The study purposes were to describe smart-phone application, Smart Buddy to improve glycemic control and quality of life of adolescents with type 1 diabetes (T1D) and to perform usability test. Considering low prevalence of T1D in Korea, the study participants included nursing students for adolescents’ mode (AM), graduate nursing students who had children for parents’ mode (PM) and graduate students at school of education for teachers’ mode (TM). Participants used it for 2 weeks and provided data on its mobile survey. The data of 84 participants were analyzed. The mean length of use (minutes) was 57.6 (±33.0) in AM, 15.9 (±12.0) in PM and 21.8 (±18.5) in TM. Their mean number of access was 52.0 (±29.0) in AM, 9.4 (±4.3) in PM, and 14.4 (±12.6) in TM. Users of AM reported that daily carbohydrate intake was 123.5±47.2 grams and length of daily exercise was 26.1±14.8 minutes on average. Smart Buddy was feasible and may help adolescents with T1D and their parents and teachers who have geographical and time barriers to access to multidisciplinary health team in hospitals.

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.

People living alone have been reported to eat differently from those living with others. Rapid increase in the number of people living alone has become a social issue in South Korea, yet few studies have examined the issue. This study aimed to examine whether and how living status was associated with dietary behaviors and nutritional risk among Korean adults. A cross-sectional study was conducted using the Korean National Health and Nutrition Examination Survey (KNHANES 2005∼2013) data. A total of 38,981 Korean adults aged above 18 was included in this study. The independent variable of this research was the living status (single-person households vs non-single-person households). The dependent variables were dietary behaviors and nutritional risks based on energy and nutrient intake. Complex sample analysis for KHANANES was conducted separately for three age groups (19-29 yr, 30-64 yr, and 65+) and sex. Single-person households had more frequently skipped meals and were less food secure than non-single-person households. People living alone in the 19-29 year-old group also seemed to eat out more frequently than those living with others. In the 30-64 year-old and the 65 + year-old women group, nutritional risk on inadequate intake of nutrition was higher in single-person households than non-single-person households. Results of this study indicated that single-person households were more likely to be at inadequate nutritional status, especially among the 30-64 and the 65 + year-old women group. The inadequacy of those living alone should be more studied and met through changes in food environments and supports.

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.

Obesity has been a great interest of public health. Studies simultaneously examining various factors associated with obesity among adolescents have been limited. Therefore, this study aimed to examine how various factors (socio-economic status, sex, age, diet, and physical activity) were simultaneously associated with obesity among Korean adolescents. This study analyzed two nationally representative datasets: 2008 Korea National Health and Nutrition Examination and Survey (KNHANES) and 2008 Korea Youth Risk Behavior Web-based Survey (KYRBWS). A total of 900 adolescents (12-18 year-old) in KNHANES and 74,451 adolescents in KYRBWS were included in statistical analyses with SPSS 19.0. Overweight (5.7%) and obesity (13.9%) rates were determined in KNHANES, and KYRBWS showed somewhat lower rates. No significant associations between the various factors and obesity were found in KNHANES. However, the analysis of KYRBWS confirmed higher obesity risk for boys, lower economic status, inferquent high-energy/low-nutrient type food consumption, practicing moderate-intensity physical activity less than five days per week, spending more than 2 hours sitting per day, and having tried exercise or diet for weight control (p ciations were mostly not significant in KNHANES. It seemed that obese adolescents tried to practice good dietary behaviors, but not necessarily physical activity, known to reduce obesity risk. Obesity policies should continue to help adolescents achieve an active lifestyle and healthy eating behaviors.

Increasing interests have been shown in associations between socioeconomic status (SES) and obesity in relation to health inequality. The research objectives were 1) to examine associations between SES and child obesity (including overweight) in Korea over 10 years and 2) to explore possible underlying mechanisms of relationships between SES and obesity. This study used the nationally representative data (KNHA-NES) from 1998, 2005, to 2009. Children (10-18 year-old) were grouped by household income (low, middle-low, middle-high and high) adjusted for the number of family members. Z-scores of height, weight, and BMI for each child were calculated from measured anthropometric data using the 2007 Korean national growth charts. No statistically significant associations were found, however, changes in association patterns were noted. The lower SES group showed shorter height as well as lighter weight among Korean children. More research should be conducted to understand the effects of socioeconomic status on child obesity.

이 연구는 제 1형 당뇨병 소아청소년의 영양지식, 식태도, 식행동에 대하여 알아보았다. 그리고 계획적 행동이론을 적용하여 당뇨관련 식행동에 영향을 미치는 요인을 파악하였다. 연구 대상자의 평균 연령은 14세, 당화혈색소 수준은 평균 9%, 당뇨병 유병기간은 5년이었다. 에너지섭취비율은 탄수화물 : 단백질 : 지방=62% : 16% : 23%로 나타났다.당뇨관련 영양지식은 전반적으로 낮은 것으로 나타났으며, 특히 식품교환표와 관련된 영양지식이 낮았다. 당뇨관련 식태도는 전반적으로 좋은 것으로 나타났지만, ‘식품의 영양성분표시를 이용하여 탄수화물계산을 하는 것’에 대한 식태도는 가장 낮았다. 당뇨관련 주관적 규범은 선생님(의사, 간호사, 영양사 등)의 영향이 가장 큰 것으로 나타났고, 외식과 같은 상황에서 인지된 행동통제력은 낮은 것으로 보였다. 혈당조절관련 식행동은 ‘하루에 식사를 규칙적인 시간에 먹는것’을 제외하고는 전반적으로 낮은 경향을 나타내었다. 계획적 행동이론 요인은 실천의도에 유의미한 영향력을 미치지 않았으며, 혈당조절관련 식행동에 영향을 미치는 요인은 인지된 행동통제력으로 나타났다. 이 연구 결과, 제 1형 당뇨병 소아청소년의 당뇨관련 식행동을 변화시키기 위해서는 다양한 상황에서 당뇨식을 실천할 수 있는 실질적인 방법 제시와 훈련의 기회를 포함한 다양한 맞춤형 영양교육이 필요할 것으로 사료된다. 이 연구는 늘어나는 제 1형 당뇨 소아청소년의 건강과 나아가 삶의 질을 높이는데 필요한 기초자료를 제공하며, 보다 명확하고 다양한 자료를 얻기 위해서는 큰 규모의 코호트 연구가 필요할 것이다.

Type 1 diabetes among children is increasing worldwide. Healthy diabetic diets are important to ensure growth and development, while postponing complications from the disease. This study aimed to understand dietary behaviors of children (7–20 year old) with type 1 diabetes using theory of planned behavior. A pre‐tested questionnaire was used to obtain information from 32 children followed by the department of Pediatrics, Inha University Hospital. The scores for attitude toward behavior, subjective norm, perceived behavioral control, and behavioral intention were 26.2+2.9, 24.1+3.4, 15.8+2.6, and 4.0+0.6, respectively. Multiple regression analyses showed that attitude toward behavior and subjective norm were positively related to behavioral intention, but perceived behavioral control were negatively related to behavioral intention. Only attitude toward behavior was statistically associated with behavioral intention (p<0.05). Behavioral intention was significantly associated with behavior (p<0.05). The findings of this study indicated how powerful the attitude variable is to behavioral intention and behavior, given that the small sample of 32 children provided sufficient statistical power. This study showed that nutrition education with children with type 1 diabetes should emphasize cultivating good attitude toward behavior.

High‐energy/low‐nutrient (HELN) food advertizing targeting children has been identified as a contributing factor to child obesity. Korea has enacted a national policy banning TV advertisement of HELN foods from 5pm to 7pm in 2010, aiming to control child obesity. This study examined how the HELN food consumption and obesity have been affected by the policy, using the Korea National Health and Nutrition Examination Survey from 2008 to 2010. The 24‐hr recall data of children (2–18 year old) were grouped into two: 1) children who consumed at least one HELN food on the day of recall and 2) children who did not consume any HELN foods. Before the national policy was enacted, 18% of children reported having a minimum of one HELN food, while 21% reported in 2010 after the policy enacted. The number of HELN foods consumed also appeared to increase after the policy. Interestingly, the proportion of HELN foods against total food consumed decreased from 19.06% to 16.65%, and the decrease was more significant among obese children. No significant changes were observed in child obesity status. This finding would be useful to designing advertising‐related food policies. This research was supported by a grant (12162‐KFDA‐110) from Korea Food and Drug Administration.

Many displaced North Koreans (NK) are living in South Korea (SK); however nutrition research with the displaced NK is limited. This study examined food and nutrient consumption status of displaced NK children (6-18 year-old) currently living in SK. A total of 154 children were recruited, and a pre-t...

Consumption of foods with high energy and low nutrient values has been linked to various health issues including obesity and chronic diseases. This study investigated the high-energy/low-nutrient food consumption status and its relationship with obesity status and intake of energy and nutrients, using the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korea Youth Risk Behavior Web-based Survey (KYRBWS). The prevalence of overweight and obesity among 2-18 year-olds was 8.4% and 10.8% in 2008 and 8.5% and 9.0% in 2009, respectively, in KNHANES. The prevalence of obesity among 12-18 year-olds was 13.9% in 2008 and 11.4% in 2009 in KNHANES, while it was 8.1% in 2008 and 8.2% in 2009 in KYRBWS. Consumption patterns of high-energy/low-nutrient foods were diverse depending on the particular food type. High-energy/low-nutrient foods such as cookies were most often consumed more frequently (2~3 times per week), but fast food type foods were generally consumed less frequently (once per week or less). No significant relationships between highenergy/low-nutrient food consumption and level of energy and nutrient intakes were found in either datasets. Adolescents who were not obese more frequently consumed ramen (p < 0.001), cookies (p < 0.001) and fast food (p < 0.001) than those who were obese in KYRBWS, however, such relationships were not found in KNHANES. This direction of the relationship could be probably attributed to the cross-sectional nature of the datasets. This study was limited by the cross-sectional nature of the data, therefore, further longitudinal research using various study techniques would be necessary to understand the effects of high-energy/low-nutrient foods on child obesity. (Korean J Community Nutr 17(2) : 226~242, 2012)

Adequate nutrition and food situation during the pregnancy are important for healthy pregnancy outcomes such as birth weight. The aim of this study was to assess effects of maternal nutritional status (height, pre‐pregnancy weight, pre‐pregnancy BMI, and self‐reported body type) and food situation on birth weight of children born to North Korean parents, and currently living in South Korea. After IRB approval, North Korean children (6–18yr) were recruited through schools and local centers. A pre‐tested questionnaire was used to collect birth weight, nutritional status of mother, and food situation (Household Food Insecurity Access Scale Score) at birth, supplemented by an interview.. Birth weight was positively associated with being male (â=0.435, p‐value=0.001), higher maternal height (â=0.033, p‐value=0.026), secure food situation (â=0.273, p‐value=0.043) and with smaller maternal body type (â=−1.154, p‐value=0.016). Maternal weight and BMI had no statistically significant associations with birth weight, while maternal height was most significant. Maternal chronic nutritional status was more important on birth weight than food situation at birth in our sample. This work was supported by National Research Foundation of Korea Grant.

Child obesity is an important public health problem because of the rising prevalence and of its association with chronic diseases. One of obesity prevention strategies is to discourage intake of foods contributing to obesity. South Korea developed a list of “high energy/low nutrient” foods; foods on this list cannot air commercials on TV during specified hours of a day. This study examined how often “high energy/low nutrient” foods were consumed among children and how much of energy and nutrient the foods contribute to daily consumption, using 2008 Korean National Health and Nutrition Examination. Food frequency questionnaire showed that adolescents (12–18 year) consumed instant noodles, breads, cookies, ice cream, and carbonated beverages approximately once a week, while they consumed hamburgers, pizza, and fried foods less often. Analyses of 1‐day 24‐hr recall data indicated that children (2–18 year) consumed, on average, 5.9% of total volume, 10.9% of energy, 4.6% of protein, 9.2% of fat, 13.1% of carbohydrate, and 9.7% of sodium from the “high energy/low nutrient” foods. This research was supported by a grant (08082KFDA 999‐205) from Korea Food & Drug Administration in 2010.

Fast food is popular among children and adolescents; however, its consumption has often been associated with negative impacts on nutrition and health. This study examined current fast food consumption status among middle school students and explored factors influencing fast food consumption by applying Theory of Planned Behavior. A total of 354 (52.5% boys) students were recruited from a middle school. The subjects completed a pre-tested questionnaire. The average monthly frequency of fast food consumption was 4.05 (4.25 for boys, 3.83 for girls). As expected, fast food consumption was considered to be a special event rather than part of an everyday diet, closely associated with meeting friends or celebrating, most likely with friends, special days. The Theory of Planned Behavior effectively explained fast food consumption behaviors with relatively high R-2 around 0.6. Multiple regression analyses showed that fast food consumption behavior was significantly related to behavioral intention (b = 0.61, P < 0.001) and perceived behavioral control (b = 0.19, P < 0.001). Further analysis showed that behavioral intention was significantly related to subjective norm (b = 0.15, P < 0.01) and perceived behavioral control (b = 0.56, P < 0.001). Attitude toward fast food consumption was not significantly associated with behavioral intention. Therefore, effective nutrition education programs on fast food consumption should include components to change the subjective norms of fast food consumption, especially among peers, and perceived behavioral control. Further studies should examine effective ways of changing subjective norms and possible alternatives to fast food consumption for students to alter perceived behavioral control.

Nutritional stress in early stage can have lasting impact on development and health. This study examined nutritional status of children born to North Korean parents, and currently living in South Korea. After IRB approval, a convenient sample of children (6 – 15 yr) was recruited. Children's height, weight, and percent body fat (InBody 720, Biospace) were obtained. Food situation at birth was assessed using Household Food Insecurity Access Scale Score with their parents through a questionnaire and an interview. Height and weight at the time of entry to South Korea were obtained from the health examination record. Children were born between 1994 and 2003 when famine was severe in North Korea. About half were born in North Korea; the other in China. More children born in North Korea (44.4%) were “food insecure” than those born in China (9.7%, ÷2=9.91, p<0.01). While 35% were stunted at entry, 8.5% were currently stunted after on average 2.2 years of stay. Only two percent of children born in “food secure” households were currently stunted, but 19.1% of children born in “food insecure” households were (÷2=4.46, p<0.05). Stunted children at entry tended to jump more weight percentiles, but not statistically significant. Nutritional status of the children improved, but overweight proportion was also increased. This work was supported by National Research Foundation of Korea Grant funded by the Korean Government (C00310).