Time Trends in Income-related Differences in Food Group Intakes: The National Health and Nutrition Survey, Japan in 2010, 2014, and 2018.

BACKGROUND: We aimed to clarify whether differences in food group intake according to household income have changed over the last decade in Japanese people aged 20 years or older. METHODS: This cross-sectional study was based on the 2010, 2014, and 2018 National Health and Nutrition Surveys in Japan. Food intake was assessed using a 1-day semi-weighed household dietary record. The participants were categorized into three groups based on their income. The mean of each food intake according to the income group was estimated by adjusting for age, occupation, and number of participants from the same household. The significance of the interaction terms between income and survey year was evaluated to assess the change in income-related differences in food intake over time. RESULTS: Cereal intake was lower in the middle- and the highest-income groups than in the lowest-income group, regardless of sex, and the interaction between income and year was nonsignificant for cereal intake. In the former two surveys, vegetable intake was higher among the highest-income women, while in the 2018 survey, the vegetable intake decreased in the women in the middle- and the highest-income groups. The interaction between income and year was significant for vegetable intake among the women. For other foods, the differences in intake among the income groups did not significantly change over time. CONCLUSION: The tendency for lower cereal intake in the higher-income groups was consistent over time in both the sexes, and the tendency for higher vegetable intake in the highest income women disappeared over time.

The association of highly processed food consumption with food choice values and food literacy in Japanese adults: a nationwide cross-sectional study.

BACKGROUND: Highly processed food (HPF) consumption is increasing globally and has become a prominent public health concern. However, the relationship between HPF consumption and food choice values and food literacy is unknown. This study aimed to examine the association of HPF consumption with food choice values and food literacy. METHODS: This cross-sectional study used data from a nationwide questionnaire survey conducted in 2018 among 2232 Japanese adults aged 18-80 years. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety) using a 25-item scale, and food literacy characterised by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). HPF consumption was estimated using a validated brief diet history questionnaire. The associations between HPF consumption and age, body mass index, energy intake, and each score on food choice values and food literacy were evaluated by multiple linear regression. RESULTS: In males, one standard deviation increase in scores for cooking skill and satiety responsiveness was associated with an increase in HPF consumption by 22.1 g/4184 kJ (95% confidence interval (CI): 6.6 to 37.5) and 15.4 g/4184 kJ (95% CI: 6.0 to 24.7), respectively. In females, one standard deviation increase in age and scores for safety and nutrition knowledge corresponded to a decrease in HPF consumption by - 16.4 g/4184 kJ (95% CI: - 23.4 to - 9.3), - 9.9 g/4184 kJ (95% CI: - 19.1 to - 0.7), and - 11.1 g/4184 kJ (95% CI: - 17.0 to - 5.3), whereas one standard deviation increase in the satiety responsiveness score corresponded to an increase in HPF consumption by 13.1 g/4184 kJ (95% CI: 6.8 to 19.4). CONCLUSIONS: This cross-sectional study suggests that several aspects of food choice values and food literacy were associated with HPF consumption in Japanese adults. Further studies are needed to confirm our findings in a broader context.

Associations of food choice values and food literacy with overall diet quality: a nationwide cross-sectional study in Japanese adults.

To date, a limited number of studies have examined aspects of food choice values and food literacy in relation to some aspects of dietary behaviours. The aim of this cross-sectional study was to comprehensively examine the associations of food choice values and food literacy with diet quality. In total, 2231 Japanese adults aged 19-80 years completed questionnaires asking about food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort and safety) and food literacy characterised by nutrition knowledge, cooking skills, food skills and eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness and slowness in eating). As a measure of diet quality, the Healthy Eating Index-2015 (HEI-2015) was calculated using a brief-type diet history questionnaire (BDHQ) or a food combination questionnaire (FCQ). In males, after adjustment for potential confounding factors (including age, BMI and the ratio of reported energy intake to estimated energy requirement), the HEI-2015 derived from BDHQ and that derived from FCQ were associated significantly (P ≤ 0·02) and positively with the food choice values of organic and inversely with food fussiness. In females, the HEI-2015 showed positive associations with the food choice values of health/weight control, nutrition knowledge and cooking skills and an inverse association with food fussiness, irrespective of the dietary assessment questionnaire (P ≤ 0·03). In conclusion, this study suggests that several aspects of food choice values and food literacy were associated with diet quality, and the aspects related differed between males and females.

Trends in dietary salt sources in Japanese adults: data from the 2007-2019 National Health and Nutrition Survey.

Identifying trends in dietary salt sources is essential for effectively reducing salt/Na intake. This study aimed to examine the trends in dietary salt sources among Japanese adults using the 2007-2019 National Health and Nutrition Survey data collected from 95 581 adults aged ≥ 20 years. Dietary intake was estimated using the 1-d household-based dietary record. Foods reported as potential sources of salt intake in Japan and other countries were categorised into twenty-one groups. Salt intake for each food group was adjusted using the density method based on the energy intake. Trends in dietary salt intake based on food sources by sex and age groups (20-39 years, 40-59 years and ≥ 60 years) were analysed using the Joinpoint Regression Program. Salt intake for each age group in both men and women decreased from 2007 (5·3 g/1000 kcal-6·4 g/1000 kcal) to 2019 (4·9 g/1000 kcal-5·6 g/1000 kcal). The major dietary source of salt continued to be seasonings such as soya sauce and soyabean paste (approximately 70 %). Salt intake from seasonings decreased over time in adults aged ≥ 40 years but did not change in those aged 20-39 years. Additionally, a decreasing salt intake from unprocessed fish and shellfish and an increasing salt intake from unprocessed meat were observed across all age categories for both sexes. This study demonstrated that a strategy targeting different age groups may be needed to reduce salt consumption from seasonings among the Japanese population. Further studies on salt content in seasonings and continued monitoring of trends in dietary salt sources are required.

Association of daily nutrient intake with breakfast and snack consumption among young Japanese adults aged 20-39 years: data from the 2012 National Health and Nutrition Survey.

Eating frequency has been associated with nutrient intake and diet quality. The aim of this study was to examine the association between daily nutrient and food group intake and consumption of breakfast and/or snacks among young Japanese adults, as secondary analysis of the 2012 National Health and Nutrition Survey in Japan involved 1420 men and 1659 women aged 20-39 years. Dietary intake data were collected using a one-day semi-weighed household dietary record. Participants were classified into four groups based their breakfast and snack consumption, defined as the consumption of any food or beverage that contained energy based on participant-defined eating occasions; both breakfast and snack consumption (B+S+), breakfast consumption without snacking (B+S-), breakfast skipping and snack consumption (B-S+) and breakfast skipping without snacking (B-S-). The proportion of breakfast skippers among men and women was 11·8 % and 6·6 %, whereas that of snack consumers among men and women was 55·3 % and 68·2 %, respectively. Energy, Mg potassium (in both sexes), vitamin B2, Ca, (only men) and folate and dietary fibre (only women) intakes were higher among breakfast and snack consumers than in the B+S- group. The nutrient intake level of the B+S- group was similar to that of the B-S+ group, whereas the B-S- group had lower energy (both sexes), Cu, dietary fibre and potassium (only women) intakes than the B+S- group. Snack consumption could supplement nutrients that may not be adequately consumed by three meals among young Japanese adults.

Consumption of meals prepared away from home is associated with inadequacy of dietary fiber, vitamin C and mineral intake among Japanese adults: analysis from the 2015 National Health and Nutrition Survey.

BACKGROUND: Consumption of home-prepared meals may lead to better nutritional intake. Few studies have examined the association between the frequency of consuming meals prepared away from home and the inadequacy of nutritional intake based on nutritional standards and food group intake. We therefore aimed to investigate this issue among Japanese adults. METHODS: This study was a secondary analysis of the 2015 National Health and Nutrition Survey in Japan, involving 921 men and 1300 women aged 18-64 years, conducted as a cross-sectional survey. The frequency of consuming meals prepared away from home was defined using two questions inquiring about the frequency of eating out and take-away meals. Data on dietary intake were collected using a one-day semi-weighed household dietary record. Participants were stratified into three groups based on the frequency of consuming meals prepared away from home (High, Moderate, Low). The inadequacy of each nutrient intake was assessed by comparing estimated average requirement (EAR) level for 14 nutrients and the range of the dietary goal (DG) for seven nutrients according to the 2015 version of the Dietary Reference Intakes for Japanese. Group differences in nutrients adequacy were assessed using the covariate and logistic regression analysis. Food intake was also compared across the groups by classifying each food item into 17 groups based on Standard Tables of Food Composition. RESULTS: The proportion of participants who consumed home-prepared meals almost every day were 34.9% among men and 46.8% among women, and the proportion of those consuming a higher frequency of meals prepared away from home were 14.7 and 6.3%, respectively. A higher frequency of consuming meals prepared away from home was associated with inadequacy of dietary fiber, vitamin C and minerals (iron, magnesium and potassium) intake, and with lower intake of vegetables and higher intake of fat and oils. CONCLUSIONS: High frequency of consuming meals prepared away from home was associated with insufficient intake of dietary fiber, vitamin C and multiple minerals among Japanese adults. These nutrients may be the potential target of interventions aimed at improving nutrient intake in individuals who predominantly eat food prepared away from home.

Snacking in Japanese nursery school children aged 3-6 years: its characteristics and contribution to overall dietary intake.

OBJECTIVE: This cross-sectional study evaluated the dietary characteristics of snacks, the contribution of snacks to daily nutrient intake and the association of energy intake (EI) from snacks with the prevalence of nutritional inadequacy in Japanese nursery school children. DESIGN: Foods and nutrients consumed in each eating occasion were assessed by 3-d dietary records. The prevalence of inadequate intake of twenty nutrients assessed by the age- and sex-specific reference values in the Japanese Dietary Reference Intakes was compared according to tertile categories of EI from snacks. SETTING: A multi-regional dietary survey based on nursery schools in Japan. PARTICIPANTS: A total of 187 boys and 191 girls aged 3-6 years. RESULTS: EI from snacks accounted for 19·5 % (sd 6·9) of total daily EI. Confectionaries accounted for the largest part of EI from snacks (35·3 %), followed by milk (19·5 %). Relative to their energy contribution, snacks accounted for a small proportion for all nutrients examined, except for free sugar, calcium, SFA and riboflavin. Although a higher EI from snacks was associated with favourable profiles for intakes of calcium, iron, thiamine and riboflavin, excessive intakes of free sugar and Na were more prevalent among children with a higher EI from snacks. CONCLUSIONS: Although snacks are effective in meeting the requirement of some nutrients among Japanese nursery school children, snacks are generally not nutrient-dense and have an impact on excessive intake of some nutrients. There is hence room for improvement in food choices at snack time.

Carbohydrate intake during early pregnancy is inversely associated with abnormal glucose challenge test results in Japanese pregnant women.

BACKGROUND: In East Asian countries, which have a high prevalence of underweight individuals, there is little information about the association between dietary factors and abnormal glucose tolerance during pregnancy. We examined the association between carbohydrate intake and moderately abnormal glucose tolerance in Japanese pregnant women. METHODS: We conducted a prospective study on 325 Japanese pregnant women without a diagnosis of diabetes mellitus prior to pregnancy. Dietary carbohydrate intake (% of total energy intake) was assessed using a 3-day dietary record during weeks 8-15 of pregnancy. Glucose tolerance was assessed by the 50 g glucose challenge test (GCT) during weeks 24-28 of pregnancy. A positive GCT result was defined by a 1-hour plasma concentration ≥ 7.8 mmol/L. Odds ratios of a positive GCT were calculated for the top and middle tertile categories of carbohydrate intake using the bottom category as reference. RESULTS: Mean (standard deviation) body mass index at the first prenatal visit was 19.7 (1.9) kg/m2 , and 95 women were underweight. Seventy-four women had positive GCT results. Carbohydrate intake was negatively associated with a positive GCT result after adjusting for age, parity, body mass index at first prenatal visit, family history of diabetes mellitus, rate of gestational weight gain, energy intake, and dietary fiber intake (odds ratio for top category: 0.46 [95% CI, 0.23-0.93]). CONCLUSIONS: These findings suggest that high carbohydrate intake was negatively associated with moderately abnormal glucose tolerance in a population with a high prevalence of underweight individuals.

Analysing food groups and nutrient intake in adults who met and did not meet the daily recommended vegetable intake of 350 g: the 2016 National Health and Nutrition Survey in Japan.

This study aimed to compare the differences in the intake of food groups and nutrients between Japanese adults who consumed the recommended daily vegetable intake (350 g/day) and those who did not. Dietary information was obtained from one-day dietary records collected from the 2016 National Health and Nutrition Survey, which was conducted in 46 prefectures in Japan. The participants aged ≥20 years (n = 21,606; 53.8% women) were classified into the < and ≥350 g/day groups. Inter-group differences for 17 food groups and 27 nutrients were assessed as percentages of consumers (food groups only) and energy-adjusted intake (units/MJ/d or % of total energy intake). Overall, 29% of participants consumed ≥350 g/day of vegetables. The ≥350 g/day group had a higher percentage of consumers and energy-adjusted intakes for all vegetable subgroups than the <350 g/day group. For other food groups, the ≥350 g/day group had higher percentages of consumers for all food groups, except for cereals, eggs, and condiments and seasonings, which showed no significant differences. However, the ≥350 g/day group had a significantly higher energy-adjusted intake for potatoes and other tubers, mushrooms, meats, and condiments and seasonings but a significantly lower value for cereals, eggs, savoury snacks and confectionaries, and beverages. The ≥350 g/day group had a significantly higher intake of almost all (25/27) nutrients, including sodium, than the <350 g/day group. Participants with vegetable intake ≥350 g/day might have a more favourable intake of food groups and nutrients; however, watching for salt intake is necessary when promoting vegetable intake.

A scoping review of dietary assessment questionnaires potentially suitable for assessing habitual dietary intake in the National Health and Nutrition Survey, Japan.

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30-76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35-0.57 for nutrients and 0.28-0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

Global Comparison of Nutrient Reference Values, Current Intakes, and Intake Assessment Methods for Sodium among the Adult Population.

Excess sodium intake is a risk factor for non-communicable diseases (NCDs), such as cardiovascular diseases and hypertension. Therefore, many countries have set nutrient reference values for sodium, specifically for the prevention of NCDs, and intake is routinely monitored by nutrition surveys. In this review, we aimed to compare the global nutrient reference values and national intakes of sodium, along with the methods of intake assessment used. Data were obtained for Australia, Canada, Ireland, Japan, the UK, the US, and the European Food Safety Authority (EFSA), where information was accessible online in English or Japanese. We collected the following information regarding sodium intake: the term used for reference values to prevent NCDs; year when reference values were established or revised; reference values to prevent NCDs; target NCDs; designation of nutrition survey; method for estimating intake; and average intake. The reference values ranged from 2,000 mg (Australia and EFSA) to 2,953 mg (Japan). Sodium intake ranged from 2,431 mg (Australia) to 3,958 mg (Japan). Out of seven countries/institutions, five used dietary assessment, and two used sodium urinary excretion for estimating dietary sodium intake. Among the dietary assessment methods, the 24-h dietary recall was most frequently used. National sodium intake exceeded the reference values in all countries, and reduction of sodium intake remains a global challenge.

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.

Food Choice Values and Food Literacy in a Nationwide Sample of Japanese Adults: Associations with Sex, Age, and Body Mass Index.

This cross-sectional study of 2231 Japanese adults described food choice values and food literacy in relation to sex, age, and body mass index. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety, using a 25-item scale), as well as food literacy, which was characterized by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviors (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). Females had higher means of all the variables than males, except for food fussiness. Compared to participants aged 19-39 and/or 40-59 years, those aged 60-80 years had low means of some food choice values (accessibility, convenience, sensory appeal, and comfort), nutrition knowledge, and all the food approach behaviors (hunger, food responsiveness, emotional overeating, and enjoyment of food) and high means of other food choice values (tradition, organic, and safety) and slowness in eating. Age was inversely associated with cooking and food skills in males, whereas the opposite was observed in females. The associations with body mass index were generally weak. These findings serve as both a reference and an indication for future research.

Trends in Food Group Intake According to Body Size among Young Japanese Women: The 2001-2019 National Health and Nutrition Survey.

Unlike in many industrialised countries, the high proportion of young women who are underweight in Japan has been a long-term problem. We evaluated trends in food group intake according to body size among young Japanese women using data from the National Health and Nutrition Survey 2001-2019. Overall, 13,771 Japanese women aged 20-39 years were included. A 1-day household-based dietary record was used to estimate food intake. Foods were classified into 34 groups based on the Standard Tables of Food Composition in Japan. The trend of food group intake was analysed using the Joinpoint Regression Program. The proportion of young women who were underweight was consistently around 20%, while obesity among young women increased between 2001 (10%) and 2019 (13%). A decreased trend in fish and shellfish and seaweed intake and an increased trend in meat and soft drink intake were observed among young women. Decreased trends in the intake of fruit and dairy products were observed in young women who were not obese. An increased trend in the intake of confectionaries was observed in young women who were obese. This study suggests that the types of unhealthy eating habits may differ according to body size among young Japanese women.

Monitoring the Consumption of Vegetables among OECD Countries, Including Japan.

Increasing intakes of vegetables are associated with risk reduction in various non-communicable diseases, especially cardiovascular disease. In order to compare the proportion of daily vegetable intake among adults from these 30 Organization for Economic Co-operation and Development (OECD) countries as well as Japan, we applied data from the OECD website and the 2017 National Health and Nutrition Survey, Japan (NHNS-J). The figures for Australia, Israel, Korea, New Zealand, and the United States exceeded 80%, where survey questions in these countries asked the amount of intake, instead of the frequency of intake. In Japan, results from the one-day dietary record showed that 99.2% of adults consumed vegetables on the survey day; however, this decreased to 66.3% when assessed by a qualitative question. Proportion of daily vegetable intake as well as average intake amount was higher among those aged 60 y or older. Health policies to increase vegetable intake should target younger age groups to promote health in future generations, in Japan.

Definitions and Assessment Methods of 'Home Cooking' in Studies with Dietary Variables: A Scoping Review.

Home cooking is a complex idea that involves multiple skills and behaviors and can be interpreted differently. Using six databases (two of which were Japanese), this scoping review examined the definitions and methods used in studies investigating the relationship between home cooking and dietary variables. Of the 40 studies (2 in Japanese) included in this review, 8 provided definitions but did not specify the extent or level that convenience foods can be allowed in food preparation. The methods were classified into two categories, namely, perception-dependent (n = 29) if using a self-reported instrument, or perception-independent (n = 11) if based on investigators' classification. Subsequently, indicators of home cooking were classified based on survey attributes (e.g., frequency, location). All but five studies used single indicators, primarily the preparation frequency (n = 18). Quality of analysis was also evaluated. Studies that used multiple indicators or perception-independent methods showed high or moderate overall quality. In contrast, studies that used single indicators based on perception-dependent methods tended to have a low overall quality. The consistency of the relationship between home cooking and dietary variables depended on study quality. In conclusion, the definitions of home cooking were inconsistent across studies, and lacked consensus for examining the association between dietary outcomes.

Association between Food Sources of Free Sugars and Weight Status among Children and Adolescents in Japan: The 2016 National Health and Nutrition Survey, Japan.

This cross-sectional study aimed to investigate the relationship between food sources of free sugars and weight status among children and adolescents aged 2-19 years in Japan (1438 males and 1340 females) from the 2016 National Health and Nutrition Survey, Japan. We estimated the percentage of energy intake (% E) from free sugars from total food sources (FStotal), solid foods (FSsolids), and beverages (FSliquids), using one-day weighed dietary record data. Weight status was determined based on body mass index (BMI) z-scores and the prevalence of overweight and obesity. The mean energy intakes of FStotal, FSsolids, and FSliquids were 5.8%, 4.1%, and 1.8% in males and 6.2%, 4.6%, and 1.6% in females, respectively. After controlling for potential confounding factors, including energy intake, there was no association of free sugars intake from all food sources with BMI z-scores or with the prevalence of overweight and obesity, except for a marginal association between higher FSsolids and lower estimated BMI z-scores in females (p = 0.05). The present findings indicate that among children and adolescents in Japan, who have a relatively low mean intake of free sugars, consuming free sugars from any food source is unlikely to have an adverse effect on weight status.

Associations Between Health Literacy and Underweight and Overweight Among Japanese Adults Aged 20 to 39 Years: A Cross-Sectional Study.

Background. Both underweight and overweight are public health concerns in Japan. Several studies examined the association between health literacy (HL) and obesity status in the general population; however, there is limited information on young adults. In addition, the association between HL and underweight status has not been extensively investigated. Aim. To examine the association between HL and underweight/overweight status among young Japanese adults aged 20 to 39 years. Method. This study was based on a cross-sectional survey of population-representative adults. HL was assessed using a questionnaire validated in Japanese adults. Body mass index (BMI) was calculated using self-reported weight and height. Participants were divided into two groups by HL score using the median score (lower vs. higher HL). The association between HL and underweight (BMI <18.5) or overweight (BMI ≥25.0) was examined using multinomial logistic regression analyses after adjusting for potential confounders. Results. In total, 476 women and 454 men were included in the analyses. Prevalence of underweight and overweight was 20.8% and 10.3% in women and 8.8% and 20.3% in men, respectively. In women, 45.1% of normal weight, 47.5% of underweight, and 30.6% of overweight had higher HL. Among men, 50.3% of normal weight, 35.0% of underweight, and 44.6% of overweight had higher HL. Bivariate analyses showed no statistically significant association between HL level and underweight/overweight status. Even after adjusting for potential confounders, these associations did not change. Discussion and Conclusion. This study suggests that HL scores may not be associated with underweight or overweight status in Japanese adults.

Association of alcohol consumption with prevalence of fatty liver after adjustment for dietary patterns: Cross-sectional analysis of Japanese middle-aged adults.

BACKGROUND & AIMS: Moderate alcohol intake is associated with reduced prevalence or incidence of fatty liver. However, whether or not the association is independent of dietary patterns remains unclear. We aimed to evaluate the cross-sectional association of alcohol intake with fatty liver after accounting for dietary patterns and obesity. METHODS: We assessed 4579 adults aged 30-79 years who participated in routine clinical examinations in St. Luke's International Hospital, Japan (January to March, 2015). We assessed their habitual diet using diet-history questionnaire, estimated alcohol intake, and derived dietary pattern variables using factor analysis. Fatty liver was ascertained using ultrasonography. Linear and U-shaped associations of alcohol intake with fatty liver were evaluated using Poisson regression, and a post hoc analysis was conducted after detecting potential outliers for alcohol intake and excluding them using sex-specific statistics (median plus 2 × interquartile range). RESULTS: Fatty liver was ascertained in 1120 participants (24.5%). Whereas no significant association of alcohol intake with fatty liver was observed when potential outliers of alcohol intake were included (p = 0.25), a significant U-shaped association was observed after excluding the outliers with and without adjustment for dietary patterns (p = 0.003 and 0.02, respectively). The lowest prevalence was estimated when alcohol consumption was approximately 7% of energy, with a prevalence ratio of 0.72 (95% confidence interval = 0.59-0.86) compared to non-drinkers. The association became imprecise and attenuated toward the null after further adjustment for body mass index (p = 0.06). CONCLUSIONS: Alcohol intake showed a U-shaped association with fatty liver prevalence. This association was independent of underlying dietary patterns, while it was sensitive to excessive alcohol intake and obesity status, providing clinical implications for the prevention of fatty liver.

Associations between nutritional adequacy and insomnia symptoms in Japanese men and women aged 18-69 years: a cross-sectional study.

OBJECTIVES: Sleep and diet are important lifestyle factors for maintaining health. Although previous studies have suggested that sleep quality may be associated with specific nutrient and food intakes, the relationship between nutritional adequacy and sleep quality remains unclear. The purpose of this study was to examine the relationship between sleep quality (insomnia symptoms) and adequate nutrient intake among Japanese adults. DESIGN: Cross-sectional. SETTING: Nationwide population survey conducted in 2013. PARTICIPANTS: 1,997 participants (940 men and 1,057 women) aged 18-69 years. MEASUREMENTS: Insomnia symptoms were assessed using the Athens Insomnia Scale (AIS) and participants were classified into three groups (absent, minor, and moderate-severe) based on the total AIS score. Dietary intake was estimated using a questionnaire and nutrient intake adequacy was evaluated by comparing the self-reported intake with two indices of the Dietary Reference Intakes for Japanese (2015): an estimated average requirement (EAR) and tentative dietary goal for preventing lifestyle-related disease (DG). RESULTS: A total of 205 men (21.8%) and 266 women (25.2%) were categorized as having moderate-severe insomnia symptoms. Among men, moderate-severe symptoms were associated with higher prevalences of inadequate intakes of total dietary fiber, vitamin C, and zinc. However, there was little association between inadequate nutrient intake and insomnia symptoms among women. The number of inadequate nutrients was significantly associated with insomnia symptoms in men (DG, P=0.004; EAR, P=0.003) but not in women. CONCLUSIONS: This study suggested that insomnia symptoms may be associated with nutritional inadequacy in Japanese adults, especially among men.