Yasuyo Abe

Inflammation and insulin resistance are independently related to all-cause of death and cardiovascular events in Japanese patients with type 2 diabetes mellitus.

Insulin resistance (IR)/hyperinsulinemia and low-grade inflammation (high-sensitivity C-reactive protein [hs-CRP]) can predict cardiovascular disease. However, because IR and inflammation (IF) have not been evaluated simultaneously, it is not known whether IR and IF are independently related to cardiovascular disease. Furthermore, the combined effect of IR and IF on the prediction of cardiovascular disease is presently unknown. Thus, we measured insulin sensitivity (K index of the insulin tolerance test; KITT) and hs-CRP in 350 Japanese patients with type 2 diabetes, and followed them for 1-7 years (mean, 4.5 years). During the follow-up, 33 patients died and 53 patients developed non-fatal coronary artery disease or stroke (endpoint). Age, systolic blood pressure, current smoking, past history of cardiovascular disease, KITT, and hs-CRP independently and significantly correlated with endpoint. One-S.D. difference was associated with a significant increase of relative risk in KITT (1.45; 95% CI 1.09-1.91) and hs-CRP (1.30; 1.04-1.67). When patients were subdivided to tertile, the relative risk in the highest tertile of KITT was 1.76 (95% CI 1.01-3.11) and hs-CRP was 2.00 (1.03-3.85) compared with the patients with lowest tertile. The relative risk in the highest tertile of both KITT and hs-CRP was 5.32 (1.18-24.0) compared with the lowest tertile of both values. In conclusion, low-grade IF and IR are independently related to all-cause of death and cardiovascular disease in Japanese patients with type 2 diabetes. Coexistence of low-grade IF and IR amplify this effect.

Relationship between falls and physical performance measures among community-dwelling elderly women in Japan

Background and aims: The relationship between falls and physical performance has focused on the frail elderly who have several health problems, particularly those in nursing homes or care facilities. It is important to clarify the relationship between falls and physical performance among the community-dwelling elderly. Methods: We examined the relationship between falls and physical performance measures (grip strength, chair stand time, functional reach, usual walking speed) among 402 community-dwelling Japanese elderly women aged 60 years and over. Results: Overall prevalence of falls was 21.1%, and increased with age. In univariate analysis, grip strength and functional reach were not significantly different between women who did and did not fall. Chair stand time of women who fell was longer than that of women who did not (p=0.05), and the usual walking speed of women who fell was significantly slower than that of women who did not fall (p<0.0001). Physical functioning significantly decreased with age; grip strength, functional reach and usual walking speed decreased, and chair stand time increased. Logistic regression analysis, adjusting for age and other covariates, showed that slower usual walking speed was significantly associated with falls, but grip strength and functional reach were not. Increased chair stand time had a borderline association (p=0.1). Conclusions: Our findings indicate that poor lower extremity function, especially walking ability, is an important risk factor for falls in elderly Japanese community-dwelling women.

Evaluation of clinical markers of atherosclerosis in young and elderly Japanese adults.

Abstract Background: In order to be able to take preventative measures early in life against the development of atherosclerosis, it is important to evaluate profiles of subclinical atherosclerosis, especially among young adults. Methods: We screened plasma homocysteine levels, highly sensitive C-reactive protein levels and carotid intima-media thickness in young and elderly adults. Results: Among both young and elderly adults, plasma homocysteine and highly sensitive C-reactive protein were significantly lower in females than in males. Highly sensitive C-reactive protein was significantly lower in young adults than in elderly adults, and homocysteine was lower (but not significantly) in young adults than in elderly adults. Among young adults, mean carotid intima-media thickness was lower (but not significantly) in females than in males. Among elderly adults, mean carotid intima-media thickness was significantly lower in females than in males. Among both males and females, mean carotid intima-media thickness was significantly higher in elderly adults than in young adults. Conclusions: These results demonstrate basic profiles of atherosclerosis markers in young and elderly Japanese adults. Further study is needed to evaluate measures developed for application in early adulthood to prevent atherosclerosis. Clin Chem Lab Med 2006;44:824–9.

Elevation of Serum Pro-Gastrin - Releasing Peptide in Patients with Medullary Thyroid Carcinoma and Small Cell Lung Carcinoma

Medullary thyroid carcinoma (MTC) arises from parafollicular or C cells of the thyroid gland and produces a variety of peptides such as calcitonin (CT) and gastrin-releasing peptide (GRP). Here we measured serum levels of pro-gastrin-releasing peptide (Pro-GRP), a more stable precursor of GRP, in 15 patients with MTC (4 males, 11 females) who did not show any clinical or radiologic signs of small cell lung cancer. Serum Pro-GRP levels were elevated in 80% (12/15) patients. Significant correlation was observed between serum Pro-GRP and CT (r = 0.52) and carcinoembryonic antigen (CEA) (r = 0.56). Serum Pro-GRP levels also correlated with tumor size (r = 0.70). Serum Pro-GRP levels also decreased below the cut-off range in one patient after surgical resection. Our data suggest that Pro-GRP, which is considered to be a specific marker for small cell lung carcinoma, seems to be also helpful and additional marker for the diagnosis and monitoring the response to therapy in patients with MTC in addition to calcitonin as the main tumor marker.

Associations of vertebral deformities and osteoarthritis with back pain among Japanese women: the Hizen-Oshima study

SummaryWe examined the spinal distribution of the types of vertebral deformities and the associations of vertebral deformities and osteoarthritis with back pain in Japanese women. Midthoracic and upper lumbar vertebrae were more susceptible to deformity. Vertebral deformity and osteoarthritis were frequent and were associated with back pain.IntroductionVertebral fractures due to osteoporosis and osteoarthritis are both common and significant health problems in aged people. However, little is known about the descriptive epidemiology of the individual deformity types and the relative clinical impact in women in Japan.MethodsLateral radiographs were obtained from 584 Japanese women ages 40 to 89 years old. Deformities were defined as vertebral heights of more than 3 standard deviations (SDs) below the normal mean. Osteoarthritis was defined as Kellgren–Lawrence (KL) grade 2 or higher. Information on upper or low back pain during the previous month was collected by questionnaire. We compared the spinal distribution of the three types of vertebral deformities (wedge, endplate, and crush) typical of fractures and examined the associations of number and type of vertebral deformities and osteoarthritis with back pain.ResultsFifteen percent of women had at least one vertebral deformity and 74% had vertebral osteoarthritis. The prevalence of upper or low back pain was 30.1%. Deformities were most common in the midthoracic and upper lumbar regions and wedge was the frequent type, followed by endplate and crush. Multiple logistic regression analysis showed that the odds of back pain was 3.0 (95% CI 1.5–6.3) times higher for women with a single wedge deformity and 3.2 (95% CI 1.0-–0.6) times higher for women with two or more wedge deformities, compared to women with no wedge deformity. Vertebral osteoarthritis was associated with back pain (OR 1.8, 95% CI 1.1–2.9), independent of other covariates including age and deformities.ConclusionOur results in this group of Japanese women are similar to and consistent with results reported previously in other populations of Japanese and Caucasians.

Factors Predicting Health-related Quality of Life in Knee Osteoarthritis Among Community-dwelling Women in Japan: The Hizen-Oshima Study

Knee osteoarthritis is the most common chronic joint disorder in elderly people. However, a population-based, longitudinal study on health-related quality of life in knee osteoarthritis has not been conducted in Japan. We studied 333 women aged 50 years and older at baseline, with 8 to 9 years of follow-up. Anteroposterior weight-bearing knee radiographs were obtained at baseline and graded according to the Kellgren-Lawrence criteria. Definite osteoarthritis was defined as Kellgren-Lawrence grade 2 or higher in at least 1 joint. At baseline, all participants were asked if they had knee pain and comorbidities (heart disease, lung disease, stroke, or diabetes mellitus). Height (m), weight (kg), and chair stand time were measured. At follow-up, quality of life in knee osteoarthritis was evaluated using the Japanese Knee Osteoarthritis Measure score. Multiple linear regression analysis showed that age, knee osteoarthritis, knee pain, comorbidity, and increasing chair stand time were independently related to subsequent health-related quality of life. These findings suggest that treating knee osteoarthritis and comorbidities, managing pain, and optimizing lower extremity muscle strength may be effective targets for intervention.

Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older.

AbstractOur aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women.The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured.The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P = 0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts.Maintaining physical functioning and managing pain may be important for elderly women with fear of falling.

Association of maternal pre-pregnancy weight, weight gain during pregnancy, and smoking with small-for-gestational-age infants in Japan.

AIM The aim of this study was to evaluate the associations of maternal pre-pregnancy body mass index (BMI), weight gain during pregnancy, and smoking, with small-for-gestational-age (SGA) births among Japanese women. MATERIALS AND METHODS Subjects were pregnant women who gave birth to single, term infants (37-42 weeks) at a clinic and hospital in the Nagasaki area between 2012 and 2013. To examine associations with SGA, 49 underweight (BMI<18.5 kg/m(2)) and 579 normal-weight (18.5 ≤ BMI<25.0 kg/m(2)) Japanese women with either appropriate-for-gestational-age or SGA infants were selected and analyzed. RESULTS The prevalence of SGA infants was 6.8%. Seven percent of women were current smokers. Prevalence of pre-pregnancy underweight and gestational weight gain less than recommendation were 20.8% and 16.7%, respectively. Multivariate logistic regression was performed to assess factors affecting SGA infants in the pregnant women. After adjusting for covariates, the amount of maternal weight gain below recommendation (odds ratio (OR), 2.72; 95% confidence interval (CI), 1.37-5.39) and maternal smoking status (OR, 2.80; 95% CI, 1.14-6.91) were significantly and independently associated with SGA births. Pre-pregnancy maternal weight status showed a borderline association (OR, 1.91; 95% CI, 0.96-3.83, p=0.067). CONCLUSION To prevent SGA births, education regarding the adequate nutrition and the adverse effect of maternal smoking is important for the women of reproductive age.

Epidemiology of Kienböck’s Disease in Middle-aged and Elderly Japanese Women

Little research has been done on the prevalence of Kienböcks disease, and there is no consensus on the relationship between Kienböcks disease and negative ulnar variance. The goal of this cross-sectional study was to determine the prevalence of Kienböcks disease in middle-aged and elderly Japanese women and to clarify the relationship between Kienböcks disease and negative ulnar variance. The authors analyzed plain radiographs of both hands in women 40 years and older residing in the community to investigate the prevalence of Kienböcks disease and the relationship between Kienböcks disease and negative ulnar variance. Kienböcks disease was seen in 7 of the 572 participants. In the group with Kienböcks disease, ulnar variance did not differ significantly between affected (0.3 mm; SD, 1.5) and unaffected (0.3 mm; SD, 1.0; P=.285) sides. No significant difference was seen in ulnar variance values between the affected side in the group with Kienböcks disease and the normal group (P=.118). The number or proportion of participants with negative ulnar variance did not differ significantly between the affected side in the group with Kienböcks disease (3 of 7) and the unaffected side in the group with Kienböcks disease (1 of 7; P=.237) and between the affected side in the group with Kienböcks disease and the normal group (111 of 504; P=.189) by chi-square test. The prevalence of Kienböcks disease was 1.2% in middle-aged and elderly Japanese women. Negative ulnar variance is not a contributing factor to Kienböcks disease.

The Impact of Multiple Roles on Psychological Distress among Japanese Workers.

Background There has been considerable interest in Japanese society in the problem of work-related stress leading to depressive symptoms, and an increasing number of primary houseworkers maintain paid employment. The purpose of this study was to examine the differential impact of multiple roles associated with psychological distress among Japanese workers. Methods We studied 722 men and women aged 18–83 years in a cross-sectional study. The K10 questionnaire was used to examine psychological distress. Results The proportion of participants with psychological distress was higher in women (17.8%) compared with men (11.5%). Having three roles significantly decreased the risk of psychological distress [women: odds ratio (OR), 0.37-fold; men: OR, 0.41] compared with only one role. In working married women, there was significantly less psychological distress (OR, 0.27), and those with childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.38) than those with only an employment role. Similarly, working married men who had childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.41) than those who had only an employment role. Conclusion The present study demonstrated that participants who had only an employment role had an increased risk of psychological distress. The degree of psychological distress was not determined solely by the number of roles. It is important to have balance between work and family life to reduce role conflict and/or role submersion, which in turn may reduce the risk of psychological distress.