Effects of Low-Calorie Diet Including High Protein-Low Carbohydrate Protein Bar on Weight Loss and Serum Lipid Indicators in Overweight Women according to Dietary Compliance / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to investigate the effect of a 6-week low-calorie diet (LCD) program including high protein-low carbohydrate protein bar on weight loss, blood pressure, and blood lipid profile in 40 overweight women according to dietary compliance.METHODS: Subjects were 62 healthy overweight women (BMI ≥ 23.0 or body fat percentage ≥ 28%), aged 20~59 yrs who were provided a high protein-low carbohydrate protein bar (each 35 g, 154 kcal, protein energy %: 28.6%, carbohydrate energy %: 38.7%) as part of dinner for 6 weeks. Forty subjects who completed the whole diet program were categorized into high compliance (HC) group (days of eating protein bar ≥ 5 weeks) or low compliance (LC) group (days < 5 weeks).RESULTS: Energy intake significantly decreased from 1,867.5 kcal at baseline to 1,137.4 kcal at 6 weeks for the HC group and from 1,971.7 kcal to 1,362.2 kcal for the LC group, respectively. On the other hand, a significant increase in protein energy percentage was observed in each group (HC group: 3.5%, LC group: 2.2%). Both groups showed significant decreases in weight (HC group: 1.8 kg, LC group: 1.1 kg), BMI, fat mass, systolic blood pressure, total cholesterol, and LDL-cholesterol. Reduction of body fat percentage and diastolic blood pressure were only observed in the HC group.CONCLUSIONS: The inclusion of a high protein-low carbohydrate protein bar as part of a low-calorie diet for a short period can be effective to achieve weight loss and concomitantly improve blood cholesterol level without serious physiological side effects. More evident results can be achieved by eating a diet with low calorie diet including high protein-low carbohydrate protein bar for more than 5 weeks.

Risk of Metabolic Syndrome according to Intake of White Rice and Kimchi in Korean Adults: based on the 6th Korea National Health and Nutrition Examination Survey, 2013–2015 / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to examine the relationship between white rice and Kimchi intakes and the risk of metabolic syndrome (Mets) in Korean adults. METHODS: Dietary intake and health data of 8289 subjects aged 19 years and over from the 2013–2015 Korea National Health and Nutrition Examination Survey (KNHANES) were used. Daily total intake of white rice and Kimchi was assessed by 24-hour recall data. Multivariate logistic regression analysis was used to estimate the risk of Mets according to the daily intake of white rice and Kimchi. RESULTS: The highest intake of white rice and Kimchi was associated with a higher risk of metabolic syndrome (Q1 vs Q5, multivariable adjusted OR=1.45, 95% CI: 1.03–2.03) in women. In addition, a significantly increased risk of elevated blood pressure (multivariable adjusted P for trend 0.0459) was associated with a higher intake of white rice and Kimchi in women. There was no significant trend in the risk of metabolic syndrome according to the intake of white rice and Kimchi in men. CONCLUSIONS: A higher intake of white rice and Kimchi was only associated with an increased risk of metabolic syndrome in women indicating it is necessary to consume more various food groups beside white rice and Kimchi, especially in women.

Risk of Metabolic Syndrome according to Intake of White Rice and Kimchi in Korean Adults: based on the 6th Korea National Health and Nutrition Examination Survey, 2013–2015 / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to examine the relationship between white rice and Kimchi intakes and the risk of metabolic syndrome (Mets) in Korean adults. METHODS: Dietary intake and health data of 8289 subjects aged 19 years and over from the 2013–2015 Korea National Health and Nutrition Examination Survey (KNHANES) were used. Daily total intake of white rice and Kimchi was assessed by 24-hour recall data. Multivariate logistic regression analysis was used to estimate the risk of Mets according to the daily intake of white rice and Kimchi. RESULTS: The highest intake of white rice and Kimchi was associated with a higher risk of metabolic syndrome (Q1 vs Q5, multivariable adjusted OR=1.45, 95% CI: 1.03–2.03) in women. In addition, a significantly increased risk of elevated blood pressure (multivariable adjusted P for trend 0.0459) was associated with a higher intake of white rice and Kimchi in women. There was no significant trend in the risk of metabolic syndrome according to the intake of white rice and Kimchi in men. CONCLUSIONS: A higher intake of white rice and Kimchi was only associated with an increased risk of metabolic syndrome in women indicating it is necessary to consume more various food groups beside white rice and Kimchi, especially in women.

Risk of Metabolic Syndrome according to Intakes of Vegetables and Kimchi in Korean Adults: Using the 5th Korea National Health and Nutrition Examination Survey, 2010–2011 / 대한지역사회영양학회지

OBJECTIVES: The objective of this study was to examine the relations between total vegetable and Kimchi intakes and the risk of metabolic syndrome (Mets) in Korean adults. METHODS: This study used dietary intake and health data of 6668 subjects aged 20 years and over from the 2010–2011 Korea National Health and Nutrition Examination Survey (KNHANES). Daily intakes of total vegetables and Kimchi were assessed by 24-hour recall data. The odds ratio of Mets risk according to daily intake of vegetables and Kimchi was analyzed, respectively. RESULTS: The highest consumption of total vegetables was associated with a lower risk of abdominal obesity (multivariable adjusted OR=0.56, 95% CI: 0.33, 0.93) in men and lower risk of Mets (multivariable adjusted OR=0.67, 95% CI: 0.47, 0.94) in women. Kimchi consumption was not related to the risk of Mets in both men and in women. However, a higher intake of Kimchi was associated with an increased risk of elevated blood pressure (Q1 vs Q5, multivariable adjusted OR=1.34, 95% CI: 0.95, 1.90, P for trend= 0.0261) in women. CONCLUSIONS: A higher intake of vegetables was associated with decreased risk of abdominal obesity and Mets in both men and women, respectively. A higher consumption of Kimchi was not related to the risk of Mets in both in men and in women. However, a higher intake of Kimchi was associated with an increased risk of elevated blood pressure in women.

Blood Pressure and Dietary Related Risk Factors Associated with High Sodium Intake Assessed with 24-hour Urine Analysis for Korean Adults / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to examine blood pressure and other characteristics of a high sodium intake group assessed with 24-hr urine analysis and the dietary factors related to the risk of high sodium intake among Korean adults. METHODS: A cross-sectional study was conducted with adults aged 20-59 years. Subjects who completed 24-hr urine collection (N = 205) were divided into 3 groups (tertile) according to the sodium intake estimated with 24-hour urine analysis. We compared the blood pressure, BMI and dietary related factors of the 3 groups (low, medium, high sodium intake group) with General Linear Model (GLM) and Duncan's multiple range test (p or = 25) (OR = 2.619; 95% CI: 1.368-5.015), current alcohol consumption (OR = 1.943; 95%CI: 1.060-3.564), and having salty soybean paste with salt percentage > 14% (OR = 3.99; 95% CI: 1.404-6.841). The dietary attitude related to increased risk of high sodium intake included 'enjoy dried fish and salted mackerel' (p < 0.001) and 'eat all broth of soup, stew or noodle' (p < 0.001). CONCLUSIONS: Because high sodium intake was associated with higher blood pressure, nutrition education should focus on alcohol consumption, emphasis on related dietary factors such as using low salt soybean paste, improvements in the habit of eating dried fish and salted mackerel or eating all broth of soup, stew or noodle.

Blood Pressure, Sodium Intake and Dietary Behavior Changes by Session Attendance on Salt Reduction Education Program for Pre-hypertensive Adults in a Public Health Center / 대한지역사회영양학회지

This study was performed to evaluate the differences in blood pressure, sodium intake and dietary behavior changes according to the extent of session attendance on sodium reduction education program for pre-hypertensive adults in a public health center. Sodium reduction education program consisted of 8 sessions for 8 weeks. Fifty three patients who completed the pre and post nutritional assessments were classified into 2 groups according to the session attendance rate. Nineteen participants who attended the education program 3 times or less ( or = 4) into the more attendance (MA) group. Blood pressure, anthropometric measurements, serum lipid profile, nutrient intakes including sodium, nutrition knowledge and dietary behavior score were assessed before and after the nutrition education program. Mean sodium intakes (p < 0.001), systolic/diastolic blood pressure (p < 0.001), and weight (p < 0.001) were significantly decreased in the MA group after sodium reduction education program. Compared to the MA group, mean sodium intakes, systolic/diastolic blood pressure were not significantly changed after the education program even with significantly increased nutrition knowledge (p < 0.05) and dietary behavior score (p < 0.01) in the LA group. It appears that pre-hypertensive adults need to attend the sodium reduction education program for at least 4 times or more to gain beneficial effects from the intervention. Positive feedback of healthcare team or offering more cooking classes may be needed to raise the attendance rate in the sodium reduction education program.

The Effect of Sodium Reduction Education Program of a Public Health Center on the Blood Pressure, Blood Biochemical Profile and Sodium Intake of Hypertensive Adults / 대한지역사회영양학회지

This study was conducted to investigate the effect of sodium reduction education program of a public health center on the blood pressure, blood biochemical profile and sodium intake of hypertensive adults. The program continued for 16 weeks with an 8-week nutrition education and an 8-week follow-up to forty two subjects, 6 males and 36 females aged 46 to 80 years. Subjects received nutrition education including lectures, activities, cooking classes and nutrition counseling. Physical fitness, management of stress, and nutrition counseling were provided during the follow-up. The program was evaluated three times, before and after the nutrition education, and after the follow-up. Systolic blood pressure (p < 0.0001) and diastolic blood pressure (p < 0.001) were decreased after completion of the program. Body weight (p < 0.005), percent body fat (p < 0.005) and body mass index (p < 0.001) were decreased, too. There were no significant differences in blood glucose, HDL-cholesterol and triglycerides, while elevated levels of total cholesterol (p < 0.001) and LDL-cholesterol (p < 0.001) appeared after the program completion. Decreased intakes of vitamin A (p < 0.05), beta-carotene (p < 0.001) and sodium (p < 0.001) were observed. Consumption frequency of noodles, soups, stews, kimchi, fishes/shellfish, seasoned vegetables, and salted seafoods/pickles (p < 0.05~p < 0.001) were decreased, while that of all food groups were not changed during the follow-up. Total score of nutrition knowledge related to sodium intake and hypertension (p < 0.001), and that of dietary behavior associated with high sodium intakes were changed positively (p < 0.001) only during the nutrition education. This sodium reduction education program, including the follow-up study showed positive effects on the blood pressure, sodium intake, nutrition knowledge and dietary behavior of hypertensive adults.

A Study on the Health and Nutritional Characteristics according to Household Income and Obesity in Korean Adults Aged over 50: Based on 2005 KNHANES / 대한지역사회영양학회지

This study investigated the health and nutritional characteristics according to household income level and obesity in Koreans aged over 50 years based on the 2005 National Health and Nutrition Examination Survey. Subjects were classified into 3 groups by average household income with reference to the minimum monthly living expenses (MLE): low (n = 319, or = 200% MLE) and each group was compared by BMI index. With increasing income level, the prevalence of systolic hypertension and hyperlipidemia was increased. In the low income group, serum total cholesterol, triglycerides, and fasting glucose were higher in the obese compared with the normal. In the middle and high income groups, the prevalence of hyperlipidemia and diastolic hypertension were higher in the obese. Subjects had nutritional imbalance, such as inadequate intake of calcium and potassium. With increasing income level, the percentages of protein and fat to total calorie were increased in addition to the intakes and density of nutrients. The obese in the low income group had higher intakes of energy, protein, phosphorus and higher consumption frequency of cereals and potatoes compared with the normal. It was shown that the obese of the middle and high income groups tended to have lower consumption frequency of Korean cabbage and higher frequency of fruits. The obese of high income group also had binge drinking habit. Therefore, this study suggests that specific approaches based on economic status should be considered in developing nutrition education program for the elderly.

Dietary and Lifestyle Factors Associated with Hypertension in Korean Adolescents: Based on 2005 Korean National Health and Nutrition Examination Survey / 대한지역사회영양학회지

This study was performed to determine dietary and lifestyle factors associated with hypertension in Korean adolescents. Study subjects were 12~19 years (n = 521) adolescents who participated in the 2005 Korean National Health and Nutrition Examination Survey (KNHANES III). Subjects were divided into the hypertensive group (HG, n = 102) and normotensive group (NG, n = 419) by '2007 Korean children and adolescents growth standard' and the relationships between blood pressure and physical measurement, nutrients intakes, eating behaviors and health related factors were analyzed. HG showed significantly higher levels in weight, waist circumference and BMI than NG. The amount of nutrient intakes was not different between NG and HG. Index of nutritional quality (INQ) for phosphate was higher in HG compared with NG. In both male and female HG, INQ for iron was higher but INQ for vitamin B1 was lower than NG. HG revealed higher consumption frequencies of snack, yoghurt, and ice cream compared with NG. In eating and behavioral factors, 'dinner with family', 'eat proper amount', 'keep Korean traditional diet', alcohol drinking, and mean alcohol intake were significantly different between the two groups. By logistic regression method, risk factors for hypertension revealed in this study were gender (male), age (15~19 years), BMI (> or = 85 percentile), and not keeping Korean traditional diet. These results suggest that education program for hypertension prevention in adolescents should include eating habits improvement and lifestyle modification as well as weight control.

Health and Nutritional Factors Related to Hypertension of Subjects Aged Over 50 in High Income Class : Based on the 2005 Korea National Health and Nutrition Examination Survey

This study was performed to determine the health and nutritional risk factors associated with hypertension in Koreans over the age of 50 in a high-income class (more than twice as much family income as the 2005 Korean minimum cost of living, 668,540 Won). A total of 505 subjects aged over 50 from the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) were divided into two groups: A hypertension group (HG) (N=151, Systolic Blood Pressure > or = 140 mmHg or Diastolic Blood Pressure > or = 90 mmHg) and normal group (NG) (N=354). Subjects who took hypertension medicines or underwent diet therapy were excluded. In HG, mean daily alcohol intake and the amount of alcohol consumption per one occasion were significantly higher than in NG, respectively. A greater number of hypertension subjects answered that they drank alcohol to reduce stress as compared to normal subjects. HG also took fewer dietary supplements than NG. Mean body mass index (BMI), waist circumference, fasting blood sugar level, and 2 hour postprandial blood sugar following a glucose load were significantly higher in HG than in NG, respectively. Also, iron, thiamin, and niacin intakes and the consumption frequency of seaweeds were significantly lower in HG than in NG, respectively. Finally, obesity (BMI > or = 25 kg/m2), abdominal obesity (waist circumference > or = 90 cm for males, > or = 80 cm for females), high blood sugar level 2 hours after an oral glucose load (> or = 140~200 mg/dl), and hypertriglyceridemia (serum TG > or = 200 mg/dl) were related to a significantly higher risk of hypertension in the subjects (odds ratio: 1.884~3.040). In conclusion, dietary factors such as higher alcohol consumption; lower intakes of iron, thiamin, and niacin; lower consumption frequency of seaweeds; and metabolic syndrome were associated with hypertension in the study subjects.

Comparison of Dietary Behaviors Related to Sodium Intake by Gender and Age / 대한지역사회영양학회지

This study was performed to understand recognition and behaviors related to sodium intake of Korean adults. The data were collected from subjects including 267 male and 285 female adults in nationwide and compared by gender and by age. We found that the male group showed significantly higher smoking, alcohol drinking, and exercise does the female group. The older group (40 to 59 years) revealed significantly higher exercise and lower alcohol drinking; however general disease and hypertension prevalence, diet therapy practice, and meditation for hypertension were higher. Recognizing sodium levels of foods containing high-sodium, and sodium-nutriture labels when purchasing foods, and knowing differences between salt and sodium of the male group or recognizing sodium levels of foods containing high-sodium of the older group was worse than the other. Among the 32 food behaviors, only 12 were identified as significantly correlated to sodium intake levels including behaviors of preferring Chinese and Japanese foods to Western foods, preferring kimchi to raw vegetables, completely consuming soup, stew, noodle liquid, liking of dried fish and salted mackerel, frequent eat-outs or delivered foods, and so forth. There were significant differences between gender or age groups in terms of sodium intake-increasing behaviors; the male group showed higher behaviors of preferring salty taste and eating all broths. And the older group revealed higher behavior of adding table salt as well as the previous two, however, the younger group showed more behaviors of eat-outs or delivered foods and not the liquid of kimchi.

Agreements between Indirect Calorimetry and Prediction Equations of Resting Energy Expenditure in End-Stage Renal Disease Patients on Continuous Ambulatory Peritoneal Dialysis

PURPOSE: Equations are frequently used to estimate resting energy expenditure (REE) in a clinical setting. However, few studies have examined their accuracy in end-stage renal disease (ESRD) patients. PATIENTS AND METHODS: To investigate agreement between indirect calorimetry and several REE estimating equations in 38 ESRD patients on peritoneal dialysis, we performed indirect calorimetry and compared the results with REEs estimated using 5 equations [Harris-Benedict (HBE), Mifflin, WHO, Schofield, and Cunningham]. RESULTS: Measured REE was 1393.2 +/- 238.7kcal/day. There were no significant differences between measured and estimated REEs except Mifflin (1264.9 +/- 224.8kcal/day). Root mean square errors were smallest for HBE, followed by Schofield, Cunningham, and WHO, and largest for Mifflin (171.3, 171.9, 174.6, 175.3, and 224.6, respectively). In Bland-Altman plot, correlation coefficients between mean values and differences were significant for HBE (r=0.412, p=0.012) and tended to be significant for Cunningham (r=0.283, p=0.086). In DM patients and patients with overhydration, HBE showed significant underestimation when REE increased. CONCLUSION: In ESRD patients on continuous ambulatory peritoneal dialysis (CAPD), REE-estimating equations have no significant differences from indirect calorimetry, except Mifflin. However, HBE showed greater bias than others when REE was high.

Sodium Intakes of Korean Adults with 24-hour Urine Analysis and Dish Frequency Questionnaire and Comparison of Sodium Intakes According to the Regional Area and Dish Group / 대한지역사회영양학회지

This study was performed to assess the sodium intakes of Korean adults using a 24-hr urine analysis and dish frequency questionnaire (DFQ) according to each dish group and the regional area. The subjects of this study were comprised of 552 adults (male: 267, female: 285), aged 20-59yr residing in the metropolitan area (N = 200), Chungcheng-Do (N = 117), Jeolla-Do (N = 117), and Gueongsang-Do provinces (N = 118). The subjects were recruited from the residents who once participated or are participating in the various health programs offered by the public health center. The number of subjects who completed the 24-hr urine collection was 205 (male : 110, female : 95).The mean age and BMI of the subjects were 39.0+/-11.7 y and 23.1+/-2.9 kg/m2, respectively. The mean systolic and diastolic blood pressure was 119.5+/-15.4 mmHg, and 77.1+/-11.1 mmHg, respectively. Eighteen percent of the subjects responded that they are currently smoking, 36% drinking and 50.4% exercising. Twenty point six percent of the subjects were assessed as having hypertension according to their systolic or diastolic blood pressure(SBP > or = 140 mmHg or DBP > or = 90 mmHg) measurements in the present study. Salt intake of the subject estimated with 24-hr sodium excretion was 12.7 g/d (male : 13.4 g/d, female : 12.1 g/d) based on the sodium excretion rate as 82%. Salt intake estimated with DFQ was 14.7 g/d (male : 16.2 g/d, female : 13.4 g/d), 2 g more than the salt intake estimated with 24-hr urine analysis. The four dish groups that contributed most to the sodium intake in order were kimchi (I1571.4mg), soup and stew (1260.5 mg), fish and shellfish (706.3 mg) and noodle and ramyeon (644.3mg). Salt intake estimated with DFQ was the highest in the subjects of Gueongsang-Do (17.0 g/d), second highest Chungcheong-Do (16.4 g/d) and the lowest in the metropolitan area (13.0 g/d). Subjects of Gueongsang-Do showed the highest sodium intakes in most of the dish group, whereas subjects of the metropolitan area showed the lowest. Residents of Chuncheong-Do revealed the highest sodium intake with kimchi and ofJeolla-Do the higher sodium intake with the main dish (meat, fish and beans). The highest salt percentage of kimchi (3.0+/-0.8%) and soybean paste (14.5 +/-5.1%) were observed in Gueongsang-Do, whereas individuals of the metropolitan area were observed as having kimchi (1.6 +/-0.5%) and soybean paste (7.4 +/-1.6%) with the lowest salt percentage. Men were observed as having more salty kimchi (2.4 +/-0.1%) than women (2.1 +/-0.1%).

Development and Evaluation of Validity of Short Dish Frequency Questionnaire (DFQ) for Estimation of Habitual Sodium Intake for Korean Adults / 대한지역사회영양학회지

The aim of this study was to develop various types of a dish frequency questionnaire (DFQ) for estimating the habitual sodium intake and to evaluate the validity of a 125 item dish frequency questionnaire (DFQ 125) with the DFQ 70, DFQ 36 and DFQ 15. For the DFQ 125, one hundred and twenty five dish items were selected based on the information of sodium content of a one serving size, consumption frequency and dish items that contributed most to the variation of sodium intake. Frequency of consumption was determined through nine categories ranging from more than 3 times a day to almost never to indicate how often the specified amount of each food item was consumed during the past 6 months. The sodium intake estimated with DFQ 125 was 5775.0 +/- 3636.3mg, 12.6% higher than that estimated with a 24 hr urine analysis (5009.7 +/- 1541.9mg) and significant correlation was observed between them (r = 0.3315, p < 0.001). When sodium content in broth leftover was subtracted from the total intake, the actual sodium intakes was decreased to 5309.6 +/- 3076.6mg, which was 3.2% higher than that with a 24-hr urine analysis. Overall, 56% of subjects in the lowest quintile of sodium intake computed with DFQ 125 were also in the lowest of adjacent quintile while categorization into the opposite quintile were 4.9%. DFQ 70 was developed from DFQ 125 by omitting the food items not frequently consumed, selecting the dish items that showed higher sodium content per one portion size and higher consumption frequency. The sodium intake estimated with DFQ 70 (5026.6 +/- 3107.1mg) showed only 0.2% difference from that estimated with a 24-hr urine analysis, significant correlation with it (r = 0.3199, p < 0.001) and higher proportion of subjects to be classified into the same or adjacent quintile. The sodium intake estimated with DFQ 36 or DFQ 15 was also significancy correlated with that estimated with a 24-hr urine analysis (r = 0.3441, p < 0.001; r = 0.321, p < 0.001 respectively) and more. The proportion of subjects was classified into the same or adjacent quintile. However, the actual sodium intake estimated with DFQ 36 or DFQ 15 were 3534.0 +/- 1804.6mg and 2508.0 +/- 1261.5mg, respectively, 31.3% or 51.3% less than that estimated with a 24-hr urine analysis. It seems the DFQ 125 with subtraction of sodium content in broth leftover or DFQ 70 can be used quantitatively to estimate sodium intake of adults. DFQ 36 or DFQ 15 can be used as a screening tool or to assess the changes of sodium intake after nutrition education.

Dietary Underreporting from the 2001 Korean National Health and Nutrition Survey

BACKGROUND: Underreporting in self-reported dietary survey is a potential source of bias in nutritional epidemiology. We assessed if dietary underreporting existed in the 2001 Korean National Health and Nutrition Survey (KNHANS) and evaluated the health related factors and nutrients associated with dietary underreporting. METHODS: The subjects were 2,552 men and 3,335 women, 18 years of age or older, with a complete 24 hour recall and physical examination data including height and weight. Basal metabolic rate (BMR) was calculated from weight and height using WHO equations. Questionnaire to assess daily physical activity and regular exercise was done. EI/BMR ratio was used to evaluate dietary underreporting. RESULTS: The mean EI/BMR ratio of Korean men and women were 1.43+/-0.56 and 1.41+/-0.57, respectively. Among the total, 20.6% of men and 22.8% of women reported their energy intake lower than their BMR. Age was negatively related with EI/BMR ratio only in women (P<0.001). Body mass index, education level, and household income were negatively and daily physical activity was positively associated with the EI/BMR ratio in both sexes. Lower EI/BMR ratio was significantly associated with lower reported fat energy density (% of energy intake) and higher reported carbohydrate and protein energy densities. The EI/BMR ratio was related negatively with nutrient energy densities of Vitamin C, Calcium, and Iron. CONCLUSION: We could confirm selective dietary underreporting in the 2001 KNHNS. Caution should be paid on the interpretation of the nutrition survey data and efforts should be exercised to reduce dietary underreporting at data collection stages.

Nutritional Status of Continuous Ambulatory Peritoneal Dialysis Patients

Dialysis patients are at risk of malnutrition not only because of losses of nutrients during peritoneal dialysis but also because of anorexia that results in inadequate nutrient intakes. The aim of this study was to estimate the nutritional status of 154 patients receiving continuous ambulatory peritoneal dialysis (CAPD), especially focused on protein-energy malnutrition and vitamin and mineral status. The mean age of the subjects was 51.2 +/- 12.4 y with educational years of 12.3 +/- 0.4 y for male and 9.6 +/- 0.4 y for female. The mean duration of dialysis was 22.7 +/- 21.7 mo. The causes of renal failure included diabetes (32.7), chronic glomerulonephritis (15.0%), and hypertension (8.5%). The main complications associated with chronic renal failure were hypertension (86.1%), diabetes (35.4%) and liver disease (9.0%). The mean daily energy intake was 1216.8 +/- 457.3 kcal and increased to 1509.2 +/- 457.2 kcal when added with the energy from dextrose in dialysate. The latter was still much lower than estimated energy requirement but energy intake per kg of body weight (28.1 kcal/1 g) was within the range of that recommended for CAPD patients' diet therapy (25 - 30 kcal/kg). The average daily intake of protein was 49.2 +/- 25.1 g with 37.6% of the patients showing their intakes less than Estimated Average Requirement. The average protein intake per kg of weight was 0.9 g/kg, which is less than that recommended for CAPD patients (1.2 - 1.5 g/kg) with mean serum albumin level 3.2 +/- 0.5 g/dl. The proportion of the patients with dietary calcium intake less than EAR was 90.9%, but when added with supplementary calcium (phosphorus binder), most patients showed their total calcium intake between EAR and UL. Fifty percent of the patients were observed with dietary iron intake less than EAR, however most patients revealed their total iron intake with supplementation above UL. The addition of folic acid with supplementation increased mean total folic intake to 1126.0 +/- 152.4 microgram and ninety eight percent of the subjects showed their total folic acid intake above UL. The prevalence of anemia was 83.1% assessed with hemoglobin level, even with high intakes of iron with supplementation. Thirty four percent of the patients showed their fasting blood glucose was not under control (> or = 126 mg/dl) even with medication or insulin probably due to dextrose from dialysate. The mean blood lipid levels were within the reference levels of hyperlipidemia, but with 72.1% of the patients showing lower HDL-C. In conclusion, Fairly large proportion of the patients were observed with protein malnutrition with low intake of protein and serum albumin level. Few patients showed their vitamins and minerals intake less than EAR with supplementation. For iron and folic acid, their intakes were increased to above UL for large proportion of the patients. However, more than eighty percent of the patients were still anemic associated with decreased renal function. The serum blood glucose and lipid level were not under control for some patients with medication. It seems that supplementation and medications that patients are taking should be considered for dietary consulting of CAPD patients.

The Effect of 6 Month Alphacalcidol Treatment or Nutrition Education on the Nutrient Intakes, Bone Mineral Density and Bone Markers in Continuous Ambulatory Peritoneal Dialysis Patients / 대한지역사회영양학회지

This study was performed to estimate the effect of alphacalcidol supplementation or nutrition education on the nutrient intakes, bone mineral density and bone markers in continuous ambulatory peritoneal dialysis (CAPD) patients. The 90 CAPD subjects were randomly assigned to 3 groups (alphacalcidol group: AG, nutrition education group: NG, and control group: CG). Alphacalcidol supplementation(0.5 microgram/day) was carried out for 8 months. Nutrition counseling was performed according to the patient's individual question for the first 6 months and scheduled nutrition education with individual counseling was carried out for the last 2 months. In baseline data, there were no significant differences in age, sex, family number, education years and monthly income except the NG showed significantly less duration of CAPD (p <0.05) compared to other two groups. After intervention all three groups showed tendency of lower intakes. NG revealed less decrease in protein, especially in animal protein, calcium from Ca-P binder, dietary calcium, dietary iron and niacin. NG showed significantly more increase in dry weight (p <0.05) and AG in waist circumference (p <0.001) after intervention. The groups did not show significant differences in the changes of biochemical indices related to bone metabolism. NG revealed more increase in trochanter BMD (p <0.05) compared to other two groups. It seems that nutrition education is more effective in preventing deterioration or improving the bone and general nutrition status.

Dietary Risk Factors Associated with Hypertension in Patients / 대한지역사회영양학회지

This study was performed to determine the dietary risk factors associated with hypertension. The hypertensive group were composed of 112 hypertensive patients (male 53, female 59) who first visited the hypertension clinic and had been diagnosed as having primary hypertension (SBP > or = 140 mmHg or DBP > or = 90 mmHg). The regular visitors or the subjects on special diets or medical therapies were excluded. The normal group consisted of as subjects (male 41, female 54) matched with age and socioeconomic levels. The subjects having higher intakes (above the 75 percentile) in energy, protein, iron, vitamin A or C showed significantly higher hypertension risk estimated with odds ratio after the covariance factors (age, sex and BMI) were adjusted. More than 2400 mg of sodium (6 g of salt) intake was associated with significantly higher risk of hypertension (odds ratio: 1.773, CI: 1.014 - 3.014 for SBP > or = 140 mmHg; odds ratio: 2.373, CI: 1.359 - 4.215 for DBP > or = 90 mmHg). Hypertensive group showed significantly increased intakes of vegetables and fish and shell fish compared to the normal group. When the vegetable intakes were classified into Kimchi, fresh vegetables and cooked vegetables with seasoning, the hypertensive group was observed as having higher intakes of Kimchi and cooked vegetables with seasoning. The intakes of highest quartile for vegetables (> or = 327 g/day)(odds ratio: 3.164, CI: 1.740 - 5.752), fish and their products (> or = 102 g/day)(odds ratio: 2.756, CI: 1.486 - 5.109), grains(> or = 311 g/day)(odds ratio 2.393, CI: 1.186 - 4.832), meats and their product (> or = 106 g)(odds ratio: 2.210, CI: 1.225 - 3.987) compared to the lower were significantly associated with the higher risk of hypertension estimated with DBP (> or = 90 mmHg) after covariance factors were adjusted. In conclusion, our findings confirm that higher intake of energy or sodium are associated with the increased risk of hypertension. Because increased intake of vegetable or fish was associated with the higher risk of hypertension, in contrast with the finding of western countries, choosing or preparation of vegetables or fish with reduced salt is recommended.

Effect of 12-week Low Calorie Diet and Behavior Modification on the Anthropomeric Indices and Biochemical Nutritional Status of Obese Woman / 대한지역사회영양학회지

This study was conducted to investigate the effect of a 3 week low calorie diet (LCD) and a 9 week of behavior modification (BM) program on the weight loss, mineral and vitamin status in 22 obese women. The subject were healthy, obese (PIBW > 120%) women aged 20 - 50 Yr and not taking any medications known to influence body composition, mineral or vitamin metabolism During the LCD program, subjects were provided commercial liquid formulas with 125 kcal per pack and were instructed to have a formula for replacement of one meal and at least one regular meal per day within the range of daily 800 - 1200 kcal intake. During the BM program the subjects weekly attended the group nutrition counseling session to encourage themselves to modify their eating behavior and spontaneously restrict their energy intakes. The BM program focused on stimulus control, control of portion sizes and modification of binge eating and other adverse habits. The initial mean energy intake of subjects was 2016.9 +/- 129.8 kcal (100.8% of RDA) and dropped to 1276.5 +/- 435.7 kcal at the end of a 3 week of LCD program and elevated to 1762 +/- 329.3 kcal at the end of a 9 week of BM program. Carbohydrate, protein and fat intakes were significantly decreased at the end of the LCD but carbohydrate was the only macro nutrient that showed significant decrease (p < 0.05) at the end of the BM program compared to baseline. Calcium and iron intakes decreased significantly (p < 0.01, respectively) with no significant changes in other micronutrients at the end of the LCD. The mean weight of the subjects decreased from 73.8 +/- 8.0 kg to 69.2 +/- 7.7 kg with LCD and ended up with 67.7 +/- 7.1 kg after 9 weeks of BM. The 3 weeks of LCD reduced most of the anthropometric indices such as BMI, PIBW, fat weight, wast-to-hip ratio and subscapular and suprailiac skinfold thickness. The 9 weeks of behavior modification showed slight change or maintenance of each anthropometric measurements. Weight loss and decreased WHR with the diet program induced significantly decreased systolic blood pressure. SGOT, SGPT and serum insulin levels with improved serum lipid profiles. Biochemical parameters related to iron status such as hemoglobin, hematocrit were significantly decreased (p < 0.01) at the end of the LCD. But their mean values were within normal range. The mean serum 25 (OH) vitamin D3 level significantly increased after whole diet program. Serum folate level significantly decreased after 12 weeks of diet program. In conclusion 3 weeks of LCD brought 4.6 kg reduction in body weight without risk of iron, zinc or vitamin D deficiency and 9 weeks of the BM was effective to maintain nutritional status with slightly more weight reduction (1.5 kg). However calcium intake and serum folate should be monitored during the LCD and BM because of increased risk of deficiencies..

Development and Evaluation of Validity of Dish Frequency Questionnaire (DFQ) and Short DFQ Using Na Index for Estimation of Habitual Sodium Intake / 대한지역사회영양학회지

The assessment of sodium intake is complex because of the variety and nature of dietary sodium. This study intended to develop a dish frequency questionnaire (DFQ) for estimating the habitual sodium intake and a short DFQ for screening subjects with high or low sodium intake. For DFQ112, one hundred and twelve dish items were selected based on the information of sodium content of the one serving size and consumption frequency. Frequency of consumption was determined through nine categories ranging from more than 3 times a day to almost never to indicate how often the specified amount of each food item was consumed during the past 6 months. One hundred seventy one adults (male: 78, female: 93) who visited hypertension or health examination clinic participated in the validation study. DFQ55 was developed from DFQ112 by omitting the food items not frequently consumed, selecting the dish items that showed higher sodium content per one portion size and higher consumption frequency. To develop a short DFQs for classifying subjects with low or high sodium intakes, the weighed score according to the sodium content of one protion size was given to each dish item of DFQ25 or DFQ14 and multiplied with the consumption frequency score. A sum index of all the dish items was formed and called sodium index (Na index). For validation study the DFQ112, 2-day diet record and one 24-hour urine collection were analyzed to estimate sodium intakes. The sodium intakes estimated with DFQ112 and 24-h urine analysis showed 65% agreement to be classified into the same quartile and showed significant correlation (r = 0.563 p < 0.05). However, the actual amount of sodium intake estimated with DFQ112 (male: 6221.9 mg, female: 6127.6 mg) showed substantial difference with that of 24-h urine analysis (male: 4556.9 mg, female: 5107.4 mg). The sodium intake estimated with DFQ55 (male: 4848.5 mg, female: 4884.3 mg) showed small difference from that estimated with 24-h urine analysis, higher proportion to be classfied into the same quartile and higher correlation with the sodium intakes estimated with 24-h urine analysis and systolic blood pressure. It seems DFQ55 can be used as a tool for quantitative estimation of sodium intake. Na index25 or Na index14 showed 39~50% agreement to be classified into the same quartile, substantial correlations with the sodium intake estimated with DFQ55 and significant correlations with the sodium intake estimated with 24-h urine analysis. When point 119 for Na index25 was used as a criterion of low sodium intake, sensitivity, specificity and positive predictive value was 62.5%, 81.8% and 53.2%, respectively. When point 102 for Na index14 was used as a criterion of high sodium intake, sensitivity, specificity and positive predictive value were 73.8%, 84.0%, 62.0%, respectively. It seems the short DFQs using Na index14 or Na index25 are simple, easy and proper instruments to classify the low or high sodium intake group.