Glycative Stress Research
Online edition : ISSN 2188-3610
Print edition : ISSN 2188-3602
Received : April 1, 2023
Accepted : May 8, 2023
Published online : June 30, 2023
doi:10.24659/gsr.10.2_64

Original article

The influence of the type of rice served at school lunches on COVID-19
infection in kindergartens and nursery schools
Masatoshi Ukezono 1, 2), Naoki Nishiyama 1), Hironori Maruyama 3), Keiji Saika 1, 4)
1) Isyoku-Dogen Research Foundation, Tokyo, Japan
2) Department of Developmental Disorders, National Institute of
Mental Health National Center of Neurology and Psychiatry, Tokyo, Japan
3) Mealcare Co. Ltd., Nagano, Japan
4) Tokyo University of Agriculture, Tokyo, Japan

Abstract

Purpose: The purpose of this study was to investigate the effect of processed brown rice on COVID-19 infections byexamining whether the number of COVID-19 cases in preschools in 2021 differed depending on whether one type ofprocessed brown rice (sub-aleurone layer residual rinse-free rice: SARFR), or white polished rice, was used as the source ofthe cases. This study aimed to investigate the effect of processed brown rice on COVID-19 infections.
Methods: We investigated the number of COVID-19 cases among preschool infants from April 2021 to March 2022 inkindergartens and nursery schools whose nutritional value of facilities was calculated based on the Dietary Reference Intakes
for Japanese by the Ministry of Health, Labor and Welfare. The survey was conducted in the same area within a 3-km linear
distance radius, followed by additional surveys of preschools in neighboring areas within a 10-km linear distance radius.
Furthermore, we compared the COVID-19 incidence rate with that of Tokyo, where the participating preschools are located.
Results: Among preschool infants in the same area, those who received processed brown rice for lunch had a significantly
lower percentage of COVID-19 cases than those who received white polished rice. In the neighboring areas, the proportion ofaffected individuals was also significantly lower in the group consuming processed brown rice. Furthermore, compared to theincidence rate in Tokyo, the incidence rate in the kindergartens where the processed brown rice was consumed tended to belower.
Conclusion: There was a trend toward a lower proportion of COVID-19 infections affected by preschool infants consuming
processed brown rice. In the future, it is necessary to examine the preventive effect of consuming processed brown rice not
only on COVID-19 but also on other infectious diseases, as well as its mechanism.

KEY WORDS: sub-aleurone-remaining wash-free rice (SARWR), processed brown rice, COVID-19, infant

Brown rice is thought to be rich in functional componentsthat are expected to have disease-preventive effects, and theeffects of each component have been studied 1, 2). In particular,
phytic acid 3, 4) and ferulic acid 5, 6) are reported to have antiinflammatory and antioxidant effects, and lipopolysaccharides(LPS) have immunostimulatory effects 7- 9). Practically, morethan 300 people have been reported to improve theirhealth and reduce their morbidity due to the consumptionof processed brown rice 10). These studies suggest that
consumption of brown rice may be useful in preventing
infectious diseases and avoiding the more serious states when
infection does occur. However, there have been no large-

scale studies in Japan on the relationship between rice andinfectious diseases in preschool infants.
COVID-19, which became a global pandemic in
December 2019, initially caused few severe cases in children
11, 12). In December 2021, a large-scale outbreak of the mutant
Omicron strain occurred, and the number of infected children
has been increasing, indicating that severe cases of COVID19 are occurring 13). The number of infected children has been
increasing, and severe cases have been reported 14). In lightof this, an indication for the vaccination of child with thenovel coronavirus vaccine was highlighted. However, evennow, there is no overall agreement on whether or not children
should be vaccinated 15, 16). In particular, there are no clear
standards for vaccination of infants.

Correspondent to: Ukezono Masatosi, PhD
Isyoku-Dogen Research Foundation
5-10-13 Ginza, Chuo-ku, Tokyo 104 - 0061 Japan
TEL : + 81-3 - 4334 -8868 e-mail: office@isyokudogen-fnd.jp
Co-authors; Nishiyama N, nishiyama@toyo-rice.jp;
Maruyama H, maruyama@mealcare.co.jp; Saika K, tysaika@icloud.com

Glycative Stress Research 2023; 10 (2): 64-69(c) Society for Glycative Stress Research

Introduction_ 64 _Glycative Stress Research

COVID-19 infection brought about numerous changes
to our daily lives. Consequently, there have been changes in
the health status of children, with weight gain and decreased
exercise time reported compared to pre-COVID-19 epidemic
levels 17, 18). One of the causes of weight gain was noted to
be an increase in dietary intake of confectionery, sugary
drinks, and instant foods 19), pointing to the possibility thatdisordered eating may have a significant impact on children's
health 17-19). One possible effect of the increase in infectious
diseases is the disruption of diet due to prolonged COVID-19
infection. These results call for the need to investigate thepossibility of preventing infectious diseases and avoiding
their severity through diet, especially in preschool infants,
for whom it is difficult to determine whether or not to take avaccine.
Therefore, as a preliminarily study, this study focusedon the impact of rice consumption differences on the numberof COVID-19 cases among preschool infants in the year 2021
stored in each kindergarten and nursery school on infectious
diseases. All participating preschools were included only
those that calculated the nutritional value of their facilities
based on the Dietary Reference Intakes for Japanese by the
Ministry of Health, Labor and Welfare. The participants werepreschool infants who did not have any chronic illnesses,
disabilities, or diseases. We then investigated whether there
was a difference in the number of COVID-19 cases dependingon whether the rice was sub-aleurone layer residual rinse-freerice (SARFR) or white polished rice (WPR). This study
focused on SARFR, a type of processed brown rice that iseasier to eat and more digestible 20, 21). SARFR is a rice with aresidual sub-aleurone layer that contains many of the nutritionaland flavor components of brown rice. Oral consumption of
the sub-aleurone layer has been shown to improve constipation,susceptibility to colds, and skin complaints by subjective
evaluation, indicating that it may be a functional food 22).
There are reports at academic meetings on immune function
activation by SARFR intake 23, 24). The current study
investigated the impact of SARFR on COVID-19 morbidity
in preschool infants.

MethodSubjects

Children in kindergartens and nursery schools in Kotoku, Tokyo, where the nutritional value of the facilities wascalculated based on the Dietary Reference Intakes for Japaneseby the Ministry of Health, Labour and Welfare, were includedin the study. Two kindergartens, one of which consumed
SARFR and the other consumed WPR, were within 3 km ofeach other. To avoid obtaining personal information, we
obtained data on the number of infants affected by COVID-19
as reported by the preschools to the national and local
governments. We excluded infants who had any of thefollowing conditions: 1) infants who consumed less than 80 %of school lunch per year, 2) infants with pre-existing medical
conditions such as childhood diseases, 3) infants withphysical disabilities such as physical diseases, 4) infants with
developmental disabilities, or 5) infants with other problems
in their home environment, which may be backgroundfactors. We excluded preschoolers whose living environment

may differ significantly from that of other preschoolers.
Data were obtained for 440 infants in the preschools
with SARFR intake and 109 infants in the preschools with
WPR intake. In addition, due to the small number of WPRingesting preschoolers, an additional survey was conductedwithin a 10-km linear distance from the two preschools. At
a preschool in Urayasu City, Chiba, 131 infants who did notcomply with the exclusion criteria were added. Because weonly obtained the number of infants, we did not obtain dataon the ages of the infants, but only those aged 3 to 5 years,
and we did not obtain any personal information, i.e., genderratios.

SARFR (sub-aleurone layer residual rinse-free rice)

SARFR is rice that has been polished to remove therice bran layer from the rice husk, leaving the sub-aleurone
layer, the base of the germ (golden bud), the blastocoel, andthe endosperm. The sub-aleurone layer contains many of
the nutrients of brown rice and has a sweet taste that makes
it desirable. It has already been reported that it contains
more B vitamins and dietary fiber than WPR, as well as
more carbohydrates that affect the environment in thegastrointestinal tract 21).

Survey Methodology.

Recruitment was conducted for preschools to which
Meal Care Corporation (Nagano, Japan) distributes school
lunches. One kindergarten in Koto-ku, Tokyo, that consumes
SARFR announced its participation (Preschool A). Preschool
A enrolled infants aged 3 to 5 years old. With a referral
from Preschool A, recruitment was conducted to Preschool
B, which consumes WPR in the same area (Koto-ku). The
preschool B also had infants aged 3 to 5 years old. The
distance between Preschool A and Preschool B was within
3 km. From the data on the number of infants affected by
COVID-19 reported by the preschools to the national andlocal governments, the person in charge in each preschool
calculated the number of infants excluding those who violated
the exclusion criteria. As a result, Preschool A had a large
number of infants and was able to obtain information on 440
attendees who did not violate the exclusion criteria. However,
only 109 infants at preschool B did not meet the exclusion
criteria. Therefore, we asked Preschools A and B to introduce
us to neighboring preschools that were conducting WPR
intake, and Preschool C in Urayasu City, Chiba, within 10
km of both preschools announced its participation. Preschool
C also enrolled infants between the ages of 3 and 5 years.
As in the past, the person in charge of preschool C excluded
infants who did not meet the exclusion criteria, resulting in
131 infants participated in the study.
The number of COVID-19 cases was collected for eachmonth of the fiscal year 2021 for those preschool infants forwhom information was available. The same preschool thatwas infected in different months was not counted. We also
accessed publicly available data from Koto-ku and obtained
data for each month during the same period. Since detailed
data by age were not available, we obtained data for the
combined total of those aged 0 to over 90 as a reference forthe incidence of infection in Koto-ku during the same month.
The total population within Koto-ku was defined as_ 65 _

Lunch Rice Differences and COVID-19 Infection in Kindergarten and Nursery School

the number of people disclosed on December 1, 2021. In
addition, we obtained data on the number of people under
10 years of age affected by COVID-19 published by the
Tokyo Metropolitan Government for each month during thesame period. The total population under 10 years of age inTokyo was defined as the number of people published by the
Ministry of Health, Labour and Welfare on October 1, 2021.

Statistical Analysis

The total number of affected persons in each monthin the SARFR and WPR groups was obtained: The total
number of infants with or without COVID-19 infection in
Preschool A with SARFR, and the total number of infants
with or without COVID-19 infection in Preschool B with
WPR, in 2021. Statistical analysis was performed using
the statistical analysis software SPSS (Statistics27: IBM
Japan, Chuo-ku, Tokyo), and a risk rate of less than 5 % wasconsidered a significant difference. Chi-square tests were
performed on the total number of people with and without
COVID-19 in Preschool A and B in the same area, Koto-ku,
and the linkage coefficients of the Clamor of the effect size
were calculated. Furthermore, the number of infants with orwithout COVID-19 in Preschool C with WPR was added tothe total for Preschool B. A chi-square test was conducted
for Preschool A and Preschools B & C, and the association
coefficient for Clamor was calculated in the same way. For
the number of COVID-19 cases in Koto Ward, the incidence
rate was calculated based on the total number of people in
the ward, and for the number of COVID-19 cases under 10
years in Tokyo, the incidence rate was calculated based on
the total number of people in Tokyo.

Results
The total number of cases and incidence rates in eachpreschool, Koto-ku, and Tokyo in FY2021 are shown in
Table 1. The cumulative number of COVID-19 cases in Kotoku is shown by month ( Fig. 1-a). In Koto-ku, an increasein the number of cases was seen around summer, when the
Delta strain became prevalent, and a large increase in thenumber of cases was seen with the outbreak of the Omicronstrain from December. The cumulative number of COVID-19
cases per month in Preschools A and B in Koto-ku is shown(Fig. 1-b). Some cases occurred during the summer when
the Delta strain was prevalent, and the number of cases
increased after January, probably because the Omicronstrain was prevalent from December onward. A chi-square
test was performed on the total number of infants with andwithout infection, and a significant difference was found (χ2(1) = 205.74, p < 0.01, φ = 0.61). In addition, the monthly
number of COVID-19 cases in Preschool C was added to
Preschool B to show the cumulative number of cases ( Fig.
1-c ). The results of the chi-square test for the total number of
infants with and without the infection showed a significant
difference between Preschool A and Preschools B & C (χ2(1) = 205.74, p < 0.01, φ = 0.49). The cumulative monthly
number of COVID-19 affected infants under 10 years of age
in the public data of the Tokyo Metropolitan Government isshown (Fig. 1-d ).

Discussion
This is a preliminarily study which examined whether
the number of COVID-19 cases differed depending on thestaple food between SARFR or WPR in the school lunches
for 3- to 5- year - old preschool infants in Koto-ku, Tokyo.
However, since the number of preschoolers consuming WPR
was not large, we additionally recruited Preschool C at whichinfants consume WPR, located in Urayasu City, Chiba within
10 km distance from Preschool A and Preschool B. The chisquare test showed that a significantly smaller proportion ofpreschool infants in Koto-ku were affected by COVID-19
than those who received SARFR. The effect size was ashigh as 0.6, indicating that SARFR intake was associatedwith COVID-19 protection compared to WPR intake. In
the results of the additional Preschool C, the proportion of
COVID-19 cases was significantly lower in the preschool
receiving SARFR, and the effect size was slightly lower
than that in Koto-ku alone study, about 0.5 which is stillenough high. The effect of SARFR intake on the reductionof COVID-19 incidence was suggested.
The monthly trends in the number of cases show anincrease in the number of cases in Koto-ku starting aroundsummer (Fig. 1-a). However, the impacts of Delta strains did
not seem to be very high in the three preschools from whichdata were obtained, and there was no significant increase in
the number of cases around summer in any of the preschools.
Although the data from the Tokyo Metropolitan Governmentshows an increase in the number of cases of Delta strain in
infants under 10 years of age (Fig. 1-d ), it may be that there
was no increase in the number of cases in infants aged 3
to 5 years, as in this study, or it may be that the number ofcases of Delta strain in the participating preschools was nothigh. However, a significant increase in the number of casesof Omicron strain since December has been observed inpreschools, in Koto-ku, and in Tokyo as a whole among thoseunder 10 years of age. Omicron strains have been reported
to cause many infections in infants, and the results of thisstudy were similar 15). Only in Preschool A, where SARFR
was taken, there was no significant increase in the numberof cases with Omicron strains, indicating that a significant
difference was observed this time and that the effect size washigh.
Since this study examined whether or not the staple
food in preschoolers' school lunches was SARFR, there areresearch limitations, such as the fact that we do not know
the children's diet at home. Furthermore, since the results
were combined for 3- to 5-year-olds, it is not possible to say
at what age the effect is most pronounced. The additional
Preschool C with WPR intake is not located in Koto-ku, but
in Urayasu City, Chiba. However, most of the area aroundKoto-ku is in Tokyo, and details on the number of affected
infants in Urayasu City are not available, so the analysis in
this study is limited by assuming that the number of affected
infants is the same level as that in Tokyo.
However, since Preschools A, B and C are within 10
km of each other, this is not a study in a significantly distantarea. At the very least, the fact that the Preschools A and B
parks in Koto-ku are less than 3 km apart in a straight line
suggests that there may be some association between SARFR
intake and a decrease in the number of COVID-19 cases.
However, it is difficult to say whether SARFR ingestion was_ 66 _Glycative Stress Research

Table 1. Number of COVID-19 cases from 2021 April to 2022 March.
Number of infected persons

Total number

Infection rate (%)

Preschool A

48

440

10.91

Preschool B

84

109

77.06

Preschool C

51

131

38.93

Koto-ku (0 ~ 99 years)

4 0,767

525, 962

7.75

Tokyo (< 10 years)

150,881

1,032,000

14.62

The number of COVID-19 cases, and incidence rate that was calculated based on the total number of people were shown from 2021
April to 2022 March. Preschool A: a kindergarten in Koto-ku that consumed SARFR. Preschool B: a kindergarten in Koto-ku,
located within a 3 km liner distance from A and consumed WPR. Preschool C : a kindergarten in Urayasu City in Tiba, locatedwithin a 10 km liner distance from A and B, and consumed WPR. Koto-ku: Publicly available data from 0s to 90s. The total
population within Koto-ku was defined as the number of people disclosed on December 1, 2021. Tokyo: Publicly available data
under 10 years. The total population under 10 years of age was defined as the number of people published by the Ministry of Health,Labour and Welfare on October 1, 2021.

b
160

cumulative number of people

48000

36000

24000

12000

0

c

Preschool B

80

40

Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec Jan. Feb. Mar.

d160

cumulative number of people

Preschool A

120

0Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec Jan. Feb. Mar.

Preschool A

Preschool B & C
120
80
40
0

Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec Jan. Feb. Mar.

cumulative number of people in Tokyo

cumulative number of people in Koto-ku

a160000120000

80000

40000

0

Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec Jan. Feb. Mar.

Fig. 1. Monthly cumulative number of COVID-19 cases. a) in Koto-ku, Tokyo.

The increase in the number of cases was observed due to the Delta strain outbreak from the summer and the Omicron strain from the end of theyear. a) in Koto-ku. b) in Preschools A and B. c) in Preschools A, B and C. Cumulative number of COVID-19 affected patients in Preschools
B and C combined. d) in Tokyo.

_ 67 _

Lunch Rice Differences and COVID-19 Infection in Kindergarten and Nursery School

effective in protecting outbreaks specifically for the Omicronstrain of COVID-19 or for outbreaks of infectious diseases
in general.
Many studies have reported that brown rice contributes
to good health 1, 2, 25). It widely contributes to health by
suppressing neutral fat 26), improving blood sugar levels 27),
improving bowel movements 28), and having a positive effecton the intestinal microflora 29). Furthermore, it has been shownto inhibit glycation, a factor in the formation of terminal
glycation products, which is one of the important factors in
aging and the development of lifestyle-related diseases 30). In
particular, γ -oryzanol, which is specifically contained in highconcentrations in brown rice, has been suggested to improvebrain function and prevent diabetes 31). However, brown riceconsumption tends to be avoided due to taste and texture
issues, and its long cooking time makes it troublesome toprepare. Therefore, it is important to study the health effects
of processed brown rice, such as the SARFR used in thisstudy, which solves the aforementioned problems and is also
good for digestion.
It has already been shown that SARFR has a positiveeffect on the skin 21). Furthermore, activation of immune
function by SARFR ingestion has been noted 23, 24). Although
the results of the present study are preliminarily results,
they suggest a possible contribution of SARFR intake to theprevention of infectious diseases in infants. Future studies
on adults to determine whether processed brown rice, as wellas SARFR, influences the prevention of infectious diseases
may be useful in preventing infection without vaccination, as
well as in studying the mechanisms of infection and immune
function, which remain unclear. Furthermore, it has been
pointed out that nutritional imbalance due to dietary changes
caused by the COVID-19 epidemic is occurring in children17, 18).
The most of previous studies have focused on adults and havenot actively examined the health effects of processed brownrice on infants. In the future, the health effects of processedbrown rice consumption will need to be examined in infants.

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Conclusion
As a preliminarily study, we examined whether thenumber of COVID-19 affected preschool infants in the year
2021 stored in kindergartens and nursery schools differeddepending on whether they consumed one type of processedbrown rice, SARFR, a total of approximately 680 infants
aged 3 to 5 years. The results showed that the number of
COVID-19 cases among preschoolers who consumed ricewith a residual sub-aleurone layer tended to be lower thanamong those who consumed WPR. Further studies areneeded to determine the effect of rice with sub-aleurone
layer on the prevention of infectious diseases.

Conflict of interest declaration
In conducting this study, Meal Care Corporation
conducted recruitment at preschools that provide school
lunches.

Acknowledgments
This study was supported by the Foundation for IsyokuDogen Syoyaku Research.

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