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Ketone bodies, comprising β-hydroxybutyric acid (BHB), acetoacetate (AcAc), and acetone, play a vital role as essential energy substrates. In individuals with diabetes, ketone bodies can be elevated under various conditions, including diabetic ketoacidosis, use of sodium-glucose transporter type 2 (SGLT2) inhibitors, and extreme carbohydrate restriction. There are three methods for measuring ketone bodies. Urine ketone analysis (AcAc) is a standard clinical test, whereas blood ketone testing (BHB+AcAc) is valuable in identifying or resolving diabetic ketoacidosis. Recently, technology for measuring breath acetone has been introduced, which provides an easy means of monitoring ketogenic diets in obese individuals. The basic breath alcohol detector also reacts with breath acetone. Therefore, it is important for professional drivers taking SGLT2 inhibitors to be cautious as workplace breath alcohol detectors may show false-positive results. Conversely, if a positive result is obtained, a detailed examination of ketosis is necessary. This review provides an overview of ketone body measurements in individuals with diabetes.

PurposeThe aim of this study is to investigate the association of oral dryness with overall survival and determine the threshold points of moisture degree for predicting 7-day survival in palliative care patients.MethodsA total of 147 consecutive palliative care patients were included between January 2017 and November 2018. Oral dryness at the lingual and buccal mucosa was measured using an oral moisture-checking device. Overall survival was compared between patients with and without oral dryness using Kaplan-Meier curves with a log-rank test. Prediction accuracy was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC).ResultsMedian survival (95% confidence interval) in patients with oral dryness at the lingual mucosa was shorter than that in patients without oral dryness (17 [11–24] days vs. 28 [22–37] days, log-rank test, p <0.001), but not at the buccal mucosa. Time-dependent ROC revealed that the AUCs for 7-, 14-, 21-, and 28-day survival predictions were 0.72, 0.68, 0.61, and 0.59 with a cutoff value of 19.2%, respectively. The prevalence of performance status (PS) 4 and oxygen administration in the 7-day death group were higher than those in the non-7-day death group. A stratified analysis indicated that moisture degree <19.2% showed fair predictive performance with an AUC of 0.74 and 0.74, in the case of PS ≤3 or without oxygen administration.ConclusionOral dryness was associated with increased risk of mortality in palliative care patients. Moisture degree <19.2% at the lingual mucosa predicted less than 7-day survival.

Background/objectivesDisturbed circadian rhythm is associated with an increased risk of obesity and metabolic disorders. Brown adipose tissue (BAT) is a site of nonshivering thermogenesis (NST) and plays a role in regulating whole-body energy expenditure (EE), substrate metabolism, and body fatness. In this study, we examined diurnal variations of NST in healthy humans by focusing on their relation to BAT activity.MethodsForty-four healthy men underwent 18F-fluoro-2-deoxy-D-glucose positron emission tomography and were divided into Low-BAT and High-BAT groups. In STUDY 1, EE, diet-induced thermogenesis (DIT), and fat oxidation (FO) were measured using a whole-room indirect calorimeter at 27 °C. In STUDY 2, EE, FO, and skin temperature in the region close to BAT depots (Tscv) and in the control region (Tc) were measured at 27 °C and after 90 min cold exposure at 19 °C in the morning and in the evening.ResultsIn STUDY 1, DIT and FO after breakfast was higher in the High-BAT group than in the Low-BAT group (P < 0.05), whereas those after dinner were comparable in the two groups. FO in the High-BAT group was higher after breakfast than after dinner (P < 0.01). In STUDY 2, cold-induced increases in EE (CIT), FO, and Tscv relative to Tc in the morning were higher in the High-BAT group than in the Low-BAT group (P < 0.05), whereas those after dinner were comparable in the two groups. CIT in the High-BAT group tended to be higher in the morning than in the evening (P = 0.056).ConclusionBAT-associated NST and FO were evident in the morning, but not in the evening, suggesting that the activity of human BAT is higher in the morning than in the evening, and thus may be involved in the association of an eating habit of breakfast skipping with obesity and related metabolic disorders.

Fibroblast growth factor (FGF) 21 is an important regulator of glycemic control, but the association between circulating FGF21 and diabetic complications is poorly understood. Moreover, basal FGF21 secretion, especially in response to insulin dose, in patients with type 1 diabetes mellitus (T1DM), has not been well examined. Therefore, this study aimed to determine the association of circulating FGF21 levels with diabetic complications and insulin dosage in middle-aged and elderly patients with T1DM. A total of 127 middle-aged and elderly patients with T1DM, including 68 patients with diabetic complications, and 106 non-diabetic individuals were analyzed in this cross-sectional study. Information on demographic characteristics and T1DM was extracted from their electronic medical records. Serum FGF21 levels were determined using ELISA. Serum FGF21 levels were significantly lower in T1DM patients (75.2 [37.4-135.1] pg/mL) than in non-diabetic participants (151.6 [92.0-224.6] pg/mL; P < 0.001). No diabetic complications were associated with serum FGF21 concentrations. Both basal and bolus insulin doses were significantly and positively correlated with serum FGF21 levels (P < 0.05). Stepwise multiple regression analysis showed that FGF21 level was associated with age and body mass index (P < 0.05), while the basal insulin dose was an independent positive predictor of serum FGF21 levels (β = 0.197, P = 0.032). Circulating FGF21 levels are reduced in patients with T1DM; however, they are not associated with diabetic complications. In addition, aging, obesity, and insulin dosage are positive determinants of circulating FGF21.

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants’ level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as “yes” if they answered “several times per year or more” and “no” if they answered “never.” Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74–0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31–0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37–0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.

We have previously reported that female patients with nontuberculous mycobacterial lung disease (NTM-LD) are thinner and eat less than healthy controls. Therefore, we hypothesized that their thinness is associated with body size misperception. The aim of this study was to clarify whether patients' body size perception (BSP) is associated with body mass index (BMI) independent of potential confounders. In this cross-sectional study, we assessed 81 outpatients for BSP using the Japanese version of Body Image Scale, body composition, dietary intake, and biochemical markers. As a control, we used BSP and self-reported anthropometric data from 111 healthy women collected via a web survey. First, BSP and BMI were compared between the patients and the controls. Second, patient data was compared between patients who overestimated their body size (OE, n = 31) and a control who did not (Non-OE, n = 50). Multiple regression analysis was performed to clarify the association between BSP (independent variable) and BMI (dependent variable), adjusting for potential confounders, such as age, disease duration, and nutritional factors. There was a negative correlation between body size distortion and BMI in both patients and controls (p < 0.001, both). In interpatient comparisons, the OE group had significantly lower BMI and body fat percentage (p < 0.001, both), normalized energy (p = 0.037), and protein (p = 0.013) intakes, and significantly greater weight loss from age 20 (p = 0.003) than the Non-OE group. Multiple regression analysis revealed that overestimation of body size was associated with lower BMI independent of confounders, such as longer disease history, longitudinal weight loss, and nutritional factors. These findings suggest that body size distortion is an etiological factor for lower BMI in female patients with NTM-LD. Thus, it may be important to understand the patient's body image when providing dietary advice.

PurposeThe aim of the study was to determine the diagnostic accuracy of patient-reported dry mouth using an oral moisture-checking device in terminally ill cancer patients.MethodsThe study was conducted following the STARD guidelines, and the participants were recruited prospectively from the Palliative Care Unit, Kyoto Medical Center, Japan, between 1 January 2017 and 30 November 2018. Patients reporting dry mouth were asked to rate oral dryness on a 5-point rating scale. The outcome was oral dryness at the lingual mucosa, measured using an oral moisture-checking device. Receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR), and overall diagnostic accuracy were calculated.ResultsOf 103 participants, the prevalence of oral dryness was 65.0%. ROC analysis indicated that patient-reported dry mouth was a poor predictor of oral dryness, with an area under the curve of 0.616 (95% confidence interval: 0.508–0.723), a sensitivity of 46.3%, a specificity of 75.8%, a PPV of 55.9%, an NPV of 68.1, a positive LR of 1.9, a negative LR of 0.7, and an overall diagnostic accuracy of 64.1%, with a cut-off value of 3 points.ConclusionIn conclusion, patient-reported dry mouth is not a useful parameter for the assessment of oral dryness in terminally ill cancer patients.

We previously reported that the intake of heat-killed Lacticaseibacillus paracasei MCC1849 suppressed the onset of cold-like symptoms in healthy young women who were susceptible to colds. This study aimed to investigate the effects of MCC1849 on subjective symptoms of physical condition in healthy adults of a wide age range. In this randomized, double-blind, placebo-controlled, parallel-group study, 200 healthy adults were randomly divided into the MCC1849 group or placebo group. The participants received test powder with 50 billion MCC1849 cells or placebo powder without MCC1849 for 24 weeks. Subjective symptoms were assessed by diary scores. Analysis was performed on 183 participants (MCC1849 group; n = 91, placebo group; n = 92) in the per-protocol set. The number of days of stuffy nose and cold-like symptoms was significantly reduced in the MCC1849 group compared with the placebo group. In addition, the duration of stuffy nose, sore throat and cold-like symptoms was significantly lower in the MCC1849 group. No side effects were observed. Therefore, oral intake of MCC1849 suppressed subjective symptoms in healthy adults of a wide age range. These data suggest that MCC1849 may help maintain physical condition.

Lifestyle interventions have been shown to prevent or delay the onset of diabetes; however, inter-individual variability in responses to such interventions makes lifestyle recommendations challenging. We analyzed the Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1) study data using a previously published mechanistic simulation model of type 2 diabetes onset and progression to understand the causes of inter-individual variability and to optimize dietary intervention strategies at an individual level. J-DOIT1, a large-scale lifestyle intervention study, involved 2607 subjects with a 4.2-year median follow-up period. We selected 112 individuals from the J-DOIT1 study and calibrated the mechanistic model to each participant’s body weight and HbA1c time courses. We evaluated the relationship of physiological (e.g., insulin sensitivity) and lifestyle (e.g., dietary intake) parameters with variability in outcome. Finally, we used simulation analyses to predict individually optimized diets for weight reduction. The model predicted individual body weight and HbA1c time courses with a mean (±SD) prediction error of 1.0 kg (±1.2) and 0.14% (±0.18), respectively. Individuals with the most and least improved biomarkers showed no significant differences in model-estimated energy balance. A wide range of weight changes was observed for similar model-estimated caloric changes, indicating that caloric balance alone may not be a good predictor of body weight. The model suggests that a set of optimal diets exists to achieve a defined weight reduction, and this set of diets is unique to each individual. Our diabetes model can simulate changes in body weight and glycemic control as a result of lifestyle interventions. Moreover, this model could help dieticians and physicians to optimize personalized nutritional strategies according to their patients’ goals.

Objectives: Falls are among the most prevalent workplace accidents, necessitating thorough screening for susceptibility to falls and customization of individualized fall prevention programs. The aim of this study was to develop and validate a high fall risk prediction model using machine learning (ML) and video-based first 3 steps in middle-aged workers.Methods: Participants to provide training data (n = 190, mean [SD] age = 54.5 [7.7] years, 48.9% male) and validation data (n = 28, age = 52.3 [6.0] years, 53.6% male) were enrolled in this study. Pose estimation was performed using a marker-free deep pose estimation method called MediaPipe Pose. The first 3 steps, including the movements of the arms, legs, trunk, and pelvis, were recorded using an RGB camera, and the gait features were identified. Using these gait features and fall histories, a stratified k-fold cross-validation method was used to ensure balanced training and test data, and the area under the curve (AUC) and 95% CI were calculated.Results: Of 77 gait features in the first 3 steps, we found 3 gait features in men with an AUC of 0.909 (95% CI, 0.879-0.939) for fall risk, indicating an “excellent” (0.9-1.0) classification, whereas we determined 5 gait features in women with an AUC of 0.670 (95% CI, 0.621-0.719), indicating a “sufficient” (0.6-0.7) classification.Conclusions: These findings suggest that fall risk prediction can be developed based on ML and the first 3 steps in men; however, the accuracy was only “sufficient” in women. Further development of the formula for women is required to improve its accuracy in the middle-aged working population.