Effect of lower-extremity muscle power training on muscle strength, balance function and walking ability in older adults with heart failure: a randomized controlled trial.

PURPOSE: This study investigated the combined effect of lower-extremity muscle power training and regular cardiac rehabilitation on muscle strength, balance function, and walking ability of older adults with heart failure. METHODS: Thirty-one patients, comprising 17 males and 14 females, aged between 66 and 89 years and diagnosed with non-severe heart failure, were randomly assigned to either the intervention group (n = 15) or control group (n = 16). Both groups participated in a 12-week regular rehabilitation program, with the intervention group receiving additional lower-extremity muscle power training. Various outcome measures, including muscle strength (the five-times-sit-to-stand test and knee extensor peak torque), balance function (Berg balance scale and functional reach test), and walking ability (4-m walk and Timed Up-and-Go tests) were assessed at baseline and 12 weeks after the intervention. RESULTS: Of the 31 participants, 27 completed the study protocol. The intervention group demonstrated significantly greater improvement in the five-times-sit-to-stand test time, indicating enhanced lower-extremity muscle power compared to the control group. Both groups showed significant differences in the Berg balance scale, functional reach test, 4-m walk test, and Timed Up-and-Go test between baseline and 12 weeks. However, the effect sizes for the changes during the study period were larger in the intervention group (d = 0.74-1.19) than the control group (d = 0.57-0.96). CONCLUSION: Combining lower-extremity muscle power training with regular cardiac rehabilitation may lead to additional improvements in muscle function for older adults with heart failure, resulting in enhanced dynamic balance and walking ability. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION: UMIN000032087/April 4, 2018.

Spot urinary sodium-to-potassium ratio is associated with blood pressure levels in healthy adolescents: the Wakayama Study.

The spot urinary sodium-to-potassium (Na/K) ratio is a simple measure of salt loading and has been shown to be associated with elevated blood pressure (BP) in middle-aged and older adults. This study aimed to evaluate the association between the spot urinary Na/K ratio and BP in 457 healthy adolescents aged 12-15 years in a school-based setting. The mean urinary Na/K ratio was 4.99 ± 2.76, and no significant difference was found between the boys and girls. When the participants were stratified based on urinary Na/K ratio quartile, age- and sex-adjusted systolic and diastolic BP gradually increased as Na/K ratio increased (systolic BP: 106.1, 106.9, 108.2, and 111.5 mmHg, Ptrend < 0.001; diastolic BP: 62.0, 62.4, 63.1, 64.3 mmHg, Ptrend = 0.022). The systolic and diastolic BP were more closely associated with urinary Na/K ratio than with Na and K levels, as well as estimated daily salt intake. In the multiple regression analysis, the urinary Na/K ratio was significantly associated with systolic BP (ß = 0.144, P < 0.001) and diastolic BP (ß = 0.114, P = 0.015) independent of potential confounding factors. An additional subgroup analysis revealed that the BP of the group with both high salt intake (≥8.5 g/day) and high Na/K ratio (≥6.60) was significantly higher than that of the group with high salt intake alone (systolic BP, 115.0 vs. 109.1 mmHg, P < 0.001; diastolic BP, 66.0 vs. 62.5 mmHg, P = 0.017). These results suggest that the urinary Na/K ratio is associated with BP levels in healthy adolescents and may be useful for assessing salt loading and its effects on BP elevation.

Appendicular Muscle Mass Index was Stronger than Body Mass Index in Association with Atherosclerosis in the Community-Dwelling Elderly.

AIMS: Low muscle mass is associated with advanced atherosclerosis. However, only very few studies on the elderly have investigated a dose-response relationship between muscle mass and atherosclerosis. Furthermore, whether the relationship between muscle mass and atherosclerosis is stronger than that between body mass index (BMI) and atherosclerosis among the elderly population remains to be determined. METHODS: A community-based sample of apparently healthy elderlies (≥ 65 years) was cross-sectionally examined for the association between appendicular skeletal muscle mass (ASM) and brachial-ankle pulse wave velocity (baPWV), a measure of atherosclerosis. We categorized the participants according to sex-specific quintiles of the ASM index (ASM/height2) or BMI. Using multivariable linear regression, we compared the slope of one standard deviation higher ASM index for baPWV with the corresponding slope of BMI, separately (single-index model) and jointly (simltaneously-adjusted model). RESULTS: The ASM index and BMI of a total of 995 participants (60.0% women, mean age 73 years) were significantly inversely associated with baPWV in a dose-response manner across the quintiles in both sexes. The slope for the ASM index tended to be greater than that for BMI in the single-index and simultaneously-adjusted models in both sexes after adjusting for confounders. CONCLUSIONS: Among a community-dwelling elderly population, the association between ASM and baPWV was stronger than, and independent of that between BMI and baPWV. These findings suggest that ASM provides more important information on atherosclerosis in the elderly than BMI does.

[Development of a Risk Prediction Model and a Simple Assessment Sheet for Cold Disorder (Hiesho) in Middle-aged and Older Adults].

OBJECTIVES: In this study, we aimed to develop a risk prediction model and a simple assessment sheet for cold disorder (hiesho) in middle-aged and older adults. METHODS: The 889 participants in this study were from a community-dwelling general population (mean age, 62.4±8.8 years). The skin surface temperatures of the face and hands of the participants were measured by thermography. The cold disorder was objectively defined as having a temperature difference of ≥8°C between the forehead and fingertips. Data on the body regions with cold perception and the various concomitant signs were collected by a self-administered questionnaire and structured interviews. RESULTS: The objectively assessed cold disorder was observed in 22.7% of participants and strongly associated with coldness of the back of the hand, palms, fingers, dorsal torso, toes, and soles of the feet. Its prevalence was found to increase with the number of signs of coldness. Older age, being female, low body mass index, hypertension, anemia, and physical inactivity were identified as potential risk factors. A logistic model for predicting the cold disorder was designed on the basis of the perceived cold, accompanying signs, and risk factors. The model showed good discrimination (area under the curve=0.737) and calibration capabilities (Hosmer-Lemeshow test, P=0.426). On the basis of this prediction model, a simple assessment sheet was developed to estimate the individual risk of experiencing the cold disorder, in middle-aged and older adults. CONCLUSIONS: With the proposed risk prediction model showing good discrimination capability, the assessment sheet may serve as a prescreening tool to evaluate the potential of middle-aged and older population to develop the cold disorder.

[Usefulness of Simple Dietary Check Sheet as Screening Tool to Assess the Risk of Muscle Mass Reduction in Community-Dwelling Middle-Aged and Older Adults].

OBJECTIVES: The aim of this study was to investigate the usefulness of a simple dietary check sheet to assess the risk of muscle mass reduction in middle-aged and older adults. METHODS: The study participants comprised 1,272 community-dwelling individuals aged 50-89 years (mean age; 68.7 years). Bioelectrical impedance analysis was performed to estimate the appendicular skeletal muscle mass index (SMI, kg/m2). The SMIs were expressed as z-scores and adjusted for age and gender. A simple dietary check sheet was used to assess the daily intake of foods associated with maintaining muscle mass, such as meat, fish, eggs, milk, soybean products, and vegetables. RESULTS: Individuals with reduced muscle masses (SMI z-scores < -1.0) had significantly lower intakes of meat, fish, eggs, milk, and vegetables, and a lower overall dietary intake than individuals without reduced muscle masses (SMI z-scores ≥ -1.0). Food intake score was calculated to obtain quantitative estimates of the daily intake of these foods. The scores ranged from 0 to 14, with higher scores indicating higher intakes of foods that contribute to maintaining the muscle mass. Compared with the reference group with scores of ≥ 10, the groups with lower scores were at a higher risk of muscle mass reduction. The odds ratios (95% confidence interval) of the groups with scores of 9, 8, 7, 6, and ≤ 5 were 1.15 (0.42-3.13), 2.10 (0.89-4.95), 3.64 (1.61-8.23), 4.49 (1.90-10.58), and 7.53 (3.06-18.51), respectively, after adjusting for age, gender, obesity, alcohol intake, smoking, physical inactivity, hypertriglyceridemia, diabetes mellitus, and liver dysfunction. CONCLUSIONS: As the food intake scores were significantly associated with decreased muscle mass, the proposed simple dietary check sheet may help assess the risk of muscle mass reduction in middle-aged and older adults from a nutritional perspective.

Effects of cigarette smoking on the association between respiratory muscle strength and skeletal muscle mass in middle-aged and older adults: the Wakayama Study.

PURPOSE: This study aimed to examine whether cumulative smoking exposure affects the association between peak expiratory flow rate (PEFR) and skeletal muscle mass in middle-aged and older adults. METHODS: The study participants comprised 832 community-dwelling individuals aged 50-89 years (mean age: 69 years) without chronic obstructive pulmonary disease. Bioelectrical impedance analysis was performed to estimate the skeletal muscle mass of each participant. PEFR was assessed using an electronic spirometer. Cumulative smoking exposure was expressed in pack years, that is a product of the average number of packs of cigarettes smoked per day and smoking duration in years. RESULTS: The whole-body skeletal muscle mass progressively reduced with decreasing PEFR levels in both males and females. In the multiple regression analysis, PEFR was found to be significantly associated with skeletal muscle mass, independent of the potential confounding factors. When participants were stratified based on the cumulative smoking exposure, the association between low PEFR and reduced skeletal muscle mass persisted in individuals with non-smoking and light-to-moderate smoking exposure (< 30 pack-years). However, this association was not clearly observed in individuals with heavy smoking exposure (≥ 30 pack-years). CONCLUSION: The findings of this study support the notion that PEFR declines with a reduction in systemic skeletal muscle mass due to aging. However, chronic cigarette smoking induces respiratory dysfunction exceeding the expected values by age, and thus a low PEFR level may not be used as a marker of reduced muscle mass in older adults exposed to heavy smoking.

Excessive alcohol intake and liver fibrosis are associated with skeletal muscle mass reduction in elderly men: the Wakayama study.

BACKGROUND: Excessive alcohol intake complicated by liver dysfunction has been presumed to affect skeletal muscles. This study aimed to examine the association between excessive alcohol intake, liver fibrosis, and loss of skeletal muscle mass in elderly men. METHODS: The study participants comprised 799 community-dwelling elderly men (age, 71 ± 3 years) with no history of treatment for liver disease. Bioelectrical impedance analysis was performed to estimate the appendicular skeletal muscle mass (ASM) of each participant. The ASM values were also normalized for height (ASM index). Liver fibrosis was evaluated using the Fib4 index, which was calculated using participant age, AST level, ALT level, and platelet count. Usual alcohol intake was estimated based on the type of alcohol, frequency of drinking, and amount of alcohol consumed per day. RESULTS: Among the excess drinkers (≥ 20 g/day), the ASM index of the subgroup with liver fibrosis (Fib4 index ≥ 2.67) was significantly lower than that of the subgroup with no liver fibrosis (Fib4 index < 2.67). However, no significant difference between the subgroups was found in the non-drinkers and moderate drinkers (< 20 g/day). In multiple regression analysis, the Fib4 index was significantly associated with the ASM index, independent of potential confounding factors. The association between the Fib4 index and ASM index was more pronounced in excess drinkers than in non-drinkers and moderate drinkers. CONCLUSION: These results suggest that liver fibrosis is associated with loss of skeletal muscle mass in elderly men, and excessive alcohol intake combined with liver fibrosis may lead to greater muscle mass reduction than each individual condition.

District Differences in the Measured Values of Arterial Stiffness in Japan.

Background: In Japan, district differences in the prevalence of cardiovascular disease (CVD) are well-known. This study examined district differences in Japan in measured values of arterial stiffness, an independent risk factor for CVD. Methods and Results: Local residents participating in health checkups conducted in the Wakayama (n=461) and Nagano (n=186) prefectures in 2018 were recruited to the study. Brachial-ankle pulse wave velocity (baPWV) was evaluated as an index of arterial stiffness. After multivariate adjustment, baPWV was significantly higher in the Wakayama than Nagano district in subjects aged ≥70 years (mean [±SE] 1,912±25 vs. 1,763±30 cm/s; P<0.01), but not in subjects aged <70 years. Multivariate linear regression analysis demonstrated that the Wakayama/Nagano district difference was significantly (P<0.01) associated with baPWV. Conclusions: District differences were observed in the measured values of arterial stiffness in Wakayama and Nagano. The Wakayama and Nagano prefectures are representative areas with a relatively high and relatively low prevalence of CVD, respectively, in Japan. Therefore, based on the results of the present study, we propose to conduct a study to examine whether district differences in arterial stiffness underlie district differences in the prevalence of CVD.

[Association of Cigarette Smoking with Muscle Mass Reduction and Low Muscle Strength in Community-Dwelling Elderly Men].

OBJECTIVES: Recently, attention has been paid to the impact of cigarette smoking on skeletal muscles, as its underlying pathophysiological mechanism has been gradually elucidated. In this study, we aimed to examine whether cigarette smoking is associated with muscle mass reduction and low muscle strength in elderly men. METHODS: The study participants comprised 417 community-dwelling elderly men (aged 73±6 years) without severe glucose intolerance, chronic kidney disease, or liver disease. Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM), which was normalized for height (ASM index, kg/m2). Handgrip strength (HGS) was measured using a Smedley grip dynamometer. Cumulative smoking exposure level during a lifetime was expressed in pack-years, which is a product of the average number of packs of cigarettes smoked per day and smoking duration in years. RESULTS: When the participants were stratified on the basis of cumulative smoking exposure (<10 pack-years, 10-39 pack-years, ≥40 pack-years), the ASM index and HGS progressively decreased with increasing exposure level (P for trend <0.01). In multiple regression analysis, heavy smoking (defined as ≥40 pack-years) was found to be a significant determinant of the ASM index and HGS, independent of potential confounding factors. Among former smokers, the subgroup that quit smoking for ≥20 years had a significantly higher ASM index and HGS than the subgroup that quit smoking for <10 years. The duration of smoking cessation was significantly associated with the ASM index and HGS, even after adjusting for cumulative smoking exposure. CONCLUSIONS: These findings suggest that cigarette smoking contributes to the loss of muscle mass and function in elderly men and that smoking cessation could reverse the impact of cigarette smoking on skeletal muscles.

The prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms.

OBJECTIVES: We aimed to examine the prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms. METHODS: This follow-up study included 48 newly graduated female nurses (aged 22 ± 3 years) employed in acute care hospitals. The orthostatic dysregulation symptoms were evaluated using a screening checklist. A sit-to-stand test was conducted to assess the autonomic nervous function. Subjective stress and depressive symptoms were determined using a self-administered questionnaire. The data were collected at baseline on the first month and on the seventh month of employment. Statistical differences within groups were analyzed using paired t-test and McNemar's test. The independent associations of orthostatic dysregulation status with stress and depressive symptoms were analyzed using a multivariate logistic regression model. RESULTS: The percentage of individuals who were diagnosed with orthostatic dysregulation increased from 25.0% at baseline to 35.4% at follow-up. Logistic regression analyses revealed that stress and depressive symptoms were closely associated with orthostatic dysregulation status at follow-up, despite a weak association reported at baseline. The participants were categorized according to their orthostatic dysregulation status: among individuals without orthostatic dysregulation at baseline but with orthostatic dysregulation at follow-up, the increase in autonomic nervous activity, as assessed by the coefficient of variation of the R-R intervals, in response to the postural changes was significantly attenuated at follow-up. Furthermore, this group exhibited a significant increase in stress and depressive symptoms. CONCLUSIONS: At 7 months after employment, newly graduated nurses showed a higher prevalence of orthostatic dysregulation in combination with autonomic nervous system modulation, which was accompanied by an increase in stress and depressive symptoms. These observations suggest that the orthostatic dysregulation is associated with poor mental and physical health among newly graduated nurses in the early phase of employment.

Bilateral atrophy of the extensor digitorum brevis muscle might be a useful sign for diagnosing diabetic polyneuropathy in Japanese men who do not sit in the traditional "seiza" style.

AIMS/INTRODUCTION: As the extensor digitorum brevis muscle is a small muscle in the most distal part of the legs, its atrophy (EDBA) might reflect symmetric polyneuropathy (SPN). We aimed to clarify the EDBA-related factors and the usefulness of bilateral EDBA detection for diagnosing SPN, especially diabetic SPN (DSPN). MATERIALS AND METHODS: In 1,893 participants from the Japanese general population (investigation I) and 133 established diabetes patients (investigation II), relationships between EDBA and various factors including the traditional sitting style called "seiza'" (kneeling and sitting on one's heels) were investigated. Analyses were carried out by univariate and multivariate analysis, and SPN or DSPN was diagnosed by the criteria of "Probable DSPN" of the Toronto Consensus. The validity of EDBA detection for diagnosing SPN/DSPN was also evaluated. RESULTS: Investigation I: EDBA was more prevalent in women than men (44% vs 20%). Significant EDBA-related factors were aging and seiza habit regardless of sex. Male-specific EDBA-related factors were SPN and known diabetes. In men without seiza habit, EDBA was significantly associated with SPN regardless of diabetes, so EDBA seemed to be a useful sign for diagnosing SPN/DSPN. Investigation II: In men, DSPN was more prevalent in the EDBA group than the non-EDBA group (71% vs 33%). Sensitivity, specificity, positive predictive value and kappa coefficient of EDBA detection for diagnosing DSPN were 44, 87, 67% and 0.323, showing fair agreement. CONCLUSIONS: EDBA detection might be a useful method to screen for distal symmetric polyneuropathy, such as DSPN in men, although the exclusion of individuals with seiza habit is necessary to improve accuracy.

Associations between deterioration of self-rated health and occupational form among community-dwelling Japanese individuals.

Objectives: In occupational therapy, occupations refer to everyday activities that people perform as individuals, in families, and with communities to live a meaningful life. Thus far, there has been no large-scale survey conducted using quantitative data to study deterioration of self-rated health from an occupational perspective. This large-scale study therefore aimed to clarify the associations between deterioration of self-rated health and occupational form, performance, and satisfaction using quantitative data. Study design: One-year prospective cohort study. Methods: Subjects included 438 community-dwelling individuals (175 males and 263 females; mean age, 66.3 ± 10.5 years) who participated in the study during 2017-2018. We administered to patients a questionnaire on self-rated health and occupational form (number, frequency, and duration), occupational performance, and occupational satisfaction. A multi-level Poisson regression analysis was performed, wherein deterioration of self-rated health was the dependent variable and occupational form, performance, and satisfaction were the independent variables. In Model 1, the independent variables were adjusted for each other; in Model 2, sex, living alone, and alcohol consumption were added to Model 1; and in Model 3, disease was added to Model 2. Results: The frequency of occupation monthly/yearly was associated with deterioration of self-rated health compared to that daily/weekly among those aged <65 years. Adjusted prevalence ratios (95% confidence interval) for models 1, 2, and 3 were 2.95 (1.07-8.18), 3.19 (1.13-8.99), and 3.81 (1.29-11.20), respectively. Conclusions: This study revealed factors for the deterioration of self-rated health from an occupational perspective that was directly related to daily life. Increasing the occupation frequency may be more important than increasing the number and duration of occupation to prevent deterioration of self-rated health.

Muscle mass reduction, low muscle strength, and their combination are associated with arterial stiffness in community-dwelling elderly population: the Wakayama Study.

Age-related loss of skeletal muscle mass and function is associated with some predisposing factors that increase the risk of vascular damage. This study aimed to examine whether muscle mass reduction, low muscle strength, and their combination were related to arterial stiffness in community-dwelling elderly population. Study participants consisted of 1046 elderly individuals (aged 72 ± 5 years) without cardiovascular disease, chronic kidney disease, or liver disease. Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM). A value for ASM was normalized for height (ASM index, kg/m2). Handgrip strength (HGS) was measured using a Smedley grip dynamometer. Brachial-ankle pulse wave velocity (baPWV) was evaluated as an index of arterial stiffness using a simple automatic oscillometric technique. When participants were stratified based on baPWV cut-off values (< 1800 cm/s, 1800 to 1999 cm/s, ≥ 2000 cm/s), ASM index and HGS progressively decreased with an increase in baPWV levels (P for trend < 0.001). In multiple regression analysis, baPWV was significantly associated with ASM index (ß = -0.270, P < 0.001) and HGS (ß = -0.102, P < 0.001) independent of potential confounding factors. The baPWV of the subgroup with low ASM index and low HGS was significantly higher than that of those with only low ASM index or low HGS (P < 0.001). These results suggest that loss of skeletal muscle mass and function is associated with increased arterial stiffness in the elderly population, and the combination of muscle mass reduction and low muscle strength may lead to greater arterial stiffness than each of the individual conditions.

Exaggerated blood pressure response to exercise is associated with subclinical vascular impairment in healthy normotensive individuals.

BACKGROUND: This study was designed to evaluate the possible association between an exaggerated blood pressure (BP) response to exercise and subclinical vascular impairment in normotensive individuals. METHODS: The study participants consisted of 92 untreated normotensive men (aged 42 ± 9 years) without a history of cardiovascular disease or stroke. A graded exercise test was conducted using a bicycle ergometer, and the mean arterial pressure (MAP) during submaximal exercise was evaluated. The brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. The second peak of radial systolic BP (SBP2) was used as an estimate of central BP. The albumin-to-creatinine ratio (ACR) values were determined as the mean of two nonconsecutive spot urine specimens. RESULTS: Compared with individuals with a normal response (MAP z-score < +1.0, n = 60), those with an exaggerated BP response to exercise (MAP z-score ≥ +1.0, n = 32) exhibited significantly higher baPWV (1412 ± 158 vs. 1250 ± 140 cm/s), radial SBP2 (122 ± 11 vs. 106 ± 13 mmHg), and greater log-ACR (0.93 ± 0.30 vs. 0.59 ± 0.23 mg/gCre). Multiple regression analysis revealed that an exaggerated BP response to exercise was significantly associated with baPWV (ß = 0.198, P= .043), radial SBP2 (ß = 0.156, P = .049), and log-ACR (ß = 0.276, P = .006) independent of potential confounding factors. CONCLUSIONS: These results suggest that subclinical vascular impairment is associated with an exaggerated increase in BP during exercise even in the absence of clinical hypertension.

Relationship between Fall History and Self-Perceived Motor Fitness in Community-Dwelling People: A Cross-Sectional Study.

History of falling is an important fall risk factor. If a relationship between fall history and self-perceived motor fitness could be established, then treating it as a correctable risk of re-fall due to falls may be possible. We conducted a cross-sectional study of the relationship between fall history and self-perceived motor fitness in daily life among 670 community-dwelling people (mean age 62.0 ± 9.6 years, 277 men and 393 women) who had participated in health examinations. They completed a self-administered questionnaire that asked about their history of single or multiple falls and included a 14-item motor fitness scale. The responses were analyzed using multivariate logistic regression analysis. The results showed that in both younger and older (<65 years) subjects, a history of single or multiple falls was associated with a negative response to "being able to put on socks, pants or a skirt while standing without support". For subjects ≥65 years, an association was also observed with "shortness of breath when climbing stairs". Self-perceived motor fitness related to fall history can easily be noticed by an individual and may help them become aware of fall-related factors earlier in everyday life.

The Relationship Between Meaningful Occupation and Self-Rated Health in Japanese Individuals: The Wakayama Study.

In this study, we conducted a quantitative cross-sectional evaluation of the relationships between self-related health and occupational form, occupational performance, and occupational satisfaction. The participants were 675 community-dwelling subjects (283 men, 392 women) who completed a self-administered questionnaire. From this data, we performed a multiple logistic regression analysis using the high and low values of self-rated health as the dependent variables and the characteristics of occupational form, occupational performance, and occupational satisfaction as the independent variables. There were three analysis models: Model 1, which mutually adjusted for all the independent variables; Model 2, with adjustment of the basic attributes, in addition to the first model; and Model 3, which was based on Model 2, but also adjusted for diseases. In all three models, high self-rated health was significantly correlated with high occupational performance scores. These findings confirmed that supporting occupational performance improvement is useful for improving self-rated health.

Brachial-ankle pulse wave velocity in healthy Japanese adolescents: reference values for the assessment of arterial stiffness and cardiovascular risk profiles.

Brachial-ankle pulse wave velocity (baPWV) has been used as a simple and convenient method of evaluating arterial stiffness and is considered useful for screening subclinical vascular damage in primary care settings and in large populations. The aim of this study was to determine the reference values of baPWV in adolescents based on age and sex to evaluate and classify vascular abnormalities in this age population. Noninvasive baPWV measurements using an oscillometric device were carried out in 5936 participants aged 12-18 years who had no history of syndromic obesity, hypertension, dyslipidemia, diabetes mellitus, or renal disease. Of these, we extracted data from 4524 healthy adolescents free from atherosclerotic risk factors and constructed sex-specific reference percentiles normalized to age using the LMS method. The baPWV increased with age and was significantly higher in males than in females. Multivariate regression analysis demonstrated that age, body mass index, and blood pressure were the major determinants of baPWV for both males and females. Among a sample of 3825 adolescents, including individuals with risk factors, the prevalence of central obesity, raised blood pressure, raised triglycerides, reduced high-density lipoprotein cholesterol, and impaired fasting glycemia significantly increased along with the standardized baPWV z-score level. In addition, there was a graded nature regarding the association between the baPWV z-score and the clustering number of the metabolic syndrome components. These results suggest that the proposed reference values of baPWV could help classify vascular abnormalities of adolescents caused by the presence of risk factors and thereby contribute to determining individuals with cardiovascular risk in this age population.

The combination of obesity and high salt intake are associated with blood pressure elevation among healthy Japanese adolescents.

We examined the associations of obesity and high salt intake with blood pressure (BP) in a cross-sectional sample of 1679 healthy Japanese adolescents (827 females and 852 males) aged 12-18 years (mean age: 14.9 years) who had no history of treatment for hypertension, diabetes mellitus, or renal disease. Brachial arterial BP of the subject was measured at the left arm using a digital BP monitor with an appropriate cuff size. The weight status was evaluated by body mass index (BMI), and obesity was determined according to the age- and sex-specific cut-off values for adolescents. All subjects were interviewed by dietitians using a food frequency questionnaire to obtain data on their average daily salt intake. In the study subjects, obesity and high salt intake were associated with a significantly increased BP except for diastolic BP in females. In multiple regression analyses, both BMI (z-score) and salt intake were found to be major determinants of systolic BP and diastolic BP after adjustment for potential confounders, including age, sex, and serum lipid and glucose parameters. The association between salt intake and BP values was more pronounced among individuals with obesity than among those with normal weight. These results suggest that high salt intake is associated with BP elevation in healthy adolescents, and the association may become stronger by the presence or severity of obesity.

Clinical polyneuropathy does not increase with prediabetes or metabolic syndrome in the Japanese general population.

AIMS/INTRODUCTION: The prevalence of clinical polyneuropathies (ClinPNs) or nerve conduction abnormality (NCA) in the groups stratified by glucose tolerance, individual components of metabolic syndrome (metabolic syndrome [MetS] components: hypertension, dyslipidemia, obesity) and MetS defined by the International Diabetes Federation consensus was investigated in the Japanese general population. Factors associated with ClinPN and NCA were also identified. MATERIALS AND METHODS: A total of 625 examinees of regional medical checkup programs were recruited to this cross-sectional study. ClinPNs were diagnosed by the Toronto Consensus. NCA was judged by at least one bilateral abnormality of sural nerve action potential amplitude or conduction velocity measured by a point-of-care nerve conduction device (DPNCheck). Clinical factors associated with ClinPNs or NCA were examined by multiple logistic regression analysis. Deteriorating factors of sural nerve action potential amplitude or conduction velocity values were also investigated in participants without diabetes (n = 550). RESULTS: As for glucose tolerance, ClinPNs or NCA significantly increased only in known diabetes patients compared with other groups. There was no difference between prediabetes and the normal group. The prevalence of ClinPNs and NCA was not significantly related to MetS or MetS' components, except for frequent NCA in obesity. The factors significantly associated with both NCA and ClinPNs were smoking and known diabetes. In non-diabetic participants, aging, tall height and hypertension were significant deteriorating factors of nerve conduction functions. CONCLUSIONS: In Japan, ClinPNs and NCA were increased in known diabetes patients, but did not increase in participants with prediabetes, MetS and MetS' components. Smoking and known diabetes were factors significantly associated with ClinPNs or NCA. Hypertension might be a modifiable deteriorating factor of nerve function.

[Liver Fibrosis is Associated with Loss of Skeletal Muscle Mass in Community-Dwelling Older Adults with No History of Liver Diseases].

OBJECTIVES: In this study, we aimed to examine the possible association between liver fibrosis and loss of skeletal muscle mass (SM) in community-dwelling older adults with no history of liver diseases. METHODS: A total of 2,028 older adults (mean age, 69.8 ± 5.2 years) who had not received any treatment for liver diseases and had participated in a comprehensive health survey for community residents in Wakayama, Japan were included in this study. We carried out bioelectrical impedance analysis to estimate the SM of the whole body including the arms, legs, and trunk of the subjects. Liver fibrosis was evaluated by calculating the Fib4 index based on the subject's age, AST level, ALT level, and platelet counts. RESULTS: The subjects were divided into three groups according to cutoff values of the Fib4 index (low: <1.30, medium: 1.30-2.66, high: ≥2.67). The SM index (kg/m2) was the lowest among subjects in the high-Fib4-index category, followed by the medium- and low-Fib4-index categories. This dose-response reduction in the SM index was more pronounced among individuals with lower blood albumin level (low nutrition) and in those with more sedentary behavior (physical inactivity). Among the selected 262 subjects who underwent SM measurement twice with an interval of 3 years, the subjects with a high Fib4 index showed greater reduction in the SM index than those with medium and low Fib4 indices. Multiple regression analysis revealed that the Fib4 index was significantly associated with the SM index, independent of age, sex, albumin level, sedentary behavior, diabetes mellitus, alcohol intake, and smoking status. CONCLUSIONS: The present findings suggest that the potential progression of liver fibrosis is associated with the excessive loss of SM among apparently healthy older adults without any treatment for liver diseases.