Epidemiological and animal experimental studies are disclosing that the malnutrition or overnutrition in utero would induce epigenetic changes of fetus, what is the origin of lifestyle-related disease in adult. Representative birth cohorts studies in DOHaD are explained.

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Numerous epidemiological and experimental studies provide compelling evidence that nutritional insults that impact fetal growth program a marked increase in blood pressure in later life. Sex and age also influence the developmental programming of hypertension; yet the exact mechanisms that permanently change the structure, physiology, and endocrine health of an individual across their lifespan following exposure to a nutritional insult are not entirely clear. Fetal exposure to maternal glucocorticoids is postulated as an initiating event. In addition, inappropriate suppression or activation of the renin angiotensin system (RAS) and/or activation of the sympathetic nervous system (SNS) leading to marked increases in oxidative stress and endothelin production are implicated in the etiology of hypertension that has its origins in fetal life. The risk of hypertension and chronic disease in one generation is transmitted to the next in the absence of an additional prenatal insult implicating epigenetic processes. Yet, further studies are needed to fully elucidate the mechanisms that contribute to hypertension programmed in response to nutritional insults during early life in order to improve the cardiovascular health of an individual across their lifespan.

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Prospective cohort studies have shown that people with a larger amount of physical activity (PA) and exercise have lower risks of non-communicable diseases (NCDs). In Japan, the Ministry of Health, Labour and Welfare published in March 2013 the “Active-Guide,” i.e. the Japanese official PA guidelines for health promotion. In this document, the most important message is “+10,” standing for “add 10 min of MVPA per day.” The establishment of the “+10” recommendation is supported by strong scientific evidence. Firstly, a meta-analysis including 26 cohort studies indicated that an increment of 10 min of moderate-to-vigorous PA per day can result in a 3.2% reduction of the average relative risk of NCDs, dementia, joint-musculoskeletal impairment, and mortality. Secondly, the National Health and Nutrition Survey (Japan, 2010) reported that 60.8% of the Japanese population is inclined to add the equivalent of 10 min of PA in their daily life. In line with these results, the “+10” recommendation is viewed as feasible and efficient for the Japanese population. To our knowledge, this implementation of an additional low-dose PA recommendation in a governmental health promotion policy is a world first. We hope that the Japanese PA policy will inspire other national and international public health agencies.

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The Japanese government has set 11 targets to promote “Shokuiku.” However, among the 11 targets, only two targets (frequency of shared family meals and the proportion of breakfast skipping in children and young men) are quantitative goals. The increase in children eating alone is often lamented in the popular media, but the methodology for identifying the status of family meals (“Kyoshoku”), or how the responses should be validated, is rarely discussed. In the current review, we attempt to clarify how a family meal and survey responses are defined, by searching literature published after 2009, using the following keywords: “family meals” or “shared meals,” in the PubMed database for English. For literature published in Japanese, we searched the Igakuchuo-Zassi Database and Google Scholar for relevant studies. In the English literature, questions were likely to focus on whether a dinner or any meal was eaten together with family members living together, while Japanese literature was more focused on “breakfast or dinner” eaten together with family members. The response options varied across different studies, such as the number of family meals a week, or the number of days (per week) these family meals were eaten. We found it quite difficult to compare across the studies, as there is no standardized definition or response options for “family meals.” Further studies are needed in order to develop a standardized method to assess the current status of “family meals.”

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In the first half of this symposium, the disaster response system in Japan will be introduced. The ultimate aim of nutrition assistance is to keep people in disaster areas healthy. This is a task for the Ministry of Health, Labour and Welfare and the health departments of prefectural governments. Our first speaker, Dr. Yasuhiro Kanatani, National Institute of Public Health, will briefly overview the disaster response system in Japan and its related laws. He will also mention how the Ministry responded to the Great East Japan Earthquake. In the second presentation, I will play one chapter of DVD that we released in last September. In that chapter, Ms. Makiko Sawaguchi, a registered dietitian working for a public health center in the area affected by the Great East Japan Earthquake, talks about her experience in supporting disaster victims. As an employee of Iwate Prefectural Government, she helped affected municipal governments and coordinated outside support. One type of outside support was registered dietitians dispatched by the Japan Dietetic Association (JDA). Dr. Nobuyo Tsuboyama-Kasaoka will report what those dietitians did in the affected areas. She will also explain the aim and training of the JDA-Disaster Assistance Team. Provision of food is essential in nutrition assistance. This is a task for the Ministry of Agriculture, Forestry and Fisheries. Our fourth speaker, Mr. Kunihiro Doi, analyzed the government procurement data and will discuss the limitations of government emergency food supplies and lessons learned from the Great East Japan Earthquake. As for the systems and experiences in the US, we invited Ms. Toni Abernathy from the Office of Emergency Management, Food and Nutrition Service (FNS), United States Department of Agriculture.

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USDA makes sure that nutritious USDA Foods are made available to States, Indian Tribal Organizations and Emergency Feeding Organizations to help feed survivors of natural disasters and other emergencies when needed.

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Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including tested interventions at the environmental and policy levels. We have conducted multi-level community trials in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies have examined change from pre- to post-study, comparing an intervention with a comparison group. Our results have shown consistent positive effects of these trials on consumer psychosocial factors, food purchasing, food preparation and diet, and, in some instances, obesity. We have recently implemented a systems science model to support programs and policies to improve urban food environments. Environmental interventions are a promising approach for addressing the global obesity epidemic due to their wide reach. Further work is needed to disseminate, expand and sustain these initiatives through policy at the city, state and federal levels.

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Prevention of non-communicable diseases is more important than ever especially for the elderly to live a healthy life in the super-aged society of Japan. In 2000, the Ministry of Health, Labor and Welfare of Japan started Health Japan 21 as goal-oriented health promotion plan like Healthy People in the US and the Health of the Nation in the UK. Its second term started in 2013 with the aim of prolonging healthy life expectancy and reducing health inequalities. Improvement in both individuals’ lifestyle and their social environment will help achieve the goal of the 2nd Health Japan 21. The National Health and Nutrition Survey (NHNS) is conducted every year to monitor the health and nutritional situation of the Japanese using a representative population. The NHNS data are useful for target setting and evaluation of the 2nd Health Japan 21, and the NHNS has shown an increasing trend of overweight (BMI≥25) only for male adults in the most recent 10 y. In contrast, the dietary intake survey of the NHNS shows a decreasing trend of total energy intake both in male and female adults aged 69 y old or younger, and the trend for physical activity is not well known. Thus, we need further investigations on the causes of the obesity trend in Japan.

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School meal service programs are essential for children’s long-term nutrition and health promotion. The programs vary in content, depending on the economic condition, health condition and the food supply situation in each country. Children are encouraged to improve their nutrition, and choose healthy foods and learn good dietary habits through school meals and nutrition education. In Japan, the school lunch program started in 1889. The percentage of elementary schools serving school lunches had reached 99.2% in 2014, and the Nutrition Teacher system started in 2004. Nutrition teachers are to play the roles of teachers on food and nutrition education in addition to managers of foodservice operations in schools. Nutrition teachers are expected to have effects on school nutrition programs by providing meal service together with nutrition education. And so, significant effort is needed from both academia and the field to raise the related nutritional issues.

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Since the school meal was first served in Korea in 1953, there have been many changes, particularly during the last decade. Recently, the representative features of the school meal system became free school meals for all pupils in elementary school and a nutrition teacher system in schools. These policies were suggested to implement more and more the educational role of the school meal. The rate of schools serving school meals reached 100% as of 2013, and 99.6% students eat a school meal each school day. Nutrition teachers were assigned to schools from 2007, and 4,704 (47.9%) nutrition teachers of all nutrition employees were employed in schools as of 2013. At present, various nutrition education materials are being development by local education offices and government agencies, and various education activities are being implemented spiritedly. The ultimate goal of school meals and school-based nutrition education are as follows: 1) improvement of the health of students; 2) promotion of the traditional Korean diet; and 3) extension of opportunities for a healthier dietary life.

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A global food composition database has been constructed by the United Nations Food and Agriculture Organization (FAO) based on food composition tables from every country in the world. To improve this database, the FAO has organized the International Network of Food Data Systems (INFOODS). The most recent version of the food composition table for Japan was published by the Ministry of Education, Culture, Sports, Science and Technology and is presented in three books: “Standard Tables of Food Composition Japan -2010-,” “Fatty Acid Composition of Foods -2005-,” and “Amino Acid Composition of Foods -2010-.” The Standard Tables of Food Composition in Japan -2015- (Energy, General Components, Minerals, Vitamins, etc. Section; Fatty Acids Section; Amino Acids Section; Carbohydrates Section) will be published in 2015 and is expected to play an important role as one of the main tables of the East Asia food composition tables.

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The new revised version of the Standard Tables of Food Composition in Japan (STFCJ 2015) will be published in 2015. The aim of the present paper is to share information on issues we have encountered during the revision. New analytical data on amino acid composition will be provided for approximately 230 foods, fatty acid composition for approximately 140 foods, and available carbohydrate (starch, glucose, fructose, sucrose, maltose, and lactose) composition for approximately 340 foods. These data will be published separately as three supplements to the STFCJ 2015: amino acid tables, fatty acid tables, and available carbohydrate tables. Available carbohydrate tables will also provide polyol (sorbitol and mannitol) and organic acid (acetic acid, lactic acid, citric acid, etc.) data. In the supplements, amino acid content will be adjusted for protein content calculated as reference nitrogen multiplied by a nitrogen to protein conversion factor, and fatty acid content adjusted for extractable lipid content, as in previous revisions. Available carbohydrate content, however, will be adjusted for water content. Values of protein content calculated as the sum of amino acid residues <PROTCAA>, lipid content expressed as triacylglycerol equivalents of fatty acids <FATNLEA>, and available carbohydrate content <CHOAVLM> will appear in the main tables of the STFCJ 2015. Protein, fat and available carbohydrate contents were significantly decreased when the preferred analytical methods of FAO were applied instead of the acceptable methods. Online publication of Japanese and English versions of these tables, reference materials, and a retrievable food composition database is planned.

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In recent years, many studies have used epidemiological techniques to investigate the relationships of daily energy and nutrition intake to food intake, and to disease onset and treatment or prevention. Therefore, dietary assessments are now being used in various situations. A range of dietary assessment methods exists, and each has advantages and disadvantages. However, there is no absolute and universally applicable dietary assessment method. The most appropriate method or a combination of methods must be selected in accordance with factors such as the objective of a study and the number of subjects. Moreover, it is necessary to interpret dietary assessment results multilaterally and to grasp dietary habits, elements of a daily lifestyle environment, and physical conditions that could influence the diet.

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Although exposure assessment of the usual diet is an essential component of nutrition epidemiology, it remains one of the most challenging issues in the field. Dietary exposure is widely measured using Food Frequency Questionnaires (FFQs), which impose a low burden on respondents and are inexpensive in large-scale studies. FFQs have long satisfied the needs of epidemiological research, and have helped deliver the tremendous recent growth in knowledge of the diet-disease association. However, issues surrounding measurement errors with FFQs have attracted substantial research interest around the world. Attenuation of the diet-disease association due to measurement errors identified in Western populations has led to extended methodological investigations comparing the performance of FFQs with biomarkers. The need for better dietary assessment methods has increased. Dietary records or recall provide relatively accurate estimates of intake for specific days, and of the usual diet if collected on multiple days. Until recently, however, their use in large-scale studies was not feasible, mainly due to cost. One innovative tool which may overcome the limitations of dietary records or recall is computerized 24-h dietary recall systems. These systems have been demonstrated to provide high-quality dietary intake data among Western populations. Incorporation of such new technology into large-scale epidemiological studies would make multiple-day administration of 24-h recall feasible in terms of cost. Research efforts to improve dietary assessment among Japanese and Asian populations are still under development. The development of innovative methods for Japanese remains an urgent research challenge.

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Non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the leading cause of death worldwide. To decrease the global burden of NCDs and strengthen national efforts to combat NCDs, the World Health Organization (WHO) released the Global Action Plan for the Prevention and Control of NCDs 2013-2020. This plan provides established procedures and several policy options for member countries and other partners. Although many countries recognize that prevention of NCDs is an important health priority, their governments currently face a challenge: How do they adopt a multi-sectoral approach to promoting a healthy lifestyle among their populations? For this, all sectors of the food system (primary production, food processing, distribution, marketing, retail, catering, and food service) need to coordinate with each other for future governance. Since regulatory policy intervention areas for diet-related NCDs are widespread throughout the global food system, for future perspectives, comprehensive and coordinated approaches are needed for policy development and implementation across all levels of governments and food sectors in order to ensure sustainable policy action.

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Millions of people in Asia are facing challenges from undernutrition, obesity, and diet-related non-communicable diseases. Unilever, as a global food business, has a simple approach to nutrition strategy: ‘better products’ help people to enjoy ‘better diets’ and live ‘better lives.’ For ‘Better Products,’ Unilever strives to improve the taste and nutritional qualities of all our products. By 2020, we commit to double the proportion of our entire global portfolio meeting the highest nutrition standards, based on globally recognised dietary guidelines. Unilever sets a clear plan to achieve reduction of sodium, saturated fat, trans fat, sugar, and calories in our products. Unilever developed fortified seasoning and spread products in 2013 for Vietnam, Indonesia, and the Philippines in collaboration with government bodies to address nutrient deficiencies. For ‘Better Diets and Better Lives,’ Unilever uses targeted communication to raise awareness and promote behavior change for healthy lifestyles. We committed to full nutrition labeling on our food products by 2015. We contribute experience to science-based regional initiatives on product labeling as well as nutrient profiling. Unilever collaborated with international, regional and country bodies to promote consumer understanding and food accessibility on public health priorities such as proper salt consumption, healthier meals, and employee well-being programs. Looking ahead, we are continuing to improve the nutritional profile of our products as well as our communication to improve diets and lives. Collaboration between industry, government and public health organizations is needed to address complex diet and life style issues.

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This author (A.I.) has witnessed the introduction of the Nutrition Care Process (NCP) and its subsequent adjustment over 10 y of her career in an acute and critical setting. A.I. observed that the NCP went through several revisions to better suit the actual clinical practices and the NCP was gradually incorporated into everyday work and accepted in a clinical setting. The NCP helped ensure that all practicing registered dietitians (RDs, RDNs) have up-to-date skill sets. The NCP is a systematic problem-solving tool with four distinct and interrelated steps that help RDs to improve critical thinking and address practice-related problems so that RDs can more effectively intervene and evaluate. In summary, RDs using the NCP are producing consistent and easy-to-read documentation of clinical practices that benefit other healthcare members. The intention to provide diagnosis-oriented assessment and to treat nutrition problems with intervention plans opens up opportunities for communication within healthcare teams and clients. The best practice requires interactive and ongoing communication with healthcare teams and clients. The NCP has resulted in improved productivity as the RDs are writing diagnosis- focused documentation with specific plans for intervention. In addition, analysis of common problems and nutrition diagnoses resolution rates appear to be in process in some facilities and may further promote RD roles in practice settings. In conclusion, the NCP is an effective tool to provide improved nutrition care.

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Zinc nutrition is of special practical importance in infants and children. Poor zinc absorption causes zinc deficiency, which leads to a broad range of consequences such as alopecia, diarrhea, skin lesions, taste disorders, loss of appetite, impaired immune function and neuropsychiatric changes and growth retardation, thus potentially threatening life in infants and children. In addition to dietary zinc deficiency, inherited zinc deficiency, which rarely occurs, is found during the infant stage and early childhood. Recent molecular genetic studies have identified responsible genes for two inherited zinc deficiency disorders, acrodermatitis enteropathica (AE) and transient neonatal zinc deficiency (TNZD), clarifying the pathological mechanisms. Both of these zinc deficiencies are caused by mutations of zinc transporters, although the mechanisms are completely different. AE is an autosomal recessive disorder caused by mutations of the ZIP4 gene, consequently resulting in defective absorption of zinc in the small intestine. In contrast, TNZD is a disorder caused by mutations of the ZnT2 gene, which results in low zinc breast milk in the mother, consequently causing zinc deficiency in the breast-fed infant. In both cases, zinc deficiency symptoms are ameliorated by a daily oral zinc supplementation for the patients. Zinc is definitely one of the key factors for the healthy growth of infants and children, and thus zinc nutrition should receive much attention.

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Asia has recorded the fastest economic growth in the world. However, some countries are still struggling with economic stagnation and poverty. Even in the emerging countries, there are economic disparities between urban and rural areas within a country. Reflecting the situations, nutritional issues in Asia came to be the antithetical situation of excess and insufficiency. The rate of overweight and obesity keeps increasing, especially in emerging countries. Meanwhile, underweight is still a critical problem in the region. Although the importance of nutrition is well recognized for social and economic development, it is difficult to identify the immediate outcome of nutrition interventions. Evidence-based decision-making is an important element of quality health care and efficiency and effectiveness are always key words. Along with enhanced attention to accountability and transparency of budget use in health services, attention to the economic evaluation of nutrition interventions has increased in recent years. In this symposium, we will review the current situation of nutritional issues and economic evaluation of nutrition interventions in Asia through experience of an international organization, the basis and trends for health care economics, and also efforts have been made in an Asian country. Discussion will be made about efficient and effective ways to evaluate projects/programmes for nutrition improvement.

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The European regulation 1924/2006 foresees that any nutrition or health claim should be assessed by EFSA and authorised by the European Commission and the Member States (with scrutiny by the European Parliament and the Council), the outcomes of which are published in the EU Register of Nutrition and Health Claims. Since 2007, EFSA has evaluated 230 dossiers submitted under Article 13.5 or Article 14. In addition, out of the 44,000 ‘general function claims’, defined under Article 13.1, proposed by Member States, a list of 4,637 claims was compiled, EFSA completed evaluation of 2,849 of them, and published the results in 365 opinions, providing the basis for a list of 229 permitted health claims. For maintaining consistency over time and scientific areas, EFSA developed a systematic approach (for food characterisation, effect characterisation and scientific substantiation). Pertinent human studies of sufficient quality are central for the substantiation; any other study type can be used as supportive. This approach is summarized in 6 guidance documents. These guidance documents are revised progressively, which includes systematic submission to public consultation.

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By using the ILSI network in Asia, we are holding a session focused on food safety programs in several Asian areas. In view of the external environment, it is expected to impact the global food system in the near future, including the rapid increase in food demand and in public health services due to population growth, as well as the threats to biosecurity and food safety due to the rapid globalization of the food trade. Facilitating effective information sharing holds promise for the activation of the food industry. At this session, Prof. Hwang shares the current situation of Food Safety and Sanitation Regulations in Taiwan. Dr. Liu provides a talk on the role of risk assessment in food regulatory control focused on aluminum-containing food additives in China. After the JECFA evaluation of aluminum-containing food additives in 2011, each country has carried out risk assessment based on dietary intake surveys. Ms. Chan reports on the activities of a working group on Food Standards Harmonization in ASEAN. She also explains that the ILSI Southeast Asia Region has actively supported the various ASEAN Working Groups in utilizing science to harmonize food standards. Prof. Park provides current research activities in Korea focused on the effect of climate change on food safety. Climate change is generally seen as having a negative impact on food security, particularly in developing countries. We use these four presentations as a springboard to vigorous discussion on issues related to Food Safety in Asia.

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In Japan, the national health policy “Healthy Japan 21 (second term)” was introduced in 2013 to support prevention of lifestyle-related disease. Policy has also been recently revised on the promotion of nutrition education (shokuiku). Community-based food and nutrition actions were developed based on those policies and aimed to reinforce the linkages across the food chain, looking along its length “from field to food”, including production, processing, preparation, eating and disposal. Local government is responsible for identifying the important food and nutritional problems, to devise and group effective actions on the basis of local health issues. The National Institute of Public Health (NIPH) is responsible for carrying out public health staff training on policy-based health issues. Training carried out by the NIPH, the Japan Dietetic Association and the Japan Public Health Association was designed to create an enabling environment for nutrition action. The community-based actions, including nutrition education and information, are carried out by several bodies, including local government, schools, facilities, volunteer groups, residents’ associations, and commercial companies, to establish sustainable food systems promoting healthy diets. The community-empowering actions and effective cooperation are reported as good practice models in an annual white paper by the Cabinet Office. Japanese dieticians are expected to share their experiences of local nutrition improvement activities in Japan with international colleagues. Experience from elsewhere, including from Japanese dieticians working in developing countries, should also be applied on their return.

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Cambodia faces a considerably high percentage of the stunted under 5 (Unicef, 2014). Despite the National Nutrition Strategy Launched by the Ministry of Health in cooperation with development partners, nutrition improvement projects have not always been effective. It is generally said these issues are addressed in many other developing nations, and the literature largely documented that successful nutrition programmes are community-based programmes because of their sustainability and the intensive communications between health workers and beneficiaries. Learning from the past experiences, the Foundation for International Development/Relief organized a project team with a Cambodian dietitian and an experienced Japanese dietitian to implement a hospital diet programme for children from April 2006 to March 2014 in the National Pediatric Hospital (NPH) in Cambodia. The project has two objectives: establishing a hospital diet management system, and developing the capacity of NPH staff. Hospital food menus were created paying particular attention to Cambodian culture, eating habits and accessibility to the ingredients for the purpose of continuous supply. We have also put emphasis on the communication between dietitians and family members of the children to let them understand the importance of a nutritious diet. After 8 y of project implementation, the hospital diet management system was established providing 7 types of menu with nutritious diets. The final evaluation of the project showed that NPH staff have the intention to continue hospital food supply with their acquired knowledge and capacity. In practice, a Cambodian dietitian currently takes the initiative for a continuous nutritional diet in NPH. The key to this success is the collaboration between Japanese dietitians with experience and Cambodian dietitians with knowledge of Cambodian eating habits. Taking our experience into account, it is highly recommended to educate Cambodian dietitians, as they are extremely scarce, and to increase the awareness of health care staff towards the importance of nutrition management.

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This paper intends to review the feasibility of scaling-up nutrition activities through integrated outreach activities to respond to development challenges. Evaluating the efficiency and effectiveness of current packages of outreach services during the period of 2006-2014 is the aim of this review for better access to basic and social services and economic opportunities in Yemen. The two components of health system performance are related to: (i) the levels of coverage for health interventions; and (ii) financial risk protection, with a focus on equity. In this sense, Yemen’s intervention coverage indicators of the health-related MDGs, such as immunization, integrated management of childhood illnesses (IMCI), reproductive health (RH) and disease control including non-communicable diseases (NCDs) have shown good progress. Yet, malnutrition is still highly prevalent among under-five children in the country. Coverage indicators of the outreach approach in Yemen, which started in 2006, indicate a strong role of the integrated services in reaching under-five children of the most vulnerable communities with basic health services including preventive and curative ones. As well, these activities respond to the financial risk protection challenges with enhancing efficiency in the provision of health services. Considering that nutrition is part of the package of integrated outreach services, inter-related measures of universal coverage in Yemen are to be addressed together with setting the impact indicators for essential health services coverage targeting the neediest populations. Coverage of health services encompasses the full targeted population in the most malnutrition-affected areas, especially the west coast of the country, for intervention and for the age group these services are directed to.

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Changes in lifestyle have led to better nutrition or increasing the risk of NCDs in Asia, while there are still many children and reproductive-aged women (RAW) suffering undernutrition whose lives are at risk in the same region.
The MDG of reducing the prevalence of underweight <5 children to half has been achieved already or nearly achieved in many Asian countries, whereas South Asian (SA) countries and several other countries (Cambodia, Laos, East Timor and Yemen) have difficulties in achieving the goal by 2015. In particular, East Timor and Yemen are in a critical situation with undernutrition. There is a strong concern about a rapid increase in overweight and obesity rates in West Asian (WA) and some Central Asian (CA) countries. Iron deficiency is one of the most important risk factors that threaten healthy life among RAW especially in SA, followed by Southeast Asia (SEA) and CA. The same issue is observed among children (1-4 y) in the same regions. Dietary risks (based on DALYS) increase with advancing age in most Asian regions whereas high Body Mass Index is the most important risk factor in WA and some CA countries. High priority should be placed on measures to tackle undernutrition and micronutrient deficiencies including iron deficiency in SA and some countries in SEA and WA; overweight and obesity in WA and CA; and dietary risks among RAW, in most Asian regions.

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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.

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Food prices and diet costs contribute to socioeconomic disparities in diet quality and health. Lower-cost diets provide ample calories but lack essential nutrients. Nutrition economics can remedy health disparities by helping to identify food patterns that are nutrient-rich, affordable, and appealing. First, nutrient profiling models—such as the Nutrient Rich Food (NRF) family of indices—are able to separate foods that are energy-dense from those that are nutrient-rich. Whereas energy-dense foods contain more calories than nutrients, nutrient-rich foods contain more nutrients than calories. Second, new value metrics have identified affordable healthy foods, based on nutrients per unit cost. Third, these methods have now been applied to the analyses of individual foods and beverages, meals, menus, and the total diet. The Healthy Eating Index (HEI), based on compliance with dietary guidelines, was the principal measure of total diet quality. Although healthier diets did generally cost more, some population subgroups managed to obtain nutrient-dense diets at a lower cost. Being able to create affordable, healthy food patterns on limited budgets is an example of nutrition resilience.

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In Japan, one of the most common causes of death in elderly people is aspiration pneumonia. Maintenance of oral hygiene and feeding functions are important elements, especially in patients with dysphagia caused by stroke, neurological diseases, and after operations on the head and neck cancer, as well as in the elderly to prevent aspiration pneumonia. It should also be noted that not only oral health care and physical therapy related to feeding functions but also dental treatment is included in the clinical management during interventions whenever needed. On the other hand, for the patients and/or elderly in need of assistance in maintaining a safe diet, it is recommended that a specialized team comprising physicians, dentists, and speech therapists in functional rehabilitation observes meal conditions of the subjects and evaluates such factors as meal contents, posture during meals, usage of dishes and cutlery, meal times, status of consciousness, perception, and motivation. First, I will present the clinical interventions to those patients, which include oral health care, dental treatment, physical therapy and meal assistance, as well as team approaches in those circumstances. In addition, clinical and basic research results will be introduced, which are expected to foster the understanding of physiology in chewing and swallowing. These results are also expected to develop the clinical technology to maintain or recover the feeding functions.

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There is growing interest in the connection between oral health and systemic health. In recent years, oral health in particular is considered a predictor of circulatory mortality. Two major pathways may mediate this relationship, namely (1) the inflammatory effects of chronic periodontal infection on the circulatory system and (2) the effects of masticatory dysfunction on dietary behavior, nutrition and systemic diseases.
Previous studies have shown that adults who are edentulous, or have fewer natural teeth are less likely to eat fruits, vegetables and meats. Because it can be easily assessed, the number of teeth has frequently been used as an indicator of oral health in investigations of food intake. However, the number of teeth alone presents a misleading picture. The role of prosthetic rehabilitation (i.e., dentures) on oral function must be taken into account as well. We investigated the association of occlusal force with food and nutrient intakes after adjusting for the number of teeth in independently living 70-y-old Japanese. After adjusting for socioeconomic status and the number of remaining teeth, decline of occlusal force was significantly associated with lower intakes of vegetables, vitamins A, C, and B6, folate, and dietary fiber (p for trend<0.05). It is concluded that occlusal force as a representative of oral function was significantly associated with intakes of vitamins and dietary fiber rather than number of remaining teeth.

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The ability of vitamin E to modulate signal transduction and gene expression has been observed in numerous cell culture and animal studies. These cellular signalling effects of vitamin E have been mainly explained as result of protection of lipids and signal transduction enzymes from random modification by free radicals or by specifically influencing their redox state. Alternatively, the observed signalling may reflect specific interactions of vitamin E with enzymes, structural proteins, and transcription factors and/or result from vitamin E-induced alterations of physical and structural properties of membrane lipid domains in which it is embedded. A novel signal transduction mechanism of vitamin E is proposed in which lipid transfer proteins (LTP) facilitate phosphorylation of phosphatidyl-inositol by exchanging it with vitamin E and presenting it to phosphatidylinositol-3-kinase (PI3K).

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Increasing evidence for phosphatidylcholine hydroperoxide (PCOOH) as a marker of oxidative food deterioration and oxidative diseases has revealed the need for a pure PCOOH standard and a reliable quantification method. Recently, we synthesized the PCOOH isomers 1-palmitoyl-2-(9-hydroperoxyoctadecadienoyl)-sn-glycero-3-phosphocholine, (16:0/9-HpODE PC) and 1-palmitoyl-2-(13-hydroperoxyoctadecadienoyl)-sn-glycero-3-phosphocholine (16:0/13-HpODE PC). Using these standards along with liquid chromatography-tandem mass spectrometry, a reliable quantification method was developed. This mini-review describes these analytical techniques, with a particular emphasis on clinical sample analysis.

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Nutritional condition in the fetus and neonate might affect the susceptibility to adult-onset lifestyle disease, such as obesity and type 2 diabetes. DNA methylation of the gene promoter region is a major epigenetic modification for gene expression, which can be affected by environmental factors. In the neonatal liver, fatty acid β-oxidation progressively increases to produce energy from the absorbed milk lipids. Here we show that upon the onset of breast feeding, DNA demethylation and increased mRNA expression of the fatty acid β-oxidation genes occur in the postnatal mouse liver. We also demonstrate that maternal administration of a nuclear receptor peroxisome proliferator-activated receptor (PPAR), α synthetic ligand; Wy14643 induces DNA demethylation of fatty acid β-oxidation-related genes in the liver of the offspring. Analysis of mice deficient in PPARα and maternal administration of Wy14643 during the gestation and lactation periods reveals that the DNA demethylation is PPARα-dependent. Furthermore, we find that the maternal administration of Wy14643 also results in increased DNA demethylation and mRNA expression of the gene encoding Fibroblast Growth Factor (FGF) 21, a major target gene of PPARα, in the neonatal mouse liver. Notably, the DNA methylation status and increased mRNA expression are maintained at least up to 10 wk after birth, which may be referred to as “epigenetic memory”. This study represents the first demonstration that the ligand-activated PPARα-dependent DNA demethylation regulates hepatic lipid metabolism during the neonatal period, thereby highlighting the role of a lipid-sensing nuclear receptor in the gene- and life stage-specific DNA demethylation of a particular metabolic pathway. Our data also suggest that the nutritional status in early life affects hepatic lipid metabolism in later life and thus provide clues to the “preemptive medicine” for adult-onset metabolic diseases in early life in the form of formula milk and functional food for both babies and mothers.

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Transient nutritional exposures during critical ontogenic periods can cause persistent changes in gene expression, metabolism, and risk of various diseases. We have been investigating whether such ‘developmental programming’ occurs via nutritional influences on developmental epigenetics. Our studies in agouti viable yellow and axin-fused mice showed that developmental establishment of DNA methylation at ‘metastable epialleles’ is especially sensitive to maternal nutritional status around the time of conception. At metastable epialleles, DNA methylation is established stochastically in the early embryo and subsequently maintained during differentiation of diverse lineages, resulting in systemic interindividual epigenetic variation that is not genetically mediated. Lately, using a multiple-tissue screen for interindividual variation in DNA methylation, we have identified human genomic regions that appear to be metastable epialleles. Stochastic establishment of DNA methylation at these loci is affected by maternal nutrition around the time of conception, consistent across multiple tissues, and stable for many years. Most recently, our studies using genome-wide bisulfite sequencing have identified candidate metastable epialleles that are associated with human disease, providing exciting opportunities for epigenetic epidemiology.

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Lifestyle-related diseases have complex pathogenesis which consists of several different steps. Basic causes of the diseases are attributed to unhealthy lifestyles in dietary habits, physical activity and suffering stress. The unhealthy lifestyles induce risk factors such as hypertension, dyslipidemia, obesity, and hyperglycemia. These risk factors all promote arteriosclerosis leading to serious vascular complications (i.e., thrombotic diseases), myocardial infarction and cerebral infarction. The total number of deaths from these thrombotic diseases almost equals that from cancer in our country. Cancer is also a typical lifestyle-related disease. Food has three different functions: the primary function is to provide enough nutrients to meet the metabolic requirements. The secondary function is the one relating to food preference. The third function is to control our body functions, which help reduction of the risk of diseases. Some of the compounds derived from food, especially phytochemicals in edible plants, vegetables and herbs, have potent functions to control our body functions and contribute to promoting our health. In this review article, we overview the lifestyle-related diseases and food functions involving prevention and amelioration of the diseases by food components especially from edible plants and vegetables. As an example, we will describe the food function of garlic and the prevention of lifestyle-related diseases by its components. Allyl sulfides are characteristic flavor compounds derived from garlic, and these organosulfur compounds are responsible for the food function of garlic.

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There are several thermosensitive transient receptor potential (TRP) ion channels including capsaicin receptor, TRPV1. Food components activating TRPV1 inhibit body fat deposition through sympathetic nerve stimulation. TRPA1 is another pungency sensor for pungent compounds and is mainly coexpressed with TRPV1 in sensory nerve endings. Therefore, TRPA1 activation is expected to have an anti-obesity effect similar to TRPV1 activation. We have searched for agonists for TRPV1 and TRPA1 in vitro from Asian spices by the use of TRPV1- and TRPA1-expressing cells. Further, we performed food component addition tests to high-fat and high-sucrose diets in mice. We found capsiate, capsiconiate, capsainol from hot and sweet peppers, several piperine analogs from black pepper, gingeriols and shogaols from ginger, and sanshools and hydroxysanshools from sansho (Japanese pepper) to be TRPV1 agonists. We also identified several sulfides from garlic and durian, hydroxy fatty acids from royal jelly, miogadial and miogatrial from mioga (Zingiber mioga), piperine analogs from black pepper, and acetoxychavicol acetate (ACA) from galangal (Alpinia galanga) as TRPA1 agonists. Piperine addition to diets diminished visceral fats and increased the uncoupling protein 1 (UCP1) in interscapular brown adipose tissue (IBAT), and black pepper extract showed stronger effects than piperine. Cinnamaldehyde and ACA as TRPA1 agonists inhibited fat deposition and increased UCP1. We found that several agonists of TRPV1 and TRPA1 and some agonists of TRPV1 and TRPA1 inhibit visceral fat deposition in mice. The effects of such compounds on humans remain to be clarified, but we expect that they will be helpful in the prevention of obesity.

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The circadian rhythm is generally existed in mammalian behavior and metabolic processes, which results from the self-sustained circadian clocks. The mammalian circadian clocks are composed of a master clock located in the hypothalamic suprachiasmatic nucleus (SCN), and of many peripheral clocks in tissues and extra-SCN brain regions. It is indicated that feeding could take over part of the SCN signaling, and affect internal synchrony between the master clock and the peripheral clocks. Thus, recent studies focus more on the relationship between the nutrients and circadian rhythms. Various nutrient components (glucose, amino acid, alcohol) are found to be able to directly affect the circadian rhythm of clock genes. Moreover, the feeding schedule of nutrients is as important as the nutrient components in maintaining a healthy circadian rhythm. Therefore, the circadian homeostasis needs not only balanced nutrient components but also regular timed nutrients.

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Well-regulated eating habits are said to be important for health. A major breakthrough was the discovery of the negative regulatory feedback for transcription via the binding of Clock/Bmal1 to E-box, which forms the basis of biological clocks. Well-regulated eating habits normalize the liver clock gene, the rhythm of CYP7A1 gene, and blood cholesterol levels through insulin secretion. Moreover, well-regulated eating habits actively contribute to better lipid metabolism such as obesity, even if animals ingest a high-fat diet. From reported results so far, chrononutition has two important functions: 1) meal timing is important for our health, and 2) meal timing entrains our body clock.

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Food hygiene and a sufficient food supply are essential requirements to stay healthy. However, this can be hindered by foodborne infections, which are known to be prevalent throughout the world. The World Health Organization reports that, annually, diarrheal disease is responsible for the deaths of over 2 million people worldwide. The majority of these deaths occur in developing countries, following the ingestion of pathogen-contaminated food and water. In the developed world, outbreaks of foodborne diseases are also frequently documented, reflecting the global importance of following good food hygiene practices.

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As natural foods derive from soil or water environments, they may contain the infective stages of parasites endemic to these environments. Infective stages may enter the human food supply via infected animal hosts so there is a need for increased awareness of the impact of parasites on the food supply. Safe handling of food and good kitchen hygiene can prevent or reduce the risk posed by contaminated foodstuffs. In addition, parasites cannot cause a health problem in any thoroughly cooked foods.

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Food is a mixture of several nutrients and non-nutrients. The functions of food in human health can be categorized as its primary function in nutrition, its secondary function in palatability and its tertiary function in bioregulation. Nutrients contribute mainly to the primary function, while many non-nutrients in foods and foodstuffs are strongly associated with the secondary and/or tertiary functions. Individual food ingredients and ingredients as a whole are the so-called food factors. Much interest has arisen in the tertiary function of food factors related to the prevention of lifestyle-related diseases and promoting health in an aging society. This is why many studies evaluating the tertiary functions of food factors are now in progress all over the world. This symposium aims to present cutting-edge knowledge from celebrated Asian professors on the molecular mechanisms for the tertiary functions of food factors, in particular, polyphenols in soybeans and green tea, and n-6 polyunsaturated fatty acids in fish. In this context, this article will briefly review recent trends in research on the tertiary function of food factors.

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Epidemiological studies have shown that increased dietary intake of natural antioxidants is beneficial for health because of their bioactivities, including antioxidant and anti-inflammation actions. Camellia oil made from tea seed (Camellia oleifera Abel.) is commonly used as an edible oil and a traditional medicine in Taiwan and China. Until now, the camellia oil has been widely considered as a dietary oil for heath. In this review, we summarize the protective effects of camellia oil with antioxidant activity against oxidative stress leading to hepatic damage and gastrointestinal ulcers. The information in this review leads to the conclusion that camellia oil is not only an edible oil but also a vegetable oil with a potential function for human health.

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Probiotics are nonpathogenic live microorganism that can provide a diverse health benefits on the host when consumed in adequate amounts. Probiotics are consumed in diverse ways including dairy product, food supplements and functional foods with specific health claims. Recently, many reports suggest that certain probiotic strains or multi strain mixture have potent immunomodulatory activity in diverse disorders including allergic asthma, atopic dermatitis and rheumatoid arthritis. However, underlying mechanism of action is still unclear and efficacy of probiotic administration is quite different depending on the type of strains and the amounts of doses. We and others have suggested that live probiotics or their metabolites could interact with diverse immune cells (antigen presenting cells and T cells) and confer them to have immunoregulatory functions. Through this interaction, probiotics could contribute to maintaining immune homeostasis by balancing pro-inflammatory and anti-inflammatory immune responses. However, the effect of probiotics in prevention or modulation of ongoing disease is quite diverse even within a same species. Therefore, identification of functional probiotics with specific immune regulatory property is a certainly important issue. Herein, we briefly review selection methods for immunomodulatory probiotic strains and the mechanism of action of probiotics in immune modulation.

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Food allergy is defined as an immune system-mediated adverse reaction to food components. Food allergic reactions are mostly IgE mediated and also known as immediate type hypersensitivity (type I reaction). There are several characteristic clinical types of food allergy, such as Anaphylaxis, Food-dependent exercise-induced anaphylaxis (FDEIA), and Oral allergy syndrome (OAS). In addition, food allergy is also classified into two types (class 1 and class 2) based on the pathophysiological mechanism. In the class 2 food allergy, pollen allergy causes plant food allergy; therefore this type of allergy is sometimes called Pollen-food allergy syndrome (PFAS). The risk of food allergy (allergenicity) may vary with the treatment of the food allergens. The formation or status of the causative food affects its allergenicity. Class 1 food allergens are generally heat-, enzyme-, and low pH-resistant glycoproteins ranging in size from 10 to 70 kD. Class 1 food allergens induce allergic sensitization via the gastrointestinal tract and are responsible for systemic reactions. Class 2 food allergens are generally heat-labile, susceptible to digestion, and highly homologous with pollen allergens. Taken together, it may be important to consider the diversity of food allergy in order to fight against food allergy.

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An immune hypersensitivity disorder called allergy is caused by diverse allergens entering the body via skin contact, injection, ingestion, and/or inhalation. These allergic responses may develop into allergic disorders, including inflammations such as atopic dermatitis, asthma, anaphylaxis, food allergies, and allergic rhinitis. Several drugs have been developed to treat these allergic disorders; however, long-term intake of these drugs could have adverse effects. As an alternative to these medicines, food and natural materials that ameliorate allergic disorder symptoms without producing any side effects can be consumed. Food and natural materials can effectively regulate successive allergic responses in an allergic chain-reaction mechanism in the following ways: [1] Inhibition of allergen permeation via paracellular diffusion into epithelial cells, [2] suppression of type 2 T-helper (Th) cell-related cytokine production by regulating Th1/Th2 balance, [3] inhibition of pathogenic effector CD4⁺ T cell differentiation by inducing regulatory T cells (Treg), and [4] inhibition of degranulation in mast cells. The immunomodulatory effects of food and natural materials on each target mechanism were scientifically verified and shown to alleviate allergic disorder symptoms. Furthermore, consumption of certain food and natural materials such as fenugreek, skullcap, chitin/chitosan, and cheonggukjang as anti-allergics have merits such as safety (no adverse side effects), multiple suppressive effects (as a mixture would contain various components that are active against allergic responses), and ease of consumption when required. These merits and anti-allergic properties of food and natural materials help control various allergic disorders.

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Branched-chain amino acids (BCAAs) are essential amino acids for humans and are major building blocks of proteins. Recent studies indicate that BCAAs act not only as components of proteins, but also as nutrasignals. In this review, we summarize the findings of recent studies investigating the physiological functions of BCAAs in the regulation of protein and glucose metabolism and brain function.

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Gastric cancer is one of the most common gastrointestinal cancer, which gastrectomy offers best curative intent. Multidisciplinary team cares enhance gastrectomy cases fast recovery.

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Essential major and trace elements, including magnesium (Mg), zinc (Zn) and copper (Cu), are involved in numerous physiological processes. These elements are important components for maintaining proper protein structure and function. They are also used as catalytic cofactors for enzymes and as mediators in signaling cascades. Thus, systemic homeostasis of these metals is sophisticatedly regulated at a molecular level. A balance between absorption and excretion of these metals is critical, and transport proteins play a key role in this balance. In particular, transport proteins in intestinal epithelial cells are indispensable and ensure adequate metal absorption. Regulation of the expression and activity of these proteins is complicated. Thus, dysfunction of these proteins causes an imbalance in the systemic homeostasis of corresponding metals, and thus likely links to disease pathogenesis. In this review, we briefly describe the importance of mammalian metal transport proteins, including Mg channels, and Zn and Cu transporters, focusing on their roles in the absorption process in intestinal epithelial cells. Specifically, TRPM6 channels in Mg absorption, ZIP4 and ZnT1 transporters for Zn absorption, and CTR1 and ATP7A for Cu absorption are overviewed.

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Inorganic phosphate (Pi) is an essential compound for several biologic functions. Pi levels outside the normal range, however, contribute to several pathological processes. Hypophosphatemia leads to bone abnormalities, such as rickets/osteomalacia. Hyperphosphatemia contributes to vascular calcification in patients with chronic kidney disease and hemodialysis patients and is independently associated with cardiac mortality.
Pi homeostasis is regulated by the coordinated function of renal and intestinal sodium-dependent phosphate (NaPi) transporters with dietary Pi, parathyroid hormone, 1,25-dihydroxyvitamin D₃, and fibroblast growth factor 23. The type II NaPi transporter/SLC34 family, with three members identified to date, is mainly responsible for Pi homeostasis in the body. SLC34A1 and SCL34A3 are predominantly expressed in the kidney, whereas SLC34A2 is expressed in the small intestine. The role of each SLC34 in the body was recently established by studies of gene-targeted mice. Mutation of SLC34A1 causes Fanconi syndrome and mutation of SLC34A3 causes autosomal recessive hereditary hypophosphatemic rickets with hypercalciuria. SLC34A2 is thought to be a major intestinal NaPi transporter and mutation of SLC34A2 causes pulmonary alveolar microlithiasis. A detailed understanding of Pi regulation in the body is important toward maintaining health.

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Bray has proposed the “MONA LISA” hypothesis, an acronym for Most Obesities kNown Are Low In Sympathetic Activity indicating that obesity is associated with a relative or absolute reduction in the activity of the thermogenic component of the sympathetic nervous system. Our series of studies have suggested a potential reversibility in ANS activity regulating fat metabolism and appetite control by regular exercise training in middle aged individuals and obese children with depressed ANS activity. In other words habitual exercise plays a vital role in enhancing not only fat and glucose metabolism, but also ANS activities in the prevention of obesity and appetite control. There are growing expectations that too much sitting is a real and substantial risk to health. One of the intriguing findings from these accelerometer measurement studies is that breaks in sedentary time were shown to have beneficial associations with metabolic biomarkers, due possibly to challenging and enhancing autonomic nervous system that regulates body weight and appetite. Recent findings of brain-derived neurotrophic factors (BDNF) seem to have shed some light upon age-related neurodegenerative diseases and appear to influence energy metabolism, appetite and aspects of neuro-cognitive function. These data strongly suggest that a lack of exercise as characterized by a sedentary lifestyle and an unhealthy diet may lead to accelerated ageing, diseases of the body and brain, and an overall decline in the quality of life.

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