Heart Rate Variability, Insulin Resistance, and Insulin Sensitivity in Japanese Adults: The Toon Health Study.

BACKGROUND: Although impaired cardiac autonomic function is associated with an increased risk of type 2 diabetes in Caucasians, evidence in Asian populations with a lower body mass index is limited. METHODS: Between 2009-2012, the Toon Health Study recruited 1899 individuals aged 30-79 years who were not taking medication for diabetes. A 75-g oral glucose tolerance test was used to diagnose type 2 diabetes, and fasting and 2-h-postload glucose and insulin concentrations were measured. We assessed the homeostasis model assessment index for insulin resistance (HOMA-IR) and Gutt's insulin sensitivity index (ISI). Pulse was recorded for 5 min, and time-domain heart rate variability (HRV) indices were calculated: the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive difference (RMSSD). Power spectral analysis provided frequency domain measures of HRV: high frequency (HF) power, low frequency (LF) power, and the LF:HF ratio. RESULTS: Multivariate-adjusted logistic regression models showed decreased SDNN, RMSSD, and HF, and increased LF:HF ratio were associated significantly with increased HOMA-IR and decreased ISI. When stratified by overweight status, the association of RMSSD, HF, and LF:HF ratio with decreased ISI was also apparent in non-overweight individuals. The interaction between LF:HF ratio and decreased ISI in overweight individuals was significant, with the odds ratio for decreased ISI in the highest quartile of LF:HF ratio in non-overweight individuals being 2.09 (95% confidence interval, 1.41-3.10). CONCLUSIONS: Reduced HRV was associated with insulin resistance and lower insulin sensitivity. Decreased ISI was linked with parasympathetic dysfunction, primarily in non-overweight individuals.

Higher vitamin D intake during pregnancy is associated with reduced risk of dental caries in young Japanese children.

PURPOSE: The intrauterine environment, including maternal nutrition status, may affect the development, formation, and mineralization of children's teeth. We assessed the relationship between self-reported maternal dietary vitamin D intake during pregnancy and the risk of dental caries among young Japanese children. METHODS: This study is based on a prospective analysis of 1210 Japanese mother-child pairs. Information on maternal intake during pregnancy was collected using a validated diet history questionnaire. Data on oral examination at 36-46 months of age were obtained from the mothers, who transcribed the information from their maternal and child health handbooks to our self-administered questionnaire. Children were classified as having dental caries if one or more primary teeth had decayed or had been filled. RESULTS: Compared with the lowest quartile of maternal vitamin D intake during pregnancy, adjusted odds ratios (95% confidence intervals) for quartiles 2, 3, and 4 were 1.06 (0.72-1.56), 0.53 (0.34-0.81), and 0.67 (0.44-1.02), respectively (P for trend = .01). When maternal vitamin D intake was treated as a continuous variable, the adjusted odds ratio (95% confidence interval) was 0.94 (0.89-0.995). CONCLUSIONS: Higher maternal vitamin D intake during pregnancy may be associated with a lower risk of dental caries in children.

Association Between TSLP Polymorphisms and Eczema in Japanese Women: the Kyushu Okinawa Maternal and Child Health Study.

We examined the association between thymic stromal lymphopoietin (TSLP) single nucleotide polymorphisms (SNPs) and eczema in young adult Japanese women. Cases were 188 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Controls were 565 women without eczema according to the ISAAC criteria, who had not been diagnosed with asthma, atopic eczema, and/or allergic rhinitis by a doctor and who had no asthma as defined by the European Community Respiratory Health Survey criteria and no rhinoconjunctivitis according to the ISAAC criteria. Compared with women with the TT genotype of SNP rs1837253, those with the TC or CC genotype had a significantly increased risk of eczema after adjustment for age and smoking, although this association was not significant in crude analysis. There were no relationships between SNP rs3806933 or rs2289276 and eczema. The TC and CC genotypes combined of SNP rs1837253 may be significantly positively associated with eczema.

Fasting and non-fasting triglycerides and risk of ischemic cardiovascular disease in Japanese men and women: the Circulatory Risk in Communities Study (CIRCS).

BACKGROUND: Non-fasting triglycerides were reported to have a greater impact on risk of ischemic cardiovascular events than fasting triglycerides. However, evidence from Asia, where the prevalence of dyslipidemia is generally lower, has been limited. METHODS: We used 1975-1986 baseline surveys to investigate cohort data of 10,659 (4264 men and 6395 women) residents aged 40-69 years, initially free from ischemic heart disease and stroke, in four Japanese communities. Serum triglyceride concentrations at baseline were obtained for 2424 fasting (≥8 h after meal) and 8235 non-fasting (<8 h after meal) participants. RESULTS: During the 22-year follow-up, 284 (165 men and 119 women) developed ischemic heart disease and 666 (349 men and 317 women) ischemic stroke. After adjustment for age, sex and known cardiovascular risk factors, multivariable hazard ratios (95%CI) of ischemic cardiovascular disease (ischemic heart disease and ischemic stroke) for the highest versus lowest quartiles of triglycerides were 1.71 (1.14-2.59), P for trend = 0.013, for fasting participants and 1.60 (1.25-2.05), P for trend <0.001, for non-fasting participants. The positive associations did not differ between fasting and non-fasting men, while they were strong for non-fasting women. They were stronger for ischemic heart disease than for ischemic stroke. After further adjustment for HDL-cholesterol, these associations were slightly attenuated, but remained statistically significant. CONCLUSION: Non-fasting as well as fasting triglycerides are predictive of risk of ischemic cardiovascular disease for Japanese men, as are non-fasting triglycerides for women.

Relationship between the ankle-brachial index and the risk of coronary heart disease and stroke: the circulatory risk in communities study.

AIM: Patients with peripheral artery disease (PAD) are at a high risk of cardiovascular disease (CVD) among Western populations. However, evidence for an elevated risk in Asian populations is limited. METHODS: This prospective cohort study examined 939 Japanese men 60-74 years of age at the time of the baseline survey. A total of 115 cases of CVD were detected during a median 9.3 years of follow-up, and the ankle brachial blood pressure index (ABI) functioned as a surrogate measurement of PAD. RESULTS: The age-adjusted risks of coronary heart disease, ischemic stroke and ischemic CVD (coronary heart disease and ischemic stroke) were higher among men in the lowest ABI tertile compared with that observed in the men in the highest tertile (<1.08 vs. >1.17). These associations did not change substantially after adjusting for cardiovascular risk factors. The respective multivariable hazard ratios (HRs, 95% CI) for the three conditions were as follows: 2.48 (1.08-5.71), p for trend=0.03; 1.95 (0.94-4.02), p for trend=0.04; and 2.16 (1.25-3.72), p for trend=0.004. These results did not vary based on a comparison of the three ABI categories: ≤0.90, 0.91-1.10 and >1.10. The multivariable HRs (95% CI) for an ABI ≤0.90 versus >1.10 were as follows: 2.04 (0.67-6.20), p for trend=0.14 for coronary heart disease; 3.39 (1.10-10.5), p for trend=0.006 for ischemic stroke; and 2.61 (1.19-5.76), p for trend=0.003 for ischemic CVD. There were no associations between the ABI and the risk of hemorrhagic stroke. CONCLUSIONS: A low ABI is associated with the risk of coronary heart disease, ischemic stroke and ischemic CVD in elderly Japanese men.

Relationships between nocturnal intermittent hypoxia, arterial stiffness and cardiovascular risk factors in a community-based population: the Toon health study.

AIM: Nocturnal intermittent hypoxia (NIH), a primary marker of obstructive sleep apnea, has increasingly been linked with cardiovascular morbidity and mortality. The purpose of this study was to investigate the association between NIH and arterial stiffness as measured according to the cardio-ankle vascular index (CAVI) based on cardiovascular risk factors in a Japanese community-dwelling population. METHODS: We conducted a cross-sectional study in Toon city among 684 men and 1,241 women 30-79 years of age. The severity of NIH was defined as mild or moderate-to-severe according to five or 15 events/hour on the 3% oxygen desaturation index (ODI), respectively. Increased arterial stiffness was diagnosed according to a CAVI of ≥9. RESULTS: The number of subjects with no, mild and moderate-to-severe NIH was 1,348 (70%), 451 (23%) and 126 (7%), respectively. Increased arterial stiffness was detected in 21.9% of the participants. The multivariable-adjusted odds ratio (95% CI) of severe NIH related to an increased CAVI in comparison with a 3% ODI of <5 was 1.36 (0.82-2.23). The stratified logistic regression analysis showed that the multivariable-adjusted OR of severe NIH for an increased CAVI was remarkably increased in the individuals with a BMI of ≥25 (OR=2.53, 1.08-5.96; p=0.03). An interaction test showed a trend for an overweight status to be a modifier of the association between OSA and increased arterial stiffness (p=0.05). CONCLUSIONS: NIH has a tendency to promote increased arterial stiffness as measured according to the CAVI, especially in overweight subjects.

An association between central aortic pressure and subclinical organ damage of the heart among a general Japanese cohort: Circulatory Risk in Communities Study (CIRCS).

BACKGROUND: This study aimed to investigate associations between central aortic pressure (CAP) and subclinical organ damage of the heart amongst the general population. METHODS: We conducted a cross-sectional study in a community-based population, consisting of 3002 men and women aged between 40 and 79 years. The CAP was measured using the HEM-9000AI device, an automated tonometer. Electrocardiograms (ECG) were read according to the Minnesota Code. Subclinical organ damage in the heart was defined as measurable left high amplitude R waves (LHAR), major and minor ST-T abnormalities, and left ventricular hypertrophy (LVH). RESULTS: Age- and sex-adjusted prevalence of LHAR, major and minor ST-T abnormalities, and LVH was higher for subjects in the highest tertile of CAP levels than those in the lowest tertile. After further adjustments for other cardiovascular risk factors, these associations did not change substantially. The multivariable odds ratios (ORs) (95% CI) of LHAR, major and minor ST-T abnormalities, and LVH for the highest tertile of CAP levels compared to the lowest tertile were 2.7(1.9-3.9), 1.8(1.1-2.9), 1.7(1.3-2.3) and 3.2(1.3-8.1), respectively. The positive associations with LHAR and minor ST-T abnormalities were observed primarily among non-hypertensive subjects. The respective corresponding ORs were 2.8(1.7-4.6) and 1.7(1.2-2.4) for non-hypertensive subjects, and 1.7(0.9-3.3) and 1.1(0.7-1.8) for hypertensive subjects. CONCLUSION: CAP levels were associated with subclinical organ damage of the heart independent of cardiovascular risk factors, and these associations were primarily seen in non-hypertensive subjects.

Total and high molecular weight adiponectin levels and risk of cardiovascular disease in individuals with high blood glucose levels.

OBJECTIVE: The association of adiponectin levels with cardiovascular disease (CVD) may vary by age and health condition. It is unknown whether adiponectin predicts CVD events among individuals with high blood glucose levels. METHODS: We conducted a nested case-control study among 15,566 men and women aged 40-85 years from four communities, who were free of CVD at baseline. During 192,181 person-years of follow-up, 117 individuals subsequently developed coronary heart disease or ischemic stroke and had high plasma glucose concentrations (fasting/nonfasting ≥ 5.6/7.2 mmol/L or treated) at baseline. Controls were randomly selected at a 2:1 ratio and matched for sex, age, blood glucose, year of survey, fasting conditions, and community (n = 234). Baseline total and high molecular weight (HMW) adiponectin and their ratio were examined for total subjects and the association with CVD was compared between ages of 40-69 and 70-85 years. RESULTS: After adjustment for matched variables and traditional risk factors, total and HMW adiponectin and their ratio were not associated with overall risk of CVD. However, significant interactions of the associations between the age groups were found. The highest quartile for HMW adiponectin and HMW/total adiponectin ratio decreased risk of CVD compared with the lowest quartile among middle-aged individuals (multivariable-adjusted odds ratio = 0.33 [95%CI, 0.13-0.83] and 0.47 [0.22-0.98], respectively), while this association was not seen among the elderly. CONCLUSIONS: High HMW adiponectin levels may decrease the risk of CVD in middle-aged adults with high blood glucose.

High-density lipoprotein subclasses and risk of stroke and its subtypes in Japanese population: the Circulatory Risk in Communities Study.

BACKGROUND AND PURPOSE: High-density lipoprotein (HDL) cholesterol is an established protective factor for ischemic stroke. However, the contribution of HDL subclasses to stroke risk and its subtypes is uncertain. METHODS: A prospective nested case-control study of 40- to 85-year-old Japanese was undertaken using frozen serum samples collected from 5280 men and 7524 women. They participated in cardiovascular risk surveys from 1985 to 1999 (1 community) and 1989 to 1998 (2 communities) under Circulatory Risk in Communities Study. HDL cholesterol subclasses were classified by high-performance liquid chromatography into 3 subgroups: S-HDL (very small or small HDL), M-HDL (medium HDL), and L-HDL (large or very large HDL) cholesterol. One control subject per case was matched by sex, age, community, serum storage year, and fasting status. RESULTS: In 2005, we identified 241 strokes (155 ischemic and 86 hemorrhagic). S-HDL and M-HDL cholesterol levels were inversely associated with total stroke risk, ischemic stroke, specifically lacunar infarction, and hemorrhagic stroke. After adjustment for cardiovascular risk factors, these associations remained statistically significant. Multivariable conditional odds ratios (95% confidence interval) for 1 SD (0.12 mmol/L) increment of S-HDL cholesterol levels were 0.34 (0.23-0.52) for total stroke, 0.38 (0.23-0.63) for ischemic stroke, 0.33 (0.18-0.61) for lacunar infarction, 0.30 (0.14-0.65) for hemorrhagic stroke, and 0.30 (0.12-0.77) for intraparenchymal hemorrhage. The respective multivariable odds ratios for 1SD (0.10 mmol/L) increment of M-HDL cholesterol levels were 0.56 (0.41-0.75), 0.63 (0.45-0.88), 0.59 (0.40-0.87), 0.41 (0.21-0.80), and 0.38 (0.16-0.90). No associations were found between L-HDL cholesterol levels and risk of total stroke and its subtypes. CONCLUSIONS: Small- to medium-sized HDL, not large HDL, cholesterol levels were inversely associated with total stroke risk.

Association of hematological parameters with insulin resistance, insulin sensitivity, and asymptomatic cerebrovascular damage: the J-SHIP and Toon Health Study.

BACKGROUND: Elevated hematocrit levels have been suggested to be an independent determinant of insulin resistance and type 2 diabetes. To clarify the diagnostic significance of hematocrit level, we investigated the association with hemodynamic profiles, insulin resistance and insulin sensitivity, arterial properties, and asymptomatic cerebrovascular damage in a general Japanese population. METHODS: This study included 1,978 participants from two independent cohorts. Insulin sensitivity was assessed by the oral 75 g glucose tolerance test. Carotid ultrasonography was performed to evaluate atherosclerosis and wall shear stress. Periventricular hyperintensity and lacunar infarction were assessed by brain magnetic resonance imaging. RESULTS: Hematocrit quartile showed a stepwise association with insulin sensitivity (Q1: 2.2±0.7, Q2: 2.0±0.7, Q3: 1.9±0.7, Q4: 1.8±0.6, p<0.001) and insulin resistance (1.0±0.6, 1.2±0.7, 1.3±0.8, 1.5±1.0, p<0.001). Multiple linear regression analysis adjusted for possible covariates identified hematocrit as an independent determinant of insulin sensitivity (ß=-0.074, p=0.019) and insulin resistance (ß=0.115, p<0.001). However, this association was lost after further adjustment for visceral fat area and plasma alanine aminotransferase level. Further, no significant association was observed between hematocrit and carotid intima-media thickness (p=0.306) where as wall shear stress was inversely associated with the carotid atherosclerosis (r=-0.250, p<0.001). In contrast, a low hematocrit level was independently associated with periventricular hyperintensity (odds ratio 0.87 (95% CI 0.80-0.95), p=0.001). CONCLUSION: Hematocrit was positively associated with insulin resistance and insulin sensitivity. This association was epiphenomenon of visceral and hepatic adiposity. Conversely, low hematocrit was a significant risk factor for periventricular hyperintensity independent of insulin resistance.

Association of parental factors with student smoking and alcohol use in Japan.

A nationwide survey was conducted on smoking and alcohol use among junior and senior high school students and their parents in Japan. The analyses were performed to assess whether parents' smoking or drinking behavior, health knowledge, and attitude toward their children's smoking or drinking behavior influenced their children's behavior using linked datasets of students and parent answers. The number of schools that responded was 24 out of 40 sampled schools. A total of 11,362 questionnaire data sets from students and parents were applied to the analyses. The influence of parental factors including smoking, alcohol use, knowledge, and attitudes were used as the covariates on students' smoking or alcohol use as independent variables. The data were analyzed using a multiple logistic analysis. The analysis revealed that the parental attitudes of children's smoking or alcohol use were important risk factors as well as parental smoking or drinking behaviors. Conversely, the parental attitude toward warning children of the hazard of smoking or alcohol use was a significant preventive factor for the outcome of their children's behavior.

[Promotion to home-based care from acute phase hospital - the problems and the role of community cooperation].

It has been emphasized that problems with the system and a lack of resources for home-based care were ones to blame for preventing a promotion of home-based care. However, the real big problems appear to be laid on the unconsciousness and lack of knowledge of home-based care by acute phase hospital, functionality of community cooperation and lack of communication with patients. We examined the actual condition of home-based care by questionnaires to the doctors who took a palliative care study session. The response rate was 73.3%(93/127). It appeared that the doctors of acute phase hospital realized and expressed the necessity of home based care and their desire to participate. However, they are deficient in experiences and trainings. In the terminal care period, the patient and family thought that a medical treatment of intravenous drip and infusion was important, though the doctor would not regard such treatment was suitable to the patient. In reality, the patient gets what he wants. With regard to consulting of a future discharge plan, it is desirable to have it done as quickly as possible. However, there were many instances where the decision was made at the last moments: when the treatment was reached at the limit, and when to offer a support to leave the hospital. Therefore, we should strive for a fulfillment of home based care study, training and resources. Furthermore, functional community cooperation is essential for a promotion of home based care.

[Nationwide survey of municipality's maternal & child health promotion planning processes and consequent changes].

PURPOSE: The purpose of this study was to offer insight into the revisions needed for promotion of Maternal and Child Health Promotion Plans in the coming years. METHODS: The maternal and child health promotion planning process and changes in maternal and child health services were surveyed by questionnaires to all municipalities in Japan. RESULTS: Completed questionnaires were obtained from 2,362 municipalities (response rate: 72.6%) Replies from 2,202 municipalities, which had completed planning by March, 1998, were analyzed. Planning committees were established by 63.9% of municipalities, and working committees were set up in 55.4% of them. Members involved in the working committees were more limited when compared to the planning committees and only 9.3% of the committees had representatives from mothers. 37.5% of working committees held meetings more than 5 times. 56.0% of municipalities conducted hearings or questionnaire surveys of mothers and health personnel for assessment of maternal and child healthcare needs. Most prefectural public health centers provided statistical data for planning assistance. Public health center staff participated as planning members in 38.5% of municipalities, and a training program for the planning sponsored by health centers was utilized by 33.8% of municipalities. Only 18.3% of municipalities received support for explanation of the plans to the mayor and/or executive officers, only 12.1% received support for the management of the planning committees, and only 11.8% received support for needs analysis. Less than half of minicipalities conducted PR activities of the plans and progress management. A higher proportion conducted these activities in larger cities. After the planning process, 72.9% of municipalities started new projects according to the plans. However, 10.1% scrapped one or more projects. Changes in maternal and child healthcare services and promotion of coordination with other related organization were seen more in municipalities with a larger population. There were major differences found between prefectures with regards to the planning process, including the support from public health centers, and the effective use of plan reports, progress management, and changes in maternal and child healthcare services after the formulation of plans.