[Consumption of ultra-processed foods and relationship between nutrient intake and obesity among participants undergoing specific health checkups provided by National Health Insurance].

Objective　Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.Method　In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.Result　Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B1, B6, C, niacin, folic acid, potassium, magnesium, and iron intake were significantly lower in the high-UPF group. Moreover, the high-UPF group had a significantly higher BMI. The odds ratio for obesity was higher (4.51[1.50-13.57]) in the high-UPF group than in the low-UPF group (1.00).Conclusion　Those who consumed more UPF had lower protein intake and suffered from multiple vitamin and mineral deficiencies. Furthermore, their energy intake was greater, and the odds ratio for obesity was significantly higher. It has been suggested that excessive UPF consumption warrants further attention.

Use of focus group interviews with public health nurses to identify the efforts of and challenges faced by branches of the Japan Health Insurance Association to achieve good performance of the Specific Health Guidance initiatives.

Objectives Aiming at improvement of the Japan Health Insurance Association's Specific Health Guidance initiatives and human resource development, we conducted a qualitative study to clarify the features necessary for and the challenges hindering the achievement of good performance of the initiatives.Methods From November 2014 to January 2015, we conducted 10 focus group interviews, each 90 minutes long, with 64 public health nurses from 10 Japan Health Insurance Association branches. In addition, self-administered questionnaires were administered to obtain the participants' basic characteristics. After we excluded one group for failing to meet our performance targets, we divided the remaining nine focus groups according to two patterns: Maintenance and Progress. The four focus groups fitting the Maintenance pattern had a well-established track record, and the five focus groups fitting the Progress pattern had a track record of good growth. Using open coding of the interview transcripts, we extracted efforts or needs in two domains, individual and branch, Then, we placed codes in eight main categories: [quality], [general practice], [dietary guidance practice], [success factor], [branch system], [training and skill development], [approach to the member office], and [past efforts]. We further extracted important subcategories based on their rates of appearance within branches.Results Data from 56 female public health nurses working at nine branches were included in the analysis. With respect to the individual domain, subcategories such as "building rapport," "creating the physical environment," and "taking the initiative in evaluating one's own lifestyle" in the 〈high emphasis〉 segment of the [general practice] category were common to both patterns. In addition, "increasing opportunities for training" and "enhancement of training program content" were found for both patterns in relation to the 〈demand〉 segment of the [training and skill development] category. However, most participants chose "yes" in response to whether there was ample training opportunity.Conclusion This study showed some common efforts and practices among public health nurses in both patterns, which indicates good performance of the Specific Health Guidance initiatives. However, there is a need to further enhance the training program to strengthen the entire organization. Future studies should focus on understanding the characteristics of and factors involved in low-performing branches.

[Effects of an intervention program for community-dwelling elderly to improve frailty and dietary habits].

OBJECTIVES: The effects of a comprehensive intervention program for community-dwelling elderly on frailty and dietary habits were examined. METHODS: We conducted randomized control trials to examine the efficacy of the intervention. To examine lasting changes, we made paired comparisons between pre- and post- intervention and at a three-month follow-up. The subjects were recruited in Hatoyama town, Saitama prefecture. The program was composed of exercise, nutritional education, and social participation and was held from October to December 2011. The exercise program aimed at fall prevention and took place twice per week for 60 min. The nutritional education aimed at prevention of malnutrition, and the social participation program aimed at prevention of "homeboundness"; both were held once per week for 30 min. Questionnaires inquired about frailty and dietary variety. A blood test was conducted to ascertain nutritional state, and a brief self-administered diet history questionnaire was used to estimate food and nutrient intake. To examine the efficacy of the intervention, 22 control subjects (CR) and 21 subjects in the intervention group (IV) were analyzed with intention to treat. To examine lasting changes, 16 subjects in IV who correctly completed surveys at each of the three time points were analyzed, using repeated ANOVA and a multiple comparison procedure. RESULTS: 1. Men comprised 70-80% of subjects, and the average age was 75.7±5.4 and 74.7±5.4 years in IV and CR, respectively. 2. There was no significant difference in pre- and post-intervention changes between IV and CR in frailty, which was the main outcome of the study. 3. A significant difference in pre- and post-intervention values was noted in ① "homeboundness", one of the components of frailty (median [25-75%tile]): IV 0 [0-0] and CR 0 [0-1] (P=0.023); ② nutrient intake (mean±standard deviation [SD], energy ratio [%E]): protein, IV 2.3±0.7 and CR -0.3±2.0 (P=0.002); animal protein, IV 2.4±1.5 and CR -0.5±1.5 (P=0.002); and ③ food intake (mean±SD, g/1000 kcal): fish, IV 18.1±25.1 and CR -4.1±21.9 (P=0.004); egg, IV 5.0±11.2 and CR -2.1±11.3 (P=0.046). All variables improved in IV. 4. Lasting improvement was observed in "homeboundness" and protein intake [%E]. CONCLUSION: Although the intervention did not improve frailty, it may improve frailty and dietary habits by improving homeboundness and increasing protein intake.