Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Revision of Nutrition Quotient for Korean adults: NQ-2021

한국 성인을 위한 영양지수 개정: NQ-2021

  • Yook, Sung-Min (Department of Foodservice Management and Nutrition, Graduate School, Sangmyung University) ;
  • Lim, Young-Suk (Department of Food & Nutrition, Myongji University) ;
  • Lee, Jung-Sug (Department of Food & Nutrition, Kookmin University) ;
  • Kim, Ki-Nam (Department of Food & Nutrition, Daejeon University) ;
  • Hwang, Hyo-Jeong (Department of Food & Nutrition, Sahmyook University) ;
  • Kwon, Sehyug (Department of Statistics, Hannam University) ;
  • Hwang, Ji-Yun (Major of Foodservice Management and Nutrition, Sangmyung University) ;
  • Kim, Hye-Young (Department of Food & Nutrition, Yongin University)
  • 육성민 (상명대학교 대학원 외식영양학과) ;
  • 임영숙 (명지대학교 식품영양학과) ;
  • 이정숙 (국민대학교 식품영양학과) ;
  • 김기남 (대전대학교 식품영양학과) ;
  • 황효정 (삼육대학교 식품영양학과) ;
  • 권세혁 (한남대학교 비즈니스통계학과) ;
  • 황지윤 (상명대학교 식품영양학전공) ;
  • 김혜영 (용인대학교 식품영양학과)
  • Received : 2022.03.11
  • Accepted : 2022.04.01
  • Published : 2022.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study was undertaken to revise and update the Nutrition Quotient (NQ) for Korean adults, a tool used to evaluate dietary quality and behavior. Methods: The first 31 items of the measurable food behavior checklist were adopted based on considerations of the previous NQ checklist, recent literature reviews, national nutrition policies, and recommendations. A pilot survey was conducted on 100 adults aged 19 to 64 residing in Seoul and Gyeonggi Province from March to April 2021 using a provisional 26- item checklist. Pilot survey data were analyzed using factor analysis and frequency analysis to determine whether checklist items were well organized and responses to questions were well distributed, respectively. As a result, the number of items on the food behavior checklist was reduced to 23 for the nationwide survey, which was administered to 1,000 adults (470 men and 530 women) aged 19 to 64 from May to August 2021. The construct validity of the developed NQ (NQ-2021) was assessed using confirmatory factor analysis, linear structural relations. Results: Eighteen items in 3 categories, that is, balance (8 items), moderation (6 items), and practice (4 items), were finally included in NQ-2021 food behavior checklist. 'Balance' items addressed the intake frequencies of essential foods, 'moderation' items the frequencies of unhealthy food intakes or behaviors, and 'practice' items addressed eating behaviors. Items and categories were weighted using standardized path coefficients to calculate NQ-2021 scores. Conclusion: The updated NQ-2021 appears to be suitable for easily and quickly assessing the diet qualities and behaviors of Korean adults.

본 연구의 성인 Nutrition Quotient (NQ)-2021은 식품·영양소 섭취 및 식행동 영역까지 고려되어 성인의 식생활 관리상태를 종합적, 객관적으로 평가할 수 있는 선별 영양진단 도구로, 영양전문가 뿐만 아니라 일반인들도 쉽게 이해할 수 있도록 함으로써 활용도를 확대하는 것을 목표로 제·개정이 진행되었다. 2015년에 기 개발된 한국 성인을 위한 NQ 평가항목을 기반으로, 성인의 다양한 식생활 영역 문제와 관련된 선행 연구, 국민건강영양조사 자료, 국가 영양 정책 및 지침에 대한 검토와 전문가 대상 심층면접을 진행하여 26개의 파일럿 조사용 체크리스트 평가항목을 우선 선정하였다. 성인 100명 대상 파일럿 조사 후, 파일럿 조사 결과에 대한 전문가 패널 의견 수렴 및 탐색적 요인분석을 거쳐 전국단위조사용 체크리스트 23개 항목이 도출되었다. 전국단위조사는 6개 광역시에서 층화추출된 총 1,000명을 대상으로 진행되었고, 조사 자료의 탐색적 요인분석 결과 NQ-2021의 평가항목을 균형, 절제, 실천의 세 영역으로 분류하였다. 확정적 요인분석 및 구조방정식모형을 통해 NQ-2021의 최종 모형에 총 18개의 평가항목이 도출되었고, 각 영역별 가중치는 분석 결과에 따라 균형 0.3, 절제 0.3, 실천 0.4로 설정되었다. 최종적으로 NQ-2021은 균형 영역 8개 항목 (전곡·잡곡류, 생선류, 콩, 견과류, 채소류 반찬, 과일, 우유·유제품, 섭취 및 아침식사 빈도), 절제 영역 6개 항목 (적색육, 가공육류, 맵고 짠 국물음식, 패스트푸드, 기름진 빵·과자류 섭취 및 과식·폭식 빈도), 실천 영역 4개 항목 폭음 (고위험음주) 빈도, 건강한 식생활을 하려는 노력, 영양표시 확인, 손 씻기)으로 구성되었다. 전국단위 조사 자료로 산출된 NQ 점수의 평균은 총점 60.8점, 균형 43.6점, 절제 75.0점, 실천 63.0점이었다. 본 연구의 NQ-2021은 18개의 평가항목이 포함된 체크리스트로 짧은 시간에 효율적으로 개인의 전반적인 식사의 질 및 식행동을 판정할 수 있고, 균형, 절제, 실천의 각 영역별 점수 및 등급 확인이 가능하여 결과의 해석과 활용이 용이하다. 또한 웹 기반으로 연동된 온라인 컴퓨터 프로그램을 제공하여 온·오프라인 환경에서 모두 사용이 용이하다는 점에서, 다양한 생활터와 대면 또는 비대면 등의 다양한 환경에서 활발한 활용이 기대된다.

Keywords

Acknowledgement

This research was supported by a grant(21162MFDS063) from Ministry of Food and Drug Safety in 2021.

References

  1. Korea Disease Control and Prevention Agency. Korea health statistics 2020: Korea National Health and Nutrition Examination Survey (KNHANES VIII-2). Osong; 2022.
  2. National Health Insurance Service. National Health Insurance. Health-Checkup [Internet]. Wonju: National Health Insurance Service; 2022 [cited 2022 Mar 4]. Available from: https://www.nhis.or.kr/nhis/policy/wbhada19700m01.do.
  3. Ministry of Health and Welfare, The Korean Nutrition Society. 2020 Dietary reference intakes for Koreans: application. Sejong; 2022.
  4. Kim DM, Kim YR, Kim KH. Dietary habits and nutritional status of young women according to breakfast frequency in Seoul. Korean J Community Nutr 2018; 23(2): 102-115. https://doi.org/10.5720/kjcn.2018.23.2.102
  5. Park JB, Seok KJ, Shin KH, Jang SJ. The effect of breakfast skipping on body mass index and weight Change in Korean adults. Korean J Fam Pract 2018; 8(2): 252-258. https://doi.org/10.21215/kjfp.2018.8.2.252
  6. Chung SJ, Lee Y, Lee S, Choi K. Breakfast skipping and breakfast type are associated with daily nutrient intakes and metabolic syndrome in Korean adults. Nutr Res Pract 2015; 9(3): 288-295. https://doi.org/10.4162/nrp.2015.9.3.288
  7. Drewnowski A, Rehm CD, Vieux F. Breakfast in the United States: food and nutrient intakes in relation to diet quality in national health and examination survey 2011-2014. A study from the international breakfast research initiative. Nutrients 2018; 10(9): 1200. https://doi.org/10.3390/nu10091200
  8. Yoon SR, Choi M, Kim OY. Breakfast consumption and meal time regularity on nutrient intake and cardiometabolic health in Korean adults. J Lipid Atheroscler 2021; 10(2): 240-250. https://doi.org/10.12997/jla.2021.10.2.240
  9. Lottenberg AM, Afonso MS, Lavrador MSF, Machado RM, Nakandakare ER. The role of dietary fatty acids in the pathology of metabolic syndrome. J Nutr Biochem 2012; 23(9): 1027-1040. https://doi.org/10.1016/j.jnutbio.2012.03.004
  10. Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore HJ, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev 2012; 2012(5): CD002137.
  11. Ministry of Health and Welfare, The Korean Nutrition Society. 2020 Dietary reference intakes for Koreans. Sejong; 2020.
  12. Park YS, Han JL, Lee JW, Cho HS, Koo J, Kim JH, et al. 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.
  13. 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. J Nutr Health 2002; 35(5): 558-570.
  14. Kim HY, Cho MS, Lee HS. Development and validation of Mini Dietary Assessment Index for Koreans. J Nutr Health 2003; 36(1): 83-92.
  15. Yook SM, Park S, Moon HK, Kim K, Shim JE, Hwang JY. Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data. J Nutr Health 2015; 48(5): 419-428. https://doi.org/10.4163/jnh.2015.48.5.419
  16. Yun S, Park S, Yook SM, Kim K, Shim JE, Hwang JY, et al. Development of the Korean Healthy Eating Index for adults, based on the Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2022; 16(2): 233-247. https://doi.org/10.4162/nrp.2022.16.2.233
  17. Kim HY, Kwon S, Lee JS, Choi YS, Chung HR, Kwak TK, et al. Development of a Nutrition Quotient (NQ) equation modeling for children and the evaluation of its construct validity. J Nutr Health 2012; 45(4): 390-399. https://doi.org/10.4163/kjn.2012.45.4.390
  18. Kang MH, Lee JS, Kim HY, Kwon S, Choi YS, Chung HR, et al. Selecting items of a food behavior checklist for the development of Nutrition Quotient (NQ) for children. J Nutr Health 2012; 45(4): 372-389. https://doi.org/10.4163/kjn.2012.45.4.372
  19. Lee JS, Kang MH, Kwak TK, Chung HR, Kwon S, Kim HY, et al. Development of Nutrition Quotient for Korean preschoolers (NQ-P): item selection and validation of factor structure. J Nutr Health 2016; 49(5): 378-394. https://doi.org/10.4163/jnh.2016.49.5.378
  20. Lee JS, Hwang JY, Kwon S, Chung HR, Kwak TK, Kang MH, et al. Development of Nutrition Quotient for elementary school children to evaluate dietary quality and eating behaviors. J Nutr Health 2020; 53(6): 629-647. https://doi.org/10.4163/jnh.2020.53.6.629
  21. Kim HY, Lee JS, Hwang JY, Kwon S, Chung HR, Kwak TK, et al. Development of NQ-A, Nutrition Quotient for Korean adolescents, to assess dietary quality and food behavior. J Nutr Health 2017; 50(2): 142-157. https://doi.org/10.4163/jnh.2017.50.2.142
  22. Lee JS, Kim HY, Hwang JY, Kwon S, Chung HR, Kwak TK, et al. Development of Nutrition Quotient for Korean adults: item selection and validation of factor structure. J Nutr Health 2018; 51(4): 340-356. https://doi.org/10.4163/jnh.2018.51.4.340
  23. Chung MJ, Kwak DT, Kim HY, Kang MH, Lee JS, Chung HR, et al. Development of NQ-E, Nutrition Quotient for Korean elderly: item selection and validation of factor structure. J Nutr Health 2018; 51(1): 87-102. https://doi.org/10.4163/jnh.2018.51.1.87
  24. Ministry of Health and Welfare. Dietary Guidelines for Korean [Internet]. Sejong: Ministry of Health and Welfare; 2021 [cited 2021 May 1]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=365279&page=1.
  25. Ministry of Health and Welfare, Korea Health Promotion Institute. Health Plan 2030, 2021-2030 [Internet]. Seoul: Korea Health Promotion Institute; 2021 [cited 2021 Mar 30]. Available from: https://www.khealth.or.kr/board/view?pageNum=1&rowCnt=8&no1=34&linkId=1002152&menuId=MENU00829&schType=0&schText=&searchType=&boardStyle=Gallery&categoryId=&continent=&country=&contents1=.
  26. Lim YS, Lee JS, Hwang JY, Kim KN, Hwang HJ, Kwon S, et al. Revision of Nutrition Quotient for elderly in assessment of dietary quality and behavior. J Nutr Health 2022; 55(1): 155-173. https://doi.org/10.4163/jnh.2022.55.1.155
  27. Kim K, Hyeon J, Lee SA, Kwon SO, Lee H, Keum N, et al. Role of total, red, processed, and white meat consumption in stroke incidence and mortality: a systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc 2017; 6(9): e005983. https://doi.org/10.1161/JAHA.117.005983
  28. Farvid MS, Stern MC, Norat T, Sasazuki S, Vineis P, Weijenberg MP, et al. Consumption of red and processed meat and breast cancer incidence: a systematic review and meta-analysis of prospective studies. Int J Cancer 2018; 143(11): 2787-2799. https://doi.org/10.1002/ijc.31848
  29. Kyro C, Tjonneland A, Overvad K, Olsen A, Landberg R. Higher whole-grain intake is associated with lower risk of type 2 diabetes among middle-aged men and women: the Danish Diet, Cancer, and Health Cohort. J Nutr 2018; 148(9): 1434-1444. https://doi.org/10.1093/jn/nxy112
  30. Kim H, Kim M. A study on the intake status of energy drinks and related factors of university students in Yeungnam region. Korean J Food Nutr 2018; 31(1): 160-172. https://doi.org/10.9799/KSFAN.2018.31.1.160
  31. Kim D, Kim J, Shin J, Kim SC, Hyun MH. The effect of long working hours on binge eating behavior: the mediating effects of negative emotions. Stress 2017; 25(1): 17-22. https://doi.org/10.17547/kjsr.2017.25.1.17
  32. Suh GS. A study on worker's dietary life according to workplace scale. Korean J Food Nutr 2016; 29(6): 1058-1069. https://doi.org/10.9799/KSFAN.2016.29.6.1058
  33. Lee ES. Effects of abdominal obesity and risk drinking on the hypertension risk in Korean adults. J Korean Acad Community Health Nurs 2018; 29(3): 349-358. https://doi.org/10.12799/jkachn.2018.29.3.349
  34. Ministry of Health and Welfare, Korea Disease Control and Prevention Agency. Korea National Health and Nutrition Examination Survey (KNHANES VII). Cheongju; 2019.
  35. Kim KJ, Lee Y, Kim JY. Current scientific technology and future challenges for personalized nutrition service. Food Sci Ind 2021; 54(9): 145-159.
  36. Choi JH, Park SJ, Kwon H, Lee HJ. Application and evaluation of mobile nutrition management service for breast cancer patients. J Nutr Health 2020; 53(1): 83-97. https://doi.org/10.4163/jnh.2020.53.1.83
  37. 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
  38. 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
  39. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national 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
  40. 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
  41. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, et al. 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
  42. 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
  43. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, et al. 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
  44. Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL, Tooze JA, et al. Update of the Healthy Eating Index: HEI-2015. J Acad Nutr Diet 2018; 118(9): 1591-1602. https://doi.org/10.1016/j.jand.2018.05.021
  45. Yim JS, Heo YR. Factors associated with the dietary quality and nutrition status using the Nutrition Quotient for adults focusing on workers in the manufacturing industry. J Nutr Health 2020; 53(5): 488-502. https://doi.org/10.4163/jnh.2020.53.5.488
  46. Bae YJ, Park SY, Bak HR. Evaluation of dietary quality and nutritional status according to the use of nutrition labeling and nutrition claims among university students in Chungbuk area-based on Nutrition Quotient. Korean J Community Nutr 2020; 25(3): 179-188. https://doi.org/10.5720/kjcn.2020.25.3.179
  47. Morgan KJ, Zabik ME, Stampley GL. The role of breakfast in diet adequacy of the U.S. adult population. J Am Coll Nutr 1986; 5(6): 551-563. https://doi.org/10.1080/07315724.1986.10720156
  48. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr 2010; 29(4): 407-418. https://doi.org/10.1080/07315724.2010.10719858
  49. Gaal S, Kerr MA, Ward M, McNulty H, Livingstone MBE. Breakfast consumption in the UK: patterns, nutrient intake and diet quality. A study from the International Breakfast Research Initiative Group. Nutrients 2018; 10(8): 999. https://doi.org/10.3390/nu10080999