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This study aimed to identify a nutritionally vulnerable group and to examine their nutritional problems based on a relationship between socioeconomic position and nutritional status through life-course. A cross-sectional nationwide survey of 2005 Korean National Health and Nutrition Examination Survey (KNHANES) was used. A total of 8,930 participants aged ≥ 1 year were included. The socioeconomic position indicator was education level. Nutritional status was assessed by the percentage attainment of a dietary reference intake (DRI) and dietary quality based on nutrient intakes estimated by a 24 hour-recall data. Food insufficiency was examined by one-item food insufficiency questionnaire. The difference in nutritional status and food insufficiency according to educational level was tested by General Linear Model and Chi-square test, respectively. The nutritional status and food insufficiency was the worst during adolescence and older age than other period. Both quantity and quality of nutrient intakes was poorer in low education group than high education group. The prevalence of food insufficiency also was higher in low education group. The results were consistent across the life-course and sex. Based on these findings, we suggest that the development of various policy and strategies targeted to nutritionally vulnerable group is necessary to reduce nutritional inequality by socioeconomic position.
This study aims to develop an index of food security in order to assess food security status in Korea and to evaluate reliability and validity of the index. The index of food security was developed based on the US Household Food Security Survey Module (US-HFSS). After the US-HFSS was translated and back-translated, it was evaluated and modified by a focus interview for experts. The developed Korean Household Food Security Survey Module (K-HFSS) was tested by cognitive interviews and a pretest for general community population to assess its application for Korean population. For the reliability and validity of K-HFSS, the survey was conducted with 300 adults aged 40 years or more living in a rural community and 212 infants and toddlers living in an urban community. The reliability was assessed by Cronbach' alpha and the validity was evaluated by content validity, construct validity, and criterion-related validity. The questionnaire items of K-HFSS were partly modified, accounting for Korean social and cultural backgrounds and adapted by general community population. The reliability was relatively high, showing Cronbach' alpha coefficients ranged from 0.80 (for adults) to 0.87 (for infants and toddlers). The content and construct validities were all acceptable. The result of criterion-related validity showed that food security status was significantly related to the household income level. In conclusion, the K-HFSS would be used as a reliable and valid instrument to assess food security status in parts of the Korean population.
이 연구는 2007년도 한국복지패널자료의 식품 보장 측정 지표를 활용하여 국내 식품 미보장 수준을 조사하고 식품 미보장 가구의 특성을 파악하고자 수행하였다. 국내 식품 미보장은 5.4%로 다른 서구산업국가와 비교했을 때, 상대적으로 낮은 수준을 보였다. 식품 미보장은 가구와 가구주의 특성에 따른 차이를 보였는데, 국민기초생활보장 수급가구, 소년소녀가장가구, 한 부모 가구, 독거노인 가구, 저소득 가구 등과 같은 취약 계층의 특성들을 갖고 있는 가구에서는 적게는 13% 많게는 27%의 높은 비율을 보였다. 가구주가 여자 또는 노인이고, 교육 수준이 낮고, 만성질환이 있고, 장애인이거나 직업이 없는 경우, 식품 미보장을 경험할 확률이 높은 것으로 나타났다. 식품 미보장을 경험하고 있는 가구 중 식품 지원 서비스를 받고 있는 가구는 전체 가구가 7.6%, 노인 가구가 16.4%, 아동 가구가 56.9%였고, 식품 지원 서비스를 받은 경험이 있는 가구에서 식품 미보장을 경험하고 있는 가구는 전체 가구가 29.3%, 노인 가구는 45.7%, 아동 가구는 13.1%였다. 결론적으로 국내 식품 미보장은 사회 경제적으로 취약한 가구 및 노인 가구에서 뚜렷하게 나타났으며 이들에 대한 식품 지원 서비스의 접근성은 낮았고, 이러한 서비스에 대한 효과도 미약한 것으로 나타났다. Recently, food insecurity has arisen as an issue in Korean society because of the limited access to food particularly for the socioeconomically disadvantaged population. Thus, this study aims to investigate the prevalence of food insecurity and its characteristics, using the third waves of Korean Welfare Panel Data. The prevalence of food insecurity was 5.4%, relatively lower than in advanced Western countries. The prevalence of food insecurity varied significantly across household types and householder`s characteristics. The socioeconomically disadvantaged households had a 13% to 27% higher prevalence of food insecurity. The households headed by women, elderly, unemployed person, or people with low education level, chronic disease or disability, were more likely to be food insecure. The food insecure households had low participation in food assistance programs (7.6% total households, 16.4% for elderly households, 56.9% for households with children) and among the households participating in food assistance programs, the prevalence of food insecurity was 29.3% for total households, 45.7% for elderly households, 13.1% for households with children. In conclusion, the problem of food insecurity was apparent in socioeconomically disadvantaged households and elderly households, In addition, the access to food assistance programs for these households was low and the programs` effect was modest. Further, the trend of food insecurity needs to investigate to provide evidence for developing a food policy related to food insecurity, using persistent monitoring and longitudinal analysis through the Korean Welfare Panel Study.
국내 나트륨 평균 섭취량은 2017년 3,477 ㎎으로 2010년 4,876 ㎎ 대비 71.3% 수준으로 감소하였다. 나트륨 섭취량 감소 추이에서 생산 및 조리 주체별 구분에 따른 기여도에서는 산업체에서 생산된 식품과 가정에서 조리한 식품으로부터의 나트륨 섭취량 감소 비율이 단체급식과 외식업체에서 조리하여 제공하는 식품으로부터의 나트륨 섭취량 감소 비율보다 컸다. 식품군과 음식군으로부터 나트륨에 가장 많이 기여하는 요인은 생산 및 조리 주체별로 다르게 나타났는데, 산업체 생산에서는 김치류에서, 가정과 단체급식에서는 조리한 국/탕/찌개/전골류에서, 외식업체에서는 조리한 면/만두류였고, 나트륨 기여도가 가장 높았던 이들 식품 및 음식들은 연도에 따른 나트륨 섭취량 감소 폭도 가장 큰 것으로 나타났다. 특히 가정에서 조리한 국/탕/찌개/전골류와 면/만두류의 나트륨 함량 감소 폭은 외식업체 및 단체급식에서 조리한 음식보다 더 큰 것으로 나타났다. 나트륨 섭취량에 주로 기여하는 주요 식품군과 음식군의 종류는 연도가 증가함에 따라 나트륨 급원 식품이 특정 식품 위주에서 다양한 식품으로 확대되는 경향을 보여, 향후 나트륨 저감 대상 품목에 대한 다양한 접근이 요구됨을 시시하였다. 국내 나트륨 섭취에 기여하는 식품은 가공식품을 완제품 형태로 섭취하는 것 외에도 조리 단계에서 식재료로 다양하게 사용하는 비율이 높으므로 본 연구에서 제안한 생산 및 조리 주체별로 식품군 또는 음식군을 분류하여 나트륨 섭취 주요 급원 및 감소 요인을 파악한 결과는 저염 식품의 개발 및 생산, 저염 섭취와 관련된 식생활 교육 등과 같은 분야의 기초 자료로 활용될 것으로 기대된다. 향후 식문화를 고려한 다양한 식품 분류체계 방법을 마련하여 나트륨 섭취량 분석 및 저감 전략 수립에 활용하는 것이 필요할 것으로 생각된다. Purpose: Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. Methods: The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. Results: Sodium intake was 4,876 mg in 2010 to 3,477 ㎎ in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. Conclusion: The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.
Objectives: The objectives of this study were to describe population-based prevention strategies for childhood obesity and to discuss its application in a city in Korea. Methods: Literature review and empirical findings for ongoing programs were performed to develop population-based prevention strategies for childhood obesity with the framework and principles of WHO population-based prevention strategies for childhood obesity. Results: The developed framework had five key strategies (supportive policies, supportive environment, supportive program, strategic development & leadership, and monitoring & evaluation) under hierarchic objectives (long-term, middle-term and short-term) with the vision of healthy growth and development of all children and youth. Each strategy included evidence-based action plans with WHO principles. Conclusions: The developed strategies have advanced the existing strategies for childhood obesity prevention by providing the sustainable and systematic framework and action plans based on ecological approach. Further, the feasibility for operating the strategies needs to be verified.
Given that household food security issues have become the concern of the Korean society, this study aimed to develop food security measures for the Korean population. Based on the literature reviews on previously developed food security measures, the 18-item US household food security survey module (US HFSSM) was adapted. The developed food security measures was assessed by qualitative validity method. It was evaluated and modified by face validity by expert focus groups belong to university, public health center, and government agencies and by cognitive interview by 40 subjects with low household income who live in an urban community and are participants in welfare programs of local districts. Then, it was reviewed and revised by the National Institute of the Korean Language and the advisory committee for nutrition survey of Korean National Health and Nutrition Examination Survey (KNHANES). The results showed that the developed questionnaire items were well adapted by expert focus groups and general subjects, showing the feasibility of measuring food security with the developed measures although there were discrepancies in some expressions of questionnaire items between experts focus groups and general subjects. The study to assess reliability and quantitative validity of the developed food security measures should be further needed to examine its application for KNHANES. (Korean J Nutr 2011; 44(6): 551 ~ 561)
본 연구는 과일바구니 사업에 참여한 서울 지역아동센터에 등록된 저소득층 아동・청소년 2,430명을 대상으로 과일에 대한 지식, 인식, 선호도와 사업 전후 섭취 빈도 변화를 파악하였다. 과일 권장 섭취 빈도에 맞게 응답한 비율은 초등학생 16.5%, 중・고등학생은 14.8%였고, 학생들의 약 1/3 이상은 권장되는 과일 섭취 빈도를 주 1회 이상~일 1회 미만으로 응답하여 권장 섭취 빈도에 대한 지식이 미흡하였다. 과일 섭취의 1회 적정 분량에 대한 이해도는 중・고등학생들이 초등학생에 비해 높았으나 전반적으로 대상자들이 생각하는 1회 섭취 권장 분량은 권장량보다 많은 양으로 인식하는 경향이었다. 과일 섭취량에 대한 자가 인식에서는 초등학생이 중・고등학생보다 스스로 많이 먹는 편이라고 응답한 비율이 유의적으로 높았고, 특히 초등학교 여학생이 남학생보다 높았다. 생과일에 대한 선호도에서는 초등학생과 중・고등학생 모두 4점 이상의 높은 선호도를 보였으나 생과일 섭취 빈도는 전반적으로 평균 일 1회 미만의 섭취를 보였다. 초등학생의 약 50%와 중・고등학생의 약 70%가 생과일을 주 1회 이상에서 일 1회 미만으로 섭취하는 것으로 응답하였고, 초등학교 여학생의 경우에만 거의 일 1회에 근접해서 섭취하고 있었다. 남녀별 섭취 빈도에서는 초등학교 여학생이 남학생보다 유의적으로 섭취 빈도가 높았고 중・고등학생은 차이가 없었다. 과일 바구니 사업 이후에도 권장 섭취 빈도에 맞게 섭취하는 대상자의 비율은 여전히 낮은 편이었으나 중・고등학생의 경우에는 1일 평균 과일 섭취 빈도가 사업 이후에는 통계적으로 유의하게 증가하였다. 결과적으로 사업 이전 낮은 섭취빈도를 보였던 취약계층 중・고등학생의 섭취가 사업 이후 유의하게 증가한 결과를 고려해 볼 때 본 사업의 지속가능성을 위한 제도 마련이 필요할 것으로 생각된다. 향후 본 연구에서 수행된 과일바구니 사업을 보완하기 위해서는 과일 권장 섭취 관련 교육 프로그램 개발과 섭취 증가를 위한 과일 제공 빈도의 보충이 이루어져야 할 것이다. A program to promote fruit intake by children and adolescents in low-income households in Korea has been initiated; however, only a few studies of its effects have been conducted. Therefore, this study was conducted to investigate the perception of fruit intake and any changes to fruit consumption attributed to the fruit provision program, which provides fruit to children and adolescents from low-income households twice a week. The subjects were 2,430 children and adolescents participating in the Healthy Fruit Basket program at local children's centers in Seoul from June 2015 to December 2015. Subjects were asked to complete a questionnaire about their fruit knowledge, awareness, preferences, and eating frequencies. All subjects, regardless of school grade, were found to have an inadequate knowledge of recommended intake frequency and amount. Self-assessed fruit intake was higher in elementary school students than in middle and high school students. The preference for fruit was relatively higher than for other snacks, but intake was generally low, with the proportion meeting the recommended intake frequency being only 29.4% of elementary school students and 14.8% of middle and high school students. Since the program started, the mean daily fruit intake frequency increased significantly among middle and high school students. In conclusion, the fruit provision program was effective, particularly among middle and high school students who had a low fruit intake frequency prior to the program. To increase fruit intake of low-income children and adolescents, the program needs to be continued with an increase in fruit supply frequency in conjunction with provision of nutrition education materials related to the recommended frequency and amount of fruit intake.
Adolescence is the most important period of healthy development. The purpose of this study was to evaluate the food recognition, snack preference, and dietary behavior of 1st grade of middle and high school boys and girls. Subjects were 5,554 students from 16 schools with healthy tuck shop and 3,406 students from 9 schools without healthy tuck shop in Seoul, Korea. Students from schools with healthy tuck shop are significantly higher than control group for facility satisfaction and hygiene satisfaction (all p<0.05). For fruit, the preference (p<0.05) and recognition (attitude, p<0.001: intention, p<0.05: eating habit, p<0.001: social-environment, p<0.001: self-efficacy, p<0.001) of students in schools with healthy tuck shop are significantly higher than those in schools without healthy tuck shop. For the habit of checking the manufacturer, students in schools with healthy tuck shop were significantly higher than students in schools without healthy tuck shop (p<0.05). The result suggested that we have to create an environment in which fruits can be purchased easily at a tuck shop and to educate adolescents for the importance of healthy food purchasing behavior. In conclusion, healthy school tuck shop had a positive effect on accessibility to healthy food.
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The Korea National Health and Nutrition Examination Survey is a nationwide health survey in Korea. This survey is composed of three parts: the Health Interview Survey, the Health Examination Survey, and the Nutrition Survey. The aim of this study was to refine the nutrition survey system in the Korean National Health and Nutrition Examination Survey (KNHANES). Based on the literature review, we summarized international survey systems and the limitations of the current system in Korea and proposed an improved system. We suggested the following: 1) A government agency which will be exclusively responsible for KNHANES overall is needed. 2) The current short-term nutrition survey should be a year-round survey. 3) The objectives of this survey should be written with more clarity and detail. 4) Biochemical measures in relation to nutritional status should be added. 5) The budget to set up various databases in the nutrition survey should be increased. 6) Various other issues should be addressed, including the definition of raw data (i.e., whether nutrient intake data per day is raw data), ethical issues in survey techniques, and strategies to produce evidence for the public using this survey data. Not all suggestions could be adopted in the short-term, but should be integrated into long-term goals for survey system improvement.
본 연구는 서울시 25개 자치구 중 2013년 아침밥 클럽으로 선정된 10개교 고등학교에 재학 중인 학생을 대상으로 2013년 아침밥 클럽 사업의 효과를 평가하였다. 사전조사와 사후조사 모두 응답한 식생활 및 학교생활 조사 대상자는 315명, 24시간 회상법에 응답한 대상자는 64명, 비만도 조사에 참여한 대상자는 124명으로 그 결과는 다음과 같다. 아침밥클럽 프로그램의 중재 후 아침식사 섭취 빈도가 증가하였으며 중재 후 38.3%, 35.7%, 17.1%의 대상자에서 각각 아침식사, 과일류, 우유류의 섭취가 주당 5회 이상으로 증가했다. 1일 식사기록법을 통해 학생들의 식품 및 영양소 섭취실태의 중재 전후 차이를 비교한 결과 아침밥 클럽 중재 이전보다 아침밥 클럽 중재 이후 곡류, 버섯류, 과일류 섭취량이 유의하게 증가했으며 난류, 유지류 섭취량이 유의하게 감소했다. 영양소는 에너지, 식물성 단백질, 탄수화물, 식이섬유, 식물성 철, 칼륨, 아연, 비타민 B1, 비타민 B6, 나이아신, 비타민 C 섭취량은 증가했으며 콜레스테롤 섭취량은 감소하였다. 학교생활에 대한 조사에서는 ‘하루의 생활을 더 편하고 즐겁게 시작하는 편이다', ‘하루의 생활을 건강하게 시작하는 편이다' 문항 점수가 유의하게 증가했다. 아침밥클럽은 청소년에게 필요한 아침식사를 제공해줘서 식습관과 식이섭취 상태를 개선할 뿐만이 아니라 학교생활에서도 개선을 보여 아침밥 이상의 효과를 가져온다는 측면에서 효과적인 프로그램이라고 할 수 있으며 향후 지속적인 프로그램이 서울시에 확산된다면 청소년기의 영양 상태와 학교생활 전반적인 상태에 개선을 가져올 수 있음을 시사한다. The adolescent period, during which physical, spiritual, and physiological growth and development occurs, is important for the development of healthy dietary habits. Particularly, eating a regular breakfast improves eating habits and school life in adolescents but few studies have investigated the effects of eating breakfast on these outcomes. Therefore, this research was performed to investigate the effects of eating a regular breakfast provided by the ‘Breakfast Club Program' on eating behaviors and school life. A total of 315 high school students were recruited for the program from 10 high schools in nine districts among 25 districts in Seoul during August to December of 2013. The average age was 17.8±0.8 years and 38.1% of students were females. Based on 315 subjects, 38.3%, 35.7%, and 17.1% increased their intakes of breakfast (P=0.001), fruit (P=0.033), and milk (P<0.001) up to 5∼7 times per week, respectively. The intake frequency of fruit (P<0.001) and eating breakfast (P<0.001) increased noticeably after program participation. Based on 64 students performing dietary record, intakes of cereals (P<0.001), mushrooms (P=0.027), and fruits (P=0.002) increased while intakes of eggs (P=0.001) and fat and oils (P=0.019) decreased after the program. Consumption of energy (P=0.004), plant protein (P=0.012), carbohydrates (P<0.001), dietary fiber (P=0.026), iron from plant sources (P=0.009), potassium (P=0.043), zinc (P=0.013), vitamin B₁ (P=0.043), and vitamin C (P<0.001) increased whereas intake of cholesterol (P=0.002) decreased. Regarding school life, the score for ‘comfortable and cheerful starting of a day' (P=0.001) and ‘healthy starting of a day' (P<0.001) increased significantly. This study indicates that a regular ‘Breakfast Club Program' may establish healthy eating habits and school life in teenagers.