BACKGROUND/OBJECTIVES: Rising pre-diabetes in Korean adults is an emerging concern, with notable increases observed even among younger adults. The interest in high-protein diets is also increasing in Korea, while concerns about excess intake remain. This study examined the associations of protein intake, diet quality, and diabetes-related metabolic indicators in Korean adults. SUBJECTS/METHODS: This study analyzed 8,254 adults aged 19-64 yrs without diabetes from the Korean National Health and Nutrition Examination Survey 2019-2021, stratified by sex and pre-diabetic status. The protein intake was assessed using a 24-h recall, expressed as a percentage of the total energy intake, and divided into quintiles. The diet quality was examined using the Korean Healthy Eating Index. The diabetes-related metabolic indicators were waist circumference, triglyceride, high-density lipoprotein cholesterol (HDL-C), blood pressure, homeostasis model assessment of insulin resistance, and triglyceride-glucose index. The associations were analyzed using complex sample general linear models and logistic regression, adjusting for sociodemographic factors, lifestyle, and total energy intake. RESULTS: The protein intake was positively associated with the diet quality, peaking at Q4, then declining. Pre-diabetic men showed a decreasing trend in the elevated triglyceride risk with higher protein intake (Q4: odds ratio [OR], 0.697 [0.489-0.995]; Pfor trend = 0.041). In women, higher protein intake was significantly associated with an increased risk of low HDL-C in the non-diabetic group (Q5: OR, 1.544 [1.141-2.088]; Pfor trend = 0.020) and with the pre-diabetic group showing a lower risk of elevated blood pressure (Q5: OR, 0.657 [0.458-0.944]; Pfor trend = 0.012). CONCLUSION: These findings suggest that in Korean adults without diabetes, maintaining an appropriate, balanced protein intake rather than simply increasing consumption may help manage the metabolic alterations associated with diabetes.

OBJECTIVES:This study aimed to identify gender- and household type-specific nutritional vulnerability among older Koreans by comparing dietary behaviors, nutrient intake, and diet quality. METHODS:We analyzed data from 2,412 adults aged ≥ 65 years (1,118 men; 1,294 women) from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Household type was classified as one-person, couple-only, or with-children. Outcome variables included dietary behavior, daily energy and nutrient intake, and diet quality, assessed using the Korean Healthy Eating Index (KHEI). Analyses were carried out accounting for the complex sampling design, adjusting for age, residential area, education level, household income level, economic activity status, self-rated health status, and survey year. RESULTS:Elderly men in one-person households, compared with those in couple-only households, were more likely to skip breakfast and lunch and to consume less energy. The odds of intake below the estimated average requirement (EAR) were higher for iron (odds ratio [OR] = 1.731, P = 0.022) and zinc (OR = 2.460, P = 0.002) among men in one-person households. The KHEI score was the lowest among men in one-person households. Elderly women in with-children households, compared with those in couple-only households, were more likely to skip breakfast and to consume less energy. The risks of intake below the estimated energy requirement (EER) and EAR were higher among women in with-children households than those in couple-only households (EER: OR = 1.448; magnesium: OR = 2.090; iron: OR = 1.692; zinc: OR = 1.902; folate: OR = 2.282; all P < 0.05). The KHEI score was lower among women in with-children households. CONCLUSION:Elderly men living alone and elderly women living with children showed significantly greater nutritional vulnerability. More attention should be given to understanding how gender-specific household types can affect nutritional vulnerability in later life.

Objectives This study aimed to analyze the association between sugar intake and cancer risk among Korean adults aged 19 years and older. Methods A total of 13,016 adults aged 19 years and older who participated in the 8th Korea National Health and Nutrition Examination Survey from 2019 to 2021 were included. Sugar intake was assessed in terms of both absolute intake and sugar energy rate. Sugar intake was divided into quartiles, while sugar energy rate was categorized into three groups (< 10%, 10%–20%, > 20%) based on the 2020 Dietary Reference Intakes for Koreans and into two groups (< 10%, ≥ 10%) based on WHO recommendations. Cancer prevalence was determined using cancer-related survey questions. The association between sugar intake and cancer prevalence was analyzed by sex and cancer type using logistic regression. All statistical analyses were performed using IBM SPSS statistics 29.0 (IBM Co.). Results From 2019 to 2021, sugar intake significantly declined with age in both men and women (P for trend < 0.001), with the highest intake observed in the 19–29 age group (61.38 g). Men consumed significantly more sugar than women across all age groups except for the 50–64 and 65–74 groups (P < 0.05). However, the sugar energy rate was significantly higher in women than in men (P < 0.05). While the association between sugar intake and cancer prevalence varied across regression models and cancer types, cervical cancer consistently showed a significant association with sugar intake (P < 0.05). Conclusion The association between sugar energy rate and the prevalence of premenopausal cervical cancer was consistent and significant. Given that women had a higher sugar energy rate than men, the relationship between sugar intake and cancer prevalence in women warrants further investigation. Longitudinal studies with more detailed sugar intake assessments are needed.

Background: Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. Objective: This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). Methods: We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. Results: The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and -521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. Conclusions: The wearable device-based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted.

BACKGROUND/OBJECTIVES North Korean refugees (NKRs) in South Korea are a unique population as they must adapt in a new country with similar cultural traits but different social, political, and economic systems, but little research has been conducted on diet and nutrition in this population. This study examined food security, dietary behaviors, and nutrient intakes among adult NKRs living in South Korea and compared them to those of South Koreans. SUBJECTS/METHODS The subjects were 139 adult NKRs (25 men, 114 women) living in the Seoul metropolitan area, and 417 age- and sex-matched South Korean controls (SKCs; 75 men, 342 women) selected from the Korea National Health and Nutrition Examination Survey (KNHANES). Food security and dietary behaviors (meal skipping, eating-out, meals with family, nutrition education and counseling, and nutrition label knowledge and utilization) were obtained using self-administered questionnaires. Nutrient intakes were assessed by 24-hr recall. The statistical analysis was performed using IBM SPSS ver. 23.0. RESULTS In South Korea, food security had improved over the previous 12 months, but remained significantly poorer for NKR women than SKC women. Meal skipping was three times more frequent than for SKCs and eating-out was rare. Average energy intake was 1,509 kcal for NKR men and 1,344 kcal for NKR women, which was lower than those of SKCs (2,412 kcal and 1,789 kcal, respectively). Significantly more NKRs (men 24.0%, women 21.9%) showed simultaneously deficient intake in energy, calcium, iron, vitamin A, and riboflavin than SKCs (men 2.7% (P = 0.003), women 7.0% (P < 0.001)). NKR women had a significantly higher index of nutrient quality (INQ) for some nutrients than SK women. CONCLUSIONS This study reports significant differences in food security, dietary behaviors, and nutrient intakes between NKRs and SKCs. Generally, NKRs reported lower intakes despite improved food security, but relatively good INQs across nutrients. Further research is needed to understand processes of food choice and consumption among NKRs to provide appropriate support aimed at improving diets.

Purpose: North Koreans could be at higher risk for their bone health because of previous periods of severe famine and the continuing low availability of food.This study determined the bone mineral density (BMD) status and its relationship with dietary behaviors and nutrient intake of North Korean refugees (NKR) in South Korea (SK).Methods: This cross-sectional study analyzed 110 female NKR from a NORNS cohort of a non-probability sample of adult NKR in Seoul.BMD examined by DEXA was used to divide participants into the normal group (NG) and the non-normal group (NNG) according to the WHO guideline.A self-administered questionnaire included questions on age, the socioeconomic situation in North Korea (NK) and SK, the food security in NK and SK, and the health behaviors, dietary behaviors, and food frequency questionnaire administered in SK.A one-day 24-hr recall was conducted and the results were analyzed by using CanPro.SPSS was used to analyze whether BMD and related dietary behaviors and nutrient intakes differed according to the groups.Results: NG (62.7%) was significantly younger and had a lower abdominal obesity score than NNG (p < 0.001).While 14.5% of NG reported experiencing menopause, all of NNG reported experiencing menopause.The NG more frequently consumed the dairy group of foods (9.6 times a week) than did the NNG (4.8 times a week) after the statistics were adjusted for age (p < 0.007).The NG consumed significantly more animal protein and animal calcium than did the NNG (p = 0.01, p = 0.009, respectively).Calcium intake was low with 49.3% of NG, and 78.0% of the NNG reported consuming calcium lower than the estimated average requirement.Only calcium showed an index of nutrient quality lower than one in both groups.Conclusion: These results showed that NKR women and possibly all North Korean women are at high risk for bone health and they consumed low levels of bone-related nutrients, and this should be considered for the nutrition policy for NKR and North Korea.

ABSTRACT Data about Asian children and adolescents with type 1 diabetes are sparse. This study’s objectives were to describe blood glucose (BG) levels and related factors at a camp for Korean children and adolescents with type 1 diabetes. This descriptive study was conducted January 8–10, 2015. The participants, 24 children and adolescents, were recruited for a 3-day residential diabetes camp. Data on 24 campers were analyzed. Their mean age was 13.4 (± 1.7) years; 44.4% were boys, and mean HgbA1c was 8.5% (± 1.4%). Results revealed that BG levels were maintained safely: The mean BG level during the 3-day stay was 171.1 (± 33.3) mg/dl. Multiple regression analysis showed that insulin adjustment for hyperglycemia (standardized β = .426; t = 2.431; p = .030) and snacks for hypoglycemia (standardized β = –.719; t = –3.723; p = .003) at the camp were the only independent contributors to mean BG levels during the 3-day study period. No demographic or clinical factor was found to be associated with the mean BG level. This is the first study of its kind to be conducted in an Asian population, presumably because the prevalence of type 1 diabetes in Asia is low and diabetes camps are a novel concept. Further research is recommended to assess the characteristics of campers (e.g., diet, activity levels, and cultural background) and to determine how the health outcomes of children and adolescents with type 1 diabetes are affected by camp programs.

North Korea suffered from severe famine in the mid-1990s; this impacted many areas, including people's transnational movement, child growth, and mortality. This review carefully examined nutritional status trends of children in North Korea using published reports from national nutrition assessment surveys. Nutritional adaptation of North Korean child refugees living in South Korea was also studied with their growth and food consumption, using published researches. The nutritional status of children in North Korea has recovered to a "low" level acute malnutrition status and a "medium" level chronic malnutrition status. Large disparities by geographic region still remain. North Korean child refugees in South Korea were significantly shorter and lighter than their age- and sex-matched South Korean counterparts (P<0.05); however, North Korean child refugees were catching up, and weight was improving faster than height. Linear growth retarded (height for age Z-score < -1) North Korean children showed a significantly higher respiratory quotient than nonlinear growth retarded children, indicating metabolic adaptation responding to the food shortage. These changes, accompanied by abundant access to food in South Korea, have led to the elimination of significant differences in the obesity ratio between North Korean and South Korean children living in South Korea after approximately 2 years of residency. This nutritional adaptation may not be beneficial to North Korean child refugees, especially given the prediction of Barker's theory. The lack of studies prevented a better understanding of this issue; therefore, large cohort studies, preferably with random sampling strategies, are needed to further understand this issue and to design appropriate interventions.

BACKGROUND/OBJECTIVES: Relocation to new environments can have a negative impact on health by altering body weight and dietary patterns. This study attempted to elucidate changes in body weight, food security, and their current food and nutrient consumption in adult North Korean refugees (NKR) living in South Korea (SK).SUBJECTS/METHODS: This study analyzed data on 149 adult NKR from a North Korean refugee health in SK cohort at four time points (leaving North Korea, entering SK, first examination, and second examination). Body weight was self-reported at the two earlier time points and directly measured at the two later time points. Food security, diet-related behaviors (dietary habits and food consumption), and sociodemographic information were obtained using a self-administered questionnaire. Nutrient intake information was obtained by one-day 24-hour recall. Statistical analyses were performed with SPSS ver 23.0.RESULTS: Body weight increased during relocation by an average of 4 kg, although diversified patterns were observed during the settlement period in SK. Approximately 39.6% of subjects maintained their body weight between the first and second examinations, whereas 38.6% gained and 22.1% lost at least 3% of their body weight at the first examination by the second examination. Food security status improved from 12.1% food secure proportion to 61.7%. NKR showed generally good food and nutrient consumption (index of nutrient quality: 0.77-1.93). The body weight loss group showed the most irregular meal consumption pattern (P < 0.05), and eating-out was infrequent in all three groups. Consumption frequencies of food groups did not differ by group, except in the fish group (P = 0.036).CONCLUSION: This study observed considerable body weight adjustment during the settlement period in SK after initial weight gain, whereas food security consistently improved. More detailed understanding of this process is needed to assist healthy settlement for NKR in SK.

Objectives: Food allergy appears to be increasing in prevalence and can potentially result in significant damaging impact on children's mental and physical health. This study investigated how dietitians/nutrition teachers in Incheon, where a fatal fool allergy incidence occurred, manage food allergy issues in school lunch systems. Methods: A survey with a pre-tested questionnaire was conducted with 358 dietitians/ nutrition teachers in Incheon area. The final analytical sample included questionnaire data from 208 study participants (58.1%). Statistical analyses used SPSS ver 19.0. Results: A total of 99.5% respondents reported having received food allergy education. The respondents showed a correction rate of the food allergy test slightly higher than 70%, where nutrition teachers and respondents working in elementary schools had correction rates higher than dietitians and those working in middle schools (p<0.05). All respondents reported regular monitoring to identify students with food allergy and making notification of allergy-prone foods on menu in their school. More nutrition teachers provided elimination (57.6%) or (37.0%) than dietitians (43.1%, 19.8%, respectively) (p<0.05). Elimination and replacement meals were provided more in elementary schools than in middle schools (p<0.05). Although counseling students with food allergy on nutrition was done by 64.9% of respondents, the areas of counseling were limited to basics of food allergy and how to use the notification system on menu. To prepare for handling food allergy events effectively, networks with regional clinics or hospitals (34.1%), hotline with parents (87.4%), and keeping an Epi-Pen ready (46.7% elementary school) were established. Only 34.1% of respondents knew how to use Epi-Pens. Conclusions: Dietitians and nutrition teachers in Incheon widely adapted food allergy management methods. It appears that education/training on food allergy for dietitians/ nutrition teachers can move on from teaching basics of food allergy to providing applicable food allergy management methods at school system. Korean J Community Nutr 21(3): 247~255, 2016

ObjectiveFood allergy, increasing worldwide, can leave damaging impact on children's mental and physical health. This study investigated how food allergy were managed in schools in Incheon, where the first fatal fool allergy incidence of Korea occurred in 2014.Design, Setting, and ParticipantsA cross-sectional survey with a pre-tested questionnaire was conducted with all 358 dietitian/nutrition teachers working in school systems of Incheon area, resulting a final sample of 208 questionnaires (58.1%).Outcome Measures and AnalysisThis study estimated the rate of food allergy education and the application level of food allergy management measures at school systems. Statistical analyses used SPSS ver 19.0.ResultsFood allergy education reached 99.5% of respondents, with approximately 70% correction rates on test questions. Nutrition teachers and respondents in elementary schools showed higher correction rates than dietitians and those in middle schools (p<0.05). All respondents established regular monitoring of students with food allergy and allergy-prone food notification in menu. More nutrition teachers provided elimination (57.6%) or replacement (37.0%) meals than dietitians (43.1%, 19.8%, respectively) (p<0.05). Although 64.9% of respondents counseled students with food allergy, the areas of counseling were limited to basics of food allergy and how to use the menu notification system. In readiness for food allergy incidences, hotline with parents (87.4%), networks with regional clinics or hospitals (34.1%), and keeping EpiPen ready (46.7%) were established.Conclusions and ImplicationsDietitians/ nutrition teachers in Incheon widely adapted food allergy management methods. Education/training on food allergy should now provide detailed food allergy management methods and counseling skills.FundingNone ObjectiveFood allergy, increasing worldwide, can leave damaging impact on children's mental and physical health. This study investigated how food allergy were managed in schools in Incheon, where the first fatal fool allergy incidence of Korea occurred in 2014. Food allergy, increasing worldwide, can leave damaging impact on children's mental and physical health. This study investigated how food allergy were managed in schools in Incheon, where the first fatal fool allergy incidence of Korea occurred in 2014. Design, Setting, and ParticipantsA cross-sectional survey with a pre-tested questionnaire was conducted with all 358 dietitian/nutrition teachers working in school systems of Incheon area, resulting a final sample of 208 questionnaires (58.1%). A cross-sectional survey with a pre-tested questionnaire was conducted with all 358 dietitian/nutrition teachers working in school systems of Incheon area, resulting a final sample of 208 questionnaires (58.1%). Outcome Measures and AnalysisThis study estimated the rate of food allergy education and the application level of food allergy management measures at school systems. Statistical analyses used SPSS ver 19.0. This study estimated the rate of food allergy education and the application level of food allergy management measures at school systems. Statistical analyses used SPSS ver 19.0. ResultsFood allergy education reached 99.5% of respondents, with approximately 70% correction rates on test questions. Nutrition teachers and respondents in elementary schools showed higher correction rates than dietitians and those in middle schools (p<0.05). All respondents established regular monitoring of students with food allergy and allergy-prone food notification in menu. More nutrition teachers provided elimination (57.6%) or replacement (37.0%) meals than dietitians (43.1%, 19.8%, respectively) (p<0.05). Although 64.9% of respondents counseled students with food allergy, the areas of counseling were limited to basics of food allergy and how to use the menu notification system. In readiness for food allergy incidences, hotline with parents (87.4%), networks with regional clinics or hospitals (34.1%), and keeping EpiPen ready (46.7%) were established. Food allergy education reached 99.5% of respondents, with approximately 70% correction rates on test questions. Nutrition teachers and respondents in elementary schools showed higher correction rates than dietitians and those in middle schools (p<0.05). All respondents established regular monitoring of students with food allergy and allergy-prone food notification in menu. More nutrition teachers provided elimination (57.6%) or replacement (37.0%) meals than dietitians (43.1%, 19.8%, respectively) (p<0.05). Although 64.9% of respondents counseled students with food allergy, the areas of counseling were limited to basics of food allergy and how to use the menu notification system. In readiness for food allergy incidences, hotline with parents (87.4%), networks with regional clinics or hospitals (34.1%), and keeping EpiPen ready (46.7%) were established. Conclusions and ImplicationsDietitians/ nutrition teachers in Incheon widely adapted food allergy management methods. Education/training on food allergy should now provide detailed food allergy management methods and counseling skills. Dietitians/ nutrition teachers in Incheon widely adapted food allergy management methods. Education/training on food allergy should now provide detailed food allergy management methods and counseling skills.

It has been suggested that new foods get adapted and diffused more early by the young, if the new food is not a core food with a high replacibility. This study examined whether the similar trend existed when almond, a new food, was introduced to food enviornments in South Korea, using 1998‐2012 Korea National Health and Nutrition Examination Survey. Almond consumer was defined as individuals with any amount of almond consumption on the day of 24‐hr recall. Almond consumption increased (0.2% in 1998 to 6.3% in 2012, p=0.000), although the consumption amount remained low (6.06+1.24g/d in 1998 to 6.59+0.73g/d in 2012). Women (p=0.006), middle‐age groups (p=0.000), better educated (p=0.000), higher income (p=0.035), and occupation (p=0.000) was significantly associated with almond consumption. Among adult almond consumers, 64.3% reported having almond during meal times, while 33.7% as snack. Only 23.8% consumers had almond as a sole food, while 74.9% reported having almond mixed in a dish. Three consumption types were: 1) almond in baked goods, 2) almond replacing other nuts in traditional Korean dishes, and 3) almond alone. More almond consumers tended to meet EER or EAR (RI) of energy/major nutrients than non‐consumers (p=0.000), excluding almond contributions. In conclusion, while the level of almond integration in South Korea remained low, almond seemed to be picked up by individuals with higher SES and relatively good diet quality. Almond was not integrated as a core food, but started to replace existing similar foods. Therefore, new foods that are peripheral foods with replicability would better integrated in South Korea. This study was supported by Almond Board of California (#14‐KIMM‐01‐Lee).

As more number of people are living alone, whether individuals living alone would be at higher risk of nutritional status and health compared to those not living alone has gained interests. This study aimed to examine whether and how the status of living alone was associated with dietary quality and health among Korean adults using 1998‐2012 Korea National Health and Nutrition Examination Surveys. The proportion of individuals living alone were significantly different by year (p=0.000) with a slight increase (5.4 % in 1998 to 7.4% in 2012). In general, being a woman (p<0.05), elderly groups (p=0.000), rural region (p<0.05), lower education (p=0.000), lower income (p<0.000), and occupation (p<0.05) was significantly associated with Living alone. People living alone reported worse perceived health status (p=0.000) and showed higher prevalence of hypertension (p=0.000) than those not living alone throughout the years. Other diseases also tended to be higher among those living alone with less consistent statistical significance over years. Individuals living alone reported a lesser diet quality by less proportions of those meeting the level of EER for energy and EAR (RI) for major nutrients (p=0.000). The significant association between living alone and dietary quality were not found in multiple logistic analyses. In conclusion, people living alone appeared to have lower health status and diet quality with possible mediating effects from other socioeconomic factors. This study was supported by Inha University Faculty Grant.

BACKGROUND:As many nations experience the nutrition transition, changes in the nutritional status of children moving from food insecure to food affluent societies has become an important, but infrequently studied, public health issue. AIM:To determine changes in the nutritional status of North Korean children after relocating to food-affluent South Korea (SK) from food-deficient North Korea (NK) and relationships of current nutritional status with food environment at birth and exposure to food affluent environments. SUBJECTS AND METHODS:Socioeconomic status, relocation history and anthropometric information were obtained from 70 NK children (6-15 years) living in SK, through questionnaires, interviews and direct measurements. RESULTS:Following the first 2 years in SK, the height and weight of NK children significantly (p = 0.000) improved, yet they were still shorter (p = 0.000) than SK peers, while the prevalence of obesity was similar to those of SK children. The likelihood of remaining stunted was significantly associated with older age and shorter residency in SK (p < 0.05), but there was no significant association with food security situation at birth. CONCLUSION:Even a short exposure to food affluent environments improved the nutritional status among children, but linear growth deficits are slow to recover as overall nutritional status remains poor compared to peers without exposures to food insecurity.

BACKGROUND/OBJECTIVES: Food shortage situation in North Korea has gained much interest, however food insecurity caused by the food shortage in North Korean households has not been much investigated. This study examined food security experiences and food consumption pattern of displaced North Korean households currently living in South Korea.SUBJECTS/METHODS: Food security experience among 51 North Korean households living in South Korea was examined using the Household Food Insecurity Access Scale (HFIAS) in three time points: immediately before childbirth, immediately before leaving North Korea, and immediately before entering South Korea. Meal/snack consumption frequencies and food diversity were also examined.RESULTS: Food security situation was the worst at the time of immediately before leaving North Korea with the average HFIAS score of 10.05. The households that were food insecure, they tended to be "severely" insecure. Although majority of the subjects reported having three or more meals a day, food diversity in their diet was very low with the average food diversity score of 2.17 immediately before childbirth and 1.74 immediately before leaving North Korea. Their diet appeared to heavily rely on grain and vegetable.CONCLUSIONS: This study is one of few that specifically examined food security of North Korean households with a pre-developed scale, and that demonstrated food security situation at different time points in quantified terms. Replicating this study with different groups of North Korean households for different time points would allow more complete understanding of impacts of food shortage. Food diversity score could provide a good way to examine changes of food consumption occurring to North Koreans in the process of adaptation. More attention to the changes occurring during adaption to South Korea should be given to understand the process and impact and to prepare public nutrition policy for the re-unified Korea.

The increasing elderly population has created an urgent need for well-managed convalescent hospitals, which should provide appropriate clinical nutrition services. The new accreditation policy requiring participation of all convalescent hospitals since 2013 may promote improvement of clinical nutrition services. This study examined whether or not the accreditation policy has increased practice level and dietitians' perception of the importance of clinical nutrition management. Of the 177 convalescent hospitals accredited by January 30, 2014, dietitians from 73 hospitals (41.2%) completed the survey questionnaire. The pre-tested questionnaire surveyed general characteristics of the hospital and dietitians, current status of clinical nutrition management, and changes in the perception and practice levels of various aspects of food and clinical nutrition management. In average, dietitians with more than 5 years of work experience (68.1%) provided food and clinical nutrition services (71.2%). After accreditation, dietitians' perception of the importance and practice level of clinical nutrition service increased (P<0.001). Level of perception, however, was significantly (P<0.001) higher than practice level before and after accreditation. During perception and practice level of initial nutrition assessment, a compulsory accreditation item, notably and significantly (P<0.001) improved after accreditation. The significant difference between perception and practice level disappeared after accreditation. In conclusion, the accreditation process had positive effects on clinical nutrition management in terms of dietitians' perception and practice levels. Making more accreditation items compulsory and providing motivation and professional education to dietitians in convalescent hospitals could lead to additional improvements.

The aim of this study was to determine the effect of television food advertising on participant food intake and risk of obesity. A total of 2419 children aged 11-13 years were selected from 118 elementary schools in South Korea. All participants completed a self-administered questionnaire with questions about height, weight, television viewing times, food preferences, and food intakes. To estimate actual exposure to food advertising, we asked participants to specify the times at which they usually watched television. We then collected data on the various types of food advertisement broadcast on five different television networks during those viewing times over the course of the previous 7 months. The amount of television watched and exposure to energy-dense/nutrient-poor (EDNP) food advertising were associated with an increased risk of being overweight or obese. Exposure to television advertising for EDNP food was also significantly associated with higher EDNP food preference and intake and lower fruit and vegetable intake. However, these relationships disappeared for all foods after adjusting for the overall amount of television watched. Although it was not possible to conclude that exposure to television advertising for EDNP food was associated with an increased risk of obesity, preference for EDNP foods, or overall food intake due to the strong comprehensive effects of television viewing time, there was a reason to believe the evidence of the effects of advertising in this study. Future longitudinal studies are needed to determine the exclusive effects of exposure to television advertising for EDNP food. (C) 2014 Elsevier Ltd. All rights reserved.