DOI QR코드

DOI QR Code

국민건강영양조사 자료를 이용한 한국 성인의 식생활평가지수 개발

Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data

  • 육성민 (상명대학교 외식영양학과) ;
  • 박소희 (연세대학교 보건대학원 보건통계학과) ;
  • 문현경 (단국대학교 식품영양학과) ;
  • 김기랑 (단국대학교 식품영양학과) ;
  • 심재은 (대전대학교 식품영양학과) ;
  • 황지윤 (상명대학교 교육대학원 영양교육전공)
  • Yook, Sung-Min (Department of Foodservice Management and Nutrition, Sangmyung University) ;
  • Park, Sohee (Department of Biostatistics, Graduate School of Public Health, Yonsei University) ;
  • Moon, Hyun-Kyung (Department of Food Science and Nutrition, Dankook University) ;
  • Kim, Kirang (Department of Food Science and Nutrition, Dankook University) ;
  • Shim, Jae Eun (Department of Food and Nutrition, Daejeon University) ;
  • Hwang, Ji-Yun (Nutrition Education Major, Graduate School of Education, Sangmyung University)
  • 투고 : 2015.09.04
  • 심사 : 2015.10.08
  • 발행 : 2015.10.31

초록

본 연구는 한국 성인을 대상으로 인구집단의 식생활지침 실천과 식생활의 질과 수준을 모니터링 하기 위해 식생활평가지수를 개발하였다. 문헌고찰 및 국가의 영양정책과 식생활지침, 전문가 의견을 바탕으로 후보항목을 도출하여 건강결과 변수에 따른 식품 및 영양소 평균섭취량을 비교하고 식품 및 영양소의 섭취량을 5분위수로 나누어 분위수별 교차비와 교차비의 경향성을 검정하였다. 후보항목의 통계분석 결과와 전문가 의견을 근거로 식사의 충분도 영역 9개 항목, 식사의 절제 영역 5개 항목등 총 14개의 지수 구성항목을 선정하였으며, 식생활지침과 2010년 한국인 영양섭취기준을 근거로 점수화 기준을 마련하고 각 항목별로 5~10점을 배정하여 총 점수가 100점이 되도록 구성하였다. 개발된 한국인 식생활평가지수는 식사의 충분도 영역 9항목 (총 과일류, 생과일류, 총 채소류, 김치와 장아찌 제외 채소류, 우유 유제품, 총 단백질 식품, 흰 고기 : 붉은 고기 섭취비율, 전곡류, 아침식사 빈도)과 식사의 절제 영역 5가지 항목 (나트륨, 고열량 저영양 식품 에너지비, 지방 에너지비, 도정곡류, 탄수화물 에너지비)으로 구성되었다. 한국인 식생활평가지수는 식생활지침과 2010년 한국인 영양섭취기준을 기반으로 제5기 국민건강영양조사 데이터를 활용하여 성인 대상 인구집단의 식사의 질을 모니터링 할 목적으로 개발되었으며 향후 타당도 확인과 국가의 식생활지침 개정과 2015년 한국인 영양소 섭취기준 등에 따라 필요시 개정과 보완을 통해 국가의 영양정책 도출 및 사업 결과의 평가 및 활용에 사용될 수 있다.

Purpose: The current study was conducted in order to develop the Korean Healthy Eating Index (KHEI) for assessing adherence to national dietary guidelines and comprehensive diet quality of healthy Korean adults using the 5th Korea National Health and Nutrition Examination Survey (KNHANES) data. Methods: The candidate components of KHEI were selected based on literature reviews, dietary guidelines for Korean adults, 2010 Dietary Reference Intakes for Koreans (2010 KDRI), and objectives of HP 2020. The associations between candidate components and risk of obesity, abdominal obesity, and metabolic syndrome were assessed using the 5th KNHANES data. The expert review process was also performed. Results: Diets that meet the food group recommendations per each energy level receive maximum scores for the 9 adequacy components of the index. Scores for amounts between zero and the standard are prorated linearly. For the three moderation components among the total of five, population probability densities were examined when setting the standards for minimum and maximum scores. Maximum scores for the total of 14 components are 100 points and each component has maximum scores of 5 (fruit intakes excluding juice, fruit intake including juice, vegetable intakes excluding Kimchi and pickles, vegetable intake including Kimchi or pickles, ratio of white meat to read meat, whole grains intake, refined grains intake, and percentages of energy intake from carbohydrate) or 10 points (protein foods intake, milk and dairy food intake, having breakfast, sodium intake, percentages of energy intake from empty calorie foods, and percentages of energy intake from fat). The KHEI is a measure of diet quality as specified by the key diet recommendations of the dietary guidelines and 2010 KDRIs. Conclusion: The KHEI will be used as a tool for monitoring diet quality of the Korean population and subpopulations, evaluation of nutrition interventions and research.

키워드

참고문헌

  1. Kang M, Joung H, Lim JH, Lee YS, Song YJ. Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr 2011; 44(2): 152-161. https://doi.org/10.4163/kjn.2011.44.2.152
  2. Lim S, Lee EJ, Koo BK, Cho SI, Park KS, Jang HC, Kim SY, Lee HK. Increasing trends of metabolic syndrome in Korea -based on Korean National Health and Nutrition Examination Surveys-. J Korean Diabetes Assoc 2005; 29(5): 432-439.
  3. Ahn BC, Hong EJ, Joung HJ. Regional convergence in the prevalence of metabolic syndrome in Korea. Korean Public Health Res 2013; 39(1): 1-11.
  4. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994; 94(1): 57-64. https://doi.org/10.1016/0002-8223(94)92042-7
  5. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Am Diet Assoc 1995; 95(10): 1103-1108. https://doi.org/10.1016/S0002-8223(95)00300-2
  6. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D. Diet and overall survival in elderly people. BMJ 1995; 311(7018): 1457-1460. https://doi.org/10.1136/bmj.311.7018.1457
  7. Huijbregts P, Feskens E, Rasanen L, Fidanza F, Nissinen A, Menotti A, Kromhout D. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study. BMJ 1997; 315(7099): 13-17. https://doi.org/10.1136/bmj.315.7099.13
  8. Bailey RL, Miller PE, Mitchell DC, Hartman TJ, Lawrence FR, Sempos CT, Smiciklas-Wright H. Dietary screening tool identifies nutritional risk in older adults. Am J Clin Nutr 2009; 90(1): 177-183. https://doi.org/10.3945/ajcn.2008.27268
  9. Haines PS, Siega-Riz AM, Popkin BM. The diet quality index revised: a measurement instrument for populations. J Am Diet Assoc 1999; 99(6): 697-704. https://doi.org/10.1016/S0002-8223(99)00168-6
  10. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The diet quality index-international (DQI-I) provides an effective tool for crossnational comparison of diet quality as illustrated by China and the United States. J Nutr 2003; 133(11): 3476-3484. https://doi.org/10.1093/jn/133.11.3476
  11. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP. Development and evaluation of the healthy eating index-2005. Technical report. Alexandria (VA): U.S. Department of Agriculture, Center for Nutrition Policy and Promotion; 2007.
  12. Guenther PM, Reedy J, Krebs-Smith SM. Development of the healthy eating index-2005. J Am Diet Assoc 2008; 108(11): 1896-1901. https://doi.org/10.1016/j.jada.2008.08.016
  13. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB. Evaluation of the healthy eating index-2005. J Am Diet Assoc 2008; 108(11): 1854-1864. https://doi.org/10.1016/j.jada.2008.08.011
  14. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the healthy eating index: HEI-2010. J Acad Nutr Diet 2013; 113(4): 569-580. https://doi.org/10.1016/j.jand.2012.12.016
  15. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 2002; 76(6): 1261-1271. https://doi.org/10.1093/ajcn/76.6.1261
  16. Woodruff SJ, Hanning RM. Development and implications of a revised Canadian healthy eating index (HEIC-2009). Public Health Nutr 2010; 13(6): 820-825. https://doi.org/10.1017/S1368980009993120
  17. Park YS, Han JL, Lee JW, Cho HS, Koo J, Kim JH, Yoon JS. The development of a simple evaluation questionnaire for screening the overweight-type dietary pattern in 30 to 49 year old adults. Korean J Community Nutr 2002; 7(4): 495-505.
  18. Kim WY, Cho MS, Lee HS. Development and validation of mini dietary assessment index for Koreans. Korean J Nutr 2003; 36(1): 83-92.
  19. Shim JE, Paik HY, Lee SY, Moon HK, Kim YO. Comparative analysis and evaluation of dietary intake of Koreans by age groups: (4) the Korean diet quality index. Korean J Nutr 2002; 35(5): 558-570.
  20. Korea Health Industry Development Institute. Diet-related health risk appraisal (D-HRA) [Internet]. Cheongju: Korea Healthy Industry Development Institute; 2013 Mar 29 [cited 2014 May 1]. Available from: http://dhra.khidi.or.kr/index.do.
  21. Lee JW, Kim KE, Kim KN, Hyun TS, Hyun WJ, Park YS. Evaluation of the validity of a simple screening test developed for identifying Korean elderly at risk of undernutrition. Korean J Nutr 2000; 33(8): 864-872.
  22. Moon HK, Kong JE. Reliability of nutritional screening using DETERMINE checklist for elderly in Korean rural areas by season. Korean J Community Nutr 2009; 14(3): 340-353.
  23. Lee HO, Lee JS, Shin JW, Lee GJ. Nutrition assessment of older subjects in a health care center by MNA (mini nutritional assessment). J Korean Diet Assoc 2010; 16(2): 122-132.
  24. Ministry of Health and Welfare (KR). Dietary guidelines for Korean adults [Internet]. Seoul: Ministry of Health and Welfare; 2009 Dec 8 [cited 2014 Mar 27]. Available from: http://www.mw.go.kr/front_new/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0320&CONT_SEQ=224044&page=1.
  25. Ministry of Health and Welfare (KR). Health plan 2020 [Internet]. Seoul: Ministry of Health and Welfare; 2011 Jul 22 [cited 2014 Apr 17]. Available from: http://www.mw.go.kr/front_new/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0319&CONT_SEQ=257824&page=1.
  26. The Korean Nutrition Society. Dietary reference intake for Koreans. 1st revision. Seoul: The Korean Nutrition Society; 2010.
  27. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey: primitive data download [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2013 Dec 15 [cited 2015 May 1]. Available from: https://knhanes.cdc.go.kr/knhanes/index.do.

피인용 문헌

  1. Quality of Diet and Nutritional Intake and Mortality Risk among South Korean Adults Based on 12-year Follow-up Data vol.21, pp.4, 2016, https://doi.org/10.5720/kjcn.2016.21.4.354
  2. Development of NQ-A, Nutrition Quotient for Korean Adolescents, to assess dietary quality and food behavior vol.50, pp.2, 2017, https://doi.org/10.4163/jnh.2017.50.2.142
  3. Development of Nutrition Quotient for Korean adults: item selection and validation of factor structure vol.51, pp.4, 2018, https://doi.org/10.4163/jnh.2018.51.4.340
  4. 영양플러스 대상자의 만족도와 식생활 평가에 대한 연구 - 서울 서대문구 지역 대상자를 중심으로 - vol.22, pp.8, 2015, https://doi.org/10.20878/cshr.2016.22.8.015
  5. 어린이 영양지수로 살펴본 유아와 초등학생의 식행동과 비만 사이의 관련성에 있어서 연령의 차이 vol.49, pp.6, 2015, https://doi.org/10.4163/jnh.2016.49.6.447
  6. Higher Diet Quality is Associated with Lower Odds of Low Hand Grip Strength in the Korean Elderly Population vol.11, pp.7, 2019, https://doi.org/10.3390/nu11071487
  7. Self-reported diet management, dietary quality, and blood pressure control in Korean adults with hypertension vol.25, pp.1, 2015, https://doi.org/10.1186/s40885-019-0130-z
  8. 연령별 식사의 질에 미치는 지역의 영향 vol.24, pp.6, 2015, https://doi.org/10.5720/kjcn.2019.24.6.453
  9. 한국 성인의 식생활평가지수에 기반한 전체 식사의 질과 대사증후군 구성요소 및 대사증후군 발생의 연관성 vol.25, pp.1, 2015, https://doi.org/10.5720/kjcn.2020.25.1.61
  10. 대구·경북지역 성인의 건강관리를 위한 식생활 안전관리 인식과 역량 vol.25, pp.2, 2015, https://doi.org/10.5720/kjcn.2020.25.2.112
  11. Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas vol.12, pp.5, 2015, https://doi.org/10.3390/nu12051314
  12. Household food insecurity and dental caries in Korean adults vol.48, pp.5, 2020, https://doi.org/10.1111/cdoe.12541
  13. Association of the Healthy Eating Index with Estimated Cardiovascular Age in Adults from the KNHANES 2013–2017 vol.12, pp.10, 2015, https://doi.org/10.3390/nu12102912
  14. 성인 영양지수(Nutrition Quotient)를 이용한 사상체질에 따른 식습관 평가: 대전시민건강코호트 vol.32, pp.4, 2015, https://doi.org/10.7730/jscm.2020.32.4.86
  15. Association between frailty and dietary quality in community-dwelling elderly: data from the 6th Korea National Health and Nutrition Examination Survey (2014-2015) vol.68, pp.3, 2015, https://doi.org/10.3164/jcbn.20-133
  16. 가임기 여성의 규칙적 운동 및 운동종류에 따른 대사증후군 간의 관련성 vol.22, pp.1, 2015, https://doi.org/10.5762/kais.2021.22.1.94
  17. Is It What They Eat or How Much They Eat That Matters More in Adults with Food Insecurity in a Wealthy-Country Context? vol.13, pp.3, 2015, https://doi.org/10.3390/nu13030851
  18. A Healthy Diet Rich in Calcium and Vitamin C Is Inversely Associated with Metabolic Syndrome Risk in Korean Adults from the KNHANES 2013-2017 vol.13, pp.4, 2015, https://doi.org/10.3390/nu13041312
  19. 2007~2015 국민건강영양조사를 이용한 고등학생의 가당음료 섭취 수준에 따른 식품군 및 영양 섭취 실태 vol.33, pp.2, 2021, https://doi.org/10.19031/jkheea.2021.6.33.2.95
  20. Relationship between psychological distress and the adherence to the Korean healthy eating index (KHEI): the Korea National Health and Nutrition Examination Survey (KNHANES) 2013 and 2015 vol.15, pp.4, 2021, https://doi.org/10.4162/nrp.2021.15.4.516
  21. Differing Nutrient Intake and Dietary Patterns According to the Presence of Hyper-Low-Density Lipoprotein Cholesterolemia or Hypertriglyceridemia vol.13, pp.9, 2021, https://doi.org/10.3390/nu13093008
  22. The New Standardized Malaysian Healthy Eating Index vol.13, pp.10, 2015, https://doi.org/10.3390/nu13103474
  23. Analysis of Fruit Consumption and the Korean Healthy Eating Index of Adults Using the 2018 Korea National Health and Nutrition Examination Survey vol.50, pp.10, 2015, https://doi.org/10.3746/jkfn.2021.50.10.1124
  24. 한국 노인의 연령 세분화에 따른 식사의 질과 주관적 건강 관련 인식 및 만성질환의 연관성 vol.26, pp.5, 2015, https://doi.org/10.5720/kjcn.2021.26.5.363
  25. Association of the Healthy Eating Index with Metabolic Abnormalities among Middle-Aged Adults Living in Single-Person Households in Korea vol.13, pp.11, 2015, https://doi.org/10.3390/nu13113937
  26. Different associations of specific non-alcoholic beverages with elevated high-sensitivity C-reactive protein in Korean adults: results from the Korea National Health and Nutrition Examination Survey ( vol.70, pp.1, 2015, https://doi.org/10.3164/jcbn.21-20
  27. Association of Household Income Level with Vitamin and Mineral Intake vol.14, pp.1, 2022, https://doi.org/10.3390/nu14010038
  28. Association of Mixed Use of Electronic and Conventional Cigarettes and Exposure to Secondhand Smoke With Prediabetes vol.107, pp.1, 2015, https://doi.org/10.1210/clinem/dgab558