213Traditional Japanese Diet Score and healthy life expectancy - a longitudinal global study

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study.

BackgroundReducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators.MethodsThe average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from − 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43− eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country’s average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million.ResultsLand use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders.ConclusionsThis ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Background Traditional Japanese diets are considered to be one cause of Japanese health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and cancer during more than 20 years using global database. Methods Total cancer incidence and mortality by country were identified from the Global Burden of Disease 2017 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations database. The TJDS by country was calculated from nine food groups, the higher scores mean the more adherence to traditional Japanese diet. That is beneficial food groups (rice, fish, soybeans, vegetables, eggs, seaweed) gave positive points to high supply amount, and food groups not commonly used in the Japanese diet (wheat, milk, and red meat) gave minus points to high supply amount. The longitudinal associations between the TJDS and cancer incidence and mortality controlled for covariates were examined during 23 years from 1990 to 2013. The country covered by this study was 139 countries with populations of 1 million or greater. Results The TJDS was negatively associated with cancer incidence and mortality longitudinally in a linear mixed-effect model controlled for covariates. Conclusions These results suggest that greater adherence with the TJDS supressed cancer incidence and mortality worldwide. Key messages Well-balanced eating habits like traditional Japanese diets is important for suppressing cancer.

Objective Prevention and improvement of hypertension is one of the most important health issues worldwide. The traditional Japanese diet contributes to the prevention of some non-communicable diseases associated with hypertension. However, whether traditional Japanese dietary patterns are associated with hypertension prevalence and systolic blood pressure (SBP) worldwide remains unknown. In this study, we aimed to investigate whether the traditional Japanese diet score (TJDS) is associated with hypertension prevalence and SBP. Methods This cross-sectional and longitudinal ecological study from 2009 to 2019 included 141 countries with a population of at least 1 million. All data used for analysis were obtained from internationally available databases. The TJDS was calculated using country-specific supplies of five foods commonly eaten in the traditional Japanese diet (rice, fish, soybean, vegetables, and egg) and three less commonly eaten foods (wheat, milk, and red meat). Hypertension was defined by SBP ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medications. The mean SBP was >25 age-standardized data. A general linear model was used for the cross-sectional model in 2009, and a linear mixed model was used for the longitudinal analysis from 2009 to 2019. The covariates included gross domestic product, percentage of population aged >65 years, years of education, smoking rate, average body mass index, physical activity, and energy supply. Results The TJDS was negatively associated with hypertension prevalence (β ± standard error: −0.861 ± 0.202, p < 0.001) and SBP (β ± standard error: −0.364 ± 0.154, p < 0.05) in the cross-sectional analysis. The TJDS was significantly negatively associated with hypertension prevalence (β ± standard error: −0.845 ± 0.200, p < 0.001) and SBP (β ± standard error: −0.312 ± 0.149, p < 0.05) in the 10-year longitudinal analysis controlled for full covariables. Conclusions Traditional Japanese dietary patterns are associated with lower hypertension prevalence and SBP worldwide.

While the traditional Japanese diet has been suggested to increase blood pressure due to its high Na content, whether the contemporary Japanese diet is associated with blood pressure remains elusive. We developed a traditional Japanese diet score (nine items: white rice, miso soup, soy products, vegetables, mushrooms, seaweeds, fish, salty food and green tea) and a modified version by substituting white rice with whole-grain rice, reverse scoring for salty food and adding fruits, raw vegetables and dairy products using data from 12213 employees from Japanese companies. Hypertension was defined as a blood pressure of 140/90 mmHg or more or the use of antihypertensive drugs. A multi-level Poisson regression model with a robust variance estimator was used to calculate prevalence ratios (PR) and 95 % CI while adjusting for covariates. The adjusted PR (95 % CI) of hypertension for the lowest through highest quartiles of the traditional Japanese diet score were 1·00 (reference), 0·94 (0·88, 1·02), 0·98 (0·90, 1·06) and 0·96 (0·90, 1·02), respectively (P for trend = 0·29), while those for the modified Japanese diet score were 1·00 (reference), 0·96 (0·94, 0·99), 0·95 (0·85, 1·05) and 0·94 (0·87, 1·01), respectively (P for trend = 0·10). In this cross-sectional study, close adherence to the traditional Japanese diet was not associated with the prevalence of hypertension, whereas there was a suggestion of an inverse association between the modified Japanese diet and the prevalence of hypertension.

The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases. HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater. Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = - 1.3 ± 0.5, p = 0.011). After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

BackgroundAlthough our previous study using a food frequency questionnaire simulated nutritional characteristics of the traditional Japanese diet, this issue has not been sufficiently evaluated. This study was conducted to examine the relationship between the traditional Japanese diet and nutrient density (ND).MethodsA cross-sectional study employing the dietary record method was conducted among 2221 community-dwelling Japanese adults (40–88 years) living in Aichi Prefecture, Japan, in 2006–2008. Based on previous studies, a 9-component Japanese Diet Index (JDI) and a 12-component modified JDI (mJDI12) were defined. To develop a new weighted index, a multiple linear regression model was used to select food components which were significantly associated with an ND score (integrated by 11 nutrient components) from the mJDI12 and weight them. Correlation analyses were performed between JDI, mJDI12, the new weighted JDI score and the ND score and its 11 nutrient components. The findings were validated with data from 2008 to 2010 by assessing the associations between the JDIs scores and the ND score.ResultsScores of the JDI and mJDI12 were positively correlated with the ND score (corresponding Spearman’s ρ [95% confidence interval; CI], 0.34 [0.31, 0.38] and 0.44 [0.41, 0.48], respectively; P < 0.05 for both). Among the mJDI12, 9 food components (rice, fish and shellfish, green and yellow vegetables, seaweed, green tea, beef and pork, soybeans and soybean foods, fruit, and mushrooms) significantly associated with the ND score. All of these 9 components were weighted and a new weighted JDI (wJDI9) was developed. The wJDI9 score was also positively correlated with the ND score (Spearman’s ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05). However, scores for all 3 indices were positively correlated with sodium intake. The wJDI9 score obtained using dietary record data from 2008 to 2010 was also positively correlated with the ND score (Spearman’s ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05).Conclusions-Adhering to a traditional Japanese diet as defined by the JDI was associated with good ND. Furthermore, the modified indices (mJDI12 and wJDI9) had a higher performance for ND. However, all of the indices were correlated with high sodium intake.

The Japanese diet from 1975 delays senescence and prolongs life span in SAMP8 mice

The objectives of this study is to evaluate the efficacy and safety of alogliptin versus very low fat/calorie traditional Japanese diet (non-inferiority trial) as an initial therapy for newly diagnosed, drug naïve subjects with type 2 diabetes (T2DM). Study design was prospective, randomized, non-double-blind, controlled trial. The study was conducted at outpatient units of municipal hospital. Patients were newly diagnosed, drug naïve patients who visited the outpatient units. The patients randomly received 12.5-25mg/day alogliptin (n=25) or severe low calorie traditional Japanese diet (n=26). The procedure of this trial was assessed by the consolidated standards of reporting trials statement. The primary end point was the change of HbA1c at 3months. Secondary end points included the changes of fasting blood glucose, insulin, homeostasis model assessment-R (HOMA-R), HOMA-B, body mass index (BMI), and lipid parameters. Similar, significant reductions of HbA1c levels were observed in both groups (from 10.51 to 8.74% for alogliptin and from 10.01 to 8.39% for traditional Japanese diet) without any clinically significant adverse events. In the alogliptin group, some subjects (16%) had mild hypoglycemic evens which could be managed by taking glucose drinks by themselves. HOMA-B significantly increased in both groups with varying degrees, whereas HOMA-R significantly decreased only in the Japanese diet group. Atherogenic lipids, such as, total cholesterol, non-high density lipoprotein cholesterol, and low density lipoprotein cholesterol levels significantly decreased in both groups. BMI had no change in the alogliptin group, whereas it significantly decreased in the Japanese diet group. (1) Concerning its glycemic efficacy, alogliptin is effective and non-inferior to traditional Japanese diet as an initial therapeutic option for newly diagnosed T2DM. However, regarding the reductions of body weight and insulin resistance, traditional Japanese diet is superior. (2) Both alogliptin and traditional Japanese diet have favorable effects on atherogenic lipid profiles.

Objective Studies conducted on Japanese people have suggested that a traditional Japanese diet contributes to good health, longevity, and protection against several non-communicable diseases. However, it is unknown whether traditional Japanese dietary patterns are associated with all-cause mortality, cardiovascular disease, and cancer mortality globally. The purpose of this cross-sectional and longitudinal ecological study is to clarify the global association between the traditional Japanese diet score (TJDS) and all-cause, cardiovascular disease, and total cancer mortality. Methods Data on food supply and all-cause mortality, cardiovascular disease mortality, total cancer mortality, and covariables by country were obtained from a relevant internationally available database. TJDS by country was calculated from eight food groups and the total score ranged from −8 to 8, with higher scores indicating greater adherence to a traditional Japanese diet. We evaluated the cross-sectional and 10-year longitudinal association between TJDS and all-cause, cardiovascular disease, and total cancer mortality using 2009 as the baseline in 142 countries with populations of more than one million. A cross-sectional analysis and a longitudinal analysis were performed using three general linear models or three linear mixed models with different covariables. Results In cross-sectional models controlled for fully-adjusted covariables, TJDS was negatively associated with all-cause mortality (β ± standard error; −43.819 ± 11.741, p < 0.001), cardiovascular disease mortality (−22.395 ± 4.638, p < 0.001), and total cancer mortality (−3.893 ± 1.048, p < 0.001). In 10-year longitudinal models controlled for fully-adjusted covariables, TJDS was significantly negatively associated with all-cause mortality (−31.563 ± 7.695, p < 0.001), cardiovascular disease mortality (−16.249 ± 4.054, p < 0.001), and total cancer mortality (−3.499 ± 0.867, p < 0.001). Conclusions This cross-sectional and longitudinal ecological study suggests that the traditional Japanese diet is associated with lower all-cause mortality, cardiovascular disease mortality, and total cancer mortality, worldwide.

AimThe Japanese diet, rich in fish, soy products, and green tea, is associated with better mental health. However, associations between Japanese dietary patterns and depressive symptoms remain inconsistent, with limited research on predefined patterns. This study developed scores for traditional and modified Japanese diets to explore their cross‐sectional associations with depressive symptoms in a large working population.MethodsAs part of the Japan Epidemiology Collaboration on Occupational Health Study, we conducted a survey between 2018 and 2021. Diet was assessed using a validated food frequency questionnaire. Scores were developed for the traditional Japanese diet (9 items: white rice, miso soup, soy products, cooked vegetables, mushrooms, seaweed, fish, salty foods, green tea) and its modified version (11 items: whole or minimally processed rice instead of white rice, reverse scoring for salty foods, and adding fruits, raw vegetables, dairy products). Depressive symptoms were assessed using the 11‐item Center for Epidemiological Studies‐Depression Scale (cutoff ≥9). Multilevel Poisson regression with robust variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for confounders and accounting for study site as a random effect.ResultsAmong 12,499 participants (76.8% participation), 30.9% reported depressive symptoms. The PRs of depressive symptoms across quartiles of the traditional Japanese diet score were 1.00 (reference), 0.94 (95% CI, 0.88–0.99), 0.91 (95% CI, 0.85–0.98), and 0.83 (95% CI, 0.80–0.86), and those for the modified version were 1.00 (reference), 0.94 (95% CI, 0.89–0.98), 0.83 (95% CI, 0.80–0.87), and 0.80 (95% CI, 0.76–0.83).ConclusionClose adherence to the traditional and modified Japanese diet score is associated with fewer depressive symptoms among the working population.

The traditional Japanese diet is considered one of the important factors of health and longevity in Japanese people. Breast cancer is the most common cancer among women in the world. However, the association between the traditional Japanese diet and breast cancer is unclear. The purpose of this study was to investigate the longitudinal association between the traditional Japanese diet score (TJDS) with the incidence and mortality of breast cancer in an ecological study. Food supply and breast cancer incidence and mortality by country were obtained from an international database. TJDS by country was calculated from nine food groups and the total score ranged from -9 to 9, with higher scores indicating greater adherence to a traditional Japanese diet. Longitudinal associations of interaction between TJDS and fiscal year on breast cancer incidence and mortality were investigated in 139 countries with populations of 1 million or greater. The longitudinal analysis was evaluated using four linear mixed-effect models with different adjustment covariables. Many countries with high scores on TJDS had lower distributions of breast cancer incidence and mortality in 1990-2017. Longitudinal analysis using a linear mixed-effect model controlled for socio-economic and lifestyle covariables showed that the interaction between TJDS and fiscal year was significantly associated with incidence of breast cancer (-0.453 ± 0.138, p < 0.01) and mortality of breast cancer (-0.455 ± 0.135, p < 0.001). This longitudinal analysis suggested that a traditional Japanese diet has been associated with lower breast cancer incidence and mortality worldwide in recent years.

A traditional Japanese diet (JD) has been widely regarded as healthy, contributing to longevity. The modern Japanese lifestyle has become markedly westernized, and it is speculated that the number of people who eat JD is decreasing. A simple evaluation of people with low adherence to JD will help improve dietary life. We developed a simple assessment tool that can capture JD, and examined factors associated with low adherence to JD. A total of 1458 subjects aged 18 to 84 years completed a brief self-administered diet history questionnaire. We constructed an empirical Japanese diet score (eJDS) consisting of 12 items from the common characteristics of a JD. In our participants, 47.7% of subjects reported low adherence to JD and only 11.1% demonstrated high adherence. In multivariate logistic regression analysis, younger age persons, physically inactive persons, and heavy drinkers were associated with low adherence to JD. Based on the cutoff values of eJDS, we proposed to create a Japanese diet pyramid that is easy to use visually. In conclusion, the eJDS and the Japanese diet pyramid will be useful tools for nutrition education and dietary guidance.

Background As the global population ages, extending not only the life expectancy (LE) but also the healthy life expectancy (HALE) has become a critical public health objective. Dietary choices, especially the intake of various fatty acids, may play a role in achieving good health. Objective The aim of this study was to describe the intake of fatty acid (FA) fractions across different countries and explore its associations with HALE and LE from 2010 to 2019 according to publicly available international data. Methods Data on FA intake in 2010 were obtained from the Global Dietary Database. HALE and LE data were sourced from the Global Burden of Disease Study 2019. A total of 151 countries with populations exceeding 1 million people were included in the analysis. Associations of the intake of each FA with HALE and LE were assessed using linear mixed models adjusted for various covariates. Results High national omega-3 fatty acid (n-3 PUFA) intake was positively associated with both HALE (β: 2.63, SE: 0.73, p < 0.001) and LE (β: 2.32, SE: 0.63, p < 0.001). These associations remained unchanged when n-3 PUFAs were separated into plant-derived and seafood-derived n-3 PUFAs. No significant associations were observed for the other FAs. Conclusion Higher intake of n-3 PUFAs is positively associated with longer HALE and LE at the national level. These findings underscore the importance of dietary fat composition in promoting healthy aging. Further research is needed to develop public health strategies adapted to each country.

To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century. This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages. Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.