J Nutr Health. 2015 Oct;48(5):419-428. Korean.
Published online Oct 30, 2015.
© 2015 The Korean Nutrition Society
Original Article

Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data

Sung-Min Yook,1,** Sohee Park,2,** Hyun-Kyung Moon,3 Kirang Kim,3 Jae Eun Shim,4 and Ji-Yun Hwang5
    • 1Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.
    • 2Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea.
    • 3Department of Food Science and Nutrition, Dankook University, Chungnam 31116, Korea.
    • 4Department of Food and Nutrition, Daejeon University, Daejeon 34520, Korea.
    • 5Nutrition Education Major, Graduate School of Education, Sangmyung University, Seoul 03016, Korea.
Received September 04, 2015; Revised September 26, 2015; Accepted October 08, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The current study was conducted in order to develop the Korean Healthy Eating Index (KHEI) for assessing adherence to national dietary guidelines and comprehensive diet quality of healthy Korean adults using the 5th Korea National Health and Nutrition Examination Survey (KNHANES) data.

Methods

The candidate components of KHEI were selected based on literature reviews, dietary guidelines for Korean adults, 2010 Dietary Reference Intakes for Koreans (2010 KDRI), and objectives of HP 2020. The associations between candidate components and risk of obesity, abdominal obesity, and metabolic syndrome were assessed using the 5th KNHANES data. The expert review process was also performed.

Results

Diets that meet the food group recommendations per each energy level receive maximum scores for the 9 adequacy components of the index. Scores for amounts between zero and the standard are prorated linearly. For the three moderation components among the total of five, population probability densities were examined when setting the standards for minimum and maximum scores. Maximum scores for the total of 14 components are 100 points and each component has maximum scores of 5 (fruit intakes excluding juice, fruit intake including juice, vegetable intakes excluding Kimchi and pickles, vegetable intake including Kimchi or pickles, ratio of white meat to read meat, whole grains intake, refined grains intake, and percentages of energy intake from carbohydrate) or 10 points (protein foods intake, milk and dairy food intake, having breakfast, sodium intake, percentages of energy intake from empty calorie foods, and percentages of energy intake from fat). The KHEI is a measure of diet quality as specified by the key diet recommendations of the dietary guidelines and 2010 KDRIs.

Conclusion

The KHEI will be used as a tool for monitoring diet quality of the Korean population and subpopulations, evaluation of nutrition interventions and research.

Keywords
Korean Healthy Eating Index; development; diet quality; KNHANES

Figures

Fig. 1
Overall flow of development process of Korean Healthy Eating Index (KHEI)

Fig. 2
Example of scoring standard : percentages of energy from fat

Fig. 3
The flow of selection process among candidates

Tables

Table 1
Components and scoring standards for Korean Healthy Eating Index

Table 2
Score distribution of Korean Healthy Eating Index using the Korea National Health and Nutrition Examination Survey V (2010-2012)

Notes

This work was supported by Research Program funded by the Korea Centers for Disease Control and Prevention (2014-E35006-00).

References

    1. Kang M, Joung H, Lim JH, Lee YS, Song YJ. Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr 2001;44(2):152–161.
    1. Lim S, Lee EJ, Koo BK, Cho SI, Park KS, Jang HC, Kim SY, Lee HK. Increasing trends of metabolic syndrome in Korea -based on Korean National Health and Nutrition Examination Surveys-. J Korean Diabetes Assoc 2005;29(5):432–439.
    1. Ahn BC, Hong EJ, Joung HJ. Regional convergence in the prevalence of metabolic syndrome in Korea. Korean Public Health Res 2013;39(1):1–11.
    1. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994;94(1):57–64.
    1. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Am Diet Assoc 1995;95(10):1103–1108.
    1. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D. Diet and overall survival in elderly people. BMJ 1995;311(7018):1457–1460.
    1. Huijbregts P, Feskens E, Räsänen L, Fidanza F, Nissinen A, Menotti A, Kromhout D. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study. BMJ 1997;315(7099):13–17.
    1. Bailey RL, Miller PE, Mitchell DC, Hartman TJ, Lawrence FR, Sempos CT, Smiciklas-Wright H. Dietary screening tool identifies nutritional risk in older adults. Am J Clin Nutr 2009;90(1):177–183.
    1. Haines PS, Siega-Riz AM, Popkin BM. The diet quality index revised: a measurement instrument for populations. J Am Diet Assoc 1999;99(6):697–704.
    1. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The diet quality index-international (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 2003;133(11):3476–3484.
    1. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP. In: Development and evaluation of the healthy eating index-2005. Technical report. Alexandria (VA): U.S. Department of Agriculture, Center for Nutrition Policy and Promotion; 2007.
    1. Guenther PM, Reedy J, Krebs-Smith SM. Development of the healthy eating index-2005. J Am Diet Assoc 2008;108(11):1896–1901.
    1. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB. Evaluation of the healthy eating index-2005. J Am Diet Assoc 2008;108(11):1854–1864.
    1. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the healthy eating index: HEI-2010. J Acad Nutr Diet 2013;113(4):569–580.
    1. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 2002;76(6):1261–1271.
    1. Woodruff SJ, Hanning RM. Development and implications of a revised Canadian healthy eating index (HEIC-2009). Public Health Nutr 2010;13(6):820–825.
    1. Park YS, Han JL, Lee JW, Cho HS, Koo J, Kim JH, Yoon JS. The development of a simple evaluation questionnaire for screening the overweight-type dietary pattern in 30 to 49 year old adults. Korean J Community Nutr 2002;7(4):495–505.
    1. Kim WY, Cho MS, Lee HS. Development and validation of mini dietary assessment index for Koreans. Korean J Nutr 2003;36(1):83–92.
    1. Shim JE, Paik HY, Lee SY, Moon HK, Kim YO. Comparative analysis and evaluation of dietary intake of Koreans by age groups: (4) the Korean diet quality index. Korean J Nutr 2002;35(5):558–570.
    1. Korea Health Industry Development Institute. Diet-related health risk appraisal (D-HRA) [Internet]. Cheongju: Korea Healthy Industry Development Institute; 2013 Mar 29; [cited 2014 May 1].
    1. Lee JW, Kim KE, Kim KN, Hyun TS, Hyun WJ, Park YS. Evaluation of the validity of a simple screening test developed for identifying Korean elderly at risk of undernutrition. Korean J Nutr 2000;33(8):864–872.
    1. Moon HK, Kong JE. Reliability of nutritional screening using DETERMINE checklist for elderly in Korean rural areas by season. Korean J Community Nutr 2009;14(3):340–353.
    1. Lee HO, Lee JS, Shin JW, Lee GJ. Nutrition assessment of older subjects in a health care center by MNA (mini nutritional assessment). J Korean Diet Assoc 2010;16(2):122–132.
    1. Ministry of Health and Welfare (KR). Dietary guidelines for Korean adults [Internet]. Seoul: Ministry of Health and Welfare; 2009 Dec 8; [cited 2014 Mar 27].
    1. Ministry of Health and Welfare (KR). Health plan 2020 [Internet]. Seoul: Ministry of Health and Welfare; 2011 Jul 22; [cited 2014 Apr 17].
    1. The Korean Nutrition Society. Dietary reference intake for Koreans. 1st revision. Seoul: The Korean Nutrition Society; 2010.
    1. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey: primitive data download [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2013 Dec 15; [cited 2015 May 1].

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