Abstract
BACKGROUND: The double burden of malnutrition is a growing public health problem in Japan. We estimated the dynamics of the energy imbalance gap (EIG) (average daily difference between energy intake and expenditure) to explain trends in the prevalence of underweight, overweight, and obese Japanese adults. METHODS: We used individual-level data on body height and weight from the National Health and Nutrition Surveys from 1975 to 2015. We calibrated a validated system dynamics model to estimate the EIG for Japanese adults aged 20 to 74 years by survey year, sex, and weight status classified by the body mass index (BMI). RESULTS: The overall EIG for men increased from 2.3 kcal/day in 1975 to 4.7 kcal/day in 1987 and then decreased to 2.3 kcal/day in 2015. The overall EIG for women consistently decreased from 4.3 kcal/day in 1975 to -0.5 kcal/day in 2015. By BMI class, the EIG for men with a BMI of <30 kg/m(2) began to decrease around 1990, indicating a deceleration in the prevalence of overweight and obese men. The EIG consistently decreased for women with a BMI of <25 kg/m(2) and reached negative values from the late 2000s to early 2010s, indicating a gradual decrease in the prevalence of overweight and obese women. CONCLUSIONS: The dynamics of the EIG were different across sex and weight groups. Public health interventions should target a further decrease in the EIG for normal-weight, overweight, and obese men and a stop in the decreasing trends of the EIG in underweight and normal-weight women.