Korean Journal of Community Nutrition

Research Articles

[English]
Serum branch chain amino acids and aromatic amino acids ratio and metabolic risks in Koreans with normal-weight or obesity: a cross-sectional study: Ji-Sook Park, Kainat Ahmed, Jung-Eun Yim; Korean J Community Nutr 2024;29(3):212-221. Published online June 30, 2024; DOI: https://doi.org/10.5720/kjcn.2024.29.3.212

Abstract PDF PubReader ePub: Objectives
Metabolic disease is strongly associated with future insulin resistance, and its prevalence is increasing worldwide. Thus, identifying early biomarkers of metabolic-related disease based on serum profiling is useful to control future metabolic disease. Our study aimed to assess the association of serum branched chain amino acids (BCAAs) and aromatic amino acids (AAAs) ratio and metabolic disease according to body mass index (BMI) status among Korean adults.
Methods
This cross-sectional study included 78 adults aged 20–59 years in Korea. We compared serum amino acid (AA) levels between adults with normal-weight and adults with obesity and investigated biomarkers of metabolic disease. We examined serum AA levels, blood profile, and body composition. We also evaluated the association between serum AAs and metabolic-related disease.
Results
The height, weight, BMI, waist circumference, hip circumference, waist-hip-ratio, body fat mass, body fat percent, skeletal muscle mass, systolic blood pressure, and diastolic blood pressure were higher in the group with obesity compared to normal weight group. The group with obesity showed significantly higher levels of BCAA, AAA, and BCAA and AAA ratio. Further, BCAA and AAA ratio were significantly positively correlated with triglyceride, body weight, and skeletal muscle mass. The evaluation of metabolic disease risks revealed an association between the ratios of BCAAs and AAAs, hypertension, and metabolic syndrome.
Conclusions
Our study is showed the associations between BCAA and AAA ratio, obesity, and obesity-related diseases using various analytical approaches. The elevated BCAA and AAA ratio could be early biomarkers for predicting future metabolic diseases in Korean population.

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[English]
Relationship of sodium index with the obesity indicators of university students in Daegu, South Korea: a cross-sectional study: Young-Won Jang, Jian Ma, Yeon-Kyung Lee; Korean J Community Nutr 2024;29(3):189-198. Published online June 30, 2024; DOI: https://doi.org/10.5720/kjcn.2024.29.3.189

Abstract PDF PubReader ePub: Objectives
The sodium index is an index that converts the estimated sodium intake calculated using a verified and reliable sodium estimation formula. This study aimed to determine the relationship between the sodium index and obesity indicators and the potential impact of excessive sodium consumption on obesity.
Methods
Obesity indicators, such as body mass index (BMI), body fat percentage, waist-to-hip ratio (WHR), and visceral fat levels, were analyzed in 120 university students (60 men and 60 women). The sodium index was calculated by indexing the estimated sodium intake according to age, sex, BMI, salt-eating habits, and salt-eating behaviors. The relationship between sodium index and obesity indicators was analyzed using multiple logistic regression.
Results
The estimated sodium intake was 3,907.1 mg, with 76.7% of the participants categorized under the “careful” level of sodium index and 10.8% under the “moderate” level. As the sodium index increased, the BMI, body fat percentage, WHR, and visceral fat levels significantly increased. All obesity indicators significantly increased in patients with a “severe” sodium index than in those with a “moderate” sodium index. In addition, a strong positive correlation was identified between obesity indicators and sodium index. When the “severe” sodium index was compared with the “moderate” sodium index, the risk of obesity based on body fat percentage increased by 2.181 times (95% confidence interval [CI], 1.526–3.118), while the risk of obesity based on visceral fat level increased by 4.073 times (95% CI, 2.097–7.911).
Conclusions
Our findings suggest a correlation between excessive sodium intake and obesity. Moreover, the sodium index can be used to determine sodium intake.

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[Korean]
Facilitators and barriers to achieving dietary and physical activity goals : focus group interviews with city bus drivers and counseling dietitians: Yongmin Jo, Suhyeun Cho, Young-Hee Han, Taisun Hyun; Korean J Community Nutr 2023;28(5):376-391. Published online October 31, 2023; DOI: https://doi.org/10.5720/kjcn.2023.28.5.376

Abstract PDF

Objectives
Our previously published study showed that a workplace nutrition intervention program with personalized goal setting and smartphone-based nutrition counseling improved dietary habits and physical activity in city bus drivers who were overweight/obese. This study explored the facilitators and barriers that participants faced in achieving their dietary and physical activity goals six months after the intervention.
Methods
The study included bus drivers and dietitians who participated in the intervention program. Three focus group interviews were conducted with 10 bus drivers (divided by two groups based on their achievement of set goals) and five dietitians who had provided nutrition counseling.
Results
Willpower was the most important intrapersonal facilitator for drivers to achieve their goals. Other factors that promoted behavioral changes were nutrition counseling by dietitians, trackable physical activity using smartwatches, and setting of practical and achievable goals. Meanwhile, the most important barriers identified were occupational factors such as long driving hours, short breaks, and shift work. Other barriers were environmental factors such as availability of snackable food, accessibility to convenience stores, and cold weather. Family and colleagues were perceived as both facilitators and barriers. In addition, dietitians identified a lack of knowledge about healthy diet as one of the barriers.
Conclusions
Our results suggested that the workplace environment should be improved and that nutrition intervention programs at the workplace could encourage bus drivers to practice healthy eating habits. The facilitators and barriers identified in this study should be considered when planning a nutrition intervention program for bus drivers.

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Process evaluation of a mobile healthcare program among employees with overweight and obesity: a 12-week intervention study investigating the role of engagement
Imhuei Son, Jiyoun Hong, Young Hee Han, Bo Jeong Gong, Meng Yuan Zhang, Woori Na, Cheongmin Sohn, Taisun Hyun
Korean Journal of Community Nutrition.2023; 28(6): 466. CrossRef

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[Korean]
Factors related to adolescent obesity and changes: a cross-sectional study based on the Korea Youth Risk Behavior Survey: Bora Lee, Ho Kyung Ryu; Korean J Community Nutr 2023;28(5):363-375. Published online October 31, 2023; DOI: https://doi.org/10.5720/kjcn.2023.28.5.363

Abstract PDF

Objectives
The objective of this study was to identify factors associated with adolescent obesity, as well as any new factors that correlated with a change in the rate of obesity over time.
Methods
The study used 5-yearly data collected by the Korea Youth Risk Behavior Survey starting from the year 2006 up until 2021 (data from 2nd, 7th, 11th, and 17th surveys were analyzed). Factors such as demographics, dietary factors, health behavioral factors, and mental health factors were studied. All data were analyzed using IBM SPSS 27.0, employing chi-square tests and multiple logistic regression analysis.
Results
This study included data from a total of 255,200 participants. Factors contributing to obesity varied with time. Over the survey duration of 15 years, low academic achievement, parents with low levels of education, low frequency of fruit consumption, low frequency of fast food intake, long periods of being seated, and high levels of stress were significantly associated with a high rate of obesity. Factors that showed a new correlation with an increase in obesity rates included living with single parents, low frequency of muscle strengthening exercises, and experiencing intense sadness and despair in the past year. Factors that were correlated with a change in obesity rates over time included household economic status, frequency of carbonated beverage consumption, frequency of intense physical activity, and frequency of alcohol consumption. Breakfast intake and smoking were not significantly associated with obesity rates in the 15-year period.
Conclusions
While several factors associated with obesity remained consistent over time, several new factors have emerged in response to social, economic, and environmental changes contributed to a change in obesity rate over time. Therefore, to prevent and manage adolescent obesity, continuous research into the new emergent factors contributing to obesity is needed.

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Effects of watching Mukbang and Cookbang videos on adolescents’ dietary habits and mental health: cross-sectional study using the 18th Korea Youth Risk Behavior Survey
Seung-Hee Hong
Korean Journal of Community Nutrition.2024; 29(2): 156. CrossRef

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Review

[English]
Mercury exposure is associated with obesity: a systematic review and meta-analysis: Jimin Jeon, Kyong Park; Korean J Community Nutr 2023;28(3):192-205. Published online June 30, 2023; DOI: https://doi.org/10.5720/kjcn.2023.28.3.192

Abstract PDF

Objectives
Previous studies have evaluated the association between mercury exposure and obesity but have yielded mixed conclusions. The aim of this study was to systematically review and summarize scientific evidence regarding the association between mercury exposure and obesity in the human population.
Methods
We conducted a systematic search of PubMed, Web of Science, Scopus, and Science Direct for articles related to mercury exposure and obesity. Meta-analyses of the highest and lowest categories of mercury levels were evaluated using a random effects model. Begg’s test was used to detect publication bias.
Results
A total of 9 articles were included. The pooled random effects odds ratio (OR) for mercury exposure and obesity of all 9 studies was 1.66 (95% confidence interval [CI]: 1.16-2.38). This positive association was evident in adults (OR: 1.61, 95% CI: 1.02-2.54) and among studies with Asian populations (OR: 2.00, 95% CI: 1.53-2.59), but not among those with North America/African populations (OR: 0.90, 95% CI: 0.50-1.65).
Conclusions
The present meta-analysis identified a positive association between mercury exposure and obesity. These findings suggest that toxic environmental metals such as mercury may be an important risk factor for obesity along with dietary habits and lifestyles.

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Association between heavy metal exposure and biomarkers for non-alcoholic fatty liver disease in Korean adolescents
Dong-Wook Lee, Jongmin Oh, Yu Min Lee, Hyun-Joo Bae, Youn-Hee Lim
Heliyon.2024; 10(19): e37840. CrossRef

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Research Articles

[English]
Nutritional status and dietary behavior of North Korean adolescent refugees based on Nutrition Quotient for Korean adolescents: a preliminary study: Young Goh, Seong-Woo Choi, So-Yeong Kim, Jeong-Hwa Choi; Korean J Community Nutr 2023;28(1):1-10. Published online February 28, 2023; DOI: https://doi.org/10.5720/kjcn.2023.28.1.1

Abstract PDF: Objectives
This study aimed to investigate the nutritional status and dietary behavior of adolescents from North Korean refugee (NKR) families residing in South Korea (SK), who are known to be at a higher risk of malnutrition due to their lower socioeconomic status and facing other psychological challenges.
Methods
A total of 178 adolescents (91 males and 87 females) from NKR families were included in the analysis, and their demographic details such as age, birthplace, parental nationality, and duration of their settlement in SK were collected through questionnaires. Anthropometric measurements were also taken to determine their growth and nutritional status according to the 2017 Korean National Growth Charts for children and adolescents. The study used the Nutrition Quotient for Korean Adolescents (NQ-A) questionnaire to assess the dietary behavior of the participants.
Results
Approximately 11.8% and 10.1% of participants were identified with malnutrition and obesity, respectively. The total mean score for the NQ-A was 50.1. The mean scores for the individual factors of balance, diversity, moderation, environment, and practice were 49.2, 44.7, 43.8, 51.2, and 61.5, respectively. Approximately 47.2% of participants had a low NQA grade. However, there was no significant difference in the NQ-A scores according to their nutritional status or duration of time in SK.
Conclusions
Adolescents from NKR families exhibited both malnutrition and obesity. However, their dietary behavior, as assessed using the NQ-A, did not vary with their nutritional status. The unique challenges and related dietary behavior of North Korean adolescent refugees should be taken into consideration, when developing targeted strategies for nutritional education and health management programs.

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[Korean]
Program Evaluation using the RE-AIM Framework: A Systematic Review and Application to a Pilot Health Promotion Program for Children: Ji-Eun Lee, Jae Eun Shim, Kirang Kim, Jae-Heon Kang, Ji-Yun Hwang; Korean J Community Nutr 2022;27(4):296-308. Published online August 31, 2022; DOI: https://doi.org/10.5720/kjcn.2022.27.4.296

Abstract PDF: Objectives
This study aimed to develop evaluation criteria for the elementary-school-based health promotion program using the RE-AIM framework and to examine their feasibility.
Methods
Previous evaluation studies on health interventions for elementary-school students using the RE-AIM framework were reviewed systematically to identify appropriate evaluation criteria. A diet and physical activity intervention based on the transtheoretical model was implemented in a pilot study using the “Happy Me” application. The feasibility of using the RE-AIM framework to evaluate it was examined.
Results
The review yielded the following evaluation criteria: “reach,” the ratio of participants out of the total target population; “efficacy/effectiveness,” the difference in outcomes between the intervention and control groups, or between a pre- and post-test; “adoption,” the rate of use of the program and participation in the next stage of the program; “implementation,” the progress on the program components; “maintenance,” the participants’ and teachers’ intention to continue using the program. The pilot study reached 76.6% of the targeted population. The intake of sugar-sweetened beverages decreased (P < 0.0001), and the duration of walking increased (P < 0.0001). Other indicators could not be evaluated; therefore, potential indicators were suggested.
Conclusions
This study produced feasible evaluation criteria for elementary-school-based health promotion using the RE-AIM framework. Nevertheless, the feasibility needs to be validated with a broader range of studies and long-term interventions.

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[English]
The Changes in Obesity Prevalence and Dietary Habits in Korean Adults by Residential Area during the Last 10 Years – Based on the 4^th (2007-2009) and the 7^th (2016-2018) Korea National Health and Nutrition Examination Survey Data: Da-Mee Kim, Kyung-Hee Kim; Korean J Community Nutr 2021;26(1):37-47. Published online February 28, 2021; DOI: https://doi.org/10.5720/kjcn.2021.26.1.37

Abstract PDF

Objectives
The purpose of this study was to discover the changes in obesity prevalence and dietary habits in Korean adults residing in various residential areas during the last 10 years. Methods: Data on Korean adults aged 19 years and above was obtained from the 4^th (2007-2009) and the 7^th (2016-2018) Korea National Health and Nutrition Examination Survey. The subjects were classified into metropolitan 4^th : n=5,977, 7^th : n=6,651), urban (4^th : n=4,511, 7^th : n=5,512) and rural (4^th : n=3,566, 7^th : n=2,570) based on their residence. The general characteristics, nutrient intake, intake amount, food groups, and healthy dietary factors were analyzed. The association between residential areas and obesity prevalence were analyzed by multiple logistic regression. Results: In urban and rural areas, the obesity rate increased in the 7^th survey compared to the 4^th survey, excluding the metropolitan area. The carbohydrate intake decreased, and lipid intake increased in the 7^th survey compared to the 4^th survey. Over the same period, the intake of cereals and vegetables decreased, and the intake of meat and processed foods increased. Rural residents had a higher intake of cereals and vegetables, and a lower intake of milk and processed foods than those in metropolitan areas and urban residents. The proportion of subjects who practiced a healthy diet increased in the 7^th survey compared to the 4^th survey. In the 4^th survey, there was no relationship seen between the prevalence of obesity and the subject’s residential area, but in the 7^th survey, the odds ratio of obesity was higher in rural areas than in the metropolitan areas, confirming the regional gap (OR: 1.16, 95% CI=1.00-1.36, p=0.044). Conclusions: This study showed that the obesity prevalence increased in rural residents compared to metropolitan residents, indicating a gap between the regions. The nutrient intake and intake of food groups changed in the 10 years under consideration, and there were differences seen between regions. Therefore, it is necessary to formulate a policy that will reduce obesity prevalence and health inequalities between regions.

Citations

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Risk of Pancreatic Cancer After Acute Pancreatitis: A Retrospective Analysis of the Korean National Sample Cohort
Sung Hoon Jeong, Kyungduk Hurh, Eun-Cheol Park, Ja-ho Leigh, Seung Hoon Kim, Sung-In Jang
Journal of Korean Medical Science.2024;[Epub] CrossRef
Association of ultra-processed food with diabetes and impaired fasting glucose in elderly populations (urban and rural): a cross-sectional study
Seung Jae Lee, Mi Sook Cho
Korean Journal of Community Nutrition.2024; 29(1): 51. CrossRef
Association of heavy metal complex exposure and neurobehavioral function of children
Minkeun Kim, Chulyong Park, Joon Sakong, Shinhee Ye, So young Son, Kiook Baek
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Anti-Obesity Activity of Ethanol Extract of Veronica peregrina L.
Su Min Kim, Cheol Park, Yung Hyun Choi, Hye Jin Hwang
Journal of the Korean Society of Food Science and Nutrition.2023; 52(4): 350. CrossRef
Effect of Type of Nutrition Labeling on the Healthfulness Evaluation and Purchase Intentions of Home Meal Replacements (HMR) in South Korea
Mee-Young Joe
Korean Journal of Community Nutrition.2022; 27(5): 387. CrossRef
Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4th(2007-2009) and the 7th(2016-2018) Korea National Health and Nutrition Examination Surveys
Sung-Won Oh, Sook-Bae Kim
Korean Journal of Community Nutrition.2022; 27(5): 406. CrossRef
Interactions between red and processed meat consumption and APOA5 gene variants associated with the incidence of metabolic syndrome in Korean adults
Woo Jeong Choi, Dayeon Shin
Genes & Nutrition.2022;[Epub] CrossRef
Association of Dietary Quality with Subjective Health-Related Perception and Chronic Diseases According to Age Segmentation of Korean Elderly
Sojeong Lee, Seungmin Lee
Korean Journal of Community Nutrition.2021; 26(5): 363. CrossRef
Regional Disparity in Adult Obesity Prevalence, and Its Determinants
Bongjeong Kim
Journal of Health Informatics and Statistics.2021; 46(4): 410. CrossRef
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Exercise Science.2021; 30(4): 419. CrossRef

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[English]
Relationship between the Dietary Behavior of Young Children and Their Mothers in Daejeon, Korea Using the Nutrition Quotient for Preschoolers and Adults: InYoung Jeong, SuJin Song; Korean J Community Nutr 2021;26(1):12-22. Published online February 28, 2021; DOI: https://doi.org/10.5720/kjcn.2021.26.1.12

Abstract PDF

Objectives
This study examined the association between the dietary behavior and weight status of preschool children and their mothers in Daejeon, Korea. Methods: A total of 301 mother–preschool children (aged 3~6 years) dyads were included in this study. The dietary behavior of children and their mothers was assessed using the Nutrition Quotient (NQ) questionnaire for preschoolers and adults, respectively. The NQ questionnaires were completed by the mothers. The overweight/ obesity status of children and their mothers was determined using data on height and body weight reported by the mothers. Multiple logistic regression was performed to examine the relationship between the dietary behavior and weight status of children and their mothers. Results: The mean NQ score was 58.9 ± 9.7 in children and 55.6 ± 9.2 in mothers. The NQ score was higher in boys than girls but did not vary by age. The prevalence of overweight/obesity was 27.5% in children and 46.5% in mothers. The physical activity level of mothers and their NQ scores were positively associated with the NQ scores of the children. After adjustment for covariates, the mothers in the highest tertile of NQ scores showed a lower odds ratio (OR) for the unhealthy dietary behavior of children (OR = 0.24, 95% CI = 0.11~0.53, P< 0.001) compared to those in the lowest tertile. The obese mothers showed a higher OR for children’s overweight/obesity (OR = 3.38, 95% CI = 1.68~6.80, P = 0.001) compared to normal weight mothers. Conclusions: The dietary behavior and weight status of young children and their mothers were closely linked. Nutrition education programs targeting mothers are necessary for improving maternal and child nutrition. Specifically, these programs need to be tailored to the socioeconomic characteristics or weight status of mothers.

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Analysis of the factors that influence preschool children eating behavior by applying the health belief model: Seoul and Gyeonggi Province
Sung-Mi Cha, Soo-Youn Kim
Nutrition Research and Practice.2023; 17(3): 541. CrossRef
Early childhood eating behaviors associated with risk of overweight and its socio-ecological determinants in Korean preschool children
Yeri Kim, Jiye Kim, Bomi Lee, Seungyoun Jung, Seo-Jin Chung, Hyekyeong Kim, Nana Shin, Yuri Kim
Nutrition Research and Practice.2023; 17(4): 717. CrossRef
Effects of the COVID-19 Pandemic on Dietary Practices for Mothers in Japan
Lin Wu, Miao Wu, Akira Ishida
Women.2022; 2(3): 264. CrossRef
Use of mothers' home meal replacement and diet quality of their young children
Bo-Yeon Kim, Mi-Hyun Kim
Journal of Nutrition and Health.2021; 54(3): 292. CrossRef

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[English]
Current Barriers of Obesity Management of Children Using Community Child Care Centers and Potential Possibility of Utilizing Mobile Phones: A Qualitative Study for Children and Caregivers: Bo Young Lee, Mi-Young Park, Kirang Kim, Jea Eun Shim, Ji-Yun Hwan; Korean J Community Nutr 2020;25(3):189-203. Published online June 30, 2020; DOI: https://doi.org/10.5720/kjcn.2020.25.3.189

Abstract PDF

Objectives
This study was performed to identify the current barriers of obesity management for children using Community Child Care Centers and their caregivers (parents and teachers working in the Centers). Further, this study explored the possibility of utilizing a mobile phone application for tailored obesity prevention and management programs to overcome the current difficulties associated with children's obesity management.
Methods
The qualitative data were collected through in-depth interviews with 20 obese and overweight children or children who wanted to participate in this study using Community Child Care Centers, 12 teachers working at the Centers, and a focus group interview with five parents of children using the Centers. Data were analyzed with a thematic approach categorizing themes and sub-themes based on the transcripts.
Results
The current barriers of obesity management of obese and overweight children using Community Child Care Centers were lack of self-directed motivation regarding obesity management (chronic obesity-induced lifestyles and reduced self-confidence due to stigma) and lack of support from households and Community Child Care Centers (latchkey child, inconsistency in dietary guidance between the Center and household, repetitive pressure to eat, and absence of regular nutrition education). Mobile phone applications may have potential to overcome the current barriers by providing handy and interesting obesity management based on visual media (real-time tracking of lifestyles using behavior records and social support using gamification), environmental support (supplementation of parental care and network-based education between the Community Child Care Center and household), and individualized intervention (encouragement of tailored and gradual changes in eating habits and tailored goal setting). It is predicted that the real-time mobile phone program will provide information for improving nutritional knowledge and behavioral skills as well as lead to sustainable children’s coping strategies regarding obesity management. In addition, it is expected that environmental factors may be improved by network-based education between the Community Child Care Centers and households using the characteristics of mobile phones, which are free from space and time constraints.
Conclusions
The tailored education program for children using Community Child Care Centers based on mobile phones may prevent and reduce childhood obesity by overcoming the current barriers of obesity management for children, providing environmental and individualized support to promote healthy lifestyles and quality of life in the future.

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An Interactive Live and Online Cooking Program for Children in Vulnerable Families—An Exploratory Study
Jiyoung Park, Sein Hwang, Seolhyang Baek, Gill A. Ten Hoor
Healthcare.2022; 10(12): 2389. CrossRef

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Original Articles

[English]
Dietary and Lifestyle Factors Associated with Weight Status among Korean Adolescents from Multicultural Families: Using Data from the 2017–2018 Korea Youth Risk Behavior Surveys: SuJin Song, Hyojune Song; Korean J Community Nutr 2019;24(6):465-475. Published online December 31, 2019; DOI: https://doi.org/10.5720/kjcn.2019.24.6.465

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