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Effects of Obesity, Body Image Dissatisfaction and Dietary Habits on the Risk of Disturbed Eating Attitudes among High School Students in Gyunggi Province, Korea
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Kyeong Sook Yim
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Korean J Community Nutr 2010;15(5):656-669. Published online October 31, 2010
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- Rapid shift to western dietary patterns and social drive of thinness would lead to increase the likelihood of developing eating disorders. This study was performed to analyze the associated factors between dietary pattern and self visualization in terms of body shape, which may increase the risk of disturbed eating attitudes among high school students in Korea. A cross-sectional study was conducted from 2009 to 2010 for high school students including both male and female students, from 6 schools in Gyunggi Province, Korea. A total of 766 students self-reported a questionnaire, including weight control practice, perceptions of self body image and ideal body image, dietary habit, and EAT-26 (Eating Attitude Test-26). Logistic regression analysis was used to fine the factors potentially associated with disturbed eating attitudes. Statistical analysis was conducted using SAS program (version 9.1). Results showed that disturbed eating attitudes were found in 8.7% of male high school students, and in 20.8% of female high school students. Experience of body weight control was reported by 56.2% of male students and by 87.3% of female students. According to multiple logistic regression analysis, obesity was independently associated with high risk of disturbed eating attitudes in male students [Odds Ratios (OR) 2.96, 95% Confidence Interval (CI) 0.90-9.71]. Body image dissatisfaction (OR 2.77, 95%CI 1.37-5.62) and extended family type (OR 2.70, 95%CI 1.05-6.90) were independently associated with high risk of disturbed eating attitudes, especially in female students. In conclusion, proper efforts in education for obesity and developing self-esteem to reduce the risks of disturbed eating attitudes should be implemented in high school nutrition program.
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The Effects of a Nutrition Education Program for Hypertensive Female Elderly at the Public Health Center
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Kyeong Sook Yim
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Korean J Community Nutr 2008;13(5):640-652. Published online October 31, 2008
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- Hypertension is among the most common and important risk factors for stroke, heart attack, and heart failure which is considered to be the leading cause of death in Korea. The prevalence rate of hypertension in Korea is 27.9%, according to the 2006 Korea National Health and Nutrition Survey. Since non-pharmacologic nutrition education is recommended as the first step in the management of hypertension, evaluation of nutrition program is needed to form strategies for improving patients' dietary adherence. This study was designed to evaluate the overall effectiveness of a hypertension nutrition education program (HNEP) for reducing the salt intake, at a public health center located in Gyunggi-province. The HNEP was offered for 16 weeks from May to September in 2007. Nutrition education activities included cooking classes, food preparation demonstrations, physical fitness programs, salty taste preference test sessions, games, case-study presentations, planning and evaluation of menus, etc. Forty patients participated fully in the program which had 47 female enrollees. Data about nutrient intake (24-hour recall), nutrition knowledge, food behavior were collected before (baseline) and after the program. Changes after program completion indicated the following: 1) diastolic blood pressure was decreased (p < 0.05), 2) sodium (salt) intake was also decreased (p < 0.01), especially baseline high salt intake group, 3) nutrition knowledge was improved (p<0.001), 4) dietary behaviors for maintaining a low salt diet was improved (p < 0.001), 5) participants preferred cooking class from nutrition education methods. As a conclusion, it appears that a nutrition education program for hypertensive female elderly for reducing the salt intake might effectively decrease blood pressure and salt intake. It also improves nutrition knowledge, dietary behavior, and finally adherence to a recommendable low-sodium diet.
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Health-Related Behavioral Factors Associated with Nutritional Risks in Korean Aged 50 years and Over
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Kyeong Sook Yim
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Korean J Community Nutr 2007;12(5):592-605. Published online October 31, 2007
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- Undernutrition could be a significant deterrent to healthy aging and could negatively affect health outcomes in elderly. This study aimed to assess health-related factors which are associated with nutritional risks in middle-aged and elderly individuals by a cross-sectional study. Interviews were conducted with 2660 subjects (847 males, 1813 females), aged 50 years and over, in 15 cities in Korea. Data on food intake were obtained through a validated semi-quantitative food frequency questionnaires. Nutritional status were analyzed according to health-related factors including cigarette smoking, alcohol drinking, exercise, stress and depression level. Less regular exercise was associated with a higher likelihood of a poor nutrition [odds ratio (OR) 1.94; 95% confidence intervals (CI) 1.43-2.65] of middle-aged and elderly male subjects. Cigarette smoking (OR 1.84; 95% CI 1.24-2.71), less exercise (OR 2.58; 95% CI 2.07-3.21), stress (OR 1.73; 95% CI 1.36-2.22), and depression (OR 1.34; 95% CI 1.08-1.67) of middle-aged and elderly female subjects was associated with a higher likelihood of a poor nutrition. The results of the multiple regression analysis showed that less exercise proved to be the strongest predictors for the poor nutrition, followed by stress, smoking, and depression (model R2= 9.0%). It suggests that guidance to promote regular exercise, to quit smoking, to minimize stress and depression level might help to improve nutritional status of middle-aged and elderly in Korea. These findings also suggest that having recommendable health behaviors are beneficial to the good nutrition of subjects aged 50 years and over.
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Evaluating Nutrient Intakes of Korean Elderly Using Semi-Quantitative Food Frequency Questionnaire
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Hae Jeung Lee, Seon Joo Park, Jung Hee Kim, Cho Il Kim, Kyung Ja Chang, Kyeong Sook Yim, Kyungwon Kim, Haymie Choi
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Korean J Community Nutr 2003;8(3):311-318. Published online June 30, 2003
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- The aim of this study was to assess the nutrient intakes of the elderly subjects in Korea. Dietary assessment was carried out using a semi-quantitative food frequency questionnaire (SQFFQ) developed by our laboratory, which included 98 commonly consumed food items selected from 1998 National Health and Nutritional Survey for Korean population. Subjects (n = 2,660) aged 50yr and over were recruited in Seoul, 6 metropolitan cities, and 8 mid-size cities. Calcium and riboflavin intakes of the elderly subjects aged 65 yr and over (n = 1,974) were much lower compared with Korean RDA. Nutrient intakes of the three age group (50-64 yr, 65-74 yr, 75 yr and over) were decreased as age increased in male and female elderly. Nutrient intakes of male elderly, 75 yr and over, were significantly decreased while in female elderly nutrient intakes were gradually decreased as age increased. Over 30% of the elderly subjects did not meet 75% RDA for calcium, iron, vitamin A, and riboflavin. The proportion of the elderly subjects whose intakes were below 75% RDA was much higher than the elderly whose intakes were above 125% RDA, especially among the elderly aged 75 yr and over. This study revealed that the Korean elderly had inadequate intakes for many nutrients. This will cause a serious nutritional problem for the elderly.
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The Development and Validation of a Food Frequency Questionnaire to Assess Diets of Korean Adolescents
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Kyeong Sook Yim, Tae Young Lee, Hye Soon Park
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Korean J Community Nutr 2003;8(2):149-159. Published online April 30, 2003
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- The purpose of this study was to develop and evaluate the validity of a food frequency questionnaire for Korean adolescents (FFQ-A) which could be used in clinical and epidemiological studies of the lifestyle and health of young people. The FFQ-A was designed to reflect the eating pattern of Korean adolescents, and was based on the 1998 Korean National Health and Nutrition Survey Reports. The FFQ-A had 25 food categories. A total of 125 subjects (aged 13 to 15 years) was recruited from a randomly chosen middle school in a middle-income neighborhood in Anyang, South Korea. Each subject completed a FFQ-A, as well as a three-day dietary record. Data from 117 subjects (boys 47, girls 70) was used in the final analyses. Data on the nutrients was analyzed to estimate the Pearson correlations, Spearman rank-order correlations and agreement with categories. The validity of the FFQ-A was assessed relative to a three-day dietary record. The Pearson correlation coefficients for all the subjects were 0.94, 0.87, 0.77, 0.79, 0.49 and 0.68 for energy, carbohydrate, protein, fat, calcium, and iron, respectively. Similarly the Spearman rank-order correlation coefficients were 0.94, 0.85, 0.79, 0.81, 0.46, and 0.77 for energy, carbohydrate, protein, fat, calcium and iron, respectively. The Kappa values for energy, carbohydrate, protein, fat, calcium, and iron were 0.88, 0.67, 0.63, 0.67, 0.26, and 0.59, respectively. The percentage for misclassification of the lowest quartile into the highest quartile or vice versa ranged from 0% (energy, carbohydrate, or fat) to 16.7% (Vitamin C). Therefore the FFQ-A has a reasonable ability to assess the energy, carbohydrate, protein and fat intakes as estimated from a three-day dietary record of Korean adolescents.
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Development and Validation of a Computerized Semi-Quantitative Food Frequency Questionnaire Program for Evaluating the Nutritional Status of the Korean Elderly
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Hae Jeung Lee, Seon Joo Park, Jung Hee Kim, Cho Il Kim, Kyung Ja Chang, Kyeong Sook Yim, Kyung Won Kim, Hay Mie Choi
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Korean J Community Nutr 2002;7(2):277-285. Published online April 30, 2002
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- The purpose of this study was to develop a semi-quantitative food frequency questionnaire (SQ-FFQ) for subjects aged 50yr and over and to evaluate the validity of this SQ-FFQ. Dietary intake was assessed using SQ-FFQ that included 98 commonly consumed flood items selected from the results of the Korean Health and Nutritional Survey, 1998. Subjects (n = 2,660) aged 50yr and over were recruited from 7 metropolitan cities and 8 small cities. Each subject was interviewed using this SQ-FFQ developed in our laboratory and 24hr-recall method. Excluding incomplete data, Data from 1,149 subjects were used in this validity study. The nutrient intakes assessed by this SQ-FFQ were validated by comparing with the results from 1 day 24-hour recalls. Pearson's correlation coefficients between two methods were 0.71, 0.64, 0.53, and 0.43 for energy, carbohydrate, protein, and fat, respectively for all subjects. Spearman's correlation coefficients were higher than those of Pearson's correlation coefficients. Kappa values for energy, carbohydrate, protein, and fat were 0.79, 0.72, 0.70, and 0.64, respectively. The percentage for misclassification of the lowest quartile into the highest quartile or vice versa was 1.25-1.39% for all nutrients. Therefore, this SQ-FFQ seems to be useful in assessing the nutritional status of the middle-aged and elderly subjects in Korea.
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Evaluation of the Effectiveness of a Nutrition Education Program for Hypertensive Patients at the Community Level
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Kyeong Sook Yim
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Korean J Community Nutr 2000;5(4):654-661. Published online December 31, 2000
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- Hypertension is the major risk factor for cardiovascular disease which is considered the leading cause of death in Korea. Since nonpharmarologic dietary intervention is recommended as the first step in the management of hypertension, evaluation of intervention programs is needed to formulate strategies for improving patients' dietary adherence. This study was designed to evaluate the overall effectiveness of a hypertension nutrition education program (HNEP) at a public health center, by assessing changes in nutrition knowledge, food attitude, self-efficacy, dietary behavior, and nutrient intake after program completion. An HNEP was conducted in Suwon city for 5 months in 1999 by a public health center. The program provided 3 sessions of group education with individual nutrition counseling. Thirty-five patients participated fully in the program out of 62 enrollees. Data about nutrition knowledge, food attitude, self-efficacy, dietary behavior, and intake (24-hour recall) were collected before (baseline) and after the program. Post program results indicate the following : 1) nutrition knowledge and perception of importance of nutrition significantly increased, 2) food attitudes also improved, 3) the self-efficacy for maintaining a low salt diet was increased significantly, whereas self-efficacy for maintaining a low fat diet or dietary guidelines was not improved, 4) frequency of intake of processed food, animal fat, and sweets as well as frequency of dining out were significantly reduced, 5) nutrient intake was not improved after the program, 6) the most serious barrier for participating in the program and practicing diet therapy was lack of time and willingness. In conclusion, it appears that HNEP might improve food attitudes, individual perceptions and self-efficacy for desirable eating behavior, but it might not improve dietary intake. It follows then, that a long term intervention program may need to increase effectiveness of patient dietary adherence.
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Strategies of Improve Elderly Nutrition through Nutrition Education : Evaluation of the Effectivenss of the Program
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Kyeong Sook Yim, Young Hee Min, Tae Young Lee, Young Joo Kim
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Korean J Community Nutr 1999;4(2):207-218. Published online June 30, 1999
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- The increased number of elderly in Korea presents great challenges for community nutrition programs. Strategies to enchance elderly nutrition are needed, as well as dietary advice that are reality-based and tailored to the need of the elderly. The purpose of this study was to evaluate the overall effectiveness of an elderly nutrition improvement program(ENIP), by assessing changes in nutrition knowledge, attitudes, and behavior after program completion. ENIP was conducted in Suwon for 4 months in 1998 at 5 centers for the elderly. The program provided individual nutrition counseling and brief biweekly group education sessions. To stimulate participation and motivation, the elderly in two centers were served free milk packs(200ml) three time a week during the program(milk+education group), and the elderly in 3 other centers were served yoghurt on the program day(education group). Altogether, 102 subjects finished the program(milk+education group 67 ; education group 35). Data about nutrition knowledge, dietary attitudes, diet records(24 hour recall) and dietary habit was collected before(baseline) and after the program(follow-up). The Drop-out rate for the milk+education group(2.9%) was significantly lower than that for the education group(30.0%)(p<.001). The Nutrition Knowledge fo females milk+education group increased significantly after the program, but no significant differences were observed in other groups. Over 60% of all the elderly showed positive responses to the healthy eating attitudes. Energy, protein, vitamin A, riboflavin, Calcium and Potassium intakes improved in the male milk+education group. The Vitamin C intake improved in the male education group. Energy and vitamin A intakes improved in the female milk+education group and energy, vitamin A, thiamin, riboflavin, niacin, Ca nad P in the female education group. A stepwise multiple regression analysis was performed to examine the effects of food intake changes on overall nutrient quality. For all elderly, the fish intake explained 12.6% of the variance, followed by candy intake and vegetable intake(model R2=19.6%). Dietary habits such as meal time regularity and salty food reduction were markedly improved in both groups. Sixty-one percent of the milk+education subjects stated their participation was voluntary and active, while 51% of education subjects did. Sixty four percent of the subjects stated their interest on diet increased remarkably through program participation. Considering the results, it is conjectured that ENIP had a great impact on nutrient intake, dietary attitudes and habits. Milk supplement showed no direct effects on elderly nutrition improvement, but it encouraged the program by reducting drop-out rates and inducing voluntary participation. Therefore milk supplement could enhance the community nutrition education program. Moreover it is strongly suggested that the ENIP be expanded to other communities.
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Strategies to Improve Elderly Nutrition : Comparisons of Dietary Behavior according to the Mean Nutrient Adequacy Ratio
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Kyeong Sook Yim
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Korean J Community Nutr 1999;4(1):46-56. Published online March 31, 1999
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- A deep understanding of the dietary patterns and nutrient intake is important for assessment of possilbe nutritional risk and for establishing nutrition improvement strategies. This study was conducted toexamine the dietary characteristics of a nutritionally poor elderly group compared to the middle-and highly-nourished group. Elderly participant was recruited from local elderly centers in Suwon city in 1998. Trained dietitians interviewed 119 elderly(35 males, 84 females) aged 60 years and over for collecting dietary data(24-hour recall) and related variables. Male and female subjects were grouped into high, middle, and low according to the mean nutrient adequancy ratio(MAR) tertiles. An analysisof the percentage of RDA(Recommended Daily Allowances of Korea) for each of the 10 nutrients showed that the male low-MAR group consumed below the RDA in all kinds of nutrients, and the female low-MAR group consumed nutrients below the RDA except vitamin C. An evaluation of nutrient density by Index of Nutritonal Quality(INQ) also showed a similar tendency. Thus, the INQ level of the male low-MAR group was significantly lower than the middle-or high-MAR group, especially in protein, vitamin A, thiamin, riboflavin, and phosphorus(p<0.05). Moreover, INQ level of female low-MAR group was significantly lower than that of the high group(p<0.05) in all nutrients. The female low-MAR group's daily food intake were also lower than those of the high-MARgroup in gains, fish, fruits, oil and beverages. The energy distribution from carbohydrates, fats and proteins showed that the male low-MAR group had significantly higher carbohydrate and lower fat proportions compared to each gender high-MAR group, respectively. The male and female low-MAR group had low scores about eating all side dishes. These findings indicate that a moderate increase of the meat/egg/fishes intake was needed by the male low-MAR group for improving nutrition adequacy, and an overall increase of the food quantity and quality was desired for the female low-MAR group. These data could be used for planning a community elderly nutrition program and establishing strategies for tailored guidelines for the individuals.
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Changes of Plasma Cardiovascular Disease Risk Factors according to the Health Practice and Dietary Habits in Healthy Male University Studnets
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Kyeong Sook yim
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Korean J Community Nutr 1998;3(5):685-694. Published online November 30, 1998
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- This cross-sectional study was conducted to describe the changes of plasma cardiovascular disease(CVD) risk factors in Korea. Overnight fasting plasma levels of total cholesterol, high density lipoprotein(HDL)-cholesterol, triacylglycerol and glucose were analyzed. Blood pressure and anthropometric data were also measured. Health practice factors such as smoking status, alcohol consumption and frequency fo exercise were evaluated by a self-administered questionnaire. Questions regarding dietary habits and food preferences were also asked. Seventy eight percent of the subjects had more than one CVD risk factor. Plasma total cholesterol, triacylglycerol, and fasting blood glucose were significantly increased according to the subjects body mass index(kg/m2, BMI), whereas HDL-cholesterol, low density lipoprotein(LDL)-cholesterol and blood pressure showed no significant differences with BMI. Current smokers had significantly high plasma total cholesterol, LDL-cholesterol and triacylglycerol levels. Alcohol consumption significantly increased plasma total cholesterol and fasting blood sugar, but regular exercise had no effects on the plasma CVD risk factors. Overeating and frequency of fast food consumption were positively correlated with the CVD risk score, whereas intake of grains, meats and vegetables were negatively correlated with that score. A stepwise multiple regression analysis was performed to examine the effects of specific dietary factors on plasma lipid levels. For plasma total cholesterol level, the frequency of fast food intake explained 8% of the variance, followed by habitual overeating, frequency of grain intake and high cholesterol food intake(Model R2=22.4%). For plasma triacylglycerol level, preference of oily foods accounted for 7.5% of the variance, followed by eating breakfast, preference of fruit and frequency of grain intake(Model R2=22.0%). The findings suggest that intervention programs to reduce the risk of CVD should focus on health practice through reducing BMI, smoking cessation and moderate or no alcohol drinking. Moreover, desirable dietary habits such as eating breakfast, not overeating and reduced intake of fast food may improve CVD risk.
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Analysis of the Characteristics of an Attendee in an Elderly Nutrition Education Program -Using the Factors of Health Promotion Model
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Kyeong Sook Yim
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Korean J Community Nutr 1998;3(4):609-621. Published online October 31, 1998
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- Although many people initially enroll in health education programs, there are many instances of erratic participation and dropouts. Inconsistent participation in intervention programs minimizes their impact on health promotion. Therefore, a theoretical understanding of factors influencing participation in these programs can potentially enhance the effectiveness of its educational strategy. This study used the Pender's Health Promotion Model to examine specific factors influencing incentives to participate in an elderly nutrition education program. The Elderly Nutrition Counseling and Education Program was conducted with 147 volunteers (76 males, 71 females), aged 60 to 87, at 5 separate community elderly centers, by public health dietitians from February to April 1997. Some participants dropped out during the program. Overall, 61 people(18 males, 43 females) finished all 7 steps over 2 months. Pre-intervention data were collected by trained dietitians. This data included individual cognitive-perceptual factors(perceived benefits of nutrition improvement, importance of health, perceived control over health by multidimensional health locus of control, self esteem, perceived health status, concern about health, depression scale and social health scale), which were known to influence the likelihood of health behavior, and modifying factors(socioeconomic variables, biological characteristics, behavioral factors, such as smoking, alcohol drinking and exercise). Male finalists had a significantly lower chance for health locus of control, and better social health status with their children and grandchildren, compared to males who dropped out. Female finalists had a significantly higher locus of control regarding food behavior, higher self-esteem, better recognized nutritional status, worse self-recognized health status and lower concern about health than those who dropped out. There was no significant difference between the attendees and dropouts in age, BMI( kg/m2), Nutritional Risk Index, depression scale and daily nutrient intake. These results suggest that elderly nutrition intervention plans should focus on the individual cognitive and perceptual factors, with interpersonal influences, to increase participation in nutrition in nutrition improvement programs.
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Strategies to Improve Nutrition for the Elderly in Suwon : Analysis of Dietary Behavior and Food Preferences
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Kyeong Sook Yim, Young Hee Min, Tae Young Lee, Young Joo Kim
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Korean J Community Nutr 1998;3(3):410-422. Published online August 31, 1998
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- To promote health status, strategies and interventions to improve nutrition should be based on the proper diagnosis of the subject's eating patterns. The elderly usually have traditional food habits and preferences, and it is very difficult to change them. This study was designed to identify dietary behavior and food preference of the elderly, in order to provide baseline data for the Elderly Nutrition Intervention Program for the Public Health Center. A survey questionnaire was made for use by trained interviewers to query 151elderly people from 5 community elderly centers located in Suwon, Korea. The majority of them ate regularly and partook of all available side dishes. Their major dietary problems were frequent consumptions of salty foods, and eating too quickly. They consumed grains and vegetables regularly, but seldomly ate dairy products, fruits, meat and food prepared with oil. They also tended to eschew ready made processed food, high cholesterol food, and fast food. Also they did not dine out as much as younger people. Desirable eating habit score were not significantly influenced by socioeconomic variables and nutrition-related characteristics. These included nutrition knowledge, Nutritional Risk Index(NRI) and a score of health concerns. However, meal balance scores were significantly higher in the younger group(p<.05), the higher household income group(p<.05). According to stepwise multiple regression analysis, NRI was the most important determinant of a desirable eating habit score for the male elderly, whereas the score of health concerns was most important for female elderly subjects. The greatest predictor of the meal f balance score was nutrition knowledge. The elderly liked sweet tasting food, grains, rice, stews and Korean style soups. They disliked sour food, dairy products, processed food, and bread. The results indicate that the Elderly Nutrition Education Program should focus on increasing consumption of dairy products, fruits and food with oil, prepared by traditional Korean cooking methods. It also suggests that the program planning should consider the socioeconomic status of the elderly, such as income and education level, as well as concern for health.
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Strategies to Improve Nutrition in the Elderly : An Analysis of Health Related Factors and the Nutritional Risk Index of the Elderly
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Kyeong sook Yim, Young Hee Min, Tae Young Lee
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Korean J Community Nutr 1997;2(3):376-387. Published online August 31, 1997
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- The elderly are the most rapidly growing segment of the population in Korea and the largest consumers of expensive medical care. It is reasonable to believe that improving the nutritional status would be beneficial to reducing morbidity and to improving the quality of their lives. This study was conducted to assess the health status and the Nutritional Risk Index of the elderly, and to provide the basic data for the Elderly Nutrition Improvement Program at the Public Health Center. One hundred and forty seven(76 males. 71 females) aged 60 years and over living in Suwon, were assessed with anthropometric measurements, body fat analysis, blood pressure measurements, and a set of about health and other related variables. Over half of them had less than a junior middle school education and were considered low income. The percentage of overweight and obese subjects was 33% by the BMI(Body Mass Index), and the prevalence of hypertension was 28%(males) and 31%(females). They had a lot of self-recognized health problems, the male elderly complained about more than the female elderly. In the case of psychological health status, however, the female elderly showed a higher proportions of depression than the male elderly(p<0.05). In social health status, the elderly had good relationships with friends and collegues, whereas they had poor relationships with their families. They had many nutritional risk factors, and smoking was the most prevalent risk factor for the male elderly and anemia was for the female elderly. The results of this study suggest that Elderly Nutrition Improvement Programs should be planned that can be easily followed. It would be helpful to design a program focusing on individual phychological and social health status, this would increase the efficiency of the program.
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