The association between obesity-related indices and cognitive function remains unclear, particularly when considering muscle mass. In this cross-sectional study, we examined these associations in 263 Japanese adults aged ≥ 40 years who underwent a health-checkup (163 males and 100 females). Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J), and obesity-related indices included body mass index, waist-to-hip ratio (WHpR), and other measures of obesity. Among males, WHpR was not significantly associated with MoCA-J scores after adjustment for age and lifestyle factors, whereas an inverse association emerged after additional adjustment for muscle mass. In the fully adjusted model, a higher WHpR was modestly associated with a lower MoCA-J score (standardised coefficient = − 0.17, P = 0.043) and higher odds of mild cognitive impairment (adjusted odds ratio = 1.08; 95% confidence interval, 1.00–1.16). No significant associations were observed among females. These findings suggest a possible modest association between WHpR and cognitive vulnerability in males when muscle mass is taken into account. However, the WHpR × sex interaction was not statistically significant, and the associations in males were borderline. Accordingly, this pattern should be interpreted as exploratory and hypothesis-generating rather than as evidence of any confirmed sex-specific effect. Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry on July 1, 2022 (UMIN000048056).

Bronchiectasis represents a growing global health burden. While computed tomography (CT) is essential for diagnosis, current criteria rely on broncho-arterial ratios and visual assessments, which are subject to inter-observer variability and can be confounded by pathological changes in arterial caliber. This study aimed to develop a novel quantitative method for assessing bronchiectasis by incorporating artificial intelligence-based airway segmentation and establishing location-specific upper limits of normal (ULN) for airway dimensions derived from healthy controls. We analyzed chest CT scans from 459 healthy non-smokers who participated in a lung cancer screening program. Of these, 445 were used to calculate sex- and height-specific ULN values, while 14 served as independent controls for comparison with 14 patients clinically diagnosed with bronchiectasis. Following automatic segmentation of airway trees using previously-established artificial intelligence-based quantitative CT image analysis software, we extracted centerlines. At each point along the airway centerline, we measured the cross-sectional radius and the distance from the lobar bronchus origin. The ULN for airway radius was defined as the 95th percentile of measurements from healthy controls, stratified by sex and height. In patients with bronchiectasis, airways exceeding the ULN were classified as bronchiectatic, and bronchiectatic airway volume percentage (BEV

BACKGROUND:The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). METHODS AND RESULTS:The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. CONCLUSIONS:The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Low body mass index (BMI) is a prognostic factor, and skeletal muscle adiposity may affect mortality irrespective of BMI in patients with chronic obstructive pulmonary disease (COPD). However, the association between muscle adiposity and healthy life expectancy in normal-weight patients remains unestablished. To examine whether lower chest computed tomography (CT)-assessed erector spinae muscle density (ESMD), which represents antigravity muscle adiposity, is associated with subsequent loss of health-related independence in normal-weight patients with COPD. The ESMD lower limit of normal (LLN) was determined in 194 healthy subjects undergoing lung cancer screening CT. In a prospective cohort of patients with COPD undergoing baseline inspiratory/expiratory CT, the onset of loss of health-related independence, requiring long-term nursing facility or home nursing/medical care, was recorded over 5 years. Smokers with COPD (n = 199) were divided into 4 groups on the basis of BMI and the ESMD–LLN: underweight (n = 22), normal-weight with (n = 40) and without (n = 81) low ESMD, and overweight (n = 56). Greater airway wall thickening was associated with BMI-independent low ESMD. A multivariable Cox proportional hazards model including only normal-weight patients with COPD (n = 121) indicated that low ESMD was independently associated with a higher loss-of-independence rate after adjusting for FEV1, COPD assessment test score, and a smaller cross-sectional area of erector spinae muscles (hazard ratio [95

Disclosure: T. Onoue: None. K. Nishida: None. Y. Nakata: None. F. Hayashi: None. M. Marutani: None. N. Sakane: None. J. Moriguchi: None. S. Muto: None. K. Kato: None. I. Masuda: None. T. Okamura: None. K. Matsuzaki: None. T. Kawamura: None. K. Tsushita: None. Background and aims: Recently, numerous smartphone applications for lifestyle improvement have been developed and rapidly disseminated commercially. Some of these mobile health (mHealth) applications are supervised by healthcare professionals, ensuring their quality. The present study aimed to explore how guiding participants of the Specific Health Guidance (SHG) program, a Japanese public health initiative for individuals with metabolic syndrome and preliminary risk, in using commercially available mHealth applications impacts mHealth application usage, lifestyle habits, and cardiovascular risk factors. Materials and methods: In this multicenter, randomized, open-label, parallel-group comparison study, 156 participants with a past history of SHG and current participants of the Motivational Health Guidance program (a type of SHG) in 2021 were assigned to the intervention (n = 76) or control (n = 80) group. In addition to the usual health guidance, the intervention group received advice for the introduction of six types of commercially available mHealth applications based on their individual behavioral goals. The primary outcome was the usage of any mHealth applications, not limited to the six applications introduced in the intervention, 3 months later. The secondary outcomes included the frequency of mHealth application usage, improvements in dietary and exercise habits, and weight loss 3 months later, as well as the changes in anthropometric measurements and clinical laboratory test results 1 year later. Results: The proportion of mHealth application users 3 months later, was significantly higher in the intervention group (73.2%) than in the control group (42.1%). The intervention group also showed a significantly greater weekly frequency of mHealth application usage. The change in triglyceride levels 1 year later was significantly decreased in the intervention group, as compared with the control group. Conclusions: This study demonstrated that advice for the introduction of mHealth applications based on individual behavioral goals in the health guidance setting significantly increased the number of mHealth application users and frequency of mHealth application usage as well as improved the participants’ triglyceride levels. These findings suggest that utilizing commercially available mHealth applications can enhance the effectiveness of a health guidance program, especially in environments with limited human and financial resources. Presentation: Monday, July 14, 2025

OBJECTIVES:Use of commercially available mobile health (mHealth) applications in supporting lifestyle improvements has become popular in recent years. However, the effectiveness of advice promoting the use of such applications based on individual behavioral goals in a health guidance setting remains unclear. This study explored how guiding participants of the Specific Health Guidance (SHG) program, a Japanese public health initiative to prevent cardiovascular disease, to use commercially available mHealth applications impacted their application usage, lifestyle habits, and cardiovascular risk factors. METHODS:In this multicenter, randomized, open-label, parallel-group comparison study, 156 individuals with a history of SHG participation and who were engaged in the Motivational Health Guidance program (a type of SHG) in 2021 were assigned to intervention (n = 76) or control (n = 80) groups. Whereas both groups received standard guidance, the intervention group also received recommendations for mHealth applications based on their individual behavioral goals. The participants' application usage, behavioral changes, and body weight were assessed after 3 months, with health checkup data evaluated after 1 year. RESULTS:The proportion of mHealth application users after 3 months was significantly higher in the intervention group (68.4%) than in the control group (40.0%). The intervention group also reported a significantly greater weekly frequency of mHealth application usage. Moreover, the intervention group reported a significantly decreased change in triglyceride levels after 1 year compared with the control group. CONCLUSIONS:Recommending commercially available mHealth applications in a health guidance setting significantly increased the number of mHealth application users and their frequency of use.

BACKGROUND:Sarcopenia is associated with an increased risk for dementia. This study aimed to elucidate the relationship between sarcopenia-related indices and cognitive decline in the general population. METHODS:This was a cross-sectional study involving 263 participants (163 men with a median age of 60 years [interquartile range = 53-70] and 100 women with a median age of 58 years [interquartile range = 49-68]) who underwent a general health examination. Sarcopenia-related indices included appendicular skeletal muscle mass (ASM)/height2, ASM/body mass index, handgrip strength (HGS), HGS/upper extremity skeletal muscle mass and phase angle (PhA). We examined the associations between these indices and cognitive function using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). RESULTS:Higher PhA, an indicator of muscle quality, was associated with a lower risk of mild cognitive impairment (MCI) in women (adjusted odds ratio = 0.28 [95% confidence interval, 0.10-0.78], p = 0.014), whereas the other sarcopenia-related indices showed no significant association with MCI in both sexes. The PhA of women was positively associated with the MoCA-J scores (β = 0.27, p = 0.005). Moreover, the PhA of women showed a positive correlation with cognitive subdomains, including memory (r = 0.22, p = 0.031), which is one of the earliest manifestations of cognitive impairment. The PhA in men was also positively correlated with memory (r = 0.24, p = 0.002). CONCLUSIONS:PhA is a potentially novel index for detecting the risk of sarcopenia and cognitive decline in the general population.

Little is known about whether central airway morphological changes beyond traction bronchiectasis develop and affect clinical outcomes in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to compare central airway structure comprehensively between patients with IPF, subjects with interstitial lung abnormality (ILA), and those without ILA (control) using computed tomography (CT). We further examined the prognostic impact of IPF-specific CT airway parameters in patients with IPF. This retrospective study included male patients with IPF, and male health checkup subjects divided into those with ILA and control based on lung cancer screening CT. Using an artificial intelligence-based segmentation technique, the extent of fibrotic regions in the lung was quantified. After airway tree segmentation, CT parameters for central airway morphology, including the lumen area of the extrapulmonary airways (LAextra), wall and lumen area of the segmental/subsegmental intrapulmonary airways (WAintra and LAintra), tracheal distortion (tortuosity and curvature) and bifurcation angle of the main carina, were calculated. There were 106 patients with IPF, 53 subjects with ILA, and 1295 controls. Multivariable models adjusted for age, height and smoking history revealed that LAintra and WAintra were larger in both ILA and IPF, and that tracheal tortuosity and curvature were higher in IPF, but not in ILA, than in the control, whereas the bifurcation angle did not differ between the 3 groups. According to multivariable Cox proportional hazards models including only patients with IPF, increased WAintra was significantly associated with greater mortality (standardized hazard ratio [95

BACKGROUND:Visually diagnosed centrilobular emphysema (CLE) and airway wall thickness and quantitative emphysema on computed tomography (CT) are associated with airflow limitation (AFL) in smokers. The aim of this study was to determine whether a combination of CT indices can be used to accurately detect AFL in smokers. METHODS:We retrospectively included male subjects aged ≥40 years with a smoking history of at least 10 pack-years who participated in health checkups and underwent lung cancer screening CT and spirometry at two Japanese hospitals. The percentage of low-attenuation areas < -950 HU (LAA%) was quantified. CLE and paraseptal emphysema were visually assessed according to the Fleischner Society criteria. Airway wall thickness was calculated as the mean percentage of wall area (WA%) of prespecified segmental and subsegmental bronchi from each lung lobe. Logistic regression models were used to develop diagnostic predictions for AFL with a forced expiratory volume in 1 s/forced vital capacity <0.7, and the area under the receiver operating characteristic curve (AUC) was determined. RESULTS:Among the 513 smokers included in this study, 55 had AFL. In multivariable regression analysis models using the stepwise backward variable selection method, CLE presence, high LAA%, and high subsegmental WA% were independently associated with AFL. A logistic regression model using CLE, LAA%, and subsegmental WA% predicted AFL with a sensitivity of 83.6 %, specificity of 87.8 %, and AUC of 0.908. CONCLUSIONS:A model using airway wall thickness, quantitative emphysema, and visually-identified CLE may facilitate the detection of AFL in smokers.

Background/Objectives: We aimed to identify questionnaire items associated with an increased risk of developing hepatic steatosis in the general population. Methods: A total of 15,063 individuals aged ≥20 years who underwent general health checkups and had no hepatic steatosis at baseline were included. The relationship between questionnaire data at baseline and hepatic steatosis incidence over a median 4.2-year follow-up was investigated across body mass index (BMI) categories. Results: Among 15,063 individuals (mean [SD] age, 47.1 [10.2] years; 6769 [44.9%] male; mean [SD] BMI, 21.4 [2.6] kg/m2), 1889 individuals (12.5%) developed hepatic steatosis during follow-up. After adjusting for age, sex, and factors related to metabolic diseases and liver injury, the strongest questionnaire-based risk factor for hepatic steatosis was self-reported weight gain of 10 kg or more after the age of 20 across all BMI categories: total population (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.90–2.34; p < 0.001), Category 1 (BMI < 22) (HR, 2.33; 95% CI, 1.86–2.91; p < 0.001), Category 2 (BMI 22 to <25) (HR, 1.43; 95% CI, 1.25–1.63; p < 0.001), and Category 3 (BMI ≥ 25) (HR, 1.41; 95% CI, 1.12–1.77; p = 0.003). Conclusions: In this cohort study, self-reported weight gain of 10 kg or more after the age of 20 was associated with an increased risk of hepatic steatosis, independent of baseline BMI. Questionnaires capturing weight gain history may support universal screening efforts to identify individuals at elevated risk.

BackgroundLow respiratory function in young adulthood is one of the important factors in the trajectory leading to the future development of COPD, but its morphological characteristics are not well characterised.MethodsWe retrospectively enrolled 172 subjects aged 40–49 years with ≥10 pack-years smoking history who underwent lung cancer screening by computed tomography (CT) and spirometry at two Japanese hospitals. Emphysema was visually assessed according to the Fleischner Society guidelines and classified into two types: centrilobular emphysema (CLE) and paraseptal emphysema (PSE). Airway dysanapsis was assessed with the airway/lung ratio (ALR), which was calculated by the geometric mean of the lumen diameters of the 14 branching segments divided by the cube root of total lung volume on a CT scan.ResultsAmong the subjects, CLE and PSE were observed in 20.9% and 30.8%, respectively. The mean ALR was 0.04 and did not differ between those with and without each type of emphysema. Multivariable regression analysis models adjusted for age, sex, body mass index and smoking status indicated that CLE and a low ALR were independently associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (estimate −1.64 (95% CI −2.68– −0.60) and 6.73 (95% CI 4.24–9.24), respectively) and FEV1% pred (estimate −2.81 (95% CI −5.10– −0.52) and 10.9 (95% CI 5.36–16.4), respectively).ConclusionsCLE and airway dysanapsis on CT were independently associated with low respiratory function in younger smokers.

Low-dose aspirin for primary prevention is determined by the balance of risks of cardiovascular events and adverse effects. We assessed the long-term gastrointestinal symptoms or bleeding with low-dose aspirin in diabetic patients. The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial was a randomized clinical trial to evaluate the efficacy and safety of low-dose aspirin in patients with type 2 diabetes. As a post hoc analysis, we investigated the incidence of upper gastrointestinal symptoms or bleeding in aspirin (100 mg enteric-coated aspirin or 81 mg buffered aspirin daily) and no-aspirin groups within and beyond 3 years. Of 2535 patients (mean age 65 years, 55

AbstractAimBody mass index and waist circumference are used for obesity diagnosis and screening of visceral fat; however, their evidence in older adults is insufficient. This study investigated the age‐specific association of body mass index and waist circumference with metabolic diseases, assessing their applicability as diagnostic criteria for individuals aged ≥65 years.MethodsAnalysis included 46,324 individuals aged ≥18 years, categorized into five age groups: 18–44, 45–54, 55–64, 65–74, and ≥75 years. Logistic regression analyses identified associations between obesity and metabolic diseases, stratified by age and sex.ResultsMen with obesity based on body mass index had a significantly high risk of hypertension, diabetes mellitus, and dyslipidemia across all age groups (all, p < 0.05). Obesity based on waist circumference was significantly positively associated with all metabolic diseases (all, p < 0.05). Women with obesity based on body mass index and waist circumference had a significantly high risk of all metabolic diseases across all age groups (all, p < 0.05), except for diabetes mellitus in individuals aged ≥75 years.ConclusionsParticipants with obesity based on body mass index and waist circumference exhibited a high risk of hypertension, diabetes mellitus, and dyslipidemia among those aged 18–74 years and men aged ≥75 years. This study contributes to the early prevention and control of metabolic diseases.

ObjectiveThis study aimed to identify the amount of weight loss needed in patients with obesity to improve metabolic syndrome (MetS), a risk factor for cardiovascular disease (CVD), over a long period of time.MethodsA total of 576 patients with obesity were enrolled in this study. Effects of continuous physician-supervised weight loss on the cumulative MetS components excluding abdominal circumference (defined as obesity-related CVD risk score) were investigated during a 5-year follow-up period. The extent of weight loss required to reduce the obesity-related CVD risk components was assessed using receiver operating characteristic (ROC) curve analyses.ResultsOf the 576 participants, 266 completed 5-year follow-up, with 39.1% and 24.1% of them achieving ≥5.0% and ≥7.5% weight loss at the 5-year follow-up, respectively. The area under the ROC curve for reducing the obesity-related CVD risk components was 0.719 [0.662–0.777] at 1 year and 0.694 [0.613–0.775] at 5 years. The optimal cut-off value for weight loss was 5.0% (0.66 sensitivity and 0.69 specificity) and the value with 0.80 specificity was 7.5% (0.45 sensitivity) at 5 years. Greater reductions in weight were associated with greater improvements in the obesity-related CVD risk score at all follow-up periods (P-trend <0.001). Obesity-related CVD risk score was significantly improved by 5.0–7.5% and ≥7.5% weight loss at 1 year (P = 0.029 and P < 0.001, respectively) and ≥7.5% weight loss at 5 years (P = 0.034).ConclusionsA weight loss of ≥5.0% at 1 year and ≥7.5% at 5 years could reduce the number of obesity-related CVD risk components in patients with obesity.

The association between subjective walking speed and metabolic diseases has received limited attention, particularly in individuals with obesity. We aimed to clarify this association using comprehensive health checkup data of participants with obesity. In total, 8578 individuals with a body mass index >= 25.0 kg/m2, 9626 individuals with waist circumference >= 85 cm in men and >= 90 cm in women, and 6742 individuals who met both criteria of body mass index and waist circumference were included in this cross-sectional analysis. Subjective walking speed was investigated using the question "Is your walking speed faster than the speed of those of your age and sex?" in a health examination questionnaire. Metabolic diseases were defined according to the guidelines for each disease, and modified Poisson regression analyses were performed. In the model adjusted for age and sex, individuals with obesity based on body mass index and fast subjective walking speed showed significantly lower risk of diabetes mellitus (risk ratio [RR] 0.70; 95% CI 0.63-0.77) and dyslipidemia (RR 0.97; 95% CI 0.94-1.00). Similarly, among those with obesity based on waist circumference and both body mass index and waist circumference, fast subjective walking speed showed a significant negative association with hypertension (RR 0.94; 95% CI 0.90-0.97 and RR 0.95; 95% CI 0.92-0.99, respectively), diabetes mellitus (RR 0.70; 95% CI 0.64-0.77 and RR 0.70; 95% CI 0.63-0.77, respectively), and dyslipidemia (RR 0.96; 95% CI 0.94-0.99 and RR 0.96; 95% CI 0.94-0.99, respectively). Thus, among individuals with obesity, the odds of metabolic diseases were lower if their subjective walking speed was fast. This study contributes to earlier prevention of the cascade of diseases that begin with obesity.

Background: Effective use of lung volume data measured on computed tomography (CT) requires reference values for specific populations. This study examined whether an equation previously generated for multiple ethnic groups in the United States, including Asians predominantly composed of Chinese people, in the Multi-Ethnic Study of Atherosclerosis (MESA) could be used for Japanese people and, if necessary, to optimize this equation. Moreover, the equation was used to characterize patients with chronic obstructive pulmonary disease (COPD) and lung hyperexpansion.Methods: This study included a lung cancer screening CT cohort of asymptomatic never smokers aged >= 40 years from two institutions (n = 364 and 419) to validate and optimize the MESA equation and a COPD cohort (n = 199) to test its applicability.Results: In all asymptomatic never smokers, the variance explained by the predicted values (R2) based on the original MESA equation was 0.60. The original equation was optimized to minimize the root mean squared error (RMSE) by adjusting the scaling factor but not the age, sex, height, or body mass index terms of the equation. The RMSE changed from 714 ml in the original equation to 637 ml in the optimized equation. In the COPD cohort, lung hyperexpansion, defined based on the 95th percentile of the ratio of measured lung volume to predicted lung volume in never smokers (122 %), was observed in 60 (30 %) patients and was associated with centrilobular emphysema and air trapping on inspiratory/expiratory CT. Conclusions: The MESA equation was optimized for Japanese middle-aged and elderly adults.

Objective: Many factors including obesity were reported as risk factors for development and progression of chronic kidney disease (CKD). However, there is a possibility that the effects of risk factors on the progression of renal dysfunction in CKD patients and the development of CKD are different. We aimed to evaluate the relationships of visceral fat area (VFA) and changes in kidney function in medical checkup participants stratified by the presence of CKD for investigation of the effect of visceral fat on CKD development and progression. Design and method: Study design: Retrospective cohort study. Setting: Routine medical checkups at two medical examination centers in Takeda Hospital Group. Participants: Subjects who underwent VFA measurements during medical checkups in 2012. The follow-up period was from April 2012 to March 2018. Exposures: VFA (≧ 100 cm 2 ). Main outcomes: Changes in estimated glomerular filtration rate (eGFRcr). Statistical analysis: The relationships between VFA and eGFRcr were evaluated using a linear mixed effects model in the participants stratified by the presence of CKD. We defined CKD as eGFR < 60 mL/min/1.73 m 2 in this study. Results: Analysis was performed on total 2,753 subjects (age [mean ± SD] 50.3 ± 10.0 years). The non-CKD group was composed of 2,516 subjects (age 49.5 ± 9.67 years, 1,277 men, 1,239 women), and the CKD group was composed of 237 subjects (age 59.5 ± 8.48 years, 142 men, 95 women). In the total subjects the VFA ? 100 cm 2 group exhibited a larger annual difference in eGFRcr compared to the < 100 cm 2 group (-0.24 mL/min/1.73 m 2 , p = 0.03). Although the difference of annual eGFRcr change in the non-CKD group was not statistically significant, VFA? 100 cm 2 was associated with larger annual declines in eGFRcr in both CKD and non-CKD groups as compared to VFA < 100 cm 2 (-0.64 mL/min/1.73 m 2 , p = 0.01, and -0.20 mL/min/1.73 m 2 , p = 0.10). Conclusions: In the CKD group VFA ≧ 100 cm 2 was significantly associated with a greater annual decline in eGFRcr. This significant difference of eGFRcr decline in the CKD group suggests the effect of visceral fat as a modifiable risk factor for CKD progression.