Search

Objective The association between adult-attained height and risk of colorectal cancer remains elusive among the Japanese population. We performed a systematic review and meta-analysis of epidemiological studies in Japan. Methods We systematically searched the MEDLINE (PubMed) and Ichushi databases and complemented it with manual search to identify eligible studies. We extracted relative risks or odds ratios from the selected studies and conducted meta-analysis to estimate the summary relative risk with 95% confidence interval. We made the final judgment based on a consensus of the research group members considering both epidemiological evidence and biological plausibility. Results This systematic review identified four cohort and one case–control studies among the Japanese. The meta-analysis of these five studies showed the summary relative risk of 1.21 (95% confidence interval: 1.07–1.35) of overall colorectal cancer for the highest vs. lowest categories of height. In the analysis by the cancer subsite, the association was significant for colon cancer with a summary relative risk of 1.26 (95% confidence interval: 1.10–1.45) but not for rectal cancer 1.05 (95% confidence interval: 0.71–1.54). In the analysis by sex, tall stature was associated with a significantly increased risk of overall colorectal cancer in both sexes; the summary relative risk was 1.21 (95% confidence interval: 1.04–1.41) in men and 1.20 (95% confidence interval: 1.00–1.44) in women, respectively. Conclusions The evidence to support that adult-attained height is associated with increased risk of colorectal cancer (colon cancer) among the Japanese population is ‘probable’.

Increasing intakes of vegetables are associated with risk reduction in various non-communicable diseases, especially cardiovascular disease. In order to compare the proportion of daily vegetable intake among adults from these 30 Organization for Economic Co-operation and Development (OECD) countries as well as Japan, we applied data from the OECD website and the 2017 National Health and Nutrition Survey, Japan (NHNS-J). The figures for Australia, Israel, Korea, New Zealand, and the United States exceeded 80%, where survey questions in these countries asked the amount of intake, instead of the frequency of intake. In Japan, results from the one-day dietary record showed that 99.2% of adults consumed vegetables on the survey day; however, this decreased to 66.3% when assessed by a qualitative question. Proportion of daily vegetable intake as well as average intake amount was higher among those aged 60 y or older. Health policies to increase vegetable intake should target younger age groups to promote health in future generations, in Japan.

Weighed food records together with an in-person interview approach constitute the most basic methods used to estimate energy and nutrient intakes in dietary surveys. In the background of the coronavirus disease-2019 pandemic, the need for non-face-to-face dietary surveys using information and communication technology (ICT) is increasing. We aimed to evaluate ICT-based dietary record surveys and identify factors that may enable this survey method to become more widely used in the future. We conducted a non-face-to-face survey of dietary records of 44 Japanese individuals, maintained by dietitians using dietary photography and video conferencing services. We conducted a focus group interview with the six dietitians who conducted that survey. Their opinions on the factors necessary to popularize ICT-based dietary survey method were analyzed. In the focus group interview, dietitians highlighted fewer restrictions on time and place as positive aspects. Negative aspects included insufficient skills to operate computers, difficulty in hearing, and understanding facial expressions using ICT. We identified three main factors for enabling widespread use of ICT-based dietary record survey: individual skill, device and technology, and social environmental factors. This suggests that a comprehensive approach is necessary for popularizing the use of ICT in dietary surveys.

This cross-sectional study aimed to investigate the relationship between food sources of free sugars and weight status among children and adolescents aged 2–19 years in Japan (1438 males and 1340 females) from the 2016 National Health and Nutrition Survey, Japan. We estimated the percentage of energy intake (% E) from free sugars from total food sources (FStotal), solid foods (FSsolids), and beverages (FSliquids), using one-day weighed dietary record data. Weight status was determined based on body mass index (BMI) z-scores and the prevalence of overweight and obesity. The mean energy intakes of FStotal, FSsolids, and FSliquids were 5.8%, 4.1%, and 1.8% in males and 6.2%, 4.6%, and 1.6% in females, respectively. After controlling for potential confounding factors, including energy intake, there was no association of free sugars intake from all food sources with BMI z-scores or with the prevalence of overweight and obesity, except for a marginal association between higher FSsolids and lower estimated BMI z-scores in females (p = 0.05). The present findings indicate that among children and adolescents in Japan, who have a relatively low mean intake of free sugars, consuming free sugars from any food source is unlikely to have an adverse effect on weight status.

Little is known about the optimal daily magnesium (Mg) intake for individuals with high levels of physical activity. The aim of this study was to clarify the optimal dietary Mg intake for people with high levels of physical activity in a scoping review. In this review, we searched MEDLINE and Japan Medical Abstracts Society for studies published up to May 31, 2020. We conducted two searches, one for studies using gold standard measurement methods such as the balance method and factorial calculation (Search 1), and the other for studies using estimation from daily food intake (Search 2). We also performed a meta-analysis of studies that compared the Mg intake among physically active people with the Mg intake among controls. After the primary and secondary screening, 31 studies were included in the final review. All of the included studies examined professional or recreational athletes. We found no studies that examined the optimal intake of Mg using gold standard measurement methods. The Mg intake among physically active individuals was below the recommended dietary allowance in most studies. In five studies that conducted meta-analyses, physically active individuals had significantly higher intakes of Mg than controls, although these levels were still below the recommended dietary allowance. The present review revealed that evidence regarding the optimal daily magnesium intake is currently scarce, and further studies are needed.

Although higher diet quality is related to higher socioeconomic status among adults, it is unclear whether this result could be generalized to children. Elementary and junior high school lunch programs may contribute to the reduction of socioeconomic disparities in diet quality. We examined the association between diet quality and household income level in school children in Japan according to age subgroups.This cross-sectional study was conducted in 866 household members (435 men and 431 women) aged 6-18 years old from the 2014 National Health and Nutrition Survey, Japan. Dietary intake was assessed by 1 day semi-weighted household dietary record, and the Japanese Food Guide Spinning Top scores (range 0-70) were calculated. The household income was assessed by low, middle, and high. Associations between diet quality and household income levels were examined by age subgroups (6-14 years and 15-18 years), i.e., those with and without school lunch programs RESULTS: Higher dietary scores were observed in those with higher household income in the 15-18 year-olds; the multivariate adjusted mean (95% CI) of diet score was 44.3 (39.0-49.7), 48.8 (47.1-50.6), 51.6 (49.7-53.4) in children with the lowest household income level through the highest, respectively (P for trend = 0.003). However, there were no significant associations among those who were 6-14 years old.Our findings suggest that school lunch program in elementary and junior high schools might help to reduce socioeconomic disparities in diet quality. The development of healthy food environment in high schools without school lunch programs, should also be considered.

Objectives Minor health complaints related to stress, mental health, sleep, and fatigue are closely associated with each other, and their deterioration may cause lifestyle diseases. The health status of people can be predicted through a questionnaire by exploring the relationship between their state of minor health complaints and objective health status indices. Therefore, we conducted a systematic review of the relationship between a questionnaire on the state of minor health complaints and health status indices among Japanese people who have a high level of stress, which they experience on a daily basis, using epidemiological literature. Additionally, we considered items for the questionnaire which were necessary for an index development.Methods The PubMed database was searched for papers on "autonomic nervous system," "sleep disorders," "mental health and stress," and "fatigue," using keywords mentioned in previous studies on minor health complaints. The extracted research papers were screened according to the following inclusion criteria: 1) the participants were healthy Japanese people; 2) descriptions included characteristics of the target population; 3) use of analytic epidemiological study design, intervention studies, and systematic reviews; 4) minor health complaints assessed by a questionnaire; 5) evaluation of the relationship between the questionnaires for minor health complaints and the health index; and 6) written in Japanese or English. Based on this, ten papers were adopted.Results Of the 10 papers collected, one was a cohort study, three were case-control studies, and six were cross-sectional studies. The participants in five of them were working adults. Reports on three out of six questionnaires on stress, four out of seven on sleep, and all two on comprehensive health status showed significant associations between minor health complaints assessed by the questionnaires and the index for health status. The increase in responses about work-related stress from the questionnaire was associated with an increase in the "risk of developing depression" [odds ratio 2.96 (confidence interval: 1.04-8.42)]. Poor sleep quality was associated with an increase in "changes in autonomic index," "number of comorbidities and the rate of depression," and the "risk of work-related injuries." Moreover, the health score was associated with the "autonomic nervous system index".Conclusion These results suggest that a questionnaire evaluating minor health complaints should include questions about "stress," "sleep quality," and "comprehensive health status." Since studies that appropriately adopted for risk of bias were limited, it is necessary to further examine these relationships by applying prospective studies such as cohort studies and intervention studies.

Objective:To investigate the relationship between nutrient intake and a straightforward Japanese nutritional goal of consuming a meal that includes staple, main and side dishes (SMS meal) more than twice a day.Design:This was a cross-sectional, observational study using the data from de-identified records of the 2012 National Health and Nutrition Survey. Dietary assessment was conducted using semi-weighed dietary records that were completed on one weekday.Setting:A home-based setting in Japan.Participants:30 269 subjects (male n 14 284; female n 15 985) aged ≥6 years (6–103 years, mean 50·4 (sd 22·3) years).Results:As the frequency of SMS meals increased, we found a higher intake of most nutrients and each food group. Subjects who consumed SMS meals at least twice a day were more likely to meet the Dietary Reference Intakes (DRI) for Japan compared with subjects who consumed an SMS meal once a day or less. However, the frequency of SMS meals did not necessarily ensure that DRI for Japan for saturated fatty acid, vitamin A, vitamin B1, calcium, iron and salt were met.Conclusions:Consuming SMS meals at least twice a day is a useful and straightforward nutrition goal to achieve adequate intake of some nutrients. However, it is necessary to provide the public with more information on foodstuff choice to ensure an adequate intake of all nutrients.

Objective:Although several studies in Western countries show that higher socioeconomic status is associated with higher diet quality, no study has observed this association in Japan. In the current study, we examined the association between diet quality and the combinations of age, sex, and household income, and also compared the dietary intake between diet quality levels according to household income.Design:Cross-sectional study.Setting:National Health and Nutrition Survey, Japan in 2014.Participants:2785 men and 3215 women.Results:Higher Japanese Food Guide Spinning Top scores (better diet quality) were observed in older women, especially those with higher household income, whereas lower scores were observed in younger men with lower household income. Those having low quality diet, especially in low income households, had higher odds of not meeting the recommended amounts of the Japanese dietary guidelines, than those having high quality diet.Conclusions:Diet quality in Japanese adults differed by age and sex as well as by household income level. A different approach to diet quality improvement is needed according to population characteristics including not only age and sex but also social economic status.

Dish-based nutrient profile analyses are essential for setting goals to achieve a balanced diet. In 2014, the Japanese government proposed the “Healthy Meal” criteria, which requires a salt content of 3 g/650 kcal per meal. To examine the current intake status of a nationally representative sample, we conducted a series of secondary analyses of the 2014–2018 National Health and Nutrition Survey data. Participants (aged 18–74 years) were grouped as “high-salt” consumers if their salt intake was 3 g/650 kcal or higher and “adequate” consumers if they consumed less than 3 g/650 kcal. A total of 13,615 participants were identified as “adequate” consumers and 22,300 as “high-salt” consumers. The median salt intake in the “high-salt” group was 11.3 g/day, while that in the “adequate” group was 7.5 g/day. Almost all dishes consumed by the “adequate” group had significantly high energy and fat content but low salt content, compared with those consumed by the “high-salt” group. For example, the median energy, fat, and salt contents in the main dishes consumed by the “adequate” group were 173 kcal, 10.4 g, and 0.9 g/dish, respectively, while those in the main dishes consumed by the “high-salt” group were 159 kcal, 8.9 g, and 1.1 g/dish, respectively. Examples of balanced dishes that are low in both salt and fat content can be proposed to help improve the Japanese consumers’ dietary behavior.

Increasing participation rates are crucial to ensure the representativeness of national survey results of the population. This study aimed to identify measures that could be taken by local government personnel in charge of the National Health and Nutrition Survey (NHNS), Japan, to improve participation rates. The subjects were twenty-one health personnel who worked in 19 local governments and participated in the training course at the National Institute of Public Health. Qualitative data were collected through a workshop. They discussed the problems that seem to affect participation rates and identified possible solutions. The contents were coded and grouped to create categories, using the Jiro Kawakita (KJ) method. For data analysis, researchers combined and reviewed all codes and categories. The measures that could improve participation rates were divided into the following 12 categories: 1. standardization of survey methods, 2. investigator skills, 3. survey organization, 4. venue setting, 5. accessing target households, 6. time of survey, 7. responses during the investigation, 8. confirming meal contents reported in the nutritional intake status survey, 9. rewards/incentives, 10. possible rewards, 11. feedback on survey results, and 12. survey practices during the COVID-19 pandemic. These findings represent viable initiatives for local health personnel to increase participation rates for the NHNS.

BackgroundConsumption of home-prepared meals may lead to better nutritional intake. Few studies have examined the association between the frequency of consuming meals prepared away from home and the inadequacy of nutritional intake based on nutritional standards and food group intake. We therefore aimed to investigate this issue among Japanese adults.MethodsThis study was a secondary analysis of the 2015 National Health and Nutrition Survey in Japan, involving 921 men and 1300 women aged 18–64 years, conducted as a cross-sectional survey. The frequency of consuming meals prepared away from home was defined using two questions inquiring about the frequency of eating out and take-away meals. Data on dietary intake were collected using a one-day semi-weighed household dietary record. Participants were stratified into three groups based on the frequency of consuming meals prepared away from home (High, Moderate, Low). The inadequacy of each nutrient intake was assessed by comparing estimated average requirement (EAR) level for 14 nutrients and the range of the dietary goal (DG) for seven nutrients according to the 2015 version of the Dietary Reference Intakes for Japanese. Group differences in nutrients adequacy were assessed using the covariate and logistic regression analysis. Food intake was also compared across the groups by classifying each food item into 17 groups based on Standard Tables of Food Composition.ResultsThe proportion of participants who consumed home-prepared meals almost every day were 34.9% among men and 46.8% among women, and the proportion of those consuming a higher frequency of meals prepared away from home were 14.7 and 6.3%, respectively. A higher frequency of consuming meals prepared away from home was associated with inadequacy of dietary fiber, vitamin C and minerals (iron, magnesium and potassium) intake, and with lower intake of vegetables and higher intake of fat and oils.ConclusionsHigh frequency of consuming meals prepared away from home was associated with insufficient intake of dietary fiber, vitamin C and multiple minerals among Japanese adults. These nutrients may be the potential target of interventions aimed at improving nutrient intake in individuals who predominantly eat food prepared away from home.

To clarify the degree of consistency between the international recommendations and the national Japanese system, the nutrient reference values (NRVs) adopted by the CODEX were compared with current Japanese NRVs 2015, the dietary reference intakes for Japanese (DRIs-J) 2015, and actual nutrient intake levels by the Japanese population. The Japanese NRV for protein was high relative to CODEX NRV-R (i.e., NRV-Requirement). The Japanese NRVs for folate and calcium were low, and vitamin K was high, relative to each CODEX NRV-R. However, it was similar to the DRI-J values, and current intake levels for the Japanese population. For iron, calculation methods were different between the CODEX and Japan. Japanese iron NRV was calculated based on the RDA without menstruatating women, whereas CODEX NRV-R was calculated based on the INL98 of all adult men and women. Actual intake levels of iron for the Japanese population were similarly low. The Japanese NRV for sodium was high and potassium was low based on DRI-J values, relative to the CODEX NRV-NCD. For nutrients that show large discrepancies between the CODEX and Japanese NRVs, the values should be discussed further.

BackgroundPrevious epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults.MethodsWe conducted face-to-face surveys of 525 adults, who were aged 40–91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40–97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia.ResultsSarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject’s calf was smaller than their finger-circle (AUROC: 0.729, ConclusionsSarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia.Trial registrationUMIN000036880, registered prospectively May 29, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027

The influence of free sugar intake on nutrient intake remains unclear in Japanese children and adolescents with relatively low free sugar intake. This cross-sectional study aimed to investigate the relationship between free sugar and selected nutrient intakes using data from the 2016 National Health and Nutrition Survey, Japan, based on the WHO recommendations (n 2919). Mean intakes for selected nutrients and food groups were compared according to free sugar intake categories (

Few studies have reported associations between the Na:K ratio and risk factors related to CVD among the general population in Asian countries. This study aimed to investigate the dietary Na:K ratio association with CVD risk factors among Japanese adults. This retrospective cross-sectional study included 48 800 Japanese participants (19 386 men and 29 414 women) aged ≥20 years, registered in the 2003–2017 National Health and Nutrition Survey. Multivariate OR and 95 % CI for risk of hypertension, high glycated HbA1c levels, hypercholesterolaemia, low serum levels of HDL-cholesterol and high non-HDL-cholesterol levels according to the Na:K ratio were estimated using logistic regression models. Dietary Na:K ratio decreased for both men and women from 2003 to 2017. Higher Na:K ratio and higher hypertension prevalence were observed (multivariate OR (fifth v. first quintiles) 1·27, 95 % CI 1·15, 1·40; Pfor trend < 0·001 for men and 1·12, 95 % CI 1·01, 1·23; Pfor trend = 0·007 for women). Higher Na:K ratio was associated with higher prevalence of high HbA1c levels in men (multivariate OR 1·56, 95 % CI 1·24, 1·96). Prevalence of low HDL-cholesterol levels was increased with higher Na:K ratio (Pfor trend =0·002 for men and

Objective:To examine 44-year trends in height, weight and BMI, and the prevalence of overweight/obesity and underweight in the elderly Japanese population because Japan, the country with the longest life expectancy, has the highest ageing population.Design:Using the nationally representative cumulative data from the Japan National Health and Nutrition Survey 1973–2016, sex-specific and age-adjusted mean height, weight and BMI, and the prevalence of overweight/obesity and underweight were calculated for each year. Trend analyses were performed using the Joinpoint Regression Program. Next, changes in height, weight and BMI, and the prevalence of overweight/obesity and underweight were estimated for each age group (65–69, 70–79 and >80 years) according to the birth year groups.Setting:Japan.Participants:Individuals aged ≥65 years with complete data on height and body weight measurements (N 94 508).Results:Trends in average height and weight increased over the four decades in both men and women. The prevalence of overweight/obesity dramatically increased and nearly tripled in men, accompanied with significantly decreased underweight prevalence. Furthermore, the increasing trend in average BMI and overweight/obesity prevalence in women reached a peak in 2002 and showed a decreasing trend thereafter, while a downward trend in underweight prevalence showed a gradual increase in women since 2003.Conclusions:Trends in height, weight and BMI among the elderly population should continue to be closely monitored in parallel with the effects of dietary changes, energy intake and physical activity (step counts).

Objective:To examine nutrient and food intakes according to the levels of skeletal muscle mass index (SMI) in the elderly.Design:Cross-sectional study.Setting:Data were derived from the 2017 National Health and Nutrition Survey in Japan. SMI was calculated by dividing appendicular skeletal muscle (or lean) mass (kg) by height squared (m2). We calculated the multivariable-adjusted means of individuals’ dietary intake. Dietary intake of energy, nutrients and food categories was assessed by examining dietary records using a semi-weighed method and compared according to the sex-specific quartiles of SMI.Participants:Men and women aged ≥60 years.Results:Among 797 men and 969 women, individuals with a higher SMI consumed more energy and more nutrients than did those with a lower SMI after adjusting for age, lifestyle and physical activity factors. After further adjusting for energy intake, total dietary fibre, vitamin A, vitamin B6, K, Fe and Cu were positively associated with higher SMI in men (Pfor trend < 0·05). For food categories, men with a higher SMI consumed more vegetables and meats, but the associations were attenuated after adjustment for energy and remained significant for vegetable only (Pfor trend = 0·018).Conclusions:Japanese elderly people with a higher SMI consumed more energy and nutrients and more vegetables than did those with a lower SMI. This finding shows that diet is important in preventing muscle loss among the elderly in an ageing society.

Dietary intake of adequate quality and quantity in early life is essential for healthy growth and development. This study aimed to examine the association between one-year change in growth and diet quality in preschool children in Adachi City, Tokyo, Japan. A total of 110 participants (49% boys, four to five years old at baseline) were included in this analysis. Body mass index for age z-score (BAZ) and height for age z-score (HAZ) were calculated in accordance with WHO reference. Dietary intakes were assessed using the brief-type self-administered diet history questionnaire for children (BDHQ3y), and daily quality score was calculated based on the Japanese Food Guide Spinning Top (JFGST score). Regression analyses found no significant association between one-year change in growth and diet quality (compared to a low JFGST score, BAZ: &beta, = 0.16, 95% CI: &minus, 0.29 to 0.60 for a middle JFGST score, &beta, = &minus, 0.14, 95% CI: &minus, 0.61 to 0.33 for a high JFGST score, HAZ: &beta, 0.15, 95% CI: &minus, 0.50 to 0.21 for a middle JFGST score, &beta, 0.06, 95% CI: &minus, 0.43 to 0.30 for a high JFGST score). Further studies are needed to develop an appropriate diet quality index for healthy growth in Japanese preschool children.

BackgroundAlthough assessing nutrient intake through dietary surveys is desirable, it can be effort- and time-intensive. We aimed to develop a brief screening method for determining sodium intake in order to raise public awareness regarding the Dietary Reference Intakes for Japanese (DRI-J) 2020.MethodsUsing data from the 2015 National Health and Nutrition Survey, we compared dietary behaviours obtained from a self-administered questionnaire according to sodium intake, which was assessed from one-day dietary records by a semi-weighed method. Participants were divided into 4 groups based on the reference values of sodium (salt equivalent) shown in the DRI-J. We also randomly divided the participants into development and validation groups, and used logistic regression analysis to identify predictive factors for sex-specific DRI-J (ResultsAmong the 6,172 Japanese individuals aged ≥20 years old, participants with lower sodium intake were found to use nutrition labels and had a lower frequency of eating out than those with higher intakes (P for difference < .001). Our final model for predicting sodium intake included adjusted sex, age, dietary behaviours, and consumption of mainly processed foods. In the development group, areas under the receiver operating characteristics curves were 0.747 and 0.741 for adherence to sex-specific DRI-J and above-average intake, respectively. The corresponding values in the validation group were 0.734 and 0.730, respectively.ConclusionsThis method could easily identify sodium intake using dietary behaviours and specific food consumption, and is expected to be widely useful for health and nutrition education in Japan.

Lower birth weight is associated with a risk of type 2 diabetes in adulthood. However, it is not clear whether this association is modified by physical activity. This study aimed to examine the association between birth weight and glycemic status and whether this association is mediated by moderate- and vigorous-intensity activity (MVPA) in Japanese women. The participants were 103 nondiabetic women (47.4 ± 10.8 years), who underwent health checkups in which data of glycated hemoglobin (HbA1c) were collected. Abdominal circumference (AC) was measured at the umbilical region. Birth weight was obtained from the Maternal and Child Health Handbook records or reported based on the participant’s or his/her mother’s recall. Time (min/day) spent in MVPA (≥3.0 metabolic equivalents) was objectively measured using a triaxial accelerometer (Actimarker EW4800). Birth weight was inversely correlated with HbA1c (r = −0.32, P < 0.01). Multiple linear regression analyses revealed that lower birth weight was associated with increased HbA1c (β = −0.22, P < 0.05) even after adjusting for age, state of menstruation, AC, and family history of diabetes. This association was little changed when MVPA was introduced as an independent variable in the model (β = −0.23, P < 0.05). These results suggest that lower birth weight may be associated with higher HbA1c levels before the onset of type 2 diabetes, irrespective of adulthood physical activity. Early-life development should be taken into account when considering the risk of diabetes in Japanese women, even if they are physically active.

Consumption of dairy products in the usual diet may be important for improving the overall quality of dietary intake. This study aimed to assess the difference in nutrient intake adequacy according to the intake of dairy products based on a 1-day weighed dietary record of Japanese adults from the 2016 National Health and Nutrition Survey. Nutritional adequacy was determined based on the Dietary Reference Intakes for Japanese 2015, with 2 goals: Tentative dietary goals (DG) for preventing lifestyle-related diseases, and the estimated average requirement (EAR). According to the dairy products consumption, participants were categorized into three groups (milk, other dairy product, or non-dairy), and the total number of those not meeting DG and EAR was compared. Non-dairy consumers were less likely to meet both DG and EAR compared to dairy consumers. Dairy consumers were more likely to exceed the DG for saturated fat than non-dairy consumers. Japanese adult dairy consumers were more likely to have adequate nutritional intake than non-dairy consumers, especially for calcium. We also observed a higher saturated fat intake in dairy consumers, which might be due to a certain dietary pattern in this group. Further investigation is needed to determine dairy intake and its influence on dietary quality among the Japanese population.

Monitoring nutritional status of the population is essential in the development and evaluation of national or local health policies. In this study, we aimed to demonstrate analysis on the trends in dietary intake of energy and macronutrients, as well as Na, in Japanese population using the data of series of cross-sectional national surveys – the National Nutrition Survey (NNS) and the National Health Nutrition Survey (NHNS) – during the period from 1995 to 2016. The NNS and NHNS participants aged 20–79 years were included in the analysis. Dietary intake was estimated using 1-d household-based dietary record. The trend in total energy intake, energy intake from macronutrients (fat and protein), Na intake and energy-adjusted Na intake were analysed using regression models adjusted to 2010 age distribution and anthropometry status. A total of 94 270 men and 107 890 women were included the analysis. Total energy intake showed a decreasing trend in both men and women. Similarly, energy intake from protein decreased, but energy intake (%) from fat increased in both sexes. Energy-adjusted Na intake showed a decreasing trend in both men and women. This study identified the decrease in total energy intake and energy intake from protein, whereas there were inverse trends in energy intake from fat among Japanese adults. Continued monitoring of trends in dietary intake will be needed, and there should be efforts to increase the accuracy of current survey procedures.

Collecting and analyzing anthropometric and health data from routine health check-ups on children are essential for developing effective health policies to reduce the prevalence of chronic lifestyle-related disease. To estimate regional differences in the prevalence of overweight children, the 2012 National Health and Nutrition Survey and School Health Survey results were used for analysis. In prefectures with high prevalence of overweight children, the adult mean BMIs were also high. Our preliminary analysis suggests the importance of region-based survey analysis of the underlying cause of this phenomenon.

There are two major nationwide birth cohort studies in Japan, namely, the Longitudinal Survey of Newborns in the 21st Century conducted by the Ministry of Health, Labor and Welfare (MHLW) and the Japan Environment and Children's Study (JECS) conducted by the Ministry of Environment. The former was a longitudinal questionnaire survey focusing on environmental and socioeconomic factors for descriptive epidemiology conducted every year since 2001 by mail. The latter was based on 15 unit centers nationwide with environmental measurements and collection of biological samples for environmental risk evaluation. Both are prospective birth cohort studies whose findings will be expected as the basis for establishing health policies. The data obtained in the former study can be used for research with permission from MHLW. To date, there have been more than ten published studies using those data. We have reviewed these studies and introduced our preliminary findings on factors affecting infant growth. Employment before delivery, educational background of parents, household income, and smoking habit of both parents have been suggested to affect infant growth. We will analyze the associations between socioeconomic factors and infant growth trajectory to elucidate the most adequate intervention for children.

In Japan, health checkups for children take place from infancy through high school and play an important role in the maintenance and control of childhood/adolescent health. The anthropometric data obtained during these checkups are kept in health centers and schools and are also recorded in a mother's maternal and child health handbook, as well as on school health cards. These data are meaningful if they are utilized well and in an appropriate manner. They are particularly useful for the prevention of obesity-related conditions in adulthood, such as metabolic syndrome and diabetes mellitus. For this purpose, we have tried to establish a scanning system with an optical character recognition (OCR) function, which links data obtained during health checkups in infancy with that obtained in schools. In this system, handwritten characters on the records are scanned and processed using OCR. However, because many of the scanned characters are not read properly, we must wait for the improvement in the performance of the OCR function. In addition, we have developed Microsoft Excel spreadsheets, on which obesity-related indices, such as body mass index and relative body weight, are calculated. These sheets also provide functions that tabulate the frequencies of obesity in specific groups. Actively using these data and digitalized systems will not only contribute towards resolving physical health problems in children, but also decrease the risk of developing lifestyle-related diseases in adulthood.

The association between free sugars and nutrient intake is unclear in Japanese adults with relatively low free sugars intake. This cross-sectional study aimed to elucidate this relationship using data from the 2016 National Health and Nutrition Survey, Japan, and according to the current World Health Organization (WHO) guidelines for the prevention of nutrient dilution [

ObjectivePrevious studies have associated dietary patterns with diabetes risk in Western countries, but such studies among the Japanese population are scarce. The present study aimed to investigate dietary patterns associated with abnormal glucose tolerance determined by elevated glycated Hb (HbA1c) levels.DesignThe 2012 National Health and Nutrition Survey (NHNS) database was used for the cross-sectional study. Dietary patterns were analysed by factor analysis of twenty-five food items from the dietary intake survey and household-based semi-weighed dietary records. OR and 95 % CI for elevated HbA1c levels (≥6·5 %) according to dietary patterns were estimated using logistic regression models.SettingJapan.ParticipantsThe study population comprised 9550 Japanese aged ≥40 years registered in the nationwide NHNS.ResultsThree dietary patterns were identified: (i) high-bread and low-rice; (ii) high-meat and low-fish; and (iii) vegetable. The high-bread and low-rice pattern, characterised by high frequent consumption of bread, milk and dairy products, and fruits, and low rice intake, was associated with marginally decreased prevalence of elevated HbA1c levels (P trend=0·047). The vegetable pattern, characterised by vegetables, mushrooms, soyabeans and soybean products, was significantly inversely associated with elevated HbA1c levels (4th v. 1st quartile: multivariable OR=0·68; 95 % CI 0·49, 0·95; P trend=0·007).ConclusionsOur findings suggest that the vegetable pattern is associated with decreased prevalence of elevated HbA1c levels among Japanese.

While previous studies have reported the association between food portion size and health outcomes, the association between food seasonings and blood pressure (BP) has not been clarified. This study aimed to investigate the association between the portion sizes of traditional Japanese seasonings and BP. Data on 25,738 Japanese participants (10,154 men and 15,584 women) aged &ge, 20 years registered in the 2012&ndash, 2016 National Health and Nutrition Survey (NHNS) were used for this cross-sectional study. The portion sizes of soy sauce or miso were calculated from the reported weight of soy sauce or miso, and the number of dishes. Regression models were used to estimate BP and prevalence of hypertension, and their 95% confidence intervals according to the portion size of soy sauce or miso. We did not observe an association between the portion sizes of soy sauce or miso and BP. A larger portion size of soy sauce or miso was associated with a higher prevalence of hypertension in the crude model among women, but no significant associations were observed in the multivariate model in both sexes. Our findings suggest that the portion sizes of soy sauce or miso are not associated with BP among Japanese adults.

Little is known about the association between dietary patterns and cardiovascular disease risk factors among Japanese adults based on nationally representative data. This study aimed to explore the association between dietary patterns and hypertension or blood lipid profiles among Japanese people.De-identified Japan National Health and Nutrition Survey (NHNS) 2012 data with a total of 8721 subjects (3524 men and 5197 women) aged 40-74 years were used. Dietary patterns were derived by principal component analysis (PCA). Generalized linear models and multivariate logistic regression analysis were used to assess the relationship between dietary patterns and blood pressure or lipid profiles.We identified four dietary patterns: (a) traditional Japanese, (b) bread-dairy, (c) meat-fat, and (d) noodle patterns. Among these, the traditional Japanese pattern was significantly related to lower blood pressure, lower low-density lipoprotein (LDL)-cholesterol in men and lower high-density lipoprotein (HDL)-cholesterol in women. Bread-dairy pattern was associated with high total cholesterol in women and higher LDL cholesterol in both men and women. Noodle pattern was associated with higher total cholesterol and HDL-cholesterol in men. No significant association was observed between meat-fat pattern and blood pressure or lipid profiles.Our study showed that the traditional Japanese pattern with high intake of miso, soy-sauce, vegetables, beans, potatoes and mushroom conferred benefits on blood pressure. Our findings have indicated clearly that it is possible to provide useful information on healthy dietary pattern for health promotion from the one-day dietary records of the NHNS.

Recent studies have analyzed dietary patterns to assess overall dietary habits, but there have been no studies of dietary patterns among the contemporary Japanese population nationwide. The objective of this study was to identify dietary patterns based on consumption of food items among Japanese adults, and to examine whether these dietary patterns were associated with nutrient intake, demographic characteristics, and lifestyle factors.The study population included 25,754 Japanese adults aged 20 years and older registered in the nationwide National Health and Nutrition Survey database in 2012. Dietary patterns were analyzed by factor analysis of 29 food items from the dietary intake survey and household-based semiweighed dietary records.Five dietary patterns were identified: high-bread and low-rice, high-meat and low-fish, vegetable, wheat-based food, and noodle and alcohol patterns. The lowest quartile of factor scores for high-meat and low-fish, wheat-based food, and noodle and alcohol patterns had higher nutrient intakes, and the highest quartile of factor scores for the vegetable pattern had a higher nutrient intake overall (all p0.01). Dietary pattern scores were associated with demographic and lifestyle factors such as sex, age, region, smoking status, and alcohol intake.Five major dietary patterns among Japanese adults were identified by factor analysis. Dietary pattern scores were associated with differences in nutrient intakes and demographic and lifestyle factors. These patterns were further used for examining the association between Japanese diets and health outcomes.

The relationship between free sugars intake and cardiometabolic risk factors is unclear in Japanese adults. This cross-sectional study aimed to investigate this association using data from the 2016 National Health and Nutrition Survey, Japan. The percentage of energy intake from free sugars was estimated based on the 1-day weighed dietary record data of Japanese men (n = 4071) and women (n = 5794) aged &ge, 20 years. Associations between free sugars intake and cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures, glycated haemoglobin (HbA1c) level and levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, were investigated using linear regression and Dunnett&rsquo, s test, with the lowest category of quartiles as a reference. After adjustment for potential confounding factors, free sugars intake was inversely associated with blood pressures (men only) and HDL-cholesterol level (both sexes) and positively associated with total-cholesterol level (women only) and LDL-cholesterol level (both sexes), whereas no association was observed for BMI, WC, and HbA1c level. This study identified both positive and inverse associations of free sugars intake with cardiometabolic risk factors in Japanese adults.

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women.Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes.Pre-pregnancy underweight was present in24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores7.Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

To evaluate protein and amino acid intakes and distribution among Japanese people in terms of prevention of sarcopenia or frailty.We carried out a cross-sectional study using data from Japan's 2012 National Health and Nutrition Survey. From the original dataset, we selected individuals aged ≥30 years, who were not pregnant or lactating, and for whom dietary intake, bodyweight and body height data were available. Protein intake was calculated using exclusive software developed for the survey. Amino acid intake was calculated using the database created by the National Institute for Longevity Sciences.More than 95% of the participants met recommended levels of protein suggested by the Dietary Reference Intake in Japan. However, nearly half of the participants did not meet recommended levels in terms of prevention of sarcopenia. Leucine intake was not sufficient for each sex and age group, probably because of decreased intake of animal protein, especially protein from milk and dairy products. Distribution of protein and leucine in each meal tended toward dinner.The Japanese population might have insufficient quality, quantity and distribution of protein intake required to prevent sarcopenia or frailty. Geriatr Gerontol Int 2018; 18: 723-731.

Background There is an increasing global interest in the role of Japanese diet as a possible explanation for the nation’s healthy diet, which contributes to the world’s highest life-expectancy enjoyed in Japan. However, nationwide studies on current food intake status among general Japanese population have not been established yet. This study examined the association between food intake patterns and cardiovascular risk factors (CVRF) such as waist circumference (WC), body mass index (BMI), blood pressure (SBP, DBP), HbA1c and blood lipid profiles among general Japanese adults. Methods De-identified data on the Japan National Health and Nutrition Survey (NHNS) 2012 with a total of 11,365 subjects aged 20–84 years were applied. Food intake patterns were derived by principal component analysis (PCA) based on 98 food groups. Generalized linear regression analysis was used to assess the relation between the food intake patterns and CVRF. Results We identified three food intake patterns: traditional Japanese, Westernized, and meat and fat patterns. Traditional Japanese pattern was significantly related to high WC and BMI in men, and high DBP in women. Westernized pattern was associated with lower SBP, but high total cholesterol and LDL cholesterol in both men and women. Meat and fat pattern was associated with high WC, high BMI, high blood pressure and blood lipid profiles in both men and women (trend P

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan's national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Survey items of the Japan National Nutrition Survey (J-NNS) have changed over time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions.We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012. The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others.Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin measurements have been performed continuously for more than 20 years.This is the first report on the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply country-by-country comparisons.背景和目的：日本国民营养普查(J-NNS)项目随时间变化。关于饮食调查的几 篇论文已经发表，但是，到目前为止，还没有关于体检的进一步论文发表。因 此，我们研究了J-NNS 和国民健康和营养普查（NHNS）中体检项目的变化， 为进一步的政策制定提供有用的数据。方法与研究设计：我们总结了从1946 年J-NNS 到2012 年NHNS 体检项目的变化。体检大致分为以下六个部分：人 体测量相关参数、临床测量、身体症状、血液检测、生活方式和药物治疗及其 它。结果：根据总部的建议，早期就已经收集与营养缺乏有关内容，如贫血、 肌腱反射消失和体重测量。从1989 年开始，增加了血液检测和身体活动的测 量，血清总蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、血糖、红细胞 和血红蛋白，已连续检测20 多年。结论：这是J-NNS 更名为NHNS 后的第一 份关于体检的报告。我们的研究结果为研究人员、临床医生和政策决策者使用 J-NNS 和NHNS 提供了基本信息。正确监测当前状态是国民健康促进的必要手 段；也可改善普查方法，从而适用于国与国之间的相互比较。.

Salt reduction is one of the most important lifestyle modifications for the prevention of hypertension. The health promotion law regulates the labeling of the nutrient content of food in Japan and, the level of sodium, not salt (sodium chloride), has to be printed on the labels of manufactured foods. In order to control their salt intake, consumers need to apply a conversion factor to the sodium levels listed on the labels to obtain the salt equivalent. However, it is not known whether people have the knowledge appropriate for making the conversion. We carried out a questionnaire survey at the 7th National Shokuiku (food education) Conference in 2012, asking subjects to determine the salt equivalent of 1000 mg of sodium on food labels. We also asked about the target values of salt reduction in grams in the Dietary Reference Intakes for Japanese 2010 (DRI2010) and the Guidelines for Management of Hypertension 2009 by the Japanese Society of Hypertension (JSH2009). We analyzed the data from 683 respondents (169 men and 514 women); only 13.3% of respondents gave a correct answer for the salt equivalent of 1000 mg of sodium (2.50-2.60 g), whereas 61.8 and 40.4% of respondents chose the correct target values for salt reduction according to DRI2010 and JSH2009, respectively. In conclusion, few people could convert sodium content to salt, which suggested difficulty in using food labels to control their salt intake. Salt content in grams, not sodium content, should be labeled on food packages for effective salt reduction and prevention of hypertension.

The Adequate Intake (AI) values in the Dietary Reference Intakes for Japanese (DRIs-J) 2010 were mainly determined based on the median intakes from 2 y of pooled data (2005-2006) from the National Health and Nutrition Survey-Japan (NHNS-J). However, it remains unclear whether 2 y of pooled data from the NHNS-J are appropriate for evaluating the intake of the population. To clarify the differences in nutrient intakes determined from 2 and 7 y of pooled data, we analyzed selected nutrient intake levels by sex and age groups using NHNS-J data. Intake data were obtained from 64,624 individuals (age: ≥1 y; 47.4% men) who completed a semi-weighed 1-d household dietary record that was part of the NHNS-J conducted annually in Japan from 2003 to 2009. There were no large differences between the median intakes calculated from 2 or 7 y of pooled data for n-6 or n-3 polyunsaturated fatty acids (PUFAs), vitamin D, pantothenic acid, potassium, or phosphorus. When the AI values and median intakes were compared, there was no large difference in the values for n-6 or n-3 PUFAs, pantothenic acid, or phosphorus. Conversely, the AI values for vitamin D and potassium differed from the median intakes of these nutrients for specific sex and age groups, because values were not based on NHNS-J data. Our results indicate that 2 y of pooled data from the NHNS-J adequately reflect the population's intake, and that the current system for determination of AI values will be applicable for future revisions.

A daily mineral supplement is useful for those who are at risk of a deficiency. Some Western reports suggest that mineral supplement users have healthy behaviors and are not mineral-deficient. It is unknown whether the same phenomenon is observed in Japan where there is a different dietary culture. The aim of this study was to examine the characteristics of personal behaviors including food consumption nationwide among mineral supplement users from the National Health and Nutrition Survey in Japan 2003-2010.Data were obtained from 16,275 adults aged 20-59 years who completed sociodemographic, health status, and 1-day household dietary assessments. Supplement users were compared with non-users. Logistic regression models were utilized to identify the characteristics of food consumption and calcium and iron supplement use, using the medium intake group as a reference.Overall, 2.1% and 1.4% of adults reported using calcium supplements and iron supplements, respectively. Calcium supplement users were more likely to be physically active, non-smokers, and eat less fat compared with non-users. Furthermore, they were more likely than non-users to consume a higher intake of calcium from foods such as tea, vegetables, seaweeds, and fruits. Iron supplement users were more likely than non-users to be non-smokers. These individuals tended to have a high intake of seaweeds and fruits.Japanese adults who had healthier behaviors were more likely to use mineral supplements, especially calcium. Mineral supplement users tended to choose healthy foods such as seaweeds and fruits, without considering their overall mineral consumption.背景与目的：每天补充矿物质对有缺乏风险的人是有用的。一些西方的报告表 明：矿物质补充剂使用者拥有健康的行为，并且没有矿物质缺乏。但在有不同 饮食文化的日本，是否也存在同样的现象还不知道。本研究的目的是探讨 2003-2010 年全国健康与营养调查中矿物质补充者食物消费的个人行为特点。 方法与研究设计：从16275 名年龄为20-59 岁完成社会人口学、健康状况和一 天家庭膳食评估的成人中获得资料。补充剂使用者与未使用者进行比较。采用 logistic 回归模型确定食物消费、钙和铁补充剂使用的特点，以中等摄入量组作 为参考。结果：总体而言，分别有2.1%和1.4%的成人使用钙和铁补充剂。钙 补充剂的使用者比不用者更倾向于锻炼身体、不抽烟和少吃脂肪。此外，他们 比不补充者更可能从茶叶、蔬菜、海藻和水果等食物中摄入更多的钙。铁补充 者比不补充者更可能不吸烟，这些人往往摄入大量的海藻和水果。结论：日本 有健康行为的成人更可能使用矿物质补充剂，尤其是钙。不论矿物质补充剂使 用者总矿物质的消费量是多少，他们更倾向于选择海藻和水果等健康的食物。.