Chisato Shimanoe

Vancomycin dosing is guided by population pharmacokinetic models that consider renal function. However, low serum creatinine (Scr) levels may reflect heterogeneous conditions and lead to inaccurate vancomycin clearance. This study evaluated the predictive ability of different population pharmacokinetic models for vancomycin clearance in low Scr settings. This single‐centre retrospective study included hospitalised patients aged ≥18 years who received intravenous vancomycin. Predicted vancomycin clearance was calculated using population pharmacokinetic models across six scenarios incorporating creatinine clearance (Ccr), serum albumin, reduced muscle mass, Scr rounding and Japanese cystatin C–based estimated glomerular filtration rate (eGFR _{Japanese, Cys‐C} ). Agreement was evaluated using concordance correlation coefficients (CCC) and Bland–Altman analysis. Among the six scenarios ( n = 24), the Ccr‐based model exhibited the best agreement (CCC = 0.79). Models based on eGFR _{Japanese, Cys‐C} or rounded‐up Scr systematically underestimated clearance under augmented renal clearance. In those with a body mass index ≥25 kg/m ² , clearance increased more substantially, and a similar trend was observed in patients aged <70 years. In patients with low Scr, Ccr‐based models showed better agreement with two‐point estimated vancomycin clearance. In obese or younger patients with low Scr, two‐point estimated vancomycin clearance may be a practical approach for vancomycin dosing.

Supplementary File (List of the contributors to the J-MICC Study)

With the increasing burden of metabolic syndrome, it is crucial to focus on lifestyle factors to reduce the risk of metabolic syndrome. This study aims to quantify the associations between dietary diversity and the risk of metabolic syndrome among the Japanese population. This study was conducted using baseline data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) study. The baseline survey was conducted from 2005 to 2014 by recruiting individuals aged 35-69. Information regarding dietary intake and biometric measurements were obtained. Dietary Diversity Score (DDS) was calculated from the data based on the food frequency questionnaire. A multiple logistic regression analysis was conducted to analyze the association between DDS and metabolic syndrome. In total, 75,332 participants were included for analysis. Inverse associations were observed between a high DDS and metabolic syndrome (adjusted odds ratio, 0.83 [95% confidential interval 0.76-0.92]). Likewise, a high DDS was associated with reduced odds of a high body mass index and hypertension. No significant associations were observed between the DDS and serum triglyceride, fasting blood glucose, or high-density lipoprotein cholesterol values. The findings of this study emphasize that dietary diversity has inversed associations with metabolic syndrome. Promoting a diverse and balanced diet can be a potential strategy for mitigating the burden of metabolic syndrome.

The incidence of hypertension and Type 2 diabetes mellitus (T2DM) is increasing, and their coexistence significantly increases the risk of cardiovascular diseases, stroke, nephropathy, retinopathy, and mortality. Mineralocorticoid receptor activity, primarily regulated by aldosterone, can be beneficially modulated by mineralocorticoid receptor antagonists, especially in patients with mineralocorticoid receptor-associated hypertension, which often occurs with obesity and T2DM. Thus, markers of mineralocorticoid receptor activation, such as 11β-hydroxysteroid dehydrogenase, may help identify patients who may not benefit from standard hypertension treatments. This study investigated the effects of the cortisol-to-cortisone ratio, a marker of 11β-hydroxysteroid dehydrogenase activity, on the relationship between T2DM and hypertension. Using a cross-sectional design, 6931 individuals aged 45–74 years from the Japan Multi-Institutional Collaborative Cohort Study were analyzed. Cortisol and cortisone levels in spot urine samples were measured using liquid chromatography-mass spectrometry. Hypertension (N = 3141) was observed among those who were older; male; current smokers; current drinkers; had T2DM, hyperlipidemia, high BMI; and low perceived stress, physical activity, and eGFR. Multiple logistic regression analysis was performed, and T2DM was associated with hypertension (odds ratio, 1.37; 95% CI, 1.14–1.66). This association varied with cortisol-to-cortisone ratio level and was more evident in participants with a higher odds ratio (2.01; 95% CI, 1.39–2.91; P_interaction = 0.040). These epidemiologic findings suggest that mineralocorticoid receptor activity and 11β-hydroxysteroid dehydrogenase regulation may play a role in hypertension among patients with T2DM, highlighting the potential for targeted treatments based on the cortisol-to-cortisone ratio.

Supplementary File (List of the contributors to the J-MICC Study)