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.2017.17.2.80 kjhp-17-80 Original Article Snack Consumption Patterns and Its Nutritional Significance in Korean Elderly Population: from the 2013-2014 Korea National Health and Nutrition Examination Survey ChoEun Byul ParkHyun Ah KangJae-Heon KimKyoungwoo ChoYoung Gyu ChoiDong-Hyun Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Corresponding author : Hyun Ah Park, PhD Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea Tel: +82-2-2270-0097, Fax: +82-2-2267-2030 E-mail: drparkhyunah@gmail.com 012017 19012017 17280 90 10012017 02062017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 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. Background:

This study aims to evaluate the importance of snacks to a balanced diet by assessing snack consumption patterns and factors associated with eating snacks of Korean elders of 60 years or more.

 Methods:

This analysis is based on participants from the 2013-2014 Korea National Health and Nutrition Examination Survey. Meal or snack consumption was based on a 24 hours recall data, and the adequacy of each nutrient intake was based on the Dietary Reference Intakes by the Korea Nutrition Society. The cutoff for snack consumption valued as meaningful was more than 200 kcal/day of snack energy intake.

 Results:

Korean male elders of age 60 years or more are consuming 333.6±11.1 kcal of snack and 271.7±7.4 kcal for females. When consumed together with meals, snack consumption increased the adequacy of all nutrients intake, except sodium. Based on energy contribution, male Korean elders are consuming snack food group in order of beverage and alcohols, grains, and fruits, while for females the order was grains, fruits, and dairy. Older age (men and women), joblessness (men), and chronic disease (women) were positively associated with having snack of 200 kcal or more per day, whereas ‘living with a partner (men)’, alcohol intake frequency of more than twice per week (men), and ‘doing regular aerobic physical activity (women)’ showed negative association.

 Conclusions:

Snack consumption of Korean elders contributed to more adequate nutritional status, but improvement of food groups is needed because they were mainly concentrated on grains.

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Adequacy of nutrients intake from snacks and meals of Korean elderly population. (A) Male, (B) female.

General characteristics of study population

Proportion (SE) Male Female Total
Unweighted, n 1,484 2,028 3,512
Age (mean [SE]), y 70.0 (0.2) 71.6 (0.4) 70.1 (0.2)
60s 52.6 (1.5) 49.5 (1.5) 50.8 (1.2)
70s 38.5 (1.4) 38.2 (1.3) 38.3 (1.0)
80+ 8.9 (0.7) 12.3 (0.8) 10.8 (0.6)
Household income      
Lower class 37.5 (1.6) 46.1 (1.6) 42.3 (1.4)
Lower middle class 28.3 (1.4) 27.0 (1.3) 27.5 (1.1)
Upper middle class 19.3 (1.2) 15.1 (1.0) 17.0 (0.9)
Upper classs 14.9 (1.2) 11.8 (1.1.) 13.2 (1.0)
Education, y      
≤9 10-12 59.5 (1.6) 24.9 (1.3) 83.5 (1.2) 11.7 (0.9) 73.0 (1.2) 17.5 (0.8)
≥13 15.6 (1.3) 4.8 (0.6) 9.5 (0.8)
Employed 39.4 (1.6) 25.4 (1.2) 31.5 (1.1)
Family type      
Living alone 7.4 (0.7) 22.2 (1.0) 15.7 (0.8)
Living with partner 49.4 (1.6) 29.7 (1.1) 38.2 (1.2)
Othersa 43.2 (1.6) 48.2 (1.3) 46.0 (1.3)
Having chronic diseaseb 61.3 (1.5) 74.8 (1.2) 68.9 (1.0)
Body mass index (mean [SE])      
Underweight/normal 44.8 (1.5) 35.6 (1.3) 39.6(1.0)
Overweight 26.8 (1.2) 24.6 (1.1) 25.6 (0.8)
Obese 28.5 (1.3) 39.5 (1.3) 34.7 (0.9)
On a therapeutic diet Current smoker 20.0 (1.1) 23.9 (1.3) 23.2 (1.2) 2.9 (0.4) 21.8 (0.9) 12.0 (0.6)
Alcohol intake frequency per week      
0 30.7 (1.3) 60.8 (1.3) 47.7 (1.0)
1 38.7 (1.5) 34.2 (1.2) 36.2 (1.0)
≥2 30.5 (1.4) 5.0 (0.6) 16.1 (0.8)
Regular aerobic activityc doers 51.2 (2.4) 38.1 (2.3) 44.0 (1.8)

Abbreviation: SE, standard error. Values are presented as mean or proportion (standard error) unless otherwise indicated.

Other family type refers to all types except for people who live alone or with partner.

Chronic diseases include hypertension, dyslipidemia, stroke, myocardial infarction, ischemic heart disease, osteoarthritis, rheumatoid arthritis, asthma, diabetes, thyroid disease, chronic kidney disease, chronic viral hepatitis, and liver cirrhosis, and any types of cancer.

Regular aerobic physical activity consists of either 2 hours and a half of medium-level body work out or an hour and 15 minutes of high-level body work out or a compound of a medium and high level body work out achieved in a week.

Nutrients intake from snacks and meals of Korean elderly population

Mean (SE) Intake from snacks Snacks proportion (%) Intake from meals Total intake
Male (unweighted n=1,484)        
Energy, kcal 333.6 (11.1) 17.0 (0.5) 1,652.4 (18.6) 1,986.0 (21.9)
Protein, g 7.3 (0.3) 11.3 (0.5) 58.1 (0.9) 65.3 (1.0)
Fat, g 6.3 (0.3) 19.9 (0.9) 25.5 (0.7) 31.7 (0.8)
Saturated fat, g 2.1 (0.1) 24.1 (1.2) 6.8 (0.2) 9.0 (0.3)
Carbohydrate, g 53.9 (1.7) 16.5 (0.5) 277.2 (3.3) 331.1 (3.9)
Calcium, mg 82.9 (3.9) 17.4 (0.7) 399.2 (10.0) 482.0 (11.3)
Phosphorus, mg 159.0 (5.8) 15.3 (0.5) 893.0 (13.0) 1,052.0 (15.2)
Iron, mg 2.3 (0.1) 11.4 (1.1) 17.7 (1.5) 19.9 (1.5)
Sodium, mg 199.4 (11.7) 5.4 (0.3) 3,622.6 (69.1) 3,822.0 (71.5)
Potassium, mg 642.0 (23.0) 21.1 (0.6) 2,426.0 (40.1) 3,068.0 (50.7)
Vitamin A, μgRE 99.1 (16.1) 14.3 (2.0) 608.5 (20.7) 707.7 (25.8)
Carotene, μg 479.0 (95.4) 13.2 (2.3) 3,275.8 (119.2) 3,754.9 (148.1)
Retinol, μg 16.9 (3.0) 21.0 (3.4) 55.8 (5.4) 72.8 (7.2)
Thiamin, mg 0.3 (0.01) 14.4 (0.5) 1.7 (0.03) 2.0 (0.03)
Riboflavin, mg 0.2 (0.01) 17.2 (0.8) 1.0 (0.02) 1.2 (0.02)
Niacin, mg 2.1 (0.1) 14.6 (0.5) 12.8 (0.2) 14.9 (0.3)
Vitamin C, mg 40.5 (2.7) 41.1 (1.7) 59.9 (2.2) 100.4 (3.7)
Female (unweighted n=2,020)        
Energy, kcal 271.7 (7.4) 17.5 (1.7) 1,289.2 (15.1) 1,560.9 (17.0)
Protein, g 6.3 (0.2) 12.9 (0.4) 43.4 (0.7) 49.7 (0.7)
Fat, g 4.7 (0.2) 20.7 (0.8) 18.3 (0.5) 23.0 (0.6)
Saturated fat, g 1.7 (0.1) 27.0 (1.1) 4.6 (0.1) 6.3 (0.2)
Carbohydrate, g 52.7 (1.5) 18.5 (0.5) 232.3 (2.8) 285.0 (3.2)
Calcium, mg 85.6 (3.2) 22.4 (0.7) 299.2 (6.3) 384.7 (7.5)
Phosphorus, mg 146.8 (4.5) 17.7 (0.5) 686.8 (10.1) 833.6 (11.6)
Iron, mg 2.6 (0.4) 16.9 (2.0) 13.0 (0.2) 15.6 (0.5)
Sodium, mg 179.8 (10.1) 6.5 (0.4) 2,722.5 (57.7) 2,902.3 (58.7)
Potassium, mg 656.6 (22.8) 25.3 (0.7) 1,951.3 (36.3) 2,607.9 (45.1)
Vitamin A, μgRE 112.4 (20.6) 18.4 (2.9) 498.6 (19.0) 611.1 (26.3)
Carotene, μg 559.2 (122.0) 17.1 (3.2) 2,707.3 (104.3) 3,266.4 (151.6)
Retinol, μg 16.9 (1.4) 28.6 (3.4) 42.3 (6.3) 59.2 (6.5)
Thiamin, mg 0.3 (0.01) 16.0 (0.5) 1.4 (0.02) 1.6 (0.02)
Riboflavin, mg 0.2 (0.01) 18.9 (0.7) 0.8 (0.02) 0.9 (0.02)
Niacin, mg 1.8 (0.1) 16.0 (0.5) 9.7 (0.2) 11.5 (0.2)
Vitamin C, mg 47.9 (2.8) 47.6 (1.5) 53.4 (2.1) 101.3 (3.9)

Abbreviation: SE, standard error. Values are presented as mean or proportion (standard error) unless otherwise indicated.

Top 5 snack food groups according to their contribution to energy intake of Korean elderly male population

Ranks Food groupa (kcal±SE)
1st 2nd 3rd 4th 5th
Male total Drinks or alcohols (87.9±5.2) Grains (67.0±5.4) Fruits (27.5±2.4) Dairy foods (32.5±2.8) Sugars (20.6±1.6)
Age, y          
60s Drinks or alcohols (107.3±9.2) Grains (71.8±7.3) Fruits (63.0±4.2) Dairy foods (32.1±3.3) Potatoes (19.6±4.1)
70s Drinks or alcohols (70.0±5.6) Grains (63.5±9.0) Fruits (55.1±5.0) Dairy foods (22.9±3.0) Sugars (22.4±3.1)
80+ Grains (53.4±12.9) Drinks or alcohols (51.3±8.1) Fruits (44.4±6.4) Sugars (21.0±4.4) Dairy foods (19.8±5.0)
Household income          
Lower Drinks or alcohols (100.6±11.0) Grains (63.5±7.2) Fruits (49.9±4.0) Dairy foods (21.6±3.0) Sugars (14.7±2.9)
Lower middle Grains (77.8±13.9) Drinks or alcohols (67.7±6.6) Fruits (61.5±5.7) Dairy foods (29.3±4.2) Sugars (24.0±4.0)
Upper middle Drinks or alcohols (103.7±12.0) Fruits (58.3±7.1) Grains (52.9±7.7) Dairy foods (28.8±4.5) Sugars (24.2±3.6)
Upper Drinks or alcohols (74.2±9.7) Fruits (73.3±7.5) Grains (73.6±13.0) Dairy foods (37.0±5.7) Potatoes (28.3±8.1)
Education, y          
≤9 Drinks or alcohols (93.3±6.4) Grains (62.7±6.4) Fruits (53.1±3.8) Dairy foods (26.6±3.4) Sugars (19.2±1.6)
10-12 Grains Drinks or alcohols Fruits Dairy foods Sugars
  (90.8±14.2) (87.3±9.1) (56.4±5.1) (24.8±3.3) (22.6±4.7)
≥13 Fruits (80.9±9.0) Drinks or alcohols (68.4±13.3) Grains (45.2±7.7) Dairy foods (35.1±5.9) Sugars (22.8±4.0)
Body mass index          
Under/normal Drinks or alcohols (88.8±7.1) Grains (61.9±6.5) Fruits (53.4±4.1) Dairy foods (28.3±3.5) Sugars (21.6±2.9)
Overweight Drinks or alcohols (85.9±10.2) Fruits (64.5±5.8) Grains (61.6±8.2) Dairy foods (27.4±4.0) Sugars (20.6±2.7)
Obese Drinks or alcohols (88.5±9.4) Grains (80.2±14.1) Fruits (60.2±5.1) Dairy foods (26.2±3.6) Sugars (20.0±2.2)

Abbreviation: SE, standard error. Values are presented as mean (standard error) unless otherwise indicated.

Food group classification adapted by the KNHNES were used. 13

Top 5 snack food groups according to their contribution to energy intake of Korean elderly female population

Ranks Food groupa (kcal±SE)
1st 2nd 3rd 4th 5th
Female total Grains (67.7±4.4) Fruits (65.4±2.8) Dairy foods (33.5±1.9) Drinks or alcohols (28.8±1.5) Potatoes (23.2±2.5)
Age, y          
60s Grains (81.1±6.2) Fruits (78.5±4.1) Dairy foods (40.2±3.0) Drinks or alcohols (29.2±2.0) Potatoes (27.9±4.1)
70s Grains (60.9±7.5) Fruits (54.6±3.5) Dairy foods (28.9±2.5) Drinks or alcohols (28.6±2.2) Potatoes (19.2±3.2)
80+ Household income Fruits (46.6±8.2) Grains (35.2±5.6) Drinks or alcohols (27.8±5.9) Dairy foods (21.0±3.3) Potatoes (17.1±3.9)
Lower Grains (59.6±5.8) Fruits (54.6±3.9) Dairy foods (28.4±2.4) Drinks or alcohols (28.2±2.4) Potatoes (20.0±2.7)
Lower middle Grains (71.1±9.5) Fruits (70.1±4.7) Dairy foods (33.8±3.3) Drinks or alcohols (29.7±2.5) Potatoes (27.8±5.7)
Upper middle Fruits (81.3±6.3) Grains (77.9±10.4) Dairy foods (36.2±6.0) Drinks or alcohols (31.2±3.5) Potatoes (18.5±6.3)
Upper Grains (78.5±12.0) Fruits (76.7±7.5) Dairy foods (49.5±6.5) Potatoes (31.6±8.8) Drinks or alcohols (26.4±3.6)
Education, y          
≤9 10-12 Grains (62.4±4.5) Grains (95.1±15.2) Fruits (62.2±3.1) Fruits (83.9±8.1) Dairy foods (31.8±2.0) Dairy foods (46.8±6.9) Drinks or alcohols (29.7±3.1) Drinks or alcohols (24.7±8.1) Potatoes (24.4±2.9) Nuts (20.4±4.2)
≥13 Grains (93.1±30.8) Fruits (77.1±11.0) Dairy foods (30.5±8.0) Drinks or alcohols (23.2±3.8) Nuts (20.0±11.6)
Body mass index          
Under/normal Grains (62.1±5.3) Fruits (60.6±4.8) Dairy foods (32.1±2.5) Drinks or alcohols (25.6±2.5) Potatoes (21.1±5.3)
Overweight Fruits (68.3±5.2) Grains (66.5±8.7) Dairy foods (37.1±3.8) Drinks or alcohols (33.6±2.9) Potatoes (27.6±5.8)
Obese Grains (73.6±7.5) Fruits (68.1±4.5) Dairy foods (32.4±3.1) Drinks or alcohols (28.8±2.2) Potatoes (22.5±3.9)

Abbreviation: SE, standard error. Values are presented as mean (standard error) unless otherwise indicated.

Food group classification adapted by the KNHNES were used. 13

Proportion of snackers according to sociodemographic and health behavioral characteristics and multivariate modeling for snacking habit among Korean elderly population

  Male Female
  Proportion (SE) of snackersb OR (95% CI)a Proportion (SE) of snackersb OR (95% CI)a
Total 44.5 (1.7)   44.5 (1.7)  
Agea, y        
60s 39.8 (2.1) Referent 44.4 (1.7) Referent
70s 48.2 (2.3) 1.74 (1.17-2.58) 55.6 (2.1) 1.24 (0.93-1.63)
80+ 55.9 (4.9) 2.01 (1.00-4.04) 64.1 (3.2) 3.39 (1.69-6.79)
Household incomea        
Lower 45.5 (2.5) Referent 56.3 (1.9) Referent
Lower middle 47.5 (2.8) 1.33 (0.80-2.22) 50.0 (2.5) 1.03 (0.70-1.53)
Upper middle 43.5 (3.6) 1.45 (0.81-2.57) 46.1 (3.4) 0.76 (0.47-1.23)
Upper 37.4 (3.8) 1.22 (0.65-2.30) 40.0 (4.0) 0.59 (0.34-1.04)
Educationa, y        
≤9 45.6 (2.1) Referent 52.9 (1.4) Referent
10-12 41.9 (3.0) 0.73 (0.47-1.05) 39.2 (3.5) 0.93 (0.60-1.46)
≥13 44.2 (3.6) 0.99 (0.63-1.55) 50.0 (6.0) 1.49 (0.78-2.82)
Employeda        
Yes 35.3 (2.2) Referent 47.4 (2.5) Referent
No 50.4 (2.1) 1.69 (1.14-2.50) 52.4 (1.5) 1.07 (0.76-1.50)
Family typea        
Living alone 48.8 (4.6) Referent 56.8 (2.3) Referent
Living with partner 41.0 (2.2) 0.50 (0.25-0.98) 49.4 (2.1) 0.91 (0.61-1.34)
Othersc 47.6 (2.7) 0.72 (0.35-1.50) 49.6 (2.2) 0.99 (0.63-1.60)
Chronic diseased        
No 46.2 (2.4) Referent 48.3 (2.8) Referent
Yes 43.4 (2.0) 1.03 (0.71-1.51) 52.1 (1.4) 1.68 (1.10-2.58)
Body mass index        
Under/normal 45.8 (2.1) Referent 52.1 (2.3) Referent
Overweight 43.8 (3.0) 0.88 (0.57-1.34) 52.9 (2.3) 0.92 (0.61-1.41)
Obese 42.9 (2.9) 0.70 (0.46-1.07) 49.2 (2.1) 0.96 (0.66-1.39)
Therapeutic diet        
Yes 41.1 (3.3) Referent 45.9 (2.6) Referent
No 45.3 (1.8) 1.48 (0.88-2.15) 52.7 (1.5) 1.13 (0.76-1.70)
Smoking        
Smoker 45.1 (3.1) Referent 63.7 (6.5) Referent
Nonsmoker 44.3 (1.9) 0.96 (0.62-1.48) 50.8 (1.4) 0.31 (0.09-1.06)
Alcohol intake frequency per week        
0 47.6 (2.9) Referent 54.5 (1.7) Referent
1 47.1 (2.4) 0.87 (0.55-1.36) 45.9 (2.3) 0.75 (0.52-1.10)
≥2 38.0 (2.6) 0.62 (0.40-0.97) 46.6 (5.6) 0.61 (0.33-1.15)
Regular aerobic activity doerse        
No 40.0 (3.2) Referent 53.4 (2.5) Referent
Yes 41.3 (2.9) 1.16 (0.81-1.65) 37.8 (3.1) 0.59 (0.42-0.84)

Abbreviations: SE, standard error; OR, odds ratio; CI, confidence interval.

OR and 95% CI were estimated by multivariate logistic regression modelling after controlling all other variables included in the table.

Snackers are people who responded that they consume more than 200 kcal of snacks toward 24 hours recall diet survey.

Other family type refers to all types except for people who live alone or with partner.

Chronic diseases include hypertension, dyslipidemia, stroke, myocardial infarction, ischemic heart disease, osteoarthritis, rheumatoid arthritis, asthma, diabetes, thyroid disease, chronic kidney disease, chronic viral hepatitis, and liver cirrhosis, and any types of cancer.

Regular aerobic physical activity consists of either 2 hours and a half of medium-level body work out or an hour and 15 minutes of high-level body work out or a compound of a medium and high level body work out achieved in a week.