Keiji Tanimoto

Association of sarcopenia with functional decline in community-dwelling elderly subjects in Japan.

The present study aimed to determine the association of sarcopenia, defined by muscle mass, muscle strength and physical performance, with functional disability from a 2‐year cohort study of community‐dwelling elderly Japanese people.

The influence of age on the GH-IGF1 axis in patients with acromegaly.

OBJECTIVE The purpose of this study was to investigate the influence of age on GH and IGF1 axis, and complications in patients with acromegaly. SUBJECTS AND METHODS From the medical records, we retrospectively analyzed clinical features and complications in 87 newly diagnosed patients with active acromegaly (34 males, 53 females; aged 18-82 years) who were admitted to Tokyo Womens Medical University between 1999 and 2006. We divided the patients into three groups according to age: <or=30 years old (young group), 31-60 years old (middle-aged group), and >or=61 years old (elderly group). RESULTS The median GH levels in young, middle-aged, and elderly groups were 18.5, 8.8, and 6.7 microg/l respectively, and the IGF1 levels were 810, 717, and 740 microg/l respectively. The values were not significantly different among the groups. However, the serum IGF1 SDS were significantly higher in the elderly group (10.2) than those in young and middle-aged groups (6.6 and 6.2 respectively, P<0.001). The age difference in the higher IGF1 SDS was remarkable in female patients. In the elderly group, glucose intolerance and hypertension were found in 94 and 53% of the patients respectively and the incidences were higher than those in the other groups. CONCLUSION This study suggests that the relatively high IGF1 secretions in elderly patients might be involved in the progression of clinical complications in acromegalic patients. Therefore, awareness of the early symptoms and examination of serum GH and IGF1 are important for patients with acromegaly.

Reversible Hypopituitarism with Pituitary Tuberculoma

A 50-year-old woman presented with a headache and nausea. A sellar and suprasellar mass was detected on MRI; the tumor was heterogeneously enhanced with gadolinium, and the pituitary stalk was slightly thickened. Laboratory tests revealed severe growth hormone, luteinizing hormone, follicle-stimulating hormone and thyroid-stimulating hormone deficiencies. A pathological examination of the tumor showed scattered granulomas with central necrosis and Langhans giant cells. Tuberculin skin and QuantiFERON TB-Gold tests (QFT-2G) were positive. Accordingly, we diagnosed the patient with pituitary tuberculoma presenting with pituitary dysfunction. Following treatment with antituberculous drugs, the pituitary hormone function normalized and the pituitary tuberculoma disappeared.

The cytokeratin-18 fragment level as a biomarker of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus.

BACKGROUND The serum cytokeratin-18 fragment (CK-18) concentration has been suggested to be a biomarker of nonalcoholic fatty liver disease (NAFLD), although its usefulness in patients with type 2 diabetes mellitus (T2DM) is unknown. METHODS The study was divided into two parts. In the first cross-sectional study, a total of 200 patients with T2DM and 58 healthy control subjects were recruited. NAFLD was diagnosed using ultrasonography. In the subsequent longitudinal study, we evaluated the three-month change (Δ) in the CK-18 concentration and other parameters in 40 T2DM patients with NAFLD. RESULTS The serum CK-18 values were significantly higher in the NAFLD group than in the nonNAFLD group among both diabetic and nondiabetic subjects. The CK-18 concentration was found to be an independent determinant of NAFLD and was positively correlated with the ultrasonography score and AST and ALT concentrations in the T2DM patients. Positive correlations were also identified between the CK-18 and transaminase concentrations in the T2DM and NAFLD cohorts. ΔCK-18 was found to be significantly associated with ΔBMI in the T2DM patients with NAFLD. CONCLUSIONS A dose effect between the CK-18 concentration and the severity of NAFLD was found in the T2DM patients; thus, the CK-18 concentration is a potentially useful biomarker for assessing the efficacy of treatment and the improvement in NAFLD in patients with T2DM.

Acute cerebral hemorrhage normalized plasma renin activity in a patient with primary aldosteronism

A 33-year-old man was admitted to an emergency medical facility because of left putamen hemorrhage, hypertension (blood pressure, 290/160 mmHg at arrival), and hypokalemia (serum potassium level, 2.6 mg/dl). His medical history and family history were unremarkable. A CT scan revealed the presence of a right adrenal tumor; however, his PRA (3.5 ng/ml/h; reference range 0.3–2.9 ng/ml/h) and plasma aldosterone concentration (PAC; 142 pg/ml; reference range for subjects in the supine position 29.9–159 pg/ml) were within normal limits on day 3 after admission. An elevated plasma norepinephrine level of 1.36 ng/ml (reference range 0.07–0.31 ng/ml) on day 3 and a urine metanephrine level of 2.39 mg/day (reference range 0.13– 0.52 mg/day) on day 4 suggested sympathetic activation. Once the patient’s condition stabilized, he was transferred to our division. He had been prescribed oral antihypertensive drugs (amlodipine 10 mg and clonidine 0.45 mg) and sustained-release potassium (48 mEq/day). Physical examination revealed speech impairment, right hemiplegia, and an inability to stand. His blood pressure was 144/98 mmHg. The laboratory data were as follows: serum potassium, 4.4 mEq/l; serum creatinine, 1.07 mg/dl; PRA, 1.1 ng/ml/h; PAC, 201 pg/ml; plasma norepinephrine, 0.10 ng/ml; and urine metanephrine, 0.06 mg/day. A brain CT scan showed a left putamen hemorrhage, and an abdominal T2-weighted MRI image showed a 16-mm right adrenal tumor with a low-intensity signal. On days 30 and 37 after the cerebral hemorrhage, PRA was undetectable, and PAC levels were elevated (Table 1). The captopril test was performed on day 37. Fifty milligrams of captopril was administered orally, and blood samples were obtained prior to and 60 and 120 min after administration. The PRA and PAC values measured at these times were \0.1, 0.3, and 0.5 ng/ml/h and 283, 217, and 243 pg/ml, respectively. I-adosterol adrenal scintigraphy showed a hot spot at the right adrenal gland. On the basis of these findings, we diagnosed the patient as having PA caused by the right adrenal tumor. Right adrenectomy was performed laparoscopically 1 year after the initial cerebral hemorrhage. Histological examination revealed a benign adrenal adenoma of the clear-cell type. His postoperative course was uneventful, and his PRA and PAC levels returned to normal.

Decreased β-Cell Function Is Associated with Reduced Skeletal Muscle Mass in Japanese Subjects without Diabetes

Background Decreased insulin secretion has a great impact on the incidence of type 2 diabetes in Japanese subjects. It is not clear whether β-cell function is related to muscle mass in subjects without diabetes. We investigated the relationship between β-cell function and skeletal muscle mass in Japanese subjects without diabetes. Methods The study included 1098 subjects (538 men and 560 women) aged 40 to 79 years, without diabetes (fasting glucose lower than 126 mg/dL and glycosylated hemoglobin lower than 6.5%), who consulted Osaka Medical College Health Science Clinic for a medical examination. Appendicular muscle mass was measured by bioelectrical impedance analysis. Appendicular muscle mass index was calculated as appendicular muscle mass divided by height squared (kg/m2). The homeostatic model assessment of β-cell function was used to assess β-cell function. The homeostatic model assessment of insulin resistance was used as a measure of insulin resistance. The association between appendicular muscle mass index and clinical parameters of β-cell function and insulin resistance was examined. Results Log-transformed homeostatic model assessment of β-cell function and Log-transformed homeostatic model assessment of insulin resistance showed a normal distribution. In both men and women, there was a significant positive correlation between appendicular muscle mass index and clinical parameters of β-cell function and insulin resistance. Tertile analysis, following stratification according to appendicular muscle mass index, found that low appendicular muscle mass index was significantly associated with the Log homeostatic model assessment of β-cell function and Log-transformed homeostatic model assessment of insulin resistance. Conclusion This study shows that decreased β cell function is associated with reduced skeletal muscle mass in Japanese subjects without diabetes.

“Benifuuki” extract reduces serum levels of lectin-like oxidized low-density lipoprotein receptor-1 ligands containing apolipoprotein B: A double-blind placebo-controlled randomized trial

(1) Background: Arteriosclerosis is associated with high levels of low-density lipoprotein (LDL) cholesterol. O-methylated catechins in “Benifuuki” green tea are expected to reduce cholesterol levels, although there is limited research regarding this topic; (2) Methods: This trial evaluated 159 healthy volunteers who were randomized to receive ice cream containing a high-dose of “Benifuuki” extract including 676 mg of catechins (group H), a low-dose of “Benifuuki” extract including 322 mg of catechins (group L), or no “Benifuuki” extract (group C). Each group consumed ice cream (with or without extract) daily for 12 weeks, and their lipid-related parameters were compared; (3) Results: A significant reduction in the level of lectin-like oxidized LDL receptor-1 ligand containing ApoB (LAB) was detected in group H, compared to groups L and C. No significant differences between the three groups were detected in their levels of total cholesterol, triglycerides, and LDL cholesterol; (4) Conclusions: “Benifuuki” extract containing O-methylated catechins may help prevent arteriosclerosis.

Effects of L-carnitine supplementation on the quality of life in diabetic patients with muscle cramps

Diabetic patients often suffer from muscle cramps. This study aimed to compare the quality of life (QOL) of diabetic patients with and without muscle cramps and to investigate the effect of L-carnitine supplementation in diabetic patients with muscle cramps. A total of 91 patients with diabetes were enrolled in this study: 69 patients with muscle cramps and 22 patients without muscle cramps. Muscle cramps and QOL were evaluated using the muscle cramp questionnaire and the Short Form 36 health survey version 2 (SF-36), respectively. Clinical characteristics were compared between diabetic patients with and without muscle cramps. In the prospective portion of the study, 25 diabetic patients with muscle cramps received L-carnitine supplementation (600 mg/day orally) for 4 months. The questionnaires were administered before and after supplementation. The SF-36 scores in diabetic patients with muscle cramps were lower than those in patients without muscle cramps on the subscales of physical function, role physical, bodily pain, vitality, general health, and social function. In the 25 patients with muscle cramps who received L-carnitine supplementation, the monthly frequency of muscle cramps and Wong-Baker FACES® Pain Rating Scale scores were significantly decreased. Scores on the following SF-36 subscales improved after L-carnitine supplementation: body pain, vitality, social function, and role emotional. This study demonstrated that muscle cramps decrease the QOL in patients with diabetes, and L-carnitine supplementation may improve the QOL by reducing the frequency and severity of muscle cramps in these patients.