Guides · 健康診断 · kenkō shindan

How to Read Your Japanese Health Checkup (健康診断) Results

By Dr. Masa · physician licensed in Japan · Last reviewed August 2026

Every year, millions of employees in Japan receive an envelope containing their kenkō shindan (健康診断) results — a grid of numbers, letters and kanji that even Japanese native speakers find confusing. If you work for a Japanese company, this checkup is not optional: employers are legally required to offer it annually, and most employees are required to take it.

This guide explains what the letters and numbers mean, which ones matter, and what to do when your report says 要精密検査.

The judgment letters: A through D

Most reports assign each test category a letter grade. Formats vary between clinics, but a typical scheme looks like this:

Two phrases deserve special attention.

要再検査 (yō-saikensa) — "re-test needed." The value was off, but a single measurement isn't conclusive. Blood pressure that was high on the day of the test is the classic example. This means repeat the test, usually after a few weeks.

要精密検査 (yō-seimitsu-kensa) — "detailed examination needed." Something was found that needs a proper diagnostic workup — a shadow on a chest X-ray, blood in a stool sample. This is the one instruction on the report that should always be acted on. It does not mean you have a disease; the large majority of detailed examinations end with reassuring results. But it is not a line to file away and forget.

Blood pressure (血圧)

Japanese guidelines treat readings of 140/90 mmHg or higher measured at a clinic as hypertension, with 130–139/80–89 flagged as elevated. A single high reading at a checkup — caused by rushing to the clinic, caffeine, or simple nerves — is why this section so often triggers a C. If you get flagged, measuring at home for a week or two gives your doctor far more useful information than any single clinic reading.

The metabolic panel: where Japan differs

If you are between 40 and 74, your checkup doubles as a "metabo" screening (特定健診), Japan's national metabolic syndrome program. This is why the nurse measured your waist. The Japanese cutoffs are a waist circumference of 85 cm or more for men and 90 cm or more for women, combined with blood pressure, lipid and glucose criteria.

Foreign residents are often startled to be labelled "metabo" at a weight considered unremarkable back home. The thresholds here are deliberately stricter, because East Asian populations tend to develop diabetes and cardiovascular disease at lower body weights than European populations. It is not an error in the scale.

Key values on this panel:

• HbA1c (ヘモグロビンA1c) — your average blood sugar over roughly three months. Values of 6.5% or higher suggest diabetes; 5.6–6.4% is the borderline zone where lifestyle changes genuinely pay off.
• LDL cholesterol (LDLコレステロール) — commonly flagged at 140 mg/dL or above. Japan reports cholesterol in mg/dL; if you are used to mmol/L, divide by roughly 38.7 to compare.
• Triglycerides (中性脂肪) — flagged at 150 mg/dL or above when fasting. This value is extremely sensitive to what you ate and drank the night before, which is why the instructions told you not to.

Liver enzymes (肝機能)

AST (GOT), ALT (GPT) and γ-GTP measure liver stress. γ-GTP is the one that rises with regular alcohol intake, and it is a running joke among Japanese office workers for a reason. Mildly raised ALT with a normal γ-GTP more often reflects fatty liver related to weight than to drinking. A C here usually means "recheck after cutting back for a few weeks" — and the value really does fall quickly when drink is the cause.

Urine, blood counts and the chest X-ray

Urine protein and blood (尿蛋白・尿潜血). A trace (±) finding is common and often benign, but repeated positives deserve a kidney workup.

Hemoglobin (血色素量). Low values (anemia) are a frequent flag, particularly in women. Markedly low values need investigation of the cause — not iron tablets bought on guesswork.

Chest X-ray (胸部X線). A legacy of Japan's tuberculosis-control era and still standard here. 要精密検査 on a chest film usually leads to a CT scan. Most findings turn out to be old scars or harmless nodules, but this is never one to skip.

What to do with a C or D as a foreign resident

Bring the actual report to the clinic. Every doctor in Japan reads this standardised format instantly, whatever their English level. The report itself is your best translation tool — better than any explanation you could attempt in Japanese.

You can usually go straight to a specialist clinic for follow-up (消化器内科 for a stomach finding, 呼吸器内科 for a lung finding). Ordinary clinics do not require a referral; only large hospitals do.

Follow-up examinations are covered by health insurance. The screening itself was paid for by your employer or by you, but investigating an abnormal result is normal insured medical care — you pay the standard 30% co-payment.

Why your doctor may seem unconcerned — or too concerned

Japanese screening is deliberately high-sensitivity: it flags early and often, on the reasoning that catching one treatable cancer justifies a great many benign re-checks. If your report carries a C or two, you are in the majority. The system prefers to look twice.

Conversely, do not expect a long counselling session about your results. Japanese consultations are short and focused. Arrive with your report and your specific questions written down, and you will get efficient, competent care.