Relationship between parents' dietary care and food diversity among preschool children in Japan.

OBJECTIVE: To identify the relationship between preschool children's dietary diversity and parents' care behaviours related to their diet including contents of foods and snacks, mealtime practice and parent-child communication. DESIGN: Cross-sectional study. Data were extracted from the National Nutrition Survey on Preschool Children in 2015 by Japan's Ministry of Health, Labour and Welfare. SETTING: The distribution of food diversity score (FDS) (maximum of eight points) was confirmed. The participants were divided into higher (≥4 points) and lower (≤3 points) food diversity groups. A comparison between the two groups examined parents' socio-economic status, children's health and living conditions, and parental care concerning children's diets (thirteen items). A multiple regression analysis was performed relating FDS to the factors of parental socio-economic status and child health, and a logistic regression analysis was conducted to identify factors of parental care related to the higher food diversity group. PARTICIPANTS: 2143 persons from households with children aged 2-6 years. RESULTS: Parental care concerning children's diets was the factor most strongly associated with children's FDS. Those factors most strongly associated with higher food diversity were nutritional balance of foods (OR: 1·76; 95 % CI 1·44, 2·16; P < 0 0001), snack contents (OR: 1·41; 95 % CI 1·07, 1·86; P = 0·014) and regular mealtimes (OR: 1·30; 95 % CI 1·08, 1·55; P = 0·005). CONCLUSIONS: The findings indicate the importance of parents paying attention to the contents of children's foods and snacks, ensuring that children eat regularly, and increasing the diversity of their diets.

Parent-child cooking meal together may relate to parental concerns about the diets of their toddlers and preschoolers: a cross-sectional analysis in Japan.

BACKGROUND: Parents often have concerns about the food habits of their young children. Cooking is a frequent behavior related to dietary activities at home. We hypothesized that "a parent cooking meals together with young children might alleviate dietary concerns." The aim of this study was to identify the relationship between parental cooking practices (e.g., cooking meals together with the child) and diet-related concerns. METHODS: Data were extracted from the "National nutrition survey on preschool children" conducted among nation-wide households with toddlers and preschoolers in 2015 by the Ministry of Health, Labour and Welfare of Japan. Parents were classified into two groups comprising those who cooked meals together with their children and those who did not. The following variables were compared: taking too much time to eat (slow eaters), "picky" eating (eating only certain foods), inconsistent food intake (eating too much or too little), playing with food/utensils while eating, preferring sweetened beverages and snacks over meals, eating too fast to chew well, not swallowing food, disinterested in eating, and spitting out food. The associations between parent-child cooking meals together and the concerns pertaining to the child's dietary habits and food intake were analyzed and compared between the two groups. RESULTS: The concerns of "picky eating" and "playing with food/utensils while eating" were lower, while "eating too much" was higher in the parent-cooking together group. The intake frequency of fish, soybeans/soy products, vegetables, and milk among children were higher in the "cooking together" group than among those in the "not cooking together" group. Children in the "cooking together" group consumed a significantly greater variety of foods than those in the "not cooking together" group. CONCLUSIONS: Cooking a meal together with a child may be related to the parent's lower concerns about the dietary habits of the child, including "picky eating" and "playing with food/utensils while eating," but may also be related to the higher concerns of "eating too much."

[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.

Multi-professional meetings on health checks and communication in providing nutritional guidance for infants and toddlers in Japan: a cross-sectional, national survey-based study.

BACKGROUND: Health personnel must provide continuous support in response to problematic results from health checks of infants and toddlers (hereinafter "infant[s]"). Among this support, it is important for health personnel to provide nutritional guidance to families as a collaborative effort between the staff from multiple disciplines and community organizations. This study aimed to clarify the factors affecting collaboration with community organizations in providing nutritional guidance to families following health checks for infants in Japan. METHODS: The design of this study consisted of a cross-sectional, multilevel survey. A self-administered questionnaire was mailed to all municipalities (1741 towns and cities) in Japan to be completed by the person responsible for nutrition advice. The research was performed in August 2015. We obtained 988 valid responses (response rate of 56.7%). To identify the factors that affect the collaboration with community organizations in providing nutritional guidance, we determined how municipalities responded to infants needing support (five items), how municipalities evaluated health guidance (five items), the number of distributed maternal and child health handbooks, and the number of infants who received follow-up evaluations. RESULTS: The results of multivariate analyses showed that the factors related to successful community collaboration in providing nutritional guidance included holding a multi-professional staff meeting after health checks (post-conference; odds ratio [OR], 2.34; P = 0.001); following up children suspected of having developmental and mental disabilities or delays before entering elementary school (OR, 1.77; P = 0.0004); and considering dental caries data from dental checkups in providing health guidance (OR, 1.56; P = 0.003). CONCLUSIONS: Holding a multi-professional meeting after infant health checks (post-conference) was strongly associated with community collaboration in providing nutritional guidance for infants.

[Association of vegetable intake with dietary behaviors, attitudes, knowledge, and social support among the middle-aged Japanese population].

Objectives Increasing vegetable consumption is one of the health objectives of "Healthy Japan 21" (2nd phase). To ensure this goal is met, the various factors related to vegetable consumption must first be clarified. Thus, this study considered vegetable consumption, dietary behaviors, attitudes, knowledge, and social support among middle-aged Japanese subjects.Method Data (2 days of maintaining a food diary and a questionnaire) of 384 respondents aged 30-59 years from the 2011 Saitama Prefectural Health and Nutrition Survey (men: 165, women: 219) were used. Their average volume of vegetable consumption was 250.2 g/day (standard deviation: 119.8), which was significantly lower than the 350 g/day goal of "Healthy Japan 21" (2nd phase); therefore, the threshold for this study was set at 300 g/day. For logistic regression analysis, vegetable consumption greater or lower than 300 g/day were defined as dependent variables; social support, attitudes, knowledge, and dietary behaviors as independent variables; and age, household composition, and household income were adjusted.Results The adjusted odds ratio (AOR) was significantly higher for those whose vegetable consumption was over 300 g/day. Dietary behaviors including an average of 2 or more meals per day including grain, vegetable, fish, and meat dishes and the analysis of subjects' food records revealed an AOR of 2.52 and a 95% confidence interval (CI) of 1.18-5.39 for men who had 2 or more meals per day. For women, the AOR was 4.06, and the 95% CI was 2.18-7.53. Significant relationships were observed among the following items in male respondents: attitude category: "self-efficacy in consuming 5 or more vegetable dishes per day" (AOR was 2.74, 95% CI was 1.30-5.79); knowledge category: "obesity prevention effectiveness" (AOR was 3.48, 95% CI was 1.24-9.78); and social support category: "support for good health and dietary life from family and surroundings" (AOR was 4.46, 95% CI was 1.47-13.54). Significant relationships were observed among the following items in female respondents: dietary behaviors category: "frequency of cooking meals" (AOR was 2.83, 95% CI was 1.02-7.87); and knowledge category: "being able to grasp the appropriate volumes and balance of foods when preparing meals for self" (AOR was 2.44, 95% CI was 1.30-4.56).Conclusions These results suggest that to increase middle-aged people's vegetable consumption, promoting adequately healthy meals is more important than both the dissemination of knowledge regarding the target vegetable quantity and enhancing of only vegetable consumption.

A Review on Eating Together and Its Health, Diet, and Lifestyle Influences among Japanese.

To discuss the importance associated with eating together for the Japanese population based on recent research evidence, we conducted a systematic review on eating together and eating alone in relation to health, diet, and lifestyle. In this review, we defined "eating together" as eating meals together with other people, not limited to family members but friends, relatives, or neighbors. Articles published between 2000 and 2018 were accessed using domestic and international databases (Igaku Chuo Zasshi, CiNii, J-STAGE, PubMed, Scopus, and Eric). After screening titles, abstracts, and full texts, 62 articles matching the criteria were included in the review. Most articles were cross-sectional studies. Target populations included preschool children (n=8), school-aged children through university students (n=34), and adults and the elderly (n=20). Although definitions of "eating together" differed by the studies, the most used indicator was "frequency of eating together," with whom eating meals together being "family," and the targeted meals were "breakfast and dinner." Having either eating together occasions or few eating alone chances were more likely to associate with better quality of life, subjective health, food intake and balanced diet, dietary behavior, and life rhythm across the life course.

Mealtime Regularity Is Associated with Dietary Balance among Preschool Children in Japan-A Study of Lifestyle Changes during the COVID-19 Pandemic.

The novel coronavirus-19 (COVID-19) pandemic has considerably impacted children's lives. The aim of this study was to determine whether the pandemic affected mealtime regularity among preschool children and whether maintaining regular mealtimes or changes in mealtime regularity during the pandemic were related to dietary balance, including chronological relationships. This online cross-sectional survey involving individuals registered with a company that provides meals to children aged 2-6 years was conducted in February 2021. Using a 40-point scale, a healthy diet score (HDS) was developed to evaluate children's dietary balance. The participants were divided into four groups based on their responses, and multiple regression analyses were performed with the HDS as the dependent variable. Maintaining regular mealtimes was associated with practices such as waking and going to bed earlier, less snacking, and eating breakfast every day. Even after adjusting for basic attributes, lifestyle habits, household circumstances, and other factors, regular mealtimes were still positively correlated with the HDS. These findings indicate that maintaining regular mealtimes is associated with higher HDS scores and better lifestyle habits. Furthermore, as the changed HDS was higher in the group whose mealtimes became regular during the pandemic, adopting regular mealtimes may lead to a more balanced diet.

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.

Variables of the Theory of Planned Behavior are associated with family meal frequency among adolescents.

OBJECTIVE: To examine associations between Theory of Planned Behavior variables and the family meal frequency. METHODS: Fifth-through seventh-grade students (n = 236) completed a self-administered questionnaire in their classrooms. The relationships between Theory of Planned Behavior variables (intention, attitudes, subjective norms, and perceived behavioral control) and family meal frequency were examined with Spearman correlations and multiple logistic regression analysis. RESULTS: Positive intention, positive subjective norm of family eating together, and lower perceived difficulty of making time increased the odds of adolescents having family dinners at least 5 d/wk compared with adolescents having family dinners 2 days or fewer per week. Positive intention and lower perceived difficulty for making time increased odds of having family breakfasts at least 5 d/wk. CONCLUSIONS AND IMPLICATIONS: To increase family meal frequency, nutrition educators are encouraged to focus on increasing intention, creating positive norms about the family meal, and reducing perceived barriers caused by time conflicts.