Kimiko Kanauchi

Frailty, health-related quality of life and mental well-being in older adults with cardiometabolic risk factors

Objective:  Frailty is an emergent health‐related problem in older adults. The aim of this study was to examine the health‐related quality of life (HRQOL) and the effect of frailty in elderly patients with cardiometabolic risk factors.

Metabolic syndrome and new category 'pre-hypertension' in a Japanese population

SUMMARY Objective: To examine whether insulin resistance and metabolic syndrome are associated with pre-hypertension, a new stage developed by the Joint National Committee on Prevention, Detection, Education and Treatment of High Blood Pressure (JNC-7). Patients and methods: Subjects included 506 Japanese taking no anti-hypertensive medication. Subjects were divided into three groups according to blood pressure status using the JNC-7 criteria. Normotension (NTN) was defined as a Systolic Blood Pressure (SBP) < 120 mmHg and a Diastolic Blood Pressure (DBP) < 80 mmHg, pre-hypertension (PHT) as a SBP 120–139 mmHg or a DBP 80–89 mmHg and hypertension (HTN) as a SBP ≥ 140 mmHg or a DBP ≥ 90 mmHg. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. Insulin sensitivity was assessed by plasma glucose and insulin concentrations obtained at fasting or during a 75 g oral glucose tolerance test. Results: There were no differences with respect to age, gender or glucose intolerance status among the three groups. The mean values of body mass index were similar between NTN and PHT, but were significantly higher in HTN than in other groups. The prevalence of the metabolic syndrome was 9.9% in NTN, 19.2% in PHT and 35.5% in HTN, respectively. The prevalence increased linearly with worsening of blood pressure status ( p < 0.0001). An increase in the number of metabolic syndrome components (MS score) was also associated with a progress in blood pressure status. Even in the non-obese persons, the prevalence of the metabolic syndrome and the MS score increased linearly with worsening in blood pressure status. The homeostasis model assessment of insulin resistance (HOMA-R) was significantly higher in PHT and HTN than in NTN and increased significantly with worsening in blood pressure status. Furthermore, the quantitative insulin sensitivity check index (QUICKI) and the insulin sensitivity index proposed by Stumvoll et al. decreased significantly with worsening in blood pressure status. Conclusions: The metabolic syndrome is prevalent even in the pre-hypertensive stage in a Japanese population and insulin resistance contributes to the underlying mechanisms of these abnormalities.

Beta-cell function and insulin sensitivity contribute to the shape of plasma glucose curve during an oral glucose tolerance test in non-diabetic individuals.

To clarify whether beta‐cell function and/or insulin resistance contributes to the shape of plasma glucose curve during an oral glucose tolerance test (OGTT), we investigated 583 Japanese subjects with normal glucose tolerance (NGT, n = 306) or impaired glucose tolerance (IGT, n = 277). Each subject was subdivided into three shapes of plasma glucose curve as follows: monophasic pattern (M type), biphasic pattern (B type) and two peaks (T type). Homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index and insulinogenic index were assessed by plasma glucose and insulin concentrations obtained at fasting or during an OGTT. There was a greater proportion of M type in the IGT group (M = 80.9%, B = 15.5% and T = 3.6%), whereas the prevalence of B and T types was much higher in the NGT group (M = 66.6%, B = 26.5% and T = 6.9%). There were significant differences in the proportions of shape types between the NGT and IGT groups (p = 0.0006). Among the NGT category, insulin sensitivity was significantly higher in the B type than in the M type, and beta‐cell function adjusted for insulin resistance was significantly higher in the B and T types than in the M type. Among the IGT category, no significant differences were seen among the three shape types with respect to insulin sensitivity, but the beta‐cell function adjusted for insulin resistance was significantly lower in the M type than in the B and T types. In conclusion, both impaired insulin secretion and insulin resistance may contribute to the underlying mechanisms of the shape of plasma glucose curve in Japanese subjects.

Surrogate markers of insulin resistance in assessing individuals with new categories “prehypertension” and “prediabetes”

Abstract Background: There are few data on the impact of insulin resistance on the recently defined categories of prehypertension (PHT) and prediabetes (PDM). The aim of this study was to examine associations of surrogate markers of insulin resistance with PHT/PDM. Methods: Subjects included 554 individuals who underwent a 75-g oral glucose tolerance test (OGTT). They were classified into four groups using a severity score for high blood pressure and glucose tolerance. Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-R) and three surrogate markers obtained from 75-g OGTT values (ISI-composite, Stumvoll index, and OGIS index). Results: HOMA-R increased significantly, but the other three surrogate indices decreased with increasing severity score. Of these markers, the OGIS index was mostly associated with prevalent PHT/PDM and the odds ratio for insulin resistance was 3.61 (95% CI 1.68–7.76, p=0.001) for subjects with either PHT or PDM and 29.98 (12.81–70.18, p<0.001) for subjects with both PHT and PDM. Conclusions: PHT and PDM frequently coexist in relatively lean Japanese subjects. Decreased insulin sensitivity may contribute to the underlying status of PHT/PDM. Among the surrogate markers of insulin resistance, the OGIS index is the most sensitive for assessment of PHT/PDM status. Clin Chem Lab Med 2007;45:35–9.

Adherence index to the American Heart Association Diet and Lifestyle Recommendation is associated with the metabolic syndrome in Japanese male workers

BACKGROUND As Japanese societies rapidly undergo Westernization, the prevalence of metabolic syndrome is increasing. We investigated the association between dietary habits and the prevalence of metabolic syndrome using a new adherence index to optimal dietary habits based on the American Heart Association Diet and Lifestyle Recommendation (AHA-DLR). METHODS We conducted a cross-sectional study of 503 male workers who completed a brief food frequency questionnaire. Adherence to the AHA-DLR was assessed using a 10-component adherence index (AI-84; a total possible score of 84 points). Metabolic syndrome was defined according to the most recently published harmonized criteria by the International Diabetes Federation in conjunction with the National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. RESULTS The prevalence of metabolic syndrome was 26.6% and the AI-84 score ranged from 5 to 56 points. Subjects with metabolic syndrome had a significantly lower AI-84 score compared with those without (27.1 ± 9.1 vs. 28.9 ± 9.2, p=0.042). After adjusting for age, energy intake, smoking habit and physical activity, a higher AI-84 score was associated with a significantly lower prevalence of metabolic syndrome, with an odds ratio of 0.778 (95% CI 0.614-0.986, p=0.038) for each 10-point score increment. CONCLUSIONS A lower AI-84 score was associated with increased prevalence of metabolic syndrome. Our findings support a potential beneficial impact of nutritional assessment using adherence to the AHA-DLR for prevention of metabolic syndrome.

Diet quality and adherence to a healthy diet in Japanese male workers with untreated hypertension

Objectives As Japanese societies rapidly undergo westernisation, the prevalence of hypertension is increasing. We investigated the association between dietary quality and the prevalence of untreated hypertension in Japanese male workers. Design and methods We conducted a cross-sectional study of 433 male workers who completed a brief food frequency questionnaire. Adherence to the WHO-based Healthy Diet Indicator (HDI), the American Heart Association 2006 Diet and Lifestyle Recommendations, the Dietary Approaches to Stop Hypertension (DASH) diet, and Mediterranean-style diet was assessed using four adherence indexes (HDI score, AI-84 score, DASH score and MED score). Hypertension classes were classified into three categories: non-hypertension, untreated hypertension and treated hypertension (ie, taking antihypertensive medication). Results The prevalence of untreated hypertension and treated hypertension was 22.4% and 8.5%, respectively. Patients with untreated hypertension had significantly lower HDI and AI-84 scores compared with non-hypertension. DASH and MED scores across the three hypertension classes were comparable. After adjusting for age, energy intake, smoking habit, alcohol drinking, physical activity and salt intake, a low adherence to HDI and a lowest quartile of AI-84 score were associated with a significantly higher prevalence of untreated hypertension, with an OR of 3.33 (95% CI 1.39 to 7.94, p=0.007) and 2.23 (1.09 to 4.53, p=0.027), respectively. Conclusions A lower dietary quality was associated with increased prevalence of untreated hypertension in Japanese male workers. Our findings support a potential beneficial impact of nutritional assessment using diet qualities.

Development of a Mediterranean diet score adapted to Japan and its relation to obesity risk

Background The Mediterranean diet (MD) is well known as a healthy diet that protects against several chronic diseases. However, there is no appropriate and easy index to assess adherence to the MD pattern in Japan. Objective The aim of this study was to develop a novel instrument to measure MD adherence adapted to a Japanese diet and to examine its association with overweight/obesity risk. Methods A cross-sectional nutritional survey provided the data for construction of a novel MD score. In total, 1,048 subjects who were employees and university students, aged 18–68 years (645 men and 403 women), completed a 58-item brief-type self-administered dietary history questionnaire. We constructed a Japanese-adapted MD score (jMD score) focusing on 13 components. Adherence to the jMD was categorized as low (score 0–4), moderate (5–7), or high (8–13). Results Men had higher jMD scores than women, and adherence to the jMD score increased with age. Only 11.6% of subjects showed high adherence to the jMD, whereas 29.6% showed low adherence. A higher jMD adherence was associated with a higher intake of favorable nutrients with the exception of salt. The jMD adherence was significantly associated with a reduced likelihood of having overweight/obesity for the highest category compared with lowest category (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.30–0.85, p-trend=0.017) after adjusting for age, sex, smoking, physical activity, alcohol intake, and hypertension. A two-point increment in jMD score was related to a reduced likelihood of having overweight/obesity with an odds ratio of 0.76 (95% CI 0.65–0.90, p=0.002). Conclusions Our novel jMD score confirmed reasonable associations with nutrient intakes, and higher MD adherence was associated with a lower prevalence of overweight/obesity.

A new handheld indirect calorimeter is acceptable to evaluate resting energy expenditure in Japanese adults with metabolic syndrome

Resting energy expenditure (REE) can be accurately measured using the Douglas bagmethod of a traditional indirect calorimeter, but such devices are often impractical or cost-prohibitive in many clinical settings. It has been commonly predicted using the Harris–Benedict (HB) equations, which is most widely used in Western countries. Recently, a new handheld indirect calorimeter, the MedGem device (HealtheTech, Inc., Golden, CO), has been developed and the validity has been shown in some studies [1]. However, there have been few reports of the use of the MedGem device for subjects of Asian populations. Particularly, most Japanese people are less obese than people of other ethnic groups despite the fact that metabolic syndrome is an emerging epidemic. Forty Japanese industrial workers, 23 to 62 years of age, participated in this study. Subjects had metabolic syndrome if three out of five International Diabetes Federation criteria were met. In the MS group (n=19; body mass index (BMI) 25.8±2.9 kg/m), the mean HB-REE (1643±127 kcal/d) was comparable to the MedGem-REE (1645±240 kcal/d). Conversely, in the non-MS group (n=21; BMI 20.6±2.1 kg/m), the mean HBREE (1452±171 kcal/d) tended to be lower than the MedGem-REE (1519±378 kcal/d), but this difference was not significant (p=0.189). Bland–Altman analysis [2] revealed a mean difference of 65.0 kcal/d, with 95% limits of agreement of −40 to +170 kcal/d with a significant trend (r=0.718, p=0.001) in the MS group and a mean difference of 92.3 kcal/d, with 95% limits of agreement of −27 to +212 kcal/d with a significant trend (r=0.664, p=0.001) in the non-MS group. In subjects without metabolic syndrome, the HB predictive equations underestimated REE by approximately 6%, which is deemed clinically acceptable because the difference between the two methods was b10%. In summary, these preliminary data indicate that the MedGem handheld indirect calorimeter is shown to have

The World Health Organization's Healthy Diet Indicator and its associated factors: A cross-sectional study in central Kinki, Japan

The Healthy Diet Indicator (HDI), which is based on adherence to World Health Organizations (WHO) nutrition guidelines, is used worldwide. In 2015, the WHO updated the Fact Sheet for their recommended healthy diet. We investigated diet quality assessed by the updated HDI (HDI-2015) and factors related to adherence to this diet in a Japanese population. We conducted a cross-sectional study of 1370 participants from 8 workplaces, 1 college, and 2 communities. All participants completed a brief-type self-administered diet history questionnaire. The HDI-2015 assesses 7 components: fruits and vegetables, total fat, saturated fatty acid, polyunsaturated fatty acid, free sugar, dietary fiber, and potassium. Only 6.6% of subjects demonstrated high adherence to HDI-2015 (met ≥6 components), whereas 52.0% demonstrated moderate adherence (4–5 components), and 41.4% demonstrated low adherence (0–3 components). Male sex, older age, and regular physical activity were associated with higher adherence. The contemporary Japanese population has an overall low diet quality as evaluated by the updated HDI score. Improving adherence to healthier dietary patterns may promote better health in Japan.