Kazuyo Tsushita

Glomerular hyperfiltration in prediabetes and prehypertension

BACKGROUND This study aimed to investigate the associations of hyperfiltration and hypofiltration with prediabetes and prehypertension. METHODS The study subjects included 99 140 people aged 20-89 years who underwent health checkups in Aichi Prefecture, Japan. The prevalence of hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the age-/sex-specific 5th percentile) was compared among stages of prediabetes (fasting plasma glucose <100, 100-109, 110-125 and ≥126 mg/dL for no prediabetes, Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively) and prehypertension [blood pressure (BP) <120/80, 120-129/80-84, 130-139/85-89 and ≥140/90 mmHg for no prehypertension, Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively). RESULTS The prevalence of hyperfiltration increased with increasing stage of prediabetes [odds ratios (ORs): 1.29, 1.58 and 2.47 for Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively] and prehypertension (ORs: 1.10, 1.33 and 1.52 for Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively). Hypofiltration was not associated with prediabetes or prehypertension. CONCLUSIONS The prevalence of glomerular hyperfiltration increased with increasing stages of prediabetes and prehypertension. Therefore, kidney function should be monitored in subjects with prediabetes or prehypertension. In subjects with hyperfiltration, earlier treatment of hyperglycemia and high BP may be necessary to prevent the development of kidney damage.

The number of metabolic syndrome components is a good risk indicator for both early- and late-stage kidney damage

BACKGROUND AND AIMS Renal hyperfiltration (early-stage kidney damage) and hypofiltration (late-stage kidney damage) are common in populations at high risk of chronic kidney disease. This study investigated the associations of renal hyperfiltration and hypofiltration with the number of metabolic syndrome (MetS) components. METHODS AND RESULTS The study subjects included 205,382 people aged 40-74 years who underwent Specific Health Checkups in Aichi Prefecture, Japan. The prevalence of renal hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the 5th percentile) was compared according to the number of MetS components. We found that the prevalence of both hyperfiltration and hypofiltration increased with increasing number of MetS components (odds ratios for hyperfiltration: 1.20, 1.40, 1.42, 1.41, and 1.77; odds ratios for hypofiltration: 1.07, 1.25, 1.57, 1.89, and 2.21 for one, two, three, four, and five components, respectively, compared with no MetS components). These associations were observed in both normal weight [body mass index (BMI) < 25 kg/m(2)] and overweight (BMI ≥ 25 kg/m(2)) subjects. Renal hyperfiltration was associated with prehypertension and prediabetes, while hypofiltration was associated with dyslipidemia, abdominal obesity, overt hypertension, and overt diabetes. CONCLUSION The number of MetS components is a good risk indicator of early- and late-stage kidney damage. Therefore, kidney function should be monitored in subjects with MetS components. MetS components should be treated as early as possible to prevent the development of kidney damage and cardiovascular diseases in people with hyperfiltration, regardless of their body weight.

Health benefits of daily walking on mortality among younger-elderly men with or without major critical diseases in the new integrated suburban seniority investigation project: a prospective cohort study

BACKGROUND Regular physical activity contributes to the prevention of cancer, cardiovascular disease, and other chronic diseases. However, the frequency of physical activity often declines with age, particularly among the elderly. Thus, we investigated the effects of daily walking on mortality among younger-elderly men (65-74 years) with or without major critical diseases (heart disease, cerebrovascular disease, or cancer). METHODS We assessed 1239 community-dwelling men aged 64/65 years from the New Integrated Suburban Seniority Investigation Project. We estimated hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) according to daily walking duration and adjusted for potential confounders, including survey year, marital status, work status, education, smoking and drinking status, BMI, regular exercise, regular sports, sleeping time, medical status, disease history, and functional capacity. RESULTS For men without critical diseases, mortality risk declined linearly with increased walking time after adjustment for confounders (Ptrend = 0.018). Walking ≥2 hours/day was significantly associated with lower all-cause mortality (HR 0.49; 95% CI, 0.27-0.90). For men with critical diseases, walking 1-2 hours/day showed a protective effect on mortality compared with walking <0.5 hours/day after adjustment for confounders (HR 0.29; 95% CI, 0.06-1.20). Walking ≥2 hours/day showed no benefit on mortality in men with critical diseases, even after adjustment for confounders. CONCLUSIONS Different duration of daily walking was associated with decreased mortality for younger-elderly men with or without critical diseases, independent of sociodemographic and lifestyle factors, BMI, medical status, disease history, and functional capacity. Incorporating regular walking into daily lives of younger-elderly men may improve longevity and successful aging.

Within-visit blood pressure variability is associated with prediabetes and diabetes.

We investigated the associations between within-visit blood pressure variability (BPV) and risk factors for cardiovascular disease (CVD). The study subjects included 17,795 people aged 40–74 years who underwent health check-ups in Aichi Prefecture, Japan, and completed two blood pressure measurements. Subjects were categorized into three groups according to the difference of systolic blood pressure (ΔSBP), namely, low-BPV (≤10 mmHg), moderate-BPV (11–20 mmHg), and high-BPV (>20 mmHg). Subjects were also divided into three categories as those without prediabetes (glycosylated hemoglobin A1c [HbA1c] < 5.7%), prediabetes (HbA1c 5.7–6.4%) and diabetes (HbA1c ≥ 6.5% or under treatment for diabetes). The proportion of prediabetes and diabetes were significantly higher in subjects with high-BPV than in those with low-BPV after adjusting for age, sex, and mean SBP (odds ratio [95% confidence interval] was 1.16 [1.01–1.33] for prediabetes and 1.33 [1.06–1.66] for diabetes). Other CVD risk factors were not associated with high-BPV after the adjustment. In conclusion, increased within-visit BPV was significantly associated with the prevalence of prediabetes and diabetes, independent of mean SBP, in a large general population. Therefore, assessing BPV in a single visit may help to identify subjects at increased risk of impaired glycemic control.

Association of gait speed with mortality among the Japanese elderly in the New Integrated Suburban Seniority Investigation Project: a prospective cohort study

BACKGROUND gait speed is associated with mortality among the elderly, but evidence for this in Japan is lacking. We investigated the impact of gait speed on mortality among younger-elderly people and determined whether daily walking modifies that association. SUBJECTS data were obtained from 2,105 community-dwelling individuals (990 men, 1,025 women) approaching age 65 who were free of heart disease, cerebrovascular disease and cancer, and who were enrolled in the New Integrated Suburban Seniority Investigation Project between 1996 and 2003. METHODS Cox proportional hazard regression was applied to estimate hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) according to gait speed and daily walking. We adjusted for potential confounders, including survey year, marital status, work status, education, smoking and drinking status, body mass index and medical history. RESULTS during the total 21,192 person-year follow-up to age 75, 188 participants (140 men, 48 women) died. Slow gait speed was significantly associated with increased all-cause mortality among men after full adjustment (HR, 1.72; 95% CI, 1.08-2.63). This association disappeared when men with slow gait speed walked ≥1 h/day (HR, 0.98; 95% CI, 0.34-2.25) compared with subjects with normal or fast gait speed walking >1 h/day. Slow gait speed yielded a threefold greater risk of mortality when women walked ≥1 h/day (HR, 3.04; 95% CI, 1.34-6.49), compared with the normal- or fast-gait group. CONCLUSION slow gait speed is associated with an increased risk of all-cause mortality among younger-elderly people. Daily walking was found to modify this association among men.

Upper-normal waist circumference is a risk marker for metabolic syndrome in normal-weight subjects

BACKGROUND AND AIMS To elucidate implication of upper-normal waist circumference (WC), we examined whether the normal range of WC still represents a risk of metabolic syndrome (MetS) or non-adipose MetS components among normal-weight subjects. METHODS AND RESULTS A total of 173,510 persons (100,386 men and 73,124 women) with normal WC (<90/80 cm in men/women) and body mass index (BMI) of 18.5-24.9 were included. Subjects were categorized as having low, moderate, and upper-normal WC for those with WC < 80, 80-84, and 85-89 cm in men and <70, 70-74, and 75-79 cm in women, respectively. The prevalence of all the non-adipose MetS components (e.g. prediabetes and borderline dyslipidemia) was significantly higher in subjects with upper-normal WC on comparison with those with low WC. Overall, the prevalence of MetS (having three or more of four non-adipose MetS components) gradually increased with increasing WC (12%, 21%, and 27% in men and 11%, 14%, and 19% in women for low, moderate, and upper-normal WC, respectively). Moreover, the risk of having a greater number of MetS components increased in subjects with upper-normal WC compared with those with low WC (odds ratios for the number of one, two, three, and four MetS components: 1.29, 1.81, 2.53, and 2.47 in men and 1.16, 1.55, 1.49, and 2.20 in women, respectively). CONCLUSION Upper-normal WC represents a risk for acquiring a greater number of MetS components and the early stage of MetS components (prediabetes and borderline dyslipidemia), after adjusting for BMI, in a large general population with normal WC and BMI.

Association between falls and depressive symptoms or visual impairment among Japanese young‐old adults

To investigate the association between falls and self‐reported depressive symptoms or visual impairment among young‐old adults.

Association of Adiponectin With Cancer and All-Cause Mortality in a Japanese Community-Dwelling Elderly Cohort: A Case-Cohort Study

Background Most studies of plasma adiponectin (APN) and mortality among community-dwelling elderly focus on cardiovascular disease, but data on the relationship between plasma APN and cancer mortality is exiguous. We investigated whether APN is associated with cancer mortality in community-dwelling elderly people. Methods We conducted a case-cohort study within the New Integrated Suburban Seniority Investigation (NISSIN) Project using a randomly drawn sub-cohort of 697 subjects (351 men and 346 women; mean age 64.5 [standard deviation, 0.5] years) among whom we compared cases of all-cause death (n = 269) and cancer death (n = 149) during a mean follow-up duration of 10.8 (standard deviation, 3.7) years. Associations between APN and mortality were assessed using weighted Cox regression analyses. Results We observed significant positive associations between the APN concentration and cancer death in the first and third APN tertiles compared with the second APN tertile (hazard ratio [HR]T1 vs T2, 1.67; 95% confidence interval [CI], 1.00–2.79 and HRT3 vs T2, 2.10; 95% CI, 1.30–3.40). Further adjustment for possible confounders attenuated the association (HRT1 vs T2, 1.63; 95% CI, 0.93–2.84 and HRT3 vs T2, 2.10; 95% CI, 1.26–3.50). A similar but weaker association was seen for all-cause mortality (multivariate HRT1 vs T2, 1.45; 95% CI, 0.95–2.21 and HRT3 vs T2, 1.51; 95% CI, 1.01–2.25). Conclusion Plasma APN and cancer mortality have a significant relationship among community-dwelling elderly people, which warrants further study.