Center for Clinical science

Tokyo, Japan

Center for Clinical science

Tokyo, Japan
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Kurotani K.,Center for Clinical science | Nanri A.,Center for Clinical science | Goto A.,National Center for Global Health and Medicine | Mizoue T.,Center for Clinical science | And 4 more authors.
British Journal of Nutrition | Year: 2014

Limited and inconsistent associations between cholesterol and egg consumption and type 2 diabetes risk have been observed in Western countries. In the present study, the association of dietary cholesterol and egg intakes with type 2 diabetes risk was examined prospectively. The study subjects comprised 27 248 men and 36 218 women aged 45-75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study and had no histories of type 2 diabetes or other serious diseases. Dietary cholesterol and egg intakes were estimated using a validated 147-item FFQ. The OR of self-reported, physician-diagnosed type 2 diabetes over 5 years were estimated using multiple logistic regression. A total of 1165 newly diagnosed cases of type 2 diabetes were self-reported. Although dietary cholesterol intake was not associated with type 2 diabetes risk in men, it was found to be associated with a 23 % lower odds of type 2 diabetes risk in women in the highest quartile of intake, albeit not statistically significant, compared with those in the lowest quartile (P trend= 0·08). Such risk reduction was somewhat greater among postmenopausal women; the multivariable-adjusted OR for the highest quartile of cholesterol intake compared with the lowest quartile was 0·68 (95 % CI 0·49, 0·94; P trend= 0·04). No association between egg intake and type 2 diabetes risk was found in either men or women. In conclusion, higher intake of cholesterol or eggs may not be associated with an increased risk of type 2 diabetes in Japanese populations. The observed association between decreased type 2 diabetes risk and higher dietary cholesterol intake in postmenopausal women warrants further investigation. Copyright © The Authors 2014.

Nanri A.,Center for Clinical science | Mizoue T.,Center for Clinical science | Poudel-Tandukar K.,Waseda University | Noda M.,National Center for Global Health and Medicine | And 6 more authors.
British Journal of Psychiatry | Year: 2013

Background: Although dietary patterns have been linked to depression, a frequently observed precondition for suicide, no study has yet examined the association between dietary patterns and suicide risk. Aims: To prospectively investigate the association between dietary patterns and death from suicide. Method: Participants were 40 752 men and 48 285 women who took part in the second survey of the Japan Public Health Centerbased Prospective Study (1995-1998). Dietary patterns were derived from principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Hazard ratios of suicide from the fourth year of follow-up to December 2005 were calculated. Results: Among both men and women, a 'prudent' dietary pattern characterised by a high intake of vegetables, fruits, potatoes, soy products, mushrooms, seaweed and fish was associated with a decreased risk of suicide. The multivariable-adjusted hazard ratio of suicide for the highest v. lowest quartiles of the dietary pattern score was 0.46 (95% CI 0.28-0.75) (P for trend, 0.005). Other dietary patterns (Westernised and traditional Japanese) were not associated with suicide risk. Conclusions: Our findings suggest that a prudent dietary pattern may be associated with a decreased risk of death from suicide.

Nawa T.,Hitachi General Hospital | Nakagawa T.,Hitachi General Hospital | Mizoue T.,Hitachi Health Care Center | Endo K.,Center for Clinical science
Journal of Thoracic Imaging | Year: 2015

Lung cancer is a leading cause of cancer death in both male and female individuals in Japan. The effect of screening using chest radiography is assumed to be limited. In Japan, screening using low-dose computed tomography (CT) was initiated in 1993, and its dissemination has progressed with studies evaluating its efficacy, although it is not officially recommended. In addition to the academic activities of the Japanese Society of CT Screening, certification of physicians and radiologic technologists by the Japan Accreditation Council for CT Screening has been progressing. Currently, several hundred thousand low-dose CT screenings are performed annually in Japan. In Hitachi City, Ibaraki Prefecture, low-dose CT screening among employees and in communities started in 2001, and it was estimated that 40% of 50-to 69-year-old citizens had undergone screening at least once by March 2009. The lung cancer mortality rate in citizens in this age group decreased by 24% in 2005 to 2009 compared with the national statistics. Low-dose CT screening targeting the general population may be effective, but it is necessary to consider the target and interval of screening separately from those for the highrisk group. Observational study may play a role in evaluating the efficacy of screening in Japan. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Yamamoto S.,Hitachi Ltd. | Matsushita Y.,Center for Clinical science | Nakagawa T.,Hitachi Ltd. | Hayashi T.,Hitachi Ltd. | And 2 more authors.
Nutrition and Diabetes | Year: 2014

BACKGROUND: Adiponectin has anti-inflammatory and insulin-sensitizing properties. Prospective studies have consistently shown a lower risk of type 2 diabetes among those with higher circulating adiponectin levels. OBJECTIVE: We examined prospectively the association between serum adiponectin levels and type 2 diabetes risk among Japanese workers, taking visceral fat mass into account. SUBJECTS AND METHODS: Subjects were 4591 Japanese employees who attended a comprehensive health screening in 2008; had biochemical data including serum adiponectin; were free of diabetes at baseline; and received health screening in 2011. Multiple logistic regression analysis was used to examine the association between adiponectin and incidence of diabetes among overall subjects, as well as subgroups. Stratified analyses were carried out according to variables including visceral fat area (VFA). RESULTS: During 3 years of follow-up, 217 diabetic cases were newly identified. Of these, 87% had a prediabetes at baseline. Serum adiponectin level was significantly, inversely associated with incidence of diabetes, with odds ratios (95% confidence interval) adjusted for age, sex, family history, smoking, alcohol drinking, physical activity and body mass index (BMI) for the lowest through highest quartile of adiponectin of 1 (reference), 0.79 (0.55-1.12), 0.60 (0.41-0.88) and 0.40 (0.25-0.64), respectively (P-value for trend o0.01). This association was materially unchanged with adjustment for VFA instead of BMI. After further adjustment for both homeostasis model assessment of insulin resistance and hemoglobin A1c, however, the association became statistically nonsignificant (P-value for trend = 0.18). Risk reduction associated with higher adiponectin levels was observed in both participants with and without obesity or insulin resistance at baseline. CONCLUSIONS: Results suggest that higher levels of circulating adiponectin are associated with a lower risk of type 2 diabetes, independently of overall and intra-abdominal fat deposition, and that adiponectin may confer a benefit in both persons with and without insulin resistance. © 2014 Macmillan Publishers Limited.

Tsujimoto T.,Center Hospital | Sugiyama T.,Center for Clinical science | Sugiyama T.,University of Tokyo | Noda M.,Saitama University | Kajio H.,Center Hospital
Diabetes Care | Year: 2016

OBJECTIVE Recent studies have suggested that β-Blockers may decrease the adverse influence of hypoglycemia and reduce hypoglycemia-associated cardiac arrhythmias and death. We evaluated whether intensive glycemic therapy in patients with diabetes receiving treatment with β-Blockers showed beneficial effects for the prevention of cardiovascular events without increased mortality compared with a standard glycemic therapy. RESEARCH DESIGN AND METHODS We used Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial data to assess the risks of cardiovascular events, all-cause death, and cardiovascular death in patients with diabetes receiving treatment with β-Blockers (n = 3,079) and not receiving treatment with β-Blockers (n = 7,145) using Cox proportional hazard models. RESULTS In patients receiving treatment with β-Blockers, the cumulative event rates for cardiovascular events were significantly lower in the intensive therapy group compared with the standard therapy group (hazard ratio [HR] 0.81; 95% CI 0.67-0.97; P = 0.02), whereas those rates in patients not receiving treatment with β-Blockers were not significantly different (HR 0.92; 95% CI 0.78-1.09; P = 0.36). Conversely, the cumulative event rates for all-cause and cardiovascular deaths in patients receiving treatment with β-Blockers were not significantly different between the standard therapy and intensive therapy groups (all-cause death: HR 1.08; 95% CI 0.83-1.42; P = 0.54; cardiovascular death: HR 1.05; 95% CI 0.72-1.51; P = 0.79), whereas in patients not receiving treatment with β-Blockers, the event rates were significantly higher in the intensive therapy group compared with the standard therapy group (all-cause death: HR 1.25; 95% CI 1.02-1.52; P = 0.02; cardiovascular death: HR 1.43; 95% CI 1.03-1.98; P = 0.03). CONCLUSIONS Intensive glycemic therapy may be effective in patients with type 2 diabetes receiving treatment with β-Blockers. © 2016 by the American Diabetes Association.

Kuwahara K.,Center for Clinical science | Kuwahara K.,Teikyo University | Honda T.,Hitachi Ltd. | Nakagawa T.,Hitachi Ltd. | And 4 more authors.
International Journal of Behavioral Nutrition and Physical Activity | Year: 2015

Background: Leisure-time physical activity is associated with a lower risk of depression. However, the precise shape of the dose-response relationship remains elusive, and evidence is scarce regarding other domains of activity. We prospectively investigated associations of physical activity during leisure, work, and commuting with risk of depressive symptoms in Japanese workers. Methods: We conducted a cohort study of 29 082 Japanese workers aged 20-64 years without psychiatric disease (including depressive symptoms) at baseline with a maximum 5-year follow-up. Physical activity was self-reported. Depressive symptoms were assessed by 13 self-report questions on subjective symptoms. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for incidence of depressive symptoms were calculated using Cox regression analysis. Results: During a mean follow-up of 4.7 years, 6177 developed depressive symptoms. Leisure exercise showed a U-shaped association with risk of depressive symptoms adjusting for potential confounders. Additional adjustment for baseline depression scores attenuated the association, but it remained statistically significant (P for trend = 0.037). Compared with individuals who engaged in sedentary work, the HR (95 % CI) was 0.86 (0.81, 0.92) for individuals who stand or walk during work and 0.90 (0.82, 0.99) for those who are fairly active at work. However, the association disappeared after adjusting for baseline depression scores. Walking to and from work was not associated with depressive symptoms. Conclusions: The findings suggest that leisure-time exercise has a U-shaped relation with depressive symptoms in Japanese workers. Health-enhancing physical activity intervention may be needed for individuals who engage in sedentary work. © 2015 Kuwahara et al.

PubMed | National Center for Global Health and Medicine, Hitachi Ltd., Center for Clinical science and Diabetes Research Center
Type: | Journal: Journal of diabetes investigation | Year: 2017

Higher iron storage has been linked to increased risk of type 2 diabetes, but little is known about the mediator of this association. Here, we prospectively investigated the association between circulating ferritin, a marker of iron storage, and the incidence of type 2 diabetes among Japanese.Subjects were 4754 employees who attended a comprehensive health checkup in 2008-2009 and donated blood for the study. During 5 years of follow-up, diabetes was identified based on plasma glucose, glycated hemoglobin, and self-report. Two controls matched to each case on sex, age, and date of checkup were randomly chosen using density sampling, giving 327 cases and 641 controls with ferritin measurement. Cox proportional hazards regression was used to estimate HR while adjusting for a series of potential confounders or mediators.Elevated serum ferritin levels were associated with a significantly increased risk of type 2 diabetes, with hazard ratio (HR) adjusted for known risk factors in the highest versus lowest quartile of 1.42 (95% confidence interval 1.03, 1.96). This association was unchanged after adjustment for C-reactive protein and adiponectin, but attenuated after adjustment for liver enzyme and insulin resistance (HR 1.04). The ferritin-diabetes association was confined to non-obese participants.These results suggest that elevated iron storage is associated with increased risk of type 2 diabetes in normal weight individuals, and that this association is partly mediated through liver dysfunction and resulting insulin resistance. This article is protected by copyright. All rights reserved.

Nishijima T.,Clinical Center | Nishijima T.,Kumamoto University | Shimbo T.,Center for Clinical science | Komatsu H.,Saku Central Hospital | And 5 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

Background: The epidemiology of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) who do not inject drugs in Asia remains unknown. Method: The incidence and risk factors for incident HCV infection among HIV-infected MSM at a large HIV clinic in Tokyo were elucidated. Poisson regression compared the incidence of HCV seroconversion at different observation periods. Results: Of 753 HIV-1 infected MSM patients negative for HCV antibody (HCVAb) at baseline and available follow-up HCVAb test, 21 patients (2.8%) seroconverted to HCVAb positive over 2246 person-years (PY), for an incidence of 9.35 per 1000 PY. The incidence increased over time from 0 per 1000 PY in 2005-2006, 3.0 per 1000 PY in 2007-2008, 7.7 per 1000 PY in 2009-2010, to 24.9 per 1000 PY in 2011-2012 (P = 0.012). Of 21 incident cases, only 4 (19%) were injection drug users, and sensitivity analysis that excluded injection drug users yielded similar findings. Multivariate analysis identified illicit drug use to be an independent risk for HCV infection (hazard ratio = 3.006; 95% confidence interval: 1.092 to 8.275; P = 0.033). Conclusions: Incident HCV infection is increasing among HIV-1- infected MSM noninjection drug users at resource-rich setting in Asia. Illicit drug use is an independent risk factor for incident HCV infection in this population. Copyright © 2013 by Lippincott Williams and Wilkins.

Nishijima T.,Clinical Center | Nishijima T.,Kumamoto University | Shimbo T.,Center for Clinical science | Komatsu H.,Saku Central Hospital | And 6 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: This study aimed to examine the effect of long-term treatment with ritonavir-boosted atazanavir (atazanavir/ritonavir) on cholelithiasis. Methods: A single-centre, cross-sectional study was conducted to elucidate the prevalence of cholelithiasis in patients with HIV-1 infection who underwent abdominal ultrasonography between January 2004 and March 2013. Univariate and multivariate logistic regression analyses were applied to estimate the effects of >2 years of atazanavir/ritonavir exposure on cholelithiasis as the primary exposure. Results: Of the 890 study patients, 84 (9.4%) had >2 years of atazanavir/ritonavir exposure. Cholelithiasis was twice as frequent in those treated for >2 years with atazanavir/ritonavir [15 (18%) of 84 patients] compared with those treated for <2 years [72 (8.9%) of 806 patients] (P1/40.018). Univariate analysis showed a significant association between >2 years of atazanavir/ritonavir exposure and cholelithiasis (OR=2.216; 95% CI=1.206-4.073; P=0.010) and the association almost persisted in multivariate analysis (adjusted OR=1.806; 95% CI=0.922- 3.537; P=0.085). Long-term treatment (>2 years) with other commonly used protease inhibitors, such as ritonavir- boosted lopinavir and ritonavir-boosted darunavir, was not associated with cholelithiasis in univariate and multivariate analysis. Additional analysis showed that >1 year of exposure to atazanavir/ritonavir was significantly associated with cholelithiasis (OR=1.857; 95% CI=1.073-3.214; P=0.027), whereas >1 year of exposure to ritonavir-boosted lopinavir and ritonavir-boosted darunavir was not. Conclusions: Long-term treatment of patients with HIV-1 infection for >2 years with atazanavir/ritonavir was associated with an increased risk of cholelithiasis compared with patients with shorter exposure. Long-term exposure to atazanavir/ritonavir appears to increase the risk of cholelithiasis in patients with HIV-1 infection.©The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Asada T.,University of Tokyo | Aoki Y.,University of Tokyo | Aoki Y.,New York University | Sugiyama T.,Center for Clinical science | And 7 more authors.
Critical Care Medicine | Year: 2016

Objectives: As interactions of each organ system have been conceptually known to play an important role during life-threatening conditions, we quantitatively evaluated the organ system interactions in critically ill patients and examined the difference in the organ system network structure between the survivors and the nonsurvivors. Design: Prospective observational study. Settings: An ICU of a university hospital. Patients: Two hundred and eighty-two patients who were admitted to the ICU. Interventions: Blood samples were obtained at ICU admission. Measurements and Main Results: We analyzed the associations among nine representative laboratory variables of each organ system using network analysis. We compared the network structure of the variables in the 40 nonsurvivors with that in the 40 survivors. Their baseline characteristics, including the degree of organ dysfunction, were matched using propensity score matching method. Network structure was quantitatively evaluated using edge (significant correlation among variables evaluated by the p value), weight (connective strength of edge evaluated by coefficient), and cluster (group with tight connection evaluated by edge betweenness). The number of edges among the nine variables was significantly fewer for the nonsurvivors than for the severity-matched survivors (3 vs 12; p = 0.035). The mean weight of edges was significantly smaller for the nonsurvivors (0.055 vs 0.119; p = 0.007). The nine laboratory variables for the nonsurvivors were divided into a significantly larger number of clusters (7 vs 2; p = 0.001). Statistical conclusions were preserved with Bonferroni multiple comparison procedure. These findings were consistently observed in comparison of the 40 nonsurvivors with all the survivors. Conclusions: This study, as a preliminary proof-of-concept, quantitatively demonstrated a more disrupted network structure of organ systems in the nonsurvivors compared with that in the survivors. These observations suggest the necessity of assessment for organ system interactions to evaluate critically ill patients. Copyright © 2015 by the Society of Criti.

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