Nutrient adequacy of Japanese schoolchildren on days with and without a school lunch by household income

  • Chika Horikawa University of Niigata Prefecture
  • Nobuko Murayama
  • Hiromi Ishida
  • Taeko Yamamoto
  • Sayaka Hazano
  • Akemi Nakanishi
  • Yumi Arai
  • Miho Nozue
  • Yukiko Yoshioka
  • Saori Saito
  • Aya Abe
Keywords: Japan, household income, schoolchildren, nutrient adequacy, dietary reference intakes


Background: Evidence for whether the nutrient intakes of Japanese schoolchildren differ according to household income is sparse.

Objective: We investigated the role of school lunches for nutrient adequacy among Japanese primary school children using dietary reference intakes in a cross-sectional survey.

Design: Participants were 10- to 11-year-old (5th grade) children from 19 public primary schools in four prefectures of East Japan, and 836 children were analyzed. The participants completed 24-h dietary records with photographs of their meals for 4 consecutive days, composed of 2 days with and 2 days without a school lunch. Children’s household income was obtained from questionnaires that were completed by the participants’ guardians and divided into the following three categories: low (0.2236–2.2361 million yen; n = 319), middle (2.3333–2.8868 million yen; n = 194), and high (3.1305–6.3640 million yen; n = 323). Logistic regression analyses were used to estimate the odds ratios for whether participants had poor nutrient intakes, with adjustment for confounders.

Results: On days without a school lunch, the prevalence of nutrient shortages was significantly higher compared with those on days with a school lunch for most macro- and micronutrients among all three levels of household income. Children from low-income households had higher rates of nutrient shortages for vitamin B6, pantothenic acid, K, Mg, P, Fe, and Zn than those from middle-income households on days without a school lunch (P = 0.004, 0.001, 0.001, 0.006, 0.037, <0.001, and 0.015, respectively), but those differences were not significant on days with a school lunch.

Conclusion: The findings suggest that school lunches are important for achieving adequate nutrient intakes in schoolchildren and reduce disparities of adequate nutrient intake by household income levels.


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  1. Cecil JE, Watt P, Murrie ISL, Wrieden W, Wallis DL, Hetherington M, et al. Childhood obesity and socioeconomic status: a novel role for height growth limitation. Int J Obes (Lond) 2005; 29(10): 1199–203. doi: 10.1038/sj.ijo.0803055.

  2. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr 2010; 91(5): 1499S–505S. doi: 10.3945/ajcn.2010.28701B

  3. Eccles JS. The development of children ages 6 to 14. Future Child 1999; 9(2): 30–44. doi: 10.2307/1602703.

  4. Westenhoefer J. Establishing dietary habits during childhood for long-term weight control. Ann Nutr Metab 2002; 46(Suppl. 1): 18–23. doi: 10.1159/000066396.

  5. Northstone K, Smith AD, Cribb VL, Emmett PM. Dietary patterns in UK adolescents obtained from a dual-source FFQ and their associations with socio-economic position, nutrient intake and modes of eating. Public Health Nutr 2013; 17(7): 1476–85. doi: 10.1017/S1368980013001547.

  6. Finger JD, Varnaccia G, Tylleskär T, Lampert T, Mensink GB. Dietary behavior and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS). BMC Public Health 2015; 15: 498. doi: 10.1186/s12889-015-1830-2.

  7. Novaković R, Cavelaars A, Geelen A, Nikolić M, Altaba II, Viñas BR, et al. Socio-economic determinants of micronutrient intake and status in Europe: a systematic review. Public Health Nutr 2014;17(5):1031–45. doi: 10.1017/S1368980013001341.

  8. Kwon Y, Oh S, Park S, Park Y. Association between household income and overweight Korean and American children: trends and differences. Nutr Res 2010; 30(7): 470–6. doi: 10.1016/j.nutres.2010.06.015.

  9. Organization for Economic Co-operation and Development. Divided we stand why inequality keeps rising. Paris: OECD; 2011.

  10. Kagamimori S, Gaina A, Nasermoaddeli A. Socioeconomic status and health in the Japanese population. Soc Sci Med 2009; 68(12): 2152–60. doi: 10.1016/j.socscimed.2009.03.030.

  11. Ministry of Health, Labour and Welfare of Japan. Comprehensive survey of living conditions 2016. 2017. Available from: [cited 17 September 2020].

  12. Okubo H, Miyake Y, Sasaki S, Tanaka K, Murakami K, Hirota Y, et al. Dietary patterns in infancy and their associations with maternal socioeconomic and lifestyle factors among 758 Japanese mother-child pairs: the Osaka Maternal and Child Health Study. Matern Child Nutr 2014; 10(2): 213–15. doi: 10.1111/j.1740-8709.2012.00403.x.

  13. Murayama N, Ishida H, Yamamoto T, Hazano S, Nakanishi A, Arai Y, et al. Household income is associated with food and nutrient intake in Japanese schoolchildren, especially on days without school lunch. Public Health Nutr 2017; 20(16): 2946–58. doi: 10.1017/S1368980017001100.

  14. Ministry of Health, Labour and Welfare of Japan. Dietary reference intakes for Japanese (2015). 2018. Available from: [cited 17 September 2020].

  15. Ministry of Education, Culture, Sports, Science and Technology Japan. School lunch survey in Japan 2018. 2019. Available from: [cited 17 September 2020].

  16. Ishida H. Role of school meal service in nutrition. J Nutr Sci Vitaminol (Tokyo) 2015; 61(Suppl): S20–2. doi: 10.3177/jnsv.61.S20.

  17. Ministry of Education, Culture, Sports, Science and Technology Japan. Standards for the school lunch program 2018. 2019. Available from: [cited 17 September 2020].

  18. Cullen KW, Chen T. The contribution of the USDA school breakfast and lunch program meals to student daily dietary intake. Prev Med Rep 2017; 5: 82–5. doi: 10.1016/j.pmedr.2016.11.016.

  19. Nguyen BT, Ford CN, Yaroch AL, Shuval K, Drope J. Food security and weight status in children: interactions with food assistance programs. Am J Prev Med 2017; 52(2S2): S138–44. doi: 10.1016/j.amepre.2016.09.009.

  20. Organization for Economic Co-operation and Development. Growing unequal? Income distribution and poverty in OECD country. Paris: OECD; 2008.

  21. Kondo N, Kawachi I, Hirai H, Kondo K, Subramanian SV, Hanibuchi T, et al. Relative deprivation and incident functional disability among older Japanese women and men: prospective cohort study. J Epidemiol Community Health 2009; 63(6): 461–7. doi: 10.1136/jech.2008.078642.

  22. Ministry of Education, Culture, Sports, Science and Technology, Japan. Standard tables of food composition in Japan 2010. 2020. [cited 17 September 2020].

  23. Ministry of Education, Culture, Sports, Science and Technology Japan. Manual for health checkup of school children. Revision in 2015. Tokyo: Gakko hokenkai; 2015.

  24. Dodd KW, Guenther PM, Freedman LS, Subar AF, Kipnis V, Midthune D, et al. Statistical methods for estimating usual intake of nutrients and foods: a review of the theory. J Am Diet Assoc 2006; 106(10): 1640–50. doi: 10.1016/j.jada.2006.07.011.

  25. Yokoyama T. Theory and application of statistical methods to estimate the distribution of usual intakes of a nutrient in a population: For the appropriate use of dietary reference intakes. Jpn J Nutr Diet 2013; 71(Suppl 1): S7–14. doi: 10.5264/eiyogakuzashi.71.S7.

  26. Agresti A. An introduction to categorical data analysis. Hoboken, NJ: Wiley-Blackwell; 1996.

  27. Asakura K, Sasaki S. School lunches in Japan: their contribution to healthier nutrient intake among elementary-school and junior high-school children. Public Health Nutr 2017; 20: 1523–33. doi: 10.1017/S1368980017000374.

  28. Murayama N. Advocacy activities at the local government level: establishing sodium restriction policies through data analysis and plan-do-check-act in cooperation with local government. Jpn J Health Educ Promot 2015; 23: 231–6. doi: 10.11260/kenkokyoiku.23.231.

  29. Ministry of Education, Culture, Sports, Science and Technology Japan. Report for the establishment of standards for the School Lunch Program 2018. 2019. Available from: [cited 17 September 2020].

  30. Ministry of Education, Culture, Sports, Science and Technology Japan. Standards for the School Lunch Program 2009. 2019. Available from: [cited 17 September 2020].

  31. Ministry of Education, Culture, Sports, Science and Technology Japan. Standards for the School Lunch Program 2013. 2019. Available from: [cited 17 September 2020].

  32. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004; 79(1): 6–16. doi: 10.1093/ajcn/79.1.6.

  33. Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review. Nutr Rev 2015; 73(10): 643–60. doi: 10.1093/nutrit/nuv027.

  34. Okubo H, Murakami K, Sasaki S. Monetary value of self-reported diets and associations with sociodemographic characteristics and dietary intake among Japanese adults: analysis of nationally representative surveys. Public Health Nutr 2016; 19(18): 3306–18. doi: 10.1017/S1368980016001695.

  35. Turrell G, Kavanagh AM. Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr 2006; 9(3): 375–83. doi: 10.1079/phn2006850.

  36. Ministry of Foreign Affairs of Japan. Explore Japan. Schools. Q. When are school vacations? How long do they last? 2020. Available from: [cited 17 September 2020].

How to Cite
Horikawa C., Murayama N., Ishida H., Yamamoto T., Hazano S., Nakanishi A., Arai Y., Nozue M., Yoshioka Y., Saito S., & Abe A. (2020). Nutrient adequacy of Japanese schoolchildren on days with and without a school lunch by household income. Food & Nutrition Research, 64.
Original Articles