Ultra-processed foods and total sugars intake in Korea: evidence from the Korea National Health and Nutrition Examination Survey 2016–2018

Shim Jee-Seon 한국영양학회 2022 Nutrition Research and Practice Vol.16 No.4

BACKGROUND/OBJECTIVES Dietary sugars intake worldwide is stable or decreasing, but overall sugars intake remains above the recommended level. Some studies suggest that ultra-processed foods (UPFs) drive excessive sugars intake. However, UPF consumption in Korea and its association with sugars intake have not yet been studied. This study aimed to estimate the contribution of UPF consumption to total sugars intake and to investigate the association between UPF consumption and total sugars intake in Koreans. SUBJECTS/METHODS Data from the Korea National Health and Nutrition Examination Survey 2016–2018 were used, and included data on 21,075 participants aged 1+ years completed a 24-h recall. Food items reported in the 24-h recall were classified according to the NOVA system as UPFs, processed foods, processed culinary ingredients, or unprocessed or minimally processed foods. RESULTS The average daily energy intake was 1,996 kcal, and UPFs accounted for 26.2% of the total energy intake (% TE). The average total sugars intake was 63.1 g (13.0% TE), and 44.9% of total sugars intake came from UPFs. Among the entire population, 15.8% exceeded the recommended limit for total sugars within 20% TE, and excessive total sugars intake was more prevalent among females (19.5%) and children (21.1%). The prevalence of excessive total sugars intake showed a significantly increasing tendency across the quartiles of UPF energy contribution, ranging from 11.9% in the lowest quartile to 23.2% in the highest quartile. Even after adjustment for sociodemographic variables, UPF consumption was positively associated with the prevalence of excessive total sugars intake (P for trend < 0.001). This association was similar in subgroup analyses by sex and age. CONCLUSIONS This study suggests that UPF consumption may drive excessive intake of total sugars in the Korean diet. Our findings conclusively establish that restricting UPF consumption may be an efficient way to reduce sugars intake in Korean population.

Current Status and Trends in Ultra-Processed Food Consumption in Korea

Jee-Seon Shim 한국식품영양과학회 2021 한국식품영양과학회 학술대회발표집 Vol.2021 No.10

The food environment is evolving rapidly. In the traditional food system, natural or freshly prepared food is consumed, whereas the modern food environment is dominated by various types of processed foods. Ultra-processed foods (UPFs) are manufactured industrially using substances extracted or refined from natural foods and chemical additives. They have poor nutrient profiles, with high energy density, high sugar, sodium, and fat content, and low protein, fiber, minerals, and vitamins. UPFs are cheap, highly palatable, and are conveniently consumed anywhere and anytime. They tend to become habitual and are less satiating, often causing overconsumption. Moreover, UPF consumption has been known to be associated with an unhealthy lifestyle (e.g., physical inactivity and smoking). Correspondingly, there is a growing concern regarding the dietary share of UPFs and their adverse health impact. Previous studies reported that the dietary energy intake from UPFs accounted for more than half of total energy intake in North American and European countries. Although UPF consumption in Latin American countries seems to be relatively low, evidence suggests that the consumption and sale of UPFs has been increasing globally. However, there is little information concerning UPF consumption among Koreans. To estimate the current status and trends in UPF consumption among Koreans, data from the Korea National Health and Nutrition Examination Survey were analyzed. This presentation includes: 1) estimates of UPF consumption (% kcal) among Koreans, 2) association between UPF consumption and dietary intake and dietary quality, 3) differences in UPF consumption across socioeconomic characteristics, and 4) trends in UPF consumption from 2010∼2018 in Korea. Further studies are needed to understand factors influencing the selection and consumption of UPFs, and to identify effective strategies to promote healthy food choices. ※ Financial disclosure: This work was supported by a grant of the National Research Foundation of Korea (NRF-2020R1I1A1A01064904).

Dietary intake and major source foods of vitamin E among Koreans: findings of the Korea National Health and Nutrition Examination Survey 2016-2019

Shim, Jee-Seon,Kim, Ki Nam,Lee, Jung-sug,Yoon, Mi Ock,Lee, Hyun Sook The Korean Nutrition Society 2022 Nutrition Research and Practice Vol.16 No.5

BACKGROUND/OBJECTIVES: Vitamin E is essential for health, and although vitamin E deficiency seems rare in humans, studies on estimates of dietary intake are lacking. This study aimed to estimate dietary vitamin E intake, evaluate dietary adequacy of vitamin E, and detail major food sources of vitamin E in the Korean population. SUBJECTS/METHODS: This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2019. Individuals aged ≥ 1 year that participated in a nutrition survey (n = 28,418) were included. Dietary intake was assessed by 24-h recall and individual dietary vitamin E intake was estimated using a newly established vitamin E database. Dietary adequacy was evaluated by comparing dietary intake with adequate intake (AI) as defined by Korean Dietary Reference Intakes 2020. RESULTS: For all study subjects, mean daily total vitamin E intake was 7.00 mg α-tocopherol equivalents, which was 61.6% of AI. The proportion of individuals that consumed vitamin E at above the AI was 12.9%. Inadequate intake was observed more in females, older individuals, rural residents, and those with a low income. Mean daily intakes of tocopherol (α-, β-, γ-, and δ-forms) and tocotrienol were 6.02, 0.30, 6.19, 1.63, and 1.61 mg, respectively. The major food groups that contributed to total dietary vitamin E intake were grains (22.3%), seasonings (17.0%), vegetables (15.3%), and fish, and shellfish (7.4%). The top 5 individual food items that contributed to total vitamin E intake were baechu kimchi, red pepper powder, eggs, soybean oil, and rice. CONCLUSIONS: This study shows that mean dietary vitamin E intake by Koreans did not meet the reference adequate intake value. To better understand the status of vitamin E intake, further research is needed that considers intake from dietary supplements.

Late eating, blood pressure control, and cardiometabolic risk factors among adults with hypertension: results from the Korea National Health and Nutrition Examination Survey 2010-2018

Jee-Seon Shim,Hyeon Chang Kim 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: Despite growing concerns regarding the timing of eating, little is known about the association between late eating and health. This study aimed to investigate whether late eating is associated with blood pressure (BP) control and cardiometabolic risk factors among Korean adults with hypertension. METHODS: Data from the Korea National Health and Nutrition Examination Survey 2010-2018 were used. Adults with hypertension aged 30-79 years (n=13,361) were included in this study. Dietary intake and information on meal timing were assessed using 1-day 24-hour recall. Late eating was defined as after the median midpoint between the times of the first and the last eating episode during the recall day. Logistic and linear regression models were used to estimate the associations of late eating with BP control and cardiometabolic risk factors. RESULTS: Among late eaters, there were more men than women. Compared to early eaters, late eaters were younger, had a higher body mass index (BMI) and unhealthier habits, and their overall dietary quality score was lower. A negative association between late eating and BP control was found in a univariate model (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.94 to 1.12), but this association disappeared after adjustment for confounders (OR, 1.03; 95% CI, 0.94 to 1.12). Late eating was independently associated with higher BMI (p=0.03) and blood triglyceride concentration (p<0.01). CONCLUSIONS: Our results do not support a link between late eating and BP control among adults with hypertension, but suggest that late eating is associated with cardiometabolic risk factors.

Socioeconomic burden of sugar-sweetened beverages consumption in Korea

Jee-Seon Shim,Nam Hoon Kang,Jung Sug Lee,Ki Nam Kim,Hae Kyung Chung,Hae Rang Chung,Hung-Ju Kim,Yoon-Sook Ahn,Moon-Jeong Chang 한국영양학회 2019 Nutrition Research and Practice Vol.13 No.2

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

Selection of key foods for the systematic management of a food and nutrient composition database

Jee-Seon Shim,Jung-Sug Lee,Ki Nam Kim,Hyun Sook Lee,Hye Young Kim,Moon-Jeong Chang 한국영양학회 2017 Nutrition Research and Practice Vol.11 No.6

BACKGROUND/OBJECTIVES: Food composition databases are necessary for assessing dietary intakes. Developing and maintaining a high quality database is difficult because of the high cost of analyzing nutrient profiles and the recent fast-changing food marketplace. Thus, priorities have to be set for developing and updating the database. We aimed to identify key foods in the Korean diet to set priorities for future analysis of foods. SUBJECTS/METHODS: The food consumption data of the Korea National Health and Nutrition Examination Surveys 2013-2014 were used. We modified the US Department of Agriculture’s key food approach. First, major foods were analyzed, contributing to 75%, 80%, 85%, or 90% of each nutrient intake. Second, the cumulative contributions to nutrient intakes were compared before and after excluding the foods least commonly consumed by individuals. Third, total nutrient score for each food was calculated by summing all percent contributions times 100 for nutrients. To set priorities among the foods in the list, we sorted the score in descending order and then compared total percent contributions of foods, within the 100, 90, 85, 80, and 75 percentiles of the list. Finally, we selected the minimum list of foods contributing to at least 90% of the key nutrient intake as key items for analysis. RESULTS: Among the 1,575 foods consumed by individuals, 456 were selected as key foods. Those foods were chosen as items above the 80 percentile of the total nutrient score, among the foods contributing at least 85% of any nutrient intake. On an average, the selected key foods contributed to more than 90% of key nutrient intake. CONCLUSIONS: In total, 456 foods, contributing at least 90% of the key nutrient intake, were selected as key foods. This approach to select a minimum list of key foods will be helpful for systematically updating and revising food composition databases.

Dietary zinc intake and sources among Koreans: findings from the Korea National Health and Nutrition Examination Survey 2016–2019

Shim Jee-Seon,Kim Ki Nam,Lee Jung-Sug,Yoon Mi Ock,Lee Hyun Sook 한국영양학회 2023 Nutrition Research and Practice Vol.17 No.2

BACKGROUND/OBJECTIVES: Zinc is an essential trace mineral which is important for the growth and development of the human body and immunological and neurological functions. Inadequate zinc intake may cause zinc deficiency with its adverse consequences. In this study, we aimed to estimate the dietary zinc intake levels and sources among Koreans. SUBJECTS/METHODS: For this secondary analysis, we obtained data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2019. Individuals aged ≥ 1 yr who had completed a 24-h recall were included. The dietary zinc intake of each individual was calculated by applying data from a newly developed zinc content database to the KNHANES raw data. We also compared the extracted data with the sex-, age-specific reference values suggested in the Korean Dietary Reference Intakes 2020. The prevalence of adequate zinc intake was then evaluated by the proportion of the individuals who met the estimated average requirement (EAR). RESULTS: The mean zinc intake of Koreans aged ≥ 1 yr and adults aged ≥ 19 yrs were 10.2 and 10.4 mg/day, equivalent to 147.4% and 140.8% of the EAR, respectively. Approximately 2 in 3 Koreans met the EAR for zinc, but the zinc intake differed slightly among the different age and sex groups. In children aged 1–2 yrs, 2 out of 5 exceeded the upper level of intake, and nearly half of the younger adults (19–29 yrs) and the elders (≥ 75 yrs) did not meet the EAR. The major contributing food groups were grains (38.9%), meats (20.4%), and vegetables (11.1%). The top 5 food contributors to zinc intake were rice, beef, pork, egg, and baechu kimchi, which accounted for half of the dietary intake. CONCLUSION: The mean zinc intake among Koreans was above the recommended level, but 1 in 3 Koreans had inadequate zinc intake and some children were at risk of excessive zinc intake. Our study included zinc intake from diet only, thus to better understand zinc status, further research to include intake from dietary supplements is needed.

A Study on the Cost-Effective Evaluation of the Sugar Reduction Policy

Jee-Seon Shim 한국식품영양과학회 2018 한국식품영양과학회 학술대회발표집 Vol.2018 No.10

Magnesium intake and dietary sources among Koreans: findings from the Korea National Health and Nutrition Examination Survey 2016–2019

Shim Jee-Seon,Kim Ki Nam,Lee Jung-Sug,Yoon Mi Ock,Lee Hyun Sook 한국영양학회 2023 Nutrition Research and Practice Vol.17 No.1

BACKGROUND/OBJECTIVES: Magnesium is an essential nutrient for human health. However, inadequate intake is commonly reported worldwide. Along with reduced consumption of vegetables and fruits and increased consumption of refined or processed foods, inadequate magnesium intake is increasingly reported as a serious problem. This study aimed to assess magnesium intake, its dietary sources, and the adequacy of magnesium intake in Korean populations. SUBJECTS/METHODS: Data was obtained from the Korea National Health and Nutrition Examination Survey 2016–2019 and included individuals aged ≥1 yr who had participated in a nutrition survey (n=28,418). Dietary intake was assessed by 24-h recall, and dietary magnesium intake was estimated using a newly established magnesium database. Diet adequacy was evaluated by comparing dietary intake with the estimated average requirement (EAR) suggested in the Korean Dietary Reference Intakes 2020. RESULTS: The mean dietary magnesium intake of Koreans aged ≥1 yr was 300.4 mg/d, which was equivalent to 119.8% of the EAR. The prevalence of individuals whose magnesium intake met the EAR was 56.8%. Inadequate intake was observed more in females, adolescents and young adults aged 12–29 yrs, elders aged ≥65 yrs, and individuals with low income. About four-fifths of the daily magnesium came from plant-based foods, and the major food groups contributing to magnesium intake were grains (28.3%), vegetables (17.6%), and meats (8.4%). The top 5 individual foods that contributed to magnesium intake were rice, Baechu (Korean cabbage) kimchi, tofu, pork, and milk. However, the contribution of plant foods and individual contributing food items differed slightly by sex and age groups. CONCLUSIONS: This study found that the mean dietary magnesium intake among Koreans was above the recommended intake, whereas nearly one in 2 Koreans had inadequate magnesium intake. To better understand the status of magnesium intake, further research is required, which includes the intake of dietary supplements.

식품안정성과 식사섭취의 관련성 : 국민건강영양조사 제3기 (2005년)

심지선(Shim Jee Seon),오경원(Oh Kyungwon),남정모(Nam Chung Mo) 韓國營養學會 2008 Journal of Nutrition and Health Vol.41 No.2

제3기 (2005년) 국민건강영양조사 자료를 이용하어 분석한 결과 연구 대상자의 과반수에서 식품확보가 불안정하였으며, 식품안정성은 식사섭취와 관련이 있어 식품확보가 불안정한 군에서 영양소 섭취량이 낮고 섭취 식품의 다양성이 적었다. 본 연구는 우리 국민의 식품안정성과 식사섭취의 관련성에 대한 거의 초기 연구로 식품확보에 대한 안정성의 문제 크기를 파악하고 식품확보 여부에 따른 식사섭취의 양적 · 질적 측면을 다루었다. 이와 함께 식생활은 건강과 밀접한 관련이 있으므로 식품안정성과 건강 및 질병에 관한 후속 연구가 필요하며, 이러한 연구 결과에 근거하여 향후에는 저소득층의 안정적인 식품확보를 지원하는 정책을 마련하고 시행중인 정책의 효과 평가와 개선 방안을 모색할 필요가 있겠다. Although food insecurity might be associated with poor dietary intake, this relationship has not been researched in Korea. This study examined the association of food security with dietary intake from the third Korea National Health and Nutrition Examination Survey. Food security was measured by a self-reported hunger measure on the dietary situation of subjects' households in the previous year and approximately 2/3 of the subjects lived in food-insecure households. Dietary intake was based on a 24-hour dietary recall. Food insecurity was significantly associated with low nutrients intake and nutrients intake compared to dietary reference intakes (DRI) was also lower among subjects in food-insecure house-holds. Overall diet quality based on dietary diversity score (DDS) was worse in food-insecure subjects. Food security should be considered an important issue to public health because dietary change due to food insecurity may affect health status. (Korean J Nutr 2008; 41 (2): l74~183)