Triglyceride-Glucose Index Associated with Future Renal Function Decline in the General Population.

BACKGROUND: The triglyceride-glucose index (TyG index), calculated as the logarithmic product of fasting triglyceride and glucose concentrations, is recognized as a simple marker of insulin resistance. However, the association between the TyG index and future decline of renal function remains unclear in the general population. OBJECTIVE: To investigate whether the TyG index was associated with future decline of renal function in the general population who had not progressed to chronic kidney disease stage G2. DESIGN: Retrospective longitudinal observational cohort study. PARTICIPANTS: Individuals who received a population-based health checkup at JA Ehime Kouseiren Checkup Center from 2010 to 2019 (n = 134,007). Individuals without data of baseline fasting triglyceride or glucose levels, or baseline and follow-up data of estimated glomerular filtration rate (eGFR), or those with baseline eGFR < 60 mL/min/1.73 m2 were excluded. MAIN MEASURES: Future renal function decline, defined as a ≥ 25% decrease in eGFR from baseline. KEY RESULTS: Of 10,758 participants, 8,076 were classified into the low TyG index group (TyG index < 8.76, 1st to 3rd quartiles) and 2,682 into the high TyG index group (TyG index ≥ 8.76, 4th quartile). The mean follow-up period was 37.8 ± 23.6 months. The incidence rates of renal function decline were 0.31 and 0.69 per 100 person-years in the low and high TyG index groups, respectively. In multivariate Cox proportional hazard models, high TyG index was significantly associated with future renal function decline (hazard ratio 2.25, 95% CI 1.40-3.60). This association was consistent across subgroups stratified by age, sex, body mass index, baseline eGFR, and diagnosed hypertension, diabetes, or dyslipidemia. CONCLUSION: In the general population, high TyG index was associated with future renal function decline. The TyG index may be useful in identifying individuals at high risk for future renal function decline in the setting of health checkups.

Association of baseline electrocardiographic left ventricular hypertrophy with future renal function decline in the general population.

Electrocardiographic left ventricular hypertrophy (LVH) could predict adverse renal outcomes in patients with hypertension. This study aimed to investigate the association between electrocardiographic LVH and future decline in renal function in the general population using a dataset of population-based health checkups from 2010 to 2019 including 19,825 participants. Electrocardiographic LVH was defined according to the Minnesota code. Renal function decline was defined as a decrease of ≥ 25% in the estimated glomerular filtration rate from baseline to < 60 mL/min/1.73 m2. Electrocardiographic LVH was found in 1263 participants at the baseline visit. The mean follow-up period was 3.4 ± 1.9 years. The incidence rates of renal function decline were 0.30 and 0.78 per 100 person-years in the non-LVH group and LVH groups, respectively. Electrocardiographic LVH was associated with the risk for renal function decline in the adjusted analysis (hazard ratio 1.69, 95% confidence interval 1.14-2.50, P = 0.009). This association was comparable across subgroups stratified by age, sex, body mass index, diagnosed hypertension, systolic blood pressure, hemoglobin A1c, and urinary protein. This study underscores the usefulness of electrocardiographic LVH to detect high-risk individuals for renal function decline in the setting of health checkups in the general population.

[Metabolic syndrome and risk of stroke incidence in a rural community in Japan].

Objective　To investigate the relationship between metabolic syndrome (MetS) and stroke incidence in a rural population by a prospective cohort study over 18.6 years.Methods　From 1996 to 1998, 4,068 subjects (aged 40-74 years) underwent a health checkup in O city, Ehime Prefecture, Japan, and 3,969 subjects were included, excluding those with a history of stroke, to determine whether they had suffered a stroke or died from stroke by the end of December 2018. The subjects were stratified into six groups on the presence of high waist circumference at baseline and the number of risk factors (0, 1, or 2 or more) for high blood pressure, dyslipidemia, and high blood glucose, according to the diagnostic criteria for MetS in Japan. Kaplan-Meier analysis of MetS survival curves and Cox proportional hazards models were used to calculate sex- and age-adjusted hazard ratios and population attributable fractions (PAFs) for total stroke, hemorrhagic stroke, and cerebral infarction.Results　During the follow-up period, 376 patients were identified as having had a stroke; the percentage of MetS in the stroke group was 15.2% compared to 9.4% in the non-stroke group, a significant difference. The sex- and age-adjusted hazard ratios for total stroke and cerebral infarction were approximately 2-fold higher in the groups with 1 risk and 2 or more risks, regardless of waist circumference, than in the group with normal waist circumference and no risks. PAF to total stroke incidence was highest in the group with normal waist circumference and 1 risk factor (18.9%).Conclusions　The contribution of MetS to stroke incidence was not significant. Consistent with previous findings, the risk of stroke was increased in non-obese individuals who had at least one risk factor, such as high blood pressure.

Low-Normal Platelets and Decreasing Platelets Are Risk Factors for Hearing Impairment Development.

OBJECTIVE: Identification of undefined risk factors will be crucial for the development of therapeutic strategies in hearing impairment. Platelets are likely to affect the development of sudden sensorineural hearing loss, which is a primary risk factor for permanent hearing impairment. This implies that abnormal platelets might contribute to long-term hearing loss. This study investigated the role of platelets in the development of hearing impairment over a 5-year period. METHODS: This study was a retrospective cohort study and consisted of a population-based survey, which was performed for 1,897 participants in 2014 to 2019. To evaluate the effect of platelet level on hearing ability, the subjects were divided into two groups: a high-normal platelet group (25 ∼ 40 × 104 cells/µL) and a low-normal platelet group (15 ∼ 25 × 104 cells/µL). Subjects were defined as having hearing impairment when pure tone audiometry was over 25 dB HL in either ear (tested in 2017 and 2019). Incidence of hearing impairment was analyzed. RESULTS: Incidence of hearing impairment at low frequencies was significantly higher in the low-normal platelet group than in the high-normal group year over year. Low-normal platelet count associated with low-frequency hearing impairment (LFHI) incidence (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15-4.76). In the low-normal platelet group, subjects whose counts declined from baseline developed more LFHI than those whose counts increased over time. Further, decreasing platelets appeared to be an independent risk factor contributing to the incidence of LFHI (OR, 2.10; 95%CI, 1.09-4.06) in the low-normal platelet group. CONCLUSION: Both a low-normal platelet and a declining platelet count were independently associated with the incidence of LFHI. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1287-E1295, 2021.

Relationship between mortality risk and health-related factors and sense of coherence in residents ofa rural area in Japan.

Objective: This study aimed to examine the relationship between mortality risk and health-related factors and sense of coherence (SOC) in a cohort study of residents from a rural area of Japan. Materials and Methods: We followed-up with 3,416 baseline respondents over 3.76 years. Residents were subdivided into three groups based on SOC score: low, middle, and high. We used the total SOC score of the low-level SOC group as the standard, and calculated the standardized mortality ratio (SMR) for the middle- and high-level SOC groups. For all three SOC groups, health-related factors were analyzed by one-way analysis of variance, and lifestyle and history were analyzed using the χ2 test. Results were also analyzed by gender and age. Results: For men in the low-level SOC group, the SMR value was defined as 1, and for men in the high-level SOC group (0.44; 95% confidence interval: 0.11-0.77), the SMR value was significantly lower. There was a statistically significant reduction in the percentage of smokers in the men in the high-level SOC group. Conclusion: In this study, high-level SOC was associated with low mortality risk. This finding was particularly pronounced in the men.

Comparison of regional differences in health indicators and standard mortality ratio for stroke in subjects in ehime prefecture.

OBJECTIVE: The purpose of this study was to investigate regional differences in the standard mortality ratio (SMR) and risk factors (including dietary habits) for stroke across the three regions of Ehime Prefecture - Toyo (east), Chuyo (central), and Nanyo (south). PARTICIPANTS AND METHODS: We obtained medical records derived from 956,979 medical examinations carried out at JA Ehime Kouseiren Medical Examination Centers between April 1994 and March 2006. We analyzed data from 132,090 subjects (Toyo - 47,654, Chuyo - 38,435, Nanyo - 46,001) who underwent their first medical examination during this period. To analyze differences between the three regions, we first calculated the SMR for stroke based on data from the Basic Residential Registers and Health Statistics Bureau. Secondly, we calculated significant differences in body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (Glu), and total cholesterol (T-CHO). Thirdly, we used the Chi-square test to calculate significant differences in the percentage of subjects who consumed the following foods on a daily basis: rice, bread, eggs, fish, meat, vegetables, dairy products, and fruit juice. RESULTS: Despite the fact that regional differences in the SMR for stroke have been decreasing, in both men and women in Nanyo, the mean values for SBP and DBP were significantly higher and the mean value for T-CHO was significantly lower than in Toyo and Chuyo. In Nanyo, the percentage of subjects who consumed rice and fish (men and women), meat (men), and juice (women) on a daily basis was higher than in Toyo and Chuyo. CONCLUSION: In Nanyo, higher SMR for stroke may be related to high SBP and DBP and low T-CHO. As background to these results, it is also thought that regional differences in dietary habits may have an influence.

Daily rice intake strongly influences the incidence of metabolic syndrome in Japanese men aged 40-59 years.

OBJECTIVES: The first objective of this study was to classify men aged 40-74 yrs with metabolic syndrome (MetS) according to daily rice intake, and the second was to investigate physical measurements, physiological examinations, blood biochemical assays, intake of food other than rice and lifestyle and environmental factors in the study group. METHODS: We analyzed data from 6095 men aged 40-74 yrs who had undergone full medical examinations. The men were classified into 3 age groups: (1) 40-49 yrs, (2) 50-59 yrs, and (3) 60-74 yrs. The men were classified further into 3 groups according to daily rice intake: group 1 (≤300 g), group 2 (300-450 g), and group 3 (≥450 g). The relationship between daily rice intake and the following factors was analyzed in the three age brackets: (1) physical measurements including waist circumference, (2) physiological measurements, (3) serum biochemical indices, (4) whether or not the person was taking medication for hypertension, diabetes mellitus or serum lipid abnormalities, (5) lifestyle, and (6) consumption of foods other than rice. RESULTS: Daily rice intake was related strongly to the occurrence of MetS in all three age brackets. Multiple logistic regression analysis showed (1) a significant increase in the odds ratio for MetS (1.461 times) for group 3 compared with group 1 in men aged 40-49 yrs and (2) a significant increase in the odds ratio for MetS (1.501 times) for group 3 compared with group 1 in men aged 50-59 yrs. However, there was no significant difference in the odds ratio for MetS among rice intake groups in the 60-74 age bracket. CONCLUSION: In men aged 40-59 yrs, daily rice intake strongly influenced the incidence of MetS, whereas in men aged 60-74 yrs, there was no relationship between daily rice intake and MetS.

A cross-sectional survey of factors influencing bone mass in junior high school students.

OBJECTIVE: The purpose of this study is to investigate factors influencing the osteo-sono assessment index (OSI) in junior high school students (boys, girls who had reached menarche, and girls who had not). METHODS: A total of 9,743 students (4,974 boys and 4,769 girls) in Ehime Prefecture participated in this study. We measured body mass index (BMI) and calcaneal bone mass using OSI. In parallel, participants answered a questionnaire relating to age, sex, menarche, exercise habits, milk intake, and history of bone fractures during the preceding year. To determine the factors influencing OSI, we calculated an individual standardized partial regression coefficient (ß) using multiple linear regression (MLR) analysis. RESULTS: For boys, MLR showed that BMI (ß = 0.300), age (ß = 0.260), current exercise habits (ß = 0.106), and milk intake per day in primary school (ß = 0.085) statistically significantly influenced OSI. For girls who had reached menarche, BMI (ß = 0.302), current exercise habits (ß = 0.237), age (ß = 0.140), and bone fracture during the preceding year (ß = 0.036) influenced OSI. For girls who had not reached menarche, current exercise habits (ß = 0.242), BMI (ß = 0.135), and age (ß = 0.085) influenced OSI. CONCLUSIONS: There were differences between the factors related to OSI among boys, girls who had reached menarche, and girls who had not. BMI, exercise habits, and age were the common factors related to OSI. Particularly for girls, exercise habits had a great influence on OSI.