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Objectives In Japanese nutrition policy, emphasis is placed on healthy food environment improvement through restaurants and other settings by prefectures and cities of cabinet order (cities). This study aimed to clarify the actual status of management implementation by prefectures and cities.Methods A mail survey of 47 prefectures and 106 cities throughout Japan was conducted in October 2020. Management implementation, including the existence of a healthy food environment improvement system (system) for restaurants and other settings, was confirmed. Local governments that had implemented the system were asked about the scope, dissemination efforts, process evaluation, and improvement of the system.Results Of the local governments that responded, 39/42 prefectures (92.9%) and 57/82 cities (69.5%) implementing the system were included in the study. A total of 84.6% of prefectures and 14.0% of cities assessed the nutrient intake of local residents within the past five years. The median number of dietitians in the main office of the department in charge of healthy food environment improvement was two in both prefectures and cities. A target for healthy food environment improvement was set by 69.2% of prefectures and 54.4% of cities. The scope of the system was restaurant meals for 94.9% of prefectures and 100.0% of cities as well as ready-made meals for 87.2% of prefectures and 93.0% of cities. A total of 69.2% of prefectures and 66.7% of cities collaborated internally or with other local governments, while 15.4% of prefectures and 15.8% of cities entrusted system dissemination to external organizations. A total of 87.2% of prefectures and 89.5% of cities assessed the number of registered stores/companies, while 17.6% of prefectures and 21.6% of cities assessed the number of restaurants and other settings in the entire jurisdiction. A total of 33.3% of prefectures and 40.4% of cities established a renewal system, while 71.8% of prefectures and 33.3% of cities improved the system.Conclusion Although underreporting due to the COVID-19 pandemic is possible, in local governments that had implemented the system, few cities assessed nutrient intake, and approximately 50-70% of prefectures and cities set targets for healthy food environment improvement. While approximately 90% of each local government assessed the number of registered stores/companies, those that assessed the number of stores/companies in the entire jurisdiction as a population size were approximately 20%. Approximately 30-40% of each local government has established a renewal system.

The COVID-19 pandemic has caused changes in the family food environment, resulting in more families relying on convenience food options. This study aimed to investigate diet quality by convenience food options (namely instant, frozen, and take-out foods) among Japanese school children during the COVID-19 pandemic. We examined the relationship between the frequency of consumption of convenience food options and nutritional status of the school children. The participants (671 children, 10–14 years old) were chosen to form a nationally representative sample of the Japanese population. Using questionnaires completed by the participants’ guardians, information was collected on the frequency of instant, frozen, and take-out food consumption. Habitual food and nutrient intake were collected using a validated food frequency questionnaire, completed by the children with help from their guardian(s). “Frequent” consumption was defined as consumption of instant, frozen, and/or take-out foods on more than 5 days per week. Using 19 nutrients and their respective dietary reference intake (DRI) values, an index was created to label each child’s nutrient intake as “Adequate”, “Inadequate”, “Excess”, or “Deficient.” Compared to children with non-frequent consumption, school children with frequent instant food consumption had significantly higher rates of inadequate nutrient intake (risk ratio (RR) = 3.0 [95% CI: 1.6–5.6]) and excess nutrient intake (RR = 2.3 [95% CI: 1.3–4.2]), while school children with frequent take-out food consumption had significantly higher rates of inadequate nutrient intake (RR = 2.1 [95% CI: 1.3–3.3]). There were no significant differences for children with frequent frozen-food intake. These associations did not change when adjusting for sociodemographic factors. Our results suggest that the frequent consumption of instant or take-out foods among school children results in non-adequate nutritional intake.

In 2020, a state of emergency (SOE) was enforced by the Japanese government, which included temporary school closures with the aim of overcoming COVID-19 spread, which prevented access to school lunches. We evaluated the relationship between meal quality and guardians' literacy of meal preparation for a nationally representative sample of 1107 Japanese schoolchildren (aged 10-14 years) before, during, and after the SOE on the basis of 7 questions scored using a 5-point Likert scale. The guardians' literacy of meal preparation for children was divided into quartiles, with Q1 and Q4 including participants with the lowest and highest scores on food literacy, respectively. School lunch menu was handed out monthly to each household by their classroom teacher. The consumption of (i) meat, fish, or eggs and (ii) vegetables at least twice a day indicated "well-balanced dietary intake", which was less frequent in all four quartiles, especially for Q1 and Q2, during compared to before the SOE. The relative risk increases (95% CI) were Q1: -40.6% (-41.4% to -39.8%; p 0.001), Q2: -34.0% (-34.7% to -33.3%; p 0.001), Q3: -13.1% (-13.8% to -12.4%; p 0.001), and Q4: -15.3% (-16.0% to -14.7%; p 0.001), adjusted for sex, age, BMI, equivalent income adjusted for the number of household members, and educational level of parents. The interaction p was0.001 for Q1-3 vs. Q4. Guardians with low total scores were significantly more likely to have less time, mental capacity, and financial ability to prepare meals after the SOE. Therefore, schoolchildren's meal quality deteriorated during the SOE, particularly among those with guardians with low food literacy even after adjustment for household income level and guardians' educational level.

In 2020, a state of emergency was declared to control the devastating impact of coronavirus, leading to temporary school closures in Japan, meaning that school lunches were not provided to the majority of schoolchildren. Using questionnaires completed by participants’ guardians, we examined the relationship between household income and the quality of meals in Japanese schoolchildren before, during, and after the state of emergency. Participants (1111 children, 10–14 years old) were chosen to form a nationally representative sample of the Japanese population. “Well-balanced dietary intake” was defined as the intake of (i) meat, fish, or eggs and (ii) vegetables. The desired prevalence was defined as equal to or more than twice a day. Household income was divided into quartiles. “Well-balanced dietary intake” was lower in all households during the state of emergency compared with before. The proportion of those with a “well-balanced dietary intake” at least twice a day was notably low in both Q3 and Q4 during the state of emergency compared with before the declared state of emergency, relative risk increase (95% CI) were Q1: −19.0% (−19.6% to −18.4%), p &lt, 0.001, Q2: −21.3% (−22.1% to −20.6%) p &lt, 0.001, Q3: −25.4% (−26.1% to −24.7%), p &lt, 0.001, and Q4: −34.8% (−35.6% to −34.0%), p &lt, 0.001. The interaction p (vs. Q1) of Q2, Q3, and Q4 were all &lt, 0.001. Guardians from low-income households had significantly higher rates of having less: time, psychological room, and financial position to prepare meals during the state of emergency. Our results suggest that schoolchildren’s quality of meals worsened during the state of emergency, especially in low-income households, because school lunches were not provided.

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

Dietary diversity is an indicator of diet quality. Dietary diversity has been suggested to result in good nutrient intake, but it can affect dietary cost. We examined whether dietary diversity correlates with nutrient intake and monetary diet cost.We used data for 3985 individuals (age range: 20-64 years) from the 2014 Japan National Health and Nutrition Survey (NHNS). Dietary diversity was assessed using the food variety score (FVS; the number of foods) and dietary diversity score (DDS; the number of food groups, range: 1-14). Mean energy and nutrient intake from NHNS, and diet cost from the National Retail Price Survey were compared among FVS quartiles using the Kruskal-Wallis test, and between 2 groups with median DDS using the Mann-Whitney U test.Mean (SD) FVS and DDS per day were 22.3 (7.2) and 9.8 (2.0), respectively. For most nutrients, intake per 4184 kJ was relatively high when FVS was high (p0.001); however, carbohydrate intake was relatively high in the low-FVS group (p0.001). For all nutrients with significant differences, intake was higher in the group with high DDS (≥10). Monetary diet cost was higher in the high-FVS and DDS groups compared with the low groups (p0.001).Intake of a variety of food and food groups resulted in higher intake of various nutrients as well as higher monetary diet cost. Additionally, care should be taken to avoid excessive intake of nutrients such as sodium and SFA that may result from diverse diets.

Background: Evidence for whether the nutrient intakes of Japanese schoolchildren differ according to household income is sparse. Objective: We investigated the role of school lunches for nutrient adequacy among Japanese primary school children using dietary reference intakes in a cross-sectional survey. Design: Participants were 10- to 11-year-old (5th grade) children from 19 public primary schools in four prefectures of East Japan, and 836 children were analyzed. The participants completed 24-h dietary records with photographs of their meals for 4 consecutive days, composed of 2 days with and 2 days without a school lunch. −Children’s household income was obtained from questionnaires that were completed by the participants’ guardians and divided into the following three categories: low (0.2236–2.2361 million yen; n = 319), middle (2.3333–2.8868 million yen; n = 194), and high (3.1305–6.3640 million yen; n = 323). Logistic regression analyses were used to estimate the odds ratios for whether participants had poor nutrient intakes, with adjustment for confounders. Results: On days without a school lunch, the prevalence of nutrient shortages was significantly higher compared with those on days with a school lunch for most macro- and micronutrients among all three levels of household income. Children from low-income households had higher rates of nutrient shortages for vitamin B6, pantothenic acid, K, Mg, P, Fe, and Zn than those from middle-income households on days without a school lunch (P = 0.004, 0.001, 0.001, 0.006, 0.037

Background: Growth retardation is a challenge in Bangladesh. School feeding programs with fortified biscuits have been evaluated in Bangladesh. However, the impacts of a school meal program using local foods on the growth and nutritional status of children have not been investigated. Objective: To determine whether a school meal program (SMP) using local foods with soybean could improve children’s growth and micronutrient status in rural Bangladesh. Methods: Two primary schools were randomly assigned as intervention (SMP; n = 200) and control (non-SMP; n = 200) schools. Children in the intervention school were supplied a school meal with local foods including soybean, containing more than one-third of the recommended daily allowance of energy and nutrients, 5 days/week for 8 months. The attendance rate and school lunch consumption of the children were monitored. Baseline and final anthropometry, hemoglobin and micronutrient status were assessed. Results: There were no significant differences in anthropometric measurements at baseline between the intervention and control groups, but there were differences in the prevalence of anemia, vitamin A deficiency and zinc deficiency. After the intervention, children in the SMP school showed a larger degree of improvement in the height-for-age Z-score (P < 0.001), red blood cell count (P = 0.001) and hemoglobin concentration (P < 0.001) than children in the non-SMP school. However, there were no positive effects on the body mass index (BMI)-for-age Z-score, serum ferritin, serum retinol or serum zinc status among children in the SMP school. Conclusion: A school meal program using local foods with soybean improved the height velocity and hemoglobin concentration of children in rural Bangladesh.

The objective of this study was to identify lifestyle and nutritional factors associated with low BMI in Japanese older adults, with a focus on alcohol energy intake. Cross-sectional study. Participants: Data from 1,093 respondents (711 men and 382 women) to the National Health and Nutrition Survey aged 65 years and older were included in this study. Data were analyzed for associations between BMI and lifestyle, energy, and nutrient intake. Alcohol energy intake was calculated from total energy and participants were categorized into BMI quartiles. Energy-adjusted nutrient intakes were calculated as residuals from a regression model, with BMI as the independent variable and lifestyle factors and nutrient intake as dependent variables. Between-BMI quartile differences were assessed for each sex using multivariate logistic regression analysis. In addition, the nutrient intakes of men consuming more than 280 kcal and less than 280 kcal of alcohol energy per day were compared. Men and women in the lowest BMI quartile had lower total energy intake but higher alcohol energy intake than men in the other BMI quartiles. In multivariate logistic regression analysis, the lowest BMI quartile was associated with total energy (OR: 0.81, p = 0.0310) and alcohol energy intake (OR: 1.22, p = 0.0472) in men. In men, protein, carbohydrate, fat, calcium, iron, and vitamin intakes were less in those that consumed ≥ 280 kcal than in those that consumed < 280 kcal of alcohol per day. Our results demonstrate an association between alcohol energy intake and low BMI in older Japanese individuals.

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.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 (4) with age, region, frailty, annual income, social support, distance to the nearest supermarket and car ownership was analyzed.The prevalence of low DVS was 40.9% for men and 18.4% for women. Frailty and low social support were associated with low DVS. A gradient association with income was found for women, whereas men showed a threshold:1.5 million yen per year was associated with low DVS. The distance to the nearest supermarket was not significantly associated with DVS.The findings of the present study imply that as well as frailty, poor social support and economic disadvantage are associated with a decline in dietary variety. In particular, frail men with income1.5 million yen per year had a high risk of decreased dietary variety. Formal and informal support to secure food accessibility for physically and socially vulnerable older adults should be encouraged. Geriatr Gerontol Int 2017; 17: 2232-2238.

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 (

Salt reduction policies have been implemented throughout the world as well as in Japan. However, most of the current questionnaires for estimating salt intake are apt to be based on empirical evidence. This study was aimed to develop and validate a questionnaire for predicting high salt intake based on salt usage using dietary behaviors that affect salt intake in cooperation with Niigata prefecture, Japan. The study was comprised of 760 participants aged 21 - 79 years (Men%: 49%) living in Niigata. Participants completed a questionnaire about dietary behaviors potentially relevant to salt intake. Second morning voiding urine for estimating dietary salt intake per day was collected on the same day. The relationship of estimated dietary salt intake to answers on the questionnaire was examined using analysis of covariance for age, gender, body mass index, and whether taking medication or not. Ten items on the questionnaire revealed an association with dietary salt intake per day: making oneself gorge on a meal, having ≥2 different staples per meal, having a 1-dish meal, number of simmered dishes per day, variety of pickled vegetables per day, having salt-cured fish eggs per day, quantity of soup consumed when eating noodles, preference for strong-tasting meals, frequency of eating out, and frequency of alcohol consumption.The current study identified 10 dietary behaviors that enabled the development of a salt intake questionnaire for identifying specific dietary behaviors for assessing regions and/or individuals when attempting to encourage salt reduction.

Though it has been reported that in Western developed countries socioeconomic status is associated with non-communicable diseases (NCD), there are sparse evidence from Japan, midst an income gap that has been pointed out in recent years. Therefore, we examined the presence or absence of NCD and the number of comorbidities according to household income in Japanese, using data from the National Health and Nutrition Survey of 2010. 1287 men and 1659 women aged 20 - 79 years from households at 3 income levels (p p = 0.041), and stroke (5.07 [2.04 - 12.60] p < 0.001). Additionally, prevalences of participants with 2 or 3 NCD (hypertension, diabetes, and hypercholesterolemia) were 15.0% and 33.0% in high and low income levels, respectively. A low income could contribute to a high prevalence of NCD and large number of comorbidities among Japanese. Establishing a health policy in Japan is needed to enable an optimal health condition and lifestyle regardless of socioeconomic disparities.

Objectives Evidence is sparse concerning whether the nutrient intake in schoolchildren differs according to parents’ work hours. The aim of this study was to investigate the relationship between parents’ work hours and nutrient inadequacy among Japanese primary schoolchildren using dietary reference intakes on days with and without a school lunch. Methods Participants included 10- to 11-y-old children in grade 5 from 19 public primary schools in four prefectures of east Japan. Data for 699 children were analyzed. Participants completed 24-h dietary records with photographs of their meals for 4 d consecutively, which included of 2 d of weekdays and 2 d of weekends. Their mothers’ and fathers’ work hours were obtained from questionnaires that were completed by the participants’ guardians. Logistic regression analyses were used to estimate the odds ratios for whether participants had poor nutrient intake, with adjustment for confounders. Results Children whose mothers worked ≥40 h/wk had significantly higher rates of nutrient shortages for vitamins A, E, K, and B6, pantothenic acid, potassium, magnesium, and iron (P = 0.007, 0.003, 0.007, 0.023, 0.021, 0.045, 0.004, and 0.009, respectively) than those in the 0 h/wk group. These differences were not significant based on fathers’ working hours, with the exception of vitamin A (≥40 versus 0–39 h/wk, P = 0.032). Additionally, nutrient shortages for children were more pronounced on weekdays than on weekends. Conclusions This evidence revealed the necessity to improve nutrition intake in children whose mothers work more than statutory working hours, which would enable children to have adequate nutrient intake, especially on weekdays.

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.

BACKGROUND/OBJECTIVES: This study aimed to examine the association of Japanese schoolchildren’s involvement in at-home meal preparation with food intake and cooking skill. SUBJECTS/METHODS: We included 1,207 fifth-grade children aged 10-11 years and one parent of each child. A cross-sectional survey was used to collect data on involvement in at-home meal preparation. Correspondence analysis was used to classify involvement in at-home meal preparation into three groups: food-related activities (cooking only or with other activities such as shopping, table-setting, clean up, and dishwashing), non-food-related activities (table-setting and/or clean up), and no (helping) activities. Food intake was assessed using a food frequency questionnaire. Logistic regression models were used to examine involvement in at-home meal preparation associations. RESULTS: The sample consisted of 1,207 fifth-grade children. Vegetable intake was lower in the no (helping) activities group than the food-related activities group (95% CI; boys: 1.2, 5.1, girls: 2.0, 8.9). Fewer children in the non-food-related activities group reported they were able to make a portion of their meals compared with the food-related activities group (95% CI; boys: 1.6, 3.5; girls: 1.5, 3.2). CONCLUSIONS: Children in the food-related activities group showed more favorable food intake and cooking skills than children in the no (helping) activities or non-food-related activities group.

ObjectiveThe present study aimed to examine the association between household income and the intake of foods and nutrients by Japanese schoolchildren, and any differences between days with and without school lunch.DesignThis was a cross-sectional study. Children, with the support of their parents, kept dietary records with photographs for 4 d (2 d with school lunch and 2 d without). The socio-economic status of each family was obtained from a questionnaire completed by the parents.SettingJapan.SubjectsAll students in 5th grade (10–11 years old) at nineteen schools in four prefectures and their parents (1447 pairs of students and parents) were invited to take part in the study; 836 pairs of complete data sets were analysed.ResultsThe average results of four days of dietary records showed that lower income level was associated with a lower intake of fish/shellfish, green vegetables and sugar at the food group level, a lower intake of protein and several micronutrients, and a higher energy intake from carbohydrates at the nutrient level among the children. These associations between income and food/nutrient intake were not significant on days with school lunches, but were significant on days without school lunch.ConclusionsOur study confirmed an association between household income and the amount of foods and nutrients consumed by Japanese schoolchildren, and suggested that school lunches play a role in reducing disparities in the diets of children from households with various incomes.

Previous studies have suggested that self-efficacy, social support, and knowledge are primary psychosocial predictors of dietary behavior in adults. The present study aimed to investigate the associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers.From September to November 2014, a self-administered questionnaire was completed by Japanese workers at 8 workplaces in Niigata, Japan. Self-efficacy and social support for fruit and vegetable consumption were measured using a 3-item Likert scale across particular situations. Knowledge was measured using a single item about the recommended guidelines for fruit and vegetable consumption in Japan. Fruit and vegetable consumption was assessed using a validated, brief-type self-administered diet history questionnaire.Of the 457 respondents, 395 participants' data were analyzed. Scores in self-efficacy and social support showed a significant and positive association with fruit (p0.001, p=0.002) and vegetable consumption (p=0.001, p=0.015). Knowledge was significantly and positively associated with vegetable consumption (p=0.015) but did not statistically differ in fruit consumption (p=0.645).The findings of this study suggest that selfefficacy and social support are positively associated with fruit and vegetable consumption in Japanese workers.

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 study examines the relationship between of food group intake and household income in a representative Japanese population. A total of 11,015 subjects (5,127 men and 5,888 women) aged 20 to 79 years, in 5,475 households who were part of the National Health and Nutrition Survey, Japan, in 2010 and 2011 were analyzed. Dietary intake was recorded for one day in November for those aged one year and older, from 300 randomly selected survey districts. Household income per year was recorded in the questionnaire in three categories: low (2 million yen), middle (2-6 million yen) and high (=6 million yen). Multilevel regression modelling was applied to take into account the hierarchical data structure of subjects nested within households, and households nested within survey districts. Dichotomous variables divided at the median intake of each food group were used. In a model where sex, age, household size and population size of municipalities to which survey districts belonged were adjusted, the total energy intake was found to be highest in individuals from middle income households, and lowest for those from low income households. In models where a total energy intake was additionally adjusted, household members with low and middle incomes had a significantly higher intake of cereals, and a lower intake of potatoes and starches, pulses, vegetables, fruits, mushrooms, fish and shellfish, milk and seasonings and spices compared with those with high incomes. In conclusion, household members with lower incomes in Japan consumed more staple foods, but less vegetable, fruit and fish.

Objective To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias. Design Nonrandomized controlled trial. Setting Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8). Participants A total of 349 Japanese male workers aged 20–59 years, who visited the cafeterias ≥ 3 times/wk. Intervention For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change. Main Outcome Measures Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires. Analysis Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position. Results The difference in the stage of change was not statistically significantly different ( P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group. Conclusions and Implications The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.

Evidence of health disparities has been reported around the world. One of the intermediate factors between socioeconomic status (SES) and health is nutrition. Many studies reported socioeconomically disadvantaged people had more risk of obesity and lifestyle-related diseases than others in western society. Micronutrient intake affected by SES, but little evidence indicates that SES affects either energy intake or the macronutrient composition of the diet in western countries. In contrast, there is not enough evidence of a consistent relationship between SES and nutrition in Asian countries at present. The present status of nutrition disparities in Asia is considered to vary by economic level of the country. For developing countries in Asia, India and Vietnam, SES associates with BMI positively in women. For relatively developed countries in Asia, Korea and Japan, SES associates with BMI negatively in women. Low SES groups consume more carbohydrate, and less protein and fat, so not only micronutrient but also macronutrient intake is affected by SES both in developing and in developed Asian countries. There are some studies on the pathway from SES to diet/nutrition. The association between low SES and obesity may be mediated, in part, by the low cost of energy-dense foods, concern about food price and dietary knowledge. Nutrition policy research is required to reduce nutrition disparities in Asia. We need a collaborative study of the impact of potential political options on diet and on health with other academic fields.

Objective: We conducted a randomized controlled crossover trial to evaluate the effects of a new worksite weight-control programme designed for men with or at risk of obesity using a combination of nutrition education and nutrition environmental interventions. Subjects and methods: Male workers with or at risk of obesity were recruited for this study at five worksites in Niigata City, Japan, of whom 57 were analysed (intervention group, n = 28, mean age 45.5 years; control group, n = 29, 46.0 years). The intervention group received a six-month programme consisting of nutrition education and the provision of healthy cafeteria meals along with nutritional information, which was thereafter repeated in the control group in a crossover design. At six months and one year after programme entry, primary outcome measures including body weight (BW), body mass index (BMI), waist circumference, blood pressure, and blood biochemistry were evaluated. Results: At the one-year follow-up, the intervention group had significantly greater reductions in BW, BMI, and alanine aminotransferase than the control group ( p = 0.017, p = 0.017, and p = 0.860, respectively). Conclusion: The effects of the six-month weight-control programme incorporating nutrition education and nutrition environmental interventions were maintained to the one-year follow-up, resulting in significant differences in relevant parameters between intervention and control groups.