Does Japan's national nutrient-based dietary guideline improve lifestyle-related disease outcomes? A retrospective observational cross-sectional study

PLoS One. 2019 Oct 17;14(10):e0224042. doi: 10.1371/journal.pone.0224042. eCollection 2019.

Abstract

Objective: The Japanese government has developed and promoted a national nutrient-based dietary guideline for preventing lifestyle-related chronic disease. However, its impact in a real-life setting has never been evaluated. We performed a critical appraisal of the guideline by examining the association between adherence to the guideline and lifestyle-related outcome indicators.

Methods: This is a retrospective observational cross-sectional study using nationally representative data on health and nutrition characteristics from the 2016 National Health and Nutrition Survey of Japan. We considered 3,861 participants aged ≥20 years, with evidence of low health risks of diabetes, hypertension, hyperlipidemia, and obesity. Five health outcome indicators (hemoglobin A1c (HbA1c), systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and body mass index), were employed. A summary score was developed to reflect adherence to the recommended intake of seven nutrients defined by the guideline, including proteins, fat, saturated fatty acid, carbohydrate, dietary fiber, sodium, and potassium. Multivariate quartile regression approaches were employed to examine the association between the adherence score and the health outcome indicators, adjusting for the covariates.

Results: Overall, the proportion of those who adhered to the guideline (adherence rate) for all seven nutrients was only 0.3%. There was considerable variation in the adherence rate between the different nutrients, from 24.2% to 61.8%. After adjustment for covariates, in most health outcome indicators, regardless of age category and quartile, there was no clear association between the guideline adherence score and indicators.

Conclusions: There is plenty of scope for improving the guideline. Nutrient impact on health may not necessarily depend on the amount of each nutrient in the diet. The significance and contribution of synergies between nutrients and complex interactions within foods to health outcomes need to be explored in future guideline updates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Body Mass Index
  • Cholesterol, HDL / blood
  • Cross-Sectional Studies
  • Diet / standards*
  • Female
  • Glycated Hemoglobin / analysis
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Japan / epidemiology
  • Life Style
  • Male
  • Metabolic Diseases / epidemiology
  • Middle Aged
  • Nutrition Policy*
  • Nutrition Surveys
  • Retrospective Studies
  • Young Adult

Substances

  • Cholesterol, HDL
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Grants and funding

This manuscript is an original work that has not been submitted for consideration or published elsewhere. This study is partially supported by a joint research grant from Ajinomoto Co., Inc., and Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). KN, HU, and NH are employed by the commercial founder, Ajinomoto Co., Inc. The commercial funder provided support in the form of salaries for KN, HU, and NH, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. The other funder (MEXT) had also no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.