[Development of a new method for assessing the availability of low-sodium foods in Japan].

Objectives　Food environment improvement involving salt reduction requires improving access to and labeling low-sodium foods. Assessing the implementation status of these measures is also necessary. However, to date, no established methods exist for assessing the availability of low-sodium foods in communities. In this study, we aimed to devise a survey on the availability of low-sodium foods as a community food environment assessment method in order to establish common assessment methods, criteria, and practical measures, as well as standardization nationwide.Methods　A preliminary survey on the availability of low-sodium foods was conducted in Kitakyushu City in four stores with nationwide representation. Consent for providing information on handled product lists was obtained. The on-site lists collected through direct investigation by surveyors were compared with the handled product lists provided by the stores and analyzed to identify survey challenges and examine feasibility and the potential for accuracy. The definition of low-sodium foods, which emerged as a challenge in the preliminary survey, was confirmed. Preliminary survey data were carefully reviewed to establish classification criteria for low-sodium foods and create a low-sodium food list to serve as a reference for on-site surveys. Forms for recording the results of on-site surveys and a survey manual were developed. Registered dietitians conducted on-site surveys using the manual to confirm its applicability.Results　The preliminary survey results revealed that the on-site lists had fewer omissions and greater feasibility than store-provided lists. After clearly defining low-sodium foods, we established classification criteria (three major categories, seven subcategories, and 37 minor categories) considering the ease of on-site investigations and purchases. Three forms for recording survey results were developed, including a standard input form allowing detailed documentation of the availability of individual low-sodium foods, an aggregation form for a quantitative assessment of low-sodium foods availability, and a display form visualizing the availability of low-sodium foods by store. Furthermore, a survey manual was developed explaining the purpose and approach of the low-sodium foods availability survey, definition and classification criteria for low-sodium foods, and the three forms for recording survey results. Findings indicated that all registered dietitians could conduct on-site surveys using the manual and successfully collect and organize data.Conclusion　On-site surveys using the manual and documentation forms enabled easy and accurate assessments of low-sodium foods availability. Thus, this standardized method to assess the availability of low-sodium foods could be a food environment assessment method for regional salt reduction initiatives.

Antioxidant Vitamin Intake and LOX-Index in Japanese Municipal Workers.

Antioxidant vitamin intake has been reported to be associated with decreased risk of cardiovascular diseases. To date, however, no study has examined the association between antioxidant vitamin intake and LOX-index, a predictive biomarker of cardiovascular disease. We investigated the cross-sectional association between antioxidant vitamin (α-carotene, ß-carotene, α-tocopherol, and vitamin C) intake and LOX-index in Japanese municipal workers. Participants were 346 workers (171 men and 175 women aged 19-71 y) who received a health check-up and participated in a nutrition and health survey. Antioxidant vitamin intake was assessed using a validated brief self-administered diet history questionnaire. LOX-index was calculated by multiplying serum concentrations of the soluble form of lectin-like oxidized LDL receptor 1 by those of LOX-1 ligands containing apolipoprotein B. Multiple regression analysis was used to estimate the geometric mean of LOX-index according to tertile of each antioxidant vitamin intake. Overall, α-carotene, ß-carotene, α-tocopherol, and vitamin C intake were not associated with LOX-index. However, in stratified analyses by sex, geometric means of LOX-index tended to decrease with antioxidant vitamin intake in women, but not in men. The geometric means of LOX-index for the lowest through highest tertile of α-carotene intake were 771 (604-984), 639 (511-799), and 564 (469-677) (p for trend=0.07). Our results suggest that there is no association between antioxidant vitamin intake and LOX-index in Japanese workers. The suggestive inverse association between antioxidant vitamin intake and LOX-index in women warrants further investigation.

[Association between subjective chewing conditions and dietary habits in Japanese workers].

OBJECTIVES: Previous studies on the elderly have reported that they avoid fiber-rich and hard foods in favor of softer foods as chewing ability declines. However, evidence of worker chewing conditions and dietary habits is scarce. This study aimed to clarify the association between chewing conditions and dietary habits in workers. METHODS: The subjects included 6,703 workers (45.6 ± 10.2 years, range 18-64 years) who underwent medical and dental check-ups from April 2018 to March 2019 with no missing data. We classified workers into two groups, those with good chewing conditions (GCC) and those with poor chewing conditions (PCC) according to their responses to the chewing condition item in our questionnaire. We performed logistic regression analysis using the questionnaire dietary habits item response as the objective variable and chewing conditions as the explanatory variable and adjusting for sex, age, number of present teeth, periodontal pocket depth, oral hygiene status, Body Mass Index, smoking habits, alcohol intake, exercise habits, history of present illness, and stages of transtheoretical model. Additionally, we performed subgroup analysis using a similar framework stratified by sex and age groups (under 40 or older). RESULTS: We found significant negative associations with PCC for the following dietary habits (p < .05): Awareness of balanced diet; Regular consumption of dark green and deep yellow vegetables; Eating slowly and chewing well; Frequent consumption of seaweed and small fish; Having three meals at almost at the same time every day; Having breakfast almost every day; Eating protein dishes with every meal; Frequently consuming dairy products; Finishing eating at least two hours before bedtime. Furthermore, we found significant positive associations with PCC for the following items (p < .05): Having on average two or more bottles/cans of juice or coffee a day; Frequently eating heavy meat dishes; Frequently eating deep-fried foods such as fried dishes and pork cutlets; Frequently having instant or processed foods; Eating two or more kinds of Western or Japanese confectioneries or snacks on average a day; Frequently eating salty food; Regularly having snacks or late-night meals. Additionally, similar trends were also observed following subgroup analysis, regardless of sex or age. CONCLUSIONS: This study suggests that workers with PCC may retain undesirable dietary habits, regardless of sex and age. Therefore, it is necessary to expand dental check-ups in the workplace and to promote dental health guidance that targets all workers.

[Evaluating the relationship between oral health status in male workers and question item regarding subjective chewing symptoms].

OBJECTIVES: In recent years, the relationship between oral health status and various diseases has been increasingly reported worldwide, leading to a growing understanding of the importance of oral health. This study aimed to investigate the relationship between oral health status, determined after a dental health check-up, and chewing condition, determined via a questionnaire for specific health check-ups with the newly added chewing condition item-When you chew your food, which most accurately describes your chewing-. METHODS: From 20,834 Japanese workers who underwent dental health check-ups and specific health check-ups from April 2018 to March 2019, 4,011 male workers (51.2 ± 6.1 years, range 40-64 years) were extracted for this study. Participants were divided into two groups, the good chewing condition group (GCG) and poor chewing condition group (PCG), according to their responses to a questionnaire regarding chewing conditions. We collected and compared data on subjects' age, smoking status, number of teeth present, number of filled teeth, number of decayed teeth, number of missing teeth with prosthetic treatment, periodontal pockets, gingival bleeding, oral hygiene status, and Eichner's classification. Additionally, to clarify the risk associated with chewing condition, we performed stepwise multiple logistic regression analysis with good chewing condition/poor chewing condition as the dependent variable, and age, smoking status, number of teeth present, number of filled teeth, number of missing teeth with prosthetic treatment, periodontal pockets, oral hygiene status, and Eichner's classification as the independent variables. RESULTS: The result of stepwise multiple logistic regression analyses, the odds ratio (OR) and 95% confidence interval (95% CI) of the factors that remained in the final model were as follows; the number of decayed teeth (OR = 1.18 [95% CI: 1.12-1.24]); periodontal pockets of 3 mm or less vs. 6 mm or more (OR = 1.63 [95% CI: 1.12-2.37]); Eichner's classification A1 vs. A2 (OR = 1.40 [95% CI: 1.08-1.82]), A3 (OR = 1.66 [95% CI: 1.09-2.52]), B1 (OR = 3.38 [95% CI: 2.04-5.61]), B2 (OR = 5.26 [95% CI: 2.46-11.2]), B3 (OR = 4.28 [95% CI: 1.20-15.2]), B4 (OR = 7.59 [95% CI: 1.06-54.5]). CONCLUSIONS: The results of this study suggest a significant association between the newly added "chewing condition" item in the questionnaire for specific health check-ups and oral status; the number of decayed teeth, periodontal pockets, Eichner's classification.

Effect of Zinc-Deficient Diet on Two Strains of Mice.

Zinc (Zn) deficiency is one of the most common nutritional deficiencies worldwide. It is associated with reduced nutritional status and has been reported in cases of growth retardation, alopecia, and decreased serum alkaline phosphatase (ALP). It has also been reported to occur during total parenteral nutrition (TPN) administration and is associated with various diseases, such as liver diseases, diabetes, and kidney disease. We used Zn-deficient mice of ICR and C57BL/6J strains to investigate the various effects of Zn deficiency on the body, assuming that a healthy person may also become deficient in Zn either due to an unbalanced diet or malabsorption. The results showed that a Zn-deficient diet suppressed body weight gain and increased the tissue weight of the kidneys and cecum in both strains of mice. Biochemical data showed no decrease in serum ALP activity in either strain. Furthermore, in C57BL/6J mice, a Zn-deficient diet caused alopecia, loss of villi in the small intestine, and eventually affected the intestinal mucosa, which could be a risk factor for poor nutritional status. Although previous reports have shown that serum ALP activity is decreased during Zn deficiency, this is the first study that used 4-wk-old mice of ICR and C57BL/6J strains to show that serum ALP activity, which is a Zn deficiency marker, did not decrease in the two strains of Zn-deficient mice; furthermore, a Zn-deficient diet causes various symptoms.

Does difficulty in chewing induce subjective musculoskeletal symptoms? A case-control study.

OBJECTIVES: Risk factors associated with the development of musculoskeletal disorders and symptoms remain an important issue worldwide. This study aimed to investigate the relationship between oral health problems such as difficulty chewing and the occurrence of stiff neck/shoulders (SN/S) and low back pain (LBP). DESIGN: Case-control study. SETTING AND PARTICIPANTS: This study was conducted from 1 April 2018 to 31 March 2020. The subjects were 77 341 workers among 646 281 workers from several employers in Japan. OUTCOME MEASURES: Participants were asked to evaluate their subjective SN/S and LBP symptoms using a self-administered questionnaire. METHODS: We defined the chewing condition using a questionnaire, and workers who responded with 'I can chew anything' were classified as the good condition group (GCG), and those who responded with 'Sometimes I have difficulty chewing due to problems with the teeth, gums, or bite' or 'I can hardly chew' were classified as the poor condition group (PCG). Setting the year 2018 as the baseline, we performed a logistic regression model using propensity score and inverse probability weighting (IPW) methods and chewing condition groups as explanatory variables and SN/S and LBP as objective variables. RESULTS: The IPW-adjusted logistic regression model showed that the OR of SN/S was approximately 1.25 (95% CI 1.17 to 1.33) times higher in the PCG than that in the GCG (p<0.001). Similarly, the OR of LBP was about 1.37 (95% CI 1.27 to 1.48) times higher in the PCG than that in the GCG in the IPW-adjusted logistic regression model (p<0.001). CONCLUSIONS: Our study suggests that the occurrence of SN/S and LBP symptoms in workers could be predicted depending on the presence of difficulty in chewing. Therefore, oral health and health guidance are gaining importance for the prevention of subjective musculoskeletal symptoms.

Feasibility of Low-Sodium, High-Potassium Processed Foods and Their Effect on Blood Pressure in Free-Living Japanese Men: A Randomized, Double-Blind Controlled Trial.

We aimed to verify the effect of new low-sodium high-potassium seasonings and processed foods containing poly-γ-glutamic acid on blood pressure in free-living settings. To this end, we conducted a randomized, double-blind controlled trial on 187 Japanese men, aged 35-67 years, who did not use antihypertensives. Participants were randomly allocated to an intervention (n = 93) or a control group (n = 94). They were given a boxed lunch and miso soup (average Na and K content for the intervention group: 1175 and 1476 mg; for the control group: 2243 and 703 mg, respectively). Blood pressure was measured three times every morning for 1 week immediately before and during the final week of the trial. On the day before and the final day of the intervention period, 24 h urine samples were collected. After intervention, the intervention group showed a significantly stronger decrease in the urinary sodium-to-potassium ratio than the control group (p < 0.001). The mean difference in systolic blood pressure change after adjustment for baseline values between the two groups was -2.1 (95% CI: -3.6, -0.6) mmHg. Compliance between the groups was similar, suggesting successful blinding. In conclusion, the use of new seasonings and processed foods aimed at lowering blood pressure in free-living settings may be feasible and effective.

Prevention Measures for COVID-19 and Changes in Kawasaki Disease Incidence.

BACKGROUND: Kawasaki disease is suspected to be triggered by previous infection. The prevention measures for coronavirus disease 2019 (COVID-19) have reportedly reduced transmission of certain infectious diseases. Under these circumstances, the prevention measures for COVID-19 may reduce the incidence of Kawasaki disease. METHODS: We conducted a retrospective study using registration datasets of patients with Kawasaki disease who were diagnosed in all 11 inpatient pediatric facilities in Yamanashi Prefecture. The eligible cases were 595 cases that were diagnosed before the COVID-19 pandemic (from January 2015 through February 2020) and 38 cases that were diagnosed during the COVID-19 pandemic (from March through November 2020). Incidence of several infectious disease were evaluated using data from the Infectious Disease Weekly Report conducted by the National Institute of Infectious Diseases. RESULTS: Epidemics of various infectious diseases generally remained at low levels during the first 9 months (March through November 2020) of the COVID-19 pandemic. Moreover, the incidence of COVID-19 was 50-80 times lower than the incidence in European countries and the United States. The total number of 38 cases with Kawasaki disease for the 9 months during the COVID-19 pandemic was 46.3% (-3.5 standard deviations [SDs] of the average [82.0; SD, 12.7 cases] for the corresponding 9 months of the previous 5 years. None of the 38 cases was determined to be triggered by COVID-19 based on their medical histories and negative results of severe acute respiratory syndrome coronavirus 2 testing at admission. CONCLUSION: These observations provide a new epidemiological evidence for the notion that Kawasaki disease is triggered by major infectious diseases in children.

Screening of frequent variants associated with congenital hypothyroidism: a comparison with next generation sequencing.

Congenital hypothyroidism (CH) is considered the most common congenital endocrine disorder of genetic origin. Next generation sequencing (NGS) is the standard method for identifying genetic mutations, but it is an expensive and complex technique. Therefore, we propose to use Sanger sequencing to identify selected variants of the four most common CH-causative genes: DUOX2, TG, TSHR, and PAX8. To analyze the performance of Sanger sequencing, we compared its variant detection ability with that of a CH NGS panel containing 53 genes. We performed Sanger sequencing of selected variants and panel NGS analysis of 25 Japanese patients with CH. Sanger sequencing identified nine variants in seven patients, while NGS identified 24 variants in 14 patients. Of these, eight, five, eight, two, and one were found to be potentially pathogenic in DUOX2, TSHR, TG, UBR1, and TPO genes, respectively. The percentage of detectable variants using Sanger sequencing compared with NGS was 37.5% (9/24 variants), whereas the percentage of detectable cases carrying variants using Sanger sequencing compared with NGS was 50% (7/14 patients). We proposed a system for screening commonly identified CH-related variants by Sanger sequencing. Sanger sequencing could therefore identify about a third of CH-causative variants, so is considered an effective and efficient form of pre-screening before NGS.

Incidence of childhood type 1 diabetes mellitus in Yamanashi Prefecture, Japan, 1986-2018.

Introduction: Several studies have examined the incidence of childhood T1DM in Japan from the 1970s onwards, but none have been long-term studies using registration data. We estimate the incidence of childhood type 1 diabetes mellitus (T1DM) from 1986 to 2018 in Yamanashi Prefecture, Japan. Methods: We began a population-based, long-term study of childhood T1DM in 1986 involving every hospital paediatrics department in Yamanashi Prefecture. In the Prefecture, every child newly diagnosed with T1DM is referred to a hospital, and therefore, almost 100% of new patients aged <15 years are registered. We calculated the incidence of T1DM among children aged <15 years from 1986 to 2018. All cases met the Japan Diabetes Society diagnostic criteria and were tested for T1DM-related autoantibodies whenever possible. Results: Ninety-nine patients (44 boys and 55 girls) were newly diagnosed with T1DM. The annual incidence among 5- to 9-year-olds increased by 5.35% over the study period (95% confidence interval 2.34%-8.35%, p = .0005), and there was a trend towards increasing 3-year incidence (15.52% increase, p = .0516). There were also trends towards increasing annual and 3-year incidence among 0- to 14-year-olds. However, there were no changes over time in annual or 3-year incidence in the 0-4 year or 10-14 year age groups. Conclusions: The incidence of T1DM in Yamanashi Prefecture increased among children aged 0-14 years over the study period, with the most significant increase occurring among 5- to 9-year-olds. These data suggest that the number of children aged <15 years with T1DM is gradually increasing in one of the local prefectures in Japan, Yamanashi Prefecture and that the age of onset is decreasing.

Effect of Monosodium Glutamate on Saltiness and Palatability Ratings of Low-Salt Solutions in Japanese Adults According to Their Early Salt Exposure or Salty Taste Preference.

Using umami can help reduce excessive salt intake, which contributes to cardiovascular disease. Differences in salt-exposed environment at birth and preference for the salty taste might affect the sense of taste. Focusing on these two differences, we investigated the effect of monosodium L-glutamate (MSG) on the saltiness and palatability of low-salt solutions. Japanese participants (64 men, 497 women, aged 19-86 years) tasted 0.3%, 0.6%, and 0.9% NaCl solutions with or without 0.3% MSG to evaluate saltiness and palatability. They were also asked about their birthplace, personal salty preference, and family salty preference. Adding MSG enhanced saltiness, especially in the 0.3% NaCl solution, while the effect was attenuated in the 0.6% and 0.9% NaCl solutions. Palatability was rated higher with MSG than without MSG for each NaCl solution, with a peak value for the 0.3% NaCl solution with MSG. There was no difference in the effect of umami ingredients on palatability between the average salt intake by the regional block at birth and salty preference (all p > 0.05). Thus, adding an appropriate amount of umami ingredients can facilitate salt reduction in diet while maintaining palatability regardless of the salt-exposed environment in early childhood or salty preference.

[Verification of the effects of three percent weight loss at 6 months and application possibility of assessment at 3 months after the specific health guidance for male workers].

OBJECTIVES: This study aimed to evaluate the effects of ≥ 3% body weight loss at 6 months in male workers and verify the application possibility of assessment at 3 months after specific health guidance. METHODS: We recruited 5,031 Japanese male workers (aged 40-64 years) who had undergone health checkups and completed specific health guidance from 2008 to 2017. Participants were divided into three groups according to the percentage of weight reduction (≥ 3%, 0%-3%, ≤ 0%) after 6 months of health guidance. We compared the body weight, waist circumference, and blood pressure at 3- and 6-months with baseline data within and between groups. Similarly, in the medical examination of the next fiscal year (n = 2,889), body weight, waist circumference, blood pressure, triglyceride levels, high-density lipoprotein-cholesterol (HDL-C) levels, plasma glucose levels, and the prevalence and improvement rates of metabolic syndrome (MetS) of specific health checkups were also compared. Furthermore, we calculated the weight reduction target after 3 months to arrive at a ≥ 3% weight reduction for 6 months. Based on the target, we investigated the prevalence and improvement rates of MetS in the next fiscal year. RESULTS: A total of 1,349 (26.8%) participants had a ≥ 3% weight reduction, 2,059 (40.9%) had a < 3% weight reduction, and 1,623 (32.3%) had no weight reduction. At the 6-month follow-up, waist circumference and blood pressure levels had increasingly improved with greater reductions in weight. The following year, body weight, waist circumference, blood pressure, triglyceride levels, HDL-C levels, and plasma glucose levels had improved in the ≥ 3% weight loss group, whereas plasma glucose levels had not improved in the 0-3% weight loss group. Additionally, only triglyceride levels and diastolic blood pressure had improved in the no weight reduction group. In the ≥ 3% weight loss group, the prevalence rate of MetS was the lowest (7.6%), and the improvement rate of MetS was the highest (70.7%). Furthermore, the weight reduction target after 3 months to arrive at a ≥ 3% body weight reduction at 6 months was 2.0% weight reduction. Those who reduced weight ≥ 2.0% had better prevalence and improvement rates of MetS than those who reduced weight < 2.0%. CONCLUSIONS: Our findings indicated that the objective of losing ≥ 3% of body weight at 6 months in male workers after completing specific health guidance was effective and that assessment after 3 months based on setting a 2.0% weight reduction target was applicable.

Lifestyle and subjective musculoskeletal symptoms in young male Japanese workers: A 16-year retrospective cohort study.

This longitudinal study was conducted from 2002 to 2018 and aimed to investigate predictive lifestyle factors for the occurrence of subjective musculoskeletal symptoms. The participants came from several employers in Japan. Setting 2002 as the baseline, we performed logistic regression analyses using lifestyle questionnaire items as explanatory variables and Stiff neck/shoulders (SN/S) and Lower back pain (LBP) as objective variables (n = 16,748). Workers who responded positively to good lifestyle items with an odds ratio < 1.0 and those who did not were classified in the Good (GL) and Poor lifestyle groups (PL), respectively. The survival period between the groups was compared using the log-rank test and Cox hazard regression analysis with propensity score matching (n = 3,593). Based on the Cox hazard regression analysis results, the risk of SN/S was about 2.54 (95% confidence interval [CI]: 1.80-3.59) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 2.33 (95% CI: 1.07-5.10) times higher for PL than for GL (p < 0.05). Further, LBP risk was about 2.45 (95% CI: 1.67-3.58) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 3.50 (95% CI: 1.60-7.68) times higher for PL than for GL (p < 0.01). This study highlighted that workers with four good lifestyle factors (life satisfaction, hours of sleep, exercise habits, and physical fitness) presented reduced risk of subjective musculoskeletal symptom occurrence. To prevent musculoskeletal symptoms, physicians and occupational health staff should advise on workers' individual lifestyle.

Validation of preferred salt concentration in soup based on a randomized blinded experiment in multiple regions in Japan-influence of umami (L-glutamate) on saltiness and palatability of low-salt solutions.

Sodium reduction is an important public health goal. Individual and population approaches are necessary for reducing the sodium content of processed foods and meals. The aim of the present study is to affirm the effect of monosodium L-glutamate (MSG), an umami substance, on the saltiness or palatability of low-salt solutions and to explore the preferred salt concentration in soup. Five hundred and eighty-four healthy participants from nineteen regions in Japan tasted 0.3, 0.6, and 0.9% NaCl solutions with or without 0.3% MSG. Evaluations of saltiness and palatability for each solution were conducted using a visual analog scale in a double-blinded randomized manner. Saltiness gradually increased depending on the concentration of NaCl. The saltiness of the 0.3% NaCl solution with MSG was rated significantly higher than that without MSG. The palatability ratings were higher for the solutions with MSG than for those without MSG for all NaCl concentrations. In particular, the palatability rating of the 0.3% NaCl solution with MSG was twice as high as that without MSG and was significantly higher than that of the other five test solutions. Furthermore, these results were observed to be approximately the same, irrespective of sex, age, region, etc. Salt reduction is believed to result in a loss of palatability. However, our results suggest that umami can compensate for the loss of palatability caused by salt reduction and that the addition of an appropriate amount of an umami substance can facilitate salt reduction from 0.9 to 0.3% without sacrificing palatability.

Analysis of amino acid profiles of blood over time and biomarkers associated with non-alcoholic steatohepatitis in STAM mice.

The changes in free amino acid (AA) levels in blood during the progression from non-alcoholic steatohepatitis (NASH) to hepatocellular carcinoma (HCC) are unclear. We investigated serum AA levels, along with biochemical and histological events, in a mouse model of NASH. We induced NASH in male C57BL/6J mice with a streptozotocin injection and high-fat diet after 4 weeks of age (STAM group). We chronologically (6, 8, 10, 12, and 16 weeks, n=4-12 mice/group) evaluated the progression from steatohepatitis to HCC by biochemical and histological analyses. The serum AA levels were determined using an AA analyzer. Serum aspartate aminotransferase and alanine aminotransferase levels were higher in the STAM group than in the normal group (non-NASH-induced mice). Histological analysis revealed that STAM mice had fatty liver, NASH, and fibrosis at 6, 8, and 10 weeks, respectively. Moreover, the mice exhibited fibrosis and HCC at 16 weeks. The serum branched-chain AA levels were higher in the STAM group than in the normal group, especially at 8 and 10 weeks. The Fischer ratio decreased at 16 weeks in the STAM group, with increasing aromatic AA levels. These results suggested that this model sequentially depicts the development of fatty liver, NASH, cirrhosis, HCC, and AA metabolism disorders within a short experimental period. Additionally, serum amyloid A was suggested to be a useful inflammation biomarker associated with NASH. We believe that the STAM model will be useful for studying AA metabolism and/or pharmacological effects in NASH.

An exaggerated blood pressure response to exercise is associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

AIM: This study was designed to examine the associations between an exaggerated systolic blood pressure (SBP) response to exercise and the nutrient intake in normotensive subjects. METHODS: The subjects consisted of 302 normotensive subjects (64 males and 238 females; age, 48.4 ± 11.3 years) without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The nutrient intake was assessed using a self-administered food frequency questionnaire. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP ≥210 mmHg in males, or ≥190 mmHg in females). RESULTS: An exaggerated SBP response to exercise was observed in 85 subjects. A multiple logistic regression analysis revealed that the dietary sodium-to-potassium (Na/K) ratio (odds ratio [OR]: 5.75, 95% confidence interval [CI]: 2.37-13.75, p = 0.001) and vitamin E intake (OR: 0.67, 95% CI: 0.51-0.93, p = 0.012) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP during exercise was found to be significantly associated with an increase in the dietary Na/K ratio (p for trend = 0.0005) and a decrease in the vitamin E intake (p for trend = 0.018). CONCLUSIONS: These results suggest that an exaggerated SBP response to exercise was associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

Relationship Between Nicotine Dependency and Occupational Injury in a Japanese Large-Scale Manufacturing Enterprise: A Single-Center Study.

OBJECTIVES: Although several studies have shown the association between smoking and occupational injury, the exact mechanism by which smoking contributes to occupational injury remains unclear. We conducted a 5-year case-control study in a population of Japanese large-scale enterprise workers aimed to verify the hypothesis that nicotine dependency is positively associated with occupational injury. METHODS: A total of 3179 to 3574 male workers annually participated in this study conducted from 2008 to 2012. Employees who had an occupational injury as detailed in the company records were included in the case group, while employees who did not have any occupational injury were included in the control group. Information on smoking status, nicotine dependency [assessed according to time to first cigarette (TTF) and cigarette per day (CPD)], and potential confounders were obtained via questionnaires administered during periodic health checkups. Odds ratios (ORs) were estimated via multiple logistic regression analysis and integrated using the general variance-based fixed effects model. RESULTS: The overall adjusted OR of occupational injury in smokers was 1.71 [95% confidence interval (95% CI): 1.10 to 2.66]. The OR for low and high nicotine dependency according to TTF was 1.52 (95% CI: 0.92 to 2.51) and 1.98 (95% CI: 1.15 to 3.41), respectively. CONCLUSION: Nicotine dependency was related to an increased risk of occupational injury. These findings support the hypothesis that smoking is associated with occupational injury.