Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study.

OBJECTIVES: Although better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: We used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study. MESUREMENTS: Dietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. RESULTS: During the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54-1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52-1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. CONCLUSIONS: Our findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.

Long-term outcomes of hemostatic therapy for variceal bleeding and the challenge pending in the post-direct-acting antivirals era.

Background and study aims: This study evaluated the longterm outcomes of mainly endoscopic hemostatic therapy for gastrointestinal variceal bleeding and of the transition of hemostatic therapy. Patients and methods: Among 1,163 patients treated for gastrointestinal varices between April 2006 and June 2020, a total of 125 patients who underwent emergency hemostatic therapy were enrolled. Survival rates and secondary evaluation points were analyzed. Additionally, patients were classified into two groups: the previous and latter term. Patients' background, therapeutic method, and treatment results were compared between the groups. Results: 94.4% had cirrhosis. The average Child-Pugh score was 8.90. Successful primary hemostasis rate was 98.4%, and 5.6% died within 2 weeks, all with a Child-Pugh score ≥9. The respective 1- and 5-year survival rates for Child-Pugh grade A/B were 81.3% and 55.4%, while those for Child-Pugh grade C were 58.1% and 17.8%. Child-Pugh grade C or hepatocellular carcinoma was significantly associated with poor prognosis. In total, 21.6% experienced variceal re-bleeding; 62.9% of these cases were triggered by continued alcohol consumption. There was no significant difference in survival between patients with and without variceal re-bleeding and in post-treatment survival between the previous and latter terms. In the latter term, the number of cases caused by continued alcohol consumption significantly increased. Conclusions: Multidisciplinary treatment and continuation of proper management after hemostatic therapy for variceal bleeding are crucial. Continued alcohol consumption leads to variceal bleeding and re-bleeding; its proper management, including alcohol abstinence, is one of the major challenges left in the post-directacting antivirals era.

Molecular and morphological analyses revealed a cryptic species of dojo loach Misgurnus anguillicaudatus (Cypriniformes: Cobitidae) in Japan.

Although it has been reported that populations of the Japanese dojo loach Misgurnus anguillicaudatus (Cypriniformes: Cobitidae) belong to two distinct mitochondrial (mt)DNA (Type I and Type II), the taxonomic status of the species remains unresolved. To address this question, nuclear DNA and morphological analyses were performed on M. anguillicaudatus population in the Nakaikemi Wetland, where Type I and Type II lineages are sympatric. Results suggest the existence of a cryptic species (Type I) within the Japanese dojo loach.

Screening for Malnutrition in Community Dwelling Older Japanese: Preliminary Development and Evaluation of the Japanese Nutritional Risk Screening Tool (NRST).

BACKGROUND: Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations. OBJECTIVE: This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II. PARTICIPANTS: The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people. MEASUREMENTS: Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People. RESULTS: The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST). CONCLUSIONS: These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.

Weight change after 20 years of age and the incidence of dyslipidemia: a cohort study of Japanese male workers.

BACKGROUND: While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development. METHODS: A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994-95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002-03 health examination. Using the 'no change' group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models. RESULTS: A total of 1342 participants developed dyslipidemia during the follow-up period. The 'increase' and 'sizable increase' groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59-2.45) and 2.68 (2.15-3.34), respectively, demonstrating that there was a significant dose-response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend). CONCLUSION: These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.

Effect of replacing corn with whole-grain paddy rice and brown rice in broiler diets on growth performance and intestinal morphology.

The present study was conducted to investigate replacing corn with whole-grain paddy rice (WPR) and whole-grain brown rice (BR) in broiler chicken diets and its effect on growth performance and histological structures of the intestinal villi. Marshall Chunky male chicks (14 days old) were divided into five groups with four replicates of four chicks each. In the dietary treatments, corn in the basal diet was replaced with WPR and BR. The chickens received five experimental diets consisting of corn, WPR and BR in ratios of 100:0:0 (Control), 50:0:50 (50Corn + 50BR), 50:25:25 (50Corn + 25WPR + 25BR), 25:50:25 (25Corn + 50WPR + 25BR) and 0:50:50 (50WPR + 50BR) respectively. Feed and water were provided ad libitum for 35 day. No significant differences were found in feed intake, body weight gain and feed efficiency among the treatment groups. The relative weights of the gizzard in the 50Corn + 25WPR + 25BR, 25Corn + 50WPR + 25BR and 50WPR + 50BR groups were significantly higher than that of the Control and 50Corn + 50BR groups (p < 0.05). The gizzard pH of the experimental groups was lower than those of Control (p < 0.05). The ileal crypt of birds on the Control diets was deeper (p < 0.05) than those observed in the experimental birds. Moreover, the ileal villus height: crypt depth ratio increased (p < 0.05) in the 50WPR + 50BR group (p < 0.05) compared with the Control group. No specific changes were observed in the epithelial cells on the duodenal apical surface among the groups except that the villus of the 25Corn + 50WPR + 25BR group had cell clusters. The jejunal and ileal villus apical surface of the experimental groups showed similar morphology to the Control group. These findings suggest that WPR and BR can totally replace corn in broiler diets without negatively affecting growth performance.

Effects of whole-grain paddy rice replacement with or without enzyme addition on broiler performance and intestinal morphology.

To investigate the effect of replacing maize with whole-grain paddy rice (WPR) in broiler chicken diets, with or without enzyme addition, on growth performance and histological structures of the intestinal villi, 14-d-old Marshall Chunky male chicks were divided into 4 groups with 4 replicates of 4 chicks each. The experimental diets containing different concentrations of WPR were as follows: (1) 0 g/kg (Control); (2) 141.5 g/kg, grower, and 125.0 g/kg, finisher (25WPR); (3) 283.0 g/kg, grower, and 250.0 g/kg, finisher (50WPR); (4) 283.0 g/kg, grower, and 250.0 g/kg, finisher, and enzyme supplementation (50WPR + enzyme). All diets were formulated to be isocaloric and isonitrogenous and provided ad libitum for 35 d. There were no differences among the diets on the growth performance and digestive organ size. The villus height and cell mitosis number of all intestinal segments did not change in any treatment. The ileal villus area, duodenal cell area, duodenal and jejunal goblet cell number in the 50WPR group increased significantly relative to the control but not when enzyme was included. In the scanning electron microscope results, all experimental groups showed clear protuberant cells and cell clusters on the villus apical surface of the duodenum. In the jejunum, cell clusters and areas having cells with no microvilli were frequently found in both the 50WPR and 50WPR + enzyme groups. In conclusion, broilers fed on diets replacing maize with WPR showed hypertrophied villi of duodenum and ileum and epithelial cells in duodenum and jejunum, especially in the 50WPR group, without negatively affecting growth performance. These findings suggest that WPR can replace maize up to a level of 50% (283.0 g/kg, starter, and 250.0 g/kg, finisher) in broiler diets without enzyme supplementation. However, further studies are needed to improve our knowledge of the influence of WPR on higher numbers of birds.

Test chamber and forensic microscopy investigation of the transfer of brominated flame retardants into indoor dust via abrasion of source materials.

Brominated flame retardants (BFRs) have been detected in indoor dust in many studies, at concentrations spanning several orders of magnitude. Limited information is available on the pathways via which BFRs migrate from treated products into dust, yet the different mechanisms hypothesized to date may provide an explanation for the range of reported concentrations. In particular, transfer of BFRs to dust via abrasion of particles or fibers from treated products may explain elevated concentrations (up to 210 mg g(-1)) of low volatility BFRs like decabromodiphenyl ether (BDE-209). In this study, an indoor dust sample containing a low concentration of hexabromocyclododecane, or HBCD, (110 ng g(-1) ΣHBCDs) was placed on the floor of an in-house test chamber. A fabric curtain treated with HBCDs was placed on a mesh shelf 3 cm above the chamber floor and abrasion induced using a stirrer bar. This induced abrasion generated fibers of the curtain, which contaminated the dust, and ΣHBCD concentrations in the dust increased to between 4020 and 52 500 ng g(-1) for four different abrasion experiment times. The highly contaminated dust (ΣHBCD at 52 500 ng g(-1)) together with three archived dust samples from various UK microenvironments, were investigated with forensic microscopy techniques. These techniques included Micro X-ray fluorescent spectroscopy, scanning emission microscopy coupled with an energy dispersive X-ray spectrometer, Fourier transform infrared spectroscopy with further BFR analysis on LC-MS/MS. Using these techniques, fibers or particles abraded from a product treated with BFRs were identified in all dust samples, thereby accounting for the elevated concentrations detected in the original dust (3500 to 88 800 ng g(-1) ΣHBCD and 24 000 to 1,438 000 ng g(-1) for BDE-209). This study shows how test chamber experiments alongside forensic microscopy techniques, can provide valuable insights into the pathways via which BFRs contaminate indoor dust.

Impact of surgical menopause on lipid and bone metabolism.

OBJECTIVE: To clarify the effects of ovariectomy on lipid and bone metabolism. METHODS: This study was a prospective study with a longitudinal design within 1 year after surgery. Sixty-two premenopausal women were recruited and divided into two groups: group M (preservation of ovary, n=27) and group BSO (bilateral ovariectomy, n=35). Serum lipid levels, urinary N-telopeptide of type I collagen (NTx) and bone mineral density (BMD) were measured. We also examined the number of postoperative episodes requiring pharmacological intervention. RESULTS: There was a significant elevation in the level of low density lipoprotein cholesterol in group BSO from 6 to 12 months compared with the baseline level; the level did not change in group M. The NTx level significantly increased from 6 to 12 months, and the BMD was significantly decreased by as much as 6.7% at 12 months in group BSO; these variables did not change in group M. The effect of lipid and bone metabolism in group BSO was observed when the ages of the two groups were matched. Carbohydrate metabolism and arterial stiffness, measured by pulse wave velocity, did not change throughout the study period in either group. No subjects in group M required medication expect for two patients whose ovarian function was diminished by postoperative radiation and by natural menopause. Eleven women received medication in group BSO: nine for climacteric disorders using hormone therapy (25.7%), and two for dyslipidemia using statins (5.7%). CONCLUSIONS: Bilateral ovariectomy seems to cause dyslipidemia and serious loss of bone mineral density within only 1 year, and patients who lose ovarian function may require careful medical care.

One-year change in the second metacarpal bone mass associated with menopause nutrition and physical activity.

OBJECTIVES: To clarify the annual changes and effects of nutrition and physical activity on bone mass at the second metacarpal using computed X-ray densitometry. DESIGN: Population-based prospective follow-up study. MEASUREMENTS: Bone mass measurements and assessments of nutritional intake, exercise habits, and health status were conducted twice with a one-year interval. PARTICIPANT: 269 Japanese women aged 40 - to -80 - years old. RESULTS: The annual change rate among subjects who started menopause during the observation period was -4.2 +/- 4.9%. Bone mass subsequently continued to decrease 3% annually until 6 years after menopause. Subjects who consumed high levels of milk or calcium in the first year showed no substantial decrease in bone mass among the post-menopausal subjects. Premenopausal subjects who began or continued exercise evidenced increased bone mass, and peri-menopausal subjects who continued exercise or a high level of daily physical activity showed inhibited bone loss. CONCLUSION: Second metacarpal bone changed by menopause, nutrition and physical activity similar with other bone site presented in the previous studies.

Development and characterization of chloroplast microsatellite markers for Cryptomeria japonica D. Don.

We developed 17 chloroplast microsatellite markers, which consisted of seven mononucleotide microsatellites with a minimum repeat number of 10 and 10 dinucleotide microsatellites with a minimum repeat number of six, from the complete chloroplast genomic sequence of Cryptomeria japonica. A survey of 45 C. japonica individuals showed the number of alleles ranging from two to 11 alleles and a diversity index ranging from 0.085 to 0.895. Consequently, the 45 C. japonica individuals were divided into 39 haplotypes. These markers will be useful genetic markers in the gene flow analysis and population genetics of C. japonica.

Long-term forskolin stimulation induces AMPK activation and thereby enhances tight junction formation in human placental trophoblast BeWo cells.

BeWo cells, derived from human choriocarcinoma, have been known to respond to forskolin or cAMP analogues by differentiating into multinucleated cells- like syncytiotrophoblasts on the surfaces of chorionic villi of the human placenta. In this study, we demonstrated that long-term treatment with forskolin enhances the tight junction (TJ) formation in human placental BeWo cells. Interestingly, AMPK activation and phosphorylation of acetyl-CoA carboxylase (ACC), a molecule downstream from AMPK, were induced by long-term incubation (>12h) with forskolin, despite not being induced by acute stimulation with forskolin. In addition, co-incubation with an AMPK inhibitor, compound C, as well as overexpression of an AMPK dominant negative mutant inhibited forskolin-induced TJ formation. Thus, although the molecular mechanism underlying AMPK activation via the forskolin stimulation is unclear, the TJ formation induced by forskolin is likely to be mediated by the AMPK pathway. Taking into consideration that TJs are present in the normal human placenta, this mechanism may be important for forming the placental barrier system between the fetal and maternal circulations.

Do the kidneys contribute to propofol elimination?

BACKGROUND: Propofol is mainly metabolized in the liver, but extrahepatic clearance may also be important since systemic propofol clearance exceeds hepatic clearance. Recent reports suggest that the kidneys contribute to propofol elimination in humans and here we investigated renal elimination of propofol in a controlled animal study. METHODS: Seventeen swine were anaesthetized with 5% isoflurane induction and 2% isoflurane maintenance. After a left subcostal incision, the left kidney and renal pedicle were exposed by an approach via the retroperitoneum and the renal vein was identified for blood sampling. Propofol was then administered via the right jugular vein at a rate of 2 mg kg(-1) h(-1). After 120 min of pseudo-steady-state infusion of propofol (Baseline 1), cardiac output (CO) was increased by continuous infusion of dobutamine for 30 min (high-CO state). Thirty minutes after stopping dobutamine (Baseline 2), CO was decreased by bolus administration of propranolol (low-CO state). Blood samples were collected simultaneously from the renal vein (direct puncture) and the femoral artery at Baseline 1, in the high-CO state, at Baseline 2, and in the low-CO state. RESULTS: There was no significant difference in propofol concentration between femoral arterial and renal venous blood in all states. The propofol concentration significantly decreased with increased CO, but renal extraction was not observed in any state. CONCLUSIONS: The kidneys are a minor site of propofol elimination in a swine model.

Identification of glutamic acid decarboxylase gene and distribution of GABAergic nervous system in the planarian Dugesia japonica.

The planarian Dugesia japonica has a relatively well-organized CNS that includes the brain and the ventral nerve cords, and also has high regenerative capacity derived from pluripotent stem cells present in the mesenchymal space throughout the body. Glutamic acid decarboxylase (GAD) is the enzyme that converts glutamic acid into GABA, a major inhibitory neurotransmitter. In this study, we first identified a full-length GAD gene (DjGAD, D. japonica glutamic acid decarboxylase) in the planarian D. japonica. Whole-mount in situ hybridization revealed that a few cells expressed DjGAD mRNA, and these cells were located in both the head and pharynx regions. In order to examine the distribution pattern of DjGAD protein, we generated a mouse monoclonal anti-DjGAD antibody. The distribution pattern of DjGAD protein was very similar to that of DjGAD mRNA. A neural network of DjGAD-immunopositive cells was also clearly observed. In addition, we examined the immunofluorescence during the process of regeneration of the head from the tail piece. At day 3 of regeneration, we could detect newly formed DjGAD-immunopositive neurons in the anterior region. During day 5-7 of regeneration, reconstruction of the neural network of DjGAD-immunopositive cells occurred. DjGAD-immunoreactivity was lost in DjGAD-knockdown planarians obtained by RNA interference. The amount of GABA was significantly decreased in DjGAD-knockdown planarians, which lost negative phototaxis but not locomotion activity. These results suggest that DjGAD is clearly required for GABA biosynthesis and photosensitivity in planarians, and expression of DjGAD as detected by anti-DjGAD antibody is a useful marker for GABAergic neurons.

Lipophilic beta-adrenoceptor antagonist propranolol increases the hypnotic and anti-nociceptive effects of isoflurane in a swine model.

BACKGROUND: We have previously reported that landiolol, an ultra-short-acting beta1-adrenoceptor antagonist, does not alter the anaesthetic effects of isoflurane. Here, we investigated the influence of propranolol on the electroencephalographic (EEG) effects and minimum alveolar concentration (MAC) of isoflurane. METHODS: Fourteen swine [25.0 (SD 4.0) kg] were anaesthetized by isoflurane inhalation. The inhalation concentration was decreased to 0.5% and maintained for 25 min, before being returned to 2%, and maintained for a further 25 min. End-tidal isoflurane concentrations and spectral edge frequencies were recorded. Pharmacodynamic analysis was performed using a sigmoidal inhibitory maximal effect model for spectral edge frequency vs effect-site concentration. After measurement of the EEG effect, MAC was determined using the dew-claw clamp technique, in which movement in response to clamping is recorded. After completion of control measurements, a propranolol 4 mg bolus followed by an infusion (2 mg h(-1)) was started. After a 30 min stabilization period, the inhalation concentration of isoflurane was varied as in the control period and MAC was re-assessed. RESULTS: Propranolol shifted the concentration-effect relationship to the left and decreased the effect-site concentration that produced 50% of the maximal effect from 1.30 (0.18) to 1.13 (0.17)%. Propranolol also decreased isoflurane MAC from 1.91 (0.35) to 1.54 (0.32)%. CONCLUSIONS: Propranolol alters both the hypnotic and anti-nociceptive effects of isoflurane. In contrast to landiolol, lipophilic beta-adrenoceptor antagonists may increase the potency of inhalational anaesthetics.

Physical activity level in healthy free-living Japanese estimated by doubly labelled water method and International Physical Activity Questionnaire.

OBJECTIVE: To measure total energy expenditure (TEE) for normal healthy Japanese by the doubly labelled water (DLW), and to compare the physical activity level (PAL) among categories classified by the categories used in daily reference intake (DRI), Japan and the International Physical Activity Questionnaire (IPAQ). SUBJECTS AND METHODS: A total of 150 healthy Japanese men and women aged 20- to 59-year-old living in four districts of Japan. TEE was measured by the DLW method, and the PAL was calculated from TEE divided by basal metabolic rate. Simultaneously with TEE measurement, the PAL was assessed employing the categories used in DRI, Japan and IPAQ. RESULTS: The average TEE and PAL were 10.78+/-1.67 MJ/day and 1.72+/-0.22 for males and 8.37+/-1.30 MJ/day and 1.72+/-0.27 for females, respectively. The subjects in the highly active categories assessed by both DRI and IPAQ showed significantly higher PAL compared with less active categories. However, PALs among light and moderate categories by DRI, and insufficient and sufficiently active by IPAQ were not significantly different. CONCLUSIONS: In developed countries, highly active subjects could be assessed by a simple questionnaire. However, the questionnaire should be improved to clarify the sedentary to moderately active subjects by assessing carefully very light to moderate physical activity.

Duodenal follicular lymphomas share common characteristics with mucosa-associated lymphoid tissue lymphomas.

BACKGROUND: Follicular lymphomas occasionally arise in the extra-nodal organs and are frequently found in the duodenum. They are often localised tumours with multiple polyps around the ampulla of Vater. AIMS: To examine a IgH/bcl-2 hybrid gene and VH gene to investigate the nature of the lymphoma cells and how they differ from nodal follicular lymphomas and MALT lymphomas. METHODS: Of 40 patients reported previously, 35 with duodenal follicular lymphoma were studied in detail with respect to clinicopathological characteristics. RESULTS: 37/40 patients were in clinical stage I (n = 30) or stage II (n = 7). Clonal immunoglobulin gene rearrangement was detected in 53.3% of examined cases, and rearrangement of IgH/bcl-2 gene at the major break point was detected in 27% of cases. Three of 8 examined cases were VH4 (38%); 2 out of them were VH4-34. As VH4 deviation is one of the common characteristics of MALT lymphomas and 2/3 were identical, duodenal follicular lymphomas have a similar aetiology to MALT lymphomas. Clinical course was also similar to that of MALT lymphomas. CONCLUSIONS: Results suggest that duodenal follicular lymphomas have intermediate characteristics of MALT lymphomas and nodal follicular lymphomas.

Validation of self-reported energy intake by a self-administered diet history questionnaire using the doubly labeled water method in 140 Japanese adults.

OBJECTIVE: To validate reported energy intake (rEI) with a self-administered diet history questionnaire (DHQ) against total energy expenditure (TEE) by the doubly labeled water (DLW) method. SUBJECTS: A total of 140 healthy Japanese adults (67 men and 73 women) aged 20-59 years living in four areas in Japan. METHODS: Energy intake was assessed twice with DHQ over a 1-month period before and after TEE measurement (rEI(DHQ1) and rEI(DHQ2), respectively). TEE was measured by DLW during 2 weeks (TEE(DLW)). RESULTS: Mean rEI(DHQ1) was lower than those of TEE(DLW) by 1.9+/-2.4 MJ/day (16.4%, P<0.001) for men and 0.6+/-1.9 MJ/day (6.0%, P<0.01) for women. In men and women together, 62 subjects (44%) were defined as underreporters (rEI(DHQ1)/TEE(DLW) <0.84), 58 (41%) as acceptable reporters (0.84-1.16) and 20 (14%) as over-reporters (>1.16). Pearson correlation coefficient was 0.34 for men and 0.22 for women. After adjustment for the dietary and non-dietary factors related to rEI(DHQ1)/TEE(DLW), the correlation coefficient improved to 0.42 and 0.37, respectively. CONCLUSION: The energy intake assessed with DHQ correlated low to modestly with TEE measured by DLW. In addition, DHQ underestimated energy intake at a group level. Caution is needed when energy intake was evaluated by DHQ at both individual and group levels.

A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials.

OBJECTIVE: It has been suggested that exercise has preferential effects on visceral fat reduction. However, the dose-response effect remains unclear because of limited evidence from individual studies. The purpose of this study was to systematically review the current literature to establish whether reduction of visceral fat by aerobic exercise has a dose-response relationship. METHODS: A database search was performed (PubMed, 1966-2006) with appropriate keywords to identify studies exploring the effects of aerobic exercise as a weight loss intervention on visceral fat reduction. Visceral fat reduction was expressed as the percentage of visceral fat change per week (%DeltaVF/w). The energy expenditure by aerobic exercise was expressed as Sigma (metabolic equivalents x h per week (METs x h/w)). RESULTS: Nine randomized control trials and seven non-randomized control trials were selected. In most of the studies, the subjects performed aerobic exercise generating 10 METs x h/w or more. Among all the selected groups (582 subjects), visceral fat decreased significantly (P<0.05) in 17 groups during the intervention, but not in the other 4 groups. There was no significant relationship between METs x h/w from aerobic exercise and %DeltaVF/w in all the selected groups. However, when subjects with metabolic-related disorders were not included (425 subjects), METs x h/w from aerobic exercise had a significant relationship with %DeltaVF/w (r=-0.75). Moreover, visceral fat reduction was significantly related to weight reduction during aerobic exercise intervention, although a significant visceral fat reduction may occur without significant weight loss. CONCLUSION: These results suggest that at least 10 METs x h/w in aerobic exercise, such as brisk walking, light jogging or stationary ergometer usage, is required for visceral fat reduction, and that there is a dose-response relationship between aerobic exercise and visceral fat reduction in obese subjects without metabolic-related disorders.