[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.

Promoting health and productivity management in small companies through outreach-based public-private partnership: the Yokohama Linkworker Project.

Introduction: With health promotion initiatives in small companies lagging behind those in larger corporations, strengthening health and productivity management in small companies through innovative strategies is an urgent priority. We hypothesized that an outreach strategy involving a public-private partnership would be beneficial for this purpose. The present study examines the implementation of a public-private partnership strategy in Yokohama City, Japan, assessing its impact on health and productivity management in small enterprises, focusing on implementation outcomes. Methods: As part of the Yokohama Linkworker Project (Y-Link Project), this study describes and examines a public-private partnership program in Yokohama City, Japan, involving the city's government and a private life insurance company. Trained insurance sales representatives served as "Linkworkers" for the program, reaching out to small enterprises in the city. These Linkworkers provided tailored support to these companies, assisting them with obtaining the "Yokohama Health and Productivity Management Certification" issued by the City of Yokohama authorities and collaborating with external entities to offer health promotion programs for employees. Program interventions took place from August to September 2020. The RE-AIM framework was utilized to evaluate the Project. Data were extracted from Linkworkers' activity records, certification records, the Linkworker survey, and follow-up surveys with participating companies at 6- and 18- months post-interventions. Results: Within 2 months, 71 Linkworkers visited 500 companies (50% were small firms, <50 employees). Among them, 224 (45%) enterprises received certifications, contributing to an increased regional certification rate. Linkworker-assisted companies tended to be significantly smaller in size. The odds ratios of implementing workplace health promotion programs in certified firms, compared to non-certified firms, were 4.09 (95% CI: 1.79-9.35) at 6 months and 2.31 (95% CI: 1.04-5.11) at 18 months. For small firms, the odds ratios were 6.87 (95% CI: 1.74-27.06) at 6 months and 3.42 (95% CI: 1.17-10.03) at 18 months. The certification retention rate at 24 months was 60%, irrespective of company size. Linkworkers perceived the outreach strategy as having a positive impact on their primary operations. Conclusion: The Y-Link Project's outreach strategy enhanced health and productivity management in small enterprises in Yokohama City, enabling long-term health promotion programs addressing program availability disparities related to company size.

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.

Prevalence of Inadequate Nutrient Intake in Japanese Community-Dwelling Older Adults Who Live Alone.

Dietary assessment of community-dwelling Japanese older adults who live alone using Dietary Reference Intakes (DRIs) is limited. The present study aimed to estimate the prevalence of inadequate nutrient intake among Japanese community-dwelling older adults by sex and young-old and old-old population groups to identify the most vulnerable groups that need support. A cross-sectional survey was conducted from October 2012 to October 2013 with community-dwelling adults aged 65 y or older who lived alone. Participants were drawn from six cities in four Japanese prefectures. We used two days of dietary survey data to estimate participants' usual intake. The proportion of inadequate intake was assessed using the Estimated Average Requirement (EAR) cut-point method, Tolerable Upper Intake Level, and the tentative dietary goal for preventing life-style related diseases (DG) based on DRIs for Japanese, 2015. Data for 494 participants (162 male, 332 female) over 988 d were examined to assess nutrient intake. We calculated the proportion of inadequate intake between males and females and between young-old and old-old population groups (65-74 y and ≥75 y) using chi-square or Fisher's exact tests. For six nutrients, the estimated proportion of participants with a usual intake below EAR was higher in males than females. In addition, a higher estimated proportion of female participants was within the DG range for the percentage of energy from protein, fat, and carbohydrates, and had a usual intake of two nutrients above DG than males. Our findings showed that among Japanese older adults, males were more vulnerable in terms of inadequate nutrient intake compared with females.