Differences in the Values and Related Factors of Eating a Balanced Meal among the Younger Generation in Japan.

This study examined young Japanese adults' values regarding the consumption of balanced meals consisting of staples, main dishes, and side dishes and how these values relate to demographics, socioeconomic status, nutrition knowledge, attitudes, skills, behaviors, and diet-related quality of life. Data were obtained from the "Survey on Dietary Habits of the Younger Generation" (2000 responses, ages 18-39), of which 1888 valid responses were analyzed. The principal component analysis identified three value patterns: PC1-valuable yet burdensome; PC2-environment-reliant, weak initiative; and PC3-low value due to hassle. Both PC1 and PC3 were associated with prioritizing prices in food choices and knowledge of a balanced meal. However, PC1 participants valued balanced meals and possessed meal preparation skills, whereas PC3 participants valued balanced meals less and had negative attitudes toward eating them. PC1 was positively associated with the frequency of eating balanced meals while PC3 was negatively associated. PC2 individuals had positive attitudes toward eating balanced meals but were less concerned about nutritional balance when choosing foods themselves. This study highlights the importance of adopting an approach that aligns with the value patterns of the target population.

[Attempts for salt reduction in workers through specific food service facility guidance by public health center: A case study at a worksite in Kawagoe City, Saitama Prefecture].

Objective　The Kawagoe City Public Health Center implemented a project to reduce salt intake through specific food service facility guidance in workplace cafeterias. Here, we report the study results.Methods　The target worksite was company A, with approximately 270 employees, located in Kawagoe City, Saitama Prefecture. There were 214 participants (approximately 80%). The project was conducted from November 2019 to November 2021. The long-term goal was to decrease the number of hypertensive cases in the city. Project outcomes included decreased salt intake, urinary sodium/potassium ratio, and average blood pressure. The project aimed to improve the cafeteria menu, focusing on salt reduction by offering Smart Meals® and reducing the salt equivalents in all menus. The project output indicators included reduced amount of salt in cafeteria menu items, increased frequency of cafeteria use, increased positive evaluations of the cafeteria, and increased daily awareness of the need for salt reduction. Spot urine samples, blood pressure measurements, and self-administered questionnaire data were collected during annual physical examinations. The amount of salt in the cafeteria menu was evaluated by receiving monthly data from the food service company to which company A outsourced its cafeteria operations.Results　The analysis included 102 individuals with complete data from to 2019-2021. Estimated salt intake (g/day) from spot urine decreased from 10.3±2.1 in 2019 to 9.8±2.4 in 2020 and 9.5±2.0 in 2021 (P=0.003). Systolic blood pressure (mmHg) decreased from 114.7±12.5 in 2019 to 111.7±12.1 in 2020 and 110.6±12.0 in 2021 (P=0.010). Compared to 2019, changes in dietary salt equivalents in cafeteria menus in 2020 and 2021decreased for set meals A and B, curries, and noodles (P<0.001).Conclusion　We offered Smart Meals® and reduced salt equivalents in all workplace cafeteria menus. After 1-2 years, employees' salt intake and blood pressure levels were lower. These results provide implications for the implementation of food environment improvements in public health centers and other local government agencies to promote the Health Japan 21 (third term) strategy.

[Development of a new method for assessing the availability of low-sodium foods in Japan].

Objectives　Food environment improvement involving salt reduction requires improving access to and labeling low-sodium foods. Assessing the implementation status of these measures is also necessary. However, to date, no established methods exist for assessing the availability of low-sodium foods in communities. In this study, we aimed to devise a survey on the availability of low-sodium foods as a community food environment assessment method in order to establish common assessment methods, criteria, and practical measures, as well as standardization nationwide.Methods　A preliminary survey on the availability of low-sodium foods was conducted in Kitakyushu City in four stores with nationwide representation. Consent for providing information on handled product lists was obtained. The on-site lists collected through direct investigation by surveyors were compared with the handled product lists provided by the stores and analyzed to identify survey challenges and examine feasibility and the potential for accuracy. The definition of low-sodium foods, which emerged as a challenge in the preliminary survey, was confirmed. Preliminary survey data were carefully reviewed to establish classification criteria for low-sodium foods and create a low-sodium food list to serve as a reference for on-site surveys. Forms for recording the results of on-site surveys and a survey manual were developed. Registered dietitians conducted on-site surveys using the manual to confirm its applicability.Results　The preliminary survey results revealed that the on-site lists had fewer omissions and greater feasibility than store-provided lists. After clearly defining low-sodium foods, we established classification criteria (three major categories, seven subcategories, and 37 minor categories) considering the ease of on-site investigations and purchases. Three forms for recording survey results were developed, including a standard input form allowing detailed documentation of the availability of individual low-sodium foods, an aggregation form for a quantitative assessment of low-sodium foods availability, and a display form visualizing the availability of low-sodium foods by store. Furthermore, a survey manual was developed explaining the purpose and approach of the low-sodium foods availability survey, definition and classification criteria for low-sodium foods, and the three forms for recording survey results. Findings indicated that all registered dietitians could conduct on-site surveys using the manual and successfully collect and organize data.Conclusion　On-site surveys using the manual and documentation forms enabled easy and accurate assessments of low-sodium foods availability. Thus, this standardized method to assess the availability of low-sodium foods could be a food environment assessment method for regional salt reduction initiatives.

Modelling of salt intake reduction by incorporation of umami substances into Japanese foods: a cross-sectional study.

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

[Relationship between the dietary behavior targets of Health Japan 21 (second term) and perceived food environment and health literacy].

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

Creating a Healthy Food Environment as a Radical Population Approach and Japanese Initiatives.

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

Desirable Diet to Lower the Japanese Nitrogen Footprint: Analysis of the Saitama Prefecture Nutrition Survey 2017.

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

[Changes in dietary behaviors and food-related accessibility issues and information needs during the COVID-19 pandemic: comparison based on household economic status].

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

Determinants of Changes in the Diet Quality of Japanese Adults during the Coronavirus Disease 2019 Pandemic.

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

Effect of workplace dietary intervention on salt intake and sodium-to-potassium ratio of Japanese employees: A quasi-experimental study.

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

Factors Influencing Changes in Food Preparation during the COVID-19 Pandemic and Associations with Food Intake among Japanese Adults.

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

The Association of Body Image Self-Discrepancy With Female Gender, Calorie-Restricted Diet, and Psychological Symptoms Among Healthy Junior High School Students in Japan.

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

[Change in dietary consciousness and its related factors among Japanese adults under the COVID-19 pandemic: Analysis using Dietary Consciousness Scale].

Objectives　This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.Methods　An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (-1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.Results　Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P<0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the "worsening tendency" group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.Conclusion　During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.

[Trajectories of Dietary Variety Score among community-dwelling older Japanese and their related factors].

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

[Consumption of ultra-processed foods and relationship between nutrient intake and obesity among participants undergoing specific health checkups provided by National Health Insurance].

Objective　Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.Method　In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.Result　Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B1, B6, C, niacin, folic acid, potassium, magnesium, and iron intake were significantly lower in the high-UPF group. Moreover, the high-UPF group had a significantly higher BMI. The odds ratio for obesity was higher (4.51[1.50-13.57]) in the high-UPF group than in the low-UPF group (1.00).Conclusion　Those who consumed more UPF had lower protein intake and suffered from multiple vitamin and mineral deficiencies. Furthermore, their energy intake was greater, and the odds ratio for obesity was significantly higher. It has been suggested that excessive UPF consumption warrants further attention.

[Food diversity and its relationship with nutrient intakes and meal days involving staple foods, main dishes, and side dishes in community-dwelling elderly adults].

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

Consumption of ultra-processed foods decreases the quality of the overall diet of middle-aged Japanese adults.

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

[Achievements and Challenges of a Sakado "Shokuiku (Food and Nutrition Education)" Program Implemented in All Elementary and Middle Schools in Sakado-city, Saitama Prefecture].

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

Social marketing including financial incentive programs at worksite cafeterias for preventing obesity: a systematic review.

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

Relationship between rice consumption and body weight gain in Japanese workers: white versus brown rice/multigrain rice.

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.