Disparities in dietary quantity and quality between the two different types of Korean family of older adults living with spouses and living alone: using data from the 6th Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: This study was conducted to examine disparities in food and nutrient intakes based on family types identified among 1,856 participants who were the Korean elderly people in the 6th Korea National Health and Nutrition Examination Survey (KNHNES) excluding those who were currently practicing the diet therapy. SUBJECTS/METHODS: We separated the subjects into two groups: living alone (LA, n = 638) and living with a spouse (LS, n = 1,218). We also examined the disparities of dietary quantity and quality of those two groups using complex sampling design general linear regression analyses (CS GLM). RESULTS: In the LA group, there was a higher percentage of females and average age in LA group was higher than the participants in the LS group. Household income and education level were significantly lower in LA compared to those of LS. The frequencies of skipping meals were higher in LA. LA's food and nutrient intakes showed lower consumption of vegetables, fruits, seaweeds, and of most nutrients. Even after adjusting for the confounding factors, the consumption of vegetables, seaweeds, carbohydrates, potassium, riboflavin, and vitamin C showed lower in LA than LS. Moreover, LA's nutrient intake ratios compared to the KDRIs were lower which turned out to be similar to their nutrient intakes. CONCLUSIONS: These results show that dietary behavior and food intake of the elderly are associated with family types. Frequently skipping meals and less dietary variety are more common with elderly persons who were living alone. Therefore, it is necessary to integrate the supplementary food programs and nutrition education programs for the elderly living alone.

Estimation model for habitual 24-hour urinary-sodium excretion using simple questionnaires from normotensive Koreans.

This study was conducted to develop an equation for estimation of 24-h urinary-sodium excretion that can serve as an alternative to 24-h dietary recall and 24-h urine collection for normotensive Korean adults. In total, data on 640 healthy Korean adults aged 19 to 69 years from 4 regions of the country were collected as a training set. In order to externally validate the equation developed from that training set, 200 subjects were recruited independently as a validation set. Due to heterogeneity by gender, we constructed a gender-specific equation for estimation of 24-h urinary-sodium excretion by using a multivariable linear regression model and assessed the performance of the developed equation in validation set. The best model consisted of age, body weight, dietary behavior ('eating salty food', 'Kimchi consumption', 'Korean soup or stew consumption', 'soy sauce or red pepper paste consumption'), and smoking status in men, and age, body weight, dietary behavior ('salt preference', 'eating salty food', 'checking sodium content for processed foods', 'nut consumption'), and smoking status in women, respectively. When this model was tested in the external validation set, the mean bias between the measured and estimated 24-h urinary-sodium excretion from Bland-Altman plots was -1.92 (95% CI: -113, 110) mmol/d for men and -1.51 (95% CI: -90.6, 87.6) mmol/d for women. The cut-points of sodium intake calculated based on the equations were ≥4,000 mg/d for men and ≥3,500 mg/d for women, with 89.8 and 76.6% sensitivity and 29.3 and 64.2% specificity, respectively. In this study, a habitual 24-hour urinary-sodium-excretion-estimation model of normotensive Korean adults based on anthropometric and lifestyle factors was developed and showed feasibility for an asymptomatic population.

Acculturation and Dietary Intakes by Gender Among Mongolians in South Korea: Nutrition Education Implication for Multicultural Families.

We explored the relationship between acculturation and dietary intake by gender for 500 Mongolians residing in South Korea. The high acculturation (HA) group females consumed more fish and shellfish, vegetables, beans, and rice, and less meats, flours, and oil than the low acculturation (LA) group did. However, there was no statistical difference in food group intake between HA and LA group males. HA group females showed higher intake of carbohydrates, fiber, sodium, potassium, calcium, vitamin A, and folate compared with LA group females. However, only folate and vitamin B2 intake was statistically different between HA and LA group males. Acculturation and gender interactions were found for the consumption of meats, flours, fish and shellfish, beans, and vegetables. The findings from this study have implications for developing customized nutrition intervention programs by gender for immigrants.

Association between 24-h urinary sodium excretion and obesity in Korean adults: A multicenter study.

OBJECTIVE: The aim of this study was to explore the association between sodium intake, as assessed by 24-h urinary sodium excretion, and various obesity parameters among South Korean adults. The associations of 24-h urinary sodium excretion and sodium intake calculated from the dietary questionnaire with obesity parameters also were compared. METHODS: This multicenter, cross-sectional study analyzed data of 640 healthy adults from eight provinces in South Korea. Obesity was assessed by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Mean 24-h urinary sodium excretion was calculated from repeatedly collected 24-h urine samples. Participants' dietary intake was assessed by 24-h dietary recall interview on the days before 24-h urine collection. RESULTS: In both sexes, the means of all anthropometric measurements tended to increase proportionally with 24-h urinary sodium excretion quartiles, regardless of adjustment. Men in the highest quartile (Q4) of 24-h urinary sodium excretion had increased odds of obesity (as assessed by BMI, WC, WHR, and WHtR) compared with men in the three lower quartiles (Q1-Q3) of 24-h urinary sodium excretion. Women in Q4 of 24-h urinary sodium excretion exhibited a higher chance of general obesity and abdominal obesity. Sodium intake calculated from the dietary questionnaire was not significantly associated with obesity in either sex. CONCLUSIONS: In Korean adults, there was a positive association between higher sodium intake as assessed by 24-h urinary sodium excretion and obesity independent of energy intake.

Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty: using data from the Korea National Health and Nutrition Examination Survey 2013 (6th).

BACKGROUND/OBJECTIVES: Chewing difficulty is a factor contributing to a poor nutritional status in the elderly. The aim of this study was to examine disparities in food and nutrition intakes among Korean elderly people with and without chewing difficulty. SUBJECTS/METHODS: This study utilized data from the sixth Korea National Health and Nutrition Examination Survey conducted in 2013. The study subjects included males and females over 65 years of age who were not required to adhere to a special diet due to disease or sickness. They were divided into groups according to their chewing ability. Those who found chewing "very difficult" or "difficult", were combined to form the chewing difficulty group. Similarly, those who found chewing "moderately difficult", "easy", and "very easy" were combined to form the normal chewing group. RESULTS: Of the 999 subjects, 47.7% had chewing difficulties and the prevalence of chewing difficulty was higher in females than in males (P = 0.03) and higher in those 75 years of age and over than in younger individuals (P < 0.001). The chewing difficulty group had a significantly lower intake of fruits and vegetables (P < 0.05) and lower vitamin C and potassium intake than those in the normal group. Comparison of the percentages of Dietary Reference Intakes for Koreans (KDRIs) in the two groups indicated that the intake of most nutrients (energy, vitamin C, thiamin, riboflavin, niacin, calcium, phosphorus, sodium, potassium, and iron) were significantly lower in the chewing difficulty group than in the normal group. In particular, calcium intake was inadequate (51% of KDRIs) in the chewing difficulty group. CONCLUSIONS: The results indicate that chewing difficulty is closely related to food and nutrient intake in the elderly and can result in vitamin and mineral intake deficiencies. It is evident that the care of elderly subjects with chewing difficulty is essential for maintaining a healthy lifestyle.

Eating habits, physical activity, nutrition knowledge, and self-efficacy by obesity status in upper-grade elementary school students.

BACKGROUND/OBJECTIVES: Childhood obesity has increased in recent decades in Korea. This study was designed to examine differences in the eating habits, physical activity (PA), nutrition knowledge, and self-efficacy of children by obesity status. SUBJECTS/METHODS: Subjects were 5th-grade children from 70 elementary schools in 17 cities nationwide. Two-stage stratified cluster sampling was employed. Survey questionnaire included items related to general characteristics, eating habits, PA, nutrition knowledge and self-efficacy. Excluding incomplete responses, 3,531 data were analyzed using SPSS. Subjects were categorized into overweight·obesity (OW) and normal weight (NW) groups based on body mass index percentiles for age by sex. RESULTS: A total of 21.5% of subjects was overweight or obese. There were significant differences in gender, perceived stress, perception of body shape, body satisfaction, and interest in weight control between the OW and NW groups (P < 0.001). With respect to eating habits, the OW group ate breakfast (P < 0.05) and snacks (P < 0.01) less frequently, ate bigger meals (P < 0.001), and demonstrated less desirable behaviors during meals (P <0.05 in boys) compared to the NW group. The OW group participated in less PA than the NW group, especially boys. OW boys spent less time walking during weekdays (P < 0.05) or the weekend (P < 0.001), spent more time being sedentary during weekdays or the weekend (P < 0.001), and exercised a fewer number of days (P < 0.01). For girls, the OW group spent more time being sedentary during the weekend (P < 0.01) and exercised a fewer number of days by walking or bicycle riding (P < 0.05) than the NW group. Nutrition knowledge was not significantly different between the OW and NW groups. Self-efficacy (P < 0.01 in boys), especially PA self-efficacy (P < 0.01), was significantly lower in the OW than NW group. CONCLUSIONS: This study revealed differences in eating habits, PA, and self-efficacy between OW and NW children. Obesity management programs for children need to focus on increasing self-efficacy, modifying eating habits, and increasing PA.

The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children.

BACKGROUND/OBJECTIVES: To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS: An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS: The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS: The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.

Daily Copper and Manganese Intakes and Their Relation to Blood Pressure in Normotensive Adults.

Although it has been proposed that trace minerals have anti-oxidative functions and are related to the control of blood pressure, only a limited number of studies directly address the issue. Thus, the purpose of our study was to assess the intake of copper and manganese, which are trace minerals, and to clarify their relation to blood pressure. In a cross-sectional study, the blood pressure of 640 normotensive adults, from 19 to 69 year-old (320 males and 320 females), was measured, and its correlation with the intake of copper and manganese was assessed using a 24-hour dietary recall method. The average value of the blood pressure was 126.4/80.2 mmHg for the males and 117.8/75.8 mmHg for the females. The daily copper intake was 1.3 mg/day for the males and 1.2 mg/day for the females. For manganese, the daily intake was 4.2 mg/day for the males and 4.1 mg/day for the females. Although the copper intake of all subjects showed a positive correlation with the systolic and diastolic blood pressures, there was no significant correlation when the potential confounding factors were adjusted. The manganese intake of the male subjects had a significantly negative correlation with the systolic blood pressure after adjusting for gender, age, body mass index, and energy intake. In conclusion, the daily manganese intake of the normotensitve adults showed a significantly negative correlation with the systolic blood pressure indicating a possibility of a positive effect of manganese on blood pressure.

Prevalence of osteoporosis according to nutrient and food group intake levels in Korean postmenopausal women: using the 2010 Korea National Health and Nutrition Examination Survey Data.

BACKGROUND/OBJECTIVES: Women's bone health status is closely related with environmental factors and lifestyle factors. The purpose of this study is to evaluate the dietary risks of osteoporosis and osteopenia for Korean postmenopausal women. SUBJECTS/METHODS: The data from 1,433 subjects from the 2010 KNHANES were used and divided into three groups: normal, osteopenia, and osteoporosis group using bone mineral density (BMD). Nutrient intakes and food intake frequency were evaluated. Logistic regression analysis was applied to determine the odds ratios for osteoporosis and osteopenia. RESULTS: The RNI percentage of each nutrient and food intake frequency from 12 food groups decreased as bone mineral density status deteriorated. Risk for osteoporosis of low calcium (Ca) intake, under the EAR, showed an odds ratio of 2.13(95% CI; 1.26-3.61, P < 0.05). Higher intake frequency showed preventive effect from osteoporosis compared to lower intake frequency in such food group as dairy products (ORs 0.40, CI 0.21-0.75), beans (ORs 0.49, CI 0.29-0.83), seaweeds (ORs 0.55, CI 0.32-0.94), fish (ORs 0.56, CI 0.32-0.98), and fruits (ORs 0.42, CI 0.23-0.79) after adjusting for age. CONCLUSION: To prevent osteoporosis in later life, sufficient Ca intake and more frequent intakes of foods containing Ca such as dairy products, beans, fish, seaweeds, and fruits, which help in Ca absorption, should be stressed for Korean postmenopausal women.

The environment modifies the relationship between social networks and secondhand smoke exposure among Korean nonsmokers in Seoul and California.

This study compared risks of secondhand smoke exposure (SHSe) among Korean nonsmokers in Seoul, South Korea and California, United States. Social networks were hypothesized to contain more smokers in Seoul than in California, and smokers were hypothesized to produce more secondhand smoke in Seoul than California, as Seoul's policies and norms are less restrictive. Telephone interviews were conducted with Korean adults in Seoul (N = 500) and California (N = 2830). In all, 69% (95% confidence interval [CI] = 64-74) of Koreans and 31% (95% CI = 29-33) of Korean Americans reported any SHSe. A total of 44% (95% CI = 40-47) of Korean family members smoked versus 29% (95% CI = 28-30) of Korean American family members (t = 7.84, P < .01). A 25% to 75% increase in the proportion of family members that smoked corresponded with a 13% (95% CI = 5-21) higher probability of any SHSe among Koreans compared with 6% (95% CI = 2-10) among Korean Americans. Network interventions in combination with policies and/or health campaigns may help reduce SHSe globally.

Eating habits and eating behaviors by family dinner frequency in the lower-grade elementary school students.

BACKGROUND/OBJECTIVES: Recently, there has been an increased interest in the importance of family meals on children's health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners. SUBJECTS/METHODS: The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children's eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using χ(2)-test or t-test. RESULTS: The group that had more frequent family dinners (≥ 5 days/week, 63.4%), compared to those that had less (≤ 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners. CONCLUSIONS: Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children's health and nutrition and making more opportunities for family meals.

The prevalence of obesity and the level of adherence to the Korean Dietary Action Guides in Korean preschool children.

The objective of this study was to investigate the associations between the prevalence of overweight and obesity and the degree of adherence to the Korean Dietary Action Guides for Children (KDAGC). In a cross-sectional study based on a child care center-based survey in Seoul, Korea, we collected parental-reported questionnaires (n = 2,038) on children's weight and height, frequency of fruit and vegetable consumption, and the quality of dietary and activity behaviors based on the 2009 KDAGC Adherence Index (KDAGCAI) which was developed as a composite measure of adherence to the KDAGC. Overweight and obesity were determined according to age- and sex-specific BMI percentile from the 2007 Korean national growth chart. Associations were assessed with generalized linear models and polytomous logistic regression models. Approximately 17.6% of Korean preschool children were classified as overweight or obese. Obese preschoolers had lower adherence to the KDAGCAI compared to those with lean/normal weight. Preschoolers with a high quality of dietary and activity behaviors had a 51% decreased odds ratio (OR) of being obese (highest vs. lowest tertile of KDAGCAI-score, 95% CI 0.31, 0.78; P = 0.001); the associations were more pronounced among those who were older (P = 0.048) and lived in lower income households (P = 0.014). A greater frequency of vegetable consumption, but not fruit, was associated with a borderline significant reduction in the prevalence of obesity. Our findings support the association between obesity prevention and high compliance with the Korean national dietary and activity guideline among preschool children.

Can religion help prevent obesity? Religious messages and the prevalence of being overweight or obese among Korean women in California.

This research examines the influence of messages from religious leaders and congregants on whether Korean women are overweight or obese. Data were drawn from telephone interviews with a probability sample (N = 591) of women of Korean descent living in California. Overweight or obese prevalence was measured using World Health Organization standards for Asians (BMI > 23). Respondents reported the frequency of messages discouraging "excessive eating" or encouraging "exercise" from religious leaders and congregants during a typical month. When conditioned on leaders' messages, the frequency of congregants' messages was associated with a significantly lower probability of being overweight or obese, although messages from either in the absence of the other were unassociated with being overweight or obese. At least for Korean women, religion may help prevent obesity via religious-based social mechanisms.

Gender modifies the relationship between social networks and smoking among adults in Seoul, South Korea.

OBJECTIVE: To evaluate the interaction of gender with social network mechanisms and smoking behaviors in Seoul, South Korea, where smoking is common among men but not women. METHODS: During 2002, telephone surveys were completed with 500 adults drawn from a probability sample in Seoul. Respondents described their smoking status, smoking rate (number of cigarettes smoked per day) and social networks by assessing who discouraged or encouraged smoking (smoking support) or smoked (smoking models). Multivariable regressions were used for analyses. RESULTS: Women encountered significantly less smoking support than men, 88% (95% confidence interval [95% CI], 85-91) versus 70% (95% CI 66-73) net discouragement of smoking in their network. A difference in smoking support from 25 to 75% net discouragement was associated with a 27% (95% CI 9-49) lower probability of smoking among women, significantly stronger (z = 3.18, p < 0.01) than among men who had a 19% (95% CI 8-27) lower probability of smoking. A similar difference in smoking support was associated with male smokers smoking 6.38 (95% CI 0.86-12.30) fewer cigarettes per day, or 2,329 (95% CI 314-4,490) fewer cigarettes per year. The later association could not be observed among women due to the small proportion of female smokers. Smoking models were not significantly associated with any smoking behaviors across genders. CONCLUSIONS: Social network mechanisms were differentially associated with the high smoking prevalence among men and low prevalence among women and should be targeted by interventions tailored to these differences.

Home smoking restrictions among Koreans in Seoul.

The prevalence and correlates of home smoking bans in the Republic of Korea were examined using population-based data from telephone interviews with 500 Seoul adult residents in 2002. Most (97%) respondents indicated that they smoked, or that their spouse, other family member, or a regular friend smoked. Nearly all indicated that environmental tobacco smoke (ETS) is harmful. Only 19% of homes banned smoking, 65% allowed smoking anywhere, and 16% allowed smoking by special guests or in certain areas. The odds of having a full ban were significantly greater for men, married individuals, those less than 35 years or more than 50 years of age, non-smokers, individuals whose nonspouse family members did not smoke, and individuals with more sources of anti-ETS messages. Home smoking bans should be promoted by media campaigns and other tobacco control activities, because knowledge of the effects of ETS was already high.

Workers intake too much salt from dishes of eating out and food service cafeterias; direct chemical analysis of sodium content.

The average sodium intake of Koreans was reported to be 5,279.9 mg/day, which is one of the highest intake levels worldwide. The average Koreans intake 19.6% of sodium from kimchi, showing kimchi as the main contributor of sodium in this country (Ministry of Health and Welfare, 2005). The sodium content of dishes that are frequently chosen by workers, and which were served by foodservice cafeterias were chemically analyzed. The average sodium content of one meal provided by 10 foodservice cafeterias was 2,777.7 mg. Twenty-one, one-dish-meals, frequently chosen by workers for a lunch menu, were collected at 4 different restaurants for each menu by one male, aged in the twenties and analyzed chemically also. Workers who eat lunch at a workplace cafeteria everyday could intake about 8 g of salt at a one-time meal and those who eat out for a one-dish-meal would intake 3-8 g of salt without counting sodium content from the side dishes. From these study results, one could estimate that over 10 g of salt could be possible for a single meal for workers who eat out everyday. A nationwide nutrition campaign and education for low salt diets for restaurant owners and foodservice providers should be seriously considered.

Children's exposure to secondhand smoke at home in Seoul, Korea.

here is little information about Korean children's secondhand smoke (SHS) exposure at home. This paper examines the extent and determinants of their SHS exposure at home. A population-based random digit dial telephone survey was conducted in 2002 with 500 adults in Seoul. We analyzed data for 207 adults with children living in the household. Thirty-one percent of respondents reported children' s SHS exposure at home. The mean weekly dose was 5 cigarettes among exposed children. Multiple logistic regression results showed that children's odds of SHS exposure at home increased if the respondent or spouse smoked, if the respondent's parent smoked, if smoking was allowed in the home, and if fewer groups discouraged smoking. Stronger protective measures are urged, such as widespread increase in home smoking bans and discouragement of smoking.

A study on nutrition knowledge and dietary behavior of elementary school children in Seoul.

The purpose of this study was to investigate the nutrition and diet related knowledge, attitude, and behavior of elementary school children in Seoul. The subjects included were 439 (male 236, female 203) elementary school children in the 4th to the 6th grades. The statistical analysis was conducted using SPSS 12.0 program. The average obesity index (OI) was 104.98 and 99.82 for male and female subjects, respectively. The average percentage of underweight, normal, overweight and obese of subjects was 33.7%, 32.8%, 12.3%, and 19.4%, respectively. The percentage of the underweight group of female subjects was higher than that of the male subjects. The percentage of the obese group of male subjects was higher than that of the female subjects. The average score of nutrition knowledge, nutrition attitude and dietary behavior was 6.8, 7.44, and 7.34, respectively. Dietary behavior of male subjects was positively correlated with parents' education levels, monthly household income and nutrition attitude. Dietary behavior of female subjects was positively correlated with monthly household income, nutrition knowledge and nutrition attitude. Dietary behavior of female subjects was positively correlated with obesity index (OI). Proper nutrition education and intervention are required for the improvement of elementary school children's nutrition knowledge, nutrition attitudes and dietary behaviors.

Acculturation and health risk behaviors among Californians of Korean descent.

BACKGROUND: This study examined the effects of acculturation on health behaviors among Korean-Americans in California compared to Koreans in Seoul. METHODS: Telephone interviews were conducted with 2,830 Korean-American adults in California (completion rate exceeding 86%) and 500 Korean adults in Seoul (completion of about 50%). RESULTS: Among Korean-Americans, acculturated women were more likely to smoke and drink while acculturated men were more likely to become obese. All Korean-American men reported significantly decreased rates of smoking and drinking compared to Koreans in Seoul. Among both men and women in California, acculturation was associated with high consumption of American foods, and low consumption of traditional Korean foods. CONCLUSIONS: These results indicate that more acculturated Korean-Americans were exposed to greater health risk than those who were less acculturated.