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Context Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood. Objective The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated. Data Sources A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022. Data Extraction Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results. Data Analysis Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], –107 kcal d–1 (95% CI, –132 to –81), protein (WMD, –5.2 g d–1; 95% CI, –6.6 to –3.8), fat (WMD, –4.6 g d–1; 95% CI, –6.7 to –2.6), carbohydrate (WMD, –8.8 g d–1; 95% CI, –13.9 to –3.7), and vitamin C intakes (WMD, –12.9 mg d–1; 95% CI, –16.6 to –9.2) in older adults. Conclusion Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored. Systematic Review Registration PROSPERO registration no. CRD42022308823. [ABSTRACT FROM AUTHOR]

This meta-analysis investigated the long-term efficacy of dietary modifications on renal outcomes in individuals with diabetes. We systematically reviewed six studies, focusing on the impact of specific dietary components, including protein and salt intake and the use of nutraceuticals such as ketoacids, across global settings, including Poland, Nigeria, Taiwan, Italy, Austria, and Japan. The studies varied in design, ranging from observational to randomized controlled trials. The sample sizes and study durations ranged from 28 to 6,213 participants and 28 days to 5 years. Our analysis revealed that dietary protein restriction generally stabilized and improved renal function. However, the response to protein restriction varied, suggesting the need for personalized dietary management strategies. Furthermore, reducing salt intake was consistently beneficial, aligning with its known effects on lowering blood pressure and reducing proteinuria. Nutraceuticals, especially ketoacids, showed their potential as supplements for renal diet management. These findings supported the integration of nutraceuticals into dietary plans to enhance renal outcomes without compromising nutritional status. Thus, our meta-analysis demonstrated the importance of tailored dietary interventions in managing renal outcomes in individuals with diabetes and suggested that personalized nutrition, which considers individual dietary needs and kidney disease stage, should be a fundamental component of comprehensive CKD management. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of an individualized nutritional education program in promoting adequate nutrient intake in pregnant women. Methods: A stratified randomized controlled trial was conducted. Participants were stratified by factors affecting the primary outcome and randomly assigned to the intervention or control groups. Intervention group participants received an individualized 30‐min booklet‐based education program in their 2nd and 3rd trimesters; the control group received usual care. The primary outcome was protein intake after the intervention, which was compared between the intervention and control groups. Secondary outcomes included comparing the amount of increase of protein before and after the intervention. Nutrient intake was measured using a self‐administered short dietary history questionnaire, and analyses of covariance and t tests were performed. Results: Of the 130 participants, 66 were assigned to the intervention group and 64 to the control group. There was no difference in protein intake between the two groups after the intervention (p =.051, 95% CI [−0.021, 12.4]). Comparing the increase in protein intake before and after intervention, the intervention group was 7.4 g/day higher than that of the control group (p =.040; F = 4.31; effect size = 0.36). Conclusions: The primary outcome, a comparison of protein intake between the groups after the program, revealed no significant differences. However, on comparing the amount of protein increase before and after the intervention, the intervention group's increase was significantly higher than that of the control group. Results indicate the potential for individualized face‐to‐face interventions for pregnant women in Japan. [ABSTRACT FROM AUTHOR]

Summary: Soybean (Glycine max L. Merr.) is a major crop worldwide, providing essential dietary proteins and edible oils for agriculture, food, animal feed and biofuel industries. However, its limited genetic variation makes it vulnerable to harsh environmental conditions, and its chemical diversity was strongly reduced after long domestication. Wild soybean (Glycine soja Sieb. et Zucc.), the ancestor of the G. max, possesses a high level of genetic diversity and thus present a precious reservoir for improving cultivated soybean. Characterising metabolomes of different G. soja accessions is crucial in exploring metabolite accumulation patterns for developing metabolic breeding strategies. This study successfully revealed the metabolomes of sixty‐four seed lines of G. soja collected throughout Japan by a widely targeted metabolomics approach, therefore, providing a good source of information for further studies to induce the production of bioactive compounds and the defence mechanism to stress. [ABSTRACT FROM AUTHOR]

Aim: Protein intake is an important component in retaining muscle mass, especially among older people. This study examined the relationship between total protein intake and/or the distribution of protein intake in each meal and appendicular muscle mass, using data from the National Health and Nutrition Survey (NHNS) in Japan. Methods: Data from the NHNS were re‐analyzed in this study. We used data from a one‐day dietary record, physical examination, and lifestyle questionnaire completed by 1766 participants aged over 60 years. Appendicular muscle mass was assessed by multiple‐frequency bioimpedance measurement. Leucine intake was calculated by the weighted average amino acid content from all 98 food subcategories used in the NHNS, based on amino acid composition data in the 2020 Standard Tables of Food Composition. Results: Participants with higher protein intake showed significantly higher appendicular muscle mass. This relationship was independent of physical activity, including steps taken per day, exercise habit, and physical labor. Frequent intake of ≥0.4 g protein/kg/meal was not related to appendicular muscle mass. The combination of higher total protein intake and higher physical activity seemed to have the largest association with appendicular muscle mass. Conclusions: Higher protein intake may be related to higher appendicular muscle mass, independent of higher physical activity, among older Japanese people. Geriatr Gerontol Int 2024; 24: 634–640. [ABSTRACT FROM AUTHOR]

The article discusses a study on community-dwelling older adults to explore the association between urinary taurine concentration and protein intake. Topics include protein intake in older Japanese adults, data used in the study, and participant characteristics. The study showed that the urinary taurine concentrations of community-dwelling older adults was associated with their protein intake.

Background: We aimed to examine the relationship between food group-specific intake and depression among workers in Japan. Methods: A questionnaire survey was administered to 568 workers in 2020; 503 workers responded and 423 were included in the study. Information on sex, age, body mass index, overtime hours, sleep duration, marital status, employment position, exercise habits, smoking status, incidence of depression, and intake of energy, proteins, lipids, carbohydrates, alcohol, and specific food groups were collected. The Center for Epidemiologic Studies Depression Scale was used to assess the presence and severity of depression. Food group-specific intake was adjusted for energy intake using the residual method and classified into low, moderate, and high by sex. Logistic regression was used to examine the odds ratios (ORs) and trends according to sex, with the presence/absence of depression as the dependent variable and food group-specific intake as the independent variable. Results: Men in the eggs low-intake, and women in the other vegetables low- and moderate-intake and eggs moderate-intake groups had significantly higher adjusted ORs (aORs) for depression. Additionally, a dose-response relationship was observed, where the OR for depression was significantly higher in men when the intake of eggs was low (p for trend = 0.024) and in women when the intakes of other vegetables (p for trend = 0.011) and eggs (p for trend = 0.032) were low. Conclusions: The intake of eggs in men and eggs and vegetables in women may be related to depression. [ABSTRACT FROM AUTHOR]

Despite the increasing market share of commercial complementary foods, their nutritional characteristics and those associated with the price of products are still unknown in Japan. We compared the nutritional characteristics of commercially available complementary foods of different price levels in Japan. Data were obtained from the websites of Japanese brands of infant and young children's food. Nutrient profiles (unit/100 g), ingredients and food additives were compared between low- and high-priced products by product type. Sixty-three dry meals, 425 soft meals, 187 snacks and sweets, and 60 drinks were analysed. One-fifth of meals and snacks exceeded the CODEX-defined limit (200 mg Na/100 g). Most products lacked content information on nutrients non-mandated to be indicated. High-priced soft meals contained more protein (2·5 v. 1·9 g/100 g) and less Na (0·18 v. 0·46 g/100 g), less frequently used ≥ 1 added sugar (23 % v. 82 %), and less frequently used food additives than low-priced products; however, they had a lower variety of ingredients. The prevalence of products containing ≥ 1 added sugar was higher in low-priced snacks and sweets (91 % v. 77 %) but lower in drinks (48 % v. 84 %) than in their high-priced counterparts. High Na content is a concern among commercial complementary foods in Japan. Nonetheless, the relationship between the price and nutritional profile of these foods differs by product type. High-priced soft meals might be more favourable regarding nutrient content but not the variety of ingredients than low-priced counterparts. These findings elucidate the nutritional characteristics of commercial complementary foods in Japan. [ABSTRACT FROM AUTHOR]

The influx of intestinal bacteria-derived lipopolysaccharide (LPS) into the blood has attracted attention as a cause of diseases. The aim of this study is investigating the associations between the influx of LPS, dietary factors, gut microbiota, and health status in the general adult population. Food/nutrient intake, gut microbiota, health status and plasma LPS-binding protein (LBP; LPS exposure indicator) were measured in 896 residents (58.1% female, mean age 54.7 years) of the rural Iwaki district of Japan, and each correlation was analyzed. As the results, plasma LBP concentration correlated with physical (right/left arms' muscle mass [β = −0.02, −0.03]), renal (plasma renin activity [β = 0.27], urine albumin creatinine ratio [β = 0.50]), adrenal cortical (cortisol [β = 0.14]), and thyroid function (free thyroxine [β = 0.05]), iron metabolism (serum iron [β = −0.14]), and markers of lifestyle-related diseases (all Qs < 0.20). Plasma LBP concentration were mainly negatively correlated with vegetables/their nutrients intake (all βs ≤ −0.004, Qs < 0.20). Plasma LBP concentration was positively correlated with the proportion of Prevotella (β = 0.32), Megamonas (β = 0.56), and Streptococcus (β = 0.65); and negatively correlated with Roseburia (β = −0.57) (all Qs < 0.20). Dietary factors correlated with plasma LBP concentration correlated with positively (all βs ≥ 0.07) or negatively (all βs ≤ −0.07) the proportion of these bacteria (all Qs < 0.20). Our results suggested that plasma LBP concentration in the Japanese general adult population was associated with various health issues, and that dietary habit was associated with plasma LBP concentration in relation to the intestinal bacteria. [ABSTRACT FROM AUTHOR]

The consumption of raw yam tuber through grated yam "tororo" is a major and popular diet in Japan. However, few studies have been undertaken to evaluate the digestive characteristics of raw yam tubers. This study aimed to fill this gap by investigating the changes in the protein profile, protein and starch digestibility, antioxidant capacity and microstructure of two typical yam tubers (Nagaimo N-10 and Nebaristar) in the Japanese diet, applying a simulated in vitro digestion method. Results showed that both samples contained a considerable protein content of about 11% (dry basis) and a protein digestibility of 43–49%. The electrophoretic patterns confirmed that dioscorin was the main protein of the yam tuber, and it could be digested into peptides and free amino acids with low molecular weight during in vitro digestion. The starch hydrolysis results suggested that eating raw yam tuber cannot induce a fast glycemic increase for consumers due to a low starch digestibility of 4.4–6.1%. In addition, Nebaristar showed a higher bioaccessibility in some key amino acids and total phenolic content than the Nagaimo N-10. This study provides some essential nutritional information and simulated digestion behaviours of the raw yam tubers, which could be useful for consumers and industries when buying and processing yam tubers from the perspective of changes in the nutritional profile during digestion. [ABSTRACT FROM AUTHOR]

Background: Diet-induced inflammation may be associated with sarcopenia; however, few reports have examined this relationship. Aim: To examine the association between the dietary inflammatory index (DII) and sarcopenia in older adults who visited a frailty clinic in Japan. Methods: This cross-sectional study used outpatient data from the Frailty Registry Study. The DII is an index of diet-induced inflammation, and a dietary assessment was performed using a brief self-administered diet history questionnaire to calculate the DII score. We classified DII scores by quartiles (Q1–Q4), and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 consensus. Logistic regression analyses for sarcopenia were performed. Age, sex, comorbidities, and physical activity were entered as confounding factors (Model 1) and Models 2, 3, and 4 with BMI, protein intake, and energy intake added to Model 1. Results: We included 304 patients in the analysis (mean age, 77.6 ± 6.3 years; female, 67.4%). The prevalence of sarcopenia was 14.5%. Logistic regression analyses showed that DII scores were significantly associated with sarcopenia in Model 1 and 2 (Model 1, reference: Q1, Q4: OR 3.10, P = 0.020; Model 2, Q4: OR 3.40, P = 0,022) but not in Model 3 and 4. Discussion: Diet-induced inflammation is associated with a higher likelihood of sarcopenia; however, this association disappeared after confounding for protein and energy intake. Conclusions: The results demonstrated that dietary protein and energy parameters were the main drivers for muscle health in medical patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the effect of lunches with different caloric contents (Study 1) and nutrient balances (Study 2) on dinner-induced postprandial glucose fluctuation. Methods: Energy trial (Study 1): Thirteen healthy young participants (n = 10 men, n = 3 women) were investigated to determine the effects of different caloric intakes at lunch on glucose level variability. The study was comprised of four trials (no lunch, low lunch, standard lunch, and high-energy lunch). Energy balance trial (Study 2): Fourteen healthy young adults (n = 8 men, n = 6 women) were investigated to determine the effect of different nutrient balances during lunch on glucose level variability. The study consisted of four trials (standard, protein-rich, fat-rich, and carbohydrate-rich). In studies 1 and 2, each trial was spaced at least 24 full hours apart, and breakfast and dinner were tested as meals. The mealtimes for each trial were then aligned. Continuous glucose monitoring was used to assess the blood glucose fluctuations. Results: Study 1: The no-lunch (95% CI 95.5–149.7) and low-energy lunch (95% CI 90.8–143.1) trials had significantly higher values in the incremental area under the curve (iAUC) of postprandial blood glucose at dinner compared to the standard (95% CI 55.4–90.0) and high-energy lunch (95% CI 29.3–54.6) trials (P = 0.006, P = 0.001 vs. none), (P = 0.004, P = 0.001 vs. low-energy trial). Study 2: A significantly higher postprandial blood glucose iAUC for dinner was found in the fat-rich trial (95% CI 58.5–114.0) than that in the protein-rich (95% CI 25.6–63.9) and standard (95% CI 25.6–112.4) trials, (P = 0.006, P = 0.035 vs. fat-rich trial). Conclusions: Our findings indicate that skipping lunch and low-calorie or high-lipid intake increased postprandial blood glucose levels after dinner. [ABSTRACT FROM AUTHOR]

This cross-sectional study explored the prevalence of iron deficiency (ID) and associations between dietary factors and incidence of ID in female rhythmic gymnasts during preseason periods. Participants were 60 elite collegiate rhythmic gymnasts (18.1 ± 0.3 years [M ± SD]) who were recruited every August over the course of 8 years. Participants were divided into 2 groups according to the presence or absence of ID. Presence of ID was denned either by ferritin less than 12 µ/L or percentage of transferrin saturation less than 16%. Anthropometric and hematologic data, as well as dietary intake, which was estimated via a semiquantitative food frequency questionnaire, were compared. ID was noted in 48.3% of participants. No significant group-dependent differences were observed in physical characteristics, red blood cell counts, hemoglobin, hematocrit, haptoglobin, or erythropoietin concentrations. The ID group had a significantly lower total iron-binding capacity; serum-free iron; percentage of transferrin saturation; ferritin; and intake of protein, fat, zinc, vitamin B2, vitamin B6, beans, and eggs but not iron or vitamin C. The recommended dietary allowance for intake of protein, iron, zinc, and various vitamins was not met by 30%, 90%, 70%, and 22%-87% of all participants, respectively. Multiple logistic analysis showed that protein intake was significantly associated with the incidence of ID (odds ratio = 0.814, 95% confidence interval [0.669, 0.990], p = .039). Participants in the preseason's weight-loss periods showed a tendency toward insufficient nutrient intake and were at a high risk for ID, particularly because of lower protein intake. [ABSTRACT FROM AUTHOR]

Background The association between total protein intake and all-cause mortality is inconsistent. Pneumonia is a major cause of death among the elderly, and the association between protein intake and pneumonia mortality warrants clarification. Objectives We aimed to examine the association between total, plant, and animal protein intake and pneumonia mortality in a prospective design. Methods The Japan Public Health Center (JPHC)–based Prospective Study prospectively follows 83,351 participants (37,652 men and 45,699 women). Total, plant, and animal protein intakes were calculated from a validated food-frequency questionnaire. A Cox hazards model was used to calculate HRs and 95% CIs, with adjustment for confounding factors. Results During ∼18.4 y of follow-up, 990 pneumonia deaths (634 men and 356 women) were observed. In the multivariable-adjusted model and in the model further adjusted for fatty acid intake, increase in total protein intake was marginally significantly associated with lower pneumonia mortality in women [lowest vs. highest quartile, HR (95% CI): 0.71 (0.53, 0.97), P -trend = 0.01 in the multivariable-adjusted model, and 0.70 (0.45, 1.06), P -trend = 0.05 in the fatty acid intake–adjusted model]. Total protein intake in men and animal and plant protein intake in both men and women were not significantly associated with pneumonia mortality in the fatty acid–adjusted model. Conclusions Although the HR in the highest quartile was not significant and further research to determine the upper limit of recommended protein intake is required, higher total protein intake was associated with lower pneumonia mortality in women. [ABSTRACT FROM AUTHOR]

Objectives: Defining an adequate protein intake in older adults remains unresolved. We examined the association between calibrated protein intake and comprehensive frailty by sex in the Kyoto-Kameoka study. Design: Cross-sectional study of baseline data. Setting and Participants: The study included 5679 Japanese participants aged 65 years or older. Methods: Calibration coefficients were estimated from food frequency questionnaires and 7-day dietary records as a reference. Comprehensive frailty was evaluated using the 25-item Kihon Checklist (KCL) and defined as a total KCL score of ≥7points. Sex-specific calibrated protein intakes were presented as % of energy, per kg of actual body weight (BW), and per kg of ideal BW. Results: Multiple logistic regression analysis shoed that calibrated protein intake is inversely associated with comprehensive frailty. The association between protein intake and comprehensive frailty was also evaluated using curve fitting with non-linear regression, a weak U-shaped association was found in males and an L-shaped association in females. Men had a low prevalence of frailty at a calibrated protein intake of 15–17% energy from protein, 1.2 g/kg actual BW/day, or 1.4 g/kg ideal BW/day, and women had a low prevalence of frailty at 17–21% energy from protein or 1.6 g/kg ideal BW/day, with the prevalence of frailty remaining unchanged at higher protein intakes. Meanwhile, the inverse relationship between protein intake per ABW and frailty showed a gradual decrease at 1.4 g/kg ABW/day for protein in women. Conclusions and Implications: A non-linear relationship was found between calibrated protein intake and frailty, with a U-shaped association in men and an L-shaped association in women. Adequate protein intake in healthy Japanese older adults was higher than the current recommended daily allowance. [ABSTRACT FROM AUTHOR]

Background Malnutrition of inpatients is often overlooked and remains a serious concern. However, there are few studies on the relations between infused energy and amino acid intakes and clinical outcomes in older patients on parenteral nutrition. Objectives We aimed to determine the short-term outcomes of infused energy and amino acid intakes in older patients receiving parenteral nutrition. Methods We conducted a retrospective observational study using a national inpatient database covering >1000 hospitals in Japan. Participants were those who underwent central venous (CV) port insertion between 2011 and 2016, were aged ≥65 y, and did not have cancer. Based on the types and amounts of products used for enteral feeding and intravenous feeding on postoperative day (POD) 7 after CV port insertion, the infused energy and amino acid intakes were estimated. The primary end point was mortality on POD 90. Multivariable logistic regression was performed to investigate the relations of infused energy and amino acid intakes with mortality on POD 90. Results A total of 10,153 patients aged ≥65 y who underwent CV port insertion were included. The mortality rates at 90 d after central venous port insertion were 14.9% and 14.0% (risk difference, 0.9%; 95% CI: –0.5%, 2.3%; P  = 0.216) with infused energy intakes <20 and ≥20 kcal/kg, respectively, and 15.4% and 13.2% (risk difference, 2.2%; 95% CI: 0.9%, 3.6%; P  = 0.001) with infused amino acid intakes <0.8 and ≥0.8 g/kg, respectively. The differences were retained after adjustment for multiple variables including hospital, age, sex, BMI, emergency admission, and 27 major underlying diseases. The OR for the ≥0.8-g/kg group compared with the <0.8-g/kg group was 0.87 (95% CI: 0.77, 0.99; P  = 0.028). Conclusions A positive relation between infused amino acid intake and mortality was found in older patients receiving parenteral nutrition. [ABSTRACT FROM AUTHOR]

Purpose: The WHO has proposed a novel model of healthy aging called intrinsic capacity (IC). However, the association between dietary patterns and IC is unclear. We aimed to investigate the prospective associations between dietary patterns and IC trajectories over a 3-year period in community-dwelling Japanese adults aged ≥ 60 years. Methods: A prospective cohort study which contained nutritional status, mental status, and physical function was used. A validated 34-item food frequency questionnaire was used to determine dietary intake and to derive five dietary patterns ("fruits and vegetables", "sugar and fat", "salt and pickles", "noodle and alcohol", and "protein-rich") using principal component analysis. The composite IC score was calculated as the mean of the locomotion Z-score, cognition Z-score, psychological Z-score, vitality Z-score, and sensory regression score. A generalized estimating equation was applied for longitudinal analysis. Results: A total of 666 enrollees were included in the analysis. The mean baseline IC was 0.07 ± 0.47. The "fruits and vegetables" dietary pattern was positively associated with composite IC score changes after adjusting for confounders (Q4 vs. Q1: mean difference [0.069], P = 0.019). Similarly, a positive correlation was observed for the "protein-rich" dietary pattern with the composite IC score changes (Q4 vs. Q1: mean difference [0.092], Q3 vs. Q1: mean difference [0.101], Q2 vs. Q1: mean difference [0.083]; all P < 0.01). However, adherence to the "sugar and fat" dietary pattern was negatively associated with composite IC score changes (Q4 vs. Q1: mean difference [− 0.072], P = 0.026). Furthermore, the percentage of animal protein to total protein intake showed a significant incremental trend in the "protein-rich" dietary pattern (P for trend < 0.001). Conclusion: The "fruits and vegetables" and "protein-rich" (animal-based protein in particular) dietary patterns were positively associated with IC changes, whereas the "sugar and fat" dietary pattern was negatively associated with IC changes. Identification and promotion of healthy dietary patterns in older adults may inform future health policies and research. [ABSTRACT FROM AUTHOR]

Carbohydrates are the major source of dietary energy, but their role in health and disease remains controversial. Recent epidemiological evidence suggests that the increased consumption of carbohydrates is associated with obesity and increased risk of mortality and dietary trials show that carbohydrate restriction leads to weight loss and improved glycaemic status in obese and diabetic subjects. In contrast, the diets of populations with long and healthy lifespans (e.g. traditional Okinawans from Japan) are high in carbohydrate and low in protein, and several clinical and preclinical studies have linked low-carbohydrate–high-protein diets with increased mortality risk. In this paper we attempt to reconcile these contradictory findings by moving beyond traditional single-nutrient analyses to consider the interactions between nutrients on health outcomes. We do so using the Geometric Framework (GF), a nutritional modelling platform that explicitly considers the main and interactive effects of multiple nutrients on phenotypic characteristics. Analysis of human data by GF shows that weight loss and improved cardio-metabolic outcomes under carbohydrate restriction derive at least in part from reduced caloric intake due to the concomitantly increased proportion of protein in the diet. This is because, as in many animals, a specific appetite for protein is a major driver of food intake in humans. Conversely, dilution of protein in the diet leverages excess food intake through compensatory feeding for protein ('protein leverage'). When protein is diluted in the diet by readily digestible carbohydrates and fats, as is the case in modern ultra-processed foods, protein leverage results in excess calorie intake, leading to rising levels of obesity and metabolic disease. However, when protein is diluted in the diet by increased quantities of less readily digestible forms of carbohydrate and fibre, energy balance is maintained and health benefits accrue, especially during middle age and early late-life. We argue that other controversies in carbohydrate research can be resolved using the GF methodology in dietary studies. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have reported a relationship between low protein intake and cognitive decline and have suggested that this association may be related to specific amino acid intake. However, the effects of amino acid intake on the maintenance of cognitive function have yet to be clarified. We examined the longitudinal association between dietary amino acid intake and cognitive function in community-dwelling older adults. Design: Longitudinal epidemiological study. Setting: Community-based setting. Participants: This study comprised 427 study participants aged 60–82 years with no cognitive decline, defined as a Mini-Mental State Examination (MMSE) score of >27 at baseline, who also participated in a follow-up. The average and standard deviation of the follow-up period was 8.2 ± 0.3 years. Measurements: Dietary intake was assessed using three-day dietary records at baseline. Participants were classified into quartiles (Q1–Q4) based on the intake of 19 amino acids for males and females. Next, we classified participants into Q1 and Q2–Q4 groups. Cognitive function was assessed using the MMSE both at baseline and at follow-up. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the Q1 group and cognitive decline (MMSE ≤;27), using the Q2–Q4 group as a reference group. Covariates were age, sex, body mass index, years of education, severity of depressive symptoms, history of lifestyle diseases (hypertension, dyslipidemia, diabetes mellitus, stroke, and ischemic heart disease), energy intake (kcal/d), protein intake (g/d), and MMSE score at baseline. Results: Cognitive decline was present in 133 (31.1%) participants. After adjustment for covariates, including total protein intake, the ORs (95% CIs) for cognitive decline were 2.40 (1.21–4.75) for lysine, 2.05 (1.02–4.09) for phenylalanine, 2.18 (1.09–4.34) for threonine, and 2.10 (1.06–4.15) for alanine. Conclusion: The results suggest that lysine, phenylalanine, threonine, and alanine intake is important for the maintenance of cognitive function in older people, independent of total protein intake. [ABSTRACT FROM AUTHOR]

Background: Soy is commonly consumed in east Asian countries and is suggested to reduce colorectal cancer (CRC) risk. However, results from epidemiologic studies are inconsistent, despite the anti-inflammatory and antiproliferative properties of soy isoflavones and soy protein.Objective: We evaluated the association between soy isoflavones and soy protein and CRC risk using 4 prospective cohort studies from China and Japan.Methods: Data were pooled from the Shanghai Women's Health Study (SWHS), Shanghai Men's Health Study (SMHS), Japan Public Health Center-based Prospective Study Cohort 1 (JPHC1), and Cohort 2 (JPHC2). Cox proportional hazards models estimated HRs and corresponding 95% CIs for the association of soy protein and isoflavone intake with CRC risk. The study included 205,060 individuals, among whom 2971 were diagnosed with incident CRC over an average follow-up of 12.7 y.Results: No statistically significant associations with CRC risk were observed for soy protein or isoflavone intake. No association was observed among ever smokers consuming higher isoflavones (HRisoflavones: 0.83; 95% CI: 0.68, 1.00) and soy protein (HRsoy protein: 0.81; 95% CI: 0.39, 1.10). However, risk reductions were observed among premenopausal women with a body mass index [BMI (kg/m2)] <23.0 at baseline for higher isoflavone (HRisoflavones: 0.58, 95% CI: 0.34, 0.98).Conclusions: No evidence for an overall reduction in CRC risk by increasing soy food intake (i.e., protein or isoflavones) was observed. However, the association between soy and CRC risk may vary by BMI, smoking, and menopausal status among women. Future investigations are needed to further understand the biologic mechanisms observed. [ABSTRACT FROM AUTHOR]

In this study, we hypothesized that spot urine can be used to predict protein intake at both group and individual levels. Participants (n = 369) of this study were recruited from all 47 prefectures in Japan. Sex-specific formulas were developed based on the ratio of urea nitrogen to creatinine concentration obtained from 3 spot urine samples. Validity of the formulas was examined against two 24-hour urine collections for 7 combinations of spot urine (single and means of 2 or 3 samples) using t test (mean estimation), Spearman correlation, and Bland-Altman plot (individual bias). Means of measured protein intake based on 24-hour urinary excretions were 87.3 g/d (standard deviation 19.7) for men and 70.5 g/d (standard deviation 14.7) for women. Irrespective of sex, the predicted intakes were not significantly different (within 2.7% of differences) from those measured by urinary excretions. Predicted intakes were moderately correlated with measured intakes (men, 0.45-0.60; women, 0.35-0.53). Even after using the mean of 3 samples, Bland-Altman plots showed a considerably wide limit of agreement (men, −30 to 33 g/d; women, −27 to 24 g/d). Except for using single spot urine samples in women, the formula tended to overestimate intake at a lower and underestimate at a higher level of protein intake (slope: men, −0.47 P <.0001]; women, −0.38 P =.002]). In conclusion, predictive formulas developed in this study can be used to predict protein intake at group level or to rank individuals' intake but not to predict absolute intake at individual level. [ABSTRACT FROM AUTHOR]

Objective: We assessed the validity of a recently developed dish composition database (DCD) against urinary biomarkers compared with a standard food composition database (FCD).Design: Intakes of protein, Na and K were estimated by 2 × 24 h urine collections and by 4 d dietary record data based on the DCD (including 128 dishes) or FCD (including 1878 foods).Setting: Japan.Participants: A total of 161 men and 163 women aged 20-69 years.Results: Compared with the 24 h urine-based estimates, the median intakes estimated using the DCD and FCD differed significantly for protein and Na in men and for Na and K in women. Deattenuated Spearman correlation coefficients using 24 h urine-based estimates for the intakes of protein, Na and K were lower in the DCD (respectively: 0·26, 0·15 and 0·44 in men; 0·22, 0·27 and 0·22 in women) than those in the FCD (respectively: 0·43, 0·40 and 0·59 in men; 0·33, 0·45 and 0·42 in women). When data on dish portion size reported by participants were used for estimation instead of standard portion-size data based on the DCD, the accuracy of the estimated median intakes did not change notably, whereas the deattenuated correlation coefficients improved (for protein, Na and K respectively: 0·32, 0·31 and 0·56 in men; 0·31, 0·41 and 0·39 in women).Conclusions: The DCD supported by individual-level information on dish portion size showed fair to moderate validity in ranking individuals according to their intakes of protein, Na and K, similar to the FCD. [ABSTRACT FROM AUTHOR]

The article discusses a 2022 study in Japan on the number of food items needed to meet the recommended protein dietary allowance (RDA) for older adults. Results suggest that consuming 20 food items per day meets the RDA for protein intake, and that consumption of about 7 food items per meal may prevent or alleviate sarcopenia and frailty in older adults. Also noted is the need for further research on the link of food diversity to health outcomes in older adults.

Background Little is known about the association between dairy intake and risk of functional disability in the elderly. Objectives We examined the influence of dairy intake on the development of declining functional capacity and activities of daily living (ADL) in a prospective cohort study of an elderly population. Methods A total of 859 community-dwelling Japanese residents, aged ≥65 y without functional disability, were followed up for 7 y. Functional capacity impairment was defined as a Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≤12, and ADL disability was defined as a Barthel Index score of ≤95. Dairy intake was evaluated using a 150-item semiquantitative food frequency questionnaire, grouped into quartiles. The RR of dairy intake on incident functional disability was computed using a Poisson regression model. Results The multivariable-adjusted RR of impaired functional capacity decreased significantly with increasing dairy intake levels (RR [95% CI]: quartile 1, 1.00 [reference]; quartile 2, 0.85 [0.71, 1.02]; quartile 3, 0.81 [0.68, 0.98]; and quartile 4, 0.74 [0.61, 0.90]; P -trend = 0.001). Regarding the three subscales of functional capacity, the inverse association between dairy intake and risk for impairment of intellectual activity and social role remained significant (P -trend = 0.0009 and 0.02, respectively), but such an association was not observed for instrumental ADL. The multivariable-adjusted risk of ADL disability also decreased weakly but significantly with elevating dairy intake (P -trend = 0.04). A similar association was seen for severity of functional disability (P -trend = 0.002). However, the magnitude of these associations was attenuated after further adjustment for protein intake. Conclusion Our findings suggest that higher dairy intake is associated with a lower risk of functional disability and its progression in the elderly, probably via an increase in protein intake. [ABSTRACT FROM AUTHOR]

Background and Objectives: More than 20% of pregnant Japanese women regularly skip breakfast, thereby resulting in a low intake of several nutrients that are required for fetal development and prevention of pregnancy complications. However, whether skipping breakfast affects circulating levels of these nutrients remains unclear. We investigated whether skipping breakfast during pregnancy was associated with decreases in dietary intake and circulating and urinary levels of several nutrients, including fatty acids and vitamins.Methods and Study Design: This cross-sectional study was conducted at a university hospital in Tokyo, Japan, between June and October 2010. Nutrient intakes were assessed using a validated diet history questionnaire. Blood and 24-hour urinary samples were collected for assessing circulating and urinary excretion levels of nutrients. Skipping breakfast was defined as forgoing breakfast including a staple food, such as rice or bread, two or more times per week. Multiple linear regression analyses were used to compare nutrient levels between breakfast skippers and non-skippers after adjusting for confounders.Results: Of 97 healthy pregnant women in the second trimester, 37 (38.1%) skipped breakfast two or more times per week. In multiple linear regression analysis, breakfast skippers had significant lower energy-adjusted intakes of protein than non-skippers (p=0.019). In addition, breakfast skippers had significantly lower levels of plasma eicosapentaenoic acid (p=0.008), plasma docosahexaenoic acid (p=0.027), serum β- carotene (p=0.013), urinary urea nitrogen (p=0.027), and urinary potassium (p=0.006), compared to non-skippers.Conclusions: Healthcare professionals need to suggest effective strategies for encouraging breakfast skippers to have breakfast regularly and to increase the intake of these nutrients. [ABSTRACT FROM AUTHOR]

Background: There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. Methods: The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals. The primary outcomes were caloric and protein intake in ICU on days 3 and 7, and at ICU discharge. The secondary outcome was the impact of nutritional management and rehabilitation on physical status at ICU discharge. We defined good physical status as more than end sitting and poor physical status as bed rest and sitting. We divided the participants into 2 groups, namely, the good physical status group (Good group) and poor physical status group (Poor group) for analysis of the secondary outcome. Data were expressed as median (interquartile range). Results: The median amount of caloric intake on days 3 and 7, and at ICU discharge via enteral and parenteral routes were 8.4 (3.1–15.6), 14.9 (7.5–22.0), and 11.2 (2.5–19.1) kcal/kg/day, respectively. The median amount of protein intake on days 3 and 7, and at ICU discharge were 0.2 (0–0.5), 0.4 (0.1–0.8), and 0.3 (0–0.7) g/kg/day, respectively. The amount of caloric intake on day 3 in the Poor group was significantly higher than that of the Good group (10.1 [5.8, 16.2] vs. 5.2 [1.9, 12.4] kcal/kg/day, p < 0.001). The proportion of patients who were received rehabilitation in ICU in the Good group was significantly higher than that of the Poor group (92 vs. 63%, p < 0.001). The multivariate analysis revealed that caloric intake on day 3 and rehabilitation in ICU were considered independent factors that affect physical status (OR 1.19; 95% CI 1.05–1.34; p = 0.005 and OR 0.07; 95% CI 0.01–0.34; p = 0.001). Conclusions: The caloric and protein intakes in Japanese ICUs were 15 kcal/kg/day and 0.4 g/kg/day, respectively. In addition, critically ill patients might benefit from low caloric intake (less than 10 kcal/kg/day) until day 3 and rehabilitation during ICU stay. [ABSTRACT FROM AUTHOR]

Objectives: Nutrition plays an important role in the development of frailty, and the present study examined the association between energy, macronutrient, and food intake and the development of physical frailty.Design: Prospective cohort study.Setting: The National Institute for Longevity Sciences — Longitudinal Study of Aging (NILS-LSA), a community-based study.Participants: Participants included 166 men and 117 women aged 65-86 years without frailty components at baseline who participated in both the sixth (2008-2010) and seventh (2010-2012) waves of the NILS-LSA.Measurements: Physical frailty was assessed using the modified criteria established by the Cardiovascular Health Study (2001). All participants were classified as "robust (number of frailty components: 0)," "prefrail (1-2)," or "frail (3-5)." Energy, macronutrient, and food intake was calculated based on 3-day dietary records during the sixth wave. Associations between dietary intake per day and the development of frailty 2 years later (from robust at the sixth wave to prefrail/frail at the seventh wave) were examined using multiple logistic regression analysis after adjusting for sex, baseline age, and other covariables.Results: Among the participants included, 36% were classified as prefrail/frail 2 years later. Higher energy [1 standard deviation (SD), odds ratio (95% confidence interval): 362 kcal, 0.68 (0.49-0.94)], protein [16 g, 0.72 (0.53-0.97)], and fat [15 g, 0.69 (0.52-0.92)] intake was negatively associated with frailty development. Higher meat [38 g, 0.68 (0.51-0.92)] and dairy [114 g, 0.73 (0.55-0.96)] intake was negatively associated with frailty development. Higher energy intake was negatively associated with the development of weakness (low grip strength) and low activity, while higher protein intake was negatively associated with the development of low activity.Conclusion: Increased consumption of meat and dairy products may provide sufficient protein and fat necessary for achieving higher energy intake, thereby effectively preventing physical frailty among older Japanese individuals. [ABSTRACT FROM AUTHOR]

Clinical trials show that protein supplement increases infant size in malnourished populations; however, epidemiological studies in high-income countries have reported mixed results. Although these findings suggest a non-linear relationship between maternal macronutrient intake and fetal growth, this relationship has not been closely examined. We assessed the association between maternal protein intake and fetal growth among 91 637 Japanese women with singletons in a nation-wide cohort study using validated FFQ. The respondents answered the FFQ twice, once during early pregnancy (FFQ1; 16·3 (sd 6·0) weeks), and second during mid-pregnancy (FFQ2, 28·1 (sd 4·1) weeks). Daily energy intake and percentage energy from protein, fats and carbohydrates were 7477 (sd 2577) kJ and 13·5 (sd 2·0), 29·5 (sd 6·5) and 55·3 (sd 7·8) %, respectively, for FFQ1, and 7184 (sd 2506) kJ and 13·6 (sd 2·1), 29·8 (sd 6·6) and 55·3 (sd 7·9) %, respectively, for FFQ2. The average birth weight was 3028 (sd 406) g, and 6350 infants (6·9 %) were small for gestational age (SGA). In both phases of the survey, birth weight was highest and the risk of SGA was lowest when the percentage energy from protein was 12 %, regardless of whether isoenergetic replacement was with fat or carbohydrates. Furthermore, when protein density in the maternal diet was held constant, birth weight was highest when 25 % of energy intake came from fat and 61 % came from carbohydrates during early pregnancy. We found maternal protein intake to have an inverse U-curve relationship with fetal growth. Our results strongly suggest that the effect of protein on birth weight is non-linear, and that a balanced diet fulfilling the minimum requirement for all macronutrients was ideal for avoiding fetal growth restriction. [ABSTRACT FROM AUTHOR]

Background Dietary protein intake is inversely associated with physical frailty risk. However, it is unknown whether an association exists between dietary protein intake and comprehensive frailty. Objective To evaluate the association between protein intake and comprehensive frailty in older Japanese adults. Design, setting and participants This cross-sectional study included 5638 Japanese participants (2707 men and 2931 women) aged ≥65 years from Kameoka City, Kyoto, Japan. Measurements Dietary intake was estimated using a validated self-administered food frequency questionnaire. Comprehensive frailty was assessed using a 25-item Kihon Checklist (KCL), which comprised instrumental activities of daily living, mobility disability, malnutrition, oral or eating function, socialization and housebound, cognitive function, and depression domains. A KCL score of 4 to 6 was defined as prefrailty, and ≥7 as frailty. Results In women, but not in men, protein intake showed a lower prevalence for prefrailty (Q1-Q4, 40.2%, 34.3%, 34.3%, and 36.0%). Higher protein intake was associated with lower prevalence of frailty both in men (32.5%, 28.4%, 28.3%, and 27.3%) and women (35.7%, 31.4%, 27.6%, and 28.2%). Moreover, higher dietary protein intake decreased the odds ratio (OR) for frailty after adjustment for potential confounding factors in both men (OR for highest vs lowest quartile, 0.62; 95% CI, 0.43-0.89; P for trend = 0.016) and women (OR 0.64; 95% CI, 0.45-0.91; P for trend = 0.017). Conclusions/implications The higher dietary protein intake may be inversely associated with the prevalence of comprehensive frailty in Japanese men and women. Future studies are needed to examine associations of dietary protein intake within KCL domains. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a 24‐week program of nutritional supplementation using whey protein, ingested after resistance exercise, in increasing muscle mass and physical function among community‐dwelling healthy older Japanese women. Methods: We carried out a randomized controlled trial, with 81 healthy women, aged 65–80 years, allocated to three groups of 27 participants each: the exercise and protein supplementation group, the exercise only group, and the protein supplementation only group. A 24‐week program of resistance exercise, carried out twice per week, was combined with whey protein supplementation, containing 22.3 g of protein. The total protein intake for participants in all three experimental groups was adjusted to a level of at least 1.2 g/kg bodyweight/day, and more during the intervention period. Between‐group differences in the pre‐ to post‐intervention change in skeletal muscle mass and physical function were evaluated using an analysis of variance. Results: The pre‐ to post‐intervention increase in the skeletal muscle mass index was significantly higher for the exercise only group than for the protein supplementation only group (P =0.008), and significantly higher for the exercise and protein supplementation group than for either the exercise only (P =0.007) or protein supplementation only (P <0.001) groups. Similarly, the increase in grip strength and gait speed was significantly greater for the exercise and protein supplementation group than for the protein supplementation only group (grip strength P =0.014, gait speed P =0.026). Conclusions: Whey protein supplementation, ingested after resistance exercise, could be effective for the prevention of sarcopenia among healthy community‐dwelling older Japanese women. Geriatr Gerontol Int 2018; 18: 1398–1404. [ABSTRACT FROM AUTHOR]

Aim: To evaluate protein and amino acid intakes and distribution among Japanese people in terms of prevention of sarcopenia or frailty. Methods: We carried out a cross‐sectional study using data from Japan’s 2012 National Health and Nutrition Survey. From the original dataset, we selected individuals aged ≥30 years, who were not pregnant or lactating, and for whom dietary intake, bodyweight and body height data were available. Protein intake was calculated using exclusive software developed for the survey. Amino acid intake was calculated using the database created by the National Institute for Longevity Sciences. Results: More than 95% of the participants met recommended levels of protein suggested by the Dietary Reference Intake in Japan. However, nearly half of the participants did not meet recommended levels in terms of prevention of sarcopenia. Leucine intake was not sufficient for each sex and age group, probably because of decreased intake of animal protein, especially protein from milk and dairy products. Distribution of protein and leucine in each meal tended toward dinner. Conclusions: The Japanese population might have insufficient quality, quantity and distribution of protein intake required to prevent sarcopenia or frailty. Geriatr Gerontol Int 2018; 18: 723–731. [ABSTRACT FROM AUTHOR]

Background and Objectives: Eggs, an important source of high-quality protein, contain a variety of key nutrients and antioxidants. Here we conducted an intervention study to evaluate whether the additional consumption of one egg per day would affect the daily nutritional intakes and blood antioxidant status in Japanese woman university students.Methods and Study Design: For 4 weeks, the 14 subjects were provided a nutritious breakfast including one boiled egg, and they were asked to keep a daily dietary record.Results: The subjects' daily energy intake during the intervention did not differ compared to the baseline, whereas the protein energy ratio and cholesterol intake were significantly increased. The subjects' consumption of confectionery during the intervention was significantly decreased compared to the pre-trial period. The total score of adherence to the food-based Japanese dietary guidelines for a healthy diet during the intervention was higher than that at baseline. The analysis of fasting blood samples showed that the subjects' serum lipids levels were not altered, whereas their malondialdehyde modified low-density lipoprotein (MDA-LDL) levels and the oxidative susceptibility of LDL were significantly reduced after the intervention. More importantly, serum folic acid levels were significantly increased.Conclusions: Our results suggest that regular egg consumption at breakfast can help improve the daily nutritional status and dietary habits and also ameliorate certain indices of antioxidant status in young women. [ABSTRACT FROM AUTHOR]

Objective: The role of school lunches in diet quality has not been well studied. Here, we aimed to determine the contribution of school lunches to overall nutrient intake in Japanese schoolchildren.Design: The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day separately. The prevalence of inadequate nutrient intake was estimated for intakes on one of the school days and the non-school day, and for daily habitual intake estimated by the best-power method. The relationship between food intake and nutrient intake adequacy was examined.Setting: Fourteen elementary and thirteen junior high schools in Japan.Subjects: Elementary-school children (n 629) and junior high-school children (n 281).Results: Intakes between the school and non-school days were significantly different for ≥60 % of nutrients. Almost all inadequacies were more prevalent on the non-school day. Regarding habitual intake, a high prevalence of inadequacy was observed for fat (29·9-47·7 %), dietary fibre (18·1-76·1 %) and salt (97·0-100 %). Inadequate habitual intake of vitamins and minerals (except Na) was infrequent in elementary-school children, but was observed in junior high-school children, particularly boys.Conclusions: School lunches appear to improve total diet quality, particularly intake of most vitamins and minerals in Japanese children. However, excess intakes of fat and salt and insufficient intake of dietary fibre were major problems in this population. The contribution of school lunches to improving the intakes of these three nutrients was considered insufficient. [ABSTRACT FROM AUTHOR]

Background: The main component of mung bean protein, accounting for more than 80%, is 8Sα globul in. Its structure closely resembles that of soybean β-conglycinin. Thereby, the mung bean protein is expected to have similar physiological effects to those of β-conglycinin, but there is no clinical evidence for these effects. Purpose of this study: The aim of this study was to confirm the positive effects of mung bean protein (GLUCODIA™) on glucose metabolism in clinical trials. Method: This clinical study was conducted using a double-blind placebo-controlled design with 45 prediabetes patients. Results: Many of the subjects were pre-diabetes with blood glucose levels exceeding 140 mg/dl by 2-hour plasma glucose level. However, the initial mean fasting plasma glucose level was less than 100 mg/dl. Therefore, mung bean protein did not lower fasting plasma glucose levels. The test period extended from summer to autumn, and increased fasting plasma glucose levels in the placebo group were observed due to seasonal factors. However, this increase was suppressed in the test group. Similarly, the mean insulin level increased in the placebo group, but the increase was also suppressed in the test group. Among obese subjects with a high body mass index, significant increases in fasting plasma glucose and insulin levels in the placebo group were observed. In the comparison between the test and the placebo groups with the average elevation value, there was a significant difference in fasting blood glucose level and significant tendencies in insulin level and homeostatic model assessment for insulin resistance value between the two groups. Conclusion: Mung bean protein suppresses fasting plasma glucose and insulin levels. Consequently, it may have an inhibitory effect on insulin resistance, a trigger of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases.Material and Methods: This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously.Results: IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031].Conclusions: IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE. [ABSTRACT FROM AUTHOR]

Background Some infants with food protein-induced enterocolitis syndrome (FPIES) have increased serum C-reactive protein (CRP) and fever in Japan. The aim of this study was therefore to clarify and compare the incidence of this in patients with FPIES versus patients with food protein-induced proctocolitis (FPIP). Methods One hundred and sixteen infants with non-IgE-mediated gastrointestinal food allergies were enrolled in this study and classified into three phenotypes: FPIES presenting with vomiting and/or diarrhea (n = 47); FPIP with bloody stool alone (n =19); and the mixed phenotype (MP), bloody stool with vomiting and/or diarrhea (n = 50). Results Serum CRP was increased in 55.3% of the FPIES group, similar to that in the MP group (54.0%), and significantly higher than in the FPIP group (15.8%; P < 0.01). Fever was observed in 29.8% of the FPIES group, significantly higher than in the MP group (8.0%; P < 0.01) and in the FPIP group (0%; P < 0.05). Patients with fever had significantly higher serum CRP than patients without fever (median, 12.8 vs <0.2 mg/dL, P < 0.00001). Conclusions Serum CRP was significantly higher in the FPIES group than in the FPIP group. This suggests that serum CRP is a useful marker for differentiating the pathogenesis of FPIES from FPIP. From the perspective of serum CRP, the pathology of the intestinal inflammation in MP subjects is suggested to be similar to that of FPIES. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the association between lower extremity motor function and occlusion in older adults and to examine the possibility of dietary intake of protein mediating the association. DESIGN: Cross-sectional, population-based study. SETTING: Urban and rural area in Japan. PARTICIPANTS: Community-dwelling septuagenarians (N = 655) and octogenarians (N = 629). MEASUREMENTS: Information was collected on occlusal force, protein intake, grip strength, walking speed, sociodemographic characteristics, and medical history. Multivariable logistic regression analysis was used to investigate the association between walking speed, occlusal force, and protein intake, and structural equation modeling analysis and mediation analysis were performed to investigate the validity of the hypothesized model and identify the indirect effect of protein intake in occlusal force and walking speed. RESULTS: The proportion of participants whose walking speed was 0.8 m/s or slower (slow walking speed) was 27.7%. Logistic regression analyses showed that slower walking speed was associated with occlusal force (odds ratio = 1.57, P = .001) after adjusting for medical history, body mass index, grip strength, and protein intake. The fit of the hypothesized model that walking speed was associated with occlusal force through protein intake was good, and the indirect effect was significant. CONCLUSION: Slower walking speed was associated with lower occlusal force. Lower protein intake mediated the association between walking speed and occlusal force. Maintaining occlusal force might prevent insufficient nutrition intake and further deterioration of motor function in older people. [ABSTRACT FROM AUTHOR]

As under-reporting of dietary intake, particularly by overweight and obese subjects, is common in dietary surveys, biases inherent in the use of self-reported dietary information may distort true diet–obesity relationships or even create spurious ones. However, empirical evidence of this possibility is limited. The present cross-sectional study compared the relationships of 24 h urine-derived and self-reported intakes of Na, K and protein with obesity. A total of 1043 Japanese women aged 18–22 years completed a 24 h urine collection and a self-administered diet history questionnaire. After adjustment for potential confounders, 24 h urine-derived Na intake was associated with a higher risk of general obesity (BMI ≥ 25 kg/m2) and abdominal obesity (waist circumference ≥ 80 cm; both P for trend = 0·04). For 24 h urine-derived protein intake, positive associations with general and abdominal obesity were observed (P for trend = 0·02 and 0·053, respectively). For 24 h urine-derived K intake, there was an inverse association with abdominal obesity (P for trend = 0·01). Conversely, when self-reported dietary information was used, only inverse associations between K intake and general and abdominal obesity were observed (P for trend = 0·04 and 0·02, respectively), with no associations of Na or protein intake. In conclusion, we found positive associations of Na and protein intakes and inverse associations of K intake with obesity when using 24 h urinary excretion for estimating dietary intakes. However, no association was observed based on using self-reported dietary intakes, except for inverse association of K intake, suggesting that the ability of self-reported dietary information using the diet history questionnaire for investigating diet–obesity relationships is limited. [ABSTRACT FROM PUBLISHER]

Long-term safety of consuming low-carbohydrate diets (LCD) in Asian populations, whose carbohydrate intake is relatively high, is not known. In the present study, the association of LCD with CVD and total mortality was assessed using data obtained in the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged 1980) during 29 years of follow-up. At baseline in 1980, data were collected from study participants aged ≥ 30 years from randomly selected areas in Japan. LCD scores were calculated based on the percentage of energy as carbohydrate, fat and protein, estimated by 3 d weighed food records. A total of 9200 participants (56 % women, mean age 51 years) were followed up. During the follow-up, 1171 CVD deaths (52 % in women) and 3443 total deaths (48 % in women) occurred. The multivariable-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing the highest v. lowest deciles of LCD score was 0·60 (95 % CI 0·38, 0·94; Ptrend= 0·021) for women and 0·78 (95 % CI 0·58, 1·05; Ptrend= 0·079) for women and men combined; the HR for total mortality was 0·74 (95 % CI 0·57, 0·95; Ptrend= 0·029) for women and 0·87 (95 % CI 0·74, 1·02; Ptrend= 0·090) for women and men combined. None of the associations was statistically significant in men. No differential effects of animal-based and plant–fish-based LCD were observed. In conclusions, moderate diets lower in carbohydrate and higher in protein and fat are significantly inversely associated with CVD and total mortality in women. [ABSTRACT FROM PUBLISHER]

This study investigated the effects of ingested food types on the pharmacokinetics of elvitegravir, cobicistat, emtricitabine, and tenofovir as a single-tablet regimen (STR) in Japanese HIV-negative healthy subjects. In this open-label, randomized, three-way crossover study, the pharmacokinetic profiles of elvitegravir, cobicistat, emtricitabine, and tenofovir were evaluated when administered with a standard breakfast, under fasting conditions, or with a nutritional protein-rich drink. All subjects (N = 11) received a single morning dose of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (150/150/200/300 mg). Administration under fasting conditions resulted in decreases in the mean AUCinf of elvitegravir and tenofovir by 50% and 28%, respectively, relative to administration with a standard breakfast, whereas the bioavailabilities of elvitegravir and tenofovir were comparable when administered with a standard breakfast or a nutritional protein-rich drink. Under fasting conditions, it appears that the bioavailabilities of elvitegravir and tenofovir were not equivalent to those when they were administered with either type of food, although they were bioequivalent to each other under fed conditions. Cobicistat and emtricitabine were bioequivalent under all conditions. These findings suggest that elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate should be administered with food, and that the bioavailability of elvitegravir and tenofovir is not affected by the type of meal ingested. [ABSTRACT FROM AUTHOR]

Background: It may be useful to examine associations of fat intakes with total mortality as a basis for dietary recommendations. We aimed to elucidate associations between dietary fat and total mortality among Japanese populations with low fat intake. Methods: We conducted a prospective study consisting of 58,672 men and women aged 40 to 79 years. Fat intakes were estimated using a food frequency questionnaire. Multivariate-adjusted hazard ratios (HRs) for mortality by sex were computed according to quintiles of energyadjusted fat intakes. Results: During the follow-up period (median duration, 19.3 years), 11,656 deaths were recorded. In men, we found no clear association between total fat and total mortality. HRs across quintiles of total fat intake were 1.00, 1.03 (95% confidence interval [CI], 0.95-1.12), 1.02 (0.94- 1.10), 0.98 (0.90-1.07), and 1.07 (0.98-1.17). No significant association was detected in regard to types of fat. In women, HR was lowest in the fourth quintile of total fat intake followed by the top quintile; HRs across quintiles were 1.00, 1.03 (0.94-1.11), 1.00 (0.92- 1.09), 0.88 (0.81-0.96), and 0.94 (0.86-1.03). Regarding types of fat in women, total mortality was inversely associated with intakes of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA); the lowest HR was in the top quintile of intake for SFA, MUFA, and PUFA: 0.91 (95% CI, 0.83-1.00), 0.91 (0.83-0.99) and 0.88 (0.80 - 0.97), respectively (trend P across quintiles, 0.020, 0.012, and 0.029, respectively). Causes of death other than cancer and cardiovascular disease contributed most to decreases in HRs for total and types of fat. In women, analysis with finer categories revealed that the lowest risk for total mortality appeared at total fat intake of 28% of energy. Conclusions: Our findings from a large cohort study among populations with relatively low fat intake provide evidence regarding optimal levels of fat intakes. [ABSTRACT FROM AUTHOR]

The present study compared the accuracy of triaxial accelerometry and the doubly labelled water (DLW) method for measuring physical activity (PA) in Japanese adolescents. A total of sixty adolescents aged 12–15 years were analysed. The total energy expenditure (TEE) was measured over 7 d by the DLW method and with an EW4800P triaxial accelerometer (Panasonic Corporation). The measured (RMRm) and predicted RMR (RMRp) were 5·7 (sd 0·9) and 6·0 (sd 1·0) MJ/d, respectively. TEE measured by the DLW method and accelerometry using RMRm or RMRp were 11·0 (sd 2·6), 10·3 (sd 1·9), and 10·7 (sd 2·1) MJ/d, respectively. The PA levels (PAL) measured by the DLW method using RMRm or RMRp were 1·97 (sd 0·31) and 1·94 (sd 0·31) in subjects who exercised, and 1·85 (sd 0·27) and 1·74 (sd 0·29) in subjects who did not exercise. The percentage of body fat correlated significantly with the percentage difference between RMRmv. RMRp, TEE, PA energy expenditure (PAEE) and PAL using RMRp, and PAL using RMRm assessed by the DLW method and accelerometry. The present data showed that while accelerometry estimated TEE accurately, it did not provide the precise measurement of PAEE and PAL. The error in accelerometry was attributed to the prediction error of RMR and assessment in exercise. [ABSTRACT FROM PUBLISHER]

Data are limited on how dietary sources of energy and nutrient intakes differ among ethnic groups in the USA. The objective of the present study was to characterise dietary sources of energy, total fat, saturated fat, protein, dietary fibre and added sugar for five ethnic groups. A validated quantitative FFQ was used to collect dietary data from 186 916 men and women aged 45–75 years who were living in Hawaii and Los Angeles between 1993 and 1996. Participants represented five ethnic groups: African-American; Japanese-American; Native Hawaiian; Latino; Caucasian. The top ten dietary sources of energy contributed 36·2–49·6 % to total energy consumption, with rice and bread contributing the most (11·4–27·8 %) across all ethnic–sex groups. Major dietary sources of total fat were chicken/turkey dishes and butter among most groups. Ice cream, ice milk or frozen yogurt contributed 4·6–6·2 % to saturated fat intake across all ethnic–sex groups, except Latino-Mexico women. Chicken/turkey and bread were among the top dietary sources of protein (13·9–19·4 %). The top two sources of dietary fibre were bread and cereals (18·1–22 %) among all groups, except Latino-Mexico men. Regular sodas contributed the most to added sugar consumption. The present study provides, for the first time, data on the major dietary sources of energy, fat, saturated fat, protein, fibre and added sugar for these five ethnic groups in the USA. Such data are valuable for identifying target foods for nutritional intervention programmes and directing public health strategies aimed at reducing dietary risk factors for chronic disease. [ABSTRACT FROM PUBLISHER]

Objectives: We aimed to clarify the factors that contribute to the improvement or progression of frailty in rural Japanese community-dwelling older adults., Methods: Of the 840 participants in the cohort study of independent older adults aged 65 years and older living in the Tamba-Sasayama area of Hyogo Prefecture (FESTA study) from September 2016 to December 2017, 551 participated in the 2-year follow-up survey from September 2018 to December 2019., Methods: We evaluated clinical background, physical and cognitive function, total physical activity, daily protein intake, quality of life (QOL) using the WHOQOL-BREF (WHOQOL-26), and frailty status diagnosed using the Japanese version of the Cardiovascular Health Study. We compared the frailty status at the initial and follow-up examinations and classified the participants into three groups: improvement, unchanged, and worsening. Each parameter was compared among the three groups and the factors contributing to the improvement or worsening of frailty status were analyzed using a modified Poisson regression analysis., Results: The median age at the first survey was 72 years (range: 68-76); 190 men and 361 women were enrolled. The improvement group consisted of individuals with a change in status from frail to prefrail/robust and from prefrail to robust (n = 114); the worsening group consisted of individuals with a change in status from robust to prefrail/frail and from prefrail to frail (n = 92). The physical domain of QOL was significantly associated with an improvement in frailty status independent of the frailty status at baseline. Contrastingly, any domains of QOL were not significantly associated with a worsening frailty status., Conclusions: This study demonstrated for the first time that QOL has a significant impact on the future improvement and progression of frailty status and that QOL conditions and frailty status affect older adults bidirectionally., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The oral food challenge test (OFC) is the gold standard for evaluating the remission of food protein-induced enterocolitis syndrome (FPIES). Few acute FPIES remissions confirmed by OFC were reported. This study aimed to examine the OFC for Japanese children with acute FPIES to evaluate its remission. A retrospective cohort study was performed on children with acute FPIES with remission evaluation by OFC based on one food challenge dose (1/50, 1/10, 1/2, and full dose per day). Acute FPIES remission was observed in 65.2% of patients (15/23 patients). Vomiting episodes occurred with 1/50 full doses on the first day among 75% of positive patients. The median duration between the onset and OFC was 14 months (IQR, 8-24 months). Soy was the most common causative food, followed by egg yolk, milk, and wheat. All patients could receive OFC safely without intensive care unit care, based on the FPIES OFC protocol. The remission rate of acute FPIES was high. However, vomiting episodes commonly occurred with 1/50 full doses on the first day. This study suggested that our OFC protocol for acute FPIES was safe and feasible, but it might be safer for some patients to start at a minimal loading dose.

Objectives To estimate protein requirements in older hospitalized adults with pressure ulcers ( Pr U) according to systemic conditions and wound severity. Design Secondary nitrogen balance study over 3 days. Setting Long-term care facility. Participants Twenty-eight older adults with Pr U using a urinary catheter. Measurements Nitrogen balance over 3 days was evaluated from habitual nitrogen intake measured using a food weighing record and nitrogen excretion from urine, feces and wound exudate. Nitrogen intake required to maintain nitrogen equilibrium was estimated as an average protein requirement using a linear mixed model. Results Nitrogen intake at nitrogen equilibrium was 0.151 gN/kg per day (95% confidence interval = 0.127-0.175 gN/kg per day) for all participants. The amount of protein loss from wound exudate contributed little to total nitrogen excretion. A Charlson comorbidity index of 4 or greater (the median value) was related to lower nitrogen intake at nitrogen equilibrium ( P = .005). Severe Pr U with heavy exudate amounts and measured wound areas of 7.9 cm2 or greater (the median value) were related to higher nitrogen intake at nitrogen equilibrium in individuals with a Charlson comorbidity index of 3 or less (both P = .04). Larger wound area (correlation coefficient ( r) = 0.55, P = .003) and heavier exudate volume ( r = 0.53, P = .004) were associated with muscle protein hypercatabolism measured according to 3-methylhistidine/creatinine ratio. Conclusion The average protein requirement is 0.95 g/kg per day for older hospitalized Japanese adults with Pr U, but protein requirements depend on an individual's condition and wound severity and range from 0.75 to 1.30 g/kg per day. Severe Pr U can require higher protein intakes because of muscle protein hypercatabolism rather than direct loss of protein from wound exudate. [ABSTRACT FROM AUTHOR]

Awareness of phosphorus intake is important because both phosphorus deficiency and overloading impair bone health and quality of life. Phosphorus consumption is increasing in many countries. Most dietary phosphorus is contained in protein-rich foods such as meat, milk, cheese, poultry, fish, and processed foods that contain phosphate-based additives to improve their consistency and appearance. Elevation of extracellular phosphorus levels causes endothelial dysfunction and medial calcification, which are closely associated with the development of cardiovascular disease (CVD). Long-term excessive phosphorus loading, even if it does not cause hyperphosphatemia, can be a risk factor for CVD. In epidemiological studies, higher levels of phosphorus intake have been associated with reduced blood pressure. Interestingly, when examined further, phosphorus from dairy products, but not from other sources, was usually associated with lower blood pressure. A dietary approach to phosphorus reduction is particularly important to prevent bone impairment and CVD in patients with chronic kidney disease. In order to improve bone health and quality of life in the general population, the impact of phosphorous, including in processed foods, should be considered, and measures to indicate the amount of phosphorous in food products should be implemented. [ABSTRACT FROM AUTHOR]

The amount of breakfast protein intake is important for maintaining muscle strength. However, the effect of breakfast protein quality (ie, bioavailability) remains unclear. We investigated the association between breakfast protein quality and the incidence of muscle weakness. Longitudinal study. Healthy older adults age 60–83 years without stroke, arthritis, Parkinson disease, or muscle weakness at baseline (maximum follow-up period and participations were 9.2 years and 5 times, respectively). Weakness was defined by the Asian Working Group for Sarcopenia 2019 criteria, using grip strength. Breakfast protein quality was evaluated using the protein digestibility–corrected amino acid score (PDCAAS), where higher scores represent higher quality, calculated from 3-day dietary records. Participants were classified according to sex-stratified tertiles of breakfast PDCAAS (ie, low to high groups). The association between PDCAAS and incident weakness was analyzed using the generalized estimating equation, after adjusting for sex, age, follow-up time, grip strength, body mass index, physical activity, cognition, education, smoking, economics, medical history, lunch and dinner PDCAASs, and energy and protein intake during 3 regular meals at baseline. Overall, 14.4% of the initial sample was excluded owing to a diagnosis of weakness-related diseases, and 58.3% (n = 701) had at least 1 follow-up measurement for inclusion in the analysis. The mean ± SD follow-up period was 6.9 ± 2.1 years; the cumulative number of participants was 3019, and 282 developed weakness. Using the low PDCAAS group as the reference, the adjusted odds ratios (95% CIs) for incident weakness in the middle and high PDCAAS groups were 0.71 (0.43–1.18) and 0.50 (0.29–0.86), respectively. Higher breakfast protein quality was associated with a reduction in incident weakness in older adults, independent of protein intake. These findings may highlight the role of protein quality for muscle health in older adults. [ABSTRACT FROM AUTHOR]