Socioeconomic burden of sugar-sweetened beverages consumption in Korea.

BACKGROUND/OBJECTIVES: Excessive sugar consumption may increase the risk for development of several diseases. Although average dietary sugar intake of Koreans is within the recommended level, an increasing trend has been found in all age groups. This study aimed to evaluate the population attributable fractions (PAF) to dietary sugar for disease and death in Korea, and to estimate the socioeconomic effects of a reduction in dietary sugar. MATERIALS/METHODS: The prevalence of sugar-sweetened beverages (SSB) overconsumption (≥ 20 g of sugar from beverages) was analyzed using the Korean National Health and Nutrition Examination Survey 2015. Disease-specific relative risks of excessive SSB consumption were obtained through reviewing previous studies. Using the prevalence of SSB overconsumption and each relative risk, PAFs for morbidity and mortality were calculated. Socioeconomic costs of diseases and death attributable to SSB overconsumption were estimated by using representative data on national medical expenditures, health insurance statistics, employment information, and previous reports. RESULTS: Disease-specific PAF to SSB consumption ranged from 3.11% for stroke to 9.05% for obesity and dental caries, respectively. Costs from disease caused by SSB overconsumption was estimated at 594 billion won in 2015. About 39 billion won was estimated to be from SSB consumption-related deaths, and a total of 633 billion won was predicted to have been saved through preventing SSB overconsumption. CONCLUSIONS: Sugars overconsumption causes considerable public burdens, although the cost estimates do not include any informal expenditure. Information on these socioeconomic effects helps both health professionals and policy makers to create and to implement programs for reducing sugar consumption.

Inflammatory potential of diet is associated with cognitive function in an older adult Korean population.

OBJECTIVE: To examine the association between the inflammatory potential of diet and the quality of cognitive function in an older adult Korean population. METHODS: A total of 239 participants (88 men and 151 women) ages ≥65 y were selected from various health centers in Korea. To assess the inflammatory potential of diet, Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed based on a single 24-h recall. Cognitive function was assessed using the Korean Mini-Mental State Examination. Multiple linear and logistic regression models were fit to estimate the association between E-DII scores and the degree of cognitive function. RESULTS: E-DII scores were significantly inversely associated with Korean Mini-Mental State Examination score in both unadjusted and adjusted models, after controlling for sex, age, body mass index, sleep hours, supplement use, education level, self-reported health conditions, history of dementia, and physical activity (ß = -1.33, 95% confidence interval [CI] = -1.95, -0.71, P <0.0001; ß = -0.58, 95% CI = -1.11, -0.06, P = 0.03, respectively). Participants in the highest E-DII tertile had increased risk for mild or moderate cognitive impairment compared with those in the lowest E-DII tertile (adjusted odds ratio 6.32, 95% CI 1.18-33.78; P for trend = 0.0031). CONCLUSIONS: Higher E-DII scores were associated with increased risk of cognitive impairment, suggesting that consuming a proinflammatory diet is associated with increased risk for cognitive impairment in the older Korean adults.

Eating Alone is Differentially Associated with the Risk of Metabolic Syndrome in Korean Men and Women.

Few studies have examined overall patterns of eating alone in relation to the risk of metabolic syndrome (MetS) in Korean populations. The present study aimed to examine the relationship between patterns of eating alone and the risk of MetS in Korean adults. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) for 2013⁻2015 were used, with 8988 Korean adult participants, including 3624 men and 5364 women, aged 18 to 64 years. Patterns of eating alone were categorized into eight groups based on the total frequency of eating alone on a daily basis in the past one year: (1) three times for breakfast, lunch, and dinner; (2) twice for breakfast and dinner; (3) twice for lunch and dinner; (4) twice for breakfast and lunch; (5) once for breakfast only; (6) once for lunch only; (7) once for dinner only; and (8) never eating alone. The presence of MetS has been defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF). Multivariable logistic regression analyses were performed to assess the association between patterns of eating alone versus the risk of MetS after controlling for age, income, occupation, number of family members, generation types, marital status, smoking status, and physical activity. The prevalence of MetS was the highest in men and women aged 40⁻64 who had breakfast, lunch, and dinner alone (50.1% and 36.8%, respectively). Men who had dinner alone or lunch and dinner alone compared with those who eat with others had a significantly higher risk of MetS, with adjusted odds ratios (AOR) of 1.51, and a 95% confidence interval (CI) of 1.06⁻2.16; and an AOR of 1.54, with a 95% CI of 1.05⁻2.25, respectively. Women who had breakfast alone compared with those who ate with others had a significantly lower risk of MetS (AOR 0.70, 95% CI 0.53⁻0.94). In conclusion, patterns of eating alone are differentially associated with the risk of MetS in a representative sample of Korean adults. Future studies are warranted to identify dietary patterns across the different eating alone patterns in relation to various health outcomes in Korean adult populations.

Identifying Dietary Patterns Associated with Mild Cognitive Impairment in Older Korean Adults Using Reduced Rank Regression.

Diet plays a crucial role in cognitive function. Few studies have examined the relationship between dietary patterns and cognitive functions of older adults in the Korean population. This study aimed to identify the effect of dietary patterns on the risk of mild cognitive impairment. A total of 239 participants, including 88 men and 151 women, aged 65 years and older were selected from health centers in the district of Seoul, Gyeonggi province, and Incheon, in Korea. Dietary patterns were determined using Reduced Rank Regression (RRR) methods with responses regarding vitamin B6, vitamin C, and iron intakes, based on both a one-day 24-h recall and a food frequency questionnaire. Cognitive function was assessed using the Korean-Mini Mental State Examination (K-MMSE). Multivariable logistic regression models were used to estimate the association between dietary pattern score and the risk of mild cognitive impairment. A total of 20 (8%) out of the 239 participants had mild cognitive impairment. Three dietary patterns were identified: seafood and vegetables, high meat, and bread, ham, and alcohol. Among the three dietary patterns, the older adult population who adhered to the seafood and vegetables pattern, characterized by high intake of seafood, vegetables, fruits, bread, snacks, soy products, beans, chicken, pork, ham, egg, and milk had a decreased risk of mild cognitive impairment compared to those who did not (adjusted odds ratios 0.06, 95% confidence interval 0.01-0.72) after controlling for gender, supplementation, education, history of dementia, physical activity, body mass index (BMI), and duration of sleep. The other two dietary patterns were not significantly associated with the risk of mild cognitive impairment. In conclusion, high consumption of fruits, vegetables, seafood, and protein foods was significantly associated with reduced mild cognitive impairment in older Korean adults. These results can contribute to the establishment of dietary guidelines targeting older Korean adults to reduce mild cognitive impairments. Future prospective cohort studies are warranted to examine the effect of the seafood and vegetable dietary pattern on reducing mild cognitive impairment to prove the cause-effect relationship between dietary patterns and cognitive function.

Pre-Pregnancy Body Mass Index Is Associated with Dietary Inflammatory Index and C-Reactive Protein Concentrations during Pregnancy.

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight), and ≥30 kg/m² (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01-5.71; AORs 24.84, 95% CIs 6.19-99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.

Sensory education program development, application and its therapeutic effect in children.

There has recently been Increased interest in the emotional intelligence (EQ) of elementary school students, which is recognized as a more important value than IQ (intelligence quotient) for predict of their success in school or later life. However, there are few sensory education programs, available to improve the EQ of elementary school student's in Korea. This study was conducted to develop an educational program that reflects the characteristics and contents of traditional rice culture and verify the effects of those programs on the EQ of children. The program was developed based on the ADDIE (Analysis, Design, Development, Implementation and Evaluation) model and participants were elementary school students in 3(rd) and 4(th) grade (n = 120) in Cheonan, Korea. Descriptive statistics and paired t-tests were used. EQ scores pertaining to the basic sense group, culture group, and food group were significantly improved after the sensory educational program(P < 0.05), but no change was observed in the control group. These findings indicate that sensory education contributed to improving elementary school children's Emotional Intelligence (EI) and their actual understanding about Korean traditional rice culture.

Comparison of dietary food and nutrient intakes by supplement use in pregnant and lactating women in Seoul.

This study was performed to compare the dietary food and nutrient intakes according to supplement use in pregnant and lactating women in Seoul. The subjects were composed of 201 pregnant and 104 lactating women, and their dietary food intake was assessed using the 24-h recall method. General information on demographic and socioeconomic factors, as well as health-related behaviors, including the use of dietary supplements, were collected. About 88% and 60% of the pregnant and lactating women took dietary supplements, respectively. The proportion of dietary supplements used was higher in pregnant women with a higher level of education. After adjusting for potential confounders, among the pregnant women, supplement users were found to consume 45% more vegetables, and those among the lactating women were found to consume 96% more beans and 58% more vegetables. The intakes of dietary fiber and ß-carotene among supplement users were higher than those of non-users, by 23% and 39%, respectively. Among pregnant women, the proportion of women with an intake of vitamin C (from diet alone) below the estimated average requirements (EAR) was lower among supplement users [users (44%) vs. non-users (68%)], and the proportion of lactating women with intakes of iron (from diet alone) below the EAR was lower among supplement users [usesr (17%) vs. non-users (38%)]. These results suggest that among pregnant and lactating women, those who do not use dietary supplements tend to have a lower intake of healthy foods, such as beans and vegetables, as well as a lower intake of dietary fiber and ß-carotene, which are abundant in these foods, and non-users are more likely than users to have inadequate intake of micro-nutrient such as vitamin C and iron.

A case of recurrent infection caused by a pancreaticoduodenal fistula associated with a pancreatic arteriovenous malformation.

Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.

Effects of kimchi ethanolic extracts on oxidative stability of refrigerated cooked pork.

The antioxidant effect of different kimchi extracts in cooked ground pork during storage for 14 days at 4°C was studied. Cooked ground pork was treated with ascorbic acid, BHT, baechu kimchi (BK), got kimchi (GK), puchu kimchi (PK), and white kimchi (WK) and compared to cooked ground pork without antioxidant. Radical scavenging and chelating activities of kimchi extracts were in the order: GK>PK>BK>WK. Total phenolic contents and flavonoid contents ranged from 32.52 to 46.73 mg of GAE/g and 5.87 to 25.58 mg quercetin/g, respectively. Significantly (P<0.05) lower values of TBARS, peroxide values, and hexanal contents were obtained for GK treated samples compared with cooked pork without antioxidant during refrigerated storage. GK showed good antioxidant activity and was significantly different (P<0.05) from the other treatments. Based on these findings, the natural antioxidants examined may have applications in the development of nutritionally enhanced meat products with enhanced shelf life.

Effects of grape pomace on the antioxidant defense system in diet-induced hypercholesterolemic rabbits.

The effects of grape seeds extract and grape peels extract prepared from grape pomace on the activity of antioxidant enzymes, degree of lipid peroxidation in serum and liver tissue were investigated in rabbits fed on high cholesterol diet. New Zealand white rabbits were divided as follows ; 1) NOR (normal group); 2) CHOL (cholesterol group); 3) GSH (cholesterol + grape seed extract group); 4) GPE (cholesterol + grape peel extract); 5) GSP (cholesterol + grape seed powder); 6) GPP (cholesterol + grape peel powder); 7) GE (cholesterol + grape seed and peel extract); 8) GP (cholesterol + grape seed and peel powder). Eight groups of rabbits were studied for 8 weeks. At the end of the experimental period, rabbits were sacrificed and the liver tissue were removed. Then, GSH, GPx, GST, CAT and MDA in the liver were measured. In liver tissues, total glutathione contents (GSH), glutathione peroxidase (GPx) and catalase (CAT) activity, which was significantly higher by grape seed extract supplementation. The level of malondialdehyde (MDA) was lower in the serum of rabbits fed grape seed extract or grape peel powder plus cholesterol than in the serum of rabbits fed cholesterol alone. It is therefore likely that grape seed extract prepared from grape pomace functioned as antioxidants in vivo, negating the effects of the oxidative stress induced by 1% cholesterol diet. The grape seed extract was found effective in converting the oxidized glutathione into reduced glutathione, and in removing H(2)O(2) that is created by oxidative stress. The grape peel powder was found to have small influence on reduced glutathione content, CAT and GPX activity, but it increased GST activity in liver tissues, resulting in promoting the combination of lipid peroxide and glutathione (GSH), and further, lowering the formation of lipid peroxide in the serum. Therefore, grape pomace (grape seed extract and grape peel powder) supplementation is considered to activate the antioxidant enzyme system and prevent damage with hypercholesterolemia.

The antioxidative properties of mustard leaf (Brassica juncea) kimchi extracts on refrigerated raw ground pork meat against lipid oxidation.

The efficacy of varying concentration of mustard leaf kimchi ethanolic extracts (MK) in retarding oxidative rancidity was tested with raw ground pork. Freshly ground pork meat was assigned to one of the following five treatments: control (no antioxidants); AC-0.02 (0.02% ascorbic acid); MK-0.05, 0.1, and 0.2 (0.05%, 0.1% and 0.2% MK, respectively). The pH of the samples decreased and the TBARS values and free fatty acids (%) increased considerably (P<0.05) during storage. The total bacterial count was lower in MK-0.1 and MK-0.2 than the control during storage. The internal L* value and a* value decreased (P<0.05) with the addition of MK. The internal b* value of MK treatments were higher (P<0.05) than that for the control and increased incrementally with MK concentration. The TBARS values and free fatty acids (%) of MK-0.02 was lowest among the treatments. The peroxide value of the control increased until 7 days and reached the maximum value at a certain storage time and decreased thereafter. In the other treatments it increased. All treatments had lower concentration of conjugated dienes (P<0.05) compared to the control sample, after the first day. Mustard leaf kimchi ethanolic extracts exhibited a protective effect against lipid oxidation in raw ground pork.

Bone density in chronic schizophrenia with long-term antipsychotic treatment: preliminary study.

OBJECTIVE: Decreased bone mineral density has been found in the chronic schizophrenic patients who have been given a long-term administration of antipsychotics. Hyperprolactinemia from the antipsychotics and the negative symptom of schizophrenia were considered as the causes for this finding. In this study, the effect of hyperprolactinemia and the negative symptom of schizophrenia on bone mineral density was investigated on male schizophrenic patients. METHODS: The cross-sectional study was carried out with the subjects of 45 male schizophrenic patients who have undertaken the monotherapy with risperidone, olanzapine and clozapine for at least one year. The demographic factors, clinical symtoms, bone mineral density and hematological test were examined for all the subjects. RESULTS: No significant relationship was found between hyperprolactinemia and the decreased bone mineral density in the subjects. The negative schizophrenia symptom of the subjects showed a significant effect on the decreased bone mineral density. CONCLUSION: The decreased bone mineral density finding in the male schizophrenic patients may be caused by the negative schizophrenia symptom rather than the hyperprolactinemia due to the antipsychotics. Additional studies are further required regarding other factors that may affect the decreased bone mineral density such as activity, calcium intake and exposure to sunlight.

Chronic diseases and dietary changes in relation to Korean Americans' length of residence in the United States.

BACKGROUND: National health in the United States is influenced by the dietary norms brought into the country by an increasing number of immigrants. OBJECTIVES: This cross-sectional study aimed to document dietary changes and disease prevalence in relation to the length of residence in the United States for Korean Americans in Michigan. DESIGN: Of 1,860 questionnaires mailed out, 637 (34.3%) were returned with respondent-reported information, including demographics, weight and height, chronic diseases, and dietary patterns. SUBJECTS/SETTING: Included in the final analyses were 497 first-generation Korean-American immigrants (263 men, 234 women, aged 30 to 87 years). STATISTICAL ANALYSES PERFORMED: Analysis of covariance with the Tukey test and logistic regression models provided sex-specific analysis of dietary changes and disease patterns. All statistical analyses were adjusted for age. RESULTS: Chronic diseases reported most frequently by men and women, respectively, were hypertension, digestive diseases, arthritis, and diabetes. Length of residence in the United States (or=26 years) was inversely associated with the prevalence of digestive diseases in men (P=0.017) and women (P=0.001), and positively with respiratory diseases in men and thyroid disease in women (P<0.05). Length of residence in the United States was inversely associated with intake of rice/rice dishes in both men (servings per week, P<0.001) and women (P=0.012). The prevalence of digestive diseases associated inversely with length of residence and positively with servings of rice/rice dishes consumed for Korean-American men. The age-adjusted odds ratio for digestive diseases was highest among men who had the shortest length of residence in the United States (2 servings per day) (odds ratio 12.10; P=0.03). CONCLUSIONS: Dietary changes of Korean-American immigrants in the United States over time were associated with changes in their chronic disease patterns. These findings may help food and nutrition professionals who work with minority immigrants because they identify factors that affect changes in dietary patterns and work toward preventing diet-related diseases. Prospective studies could address underlying mechanisms of the observed diet-disease relationship with subsequent generations of Korean Americans, as well as various ethnic minority immigrants in the United States.

[Effects of assertive training on interpersonal relations, social behavior, and psychiatric symptoms in patients with a mental disorder].

PURPOSE: This study was designed to examine the effects of an assertive training program on interpersonal relations, and psychiatric symptoms in patients with a mental disorder. METHOD: The study employed a quasi experimental design. The subjects included 44 patients with a mental disorder, 20 in the experimental group, and 24 in the control group. Data was collected using structured questionnaires over a 3 month period. RESULTS: There were greater significant increases in scores of interpersonal relations and content of communication in the experimental group than the control group. Also, there was a greater significant decrease in the score of psychiatric symptoms in the experimental group than the control group. CONCLUSION: Assertive training has an effect on increasing content of communication and decreasing psychiatric symptoms.

[Predictive factors of aspects of the transtheoretical model on smoking cessation in a rural community].

PURPOSE: This study was done to evaluate the predictive value of aspects of the Transtheoretical model (TTM) of behavior change as applied to smoking cessation in a rural population. METHOD: A convenience sample was recruited from a public health center in a community. A total of 484 participants were recruited, including 319 smokers, 116 ex-smokers and 49 non-smokers. A cross-sectional and descriptive design was used in this study. Data was analyzed using descriptive statistics, frequency statistics, ANOVA and Logistic regression. RESULT: The major findings were 1) The participants were assessed at baseline for their current Stage of Change resulting in a distribution with 42.1% in Precontemplation, 24.1% in Contemplation, 9.7% in Preparation, 6.2% in Active, and 17.9% in the Maintenance stage. 2) There were statistically significant differences of processes of change, decisional balance and situational temptation across the stages of change. 3) The main factors that affect smoking cessation were age, number of years smoking, age when began smoking, self-liberation and negative/affective situations, which combined explained 33.2% of the smoking cessation. CONCLUSION: TTM variables measured prior to a smoking cessation program added little predictive value for cessation outcome beyond that explained by demographic and smoking history variables.

[A study on the variables forecasting male adolescents' sexual intercourse].

PURPOSE: This study was designed to identify the variables affecting male adolescents' sexual intercourse through a comprehensive analysis of individual and environmental factors. METHOD: The subjects of this descriptive survey on causal relations were 462 subjects enrolled in liberal and vocational high schools selected on a convenience sampling basis. The data collected from May-July 2002 was put to logistic regression analysis to build a forecast model. FINDINGS: 1) Individual factors such as school record, experience seeking, non-inhibition and sexual permissiveness, 2) family factors such as parental living arrangement, 3) school factors such as career tract and 4) peer factors such as having a boy/girl friend were identified as significant variables forecasting sexual intercourse. CONCLUSION AND RECOMMENDATION: The theoretical model built on the basis of the major findings of this study will hopefully help promote a wholesome youth culture related to sexual intercourse. It is recommended that a program be developed that can help control the variables identified in this study along with a follow-up study to verify the model.

Carbohydrate intake is associated with diet quality and risk factors for cardiovascular disease in U.S. adults: NHANES III.

OBJECTIVES: To determine if carbohydrate intake, as a % of energy, was related to diet quality and risk factors for cardiovascular disease (CVD) in adults in a cross-sectional and population-based study in the U.S. METHODS: Data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) were utilized. The nationally representative sample of the U.S. population (3,754 men, 4,074 women, ages 25 to 64 years) was divided into quintiles of carbohydrate intake (% of energy), which was examined in relation to risk factors for CVD: systolic blood pressure, body mass index (BMI), and concentrations of serum triglyceride, serum total and HDL cholesterol and plasma glucose. RESULTS: When covariates (age, ethnicity, smoking, alcohol intake and total energy intake) were adjusted in multivariate analyses, carbohydrate intakes (% of energy) were inversely associated with BMI and serum total cholesterol concentration in men and BMI in women and positively associated with serum triglyceride concentration in women. When total sugar intake (% of energy) was further controlled as a step to understand the quality of carbohydrate, carbohydrate intakes (% of energy) was a stronger predictor of BMI and plasma glucose in men and BMI in women. A high carbohydrate diet (>57.4% of energy in men and >59.1% of energy in women) was associated with a low serum HDL-cholesterol concentration in men and high serum triglyceride in women. CONCLUSION: Moderately high carbohydrate (50% to 55% of energy) diets were associated with low CVD risks with favorable lipid profiles.