Quantitative assessments of the health status of a population are essential to make decisions and set priorities in the field of public health. Changing epidemiologic patterns increase the demand for comprehensive estimates of population health across the full health spectrum, including non-communicable diseases and injuries. Burden of disease (BoD) analysis has helped meet this need. With the success of the Global Burden of Disease (GBD) Study, the BoD technique has become predominantly associated with the GBD approach and its methodology using disability-adjusted life year (DALY) has been rapidly disseminated and generally accepted over the last several years. The first Korean BoD study using the DALY metric was presented in 2002. Various BoD studies have since been conducted, but the DALY concept has remained primarily academic and has not yet been actively utilized in the health policy arena. Here, we review the DALY metric and population-based Korean BoD studies using national health data, with the intent of increasing the understanding of their value and their potential role in strengthening future assessments of the Korean population’s health status.
Health Policy ; Korea* ; Public Health

The purpose of this study was to propose the appropriate sizes and dish combination for nutritional-balanced lunch boxes delivered to children under the government-funded meal service program in Korea. The study was based on the 3 : 1 : 2 Meal Box Magic, a nutrition education method developed in Japan. A total of 290 lunch menus, comprising of 10 day menus from 29 organizations having delivered lunch boxes to children during summer vacation of 2008, were analyzed and used as the base data for lunch box combination. Dishes of the menus were classified into 6 groups: Rice group, Protein side dish group (including meat, fish, egg, and bean dishes), Vegetable side dish group, Kimchi group (including kimchi and jangajji), Soup, stew group, and the other group. Nutrient analysis was conducted for 100 ml of these dishes by CAN Pro 3.0 utilizing volume and weight conversion data used for analysis of the Korea Health and Nutrition Examination Survey and those from the Nutrient Composition of Food for Consumers. All the possible combinations of 5 dishes, comprising of 3 dishes from Rice group, Protein side dish group, and Kimchi group, respectively, and 2 dishes from Vegetable side dish group, were made using the frequently served dishes from the respective dish group. Nutrient analysis of each combination was conducted based on the assumption that a lunch box was 600 ml and filled up to 80% by dishes using the volume ratio of 3 : 1 : 1.5 : 0.5 for Rice group : Protein side dish group : Vegetable side dish group : Kimchi group. The mean and standard deviation of energy and nutrients of all combinations calculated by weighting the serving frequency of each dish selected for the combinations were 621 +/- 81 kcal for Energy, 22.1 +/- 5.0 g for Protein, 120 +/- 45 mg for Calcium, 4.1 +/- 1.1 mg for Iron, 201 +/- 130microgram RE for Vitamin A, 0.34 +/- 0.10 mg for Thiamin, 0.27 +/- 0.10 mg for Riboflavin, and 24.3 +/- 9.6 mg for Vitamin C. The energy percentages from Carbohydrate, Protein and Fat were 66%, 14% and 20%. The analysis results met the nutrition standard of lunch boxes for male elementary students in grades 4 through 6 under the government-funded meal service program regarding calories, nutrients except calcium and riboflavin, and macronutrient distribution ranges. Accordingly appropriate box sizes were suggested for different age and sex groups to meet the respective nutrition standards. In addition, milk or dairy products were suggested to accompany lunch boxes to supplement calcium and riboflavin intake. The method of selecting box sizes and making dish combination suggested in this study could be useful for the organizations preparing lunch boxes under the government-funded children's meal service program where nutrition professionals are not available.
Ascorbic Acid ; Calcium ; Child ; Dairy Products ; Humans ; Iron ; Japan ; Korea ; Lunch ; Magic ; Male ; Meals ; Meat ; Milk ; Ovum ; Riboflavin ; Vegetables ; Vitamin A

OBJECTIVES: This study was conducted to investigate Chinese female marriage immigrants' dietary life after immigration to Korea, focusing on comparison between Han-Chinese (traditional Chinese) and Korean-Chinese (Chinese of Korean descent). METHODS: An in-person survey was conducted with women married to Korean men, having one child or more aged 1-6 years old, and having resided in Korea for at least one year before the survey. The data were collected from the 309 respondents comprising 151 Han-Chinese and 158 Korean-Chinese in the summer of 2013. RESULTS: Overall, there was no significant difference in dietary practice, dietary acculturation, dietary behavior, dietary habits, and food intake between the Han-Chinese and the Korean-Chinese respondents. Over 50% of the respondents ate Korean food every day. The overall level of dietary acculturation was about 3.5 out of 5 points. The average score of healthy dietary behavior was a little bit higher than 3 out of 5 points. Approximately 3/4 of the respondents showed increasing frequency of eating out. The respondents reporting increase food diversity were over 70%. Decreased frequency of skipping meal was about 60% of the respondents. Over 50% of the respondents showed increasing consumption of Kimchi, vegetables, fruit, and meat. CONCLUSIONS: Dietary life of Korean-Chinese female marriage immigrants was similar to that of Han-Chinese female marriage immigrants after immigration to Korea. The results from this study suggest that not only Han-Chinese but also Korean-Chinese should be targeted in various diet-related acculturation support programs as important multicultural populations in Korea.
Acculturation ; Asian Continental Ancestry Group* ; Child ; Surveys and Questionnaires ; Eating ; Emigrants and Immigrants ; Emigration and Immigration* ; Female ; Food Habits ; Fruit ; Humans ; Korea ; Male ; Marriage* ; Meals ; Meat ; Vegetables

The objectives of this study were to investigate the current status of the Korean government-funded meal support program for low-income children through convenience stores and to evaluate the nutritional quality of the meal items available under the program. The POS data of three convenient stores where children had used their electronic meal cards most often in Seoul during January 2010 and the kinds and amounts of ingredients of the meals items available to the children were obtained from the headquarter of the convenient stores. A total of 5,081 transactions by 693 children included in the POS data was analyzed. In addition, nutritional contents of meal items, which were meal boxes (11 kinds), kimbab (13 kinds), rice balls (27 kinds), inari sushi (1 kind), and sandwiches (26 kinds), were analyzed with Can Pro 3.0. The results showed that children had purchased flavored-milk products most often. Children tended to purchase meal items together with drinks (60.9% of transactions), but some purchased drinks (27.6%) or meal items only (11.5%). Except for meal boxes, none of the meal items satisfied 1/3 of Estimated Energy Requirements of the 9-11 year-old boys per day. The average energy contents of different kinds of meal boxes, kimbabs, rice balls, and sandwiches were 619, 357, 200, and 380 kcal, respectively, and the energy content of a package of Inari sushi was 457 kcal. Vitamin C amount was found to be deficient in all the meal items, compared to 1/3 of Recommended Intake of the 9-11 year-old boys per day. The results of this study could be useful to develop nutritionally appropriate meal items for the convenient stores participating in the government-funded meal support program for children from low-income families.
Ascorbic Acid ; Child ; Electronics ; Electrons ; Humans ; Meals ; Nutritive Value

The purpose of this study was to determine factors affecting intention to participate in school breakfast programs of middle and high school students in Seoul using the Theory of Planned Behavior. Out of 2,280 questionnaires distributed to the middle and high school students, 2,060 were returned (90.4% response rate) and 1,799 were analyzed (78.9% analysis rate). To determine factors affecting intention to participate in school breakfast programs, logistic regression analyses were conducted for middle and high school students, respectively. For logistic regression, data of 1,217 out of 1,799 students (637 middle and 580 high school students) were used after excluding 582 students which had an answer 'Not sure' to the question about intention to participate in school breakfast programs. In case of middle school students, male than female students (OR = 1.504), the students who skipped all breakfast (OR = 1.851), who ate breakfast 1~2 times (OR = 3.474) or 3~4 times (OR = 1.950) than those who ate breakfast everyday during weekdays of the previous week were more likely to participate in school breakfast programs. In case of high school students, male than female (OR = 1.967), the students who skipped all breakfast (OR = 4.187), the students who ate breakfast 1~2 times (OR = 3.024) or 3~4 times (OR = 2.095) than those who ate breakfast everyday during weekdays of the previous week were more likely to participate in school breakfast programs. In addition, both possibility of middle and high school students' participation in school breakfast programs increased as the satisfaction with school lunch service (OR = 1.704, 1.653) increased. Middle school students who perceived their household income level 'low or middle low' (OR = 1.999) than those who perceived their household income level 'middle' and the students who had more positive 'attitude' (OR = 1.311) toward eating breakfast were more likely to participate in school breakfast programs. However, high school students who had higher 'perceived difficulty in access to breakfast' (OR = 1.370) were more likely to participate in school breakfast programs. The results of this study could be useful data to plan and develop school breakfast programs in Korea.
Breakfast* ; Eating ; Family Characteristics ; Female ; Humans ; Intention* ; Korea ; Logistic Models ; Lunch ; Male ; Seoul* ; Surveys and Questionnaires

Considering the importance of institutional foodservice in modern dietary life and its influence on the environment, sustainable development in institutional foodservice industry carries great significance. The current study was conducted to investigate dietitians' perceptions of sustainable business-and-industry foodservice and their intentions to perform sustainable practices by applying a mixed methodology. For the quantitative study, an online survey was conducted on 362 dietitians who had worked at a contact foodservice company for more than 1 year. The survey was performed from December 15th, 2011 to January 30th, 2012, and 202 responses were used for the analysis. For the qualitative a study, a focus group interview was conducted during May, 2012 with representative employees of the company. According to the results, dietitians seemed to be unfamiliar with the terms "sustainability" or "sustainable development," whereas they understood related contents and practices. Dietitians' awareness and perceived need in terms of sustainable business-and-industry foodservice were not significantly different across general characteristics. Dietitians seemed to be highly aware of the impacts of business-and-industry foodservice on economy, whereas they appeared to lack understanding of its impacts on society and environment. Cost increase and levy on work in daily operations were considered as main obstacles hampering dietitians' intentions to perform sustainable practices. A total of 88.1% of responding dietitians expected that the meal price at a sustainable business-and-industry foodservice should be higher than the supposed standard price of 4,000 won, with an average reaching 5,270 won. Findings from this study could be used as baseline information for vitalizing sustainable business-and-industry foodservice in Korea.
Natural Resources ; Focus Groups ; Intention* ; Korea ; Meals ; Nutritionists

The purpose of this study was to examine the effect of sustainability management (SM) at coffee houses on customers' store image and behavioral intention. In addition, customers' willingness to pay a premium for sustainable coffee houses was studied. During October 2011, a web survey was conducted via an on-line research company with customers aged 20 to 39 visiting one of the top five coffee houses in Korea at least once a month. A total of 300 targeted customers responded and all the data were analyzed. An exploratory factor analysis derived two dimensions of SM: SM in Social and Environmental Perspective and SM in Economic Perspective. The result of structural equation modeling indicated that SM in Economic Perspective at coffee houses had a significant positive effect on customers' behavioral intention with mediating effect by store image, but SM in Social and Environmental Perspective did not have such effect. Approximately one-third (31%) of the respondents were willing to pay a premium for a sustainable coffee house in a scenario. approximately 84% of the respondents unwilling to pay a premium for the sustainable coffee house chose the cost-related reasons including "Coffee price at the coffee house that they most often visit is already expensive (62.3%)" for such unwillingness. The results of this study showed that SM of coffee houses, especially that in Economic Perspective, could contribute to store image, and therefore increase customers' favorable behavioral intention, although the additional cost resulted from such SM practices might not be easily accommodated by customers.
Aged ; Coffee ; Surveys and Questionnaires ; Humans ; Intention ; Korea ; Negotiating

This study was conducted to investigate how child-care teachers participate, practice mealtime instruction, and perceive difficulties in food service, focusing on comparison between the teachers caring two different age groups: children younger than three years (Younger Group) and those three years or older (Older Group). Questionnaires were distributed to 151 child-care centers in Kwanak-gu, Seoul, Korea during December, 2011. Only the data from 25 child-care centers, where two respective teachers in charge of Younger Group and Older Group completed the questionnaires, were analyzed. The results showed that there was no difference in terms of child-care teachers' participation in food service practice between the two groups, except for serving method; 'Pre-plated' serving was used significantly more often in Younger Group, whereas 'Line-up' serving was used in Older Group. Approximately, three quarters of the child-care centers had policies or guidelines on mealtime instruction. During mealtime, child-care teachers tended to use frequently verbal instructions such as "sit up straight when you eat" about eating manner, "don't be picky with your food" about eating habit, and "wash your hands before eating" about eating procedure in both the groups. There was no statistically significant difference regarding child-care teachers' perceived difficulties in food service between the two groups. These results indicated that child-care teachers' participation and mealtime instruction in food service did not differ between the two age groups, although children's development of digestion and eating skill differed by age. Therefore, training should be provided to child-care teachers about food service practices and mealtime instruction appropriate to children's age.
Child ; Digestion ; Eating ; Fees and Charges ; Food Services ; Hand ; Humans ; Korea ; Meals ; Surveys and Questionnaires

The purpose of this study was to examine if Likert scales had been properly utilized in community nutrition research. A total of 527 research articles published in the 32 issues of Korean Journal of Community Nutrition from the volume 5, issue 1 in 2000 to the volume 10, issue 2 in 2005 were screened and 55 articles were found to have utilized one or more Likert scales for the studies. Therefore, 109 Likert scales used in the 55 studies were reviewed regarding the name, statement and response items, reliability and validity check, and analysis method. The scales were mostly referred as Likert scales (60%) or Likert-type scales (27%). Some scales were found to be referred as Likert scales although they were Likert-type scales when judged based on the information given in the respective articles. However some scales couldn't be judged for the rightness of the names because the information given for the scales in the articles was not enough. About 23% of the scales consisted of items less than 6 or more than 30, and therefore found to be inappropriate. The percentage of the scales listing all the statement items in the articles was only 25%. Most of the scales (85%) included 5 response items, and the rest included 4 (7%), 7 (6%), or 3 (2%). The percentages of the scales including appropriate center and end items were only 2% and 22%, respectively. Less than half of the scales (41%) were found to have been checked for reliability and only one scale was reported to have been checked for validity. In some scales (6%), the responses were scored improperly for analysis. The responses to the scales were frequently found to have been analyzed by parametric statistics such as mean, ANOVA, t-test, and Pearson's correlation, which might be a problem depending on the size and distribution of study samples. In conclusion, there is much room for improvement in the use of Likert scales in community nutrition research.
Reproducibility of Results ; Weights and Measures

Purpose: Previous studies have reported the difference in nutritional status between South and North Korean infants and young children (IYC). Clear understanding on the nature of such differences is essential for planning food and nutrition policies and programs to prepare for a possible re-unification of the two Koreas in future. This study was undertaken to yield valid statistics comparing the nutritional status between North and South Korean IYC. Methods: Raw data obtained from the 2017 Korean National Growth Chart and the 2013–2017 Korea National Health and Nutrition Examination Survey were analyzed to determine the comparable statistics that include weight for age z-score (WAZ), height for age z-score (HAZ) and weight for height z-score (WHZ), with data reported in the Survey Findings Report of the 2017 DRP Korea Multiple Indicator Cluster Survey. The average weight and height by gender and month were estimated for North Korean IYC and calculated for South Korean IYC. SPSS analysis was applied to evaluate the acquired statistics and compare the nutritional status of South and North Korean IYC. Results: WAZ, HAZ and WHZ of North Korean IYC were observed to be lower than values obtained for South Korean IYC as well as the median values of World Health Organization Child Growth Standards across all ages. Similar patterns were observed for average height and weight.The nutritional status of North Korean IYC revealed a prevalence of highly underweight (9.3%), stunting (19.1%) and wasting (2.5%) values, and was determined to be significantly lower than values obtained for South Korean IYC (0.8%, 1.8%, and 0.7%, respectively). Conclusion This study has yielded valid statistics that compare the nutritional status of North and South Korean IYC. Results of this study confirm the prevalence of nutritional status difference between South and North Korea.