• Journal of Preventive Medicine and Public Health
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• 제49권4호
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• pp.220-229
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• 2016

Objectives: The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. Methods: From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years). Results: Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed. Conclusions: A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.

• Nutritional Sciences
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• 제5권4호
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• pp.234-244
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• 2002

This study was conducted to compare the rates of hyperlipidemia, hypertension, high blood glucose, and liver dysfunction, between 64 obese children (24 boys and 11 girls who were moderately obese, and 21 boys and 8 girls who were severely obese) and 45 normal weight children (31 boys and 14 girls) from 13 elementary schools in Kangnung city. Among the boys with severe obesity, the levels of serum triglycerides and LDL-cholesterol (133.60 $\pm$ 49.99 mg/dl and 105.00 $\pm$ 41.12 mg/dl( respectively) were significantly higher compared to the normal Weight group (81.16 $\pm$ 23.59 mg/dl and 87.74 $\pm$ 32.095 mg/dl, respectively) of moderately obese group (102.30 $\pm$ 36.03 mg/dl, 89.99 $\pm$ 32.10 mg/이, respectively). In girls, only serum triglycerides were significantly higher in the severely obese group (154.30 $\pm$ 46.84 mg/dl), compared with the normal weight group (80.00 $\pm$ 25.31 mg/dl) or moderately obese group (106.40 $\pm$ 41.73 mg/dl). In boys, blood pressure in the severely obese group (systolic: 120.5 $\pm$ 9.74 mmHg; diastolic: 80.95 $\pm$ 10.44 mmHg) was significantly higher compared with the groups of normal weight or moderately obese children. The rate of hypertriglyceridemia was significantly different among normal weight, moderately obese, and severely obese boys (9.7%, 41.7%, and 76.2%, respectively). The proportion of boys who had an Atherogenic Index(AI) higher than 3 was found to be significantly higher in the severely obese group (28.6%), compared to 6.5% in the normal weight group and 4.1% in the moderately obese group. Among boys, a significantly higher rate of hypertension was found in the severely obese group, which showed high systolic blood pressure and high diastolic pressure (81.0% and 81.0%), compared with the normal weight group (16.1% and 22.6%) and moderately obese group (33.3% and 33.3%). In conclusion, the diagnosis and management of obese children needs to be tailored to gender and the degree of obesity. Furthermore, a systematic management program needs to be developed for early screening and detection of obesity in order to minimize the risk of hyperlipidemia and hypertension, especially in severely obese children.

• Nutrition Research and Practice
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• 제12권4호
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• pp.315-323
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• 2018

BACKGROUND/OBJECTIVES: Available data suggest that seasonal changes may influence the nutritional status and overall health of elderly individuals. Therefore, this study was conducted to investigate the effects of seasonal changes and related factors on energy and nutrient intake of older adults. SUBJECTS/METHODS: Individuals aged 65 years or over were prospectively enrolled in this single-center study (male: 11, female: 20). Data were collected between May 2013 and February 2014 during winter, spring, summer and autumn. Food consumption and biochemical parameters were taken during each season to assess the seasonal nutrition status of the elderly. Upon analysis of biochemical parameters (retinol, vitamin D and vitamin C), an high-performance liquid chromatography device was utilized whereas an Immulite 2000 device was utilized during analysis of serum folic acid and parathyroid hormone. RESULTS: Fruit, fat, egg and bread consumption varied seasonally in males and females (P < 0.05). During winter, daily energy intake was found to be greater than in other seasons in males (557 kcal) and females (330 kcal) (P < 0.05). Additionally, carbohydrates, vegetable protein, n-3 fatty acid and sodium intake increased in winter, while the n-6/n-3 ratio increased in summer among males (P < 0.05). Dietary fiber and sodium intake in winter, vitamin C, iron and zinc intake in spring, and cholesterol, retinol, vitamin D and niacin intake in autumn were found to be higher in females when compared to other seasons (P < 0.05). Serum parathyroid hormone level was higher in winter, and vitamin D level was higher in autumn in both genders (P < 0.05). In males, blood folic acid level was higher in winter, while vitamin C level was higher in females, and there was no seasonal variation in retinol concentration (P < 0.05). CONCLUSION: Food consumption and biochemical parameters showed significant seasonal variations in older adults. It is not clear if nutrition plans in older adults will benefit from consideration of seasonal changes in eating habits.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9453-9458
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• 2014

Background: Breast cancer is the second leading cause of cancer death for women in the United States. Differences in survival of breast cancer have been noted among racial and ethnic groups, but the reasons for these disparities remain unclear. This study presents the characteristics and the survival curve of two racial and ethnic groups and evaluates the effects of race on survival times by measuring the lifetime data-based half-normal model. Materials and Methods: The distributions among racial and ethnic groups are compared using female breast cancer patients from nine states in the country all taken from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry. The main end points observed are: age at diagnosis, survival time in months, and marital status. The right skewed half-normal statistical probability model is used to show the differences in the survival times between black Hispanic (BH) and black non-Hispanic (BNH) female breast cancer patients. The Kaplan-Meier and Cox proportional hazard ratio are used to estimate and compare the relative risk of death in two minority groups, BH and BNH. Results: A probability random sample method was used to select representative samples from BNH and BH female breast cancer patients, who were diagnosed during the years of 1973-2009 in the United States. The sample contained 1,000 BNH and 298 BH female breast cancer patients. The median age at diagnosis was 57.75 years among BNH and 54.11 years among BH. The results of the half-normal model showed that the survival times formed positive skewed models with higher variability in BNH compared with BH. The Kaplan-Meir estimate was used to plot the survival curves for cancer patients; this test was positively skewed. The Kaplan-Meier and Cox proportional hazard ratio for survival analysis showed that BNH had a significantly longer survival time as compared to BH which is consistent with the results of the half-normal model. Conclusions: The findings with the proposed model strategy will assist in the healthcare field to measure future outcomes for BH and BNH, given their past history and conditions. These findings may provide an enhanced and improved outlook for the diagnosis and treatment of breast cancer patients in the United States.

• 대한영양사협회학술지
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• 제20권4호
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• pp.235-246
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• 2014

The purpose of this study was to evaluate nurses' perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20 general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses' experience in group education on cancer at capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The mean scores of perceived importance of clinical nutrition services were 4.46/5.00 for 'group nutrition education', 4.46/5.00 for 'individual consultation', and 4.40/5.00 for 'nutrition management for enteral nutrition (EN) patients'. The most common reason why clinical nutrition services are important was 'improving malnutritional status'. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9543-9547
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• 2014

Background: The aim of this study was to investigate demographic features, dietary habits, and some possible risk factors for being susceptible to breast cancer in Iranian women. Materials and Methods: A study of dietary habits and breast cancer was conducted among 53 Iranian women with histological confirmed disease and 40 matched controls. A dietary habits questionnaire was used to evaluate the pattern of selected food intakes. The risk of cancer was analyzed after adjustment for confounding factors. Age, weight, body mass index (BMI), waist circumference, educational status, parity, lactation, marital status, menopause, history of estrogen therapy, and family history of breast disease or cancer were assessed among participants. Special attention was given to the relationship between consumption of high fat meat, milk, yogurt and cheese as well use of frying oils for frying foods, use of olive/liquid oils for cooking, removing fat from meat and poultry, removing chicken skin and not use of mayonnaise as salad dressing and the risk of breast cancer. Moreover, salad, vegetable and fruit consumption, and eating outdoors owere investigated. Results: Our results revealed significant lower education and higher BMI and waist circumference levels in patients with breast cancer. There was significantly increased breast cancer risk in overweight women in comparison with normal weight (OR=2.91, 95%CI 1.24 to 6.82). High intake of fat dairy products including milk and cheese was found to be a statistically significant factor for increasing breast cancer risk in models adjusting for age, BMI and education. Use of olive/liquid oils for cooking and avoidance of mayonnaise as salad dressing are related to lower risk of breast cancer. The frequency of vegetable and fruit consumption was significantly lower in patients with breast cancer compared to healthy women. Conclusions: Dietary habits might be risk factors for breast cancer among Iranian women. Adoption of a prudent diet could be an appropriate strategy for preventing breast cancer.

• 대한영양사협회학술지
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• 제20권3호
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• pp.183-198
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• 2014

The purpose of this study was to investigate the status of clinical nutrition services provided at tertiary hospitals and general hospitals in Korea. In total, 157 questionnaires were distributed to the departments of nutrition at hospitals on September 2013. The results of this study are as follows. The median number of beds was 607 and average length of stay was 8 days. 63.1% of dietitians had over 5 years of career experience. Nutritional screening rate was 97% in tertiary hospitals but only 67.2% in general hospitals (P<0.001). The rate of equipment with computerized nutritional screening system was 100% in tertiary hospitals but 71.9% in general hospitals (P<0.001). Hospitals with the best regarding nutritional care were hospitals accredited by JCI (Joint Commission International). On the other hand, hospitals not accredited by the JCI but KOIHA (Korea Institute for Healthcare Accreditation) showed the lowest performance rate of nutritional care. Nutrition support teams (NSTs) were established in all tertiary hospitals but in only 73% of general hospitals (P<0.001). The rate of actively operating NSTs was 89% in tertiary hospitals but only 62% in general hospitals (P<0.001). There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.

• Nutrition Research and Practice
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• 제11권4호
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• pp.319-326
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• 2017

BACKGROUND/OBJECTIVE: Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects. SUBJECTS/METHODS: Fifty overweight and obese subjects aged 19-60 years with a body mass index ${\geq}23kg/m^2$ were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing. RESULTS: Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss ($1.98{\pm}1.75kg$; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a $0.17{\pm}1.67kg$ loss in the control group. There were significant differences between intervention and control groups in BF mass ($-1.68{\pm}1.78$, $-0.04{\pm}1.62kg$); percentage BF ($-1.54{\pm}2.11$, $0.08{\pm}2.05$); WC ($-5.35{\pm}3.84$, $0.13{\pm}3.23cm$); WHtR ($-0.0336{\pm}0.02$, $-0.0004{\pm}0.02$), and energy consumption ($-405.09{\pm}431.31$, $-74.92{\pm}499.54kcal/day$) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by $16.00{\pm}11.73$ and $7.74{\pm}14.97$ in the intervention and the control groups, respectively. PA level did not change in either group. CONCLUSIONS: The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.

• Preventive Nutrition and Food Science
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• 제10권1호
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• pp.74-80
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• 2005

The purpose of this study was to investigate culinary arts and hospitality students' food safety practice behaviors, intentions, attitudes, and barriers to food safety compliance. This descriptive study used the self-report questionnaire. The convenience sample was composed of 266 college students majoring in culinary arts and hospitality. The students indicated that they never or rarely use a thermometer to determine if meats have been adequately cooked. Examples of positive food handling behaviors were hand washing, sanitation of fruits and vegetables, discarding of food past its expiration date, counter top sanitation, and proper food storage. Students strongly agreed it is their responsibility to practice food safety and to educate their employees about food safety. The primary barrier to proper food safety as ranked by student respondents is the misunderstanding about food labeling. Previous food safety education and internship experience appeared to improve the student respondents' perceived attitudes toward following the principles of food safety practices (p < 0.05), although behaviors and intentions to use the correct food safety practices were not affected. The findings of this study suggest that programs should consider integrating information and experiential learning opportunities in their courses that would be enhance student understanding about food safety. The outcomes of this study can be applied to develop food safety education materials and programs for culinary arts and hospitality students.

• Preventive Nutrition and Food Science
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• 제10권1호
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• pp.68-73
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• 2005

A significant number of cases of illness has been attributed to food consumption in restaurants, and as the number of meals eaten away from home continues to rise, the potential for large-scale, foodborne illness outbreaks will continue to increase. It is critical that hospitality and culinary arts students preparing for careers as professionals in foodservice establishments or restaurants have an appropriate understanding of food safety. The level of food safety knowledge was similar between hospitality and culinary arts students, and an analysis of 266 questionnaires indicated that specific areas, such as hand washing, cross contamination in refrigerator, reheating leftovers, refrigeration of cooked food within two hours, proper temperature of food storage, using of thermometers to monitor temperatures, proper egg handling, and possible food borne illness caused by fruits, should be the primary focus of educational resources. Student respondents showed a higher awareness level of responsibility in their roles for food safety, but more emphasis needs to be given to the correct understanding of food safety issues. Hospitality and culinary arts educators can use this precise information to develop food safety education materials and programs to assist in the prevention of foodborne illness and to knowledgeably educate their graduates about food safety.