394

Asia Pac J Clin Nutr 2008;17 (S2):394-398

Original Article

Overview of nutrition reference and dietary
recommendations in Japan: application to nutrition
policy in Asian countries
Melissa K Melby PhD, Megumi Utsugi PhD MPH RD, Miki Miyoshi RD MPhil RPHNutr,and Shaw Watanabe MD PhD
National Institute of Health and Nutrition, Tokyo, JapanThe nutritional needs of Asian populations have changed dramatically in the last century. The role of nutrition,
not only in preventing diseases associated with deficiency, but also in preventing lifestyle diseases such as cardiovascular disease and cancer, has become increasingly clear. Japan established the world’s first nutrition institute almost 100 years ago, and initially focused on combating malnutrition and food insecurity. The current focus
is prevention of lifestyle diseases, and along with revised dietary reference intakes, Japan has launched a programof Shokuiku (eating education) for children and families. As developing countries are simultaneously facing continuing undernutrition and increasing obesity and lifestyle diseases, collaboration in research and programs is urgently needed to prevent disease through nutrition intervention. This symposium and the Asian network are initial steps toward integrating nutriology into Asia-wide nutrition-based public health research and programs suchas Japanese Shokuiku (eating education).

Key Words: Japan, nutrition reference, public health, epidemiology

ESTABLISHMENT OF NUTRIOLOGY (NUTRITIONAL SCIENCE) IN JAPANFollowing World War II, the increased life expectancy ofJapanese resulted not only from improvements in sanitation, but also from improvements in diet. During theMeiji and Taisho eras (1868-1926), beriberi and tuberculosis were the major endemic diseases in Japan. In orderto prevent these diseases through nutrition, Dr. Tadasu
Saiki established the world’s first nutrition institute in1914. The institute was nationalized in 1920 as the Imperial State Institute for Nutrition. It subsequently became
the National Institute of Health and Nutrition (NIHN),
and has made significant contributions to the nutritional
improvement of the nation for more than 85 years.
In the early 20th century, rice, miso soup and pickles
constituted the typical diet in Japan. The institute endeavored to promote a well-balanced diet by reducing
rice intake and increasing protein and fat intake. Food
security concerns in part motivated studies of applied
nutrition that included study of foods for use during famine and discovery of new foods. Dr. Saiki played a crucial role as a pioneer in establishing “nutrition” as an academic discipline in its own right, making theoretical aswell as applied contributions to improve the diet of thepopulation, including the training of dietitians and nutrition education.
Dr. Saiki, the ‘father of nutrition’ in Japan, establishedscience-based nutrition, or nutriology, in 1910 and in1926 wrote a report entitled “Progress of the Science ofNutrition in Japan” for the League of Nations.1,2 The
concept of nutriology covered nutrients in food, alterations by cooking, and bioavailability in the body. It was

an integrated theory for improving public health throughnutrition, including consideration of socio-economic policies and covering the continuum from the kitchen to thetable to the body (Fig. 1). He described the importance tonutrition research in accounting for the interdependenceof physiological and economic aspects of nutrition, while
also recognizing the socioeconomic inequalities that exist
in all populations, which he referred to as the ‘social aspect’. After identifying the natural products best able tomeet physiological requirements, and selecting those that
also meet the requirements of the national economy, thegoal was to design a ‘food code’ or dietary recommendations based on social considerations that would optimize
nutrition for the greatest number of people in Japan.
Highlights of Japanese nutritional science researchfeatured in the report included data on basal metabolism,
body surface area, metabolic changes during fasting andimprovements of physical conditions of malnourishedchildren. Studies of digestibility and physico-chemical
properties of rice under various processing conditions,other grains such as millet and buckwheat, and vitamins
in Japanese foods and animal feed, and finally a rat studyof gastric carcinoma in relation to diet also were included.
Dr. Saiki and colleagues determined the energy requirements for Japanese and created food composition tables,Corresponding Author: Melissa K. Melby, PhD, Nutrition
Education Program, National Institute of Health and Nutrition,
1-23-1, Toyama, Shinjuku, Tokyo, 162-8636
Tel: +81-3-3203-5418; Fax: +81-3-5155-0573
E-mail: melby-m@nih.go.jp
Manuscript accepted 16 January 2008.

Melby MK, Utsugi M, Miyoshi M and Watanabe S395

Figure 1. Integrated theory for improving public health through nutrition by Dr. Saiki1. Figure 1 illustrates the flow of food components,
which starts from obtaining food items and cooking. Then, when we eat meals on the table, nutrients can be taken into one’s body, which
will bring physiological effects and improve one’s health.

which permitted analysis of nutritional intake.
Based on research on energy metabolism, they developed nutrition standards, which constituted the basis forthe recommended dietary allowances (current “DietaryReference Intakes”) first established in 1970.
Under the order of General Headquarters Supreme
Commander for the Allied Power (GHQ/SCAP) during
the post-WWII U.S. occupation of Japan, the Instituteconducted several food consumption and national nutrition surveys to estimate nutrient intake and provide data
for the food distribution program to respond to the postwar food shortage.3 Utilizing post-war food aid from theUSA, dietary improvement campaigns like “Eat foodsfrom three colors” were implemented, and Japan overcame the problems of malnutrition.
In addition, there were two well-known programs by
the graduates of Saiki Nutrition School: (1) the “Use frying pan for cooking once a day” and (2) “Kitchen car”
cooking classes conducted throughout the country toteach people how to use flour, dairy products, oil, meat,sausage and eggs in cooking.4 While undernutrition andinfectious disease (e.g. tuberculosis) were significant public health problems in Japan before 1960, the nutritionalsituation greatly improved with rapid economic growthand nutrition education and programs.
RECENT EPIDEMIC OF OBESITY IN JAPAN AND
ASIA AND INCREASE IN LIFESTYLE-RELATEDDISEASES
In the 1980s, paralleling the growth in the economy, theJapanese population’s waistline also increased. By the1980s, obesity and overweight, rather than undernutrition,
had become significant problems for many segments of
the Japanese population,5,6 leading to an increase in lifestyle-related diseases (e.g. diabetes, hypertension, andcardiovascular diseases).7 An examination of the historical changes in the recommended dietary allowances(RDAs), which describe adequate dietary intake for 9798% of the population,8 provides some insight into thistransition.
As seen in Table 1, the 2005 RDAs for energy intake

Table 1. RDAs for energy and protein intake by children in Japan (1940-2005)
Institute of Health Sciences
1940*
Energy (kcal)
0～1
1～3
4～5
6～8
9～11
12～14
15～20
Protein (g)
0～1
1～3
4～5
6～8
9～11
12～14
15～20

Committee of food inspectors onnutrition standards
1944*
MFM

F

850
1,200
1,460
1,690
1,880
2,160
2,500

850
1,200
1,460
1,570
1,740
2,030
2,100600
1,250
1,450
1,700
1,900
2,200
2,100

3550607080901003550606570859030404550657575

Dietary Reference Intakes
2005
M

F

600
1,250
1,450
1,700
1,900
2,100
1,700

650
1050
1400
1650
2300
2650
2750

600
950
1250
1450
2150
2300
2200

30404550
657070152025355060
6515202530505550* Recommendation of introducing school lunch (Joint message by Ministry of Education, Ministry of Health, Ministry of Agriculture. (December 11, 1946)

396

Japanese Nutrition Policyby children aged 9-20 years old are considerably higher
than the 1940 RDAs, although the RDAs for protein intake have decreased to approximately 50-70% of the 1940
RDAs.8 Prior to the war, protein malnutrition wascommon and thus recommendations for protein intake
were high. The 2005 RDAs for protein represent recommended intake for a healthy, well-nourished population.
However, the 2005 RDAs for energy intake were estimated average requirements (see Sasaki, this volume) andmay be overestimates, given the decreasing activity levels
and trends toward overweight and obesity in much of theJapanese population. The additional energy consumed,derived primarily from excess fats and carbohydrates,may be responsible in part for the increased numbers ofobese children and may foreshadow an obesity epidemic
in Japan.9 It is important to clearly distinguish between
RDAs (population based data for assessment by nutritionists and other scientific professionals) and dietary guidelines (for use by dieticians and the general population toachieve individual health and nutrition).
Similar changes have been observed worldwide overthe past 20 years, with a marked shift to diets high insaturated fat, added sugar and refined foods affecting disease trends in many countries, especially in developing
countries. Projections for causes of death suggest thatwhile progress is being made in preventing and treating
infection, pregnancy-related problems and injuries, lifestyle diseases such as cardiovascular disease and cancer
will continue to be the major causes of death in developed
countries and also will become major causes of death indeveloping countries.10 Currently, a growing number ofdeveloping countries face "the double burden of malnutrition": the persistence of undernutrition along with therapid rise of overnutrition and chronic diseases.
PREVENTION OF DISEASES THROUGH GOODDIETARY HABITS
The latter half of the 20th century witnessed a paradigm
shift concerning nutrition with a focus on overconsumption and an increase in lifestyle-related diseases displacing undernutrition as the primary nutritional concern andchallenge facing nutrition scientists and public healthworkers. At the beginning of the 21st century, dramaticincreases in obesity and associated lifestyle related diseases have led to health programs ranging from the global
to local levels. The World Health Organization (WHO)launched the WHO Global strategy on Diet, Physical Activity and Health in 2004.11 In Japan, one of the primaryaims of the 10 year national plan for health promotion'Health Japan 21’ promotes maintenance of appropriate
body weight (obesity control and prevention of thinness
brought about by dieting in young women).12 However,as the midterm report documents, with an overweight
prevalence of 29.0% in males aged 20-60 and 24.6% infemales aged 40-60, Japan is far from reaching its targetsof an overweight prevalence of less than 15% and 20% in
men and women respectively.13 From 1950 to 1980, energy intake stayed relatively constant but energy derived
from fat more than tripled (7.7% to 23.6%) and then leveled off.14 It is especially noteworthy that while fat fromall sources increased, animal-derived fat increased byalmost 4-fold.14 Although the economic burden of life-

style-related diseases is already high and increasing, financial resources for public health prevention efforts fall
far short of those needed to avoid epidemics of metabolicsyndrome related diseases.
In response to these disturbing trends, governments
throughout the world have produced various food guidelines (Fig. 2). Ideally these guidelines should reflect
countries’ cuisines and socio-economic situation, and be
tailored to their populations’ needs. Indeed, the designand visual image of the Food Guides often reflects acountry’s culture (e.g. koma in Japan, pagoda in Koreaand China, pot in Guatemala).15 However, most of theseguidelines have been modifications of the nutritionalguidelines developed in the US, which in turn reflect bothnutritional science and food industry influence as they
were produced primarily by the Department of Agriculture.16 Now, there is an urgent need to develop a Nutrition Network in Asia so that nutritional scientists can collaborate by exchanging information and data on theircommonalities and differences to create nutrition guidelines that reflect the rich food histories of their culturesand meet the varied needs of their populations. Drawing
on the healthy traditional food and dietary patterns ofAsia, and as an outgrowth of a conference series, "Public
Health Implications of Traditional Diets," jointly organized by Harvard School of Public Health, a United Nations World Health Organization/Food and Agriculture
Organization (WHO/FAO) Collaborating Center, andOldways Preservation Trust in 1993, the traditional
healthy Asian Diet Pyramid (Fig. 3) provides an exampleof a nutritional guideline that incorporates both thehealthy nutritional history of Asia as well as clinical andepidemiological nutritional-science informed dietary recommendations.17
In Japan, the 2000 Dietary Guidelines for Japanese
were established jointly by the Ministry of Health, Labourand Welfare (MHLW); the Ministry of Agriculture, Forestry and Fisheries (MAFF); and the Ministry of Education, Culture, Sports, Science and Technology (MEXT).
In 2005 in order to disseminate the information more
widely to the general population, a Japanese Food Guide“Japanese Food Guide Spinning Top” (Fig. 4) was produced jointly by MHLW and MAFF.18 It was intended tobe used not only as a tool for nutrition education at thecommunity level, but also for food system industries, andrepresentatives were involved from the early stages of its
creation. Also in 2005, the Basic Act on Shokuiku (inJapanese, shoku means ‘eating’ and iku means‘growth/education’) promoted the introduction of the“Japanese Food Guide Spinning Top” food and nutrition
education for children, as well as for their families.19There is a long history of integrated or holistic approaches to nutrition in Japan. Shokuiku is one componentof the traditional 4-prong approach to health that also
includes an emphasis on knowledge, virtue and physicalwell-being. The 2005 Shokuiku Act and its associatedprograms integrate eating education in the home/family,school, and local community (government, non-profitorganizations, companies, etc). This integration is believed to be essential to achieve significant behavioral
changes on an individual and social level. Effective confrontation of the epidemic of obesity and lifestyle

Melby MK, Utsugi M, Miyoshi M and Watanabe S397

Figure 2. Food pyramids from around the world

Figure 3. Traditional healthy Asian diet pyramid

Figure 4. Japanese food guide spinning top

diseases cannot be achieved with narrowly focused programs, but requires an integrated approach such as that
embodied in Shokuiku.

WHAT IS OUR GOAL?
Japan currently has the longest life expectancy rates in theworld (mean of 85.33 years for women in 2003).20 Yetwith increasing rates of lifestyle diseases, life expectancy

Japanese Nutrition Policy

Percentage of people alive398

Tailor-made Nutrition
21century

100

Epidemiology, Public Health

20 century
Bacteriology, Hygiene
19 century

50
Roman era

Africa 50,000yrs ago

0Age in years 50

100Figure 5. Elongation of life in human history

and quality of life are likely to decrease. Our aim is toextend life expectancy and enhance quality of life throughtailor-made nutrition and public health education (Fig. 5).
We aim to educate and train nutrition professionals thatcan provide information and guidance utilizing Dietary
Reference Intakes (DRIs) and Nutrition and Food
Guidelines but also be tailored to each individual’s needs,
thereby promoting health among the entire population.
AUTHOR DISCLOSURES
Melissa K Melby, Megumi Utsugi, Miki Miyoshi and Shaw
Watanabe, no conflicts of interest.
REFERENCES
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untry_en.stm
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