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特集2: フィールド医学 = Special Issue 2: Field Medicine, 本誌公刊にあたっては、京都大学学士山岳会、京都大学「霊長類学・ワイルドライフサイエンス」・リーディング大学院からの助成をうけました。

本稿は, 高所プロジェクトの提唱してきた「糖尿病アクセル仮説」の一部について検証した科学論文 (Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland. BMJ open 2016) のレビューである。耐糖能障害がライフスタイルと低酸素血症といかに関連するかを, 中国からインドにわたるチベット高原 (2900-4800m) の1258人の住民において研究された。社会経済的要因, 高度3500m 以上在住, および低酸素血症が, 高所住民の耐糖能異常の増加に大きく関与していることが報告された。低酸素血症, 多血症, 耐糖能異常の3者には密接な関係があり, 加齢とライフスタイル変化がその関係を促進している (糖尿病アクセル仮説) ことが検証された。, The association between glucose intolerance and high altitudes (2900-4900m) was clarified in Tibetan highlanders. The hypothesis was verified that dwelling at high altitudes have vulnerability to diabetes accelerated by lifestyle change or aging. 1258 subjects (40-87 years) were examined; farmers in Domkhar (2900-3800m), nomads in Haiyan, Ryuho, and Changthang (3000-4800m), and urban dwellers in Leh and Jiegu (3300-3700m). The prevalence of glucose intolerance was higher in urban dwellers and in farmers compared with nomads. Dwelling at a higher altitude was significantly associated with fasting hyperglycemia (odds ratios for >4500 and 3500-3999m were 3. 59 and 2. 07 vs 1.0, 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension., 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension., 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

生活習慣病と診断された者の身体活動量として1 日の歩数を測定し, 彼らの生活実態を探ることを目的とした. 40歳以上のドムカルの住民(ラダーキー)のうち, 高血圧, 耐糖能異常のいずれかに該当した23名(平均年齢61歳, 男性13名 女性10 名)の歩数を1-3 日間にわたって測定した. 年齢と歩数には負の相関が見られ(r =-0.71, p, Objective of the study is to investigate the daily activities of people with hypertension or diabetes using a pedometer to count daily walking steps in one day. We measured walking steps during 1-3days in 23 subjects aged 40 years or over (mean age: 61years old, male/female:13/10) diagnosed as cases of hypertension or impaired glucose tolerance in Domkhar village. There was a significant negative correlation between age and walking steps (r =-0.71, p

ヒマラヤ・チベット高所のグローバリゼーションの浸透の異なる地域を比較することによって, 生活習慣病と老化の変容の実態が明らかになってきた. 高所環境適応への長期の歴史との密接な関連の中で, 生活習慣病の変容が, 今まさに起こっていること. また, 最近のグローバル化のライフスタイルの変化による, 健康や老化の変容への影響が非常に大きいことである. さらに, 今後の課題としては, 高所の特徴である低酸素に対する進化的身体的適応が, 生活習慣病の発症や老化の変容に予防的に働くのか, あるいは, 促進しているのか. 高所への文化的適応としての高地文明と, グローバル化による生活の変化の中で, どのように, 老人のQOL の向上につなげていくべきかを追求していく必要がある., Elderly highlanders have had long-term adaptation to the harsh environment of hypoxia and low food resources; however, rapid changes in life styles associated with the progress of global modernization and urbanization might overwhelm high altitude adaptation with lifestyle-related diseases and the change of ageing in elderly highlanders in Himalaya/Tibet. Worthy of study is the question of whether elderly highlanders who have had evolutionary adaptation to hypoxic environments are vulnerable to lifestyle-related diseases associated with globalism.

インド・ラダックの医学の問題をレビューし, 予備調査の結果や情報収集とあわせて今後の課題を概説した. インド・ラダックでは, 高血圧と脳梗塞の問題, 貧困と野菜の不足と胃癌の問題, 塵肺, 硅肺の問題がある. 社会・経済的グローバリゼーションに伴うライフスタイルの変化が, 疾病, 老化のあり方とともに, 老人のwell-being にどう影響するかを今後, 医学, 文化, 生態の各学問分野の連携により, 環境や生態のバックグラウンドとの因果関係を調べていく必要がある., The health problem in Ladakh in India was reviewed. There were the problems on hypertension, stroke, gastric cancer associated with poverty and low intake of vegetable, pneumoconiosis, and silicosis. Now, rapid lifestyle changes with socio-economic globalization are occurring and effects will be prominent. The influence of changing lifestyles on these diseases and quality of life in the elderly should be studied from interdisciplinary and comprehensive perspectives, including medicine, geography, agriculture, anthropology, meteorology, ecology and economics.

Domkhar consists of three villages located in the northwestern part of Ladakh, at altitudes between 2900 and 4000 meters above sea level. We visited there in July, 2008 and conducted medical check-ups for the elderly and interviewed with them. About 73% of elderly residents over 60 years old who took our medical checkups had blood pressures of 140/90 mmHg or higher. Knee pain was the most common symptom supposed to be associated with heavy physical activities in the mountain. The average arterial blood oxygen saturation was 91.4±3.6 % among males and 88.7±4.8 % among females. The average hemoglobin level was 15.9±2.8 g/dl among males and 13.9±2.9 g/dl among females. Three out of 17 residents had a casual blood sugar 140 mg/dl or more. The average subjective quality of life (QOL) measured by visual analogue scale was 52.7±18.0 in health, 82.2±10.0 in family relationship, 82.7±9.9 in friendship, 62.4±21.3 in economics and 69.4±19.0 in happiness. We should pay more attention to the impact of changing lifestyle and environments on prevalence of lifestyle-related diseases and QOL in the elderly in highland worlds.

The association between glucose intolerance and high altitudes (2900-4900m) was clarified in Tibetan highlanders. The hypothesis was verified that dwelling at high altitudes have vulnerability to diabetes accelerated by lifestyle change or aging. 1258 subjects (40-87 years) were examined; farmers in Domkhar (2900-3800m), nomads in Haiyan, Ryuho, and Changthang (3000-4800m), and urban dwellers in Leh and Jiegu (3300-3700m). The prevalence of glucose intolerance was higher in urban dwellers and in farmers compared with nomads. Dwelling at a higher altitude was significantly associated with fasting hyperglycemia (odds ratios for >4500 and 3500-3999m were 3. 59 and 2. 07 vs 1.0 ; <3500m) by multiple logistic regression analysis with adjustment of age, sex, and confounding factors. Further hypoxemia and polycythemia were closely associated with glucose intolerance. Socioeconomic factors, hypoxemia, and the effects of altitudes over 3500m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and aging.

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension.

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension.

Objective of the study is to investigate the daily activities of people with hypertension or diabetes using a pedometer to count daily walking steps in one day. We measured walking steps during 1-3days in 23 subjects aged 40 years or over (mean age: 61years old, male/female:13/10) diagnosed as cases of hypertension or impaired glucose tolerance in Domkhar village. There was a significant negative correlation between age and walking steps (r =-0.71, p<0.001). The average walking steps in one day were 8603 in male and 5821 in female, respectively. It is assumed that lifestyle-related diseases are increasing in Domkhar village due to modern lifestyle change. Traditional lifestyle with simple meals and hard labor activities have changed into modernized one with a increase in taking high calories and a decrease in daily physical activities. Education and promotion of healthy exercise and diet might be recommended for prevention of aggravation in ADL accompanying lifestyle-related diseases.

Elderly highlanders have had long-term adaptation to the harsh environment of hypoxia and low food resources; however, rapid changes in life styles associated with the progress of global modernization and urbanization might overwhelm high altitude adaptation with lifestyle-related diseases and the change of ageing in elderly highlanders in Himalaya/Tibet. Worthy of study is the question of whether elderly highlanders who have had evolutionary adaptation to hypoxic environments are vulnerable to lifestyle-related diseases associated with globalism.

The health problem in Ladakh in India was reviewed. There were the problems on hypertension, stroke, gastric cancer associated with poverty and low intake of vegetable, pneumoconiosis, and silicosis. Now, rapid lifestyle changes with socio-economic globalization are occurring and effects will be prominent. The influence of changing lifestyles on these diseases and quality of life in the elderly should be studied from interdisciplinary and comprehensive perspectives, including medicine, geography, agriculture, anthropology, meteorology, ecology and economics.

Domkhar consists of three villages located in the northwestern part of Ladakh, at altitudes between 2900 and 4000 meters above sea level. We visited there in July, 2008 and conducted medical check-ups for the elderly and interviewed with them. About 73% of elderly residents over 60 years old who took our medical checkups had blood pressures of 140/90 mmHg or higher. Knee pain was the most common symptom supposed to be associated with heavy physical activities in the mountain. The average arterial blood oxygen saturation was 91.4±3.6 % among males and 88.7±4.8 % among females. The average hemoglobin level was 15.9±2.8 g/dl among males and 13.9±2.9 g/dl among females. Three out of 17 residents had a casual blood sugar 140 mg/dl or more. The average subjective quality of life (QOL) measured by visual analogue scale was 52.7±18.0 in health, 82.2±10.0 in family relationship, 82.7±9.9 in friendship, 62.4±21.3 in economics and 69.4±19.0 in happiness. We should pay more attention to the impact of changing lifestyle and environments on prevalence of lifestyle-related diseases and QOL in the elderly in highland worlds.