The Korea National Health and Nutrition Examination Survey is a nationwide health survey in Korea. This survey is composed of three parts: the Health Interview Survey, the Health Examination Survey, and the Nutrition Survey. The aim of this study was to refine the nutrition survey system in the Korean National Health and Nutrition Examination Survey (KNHANES). Based on the literature review, we summarized international survey systems and the limitations of the current system in Korea and proposed an improved system. We suggested the following: 1) A government agency which will be exclusively responsible for KNHANES overall is needed. 2) The current short-term nutrition survey should be a year-round survey. 3) The objectives of this survey should be written with more clarity and detail. 4) Biochemical measures in relation to nutritional status should be added. 5) The budget to set up various databases in the nutrition survey should be increased. 6) Various other issues should be addressed, including the definition of raw data (i.e., whether nutrient intake data per day is raw data), ethical issues in survey techniques, and strategies to produce evidence for the public using this survey data. Not all suggestions could be adopted in the short-term, but should be integrated into long-term goals for survey system improvement.
Budgets ; Ethics ; Government Agencies ; Health Surveys ; Korea ; Nutrition Surveys* ; Nutritional Status

Purpose: Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. Methods: The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. Results: Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. Conclusion The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

BACKGROUND/OBJECTIVES: The study objectives were to examine the participation rate in food assistance programs and explore the factors that contribute to such participation among the Korean elderly population. SUBJECTS/METHODS: The study sample comprised 3,932 respondents aged 65 years or older who were selected from a secondary data set, the fourth Korean Welfare Panel Study (KoWePS). The factors, related to participation in programs were examined based on the predisposing, enabling and need factors of the help-seeking behavior model. Multiple logistic regression analysis was used to select the best contributors among the factors related to program participation. RESULTS: The predisposing rate in food assistance programs was 8.5% (7.1% for men and 10.4% for women). When all variables were included in the model, living without spouse, no formal education, low income, having social security benefits and food insecurity in elderly men, and age, low income, having social security benefits and feeling poor in elderly women were significantly related to a higher tendency to program participation. CONCLUSIONS: The predisposing and need factors, such as living without spouse, low education level, food insecurity and feeling poor were important for program participation, as well as enabling factors, such as household income and social security benefits. A comprehensive approach considering these factors to identify the target population for food assistance programs is needed to increase the effectiveness and target population penetration of these programs.
Aged* ; Causality ; Surveys and Questionnaires ; Dataset ; Education ; Family Characteristics ; Female ; Food Assistance* ; Food Supply ; Health Services Needs and Demand ; Humans ; Logistic Models ; Male ; Social Security ; Spouses

Objectives: This study explored the community food environmental factors affecting food purchasing using a qualitative research methodology for the elderly as well as the various food environments under their socioeconomic diversity. Methods: For the qualitative data collection, this study interviewed 20 elderly people aged 65 years or more, who participated in a public health program or lunch services operated by the senior welfare center in Seoul. Five dimensions, such as availability, physical accessibility, affordability, acceptability, and accommodation suggested in previous studies, were used to identify the community food environmental factors. Results: The elderly participants showed overall similarities to the concepts derived from existing studies on the five dimensions of food accessibility environment. In addition, other important food accessibility environmental factors that were not present in previous studies, such as acceptability for a product of domestic origin, delivery service to home, and small-packaged food sales, were derived. On the other hand, the concept of some subjects differed depending on the household income and specifically for the physical accessibility concept. This showed that the close distance factor from a grocery store at home might not apply to older adults in low-income households in Korea. Conclusions This study found that five dimensions of the food environment suggested by previous studies could also be applied to vulnerable older adults in Korea. On the other hand, the socioeconomic characteristics of individuals and households would affect the perspectives of their local food environments differently. The findings of this study could help in the development of tools for evaluating the community food environment.

OBJECTIVES: This study was conducted to establish profiles of socioeconomic characteristics, dietary intake, and health status among Korean older adults by employing 3 multivariate analysis techniques. METHODS: Data were obtained from 1,352 adults aged 65 years and older who participated in the 2019 Korea National Health and Nutrition Examination Survey. Principal component analysis (PCA), factor analysis (FA), and cluster analysis (CA) were utilized for profiling, with data preprocessing undertaken to facilitate these approaches. RESULTS: PCA, FA, and CA yielded similar results, reflecting the high common variance among the variables. PCA identified 4 components, accounting for 71.6% of the accumulated variance. FA revealed 5 factors, displaying a Kaiser-Meyer-Olkin value of 0.51 and explaining 74.3% of the total variance. Finally, CA grouped the participants into 4 clusters (R2=0.465). Both PCA and FA identified dietary intake (energy, protein, carbohydrate, etc.), social support from family (incorporating family structure, number of family numbers, and engagement in social eating), and health status (encompassing oral, physical, and subjective health) as key factors. CA classified Korean older adults into 4 distinct typologies, with significant differences observed in dietary intake, health status, and household income (p<0.01). CONCLUSIONS The study utilized PCA, FA, and CA to analyze profiling domains and derive characteristics of older adults in Korea, followed by a comparison of the results. The variables defining the clusters in CA were consistent with those identified by PCA and FA.

OBJECTIVES: This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake. METHODS: In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire. RESULTS: With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile. CONCLUSIONS Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.

OBJECTIVES: The purpose of this study was to suggest the strategies for improvement of home-delivered meal services for the elderly, to identify reasons for recipients to get started with the services and to evaluate the attitude, acceptability and adaptation of recipients to the services from the perspective of life context. METHODS: The data was collected through face-to-face in-depth interviews with eighteen low-income elderly recipients of home-delivered meals and analyzed using a qualitative research method. RESULTS: The results were deduced as four themes which comprised of long-term vulnerable socioeconomic contexts resulted in entry to the services, conflicting acceptability to the services, passive adaptation to taking the services, and positive practices to cope with supplement free meals or other services. The service participation was initiated because of a combination of prolonged, vulnerable socioeconomic contexts, including poverty and unexpected life events such as diseases, disability, living alone, aging and unemployment. With regard to taking the services, conflicting acceptability was observed: positive aspects including saving living cost and good quality of meals, and negative aspects including lack of a tailored service and feeling of stigma. Although the recipients needed an individualized service, they did not express their needs and demands for the services and they accepted the unavailability as an accustomed, prolonged vulnerable socioeconomic context. With regard to lack of tailored services, either self-solution such as modification of eating patterns or community-based network and services were used. CONCLUSIONS: We suggest that a system to concretely identify recipients' attitude, acceptability and adaptation for home-delivered meal services should be developed in the establishment of a tailored nutrition support system for the low-income elderly.
Aged* ; Aging ; Eating ; Humans ; Meals* ; Poverty ; Qualitative Research ; Unemployment

OBJECTIVES: During the past two decades, food deprivation and hunger have been recognized to be not just the concerns of only underdeveloped or developing countries, but as problems for many affluent Western nations as well. Many countries have made numerous efforts to define and measure the extent of these problems. Based on these efforts, the theory and practice of food security studies has significantly evolved during the last decades. Thus, this study aims to provide a comprehensive review of the concept and measurement of food security. METHODS AND RESULTS: In this review, we introduce the definition and background of food security, we describe the impact of food insecurity on nutrition and health, we provide its measurements and operational instruments and we discuss its applications and implications. Some practical information for the use of the food security index in South Korea is also presented. CONCLUSIONS: Food security is an essential element in achieving a good nutritional and health status and it has an influence to reduce poverty. The information about the current understanding of food security can help scientists, policy makers and program practitioners conduct research and maintain outreach programs that address the issues of poverty and the promotion of food security.
Concept Formation ; Food Supply/*economics ; Humans ; Hunger ; Poverty ; Questionnaires ; Socioeconomic Factors

This study aims to develop an index of food security in order to assess food security status in Korea and to evaluate reliability and validity of the index. The index of food security was developed based on the US Household Food Security Survey Module (US-HFSS). After the US-HFSS was translated and back-translated, it was evaluated and modified by a focus interview for experts. The developed Korean Household Food Security Survey Module (K-HFSS) was tested by cognitive interviews and a pretest for general community population to assess its application for Korean population. For the reliability and validity of K-HFSS, the survey was conducted with 300 adults aged 40 years or more living in a rural community and 212 infants and toddlers living in an urban community. The reliability was assessed by Cronbach' alpha and the validity was evaluated by content validity, construct validity, and criterion-related validity. The questionnaire items of K-HFSS were partly modified, accounting for Korean social and cultural backgrounds and adapted by general community population. The reliability was relatively high, showing Cronbach' alpha coefficients ranged from 0.80 (for adults) to 0.87 (for infants and toddlers). The content and construct validities were all acceptable. The result of criterion-related validity showed that food security status was significantly related to the household income level. In conclusion, the K-HFSS would be used as a reliable and valid instrument to assess food security status in parts of the Korean population.
Accounting ; Adult ; Aged ; Family Characteristics ; Food Supply ; Humans ; Infant ; Korea ; Surveys and Questionnaires ; Reproducibility of Results ; Rural Population

OBJECTIVES: The objective of this study was to examine whether dietary quality variesamong different age groups and geographic areas, and whether the difference betweengeographic areas varies across several age groups in Korea.METHODS: The subjects were 14,170 subjects who participated in the 2013–2015 Korea National Health and Nutrition Examination Survey. The dietary quality was assessed using the Korean Health Eating Index (KHEI). Age groups were categorized into six groupings, and areas were categorized into urban and rural according to their administrative districts. The effect of area on the KHEI score was analyzed by multiple linear regression analysis.RESULTS: The KHEI was the lowest in the 20-30s group (57.7 ± 0.4 score for 20s and 61.2 ± 0.3 score for 30s) and increased with age (p<0.001), showing the highest score in the 60s (67.9 ± 0.3 score), and then decreased again in the 70s and older (64.6 ± 0.3 score). As a result of comparing the KHEI score by area, the urban areas had higher KHEI scores than did the rural areas (63.5 ± 0.2 score for urban area and 62.2 ± 0.4 score for rural area, p=0.002). The difference between areas was dependent on the age group, showing a significant difference for subjects who were aged from 50s and older (p=0.002 for 50s, p<0.001 for 60s and p<0.001 for 70s and older). After adjusting for confounding factors, the effect of area on the KHEI score was only shown for those subjects in the over 60 years old group (p=0.035 for 60s and p<0.001 for 70s and older).CONCLUSIONS: The dietary quality differed according to the age group and geographic area. The dietary quality was lower for younger people than that for older people, and in rural areas compared to that in urban areas, and especially for older adults. The area factor was a very important factor for the dietary quality.
Adult ; Eating ; Humans ; Korea ; Linear Models ; Nutrition Surveys