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Background The collection of weighed food records (WFR) is a gold standard for dietary assessment. We propose using the 24-h recall method combined with a portable camera and a food atlas (24hR-camera). This combination overcomes the disadvantages of the 24-h dietary recall method. Our study examined the validity of the 24hR-camera method against WFR by comparing the results. Methods Study subjects were 30 Japanese males, aged 31–58 years, who rarely cook and reside in the Tokyo metropolitan area. For validation, we compared the estimated food intake (24hR-camera method) and weighed food intake (WFR method). The 24hR-camera method uses digital photographs of all food consumed during a day, taken by the subjects, and a 24-h recall questionnaire conducted by a registered dietitian, who estimates food intake by comparing the participant’s photographs with food atlas photographs. The WFR method involves a registered dietitian weighing each food item prepared for the subject to consume and any leftovers. Food intake was calculated for each food group and nutrient using the 24hR-camera vs. weighed methods. Results Correlation coefficients between the estimated vs. weighed food intake were 0.7 or higher in most food groups but were low in food groups, such as oils, fats, condiments, and spices. The estimated intake of vegetables was significantly lower for the 24hR-camera method compared to the WFR method. For other food groups, the percentages of the mean difference between estimated vs. weighed food intake were -22.1% to 5.5%, with no significant differences between the methods (except for algae, which had a very low estimated intake). The correlation coefficients between the two methods were 0.774 for energy, and 0.855, 0.769, and 0.763 for the macronutrients, proteins, lipids, and carbohydrates, respectively, demonstrating high correlation coefficients: greater than 0.75. The correlation coefficients between the estimated vs. weighed for salt equivalents and potassium intake were 0.583 and 0.560, respectively, but no significant differences in intake were observed. Conclusions The 24hR-camera method satisfactorily estimated the intake of energy and macronutrients (except salt equivalents and potassium) in Japanese males and was confirmed as a useful method for dietary assessment.

Background The collection of weighed food records (WFR) is a gold standard for dietary assessment. However, what a person eats changes every day, and it is practically difficult to weigh foods and drinks daily and calculate their nutrient contents. The validity of 24-hour dietary recall with the use of a portable camera (24hR-camera) was examined by comparison with the WFR.Methods The study subjects were recruited from 30 male adults who were fathers of university students and cooked rarely. For the validation of the 24hR-camera, we compared it and the WFR. The digital photographs were taken by the subjects of all food consumed during a day and a 24-h recall questionnaire was conducted by a registered dietitian who was trained on the survey methodology. An estimate of the amount of food consumed was made using a food atlas and the photographs taken by the subjects. For validation, comparison was made between the calculations, by both methods, of the levels of food group and nutrient. Results Correlation coefficients between the two methods were 0.7 or higher in most food groups but were low in food groups that are difficult to see, such as oils, fats, condiments, and spices. The intake of vegetables was significantly lower for the 24hR-camera method compared to the WFR method. For other food groups, except for algae, of which intake amount (in weight base) is very low, the percentages of mean difference between 24hR-camera and WFR s were -22.1% to 5.5%, with no significant differences between the methods. The correlation coefficients between the two methods were 0.774 for energy, and 0.855, 0.769, and 0.763 for the three major nutrients, proteins, lipids, and carbohydrates, respectively, demonstrating high correlation with coefficients greater than 0.75. The correlation coefficients between the two methods were 0.583 and 0.560 for salt and potassium intake, respectively, but no significant differences in intake were observed. Conclusions The method of 24-hR-canera satisfactorily estimated the intake of energy and major nutrients (except salt and potassium) in Japanese males, and was confirmed as a useful method for dietary assessment.

Because of the tastiness of sugars, it is easy to consume more than an adequate amount. There are many research reports that excess sugar intake contributes to dental decay, obesity, diabetes etc. Continuing economic development in Cambodia has made it easier than before for people to consume sugars in their daily life. Currently, isomerized sugar (a mixture of glucose and fructose) made from starches is commonly used in commercial beverages because of its low price. However, in Cambodia and Japan, sugar composition tables that include not only sucrose but also glucose, fructose, lactose and maltose have not been available. Prior to the present nutrition surveys, we made sugar composition tables for both countries. In this study we tried to estimate the intakes of various sugars by children in Cambodia and Japan and to determine the relationship between intake and body weight. Nutrition surveys of children aged 7, 10 and 13 years old were conducted for 3 nonconsecutive days by the 24 h recall method in 89 Cambodian children living in the capital city of Cambodia, Phnom Penh, and 151 Japanese children living in 3 prefectures from north to south. Height and weight of children in Cambodia and Japan were similar until 10 years old but at 13 years old, the Cambodians were shorter and lighter than the Japanese. We could not observe any differences in BMI in either country. The sugar intakes from beverages and snacks were not different among the different gender and age. Thus we combined the mean total sugar intake for Cambodian and Japanese, 28.42 ± 25.28 g and 25.69 ± 16.16 g respectively. These were within the range of WHO recommendations (less than 10% of energy intakes). Cambodian children consumed about 46% of sugars from commercial beverages and snacks and Japanese children 26%. This means that for Cambodians half of the sugars came from isomerized sugar made from starches. Relationships between sugar intake and body weight were not observed in both countries. In conclusion, the Cambodian children consumed about 46% of sugar from glucose and fructose (probably in the form of isomerized sugar), while the Japanese children took 26%; however, the intakes in both countries met the WHO recommendation and there was no relationship to body weight.

The Japanese government has set 11 targets to promote "Shokuiku." However, among the 11 targets, only two targets (frequency of shared family meals and the proportion of breakfast skipping in children and young men) are quantitative goals. The increase in children eating alone is often lamented in the popular media, but the methodology for identifying the status of family meals ("Kyoshoku"), or how the responses should be validated, is rarely discussed. In the current review, we attempt to clarify how a family meal and survey responses are defined, by searching literature published after 2009, using the following keywords: "family meals" or "shared meals," in the PubMed database for English. For literature published in Japanese, we searched the Igakuchuo-Zassi Database and Google Scholar for relevant studies. In the English literature, questions were likely to focus on whether a dinner or any meal was eaten together with family members living together, while Japanese literature was more focused on "breakfast or dinner" eaten together with family members. The response options varied across different studies, such as the number of family meals a week, or the number of days (per week) these family meals were eaten. We found it quite difficult to compare across the studies, as there is no standardized definition or response options for "family meals." Further studies are needed in order to develop a standardized method to assess the current status of "family meals."

In recent years, the prevalence and problem of overweight and obesity in Taiwanese children have increased. There are many reports that the excessive intake of sugar increases the risk of lifestyle-related disease. However, sugar intake in Taiwanese children is not known. In this study, we investigated sugar intake from sugar-sweetened beverages, snacks and desserts among school-age children in Kaohsiung, Taiwan. We also tried to determine the relationship between sugar intake and body mass index (BMI). We contacted all the public elementary schools (10 schools) in a district, Kaohsiung, and obtained permission from 3 schools. The survey subjects were 410 (210 boys, 200 girls) school-age children (7, 10 and 12 y old). A nutrition survey was conducted using 3 non-consecutive days of the 24 h dietary recall method for sugar-sweetened beverages, snacks and desserts. Height and weight were measured. Sugar intakes were not significantly different among the different genders or ages (p>0.05) and average intake of all was 51.6 g/d. Percentages of each sugar in total intake were sucrose 60%, glucose 18%, fructose 16%, and lactose 6%. The intake of glucose and fructose may have come from isomerized sugar. Contributions of sugar-sweetened beverages and snacks (desserts) were 83.5% and 16.5%, respectively. Among the sugar-sweetened beverages the top 3 sources were tea (22%), milk tea (19%) and milk beverages (18%). A relationship between sugar intake and BMI was not observed. In conclusion, sugar intake of the children was higher than the WHO recommendation due to the high intake from beverages; however, sugar was not the cause of the high obesity rate.

While sugar intake is an important factor for obesity, diabetes and dental caries, sugars are also important energy sources, especially for rapidly growing children. Children like sugar-rich sweet foods. However, intake for Japanese children is not known due to a lack of studies and sugar composition data. This study was designed to determine sugar intakes from snacks and beverages in Japanese school children. A nutrition survey was conducted for 3 weekdays for 283 Japanese school children (7, 10 and 13 y old) in 8 prefectures from different areas of Japan. The methods for the survey were the weighing method for school lunches and the 24-h recall method for other foods. To estimate sugar intakes, the sugar composition table that was recently compiled by us for 135 beverages, cakes and other sweets was used. Height and weight were measured. They were similar to Japanese averages. Energy intakes were also similar to the results of the Japanese National Health and Nutrition Surveys. Sugar eaten outside meals was 24.7±15.5 g/d. From the National Health and Nutrition Surveys conducted in 2009, the mean sucrose intake from meals including some home-made cookies for 7-14-y-old children was 5.5 g/d, suggesting the mean total sugar intake of these children was about 30 g/d. This was within the range of FAO/WHO recommendation (less than 10% of energy intake, 49 g for these children. Mean intakes among age groups were not significantly different (p>0.05), but the intake for girls was lower than for boys in the oldest age group (p

【目的】亜鉛欠乏によって味覚障害や成長障害等を引き起こすことが知られている。一般的な指標となっている血清亜鉛値は，生体内で恒常性機構が働いていることなどから，亜鉛摂取量とは単純に相関しないため，その他の指標と総合的に評価することが望まれている。本研究では，健常人における亜鉛栄養状態を，血清亜鉛値とACE活性比から検討することを目的とした。【方法】研究Iでは，亜鉛欠乏食で飼育された亜鉛欠乏状態のラットにより，亜鉛栄養状態を，血清亜鉛濃度とACE活性比から検討した。5週齢のラット20匹（亜鉛欠乏群）とコントロール食を与えた5匹（コントロール群）の2群に分けた。その亜鉛欠乏群をさらに，欠乏2週，欠乏3週，欠乏4週までの3群に分け，それぞれの期間，亜鉛欠乏食で飼育後，血清亜鉛濃度とACE活性を測定し，ACE活性比を算出した。次に，研究IIにおいて，健康な男女22名の食事調査と，採血を行い，血清亜鉛濃度，ACE活性を測定し，ACE活性比を算出した。【結果】亜鉛欠乏食で飼育したラットでは，血清亜鉛濃度は有意に低下し，ACE活性比は有意に増加した。また，健康な男女においても血清亜鉛濃度を 75 μg/dl を境界に低値群と高値群に分けたところ，ACE活性比に有意な関連がみられた。【結論】従来一般に使用されている亜鉛栄養状態の指標である血清亜鉛濃度以外に，ACE活性比が健常人の測定にも適用できる可能性が示唆された。

Objective The aim of the present study was to evaluate the effects of zinc supplementation on hypogeusia, serum zinc concentration and the ratio of apo/holo-activities of angiotensin converting enzyme (ACE ratio) in patients with taste impairment. ACE ratio was used as an index of zinc nutritional status. Methods Forty patients complaining of taste impairment were divided into two groups: zinc deficiency taste impairment ( n = 12) and idiopathic taste impairment ( n = 28). Patients with zincemia values of less than 63 μg/dl with no history of other disorder or medication known to cause dysgeusia were diagnosed as zinc deficiency group, while those with the same condition and values more than 64 μg/dl were considered to belong to the idiopathic group. Patients orally received 150 mg of polaprezinc containing 33 mg of zinc every day. Subjective symptom was scored according to visual analogue scale (VAS). Results Zinc supplementation improved hypogeusia in both idiopathic and zinc deficiency groups. The mean improvements of VAS were 3.02 ± 3.03 in the idiopathic group and 3.13 ± 2.53 in the zinc deficiency group. Thus, there were no significant differences in idiopathic and zinc deficiency groups. Significant correlations were found between the improvement of VAS score and the ACE ratio after zinc supplementation in both idiopathic and zinc deficiency groups. On the contrary, significant correlations were not found between the improvement of VAS score and the zinc concentration in the serum after zinc supplementation in both groups. Conclusion The results of the present study indicated that zinc deficiency is a predominant factor underlying taste impairment and ACE ratio may be a predictor of the prognosis for taste impairment after zinc supplementation, in addition to a more sensitive indicator of zinc nutrition than zinc concentration in the serum.

エネルギー及び栄養素摂取量を把握するために食事調査が用いられる。ほとんどの思い出し調査の方法では，食事の記録の際，目安量が用いられる。そのため，目安量から実際に摂取した重量を推定する必要がある。しかしながら，各書籍や栄養計算ソフトに収載されている食品の目安量は様々であり，特に野菜，果物，魚，肉などの生鮮食品の重量についての研究は少ない。従って，本研究では，青果物の規格の面から，階級やその重量等が地域によって，どの程度異なるのかを明らかにすることを目的とした。さらに，食事調査において，青果物を目安量から重量に換算する際の問題点や課題等について検討した。青果物により階級の数及び名称は複数にわたり，なすでは13の階級，いちごでは28の階級があった。さらに，各階級における重量等にも幅があり，いちごのMにおいては，下限の最小値が7g，最大値が74gであった。これらのことから，食事調査において，目安量によって食品が記録された場合に，対象者と調査員，さらに調査員の間で，その目安量に関して共通の認識を持っていることが確認できることが望ましいと考えられる。実際の青果物の摂取量を過大あるいは過小に評価してしまうことを避けるためには，目安量の設定，つまりどの目安をどの重量で採用するのかを十分に配慮する必要がある。（オンラインのみ掲載）

An unbalanced diet and low weight in women of childbearing age are becoming more common and are considered as important health problems in Japan. The “Dietary Guideline for Pregnancy and Lactation” was revised in 2006, and shows the proper weight increase during pregnancy based on pre-pregnancy BMI, and nutrition education for the pregnant woman and family. A nationwide survey was conducted among registered dietitians at those medical facilities offering obstetrics and gynecology to identify how nutrition assessment and nutrition education were being applied. The response rate was 16.0% (n=208). The respective application of nutrition assessment to outpatients and inpatients was 22.7% and 30.7%, while 31.8-39.8% received nutrition education based on appropriate energy and nutrients. These results suggest that it may be necessary to revise the system for providing nutrition education to the relevant patients. The answers from the medical facilities show that there was no coordinated system with another organization in 58.7% of cases. Comprehensive action for women of childbearing age and expected mothers is necessary to provide cooperation between the community and medical facilities.

Optimal Weight Gain Recommendations For Non- Obese Japanese Pregnant Women To determine optimal weight gain recommendations for reducing unfavorable pregnancy outcomes in non-obese women, by comparing four different cutoffs for weight gains. Out of 4774 cases in the hospital-based survey of the 2010National Growth Survey of Preschool Children, data on 3547 singleton term deliveries with maternal pre-pregnancy BMI

Elderly patients often have impaired taste, nausea, anorexia and delayed healing of decubitus. In many of these patients, serum zinc levels are low and they respond to zinc supplementation. To date, no epidemics of zinc deficiency have been reported in Japan. We studied the prevalence of zinc deficiency and its causative factors in a typical local town in Japan. Cross-sectional study. Nagano Prefecture (central Japan). Serum zinc levels were measured in 1009 habitants (18–96 years old) who participated in an annual mass health examination program of the City in 2003. Of all subjects, 86 with low serum zinc (

Objective To estimate the zinc nutrition in healthy subjects and patients with taste impairment. Dietary zinc intake, zinc concentration in the serum and the ratio of apo/holo-activities of angiotensin converting enzyme (ACE), a zinc dependent enzyme in the serum (ACE ratio) were used as indices. Subjects Healthy paramedical volunteers from a local hospital and patients with taste impairment seen in the Department of Otolaryngology, Tokushima University Hospital. Measurements Dietary zinc intake was estimated with the food frequency questionnaire (FFQ). Zinc concentration in the serum was measured by means of atomic absorption spectrometry. The ACE activity in the serum was measured spectrophotometrically as the activity of holo-ACE, which contains zinc and shows full ACE activity. The activity of apo-ACE, which dose not contain zinc, was determined as the increase of its activity over that of the initial holo-ACE activity after the addition of zinc to the serum in vitro. ACE ratio was used as a more sensitive indicator of zinc nutrition than measuring zinc concentration in the serum. Results There were no differences in dietary intake of zinc after adjusting for energy and zinc concentration in the serum between patients and age-adjusted healthy subjects. The ACE ratio in patients with taste impairment was significantly higher than that in age-adjusted healthy subjects ( P Conclusion Our date demonstrate that zinc deficiency is a predominant factor underlying taste impairment and we hypothesize that patients with taste impairment may have malabsorption of dietary zinc.

We investigated the effects of dietary supplementation of zinc (Zn) with or without vitamin A (Vit. A), to elucidate any cross activity between the two micronutrients, on memory and nerve growth factor (NGF) production in ddY male mice depleted for the two elements. After 3 mo-feeding with a Zn and Vit. A deficient (VAD) diet, mice were divided into three groups and replenished with normal Zn with VAD diet (NZ-VAD), high Zn with VAD diet (HZ-VAD) or normal Zn + normal Vit. A (NZ-NVA) for additional 2 mo. One more group was made and given the normal diet for the same period (Control group). Levels of NGF were measured from extracts of hippocampus, cerebellum and cortex at the end of the 3rd and 5th month. In addition, a radial arm maze task was performed at the end of the 5th month. The two Zn supplemented groups (NZ-VAD and HZ-VAD) tended to show high NGF concentration but memory was not improved. However, improved memory was observed in the NZ-NVA group. From these results we concluded that Zn may increase NGF; however, memory was improved only when Vit. A was sufficient.

Food stockpiles and methods of ensuring food availability after the Great East Japan Earthquake of March 11, 2011 have been studied. Questionnaires were sent to 1911 registered dietitians and general dietitians who were members of the Japan Dietetic Association in August 2012. Four hundred thirty-five dietitians (22.8%) completed the questionnaire about work involved in feeding facilities, types and administration of meals, and food stockpiles. Methods of ensuring food availability, preparation, and accommodating food for special dietary uses were recorded for the three-day period immediately following the earthquake, and the period from 4 days to one month after the earthquake. Three days after the earthquake, differences in administration of meals at feeding facilities providing three meals daily, food stockpiles, organization, contactable facilities, and how to contact them for food items were assessed. Sixty-nine percent of all feeding facilities in this study had stockpiles of food before the Great East Japan Earthquake. Administration of meals in feeding facilities and the possibility of contact with cooperative feeding facilities were found to correlate positively with ensuring the availability of food groups. Food scores were higher in facilities providing three meals daily by direct administration of meals and with accessible public administrators, cooperative facilities and suppliers, and facilities that were contactable by landline telephone, mobile phone, fax or email. The necessity for natural disaster-readiness through continuous stockpiling food at feeding facilities is confirmed. Each prospective feeding facility must be required to plan its stockpiles, their turnover and replaceability to maximise food security in the face of disaster.本课题研究了日本2011 年3 月11 日东部大地震之后的食品库存以及确保食品 供应的方法。2012 年8 月研究人员将问卷发给了日本营养师协会的1911 名注 册营养师和普通营养师。435 名营养师(22.8%)完成了关于食品用具、类型、饭 菜的处理和食品的储存情况的问卷。研究记录了震后三天内以及从震后第四天 到一个月之间确保食物供应的方法、食物的准备和一些特殊用途食物的储存。 地震三天后，对供餐点提供每日三餐、食物的储存、组织和管理、以及如何能 联系到供餐点进行了评估。本研究中，在日本东部大地震之前69%的供餐点 都有食物贮备。供餐点食物的供给和与供餐点有合作关系的食物集团现存食物 成正相关。能直接提供一日三餐、公众容易找到、提供有有线电话、手机、传 真和电子邮件的供餐点的评分较高。本研究证实了为自然灾害在供餐点贮备食 物的必要性。必须要求每个未来供餐点规划它的食物贮备、定期更换和可替代 性，以最大限度地提高在灾难面前的粮食安全。

Sodium in salt is a major factor in various non-communicable diseases. These include high blood pressure, stroke, stomach cancer and others. In Japan before the 1970’s, salt intake was about 15 g/day/person and the leading cause of death was stroke, especially brain hemorrhage. Through various types of nutrition education designed to reduce salt intake, the prevalence of stroke has been decreasing dramatically; however, it is still one of the leading causes of death. The highest number of patients are those with illnesses related to high salt intake and themedical cost of these illnesses may be greater than 50% of all medical costs. Many other countries may have similar problems. To reduce salt intake, UMAMI is commonly recommended in Japan and this actually has favorable effects;however, this has not yet been fully supported by scientific evidence. Among UMAMI seasonings, glutamate from kelp, (a kind of seaweed) is common in Japan. Since the UMAMI in kelp was found to be monosodium glutamate,artificial production of it was developed and is now used world-wide. In this article, we would like to review the role of salt in the body, its effects on health and sickness, attempts to reduce salt intake, and effective reduction methods, especially those using monosodium glutamate.

市販生分解性プラスチックから射出成形により試験片を作成し, 富山県内6カ所の土壌・水中での生分解性を評価した. バイオポールは, 分解によりき裂が発生し, 試験片の強度が大きく低下した. マタービーは, 試験片表面で分解と樹脂や可塑剤の溶出が起きた. また, 重量や強度の低下は他の樹脂に比べ大きくなった. エコスタープラスをブレンドした試験片では, 表面のでんぷんのみ分解が起き, 重量や強度の低下はほとんど見られなかった. 試験場所や埋設深さにより分解の進行に違いがあった. また, 分解の進行は春から秋にかけて速く, 冬から春にかけて緩やかになる傾向があり, 分解場所や季節による分解環境の影響がみられた.

In the present study, we first examined the dietary zinc intake from food groups in 109 healthy Japanese (24-82 years old, 45 male and 64 female) by means of the 72-h recall method. We then used the ratio of apo/holo-activities of angiotensin converting enzyme (ACE ratio) that is a more sensitive index of zinc nutrition than zinc concentration in the serum and examined the correlation between their zinc intake and ACE ratio. Dietary zinc intake in healthy Japanese was maximal from rice and rice products. There were significant inverse correlations between the ACE ratio and dietary zinc intake from rice and rice products and shellfish, and a significant positive correlation between ACE ratio and dietary zinc intake from other beans and bean processed foods. On the other hand, there were no significant correlations between serum zinc concentrations and dietary zinc intake from any food group except processed fish. These findings suggested that rice is a major source of dietary zinc intake in healthy Japanese. It is also suggested that shellfish also has a major impact on zinc nutrition, although dietary zinc intake from this source is minimal. Since beans contain phytic acid, which inhibits the absorption of dietary zinc, it is suggested that intake of beans causes impairment of zinc nutrition.

Objective The aim of the present study was to evaluate the effects of dietary zinc deprivation on zinc concentration, the activity of angiotensin converting enzyme (ACE) and ratio of apo/holo-activities of ACE (ACE ratio) in the serum of mice. Methods Twenty-two male mice were deprived of dietary zinc for up to 9 days. Zinc concentration in the serum was measured by means of atomic absorption spectrometry. Also, the activity of ACE in the serum was measured by HPLC as the activity of holo-ACE. After addition of zinc to the serum in vitro, the increase of ACE activity over the initial value was determined as that of apo-ACE. Finally, the ratio of apo/holo-ACE activities was calculated. Results There was a significant decrease of zinc concentration, but a slight decrease of the activity of ACE in the serum of mice by intake of zinc-deficient diet for 9 days. ACE ratio tended to increase on day 5 and was significantly increased on day 9 in mice deprived of dietary zinc. Conclusion These findings suggest that ACE ratio is as sensitive as serum zinc concentration for the evaluation of zinc deficiency and can be used for the biochemical diagnosis of zinc nutritional status in patients with zinc deficiency-induced taste impairment.

application/pdf, 学術雑誌論文, To elucidate the effect of a typical Vietnamese diet including a high content of white rice on postprandial blood glucose levels, the present study was designed. Thirty healthy female subjects with a similar body mass index, 10 each in their twenties, forties and sixties, were recruited. Four meals with a similar protein energy percentage (13-15%) but different energy ratios of fat and carbohydrate (FC ratio) and vegetable contents were provided by cross-over design. Meal A was designed according to the commonly consumed diet in Vietnam. The FC ratio was 14:71 and 84 g of carbohydrate was from rice. Meal B contained carbohydrate in a lower ratio than meal A by fat replacement and its FC ratio was 30:57. Meal C was similar to meal A except lacking vegetables. The energy of meal A, B and C was about 2.1 MJ. Meal D was designed to match the amount of carbohydrate and fat within A and B, respectively. The FC ratio of meal D was 26:61 and the energy was about 2.4 MJ. Fasting blood glucose was measured before consumption of a test meal. Postprandial blood glucose was measured every 30 min for 2 h. Areas under the curve\ (AUC) were calculated to compare the glycemic response among the four test meals. There was no significant difference in AUC among the four test meals in the subjects in their twenties. In the subjects in their forties, the AUC of meal A tended to be lower than that of meal C (p=0.07). In the subjects in their sixties, the AUC of meal A was significantly higher than that of meal B (p