Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study.

BACKGROUND: Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown. METHODS: Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model. RESULTS: In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation. CONCLUSION: The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

[The effect of lunch box provision and mass feeding on energy and nutrient supply at emergency shelters after the Great East Japan Earthquake].

Objectives　Improvement in the quality of meals provided after a disaster is an important issue. We reanalyzed the data obtained from the dietary survey of emergency shelters in Miyagi Prefecture 2 and 3 months after the Great East Japan Earthquake in 2011 to improve the quality of meals at emergency shelters.Methods　We performed a secondary analysis of the data from the dietary survey conducted by the Miyagi prefectural government. Two hundred and forty-one and 49 emergency shelters participated in the 1-day dietary survey in May 2011 and June 2011, respectively. We targeted emergency shelters that had no missing data and provided 3 meals a day. As a result, we targeted 216 emergency shelters in May and 49 in June. We examined the amounts of nutrients (i.e. energy, protein, vitamin B1, vitamin B2, and vitamin C) and food groups (i.e. cereal, potatoes, meat, seafood, eggs, dairy, vegetables, fruits, and fats) in meal portions provided in lunch boxes, rationing, and mass feeding.Results　We found significant differences in the amounts of energy and nutrients in the meals provided at the emergency shelters 2 months after the Great East Japan Earthquake but found no significant differences 3 months after the disaster. The amounts of energy, protein, seafood, and fats were high, and those of vitamins B1 and C, potatoes, and vegetables were low, at the emergency shelters where lunch boxes were provided. The amounts of potatoes, meat, and vegetables were high at the emergency shelters where mass feeding was conducted.Conclusion　Two months after the Great East Japan Earthquake, the provision of lunch boxes at emergency shelters may have increased the amounts of energy, protein, and seafood in meals served to survivors, whereas the amounts of vitamins B1 and C have remained low. These results indicate that providing lunch boxes at an early stage in the event of a disaster can improve energy and protein supply. We believe a combination of lunch box and mass feeding will improve the nutrient supply at emergency shelters.

The effects of changes in the meal providing system on emergency shelter menus following the Great East Japan Earthquake.

Objectives　To assess the improvement of the menus by the meal providing system in emergency shelters, we reanalyzed the data obtained from the dietary survey at emergency shelters in the Miyagi Prefecture one month after the Great East Japan Earthquake in 2011.Methods　We performed secondary use of the dietary survey conducted by the Miyagi prefectural government. In total, 386 emergency shelters participated in the dietary survey of one day in April 2011. We examined the meal providing system (the frequency of meals per day, the frequency of mass feeding for evacuees per day, and menu creators) and the menus at each emergency shelter (260). We classified menus into the following five groups: staple foods, main dishes, side dishes, dairy products, and fruits, and calculated the frequency of provision per day.Results　There was no emergency shelter that provided zero or one meal per day. Compared with the emergency shelters that provided two meals per day, shelters that provided three had a significantly higher provision frequency of staple foods. However, there were no significant differences in the provision frequencies of the other four food groups between the shelters with two or three meals per day. In emergency shelters with a higher frequency of mass feeding for evacuees, the provision frequency of four food groups (staple foods, main dishes, side dishes, and fruits) was significantly higher compared to shelter with a lower frequency of mass feeding for evacuees. Furthermore, in the emergency shelters where dietitians created menus, the provision frequency for two food groups (dairy products and fruits) was significantly higher compared to shelters without dietitians.Conclusion　A high frequency of mass feeding for evacuees resulted in a high provision frequency of main dishes, side dishes, and fruits, which can be limited in supply after a disaster. Also, in the emergency shelters where dietitians created menus, the provision frequency of dairy products and fruits was higher than in those without dietitians. These results suggested that diets in the emergency shelters may be improved by mass feeding and the involvement of dietitians.

Relationships between social factors and physical activity among elderly survivors of the Great East Japan earthquake: a cross-sectional study.

BACKGROUND: Physical inactivity is a health issue that often occurs after serious disaster. Social factors, which can be disrupted by disaster, are important determinants of physical activity levels in everyday living. This study was designed to confirm the association between social factors and physical activity among elderly survivors of the Great East Japan Earthquake. METHODS: From September 2011 to February 2012, 4316 males and females aged 65 or older participated in a health survey of Great East Japan Earthquake survivors. Multiple logistic regression analyses were performed with the dichotomous dependent variable of physical activity (high versus low) and working status, social network, and place of residence (one's own home versus elsewhere) as independent variables. RESULTS: Participants who had been displaced from their homes were more likely to have low physical activity (odds ratio [OR], 95% confidence interval [CI] for men: 1.37, 1.12 to 1.68; for women: 1.30, 1.09 to 1.55). Non-working status was significantly associated with low physical activity (men: 2.03, 1.65 to 2.49; women: 1.94, 1.60 to 2.34). Detriments to the social network were significantly associated with low physical activity (men: 1.71, 1.41 to 2.08; women: 1.79, 1.51 to 2.13). CONCLUSION: Place of residence and social factors were associated with physical activity levels in elderly survivors of the Great East Japan Earthquake. The findings suggest a need for improvement of social factors to encourage increases in physical activity for elderly persons after disaster.

The longitudinal change in physical activity among Great East Japan Earthquake victims living in temporary housing.

OBJECTIVES: This study investigated the longitudinal changes in the physical activity of the Great East Japan Earthquake victims living in temporary housing. METHODS: Thirty-nine residents (10 men and 29 women) living in temporary housing in Kamaishi City, Iwate Prefecture, participated in a health survey in 2012. Among these residents, 31 who also participated in a health survey in 2011 were included in a longitudinal study of physical activity. The physical activity for two weeks after the health survey was measured using a tri-accelerometer. RESULTS: During the one-year period from 2011 to 2012, the median daily step counts changed from 4,959 (interquartile range: 2,910-6,029) steps/day to 4,618 (interquartile range: 3,007-7,123) steps/day. The step counts increased for 18 people (56%). The amount of moderate to vigorous physical activity changed from 13.3 (interquartile range: 7.7-22.4) METs h/week to 16.1 (interquartile range: 6.3-25.2) METs h/week. An increase in daily step counts occurred for 14 out of 21 subjects who were <65 years old (67%) and only 3 out of 10 subjects who were ≥65 years old (30%). CONCLUSION: It was suggested that physical activity levels increased because the interquartile range of step counts moved in the direction of an increase and the median amount of moderate to vigorous physical activity increased. However, increasing support for physical activity in the future is required because the physical activity levels of the Great East Japan Earthquake victims who were living in temporary housing were still low compared to the national and regional averages.

Revision of "Nutritional Reference Values for Feeding at Evacuation Shelters" and Model Menus: A Qualitative Study.

OBJECTIVE: In 2011, the Japanese government issued nutritional reference values for energy; protein; vitamins B1, B2, and C; and salt to deal with poor meal quality in evacuation shelters. Because they were not widely used owing to their impracticality, the authors had examined the values according to the experience-based opinions of public health dietitians. Furthermore, we developed a usage tool containing a model menu that meets these values. This study aimed to confirm the usability of these revised values and model menus and collect ideas for improvement. METHODS: We conducted 8 semi-structured group interviews with 12 dietitians, 9 disaster management officers, and 2 public health nurses in local governments supposed to have been affected by a large-scale disaster. RESULTS: New reference values were highly evaluated by most participants. Interviewees said that model menus were helpful for evacuees or disaster officers who are unfamiliar with nutrition because they show combinations of food items that meet the reference values instead of the amounts of energy and nutrients. To improve their understanding, it was suggested that food items be categorized by staples, main dishes, and side dishes, encouraging them to complete these three components of a balanced diet. Because it was difficult to meet all the reference values in the immediate aftermath of the disaster, it was suggested that the time-dependent priority of each nutrient and model menus that supply the nutrient should be shown by disaster phases along with the assumed availability of utility for cooking in each phase. CONCLUSION: The new reference values were feasible to meet during emergencies. Although model menus were also appreciated, further improvements were necessary for better understanding.

Relationship of living conditions with dietary patterns among survivors of the great East Japan earthquake.

BACKGROUND: During the year after the Great East Japan Earthquake on March 11, 2011, the health conditions and lifestyles of survivors were extensively surveyed. We examined the relationship between living conditions and dietary pattern among survivors. METHODS: A total of 10 466 survivors aged 18 years or older (25% of the population of that age in the area) participated in a survey of Iwate Prefecture. The average frequency of daily consumption of 8 food groups was determined by questionnaire. After excluding staple foods, which were consumed 3 times a day by 85% of participants, factor analysis was performed on 7 food groups among 9789 people (3795 men, 5994 women). RESULTS: Factor analysis identified 2 dietary patterns-prudent and meat. The prudent dietary pattern is characterized by high intakes of fish and shellfish, soybean products, vegetables, fruit, and dairy products and was more evident among older participants and women. The meat dietary pattern is characterized by high intakes of meat and eggs and was more evident among younger participants and men. Age-adjusted multiple logistic regression analyses showed that male and female current smokers and men and women living in difficult conditions were likely to have a lower prudent dietary pattern score; male current smokers and male daily alcohol drinkers were likely to have a higher meat dietary pattern score. CONCLUSIONS: During the year after the earthquake, the prudent dietary pattern was associated with better living conditions among survivors, whereas the meat dietary pattern was not.

[Validity and reproducibility of a physical activity questionnaire used for health surveying among victims of the Great East Japan Earthquake].

OBJECTIVES: This study was performed to assess the validity and reproducibility of a questionnaire on physical activity status used for health surveying among victims of the Great East Japan Earthquake. METHODS: Seventy-four residents (21 men and 53 women) living in temporary housing in Kamaishi City, Iwate Prefecture, participated in this study. The physical activity status questionnaire was composed of 4 questions regarding the frequency of performing domestic and occupational physical activities, the frequency of leaving their residence, walking duration per day, and sedentary time. The physical activity level for 2 weeks was measured using a tri-accelerometer to validate the responses to the questionnaire. Test-retest reproducibility was examined at 2-week intervals. RESULTS: The physical activity levels were 4,521 +/- 2,266 steps/day for men and 4,533 +/- 2,070 steps/day for women. There was a significant difference in step count between those responding differently to the 3 options in the questionnaire regarding average walking duration per day: those who reported walking for > or = 60 min, 30-60 min, or < or = 30 min had step counts of 5,343 +/- 1,757, 4,760 +/- 1,752, and 3,063 +/- 1,772 steps/day, respectively (P < 0.05). When the response options for 3 questions (excluding those for sedentary time) were given scores (a higher score for a higher physical activity level), there were significant correlations between question score and step count (r = 0.486, P < 0.05) and the amount of moderate to vigorous physical activity (r = 0.342, P < 0.05). The test-retest trial showed a moderate degree of reproducibility, with weighted K coefficients of 0.41-0.65. CONCLUSION: Three questions on physical activity levels may allow assessment of an individual's physical activity level, with a moderate degree of reproducibility.

Children's Diet and Nutrition in the Aftermath of the Torrential Rain Disaster in Western Japan: An Evaluation of Support Activities by Dietitians to Alleviate Mothers' Anxieties.

OBJECTIVE: The purpose of this study was to clarify whether the support activities of dietitians during disasters were able to address the problems faced by mothers about their children's diet and nutrition. METHODS: Dietitians (7 in total) and mothers (8) were selected by the snowball sampling method. Semi-structured interviews were used to conduct focus group interviews about children's diet and nutrition. Verbatim data were generated, and an inductively qualitative descriptive analysis was conducted. RESULTS: Six categories were generated for each group. Dietitians responded to problems that mothers had regarding their children's diet and nutrition via 2 activities: [dealing with allergy food shortages] and [school lunch support]. CONCLUSION: It is important for dietitians to recommend stockpiling allergy-friendly foods to accommodate children with allergies and achieve early resumption of school lunches to meet children's nutritional needs.

Validity and reproducibility of food photographic estimation for evaluating meals in evacuation shelters.

Objective: The primary goal was to evaluate the validity of food photographic estimation for nutritional assessment compared with weighed food record (WFR). Methods: We evaluated the validity and reproducibility of photographic estimation of foods provided in evacuation shelters. We analyzed 35 meals served at 12 shelters in Kumamoto Prefecture in Japan, affected by a heavy rain disaster in 2020. In this context, we compared 21 senior students' portion size estimation by food photographs to WFR. In addition, we assigned five meals for each of the 21 senior students, and the same meal photograph was estimated by three students to test reproducibility. Results: No statistically significant difference was detected between the two methods regarding energy, the total grams of meal, the protein, and vitamins B1, B2, and C, except for salt. In addition, the students who never self-cooked underestimated the total grams. Conclusion: Food photographic estimation could simplify the nutritional assessment in evacuation shelters. However, unclear photographs and food items served by weight could weaken the estimation accuracy. According to previous studies and the applied postestimation questionnaire, photographs taken from specified angles and reference food photobooks for portion size estimation may improve accuracy.

Usefulness of Simple Meal Screening Using Dietary Assessment Sheets for Evacuation Shelters.

To maintain the health of evacuees, meals provided at emergency shelters should be monitored and improvement measures should be taken where necessary. Time and human resources are limited during devastating disasters; thus, the authors have developed the Dietary Assessment Sheets for Evacuation Shelters. This study examines whether the quality of meals can be assessed using simple check items on the Dietary Assessment Sheets.A total of 28 Dietary Assessment Sheets for 98 meals provided 16-19 days after the heavy rains in Kumamoto in July 2020 at 12 shelters were used in the analysis. Dietitians working for shelters were requested to fill the Dietary Assessment Sheets and food record sheets provided by the Prefectural Government. If any subitem was checkmarked, it was considered "checked," and if left blank, it was considered "not checked" and divided into categorical groups. Based on the food record sheets and meal photos, contents of energy, protein, and vitamins B1, B2, and C were calculated for each meal. Energy and nutrient contents were compared between the categorical groups.The study revealed that nutritionally poor meals were characterized as those comprising only "Grain dishes," those that were not "Boxed meals," and those involving "Self-Defense Forces," "Dietitians," or "Others." Their energy, protein, and vitamin B1, B2, and C content was significantly lower than that of meals with marks on other checkboxes in the same category.Shelters that provide these meals should be given priority for nutrition assistance due to their poor diets. The results imply that the Dietary Assessment Sheets could serve as a simple tool to determine the shelters that require nutritional assistance.

Meal plans for meeting the reference values using food items available in shelters.

BACKGROUND: We have suggested "Revised Nutritional Reference Values for Feeding at Evacuation Shelters" (Revised RV) as a daily nutritional recommendation for meals served at evacuation shelters where poor diets had been reported. Since there are no meal examples to satisfy the Revised RV, our objectives were, for the future meal provision, to develop nutritionally adequate meal plans using the foods served at shelters in the past and to examine if the Revised RV could be met by changing combination of foods available. METHODS: In this case study using secondary data, we analyzed food weights of 86 meals served and recorded at 12 shelters after the heavy rains in July 2020. We obtained these data from Kumamoto Prefecture that was damaged and asked us dietary assessment for nutrition assistance. Foods were classified into 3 types according to the check mark in the record sheets: food aid (commercial packaged food), boxed meal, and hot meal service. We counted serving frequency of each food and analyzed nutritional differences by their combinations. Menus were devised by choosing foods that were served more frequently or were more nutritious among those served at shelters. The target values for one meal were set at 1/3 of the Revised RV for energy, protein, vitamins B1, B2, and C, and salt. RESULTS: None of the meals served in the shelters satisfied the target. We created 2 menus using food aid only: (#1 curry doughnut, milk with long shelf-life, and orange jelly) and (#2 salmon rice ball, ham and cheese sandwich, and vegetable juice); 1 menu by combination of boxed meal and food aid: (#3 boxed meal and vegetable juice); and 2 menus by combination of hot meal service and food aid: (#4 chicken meatball soup, packaged tofu, soy sauce, preprocessed white rice, and bottled green tea) and (#5 bamboo shoots rice, chicken and vegetable miso soup, and bottled green tea). Planned menus generally contained more energy, protein, and vitamins and less salt than the meals served. Their vitamin C contents were especially higher. CONCLUSION: Nutritionally adequate meals could be planned by changing the combination of foods available in shelters.

Frontiers in Disaster Nutrition: Evidence to Action.

The need for food and nutrition assistance has increased due to the frequent occurrence of disasters and pandemics, such as coronavirus disease 2019 (COVID-19). However, after a disaster, food and nutrition are insufficient in terms of quantity and quality. In the case of the Great East Japan earthquake, the improvement factors for food and nutrition at emergency shelters included 1) emergency shelter size and equipment, 2) provision and content of meals, 3) collaboration among professionals, and 4) cooperation between shelters. However, there were hygiene and oral health problems, and dispatched dietitians had problems with nutrition assistance. The hygiene problems included 1) food, 2) cooking environment, 3) water supply and discharge, and 4) living space. In addition, oral health problems included 1) difficulty swallowing, 2) difficulty chewing, 3) environmental degradation, and 4) degradation of the oral condition. The problematic points of dispatched dietitians included the support provided not necessarily being consistent with needs, operational deficiencies at both the dispatching and receiving sides, and the short period of support. "Enthusiasm" can be a source of encouragement and a burden. To solve these problems, a training system for disaster dietitians and certification systems for disaster food have been established in Japan. Since the Great East Japan earthquake, various kinds of evidence and actions have been taken, and nutritional problems after disasters have gradually improved. Therefore, it seems that advanced actions and standards should be set not only in Japan but also globally.

Similarities between Disaster Food and Space Food.

Disaster and space environments are similar in that they are closed environment, with limited lifelines. Here, we examined the similarity between disaster food and space food, to explore interactive problem-solving of food support for disaster and space environments. The Japan Disaster Food Certification Standards (Japan Disaster Food Society) and the Japanese Space Food Certification Standards (Japan Aerospace Exploration Agency) requirements and certified products, which were posted on the websites as of June 16, 2021, were compared. Certified products were classified into "staple foods," "main and/or side dishes," "milk and dairy products," "fruits," "confectionery and favorite beverages," "condiments," "dietary supplements," and "sets." Certification standards involved six items for Japan Disaster Food and eight items for Japanese Space Food. Most standards were similar. Concretely, both standards demanded room temperature storage, tough packaging and hygiene management in facilities. Both emphasized habitual food and easy eating. However, the best-by date was ≥6 mo for Japan Disaster Food, but ≥1.5 y for Japanese Space Food. In addition, Japanese Space Food required noted nutritious, food hygienic, eatable in space, cookable by specific equipment, endurable pressure by launch, and domestically produced food. There were 171 and 47 products of Japan Disaster Food and Japanese Space Food, respectively. Staple foods (pregelatinized rice, etc.) and main and/or side dishes were commonest among Japan Disaster Foods and Japanese Space Foods, respectively. It is possible to utilize of Space Food as Disaster Food, but there are some issues that must be cleared before "utilization of Disaster Food as Space Food."

Attitudes toward using "Simple simulator for calculating nutritional food stocks in preparation for large-scale disasters" among local governmental personnel and public health dietitians in Japan: An explanatory mixed methods study.

The Japanese Ministry of Health, Labour and Welfare compiled an Excel sheet - "Simple simulator for calculating nutritional food stocks in preparation for large-scale disasters" (Simulator). We examined the level of recognition and use of the Simulator by local governments and identified the points for its improvement. In stage 1, we surveyed local government personnel who participated in the "Workshop for nutrition assistance during large-scale disasters" held in November 2020 (n = 458; 313 responded) with an online questionnaire on the use of the Simulator and associated issues. Stage 2 involved group interviews with 15 public health dietitians who had been involved in food assistance during past natural disasters to identify points for improving the Simulator and the problems with food assistance during natural disasters. In stage 1, 233 responders (74.4%) confirmed their awareness of the existence of the Simulator. While 85 individuals (36.6%) used the Simulator, 63 individuals (74.1%) confirmed that they would use it in the future to plan and evaluate local government stocks. In stage 2, multiple comments regarding the Simulator's applicability and improvement in a realistic situation were collected. In order for the administrative staff in charge of disaster management to understand the nutritional importance of stockpiling main/side dishes, it was suggested that specific combinations of foods that meet the required amounts should be shown and that visualization using food products and the number of people covered by stockpiled foods may be easier to understand than pure nutritional values.

Seven-year incidence of new-onset hypertension by frequency of dairy intake among survivors of the Great East Japan Earthquake.

Survivors of natural disasters are at a high risk of cardiovascular disease. Behavioral risk factors, including modifiable diet, need to be identified. Thus far, the association between dairy intake and new-onset hypertension among these survivors is unknown. Therefore, we investigated this relationship. We conducted a longitudinal cohort study of 4475 survivors of the Great East Japan Earthquake in 2011 who participated in a 7-year follow-up survey. New-onset hypertension was assessed using annual health checkup data. Information on the frequency of dairy intake was obtained using a self-report questionnaire. The hazard ratio for developing hypertension according to the frequency of dairy intake was calculated using Cox proportional hazards regression models. The total number of person-years observed was 20,042, with a median follow-up of 5.4 years. During the observation period, 1554 individuals developed hypertension. The multivariable-adjusted hazard ratios of new-onset hypertension were significantly lower in those who consumed dairy products once per day (0.82, 95% confidence interval 0.71-0.94) and twice or more times per day (0.84, 95% confidence interval 0.71-0.99) than in nonconsumers; the inverse linear trend was marginally significant (P = 0.083). This association was not affected by lipid metabolism and was consistent across subgroups by sex, age, behavioral factors, cardiometabolic factors, and housing type due to the disaster. A higher frequency of dairy intake was associated with a lower risk of new-onset hypertension in community-dwelling survivors of earthquakes and tsunamis. Dietary guidance involving dairy intake could reduce the risk of developing hypertension among these survivors.

Association between the prevalence of hypertension and dairy consumption by housing type among survivors of the Great East Japan Earthquake.

Survivors of the Great East Japan Earthquake in 2011 had higher risks of cardiovascular diseases and hypertension, particularly residents of heavy flooding areas and evacuees. Thus far, the association between the prevalence of hypertension and dairy consumption remains unknown among these evacuees. We investigated this association by housing type after the Great East Japan Earthquake. In this cross-sectional study, we conducted a baseline survey among 9569 survivors of the earthquake, aged ≥18 years, between September 2011 and February 2012. Hypertension was defined as a systolic/diastolic blood pressure ≥140/90 mmHg or as persons undergoing treatment for high blood pressure. The frequency of dairy consumption was determined using a questionnaire. Participants living in prefabricated housing and emergency shelters were regarded as residents of temporary housing. Hypertension was prevalent among 43.8% and 44.7% of the participants in temporary and non-temporary housing, respectively. A logistic regression analysis of the prevalence of hypertension by daily dairy consumption showed that the magnitude of multivariable-adjusted odds ratios differed according to housing type (odds ratio, 0.64; 95% confidence interval, 0.51-0.80 in temporary housing; odds ratio, 0.85; 95% confidence interval, 0.73-0.995 in non-temporary housing; P for interaction = 0.0501). These associations were consistent across subgroups according to sex, age, behavioral factors, obesity, disorders of lipid metabolism, and economic status. A higher frequency of dairy consumption was associated with a lower prevalence of hypertension among community-dwelling survivors of earthquakes and tsunamis, particularly those living in temporary housing. Therefore, dietary therapy involving dairy consumption could help prevent hypertension among evacuees.

Association between Lifestyle Changes and at-Home Hours during and after the State of Emergency Due to the COVID-19 Pandemic in Japan.

Lifestyle changes during the coronavirus disease (COVID-19) lockdown have been previously examined, but there is limited understanding about changes after such restrictions were lifted. This study examines changes in lifestyle habits and body weight among the Japanese population with regard to the length of at-home hours both during (April to May) and after (September) the nationwide stay-at-home request compared to those before the COVID-19 pandemic (January 2020). An online survey was conducted in September 2020 involving 10,000 Japanese survey monitors, selected according to population distribution. During the stay-at-home request, 34% participants extended their at-home hours. More respondents in the group with extended at-home hours experienced an increase or decrease in total physical activity, snacking, food intake, alcohol drinking, and body weight than those in the group with nonextended at-home hours. Some of these changes had a trend according to age. The prevalence of most of these changes decreased when at-home hours returned to normal after the stay-at-home request period; however, increased alcohol consumption and increased or decreased body weight persisted. Our findings suggest that close monitoring for further health outcomes and age-appropriate measures to encourage favorable health behaviors is needed.

Revising "Nutritional Reference Values for Feeding at Evacuation Shelters" According to Nutrition Assistance by Public Health Dietitians Based on Past Major Natural Disasters in Japan: A Qualitative Study.

It is important to provide nutritionally adequate food in shelters to maintain the health of evacuees. Since the Great East Japan Earthquake in 2011, Japan's Ministry of Health, Labour and Welfare has released the "Nutritional Reference Values for Evacuation Shelters" (Reference Values) after every major natural disaster. There is clear evidence, however, that the Reference Values have only been used infrequently. This study aims to revise these guidelines to include the actual situation in the affected areas and the feasibility of the endeavor. This qualitative study uses group interviews with local government dietitians to propose revisions to Japan's Reference Values. These revisions include the following: issuing Reference Values within 1 week of a disaster, showing one type of values for meal planning for each age group, showing the minimum values of vitamins, upgrading salt to basic components, creating three phases of nutrition (Day 1, Days 1-3, and After Day 4), stipulating food amounts rather than nutrient values, and creating a manual. Local government officials could use the Reference Values as guidelines for choosing food reserves, and dietitians could use them while formulating supplementary nutrition strategies for a model menu in preparation for disasters.