Understanding how organizational environments affect food intake among employees in South Korea / 한국영양학회지

PURPOSE: Previous studies have highlighted that the nutritional behaviors among South Korean workers are far from ideal. This study examined the organizational influences affecting the eating practices of office workers in South Korea.METHODS: We conducted in-depth interviews with 22 office workers at 12 companies in South Korea. The interviewer inquired about the employees' daily routines on food and beverage intake. The various factors that influence their food choices in their work environments were also explored. The interviews were transcribed and then analyzed using a content analysis.RESULTS: A framework analysis revealed 7 key recurring themes, and these were grouped under three levels: team-, company-, and corporate group-levels. First, team dinners are core social events for all the workers and they tend to include high-caloric food and alcoholic beverages. The frequency of team meals and the food associated with them depend on various team characteristics such as gender composition, the nature of a team's work and the team leaders' emphasis on group meals. Second, the company's policies and practices regarding budget allocation for team meals and subsidies for cafeteria meals affect the workers' food intake practices. In addition, the physical environment of the worksite cafeterias can influence the choices of foods. Third, various corporate group policies that were not designed to target food intake had additional positive effects on the workers' eating behaviors.CONCLUSION: This study provides important insights into the broader organizational influences on the food consumption of employees in their workplace. These insights can be used to design and implement more effective intervention strategies for improving the nutritional behaviors of office workers.

Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention / 가정의학회지

BACKGROUND: The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. METHODS: The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,”“methods of intervention,”“measurement of outcomes,”“future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. RESULTS: For priority populations, the panel favored “elementary,”“preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. CONCLUSION: According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students

BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

Evidence of Interventions for Preventing Obesity of Children and Adolescents Using Existing Systematic Reviews and Meta-Analyses

BACKGROUND: Pediatric obesity is an important global issue in public health. However, previous efforts for childhood obesity prevention have sporadically been implemented in Korea, neither evidence-based nor with proper evaluation. We aimed to investigate the characteristics of an effective intervention for prevention of pediatric obesity by reviewing previous systematic reviews and Meta-analyses. METHODS: PubMed was searched for articles published frombetween January 2005 to November 2015. Inclusion criteria were as follows: (1) articles published in English; (2) child and/or adolescents (between 2 and 18 years of age) as subjects; and (3) systematic reviews or meta-analyses concerning the preventive intervention of pediatric/adolescent obesity. Each study was evaluated via the Assessment of Multiple Systematic Reviews for quality assessment. We conducted a quantitative analysis to evaluate the implications, strengths, and limitations of each study. RESULTS: Our final analysis included 35 articles, of which 15 were systematic reviews and 20 were meta-analyses. Among these, 24 studies (69%) advocated the efficacy of preventive intervention for pediatric obesity. Multidimensional approach including diet, exercise, and environmental factors conducted in schools with a parent and community involvement wasis more effective at preventing obesity. The efficacy of intervention varied depending on the age, sex, region, and socioeconomic characteristics of participantssubjects. CONCLUSIONS: Preventive intervention of pediatric obesity demonstrated smallminor improvements in body mass index and had positive effects on behavioral and clinical variables, which are associated with obesity. For the efficient prevention of pediatric obesity, it is necessary to consider efforts for developing various intervention programs, with active as well as the participation of school, family, and social community groups.

Development of a Smartphone Application Prototype for Child Obesity Prevention: Rationale and Study Design of Acceptability and Feasibility Tests

BACKGROUND: There have been many efforts to rectify lifestyles that contribute to obesity using a variety of methodologies in heterogeneous settings, but effective and sustainable interventions that are suitable for children are still needed. We developed a smartphone application called "HAPPY ME" for guiding health behavior decisions, which employs gamification and self-monitoring strategies. The aim of this paper is to outline the rationale and methods for the development and feasibility test of "HAPPY ME". METHODS: The study consisted of two phases: 1) description of theory-based conceptual framework and rationales for smartphone application development and 2) outline of a pre- and post-test design in 4th-6th grade of healthy elementary school students for 4 weeks. The students will be delivered missions or messages on a daily basis, which is to stretch the knowledge and skills for action. They will simultaneously be engaged in self-monitoring their eating and physical activities to clear daily quests. To measure acceptability and feasibility we will monitor usability, compliance, and satisfaction for a 4-week study period and evaluate the intervention effects on self-efficacy, readiness, and intention to engage in healthy behavior. CONCLUSIONS: The results of the feasibility study will show whether the smartphone application "HAPPY ME" for children is acceptable, as well as if it is usable and feasible for self-directed health management. The results will provide preliminary evidence of the effectiveness of smartphone application-supported child behavioral modification for child obesity prevention and management.

Development of the Perceived Stress Inventory: A New Questionnaire for Korean Population Surveys / 가정의학회지

BACKGROUND: Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea. METHODS: From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood. RESULTS: Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version. CONCLUSION: The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys.

A Validation Study of the Brief Alcohol Use Disorder Identification Test (AUDIT): A Brief Screening Tool Derived from the AUDIT / 가정의학회지

BACKGROUND: The prevalence of alcohol use disorder (AUD) is very high in Korea. To identify AUD in the busy practice setting, brevity of screening tools is very important. We derived the brief Alcohol Use Disorders Identification Test (AUDIT) and evaluated its performance as a brief screening test. METHODS: One hundred male drinkers from Kangbuk Samsung Hospital primary care outpatient clinic and psychiatric ward for alcoholism treatment completed questionnaires including the AUDIT, cut down, annoyed, guilty, eye-opener (CAGE), and National Alcoholism Screening Test (NAST) from April to July, 2007. AUD (alcohol abuse and dependence), defined by a physician in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV, was used as a diagnostic criteria. To derive the brief AUDIT, factor analysis was performed using the principal component extraction method with a varimax rotated solution. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief AUDIT. Areas under the ROC curve were compared performance of screening questionnaires with 95% confidence intervals. RESULTS: The derived brief AUDIT consists of 4 items: frequency of heavy drinking (item 3), impaired control over drinking (item 4), increased salience of drinking (item 5), and alcohol-related injury (item 9). Brief AUDIT exhibited an AUD screening accuracy better than CAGE, and equally to that of NAST. Areas under the ROC curves were 0.87 (0.80-0.94), 0.76 (0.66-0.85), and 0.81 (0.73-0.90) for the brief AUDIT, CAGE, and NAST for AUD, and 0.97 (0.95-0.99), 0.93 (0.88-0.98) and 0.93 (0.88-0.98) for alcohol dependence. CONCLUSION: The new brief AUDIT seems to be effective in detecting male AUD in the primary care setting in Korea. Further evaluation for women and different age groups is needed.

Metabolic Syndrome as a Predictor of Coronary Artery Calcification in Asymptomatic Korean Adults

INTRODUCTION: Identification of individuals at high risk for coronary heart disease (CHD) is a challenge, though essential, for the prevention of future events. Thus, early detection of CHD has been a priority in research and practice. We conducted a study to evaluate the relationship between metabolic syndrome (MS) and its components with coronary artery calcium (CAC) as a surrogate of CHD in a large Korean adult population. METHODS: The study subjects (n=14,429) were individuals who visited a health promotion center in Seoul, Korea from Jan. 2010 to Dec. 2010. Personal and family medical histories were collected and smoking status, anthropometric measurements, and laboratory tests were measured. CAC scores were measured by the multi-detector computed tomography. RESULTS: The study population consisted of 11,884 men (mean age 41.9+/-6.6 years) and 2,544 women (mean age 42.9+/-8.0 years). The total prevalence of MS was 19.6%, with 21% in men and 13.2% in women. CAC (CAC>0) was found in 15.0% of men and 5.4% of women. When compared to the non-MS group, the MS group had a higher prevalence of CAC after adjusting for age, smoking, and family history of stroke and CHD in both men (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.62-2.05; P<0.001) and women (OR, 2.23; 95% CI, 1.49-3.33; P<0.001). All individual components of MS, except high density lipoprotein cholesterol level, were associated with a high risk for CAC presence. CONCLUSIONS: Individuals with MS had a greater prevalence of CAC compared with individuals without this condition.

Metabolic Syndrome as a Predictor of Coronary Artery Calcification in Asymptomatic Korean Adults

INTRODUCTION: Identification of individuals at high risk for coronary heart disease (CHD) is a challenge, though essential, for the prevention of future events. Thus, early detection of CHD has been a priority in research and practice. We conducted a study to evaluate the relationship between metabolic syndrome (MS) and its components with coronary artery calcium (CAC) as a surrogate of CHD in a large Korean adult population. METHODS: The study subjects (n=14,429) were individuals who visited a health promotion center in Seoul, Korea from Jan. 2010 to Dec. 2010. Personal and family medical histories were collected and smoking status, anthropometric measurements, and laboratory tests were measured. CAC scores were measured by the multi-detector computed tomography. RESULTS: The study population consisted of 11,884 men (mean age 41.9+/-6.6 years) and 2,544 women (mean age 42.9+/-8.0 years). The total prevalence of MS was 19.6%, with 21% in men and 13.2% in women. CAC (CAC>0) was found in 15.0% of men and 5.4% of women. When compared to the non-MS group, the MS group had a higher prevalence of CAC after adjusting for age, smoking, and family history of stroke and CHD in both men (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.62-2.05; P<0.001) and women (OR, 2.23; 95% CI, 1.49-3.33; P<0.001). All individual components of MS, except high density lipoprotein cholesterol level, were associated with a high risk for CAC presence. CONCLUSIONS: Individuals with MS had a greater prevalence of CAC compared with individuals without this condition.

Factors Related to Bone Mineral Density in Menopausal Women Younger than 65 Years

BACKGROUND: Bone mineral density (BMD) screening guidelines for women younger than 65 years are inconsistent. We investigated BMD-related factors in postmenopausal women younger than 65 years to help clinicians identify which women in this age group should undergo this investigation. METHODS: The study subjects included 108 postmenopausal women, younger than 65 years, who visited one university hospital from January to June 2007 and had a BMD by DEXA. Information on socio-demographic characteristics, menarche, menopause, smoking, alcohol use, past history of fracture and diet were gathered using a self-reported questionnaire. Height and weight were measured. The association between each risk factor and BMD was assessed using Pearson's correlation and ANOVA test. Finally, multiple regression analysis was done, using the model including significant variables of baseline analysis. RESULTS: In our subjects, age was negatively and body weight was positively correlated with BMD of lumbar spine and femur. The reproductive years was positively correlated with BMD of lumbar spine and past history of fragility fracture was negatively associated with BMD of femur. Moderate alcohol users had higher BMDs of lumbar spine and femur. CONCLUSIONS: In postmenopausal women younger than 65 years, age and body weight are major determinants of BMD of lumbar spine and femur, negatively and positively, respectively. Our data suggest women younger than 65 years with low lean body mass, past history of fracture, and premature menopause could be good candidates for BMD.

Factors Related to Bone Mineral Density in Menopausal Women Younger than 65 Years

BACKGROUND: Bone mineral density (BMD) screening guidelines for women younger than 65 years are inconsistent. We investigated BMD-related factors in postmenopausal women younger than 65 years to help clinicians identify which women in this age group should undergo this investigation. METHODS: The study subjects included 108 postmenopausal women, younger than 65 years, who visited one university hospital from January to June 2007 and had a BMD by DEXA. Information on socio-demographic characteristics, menarche, menopause, smoking, alcohol use, past history of fracture and diet were gathered using a self-reported questionnaire. Height and weight were measured. The association between each risk factor and BMD was assessed using Pearson's correlation and ANOVA test. Finally, multiple regression analysis was done, using the model including significant variables of baseline analysis. RESULTS: In our subjects, age was negatively and body weight was positively correlated with BMD of lumbar spine and femur. The reproductive years was positively correlated with BMD of lumbar spine and past history of fragility fracture was negatively associated with BMD of femur. Moderate alcohol users had higher BMDs of lumbar spine and femur. CONCLUSIONS: In postmenopausal women younger than 65 years, age and body weight are major determinants of BMD of lumbar spine and femur, negatively and positively, respectively. Our data suggest women younger than 65 years with low lean body mass, past history of fracture, and premature menopause could be good candidates for BMD.

Association of Serum Total Bilirubin with Serum High Sensitivity C-reactive Protein in Middle-aged Men / 가정의학회지

BACKGROUND: It has been suggested that bilirubin has an inverse association with cardiovascular disease (CVD) due to its antioxidant properties. However, there are few data regarding the relationship between serum total bilirubin (sTB) and risk factors for CVD in Koreans. This study aimed to evaluate the relationship between sTB and high sensitivity C-reactive protein (hsCRP), which is an independent risk factor for CVD. METHODS: We performed a cross sectional study in 6,800 men who were examined at a health promotion center at a university hospital in Korea between May 2005 and June 2006. We grouped the subjects according to values of serum hsCRP (above or below 1.0 mg/L) and compared the characteristics of the two groups. To evaluate the relationship between sTB and hsCRP, we classified the subjects according to quartile values of sTB. Multivariate logistic regression analyses were used to analyze the relationship of levels of sTB and hsCRP after adjusting for known risk factors for CVD. RESULTS: Serum hsCRP was significantly associated with body mass index (BMI), smoking, diabetes, hypertension, fasting plasma glucose, systolic blood pressure, alanine aminotransferase, and total cholesterol/high density lipoprotein (TC/HDL-C) ratio, but not with age or alcohol use. As levels of sTB increased, there was a decrease in age, numbers of smokers, BMI, and TC/HDL ratio. Compared to the lowest quartile of sTB, levels of hsCRP decreased with odds ratios of 0.82 (95% CI, 0.71 to 0.96), 0.75 (95% CI, 0.65 to 0.88), and 0.63 (95% CI, 0.54 to 0.74) in the 2nd, 3rd, and 4th quartiles of bilirubin, respectively. CONCLUSION: Bilirubin may be inversely associated with hsCRP

Insulin Resistance is Associated with Gallstones Even in Non-obese, Non-diabetic Korean Men

It remains unclear as to whether insulin resistance alone or in the presence of wellknown risk factors, such as diabetes or obesity, is associated with gallstones in men. The aim of this study was to determine whether insulin resistance is associated independently with gallstone disease in non-diabetic men, regardless of obesity. Study subjects were 19,503 Korean men, aged 30-69 yr, with fasting blood glucose level 75 percentile) in subjects with gallstones was significantly higher than in those without, and this association remained even after the obesity stratification was applied. In multiple logistic regression analyses, only age and HOMA proved to be independent predictors of gallstones. Insulin resistance was positively associated with gallstones in non-diabetic Korean men, and this occurred regardless of obesity. Gallstones appear to be a marker for insulin resistance, even in non-diabetic, nonobese men.

Factors Related to Increase of Blood Pressure in Obese Children and Adolescents

Background: As obese population is increasing nowadays, research on blood pressure of obese children is being performed more frequently. However, there are only few research related to factors about blood pressure among obese children in Korea. The purpose of this study was to analyze the factors affecting blood pressure of obese children and adolescents. Methods: The subjects were elementary and middle school students diagnosed with obesity (n=1716). Height, weight, waist circumstance, body fat percent, blood pressure were measured. Family history and sexual maturity were investigated through the questionnaire. The relationship between the factors and the increase of blood pressure was analyzed. Results: Body weight was the most powerful factor among to factors related to increase of blood pressure (male r=0.45, P<0.05, female r=0.37, P<0.05). Also, height, percentage weight for height (PWH), body mass index (BMI) and waist circumference was correlated with the blood pressure. In multiple regression analysis, family history of hypertension and the sexual maturity were significant determinants of blood pressure in males after adjusting for weight. However, body fat percent was a significant determinant in females. Conclusion: Body weight was the most important factor which increased the blood pressure in obese children and adolescents in both sexes. But males and females had different factors related to the increase of blood pressure with the exception of body weight.