Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Development of nutrition quotient for elementary school children to evaluate dietary quality and eating behaviors

학령기 아동 대상 영양지수 개발과 타당도 검증

  • Received : 2020.08.31
  • Accepted : 2020.11.11
  • Published : 2020.12.31
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Abstract

Purpose: This study was undertaken to develop a nutrition quotient for elementary school children (NQ-C) for evaluating the overall dietary quality and eating behaviors. Methods: The NQ-C was developed by implementing 3 stages: item generation, item reduction, and validation. Candidate food behavior checklist (FBC) items of the NQ-C were derived from systematic literature reviews, expert in-depth interviews, statistical analyses of the fifth Korean National Health and Nutrition Examination Survey data, and national nutrition policies and recommendations. For the pilot survey, 260 elementary school students (128 second graders and 132 fifth graders) completed self-administered questionnaires as well as 24-hour dietary intakes, with the help of their parents and survey team staff, if required. Based on the pilot survey results, expert reviews, and priorities of national nutrition policy and recommendations, checklist items were reduced from 41 to 24. A total of 20 items for NQ-C were finally selected from results generated from 1,144 nationwide samples surveyed. Construct validity of the NQ-C was assessed using the confirmatory factor analysis, LInear Structural RELations. Results: Analyses of the exploratory factors of NQ-C identified that 5 dimensions of diet (balance, diversity, moderation, practice and environment) accounted for 46.2% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-C and 5-factor scores of the subjects were calculated using the obtained weights of the FBC items. Conclusion: Our data indicates that NQ-C is a useful and suitable instrument for assessing nutrition adequacy, dietary quality, and eating behaviors of Korean elementary school children.

본 연구는 생애주기 중 학령기 아동을 위한 영양지수 (nutrition quotient for elementary school children, NQ-C) 모형을 개발하고자 하였다. 학령기 아동 영양지수 평가항목 선정을 위해 학령기 아동 대상의 영양섭취 및 식생활 관련 문헌, 국민건강영양조사 자료, 식생활지침 및 국가 영양정책, 전문가 집단의 포커스 심층면접을 통해 파일럿 조사용 체크리스트 41문항 (식품섭취 영역: 20문항, 식행동·식습관 영역: 21문항)을 개발하였다. 학령기 아동 260명을 대상으로 체크리스트 문항과 1일 식사섭취조사를 포함한 파일럿 조사를 수행하고, 체크리스트 평가항목별 점수와 식사섭취 조사 결과인 영양섭취 수준 간의 상관성이 높은 24개 평가항목으로 구성된 전국단위 조사용 체크리스트를 개발하였다. 전국단위 조사는 시도별, 학교 유형별로 층화추출된 초등학생 1,144명을 대상으로 면대면 조사를 수행하였다. 탐색적 요인분석을 실시하여 학령기 아동 영양지수 평가항목을 20개 항목, 5개 요인으로 분류하고, 구조방정식 모형을 적용하여 평가항목의 구성타당도를 검증하고 추정된 경로 계수를 활용하여 5개 요인별 가중치와 평가항목별 가중치를 산출하였다. 학령기 아동용 영양지수를 위한 5개 요인과 가중치는 각각 균형 0.25, 다양 0.15, 절제 0.25, 환경 0.15, 실천 0.20 이었다. '균형' 요인에는 과일, 흰 우유, 콩이나 콩제품, 생선류, 고기류 섭취 빈도 5개 평가항목이 포함되었고, '다양' 요인에는 끼니별 채소 반찬 섭취, 반찬 골고루 먹기, 편식의 3개 평가항목이, '절제' 요인에는 달거나 기름진 빵, 가공 음료, 가공 육류, 라면, 카페인 음료, 길거리 음식 (학교 앞 음식) 섭취 빈도의 6개 평가항목이, '실천' 요인에는 영양성분표시 확인, 식사 전 손 씻는 빈도, 숨이 찰 정도의 운동 빈도 3개의 평가항목이, '환경' 요인에는 아침식사 빈도, 가족과 함께 식사하는 빈도, 정해진 장소에서 식사하기의 3개 평가항목이 포함되었다. 전국단위 조사대상자의 영양지수 (NQ-C) 평균 점수는 65.7점이었고, 요인별 점수는 균형 66.4점, 다양 67.0점, 절제 55.4점, 환경 75.3점, 절제 69.2점이었다. 영양지수와 각 요인별 등급은 전국단위 조사 결과의 백분위수 분포를 기준으로 75 to 100백분위의 경우 '상' 등급, 50 to < 75 백분위의 경우 '중상' 등급, 25 to < 50백분위의 경우 '중하' 등급, 0 to < 25 백분위의 경우 '하' 등급으로 분류하였다. 학령기 아동 영양지수 (NQ-C) 점수가 72.4-100점의 경우 '상' 등급, 65.8-72.3점의 경우 '중상' 등급, 59.2-65.7점의 경우 '중하' 등급, 65.7점 미만의 경우 '하' 등급으로 판정되었다. 본 연구에서 개발된 학령기 아동 영양지수 (NQ-C)는 20개 평가항목으로 구성된 체크리스트를 통해 영양지수 점수와 균형, 다양, 절제, 실천, 환경 요인의 점수 산출이 가능하고, 상대적인 영양지수 등급 부여를 통해 식사의 질과 영양상태가 양호한 지를 평가할 수 있다. 따라서, 학령기 아동 영양지수는 초등학생들의 식사의 질과 식행동 평가, 영양교육의 효과 평가 뿐만 아니라 정부의 영양교육사업, 영양정책의 효과 평가 등에도 활용될 수 있을 것으로 사료된다.

Keywords

Acknowledgement

This research was supported by a grant (14162MFDS126) from Ministry of Food and Drug Safety in 2014.

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