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HOME > Epidemiol Health > Volume 39; 2017 > Article
Review
The criteria for metabolic syndrome and the national health screening and education system in Japan
Kazumasa Yamagishi1orcid, Hiroyasu Iso1,2orcid
Epidemiol Health 2017;39:e2017003.
DOI: https://doi.org/10.4178/epih.e2017003
Published online: January 6, 2017

1Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

2Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan

Correspondence: Kazumasa Yamagishi  Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan  E-mail: yamagishi.kazumas.ge@u.tsukuba.ac.jp
The main contents of this manuscript were presented at the Ninth Korea–Japan Joint Epidemiology Seminar in Seoul, South Korea in December 2016.
• Received: January 1, 2017   • Accepted: January 6, 2017

©2017, Korean Society of Epidemiology

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
Japan has several unique points in criteria, screening and education systems for metabolic syndrome. In this review, we discuss topics related to metabolic syndrome in Japan, including the Japanese criteria for metabolic syndrome; the universal health screening and education system for metabolic syndrome; and recent debates about Japanese criteria for metabolic syndrome.
Many definitions of metabolic syndrome have been used worldwide, but they can be classified into two major types of criteria. The definition of the International Diabetes Federation (IDF) represents one type of criteria [1], while the definitions of the American Heart Association (AHA) and the National Heart, Lung and Blood Institute (NHLBI) of the US represent the other type (Figure 1) [2]. The major difference between these definitions is that the IDF criteria regard central obesity as an essential component of metabolic syndrome, whereas the AHA criteria focus on the accumulation of metabolic risk factors. The AHA criteria take waist circumference (WC) into consideration as one of five risk factors and define metabolic syndrome as the presence of any three components out of these five. The Japanese criteria [3] were established in 2005 and are quite similar to those of the IDF, except for the cutpoint for WC (Figure 1).
In 2009, the IDF, NHLBI, AHA, and other organizations unified their criteria [4], and these newer criteria are essentially similar to the AHA/NHLBI criteria (Figure 1). As a result, only the Japanese criteria maintain WC as an essential component of the definition.
The prevalence of metabolic syndrome among the Japanese according to different criteria was compared in a community sample from the Circulatory Risk in Communities Study (1990-1993, Kyowa, Japan; subjects aged 40-69 years old) [5]; 33% were evaluated by the AHA/NHLBI criteria; 27% were evaluated by the IDF criteria; and 17% were evaluated by the Japanese criteria.
Before the 1950s, the leading cause of death in Japan was tuberculosis, and the main measure at that time was the universal tuberculosis screening system. From the 1950s to 1980s, the leading cause was stroke; thus, the national prevention strategy focused on high blood pressure screening. In 1981, cancer overtook stroke, and in 1985 heart disease also overtook stroke, followed by pneumonia in 2011. Stroke is now the fourth leading cause of death in Japan. Given these changes, the Japanese government has shifted the target of screening to metabolic syndrome for the prevention 2and control of diabetes mellitus and the prevention of coronary heart disease and chronic kidney disease. In 2008, the Japanese government launched a new cardiovascular screening and education system, focusing on the detection and control of metabolic syndrome.
This policy change was informed by the existence of two major types of arteriosclerosis: atherosclerosis, which affects large arteries such as the coronary artery and middle cerebral arteries; and arteriolosclerosis, which affects small vessels such as the perforating arteries in the brain [6]. Atherosclerosis predominates in Americans and Europeans, reflecting the greater prevalence of dyslipidemia, glucose abnormalities, and metabolic syndrome, whereas arteriolosclerosis predominates in East Asians, reflecting the greater prevalence of hypertension [6].
The prevalence of hypertension and arteriolosclerosis has decreased over the past 50 years in Japan, and lifestyle patterns in East Asia are undergoing rapid westernization, especially in the middle-aged urban male population. This is the rationale that the Japanese government considered for changing the target of preventive screening to metabolic syndrome. In addition, although Japan has already established a universal health screening system, a post-screening education system has not been sufficiently developed. WC can function as a visible marker for motivating people to make lifestyle changes after screening, which is another rationale for the government to target metabolic syndrome.
The current system of post-screening measures for metabolic syndrome is shown in Figure 2. Based on the results of the screening, participants are classified into three groups based on the criteria for metabolic syndrome. As previously stated, WC is an essential component of the criteria for metabolic syndrome, and if participants exhibit two or more other risk factors, the insurer provides them with active support for making changes to their lifestyle. If they have abdominal obesity and one risk factor, then they are assigned to a motivational support group. All other participants receive information on preventing metabolic syndrome.
On the one hand, this system has produced several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved (although many people still confuse metabolic syndrome with simple obesity); preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. On the other hand, several problems with this system have been identified, which are now under debate.
Debate has arisen concerning the preventive system targeting metabolic syndrome and revisions to the program are currently under consideration. The following questions have informed the discussions of the Japanese government commission on the way of universal cardiovascular screening and education system.
Q1: Is metabolic syndrome really important among the Japanese?
This question has arisen because many studies have shown that the population attributable risk fraction (PAF) of metabolic syndrome is not as high as the PAF of high blood pressure. For example, the Japan Public Health Center-based Prospective Study reported that the PAF of high blood pressure was 50% for men and 53% for women, whereas that of metabolic syndrome (based on IDF criteria) was 10% for men and 6% for women [7].
However, an upward trend in obesity among East Asian men (but not among women, and not as steep as among non-Asians) may increase the impact of metabolic syndrome in the near future, especially among younger men. Therefore, it has been decided that metabolic syndrome is of importance among the Japanese, as a matter of disease management and prevention of cardiovascular disease in the future.
Q2: Is it appropriate to keep waist circumference as an essential component of the criteria for metabolic syndrome?
This question is based on the fact that many studies have shown that the PAF of metabolic syndrome itself is not as high as that found in the non-obese, but high-risk population. For example, the Ibaraki Prefectural Health Study reported that the PAF of cardiovascular mortality was 10% for persons with a body mass index (BMI) of ≥25 kg/m2 and two or more metabolic risk factors, whereas it was 15% for those with a BMI of <25 kg/m2 and two or more metabolic risk factors [8].
In response, the committee has determined that it is necessary to provide additional health education for non-obese, but high-risk people.
Q3: Are the Japanese waist circumference cutpoints appropriate?
The harmonized criteria of metabolic syndrome define central obesity with race-specific and gender-specific WC cutoffs [4]. Japanese cutoffs are ≥85 cm for men and ≥90 cm for women, defined based on cross-sectional studies that showed that these cutpoints were equivalent to 100 cm2 of visceral fat area [3]. These cutoffs have sometimes been criticized, because only Japan sets higher cutoffs for women than men. However, according to a study supported by the Ministry of Health, Labour, and Welfare [9], changing WC cutoffs from 80 to 90 cm had virtually no effect on the impact of metabolic syndrome on cardiovascular disease. Taken together with the fact that the incidence of cardiovascular disease is much lower in women than in men, the committee concluded that the WC cutpoints should be maintained as is.
The conclusions of this review are as follows. First, the Japanese criteria for metabolic syndrome differ in several respects from the international criteria, including the use of WC as an essential component, with unique WC cutpoints. Second, though a universal metabolic syndrome screening and education system was launched in 2008, the epidemiological evidence for the metabolic syndrome measures was not sufficient at the start of the system’s implementation. Third, revision of the metabolic syndrome screening system is now under consideration, but it is unlikely to be changed drastically. Fourth, considering measures of metabolic syndrome in East Asia, we should note that the etiology of arteriosclerosis differs between East Asians and Westerners.

The authors have no conflicts of interest to declare for this study.

Figure 1.
Selected criteria of metabolic syndrome. IDF, International Diabetes Federation; WC, waist circumference; TG, triglyceride; HDL, high-density lipoprotein cholesterol; BP, blood pressure; FPG, fasting plasma glucose; AHA, American Heart Association; NHLBI, National Heart Lung and Blood Institute; WHF, World Heart Federation; IAS, International Atherosclerosis Society; IASO, International Association for the Study of Obesity; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.
epih-39-e2017003f1.gif
Figure 2.
Current system of post-screening measures for metabolic syndrome. 1Additional risk factors: hyperglycemia (FBS ≥100 mg/dL or HbA1c ≥5.6%); dyslipidemia (TG ≥150 mg/dL or HDL ≤40 mg/dL); hypertension (SBP ≥130 mmHg or DBP ≥ 85 mmHg); Smoking. FBS, fasting blood sugar; HbAlc, glycated hemoglobin; TG, triglyceride; HDL, high-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure.
epih-39-e2017003f2.gif
  • 1. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet 2005;366:1059-1062.ArticlePubMed
  • 2. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-2752.ArticlePubMed
  • 3. Committee to Evaluate Diagnostic Standards for Metabolic Syndrome. Definition and the diagnostic standard for metabolic syndrome. Nihon Naika Gakkai Zasshi 2005;94:794-809 (Japanese).PubMed
  • 4. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-1645.ArticlePubMed
  • 5. Chei CL, Yamagishi K, Tanigawa T, Kitamura A, Imano H, Kiyama M, et al. Metabolic syndrome and the risk of ischemic heart disease and stroke among middle-aged Japanese. Hypertens Res 2008;31:1887-1894.ArticlePubMed
  • 6. Iso H. A Japanese health success story: trends in cardiovascular diseases, their risk factors, and the contribution of public health and personalized approaches. EPMA J 2011;2:49-57.ArticlePubMedPMCPDF
  • 7. Noda H, Iso H, Saito I, Konishi M, Inoue M, Tsugane S, et al. The impact of the metabolic syndrome and its components on the incidence of ischemic heart disease and stroke: the Japan public health center-based study. Hypertens Res 2009;32:289-298.ArticlePubMedPDF
  • 8. Irie F, Iso H, Noda H, Sairenchi T, Otaka E, Yamagishi K, et al. Associations between metabolic syndrome and mortality from cardiovascular disease in Japanese general population, findings on overweight and non-overweight individuals. Ibaraki Prefectural Health Study. Circ J 2009;73:1635-1642.ArticlePubMed
  • 9. Kadowaki T. Report on the Health, Labour Science Research Grant: epidemiological study on innovating evidence for metabolic syndrome diagnosis and control in national health checkups and education system. Tokyo: Ministry of Health, Labour and Welfare; 2014. p 1-14 (Japanese).

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    • Effect of overweight/obesity and metabolic syndrome on frailty in middle‐aged and older Japanese adults
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      BPB Reports.2022; 5(6): 140.     CrossRef
    • Validity of "One-size-fits-all" Approaches for the National Health Screening and Education Program: A Large-scale Cohort Study of Corporate Insurance Beneficiaries
      Kyoko Kikuchi, Takahiro Imaizumi, Masahiko Ando, Sawako Kato, Takaaki Kondo, Hiroyuki Honda, Yasuko Yoshida, Shoichi Maruyama
      Internal Medicine.2021; 60(11): 1681.     CrossRef
    • Mid-regional pro-adrenomedullin is a novel biomarker for arterial stiffness as the criterion for vascular failure in a cross-sectional study
      Teruhide Koyama, Nagato Kuriyama, Yosuke Suzuki, Satoshi Saito, Ryota Tanaka, Motoshi Iwao, Megumu Tanaka, Takakuni Maki, Hiroki Itoh, Masafumi Ihara, Takayuki Shindo, Ritei Uehara
      Scientific Reports.2021;[Epub]     CrossRef
    • Ethno‐essentialisms of the self: A critique of the cultural scripting of obesity in Japan
      Genaro Castro‐Vázquez
      Sociology of Health & Illness.2021; 43(3): 796.     CrossRef
    • Psoriasis: Comorbidities
      Fumikazu Yamazaki
      The Journal of Dermatology.2021; 48(6): 732.     CrossRef
    • Subclass distribution of low‐density lipoprotein triglyceride and the clustering of metabolic syndrome components in Japanese children
      Ryousuke Tonouchi, Tomoo Okada, Yuriko Abe, Minako Kazama, Yuki Kuromori, Yayoi Yoshino, Fujihiko Iwata, Mitsuhiko Hara, Emiko Saito, Ichiro Morioka
      Pediatrics International.2021; 63(6): 664.     CrossRef
    • Dynapenia Rather Than Sarcopenia Is Associated with Metabolic Syndrome in Patients with Chronic Liver Diseases
      Hiroki Nishikawa, Kazunori Yoh, Hirayuki Enomoto, Shuhei Nishiguchi, Hiroko Iijima
      Diagnostics.2021; 11(7): 1262.     CrossRef
    • Association between Metabolic Syndrome and Osteoporosis: A Systematic Review and Meta-Analysis
      Weida Liu, Chuangshi Wang, Jun Hao, Lu Yin, Yang Wang, Wei Li, Alberto Ferlin
      International Journal of Endocrinology.2021; 2021: 1.     CrossRef
    • Insulin resistance and the adiponectin/leptin ratio as a surrogate measure of insulin resistance in Japanese collegiate baseball players
      Kazuto ODA, Hisaya KAWATE, Aya ISHIBASHI, Hiroyuki IMAMURA
      The Journal of Sports Medicine and Physical Fitness.2021;[Epub]     CrossRef
    • Negative effect of fatty liver on visualization of pancreatic cystic lesions at screening transabdominal ultrasonography
      Kazuhiro Kashiwagi, Takashi Seino, Kanako Makino, Ryoko Shimizu‐Hirota, Michiyo Takayama, Toshifumi Yoshida, Eisuke Iwasaki, Yoshinori Sugino, Nagamu Inoue, Yasushi Iwao, Takanori Kanai
      Journal of Evaluation in Clinical Practice.2020; 26(1): 256.     CrossRef
    • Rationale, Design, and Methods of the Study of Comparison of Canagliflozin vs. Teneligliptin Against Basic Metabolic Risks in Patients with Type 2 Diabetes Mellitus (CANTABILE study): Protocol for a Randomized, Parallel-Group Comparison Trial
      Cheol Son, Masato Kasahara, Tomohiro Tanaka, Noriko Satoh-Asahara, Toru Kusakabe, Kunihiro Nishimura, Yoshihiro Miyamoto, Shu Kasama, Kiminori Hosoda
      Diabetes Therapy.2020; 11(1): 347.     CrossRef
    • Association between metabolic syndrome and prognosis of breast cancer: a meta-analysis of follow-up studies
      Peiting Li, Tianying Wang, Chen Zeng, Meng Yang, Gang Li, Jiang Han, Wei Wu
      Diabetology & Metabolic Syndrome.2020;[Epub]     CrossRef
    • Risk and population attributable fraction of metabolic syndrome and impaired fasting glucose for the incidence of type 2 diabetes mellitus among middle‐aged Japanese individuals: Aichi Worker’s Cohort Study
      Kayo Kaneko, Hiroshi Yatsuya, Yuanying Li, Mayu Uemura, Chifa Chiang, Yoshihisa Hirakawa, Atsuhiko Ota, Koji Tamakoshi, Atsuko Aoyama
      Journal of Diabetes Investigation.2020; 11(5): 1163.     CrossRef
    • Metabolic syndrome and dyslipidemia among nigerians with lichen planus: A cross-sectional study - Reader's question
      MahmoodD Al-Mendalawi
      Indian Journal of Dermatology.2020; 65(3): 228.     CrossRef
    • Glycosylated Hemoglobin A1c Improves the Performance of the Nomogram for Predicting the 5-Year Incidence of Type 2 Diabetes


      Chun-Ming Ma, Fu-Zai Yin
      Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 1753.     CrossRef
    • Mental stress and physical activity interact with the genetic risk scores of the genetic variants related to sweetness preference in high sucrose‐containing food and glucose tolerance
      Sunmin Park, Meiling Liu, Mi Young Song
      Food Science & Nutrition.2020; 8(7): 3492.     CrossRef
    • Effect of Metabolic Syndrome on Blood Pressure Changes During Cataract Surgery
      Takashi Ono, Takuya Iwasaki, Sayumi Sameshima, Jinhee Lee, Yosai Mori, Ryohei Nejima, Makoto Aihara, Kazunori Miyata
      Asia-Pacific Journal of Ophthalmology.2020; 9(1): 14.     CrossRef
    • Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: Aldosterone‐producing adenoma and idiopathic hyperaldosteronism
      Mikiko Okazaki‐Hada, Ayako Moriya, Mototsugu Nagao, Shinichi Oikawa, Izumi Fukuda, Hitoshi Sugihara
      Journal of Diabetes Investigation.2020; 11(6): 1511.     CrossRef
    • Added and Free Sugars Intake and Metabolic Biomarkers in Japanese Adolescents
      Masayuki Okuda, Aya Fujiwara, Satoshi Sasaki
      Nutrients.2020; 12(7): 2046.     CrossRef
    • Apolipoprotein B/A1 Ratio as a Diagnostic Alternative to Triglycerides and HDL-Cholesterol for the Prediction of Metabolic Syndrome among Hypertensives in Kazakhstan
      Alma Nurtazina, Dana Kozhakhmetova, Daulet Dautov, Aizhan Shakhanova, Vijay Kumar Chattu
      Diagnostics.2020; 10(8): 510.     CrossRef
    • Visceral fat in different locations assessed by ultrasound: Correlation with computed tomography and cut‐off values in patients with metabolic syndrome
      Sergey Pimanov, Vladimir Bondarenko, Elena Makarenko
      Clinical Obesity.2020;[Epub]     CrossRef
    • Daily Consumption of Coffee and Eating Bread at Breakfast Time Is Associated with Lower Visceral Adipose Tissue and with Lower Prevalence of Both Visceral Obesity and Metabolic Syndrome in Japanese Populations: A Cross-Sectional Study
      Teruhide Koyama, Mizuho Maekawa, Etsuko Ozaki, Nagato Kuriyama, Ritei Uehara
      Nutrients.2020; 12(10): 3090.     CrossRef
    • Does the Energy Restriction Intermittent Fasting Diet Alleviate Metabolic Syndrome Biomarkers? A Randomized Controlled Trial
      Yasemin Ergul Kunduraci, Hanefi Ozbek
      Nutrients.2020; 12(10): 3213.     CrossRef
    • Fisher’s Linear Discriminant Function Analysis and its Potential Utility as a Tool for the Assessment of Health-and-Wellness Programs in Indigenous Communities
      Eric N. Liberda, Aleksandra M. Zuk, Ian D. Martin, Leonard J. S. Tsuji
      International Journal of Environmental Research and Public Health.2020; 17(21): 7894.     CrossRef
    • Longitudinal effects of a nationwide lifestyle intervention program on cardiometabolic outcomes in Japan: An observational cohort study
      Yoshinori Takeuchi, Kosuke Kashiwabara, Hiroki Hosoi, Hirohisa Imai, Yutaka Matsuyama
      Preventive Medicine.2020; 141: 106301.     CrossRef
    • Lycopene and Metabolic Syndrome: A Systematic Review of the Literature
      Katelyn E Senkus, Libo Tan, Kristi M Crowe-White
      Advances in Nutrition.2019; 10(1): 19.     CrossRef
    • Addition of oat bran reduces HDL-C and does not potentialize effect of a low-calorie diet on remission of metabolic syndrome: A pragmatic, randomized, controlled, open-label nutritional trial
      Leila Sicupira Carneiro de Souza Leão, Luana Azevedo de Aquino, Juliana Furtado Dias, Rosalina Jorge Koifman
      Nutrition.2019; 65: 126.     CrossRef
    • Comparison of various steady state surrogate insulin resistance indices in diagnosing metabolic syndrome
      Sikandar Hayat Khan, Ali Nawaz Khan, Nayyer Chaudhry, Roomana Anwar, Nadeem Fazal, Muhammad Tariq
      Diabetology & Metabolic Syndrome.2019;[Epub]     CrossRef
    • Population Approaches Targeting Metabolic Syndrome Focusing on Japanese Trials
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      Nutrients.2019; 11(6): 1430.     CrossRef
    • Pancreatic fat content may increase the risk of imaging progression in low‐risk branch duct intraductal papillary mucinous neoplasm
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    • Association between metabolic syndrome and the incidence of gastric cancer: a meta-analysis of cohort studies
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      Diabetology & Metabolic Syndrome.2019;[Epub]     CrossRef
    • Lower limb muscle mass is associated with insulin resistance more than lower limb muscle strength in non‐diabetic older adults
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      Geriatrics & Gerontology International.2019; 19(12): 1254.     CrossRef
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      Meng Guo, Tingting Liu, Peiting Li, Tianying Wang, Chen Zeng, Meng Yang, Gang Li, Jiang Han, Wei Wu, Ruopeng Zhang
      Frontiers in Oncology.2019;[Epub]     CrossRef
    • Diagnostic Criteria for Metabolic Syndrome Using BMI in Place of Waist Circumference (WC)
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      Kazuhiro Kashiwagi, Takashi Seino, Seiichirou Fukuhara, Kazuhiro Minami, Masayasu Horibe, Eisuke Iwasaki, Hiromasa Takaishi, Kazunari Itoh, Yoshinori Sugino, Nagamu Inoue, Yasushi Iwao, Takanori Kanai
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      Hirotaka Suga, Tomohiro Shiraishi, Naoko Tsuji, Akihiko Takushima
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    • Insomnia and depression: Japanese hospital workers questionnaire survey
      Fumihiko Koyama, Takeshi Yoda, Tomohiro Hirao
      Open Medicine.2017; 12(1): 391.     CrossRef

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