Can tailored home-delivered meal services alleviate self-rated frailty of the low-income older adults in Korea?

BACKGROUND/OBJECTIVES@#This study aimed to examine whether the tailored homedelivered meal (HDM) services included nutrition counseling impacts alleviating self-rated frailty among low-income older adults in Korea. @*SUBJECTS/METHODS@#Pre- and post-test were implemented on May 27 and on November 25 in 2019 during 3 weeks, respectively, before and after the 6 months intervention program.Participants completed a questionnaire measuring frailty, malnutrition, food security, depression, and underlying diseases. Initially, 136 older adults were selected as participants for this study, they were recipients of a free meal program from 2 senior welfare centers in Seoul, the final sample size of those who completed the intervention program was 117 (female 70.9%, male 29.1%). Statistical analyses were conducted with IBM SPSS package program, paired t-test and χ 2 test to validate the test. @*RESULTS@#There were statistically significant differences in the score of the Tilburg Frailty Indicator (TFI) before and after receiving the tailored HDM services (pre-test 9.46, post-test 2.8, P < 0.01). The differences in the score of TFI by 3 risk groups at the pre-test decreased as a result of receiving these services. @*CONCLUSIONS@#The tailored HDM services alleviated the self-rated frailty of low-income older adults with limited mobility in a community setting. Based on the positive outcomes this study could be applied to developing social services for aging in place.

Current Status of Outsourced Food Service Operations According to the Type of Long-Term Care Institution and Plans for Improvement

This study aimed to explore the status of food service outsourcing behavior of long-term care institutions (LTCIs) through a cross-sectional survey using a questionnaire administered between July 16th and August 7th, 2020. The survey respondents were either dietitians or facility managers, who worked at 731 nursing homes, 477 group homes, and 673 day-care centers. Approximately 25.9% of nursing homes, 11.7% of group homes, and 33.1% of day-care centers used a managed-services company to operate their food service units.The main reason for outsourcing food service by nursing homes was related to the staffing of dietitians and cooks, whereas group homes and day-care centers outsourced food services due to factors relating to meal costs and the cooking process. Almost all the LTCIs entered into private contracts for outsourced food services. Only a few food service contracts included the types of meals, nutrition standards such as protein and calories per meal, and the parameter or ratio of food cost. Of the respondents, 84.5% from nursing homes, 87.5% from group homes, and 87.1% from day-care centers agreed that the quality of outsourced food services of the LTCIs should be regulated. Meals are essential for maintaining the health and functional status of LTCI users. As more LTCIs outsource their food services, we suggest the following: (1) Increasing the minimum dietitian staffing standards for LTCIs as per the Welfare of Senior Citizens Act and requiring at least one dietitian for every nursing home, (2) Making it mandatory to use a standard food service contract template when drafting food service contract, and (3) Developing realistic standards for food service operations considering the size and operation type of the LTCIs.

Do types of snacks, sleep hours, and eating places affect nutritional intakes and its adequacy in adolescents?

BACKGROUND/OBJECTIVES@#High-quality meal intake, including snacks, is necessary for optimal development during adolescence. The purpose of this study was to evaluate the nutritional intake of adolescents and the quality of their diet according to snack type, eating location, and sleep hours. @*SUBJECTS/METHODS@#A survey of middle school students living in Seoul and Gyeonggi province was conducted using questionnaires and the 24-h recall method to collect data on the 1-day dietary intake of the students from March to May, 2018. The data were analyzed using SPSS 23.0 and the CAN program. @*RESULTS@#The average nutritional intake status among the respondents showed that the energy intake was lower than the recommended, showing 1,914.8 kcal for middle school boys and 1,752.7 kcal for girls. In terms of the nutritional intake status by gender, only the consumption of protein and niacin were significantly higher in boys than girls (P < 0.05).According to the sleep amounts, vitamin C intake was significantly higher in the sleepdeprived group than in the sleep-moderate or sleep-recommended group (P < 0.05), but the intake did not meet the recommendation in any group. The lower density nutrients found in the index of nutritional quality according to eating places were vitamin C, calcium, iron, and folic acid. School meals showed a higher nutritional density in protein, vitamin B 1 , and niacin compared to convenience store meals (P < 0.05). @*CONCLUSIONS@#This study suggested that sleep amount, and eating place affected the dietary quality of adolescents.

Do types of snacks, sleep hours, and eating places affect nutritional intakes and its adequacy in adolescents?

BACKGROUND/OBJECTIVES@#High-quality meal intake, including snacks, is necessary for optimal development during adolescence. The purpose of this study was to evaluate the nutritional intake of adolescents and the quality of their diet according to snack type, eating location, and sleep hours. @*SUBJECTS/METHODS@#A survey of middle school students living in Seoul and Gyeonggi province was conducted using questionnaires and the 24-h recall method to collect data on the 1-day dietary intake of the students from March to May, 2018. The data were analyzed using SPSS 23.0 and the CAN program. @*RESULTS@#The average nutritional intake status among the respondents showed that the energy intake was lower than the recommended, showing 1,914.8 kcal for middle school boys and 1,752.7 kcal for girls. In terms of the nutritional intake status by gender, only the consumption of protein and niacin were significantly higher in boys than girls (P < 0.05).According to the sleep amounts, vitamin C intake was significantly higher in the sleepdeprived group than in the sleep-moderate or sleep-recommended group (P < 0.05), but the intake did not meet the recommendation in any group. The lower density nutrients found in the index of nutritional quality according to eating places were vitamin C, calcium, iron, and folic acid. School meals showed a higher nutritional density in protein, vitamin B 1 , and niacin compared to convenience store meals (P < 0.05). @*CONCLUSIONS@#This study suggested that sleep amount, and eating place affected the dietary quality of adolescents.

Suggestion of an Evaluation Tool for Sustainable Practices in School Foodservices and Analysis of Performance: Focus on Gyeonggi Province

Sustainable practices of school foodservices are gaining more attentions. The study aimed to investigate dietitians' performance levels of sustainable practices in school foodservice settings in Gyeonggi Provinces. Using a survey method was used, and data were collected from 358 participants (response rate 59.7%) to be analyzed using the SPSS program. The evaluation tool for sustainable practices of school foodservices consisted of four sections and 34 criteria with 100 points. Employment status of the respondents was as follows: nutrition teachers 40.9%, dietitians (permanent) 45.1%, and temporary position dietitians 13.2%. Dietitians' performance for sustainable practices marked 65.67 points out of 100 (performance rate 66%) and were in the following order by section: sustainable foodservice management criteria (69%), support activities (69%), planning and evaluation (68%), and outcome management (52%). Regarding sub-sections, criteria that acquired higher performance rates were labelling of food origin (99%), use of seasonal vegetables and fruits (98%), food waste management by contract dealer (98%), and planning for reducing of food waste and solid waste (91%). Meanwhile, criteria that showed the lowest scores were installing water conservation devices on equipment (19%), operating food donation programs for communities (21%), use of sensor lights for electricity conservation (24%), planning for annual energy conservation (40%), and implementation of education programs for foodservice workers on sustainable activities (42%). Performance scores differed according to school levels and working experience of dietitians, indicating that dietitians at elementary school foodservices or with work experience of 15 to 20 years showed higher performance than those at high schools or with less than 5 years of work experience (P < 0.001, P < 0.05). Based on the results, action plans for improvement were suggested.

Relationship between Air Quality of Functional Areasand Hygiene Safety Management Performance in High School Foodservices in Gyeonggi Province

The study examined evaluated the sanitation management state of the high school foodservice operations, as measured by temperature, humidity and airborne bacteria concentration in functional areas and further identified their relationships. Data were collected from 26 high school foodservices in Gyeonggi Province. Statistical analyses were conducted with the SPSS program using descriptive analysis and spearman's correlation. The sanitation management performances in high school foodservice scored 86.85 out of 100 points and showed higher scores in the dimensions of preparation and storing management (17.85/20 points), operation management (17.78/20 points), and cooking utensil management (17.62/20 points), while the dimensions of cross contamination management as well as personal hygiene management needed action plans for prompt improvement. The airborne bacteria concentration was highest in the dining area (179.2 CFU/plate), and requiring action plans for improvement. The relative humidity in functional areas ranged from 66.5% in the receiving area to 74.4% (dish-washing area) and the temperature of the preparation area showed an average of 25.1°C with the highest of 35.4°C in the dish-washing area. In terms of the relationships among airborne bacteria, temperature, and humidity, the concentration of airborne bacteria was negatively correlated with and temperature in the dish-washing area (r= -0.693, P<0.05), and no other significances were shown in the other areas.

Exploratory study on effect of eco-friendly program in high school foodservice on adolescents' dietary behavior and satisfaction with foodservice / 한국영양학회지

PURPOSE: The purpose of this study was to evaluate the effects of an eco-friendly foodservice program at a high school on dietary behaviors of students, awareness of importance of eco-friendly activities, and foodservice satisfaction. METHODS: The survey was conducted with students at two schools in Gyeonggi, Korea. A total of 576 of 650 students were used for this study. Data were analyzed using Chi-square test, independent t-test, and factor analysis to test the two group's differences. RESULTS: The practices of ‘eat balanced meals’ or ‘finish all food on the plate’ scored high (p < 0.001) in students that participated in the eco-friendly foodservice program than those who did not. Regarding awareness of the importance of eco-friendly activities, all attributes scored higher in students that participated in the eco-friendly foodservice program. All attributes for satisfaction except two scored higher (p < 0.05) in students that participated in the eco-friendly foodservice program. Principal Components Analysis (PCA) of the correlation showed that high subjective income status was positively associated with foodservice satisfaction. CONCLUSION: Students that participated in the eco-friendly foodservice program are highly aware of the importance of eco-friendly activities. They demonstrate more positive dietary behaviors and higher awareness of the importance of eco-friendly programs with greater foodservice satisfaction.

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea

BACKGROUND/OBJECTIVES: Sustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer's perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention. SUBJECTS/METHODS: The study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions. RESULTS: Sustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (beta = 0.154), waste management (beta = 0.204) and sustainable food preparation (beta = 0.183). Green packaging (beta = 0.107) and the social contribution of the foodservice organization (beta = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (beta = 0.775). CONCLUSIONS: The results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community.

Expert opinions on improvement of current food code related to hygiene management standards for cooked foods in restaurants / 한국영양학회지

PURPOSE: Needs for reevaluation of food code standards and regulations for cooked foods produced in restaurants and institutional foodservice to minimize risk factors leading to foodborne outbreaks are on the rise. The purpose of the study was to propose updated standards for cooked foods of restaurants by testing whether or not experts agree to include them as a standard. METHODS: Qualitative and quantitative research methods were applied via a survey by email and workshop hold for experts panel discussions. RESULTS: Seven newly proposed standards were selected as follows: (1) sanitizing vegetables and fruits with no heating process after washing, (2) rapid cooling of cooked foods after heating process, (3) monitoring cooking temperatures, (4) minimum 2 hours holding after cooking for temperature control of safety (TCS) foods without temperature control, (5) banning practices for workers such as bare hands handling of ready-to-eat foods, (6) maintaining cleanliness of food contact surfaces for disposable products, and (7) cold holding standards for sushi. CONCLUSION: The proposed proposal can be utilized as control measures for preventing foodborne illness in restaurants. However, a feasibility study should be conducted to test whether they are applicable to the field of restaurant operation.

Development of the evaluation tool for the food safety and nutrition management education projects targeting the middle class elderly: Application of the balanced score card and the structure-process-outcome concept / 한국영양학회지

PURPOSE: The aim of this study is to develop an evaluation tool for operation of food safety and nutrition education projects for middle class elderly using the concept of the balanced score card. METHODS: After the draft of the evaluation tool for the elderly training projects was completed, it was revised into the questionnaire and the validity of the indicators was tested by the Delphi group. The validity of the indicators was rated using a 5-point scale. The Delphi group consisted of 26 experts in the education sector, 16 government officials, and 24 professionals of the related area in communities. The first round test was conducted from July 9 to July 17, 2012, and 45 persons responded. The second round test was conducted from July 18 to July 25 and 32 persons responded. RESULTS: The indicators, which were answered by more than 75 percent of the experts as 'agree' (4 points), 'strongly agree' (5 point) were included as the final indicators for the evaluation tool: 28 items out of 36 in outcome perspectives, 9 items out of 12 in process perspectives, and 17 out of 20 items in structure perspectives. The score was allocated as 50 points for outcome indicators, 20 points for process indicators, and 30 points for structure indicators. CONCLUSION: Completion of the evaluation tool is a prerequisite to determine whether the program is effectively implemented. The monitoring tool developed in the study could be applied for identification of the most optimal delivery path for the food safety and nutrition education program, for the spread of the food safety and nutrition education program for middle class elderly.

Food allergy knowledge, perception of food allergy labeling, and level of dietary practice: A comparison between children with and without food allergy experience

BACKGROUND/OBJECTIVES: The prevalence of food allergies in Korean children aged 6 to 12 years increased from 10.9% in 1995 to 12.6% in 2012 according to nationwide population studies. Treatment for food allergies is avoidance of allergenic-related foods and epinephrine auto-injector (EPI) for accidental allergic reactions. This study compared knowledge and perception of food allergy labeling and dietary practices of students. SUBJECTS/METHODS: The study was conducted with the fourth to sixth grade students from an elementary school in Yongin. A total of 437 response rate (95%) questionnaires were collected and statistically analyzed. RESULTS: The prevalence of food allergy among respondents was 19.7%, and the most common food allergy-related symptoms were urticaria, followed by itching, vomiting and nausea. Food allergens, other than 12 statutory food allergens, included cheese, cucumber, kiwi, melon, clam, green tea, walnut, grape, apricot and pineapple. Children with and without food allergy experience had a similar level of knowledge on food allergies. Children with food allergy experience thought that food allergy-related labeling on school menus was not clear or informative. CONCLUSION: To understand food allergies and prevent allergic reactions to school foodservice among children, schools must provide more concrete and customized food allergy education.

Correlation between attention deficit hyperactivity disorder and sugar consumption, quality of diet, and dietary behavior in school children

This study investigated the correlation between consumption of sugar intake by fifth grade students in primary schools and development of Attention Deficit Hyperactivity Disorder (ADHD). A total of 107 students participated, and eight boys and one girl (8.4% of the total) categorized as high risk for ADHD according to diagnostic criteria. There were significant differences in the occupations and drinking habits of the respondents' fathers between the normal group and risk group. In a comparison of students' nutrition intake status with daily nutrition intake standards for Koreans, students consumed twice as much protein as the recommended level, whereas their calcium intake was only 60% of the recommended DRI (dietary reference intake). Regarding intake volume of vitamin C, the normal group posted 143.9% of the recommended DRI, whereas the risk group showed only 65.5% of the recommended DRI. In terms of simple sugar intake from snacks, students in the normal group consumed 58.4 g while the risk group consumed 50.2 g. These levels constituted 12.5% of their total daily volume of sugar intake from snacks, which is higher than the 10% standard recommended by the WHO. In conclusion, children who consumed less sugar from fruit snacks or whose vitamin C intake was less than RI was at increased risks for ADHD (P < 0.05). However, no significant association was observed between total volume of simple sugar intake from snacks and ADHD development.

The Effectiveness of Nutrition Education Provided by Dietitians in Child Care Centers / 대한지역사회영양학회지

The purpose of this study was to evaluate the effectiveness of nutrition education with nutrition services provided by dietitians who were placed in child care facilities from the Korean Dietetic Association. For this, we investigated the levels of nutrition knowledge and dietary intakes of children who attended child-care centers as well as dietary practices of children assessed by their parents. The treatment for children consisted of nutrition education and food service activities that are provided by the dietitian who have 3 to 5 years experience. Nutrition education was implemented during 10 weeks, 20 times, and a total 400 min and it's effectiveness was evaluated by questionnaire. Data were obtained for 123 children aged 4 to 5 years old who attended four child-care centers, one for a control group and 3 for intervention groups. Dietary intakes were investigated by measuring one-serving size and plate waste a of child for one-day dietary records before and after nutrition education. The levels of nutrition knowledge of children improved showing 70.80 points before to 83.45 points after nutrition education (p < 0.001). Dietary intakes of the children after nutrition service increased significantly on cooked rice (133.66 g), Kimchi (19.41 g), side dish of meat/fish (48.40 g), and side dish of vegetables (24.88 g). Dietary practices of children after treatment also improved especially 'eat diverse meat, fish, egg, and bean' and 'never leave plate waste'. To summarize, this study pointed out that nutrition service and nutrition education provided by dietitians had influences on increases of the nutrition knowledge, dietary intake, and dietary practices. Therefore, placement of dietitians needs to extend to child care facilities from the 100 persons-over-capacity facility to the 50 persons-over-capacity facility, for providing professional service such as nutrition education and nutrition counseling.

Product Development and Market Testing of Ready-to-Eat Mandu with Pond-Snail as a Health Food / 대한지역사회영양학회지

Recently, according to increase in production of pond snails resulting from the widespread organic farming, organic farmers are showing a lot of interests in the promotion of consumption and extending the market of pond snails. This study was performed to suggest the process of product development of the ready-to-eat pond-snail Mandu as a health food, to show the results of market test of the pilot product, and to investigate the change of the sensory characteristics during storage periods. For the market test of pond-snail Mandu, the survey was developed and delivered to consumers. The questionnaire consisted of 3 parts such as respondents demographic characteristics, customer's perception of pond-snail Mandu before tasting, and customer's perception of that after tasting. And the market test was carried out with university students, welfare institution residents and apartment residents in the Seoul and Gyeonggi areas. As a result of the test, the most important purchasing factors were determined in the order of taste (49.5%), hygienic quality (12.5%), nutritional value (10%) and price (9%). And only 4.2% of respondents selected brand name as an important purchasing factor. After tasting pondsnail Mandu, consumers had suggested the better taste (t = 6.986, p 0.05) was not founded by storage period of 7, 14, 21 and 28 days. Based on the result, the improvement of these characteristics are desired in developing the pond-snail Mandu. Research method applied to this study can be useful for developing a new product.

Development of Performance Indicators Based on Balanced Score Card for School Food Service Facilities / 대한지역사회영양학회지

This study raised the necessity of developing performance indicators for measuring the management efficiency and effectiveness of school food service, and as a means of helping its implementation, a balanced score card (BSC) approach developed by Norton and Kaplan was adopted. This study established BSC in seven phases through literature: Phase 1 Defining a school food service and the scope of working activities, Phase 2 Establishing the vision of a school food service, Phase 3 Setting strategic goals, Phase 4 Identifying critical success factors (CSFs), Phase 5 Developing Key Performance Indicators (KPIs), Phase 6 Extracting cause and effect relationship, and Phase 7 Completing a preliminary BSC. The preliminary BSC was turned into a survey, which was administered to food service related people working at the Office of Education and School Food Service including 16 offices, 209 dietitians, 48 school administrators both from self-operated and contract-managed, and 9 experts in areas related to school food service. They were asked questions about strategics from 4 different perspectives, 12 CSFs, 39 KPIs, and the cause and effect relationships among them. As a result, among the CSFs based on 4 different perspectives, all factors other than "zero sum on profit/loss" from the financial perspective turned out to be valid. In terms of KPIs, manufacturing cost percentages, casualty loss count/reduction rates, school foodervice participation rates, and sales goal achievement rates were found to be valid from the financial perspective, while student satisfaction index, faculty satisfaction index, leftover ratio, nutrition educational performance count, index of evaluating nutrition education, customer claim count/reduction rate, handling customer claim count/reduction rate, and parent satisfaction index were found to be valid from the customers' perspective. Besides, nutritional requirement sufficient ratio, nutritional management score, food poisoning outbreak count, employee safety accident count, sanitary inspection assessment index, meals per labor hour (productivity index), computerization ratio, operational management index, and purchase management assessment index were also found to be valid from the perspective of internal business processes. From the perspective of innovation and learning, employee turnover ratio/rate of absenteeism, annual education and training count, employee satisfaction index, human resource management assessment index, annual menu-related customer feedback, food service information index for employees and parents/schools were also found to be valid. The significance of this study is to present indices for measuring overall performance of school lunch food service operations without putting any limitation on types of school food service management, and to help correctly assess the contribution of the current types of school food service management to schools and students.

A Study on Cost Analyses and an Efficient Financial Management in Self-Operated and Contract-Managed Secondary School Foodservices

Efficient financial management is a critical factor in achieving school foodservice goals. The objective of this study was to suggest efficient financial management practices in secondary school foodservices. In pursuit of this objective, we first identified performance indexes for measuring the success of financial management. Second, we suggested financial management standards, financial data classification methods and a report system. Last, we analyzed operating ratios with the financial data of self-operated and contract-managed school food services. The data were collected through an open-ended questionnaire from 10 middle/high school foodservices in Seoul and Kyeonggi Provincial during on-sites visits and interviews with dieticians and managers. Student participation, sales goals, re-contract frequency and number and cost of disaster loss were identified as the performance indexes for financial management. Income statements were compiled by identifying and classifying financial data. Total revenues consisted of subsidies, meal sales, other revenue and interest. Expenditures consisted of purchased food, salaries and wages, utility costs, office supplies, kitchen supplies, purchased services, company overhead indirect costs, facility investment and maintenance, facility usage expenses, employee benefits and miscellaneous. Mean price of a meal was 2,326 won at self-operated foodservices when the subsidies were included as revenues and 2,360 won at contract-managed foodservices. When including the subsidies as revenues, the operating ratios of self-operated foodservice showed that the food cost percentage was 66.9%, labor cost 23.2%, operation cost 9.9% and profit 0%. The correspond figures at contract-managed foodservices were 57.6%, 21.5%, 15.3%, and 5.5%, respectively. Food costs in self-operated foodservices was significantly higher than that for contract-managed foodservices, however, facility investment and maintenance and facility usage expenses at self-operated foodservices was significantly lower than those for contract-managed foodservices. Based on this study, the methodology and classification system of financial data was found to be applicable to assess the financial structure of school foodservices.