Association Between Adherence to the Japanese Meal-based Dietary Guideline and All-cause and Cause-specific Mortalities: A Japan Public Health Center-based Prospective Study

Abstract

Background: The Ministry of Health, Labour, and Welfare in Japan has published a meal-based dietary guideline (Healthy Meal); however, its relationship with health outcomes remains unclear. This observational study examined the association between adherence to Healthy Meal and all-cause and cause-specific mortalities. Methods: We analyzed data from the Japan Public Health Center-based Prospective Study (JPHC Study) with a mean follow-up of 19.0 years, including 40,222 men and 47,350 women aged 45–75 years with no history of cancer, stroke, ischemic heart disease, chronic liver disease, or kidney disease. Adherence to Healthy Meal was scored using dietary intake from a validated food frequency questionnaire. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortalities across score quartiles. Results: A higher Healthy Meal adherence score was significantly associated with a lower risk of all-cause mortality. The multivariable-adjusted HRs for the highest versus the lowest adherence group were 0.86 (95% CI, 0.82–0.91, P < 0.001 for trend) in men and 0.92 (95% CI, 0.87–0.98, P = 0.005 for trend) in women. Significant associations with a lower risk of cerebrovascular disease and respiratory disease mortalities were observed in both sexes. In contrast, significant associations were observed for cancer, cardiovascular disease, and heart disease mortalities in men only. Conclusion: Higher adherence to the Japanese meal-based dietary guideline was associated with a lower risk of all-cause, cerebrovascular disease, and respiratory disease mortalities in Japanese men and women, and cancer, cardiovascular disease, and heart disease mortalities in men only.