Nobuko Murayama

Effects of Socioeconomic Status on Nutrition in Asia and Future Nutrition Policy Studies.

Evidence of health disparities has been reported around the world. One of the intermediate factors between socioeconomic status (SES) and health is nutrition. Many studies reported socioeconomically disadvantaged people had more risk of obesity and lifestyle-related diseases than others in western society. Micronutrient intake affected by SES, but little evidence indicates that SES affects either energy intake or the macronutrient composition of the diet in western countries. In contrast, there is not enough evidence of a consistent relationship between SES and nutrition in Asian countries at present. The present status of nutrition disparities in Asia is considered to vary by economic level of the country. For developing countries in Asia, India and Vietnam, SES associates with BMI positively in women. For relatively developed countries in Asia, Korea and Japan, SES associates with BMI negatively in women. Low SES groups consume more carbohydrate, and less protein and fat, so not only micronutrient but also macronutrient intake is affected by SES both in developing and in developed Asian countries. There are some studies on the pathway from SES to diet/nutrition. The association between low SES and obesity may be mediated, in part, by the low cost of energy-dense foods, concern about food price and dietary knowledge. Nutrition policy research is required to reduce nutrition disparities in Asia. We need a collaborative study of the impact of potential political options on diet and on health with other academic fields.

Food accessibility and perceptions of shopping difficulty among elderly people living alone in Japan

ObjectivesThis aim of this study was to describe the association between shopping difficulty and food accessibility for elderly people living alone in Japan.DesignA cross-sectoral, multilevel survey was designed to measure shopping difficulty from a food accessibility perspective. The questionnaire was distributed by mail.SettingThe sample was drawn from seven towns and cities across Japan.ParticipantsA geographic information system was used to select the sample: it identified the proximity of elderly people living alone to a supermarket. In total, 2,028 elderly people (725 men and 1,303 women) responded to the questionnaire.MeasurementsThe binary dependent variables were shopping is easy/shopping is difficult. A logistic regression analysis adjusting for age and area of residence and using stepwise variable analyses was performed.ResultsThe response rate was 58.6%. Overall, 14.6% of elderly men and 21.7% of elderly women consider shopping difficult. The stepwise logistic analysis showed that the food accessibility factors strongly related to shopping difficulty are infrequent car use (women: OR = 6.97), walking difficulties (men: OR = 2.81, women: OR = 3.48), poor eyesight (men: OR = 2.26, women: OR = 1.75), not cooking lunch by oneself (men: OR = 1.63, women: OR = 1.72), not having anyone to help with food shopping (women: OR = 1.45) and living over 1 km away from a supermarket (men: OR = 2.30, women: OR = 2.97).ConclusionThe study concludes that elderly people’s assessment of shopping difficulty is related to their food accessibility. Important food accessibility aspects include car or motorbike ownership, walking continuously for 1 km, poor eyesight, and having cooking skills and having someone to help with shopping. These physical activity restrictions have a greater influence on shopping difficulty than do either income or proximity to a supermarket.

Association between satisfaction with state of health and meals, physical condition and food diversity, health behavior, and perceptions of shopping difficulty among older people living alone in Japan

ObjectiveThis study aimed to examine perceptions of shopping difficulty, and the relationships with satisfaction with state of health and meals, physical condition, food diversity and health behavior in older people living alone in Japan.DesignA cross-sectional, multilevel survey was designed. The questionnaire was distributed by mail and self-completed by participants.SettingThe sample was drawn from seven towns and cities across Japan.ParticipantsA geographic information system was used to select the sample of older people living alone, by proximity to a supermarket. In total, 2,346 older people (827 men and 1,519 women) completed the questionnaire.MeasurementsThe dependent variable was whether shopping was easy or difficult. A logistic regression analysis was performed, adjusting for age, socioeconomic status and proximity of residence to a supermarket using stepwise variable analyses.ResultsThe response rate was 67.8%. Overall, 14.5% of men and 21.7% of women considered shopping difficult. The stepwise logistic analysis showed that the factors most strongly related to shopping difficulty were a subjective feeling of poor health (men: OR = 3.01, women: OR = 2.16) and lack of satisfaction with meals (men: OR = 2.82, women: OR = 3.69). Other related physical condition and dietary factors were requiring nursing care (men: OR = 3.69, women: OR = 1.54), a high level of frailty, measured using the frailty index score (women: OR = 0.36) and low food diversity score (men: OR = 1.84, women: OR = 1.36).ConclusionThe study found that older people’s assessment of their shopping difficulty was related to satisfaction aspects, including a subjective feeling of poor health, and lack of satisfaction with meals, as well as physical condition. These have a greater influence on shopping difficulty than income in both sexes, and proximity to a supermarket in women.

Alcohol energy intake is related to low body mass index in Japanese older adults: Data from the 2010–2011 National Health and Nutrition Survey

ObjectiveThe objective of this study was to identify lifestyle and nutritional factors associated with low BMI in Japanese older adults, with a focus on alcohol energy intake.DesignCross-sectional study. Participants: Data from 1,093 respondents (711 men and 382 women) to the National Health and Nutrition Survey aged 65 years and older were included in this study.MeasurementsData were analyzed for associations between BMI and lifestyle, energy, and nutrient intake. Alcohol energy intake was calculated from total energy and participants were categorized into BMI quartiles. Energy-adjusted nutrient intakes were calculated as residuals from a regression model, with BMI as the independent variable and lifestyle factors and nutrient intake as dependent variables. Between-BMI quartile differences were assessed for each sex using multivariate logistic regression analysis. In addition, the nutrient intakes of men consuming more than 280 kcal and less than 280 kcal of alcohol energy per day were compared.ResultsMen and women in the lowest BMI quartile had lower total energy intake but higher alcohol energy intake than men in the other BMI quartiles. In multivariate logistic regression analysis, the lowest BMI quartile was associated with total energy (OR: 0.81, p = 0.0310) and alcohol energy intake (OR: 1.22, p = 0.0472) in men. In men, protein, carbohydrate, fat, calcium, iron, and vitamin intakes were less in those that consumed ≥ 280 kcal than in those that consumed < 280 kcal of alcohol per day.ConclusionOur results demonstrate an association between alcohol energy intake and low BMI in older Japanese individuals.

Associations between Japanese schoolchildren's involvement in at-home meal preparation, their food intakes, and cooking skills

BACKGROUND/OBJECTIVES This study aimed to examine the association of Japanese schoolchildrens involvement in at-home meal preparation with food intake and cooking skill. SUBJECTS/METHODS We included 1,207 fifth-grade children aged 10-11 years and one parent of each child. A cross-sectional survey was used to collect data on involvement in at-home meal preparation. Correspondence analysis was used to classify involvement in at-home meal preparation into three groups: food-related activities (cooking only or with other activities such as shopping, table-setting, clean up, and dishwashing), non-food-related activities (table-setting and/or clean up), and no (helping) activities. Food intake was assessed using a food frequency questionnaire. Logistic regression models were used to examine involvement in at-home meal preparation associations. RESULTS The sample consisted of 1,207 fifth-grade children. Vegetable intake was lower in the no (helping) activities group than the food-related activities group (95% CI; boys: 1.2, 5.1, girls: 2.0, 8.9). Fewer children in the non-food-related activities group reported they were able to make a portion of their meals compared with the food-related activities group (95% CI; boys: 1.6, 3.5; girls: 1.5, 3.2). CONCLUSIONS Children in the food-related activities group showed more favorable food intake and cooking skills than children in the no (helping) activities or non-food-related activities group.

Household income is associated with food and nutrient intake in Japanese schoolchildren, especially on days without school lunch

OBJECTIVE The present study aimed to examine the association between household income and the intake of foods and nutrients by Japanese schoolchildren, and any differences between days with and without school lunch. DESIGN This was a cross-sectional study. Children, with the support of their parents, kept dietary records with photographs for 4 d (2 d with school lunch and 2 d without). The socio-economic status of each family was obtained from a questionnaire completed by the parents. SETTING Japan. SUBJECTS All students in 5th grade (10-11 years old) at nineteen schools in four prefectures and their parents (1447 pairs of students and parents) were invited to take part in the study; 836 pairs of complete data sets were analysed. RESULTS The average results of four days of dietary records showed that lower income level was associated with a lower intake of fish/shellfish, green vegetables and sugar at the food group level, a lower intake of protein and several micronutrients, and a higher energy intake from carbohydrates at the nutrient level among the children. These associations between income and food/nutrient intake were not significant on days with school lunches, but were significant on days without school lunch. CONCLUSIONS Our study confirmed an association between household income and the amount of foods and nutrients consumed by Japanese schoolchildren, and suggested that school lunches play a role in reducing disparities in the diets of children from households with various incomes.

Serum Albumin Levels and Economic Status in Japanese Older Adults

Background Low serum albumin levels are associated with aging and medical conditions such as cancer, liver dysfunction, inflammation, and malnutrition and might be an independent predictor of long-term mortality in healthy older populations. We tested the hypothesis that economic status is associated with serum albumin levels and explained by nutritional and health status in Japanese older adults. Design We performed a cross-sectional analysis using data from the Japan Gerontological Evaluation study (JAGES). The study participants were 6528 functionally independent residents (3189 men and 3339 women) aged ≥65 years living in four municipalities in Aichi prefecture. We used household income as an indicator of economic status. Multiple linear regression was used to compare serum albumin levels in relation to household income, which was classified as low, middle, and high. Additionally, mediation by nutritional and health-related factors was analyzed in multivariable models. Results With the middle-income group as reference, participants with low incomes had a significantly lower serum albumin level, even after adjustment for sex, age, residential area, education, marital status, and household structure. The estimated mean difference was −0.17 g/L (95% confidence interval, −0.33 to −0.01 g/L). The relation between serum albumin level and low income became statistically insignificant when “body mass index”, “consumption of meat or fish”, “self-rated health”, “presence of medical conditions”, “hyperlipidemia”, or “respiratory disease “was included in the model. Conclusion Serum albumin levels were lower in Japanese older adults with low economic status. The decrease in albumin levels appears to be mediated by nutrition and health-related factors with low household incomes. Future studies are needed to reveal the existence of other pathways.

Subjective Well-Being Is Associated with Food Behavior and Demographic Factors in Chronically Ill Older Japanese People Living Alone

ObjectivesThis study aimed to examine the relationships among subjective well-being, food and health behaviors, socioeconomic factors, and geography in chronically ill older Japanese adults living alone.DesignThe design was a cross-sectional, multilevel survey. A questionnaire was distributed by post and self-completed by participants.SettingThe sample was drawn from seven towns and cities across Japan.ParticipantsA geographic information system was used to select a representative sample of older people living alone based on their proximity to a supermarket. Study recruitment was conducted with municipal assistance.MeasurementsTo assess subjective well-being and food and health behaviors of respondents with disease, a logistic regression analysis was performed using stepwise variable analyses, adjusted for respondent age, socioeconomic status, and proximity to a supermarket. The dependent variable was good or poor subjective well-being.ResultsIn total, 2,165 older people (744 men, 1,421 women) completed the questionnaire (63.5% response rate). Data from 737 men and 1,414 women were used in this study. Among people with a chronic disease, individuals with good subjective well-being had significantly higher rates than those with poor subjective well-being for satisfaction with meal quality and chewing ability, food diversity, food intake frequency, perception of shopping ease, having someone to help with food shopping, eating home-produced vegetables, preparing breakfast themselves, eating with other people, and high alcohol consumption. A stepwise logistic analysis showed that the factors strongly related to poor subjective well-being were shopping difficulty (men: odds ratio [OR] = 3.19, 95% confidence interval [CI], 1.94–5.23; P < 0.0001; women: OR = 2.20, 95% CI, 1.54–3.14; P < 0.0001), not having someone to help with food shopping (women: OR = 1.41, 95% CI, 1.01–1.97; P = 0.043), not preparing breakfast (women: OR = 2.36, 95% CI, 1.40–3.98; P = 0.001), and eating together less often (women: OR = 1.99, 95% CI, 1.32–3.00; P = 0.002).ConclusionSubjective well-being of people with chronic diseases is associated with food intake and food behavior. The factors that affect poor subjective well-being in chronically ill older Japanese people living alone include food accessibility and social communication.

A Pilot School Meal Program Using Local Foods with Soybean in Rural Bangladesh: Effects on the Nutritional Status of Children

Background: Growth retardation is a challenge in Bangladesh. School feeding programs with fortified biscuits have been evaluated in Bangladesh. However, the impacts of a school meal program using local foods on the growth and nutritional status of children have not been investigated. Objective: To determine whether a school meal program (SMP) using local foods with soybean could improve children’s growth and micronutrient status in rural Bangladesh. Methods: Two primary schools were randomly assigned as intervention (SMP; n = 200) and control (non-SMP; n = 200) schools. Children in the intervention school were supplied a school meal with local foods including soybean, containing more than one-third of the recommended daily allowance of energy and nutrients, 5 days/week for 8 months. The attendance rate and school lunch consumption of the children were monitored. Baseline and final anthropometry, hemoglobin and micronutrient status were assessed. Results: There were no significant differences in anthropometric measurements at baseline between the intervention and control groups, but there were differences in the prevalence of anemia, vitamin A deficiency and zinc deficiency. After the intervention, children in the SMP school showed a larger degree of improvement in the height-for-age Z-score (P < 0.001), red blood cell count (P = 0.001) and hemoglobin concentration (P < 0.001) than children in the non-SMP school. However, there were no positive effects on the body mass index (BMI)-for-age Z-score, serum ferritin, serum retinol or serum zinc status among children in the SMP school. Conclusion: A school meal program using local foods with soybean improved the height velocity and hemoglobin concentration of children in rural Bangladesh.

Relationship between rice consumption and body weight gain in Japanese workers: white versus brown rice/multigrain rice

Increasing obesity rates have driven research into dietary support for body weight control, but previous studies have only assessed changes in body weight of ±3 kg. We investigated the relationships between white or brown/multi-grain rice consumption and 1-year body weight gain ≥3 kg in Japanese factory workers (n = 437). Routine medical check-up data from a 1-year nutrition and lifestyle cohort study were analysed. Participants were divided into white rice and brown/multi-grain rice consumption groups and further classified by tertile of rice consumption. Multiple logistic regression analyses were performed by tertile. At 1 year, high white rice consumption was significantly associated with increased risk of body weight gain ≥3 kg compared with low white rice consumption, maintained after adjustment for age, sex, and consumption of other obesogenic foods (p = 0.034). In the brown/multi-grain rice consumption group, however, there was no significant difference in risk between high and low consumption, even after multi-variate adjustment (p = 0.387). The consumption of white rice, but not brown rice/multi-grain rice, was positively correlated with the risk of a 1-year body weight gain of 3 kg or more. This suggests that brown rice/multi-grain rice consumption is useful for body weight control among Japanese workers.