Snack Consumption Patterns and Its Nutritional Significance in Korean Elderly Population: from the 2013-2014 Korea National Health and Nutrition Examination Survey

Eun Byul Cho; Hyun Ah Park; Jae-Heon Kang; Kyoungwoo Kim; Young Gyu Cho; Dong-Hyun Choi

doi:10.15384/kjhp.2017.17.2.80

Korean J Health Promot > Volume 17(2); 2017 > Article

Snack Consumption Patterns and Its Nutritional Significance in Korean Elderly Population: from the 2013-2014 Korea National Health and Nutrition Examination Survey

Original Article

Korean Journal of Health Promotion 2017;17(2):80-90.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.80

Snack Consumption Patterns and Its Nutritional Significance in Korean Elderly Population: from the 2013-2014 Korea National Health and Nutrition Examination Survey

Eun Byul Cho, Hyun Ah Park, Jae-Heon Kang, Kyoungwoo Kim, Young Gyu Cho, Dong-Hyun Choi

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

Received January 10, 2017 Accepted June 02, 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.

요약

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.

Keywords: Snack eating, Snack, Elders, Nutritional status

Figure 1.

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

Table 1.

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)
Others^a	43.2 (1.6)	48.2 (1.3)	46.0 (1.3)
Having chronic disease^b	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 activity^c 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.

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

^bChronic 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.

^cRegular 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.

Table 2.

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.

Table 3.

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

Ranks	Food group^a (kcal±SE)
Ranks	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.

^aFood group classification adapted by the KNHNES were used. 13

Table 4.

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

Ranks	Food group^a (kcal±SE)
Ranks	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.

^aFood group classification adapted by the KNHNES were used. 13

Table 5.

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 snackers^b	OR (95% CI)^a	Proportion (SE) of snackers^b	OR (95% CI)^a
Total	44.5 (1.7)		44.5 (1.7)
Age^a, 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 income^a
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)
Education^a, 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)
Employed^a
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 type^a
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)
Others^c	47.6 (2.7)	0.72 (0.35-1.50)	49.6 (2.2)	0.99 (0.63-1.60)
Chronic disease^d
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 doers^e
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.

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

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

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

^dChronic 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.

^eRegular 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.

REFERENCES

1.. Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract 2006;12(2):110-8.

2.. Kwon SO, Oh SY. Associations of household food insecurity with socioeconomic measures, health status and nutrient intake in low income elderly. Korean J Nutr 2007;40(8):762-8.

3.. Yim KS, Lee TY. Sociodemographic factors associated with nutrients intake of elderly in Korea. Korean J Nutr 2004;37(3):210-22.

4.. Kim SY, Kim SM. Energy intake and snack choice by the meal patterns of employed people. Nutr Res Pract 2010;4(1):43-50.

5.. Park MS, Suh YS, Chung YJ. Comparison of chronic disease risk by dietary carbohydrate energy ratio in Korean elderly: using the 2007-2009 Korea National Health and Nutrition Examination Survey. J Nutr Health 2014;47(4):247-57.

6.. Edelstein SL, Barrett-Connor EL, Wingard DL, Cohn BA. Increased meal frequency associated with decreased cholesterol concentrations; Rancho Bernardo, CA, 1984-1987. Am J Clin Nutr 1992;55(3):664-9.

7.. Kerver JM, Yang EJ, Obayashi S, Bianchi L, Song WO. Meal and snack patterns are associated with dietary intake of energy and nutrients in US adults. J Am Diet Assoc 2006;106(1):46-53.

8.. Mann J. Meal frequency and plasma lipids and lipoproteins. Br J Nutr 1997;77(Suppl 1):S83-90.

9.. Korea Centers for Disease Control and Prevention. Analysis guideline for users, the sixth korea National Health and Nutrition Examination Survey (KNHANES VI-3) [Internet]. Cheon gju: Korea Centers for Disease Control and Prevention; 2015. [Accessed Apr 26, 2017]. Available from:. http://www.mohw.go.kr/front_new/jb/sjb030301ls.jsp?PAR_MENU_ID=03&MENU_ID=032903&page=8#.

10.. Johnson GH, Anderson GH. Snacking definitions: impact on interpretation of the literature and dietary recommendations. Crit Rev Food Sci Nutr 2010;50(9):848-71.

11.. Ministry of Health and Welfare. Dietary Reference Intakes for Koreans (KDRIs) [Internet]. Sejong: Ministry of Health and Welfare, Republic of Korea, The Korean Nutrition Society; 2015. [Accessed Apr 26, 2017]. Available from:. http://www.mohw.go.kr/front_new/jb/sjb030301vw.jsp.

12.. Kohri T, Kaba N. Study of the effects of snack-centered dietary education on first-grade elementary students and duration of these effects. Am J Public Health Research 2015;3(1):1-7.

13.. Rural Development Administration. Food composition table 8th ed [Internet]. Jeonju: Rural Development Administration; 2011. [Accessed Apr 26, 2017]. Available from:. http://korean-food.rda.go.kr/kfi/fct/fctIntro/list?menuId=PS03562.

14.. Bellisle F, Dalix AM, Mennen L, Galan P, Hercberg S, de Castro J, et al. Contribution of snacks and meals in the diet of French adults: a diet-diary study. Physiol Behav 2003;79(2):183-9.

15.. Inglis V, Ball K, Crawford D. Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration. Appetite 2005;45(3):334-43.

16.. Grundy SM, Denke MA. Dietary influences on serum lipids and lipoproteins. J Lipid Res 1990;31(7):1149-72.

17.. Choi YS, Park WH, Song KE, Lee JB, Seo JM, Lee NH, et al. Diet lifestyle behaviors, serum antioxidant and lipid status in patients with coronary artery disease. Korean J Lipidol 1999;9:183-94.

18.. Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC, et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med 2013;369(21):2001-11.

19.. Ericson U, Hellstrand S, Brunkwall L, Schulz CA, Sonestedt E, Wallström P, et al. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am J Clin Nutr 2015;101(5):1065-80.

20.. Soroko S, Holbrook TL, Edelstein S, Barrett-Connor E. Lifetime milk consumption and bone mineral density in older women. Am J Public Health 1994;84(8):1319-22.

21.. Shahar D, Shai I, Vardi H, Fraser D. Dietary intake and eating patterns of elderly people in Israel: who is at nutritional risk? Eur J Clin Nutr 2003;57(1):18-25.

22.. Shin SK, Kim HJ, Choi BY, Lee SS. A comparison of food frequency for the elderly regarding different family types: based on Community Health Survey for 2008. Korean J Nutr 2012;45(3):264-73.

23.. Kim EM, Song YJ, Kim HS. Evaluation of eating habit and dietary intake by family type of seniors utilizing social welfare center in Seoul. Korean J Nutr 2007;40(8):753-61.

24.. Hillers VN, Massey LK. Interrelationships of moderate and high alcohol consumption with diet and health status. Am J Clin Nutr 1985;41(2):356-62.

25.. Shahar D, Shai I, Vardi H, Shahar A, Fraser D. Diet and eating habits in high and low socioeconomic groups. Nutrition 2005;21(5):559-66.

26.. Andersson J, Nydahl M, Gustafsson K, Sidenvall B, Fjellström C. Meals and snacks among elderly self-managing and disabled women. Appetite 2003;41(2):149-60.

27.. Drummond S, Crombie N, Kirk T. A critique of the effects of snacking on body weight status. Eur J Clin Nutr 1996;50(12):779-83.

28.. Summerbell C, Moody R, Shanks J, Stock M, Geissler C. Sources of energy from meals versus snacks in 220 people in four age groups. Eur J Clin Nutr 1995;49(1):33-41.

29.. Freisling H, van Bakel MM, Biessy C, May AM, Byrnes G, Norat T, et al. Dietary reporting errors on 24 h recalls and dietary questionnaires are associated with BMI across six European countries as evaluated with recovery biomarkers for protein and potassium intake. Br J Nutr 2012;107(6):910-20.