보육시설 유아들의 영양상태 및 영양교육 프로그램 개발과 적용

다국어 초록 (Multilingual Abstract)

This study's aim was to develop various nutrition education materials including an animated CD for day-care center children and teachers. The objectives of this study were to screen the health status and investigate the food habits, eating behaviors, food preferences and dietary intake of day-care center children, and apply the nutrition education programs systematically. We hope to evaluate the effect of the nutrition education programs on nutritional knowledge, food attitudes and eating behaviors on day-care center children.
1. Nutritional status of day-care center children
1) Health status of day-care center children
The mean height and weight of 4, 5 and 6 year old children were 103.0 cm and 17.1 kg, 107.2 cm and 18.3 kg and 113.4 cm and 20.6 kg, respectively. According to the obesity index criteria, 5% of boys and 4% of girls were obese, whereas 10% of boys and 9% of girls were underweight. According to the Kaup index criteria, 7% of boys and 4% of girls were obese. According to the percentage of body fat criteria, 5% of both boys and girls were obese. The mean concentrations of total serum cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, Atherogenic Index and serum glucose were 154.1-156.5 mg/dL, 80.1-81.9 mg/dL, 46.8-47.4 mg/dL, 90.9-92.8 mg/dL, 2.34-2.39 and 76.4-77.8 mg/dL, respectively. Serum triglyceride levels, AI and body fat percentages of obese children were significantly higher than other children and were significantly lower at HDL-cholesterol level(p<0.05). In addition, there were significant correlations between anthropometric values and biochemical serum indices: the Kaup index and the obesity index were positively correlated to systolic blood pressure and diastolic blood pressure in both boys and girls(p<0.01) and to the triglyceride concentration in boys(p<0.05).
2) Food habits, eating behaviors and food preferences of day-care center children
Results from eating behavior studies showed that 70.7% of preschool children had unbalanced diets. No gender based differences in eating behaviors were found, but in regards to food preferences, however, boys tended to prefer carbonated drinks more than girls. Results indicated that among all menus, fruit ranked highest(3.97±0.65) as a food preference, and vegetables ranked lowest as a food preference(2.46±0.68). Food preference in regards to cooking process indicated the highest preference was for fried foods(3.80±0.68) and the lowest preference was for raw vegetables(2.61±1.27) and namul (2.85±1.13).
3) Food and nutrient intake of day-care center children
Total daily dietary intakes were calculated by weighing food consumed at the day-care centers together with dietary records provided by children's mothers for intake at home. This survey was conducted over a 3-day period which included week and weekend days. Diet quality was assessed by NAR(Nutrient Adequacy Ratio), MAR(Mean Adequacy Ratio), and DDS(Dietary Diversity Score). The daily food intake was 992.7 g. The plant food intake(68%) was higher than animal food intake(32%). The daily energy intake was 1249.2 kcal(85% RDA) and protein 43.8 g(153.6% RDA). Percentage of calcium, iron, and niacin consumed below 75% of RDAs were 29.8%, 35.1% and 28.1%, respectively. Proportions of energy obtained from carbohydrates, proteins and fats were 61.0%, 14.1% and 25.5%, respectively. Calorie intake proportion obtained from breakfast, lunch, dinner and a snack were 15%, 20%, 19% and 46%, respectively. The NAR of Ca and Fe and MAR were 0.84, 0.85 and 0.92, respectively. Persons who had higher DDS's correlated positively with NAR and MAR.
2. Development and application of nutrition education programs for day-care center children
1) Development of nutrition education programs In 2003, nutrition education programs such as animated CD-ROM, text book, panels, videotape, posters, slogans, leaflets, picture disks, hand puppets, sticker for compensation and cardboard were developed. The education programs consisted of 5 different components such as‘Wash Your Hands Before Eating’,‘Be Friends With Foods’,‘Let's Eat Balanced Diet’,‘Enjoy Your Meal With a Pleasant Mind’and ‘Have the Right Eating Habits’. In 2004, nutrition education programs such as animated CD-ROM and text book were developed. These programs consisted of 4 different components such as ‘Meal Guidelines for Good Health’,‘Bomi Has the Best of the Best Table Manners’,‘The Story of Food and Health With Janggmi’ and ‘Keep the Earth From Food Garbage’.
2) Evaluation of the effect of nutrition education programs
In 2003, nutrition education programs were applied in 24 day-care centers by a one-group pretest-posttest design. The subjects were 537 children(286 boys, 251 girls) aged 4 to 6 years. For the nutrition knowledge test results, pretest means of children were 6.82, however posttest means were 11.35 and showed a significant increase(p<0.001). In 2004, nutrition education programs were applied in 34 day-care centers by a non-equivalent control group design. The subjects with nutrition education included 368 children(177 boys, 191 girls) aged 4 to 6 years, and the subjects without nutrition education consisted of 108 children(54 boys, 54 girls). For the nutrition knowledge test results, the group without nutrition education had pre and posttest means that were not significant, but those with nutrition education had higher posttest means which shown to be significant(p<0.001). The results of analysis of covariance between with and without nutrition education groups show that the mean difference between the groups is about 1.42 points on average. For the food attitude test results, the group without nutrition education had posttest means that were shown to have significantly(p<0.01) lower result, but those with nutrition education had posttest means which shown to be significantly increased(p<0.001).
The results of analysis of covariance between with and without nutrition education groups show that the mean difference between the groups is about 2.67 points on average. For the eating behavior test results, all of the two groups posttest means were shown to have increased significantly(p<0.01). The posttest means between those without nutrition education and those with nutrition education were not significant. The test results show that several months of nutrition education is not enough to improve eating behaviors. As a result nutrition education has improved nutrition knowledge and food attitudes in day-care center children but short-term nutrition education was not sufficient to induce a change in eating behaviors. To improve eating behaviors in day-care center children, nutrition education programs must applied to day-care center children in addition to their parents and persistent education will have to be continued.

목차 (Table of Contents)

• 목차
• Ⅰ. 서론 = 1
• Ⅱ. 연구배경 = 4
• 1. 보육시설의 현황 및 평가지표 = 4
• 2. 유아들의 건강상태 = 7
• 3. 유아들의 식습관 및 식품 기호도 = 9
• 4. 유아들의 영양상태 = 11
• 5. 유아대상 영양교육프로그램 개발 및 평가 = 14
• Ⅲ. 연구내용 및 방법 = 20
• 1. 유아들의 영양상태 평가 = 20
• 1) 유아들의 건강상태 평가 = 20
• (1) 연구대상 및 기간 = 20
• (2) 신체계측 = 20
• (3) 혈액검사 = 21
• (4) 통계분석 = 22
• 2) 유아들의 식습관, 식행동 및 식품기호도 평가 = 22
• (1) 조사대상 및 기간 = 22
• (2) 식습관 및 식행동 조사 = 23
• (3) 식품기호도 조사 = 23
• 3) 유아들의 영양소 섭취상태 평가 = 24
• (1) 조사대상 및 기간 = 24
• (2) 조사방법 = 24
• (3) 영양소 섭취상태의 양적 평가 = 25
• (4) 영양소 섭취상태의 질적 평가 = 25
• (5) 구성식품의 다양성과 영양소 섭취상태와의 관계 = 26
• (6) 통계분석 = 27
• 2. 보육시설 유아들의 영양교육 프로그램 개발 및 적용 = 27
• 1) 1차년도 영양교육 프로그램 개발 및 적용 = 27
• (1) 대상자 선정 = 27
• (2) 영양교육 프로그램 개발 = 28
• (3) 영양교육 실시 = 36
• (4) 효과평가 = 37
• 2) 2차년도 영양교육 프로그램 개발 및 적용 = 37
• (1) 대상자 선정 = 37
• (2) 영양교육 프로그램 개발 = 38
• (3) 영양교육 실시 = 44
• (4) 효과평가 = 46
• Ⅳ. 연구결과 및 고찰 = 47
• 1. 유아들의 영양상태 평가 = 47
• 1) 유아들의 건강상태 평가 = 47
• (1) 조사대상자의 신체계측 = 47
• (2) 조사대상자의 혈청 지질농도 = 53
• (3) 조사대상자의 혈액학적 지표 = 55
• (4) 조사대상자의 간기능 지표 = 58
• (5) 신체계측과 혈액생화학치 간의 상관관계 = 59
• 2) 유아들의 식습관, 식행동 및 식품기호도 평가 = 62
• (1) 조사대상자의 일반사항 = 62
• (2) 조사대상자의 식습관과 식행동 = 63
• (3) 조사대상자의 식품기호도 = 68
• 3) 유아들의 식품 및 영양소 섭취상태 평가 = 80
• (1) 유아들의 영양소섭취 상태의 양적 평가 = 80
• (2) 유아들의 영양소섭취 상태의 질적 평가 = 94
• (3) 섭취 식품의 다양성 평가 = 96
• 2. 유아들의 영양교육 프로그램 개발 및 적용 = 99
• 1) 1차년도 영양교육 및 효과평가 = 99
• (1) 대상 진단 결과 = 99
• (2) 영양교육 프로그램 개발 매체 = 103
• (3) 영양교육 효과평가 = 104
• 2) 2차년도 영양교육 및 효과평가 = 107
• (1) 대상진단 결과 = 107
• (2) 영양교육 프로그램 개발 매체 = 111
• (3) 영양교육 효과평가 = 111
• Ⅴ. 요약 및 결론 = 120
• 1. 유아들의 영양상태 = 120
• 1) 유아들의 건강상태 = 120
• 2) 유아들의 식습관, 식행동 및 식품기호도 조사 = 122
• 3) 유아들의 식품 및 영양소 섭취상태 = 122
• 2. 유아들의 영양교육 프로그램 개발 및 적용 = 123
• 1) 영양교육 프로그램 개발 = 123
• 2) 유아들의 영양교육 프로그램 효과평가 = 124
• Ⅵ. 참고문헌 = 127
• 부록 2003 유아들의 영양 및 위생지식 설문지 = 147
• 부록 2004 유아들의 영양지식 설문지 = 149
• 부록 2004 유아들의 태도 설문지 = 150
• 부록 보육시설 아동 식생활 진단용 설문지 = 151
• 부록 식품 섭취 조사지 = 162
• 부록 2004년 식 행동 조사지 = 165
• 영문초록 = 166