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The primary aim of this study was to evaluate factors associated with changes in food-preparation practices during the Coronavirus Disease 2019 (COVID-19) pandemic in Japan and its associations to food-group intake. To examine this, a cross-sectional online survey was conducted in July 2020. Participants were 2285 adults aged 20–69 years who resided in any of 13 prefectures in Japan where specific COVID-19 regulations had been implemented. Self-reported changes in food-preparation practices when compared to the pre-COVID-19 pandemic period were measured as “increased” (24.6%), “decreased” (7.3%), and “no change” (68.1%), respectively. Stepwise logistic regression analyses indicated that participants who increased the time and effort for food preparation were younger in age, partially working remotely, experiencing reduced household income due to COVID-19, but highly concerned the importance of diet. On the other hand, participants whose household income decreased, and household economic status worsened, as well as those whose importance of diet deteriorated due to COVID-19 were more likely to decrease time and effort for cooking. Although the increased group were more likely to prepare meals with raw ingredients, the decreased group showed higher frequency of using takeout. These results indicated major determinants of changes in time spending on food preparation in consequence of COVID-19, and highlighted essential targets for future nutrition education.

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.

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.

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.

Little attention has been devoted to the importance of understanding the association between dietary intake and childhood obesity in Thailand. This study aimed to explore food types affecting the weight status of preadolescents in urban settings, where obesity is remarkably prevalent. This study was conducted in 2015–2016 and assessed the dietary intake of 263 children aged 10–12years from Bangkok Metropolitan Regions through three- nonconsecutive-day 24h recall. Lifestyle and sociodemographic information was obtained using questionnaires. Participants were classified into non-obese and overweight/obese groups based on the WHO child growth standard curve. Foods were categorized into 13 groups based on Thailand's dietary guidelines and food environment context regarding two eating occasions (main and between meals) of children, which resulted in the newly classified “street-side snacks”. Data were examined using analysis of covariance and multiple linear regression analysis. After adjusting for sex and energy misreporting, overweight/obese participants had higher energy and macronutrient intake and consumed more cereal grains, meat/fish, flavored milk, and sugar-sweetened beverages during main meals and street-side snacks and confectioneries during between meals than non-obese participants. The consumption of street-side snacks had the highest beta coefficient on BMI z-scores among the food types in the model, adjusted further for energy intakes. Street-side snacks may be an important predictor of obesity in Thai children. A prospective investigation of the impact of accessibility and availability of this food item is needed. Keywords: Thailand, Preadolescents, Weight status, Dietary intake, Sugar-sweetened beverages, Snacking

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:To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults.Design:Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake).Setting:Saitama Prefecture in Japan.Participants:Community-dwelling adults aged 30–59 years (256 men, 361 women).Results:Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 (se 0·8) %, 5·5 (se 0·2) %, 11·3 (se 0·4) % and 38·2 (se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B6, dietary fibre, magnesium, phosphorus and iron.Conclusions:Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.

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.

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.

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.

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.

【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。

目的：フォーマティブ・リサーチに基づいた体重管理プログラムを職域において実施し，プログラムのプロセス評価およびプログラム実施後の対象者の行動，BMIの変化を検討する。方法：都内にある運送業者の一営業所（社員317名）で実施した。プログラムの計画のため，環境調査と社員18名を対象にインタビュー調査を実施した（研究1）。フォーマティブ・リサーチの結果からプログラムを計画し，約6カ月間プログラムを実施した。BMI，体重管理における誘惑場面におけるセルフエフィカシーおよび対策行動，体重管理に関する知識などの変化をプログラム実施前後で比較した（研究2）。結果：フォーマティブ・リサーチの結果，勤務時間内に社員がプログラムに参加する時間を確保することが難しいことがわかり，食生活調査の個人結果返却と社内の休憩室の掲示板を用いたプログラムを実施した。その結果，対象者の36.3％（115名）が事前事後調査に回答し，21.5％（68名）が個人結果を受け取りかつポスターを利用したと回答した。後者では，体重管理の知識も増え（p＝0.021），体重管理の誘惑場面における対策行動を実行する者が増える傾向にあった（p＝0.064）。また，一日の菓子・嗜好飲料の回数も減っていた（p＝0.001）。考察：本研究の解析対象者は，事前事後調査に回答した者であり，かつ本研究ではコントロール群を設定していないため，プログラムの効果は評価できない。本稿は，対象者のニーズをもとにプログラムを開発した点において先進性があり，職域での体重管理プログラムの事例として紹介するものである。（オンラインのみ掲載）

application/pdf, 学術雑誌論文, Objective: The purpose of the present study was to develop scales to measure the strategies used ofr coping with the temptations experienced during weight control.\Methods: The subjects for this study consisted of 994 consenting adults who anonymously responded to a selfadministered\questionnaire. The questions focused on the frequency with which the subjects used various strategies to cope with the temptations experienced during weight control, their stage of change, their knowledge about weight control, their self-efficacy, their perceptions of their current weight, and their demographic characteristics. Data were analyzed in terms of the item selection, exploratory and confirmatory factor analyses, and assessment of the reliability (Cronbach's alpha) and validity of the scales.\Results: There were 752 respondents for subsequent analyses (518 males, 210 females, nad 42 missing data). Five scales comprising 44 items concerning coping strategies were extracted from the data: counter- conditioning (11 items), eating style (12 items), stimulus ocntrol (5 teims), social support (4 items), and cognitive coping (12 items). The internal consistency (Cronbach’s alpha) of these scales were 0.68~0.87. More advanced stages of change and greater knowledge weight control were associated with significantly higher scores for the scales measuring coping\strategies.\Conclusions: The validity and reliability of these five new scales were confirmed for subjects who were in weight control. Since this study used cross-sectional survey methodology, a longitudinal study will be necessary to examine the relationship between coping strategies and self-efficacy for dealing with temptation during about weight control.

Non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the leading cause of death worldwide. To decrease the global burden of NCDs and strengthen national efforts to combat NCDs, the World Health Organization (WHO) released the Global Action Plan for the Prevention and Control of NCDs 2013-2020. This plan provides established procedures and several policy options for member countries and other partners. Although many countries recognize that prevention of NCDs is an important health priority, their governments currently face a challenge: How do they adopt a multi-sectoral approach to promoting a healthy lifestyle among their populations? For this, all sectors of the food system (primary production, food processing, distribution, marketing, retail, catering, and food service) need to coordinate with each other for future governance. Since regulatory policy intervention areas for diet-related NCDs are widespread throughout the global food system, for future perspectives, comprehensive and coordinated approaches are needed for policy development and implementation across all levels of governments and food sectors in order to ensure sustainable policy action.

A new framework for the evaluation of participatory nutritional education is presented after a review of the concepts relating to participation and empowerment. There was a paradigm change from health education to health learning during the late 1980s in Japan, being similar to that from health education to health promotion in the Ottawa Charter of WHO in 1986. It is more important for people to participate in the planning and decision-making process than in its implementation. Community participation, involvement, organization, and empowerment are closely associated with this participatory approach. Japanese participatory health education, which is called health learning, closely resembles the idea of educational empowerment based on Freire's idea. In summary, participatory nutritional education needs the active involvement of participants in the decision-making process, dialogue among the participants, and identification of their problems and the social roots of these problems by critical thinking, besides empowerment for the action to overcome obstacles in achieving their goals.Few papers have been published in Japan on participatory nutritional education, and there is a need to discuss more about the methodology and to put most emphasis on the evaluation. In an ideal evaluation of participatory nutritional education, both an evaluation of the process and of the outcome are needed. The process evaluation should involve measurement on each level to identify individual, organizational, and community change. For the outcome evaluation, measurement should be made on each level to identify the knowledge, skill, attitude and behavior related to food and nutrition, food consumption, nutrient intake, nutritional and health status, and quality of life. The framework that I present in this article is intended to be useful for these evaluations.

The purpose of this study was to examine appropriate measures of knowledge, attitudes, and behavior for assessment/evaluation for nutrition education for young adults. The conceptual framework was developed based on two models: one is the Precede-Proceed model by Green and the other is the framework of nutrition ecology by Adachi. Firstly, based on the review of the recent studies and 16 focus group interviews for young adults conducted at worksite and community, several measures were selected; such as self-efficacy, stage of change, and the scale for positive dietary behavior and attitude developed by the author. Secondly, a cross-sectional survey was conducted with questionnaires including those measures, for 397 young adults at 3 worksites. The correlations among health, nutritional status and those measures were examined. Thirdly, participatory nutrition education intervention was implemented at 2 worksites in order to examine the appropriate measures for evaluation of the participants' changes of attitudes and behaviors. Finally, worksite health professionals and dietitians examined the selected measures, from the viewpoints of those applications into worksite health and nutrition promotion. Conclusively, self-efficacy, dietary stage of change, and dietary skill were suggested to be appropriate and valid measures for assessment and evaluation for nutrition education for young adults.

The Dietary Guidelines for Japanese, released in 2000, provides the basics of a healthy diet for the people of Japan. In July 2005, the Ministry of Health, Labour and Welfare and the Ministry of Agriculture, Forestry and Fisheries of Japan jointly released a new pictorial guide, The Japanese Food Guide Spinning Top, to help people implement the Dietary Guidelines for Japanese. It guides people as to what kinds and how much food they should eat each day to promote health. This paper describes the nature of the diet and the theoretical framework applied in the development of the new guidelines.