[The concept and measurement of food security]

Effects of Perceived Food Store Environment on Malnutrition and Frailty among the Food-Insecure Elderly in a Metropolitan City

This study aimed to identify food environment factors in the local community that could affect the levels of nutritional status and frailty in 372 older adults (at least 65 years old) experiencing food insecurity and enrolled in the integrated Community Health Promotion Program (CHPP) in two districts of Seoul. The local food environment was assessed using perceived food store accessibility questionnaires. In order to quantify nutrient intake, the 24-h recall method was applied. Malnutrition was measured using the Mini Nutritional Assessment tool, while frailty was assessed using the Frailty Measurement Questionnaire developed for the CHPP. Malnourished or frail elderly adults commonly had a lower intake of cereals and potatoes, meats, and vegetables than those who were not, and their resulting intake levels of energy, protein, iron, and vitamin groups were also significantly lower (all p-values < 0.05). Among the local community food store environment factors, the sufficiency of food stores (odds ratio (OR) = 1.988, 95% confidence interval (CI] = 1.211-3.262), freshness of foods (OR = 1.767, 95% CI = 1.075-2.886), and variety in foods (OR = 1.961, 95% CI = 1.197-3.212) were significant factors affecting the risk of malnutrition. For frailty, the freshness of foods (OR = 1.997, 95% CI = 1.053-3.788), variety in foods (OR = 2.440, 95% CI = 1.277-4.661), and small purchase of foods (OR = 2.645, 95% CI = 1.362-5.139) were significant environmental factors. In conclusion, we found that the perceived food store environment in the local community can influence the occurrence of malnutrition and frailty in vulnerable, urban older adults.

Food deserts in Korea? A GIS analysis of food consumption patterns at sub-district level in Seoul using the KNHANES 2008-2012 data

BACKGROUND/OBJECTIVES

The concept of "food deserts" has been widely used in Western countries as a framework to identify areas with constrained access to fresh and nutritious foods, providing guidelines for targeted nutrition and public health programs. Unlike the vast amount of literature on food deserts in a Western context, only a few studies have addressed the concept in an East Asian context, and none of them have investigated spatial patterns of unhealthy food consumption from a South Korean perspective.

SUBJECTS/METHODS

We first evaluated the applicability of food deserts in a Korean setting and identified four Korean-specific unhealthy food consumption indicators, including insufficient food consumption due to financial difficulty, limited consumption of fruits and vegetables, excessive consumption of junk food, and excessive consumption of instant noodles. The KNHANES 2008-2012 data in Seoul were analyzed with stratified sampling weights to understand the trends and basic characteristics of these eating patterns in each category. GIS analyses were then conducted for the data spatially aggregated at the sub-district level in order to create maps identifying areas of concern regarding each of these indicators and their combinations.

RESULTS

Despite significant reduction in the rate of food insufficiency due to financial difficulty, the rates of excessive consumption of unhealthy foods (junk food and instant noodles) as well as limited consumption of fruits and vegetables have increased or remained high. These patterns tend to be found among relatively younger and more educated groups, regardless of income status.

CONCLUSIONS

A GIS-based analysis demonstrated several hotspots as potential "food deserts" tailored to the Korean context based on the observed spatial patterns of undesirable food consumption. These findings could be used as a guide to prioritize areas for targeted intervention programs to facilitate healthy food consumption behaviors and thus improve nutrition and food-related health outcomes.

Nutritional status of toddlers and preschoolers according to household income level: overweight tendency and micronutrient deficiencies

BACKGROUNDS/OBJECTIVES

The effects of malnutrition on growth of toddlers and preschoolers by socioeconomic status are not well known. This study aimed to examine the effects of dietary intake on growth outcomes in toddlers and preschoolers by household income level.

SUBJECTS/METHODS

The study population was a total of 1,687 children aged 1 to 5 years that participated in the KNHANES from 2009 to 2011. Growth of children was assessed by height for age (HFA) and weight for height (WFH). Children were classified into three groups according to children's HFA and WFH compared to the 10^th and 90^th percentiles of the 2007 Korean Children and Adolescent Growth Standard. Average monthly household income was divided into quartile groups. Dietary intake data were obtained by using the one day 24-hr recall method. Risks of inadequate intake of nutrients and unfavorable growth were estimated by using a multiple logistic regression model adjusted for sex, age, region, and energy intake.

RESULTS

The low HFA group (< 10^th percentile) had significantly lower intakes of energy, carbohydrate, and thiamin as compared with the high group (≥ 90^th percentile). For WFH status, vitamin C intake was lower in the low group than in the high group. Household income level was related to WFH status but not HFA. Children from lower income households were more likely to have high WFH than those from higher income households (P for trend = 0.038). Household income status was also significantly related with risk of inadequate intake of micronutrients such as thiamin (P for trend = 0.032) and vitamin C (P for trend = 0.002), showing higher odds of inadequate intakes in children from lower income households.

CONCLUSIONS

Children from lower income households were prone to be overweight and to have inadequate intakes of micronutrients such as thiamin and vitamin C. To reduce nutritional and health disparities, collective action in the public sector is required from early life.

Factors contributing to participation in food assistance programs in the elderly population

BACKGROUND/OBJECTIVES

The study objectives were to examine the participation rate in food assistance programs and explore the factors that contribute to such participation among the Korean elderly population.

SUBJECTS/METHODS

The study sample comprised 3,932 respondents aged 65 years or older who were selected from a secondary data set, the fourth Korean Welfare Panel Study (KoWePS). The factors, related to participation in programs were examined based on the predisposing, enabling and need factors of the help-seeking behavior model. Multiple logistic regression analysis was used to select the best contributors among the factors related to program participation.

RESULTS

The predisposing rate in food assistance programs was 8.5% (7.1% for men and 10.4% for women). When all variables were included in the model, living without spouse, no formal education, low income, having social security benefits and food insecurity in elderly men, and age, low income, having social security benefits and feeling poor in elderly women were significantly related to a higher tendency to program participation.

CONCLUSIONS

The predisposing and need factors, such as living without spouse, low education level, food insecurity and feeling poor were important for program participation, as well as enabling factors, such as household income and social security benefits. A comprehensive approach considering these factors to identify the target population for food assistance programs is needed to increase the effectiveness and target population penetration of these programs.