Changes in nutritional status of Korean older adults during COVID-19 Pandemic by household income and demographic factors -using the Korea National Health and Nutrition Examination Survey(2019-2020): a cross-sectional study / 대한지역사회영양학회지

Objectives@# The study aim was to identify changes in the nutritional status of older adults during the COVID-19 pandemic according to household income and demographic characteristics. @*Methods@# Study participants were 2,408 adults aged 65 and over who participated in the 2019–2020 Korea National Health and Nutrition Examination Survey (KNHANES). To examine changes in nutrient intake levels resulting from COVID-19, data of 2019 and of 2020 were compared. Study participants were divided into three groups based on household income level to compare these changes. The changes were compared according to household income level, age group, and household type. @*Results@# Percentages of recommended intakes for energy, protein, and most micronutrients were the lowest for the low-income group of both males and females in 2020. The Mean Adequacy Ratio (MAR) score was the lowest for the low-income group in both years. When comparing nutrient density for 2019 and 2020 by income group, the male low-income group experienced a decrease in nutrient densities of vitamin A, thiamine, calcium, and iron. For the same group, a decreased percentage for energy intake from protein was noted. Fruit intake was lowest in the low-income group for both males and females. Low-income males had the lowest intake levels for meat, fish, eggs, and legumes in both 2019 and 2020 and the lowest milk and milk product intake levels in 2020. Older adults living alone or single older adults with children had lower MAR scores than those living with a spouse. Older adults living alone experienced decreases in energy and thiamine and iron intake levels in 2020 compared to their intake levels in 2019. @*Conclusions@# Because of the COVID-19 pandemic, nutrition intake levels worsened for older adult males in the low-income group and older adults living alone. This finding shows the need for a more systematic nutritional support strategy for the vulnerable older adults population in national disaster situations.

Current status, perception and practicability of restaurant staffs related to reducing sodium use in Seongnam, Korea / 한국영양학회지

PURPOSE: With the increase of going out to eat, reducing the sodium in restaurant foods has a crucial impact on reducing sodium intake. This study aimed to assess the current status and perceptions of restaurant staffs related to reducing sodium use in restaurants. METHODS: Restaurant managers and chefs (n = 312) in Seongnam area completed a questionnaire on the current status related to sodium use, the barriers to practice for reducing sodium use, support needs, and the practicability of methods for reducing sodium use in restaurants. RESULTS: The percentage of restaurants in the preaction stage (including the precontemplation, contemplation, and preparation stages) for reducing sodium use was 79.7%. Logistic regression analysis showed that measuring salinity while cooking was associated with measuring seasoning (OR, 4.761; 95% CI, 2.325 ~ 9.751), action/maintenance stages of behavior change (OR, 2.829; 95% CI, 1.449 ~ 5.525) and providing salinity information of restaurant foods (OR, 6.314; 95% CI, 2.964 ~ 13.45). Maintaining taste and hindering the cooking process were the main barriers to reduce sodium use. The total practicability of actions for reducing sodium was higher in staffs who worked in restaurants that measured seasoning and salinity while cooking (p < 0.05 and p < 0.01, respectively). The hardest item to practice was ‘purchase foods after comparing sodium content in the nutrition labeling’. ‘Avoid serving salt-fermented foods as side dishes’, ‘serve small portions of kimchi and less salty kimchi’, and ‘put up promotional materials for reducing sodium intake’ were selected as easy items to perform. The majority (82%) was willing to reduce sodium in restaurant foods under the support of local government and they desired the promotion of participating restaurants and education on cooking skills to reduce sodium. CONCLUSION: Measuring seasoning and salinity while cooking is a meaningful practice that is associated with stages of behavior change and the practicability of actions for reducing sodium. It is necessary to provide support and education with a gradual approach to staffs for reducing sodium in restaurant foods.

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.

Study of the Coverage of Nutrition Labeling System on the Nutrient Intake of Koreans - using the 2013 Korea National Health and Nutrition Examination Survey (KNHANES) Data / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to examine the coverage of the current mandatory nutrition labeling system on the nutrient intake of Koreans. METHODS: KNHANES dietary intake data (2013) of 7,242 subjects were used in the analysis. KNHANES dietary intake data were collected by a 24-hour recall method by trained dietitians. For analysis, all food items consumed by the subjects were classified into two groups (foods with mandatory labeling and other foods). In the next step, all food items were reclassified into four groups according to the food type and nutrition labeling regulations: raw material food, processed food of raw material characteristics, processed foods without mandatory labeling, and processed foods with mandatory labeling. The intake of energy and five nutrients (carbohydrate, protein, fat, saturated fat, and sodium) of subjects from each food group were analyzed to determine the coverage of the mandatory nutrition labeling system among the total nutrient intake of Koreans. RESULTS: The average intake of foods with mandatory labeling were 384g/day, which was approximately one quarter of the total daily food intake (1,544 g/day). The proportion of energy and five nutrients intake from foods with mandatory labeling was 18.1%~47.4%. The average food intake from the 4 food groups were 745 g/day (48.3%) for the raw food materials, 54 g/day (3.5%) for the processed food of raw material characteristics, 391 g/day (25.3%) for the processed foods without mandatory labeling, and 354 g/day (22.9%) for the processed foods with mandatory labeling. CONCLUSIONS: Although nutrition labeling is a useful tool for providing nutritional information to consumers, the coverage of current mandatory nutrition labeling system on daily nutrient intake of the Korean population is not high. To encourage informed choices and improve healthy eating habits of the Korean population, the nutrition labeling system should be expanded to include more food items and foodservice menus.

Study of the Coverage of Nutrition Labeling System on the Nutrient Intake of Koreans - using the 2013 Korea National Health and Nutrition Examination Survey (KNHANES) Data / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to examine the coverage of the current mandatory nutrition labeling system on the nutrient intake of Koreans. METHODS: KNHANES dietary intake data (2013) of 7,242 subjects were used in the analysis. KNHANES dietary intake data were collected by a 24-hour recall method by trained dietitians. For analysis, all food items consumed by the subjects were classified into two groups (foods with mandatory labeling and other foods). In the next step, all food items were reclassified into four groups according to the food type and nutrition labeling regulations: raw material food, processed food of raw material characteristics, processed foods without mandatory labeling, and processed foods with mandatory labeling. The intake of energy and five nutrients (carbohydrate, protein, fat, saturated fat, and sodium) of subjects from each food group were analyzed to determine the coverage of the mandatory nutrition labeling system among the total nutrient intake of Koreans. RESULTS: The average intake of foods with mandatory labeling were 384g/day, which was approximately one quarter of the total daily food intake (1,544 g/day). The proportion of energy and five nutrients intake from foods with mandatory labeling was 18.1%~47.4%. The average food intake from the 4 food groups were 745 g/day (48.3%) for the raw food materials, 54 g/day (3.5%) for the processed food of raw material characteristics, 391 g/day (25.3%) for the processed foods without mandatory labeling, and 354 g/day (22.9%) for the processed foods with mandatory labeling. CONCLUSIONS: Although nutrition labeling is a useful tool for providing nutritional information to consumers, the coverage of current mandatory nutrition labeling system on daily nutrient intake of the Korean population is not high. To encourage informed choices and improve healthy eating habits of the Korean population, the nutrition labeling system should be expanded to include more food items and foodservice menus.

Preconceptional use of folic acid and knowledge about folic acid among low-income pregnant women in Korea

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea. SUBJECTS/METHODS: A questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers. RESULTS: Among women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%). CONCLUSIONS: Our results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.

Study on Energy and Nutrient Intake and Food Preference of the Elderly in Care Facilities / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to assess energy and nutritional intake and investigate the preference for food and cooking methods of the residents in elderly care facilities. METHODS: Data were collected from 72 residents (10 males and 62 females) aged ≥ 70 years in elderly care facilities using questionnaires, food photographs for estimating dietary intake and records for daily physical activity. RESULTS: Average age of the study participants was 85.0 years and 41, 36 and 8 had dementia, hypertension and diabetes mellitus, respectively. 15%, 65% and 19% of subjects were physically mobile, enervated, and immobile, respectively. Daily energy intake was 1360.2 kcal in men and 1378.0 kcal in women, which were 68.0% and 86.1% of the estimated energy requirement (EER) of dietary reference intake for Koreans (KDRI) for ≥ 75 year old individuals, respectively. Estimated energy expenditure (EEE) of subjects calculated using formula from KDRI was 1361.9 kcal and EER calculated using estimated daily physical activity (EDPA) was 1232.9 kcal. Energy intake and EEE from KDRI were higher than EER from EDPA. Dietary intake of dietary fiber, calcium, potassium, zinc, vitamin B2, niacin, vitamin C were lower, and protein, phosphorous, iron, sodium, vitamin A, vitamin B1, vitamin B6, vitamin E were higher than the corresponding ones of KDRI. Subjects liked meats, fishes and shellfish, and fruits, while subjects disliked milk, seaweeds and salted fish and salted vegetables. Cooked rice, soybean paste soup, beef, cooked sliced radish strip, and yogurt were favorite foods, with steam being a favorite cooking method. Subjects considered nutrition as the most important factor for improving food service quality. CONCLUSIONS: Results of this study could be utilized for improving food-service for the residents in elderly care facilities, and provide a basis for setting reference intake of energy and nutrients of the elderly having very low activity levels.

The Development and Validation of Eating Behavior Test Form for Infants and Young Children / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to develop and validate Eating Behaviors Test form (EBT) for infants and young children, including eating behaviors of their parents and parental feeding practices. METHODS: Draft version of EBT form was developed after a pretest on 83 mothers. It was consisted of 42 questions including 3 components; eating behavior of children, eating behavior of parents, and parental feeding practices. Using these questionnaires, the first survey was conducted on 320 infants and children, 1 to 6 year old, for exploratory factor analysis, and the second survey was collected on 731 infants and children for confirmatory factor analysis. RESULTS: Exploratory factor analysis on 42 questions of EBT form resulted in 3 factor model for children's eating behavior, 3 factor model for parents' eating behavior, and 1 factor model for parental feeding practices. Three factors for children's eating behavior could be explained as follows; factor 1, pickiness (reliability alpha=0.89; explanation of variance=27.79), factor 2, over activity (alpha=0.80, explanation of variance=16.51), and factor 3, irregularity (alpha=0.59, explanation of variance=10.01). Three factors for mother's eating behavior could be explained as follows; factor 1,irregularities (alpha=0.73, explanation of variance=21.73), factor 2, pickiness (alpha=0.65, explanation of variance= 20.16), and factor 3, permissiveness (alpha=0.60, explanation of variance=19.13). Confirmatory factor analysis confirmed an acceptance fit for these models. Internal consistencies for these factors were above 0.6. CONCLUSIONS: Our results indicated that EBT form is a valid tool to measure comprehensive eating and feeding behaviors for infants and young children.

Breakfast skipping and breakfast type are associated with daily nutrient intakes and metabolic syndrome in Korean adults

BACKGROUND/OBJECTIVES: Emerging evidence shows that eating breakfast and breakfast types may be associated with health outcomes and dietary intakes in various populations. The aim of this study was to investigate the association between breakfast types in Korean adults with their daily nutrient intakes and health outcomes. SUBJECTS/METHODS: A total of 11,801 20- to 64-year-old adults (age 42.9 +/- 11.8 yrs [mean +/- standard error of the mean]; male 41.1%, female 58.9%) in 2007-2009 Korean National Health and Nutrition Survey data were divided into 5 groups based on breakfast types in a 24-hr dietary recall: rice with 3 or more side dishes (Rice3+, 35.3%), rice with 0-2 side dishes (Rice0-2, 34.73%), noodles (1.56%), bread and cereal (6.56%), and breakfast skipping (21.63%). Daily nutrient intakes and the risk of metabolic syndrome were compared among five groups. RESULTS: Compared with Korean Recommended Nutrient Intake levels, the breakfast-skipping group showed the lowest intake level in most nutrients, whereas the Rice3+ group showed the highest. Fat intake was higher in the bread and noodle groups than in the other groups. When compared with the Rice3+ group, the odds ratios for the risk of obesity and metabolic syndrome were increased in the breakfast skipping, Rice0-2, and noodle groups after controlling for confounding variables. CONCLUSIONS: The rice-based breakfast group showed better nutritional status and health outcomes when eating with 3 or more side dishes. Nutrition education is needed to emphasize both the potential advantage of the rice-based, traditional Korean diet in terms of nutritional content and the importance of food diversity.

Characteristics of the dietary intake of Korean elderly by chewing ability using data from the Korea National Health and Nutrition Examination Survey 2007-2010 / 한국영양학회지

The purpose of this study was to examine the characteristics of the dietary intake of Korean elderly according to chewing ability using data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted during 2007-2010. Among subjects aged 65 years and over, more than half, 54.3% of elderly people, were classified as the difficulty in chewing group (DC). The DC group had lower nutrients and food intakes than those of in the no difficulty in chewing group (NDC). Findings showed that subjects in the DC group consumed fewer foods, especially fruits and vegetables. In addition, the DC group had significantly lower intakes of pan-fried food, stir-fried food, braised food, and seasoned-cooked vegetables, which could not be easily cooked or chewed. On the other hand, the number of soups and stews included in the top 30 largely consumed dishes were higher in the DC group than in the NDC group. No difference in numbers of daily meal/snack intake was observed between the two groups, however, the DC group had lower numbers of side-dishes compared to the NDC group. Fewer side-dishes per meal could be related to lower intakes of nutrients in dietary quality. Findings of this study demonstrated that dietary intake was influenced by chewing ability of elderly Korean people. Therefore, study of factors affecting dietary intake such as convenient cooking methods to decrease cooking time and skills to extend preservation and storage time of foods will necessary. In addition, development of food products and new techniques of cooking considering health status, chewing, and swallowing ability is required for the elderly, followed by establishment of standards for senior-friendly food products.

Dairy Product Intake Is Inversely Associated with Metabolic Syndrome in Korean Adults: Anseong and Ansan Cohort of the Korean Genome and Epidemiology Study

The objective of this study was to examine the relationship between dairy product intake and the incidence of metabolic syndrome (MetS) and its components among middle-aged Koreans. We examined 7,240 adults aged 40-69 yr without MetS at baseline over a 45.5-month follow-up period. They were taken from the Anseong and Ansan cohort of the Korean Genome and Epidemiology Study. Dairy product intake including milk, yogurt, and cheese was assessed with food frequency questionnaire. At the follow-up, the incidence of MetS was 17.1%. The incidences of MetS components were as follows: low HDL cholesterol (16.2%), abdominal obesity (14.0%), hypertriglyceridemia (13.8%), hyperglycemia (13.3%), and hypertension (13.1%). Adjusting for potential confounders, dairy product consumption frequency was inversely associated with the risk of MetS and abdominal obesity. Hazard ratio (HR) (95% confidence interval) for dairy product consumption more than 7 times/week compared to never was 0.75 (0.64-0.88, P for trend < 0.001) for MetS and 0.73 (0.61-0.88, P for trend < 0.001) for abdominal obesity. HR for milk intake was 0.79 for MetS and 0.82 for abdominal obesity. The results of this study suggest that daily intake of dairy products protects against the development of MetS, particularly abdominal obesity, in middle-aged Koreans.

A Study on Dietary Behaviors, Health-Related Lifestyle of Adult Visitors at Public Health Centers in Gyeonggi Urban Area / 대한지역사회영양학회지

The purpose of this study was to investigate dietary behaviors and health-related lifestyles of adult visitors at a public health center in Gyeonggi urban area. A survey using questionnaire was conducted with 949 visitors at Seongnam public health centers from June to August, 2012. The data from 905 respondents were analyzed by gender, consisting of 322 males and 583 females, and age group, consisting of 243 low-age group (LA), 312 middle-age group (MA), 350 high-age group (HA), aged 20 to 30 years, 31 to 50 years, and 51 to 69 years, respectively. Average Body Mass Index was 23.0, which increased with age, and education level was high in LA. 59.0 percent of the subjects had various diseases, and the incidence of hypertension was the highest, followed by allergy, hyperlipidemia, diabetes mellitus, joint rheumatism. Incidence rates of chronic disease increased with age, which were lower than those from 2011 Korea National Health and Nutrition Examination Survey (KNHANES). Weekly drinking frequency rate and smoking rate decreased with age, and exercise performing rate was high at male and HA, which showed the same tendency as KNHANES. Female and HA showed more healthy dietary behaviors such as restricting salt, sugar, oily foods, foods containing food additives, calorie, caring for balanced diet, and referring to nutrition label. Subjects chose stress as the first factor, followed by diet, exercise, etc., among 13 suggested factors which strongly influence on human's life-span. In general, public health center visitors, especially female and HA, showed better dietary behaviors and health-related lifestyles compared with KNHANES.

Weight Status and Dietary Factors Associated with Sugar-Sweetened Beverage Intake among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2008-2011

There has been growing concern about the role of sugar-sweetened beverages (SSBs) in the development of obesity. This study investigated factors associated with SSB intake among Korean children (7-12 years) and adolescents (13-18 years). We examined associations between SSB intake and demographic and dietary factors using nationally representative data from the 2008-2011 Korea National Health and Nutrition Examination Survey, and 3,179 children and 2,242 adolescents were included in the final analysis. We calculated adjusted odds ratios (ORs) for factors associated with high SSB intake (> or = 300 ml/day) by multivariable logistic regression. The mean daily SSB intake of school children was 98.7 ml/day, with a mean of 64.7 ml/day for those aged 7-12 years and 120.2 ml/day for those aged 13-18 years. SSB intake of > or = 300 ml/day was found in 12.0% of the children and adolescents. Factors associated with a greater OR for high SSB intake were high energy intake (> or = 125% of EER; OR = 3.17 for boys aged 7-12 years, OR = 2.74 for girls aged 7-12 years, OR = 3.0 for girls aged 13-18 years), low milk consumption (< 1 cup/day; OR = 1.93 for boys aged 7-12 years; OR = 2.53 for girls aged 7-12 years; OR = 1.83 for boys aged 13-18 years), and not meeting the recommended fruit and vegetable intake (< 400 g/day; OR = 1.71 for boys aged 7-12 years). Being overweight and obese was significantly associated with greater ORs for high SSB intake among boys aged 7-12 years (OR = 1.72). These findings may be used to develop targeted education programs for reducing SSB intake and encouraging healthier food choices.

Development of Nutrition Education Program for Hypertension Based on Health Belief Model, Applying Focus Group Interview / 대한지역사회영양학회지

Health Belief Model is a socio-psychological theory of decision making to individual health-related behaviors. This study was aimed to develop an effective education program for hypertension based on health belief model. The main factors of health belief model were investigated by focus group interview (FGI) with 23 hypertensive or prehypertensive subjects aged over fifty years. 'Perceived susceptibility' to hypertension was family history, neglect of health care, preference for salty food, broth of soup and stew. Lifelong medication, complications, and medical costs were reported as 'perceived severity' of hypertension. 'Perceived benefits' of hypertension management were decrease of medicinal dose, reduction of medical costs, and healthy eating habits of the family, while 'perceived barriers' were lack of palatability of low salt diet, convenience-oriented dietary habits, and limited choice of foods when eating out. Subjects mentioned TV health programs, public health center programs, and advice from doctors and family as 'cues to action' of hypertension management. These qualitative information provided basis for developing a nutrition education program for hypertension which could be implemented in the public health center. Eight week program was composed of understanding hypertension, risk factor management (eating habits, weight), low salt diet (principles, cooking), advanced management for healthy diet in 2 sessions, and summary. Each session was designed to alert the susceptibility and severity, to emphasize the benefits, and to reduce the barriers by providing dietary monitoring, practical advice, and action tips.

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals.

Measures for a closer-to-real estimate of dietary exposure to total mercury and lead in total diet study for Koreans

Previous Korean total diet studies (KTDSs) have estimated dietary exposure to toxic chemicals based on 110-120 representative foods selected from over 500 foods appeared in the Korea National Health & Nutrition Examination Surveys (KNHANES), which would result in a possible underestimation. In order to find measures for a closer-to-real estimate of dietary exposure to heavy metals, this study examined the feasibility of mapping foods to the representative foods in the KTDS by comparing estimates. In mapping, those foods not analyzed in the 2009 KTDS (443 out of 559 foods appeared in the 2007 KNHANES) were mapped to the 114 representative foods used in the 2009 KTDS based on the closeness in regards to biological systematics and morphological similarity. Dietary exposures to total mercury and lead were re-estimated using the content of total mercury and lead in 114 foods analyzed in the 2009 KTDS, food intake, and individual's own body weight for respondents in the 2007 KNHANES instead of mean body weight of Koreans used in the 2009 KTDS. The re-estimates of exposure with mapping were approximately 50% higher than the original estimates reported in the 2009 KTDS. In addition, mapping enabled the comparison of percentile distribution of the exposure among populations of different age groups. In conclusion, estimates via mapping resulted in a more comprehensive estimation of dietary exposure to heavy metals present in foods that Koreans consume.

Comparison of the Nutrient Intakes by the Score of Dietary Action Guides for Korean Children among the Elementary School Students in Gwangju City / 대한지역사회영양학회지

This study was conducted to examine differences in nutrient intakes by the compliance with the Dietary Action Guide for Korean Children. The subjects included 343 elementary school students in Gwangju city. Compliance with the Dietary Action Guide for Children showed that 62.4% of subjects had breakfast everyday; 44.3% of subjects ate vegetables/fruits/milk and dairy products daily; 26.8% of subjects ate a variety of lean meats/fish/eggs/bean products daily; 32.9% of subjects enjoyed outdoor activity everyday and ate according to their energy needs; 40.2% of subjects chose healthy and nutritious foods for snack; and 15.5% of subjects avoided food waste. Intakes of most of nutrients including energy were significantly higher (p < 0.05) in those who complied with the Dietary Action Guide well. Also nutrient intakes had the positive correlation with the scores of Dietary Action Guide (p < 0.05). From these results, nutrient intakes of children were significantly influenced by dietary factors suggested in the Dietary Action Guide for Children. In addition, the results also confirmed that good food behaviors were indispensible to maintaining a proper nutritional status. Based on these results, good food behaviors and practice were critical to secure good health and proper nutritional status for children, and that nutrition education should be strengthened in school as well as at home.

Major Sources of Sodium Intake of the Korean Population at Prepared Dish Level: Based on the KNHANES 2008 & 2009 / 대한지역사회영양학회지

We attempted to define the sources of sodium intake for the Korean population at prepared dish level to provide a basis for developing sustainable nutrition policies and feasible programs for sodium intake reduction. Dietary intake data from 2008 and 2009 Korea National Health and Nutrition Examination Survey was used in the analysis for sodium intake sources. Sodium intake from individual dish consumed by each subject was calculated and used in delineating major sodium sources at dish and dish group level for sub-populations of different sex and age. Also, sodium intake was compared between eaters and non-eaters of some specific dish groups with considerable contribution to total sodium intake. The number of subjects included in the analysis was 18,022 and mean sodium intake was 4,600 mg/capita/day. Major sources of sodium intake at dish group level were in the following order: kimchi (1125 mg, 24.5%), noodles (572 mg, 12.4%), soups (488 mg, 10.6%), stews (399 mg, 8.7%), and cooked rice (284 mg, 6.2%). The magnitude of contribution to total sodium intake by soups and stews was different by age group. Sodium intake difference between eaters and non-eaters was much larger for kimchi group (2,343 mg for male, 1,452 mg for female) than for soups or stews. Interaction between consumption of aforementioned specific dish groups and age was highly significant (p < 0.0005) for both sexes. This study revealed an importance of having not only the control over sodium content of foods/dishes, but also the customized approach for different groups of population to accomplish an appreciable reduction in sodium intake.

Influencing Factors on the Dietary supplements Consumption among Children in Korea / 대한지역사회영양학회지

With a recent increase in dietary supplements (DS) consumption among children in Korea, this study was performed to examine the influencing factors on children's DS consumption. A nationwide survey was conducted employing 3 representative samples of children for summer & fall of 2008 and spring of 2009 by stratified multistage sampling of 120 survey sites per season based on the 2005 census population. Approximately 30 households from each survey site were screened for residing children of 0-19 years and about 1,700 households remained as eligible samples per season. Trained dietitians visited households to perform face-to-face interview to children and/or parents regarding DS consumption including health functional foods (HFF), vitamins/minerals (V/M) supplements and other food supplements during 1 month prior to interview. Out of 5,328 children responded, 18.7% reported DS consumption. Consumption rate was higher in boys (19.9% vs. 17.3% in girls, P < 0.05) and youngsters (22.8% compared to 15.0% in adolescents, P < 0.001). Children from higher income family (P < 0.001), those living in apartments (P < 0.001), those residing in metropolitan area (P < 0.001), and those of mothers with higher education (P < 0.001) were more likely to take DS. Also, mother's employment status and occupation were significantly associated with children's DS consumption. The most popular DS was HFF (72.1%), which was consumed more in children of higher income family. It is revealed that socioeconomic factors affect children's DS consumption significantly. Also it is necessary to estimate children's V/M intake from DS and foods together especially because there are tolerable upper limits set for V/M for safety purposes.

Development of supplemental nutrition care program for women, infants and children in Korea: NutriPlus+

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in NutriPlus + aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the NutriPlus + in 2008.