptomatic. When the FVS and SF-36 were administered to other subjects, a part of which overlap with the first subjects, we found an association between the two scales, and the same findings were obtained when symptomatic and asymptomatic subjects were compared regardless of age and sex. In conclusion, the FVS may be effective in clinical diagnosis.

Self-Reported Symptoms Related to Depression and Suicidal Risk

Depression is often accompanied by a wide variety of somatic symptoms even when there is no evidence of any organic disorder that can cause such symptoms. Though the underlying mechanism still remains unclear, there are two assumptions explaining the associations between somatic symptoms and depression. One is that depression itself causes several somatic symptoms. That is, people with depression may express their mental conflicts in various somatic symptoms. This hypothesis could apply especially to those who have a vague feeling of stigma or prejudice against mental disorders, and who are reluctant to frankly express their mental symptoms. From another point of view, this might mean that some chronic somatic symptoms are magnified due to the person’s depressive state. Another possible hypothesis is that those who have had chronic somatic symptoms of unknown origin, in other words, functional somatic symptoms, are likely to be depressed since they cannot always receive effective medical treatment for such symptoms.