Personal factors associated with smoking among marginalized and disadvantaged youth in Japan. A strong relationship between smoking and convenience store use.

BACKGROUND: A national survey in Japan reported that the prevalence of smoking among high school students has sharply decreased in recent years. However, the survey only considered students who attended regular high schools (RHSs), and Japan offers part-time high schools (PHSs) that are often attended by academically and socioeconomically disadvantaged youth. PURPOSE: Therefore, we examined the smoking prevalence and smoking-related factors among PHS students. METHOD: A self-administered questionnaire-based survey was conducted at six PHSs. The subjects included 540 enrolled students aged 15 to 18 years. The questionnaire included items on smoking status, smokers in the family, frequency of convenience store use, lifestyle behaviors, and health awareness. Logistic regression analysis was used to identify factors that were significantly associated with smoking. RESULTS: A total of 45.6 % of students had smoking experience, and 29.3 % were smokers. For males and females, the smoking prevalence was about 3 and 7-12 times higher, respectively, than that reported in the national survey. The factors found to be significantly associated with smoking included having a smoker in the family, experience with drinking alcohol, and using convenience store daily (odds ratio [OR] = 12.5) or sometimes (OR = 3.63). There was a significant dose-response relationship between smoking and convenience store use. CONCLUSION: The smoking prevalence among PHS students was remarkably higher than that among RHS students. These findings suggest that marginalized and disadvantaged youth should be targeted for tobacco control, and intervention is needed to protect youth from tobacco sales and advertising at convenience stores.

eNOS genotype modifies the effect of leisure-time physical activity on serum triglyceride levels in a Japanese population.

BACKGROUND: Nitric oxide is a key molecule not only in the cardiovascular system, but also in the metabolic-endocrine system. The purpose of this study was to examine possible associations of the NOS3 T-786C polymorphism (rs2070744) with serum lipid levels on the basis of lifestyle factors for tailoring prevention of dyslipidemia. METHODS: For this cross-sectional study, a total of 2226 subjects aged 35 to 69 years (1084 men and 1142 women) were selected from Japanese participants in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. They were recruited in eight areas throughout Japan between February 2004 and November 2008. RESULTS: In a stratified analysis by leisure-time physical activity, the likelihood of hypertriglyceridemia (serum triglyceride levels ≥ 150 mg/dL) among subjects with the C allele was significantly lower than those without it in the active group (OR = 0.43, 95% CI = 0.22-0.84 in the fasting group), but not in the sedentary group. A gene-environment interaction between the T-786C polymorphism and leisure-time physical activity for hypertriglyceridemia was significant (P = 0.007 in the fasting group). Additionally, serum triglyceride levels (mean ± SD) across leisure-time physical activity classes decreased significantly only in the TC + CC genotype group (111 ± 60 mg/dL for sedentary, 95 ± 48 mg/dL for moderately active, 88 ± 44 mg/dL for very active, P for trend = 0.008 in the fasting group), but not in the TT genotype group. Total cholesterol, high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol levels had no significant association with the polymorphism. CONCLUSIONS: This study suggests that the NOS3 T-786C polymorphism modifies the effect of leisure-time physical activity on serum triglyceride levels.

Adiponectin and smoking status: a systematic review.

AIM: Smoking and adiponectin are individually associated with cardiometabolic pathologies. The present systematic review was carried out in order to summarize the association between the smoking status and circulating adiponectin levels. METHODS: Original articles, restricted to epidemiological studies (by a cross-sectional, case-control and cohort study design) and intervention studies for adult humans, were screened for the years 1995-2010. All of the research group members then selected the eligible literature and assessed the articles in a structured systematic review manner. RESULTS: There were 11 key studies, which included 9 articles with a cross-sectional design and 2 articles with an intervention design. Most cross-sectional studies reported lower levels of adiponectin in current smokers than in non/never smokers and/or ex-smokers, while 2 studies reported a non-significant difference in adiponectin between male smokers and non-smokers. The two intervention studies, conducted in patients on 9-week bupropion treatment and 6-month non-pharmacological treatment, reported that smoking cessation increased the adiponectin levels. CONCLUSION: This review suggests that there is a decreased adiponectin level in current smokers and this reduction can be reversed by quitting smoking. More studies are required to confirm the findings and elucidate the biological mechanisms underlying the association between the smoking status and adiponectin levels.

Determinants of brachial-ankle pulse wave velocity in a Japanese population: a cohort study.

Arterial stiffness is one of the biggest predictors of coronary heart disease (CHD). We evaluated whether brachial-ankle pulse wave velocity (baPWV) and augmentation index (AI) are correlated with risk factors of CHD. All of the 528 participants (270 males and 258 females) in this study were healthy workers aged from 36 to 69 (mean age: 47.9 ± 8.1 years). The Framingham Risk Score (FRS) showed a good correlation with baPWV (r = 0.53, p < 0.01), indicating that FRS is also applicable as an index of arterial stiffness in Japanese people. Blood pressures were well controlled in patients with medical treatment for hypertension; however, vessels remained relatively still stiff, whereas the AI was considerably low. Multivariate linear regression analysis showed that factors of such as FRS, body mass index, alcohol consumption and AI P75 were significantly correlated with baPWV.

Factors associated with influenza vaccination status of residents of a rural community in Japan.

BACKGROUND: The rate of influenza vaccination in Japan has declined over the past several decades. It is essential to identify community-specific factors that affect attitudes toward vaccination, but such parameters have not yet been fully determined in Japan. The present study used the Health Belief Model (HBM) to identify perceptions of influenza vaccination in a rural Japanese community. METHODS: All subjects were residents of a rural town in the southern part of Kyoto, Japan. An anonymous self-administered questionnaire was mailed to 846 randomly chosen households (containing 2,665 subjects). The survey explored gender, age, history of influenza, and factors associated with obtaining influenza vaccination, based on the HBM. RESULTS: A total of 1,182 valid responses (response rate, 44.4%) were received. Sources of information that were associated with vaccination decisions were medical facilities for children (OR=4.21; 95% CI: 1.17-15.1), workplaces for adults (OR=2.40; 95% CI: 1.22-4.75), medical facilities, town office and family for elderly subjects (OR=6.18; 95% CI: 2.42-15.7, OR=5.59; 95% CI: 2.26-13.8 and OR=3.29; 95% CI: 1.01-10.6). Subjects, in all age groups, who strongly agreed that the vaccine was effective were significantly more likely to be vaccinated (OR=10.5; 95% CI: 2.68-41.7 for children; OR=8.85; 95% CI: 4.61-16.9 for adults; OR=19.9; 95% CI: 8.28-48.0 for the elderly). The vaccination rate of elderly subjects who expressed concerns regarding adverse vaccine effects (OR=0.34, 95% CI: 0.15-0.78) or who were worried about practical barriers to the vaccination process (OR=0.13; 95% CI: 0.05-0.31) was significantly lower than in other populations. CONCLUSIONS: Our results indicate that vaccination coverage can be increased if accurate information on personal risk, severity of influenza illness, and efficacy of vaccination are provided by responsible information sources that are easily accessible. Such sources include medical facilities and municipal offices. In addition, barriers and inconveniences associated with vaccination should be removed, especially if they impact on elderly people.

A cross-sectional study of familial clustering in hyperhomocysteinemia.

BACKGROUND: Hyperhomocysteinemia is correlated with diseases and lifestyle habits. However, there is no epidemiological evidence concerning the distribution and prevalence of hyperhomocysteinemia in a local community. OBJECTIVE: The purpose of this study was to clarify the distribution and prevalence of hyperhomocysteinemia and the existence or nonexistence of familial clustering. METHODS: The subjects were participants in the Basic Health Check Service 1999. We administered a questionnaire and obtained blood samples from 865 subjects (306 men, 559 women) who agreed to participate in our study. RESULTS: Hyperhomocysteinemia was present in 52 men (17.0%) and 25 women (4.5%). Ten subjects who had hyperhomosysteinemia ha a family member who also had hyperhomocysteinemia. The odds ratio for hyperhomocysteinemia adjusted for age and sex was 4.77 (p < 0.01, 95% CI = 1.95-11.65). CONCLUSION: Hyperhomocysteinemia shows familial clustering. Men and elderly persons were more likely to have hyperhomocysteinemia.

Serum albumin levels predict vascular dysfunction with paradoxical pathogenesis in healthy individuals.

BACKGROUND: Serum albumin is affected by both nutritional status and inflammation. It is, therefore, thought to be highly linked with pathogenesis of vascular dysfunction. METHODS: Cross-sectional data from 2091 individuals aged 23-87, who underwent a general health examination, were analyzed. First, we investigated the association between serum albumin level and vascular functions, as assessed by brachial-ankle pulse-wave velocity (PWV). Then, we evaluated the prevalence of hyperglycemia (fasting blood sugar >or=100mg/dl), metabolic syndrome as determined by NCEP criteria, and inflammation (CRP >or=0.4mg/dl), across tertiles of albumin levels. RESULTS: In a multivariate regression model, a U-shaped relationship between serum albumin and PWV was statistically significant when albumin level was treated as a continuous variable in g/dl and centered at 4.4g/dl (quadratic term P-value=0.006). The highest tertile of albumin level (4.6-5.4g/dl) was associated with increased odds ratios for hyperglycemia of 1.35 (1.07-1.70) compared to the middle tertile (4.4-4.5g/dl), whereas the lowest tertile (3.3-4.3g/dl) was associated with reduced odds ratios for hyperglycemia of 0.80 (0.65-0.99). The highest tertile was also associated with increased odds ratios for metabolic syndrome of 1.30 (0.96-1.76) compared to the middle tertile, whereas the lowest tertile was associated with reduced odds ratios of 0.70 (0.51-0.95). Furthermore, the lowest tertile was associated with increased prevalence of inflammation with an adjusted odds ratio of 1.85 (1.15-2.97). CONCLUSIONS: The current results demonstrate that extremes of serum albumin levels are linked to vascular dysfunction among healthy individuals. Furthermore, serum albumin is paradoxically linked to vascular disease under conditions both of overnutrition and of malnutrition and inflammation complex.

Joint effect of alcohol and usual sleep duration on the risk of dysglycemia.

STUDY OBJECTIVES: Sleep duration and alcohol use influence metabolic function. However, limited information exists regarding a combined effect of alcohol and sleep duration on glucose metabolism. The aim of this study was to assess the potential interaction effect of alcohol and inappropriate sleep duration on dysglycemia epidemiologically. DESIGN: Cross-sectional and observational retrospective study. SETTING: A medical health checkup program in a general hospital. PARTICIPANTS: 2933 apparently healthy Japanese individuals, aged 46 to 60 years. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: We examined the relationships between usual sleep duration and dysglycemia, and furthermore assessed the combined effects of alcohol consumption and sleep time on glucose dysmetabolism. A U-shaped relationship between sleep duration and the prevalence of hyperglycemia (fasting plasma glucose level > or =110 mg/dL) was observed when sleep duration was treated as a continuous variables and centered at 7.0 h (quadratic term P = 0.024). In a multivariate quadratic regression model, there was a significant interaction effect between sleep duration and alcohol consumption category (nondrinkers, light-moderate drinkers [ethanol comsumption < or =210 g/wk], and heavy drinkers [ethanol consumption of >210 g/wk]) on fasting plasma glucose levels, with shorter or longer sleep duration being more diabetogenic in individuals who consumed more alcohol (P interaction = 0.018). Furthermore, we found a similar interaction effect of sleep duration and alcohol consumption on the incidence of hyperglycemia during the past 5 years (P interaction = 0.039). CONCLUSION: Alcohol interacts with reduced sleep duration to increase the risk of dysglycemia.

Relation of obesity to acute myocardial infarction in Japanese patients.

BACKGROUND: It remains uncertain whether obesity is an independent risk factor for coronary heart disease in young adults, as well as adults, in Japan. METHODS AND RESULTS: In the present study, 1,260 cases of acute myocardial infarction (AMI) and 3,775 community controls were recruited from the AMI-Kyoto Multi-Center Risk Study and Kyoto Citizen's Health and Nutrition Study, respectively. Obesity and other risk factors were retrospectively examined between cases and controls in each subgroup of young males (20-40 years), middle-aged males or females (40-60 years), older males or females (60-80 years), and very old males or females (80-100 years). In young, middle-aged, and older males, as well as in older females, cases had a higher body mass index (BMI) than controls. In young males, as well as in middle-aged and older females, cases had a higher prevalence of smoking than controls. Except for very old males, the prevalences of hypercholesterolemia, hypertension, and diabetes mellitus were higher in each subgroup of cases than in controls. Multivariate logistic regression analysis revealed that obesity (BMI >or=25) was an independent risk for AMI in young and middle-aged males, but not in females, whereas smoking was an independent risk for AMI in middle-aged and older females as well as in older males. CONCLUSIONS: Obesity is significantly associated with AMI, independent of the classic coronary risk factors, in young and middle-aged males. These findings support the current emphasis on controlling obesity to prevent coronary events in young Japanese male adults.

Smoking cigarettes of low nicotine yield does not reduce nicotine intake as expected: a study of nicotine dependency in Japanese males.

BACKGROUND: Many Japanese believe that low-yield cigarettes are less hazardous than regular cigarettes, and many smokers consume low-yield cigarettes to reduce their risks from smoking. We evaluate the association between actual nicotine intake and brand nicotine yield, and the influence of nicotine dependence on this association. METHODS: The study subjects included 458 Japanese male smokers, aged 51.2 +/- 9.9 years, who participated in health check-ups in a hospital in 1998 and 2000. Each subject filled out a self-administered smoking questionnaire and the score of each on the Fagerström Test for Nicotine Dependence was calculated. Urinary cotinine concentration was measured at the time of participation. RESULTS: The geometric mean of urinary cotinine concentration was 535 ng/mgCr for those who smoked brands with the lowest nicotine (0.1 mg on the package), compared with 1010 ng/mgCr for those who smoked brands with the highest (0.9-2.4 mg, weighted mean of 1.1 mg). Thus, despite the 11-fold ratio of nicotine yield on the packages, the ratio of urinary cotinine level was less than twofold. Both nicotine yield on the package and nicotine dependence significantly increased urinary cotinine concentration, and the negative interaction between them almost attained statistical significance. Cotinine concentration in heavily dependent smokers was consistently high regardless of the nicotine yield of brands. CONCLUSIONS: The nicotine yield of cigarettes measured by machine-smoking does not reliably predict the exposure of smokers. Smokers consuming low-yield nicotine cigarettes did not reduce actual intake of nicotine to the level that might be expected, especially for those heavily dependent on nicotine. Current labeling practices are misleading for the two-third of smokers who are moderately or highly dependent on nicotine.

A case of lymphomatoid granulomatosis/angiocentric immunoproliferative lesion with long clinical course and diffuse brain involvement.

Lymphomatoid granulomatosis (LYG)/angiocentric immunoproliferative lesions (AIL) consist of angiocentric and angiodestructive lymphoreticular proliferation predominantly involving the lungs and other extranodal sites, such as the central nervous system (CNS). This clinical entity is considered as a B cell process related to Epstein-Barr virus (EBV) infection and EBV positive diffuse large B-cell lymphoma. The CNS is involved in 20% of cases of LYG, but initial involvement is rare. In cases without pulmonary symptoms, diagnosis may be difficult. We report a rare case involving initial progression of CNS symptoms followed by a pulmonary abnormality.A 14-year-old girl suffered from high fever, ataxic gait and paraparesis. MRI revealed diffuse T2 high signals with multiple gadolinium enhancements in the cerebellum, brain stem and cerebral white matter. Her symptoms briefly improved after steroid therapy, but ataxia gradually progressed. Dyspnea due to pulmonary interstitial involvement appeared when she was 18 years old. Steroid therapy proved effective for respiratory symptoms. At 20 years old she suffered from disseminated intravascular coagulopathy (DIC) and hemophagocytic syndrome (HPS) with respiratory symptoms and repeated seizures. Her symptoms improved after the administration of cyclophosphamide. Mild hemiparesis and gait disturbance appeared when she was 22 years old. MRI revealed new lesions at the basal ganglia and subcortical white matter, brain atrophy and diffuse T2 high intensity of cerebral white matter. Cyclophosphamide was effective and there has been no recurrence of symptoms in the last 5 years. We reviewed the non-tumorous LYG/AIL involving the CNS, and discussed the clinical features, MRI imaging and diagnosis of the LYG/AIL.

Augmentation of central arterial pressure as a marker of atherosclerosis in patients with type 2 diabetes.

Macrovascular disease is the most common cause of morbidity and mortality in diabetic patients. With the increasing numbers of patients with type 2 diabetes, a simple, noninvasive method is needed to detect atherosclerosis. Augmentation represents the difference between the second and first peaks of the central arterial pressure waveform in systole and is a measure of systemic arterial stiffness, which causes the pressure wave to rebound. We investigated whether augmentation could serve as a marker of atherosclerosis in patients with type 2 diabetes. Central arterial pressure and degree of its augmentation by pulse wave rebound were measured sphygmographically in 208 consecutive patients with type 2 diabetes and 117 healthy control subjects. The relationship between augmentation and carotid atherosclerosis detected by carotid ultrasonography was investigated in a subgroup of 81 diabetic patients. Augmentation was greater in diabetic patients than control subjects (13.2+/-6.9 vs. 9.4+/-5.7 mm Hg, P<0.0001). The positive correlation between augmentation and intima-media thickness (r=0.309, P=0.0051) and between augmentation and plaque score (r=0.304, P=0.0059) were found in patients with type 2 diabetes. Augmentation was greater in diabetic patients with cardiovascular disease (n=47) than without (n=161; 15.1+/-8.4 vs. 12.6+/-6.3 mm Hg, P=0.031). Augmentation of central arterial pressure is a reliable marker for atherosclerosis in patients with type 2 diabetes. This simple, noninvasive determination would permit large-scale, early screening for atherosclerosis in patients with type 2 diabetes, who are at increased risk for cardiovascular disease.

The Role of the Human Dry Dock in Smoking Cessation in Japan.

The human dry dock, a Japanese system of detailed health check-ups for middle-aged and elderly people was originally set up for the purpose of secondary prevention, but it is now expected to increasingly play a role in primary prevention. A series of our studies of smoking cessation in the human dry dock setting showed that the abstinence rate increased from 5-6% for non-advised smokers to 9-10% for those who were advised. Thoracic CT screening participants were found to be more likely to quit smoking. It can be estimated that an additional seventy thousand male smokers would quit smoking every year if advice on smoking cessation was routinely given in every dock in Japan.