著者

大櫛 陽一 春木 康男 宗田 哲男 銅冶 英雄 糖質ゼロ食 研究会 山内 忠行

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.19, no.1, pp.53-58, 2010 (Released:2010-05-01)

参考文献数

19

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Introduction: A control of blood glucose is known to be the most important fact to protect development of complications of diabetes. A low-carbohydrate diet has been recognized to be one of the choices of diets for patients with diabetes. But, a very low-carbohydrate diet where the uptake of carbohydrate is lower than 130g per day is not recommended by American Diabetes Association now. Methods: We examined 16 patients who are continuing in some years a very low-saccharide diet where the uptake of saccharide is lower than 5g per diet. Results: Their fasting glucose, HbA1c, triglyceride, HDL-C, creatinine, all ionic values, pH and bicarbonate of venous blood were normal. Their ketone body and free fatty acid were higher than people who have normal diet, but their respiratory quotient was 0.72 and it assures their resource of energy changes from glucose to ketone body. Conclusion: Dietary ketosis never makes acidosis. The very low-saccharide diet is a safe and most effective diet for patients with diabetes.

著者

大櫛 陽一 小林 祥泰 栗田 由美子 山田 敏雄 阿部 孝一 脳卒中急性期患者データベース構築研究グループJSSRS

出版者

一般社団法人 日本医療情報学会

雑誌

医療情報学 (ISSN:02898055)

巻号頁・発行日

vol.28, no.3, pp.125-137, 2008 (Released:2015-03-20)

参考文献数

40

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血圧の基準が下げられ健診で高血圧とされる人が増え,高血圧治療費と降圧剤はそれぞれ医療費および薬剤費の1位になっている.このような治療の背景となっている高血圧治療ガイドラインについて検証した.①住民コホートによる血圧レベルと総死亡の比較,②血圧レベルと原因別死亡率の比較,③降圧治療群と非治療群での総死亡率の比較,④一般住民と脳卒中患者との高血圧およびその治療率の比較,により検討した.160/100mmHgまで総死亡率および循環器疾患による死亡率の上昇はみられなかった.ベースラインで180/110mmHg以上の群では,160/100未満に下げると緩やかな降圧群に較べて死亡率が4倍であった.脳梗塞群での高血圧治療オッズ比が有意に高かった.160/100mmHgまで治療の必要はない,薬物による降圧は20mmHg程度に抑える必要がある,高血圧治療ガイドラインはエビデンスに基づいて修正すべきである.

著者

浜崎 智仁 奥山 治美 大櫛 陽一

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.21, no.1, pp.77-87, 2012 (Released:2012-04-29)

参考文献数

27

被引用文献数

1 1

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ファルマシアの2011年6月号に上島弘嗣氏の話題1)が掲載されており、我々の「コレステロールは高いほうが長生きする」の理論の“誤り”について解説している(引用符号は筆者らによる).小論では、上島氏の指摘に関し、その問題点を取り上げ,反論する.なお、小論は本来2011年に発表すべく努力してきたが、ファルマシアが掲載を認めなかったため、発表が遅れた。

著者

奥山 治美 浜崎 智仁 大櫛 陽一 浜 六郎 内野 元 渡邊 浩幸 橋本 道男

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.22, no.2, pp.173-186, 2013 (Released:2013-10-01)

参考文献数

60

被引用文献数

1 1

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Statins have been recognized clinically to raise blood glucose and glycated protein (HbA1c) levels enhancing the development of insulin resistance. However, most clinicians appear to adopt the interpretation that the benefit (prevention of CHD) outweighs the risk (new-onset of diabetes mellitus). Consistently, "Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2012" recommends diabetics to maintain LDL-C levels below 120 mg/dL; 40 mg/dL lower than the value for those without risky complications. This recommendation necessitates many diabetics to use statins. However, we pointed out that statins exhibited no significant benefit for the prevention of CHD in the trials performed by scientists independent of industries after 2004, when a new regulation on clinical trials took effect in EU (Cholesterol Guidelines for Longevity, 2010). Here, we reviewed clinical evidence that statins could induce diabetes mellitus, and biochemical evidence that statins are toxic to mitochondria; they suppress electron transport and ATP generation through decreased prenyl-intermediate levels. They also inhibit seleno-protein synthesis and dolichol-mediated glycation of insulin receptor leading to insulin resistance and cardiac failure, similarly to the case of Se-deficiency. These mechanisms of statin actions are consistent with clinically observed decreases in blood ketone body, mitochondrial dysfunctions and enhanced glucose intolerance. Based on these lines of evidence, we urgently propose that statins are contraindicant to diabetics and their prescription should be restricted to special cases* for which medical doctors rationally decide to be necessary.

著者

大櫛 陽一 小林 祥泰

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.30, no.6, pp.943-947, 2008 (Released:2009-01-13)

参考文献数

12

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1. Introduction Cost of antihypertensive therapy has increased constantly. It accounts 7.8% in total cost of medical treatments in japan. Cost of antihypertension drugs also accounts 12.5% in all kinds of medical drugs. Especially, angiotensin receptor blocker (ARB) is discussed to be set cheaper. We verified the performance of antihypertensive therapy with our cohort study. 2. Methods We performed (1) cohort study to compare blood pressure levels and total disease's mortality in general population, (2) calculated hazard rates of antihypertensive therapy in general population, and (3) odds ratio of hypertension and antihypertensive therapy between general population and patients with stroke. 3. Results The total mortality were in lowest level until SBP/DBP of 160/100 mmHg. The hazard rate in persons who had cure of hypertension and blood pressure more than 180/110 mmHg at the baseline was increased five times than that in persons who did not have the cure. Hypertension did not show risk of stroke for older people over 60 years. Hypertensive therapy was risk of stroke for younger and elder people. 4. Conclusion Severe antihypertensive therapy will cause increase of total mortality and incidence of stroke. The target of the therapy should be restricted to people who have hypertension over 160/100 mmHg without atrial fibrillation. We should not decrease acutely blood pressure beyond 20 mmHg by drugs.

著者

大櫛 陽一 小林 祥泰

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.18, no.1, pp.21-32, 2009 (Released:2009-05-22)

参考文献数

11

被引用文献数

1 1

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The targets of lipid lowering therapy in Japan are severer than those in western countries. Two hundred twenty mg⁄dl for total cholesterol (TCH), 140mg⁄dl for LDL-C, 150 mg⁄dl for triglyceride (TG) are used for the target values. In western countries, those values are 270 mg⁄dl, 190 mg⁄dl and 1,000 mg⁄dl respectively for low risk persons. But, a morbidity rate of coronary heart disease in Japan is a third in western countries. Strange to say, the number of women who accepts the therapy is twice of that of men in Japan. We have verified the targets used in Japan by some kinds of studies. We established clinical reference intervals of TCH, LDL-C, TG and HDL-C from the results of health checkup of about 700,000 persons by the method comparable to NCCLS in USA. We performed cohort studies and found cutoff points where mortalities increased significantly. These results are equal to the targets used in western countries. People diagnosed as hyperlipidemia by Japanese standard have less morbidity of strokes. If they develop strokes, their clinical indexes are better than persons in normal lipid level. In conclusion, the guideline for hyperlipidemia in Japan should be revised according to Japanese evidences soon.

著者

大櫛 陽一 小林 祥泰 JSSRS

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.29, no.6, pp.777-781, 2007-11-25 (Released:2009-02-06)

参考文献数

10

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Object: We analyzed relations between stroke and hyper tension or the therapy with resent elder Japanese data.Methods: 1) We performed a case control study by comparing rates of hypertension or the therapy with the data of patients in JSSRS and a general population. 2) We performed a open cohort study to analyze a relation between blood pressure revel and total mortality with a general population. The analysis repeated in each gender and each generation (40-59 years, 60-69 years, 70-79 years, 80-89 years). 3) We performed a open cohort study to calculate the risks of hypertension therapy in the same blood pressure revels with another general population.Results: Hyper tension showed significant risk to cerebral infarction in people less than 60 years old, but did not in people more than 60 years old. Hyper tension therapy showed significant risk to cerebral infarction in all generation. Blood pressure showed did not show significant risk to total mortality until 160/100 (systolic/diastolic) in both gender and all generations of the general population. Hyper tension therapy showed significant risk to total mortality at the revel of blood pressure over 180/110. The reason is assumed as the patients with higher blood pressure were treated with hard therapy.Discussion: Hypertension therapy is aiming to decrease blood pressure less than 140/90 now. This study shows the goal is not adequate for elder people. Cerebral infarction may result from the hard treatment.

著者

浜崎 智仁 奥山 治美 浜 六郎 大櫛 陽一

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.23, no.1, pp.71-78, 2014 (Released:2014-05-01)

参考文献数

8

被引用文献数

1

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The risk chart of NIPPON DATA80 showing the absolute mortality from coronary heart disease (CHD) is the only chart of this type widely used in the medical field in Japan. In this chart, there are 240 frames for men with casual blood glucose of ≥200 mg/dL (the right side of the chart); these frames are separated according to smoking status, age, systolic blood pressure, and total cholesterol. The absolute CHD mortality during 10 years in these 240 frames ranges from <0.5% to ≥10% (more than 20 times difference). However, we estimated that there were only 5 CHD deaths at most in these 240 diabetic frames during the study period of NIPPON DATA80. The left (non-diabetic; another 240 frames) part of the chart was adopted for the Guidelines by Japan Atherosclerosis Society after excluding 60 frames for those in their 70s (180 frames as a whole), but those 180 frames were estimated to have only 35 CHD deaths despite the risk difference being more than 10. Furthermore, statistical values such as p value and confidence interval were not found either in the paper introducing the risk chart or in the referred paper for methodology. We, therefore, could not statistically estimate appropriateness of the risk chart. In conclusion, the NIPPON DATA80 risk chart for CHD mortality is not suitable for guidelines or education.

著者

浜崎 智仁 奥山 治美 大櫛 陽一 浜 六郎

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.22, no.1, pp.69-76, 2013 (Released:2013-05-01)

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On September 8, 2012, the panel discussion “The Rethinking of Cholesterol Issues” was held in Sagamihara City, Japan. This paper is the summary of that panel discussion. Four discussants expressed their skeptical views against the cholesterol hypothesis. The whole discussion will be freely seen on the net. Also a similar editorial written by the four discussants will be published in English (Ann Nutr Metab 2013;62:32-36, a free PDF file is already available on the internet). Because Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2012 (JASG 2012) has recently been published, the main part of this paper is focused on serious flaws found in JASG 2012. Dr Harumi Okuyama discusses the differences between JASG 2012 and our guidelines indicating that high cholesterol levels are a good index of longevity; the most important point is that the statin trials that have been performed after 2004, when the new EU law regulating clinical trials became in effect, are all negative. Dr Yoichi Ogushi claims that JASG 2012 intentionally omits some good aspects of cholesterol; cholesterol is a negative risk factor of stroke. His own data also show that cholesterol is good for stroke. He also claims that to properly treat patients with diabetes, we need to reject the cholesterol hypothesis and to reduce carbohydrate rather than cholesterol. Dr Tomohito Hamazaki points out unforgivable flaws in JASG 2012. It does not disclose any COI. It does not contain any relationship between cholesterol levels and all-cause mortality in Japan. Pharmaceutical companies spend 600 billion yen (7 billion US$) per year for advertisement in Japan. This works as “devil’s insurance” (withdrawal of advertisement is a real threat to the mass media). The last discussant, Dr Rokuro Hama, explains the mistake made by JAS (liver disease causes both death and depression of cholesterol levels, and low cholesterol levels are not the cause of death). Hepatitis C virus (HCV) enters hepatic cells via LDL receptors, and low cholesterol levels are one of the major risk factors of HCV infection and chronic hepatitis. Hence, death from liver disease could be the result of low cholesterol levels.

著者

奥山 治美 浜 六郎 大櫛 陽一 浜崎 智仁 内野 元

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.27, no.1, pp.30-38, 2018 (Released:2018-07-16)

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An open-label, randomized controlled trial in type 2 diabetics with hypertension, dyslipidemia, or both was reported (J-DOIT3 study).The participants were randomly assigned to receive conventional or intensive therapy with respect to HbA1c, blood pressure and LDL-C (n=1,271 in each group),and were followed for 8.5 years at 81 clinical sites. Both the participants and doctors in charge were aware of the group assigned. The experimental design was essentially as recommended in the [Comprehensive risk management chart for the prevention of cerebro- and cardiovascular diseases 2015] from the Joint Committee consisted of 13 internal medicine-related societies in Japan, and the Japan Atherosclerotic Society Guidelines 2017. Therefore, the conclusion from the J-DOIT3 study is expected in medical field to affect the current and future medications for the prevention of atherosclerotic cerebro- and cardiovascular diseases (ASCVD).While analyzing the results of this study,we encountered serious problems associated with the methodology, logics and its interpretations, which were summarized in this review. The follow-up study appears to be in progress as described in the Discussion, but we interpret that the intensive therapy used in the J-DOIT3 study is risky in view of currently available evidence. We propose the authors of the study to let the participants know of the results on its objective endpoint, and newly obtain Informed Consents including the potential risks of the intensive intervention based on the progress in this field after the start of this study.

著者

大櫛 陽一 浜 六郎 浜崎 智仁 内野 元

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.27, no.1, pp.39-47, 2018 (Released:2018-07-16)

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A nationwide multicenter randomized controlled study (JDCS) was performed in type-2 diabetes patients. The conventional (CON) group received usual care including anti-diabetic, anti-hypertensive and anti-hyperlipidemic agents to maintain their targeted levels, and the intervention (INT) group additionally received intensive education on lifestyle modifications and adherence to treatment by telephone counselling and at each time outpatient clinic visit for 8 years. The JDCS appears to be based on an assumption that usual treatment of diabetes is appropriate for the prevention of diabetes complications, and that the lack of patients’ compliance is the major cause of unsuccessful treatments. No significant differences between the two groups were found in most of the test results (BMI, blood pressure, fasting glucose level, TC, HDL, lipoprotein-a), use of agents, life style (energy intake, smoking and alcohol intake) at 4 years of intervention. The exercise level was higher at 5 years of intervention, and triglyceride level was lower at 8 years. The incidence of coronary heart disease, retinopathy and neuropathy did not differ significantly between the two groups, but stroke incidence was lower in the INT group. We conducted new analyses on the changes of some explanatory variables in each group. The proportion of participants with pharmacological treatment including insulin significantly increased in both groups except sulfonylureas which about 60% of the participants used at the baseline. On the other hand, those without pharmacological treatment decreased from 19% to 4% in both groups. These indicate that both groups failed in diabetes treatment together. As for the exercise and the smoking cessation, these may prevent stroke, but do not contribute to improvement of diabetes. It is not convincing enough for us to support the validity of publicizing the treatment of diabetes patients used in the JDCS study performed at 59 universities and general hospitals in Japan.

著者

奥山 治美 浜崎 智仁 大櫛 陽一

出版者

日本脂質栄養学会

雑誌

脂質栄養学 (ISSN:13434594)

巻号頁・発行日

vol.23, no.1, pp.79-88, 2014 (Released:2014-05-01)

参考文献数

13

被引用文献数

1

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Previous cholesterol guidelines for the prevention of CHD were based on "the lower, the better" hypothesis, setting upper LDL-C limits and treating patients to maintain their cholesterol levels below the targets, as seen in the ATP 3 issued from the National Heart, Lung, and Blood Institute (NHLBI) and that issued from the Japan Atherosclerosis Society (JAS GL). We published a new cholesterol guideline for longevity (JSLN GL 2010), in which evidence was presented that a high cholesterol level is not a causative factor of CHD but is a predictor of longevity among general populations over 40-50 years of age. Recently, a long-waited revision of the ATP 3 was published from the NHLBI in conjunction with the American College of Cardiology and the American Heart Association (ACC/AHA GL 2013), in which "setting targets to treating patients with statins" and "the lower, the better hypothesis" were abandoned because of the lack of clinical evidence. However, both the JAS GL 2012 and ACC/AHA GL 2013 brought about estimated 10-year CHD (ASCVD) risk mainly based on NIPPON DATA 80 and NHLBI-supported studies, respectively, resulting in increased estimated number of subjects to be treated with statins. Here, we point out that the estimated 10-year risks are not usable because they are not evidence-based. Moreover, we summarize biochemical mechanisms underlying the statin actions to increase heart failure, diabetes mellitus and other diseases after long-term treatments. The cases for which statins, all mitochondrion-toxic, are applicable should be extremely restricted.