Thirteen-Year Trends in Dietary Patterns among Japanese Adults in the National Health and Nutrition Survey 2003⁻2015: Continuous Westernization of the Japanese Diet

Longitudinal and regional association between dietary factors and prevalence of Crohn's disease in Japan

Although a Western diet has been identified as a risk factor for Crohn's disease (CD), there is still controversy surrounding the specific foods that may contribute to the development of the disease. In this study, we examined the association between food intake and the prevalence of CD in Japan, as Japanese patients with CD are known to have limited genetic involvement. We identified changes in food intake associated with an increase in the number of patients with CD by analyzing the per capita consumption of food types from 1981 to 2014. Additionally, we examined the association between CD prevalence and food intake in each prefecture. Finally, the relationship between food intake and estimated age at CD onset was also investigated. Between 1981 and 2014, we observed Increased consumption of meat, eggs, milk and dairy products, oil, and potatoes and decreased consumption of grains, beans, vegetables, fruit, fish, sugar, and seaweed. The annual incidence of CD increased by 1388% over the same period. We found that meat consumption was significantly associated with CD prevalence (β = 0.503, p = 0.0003), while a significant negative correlation was observed between CD prevalence and fruit and vegetable consumption (fruit, β = 0.464, p = 0.0012; vegetables, β = 0.404, p = 0.0023). Furthermore, we estimated that the peak consumption of more meat and less fruit and vegetables and the peak age of CD onset occurred within the age range of 20-24 years. Our study identified a clear correlation between the consumption of meat, fruits, and vegetables and the prevalence of CD in Japan. Additionally, we found an association between meat, fruit, and vegetable consumption and the age at CD onset.

Trends and Characteristics of Brown Rice Consumption among Adults in Japan: An Analysis of the National Health and Nutrition Surveys, 2012-2019

Brown rice is a familiar whole grain in Japan. We examined national trends in brown rice consumption among Japanese adults aged ≥20 years old, using individual-level data from the National Health and Nutrition Surveys conducted between 2012 and 2019. We employed multivariable logistic regression to identify factors associated with brown rice consumption. The 95th percentile of daily brown rice intake remained at 0.0 g throughout the study period. The percentage of brown rice consumers increased from 1.8% (95% confidence interval: 1.6-2.1) in 2012 to 2.6% (95% confidence interval: 2.0-3.4) in 2019. Compared with individuals who consumed only white rice, brown rice consumers had significantly higher mean intake levels of macronutrients, legumes, vegetables, fruits, and nuts. Brown rice consumption was positively associated with certain sociodemographic characteristics (being female, older age, residing in a major city, living without very young children, and having higher education levels) and health behaviors (lower body mass index, engaging in regular exercise, and being a former or never smoker). Despite its potential nutritional benefits in balanced diets, only a small fraction of adults in Japan consume brown rice, indicating a need for further promotion, particularly among individuals with characteristics associated with brown rice consumption.

A Cross-Sectional Pilot Study on Association of Ready-to-Eat and Processed Food Intakes with Metabolic Factors, Serum Trans Fat and Phospholipid Fatty Acid Compositions in Healthy Japanese Adults

Frequently consuming processed and ready-to-eat (RTE) foods is regarded as unhealthy, but evidence on the relationships with circulating metabolic parameters is lacking. Japanese residents of a metropolitan area, 20 to 50 years of age, were studied in terms of anthropometric and biochemical parameters, including circulating trans fat and serum phospholipid fatty acid levels. Processed foods, except drinks and dairy items, were categorized according to requirements for additional ingredients and cooking before eating. Processed and RTE foods were divided according to fat and/or oil content into non-fatty or fatty foods. The participants were grouped into tertiles based on the energy percent (En%) derived from fatty-RTE foods. Fatty-RTE En% showed negative associations with fish, soybean and soybean products, dairy, eggs, vegetables, seaweed/mushrooms/konjac, fruit and non-oily seasonings reflecting lower dietary fiber, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and mineral and vitamin intakes, while the associations with fat/oil, confectionaries, and sweet beverages were positive. Fatty-RTE En% consumption was positively associated with alkaline phosphatase, leucine aminopeptidase, direct bilirubin, elaidic acid, and C18:2 but inversely associated with HDL cholesterol, C15:0, C17:0, EPA, and DHA. A higher fatty-RTE food intake was suggested to contribute to unbalanced nutrient intakes, as reflected in lipid metabolic parameters. Further large-scale studies are needed to evaluate the quality and impacts of RTE foods.

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.

Association of Pro-Inflammatory Diet with Long-Term Risk of All-Cause and Cardiovascular Disease Mortality: NIPPON DATA80

AIM

A pro-inflammatory diet may increase the risk of cardiovascular disease (CVD) and all-cause mortality. However, this remains inconclusive as there is yet no study using a dietary record method that has been conducted in a large general population. Furthermore, an underestimation of the pro-inflammatory diet may exist due to the unmeasured effect of salt intake. Thus, in this study, we aimed to examine how pro-inflammatory diet is associated with the long-term risk of all-cause and CVD mortality in a representative Japanese population.

METHODS

A national nutrition survey was conducted throughout Japan in 1980. After considering the exclusion criteria, 9284 individuals (56% women aged 30-92 years) were included in this study. In total, 20 dietary parameters derived from 3-day weighed dietary records were used to calculate the dietary inflammatory index (DII). The causes of death were monitored until 2009. The Cox proportional hazards model was used to determine multivariable-adjusted hazard ratios (HRs). Stratified analysis according to salt intake level was also performed.

RESULTS

Compared with the lowest quartile of DII, multivariable-adjusted HRs (95% confidence intervals) in the highest quartile were 1.28 (1.15, 1.41), 1.35 (1.14, 1.60), 1.48 (1.15, 1.92), 1.62 (1.11, 2.38), and 1.34 (1.03, 1.75) for all-cause mortality, CVD mortality, atherosclerotic CVD mortality, coronary heart disease mortality, and stroke mortality, respectively. Stratified analysis revealed stronger associations among individuals with higher salt intake.

CONCLUSIONS

As per our findings, a pro-inflammatory diet was determined to be positively associated with the long-term risk of all-cause and CVD mortality in a representative Japanese population. Thus, considering both salt intake and pro-inflammatory diet is deemed crucial for a comprehensive assessment of CVD risk.

Development of a Machine Learning Model for Classifying Cooking Recipes According to Dietary Styles

To complement classical methods for identifying Japanese, Chinese, and Western dietary styles, this study aimed to develop a machine learning model. This study utilized 604 features from 8183 cooking recipes based on a Japanese recipe site. The data were randomly divided into training, validation, and test sets for each dietary style at a 60:20:20 ratio. Six machine learning models were developed in this study to effectively classify cooking recipes according to dietary styles. The evaluation indicators were above 0.8 for all models in each dietary style. The top ten features were extracted from each model, and the features common to three or more models were employed as the best predictive features. Five well-predicted features were indicated for the following seasonings: soy sauce, miso (fermented soy beans), and mirin (sweet cooking rice wine) in the Japanese diet; oyster sauce and doubanjiang (chili bean sauce) in the Chinese diet; and olive oil in the Western diet. Predictions by broth were indicated in each diet, such as dashi in the Japanese diet, chicken soup in the Chinese diet, and consommé in the Western diet. The prediction model suggested that seasonings and broths could be used to predict dietary styles.

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.

Consumption of highly processed foods in relation to overall diet quality among Japanese adults: a nationwide study

OBJECTIVE

To (i) examine the consumption of highly processed foods (HPF) in relation to diet quality among Japanese adults and (ii) compare the results when dishes prepared away home are disaggregated into food ingredients before classification by processing levels and the results when they are not.

DESIGN

Cross-sectional analysis using 4-day dietary record data. Foods were categorised by level of processing using the framework developed by the University of North Carolina at Chapel Hill. Specifically, dishes prepared away from home were classified at both the food level (classified after disaggregation into ingredients) and dish level (classified without disaggregation). Diet quality was assessed using the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3.

SETTING

Twenty areas in Japan.

PARTICIPANTS

Adults aged 20-69 years (n 388).

RESULTS

Energy contribution of HPF was higher when dishes prepared away from home were classified at dish level than food level (48·3 % v. 32·9 %, P < 0·0001). Regardless of the classification method, cereals and starchy foods were the top food groups contributing to total energy intake from HPF. After adjusting for potential confounders, participants in higher tertiles of the energy contribution of HPF had lower total scores for Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3 (P for trend ≤ 0·007 for all), irrespective of the food- or dish-level classification.

CONCLUSIONS

HPF accounted for at least one-third of energy intake of Japanese adults. Regardless of the classification methods for dishes prepared away from home, higher consumption of HPF was associated with lower diet quality.

Relationship between dietary patterns and physical performance in the very old population: a cross-sectional study from the Kawasaki Aging and Wellbeing Project

OBJECTIVES

As the world's population is ageing, improving the physical performance (PP) of the older population is becoming important. Although diets are fundamental to maintaining and improving PP, few studies have addressed the role of these factors in adults aged ≥ 85 years, and none have been conducted in Asia. This study aimed to determine the dietary patterns (DP) and examine their relationship with PP in this population.

DESIGN

This cross-sectional study (Kawasaki Aging and Wellbeing Project) estimated food consumption using a brief-type self-administered diet history questionnaire. The results were adjusted for energy after aggregating into thirty-three groups, excluding possible over- or underestimation. Principal component analysis was used to identify DP, and outcomes included hand grip strength (HGS), timed up-and-go test, and usual walking speed.

SETTING

This study was set throughout several hospitals in Kawasaki city.

PARTICIPANTS

In total, 1026 community-dwelling older adults (85-89 years) were enrolled.

RESULTS

Data of 1000 participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1: various foods, DP2: red meats and coffee, DP3: bread and processed meats) were identified. The results of multiple regression analysis showed that the trend of DP2 was negatively associated with HGS (B, 95 % CI -0·35, -0·64, -0·06).

CONCLUSIONS

This study suggests a negative association between HGS and DP characterised by red meats and coffee in older adults aged ≥ 85 years in Japan.

Association between the Japanese Diet and Coronary Artery Disease in Patients Undergoing Coronary Angiography

Several cohort studies have reported that the Japanese diet is associated with reduced cardiovascular disease mortality. However, the results were not always consistent, and most of those studies conducted dietary surveys around 1990. We investigated the association between the Japanese diet and coronary artery disease (CAD) in 802 patients undergoing coronary angiography. The Japanese diet score was defined as the sum of scores of the intakes of fish, soy products, vegetables, seaweed, fruits, and green tea. CAD was found in 511 patients, of whom 173 had myocardial infarction (MI). Intakes of fish, soy products, vegetables, seaweed, fruits, and green tea were lower in patients with CAD, especially in those with MI, than in those without CAD. As a result, the Japanese diet score was significantly lower in patients with CAD than in those without CAD (p < 0.001). To clarify the association between the Japanese diet and CAD, the 802 study patients were divided into three tertiles by the Japanese diet score. The proportion of CAD decreased with the Japanese diet score, reaching 72% in patients at T1 (lowest score), 63% at T2, and 55% at T3 (highest) (p < 0.05). The proportion of MI also decreased with the Japanese diet score, reaching 25% at T1, 24% at T2, and 15% at T3 (p < 0.05). In a multivariate analysis, compared with T1, the adjusted odds ratios for CAD and MI were 0.41 (95% confidence interval [CI]: 0.26-0.63) and 0.61 (95% CI: 0.38-0.99) for T3, respectively. Thus, the Japanese diet was found to be inversely associated with CAD in Japanese patients undergoing coronary angiography.

Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations

While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies.

Current dietary intake of the Japanese population in reference to the planetary health diet-preliminary assessment

Introduction

We sought to assess the Japanese diet by examining the current dietary intake in Japan using the global reference diet from the EAT-Lancet Commission (Planetary Health Diet; PHD), from the perspective of protein intake in different age groups.

Methods

Average dietary intake by food group in the Japan National Health and Nutrition Survey 2019 (NHNS 2019) was converted to the PHD food groups, and the diet gap (DG) (%) of the global reference of the PHD was calculated by age group.

Results

Although the DG of the intake was excessive compared with the global reference of the PHD in most food groups in all age groups (7.1-416%), the intake exceeded the upper limit of the range only for red meat (640%). Red meat had the highest DG among subjects in their 40s, although the DG decreased with increasing age. Protein intake was within the possible range and did not greatly exceed the recommended dietary intake in the Japanese standard.

Discussion

The current Japanese diet contains an excessive intake of red meat in terms of the global reference of the PHD. This trend is similar to that previously reported in various western regions and countries. However, the Japanese diet does not significantly exceed the recommended protein intake for Japanese people, suggesting that the PHD is an environmentally friendly and healthy choice for younger and older age groups in an aging Japanese society. Policy makers need to develop sustainable and healthy food-based dietary guidelines in addition to providing food and nutrition education and developing a food environment that encourages sustainable and healthy choices to support dietary change.

Highly Processed Food Consumption and Its Association with Anthropometric, Sociodemographic, and Behavioral Characteristics in a Nationwide Sample of 2742 Japanese Adults: An Analysis Based on 8-Day Weighed Dietary Records

This cross-sectional study assessed highly processed food (HPF) consumption and its association with individual characteristics in a nationwide sample of Japanese adults. Eight-day weighed dietary records were obtained from 2742 free-living adults aged 18-79 years across Japan. HPFs were identified based on a classification method developed by researchers at the University of North Carolina at Chapel Hill. The basic characteristics of the participants were assessed using a questionnaire. On average, HPF contributed to 27.9% of daily energy intake. The contribution of HPF to the daily intake of 31 nutrients ranged from 5.7% for vitamin C to 99.8% for alcohol (median, 19.9%). Cereals and starchy foods were the main food groups that contributed to the total energy intake of HPF. Multiple regression analysis showed that the older group (60-79 years) had a lower HPF energy contribution than the younger group (18-39 y) (regression coefficient (β) = -3.55, p < 0.0001). Compared to current smokers, past and never-smokers had lower HPF energy contributions (β = -1.41, p < 0.02; and -4.20, p < 0.0001, respectively). In conclusion, HPFs account for approximately one-third of energy intake in Japan. Younger age and current smoking status should be considered in future intervention strategies to reduce HPF consumption.

Development of a Diet Quality Score for Japanese and Comparison With Existing Diet Quality Scores Regarding Inadequacy of Nutrient Intake

BACKGROUND

Few studies have explored optimal diet quality scores in Japan.

OBJECTIVES

We developed a Diet Quality Score for Japanese (DQSJ) and examined the associations of DQSJ and existing diet quality scores with inadequacy of nutrient intake in Japanese adults.

METHODS

Candidate components of the DQSJ were extracted from well-established diet quality scores: Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet score (AMED), and Dietary Approaches to Stop Hypertension (DASH). From candidates, we selected the components of the DQSJ, considering potential health effects of the components (from the Global Burden of Disease Study) and dietary intake in Japan. The DQSJ included 10 components: fruits, vegetables, whole grain, dairy, nuts, legumes, fish, red and processed meat, sugar-sweetened beverages, and sodium. We calculated the DQSJ, HEI-2015, AHEI-2010, AMED, DASH, and Japanese Food Guide Spinning Top score (JFGST) based on 4-d dietary records of 392 Japanese aged 20-69 y. Inadequate intakes of 21 nutrients were assessed using the DRIs for Japanese. Logistic regression was used to examine the prevalence of inadequate nutrient intake according to quartiles of the scores.

RESULTS

All examined scores except the JFGST were moderately to strongly correlated with each other (Spearman correlation coefficients: 0.52-0.84). They were inversely associated with the prevalence of inadequate intake of most nutrients (n = 16 for DQSJ and HEI-2015, n = 13 for AHEI-2010 and DASH, n = 17 for AMED, compared with n = 4 for JFGST). AMED was also positively associated with the prevalence of inadequate sodium intake, whereas no such associations were observed for the other scores.

CONCLUSIONS

Similar to HEI-2015, AHEI-2010, and DASH, the DQSJ was generally associated with the low prevalence of inadequate intake of most nutrients in Japanese adults. Further evaluations against biomarkers and health outcomes are warranted.

Dietary Patterns and New-Onset Type 2 Diabetes Mellitus in Evacuees after the Great East Japan Earthquake: A 7-Year Longitudinal Analysis in the Fukushima Health Management Survey

Background: Dietary patterns may be linked to the incidence of type 2 diabetes mellitus (T2DM) after disasters. We investigated the association between dietary patterns and new-onset T2DM in evacuees of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Methods: Among the 22,740 non-diabetic participants aged 20-89 years who completed the dietary assessment in the Fukushima Health Management Survey between July 2011 and November 2012, the incidence of T2DM was evaluated until 2018. Principal component analysis with varimax rotation was applied to derive dietary patterns based on a validated, short-form food frequency questionnaire. The identified dietary patterns were categorized as typical Japanese, juice, and meat. Results: The cumulative incidence of T2DM was 18.0 and 9.8 per 1000 person-years in men and women, respectively, during the follow-up period. The multiple-adjusted hazard ratio (95% confidence interval) of the highest vs. lowest quartile of the typical Japanese pattern scores for T2DM was 0.80 (0.68, 0.94; P for trend = 0.015) in total, 0.85 (0.68, 1.06; P for trend = 0.181) in men, and 0.76 (0.60, 0.95; P for trend = 0.04) in women. Conclusions: A typical Japanese dietary pattern may be associated with a reduced new-onset T2DM risk in evacuees, especially women, after the Great East Japan Earthquake and the FDNPP accident.

Association of Japanese and Mediterranean Dietary Patterns with Muscle Weakness in Japanese Community-Dwelling Middle-Aged and Older Adults: Post Hoc Cross-Sectional Analysis

The association of Japanese and Mediterranean dietary patterns with muscle weakness in middle-aged and older Japanese individuals is unclear. This cross-sectional study investigated the association between Japanese and Mediterranean dietary patterns and muscle weakness in community-dwelling, middle-aged, and older Japanese individuals (enrolled from 2007 to 2011). Based on the dietary consumption information obtained from the brief self-administered diet history questionnaire, we assessed adherence to the Japanese (12-component revised Japanese diet index (rJDI12)) and Mediterranean (alternate Mediterranean diet (aMed) score) dietary patterns. Muscle weakness was defined as handgrip strength <28 and <18 kg for men and women, respectively. Logistic regression was used to ascertain the relationship between dietary pattern and muscle weakness. In our study, with 6031 participants, the Japanese, but not Mediterranean, dietary pattern was inversely associated with muscle weakness (p for trend = 0.031 and 0.242, respectively). In the model adjusted for confounders, including energy intake, the highest quartile of rJDI12 scores (9-12 points), and the rJDI12 scores, entered as continuous variables, showed an independent association (odds ratio (95% CI), 0.703 (0.507-0.974), and 0.933 (0.891-0.977), respectively). Our findings showed that adherence to the Japanese dietary pattern is associated with a low prevalence of muscle weakness.

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.

Changes in the Eicosapentaenoic Acid to Arachidonic Acid Ratio in Serum over 10 Years in a Japanese Community: The Hisayama Study

AIM

Circulating omega-3 and omega-6 polyunsaturated fatty acids may to contribute to cardiovascular health at the population level. Over a decade, we investigated changes in the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio, and in serum concentrations of the individual fatty acids, in a Japanese community.

METHODS

Community surveys took place in 2002-2003 and 2012-2013 in a rural area of Japan. The community surveys included 3,194 and 3,220 community dwellers aged ≥ 40 years who did not take EPA medication in 2002-2003 and 2012-2013, respectively. Fatty acid fractionations in serum were measured using a gas chromatography method. Changes in the serum EPA/AA ratio over time were examined using linear mixed models.

RESULTS

Overall, the average serum EPA/AA ratio decreased over the 10 years. A decreasing trend in the serum EPA/AA ratio occurred in all age groups except participants aged ≥ 80 years, with larger decreases in the younger age groups. A similar decline in serum EPA/AA ratio occurred in participants with and those without lipid-lowering therapy. Serum EPA concentrations were slightly increased in the whole population but remained stable or even decreased in participants aged 40-69. In contrast, the average serum AA concentrations increased in all age groups.

CONCLUSION

In a Japanese community, the serum EPA/AA ratio decreased over 10 years at the population level, especially in middle-aged participants.

Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

The Lifelong Health Support 10: a Japanese prescription for a long and healthy life

Background

Although the age-adjusted incidence and mortality of cancer and cardiovascular disease (CVD) have been decreasing steadily in Japan, both diseases remain major contributors to morbidity and mortality along with the aging society. Herein, we aim to provide a prescription of 10 health tips for long and healthy life named the “Lifelong Health Support 10 (LHS10).”

Method

The LHS10 was developed by the preventive medicine specialists at the National Cerebral and Cardiovascular Center in Suita, where it has been used for health guidance to prevent CVD, cancer, and cognitive decline in addition to their major risk factors such as hypertension, diabetes, and obesity. It consisted of the lifestyle modification recommendations of the 2014 Japanese Society of Hypertension guidelines and the 2017 Japan Atherosclerosis Society Guidelines for preventing atherosclerotic CVD. Further, it came in line with other international lifestyle modification guidelines. In this narrative review, we summarized the results of several Japanese epidemiological studies investigating the association between the LHS10 items and the risk of cancer, CVD, and other chronic diseases including dementia, diabetes, and chronic kidney disease.

Results

The LHS10 included avoiding smoking and secondhand smoke exposure, engaging in physical activity, refraining from excessive alcohol drinking, reducing fried foods and sugary soft drinks, cutting salt in food, consuming more vegetables, fruits, fish, soy foods, and fibers, and maintaining proper body weight. All items of the LHS10 were shown to reduce the risk of cancer, CVD, and other chronic diseases.

Conclusions

The LHS10 can be a helpful tool for health guidance.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00085.

Rice-Based Diet and Cardiovascular Disease Mortality in Japan: From the Takayama Study

Rice is the staple food in Japan and many other Asian countries, but research on rice-based diets and cardiovascular disease is limited. We aimed to evaluate the association between rice consumption as grain dishes and cardiovascular disease mortality in comparison with bread and noodle consumption. The subjects were 13,355 men and 15,724 women aged ≥35 years who enrolled in the Takayama Study. Diet intake was assessed using a validated food-frequency questionnaire. Causes of death were identified from death certificates. Cardiovascular disease was defined according to the International Classification of Diseases and Health Related Problems, 10th Revision (code I00–I99). Hazard ratios in the second, third, and highest quartiles versus the lowest quartile of rice intake for cardiovascular disease mortality were 0.98, 0.80, and 0.78 for men, respectively (trend p = 0.013), but no significant association was observed among women. Rice intake was positively correlated with the intake of soy products and seaweed, and negatively correlated with the intake of meat and eggs. Neither bread nor noodles were associated with cardiovascular disease mortality. In Japan, choosing rice as a grain dish is likely to be accompanied by healthier foods as side dishes, which may have a potential role in the prevention of cardiovascular disease.

Development of a Digital Photographic Food Atlas as a Portion Size Estimation Aid in Japan

This study aimed to develop a digital photographic food atlas as a portion size estimation aid. Commonly consumed foods were identified from the 5512-day weighed dietary records of 644 Japanese adults. Portion sizes were determined based on the market research and distribution of food consumption in the dietary records. Each food item was classified into one of two photo types: a series of photographs showing gradually increasing portion sizes or guide photographs representing a range of portion sizes and food varieties in one photograph. Photographs of the food were taken at an angle of 42°, along with appropriate reference objects such as chopsticks. In total, 209 food and dish items were included in the food atlas. Series of photographs were taken for 105 items that are not usually served in predetermined amounts (e.g., rice and pasta), whereas guide photographs were taken for 104 items usually served in predetermined amounts (e.g., bananas and cookies). Moreover, photographs were taken for 12 kinds of household measurement items, such as cups and glasses. The food atlas could be a valuable tool for estimating the portion size in dietary surveys. Evaluating the validity of this food atlas for portion size estimation is warranted.

Japanese-Style Diet and Cardiovascular Disease Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

This systematic review and meta-analysis elucidate the effects of the Japanese-style diet and characteristic Japanese foods on the mortality risk of cardiovascular disease (CVD), cerebrovascular disease (stroke), and heart disease (HD). This review article followed the PRISMA guidelines. A systematic search in PubMed, The Cochrane Library, JDreamIII, and ICHUSHI Web identified prospective cohort studies on Japanese people published till July 2020. The meta-analysis used a random-effects model, and heterogeneity and publication bias were evaluated with I² statistic and Egger’s test, respectively. Based on inclusion criteria, we extracted 58 articles, including 9 on the Japanese-style diet (n = 469,190) and 49 (n = 2,668,238) on characteristic Japanese foods. With higher adherence to the Japanese-style diet, the pooled risk ratios (RRs) for CVD, stroke, heart disease/ischemic heart disease combined (HD/IHD) mortality were 0.83 (95% CI, 0.77–0.89, I² = 58%, Egger’s test: p = 0.625, n = 9 studies), 0.80 (95% CI, 0.69–0.93, I² = 66%, Egger’s test: p = 0.602, n = 6 studies), and 0.81 (95% CI, 0.75–0.88, I² = 0%, Egger’s test: p = 0.544, n = 6 studies), respectively. Increased consumption of vegetables, fruits, fish, green tea, and milk and dairy products decreased the RR for CVD, stroke, or HD mortality. Increased salt consumption elevated the RR for CVD and stroke mortality. Increased consumption of dietary fiber and plant-derived protein decreased the RR for CVD, stroke, and HD/IHD mortality. The Japanese-style diet and characteristic Japanese foods may reduce CVD mortality. Most studies conducted diet surveys between 1980 and the 1990s. This meta-analysis used articles that evaluated the same cohort study by a different method. A new large-scale cohort study matching the current Japanese dietary habits is needed to confirm these findings.

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.

Maternal Iodine Intake and Neurodevelopment of Offspring: The Japan Environment and Children's Study

Inadequate maternal iodine intake affects thyroid function and may impair fetal brain development. This study investigated the association between maternal iodine intake during pregnancy and neurodevelopmental delay in offspring at 1 and 3 years of age using a nationwide birth cohort: the Japan Environment and Children’s Study. We assessed dietary iodine intake during pregnancy using a food frequency questionnaire and child neurodevelopment using the Japanese translation of the Ages and Stages Questionnaire, Third Edition. The risk of delay (score below the cut-off value) for fine motor domain at 1 year of age was increased in the lowest quintile iodine intake group compared with the fourth quintile iodine intake group. The risk of delay for problem-solving at 1 year of age was increased in the lowest and second quintile iodine intake group and decreased in the highest quintile iodine intake group. The risk of delay for communication, fine motor, problem-solving, and personal–social domains at 3 years of age was increased in the lowest and second quintile iodine intake group compared with the fourth quintile iodine intake group, while the risk of delay for fine motor and problem-solving domains was decreased in the highest quintile iodine intake group. Low iodine intake levels in pregnancy may affect child neurodevelopment.

Trends of Dietary Intakes and Metabolic Diseases in Japanese Adults: Assessment of National Health Promotion Policy and National Health and Nutrition Survey 1995–2019

Health Japan 21 is Japan’s premier health promotion policy encompassing preventive community health measures for lifestyle-related diseases. In this repeated cross-sectional survey, we report 24-year trends of type 2 diabetes mellitus (T2DM), obesity, hypertension, and their association with dietary intakes to evaluate Health Japan 21’s impact and identify gaps for future policy implementation. We analyzed data from 217,519 and 232,821 adults participating in the physical examination and dietary intake assessment, respectively, of the National Health and Nutrition Survey 1995–2019. Average HbA1c and BMI have significantly increased along with the prevalence of T2DM and overweight/obesity among males. Despite a significant decrease in daily salt intake, the decline in the combined prevalence of Grades 1–3 hypertension was non-significant. Seafood and meat intakes showed strong opposing trends during the study period, indicating a dietary shift in the Japanese population. Neither salt nor vegetable/fruit intake reached the target set by Health Japan 21. Metabolic disease trend differences between males and females highlight the need for a gender-specific health promotion policy. Future Health Japan 21 implementation must also consider locally emerging dietary trends.

The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: A descriptive review

BACKGROUND

The East Asia region is facing an increasing burden of overweight, obesity and related noncommunicable diseases, resulting from an ongoing nutrition transition. This study aimed to document the growing burden of overweight and obesity, and the accompanying dietary shifts, in the East Asia region and describe the policy responses to this.

METHODS

We present noncommunicable disease risk factor collaboration data on trends in the burden of malnutrition, and Euromonitor International data on trends in dietary purchases, in the East Asia region. We searched the NOURISHING and GINA databases to identify food and nutrition policies implemented in these countries.

RESULTS

There is an ongoing nutrition transition in the East Asia region, notably in upper-middle and lower-middle income countries. The prevalence of overweight, obesity, and accompanying health conditions, purchases of ultra-processed foods and beverages, and purchasing from supermarkets, fast-food and takeaway outlets, and other convenience retailers, are increasing. The policy response to this nutrition transition is limited, with the majority of policies implemented in higher-income countries.

CONCLUSIONS

East Asian countries are facing a growing burden of malnutrition, due in part to the dietary shifts occurring here. An ecological approach to policy intervention is needed to drive transformative food systems change.

Sustainable Home Meal Replacement (HMR) Consumption in Korea: Exploring Service Strategies Using a Modified Importance-Performance Analysis

The COVID-19 pandemic has changed traditional consumer consumption behavior and requires a new service strategy to cope with sustainable consumption. Moreover, it is necessary to focus academic attention on consumer behavior to cook and eat more easily amid Korea’s socioeconomic changes such as the increase in single-person households, aging, rising prices, and continuing economic recession. In this study, we used a revised importance–performance analysis (IPA) to identify specific measures to improve consumer satisfaction with home meal replacements (HMRs). An online survey of Korean adults who had purchased HMRs was conducted based on a convenience sampling method. According to the results, items that could be intensively improved were the ‘introduction of new dishes’, ‘creation of various flavors’, ‘cost-effectiveness, and ‘reasonable price’, whereas ‘easy to prepare’, ‘easily available’, and ‘identified country of origin’ received favorable assessments. With the growth of the non-face-to-face economy due to COVID-19, our findings suggest marketing strategies for sustainable HMR consumption.

Characterisation of breakfast, lunch, dinner and snacks in the Japanese context: an exploratory cross-sectional analysis

OBJECTIVE

To characterise different meal types by examining the contribution of specific meals to the total intakes and the nutritional quality of each meal.

DESIGN

A cross-sectional analysis was conducted based on dietary data collected using 4-d dietary record. Diet quality was assessed by the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3.

SETTING

Japan.

PARTICIPANTS

Adults aged 20-81 years (n 639).

RESULTS

Diet quality was, on average, highest for dinner, followed, in order, by lunch, breakfast and snacks. Breakfast, lunch, dinner and snacks, on average, accounted for 21 %, 32 %, 40 % and 11 % of total energy intake, respectively. For many nutrients, the percentage contribution to total intake did not vary within each meal, broadly in line with that for energy: 18-24 % for breakfast, 26-35 % for lunch, 35-49 % for dinner and 4-15 % for snacks. However, intakes of many foods largely depended on one meal type. The foods mainly eaten at dinner were potatoes, pulses, total vegetables, fish, meat and alcoholic beverages (52-70 %), in contrast to noodles (58 %) at lunch and bread (71 %) and dairy products (50 %) at breakfast. The foods mainly eaten at snacks were confectioneries (79 %) and sugar-sweetened beverages (52 %). Conversely, rice and eggs were more evenly distributed across three main meals (19-41 % and 30-38 %, respectively), while fruit and non-energetic beverages were more evenly distributed across all meal types (17-30 % and 19-35 %, respectively).

CONCLUSIONS

These findings provide the background information on each meal type in Japanese and may help inform the development of meal-based guidelines and public health messages.

Trends in male breast cancer mortality: a global overview

OBJECTIVES

Recent trends in male breast cancer have been inadequately studied. We updated mortality trends in selected countries and regions worldwide using most recent available data and we predicted figures for 2020.

METHODS

We extracted official death certification data for male breast cancer and population estimates from the WHO and the Pan American Health Organization databases, from 2000 to 2017. We computed age-standardized (world population) death rates for selected countries and regions worldwide. We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2020.

RESULTS

In 2015-2017, Central-Eastern Europe had a rate of 2.85/1 000 000, and Russia of 2.22, ranking among the highest. North-Western and Southern Europe, the European Union as a whole and the USA showed rates ranging between 1.5 and 2.0. Lower rates were observed in most Latin American countries, with values below 1.35/1 000 000, in Australia, 1.22, and Japan, 0.58. Between 2000-2004 and 2015-2017, age-adjusted death rates decreased between 10 and 40% in North-Western Europe, Russia, and the USA, and between 1.5 and 25% in the other areas under study, except Latin America (+0.8%). Except for Central-Eastern Europe, predicted rates for 2020 were favourable.

CONCLUSION

Advancements in management are likely the main drivers of the favourable trends in male breast cancer death rates over the last decades. Delayed diagnosis and limited access to effective care explain the higher mortality in some areas.

Unique Habitual Food Intakes in the Gut Microbiota Cluster Associated with Type 2 Diabetes Mellitus

This cross-sectional study aimed to clarify the characteristic gut microbiota of Japanese patients with type 2 diabetes (T2DM) using t-distributed stochastic neighbor embedding analysis and the k-means method and to clarify the relationship with background data, including dietary habits. The gut microbiota data of 383 patients with T2DM and 114 individuals without T2DM were classified into red, blue, green, and yellow groups. The proportions of patients with T2DM in the red, blue, green, and yellow groups was 86.8% (112/129), 69.8% (81/116), 76.3% (90/118), and 74.6% (100/134), respectively; the red group had the highest prevalence of T2DM. There were no intergroup differences in sex, age, or body mass index. The red group had higher percentages of the Bifidobacterium and Lactobacillus genera and lower percentages of the Blautia and Phascolarctobacterium genera. Higher proportions of patients with T2DM in the red group used α-glucosidase inhibitors and glinide medications and had a low intake of fermented soybean foods, including miso soup, than those in the other groups. The gut microbiota pattern of the red group may indicate characteristic changes in the gut microbiota associated with T2DM in Japan. These results also suggest that certain diabetes drugs and fermented foods may be involved in this change. Further studies are needed to confirm the relationships among traditional dietary habits, the gut microbiota, and T2DM in Japan.

Impact of dietary compositions and patterns on the prevalence of nonalcoholic fatty liver disease in Japanese men: a cross-sectional study

BACKGROUND

This study aimed to examine the impact of dietary compositions and patterns on nonalcoholic fatty liver disease (NAFLD) morbidity in Japanese men.

METHODS

We conducted a cross-sectional study of 281 individuals who underwent comprehensive medical examinations during health screening. Dietary intake was assessed using a semi-quantitative food frequency questionnaire, and factor analysis was performed to detect dietary patterns. NAFLD was diagnosed by the presence of fatty liver on abdominal ultrasonography in nondrinkers (< 30 g/day), and patients were categorized into control (n = 192) and NAFLD groups (n = 89).

RESULTS

Compared with the control group, the NAFLD group consumed fewer mushrooms. Three dietary patterns were identified, namely, a healthy pattern, a western pattern, and a snack pattern. The score of healthy pattern was negatively correlated with the risk of NAFLD. Compared with the lowest tertile of the healthy pattern, the middle tertile was associated with a lower risk of NAFLD after adjusting for age, physical activity, and smoking (odds ratio: 0.47, 95% confidence interval: 0.25-0.91). After further adjustments for body mass index, the middle tertile was associated with a lower risk of NAFLD (odds ratio: 0.46, 95% confidence interval: 0.23-0.92).

CONCLUSIONS

A healthy dietary pattern comprising frequent intake of seaweeds, vegetables, mushrooms, pulses, and potatoes and starches was associated with a lower risk of NAFLD in Japanese men. In our opinion, this healthy pattern closely resembles the Japanese Washoku diet, indicating that adherence to Washoku may help prevent NAFLD.

Identification of Salty Dietary Patterns of the Japanese Macroregion

Objective

The traditional Japanese dietary pattern, “Washoku,” is considered to provide an ideal nutritional balance. However, it tends to have a high salt intake. To reduce population-level salt intake, it is important to review the overall dietary patterns over a wide area.

Methods

To identify dietary patterns with high salt intake, partial least squares regression analysis was conducted using population-based household survey data from 52 cities. Annual salt consumption was set as the target variable, and the annual purchase weight of 109 foods was set as the explanatory variable.

Result

At least three dietary patterns (traditional, urban, and local) accounted for more than 90% of the variation in salt consumption and 29% of the explanatory variables (food purchases). Traditional patterns explained the salt consumption and regional differences in energy and protein consumption; however, their relationship to fat consumption was weak. The results reconfirmed that “Washoku” has an ideal nutritional balance but has high salt intake. The distribution of scores for traditional Japanese food patterns was high in northeast Japan and low in southwest Japan, with a geographical gradient. This pattern is thought to have formed over a long period of time because of the influence of environmental factors, such as local climate.

Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver disease in 2 decades: the NAGALA study

Background

In this study, to clarify the evolving background of people with non-alcoholic fatty liver disease (NAFLD), we compared the current prevalence of NAFLD with that of 2 decades ago.

Methods

We included two cohorts. The past cohort was from 1994 to 1997 and included 4279 men and 2502 women. The current cohort was from 2014 to 2017 and included 8918 men and 7361 women. NAFLD was diagnosed by abdominal ultrasonography.

Results

The prevalence of NAFLD increased in both genders throughout these 2 decades (18.5% in the past cohort and 27.1% in the current cohort for men; and 8.0% in the past cohort and 9.4% in the current cohort for women). The prevalence of hyperglycemia increased, whereas the prevalence of low high-density lipoprotein cholesterol levels and hypertriglyceridemia significantly decreased. There was no significant difference in the mean body mass index. Multivariate analysis revealed that the prevalence of obesity and body mass index were significantly associated with the prevalence of NAFLD in both the past and current cohorts.

Conclusions

The incidence of NAFLD significantly increased throughout these 2 decades, and obesity is the most prevalent factor. Thus, body weight management is an essential treatment option for NAFLD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01809-2.

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

The rising incidence of cardiometabolic diseases and chronic kidney disease (CKD) is a leading public health problem in East Asia. Diet is an important modifiable risk factor; thus, adopting a healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) diet may help combat these chronic diseases. The DASH diet was originally developed in a U.S. population, and East Asia is demographically and culturally different from the U.S. Therefore, it is important to examine the evidence regarding the DASH diet and chronic disease in this unique population. This narrative review summarizes the evidence on the DASH diet and cardiometabolic health and CKD in East Asia. Culturally-modified DASH diets have been developed in some East Asian countries. Studies suggest the DASH diet is effective at lowering blood pressure in this population, though the long-term benefits remain unclear. Evidence also suggests the DASH diet may reduce the risk of type 2 diabetes and metabolic syndrome. Further research indicates the DASH diet and its components may reduce CKD risk. However, recommending the DASH diet in those who already have CKD is controversial, as it conflicts with current CKD dietary guidelines, especially in advanced CKD. Notably, current intakes in the general population differ from the DASH dietary pattern, suggesting public health efforts would be needed to encourage adoption of the DASH diet.

Association between Oral Frailty and Dietary Variety among Community-Dwelling Older Persons: A Cross-Sectional Study

OBJECTIVE

To examine the association between the severity of oral frailty (OF), which is one of the comprehensive oral functions evaluated, and dietary variety in community-dwelling older persons.

DESIGN

Cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

A total of 769 community-dwelling older persons aged 65 and over.

INTERVENTIONS

We examined basic demographic information, functional status, cognitive status, depressive symptoms, medical history, and oral functions of the participants.

MEASUREMENTS

OF was defined by 1-2 and 3 or more of 6 items of oral function evaluation in the pre-oral frailty and oral frailty groups, respectively. Dietary variety was assessed using the dietary variety score (DVS). The participants were categorized into 3 groups for evaluation: those with a low score (0-2), medium score (3-5), and high score (≥6). Ordinal logistic regression analysis was performed to examine the association between OF and DVS.

RESULTS

The rate of OF in the participants was 21.6%, and its severity was significantly associated with DVS after adjusting for potential confounders (Pre-OF; adjusted odds ratio [OR] = 1.687, 95% confidence interval [CI] = 1.219-2.335, OF; adjusted OR = 2.857, 95% CI = 1.489-5.484).

CONCLUSION

The severity of OF was significantly associated with DVS in community-dwelling older persons. This suggests that DVS may be useful in understanding the effects of OF on the nutritional status. Further longitudinal studies are needed to elucidate the association between OF and DVS.

Bonding With Parents, Body Image, and Sociocultural Attitudes Toward Appearance as Predictors of Eating Disorders Among Young Girls

A more holistic approach to treatment and prevention focuses on identifying the multiple risk and protective factors for eating disorders. However, there is a lack of research verifying the nature of the relationship between patterns of bonding with parents, sociocultural attitudes toward appearance, body image, and their role in developing or preventing eating disorders. The main aim of the study was to verify whether there is a specific set of risk or/vs. protective factors/measures for behaviors and dispositions related to the development of eating disorders. The study group consisted of 134 young Polish females (M = 14.92; SD = 1.349), with an average body mass index. The variables were measured using the Parental Bonding Instrument, the Sociocultural Attitudes Toward Appearance Questionnaire-3, The Multidimensional Body-Self Relations Questionnaire, and the Eating Disorder Inventory 3. Stepwise regression analysis was applied. Statistical analysis showed that bonding with parents (including maternal overprotection), body image (including overweight pre-occupation, fitness evaluation, health orientation, and self-classified weight), and sociocultural attitudes toward appearance (such as searching for information, pressures, and internalization) are predictors of eating disorder risks. On the other hand, maternal and paternal care (aspects of patterns of bonding with parents), positive fitness evaluation, positive appearance evaluation, and satisfaction with one's body were found to be the most significant protective factors. The results may improve prevention and intervention aimed at increasing protective factors.

Seafood Consumption and Its Contribution to Nutrients Intake among Canadians in 2004 and 2015

Fish and seafood are excellent sources of nutrients such as omega-3 fatty acids, Vitamin D, and selenium. The aims of this study were to examine the pattern of seafood consumption among Canadians and determine their contribution to intakes of energy and nutrients. Day-1 24-h dietary recalls data collected from a national survey, the Canadian Community Health Survey—Nutrition in 2004 and 2015, were used to estimate food and nutrient intakes among Canadians. Seafood was classified according to the Bureau of Nutritional Sciences food list. Descriptive statistics were used to calculate the consumption rate and the average consumption amount of seafood by different age groups and sociodemographic characteristics. Population ratios were used to assess the contribution of seafood to the total intake of energy and nutrients. The overall consumption rate of seafood was around 17%, and the rate was similar between males and females, and slightly higher in 2015 (17.71%) compared to 2004 (16.38%). The average portion size is approximately 100 g, which translates into a ≈36 kg annual intake among the consumers and ≈6.2 kg per capita consumption. Adults (especially 30 years and above), Asians, individuals who were married, and with post-secondary education were more likely to consume seafood. Salmon, tuna, shrimp, cod, and crab were the most frequently consumed seafood in Canada, the consumption rate of which all increased from 2004 to 2015. Seafood provided up to 75% of n-3 PUFAs, 18% of Vitamin D, 19% Vitamin B12, 6% of niacin, and 4% of Vitamin B6 from all food sources. Seafood consumers had a healthier diet, as seafood consumption was related to a higher intake of key nutrients and a lower intake of total sugar and saturated fatty acids. Therefore, fish consumption should be promoted among Canadians.

What is the scientific definition of the Japanese diet from the viewpoint of nutrition and health?

The Japanese people have enjoyed longevity for several decades, and Japanese dietary habits are considered to contribute to this longevity. The scientific definition of the Japanese diet, however, is not yet fully established. The Working Group 1 of the Healthy Diet Research Committee of the International Life Sciences Institute Japan reviewed the literature to collect definitions of the Japanese diet appearing in articles in the fields of diet, nutrition, foods, and human health. This report addresses the definitions and the questions raised by these definitions. Among 283 relevant articles identified, 116 were carefully screened and included in the analysis. In most of the articles, the authors self-defined the Japanese diet; some studies used a government-proposed definition. This review revealed no systematic approach to define the Japanese diet from the viewpoints of nutrition and health. Before conducting studies to determine whether the Japanese diet is healthy, it is important to address the question of what the Japanese diet is from the viewpoint of human nutrition rather than culinary culture.

Dietary Components, Microbial Metabolites and Human Health: Reading between the Lines

Trillions of bacteria reside in the human gut and they metabolize dietary substances to obtain nutrients and energy while producing metabolites. Therefore, different dietary components could affect human health in various ways through microbial metabolism. Many such metabolites have been shown to affect human physiological activities, including short-chain fatty acids metabolized from carbohydrates; indole, kynurenic acid and para-cresol, metabolized from amino acids; conjugated linoleic acid and linoleic acid, metabolized from lipids. Here, we review the features of these metabolites and summarize the possible molecular mechanisms of their metabolisms by gut microbiota. We discuss the potential roles of these metabolites in health and diseases, and the interactions between host metabolism and the gut microbiota. We also show some of the major dietary patterns around the world and hope this review can provide insights into our eating habits and improve consumers' health conditions.

Intake of sucrose affects gut dysbiosis in patients with type 2 diabetes

Aims/Introduction

Gut dysbiosis is generally associated with type 2 diabetes mellitus. However, the effect of habitual dietary intake on gut dysbiosis in Japanese patients with type 2 diabetes mellitus has not yet been explicated. This study investigated whether alteration of the gut microbiota was influenced by dietary intake of sucrose in Japanese patients with type 2 diabetes mellitus.

Materials and Methods

In this cross‐sectional study, 97 patients with type 2 diabetes mellitus and 97 healthy individuals were matched by age and sex, and then, fecal samples were obtained. Next‐generation sequencing of the 16S ribosomal ribonucleic acid gene was carried out, and functional profiles for the gut microbiota were analyzed. We selected the top 30 gut microbial genera and top 20 functional profiles for the gut microbiota specified by the weighted average difference method. The association between gut microbial genera or functional profiles and habitual dietary intake was investigated by Spearman’s rank correlation coefficient, and then, clustering analysis was carried out to clarify the impact of habitual dietary intake.

Results

The Actinobacteria phylum was highly abundant in patients with type 2 diabetes mellitus, whereas the Bacteroidetes phylum was less abundant. Diabetic‐type gut microbes, specifically Bacteroides and Bifidobacterium, were altered by sucrose intake at the genus level. Furthermore, sucrose intake was associated with glycolysis/gluconeogenesis in the diabetic‐type functional profiles of the gut microbiota.

Conclusions

The gut microbiota and functional profiles for the gut microbiota in patients with type 2 diabetes mellitus were significantly different from those in healthy individuals. Furthermore, we showed that sucrose intake was closely associated with these differences.

Comparison of Food and Nutrient Intakes between Japanese Dyslipidemic Patients with and without Low-Density Lipoprotein Cholesterol Lowering Drug Therapy: A Cross-Sectional Study

Aim: We aimed to clarify actual food and nutrient intakes in Japanese patients with dyslipidemia. We also compared food and nutrient intakes between patients with and without low-density lipoprotein cholesterol (LDL-C) lowering drug therapy.

Methods: Food and nutrient intakes were assessed employing 3-day weighted dietary records in this cross-sectional study of 104 Japanese outpatients with dyslipidemia, age 30–65 years, not given dietary counseling. Anthropometric and biochemical parameters were measured after an overnight fast. Food and nutrient intakes were compared between patients with versus without LDL-C lowering drug prescriptions. Stepwise multiple regression analysis was performed to identify relationships between the serum LDL-C concentrations and food intakes.

Results: Of the 104 patients, 43.3% were prescribed LDL-C lowering drugs, primarily statins. Of the total patients, 83% had lipid intakes over 25% of total energy consumption (%E), exceeding the recommendation for dyslipidemia by the Japan Atherosclerosis Society. Similarly, 77% had saturated fatty acid intakes over 7%E, and 88% had cholesterol intakes over 200 mg per day. Dietary fiber consumption was low (< 25 g) in 97% of patients. Those taking LDL-C lowering drugs consumed less “meat, poultry and processed meat products” and “cereals”, and more “fish”, “fruits” and “nuts”, than patients not taking these drugs (p < 0.05). Food intakes correlating with LDL-C concentrations independently of drug therapy differed between patients taking versus not taking these medications.

Conclusion: Our results support the necessity of diet therapy for patients with dyslipidemia regardless of whether LDL-C lowering drugs are prescribed.

The clinical trial registration number: UMIN000022955

Systematic review and meta-analysis: Association of a pre-illness Western dietary pattern with the risk of developing inflammatory bowel disease

OBJECTIVE

Previous studies have presented conflicting results on Western diets and the risk of inflammatory bowel disease (IBD). This study aimed to evaluate the role of a pre-illness Western dietary pattern in the development of IBD.

METHODS

The Western dietary pattern was defined as that met at least two of the following, either a high intake of refined grains, red and processed meat, animal protein, animal fats or high-fat dairy products, or with a low consumption of fruit and vegetables. Four medical databases (PubMed, EMBASE, the Cochrane Library and the China National Knowledge Infrastructure) were searched to identify all relevant references. Risk estimate and corresponding 95% confidence interval (CI) were pooled using a random-effects model.

RESULTS

Nine studies (seven case-control studies and two prospective cohorts) were included, with a total of 1491 IBD cases and 53 089 controls. A Western dietary pattern was associated with a risk of all IBD (relative risk [RR] 1.92, 95% CI 1.37-2.68) and separately with Crohn's disease (CD) (RR 1.72, 95% CI 1.01-2.93) and ulcerative colitis (UC) (RR 2.15, 95% CI 1.38-3.34). Subgroup analysis by region showed that a Western dietary pattern was associated with the risk of CD and UC for studies performed in Europe (RR 2.25, 95% CI 1.44-3.50 for CD; RR 2.65, 95% CI 1.61-4.36 for UC). The pooled RR was 2.26 (95% CI 1.42-3.59) in the pediatric CD subgroup.

CONCLUSION

This meta-analysis indicates that a pre-illness Western dietary pattern may increase the risk of developing CD and UC.

Ocular and Systemic Effects of Antioxidative Supplement Use in Young and Healthy Adults: Real-World Cross-Sectional Data

Randomized controlled studies have shown that antioxidative supplements are effective in suppressing the progression of age-related macular degeneration and visual display terminal syndrome. However, effects of their general use in the real-world and by young and healthy individuals have not been well documented. We analyzed 27 participants who were under 35 years of age and had no diagnosed diseases. Mean functional visual acuity (FVA) score and visual maintenance ratio, which represent quick recognition of a target, both measured using FVA system, were better (both p < 0.01) in subjects who had had regular antioxidative supplement intake for more than 2 months (11 participants) compared with those who had not. Systemic data, i.e., total cholesterol, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) levels, which correspond to chronic low-grade inflammation, were lower (all p < 0.05) in the former. Overall, hs-CRP levels had a correlation with total cholesterol (p < 0.05) and a trend of correlation with HbA1c (p = 0.054) levels. Thus, current real-world data showed that young, healthy participants who had a regular intake of antioxidative supplements had better visual acuity and systemic levels of metabolic and low-grade inflammation markers. This study will help promote future research into the effects of general antioxidative supplement use.

Long-Term Safety and Efficacy of Sitagliptin for Type 2 Diabetes Mellitus in Japan: Results of a Multicentre, Open-Label, Observational Post-Marketing Surveillance Study

Introduction

A post-marketing surveillance (PMS) study was conducted to confirm the long-term risk–benefit profile of sitagliptin administered to Japanese patients with type 2 diabetes mellitus (T2DM) under real-world conditions.

Methods

This prospective, multicentre, open-label PMS collected data from 3326 patients receiving sitagliptin according to the approved indication during the case registration period (July 2010–June 2012; observation period, 3 years). Safety was assessed via collection of data on adverse drug reactions (ADRs), estimated glomerular filtration rate (eGFR) and cardiovascular events whereas efficacy was assessed via changes in glycated hemoglobin (HbA1c).

Results

In 3265 patients evaluated for safety, 270 ADRs occurred in 207 (6.3%) patients overall. Metabolism and nutrition disorders were the most common class of ADRs, occurring in 58 patients overall (53 non-serious, 5 serious) with hypoglycaemia (17 patients, 0.52%) the most common ADR. In patients with eGFR > 90 mL/min/1.73 m² at baseline (mean ± SD, 106.42 ± 18.11 mL/min/1.73 m², n = 584), eGFR declined by 11.83 ± 17.53 mL/min/1.73 m² (P < 0.0001; n = 360) over the observation period whereas eGFR appeared to be relatively maintained in patients with lower baseline eGFR levels. Cardiovascular events were infrequent [occurring in 4 of 84 (4.76%) patients at high cardiovascular risk] with no distinct features in this Japanese population and the cumulative incidence [8.42% (3.12–21.70) at 36 months; n = 32] was similar to that noted in previous studies involving sitagliptin. In patients evaluated for efficacy, the overall change in HbA1c from baseline to final evaluation was mean ± SD − 0.68 ± 1.34% (P < 0.0001, n = 2070). Reductions in HbA1c tended to be greater in younger patients and patients with higher body mass index (BMI) and HbA1c values at the start of administration.

Conclusion

Long-term sitagliptin administration in the routine clinical practice setting is associated with good efficacy, including as monotherapy, with no additional safety concerns.

Electronic supplementary material

The online version of this article (10.1007/s12325-020-01293-2) contains supplementary material, which is available to authorized users.

Type 1 diabetes-early life origins and changing epidemiology

Type 1 diabetes is a chronic, immune-mediated disease characterised by the destruction of insulin-producing cells. Standardised registry data show that type 1 diabetes incidence has increased 3-4% over the past three decades, supporting the role of environmental factors. Although several factors have been associated with type 1 diabetes, none of the associations are of a magnitude that could explain the rapid increase in incidence alone. Moreover, evidence of changing prevalence of these exposures over time is insufficient. Multiple factors could simultaneously explain the changing type 1 diabetes incidence, or the magnitude of observed associations could have been underestimated because of exposure measurement error, or the mismodelling of complex exposure-time-response relationships. The identification of environmental factors influencing the risk of type 1 diabetes and increased understanding of the cause at the individual level, regardless of the ability to explain the changing incidence at the population level, is important because of the implications for prevention.

Body Dissatisfaction, Restrictive, and Bulimic Behaviours Among Young Women: A Polish-Japanese Comparison

The growing number of women, who are characterized by restrictive and bulimic behaviours towards their own body is observed especially in countries influenced by Westernalization. However, there is a lack of cross-cultural studies in this area. The main aim of the present study was to examine the psychological and socio-cultural risk factors for eating disorders in Polish and Japanese women. A cross-sectional research study was conducted among 18- to 29-year old Polish (n = 89) and Japanese (n = 97) women. The variables were measured using the Sociocultural Attitudes Towards Appearance Scale SATAQ-3, and the Eating Disorders Inventory EDI-3. The descriptive and comparative statistics, Spearman's rho, and the stepwise regression analysis were used. The global internalization of socio-cultural standards of body image proved to be a significant predictor of Body Dissatisfaction among Polish and Japanese women. The main analysis showed a significant relation between the Drive for Thinness and Interoceptive Deficits in the group of Japanese women, as well as a correlation between Drive for Thinness and Asceticism in the group of Polish women. The obtained results could improve the prevention aimed the dysfunctional eating behaviours. However, the cultural nuances need to be considered in understanding the risk factors for eating disorders.