• Nutrition Research and Practice
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• 제9권6호
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• pp.658-666
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• 2015

BACKGROUND/OBJECTIVES: The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years. SUBJECTS/METHODS: Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level ${\geq}126mg/dl$. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design. RESULTS: Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased. CONCLUSIONS: Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.

• 한국식생활문화학회지
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• 제25권2호
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• pp.109-116
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• 2010

Ramyen and Korean noodles (guksu) are popular foods in Korea and around the world. Since 1998, rice consumption in Korea has gradually decreased, whereas consumption of noodles has continuously increased. The purpose of this study is to assess the consumption of ramyen and Korean noodles of Koreans, using data from the Korean National Health and Nutrition Examination Survey (KNHANES) of 2007. Korean adults (>20) were selected to examine the associations between noodle consumption and food and nutrient intake and health status. SAS 9.1 and SUDAAN 9.1 were used for the data analysis. 10.3% of Korean adults consumed ramyen, and 15.4% consumed Korean noodles. The consumption of ramyen and Korean noodles were higher in men than in women, in lunch than in other meals, and in the lowest income quartile than the highest quartile. Ramyen and Korean noodle consumer groups consumed more grain products, seasonings, and oils than the nonconsumer group. The noodle group showed significantly lower systolic blood pressure than the non-consumer group. The noodle groups showed lower rates of hypertension and metabolic syndrome than the non-consumer group. From these results, we conclude that ramyen and Korean noodles may have positive health effects. More studies on the association between noodles and the health of Koreans and those in other countries should be done in the future.

• Journal of Nutrition and Health
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• 제42권7호
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• pp.631-638
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• 2009

본 연구 결과를 종합하여 볼 때 모든 비만 유형에서 고콜레스테롤혈증, 고LDL콜레스테롤혈증, 고중성지방혈증, 대사증후군의 위험도가 증가하였으나, 당뇨병에서는 복부비만의 유무에 따라 위험도에서 유의적인 차이가 있었다. 대사증후군에서는 복부비만을 가지고 있는 비만 유형에서 질병위험도의 값이 크게 나타나 복부비만은 대사증후군의 강력한 예측인자로 사용 될 수 있을 것으로 사료된다. 비만 유형에 따른 질병 위험도가 달라지는 것은 비만을 진단하는 지표 중 어느 기준을 사용하여 비만을 구분하느냐에 따라 위험도가 높아지는 질병이 다름을 의미하며, 비만과 관련된 질병의 관리에 있어 특정 질병과 관련된 적절한 비만 지표를 선택하여 사용하는 것이 비만 유형에 따른 비만인의 건강관리에 효과적일 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.443-448
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• 2005

Objectives : This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. Methods : The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. Results : The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). Conclusions : The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

• 산업식품공학
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• 제14권4호
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• pp.307-315
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• 2010

본 연구에서는 국민건강영양조사 1998년(제1기)부터 2008년(제4기 2차) 조사까지 총 5기의 식품섭취조사 자료를 이용하여, '들깻잎, 생것', '들깻잎, 데친것', '들깻잎, 찐것', '들깻잎, 통조림'의 섭취자 및 섭취량에 대한 분석을 시행하였다. 특히, 국민건강영양조사의 식품 섭취량 자료로부터 합리적이고 객관적으로 들깻잎 섭취자의 수 및 섭취량을 산출할 수 있는 방법을 개발하였다. 들깻잎의 섭취량에 대한 분석은 국민건강영양조사의 전체 응답자의 평균 섭취량(응답자 평균 섭취량), 들깻잎 섭취자의 평균 섭취량(섭취자 평균 섭취량), 상위 5%의 극단 섭취자의 평균 섭취량(극단 섭취량), 남성 및 여성의 평균 섭취량, 20세 미만과 20세 이상의 평균 섭취량의 5가지의 항목으로 구분하여 분석되었다. 들깻잎 섭취자의 수 및 섭취량을 분석한 결과 들깻잎 섭취자의 수는 조사연도별로 균일한 분포를 나타내었으며, 1일 7-10명 중 1명이 들깻잎을 섭취한다는 결과를 도출하였다. 남성과 여성의 섭취자 비율은 여성이 남성에 비해 평균 1.22배 더 많았다. 응답자 평균 섭취량은 2.20 g이었으며, 섭취자의 평균 섭취량은 2005년에서 가장 높았고(21.40 g), 1998년과 2008년에 비하여 0.24 g 정도 증가하였다. 대부분의 조사연도에서 남성의 섭취량이 여성에 비해 높았고, 20세 미만의 섭취량은 전체적으로 20세 이상 섭취량보다 낮았다. 극단 섭취량 1998년에서 2005년까지의 섭취량이 평균 78.02 g으로 높았지만, 2007년과 2008년에는 평균 55.58 g로 낮아졌다. 들깻잎 섭취형태를 분석한 결과 '들깻잎, 생것', '들깻잎, 통조림', '들깻잎, 데친것', '들깻잎, 찐것' 순으로 응답자 수 및 섭취량 순위가 결정되었다. 그 중 '들깻잎, 데친것', '들깻잎, 찐것'의 데이터가 충분치 않아 결과가 좋지 않게 나왔다. 또한 국민건강영양조사 식품 섭취량 데이터는 2007년부터 상시조사를 시작하였으며, 그 이전에는 시행된 연도에 따라 조사 기간 및 계절이 1998년과 2001년에는 11-12월, 2005년에는 4-6월로 일관되지 않았기 때문에 연간 일일 섭취량을 판단하는 데 한계가 있을 것이라 생각된다. 본 연구의 결과를 확대하면 들깻잎 이외의 다른 농산물, 축산물, 수산물 및 이들의 가공품에도 적용할 수 있다. 이러한 식품의 섭취량에 대한 객관적인 정보는 농축수산물 및 가공식품을 통해 의도 또는 비의도적으로 섭취하는 화학 잔류물질의 위해성 평가를 위한 좋은 기초 자료가 될 것이다.

• Journal of Preventive Medicine and Public Health
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• 제35권1호
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• pp.1-12
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• 2002

Objective : To estimate the socioeconomic costs of obesity in Korea,1998. Methods : The 1998 National Health and Nutrition Examination Survey(1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM(non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF(Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. Results : The direct costs of obesity were 2,126 billion${\sim}965$ billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion${\sim}1,086$ billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4.225 billion${\sim}2,050$ billion Won, which corresponded to about $0.094%{\sim}0.046%$ of GDP and $1.88%{\sim}0.91$ of total health care costs in Korea. Conclusions : Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. further studies are needed to caculate socioeconomic costs of obesity more exactly.

• Journal of Nutrition and Health
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• 제47권3호
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• pp.186-192
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• 2014

본 연구는 제1기~제4기 국민건강영양조사 (1998~2009) 자료를 이용하여 10~18세 청소년을 대상으로 고탄수화물 식사 그룹 (HCLF)과 고지방 식사 그룹 (LCHF)의 식사 특성이 대사증후군 위험요인에 미치는 영향에 대해 분석하였다. 1) 에너지 섭취비율은 HCLF 그룹의 경우 탄수화물 : 단백질 : 지질이 76.3 : 12.6 : 11.1 인 반면, LCHF 그룹의 경우 52.9 : 14.7 : 32.4 로 두 그룹 간 유의적 차이가 났으며, 에너지 섭취는 HCLF 그룹이 1,733.1 kcal로 LCHF 그룹의 2,233.0 kcal에 비해 유의적으로 낮았다. 2) 두 그룹 간 에너지 섭취를 연령별 에너지 필요 추정량에 대비해 평가해보니 HCLF 그룹은 평균 79.0%를 충족하였고, LCHF 그룹은 100.3%를 충족하였다. 3) 에너지 섭취 보정을 위해 1,000 kcal 당의 영양소 밀도로 평가해보면 HCLF 그룹은 탄수화물, 나트륨, 철, 칼륨, 비타민 C의 섭취량은 유의적으로 높았으나, 단백질, 지방, 칼슘, 인, 비타민 A, 티아민, 리보플라빈, 나이아신의 섭취량은 유의적으로 낮았다. 4) 대사증후군 위험요인을 비교해보면, HCLF 그룹에서 LCHF 그룹에 비해 혈청 중성지질 농도와 수축기 혈압은 유의적으로 높았고, 혈청 HDL-콜레스테롤은 유의적으로 낮았다. 다른 지표들은 두 그룹 간 차이가 없었다. 5) HCLF 그룹과 LCHF 그룹 간에 대사증후군 위험요인의 위험도와 대사증후군의 교차비는 유의적 차이가 없었다. 본 연구의 결과를 통해 청소년 시기에도 고탄수화물 섭취가 대사증후군 지표에 영향을 미친다는 것을 살펴볼 수 있었다. 우리나라 탄수화물 섭취는 매우 높은 편이어서 앞으로 이 시기의 탄수화물의 질적, 양적 섭취 수준과 대사질환과의 관련성 연구가 더 이루어져야 하며, 성인기 만성질환으로의 이행에도 관련이 있으므로 장기적인 연구가 필요하다고 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제48권6호
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• pp.310-318
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• 2015

Objectives: Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase. Methods: Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761). Results: Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period. Conclusions: These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.

• Nutrition Research and Practice
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• 제12권1호
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• pp.69-77
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• 2018

BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS: Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ${\geq}30years$, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ${\geq}10years$). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS: In the multivariable adjusted models, patients with a longer duration (${\geq}10years$) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ${\geq}10years$ (P for trend = 0.004). CONCLUSION: Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.

• Journal of Preventive Medicine and Public Health
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• 제40권6호
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• pp.505-511
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• 2007

Objectives : While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. Methods : Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. Results : Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. Conclusions : Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.