Objectives: The National Health and Nutrition Survey (NHNS; formerly the National Nutrition Survey) has been conducted every year in Japan for the past 75 years. From its start and to the present, it has changed in order to focus on the public health issues of the time, which is the unique characteristic of this survey. Therefore, our aim is to summarize the history and origins of the national survey and describe its present situation.

Methods: Previously published national reports were investigated to obtain information on the aims, survey areas, subjects, and survey items of the NHNS.

Results: The National Nutrition Survey in Japan was initiated with the aim of obtaining information about food supplies due to postwar food shortages. This survey has since been conducted with the goal of improving nutritional health and to allow the NHNS to more comprehensively promote health in accordance with enacted laws. The survey was designed to provide national representation through randomized selection and was initially conducted in separate parts on dietary intake and physical symptoms. At present, it is conducted in three parts that collect nutrition, physical, and lifestyle data. Consequently, the purpose and content of the NHNS have expanded over time. Throughout its 75-year history, the NHNS has continued to monitor Japanese dietary intake and health status, further contributing to various national policies on health, food systems, and nutrition.

Conclusion: The current state of health in Japan may be largely due to the contributions of the NHNS to public health through public health policy based on survey results. We hope that the NHNS continues to develop in the future and that this report will contribute to the development of public health worldwide.

Objective: There are regional health disparities in Japan regarding the physical condition and lifestyle as demonstrated in the gaps among prefectures. However, no regional annual trends have been reported. This study investigated the regional trends in dietary intake among Japanese adults.

Methods: Overall, 140,817 Japanese participants (64,773 men and 76,044 women) aged ≥20 years, registered in the 2003~2017 National Health and Nutrition Survey were included. The dietary survey was conducted with a semi-weighted household-based dietary record on a single day. The 47 prefectures were regrouped into 12 regions. Age-adjusted mean intakes of energy, carbohydrate, fat, protein, salt, vegetables, and fruits by region were estimated using a regression model, according to the survey years. Trend analyses from 2003 to 2017 were performed using the Joinpoint Regression Program.

Results: Significant decreases in carbohydrate and salt intake were noted in all regions, whereas fat intake showed a significant change in trend with annual increases. Protein intake decreased in approximately half and fruit intake decreased in two thirds of the regions. No changes in trend in energy and vegetable intake were observed in most regions, although a declining annual trend was observed in some regions.

Conclusions: In Japan, annual trend in intakes of energy, protein, vegetables, and fruits differed among regions from 2003 to 2017. These results may be attributed to the differences in health and nutrition policies between local governments. Regional trends in dietary intake among Japanese need to be monitored continuously to develop health and nutrition policies for local governments.

Objective: In the dietary survey of the National Nutrition Survey (NNS) and National Health and Nutrition Survey (NHNS), which has been conducted for more than 70 years, the reference weight of food portion is indispensable for accurately assessing the dietary intake. Thus, we summarized the history of the food composition table and the food number lists focusing on the reference weight of food portion, and the latest revision of the reference weight of food portion.

Methods: We reviewed the articles, laws, and the report of the results and webpages of NNS and NHNS. Additionally, we outlined the chronological flow of determining the latest reference weight of food portion.

Results: The Standard Tables of Food Composition in Japan have been used for nutrient intake calculation for NNS (1945 to 2002) and NHNS (2003~). In accordance with the revision of the Standard Tables of Food Composition in 2000, the food number lists used in the NNS were significantly revised, and the reference weight of food portion lists were added. The number of the foods listed as the reference weight of food portion has been increasing with each revision, as 440 were indicated as the reference weight of food portion in 2019's latest revision. Additionally, it was decided that the reference weight of food portion is indicated as a wide range.

Conclusions: It is important to provide a reference weight of food portion to assess dietary intake in a nationwide dietary survey and necessary to regularly revise the reference weight of food portion.

Objective: This study aimed to describe prevalence and trends in Japan in nutritional indicators/nutritional status, according to the Global Nutrition Monitoring Framework on Maternal, Infant and Young Child Nutrition (WHO, 2014).

Methods: We used vital statistics data on birth weight since 1951. Height and weight data for children, adolescents, and women of reproductive age, and hemoglobin concentration data for women were obtained from the National Nutrition Survey of Japan (NNS-J) and National Health and Nutrition Survey of Japan (NHNS-J). Underweight and overweight/obesity was defined using the percentage of overweight (POW) and body mass index (BMI). Anemia was defined as hemoglobin < 12 g/dl in non-pregnant women. Status on primary outcome indicators for the six global nutrition targets were observed regardless of data availability of annual trends.

Results: A high prevalence and increasing trends were observed in low birth weight (< 2,500 g) infants since 1975. Trends in the nutritional status among children under 5 years were unclear. Obesity (POW ≥ 20%) among school-aged children has declined. There were high percentages of underweight (BMI < 18.5 kg/m²) among adolescents and young women, with increasing trends since 1980. The percentage of overweight/obesity was consistently high among women aged ≥ 20 years. A high prevalence of anemia was consistently found among women of reproductive age since 1997.

Conclusions: Progress on reducing Japanese maternal and child malnutrition remains challenging. Continuous assessment of key indicators of maternal and child nutritional status will help to shape future strategies to encourage health and well-being through the life course.

Objective: This paper describes the key laws, policies, and activities related to Shokuiku (food and nutrition education).

Methods: The Basic Law on Shokuiku, the Basic Program for Shokuiku Promotion, and Shokuiku promotion programs by prefectural and municipal governments were summarized.

Results: The Basic Law on Shokuiku (enacted in 2005) aimed to promote healthy nutrition and lifestyles for Japanese through Shokuiku to ensure mental and physical public health. It mandated the promotion of Shokuiku through the formulation and implementation of the five-year Basic Program for Shokuiku Promotion. Between 2005 and 2015, Japan's Cabinet Office was in charge of Shokuiku promotion. After 2016, the Ministry of Agriculture, Forestry and Fisheries (MAFF) has been in charge of Shokuiku promotion. Every year, the MAFF evaluates targets and the current status of Shokuiku promotion measures. The Third Basic Program for Shokuiku Promotion was developed in light of the previous five years' achievements and challenges to cover fiscal year (FY) 2016 through FY 2020. The third program stipulates 21 specific quantitative targets. The coverage of Shokuiku promotion programs implemented by the prefectural governments was 100%, whereas it was just 84.5% (by the end of 2018) at the smaller municipality levels.

Conclusions: While some issues around Shokuiku have improved partly due to Shokuiku promotion programs during the past 15 years after the Basic Law on Shokuiku was enacted in 2005, serious problems remain (i.e. skipping breakfast among children and young people). Recently, the social environment and living conditions were dramatically and rapidly changed due to COVID-19. All people who are engaged in Shokuiku promotion need to make an effort to respond to diet and health-related issues for creating a bright future.

Objective: To describe the nutritional issues faced during the search for the "optimal diet" in modern Japan, how it evolved into the development of the current Dietary Reference Intakes, and its future perspectives for further health promotion.

Methods: We investigated and summarized the history of the Dietary Reference Intakes in Japan, by reviewing articles, books, official reports, and the publications of the National Institute of Nutrition.

Results: Thiamin deficiency has long been reported in the Japanese people due to their diet based mainly on polished rice. Medical doctors and nutritional scientists made efforts to determine the cause and to set dietary standards for people to maintain health. The first "Health Diet for the Japanese" (Nihonjin no Hoken Shokuryo) was made public in 1877. Furthermore, the State Institute of the Study of Nutrition was founded in 1920, which conducted studies on nutritional requirements and collaborated with the League of Nations. During and soon after World War 2, the mission of "Dietary Allowances" was the prevention of nutritional deficiencies. With accumulating knowledge, this evolved into the development of the "Dietary Reference Intakes," published since 2000.

Conclusions: The current Dietary Reference Intakes is the fruit of the historical pursuit for determining the optimal nutrition for the overall health of the general population. They provide a standard for nutritional assessment, school lunches, and hospital meals, and support the development of nutrition policies, such as food-based dietary guidelines. Further accumulation of evidence, such as the life-course approach to nutrition, may be needed to ensure the future health of the coming generations.

Objective: After the National Institute of Nutrition was founded at Tokyo in 1920, one of the main research areas has been energy metabolism. This review summarizes the history of studies on energy requirements and anthropometry conducted at the National Institute of Health and Nutrition.

Methods: A literature review of the published papers from the institute, including papers published in Progress of the Science of Nutrition in Japan was conducted. Furthermore, information on the circumstances surrounding the research was obtained from the institute's commemorative journals.

Results and Discussion: Dr. Tadasu Saiki, the first appointed director, focused on research on energy metabolism. Takahira studied the methods to measure basal metabolic rate (BMR) using a respiration chamber from Benedict in Nutrition laboratory of the Carnegie Institution in Washington. They measured basal metabolic rate to obtain the representative values in the Japanese and examined the differences in the BMR according to sex, age, body weight, and height among Japanese. Anthropometric studies were also performed to predict body surface area and percentage of body fat from skinfold thicknesses, and the predictive equations were utilized to calculate the BMR. In 2000, human calorimetry and the doubly labelled water method were introduced at the National Institute of Health and Nutrition to evaluate total energy expenditure, and determinants such as body composition and physical activity have been examined and methods for the prediction of energy expenditure have been proposed.

Conclusions: These results have contributed to the determination of energy requirements for the Dietary Reference Intakes for Japanese and provided valid methods for various types of research.

Objective: This article aimed to review the Japanese regulation of the food labelling systems for health and nutrition, and associated role of the National Institute of Health and Nutrition (NIHN).

Methods: We investigated the development of standards and challenges associated with the Japanese regulation of food labelling system for health and nutrition. We also examined the contribution of the National Institute of Health and Nutrition to the development of the systems.

Results: In 1991, the Ministry of Health and Welfare established the concept of Foods for Specified Health Uses (FOSHU), under the Nutrition Improvement Act. In 2001, the labelling system for vitamins and minerals was established under the Foods with Nutrient Function Claims regulations, and the Foods with Health Claims (FHC) system was set up with FOSHU. In 2015, the Foods with Function Claims classification was established under the Food Labelling Act by the Consumer Affairs Agency. Despite the regulated food labelling system in Japan, some "health foods" may have inappropriate use and labelling. The NIHN functions to (1) measure the amount of nutrients and ingredients in foods, ensuring accurate information on the labels for approval by the foods labelling system; (2) assesses safety and efficacy of health foods including FHC providing scientific evidences on their nutritional and physiological effects; and (3) provide reliable online information regarding health foods, the FHC and their labelling.

Conclusions: The NIHN has an important role within the regulation systems of health foods including FHC system in Japan.

Objective: To review the regulatory system for nutrition labeling, especially for nutrient declaration, in Japan, and to highlight the contributions made by the National Institute of Health and Nutrition (NIHN) with regard to the reliability of nutrition labeling of food in recent years.

Methods: We investigated the laws and official documents related to nutrition labeling of food in Japan, as well as relevant academic papers published by the NIHN from 1996 to 2020.

Results: In Japan, under the Food Labeling Act, nutrient declaration of the five nutritional components, namely energy, protein, fat, carbohydrates, and salt equivalent, has been mandatory for all prepackaged processed foods since 2015. Declared nutritional values should be consistent with the values obtained by laboratory analysis in principle, but "the value obtained by reasonable estimate" is permitted under certain conditions. Laboratory analysis is indispensable for verifying the accuracy of label values of foods with nutrient content or health claims. The NIHN has contributed to the regulatory system of nutrition labeling from the following three standpoints: 1) legal inspection body for the Foods for Special Dietary Uses, including the Foods for Special Health Uses, (approval testing) and other prepackaged foods bearing nutrient declaration (compliance testing); 2) proficiency testing provision for organizations performing food nutrition analysis; and 3) research institute to develop and improve analytical methods for nutritional and functional components in foods.

Conclusions: The NIHN has played pivotal roles in ensuring the reliability of nutrition labeling for more than half a century and will continue to do so in the future.

Objective: Mortality from noncommunicable diseases (NCDs) is increasing worldwide as well as in the Asia-Pacific region. To prevent NCDs, international collaborative activities for healthy nutrition and proper physical activities should be prioritized. This review aims to introduce international collaborative activities with Asia-Pacific countries for monitoring and evaluating national and international strategies for NCD prevention in the National Institute of Health and Nutrition (NIHN).

Methods: We reviewed activity reports from international symposia and fellowships conducted from 2004, the data of the WHO Collaborating Centres from 2014, and collaborative studies and other related activities by using internal NIHN records from 2002.

Results: The NIHN has held the Asian Network Symposium on Nutrition every other year nine times and has discussed nutrition challenges in the Asian region with invited experts. To support capacity strengthening in the surveillance of nutrition and physical activity, the NIHN started the Fellowship Program for Asian Researchers in 2004 and has invited 26 researchers from 12 countries. These continuous activities resulted in international collaborative studies with researchers in the Asia-Pacific region.

Conclusion: The international collaboration and networks on nutrition and physical activity resulted in the invitation of competent foreign researchers to the NIHN Fellowship Program for Asian Researchers at the nine-time Asian Network Symposium on Nutrition and given rise to international collaborative studies with countries in the Asia-Pacific region. The NIHN will continue these activities by monitoring and evaluating government policies for healthy food environments in the Asia-Pacific region under the Sustainable Development Goals.

Objective: This review aimed to clarify the improvement methods for diet and nutrition at emergency shelters and the various initiatives implemented to improve health and nutrition after natural disasters in Japan.

Methods: To find scientific evidence of dietary improvement methods at emergency shelters worldwide a literature search was conducted in PubMed and J-STAGE using the following keywords: "Disaster" AND "shelter OR camp" AND "nutrition OR food OR diet". Activity reports, reviews, articles without methods, and non-English or Japanese articles were excluded. In addition, we organized the information regarding initiatives taken to improve health and nutrition after natural disasters by governments, professional organizations, and academic research organizations in Japan.

Results: The literature search yielded seven articles. Four major factors associated with nutritional problems after natural disasters were identified from the literature review: 1) shelter size and equipment of the emergency shelter, 2) the method of provision and content of meals in emergency shelters, 3) collaboration with professionals, and 4) cooperation between shelters. After the Great East Japan Earthquake (GEJE), various initiative aimed at health and nutrition improvement after natural disasters, such as establishment of a specialized section, initiative/strategy to stockpile disaster food, development of human resources, and the nutrition standards for disasters, were started in Japan.

Conclusions: The present review identified factors associated with the improvement of nutritional problems in emergency shelters and various initiatives to reduce nutrition and health problems associated with natural disasters after the GEJE.