Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Health and nutrition intake status of the Korean elderly according to their food security level: data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII), 2016-2018

식품안정성 수준에 따른 한국노인의 건강상태와 영양섭취현황: 제7기 (2016-2018) 국민건강영양조사 자료 활용

  • Maeng, Ahreum (Department of Food Science and Nutrition, Pusan National University) ;
  • Lee, Jeehyun (Department of Food Science and Nutrition, Pusan National University) ;
  • Yoon, Eunju (Department of Food Science and Nutrition, Dong-A University)
  • Received : 2020.12.18
  • Accepted : 2021.02.18
  • Published : 2021.04.30
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Abstract

Purpose: This study examined general characteristics, health status, accessibility to medical services, health-related quality of life, dietary behavior, and energy and nutrient intakes of the elderly at different levels of food security utilizing data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018). Methods: The elderly subjects (1,721 males and 2,271 females) were divided into 3 groups (secure, mildly insecure, moderately/severely insecure) according to their food security levels. Health and nutrient status was determined using energy intake, nutrient density, the prevalence of insufficient nutrient intake, dietary behavior, and health status. Results: The elderly with food insecurities had a lower self-evaluated health status and a higher prevalence of physician-diagnosed chronic diseases such as arthritis, osteoarthritis, rheumatoid arthritis, osteoporosis for males, and hypertension, stroke, arthritis, and osteoarthritis for females. The associated financial burden was the major reason for not accessing medical services in the food insecure group. Furthermore, the food insecure group had a higher risk of impaired health-related quality of life compared to the secure group. The proportion of subjects with an energy intake below the estimated energy requirement was higher in the food insecure group and a significantly higher prevalence of insufficient intake was observed for all the nutrients (proteins, vitamin A, vitamin B1, vitamin B2, niacin, vitamin C, calcium, and iron) assessed in this study compared to the food secure group. Conclusion: This study suggests that food insecurity poses a challenge to the health and nutritional status of the elderly population in Korea and needs proper management. It would be helpful to develop food and nutrition assistance programs to ensure the food stability of the elderly population and assure quality to address gaps in their nutrient intake.

본 연구는 제7기 (2016-2018년) 국민건강영양조사 자료를 활용하여 노인의 식품안정성에 따른 건강과 영양섭취 현황을 분석하고자 하였다. 식품불안정 그룹일수록 직장건강보험 가입자 비율이 유의적으로 낮았으며, 자신의 건강상태에 대한 주관적 평가 점수가 낮았다. 질환과의 상관관계에서 식품불안정 그룹일수록 남자는 류마티스성 관절염, 골다공증에서 여자는 고혈압과 뇌졸중 진단 비율이 높았으며, 관절염과 골관절염은 남녀 노인 모두에서 질환보유 비율이 유의적으로 높게 나타났다. 의료이용실태에서는 식품안정성이 낮을수록 필요한 의료를 받지 못한 것으로 나타났고, 의료서비스를 이용하지 못한 이유를 분석해본 결과, 경제적인 이유라고 답한 비율이 식품안정성이 낮은 그룹에서 높았다. 또한 남녀 노인 모두 유의하게 나타나는 변수를 보정한 후, 건강관련 삶의 질 저하에 대해 식품안정성에 따라 분석한 결과, 성별에 따라 세부 항목에 차이는 나타났지만 전반적으로 식품불안정 그룹일수록 안정한 그룹에 비해 더욱 삶의 질이 저하되는 위험이 컸다. 한 번에 마시는 음주량이 7잔 이상인 비율이 식품안정성이 낮을수록 남녀 노인 모두 유의적으로 높았으며, 특히, 남자 노인에서는 식품안정성이 낮을수록 가족이나 의사로부터 금주를 권유 받거나, 조사 시점 직전 1년 동안 음주 상담을 받은 경험이 유의적으로 더 높았다. 에너지 필요추정량 (EER)보다 낮게 섭취하는 비율이 남녀 노인 모두 식품불안정 그룹에서 유의적으로 높았으며, 단백질, 비타민 A, 비타민 B1, 비타민 B2, 나이아신, 비타민 C, 칼슘, 철분을 낮게 섭취하는 비율 또한 이 그룹에서 유의적으로 높았다. 식품안정성에 따른 영양소의 에너지 섭취비율 및 주요 영양소의 밀도를 분석한 결과, 남녀 모두 단백질, 지방에서의 에너지섭취 비율과 비타민 B2, 나이아신, 칼슘, 칼륨, 인의 영양밀도가 식품불안정 그룹에서 유의하게 낮게 나타났으며, 식품불안정군 남자노인은 비타민 A, 여자 노인은 철분의 영양밀도가 유의하게 낮은 것으로 나타났다. 결론적으로 식품안정성은 사회경제적인 특성, 건강 상태, 삶의 질, 영양과 밀접하게 서로 연계되어 있는 것으로, 고령화 사회에서 취약 계층인 노인의 식품안정성 영향 요인을 확인하여 식품안정성을 확보하는 것과 함께 이들의 식품안정성과 관련한 건강 문제를 개선함으로써 추후 막대한 사회적 비용이 될 노인 의료비를 줄일 수 있는 영양지원 프로그램을 개발하기 위한 방향성을 설정하는데 있어 본 연구가 도움이 될 것으로 사료된다.

Keywords

References

  1. Anderson SA. Core indicators of nutritional state for difficult-to-sample populations. J Nutr 1990; 120 Suppl 11: 1555-1600.
  2. Food and Agriculture Organization of the United Nations. The State of Food Insecurity in the World 2012. Rome: Food and Agriculture Organization; 2012.
  3. Leroy JL, Ruel M, Frongillo EA, Harris J, Ballard TJ. Measuring the food access dimension of food security: a critical review and mapping of indicators. Food Nutr Bull 2015; 36(2): 167-195.
  4. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood) 2015; 34(11): 1830-1839. https://doi.org/10.1377/hlthaff.2015.0645
  5. Choi SK, Fram MS, Frongillo EA. Very low food security in US households is predicted by complex patterns of health, economics, and service participation. J Nutr 2017; 147(10): 1992-2000. https://doi.org/10.3945/jn.117.253179
  6. Lee JS, Frongillo EA Jr. Factors associated with food insecurity among U.S. elderly persons: importance of functional impairments. J Gerontol B Psychol Sci Soc Sci 2001; 56(2): S94-S99.
  7. Alaimo K, Olson CM, Frongillo EA. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr 2002; 132(4): 719-725.
  8. Loopstra R. Interventions to address household food insecurity in high-income countries. Proc Nutr Soc 2018; 77(3): 270-281. https://doi.org/10.1017/s002966511800006x
  9. Pollard CM, Booth S. Food insecurity and hunger in rich countries; it is time for action against inequality. Int J Environ Res Public Health 2019; 16(10): 1804. https://doi.org/10.3390/ijerph16101804
  10. Davis O, Geiger BB. Did food insecurity rise across Europe after the 2008 crisis? An analysis across welfare regimes. Soc Policy Soc 2017; 16(3): 343-360. https://doi.org/10.1017/S1474746416000166
  11. Korean Statistical Information Service. Population Projections for Korea (2017-2067) [Internet]. Daejeon: Korean Statistical Information Service; 2019 [cited 2020 Sep 5]. Available from: https://kosis.kr/.
  12. Amarya S, Singh K, Sabharwal M. Changes during aging and their association with malnutrition. J Clin Gerontol Geriatr 2015; 6(3): 78-84. https://doi.org/10.1016/j.jcgg.2015.05.003
  13. Vassilakou T, Triantafillou G, Evrenoglou L. Early identification of malnutrition risk among free-living elderly persons in Athens, Greece. J Aging Res Clin Pract 2017; 6: 193-199.
  14. Gkiouras K, Cheristanidis S, Papailia TD, Grammatikopoulou MG, Karamitsios N, Goulis DG, et al. Malnutrition and food insecurity might pose a double burden for older adults. Nutrients 2020; 12(8): 2407. https://doi.org/10.3390/nu12082407
  15. Chung WK. Medical expenditure at end-of-life. Korean J Health Econ Policy 2012; 18(4): 149-168.
  16. Son KB, Shin JW, Lim EO, Lee TJ, Kim HS. Population aging and health care expenditure in South Korea: a critical review. Korean J Health Econ Policy 2015; 21(1): 51-77.
  17. Choi MK, Kang MH, Kim MH. Diet and health status of elderly women according to the family type. Korean J Community Nutr 2016; 21(3): 256-264. https://doi.org/10.5720/kjcn.2016.21.3.256
  18. Bird CL, McClelland JW. Educating limited resource older adults for better choices to lower risk of food insecurity. Int J Consum Stud 2017; 41(2): 225-233. https://doi.org/10.1111/ijcs.12333
  19. Murthy VH. Food insecurity: a public health issue. Public Health Rep 2016; 131(5): 655-657. https://doi.org/10.1177/0033354916664154
  20. Shim JS, Oh K, Nam CM. Association of household food security with dietary intake: Based on the third (2005) Korea National Health and Nutrition Examination Survey (KNHANES III). Korean J Nutr 2008; 41(2): 174-183.
  21. Kim K, Hong SA, Kim MK. Nutritional status and food insufficiency of Korean population through the life-course by education level based on 2005 National Health and Nutrition Survey. Korean J Nutr 2008; 41(7): 667-681.
  22. Kim K, Hong SA, Kwon SO, Oh SY. Development of food security measures for Korean National Health and Nutrition Examination Survey. Korean J Nutr 2011; 44(6): 551-561.
  23. Bae A, Yoon J, Yun SY, Asano K. Dietary and health characteristics of the young-old and the old-old by food security status: analysis of data from the 6th (2013-2015) Korea National Health and Nutrition Examination Survey. J Nutr Health 2019; 52(1): 104-117. https://doi.org/10.4163/jnh.2019.52.1.104
  24. Yang YJ. Socio-demographic characteristics, nutrient intakes and mental health status of older Korean adults depending on household food security: based on the 2008-2010 Korea National Health and Nutrition Examination Survey. Korean J Community Nutr 2015; 20(1): 30-40. https://doi.org/10.5720/kjcn.2015.20.1.30
  25. Park GA, Kim SH, Kim SJ, Yang YJ. Health and nutritional status of Korean adults according to age and household food security: using the data from 2010~2012 Korea National Health and Nutrition Examination Survey. J Nutr Health 2017; 50(6): 603-614. https://doi.org/10.4163/jnh.2017.50.6.603
  26. Korea Disease Control and Prevention Agency. Guideline for Raw Data Use of the Seventh Korea National Health and Nutrition Examination Survey (KNAHNES VII), 2016-2018 [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2020 [cited 2020 Sep 5]. Available from: https://knhanes.cdc.go.kr/knhanes/sub03/sub03_06_02.do.
  27. Kim MH, Cho YS, Uhm WS, Kim S, Bae SC. Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res 2005; 14(5): 1401-1406. https://doi.org/10.1007/s11136-004-5681-z
  28. Nam HS, Kim KY, Kwon SS. Research Report for Quality Estimated Weight for Quality of Life Survey Tool (EQ-5D). Cheongju: Korea Centers for Disease Control and Prevention; 2007.
  29. Kim H, Kim YJ, Lim Y, Kwon O. Association of coffee consumption with health-related quality of life and metabolic syndrome in Korean adults: based on 2013-2016 Korea National Health and Nutrition Examination Survey. J Nutr Health 2018; 51(6): 538-555. https://doi.org/10.4163/jnh.2018.51.6.538
  30. Ministry of Health and Welfare (KR); The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2015. Sejong: Ministry of Health and Welfare; 2015.
  31. Korea Ministry of Government Legislation. National Basic Living Security Act [Internet]. Sejong: Korea Ministry of Government Legislation; 2020 [cited 2020 Sep 10]. Available from: https://www.law.go.kr.
  32. Ministry of Health and Welfare (KR). Medicaid [Internet]. Sejong: Ministry of Health and Welfare; 2020 [cited 2020 Sep 5]. Available from: http://www.bokjiro.go.kr.
  33. Coates J, Frongillo EA, Rogers BL, Webb P, Wilde PE, Houser R. Commonalities in the experience of household food insecurity across cultures: what are measures missing? J Nutr 2006; 136(5): 1438S-1448S. https://doi.org/10.1093/jn/136.5.1438S
  34. Jones AD. Food insecurity and mental health status: a global analysis of 149 countries. Am J Prev Med 2017; 53(2): 264-273. https://doi.org/10.1016/j.amepre.2017.04.008
  35. Depa J, Gyngell F, Muller A, Eleraky L, Hilzendegen C, Stroebele-Benschop N. Prevalence of food insecurity among food bank users in Germany and its association with population characteristics. Prev Med Rep 2018; 9: 96-101.
  36. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr 2010; 140(2): 304-310. https://doi.org/10.3945/jn.109.112573
  37. Pal S, Palacios R. Understanding poverty among the elderly in India: implications for social pension policy. J Dev Stud 2011; 47(7): 1017-1037. https://doi.org/10.1080/00220388.2010.509783
  38. Lee HS. The factors influencing health-related quality of life in the elderly: focused on the general characteristics, health habits, mental health, chronic diseases, and nutrient intake status: data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES V), 2010~2012. Korean J Community Nutr 2014; 19(5): 479-489. https://doi.org/10.5720/kjcn.2014.19.5.479
  39. Bae YJ. Relationship among practicing healthy diet and metabolic syndrome indicators in adults: from the Korea National Health and Nutrition Examination Survey, 2013~2014. J Nutr Health 2016; 49(6): 459-470. https://doi.org/10.4163/jnh.2016.49.6.459
  40. Niles MT, Bertmann F, Belarmino EH, Wentworth T, Biehl E, Neff R. The early food insecurity impacts of COVID-19. Nutrients 2020; 12(7): 2096. https://doi.org/10.3390/nu12072096
  41. Choe JS, Ji SM, Park YH. The associations of household food insecurity with socioeconomic status, food behaviors, health status and nutrient intake in the elderly in rural areas. Korean J Community Living Sci 2009; 20(1): 19-32.
  42. Frongillo EA, Nguyen HT, Smith MD, Coleman-Jensen A. Food insecurity is more strongly associated with poor subjective well-being in more-developed countries than in less-developed countries. J Nutr 2019; 149(2): 330-335. https://doi.org/10.1093/jn/nxy261
  43. Muirhead V, Quinonez C, Figueiredo R, Locker D. Oral health disparities and food insecurity in working poor Canadians. Community Dent Oral Epidemiol 2009; 37(4): 294-304. https://doi.org/10.1111/j.1600-0528.2009.00479.x
  44. Lee MH, Park JW, Kwon YJ. Household food insecurity and dental caries in Korean adults. Community Dent Oral Epidemiol 2020; 48(5): 371-378. https://doi.org/10.1111/cdoe.12541
  45. Kim DH, Choi MH, Lee HJ, Min HH, Kim YS. Oral health status depending on the type of national health insurance: the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII). J Korean Acad Oral Health 2020; 44(3): 151-157.
  46. Bloom DE, Canning D, Fink G. Implications of population ageing for economic growth. Oxf Rev Econ Policy 2010; 26(4): 583-612. https://doi.org/10.1093/oxrep/grq038