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

Autoři: Daisuke Yoneoka aff001;  Shuhei Nomura aff002;  Kayo Kurotani aff003;  Shiori Tanaka aff002;  Keiji Nakamura aff005;  Hisayuki Uneyama aff005;  Naoki Hayashi aff005;  Kenji Shibuya aff002
Působiště autorů: Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan aff001;  Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan aff002;  Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjyuku-ku, Tokyo, Japan aff003;  Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan aff004;  Ajinomoto Co., Inc., Chuo-ku, Tokyo, Japan aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224042



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.


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.


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.


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.

Klíčová slova:

Blood pressure – Carbohydrates – Diet – Fats – HbA1c – Japan – Nutrients – Nutrition


1. GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1084–150. doi: 10.1016/S0140-6736(17)31833-0 28919115

2. Nomura S, Sakamoto H, Glenn S, Tsugawa Y, Abe SK, Rahman MM, et al. Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015. Lancet. 2017;390(10101):1521–38. doi: 10.1016/S0140-6736(17)31544-1 28734670

3. Spotlight on food science in Japan. Nature. 2016;534(7606).

4. Making sense of taste. London: Nature, 2018.

5. MHLW. Dietary Reference Intakes for Japanese (2015). Tokyo: Ministry of Health, Labour and Welfare, 2015.

6. Ishimi Y. Dietary Reference Intakes and Nutrient Reference Values. Nippon Eiyo Shokuryo Gakkaishi. 2016;69(4):145–50. doi: 10.4327/jsnfs.69.145

7. Ministry of Agriculture, Forestry and Fisheries. Practical navigation for food and nutrition education [Japanese] Tokyo: Ministry of Agriculture, Forestry and Fisheries; [cited 2019 September 20]. Available from:

8. Kurotani K, Akter S, Kashino I, Goto A, Mizoue T, Noda M, et al. Quality of diet and mortality among Japanese men and women: Japan Public Health Center based prospective study. BMJ. 2016;352:i1209. doi: 10.1136/bmj.i1209 27005903

9. Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, et al. Diet based on the Japanese Food Guide Spinning Top and subsequent mortality among men and women in a general Japanese population. J Am Diet Assoc. 2009;109(9):1540–7. doi: 10.1016/j.jada.2009.06.367 19699833

10. MHLW. National Health and Nutrition Survey [Japanese] Tokyo: Ministry of Health, Labour and Welfare; [cited 2019 September 20]. Available from:

11. Ikeda N, Takimoto H, Imai S, Miyachi M, Nishi N. Data resource profile: the Japan National Health and Nutrition Survey (NHNS). Int J Epidemiol. 2015;44(6):1842–9. doi: 10.1093/ije/dyv152 26239276

12. MEXT. Standards tables of food composition in Japan– 2015 (seventh revised edition) Tokyo: Ministry of Education, Culture, Sports, Science and Technology; 2015 [cited 2019 September 20]. Available from:

13. MHLW. The National Health and Nutrition Survey in Japan, 2016. Tokyo: Ministry of Health, Labour and Welfare, 2017.

14. Greene WH. Econometric Analysis: Prentice Hall; 2003.

15. Tormo MJ, Navarro C, Chirlaque MD, Barber X, Cancer EGoSEPIo. Is there a different dietetic pattern depending on self-knowledge of high blood pressure? Eur J Epidemiol. 2000;16(10):963–71. doi: 10.1023/a1011056404243 11338129

16. Wirt A, Collins CE. Diet quality—what is it and does it matter? Public Health Nutr. 2009;12(12):2473–92. doi: 10.1017/S136898000900531X 19335941

17. Koenker R. Quantile regression. Cambridge: Cambridge University Press; 2005.

18. Geraci M, Bottai M. Linear quantile mixed models. Statistics and Computing. 2014;24(3):461–79. doi: 10.1007/s11222-013-9381-9

19. Fogli-Cawley JJ, Dwyer JT, Saltzman E, McCullough ML, Troy LM, Jacques PF. The 2005 Dietary Guidelines for Americans Adherence Index: development and application. J Nutr. 2006;136(11):2908–15. doi: 10.1093/jn/136.11.2908 17056821

20. NIBIOHN. What foodstuffs do Japanese take sodium from? [Japanese]. Tokyo: National Institute of Biomedical Innovation, Health and Nutrition, 2016.

21. Anderson CA, Appel LJ, Okuda N, Brown IJ, Chan Q, Zhao L, et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc. 2010;110(5):736–45. doi: 10.1016/j.jada.2010.02.007 20430135

22. Takimoto H, Saito A, Htun NC, Abe K. Food items contributing to high dietary salt intake among Japanese adults in the 2012 National Health and Nutrition Survey. Hypertens Res. 2018;41(3):209–12. doi: 10.1038/s41440-017-0007-z 29335613

23. Jacobs DR Jr, Gross MD, Tapsell LC. Food synergy: an operational concept for understanding nutrition. Am J Clin Nutr. 2009;89(5):1543S–8S. doi: 10.3945/ajcn.2009.26736B 19279083

24. Mozaffarian D, Forouhi NG. Dietary guidelines and health-is nutrition science up to the task? BMJ. 2018;360:k822. doi: 10.1136/bmj.k822 29549076

25. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133(2):187–225. doi: 10.1161/CIRCULATIONAHA.115.018585 26746178

26. Yu D, Zhang X, Xiang YB, Yang G, Li H, Gao YT, et al. Adherence to dietary guidelines and mortality: a report from prospective cohort studies of 134,000 Chinese adults in urban Shanghai. Am J Clin Nutr. 2014;100(2):693–700. doi: 10.3945/ajcn.113.079194 24944055

27. Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR, et al. Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr. 2015;101(3):587–97. doi: 10.3945/ajcn.114.090688 25733644

28. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men. J Nutr. 2014;144(5):673–80. doi: 10.3945/jn.113.186486 24572037

29. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003;77(5):1146–55. doi: 10.1093/ajcn/77.5.1146 12716665

30. Jacobs DR Jr, Steffen LM. Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr. 2003;78(3 Suppl):508S–13S. doi: 10.1093/ajcn/78.3.508S 12936941

31. Soden PM, Fletcher LR. Modifying diets to satisfy nutritional requirements using linear programming. Br J Nutr. 1992;68(3):565–72. doi: 10.1079/bjn19920115 1493126

32. Okubo H, Sasaki S, Murakami K, Yokoyama T, Hirota N, Notsu A, et al. Designing optimal food intake patterns to achieve nutritional goals for Japanese adults through the use of linear programming optimization models. Nutr J. 2015;14:57. doi: 10.1186/s12937-015-0047-7 26048405

33. Cruz-Jentoft AJ, Kiesswetter E, Drey M, Sieber CC. Nutrition, frailty, and sarcopenia. Aging Clin Exp Res. 2017;29(1):43–8. doi: 10.1007/s40520-016-0709-0 28155181

34. Gazan R, Brouzes CMC, Vieux F, Maillot M, Lluch A, Darmon N. Mathematical optimization to explore tomorrow's sustainable diets: a narrative review. Adv Nutr. 2018;9(5):602–16. doi: 10.1093/advances/nmy049 30239584

35. Drewnowski A, Dwyer J, King JC, Weaver CM. A proposed nutrient density score that includes food groups and nutrients to better align with dietary guidance. Nutr Rev. 2019;77(6):404–16. doi: 10.1093/nutrit/nuz002 31222368

Článek vyšel v časopise


2019 Číslo 10