Importance, performance frequency, and predicted future importance of dietitians' jobs by practicing dietitians in Korea: a survey study.

PURPOSE: This study aimed to explore the perceptions held by practicing dietitians of the importance of their tasks performed in current work environments, the frequency at which those tasks are performed, and predictions about the importance of those tasks in future work environments. METHODS: This was a cross-sectional survey study. An online survey was administered to 350 practicing dietitians. They were asked to assess the importance, performance frequency, and predicted changes in the importance of 27 tasks using a 5-point scale. Descriptive statistics were calculated, and the means of the variables were compared across categorized work environments using analysis of variance. RESULTS: The importance scores of all surveyed tasks were higher than 3.0, except for the marketing management task. Self-development, nutrition education/counseling, menu planning, food safety management, and documentation/data management were all rated higher than 4.0. The highest performance frequency score was related to documentation/data management. The importance scores of all duties, except for professional development, differed significantly by workplace. As for predictions about the future importance of the tasks surveyed, dietitians responded that the importance of all 27 tasks would either remain at current levels or increase in the future. CONCLUSION: Twenty-seven tasks were confirmed to represent dietitians' job functions in various workplaces. These tasks can be used to improve the test specifications of the Korean Dietitian Licensing Examination and the curriculum of dietetic education programs.

Food contributing to fermentable oligosaccharide, disaccharide, monosaccharide, and polyols intake in Korean adults.

BACKGROUND/OBJECTIVES: The dietary intake of foods with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is known to adversely affect patients with irritable bowel syndrome (IBS). However, the effects of FODMAP have been studied predominantly among Western populations. This study aimed to identify foods high in FODMAP content which form a part of the Korean adult diet and obtain basic data for the preparation of IBS guidelines. SUBJECTS/METHODS: An online survey of 1,000 adults from the general population in the age group of 20 to 40 years was performed. Data from 787 participants (men, 386; women, 401) were analyzed. The general characteristics of the participants, health status, IBS diagnosis using the Rome III diagnostic criteria, semi-quantitative food frequency questionnaire findings, and food items causing symptoms were analyzed. RESULTS: Overall, 169 participants (21.5%) had IBS. The contribution of the FODMAP nutrients in both IBS and healthy groups was as follows: fructan > lactose > excess fructose > sorbitol > mannitol > galacto-oligosaccharides (GOS). The fructan intake was 4.6 ± 2.2 g/day and 4.3 ± 2.5 g/day in the IBS and healthy groups (P = 0.014), respectively. In the IBS group, the ratio of the intake of fructan to the total FODMAP intake was 39.5%, 29.8%, and 5.8% through onions, garlic, and bananas, respectively. CONCLUSIONS: Fructan was the FODMAP nutrient most consumed by Korean adults. Therefore, given the difference in the dietary habits of each country's population, the dietary guidelines for IBS should be country specific.

Relationship between metabolic syndrome and intake of ultra-processed foods in Korean adults: based on 6th and 7th Korea National Health and Nutrition Examination Survey (2013-2018).

BACKGROUND/OBJECTIVES: Metabolic syndrome is closely associated with lifestyle factors, including diet and nutritional intake. Modern trends show a shift in food consumption from healthy home-cooked meals to processed and instant foods. Therefore, this study analyzed the association between ultra-processed food intake and the development of metabolic syndrome in Korean adults based on the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2018. SUBJECTS/METHODS: The subjects of this study were 17,414 adults aged 19-80 years who participated in the 6th-7th KNHANES. Processed food was classified into four categories, NOVA1 to NOVA4, using 24-h recall data. The higher the NOVA category, the more processed the food. Statistical analysis was conducted using logistic regression to investigate the prevalence of metabolic syndrome according to the consumption of ultra-processed foods. RESULTS: Among the diagnostic criteria for metabolic syndrome, hypertension (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62-0.85; Q4 vs. Q1, P-trend < 0.001) and high triglycerides (OR, 0.83; 95% CI, 0.72-0.94; Q4 vs. Q1, P-trend < 0.001) showed a correlation with the percentages of energy consumed from ultra-processed foods. The OR for metabolic syndrome, according to the percentages of energy consumed from ultra-processed foods, is shown only for men. The OR showed that the percentages of energy consumed from ultra-processed foods were associated with increased metabolic syndrome. CONCLUSIONS: This study suggests that consumption of ultra-processed foods raises the risk of metabolic syndrome especially among men. To prevent metabolic syndrome, it is necessary to prepare appropriate dietary guidelines for Korean adults.

Erratum: Evaluation of medical nutrition therapy using the food-based index of dietary inflammatory potential (FBDI) in diabetes mellitus patients.

[This corrects the article on p. 529 in vol. 17, PMID: 37266119.].

Evaluation of medical nutrition therapy using the food-based index of dietary inflammatory potential (FBDI) in diabetes mellitus patients.

BACKGROUND/OBJECTIVES: Inflammation is often associated with chronic diseases, and numerous studies suggest that certain foods can modulate inflammatory status. This study aimed to assess the impact of intensive nutrition education on glycemic control and inflammation in patients with diabetes mellitus using the Korean food-based index of dietary inflammatory potential (FBDI). SUBJECTS/METHODS: A total of 120 patients (male: 70, 58.3%) were randomly divided into two groups of 60 each, to be given intensive nutritional education (IE) and basic nutritional education (BE), respectively. As part of the nutrition education intervention, basic diabetes-related nutrition education was provided to both groups initially. In addition, the IE was provided two face-to-face nutrition education sessions based on FBDI over six months, and text transmissions were made at least eight times. We surveyed the anthropometric measurements, biochemical indicators, inflammatory markers, and dietary intake before and after the interventions. We analyzed the effects of the intensive nutrition education using the t-test, χ2 test and paired t-test. RESULTS: Of the subjects, 76.7% (46/60) of the IE and 86.7% (52/60) of the BE completed the study. The results of the paired t-test to evaluate the effectiveness of nutrition education using FBDI showed that high density lipoprotein-cholesterol increased significantly from 42.6 mg/dL before intervention to 49.2 mg/dL after intervention (P = 0.009), tumor necrosis factor-α significantly decreased from 1.25 pg/mL before intervention to 1.11 pg/mL after intervention (P =.012) in the IE. Also, glycated hemoglobin decreased from 8.0% to 7.5% in the IE but increased from 7.4% to 7.7% in the BE, and the differences between the groups were significant (P = 0.008). CONCLUSION: These findings suggest that providing intensive FBDI-based education on anti-inflammatory foods positively affected glycemic control and inflammatory status in diabetes patients. Therefore, practical dietary plans using FBDI should be considered for diabetes patients to prevent increased inflammation.

The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis.

BACKGROUND/OBJECTIVES: The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. SUBJECTS/METHODS: A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. RESULTS: This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m2; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I2 = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m2; 95% CI, 1.13-1.55; P < 0.001; I2 = 95%) and dietary methods (mean difference = 0.85 kg/m2; 95% CI, 0.1-1.51; P < 0.05; I2 = 95%). CONCLUSIONS: Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.

Minor alleles in the FTO SNPs contributed to the increased risk of obesity among Korean adults: meta-analysis from nationwide big data-based studies.

BACKGROUND/OBJECTIVES: Many studies have revealed an association between fat mass and the obesity-related gene (FTO) and obesity. On the other hand, no meta-analysis was conducted with data from only Koreans. Therefore, this study performed a meta-analysis using Korean data to provide evidence for the association between FTO single nucleotide polymorphisms (SNPs) and the risk of obesity among Korean adults. SUBJECT/METHODS: Meta-analysis was finally conducted with data extracted from seven datasets of four studies performed on Korean adults after the screening passed. Five kinds of FTO SNPs (rs9939609, rs7193144, rs9940128, rs8050136, and rs9926289) were included, and the relationship between FTO SNPs and body mass index (BMI) was investigated using linear regression with an additive model adjusted for covariants, such as age, sex, and area. RESULTS: The minor alleles of FTO SNPs were associated with increased BMI (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.21-1.42). In sub-group analysis, FTO rs9939609 T>A was significantly associated with BMI (OR, 1.23; 95% CI, 1.06-1.42). The other FTO SNPs together were significantly associated with BMI (OR, 1.37; 95% CI, 1.25-1.49). The publication bias was not observed based on Egger's test. CONCLUSIONS: This meta-analysis showed that minor alleles in the FTO SNPs were significantly associated with an increased BMI among Korean adults. This meta-analysis is the first to demonstrate that minor alleles in the FTO SNPs contribute significantly to the increased risk of obesity among Korean adults using data from a Korean population.

Association between frailty and dietary quality in community-dwelling elderly: data from the 6th Korea National Health and Nutrition Examination Survey (2014-2015).

Frailty is a progressive age-related disorder associated with odds ratio for subsequent falls, disability, and mortality. This study analyzed the association between frailty odds ratios and diet quality using the Korean Healthy Eating Index in older individuals. Data were obtained for 2,660 community-dwelling individuals aged ≥60 years who participated in the 6th Korea National Health and Nutrition Survey (2014-2015). Frailty was diagnosed following the Fried phenotype index based on five criteria: unintentional weight loss, emotional exhaustion, low physical activity, slow walking speed, and weak grip strength. The participants were categorized as normal, pre-frail, and frail. Diet quality was assessed using Korean Healthy Eating Index scores calculated based on 24-h dietary recall. Compared to the group with the highest Korean Healthy Eating Index score, the group with low Korean Healthy Eating Index showed a 1.71-fold higher pre-frail odds ratio (95% CI 1.31-2.22, p<0.001) and 1.87-fold higher frail odds ratio (95% CI 1.21-2.91, p = 0.009). Also, compared to the group with the highest adequacy score, the group with the lowest score showed a 1.51-fold higher pre-frail odds ratio (95% CI 1.16-1.96, p = 0.010) and a 2.39-fold higher frail odds ratio (95% CI 1.48-3.86, p = 0.002). The findings of this study suggested that a high-quality diet, as assessed by Korean Healthy Eating Index, was negatively associated with the odds ratio of frailty.

High-Fat Foods and FODMAPs Containing Gluten Foods Primarily Contribute to Symptoms of Irritable Bowel Syndrome in Korean Adults.

Dietary control plays an important role in the treatment of irritable bowel syndrome (IBS). However, few studies have examined the relationship between dietary intake and symptoms of IBS in Koreans. The current cross-sectional study aimed to examine the diet in food consumption and nutrient intake in Korean adults aged 20 to 40 with IBS. The data collected were completed by 857 subjects using a community-based web survey. The questionnaire covered functional bowel disorders based on Rome III, the semi-quantitative Food Frequency Questionnaire (SQ-FFQ), and the food items causing symptoms. In total, 186 of 857 subjects (21.7%) were diagnosed with IBS. The non-IBS group had a fat intake of 76.9 ± 47.9 g/day, while the IBS group had a fat intake of 86.6 ± 55.1 g/day (p = 0.014). The non-IBS group had a total fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intake of 12.6 ± 9.7 g/day, whereas the IBS group had a total FODMAP intake of 13.9 ± 9.9 g/day (p = 0.030). Foods that contributed to the onset of symptoms in the IBS group were instant noodles (70.8%), Chinese noodles with vegetables and seafood (68.7%), pizza (67.2%), and black bean sauce noodles (66.3%) which are mostly classified as high fat and high gluten foods. The dietary intake of IBS patients differs from that of non-IBS subjects. Increased intake of gluten-containing or high-fat foods due to the westernized diet caused more IBS symptoms than high FODMAPs and dairy products in Korean adults in their 20 s to 40 s.

Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly.

Adequate nutritional intake in elderly individuals improves frailty. Elderly individuals may exhibit improvements in frailty with the use of community care facilities. Therefore, this study evaluated the effects of nutritional intervention in elderly subjects at community care facilities receiving oral nutritional supplements (ONSs) and determined their nutritional status. Sixty-two elderly individuals using community care facilities were divided into the experimental group (EG) (before [n = 31]/after [n = 28]) and control group (CG) (before [n = 31]/after [n = 25]). Subjects in both groups were treated with ONSs (200 mL/200 kcal) for 90 days. However, those in the EG received the product with increased protein; vitamins A, C, D, and E; phosphorus; calcium; and zinc. The data collected included anthropometric data, dietary assessment findings, frailty status (Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight questionnaire), and nutritional status (Mini Nutritional Assessment, MNA). The changes in the two groups were analyzed using the Mann-Whitney U Wilcoxon signed-rank test. Nutritional intervention increased the weight, body mass index, and lean body mass in the EG (p < 0.05). Protein, calcium, and iron levels increased only in the EG (p < 0.05). The MNA score increased and sum of frailty indicators improved in the EG, and the increase in the MNA score in the EG was greater than that in the CG. This study verified the improved anthropometric data and dietary intake in the EG. Thus, the higher number of pre-frailty elderly individuals at facilities of community care indicates the need for adequate nutritional supplementation for frailty management.

Relationship between diet quality and sarcopenia in elderly Koreans: 2008-2011 Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008-2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken. RESULTS: The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points (P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003-3.254, P < 0.05). CONCLUSIONS: This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.

The Association between Dietary Inflammatory Index (DII) and Cancer Risk in Korea: A Prospective Cohort Study within the KoGES-HEXA Study.

Several epidemiological studies have shown that there are consistent positive associations between dietary inflammatory index (DII®) and cancer incidence in Western populations. However, few DII-cancer studies have been conducted in East Asian populations. In a large cohort representative of the general Korean population, we investigated whether the DII is associated with overall cancer risk. A total of 163,660 participants (56,781 males and 106,879 females) had evaluable data for analyses. This follow-up study was carried out over the course of 7.9 years. DII was calculated based on Semi-Quantitative Food-Frequency Questionnaire (SQ-FFQ) data for 106 food items. Cancers were self-reported based on notification by the participants' medical doctors. Multivariable Cox proportional hazard regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). After the follow-up, 1,643 cases of cancer (520 males and 1123 females) had developed. In a fully adjusted model, women in the highest DII quintile showed a 44% increased risk of getting cancer (HRQ5vsQ1 = 1.44; 95% CI = 1.14-1.82; p-trend = 0.0006), while men showed no apparent association (HRQ5vsQ1 = 0.80; 95% CI = 0.58-1.10). These results indicate that in Korean women, a more pro-inflammatory diet is associated with a higher risk of cancer incidence.

A Relationship between Dietary Patterns and Dyslipidemia in Urban-dwelling Middle-Aged Korean Men: Using Korean Genome and Epidemiology Study (KoGES).

An increase in the prevalence of dyslipidemia has been strongly associated with the mortality rate of cardiovascular disease. We conducted a cross-sectional analysis to determine the relationship between dietary patterns and dyslipidemia in adult men aged 40-64 years. A total of 5,643 subjects from the Korean Genome and Epidemiology Study (KoGES) were selected for the final analysis. We analyzed 24-hour dietary recall data. Using principal component analysis, 3 dietary patterns were identified: rice based Korean food pattern, flour based western dietary pattern, and convenience food dietary pattern. The flour based western dietary pattern was significantly and positively associated with total cholesterol, and low density lipoprotein (LDL) cholesterol (p for trend < 0.05). With regard to the rice based Korean food pattern, the group with the highest factor score had a significantly lower risk of hyper LDL cholesterolemia (odds ratio [OR], 0.802; 95% confidence interval [CI], 0.698-0.922) and high total cholesterol levels (OR, 0.868; 95% CI, 0.761-0.990) than the group with the lowest factor score. For the flour based western dietary pattern the group with the highest factor score showed a significantly high risk of hyper LDL cholesterolemia (OR, 1.189; 95% CI, 1.033-1.367; p for trend < 0.05) than the group with the lowest factor score. Our results showed that the rice based Korean food pattern protected against dyslipidemia. In contrast, the western staple pattern, which is rich in flour and processed foods, was independently associated with dyslipidemia in urban male residents of Korea.

Higher Pro-Inflammatory Dietary Score is Associated with Higher Hyperuricemia Risk: Results from the Case-Controlled Korean Genome and Epidemiology Study_Cardiovascular Disease Association Study.

In previous studies, the elevated dietary inflammatory index (DII®) scores have been consistently associated with several chronic diseases. However, the relationship with hyperuricemia remains unknown. The aim of this study was to determine if the DII is associated with hyperuricemia risk. The study included 13,701 participants (men 5102; women 8599) in a large-scale cross-sectional study in South Korea. A validated semi-quantitative food frequency questionnaire (SQFFQ) was used to measure dietary intake, and blood samples were obtained to determine hyperuricemia. As the DII score increased, the hyperuricemia risk increased among women (OR 1.35, 95% CI 1.03-1.77, p trend = 0.02). However, no significant results were found for men. Women with lower BMI scores had higher risks of hyperuricemia with higher DII scores (OR 1.62, 95% CI 1.05-2.52, p trend = 0.03). As the DII increased, however, only women who consumed alcohol ("past or current drinkers") had higher risks of hyperuricemia (OR 1.92, 1.22-3.02, p trend = 0.004). Among the DII components, intake of flavonoids showed a significant association with the hyperuricemia risk in women (OR 0.75, 0.59-0.96, p trend = 0.03). Our results suggest that higher intake of pro-inflammatory diet is significantly associated with higher risk of hyperuricemia among women. These results reinforce the importance of less pro-inflammatory habitual dietary patterns in lowering the risk of hyperuricemia and secondary afflictions such as cardiovascular diseases.

Development of a food-based index of dietary inflammatory potential for Koreans and its relationship with metabolic syndrome.

BACKGROUND/OBJECTIVES: Inflammation is known to be a risk factor for metabolic diseases. This study aimed to develop a Food-based Index of Dietary Inflammatory Potential (FBDI) and examine its association with metabolic biomarkers. SUBJECTS/METHODS: This study analyzed the raw data from the 2012-2014 Korean Genome and Epidemiology Study data of 17,771 people. To analyze the relationship between foods consumed by Koreans and inflammation, we conducted a correlation analysis between 51 food groups and hs-CRP levels. The FBDI was developed from 17 food groups selected by multiple regression method. We examined whether FBDI was associated with metabolic markers (waist circumference, blood pressure, fasting glucose, triglyceride, and HDL-cholesterol) in the 6th Korea National Health and Nutrition Examination Survey (KNHANES). We used binary logistic regression analysis to examine the association. RESULTS: The FBDI model included seven of the anti-inflammatory food groups and three of the pro-inflammatory food groups. The FBDI formula was calculated by multiplying the intake of food group by ß-coefficients derived from the multiple regression model based on the correlation analysis. The FBDI was significantly associated with waist circumference (P < 0.001), blood pressure (P < 0.001), triglyceride level (P < 0.001), and HDL-cholesterol (P < 0.001) level among adults aged 20-64 years in the KNHANES. The prevalence of metabolic syndrome was 2.618 times higher in the group with the highest FBDI than in the group with the lowest one (95% confidence interval: 1.778-3.856, P for trend < 0.001). CONCLUSIONS: This study established an FBDI reflecting food intake patterns of Koreans, which showed a significant relationship with the prevalence of metabolic syndrome.

Association between Inflammatory Potential of Diet and Bone-Mineral Density in Korean Postmenopausal Women: Data from Fourth and Fifth Korea National Health and Nutrition Examination Surveys.

Post menopause is considered a critical period for bone-mass loss. Impaired bone metabolism during this phase can increase the risk of fractures in old age. Inflammation is a risk factor for bone health, and diet is a potential source of inflammation. However, few studies have examined the association between the dietary inflammatory index (DII®) and bone-mineral density (BMD) in postmenopausal women in Korea. The objective of this study was to determine, by means of a Korean cross-sectional investigation, whether higher DII scores are associated with decreased BMD in postmenopausal women. To that end, the raw data from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES, 2009-2011) for 2778 postmenopausal women aged over 50 years were analyzed. The subjects' BMD were measured by dual-energy x-ray absorptiometry, and their DII® scores were calculated from a single 24-h dietary recall. Further, the participants were classified into three groups according to DII® score. Women with more pro-inflammatory diets (i.e., those in the highest tertile of DII®) had significantly lower BMD in the femoral neck as compared with women in the lowest tertile (p for trend <0.05) after adjustment for age, body-mass index (BMI), household income, education status, smoking habits, physical activity, total calcium intake, female-hormone use, age at menopause, and blood vitamin D levels. Multiple logistic regression analyses revealed that the odds ratio (OR) of total femur osteopenia/osteoporosis was higher in women in the highest tertile of DII® than in those in the lowest (OR 1.27, 95% CI 1.00-1.62, p for trend < 0.05). This study established that more pro-inflammatory diets might be associated with lower BMD in postmenopausal Korean women.

Positive Association between Dietary Inflammatory Index and the Risk of Osteoporosis: Results from the KoGES_Health Examinee (HEXA) Cohort Study.

Previous studies have found that diet's inflammatory potential is related to various diseases. However, little is known about its relationship with osteoporosis. The aim of this study was to investigate the association between the dietary inflammatory index (DII®) and osteoporosis risk in a large-scale prospective cohort study in Korea. This prospective cohort study included 159,846 participants (men 57,740; women 102,106) from South Korea with a mean follow-up of 7.9 years. The DII was calculated through a validated semi-quantitative FFQ (SQFFQ), and information on osteoporosis was self-reported by the participants. Analyses were performed by using a multivariable Cox proportional hazard model. Higher DII scores were associated with higher osteoporosis risk (HR 1.33; 95% CI 1.12⁻1.58). In women, a higher DII score indicated a higher risk of osteoporosis (HR 1.33; 95% CI 1.11⁻1.59). However, a hazards ratio of similar magnitude in men was not significant (HR 1.32; 95% CI 0.64⁻2.71). Post-menopausal women had higher risks of osteoporosis for higher DII scores (HR 1.33; 95% CI 1.09⁻1.63), whereas among pre-menopausal women, the relationship was not statistically significant (HR 1.39; 95% CI 0.87⁻2.21). Also, there was an increase in osteoporosis risk when the DII increased among women participants with irregular physical activity (HR 1.53; 95% CI 1.17⁻2.01); however, there was no statistically significant increase in osteoporosis risk among women participants with regular physical activity (HR 1.19; 95% CI 0.93⁻1.52). A more pro-inflammatory diet was significantly associated with higher osteoporosis risk in women. Given the similar magnitude of the hazards ratio, studies with sufficient numbers of men are warranted.

Relationship between osteosarcopenic obesity and dietary inflammatory index in postmenopausal Korean women: 2009 to 2011 Korea National Health and Nutrition Examination Surveys.

Osteosarcopenic obesity syndrome is a condition including osteopenia, sarcopenia and obesity. A pro-inflammatory dietary pattern has been reported to be associated with obesity and osteoporosis. However, studies on the association of dietary inflammatory index with osteosarcopenic obesity syndrome in the Korean population are lacking. The aim of this study was to analyze the relationship between dietary inflammatory index and osteosarcopenic obesity syndrome among Korean postmenopausal women. We analyzed the 2009-2011 Korea National Health and Nutrition Examination Survey, consisting of 1,344 postmenopausal women aged 50 years or older. Body composition was evaluated by dual-energy X-ray absorptiometry. Dietary inflammatory index was estimated after analyzing 36 nutrients and 9 foods using a 24-h dietary recall data. The association between dietary inflammatory index levels and the body composition was analyzed by logistic regression models with dietary inflammatory index fit as a dichotomous variable. The dietary inflammatory index was -0.96 ± 0.22 in the normal group, 0.12 ± 0.16 in the osteopenic obesity group, 0.00 ± 0.18 in the osteosarcopenia group, 0.12 ± 0.33 in the sarcopenic obesity group, and -0.02 ± 0.14 in the osteosarcopenic obesity group (p<0.001). After adjusting for potential covariates, women with higher dietary inflammatory index scores were more likely to have risk of osteopenic obesity (OR = 2.757, 95% CI: 1.398-5.438, p<0.01) and that of osteosarcopenic obesity (OR = 2.186, 95% CI: 1.182-4.044, p<0.05). The results indicate that pro-inflammatory diet was associate with increased odds of the osteosarcopenic obesity in postmenopausal Korean women. Therefore, studies are needed to identify the effects of anti-inflammatory diets, which can reduce the degree of inflammation through dietary intake.

Dietary inflammatory index and its relationship with high-sensitivity C-reactive protein in Korean: data from the health examinee cohort.

Inflammation is associated with chronic disease. High-sensitivity C-reactive protein (hs-CRP) is a predictor of chronic disease. The dietary inflammatory index (DII) is used to determine the overall inflammatory potential of diet. A cross-sectional analysis of Health Examinee cohort data (2012-2014) from Korea was performed. Subjects were 40-79 years of age (8,332 males; 19,754 females). The DII was used to analyze the relationship between subject characteristics, nutrient intake, and the hs-CRP. Additionally, the relationship between DII and hs-CRP as a predictor of chronic disease was examined. The DII was divided into 4 quartile: Q1 = -7.21 to -1.88 (median: -3.020), Q2 = -1.87 to -0.02 (median: -0.410), Q3 = -0.01 to 1.87 (median = 0.870) and Q4 = 1.88 to 7.34 (median = 3.040). For each group, the carbohydrate/protein/fat intake ratio was Q1 = 66.7:16.6:19.2, Q2 = 67.2:15.6:18.7, Q3 = 67.3:15.1:18.4 and Q4 = 67.3:14.0:17.9. The odds of elevated hs-CRP were 1.241 times higher in participants with the most proinflammatory diets than those with the most anti-inflammatory diets [hs-CRP; odds ratio (95% confidence interval) for Q4 vs Q1: 1.241 (1.071, 1.438); p for trend = 0.002]. An association was found between a high DII and high levels of hs-CRP. The DII may be applied to measure the association between diet and chronic diseases.

Applicability Evaluation of Job Standards for Diabetes Nutritional Management by Clinical Dietitian.

This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. 'Nutrition intervention' was 4.5 ± 0.5 for task importance, 'nutrition assessment' was 4.0 ± 0.7 for performance, and 'nutrition diagnosis' was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were 'checking basic information,' 'checking medical history and therapy plan,' 'decision of nutritional needs,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.' The tasks with high importance but low performance were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'monitoring of nutrition intervention process.' The tasks of both high importance and high difficulty were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'supply of foods and nutrients,' 'education of nutrition and self-management,' and 'monitoring of nutrition intervention process.' The tasks of both high performance and high difficulty were 'documentation of nutrition assessment,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.'