Number 63 (November 10, 2020)

Health andNutrition News

No.63

Contents

Shigeho Tanaka
Department of Nutrition and Metabolism

Efforts to improve fatty liver disease through intestinal microbiota
by oral carbon adsorbents ･･････････････････････････････････････ 3
Tetsuya Kubota
Department of Clinical Nutrition

Concomitant Use of Dietary Supplements and Medicines
Among Preschool and School-aged Children in Japan ･････････････ 4
Tsuyoshi Chiba
Department of Food Function and Labeling

Miwa YamaguchiInternational Center for Nutrition and Information, Section of International Nutrition Strategy

Comparison between energy intake as estimated by self-reporting dietaryassessment methods and total energy expenditure as measured by the doubly
labeled water method: The Kyoto-Kameoka study ････････････････････････
Tsukasa Yoshida
Section of Healthy Longevity Researches

Summary Results of the National Health and Nutrition Survey
Japan, 2018 ･･････････････････････････････････････････････････
Mai Matsumoto
Section of the National Health and Nutrition Survey
Department of Nutritional Epidemiology and Shokuiku

o.6 3

Evaluation of policies on a healthy food environment
using an international index ････････････････････････････････････ 5

Health and Nutrition News N

Prediction of physical activity intensity
in various populations･･･････････････････････････････････････ 2

6

7Metabolic equivalents of body weight resistance exercise with slow
movement in older adults using indirect calorimetry ･･････････････ 8
Takashi Nakagata
Section of Behavioral Physiology, Department of Physical Activity Research

National Institutes of Biomedical Innovation, Health and Nutrition

National Institute of Health and Nutrition1

Prediction of physical activity intensity
in various populations
Shigeho Tanaka, Department of Nutrition and Metabolism【Introduction】
The use of wearable devices has increasingly become common,and time-series data of physical activity intensity and energy
expenditure can now be obtained. Most devices estimate
accelerations or heart rates; however, these estimations are notvery accurate1,2). Moreover, prediction equations for older adults
or children are different than those for adults; thus, appropriate
equations for each population are necessary.
Therefore, we have validated and developed prediction algorithms
for various populations using accelerometers or heart ratemonitors.

【Participants and Methods】
Participants in their 20s to 50s, 60 years or older, and of preschool
age were asked to perform 10–20 daily activities forseveral minutes. They wore accelerometers and a heart ratemonitor, and energy expenditure was evaluated with a mask andDouglas bag. The resting metabolic rate while sitting was alsomeasured, and the metabolic equivalent for each activity wascalculated using these measurements.

【Results】
Higher intensity activities were underestimated for participants aged
over 60 years, different to that in those aged under 50 years(Figure) 3).
We found that even low-intensity activity can be predicted without
large systematic errors using %Heart rate reserve, % of thedifference between maximum and resting heart rate4), although it
has been suggested that physical activity intensity cannot be
accurately estimated from heart rate without a predictive equationfor each individual. Resting heart rate, BMI, and age were included
because physical fitness affects the relationship between heart rate
and physical activity intensity, but they did not have any significant

contribution. We also proposed an algorithm involving the additionof heart rate to acceleration, which can relatively accurately predict
the intensity of stair climbing5).
We also developed algorithms to accurately predict the intensity ofdaily activities, including sedentary behavior, for preschoolers6).

【Future direction】
We are validating methods for physical activity intensity and totalenergy expenditure for patients with diabetes or chronic obstructive
pulmonary disease, using the doubly labeled water method. Basedon the results, we are trying to improve wearable devices for
accurate predictions.

【References】
1) Murakami H, et al.: Accuracy of wearable devices for estimating
total energy expenditure: comparison with metabolic chamber anddoubly labeled water method. JAMA Intern Med 176: 702-703,
2016.
2) Murakami H, et al.: Accuracy of 12 wearable devices for
estimating physical activity energy expenditure using a metabolic
Chamber and the doubly labeled water method: validation study.
JMIR Mhealth Uhealth. 7: e13938, 2019.
3) Nagayoshi S, et al.: Validity of estimating physical activity
intensity using a triaxial accelerometer in healthy adults and older
adults. BMJ Open Sport Exerc Med 5: e000592, 2019.
4) Caballero Y, et al.: Simple Prediction of Metabolic Equivalentsof Daily Activities Using Heart Rate Monitor without Calibrationof Individuals. Int J Environ Res Public Health. 17 pii: E216, 2019.
5) Nakanishi M, et al.: Estimating metabolic equivalents for
activities in daily life using acceleration and heart rate in wearable
devices. Biomed Eng Online. 17: 100, 2018.
6) Tanaka C, et al.: Prediction of Physical Activity Intensity withAccelerometry in Young Children. Int J Environ Res Public Health.
16 pii: E931, 2019.

Relationship between observed and predicted MET values using an activity
monitor in younger adults and elderly 3)

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Health and Nutrition News No. 63

Efforts to improve fatty liver disease throughintestinal microbiota by oral carbon adsorbents
Tetsuya Kubota, Department of Clinical Nutrition【Introduction】【Results】

The prevalence of nonalcoholic fatty liver disease

Treatment with oral carbon adsorbents inhibited liver(NAFLD) has been increasing in concert with the rising

weight and liver area occupied by lipid droplets in obese

rates of obesity and metabolic syndrome, with a

db/db mice. The Bacteroidetes to Firmicutes ratio (B/Fconsequent increase in the incidence of liver cirrhosis

ratio) in the feces was restored to normal after oral

and liver cancer worldwide 1).

carbon adsorbent treatment in db/db mice. We also foundOral carbon adsorbents have been reported to promote
the excretion of metabolites produced by the intestinal

a positive correlation between the B/F ratio and the area
under the curve of the liver weight.

microbiota by changing the gut microbiota composition.

【Conclusion】

However, whether or not oral carbon adsorbents improve

These data suggest that the oral

fatty liver disease by changing the gut microbiota

treatment suppresses fatty liver formation by impro-

composition remains unclear.

ving the B/F ratio. We believe that we will be able to【Methods】

develop new methods and drugs to prevent and improve

Oral carbon adsorbents were administered to 6-

fatty liver disease.

week-old male db/db mice for 8 weeks. Body weight,【Reference】

blood glucose, and food consumption were examined.

1) Kubota N et al. Differential hepatic distribution of insulin
receptor substrates causes selective insulin resistance indiabetes and obesity. Nat Commun 7:12977, 2016

Hepatic lipid droplets and epididymal fat cell size were
measured.

Gut

microbiota

compositions

carbon adsorbent

wereinvestigated in the feces and the cecum.

The mechanisms of improvement on fatty liver by Oral carbon adsorbents (Hypothesis)

Health and Nutrition News No. 63

3Concomitant Use of Dietary Supplements
and Medicines Among Preschool and
School-aged Children in Japan
Tsuyoshi Chiba, Department of Food Function and Labeling【Introduction】

Dietary supplement use is widespread among the general
population, including children and adolescents. Previously, ourinstitute reported that the prevalence of dietary supplements
was 8.815.0% in preschool-aged children and 16.4% in
school-aged children. The ingredients in dietary supplements,
especially those concentrated as capsules or tablets, caninteract with medicines and cause adverse events when
patients take them concomitantly. However, the prevalence ofconcomitant use of dietary supplements and medicines inJapan among children remains unclear.

【Methods】

A nationwide internet survey was administered to about 55,000
mothers (25–60 years old) of preschool- or school-aged
children (from 1-year-old children to high school age
students) in Japan. In this survey, we defined dietary
supplements as foods that were in the form of capsules,
tablets, and powders, which were considered to havebeneficial effects on children’s health.

【Results】
Among them, 7.6% currently provide dietary supplements and3.2% concomitantly provide dietary supplements andprescription or over-the-counter medicines to theirchildren. The prevalence of dietary supplement use andconcomitant use increased with the children’s grade.
Among 1,000 mothers with children who were concomitantly
using dietary supplements and medicines, most mothers gave

their children vitamin or mineral supplements, whereas somegave herbal supplements and others for the treatment ofdiseases. In addition, 4.9% of mothers recognized theadverse effects of dietary supplements in their children.
Among concomitant users, 69.1% provided dietary
supplements without physician consultation because they
considered dietary supplements to be just food andtherefore safe; they encouraged their children to take dietary
supplements for the supplementation of nutrients.

【Future direction】

The health of preschool- or school-aged children are easily
affected by dietary supplements and medicines, and theinteractions between dietary supplements and medicinesremain unclear in children. However, most mothers do notconsult with physicians before administering supplements;
thus, parental education about the safety of dietary
supplements and potential risk of drug–supplement
interaction is needed.

【References】
1) Etsuko Kobayashi et al. The prevalence of dietary supplement use
among elementary, junior high, and high school students: A
nationwide survey in Japan. Nutrients, 10(9): 1176, 2018
2) Etsuko Kobayashi et al. Concomitant Use of Dietary Supplements
and Medicines among Preschool and School-Aged Children in Japan.
Nutrients, 11(12), 2960, 2019

Figure. The ratio of concomitant use of dietary supplements
and medicines among preschool and school-aged children (%)

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Health and Nutrition News No. 63

Evaluation of policies on a healthy foodenvironment using an international index
Miwa Yamaguchi, International Center for Nutrition and Information
Section of International Nutrition Strategy【Introduction】【Future direction】

Our dietary habits are affected by various factors based on
individual characteristics. Although no clear global definitionis given, the food environment is known as the community
food environment, nutritional food environment, or local foodenvironment1). The food environment interacts with foodindustries, governments, and societies to create a physicalenvironment, such as availability of food stores, andeconomic environments such as food prices, policy andsocio-cultural environments. Personal characteristics interact
with the food environment and shape individual diets2).
Improvement in the food environment has been raised as oneof the important policies for the second term of the National
Health Promotion Movement in the 21st century (HealthJapan 21 [the second term]). Currently, a healthy foodenvironment is a global challenge as well as a national one.
Swinburn et al.2) developed the Healthy Food Environment
Policy Index (Food-EPI) to assess the food environment
comprehensively, and this tool has been used byapproximately 15 countries3). According to a comparison
between the 11 countries which conducted the Food-EPI
survey from 2015 to 2018, the results of Australia, England,
Chile, and Singapore revealed that their implementation levelsof policy actions were “medium”4). Although the 11
countries above included five countries in Asia and thePacific, there were no reports from East Asia, including
Japan. Therefore, our study started to comprehensively
evaluate the policies of the food environment in Japan,
utilizing an internationally validated index.

After receiving the ratings of the policy implementationlevel by the online survey, we will recruit experts for theworkshop to discuss the prioritization of policies thatshould be implemented in the future (Figure 2). We willsummarize the findings by quantitative analysis of theratings of the policy implementation level and conduct
qualitative analyses to summarize the prioritized policies in
the workshop. We expect that this study will contribute toproviding evidence for improving policies related to thefood environment in Japan, one of the developed countries
in East Asia.

【Participants and Methods】【References】
1)National Center for Environmental Health, Centers for Disease
Control and Prevention, General Food Environment Resources 2014.
https://www.cdc.gov/healthyplaces/healthtopics/healthyfood/general.htm(Accessed January 8, 2020)
2) Swinburn B et al., Monitoring and benchmarking government
policies and actions to improve the healthiness of food environments: aproposed Government Healthy Food Environment Policy Index. Obes
Rev. Obes Rev.14 (1), 24-37, 2013
3)INFORMAS, International Network for Food and Obesity / Noncommunicable Diseases. Public Sector Policies and Actions (Food-EPI)
2019. https://www.informas.org/modules/public-sector/(Accessed January 8, 2020)
4) Vandevijvere S et al., An 11-country study to benchmark theimplementation of recommended nutrition policies by national
governments using the Healthy Food Environment Policy Index.
2015-2018. Obes Rev. 20(2), 57-66, 2019

The policy implementation level was rated by experts from thefields of public health nutrition and public health, national andlocal governments, non-governmental organizations, andprivate companies. The index comprises 13 domains (sevenfor policy and six for infrastructure support), including 47
common good practice indicators (Figure 1). According to
the process of the survey shown in Figure 2, we have finishedthe online survey for rating of the policy implementation level.

Figure 1. Components and domains of
the Government Healthy Food Environment
Policy Index (Food-EPI).
Swinburn et al. 2013

Figure 2. Process of the survey
Food-EPI: Healthy Food Environment Policy Index

Health and Nutrition News No. 63

5Comparison between energy intake as estimatedby self-reporting dietary assessment methods andtotal energy expenditure as measured by the doubly labeledwater method: The Kyoto-Kameoka study
Tsukasa Yoshida, Section of Healthy Longevity Researches【Introduction】
In population-based epidemiologic studies, dietary energy
intake (EI) is commonly assessed using self-administereddietary assessment methods, such as dietary records (DRs)and food frequency questionnaires (FFQs). However, whenevaluating EI using self-reporting dietary assessment
methods such as DRs and FFQs, one cannot entirely avoid
systematic or random errors. Park et al. reported totalenergy expenditure (TEE) as measured using the doubly
labeled water (DLW) method; the EI estimated using DR
and FFQs were underestimated by approximately 20% and30%, respectively (Figure 1; orange bars)1). In this study,
we aimed to examine the validity of the EI estimated by the
DR and the 47-item FFQ against the TEE measured by the
DLW method2).

【Methods】
Participants were 109 Japanese older adults (50 womenand 59 men) aged 65–88 years. The EI was evaluatedusing a DR and a 47-item FFQ over 1 year. This FFQ has
been validated against 7-day DR for older adults aged
≥65 years3). We collected DR over 7 consecutive days,
including both weekdays and weekends, during the DLW
measurement period. TEE was measured by the DLW
method for approximately 2 weeks.

【Results】

Among all participants, the mean TEE was 2,175 kcal/day,and EI estimated by DR and FFQ were 1,972 kcal/day and1,774 kcal/day, respectively. Ratios of EI assessed by DR

Figure 1. Ratios of EI assessed by DR andFFQ against TEE

6Health and Nutrition News No. 63

and FFQ against TEE were 0.91 and 0.82, respectively(Figure 1; light blue bars). TEE was significantly andmoderately correlated with the EI estimated by the DR(r = 0.45, p < 0.01) and FFQ (r = 0.37, p < 0.01).

【Future Direction】
Recently, a prospective nutritional epidemiological study
reported that EI is associated with the incidenceof diabetes only when the EI is calibrated (Figure 2)4).
We also developed a calibration equation to address
self-reporting bias for EI estimated by FFQs2). In the
future, the calibration technique using the DLW method
for EI estimated by FFQs may be helpful inassessing the relationship between EI and the risk ofmortality and long-term care in nutritional epidemiologicalstudies.

【References】
1)Park et al. Comparison of self-reported dietary intakes fromthe Automated Self-Administered 24-h recall, 4-d food records,
and food-frequency questionnaires against recovery biomarkers.
Am J Clin Nutr. 2018; 107: 80-93.
2)Watanabe et al. Estimation of Energy Intake by a Food
Frequency Questionnaire: Calibration and Validation with the
Doubly Labeled Water Method in Japanese Older People.
Nutrients. 2019;11: E1546.
3)Watanabe et al. Validation of Energy and Nutrition Intake inJapanese Elderly Individuals Estimated Based on a Short Food
Frequency Questionnaire Compared against a 7-day Dietary
Record: The Kyoto-Kameoka Study. Nutrients. 2019;11: E688.
4)Tinker et al. Biomarker-calibrated dietary energy and protein
intake associations with diabetes risk among postmenopausal
women from the Women's Health Initiative. Am J Clin Nutr.
2011;94:1600-6.

Figure 2. Association between incident ofdiabetes and EI with and without using
biomarker-calibration approach.

Summary Results of the National Health andNutrition Survey Japan, 2018
Mai Matsumoto, Section of the National Health and Nutrition Survey
Department of Nutritional Epidemiology and Shokuiku【Introduction】【Results】

The National Health and Nutrition Survey Japan aimed toclarify the physical conditions, nutrient intake, and lifestyleof citizens based on the Health Promotion Act (Law No.
103, enacted in 2002) and to obtain basic data for thecomprehensive promotion of their health. The 2018 survey
was conducted with a focus on understanding
socioeconomic status, such as income and lifestyle habits,
in addition to the basic survey items evaluated every year.

A total of 3,268 households of 5,032 target households
responded to the questions. The proportion of those who
were eating balanced diets with staple dishes, main dishes,and side dishes twice per day or more “almost every day”
tended to be lower in the younger generation (Figure 1). The
proportion of those who were eating balanced diets withstaple dishes, main dishes, and side dishes twice per day ormore “almost every day” was also significantly lower inboth men and women with a household income of less than
2,000,000 yen than in those with a household income of
6,000,000 yen or more (Figure 2).

【Participants and methods】
In the Comprehensive Survey of Living Conditions in 2018
(approximately 1,106 areas with 60,000 households and
146,000 family members), the participants were family
members (aged 1 year and over as of November 1, 2018)
who were residing in households of selected 300 areas,
which were stratified and randomly extracted from thegeneral census areas. This survey consisted of a physicalexamination, a dietary survey, and a lifestyle habits
questionnaire survey. The survey items and target age wereas follows:①Physical examination: height/body weight (aged 1 year andover) and abdominal circumference/blood pressure/blood
tests/medical interview (aged 20 years and over)②Dietary survey: household status/meal classification/foodintake (aged 1 year and over) and daily physical activity (thenumber of steps in a day, aged 20 years and over)③Lifestyle questionnaire: eating habits, physical activity,
exercise, resting (sleep), alcohol intake, smoking status,
dental health, and socioeconomic status, such as householdincome (aged 20 years and over)Figure 1【Future directions】
The survey results found that age and income may be factors
related to the frequency of eating a combination of
staple dishes,
main
dishes,andsidedishes.
"Increase the proportion of people eating a combinationof staple dishes, main dish and side dish" is set as atarget item in "Health Japan 21 (secondary)" implemented
to promote the health of the people, but the situation
toward achieving the goals is deteriorating. Further studies
will be conducted to achieve this goal.

【Reference】
Ministry of Health, Labour and Welfare. The National Healthand Nutrition Survey in Japan, 2018.
https://www.mhlw.go.jp/content/10900000/000688863.pdf

Frequency of eating balanced diets with staple dishes, main dishes, and side dishes (aged 20 years and over)Figure 2 Income and frequency of consuming balanced diets composed of sstaple dishes, main dishes, and side dishes(aged 20 years and over)Health and Nutrition News No. 63

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Metabolic equivalents of body weightresistance exercise with slow movementin older adults using indirect calorimetry
Takashi Nakagata, Section of Behavioral Physiology
Department of Physical Activity Research

The load of body weight resistance training (BWRE), such as squat or heel-raise cannot be expressed
as work kg lifted, and the relative intensity is expresses as %1RM or number of RM to failure (e.g.
10RM). We examined the exercise intensity (Metabolic equivalents, METs) of BWRE with slow
movement based on oxygen consumption (VO2) in older adults using indirect calorimetry. Thirteen men
and seven women (mean age, 70.8 ± 4.8 years) participating in this study performed 4 exercises (squat,knee push-up, crunch, and heel-raise). Both the concentric and eccentric phase were set to 3 sec forslow movement methods. A total of 3 sets (10 repetitions) with 30 sec rest between sets were
performed for each exercise. The METs intensity of BWRE-slow determined by aerobic component ofVO2, which is ranged from 2.0 to 3.8 METs, and there were no significant differences between sex(except for knee push-up). Squat was categorized 3.6 to 3.8 METs, whereas knee push-up, crunch,and heel-raise were categorized 2.1 to 3.2 METs based on aerobic energy expenditure. In conclusion,
the METs intensity for BWRE-slow ranged from 2.0 to 3.8 METs in older adults.

【References】
１) Nakagata et al. 2019. Metabolic equivalents of body weight resistance exercise with slow movementin older adults using indirect calorimetry. Appl. Physiol. Nutr. Metab. 44（11）: 1254-1257.
２) Nakagata et al. 2018. Metabolic equivalents of body weight resistance training with slow movement: Implications for exercise prescription and health promotion. J. Exerc. Physiol. Online 21（5）:29-38Table. METs intensity during body weight resistance exercise.

The underline means that significantly different versus young men.2) From Nakagata et al.(JEPonline, 2018)# With regards to the push-up exercise, unlike the young men, all older adults performed knee push-ups.
Thus, we did not perform statistical

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Health and Nutrition News No. 63