[An examination of relevant factors attributable to child health, food behavior, and lifestyle concerns of parents with infants aged at least 18 months: With a view to expanding into Shokuiku (food and nutrition education)].

Objectives　This study focused on food after weaning and examined the children's diet and home environmental factors that influence parents' concerns during health checkup for infants (aged 1.6 and 3 years).Methods　In the analysis, 646 participants, excluding invalid responses, who cooperated with the survey during health checkup for 1.6- and 3-year-old in the Tohoku, Chubu, and Chugoku regions from March 2019 to January 2020, were included. The survey included 56 items of dietary, lifestyle, and health concerns (yes/no answers), child attributes, and frequency of food intake (six options, 18 types). Concern factors were extracted by factor analysis. The association between the worry scores and each factor was analyzed.Results　The 1.6- and 3-year-olds were associated with high scores for (health awareness and lifestyle) and low fruit intake, high salty snacks intake, and low subjective economic status, high scores for (diet content and atmosphere) and low intakes of carotene-rich vegetables, other vegetables, seaweed, and fruits, high scores for (interest and motivation in food) and low carotene-rich vegetables intake, high scores for (food experience and behavior) and high cereals (bread) intake, low subjective economic status. The 3-year-olds were associated with high scores and being boys.Conclusion　We extracted four worry factors that parents with children after the weaning period have and clarified the factors related to each factor and group characteristics.

Gap between the concerns of healthcare professionals and parents' perceptions regarding dietary habits for 18-month- and 3-year-old children in Japan.

BACKGROUND: A gap has been reported between healthcare professionals' (hereafter "professionals") recognition of preschool children's diets and parents' perception of concern. This study investigated the gap between the concerns reported by professionals and parents' perceptions regarding health and dietary habits by age (18 months and 3 years) and gender in Japan. METHODS: The study design consisted of a cross-sectional, multilevel survey. The request letters were sent to all households with target children with the cooperation of local governments. After obtaining written informed consent from parents, questionnaires were distributed to them. The survey included 30 items on children's concerns about health and dietary habits. At the health checkup, parents indicated whether they were concerned in response to each item, and responded child's height and weight and birth height and weight. Next, the professionals provided counseling to the parents at a health checkup. After that, the professionals noted their concerns in response to the same 30 items as those given to parents. The participation rates were 82.9% (18 months) and 82.8% (3 years). Data of 239 persons for 18 months and 223 persons for 3 years old were analyzed. In the statistical analysis, the items that were judged as concerning by professionals but not by parents were identified; likewise, the items that were of concern to parents but not to professionals were identified. Sensitivity, false negative rate, specificity, false positive rate, and Youden index were calculated to analyze the discordance rate for each item. RESULTS: Many parents in this study were concerned about the issues that professionals did not consider to be concerning. Moreover, the parents worried about more issues for 3-year-olds than for 18-month-olds. The items for which ≥ 10 professionals indicated concerns and with higher discordance between the professionals and parents for both boys and girls were "picky eating" for 18-month-olds and "inconsistent amount of food" for 3-year-olds. CONCLUSIONS: The concerns that professionals have with respect to children's diets and the things that parents worry about show gaps. It might be necessary to provide professional counseling for parents to develop a correct understanding of their children's dietary habits.

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.

[Analysis of sweet snack eating habits and lifestyle using a health check for toddlers].

Objectives　In Japan, medical questionnaires on diet and lifestyle are administered during health checkups for children. Since the rate of health checkup participation is high, the information obtained from these questionnaires can be used for regional diagnoses. In this study, we evaluated the relationship between sweet snack eating habits (SSEHs) and lifestyle habits in toddlers using data from the questionnaires.Methods　This study was conducted across 35 municipalities in Aichi Prefecture, Japan, where individual toddlers can be tracked at medical examinations at the age of 1 year 6 months (18 m) and 3 years (36 m). The subjects were 18,251 toddlers (9,393 boys [51.5%]) who participated in the health checkup in the same municipalities at 18 m in 2013 and 36 m in 2014-2015. Subjects were divided into four categories based on their SSEHs at 18 m and 36 m: N-N (no SSEH at either 18 m or 36 m); Y-N (no SSEH at 36 m only); N-Y (no SSEH at 18 m only); Y-Y (SSEH at both 18 m and 36 m). Other lifestyle habits were divided into two levels: good habits and bad habits. A multinomial logistic regression analysis was performed using the SSEH category as the dependent variable and lifestyle as the independent variable. The control groups were the Y-Y category and bad habit for the dependent and independent variables, respectively.Results　The proportions of N-N, Y-N, N-Y, and Y-Y subjects were 27.7%, 8.6%, 24.1%, and 39.6%, respectively. At 18 m, 48.2% toddlers had an SSEH, which increased to 63.7% at 36 m. Most toddlers (82.2%) had a habit of sweet snacking at 18 m and habitually consumed sweet snacks at 36 m. The absence of nursing at bedtime at 18 m was positively associated with the N-N group (odds ratio [99% confidence interval]=1.25 [1.11-1.41]) and the Y-N group (1.28 [1.07-1.52]); however, no association was found with the N-Y group (0.99 [0.88-1.11]). Parental finish polishing at 18 m tended to show a positive association only with the N-N group (1.10 [0.99-1.23]).Conclusion　Nearly half of toddlers had SSEHs by 18 m, and most of them continued to have the habit at 36 m. Oral hygiene behavior at 18 m was associated with SSEHs of toddlers up to 36 m. A regional diagnosis using the results of the health checkup for children is useful for identifying factors related to health problems.

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."

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.

[Relationship between dietary diversity and food access among elderly living alone in Saitama Prefecture].

OBJECTIVES: To examine the relationship between dietary diversity and food access among elderly living alone. METHODS: In September 2013, a cross-sectional study using a self-administered questionnaire was conducted with 4,348 elderly aged 65-89 years, living in A city in Saitama Prefecture. The subjects answered about their health conditions, frequency of food consumption, difficulty of food store access, social support, food preparation, and so on. The response rate was 59.6%. The dietary diversity score (DDS) was calculated as the number of food groups consumed in a day (0 to 10). The DDS was validated by its association with independence and health status of the elderly. As indicators of food access, objective food access was measured using a geographic information system (GIS), and subjective food access was measured by the questionnaire. Responses of 1,043 subjects (452 male and 591 female) were analyzed after excluding those who live with others in an actual household composition. We classified the subjects into two groups according to the DDS: low group (three or less) and high group (four or more). Multiple logistic regression analyses were conducted using the DDS groups as the dependent variable, and subjective food access and other factors as independent variables, adjusting for age, income, subjective economic status, education, and frailty status. RESULTS: The number of subjects in each group were as follows: low=107 (23.7%), high=345 (76.3%) for males, high=263 (44.5%), low=328 (55.5%) for females. A multiple logistic regression analysis showed that the difficulty in subjective food store access was associated with a low DDS in males [OR=4.00, 95% CI (1.36-11.82)] as well as in females [OR=2.24, 95% CI (1.11-4.51)]. Further, for females, social support and preparation of supper by oneself were significantly associated with their DDS. No significant relationships were found between objective food store access and DDS in both males and females. CONCLUSION: The DDS was strongly associated with subjective food store access among the elderly living alone. For females, social support and meal preparation skills were also suggested as important factors affecting their DDS.

Aging-related changes in protein and fat intake and their related meal types factors by longitudinal birth cohort analysis using the National Health and Nutrition Survey in Japan from 2001 to 2019.

BACKGROUND: To provide seamless nutritional support from early adulthood to late adulthood in Japan, this study aimed to identify aging-related changes in protein and fat intake and meal types. METHODS: Birth cohort analysis was conducted in this study. The protein intake, protein-to-energy ratio, fat intake, and fat-to-energy ratio in men and women from their 20s to 60s in 2001 was calculated using the data of the National Health and Nutrition Survey in Japan between 2001 and 2019 (n = 139,876, 47.0% men, mean age: 54.9 and 55.4 years for men and women, respectively). The intakes were calculated for every subsequent year, the aging-related changes were identified by age group, and the 99 food groups were classified into staple-focused meal types through factor analysis. The weighted average component value per 1 g of each food group was calculated, multiplied by the food weight, and totaled to determine the mean intake by meal type and to confirm the aging-related changes. The year when the slope changed before and after was identified through Joinpoint regression analysis. RESULTS: The protein intake, protein-to-energy ratio, fat intake, and fat-to-energy ratio initially declined or remained unchanged with aging in almost all generations (20s to 60s in 2001) but began to increase after 8-15 years. The food groups were classified into rice, noodle, and bread types. The protein and fat intake from the noodle type initially showed a decreasing trend but began to increase with aging after 8-15 years in almost all generations in both sexes (p < 0.05 for difference in slope). CONCLUSIONS: The increase of protein intake and protein-to-energy ratio and fat intake and fat-to-energy ratio over time observed among Japanese adults may be related to the increased intake of food groups from noodle type meals. Thus, considering the type of staple food (i.e., rice, noodles, or bread) and its combination with other foods when adhering to a balanced diet is necessary.

Trend of estimated participation rate by regional block, gender, and age group in the 1997-2019: National Health and Nutrition Survey in Japan.

This study aimed to identify the trend of approximate participation rate in Japan's National Health and Nutrition Survey (NHNS_J). The proportion of participants among all residents of surveyed districts (estimated participation rate: EPR) was calculated by 12 regional blocks, gender, and age group, and the trend and annual percent change (APC) were clarified. Based on the 1997-2019 NHNS_J data, we created a database classified by prefecture, gender, and age group; in addition to these, the number of people per household by Population Census or population estimates were obtained from e-Stat and added to the database. All analyses were performed by regional block and gender and EPR for each year was calculated by the age group. Trends of EPR, overall and by the age group, were presented using graphs, illustrating the exponential regression curve. The graphs showed APC, standard error, and statistical significance by age group. The EPRs were declining in all the regional blocks. Additionally, the rates of decline in APC in young people under the age of 50 years were higher than those in the older age groups in 9 of 12 regional blocks. The nationwide APC in the age group <50 years was significantly larger than that in the age group ≥50 years. The declining EPR trend in NHNS_J in all regional blocks (especially among younger people) suggests the need for a strategy to improve participation rates in the future.

Validation of Dietary Intake Estimated by Web-Based Dietary Assessment Methods and Usability Using Dietary Records or 24-h Dietary Recalls: A Scoping Review.

The goal was to summarize studies comparing the accuracy of web-based dietary assessments with those of conventional face-to-face or paper-based assessments using 24-h dietary recall or dietary record methods in the general population. Using two databases, mean differences and correlation coefficients (CCs) for intakes of energy, macronutrients, sodium, vegetables, and fruits were extracted from each study independently by the authors. We also collected information regarding usability from articles reporting this. From 17 articles included in this review, the mean dietary intake differences in the web-based dietary assessment compared to conventional methods, were -11.5-16.1% for energy, -12.1-14.9% for protein, -16.7-17.6% for fat, -10.8-8.0% for carbohydrates, -11.2-9.6% for sodium, -27.4-3.9% for vegetables, and -5.1-47.6% for fruits. The CC was 0.17-0.88 for energy, protein, fat, carbohydrates, and sodium, and 0.23-0.85 for vegetables and fruits. In three out of four studies reporting usability, more than half of the participants preferred the web-based dietary assessment. In conclusion, % difference and CC of dietary intake were acceptable in both web-based dietary records and 24-h dietary recalls. The findings from this review highlight the possibility of wide-spread application of the web-based dietary assessment in the future.

[Study on difficulties and solutions of activities according to dispatch type of dietitians in Japan Overseas Cooperation Volunteers].

OBJECTIVE: The objective of the study was to identify differences in the content and difficulty of activities according to dispatch type (new volunteer or successor) of dietitian Japan Overseas Cooperation Volunteers (JOCV) and to analyze their support needs. METHODS: A questionnaire was distributed concerning the dispatch type, the activities' contents, and the difficulties of all ex-JOCV dietitians in 2007. A total of 66 members provided responses. RESULTS: Activities involving nutrition education for community residents were greater among new volunteers compared to successors, whereas the management of clinical nutrition in hospitals was greater in the successors. The difficulties of both types of volunteers were related to acquiring their positions, coordinating activities, and offering services based on the values and lifestyles of the peoples. The rate for volunteers with local counterparts was significantly smaller among new volunteers. Both types refered to advice in books to overcome their difficulties. It will be necessary to develop effective books to support JOCV dietitians. CONCLUSION: The study identified differences in the content and the difficulty of activities according to the volunteer dispatch type and provided information on support needs for dietitians in the JOCV.

The relationship between individual and environmental factors related to health, nutritional status, and diet in elderly people living alone in Japan.

Aging is an essential milestone that governments worldwide must plan for. At a global level, Japan currently has the highest share of population older than 65 years. Thus, the Japanese experience may be a useful guide to other countries as they consider their policies. Elderly individuals living alone encounter many challenges typically not faced by those living in a multiperson household. Nutrition status and diet are 2 such challenges, both of which are crucial determinants of health and well-being. The health and nutrition statuses as well as some other factors in elderly individuals living alone in Japan were investigated. The identification of the factors relating to food diversity, social relationships, and physical ability, among others, indicates, as hypothesized, that the relationship between individual and environmental factors is associated with the health, nutritional statuses, and diets of elderly people living alone. The findings and approach may be useful to scholars and policy makers in significantly aging societies like Japan as well as other societies experiencing population aging.

Possible Measures to Improve Both Participation and Response Quality in Japan's National Health and Nutrition Survey: Results from a Workshop by Local Government Personnel in Charge of the Survey.

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

Difference and Variance in Nutrient Intake by Age for Older Adults Living Alone in Japan: Comparison of Dietary Reference Intakes for the Japanese Population.

This study aimed to estimate the distribution of usual intakes in protein, sodium, potassium, and calcium by age group and assessed whether proportions of deficiencies/excesses of each nutrient would occur more in older age via a comparison with the dietary reference intakes for the Japanese population (DRIs_J). A cross-sectional analysis was conducted using a database of the 2-day nutrient intake of 361 Japanese people aged 65-90 years. The AGEVAR MODE was used to estimate usual intake. Percentile curves using estimated distribution by sex and age and usual nutrient intake were compared to those of the DRIs_J. The usual intake of protein (male and female) and potassium and calcium (female) were lower with older age. Within-individual variance of protein in female (p = 0.037) and calcium in male (p = 0.008) subjects were considerably lower with older age. The proportion of deficiencies in protein (male and female), potassium (female), and calcium (female) were higher with older age. However, the proportion of people with excess salt (converted from sodium; male and female) did not differ by age. The variances found herein could be important for enhancing the understanding of differences in dietary intake by age.

Study of the Relationship between Body Mass Index, Body Image, and Lifestyle Behaviors: A Community Survey in Fiji.

INTRODUCTION: Public health promotion efforts aimed at overweight and obesity prevention often proceed from the premise that the first step should be losing weight. Appropriate perceptions of body image may be important for improving weight loss awareness. Therefore, we aimed to examine the relationship between body mass index and body image perception in Fiji, where increasing obesity is currently the most important health-related issue. METHODS: Using the resident register based on the governmental census, one household member, aged between 18 and 69 years, was randomly selected from each household in two areas. There were 1,014 participants in the study. The questionnaire items were related to body image, dietary behaviors, physical activity, smoking habits, and alcohol consumption habits. Moreover, information regarding height, weight, blood pressure, and hemoglobin A1c were measured, and questions about social status (age, ethnicity, education, marital status, and employment), and subjective living status were asked. A multivariate logistic regression analysis was performed to analyze the relationship between body mass index (BMI) and body image perception. RESULTS: Data from 391 men and 537 women were analyzed. Men within higher BMI quartiles smoked less (p = 0.0004) and drank less alcohol (p = 0.042). Women in higher BMI quartiles engaged in less physical activity (p = 0.022). Among the assessed data, both men and women in the higher BMI quartiles underestimated their body image compared with their actual physique (p < 0.0001). The higher BMI was associated with underestimated body image (men: odds ratio [OR] = 3.22, 95% confidence interval [CI], 1.94-5.35; p < 0.0001; women: OR = 18.11, 95% CI, 10.10-32.47; p < 0.0001). CONCLUSIONS: Higher BMI is strongly associated with underestimated body image among Fiji residents. Health-related counseling should be included within programs that aim to increase recognition of one's actual physical size.

[Informational approach to radiology department by end user computing].

In recent years, due to the advanced computerization of medical institutions, systems such as radiology information system (RIS) and reporting have been used extensively also at radiology departments. However, the introduction of these systems will need a great amount of money, and the systems are not yet introduced in our hospital. On the contrary, thanks to the sophistication and price reduction of personal computers (PCs), there is now found a rapid expansion of end user computing (EUC) in which users of a system actively build and manage the system of their duties. Under these circumstances, in order to assist the duties at low costs, we worked the computerization of duties done at our Radiology Department by using the EUC. Specifically, we used software of general-purpose database to build the system with functions dealing with records on implementing medical examinations and treatments, examination booking and diagnostic imaging report. This system which has been developed according to details of conventional duties and requests from medical personnel makes it possible to alleviate the duties which were done manually.

[Processes of sharing issues among participating groups in the form of a food and nutrition education network: the case of the "S Network"].

OBJECTIVE: To review processes of sharing issues among participating groups in the form of a food and nutrition education network and elucidate how organizations develop commitment and how individuals change their attitudes. METHODS: (1) Process regarding the form of a food and nutrition education network: After discussions by administrative public health nutritionists at public health centers and meetings with faculty members at J University, we encouraged three groups to participate in a network to share information on food and nutrition issues and gave them opportunities to interact with each other. Group A primarily provided food and nutrition information, group B primarily provided foods, and group C provided both. Specifically, these activities included two open community programs and eight volunteer activities. In the first open community program, they identified capacity to be developed through food and nutrition education and volunteers explored possible cooperation among organizations on the basis of the categorization and classification of issues. To provide feedback on the results, a workshop was held during the second open program. (2) Analysis of the process: We documented organizations involved in the form of a food and nutrition education network from 2003 through 2006, the processes and details of their activities, and activities and remarks by participants. These documents were classified by issue, broken down into categories, and listed chronologically with titles for characteristic entries, thereby reviewing the processes. On the basis of these results, we asked participants who were involved in the entire process of the construction of the food and nutrition education network to review their own activities, and we then investigated the changes in their attitudes. RESULTS: (1) A total of 63 persons in 34 organizations participated in open community programs. Local food issues included changing dietary behaviors along with diversification of lifestyle; problems with cooking, eating, and continuation of tradition because of the lack of nutritional knowledge and experience; and the uncontrolled flood of information. Participating organizations were found to engage in different activities to address nutritional issues. In addition, insufficient or low efficiency activities were identified, indicating the need for cooperation. (2) Issue-sharing processes consisted of the following three steps: identification of local nutritional issues, characterization of group activities to address food and nutritional problems, and exploration of possible cooperation among groups. Analysis of attitudes of three persons participating in the entire process of network construction revealed their interest in other organization activities and sympathy with other organizations. DISCUSSION: Factors for promotion of sharing issue include (1) our support to allow them to share food and nutrition issues in the early stages and thereafter, and (2) repeated deliberations within open community programs involving information and feedback from prior identification and analysis of problems, as well as selection of activities.

Diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries.

OBJECTIVE: To examine the possibility of diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries. METHODS: A modified version of the Japanese Diagnostic Tool was used. Data on 194 countries were analyzed, including data from the United Nations International Children's Fund, World Health Organization and World Bank. After conducting a Box-Cox transformation, deviation values were calculated. The degree to which the values deviated relative to a deviation cutoff value of 50 was assessed. Focusing on countries with low- and middle-income economic levels, we examined the utility of this tool to show characteristic nutritional problems in each country. RESULTS: The deviation values had normal, distorted, bimodal, or trimodal distributions. In the lower-middle-income countries, almost all countries had values ranging from 40 to 60 for education and water environments (urban and rural), and the differences were minimal. However, different causes of noncommunicable disease-related deaths were considered, and the primary cause appeared to be related to lifestyle factors, particularly alcohol consumption and tobacco smoking. In comparison, the deviation values related to death among low-income countries also appeared to be related to differences in education and sanitation in urban and rural areas. CONCLUSION: The study results can help to determine the status of nutritional inequalities and plan country-specific strategies to reduce the double burden of malnutrition.

Physical and social determinants of dietary variety among older adults living alone in Japan.

AIM: Food security and sufficient nutrient intake are critical to longevity and active aging. The present study aimed to elucidate physical and social factors related to dietary variety among single-living older adults in Japanese communities. METHODS: The cross-sectional survey with a self-administrated questionnaire was carried out for all older adults living alone aged 65 years and older in three cities of Japan during 2014. Dietary variety score (DVS) was determined by counting the number of 10 food groups consumed at least once in 2 days using a food frequency questionnaire. Using the data of 704 men and 1366 women, the sex-specific association of low DVS (<4) with age, region, frailty, annual income, social support, distance to the nearest supermarket and car ownership was analyzed. RESULTS: The prevalence of low DVS was 40.9% for men and 18.4% for women. Frailty and low social support were associated with low DVS. A gradient association with income was found for women, whereas men showed a threshold: <1.5 million yen per year was associated with low DVS. The distance to the nearest supermarket was not significantly associated with DVS. CONCLUSIONS: The findings of the present study imply that as well as frailty, poor social support and economic disadvantage are associated with a decline in dietary variety. In particular, frail men with income <1.5 million yen per year had a high risk of decreased dietary variety. Formal and informal support to secure food accessibility for physically and socially vulnerable older adults should be encouraged. Geriatr Gerontol Int 2017; 17: 2232-2238.