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Papers - MORI Masaaki

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Secular trends and age-specific distribution of blood pressure in Japanese adolescents aged 12–18 years in 2000–2019

Azegami T., Uchida K., Sato Y., Murai-Takeda A., Inokuchi M., Hayashi K., Mori M.

Hypertension Research 47 ( 1 ) 184 - 194 2024.01

ISSN 09169636

Adolescent blood pressure is a predictor of future risk for hypertension and cardiovascular diseases, and therefore its status needs to be accurately determined. However, limited evidence is available regarding the secular trends and distribution of adolescent blood pressure. In the present study, we assessed the secular trends and age-specific distributions of blood pressure in Japanese adolescents aged 12–18 years by using data drawn from 20 years of annual health checkups conducted between 2000 and 2019. Participants underwent health checkups every year for three years at the same school and the data were divided into four 5-year cycles: 2000–2004, 2005–2009, 2010–2014, and 2015–2019. From a total of 124,460 records (33,496 individuals) retrieved, 3000 records (3000 individuals) from each year-cycle were randomly selected to avoid duplicating data from the same individuals. In the study period, in males systolic blood pressure showed a decreasing trend over time, whereas in females diastolic blood pressure showed an increasing trend. Subgroup analyses by school category (junior/senior high school) and by obesity category showed similar blood pressure trends as in the overall analysis. Age-specific blood pressure values in Japanese adolescents increased with age in males but not in females. Thus, different patterns of change in blood pressure values over the past 20 years were observed between males and females. Age-specific blood pressure distributions are also presented. Together, these findings will be useful for understanding blood pressure trends among adolescents. [Figure not available: see fulltext.]

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Secular trends in blood pressure among university students in Japan over the last two decades

Adachi K., Azegami T., Sei N., Yamada-Goto N., Uchida K., Murai-Takeda A., Inokuchi M., Hayashi K., Mori M., Hirose H.

Hypertension Research 2024

ISSN 09169636

High blood pressure (BP) increases the risk of cardiovascular disease, not only among middle-aged and older adults, but also in young adults. Early interventions for high BP may prevent future organ damage. Therefore, it is essential to monitor BP trends in young adults to support this approach. During the COVID-19 pandemic, a trend of increasing BP was observed worldwide. However, young adults have not been fully evaluated. Therefore, this study examined BP trends among university students (n = 106,691) over two decades, every 5 years from 2003 to 2023, including the period before and after the COVID-19 pandemic. From 2003 to 2018, there were no notable changes in BP. However, following the COVID-19 pandemic, increased BP was observed in both men and women, with systolic BP increasing from 118.1 (SD, 14.2) mmHg in 2018 to 120.6 (SD, 12.5) mmHg in 2023 among men, and from 104.6 (SD, 11.8) mmHg to 105.1 (SD, 11.7) mmHg among women. These trends were particularly pronounced among students with normal and underweight somatotypes and among first- and second-year students. The results of the lifestyle survey showed a decrease in smoking and drinking habits, insufficient sleep, mental stress, consumption of fast food and snacks, and an increase in exercise habits. Although contributing factors to the recent increase in BP were not identified, there was an upward trend in BP among Japanese university students. It is important to carefully observe how BP trends change over the long term following the end of the COVID-19 pandemic. (Figure presented.)

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Pediatric blood pressure category predicts longitudinal blood pressure change in adolescence and early adulthood

Azegami T., Uchida K., Sato Y., Murai-Takeda A., Inokuchi M., Itoh H., Mori M.

Pediatric Research 94 ( 5 ) 1731 - 1737 2023.11

ISSN 00313998

Background: Patterns of blood pressure (BP) change from early adolescence to young adulthood have not been well-described. The objective of this study was to examine the predictive value of pediatric BP classification on BP change and identify subpopulations with large BP increases during adolescence and early adulthood. Methods: Baseline data were obtained from medical checkups of Japanese adolescents aged 12–13 years in 2009 or 2010 and subsequent BP values were followed for a 9-year period. Mixed-effects models were used to estimate the effects of baseline factors on subsequent BP changes. Results: Hypertensive and elevated BP group consistently had higher BP values than normal BP group throughout the observation period. Multivariate mixed-effects model analyses revealed group-by-time interactions between systolic BP change and BP category in males and uric acid category in females, and between diastolic BP change and white blood cell count in males and obesity and high-density lipoprotein cholesterol in females; however, these factors had limited effects on the rate of BP increase, indicating that they are not suitable as clinical predictors of BP increase. Conclusions: Pediatric BP category predicted BP values, but there was no factor that identified subpopulations with large BP increases in adolescence and early adulthood. Impact: Blood pressure category in the American Academy of Pediatrics clinical practice guideline at age 12–13 years predicted subsequent blood pressure values during adolescence and early adulthood.No baseline factor that identified a subpopulation with large increase in blood pressure during adolescence and early adulthood in clinical practice was found.Our study contributes to the existing literature by demonstrating the usefulness of the American Academy of Pediatrics clinical practice guideline for blood pressure classification in a Japanese population.

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Blood Pressure Tracking From Childhood to Adulthood

Azegami T., Uchida K., Tokumura M., Mori M.

Frontiers in Pediatrics 9 2021.11

Hypertension is the most common non-communicable disease among adults and is the most important modifiable risk factor for premature cardiovascular disease. The increasing worldwide burden of hypertension is a major global health issue. Early prevention with lifestyle modification or pharmaceutical treatment reduces the incidence of hypertension and the risk of subsequent cardiovascular disease. Therefore, identification of young persons at risk for hypertension has the obvious benefit of providing a chance for early intervention. Previous studies have demonstrated the positive association of elevated childhood blood pressure with hypertension in adulthood. Accumulated evidence also indicates the possibility that elevated pediatric blood pressure is associated with increased risk of future cardiovascular disease. In this article, we review the tracking of blood pressure from childhood to adulthood and emphasize the importance of pediatric blood pressure monitoring and control for predicting and preventing adult hypertension and cardiovascular disease.

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Association of childhood anthropometric measurements and laboratory parameters with high blood pressure in young adults

Azegami T., Uchida K., Arima F., Sato Y., Awazu M., Inokuchi M., Murai-Takeda A., Itoh H., Tokumura M., Mori M.

Hypertension Research (Hypertension Research) 44 ( 6 ) 711 - 719 2021.06

ISSN 09169636

Early intervention to manage high blood pressure (BP) in young adulthood is a promising approach for the prevention of future cardiovascular diseases. We aimed to examine the ability of childhood health information to predict the incidence of young adults with high BP. This cohort study included baseline clinical data of Japanese individuals aged 12–13 years. A total of 1129 participants were followed up for an average of 8.6 years. We examined the association of childhood variables consisting of body weight, body mass index, systolic BP, white blood cell count, red blood cell count, hemoglobin, hematocrit, platelet count, uric acid, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol with the development of high BP defined as ≥120/80 mmHg at 18–22 years old. At follow-up, the prevalence of high BP was 42.2% in men and 7.7% in women. Young men with high BP had childhood baseline characteristics that included higher body weight, body mass index, systolic BP, red blood cell count, hemoglobin, hematocrit, and uric acid than normotensive men. Young women with high BP had higher body weight, systolic BP, and uric acid at baseline. Multivariable logistic regression analysis revealed that a model including body weight, systolic BP, hematocrit, and uric acid had the highest predictive power (AUC 0.65 [95% CI, 0.62–0.69]) for men, and a model including body weight, systolic BP, and uric acid had the highest predictive power (AUC 0.70 [95% CI, 0.58–0.81]) for women. Comprehensive childhood health information contributes to the prediction of high BP in young adults.

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Sars-cov-2 infection among medical institution faculty and healthcare workers in tokyo, japan

Nishimura T., Uwamino Y., Uno S., Kashimura S., Shiraki T., Kurafuji T., Morita M., Noguchi M., Azegami T., Yamada-Goto N., Murai-Takeda A., Yokoyama H., Kuwabara K., Kato S., Matsumoto M., Hirata A., Iida M., Harada S., Ishizaka T., Misawa K., Murata M., Saya H., Amagai M., Kitagawa Y., Takeuchi T., Mori M., Takebayashi T., Hasegawa N.

Internal Medicine 60 ( 16 ) 2569 - 2575 2021

ISSN 09182918

Objective To consider effective measures against severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) infection in medical institutions, this study estimated the SARS-CoV-2 infection rate among healthcare workers (HCWs) in Tokyo, Japan, and determined the specific findings for mild coronavirus disease 2019 (COVID-19) cases. Methods This study analyzed the results of serologic tests to detect immunoglobulin G antibodies against SARS-CoV-2 and evaluated the demographic and clinical characteristics of the faculty and HCWs at a Tokyo medical institution in August 2020. The demographic and clinical characteristics of participants with antibody-positive results were compared to those of participants with antibody-negative results. Materials This study recruited 2,341 faculty and HCWs at a Tokyo medical institution, 21 of whom had a COVID-19 history. Results Of the 2,320 participants without a COVID-19 history, 20 (0.862%) had positive serologic test results. A fever and dysgeusia or dysosmia occurred with greater frequency among the participants with positive test results than in those with negative results [odds ratio (OR), 5.475; 95% confidence interval (CI), 1.960-15.293 and OR, 24.158; 95% CI, 2.693-216.720, respectively]. No significant difference was observed in the positivity rate between HCWs providing medical care for COVID-19 patients using adequate protection and other HCWs (OR, 2.514; 95% CI, 0.959-6.588). Conclusion To reduce the risk of COVID-19 spread in medical institutions, faculty and HCWs should follow standard and necessary transmission-based precautions, and those with a fever and dysgeusia or dysosmia should excuse themselves from work as soon as possible.

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The distributions of hematologic and biochemical values in healthy high-school adolescents in Japan

Azegami T., Nishimura T., Murai-Takeda A., Yamada-Goto N., Sato Y., Mori M.

PLoS ONE (PLoS ONE) 15 ( 11 November ) 2020.11

Laboratory tests of adolescents are often interpreted by using reference intervals derived from adults, even though these populations differ in their physical and physiologic characteristics and disease susceptibility. Therefore, to examine the distribution of laboratory values specific for adolescents, we analyzed hematologic and biochemical measurements obtained from 12,023 healthy Japanese adolescents (ages 15 through 18 years; male, 9165; female, 2858) during 2009 through 2018. Distributions were shown as medians with 95% (2.5th and 97.5th percentiles) of values and were compared with those from previous studies that examined similar Asian populations. There were some differences between hematologic parameters, serum creatinine and uric acid concentration, and lipid levels of Japanese adults and adolescents. In comparison with other Asian populations, the distributions of serum uric acid and high-density–lipoprotein cholesterol in the present study were slightly higher than those in the other studies. Although further research is need, the distributions of hematologic and biochemical tests in adolescents may have the potential to facilitate the early identification and management of disease in this population.

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The annual risk of tuberculosis infection in newly hired researchers and healthcare workers using interferon-gamma release assay in Japan

Nishimura T., Ota M., Mori M., Takano Y., Fujiwara H., Uwamino Y., Uno S., Hasegawa N.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 26 ( 8 ) 818 - 822 2020.08

ISSN 1341321X

The tuberculosis (TB) notification rate in Japan is gradually decreasing but has not yet achieved “pre-elimination,” defined by the World Health Organization. To effectively tackle, control, and eliminate TB, estimating and monitoring the annual risk of TB infection (ARI) using tuberculin skin testing (TST) to understand the dynamics of TB epidemiology are significantly important. However, studies estimating ARIs using TST are few considering that Bacillus Calmette-Guérin vaccination coverage is high in Japan. This was a single-center, cross-sectional study conducted between January 2011 and December 2018 in Tokyo area where interferon-gamma release assays (IGRAs) were performed in newly hired researchers of Keio University School of Medicine and healthcare workers of Keio University Hospital to determine TB infection. We estimated the prevalence of TB infection and ARI based on their IGRA results. Among the 3908 subjects, 83 (2.124%) had positive IGRA results. Multiple logistic regression analysis revealed that age was a significant risk factor for positive IGRA result (adjusted odds ratio, 1.046). The ARIs were 0.049%–0.156% between 1986 and 2004, midyears of TB infection, but have not significantly decreased over approximately two decades. To decrease the risk of TB infection, advanced strategies to control and eliminate TB in Tokyo area are significantly required.

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Effect of refrigeration of blood samples in lithium-heparin tubes on QuantiFERON TB Gold Plus test result

Uwamino Y., Sakai A., Nishimura T., Noguchi M., Uno S., Fujiwara H., Mori M., Wakui M., Murata M., Hasegawa N.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 26 ( 3 ) 312 - 314 2020.03

ISSN 1341321X

The QuantiFERON TB Gold Plus (QFT-Plus) test is a newly approved interferon-gamma releasing assay test for detecting latent tuberculosis. Although blood samples for QFT test can be refrigerated for 48 h in lithium-heparin tubes according to package inserts, no published data are available on the effects of sample refrigeration on the test results. We conducted a clinical study that aimed to elucidate whether sample refrigeration for 48 h affects QFT-Plus test results. We collected 2 blood samples each from 40 participants for QFT-Plus; one sample was refrigerated before incubation for QFT-Plus assay, while the other sample was incubated soon after collection and treated as control. After comparing QFT-Plus test results of refrigerated samples and control samples, the concordance rate and kappa coefficient between them were 95% and 0.90, respectively. Thus, blood samples for QFT-Plus test can be refrigerated for 48 h in lithium-heparin tubes without influencing the test results.

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Showering is associated with Mycobacterium avium complex lung disease: An observational study in Japanese women

Uwamino Y., Nishimura T., Sato Y., Tamizu E., Uno S., Mori M., Fujiwara H., Kawabe H., Murata M., Hasegawa N.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 26 ( 3 ) 211 - 214 2020.03

ISSN 1341321X

Mycobacterium avium complex refers to a group of environmental bacteria which inhabit water and soil. Although Mycobacterium avium complex is capable of causing refractory lung infections, the risk factors for Mycobacterium avium complex lung disease are still unclear. This study aimed to determine the associations between Mycobacterium avium complex lung disease and soil or water exposure. Using questionnaires along with clinical data, we compared soil exposure, along with bathtub bathing and showering habits between 172 women with Mycobacterium avium complex lung disease and 339 women without Mycobacterium avium complex infection as controls. Showering was found to be independently associated with the presence of Mycobacterium avium complex lung disease (adjusted odds ratio 5.72, 95%, confidence interval 1.99 to 16.46). Although the mean age of the groups was different, an age-matched sub-analysis yielded similar results. These results indicate that showering may be a risk factor for Mycobacterium avium complex lung disease.

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Low serum estradiol levels are related to Mycobacterium avium complex lung disease: A cross-sectional study

Uwamino Y., Nishimura T., Sato Y., Tamizu E., Asakura T., Uno S., Mori M., Fujiwara H., Ishii M., Kawabe H., Murata M., Hasegawa N.

BMC Infectious Diseases (BMC Infectious Diseases) 19 ( 1 ) 2019.12

Background: The risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known. We hypothesized that low serum estradiol (E2) levels are related to MAC-LD as most patients with MAC-LD are postmenopausal women. Methods: This cross-sectional study compared patients with MAC-LD and healthy controls. Study subjects were postmenopausal women aged 65 years or younger. Serum testosterone, dehydroepiandrosterone sulfate (DHEA-S), and E2 levels were measured and categorized as high or low based on median levels. We performed multivariate analysis, receiver operating characteristic (ROC) curve analysis, and age-and body mass index (BMI)-matched subgroup analysis to evaluate the association between low serum E2 levels and MAC-LD. Additionally, using blood samples obtained for other clinical studies, the levels of sex steroid hormones were compared between age-and BMI-matched MAC-LD and bronchiectasis female patients without non-tuberculosis mycobacterial infections (non-NTM BE). Results: Forty-two patients with MAC-LD and 91 healthy controls were included. The median E2 (2.20 pg/mL vs. 15.0 pg/mL, p < 0.001), testosterone (0.230 ng/L vs. 0.250 ng/L, p = 0.005), and DHEA-S (82.5 μg/dL vs. 114.0 μg/dL, p < 0.001) levels were lower in the MAC-LD group than in the control group. Multivariate analysis revealed that low serum E2 (adjusted odds ratio = 34.62, 95% confidence interval = 6.02-199.14) was independently related to MAC-LD, whereas low DHEA-S and testosterone were not. ROC analysis illustrated a strong relationship between low serum E2 levels and MAC-LD (area under the curve = 0.947, 95% confidence interval = 0.899-0.995). Even the age-and BMI-matched subgroup analysis of 17 MAC-LD patients and 17 healthy controls showed lower serum E2 in MAC-LD patients than in healthy controls. Additionally, serum E2 levels of 20 MAC-LD patients were lower than plasma E2 levels of 11 matched non-NTM BE patients (1.79 pg/mL vs. 11.0 pg/mL, p < 0.001). Conclusions: Low serum E2 levels were strongly related to MAC-LD in postmenopausal women.

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Low birth weight is associated with decline in renal function in Japanese male and female adolescents

Murai-Takeda A., Kanda T., Azegami T., Hirose H., Inokuchi M., Tokuyama H., Wakino S., Tokumura M., Kawabe H., Mori M., Itoh H.

Clinical and Experimental Nephrology (Clinical and Experimental Nephrology) 23 ( 12 ) 1364 - 1372 2019.12

ISSN 13421751

Background: Low birth weight (LBW) is a risk factor for chronic kidney disease (CKD) in later life and is becoming increasingly common in developed countries, including Japan. Furthermore, a serial decrease in birth weight has been associated with an increasing prevalence of CKD stage 2 in male Japanese adolescents. Sex-specific differences affect CKD susceptibility, and the association between birth weight and CKD in women, has not been elucidated. In this study, we investigated the sex-specific effect of LBW on renal function. Methods: Annual cross-sectional data of 2417 Japanese adolescents (males 1736; females 681), aged 15–16 years, were evaluated over 8 years (2007–2014). Results: Over the study period, mean birth weights decreased significantly in males (p < 0.01) and females (p < 0.05). Furthermore, both sexes showed significant decrease in estimated glomerular filtration rates corresponding to the birth weight reduction. The prevalence of CKD stage 2 also increased in males (from 26.0 to 32.4%, p < 0.01) and females (from 6.3 to 18.5%, p < 0.05). The incidence of CKD stage 2 was significantly related to history of LBW (males: odds ratio 1.73; 95% confidence interval 1.06–2.80; p < 0.05; females: odds ratio 3.29; 95% confidence interval 1.25–8.02; p < 0.05). Conclusions: Our data revealed that renal function and birth weight have decreased over time, in healthy Japanese adolescents. In view of the recent declining trend demonstrated by birth weight in Japan, we speculate that the prevalence of CKD might increase in the future.

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Risk of tuberculosis infection among health care workers and nursing students in Japan

Nishimura T., Ota M., Mori M., Fujiwara H., Takano Y., Kato S., Kawabe H., Hasegawa N.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 24 ( 11 ) 921 - 924 2018.11

ISSN 1341321X

It is important to evaluate the risk of tuberculosis (TB) infection among health care workers (HCWs) and nursing students in Japan to propose the optimal countermeasure against new TB infection for them. To estimate the annual incidence of TB infection in HCWs at a Japanese university hospital without TB wards and in nursing students at a Japanese university using interferon-gamma release assay (IGRA). Serial IGRAs were prospectively conducted on the HCWs between August 2010 and December 2015. For nursing students, two IGRA tests were conducted before commencement of clinical training and at employment as nurses between April 2007 and December 2015. A total of 328 HCWs and 298 nursing students were followed for 670.15 and 1212.80 person-years, respectively. Assuming IGRA-positive conversions were all attributable to true infection, the incidence of TB infection in HCWs and nursing students was 0.149/100 and 0.0825/100 person-years, respectively. At a Japanese university hospital without TB wards and a Japanese university, the annual incidence of TB infection among HCWs and nursing students estimated from serial IGRA results was low, but continued vigilance for the prevention of TB infection is essential.

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Explanation of the manual for chest radiograph in the student checkup.

MASAAKI MORI

The Bulletin of Keio University Health Center 36 ( 1 ) 39 - 45 2018.08

Research paper (bulletin of university, research institution), Accepted

Significance of measuring serum adiponectin levels in health checkups and Ningen dock in hospital.

MASAAKI MORI

The Bulletin of Keio University Health Center 36 ( 1 ) 7 - 12 2018.08

Research paper (bulletin of university, research institution), Joint Work, Accepted

The management of concussions in high schools

MASAAKI MORI

The Bulletin of Keio University Health Center 36 ( 1 ) 33 - 38 2018.08

Research paper (bulletin of university, research institution), Joint Work, Accepted

School-age children and adolescents suspected of having been to be infected with pertussis in Japan

Yasui Y., Mitsui T., Nishimura T., Uchida K., Inokuchi M., Mori M., Tokumura M., Nakayama T.

Vaccine (Vaccine) 36 ( 20 ) 2910 - 2915 2018.05

ISSN 0264410X

Many countries including Japan have adapted acellular pertussis vaccines combined with diphtheria and tetanus toxoids (DTaP). DTaP vaccine coverage is approximately >90%, but pertussis re-emergence has been observed since 2000 in Japan. In the present study, anti-pertussis antibodies were investigated among school-age children and adolescents from 2013 to 2015. The positive rate of anti-pertussis toxin (PT) antibodies was higher among children aged 12–13 years (60.0%. 95%CI; 56.0–63.9%) in 2014 and 18–19 years (73.0%. 95%CI; 61.4–82.6%) in 2013, compared with 6–7 years (47.1%. 95%CI; 40.7–53.6%). The mean PT antibody titer was higher among children aged 12–13 years (23.8 EU/ml. 95%CI; 21.9–25.8) in 2014 and 18–19 years (29.3 EU/ml. 95%CI; 23.0–35.6) in 2013, compared with 6–7 years (18.3 EU/ml. 95%CI; 15.5–21.2). Distributions of pertussis antibodies and mean titers at their same grade of school-age were similar from 2013 to 2015. Although school-age children were immunized with 4 doses of DTaP, the data suggested the decay of vaccine-acquired immunity and possibility of asymptomatic infection in school age, indicating the additional DTaP vaccination before the entry of elementary school, preventing household contact.

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5年間の年齢階級別追跡調査に基づくメタボリックシンドローム予防対策の検討

MASAAKI MORI

CAMPATH HEALTH 55 ( 1 ) 116 - 118 2018.03

Research paper (scientific journal), Joint Work

13年間における当大学での自動体外式除細動器の使用経験

MASAAKI MORI

CAMPATH HEALTH 55 ( 1 ) 195 - 197 2018.03

Research paper (scientific journal), Joint Work

当大学医学部留学生に対するImmunization Recordの運用と考察

MASAAKI MORI

CAMPATH HEALTH 55 ( 1 ) 466 - 467 2018.03

Research paper (scientific journal), Joint Work

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