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BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea. SUBJECTS/METHODS: A questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers. RESULTS: Among women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%). CONCLUSIONS: Our results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.

The purpose of this study was to compare the degree nutrient intake, health status and other characteristics of females aged 65 years and over in a longevity area according to family arrangement. For analysis, 585 female elderly were recruited from the Kugoksoondam area (Kurye, Goksung, Soonchang and Damyang counties), known as the longevity-belt region in Jeonla province, Korea. The subjects were categorized into three groups according to family arrangement (living alone, living with spouse only and living with family). Demographic characteristics were collected, as well as information on physical measurements, blood tests for biochemical indicators, health status and health-related life style, dietary behavior, favorite food groups, consumption frequency of food groups, nutrient intake and mini nutrition assessment. In the group living with their spouse only, the highest education, physical activity, diverse food intake, frequency of eating meats and fish, energy and nutrients intake, and score on the mininutrient status assessment (MNA) were found to be significantly favorable factors. Taken together, these results demonstrated that the group living with their spouse only had relatively superior nutrient intake and the quality of diet. In contrast, the group living alone showed the lowest self-rated economic status, diversity of food intake, and physical activity, with the highest frequency of drinking, smoking and regular exercise for almost everyday compared with the other groups. On the other hand, those living with family demonstrated the lowest intake of supplements or functional foods, and levels of hemoglobin hematocrit MCH, but the highest HBA1c and blood sugar. Therefore, the group living with family was assumed to be at risk of anemia and diabetes. These results could be useful to plan effective strategies to increase the health-life expectancy of Korean elderly people living in rural areas, according to family arrangement.Key words: biochemical indicator, nutrient intake, living alone, living with spouse only, living with family

Food Contaminants Division, Food Safety Evaluation Department, National Institute of Food & Drug Safety EvaluationAbstract A food list representing the typical diet of Koreans was developed for a total diet study based on the 687 fooditems which appeared in the dietary intake data collected during the 2008 & 2009 Korea National Health & NutritionExamination Survey. Food items included in 90% of the cumulative intake, items with a consumption frequency of 5%or higher and items contributing to 80% of cumulative fat intake were considered first. From the resulting 165 food items,15 items were removed to avoid similar foods, while 10 distinct items were added to increase the efficiency of 'best-fit'mapping. Consequently, 160 items were selected as representative foods, which cover 90.93% of intake amount, 91.36%of energy intake and 89.05% of fat intake. Given that every food consumed by Koreans can’t be analyzed forcontaminants of interest, mapping other foods to the previously mentioned representative 160 foods is warranted becauseit enables a more comprehensive dietary exposure assessment that is close to reality.Keywords: food list, food contaminants, dietary exposure assessment, mapping

We assessed folate nutritional status from birth to 12 months in fifty-one infants who were fed human milk (HM;n20), casein-based formula (CBF;n12) or soya-based formula (SBF;n19). Folate contents in ninety-five HM samples obtained from twenty mothers for the first 6-month period and twelve CBF and nineteen SBF samples were measured by bioassay after trienzyme extraction. Folate intake was estimated by weighing infants before and after feeding in the HM group and by collecting formula intake records in the formula-fed groups. After solid foods were introduced, all foods consumed were included to estimate folate intake. Serum folate and total homocysteine (tHcy) concentrations were determined at 5 and 12 months of age, and infant growth was monitored for the first 12 months. Mean HM folate contents ranged from 201 to 365 nmol/l with an overall mean of 291 nmol/l, and the contents peaked at 2 months postpartum. HM folate contents were higher than those reported in North America. Folate contents in CBF and SBF were markedly higher than those in HM and those claimed on the product labels. The overall folate intakes in formula-fed infants were significantly higher than those in HM-fed infants, and this was associated with significantly higher folate and lower tHcy in formula-fed infants than HM-fed infants at 5 months. At 12 months, serum folate was significantly higher in the SBF group than the other groups, whereas serum tHcy and overall growth were similar among all groups.

Folate extraction by trienzyme treatment (TT; α-amylase, protease and folate conjugase) is considered to be more effective than folate conjugase treatment alone (CT) for certain foods, indicating that some of the previously published food folate values may be underestimated. We measured folate content in 111 foods commonly consumed by Koreans by microbiological assay after the two extraction methods. Folate values by TT were higher in all the foods with the exception of a few items such as cucumber (improved strain), eggplant, and banana than those by CT. Some of our values were comparable to the data using TT and microbiological assay in the literature. Our results support the idea that food folate should be measured using the TT method. Folate values presented here can be used to accurately assess dietary folate intake of the Korean population.

Previous Korean total diet studies (KTDSs) have estimated dietary exposure to toxic chemicals based on 110-120 representative foods selected from over 500 foods appeared in the Korea National Health & Nutrition Examination Surveys (KNHANES), which would result in a possible underestimation. In order to find measures for a closer-to-real estimate of dietary exposure to heavy metals, this study examined the feasibility of mapping foods to the representative foods in the KTDS by comparing estimates. In mapping, those foods not analyzed in the 2009 KTDS (443 out of 559 foods appeared in the 2007 KNHANES) were mapped to the 114 representative foods used in the 2009 KTDS based on the closeness in regards to biological systematics and morphological similarity. Dietary exposures to total mercury and lead were re-estimated using the content of total mercury and lead in 114 foods analyzed in the 2009 KTDS, food intake, and individual’s own body weight for respondents in the 2007 KNHANES instead of mean body weight of Koreans used in the 2009 KTDS. The re-estimates of exposure with mapping were approximately 50% higher than the original estimates reported in the 2009 KTDS. In addition, mapping enabled the comparison of percentile distribution of the exposure among populations of different age groups. In conclusion, estimates via mapping resulted in a more comprehensive estimation of dietary exposure to heavy metals present in foods that Koreans consume.

To measure folate content in cooked foods commonly consumed in Korea for evaluating its relation to folate nutriture of college students.Folate content in 32 raw and cooked foods was measured by microbiological assay after trienzyme extraction. These values and the previously published values of 110 raw foods commonly consumed in Korea were used to update the currently available food tables to estimate dietary folate intake of 106 students based on a 3-day 24-h recall. The association of folate intake with blood folate and homocysteine concentrations was evaluated.Cheongju, Korea.Healthy college students aged 18 to 27 y old (44 males and 62 females).The average folate loss in 32 foods caused by cooking was 29%. The mean daily dietary folate intakes estimated with an updated database were 406 and 305 mug in males and females, respectively. About 10% of both male and female students showed low serum folate (6.8 nmol/l). Folate intake was positively correlated with serum and erythrocyte folate concentrations in female students (r=0.27 and 0.29, respectively, P0.05), and negatively correlated with serum homocysteine in male students (r=-0.41, P0.05).Mean dietary folate intake was higher than those of previous studies since the database was updated using values obtained with trienzyme extraction. Folate intake for the general population should be re-evaluated using reliable food folate values obtained with trienzyme extraction.

Purpose: The aim of this study is to estimate total sugar intake and identify major food sources of total sugar intake in the diet of the Korean population. Methods: Dietary intake data of 33,745 subjects aged one year and over from the KNHANES 2008-2011 were used in the analysis. Information on dietary intake was obtained by one day 24-hour recall method in KNHANES. A database for total sugar content of foods reported in the KNHANES was established using Release 25 of the U.S. Department of Agriculture National Nutrient Database for Standard Reference, a total sugar database from the Ministry of Food and Drug Safety, and information from nutrition labeling of processed foods. With this database, total sugar intake of each subject was estimated from dietary intake data using SAS. Results: Mean total sugar intake of Koreans was 61.4 g/person/day, corresponding to 12.8% of total daily energy intake. More than half of this amount (35.0 g/day, 7.1% of daily energy intake) was from processed foods. The top five processed food sources of total sugar intake for Koreans were granulated sugar, carbonated beverages, coffee, breads, and fruit and vegetable drinks. Compared to other age groups, total sugar intake of adolescents and young adults was much higher (12 to 18 yrs, 69.6 g/day and 19 to 29 yrs, 68.4 g/ day) with higher beverage intake that beverage-driven sugar amounted up to 25% of total sugar intake. Conclusion: This study revealed that more elaborated and customized measures are needed for control of sugar intake of different sub- population groups, even though current total sugar intake of Koreans was within the range (10-20% of daily energy intake) recommended by Dietary Reference Intakes for Koreans. In addition, development of a more reliable database on total sugar and added sugar content of foods commonly consumed by Koreans is warranted.

Objectives: To evaluate the critical environmental factors on healthy-aging of Korean people, we investigated the significant factors influencing health status of septuagenarians living in rural area of Jeonla province, known to be one of the representative longevity regions in Korea. Methods: We divided subjects into healthy group (36M/25F) or poor-health group (26M/73F) based on self-reported health status, body mass index, a number of prescription, and blood test data. General characteristics, physical measurements, lifestyle, dietary behavior and nutrient intake, physical health and mental health data were statistically compared between the two groups. Results: Average age was not different between healthy group and poor-health group in men and women, respectively. In men, significantly favorable factors to health were observed to be higher education, regular exercise, higher grip strength and walking function, body mass index (≥ 18.5 kg/m ), moderate frequency of drinking and eating-out, non-smoking, normal red blood cell (RBC) count, higher serum dehydroepiandrosteronesulfate (DHEAS) level, good digestive function and appetite, normal hearing function, regular meals, adequate vegetable and fruit intake, diverse food intake, adequate energy and nutrients (protein, vitamin B , B , C and E, folate, niacin, P, Zn and K) intake, higher mininutrient status assessment (MNA) score and low level of depression. On the other hand, in women, those were literacy, living arrangement, moderate frequency of drinking, healthy teeth, higher grip strength and walking function, bone mineral density, normal RBC and white blood cell (WBC) count, higher DHEAS concentration, higher MNA score, normal cognition and memory function, having snack and adequate fruit intake. Conclusions: These results could be useful to plan effective strategies to increase health-life expectancy of Korean old people living in rural areas. Korean J Community Nutr 19(2): 142~162, 2014

Miyong Yon, Haeng-Shin Lee, Dohee Kim, Jeeyeon Lee, Jiwoon Nam, Gui-Im Moon, Jinhwan Hong, Yoonna Lee, Daekyu Oh*, Cho-il Kim* Nutrition Policy & Promotion Team, Korea Health Industry Development Institute, Cheongju; Safety Evaluation Department, Ministry of Food and Drug Safety Food, Cheongju; Department of Food & Nutrition, Shingu College, Seongnam; Department of Preventive Medicine, Gachon University School of Medicine, Incheon; Bureau of Health Industry Promotion, Korea Health Industry Development Institute, Cheongju, Korea

Subclinical vitamin B 12 deficiency is common in the elderly worldwide. We investigated the change of serum vitamin B12 concentration with aging and compared anthropometric data and clinical health indicators between normal (≥ 340 pg/mL) and low (＜ 340 pg/mL) serum vitamin B 12 groups in 470 Korean women aged 65 years and over living in a rural area. Serum vitamin B 12 concentration showed inverse correlation with age (r = -0.0992, p ＜ 0.05). The normal B 12 group showed significantly (p ＜ 0.05) higher red blood cell count, hemoglobin, and hematocrit compared to the low B 12 group, however, no difference in mean corpuscular volume was observed between the two groups. The normal B 12 group showed significantly lower serum homocysteine concentration (p ＜ 0.01) and prevalence of vitamin D (p ＜ 0.01) or folate deficiency (p ＜ 0.001). Bone mineral density (T-score) was significantly higher (p ＜ 0.05) in the normal B 12 group, compared with that in the low B 12 group, and showed positive correlation (r = 0.1490, p ＜ 0.01) with serum vitamin B 12 concentration after adjusting for age, body weight, and body mass index. No differences in anthropometric data, physical activity, and smoking and drinking habits were observed between the two groups. In conclusion, it could be suggested that older female adults with normal serum vitamin B 12 level would be less anemic and osteoporotic and more resistant to hyperhomocysteinemia associated chronic diseases than those with low serum vitamin B 12 level.

Childhood obesity has rapidly increased worldwide and is one of the most serious health problems in this age group. In order to prevent and manage childhood obesity, we developed a nutrition education website. The website consisted of three parts. The first part was made for self-assessment with regard to obesity index, dietary habits, food frequency, dietary attitude, nutrition knowledge, nutrient intake, energy expenditure, and the stage of behavioral change, and tailored messages and advice according to the assessment results. A total of 612 real-size food photos as well as a nutrient database of 3,346 foods and 541 dishes were created to help children estimate nutrient intakes accurately. In addition, an energy expenditure database of 156 activities for children was established to calculate calorie consumption. The second part was made for setting long-term and short-term goals and keeping track of the changes in energy intake and expenditure in one`s own page. The third part was made for education. Various types of nutrition information were provided; texts, pictures, calculators and games. The readability and design of the website were evaluated by 46 obese children. Usefulness, design and readability of the website were found to be desirable for children. This website is expected to be used by an obese child alone or with parents or nutrition teachers in order to control body weight through healthy dietary habits and physical activities. In addition, a non-obese child can also use this website for maintaining healthy dietary habits and preventing obesity. (Korean J Community Nutr 17(4): 390~406, 2012)

The population aged 95 years and older in Seoul approximately increased to five-fold over the past 10 years, while nationwide rates increased to three-fold. In order to examine the dietary habit and nutritional status of oldest-old population living in Seoul, we recruited 87 subjects (25 males and 62 females) aged 95 years and older. The prevalence of underweight (BMI < 18.5 kg/m ) and obesity (BMI ≥ 25 kg/m ) were 18.2% and 18.2% in males, and 20.8% and 9.4% in females, respectively. In self-assessment of health, only 25.3% answered to be unhealthy. More males exercised regularly and reported a wide range of activities than females. The average of %Kcal from carbohydrate, protein and fat (C : P : F) was 64.9 : 13.8 : 21.2 in males and 68.1 : 14.2 : 17.7 in females. The average daily energy intake was 1,307 kcal in males and 1,304 kcal in females. More than 75% of subjects were taking under estimated average requirements (EAR) for vitamin B , B & C and Ca. The average of mean adequacy ratio (MAR) was 0.66 in males and 0.70 in females, and 28.8% of males and 12.9% of females were in MAR < 0.50. Based on MAR, 32.0% of males and 14.5% females were classified as normal and 16.0% of males and 25.8% of females were classified as malnourished. Our subjects were taking more animal food, especially milk and its products, compared to those living, in rural areas. However, a significant proportion did not meet the EAR for vitamin B , B & C and Ca. (Korean J Community Nutr 17(5) : 603~622, 2012)

We attempted to define the sources of sodium intake for the Korean population at prepared dish level to provide a basis for developing sustainable nutrition policies and feasible programs for sodium intake reduction. Dietary intake data from 2008 and 2009 Korea National Health and Nutrition Examination Survey was used in the analysis for sodium intake sources. Sodium intake from individual dish consumed by each subject was calculated and used in delineating major sodium sources at dish and dish group level for sub-populations of different sex and age. Also, sodium intake was compared between eaters and non-eaters of some specific dish groups with considerable contribution to total sodium intake. The number of subjects included in the analysis was 18,022 and mean sodium intake was 4,600 mg/capita/day. Major sources of sodium intake at dish group level were in the following order: kimchi (1125 mg, 24.5%), noodles (572 mg, 12.4%), soups (488 mg, 10.6%), stews (399 mg, 8.7%), and cooked rice (284 mg, 6.2%). The magnitude of contribution to total sodium intake by soups and stews was different by age group. Sodium intake difference between eaters and non-eaters was much larger for kimchi group (2,343 mg for male, 1,452 mg for female) than for soups or stews. Interaction between consumption of aforementioned specific dish groups and age was highly significant (p < 0.0005) for both sexes. This study revealed an importance of having not only the control over sodium content of foods/dishes, but also the customized approach for different groups of population to accomplish an appreciable reduction in sodium intake. (Korean J Community Nutr 16(4) : 473~487, 2011)

A trienzyme extraction method (use of α-amylase, protease and folate conjugase) for food folate assay has been used to release folate from the food matrix. In order to reduce the incubation time with three enzymes, folate values were compared between two incubation protocols; separate incubation (SI, incubated with α-amylase and conjugase separately for 2 hours after protease treatment) and combined incubation (CI, incubated with α-amylase and conjugase together for 2 hours after protease treatment) using 88 food items from 12 kinds of fast foods and processed foods. We found that folate values by CI were comparable to or higher than those by SI, indicating that CI might be a better extraction procedure to shorten the entire incubation time. We measured folate contents in 49 fast foods and 26 processed foods by microbiological assay after CI. Mean folate contents of one serving of various burgers ranged from 43.1 to 62.0 ㎍. One serving of French fries, pizza, sandwich and triangled kimbab contained a mean of 53.3, 28.4, 47.4, and 25.7 ㎍ of folate, respectively. Folate contents of non-alcoholic beverages were very low, ranging from 1.0 to 5.2 ㎍/100 g. Some of our values were comparable to the values in the folate database published in Korean Nutrition Society, however, some of the published values were 140 times higher than the measured values in this study. Folate values measured by the more recent modifications here can be used to update Korean folate database to accurately estimate dietary folate intake