• Nutrition Research and Practice
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• 제16권2호
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• pp.233-247
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• 2022

BACKGROUND/OBJECTIVES: The objective of this study was to describe the development process of the Korean Healthy Eating Index (KHEI) based on the Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The components of KHEI were selected based on Dietary Guidelines for Koreans, domestic and overseas dietary quality indices, and results of the analysis of association with chronic diseases. The standards for scoring of KHEI were selected based on the 2015 Dietary Reference Intakes for Koreans (KDRI). The KHEI scores of Korean adults were calculated using a 1-day 24-h recall data in the 2013-2015 KNHANES. RESULTS: The KHEI included eight adequacy components evaluating the proper intake of recommended foods such as fruit, vegetable, and milk and three moderation components evaluating the consumption of food that limit intake such as sodium and saturated fatty acid. In addition, three balance components assessing the balance of energy intake were included. The KHEI score was defined to range from the minimum of 0 point to the maximum of 100 points. Among Korean adults, the total KHEI score was 63.2 out of 100. Gender and age differences were found in the average of total KHEI scores. Women showed higher score than men (61.7 in men and 64.7 in women, respectively). By age group, 20s and 30s showed the lowest scores with 57.4 and 61.1 respectively, and the scores increased with age by peaking at 67.8 in ages 60-69 and slowed down again in ages 70 or over. CONCLUSIONS: The KHEI can be useful for establishing and assessing national nutritional policies and in epidemiological studies to assess the relationship between overall dietary quality and chronic diseases. KHEI will need to be continuously updated to reflect changes in dietary guidelines and the KDRI.

• Nutrition Research and Practice
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• 제17권2호
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• pp.316-329
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• 2023

BACKGROUND/OBJECTIVES: This study investigated the association between dietary quality based on the Korean Healthy Eating Index (KHEI), and the prevalence of chronic conditions among middle-aged individuals (40-60 yrs of age) living alone. MATERIALS/METHODS: The participants were selected (1,517 men and 2,596 women) from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018 and classified into single-person households (SPH) and multi-person households (MPH). Nutrient intake, KHEI, and the prevalence of chronic conditions were compared according to household size. The odds ratios (ORs) of chronic conditions were analyzed according to the tertile levels of KHEI by gender within each household size category. RESULTS: Men in SPH had a significantly lower total KHEI score (P < 0.0001) and a lower prevalence of obesity (OR, 0.576) than those in MPH. For men, the adjusted ORs for obesity, hypertension, and hypertriglyceridemia in the first tertile (T1) of KHEI scores within SPH compared with the third tertile (T3) were 4.625, 3.790, and 4.333, respectively. Moreover, the adjusted OR for hypertriglyceridemia in the T1 group compared to the T3 group within the MPH was 1.556. For women, the adjusted ORs for obesity and hypertriglyceridemia in T1 compared to T3 within the SPH were 3.223 and 7.134, respectively, and 1.573 and 1.373 for obesity and hypertension, respectively, within MPH. CONCLUSIONS: A healthy eating index was associated with a reduced risk of chronic conditions in middle-aged adults. Greater adherence to a healthy eating index could lower the risk of chronic conditions in middle-aged adults living alone.

• Nutrition Research and Practice
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• 제15권4호
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• pp.516-527
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• 2021

BACKGROUND/OBJECTIVES: This study examined the association of depressive symptoms, stress perception, and suicidal ideation with overall dietary quality using the newly developed Korean healthy eating index (KHEI). SUBJECTS/METHODS: This study included 9,607 adults (3,939 men and 5,668 women, ≥ 19 years) who participated in the 6th Korea National Health and Nutrition Examination Survey 2013 and 2015. The KHEI scores were calculated using the food frequency questionnaire data. Survey logistic regression analyses were performed to analyze the association between psychiatric distress and dietary quality. RESULTS: The percentage of subjects with experience of depressive mood, higher stress perception, and suicidal ideation was 8.2%, 25.0%, and 3.7% in men and 15.4%, 27.3%, and 6.0% in women, respectively. The mean KHEI score was 61.5 ± 0.29 in men and 64.8 ± 0.24 in women (P < 0.001). The present study found a difference in the adherence to specific dietary components of the KHEI between sexes. Men experiencing depressive symptoms were less likely to eat meat, fish, eggs, and beans, while depressed women showed lower vegetable intake. Both men and women with suicidal ideation showed a lower intake of vegetables. The men with stress had a lower breakfast eating score than those without stress (7.21 vs. 6.77, P = 0.016). The multivariate-adjusted odds ratios for depressive symptoms, stress perception, and the suicidal idea in women with the highest quartile of KHEI scores compared to the lowest quartile was 0.69 (95% confidence interval, 0.51-0.92), 0.73 (0.58-0.82), and 0.52 (0.33-0.82), respectively and significant dose-response associations were observed (P for trends < 0.05 for all). On the other hand, these associations were not observed in men after adjusting for the confounding variables (P for trends > 0.05 for all). CONCLUSIONS: Poor adherence to dietary recommendations is associated with psychological distress, especially in women.

• 대한영양사협회학술지
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• 제28권2호
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• pp.114-126
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• 2022

The relationship between mortality and the Korean Healthy Eating Index ("KHEI") is well established. This study was to investigate the associations between health habits, mental health, and nutritional status and KHEI in older Koreans (aged≥65 years). A total of 4,247 subjects (1,842 men and 2,405 women) that participated in the 2016~2018 Korean National Health and Nutrition Examination Survey were included in the analysis. The lowest scoring KHEI item was milk and milk products. KHEI tertile groups were classified by total KHEI score. Tertile group percentages were related to general characteristics such as gender, residential area, educational level, income level, number of family members, and age. Logistic regression analysis adjusted for general characteristics, showed that ex-smokers (OR: male 1.53 female 2.29), smokers (OR: male 2.90), low hand grip strength (OR: male 1.42 female 1.90), poor self-rated health status (OR: female 1.83), stressful mental status (OR: female 1.51), poor health-related quality of life (OR: female 1.64), poor nutritional status (OR: male 2.88~37.20 female 1.98~16.12), and food insecurity (OR: male 6.87 female 2.03) were significantly related to a lower KHEI. This study suggests that gender-specific associations exist between mental health status and KHEI.

• 대한지역사회영양학회지
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• 제25권1호
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• pp.61-70
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• 2020

Objectives: This study examined the association of the total diet quality with the incidence risk of metabolic syndrome constituents and metabolic syndrome among Korean adults. Methods: Based on a community-based cohort of the Korean Genome and Epidemiology Study (KoGES) from 2001 to 2014, data from a total of 5,549 subjects (2,805 men & 2,744 women) aged 40~69 years at the baseline with a total follow-up period of 38,166 person-years were analyzed. The criteria of the National Cholesterol Education Program Adult Treatment Panel was employed to define metabolic syndrome. The total diet quality was estimated using the Korean Healthy Eating Index (KHEI). Hazard ratios (HR) and 95% confidence intervals (CI) for risk of metabolic syndrome constituents and metabolic syndrome in relation to KHEI quintile groups was calculated by multivariate Cox proportional hazards regression model. Results: After adjusting for age, energy intake, income, education, physical activity, smoking, and drinking, the incidence of abdominal obesity and high blood pressure was significantly lower, by approximately 29.7% (P < 0.01) and 25.2% (P < 0.01), respectively, in the fifth KHEI quintile compared to the first quintile in men. A significant decreasing trend of the metabolic syndrome incidence was observed across the improving levels of KHEI (HRq5vs.q1: 0.775, 95% CIq5vs.q1: 0.619~0.971, P for trend < 0.01). In women, the incidence of abdominal obesity and metabolic syndrome was significantly lower, by approximately 29.8% (P < 0.01) and 22.5% (P < 0.05), respectively, in the fifth KHEI quintile compared to the first quintile adjusting for multiple covariates. On the other hand, the linear trend of metabolic syndrome risk across the KHEI levels did not reach the significance level. Conclusions: A better diet quality can prevent future metabolic syndrome and its certain risk factors among Korean men and women.

• Journal of Nutrition and Health
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• 제57권1호
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• pp.88-104
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• 2024

본 연구는 국민건강영양조사 2015년부터 2018년도 자료를 활용하여 우리나라 만 19세 이상 성인의 KHEI와 복부비만의 관련성 및 hs-CRP의 매개 효과를 분석한 연구이다. 한국 성인 남성의 경우 허리둘레 90 cm 이상, 여성은 허리둘레 85 cm 이상인 경우에 복부비만군으로 정의하였다. 남성에서 복부비만군은 2,587명, 정상군은 5,007명이였고 여성의 복부비만군은 2,869명, 정상군은 7,307명이였다. KHEI, hs-CRP, 복부비만의 연관성 분석에서는 모든 공변량을 보정하였을 때 남성의 KHEI는 복부비만과 유의한 연관이 없었지만, hs-CRP와 음의 연관성이 있었다. 여성의 경우, 복부비만과 hs-CRP 모두 음의 연관성이 관찰되었다. 또한, 남성과 여성에서 hs-CRP 위험군 (> 1.0 mg/L) 이 hs-CRP 정상군 (≤ 1.0 mg/L)보다 복부비만 유병률이 유의하게 높았다. Bootstrapping을 이용한 매개효과 분석에서는 KHEI와 복부비만 관계에서 hs-CRP가 매개 효과를 가지는 것으로 나타났으며 공변량을 단계적으로 보정하였을때 증가하는 양상이 나타났다. 결론적으로, 본 연구 결과는 균형잡힌 식생활를 통한 높은 식사의 질이 hs-CRP에 영향을 미쳐 복부비만 예방에 중요한 영향을 미칠 수 있음을 시사한다.

• 사상체질의학회지
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• 제34권1호
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• pp.46-57
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• 2022

Background Adherence to healthy diet acts as a key role to modify sedentary lifestyle in real life setting. Constitution type of traditional Korean medicine has been prediagnosed to risk factors of cardiometabolic diseases. This study aims to evaluate the associations between body composition and healthy eating status in Korean adults by their constitution type. Methods Of 4046 participants from Korean Medicine Daejeon Citizen Cohort study, Korean Medicine Daejeon Citizen Cohort (KDCC) study were included for analysis. Demographic, health-related behaviors and Korean Medicine (KM) type were surveyed based on a general health-related questionnaire. Anthropometric measurements and dietary factors by using Korean Healthy Eating Index (KHEI) were assessed only in the half of the original participants. Results 50.8% of Taeeum was observed from eligible 1967 participants (66.7%, women). The highest KHEI score was observed in soyang group (52.0±0.3, p=0.006) compared to other two groups. In taeeum group, lower appendicular skeletal muscle mass (ASM)(%)(Taeeum: 38.7±0.1 vs. Soeum/Soyang: 39.2±0.1, p < 0.05), and higher percent of body fat (PBF)(%) (Taeeum: 32.9±0.2 vs. Soeum/Soyang: 29.0±0.2, p < 0.05) by the lowest tertile (T1) of the KHEI score, respectively. When the KHEI score increased by 1 point in taeeum group, a positive relationship was observed, which increased by 0.015% of ASM, however, a negatively related to in which body fat mass (BFM) decreased by 0.022 kg and PBF decreased by 0.024%. Conclusion Customized nutritional management is required that could help maintaining physical health and diet by their constitution type.

• 한국치위생학회지
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• 제21권5호
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• pp.535-543
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• 2021

연구목적: 본 연구는 국내의 19세 이상의 성인을 대상으로 식생활의 질이 치주질환에 미치는 영향을 파악하고자 실행되었다. 연구방법: 국민건강영양조사의 제7기(2016-2018) 자료를 이용하였으며 성인 대상자 중 치주조직 검사를 실시한 12,689명을 대상으로 분석을 실시하였다. 치주질환 유병여부에 따른 일반적 특성과 식생활 평가지수(KHEI) 세부점수 자료는 교차분석과 t-test를 실시하였다. 식생활의 질에 따른 치주질환 간의 연관성을 평가하기 위해 다변량 로지스틱 회귀분석을 실시하여 검정하였다. 통계적 유의수준은 0.05로 설정하였다. 연구결과: 인구사회학적요인, 의학적 요인 및 건강행태에 대한 요인을 보정한 후 다변량 로지스틱 회귀분석을 실시한 결과 KHEI 3 식생활평가의 상위 점수자에 비해 KHEI 1 평균점수 이하의 군에서 치주질환 승산비가 1.23배(95% CI: 1.03-1.46)으로 증가하였으며, KHEI 2 평균점수에서 80점 미만인 군에서는 1.14배(95% CI: 0.97-1.34)로 나타났다. 결론: 식생활의 질 수준이 치주질환에 영향을 줄 수 있는 것으로 나타났다. 따라서 치주질환 예방과 관리를 위해 식생활에 대한 질을 높이기 위한 교육과 프로그램이 마련되어야 할 것으로 보인다.

• Nutrition Research and Practice
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• 제17권5호
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• pp.959-968
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• 2023

BACKGROUND/OBJECTIVES: Few studies have provided evidence of the association between diet quality and dental caries. This study aimed to examine the association between diet quality and untreated dental caries in a Korean representative population. SUBJECTS/METHODS: The study population included a sample of 13,815 participants, aged ≥ 19 from the Korea National Health and Nutrition Examination Survey during 2013-2015. The explanatory variable was diet quality and the outcome variable was untreated dental caries. Untreated dental caries were defined by the number of decayed teeth recorded according to the criteria established by the World Health Organization. Diet quality was defined by using the Korean Healthy Eating Index (KHEI) through the 24-h recall methods. We assessed the association between diet quality and untreated dental caries while adjusting for age, sex, education, income, smoking status, dental visits, toothbrushing frequencies, obesity, and diabetes mellitus. RESULTS: The mean overall KHEI scores in the untreated dental caries group were significantly lower than those in the group without untreated dental caries. Significant differences were observed in the untreated dental caries group based on the KHEI quartiles (P < 0.001). After adjusting for potential confounders, the quartiles of KHEI scores showed an association with untreated dental caries, demonstrating a dose-effect trend (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.35-1.84 for 1st quartile; OR, 1.38; 95% CI, 1.19-1.59 for 2nd quartile; OR, 1.32; 95% CI, 1.14-1.53 for 3rd quartile; reference quartile highest]). CONCLUSIONS: The findings indicated an inverse association between diet quality and untreated dental caries in Korean adults. Healthcare providers should take into account the significant role of diet quality in preventing and managing oral health.

• Journal of Nutrition and Health
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• 제55권1호
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• pp.120-140
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• 2022

본 연구는 제7기 (2016-2018) 국민건강영양조사자료를 이용하여, KHEI 점수와 대사증후군 위험요소 및 대사증후군의 발생 관련성을 연구하고자 하였다. 연구대상자는 제7기 국민건강영양조사 참여자 중 20-59세의 성인으로 연구에 이용한 변수의 결측치가 없는 8,345명을 최종대상으로 분석하였다. KHEI의 총 평균은 100점 만점에 61.06점, 남성의 총 평균은 59.63점, 여성의 총 평균은 62.50점으로 여성이 남성보다 유의적으로 KHEI 총 평균이 높았다. KHEI의 3개 영역 중 '권고하는 식품 및 적정성 평가영역'과 '절제영역'에서 여성이 남성보다 유의적으로 점수가 높았다. KHEI 점수에 따른 일반적 특성을 파악하기 위하여 KHEI 점수를 4분위수로 나누었으며 남녀 모두 연령대와 가구소득이 Q1그룹에서 Q4그룹으로 갈수록 유의적으로 높았으며, 현재 흡연 비율은 유의적으로 낮았다. 남성은 교육수준과 경제활동상태에서 Q1그룹에 비해 Q4그룹이 대학교 졸업이상 비율과 경제활동 참여율이 유의적으로 높았다. 여성은 음주여부, 우울증여부, 외식횟수에서 Q4그룹이 Q1그룹보다 현재 음주, 우울증 유병자비율과 1일 1회이상 외식 비율이 유의적으로 낮았다. 식품안정성에서는 남녀 모두 Q1그룹이 Q3그룹보다 '식품안정군'이 유의적으로 낮았다. 대사증후군과 관련된 영양소 섭취 실태에서 남녀 모두 Q1 그룹의 에너지 필요 추정량 미만 섭취자 비율이 유의적으로 높았으며, 탄수화물, 단백질, 비타민 C, 칼슘, 비타민 B1, 비타민 B2, 니아신은 평균필요량 미만 섭취자 비율이 유의적으로 높았고, 식이섬유소는 충분 섭취량 미만 섭취자 비율이 유의적으로 높았다. 남성의 공복혈당은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 BMI는 Q4그룹이 Q2그룹보다 유의적으로 낮았으며, 수축기 혈압은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 총콜레스테롤은 Q4그룹이 Q1그룹보다 유의적으로 높았다. 대사증후군 위험요인에서 남성의 고중성지방혈증 유병률은 Q1그룹이 Q4그룹보다 유의적으로 높았으며, 고혈당 유병률은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 고혈압 유병률은 Q3그룹이 Q1그룹보다 유의적으로 높았으며 대사증후군은 Q2그룹이 Q1그룹보다 유의적으로 높았다. KHEI 점수에 따른 대사증후군 위험요인과 대사증후군 연관성 연구결과, 남녀 모두 KHEI 총점수가 높을수록, 20-29세가 50-59세에 비해 대사증후군 위험요소 및 대사증후군의 발생위험이 유의적으로 낮았다. 교육수준, 소득수준, 흡연, 음주, 우울증 여부는 성별에 따라 다른 양상을 보였다. 교육수준에서 남성은 저HDL콜레스테롤혈증, 고혈당의 발생위험이 유의적인 차이를 보였으며, 여성은 우울증이 있는 경우가 없는 경우보다 고중성지방혈증은 1.81배, 고혈당은 1.90배, 대사증후군은 2.50배로 발생위험이 유의적으로 높았다. 남녀 모두 소득수준이 '하'일 때 '상'에 비해 고중성지방혈증, 대사증후군의 발생위험이 유의적으로 높았으며 특히, 여성은 복부비만, 고혈당, 고혈압을 남성은 저HDL콜레스테롤혈증 발생위험이 유의적으로 높았다.