• Nutrition Research and Practice
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• v.9 no.6
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• pp.637-643
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• 2015

BACKGROUND/OBJECTIVES: Malnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly. SUBJECTS/METHODS: Elected medical records of 141 elderly patients (86 men and 55 women, aged $73.5{\pm}5.2years$) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification. RESULTS: According to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index. CONCLUSIONS: MNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.

• Korean Journal of Community Nutrition
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• v.27 no.3
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• pp.223-244
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• 2022

Objectives: This study was designed to investigate the relationship between metabolic risk factors, Index of Nutrition Quality, and the dietary quality index score of Korean adults. Methods: The subjects were 18,652 Korean adults aged 19 years or older (7,899 males, 10,753 females) who participated in the 2016-2019 Korea National Health and Nutrition Examination Survey. Subjects were divided into normal, pre-metabolic syndrome, and metabolic syndrome (MetS) groups according to the number of their metabolic risk factors. Data were analyzed using the SPSS program. Results: About 44.7% of men in the MetS group were at least college graduates (P < 0.001), whereas 52.0% of women in the MetS group were middle school graduates or lower (P < 0.001). The frequency of fruit and dairy products intake tended to decrease as the number of metabolic risk factors increased in both men and women (P for trend < 0.001). As the number of metabolic risk factors decreased, the frequency of grain intake tended to decrease in men (P for trend < 0.001) while the frequency of intake of red meat (P for trend = 0.001), poultry (P for trend < 0.001), and eggs (P for trend < 0.001) decreased in women. The total scores of Diet Quality Index-International (DQI-I) (men P < 0.001, women P < 0.01) and Korean Healthy Eating Index (KHEI) (men and women P < 0.001) were significantly lower in the MetS group compared to the other groups, and the total score of DQI-I and KHEI tended to decrease as the number of metabolic risk factors increased. Conclusions: Dietary quality evaluation using various indices can provide more information on the dietary problems related to metabolic risk factors. Nutrients and foods that have been confirmed to be related to metabolic risk factors can be used to develop dietary guidelines for the nutritional management of metabolic diseases.

• Nutrition Research and Practice
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• v.1 no.3
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• pp.231-236
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• 2007

Underreporting patterns by the level of obesity have not been fully assessed yet. The purpose of this study was to examine the differential underreporting patterns on cardiovascular risk factor, macronutrient, and food group intakes by the level of Body Mass Index (BMI). We analyzed cross-sectional baseline nutritional survey data from the population-based longitudinal study, the Healthy Women Study (HWS) cohort. Study subjects included 538 healthy premenopausal women participating in the HWS. Nutrient and food group intakes were assessed by the one-day 24-hour dietary recall and a semi-quantitative food frequency questionnaire, respectively. The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used as a measure of relative energy reporting status and categorized into tertiles. Overweight group ($BMI{\geq}25kg/m^2$) had a higher ratio of EI to BMR (EI/BMR) than normal weight group ($BMI<25kg/m^2$). Normal weight and overweight groups showed similar patterns in cardiovascular risk factors, nutrient intake, and food group intake by the EI/BMR. Fat and saturated fat intakes as a nutrient density were positively associated with the EI/BMR. Proportion of women who reported higher consumption (${\geq}4\;times/wk$) of sugar/candy, cream and red meat groups was greater in higher tertiles of the EI/BMR in both BMI groups. Our findings suggest similar patterns of underreporting of cardiovascular risk factors, and macronutrient and food group intakes in both normal and overweight women.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.2747-2751
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• 2013

In this study we assessed the dietary phytochemical index in relation to the risk of breast cancer in women. This case-control study was conducted on 100 incident breast cancer cases and 175 healthy controls. Data regarding socio-demographic factors, medical history, medications, and anthropometric measurements were collected. Dietary data were obtained using a validated food frequency questionnaire and a energy-adjusted dietary phytochemical index (PI) was calculated. The odds ratios of breast cancer were assessed across energyadjusted PI quartile categories. The mean age of participants was $46.2{\pm}8.9$ and $45.9{\pm}9.4$ years in cases and controls, respectively. The mean PI across quartile categories was $13.9{\pm}2.6$, $21.1{\pm}1.8$, $26.7{\pm}2.1$, $41.6{\pm}10.2$ in the first, second, third and fourth quartiles, respectively. After adjustment for all potential confounders, the risk of breast cancer in the forth quartile of dietary PI was significantly decreased (OR=0.08, 95%CI=0.01-0.84). Higher intake of phytochemical-rich foods is associated with lower risk of breast cancer.

• Journal of the Korean Dietetic Association
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• v.11 no.3
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• pp.365-374
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• 2005

This study was conducted to compare the validity of obese index among body mass index(BMI), waist to hip ratio(WHR), and waist circumference(WC) and to determine which is the best in relation to cardiovascular risk factors of middle aged Korean(40-64yr).Data from the 1998 Korean Health and Nutrition Survey were used(N=3380). Anthropometric indices and cardiovascular risk factors were measured. Chi-square test, analysis of variance following duncan's multiple range test, partial correlation analysis, and Receiver Operator characteristic(ROC) curves were used in the analysis. There was a significant increasing trend in WHR, systolic blood pressure(SBP), high density lipoprotein cholesterol(HDL), and fasting blood sugar(FBS) with age categories of male and in BMI, WC, WHR, diastolic blood pressure(DBP), SBP, total cholesterol(TC), low density lipoprotein cholesterol(LDL), triglycerol(TG), and FBS with those of female. Specially female had the characteristics of upper body fat and systolic blood pressure risk(p<0.05). Proportions of subjects with lifestyle factors related to cardiovascular risk in overweight or upper body fat group were higher than that of normal group. Higher proportions of subjects were practiced exercise in upper body fat group of male than in other groups. Among 7 cardiovascular risk factors in partial correlation analysis, BMI had the highest correlation coefficient in 6 risk factors in male, whereas WC in 4 risk factors in female. Mean of each obese index according to cardiovascular risk groups except smoker was higher than that of normal(p<0.05). These trends were shown in upper body fat group and female. In ROC analysis of 12 risk factors and health conditions, the largest area under curve among obese indices for risk factors were BMI in male and WHR in female. The optimal cutoff values of each index(BMI: WHR: WC) for one or more cardiovascular risk factors were 23.13: 0.89: 85.35 in male and 23.57: 0.84: 78.35 in female. The results showed that cardiovascular risk factors were prevalent in middle aged Koreans within normal limits of obese indices like another Asians. For the identification of cardiovascular risk factors of middle aged Koreans, BMI for men and WHR for women are appropriate indices. But it is recommended that BMI, WHR, and WC, all three indices should be considered, when using these indices.

• Nutritional Sciences
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• v.6 no.4
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• pp.232-238
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• 2003

Cardiovascular disease (CVD) is one of the most common causes of death in elderly Koreans, and HDL-cholesterol is known to have a pivotal role in protecting against CVD. This study was undertaken to study the relationships between plasma HDL-cholesterol levels and dietary, anthropometric, and biochemical factors in elderly Koreans. The 102 subjects, who were over 60 years old, were classified into two groups based on their plasma HDL-cholesterol levels: a risk group with plasma HDL-cholesterol < 40mg/dl in men or HDL-cholesterol < 50mg/d1 in women, and a control group with higher HDL-cholesterol levels. The subjects' mean intakes of energy, calcium, zinc, vitamin A, vitamin $B_2$, vitamin E, and folate did not meet the Korean RDA for elderly people. Vitamin $B_2$ and folate intakes were significantly lower (p<0.l) in the risk group compared to the control group. The consumption of seaweed was significantly lower (p<0.05), and fish intake was 33% lower, in the risk group compared to the control group. Subjects in the risk group showed a higher BMI, waist/hip ratio, triceps skinfold thickness, and % body fat, compared to control subjects. Plasma triglyceride levels and values of the atherogenic index were significantly higher (p<0.00l) in risk group subjects. Significant negative correlations between HDL-cholesterol level and plasma triglyceride level (r= 0.37), and values of the atherogenic index (r=-0.74), were found. In summary, subjects with low levels of HDL-cholesterol were found to have relatively low intakes of vitamin B$_2$, folate, and seaweed, and higher levels of the CVD risk factors: body fat, plasma TG, and AI. These results suggest that plasma HDL-cholesterol levels can be modified by dietary, anthropometric, and hematological means.

• Journal of Nutrition and Health
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• v.38 no.6
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• pp.445-454
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• 2005

The purpose of this study was to compare the validity of obese index among body mass index (BMI), waist to hip ratio (WHR), and waist circumference (WC) and to determine which is the best in relation to cardiovascular disease (CVD) risk in Korean elderly more than 65 ages. Data from the 1998 Korean Health and Nutrition Survey were used (n=1017). Anthropometric indices and CVD risk factors were measured, and chi-square test, analysis of variance following duncan's multiple range test, partial correlation analysis, and Receiver Operator Characteristic (ROC) curves were used in the analysis. Anthropometric values were decreased in both male and female when ages were goes up. In female elderly, it specially showed the characteristics of upper body fat and systolic blood pressure risk (p<0.05). Among life style factors the current smokers were prevalent in obese male (p<0.05), but not prevalent in female having obese or upper body fat. Also, person with upper body obesity have more exercise than that of normal group (p<0.01). Mean BMI values of the current smoker was lower than that of normal group in both sexes (p<0.01). Mean BMI value of person with other risk factors were higher than that of normal groups (p<0.05). Among 7 CVD risk factors in partial correlation analysis, WC had the highest correlation coefficient in 5 in male, whereas BMI in 4 in female. In ROC analyses of 12 risk factors and health conditions, the largest area under curve of obese indices for risk factors were WC>WHR>BMI in male and BMI>WHR>WC in female. The optimal cutoff values of each index (BMI : WHR : WC) for one or more risk factors were 19.02 : 0.84 : 71.3 in male and 19.04 : 0.88 : 85.6 in female. In conclusion, Most Korean elderly showed non-obese and abdominal obesity likewise other Asians. Also CVD risk factors were prevalent in Korean elderly within normal limits of obese indices. Therefore the upper body fat indices reflected in the aged whose muscle mass is replaced by fat must be used as an indicator of CVD risk together with BMI. Although WHR was the worst index based on partial correlation analysis and so located between BMI and WC in ROC curve analysis in both sexes, it need to be use with WC to screen the cardiovascular risk group.

• Journal of Nutrition and Health
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• v.42 no.3
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• pp.234-245
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• 2009

Nutritional assessment for the elderly can identify health status and morbidity. However, development of Nutritional Risk Index (NRI) remains limited for elderly because of difficulties in understanding physiological mechanism of elderly. This study was performed to analyze and develop Nutritional Risk Index for Korean elderly Women (Geriatric Nutritional Risk Index, GNRI). Based on literature review, factors for NRI were identified and indices were assessed by a cross-sectional survey. The survey involved Korean elderly women (${\geq}$60, n = 94) in Gwangju area, and sociodemographics, lifestyle characteristics, health conditions, dietary intakes based on 24h- recall, anthropometric measures (wt, ht, BMI, waist, hip, WHR, body protein, body fat, abdominal fat, and triceps skinfold thickness), and clinical biochemistry parameters (systolic blood pressure, diastolic blood pressure, cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, prealbumin, hemoglobin, hematocrit, fasting blood glucose, HbAlc, ferritin, Zn, Ca, Na, K, Vit E, Vit $B_{12}$, folate, C-reactive protein) were examined relation to nutritional risk index. Based on literature review and data analyses, three NRIs were categorized (NRI I, NRI II, NRI III) and used for further analysis. NRI I was related to having metabolic syndrome, NRI II was related to serum albumin and body weight, and NRI III was related to food habit and health concerns. Abdominal fat (%) of elderly was correlated with each NRIs. NRI II was correlated with nutritional deficiency and higher tendency of inflammatory response, and NRI III was correlated with nutritional status which tend to be lower on aging (protein, folate, Vit $B_{12}$). NRI can serve as a useful tools in assessing health risk and nutritional status. Some modification of items in NRI and validity study are need to apply to Korean elderly.

• Journal of the Korean Society of Food Science and Nutrition
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• v.28 no.5
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• pp.1164-1171
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• 1999

In this study, we investigated the effects of obesity index on the risk factors of chronic diseases in obese children. The subjects were male and female children aged 9 to 12. The average obesity index was 147.7$\pm$13.8% in boys and 147.6$\pm$16.5% in girls. The average percentages of body fat was significantly higher in boys(33.9$\pm$5.7%) than in girls(30.7$\pm$4.4%). It was found that 26% of subjects had abnormal serum GOT and GPT values. Percentages of subjects at risk of cardiovascular disease(CVD) based on corresponding criteria of TG, T chol, HDL chol, and LDL chol were 28.6%, 28.6%, 45.5% and 42.7%, respectively. The risk of CVD was increased with the degree of obesity, which was not significant. The AI(atherogenic index) was higher in boys(4.6$\pm$2.3) than in girls(3.6$\pm$1.2). The serum T chol and LDL chol levels of subjects whose mother are in thirties were significantly higher than those of subjects whose mother are in fourties. The T chol levels of subjects who had mother with job were significantly higher compaired to those of subjects who had housewife mother. The results indicated the urgent need of nu tritional management for the obese children to prevent further devel opment of childhood obesity and hyperlipidemia. Based upon this study, devising method and media for the mother nutritional education as well as for the children nutritional education is required for better growth and health promotion of primary school children.

• The Korean Journal of Food & Health Convergence
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• v.8 no.1
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• pp.1-7
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• 2022

This study classified subjects aged 30 to 64 into normal group, impaired fasting glucose group, and diabetes mellitus patient group based on data from the 6th period of the National Health and Nutrition Examination Survey (2013-2015). Skipping breakfast, lack of physical activity, inadequate sleep time, inadequate weight, excessive drinking, and current smoking are classified as a low health risk group when three or less items are present, and a high health risk group when three or more items are included. By classification, each item included in the physical measurement and biochemical analysis factors and health risk behavior factors was comparatively analyzed. As a result, in the normal group, impaired fasting glucose group, and diabetes group, the average age was higher in the group with high health risk factors than the group with low risk factors, and the male ratio was higher. Body mass index, waist circumference, blood pressure, triglyceride showed a significantly higher result. In the normal group, the fasting blood glucose level and total cholesterol level were also higher in group 2. Therefore, it is thought that it is necessary to control health risk behaviors through lifestyle changes in the normal group, fasting glucose disorder group, and diabetes group.