Korean Journal of Community Nutrition

Volume 7(1); February 2002

Original Articles

[English]
Comparison of Dietary Attitudes and Attitudes to the School Lunch Service of Elementary and Middle School Students Living in the Same Region: Myung Hee Park, Young Sun Choi, Yeun Ju Kim; Korean J Community Nutr 2002;7(1):3-13. Published online February 28, 2002

Abstract PDF: The purpose of this study was to examine dietary attitudes of students and changes in their attitudes toward the school lunch service. The participants of the study were 483 students ranging from third grade elementary school students to middle school sophomores living in the Seoguipo area of Jeju Island. The subjects were asked to complete questionnaires under the supervision of their teachers or dietitians, and data were grouped into elementary school 3rd and 4th grades, elementary school 5th and 6th grades; and middle school 1st and 2nd grades for each gender. There were no significant differences among the groups with respect to their regularity of food intake, dietary considerations, or the frequency of imbalance in their diets. In the case of female participants, their frequency of snacking decreased as their grade level increased. In general, the overall changes in dietary attitudes became more negative as their grade level increased. Male students demanded increased serving sizes of both staple food and side dishes, while female students demanded increased serving sizes dishes, but not staple food as their grade levels increased. there was also an increase in the number of student sin higher grades who discarded or did not eat enough their entire meals. The major reasons for not eating the food were : no taste to the food and not proper saltiness of food. These results may suggest that school dietitians need to pay more attention to increased taste and proper seasoning of meals. Students suggested that the school lunch service should be continued, but that it needs improvement. Students in higher grades were more aware of the importance of the environment in which the meal was provided. Also, an early education in nutrition and healthy diets seemed important in preparing them for following a healthy lifestyle in later life.

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[English]
Smoking Status and Dietary Habits of Middle School Students: Eun Hee Jung; Korean J Community Nutr 2002;7(1):14-22. Published online February 28, 2002

Abstract PDF: Adolescent smoking has been a great concern with respect to it's causing more serious health problems than adult smoking. The smoking status and habits of middle school students were studied using anonymous questionnaires, and their dietary habits were compared. Ninety-two of 4l4 students (22.2%) had experienced smoking, and 62.0% of them began in primary school, mostly out of curiosity. The most plausible reasons for smoking were 'boredom' and/or 'stress reduction'. Dietary habits were generally inadequate in the smoking group. Compared with the non-smoking group, the smoking group paid less attention to a balanced diet, more skipped breakfasts, more had irregular meal times and fewer snacked. There was no significant difference between the smoking and non-smoking groups in food intake frequency, except of sweet foods and caffeinated foods, which were more frequent consumed by the smoking group. These results suggest that more attention needs to be paid to nutrition and health education programs in elementary schools and also that proper support programs for smoking by themselves.

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[English]
A Study on nutrition Knowledge, Nutritional Attitudes, Dietary Behavior and Dietary Intake by Weight Control Attempt among Middle School Female Students: Kyung Won Kim, Eun Mi Shin; Korean J Community Nutr 2002;7(1):23-31. Published online February 28, 2002

Abstract PDF: The purpose of this study was to investigate weight control attempts and related factors among 209 middle school female students in Daejeon. Variables examined were body satisfaction, beliefs regarding weight control, body image, nutrition knowledge, nutritional attitudes, dietary behavior and dietary intake. A cross-sectional survey was employed, and data was analyzed using t-test and chi-square teat (at alpha=0.05). The average height, weight, and body fat (%) of subjects were 160.2 cm, 52.4 kg, and 25.9%, respectively. Those who attempted weight control were 61.7% of the samples, suggesting that weight control was quite popular among adolescents. Students in the weight control attempt group were more satisfied with their body size (p<0.001), and showed more distorted body image than those in the no weight control attempt group (p<0.001). Most of beliefs regarding weight control were also different in the two groups. The attempt group believed more strongly in the advantages of weight control, and believed less strongly in the harmful effects or difficulties associated with weight control. Although there were no differences in nutrition knowledge in the two groups, nutritional attitudes were slightly more favorable in the attempt group (p<0.01). In contrast, eating behaviors, such as those related to caloric intake (p<0.001), body image (p<0.001), and specific situations (p<0.01) were more desirable in the no-attempt group than in the attempt group. In addition, dietary intake of the attempt group was less adequate than that of the no-attempt group for nutrients such as iron (p<0.01), vitamin A, thiamin, riboflavin, and vitamin C(p<0.05). This study suggests that adolescents who attempt control weight have a more distorted body image and inadequate diet and showed more undesirable eating behaviors. Students should be taught and practice desirable methods of weight control. Educational programs should also include strategies for changing beliefs regarding weight control, as well as modifying diets and eating behaviors.

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[English]
College Students' Dietary and Health Behaviors related to Their Myers-Briggs Type Indicator Personality Preferences: Byung Sook Kim, Young Eun Lee; Korean J Community Nutr 2002;7(1):32-44. Published online February 28, 2002

Abstract PDF: The objective of this study was to evaluate college students' dietary and health behaviors in relation to their Myers-Briggs Type Indicator (MBTI) personality preferences. Dietary and health behaviors were surveyed for 444 college students who performed the MBTI personality test. Only 6.1% of the subjects regularly had three meals a day, while 27.1% ate breakfast every day. Fifty-six point nine percent of the students took less than 15 minutes to eat a meal and had the habit of eating fast. The number of food groups they ate was, on average, 2.74 and was eaten mainly at dinner. This showed that college students did not eat a large variety of foods. Eighty-two percent of the subjects drank alcoholic beverages, 21.4% smoked, and 69.3% exercised. In addition, 73.9% of them were not satisfied with their body image, but they were not eager to try weight control. There were not many significant differences between Extraversion (E)-Introversion (I), Sensing (S)-iNtuition (N), and Thinking (T)-Feeling (F) in their dietary and heath behaviors, although some gender differences existed. Significantly better dietary and health behaviors were shown in subjects preferring Judging (J) rather than Perceiving (P). There behaviors included eating breakfast, regularly eating three meals a day, smoking less, exercising more and having a lower tendency to night-eating. The personality preference of J-P could be useful index for nutritional education and counseling or behavior modification programs for obese people.

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[English]
Effects of Nutrition Knowledge, Dietary Attitude, Dietary Habits and Life Style on the Health of College Students in the Chungnam Area: In Sook Kim, Hyeon Hee Yu, Hyeo Sook Han; Korean J Community Nutr 2002;7(1):45-57. Published online February 28, 2002

Abstract PDF: The purpose of this research of this research was to survey the health of 181 male and 130 female students at K University in Chunganm from June 1 to June 23, 2001. It analyzed the students' dietary behaviors, life styles and perceived body shapes and the correlation of these factors to the health condition of the students surveyed. The results of the survey are summarized as follows. The average nutrition knowledge score (out of a possible 20 points), dietary attitudes score (out of a possible 50 points) and dietary habits score (out of a possible 30 points) were 8.66, 33.14 and 19.02 for males, and 9.99, 32.64, and 19.05 for females, respectively. The percentages of those who smoked, drank, smoked and drank and exercised regularly were 55.2, 92.8, 54.1, 82.9% for males, and 6.9, 91.5, 6.9, 63.1 for females, respectively. A significantly higher proportion of males smoked, drank, and exercised as compared to females (p<0.001). The percentages of students who were underweight, normal or overweight by BMI were 5.0, 79.0 and 16.0 for males, and 20.0, 78.5 and 1.5 for females, respectively. Fifty percent of females indicated that they felt they were obese, versus only 31.1% of males. Half of the females thought they were fattish, while only 31.1% of males thought that. Seventy-six point nine percent of females and 61.9% of males, more females than males, were dissatisfied with their weights. The health scores (the higher the point, the better the health condition) of the females (44.17) were significantly lower than those of the males (47.17) (p<0.001). A stepwise multiple regression analysis with health scores as the dependent variable and other scores as independent variables, indicated that the health scores of males were highly correlated with satisfaction with his body weight, smoking and drinking, and perceived body shape, whereas the females' health scores were highly correlated with obesity level, satisfaction with her body weight, and smoking and drinking.

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[English]
Development of a Semi-Quantitative Food Frequency Questionnaire for Pre-school Children in Korea: Young Lim, Se Young Oh; Korean J Community Nutr 2002;7(1):58-66. Published online February 28, 2002

Abstract PDF: The purpose of the study was to develop and evaluate the reliability of a semi-quantitative food frequency questionnaire (SFFQ) intended to measure mainly nutrient intake (energy, protein, fat, calcium and iron) related to growth in pre-schoolers in Korea. Based on foods with up to 90 cumulative percent contribution of the 5 nutrients, we developed a SFFQ for 86 foods. In order to evaluate the reliability of both nutrient and food intakes, caregivers of a sample of 101 children aged 4 to 6 years completed the SFFQ repeatedly at 3 month intervals. There were small differences in the nutrient intakes assessed by the SFFQ ranging from 0.55% to 9.91%. There were no significant differences in nutrient values calculated from the repeat questionnaires, except in the case of niacin and vitamin C. The Pearson correlation coefficients of most of the nutrients ranged form 0.54 to 0.75 (mean = 0.66). When energy intake was adjusted, there was approximately a 0.2 decrease in the correlation coefficient of most nutrients, due to the high correlation of energy intake with other nutrients (r=0.7-0.9). The amount of food intake differed by 0.1 to 66.4% (mean = 17.5%), depending on the food item. Out of 86 foods, 74 foods (86%) showed less than a 30% difference in intake and 30 foods (35%) showed less than a 10% difference. Only 6 (7%) out of the 86 foods presented statistically significant differences in intake. The Spearman correlation coefficients of most food intakes assessed repeatedly by the SFFQ ranged from 0.4 to 0.7. Reproducibility of the nutrient and food intakes found in this study was better or similar to those found in cases of Korean adults. Therefore, the SFFQ developed in the present study can be a useful tool to assess the dietary intake of pre-schoolers in Korea.

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[English]
Study of the Difference in Body Composition, Eating Habits and Dietary Intake in Three Sasang Constitutions among Elementary School Children: Jeong Mi Hong, Yoo Sik Yoon, Sun Mi Choi; Korean J Community Nutr 2002;7(1):67-75. Published online February 28, 2002

Abstract PDF: The purpose of this study was to investigate the difference of body composition, eating habits and dietary intake in three Sasang constitutions. This survey was carried out using anthropometry, a questionnaire about eating habits, and 24-hour recall of dietary intake on 45 male and 29 female students of the fifth grade at C elementary school. The results are summarized as follows: A total of 44.6% of the subjects were Taeumin, 35.1% were Soyangin, and 20.3% were Soeumin. The average weight, WHR, Triceps, Rhrer index and BMI in the Taeumin group were significantly higher than those of the Soeumin and Soyangin groups. The body fat mass (kg) and abdominal fat (%) in the Taeumin group were significantly higher than those of the Soeumin and Soyangin groups. The soft body mass (%) in the Soeumin group was significantly higher than that of the Soeumi and Soyangin groups. The Taeumin's energy expenditure in physical activities was little high than that of the Soyangin and Soeumin groups, but the Soyangin's energy expenditure in physical activities per weight was a little higher than that of the Taeumin and Soeumin groups. The calorie and most of the nutrient intake were lower than those of Korean RDA. In the case of males, most nutrient intake, except for fiber, carotene and vitamin C were high in the Taeumin. For females, most nutrient intake, except for calcium and retinol were significantly higher in the Taeumin group. Conclusively, anthropometry characteristics, body composition, energy expenditure in physical activities, eating habits and dietary intake are different among the three Sasang constitutions. This study suggests the possibility of using Sasang consitutions as a basis for providing nutritional education and health guidelines.

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[English]
Food Habits, Nutrients Intake, and Disease Distribution according to Sasang Constitutions in the Elderly Aged over 65 Years(II): Youn Kyoung Kim, Mi Ran Cho, Rin Chang, Ryo Won Choue; Korean J Community Nutr 2002;7(1):76-85. Published online February 28, 2002

Abstract PDF: Since the 1970s, the average life expectancy of Koreans has been increasing. Our concerns are not simply about longevity, but also about disability-free life. lately, Sasang constitutional medicine has attracted public attention, especially with respect to the elderly. The purpose of this study was to investigate the food habits, nutrients intake, and disease distribution among the elderly, according to their Sasang constitutions. The results are as follow : The distribution of constitutions of the subjects were Tae-eum 48.8%, So-yang 27.4%, So-eum 22.6%, and So-yang + So-eum 1.2%. In both elderly men and women, body weight, percent ideal body weight, and diastolic pressure of the Tae-eum were significantly higher than those of other constitutions. In both men and women, the level of hemoglobin in the Tae-eum was significantly higher than those of other constitutions. The level of LDL-cholesterol was higher, and the level of HDL-cholesterol was lower in the So-eum elderly women. Food habits of the So-eum were the most irregular, and nutrients intake of the So-eum was lower than that of other constitutions in both elderly men and women. In elderly men, the incidence of hypertension was the highest in the Tae-eum, and the incidence of gastritis was the highest in both So-yang and So-eum. In elderly women, the incidence of fatty liver was the highest in the Tae-eum and So-yang, and gastritis and hypertension were the highest in the So-eum. In the elderly, obese and anemic persons were significantly more in the Tae-eum and the So-eum, respectively. The results of this study showed that there were significant differences of physical, characeristics, food, habits, and distributions of disease for the subjects according to each Sasang constitutions. Intake of nutrient was poor, regardless of Sasang constitutions, in both men and women.

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[English]
Characteristic Analysis of Internet nutrition Counseling Served by the Korean Society of Community Nutrition: Joung Won Lee, Sun Yung Ly, Kyeung Eun Kim; Korean J Community Nutr 2002;7(1):86-91. Published online February 28, 2002

Abstract PDF: An analysis for a period of 15 months (from September 2000 to November 2001), of the nutrition counseling internet site, "Dietnet" served by the Korean Society of Community Nutrition, showed the following results. Nutrition counseling was conducted without charge by 50 professionals, including professors in the food and nutritional areas, medical doctors, and dietitians. Counselees consisted of mostly females under 30 years of age. Although two thirds of the users of this site asked questions anonymously, they were very sincere. They asked questions mostly related to their own concerns, but there were quite a few inquiries about their parents or grandparents. There were significant differences in the counseling contents depending on the ages of the counselees. Teenagers showed the highest interest in height growth and weight control, whereas people in their twenties were mostly interested in diseases, foods, and weight control. Those over the thirty made inquiries mostly about diseases. The most frequent questions were relevant to gastrointestinal, circulatory and hepatic diseases. As indicated above, counseling questions included of a variety of both comprehensive and specific questions. There were also quite a few questions related to decisions on the correct usage of specific foods. Therefore, we recommend that more professionals, such as food science majors, medical doctors who practice western and oriental medicine, and other professionals who specialize in psychological behaviors related to weight control and infant food habits be recruited to serve the site more effectively and intensively. In light of the further need for internet sites with nutrition counseling and delivery of nutritional information to the public, nutritionists capable of managing websites are also required.

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Randomized Controlled Trial

[English]
The Effects of Nutrition Counseling on Food Intakes and Bloodlipids in Cardiac Patients: Soo Gyoung Wang, Seon Mi Park; Korean J Community Nutr 2002;7(1):92-101. Published online February 28, 2002

Abstract PDF: The purpose of this study was to investigate whether nutrition counseling and exercise could be beneficial to patients with acquired cardiac disease (ACD). Twenty-five ACD patients participated in this program, which was based on guidelines for serum lipid management. To measure the effects of the nutrition counseling and exercise education, outpatients with ACD were selected and randomly assigned to three groups which were a control group, a diet only group and a diet and exercise group. Nine diet only group patients and nine diet and exercise group patients received nutrition counseling or nutrition counseling and exercise education every other week. Patients who served as a non counseled control group did not receive any counseling during the same study period. Various markers of disease risk, including lifestyle, anthropometric indices, eating behaviors, and serum lipid levels were measured before and after the program. The program lasted up to 12 weeks, depending on the individuals involved. Database management and statistical analyses were performed using SPSS 7.5 software. As a result, BMI and %IBW showed decreased trends in the diet only and the diet and exercise group. Food habit scores were significantly increased in the diet only group and the frequency of saturated fatty acid, dietary cholesterol, salty food and instant food intake were decreased in the diet only group. Comparisons of the daily nutrient intakes of the groups showed their total calorie, carbohydrate and protein intake had decreased significantly, and also the total fat and dietary cholesterol intake had decreased in the nutrition counseling group. The serum total cholesterol and LDL-cholesterol decreased after 12 weeks in the nutrition counseling group. The diet and exercise group showed less interest in diet control than the diet only group. These results show that a well-planned nutrition counseling program would reduce the risks of ACD and cardiovascular disease and help to care such diseases.

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Original Articles

[English]
Studies on Lipid Intake, Serum Lipid Profiles and Serum Fatty Acid Composition in College Women Who Smoke: Hong Seok Ahn, Geum Ja Lee, Na Young Kim; Korean J Community Nutr 2002;7(1):102-110. Published online February 28, 2002

Abstract PDF: Cigarette smoking has long been recognized as a major risk factor in the development of coronary heart disease. Several investigators have reported the strong association between smoking and high serum cholesterol, triglyceride concentration, SFA and low HDL cholesterol, PUFA and omega6 concentrations. Therefore, this study was done to investigate the effect of smoking on the serum lipid profile and fatty acid composition of college women. Sixty-one non-smokers and twenty-seven smokers were selected from college women students in the Seoul area. Their lipid intake, serum lipid concentration and fatty acid composition were examined. There were no differences in the general characteristics and anthropometric indices between the smokers and non-smokers. However, alcohol consumption was significantly higher in smokers than non-smokers (p<0.001). The daily caloric intake of smokers and non-smokers were 1875.84 kcal and 1915.53 kacl, respectively. On the other hand, the mean daily intake of lipids and cholesterol were significantly lower in smokers (p<0.05). In smokers, the mean concentrations of serum total cholesterol, LDL-cholesterol and the LDL-C/HDL-C ratio were higher, and the compositions of EPA and DHA were lowe than in non-smokers. There was a negative correlation between the serum triglyceride and PUFA levels in the two groups. Also, serum HDL-C correlated negatively with MUFA in smokers and non-smokers (p<0.01). These results suggest that smoking cause inadequate changes in serum lipid profile and serum fatty acid composition, thereby increasing the tendency for coronary heart disease.

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[English]
A Study of Nutrient Intake and Serum Levels of Osteocalcin, Ca, P, and Mg and Their Correlation to Bone Mineral Density in Korean Postmenopausal Women Residing in Rural Areas: Chung Ja Sung, Yun Hee Choi, Mi Hyun Kim, Sun Hae Choi, Kyung Ok Cho; Korean J Community Nutr 2002;7(1):111-120. Published online February 28, 2002

Abstract PDF: Postmenopausal women lose more bone mass than men as a result of estrogen deprivation. The resultant low bone mineral density (BMD) is a major risk factor in the development of osteoporosis. Calcium, phosphorus and magnesium are main components of bone. The purpose of this study is to investigate nutrient intake and serum osteocalcin, Ca, P and Mg and their correlation to bone mineral density in Korean postmenopausal women residing in rural areas. We conducted 24 hour dietary recalls, anthropometric measurements and blood analysis on 60 postmenopausal women. The BMD of the lumbar spine (L2-->L4) and the femoral neck were measured by dual energy X-ray absorptiometry (DEXA). Subjects were assigned to one of three groups:normal (T-score> -1, n=20), osteopenia (-2.5> T-score< or = -1, n=23), and osteoporosis ( T-score< or = -2.5, n=17). The mean age, height, weight and BMI were 62.37 yr, 154.36 cm, 55.28 kg and 23.18 kg/m2 respectively. The mean daily energy and protein intakes were 76.35% and 87.41% of RDA for Koreans. The mean intakes of calcium, phosphorus, and magnesium were 463.62 mg (66.23% of RDA), 955.32 mg (136.47% of RDA), 345.87 mg respectively. The mean serum levels of calcium, phosphorus and magnesium were 8.76 mg/dl, 3.80 mg/dl, and 2.10 mg/dl, respectively, and there were no significant differences among the three groups. However, the BMD of the femoral neck showed a significantly negative correlation with serum magnesium (p<0.05). To summarize the results, most nutrient intakes (especially calcium) in postmenopausal women did not reach the RDA values for Koreans. Also, increase of serum magnesium levels may be related to bone loss.

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[English]
Some Factors Affecting Bone Mineral Status of Postmenopausal Women: Se In Oh, Hang Shin Lee, Mee Sook Lee, Cho Il Kim, In Soon Kwon, Sang Chul Park; Korean J Community Nutr 2002;7(1):121-129. Published online February 28, 2002

Abstract PDF: Osteoporosis, the typical metabolic bone disease of the elderly, is characterized by a reduction in bone mineral density (BMD) and increased fracture risk. Genetic and environmental factors are known to play a key role in bone metabolism, and diet is also considered to be one of the important factors. The purpose of the present study was to investigate the relationship among the factors affecting BMD, including stature, body weight, age, time period since onset of menopause, and biochemical markers of bone turnover in postmenopausal women. Seventy-eight postmenopausal women who visited health promotion center for health examinations volunteered to participate in this study and they were divided into two groups according to the time period since onset of menopause : women with a time period since onset of menopause of less than 5 years (Group 1) and women with a time period since onset of menopause of 5 years or more (Group 2). The demographic characteristics and dietary intake were surveyed using a questionnaire. BMDs of the lumbar spine and femoral neck of subjects were measured by dual energy X-ray absorptiometry. Serum levels of 25-hydroxy-vitamin D and parathyroid hormone (PTH), known to be indicators of bone related hormone status, were anlyzed. Serum samples were measured for calcium, phosphorus, alkaline phosphatase, and osteocalcin as bone formation indicators, and urine was analysed for deoxypyridinoline, creatinine, calcium, and sodium as bone resorption indicators. The results are as follow : The mean BMDs of the lumbar spin and femoral neck were 1.02+/-0.02 g/cm2 and 0.81 +/-0.02 g/cm2, respectively, and the BMD level of Group 2 was significantly lower than tat of Group 1 (p<0.01, p<0.05, respectively). The mean daily intake of energy was 1838 +/- 55 kcal. When nutrient intake was compared with the recommended dietary allowances (RDA) of the subjects, only calcium, vitamin A and riboflavin intake showed means lower than the RDA. The nutrient intake did not show any significant differences between Group 1 and 2 Serum and urine levels of biochemical markers of bone turnover did not show any significant differences between Group 1 and 2, and all were within the normal range. However, the PTH and deoxypyridinoline levels showed a tendency to be higher, and the osteocalcin level to be lower in Group 2 than in Group 1. Although age and years after menopause (YAM) showed negative correlations with lumbar spine bone mineral density (LBMD) (r= -0.38, p<0.001, and r= -0.26, p<0.05, respectively), no correlation was found with femoral neck bone mineral density (NBMD). While height, body weight and body mass index (BMI) showed a positive correlation with LBMD (r= 0.32, p<0.001, r= 0.38, p<0.001, r= 0.22, p= 0.05, respectively), only body weight and BMI showed a positive correlation with NBMD (r= 0.30, p<0.01, and r= 0.27, p<0.05, respectivley). There was no significant corealtion between BMDs and the nutrient intake of subjects, except in the case of carbohydrates (r= 0.22, p<0.05). Also, serum and urine levels of bone turnover markers showed no significant correlation with nutrient intake. On the other hand, serum osteocalcin had a positive correlation with vitamin C intake (r= 0.22, p= 0.05), and urine deoxypyridinolin showed a negative correlation with niacin intake (r= -0.22, p= 0.05). Urinary na was negatively correlated with protein intake(r= -0.23, p= 0.05). The results suggested that it is difficult to prevent the decrease in bone mass among postmenopausal women eating the usual Korean diet. However, the BMDs of the lumbar spine and femoral neck were positively related to body weight ad BMI in postmenopausal women. Therefore, this study confirmed that one of the most effective ways to minimize bone loss in postmenopausal women would be to maintain an adequate body weight with balanced nutrient intake and activity in the pre-and postmenopausal periods.

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[English]
Korean Family's Perception of the Importance of the Quality of Restaurants according to Family Life Cycle: Jeong Lim Yu, Dong Yean Park; Korean J Community Nutr 2002;7(1):130-140. Published online February 28, 2002

Abstract PDF: The purpose of this study was to examine the customer's perception of the importance of restaurant quality by using a developed SERVQUAL model. In particular, it was intended to provide the basic information for nutrition education for family's eating out. the data were collected through the survey over 440 families who have lived around the apartments in Kyongju and Seoul. The structure questionnaire included 35 items evaluating the quality of restaurants, adapting SERVQUAL model and adding other factors related to restaurant and the general characteristics of the families. The data were analyzed using SPSS 10.0 WIN program for descriptive analysis, a chi-square test and Pearson's correlation test. The major results were as follows: From the factor analysis, the 35 items related to the quality of restaurant have been categorized into 10 factors, ie., 'Health', 'Reliability', 'Employee', 'Food', 'Facilities', 'Product', 'Empathy', 'Access', 'Comfort', and 'Safety'. From the analysis of the correlation between family life cycle of four steps and 10 factors, four factors such as 'Health', 'Facilities' (p<0.001), 'Comfort' (p<0.01) and 'Product' (p<0.05) showed statistical significance. 'Health' and 'Product' factors marked the highest score in the family with senior couple live without children or single, but the lowest score in the family with young couple without children or single. 'Facilities' and 'Comfort' factors showed the highest scores in the family with under elementary school children, and the lowest scores in the family with over elementary school children.

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