Journal of the National Institute of Public Health
Online ISSN : 2432-0722
Print ISSN : 1347-6459
ISSN-L : 1347-6459
Volume 66 , Issue 6
Nutritional challenges and solutions based on life course perspective in Japan
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  • Midori Ishikawa, Tetsuji Yokoyama
    Type: Preface
    2017 Volume 66 Issue 6 Pages 565
    Published: 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS
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  • Nobuo Yoshiike
    Type: Review
    2017 Volume 66 Issue 6 Pages 556-573
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    The nutrition and diet of infants and small children are considered important factors, not only for growth and development at the time, but also to reduce the risk of non-communicable diseases (NCDs) during adulthood. The infant and child nutrition surveys conducted every 10 years have provided important information about the status of nutrition and diet of this age group. The latest survey in 2015 showed some progress towards a supportive environment for breast feeding, resulting in an increased rate of breastfeeding (51.3% in 1 month and 54.7% in 3 months). It also demonstrated that complementary feeding started later than in previous surveys, which implied the effectiveness of “a support guide for breastfeeding and weaning” (2007), and subsequent activities for disseminating the guide. On the other hand, about 75% of caregivers felt that some problems regarding the weaning practices remained. They believed that public health centers and municipality health service centers were the most important places to learn about diet, and that opportunities for support in these centers should be strengthened.

    As the caregivers are thought to significantly influence the development of dietary habits in infants and small children, supportive measures for caregivers regarding feeding practices are essential. The third Shokuiku promotion basic plan prioritized the areas of support to tackle the problems encountered by caregivers, which were “nutrition education (Shokuiku) focused on young generations” and “continuous responsiveness according to the stages of growth and development in children”. For infants and small children, important measures such as support for children with food allergies, and prevention of obesity, remain a challenge, and must be solved. Child poverty has become a large social problem in recent years, therefore, support measures should be further discussed according to the economic conditions in their home.

    Due to the rapidly ageing population, as well as the routine maternal child health services in municipal government, the relevant bodies such as nursing schools, kindergartens, medical services, and suppliers of various information, are expected to provide more appropriate support for children and their caregivers. These groups must consider the child and caregiver's individual situation and dietary problems in order to reinforce a supportive environment for society as a whole.

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  • Rie Akamatsu
    Type: Review
    2017 Volume 66 Issue 6 Pages 574-581
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    The eating habits of children aged 6 to 12 years are more important than adults' because they not only promote life and health, but also growth. This article explains the current issue of food and nutrition for school-age children in Japan and discusses the approach to solving it.

    When we look back at the heights and weights of children in the past 40 years as an index of nutrition status, we see that their body types have improved. However, there are differences with respect to age and region. There were more overweight and underweight children aged 10 years and over and more overweight children in thinly populated regions. Skipping breakfast, an unbalanced diet, and eating fast are the major unhealthy eating habits among children. Skipping breakfast has particularly been shown as being related to excess weight and lower academic and physical scores.

    To improve children's nutrition status, the Japanese government has been providing school lunches, and this has contributed to improving children's nutrition status. In addition to the school lunch system, the government has started to train food and nutrition teachers who are licensed dietitians as well as teachers to promote nutrition education in schools. It has been a long time since food and nutrition teachers have been trained, and many schools now provide nutrition education.

    However, it has been pointed out that there is no evidence of food and nutrition education programs, even though many schools have conducted them. It is necessary to show visible accomplishments. Furthermore, the social divide is also creating a problem with regard to children's nutrition status. Some regions have started to provide free or inexpensive meals and school lunches to children from poor families. The issue of food and nutrition for children is becoming complex and varies among individual children, so food and nutrition teachers and school dietitians should adopt a professional approach and work in collaboration with other teachers.

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  • Tetsuji Yokoyama
    Type: Review
    2017 Volume 66 Issue 6 Pages 582-589
    Published: December 01, 2017
    Released: February 20, 2018
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    The risks of stroke, heart diseases, and diabetes mellitus (so-called lifestyle-related diseases or non-communicable diseases) are strongly related to the duration of unhealthy lifestyles from youth. The age-adjusted mortality rate from stroke in Japan was once much higher than that in other countries a half century ago but decreased drastically in recent years because of the improvement in lifestyles and implementation of mass health examination. On the other hand, the health issues change from one era to the next, for example, the prevalence of obesity and diabetes mellitus is increasing due to excessive eating and low physical activity. Since the dietary habits greatly differ according to regions and generations, a continuous monitoring for dietary habits among Japanese people is necessary to execute a PDCA cycle for the improvement of effective control measures against lifestyle-related diseases. The expected decline in mortality rate from cardiovascular diseases due to improvement in several lifestyle factors is estimated in Health Japan 21 (2nd edition) based on the evidence from epidemiological studies. According to the estimation, it is expected that the improvement in dietary habits is largely attributable to the risk reduction. The purpose of this paper is to explain the concept of preventive measures against cardiovascular diseases and diabetes mellitus in Health Japan 21 (2nd edition) particularly from the point of view of nutrition and diet.

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  • Junko Ishihara, Shoichiro Tsugane
    Type: Review
    2017 Volume 66 Issue 6 Pages 590-602
    Published: December 01, 2017
    Released: February 20, 2018
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    Here, we review recent evidence concerning nutrition- and diet-related risk factors for cancer. We then discuss issues and future prospects for cancer prevention and control from the perspective of life course.

    “Cancer Prevention Recommendations for Japanese” is a guide developed by the National Cancer Center of Japan, based on guidelines for potential cancer risks derived from systematic reviews and summaries of existing research conducted among Japanese. These reviews and summaries were evaluated for their reliability as scientific evidence and the strengths of association between risk factor and specific cancers. Risk factors in the guidelines which related to diet and nutrition were “alcoholic drinks”, “salt and salted foods”, “fruits and vegetables”, “physical activity”, and “body mass index”. These factors were attributed as the leading causes of cancer (Population Attributable Fractions) in Japanese, following smoking and infections, the two main causes.

    Since its initial publication in 2007 by the World Cancer Research Fund/American Institute for Cancer Research, the “Second Expert Report: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective” has been continuously updated. This Continuous Updating Project has evaluated risk factors which showed weak associations among the current Japanese population, or which have not been evaluated because of a lack of research.

    The results of translational research, namely research which evaluates and publishes current knowledge, are important when determining priorities in solving issues of disease prevention. For future resolution of cancer prevention and control from the perspective of life course, two points are important: 1) promotion of ongoing research into known cancer risk factors, including methods of measurement and utilization; and 2) monitoring of young generations in terms of diet and lifestyle change, especially for factors which are considered to be cancer risks internationally. Cancer prevention and control through the life course is especially important, given that cancer develops over an extended period. Risk communication to promote ideal lifestyle decisions for diet and nutrition based on current evidence among Japanese is important. In addition, it may also be important to monitor internationally identified hazard factors which have the potential to become risk factors in Japanese.

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  • Yukari Takemi, Kaori Koiwai
    Type: Review
    2017 Volume 66 Issue 6 Pages 603-611
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    In Japan, super aging is developing at an unprecedented speed in the world. There is a significant increase in the number of single-person households of elderly people and elderly households. The average life expectancy is the top class in the world, but the number of elderly people who receive support and/or nursing care under the long-term care insurance system is increasing. Conditions requiring support and/or nursing care caused by elderly factors such as dementia, bone fracture, falling, and frailty account for more than 50%, and are more frequent than factors arising from lifestyle-related diseases such as cerebrovascular disease, heart disease, and diabetes. Insufficient food intake and undernutrition are strongly related to frailty in the preliminary stage. Therefore, in considering the health of the elderly, effective approaches to reduce undernutrition are urgent issues.

    According to the results of the latest National Health and Nutrition Survey conducted by the Ministry of Health, Labor and Welfare (MHLW), 13.4% of males and 22.4% of females were with a low malnutrition tendency of BMI 20 kg/m2 or less", which is an indicator of Health Japan 21 (second phase) for the elderly. This percentage is a significant increase among females. Those with BMI less than 20 kg/m2 had lower intake of energy, protein, vitamin B, etc. and were concerned about undernutrition. Also, elderly people living alone had lower score of the Food Diversity Index.

    Factors related to food diversity among elderly people who live alone include access to grocery stores, instrumental social support, preparations for meals, etc. Therefore, as a strategy for the prevention of undernutrition among elderly people, it is important to develop a food environment that can ensure their intake of the appropriate amount and quality of foods. Specifically, this implies the enhancement of the meal delivery industry and the increase in opportunities for eating together in the community. Regarding the former, in March 2007, the MHLW developed guidelines on nutrition management of the meal delivery service for the health promotion of the elderly people dwelling in the community. For the latter, it is important to make room to prepare and eat together for different generations gathered from children to elderly as a place of Shokuiku (food and nutrition education) for the succession of food culture.

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  • Midori Ishikawa
    Type: Review
    2017 Volume 66 Issue 6 Pages 612-619
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    The understanding of the importance of nutrition with a focus on life course perspective is progressing today. the Second International Conference on Nutrition (ICN2) showed the promotion for life course perspective nutrition action. There have been very few studies on the effective solutions for the improvement of nutrition and there is still not a clear consensus on this issue. However, in recent years, policy studies suggesting solutions to nutritional issues with a focus on life course perspective have been published. Therefore, in this study, we reviewed these potential solutions and examined the relationship between these potential solutions and their impacts along the stages of life.

    The methodology used was as follows: 1) A characteristic nutritional problem at a certain timeline is extracted; 2) Nutrition-sensitive and/or Nutrition-specific programs is implemented; and 3) the framework of the programs includes the “development of effective nutrition services,”“early intervention (long-term nutrition education),”“social security,”“monitoring and evaluation (development of measurement indicators),”and the “development of professional (leadership) training (improvement of coordination capacity of multi-field collaboration),”all of which may be important.

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Articles
  • Hidenori Onishi, Osamu Yamamura, Ikuko Kosugi, Tami Yamamoto, Satoshi ...
    Type: Original
    2017 Volume 66 Issue 6 Pages 620-629
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    Objectives: There is a possibility that the risk factors for the development of deep vein thrombosis (DVT) after a large-scale disaster vary depending on the shelter’s environment. This time we conducted DVT examinations of the victims of the Kumamoto earthquake which occurred on 16th April 2016, and compared the DVT detection rates between the groups of people in the general shelters and welfare-type shelters. This paper is to report our findings.

    Method: We conducted DVT examinations at the shelters in Aso city and Minamiaso Village in Kumamoto prefecture. The number of subjects was 207 (48 males, 159 females with a mean of 68.1 ± 16.1 years old) who wanted medical examinations. In all cases, we conducted medical interviews, took blood pressure measurements and did lower limb venous ultrasound examinations, and we then compared the DVT detection rates by groups of people in different types of shelters.

    Result: 8 out of 10 shelters were general shelters (156 people; 38 males, 118 females, with a mean of 65.2±16.4 years old), and 2 of them were the welfare-type shelters (51 people; 10 males, 41 females, with a mean of 77.0±11.2 years old). It was found that 11.1% (23 people) out of all the victims had developed DVT. As the DVT detection rate for the group of people in the general shelters was 10.3% (16 people), and that for the welfare-type shelters was 13.7% (7 people), there was no significant difference (p = 0.80). The detection rates were as high as 23.2%, which was about one in four people, for the group of people over 75 years old in the general shelters, and it was 16.6%, which was about one in six people, for the people over 75 years old in the welfare-type shelters.

    Conclusion: The DVT detection rates were equivalent between the groups of people in the general shelters and welfare-type shelters. Regarding the DVT prevention measures at the general shelters, appropriate allocation of human resources and environmental improvements are important. Also, the DVT detection rate was high in the latter-stage elderly people who were over 75 years old even if they were in the welfare-type shelters which had a better environment, so special attention should be paid to this fact."

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  • Yasuko Aso, Masashige Saito, Yuka Nojiri, Yukiko Mochizuki, Mihoko Shi ...
    Type: Original
    2017 Volume 66 Issue 6 Pages 630-639
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    Objectives: Individuals involved in nursing or social work should organize/tidy up to better serve patients. According to studies, several members of the general public have difficulty organizing/tidying up, and the life-coping skills of undergraduates correlate with their score on the Rosenberg Self-Esteem Scale (RSES); however, no study has examined whether nursing or social work students have difficulty in organizing/tidying up. The current study aimed to examine difficulty in organizing/tidying up in nursing or social work students, and factors related to this difficulty, and effective forms of support for students facing this difficulty.

    Methods: The subjects were 450 nursing or social work students. Subjects completed a self-administered questionnaire asking whether one had difficulty in organizing and tidying up and how often one organized/tidied up. The questionnaire also included the Japanese version of the RSES, the Saving Inventory-Revised (SI-R), and the Clutter Image Rating (CIR) scale. In analysis, whether one had difficulty in organizing/tidying up served as the outcome variable. Furthermore, crude and adjusted odds ratios (ORs) were calculated for subject characteristics. ORs (95% CI) were estimated using the logistic regression analysis (stepwise variable selection). In addition, multivariate regression analyses were performed with the hoarding condition as an objective variable and other survey items as explanatory variables. The significance level was two-tailed (p < 0.05), and the analysis was performed using SAS v9.4.

    Results: Having difficulty in organizing/tidying up was related to a low score on the RSES, and who organized/tidied up. Adjusted for subject characteristics, the OR for one’s score on the RSES was 0.96 (95% CI: 0.93, 0.99) and that for having someone else organize/tidy up was 2.77 (95% CI: 1.29, 5.95). Difficulty in organizing/tidying up, SI-R, CIR, and the frequency of organizing/tidying up were correlated with each other. SI-R was related to sex and RSES, and CIR was related to the number of years in school, living alone or with someone else, who organized/tidied up, and RSES. The frequency of organizing/tidying up was related to the department of school, whether the subject lived alone or with someone else, and who organized/tidied up.

    Conclusion: In nursing or social work students, difficulty in organizing/tidying up was related to low self-esteem and the habit of not organizing/tidying up for oneself.

    Despite being organized frequently, there was a situation when students living alone did not advance improvement of one’s room clutter. Organizing/tidying up skills should be taught based on an individual’s self-esteem level.

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  • Naomi Akiyama, Takeru Shiroiwa
    Type: Original
    2017 Volume 66 Issue 6 Pages 640-649
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    Objectives: Most developed countries share a growing concern about care services and increasing healthcare expenditures. In this regard, many studies have identified the impact of seasons effects on health, but have not clarified the relationship between seasons and healthcare services and costs. The aim of this study was to examine the impact of seasons on the healthcare expenditures; we used a longitudinal cohort of older persons for healthcare utilization and costs.

    Methods: This paper describes the results of a longitudinal retrospective study conducted in City A, Hokkaido, with a panel survey of medical care (MC) and/or LTC utilization and costs. The subjects were community-based elderly residents aged 65 years and above (n = 1,793) who are classified as requiring Support Levels 1 or 2, or Care Needs Levels 1 to 5, in accordance with the LTC insurance system. The study used data from July and December of the years 2007 to 2009 (i.e., a total of six survey points). The data were collected from MC insurance claim records, LTC insurance claim records, and questionnaires used to evaluate the cognitive and physical status of each subject in order to ascertain his or her nursing care needs in terms of the LTC insurance system.

    Results: In 2007, the mean age of the subjects was 84 years, 71% of them were female, most had cognitive impairment and/or functional disability, and most were on low incomes. There were no significant various in the seasonal and yearly data for the MC and LTC costs. Probit analysis was conducted to determine factors that are associated with the coefficients of healthcare behaviors per month. Winter season was a negative determinant of the utilization of outpatient care and positive determinant of the use of facility care. Furthermore, we used a Tobit model to analyze the determinants of the coefficients of healthcare costs per month. Winter season was found to be a negative determinant of outpatient costs, but had no impact on other costs. Of the population variables, severe cognitive impairments and functional disabilities were associated with greater hospital and/or facility care costs.

    Conclusion: Seasonal variations influence the use of healthcare services in the elderly who are in need of support or care. The population of elderly is growing and the MC and LTC costs are rising as the baby-boomer generation is aging; thus, healthcare policymakers should pay attention to the relationship between seasonal variations and healthcare utilization and costs.

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  • Mikio Takeda
    Type: Review
    2017 Volume 66 Issue 6 Pages 650-657
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    In the current social security system reform, rebuilding of health care provision system and establishment of integrated community care system are required in order to use medical resources efficiently and suppress the increase of medical expenses.

    In order to realize these reforms, it is necessary to enrich home health care and home long-term care and to provide them in an integrated manner, in reality these collaborations are not easy. Especially in health policy, it is necessary to thoroughly examine the way of health care as support in "place of life" and how to cooperate with long-term care in order to switch from health care provided at hospital to health care provided at long-term care facilities and at home.

    In addition, as expertise is advanced in each field such as medical care, nursing, rehabilitation, long-term care, etc., it is required to utilize diverse professionals according to needs. Under such circumstances, unless services are provided based on consistent policies and methods, not only consuming unnecessary resources, but also the life of people receiving services are confused, and leading futher severe state. Therefore, it is necessary to establish comprehensive and practical methodology that can carry out integrated care management of health care and long-time care. However, it is pointed out that current long-term care support specialists lack knowledge about health care, and medical professionals lack viewpoints to consider the quality of life.

    Based on these issues, in this paper, I point out that there is a limit to care management that rely solely on cooperation among individuals or providers, and that an organizational care management system should be established. And I propose the establishment of collaboration supporting institution independent from providers, and the new way of care management system by multi-disciplinary cooperation.

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  • Tomoo Yasue, Takahiro Koyama, Tomoharu Takekoshi, Shizuyo Inaba, Yoshi ...
    Type: Report
    2017 Volume 66 Issue 6 Pages 658-668
    Published: December 01, 2017
    Released: February 20, 2018
    JOURNALS OPEN ACCESS

    Training and exercise are crucial to enhance understanding of pandemic planning under the Act on Special Measures for Pandemic Influenza and New Infectious Disease Preparedness and Response relevant action plan and guidelines, and develop appropriate and rapid response capability in preparation for pandemic of novel flu or other newly emerging diseases. Gifu Prefecture of Japan hosted four table top exercise workshop based on the Facilitator's Guide for Pandemic Flu Response Exercise from the fiscal year 2015 to 2016. Here we report the exercise planning and outcomes to describe the effectiveness of this tool for promoting mutual understanding of stakeholders e.g. doctors in hospitals and clinics, infection control nurses, and public health officers and their cooperation, as well as understanding of the special measures act and pandemic action plan. This is the first report of the exercise that implemented this Facilitator's guide at a prefecture level.

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