Effects of the National School Lunch Program on Bone Growth in Japanese Elementary School Children

Association of physiological factors with grip and leg extension strength: tohoku medical megabank community-based cohort study

BACKGROUND

Upper and lower extremity muscle strength can be used to predict health outcomes. However, the difference between the relation of upper extremity muscle and of lower extremity muscle with physiological factors is unclear. This study aimed to evaluate the association between physiological data and muscle strength, measured using grip and leg extension strength, among Japanese adults.

METHODS

We conducted a cross-sectional study of 2,861 men and 6,717 women aged ≥ 20 years living in Miyagi Prefecture, Japan. Grip strength was measured using a dynamometer. Leg extension strength was measured using a hydraulic isokinetic leg press machine. Anthropometry and physiological data, including blood pressure, calcaneal ultrasound bone status, pulmonary function, carotid echography, and blood information, were assessed. We used a general linear model adjusted for age, body composition, and smoking status to evaluate the association between muscle strength and physiological factors.

RESULTS

Grip and leg extension strength were positively associated with bone area ratio, vital capacity, forced vital capacity, forced expiratory volume in one second, and estimated glomerular filtration rate, and negatively associated with waist circumference and percentage body fat mass in both the sexes. Diastolic blood pressure was positively associated with grip strength in both the sexes and leg extension strength in men, but not women. High-density lipoprotein cholesterol and red blood cell counts were positively associated with grip and leg extension strength in women, but not men. In both the sexes, pulse rate, total cholesterol, and uric acid were consistently associated with only leg extension strength, but not grip strength. In women, glycated hemoglobin demonstrated negative and positive associations with grip and leg extension strength, respectively.

CONCLUSIONS

Grip and leg extension strength demonstrated similar associations with anthropometry, pulmonary function, and estimated glomerular filtration rate, but the associations with the other factors were not always consistent.

Children's Diet and Nutrition in the Aftermath of the Torrential Rain Disaster in Western Japan: An Evaluation of Support Activities by Dietitians to Alleviate Mothers' Anxieties

OBJECTIVE

The purpose of this study was to clarify whether the support activities of dietitians during disasters were able to address the problems faced by mothers about their children's diet and nutrition.

METHODS

Dietitians (7 in total) and mothers (8) were selected by the snowball sampling method. Semi-structured interviews were used to conduct focus group interviews about children's diet and nutrition. Verbatim data were generated, and an inductively qualitative descriptive analysis was conducted.

RESULTS

Six categories were generated for each group. Dietitians responded to problems that mothers had regarding their children's diet and nutrition via 2 activities: [dealing with allergy food shortages] and [school lunch support].

CONCLUSION

It is important for dietitians to recommend stockpiling allergy-friendly foods to accommodate children with allergies and achieve early resumption of school lunches to meet children's nutritional needs.

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.

Longitudinal Study on Relationships among Snack Energy Intake, Body Mass Index, and Nutrient Intake in Japanese Children Aged 6-7 Years

A longitudinal study was conducted to assess associations between snack energy intake and either body mass index (BMI) or nutrient intake in Japanese children. A baseline survey was conducted with 243 children aged 6-7 y, and follow-up was performed 4 y later. Finally, 189 subjects were selected for the analysis. Snack intakes were obtained from self-administered records by guardians. The daily habitual whole dietary intake and exercise/sleep hours were obtained by questionnaires during the follow-up. Subjects were grouped into three, as per snack energy intake tertiles at baseline. Differences and linear trends between the three groups were tested for the mean values of snack energy intake, BMI, and nutrient density, 4 y after the baseline survey. In follow-up, the snack energy intake (kcal) in females was significantly higher in the intermediate (335±35, p<0.01) and high (318±32, p<0.05) groups than in low group (196±25). There was no significant difference in follow-up BMI in the three groups. However, after adjustment of the baseline BMI, a significantly positive linear trend (p<0.05) was observed in the follow-up BMI in females. There was no significant difference in total energy intake per day. In contrast, a significantly negative linear trend (p<0.05) was observed among the three groups in dietary nutrient density of calcium and vitamin A in females. These results suggest that, in females, a higher intake of snacks may affect the daily dietary balance, resulting in a higher BMI and lower mineral and vitamin intakes.

The Association between Milk Intake and Nutrient Intake Adequacy among Japanese Female Junior High School Students: A Cross-Sectional Study

The consumption of dairy products, including milk, may be important for improving the overall quality of a diet. The aim of this study was to examine the relationship between milk intake and nutritional adequacy among Japanese female junior high school students. The participants of this study were Japanese female junior high school students aged between 12 and 15 years. Dietary habits over the past month were assessed by a brief self-administered diet history questionnaire. The adequacy of each nutrient intake was determined based on the Dietary Reference Intakes for Japanese 2020, with two goals: the estimated average requirement for fourteen nutrients and tentative dietary goals for preventing lifestyle-related diseases for six nutrients. The participants were classified into five groups according to milk intake (Q1 (lowest) to Q5 (highest)) by quintile. The adequacy of vitamin B₂, calcium, magnesium, and potassium were higher among students with a higher milk consumption than among those with a lower milk consumption. However, the intake of saturated fatty acids was in excess among higher milk consumers. The present study suggests that milk intake was related to an adequate intake of some vitamins and minerals and an inadequate intake of saturated fatty acids among Japanese female junior high school students.

A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era

OBJECTIVE

The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies.

DESIGN

We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate.

SETTING

Low-, middle- and high-income countries.

PARTICIPANTS

Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age.

RESULTS

Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects.

CONCLUSIONS

Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00693-6.

School-based nutrition interventions can improve bone health in children and adolescents

Objectives

Osteoporosis is a major global health problem, and optimizing bone health during childhood and adolescence with adequate calcium and vitamin D intake is a recommendation to prevent the disease. School milk programs may be a viable approach to help children and adolescents increase calcium and vitamin D intakes while improving their bone health.

Methods

A review of the literature was conducted on school milk programs, including examination of details regarding these studies and their participants, and assessments of their effects on bone health in children and adolescents.

Results

Nearly all studies reviewed showed significant increases in the bone health behaviors and outcomes that were measured, such as bone mineral density, milk consumption, and calcium and vitamin D intake.

Conclusions

School milk programs can be effective in improving bone health in children and adolescents, and public health policies should be considered to help support and fund effective programs that promote bone health and prevent osteoporosis in population health.

Levels of Physical Fitness and Weight Status in Children and Adolescents: A Comparison between China and Japan

This study compared the physical fitness level and weight status of children and adolescents in China and Japan. Children and adolescents aged 7–18 years were recruited (China: n = 5660; Japan: n = 5660). Physical fitness was assessed using seven core items—grip strength, 30-s sit-ups, standing long jump, sit-and-reach, 20-s repeated straddling, 20-m shuttle run test, and 50-m dash. A physical fitness index (PFI) was calculated by adding all items’ Z-scores. We conducted comparisons of PFI and its distribution, each physical fitness item, and weight status for individuals from China and Japan across all ages. The PFI was lower in China than in Japan for all age groups, with an especially large difference at age 18 years for boys (a difference of 9.05) and girls (a difference of 9.10) (p < 0.001). The same result was seen for the seven items. The PFI distribution for children and adolescents was more disperse among those in Japan than among those in China. Obesity prevalence was 2.84 times higher in China than in Japan. An inverted U-shaped relationship was observed between physical fitness and nutritional status. Children and adolescents showed markedly lower physical fitness and higher obesity prevalence in China than in Japan.

Mothers' Nutrition Knowledge Is Unlikely to Be Related to Adolescents' Habitual Nutrient Intake Inadequacy in Japan: A Cross-Sectional Study of Japanese Junior High School Students

Dietary habits in adolescence persist into adulthood; thus, it is important to identify the factors that influence adolescent diet and establish a healthy diet. This study aimed to examine the association between mothers' nutrition knowledge and their children's nutrient intake inadequacy among Japanese junior high school student-mother dyads. The participants were 288 students and their mothers. Data regarding mothers' nutrition knowledge were obtained using a validated, self-administered general nutrition knowledge questionnaire for Japanese adults (JGNKQ). Participants were categorised into two groups according to the mothers' total JGNKQ scores. Adolescents' dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire. Inadequacy of each nutrient intake was assessed using the cut-point method, which showed that 14 nutrients were below "estimated average requirement (EAR)" and five nutrients were outside the range of "tentative dietary goal to prevent lifestyle-related diseases (DG)". In the habitual daily nutrient intakes and the proportion of nutrient intake inadequacy of the students, no differences were observed according to mother's nutritional knowledge level. Our findings suggest that mothers' nutrition knowledge may not be directly associated with adolescents' nutrient intake among Japanese junior high school student-mother dyads.

Breakfast skipping is related to inadequacy of vitamin and mineral intakes among Japanese female junior high school students: a cross-sectional study

Breakfast skipping is a public health issue which affects nutrient intake among adolescents worldwide. However, there have been few reports comparing intake and reference values to assess the deficiency of nutrient intake between breakfast consumers and skippers. Therefore, the present study aimed to examine the relationship between breakfast skipping and adequacy of total habitual nutrient intake among junior high school female students. The participants were 516 Japanese female junior high school students. Dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire. Inadequacy of each nutrient intake was assessed by the cut-point method, based on the estimated average requirement for fourteen nutrients and on dietary goal values for five nutrients. The overall nutritional inadequacy in participants was assessed by the number of consumed nutrients which did not meet the requirements as per the dietary reference intakes for Japanese, 2015 version. The participants were classified into two groups according to the frequency of breakfast eating: breakfast consumers (seven times/week) and breakfast skippers (0-6 times/week). Adequacy of vitamin A, vitamin B1, vitamin B2, vitamin C, Ca, Fe, Zn and K was higher among breakfast consumers than among skippers. Breakfast consumers had more intakes of fruits, vegetables and dairy products. Our findings suggest that breakfast skipping was related to deficiencies in vitamin and mineral intakes, and to an unfavourable dietary pattern, among Japanese female junior high school students.

The Association between Milk and Dairy Products Consumption and Nutrient Intake Adequacy among Japanese Adults: Analysis of the 2016 National Health and Nutrition Survey

Consumption of dairy products in the usual diet may be important for improving the overall quality of dietary intake. This study aimed to assess the difference in nutrient intake adequacy according to the intake of dairy products based on a 1-day weighed dietary record of Japanese adults from the 2016 National Health and Nutrition Survey. Nutritional adequacy was determined based on the Dietary Reference Intakes for Japanese 2015, with 2 goals: Tentative dietary goals (DG) for preventing lifestyle-related diseases, and the estimated average requirement (EAR). According to the dairy products consumption, participants were categorized into three groups (milk, other dairy product, or non-dairy), and the total number of those not meeting DG and EAR was compared. Non-dairy consumers were less likely to meet both DG and EAR compared to dairy consumers. Dairy consumers were more likely to exceed the DG for saturated fat than non-dairy consumers. Japanese adult dairy consumers were more likely to have adequate nutritional intake than non-dairy consumers, especially for calcium. We also observed a higher saturated fat intake in dairy consumers, which might be due to a certain dietary pattern in this group. Further investigation is needed to determine dairy intake and its influence on dietary quality among the Japanese population.

Differences in Cardiorespiratory Fitness between Chinese and Japanese Children and Adolescents

Background: This study aimed to compare the difference in cardiorespiratory fitness between Chinese and Japanese children and adolescents. Methods: Participants comprised 9025 children and adolescents aged 7–18 years from China and Japan. Cardiorespiratory fitness (CRF) was measured by performance in the 20 m shuttle run test (20mSRT) and estimated maximal oxygen consumption (VO_2max). Differences in CRF between countries were evaluated by t-tests. Centile curves for the 20mSRT and VO_2max values were constructed for Chinese and Japanese children and adolescents, respectively, using the Lambda Mu and Sigma (LMS) method. Results: (1) For most of the age groups, the 20mSRT and VO_2max performances among Chinese participants were lower than among Japanese participants. (2) Japanese children had the most apparent gains in P₁₀, P₅₀, and P₉₀ VO_2max values in primary school; however, they gradually decreased in middle school. For Chinese girls, the P₁₀, P₅₀, and P₉₀ VO_2max values decreased gradually with age. (3) The VO_2max value among Japanese children increased; however, it decreased or remained flat among Chinese children in primary school. Conclusions: CRF among Chinese participants was lower than among Japanese participants while the VO_2max value showed different trends in primary school. Effective measures should be taken to improve CRF among children and adolescents.

Universal school lunch programme closes a socioeconomic gap in fruit and vegetable intakes among school children in Japan

Background

Universal school lunch programmes are expected to cover all children equally, compared with selective programmes that may stigmatize socially vulnerable children. However, the effectiveness of universal programmes in closing dietary disparity has not been empirically proven. We evaluated whether Japan's universal school lunch programmes contribute to a reduction in the socioeconomic status (SES)-related gradient in fruit and vegetable intakes.

Methods

We analyzed data for 719 school children aged 6-12 years in a population-based survey conducted in the greater Tokyo metropolitan area. We measured dietary intakes using a validated self-administered brief diet history questionnaire for young children (BDHQ-10 y). We assessed parental education, annual household income and maternal employment status as SES indicators of children. We used multiple regression to estimate mean fruit and vegetable intakes by parental education and household income, and the contribution of school lunch to reducing the SES-related gradient in fruit and vegetable intakes.

Results

Compared with children with high maternal education (>15 years), those with low maternal education (<13 years) had less vegetable intake by 22.3 g/1000 kcal (95% confidence interval = 12.5, 32.2) and less fruit intake by 7.5 g/1000 kcal (95% confidence interval = -2.4, 17.3). However, fruit and vegetable intakes from school lunch did not vary by SES, indicating that school lunch intake alleviated the SES-related gradient of total vegetable intake by 9.9% and that of fruit intake by 3.4%.

Conclusions

Universal school lunch programmes can partially contribute to a reduction in the SES-related gradient in dietary intakes.

The frequency of cooking dinner at home and its association with nutrient intake adequacy among married young-to-middle-aged Japanese women: the POTATO Study

Home cooking has been suggested as a key to healthy dietary intakes. However, little is known about the association between cooking behaviour and nutrient intake among young-to-middle-aged women. We aimed to investigate the association between home cooking frequency and nutrient intake adequacy among married Japanese women. Self-administered questionnaires were used to assess the weekly frequency of cooking dinner at home and habitual nutrient intake during the preceding month. We evaluated nutrient intake adequacy by comparing the self-reported intake with two indices of the dietary reference intakes for Japanese (2015): the estimated average requirement (EAR) of fourteen nutrients, and the 'tentative dietary goal for preventing lifestyle-related diseases' (DG) of seven nutrients. A total of 143 participants (25-44 years old) completed the questionnaires, with 32·9 % of participants reporting a weekly home cooking frequency of seven times/week. Women with a higher home cooking frequency (seven times/week) were more likely to have children (P = 0·001) than those with a lower home cooking frequency (0-6 times/week). Of the nutrients evaluated, there was no significant difference between the two groups in meeting EAR and DG. Our findings suggest that daily home cooking may not be necessary to achieve adequate nutrient intake, specifically among married, young-to-middle-aged Japanese women.

Household food unavailability due to financial constraints affects the nutrient intake of children

Background

A household’s food unavailability due to financial constraints may act as a barrier to a healthy diet for children. This cross-sectional study aimed to examine the association between food unavailability due to financial constraints and the nutrient intake of children aged 1–15 years using data of a nationwide survey among the Japanese population.

Methods

Datasets from the National Health and Nutrition Survey and the Comprehensive Survey of Living Conditions in Japan, 2014 were used for this study. The dietary intakes of energy and nutrients were estimated using a one-day dietary record. Participants were categorized into four subgroups, according to their households’ frequency of food unavailability due to financial constraints. The adjusted means and 95% confidential intervals of the energy and nutrient intakes in each subgroup were calculated using analysis of covariance. The statistical trends across the subgroups were examined using analysis of covariance.

Results

Of the 895 children included in the analysis, 202 (22.6%) were classified into subgroups with frequent food unavailability due to financial constraints. Significant decreases in the mean intakes of carbohydrate, calcium, retinol activity equivalents, riboflavin, folate and vitamin C were observed with increases in the frequency of households’ food unavailability. In contrast, frequent food unavailability was associated with higher total fat and vitamin B12 intake.

Conclusion

A substantial proportion of children in Japan experienced food unavailability due to financial constraints, and this affected their nutrient intake. Adopting a population approach may help overcome this problem.