OBJECTIVE -To investigate the association between serum ␥-glutamyltransferase (GGT) and risk of metabolic syndrome and type 2 diabetes in Japanese male office workers.RESEARCH DESIGN AND METHODS -This study included 2,957 metabolic syndrome-free men and 3,260 nondiabetic men aged 35-59 years who did not have medication for hepatitis, alanine aminotransferase (ALT) levels higher than three times the upper limit of the reference range, or a history of cardiovascular disease at study entry. Subjects were reexamined at periodic annual health examinations over a 7-year period. We used a modified National Cholesterol Education Program definition of metabolic syndrome with BMI instead of waist circumference and the revised criteria of the American Diabetes Association for type 2 diabetes.RESULTS -With adjustment for age, family history of diabetes, BMI, alcohol intake, cigarette smoking, regular physical activity (fasting plasma glucose for the risk of type 2 diabetes), and white blood cell (WBC) count, the risk of metabolic syndrome and type 2 diabetes increased in correlation with the levels of serum GGT, ALT, aspartate aminotransferase (AST), and alkaline phosphatase. Additional adjustment for all of the other liver enzymes attenuated these associations, but serum GGT remained a significant risk factor for the risk of both metabolic syndrome and type 2 diabetes (P for trend Ͻ0.001 for both). Top one-fifth versus bottom one-fifth relative risks of metabolic syndrome and type 2 diabetes were 2.23 (95% CI 1.51-3.30) and 2.44 (1.34 -4.46), respectively.CONCLUSIONS -These results indicate that serum GGT may be an important predictor for developing metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care 27:1427-1432, 2004I n addition to its diagnostic uses, serum ␥-glutamyltransferase (GGT) has substantial epidemiologic significance (1). Prospective studies (2,3) have shown a significant relationship between serum GGT and the development of specific conditions including coronary heart disease (CHD) and stroke. In addition to alcohol, obesity has been found (4) to have a major effect on serum GGT, and there is increasing evidence (4 -8) linking raised serum GGT levels with other metabolic disturbances, such as glycemic disorder, hypertension, hypertriglyceridemia, and low HDL cholesterol. Excess deposition of fat in liver, usually termed nonalcoholic fatty liver disease, is closely associated with elevated serum GGT, obesity, insulin resistance, and hyperinsulinemia (9 -11). These interrelations between serum GGT, obesity, other metabolic disturbances, and plasma insulin raise the possibility that elevated GGT levels can help predict the development of metabolic syndrome and type 2 diabetes.The Adult Treatment Panel III of the National Cholesterol Education Program (NCEP) recently proposed a definition of the metabolic syndrome to aid identification of individuals at risk for both CHD and type 2 diabetes (12). The definition incorporates thresholds for five easily measured variables linked to insu...

We examined the association of serum uric acid (SUA) with development of hypertension (blood pressure > or = 140/90 mmHg and/or medication for hypertension) and impaired fasting glucose (IFG) (a fasting plasma glucose level 6.1-6.9 mmol/l) or Type II (non-insulin-dependent) diabetes (a fasting plasma glucose level > or = 7.0 mmol/l and/or medication for diabetes) over a 6-year follow-up among 2310 Japanese male office workers aged 35-59 years who did not have hypertension, IFG, Type II diabetes, or past history of cardiovascular disease at study entry. After controlling for potential predictors of hypertension and diabetes, the relative risk for hypertension compared with quintile 1 of SUA level was 1.27 [95% confidence interval (CI): 1.00-1.62] for quintile 2, 1.34 (95% CI: 1.08-1.74) for quintile 3, 1.48 (95% CI: 1.18-1.89) for quintile 4, and 1.58 (95% CI: 1.26-1.99) for quintile 5 (p for trend <0.001). The respective multivariate-adjusted relative risks for IFG or Type II diabetes compared with quintile 1 of SUA level were 1.55 (95% CI: 0.95-2.63), 1.62 (95% CI: 0.98-2.67), 1.61 (95% CI: 1.01-2.58), and 1.78 (95% CI: 1.11-2.85) (p for trend = 0.030). The association between SUA level and risk for hypertension and IFG or Type II diabetes was stronger among men with a body mass index (BMI) <24.2 kg/m2 than among men with a BMI > or = 24.2 kg/m2, although the absolute risk was greater in more obese men. These results indicate that SUA level is closely associated with an increased risk for hypertension and IFG or Type II diabetes.

Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.

Aim: All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database.Methods: We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n = 31,790) and nonparticipants (n = 189,726) who were eligible for SHG in 2008.Results: Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p < 0.01) and 2.25 vs 0.68 kg in women (p < 0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p < 0.01) and 1.53 vs 0.42 kg in women (p < 0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants.Conclusion: Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

Study objective-To evaluate the association of long working hours with the risk for hypertension. Design-A five year prospective cohort study. Setting-Work site in Osaka, Japan. Participants-941 hypertension free Japanese male white collar workers aged 35-54 years were prospectively examined by serial annual health examinations. Men in whom borderline hypertension and hypertension were found during repeated surveys were defined as incidental cases of borderline hypertension and hypertension. Conclusions-These results indicate that long working hours are negatively associated with the risk for hypertension in Japanese male white collar workers. (J Epidemiol Community Health 2001;55:316-322) With regard to the eVect of working hours on health, long working hours have been shown to be related to various disorders and diseases such as chronic fatigue, 1 2 musculoskeletal complaints, 3 mental stress or health, 4-6 dissatisfaction with work, 7 depression, 8 and coronary heart disease. 9 10 In particular, "Karoshi", or sudden unexplained death in relatively young workers, has received considerable attention as a social problem in Japan.11 It is widely thought that strenuous work for long hours, which is so much a part of the modern Japanese culture, is a major contributory factor for Karoshi resulting from hypertensive or arteriosclerotic disease.As for the association between long working hours and blood pressure, the influence of long working hours on blood pressure is related to sympathetic nerve activity and concentrations of counterregulatory hormones that accompanies psychological stress 12 13 and physical activity.14 As overtime work is very often accompanied by such stress and physical activity, it is reasonable to expect an association between long working hours and the risk for hypertension. However, there is no convincing evidence to support the view that long working hours contribute to long term blood pressure and predisposition to hypertension. Therefore, it is necessary to conduct a longitudinal study to clarify the relation between long working hours and the risk for hypertension.In this report on a longitudinal population study based on serial annual health examinations at the workplace, we have tried to prospectively examine the association between long working hours and the risk for hypertension in hypertension free Japanese male white collar workers. Methods STUDY COHORTOur study is an ongoing cohort investigation designed to clarify risk factors for major diseases, including hypertension, dyslipidaemia, and diabetes among Japanese male white collar workers, not working in a shift system at T Corporation, one of the biggest building contractors in Osaka, Japan. The Industrial Safety and Health Law in Japan requires the employer to conduct annual health examinations of all employees; the employee data, which are anonymised, are available for research with the approval of the employer. To evaluate the association of long working hours with the risk for hypertension, a surveillance of the in...