Jae Eun Shim

Development of Han-sik Database Utilizing an Expert Focus Group and Assessment of Han-sik Effects on Diet Quality

This study was conducted to develop a Han-sik database as well as to assess the effects of Han-sik on dietary quality among Koreans. The Han-sik database was developed by a focus group composed of food and nutrition specialists considering the results of Han-sik perception surveys conducted in previous studies for frequently consumed dishes. Among the 1,322 dish items identified in the 4 (2007-2009) Korea National Health and Nutrition Examination Survey (KNHANES), 973 items (73.6%) were classified as Han-sik. Han-sik usage was defined as the percentage of Han-sik items of all individually consumed dish items in the dietary data of 22,113 subjects who participated in a 24-hour diet recall in the 4 (2007-2009) KNHANES. Dietary quality was evaluated based on adherence to the Korean Food Guidance System (KFGS), which was calculated as the percentage of the number of servings consumed in each food group out of recommended servings according to age and sex. Mean usage of Han-sik was 80.1% and was higher in older age groups, rural areas, as well as in households at the lowest income level. Han-sik usage was also higher on weekdays as well as for breakfast. Adherence to the KFGS was significantly higher for grains, meat · fish · egg · beans, vegetables, and fruits (p<0.001) but lower for milk · dairy products and oils · fats · sugars (p<0.001) across the quartiles of Han-sik usage. The results of this study indicate that Han-sik usage is high among Koreans. Further studies are needed to update the Han-sik database as well as investigate the association between health-related factors and Han-sik use.

Recommendation of Serving Size of the Meal Service of Community Child Centers in Korea

Objectives: This study was performed to set easily applicable portion sizes by sex and age for children at the Community Child Centers (CCC) in Korea. Methods: Considering the age and gender specific energy level at Target Patterns for children aged 6-18 years, which were suggested as a part of the 2010 Korean Food Guidance System (KFGS), we set three meal sizes. We reclassified the recommended daily servings of Grains, Meat⋅fish⋅eggs⋅beans and Vegetables group at Target Patterns into three meal sizes, and then calculated the recommended serving per meal. Each proposed amount of food per meal was calculated based on serving size of foods commonly eaten at KFGS, which was then allocated to five meal components; rice, soup?stew, protein and vegetable side-dishes and Kimchi. Each proposed amount of food per meal was applied to 173 menus’ recipes from CANpro 3.0 as main ingredient’s amounts. We cooked the 173 menus at the medium size and measured their weights after cooking. Results: Each recommended serving per meal was 0.75, 0.9 and 1.2 for Grains; 1.2, 1.6 and 2.4 for Meat⋅fish⋅eggs⋅beans; 2, 2.4 and 2.8 for Vegetables by meal sizes. Among five meal components, the ratio of small and large to medium size was 1/5 less and 1/3 more for rice and 1/3 less and 1/3 more for soup⋅stew, protein side-dish and Kimchi, respectively. We suggested the same amount for a vegetable side-dish to encourage vegetable intake. Proper portion sizes per meal of medium were rice 190 g, soup⋅stew 210 g (solid ingredients 60 g), protein side-dish 100 g (meat⋅eggs⋅beans) and 70 g (fish), vegetable side-dish 80g and Kimchi 30 g. Conclusions: Proper portion size per meal suggested in this study may be useful at the CCC where dietitians are not available and the approach could be applicable to the other types of meal services. Korean J Community Nutr 19(4): 361~371, 2014

Nutritional status of toddlers and preschoolers according to household income level: overweight tendency and micronutrient deficiencies.

BACKGROUNDS/OBJECTIVES The effects of malnutrition on growth of toddlers and preschoolers by socioeconomic status are not well known. This study aimed to examine the effects of dietary intake on growth outcomes in toddlers and preschoolers by household income level. SUBJECTS/METHODS The study population was a total of 1,687 children aged 1 to 5 years that participated in the KNHANES from 2009 to 2011. Growth of children was assessed by height for age (HFA) and weight for height (WFH). Children were classified into three groups according to childrens HFA and WFH compared to the 10th and 90th percentiles of the 2007 Korean Children and Adolescent Growth Standard. Average monthly household income was divided into quartile groups. Dietary intake data were obtained by using the one day 24-hr recall method. Risks of inadequate intake of nutrients and unfavorable growth were estimated by using a multiple logistic regression model adjusted for sex, age, region, and energy intake. RESULTS The low HFA group (< 10th percentile) had significantly lower intakes of energy, carbohydrate, and thiamin as compared with the high group (≥ 90th percentile). For WFH status, vitamin C intake was lower in the low group than in the high group. Household income level was related to WFH status but not HFA. Children from lower income households were more likely to have high WFH than those from higher income households (P for trend = 0.038). Household income status was also significantly related with risk of inadequate intake of micronutrients such as thiamin (P for trend = 0.032) and vitamin C (P for trend = 0.002), showing higher odds of inadequate intakes in children from lower income households. CONCLUSIONS Children from lower income households were prone to be overweight and to have inadequate intakes of micronutrients such as thiamin and vitamin C. To reduce nutritional and health disparities, collective action in the public sector is required from early life.

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.

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.

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.

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.