Development of the Japanese version of the Council on Nutrition Appetite Questionnaire and its simplified versions, and evaluation of their reliability, validity, and reproducibility.

BACKGROUND: Because few Japanese questionnaires assess the elderly's appetite, there is an urgent need to develop an appetite questionnaire with verified reliability, validity, and reproducibility. METHODS: We translated and back-translated the Council on Nutrition Appetite Questionnaire (CNAQ), which has eight items, into Japanese (CNAQ-J), as well as the Simplified Nutritional Appetite Questionnaire (SNAQ-J), which includes four CNAQ-J-derived items. Using structural equation modeling, we examined the CNAQ-J structure based on data of 649 Japanese elderly people in 2013, including individuals having a certain degree of cognitive impairment, and we developed the SNAQ for the Japanese elderly (SNAQ-JE) according to an exploratory factor analysis. Confirmatory factor analyses on the appetite questionnaires were conducted to probe fitting to the model. We computed Cronbach's α coefficients and criterion-referenced/-related validity figures examining associations of the three appetite battery scores with body mass index (BMI) values and with nutrition-related questionnaire values. Test-retest reproducibility of appetite tools was scrutinized over an approximately 2-week interval. RESULTS: An exploratory factor analysis demonstrated that the CNAQ-J was constructed of one factor (appetite), yielding the SNAQ-JE, which includes four questions derived from the CNAQ-J. The three appetite instruments showed almost equivalent fitting to the model and reproducibility. The CNAQ-J and SNAQ-JE demonstrated satisfactory reliability and significant criterion-referenced/-related validity values, including BMIs, but the SNAQ-J included a low factor-loading item, exhibited less satisfactory reliability and had a non-significant relationship to BMI. CONCLUSIONS: The CNAQ-J and SNAQ-JE may be applied to assess the appetite of Japanese elderly, including persons with some cognitive impairment.

Effectiveness of individual nutrition counselling for the prevention of undernutrition among elderly people living in depopulated areas: secondary analysis of a model project in Tsu city.

Objectives: To examine the effectiveness of nutrition counselling (NC) in preventing undernutrition in elderly people living in depopulated areas. Design: Participants were elderly people aged at least 65 years living in a depopulated area. Participants completed self-administered questionnaires evaluating nutritional status, frailty and body composition at the start of the study, after a non-NC period (3-month control) and after an NC period (3-month intervention). During the NC period, participants attended monthly 1-hour NC sessions over 3 months. Sessions were conducted in three areas (A, B and C), and the schedule was staggered so that the NC period in one area was conducted simultaneously with the non-NC period of the next. All sessions within an area were attended by the same registered dietitian. Outcomes were assessed three times: before the non-NC period, after the non-NC period and after the NC period. The effects of NC were assessed by comparing the results between the non-NC and NC periods of all participants, using the Cochran-Mantel-Haenszel stratified test. Outcome measures: The primary outcome was undernutrition, as determined by the Mini Nutritional Assessment-Short Form. Secondary outcomes were Dietary Diversity Score (DVS), body weight and frailty. Body composition was also assessed. Results: Of 106 individuals who joined the project, 61 completed the project and were analysed. The NC in this study had no effect on the primary outcome. DVS in area A was significantly higher after the NC period than after the non-NC period (p=0.012). Frailty in area C was significantly lower after the NC period than after the non-NC period (p=0.025). NC had no significant effects on the other outcomes. Conclusions: NC improved food variety but did not improve nutritional status, frailty or body composition.

[Prediction of serum albumin levels by non-invasive factors among elderly female patients].

AIM: To apply nutrition care management to elderly female patients, we predicted serum albumin (s-Alb) levels by non-invasive factors. METHODS: After excluding patients with lesions/diseases which were directly related to s-Alb levels, we investigated 147 elderly women aged 75-years or over who were taking meals orally and were hospitalized from April 2008 to April 2009 at a hospital in Toyota. The patients were classified into 2 groups, one of patients with s-Alb levels of 3.5 g/dl or below (n=80), and the other of those with s-Alb levels of over 3.5 g/dl (n=67). Between the 2 groups, we examined differences in age, body mass index (BMI), living arrangements, necessary nursing care level (NNCL), bed confinement level (BCL), OH scale level (OHSL), and dietary intake either by the Student t-test, Mann-Whitney U test or chi-square test. Pearson correlation coefficients were calculated among s-Alb levels and selected variables. Taking into account the correlation coefficients, we conducted multiple regression analysis adopting the s-Alb level as a dependent variable and non-invasive factors as independent variables. For all the performed tests and analyses, a p value of less than 0.05 (on two-tailed analysis) was assumed to represent a statistically significant difference. RESULTS: S-Alb level was significantly associated with variables, including age, BMI, NNCL, BCL, OHSL, and percentage of protein intake (PPI). Multiple regression analysis revealed 4 significant variables: age, BCL, OHSL, and PPI. The multiple regression equation was y=4.977-(0.098×OHSL)-(0.080×BCL)-(0.016×age)+(0.003×PPI), and the multiple correlation coefficient R(2) was 0.398 (p <0.001). CONCLUSIONS: S-Alb levels among elderly female patients may be predicted by 4 non-invasive variables: age, BCL, OHSL, and PPI.

Changes in thioredoxin concentrations: an observation in an ultra-marathon race.

OBJECTIVES: Changes in plasma thioredoxin (TRX) concentrations before, during, and after a 130-km endurance race were measured with the aim of elucidating the relationship between exercise and oxidative stress (OS). METHODS: Blood samples were taken from 18 runners participating in a 2-day-long 130-km ultra-marathon during the 2 days of the race and for 1 week thereafter. There were six sampling time points: at baseline, after the goal had been reached on the first and second day of the endurance race, respectively, and on 1, 3, and 5/6 days post-endurance race. The samples were analyzed for plasma TRX concentrations, platelet count, and blood lipid profiles. RESULTS: Concentrations of plasma TRX increased from 17.9 ± 1.2 ng/mL (mean ± standard error of the mean) at baseline to 57.3 ± 5.0 ng/mL after the first day's goal had been reached and to 70.1 ± 6.9 ng/mL after the second day's goal had been reached; it then returned to the baseline level 1 day after the race. Platelet counts of 21.3 ± 1.2 × 10(4) cell/µL at baseline increased to 23.9 ± 1.5 × 10(4) cells/µL on Day 1 and to 26.1 ± 1.0 × 10(4) cells/µL on Day 2. On Day 7, the platelet counts had fallen to 22.1 ± 1.2 × 10(4) cell/µL. There was a significant positive correlation between plasma TRX and platelet count. CONCLUSIONS: These data suggest that plasma TRX is an OS marker during physical exercise. Further studies are needed to determine the appropriate level of exercise for the promotion of health.

Changes in blood biochemical markers before, during, and after a 2-day ultramarathon.

We studied changes in blood markers of 18 nonprofessional, middle-aged runners of a 2-day, 130 km ultramarathon. Blood was sampled at baseline, after the goals on the first and second day, and at three time points (1, 3, and 5/6 days) after the race. Blood indices showed three patterns. First pattern indices showed essentially no changes after the two goals and after the race, including red blood cell indices, gamma-glutamyl transferase, and tumor necrosis factor-α. Second pattern markers, including the majority of indices, were elevated during the race (and also after the race for some parameters) and then returned to baseline afterward, including hemolysis/red blood cell destruction markers (indirect bilirubin) and an iron reservoir index (ferritin), muscle damage parameters (uric acid, creatine kinase, lactate dehydrogenase, and aspartate aminotransferase), renal function markers (creatinine and blood urea nitrogen), liver injury index (alanine aminotransferase), lipid metabolism indices (free fatty acid), reactive oxygen species and inflammation parameters (white blood cells, interleukin-6, and C-reactive protein), and energy production and catecholamines (adrenaline, noradrenaline, and dopamine). Third pattern index of a lipid metabolism marker - triglyceride - decreased during the race periods and started returning to baseline from then onward. Some hormonal markers such as insulin, leptin, and adiponectin showed unique patterns. These findings appeared informative for nonprofessional athletes to know about an optimal physical activity level, duration, and total exercise for elevating physical performance and monitoring physical/mental conditioning as well as for prevention of overtraining and physical injuries.

Dietary n-3/long-chain n-3 polyunsaturated fatty acids for prevention of sporadic colorectal tumors: a randomized controlled trial in polypectomized participants.

To address preventive effects of n-3 PUFAs/LC n-3 PUFAs on CRTs, a randomized controlled trial was conducted. One-hundred four experimental group participants were advised to increase intake of n-3 PUFAs, including fish/shell fish, fish oil supplements and perilla oils, and to decrease consumption of n-6 PUFAs and fats/oils as a whole for 24 months. One-hundred one control group participants were only cautioned to reduce consumption of fats/oils as a whole. Random allocation was satisfactorily attained, and participants sufficiently complied with our regimen. Intakes, plasma concentrations, and compositions of the RBC and sigmoid colon membranes of n-3 PUFAs, LC n-3 PUFAs, EPA and DHA increased, and the ratios of n-6 PUFAs/n-3 PUFAs and AA/LC n-3 PUFAs decreased without any adverse response. Twenty-four months after the intervention, the multivariate-adjusted hazard ratio (95% confidence intervals) was estimated to be 0.805 (0.536-1.209) with a signal towards the reduced CRT incidence.

Development of a data-based short food frequency questionnaire for assessing nutrient intake by middle-aged Japanese.

OBJECTIVE: Development of a data-based short food frequency questionnaire (FFQ) for evaluating intake of nutrients by middle-aged Japanese. METHODS: Of 102 foods listed in the formerly developed semi-quantitative FFQ, foods having similar nutrient contents were combined into 72 foods/food groups by research dietitians. Nutrient contents were computed by multiplying the weight of foods consumed and its nutrient contents. Next, a cumulative multiple regression coefficient up to 0.85 was applied, and 47 foods/food groups were chosen for a brief FFQ for assessing intake of 21 nutrients including energy, protein, fat, carbohydrate, vitamins, minerals, and dietary fibers. RESULTS: The 47 foods/food groups comprised rice, bread and noodles (3), margarine/butter (2), eggs (1), milk and dairy products (2), soybean and soybean products (3), miso-soup (1), meat including beef, pork and chicken (4), fish (3), other fish, shellfish and fish products (4), green-yellow vegetables (5), other vegetables and mushrooms (3), edible roots (4), seaweeds (1), mayonnaise (1), fried dishes (2), seeds (1), fruit (2), beverages, including alcohol (3), and confectioneries (2). CONCLUSIONS: The evidence-based short FFQ efficiently covered the intake of 21 nutrients, and may be competent to rank the middle-aged general public Japanese according to intake of nutrients.

Reproducibility of a food frequency questionnaire in koreans.

OBJECTIVE: The present study was conducted to report upon the reproducibility of a 98-item food frequency questionnaire among Koreans. SUBJECTS: The study subjects were recruited from among those who visited for a regular health check-up at the health centers from Samsung Hospital and Hallym University Hospital. SETTING: The FFQ was administered first in April to June of 2002 to 145 Korean adults aged 40 and over residing in Seoul and its vicinity and was then re-administered to 126 three months later between July and September of 2002 (FFQ 1 and FFQ 2). METHODS: Reproducibility was evaluated using the Pearson correlation coefficients of log-e and the calorie-adjusted nutrient score. Weighted kappa (k) statistics with 95% confidence limits were calculated to assess the chance adjusted level of agreement between the FFQ 1 and the FFQ 2. The proportions of correctly categorized subjects in the same or adjacent quintiles were calculated. RESULTS: The average intake in FFQ 1 was no more than 12 percent different from the average intake in FFQ 2. Correlations varied between 0.47 for sodium and 0.72 for vitamin C. All k values exceeded 0.5 except that of fiber. The average k for all nutrients was 0.67. The percentage agreement varied from 62% for energy and potassium to 82% for vitamin B(2) and cholesterol. The average of the agreement was 72%. CONCLUSION: The results of this study verify that it is possible to use tailored, relatively simple, but comprehensive, self-administered food frequency questionnaires to study nutrient consumption in large-scale epidemiological studies.

Usual dietary intakes of selected trace elements (Zn, Cu, Mn, I, Se, Cr, and Mo) and biotin revealed by a survey of four-season 7-consecutive day weighed dietary records in middle-aged Japanese dietitians.

We aimed to identify food sources of selected trace elements (Zn, Cu, Mn, I, Se, Cr, Mo) and biotin in the Japanese diet and to assess usual dietary intakes based on the ratios of within-person to between-person variance. Subjects were 98 middle-aged dietitians living in central Japan who participated in a survey of four-season 7 consecutive day weighed diet records. Based on the latest Standard Tables of Food Composition in Japan published in 2010, food sources of selected nutrients were located according to a contribution analysis, and computed usual dietary intakes. Dietary intakes were checked with the Dietary Reference Intakes for Japanese 2010. Prevalence of inadequacy in a group was determined using the Estimated Average Requirement cut-point method. The major contributors to selected trace elements and biotin were not only meat and milk, but also traditional Japanese food items, including rice, tofu and tofu products, fish, seaweed, chicken eggs, fermented soy bean seasonings, and green tea. Medians of usual intakes were estimated for Zn (men 8.9 mg, women 8.4 mg), Cu (1.32 mg, 1.21 mg), Mn (3.73 mg, 3.76 mg), I (312 µg, 413 µg), Se (97 µg, 94 µg), Cr (10 µg, 9 µg), Mo (226 µg, 184 µg), and biotin (51.7 µg, 47.6 µg). The prevalence of inadequacy of dietary intakes was high for Zn, Cu and Cr. Regarding I, the proportion above the Tolerant Upper Level was overestimated based on the crude mean value. We first identified food sources of selected trace elements and biotin in the Japanese diet, and assessed the usual intakes.

Sex and seasonal variations of plasma retinol, alpha-tocopherol, and carotenoid concentrations in Japanese dietitians.

AIM: To clarify sex and seasonal variations of plasma antioxidant concentrations among middle-aged Japanese. SUBJECTS AND METHODS: We investigated sex and seasonal variations of plasma antioxidant concentrations, including retinol, alpha-tocopherol, and carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein and lycopene), in 55 middle-aged dietitians (46 women and 9 men) in Aichi Prefecture, Central Japan, who took no supplements from autumn 1996 to summer 1997. Reversed-phase high performance liquid chromatography was used to measure plasma antioxidant concentrations in overnight-fasting blood samples. RESULTS: Plasma levels of alpha-tocopherol, alpha-/beta-carotene, b-cryptoxanthin and lutein were significantly influenced by sex, being significantly higher for women than men in each corresponding season; retinol and lycopene, however, showed no such difference. For women, winter values of alpha-tocopherol, alpha-/beta-carotene, lutein and lycopene were significantly lower than corresponding summer values, and had reached their annual lowest. Retinol failed to show any significant seasonal variation, whereas the winter value of beta-cryptoxanthin had reached its annual highest. For men, beta-cryptoxanthin exhibited significant seasonal changes and was also highest in winter. Winter values of alpha-tocopherol, alpha-/beta-carotene and lycopene were lower compared with other seasons, but not statistically significant, probably due to the small sample size. CONCLUSIONS: The findings indicate that sex and seasonal variations of plasma antioxidant concentrations should be taken into account in nutritional epidemiologic studies.

Serum concentrations of fatty acids and colorectal adenoma risk: a case-control study in Japan.

BACKGROUND: Epidemiologic studies of n-3 fatty acids (FAs) and risk of colorectal cancer have generated inconsistent results, and relations with precursor colorectal adenomas (CRA) have not been evaluated in detail. We here focused on possible associations of serum FAs with CRA in the Japanese population. METHODS: We conducted a case-control study of 203 asymptomatic CRA cases (148 men, 55 women) and 179 healthy controls (67 men, 112 women) during 1997-2003 in Nagoya, Japan. Baseline information was obtained using a lifestyle questionnaire and serum FA levels were measured by gas chromatography. RESULTS: A non-significant inverse association with CRA was observed for eicosapentaenoic acid (EPA) among women. Moreover, the concentrations of docosahexaenoeic acid (DHA), a major component of n-3 highly-unsaturated FAs (HUFAs), were significantly lower in cases in both sexes. In addition, serum concentrations of total FAs, saturated FAs (SFAs) and mono-unsaturated FAs (MUFAs) had strong positive links with CRA risk. In contrast, arachidonic acid (AA) and DHA were inversely related, with 66% and 59% risk reduction, respectively. Ratios of SFAs/n-3 PUFAs and SFAs/n-3 HUFAs exhibited significant positive relations with CRA risk but there was no clear link with n-6 PUFAs/n-3 PUFAs. CONCLUSIONS: Our findings suggest a promoting influence of SFAs and MUFAs along with a protective effect of DHA on CRA risk. However, further research is needed to investigate the observed discrepancy with the generally accepted roles of the AA cascade in carcinogenesis.

Reproducibility of a short food frequency questionnaire for Japanese general population.

BACKGROUND: In epidemiologic field studies, a food frequency questionnaire (FFQ) is one of the most feasible tools to assess usual dietary habits. The purpose of this study is to evaluate the reproducibility of consumption of foods and nutrients assessed with a self-administered short FFQ in a Japanese general population. METHODS: We have investigated 1-year interval reproducibility of a self-administered short FFQ, comprising 47 food items, and 8 frequency categories, among 1,918 subjects (844 males and 1,074 females) who participated in health check-up programs in Central Japan. RESULTS: Intakes of energy and 24 nutrients along with 15 food groups estimated using the first questionnaire (FFQ1) were approximately equal to those using the second (FFQ2). Spearman's rank correlation coefficients (CCs) between intakes of nutrients quantified with FFQ1 and FFQ2 in males were distributed as 0.74 - 0.66- 0.55 (maximum - median - minimum), and intraclass CCs (ICCs) as 0.85 - 0.78 - 0.67. Among females, Spearman's rank CCs were distributed as 0.73 - 0.62 - 0.54, and ICCs as 0.84 - 0.77 - 0.69. Percentages of exact agreement, exact agreement plus agreement within adjacent categories and disagreement according to quintile categorization were 43%, 80%, and 1%, for males, and 42%, 79%, and 1% for females. Reproducibility figures were higher for the elderly than for young people in both sexes. CONCLUSIONS: Our FFQ yielded substantially high reproducibility and it may be applicable for assessing consumption of foods/food groups and energy and selected nutrients for the middle-aged and elderly population in Japan.

Relative validity of a short food frequency questionnaire for assessing nutrient intake versus three-day weighed diet records in middle-aged Japanese.

BACKGROUND: Validation studies on brief food frequency questionnaires (FFQs) for measuring consumption of macro- and micro-nutrients for the general populace are not fully executed in Japan. METHODS: Two hundred and two middle-aged Japanese (73 males and 129 females) in Aichi Prefecture, Japan completed an FFQ and 3day-weighed diet records (3d-WDRs) in February 2004. We compared intakes of energy and 26 nutrients computed with the FFQ against those with the 3d-WDRs as a reference. RESULTS: Mean daily intakes of selected nutrients determined with the FFQ were generally less than those with 3d-WDRs. The ratios assessed with the FFQ vs. 3d-WDRs (minimum-median-maximum) were distributed from 0.57-0.79-1.09 for males, and 0.61-0.86-1.04 for females. De-attenuated, log-transformed and energy-adjusted Pearson's correlation coefficients between intakes of selected nutrients quantified with both devices were distributed from 0.12-0.45-0.86 and energy-adjusted Spearman's rank correlation coefficients were from 0.13-0.35-0.76, for males. The respective values for females were 0.10-0.38-0.66, and 0.11-0.34-0.47. Median percentages for exact agreement, agreement within adjacent categories, and disagreement according to quartile classification of the energy-adjusted nutrient intakes measured with both methods were 33, 74, and 5 for males, and 35, 76, and 7 for females, respectively. CONCLUSION: Satisfactorily high relative validity indices of most nutrient intakes computed with the FFQ were attained against those with the 3d-WDRs. The questionnaire therefore appears applicable for categorizing individuals according to consumption of energy and selected nutrients in dietary studies of middle-aged Japanese.

Reproducibility and validity of a self-administered food frequency questionnaire used in the JACC study.

BACKGROUND: A self-administered questionnaire on dietary habits used in the JACC Study contained a 40-item food frequency questionnaire (FFQ). Although more than 110 thousand subjects enrolled in JACC Study and responded to the FFQ, no validation study has been conducted to date. METHODS: Eighty-five volunteers among the cohort members completed 2 FFQs (FFQs 1&2) and 12-day weighed dietary records (WDR). The interval between the two FFQs was one year. During the one year, the subjects carried out a 3-consecutive-day WDR in each season. We tested the reproducibility by using two FFQs. Also, we tested the validity of the FFQ by using the 12-day WDR as a gold standard. RESULTS: The intake frequencies of the 2 FFQs often agreed, showing the Spearman correlation coefficients ranging from 0.42 (edible wild plants) to 0.86 (coffee). The Spearman correlation coefficients of the energy and nutrient intakes from FFQ2, and that of the 12-day WDR were 0.20(energy) to 0.46 (animal protein, potassium). After adjusting the energy intake, the correlation coefficients showed 0.21(fish fat) to 0.51(animal fat). When classifying the FFQ2 and WDR by quartiles and examining the degree of agreement between the two methods, we obtained its median 30%. CONCLUSIONS: The FFQ is suitable to deal with a large group of subjects. However, since the energy and the amount of nutrient intake from this FFQ can not show the overall dietary intake situation, the subjects' dietary intake should be assessed by categories.

Folate intake and food sources in Japanese female dietitians.

OBJECTIVE: To assess intake of folate/folic acid and food sources in Japanese female dietitians. SUBJECTS AND METHODS: We evaluated folate consumption based on four season 7 consecutive day weighed diet records (WDRs) provided by 80 Japanese female dietitians and compared the results with data from a national survey. We then selected informative foods for folate intake on the basis of 2,240 WDRs according to contribution and multiple regression analyses. RESULTS: Daily folate consumption (mean±SD) among Japanese dietitians was 413±158 µg from raw foods and 343±128 µg from cooked foods. Average residual rate after cooking was 84±8%. Folate intake in summer was lower than that in other seasons by analysis of variance. According to contribution and multiple regression analyses, the major contributors were vegetables, fruit and green tea. CONCLUSIONS: Daily folate intake among Japanese female dietitians was far greater than the 200 µg recommended daily allowance for the Japanese. Irrespective of selection methods and raw/cooked foods, major folate sources were found to be green tea along with vegetables and fruit.