1 1과제 부록

별첨

“식사패턴과 식이지수”국제심포지엄 International Symposium on Dietary Pattern & Diet Score

일시: 2010년 12월 3일(금) 13:30-18:00

Date: 13:30-18:00, Friday, Dec. 3. 2010 Venue: Geumkang Hall A, 2nd floor, annes,

장소: 서울 교육문화회관 별관2층 금강A홀 주관: 농림수산식품부, 한식재단 주최: 전북대학교병원 기능성식품임상시험지원

Seoul KyoYuk MunHwa Hoekwan Host: Ministry for Food, Agriculture, Forestry and Fisheries, Korean Food Foundation Organizer: Chonbuk National university Hospital Clinical Trial Center for Functional Foods,

센터, 한국식생활문화학회

Korean Society of Food Culture

INVITATION 환영합니다.

전 세계적으로 급격한 식생활 변화와 함께 만성질환률이 증가하고 있어 이를 예방 및 치료하려는 노력이 식품영양 및 자연과학 각 분야에서 다방면으로 시도되고 있습니다.

지중해식 식사는 수십년에 걸쳐서 이루어진 영양역학 연구로 지중해식 건강식이패턴이 정립되었고, 이를 근간으로 임상시험을 통하여 만성질환의 위험을 낮춘다는 과학적 근거 자료를 도출하여 지중해식 식사패턴을 세계적으로 보급 및 홍보하여 관련 산업화에 기 여하고 있습니다.

우리가 전통적으로 먹어온 한식은 지중해식사 못지않게 만성질환의 위험을 감소시킬 수 있는 속성을 지니고 있으나, 현재 이를 뒷받침할 수 있는 식품 영양학과 임상의학연구를 통한 과학적인 근거자료가 턱없이 부족합니다. 특히, 한식섭취 식사유형 및 식이지수에 대한 연구부족으로 한식이 건강식으로 대표성을 나타낼 수 있는 과학적 임상접근이 현 실적으로 어려운 실정이며 이는 한식의 우수성을 전세계에 홍보하는데 가장 큰 장애요 인이 되고 있습니다.

따라서, 정부가 앞장서서 추진하고 있는 한식의 세계화를 위해서는 한식의 식사유형정립 과 식이지수를 규명하는 일이 시급한 실정입니다.

이번 국제심포지엄을 통해 우리나라 건강식사패턴을 정립하고 한식의 식이지수를 도출 하여 향후 한식의 세계화를 위한 기초를 다지시는 계기가 되시길 바랍니다.

2010. 12

전북대학교병원장

김 영 곤

기능성식품임상시험지원센터장 채 수 완

3

INVITATION Welcome you all, In this current era, there is a drastic increase in chronic diseases worldwide depending up on one's dietary pattern.

Several years of scientific research, epidemiological studies and clinical trials already proven that Mediterranean style diet decreases the risk of chronic disease.

And now it's well-known that Mediterranean diet has a greater

health benefiting properties.

'Han-Sik' is Korean traditional diet, having the properties to decrease the risk of chronic diseases, not lesser than that of Mediterranean diet.

However,

there is a lack of sufficient knowledge on the dietary pattern and diet score of Han-Sik.

Without being aware of the dietary pattern and diet score o

Han-Sik, it would not be possible to get fruitful and justified results from clinical trials on Han-Sik. Therefore, the establishment of scientific exploration on Han-Sik's dietary pattern and diet score is a need of urgent for globalizing it and this effort needs government promote for its successful promotion.

Through

this

international

symposium,

the

confirming

of

Korean

dietary

pattern and diet score gets the opportunity of laying a foundation for the globalization of Han-Sik. 2010. 12 Director

Young-Gon Kim Soo-Wan Chae

Chonbuk National University Hospital Clinical Trial Center for Functional Foods

4

Program 2010년 12월 3일 (금) / 13:30 ~ 18:00

시 간

내 용

비 고 사 회: 차연수(전북대학교)

13:30 - 13:40

개회식

환영사: 김영곤(전북대학병원장) 축 사: 손숙미(국회의원)

Session1.

식사패턴: 역학적 접근 (좌장 : 김영옥 교수, 동덕여자대학교)

13:40 - 14:20

일본인의 식사패턴과 건강

14:20 - 15:00

식사패턴과 건강

15:00 - 15:40

한국인의 식사패턴과 건강

15:40 - 16:00

휴식

Session 2.

Satoshi Sasaki 교수 (일본, 동경대학교) 송원옥 교수 (미국, 미시간주립대학교) 김미경 박사 (한국, 국립암센터)

식사패턴: 음식문화 관점 (좌장: 오명숙 교수, 가톨릭대학교)

16:00 - 16:40

일본인의 음식문화와 식사패턴

16:40 - 17:20

한국인의 식사패턴과 식이지수

Keiko Hatae 교수 (일본, 와요여자대학교) 조미숙 교수 (한국, 이화여자대학교) 오경원 박사(한국 질병관리본부) 송윤주 교수(가톨릭대학교)

17:20 - 18:00

패널토의

김희섭 교수(수원대학교) 정진은 교수(안산대학교) 정효지 교수(서울대학교)

18:00

만찬

5

Program 2010년 12월 3일 (금) / 13:30 ~ 18:00

시 간

내 용

비 고 Chaired: Dr.Youn-Soo Cha(Chonbuk National Univ)

13:30 - 13:40

Welcome Address: Youmg Kon Kim

Opening Ceremony

(Director, Chonbuk National Univ. Hospital) Congratulatory Remark: Sook-Mee Son(Congressperson)

Session 1.

Dietarypattern: Epidemiologic approaches (Chaired by Dr.Young Ok Kim, Dongduk Women's Univ, Korea) Japanese dietary

13:40 - 14:20

Dr.Satoshi Sasaki,

pattern and it's

(Tokyo Univ, Japan)

implication to health

14:20 - 15:00

15:00 - 15:40

15:40 - 16:00 Session 2

Dietary

Pattern

&

Dr.Won Ok Song,

Health

(Michigan State Univ, USA)

Korean Dietary Pattern

Dr.Mi KYung Kim,

& Health

(National Cancer Center, Korea)

Coffee Break

Dietary pattern: Food Cultural aspects (Chaired by Dr.Myung Suk Oh, Catholic Univ, Korea)

16:00 - 16:40

16:40 - 17:20

Japanese Food Culture

Dr.Keiko Hatae,

& Dietary pattern

(Wayo Women's Univ, Japan)

Korean Meal Pattern &

Dr.Mi Sook Cho,

Diet Score

(Ewha Womans Univ, Korea) Kyung Won Oh(Korea CDC, Korea) YoonJu Song(Catholic Univ, Korea)

17:20 - 18:00

Panel Discussion

Hee Sup Kim(Suwon Univ, Korea) Chin Eun Chung(Ansan Univ, Korea) Hyojee Joung(Seoul National Univ, Korea)

18:00

Banquet

6

목 차 Session 1 일본인의 식사패턴과 건강

················································

11

Satoshi Sasaki 교수 (일본, 동경대학교)

Japanese dietary pattern and it's implication to health Dr.Satoshi Sasaki, (Tokyo Univ, Japan)

식사패턴과 건강

················································

31

송원옥 교수 (미국, 미시간주립대학교)

Dietary Pattern & Health Dr.Won Ok Song, (Michigan State Univ, USA)

한국인의 식사패턴과 건강

················································

57

김미경 박사 (한국, 국립암센터)

Korean Dietary Pattern & Health Dr.Mi KYung Kim, (National Cancer Center, Korea)

Session 2 일본인의 음식문화와 식사패턴

················································

77

Keiko Hatae 교수 (일본, 와요여자대학교)

Japanese dietary pattern and it's implication to health Dr.Keiko Hatae, (Wayo Women's Univ, Japan)

한국인의 식사패턴과 식이지수

················································ 조미숙 교수 (한국, 이화여자대학교)

Korean Meal Pattern & Diet Score Dr.Mi Sook Cho, (Ewha Womans Univ, Korea)

7

113

1 일본인의 식사패턴과 건강 Satoshi Sasaki 교수 (일본, 동경대학교)

Japanese dietary pattern and it's implication to health Dr.Satoshi Sasaki, (Tokyo Univ, Japan)

9

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

Japanese dietary pattern and its implication to health Satoshi Sasaki, M.D., Ph.D. (Professor), Hitomi Okubo (Ph.D. candidate) Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo.

We would like to introduce Japanese dietary patterns and the related epidemiologic studies with their implication to health.

For seeking dietary patterns in a population, analytical approach such as factor and cluster analyses are mainly used. The dietary patterns identified are then examined their associations with health status. In Japan, 29 articles which used dietary pattern analysis have appeared in medical and nutritional journals between 1986 and 2010 when checked in PubMed. The increase in the articles is remarkable since 2007. Especially, 9 articles have been published in this year (2010). Most of the articles examined the associations between dietary patterns and health outcomes such as colorectal cancer, stomach cancer, bone health, diabetes, obesity (BMI as index), cardiovascular diseases and their markers. With one exception, all the studies sued diet assessment questionnaires such as FFQs rather than dietary record or recall method.

However, a question arises here whether true dietary pattern can be captured by these questionnaires or not. If the validity was low, all the results drawn from the questionnaires are difficult to believe. Therefore, the validation study to examine ability to capture dietary patterns by the diet assessment questionnaire is very essential. It is particularly important because even FFQs without a validation study can figure out dietary patterns. It is in many cases much easier in simpler questionnaires without questions of quantity or dietary behaviors. Therefore, dietary pattern analysis may be preferred by easy-going epidemiologists with a lack of knowledge on nutrition or of complicated dietary behaviors. Until now, five dietary assessment questionnaires have been examined their ability to identify dietary patterns in the world, and only one in Asia.

In the validation study which examined the ability to identify dietary patterns of Japanese adults by factor analysis using self-administered diet history questionnaire (DHQ), a relatively reasonable validity was reported both in 92 women and 92 men (Pearson correlation coefficient between DHQ and 16-day dietary records = 0.36-0.65) [1]. In this article, three and two dietary patterns were identified in women and men, respectively. In women, the dietary

11

식사패턴과 식이지수 국제심포지엄

““

””

patterns identified were “healthy”, “western”, and “Japanese traditional”. The western patterns were characterized by high intakes of meats and fats/oils. The Japanese traditional patterns were characterized by very high intakes of rice and miso-soup. In men, the dietary patterns identified were “healthy” and “western”. The food groups characterizing the dietary patterns were similar as those in women. High intake of rice appeared as a negative character in western pattern. Similar dietary patterns were identified by cluster analysis in a different population (in young women) although four dietary patterns such as “fish and vegetables”, “meats and eggs”, “rice”, and “breads and confectioneries”, were identified [2]. When nutritional adequacy was compared among these four dietary patterns, Nutrient intakes were generally the best in the “fish and vegetable” group, and the worst in the “rice” group except for fats and salt.

Several articles published from Japan reported favorable health effects of dietary patterns rich in vegetables and fish (this pattern was, in many studies, called “healthy” pattern). For example, in a study using premenopausal Japanese farm women, a significantly positive association was found between healthy dietary pattern and bone mineral density of a non-dominant arm after adjusting for the several confounding factors [3]. In another study using 3760 women aged 18-20 years, a significantly negative association was found between healthy dietary pattern and a prevalence of obesity [4]. In this study, Japanese traditional pattern sowed, interestingly, a significantly positive association with the prevalence of obesity as well as western pattern did. This could partly be explained by a significantly negative association of dietary fiber and significantly positive association of dietary glycemic load with mean body mass index in this population [5]. These results suggest that two different Japanese dietary patterns exist, such as traditional and modern ones: characterized by very high intake of rice and miso-soup, and by high intakes of vegetables and fish, respectively.

More importantly, each dietary pattern possibly shows markedly different health effect each other. It means that we should be careful when talking about “Japanese dietary pattern”.

We have another approach to identify dietary patterns and examine their health effects. It is, let’s say, historical approach. Let me show one example: a case of Okinawa. Okinawa used to be famous as a paradise of longevity. Okinawa, an isolated southern island prefecture of Japan, has among the world's longest average life expectancy and the highest prevalence of exceptionally long-lived persons. However, we can see a remarkable difference of all-cause mortality between young (middle-aged) and elderly populations: high and very low, respectively. We also see a remarkable difference of dietary habits between young and

12

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth Ⅰ Ⅰ

elderly persons in Okinawa. For example, a generation difference of folate intake is wider in Okinawa than in the mainland. Goya (bitter melon), which is a common traditional vegetable in Okinawa, is much less frequently eaten in the young generation. When comparing traditional Okinawa dietary pattern, the pattern is incidentally very close to the manmade DASH diet [6]. This is quite an interesting phenomenon because DASH diet was made by several scientific works and the traditional Okinawa diet has existed for many decades in Okinawa before our discovery. However, I think, we should be very careful to say “Okinawa diet is healthy”. It is because we have no direct proof. Several life-styles and social structures were different in many decades ago compared to those in the present time such as high physical activity. Therefore, in order to find direct proofs, we are now conducting several randomized controlled trials using subjects with different characteristics.

Another topic on Japanese dietary pattern is about a practical dietary recommendation authorized by Ministry of Health and Welfares and Labors and Ministry of Agriculture, Forestry, and Fishery: dietary balance guide (shokuji-baransu-gaido). This is an illustrated dietary guide easy to understand for normal Japanese. However, as far as I know, there seem to be no original paper either for the development process, theoretical background for the calculation algorithm, or the effeteness as education. Several governmental and non-governmental activities and campaigns are now held all-over Japan to let people know this guide. But at least I do not know whether these activities would lead future health status of Japanese to good or bad direction. There is one retrospectively-analyzed prospective study which examined the effectiveness of the guide [7]. In this study, a significantly negative association was seen between the score of the guide and the mortality only in women, but not in men. Although this type of dietary guide is undoubtedly important and necessary, we need more careful researches before this guide are introduced widely to the public.

The conclusions are as follows. We have several approaches to seek Japanese dietary patterns: mainly analytical and historical approaches. Recent Japanese dietary pattern characterized by high intakes of vegetables and fish may have several beneficial effects for health outcomes. On the other hand, Japanese traditional dietary pattern with very high intake of rice may be unhealthy. The original Okinawa dietary pattern is interesting and worthy to study. However, while scientific evidence is lacking or scarce, we should be careful for not claiming “Japanese dietary pattern is healthy”. Even the dietary pattern authorized by the government may not have reliable evidence. We should also be careful for this. Japanese do not yet know what Japanese dietary pattern really is. There is no scientific

13

식사패턴과 식이지수 국제심포지엄

““

””

definition because of shortage of high-quality studies. Further, and fully scientific, studies are extremely needed in Japan before we talk about Japanese dietary patterns and their health effects.

References: [1] Okubo H, Murakami K, Sasaki S, Kim MK, Hirota N, Notsu A, Fukui M, Date C. Relative validity of dietary patterns derived from a self-administered diet history questionnaire using factor analysis among Japanese adults. Public Health Nutr 2010; 13: 1080-9.

[2] Okubo H, Sasaki S, Murakami K, Takahashi Y, the Freshmen in Dietetic Course Study II Group. Nutritional adequacy of four dietary patterns defined by cluster analysis in 3756 Japanese women aged 18-20 years Asia Pac J Clin Nutr 2010: (in press).

[3] Okubo H, Sasaki S, Horiguchi H, Oguma E, Miyamoto K, Hosoi Y, Kim MK, Kayama F. Dietary patterns associated with bone mineral density in premenopausal Japanese farmwomen. Am J Clin Nutr 2006; 83: 1185-92.

[4] Okubo H, Sasaki S, Murakami K, Kim MK, Takahashi Y, Hosoi Y, Itabashi M, the Freshmen in Dietetic Courses Study II Group. Three major dietary patterns are all independently related to the risk of obesity among 3760 Japanese women aged 18-20 years. Int J Obes 2008; 32: 541-9.

[5] Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M, the Freshmen in Dietetic Courses Study II Group. Dietary fiber intake, dietary glycemic index and load, and body mass index: a cross-sectional study of 3931 Japanese women aged 18-20 years. Eur J Clin Nutr 2007; 61: 986-95.

[6] Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117-24.

[7] Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, Shimizu H. Diet based on the Japanese Food Guide Spinning Top and subsequent mortality among men and women in a general Japanese population. J Am Diet Assoc 2009; 109: 1540-7.

14

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

15

식사패턴과 식이지수 국제심포지엄

““

””

16

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

17

식사패턴과 식이지수 국제심포지엄

““

””

18

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

19

식사패턴과 식이지수 국제심포지엄

““

””

20

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

21

식사패턴과 식이지수 국제심포지엄

““

””

22

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

23

식사패턴과 식이지수 국제심포지엄

““

””

24

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

25

식사패턴과 식이지수 국제심포지엄

““

””

26

Ja Jappan anese ese ddieieta tary ry ppaattern ttern aanndd it's it's im im pplicatio licationn to to hheealth alth â… â…

27

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

2 식사패턴과 건강 송원옥 교수 (미국, 미시간주립대학교)

Dietary Pattern & Health Dr.Won Ok Song, (Michigan State Univ, USA)

29

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

International Symposium on Dietary Pattern & Diet Score Dec 3, 2010 Seoul KyoYuk MunHwa Hoekwan, Seoul, Korea

Why Research Dietary Patterns - Meanings and Applications?

Won O Song, PhD, MPH, RD, Department of Food Science and Human Nutrition, Michigan State University

In the past three decades, nutrition science has transformed dramatically from a branch of science focusing on bodily nourishment and thus sustaining human health to the current epigenetics with physiological and genetical implications. Incorprating biological, analytical, quantitative, epidemiological and medical sciences in its own discovery of science, nutritional science shifted its attentions to discovery of new nutrients and other components in food such as dietary fiber, cholesterol, trace minerals and polyphenols, and their associations to prevention of chronic diseases and deficiencies. The common directions taken in nutritional science were establishing causal-effect relationships between specific elements in foods as a risk of chronic diseases. Subsequent scientific challenges encountered were to identifying biomarkers or intermediary metabolites that explain the chronic diseases with the hypothesized food compoments. Much of the scientific associations were yet to be controversial because the association between exposure to suspected dietary elements and develeopement of diseases of interest were non-linear as in the case of dietary intake of cholesterol to cardiovasuclar diseases and salt intake to hypertension.

Two subsequent challenging questions then followed: 1) what if there were unknown or yet unidentified elements in foods that impact human health? 2) What explain the differences in biological responses? The first challenge has led to the advancement in analytical methodologies in one direction and development of macro-version of the human food consumption behaviors by imcorporating fastly expanding computational sciences. The second challenge has been addressed by incorporating new genetic sciences and then to epigenetics.

Conceptually, we began to develop dietary patterns in relation to cardiovascular diseases based on many important premises: human consumes foods not nutrients; human eats combinations of foods not a single food in common manner (“pattern”) conforming to different lifestyles and cultures in each society and locals; food item contains many nutrients

31

식사패턴과 식이지수 국제심포지엄

““

””

and non-nutrient elements that might not have found even with modern analytical sciences; elements in foods interact with each other as they interact with human body which has its own diurnal variations; the manner and combinations of food consumed in each day matters in devleoping or preventing chronic diseases; the interation between dietary intake and host system is one of numerous contributors to the development or prevention of chronic diseases; and the variation depends on the host system.

We reported on the dietary patterns based on food groupings, food items and meal patterns in relation to cardiovascular disease and its risk factors in nationally representative populations in the U.S.(Kerver et al., 2003, 2006). Follwed were numerous reports on different sub-poputation groups and nationalities (Yang et al, 2005). Dimensions of dietary patterns other than food intake frequencies and their intercorrelations, for example daily eating frequency, however, have received little attentions other than the importance of breakfast consumption in attaining high quality of diets. Paucity of information exists on the association between dietary behaviors and other health risk factors.

The issue of diet composition by daily eating frequency is also important in studying the effects of daily eating frequency on health outcomes.

In free-living populations, nutrient

intakes may vary depending on meal or snacking habits, for example eating frequency and breakfast skipping. Increased daily eating frequency is associated with higher intakes of energy, fat, carbohydrate, and protein in most studies that focused on meal skippings in many different countries (Song et al, 2005). However, favorable lipid concentrations are associated with increased meal frequency after adjusting for macronutrient intake and other confounding variables in multivariate analyses.

Dietary pattern is an important secular marker of lifestyles, and a determinant of chronic diseases (Song et al, 2005). Globally across nationalities, dietary patterns tend to vary by age, gender, SES and various lifestyle measurement including smoking, drinking, nutritional supplement uses, and other health indicators. Consequently the associations of dietary patterns vary among host systems in serving as a predcitor of chronic diseases. As we continue our research efforts in this area, we must be congnizant of the limitations in generalizing the findings and limited tools in assesssing dietary intake information from consumers.

Kerver JM, Yang EJ, Bianchi LJ and Song WO. Dietary Patterns associated with Risk Factors for Cardiovascular Disease in Healthy U.S. Adults. Am J. Clin Nutr. 78:1103-1110, 2003

32

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

Yang EJ, Kerver JM, Song WO. Dietary Patterns of Korean American Described by Factor Analysis. J. Am Coll Nutr. 24(2): 115-121, 2005

Song WO, Chun OK, Obayashi S, Cho S, Chung CE. Is breakfast consumption associated with Body Mass Index in U.S. adults? J Am Dietetic Assoc. 105:1373-1382, 2005.

Kerver JM, Yang EJ, Obayashi S, Bianchi LJ, Song WO. Meal and Snack Patterns are Associated with Dietary Intake of Energy and Nutrients in U.S. Adults. J Am Dietet Assoc.

106:46-53, 2006

33

식사패턴과 식이지수 국제심포지엄

““

””

34

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

35

식사패턴과 식이지수 국제심포지엄

““

””

36

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

37

식사패턴과 식이지수 국제심포지엄

““

””

38

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

39

식사패턴과 식이지수 국제심포지엄

““

””

40

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

41

식사패턴과 식이지수 국제심포지엄

““

””

42

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

43

식사패턴과 식이지수 국제심포지엄

““

””

44

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

45

식사패턴과 식이지수 국제심포지엄

““

””

46

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

47

식사패턴과 식이지수 국제심포지엄

““

””

48

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

49

식사패턴과 식이지수 국제심포지엄

““

””

50

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

51

식사패턴과 식이지수 국제심포지엄

““

””

52

DD ietary ietary PPaatte ttern rn && HHea ealth lth Ⅱ Ⅱ

53

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

3 한국인의 식사패턴과 건강 김미경 박사 (한국, 국립암센터)

Korean Dietary Pattern & Health Dr.Mi KYung Kim, (National Cancer Center, Korea)

55

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth â…˘ â…˘

Korean dietary pattern and health Mi Kyung Kim, PhD National Cancer Center, Korea Identification of population dietary patterns has been recommended by experts as a key to developing innovative and targeted nutrition interventions and achieving long-term dietary behavior change for health promotion and chronic disease risk reduction. Essential in this task is the evaluation of methods to accurately identify these unique dietary patterns.

Nutritional epidemiologic studies involving the overall dietary pattern which reflects the combined effect of many dietary exposures, nutrients and foods, may be an important complementary approach for elucidating relationships between diet and health. Traditional nutrition researches have mostly been focused in individual dietary components, such as a single or a few nutrients (Kerver et al., 2003; Newby & Tucker, 2004). However, people do not usually consume isolated foods or nutrients (Terry et al., 2001; Kim et al., 2005b). Rather people consume meals consisting of a various kinds of foods with complex combinations of nutrients, not isolated nutrients. In addition, many nutrients are highly correlated within foods or meal, it is difficult to examine their effects separately. Dietary pattern approach may provide additional insight that takes into account the combined effects of foods (Smith-Warner et al., 1998). Because of the complexity of diets, the traditional approach with a single nutrient may potentially be confounded by the interactions between food components that are likely to be interactive or synergistic (Hu, 2002). Several approaches for dietary pattern analysis is useful because it provides a basis from which to make recommendations on eating practices such as healthy food choice for preventive disease (Okubo et al., 2008). Complex combinations of nutrients from the food may interact (Randall et al., 1992). From 1998, the World Health Organization (WHO) had suggested that dietary guidance for populations should be based on foods instead of nutrients (World Health Organization, 1998). A composite measure of diet has been preferred to an index of a single nutrient or food in the area of dietary assessment. Several such overall diet measures have been developed, including Mediterranean-Style Dietary Pattern Score (MSDPS), the Diet Quality Index-International (DQI-I), the Healthy Eating Index (HEI) and the Japanese Food Guide Spinning Top. MSDPS is to assess the conformity of an individual’s diet to a traditional Mediterranean-style diet, which is based on the recommended intakes of 13 food

57

식사패턴과 식이지수 국제심포지엄

““

””

groups in the Mediterranean diet pyramid. Diet Quality Index-International (DQI-I) is an overall measure of diet quality that can be used for international comparisons. The DQI-I focuses on concerns related not only to chronic diseases but also to problems of undernutrition, thus providing a global tool for monitoring healthfulness of diet and for exploring aspects of diet quality related to the nutrition transition. The Japanese Food Guide Spinning Top is to provide recommended food choices and quantities for a healthful diet that can be easily adopted by the Japanese public measured by adherence to the Dietary Guidelines. Here, the purpose of this study was to identify the major dietary pattern of Korean adult using principal component analysis and cluster analysis, and to examine the relationship between dietary pattern and the risk of several health outcomes among Korean adults aged over 30 y. The data of Korean National Health and Nutrition Survey (KNHANES) from 1998 to 2008 were used in the analysis. The 17,760 subjects (7631 male and 10,129 female) who completed dietary assessment and health examination from the Korean National Health and Nutrition Examination Survey were included for the analysis. The 24 h recall data and food frequency questionnaire data were employed for the dietary survey. For factor analysis, mean amount of each food group was used and also 4 patterns were identified; “Diverse”, “rice and Kimchi”, “bread, milk and dairy products”, and “processed products”. “Diverse” pattern was significantly reduced risk of metabolic syndromes among female (comparing highest and lowest quintiles of the score, OR 0.76, 95% CI 0.62 to 0.95, P for trend 0.002 in a multivariate analysis), and “processed products” pattern was positively associated with risk of metabolic syndromes among male (comparing highest and lowest quintiles of the score, OR 1.36, 95% CI 1.08 to 1.71, P for trend 0.02 in a multivariate analysis). For cluster analysis, the percent of energy intake from each food group was used and 4 patterns were identified: “Diverse”, “rice and Kimchi”, “processed products”, and “noodle & egg”. . “Diverse” pattern was more likely to have a lower blood pressure among female. Participants with a higher MSDPS were more likely to have a reduced risk of hypertension in both gender: comparing highest and lowest quintiles of the score in a multivariate analysis, OR 0.83, 95% CI 0.73 to 0.95, P for trend 0.002 among male, and OR 0.81, 95% CI 0.67 to 0.98, P for trend 0.005 among female. Participants with a higher DQI-I were more likely to have a reduced risk of hypertension and metabolic syndromes among female: comparing highest and lowest quintiles of the score in a multivariate analysis, OR 0.60, 95% CI 0.49 to 0.73, P for trend <0.0001 for hypertension, and OR 0.83, 95% CI 0.71 to 0.97, P for trend 0.08 for metabolic syndromes. Adherence to the Korean Food Guide

58

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth â&#x2026;˘ â&#x2026;˘

Dabotap developed by the Korean Nutrition Society to promote healthful diets. The risks of hypertension were significantly lower for women in the highest quintile compared to those in the lowest quartile of the adherence score, and the analysis of linear trend also showed inverse associations: comparing highest and lowest quintiles of the score in a multivariate analysis, OR 0.89, 95% CI 0.78 to 0.99, P for trend= 0.05. In summary, this study examined the quality and quantity of total dietary intake and its relationship to health by measuring several indices and scores of overall diet quality. Dietary pattern analysis and adherence to healthy diet using scores of MSDPS, DQI-I and the Korean Food Guide Dabotap have been found to relate to the risk of health outcomes more consistently than individual nutrients or foods. Korean diet could reduce the risk of several health outcomes, especially hypertension and metabolic syndromes. It should be noted, however, that the most recognizable effects of the Korean diet concern many chronic diseases, and that a further assessment of the benefit of the diets based on the food guide in relation to biomarkers or risk factors in major chronic disease would be interesting in a prospectively follow-up study. Making use of prior knowledge or suspected diet?disease associations can be helpful in building more clearly defined and sensible dietary patterns and in deriving disease-specific dietary patterns.

59

식사패턴과 식이지수 국제심포지엄

““

””

60

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

61

식사패턴과 식이지수 국제심포지엄

““

””

62

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

63

식사패턴과 식이지수 국제심포지엄

““

””

64

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

65

식사패턴과 식이지수 국제심포지엄

““

””

66

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

67

식사패턴과 식이지수 국제심포지엄

““

””

68

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

69

식사패턴과 식이지수 국제심포지엄

““

””

70

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

71

식사패턴과 식이지수 국제심포지엄

““

””

72

KKoorea reann DD ieta ietary ry PPattern attern && HH ea ealth lth Ⅲ Ⅲ

73

식사패턴과 식이지수 국제심포지엄

““

””

74

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth Ⅳ Ⅳ

4 일본인의 음식문화와 식사패턴 Keiko Hatae 교수 (일본, 와요여자대학교)

Japanese dietary pattern and it's implication to health Dr.Keiko Hatae, (Wayo Women's Univ, Japan)

75

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth Ⅳ Ⅳ

Japanese Food Culture Keiko Hatae Wayo Women’s University Japan Korean culture is very much admired in Japan, especially since a Korean TV drama series gained huge popularity there. A lot of Japanese travel to Korea every year. Korean food is also very popular, and there are many Korean restaurants in Japan.

Some Japanese foods are similar to Korean food, but some are not. The difference can be regarded as that of food culture, because daily diet reflects food culture.

Let us consider Japanese food culture through its characteristics of daily diet.

Characteristics of Dietary Life in Japan Dietary life reflects food culture.

The characteristics of everyday dietary life are following

seven points.

1. Rice is staple.

2. Combination of rice, soup, main dish, and side dish.---Basic pattern.

3. Plenty of fish and shellfish are eaten.

They can be eaten raw when fresh, or cooked and they can be eaten processed.

4. Variety of soybean products is eaten.

5. Japanese eat plenty of seaweed.

6. A sense of the season is appreciated.

7. Matching between food and tableware, and arrangement of food on a plate are valued.

1. Rice as the staple food: The intake of rice is decreasing yearly. Although they eat rice at least once a day, the amount of the single intake is decreasing. Rice is still an important food. At annual events, Japanese eat special dishes made with rice cooked into various styles.

77

식사패턴과 식이지수 국제심포지엄

““

””

New Year’s Day is one of the most important annual events in Japan, and traditionally, we have a custom to eat “Zouni” at the New year’s day.

We made a survey on the eating habit of "Zouni" in young generation all over Japan, to know whether the younger generation eats this traditional food. The questionnaires were distributed to the University students all over Japan, from Hokkaido to Okinawa, on December of 2001 and recovered on January of 2002.

As the results, more than 90% of young people ate "Zouni" on the New Year's Day of 2002.

The shape of the rice cake was divided into two, round and square.

The seasoning of

"Zouni" was also divided into two, miso and soysauce. The traditional way of eating "Zouni" was kept in their respective district, which has its own special way of making "Zouni". The young generation has also adopted this tradition.

2. Combination of rice, soup, main dish and side dish:---This is a Basic pattern.

This pattern probably originated from the dinners of upper class society 1000 years ago for treating guests.

Before 1940, people would eat breakfast, lunch, supper, all in this basic pattern though main dish were simple and ate foods locally harvested area.

3. Sea Food Dishes or sea Food Products: The Japanese eat a lot of fish in various ways in everyday dish.

1) Raw fish and shellfish: sashimi, tataki, sushi…

2) Cooked fish: Grilled fish, boiled fish, tempura…

3) Processed fish: dried fish, salted fish smoked fish…

4) Fish paste products: “Kamaboko”, “chikuwa”, “satsuma-age” Recently, younger generation tend to prefer meat like hamburger steak, fried chicken or sauted meat to fish. Thus younger generation, in their teens, twenties, and thirties, take much fat than recommended ratio that is 25% of total energy intake.

78

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

4. Many Soybean Products: There are a lot of traditional soybean products popular among the Japanese. For example: seasonings (miso, soysauce), soybean curd (Tofu), fried soybean curd, soy milk, freeze and dried soybean curd.

5. Sea weed: Japanese are also fond of sea weeds and use them in everyday meal.

1) "Wakame" 2) "Nori" 3) Kelp (konbu) 4) Brown algae (hijiki) 5) Agar-agar

6. The Sense of season: Japan has distinct four seasons.

In summer, its warm and humid. In autumn, the

temperature cools down, with clear sky and trees turn into red and yellow. In winter, its cold and dry, snow falls in some regions. In spring, it becomes warm and many flowers bloom, especially, Japanese love cherry flower.

From the old time, we appreciate the sense of four seasons. Though, air conditioner and heater are widely spread recently, we still make various dishes according to the season.

7. Beautiful combination of Food and Tableware: Food is served in individual dishes. Tableware for courses is not in uniform. They use chopsticks for eating

79

식사패턴과 식이지수 국제심포지엄

““

””

Japanese people eat traditional Japanese foods was well as western style foods.

More

and more Japanese have become traditional foods not to make at home but buy from take-out foods shops.

For example, “tempura” (deep fried fish or vegetables), cooked root vegetables or pickled vegetables are formerly made at home, but these days, some house wives do not like to make time consuming dishes.

Food industry plays an important role in maintaining traditional food culture.

80

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

81

식사패턴과 식이지수 국제심포지엄

““

””

82

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

83

식사패턴과 식이지수 국제심포지엄

““

””

84

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

85

식사패턴과 식이지수 국제심포지엄

““

””

86

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

87

식사패턴과 식이지수 국제심포지엄

““

””

88

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

89

식사패턴과 식이지수 국제심포지엄

““

””

90

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

91

식사패턴과 식이지수 국제심포지엄

““

””

92

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

93

식사패턴과 식이지수 국제심포지엄

““

””

94

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

95

식사패턴과 식이지수 국제심포지엄

““

””

96

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

97

식사패턴과 식이지수 국제심포지엄

““

””

98

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

99

식사패턴과 식이지수 국제심포지엄

““

””

100

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

101

식사패턴과 식이지수 국제심포지엄

““

””

102

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

103

식사패턴과 식이지수 국제심포지엄

““

””

104

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

105

식사패턴과 식이지수 국제심포지엄

““

””

106

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

107

식사패턴과 식이지수 국제심포지엄

““

””

108

Jap Japaanneese se ddietary ietary ppaatte ttern rn aanndd it's it's im im pplica licatio tionn to to hhea ealth lth â&#x2026;Ł â&#x2026;Ł

109

식사패턴과 식이지수 국제심포지엄

““

””

110

KKoorea reann M M ea eall PPaattern ttern && DD iet iet SSco core re Ⅴ Ⅴ

5 한국인의 식사패턴과 식이지수 조미숙 교수 (한국, 이화여자대학교)

Korean Meal Pattern & Diet Score Dr.Mi Sook Cho, (Ewha Womans Univ, Korea)

111

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

Korean Meal Pattern & Diet Score Mi Sook Cho Ewha Womans University Korean table(Bansang) have been consisted of rice and soup with the salted food such as kimchi, jeotgal(salted fish), vegetables, and jang. From the ancient Goguryeo paintings, we can see plates on the table showing cooked rice(bap) and side dish(Banchan). The Korean table setting that is offered by rice and soup in a group is also discovered in 『Wonheng Ulmyo Jungri Euigwae (1795)』of Joseon Dynasty, and this dietary life was the same from the king to the people, which has been continued so far.However, the Korean table setting at a palace of Joseon Dynasty was not a royal table(Sura Sang) of 12 chup in the modern life but of 5 or 7 chup, and the number of chup(dish) was also not calculated as mentioned in the contemporaneous cuisine after the end of the 19th century but as included rice, meat soup, pot strew, and kimchi. In this aspect, the Korean table setting was not luxury but simple, polite and elegant, which has been changed in quality and distorted during a historical period of disgrace such as a turbulent end of Joseon Dynasty, and annexation of Korea by Japan, and this wrong dietary life has been spread to people. The modern luxury table setting is causing side effects such as disease by overconsumption and financial waste by food waste. Even though a royal meal, typical Korean meal is simple but well-balanced can be a healthy diet like Mediterranean.

Therefore, this research, based on our own simple and artless table setting in the middle of Joseon Dynasty, intends to be used as an evidence/data that develops the Korean diet score, realizes the Korean healthy table setting, and makes a scientific examination on the excellence of Korean meal pattern.

The index developed by this research, the Korean Dietary Pattern Score(KDPS: Korean Dietary Pattern Score) reflected all 3 chup bansang and 1 serving size, nutrition dietary status worrying the deficient and overconsumption, variety of food intake, dietary balance, various risk factors of disease for its evaluation. The KDPS has been based on the basic table setting since the ancient times, '3 chup bansang’, which is the table with rice used in the breakfast and dinner, and based on rice, soup, kimchi, Jochi(pot stew) and soy that is prepared with

113

식사패턴과 식이지수 국제심포지엄

““

””

3, 5, 7 or 9 plates of different recipients and recipes of raw vegetables, roasted food, hard-boiled food, panfried food, dried plates, slided raw fish. It is called as 3 chup, 5 chup, 7chup and 9 chup bansang by number of plates, and 12 chup bansang was a royal table for the King. 3 chup bansang used as an evaluation criteria in this research is the people's simple and basic table setting, which is based on rice, soup, kimchi and soy, and prepared with raw vegetables or heated vegetables, roasted or boiled food, dried dish·salted fish·jangachi. The KDPS is composed by 8 components in total with 7 components that compose 3 chups and 1component that evaluates adherence to Korean diet. Each component will be scored by 10 points to satisfy a full mark, with its scored differentiated by satisfaction. In case of cooked rice(bap) component, it was scored by 30 points of full marks as it was attributed a weight to consider its position and importance in the Korean diet. The food intake used to attribute the KDPS point has established its standard on the 1 serving size of Korean Nutrition Society and of Korean Society of Community Nutrition, and in case it has been consumed by its intake in‘1 serving size ± 10% of 1 serving size’as full mark, in case of no consumption or by more than 200% of 1 serving size as 0 point, and the intake among them was proportionally scored by intake. In case of underconsumption and overconsumption

by 10% of unit on basis of 1 serving size in much of the index

development related researches for the evaluation of dietary pattern to complement the weak point of lots of existing index that reflects the underconsumption of nutrition but the overconsumption like this, all the intakes were proportionally scored.

As above-mentioned, rice is in important location of the Korean diet, 2 groups were divided by kind of rice consumed in cooked rice comsuming group(n=757) and mixed rice consuming group(n=1,498), which have been applied to the developed score and compared the average score per component and nutrition intake. In case of total KDPS score and of the average point of component 1(bap), component 6(Gui), and component 8(adherence to Korean diet), mixed rice consuming group was significantly highly shown more than cooked rice consuming group. By applying the developed index to Korean National Health and Nutrition Examination Survey(KNHANES) in 2007, a relation between the KDPS and disease risk was investigated. To analyze the degree of risk by 3 groups divided by the total point of the KDPS odds ratios has been studied by multiple logistic regression analysis. The group with the highest point of the KDPS has been shown to be reduced in the risk of obesity, central obesity, and metabolic syndrome more than the subgroup: comparing highest and lowest tertiles of the score, OR 0.66, 95% CI 0.48 to 0.90, P for trend <0.05(0.035) for

114

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re â&#x2026;¤ â&#x2026;¤

obesity, OR 0.73, 95% CI 0.57 to 0.93, P for trend <0.05(0.035) for central obesity, and OR 0.73, 95% CI 0.54 to 0.97, P for trend <0.05(0.024) for metabolic syndrome.

115

식사패턴과 식이지수 국제심포지엄

““

””

116

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

117

식사패턴과 식이지수 국제심포지엄

““

””

118

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

119

식사패턴과 식이지수 국제심포지엄

““

””

120

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

121

식사패턴과 식이지수 국제심포지엄

““

””

122

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

123

식사패턴과 식이지수 국제심포지엄

““

””

124

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

125

식사패턴과 식이지수 국제심포지엄

““

””

126

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

127

식사패턴과 식이지수 국제심포지엄

““

””

128

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

129

식사패턴과 식이지수 국제심포지엄

““

””

130

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

131

식사패턴과 식이지수 국제심포지엄

““

””

132

KKoorea reann M M ea eall PPattern attern && DD iet iet SSco core re Ⅴ Ⅴ

133

식사패턴과 식이지수 국제심포지엄

““

””

134