BACKGROUND/OBJECTIVES: To encourage schools to transform school meal programs to be more educational, it is necessary to evaluate the related environment using a whole school approach. We developed a school food culture evaluation tool to quantitatively evaluate school food culture in Gyeonggi Province, Korea. SUBJECTS/METHODS: Based on a literature review, a school food culture evaluation system consisting of areas, subareas, indicators, and questions (scored on a 5-point scale) was constructed. The validity of the tool was reviewed using focus group interviews, the Delphi technique, and a preliminary survey. Subsequently, evaluation tool was applied to elementary, middle, and high schools in Gyeonggi Province. Data from 115 schools were used for the final analysis. This included 64 elementary schools, 29 middle schools, and 22 high schools. At least one respondent from each group—school administrators, teachers, and nutrition teachers (or dietitians)—participated. The results were compared at the school level. RESULTS: The evaluation tool consisted of 66 questions in 5 areas (institutional environment, physical environment, educational environment, educational governance, and school meal quality). The total average score for school food culture was 3.83 points (elementary school 3.89 points, middle school 3.76 points, and high school 3.76 points) and did not differ significantly among school levels. Among the 5 evaluation areas, scores were highest for institutional environment (4.43 points) and lowest for physical environment (3.07 points).Scores for educational environment, educational governance, and school meal quality were 3.86, 3.85, and 3.97 points, respectively. CONCLUSION It is necessary to improve the physical environment to create a desirable school food culture in Gyeonggi Province. To effectively promote healthy eating, ongoing investment and interventions by local authorities at improving school food culture are needed, with an emphasis on particular factors, such as the eating environment and staff training.

BACKGROUND/OBJECTIVES: The purpose of this study was to evaluate the feasibility of application of the draft nutritional standards for school lunches in the Republic of Korea (South Korea) from the supplier perspective. SUBJECTS/METHODS: In November 2018, a pilot operation was conducted at 104 participating schools for 2 weeks each by applying the draft standards A and B. To evaluate the ease and appropriateness of application of the standards, we analyzed the nutritional values and food cost of the school lunches for 2 weeks before and for 4 weeks under the pilot operation. We conducted an online survey of school dietitians or nutrition teachers of the participating schools to evaluate the feasibility of application of the standards in school lunch sites. RESULTS: The proportions of schools of which lunches met the reference values of the school’s own nutritional standards were 19.2% for the standards A and 21.2% for the standards B. The food cost of school lunches applying the standards A (KRW 2,880) was significantly lower than that of school lunches applying the standards B (KRW 3,030) or the existing standards (KRW 2,980). As a result of the survey, the mean score for the ease of application was significantly higher for the standards B (2.75) than for the standards A (2.24). The proportions of school dietitians or nutrition teachers reporting no problem in meeting an existing food cost standard were 72.5% for the standards A and 61.8% for the standards B, respectively. The overall appropriateness of application was higher for the standards B, because almost two-thirds (58.8%) of the respondents answered that the standards B were more appropriate than the standards A. CONCLUSION The standards B were more feasible to apply as nutritional standards for school lunches than the standards A from the supplier perspective.

BACKGROUND/OBJECTIVES: In times of disaster, simplified and minimized nutritional standards are necessary for a quick response to provide nutritious relief food. This study aimed to develop nutrient-based nutritional standards for foodservice at shelters during disasters in the Republic of Korea (South Korea). SUBJECTS/METHODS: The standards were developed in 2 phases. First, nutrients to be included in the standards were selected. Initial candidates were selected considering 3 aspects: preceding standards, insufficient intake during disasters, and inadequate intake among South Koreans. Final selection was made by excluding nutrients for 3 reasons:nutrients for which there is no deficiency concern in South Korea, nutrients whose intake data were not available, or nutrients whose values presented by Dietary Reference Intakes for Koreans are difficult to achieve based on the current diet among South Koreans. Second, the reference values of energy and the selected nutrients were calculated. The reference values for the entire population who were 1-year-old and over were calculated by multiplying the estimated energy requirements or the recommended nutrient intake and the proportion of each age and sex group. Respective reference values were also calculated for 4 different age groups (1–5, 6–11, 12–64, and ≥ 65-year-old). RESULTS: The standards for the entire population were 2,000 kcal for energy, 55 g for protein, 650 µg retinol activity equivalents for vitamin A, 95 mg for vitamin C, 1.1 mg for thiamin, 1.3 mg for riboflavin, 14 mg niacin equivalents for niacin, 350 µg dietary folate equivalents for folic acid, 750 mg for calcium, and 11 mg for iron. Four additional standards corresponding to each age group were developed. CONCLUSIONS The nutritional standards during disasters were developed for South Korea, including energy and 9 nutrients with reference values for the entire population and 4 different age groups. The standards will contribute to maintaining the health of disaster evacuees in South Korea.

BACKGROUND/OBJECTIVES: This study investigated the importance and performance level of sodium reduction practices in school meal service by school nutrition teachers and dietitians, and compared them according to school level and placement of the school nutrition teacher. SUBJECTS/METHODS: An online survey was conducted with 608 nutrition teachers and dietitians in schools in the Republic of Korea from September 28 to November 12, 2021 (response rate: 57%). The questionnaire comprised 11 items related to sodium reduction practices (purchasing, food preparation and serving, and education). The importance and performance level of each item was rated on a 5-point scale. The mean differences were analyzed using t-tests or one-way analyses of variance and Duncan’s post-hoc tests. An importance-performance analysis was performed on sodium reduction practices. RESULTS: Participating in sodium reduction education, sodium reduction education for cooks, and sodium reduction education for students were assessed to have high importance but low performance. Overall, the higher the school level, the lower was the importance level of sodium reduction practices. The performance in kindergartens and elementary schools was higher than that in middle and high schools. The importance in the purchasing category perceived by dietitians was lower as compared to nutrition teachers. In addition, the performance in the purchasing, food preparation and serving, and education categories perceived by dietitians was lower than those of nutrition teachers. CONCLUSION Sodium reduction education for nutrition teachers and dietitians, cooks, and students should prioritize practicing sodium reduction in school meal service. Specific guidelines for managing sodium reduction at all stages—purchasing, food preparation, and serving—should also be developed. The results could be used as basic data to reduce the sodium content in school meals.

BACKGROUND/OBJECTIVES: This study aimed to analyze the potential of school meals in South Korea as a sustainable tool to reduce carbon emissions by focusing on animal- vs.plant-based protein foods.MATERIALS/METHODS: By using a stratified proportional allocation method, 536 out of the 11,082 schools nationwide were selected including 21 kindergartens, 287 elementary-, 120 middle- and 108 high schools. A total of 2,680 meals served for 5 consecutive days (June 21–25, 2021) were collected. We analyzed the average serving amounts of protein foods (animal- vs. plant-based) per meal and then, calculated the estimated average amounts of carbon emission equivalents per meal by applying the conversion coefficients. The t-test and analysis of variance were used for statistical analyses (α = 0.05). RESULTS: The average serving amount of animal-based protein foods per meal was 12.5 g, which was approximately 3 times higher than that of plant-based ones (3.8 g) (P < 0.001); the Meat-group had the highest average amount of 17.0 g, followed by Egg-group (9.6 g), Fishgroup (7.6 g), and Beans-and-Nuts-group (3.8 g) (P < 0.05). Specifically, pork (25.1 g) was ranked first, followed by poultry (19.6 g), processed meat products (18.0 g). The estimated average amount of carbon emission equivalents of animal-based protein foods per meal was 80.1 g CO 2 e, which was approximately 31 times higher than that of plant-based ones (2.6 g CO 2 e) (P < 0.001); the Meat-group had the highest average amount of 120.3 g CO 2 e, followed by Fish-group (44.5 g CO 2 e), Egg-group (25.9 g CO 2 e), and Beans-and-Nuts-group (2.6 g CO 2 e) (P < 0.05). Specifically, processed meat products (270.8 g CO 2 e) were ranked first, followed by pork (91.7 g CO 2 e), and processed fish products (86.6 g CO 2 e). CONCLUSIONS The results implied that school meals with plant-based alternatives could be a sustainable tool to improve carbon footprint.

Objective: Establishing positive network resources and rebuilding drug free networks are key components of recovery process for women with substance use disorder (SUDs). Theory of planned behavior (TPB) posits that behaviors are determined by behavioral intentions, which are determined by three factors: attitude toward the behavior, perceived behavioral control, and subjective norms. The current study applied TPB to examine whether women’s personal social network characteristics (as subjective norms) were related to intentions towards, and/or a substance use relapse using prospective research design. Methods: Longitudinal data from 300 American women with SUD who received treatment at three county-funded, women-only intensive treatment programs was utilized for the current study. Results: Bayesian estimation path analyses indicated that attitude and abstinence self-efficacy at intake were not related to intention at the 6-month follow-up, but abstinence self-efficacy was directly related to substance use relapse by 12 months. Personal social network characteristics, number of treatment related persons in personal social network and sobriety support were significantly associated with intention at 6 months. The interaction between the numbers of treatment related persons and density was found on intention, suggesting that density strengthens the relationship between treatment related persons in network and intention. Intention to use substance was associated with relapse to substance use behavior. Conclusion Our findings support that personal social network characteristics can be considered as subjective norms in the TPB model. Personal social network interventions focusing on rebuilding consistent social norms against drug-using behaviors may decrease intention to use substance, which will lead to abstinence.

Objectives: ：Maltreatment is one of representative risk factor for psychiatric illnesses. While several studies indicate the relationship between physical activity and maltreatment, there was lack of study using objective measurements. This study was conducted to find the biomarkers of physical activity related to maltreatment experiences in healthy adults using wearable device. Methods: ：A total of 60 healthy adults were recruited; 15 subjects reported maltreatment experiences. Physical activity and sleep data were collected using Fitbit for 2 weeks. Child maltreatment experiences were assessed by Adverse Childhood Experiences (ACE). Symptoms were measured using the Insomnia Severity Index (ISI), Morningness-Eveningness Questionnaire (MEQ), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Results: ：The child maltreatment group showed lower movement distance (p=0.025) and number of walks (p=0.010) compared to the control group. After controlling for anxiety and depressive symptoms in women, maltreatment group represented significant reduction in light activities (p=0.021) as well as movement distance (p=0.024) and number of walks (p=0.011). There was no significant difference in sleep variables between the two groups. Conclusions ：Even in healthy participants, maltreatment experiences can negatively affect daily light physical activity.

Background: Early identification of patients with high-risk papillary thyroid microcarcinoma (PTMC) that is likely to progress has become a critical challenge. We aimed to identify somatic mutations associated with lateral neck lymph node (LN) metastasis (N1b) in patients with PTMC. Methods: Whole-exome sequencing (WES) of 14 PTMCs with no LN metastasis (N0) and 13 N1b PTMCs was performed using primary tumors and matched normal thyroid tissues. Results: The mutational burden was comparable in N0 and N1b tumors, as the median number of mutations was 23 (range, 12 to 46) in N0 and 24 (range, 12 to 50) in N1b PTMC (P=0.918). The most frequent mutations were detected in PGS1, SLC4A8, DAAM2, and HELZ in N1b PTMCs alone, and the K158Q mutation in PGS1 (four patients, Fisher’s exact test P=0.041) was significantly enriched in N1b PTMCs. Based on pathway analysis, somatic mutations belonging to the receptor tyrosine kinase-RAS and NOTCH pathways were most frequently affected in N1b PTMCs. We identified four mutations that are predicted to be pathogenic in four genes based on Clinvar and Combined Annotation-Dependent Depletion score: BRAF, USH2A, CFTR, and PHIP. A missense mutation in CFTR and a nonsense mutation in PHIP were detected in N1b PTMCs only, although in one case each. BRAF mutation was detected in both N0 and N1b PTMCs. Conclusion This first comprehensive WES analysis of the mutational landscape of N0 and N1b PTMCs identified pathogenic genes that affect biological functions associated with the aggressive phenotype of PTMC.

Objectives: The number of schools offering school lunches has increased in China. This study examined the dietary quality of the lunches consumed by Chinese school-age children and adolescents, with a focus on comparing school lunches with home lunches. Methods: The first weekday 24-hour dietary recall data of 6~17-year-old students (n=1,084) from the 2011 China Health and Nutrition Survey were analyzed. The subjects were divided into the school lunch group and the home lunch group, and the dietary quality of lunches was compared between the two groups among 6~11-year-old students (n=634; 177 in the school lunch group and 457 in the home lunch group) and 12~17-year-old students (n=450;144 in the school lunch group and 306 in the home lunch group), respectively. Frequently consumed foods, amount of food group intake, food group intake pattern, Dietary Diversity Score (DDS), and Dietary Variety Score (DVS) were examined. Results: The most frequently consumed foods in both lunch groups were rice and pork. An excessive intake of meat and insufficient intake of seafood were noted in both lunch groups. The school lunch group showed a lower level of vegetable consumption than the home lunch group (P=0.017 in 6~11-year-old students, P=0.003 in 12~17-year-old students).Although more students ate meals with a better dietary pattern in the school lunch group than the home lunch group, there were no significant differences in DDS and DVS between the two groups. Conclusions Overall, the dietary quality of lunches was not superior in the school lunch group compared to the home lunch group. This suggests that much room remain for improving dietary quality of school lunches in China.

Objectives: The number of schools offering school lunches has increased in China. This study examined the dietary quality of the lunches consumed by Chinese school-age children and adolescents, with a focus on comparing school lunches with home lunches. Methods: The first weekday 24-hour dietary recall data of 6~17-year-old students (n=1,084) from the 2011 China Health and Nutrition Survey were analyzed. The subjects were divided into the school lunch group and the home lunch group, and the dietary quality of lunches was compared between the two groups among 6~11-year-old students (n=634; 177 in the school lunch group and 457 in the home lunch group) and 12~17-year-old students (n=450;144 in the school lunch group and 306 in the home lunch group), respectively. Frequently consumed foods, amount of food group intake, food group intake pattern, Dietary Diversity Score (DDS), and Dietary Variety Score (DVS) were examined. Results: The most frequently consumed foods in both lunch groups were rice and pork. An excessive intake of meat and insufficient intake of seafood were noted in both lunch groups. The school lunch group showed a lower level of vegetable consumption than the home lunch group (P=0.017 in 6~11-year-old students, P=0.003 in 12~17-year-old students).Although more students ate meals with a better dietary pattern in the school lunch group than the home lunch group, there were no significant differences in DDS and DVS between the two groups. Conclusions Overall, the dietary quality of lunches was not superior in the school lunch group compared to the home lunch group. This suggests that much room remain for improving dietary quality of school lunches in China.