ANPEP and Insulin resistance: In the 2009–2010 medical survey, insulin resistance, total APN level, and C1q-APN/total-APN ratio, which is a new potential biomarker based on C1q-APN levels, were compared between two cohorts of Japanese people who shared the same genetic predispositions but lived different lifestyles; that is, Japanese–Americans living an American lifestyle in Los Angeles and native Japanese living a Japanese lifestyle in Hiroshima.