Keywords

12.1 Why Hasn’t Malnutrition Disappeared

The United Nations has formulated the Decade of Action for Nutrition (2016–2025) and the Sustainable Development Goals (SDGs). Furthermore, The Japanese government have announced that a “Tokyo Nutrition Summit 2021” will be held in December 2021. Now is the perfect opportunity to put an end to global malnutrition. However, “2018 Global Nutrition” reports with a sense of urgency that “the reality of nutrition is unacceptably poor and progress in improving it is not being made”.

This is because there has been no improvement in eight key nutritional indicators: hypertension, obesity and overweight in adults; stunting, wasting and overweight in children; and anemia and excess salt intake at all ages. 22.2% (150.8 million) of the world’s children are stunted, 7.5% (50.5 million) suffer wasting, and 5.6% (38.3 million) are overweight.

In recent years, nutritional science has made remarkable progress, about 35–40 different nutrients have been discovered, and their functions, foods containing them, and nutrient deficiencies and excesses have been identified. The development of comprehensive nutritional foods and nutritional supplements that contain all the nutrients has made it possible to correct malnutrition and to administer all the nutrients directly into the digestive tract and bloodstream through a tube or drips, even in cases where eating is difficult due to illness or disability. In other words, we now know the causes and solution for the malnutrition that plagues the world.

However, the double burden of malnutrition cannot be eradicated.

This is because even if nutrition and nutritional supplements temporarily solve malnutrition, it is necessary to adjust the daily diet to maintain good nutritional status continuously, universally, and for a lifetime. This means that malnutrition can be eradicated only if all people have access to a sustainable healthy diet. On the other hand, it is not easy to create a situation where everyone has access to such a diet, because the diet depends on a huge industrial system centered on food, and this system is influenced by a wide variety of factors.

For example, the food that makes up a meal depends on a system of production, processing, distribution, cooking, and presentation, and each of these processes is influenced by the food environment and food culture.

Even if a rural life of gathering vegetables from the garden and keeping chickens for eggs and meat is partially achieved through home gardens, it is not possible to feed the global population in this way. The vast majority of people live on food produced and distributed by giant agricultural and food corporations, and it will take a comprehensive force to make this system work properly.

If we consider the human side and the energy and nutrients required for sustaining life, the human body consists of cells and organs, and in addition humans also depend on mental and social aspects of life within the framework of family, community, and nation. Traditionally, nutrition science has examined the relationships among the factors that impact food and living things (humans), beginning with energy and nutrients on the left of the chart of the chart below and extending to food, cooking, menus, health and supplements, and even to the role of the state on the right. However, these methods, even if they increase the integration’ of the left-right relationships, reveal only the connections between various parts of the whole , and do not lead to a way to make sustainable healthy eating accessible to all.

Moreover, both the food on the left axis and the people on the right axis are organisms that exist on the same finite planet, and if the earth loses its ability to sustain them, this system will collapse from the foundation up.

To sustain life and develop a healthy and cultured life for the future, without leaving anyone behind, we must create a world where everyone has access to a healthy diet that recognizes biodiversity and does not burden the global environment. In order to achieve this, it is necessary for all organizations and people involved in nutrition and diet to raise a unified banner of “eradicating malnutrition” and to strive to set feasible goals in their respective areas. This is why comprehensive measures are needed through collaboration among governments, universities, industry, economy, finance, etc.

12.2 Integrated Nutrition and Innovation

I have already mentioned the need for individuals and organizations involved in nutrition to work together to increase their collective effectiveness in order to eradicate malnutrition, and in fact, The science of nutrition in Japan has been putting this into practice.

The improvement of nutrition in Japan started 150 years ago, when the nation was modernized by the Meiji Restoration, and nutrition as a science was introduced. In particular, it was around 1890, the time of the Sino-Japanese War and the Russo-Japanese War, that the nation began to make serious efforts. The government addressed the issue of nutrition as a national policy in order to raise healthy citizens and strong soldiers under the national policy of “Wealthy Nation, Strong Army”. Nutritional deficiencies due to food shortages were particularly serious before and after World War II, and the country was plagued by severe malnutrition and a variety of nutritional deficiency diseases. The government imported food from the United States and at the same time imposed food controls. It also educated people about the importance of nutrition and how to improve nutrition in order to consume the limited food rationally. For this purpose, the government trained nutritionists whose professional mission was to improve nutrition and established a national qualification for them based on the Status Law. Moreover, the “Nutrition Improvement Act” was enacted so that nutritionists could be placed in every corner of society.

Nutritionists were assigned not only to hospitals and schools, but also to day-care centers for infants, kindergartens, welfare facilities, enterprises, the Self-Defense Forces, prisons, and all other facilities where meals were served. In 1954, the “Japan Society for the Improvement of Nutrition” was established to study methods of improving nutrition, and improvement of nutrition became the theme of scientific research.

In recent years, when I meet with representatives of countries suffering from malnutrition, I ask them, “Are there any nutrition experts in your country?” The representative of the country introduce me to a well-known nutritionist, who shows me the nutritional problems of the country and explains at length the results of his or her research on them. I then ask the following question.

“I understand that your research deserves a Nobel Prize. By the way, what are you going to do about those skinny children and those old men whose belts look like they are about to fall down that you see so often in this town?”

In many cases, I don’t get a decent answer.

There are so-called nutrition researchers all over the world, and the more serious the nutrition problem is in a country, the more famous the nutritionists are. By the same token, the country with the world’s best obesity research has the world’s highest obesity rates.. What I would like to know is whether or not there are nutritionists, or nutrition professionals, who can provide practical guidance on improving nutrition. In many countries, the training of nutritionists is inadequate, or their work is limited to medical treatment and they are positioned as leaders in dietary therapy. In Japan, more dietitians and nutritionists are trained than in any other country in the world, and they are placed not only in medical care but also in health and welfare facilities, contributing to health promotion and disease prevention.

Furthermore, one of the characteristics of nutrition in Japan is the contribution of the food industry. This is because the dawn of the modernization of the food industry in Japan occurred in many cases with the aim of improving the nutrition of the people. For example, Ajinomoto Co., Ltd developed a seasoning made from the umami ingredient (glutamic acid) discovered in kelp “dashi” by Dr. Kikunae Ikeda of Tokyo Imperial University, and popularized it as an easy and tasty way to make simple meals more palatable. Subsequent research led to the addition of umami to the four primary flavors. The founder of Ezaki Glico Co Ltd., Riichi Ezaki, collected glycogen from oyster broth and added it to caramel, and the founder of Yakult Honsha Co., Ltd Dr. Minoru Shirota, popularized “lactobacillus beverages” as a way to “contribute to the health of the people”. Dairy manufacturers such as Meiji, Morinaga, and Snow Brand worked to popularize milk and dairy products as foods that provided high-quality protein, vitamins, and minerals, which were in short supply at the time. School lunches, which are highly regarded internationally as a model of nutrition education for children, also began with milk served during lunch period after the war. The Takeda Pharmaceutical Company Lid fortified white rice with vitamin B1 to prevent beriberi, and Otsuka Pharmaceutical and Taisho Pharmaceutica popularized many kinds of nutritional foods. Oil and fat manufacturers such as Nisshin Oillio contributed to the westernization of meals by popularizing seasoning oil. Furthermore,

Kagome Co., Ltd. produced ketchup, an essential ingredient in Western-style meals, and House Foods and S&B Foods developed the technology to produce curry in Japan, which had been adopted by the British Navy as a highly nutritious and delicious dish. The Japanese food industry had a strong desire on the part of its founders to free people from poverty and make their diet richer and healthier.

Because Japan’s food processing technology and distribution system had not developed as much as those of advanced Western countries, local cuisine, which was mainly rice and items processed from locally produced ingredients, flourished and became traditional. In other words, in order to modernize the nation, the movement to improve nutrition was based on nutritional science. However, in the natural environment in each region, people did not oppose nature, but enjoyed the changes of the four seasons, devised cooking and preservation methods, and utilized seasonings to create delicious and healthy meals.

“Japan Nutrition” was a major project that demonstrated the comprehensive power of the “industry-government-academia collaboration” that has been called for in recent years. Such a comprehensive approach to nutrition was effective in resolving postwar nutritional deficiencies, and at the same time, because many citizens learned the importance of nutrition and the basics of healthy eating, it was also effective in preventing and eliminating obesity and metabolic syndrome, which emerged after Japan’s rapid economic growth.

The Japanese government changed the existing “ Science and Technology Basic Law” to the “ Science Technology Innovation Basic Law” starting in FY2021. The goal is not only to develop science and technology, but also to encourage research to implement the results, and ultimately to create innovation. The innovation is not limited to product development, but includes a broad range of activities that bring about major changes in society, creating new value and transforming society itself.

In April 2019 Kanagawa University of Human Services established the School of Health Innovation (SHI). Focusing on public health, the school aims to bring innovation to health, medicine, and welfare. In other words, the School seeks to create the next generation of health innovators, and as an affiliated institution of the entire university, it is an organization that performs think tank functions in order to support policy making and promote academic research and its social implementation. In addition to conducting policy research and making recommendations on health, medical care, and welfare, the institute promotes the establishment of innovative pre-disease and healthcare industries, and matches academic research with real-world issues to facilitate the social implementation of innovation.

We hope that in the future, all countries will be able to eliminate malnutrition and create nutritional and dietary innovation that is kind to the planet and to people, and to enable all people to live healthy and happy lives.

12.3 COVID-19 and Nutrition

In November 2019, a new type of coronavirus emerged, and by late January of the following year, it had spread to mainland China, followed by East Asia, Europe, and the rest of the world. On January 31, 2020, the WHO declared it a “public health emergency of international concern” and urged people around the world to take precautions. As of March 7, the spread of the disease had not stopped, with the number of infected people exceeding 100,000 worldwide, and on March 11, the WHO recognized that the spread of the disease was equivalent to a pandemic. The term “pandemic” is derived from the Greek word.

On April 7, 2020, amidst a flurry of policy announcements by the Japanese government, Prime Minister Abe declared a state of emergency because of the new coronavirus infection. All countries appealed to their citizens to stay at home and not to go out, and people disappeared from towns and cities, and were banned from eating out, going to school, traveling, and going to work. However, mankind has historically gone through this many times and survived, each time advancing science and culture and creating new social structures. The problem is that in this battle, many casualties occur, and the brakes are put on the activities of science, art, culture, etc. and it becomes impossible for some fields to function and they disappear.

There are hundreds of thousands of unknown viruses on the earth, and with the thawing of the frozen soil due to global warming and the development tropical forest areas, the opportunities for human contact with viruses are increasing. Each time a new virus emerges , people’s lives are affected, and it takes time for a vaccine to be developed. During an outbreak, in order to reduce the number of victims as much as possible, it is necessary to ensure good hygiene habits and to build up the body’s resistance. In order to enhance the body’s protective functions, it is essential to maintain good nutritional status. The Japan Dietetic Association sent out a message ahead of the rest of the world on April 3, 2020. The purpose of this message was to say, “Since many nutrients are involved in maintaining immunity, it is necessary to maintain a healthy diet even when daily life is restricted” (Table 12.1).

Table 12.1 Overcoming difficulties with the power of nutrition
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In addition COVID-19 has been found to be exacerbated by obesity associated with overnutrition. This is because the production of anti-inflammatory adiponectin from visceral adipocytes is reduced, leading to chronic inflammation of adipose tissue, and the disease is exacerbated by a cytokine storm, which causes the immune system to run amok when infected with a [the?] virus. Belanger and colleagues have shown that not only is obesity involved in the exacerbation of COVID -19, but obesity also puts people at risk for chronic diseases such as diabetes, and that these diseases are also factors in the exacerbation of COVID -19. Ultimately, access to a healthy diet is important for the prevention and moderation of COVID -19.

12.4 “Green Recovery” and Future Nutrition

The International Energy Agency (IEA) has reported a significant reduction in global greenhouse gas emissions as a result of COVID-19’s urban closings and travel restrictions. Ironically, COVID-19 reduced the burden on the global environment: in April 2020, the environment ministers of the EU and other countries proposed “Green Recovery” as a recovery plan for COVID-19. Green Recovery is a plan that aims to develop the post-COVID-19 reconstruction of the economy while reducing the emission of greenhouse gases that cause environmental impact.

What role should nutrition and diet play in a green recovery plan?

According to the FAO report “Livestock’s Long Shadow”, greenhouse gas emissions from transportation and livestock farming account for 13.5% and 18% of total emissions, respectively, indicating that meat-eating has a particularly large environmental impact. Livestock feed, manure and even burps increase the amount of emissions. In January 2019, the Lancet published “Food for the Anthropocene: The EAT Lancet Commission on Healthy Eating through Sustainable Food Systems”, which stated that meat consumption should be reduced to 14 g per day. This philosophy is the basis of the proposed “Planetary Healthy Diet”, in which half the plate consists of fruits, vegetables, and nuts, and the other half of whole grains, vegetable proteins, unsaturated vegetable oils, moderate amounts of meat and dairy products, and sugar and starchy vegetables.

In February 2019, Japan’s National Institute for Global Environmental Strategies, along with others, published “1.5-Degree Lifestyles: Targets and Options for Reducing Lifestyle Carbon Footprints”. The total amount of greenhouse gases emitted by an average Japanese person in a year is 7.6 tons per person. Of this, 2.4 tons are from housing and electricity, 1.6 tons from transportation, cars, etc., and 1.4 tons from food. Of the dietary sources, meat and milk and dairy products combined account for 0.5 ton, or 6.6% of the total emissions of Japanese people. This value is less than half of the global average of 14.5% as determined by FAO (Fig. 12.1).

Fig. 12.1
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Breakdown of Japanese carbon footprint by food group (2017)

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In other words, Japanese people consume protein from seafood and soybean products, and their consumption of meat, milk, dairy products, and other livestock is consequently low, so there is no need to restrict livestock as drastically as in the West. The Lancet Commission analyzed the diets of 20 industrialized countries from the viewpoint of environmental impact, and reported that in the case of the Japanese, both the current diet and the content of the dietary guidelines are the same as the ideal Planetary Healthy Diet (Fig. 12.2).

Fig. 12.2
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Japanese food has a low environmental impact and is similar to planetary diets ‘kg/person/year’

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12.5 Promoting Japan Nutrition at the “Tokyo Nutrition for Growth Summit 2021”

The Japanese government has announced that the Tokyo Nutrition Summit 2021 will be held in December. The summit will be hosted by the Japanese government and co-hosted by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Food Programme (WFP), the United Nations Children’s Fund (UNICEF), and the World Bank ; leaders and ministers from various countries are expected to attend.

The “Nutrition Summit” is an international effort to improve nutrition initiated by the United Kingdom and formed of the London Olympics.

Held for the first time in London in 2013, it was triggered by the “Hunger Summit” held by then British Prime Minister Cameron. The second time at the Rio de Janeiro 2016 Olympic Games, and it will be carried over as the “Tokyo Nutrition for growth Summit 2021”

The main themes of the summit are: Health: integrating nutrition into universal health coverage (UHC); Food: building healthy and sustainable food systems; Resilience: combating malnutrition in fragile situations; Accountability: data-based monitoring; and Finance: securing financial resources to improve nutrition.

At the “Tokyo Nutrition Summit 2021”, Japan’s approach to nutrition will be presented as a package. The Ministry of Health, Labor and Welfare (MHLW) aims to visualize the direction of Japan’s efforts in nutrition policy and to make international contributions in nutrition. Japan is a country that has tackled head-on the double burden of under-nutrition in the prewar and postwar periods and over-nutrition in the period of rapid economic growth, and has built a nation of longevity. The presentation will introduce the nutrition policy from the post-war reconstruction period to the present day, the nutrition policy in the context of an aging society with a low birthrate, disaster prevention nutrition that supports the life and livelihood of residents even in times of disaster, the training and activities of professionals such as dietitians, nutritionists, dietary life improvement promoters, and nutrition teachers, as well as the efforts of industry-government-academia collaboration. The Japan Dietetic Association plans to make a commitment to Asian and African countries suffering from malnutrition by providing assistance in the education and training of dietitians, who are key players in the eradication of malnutrition, and in the development of dietitian systems.

At present, the system to eradicate malnutrition world-wide is better prepared than ever before and the situation is gradually improving. I would like to call on this international conference to accelerate the speed of this process and the need for further expansion. It is significant that the Nutrition Summit is being held in Japan at such a time. While inheriting a traditional food culture that respects nature, Japan introduced nutritional science after the Meiji era (1868–1912), and solved malnutrition through comprehensive nutritional improvement. Even after its rapid economic growth, Japan worked on the prevention of obesity and non-communicable diseases, and formed a nation with a long and healthy life. We hope that Japan can contribute to the health and well-being of people around the world by introducing to the world this unique Japanese nutritional improvement that combines “culture and science”

I collectively called these things “Japan Nutrition” and decided to disseminate them to the world (Table 12.2).

Table 12.2 What is “Japan Nutrition”?
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