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We determined the total energy expenditure (TEE) of healthy overweight or obese people, and those with impaired glucose tolerance and/or impaired fasting glycemia (IGT/IFG), or type 2 diabetes (T2DM) using the doubly-labeled water method. As a second purpose, we compared the measured TEE with the target energy intake recommended in the treatment guidelines for diabetes. The participants were normal glucose tolerance (NGT), and IGT/IFG (n=11) and T2DM (n=9) patients, who were 50-59 y and had a body mass index >25 kg/m 2 . The median TEE/body mass (BM) values were 32.6, 33.3, and 34.4 kcal/kg BM and the TEE/target BM values (target BM: BM at a BMI of 22 kg/m 2 ) were 43.7, 50.2, and 46.5 kcal/kg target BM for each group, respectively, and did not differ significantly among them. Obese Japanese participants with T2DM in this study had lower TEE/BM than previously studied in non-obese participants with T2DM. In IGT/IFG or T2DM patients, if 30 kcal/kg target BM was used as the energy coefficient, on the basis of the treatment guidelines, the difference between TEE and the target energy intake would be -1,174±552 kcal (-38±11%). When 35 kcal/kg target BM was used as the energy coefficient, the difference between TEE and the target energy intake would be -877±542 kcal (-27±13%). Thus, the energy coefficients used to estimate target energy intake during lifestyle modification in obese/overweight patients with T2DM are considered to be quite low during the first step of diet therapy.

Background and Objectives: Limited information is available on how weight loss intervention programs affect skeletal muscle mass especially in trunk., Methods and Study Design: A total of 235 overweight Japanese men and women aged 40-64 years with a body mass index of 28.0 to 44.8 kg/m2 participated in this randomized controlled intervention study. They were randomly divided into a lifestyle intervention group and control group. Before and after the one-year lifestyle intervention for weight loss an abdominal transverse image was acquired by computed tomography. The cross-sectional areas (CSAs) of visceral fat, subcutaneous fat, and skeletal muscle of rectus abdominis, abdominal oblique, iliopsoas, and erector spinae muscle were calculated., Results: The body weight changed by approximately -5% in the intervention groups. The corresponding values for subcutaneous fat and visceral fat CSAs were -10.8 to -17.5% in both sexes. The reductions observed in skeletal muscle CSAs were significantly less (-6.0% and -7.2% in the men and women intervention groups respectively) than those in fat tissue CSAs. The CSA of each of the four skeletal muscle groups also significantly decreased; however, after adjustments for body weight at each time point, only reductions in the iliopsoas muscle in both sex and abdominal oblique muscles in men remained significant., Conclusions: The lifestyle weight loss intervention might reduce the relative amount of the abdominal skeletal muscles especially in iliopsoas muscle.

The objective of the present study was to investigate whether a previously reported apparent negative relationship between fat mass and daily physical activity in Japanese adult women would also be observed in Japanese adult men. The subjects were grouped into quartiles of BMI and body fat percentage (%BF). The number of steps walked each day and the duration of light- to vigorous-intensity physical activity were assessed by an accelerometer over the same period of time as for the doubly labelled water experiment. The results showed that BMI negatively correlated with the number of steps and time spent in moderate-intensity physical activity, whereas %BF showed a negative relationship with physical activity-related energy expenditure (PAEE)/body weight (BW) and physical activity level. The analysis of data using %BF quartiles revealed that PAEE/BW decreased from the second quartile in which the BMI was < 25 kg/m2. These observations are similar to those reported in our previous study in Japanese adult women. These cross-sectional studies cannot prove causality, and that obesity causes physical inactivity may be the case. However, the results of the present study provide information regarding which physical activity variables should be used in longitudinal studies.

Preproghrelin gene single-nucleotide polymorphisms are possible predisposing factors to obesity and other metabolic syndromes. To study the correlation between genotypes and obesity, we recruited 117 obese Japanese women (BMI, 25.0-41.1; average, 31.1). Minor homozygotes for five preproghrelin gene polymorphisms, namely, -1500C>G (rs3755777), -1062G>C (rs26311), -994C>T (rs26312) (promoter region), Leu72Met (rs696217) (exon 2), and +3056T>C (rs2075356) (intron 2), had high values of total and visceral fat areas, waist circumference, and BMI, indicating significant correlation of the polymorphisms with obesity and fat metabolism. Here, we studied the relationship between the genotypes and dietary tendency. Self-administered Diet History Questionnaire showed that total food intake, sugar, and dairy product intake were low in +3056C/C women. Their energy, protein, fat, and meat intake was also low. Energy balance calculation showed considerably reduced fat and protein consumption. Dietary habits were surveyed using Sakata's Questionnaire on Eating Behavior. Of the genotypes, -1062C/C women showed low scores for "motivation for eating" and "eating because of stress or something else." Thus, surprisingly, it was revealed that minor homozygotes for preproghrelin gene polymorphisms were light eaters, did not prefer fat or protein, and apparently had a poor appetite, although they were predisposed to obesity., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: A reduction in adiposity may be associated with an improvement in insulin sensitivity and β-cell function as well as cardiovascular disease (CVD) risk factors; however, few studies have investigated these associations in a longitudinal setting., Methods: To investigate these associations over a 1-year period, we conducted an observational analysis of 196 Japanese subjects with obesity in the Saku Control Obesity Program. We investigated the relations between changes in adiposity (body mass index [BMI], waist circumference, subcutaneous fat area [SFAT], and visceral fat area [VFAT]) and changes in HbA1c, fasting plasma glucose (FPG), insulin sensitivity index (ISI), the homeostasis model assessment β cell function (HOMA-β), lipids, and blood pressure., Results: All adiposity changes were positively associated with HbA1c and FPG changes. Reductions in BMI and VFAT were associated with HOMA-β reduction. Reductions in all adiposity measures were associated with an improvement in the ISI. Changes in most adiposity measures were positively associated with changes in blood pressure and lipid levels, except for LDL., Conclusion: The present findings provide additional supportive evidence indicating that a reduction in adiposity may lead to an improvement in insulin sensitivity and the reduction of CVD risk factors in obese individuals.

Objective: To assess the risk of smoking, body mass index (BMI), and both for incidence of diabetes in a rural Japanese population., Method: This study was a 10.1-year cohort study of 2070 men and 3802 women aged 40-69 years without diabetes at baseline who underwent a health check-up at one central hospital in Nagano Prefecture. Participants were classified according to a combination of smoking status and BMI. Participants were followed from 1990 to 2006. The incidence of diabetes was determined from fasting and random levels of plasma glucose, HbA(1c) levels or being under medical treatment for diabetes., Results: Diabetes developed in 595 of the participants during 59,111 person-years of follow-up. In men, the multivariable-adjusted hazard ratios for incidence of diabetes compared with non-smokers of normal weight were as follows: 3.36 (2.02-5.60) in current smokers with normal weight and 1.70 (0.87-3.34) and 3.93 (2.22-6.96) in obese non-smokers and obese current smokers, respectively. In men the population-attributable fraction of diabetes onset due to current smoking, obesity and both were 22.0%, 2.5% and 11.2%, respectively., Conclusion: Regardless of BMI, smoking is an important risk factor for diabetes in male populations with a high prevalence of smoking., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This study evaluated effects of a behavioral approach which placed emphasis on tailored behavior counseling, diet, weight loss and weight maintenance. A one-year randomized controlled trial was conducted among 235 overweight/obese adults in Japan. The intervention group (n=119) received individual-based counseling using a behavioral approach and the changes made in the diet and physical activity were dependent on each participant as much as possible. One year later, the intervention group lost significantly more weight than the control group (-5.0 kg vs. 0.1 kg for men and -3.9 kg vs. -0.2 kg for women). Compared to the control group, the male intervention group reduced overall energy, cereals and dairy products consumption significantly, while increasing green and yellow vegetable intake, and the female intervention group significantly reduced intake of dairy products. Regarding behaviors, both male and female intervention groups increased the number of walking steps and women improved their irregular eating habits compared to those in the control groups. Behavior changes were related to weight loss; participants who maintained the action/maintenance stage or moved to later stages lost significantly more weight than participants who remained in the pre-contemplation/contemplation/preparation stages or regressed to earlier stages. After one-year follow-up, the intervention group maintained significantly lower weights, lower energy intakes and improvements in irregular eating habits. Our behavioral approach led to diet and behavior modification, weight loss and maintenance. Because modified variables differed between men and women, gender-specific approaches may be necessary.

The prevalence of diabetes is increasing globally. In addition to established risk factors for diabetes, such as diet, inactivity, overweight and obesity, the involvement of persistent organic pollutants, including dioxins and polychlorinated biphenyls (PCBs), has also been suggested to be a possible, but controversial, cause of this epidemic. The present study investigated the association between blood PCB congener levels and the prevalence of diabetes among middle-aged, overweight and obese Japanese participants in the Saku Control Obesity Program. One hundred seventeen participants had their congener-specific PCB levels measured in addition to undergoing routine blood analyses at the time of a medical checkup. Prevalent diabetes was defined according to two methods: definite diabetes was defined as people with an HbA1c level ≥ 6.9% or who were taking medication for diabetes, and all diabetes was defined as people with an HbA1c level ≥ 6.5%, a fasting plasma glucose level ≥ 126 mg/dL, or a history of doctor-diagnosed diabetes. A multiple logistic regression analysis was performed to analyze the association between the PCB levels and the prevalence of diabetes, with adjustments for sex, age, body mass index and total lipids. As a result, PCB 146 and 180 were positively associated and PCB 163/164 and 170 were negatively associated with the prevalence of definite diabetes. The significance of the association of PCB 180 and 163/164 with the prevalence of diabetes persisted regardless of the definition of diabetes or adjustments for total lipids, suggesting the possibility that these parameters may modify the risk of diabetes., (©The Japan Endocrine Society)

Several cross-sectional studies in Pima Indians and Caucasians have indicated that obese individuals with type 2 diabetes have a higher basal metabolic rate (BMR) than healthy, obese individuals. However, no study has investigated this comparison in Japanese subjects, who are known to be susceptible to type 2 diabetes due to genetic characteristics. Thirty obese Japanese adults with pre-type 2 diabetes (n=7) or type 2 diabetes (n=13) or without diabetes (n=10) participated in this study. BMR was measured using indirect calorimetry. The relationships between residual BMR (calculated as measured BMR minus BMR adjusted for fat-free mass, fat mass, age, and sex) and biomarkers including fasting glucose, glycosylated hemoglobin (HbA(1c)), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-R), triglycerides, and free fatty acids were examined using Pearson's correlation. BMR in diabetic subjects adjusted for fat-free mass, fat mass, age, and sex was 7.1% higher than in non-diabetic subjects. BMR in diabetic subjects was also significantly (p<0.05) higher than in non-diabetic subjects. There was a significant correlation between residual BMR and fasting glucose (r=0.391, p=0.032). These results indicate that in the Japanese population, obese subjects with type 2 diabetes have higher BMR compared with obese non-diabetic subjects. The fasting glucose level may contribute to these differences.

The nutritional needs of Asian populations have changed dramatically in the last century. The role of nutrition, not only in preventing diseases associated with deficiency, but also in preventing lifestyle diseases such as cardiovascular disease and cancer, has become increasingly clear. Japan established the world's first nutrition institute almost 100 years ago, and initially focused on combating malnutrition and food insecurity. The current focus is prevention of lifestyle diseases, and along with revised dietary reference intakes, Japan has launched a program of Shokuiku (eating education) for children and families. As developing countries are simultaneously facing continuing undernutrition and increasing obesity and lifestyle diseases, collaboration in research and programs is urgently needed to prevent disease through nutrition intervention. This symposium and the Asian network are initial steps toward integrating nutriology into Asia-wide nutrition-based public health research and programs such as Japanese Shokuiku (eating education).

Abstract Background Dietary glycemic index or load is thought to play an important role in glucose metabolism. However, few studies have investigated the relation between glycemic index (GI) or load (GL) and glycemia in Asian populations. In this cross-sectional analysis of a randomized controlled trial, the Saku Control Obesity Program, we examined the relation between the baseline GI or GL and glycemia (HbA1c and fasting plasma glucose [FPG] levels), insulin resistance (HOMA-IR), β-cell function (HOMA-β), and other metabolic risk factors (lipid levels, diastolic and systolic blood pressure, and adiposity measures). Methods The participants were 227 obese Japanese women and men. We used multiple linear regression models and logistic regression models to adjust for potential confounding factors such as age, sex, visceral fat area, total energy intake, and physical activity levels. Results After adjustments for potential confounding factors, GI was not associated with HbA1c, but GL was positively associated with HbA1c. For increasing quartiles of GI, the adjusted mean HbA1c were 6.3%, 6.7%, 6.4%, and 6.4% (P for trend = 0.991). For increasing quartiles of GL, the adjusted mean HbA1c were 6.2%, 6.2%, 6.6%, and 6.5% (P for trend = 0.044). In addition, among participants with HbA1c ≥ 7.0%, 20 out of 28 (71%) had a high GL (≥ median); the adjusted odds ratio for HbA1c ≥ 7.0% among participants with higher GL was 3.1 (95% confidence interval [CI] = 1.2 to 8.1) compared to the participants with a lower GL ( Conclusions Our findings suggest that participants with poor glycemic control tend to have a higher GL in an obese Japanese population.

Summary Background Quantitative evaluation of visceral fat mass and skeletal muscle mass is important for health promotion. Recently, some studies suggested the existence of adipocyte–myocyte negative crosstalk. If so, abdominal skeletal muscles may easily and negatively affected not only by the age but also the visceral fat because age-related reduction in abdominal region is greater compared with limbs. Objective We cross-sectionally examined the existence of quantitative associations between visceral fat area and abdominal skeletal muscle distribution in overweight people. Methods A total of 230 Japanese males and females who aged 40–64 years and whose body mass index (BMI) was 28.0–44.8 kg/m 2 participated in this study. The cross-sectional area (CSA) of the visceral fat, subcutaneous fat, and abdominal skeletal muscles, namely, the rectus abdominis, abdominal oblique, erector spinae, and iliopsoas muscles were measured by the computed tomography images. Results Stepwise regression analyses revealed the existence of sex difference in the relation between visceral fat CSA and other morphological variables. In males, BMI was a positive, and the iliopsoas muscle group CSA was a negative contributor of the visceral fat CSA. In females, both age and BMI were selected as positive contributors. Conclusion These data suggested that the visceral fat CSA may negatively associated with iliopsoas muscle group CSA in males. In females, the visceral fat CSA was not significantly related to the distribution of the abdominal skeletal muscle groups. [ABSTRACT FROM AUTHOR]