Fasting biochemical hypoglycemia and related-factors in nondiabetic population: Kanagawa Investigation of Total Check-up Data from National Database-8

BACKGROUND In healthy people,the lowest daily blood glucose concentration is usually observed in the early morning,after overnight fasting.However,the clinical relevance and the prevalence of fasting biochemical hypoglycemia(FBH)are poorly understood in people who do not have diabetes,although the clinical implications of such hypoglycemia have been extensively studied in patients with diabetes.FBH can be influenced by many factors,including age,sex,body mass,smoking,alcohol drinking,exercise levels,medications,and eating behaviors,such as breakfast skipping and late-night eating.AIM To determine the prevalence of FBH and investigated its association with potential risk factors in a population without diabetes.METHODS Clinical parameters and lifestyle-related factors were assessed in a cross-sectional study of 695613 people aged 40-74 years who had undergone a health check-up(390282 men and 305331 women).FBH was defined as fasting plasma glucose<70 mg/dL(3.9 mmol/L)after overnight fasting,regardless of any symptoms.The absence of diabetes was defined as HbA1c<6.5%,fasting plasma glucose<126 mg/dL(7.0 mmol/L),and no pharmacotherapy for diabetes.Multivariate logistic regression analysis,with adjustment for confounding factors,was used to identify associations.RESULTS FBH was present in 1842 participants(0.26%).There were significantly more women in the FBH group(59.1%)than in the non-FBH group(43.9%).Values of most of the clinical parameters,but not age,were significantly lower in the FBH group than in the non-FBH group.Logistic regression analysis showed that a body mass index of≤20.9 kg/m2(reference:21-22.9 kg/m2)and current smoking were significantly associated with FBH,and this was not altered by adjustment for age,sex,and pharmacotherapy for hypertension or dyslipidemia.Female sex was associated with FBH.When the data were analyzed according to sex,men in their 60s or 70s appeared more likely to experience FBH compared with their 40s,whereas men in their 50s and women aged≥50 years appeared less likely to experience FBH.The relationships of FBH with other factors including alcohol drinking and pharmacotherapies for hypertension and dyslipidemia also differed between men and women.CONCLUSION FBH occurs even in non-diabetic people,albeit at a very low frequency.FBH is robustly associated with low body mass and smoking,and its relationship with lifestyle factors varies according to sex.

Determinants of Sleepiness among Pupils in Kanto District of Japan

Backgrounds: Sleepiness is reported to predict sleep quality, academic performance and self-regulation. This study aimed to discover determinants of sleepiness. Methods: On 2722 questionnaires obtained from pupils in grades 5 - 12 in the Kanto district of Japan, lifestyle habits associated with sleepiness were analyzed using a multivariable logistic regression model. Results: The rate of sleepy pupils (who feel sleepy during class as often and always) increased from elementary school (6.3%) to senior high school (42.4%) via junior high school (17.1%). Higher grade (adjusted odds ratio [OR], 1.28;95% confidence interval [CI], 1.21 - 1.37;p < 0.001), later bedtime before school day (OR, 1.41;CI, 1.26 - 1.57;p < 0.001), longer non-school day screen time (OR, 1.27;CI, 1.16 - 1.40;p < 0.001), poor self-reported academic performance (OR, 1.41;CI, 1.24 - 1.60;p < 0.001), skipping breakfast (OR, 1.18;CI, 1.01 - 1.39;p = 0.041), earlier wake time on school day (OR, 0.84;CI, 0.71 - 0.98;p = 0.026), and higher after-school (OR, 1.03;CI, 1.02 - 1.04;p < 0.001) and physical activities (OR, 1.06;CL, 1.03 - 1.10;p < 0.001) were independently associated with sleepy pupils. Conclusions: To reduce adolescents’ sleepiness in the Kanto district of Japan, we recommend them to have adequate waking time, and to avoid late bedtime, breakfast skipping, excessive screen time, after-school activity, and physical activity. Further prospective studies are needed to confirm involvements of these recommended factors in sleepiness and both physical and mental health outcomes.