DOI QR코드

DOI QR Code

Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data

  • Kang, Minji (BK21 FOUR Education and Research Team for Sustainable Food & Nutrition, Department of Food and Nutrition, College of Human Ecology, Seoul National University) ;
  • Choi, So Yoon (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine) ;
  • Jung, Minyoung (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine)
  • Received : 2020.10.05
  • Accepted : 2020.12.07
  • Published : 2021.09.15

Abstract

In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk Behavior Web-based Survey and describes key nationwide survey findings published in the last 5 years on infant feeding practices and the dietary intake and nutritional status of Korean infants, children, and adolescents. There have been increasing trends in children, and teenagers who skip breakfast, eat fast food, consume sugary drinks, have vitamin D deficiency, and are obese. This review will inform pediatricians, nutritionists, and other health care practitioners who track children's growth and development. It may also help researchers and policymakers identify diet-related policies and strategies for chronic disease prevention in Korean infants, children, and adolescents.

Keywords

Acknowledgement

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Ministry of Science & ICT (grant number 2019M3E5D1A02070867). We thank Professor Jihyun Kim (Department of Pediatrics, Samsung Medical Center, Seoul, Korea) and Professor Young Mi Lee (Department of Food and Nutrition, Myongji University, Yongin-si, Kyeonggi, Korea) for their advice about the manuscript.

References

  1. Lee MP. Overview of pediatrics. In: Kliegman RM, Stanton BF, St. Geme JW III, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 21st ed. Philadelphia (PA): Elsevier Saunders, 2020:1-9.
  2. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70:3-21. https://doi.org/10.1111/j.1753-4887.2011.00456.x
  3. Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics 2018;141: e20173716. https://doi.org/10.1542/peds.2017-3716
  4. Kelly M. The nutrition transition in developing Asia: dietary change, drivers and health impacts. In: Jackson P, Spiess WEL, Sultana F, editors. Eating, drinking: surviving: the international year of global understanding. Cham: Springer International Publishing, 2016:83-90.
  5. Song S, Song WO. National nutrition surveys in Asian countries: surveillance and monitoring efforts to improve global health. Asia Pac J Clin Nutr 2014;23:514-23.
  6. Lee E, Baik D, Park Y, Ki M. The current status of health data on Korean children and adolescents. Epidemiol Health 2017;39:e2017059. https://doi.org/10.4178/epih.e2017059
  7. Korea Centers for Disease Control and Prevention. Korea Health Statistics [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2018 [cited 2020 Aug 20]. Available from: http://www.kdca.go.kr/.
  8. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. https://doi.org/10.1093/ije/dyt228
  9. Kim Y. The Korea National Health and Nutrition Examination Survey (KNHANES): current status and challenges. Epidemiol Health 2014;36:e2014002. https://doi.org/10.4178/epih/e2014002
  10. Korea Centers for Disease Control and Prevention. The Korea National Health and Nutrition Examination Survey [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2020 [cited 2020 Aug 21]. Available from: http://www.kdca.go.kr/.
  11. Korea Centers for Disease Control and Prevention. The Korea youth risk behavior web-based survey [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2020 [cited 2020 Jun 21]. Available from: http://www.kdca.go.kr/.
  12. Kim Y, Choi S, Chun C, Park S, Khang YH, Oh K. Data resource profile: the Korea Youth Risk Behavior Web-based Survey (KYRBS). Int J Epidemiol 2016;45:1076-1076e.
  13. Butte NF, Wong WW, Hopkinson JM, Smith EO, Ellis KJ. Infant feeding mode affects early growth and body composition. Pediatrics 2000; 106:1355-66. https://doi.org/10.1542/peds.106.6.1355
  14. Saadeh MR. A new global strategy for infant and young child feeding. Forum Nutr 2003;56:236-8.
  15. Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S, Hernell O, et al. Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. J Pediatr Gastroenterol Nutr 2005;41:584-99. https://doi.org/10.1097/01.mpg.0000187817.38836.42
  16. Lee AR, Yu YL, Kim HJ, Kim KA, Kim KW. Status of dietary life related knowledge, self-efficacy, food preference and dietary behavior of preschoolers in Kyunggi area. Korean J Community Nutr 2016;21:274-83. https://doi.org/10.5720/kjcn.2016.21.3.274
  17. Choi ES, Shin NR, Jung EI, Park HR, Lee HM, Song KH. A study on nutrition knowledge and dietary behavior of elementary school children in Seoul. Nutr Res Pract 2008;2:308-16. https://doi.org/10.4162/nrp.2008.2.4.308
  18. Chang HS, Kim MJ. The study on dietary behaviors of elementary school student in Chungnam area according to the school food service type, gender and grade. Korean J Community Nutr 2006;11:608-17.
  19. Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110. https://doi.org/10.1097/01.mpg.0000304464.60788.bd
  20. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk Pediatrics 2012;129:e827-41. https://doi.org/10.1542/peds.2011-3552
  21. Park HW, Ryu KH, Piao Y, Li P, Hong JS, Kim HB, et al. Positive effect of baby-friendly hospital initiatives on improving mothers' intention for successful breastfeeding in Korea. J Korean Med Sci 2018;33:e272. https://doi.org/10.3346/jkms.2018.33.e272
  22. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827-41. https://doi.org/10.1542/peds.2011-3552
  23. World Health Organization. UNICEF. Global strategy for infant and young child feeding. [Internet]. Geneva (Switzerland): World Health Organization; 2003 [cited 2020 Aug 2]. Avaliable from: https://www.who.int/nutrition/publications/infantfeeding/9241562218/en/.
  24. Fewtrell M, Bronsky J, Campoy C, Domellof M, Embleton N, Fidler Mis N, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017;64:119-32. https://doi.org/10.1097/MPG.0000000000001454
  25. Kim EK, Song BC, Ju SY. Dietary status of young children in Korea based on the data of 2013-2015 Korea National Health and Nutrition Examination Survey. J Nutr Health 2018;51:330-9. https://doi.org/10.4163/jnh.2018.51.4.330
  26. Kim YH, Lee SG, Kim SH, Song YJ, Chung JY, Park MJ. Nutritional Status of Korean Toddlers: from the Korean National Health and Nutrition Examination Survey 2007-2009. Korean J Pediatr Gastroenterol Nutr 2011;14:161-70. https://doi.org/10.5223/kjpgn.2011.14.2.161
  27. Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, et al. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019;17:e05780.
  28. World Health Organization. Complementary feeding: family foods for breastfed children. [Internet]. Geneva (Switzerland), World Health Organization. 2000; [cited 2020 Aug 2]. Avaliable from: https://www.who.int/nutrition/publications/infantfeeding/WHO_NHD_00.1/en/.
  29. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998;316:21-5. https://doi.org/10.1136/bmj.316.7124.21
  30. Morgan JB, Lucas A, Fewtrell MS. Does weaning influence growth and health up to 18 months? Arch Dis Child 2004;89:728-33. https://doi.org/10.1136/adc.2003.036137
  31. Grummer-Strawn LM, Scanlon KS, Fein SB. Infant feeding and feeding transitions during the first year of life. Pediatrics 2008;122 Suppl 2:S36-42. https://doi.org/10.1542/peds.2008-1315D
  32. World Health Organization. Strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health. Reprod Health Matters 2005;13:11-8.
  33. Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, et al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr 2014;58:119-29. https://doi.org/10.1097/MPG.0000000000000206
  34. Jonsdottir OH, Thorsdottir I, Hibberd PL, Fewtrell MS, Wells JC, Palsson GI, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics 2012;130:1038-45. https://doi.org/10.1542/peds.2011-3838
  35. Dube K, Schwartz J, Mueller MJ, Kalhoff H, Kersting M. Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial. Eur J Nutr 2010;49:11-8. https://doi.org/10.1007/s00394-009-0043-9
  36. Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Am J Clin Nutr 1998;67:878-84. https://doi.org/10.1093/ajcn/67.5.878
  37. Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and risk for iron deficiency in U.S. infants. Breastfeed Med 2007;2:63-73. https://doi.org/10.1089/bfm.2007.0002
  38. Yon M, Shin HS, Lee HS. Relationship between complementary feeding introduction and early childhood caries: results from the Korea National Health and Nutrition Examination Survey 2008-2015. Korean J Community Nutr 2019;24:97-105. https://doi.org/10.5720/kjcn.2019.24.2.97
  39. English LK, Obbagy JE, Wong YP, Butte NF, Dewey KG, Fox MK, et al. Timing of introduction of complementary foods and beverages and growth, size, and body composition: a systematic review. Am J Clin Nutr 2019;109:935S-955S. https://doi.org/10.1093/ajcn/nqy267
  40. Yom HW, Seo JW, Park H, Choi KH, Chang JY, Ryoo E, et al. Current feeding practices and maternal nutritional knowledge on complementary feeding in Korea. Clin Exp Pediatr 2009;52:1090-102.
  41. Lee SJ, Park JO, Sohn CS, Lee HR, Shin JH, Chung HI, et al. A survey on the present status of weaning. J Korean Pediatr Soc 1994;37:1643-56.
  42. Nicklas TA, Bao W, Webber LS, Berenson GS. Breakfast consumption affects adequacy of total daily intake in children. J Am Diet Assoc 1993; 93:886-91. https://doi.org/10.1016/0002-8223(93)91527-w
  43. Spence C. Breakfast: the most important meal of the day? Int J Gastron Food Sci 2017;8:1-6. https://doi.org/10.1016/j.ijgfs.2017.01.003
  44. Ramsay SA, Bloch TD, Marriage B, Shriver LH, Spees CK, Taylor CA. Skipping breakfast is associated with lower diet quality in young US children. Eur J Clin Nutr 2018;72:548-56. https://doi.org/10.1038/s41430-018-0084-3
  45. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr 2010;92:1316-25. https://doi.org/10.3945/ajcn.2010.30101
  46. Junior IFF, Christofaro DG, Codogno JS, Monteiro PA, Silveira LS, Fernandes RA. The association between skipping breakfast and biochemical variables in sedentary obese children and adolescents. J Pediatr 2012;161:871-4. https://doi.org/10.1016/j.jpeds.2012.04.055
  47. Berkey CS, Rockett HRH, Gillman MW, Field AE, Colditz GA. Longitudinal study of skipping breakfast and weight change in adolescents. Int J Obes 2003;27:1258-66. https://doi.org/10.1038/sj.ijo.0802402
  48. Korea Health Statistics 2018: Korea National Health and Nutrition Examination Survey (KNHANES VII-3) [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2020 [cited 25 Aug 2020]. Available from: https://knhanes.kdca.go.kr/knhanes/main.do.
  49. Hong J, Kim M, Yoon J, Kim S. Family breakfast and diet quality among school-aged children and adolescents. J Korean Soc Food Cul 2019;34:378-88.
  50. Yu S, Yang Y. Nutritional status and related parental factors according to the breakfast frequency of elementary school students: based on the 2013-2015 Korea National Health and Nutrition Examination Survey. J Nutr Health 2019;52:73-89. https://doi.org/10.4163/jnh.2019.52.1.73
  51. Bae YJ. Evaluation of nutritional dtatus in Korean Adolescents according to rating breakfast together as a family-based on the 2013-2015 Korea National Health and Nutrition Examination Survey. Korean J Food Nutr 2017;30:1210-21. https://doi.org/10.9799/KSFAN.2017.30.6.1210
  52. Kim HS, Lee US, Kim SH, Cha YS. Evaluation of dietary habits according to breakfast consumption in Korean adolescents: based on the 6th Korea National Health and Nutrition Examination Survey, 2013-2015. J Nutr Health 2019;52:217-26. https://doi.org/10.4163/jnh.2019.52.2.217
  53. Kye S. Breakfast skipping, body mass Index, health related factors in Korean adolescents: analysis of the data from the 2018 Youth Health Behavior Online Survey. J Learn Cent Curric Instr 2019;19:1263-81.
  54. De Vogli R, Kouvonen A, Gimeno D. The influence of market deregulation on fast food consumption and body mass index: a cross-national time series analysis. Bull World Health Organ 2014;92:99-107. https://doi.org/10.2471/BLT.13.120287
  55. Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 2012;9:e1001235. https://doi.org/10.1371/journal.pmed.1001235
  56. Paeratakul S, Ferdinand DP, Champagne CM, Ryan DH, Bray GA. Fastfood consumption among US adults and children: dietary and nutrient intake profile. J Am Diet Assoc 2003;103:1332-8. https://doi.org/10.1016/S0002-8223(03)01086-1
  57. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113:112. https://doi.org/10.1542/peds.113.1.112
  58. Korea Centers for Disease Control and Prevention. 2019 Korea Youth Risk Behavior Web-based Survey Statistics [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2018 [cited 2020 Sep 1]. Available from: http://www.kdca.go.kr/yhs/.
  59. Korea Centers for Disease Control and Prevention. Korea Youth Risk Behavior Web-based Survey. [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2019 [cited 2020 Aug 10]. Available from: http://www.kdca.go.kr/yhs.
  60. Hong MH. The effect of adolescents' health behavior on obesity. JKAIS 2019;20:295-302.
  61. Cha S. Dietary habits and physical activity on height, weight and BMI of high school students in Korea. Korean J Phys Educ 2020;59:357-72. https://doi.org/10.23949/kjpe.2020.3.59.2.357
  62. Lee J, Kwon M. The effect of eating behaviors on subjective happiness in adolescents. J Korean Soc Sch Health 2018;31:39-47. https://doi.org/10.15434/KSSH.2018.31.1.39
  63. An YS. Effects of eating habits of Korean youth on depression. J Humanit Soc Sci 21 2018;9:911-24.
  64. 2015-2020 Dietary Guidelines for Americans. 8th ed. U.S. Washington, DC: Department of Health and Human Services and U.S. Department of Agriculture; 2015 [cited 2020 Jul 20]. Available from: https://health.gov/our-work/food-and-nutrition/2015-2020-dietary-guidelines/.
  65. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 2013;98:1084-102. https://doi.org/10.3945/ajcn.113.058362
  66. Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ 2015;351:h3576.
  67. Wang H, Jeong H, Kim NH, Kang Y, Hwang K, Lee H, et al. Association between beverage intake and obesity in children: the Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2015. Nutr Res Pract 2018;12:307-14. https://doi.org/10.4162/nrp.2018.12.4.307
  68. Oh J, Chung J. Energy drink consumption and dietary-, lifestyle-, and mental health-related behaviors in Korean Adolescents: based on the 10th-13th Korea Youth Risk Behavior Web-Based Survey. Korean J Health Promot 2019;19:145-54. https://doi.org/10.15384/kjhp.2019.19.3.145
  69. Kim A, Kim J, Kye S. Sugar-sweetened beverage consumption and influencing factors in Korean adolescents: based on the 2017 Korea Youth Risk Behavior Web-based Survey. J Nutr Health 2018;51:456-79.
  70. Hwang S, Kye S. Self-rated health Status among Korean adolescents: differences in home environmental factors, health behaviors, psychological factors, and dietary habits. J Korean Soc Scool Community Health Educ 2018;19:27-45. https://doi.org/10.35133/kssche.20180430.03
  71. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001;344:3-10. https://doi.org/10.1056/NEJM200101043440101
  72. World Health Organization. Sodium intake for adults and children. [Internet]. Geneva (Switzerland), World Health Organization. 2012 [cited 2020 Aug 5]. Avaliable from: https://www.who.int/publications/i/item/9789241504836.
  73. Park HK, Lee Y, Kang BW, Kwon KI, Kim JW, Kwon OS, et al. Progress on sodium reduction in South Korea. BMJ Glob Health 2020;5:e002028. https://doi.org/10.1136/bmjgh-2019-002028
  74. Lee HS, Duffey KJ, Popkin BM. Sodium and potassium intake patterns and trends in South Korea. J Hum Hypertens 2013;27:298-303. https://doi.org/10.1038/jhh.2012.43
  75. World Health Organization. Policy - Special Act on Safety Management of Children's Dietary Lifestyle. [Internet]. Geneva (Switzerland), World Health Organization. 2009; [cited 2020 Aug 5]. Avaliable from: https://extranet.who.int/nutrition/gina/en/node/22937.
  76. Kim M. The relationship between parental sodium intake and adolescent sodium intake JKAIS 2018;19:453-62.
  77. Lee J, Hwang Y, Kim KN, Ahn C, Sung HK, Ko KP, et al. Associations of urinary sodium levels with overweight and central obesity in a population with a sodium intake. BMC Nutr 2018;4:47. https://doi.org/10.1186/s40795-018-0255-6
  78. Lee SK, Kim MK. Relationship of sodium intake with obesity among Korean children and adolescents: Korea National Health and Nutrition Examination Survey. Br J Nutr 2016;115:834-41. https://doi.org/10.1017/S0007114515005152
  79. So CH, Jeong HR, Shim YS. Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey 2010-2013. PLoS One 2017;12:e0189934. https://doi.org/10.1371/journal.pone.0189934
  80. Kim YM, Kim SH, Shim YS. Association of sodium intake with insulin resistance in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey 2010. J Pediatr Endocrinol Metab 2018;31:117-25. https://doi.org/10.1515/jpem-2017-0362
  81. Han SY, Kim NH, Kim DH, Han K, Kim SM. Relationship between urinary sodium-creatinine ratios and insulin resistance in Korean children and adolescents with obesity. J Pediatr Endocrinol Metab 2018;31:375-83. https://doi.org/10.1515/jpem-2017-0447
  82. Chun YH, Han K, Kim do H, Park YG, Cho KH, Choi YS, et al. Association of urinary sodium excretion with insulin resistance in Korean adolescents: Results from the Korea National Health and Nutrition Examination Survey 2009-2010. Medicine (Baltimore) 2016;95:e3447. https://doi.org/10.1097/md.0000000000003447
  83. Adams JS, Hewison M. Update in Vitamin D. J Clin Endocrinol Metab 2010;95:471-8. https://doi.org/10.1210/jc.2009-1773
  84. Christakos S, Dhawan P, Porta A, Mady LJ, Seth T. Vitamin D and intestinal calcium absorption. Mol Cell Endocrinol 2011;347:25-9. https://doi.org/10.1016/j.mce.2011.05.038
  85. Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother 2012;3:118-26. https://doi.org/10.4103/0976-500X.95506
  86. Muller DN, Kleinewietfeld M, Kvakan H. Vitamin D review. J Renin Angiotensin Aldosterone Syst 2011;12:125-8. https://doi.org/10.1177/1470320311410924
  87. Cashman KD. Vitamin D in childhood and adolescence. Postgrad Med J 2007;83:230-5. https://doi.org/10.1136/pgmj.2006.052787
  88. American Academy of Pediatrics Commmittee on Nutrition. Pediatric nutrition handbook. 6th ed. Itasca (IL): American Academy of Pediatrics, 2009.
  89. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003;111:908-10. https://doi.org/10.1542/peds.111.4.908
  90. The Korean Nurtrition Society. Dietary refenece intakes for Koreans. Sejong (Korea): Ministry of Health and Welfare; 2015.
  91. Jung SJ, Hwangbo Y, Jung JH, Kim J, Kim H, Jeong KH, et al. Recent trends in serum vitamin D Levels among Korean population: Korea National Health and Nutrition Examination Survey 2008~2014. Korean J Clin Geri 2018;19:55-62. https://doi.org/10.15656/kjcg.2018.19.1.55
  92. Park JH, Hong IY, Chung JW, Choi HS. Vitamin D status in South Korean population: seven-year trend from the KNHANES. Medicine (Baltimore) 2018;97:e11032. https://doi.org/10.1097/md.0000000000011032
  93. Byun EJ, Heo J, Cho SH, Lee JD, Kim HS. Suboptimal vitamin D status in Korean adolescents: a nationwide study on its prevalence, risk factors including cotinine-verified smoking status and association with atopic dermatitis and asthma. BMJ open 2017;7:e016409. https://doi.org/10.1136/bmjopen-2017-016409
  94. Lee YA, Kim HY, Hong H, Kim JY, Kwon HJ, Shin CH, et al. Risk factors for low vitamin D status in Korean adolescents: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2009. Public Health Nutr 2014;17:764-71. https://doi.org/10.1017/S1368980013000438
  95. Jang H, Lee Y, Park K. Obesity and vitamin D insufficiency among adolescent girls and young adult women from Korea. Nutrients 2019;11:3049. https://doi.org/10.3390/nu11123049
  96. Yoo HN, Kim HS. Vitamin D deficiency and Metabolic Syndrome among Korean adolescents: based on Korea National Health and Nutrition Examination Survey V (KNHANES). J Korean Soc School Health 2016;29:22-32. https://doi.org/10.15434/KSSH.2016.29.1.22
  97. Cho YH, Kim JW, Shim JO, Yang HR, Chang JY, Moon JS, et al. Association between vitamin D deficiency and suspected nonalcoholic fatty liver disease in an adolescent population. J Pediatr Gastroenterol Nutr 2019;22:233-41. https://doi.org/10.5223/pghn.2019.22.3.233
  98. Nam GE, Kim DH, Cho KH, Park YG, Han KD, Kim SM, et al. 25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr 2014;17:186-94. https://doi.org/10.1017/S1368980012004855
  99. Chung SJ, Lee YA, Hong H, Kang MJ, Kwon HJ, Shin CH, et al. Inverse relationship between vitamin D status and insulin resistance and the risk of impaired fasting glucose in Korean children and adolescents: the Korean National Health and Nutrition Examination Survey (KNHANES) 2009-2010. Public Health Nutr 2014;17:795-802. https://doi.org/10.1017/S1368980013002334
  100. Choi S, Seo DG, Hwang JY. Serum 25-hydroxyvitamin D levels are associated with dental caries experience in Korean adolescents: the 2010-2014 Korean National Health and Nutrition Examination Surveys. J Nutr Health 2018;51:287-94. https://doi.org/10.4163/jnh.2018.51.4.287
  101. Kang JW, Kim JH, Yoon JH, Kim CH. The association between serum vitamin D level and immunoglobulin E in Korean adolescents. Int J Pediatr Otorhinolaryngol 2014;78:817-20. https://doi.org/10.1016/j.ijporl.2014.02.021
  102. Choi J, Han K, Park Y, La T. Low serum 25-hydroxyvitamin D is associated with myopia in Korean adolescents. Invest Ophthalmol Vis Sci 2014;55:2041-7. https://doi.org/10.1167/iovs.13-12853
  103. Lee JA, Hwang JS, Hwang IT, Kim DH, Seo JH, Lim JS. Low vitamin D levels are associated with both iron deficiency and anemia in children and adolescents. Pediatr Hematol Oncol 2015;32:99-108. https://doi.org/10.3109/08880018.2014.983623
  104. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-52. https://doi.org/10.1542/peds.2008-1862
  105. Lieu PT, Heiskala M, Peterson PA, Yang Y. The roles of iron in health and disease. Mol Aspects Med 2001;22:1-87. https://doi.org/10.1016/S0098-2997(00)00006-6
  106. McDowell LR. Minerals in animal and human nutrition. Philadelphia (PA): Elsevier Science BV, 2003.
  107. Trumbo P, Yates AA, Schlicker S, Poos M. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J Am Diet Assoc 2001;101:294-301. https://doi.org/10.1016/S0002-8223(01)00078-5
  108. Sachdev H, Gera T, Nestel P. Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials. Public Health Nutr 2005;8:117-32. https://doi.org/10.1079/PHN2004677
  109. Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutrition 2001;131: 649S-668S. https://doi.org/10.1093/jn/131.2.649S
  110. Iron fortification of infant formulas. American Academy of Pediatrics. Committee on Nutrition. Pediatrics 1999;104:119-23. https://doi.org/10.1542/peds.104.1.119
  111. Korea Centers for Disease Control and Prevention. 2010 Korea Health Statistics [Internet]. Cheongju (Korea); Korea Centers for Disease Control and Prevention; 2018 [cited 2020 May 1]. Available from: http://www.kdca.go.kr/.
  112. Lee JO, Lee JH, Ahn S, Kim JW, Chang H, Kim YJ, et al. Prevalence and risk factors for iron deficiency anemia in the Korean population: results of the fifth Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2014;29:224-9. https://doi.org/10.3346/jkms.2014.29.2.224
  113. Kim SK, Kang HS, Kim CS, Kim YT. The prevalence of anemia and iron depletion in the population aged 10 years or older. Korean J Hematol 2011;46:196-9. https://doi.org/10.5045/kjh.2011.46.3.196
  114. Cheuh HW, Choi YC, Shin JH, Yoo JH. Family history as a risk factor for iron deficiency anemia among Korean Adolescents: Data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES). Clin Pediatr Hematol Oncol 2018;25:31-7. https://doi.org/10.15264/cpho.2018.25.1.31
  115. Lee BK, Kim SH, Kim NS, Ham JO, Kim Y. Iron deficiency increases blood cadmium levels in adolescents surveyed in KNHANES 2010-2011. Biol Trace Elem Res 2014;159:52-8. https://doi.org/10.1007/s12011-014-9982-y
  116. Sim CS, Kim Y, Lee H, Park CY, Ham JO, Lee BK. Iron deficiency increases blood lead levels in boys and pre-menarche girls surveyed in KNHANES 2010-2011. Environ Res 2014;130:1-6. https://doi.org/10.1016/j.envres.2014.01.004
  117. Lee BK, Kim Y. Iron deficiency is associated with increased levels of blood cadmium in the Korean general population: analysis of 2008-2009 Korean National Health and Nutrition Examination Survey data. Environ Res 2012;112:155-63. https://doi.org/10.1016/j.envres.2011.10.013
  118. Conrad ME, Barton JC. Factors affecting the absorption and excretion of lead in the rat. Gastroenterology 1978;74:731-40. https://doi.org/10.1016/0016-5085(78)90253-6
  119. World Health Organization. Obesity and overweight. [Internet]. World Health Organization, Geneva (Switzerland): World Health Organization; [cited 2020 Sep 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
  120. Kim JH, Moon JS. Secular trends in pediatric overweight and obesity in Korea. J Obes Metab Syndr 2020;29:12-7. https://doi.org/10.7570/jomes20002
  121. Lee HJ, Kim SH, Choi SH, Lee JS. The association between socioeconomic status and obesity in Korean children: an analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012). J Pediatr Gastroenterol Nutr 2017;20:186-93. https://doi.org/10.5223/pghn.2017.20.3.186
  122. Lee G, Kim HR. Mothers' working hours and children's obesity: data from the Korean National Health and Nutrition Examination Survey, 2008-2010. Ann Occup Environ Med 2013;25:28. https://doi.org/10.1186/2052-4374-25-28
  123. Umer A, Kelley GA, Cottrell LE, Giacobbi P Jr, Innes KE, Lilly CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health 2017;17:683. https://doi.org/10.1186/s12889-017-4691-z
  124. Lee JS, Song YH. Relationship between waist circumference and cardiovascular risk factors in adolescents: analysis of the Korea National Health and Nutrition Examination Survey data. Korean Circ J 2020;50: 723-32. https://doi.org/10.4070/kcj.2019.0329
  125. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics 2007;120: 340-5. https://doi.org/10.1542/peds.2006-1699
  126. Kim S, So WY. Prevalence of metabolic syndrome among Korean adolescents according to the National Cholesterol Education Program, Adult Treatment Panel III and International Diabetes Federation. Nutrients 2016;8:588. https://doi.org/10.3390/nu8100588
  127. Cho WK, Han K, Ahn MB, Park YM, Jung MH, Suh BK, et al. Metabolic risk factors in Korean adolescents with severe obesity: results from the Korea National Health and Nutrition Examination Surveys (K-NHANES) 2007-2014. Diabetes Res Clin Pract 2018;138:169-76. https://doi.org/10.1016/j.diabres.2018.01.030
  128. Jin HY. Prevalence of subclinical hypothyroidism in obese children or adolescents and association between thyroid hormone and the components of metabolic syndrome. J Paediatr Child Health 2018;54:975-80. https://doi.org/10.1111/jpc.13926
  129. An YM, Moon SJ, Kim SK, Suh YJ, Lee JE. Thyroid function in obese Korean children and adolescents: Korea National Health and Nutrition Examination Survey 2013-2015. Ann Pediatr Endocrinol Metab 2018;23:141-7. https://doi.org/10.6065/apem.2018.23.3.141
  130. Kim HY, Jung HW, Hong H, Kim JH, Shin CH, Yang SW, et al. The role of overweight and obesity on bone health in Korean adolescents with a focus on lean and fat Mass. J Korean Med Sci 2017;32:1633-41. https://doi.org/10.3346/jkms.2017.32.10.1633
  131. Julia V, Macia L, Dombrowicz D. The impact of diet on asthma and allergic diseases. Nat Rev Immunol 2015;15:308-22. https://doi.org/10.1038/nri3830
  132. Hancu A, Mihaltan F, Radulian G. Asthma and ultra-processed food. Maedica (Buchar) 2019;14:402-7.
  133. Mustapa Kamal Basha MA, Majid HA, Razali N, Yahya A. Risk of eczema, wheezing and respiratory tract infections in the first year of life: a systematic review of vitamin D concentrations during pregnancy and at birth. PLoS One 2020;15:e0233890. https://doi.org/10.1371/journal.pone.0233890
  134. Tian Y, Tian Q, Wu Y, Peng X, Chen Y, Li Q, et al. Vitamin A supplement after neonatal Streptococcus pneumoniae pneumonia inhibits the progression of experimental asthma by altering CD4(+)T cell subsets. Sci Rep 2020;10:4214. https://doi.org/10.1038/s41598-020-60665-4
  135. Zhang Z, Shi L, Pang W, Liu W, Li J, Wang H, et al. Dietary fiber intake regulates intestinal microflora and inhibits ovalbumin-induced allergic airway inflammation in a mouse model. PLoS One 2016;11: e0147778. https://doi.org/10.1371/journal.pone.0147778
  136. Wendell SG, Baffi C, Holguin F. Fatty acids, inflammation, and asthma. J Allergy Clin Immunol 2014;133:1255-64. https://doi.org/10.1016/j.jaci.2013.12.1087
  137. Tashiro H, Takahashi K, Sadamatsu H, Kato G, Kurata K, Kimura S, et al. Saturated fatty acid increases lung macrophages and augments house dust mite-induced airway inflammation in mice fed with high-fat diet. Inflammation 2017;40:1072-86. https://doi.org/10.1007/s10753-017-0550-4
  138. Greer FR, Sicherer SH, Burks AW. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods. Pediatrics 2019;143:e20190281 https://doi.org/10.1542/peds.2019-0281
  139. Netting MJ, Campbell DE, Koplin JJ, Beck KM, McWilliam V, Dharmage SC, et al. An Australian consensus on infant feeding guidelines to prevent food allergy: outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 2017;5:1617-24. https://doi.org/10.1016/j.jaip.2017.03.013
  140. Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR Jr, Beck LA, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol 2017;139:29-44. https://doi.org/10.1016/j.jaci.2016.10.010
  141. Boyle RJ, Ierodiakonou D, Khan T, Chivinge J, Robinson Z, Geoghegan N, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ 2016;352:i974.
  142. Lodge CJ, Tan DJ, Lau MX, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and asthma and allergies: a systematic review and metaanalysis. Acta Paediatr 2015;104:38-53.
  143. Jung M, Kim J, Ahn SM. Factors associated with frequency of peanut consumption in Korea: a national population-based study. Nutrients 2020;12:1207. https://doi.org/10.3390/nu12051207
  144. Lee KS, Rha YH, Oh IH, Choi YS, Kim YE, Choi SH. Does breast-feeding relate to development of atopic dermatitis in young Korean children? Based on the fourth and fifth Korea National Health and Nutrition Examination Survey 2007-2012. Allergy Asthma Immunol Res 2017;9:307-13. https://doi.org/10.4168/aair.2017.9.4.307
  145. Kull I, Bohme M, Wahlgren CF, Nordvall L, Pershagen G, Wickman M. Breast-feeding reduces the risk for childhood eczema. J Allergy Clin Immunol 2005;116:657-61. https://doi.org/10.1016/j.jaci.2005.04.028
  146. Gdalevich M, Mimouni D, David M, Mimouni M. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 2001;45:520-7. https://doi.org/10.1067/mjd.2001.114741
  147. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012;2012:Cd003517.
  148. Kim M, Youn C, Kim A, Ko H, Kim H, Kim H, et al. Food habits and allergic disease in Korean adolescent. Korean J Fam Pract 2017;7:179-87. https://doi.org/10.21215/kjfp.2017.7.2.179
  149. Kang SY, Song WJ, Kim MH, Kim SH, Cho SH, Chang YS, et al. Dietary assessment and the development of asthma in Korean adolescents and adults. Allergy 2018;73:2254-6. https://doi.org/10.1111/all.13554
  150. Patel S, Custovic A, Smith JA, Simpson A, Kerry G, Murray CS. Cross-sectional association of dietary patterns with asthma and atopic sensitization in childhood - in a cohort study. Pediatr Allergy Immunol 2014;25:565-71. https://doi.org/10.1111/pai.12276
  151. Jaworowska A, Blackham T, Davies IG, Stevenson L. Nutritional challenges and health implications of takeaway and fast food. Nutr Rev 2013;71:310-8. https://doi.org/10.1111/nure.12031
  152. Venter C, Meyer RW, Nwaru BI, Roduit C, Untersmayr E, Adel-Patient K, et al. EAACI position paper: influence of dietary fatty acids on asthma, food allergy, and atopic dermatitis. Allergy 2019;74:1429-44.
  153. Rodriguez-Rodriguez E, Perea JM, Jimenez AI, Rodriguez-Rodriguez P, Lopez-Sobaler AM, Ortega RM. Fat intake and asthma in Spanish schoolchildren. Eur J Clin Nutr 2010;64:1065-71. https://doi.org/10.1038/ejcn.2010.127
  154. Kim SY, Sim S, Park B, Kong IG, Kim JH, Choi HG. Dietary habits are associated with school performance in adolescents. Medicine (Baltimore) 2016;95:e3096. https://doi.org/10.1097/md.0000000000003096
  155. Park S, Lee J. Factors influencing the consumption of convenience foods among Korean adolescents: analysis of data from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. J Nutr Health 2020;53:255. https://doi.org/10.4163/jnh.2020.53.3.255
  156. Nakitto M, Asano K, Choi I, Yoon J. Dietary intakes of adolescents from food insecure households: analysis of data from the 6(th) (2013-2015) Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2017;11:507-16. https://doi.org/10.4162/nrp.2017.11.6.507
  157. Hong N, Lee YK, Rhee Y. Familial clustering of vitamin D deficiency via shared environment: The Korean National Health and Nutrition Examination Survey 2008-2012. Eur J Clin Nutr 2018;72:1700-8. https://doi.org/10.1038/s41430-018-0157-3
  158. Oh HL, Lee JA, Kim DH, Lim JS. Reference values for serum ferritin and percentage of transferrin saturation in Korean children and adolescents. Blood Res 2018;53:18-24. https://doi.org/10.5045/br.2018.53.1.18
  159. Lim JS, Seo JH, Kim DH, Lee JA. The hemoglobin values of Korean adolescents show distinctive characteristics in comparison to those of Caucasians and African Americans. Pediatr Blood Cancer 2015;62:409-13. https://doi.org/10.1002/pbc.25349
  160. Jung DW, Park JH, Kim DH, Choi M, Kim S, Kim H, et al. Association between serum ferritin and hemoglobin levels and bone health in Korean adolescents: a nationwide population-based study. Medicine 2017;96:e9403. https://doi.org/10.1097/MD.0000000000009403
  161. Hong J, Chang JY, Shin S, Oh S. Breastfeeding and red meat intake are associated with iron status in healthy Korean weaning-age infants. J Korean Med Sci 2017;32:974-84. https://doi.org/10.3346/jkms.2017.32.6.974
  162. Shin YY, Ryu IK, Park MJ, Kim SH. The association of total blood mercury levels and overweight among Korean adolescents: analysis of the Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2013. Clin Exp Pediatr 2018;61:121-8. https://doi.org/10.3345/kjp.2018.61.4.121
  163. Kang M, Yoo JE, Kim K, Choi S, Park SM. Associations between birth weight, obesity, fat mass and lean mass in Korean adolescents: the Fifth Korea National Health and Nutrition Examination Survey. BMJ Open 2018;8:e018039. https://doi.org/10.1136/bmjopen-2017-018039
  164. Park SH, Park YE, Lee J, Choi JH, Heo NY, Park J, et al. The change in prevalence of suspected non-alcoholic fatty liver disease in Korean adolescents from 2001 to 2017. Paediatr Int Child Health 2020;40:166-70. https://doi.org/10.1080/20469047.2020.1747002
  165. Lee JH. Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents: analysis based on the 2016-2017 Korea National Health and Nutrition Examination Survey. Korean J Pediatr 2019;62:317-23. https://doi.org/10.3345/kjp.2019.00444
  166. Kim M, Choi S, Choi SH, Shin SH, Kim SK, Shim YS, et al. Metabolic syndrome and lung function in Korean children and adolescents: a cross-sectional study. Sci Rep 2019;9:15646. https://doi.org/10.1038/s41598-019-51968-2
  167. Kim YM, Kim SH, Shim YS. Associations of non-high-density lipoprotein cholesterol with metabolic syndrome and its components in Korean children and adolescents: the Korea National Health and Nutrition Examination Surveys 2008-2014. World J Pediatr 2018;14:461-9. https://doi.org/10.1007/s12519-018-0160-8
  168. Choi DH, Hur YI, Kang JH, Kim K, Cho YG, Hong SM, et al. Usefulness of the waist circumference-to-height ratio in screening for obesity and metabolic syndrome among Korean children and adolescents: Korea National Health and Nutrition Examination Survey, 2010-2014. Nutrients 2017;9:256. https://doi.org/10.3390/nu9030256
  169. Yoon DY, Lee YA, Lee J, Kim JH, Shin CH, Yang SW. Prevalence and clinical characteristics of metabolically healthy obesity in Korean children and adolescents: data from the Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2017;32:1840-7. https://doi.org/10.3346/jkms.2017.32.11.1840
  170. Chung IH, Park S, Park MJ, Yoo EG. Waist-to-height ratio as an index for cardiometabolic risk in adolescents: results from the 1998-2008 KNHANES. Yonsei Med J 2016;57:658-63. https://doi.org/10.3349/ymj.2016.57.3.658
  171. Yu Y, Song Y. Three clustering patterns among metabolic syndrome risk factors and their associations with dietary factors in Korean adolescents: based on the Korea National Health and Nutrition Examination Survey of 2007-2010. Nutr Res Pract 2015;9:199-206. https://doi.org/10.4162/nrp.2015.9.2.199
  172. Kim J. Relation of polyunsaturated fatty acid, n-3 fatty acid and n-6 fatty acid intakes and atopic dermatitis in the 9-11 year old children: KNHANES 2013-2015. J Nutr Health 2019;52:47-57. https://doi.org/10.4163/jnh.2019.52.1.47
  173. Kim SY, Sim S, Park B, Kim JH, Choi HG. High-fat and low-carbohydrate diets are associated with allergic rhinitis but not asthma or atopic dermatitis in children. PLoS One 2016;11:e0150202. https://doi.org/10.1371/journal.pone.0150202