• Journal of Nutrition and Health
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• v.57 no.1
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• pp.1-15
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• 2024

Purpose: This study aimed to develop a comprehensive tool for assessing dietary guideline adherence among older Korean adults, focusing on the domains of food and nutrient intake, eating habits, and dietary culture. Methods: Candidate items were selected through a literature search and expert advice. The degree of adherence to dietary guidelines was then evaluated through a face-to-face survey conducted on 800 elderly individuals across five nationwide regions. The items for dietary guideline adherence evaluation tool were selected through exploratory factor analysis of the candidate items in each of the three areas of the dietary guidelines, and construct validity was verified by performing confirmatory factor analysis. Using the path coefficient of the structural equation model, weights were assigned to each area and item to calculate the dietary guideline adherence score. A rating system for the evaluation tool was established based on national survey results. Results: A total of twenty-eight items were selected for evaluating dietary guideline adherence among the elderly. Thirteen items related to food intake, seven to eating habits, and eight to dietary culture. The average score for dietary guideline adherence was 56.9 points, with 49.8 points in the food intake area, 63.2 points in the eating habits area, and 58.6 points in the dietary culture area. Statistically significant correlations were found between dietary guideline adherence scores and food literacy (r = 0.679) and nutrition quotient scores (r = 0.750). Conclusion: The developed evaluation tool for dietary guideline adherence among Korean older adults can be used as a simple and effective instrument for comprehensively assessing their food and nutrient intake, dietary habits, and dietary culture.

• Korean Journal of Community Nutrition
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• v.20 no.2
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• pp.129-140
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• 2015

Objectives: We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. Methods: A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. Results: Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). Conclusions: Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.

• Korean Journal of Community Nutrition
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• v.28 no.3
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• pp.220-234
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• 2023

Objectives: This study aimed to assess the adherence to dietary guidelines among college students in the post-COVID-19 era and examine the changes in their dietary habits as the learning environment transitioned from remote to in-person classes. Methods: We conducted a survey involving 327 college students in Daejeon from March to April 2023. The survey questionnaires included various factors, including age, gender, type of residence, frequency of use of delivery food, convenience food, and eating out. In addition, we investigated the extent of adherence to the dietary guidelines for Koreans and the degree of dietary changes following the post-COVID-19 shift in class format were investigated. For comparative analysis of the level of adherence to dietary guidelines in relation to dietary habit changes, an ANOVA and a post hoc Scheffe test were employed. We also performed a multiple linear regression analysis to identify dietary factors influencing the level of adherence to dietary guidelines. Results: The study revealed a high rate of convenience food consumption and a low rate of homemade food intake among students. There was a marked increase in the consumption of processed foods, convenience foods, dining out, sweet foods, high-fat fried foods, beverages, and alcohol following the transition from online to in-person classes. When examining adherence to Korean dietary guidelines, the highest scored practice was 'Hydration', and the lowest was 'Breakfast habit'. Increased consumption of convenience foods, late-night snacks, and dining out were negatively correlated with adherence levels to dietary guidelines, specifically correlating with 'Healthy weight', 'Hydration', 'Breakfast habit', and the total score of adherence. The adoption of 'regular meals' was positively associated with increased adherence levels to dietary guidelines. Conclusions: The transition from remote to in-person classes post-COVID-19 led to increased intake of convenience foods, dining out, sweet foods, high-fat fried foods, and alcohol. The rise in convenience food and late-night snack consumption negatively influenced several aspects of the dietary guidelines adherence, thereby suggesting the need for strategies to encourage healthy dietary habits among college students.

• Nutrition Research and Practice
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• v.14 no.6
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• pp.621-636
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• 2020

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of "yes" responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

• Preventive Nutrition and Food Science
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• v.17 no.4
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• pp.254-260
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• 2012

This study surveyed dietary intake and adherence to the Korean national dietary guidelines in Korean adolescents. To elucidate basic data for use in nutrition education, which aims to improve adolescent compliance with the national dietary guidelines and to increase the intake of dietary fiber, we evaluated the sources of fiber in adolescent diets. This study included 182 male and 212 female students from 2 middle schools in the Jeonju province. From November 15~20, 2011, we surveyed the students for general characteristics, adherence to the Korean national dietary guidelines, and dietary intake. Dietary fiber intake was $16.57{\pm}6.95$ g/day for male students and $16.14{\pm}7.11$ g/day for female students. The food groups that contributed most to dietary fiber intake were (in descending order) cereals, vegetables, seasoning, and fruits. The fiber-containing food items consumed most were cabbagekimchi, cooked rice, instant noodles, and cabbage. Based on adherence to the Korean national dietary guidelines, the vegetable-based intake of dietary fiber in groups 1 (score 15~45), 2 (score 46~52), and 3 (score 53~75) were $4.41{\pm}2.595$ g/day, $4.12{\pm}2.692$ g/day, and $5.49{\pm}3.157$ g/day, respectively (p 0.001). In addition, the total intake of dietary fiber varied significantly among the three groups (p 0.001) as follows: Group 1, $14.99{\pm}6.374$ g/day; Group 2, $15.32{\pm}6.772$ g/day; and Group 3, $18.79{\pm}7.361$ g/day. In this study, we discovered that adherence to the Korean national dietary guidelines correlates with improved intake of dietary fiber. Therefore, marketing and educational development is needed to promote adherence to the Korean national dietary guidelines. In addition, nutritional education is needed to improve dietary fiber consumption through the intake of vegetables and fruits other than kimchi.

• Nutrition Research and Practice
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• v.7 no.3
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• pp.207-215
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• 2013

The objective of this study was to investigate the associations between the prevalence of overweight and obesity and the degree of adherence to the Korean Dietary Action Guides for Children (KDAGC). In a cross-sectional study based on a child care center-based survey in Seoul, Korea, we collected parental-reported questionnaires (n = 2,038) on children's weight and height, frequency of fruit and vegetable consumption, and the quality of dietary and activity behaviors based on the 2009 KDAGC Adherence Index (KDAGCAI) which was developed as a composite measure of adherence to the KDAGC. Overweight and obesity were determined according to age- and sex-specific BMI percentile from the 2007 Korean national growth chart. Associations were assessed with generalized linear models and polytomous logistic regression models. Approximately 17.6% of Korean preschool children were classified as overweight or obese. Obese preschoolers had lower adherence to the KDAGCAI compared to those with lean/normal weight. Preschoolers with a high quality of dietary and activity behaviors had a 51% decreased odds ratio (OR) of being obese (highest vs. lowest tertile of KDAGCAI-score, 95% CI 0.31, 0.78; P = 0.001); the associations were more pronounced among those who were older (P = 0.048) and lived in lower income households (P = 0.014). A greater frequency of vegetable consumption, but not fruit, was associated with a borderline significant reduction in the prevalence of obesity. Our findings support the association between obesity prevention and high compliance with the Korean national dietary and activity guideline among preschool children.

• Nutrition Research and Practice
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• v.8 no.6
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• pp.705-712
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• 2014

BACKGROUND/OBJECTIVES: Dietary guidelines for Korean children were released in 2009. The goal of the present study was to examine diet quality in terms of adherence to these dietary guidelines as well as explore the association between guideline adherence and risk of obesity in Korean children. SUBJECTS/METHODS: Children aged 5-11 years (mean age = 8.9 years old, n = 191, 80.6% girls) were recruited from a university hospital in Seoul, Korea. Adherence to dietary guidelines for Korean children was calculated using the Likert scale (1-5), and children were then categorized into low, moderate, and high groups based on adherence scores. Obesity or being overweight was determined based on an age- and gender-specific percentile for body mass index (BMI) of the 2007 Korean National Growth Charts. Diet quality was evaluated from 3 days of dietary intake data. RESULTS: Children in the high adherence group were characterized by significantly lower BMI percentiles and paternal BMIs as well as higher percentages of fathers with a high level of education and higher household incomes compared to those in the low or moderate group. Children in the high adherence group consumed significantly higher amounts of milk and dairy products, were less likely to consume lower than the EAR of phosphorus and iron, and had higher NARs for calcium, phosphorus, iron, zinc, and MAR than those in low groups. The ORs for obesity ($BMI{\geq}95^{th}$ percentile) or being overweight including obesity ($BMI{\geq}85^{th}$ percentile) were significantly lower in the high adherence group compared to the low adherence group (OR: 0.33, 95% CI = 0.13-0.82, P for trend = 0.019; OR: 0.26, 95% CI: 0.11-0.61 P for trend = 0.002). CONCLUSIONS: Korean children who adhered to dietary guidelines displayed better diet quality and a reduced risk of obesity.

• The Korean Journal of Food And Nutrition
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• v.27 no.4
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• pp.660-672
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• 2014

The purpose of this study was to evaluate dietary habit and nutritional status by household income in female adults, using data from the $4^{th}$ Korea National Health and Nutrition Examination Survey (2007~2009). Subjects were 8,356 women over the age of 20 years. The subjects were classified into 4 groups by household income level. Dietary data from 24 hr recall methods were used to analyze nutritional status. The obesity rate of the low income group was significantly higher than the rates of other income groups. Additionally, the nutritional status of the low income group was worse than those of other groups. The percentage of carbohydrate in total energy intake was higher and food security status was lower in the low income group than in other groups. Awareness and adherence to dietary guidelines were also lower in the low income group. Adherence to a dietary guideline of 'avoiding salty foods and trying to eat foods with bland taste' and 'eating a variety of foods from each food group' were lower than those of other groups. However, the frequency of skipping breakfast among the low income group was lower than that of others. Therefore, this study suggested that low income women should decrease the percentage of carbohydrate in total energy intake and adhere to dietary guidelines, especially those of avoiding salty foods and eating a variety of food groups, in order to improve their nutritional status.

• Journal of the East Asian Society of Dietary Life
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• v.25 no.2
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• pp.246-260
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• 2015

The purpose of this study was to evaluate the prevalence of obesity, dietary habits, and nutritional status by age among low-income women, using data from the fourth Korea National Health and Nutrition Examination Survey (2007~2009). Subjects were 8,356 women aged 20 and over. The subjects were classified into four groups by age. Dietary data from 24-hr recall methods were used to analyze nutritional status. The prevalence of obesity in the 50~64 years age group was significantly higher than those of the other age groups. Among age groups, malnutrition was the highest in the 65-and-over age group. It appears that women in the 20~29 and 65-and-over age groups were the highest nutritional risk. The percentage of carbohydrates in total energy intake was higher and the percentages of protein and fat were lower in the 65-and-over age group than other groups. Frequency of skipping breakfast was lower in women aged 65-and-over, and moderate physical activity significantly decreased with increasing age. Awareness of dietary guidelines was higher in women aged 30~49 years than other groups, whereas it was lower in those aged 65-and-over years. Adherence to dietary guidelines of 'eating a variety of foods from each food group' was significantly lower in women aged 65-and-over years than those of other groups. However adherence to dietary guidelines of 'eating breakfast everyday with a pleasant mind' was significantly lower in women aged 20~29 years than those of other groups. Therefore, this study shows that low income women have various nutritional problems by age group, and we should support a tailored approach to improve their nutritional status.

• The Korean Journal of Food And Nutrition
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• v.28 no.3
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• pp.376-386
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• 2015

The purpose of this study was to evaluate the sodium-related dietary attitudes, behaviors, and nutritional knowledge in university students according to the practice of dietary guidelines for Koreans established by the Ministry of Health and Welfare, Republic of Korea. Based on the total practice score related to the dietary guidelines (PDG), we classified subjects into a "low practice of the dietary guidelines (LPDG)" group (n=94, male=43, female=51) (total score of PDG ${\leq}13$) and a "high practice of the dietary guidelines (HPDG)" group (n=56, male=32, female=24) (total score of PDG >13). Subjects were asked about general characteristics, lifestyle, salt-related dietary attitudes, behaviors, and nutritional knowledge using a questionnaire. The LPDG group had more subjects who were breakfast skippers (p<0.001) compared to the HPDG group. The LPDG group (31.26) had a significantly lower score in terms of salt-related dietary attitudes compared to the HPDG group (33.77) (p=0.0042). The score for salt-related dietary attitudes was significantly higher in the HPDG (32.52) group than in the LPDG (29.91) group (p=0.0041). There was no significant difference in the total score for salt-related nutrition knowledge between the groups. The correlation analysis indicated that the dietary guidelines practice score had a positive correlation with the salt-related dietary attitude score (r=0.3593, p<0.0001) and the dietary attitude score (r=0.3443, p<0.0001) after adjustments for sex. These results show that the degree of adherence to the dietary guidelines for adults may be related to sodium-related dietary attitudes, behaviors, and nutrition knowledge.