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Background Evidence has demonstrated that excess sodium intake is associated with development of several non-communicable diseases. The main source of sodium is salt. Therefore, reducing salt intake in foods is an important global public health effort to achieve sodium reduction and improve health. This study aimed to model salt intake reduction with 'umami' substances among Japanese adults. The umami substances considered in this study include glutamate or monosodium glutamates (MSG), calcium diglutamate (CDG), inosinate, and guanylate. Methods A total of 21,805 participants aged 57.8 years on average from the National Health and Nutrition Survey was used in the analysis. First, we employed a multivariable linear regression approach with overall salt intake (g/day) as a dependent variable, adjusting for food items and other covariates to estimate the contribution of salt intake from each food item that was selected through an extensive literature review. Assuming the participants already consume low-sodium products, we considered three scenarios in which salt intake could be reduced with the additional umami substances up to 30%, 60% and 100%. We estimated the total amount of population-level salt reduction for each scenario by age and gender. Under the 100% scenario, the Japan’s achievement rates against the national and global salt intake reduction goals were also calculated. Results Without compromising the taste, the 100% or universal incorporation of umami substances into food items reduced the salt intake of Japanese adults by 12.8–22.3% at the population-level average, which is equivalent to 1.27–2.22 g of salt reduction. The universal incorporation of umami substances into food items changed daily mean salt intake of the total population from 9.95 g to 7.73 g: 10.83 g to 8.40 g for men and 9.21 g to 7.17 g for women, respectively. This study suggested that approximately 60% of Japanese adults could achieve the national dietary goal of 8 g/day, while only 7.6% would meet the global recommendation of 5.0 g/day. Conclusions Our study provides essential information on the potential salt reduction with umami substances. The universal incorporation of umami substances into food items would enable the Japanese to achieve the national dietary goal. However, the reduced salt intake level still falls short of the global dietary recommendation.

This study evaluated changes in diet quality during the coronavirus disease 2019 (COVID-19) pandemic and its association with variations in attitudes or behavior, as well as health status changes. Participants were Japanese adults aged 20–69 years who resided in 13 prefectures where specific cautions were announced to prevent the spread of the virus. An online survey was conducted in September 2021, and participants were those who shopped for food or prepared meals more than twice a week during the survey. Overall, 2101 participants were analyzed. An improved or worsened diet quality was determined based on changes in food consumption patterns, and participants were categorized into three groups (improved diet quality (IDQ), worsened diet quality (WDQ), and others). The IDQ group participants (10.2%) improved their dietary consciousness during COVID-19, cooked almost everything from ingredients, and increased their balanced meal eating frequency. However, the WDQ participants (11.1%) had worsened dietary consciousness and increased consumption of takeaway meals and alcohol but decreased balanced meal consumption. Cooking frequency changes were not independent determinants of variations in diet quality. Our results show that the diet quality changes during COVID-19 were possibly caused by changes in dietary consciousness or different levels of meal preparation practices.

Nutrition education is important to encourage people to promote a healthy diet; however, education alone exerts a limited effect. It is crucial to create a healthy food environment, including food systems that supply diversified, balanced, and healthy food options. Improving the food environment is a population approach. Radical population approaches necessitate removing the underlying impediments, such as high sodium products, sugar-sweetened beverages, and unhealthy ultra-processed foods. Negotiation and collaboration with the private sector is critical to tackle and solve these issues. In Japan, public-private-academic collaboration has been implemented since 2013 in the national health promotion action, termed Health Japan 21 (Second term). Recently, Japan has launched a novel initiative to create a healthy food environment.

With the growing interest in healthy and sustainable diets, studying diets with high nutritional quality and low environmental impact is needed. We focused on the nitrogen footprint (NFP)-an indicator of reactive nitrogen loss that causes various environmental impacts-of Japanese diets using individual dietary records and identified the characteristics of lower NFP diets. This cross-sectional study was a secondary data analysis from the 2017 Saitama Prefecture Nutrition Survey. We analyzed the data obtained from a questionnaire and two-day dietary records of 479 men and women aged 30-65 y who had no misreported or missing data. The NFP was calculated using the virtual nitrogen factors of each food group reported in a previous study. After assessing NFP and its contributions, we conducted sub-group analysis for participants with appropriate weight status and adequate protein intake, classifying them into three groups according to tertiles of NFP to protein ratio. We compared NFP, its contributions, and nutrient intake between the groups. The total NFP (kg N/y) was 18.2±5.0 in men and 16.1±4.4 in women. In the sub-group analysis, total NFPs of the lower NFP group were 16.5±3.1 in men and 13.6±2.8 in women. Cereals, pulses, and fish and seafood contributed more significantly to the total NFP in the lower NFP group than in the higher NFP group. These results suggest that adequate protein intake from a variety of food sources is required to lower the environmental impact of adequate diets.

Objective The interim evaluation of Health Japan 21(second term), a national health promotion plan, suggested that improvements in the food environment did not lead to improvements in individual dietary habits. The present study aimed to evaluate the relationship between the dietary behavior targets of Health Japan 21 (second term) and perceived food environment and health literacy.Method We conducted an online cross-sectional survey in March 2019 among adults aged 20-64 years. From the 9,667 registered monitors of the research firm, we collected 2,851 responses (29.5% response rate). The perceived food environment (how people perceive the local food environment) was estimated using the following six questions, namely, availability: easy access to nutritionally balanced meals, accessibility: no inconvenience in daily shopping, affordability: access to nutritionally balanced meals at reasonable prices, accommodation: easy access to food services within business hours, acceptability: satisfaction with the quality of food ingredients, and another form of acceptability: adequate food safety. Health literacy was evaluated using five questions related to information gathering, information selection, information transfer, information judgment, and self-determination. Last, we asked the respondents about two dietary behaviors, namely, the frequency of a balanced diet (defined as comprising the staple food, a main dish, and a side dish) and the quantity of vegetable intake, along with sociodemographic information. The analysis included 2,111 respondents, excluding those whose socioeconomic status was unknown. Multiple logistic regression analyses were performed to determine the relationship between perceived food environment and health literacy on dietary behaviors, while adjusting for sociodemographic factors.Result A balanced diet was associated with the following perceptions of the food environment: "access to nutritionally balanced meals at reasonable prices" (adjusted odds ratio [95% confidence interval] = 1.37 [1.02, 1.82]; women), and "adequate food safety" (1.54 [1.19, 1.98]; men), and health literacy: "information gathering" (0.84 [0.73,0.97]; men) and "self-determination" (1.28 [1.10,1.50], 1.37 [1.14,1.63]; men, women). The quantity of vegetable intake was associated with the following perceptions of the food environment: "easy access to nutritionally balanced meals" (1.54 [1.15,2.06]; men), and "no inconvenience in daily shopping" (1.55 [1.12,2.15]; women), and health literacy: "information transfer" (1.30 [1.10,1.54]; men), and "self-determination" (1.67 [1.38,2.02]; women)).Conclusion To achieve a balanced diet and increased vegetable intake in a population, it is necessary to promote both the acquisition of a higher level of "self-determination" (rather than "information gathering") in health literacy and the creation of a heathy food environment.

Objective This study aimed to assess the household income changes during COVID-19 pandemic among Japanese adults, and to evaluate how this was related to changes in dietary behaviors and food-related accessibility issues and information needs during the emergency period.Method We conducted an online cross-sectional survey in July, 2020 among residents (aged 20-69 years) of the 13 prefectures under special confinement during the COVID-19 pandemic. Participants were asked about their dietary behaviors before the pandemic (before February 2020) and during the confinement period (April-May 2020), as well as about their food-related accessibility issues and information needs during the confinement period. Data from 2,225 residents were analyzed. Participants were divided into three groups (decreased, unchanged, and increased) based on the household income changes due to COVID-19. Demographics, dietary behaviors, and food-related accessibility issues and information needs were then compared among these three groups. Multiple logistic regression analyses were performed to examine the effect of household income changes on dietary behavior changes, food-related accessibility issues, and food-related information needs, while adjusting for sociodemographic factors. Furthermore, the effect of household income changes and subjective economic status were also analyzed using multiple logistic regression analyses.Result The participant distribution in each group were as follows: decreased (34.6%), unchanged (63.9%), and increased (1.6%). Higher proportion of those who were employed part-time, self-employed, or unemployed during the confinement period were found among the decreased group. The odds ratios (OR) of the decreased group were significantly higher than the unchanged group for lower frequency of eating out, and for higher frequency of home-cooking, consuming ready-to-eat convenience meals, and eating with children during the confinement period. Furthermore, regardless of the subjective economic status, the decreased group experienced difficulties in accessing required foods because of shortages and congestion in grocery stores, as well as increased prices. Additionally, food-related information needs regarding reduction of food expenses were also high among the decreased group.Conclusion Participants with a decreased household income were more likely to experience difficulties with food accessibility and desire information about lowering food-related expenses. Furthermore, they reported lower frequency of eating out, and higher frequency of home-cooking and consuming ready-to-eat convenience meals during the confinement period than before the pandemic. Future studies should evaluate the direction (positive or negative) of these changed food consumption patterns.

Background: Body image self-discrepancy reflects a preference for weight loss regardless of normal body size and is a distorted cognition that may be a precursor to eating disorders. The aim of this study was to investigate factors associated with body image self-discrepancy among healthy junior high school students in Japan.Method: This cross-sectional study was conducted at one junior high school in Saitama, Japan, in December 2016. After excluding obese participants (defined as 20% above their ideal weight), 304 students (mean age, 13.9years; n=181 girls, 59.5%) who fell into underweight (n=22, 7.2%) and normal weight categories were selected. Body image self-discrepancy was measured using the Contour Drawing Rating Scale which includes eight separate figures representing body sizes. We then calculated the difference by subtracting ideal from current body sizes and defined body image self-discrepancy if the difference >1.Results: Girls constituted 92% (n=49) of the 53 students with body image self-discrepancy. In all students, multivariable stepwise models demonstrated that female gender (OR, 6.92, 95% CI: 2.33–20.51), a calorie-restricted diet (OR, 5.18, 95% CI: 2.22–12.05), and psychological symptoms (OR, 1.47, 95% CI: 1.15–1.87) were significantly associated with an increased risk of body image self-discrepancy. Specifically for girls, an increased risk of body image self-discrepancy was associated with calorie-restricted suppers and psychological symptoms.Conclusion: Body image self-discrepancy among healthy adolescents in Japan was found to be closely linked to being a girl, having a calorie-restricted diet, and having psychological symptoms.

Objectives Excess salt intake is a major risk factor for hypertension and cardiovascular disease. Modifying workplace environments has been recognized to be important for reducing salt intake. However, studies examining the effects of improving the workplace environment regarding salt reduction are limited. This study aimed to evaluate the effects of workplace dietary intervention on employees' salt intake and sodium‐to‐potassium (Na/K) ratio. Methods A quasi‐experimental study was conducted. Two small business establishments in Saitama Prefecture, Japan, were allocated as the intervention (n = 69) and comparison (n = 68) workplaces, respectively. The 1‐year intervention involving healthy lunch and nutrition education was implemented in the intervention workplace. Spot urine samples, physical assessments, and self‐administered questionnaire data were collected at baseline, 6 months, and 1 year after the start of the intervention. Analysis of covariance was conducted to investigate differences in the salt intake or Na/K ratio between the study workplaces at year 1. Educational status and rotating work schedules were included as covariates. Results Salt intake in the intervention workplace decreased significantly from 10.7 to 9.3 g (−1.4 g change; 95% confidence interval [CI]: “−2.4, −0.5”). The adjusted difference in changes in salt intake between workplaces was statistically significant (−3.7 g change; 95% CI: “−5.2, −2.3”). Although no significant change was observed in the Na/K ratio in the intervention workplace (3.37–3.08; −0.29 change; 95% CI: “−0.59, 0.01”), the adjusted difference in changes between the workplaces was statistically significant (−0.60 change; 95% CI: “−1.03, −0.17”). Conclusions Providing healthy lunch and nutrition education may be effective approaches to reduce employees' salt intake and Na/K ratio.

Objectives This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.Methods An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (-1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.Results Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the "worsening tendency" group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.Conclusion During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.

BackgroundEvidence has demonstrated that excess salt intake is associated with the development of several non-communicable diseases. Therefore, reformulating the sodium content of foods is an important global public health effort to achieve salt reduction and improve health. This study aimed to model sodium replacement with 'umami' substances and estimate the possible reduction effects of the umami substances on the daily salt intake among Japanese adults. The umami substances considered in this study include glutamate or monosodium glutamates (MSG), calcium diglutamate (CDG), inosinate, and guanilate.MethodsA sample of 21,805 participants aged 57.8 years on average from the National Health and Nutrition Survey (NHNS) were used in the analysis. First, we employed a multivariable linear regression approach, with overall salt intake (g/day) as a dependent variable, adjusting for intake (g/day) from food items and other covariates, to estimate the contributions of each food item to daily salt intake. We then considered three hypothetical scenarios with varying market share percentages of umami substitute foods (30%, 60%, and 100%). We estimated the population-level salt reduction for each scenario, by age and gender, based on the contribution of each food to salt intake estimated by the regression model and the estimated salt reduction rates by food item based on an extensive literature review. Under the 100% scenario, the achievement rates for national and global dietary goals of salt intake in the Japanese population were also calculated.ResultsWithout compromising the taste, the universal incorporation of umami substances can reduce the salt intake of adult Japanese persons by 12.0-21.1% in the population level, which is equivalent to 1.27-2.22g of salt reduction. A mean daily salt intake before and after scenario in universal umami substance’s incorporation changes from 9.95g to 7.73g for the total population, from 10.83g to 8.40g for men and from 9.21g to 7.17g for women, respectively. Approximately 60% of Japanese adults could achieve the national dietary goal of 8g/day, while only 7.6% could meet the global target of 5.0g/day. ConclusionsOur study provides essential information on the potential salt reduction from sodium replacement with alternatives. The universal incorporation of umami substances into some foods could achieve the national dietary goals for the Japanese. However, the reduced salt intake level still falls short of the global dietary recommendation of 5g of salt daily.

Increasing obesity rates have driven research into dietary support for body weight control, but previous studies have only assessed changes in body weight of ±3 kg. We investigated the relationships between white or brown/multi-grain rice consumption and 1-year body weight gain ≥3 kg in Japanese factory workers (n = 437). Routine medical check-up data from a 1-year nutrition and lifestyle cohort study were analysed. Participants were divided into white rice and brown/multi-grain rice consumption groups and further classified by tertile of rice consumption. Multiple logistic regression analyses were performed by tertile. At 1 year, high white rice consumption was significantly associated with increased risk of body weight gain ≥3 kg compared with low white rice consumption, maintained after adjustment for age, sex, and consumption of other obesogenic foods (p = 0.034). In the brown/multi-grain rice consumption group, however, there was no significant difference in risk between high and low consumption, even after multi-variate adjustment (p = 0.387). The consumption of white rice, but not brown rice/multi-grain rice, was positively correlated with the risk of a 1-year body weight gain of 3 kg or more. This suggests that brown rice/multi-grain rice consumption is useful for body weight control among Japanese workers.

Aim To categorize the age-related trajectories of dietary variety score (DVS) in the community-dwelling elderly and to examine the associated factors. Methods The study population included 1,195 people who underwent a medical checkup for the elderly in Kusatsu-town, Gunma Prefecture in 2012 to 2017. A multinomial logistic regression analysis was performed to examine the factors associated with the age-related trajectories of DVS. The dependent variables were sex, age, family structure, years of education, BMI, subjective chewing ability, TMIG-IC, GDS-15, MMSE, smoking, alcohol consumption, and history of hypertension, dyslipidemia, diabetes mellitus, and stroke. Results The adjusted odds ratio (95% confidence intervals) of the low trajectory group in comparison to the medium trajectory group were 2.69 (1.02-7.08) for subjective chewing ability (no chewing), 1.11 (1.06-1.17) for GDS-15, 1.76 (1.14-2.73) for current smoking, and 1.70 (1.19-2.43) for past smoking. In contrast, the adjusted odds ratio of the high trajectory group in comparison to the medium trajectory group were 0.61 (0.37-1.00) for men, 1.04 (1.01-1.07) for age, 0.58 (0.38-0.89) for subjective masticatory ability (difficult to chew), 0.88 (0.82-0.96) for GDS-15, and 0.55 (0.37-0.83) for a history of hypertension. Conclusions The age-related trajectory patterns of DVS in the community-dwelling elderly can be categorized into three types. In order to maintain a high quality of food intake, it was shown that, in addition to subjective masticatory ability and mental health factors, such as depression, we should pay attention to the control of hypertension, which is a risk factor for lifestyle diseases, and lifestyle habits such as smoking.

Objective Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.Method In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.Result Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B

Objectives One of the diversity indicators of food intake in the elderly Japanese population is the Dietary Variety Score (DVS). Studies on elderly people have reported the relationship of food intake with health outcomes, such as body function, higher-level functional capacity, fall risk, and sarcopenia. However, the index have not been studied enough whether it is suggestive of nutrients and the characteristics of the meal by various food intakes. The purpose of this study was to clarify the DVS and its relationship with nutrient intakes and meal days consisting of staple foods, main dishes, and side dishes among elderly adults.Methods The participants were 182 community-dwelling elderly adults (65-84 years) in Itabashi city, Tokyo. For the food diversity indicator, we used the DVS developed by Kumagai et al. and classified the patients as follows: the low score group (0-3 points), the medium score group (4-6 points), and the high score group (7-10 points). Dietary intakes were assessed using a 3-day dietary record. The daily amounts from foods and nutrients, and days of balanced diet with staple foods, main dishes, and side dishes greater than twice a day (hereafter "balanced meal days") were calculated. The relationships between the DVS classification and each dietary index were evaluated by the general linear model adjusted for sex, age, and energy levels. Additionally, we calculated the percentage of people with intakes below the estimated average requirement (EAR) of each nutrient and estimated the risk of below the EAR in the groups by multiple logistic regression analysis.Results The low DVS group had significantly fewer balanced meal days (low 1.4 [1.2-1.6] days, medium 1.8 [1.6-1.9] days, high 1.9 [1.7-2.1] days, p for trend=0.001) than the high DVS group. The low DVS group showed significantly low energy ratios of protein and fat, as well as lower intakes of protein, dietary fiber, phosphorus, magnesium, potassium, vitamin K, and vitamin B12. In contrast, the low DVS group showed significantly higher energy ratios of carbohydrates and grains and higher carbohydrate intake. Compared to the high DVS group, the odds ratio for inadequate vitamin C intake (below the EAR) was significantly high in the low DVS group, and the odds ratios for inadequate intakes of magnesium, zinc, and vitamin B6 were significantly high in the middle DVS group.Conclusion The high DVS group had significant associations with increased intake of protein and micronutrients, as well as balanced meal days. DVS can be a dietary indicator that leads to the intake of a desirable variety of food and nutrients in old age.

This study aimed to examine the relationships among subjective well-being, food and health behaviors, socioeconomic factors, and geography in chronically ill older Japanese adults living alone. The design was a cross-sectional, multilevel survey. A questionnaire was distributed by post and self-completed by participants. The sample was drawn from seven towns and cities across Japan. A geographic information system was used to select a representative sample of older people living alone based on their proximity to a supermarket. Study recruitment was conducted with municipal assistance. To assess subjective well-being and food and health behaviors of respondents with disease, a logistic regression analysis was performed using stepwise variable analyses, adjusted for respondent age, socioeconomic status, and proximity to a supermarket. The dependent variable was good or poor subjective well-being. In total, 2,165 older people (744 men, 1,421 women) completed the questionnaire (63.5% response rate). Data from 737 men and 1,414 women were used in this study. Among people with a chronic disease, individuals with good subjective well-being had significantly higher rates than those with poor subjective well-being for satisfaction with meal quality and chewing ability, food diversity, food intake frequency, perception of shopping ease, having someone to help with food shopping, eating home-produced vegetables, preparing breakfast themselves, eating with other people, and high alcohol consumption. A stepwise logistic analysis showed that the factors strongly related to poor subjective well-being were shopping difficulty (men: odds ratio [OR] = 3.19, 95% confidence interval [CI], 1.94–5.23; P < 0.0001; women: OR = 2.20, 95% CI, 1.54–3.14; P < 0.0001), not having someone to help with food shopping (women: OR = 1.41, 95% CI, 1.01–1.97; P = 0.043), not preparing breakfast (women: OR = 2.36, 95% CI, 1.40–3.98; P = 0.001), and eating together less often (women: OR = 1.99, 95% CI, 1.32–3.00; P = 0.002). Subjective well-being of people with chronic diseases is associated with food intake and food behavior. The factors that affect poor subjective well-being in chronically ill older Japanese people living alone include food accessibility and social communication.

Aim Food security and sufficient nutrient intake are critical to longevity and active aging. The present study aimed to elucidate physical and social factors related to dietary variety among single-living older adults in Japanese communities. Methods The cross-sectional survey with a self-administrated questionnaire was carried out for all older adults living alone aged 65 years and older in three cities of Japan during 2014. Dietary variety score (DVS) was determined by counting the number of 10 food groups consumed at least once in 2 days using a food frequency questionnaire. Using the data of 704 men and 1366 women, the sex-specific association of low DVS (

Objective Since 2006, Sakado city in Saitama prefecture, Japan, has been implementing the Sakado "Shokuiku (food and nutrition education)" Program in collaboration with Kagawa Nutrition University. The present study aimed to evaluate the program, and to discuss its achievements and future challenges.Methods This program targeted all students from the 5th through the 8th grade. Data from surveys conducted with students and teachers during the school year from 2006 through 2014 were to analyze the program's implementation process and to evaluate its impact. For process evaluation, two surveys conducted with teachers were used. Survey A pertained to the status of program implementation and students' reaction towards each lesson conducted at schools. Survey B pertained to school teachers' involvement in the program and changes of teaching content and interest in food and nutrition education after its implementation, to assess their reaction towards the program. For impact evaluation, three surveys conducted with students were used. Specifically, Survey C aimed to confirm the effectiveness of the 4-year program, Survey D assessed the same in each grade, and Survey E examined the attitudes and behaviors of students who completed the 4-year program.Results More than 70% of the classes were able to implement the program successfully in the fourth year of elementary school and the second year of middle school. Further, 80% of the classes utilized all the educational materials, and more than 50% of the students understood almost all the contents of the program. Teachers in elementary school and male teachers in middle school, who had attended the teacher training program and/or had implemented the program, were more likely to interest in nutrition education. The impact evaluation did not reveal any significant long-term effects on students; however, their dietary attitudes related to Educational Goal 2 ("eat a well-balanced diet considering its health benefits") improved after each year of participation in the program. More than 90% of the 8th grade students answered that they were happy to have participated in this program.Conclusion The continual implementation of this nutrition program increased teachers' interest in food and nutrition education and improved some dietary attitudes of students. Future challenges include improving program content, promoting continued implementation, and identifying broader approaches to include students' family and significant others from different generations.

Background As with food-taxation strategies, such interventions as discounted healthy menus, point-of-purchase advertisements, and sugar-free beverages for employees at worksites could help prevent obesity. This study assessed the effectiveness of food environment interventions incorporating financial incentive or social marketing strategies at workplace cafeterias, vending machines, and kiosks toward preventing obesity and improving dietary habits. Methods We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO databases. The study designs included were randomized control trials (RCTs) and cluster RCTs. We evaluated the effectiveness of financial incentive or social marketing strategies interventions (such as discounts) on health outcomes or food intake behavior. Two reviewers independently screened the studies for inclusion. We assessed the risk of bias using the Cochrane Collaboration’s tool. This protocol was published in 2014. Results We included three trials, with a combined total of 3013 participants. There were limited available data from RCTs on changes in body weight. No eligible social marketing studies were retrieved. In some cases, a meta-analysis could not be conducted owing to differences in the analytic methods for the outcomes. Conclusions Lack of evidence made it difficult to draw any conclusions. In future surveys, it will be necessary to conduct interventions focusing only on financial incentive intervention versus no intervention in order to determine whether the incentive strategy has a clear impact. Systematic review registration PROSPERO CRD4201401056 Electronic supplementary material The online version of this article (10.1186/s13643-019-0965-0) contains supplementary material, which is available to authorized users.

This study aimed to examine perceptions of shopping difficulty, and the relationships with satisfaction with state of health and meals, physical condition, food diversity and health behavior in older people living alone in Japan. A cross-sectional, multilevel survey was designed. The questionnaire was distributed by mail and self-completed by participants. The sample was drawn from seven towns and cities across Japan. A geographic information system was used to select the sample of older people living alone, by proximity to a supermarket. In total, 2,346 older people (827 men and 1,519 women) completed the questionnaire. The dependent variable was whether shopping was easy or difficult. A logistic regression analysis was performed, adjusting for age, socioeconomic status and proximity of residence to a supermarket using stepwise variable analyses. The response rate was 67.8%. Overall, 14.5% of men and 21.7% of women considered shopping difficult. The stepwise logistic analysis showed that the factors most strongly related to shopping difficulty were a subjective feeling of poor health (men: OR = 3.01, women: OR = 2.16) and lack of satisfaction with meals (men: OR = 2.82, women: OR = 3.69). Other related physical condition and dietary factors were requiring nursing care (men: OR = 3.69, women: OR = 1.54), a high level of frailty, measured using the frailty index score (women: OR = 0.36) and low food diversity score (men: OR = 1.84, women: OR = 1.36). The study found that older people’s assessment of their shopping difficulty was related to satisfaction aspects, including a subjective feeling of poor health, and lack of satisfaction with meals, as well as physical condition. These have a greater influence on shopping difficulty than income in both sexes, and proximity to a supermarket in women.

Objectives Increasing vegetable consumption is one of the health objectives of "Healthy Japan 21" (2nd phase). To ensure this goal is met, the various factors related to vegetable consumption must first be clarified. Thus, this study considered vegetable consumption, dietary behaviors, attitudes, knowledge, and social support among middle-aged Japanese subjects.Method Data (2 days of maintaining a food diary and a questionnaire) of 384 respondents aged 30-59 years from the 2011 Saitama Prefectural Health and Nutrition Survey (men: 165, women: 219) were used. Their average volume of vegetable consumption was 250.2 g/day (standard deviation: 119.8), which was significantly lower than the 350 g/day goal of "Healthy Japan 21" (2nd phase); therefore, the threshold for this study was set at 300 g/day. For logistic regression analysis, vegetable consumption greater or lower than 300 g/day were defined as dependent variables; social support, attitudes, knowledge, and dietary behaviors as independent variables; and age, household composition, and household income were adjusted.Results The adjusted odds ratio (AOR) was significantly higher for those whose vegetable consumption was over 300 g/day. Dietary behaviors including an average of 2 or more meals per day including grain, vegetable, fish, and meat dishes and the analysis of subjects' food records revealed an AOR of 2.52 and a 95% confidence interval (CI) of 1.18-5.39 for men who had 2 or more meals per day. For women, the AOR was 4.06, and the 95% CI was 2.18-7.53. Significant relationships were observed among the following items in male respondents: attitude category: "self-efficacy in consuming 5 or more vegetable dishes per day" (AOR was 2.74, 95% CI was 1.30-5.79); knowledge category: "obesity prevention effectiveness" (AOR was 3.48, 95% CI was 1.24-9.78); and social support category: "support for good health and dietary life from family and surroundings" (AOR was 4.46, 95% CI was 1.47-13.54). Significant relationships were observed among the following items in female respondents: dietary behaviors category: "frequency of cooking meals" (AOR was 2.83, 95% CI was 1.02-7.87); and knowledge category: "being able to grasp the appropriate volumes and balance of foods when preparing meals for self" (AOR was 2.44, 95% CI was 1.30-4.56).Conclusions These results suggest that to increase middle-aged people's vegetable consumption, promoting adequately healthy meals is more important than both the dissemination of knowledge regarding the target vegetable quantity and enhancing of only vegetable consumption.

Objectives Creating a healthy food environment is crucial for healthful longevity in Japan. This study aimed to provide an overview of the status and challenges related to creating that environment through prefectural public health centers.Methods Public health dieticians working at 489 prefectural public health centers in March 2015 individually completed an anonymous self-administered questionnaire. Berelson's content analysis was utilized for response analysis.Results Data from 359 (response rate: 74.3%) prefectural public health centers, involving 599 public health dieticians, were included in the analysis. More than 80% of the prefectural public health centers implemented a registration system for dining facilities such as restaurants. Furthermore, greater than 80% of the public health dietitians thought that creating a healthy food environment was an important aspect of their work mission. On the other hand, more than 50% of these dieticians expressed dissatisfaction in their role. In terms of evaluation, the public health centers only monitored the number of registered facilities, with few other evaluations conducted. Approximately 80% of the participants requested national guidelines and/or some legal support from the Ministry of Health, Labor, and Welfare and/or the prefectural administration.Conclusion This study demonstrated that there are challenges related to creating a healthy food environment through prefectural health centers. Improving the evaluation methods and government/administrative provision of national guidelines and/or legal supports were identified as courses of action.

This study aimed to examine the relationships between eating together and subjective health, frailty, food behaviors, food accessibility, food production, meal preparation, alcohol intake, socioeconomic factors and geography among older Japanese people who live alone. A cross-sectional, multilevel survey was designed. The questionnaire was distributed by post and self-completed by participants. The sample was drawn from seven towns and cities across Japan. A geographic information system was used to select a representative sample of older people who lived alone based on their proximity to a supermarket. Recruitment for the study was conducted with municipal assistance. A logistic regression analysis was performed that adjusted for the respondent’s age, socioeconomic status and proximity to a supermarket using stepwise variable analyses. The dependent variable was whether the respondent ate together more or less than once a month. In total, 2,196 older people (752 men and 1,444 women) completed the questionnaire (63.5% response rate). It was found that 47.1% of men and 23.9% of women ate together less than once a month. Those who ate together less than once a month had a significantly lower rate of subjective health, food diversity and food intake frequency than those who ate together more often. A stepwise logistic analysis showed that the factors most strongly related to eating together less than once a month were not having any food shopping assistance (men: OR = 3.06, women: OR = 2.71), not receiving any food from neighbors or relatives (men: OR = 1.74, women: OR = 1.82), daily alcohol intake (women: OR = 1.83), frailty (men: OR = 0.48) and income (men: OR = 2.16, women: OR = 1.32). Eating together is associated with subjective health and food intake. Factors that affect how often older Japanese people who live alone eat together include food accessibility, daily alcohol intake, frailty and a low income.

Objective The present study examined nutritional status and dietary intake of pregnant women in Japan in relation to pre-pregnancy body mass index (BMI).Methods Participants included 141 Japanese women with singleton pregnancies, from the outpatient department of the S hospital, Gunma prefecture, Japan. Two-day food records, dietary assessment questionnaires, and clinical records were obtained at 20 weeks gestation. Nine patients were excluded from the study due to morning sickness. The remaining 132 participants were divided into 3 groups according to pre-pregnancy BMI: underweight, normal weight, and overweight. Nutritional status and dietary intake were analyzed in relation to BMI using the chi-square test, Fisher's exact test, Kruskal-Wallis test, one-way analysis of variance, and analysis of covariance with adjustment for age, employment status, and total energy intake.Results Women who were underweight before pregnancy were more frequently working full-time than normal weight and overweight women. Underweight women were also more frequently anemic (P=0.038, underweight 39.3%, normal weight 24.7%, overweight 0%) and had lower mean hemoglobin (Hb) (P=0.021, underweight 11.3 g/dL, normal weight 11.6 g/dL, overweight 12.1 g/dL) and hematocrit (Hct) levels (P=0.025, underweight 33.7%, normal weight 34.3%, overweight 36.0%). Their dietary intake of protein, iron, magnesium, and folic acid was lower than that of normal weight and overweight women. Their meals tended to include fewer meat, fish, egg, and soybean dishes (underweight, mean of 4.7 servings per day; normal weight, 6.1 servings; overweight, 6.1 servings).Conclusion Pregnant women who were underweight before pregnancy had increased risk of anemia as well as reduced Hb and Hct levels. They had lower dietary intake of protein, iron and folic acid compared to women in the other BMI categories. Anemia and these nutrient deficiencies are known risk factors for low birth weight. Our findings suggest the importance of providing underweight pregnant women with support to improve dietary intake during their pregnancy, especially to increase intake of protein and iron through consumption of fish and meat dishes.

This aim of this study was to describe the association between shopping difficulty and food accessibility for elderly people living alone in Japan.A cross-sectoral, multilevel survey was designed to measure shopping difficulty from a food accessibility perspective. The questionnaire was distributed by mail.The sample was drawn from seven towns and cities across Japan.A geographic information system was used to select the sample: it identified the proximity of elderly people living alone to a supermarket. In total, 2,028 elderly people (725 men and 1,303 women) responded to the questionnaire.The binary dependent variables were shopping is easy/shopping is difficult. A logistic regression analysis adjusting for age and area of residence and using stepwise variable analyses was performed.The response rate was 58.6%. Overall, 14.6% of elderly men and 21.7% of elderly women consider shopping difficult. The stepwise logistic analysis showed that the food accessibility factors strongly related to shopping difficulty are infrequent car use (women: OR = 6.97), walking difficulties (men: OR = 2.81, women: OR = 3.48), poor eyesight (men: OR = 2.26, women: OR = 1.75), not cooking lunch by oneself (men: OR = 1.63, women: OR = 1.72), not having anyone to help with food shopping (women: OR = 1.45) and living over 1 km away from a supermarket (men: OR = 2.30, women: OR = 2.97).The study concludes that elderly people's assessment of shopping difficulty is related to their food accessibility. Important food accessibility aspects include car or motorbike ownership, walking continuously for 1 km, poor eyesight, and having cooking skills and having someone to help with shopping. These physical activity restrictions have a greater influence on shopping difficulty than do either income or proximity to a supermarket.

Objectives Aiming at improvement of the Japan Health Insurance Association's Specific Health Guidance initiatives and human resource development, we conducted a qualitative study to clarify the features necessary for and the challenges hindering the achievement of good performance of the initiatives.Methods From November 2014 to January 2015, we conducted 10 focus group interviews, each 90 minutes long, with 64 public health nurses from 10 Japan Health Insurance Association branches. In addition, self-administered questionnaires were administered to obtain the participants' basic characteristics. After we excluded one group for failing to meet our performance targets, we divided the remaining nine focus groups according to two patterns: Maintenance and Progress. The four focus groups fitting the Maintenance pattern had a well-established track record, and the five focus groups fitting the Progress pattern had a track record of good growth. Using open coding of the interview transcripts, we extracted efforts or needs in two domains, individual and branch, Then, we placed codes in eight main categories: [quality], [general practice], [dietary guidance practice], [success factor], [branch system], [training and skill development], [approach to the member office], and [past efforts]. We further extracted important subcategories based on their rates of appearance within branches.Results Data from 56 female public health nurses working at nine branches were included in the analysis. With respect to the individual domain, subcategories such as "building rapport," "creating the physical environment," and "taking the initiative in evaluating one's own lifestyle" in the 〈high emphasis〉 segment of the [general practice] category were common to both patterns. In addition, "increasing opportunities for training" and "enhancement of training program content" were found for both patterns in relation to the 〈demand〉 segment of the [training and skill development] category. However, most participants chose "yes" in response to whether there was ample training opportunity.Conclusion This study showed some common efforts and practices among public health nurses in both patterns, which indicates good performance of the Specific Health Guidance initiatives. However, there is a need to further enhance the training program to strengthen the entire organization. Future studies should focus on understanding the characteristics of and factors involved in low-performing branches.

Objectives To examine the prevalence of health consciousness regarding "Health Japan 21" (2nd edition) among the Japanese population, we conducted a telephone survey of a sample extracted randomly from the whole nation in 2013 and 2014.Methods We extracted 1800 men and women with 150 persons for each gender and 10-year age group (6 age groups ranging from 20 years to 70 years and older) using Random Digital Dialing sampling. Each participant was asked about 1) recognition of the following items: "Health Japan 21," "healthy life expectancy," "metabolic syndrome (MetS)," "chronic obstructive pulmonary disease (COPD)," "locomotive syndrome," "Active Guide," "WHO Framework Convention on Tobacco Control," and "Smart Life Project" and 2) health consciousness toward the following: "health examination taken within the past one year," "smoking status," and "the amount of vegetables considered desirable to consume per day for health." We performed simple tabulation of the collected answers and cross-tabulation by sex and age groups, respectively. For each question about recognition, we categorized "I know the name and meaning" and "I know the name but not the meaning" as "awareness." We compared data between 2013 and 2014, sexes, and age groups, using chi-squared test.Results In 2013, the top 5 items with high awareness were "MetS" (96.2%), "COPD" (51.1%), "healthy life expectancy" (34.2%), "locomotive syndrome" (30.2%), and "WHO Framework Convention on Tobacco Control" (28.0%). Moreover, awareness of "healthy life expectancy," "locomotive syndrome," and "Active Guide" were significantly higher in 2014 than in 2013. Meanwhile, the proportion of participants who correctly chose "350 grams" as "the desirable amount of vegetables to consume per day" was 41.6% in 2013 and became significantly higher at 50.1% in 2014. In 2013, awareness of "healthy life expectancy," "COPD," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day" were significantly higher among women than among men. In 2013, there were significant differences among age groups in awareness of "MetS," "COPD," "healthy life expectancy," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day."Conclusion Awareness of "healthy life expectancy," "locomotive syndrome," and health consciousness of "the desirable amount of vegetables to consume per day" were significantly higher in 2014 than in 2013. There were discrepancies on respective items among both sexes and age groups. Therefore, interventions for groups with lower awareness or health consciousness may be required.

Dietary assessment of community-dwelling Japanese older adults who live alone using Dietary Reference Intakes (DRIs) is limited. The present study aimed to estimate the prevalence of inadequate nutrient intake among Japanese community-dwelling older adults by sex and young-old and old-old population groups to identify the most vulnerable groups that need support. A cross-sectional survey was conducted from October 2012 to October 2013 with community-dwelling adults aged 65 y or older who lived alone. Participants were drawn from six cities in four Japanese prefectures. We used two days of dietary survey data to estimate participants' usual intake. The proportion of inadequate intake was assessed using the Estimated Average Requirement (EAR) cut-point method, Tolerable Upper Intake Level, and the tentative dietary goal for preventing life-style related diseases (DG) based on DRIs for Japanese, 2015. Data for 494 participants (162 male, 332 female) over 988 d were examined to assess nutrient intake. We calculated the proportion of inadequate intake between males and females and between young-old and old-old population groups (65-74 y and ≥75 y) using chi-square or Fisher's exact tests. For six nutrients, the estimated proportion of participants with a usual intake below EAR was higher in males than females. In addition, a higher estimated proportion of female participants was within the DG range for the percentage of energy from protein, fat, and carbohydrates, and had a usual intake of two nutrients above DG than males. Our findings showed that among Japanese older adults, males were more vulnerable in terms of inadequate nutrient intake compared with females.

To examine the relationship between dietary diversity and food access among elderly living alone.In September 2013, a cross-sectional study using a self-administered questionnaire was conducted with 4,348 elderly aged 65-89 years, living in A city in Saitama Prefecture. The subjects answered about their health conditions, frequency of food consumption, difficulty of food store access, social support, food preparation, and so on. The response rate was 59.6%. The dietary diversity score (DDS) was calculated as the number of food groups consumed in a day (0 to 10). The DDS was validated by its association with independence and health status of the elderly. As indicators of food access, objective food access was measured using a geographic information system (GIS), and subjective food access was measured by the questionnaire. Responses of 1,043 subjects (452 male and 591 female) were analyzed after excluding those who live with others in an actual household composition. We classified the subjects into two groups according to the DDS: low group (three or less) and high group (four or more). Multiple logistic regression analyses were conducted using the DDS groups as the dependent variable, and subjective food access and other factors as independent variables, adjusting for age, income, subjective economic status, education, and frailty status.The number of subjects in each group were as follows: low=107 (23.7%), high=345 (76.3%) for males, high=263 (44.5%), low=328 (55.5%) for females. A multiple logistic regression analysis showed that the difficulty in subjective food store access was associated with a low DDS in males [OR=4.00, 95% CI (1.36-11.82)] as well as in females [OR=2.24, 95% CI (1.11-4.51)]. Further, for females, social support and preparation of supper by oneself were significantly associated with their DDS. No significant relationships were found between objective food store access and DDS in both males and females.The DDS was strongly associated with subjective food store access among the elderly living alone. For females, social support and meal preparation skills were also suggested as important factors affecting their DDS.

【目的】食品企業従業員の会社の食育活動に参加する行動意思とその関連要因を明らかにすることを目的とした。【方法】中食企業Ｏ社の従業員501名を対象に，集合法による自記式質問紙調査を実施し，390名から有効回答を得た（有効回答率77.8％）。調査項目は合理的行動理論に基づき設定し，「会社の食育活動に参加しようと思うか」という行動意思への回答から，「大いに思う群（23.6％）」「少し思う群（37.4％）」「どちらともいえない又は思わない群（39.0％）」の3群に分け，会社の食育活動に関する態度，主観的規範，消費者支援のための態度，知識・スキル，会社へ期待するサポートと，個人についてのQOL，健康状態，食育活動による変化，従業員個人の特性について比較検討した。さらに，行動意思に関連する要因を検討するために，多項ロジスティック回帰分析を行った。【結果】会社の食育活動に参加しようと大いに思うこと（行動意思）には，食育に関心がある（オッズ比［95％信頼区間］：5.34［2.86～9.95］），主観的規範が高い（同2.65［1.81～3.88］），食育という言葉も意味も知っている（同2.40［1.19～4.82］）ことが関連していた。【結論】食品企業従業員の食育活動への行動意思には，食育への関心と主観的規範が強く関連していることを明らかにし，従業員の行動意思を高めるための具体的方策を示唆した。

【目的】「1日に野菜を5皿以上食べること」を目標とした行動変容ステージを評価するための日本版アルゴリズムと習慣的野菜摂取量及び認知的要因との関連を検討すること。【方法】新潟市内に社員食堂を有する20の企業施設に属する20～59歳の成人男性勤労者を対象に，2009年9月に自記式質問紙調査を実施した。野菜摂取量の測定は簡易型自記式食事歴法質問票を用い，認知的要因は知識及び自己効力感の尺度より把握した。行動変容ステージの評価は目標行動の実施度と行動変容の準備性の2段階で構成したアルゴリズムを用い，各関連について検討した。【結果】解析対象521名 (中央値42歳) の行動変容ステージは前熟考期58.5％，熟考期20.7％，準備期13.8％，実行期＋維持期6.7％であり，これらと年齢との間には有意な関連 (p＝0.028) がみられたが，BMIとの間には関連がなかった。1,000 kcal当たりの野菜摂取量は，中央値で前熟考期 88.2 g，熟考期 78.4 g，準備期 98.9 g，実行期＋維持期 116.8 gとステージ間で有意な差 (年齢調整後 p＝0.004) がみられ，認知的要因もステージ間で差がみられた。また，1日に食べる野菜の皿数と野菜摂取量との間には強い正相関が認められた。【結論】本行動変容ステージのアルゴリズムは，半定量的な野菜摂取量及び認知的要因との間に明確な関連がみられた。集団への評価指標としての活用等が考えられるが，個人への活用に際しては誤分類に留意する必要がある。