• Nutrition Research and Practice
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• v.3 no.3
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• pp.171-179
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• 2009

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in $NutriPlus^+$ aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the $NutriPlus^+$ in 2008.

• Journal of the Korean Society of School Health
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• v.21 no.2
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• pp.61-73
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• 2008

Purpose: Several health behavior factors affect the incidence of type 2 diabetes. Especially, obesity, which causes insulin resistance, is the most important determinant of diabetes. Therefore, we expect the risk factors associated with insulin resistance and type 2 diabetes are affected by obesity and, additionally, the related factors with diabetes caused by obesity can be controlled. Methods: This study used data collected from the 2001 Korea National Health and Nutrition Examination Survey (KNHANES). A stratified multistage probability sampling method was applied and the final sample included 5,500 subjects over 30 years old who had completed necessary health examinations and health behaviors survey. Results: The risk factors associated with type 2 diabetes are affected by obesity. According to logistic regression model stratified by body mass index (BMI) and sex, abdominal obesity and age were the significant risk factors of diabetes regardless of sex and BMI. However, drinking, smoking, total energy consumption, and protein consumption were risk factors for women with normal BMI, while carbohydrate consumption was a risk factor for man with normal BMI. Sleeping hours affected diabetes for women with obesity and fiber consumption was a risk factor for both women and men with obesity. In addition, statistically the family history of diabetes was a significant risk factor only in the group with normal weight, not in the group with obesity. Conclusion: The study results will provide information for implementing a regional initiative of type 2 diabetes prevention by BMI.

• Korean Journal of Health Education and Promotion
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• v.18 no.3
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• pp.11-36
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• 2001

The purpose of this study is to analyze health behavior by comparing the difference between self-perceived health status and health examination results. The study subjects consist of 7,702 people aged over 20, surveyed by Health Interview survey, Health Examination survey, Dietary Life survey, Health Consciousness and Behavior survey. Data used in the study are drawn from raw data from a 1998 National Health and Nutrition survey. General characteristics variables are sex, age, education level, residential area, marital status, occupation, and living standard while dichotomous variables, ‘not healthy’ and ‘healthy’ are used to measure self-perceived health status. Variables for health examination results are high blood pressure, high cholesterol, diabetes, liver diseases, liver inflammation, kidney diseases, normal weight, regular diet, optimum sleeping time(7-8 hours), regular health examination and health behavior practice group. Major findings of the study are as follows: 1) Analysis of self-perceived health status and health behavior by disease: Variables significantly correlated with high self-perceived health status have strong associations with high health behavior practice, which supports the hypothesis that as one has high self-perceived health status, one is more likely to practice health promoting behavior. The results of analysis of health behavior differences by dividing subjects into two categories, ‘cases of illness’ and ‘cases of no illness’ indicate that drinking, sleeping time, health examination are significant variables (p〈0.001, 0.05) whereas smoking, weight control, regular exercise, regular diet are not significant. 2) Analysis of disparity patterns between self-perceived health status and health examination: The hypothesis that health behaviors would be different according to the disparity pattern between self-perceived health status and health examination is supported as a result of χ2 test. Among Type I : Self-perceived health status is high and actual health status is good (no disease) Type II: Self-perceived health status is high and actual health status is poor(have disease) Type III: Self-perceived health status is low and actual health status is good(no disease) Type IN: Self-perceived health status is low and actual health status is poor(have disease) Type I and Type IV show no disparity, Type I shows the highest health promoting behavior whereas Type IV shows the lowest health promoting behavior. Type II, and III, compared to Type I, practise lower health promoting behavior. Multi-logistics regression analysis was conducted to find out the degree of impact on health behavior. Independent variables are general characteristics, self-perceived health status and health examination result and presence of illness, while the dependent variable is health promoting behavior. The analysis of the impact of self-perceived health status on the health promoting behavior shows that smoking, drinking, weight control, regular exercise, health examination practice, and/or regular diet are significantly correlated to self-perceived health status. High self-perceived health status is inversely related to high health promoting behavior. This finding supports the hypothesis that the higher one perceives one's health, the more likely one is to practice health promoting behavior. On the contrary, the presence of illness has little impact on health promoting behavior. 3) Multiple logistics analysis on how disparity patterns between self-perceived health status and health examination affect health behavior: The results of multiple logistics analysis made on health behavior variables compared to the standard variable are as follows: When analyzed on the standard of Type I, smoking is a significant risk factor for the Type IV. In case of drinking, all the patterns show a high probability of relative risk ratio. With regard to weight control, it is a risk factor for Type II while all the patterns show high probability of not practising when analyzed on the standard of type IV. Type III and IV show high probability of not doing regular exercise while Type IV, shows a high probability of not taking appropriate sleeping time. When analyzed on the standard of type IV, all the patterns show a high probability of not taking health examinations. Type III and IV show a high probability of not having regular meals. As for overall health promoting behavior, Type III and IV show a high relative risk ratio. These two groups have low self-perceived health status. It implies that self-perceived health status has significant impact on health promoting behavior. This is also supported by the fact that Type I with high self-perceived health status and no illness shows a high practice rate of health promoting behavior. Types II and III the groups with high disparity between self-perceived health status and health examination results, show a low practice rate of health promoting behavior when compared to Type I. Type IV, that is the group with low self-perceived health status and actual illness, shows the lowest practice of health promoting behavior. It is highly probable that this type proves to be the poorest health group.

• Journal of Nutrition and Health
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• v.40 no.sup
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• pp.29-38
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• 2007

The purpose of this study was to establish an association between the percent of energy from total sugar and disease prevalence of obesity, hypertension, dyslipidemia, insulin resistance, and metabolic syndrome with the context of the current population dietary practice in Korea. The Korean National Health and Nutrition Survey, 2001 and 2002 dataset were used as the source of data for this research. Usual nutritional intakes for over 20 years old people were calculated from the two non-consecutive dietary intake data from KNHANES 2001 and 2002 dataset. SAS and SUDAAN were used for statistical analyses. Sample weighted means, standard errors, and population percentages were calculated, and multiple logistic regression model with adjustment for covariates were used to determine the odds ratios(ORs) and 95% confidence intervals. Subjects were categorized as 3 ways and compared the LS means and ORs for heath factors. First, subjects excluding pregnant women, were categorized according to percent of energy from the usual total sugar intakes as ${\leq}10%$, 11-15%, 16-20%, 21-25%, >25%. Risk of LDL cholesterol showed a tendency to increase in the '>25%' group compared to the '<10%' group. The risks of the other health effects did not show any significant differences. Second, the subjects were categorized considering both Acceptable Macronutrient Distribution Range(AMDR) from carbohydrate and %Energy from total sugar as 'CHO<55% & Total sugar ${\leq}10%$', 'CHO 55-70% & Total sugar 11-25%', and '$CHO{\geq}70%$ & Total sugar ${\geq}25%$'. The risk of obesity tended to increase in the '$CHO{\geq}70%$ & Total sugar ${\geq}25%$' group compared to the 'CHO<55% & Total sugar ${\leq}10%$'. Third, the subjects were categorized as 'CHO<55% & Total sugar ${\leq}10%$', 'CHO 55-70% & Total sugar 11-20%', and '$CHO{\geq}70%$ & Total sugar ${\geq}20%$'. The risk of obesity also tended to increase in the '$CHO{\geq}70%$ & Total sugar ${\geq}20%$' group compared to the 'CHO<55% & Total sugar ${\geq}20%$' group. In conclusion, risk of LDL cholesterol showed a tendency to increase in the over 25% total sugar intake group, and the risk of obesity tended to increase in the 20-25% total sugar intake and high carbohydrate intake group. The risks of hypertension, hyperlipidemia, insulin resistance, and metabolic syndrome were not associated with total sugar intakes. More research to elucidate the association for Korean between the intakes of total sugar, added sugar, glucose, fructose, and sweeteners and diseases prevalences shoud be excuted in the future.

• Tuberculosis and Respiratory Diseases
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• v.71 no.5
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• pp.328-334
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• 2011

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and is the only major disease that is continuing to increase in both prevalence and mortality. The second Korean National Health and Nutrition Survey revealed that the prevalence of COPD in Korean subjects aged ${\geq}45$ years was 17.2% in 2001. Further surveys on the prevalence of COPD were not available until 2007. Here, we report the prevalence of spirometrically detected COPD in Korea, using data from the fourth Korean National Health and Nutrition Survey (KNHANES IV) which was conducted in 2007~2009. Methods: Based on the Korean Statistical Office census that used nationwide stratified random sampling, 10,523 subjects aged ${\geq}40$ years underwent spirometry. Place of residence, levels of education, income, and smoking status, as well as other results from a COPD survey questionnaire were also assessed. Results: The prevalence of COPD (defined as forced expiratory volume in 1 sec/forced vital capacity <0.7 in subjects aged ${\geq}40$ years) was 12.9% (men, 18.7%; women, 7.5%). In total, 96.5% of patients with COPD had mild-to-moderate disease; only 2.5% had been diagnosed by physicians, and only 1.7% had been treated. The independent risk factors for COPD were smoking, advanced age, and male gender. Conclusion: The prevalence of COPD was 12.9% in the KNHANES IV data. Most patients with COPD were undiagnosed and untreated. Based on these results, a strategy for early COPD intervention is warranted in high risk subjects.

• Journal of Nutrition and Health
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• v.42 no.5
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• pp.474-485
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• 2009

The purpose of the present study was to evaluate the characteristics of nutrient intakes of adults aged 20-64 years in Daegu and Gyeongbuk areas in comparison with Seoul and the whole nation. Data from the 1st (1998) to 3rd (2005) Korean National Health and Nutrition Examination Survey (KNHANES) were used. Total numbers of subjects were 296-369 from Daegu and 307-447 from Gyeongbuk while 1076-1244 from Seoul and 5436-6852 from the whole nation. Average energy intakes (men; 2,386, 2,581, 2,305 Kcal, women; 1,937, 1,981, 1,804 Kcal in 1998, 2001, 2005, respectively) of the subjects from Daegu were higher than those from Gyeongbuk (men; 2309, 2267, 2487 Kcal, women; 1,851, 1,845, 1,901 Kcal) and those from Seoul in 1998 and 2001 but not different from those in 2005. Energy from carbohydrate was consistently higher in the subjects from Daegu and Gyeongbuk than in those from Seoul from 1998 to 2005, when the subjects whose carbohydrate energy was over 70% comprised 34 to 58% of the total in the two regions. In 2005, the average intakes of calcium of women and men from Daegu were 512 and 573 mg, iron, 12.8 and 16.6 mg, sodium, 4,650 and 5,951 mg, potassium, 2,585 and 3,152 mg, vitamin A, 823 and 1,038 ${\mu}$gRE, thiamin, 1.10 and 1.43 mg, riboflavin, 1.08 and 1.33 mg, and niacin. 15.4 and 19.3 mg, and vitamin C, 94 and 105 mg and these intakes were not very different from those from Gyeongbuk except higher sodium intake of the Gyeongbuk subjects. Nutrients of which the intakes were over 50% lower than EAR were calcium and riboflavin and those about 30% lower than EAR were iron in women, vitamins A and C in men and women from Daegu and Gyeongbuk. From the present results, it is concluded that high dependence on carbohydrate as energy source and low calcium intake in adults of Daegu and Gyeongbuk are serious and that low intakes of riboflavin, iron and vitamins A and C need to be improved. But changes in the intakes of total energy and other micronutrients from 1998 to 2005 were not reliable enough to judge the regional nutrition due to large variations during this period. The present study also provides the adults' nutrient intakes separated by sex and age groups in the three regions which could be readily used for setting up the nutrition policy for the adults in the regions.

• Journal of the Korean Society of School Health
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• v.22 no.2
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• pp.25-36
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• 2009

Purpose: The purpose of this study was to estimate income-related health inequalities among adolescent population across regions in Korea. Methods: Data of 8,456 adolescents from 1998, 2001, 2005, 2007 Korean Health and Nutrition Examination Survey were used for the analysis. True health status was proxied by self-rated health and overweight status. Per capita income was computed from household monthly average income adjusted by consumer price with base year 2005. Adolescent health inequalities were estimated by Concentration Index (CI) across income and space. Results: Ill health score was related with age (p<0.0001), gender (p=0.0155) and income (p<0.0001). Negative relationship between income and ill-health indicated that higher income group tended to enjoy better health and less overweight. These evidences suggested ill health were accumulated on the economically disadvantaged adolescents. The size of health inequalities (ill-health score) were estimated as CI=-0.057 and CI=-0.030 across income groups and regions, respectively. Comparable measures of within region health disparities were also observed. Conclusion: Since health disparity among adolescent population was small compared to adult population, lessening adolescent health inequality could be a helpful way of mitigating health disparities in later stage. Considering life stage of adolescents, school system and local communities could play important roles toward adolescent health distribution. Although health disparity between regions existed, health disparity within a region should not be neglected.

• Journal of Nutrition and Health
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• v.42 no.2
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• pp.128-134
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• 2009

For children, voluntary addition of micronutrients to foods must be done without health risk to any of them. This study examined safe maximum levels of vitamin A and C, and calcium for children based on nutrient intake data from the 2001-2002 and 2005 National Health and Nutrition Examination Survey (NHANES) in Korea, while using the safe strategy for addition of micronutrients to foods suggested by EU. For the respective 2001-2002 and 2005 NHANES data proportions of potentially fortifiable energy intake ranged 0.36-0.40 and 0.31-0.34 and the $95^{th}$ percentile intake of energy were 2,325-3,296 kcal and 2,286-3,814 kcal depending upon age groups. Ninety-fifth percentile intake levels of vitamin A were over or close to UL, even without considering supplement intake for some age groups, which suggest that vitamin A fortification to foods required further consideration. For calcium, 12-14 year old children were the most sensitive group for excessive intake and nutrient fortification to foods. In these children, maximum levels for fortification were 242-290 mg and 484-580 mg with 0.135 and 0.068 proportions of fortified food (PFF) assumed, respectively, without considering calcium intake from supplements. With consideration of calcium intake from both diet and supplement, the maximum levels for fortification were 20-36% of those without supplement intake. The maximum fortification levels of vitamin C were the lowest in 3-5 year old children, showing 77-187 mg and 68-164 mg with and without supplement intake, respectively. These results suggest that the model used for risk assessment in this study can be used to help risk managers to set maximum levels for safe addition of micronutrients to foods.

• Journal of Nutrition and Health
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• v.38 no.10
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• pp.856-863
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• 2005

Dietary Variety Score (DVS) or Nutrient Adequacy Ratio (NAR) offers a way of comparing eating habits across populations and across countries. This study compared nutrients intakes, food intakes, DVS, and NAR between Korean and US adults using the large national survey data. 4662 Korean adults (men: 2201, women: 2461) aged 20-49 years were selected from the 'Korean National Health and Nutrition Survey,2001' and 4199 US adults (men: 2127, women: 2072) aged 20-49 years were selected from the 'US National Health and Nutrition Examination Survey (NHANES IV,1999-2002)'. The total plant food intakes were high in Korean adults, but the total animal food intakes were high in US adults. Intakes of legumes and nuts, vegetables and mushrooms were higher in Korean than in US adults. On the other hand, intakes of meats, milk and dairy products of US adults were higher than Korean. Beverage intakes were 8 - 10 times higher in US adults than in Korean. The mean DVS of Korean men and women were higher than US men and women. Intakes of fat, calcium and vitamin $B\_{2}$ of US adults were 1.5 - 2 times higher than those of Korean, which could probably related to larger consumption by US adults on milk and dairy product. While the intakes of carbohydrate and vitamin C of the Korean were higher than the US adults, which could presumably related to higher grain and vegetable consumption. Percent energy intakes from carbohydrate, protein, and fat were $64.1\%$, $15.8\%$, and $20.1\%$ for Korean men, $52.4\%$, $15.0\%$, and $32.6\%$ for US men, $65.9\%$, $14.9\%$, $19.2\%$ for Korean women, and $52.1\%$, $14.7\%$, $33.2\%$ for US women respectively, which showed higher $\%$energy from carbohydrate in Korean and higher $\%$energy from fat in US adults. Most nutrient intakes except energy and vitamin C expressed as $\%$RDA were higher in US than in Korean adults. Mean Adequacy Ratio (MAR) of US men and Korean men were both 0.85, while the MAR was 0.81 for Korean women,0.79 for US women. The Korean women's diet showed more diverse and adequate than the US women's diet.

• Journal of Nutrition and Health
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• v.50 no.5
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• pp.483-493
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• 2017

Purpose: The purpose of this study was to determine trends in dietary vitamin E intakes and contributing food groups among Korean adults. Methods: This study included 66,695 subjects aged ${\geq}19years$ who completed a nutrition survey as part of the Korea National Health and Nutrition Examination Survey (1998, 2001, 2005, 2007~2009, 2010~2012, 2013~2015). We estimated individual daily intakes of ${\alpha}-$, ${\beta}-$, ${\gamma}-$, ${\delta}-tocopherol$, and total vitamin E by linking food consumption data with a vitamin E database of commonly consumed foods. Results: Daily vitamin E intake significantly increased from $6.4mg\;{\alpha}-TE/d$ in 1998 to $7.7mg\;{\alpha}-TE/d$ in 2013~2015 (p for trend < 0.0001) among men as well as from $5.4mg\;{\alpha}-TE/d$ in 1998 to $6.5mg\;{\alpha}-TE/d$ in 2013~2015 among women (p for trend < 0.0001). However, the intake of vitamin E was lower than the adequate intake (AI) of Dietary Reference Intakes for Koreans 2015 (2015 KDRI). In 2013~2015, men consumed 6.5 mg/d of ${\alpha}-tocopherol$, 0.5 mg/d of ${\beta}-tocopherol$, 6.0 mg/d of ${\gamma}-tocopherol$, and 3.9 mg/d of ${\delta}-tocopherol$, whereas women consumed 5.7 mg/d of ${\alpha}-tocopherol$, 0.4 mg/d of ${\beta}-tocopherol$, 4.8 mg/d of ${\gamma}-tocopherol$, and 2.8 mg/d of ${\delta}-tocopherol$. The major food groups contributing to vitamin E intake were vegetables (men: 23.3%, women: 22.7%), grains (men: 14.5%, women: 13.9%), and eggs (men: 13.0%, women: 12.5%). Conclusion: This study provides scientific evidence for vitamin E intake in Korean adults. Since the current intake of vitamin E was lower than the reference intakes set by 2015 KDRI, dietary vitamin E intake should be monitored regularly among Korean adults.