kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.4.131 kjhp-14-131 Original Article Nutrition Label Use and Its Relation to Dietary Intake among Chronic Disease Patients in Korea: Results from the 2008–2009 Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV) ParkSeung Guk 1 KimHyeon Ju 2 KwonYoung-Min 3 KongMi Hee 2 Department of Family Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan Department of Family Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju Department of Family Medicine, SamYook Seoul Medical Center, Seoul, Korea Corresponding author：Mi Hee Kong, MD, PhD Department of Family Medicine, Jeju National University Hospital, Jeju National University College of Medicine, 15 Aran 13-gil, Jeju 690-767, Korea Tel: +82-64-717-1830, Fax: +82-64-717-1581 E-mail: mdoc74@daum.net 01 2014 20 01 2014 14 4 131 140 28012014 17092014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 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 Background

Nutrition label reading is helpful in attaining a healthy diet. Nutrition label use and its related factors have been studied in many Korean articles, but their research samples were the general population and not chronic disease patients. This study aimed to explore the use of nutrition labels and its relation to dietary intake among chronic disease patients in Korea.

 Methods

A total of 3160 respondents aged≥20 years from the 2008–2009 Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV) participated in the study. Their chronic medical conditions included hypertension, hyperlipidemia, coronary artery disease, diabetes and/or stroke and they were interviewed regarding their use of nutrition labels. Nutrition intake was also estimated by 24-hour dietary recalls.

 Results

Overall, 10.4% of the chronic disease patients reported to using nutrition labels. The nutrients they looked at first were total calories, fat and cholesterol. Factors related to reading nutrition labels were relatively higher education, high body mass index and lower frequency of alcohol intake in males and relatively younger age and higher education in females. Nutrition label users consumed lower total calories, protein and fat in the male CAD group, lower total calories and carbohydrate in both diabetes and total groups and lower total calories and fiber in the female stroke group.

 Conclusions

Our study found that, in Korea, a significantly lower rate of patients with chronic disease read nutrition labels. Strategies need to be developed to improve clinical application of nutrition labels in this population.

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Comparison of characteristics between nutrition label users and non-users in chronic disease patients

  Male (n=1329, N=3.62) Female (n=1831, N=3.65)
Users (SE) Non-users (SE) Pa Users (SE) Non-users (SE) Pa
Age, y 49.41 (1.61) 56.99 (0.54) <0.001 52.55 (0.76) 64.05 (0.38) <0.001
Area,%            
 Urban 86.8 (4.8) 75.6 (2.8) 0.062 83.8 (3.8) 73.1 (2.8) 0.015
 Rural 13.2 (4.8) 24.4 (2.8)   16.2 (3.8) 26.9 (2.8)  
Monthly incomeb, %            
 Low (0–0.7) 15.0 (4.1) 29.7 (1.8) 0.116 19.2 (3.4) 47.7 (1.7) <0.001
 Middle low (0.7–1.25) 24.1 (5.8) 21.3 (1.4)   21.0 (3.2) 20.2 (1.2)  
 Middle high (1.25–2.0) 29.4 (6.3) 22.7 (1.6)   29.1 (3.7) 16.2 (1.2)  
 High (more than 2.0) 31.5 (6.3) 26.4 (1.8)   30.7 (3.7) 16.0 (1.5)  
Educational level,%            
 Less than middle school 9.2 (3.1) 41.4 (2.0) <0.001 40.5 (4.4) 79.8 (1.5) <0.001
 high school 37.7 (6.5) 30.9 (1.7)   39.9 (4.1) 16.0 (1.2)  
 College or higher 53.1 (6.2) 27.7 (2.0)   19.7 (3.5) 4.2 (0.7)  
Alcohol use,%            
 No 18.8 (4.7) 22.0 (1.3) <0.001 37.2 (3.7) 57.9 (1.5) <0.001
 1 day/wk 55.9 (6.3) 35.9 (1.7)   53.5 (3.8) 35.5 (1.5)  
 2–3 days/wk 23.4 (5.4) 23.9 (1.4)   7.8 (2.0) 4.7 (0.7)  
 ≥4 days/wk 1.9 (1.1) 18.1 (1.3)   1.6 (0.9) 1.9 (0.4)  
Smoking,%            
 Current smoker 30.2 (5.9) 33.6 (1.8) 0.814 3.9 (2.0) 4.9 (0.7) 0.783
 Past smoker 49.1 (6.4) 48.3 (1.9)   4.3 (1.5) 5.6 (0.6)  
 Non-smoker 20.7 (5.3) 18.1 (1.5)   91.8 (2.5) 89.4 (0.9)  
Physical activity, METs/wk 48.46 (7.22) 54.80 (2.74) 0.046 50.99 (5.28) 40.12 (2.12) <0.001
BMI, kg/m2 26.73 (0.51) 24.90 (0.11) 0.001 25.00 (0.26) 24.99 (0.11) 0.987

Abbreviations: METs, Metabolic equivalents; BMI, Body mass index; wk, week; n, unweighted sample size; N, weighted sample size in millions; Users, patients who read nutrition labels; Non-users, patients who do not read nutrition labels

Categorical variables were calculated by χ2 test and continuous variables were calculated by regression analysis.

Unit: 1,000,000 (KW).

Adjusted comparison of characteristics between nutrition label users and non-users in chronic disease patients

  Male (n=1329, N=3.62) Female (n=1831, N=3.65)
Users (SE) Non-users (SE) Pa Users (SE) Non-users (SE) Pa
Age, y 55.68 (1.57) 58.56 (0.43) 0.086 59.69 (0.78) 64.12 (0.30) <0.001
Area            
 Urban 1 0.369 1 0.585
 Rural 0.68 (0.29–1.57)   0.85 (0.49–1.48)  
Monthly incomeb        
 Low (0–0.7) 1 0.899 1 0.075
 Middle low (0.7–1.25) 1.94 (0.88–4.28)   1.46 (0.79–2.72)  
 Middle high (1.25–2.0) 1.52 (0.63–3.66)   1.91 (1.04–3.50)  
 High (more than 2.0) 1.27 (0.54–3.00)   1.64 (0.88–3.07)  
Educational level        
 Less than middle school 1 <0.001 1 0.001
 high school 4.05 (1.59–10.30)   1.75 (1.04–2.96)  
 College or higher 5.36 (2.21–12.94)   3.48 (1.69–7.17)  
Alcohol use        
 No 1 0.005 1 0.470
 1 day/wk 1.37 (0.64–2.94)   1.28 (0.84–1.94)  
 2–3 days/wk 0.86 (0.72–1.96)   1.10 (0.46–2.63)  
 ≥4 days/wk 0.13 (0.00–0.51)   1.23 (0.28–5.27)  
Smoking        
 Current smoker 1 0.608 1 0.666
 Past smoker 1.39 (0.66–2.92)   0.85 (0.20–3.50)  
 Non-smoker 0.95 (0.40–2.23)   1.10 (0.40–3.04)  
Physical activity, METs/wk 50.11 (7.46) 52.87 (2.36) 0.719 43.97 (5.94) 40.56 (2.23) 0.591
BMI, kg/m2 25.78 (0.48) 24.58 (0.10) 0.017 24.99 (0.27) 24.98 (0.10) 0.975

Abbreviations: METs, Metabolic equivalents; BMI, Body mass index; wk, week; n, unweighted sample size; N, weighted sample size in millions; Users, patients who read nutrition labels; Non-users, patients who do not read nutrition labels.

Categorical variables were calculated by multivariable logistic analysis and continuous variables were calculated by multivariable linear regression analysis adjusted for age, area, education, income, smoking status, frequency of alcohol intake, physical activity and BMI.

Unit: 1,000,000 (KW)

Utilization rate of nutrition label and the difference according to nutrition education in chronic disease patients

  Male Pa   Female Pa
Nutritional education % (SE) Use nutrition label % (SE) Non-Use nutrition label % (SE) Nutritional education % (SE) Use nutrition label % (SE) Non-Use nutrition label % (SE)
HTN       <0.001 HTN       0.001
 n=1000, N=2.65   6.9 (1.1) 93.1 (1.1)    n=1441,   10.9 (1.0) 89.1 (1.0)  
 Educated 6.3 (0.9) 21.8 (6.1) 5.1 (0.9)    N=2.84 6.7 (0.8) 14.5 (3.4) 5.8 (0.8)  
 Not educated 93.7 (0.9) 78.2 (6.1) 94.9 (0.9)     93.3 (0.8) 85.5 (3.4) 94.2 (0.8)  
DLP       0.085  DLP       0.217
 n=225, N=0.73   11.4 (2.4) 88.6 (2.4)    n=408,   19.6 (2.4) 80.4 (2.4)  
 Educated 11.8 (2.5) 22.9 (8.9) 10.3 (2.5)    N=0.87 10.7 (1.7) 15.1 (4.7) 9.6 (1.8)  
 Not educated 88.2 (2.5) 77.1 (8.9) 89.7 (2.5)     89.3 (1.7) 84.9 (4.7) 90.4 (1.8)  
CAD       0.676 CAD       0.089
 n=105, N=0.24   2.0 (1.4) 98.0 (1.4)    n=108,   6.5 (2.7) 93.5 (2.7)  
 Educated 7.8 (2.9) 0.0 (0.0) 7.9 (3.0)    N=0.18 11.3 (4.8) 37.0 (21.7) 9.5 (4.9)  
 Not educated 92.2 (2.9) 100.0 (0.0) 92.1 (3.0)     88.7 (4.8) 63.0 (21.7) 90.5 (4.9)  
DM       0.014 DM       0.067
 n=386, N=1.00   8.0 (1.8) 92.0 (1.8)    n=493,   14.9 (2.1) 85.1 (2.1)  
 Educated 12.0 (1.9) 26.5 (8.9) 10.7(1.8)    N=1.01 12.2 (1.7) 20.1 (5.9) 10.8(1.7)  
 Not educated 88.0 (1.9) 73.5 (8.9) 89.3(1.8)     87.8 (1.7) 79.9 (5.9) 89.2(1.7)  
Stroke       0.132 Stroke       0.329
 n=91, N=0.22   6.6 (3.2) 93.4 (3.2)    n=96,   9.1 (4.9) 90.9 (4.9)  
 Educated 4.5 (2.4) 18.0 (17.2) 3.5 (2.2)    N=0.15 9.4 (3.6) 22.7 (21.3) 8.1 (3.3)  
 Not educated 95.5 (2.4) 82.0 (17.2) 96.5 (2.2)     90.6 (3.6) 77.3 (21.3) 91.9 (3.3)  
Total       <0.001 Total       <0.001
 n=1329, N=3.62   7.6 (1.0) 92.4 (1.0)    n=1831,   13.2 (1.0) 86.8 (1.0)  
 Educated 6.8 (0.8) 19.2 (4.8) 5.8 (0.8)    N=3.65 8.2 (0.8) 15.7 (2.9) 7.1 (0.8)  
 Not educated 93.2 (0.8) 80.8 (4.8) 94.2 (0.8)     91.8 (0.8) 84.3 (2.9) 92.9 (0.8)  

Abbreviations: HTN, Hypertension; DLP, Dyslipidemia; CAD, Coronary artery disease; DM, Diabetes mellitus; n, unweighted sample size; N, weighted sample size in millions.

Calculated by χ2 test.

Nutrients most commonly read and effects of nutrition label using in nutrition label users

Male HTN DLP CAD DM Stroke Total
n=53, N=0.18 n=24, N=0.08 n=3, N=0.005 n=25, N=0.08 n=4, N=0.01 n=78, N=0.27
Effect of nutrition label using, % (SE)a 79.8 (6.7) 92.8 (5.1) 77.7 (27.5) 61.3 (11.6) 39.1 (27.5) 76.7 (5.3)
Nutrients,% (SE)b
 Total Calories 23.8 (6.7) 24.9 (9.0) 61.8 (35.6) 36.0 (10.0) 18.0 (19.8) 27.2 (5.4)
 Carbohydrate 1.2 (1.2) 3.2 (3.3) 15.8 (20.7) 0 0 2.1 (1.3)
 Sugar 3.0 (2.9) 2.3 (2.4) 0 11.1 (6.7) 0 3.3 (2.1)
 Protein 16.6 (6.6) 2.3 (2.3) 0 10.4 (7.2) 0 12.5 (4.8)
 Fat 34.2 (7.8) 32.9 (9.6) 0 30.4 (11.9) 50.2 (29.6) 30.7 (6.1)
 Cholesterol 16.9 (5.9) 22.6 (10.2) 22.3 (27.5) 4.8 (3.0) 31.8 (29.1) 19.0 (5.1)
 Na 0.6 (0.6) 0 0 1.4 (1.5) 0 0.4 (0.4)
 Others 4.4 (2.4) 11.8 (7.3) 0 5.9 (4.6) 0 4.9 (2.4)
Female
 n=125, N=0.31 n=69, N=0.17 n=6, N=0.01 n=53, N=0.15 n=4, N=0.01 n=192, N=0.48
Effect of nutrition label using, % (SE) 78.2 (4.3) 85.8 (5.1) 89.3 (11.5) 78.6 (7.1) 22.7 (24.5) 77.8 (3.5)
Nutrients,% (SE)
 Total Calories 22.9 (4.5) 22.6 (5.5) 43.9 (23.2) 33.4 (7.6) 5.5 (7.0) 24.7 (3.7)
 Carbohydrate 0.7 (0.7) 0 19.4 (19.0) 0 0 0.9 (0.7)
 Sugar 6.7 (2.5) 4.6 (2.7) 0 22.7 (7.3) 27.8 (28.2) 9.1 (2.6)
 Protein 5.6 (2.0) 6.4 (3.1) 0 6.7 (3.5) 0 6.8 (1.9)
 Fat 23.1 (3.8) 26.2 (6.2) 36.7 (23.6) 16.5 (5.7) 22.7 (24.5) 21.4 (3.0)
 Cholesterol 26.2 (4.6) 35.3 (6.7) 0 11.9 (4.8) 0 26.3 (3.7)
 Na 4.7 (2.0) 0 0 1.8 (1.8) 0 3.0 (1.3)
 Others 10.0 (3.5) 4.8 (2.5) 0 6.9 (4.4) 44.0 (33.9) 7.8 (2.4)

Abbreviations: HTN, Hypertension; DLP, Dyslipidemia; CAD, Coronary artery disease; DM, Diabetes mellitus. n, unweighted sample size; N, weighted sample size in millions.

Proportion of people who answered they were influenced by nutrition labels when purchasing food.

Nutrients which patients check first when reading nutrition labels.

Differences in nutrient intake according to nutrition label use in chronic disease patients, males

  Total Calories (kcal) Pa Carbohydrate (g) Pa Protein (g) Pa Fat (g) Pa Fiber (g) Pa Na (mg) Pa
HTN (n=1000, N=2.65)   0.737   0.200   0.883   0.800   0.057   0.169
 Users Non -users 1996.4±178.02057.1±35.6   331.6±3.9306.7±18.9   73.6±6.872.6±1.4   36.5±6.434.8±1.5   10.8±1.38.1±0.1   4841.4±427.15453.8±136.8  
DLP (n=255, N=0.73) Users Non -users 2352.2±151.42168.5±53.4 0.280 362.3±27.1340.9±7.7 0.462 84.5±7.481.4±2.6 0.701 42.8±6.739.7±2.0 0.676 9.5±1.19.4±0.4 0.967 6840.7±820.46242.9±295.9 0.495
CAD (n=105, N=0.24) Users Non -users 1091.8±288.81813.8±53.4 0.015 213.8±59.8323.2±9.7 0.074 31.3±7.361.6±2.5 <0.001 14.4±4.927.2±1.8 0.012 9.8±2.59.0±0.7 0.777 3187.1±1271.75563.2±415.9 0.118
DM (n=386, N=1.00) Users Non -users 1760.7±139.81983.0±53.1 0.137 311.1±21.6334.9±8.8 0.307 66.1±6.570.2±2.5 0.569 28.3±5.233.1±1.9 0.391 11.8±2.69.3±0.6 0.362 5021.1±541.65216.9±254.2 0.740
Stroke (n=106, N=0.22) Users Non -users 1510.8±247.51755.0±63.7 0.372 286.9±30.2310.2±11.0 0.503 50.0±18.059.8±2.9 0.607 14.5± 10.926.6±2.0 0.292 6.3±2.07.4±0.4 0.605 3631.8±1250.74324.8±293.5 0.604
Total (n=1329, N=3.62) Users Non -users 1982.5±130.62053.2±32.1 0.597 312.7±15.1333.7±4.2 0.184 71.6±5.173.1±1.4 0.778 34.3±4.735.1±1.4 0.866 9.6±1.08.6±0.3 0.407 5062.3±377.55556.2±145.6 0.219

Abbreviations: HTN, Hypertension; DLP, Dyslipidemia; CAD, Coronary artery disease; DM, Diabetes mellitus. n, unweighted sample size; N, weighted sample size in millions; Users, patients who read nutrition labels; Non-users, patients who do not read nutrition labels.

Calculated by multivariable linear regression analysis adjusted for age, area, education, income, smoking status, frequency of alcohol intake, physical activity and BMI.

Differences in nutrient intake according to nutrition label use in chronic disease patients, females

  Total Calories (kcal) Pa Carbohydrate (g) Pa Protein (g) Pa Fat (g) Pa Fiber (g) Pa Na (mg) Pa
HTN (n=1441, N=2.84)                        
 Users Non -users 1348.4±55.61438.4±18.5 0.152 254.0±10.6266.9±3.7 0.292 46.6±2.648.4±0.7 0.524 18.9±1.520.1±0.5 0.468 6.7±0.56.8±0.2 0.894 3373.6±213.73582.3±70.6 0.373
DLP (n=408, N=0.87)                        
 Users Non -users 1461.7±68.31555.6±33.3 0.252 265.2±13.8283.4±6.2 0.265 54.2±3.454.1±1.4 0.969 23.8±2.724.2±1.0 0.899 6.5±0.57.4±0.3 0.187 3628.8±310.63916.7±152.6 0.435
CAD (n=108, N=0.18)                        
 Users Non -users 1307.4±204.71415.2±46.6 0.605 254.3±49.0269.1±9.9 0.768 49.4±12.447.5±2.1 0.882 18.4±5.717.9±1.3 0.937 10.2±4.06.3±0.3 0.327 2779.9±493.73575.1±207.1 0.148
DM (n=493, N=1.01)                        
 Users Non -users 1228.6±99.01480.5±40.3 0.037 215.5±19.0278.4±8.0 0.007 45.4±4.048.2±1.2 0.544 20.2±2.519.9±0.8 0.926 5.6±0.66.8±0.2 0.064 3779.0±399.83510.1±127.8 0.542
Stroke (n=96, N=0.15)                        
 Users Non -users 1036.9±250.51429.9±59.9 0.133 162.2±43.2274.8±12.4 0.014 50.1±13.045.4±2.1 0.730 22.8±5.017.1±1.1 0.266 3.5±1.05.8±0.3 0.042 2546.8±652.63279.7±207.1 0.285
Total (n=1831, N=3.65)                        
 Users Non -users 1363.0±47.01467.9±16.9 0.049 249.3±8.9272.4±3.4 0.023 47.8±2.149.5±0.6 0.472 20.3±1.420.8±0.4 0.735 6.3±0.46.9±0.1 0.242 3537.6±203.43673.1±64.6 0.543

Abbreviations: HTN, Hypertension; DLP, Dyslipidemia; CAD, Coronary artery disease; DM, Diabetes mellitus. n, unweighted sample size; N, weighted sample size in millions; Users, patients who read nutrition labels; Non-users, patients who do not read nutrition labels.

Calculated by multivariable linear regression analysis adjusted for age, area, education, income, smoking status, frequency of alcohol intake, physical activity and BMI.