Urine Cotinine for Assessing the Association between Secondhand Smoke Exposure and Depression in Adult Non-Smokers in Korea: Analysis of the Korea National Health and Nutrition Examination Survey 2016

BACKGROUND: Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea. METHODS: We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups. RESULTS: After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020–3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression. CONCLUSIONS: This concluded that depression was associated with high urine cotinine level in adult non-smokers.

Children's Food Intake and Nutrition Levels, and Obesity by Maternal Employment: Based on the Korea National Health and Nutrition Examination Survey 2013–2015 / 대한지역사회영양학회지

OBJECTIVES: This study examines the intake of food and nutrients of children according to the employment and working hours of their mothers. METHODS: The married women in the source data from the 6th National Health and Nutrition Survey were classified into full-time working mothers, part-time working mothers and housewives according to the working type and the data on their children from 3 to 18 years old were analyzed using SAS 9.4. RESULTS: The group from 3 to 5 years old was the smallest group with 682 children (20.2%), followed by the group from 6 to 11 years with 1,345 children (39.8%) and the group from 12 to 18 years old with 1,355 children (40.1%). The lowest rates for having no breakfast and dinner were observed in the group with housewives (p<0.05). The calcium and phosphorous intakes were the highest in the group with housewives at 61.9% and 126.8%, respectively, and the lowest in the group with full-time working mothers at 54.7% and 115.3%, respectively (p<0.05). The group with full-time working mothers had the highest rate in the calcium and iron intake less than the dietary reference intake at 74.9% and 30.0%, respectively. It indicated that the group with full-time working mothers did not have sufficient nutrients as compared to the other two groups. Moreover, the group with the part-time working mothers showed the high vitamin A intake ratio of 41.4% (p<0.05). CONCLUSIONS: This study found evidence of a negative association between mother's employment status and children's diet quality. The employment and economic activity of married women will continuously increase in the future. Therefore, a national nutrition policy is required to provide quality nutrition care for children in the households.

The examination of a decline in steps in the last decade and its reason -A serial cross-sectional study in male college freshmen- / 体力科学

The present study aimed to investigate whether daily steps in male college students have actually decreased in the last decade. If the decline in steps is found, we additionally aimed to examine whether the decline in steps is attributed to a reduction of exercise or, rather, to a reduction of non-exercise activity. A serial cross-sectional study was performed from 2003 to 2012 at the Osaka Institute of Technology. A total of 1,215 male college freshmen were analyzed. Every year, scores of the physical activity levels were evaluated by a questionnaire, and we measured daily steps of participants using a pedometer during usual 1 week. Daily behavior record was also analyzed (n = 69). There were no significant trends or differences in characteristics of participants and the scores of physical activity levels throughout the 10 years. However, interestingly, significant decreasing trends were observed in the steps of average and weekend. In addition, daily behavior record analyses indicate that a cell-phone or a PC usage increased significantly in both weekday and weekend and that playing video games increased significantly in weekday. Therefore, these data support the view that daily steps have actually reduced in the last decade. Our findings also raise the possibility that the decline in steps may be related to the decline in non-exercise activity associated with the increase in a cell-phone or a PC usage and playing the video games.

Gender Difference in the Level of HDL Cholesterol in Korean Adults / 가정의학회지

BACKGROUND: High density lipoprotein (HDL) cholesterol level varies with ethnicity and gender. In Korea there has not been an agreement on standards for HDL cholesterol level. Therefore, in order to establish a foundation for research on HDL cholesterol, we investigated the gender difference in HDL cholesterol level after adjusting associated factors. METHODS: The study population included 4,465 individuals (1,833 men, 2,632 women) representing 33,502,918 Koreans 20 years of age or older, who participated in the 2005 Korean National Health and Nutrition Survey. After stratifying by gender, we analyzed the HDL cholesterol level according to the general characteristics of the study population. Then we identified independent factors associated with HDL cholesterol level. After adjusting for covariates, we estimated the gender difference in HDL cholesterol level. RESULTS: We demonstrated that age, current smoking, body mass index, alcohol intake, triglyceride and low density lipoprotein cholesterol level have significant impact on HDL cholesterol level. In addition, educational status was also an important factor for men, while fat intake was a significant factor for women. After adjusting associated factors, the means (standard errors) of HDL cholesterol level were 43.8 (0.2) mg/dL in men and 46.3 (0.2) mg/dL in women, respectively. CONCLUSION: The mean gender difference in HDL level (2.5 mg/dL) in Korean adults was, therefore, less than those observed in previous western studies.

Top 10 Dietary Supplements of Korean Adults from the 4th Korea National Health and Nutrition Examination Survey / 가정의학회지

The aim of this study is to assess the prevalence, types, and trends of dietary supplement (DS) use. We analyzed the Dietary Supplement Questionnaire data of Korean aged 19 years old or older from the Nutrition Survey of the 4th Korea National Health and Nutrition Survey. Each reported DS was coded based on ingredients according to the 2010 Korean Food and Drug Administration Notification. The prevalence (standard error) of current DS use was 20.6% (0.7) for men, 32.2% (0.7) for women. Those with DS use for longer than two weeks during previous one year were 27.2% (0.7), and 40.2% (0.8), for men and women respectively. Vitamin mineral supplement (221.6/10(3) persons) was the most frequently consumed DS in Korean adults. The trend for DS use in Korean adults is changing as well as increasing.

Relation of Breakfast Intake to Diet Quality in Korean School-Aged Children: Analysis of the Data from the 2001 National Health and Nutrition Survey / 대한지역사회영양학회지

The aims of this study were to assess the quality of breakfast intake and to examine the relation of breakfast intake to the quality of daily diet in Korean school-aged children. The one day 24-hour recall data from the 2001 National Health and Nutrition Survey were analyzed. The sample of this study consisted of 1,600 children aged 7 to 18 years attending elementary, middle, or high schools. By calorie level of breakfast intake, the children were grouped into Breakfast Skippers (0 kcal; n = 268, 17%), Low Calorie Breakfast Eaters (0 kcal or = 25% of EER; n = 281, 17%). General characteristics including weight status and nutritional quality of breakfast and daily diet were compared among the four groups. The average daily calorie intake of Breakfast Skippers, Low, Moderate, and Sufficient Breakfast Eaters were 1,771 kcal, 1,719 kcal, 1,902 kcal, and 2,349 kcal, respectively; they were 86.3%, 85.9%, 98.0%, and 124.9% of EER, respectively. The percentages of students consuming daily diet with protein, vitamin A, B1, B2, niacin, vitamin C, calcium, phosphorus, or iron less than Estimated Average Requirement decreased in the breakfast groups with the higher calorie level of breakfast intake. The Dietary Variety Score of daily diet significantly increased by increasing the calorie level of breakfast intake. The results indicated the quality of daily diet was positively related to the level of calorie intake from breakfast.

Factors Associated with Skipping Breakfast in Korean Children: Analysis of Data from the 2001 National Health and Nutrition Survey / 대한지역사회영양학회지

The purpose of this study was to identify the factors associated with skipping breakfast of Korean children by analyzing the 24-hour recall intake data from the 2001 National Health and Nutrition Survey. The sample of this study consisted of 1,600 children aged 7 to 18 years. About 17% of the children skipped breakfast, consuming no food or beverage at all. About 30% of children reporting breakfast skipping in a self-administered survey were shown to have eaten some foods as a result of analysis of the 24-hour recall data. Students having eaten breakfast consumed 21% of Estimated Energy Requirement at breakfast. The multivariate logistic regression analyses showed that age was associated with skipping breakfast both in elementary and middle/high school students; older students were more likely to skip breakfast. Elementary school students from low-income families were more likely to skip breakfast than those from upper-high income families. Intervention programs are needed to prevent children from skipping breakfast by targeting older students. For elementary school students, such programs should be first developed for those from lowincome families.

Analysis of Dietary Fiber Intake in the Korean Adult Population Using 2001 Korean National Health and Nutrition Survey Data and Newly Established Dietary Fiber Database

The present study estimates intake levels of dietary fiber (DF) in Korean adults aged 20 and over, using a newly established dietary fiber database for 3,149 food items, as well as 24-hour recall method data from the 2001 Korean National Health and Nutrition Survey. Dietary fiber intake and food groups are analyzed by gender, age, and region. The average dietary fiber intake, per capita of Korea was estimated to be 12.24 g/1,000 kcal or 23.58 g/day. Caloriebased dietary fiber intake for 20-49 year-old-Korean males, 20-29 year-old females, and the adults who resided in metropolitan areas was under the Adequate Intake for DF, 12 g/1,000 kcal. Further, the dietary fiber intake after adjusting energy intake in people over 75 year-old was estimated to be 75% of AI. Vegetables, cereals and fruits were three major sources of DF for Korean, making up approximately 75% of DF. Regarding the subjects of this study, major sources of dietary fiber were Kimchi and well-polished rice, which supplied 13.98% and 9.16% of total dietary fiber intake, respectively. The result of this study could contribute to the establishment of DRIs for dietary fiber, after adjusting energy intake for Korean aged 75 years and over. The beneficial health effects of DF and the necessity of nutritional education in this area should be continuously emphasized concerning 20-29 year-old people and metropolitan adults.

Analysis of the Relationship between Dietary Fiber Intake & Food Habits in the Korean Adult Population: Using the 2001 Korean National Health and Nutrition Survey Data and the Newly Established Dietary Fiber Database

The present study assessed the relation of dietary fiber to food habits in Korean adults aged 20 and over, using a newly established dietary fiber, as well as the 2001 Korean National Health and Nutrition Survey. The per capita average dietary fiber intake of Koreans was estimated to be 12.25 +/- 5.23 g/1,000 kcal. Calorie-based dietary fiber intakes for females was over the KDRI, but for males it was below the KDRI. The levels of total dietary fiber and energy corresponded with frequent snacking but calorie-based dietary fiber intake did not. The subjects who skipped meals, frequently ate out and consumed fried foods tended to have lower levels of calorie-based dietary fiber although the levels of energy and total dietary fiber corresponded with frequent eating-out and consumption of fried foods. The results of this study suggest that Koreans must make efforts to regularly have three meals a day, reduce the frequency of eating out and consume fewer fried foods in order to maintain the optimum intake levels of dietary fiber that protect against chronic diseases.

Dietary patterns of children and adolescents analyzed from 2001 Korea National Health and Nutrition Survey

The purpose of this study was to identify dietary patterns among children and adolescents in Korea and to examine their associations with obesity and some blood profiles. One day food consumption data measured by 24-hour recalls on 2704 subjects aged 1 to 19 were used from 2001 Korea National Health and Nutrition Survey. The data of blood profiles available in the ages of 10 or older was also used. After categorizing each food consumed into 29 food or food groups, five dietary patterns were derived through a factor analysis and subjects were classified into three major dietary patterns via a cluster analysis using the factor scores. Three dietary patterns were identified as 'traditional diet' (25.6%), 'westernized-fast food' (6.2%), and 'mixed diet' (68.2%). The 'traditional diet' pattern had a higher percentage in boys. Both the 'traditional diet' and the 'westernized-fast food' had higher proportions of adolescents (12-19 y) than younger children, while the 'mixed diet' had a higher percentage of preschool children (1-5 y). Obesity rate analyzed within each age group showed no differences among 3 dietary pattern clusters. Blood pressure and all plasma profiles were not different among dietary patterns when adjusted with age and gender. Conclusively, children and adolescents in Korea had three distinct dietary patterns, which were associated with gender and age. These patterns could be useful to plan nutrition interventions for teenager health promotion.

Dietary Pattern by Sex and Age with Menu Analysis Using 1998, 2001 National Health and Nutrition Survey of Korea / 대한지역사회영양학회지

The purpose of this study is to compare menu patterns by sex and age (3-6, 7-12, 13-19, 20-29, 30-49, 50-64, 65 over years old) between the 1998 and 2001 National Health and Nutrition Surveys of Korea. Frequently consumed menu patterns were investigated using the 24-hour recall data for 19,809 subjects (1998:10,102; 2001:9,707). To analyze patterns, dishes were classified into 29 categories by cooking method (KHIDI 2003). The results are as follows: the most frequent menu patterns were "rice + soup + kimchi" and "rice + stew + kimchi" in both men and women in both 1998 and 2001. Intake frequency of these menu patterns, a traditional Korean menu pattern, was higher with increased age. Intake frequency of "noodles" and "bread" increased in 2001 in both men and women, compared to 1998. And these patterns increased in the younger age groups, especially women in their twenties. Menu patterns of 2001 showed greater variety than those of 1998. Overall, the men's menu patterns showed more side dishes than those of women; intake frequencies of "seasoned vegetables", "stir-fried foods", and "grilled foods" were higher in men than in women. In short, so far the main menu pattern has been "rice-style" in both men and women, and in all age groups in Korea, whereas the Western menu pattern is increasing in younger age groups. The diet of 2001 showed more side dishes than that of the 1998 menu pattern; however, certain groups such as female and males in adolescents and young adults were still a simple menu pattern. Consequently, to make recommended menu patterns and nutrition education programs for Koreans should take into consideration sex and age.

Ready-to-eat Cereal Consumption Enhances Milk and Calcium Intake in Korean Population from 2001 Korean National Health and Nutrition Survey

The purpose of this study was to establish an association between the consumption of ready-to-eat cereal (RTEC), milk, and calcium within the context of the most current population dietary practice in Korea. Inadequate calcium intake among Korean children and adults is one of the important public health concern. Milk is one of the best calcium sources because of its bioavailability, and RTEC is one of the foods commonly consumed with milk. The most recent Korean National Health and Nutrition Survey, 2001 dataset was used as the source of data for this research. Subjects excluding pregnant women, were categorized according to gender and age (1~5, 6~11, 12~19, 20~49, 50 + years) and then by consumption of RTEC and milk. SAS and SUDAAN were used for statistical analyses. Sample weighted means, standard errors, and population percentages were calculated, and multiple regression model with adjustment for covariates were used to determine the predictability of total daily calcium intake from inclusion of RTEC and milk compared to the meal without RTEC and milk. RTEC was consumed by 2.4% of Korean people. Average calcium intake was 17 times greater when RTEC was consumed with milk than when RTEC was consumed without milk. Respondents who consumed RTEC with milk had significantly higher mean daily calcium and other nutrient intakes than respondents who consumed neither. In the multiple regression analysis, milk consumption with or without RTEC predicted total daily calcium intake after adjusting for age, income, and alcohol consumption (p < 0.0001). The percentage of respondents below the estimated average requirement (EAR) level for calcium was lower for RTEC consumers than for RTEC non-consumers in all age-gender groups, especially significant differences were in children aged 1~5, boys and girls aged 12~19, men aged 20~49, and women older than 50 years of age. RTEC consumption was not associated with intake in excess of the tolerable upper intake level (UL) for calcium. In conclusion, RTEC consumption was positively associated with both milk and calcium intakes in all age and gender groups in Korean population.

Dietary Intake Pattern of the Korean Adult Population by Weight Status: 2001 National Health and Nutrition Survey / 대한지역사회영양학회지

To explore the relationship between weight status and food intake pattern, the Nutrition Survey results of the 2001 National Health and Nutrition Survey were analyzed. Dietary intake data of Korean adults aged 20 to 64, years who participated in the 2001 National Health and Nutrition Survey, was used along with their demographic data. Subjects were classified into 4 groups based on the BMI value of subjects: underweight, normal, overweight and obese. For male adults, obese subjects had significantly higher mean intake of energy, protein, carbohydrates, and fat than normal subjects. In addition, obese male adults consumed more animal foods, especially more meats, than normal subjects. However, females obese subjects did not show higher intake of energy or fat. Although obese male adults showed higher energy intake, calcium and iron intake per 1000 kcal was lower than normal adults. Average calcium intake in females was low; about 70% of RDA regardless of obesity level. In addition, riboflavin and Vitamin A intake was lower in overweight and obese female than in normal females. Percentage of subjects with low fruit and vegetable intake (<400 g per day) was also high in female subjects. These results showed that food and nutrient intake patterns of obese population were different between male and female adults. These dietary intake patterns need to be considered in developing and implementing nutrition policy and intervention programs to prevent and control obesity. Moreover, the National Survey and monitoring system should be developed for continuous and effective investigation on the relationship between obesity and dietary intake.

Food and Nutrient Consumption Patterns of the Korean Adult Population by Income Level - 2001 National Health and Nutrition Survey / 대한지역사회영양학회지

To explore the relationship between economic status and food and nutrient intake patterns, the 2001 National Health and Nutrition Survey result was analyzed. Dietary intake data of 6,978 Korean adults of 20 years and older who participated in the 2001 National Health and Nutrition Survey were used along with their demographic data. Economic status of the subjects was classified into the following 4 groups based on the self-reported average monthly income of household with reference to the minimum monthly living expenses (MLE) in 2001: low<100% MLE < or = middle<200% MLE < or = high<300% MLE < or = higher. Individuals in the higher income class had significantly higher mean intake for most of the nutrients including energy, protein, carbohydrate, fat, calcium, thiamin, riboflavin, niacin and vitamin C, and a higher percentage of energy intake from fat. In addition, they consumed more animal foods including meats, eggs, fish/shellfish, milk/dairy products and fats. On the other hand, the mean intakes of individuals in the lower economic class for calcium, vitamin A, and riboflavin were lower than 75% of RDAs. And, there was a predominant difference in contribution of fat to total energy intake among the groups of different economic status. These results showed that household income is an important factor influencing the food and nutrient intake patterns of the Korean adult population. Although individuals at different age classes may respond differently to a change in economic status, developing and implementing nutrition policy and intervention programs for those nutritionally vulnerable groups should consider the economic status as an important factor to customize and differentiate the content of the program.

Nutrient Intake Patterns of Koreans by the Economic Status Using 1998 Korean National Health and Nutrition Survey

The purpose of this study was to investigate differences in the diet with the amount and the qualitative assessment of nutrient intakes by the economic level. Data from the 1998 Korean Health and Nutrition Survey were used. Using the poverty line based on the 1998 Korean minimum cost of living, Subjects (n = 10400) were classified into high class (36.1%), middle class (40.7%) and low class (23.1%). Chi-square-test and Analysis of Variance following Duncan's multiple range test were used to test the difference in nutrient intake pattern among three groups (alpha = 0.05). The amount of nutrient intake and nutrient intake adequacy were statistically different by the economic level (p<0.01). The ratio of energy intake from carbohydrate is higher than the criteria of WHO recommendation in all economic levels. Especially people in the low class depended much on the carbohydrate for the energy intake. The ratio of energy from the protein and fat are lower in the middle and low class than that of the high class. The Intake level of calcium and vitamin B2 were lower than those of the Recommended Dietary intake level, regardless of economic status. It also showed differences in major food sources of nutrients by the economic level Consequently, it seems that the nutrition policy and program should be prepared according to their economic status. Also, there should more detailed studies to find out the nutrient intake pattern, their determinant, and health consequences.

Identification of the Dietary Intake Patterns of Korean Adults according to Their Exercise Levels / 대한지역사회영양학회지

The purpose of this study was to identify the differences in dietary consumption patterns according to the exercise level of Korean adults. The study subjects were the 7,370 Koreans aged 20 years and older of the 1998 Korean Health and Nutrition Survey. The dietary assessment was conducted by means of the 24 hour recall method. Data for individual exercise behavior were collected by interviews as part of the National Health Behavior Survey. Following the analysis of variances the Duncan's Multiple Range Test was used to test the differences in food and nutrient intakes among groups with different levels of exercise. Current exercise practices were reported by 22% of the male subjects and 15% of the female subjects. Unlike observations from the American and European studies, a greater amount of meat intake was observed more frequently among high exercises group than among middle and low exercisers in the case of the male subjects. This was reflected in the increasing levels of protein and fat intake in proportion to the exercise levels. However, the food and nutrient intake patterns of female exercisers were quite different from those of the males. The least intake of fatty foods was observed among the high exercisers. Energy intake from fat was the lowest among the high exercisers. These results may imply that the motivation to exercise was quite different between male and female Koreans. This dietary pattern may have a risk of undernution. Summerizing the results, whatever the motivation of the exercise, the Korean exercisers of both sexes had unhealthy dietary pattern. Therefore, nutritional education should be conducted to encourage the eating of a balanced diet along with exercise, among Koreans of both sexes, in order to promote a healthy lifestyle.

Food and Nutrient Consumption Patterns of Korean Adults by Socioeconomic Status / 대한지역사회영양학회지

The relationship between socio-economic status and food and nutrient consumption patterns was studied in 7,370 Koreans aged 20 years and older in the 1995 Korean Health and Nutrition Survey. The aim of this study was to investigate the effect of rapid economic growth on food and nutrient consumption for Korean adults in the last 30 years. Monthly household income, and individual's educational level and occupation were chosen as variables of socio-economic status for individuals. A one day 24 hour recall method was used for the dietary survey. One way analysis of varience was adopted to test tole association between socio-economic variables and food and nutrient consumption patterns. Individuals who had a high socio-economic status had significantly higher daily intake of most of the nutrients including calcium, vitamin A, vitamin B2 which reached above the recommended dietary allowances(RDA) and a higher percentage energy consumption from fat. In addition, individual who belonged to a low socio-economic status consumed less animal foods, including meat, egg, milk and consumed low proportion of energy from fat. The results suggest that in spite of rapid economic growth during the last 30 years in Korea, individuals who belonged to low socio-economic status categories are still nutritionally vulnerable. Among the socio-economic variables, income and education except occupation were the influential factors on the food and nutrient consumption of Koreans. Therefore, nutrition policy should focus on influencing the dietary patterns of lower social class individuals to improve the health status of the population as a whole.