論文

OBJECTIVE: To examine the association between weight change and risk of type 2 diabetes and whether initial weight modifies the association. RESEARCH METHODS AND PROCEDURES: This is a prospective cohort study of 20,187 alumni from Harvard University and the University of Pennsylvania. At baseline in 1962 or 1966, men (mean age, 45.9 years) reported their weight, height, and other risk factors. They also had had their weight and height measured at university entry (mean age, 18.5 years). Participants were followed from baseline to 1998 for type 2 diabetes. RESULTS: During follow-up, 1223 men developed type 2 diabetes. Weight gain significantly increased the risk of this disease. The multivariate relative risks associated with BMI change from university entry to baseline of <-0.5, +/-0.5, >0.5 to 1.0, >1.0 to 1.5, >1.5 to 2.0, >2.0 to 3.0, and >3.0 kg/m(2) per decade were 0.88, 1.00 (referent), 1.29, 2.09, 2.69, 4.67, and 7.02, respectively (p for trend < 0.0001). Even among men with a low initial BMI < 21 kg/m(2), weight gain significantly increased risk; the corresponding relative risks were (no cases), 1.00 (referent), 1.00, 1.93, 2.47, 4.82, and 7.68, respectively (p for trend < 0.0001). DISCUSSION: A low initial BMI does not ameliorate the increase in risk of type 2 diabetes with weight gain. Avoidance of weight gain, even among lean individuals, is important to reduce the risk of this disease.

We investigated the efficacy of additional administration of 400 mg troglitazone (+T), which became available as a treatment for type 2 diabetes following the demonstration of its ability to reduce insulin resistance, in combination with diet (D + T) or sulfonylurea (S + T) therapy. Body fat area as determined by computed tomographic (CT) scanning at the umbilical level, as well as several clinical and biochemical parameters of glycemic control and lipid metabolism, were compared before and after 3 months of additional treatment with troglitazone. The body mass index (BMI) tended to increase in both groups (22.7 +/- 0.6 v 23.2 +/- 0.6 kg/m2 in D + T, nonsignificant [NS]; 22.2 +/- 0.5 v 22.3 +/- 0.5 kg/m2 in S + T, NS), while it tended to decrease in the control group (only diet therapy, 23.6 +/- 0.6 v 23.1 +/- 0.8 kg/m2, NS). Mean blood pressure ([BP] 96 +/- 3 v 89 +/- 4 mm Hg, P < .05) decreased significantly in the D + T group. Changes in the glycemic and lipid profile and leptin did not reach statistical significance. The D + T group showed a significant decline in immunoreactive insulin ([IRI] 12.4 +/- 1.2 v 8.0 +/- 1.0 microU/mL, P < .05), reflecting markedly reduced insulin resistance, as well as a significant increase in plasma insulin-like growth factor-1 ([IGF-1] 175.7 +/- 14.2 v 189.8 +/- 12.6 ng/mL, P < .05). A slight weight gain was associated with a tendency for subcutaneous fat to increase, while visceral fat decreased in both troglitazone-treated groups. The decrease in the visceral to subcutaneous fat ratio (V/S ratio) was statistically significant in the D + T group (1.09 +/- 0.11 v 0.94 +/- 0.09, P < .05), while the V/S ratio in the control group did not change. A notable finding of this study is the difference in the response to troglitazone between subcutaneous and visceral adipose tissue. It is suggested that troglitazone may exert beneficial effects by reducing visceral fat.

「運動療法教室はライフスタイル改善のきっかけになったと思う」「受診したので,その後安心してトレーニングできる」「定期的に受診しながら運動を継続したい」の得点が高かった.主治医から見てよく運動療法に適応している患者群は「健康感」や「楽しさ」に関する得点が高く,時間的余裕がないにも拘わらず家族や運動仲間に恵まれ,病院との二人三脚を自覚し,上手く運動療法を自分の生活に取り入れていた.以上から,家族や病院を含む患者の周辺において,患者のライフスタイル改善継続のモチベーションを,時間経過と程度に応じて段階的に支え続けられるサポートチームとしての支援体制が重要であることが示唆された

© 2020, The Author(s). Following publication, the authors asked to add the following institution to the affiliations of author Madoka Matsushita: Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine Both the PDF and HTML versions of the Article have been updated accordingly.

本研究では生体内の代謝反応をネットワークとしてモデリングし,その特性を検証することにより,代謝ネットワークの新しい性質の発見を試みる。そこで我々は,大腸菌およびH.B.Pyloriに関する代謝反応に対して,5種類のネットワークモデルで特性解析を行い,ネットワークとしての見方により性質がどのように異なるかを解明することを目的とする。解析結果から,スケールフリーネットワークが現れるモデルと現れないモデルがあることが分かった。スケールフリーネットワークが現れるモデルは長い進化過程をかけて生き残った物質が関わっていることがわかった。 (著者抄録)