Korean Journal of Community Nutrition

[English]
A Study of Premenstrual Syndrome(PMS) and the Nutritional Intake of College Women Residing in Busan Metropolitan City: Hye Jin Hwang, Young Man Kim; Korean J Community Nutr 2002;7(6):731-740. Published online December 31, 2002

Abstract PDF: This study was designed to identify premenstrual syndrome (PMS) and to investigate the correlation between premenstrual syndrome and nutritional intakes. The subjects of this study were 138 college women residing in Busan Metropolitan City. The subjects were asked to complete Menstrual Discomfort Questionnaire (MDQ) regarding PMS, food intake frequencies and nutritional intake. We studied the correlation between PMS symptoms and nutritional intake. The average height and weight of anemic subjects were 161.42 +/- 3.50 cm and 51.87 +/-5.42 kg. The average BMI (body mass index, kg/m2) was 19.92 +/-2.14 and PIBW (percent ideal body weight) were 93.02 +/-9.75%. Except for phosphorous, vitamin A and vitamin C intakes, the intake levels of all other nutrients were below the Korean RDA. The average calorie intake of the subjects was 1645.65 +/-352.63 kcal (82.2% of the Korean RDA) and iron intake of the subject was 11.06 +/-4.03 mg (69.1% of the Korean RDA). The calcium and vitamin B6 intakes were 512.26 +/-183.12 mg (73.1% of the Korean RDA) and 1.12 +/-0.14 mg (80.0% of the Korean RDA), respectively. With regard to their menstrual state, 45.9% subjects responded that their menstrual cycles were 'irregular'. The frequency of PMS of the subjects was 30.2% (over 3 points) on 5 point scale (1 : no. 5 : severe). The common symptoms of PMS of the subjects were pain (2.32 +/-1.01), negative effects (2.27 +/-0.87), behavioral changes (2.26 +/-0.85), water retention (2.07 +/-0.78), arousal (1.79 +/-0.84), autonomic reactions (1.77 +/-0.87), lack of control (1.69 +/-0.75) and decreased concentration (1.68 +/-0.75). There was significant correlation between all the PMS symptoms and calcium (p < 0.01), vitamin E (p < 0.05), carbohydrate (p < 0.05). This suggests that PMS represents the clinical manifestation of nutrient deficiency states especially calcium. Therefore we concluded that calcium supplementation is likely to be of benefit in relieving PMS symptoms.

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A Nutritional Survey of Women Divers in Tongyoung Area: Joo Hee Lee, Chan Kim; Korean J Community Nutr 2002;7(6):741-748. Published online December 31, 2002

Abstract PDF: The purpose of this study was to investigate the nutritional intake and dietary habits of women divers in Tongyoung area and to support the guideline for the improvement of their dietary life style by a validation of a Computerized Semiquantitative Food Frequency Questionaire. Compared to the women at Jeju Island, the Tongyoung divers showed similar heights (154.6 +/-0.8 cm), weights (53.5 +/-1.0 kg) and BMIs (23.3 +/-0.4), but they showed especially high levels of body fat (33.8 +/-0.8). Their dietary habits showed they usually skipped lunch, but ate too much food at once, which may represent the dietary habits shown by obese people. Over 40% of the divers were taking some nutritious food or complementary food for health, without realizing the efficacy of these foods. The analysis of nutritional intake showed that all of average daily nutrients intakes of those below 50 years were higher than those of the Korean RDA. In the case of those above 50 years , it was shown that the average daily nutrients intakes were also higher than those of the Korean RDA except for energy (94.5%) and calcium (82.1%). However, some individual divers showed lower nutrients intakes than 75% of RDA for calcium, iron, Vitamin A and Vitamin B2. Also, excessive intakes of phosphorous and sodium could be a dietary problem. There was no correlation between BMI or percentage of body fat and energy, CHO, protein or fat. These results can provide the nutritional information for this special community, women divers, to improve their health.

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[English]
A Study of Health-related Habits, Dietary Behaviors and the Health Status of the Middle-aged and the Elderly Living in the Chonju Area (II): Mee Sook Lee, Mee Kyung Woo; Korean J Community Nutr 2002;7(6):749-761. Published online December 31, 2002

Abstract PDF: This study investigated the anthropometric and biochemical indices, and the health and nutritional factors influencing the two indices among 194 middle-aged and elderly subjects (108 middle-aged and 86 elderly) residing in a medium sized city for more than 10 years. In the examination of their dietary habits, 8.3% of the middle-aged subjects and 14.0% of the elderly subjects had two meals a day, and more female subjects had two meals per day. Of the subjects who ate meals at regular times, 75.0% were middle-aged and 79.1% were elderly, and the degree of irregularity of meals was greater for female subjects. The study of the dietary behavior of the subjects indicated that 71.3% and 66.3% of the middle-aged and elderly, respectively responded that the amount of food in each meal was sufficient. The subjects ate alone comprised 19.7% of the middle-aged females and 31.5% of the elderly females. The prevalence of smoking among the subjects was 28.1% for the middle-aged, 18.8% for the elderly male and 7.4% for the elderly females. The percentage of the subjects who drank alcohol was 34.4% of the middle-aged males and 13.2% of the middle-aged females. Slightly less than half of the subjects exercised more than once a week, with the male subjects showing a higher rate than the female subjects. The average body mass indices (BMI) were 24.5 and 24.6 for the middle-aged male and female, respectively, and 22.6 and 24.0 for the elderly male and female, respectively. BMI assessment showed that underweight subjects (BMI < 20) comprised 3.7% of the middle-aged, 14.0% of the elderly, and that 40.7% of the middle-aged and 24.4% of the elderly were overweight (25 < BMI < 30); and 0.9% of the middle-aged and 1.2% of the elderly were classified as obese (BMI > or = 30). A waist/hip ratio (WHR) greater than 0.8 was found in 89.5% of the middle-aged females and 90.7% of the elderly females, showing high abdominal fat deposition in the majority of females. The average systolic blood pressure of females was 121.1 +/- 17.1 mmHg for the middle-aged and 129.6 +/- 21.3 mmHg for the elderly subjects. The systolic blood pressures showed a significantly difference between the two age groups. Those defined as anemic subjects based on hemoglobin values comprised 13.0% of the middled-aged group and 16.3% of the elderly group. There was a tendency for higher fasting glucose levels among the elderly subjects. An increase in total plasma cholesterol levels with age was shown. The female subjects had higher cholesterol levels than the males'. The study of the correlation between the daily habits and health status showed that the amount of food eaten at each meal, the frequency of eating out, and the use of dietary supplements appeared to influence BMI, WHR, the plasma triglyceride and plasma cholesterol levels; omitting one meal had a positive correlation with the systolic blood pressure and plasma cholesterol. These results suggest that desirable dietary habits and concerns for health are contributing factors for maintaining good health, as indicated by normal blood lipid levels.

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[English]
Antropometric and Health Status of the Elderly Women Attending a Health Promotion Program in an Urban Community: Jin Hee Kwon, Hee Jung Yoon, Hyo Jung Moon, Jae Moo Lee, Yoon Hee Son, Sung Hwa Park, Hee Kyung Lee, Sung Kook Lee; Korean J Community Nutr 2002;7(6):762-768. Published online December 31, 2002

Abstract PDF: This study was conducted to evaluate the health status of elderly women who attended in a Health Promotion Program of the Seo-gu Health Center in Daegu. The study subjects were 158 elderly women (over 65 years) in an urban community. The subjects were investigated by means of individual interviews using a questionnaire, Blood tests for analyzing their biochemical status were carried out. The average age of the study subjects was 70.9 +/- 2.3 years. Of the subject group 79.1% ranged in age from 65 to 74 year and 20.9% were over 75 years. With respect to health related factors, 23.4% of subjects drank alcoholic beverages and 15.2% of sujects currently smoker. The prevalence with chronic diseases was 51.9%, and 26.6% of the subjects were healthy. The diseases most frequently reported as having been or being treated were arthritis (38.1%), hypertension (21.4%), and diabetes (17.9%). The average height of subjects was below the standard established in the Korean Recommended Dietary Allowances, while the average weight was close to the standard. The means of systolic and diastolic blood pressure were 130.2 mmHg and 71.9 mmHg, respectively. The mean serum albumin level was 4.5 mg/dl, and the value of hemoglobin and hematocrit was 12.5 mg/dl and 0.7%, respectively. The mean serum cholesterol level was 207.1 mg/dl and the mean triglyceride level was 187.7 mg/dl. The serum lipid levels were higher then in those reported in research. The serum cholesterol levels of 71.5%of subjects were within the normal range. The GOT and GTP levels were within the moderate range. In conclusion, the health status of the elderly who attended the Health Promotion Program in the Seo-gu Health Center were very average. However, it was necessary to prepare a health management program to deal with the serum lipids so as to establish and maintain good health. When we carry out the health promotion program in a community, individual program of adequate to health status should be developed more.

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Identification of the Dietary Intake Patterns of Korean Adults according to Their Exercise Levels: Young Ok Kim; Korean J Community Nutr 2002;7(6):769-780. Published online December 31, 2002

Abstract PDF: The purpose of this study was to identify the differences in dietary consumption patterns according to the exercise level of Korean adults. The study subjects were the 7,370 Koreans aged 20 years and older of the 1998 Korean Health and Nutrition Survey. The dietary assessment was conducted by means of the 24 hour recall method. Data for individual exercise behavior were collected by interviews as part of the National Health Behavior Survey. Following the analysis of variances the Duncan's Multiple Range Test was used to test the differences in food and nutrient intakes among groups with different levels of exercise. Current exercise practices were reported by 22% of the male subjects and 15% of the female subjects. Unlike observations from the American and European studies, a greater amount of meat intake was observed more frequently among high exercises group than among middle and low exercisers in the case of the male subjects. This was reflected in the increasing levels of protein and fat intake in proportion to the exercise levels. However, the food and nutrient intake patterns of female exercisers were quite different from those of the males. The least intake of fatty foods was observed among the high exercisers. Energy intake from fat was the lowest among the high exercisers. These results may imply that the motivation to exercise was quite different between male and female Koreans. This dietary pattern may have a risk of undernution. Summerizing the results, whatever the motivation of the exercise, the Korean exercisers of both sexes had unhealthy dietary pattern. Therefore, nutritional education should be conducted to encourage the eating of a balanced diet along with exercise, among Koreans of both sexes, in order to promote a healthy lifestyle.

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[English]
Nutritional Education Status and Recognition of the Importance of Elementary School Dietitians in the Gyeongnam Area: Eun Sil Her, Hal La Yang, Hyun Sook Yoon, Kyung Hea Lee; Korean J Community Nutr 2002;7(6):781-793. Published online December 31, 2002

Abstract PDF: This study was carried out to investigate the nutritional education status and the recognition of the importance of elementary school dietitians (N=183) in the Gyeongnam area. The results are summarized as follows. All subjects took part in nutritional education program, but the educational methods were passive, as in the case of "home correspondence" (80.8%) and "bulletin board poster" (16.4%), and the education frequency was very low as in "one time/month" (90.2%). The subjects thought "as an independent subject" (41.5%) and "as a related subjects" (35.1%) were suitable teaching venues for the nutritional education. They were very low in individual counseling (4.5%) for school children because of "lack of opportunity" (42.2%) and "heavy work load" (24.1%). However, most of the subjects wished that nutritional counseling could offered in the future (95.5%). The parents' experience of nutritional education was also low (34.3%). Information sources for nutritional education were mainly the "internet" (53.1%) and "re-educational materials" (25.0%). The available instructional materials included "printed materials" (96.7%), "exhibition bulletin materials" (70.3%) and "electronic materials" (46.4%). The preferred education materials were "exhibition bulletin materials" (32.2%), "printed materials" (29.2%), and "electronic materiaThis study was carried ls" (27.7%). However, materials they wished to purchase were "electronic materials" (54.5%) and "cubic materials" (26.0%). These results show a difference between the preferred materials and the possessed materials. Most school dietitians (98.4%) recognized the necessity of nutritional education with respect to "good table manners" (42.0%), "correction of food prejudices" (30.3%), and "proper nutrition for growth" (21.0%). Although they had a great interest in nutritional education, they had difficulty in cutting their learning into practice because of "heavy work load" (30.9%), "lack of a systematic curriculum" (25.2%), and "lack of a educational opportunity" (22.8%). Ninety five percent of subjects wished to have nutrition education taught as an independent subject. They pointed out "kindergarten" (60.0%) and "lower grades in elementary school" (33.9%) as the optimal starting times for nutritional education and "school dietitians" (91.3%) as suitable teachers for these programs. The required topics chosen by the subjects for nutritional education for children were "proper eating habits" (54.2%) and "nutritional problem" (31.5%). The dietitians thought "food prejudices" (44.7%), "eat too much processed and instant foods" (36.5%), and "obesity" (11.8%) were the most common nutritional problems among elementary school children. These results suggest the necessity of solving the nutritional problems in children by developing a nutritional education program. Along with this program, if dietitian assisted programs for parents were developed, the effects of nutritional education could definitely be increased.

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The Effect of Individualized Nutritional Education on Adults having two or more Symptoms of Chronic Degenerative Disease: Jin Sook Yoon, Young Hye Jeong, Jung A Park, Hyun Mee Oh; Korean J Community Nutr 2002;7(6):794-802. Published online December 31, 2002

Abstract PDF: This study was intended to evaluate the overall effects of nutritional education on adults having two or more symptoms of chronic degenerative disease. A nine week nutritional education program was provided for 65 adults with chronic diseases. We assessed the changes in dietary knowledge, eating behavior and socio-psychological factors. When we evaluated the nutrient intakes of the subjects, their energy intake was 79.4% of the Korean Recommended Dietary Allowances (RDA). Their dietary intake of other nutrients was also below the RDA level except for Vitamin C. Their knowledge of dietary therapy was slightly improved after the implementing of nutritional education. The dietary behavior of 'night snacks before sleep' was significantly improved. While the overall fear due to disease was significantly increased, self-efficacy was not improved. Self-efficacy for eating "three regular meals" and "choosing fruit, vegetable and grain" were significantly decreased. Family support for "buying food which is good for my health" was also significantly increased, whereas "advises me to eat appropriate foods for health" was decreased. Biochemical analysis indicated that blood levels of triglyceride, cholesterol and blood pressure improved after nutrition education. Therefore, we concluded that nutritional education program for people with chronic degenerative diseases could change the diet therapy knowledge, dietary behavior, and the fear due to disease, support from family and behavior intention toward the direction to improve the chronic disease condition. However, it did not improve self-efficacy. Our study also indicated that nutritional education strategies to improve self-efficacy should be an important aspect in a long term education plan for patients to establish desirable eating habits.

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Dietary Behaviors, Health-related Lifestyle and Blood Lipid Profile of Obese Children in Incheon: Mi Young Lee, Soon Ki Kim, Kyung Ja Chang; Korean J Community Nutr 2002;7(6):803-813. Published online December 31, 2002

Abstract PDF: The purpose of this study was to investigate the anthropometric and blood biochemical characteristics, the dietary behaviors and health-related lifestyles of obese children in Incheon. A cross-sectional survey was conducted using anthropometric measurements, biochemical assessments and questionnaire analysis. The subjects included 7,055 obese children residing in the Incheon area (from 106 elementary schools). The degree of obesity was classified using the Obesity Index (OI) as : light 20% < OI < 30% ; Medium 30% < OI < 50% ; Severe 50% > OI. The statistical analysis was conducted using SPSS 10.0 program. Most subjects fell within the medium range of obesity. Most subjects had dietary problems such as overeating, unbalanced meals and skipping breakfast. The ratio of boy subjects eating green and yellow vegetables was lower when compared to that of the girl subjects. The boy subjects exercised more frequently and longer than the girls. As the Obesity Index increased, hypercholesterolemia significantly increased. The blood cholesterol levels of the subjects were positively correlated with body fat, waist/hip ratio and BMI; HDL cholesterol levels of the subjects were negatively correlated with the anthropometric data and the LDL cholesterol levels of the subjects were positively correlated with body fat. The blood triglycerides levels of the subjects were positively correlated with body weight, body fat, waist/hip ratio and BMI. Therefore, proper nutritional education and intervention are required for an improvement of obese children's dietary behavior, heath-related factors and blood lipid profiles.

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Dietary Behavior and Nutritional Status of the Elderly Women Attending at the Health Promotion Program in an Urban Community: Jin Hee Kwon, Hee Jung Yoon, Jae Moo Lee, Sung Kook Lee; Korean J Community Nutr 2002;7(6):814-823. Published online December 31, 2002

Abstract PDF: This study was conducted to evaluate the nutritional status of the elderly women, who attended the Health Promotion Program of the Seogu Health Center in Daegu. The study subjects were 158 elderly women in an urban community. The general characteristics, dietary behavior (nutritional knowledge, nutritional attitudes and dietary habits), food and nutrient intake were surveyed by an individual interview. The average age of the study subjects was 70.9 +/- 2.3 years of the subject group 79.1% ranged in age from 65 to 74 years and 20.9% were over 75 years. Their average score for nutritional knowledge, nutritional attitudes and dietary habits was 7.3 (total mark of 10), 7.2 (total mark of 10) and 9.1 (total mark of 22) respectively. Specifically, the level of the dietary habits of the study subjects was very low. In relation to food group intake of the study subjects according to age, their food intake was low. The total, plant, and animal food intake were 1078.9 g, 954.4 g (88.5%), and 244.4 g (11.5%), respectively. The mean daily energy intake and nutrient intake according to percentage of the Korean RDA were higher in the from 65 to 74 year group than in those people over 75 years. The average calories and the mean percentage of nutrient intake, except for vitamin C and phosphorus, were below 75% of the Korean RDA. It seems that the nutrient intake was very low. The mean nutrient adequacy ratio (MAR) was 0.59. Nutritional status of age over 75 years old was significantly lower than that of 65 - 74 years old group (Mar = 0.60 VS 0.54, p < 0.05). The correlation coefficients between their dietary behavior (nutritional knowledge, nutritional attitudes, dietary habit) and their mean nutrient adequacy ratio (MAR) showed significant linear relations. In conclusion, if nutritional education is to affect the dietary behavior of elderly women, it should be included in a program to promote their nutrition and health status.

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A Study of the Nutritional Intake from Lunch-Box of Middle School Girls in the Chonbuk Area: Mi Ran Kim, Hee Sook Sohn, Sook Bae Kim, Youn Soo Cha; Korean J Community Nutr 2002;7(6):824-832. Published online December 31, 2002

Abstract PDF: The present study was conducted to evaluate nutritional intake by lunch-box of middle school girls who live in Chonbuk area. Anthropometric measurements and food intake from lunch-box over a three day period were investigated in a total of 110 middle school girls from rural (n = 37) and urban (n = 73) areas. The results are summarized as follows : 1. Not all the steamed rice in the lunch-box had enough mixed-cereal. 2. In the survey of food intake by food groups, 70.5% of the food came from the cereal group. 3. The intake of protein, phosphate, Vitamins B1 and B2, niacine and Vitamin E were adequate, however, the intake of other nutrients was significantly lower than those of one-third of the Korean RDA. 4. Protein, lipid, and zinc intakes of the students from the rural area were significantly lower than those of students from the urban area, however, the carbohydrate and dietary fiber intakes of those in the rural area were significantly higher than those of the students in the urban area. 5. The percentage of calories from carbohydrate : protein : lipid ratio was 67.6 : 12.2 : 16.9 for students in the rural area and 59.2 : 14.9 : 22.5 respectively for those in the urban area. In Summary, the intake of calcium, iron, Vitamins A, B6, and D, folate and zinc from lunch-box in middle school girls was much lower than that of one-third of the Korean RDA. The intake of carbohydrate and dietary fiber of the students in the rural area was significantly higher, but that of protein, lipids, and zinc was lower than that of the students in the urban area. Therefore, nutritional education programs for both students and their parents should be provided to improve the daily food intake from lunch-box.

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Nutritional Evaluation, Stability of Cereals and Sanitation Status of Processing Utensils and Environments Based on Hygiene Education: Eun Mi Kim, Hyun Sook Kim; Korean J Community Nutr 2002;7(6):833-843. Published online December 31, 2002

Abstract PDF: This study was carried out to investigate the effect of hygiene education on the microbiological changes of processing utensils and the environmental in the manufacture of cereals and to evaluate the Cd, Pb contents and nutrient compositions of 11 cereals. The result of microbiological evaluation was that fungi, coliforms and staphylococcus species were detected in employees, on equipment, utensils and environments in the first inspection. Fungi were detected in most of the cereals, staphylococcus species were detected in soybeans, perilla seeds and sea tangle flour, and bacillus cereus was detected in sorghum and black sesame seeds. The water content of rice, barley, glutinous rice, brown rice and carrot flour in packaged products, and in carrot flour, angelica keiskei, carrot, sea mustard and potato in bulk products was in excess of 8.0%. The Pb content of cereals was 0.14 - 0.51 mg/kg and Cd was not found. The acid value of Job's tears flour and black sesame seed flour was higher than 5.0 mg/g oil. Cereals were manufactured from 41 different cereals and grains, legumes, seeds and nuts, vegetables, potatoes, seaweeds, fruits, glucose and salt. The average content of cereals and grains, legumes, and seeds and nuts in cereals was 75.75%, 16.19% and 4.93%, respectively. The mean nutrient content per 100 g of cereals was calories 365.8kcal, protein 13.3 g, fats 5.9 g, carbohydrates 63.4 g, Ca 91.8 mg, P 269.9 mg, Fe 3.15 mg, Na 76.2 g, K 421.8 mg, Zn 2.33 mg, Vit. A 12.5 R.E., Vit. B1 0.23 mg, Vit. B2 0.16 mg, Vit. B6 0.46 mg, Niacin 3.5 mg, Vit. C 1.36 mg, folic acid 62.3 microgram and Vit. E 1.24 mg. When nutrients value of 48 g of cereals and 200 ml of milk was compared to 1/3 of the RDA, the values were below than 60% of 1/3 of the RDA except Na, K, Vitamin B1 and C contents. The average carbohydrate : protein : fat ratio of energy intake was 54.27 : 17.45 : 28.28, respectively. Therefore, a training program consisting of the education of the staff in surveillance and standard operating procedures, the elimination of dangerous procedures, sanitation checklist, the implementation of preparation methods and standard recipes for cereals is required.

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The Effects of Smoking on Antioxidative Enzyme Activities in Male Adolescents: Jae Yeon Lim, Jung Hee Kim; Korean J Community Nutr 2002;7(6):844-851. Published online December 31, 2002

Abstract PDF: Smoking can increase oxidative stress and thereby change the antioxidant defense system in the body. To investigate the relationship between male adolescent smoking and antioxidant status, we surveyed the eating habits and dietary intake of 82 smokers and 44 nonsmokers recruited from a male technical high school. In addition, antioxidant enzyme activity and lipid peroxide values were determined in both the plasma and the erythrocytes. Although the frequency of food intake was not significantly different, most nutrient intake was unexpectedly higher in smokers than in nonsmokers. In comparison with the Korean RDA, especially the average intake of Ca, Fe and vitamin B2 didn't reach 75% of the Korean RDA in either smokers or nonsmokers. An analysis of antioxidant enzyme activity showed that plasma catalase, superoxide dismutase (SOD), glutathione peroxidase (GSH-px), erythrocyte catalase and GSH-px activities showed no significant difference between smokers and nonsmokers. However, the erythrocyte SOD activity of smokers (1.57 unit/mgHb) was significantly lower than that of nonsmokers (2.00 unit/mgHb). In addition, the plasma ceruloplasmin concentration of smokers (28.68 mg/dl) was significantly higher than that of nonsmokers (26.30 mg/dl), whereas the specific ceruloplasmin ferroxidase activity of smokers (0.31 unit/mg) was lower than that of nonsmokers (0.35 unit/mg). The plasma and erythrocyte thiobarbituric acid reactive substance (TBARS) of smokers (2.57 micromol/L, 0.32 micromol/gHb) were also significantly higher than those of nonsmokers (2.25 micromol/L, 0.27 micromol/gHb). The overall data indicate that adolescent smoking might decrease the antioxidant capacity of the body, in part, by lowering the erythrocyte SOD activity and the specific ceruloplasmin ferroxidase activity.

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A Review of the Medical Nutrition Therapy (MNT) of the U.S. Medicare System: Eun Cheol Park, Hyun Ah Kim, Hae Young Lee, Young Eun Lee, Il Sun Yang; Korean J Community Nutr 2002;7(6):852-862. Published online December 31, 2002

Abstract PDF: The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as "the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases". Also, the MNT Act defined "conditions for coverage of MNT", "limitations on coverage of MNT", and "qualifications of MNT service provider". To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therfore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by policy makers, so the ADA contracted with the Lewin Group to carry out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, "The Cost of Covering Medical Nutrition Therapy under Medicare: 1998 through 2004", it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion). Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MNT. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.

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The Economic Benefits of Breastfeeding: Taisun Hyun, Ki Nam Kim, Nammi Kang, Eun Young Lim; Korean J Community Nutr 2002;7(6):863-871. Published online December 31, 2002

Abstract PDF: To compare the costs incurred by infant feeding between mothers who breastfed their infants and those who fed them infant formula, a questionnaire survey was carried out to 136 mothers living in Seoul, Cheongju and Chungju who breastfed and 199 mothers who formula-fed their infants. The cost of formula-feeding was estimated based on the expenditures for formula and feeding apparatus, and the time needed to wash bottles and prepare formula. The cost of breastfeeding was estimated based on the expenditures for food for the additional nutritional intake of these mothers. The mean cost of formula-feeding was 1,870,125won during the first year of the baby's life. The food cost for the additional nutritional intake of the breastfeeding mothers was 203,004 won per year. The extra medical cost for respiratory illnesses in the formula-fed group compared to the breastfed group was 62,920 won because the formula-fed infants required medical attention for respiratory illnesses more often than the breast-fed infants. Therefore, breastfeeding could save 1,730,041 won during the first year of an infant's life. We may have underestimated the cost savings from breastfeeding because we did not take into account the potentially decreased costs of fertility control and the health benefits for mothers, as well as the decreased usage of water and gas. Analyses showed that breastfeeding is not only nutritionally advantageous, but also economically advantageous for families and society.