Development of the Korean Healthy Eating Index for adults,based on the Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVESThe 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/METHODSThe 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.RESULTSThe 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.CONCLUSIONSThe 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.     

Dietary Assessment and Factors According to Fruits and Vegetables Intake in Korean Elderly People: Analysis of Data from the Korea National Health and Nutrition Examination Survey, 2013–2018

This study analyzed dietary assessment and factors according to fruits and vegetables intake in Korean elderly people. We enrolled 8336 Korean elderly people aged ≥65 who participated in the dietary intake survey (24-h recall methods) of the 2013–2018 Korea National Health and Nutrition Examination (KNHANES). The intake of fruits and unsalted/non-starchy vegetables was 372.06 g/day. According to age group, the intake in the age group 65–74 years as 422.47 g/day, and the intake in the age group 75 years + was 301.12 g/day. Based on the intake of daily meals and snacks, the intake of fruits and unsalted/non-starchy vegetables was the highest in snack-eating individuals (480.96 g/day). The subjects who consumed more than the World Health Organization (WHO)/World Cancer Research Fund (WCRF)’s plant food intake standards (over 400 g/day of intake of fruits and unsalted/non-starchy vegetables) were 35.47% of the elderly people. These results suggest that it is necessary to develop more fundamental strategies to increase fruits and vegetables intake among elderly people. Furthermore, the study outcomes are expected to provide basic information for developing education programs to improve the dietary life of Korean elderly people.     

Vital Signs: Sodium Intake Among U.S. School-Aged Children — 2009–2010

Background

A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts.

Methods

Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010.

Results

U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%).

Implications for Public Health Practice

Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals.     

Analysis of Kimchi,vegetable and fruit consumption trends among Korean adults: data from the Korea National Health and Nutrition Examination Survey (1998-2012)

BACKGROUND/OBJECTIVES

The purpose of this study is to analyze daily kimchi, vegetable and fruit consumption by general characteristics and vegetable and fruit consumption from 1998 to 2012 by the Korean population based on the data of the KNHANES (Korea National Health and Nutrition Examination Survey).

SUBJECTS/METHODS

This study is based on the 1998-2012 KNHNES. Analysis data on 54,700 subjects aged 19 years and older were obtained from health behavior interviews and the 24-hour dietary recall method.

RESULTS

Daily kimchi consumption and portion size of kimchi decreased significantly from 1998 to 2012 (adjusted P for trend < 0.0001). Meanwhile, daily consumption of both non-salted vegetable and fruit with and without kimchi did not significantly change between 1998 and 2012. Reduced consumption of kimchi, non-salted vegetable, and fruit was observed for both genders as well as daily meal episodes and cooking locations. Male and female subjects with insufficient non-salted vegetable and fruit intake were increased 1.4 times and 1.3 times, respectively, in 2012 than 1998. All subjects consumed at least 400 g/day of non-salted vegetable, fruit, and kimchi in each survey year, although they consumed insufficient amounts (< 400 g/day) of non-salted vegetable and fruit without kimchi.

CONCLUSIONS

Since Koreans generally consume high amounts of fermented vegetables, including kimchi, total vegetables and fruit. Consumption of these foods by the Korean adult population reached 400 g, which is the recommended intake of the WCRF/AICR. Based on this result, it is necessary to promote consumption of kimchi in the Korean population and research the development of low sodium kimchi in the future.     

Dietary quality of lunches in senior leisure service facilities in South Korea: analysis of data from the 2013–2017 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVESThis study analyzed the quality of lunches provided in senior leisure service (SLS) facilities and compared institutional foodservice (IF) and non-institutional foodservice (non-IF).SUBJECTS/METHODSData of 390 adults aged 65 years or older who ate lunches in SLS facilities were analyzed using the information from the 2013–2017 Korea National Health and Nutrition Examination Survey. The participants were classified into IF (n = 129) and non-IF (n = 261) groups according to meal type provided. The intake of major food groups, energy and nutrients, and nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were analyzed. The diversity of meals was evaluated by food group patterns, dietary diversity score (DDS) and dietary variety score (DVS). Energy intake was adjusted in model 1, while energy and sex were adjusted in model 2. All confounding variables were adjusted in model 3.RESULTSThe intake of seafoods (P < 0.001 in models 1, 2, and 3), seaweeds (P < 0.01 in models 1 and 2), and dairy products (P < 0.05 in models 1, 2, and 3) was significantly higher in the IF group. No significant difference existed in energy intake; however, the intake of all nutrients except carbohydrate and vitamin C was significantly higher in the IF group. NAR of all nutrients, excluding vitamin C, was higher in the IF group, and MAR was also higher in the IF group (P < 0.001 in models 1, 2, and 3). The IF group had significantly higher DDS and DVS than the non-IF group (P < 0.001).CONCLUSIONSThe lunches provided in SLS facilities were better in terms of quantity and quality when provided through IF than through non-IF. More systematic foodservice programs should be implemented in SLS facilities, especially in facilities wherein users prepare their own meals.     

The Equity and Effectiveness of Achieving Canada’s Voluntary Sodium Reduction Guidance Targets: A Modelling Study Using the 2015 Canadian Community Health Survey—Nutrition

Background: High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada’s voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods: We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey—Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results: In children aged 2–8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: −45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9–18 (96 mg/day, 95%CI: −149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: −30,327; female: −45 mg/day, 95%CI: −141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians’ are above the CDRR thresholds. Conclusion: Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.     

Western dietary pattern is associated with higher risk of lower lean muscle mass in Korean postmenopausal women: data from the Korea National Health and Nutrition Examination Survey 2008–2011

BACKGROUND/OBJECTIVESIn a healthy person, from 35 years of age, there is an annual loss of muscle mass at the rate of 1–2% and is associated with a decline in the quality of life. This study aimed to identify the particular dietary patterns associated with the risk of lower lean muscle mass in Korean postmenopausal women.SUBJECTS/METHODSThe Korea National Health and Nutrition Examination Survey (KNHANES) is a population-based, continuous cross-sectional annual survey. The participants of the KNHANES IV (2008–2009) and V (2010–2011) were considered for this study. The study sample consisted of 1548 postmenopausal women, aged 45–86 years. Lower lean muscle mass was defined as having appendicular skeletal muscle mass corrected for body weight less than 1 standard deviation of the young reference group aged 20 to 39 years in KNHANES IV and V. To identify the dietary pattern using factor analysis, 24-h recall data was used.RESULTSThe prevalence of lower lean muscle mass was 31.3% in this study population. Four dietary patterns were identified by factor analysis; ‘Diverse’, ‘Western’, ‘Traditional’, and ‘Snacks and beverages’. The ‘Western’ pattern, highest factor loadings for flour and bread, potatoes, red meat, processed meat, eggs, and cheese, was significantly associated with a high (60%) risk of lower lean muscle mass (odds ratio [95% confidence interval] = 1.60 [1.07–2.39], P for trend = 0.01) after adjustments for potential covariates. The other 3 dietary patterns were not associated with lower lean muscle mass.CONCLUSIONSThe study findings suggest that the ‘Western’ dietary pattern that includes flour and bread, potatoes, red meat, processed meat, eggs, and cheese, may be associated with a higher risk of lower lean muscle mass in Korean postmenopausal women.     

Dietary Sources of Sodium Intake in Brazil in 2008-2009

Information on the main dietary sources of sodium is essential for developing public health strategies to reduce sodium intake. This study aimed to describe sodium intake according to sex, age, and income and identify the main dietary sources of sodium in Brazil. In total, 34,003 subjects aged 10 years and older participated in the first Brazilian National Dietary Survey, conducted in 2008-2009. Food was classified according to the sodium profile into 31 groups based on a 1-day food record. The daily per capita intake of sodium (mg/day) and sodium density (mg/100 g) were estimated for each food group and stratified by sex, age, and per capita income quartile. The average daily intake of sodium was 3,190 mg/day. The sodium density of the diet increased with age and income (P<0.05). Food groups with the highest densities for both sexes and across all income quartiles included salty preserved meats (997 mg/100 g), processed meats (974 mg/100 g), cheeses (883 mg/100 g), crackers (832 mg/100 g), sandwiches (800 mg/100 g), pizza (729 mg/100 g), and breads (646 mg/100 g), as well as oils, spreads, sauces, and condiments (804 mg/100 g). Altogether, these food groups contributed to 811 mg/day of sodium, which is more than half of the recommended daily sodium intake. Mean sodium intake in Brazil exceeded the tolerable upper intake level of 2,300 mg/day. Processed food contributed to half of the recommended intake and should be targeted by future public health policies aiming at reducing total sodium intake.     

Food behaviors accounting for the recent trends in dietary fatty acid profiles among Korean adults

BACKGROUND/OBJECTIVESThis study examined the changes in food behaviors of dietary fatty acids over 2007–2018 among Korean adults.SUBJECTS/METHODSThis study used data from the 4th (2007–2009), 5th (2010–2012), 6th (2013–2015), and 7th (2016–2018) Korea National Health and Nutrition Examination Surveys. A total of 46,307 adults aged 19–64 yrs were selected and dietary data were obtained from a single 24-h recall. In the 4th and 7th data, the major food sources for each fatty acid based on the contributing percentage of the food item were compared. The consumption trends in the major food sources were presented as grams per day over 2007–2018 and compared across the survey periods using the multiple regression model.RESULTSFrom 2007 to 2018, for total fat, saturated fatty acid (SFA), and monounsaturated fatty acid, the contribution of animal food sources, including beef, chicken, and eggs increased but plant food sources (e.g., tofu, soybean, and plant oil) decreased. As polyunsaturated fatty acid sources, mayonnaise, eggs, and bread showed higher contributions, whereas soybean and tofu showed lower contributions in the 7th data compared to the 4th data. For n-3 fatty acids, the contribution of fish decreased between the 4th and 7th data. Over 12 yrs, the significant increases in the absolute amount of consumption from animal sources were observed. In contrast, decreases in the consumption from plant sources and fish were seen across the survey periods.CONCLUSIONSIn Korean adults, increases in the intake of dietary fatty acids along with changes in the food behaviors during 2007–2018 have evoked great concern for SFA intake, which is a cardiovascular disease risk factor. Healthy food sources of dietary fatty acids should be emphasized in this population.     

Inadequate vitamin D intake among pregnant women in Malaysia based on revised recommended nutrient intakes value and potential dietary strategies to tackle the inadequacy

BACKGROUND/OBJECTIVESRecently, the recommended nutrient intakes (RNI) for vitamin D for Malaysian aged 1–70 yrs has been revised from 5 µg/day to 15 µg/day. This study is aimed to assess the adequacy of vitamin D intake based on revised RNI and to recommend several dietary strategies to increase total vitamin D intake.SUBJECTS/METHODSVitamin D intake from both food and supplement of 217 pregnant women was assessed using a validated food frequency questionnaire. Hypothetical effect of expanded supplementation and food fortifications strategies were modelled using the consumption data.RESULTSThe results revealed that more than half (67.7%) of pregnant women had inadequate vitamin D intake (RNI < 15 µg/day). The modelling results demonstrated the potential of universal provision of 10 µg/day of multivitamins supplements in increasing vitamin D intake. Moreover, mandatory fortification of both milk and malted drink at single level of 5 µg/serving would lead to increase in vitamin D intake of Malaysians, particularly pregnant women.CONCLUSIONSThe outcome of this study can be used as a reference for public health professionals to re-evaluate the existing Malaysian food fortification policies and supplementation recommendation for vitamin D for pregnant women.     

Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location

New sources of caffeine, besides coffee and tea, have been introduced into the US food supply. Data on caffeine consumption age and purchase location can help guide public health policy. National Health and Nutrition Examination Surveys (NHANES) were used to estimate population-level caffeine intakes, using data from 24-h dietary recall. First, caffeine intakes by age-group and beverage type were estimated using the most recent 2011–2012 data (n = 7456). Second, fourteen years trends in caffeine consumption, overall and by beverage type, were evaluated for adults and children. Trend analyses were conducted by age groups. Last, trends in caffeine intakes by purchase location and beverage type were estimated. In 2011–2012, children aged four to eight years consumed the least caffeine (15 mg/day), and adults aged 51–70 years consumed the most (213 mg/day). The population mean (age ≥ four years) was 135 mg/day, driven largely by coffee (90 mg/day), tea (25 mg/day), and soda (21 mg/day). For the 14–19 years and 20–34 years age-groups, energy drinks contributed 6 mg/day (9.9%) and 5 mg/day (4.5%), respectively. The bulk of caffeine came from store-bought coffee and tea. Among both children and adults combined, caffeine intakes declined from 175 mg/day (1999–2000) to 142 mg/day (2011–2012), largely driven by a drop in caffeine from soda (41 mg/day to 21 mg/day). Store-bought coffee and tea remain principal drivers of caffeine intake in the US. Sodas and energy drinks make minor contributions to overall caffeine intakes.     

Gastric Cancer and the Daily Intake of the Major Dish Groups Contributing to Sodium Intake: A Case-Control Study in Korea

Studies on the association between gastric cancer (GC) and the intake of soup-based dish groups (noodles and dumplings, soups, and stews), which are sodium-contributing foods, in Korea are insufficient, and the results of studies on the intake of pickled vegetables such as kimchi are inconsistent. This study aimed to determine the association between the incidence of GC and the daily intake of high-sodium dish groups (noodles and dumplings, soups, stews, and pickled vegetables) and whether these associations differ depending on behavioral risk factors for GC. In this case-control study, subjects aged 20–79 years were recruited from two hospitals between December 2002 and September 2006. A total of 440 cases and 485 controls were recruited, of which 307 pairs were matched and included for the analysis. In our results, a higher intake of noodles and dumplings was associated with a significantly increased incidence of GC. In the participants who consumed past or current alcohol, a higher intake of noodles and dumplings was associated with a significantly increased incidence of GC. Our results suggest that efforts to reduce the daily sodium intake from noodles and dumplings are needed to prevent and reduce the incidence of GC.     

Urinary Sodium and Potassium Levels and Blood Pressure in Population with High Sodium Intake

The purpose of this study was to examine the association of urinary sodium-to-creatinine ratio and potassium-to-creatinine ratio with blood pressure in a cross-sectional study comprising Korean adults who participated in the Healthy Twin Study. The participants consisted of 2653 men and women in the Healthy Twin Study aged ≥19 years. Participants’ urinary excretion of sodium, potassium, and creatinine was measured from overnight half-day urine samples. Food intake was assessed using a validated food frequency questionnaire. We examined systolic and diastolic blood pressures according to sodium- or potassium-to-creatinine ratios using the generalized linear model. We determined food groups explaining high urinary sodium- or potassium-to-creatinine ratio using the reduced rank regression and calculated sodium- or potassium-contributing food score. We observed that systolic blood pressure was higher among men and women in the highest quintile of urinary sodium-to-creatinine ratio or sodium-to-potassium ratio than it was in the lowest quintile. Geometric means (95% CIs) of the lowest and the highest quintiles of systolic blood pressure (mmHg) were 113.4 (111.8–115.0) and 115.6 (114.1–117.2; P for trend = 0.02), respectively, for sodium-to-creatinine ratio. The association between urinary sodium-to-creatinine and systolic blood pressure was more pronounced among individuals whose body mass index (BMI) was less than 25 kg/m² (P for interaction = 0.03). We found that vegetables, kimchi and seaweed intake contributed to high sodium intake and a sodium-contributing food score were associated with increased blood pressure. In our study, we identified the food groups contributing to high sodium intake and found that high urinary sodium levels were associated with increasing blood pressure among Korean adults.     

Association between dietary omega-3 fatty acid intake and depression in postmenopausal women

BACKGROUND/OBJECTIVESThis study aimed to analyze the association between dietary omega-3 fatty acid intake and depression in postmenopausal women using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI.SUBJECTS/METHODSThe KNHANES is a cross-sectional nationwide health and nutrition survey. Dietary data, including omega-3 fatty acids, were assessed using the 24-h recall method. Depression was evaluated using a survey questionnaire. The association between dietary omega-3 fatty acids and depression was evaluated using multivariate logistic regression analysis. Depression, according to the dietary omega-3 fatty acid intake, was expressed as the odds ratio (OR) with a 95% confidence interval (CI). A total of 4,150 postmenopausal women were included in the analysis.RESULTSIn the fully-adjusted model, the group with the highest dietary omega-3 fatty acid intake significantly showed lower prevalence of depression than the group with the lowest intake (OR, 0.52; 95% CI, 0.33–0.83); a significant linear trend was detected (P for trend = 0.04). According to the dose-response analysis using cubic restricted spline regression, this association was linear and monotonic (P for non-linearity = 0.32).CONCLUSIONSIn this study, the dietary omega-3 fatty acid intake in postmenopausal women was inversely proportional to depression in a dose-response manner. Large cohort studies are needed to verify the causality between omega-3 fatty acids and depression in Korean postmenopausal women.     

Ten-Year Trends in Fiber and Whole Grain Intakes and Food Sources for the United States Population: National Health and Nutrition Examination Survey 2001–2010

Current U.S. dietary guidance includes recommendations to increase intakes of both dietary fiber and whole grain (WG). This study examines fiber and WG intakes, food sources and trends from 2001 to 2010 based on National Health and Nutrition Examination Survey (NHANES) data for children/adolescents (n = 14,973) and adults (n = 24,809). Mean fiber intake for children/adolescents was 13.2 (±0.1) g/day. Mean fiber intake for adults 19–50 years (y) was 16.1 (±0.2) g/day and for adults 51+ was 16.1 (±0.2) g/day. There were significant increases in fiber intake from 2001–2010 for children/adolescents and for adults 51+ y. Mean WG intake for children/adolescents was 0.52 (±0.01) oz eq/day. Mean WG intake for adults 19–50 y was 0.61 (±0.02) oz eq/day and for adults 51+ 0.86 (±0.02) oz eq/day. There were no significant changes in WG intake for any age group from 2001–2010. The main food groups contributing to dietary fiber intake for children/adolescents were vegetables (16.6%), grain mixtures (16.3%), other foods (15.8%) and fruits (11.3%). For adults 19+ y, the main sources of dietary fiber were vegetables (22.6%), other foods (14.3%), grain mixtures (12.0%) and fruits (11.1%). Major WG sources for children/adolescents included ready-to-eat cereals (RTEC) (31%), yeast breads/rolls (21%) and crackers and salty grain snacks (21%). The main sources of WG for adults 19+ were yeast breads/rolls (27%), RTEC (23%) and pastas/cooked cereals/rice (21%). Recommending cereals, breads and grain mixtures with higher contents of both dietary fiber and WG, along with consumer education, could increase intakes among the United States (U.S.) population.     

Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013

BACKGROUND/OBJECTIVESThe aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013).SUBJECTS/METHODSTotal fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food.RESULTSThe mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively.CONCLUSIONSEstimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.     

Development and application of the sodium index to estimate and assess sodium intake for Korean adults

BACKGROUND/OBJECTIVESThe purpose of this study was to develop a sodium index, which is a tool for estimating and assessing sodium intake easily and quickly, to assist in the prevention of various diseases induced by excess sodium intake in Korean adults.SUBJECTS/METHODSThe 24-h urine collection and dietary behavior surveys were performed on 640 healthy people in 4 regions of South Korea, and an equation for the estimation of 24-h sodium intake was developed. The validity and reliability of the equation were verified with 200 adults. The sodium index was developed by converting the estimated sodium intake using the equation. Finally, the sodium intake status of 1,600 adults was assessed using the sodium index.RESULTSThe equation included sex, age, body mass index, eating habit and dietary behaviors related to sodium intake. In validity test of the equation, the mean bias between sodium intake using 24-h urine analysis and using the equation from the Bland-Altman plots was −1.5 mg/day. The sensitivity and specificity of the equation for estimation of sodium intake were 80.5% and 64.4%, respectively. In the reliability test of the equation, there was no significant difference between the first and second sodium intakes calculated using the equations, and Spearman''s correlation coefficient between the 2 sodium intakes was 0.98. Sodium intake can be assessed as ‘very moderate’ for 75–100 on the sodium index, ‘moderate’ for 100–150, ‘careful’ for less than 75 or 150–200, and ‘severe’ for 250 or more. When sodium intake was assessed using the sodium index in 1,600 subjects, 54.3% and 24.3% of the subjects were assessed to be in the ‘careful’ and ‘severe’ categories, respectively.CONCLUSIONSUsing a simple questionnaire, the sodium index can be used to monitor and assess sodium intake status, assisting in nutrition education and counseling in a large population.     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes—Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)

This study investigates the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65–85. Data from 912 individuals regarding their dietary intake at baseline is analyzed and assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes are times to diabetic retinopathy, overt nephropathy, cardiovascular disease (CVD), and all-cause mortality during six years. We find that mean sodium intake in quartiles ranges from 2.5 g to 5.9 g/day. After adjustment for confounders, no significant associations are observed between sodium intake quartiles and incidence of diabetes complications and mortality, except for a significant trend for an increased risk of diabetic retinopathy (p = 0.039). Among patients whose vegetable intake was less than the average of 268.7 g, hazard ratios (HRs) for diabetic retinopathy in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 0.87 (95% CI, 0.31–2.41), 2.61 (1.00–6.83), and 3.70 (1.37–10.02), respectively. Findings indicate that high sodium intake under conditions of low vegetable intake is associated with an elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes.