成瀬 寛之

Background 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a pivotal tool for diagnosing cardiac sarcoidosis, but its prognostic value during the phase of stable medical and device therapy after initiation of immunosuppressive therapy remains unclear. We aimed to evaluate the prognostic significance of cardiac FDG uptake in patients with cardiac sarcoidosis after treatment initiation. Methods We retrospectively analyzed 79 patients who underwent FDG-PET/CT ≥ 12 months after initiating immunosuppressive therapy (June 2013–October 2023). Patients were categorized into the cardiac accumulation (+) and (-), and Cardiac metabolic activity (CMA) was also quantitatively measured. Major adverse cardiac events—including cardiac death, ventricular arrhythmias, ICD therapy, and heart failure hospitalization—were evaluated. Results Patients in the cardiac accumulation (+) had a higher 2-year incidence of major adverse cardiac events than those in the cardiac accumulation (-), as determined by Kaplan–Meier analysis (log-rank P = 0.030), but FDG uptake was not identified as a predictor in Cox regression analysis. In long-term outcomes, the incidence of cardiac events tended to be higher in the cardiac accumulation (+) group, although this difference did not reach statistical significance (log-rank P = 0.078). Among patients with preserved left ventricular ejection fraction (LVEF ≥50%, independently associated with fewer events), annual cardiac event rates were similarly low regardless of uptake status (1.3% vs. 0.8%; log-rank P = 0.91). In 41 patients who underwent repeat PET imaging, CMA significantly decreased (median 4.83 to 0.82, P = 0.038). Among 23 patients without intensified immunosuppression despite uptake, it resolved spontaneously in 8 patients. Conclusions Follow-up cardiac FDG uptake may be associated with an increased risk of short-term events but has limited value for predicting long-term prognosis. LVEF and the temporal dynamics of FDG uptake should be considered when managing cardiac sarcoidosis.

Background: Underweight status is common among young women in Japan and has been linked to impaired glucose tolerance, but its long-term association with HbA1c trajectories remains unclear. This study examined whether body size history in the twenties is associated with subsequent HbA1c trajectories across adulthood. Methods: We analyzed health check-up data from Fujita Health University, collected between 2003 and 2025. Participants were classified as normal weight in the twenties (NW20s), underweight at least once in the twenties (UW20s_ever), or overweight at least once in the twenties (OW20s_ever), excluding mixed underweight/overweight histories. Eligible individuals had at least 5 years of follow-up, at least five BMI and HbA1c measurements, and at least one BMI record between ages 20 and 29 years. HbA1c trajectories were evaluated using sex-stratified linear mixed-effects models. Kaplan-Meier and Cox regression analyses were used to assess the risk of first reaching HbA1c ≥ 5.6%. Results: A total of 2923 participants were included in the trajectory analysis. For the time-to-event analysis, 2753 participants were included after exclusion of 170 participants with HbA1c ≥ 5.6% at study entry. Body size history in the twenties was associated with distinct, sex-specific HbA1c trajectories. OW20s_ever showed persistently higher HbA1c levels in both women and men, but the local slope of HbA1c was greater at ages 35 and 45 years in women and at age 25 years in men. In contrast, UW20s_ever showed lower HbA1c levels than NW20s at ages 25 and 35 years only in women. In complementary time-to-event analyses, OW20s_ever was associated with a higher risk of HbA1c ≥ 5.6% in both women and men (women: HR 1.37, 95% CI 1.06-1.76, p = 0.016; men: HR 1.81, 95% CI 1.41-2.32, p < 0.001), whereas UW20s_ever was associated with a lower risk only in women (HR 0.81, 95% CI 0.67-0.98, p = 0.028). Conclusions: Underweight and overweight history in the twenties are not simply mirror-image exposures but rather have sex-dependent and asymmetric associations with later HbA1c regulation.

AIMS: The global distribution of lipoprotein(a) [Lp(a)] levels varies due to racial and ethnic differences. However, the clinical relevance of Lp(a) levels in Japanese patients has not been fully explored. METHODS: We investigated the association of Lp(a) levels, the Suita score, and the presence of high-risk plaque (HRP) as well as that of ≥ 50% stenosis, quantitative plaque volume, and the value of coronary artery calcium score in coronary computed tomographic angiography (CCTA), among 272 Japanese patients (mean age: 65 years) in whom serum Lp(a) levels were measured due to suspected coronary artery disease. HRP was defined as positive remodeling and/or low attenuation. Plaque volume was quantified as the percent plaque volume. RESULTS: HRP was identified in 33 (12.1%) patients. The prevalence of HRP, ≥ 50% stenosis, and percent plaque volume progressively increased with higher Lp (a) levels and Suita scores. In multivariate analyses, Lp(a) and the Suita score independently predicted HRP when assessed as continuous (p = 0.02, p＜0.001, respectively) or categorical variables (p = 0.005, p = 0.007, respectively). Patients in the highest tertile of Lp(a) and classified as high- or intermediate-risk by the Suita score had the highest HRP risk, whereas those in the lower 2 tertiles and low-risk group had the lowest. Incorporating Lp(a) into the Suita score improved the prediction of HRP beyond the Suita score alone (p = 0.005). CONCLUSIONS: The combinatorial value of assessing Lp(a) levels and Suita score may provide useful insight regarding Japanese patients undergoing CCTA for the prediction of HRP.

BACKGROUND: Underweight (BMI < 18.5 kg/m2) remains prevalent among young Japanese women but lacks standardized measurement approaches. We compared four analytical methods and identified discrepancies. METHODS: A retrospective analysis of 883 underweight women aged 20-29 years followed for 6.1 ± 4.2 years was performed. We compared (1) year-to-year transitions, (2) state occupancy, (3) the Aalen-Johansen estimator, and (4) Kaplan-Meier Survival Analysis. We performed bidirectional flow analysis quantifying inflow/outflow rates, BMI distribution analysis, and time-weighted classification. RESULTS: Methods 1 and 4 showed 31-point discrepancies (78.1% vs. 47.1% in women). In bidirectional flow, inflow exceeded outflow at ages 22-27 (35.7%/yr vs. 20.7%/yr, outflow/inflow ratio: 0.58), balanced at ages 27-37 (ratio: 1.02) and showed outflow-dominant pattern at ages 37-47 (ratio: 4.92). BMI clustered at 18.0-19.0 kg/m2 (42.7%); 69.4% crossed the threshold once. Time-weighted classification revealed four phenotypes: persistent (≥75% time underweight; 40.1%, BMI: 17.54 kg/m2), moderate (50-74%; 17.6%, BMI: 18.40 kg/m2), intermittent (25-49%; 17.6%, BMI: 18.97 kg/m2), and transient (<25%; 24.8%, BMI: 19.49 kg/m2). The moderate + intermittent group showed yo-yo phenotypes (35.2%). CONCLUSIONS: Underweight in young Japanese women should be viewed as a heterogeneous dynamic nutritional state. The methodological discrepancy, threshold crossing, and phenotypic classification show that BMI-defined underweight comprises distinct patterns. Cross-sectional data evaluation may lead to incorrect assessments. Future research examining relationships between longitudinal low body weight subgroups and clinical outcomes could identify at-risk populations within the underweight group.

Background: Studies outside Japan have linked sugar-sweetened beverage (SSB) intake with weight gain; however, evidence in Japanese adults is scarce, and no study has examined beverage-derived energy in relation to anthropometric indices and handgrip strength. Methods: The participants were employees of Fujita Health University aged 20-39 years (n = 76; male n = 35, average age: 29.97 ± 4.67 years; female n = 41, average age: 27.29 ± 4.53 years). Energy from beverage intake was assessed via the Brief Beverage Intake Questionnaire-15, and energy from alcoholic drinks, milk, SSBs, and total beverages was calculated. The associations of energy from different beverages with nutrient intake, BMI, skeletal muscle mass index (SMI), and handgrip strength were analyzed via ordinary least squares (OLS) regression; quantile regression (QR) and the generalized additive model (GAM) were used for sensitivity analyses. Results: Increased SSB intake was associated with increased BMI (standardized β = 0.35, 95% CI 0.12-0.58, p(OLS) < 0.001; p(QR) = 0.23; p(GAM) < 0.001) and was nonlinearly associated with increased SMI (standardized β = 0.21, 95% CI 0.043-0.37, p(OLS) = 0.02; p(QR) = 0.11; p(GAM) = 0.02), even after adjustment for total energy intake. Modest milk intake was linked to higher protein intake and a higher SMI without a higher BMI (standardized β = 0.18, 95% CI 0.020-0.35, p(OLS) = 0.03; p(QR) = 0.39; p(GAM) = 0.03). Conclusions: A positive association was found between SSB intake and both BMI and SMI and between MILK intake and SMI. Clarification in larger, diverse Japanese populations will be necessary.