Frequency of Food Intake and Estimated Nutrient Intake among Men and Women: The JACC Study.

BACKGROUND: The aim of this study was to determine the frequency of food intake and estimated nutrient intake in the JACC study cohort. METHODS: The subjects were 46,465 men and 64,327 women aged 40-79 years who responded to the self-administered food frequency questionnaire. We calculated the dietary intake of major nutrients by multiplying the frequency of consumption of each food with each portion size, estimated from a validation study. RESULTS: Women reported to more likely consume vegetables, seaweed, fruits, sweets, oolong-tea, western-style-breakfast, and less likely to consume rice and miso-soup than men. Women reported less preference of salty foods and fatty foods than men. Compared with men, women had higher mean intakes of carotene and vitamin C, and lower intake of total energy, carbohydrate and sodium. The frequency of consumption of beef, chicken, dairy products, fresh fish, fish products, rice, and miso-soup increased with age in men, and that of vegetables, seaweed, beans, tofu, fruits, sweets, and green-tea increased with age in both sexes. Men aged 40-49years had the lowest mean intake levels of crude fiber, calcium, iron, retinol, carotene, and vitamins A, C, and E. Women aged 40-49years had the lowest mean intake levels of crude fiber, iron, and vitamins C. Women aged 70-79years had the lowest mean intake levels of calcium, retinol, and vitamins A. CONCLUSIONS: Women had a more westernized dietary pattern than men. Elderly men had a mixture of unhealthy and healthy dietary patterns while elderly women generally had a healthier dietary pattern compared with younger persons.

We provided a baseline food frequency questionnaire of 39 foods to the participants in the Japan Collaborative Cohort Study (JACC Study) for Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho).Approximately, 110,000 participants provided valid responses, which enabled us to examine the relationships between food and nutrient intake with risk of mortality from various diseases.
Elucidation of the frequency of food intake and estimation of nutrient intake at baseline would be of value for the hypothesis development and interpretation of the diet-mortality associations.
In the present study, we examined the frequency of food and nutrient intake among 110,792 Japanese men and women.

Eggs and dairy products
The percentage of individuals with intake 3+ times/week was about 70% for eggs, 50 to 60% for milk, 5 to 15% for yogurt, 5 to 10% for cheese, and 10% for butter, 15 to 30% for margarine.Women reported the highest frequency of margarine than men, but the frequency was similar in both sexes for other foods.The percentage of intake 3+ times/week increased with age for milk, yogurt, cheese, butter and margarine in men while the percentage decreased with age for margarine in women.The percentage of high intake was similar among the age groups for eggs in men and women and for milk, yogurt, cheese and butter in women.Egg intake at 5+ times/week was reported by 35 to 50% of individuals, and the frequency increased with age in men but not in women.

Deep-fried foods, and fried vegetables
The percentage of individuals with intake 3+ times/week was about 20 to 25% for deep-fried foods or tempura, and 25 to 40% for fried vegetables, in both men and women.In general, vegetable oils were used for frying.The percentage of individuals with intake 3+ times/week increased with age for fried vegetables while it did not change with age for deep-fried foods in both sexes.

Raw fish and fish products
The percentage of individuals reporting intake 3+ times/week was about 55 to 65% for raw fish, 10 to 15% for Kamaboko (fish paste), and 25 to 30% for Himono (dried fish or salted fish).A higher frequency of fresh fish intake was reported by women than men, but the frequency was similar for fish products.The percentage of individuals with intake 5+ times/week increased with age for fish products but not for fresh fish.The percentage of raw fish intake 5+ times/week was 20 to 30%, and increased with age in men but not in women.Only 10% of men and women had raw fish intake less than 1 time/week.

Vegetables, fungi, seaweed and beans
The percentage of individuals with intake 5+ times/week (almost every day) was about 20 to 40% for Spinach or garland chrysanthemumm, 10 to 25% for carrot or pumpkin, 5 to 20% for tomatoes, 20 to 30% for cabbage or head lettuce, 10 to 20% for Chinese cabbage, 5% for Sansai (edible wild plants), 5 to 10% for fungi (enokidake, shiitake, mushroom), 10 to 25% for potatoes, 20 to 40% for seaweed (algae), 55 to 65% for pickles, 5 to 10% for Tukudani (Preserved foods concocted with say sauce), 3 to 10% for boiled beans, and 20 to 35% for Tofu (soybean curd).Women reported a higher frequency of these food intakes than men.The percentage of individuals with intake 5+ times/week increased with age for all of these food items.

Fruits
The percentage of individuals with intake 5+ times/week (almost Iso H, et al.

METHODS
The JACC Study began in 1988-1990 when 110,792 individuals  (46,465 men and 64,327 women) aged 40-79 years living in 45 communities across Japan participated in municipal health screening examinations and completed self-administered questionnaires about their lifestyles and medical histories of cardiovascular disease and cancer.
Each participant was asked about the frequency of intake of 35 foods, and five responses were possible for each food item, ranging from "rarely", "1-2 days/month", "1-2 days/week", "3-4 days/week", and "almost every day".We calculated the consumption of each food by multiplying the frequency score of consumption of each food 0, 1.5, 3.5, and 7, respectively) with each portion size, estimated from the validation study conducted in 8 men and 77 women from the baseline participants.The average daily intake of nutrients was calculated by multiplying the frequency of consumption of each item by its nutrient content per serving and totaling the nutrient intake for all food items.We obtained the nutrient data for 24,386 men and 37,493 women aged 40-79 years.For each food, the valid number of variables varied due to missing data.The reproducibility and validity of this dietary questionnaire was reported elsewhere. 1Statistical analyses were not conducted because of the large sample size in each sex and age category.
We examined the frequency of food intake and the mean intakes of major nutrients according to sex and age groups, geographical areas (Hokkaido, Tohoku, Kanto, Chubu, Kinki, Chugoku and Kyushu), and community features (seaside, plains, and mountains/basins).Seaside communities were 9 sites that faced the sea.Plain communities were 20 sites that did not face the sea and did have any mountains or basins.Mountains/basins communities were 16 sites that were not regarded seaside or plain communities.
Our entire study design was approved in 2000 by the Ethical Board at Nagoya University School of Medicine, where the central secretariat of the JACC study is located.

RESULTS
Table 1 shows the frequency of food intake according to sex and age groups.

Meat and liver
For both men and women, the percentage of individuals reporting intake of 3+ times/week was about 5 to 15% for beef, 15 to 25% for pork (excluding ham and sausages), 15 to 20% for ham and chicken and 5% for liver.Only in men the percentage reporting intake 3+ times/week for beef and chicken increased with age while in both sexes the percentage decreased with age for pork and ham.The percentage of high intake was similar among age groups for liver in men and women and for beef and chicken in women.
every day) was about 20 to 50% for citrus fruits, 10 to 20% for fresh fruit juice, 25 to 45% for other fruits (excluding citrus fruit).The frequency of intakes of fruits was higher in women than men.The percentage of individuals with intake 5+ times/week increased with age for citrus fruits in men and women, and for other fruits in men.The percentage of the higher intake was similar among the age groups for fresh fruit juice in men and women and for other fruits in women.

Sweets and beverages
The percentage of individuals with intake 5+ times/week (almost every day) was about 10 to 20% for sweets, 20 to 50% for coffee, 1 to 3% for black tea, 55-70% for green tea, 3 to 10% for oolong tea.The frequency of intake of sweets and oolong tea was high in women than men, but the frequency was similar in both sexes for coffee, black tea and green tea.The percentage of individuals with intake 5+ times/week increased with age for sweets, green tea, and decreased with age for coffee and oolong tea in both sexes.

Type of breakfast
The percentage of individuals who reported having Japanese style breakfast was 80%, western style breakfast 10 to 20%, Chagayu (Tea gruel) 5%, other types 2% and no breakfast less than 5%.Having western style breakfast was highest in women but the frequency was similar in both sexes for Japanese style, Chagayu, other styles or no breakfast.

Rice
The percentage of individuals who reported eating rice at 3+ bowls/day was 65 to 80% at present and 80 to 90% at age of 30 years.More men reported eating rice than women.The percentage of individuals who reported eating rice at a frequency of 6+ bowls/day was 5 to 20% at present and 10 to 60% at age of 30 years.The percentage of rice intake 3+ bowls/day at present decreased with age in men and women while that at age of 30 years increased with age in both sexes.

Miso soup
The percentage of individuals who reported consuming miso soup (soy bean soup) every day was 65 to 80% at present with a higher frequency of men than women.The percentage of individuals who consumed 3+ bowls of miso soup/day was 20 to 40% at present and 25 to 60% at age of 30 years with higher frequency of men than women.The percentage of individuals who consumed 6+ bowls miso soup/day at present was less than 2% of men and women while that at age of 30 years was 3 to 10% of men and 1 to 5% of women.The proportion of individuals reporting consuming miso soup increased with age in both sexes.

Taste for salty and fatty foods
Thirty to 50% of individuals reported preference of salty foods, with a higher frequency among men than women.This percentage areas.The percentage of individuals who consumed high amounts of coffee was higher in seaside areas while the percentage of those who consumed more green tea was highest in mountains/basin areas.The percentages of individuals who consumed more rice and miso soup were lower in seaside areas.
Table 5 shows the frequency of estimated major nutrient intake according to sex groups by geographical area.For both men and women, the intake values of mean total energy and other major nutrient except animal fat were higher in Tohoku, and generally lower in Chugoku.
Table 6 shows the frequency of estimated major nutrient intake according to sex groups by geographical feature.For both men and women, the mean intake values of total energy and other major nutrient except for animal fat were lowest in seaside areas while the mean animal fat intake was highest in mountainous areas.The mean intake levels of retinol, carotene and vitamin A were highest in plain areas, and mean vitamin C intake was higher in mountainous areas.

DISCUSSION
We found the consumption of certain foods and nutrients varied according to age and sex in the JACC Study cohort.Compared with men, women were more likely to consume vegetables, seaweed, fruits, sweets, oolong tea, western-style breakfast, but less likely to have rice and miso soup.These sex differences suggest that women has more westernized dietary pattern than men.Women also reported less preference of salty foods and fatty foods than men, indicating that women attempt to have healthier diet than men. 2 Women had higher mean intakes of carotene and vitamin C, and lower intake of total energy, carbohydrate and sodium than men.These sex difference were compatible with the findings of the National Nutrition Surveys. 2 The frequency of consumption of beef, chicken, dairy products, fresh fish, fish products, rice, miso soup increased with age in men, and that of vegetables, seaweed, beans, tofu, fruits, sweets, green tea increased with age in both men and women.These agerelated changes in food consumption suggest that older men had a mixture of unhealthy and healthy dietary pattern while older women generally had a healthier dietary pattern compared with younger persons.The exception was that women aged 70-79 years had low mean intakes of calcium, retinol, and vitamins A. As for potential problems related to major nutrient intake, men aged 40-49 years had the lowest mean intake values of crude fiber, calcium, iron, retinol, carotene, vitamins A, C and E than men of other age groups.Likewise, women of the same age group also had the lowest mean intake values of crude fiber and iron than women of other age groups.These potential problems had not been highlighted in previous nutrition surveys, and should be confirmed by additional analysis of the National Nutrition Surveys or other studies.
Our analysis showed substantial differences in the frequency of food intake and mean major nutrient intake by geographical area Iso H, et al.
sex and age groups.The mean carotene intake was 1,700 to 2,000 mg/day in men and 1,900 to 2,200 mg/day in women, and it increased with age in both sexes except for women aged 70-79.The mean vitamin A intake was 2,700 to 3,200 U/day in both men and women, and it increased with age except for women aged 70-79.
The mean values of vitamins B1, B2 and niacin intake were similar between men and women, and among age groups.The mean vitamin C intake was about 90 to 100 mg/day in men and 100 to 110 mg/day in women.The intake was lower in ages of 40-49 than in other age groups in men and women.
The mean cholesterol intake was 230 to 250 mg/day in both men and women, and it was lower in men aged 40-49 and women aged 70-79 than in other sex and age groups.The mean values of intake of alpha to gamma-tocopherol and vitamin E were similar between the sexes, and it was lowest in ages of 40-49 for both sexes.
The mean saturated fat intake was about 9 g/day and mean monounsaturated fat was 9 to 10 g/day in both men and women, and they were lower in men aged 70-79 and women aged 60-79 than other sex and age groups.The mean polyunsaturated fat intake was about 8 g/day in both sexes, and it was lowest in men aged 40-49 than men of other age groups.The mean intake of n3 fatty acids was about 2 g/day and the mean intake of n6 fatty acids was about 6 g/day in both sexes of all age groups.

Analyses of food and nutrient intake according to sex and geographical parameters
Table 3 shows the frequency of food intake according to sex by geographical area.The percentages of men and women who consumed more meats, eggs, deep-fried foods, fried vegetables, and fresh fish were generally higher in Tohoku and Kyushu than in other areas.The percentages of men and women who consumed more milk and dairy products were higher in Hokkaido and Chubu than in other areas.The percentage of individuals who consumed more vegetables was higher in Tohoku and Chubu and lower in Kinki and Chugoku.The percentage of individuals who consumed more green tea was lower in Hokkaido.The percentage of individuals who consumed more rice was higher in Hokkaido, Tohoku and Kinki, and lower in Chugoku.The percentage of individuals who consumed more miso soup was higher in Hokkaido and Tohoku and lower in Kinki and Kyushu.The percentage of individuals who preferred salty foods was lower in Hokkaido and Kyushu than in other areas.The percentage of individuals who preferred fatty foods was lower in Kyushu than in other areas.
Table 4 shows the frequency of food intake according to sex by geographical feature.For both men and women, the percentage of individuals who consumed high amounts of milk and dairy products was lower in plain areas than in seaside and mountainous areas.The percentage of individuals who consumed high amounts of fish was lower in mountainous areas.The percentage of individuals who consumed vegetables was generally lower in seaside and feature.Similar differences were observed in a previous nutrition study based on 24-hour dietary recall.Residents in seaside areas of Akita and Kochi prefecture had higher intake of fish and shellfish than residents in Osaka prefecture. 3These differences were attributable mostly to the accessibility to foods and local culture, some of which may contribute to regional differences in mortality from certain causes.Previous ecological analyses of the data of the National Nutrition Surveys in Japan and mortality statistics indicated that miso, pickled vegetables, soy products and fish (traditional Japanese diets) were positively associated with mortality due to cerebrovascular disease, while intakes of beef, eggs, butter, margarine and wheat (western-style diets) were inversely associated with mortality. 4ur findings are potentially useful for the development of hypothesis and interpretation of the relationships between food types and nutrient and the risk of mortality from various diseases.6) 2079 ( 4) 527 ( 6) 2150 ( 6) 2966 ( 20 ) 0.80 ( 0.00 ) 1.07 ( 0.00 ) 11.04 ( 0.02 ) 114.2 ( 0.3 ) 5.28 ( 0.01 ) 245.6 ( 0.6 ) 3.98 ( 0.01 ) 0.12 ( 0.00 ) 4.08 ( 0.01 ) 1.60 ( 0.01 ) 4.21 ( 0.01 ) 27.1 ( 0.1 ) 9.28 ( 0.02 ) 9.70 ( 0.02 ) 8.00 ( 0.02 ) 1.67 ( 0.00 ) 6.32 ( 0.01 )

Men Women
Standard deviations in parentheses.

Table 1 .
Frequency of food intake according to sex and age groups.

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 1 .
Frequency of food intake according to sex and age groups.(cont.)

Table 2 .
Nutrient intake (mean and standard deviation) according to sex and age.

Table 4 .
Sex-specific age-adjusted means and standard deviations of nutrient intake by geographical area.

Table 6 .
Sex-specific age-adjusted means and standard deviations of nutrient intake by geographical feature.