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Volume 2(4); October 1997
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Original Articles
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Status of Public Health-Democratic People's Republic of Korea
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Sook Mee Son
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Korean J Community Nutr 1997;2(4):467-469. Published online October 31, 1997
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- No abstract available.
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The Changes of Dietary Intakes in the Defectors from North Korea
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Ryo Won Choue, Ju Young Hong, Jung Eun Yim
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Korean J Community Nutr 1997;2(4):470-476. Published online October 31, 1997
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- No abstract available.
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Serum Concentration of Major Minerals, Trace Elements, Lipids and Fatty Acids Composition Related to Whole Cow's Milk Feeding in Infancy & Young Childhood
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Hong Seok Ahn, hyun Sook Bai, Sung Hye Park, Eun jung Chung, Kyung Hwan Oh
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Korean J Community Nutr 1997;2(4):477-485. Published online October 31, 1997
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- This study was conducted to determine the effect of large amounts of whole cow's milk intake on serum levels of minerals and lipids. Subjects were normal infants who were brought to the pediatric hospital for vaccination at the age of 7-26 months after birth, living in Eumsung-Choongbuk area. The serum concentrations of the imnerals(calcium, phosphorus, magnesium, iron, zinc and copper), lipids and fatty acids composition were analyzed in 38 infants which consumed large amount of whole cow's milk(over 700ml/day). The results obtained are summarized as follows : 1) The mean levels of calcium, phosphorus and magnesium in the serum of the total subjects were 7.56+/-0.51mg/dl, 11.12+/-0.72mg/dl and 1.62+/-0.13mg/dl respectively. The serum concentrations of iron, zinc and copper in total subjects averaged 72.42+/-1.62 microgram/dl, 76.29+/-3. 62 microgram/dl and 86.44+/-2.98 microgram/dl respectively. 2) The mean serum concentrations of triglyceride, total cholesterol, HDL and LDL in the total number of subjects were 96.84+/-9.22mg/dl, 133.45+/-6.30mg/dl, 32.79+/-1.77mg/dl and 81.29+/-4.81mg/dl respectively. 3) The average percentages of SFA, MUFA and PUFA inth total serum fatty acids were 38.98+/-2.42%, 25.82+/-0.98% and 37.30+/-1.09% respectively and the mean omega6/omega3 fatty acids ratio was 13.48. In general, the levels of serum minerals and omega3 fatty acid composition in the subjects of this study, who were whole cow's milk fed infants were lower than those reported in breast milk or formula fed infants. Therefore, the intake of large amount of whole cow's milk in the weani ng period should be controlled and adequate for the infant's nutritional status.
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Prevalence of Obesity and Eating Habits of Elementary School Students in Kwangju
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Sung Sug Lee, Seung Ho Oh
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Korean J Community Nutr 1997;2(4):486-495. Published online October 31, 1997
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- The purpose of this study was to determine the prevalence of obesity and to examine the eating habits of elementary school students in Kwangju. The study was carried out on 931 students(male : 454, female : 477) in September and October of 1996. The results are summarized as follows ; Obesity was defined as body mass index(BMI) that exceeds 20. The rate of obesity was 10.0%(male 4.7%, female 5.3%) in subjects. Subjects were divided into 3 groups : normal group(BMI<20), mildly obese group(20
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A Study of the Obesity Index and Psychosocial Factors Influencing Obesity among Adolescent Girls
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Kyung Won Kim, Young Ah Kim, Jung Hee Kim
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Korean J Community Nutr 1997;2(4):496-504. Published online October 31, 1997
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- The purpose of this study was to investigate the dietary intake, obesity index and psychosocial factors influencing obesity among 200 high school girls in Seoul. The Social Cognitive Theory provided the Conceptual basis for this study. A cross-sectional survey was conducted to examine factors related to obesity, including self-efficacy for controlling overeating, social support for eating behavior, perception of body image and weight control, nutrition knowledge, and attitudes toward obesity. The data were analyzed using t-test and multiple logistic regression. The results of this study are as follows : 1) The mean age of the girls was 16.4 years, and the rate of overweight and obesity(measured by obesity index) was 27.0%. 2) The mean energy intake of subjects was 1832.3+/-384.0kcal. The energy derived from carbohydrates, proteins and fats was 62.7%, 13.8%, and 23.5%, respectively. There was no significant difference between the obese and the comparison group in energy intake. 3) The result of multivariate analysis indicated that obesity had a significant relation to the perception of ideal body image, social support for eating behavior, and self-efficacy for controlling overeating(p<0.01). As subjects preferred thinner body images(OR=0.39) and received less social support(OR=0.93), the odds of being classified as obese increased. The odds of being obese were also associated with self-efficacy, however, the relation was not strong(OR=1.04). 4) Specific social support was related to obesity among adolescent girls. As subjects received more support from family member, the odds of being obese decreased. The emotional support as well as family member's positive nutrition behavior plays a significant role. In addition, instrumental support from friends was associated with obesity. With repect to self-efficacy, the odds of being obese were increased as subjects felt less confident in controlling overeating when tempting food was placed in front of them or after an argument. In contrast, the obese group felt more confident in controlling overeating for the rest of the specific situations examined. These findings suggest that educational interventions for weight control should incorporate strategies to help participants realize their degree of obesity, to reduce the discrepancy between current and ideal body image, to elicit and maintain social support from friends and family, and to increase the self-efficacy for changing eating behaviors.
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Body Image, Eating Problems and Dietary Intakes among Female College Students in Urban Area of Korea
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Hye Soon Park, Hyun Ok Lee, Chung Ja Sung
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Korean J Community Nutr 1997;2(4):505-514. Published online October 31, 1997
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- Concern about body weight among young females is too much, so distorted body image and restrained eating are serious problems among Korean young females. A society preoccupied with thinness give a psychological burden to women, this burden may have adverse effects on health physically and psychologically. We tried this study to investigate body image, eating problems, and dietary intakes among female college students in urban areas of Korea. We satisfactorily surveyed using their body weight, desired weight dieting, binge eating, and night eating by self- with 500 female college students. We evaluated their dietary intakes by semi-quantitative food frequency to assess their usual intakes. After removing incomplete data, we analyzed 469 data by SAS 6.10. The 469 women aged 21.1 years. Their mean height, weight, and BMI were 161.4cm, 52.5kg, and 20.2kg/m2 respectively. Though the frequency of obesity was only 2.6%, the frequency of dissatisfaction with their body weight was 84.7%. Female college students desired their hight, weight, and BMI to be 165.8cm, 48.2kg, and 17.5kg/m2, respectively. The frequency of binge eating and night eating were 20.7% and 6.8%. The odds ratios for binge eating and night eating were 10.9(95% CI : 2.6-15.1) and 6.0(95% CI : 1.8-14.8) in the group satisfied with their body weight compared with the dissatisfied group. The odds ratios for binge eating and night eating were 2.6(95% CI : 1.6-4.4) and 2.4(95% CI : 1.1-5.4) in the dieting group compared with the non-dieting group. The mean caloric intake was 1,840kacl and percent intakes of carbohydrate, protein, and fat wee 57.2%, 16.3%, and 24.0%, respectively. The dieting group showed deficient intakes of protein and calcium significantly compared with the non-dieting group showed deficient intakes of protein and calcium significantly compared with the non-dieting group. Almost all women college students in urban area had dissatisfaction with their body shape, and desired severe undrerweight. The frequency of binge eating and night eating increased according to dissatisfaction with body weight, diet, and distortion of body image. Dieting has adverse effect on the intakes of essential nutrients. Educations is needed to correct distorted body image, and bad eating habits in young females, and marked preoccupation with thinness among women should then be reduced.
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Levels of Serum Lipids, Copper, Zinc, Ceruloplasmin and Ferroxidase Activity in Smoking College Women
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Jung Hee Kim, Hwa Shin Lee
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Korean J Community Nutr 1997;2(4):515-522. Published online October 31, 1997
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- This study was done to compare serum levels of lipids, trace minerals, ceruloplasmin and ferroxidase activity between female college smokers and nonsmokers. Serum levels of lipids, Cu, Zn, ceruloplasmin and ferroxidase activity were determined in 33 smokers and 42 nonsmokers residing in the Seoul area. Serum levels of TG, total cholesterol and HDl-cholesterol were measured using test kits. Serum Cu Zn were determined by the AAS. Serum ceruloplasimin level and ferroxidase activity were determined by spectrophotometric methods. All data were statistically analyzed by the SAS PC package program. Mean and standard errors were calculated for each item, and the significance of the difference between two groups was evaluated by Student's t-test at p<0.05. There was no significant difference in levels of total cholesterol, TG, VLDL-cholesterol, LDL-cholesterol, LDL/HDL and atherogenic index, but HDL-cholesterol level was significantly lower(p<0.05) in female college smokers than in nonsmokers. Serum zinc level showed no significant difference, whereas copper level was significantly higher in smokers, consequently yielding higher Cu/Zn ratio in smoking college women. Ceruloplasmin level was 32.6mg/dl in smoking college women, which was significantly higher(p<0.05) than that of 28.6mg/dl in nonsmokers. However, cerulopasmin ferroxidase activity, 0.34U/mg in nonsmokers was higher(p<0.05) than that of 0.29U/mg in smokers. From these results, it is confirmed that cigarette smoking itself has a very detrimental effect on health and mineral nutritional status although the smoking history is relatively short among college women(pack-years=1.7).
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Intake/Balanc of Dietary Protein in Korean College Women
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Seung Ho Oh, In Seon Choi
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Korean J Community Nutr 1997;2(4):523-529. Published online October 31, 1997
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- This study was conducted to obtain accurate data on the intake, digestibility and nitrogen balance of protein in Korean college women. Subjects were 8 female college students, aged from 21 to 23, and maintained their menu and life patterns regular during a 4-week study. The same amount of diet that the subjects had consumed, and feces and urine were collected and measured to extract their nitrogen content by Kjeldahl method. From this data, apparent digestibility and the body nitrogen balance were estimated by determing daily protein intake and excretion. The daily protein intake was 56.9+/-1.4g and daily fecal protein loss was 6.3+/-0.2g. The apparent digestibility of protein was 89.6+/-0.7%. The daily nitrogen intake measured by Kjeldahl method was 9.43+/-0.2g. The urinary nitrogen excretion was 7.64+/-0.23g and fecal nitrogen excretion was 1.02+/-0.03g. The nitrogen balance indicated a positive balance of 0.45+/-0.18g.
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A Study on the Attitude toward Control, Diet Behavior and Food Habits of College Students
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Bok Ran Kim, Yong Bong Han, Un Jae Chang
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Korean J Community Nutr 1997;2(4):530-538. Published online October 31, 1997
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- 148 male and 153 female college students attitude toward weight control, diet behaviors and food habits were investigated by self questionnaire. Among the students, underweight students were 11.0%, normal weight students were 63.5% and obese students were 25.6% by RBW standard, and underweight students were 16.0%, nromal weight students were 70.4% and obese students were 13.6% by BMI standard. However, more than 10% of male and 38% of female students thought they were obese even thought their body weight were normal. Female students tended to overeat when they were stressed or in a bad mood and generally all participants had poor scores on the dietary attitudes test, however, male students had significantly higher scores than female students. Female students tended to choose food more for its taste. Collegestudents are in early stage of adult life and their dietary attitudes, food behaviors and life style will continue to their later life. Therefore college students need more good nutrition knowledge, positive dietary attitudes, modified life styles to prevent and treat collegestudents obesity.
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A Study on Factors Related to Recovery from Cerebrovascular Accidents
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bong soon choi, Myeung Hee Park, young Mee Jeoung
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Korean J Community Nutr 1997;2(4):539-546. Published online October 31, 1997
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- This study was designed to investigate factors related to recovery from cerebrovascular accidents(CVA). Medical charts of 100 CVA patients(40 males and 60 females) who had been treated at Bul-Guang hospital in Teagu from June to December 1994 were reviewed to assess their recovery from CVA. Not only types of CVA, blood pressure and serum cholesterol and triglyceride were factors affecting recovery from CVA, but also smoking and drinking status and food preference seemed to be important factors. The percentages of recovered patients were higher in the order of cerebral thrombosis(83.3%), subarachnoid hemorrhage(57.1%), cerebral embolism(50.0%), and cerebral hemorrhage(26.7%). Recovery rates of patients with serum cholesterol below 200mg/dl, 200-239mg/dl, over 240mg/dl were 81.8%, 66.6%, and 16.6% respectively. Recovery rates of patients with serum triglyceride below 160mg/dl, 160-209mg/dl, and oover 210mg/dl were 84.6%, 72.8%, and 35.7% respectively. Patients with standard weight recovered better than those with overweight or obesity. Recovery rates of underweight, standard weight, overweight and obesity patients were 73.3%, 85.7%, 45.8%, and 31.6% respectively. Smoking and drinking seemed to be important factors which inhibited recovery from CVA. Patients preferring spiced foods were recovered better than those preferring salty or pungent foods.
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Nutritional Status and Indicators of Immune Function of Elderly Residing in Low Income Urban Area
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Sook Mee Son, Hye young Yoon
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Korean J Community Nutr 1997;2(4):547-555. Published online October 31, 1997
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- No abstract available.
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Nutritional Status of the Elderly Living in Cheongju - I. Health-Related Habits, Dietary Behaviors and Nutrient Intakes
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Ki Nam Kim, Joung Won Lee, young Sook Park, Tai Sun Hyun
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Korean J Community Nutr 1997;2(4):556-567. Published online October 31, 1997
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- The health-related habits dietary behaviors and nutrient intakes of the elderly living in Cheongju were investigated by interviews with a questionnaire from August to September in 1996. The responses of 169 free-living elderly aged over 65(male 91, female 78) were analyzed. Thirty-six percent of the subjects smoked currently, 33%, drank alcoholic beverages, and 52% exercise regularly. Exercise was mostly in the from of walking for 1/2-1 hour. Significantly higher proportions of males smoked, drank, and exercised as compared to females. Food groups eaten at every meal were examined on a 5-point scale, and the consumption scores were compared with groups according to sex, age, smoking, drinking, and exercise habits. The elderly who exercised regularly got significantly higher scores in their calcium intakes and the variety of the 6 food groups than the elderly who did not exercise. The dietary assessment data showed that the energy intakes of males and females were 81.9% and 72.8% of the RDAs, respectively. The proportions of the elderly consuming less than 75% of RDAs of vitamin A and calcium were 96.5% and 91.1% of the total subjects, respectively. Higher educational status, more pocket money and regular exercise had positive effects on nutrient intakes, while smoking and drinking among females, but not males, had negative effects. Therefore, to improve nutritional status of the elderly, intake of vitamin A-and calcium-rich food such as milk with regular exercise should be emphasized on the education program.
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Nutritional Status of the Elderly Living in Cheongju - II. Anthropometric, Biochdemical and Clinical Assessment
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Tai Sun Hyun, Ki Nam Kim
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Korean J Community Nutr 1997;2(4):568-577. Published online October 31, 1997
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- To assess the nutritional and health status of the elderly, anthropometric measurements and blood test for analyzing biochemical indices were carried out from August to September in 1996. Data on the incidence of a specific disease and clinical symptoms were also collected by interviews with a questionnaire. Among the total of 169 free-living elderly interviewed(91 men, 78 women), 86 elderly(57 men, 29 women) participated in the anthropometric measurements, and 73 elderly(52 men, 21 women) in blood tests. Average heights and weights were much lower than the standards established in the Korean Recommended Dietary Allowances. While average triceps skinfold thickness of men and women were above the 50 percentile of the reference data, mid-arm muscle circumferences were lower than the 50 percentile. Prevalences of anemia, assessed by hemoglobin using WHO definition, were 38.5% for men and 33.3% for women. Blood levels of total protein and albumin were above the normal limit for all participants. Mean blood cholesterol levels of men and women were 163.9mg/dl and 185.8mg/dl, and triglyceride levels were 138.2mg/dl and 161.9mg/dl, respectively. Women older than 75 years generally had high levels of BMI, total cholesterol and triglyceride. Health status assessed by clinical symptoms generally showed no significant difference by age, and their smoking, and drinking habits. Males and the elderly who exercised regularly had better health status. It was suggested that exercise was a good way to improve health status.
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A Study of the Dietary Intake Status and One Portion Size of Commonly Consumed Food and Dishes in Korean Elderly Women
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Sang yeon Kim, Kyungah Jung, Bokyung Lee, Yukyung Chang
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Korean J Community Nutr 1997;2(4):578-592. Published online October 31, 1997
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- The use of semiquantitative food frequency to estimate dietary intake has become widespread in nutritional epidemiologic studies. It had been suggested that knowledge about a person's usual portion size of each meal in addition to consumption frequency will improve the accuracy of this method. This study was performed to investigate the dietary intake status(nutrient, food, and dish intake) and one portion size of commonly consumed food and dishes to develop a semiquantitative food frequency questionnaire that will be used to expore the relationship between the incidence of cardiovascular disease and diet in Korean women after menopause. Intake of food or dish in 123 elderly women were measured by 3-day food records in March to May, 1996. The results obtained in this study were summarized as follow : 1) Calcium, vitamin A, and vitamin E intakes were less adequate than Recommended dietary allowances(RDA). 2) The subjects who consumed more than 20% of the energy from fat were 35% and the subjects consumed dietary cholesterol more than 300mg were 18%. 3) The most frequently consumed foods or dishes by the subjects were Korean cabbage kimchi
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An Analysis of Competencies of Dietitians in Self-operated vs. Contracted Employee Foodservice by Worker-oriented Job Analysis Methodology
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Jin A cha, Il Sun Yang, Tae Yong Yu
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Korean J Community Nutr 1997;2(4):593-604. Published online October 31, 1997
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- The job characteristics and competencies of 285 dietitians in employee foodservices were investigated by worker-oriented job analysis methodology. The purposes of this study were to : a) determine the knowledge, abilities, skills and other characteristics(KASO, hereafter) needed for dietitians in two types of employee foodservice groups(self-operated vs. contracted) and b) the analysis of the degree of frequency and importance and entry requirements of KASO items listed below : their degree of frequency, the level of importance and their function as entry requirements. The 134 KASO items would be divided into 12 task categories. The questionnaire was mailed to 250 dietitians who are members of The Korean Dietetic Association Practice Group in self-operated foodservices(hereafter group A) and 250 dietitians who are employed in contracted foodservice companies(hereafter group B). Completed were received from 285 dietitians(121 in self-operated, 164 in contracted) ; with a response rate of 57%. Statistical data analysis was completed using the SPSS/win and the SAS/win packages. The results of this study can be summarized as follows. 1) Analysis of the degree of frequency, importance and entry requirements of 134 KASO items in group A showed a high priority(score<4.0) placed on 14 items in relation to dietetic tasks and 9 items in relation to human attributes, whereas in group B 19 items in relation to dietetic tasks and 11 items in relation to human attributes. 2) Comparing responses about the KASO items in the 12 task categories, there was a significant difference between the two sample groups with regard to degree of frequency : group A scored 3.29, group B scored 3.50(p<0.01). With regard to importance of KASO items in 12 task categories, group A scored 3.78 and group B scored 3.88 showing no significant differences. With to entry requirements of KASO items in 12 task categories, group A scored 3.29 and group B scored 3.46 showing a significant difference(p<0.05).
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Categorization of Competencies and Description of Job Informations for Dietitians in Employee Foodservice by Wdorker-oriented Job Analysis Methodology
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Jin A cha, Il Sun Yang, Tae Yong Yu
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Korean J Community Nutr 1997;2(4):605-615. Published online October 31, 1997
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- The job characteristics and competencies of 285 dietitians in employee foodservices were investigated by worker-oriented job analysis methodology. The purposes of this study were to : a) determine the knowledge, abilities, skills and other characteristics(KASO) needed for dietitians in two types of employee foodservice groups(self-operated vs. contracted), b) categorize KASO items by factor analysis and c) provide job information and job descriptions for dietitians in employee foodservices. The job analysis questionnaire was consisted of questions concerning the 134 KASO items. The questionnaire was mailed to 250 dietitians who are members of The Korean Dietetic Association Practice Group in self-operated foodservices(group A) and 250 dietitians who are employed in contracted foodservice companies(group B). Completed were received from 285 dietitians(121 in self-operated, 164 in contracted) ; with response rate of 57%. Statistical data analysis was completed using the SPSS/win and the SAS/win packages. The results of this study can be summarized as follows. 1) Through factor analysis, the 134 KASO items were regrouped into 6 categories: 'primary dietetic tasks concerning menu management and administrative work regarding merchants', 'primary dietetic tasks concerning procurement and purchasing of food and supplies and meal production and service control', 'primary dietetic tasks concerning facility, sanitation and safety control', 'secondary dietetic tasks concerning nutrition education and research', 'secondary dietetic tasks concerning foodservice operation management' and 'human attributes'. 2) Analysis of the total scores(average scores of degree of frequency, importance and entry requirements of KASO items within 6 categories), group A showed high priorities placed on 'human attributes', 'procurement and purchasing of food and supplies and meal production and service control', 'menu management and administrative work regarding merchants', 'whereas group B showed high priorities placed on 'human attributes', 'foodservice operation management'.
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Patients' Evaluation on Foodservice in University and General Hospitals
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Jong Ju Lee, Myung Han Choi, Sok Goo Lee, Dong Bae Lee
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Korean J Community Nutr 1997;2(4):616-623. Published online October 31, 1997
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- This study was conducted to investigate and to improve the actual condition of food service for patients in hospitals. For this purpose, were distributed to 283 patients admitted to a university hospital and three general hospitals between January 27 and February 15, 1997. The department participated in the study included internal medicine, surgery, obstetrics, orthopedics and so forth. For meal time, 61.1% of patients wanted to eat breakfast at 8 am, 55.8% lunch at noon, and 73.5% dinner at 6 pm. The patients complained about unsatisfactory hospital food itself by 37.8%, about insufficient food amount by 19.6%, about menu with no choice by 41.2% and about low variety of the meals by 32.7%. Sixty two point nine percent of the subjects enjoyed snacks between meals because of poor appetite at meal time(46.1%), delayed food service(39.9%) and others(11.2%). The types of diet were mainly regular ones(58.6%) with some high protein(12.4%) and diabetic sensitive ones(7.1%). As eating place, the patient's prefered bed(51.9%), room-table(27.2%) and dining room(17.7%). Fifty-five percent of them also wanted hospital foods available to their caring relatives.
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Study on the Establishment of Nutrient Requirements for Commercial Supplementary Foods for Infants and Young Children
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Dong Yeon Kim, Kyung Hee Kim, Haymie Choi
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Korean J Community Nutr 1997;2(4):624-632. Published online October 31, 1997
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- This study was conducted to evaluated the nutrition quality of the commercial supplementary foods for infants and young children and to seek a solution to the establishment of standards of nutrient requirements for supplementary foods in Korea. Information on food ingredients, nutrient contents, claims about usefulness of food components and instructions for feeding preparation were obtained from the labels of 33 commercial supplementary foods manufactured by 4 different domestic companies. According to the standard of supplementary foods for infants and young children described in the Korean Food Code, the commercial supplementary foods were categorized into two different types, weaning food and baby food. All the commercial weaning foods were in powder form and mainly composed of cereals, whereas all the baby foods were mainly composed of fruits in the form of canned juice. The weaning foods contained more nutrients than the baby foods did, and the nutrient levels of the weaning foods expressed as nutrient density on energy basis were higher than the RDA for infants aged 5 to 11 months, suggesting that the commercial weaning foods provide adequate amounts of nutrients. If one followed the instructions for feeding preparation appearing on the label, however, recommended amounts of intake of the weaning foods would provide too much energy as well as nutrients. There were many differences in nutrient standards of weaning foods between the Korean Food Code and Codex international food standard. In conclusion, the establishment of standards for nutrient requirements for the supplementary foods requires significant scientific studies on what nutrients are the most inadequate in Korean infants and young children feeds and what levels of nutrients should be added to the foods in order to supplement their nutrition. In addition, it is very important to have a strong scientific basis to support our standard when discrepancies exist between our standard and the international standard.
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Analysis of Food Consumption Patterns by Income Levels Using Annual Report on the Family Income and Expenditure Survey
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Hae Ryun Park, Hyung Hee Lee, Jeong Soon Ryu
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Korean J Community Nutr 1997;2(4):633-646. Published online October 31, 1997
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- Korea has not tried any food consumption survey so far except the national nutrition survey, which does not show food consumption patterns of different income stratas. The results of the family income and expenditure survey(FIES) by the national statistical office can be precious sources which show household food consumption patterns due to large, random. Samples, year-round survey period and socioeconomic background data. This study analyzed the FIES data to find out food consumption patterns including nutrient intakes and frequently consumed foods by households among different monthly income levels. Big difference was found in food consumption patterns among the quartile-income groups especially the amount of consumed foods, food expenditure, and nutrient intakes. For every food item, the higher the monthly invomr, yhr motr og goof yhry vondumrf. The monthly food expenditure of higher higher income strata was composed with higher percentage of relatively expensive foods compared to other stratas. Nutrient intake levels of lower income strata were 50-60% of the RDA, which showed the necessicity of food assistance programs for those high risk groups to complement the nutritional difficiency.
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