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Article History

Received: 29 July 2026

Accepted: 26 September 2026

First Online: 1 October 2026

Declarations

Ethics approval and consent to participate: This study used irreversibly anonymized secondary data obtained from routine occupational health examinations conducted under the Industrial Safety and Health Act of Japan. The original study protocol was approved by the Joint Ethical Review Board jointly established by Medical Corporation Satsukikai Susaki Kuroshio Hospital, Medical Corporation Usuikai Tano Hospital, and Specified Medical Corporation Takeshita Hospital on April 17, 2026. A protocol amendment expanding the prespecified analyses to include the TG/HDL-C ratio and additional lipid, glycemic, blood pressure, and BMI-related analyses using the existing anonymized dataset was approved by the same committee on May 15, 2026 (approval No. 14000050.20260417-27S388). The requirement for informed consent was waived because neither identifiable information nor linkage keys were accessible to the investigator. The study was conducted in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan and the Declaration of Helsinki. Clinical trial number: not applicable.

Consent for publication: Not applicable.

Competing interests: The author declare no competing interests.