中出 麻紀子

Abstract 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.

This study comprehensively examined the associations between shokuiku (food and nutrition education) during school years, current well-balanced diets, and current eating and lifestyle behaviours of Japanese female university students. A hypothetical model was developed using factors potentially associated with well-balanced diets. A simultaneous multipopulational analysis was performed according to the living arrangements of 148 female Japanese students (48.6% living alone) from a registered dietitian course. The analysis showed acceptable goodness of fit and a significant positive path from shokuiku during school years (living alone: standardised estimate 0.29, p = 0.004; with family: 0.32, p = 0.006) and a negative path from eating out frequency (-0.19, p = 0.039; -0.24, p = 0.017) towards a well-balanced diet. A significant negative path was identified from late bedtimes (-0.45, p < 0.001) and home meal replacement use frequency (-0.24, p = 0.010) in those living alone and from late-night snacking frequency (-0.27, p = 0.007) in those living with family. Well-balanced diets in female university students may be positively associated with shokuiku during school years and limited by a late bedtime, eating out, and home meal replacement use in those living alone, and by late-night snacking and eating out in those living with family.

Development of an accurate and efficient dietary method is required for national nutrition surveys. Some countries conduct dietary surveys and combine 24-h dietary records or 24-h dietary recalls with dietary questionnaires. This scoping review aimed to summarize studies that used results from national surveys that combined detailed dietary surveys (dietary records or 24-h dietary recall) and dietary questionnaires and identify the purpose of combining the two methods. The PubMed database and manual searches were used for the literature review. We extracted 58 articles from 16 national nutrition surveys from 14 countries. Most studies used 24-h dietary recall for detailed dietary surveys and the food frequency questionnaire (FFQ) or food propensity questionnaire (FPQ) for questionnaire surveys. Among 37 studies from eight countries, the purpose of combining the two dietary survey methods was to estimate energy and nutrient intakes from detailed dietary surveys and habitual food intake from questionnaires. These findings are useful as a reference when introducing new dietary survey methods in future national nutrition surveys.

【目的】バランスの良い食事、朝食習慣、野菜摂取を含む健康な食事の習慣に関わる要因を包括的に明らかにする。【方法】平成28年度ひょうご食生活実態調査に回答した20〜40歳代の720名(男性46%)を対象とした。深康な食事を構成する変数として、バランスの良い食事が1日2回以上、朝食習慣、1日の野菜料理の皿数を設定し、これに関わる要因として、生活習慣病予防のための食態度(エネルギー摂取量の調整、塩分制限、脂肪摂取量の調整、糖分を取り過ぎない、野菜をたくさん食べる、果物を食べる)、健康維持の姿勢(適正体重の心がけ、栄養成分表示の活用)、外食頻度を用いた仮説モデルを立て、共分散構造分析を行った。【結果】本仮説モデルにおいて、許容範囲の適合度が得られた(χ2=153.015、df=86、GFI=0.967、AGFI=0.940、CFI=0.974、RMSEA=0.033、AIC=293.015)。健康な食事の習慣には、生活習慣病予防のための食態度からの直接的な影響が示されず、健康維持の姿勢を経由して影響を及ぼし、標準化総合効果は、男性が0.40、女性0.41であった。また、男性では、外食頻度から健康な食事への標準化推定値が-0.17(p=0.021)の有意な負のパスが示された。【結論】健康な食事の習慣には、生活習慣病予防のための食態度に健康維持の姿勢が介在し、加えて男性では、外食頻度が悪影響を及ぼす可能性が示唆された。(著者抄録)

本研究では若年成人における主食・主菜・副菜の揃った食事と関連する食習慣について明らかにすることを目的とし,平成28年度ひょうご食生活実態調査に参加し,回答に欠損のない20,30歳代の男女343名のデータを解析した。主食・主菜・副菜の揃った食事(1日2回以上)の頻度により,高頻度群(週4日以上)と低頻度群(週3日以下)に分け,食習慣項目をカイ二乗検定で比較した後,属性項目で調整した二項ロジスティック回帰分析を行った。その結果,高頻度群,低頻度群の人数と割合はそれぞれ227(66.2%),116(33.8%)であった。二項ロジスティック回帰分析の結果,朝食摂取頻度(週4日以上),外食頻度(週3回以下),米飯の食事摂取頻度(朝食,昼食,夕食)(5日以上)の人は,そうでない人と比較して高頻度群の割合が有意に多かった。以上より,朝食摂取頻度や米飯の摂取頻度が高いこと,外食頻度が低いことは主食・主菜・副菜の揃った食事頻度が高いことと関連することが示唆された。(著者抄録)

目的:主食・主菜・副菜の揃った食事と生活習慣,知識・健康意識,健康状態との関連を明らかにする.方法:横断研究として,兵庫県の1大学の1〜4年次学生を対象に2019年に自記式質問紙調査を実施し,健診データの提供も受けた.153名の女子学生を解析対象とし,主食・主菜・副菜の揃った食事(1日2回以上)の摂取頻度が週4日以上の高頻度群,週3日以下の低頻度群に分類し,2群間で生活習慣,知識・健康意識,健康状態を比較した後,年齢と現在の居住形態で調整した二項ロジスティック回帰分析を行った.結果:高頻度群は90名,低頻度群は63名であった.二項ロジスティック回帰分析の結果,自炊頻度が高い人(オッズ比[95%信頼区間]:2.96[1.15,7.64]),栄養に関する知識がある人(3.33[1.30,8.48]),健康に気をつかう人(7.29[3.13,16.98])は,そうでない人と比較して高頻度群の割合が高かった.また,BMIや体脂肪率が高いことが高頻度群の割合が低いことと関連していた(それぞれ0.84[0.72,0.98],0.90[0.83,0.98]).BMIが18.5以上25kg/m2未満の人と比較し,18.5kg/m2未満の人(3.49[1.19,10.22])では高頻度群の割合が高かった.結論:主食・主菜・副菜の揃った食事は自炊,栄養に関する知識,健康意識の高さ,体格と関連していた.(著者抄録)

【目的】朝食におけるバランスの良い食事(主食・主菜・副菜の揃った食事)を推奨するために、バランスの良い朝食摂取者における食習慣および健康意識の特徴を明らかにすること。【方法】平成28年度ひょうご食生活実態調査に回答した20歳〜60歳代で朝食頻度が週4日以上の1,255名を対象とした。解析は性・年齢別(20〜40歳代、50〜60歳代)に、従属変数をバランスの良い朝食摂取の有無、独立変数を食習慣および健康意識、調整因子を年齢、家族構成、BMIとした二項ロジスティック回帰分析を行った。【結果】どの性・年齢階級でも、朝食でごはん(米)を週0回又は主食・主菜・副菜の揃った食事を1日2回以上食べる頻度が週5日以下を基準として、週5〜7回又は週6日以上の者で、バランスの良い朝食摂取者のオッズ比が有意に高かった。また、男性では、50歳以上における健康意識に関連した項目において、ネガティブな者を基準として、現在の食事を自分で良いと思っている、食事時間が不規則ではない、生活習慣病予防の食事を実践している、適正体重を心がけている者で、バランスの良い朝食摂取者のオッズ比が有意に高かった。【結論】朝食にごはん(米)を食べていることや主食・主菜・副菜の揃った食事を1日2回以上食べていることは、性や年代を問わずバランスの良い朝食摂取と関連していた。また、男性の50歳代〜60歳代では高い健康意識にも関連がみられた。(著者抄録)

目的:20〜40歳代成人における朝食時の家族との共食状況と朝食欠食との関連について検討を行う.方法:平成28年度ひょうご食生活実態調査に参加した20〜40歳代の男女804名のうち,家族と同居し,データに欠損のない522名を解析対象とした.朝食欠食者は朝食摂取頻度が週3日以下の者とし,朝食時の家族との共食状況と朝食欠食との関連についてχ2検定,二項ロジスティック回帰分析を行った.結果:朝食時に毎日家族全員が揃って食べる人は62名,時々家族全員が揃って食べる人は106名,家族の一部が揃って食べる人は205名,家族がばらばらに食べる人は149名であった.朝食欠食者は上記の順に3.8%,14.2%,34.0%,48.1%であり,家族との共食状況と朝食欠食の有無との間に有意な関連が見られた.従属変数を朝食欠食の有無,独立変数を家族との共食状況,属性や朝食欠食と関連する項目を調整因子とした二項ロジスティック回帰分析を実施したところ,毎日家族全員が揃って食べる人を基準として,時々家族全員が揃って食べる人の朝食欠食のオッズ比[95%信頼区間]は2.45[0.74,8.14],家族の一部が揃って食べる人は3.37[1.08,10.56],家族がばらばらに食べる人は7.91[2.57,24.39]であった.結論:朝食時に家族全員が揃って食べない人では,朝食欠食者が多いことが示唆された.(著者抄録)

In Japan, the amount of vegetable intake in young adults, especially at breakfast, is low. We aimed to examine the factors associated with vegetable intake at breakfast among young adults. In 2016, a self-administered questionnaire survey was conducted at a Japanese university. The questionnaire measured the frequency of ≥70 g vegetable intake at breakfast, lifestyle, eating habits, environmental factors, knowledge and attitudes (including the variable "Perceived behavior control (PBC)", from the Theory of Planned Behavior). The data of 1,455 male students who usually ate breakfast were analyzed. They were divided into two groups based on the median of the frequency of vegetable intake and the above factors were compared using a chi-squared test by living condition. The significant factors were subsequently entered into a logistic regression analysis as independent variables. Eating breakfast with family or friends and PBC were positively associated with vegetable intake in students living with their family. Often doing one's own cooking, having knowledge about a well-balanced diet, and PBC were positively associated with vegetable intake in students living alone. Along with PBC, different factors pertaining to an individual's living condition may need to be considered to increase vegetable intake at breakfast.

Background and Objectives: Information about an association between animal food intakes and risk of anemia is still limited. This study aimed to investigate the association between fish and meat intake and anemia risk in the Japanese elderly. Methods and Study Design: A nationally representative sample of 6,469 aged 65 years and over was obtained from pooled data of annual National Health and Nutritional Survey in Japan during 2002-2011. Anemia was defined as hemoglobin concentrations <13.0 g/dL in males and <12.0 g/dL in females. Logistic regression analysis, with the lowest intake tertile as the reference, was applied to estimate anemia risk for each nutrient and food group. Results: After adjustment for putative confounding factors, males in the highest tertile of animal protein intake had significantly lower risk of anemia than those in the lowest tertile (odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63, 0.95; p for trend=0.017). These associations were not seen in females (OR: 0.72, 95% CI: 0.49, 1.06; p for trend=0.100). Multivariate analyses revealed that anemia risk (OR: 0.80; 95% CI: 0.65, 0.97; p for trend=0.002) was lower for males in the highest tertile of fish intake than in the lowest tertile; this effect was also observed for females (OR: 0.64; 95% CI: 0.45, 0.92; p for trend=0.014). In both sexes, the highest tertile of meat intake was not associated with lower anemia risk in the multivariate-adjusted models. Conclusions: The current cross-sectional study in Japanese elderly males suggests that higher animal protein, specifically the high protein content of fish may be associated with a lower prevalence of anemia.

【目的】主食・主菜・副菜を組み合わせた食事と健康・栄養状態および食物・栄養素摂取との関連について国内の研究動向を把握した。【方法】2000〜2017年に発表された論文を対象に、医学中央雑誌とNII学術情報ナビゲータ(CiNii)を用い「主食AND主菜AND副菜」で検索した。表題、抄録、本文を、本研究の以下の採択基準と照合・精査し、包含基準(日本人対象、分析疫学研究、曝露が主食・主菜・副菜を組み合わせた食事摂取、アウトカムが食物・栄養素摂取状況及び健康・栄養状態、対象集団の特徴明記)と除外基準(介入研究、ケースレポート、ケースシリーズ、エコロジカル研究)を満たす12件を採択した。【結果】採択論文はすべて横断研究で、研究対象者は成人期が最も多かった。主食・主菜・副菜を組み合わせた食事の把握は、質問紙調査法によるものが過半数を占め、それらの質問項目は様々であった。食物・栄養素摂取との関連を検討した研究6件では、いずれも主食・主菜・副菜の揃った食事回数の多い人ほど、エネルギー、たんぱく質、各種ビタミン・ミネラルの摂取量が多く、日本人の食事摂取基準に合致していることが報告されていた。健康・栄養状態との関連を検討した8件の研究は、一貫した結果を示さなかった。【結論】主食・主菜・副菜を組み合わせた食事は必要な栄養素の十分な摂取に関連していることが示唆された。健康指標との関連については、縦断研究を含めたさらなる研究が必要である。(著者抄録)

我々は,肥満者に対する行動科学的手法を用いた減量プログラム(佐久肥満克服プログラム)を開発し,無作為化比較対照試験および1年間の追跡により,その有効性を明らかにしてきた。本資料論文では,日本運動疫学会プロジェクト研究「介入研究によるエビデンスの『つくる・伝える・使う』の促進に向けた基盤整備」の一環として,減量プログラムのエビデンスを提供し,プログラムの一般化可能性についてRE-AIMの観点から検討を行った。本減量プログラムは,食事や身体活動の改善に関する目標を対象者自身が考え,日常生活において実践できるよう,医師,管理栄養士,健康運動指導士が連携し支援を行うものであった。対象は,人間ドック受診者における肥満者であり,プログラムの到達度は24.1%であった。介入群の対象者では,プログラムにより,体重等の減少やその維持が認められた。本プログラムは特別な施設等を必要とせず比較的容易に実施することが可能であるが,今回総勢19名もの管理栄養士・健康運動指導士が指導に携わり,その多くが研究所のスタッフであったこと,介入に多くの時間を要したことを考えると,通常の保健指導の現場へそのまま適用するのは困難であると考えられる。したがって,今後,今回得られた成果から介入手法の中で効果的であったものを明確にし,それを現場の予算に応じて活用していくことが重要だと考えられる。(著者抄録)

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan's national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Background and Objectives: Survey items of the Japan National Nutrition Survey (J-NNS) have changed over time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions. Methods and Study Design: We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012. The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others. Results: Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin measurements have been performed continuously for more than 20 years. Conclusions: This is the first report on the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply country-by-country comparisons.

Recently, there has been an increasing concern about noncommunicable diseases (NCDs), in which oxidative damage plays a role. In this paper, we have re-analyzed the data from the National Health and Nutrition Survey (NHNS) 2007 to study the relationship between an NCD (e.g. hypertension) and the dietary intake of vitamin E, a potent antioxidative vitamin. The inclusion criteria were those aged 40 and over, excluding pregnant or lactating women, and data from 1,405 males and 2,102 females were analyzed. The mean ages were 63.5 and 62.4, respectively. Nutrients intake was evaluated from a semi-weighted, 1-d household dietary record. When the subjects were categorized into tertiles based on their vitamin E intake, higher vitamin E intake was associated with a lower percentage of subjects with hypertension (p for trend=0.01). Subjects with higher vitamin E intake had higher energy intake-adjusted intake of other nutrients which have been considered to be related to hypertension such as potassium, magnesium, and vitamin C. Logistic regression analysis was done with the low tertile of vitamin E intake as the reference. The medium and high tertiles of vitamin E intake were associated with a significantly lower odds ratio for hypertension, 0.73 (95% CI; 0.62-0.87) for the former and 0.81 (95% CI; 0.69-0.96) for the latter. Additional analyses, one adjusted for the indices associated with hypertension and one excluding the subjects with vitamin E supplementation, have yielded the similar results. In summary, re-analysis of data from NHNS has revealed that higher vitamin E intake was significantly associated with lower prevalence of hypertension.

本研究は、仮設住宅に居住している東日本大震災被災者の食物摂取状況を把握することを目的とした。対象者は、18歳以上の岩手県釜石市H地区の仮設住宅居住者72名(男性22名、女性50名)であった。調査は2011年10月に実施した。1日の食物摂取状況は24時間思い出し法(24HR)を用いて評価した。また、対象者には、東日本大震災被災者健康調査の食事に関する9項目の質問票(FFQ-H)への回答を依頼した。FFQ-Hの質問項目は、数日間を振り返った1日あたりの食事回数と、8つの食品群(主食、肉、魚介類、卵、豆類、野菜、果物、乳製品)の1日あたりの摂取回数(0、1、2、3、4回以上)とした。24HRによって評価した1日あたり栄養素および食物摂取状況の中央値[25-75パーセンタイル]は、エネルギー量1903kcal[1493-2238]、総たんぱく質70.7g[47.4-84.7]、ビタミンB1 0.8mg[0.6-1.4]、ビタミンB21.3mg[0.9-1.9]、ビタミンC 86mg[50-144]、食塩相当量12.1g[8.2-14.3]、野菜類220g[158-329]、果物122g[0-161]であった。エネルギー、栄養素、群別食品の摂取状況を2009年国民健康・栄養調査の性・年齢階級別摂取量の結果と比較すると、72名中、ビタミンC48名、野菜53名、果物42名で低値であった。24HRとFFQ-Hによる食物摂取回数間の相関係数は0.03〜0.43の範囲であった。本研究の対象者である岩手県釜石市H地区の仮設住宅居住者は、2009年国民健康・栄養調査の結果と比較して、ビタミンC、野菜、果物の摂取量が少ないことが示唆された。(著者抄録)

This study was performed to: (1) assess the prevalence of dietary supplement and fortified food use, (2) examine the differences in vitamin E intake with and without dietary supplementation and/or fortified food use, and (3) determine whether some individuals consume vitamin E above the tolerable upper intake level (UL). Data were obtained from 64,624 individuals (age, >= 1 y; 47.4% males) who completed a 1-d household dietary assessment that was part of the National Health and Nutrition Survey conducted in Japan, 2003-2009. The survey also obtained information on the brand or generic name of each dietary supplement or fortified food reported, including their ingredients, through dietary assessment. The prevalence of a potential risk of excess was estimated by the proportion of persons above the age-/sex-specific ULs provided by the Dietary Reference Intakes for Japanese 2010. Supplement use was reported by 5.8% of men and 7.7% of women, whereas fortified food consumption was reported by only 2.9% of men and 3.6% of women. Use of dietary supplements was most common among older women, whereas use of fortified foods was most common among younger women. Both dietary supplement and fortified food use accounted for maximum vitamin E intake; however, the use of dietary supplements and fortified foods had little effect on the median and 95th percentile intake values. None of the subjects consumed nutrients above the UL. The collected data confirm that the use of both dietary supplements and fortified foods contributes a small amount to nutrient intake in Japanese subjects.

The Adequate Intake (AI) values in: the Dietary Reference Intakes for Japanese (DRIs-J) 2010 were mainly determined based on the median intakes from 2 y of pooled data (2005-2006) from the National Health and Nutrition Survey-Japan (NHNS-J). However, it remains unclear whether 2 y of pooled data from the NHNS-J are appropriate for evaluating the intake of the population. To clarify the differences in nutrient intakes determined from 2 and 7 y of pooled data, we analyzed selected nutrient intake levels by sex and age groups using NHNS-J data. Intake data were obtained from 64,624 individuals (age: >= 1 y; 47.4% men) who completed a semi-weighed 1-d household dietary record that was part of the NHNS-J conducted annually in Japan from 2003 to 2009. There were no large differences between the median intakes calculated from 2 or 7 y of pooled data for n-6 or n-3 polyunsaturated fatty acids (PUFAs), vitamin D, pantothenic acid, potassium, or phosphorus. When the AI values and median intakes were compared, there was no large difference in the values for n-6 or n-3 PUFAs, pantothenic acid, or phosphorus. Conversely, the AI values for vitamin D and potassium differed from the median intakes of these nutrients for specific sex and age groups, because values were not based on NHNS-J data. Our results indicate that 2 y of pooled data from the NHNS-J adequately reflect the population's intake, and that the current system for determination of AI values will be applicable for future revisions.

The Japanese population routinely consumes iodine-rich seaweed, thereby probably making Japan the nation with the highest iodine intake worldwide. The present study aimed to estimate the duration of dietary records (DRs) needed to calculate the usual iodine intake and to ascertain the frequency of iodine intakes above the tolerable upper intake level (UL) in the Dietary Reference Intakes for Japanese. Four 3-d DRs for the 4 seasons within a year were collected for 55 men and 58 women. On the basis of analysis of variance, the total variance in iodine intake was classified into inter-individual and intra-individual components. The frequency of appearance for high iodine intakes was estimated. The most commonly consumed types of iodine-containing food items were seaweed, milk and milk products, fish and shellfish, and tofu. The percentage contribution of intra-individual variance was markedly greater than that of inter-individual variance, and the excessive iodine intake was intermittent rather than continuous. The duration for which dietary records were required to assess the usual intake of iodine within 10% of their true mean was 6,276 d for men and 4,953 d for women. The period that transpired until a value was exceeded once was 6.3 d/occurrence for values above UL (2,200 mu g), 8.5 d/occurrence for values above 3,000 mu g, 9.8 d/occurrence for values above 4,000 mu g, 11.2 d/occurrence for values above 5,000 jig, and 16.7 d/occurrence for values above 10,000 mu g. To avoid errors in interpretation, it is inappropriate to assess the habitual nutrient intake of a nutrient that is intermittently consumed at maximal levels. It is important to assess the iodine intake in consideration of the range of the nutrient intake and of the time period in which the upper limit is exceeded.

本研究では、栄養に関連するガイドラインを作成するためのガイダンスが公開されている国内外の研究機関等(WHO、コクラン共同計画、米国Agency for Healthcare Research and Quality、Medical Information Network Distribution Service診療ガイドライン選定部会)を対象に、レビューシステムについて体系的分類を行い、「日本人の食事摂取基準(2010年版)」との比較を行った。対象とした4つのガイダンスにおいて、作成手順は研究機関によって大きな違いがなく、「PICO形式を用いた疑問の定式化」、「情報源としてプライマリーデータベースと非出版物を使用」、「研究デザインは出来る限りランダム化比較試験とし、観察研究をも含む」は、共通していた事項であった。エビデンスの質、推奨度を判断するスケールは、「日本人の食事摂取基準(2010年版)」では決まったものは公表していなかったが、「GRADEシステム」を推奨しているガイダンスが多くみられた。本研究では、系統的レビューに基づいて策定されている国内外のガイドラインのガイダンスから、作成と手順、レビューシステムについて調査し、共通する部分を明らかにした。今後、「日本人の食事摂取基準」を策定する上で、目的に応じた系統的かつ網羅的なレビューシステムのさらなる構築が期待される。(著者抄録)

Although nutritional standards for Japanese were published by national organizations until the 1940s, the Recommended Dietary Allowances (RDAs) for Japanese was officially established in 1969 by the Ministry of Health and Welfare (presently Ministry of Health, Labour and Welfare). These RDAs were revised every five years until 2005, when they were established as Dietary Reference Intakes for Japanese (DRIs-J). The nutrients included in RDAs and DRIs-J were changed according to the health condition and eating habits of Japanese. The current version, DRIs-J 2010, comprises reference values for energy and 34 nutrients.

The Dietary Reference Intakes (DRIs) of carbohydrates and dietary fiber were determined for Japanese. The estimated average requirement (EAR) and recommended dietary allowance (RDA) for carbohydrates were not determined because of insufficient data. The tentative dietary goal for preventing lifestyle-related diseases (DG) for children aged 1 y and above was determined for carbohydrates (% energy). In addition, the DG for adults aged 18 y and above was determined for dietary fiber. Dietary fiber intake is associated with myocardial infarction; therefore, the DG was determined on the basis of the results of a meta-analysis and the median dietary fiber intake of Japanese. The DG for alcohol was not determined because of insufficient data.

In Asia, the concept of dietary reference values is shifting from recommended dietary allowances (RDAs) to dietary reference intakes (DRIs). To assist Asian countries that are planning to develop or revise their own DRIs, this study summarizes the scientific literature used in the development of the latest DRIs for the Japanese (DRIs-J 2010): it aims to clarify critical issues on- and discuss figure prospects for DRIs in Asia. The criteria and studies used to determine reference values in DRIs-J 2010 in adults were extracted from the DRIs-J 2010 report, systematically classified, and summarized for each nutrient in tables according to the type of DRIs. The classification categories were as follows: criteria, subject ethnicity, year of publication, type of study and study design, number of subjects, and study content. In all, 184 studies were extracted and some issues in DRIs-J 2010 were clarified: 1) some nutrients were lacking in studies based on native populations; 2) only a few and relatively old studies determined tolerable upper intake levels for some nutrients; 3) with the same DRIs, there were inconsistencies among the nutrients in the study criteria These were considered common issues when determining DRIs in other Asian countries. When establishing DRIs, these issues should be considered, in addition to population health status and country-specific needs.

目的 国民健康・栄養調査のデータは健康日本21の最終評価等に活用され,健康増進施策の推進,評価のために貴重な資料となっている。本研究は,国民健康・栄養調査の調査地区が国民生活基礎調査の調査地区から抽出されることを利用して,世帯および個人単位で国民健康・栄養調査の協力率とそれに関連する要因を検討することにより,統計学的な代表性を評価することを目的とした。方法 平成15年から19年の国民健康・栄養調査の調査地区について,国民生活基礎調査と国民健康・栄養調査のレコードリンケージを行った。世帯単位の協力率については,世帯単位でレコードリンケージを行い,国民健康・栄養調査の協力率および協力率に関連する要因を検討した。個人単位の協力率については,国民生活基礎調査に協力した世帯の20歳以上の世帯員を対象に個人単位でレコードリンケージを行い,国民健康・栄養調査の協力率を身体状況調査およびその一部の血液検査と,栄養摂取状況調査,生活習慣調査の各々について検討した。結果 世帯単位の協力率は平成15年から19年の平均で66.4%であり,世帯人員が1人の世帯,特に男性の単独世帯で低かった。個人単位の協力率は身体状況調査が53.2%,血液検査が34.4%,栄養摂取状況調査が61.3%,生活習慣調査が63.1%であり,身体状況調査,特に血液検査で低かった。性別にみると,いずれの調査も男性より女性の協力率が高く,特に身体状況調査と血液検査で男女の差が大きかった。年齢階級別にみると,いずれの調査も20歳代が最も低く,男性では60歳代と70歳以上が,女性では60歳代が高かった。配偶者の有無別にみると,男女のいずれの年齢階級でも配偶者なし(未婚・死別・離別)の者に比べて配偶者ありの者の協力率が高かった。結論 世帯や個人の特性により国民健康・栄養調査の協力率に差がみられたことは,統計学的な代表性が損なわれてきている可能性を示唆している。また,調査の種類によっても協力率に大きな差がみられた。今後,国民健康・栄養調査の協力率を向上させるためには,調査の種類ごとに対象者の特性に応じた方法を検討する必要があると考えられる。(著者抄録)

This study evaluated effects of a behavioral approach which placed emphasis on tailored behavior counseling, diet, weight loss and weight maintenance. A one-year randomized controlled trial was conducted among 235 overweight/obese adults in Japan. The intervention group (n=119) received individual-based counseling using a behavioral approach and the changes made in the diet and physical activity were dependent on each participant as much as possible. One year later, the intervention group lost significantly more weight than the control group (-5.0 kg vs. 0.1 kg for men and -3.9 kg vs. -0.2 kg for women). Compared to the control group, the male intervention group reduced overall energy, cereals and dairy products consumption significantly, while increasing green and yellow vegetable intake, and the female intervention group significantly reduced intake of dairy products. Regarding behaviors, both male and female intervention groups increased the number of walking steps and women improved their irregular eating habits compared to those in the control groups. Behavior changes were related to weight loss; participants who maintained the action/maintenance stage or moved to later stages lost significantly more weight than participants who remained in the pre-contemplation/contemplation/preparation stages or regressed to earlier stages. After one-year follow-up, the intervention group maintained significantly lower weights, lower energy intakes and improvements in irregular eating habits. Our behavioral approach led to diet and behavior modification, weight loss and maintenance. Because modified variables differed between men and women, gender-specific approaches may be necessary.

Purpose. To examine behavioral factors related to successful weight maintenance. Methods. Subjects were 90 middle-aged participants who attended a weight loss program and were followed for one year. The subjects were classified into either successful weight maintainers (maintained a weight loss of 5% or more from their initial weight for one year) (SWM) or unsuccessful weight maintainers (USWM), and weight control practice, stress, obstacles, support, and self-efficacy during the program and follow-up period were compared. Results. SWM had mean loss of 12% from their initial weight during the program. They showed a greater improvement in their regularity of eating, walked more, and felt less stress regarding their increased physical activity than the USWM. During the follow-up period, significantly more SWM participants had self-efficacy (for measuring weight, practicing dietary objective, and assessing the practice and keeping records), actually kept records and measured weight more than the USWM participants. In contrast, more USWM participants felt stress about measuring weight. Conclusion. In addition to a substantial initial weight loss due to an increased amount of physical activity, having a higher self-efficacy and consistently keeping records of one's activities, as well as regularly weighing themselves, may be important for successful weight maintenance.

Lifestyle modification is the cornerstone of preventive management for people with cardiovascular disease risks, such as obesity, hypertension, dyslipidemia and diabetes. This study investigated the effect of a 27-month community-based lifestyle intervention on the reduction of cardiovascular disease risks in middle-aged Japanese. Of 549 participants with cardiovascular disease risk factors of overweight, hypertension, dyslipidemia or diabetes enrolled in this non-randomized controlled study, 397 participants aged 39-71 years old completed all 3 serial surveys at baseline, 15 months and 27 months. For the intervention group (39 males and 174 females), 31 specific interventions including individual counselling and group sessions were conducted. The control group (64 males and 120 females) only received 7 newsletters providing health information and results of health checkups. Multiple logistic regression analysis adjusted for sex, each baseline risk category and age category showed that the proportion of those who were overweight or showed dyslipidemia risk were significantly lower in the intervention group only at 27 months [Odds ratio (OR): 0.43 (95% CI 0.20-0.94), OR: 0.43 (95% CI 0.21-0.87), respectively] and the proportion of those showing diabetes risk was significantly lower in the intervention group at both 15 months [OR: 0.42 (95% CI 0.18-0.97)] and 27 months [OR: 0.56 (95% CI 0.32-0.99)]. In conclusion, the 27-month community-based lifestyle modification of cardiovascular disease risks shows significant reductions in risks of diabetes, overweight and dyslipidemia in middle-aged Japanese.

生活習慣改善を希望する中高年男女15名を対象に、コンピュータを用いた健康教育プログラムを6ヵ月間実施した。参加者が生活習慣の改善目標と毎月の計画を立て、管理栄養士のサポートのもとで計画を実践し、14名がプログラムを終了した。6ヵ月後には参加者の中等度及び強い身体活動の実施時間と10分以上の歩行を行う日数が有意に増加した。また、調理法では鍋物と蒸し物の頻度が有意に増加した。一方、揚げ物と妙め物の頻度は有意に減少した。目標達成者と目標非達成者を比較した結果、目標達成者はプログラムの機能を多く活用し、管理栄養士がサポートに費やす時間も長く、体重も多く減少していた。プログラムに対する感想についてアンケート調査を行った結果、管理栄養士の多くは本プログラムが健康教育において有用であると回答したものの、非対面であるため参加者の反応をつかみにくいという意見も得られた。

Recently, food intake pattern analysis associated with body weight has been conducted instead of traditional dietary analysis focusing on a single nutrient or food group, but there have been few studies examining the association between change in food intake patterns and body weight loss. In this study, short- and tong-term relationships between changes in food intake patterns and body weight loss were examined. Subjects were 506 overweight/obese men and women who participated in a 12-week health promotion program and a follow-up check 9 months later. Diet was assessed with a FFQ and food intake patterns named "Plant foods and seafood" and "Sweets, meats, dairy products and alcohol" were derived by cluster analysis using the intake of 17 food groups at the baseline. During the program, body weight* toss of the subjects changed pattern from "Sweets, meats, dairy products and alcohol" to "Plant foods and seafood" (SP group) was significantly Larger than that of the subjects who showed an opposite pattern change (PS group) or the subjects who maintained "Sweets, meats, dairy products and alcohol" pattern after adjusting for age, sex, body weight at the baseline, changes in energy intake and exercise habit. Body weight loss of the SP group was also significantly greater than that of the PS group during the follow-up period. Changes in food intake patterns were related to body weight loss and changing the pattern from "Sweets, meats, dairy products and alcohol" to "Plant foods and seafood" was most effective for short- and long-term body weight loss. (C) 2009 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

To examine the effectiveness of a computer-tailored support tool for lifestyle modification developed for employees, we conducted an intervention study of pre-post test design. The program was based on principles of behavior science referring to goal setting processes, self monitoring, and feedback. The program of the support process was fully automated. A total of 650 participants of four workplaces in Japan completed the baseline assessment, 185 (28.5%) of those returned for the post-test assessment 4 months later. There were significant improvements in lifestyle behaviors between baseline and post-test: In men, low energy intake (p<0.01) and exercise frequency (p<0.05), and in women, low salt intake (p<0.05) and exercise frequency (p<0.05). Furthermore, significant improvements were shown in the stage of change between baseline and post-test: Low salt intake (p<0.01) and regular exercise in men (p<0.01). Our results suggest a possibility that the program, utilizing a computer-tailored lifestyle modification support tool developed for use by employees, had a positive effect on participants' lifestyle behaviors in Japanese workplaces. The degree to which our results generalize to effects of the program is unclear but examination to develop more efficient and effective programs is warranted.

Morbidity and mortality associated with cardiovascular disease remain primary public health problems in Japan. We developed a large-scale community-based 15-month intervention program, and evaluated its long-term effects on improving lifestyle and cardiovascular risk. Of 549 participants, 436 (46 males and 186 females in intervention group and 72 males and 132 females in control group) completed the study. The intervention program consisted of a 6-month program including 15 sessions, with one lecture and individual counseling, two workshops and nutrition educations, and nine exercises (total 29 hours) and a 9-month maintenance program including 4 sessions of individual counseling, workshop, nutrition, and exercise (total 7 hours). Changes from the baseline to 15 months were significantly different between intervention and control groups by gender: the proportion of subjects who walked more than 6,000 steps/day (+39% vs. +2% for males; +17% vs. +1% for females), exercised more than 20 min/day and 3 times/week (+22% vs. +1% for males; +22% vs. +8% for females), ate vegetables at every meal (+18% vs. +4% for females), and consumed less salt (+9% vs. +3% for females); and the changes in body weight (-1.0 vs. -0.1 kg for males; -1.8 vs. -0.6 kg for females). Other changes detected only in females were body mass index (-0.8 vs. -0.3 kg/m(2)), systolic blood pressure (-6.6 vs. -2.4 mmHg), total cholesterol (-2.2 vs. +1.5 mg/dl), and the total risk scores (-0.5 vs. -0.1 points). The 15-month intervention program effectively improves and maintains lifestyle and cardiovascular risk, with greater effects of the long-term intervention in females.

目的:食事の多様性とバランスを評価する簡便な評価方法を提案し,その方法を用いてメタボリックシンドローム(MS)の食事の多様性とバランスを評価し,提案した方法の有用性を明らかにすることを目的とした.方法:厚生労働省のヘルスアップモデル事業参加者491人を研究対象とした.郵送法にて食物摂取頻度調査とその他の生活習慣調査を行った.身体計測ならびに血圧,血液検査は早朝空腹時に行った.日本のMS診断基準を用い,ウエスト周囲径に該当かつ項目基準の高脂血症,高血圧,高血糖のうち2つ以上に該当するものをMS群,ウエスト周囲径に該当かつ項目基準の1つに該当するものを一部該当群,どちらも該当しないものを非該当群とした.食事の多様性は「食事バランスガイド」の料理区分別食品群を使用し,摂取した食品群の種類を得点化した.得点が高いほど多様性があることとなる.食事のバランスは料理区分の目安量を用い,摂取量が目安量を満たすか否かを判断し得点化した.得点が正の場合は目安量を上回り,負であれば目安量を満たしていないこととなる.分類した3群の食事の多様性得点,バランス得点とともに食品群別摂取量,栄養素等摂取量,その他の生活習慣を男女別に比較検討した.結果:男性では非該当群11人(15.7%),一部該当群27人(58.6%),MS群32人(45.7%),女性では非該当群101人(24.0%),一部該当群235人(55.8%),MS群85人(20.2%)であった.年齢,BMI,総エネルギー摂取量を調整した共分散分析の結果,食事の多様性の得点は男女とも群間に有意な差はみられなかった.料理区分ごとのバランス得点は,男性では主食で非該当群に比べ一部該当群とMS群の得点が負の値で有意に低かった.牛乳・乳製品バランス得点は一部該当群のみ負の値で,非該当群に比べ有意に低かった.主菜,副菜,果物バランス得点では有意な差はみられなかった.女性では主菜で非該当群に比べMS群の得点が正の値で有意に高かった.主食,副菜,牛乳・乳製品,果物バランス得点では群間に有意な差はみられなかった.料理区分別のバランス得点は食品群別摂取量,栄養素等摂取量,各種臨床検査値とも妥当な相関関係であった.結論:食事の多様性とバランスを評価する簡便な方法を提案し,MS群と一部該当群の食事の特徴を非該当群と比較することで明らかにした.その結果,食事のバランスの指標により男性の一部該当群とMS群では主食バランス得点が低いこと,女性のMS群では主菜のバランス得点が高いという食事の実態が明らかになった.食事のバランスの評価指標は食品群別摂取量,栄養素等摂取量のみならず臨床検査値とも妥当な関連を示し,算出が簡便であることから,食事全般の評価方法として有用であることが示された.食事の多様性の指標についてはさらなる検討が必要である.(著者抄録)

The patterns of food intake change which are effective for weight loss have not been clearly researched yet. The objective of this study was to examine the correlation between food intake change patterns and body weight loss. One hundred and two overweight women completed a 2-day dietary record before and after a 12-week weight-reduction program, and 28 food groups were classified. Patterns of food intake change were derived by cluster analysis, and compared with the changes of physical measurements and nutrition intake. As a result, decreasing Japanese foods pattern (DJP), increasing healthy foods pattern (IHP) and changing staple foods pattern (CSP) were classified. DJP and CSP mainly changed staple food intake. IHP decreased sugars, oils, beans except soybeans and meat intake, and increased fruits and seafood intake. DJP decreased fat and carbohydrate intake most but CSP showed least change. IHP also decreased fat and carbohydrate intake but maintained protein intake. Although no significant differences were seen in the change of energy intake between IHP and DJP or CSP, subjects of IHP showed the largest reduction in mean body weight, BMI, %body fat, waist circumference and serum triacylglycerol after adjusting for age and baseline values. Body weight, BMI and %body fat maintained their significance further adjusting for changes in energy intake and the number of walking steps.Food intake change patterns affected the magnitude of body weight loss independent of energy intake. In addition to energy intake, assessment of food intake change patterns could be useful for effective weight loss. (c) 2007 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

The purpose of this study is to determine the relationship between lifestyle and change of cardiovascular risk factors based on a five-year follow up. The subjects were 307 employees participating in annual health check-ups in Tokyo, Japan from 1998 to 2003. Personal health checkup data were collected on their systolic/diastolic blood pressure (SBP/DBP), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), uric acid (UA), body mass index (BMI), questionnaire on medication history and Breslow's lifestyle. Over five years, cardiovascular risk factors such as SBP/DBP, TC, TG, FBG, UA and BMI have become worse; however, some of these risk factors were significantly different after 5 yr among lifestyle groups. TG in the poor lifestyle group was significantly higher than in good or moderate lifestyle groups after adjusting for age in men. In women, SBP and BMI in poor lifestyle group were significantly higher than those in good or moderate lifestyle groups after adjusting for age and baseline values. These results show that aging is the major influencing factor of cardiovascular risk factor deterioration. At the same time, lifestyle conditions are related to changes in some cardiovascular risk factors among Japanese employees.