[Intervention effects of inclusive support in an "exercise and a nutritional community-based prevention program" for pre-frail elderly individuals].

OBJECTIVES: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care). METHODS: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention. RESULTS: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study. CONCLUSION: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

[Examination of effects of alfacalcidol vitamin D supplement and renal function on improvement in the physical fitness of pre-frail elderly persons attending a nursing care prevention class].

AIM: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people. METHODS: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m(2)) was calculated using a new formula. Alfacalcidol 1 µg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed. RESULTS: The prevalence of eGFR <60.0 ml/min/1.73 m(2) was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)(2)D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests. CONCLUSIONS: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

[Factors affecting burden of caregivers for the elderly of Han Chinese and the Korean minority living in a community in northeast China].

UNLABELLED: Objective In the People's Republic of China (China), caregivers carry a large burden because of the rapid aging of the population, the one-child policy and the uncertainty of the social security system. The situation is further complicated by the fact of 56 ethnic groups in the country. Few studies on caregiver burden in different ethnic groups have been reported, although different customs, cultures and methods of caring for the elderly do certainly exist. The aim of the present study was to compare the caregiver burden for the elderly among Han Chinese and the Korean Minority living in a community and to examine the factors affecting this burden. METHODS: An investigation was conducted using a questionnaire for 76 pairs of elderly people and their caregivers in Yanji City, China (Korean Minority pairs 52, Han pairs 24). The questionnaires for the elderly included their characteristics, economic conditions, ADL, behavioral disturbances associated with dementia, etc. For the caregivers, their characteristics, the state of their health, daily length of care time, social support, intent to continue home care, and Zarit Caregiver Burden Interview (ZBI) score were investigated. RESULTS: The rate (70.8%) of caregivers with a "high caregiver burden," i.e., those with a median ZBI total score of 33 or more, and the personal strain scores of the Han Chinese were significantly higher than in the Korean Minority. As for who was a suitable caregiver, a high percentage of Han caregivers answered the "children" of the elderly, while Korean Minority caregivers answered the "spouses". When the caregiver was a child of the elderly receiving care, the Hans' ZBI score was higher than that for the Korean Minority. Factors most affecting caregiver burden in the Korean Minority were behavioral disturbances associated with dementia of the elderly, ADL, and degree of life independence of the elderly, along with disorders, sex and health state of the caregivers, relations, length of daily care time, number of vice-caregivers, and social support. Factors affecting caregiver burden in the Han group were the presence of private rooms for the elderly, their life satisfaction and family economic conditions. About 80% of caregivers of both groups had the intention to continue home care, and about 50% of the elderly of both groups answered that entering an institution was not acceptable. CONCLUSION: Factors affecting caregiver burden differ between these two ethnic groups, although in both cases about 80% of caregivers intend to continue home care. Therefore, it is necessary to support the elderly and caregivers in ways that suit their ethnic characteristics.

Effects of serum 25-hydroxyvitamin D(3) levels on physical fitness in community-dwelling frail women.

The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D(3) (25(OH)D(3)) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36 degrees north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D(3), intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D(3)<50 nmol/l or 25(OH)D(3)<75 nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), "timed up & go" (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D(3) levels greater than 67.5 nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D(3) levels <47.5 nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D(3) level of greater than 47.5 nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5 nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.

[Examination of activated charcoal preparations in chronic kidney disease: comparing Kremezin (K) and Merckmezin (M)].

BACKGROUND: Two activated charcoal preparations, Kremezin (K) and Merckmezin (M), are both available in Japan and derived from similar materials. However, their microstructures are distincty different, and possibly reflect differences in their properties of absorbance. To evaluate the difference between K and M, we investigated the effects of K and M on the clinical parameters related to uremia in pre-dialysis patients. METHODS: A prospective, randomized, open-label, two-arm, parallel-group comparative clinical trial was planned, as follows. After the 4-week observation period, twenty-two patients who were enrolled in this study were randomly distributed into two groups, K or M, for 8 weeks. RESULTS: There were no significant differences between the K and M groups in the characteristics of the patients. The rate of change of serum indoxyl sulfate was significantly reduced in the K group compared with the M group (p=0.002). Creatinine clearance was preserved in the K group, but decreased in the M group (p=0.045). CONCLUSIONS: K had more favorable effects in adsorbing uremic toxins and preserving renal function in the uremic patients than M.

[Evaluation of the association between impaired renal function and physical function among community-dwelling Japanese frail elderly based on the estimated glomerular filtration rate (eGFR)].

AIM: Falls are major risk factors in nursing care and reported to be associated with low vitamin D levels or impaired renal function. It is unknown whether physical function is associated with impaired renal function. The aim of this study was to examine the association between estimated glomerular filtration rate (eGFR) (ml/min/1.73 m(2)), vitamin D, and physical function in Japanese frail elderly. METHODS: A cross-sectional survey was conducted in two towns (latitude 36 degrees north) from June 2006 to January 2008. Subjects counted of 109 community-dwelling frail elderly, aged 65 years and over (mean+/-SD: 75.8+/-5.2 yr) who attended a program for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25 (OH) D), 1,25-dihydroxyvitamin D (1,25 (OH)(2)D), and creatinine were measured. eGFR (ml/min/1.73 m(2)) was calculated using the Modification of Diet in Renal Disease formula. The following functional fitness tests were performed: timed up and go (TUG), a 5-meter walk, functional reach (FR), one leg stance, tandem stance, and grip strength. RESULTS: Of the subjects, 59.6% experienced falls, 75.2% experienced stumbling at least once during the past year. eGFR was 68.0+/-14.1 ml/min/1.73 m(2) in the subjects. The prevalence of eGFR<60.0 ml/min/1.73 m(2) was 30%. The subjects with eGFR> or =60 ml/min/1.73 m(2) showed significantly better results for FR, one leg stance, and tandem stance than those with eGFR<60 ml/min/1.73 m(2). Multiple liner regression analysis suggested that FR and tandem stance were significantly affected by eGFR. CONCLUSIONS: Our data suggest that assessment of renal function seems to be significant when we consider balance ability in the frail elderly.

[Correlation between vitamin D and functional capacity, physical function among Japanese frail elderly living in the community].

AIM: To examine the distribution of 25-hydroxyvitamin D(3) [25(OH)D] levels among the Japanese frail elderly, and to explore any association in these subjects between 25 (OH)D levels and functional capacity or physical performance. METHODS: A cross-sectional survey was conducted in a town (latitude 36 degrees north) in June 2005 to September 2006. The 76 participants were community-dwelling elderly aged 65 years and over who attended a class for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of 25(OH)D, intact parathyroid hormone (iPTH) and calcium were measured. The following physical tests were performed: timed up and go (TUG), a 5-meter walk, functional reach, trunk flexion, and grip strength. Functional capacity and physical performance were compared between the subjects with 25(OH)D>or=50 nmol/L and those with 25(OH)D<50 nmol/L. RESULTS: About 52.6% experienced falls, 75.0% experienced stumbling or body sway more than once during the past year, and 20.0% were housebound. The mean 25(OH)D level (+/-SD) was 60.4+/-13.6 nmol/L (range: 27.5-87.5). The ratio of the 25(OH)D level below 50.0 nmol/L was significantly higher in the group of subjects who had lower mobility or body imbalance or were housebound. The risk factor for stumbling or body sway was 25(OH)D<50 nmol/L (OR: 4.41, 95%CI: 1.31-14.86). CONCLUSION: The prevalence of 25(OH)D<50 nmol/L was 21% among Japanese frail elderly, and 25(OH)D deficiency is associated with lower mobility or body imbalance. It is suggested that the level of 25(OH)D should be needed over 50 nmol/L for nursing care prevention in the frail elderly and that measurements of 25(OH)D for the frail elderly are needed.

[A study of factors related to activities of daily living (ADL) of the elderly receiving in-home service longitudinal study using functional independence measures].

OBJECTIVE: We conducted a longitudinal study using Functional Independence Measures to clarify factor related to independence of activities of daily living of elderly receiving in-home service under the long-term care insurance system METHODS: Fifty-four elderly users of the in-home service of Ibaraki Prefecture assented to participate in this study and were analyzed. A researcher conducted survey at the baseline and after follow-up by visiting the elderly at each home. The evaluation standards used here were the Japanese version of Functional Independence Measure (FIM), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS-15). RESULTS: The FIM score (mean+/-SD) was decreased 83.6+/-36.4 to 81.7+/-37.4 during the 112+/-22.2 day follow up period. Thirty-nine elderly demonstrated improvement or no change in FIM and 15 had declining scores. To clarify independent factors related to FIM change, we conducted a step-wise multifactor logistic regression analysis, and the results suggested importance for "in-home service availability" and "home care period less than one year". CONCLUSION: Our study suggested that it is important for maintenance or improvement of ADL in home care elderly to provide sufficient home .care services from the beginning under the long-term care insurance system.

Effects of naphthoquinone on airway responsiveness in the presence or absence of antigen in mice.

We have recently demonstrated that naphthoquinone (NQ), one of extractable chemical compounds of diesel exhaust particles (DEP), enhances antigen-related airway inflammation with goblet cell hyperplasia in mice (Inoue et al. in Eur Respir J 209(2):259-267, 2007). Further, NQ has enhanced lung expressions of interleukin (IL)-4 and IL-5. However, the effects of NQ on other cardinal features of asthma have not been completely investigated. The aim of the present study was to evaluate the effects of NQ on airway responsiveness on the model. Vehicle, NQ, ovalbumin (OVA), or NQ + OVA was administered intratarcheally to ICR mice for 6 weeks. Twenty-four hours after the last instillation, lung histology, lung functions such as total respiratory system resistance (R) and Newtonian resistance (R (n)), and protein level of IL-13 and mRNA level for MUC5AC in the lung were examined. Repetitive exposure to NQ aggravated antigen-related lung inflammation. NQ alone enhanced R and R (n) as compared to vehicle without statistical significance. OVA alone or NQ plus OVA showed increases in R and R (n), which was prominent in NQ plus OVA (P < 0.05 vs. vehicle). Combined exposure to NQ and OVA elevated the levels of IL-13 and MUC5AC in the lung as compared with exposure to NQ or OVA alone. These results indicate that NQ can enhance airway hyperresponsiveness in the presence or absence of an antigen. Also, amplified lung expressions of IL-13 and MUC5AC might partly contribute to the deterioration of asthma features by NQ.

[Factors that influence home return from health care facilities for the elderly--related to the attitude of family caregivers].

AIM: The number of users of long-term care insurance has been increasing rapidly since it started in 2000. The number of those who want to enter the long-term care insurance facilities has increased. Although the basic philosophy of long-term care insurance is independence support and self-decision, to enter a facility or home return from facilities is likely to be decided by family caregivers, not by the elderly themselves. Moreover, the number of elderly who return home from welfare facilities is decreasing. We investigated the intension of caregivers who are willing to accept the institutionalized elderly at home and analyzed the factors affecting the acceptance of caregivers. METHODS: Subjects were elderly who were in long-term care insurance facility in June 2004, and their caregivers. The study was conducted between June 2004 and September 2004 in Ibaraki Prefecture in Japan. A face-to-face interview based on a questionnaire was conducted for the institutionalized elderly and by the mail for the caregivers. RESULTS: The caregivers of 34.6% of the elderly who hoped to return home intended to accept them home. There were differences between the plans of the elderly and caregivers. The risk factors (OR, 95% CI) to make the intention of the caregivers to accept the institutionalized elderly home difficult were level of cooperation with other family members to take care of elderly (OR 15.37, 2.05-115.24), dementia behavior disturbance category with more than one (OR 8.34, 1.02-68.05), time spending in bed of a day (OR 1.31, 1.01-1.71), few knowledge of long-term care insurance system of caregivers (OR 3.65,0.81-16.38). CONCLUSION: It has been suggested that more physical activities in the facility, establishment of a care-system for the demented elderly living in the community and an educational campaign by the long-term care insurance system are necessary to increase the willingness of caregivers to accept home return of institutionalized elderly.

Asian sand dust enhances ovalbumin-induced eosinophil recruitment in the alveoli and airway of mice.

Asian sand dust (ASD) containing sulfate (SO4(2-)) reportedly causes adverse respiratory health effects but there is no experimental study showing the effect of ASD toward allergic respiratory diseases. The effects of ASD and ASD plus SO4(2-) toward allergic lung inflammation induced by ovalbumin (OVA) were investigated in this study. ICR mice were administered intratracheally with saline; ASD alone (sample from Shapotou desert); and ASD plus SO4(2-) (ASD-SO4); OVA+ASD; OVA+ASD-SO4. ASD or ASD-SO4 alone caused mild nutrophilic inflammation in the bronchi and alveoli. ASD and ASD-SO4 increased pro-inflammatory mediators, such as Keratinocyte chemoattractant (KC) and macrophage inflammatory protein (MIP)-1 alpha, in bronchoalveolar lavage fluids (BALF). ASD and ASD-SO4 enhanced eosinophil recruitment induced by OVA in the alveoli and in the submucosa of the airway, which has a goblet cell proliferation in the bronchial epithelium. However, a further increase of eosinophils by addition of SO4(2-) was not observed. The two sand dusts synergistically increased interleukin-5 (IL-5) and monocyte chemotactic protein-1 (MCP-1), which were associated with OVA, in BALF. However, the increased levels of IL-5 were lower in the OVA+ASD-SO4 group than in the OVA+ASD group. ASD caused the adjuvant effects to specific-IgG1 production by OVA, but not to specific-IgE. These results suggest that the enhancement of eosinophil recruitment in the lung is mediated by synergistically increased IL-5 and MCP-1. IgG1 antibodies may play an important role in the enhancement of allergic reaction caused by OVA and sand dust. However, extra sulfate may not contribute to an increase of eosinophils.

Factors affecting the mental health of residents in a communal-housing project for seniors in Japan.

The aim of this study was to investigate mental health status and the factors related to it in residents of a communal-housing project for independently living elderly in Japan. Two hundred and seven persons (average age: 74 years) residing in the Silver Peer Housing Project, a seniors' communal-housing project designed for independent living, were interviewed face-to-face using a general health questionnaire (GHQ-28), mental status questionnaire (MSQ) and other questionnaire containing items on personal, social, and building/facility parameters. Using a GHQ score of 7 or over to indicate poor general mental health, approximately half of the residents (45.7%) were shown to have some psychiatric problems. Independent contributors to a high GHQ score were attendance of hobby-club meetings (odds ratio (95% CI): 0.4; range, 0.2-0.8); difficulty in laying out or putting away the bedding (odds ratio (95% CI): 2.0; range, 1.0-4.2); difficulty in standing up from a sitting position on a mat (odds ratio (95% CI): 2.0; range, 1.0-4.1); and difficulty in reaching bus or train stops (odds ratio (95% CI): 2.5; 1.2-5.2); by the step-wise multiple logistic regression analysis. It was shown that a considerable number of the residents in the Silver Peer Housing facilities studied had mental health problems associated with limitations in the layout of their apartment and/or the location of the housing. Our results suggest that it may be worthwhile to prepare more comfortable housing, and to provide psychogeriatric day treatment and a communal space open to public in the Silver Peer Housing.

Effects of a single intratracheal administration of phenanthraquinone on murine lung.

Although several studies have reported that diesel exhaust particles (DEP) affect cardiorespiratory health in animals and humans, the responsible components in DEP for the effects remain to be defined. Diesel exhaust particles contain quinones that can catalyse the generation of reactive oxygen species, resulting in the induction of oxidative stress. Oxidative stress can correlate with a variety of diseases and health effects. In the present study, we investigated the effects of phenanthraquinone--a relatively abundant quinone in DEP--on lung inflammation and the local expression of cytokine proteins in mice as a measure of oxidative damage. The animals were randomized into two experimental groups that received vehicle or phenanthraquinone by intratracheal instillation. The cellular profiles of bronchoalveolar lavage fluid (BALF) and local expression of cytokines were evaluated 24 and 48 h after the instillation. Phenanthraquinone challenge revealed an increase in the numbers of neutrophils and eosinophils in BALF as compared to vehicle challenge (P < 0.05 at 48 h post-instillation). Phenanthraquinone induced the lung expression of interleukin (IL)-5 and eotaxin 48 h and 24 h after the challenge, respectively. These results indicate that intratracheal exposure to phenanthraquinone induces recruitment of inflammatory cells, at least partly, through the local expression of IL-5 and eotaxin.

Pulmonary toxicity induced by intratracheal instillation of Asian yellow dust (Kosa) in mice.

Asian yellow dust (Kosa) causes adverse respiratory health effects in humans. The objective of this study was to clarify the lung toxicity of Kosa. ICR mice (5 weeks of age) were administered intratracheally with Kosa samples-two samples from Maowusu desert and Shapotou desert, one sample consisted of Shapotou Kosa plus sulfate, and natural Asian dust (NAD) from the atmosphere of Beijing-at doses of 0.05, 0.10 or 0.20mg/mouse at four weekly intervals. The four Kosa samples tested had similar compositions of minerals and concentrations of elements. Instillation of dust particles caused bronchitis and alveolitis in treated mice. The magnitude of inflammation was much greater in NAD-treated mice than in the other particles tested. Increased neutrophils, lymphocytes or eosinophils in bronchoalveolar lavage fluids (BALF) of treated mice were dose dependent. The number of neutrophils in BALF at the 0.2mg level was parallel to the content of ß-glucan in each particle. The numbers of lymphocytes and eosinophils in BALF at the 0.2mg level were parallel to the concentration of SO(4)(2-) in each particle. Pro-inflammatory mediators-such as interleukin (IL)-12, tumor necrosis factor-(TNF)-α, keratinocyte chemoattractant (KC), monocyte chemotactic protein (MCP)-l and macrophage inflammatory protein-(MIP)-lα in BALF-were greater in the treated mice. Specifically, NAD considerably increased pro-inflammatory mediators at a 0.2mg dose. The increased amounts of MlP-lα and TNF-α at 0.2mg dose corresponded to the amount of ß-glucan in each particle. The amounts of MCP-l or IL-12 corresponded to the concentration of sulfate (SO(4)(2-)) at a 0.2mg dose. These results suggest that inflammatory lung injury was mediated by ß-glucan or SO(4)(2-), which was adsorbed into the particles, via the expression of these pro-inflammatory mediators. The results also suggest that the variations in the magnitude of inflammation of the tested Kosa samples depend on the amounts of these toxic materials.

Serial changes in independent sitting in adults with severe cerebral palsy.

We investigated the natural course of independent sitting in 28 institutionalized patients with severe cerebral palsy (CP) and evaluated the factors associated with presence or absence of independent sitting during adulthood. Seventeen subjects (61%) who could not sit at the age of 10 years were never able to reach the milestone of independent sitting. Five (45%) of 11 subjects subsequently lost the ability to sit independently during the early stage of adult life. In adulthood, many of the dependent sitters had poor activities of daily living (ADL) scores and required medical care for respiration and eating/swallowing. Hip dislocation was not directly associated with the presence or absence of independent sitting. We conclude that it is important to prevent further deterioration of swallowing and respiratory functions, as well as the development of deformities or contractures from childhood and to maintain previously acquired motor function and ADL in adults with severe CP.

[Analysis of factors that influence the desire to use public health nursing visit and visiting nursing agencies' service].

PURPOSE: The purpose of this study was to forecast the demand for public health nursing visit and visiting nursing agencies' service, and to obtain basic information on public policy after the Long-term Care Insurance Project Plan starts. METHOD: 8,940 randomly sampled subjects aged 65 and over, and 7,984 aged 64 and below, were selected for the surveys and mailed the questionnaire. A total of 5,775 aged 65 and over and 4,774 aged 64 and below responded to the questionnaire. RESULTS: 2,474 (42.8%) aged 65 and over and 1,643 (34.4%) aged 64 and below knew the name 'public health nursing visit', and the service provided, 1,635 (28.3%) aged 65 and over and 1,073 (22.5%) aged 64 and below, were aware of the visiting nursing agencies' service. The percentage of those who desired to use the service was significantly higher among the respondent aged 65 and over than among those aged 64 and below. It was also significantly higher among those who had already experienced the service previously. CONCLUSION: Awareness of the service and the number of those who use the visit will increase, as those aged 64 and below become more the elderly. We therefore can expect that service demand will increase in the future.

Association found between the promoter region polymorphism in the apolipoprotein A-V gene and the serum triglyceride level in Japanese schoolchildren.

The purpose of this study was to assess the influence of single nucleotide polymorphism 3 (SNP3) of the apolipoprotein A-V ( APOA5) gene on the serum triglyceride (TG) level in Japanese schoolchildren. To determine the frequency of the genotype, we analyzed 552 schoolchildren. The frequencies of the T/T, T/C and C/C genotypes of the APOA5 gene were 225 (40.8%), 263 (47.6%) and 64 (11.6%), respectively. The serum TG level was significantly different among the genotypic groups after adjustments for age, gender and obesity index (T/T 71.6+/-34.8 mg/dl, T/C 80.7+/-36.1 mg/dl, C/C 94.4+/-69.4 mg/dl, P<0.0001). The odds ratio (95% confidence interval) for hypertriglyceridemia of the C allele was 2.4 (1.0-6.2). Our data suggested that the T/C promoter region polymorphism of the APOA5 gene appears to be a genetic risk factor for hypertriglyceridemia in Japanese children.

Relation of the -514C/T polymorphism in the hepatic lipase gene to serum HDL and LDL cholesterol levels in postmenopausal women under hormone replacement therapy.

Hepatic lipase (HL) is a lipolytic enzyme that catalyzes hydrolysis of triglycerides and phospholipids in all major classes of lipoproteins. Recently, a -514C/T polymorphism in the promoter region of the HL gene was found to be associated with variations in hepatic lipase activity and serum high density lipoprotein cholesterol (HDL-C) levels. Postmenopausal hormone replacement therapy (HRT) has known favorable effects on serum lipid and lipoprotein levels. In this study, we examined the relation between the -514C/T polymorphism and serum lipid and lipoprotein levels in postmenopausal women prior to and after 3 months of HRT. Significant associations between the -514 C/T polymorphism and HDL-C, low density lipoprotein cholesterol (LDL-C) and apolipoprotein A-I (apo A-I) levels were observed before and/or after 3 months of HRT. With HRT, serum total cholesterol (TC), LDL-C and apolipoprotein B (apo B) levels were reduced significantly (P=0.0001), and HDL-C and apo A-I levels were increased significantly (P=0.0001). However, the degrees of change in lipid and lipoprotein levels due to HRT did not differ significantly between the HL genotypes.

Effects of hormone replacement therapy and methylenetetrahydrofolate reductase polymorphism on plasma folate and homocysteine levels in postmenopausal Japanese women.

OBJECTIVE: To evaluate the relationships among the methylenetetrahydrofolate reductase (MTHFR) polymorphism, plasma folate, total homocysteine (Hcy) levels, lipids, and the reduction of Hcy levels resulting from hormone replacement therapy (HRT). DESIGN: Clinical study. SETTING: Outpatient department of obstetrics and gynecology in a general hospital. PATIENT(S): Two hundred seventeen postmenopausal Japanese women. INTERVENTION(S): Of the 217 women, 172 patients were under continuous treatment with oral conjugated equine estrogen and medroxyprogesteron acetate. MAIN OUTCOME MEASURE(S): Fasting Hcy, folate, methionine, lipids, and apolipoproteins were measured before and after 3 months of HRT. RESULT(S): The plasma Hcy concentration was significantly higher in the low folate than in the high-folate group only in patients with the homozygous (T/T) mutant. Plasma Hcy concentrations were significantly correlated with age (R = 0.64, P=.02) or years since menopause (R = 0.73, P=.02) only in the low-folate group with T/T. The plasma Hcy concentration decreased significantly in all genotypes after 3 months of HRT, but the levels of serum folate and methionine remained unchanged. CONCLUSION(S): The MTHFR polymorphism was associated with a higher Hcy concentration, and this association was related to the serum folate level. Hormone replacement therapy reduced the plasma Hcy concentration independently of the MTHFR polymorphism.