A associação entre câncer colorretal e índice de qualidade nutricional (INQ); um estudo de caso-controle / The association between colorectal cancer and index of nutritional quality (inq); a case-control study

ABSTRACT Background: The nutritional quality of diet may influence the risk of colorectal cancer (CRC). This study compared the Index of Nutritional Quality (INQ) of various dietary components between colorectal cancer patients and healthy controls. Methods: A total of 480 participants were enrolled in the study (160 patients with colorectal cancer as a case group and 320 healthy control). An analysis was conducted on the general characteristics of the participants, their medical histories, anthropometric indicators, physical activity, alcohol consumption, reproductive history, smoking and food intake. A valid food frequency questionnaire was used to assess nutrient intake and INQ was calculated from daily nutrient intake. Results: A Significant inverse association was found between CRC and INQ for vitamins A (OR=0.01, CI: 0.01-0.01), K (OR=0.04, CI: 0.01-0.15), and B12 (OR=0.71, CI: 0.51-0.98), B5 (OR=0.43, CI: 0.00-0.01), zinc (OR=0.35, CI: 0.13-0.95), and phosphorus (OR=0.17, 0.19-0.94). The association between the INQ of vitamin B12 and zinc with colorectal cancer was disappeared after age adjustment. There was a significant negative association between CRC with the INQ of vitamins A, K, B5, phosphorus, and calcium after further adjustments for gender, BMI, menopausal status, and total energy intake. Conclusion: CRC is significantly associated with INQ for some micronutrients. INQ can be considered as an indicator to assess clinical nutritional problems.

RESUMO Contexto: A qualidade nutricional da dieta pode influenciar o risco de câncer colorretal (CCR). Este estudo comparou o Índice de Valor Nutricional (INQ) de vários componentes dietéticos entre pacientes com CCR e controles saudáveis. Métodos: Um total de 480 participantes foram inscritos no estudo (160 pacientes com CCR como um grupo de casos e 320 controles saudáveis). Uma análise foi conduzida sobre as características gerais dos participantes, seus históricos médicos, indicadores antropométricos, atividade física, consumo de álcool, histórico reprodutivo, tabagismo e ingestão de alimentos. Um questionário de frequência alimentar válido foi usado para avaliar a ingestão de nutrientes e o INQ foi calculado a partir da ingestão diária de nutrientes. Resultados: Associação significativa entre CCR e INQ para as vitaminas A (OR=0,00, IC: 0,00-0,01), K (OR=0,04, IC: 0,01-0,15), B12 (OR=0,71, IC: 0,51-0,98) houve uma associação negativa), B5 (OR=0,43, IC: 0,00-0,01), zinco (OR=0,35, IC: 0,13-0,95), fósforo (OR=0,17, IC: 0,19-0,94). A associação entre o INQ da vitamina B12, zinco e CCR desapareceu após o ajuste pela idade. Houve uma associação negativa significativa entre CCR e INQ de cálcio, e outros resultados não mudaram após ajustes adicionais para idade, gênero, Índice de Massa Corporal, estado de menopausa e ingestão total de energia. Conclusão: CCR está significativamente associado ao INQ para alguns micronutrientes. O INQ pode ser usado como um indicador para avaliar problemas nutricionais clínicos.

Evaluation of dietary intake in Korean adults according to energy intake from eating-out: Based on 2013~2014 Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: The objective of the present study was to evaluate nutrient and food group intakes in Korean adults according to energy intake from eating-out. METHODS: This study was a cross-sectional study based on the 2013~2014 Korea National Health and Nutritional Examination Survey, and study subjects were 5,186 males (2,151) and females (3,035) aged 19~64 years. Energy intake from eating-out was analyzed using the 24-hour dietary recall method, and groups were classified by quartile according to energy intake from eating-out. RESULTS: Subjects who had more energy intake from eating-out tended to be younger, highly educated, have a higher income, and have higher alcohol consumption. Total energy intake and fat intake density of the highest quartile group of energy intake from eating-out were higher than those of the other groups. However, fiber, vitamin B1, calcium, phosphorus, potassium, and iron intake density levels were significantly lower in the highest quartile group of energy intake from eating-out. The highest quartile group of energy intake from eating-out consumed significantly more meat and beverages compared to the other groups. In addition, regarding diet quality (Index of nutritional quality), significantly lower vitamin B1, calcium, phosphorus, and iron levels were observed in the highest quartile group of energy intake from eating-out compared to those in the other groups. CONCLUSION: In conclusion, in Korean adults, consumption of eating-out decreased dietary quality, including vitamin B1, calcium, phosphorus, and iron levels. Further studies are needed to confirm these findings.

A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients

Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 +/- 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 +/- 6.7 kcal/kg/day) and protein (0.9 +/- 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 +/- 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ > or = 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy.

Assessment of Menu Plan Prepared by Middle School Students According to Ordinary Meal Pattern and Single Serving Size / 대한지역사회영양학회지

It is important to prepare and execute the menu plan for proper and balanced intake of nutrients in the adolescence. This study investigated the new approach for planning menu by ordinary meal pattern based on cooked foods groups. The amounts of cooked foods in the menu plan assumed to be single serving size. The middle school second graders participated for the study. A total of 313 questionnaires were analyzed using CAN-pro 3.0 and SPSS WIN 12.0 program. The average content of energy in the menu plan was 2,453 kcal, the average ratios of energy contribution by carbohydrate, protein and fat were 54.3%, 17.9%, 27.8%, respectively. A total of 56.9% menu plans (94.9% of male and 8.7% of female students') were below the lowest limit of optimum carbohydrate energy ratio of 55%. A total of 29.1% menu plans (33.1% of male and 23.9% of female students') were exceed the highest limit of optimum fat energy ratio of 30%. The NAR of minerals and vitamins were all 1.0 except for calcium (0.92) and folate (0.88). When INQ of the individual cooked food groups were calculated, kimch was the highest in all minerals and vitamins examined, suggesting that kimch may be the best source for all minerals and vitamins, including calcium and folate with the minimum change in energy content. In conclusion, the menu plan by ordinary meal pattern in this study was low in carbohydrate, high in fat, and contained enough minerals and vitamins except for calcium and folate for middle school students.

Evaluation of Nutrient Intake and Anthropometric Parameters related to Obesity in Korean Female Adolescents according to Dietary Diversity Score: From the Korean National Health and Nutrition Examination Surveys, 2007-2009 / 대한지역사회영양학회지

The purpose of this study was to evaluate nutrient intake and anthropometric parameters related to obesity in Korean female adolescents according to dietary diversity score. We analyzed data from the combined 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES). The subjects were 770 female adolescents. Nutrient intakes, Dietary Diversity Score (DDS) ) and Dietary Variety Score (DVS) were derived by using the data from the 24-recall method. The DDS was defined as the number of six food groups (cereals, meats, fruits, vegetables, dairy, fats and oils) consumed. The DVS was defined as the number of food items consumed. The average age of the subjects of the study was 15.02 years and the average height, weight, and BMI were 159.50 cm, 52.58 kg, 20.62 kg/m2, respectively. The energy and nutrients intakes, percent of the recommended intake for nutrients in DDS = 5~6 group were significantly higher than those of the other groups. Calcium and vitamin C INQ in DDS = 5~6 group were significantly higher than those of the other groups. The average DVS of the subjects was 29.33. The most frequent style of food pattern was CMDFVO (cereals, meats, dairy, fruits, vegetables, fats and oils) = 111011. In conclusion, in healthy Korean female adolescents, food diversity intake variety did beneficially affect the intakes of calcium and vitamin C. Further studies are needed to confirm these findings.

The Evaluation Study on Eating Behavior and Dietary Quality of Elderly People Residing in Samcheok According to Age Group / 대한지역사회영양학회지

The purpose of this study was to evaluate the eating behaviors and dietary quality of various aged adults. This study conducted through questionnaire and dietary survey by 24-hr recall to 850 adults residing in Samcheok. Subjects were divided into four groups according to the age in male and female, which included 20~29 yrs group (male n = 94, female n = 66), 30~49 yrs group (male n = 201, female n = 216), 50~64 yrs group (male n = 88, female n = 96), and >or = 65 yrs group (n = 46, female n = 43). In male, 20~29 yrs group had a larger proportion of subjects who skipped breakfast, lunch and dinner compared to other groups (p or = 50 yrs group were significantly lower than those of or = 65 yrs group in male were 4.1, 3.8, 3.7 and 3.5 respectively and there was significant difference (p or = 65 yrs group. The ND (Nutrient Density) of animal protein, vitamins A and B1 in 20~29 yrs group were significantly lower than those of other groups. The KDDS of 20~29 yrs group, 30~49 yrs group, 50~64 yrs group and > or = 65 yrs group in female were 4.0, 3.9, 3.9 and 3.6 respectively and >or = 65 yrs group was significant lower than other groups. According to these results, >or = 65 yrs and 20~29 yrs group had more dietary habit problems and poor nutrition status than 30~64 yrs group. The results of this study revealed that nutritional management and education for adequate meals should be emphasized in adults and elderly.

Seasonal Nutrient Intakes of Elderly Women Living Alone as Compared to Those Living with Family in the Gyeongbuk Rural Area / 대한지역사회영양학회지

For the rapidly growing elderly population, the achievement and maintenance of good nutritional status is critical to health, functioning and quality of life. Elderly women living alone have been identified as a group associated with poor nutrition. The purpose of this study was to assess dietary intakes of elderly women living alone as compared to those of elderly women living with family in a rural area and to examine seasonal variation. The subjects are 49 elderly women living alone and 41 elderly women living with family who reside in Goryeong-gun, Gyeongbuk, and their food intakes were assessed once each time in summer 2005, winter 2005-2006, and spring 2006. The average ages were 74.7 years for living alone and 72.8 years for living with family. Education level was not different between the two groups. Height, weight, body mass index, systolic and diastolic blood pressures, and fasting blood glucose were not significantly different between the two groups. Average intakes of major nutrients, nutrient adequacy ratio, mean adequacy ratio and index of nutritional quality were lower in the elderly women living alone compared with the elderly women living with family in summer, but the differences in intakes of most nutrients became insignificant both in winter and in spring. High carbohydrate and low fat diet was prevalent and intakes of carbohydrate and fat in summer deviated from macronutrient acceptable distribution ranges. Percentages of the subjects who consumed energy less than 75% of the estimated energy requirement and nutrients less than the estimated average requirement were higher than those reported by the Third National Health and Nutrition Examination Survey. In summer, the percentage of the subjects who consumed energy less than both 75% of the estimated energy requirement and 4 nutrients less than estimated average requirements was 58.5% of the elderly women living alone, which was higher than 26.5% of the elderly women living with family and that of National Nutrition Survey. Therefore, nutrition policies including nutrition education and support are necessary to improve nutritional status of elderly, especially elderly women living alone and should reflect regional and seasonal characteristics.

Composition of Food Groups Appropriate for Evaluation of Diet Quality of Korean Adolescents: Based on Kant's Minimum Amount

The purpose of this study was to determine composition of food groups appropriate for the evaluation of the quality of total diet or food guide, using the data from the 1998 National Health and Nutrition Survey. Twenty-fourhour-dietary recalls of total 1,110 Korean adolescents aged 13 - 19 years (male 543, female 567) were analyzed for food group consumed (Dietary Diversity Score, DDS), intake patterns of food group, mean index of nutritional quality (mINQ) and nutrient adequacy ratio (NAR). Considering Korean food pattern different from the Americans, this study is to check if Korean 5 food groups with both of oil & sugar group and vegetable &fruit group, and a minimum amount of 30 g in grain group and 15 g in meat group modified from Kant's minimum amount, 15 g in grain and 30 g in meat, could also be appropriate for the diet evaluation of Korean adolescents. Combination of food group and minimum food intake per each food group used in the first trial were categorized into 6 kinds of types: 1) American 5 food groups with Kant's minimum amount as control or 2) American 5 food groups with modified Kant's minimum amount 3) Korean 5 food groups excluded by sugar with the modified amount 4) Korean 5 food groups with modified amount 5) American food groups added oil group with the modified amount 6) American food groups added oil & sugar group with the modified amount. In case of oil group or oil and sugar group, 5 g was quoted for the minimum amount. Correlation between DDS and indices of other diet quality in each type of food group composition were analyzed and the best food group composition was traced by comparing the correlation coefficients of DDS and mINQ or MARs at alpha < 0.01. There was no meaningful difference in weight length index of the subjects of eating or not-eating oil or oil & sugar, while the values of mINQ showed higher in the subjects eating oil but no difference in the subjects eating oil & sugar, compared to the group not-eating, respectively. In comparison of type 1 and type 2, correlation between DDS and indices of other diet quality showed higher in type 1 using Kant's amount. And comparing the type of a combined group of fruit & vegetable (type 3 and 4) and the type of separated group of fruit and vegetable (type 5 and 6). six groups of separated vegetable and fruit showed the higher correlation of DDSs and indices of diet quality. In case of being classified into six groups with oil, DDS showed correlation of r = 0.293 with INQ. While, being classified into six groups with oil & sugar instead of oil only, DDS showed correlation of r = 0.249 with INQ. Accordingly the type 5 with oil is regarded as the better food group type than the type 6 with oil & sugar. Since better result was shown in the composition of six groups with Kant's minimum amount, the comparative analysis on both of type 1 with oil and oil & sugar was finally performed. Then oil added type 1 showed higher correlation of DDS and indices of diet quality. These result indicated that it would be more appropriate to use six food groups with separate vegetable and fruit including oil group (oil-added type 1) rather than oil &sugar group for evaluat ion of dietary quality of Korean adolescents using DDS.

Relationship between the Number of Different Food Consumed and Nutrient Intakes / 대한지역사회영양학회지

In order to examine the relationship between the number of different foods consumed and nutrient intake, one-day food consumption were surveyed by 24-hour recall from a sample of 287 individuals(20-49 years) living in Daejon City. The number of consumed food items did not include seasonings except red pepper power, sugar, oil, and soybean paste when used in large amounts(DVS). The number, including all seasonings except salt and vinegar(DVSS), was also counted. Of the total subjects, 43.6%(DVS) or 39.0%(DVSS) consumed 18-23 daily different foods with an average of 20.2 or 22.9, respectively. As the DVS increased, daily intakes of total foods and most food groups were elevated. Cereals however were not changed and eggs were decreased with increasing DVS. Energy and nutrient intakes and their mean adequacy ratio(MAR) and index of nutritional quality(INQ) also show positive correlations with DVS. MAR equal to or greater than(> or =) 0.75 was taken as a cut-off point for nutritional adequacy. In that case, the mean INQ was shown to be > or =1. MRI(10) for energy and 9 nutrients and MAR(3) for Ca, vitamin A, and riboflavin were estimated. Form a regression analysis, when MAR(10) was 0.75, the DVS and DVSS were assumed to be 19.6 and 22.2, respectively. And when MAR(3) was 0.75, the DVS and DVSS were assumed to be 31.6 and 34.6, respectively. However the subjects whose MAR(3) was 0.75(0.7-0.8) 23.8(DVS) or 26.6(DVSS) different foods in average, and their mean intakes of energy and all nutrients, except vitamin A, were ranged at 85-100% of the RDA. Of the 74 subjects who consumed DVS> or =24, 24 to 42 numbers took or =32 took > or =125%RDA of protein, which showed concerns of overnutrition in case of DVS> or =32. Form the above results it could be suggested that a daily intake of 24-32(or 28) of DVS or 27-35(or 31) of DVSS was recommendable for an optimal nutritional of all nutrients if the variety of food groups and sufficient intake of vitamin A and calcium were emphasized together.

Strategies to Improve Elderly Nutrition : Comparisons of Dietary Behavior according to the Mean Nutrient Adequacy Ratio / 대한지역사회영양학회지

A deep understanding of the dietary patterns and nutrient intake is important for assessment of possilbe nutritional risk and for establishing nutrition improvement strategies. This study was conducted toexamine the dietary characteristics of a nutritionally poor elderly group compared to the middle-and highly-nourished group. Elderly participant was recruited from local elderly centers in Suwon city in 1998. Trained dietitians interviewed 119 elderly(35 males, 84 females) aged 60 years and over for collecting dietary data(24-hour recall) and related variables. Male and female subjects were grouped into high, middle, and low according to the mean nutrient adequancy ratio(MAR) tertiles. An analysisof the percentage of RDA(Recommended Daily Allowances of Korea) for each of the 10 nutrients showed that the male low-MAR group consumed below the RDA in all kinds of nutrients, and the female low-MAR group consumed nutrients below the RDA except vitamin C. An evaluation of nutrient density by Index of Nutritonal Quality(INQ) also showed a similar tendency. Thus, the INQ level of the male low-MAR group was significantly lower than the middle-or high-MAR group, especially in protein, vitamin A, thiamin, riboflavin, and phosphorus(p<0.05). Moreover, INQ level of female low-MAR group was significantly lower than that of the high group(p<0.05) in all nutrients. The female low-MAR group's daily food intake were also lower than those of the high-MARgroup in gains, fish, fruits, oil and beverages. The energy distribution from carbohydrates, fats and proteins showed that the male low-MAR group had significantly higher carbohydrate and lower fat proportions compared to each gender high-MAR group, respectively. The male and female low-MAR group had low scores about eating all side dishes. These findings indicate that a moderate increase of the meat/egg/fishes intake was needed by the male low-MAR group for improving nutrition adequacy, and an overall increase of the food quantity and quality was desired for the female low-MAR group. These data could be used for planning a community elderly nutrition program and establishing strategies for tailored guidelines for the individuals.

Elderly Nutrition Improvement Program in the community health center : Nutritional evaluation of the elderly using the Index of Nutritional Quality and food group intake pattern

Physiological changes that affect nutrient absorption and utilization occur in older adults, and the collection of nutritional information is an important part of examining the nutrition and health issue. A nutritional survey using the 24-hour recall method was performed to identify nutritional quality and leading patterns of food group intake for protein, vitamin C, P and Fe were over 1, whereas those for vitamin A, B1, B2, niacin and Ca were below 1. The MAR(Mean Adequacy Ratio) was relatively low(0.75). The percentage of energy from carbohydrate, protein, and fat was 65.1, 15.6, and 19.5, respectively, thus the quantities of energy source were ideal. The Older subjects revealed poorer nutrition quality than the younger subjects did. The food group intake pattern of the elderly was not diverse, only 9% of them consumed all food groups in a day. These results suggest that nutritional guiflines for older Koreans should focus on the maintenance of adequate energy intake. In addition, selection of foods with high protein and calcium, such as dairy food, should be emphasized, particularly in the older elderly. Nutrition programs should target individuals at risk of not receiving enough nutrients, like the oldest elderly, and persons with lower education.