Food sources of zinc and nutritional status with usual dietary zinc intake in Korean toddlers and preschool children.

BACKGROUND/OBJECTIVES: This study aimed to evaluate the food sources of zinc and the usual intake of dietary zinc among Korean toddlers and preschool children. SUBJECTS/METHODS: A total of 2,679 children aged 1-5 years was selected from the 2009-2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. Dietary data collected from a single 24-h recall were used to evaluate the food sources of zinc. To estimate usual zinc intake, the distribution obtained from single 24-h recall data in the total sample was adjusted using the ratio of within-to-between-person variance in zinc intake obtained from 2-day 24-h recall sub-sample data of the 2009 KNHANES. The proportion of children with usual zinc intake below the estimated average requirement (EAR) and above the tolerable upper intake level (UL) was assessed. RESULTS: The main sources of zinc in Korean children were grains, dairy products, and meat. The mean usual intakes of zinc among all individuals, those aged 1-2 yrs, and those aged 3-5 yrs were 5.50, 5.01, and 5.83 mg/d, respectively. In all participants, 1.1% of the children consumed zinc below the EAR, whereas 10.7% exceeded the UL. The proportion of children with excessive zinc intake was 25.6% in the 1-2 yrs age group and 0.6% in the 3-5 yrs age group. CONCLUSIONS: According to the current UL, the risk of excessive zinc intake appears to be high among Korean toddlers. Future studies that monitor the health effects of excessive zinc intake are needed to appropriately guide zinc intake in children.

Trends in dietary intake and food sources of long-chain polyunsaturated fatty acids among Korean adults between 2007 and 2018.

OBJECTIVES: This study examined trends in the dietary intake and food sources of long-chain polyunsaturated fatty acids (LC-PUFAs) in Korean adults from 2007 to 2018. METHODS: In total, 46,307 adults (aged 19-64 years) were selected from the 2007-2018 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained using 24-hour dietary recall. Intake levels and food sources of LC-PUFAs, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and linoleic acid (LA), were evaluated across the survey years and assessed based on compliance with dietary recommendations over the 2007-2018 period. Linear trends in LC-PUFAs intake levels over time were examined through multiple linear regression analysis. RESULTS: From 2007 to 2018, ALA and LA consumption increased from 1.1 g (0.5% of energy) to 1.4 g (0.6% of energy) and from 8.6 g (3.9% of energy) to 10.0 g (4.5% of energy), respectively. EPA intake decreased from 0.14 g to 0.12 g, and EPA+DHA intake showed a decreasing trend. The proportion of individuals who did not meet the recommended intake of EPA+DHA (250 mg/day) increased (64.4 to 68.4%). Regarding changes in food sources of ALA and LA, the contributions from mayonnaise, eggs, and bread increased, while those from plant food sources decreased. Among food sources of EPA and DHA, anchovy, saury, and Atka mackerel showed lower contributions over time. CONCLUSIONS: Our findings suggest that strategies to encourage the consumption of EPA and DHA from healthy food sources are necessary to improve cardiovascular health in the Korean population.

Association of added sugar intake with all-cause and cardiovascular disease mortality: a systematic review of cohort studies.

BACKGROUND/OBJECTIVES: The long-term health impacts of dietary sugar have begun to be reported. The committee on the 2020 Dietary Reference Intakes for Koreans for sugar intended to update the scientific evidence on the association of added sugar intake with health outcomes, including mortality. This study evaluated the evidence on the association of dietary sugar with the all-cause and cardiovascular disease mortality from cohort studies. SUBJECTS/METHODS: The PubMed and ScienceDirect databases were searched until July 2021. The search terms were based on multiple combinations of keywords, such as added sugar, beverage, and mortality, included in the title or abstract. Two authors independently assessed the eligibility criteria of study selection and extracted the information from each selected article for this systematic review. RESULTS: The literature search identified 276 articles. Seventeen cohort studies met the inclusion criteria and were included in this systematic review. This study extracted information on the cohort and participants, dietary assessment methods, exposure and its comparison groups, health outcomes, and risk measures. Five articles reported added sugar intake, and 15 articles reported the food sources of the added sugar in the association with mortality. Increased mortality was observed in higher added sugar intake and a lower intake of less than 5% of energy, while higher discrepancies between gender, age groups, and countries were noted. In addition, nutritious sugary foods and beverages did not increase mortality. CONCLUSIONS: A 'U' or 'J' shaped relationship between the added sugar intake and mortality was estimated. The observed discrepancy indicated the need for more evidence to establish the dose-response relationship for Koreans.

Food behaviors accounting for the recent trends in dietary fatty acid profiles among Korean adults.

BACKGROUND/OBJECTIVES: This study examined the changes in food behaviors of dietary fatty acids over 2007-2018 among Korean adults. SUBJECTS/METHODS: This study used data from the 4th (2007-2009), 5th (2010-2012), 6th (2013-2015), and 7th (2016-2018) Korea National Health and Nutrition Examination Surveys. A total of 46,307 adults aged 19-64 yrs were selected and dietary data were obtained from a single 24-h recall. In the 4th and 7th data, the major food sources for each fatty acid based on the contributing percentage of the food item were compared. The consumption trends in the major food sources were presented as grams per day over 2007-2018 and compared across the survey periods using the multiple regression model. RESULTS: From 2007 to 2018, for total fat, saturated fatty acid (SFA), and monounsaturated fatty acid, the contribution of animal food sources, including beef, chicken, and eggs increased but plant food sources (e.g., tofu, soybean, and plant oil) decreased. As polyunsaturated fatty acid sources, mayonnaise, eggs, and bread showed higher contributions, whereas soybean and tofu showed lower contributions in the 7th data compared to the 4th data. For n-3 fatty acids, the contribution of fish decreased between the 4th and 7th data. Over 12 yrs, the significant increases in the absolute amount of consumption from animal sources were observed. In contrast, decreases in the consumption from plant sources and fish were seen across the survey periods. CONCLUSIONS: In Korean adults, increases in the intake of dietary fatty acids along with changes in the food behaviors during 2007-2018 have evoked great concern for SFA intake, which is a cardiovascular disease risk factor. Healthy food sources of dietary fatty acids should be emphasized in this population.

Increasing trends in dietary total fat and fatty acid intake among Korean children: using the 2007-2017 national data.

BACKGROUND/OBJECTIVES: The prevalence of obesity has been increasing in Korean children. As an unhealthy diet is known as one of the major determinants of childhood obesity, assessing and monitoring dietary fat intake of children is needed. SUBJECTS/METHODS: This analysis included 9,998 children aged 3-11 yrs from the 2007-2017 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained from a single 24-h dietary recall. Intakes of total fat and fatty acids, including saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) were evaluated as the absolute amount (g) and proportion of energy from each fatty acid (% of energy). The total fat and SFA intake were also assessed according to compliance with dietary guidelines. Linear trends in the dietary fats intake across the survey period were tested using multiple regression models. RESULTS: Total fat intake significantly increased from 38.5 g (20.3% of energy) to 43.4 g (23.3% of energy) from 2007 to 2017. This increase was mainly accounted for the increases in intakes of SFA (7.2% to 8.4% of energy) and MUFA (6.2% to 7.5% of energy). PUFA intake increased from 4.4 to 4.7% of energy during the 11-yrs period: from 0.57 to 0.63% of energy for n-3 FA and from 3.8 to 4.1% of energy for n-6 FA. The proportions of children who consumed amounts exceeding the dietary guidelines for total fat and SFA significantly increased from 2007 to 2017, with increases from 9.8% to 17.4% for total fat and from 36.9% to 50.9% for SFA. CONCLUSIONS: Prominent increasing trends in the consumption of total fat and SFA but tiny change in n-3 FA intake were observed in Korean children. The healthy intake of dietary fats should be emphasized in this population.

Development of the Korean Healthy Eating Index for adults, based on the Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: The objective of this study was to describe the development process of the Korean Healthy Eating Index (KHEI) based on the Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The components of KHEI were selected based on Dietary Guidelines for Koreans, domestic and overseas dietary quality indices, and results of the analysis of association with chronic diseases. The standards for scoring of KHEI were selected based on the 2015 Dietary Reference Intakes for Koreans (KDRI). The KHEI scores of Korean adults were calculated using a 1-day 24-h recall data in the 2013-2015 KNHANES. RESULTS: The KHEI included eight adequacy components evaluating the proper intake of recommended foods such as fruit, vegetable, and milk and three moderation components evaluating the consumption of food that limit intake such as sodium and saturated fatty acid. In addition, three balance components assessing the balance of energy intake were included. The KHEI score was defined to range from the minimum of 0 point to the maximum of 100 points. Among Korean adults, the total KHEI score was 63.2 out of 100. Gender and age differences were found in the average of total KHEI scores. Women showed higher score than men (61.7 in men and 64.7 in women, respectively). By age group, 20s and 30s showed the lowest scores with 57.4 and 61.1 respectively, and the scores increased with age by peaking at 67.8 in ages 60-69 and slowed down again in ages 70 or over. CONCLUSIONS: The KHEI can be useful for establishing and assessing national nutritional policies and in epidemiological studies to assess the relationship between overall dietary quality and chronic diseases. KHEI will need to be continuously updated to reflect changes in dietary guidelines and the KDRI.

Evaluation of portion size estimation aids for the Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: This study aimed to improve portion size estimation aids (PSEAs) used in the nutrition survey of the Korea National Health and Nutrition Examination Survey (KNHANES) and validate the accuracy and precision of the newly developed aids. SUBJECTS/METHODS: We conducted intensive interviews with survey experts in KNHANES and consulted with experts to collect opinions about improvement of PSEAs. Based on the results of the interviews, 5 types of PSEAs (rice bowl, earthen pots, mounds, measuring spoons, and thickness sticks) were newly developed using 3-dimensional (3D) modeling or modification of color or shape. Validation tests were conducted with 96 adults 20 years old or older. For the rice bowl and earthen pots, the participants were asked to select the more similar PSEA in size after being shown the real dishes. For the mounds, measuring spoons, and thickness sticks, the participants were presented with actual plates of food and asked to estimate the given portion sizes using the given PSEAs. RESULTS: The improved 2-dimensional (2D) picture aid for the rice bowl reflecting the size distortion by angle of view using 3D modeling was perceived more closely to the actual size than the current 2D picture (P < 0.001). The change of the color of 2D pictures and 3D models, the change of shape of the measuring spoons, and the 3-dimensionalization of the 2D mounds had no significant improvement in the subjects' perception. CONCLUSIONS: The currently used 2D PSEAs need to be fully redesigned using 3D modeling to improve subjects' perception. However, change of color or shape will not be necessary. For amorphous foods, it is suggested that more evaluation be performed before reaching a final conclusion in the use of PSEAs, or alternative ways to improve accuracy of estimation need to be explored.

Development of a food frequency questionnaire for dietary intake of preschool children.

BACKGROUNDS/OBJECTIVES: To describe the data-based development of a food frequency questionnaire (FFQ) for dietary evaluation of Korean preschool children. SUBJECTS/METHODS: Development of the FFQ was based on the data from 2,766 preschool children aged 1-5 years, who had completed 24-hour dietary recalls in the 2009-2013 Korea National Health and Nutrition Examination Survey. We selected the food list based on the results of nutritional contribution and between-person variability for energy and 13 nutrients. We selected 88 foods with over 80% of total contribution to each nutrient and with over 80% of accumulated r 2 for each nutrient. A dish containing any of the 88 foods in the recipe was listed, and a total of 903 dishes were extracted. Among the 903 dishes, we selected 438 dishes contributing more than 1% of total consumption. RESULTS: FFQ included 116 dish items combined from 438 dishes based on nutrient profile and recipe. Quantities of dietary intake were assessed by nine categories of frequency and portion size option. In addition, when comparing the food portions of children with the reference portion size, subjects would be asked to select one of three response categories (less, similar, and more) and then to record the amount as a percentage for the reference portion. Percentages of coverage for energy, protein, fat, and carbohydrate were 89.2%, 88.4%, 88.2%, and 89.4%, respectively. CONCLUSIONS: The dietary intake of Korean preschool children can be assessed by this new data-based FFQ. In addition, the new instrument can be used to identify nutritional needs of target groups for planning nutrition education and strategies to improve diet. Further studies are warranted to evaluate the performance of the instrument.

Objective and perceived food environment and household economic resources related to food insecurity in older adults living alone in rural areas.

BACKGROUND: Limited attention has been paid to an association between food environment and household economic resources related to food expenditure in food-insecure seniors. The aim of the study was to investigate the relationship between factors of economic resource, food environment, and food insecurity in single seniors residing in rural areas of South Korea. METHODS: A cross-sectional study was conducted in 170 single senior households aged 65 years or over residing in rural areas. Face-to-face interviews were performed to collect data on demographic characteristics, household economic resources/expenditure, food environmental factors, and food insecurity. RESULTS: Among economic resources, generally limited food expenditures due to housing fees and heating costs during the winter were positively related to food insecurity. Among food environmental factors, food accessibility at community level such as food stores located far from home and inconvenient bus routes was related to food insecurity. The most explainable economic and food environment factors related to food insecurity by stepwise logistic regression analysis were the percentage of total expenditure on housing fee (OR = 1.021, 95% CI: 1.008-1.034), foods purchasing at super supermarket (OR = 0.398, 95% CI: 0.166-0.951), having difficulties in food purchasing due to food stores being located far from home (OR = 14.487, 95% CI: 5.139-40.842) and inconvenient bus routes (OR = 0.083, 95% CI: 0.015-0.460). CONCLUSION: Inadequate community food environment as well as limited household food resources were an important risk factor for food insecurity in Korean single rural seniors. Findings of this study could help us better understand how characteristics of household food resources and community food environment can serve as barriers or facilitators of food security among single older adults residing in rural areas.

Contribution of foods to absolute nutrient intake and between-person variations of nutrient intake in Korean preschoolers.

BACKGROUND/OBJECTIVES: The aim of this study was to analyze specific foods influencing absolute nutrient intake and between-person variations of nutrient intake among Korean preschoolers. SUBJECTS/METHODS: This study included 2,766 participants aged 1-5 years in the 2009-2013 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained from a 24-h dietary recall method. Major food sources of absolute nutrient intake were evaluated based on percent contribution of each food. To assess the contribution of specific foods to between-person variations in nutrient intake, stepwise multiple regressions were performed and cumulative R2 was used. RESULTS: White rice and milk were main food sources of energy, protein, carbohydrate, phosphorus, iron, potassium, thiamin, riboflavin, and niacin. The percentage of fat contributed by milk was 21.3% which was the highest, followed by pork, soybean oil, and egg. White rice accounted for 25% and 40% of total variability in total energy and carbohydrate intakes, respectively. About 39% of variation in calcium intake was explained by milk while 40% of variation in phosphorous intake was explained by cheese. The top 10 foods contributing to between-person variations in nutrient intakes were similar with food items that mainly contributed to absolute nutrient intakes. The number of foods explaining 90% of absolute amounts of nutrient intakes varied from 28 for vitamin A to 80 for iron. CONCLUSIONS: This study identified specific foods that contributed to absolute nutrient intakes and between-person variations in nutrient intakes among Korean preschoolers. Our findings can be used to develop dietary assessment tools and establish food-based dietary guidelines for young children.

Trends in total fat and fatty acid intakes and chronic health conditions in Korean adults over 2007-2015.

OBJECTIVE: To investigate trends in total fat and fatty acid intakes and chronic health conditions among Korean adults over nine years between 2007 and 2015. DESIGN: Cross-sectional, observational study using a stratified, multistage probability sampling design at a national level. Intakes of total fat and fatty acids were estimated from 24 h dietary recalls by sex and age groups. Trends of total fat and fatty acid intakes were determined by multiple linear regression after adjusting for covariates. Trends in age-standardized prevalence of obesity, hypercholesterolaemia and hypertriacylglycerolaemia were examined by sex. SETTING: Korea.ParticipantsPopulation data of 47749 healthy adults (aged ≥19 years) derived from the Korea National Health and Nutrition Examination Survey between 2007 and 2015. RESULTS: Over the survey period, daily intakes of energy and total, saturated, monounsaturated, polyunsaturated, n-3 and n-6 fats (grams and percentage of energy (%E)) increased steadily. In all sex and age groups, significant increases were seen in SFA intake from 9·9 g (4·7 %E) to 12·0 g (5·3 %E) and in MUFA intake from 9·9 g (4·6 %E) to 13·3 g (5·8 %E). The prevalence of hypercholesterolaemia increased from 10·7 to 17·9 % over the same period. CONCLUSIONS: In Korean adults, total fat, SFA and other fatty acids have been increasing along with the prevalence of hypercholesterolaemia. This information can help set adequate macronutrient and fatty acid distribution ranges in developing population-specific preventive strategies against diet-related illness.

Trends in Dietary Intake of Total Fat and Fatty Acids Among Korean Adolescents from 2007 to 2017.

We analyzed the trends in dietary intake of total fat and fatty acids among Korean adolescents during 2007-2017. A total of 6406 adolescents from the 2007-2017 Korea National Health and Examination Surveys were selected. Total fat and fatty acids intakes were calculated based on single 24-hour recall data and presented as grams (g) and percentage of energy intake (% kcal) across the survey period. Linear trends in intake across the survey period were compared using the multiple regression model. Total fat intake increased during the 11-year period from 54.3 g (21.7% kcal) to 61.8 g (25.2% kcal). Saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) intakes changed from 17.8 g (7.1% kcal) and 17.2 g (6.8% kcal) to 20.6 g (8.4% kcal) and 20.7 g (8.4% kcal) over time, respectively. For polyunsaturated fatty acids (PUFA), n-3 fatty acid intake did not change during the survey period. The proportions of individuals who had total fat and SFA above the recommendations increased across the survey period: 13.7% to 27.5% for total fat and 36.0% to 49.7% for SFA. Among Korean adolescents, dietary fat intake increased over time and the increases in SFA and MUFA intake were prominent. Monitoring dietary fat intake is helpful to suggest dietary guidelines and health policies.

Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults.

Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook's physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.

Dietary intake of fat and fatty acids by 1-5-year-old children in Korea: a cross-sectional study based on data from the sixth Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: We examined dietary fat intake and the major food sources by young children in Korea. SUBJECTS/METHODS: A total of 1,041 children aged 1-5 years were identified from the 2013-2015 Korea National Health and Nutrition Examination Survey. Data on total fat and fatty acid intake were obtained by a single 24-h dietary recall. Food sources were identified based on the amounts of total fat and fatty acids consumption according to each food. Fat and fatty acid intakes and their food sources were presented by age group (1-2-y, n = 401; 3-5-y, n = 640). Fat and fatty acid intakes were also evaluated according to socioeconomic characteristics. RESULTS: The mean intake of fat was 27.1 ± 0.8 g in the 1-2-y group and 35.5 ± 0.7 g in the 3-5-y group, and about 23% of the total energy was obtained from fat in both age groups. The mean intake of saturated fatty acids (SFA) was 10.5 ± 0.3 g in the 1-2-y group and 12.7 ± 0.3 g in the 3-5-y group, with the 1-2-y group obtaining more energy from SFA than the 3-5-y group (9.2% vs. 8.3%). The mean intake of polyunsaturated fatty acids (PUFA) was 6.3 ± 0.1 g in the total subjects, with 0.8 ± 0.03 g of n-3 fatty acids and 5.5 ± 0.1 g of n-6 fatty acids being consumed. Milk, pork, and eggs were major food sources of total fat, SFA, and monounsaturated fatty acids, and soybean oil was the main contributor to PUFA in both age groups. In the 1-2-y group, children in rural areas had significantly higher intake of PUFA and n-3 fatty acids than did those in urban areas. CONCLUSIONS: Our findings provide current information on dietary fat intake among young Korean children and could be used to establish dietary strategies for improvement of health status.

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.

Association between Picky Eating Behaviors and Nutritional Status in Early Childhood: Performance of a Picky Eating Behavior Questionnaire.

Picky eating behaviors are frequently observed in childhood, leading to concern that an unbalanced and inadequate diet will result in unfavorable growth outcomes. However, the association between picky eating behaviors and nutritional status has not been investigated in detail. This study was conducted to assess eating behaviors and growth of children aged 1-5 years from the Seoul Metropolitan area. Primary caregivers completed self-administered questionnaires and 3-day diet records. Differences in the nutrient intake and growth indices between picky and non-picky eaters were tested by analysis of covariance. Children "eating small amounts" consumed less energy and micronutrients (with the exception of calcium intake), but picky behaviors related to a "limited variety" resulted in a significant difference regarding nutrient density for some micronutrients. Children with the behavior of "eating small amounts" had a lower weight-for-age than that of non-picky eaters; especially, the older children with the behaviors of "eating small amounts" or "refusal of specific food groups" had lower height-for-age compared with non-picky eaters. These results suggest that specific picky eating behaviors are related to different nutrient intake and unfavorable growth patterns in early childhood. Thus, exploration of potential interventions according to specific aspects of picky eating and their efficacy is required.

Dietary Supplement Use and Nutrient Intake among Children in South Korea.

BACKGROUND: The use of dietary supplements (DS) is common in South Korea and other countries. However, few studies have been conducted in South Korea on their use, especially in early childhood. OBJECTIVE: The objective of this study was to compare total nutrient intake and nutrient adequacy among DS users and nonusers in Korean children. DESIGN: Cross-sectional study. PARTICIPANTS/SETTING: Data of participants aged 1 to 8 from the 4th (2007-2009) Korea National Health and Nutrition Examination Survey were used. The participants were divided into two groups based on use of dietary supplements (DS users, n=766; nonusers, n=1,648). MAIN OUTCOME MEASURES: Dietary intake measured by 24-hour recall and DS information from questionnaires was collected with the assistance of a caregiver. Nutrient intake was adjusted within and between person variations, using C-SIDE (Software for Intake Distribution Estimation, version 1.02, 1996; available from the Center for Survey Statistics and Methodology, Iowa State University) software to estimate usual intake. Total nutrient intake was calculated as the sum of nutrient intake from food and DS. STATISTICAL ANALYSES PERFORMED: Nutrient intake between groups was compared by using a multivariate regression model adjusted for demographic characteristics. Adequacy of nutrient intake between the two groups was compared with Dietary Reference Intakes for Koreans by using the Cochran-Mantel-Haenszel test, controlling for demographic characteristics. RESULTS: No significant differences were observed in dietary macronutrients and micronutrients between DS users and nonusers, except for calcium. Total intake (food+DS) of vitamin A, vitamin C, thiamin, riboflavin, niacin, calcium, and iron were higher in DS users compared with nonusers. A lower percentage of DS users had total micronutrient intakes below the estimated average requirement compared with nonusers. DS use was associated with intakes of vitamin A and C that were higher than the tolerable upper intake levels. CONCLUSIONS: DS use in children contributes to adequate micronutrient intake. However, concerns exist about excessive intakes of specific nutrients, especially among children who consume more than the suggested dosage.

Fruit and Vegetable Intakes of Preschool Children Are Associated With Feeding Practices Facilitating Internalization of Extrinsic Motivation.

OBJECTIVE: To examine the association between feeding practices and both fruit and vegetable intakes of preschoolers. DESIGN: Cross-sectional; data collected from 2009 to 2010. SETTING: Child care centers enrolled in the cohort of the Synergistic Theory and Research on Obesity and Nutrition Group Kids program. PARTICIPANTS: Three hundred and sixteen mother-child dyads were recruited in the baseline survey as primary caregivers of children aged 2-5 years. MAIN OUTCOME MEASURES: Ten aspects of maternal feeding practices were measured using a Comprehensive Feeding Practices Questionnaire. The frequency of children's fruit and vegetable consumption was estimated by mothers. ANALYSIS: Spearman's rank order correlation and linear regression analysis between parental feeding practices and both fruit and vegetable consumption were adjusted for potential confounders. Pearson's correlation coefficients among 10 parental feeding practices were calculated. RESULTS: Children in the study consumed fruit 1.7 ± 0.9 times per day and vegetables 1.4 ± 0.8 times per day. Feeding practices of building a healthy home food environment and involvement were positively related and those of restriction for health were negatively related to children's vegetable consumption (P < .001); moreover, encouraging balance and variety and monitoring were positively related to children's fruit consumption (P < .001). CONCLUSIONS AND IMPLICATIONS: The results of this study suggest that both fruit and vegetable intakes of preschool children are more likely to increase if parents employ feeding practices that encourage child autonomy, competence, and relatedness.

Gender analysis in the development and validation of FFQ: a systematic review.

FFQ comprising food items, intake frequency categories and portion sizes have been used in large-scale observational studies to assess long-term dietary exposure. Although gender is an important influence on food choice and portion size, gender differences are not often analysed during FFQ development. This study investigated whether gender differences were considered sufficiently when developing FFQ, which affects the results of validation studies. A PubMed search using combinations of 'FFQ', 'Food Frequency Questionnaire', 'Validation' and 'Validity' identified 246 validation studies available in English, published between January 1983 and May 2014, which included healthy male and female adults. The development process of the 196 FFQ used in the 246 validation studies was examined. Of these, twenty-one FFQ (10·7%) considered gender during item selection or portion size determination, and were therefore classified as gender specific (GS), but 175 (89·3%) did not consider gender, and were classified as 'not gender specific (NGS)'. When the ratios between intake levels obtained using the FFQ and a reference method for energy and seven nutrients were compared between the GS group and the NGS group, more significant differences were observed in women than in men (four v. one nutrient). Intake of three nutrients was significantly underestimated in both sexes in the GS group. In the NGS group, nutrient intakes were significantly overestimated more often in women than in men (four v. one). These results indicate that not considering gender in FFQ development causes greater inaccuracy in dietary intake assessment in women than in men. Results of nutritional epidemiological studies should be re-evaluated for their validity, especially if the studies used NGS-FFQ.

Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013.

BACKGROUND/OBJECTIVES: The aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013). SUBJECTS/METHODS: Total fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food. RESULTS: The mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively. CONCLUSIONS: Estimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.