Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic.

BACKGROUND: The definition of psychosomatic medicine is not consistent across countries. PURPOSE: The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital. METHODS: The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other. RESULTS: In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p < 0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p < 0.05). CONCLUSIONS: Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.

Effectiveness of mobile applications in improving insomnia symptoms among adults from multi-community: A systematic review and meta-analysis.

OBJECTIVE/BACKGROUND: To clarify whether mobile sleep applications alleviate insomnia symptoms among adults from multi-community. PATIENTS/METHODS: A literature search was conducted using the PubMed, Cochrane, PsycINFO, and Web of Science databases for articles related to mobile technology and sleep interventions published between database inceptions and March 27, 2023. We pooled relevant data using a random-effects model, and a meta-analysis was performed using a web version of the Cochrane Review Manager. The effect size was estimated and reported as the combined overall effect (weighted average). Forest plots were created, and the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale were used to evaluate studies. RESULTS: After an initial screening and full-text reviews, seven studies were identified with a total of 10,139 participants (females n = 8844, 87.2 %) recruited from multi-community and not diagnosed with sleep disorders or taking medications. These studies included one cross-sectional study investigating mindfulness meditation apps and six randomized-controlled trials (RCTs), including one with sleep-feedback messaging, one comparing sleep applications with or without a wearable device, and four with multicomponent interventions based on cognitive theory and subsequent behavioral change techniques. In a meta-analysis of three cognitive behavior therapy (CBT)-based RCTs, the intervention group showed statistically significant improvements in insomnia symptoms according to the Pittsburgh Sleep Quality Index but with high heterogeneity, while two CBT-based RCTs showed no significant improvements in the Insomnia Severity Index with low heterogeneity. CONCLUSIONS: A small body of evidence supports the use of CBT-based sleep applications to improve insomnia symptoms among adults from multi-community.

The Association of Central Sensitisation with Depression, Anxiety, and Somatic Symptoms: A Cross-Sectional Study of a Mental Health Outpatient Clinic in Japan.

For patients with chronic pain and persistent physical symptoms, understanding the mechanism of central sensitisation may help in understanding how symptoms persist. This cross-sectional study investigated the association of central sensitisation with depression, anxiety, and somatic symptoms. Four hundred and fifteen adults attending an outpatient psychosomatic clinic were evaluated. Participants completed the Hospital Anxiety and Depression Scale, Somatic Symptom Scale 8, and the Central Sensitisation Inventory. The relationships between these factors were examined using descriptive statistics and multiple logistic regression analyses. The mean age was 42.3 years, and 59% were female. The disorders included adjustment disorders (n = 70), anxiety disorders (n = 63), depressive disorders (n = 103), feeding and eating disorders (n = 30), sleep-wake disorders (n = 37), somatic symptoms and related disorders (n = 84), and others (n = 28). In multiple logistic regression analyses, higher central sensitisation was associated with more severe anxiety, depression, and somatic symptoms after controlling for potential confounders. In the disease-specific analysis, somatic symptoms correlated more positively with central sensitisation than with depression or anxiety. Central sensitisation and depression, anxiety, and somatic symptoms were associated with patients attending an outpatient clinic. These findings highlight the importance of evaluating depression, anxiety, and somatic symptoms when assessing central sensitisation.

Association Between Ego-Resilience and Social Isolation Among Urban Older People.

Social isolation among older adults affects their physical and mental health. Ego-resilience is associated with flexible adaptation to various environments and acceptable behaviors. However, its association with social isolation among older people is unclear. Therefore, a health survey was conducted with 510 adults aged 65 years or older to assess social isolation, its associated factors, and ego resilience. The results showed that the social isolation group had a lower median ego-resiliency scale score (42.0) compared to the non-social isolation group (38.0). The social isolation group were mostly males without spouses, took time to move, had more depressive moods, and poorer subjective health status. The non-social isolated group had faster maximum walking speed. Low ego-resilience was newly identified as a factor associated with social isolation among older people, as were being male, having no spouse, and depressive symptoms. Mediation analysis revealed that ego-resilience affected social isolation and was partially mediated by depressive symptoms.

Association of metabolic syndrome with atypical features of depression in Japanese people.

AIM: It has been controversial whether metabolic syndrome (MetS) is associated with depression. We aimed to clarify the correlation between MetS and depression, considering atypical features of depression. METHODS: Participants were 1011 Japanese men aged 20-59 years. MetS was diagnosed according to criteria set by the International Diabetes Federation. Clinical interviews for major depressive disorder (MDD) employed the DSM-IV; MDD was classified into atypical and non-atypical types. The prevalence of MetS was compared between the groups with no MDD, atypical depression, and non-atypical depression via trend analyses. Multiple logistic regression analyses examined the association of MetS with atypical depression and the features thereof. RESULTS: In total, 141 (14.0%) participants were diagnosed with MetS and 57 (5.6%) were diagnosed with MDD (14 had atypical and 43 had non-atypicalMDD). The prevalence of MetS was the highest in the group with atypical depression, followed by the non-atypical depression and no MDD groups, respectively, with a marginally significant trend (P = 0.07). The adjusted odds ratios of MetS associated with depression were 3.8 (95% confidence interval [CI] 1.1-13.2) for atypical depression and 1.6 (95% CI 0.7-3.6) for non-atypical depression. Among the five features of atypical depression, only hyperphagia was significantly related to MetS (odds ratio 2.7, 95% CI 1.8-4.1). CONCLUSION: There was a positive association between MetS and atypical depression, but not between MetS and non-atypical depression. Specifically, hyperphagia seems to be an important factor affecting the correlation between MetS and atypical depression.

An overview of the China National Tobacco Corporation and State Tobacco Monopoly Administration.

OBJECTIVES: China is facing a serious public health problem in active and passive smokers. Confronted with this, China has taken some measures to control tobacco. However, this information has not been surveyed at academic level. Our aim is to investigate information relating to tobacco controls in China. METHODS: To find information relating to tobacco control, we reviewed and analysed the China National Tobacco Corporation (CNTC) and State Tobacco Monopoly Administration (STMA) mainly by systematic examination of documents made available in the University of California, San Francisco Legacy Tobacco Documents Library and China Tobacco database. RESULTS: Eleven relevant documents met our research purpose, and 18 further relevant documents were found on the CNTC, STMA and Tobacco China database websites. As a result, 29 relevant articles were included in our analysis. We describe the CNTC and STMA's history, structure, and relation to the Chinese Government ministry and to other tobacco companies, and China's tobacco control in detail. CONCLUSIONS: The Chinese cigarette market is dominated by a state-owned monopoly, the STMA. Under the protection of the Law of the People's Republic of China on Tobacco Monopoly, the STMA controls all aspects of the tobacco industry. As far as the Chinese tobacco monopoly is concerned, although smoking harms people's health, restraining smoking threatens social stability and government income, which may be more serious problems for any government. China still has a long way to go in creating smoke-free environments.

Sex differences in the association between smoking and central sensitization: A cross-sectional study.

INTRODUCTION: Despite the acknowledged interconnection between smoking and pain, research on the relationship between smoking and central sensitization (CS) is scarce; this pain mechanism has attracted recent research attention. Considering potential sex differences, this cross-sectional study aimed to investigate the association between smoking and CS. METHODS: Overall, 415 adult participants from an outpatient clinic underwent evaluation. The analysis focused on determining the relationship between smoking status and CS by differentiating between sexes. Data were collected on smoking presence or absence (independent variable) and CS (dependent variable) for each sex, with age, education level, drinking history, depression, and anxiety as covariates. CS was evaluated using the Central Sensitization Inventory. Following a descriptive analysis of the study population's characteristics, logistic regression analysis was employed to assess the relationships. RESULTS: The average participant age was 42.3 years, with 59% being women. Among women, a significant association was found between smoking status and higher CS severity (AOR=3.21; 95% CI 1.29-7.99, p<0.01), after accounting for confounding variables. Conversely, no significant association was observed for men (AOR=1.50; 95% CI 0.63-3.60, p=0.36). Interaction by sex on the relationship between smoking and CS was not statistically significant (p=0.23). CONCLUSIONS: This study suggests a potential association between smoking and CS in women, whereas no conclusive relationship was observed among men. These findings indicate the necessity of considering CS when examining the relationship between smoking and pain.

Psychosomatic symptoms related to exacerbation of fatigue in patients with medically unexplained symptoms.

Background: Medically unexplained symptoms (MUS) are common conditions that cause various somatic complaints and are often avoided in primary care. Fatigue frequently occurs in patients with MUS. However, the somatic and psychiatric symptoms associated with fatigue in patients with MUS are unknown. This study aimed to clarify the intensity of fatigue and the related somatic and psychiatric symptoms in patients with MUS. Methods: A total of 120 patients with MUS aged 20-64 years who visited the Department of Psychosomatic Medicine, Toho University Medical Center Omori Hospital, between January and March 2021 were considered. The participants' medical conditions were assessed using the Chalder Fatigue Scale (CFS), Somatic Symptom Scale-8 (SSS-8), and Hospital Anxiety and Depression Scale (HADS). We estimated the relationship between CFS, SSS-8 and HADS by using Spearman's rank correlation. Additionally, linear multiple regression analysis with CFS as the objective variable was used to identify symptoms related to fatigue. Results: Fatigue was significantly associated with all symptoms observed (p < 0.01). Linear multiple regression analysis revealed that "dizziness," "headache," and "Sleep medication" were extracted as relevant somatic symptoms (p < 0.05), independent of anxiety and depression, which were already known to be associated with fatigue in MUS. Conclusion: The intensity of anxiety, depression, headache, and dizziness were all associated with the intensity of fatigue in MUS patients. On the contrary, sleeping medication was associated with lower levels of fatigue in MUS.

Association of illness perception and alexithymia with fatigue in hemodialysis recipients: a single-center, cross-sectional study.

Fatigue in hemodialysis recipients interferes with daily activities and renal rehabilitation, and its underlying causes and treatment remain unclear. Psychological factors, like illness perceptions and alexithymia, cause fatigue in other diseases; however, their contribution to hemodialysis-related fatigue is unknown. This cross-sectional study included 53 hemodialysis recipients. To assess participants' fatigue, we used a self-administered patient-reported outcome questionnaire whose items have shown correlation with those of established scales, such as the Profile of Mood States and Visual Analogue Scales. The associations among the scores of the revised Illness Perceptions Questionnaire (IPQ-R), Toronto Alexithymia Scale (TAS-20), and Hospital Anxiety and Depression Scale and fatigue were analyzed using bivariable and multivariable analyses. Patients with fatigue had significantly higher median scores for the IPQ-R subscales "Identity" and "Negative emotional representation about illness" than those without fatigue, suggesting the association of specific illness perception with fatigue. Median scores for the TAS-20 subscale "Difficulty identifying feelings" were also significantly higher among fatigued patients, suggesting the association of alexithymia with fatigue. Depression was not associated with fatigue. Multivariable logistic regression revealed the association of a high "Identity" score with the risk of fatigue (adjusted odds ratio, 1.32; 95% confidence interval, 1.00-1.73; P = 0.04), while there were no significant association between a high "Difficulty identifying feelings" score and the risk of fatigue (adjusted odds ratio, 1.09; 95% confidence interval, 0.95-1.24). Specific illness perception and alexithymia were slightly associated with hemodialysis-related fatigue. Cognitive-behavioral therapy for these conditions could reduce fatigue and promote renal rehabilitation.

Job stress strengthens the link between metabolic risk factors and renal dysfunction in adult men.

Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease. The metabolic risk factors obesity, hypertension, diabetes, and dyslipidemia are closely associated with renal dysfunction. As psychosocial stress affects these risk factors, here, we examined relationships between metabolic risk factors and renal function, and their association with job stress. The participants were 1,231 Japanese male office workers attending annual health examinations. The estimated glomerular filtration rate (eGFR) was determined using the equation recommended by the Japanese Society for Nephrology: eGFR (mL/min/1.73 m(2)) = 194 × age(-0.287) × Cr(-1.094). Job stress was measured using the Job Content Questionnaire based on the job demand-control model. The job strain index equaled the job demand scores divided by the job control scores. The participants were classified into four ordinal groups of job strain index, based on previous studies (i.e., ≤ 0.4 the lowest, 0.4-0.5 lower, 0.5-0.6 higher, or ≥ 0.6 the highest). A significant correlation was found between lowered eGFR and each of the metabolic risk factors waist circumference, systolic and diastolic blood pressure, and total cholesterol (p < 0.001). Furthermore, job stress had an interactive effect on the relationships between eGFR and systolic and diastolic blood pressure, and triglycerides, depending on the job strain index (highest vs. lowest) (p < 0.05). The highly stressed workers exhibited a close association of eGFR with metabolic risk factors like hypertension and dyslipidemia. Therefore, intensive management may be important for preventing the progression of renal dysfunction and cardiovascular complications in those experiencing stress.

Utility and optimal cut-off point of the Somatic Symptom Scale-8 for central sensitization syndrome among outpatients with somatic symptoms and related disorders.

BACKGROUND: Central sensitization syndrome (CSS) involves severe functional symptoms due to central sensitization. for patients with severe somatic symptoms and related disorders (SSRDs), central sensitization may be responsible for their functional symptoms. We hypothesized that screening for CSS in patients with SSRDs would identify those with severe disease. The Somatic Symptom Scale-8 (SSS-8) is a simple tool to assess medical conditions related to SSRDs, but the cut-off point to identify severe cases of comorbid CSS is unknown. This study aimed to determine the optimal cut-off point of SSS-8 for screening the CSS of patients with severe SSRDs. METHODS: In total, 143 patients with SSRDs attending outpatient clinics of a university hospital in Japan were included in the study. The participants were evaluated using the SSS-8 for somatic symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Pain Catastrophizing Scale (PCS) for catastrophic thoughts, and Central Sensitization Inventory (CSI-A, B) for CSS. Receiver operating characteristic (ROC) curve analysis was performed using the propensity score. The area under the curve (AUC) was calculated using a propensity score considering PCS, age, sex, HADS, and CSI-B as confounders of SSS-8 and CSS to evaluate differences in diagnostic accuracy between patients with and without SSS-8. The sensitivity and specificity of the ROC analysis were then used to determine the cut-off point for discriminating severe cases of SSS-8. RESULTS: Of the 143 participants, 126 responded (51 CSS group and 75 non-CSS group), with a valid response rate of 88.1 percent. In the ROC analysis, the propensity score including SSS-8 was statistically more accurate. The optimal cut-off point was 13, with an AUC of 0.88, sensitivity of 84.3 percent, and specificity of 77.3 percent. CONCLUSIONS: The SSS-8 is a useful tool for discriminating severe cases of SSRDs comorbid with CSS.

Effect of central sensitization on dizziness-related symptoms of persistent postural-perceptual dizziness.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic functional dizziness symptom triggered by psychological stress, but its pathophysiology is unknown. Central sensitization is considered the cause of functional diseases, such as medically unexplained symptoms, and is a psychosocially affected condition. However, the association between dizziness symptoms in PPPD and central sensitization remains unclear. Thus, we conducted a cross-sectional study on the relation between dizziness symptoms and central sensitization in PPPD. METHODS: We recruited 61 outpatients with dizziness who met the PPPD diagnostic criteria. In addition to the evaluation of dizziness symptoms using the Dizziness Handicap Inventory, the participants were evaluated using the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Central Sensitization Inventory (CSI). A CSI score of 40 or higher was defined as central sensitization syndrome (CSS), and the severity of each condition in CSS and non-CSS participants was compared. We also evaluated the association between dizziness symptoms and central sensitization and coexisting symptoms using linear multiple regression analysis. RESULTS: We analyzed the data of 50 valid responses (valid response rate of 82.0 percent). Compared with the non-CSS group, the CSS group had a higher degree of disability owing to dizziness and a higher rate of complications of anxiety and depression. The regression analysis results showed that the severity of central sensitization was a related factor that could enhance the dizziness symptoms of PPPD. CONCLUSIONS: Central sensitization may affect the dizziness symptoms of PPPD as an exacerbating factor.

Smoking rates among schizophrenia patients in Japan.

According to the meta-analysis performed by de Leon and Diaz, the smoking rate was higher among schizophrenia patients than in the general population with the exception of the populations of Japan and Colombia. The purpose of this study was to reexamine the association between schizophrenia and smoking among Japanese schizophrenia patients using objective measures. The sample comprised 172 schizophrenia inpatients (mean age: 54years; 55% male). Participants were asked by a psychiatrist whether they currently smoked, and their answers were confirmed by the Fagerström Test for Nicotine Dependence and a measurement of the carbon monoxide level in expired air. Data on 7496 Japanese people obtained from the national survey of health were used as the control group. Seventy schizophrenia patients (40.7%) were identified as smokers; the smoking rate was higher among men in their 50s (66.7%) and among women in their 40s (54.6%). The smoking rate was 24.2% in the control group, and multiple logistic regression analysis showed that this percentage was significantly higher in the schizophrenia than in the control group (odds ratio: 2.17), adjusting for sex and age. The association between smoking rate and schizophrenia is consistent across countries, including Japan.

Lack of leisure-time physical activity in non-obese Japanese men with components of metabolic syndrome.

A focus exclusively on waist circumference, the main component used in the diagnosis of metabolic syndrome (MetS), may lead to ignoring non-obese individuals with other MetS components, including high levels of blood pressure, fasting blood glucose, and triglycerides and low levels of high-density lipoprotein. This study investigated lifestyles and eating behaviors among non-obese individuals with components of MetS. Of the 918 Japanese male workers, 151 subjects (16.4%) had a waist circumference < 85 cm with more than one MetS component. This non-obese high-risk group for MetS gained weight in adulthood, consume alcohol, and engage in less leisure-time physical activity compared to 317 subjects (34.5%) with a waist circumference < 85 cm and without MetS components (p < 0.05). The remaining 450 subjects (49%) were obese with a waist circumference ≥ 85, including 93 men with MetS. A lack of leisure-time physical activity was associated with the non-obese high-risk group for MetS [odds ratio 1.59, 95% confidence interval 1.02 - 2.49] compared to the 317 non-obese men without MetS (reference group). Such a difference in physical activity was not found between the 450 obese subjects and the reference group. Instead, eating behaviors, such as eating rapidly, preference for fatty foods, and eating out for dinner, were significantly associated with MetS. Thus, men with smaller waist circumferences and any MetS component should be carefully monitored for physical activity to prevent further development of MetS, while men with larger waist circumferences including MetS need to be monitored for unfavorable eating behaviors.

Job stress and healthy behavior among male Japanese office workers.

BACKGROUND: Lifestyle modification in healthy workers is challenging. We aim to investigate associations between job stress and healthy behavior change among workers. METHODS: This cross-sectional study investigated 1,183 Japanese male white-collar workers in 2008 during health checkups for Metabolic Syndrome. Healthy behavior included either a calorie-focused diet or regular exercise. Job stress was measured by Job Content Questionnaire based on the job demands-control model and tension-anxiety and anger-hostility scales on the Profile of Mood States. RESULTS: Healthy behaviors were confirmed in 54% of study subjects. Multivariate logistic model showed that healthy behaviors were positively associated with a higher degree of work control and negatively associated with greater work demand. Work control and support were negatively correlated with tension-anxiety and depression, whereas work demand and strain were positively correlated with these two emotion domains (all P's < 0.0001). CONCLUSIONS: It is suggested that addressing job stress is of clinical importance to promote healthy behaviors.

Validity of self-reported smoking in schizophrenia patients.

AIMS: It is important to evaluate smoking status among schizophrenia patients because such patients are highly inclined to take up smoking, but only a few studies have focused on the validity of self-reported smoking in relation to schizophrenia. The aim of the present study was therefore to determine the validity of self-reported smoking and to investigate whether self-reported smoking is biased in schizophrenia patients. METHODS: A total of 158 schizophrenia patients answered self-rated questions of smoking status, and the level of carbon monoxide (CO) in expired air was measured. The relationship of the self-reported smoking to the CO levels was determined, and interaction of the disease duration and education level on this relationship was evaluated using correlation and receiver operating characteristic analyses. RESULTS: The CO levels in the expired air were found to be positively related to the self-reported data (P < 0.01). The stratified data on the duration of schizophrenia indicated that the positive relationship between self-reported smoking and the CO concentration became less obvious with the increase in duration of schizophrenia (P(trend) < 0.01). In contrast, the stratified data on education level did not indicate any such significant modifying effect. CONCLUSIONS: Although self-reporting is useful for evaluating smoking status, psychiatrists should use objective methods of measurement to assess the smoking status of chronic schizophrenia patients.

Effect of relaxation therapy on benzodiazepine use in patients with medically unexplained symptoms.

BACKGROUND: The change in the benzodiazepine (BZD) use of patients with medically unexplained symptoms (MUS) following the application of relaxation therapy were examined. METHODS: Of the 221 outpatients with MUS using BZD, 42 received relaxation therapy. Change in BZD use was compared using a relaxation group (n = 42) and a control group that had 84 MUS patients whose baseline was matched by optimal matching algorithms. Logistic regression analysis was done to evaluate the effect of BZD-dependent factors on the BZD dose of the relaxation group. RESULTS: Compared with the control group, the number of patients who decreased the amount of BZD and the number of patients whose subjective symptoms of MUS improved were significantly higher in the relaxation group (p < 0.05). In addition, a factor that made it difficult to reduce the BZD of MUS patients who had undergone relaxation was a long history of BZD use, for more than 6 months (odds ratio, 0.06, 95% confidence interval, 0.01-0.36). CONCLUSIONS: Relaxation therapy for patients with MUS may help reduce BZD use; however, early intervention is important to prevent BZD dependence.

Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study.

BACKGROUND: Recent studies on the association between the metabolic syndrome (MetS) and depression have reported conflicting findings. This 1-year cohort study aims to evaluate the association of MetS with the development of both depression and anxiety. METHODS: The cohort comprised 956 Japanese male employees of an enterprise (mean age, 42.7 years; SD, 10.2 years). MetS was diagnosed according to the International Diabetes Federation criteria. The psychological conditions of depression and anxiety were assessed in 2 successive years by using the profile of mood states (POMS) questionnaire and by conducting clinical interviews as per the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). We evaluated the temporal and dose-response relationships between MetS and the development of depression and anxiety, controlling for potential confounding factors like age and lifestyle-related factors. RESULTS: We identified a positive relationship between MetS at baseline and new-onset depression in the subsequent year (OR 2.14, 95% CI 1.10-4.17). Of the five MetS components examined, only waist circumference was significantly related to new-onset depression (OR 2.08, 1.23-3.50). Trend analysis revealed a significant positive trend of association between the number of MetS components identified and new-onset depression (P(trend) < 0.01), but not between Mets and new-onset anxiety. CONCLUSIONS: Our results suggest that MetS is a predictive factor for the development of depression, and that waist circumference largely contributes to the association between MetS and depression.

Association of metabolic syndrome with smoking and alcohol intake in Japanese men.

INTRODUCTION: There have been conflicting findings on whether metabolic syndrome (MetS) is associated with smoking and alcohol intake. This study investigated the association of MetS with smoking and alcohol intake. METHODS: MetS was defined according to the International Diabetes Federation criteria, and smoking and alcohol intake were evaluated for 1,215 Japanese male workers using a questionnaire. The association of MetS with smoking and alcohol intake was assessed using logistic regression after adjusting for potential confounders. Proportional analyses for the prevalence of MetS among smoking and alcohol intake were performed as well. RESULTS: Among the subjects, 148 (12%) were diagnosed with MetS, 485 (40%) were smokers, and 954 (79%) were regular alcohol users. The prevalence of MetS was the highest (19%) in smokers who did not drink, followed by smokers who also drank (13%), nonsmokers who drank (12%), and those who neither smoked nor drank (7%). Smoking itself was positively related to MetS (odds ratio [OR] = 1.4; 95% CI = 1.1-2.1) and MetS components, including larger waist circumference (OR = 1.5; 95% CI = 1.2-1.9), elevated triglyceride (OR = 1.9; 95% CI = 1.4-2.4), and reduced high-density lipoprotein cholesterol (OR = 1.7; 95% CI = 1.1-2.7). Alcohol intake was not significantly related to MetS; it was positively correlated only to higher fasting plasma glucose (OR = 1.7; 95% CI = 1.1-2.6). DISCUSSION: These results suggest that cigarette smoking is an independent risk factor for MetS, but the risk does not seem to be exaggerated by alcohol intake.