Objective: The increasing use of health foods has led to concerns about the possible health problems it could create. This review aims to clarify the current status and problems in ensuring the safety of health foods in Japan by comparing it with the measures prescribed for dietary supplement (DS) systems in the US.

Methods: A literature review provided data on actual status, usage of products, and systems for collecting and evaluating adverse events. Information on the situation in the US was obtained by visiting the concerned department in charge.

Results: The majority of severe adverse events suspected to be related to health foods was not attributed to the foods themselves, but to unapproved pharmaceutical ingredients added illegally to them. Minor to moderate cases involved discomforts such as gastrointestinal problems and allergies, which were not reported to the concerned authorities. Not enough action was taken on the reported adverse events owing to the small number of cases and the difficulty in determining the causal relationship of the symptom with the product. The US DS system and the Japanese system are similar in terms of safety measures, except for the mandatory GMP for products, compulsory reporting of severe adverse events to business operators, quick information collection using electronic media, and evaluation of information.

Conclusions: Measures should be implemented to collect and evaluate as many cases of minor to moderate adverse events as possible, which have occurred post marketing of the health foods, to prevent recurrence of such events and more severe reactions.

Objective: To identify the causal structure of the association of self-esteem with dietary and lifestyle habit self-efficacy, stage of eating behavior change, and dietary intake in high school students.

Methods: Of 357 second-year students enrolled in 2015 in a public high school in City A, Hyogo Prefecture, 301 from whom responses were obtained were included in the analysis. Self-esteem was evaluated by the Rosenberg Scale. As observed variables with potential associations, dietary and lifestyle habit self-efficacy (12-item scale with confirmed reliability and validity), stage of eating behavior change (5-point scale based on the Transtheoretical Model), and dietary intake (based on a Food Frequency Questionnaire and Dietary Reference Intakes for Japanese) were used to develop a hypothetical model and perform a covariance structure analysis.

Results: Configural invariance evaluation revealed that the hypothetical model had acceptable goodness of fit (χ² = 226.458, df = 176, GFI = 0.919, AGFI = 0.874, CFI = 0.948, RMSEA = 0.031). In boys, no significant positive path was observed from self-esteem to the variables, including the 12-item dietary and lifestyle habit self-efficacy scale. In girls there was a significant positive path from self-esteem to self-efficacy (0.16, p = 0.041) and from self-efficacy to dietary intake (0.19, p = 0.013) via stage of eating behavior change (0.29, p = 0.002), indicating indirect effects.

Conclusion: The results suggest that, in second-year female high school students, higher self-esteem leads to greater dietary and lifestyle habit self-efficacy and, through improved stage of eating behavior change, influences diet.

Objective: The present study aimed to investigate current practices of responding to halal requests in hospital food services to develop a system for accepting patients with religious beliefs and practices such as those observed in Islam.

Method: A questionnaire on individualized responses to requests for specific hospital foods was mailed in December 2019 to registered dietitians working at 161 hospitals in A Prefecture. A total of 122 responses was received; the data were analyzed using either the chi-square test or Fisher's exact test.

Results: The percentage of respondents that implemented individualized responses to specific dietary requests was 30.3%; large hospitals with many beds tended to implement such responses. The proportion of those who had experience responding to halal requests was 14.8% of the total surveyed dietitians. Most hospitals provide meals by removing or replacing forbidden foods from the existing menu. Of the 120 responses, 87.5% said that they either knew or had heard of halal foods; significantly more respondents who said that they knew about halal foods selected "pork", "alcoholic beverages", and "alcohol" as items to be mindful of; many respondents also tended to choose "soy sauce".

Conclusion: Although the level of awareness of halal food was high among registered dietitians working at hospitals, the number of hospitals that had experience with halal requests in their food services was low. Sharing of information and organizing opportunities for learning are essential for handling halal requests.

Objective: This study aimed to develop a flowchart for selecting nutrition diagnostic codes (NDCs) with high validity and consistency in the nutrition care process.

Methods: The NDC selection flowchart consisted of two parts: first, NDC (P1) related to nutritional intake was derived, and then the second, NDC (P2) indicating the root cause of the nutritional problem was derived. Registered dietitians/dietitians were asked to determine the nutritional diagnosis of simulated patients using the NDC selection flowchart. Based on this, the flowchart was evaluated.

Results: Responses were received from 43.2% of the participants. For patient A simulation, the agreement on correct answers for both P1 and P2 was ≥ 80%, and the validity rate exceeded 90%. In contrast, for patient B simulation, the agreements on correct answers and the validity rate for P1 were approximately 40% and 90%, respectively. For P2, the agreement on correct answers was 10%, and the validity rate was 50%. The degree of difficulty of the NDC selection flowchart was rated lower than its efficacy.

Conclusion: Although the efficacy of the NDC selection flowchart was confirmed as expected, the results of this study show that the flowchart needs further improvement to serve as a tool for selecting NDCs with high validity and consistency.

Objective: A series of experiments using rats have revealed that the intake of fermented brown rice extract (FBR) containing high nucleic acid suppresses the increase in blood glucose level. However, this series of experiments were conducted on animals, and the amount of FBR ingested was large. Therefore, the purpose of this study was to confirm by oral sugar tolerance test whether the same effect can be expected in humans when the intake is close to the estimated normal intake.

Methods: A single-blind crossover was performed on 25 healthy young Japanese adults by co-ingesting maltodextrin aqueous solution with a concentration of about 10%, and 5g of powdered normal brown rice (NBR) or FBR. The blood glucose level was measured at 30-minute intervals for 120 minutes after glucose loading.

Results: There was no difference between FBR and NBR in the way blood glucose levels altered, which is affected by the time elapsed post sugar loading. However, the change in blood glucose of FBR was slower than NBR. Additionally, the total area under the blood concentration time curve and the incremental area under the blood concentration time curve for 120 minutes after sugar loading were compared. As a result, both the actual measurement value calculation and the change rate calculation showed significantly lower values when FBR was simultaneously ingested than when NBR was ingested.

Conclusions: It was suggested that the intake of FBR can be expected to suppress the increase in postprandial blood glucose even in humans.

Objective: We aimed to examine the history behind the proposal of double-duty actions for nutrition in the global discussion on the double burden of malnutrition and consider the nutrition-related policies in Japan.

Methods: We examined nutrition-related reports and policy documents issued by the United Nations and related organizations on their official websites and searched the literature using the keywords "double-duty actions" and "nutrition."

Results: While policies and interventions for undernutrition and overnutrition are typically conducted separately and independently, the concept of simultaneously tackling both these nutritional problems, i.e., double-duty actions, has been discussed recently. Since policymakers are required to achieve multiple goals with limited resources, the World Health Organization and the Lancet have proposed several double-duty actions as solutions. These were relatively more focused on policies and interventions for mothers and children. Moreover, the emphasis was on interventions in the early stages of life.

Conclusions: To achieve Goal 2 (Zero Hunger) of the Sustainable Development Goals, double-duty actions should be considered for a wider population, similar to the policies that have been executed traditionally in Japan. These include the provision of maternal and child health handbooks, maternal and child nutrition services through antenatal and infant health checkups, and school meals; food and nutrition education (SHOKUIKU); educating nutrition professionals; conducting the National Health and Nutrition Survey; and devising dietary standards and guidelines.

Objective: The physical status of children improved considerably during the period of high economic growth, but there has been no analysis of the change in the school lunches at that time, which is one of the factors of improvement. Therefore, we investigated school lunch menus to understand the characteristics of the ingredients used in school lunches during the period.

Methods: In March 2019, with the cooperation of the Hiroshima City Board of Education, we analyzed the lunch menus of elementary school for a total of 1,445 days from 1957–1966, except 1958. We created three age groups: the "introduction period (1957, 1959, 1960)", "maturity period (1961–1963)", and "transformation period (1964–1966)", and compared the ingredients of menus by each age group using the χ² test or Kruskal-Wallis test.

Results: According to the analysis of 1,445 menus, the number of dishes and ingredients was the highest during the "transformation period". There was a difference in the use of ingredients by age groups as well. Items such as pork, chicken, milk, mayonnaise etc. were increased and whale meat, potatoes, carrots, onions, and miso were decreased. Furthermore, there was a significant difference in the number of types of seasonings by age groups, which was higher in the "maturity period" and the "transformation period" than in the "introduction period".

Conclusions: During the period of high economic growth, the number of dishes and ingredients in school lunches were changed. The use of whale meat was decreased, while the use of pork, and chicken was increased, and the number of seasonings was also increased.