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1.
Diabet Med ; 32(5): 665-72, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25438871

RESUMEN

AIMS: We investigated the risk of developing diabetes across various metabolic phenotypes by considering the presence of overall adiposity or abdominal adiposity and the number of metabolic abnormalities and aimed to clarify whether a 'healthy overweight' phenotype, that is, overweight with no metabolic abnormalities, was protective of the development of diabetes. METHODS: We studied 29 564 Japanese individuals without diabetes. The 5-year incidence of diabetes was assessed according to a combination of either overweight (BMI ≥ 25.0 kg/m(2) ) or abdominal obesity (waist circumference ≥ 90 cm in men and ≥ 80 cm in women) and the number of metabolic factors present (hypertension, elevated triglyceride concentration, low HDL cholesterol concentration and impaired fasting glucose). RESULTS: A total of 1188 individuals developed diabetes. Compared with normal weight individuals with none of the four metabolic abnormalities, in overweight individuals with none of the four abnormalities there was an odds ratio (OR) of 2.32 [95% confidence interval (CI) 1.50, 3.59] for diabetes; having any one metabolic abnormality increased the risk of developing diabetes among normal weight individuals [OR 3.23 (2.55, 4.10)] and overweight individuals [OR 5.00 (3.77, 6.63)]. Among overweight individuals, the presence of impaired fasting glucose alone substantially elevated the risk of diabetes by 8.98-fold (5.52, 14.6) in comparison with the absence of the four metabolic factors. CONCLUSIONS: Being 'healthy overweight' was associated with a higher OR of developing future diabetes among Japanese individuals than normal weight individuals with no metabolic abnormalities, and being overweight with one or more abnormalities had a further elevated OR compared with 'healthy overweight' people.


Asunto(s)
Pueblo Asiatico , HDL-Colesterol/deficiencia , Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/complicaciones , Hipertrigliceridemia/complicaciones , Obesidad Abdominal/complicaciones , Obesidad/complicaciones , Sobrepeso/complicaciones , Adiposidad/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/fisiopatología , Ayuno/metabolismo , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Fenotipo , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
2.
Int Endod J ; 48(2): 124-30, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24702182

RESUMEN

AIM: To evaluate two fast-setting calcium silicate-based endodontic materials (Endocem mineral trioxide aggregate (MTA) and Endocem Zr) with regard to their ability to release calcium ions (Ca(2+)) and produce apatite-like precipitates after immersion in phosphate-buffered saline (PBS). METHODOLOGY: Endocem MTA, Endocem Zr and white ProRoot MTA (WMTA) were used. Chemical composition of the powder of each material was analysed with a wavelength-dispersive X-ray spectroscopy electron probe microanalyser with image observation function (SEM-EPMA). The amount of Ca(2+) released from water-immersed set cements was measured with an EDTA titration method. Morphology and chemical composition of surface precipitates formed on the surface of PBS-immersed cements were analysed with the SEM-EPMA. Data obtained were analysed using one-way analysis of variance and Tukey's honestly significant difference test with a significance level of 5%. RESULTS: Endocem MTA and WMTA contained calcium (Ca), silicon (Si) and bismuth as the major elemental constituents, whereas Endocem Zr contained zirconium as the most abundant element, followed by Ca and Si. The amount of Ca(2+) release was WMTA >Endocem MTA ≥Endocem Zr. After immersion in PBS for 14 days, the three materials produced Ca- and phosphorus (P)-containing apatite-like surface precipitates. WMTA showed higher Ca/P ratio of the precipitates compared with the other cements, with statistical significance between WMTA and Endocem Zr (P < 0.05). CONCLUSION: Compared with WMTA, Endocem MTA and Endocem Zr were associated with significantly less Ca ions release and, when immersed in PBS, produced apatite-like crystalline precipitates of significantly lower Ca/P ratios.


Asunto(s)
Compuestos de Aluminio/química , Apatitas/química , Compuestos de Calcio/química , Calcio/química , Óxidos/química , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Combinación de Medicamentos , Ensayo de Materiales , Espectroscopía de Fotoelectrones
3.
Diabet Med ; 31(11): 1363-7, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25124930

RESUMEN

AIM: To compare the role of short sleep duration as a risk factor for diabetes among adults of different ages. METHODS: The study enrolled 38987 Japanese individuals without diabetes, and the 8-year risk of developing diabetes attributable to different sleep durations (< 5.5 h, 5.5 to < 6.5 h, 6.5 to < 7.0 h, 7.0-7.5 h, > 7.5-8.0 h, or > 8.0 h) was assessed among individuals aged ≤ 45, 46-59 or ≥ 60 years. RESULTS: During the 8-year follow-up period, 2085 individuals developed diabetes. Overall, individuals with a short sleep duration of < 5.5 h or 5.5 to < 6.5 h had, respectively, a 1.53-fold (95% CI 1.19, 1.97) or 1.25-fold (95% CI 1.10, 1.42) increased risk of diabetes as compared with those who had 7.0-7.5 h of sleep. A sleep duration of < 5.5 h or 5.5 to < 6.5 h was predictive of the development of diabetes among individuals aged ≤ 45 years, but not among those aged ≥ 60 years. With increasing age, the effect of short sleep duration on the risk of diabetes was attenuated. CONCLUSIONS: Short sleep duration was predictive of diabetes among young or middle-aged Japanese adults but not among elderly individuals after age was considered. Managing habitual short sleep and the possible reasons for having such short sleep duration could be particularly important for young or middle-aged adults in the development of future diabetes.


Asunto(s)
Envejecimiento , Diabetes Mellitus Tipo 2/etiología , Privación de Sueño/fisiopatología , Salud Urbana , Adulto , Anciano , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Incidencia , Japón/epidemiología , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Privación de Sueño/etnología , Encuestas y Cuestionarios , Salud Urbana/etnología
4.
Diabet Med ; 31(11): 1378-86, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24750392

RESUMEN

AIMS: To examine current BMI and various aspects of BMI history as pre-screening tools for undiagnosed diabetes in Japanese individuals. METHODS: This cross-sectional study included 16 226 men and 7026 women aged 30-75 years without a self-reported history of clinician-diagnosed diabetes. We estimated the probability of having undiagnosed diabetes (fasting glucose ≥ 7.0 mmol/l and/or HbA1c ≥ 48 mmol/mol (≥ 6.5%) for the following variables: current BMI, BMI in the early 20s (BMI(20y)), lifetime maximum BMI (BMI(max)), change between BMI in the early 20s and current BMI (ΔBMI(20y-cur)), change between BMI in the early 20s and maximum BMI (ΔBMI(20y-max)), and change between lifetime maximum and current BMI (ΔBMI(max-cur)). RESULTS: The prevalence of undiagnosed diabetes was 3.3% (771/23252) among participants. BMI(max) , ΔBMI(20y-max) and current BMI (1-sd increments) were more strongly associated with diabetes than the other factors (multivariate odds ratio 1.58 [95% CI 1.47-1.70] in men and 1.65 [95% CI 1.43-1.90] in women for BMI(max) ; multivariate odds ratio 1.47 [95% CI 1.37-1.58] in men and 1.61 [95% CI 1.41-1.84] in women for ΔBMI(20y-max) ; multivariate odds ratio 1.47 [95% CI 1.36-1.58] in men and 1.63 [95% CI 1.40-1.89] in women for current BMI). The probability of having diabetes was markedly higher in those with both the highest tertile of BMI(max) and greatest ΔBMI(20y-max) ; however, a substantially lower likelihood of diabetes was observed among individuals with the lowest and middle tertiles of current BMI (< 24.62 kg/m² in men and < 22.54 kg/m² in women). CONCLUSIONS: Lifetime maximum BMI and BMI changes from early adulthood were strongly associated with undiagnosed diabetes. Adding BMI history to people's current BMI would improve the identification of individuals with a markedly higher probability of having undiagnosed diabetes.


Asunto(s)
Envejecimiento , Diabetes Mellitus Tipo 2/epidemiología , Obesidad/complicaciones , Sobrepeso/complicaciones , Adulto , Anciano , Glucemia/análisis , Índice de Masa Corporal , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/análisis , Hospitales Urbanos , Humanos , Japón/epidemiología , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Obesidad/terapia , Sobrepeso/terapia , Prevalencia , Factores de Riesgo , Autoinforme , Aumento de Peso
5.
Skin Res Technol ; 20(1): 43-9, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23781849

RESUMEN

PURPOSE: We analyzed skin heat conduction under moist and dry heat conditions to confirm the influence of moist heat on the skin and subcutaneous region. METHODS: Six healthy subjects placed their forearms in moist and dry heat air chambers, and the thickness of and moisture levels in the stratum corneum were measured. Skin surface temperatures, heat flux, and skin blood flow were measured in 11 healthy subjects. RESULTS: Within 10 min, the stratum corneum in skin exposed to moist heat reached a thickness of about 150%, and water content in the stratum corneum increased to about 200%. In contrast, the thickness of water content in the stratum corneum did not change in the dry heat condition. Skin surface temperatures of skin exposed to moist heat were significantly higher after 0.5 min of exposure (P < 0.01), the skin surface heat flux was greater, and blood flow was significantly higher (P < 0.05) after 10 min than that of skin exposed to dry heat. CONCLUSION: Stratum corneum moisture levels and skin surface heat conductivity were higher in the moist heat condition and skin blood flow was significantly greater than that in skin exposed to dry heat. Therefore, moist heat is more efficient at warming the body than dry heat.


Asunto(s)
Regulación de la Temperatura Corporal/fisiología , Agua Corporal/fisiología , Calefacción/métodos , Humedad , Temperatura Cutánea/fisiología , Vapor , Conductividad Térmica , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Transferencia de Energía/fisiología , Femenino , Humanos , Masculino , Piel/irrigación sanguínea , Adulto Joven
6.
Diabetologia ; 56(5): 1021-30, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23443242

RESUMEN

AIMS/HYPOTHESIS: Our aim was to clarify the association between leisure-time physical activity (LTPA) and cardiovascular events and total mortality in a nationwide cohort of Japanese diabetic patients. METHODS: Eligible patients (1,702) with type 2 diabetes (mean age, 58.5 years; 47% women) from 59 institutes were followed for a median of 8.05 years. A comprehensive lifestyle survey including LTPA and occupation was performed using standardised questionnaires. Outcome was occurrence of coronary heart disease (CHD), stroke and total mortality. The adjusted HR and 95% CI were calculated by Cox regression analysis. RESULTS: A significant reduction in HR in patients in the top (≥ 15.4 metabolic equivalents [MET] h/week) vs the bottom tertile (≤ 3.7 MET h/week) of LTPA, adjusted by age, sex and diabetes duration, was observed in stroke (HR 0.55, 95% CI 0.32, 0.94) and total mortality (HR 0.49, 95% CI 0.26, 0.91) but not in CHD (HR 0.77, 95% CI 0.48, 1.25). The HR for stroke became borderline significant or nonsignificant after adjustment for lifestyle or clinical variables including diet or serum lipids. The significantly reduced total mortality by LTPA was independent of these variables and seemed not to be, at least mainly, attributed to reduced cardiovascular disease. CONCLUSIONS/INTERPRETATION: In Japanese persons with type 2 diabetes, LTPA of 15.4 MET h/week or more was associated with a significantly lower risk of stroke partly through ameliorating combinations of cardiovascular risk factors. It was also associated with significantly reduced total mortality but independently of cardiovascular risk factors or events. These findings, implying differences from Western diabetic populations, should be considered in the clinical management of East Asians with diabetes.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/prevención & control , Actividades Recreativas , Mortalidad , Actividad Motora , Accidente Cerebrovascular/prevención & control , Adulto , Anciano , Estudios de Cohortes , Diabetes Mellitus Tipo 2/etnología , Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/etnología , Angiopatías Diabéticas/etiología , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/etiología , Análisis de Supervivencia
7.
Br J Cancer ; 108(10): 1957-63, 2013 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-23640393

RESUMEN

BACKGROUND: A phase III trial was conducted to determine whether neoadjuvant chemotherapy (NACT) before radical surgery (RS) improves overall survival. METHODS: Patients with stage IB2, IIA2, or IIB squamous cell carcinoma of the uterine cervix were randomly assigned to receive either BOMP (bleomycin 7 mg days 1-5, vincristine 0.7 mg m(-2) day 5, mitomycin 7 mg m(-2) day 5, cisplatin 14 mg m(-2) days 1-5, every 3 weeks for 2 to 4 cycles) plus RS (NACT group) or RS alone (RS group). Patients with pathological high-risk factors received postoperative radiotherapy (RT). The primary end point was overall survival. RESULTS: A total of 134 patients were randomly assigned to treatment. This study was prematurely terminated at the first planned interim analysis because overall survival in the NACT group was inferior to that in the RS group. Patients who received postoperative RT were significantly lower in the NACT group (58%) than in the RS group (80%; P=0.015). The 5-year overall survival was 70.0% in the NACT group and 74.4% in the RS group (P=0.85). CONCLUSION: Neoadjuvant chemotherapy with BOMP regimen before RS did not improve overall survival, but reduced the number of patients who received postoperative RT.


Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias del Cuello Uterino/terapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Braquiterapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Terapia Combinada , Femenino , Humanos , Histerectomía/métodos , Japón , Oncología Médica/organización & administración , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/uso terapéutico , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Vincristina/administración & dosificación , Vincristina/uso terapéutico , Adulto Joven
8.
Am J Transplant ; 13(8): 2154-60, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23746308

RESUMEN

Pancreatic islet transplantation is an attractive therapy for the treatment of insulin-dependent diabetes mellitus. However, the low efficiency of this procedure necessitating sequential transplantations of islets with the use of 2-3 donors for a single recipient, mainly due to the early loss of transplanted islets, hampers its clinical application. Previously, we have shown in mice that a large amount of HMGB1 is released from islets soon after their transplantation and that this triggers innate immune rejection with activation of DC, NKT cells and neutrophils to produce IFN-γ, ultimately leading to the early loss of transplanted islets. Thus, HMGB1 release plays an initial pivotal role in this process; however, its mechanism remains unclear. Here we demonstrate that release of HMGB1 from transplanted islets is due to hypoxic damage resulting from Ca(2+) influx into ß cells through the Na(+) /Ca(2+) exchanger (NCX). Moreover, the hypoxia-induced ß cell damage was prevented by pretreatment with an NCX-specific inhibitor prior to transplantation, resulting in protection and long-term survival of transplanted mouse and human islets when grafted into mice. These findings suggest a novel strategy with potentially great impact to improve the efficiency of islet transplantation in clinical settings by targeting donor islets rather than recipients.


Asunto(s)
Compuestos de Anilina/farmacología , Diabetes Mellitus Experimental/prevención & control , Diabetes Mellitus Tipo 1/inmunología , Rechazo de Injerto/inmunología , Trasplante de Islotes Pancreáticos/inmunología , Islotes Pancreáticos/inmunología , Éteres Fenílicos/farmacología , Intercambiador de Sodio-Calcio/antagonistas & inhibidores , Animales , Diabetes Mellitus Experimental/enzimología , Diabetes Mellitus Experimental/inmunología , Citometría de Flujo , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/metabolismo , Proteína HMGB1/metabolismo , Humanos , Hipoxia/metabolismo , Hipoxia/patología , Islotes Pancreáticos/efectos de los fármacos , Islotes Pancreáticos/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Endogámicos NOD , Ratones SCID , Intercambiador de Sodio-Calcio/metabolismo
9.
Diabet Med ; 30(1): 70-3, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22612636

RESUMEN

AIMS: Maternal obesity and weight gain since early adulthood are known predictors of gestational diabetes in Western countries. However, their impact has not been evaluated well in Asia, where mean BMI levels are generally lower than in Western countries. We therefore examined the associations of BMI at age 20 years and BMI change since age 20 years with the risk of gestational diabetes in Japanese pregnant women. METHODS: Six hundred and twenty-four consecutive pregnant women without recognized diabetes before pregnancy, whose initial obstetric clinic visit was before 13 weeks' gestation, were prospectively observed. Weight at age 20 years was self-reported. Baseline height and weight measurements were obtained at the initial obstetric visit. Multivariate logistic regression analysis estimated the risk of incident gestational diabetes for BMI change since 20 years and BMI at age 20 years. RESULTS: Twenty-eight women developed incident gestational diabetes. By multivariate logistic regression analysis that adjusted for maternal age, parity and baseline BMI, we observed a statistically significant inverse association between BMI at age 20 years and incidence of gestational diabetes (odds ratio 0.68, 95% CI 0.51-0.92). Similarly, when we assessed the association of BMI change since age 20 years, adjusted for maternal age and parity, BMI change was associated with an increased risk of gestational diabetes (odds ratio 1.26, 95% CI 1.03-1.53). When we focused on the threshold of risk of gestational diabetes, women with BMI at 20 years of less than 18 kg/m(2) had a 6.30-fold (2.26-17.59) greater risk than women with both BMI at age 20 years of 18 kg/m(2) or more and BMI change since age 20 years of less than 1.85. CONCLUSIONS: Both low BMI at age 20 years and BMI change since age 20 years were significantly associated with increased risk of incident gestational diabetes.


Asunto(s)
Índice de Masa Corporal , Diabetes Gestacional/etiología , Adulto , Femenino , Humanos , Japón , Edad Materna , Paridad , Embarazo , Estudios Prospectivos , Factores de Riesgo , Aumento de Peso , Adulto Joven
10.
Diabet Med ; 30(11): 1355-9, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23756249

RESUMEN

AIMS: To investigate whether living alone was associated with the presence of undiagnosed diabetes and whether this association could be attenuated by modifiable lifestyle habits. METHODS: This cross-sectional study included 6400 Japanese men without a history of diagnosed diabetes. Individuals with currently undiagnosed diabetes were identified through fasting glucose concentration ≥7.0 mmol/l or HbA1c concentration ≥ 48 mmol/mol (≥ 6.5%). Effect modification was examined using body mass index, hypertension, history of dyslipidaemia, drinking habits, smoking habits, physical activity, vegetable intake, emotional stress and depressed mood. RESULTS: Men who lived alone (n = 1098) had a significantly elevated odds ratio for having undiagnosed diabetes in an age-adjusted model (odds ratio 1.45, 95% CI 1.07, 1.96; P = 0.018). After adjustment for lifestyle factors, the association was slightly attenuated (odds ratio 1.40, 95% CI 1.02, 1.91; P = 0.036). After further adjustment for all factors mentioned above, living alone was still marginally significantly associated with the presence of undiagnosed diabetes (odds ratio 1.38, 95% CI 1.003, 1.90; P = 0.048). A significant association of living alone with the presence of undetected diabetes was particularly observed among men who were overweight, currently smoked and were physically inactive, or had any one of those three factors. CONCLUSIONS: The association between undiagnosed diabetes and living alone can be partially influenced by modifiable lifestyle factors. Men who lived alone, especially those who did not engage in favourable lifestyle habits, were more likely to have undiagnosed diabetes. Such individuals have a higher probability of having undetected diabetic hyperglycaemia and would need to undergo glucose tests to identify the disease.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Persona Soltera/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Estudios de Casos y Controles , Depresión/epidemiología , Dieta , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Conducta de Reducción del Riesgo , Fumar/epidemiología , Estrés Psicológico/epidemiología , Adulto Joven
11.
Diabetologia ; 55(8): 2128-31, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22580991

RESUMEN

AIMS/HYPOTHESIS: The aim of this study was to examine the association between HbA(1c) variability and the development of microalbuminuria as defined by an albumin/creatinine ratio ≥ 3.4 mg/mmol (≥ 30 mg/g) in at least two of three consecutive urine samples in Japanese patients with type 2 diabetes. METHODS: HbA(1c) level was measured in 812 serially registered normoalbuminuric adults aged 21-79 years with type 2 diabetes. After registration, a 1-year period to establish baseline values for mean HbA(1c) and HbA(1c) variability (measured as the intrapersonal SD of serially collected HbA(1c)) was decided upon. The association between HbA(1c) variability and the development of microalbuminuria was determined by Cox regression analysis after adjustment for other risk factors for microalbuminuria. RESULTS: Microalbuminuria occurred in 193 patients during the observation period of (mean ± SD) 4.3 ± 2.7 years. Even after adjustment for mean HbA(1c), HbA(1c) variability was a significant predictor of microalbuminuria independently of the mean HbA(1c); the HR for every 1% (95% CI) increase in mean HbA(1c) was 1.22 (1.06, 1.40) (p = 0.005), and that for HbA(1c) variability was 1.35 (1.05, 1.72) (p = 0.019). The effects of these two variables were quite similar when 1 SD was used; the HR for every 1 SD increase (95% CI) in HbA(1c) was 1.23 (1.07, 1.43) (p = 0.005), and that for HbA(1c) variability was 1.20 (1.03, 1.39) (p = 0.019). CONCLUSIONS/INTERPRETATION: HbA(1c) variability affects the development of microalbuminuria independently of mean HbA(1c) in type 2 diabetes. Further studies should be performed to evaluate the influence of HbA(1c) variability on other complications and in individuals of other ethnicities with type 2 diabetes.


Asunto(s)
Albuminuria/orina , Creatinina/orina , Diabetes Mellitus Tipo 2/sangre , Angiopatías Diabéticas/sangre , Nefropatías Diabéticas/sangre , Hemoglobina Glucada/metabolismo , Pueblo Asiatico , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/fisiopatología , Angiopatías Diabéticas/etnología , Angiopatías Diabéticas/fisiopatología , Nefropatías Diabéticas/etnología , Nefropatías Diabéticas/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Sistema de Registros , Factores de Riesgo , Albúmina Sérica/metabolismo
12.
Diabetologia ; 55(12): 3213-23, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22955996

RESUMEN

AIMS/HYPOTHESIS: The aims of this study were to assess the clinical significance of introducing HbA(1c) into a risk score for diabetes and to develop a scoring system to predict the 5 year incidence of diabetes in Japanese individuals. METHODS: The study included 7,654 non-diabetic individuals aged 40-75 years. Incident diabetes was defined as fasting plasma glucose (FPG) ≥7.0 mmol/l, HbA(1c) ≥6.5% (48 mmol/mol) or self-reported clinician-diagnosed diabetes. We constructed a risk score using non-laboratory assessments (NLA) and evaluated improvements in risk prediction by adding elevated FPG, elevated HbA(1c) or both to NLA. RESULTS: The discriminative ability of the NLA score (age, sex, family history of diabetes, current smoking and BMI) was 0.708. The difference in discrimination between the NLA + FPG and NLA + HbA(1c) scores was non-significant (0.836 vs 0.837; p = 0.898). A risk score including family history of diabetes, smoking, obesity and both FPG and HbA(1c) had the highest discrimination (0.887, 95% CI 0.871, 0.903). At an optimal cut-off point, sensitivity and specificity were high at 83.7% and 79.0%, respectively. After initial screening using NLA scores, subsequent information on either FPG or HbA(1c) resulted in a net reclassification improvement of 42.7% or 52.3%, respectively (p < 0.0001). When both were available, net reclassification improvement and integrated discrimination improvement were further improved at 56.7% (95% CI 47.3%, 66.1%) and 10.9% (9.7%, 12.1%), respectively. CONCLUSIONS/INTERPRETATION: Information on HbA(1c) or FPG levels after initial screening by NLA can precisely refine diabetes risk reclassification.


Asunto(s)
Pueblo Asiatico/estadística & datos numéricos , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina Glucada/metabolismo , Tamizaje Masivo/métodos , Adulto , Anciano , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Ayuno/sangre , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Fumar/epidemiología , Factores de Tiempo
13.
Int J Obes (Lond) ; 36(5): 675-85, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-21694698

RESUMEN

OBJECTIVE: Web-based treatment programs are attractive in primary care because of their ability to reach numerous individuals at low cost. Our aim of this meta-analysis is to systematically review the weight loss or maintenance effect of the Internet component in obesity treatment programs. METHODS: MEDLINE and EMBASE literature searches were conducted to identify studies investigating the effect of Web-based individualized advice on lifestyle modification on weight loss. Randomized controlled trials that consisted of a Web-user experimental and non-Web user control group were included. Weight changes in the experimental group in comparison with the control group were pooled with a random-effects model. RESULTS: A total of 23 studies comprising 8697 participants were included. Overall, using the Internet had a modest but significant additional weight-loss effect compared with non-Web user control groups (-0.68 kg, P=0.03). In comparison with the control group, stratified analysis indicated that using the Internet as an adjunct to obesity care was effective (-1.00 kg, P<0.001), but that using it as a substitute for face-to-face support was unfavorable (+1.27 kg, P=0.01). An additional effect on weight control was observed when the aim of using the Internet was initial weight loss (-1.01 kg; P=0.03), but was not observed when the aim was weight maintenance (+0.68 kg; P=0.26). The relative effect was diminished with longer educational periods (P-trend=0.04) and was insignificant (-0.20 kg; P=0.75) in studies with educational periods of 12 months or more. CONCLUSION: The current meta-analysis indicates that the Internet component in obesity treatment programs has a modest effect on weight control. However, the effect was inconsistent, largely depending on the type of usage of the Internet or the period of its use.


Asunto(s)
Internet/estadística & datos numéricos , Obesidad/prevención & control , Conducta de Reducción del Riesgo , Autocuidado , Peso Corporal , Femenino , Conductas Relacionadas con la Salud , Promoción de la Salud , Humanos , Masculino , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Pérdida de Peso
14.
Diabet Med ; 29(9): e279-85, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22510023

RESUMEN

AIM: To evaluate various screening criteria for pre-diabetes to identify which combination of impaired fasting glucose and elevated HbA(1c) values performs most effectively in predicting future diabetes in a large cohort of Japanese individuals. METHODS: The study included 4670 men and 1571 women without diabetes (diabetes: fasting plasma glucose ≥ 7.0 mmol/l, HbA(1c) ≥ 48 mmol/mol (≥ 6.5%), or self-reported clinician-diagnosed diabetes). Pre-diabetes was diagnosed by a combination of impaired fasting glucose (fasting plasma glucose 5.6-6.9 mmol/l or 6.1-6.9 mmol/l) and elevated HbA(1c) [39-46 mmol/mol (5.7-6.4%) or 42-46 mmol/mol (6.0-6.4%)]. RESULTS: During a 5-year follow-up, 338 incident cases of diabetes occurred. The combination of HbA(1c) 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l yielded the highest sensitivity (86%) and generated a large population-attributable per cent risk (78%) for predicting development of diabetes. Among individuals classified as having pre-diabetes by any of the four combined criteria, 20.5-32.0% reverted to the normoglycaemic state as having neither elevated HbA(1c) nor impaired fasting glucose at the last follow-up examination. At 5.6 years after the baseline examination, however, pre-diabetic individuals who fulfilled both HbA(1c) 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l had a 100% cumulative risk of developing diabetes. CONCLUSIONS: The combination of HbA(1c) 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l would have the best performance in reducing the likelihood of missing future cases of diabetes. Identifying pre-diabetic individuals who strictly fulfil HbA(1c) 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l would predict definite progression to diabetes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus/epidemiología , Ayuno/metabolismo , Hemoglobina Glucada/metabolismo , Tamizaje Masivo/métodos , Estado Prediabético/sangre , Estado Prediabético/diagnóstico , Adulto , Estudios de Cohortes , Diabetes Mellitus/sangre , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón , Masculino , Persona de Mediana Edad , Estado Prediabético/clasificación , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y Especificidad
15.
Diabet Med ; 29(10): 1285-90, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22486679

RESUMEN

AIMS: We aimed to characterize the association of insulin resistance, impaired insulin secretion and ß-cell dysfunction in relation to HbA(1c) levels in a non-diabetic range in Japanese individuals without clinically diagnosed diabetes. METHODS: This cross-sectional study included 1444 individuals without a history of outpatient treatment of diabetes or use of insulin or oral hypoglycaemic agents. The homeostasis model assessment of insulin resistance and beta-cell function, insulinogenic index, Matsuda index and disposition index were calculated using data from 75-g oral glucose tolerance tests and compared across quintile (Q) categories of HbA(1c) levels. RESULTS: Fasting plasma glucose and 30-min and 60-min plasma glucose (PG) levels were significantly higher when HbA(1c) exceeded 36 mmol/mol (5.4%). A HbA(1c) concentration of 36-37 mmol/mol (5.4-5.5%) (Q3) was significantly associated with a 15% lower homeostasis model assessment of ß-cell function value and 31% lower insulinogenic index value compared with HbA(1c) ≤ 32 mmol/mol (≤ 5.1%) (Q1) (P <0.01). Further, a HbA(1c) concentration of 38-40 mmol/mol (5.6-5.8%) (Q4) was associated with 17% (P <0.01) and 24% (P <0.05) reductions in those indexes, respectively. However, the homeostasis model assessment of insulin resistance was not significantly elevated and the Matsuda index was not significantly lower unless HbA(1c) exceeded 41 mmol/mol (5.9%). Individuals with HbA(1c) ≥ 41 mmol/mol (≥ 5.9%) (Q5) had a 69% lower disposition index than those with a HbA(1c) concentration of ≤ 32 mmol/mol (≤ 5.1%) (Q1). CONCLUSIONS: Elevated HbA(1c) levels ≥ 41 mmol/mol (≥ 5.9%) were associated with substantial reductions in insulin secretion, insulin sensitivity and ß-cell dysfunction in Japanese individuals not treated for diabetes. High normal HbA(1c) levels of 36-40 mmol/mol (5.4-5.8%) were also associated with impaired insulin secretion without marked insulin resistance in Japanese individuals.


Asunto(s)
Glucemia/metabolismo , Hemoglobina Glucada/metabolismo , Resistencia a la Insulina , Células Secretoras de Insulina/metabolismo , Insulina/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Pueblo Asiatico , Biomarcadores/sangre , Estudios Transversales , Ayuno/sangre , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Secreción de Insulina , Japón , Masculino , Persona de Mediana Edad , Adulto Joven
16.
Diabetologia ; 54(4): 762-6, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21212932

RESUMEN

AIMS/HYPOTHESIS: Evidence has suggested that low serum potassium concentrations decrease insulin secretion, leading to glucose intolerance, and that hypokalaemia induced by diuretics increases the risk for diabetes in hypertensive individuals. However, no prospective study has investigated the association between serum potassium and the development of type 2 diabetes in a healthy cohort comprised of Asian individuals not being administered antihypertensive medications. This study aimed to investigate whether low serum potassium is associated with increased risk of type 2 diabetes in apparently healthy Japanese men. METHODS: We followed 4,409 Japanese men with no history of diabetes, use of antihypertensives, renal dysfunction or liver dysfunction (mean ± SD age, 48.4 ± 8.4 years). Cox proportional hazards regression was used to estimate HRs for incident diabetes (fasting plasma glucose level ≥ 7.0 mmol/l, HbA(1c) ≥ 6.5% or self-reported) including serum potassium concentration as either a categorical or a continuous variable. RESULTS: During a 5 year follow-up, 250 individuals developed type 2 diabetes. The lowest tertile of serum potassium (2.8-3.9 mmol/l) was independently associated with the development of diabetes after adjustment for known predictors (HR 1.57 [95% CI, 1.15-2.15]) compared with the highest tertile (4.2-5.4 mmol/l). Every 0.5 mmol/l lower increment in the baseline serum potassium level was associated with a 45% (12-87%) increased risk of diabetes. CONCLUSIONS/INTERPRETATION: Mild to moderately low serum potassium levels, within the normal range and without frank hypokalaemia, could be predictive of type 2 diabetes in apparently healthy Japanese men.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Potasio/sangre , Adulto , Pueblo Asiatico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo
17.
Eat Weight Disord ; 16(3): e157-63, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22290031

RESUMEN

Attempting to lose weight by normal or underweight adolescent girls is a serious issue in many countries. It has been reported that the mode of attempted weight loss does not differ between normal weight and overweight girls. These inappropriate weight loss attempts (IWLA) by normal or underweight adolescent girls is associated with various health issues, but factors associated with IWLA have only been marginally elucidated. In this study, we applied a single multivariate regression analysis to clarify independent factors for IWLA. Study subjects were 134 pairs of early adolescent girls (aged 12-15) and their mothers. In addition to IWLA, many factors including height, weight, body image, perceived weight status, depressive symptoms, media influence and self-esteem were surveyed in both mothers and daughters and subjected to multivariate analysis. Approximately half of girls surveyed had IWLA, even though all were of normal weight and 62.9% knew that they were of normal weight. IWLA were independently associated with depressive symptoms (OR (95% CI); 2.80 (1.21-6.50), p=0.016) independent of actual or perceived weight status. Factors significantly associated with IWLA by the girls were percentage deviation of weight from standard weight (%DW) and media influence on the girls themselves, and media influence on and self-esteem of their mothers. IWLA, which were frequently observed among early adolescent girls even among those of normal weight, were closely related to depressive status. IWLA were significantly associated with not only factors related to the girls (1.09 (1.04-1.14), p=0.001), but also with maternal psychological factors (1.06 (1.00-1.13), p=0.035) conveyed by the media. Future prospective or interventional studies are required to clarify whether these factors could be targeted in an effort to prevent IWLA.


Asunto(s)
Imagen Corporal , Depresión/psicología , Dieta Reductora/psicología , Autoimagen , Pérdida de Peso , Adolescente , Peso Corporal , Niño , Femenino , Humanos , Japón , Madres/psicología , Obesidad/prevención & control , Obesidad/psicología
18.
Diabetes Metab ; 46(4): 331-334, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-30213710

RESUMEN

AIM: To examine the association between treatment-achieved HbA1c values and incidence of both coronary artery disease (CAD) and severe eye disease with different diabetes treatments. METHODS: Associations of treatment-achieved HbA1c were investigated in various treatment groups [diet only; insulin; sulphonylurea (SU) alone; SU with glinides; and antihyperglycaemic agents other than glinides, SU or insulin] taken from a nationwide claims database of 14,633 Japanese diabetes patients. Cox's regression analysis examined risks over a 5.1-year follow-up. RESULTS: A significant linear trend was associated with HbA1c levels and CAD events in the diet-only group, and CAD risks were significantly higher in insulin and SU groups with HbA1c ≤ 7.0% and > 8.0% than in the diet-only group with HbA1c ≤ 7.0%. In contrast to CAD, a linear association was observed regardless of treatment modality between achieved HbA1c levels and risk of severe diabetic eye disease, but with no significant difference in eye disease risk between groups with HbA1c ≤ 7.0% and 7.1-8.0% in those treated with either SU alone, SU with glinides, or insulin. CONCLUSION: These findings suggest that the relationship between treatment-achieved HbA1c and incidence of both CAD and severe diabetic eye disease differed according to treatment, based on a large-scale real-life database. More research is now needed to confirm these findings and to further investigate the underlying mechanisms.


Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Diabetes Mellitus Tipo 2/terapia , Retinopatía Diabética/epidemiología , Dieta para Diabéticos , Hemoglobina Glucada/metabolismo , Hipoglucemiantes/uso terapéutico , Edema Macular/epidemiología , Inhibidores de la Angiogénesis/uso terapéutico , Diabetes Mellitus Tipo 2/metabolismo , Retinopatía Diabética/terapia , Femenino , Humanos , Incidencia , Insulina/uso terapéutico , Inyecciones Intravítreas , Fotocoagulación , Edema Macular/fisiopatología , Edema Macular/terapia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Índice de Severidad de la Enfermedad , Compuestos de Sulfonilurea/uso terapéutico , Resultado del Tratamiento
19.
Radiat Prot Dosimetry ; 186(1): 139-142, 2019 12 31.
Artículo en Inglés | MEDLINE | ID: mdl-30576530

RESUMEN

In 2015, the Asian Radiation Dosimetry Group established a regional network of biological dosimetry laboratories known as the ARADOS-WG03 (Working Group 03; Biological Dosimetry). A survey was conducted in 2017 to evaluate the capabilities and capacities of the participating laboratories for emergency preparedness and responses in large-scale nuclear and/or radiological incidents. The results of this survey were identified and assessed. The data provide important information on the current state of emergency cytogenetic biological dosimetry capabilities in the Asian region.


Asunto(s)
Bioensayo/métodos , Defensa Civil/organización & administración , Planificación en Desastres/organización & administración , Laboratorios/organización & administración , Exposición a la Radiación/efectos adversos , Liberación de Radiactividad Peligrosa/prevención & control , Radiometría/métodos , Asia , Análisis Citogenético , Sistemas Especialistas , Humanos , Laboratorios/normas , Protección Radiológica/métodos , Protección Radiológica/normas
20.
Obes Rev ; 19(12): 1621-1629, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30270528

RESUMEN

BACKGROUND: Bariatric surgery leads to a higher remission rate for type 2 diabetes mellitus than non-surgical treatment. However, it remains unsolved which surgical procedure is the most efficacious. This network meta-analysis aimed to rank surgical procedures in terms of diabetes remission. METHODS AND FINDINGS: We electronically searched for randomized controlled trials in which at least one surgical treatment was included among multiple arms and the diabetes remission rate was included in study outcomes. A random-effects network meta-analysis was performed within a frequentist framework. The hierarchy of treatments was expressed as the surface under the cumulative ranking curve value. Results of the analysis of 25 eligible randomized controlled trials that covered non-surgical treatments and eight surgical procedures (biliopancreatic diversion [BPD], BPD with duodenal switch, Roux-en Y gastric bypass, mini gastric bypass [mini-GBP], laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, greater curvature plication and duodenal-jejunal bypass) showed that BPD and mini-GBP had the highest surface under the cumulative ranking curve values among the eight surgical treatments. CONCLUSION: Current network meta-analysis indicated that BPD or mini-GBP achieved higher diabetes remission rates than the other procedures. However, the result needs to be interpreted with caution considering that these procedures were in the minority of bariatric surgeries.


Asunto(s)
Cirugía Bariátrica/métodos , Diabetes Mellitus Tipo 2/cirugía , Humanos , Metaanálisis en Red , Inducción de Remisión/métodos , Resultado del Tratamiento
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