Establishment of a Meal Coding System for the Characterization of Meal-Based Dietary Patterns in Japan

Development of a Nutrient Profile Model for Dishes in Japan Version 1.0: A New Step towards Addressing Public Health Nutrition Challenges

To address the rising incidence of non-communicable diseases (NCDs) and promote healthier eating habits, Japan requires a culturally tailored Nutrient Profile Model. This study aimed to develop a Nutrient Profile Model for Dishes in Japan version 1.0 (NPM-DJ (1.0)) that corresponds to the nutritional issues and food culture in Japan. The aim of the NPM-DJ (1.0) was to promote the health of the general population, and to prevent the increase in NCDs in Japan. The NPM-DJ (1.0) categorizes dishes into staples, sides, mains, mixed dishes, and mixed dishes with staples. The model evaluates dishes based on energy, saturated fats, sugars, and sodium as restricted nutrients, while considering protein, dietary fiber, and the weight of certain food groups as recommended nutrients. The distribution of the overall score for each dish category was analyzed and a rating algorithm was created. The baseline, modification points, and final scores were significantly lower for side dishes than for staple dishes. In contrast, the baseline points and final scores were significantly higher for mixed dishes with staple. The model effectively differentiated nutritional profiles across five dishes categories, which may promote healthier dish reformulation by food businesses operators and encourage consumers to select healthier dishes.

Relationship between Household Shared Meal Frequency and Dietary Intake among Men and Women Aged ≥20 Years: Cross-Sectional Analyses Based on 2018 and 2019 National Health and Nutrition Surveys in Japan

This study aimed to examine the relationship between the frequency of household shared meals and the intake of 17 food groups and 21 nutrients. Participants were 3310 men and 3386 women ≥20 years old living in a household of ≥2 members from 2018 and 2019 National Health and Nutrition Surveys in Japan. A one-day household dietary record was used to classify an individual's shared meal frequency and dietary intake. A shared meal is defined as an eating occasion (i.e., breakfast, lunch, and dinner) where ≥1 food item-other than sugars, fats and oils, beverages, and condiments-was recorded with an assigned approximated shared proportion. The shared meal frequency for each individual was classified into one of four categories: 0, 1, 2, and 3 times/day. Dietary intake was compared across the shared meal categories adjusted for age, occupation, household size, meal skipping, snacking, residential areas, and within-household correlations. Both men and women who had more frequent shared meals showed higher intakes of potatoes, vegetables, mushrooms, and condiments but less confectioneries and beverages. A higher shared meal frequency was also related to a higher intake of many (12/21) nutrients (e.g., protein, dietary fiber, and potassium). However, in women, there was a positive association between shared meal frequency and sodium intake. A higher frequency of household shared meals may be related to a more favorable dietary intake; except for concerns about sodium intake in women.

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.

Food combination questionnaire for Japanese: relative validity regarding food and nutrient intake and overall diet quality against the 4-day weighed dietary record

The aim of this cross-sectional study was to examine the relative validity of food and nutrient intakes and overall diet quality scores derived using a newly developed dietary assessment questionnaire (food combination questionnaire, FCQ). Dietary data were collected from 222 Japanese adults (111 for each sex) aged 30-76 years using the online FCQ and then the 4-non-consective-day weighed dietary record (DR). The median of Spearman correlation coefficients for sixteen food groups was 0⋅32 among women and 0⋅38 among men. The median of Pearson correlation coefficients for forty-six nutrients was 0⋅34 among women and 0⋅31 among men. The Pearson correlation coefficient between the total scores of Healthy Eating Index-2015 (HEI-2015) derived from the DR and FCQ was 0⋅37 among women and 0⋅39 among men. The corresponding value for the Nutrient-Rich Food Index 9.3 (NRF9.3) total scores was 0⋅39 among women and 0⋅46 among men. Bland-Altman plots for these diet quality scores showed poor agreement at the individual level, although mean difference was small for the HEI-2015 (but not NRF9.3). Similar results were obtained using the paper version of FCQ, which was answered after conducting the DR, except for somewhat high Pearson correlation coefficients for the total scores of HEI-2015 (0⋅50 among both women and men) and NRF9.3 (0⋅37 among women and 0⋅53 among men). In conclusion, this analysis may lend support to the possible use of the FCQ as a rapid dietary assessment tool in large-scale epidemiologic studies in Japan, but further refinement of this tool should be pursued.

Relative Validity of the Meal-Based Diet History Questionnaire for Estimating Nutrient Intake among Japanese Women and Men aged 30–76 Years

The purpose of this study was to examine the relative validity of the Meal-based Diet History Questionnaire (MDHQ) for estimating nutrient intake. Dietary data were obtained from 111 Japanese women and 111 Japanese men, using the online MDHQ and the 4-non-consecutive-day weighed dietary record (DR). The number of nutrients (total n = 46) showing no significant mean differences between estimates from the online MDHQ and DR (with energy adjustment by the density model) was 17 among women and 12 among men. The median value (25th and 75th percentiles) of the Pearson correlation coefficients between the online MDHQ and DR estimates was 0.54 (0.35–0.57) among women and 0.45 (0.25–0.53) among men. Bland–Altman plots for energy-providing nutrients indicated wide limits of agreement (and proportional bias for protein) with overall underestimation of protein and fat and overestimation of carbohydrate by the online MDHQ. Similar results were found when the paper version of the MDHQ (completed after the DR) was examined. For example, the median value of the Pearson correlation coefficients was 0.54 for women and 0.45 for men. This study suggests that the MDHQ has an acceptable ability to rank individuals according to intakes of a wide range of nutrients.

Relative Validity of Food Intake in Each Meal Type and Overall Food Intake Derived Using the Meal-Based Diet History Questionnaire against the 4-Day Weighed Dietary Record in Japanese Adults

We examined the relative validity of food intake for each meal type (breakfast, lunch, dinner, and snacks) and overall food intake obtained through the Meal-based Diet History Questionnaire (MDHQ). In total, 222 Japanese adults (111 for each sex) aged 30–76 years completed the web version of the MDHQ and then the 4-non-consecutive-day weighed dietary record (DR). The number of major food groups (n = 24 in total) for which no statistically significant difference was observed between median intakes estimated using the DR and MDHQ ranged from 8 (snacks) to 12 (dinner) among women, and from 8 (breakfast) to 13 (lunch) among men. The median values of the Spearman’s correlation coefficients between the MDHQ and DR estimates ranged from 0.28 (dinner) to 0.54 (breakfast) among women, and from 0.24 (dinner) and 0.60 (breakfast) among men. Bland–Altman analyses generally showed wide limits of agreement and proportional bias. Similar results were obtained using the paper version of the MDHQ, which was completed after conducting the DR. In conclusion, the MDHQ has a satisfactory ability to estimate median intake and rank individuals according to consumption for many food groups, despite a limited ability to estimate food group intakes on an individual level.

Web-Based Personalized Nutrition System for Delivering Dietary Feedback Based on Behavior Change Techniques: Development and Pilot Study among Dietitians

Given the complex and varied nature of individual characteristics influencing dietary behaviors, personalized dietary advice may be more effective than generalized “one-size-fits-all” advice. In this paper, we describe a web-based personalized nutrition system for improving the quality of overall diet in the general adult population. The development process included identification of appropriate behavior change techniques, modification of dietary assessment method (Meal-based Diet History Questionnaire; MDHQ), selection of dietary components, and a personalized dietary feedback tool. A pilot study was conducted online among 255 dietitians. Each completed the MDHQ, received his/her own dietary feedback report, and evaluated the relevance of the report based on 12 questions using a 5-point Likert scale from “totally disagree” (score 1) to “totally agree” (score 5). The mean value of overall acceptability score of dietary feedback report was 4.2. The acceptability score was, on average, higher in plausible energy reporters (compared with implausible energy reporters), participants who printed out the report (compared with those who did not), and those spending ≥20 min to read the report (compared with those spending <20 min). This is the first attempt to develop a web-based personalized nutrition system in Japan, where dietitians were broadly supportive of the dietary feedback report.

Using food network analysis to understand meal patterns in pregnant women with high and low diet quality

BACKGROUND

Little is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification.

METHODS

Women were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles.

RESULTS

In both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile.

CONCLUSIONS

In this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies.

TRIAL REGISTRATION

PEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

Identification of Dish-Based Dietary Patterns for Breakfast, Lunch, and Dinner and Their Diet Quality in Japanese Adults

We identified dish-based dietary patterns for breakfast, lunch, and dinner and assessed the diet quality of each pattern. Dietary data were obtained from 392 Japanese adults aged 20–69 years in 2013, using a 4 d dietary record. K-means cluster analysis was conducted based on the amount of each dish group, separately for breakfasts (n = 1462), lunches (n = 1504), and dinners (n = 1500). The diet quality of each dietary pattern was assessed using the Healthy Eating Index 2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). The extracted dietary patterns were as follows: ‘bread-based’ and ‘rice-based’ for breakfast; ‘bread’, ‘rice-based’, ‘ramen’, ‘udon/soba’, and ‘sushi/rice bowl dishes’ for lunch; and ‘miscellaneous’, ‘meat dish and beer’, and ‘hot pot dishes’ for dinner. For breakfast, the HEI-2015 and NRF9.3 total scores were higher in the ‘rice-based’ pattern than the ‘bread-based’ pattern. For lunch, the HEI-2015 and NRF9.3 total scores were relatively high in the ‘rice-based’ pattern and low in the ‘ramen’ pattern. For dinner, the HEI-2015 total score was the highest in the ‘meat dish and beer’ pattern, and the NRF9.3 total score was higher in the ‘hot pot dishes’ than the ‘miscellaneous’ pattern. These results suggested that breakfast, lunch, and dinner have distinctive dietary patterns with different diet qualities.

Identifying Usual Food Choice Combinations With Walnuts: Analysis of a 2005-2015 Clinical Trial Cohort of Overweight and Obese Adults

Consumption of nuts has been associated with a range of favorable health outcomes. Evidence is now emerging to suggest that walnuts may also play an important role in supporting the consumption of a healthy dietary pattern. However, limited studies have explored how walnuts are eaten at different meal occasions. The aim of this study was to explore the food choices in relation to walnuts at meal occasions as reported by a sample of overweight and obese adult participants of weight loss clinical trials. Baseline usual food intake data were retrospectively pooled from four food-based clinical trials (n = 758). A nut-specific food composition database was applied to determine walnut consumption within the food intake data. The a priori algorithm of association rules was used to identify food choices associated with walnuts at different meal occasions using a nested hierarchical food group classification system. The proportion of participants who were consuming walnuts was 14.5% (n = 110). The median walnut intake was 5.14 (interquartile range, 1.10–11.45) g/d. A total of 128 food items containing walnuts were identified for walnut consumers. The proportion of participants who reported consuming unsalted raw walnut was 80.5% (n = 103). There were no identified patterns to food choices in relation to walnut at the breakfast, lunch, or dinner meal occasions. A total of 24 clusters of food choices related to walnuts were identified at others (meals). By applying a novel food composition database, the present study was able to map the precise combinations of foods associated with walnuts intakes at mealtimes using data mining. This study offers insights into the role of walnuts for the food choices of overweight adults and may support guidance and dietary behavior change strategies.

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

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

Application of the Healthy Eating Index-2015 and the Nutrient-Rich Food Index 9.3 for assessing overall diet quality in the Japanese context: Different nutritional concerns from the US

Objectives

While it is widely perceived that the diet consumed by Japanese is healthy, empirical evidence supporting this notion is limited. In this cross-sectional study, we assessed the overall diet quality of Japanese using the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), and compared diet quality scores between Japanese and Americans.

Methods

We used 1-d dietary record data from 19,719 adults (aged ≥20 y) in the Japanese National Health and Nutrition Survey 2012 and the first 24-h dietary recall data from 4614 adults in the US NHANES 2011–2012.

Results

As expected, a higher total score of the HEI-2015 and NRF9.3 was associated with favorable patterns of overall diet in the Japanese population. The range of total score was wide enough for both HEI-2015 (5th percentile 37.2; 95th percentile 67.2) and NRF9.3 (5th percentile 257; 95th percentile 645). Both HEI-2015 and NRF9.3 distinguished known differences in diet quality between sex, age, and smoking status. The mean total scores of HEI-2015 and NRF9.3 were similar between Japanese (51.9 and 448, respectively) and US adults (52.8 and 435, respectively). However, component scores between the 2 populations were considerably different. For HEI-2015, Japanese had higher scores for whole fruits, total vegetables, green and beans, total protein foods, seafood and plant proteins, fatty acids, added sugars, and saturated fats, but lower scores for total fruits, whole grains, dairy, refined grains, and sodium. For NRF9.3, the intakes of vitamin C, vitamin D, potassium, added sugars, and saturated fats were more favorable in Japanese, while those of dietary fiber, vitamin A, calcium, iron, magnesium, and sodium were less favorable.

Conclusions

This study suggests the usefulness of HEI-2015 and NRF9.3 for assessing the diet quality of Japanese, as well as for highlighting different nutritional concerns between Japan and the US.

Food Combinations in Relation to the Quality of Overall Diet and Individual Meals in Japanese Adults: A Nationwide Study

We examined food combinations in relation to the quality of the overall diet and individual meals using a newly developed food combination questionnaire (FCQ) in a nationwide sample of Japanese adults aged 19–80 years (n = 2233). The quality of the overall diet and of each meal was assessed by the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). For all main meals (breakfast, lunch, and dinner), the most commonly consumed food combinations consisted of ‘rice, total vegetables, and tea and coffee’. Consistently positive associations between these food combinations and diet quality were found for breakfast (Spearman r: ≥0.46). Positive rather weak associations between these food combinations and diet quality were also observed for lunch (Spearman r: ≤0.48). Conversely, the associations were inconsistent for dinner: inverse associations with HEI-2015 (Spearman r: ≤−0.35) and generally weak positive associations with NRF9.3 (Spearman r: ≥0.09). For snacks, the most commonly consumed food combinations consisted of ‘confectioneries and tea and coffee’, but these showed rather weak associations with diet quality. Similar results were obtained when associations with the quality of overall diet were investigated. The FCQ may be useful in capturing the complex nature of food combinations in Japanese adults.

High starchy food intake may increase the risk of adverse pregnancy outcomes: a nested case-control study in the Shaanxi province of Northwestern China

Background

There was a wider disparity in the diet characterization among most studies on diet and pregnancy outcomes in different countries, and the research in northern China is limited. Therefore, the purpose of the present study that was conducted in northwest China was to understand the dietary characteristics of periconceptional women and to explore the relationship between and specific dietary patterns with adverse pregnancy outcomes.

Methods

A nested case-control study was conducted from October 2017 to November 2018 in Shaanxi, China. Based on a prospective cohort of 368 women who were pregnant or prepared for pregnancy, 63 participants who developed the outcomes of gestational hypertension, gestational diabetes, preterm birth, low birth weight, and birth defects were included in the case group. A total of 237 healthy pregnant women were included during the same period in the control group. Dietary intake was assessed using a validated food frequency questionnaire for the three months before pregnancy and the first trimester. Information on delivery details and antenatal pregnancy complications was obtained from the hospital maternity records. Dietary patterns were derived using factor analysis. Stratified analysis was performed on the overall, single and multiple adverse pregnancy outcomes categories. Adjustment was made for sociodemographic characteristics and nutritional supplement status.

Results

Six major dietary patterns were identified. The ‘starchy’ dietary pattern, composed of high intake in noodle and flour products and/or rice and its products, was associated with the odds of developing of adverse pregnancy outcomes (OR: 2.324, 95% CI: 1.293–4.178). This risk remained significant following adjustment for potential confounders of maternal demographic characteristics and nutritional status (aOR: 2.337, 95% CI:1.253–4.331). Strong association were found during the first trimester of pregnancy, but showed no association during the three months before pregnancy (aOR:1.473, 95% CI: 0.682–3.234).

Conclusions

High starchy food intake was associated with adverse pregnancy outcomes, particularly during the first trimester of pregnancy. Health education focusing on periconceptional dietary patterns could be a practical strategy for preventing adverse pregnancy outcomes.

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

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

Diet quality scores in relation to metabolic risk factors in Japanese adults: a cross-sectional analysis from the 2012 National Health and Nutrition Survey, Japan

OBJECTIVE

Associations between the overall quality of Japanese diets and metabolic risk factors are largely unknown. This cross-sectional study investigated this issue using data from the 2012 National Health and Nutrition Survey, Japan.

METHODS

Dietary intake was assessed by a 1-day weighed dietary record in 15,618 Japanese adults aged ≥ 20 years. Overall diet quality was assessed by adherence to the Japanese Food Guide Spinning Top (JFG score), its modified version (modified JFG score), the Mediterranean diet score (MDS) and the Dietary Approaches to Stop Hypertension (DASH) score. Metabolic risk factors included BMI, waist circumference, blood pressure, total, HDL- and LDL-cholesterol and glycated haemoglobin.

RESULTS

While DASH score was consistently associated with favourable nutrient intake patterns (including higher micronutrient and dietary fibre intakes and lower SFA and sodium intakes), other scores were associated with both favourable and unfavourable aspects (e.g., lower micronutrient intakes for JFG score, higher SFA intakes for modified JFG score and higher sodium intakes for MDS). The associations with metabolic risk factors were also inconsistent and unexpected, including positive associations of JFG and modified JFG scores with LDL-cholesterol, inverse associations of MDS with HDL-cholesterol and null associations of DASH score with blood pressure.

CONCLUSIONS

This study did not show expected and consistent associations of the four available diet quality scores with nutrient intakes and metabolic risk factors in Japanese adults. This in turn suggests the need for a scientific base on which to develop an appropriate tool for assessing the quality of diets in the Japanese context.

The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia

Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast-CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (-0.34 kg/m², 95% confidence interval (CI) -0.02, -0.66), and serum total (-0.07 mmol/L 95% CI -0.02, -0.13) and LDL (-0.07 mmol/L 95% CI -0.02, -0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality.

Applying a meal coding system to 16-d weighed dietary record data in the Japanese context: towards the development of simple meal-based dietary assessment tools

Data on the combination of foods consumed simultaneously at specific eating occasions are scarce, primarily due to a lack of assessment tools. We applied a recently developed meal coding system to multiple-day dietary intake data for assessing its ability to estimate food and nutrient intakes and characterise meal-based dietary patterns in the Japanese context. A total of 242 Japanese adults completed sixteen non-consecutive-day weighed dietary records, including 14 734 eating occasions (3788 breakfasts, 3823 lunches, 3856 dinners and 3267 snacks). Common food group combinations were identified by meal type to identify a range of generic meals. Dietary intake was calculated on the basis of not only the standard food composition database but also the substituted generic meal database. In total, eighty generic meals (twenty-three breakfasts, twenty-one lunches, twenty-four dinners and twelve snacks) were identified. The Spearman correlation coefficients between food group intakes calculated based on the standard food composition database and the substituted generic meal database ranged from 0·26 to 0·85 (median 0·69). The corresponding correlations for nutrient intakes ranged from 0·17 to 0·82 (median 0·61). A total of eleven meal patterns were established using principal components analysis, and these accounted for 39·1 % of total meal variance. Considerable variation in patterns was seen in meal type inclusion and choice of staple foods (bread, rice and noodles) and drinks, and also in meal constituents. In conclusion, this study demonstrated the usefulness of a meal coding system for assessing habitual diet, providing a scientific basis towards the development of simple meal-based dietary assessment tools.

Breakfast in Japan: Findings from the 2012 National Health and Nutrition Survey

We assessed breakfast in Japan using data from the 2012 National Health and Nutrition Survey. Dietary data were obtained from 1444 children (aged 6⁻11 years), 1134 adolescents (aged 12⁻17 years), 6531 younger adults (aged 18⁻49 years), and 13,343 older adults (aged ≥ 50 years), using a one-day weighed dietary record. Overall, 97% of participants reported consuming breakfast. Compared with breakfast skippers, breakfast consumers had a higher daily diet quality score assessed by the Nutrient-Rich Food Index 9.3 (NRF9.3). For those who consumed breakfast, breakfast accounted for 20⁻25% of daily energy intake. In comparison with the contribution to energy, breakfast accounted for higher proportions of carbohydrate and riboflavin, and lower proportions of MUFA, n-3 PUFA, thiamin, and niacin, as well as vitamins B-6 and C. The overall diet quality (NRF9.3 score) was positively associated with breakfast intake of protein, n-6 PUFA, n-3 PUFA, carbohydrate, dietary fiber, and almost all micronutrients examined, and inversely with that of added sugar. For foods, the NRF9.3 score was positively associated with breakfast intake of rice, potatoes, pulses, vegetables, fruits, and eggs and inversely with that of bread, sugar, and soft drinks. The findings will be useful in developing dietary recommendations for a balanced breakfast among Japanese.

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

We examined 13-year trends in dietary patterns, using data from the National Health and Nutrition Survey, Japan 2003–2015. In repeated, independent cross-sectional studies, dietary intake was assessed with a one-day weighed dietary record in 88,527 Japanese adults aged ≥20 years. Using principal component analysis based on the daily consumption of 31 food groups, we identified three dietary patterns, the “plant food and fish”, “bread and dairy”, and “animal food and oil” patterns. In the whole sample, the “plant food and fish” pattern score decreased while the “bread and dairy” and “animal food and oil” pattern scores increased. The decreasing trends in the “plant food and fish” pattern were observed in all subgroups considered. The increasing trends in the “bread and dairy” pattern were similar across sexes and by current smoking status. However, in terms of age, occupation, and weight status, the increasing trends were only evident in particular subgroups (i.e., age 50–64 and ≥65 years; security/transportation/labor occupation and nonworker; and normal weight and overweight participants). For the “animal food and oil” pattern, the increasing trends were observed in all subgroups, except for the youngest age group (20–34 years old). This study suggests continuous Westernization of the Japanese diet.

Generic Meal Patterns Identified by Latent Class Analysis: Insights from NANS (National Adult Nutrition Survey)

Nutritional data reduction methods are widely applied in nutrition epidemiology in order to classify individuals into meaningful groups with similar dietary patterns. To date, none of the existing studies have applied latent class analysis to examine dietary patterns which include meal types consumed throughout a day. We investigated main meal patterns followed on weekend and weekdays, and evaluated their associations with cardio-metabolic biomarkers. The analyses were performed within the NANS (National Adult Nutrition Survey) a cross-sectional national food consumption survey of 1500 nationally representative Irish adults. A total number of seven dietary patterns were identified using latent class analysis. The typical meal pattern followed by the majority of the population was characterized by consumption of cereal or toast for breakfast, skipping or consuming a sandwich for light meal, and meat or fish with potatoes, pasta or vegetables for the main meal. Eating patterns differed on weekends, and those participants who consumed meat and eggs for breakfast instead of breakfast cereal and skipped light meal were more likely to have an unhealthier dietary pattern, a higher diastolic blood pressure, and increased serum ferritin. The application of data reduction techniques to simplify the multifaceted nature of dietary data is a useful approach to derive patterns, which might shed further light on the typical dietary patterns followed by populations.