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)
- Seung Guk Park1, Hyeon Ju Kim2, Young-Min Kwon3, Mi Hee Kong2,
- Received January 28, 2014 Accepted September 17, 2014
- 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.
Table 1.
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
Table 2.
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.
Table 3.
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) | |||
Table 4.
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) |
Table 5.
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±178.0 2057.1±35.6 |
331.6±3.9 306.7±18.9 |
73.6±6.8 72.6±1.4 |
36.5±6.4 34.8±1.5 |
10.8±1.3 8.1±0.1 |
4841.4±427.1 5453.8±136.8 |
||||||
|
DLP (n=255, N=0.73) Users Non -users |
2352.2±151.4 2168.5±53.4 |
0.280 |
362.3±27.1 340.9±7.7 |
0.462 |
84.5±7.4 81.4±2.6 |
0.701 |
42.8±6.7 39.7±2.0 |
0.676 |
9.5±1.1 9.4±0.4 |
0.967 |
6840.7±820.4 6242.9±295.9 |
0.495 |
|
CAD (n=105, N=0.24) Users Non -users |
1091.8±288.8 1813.8±53.4 |
0.015 |
213.8±59.8 323.2±9.7 |
0.074 |
31.3±7.3 61.6±2.5 |
<0.001 |
14.4±4.9 27.2±1.8 |
0.012 |
9.8±2.5 9.0±0.7 |
0.777 |
3187.1±1271.7 5563.2±415.9 |
0.118 |
|
DM (n=386, N=1.00) Users Non -users |
1760.7±139.8 1983.0±53.1 |
0.137 |
311.1±21.6 334.9±8.8 |
0.307 |
66.1±6.5 70.2±2.5 |
0.569 |
28.3±5.2 33.1±1.9 |
0.391 |
11.8±2.6 9.3±0.6 |
0.362 |
5021.1±541.6 5216.9±254.2 |
0.740 |
|
Stroke (n=106, N=0.22) Users Non -users |
1510.8±247.5 1755.0±63.7 |
0.372 |
286.9±30.2 310.2±11.0 |
0.503 |
50.0±18.0 59.8±2.9 |
0.607 |
14.5± 10.9 26.6±2.0 |
0.292 |
6.3±2.0 7.4±0.4 |
0.605 |
3631.8±1250.7 4324.8±293.5 |
0.604 |
|
Total (n=1329, N=3.62) Users Non -users |
1982.5±130.6 2053.2±32.1 |
0.597 |
312.7±15.1 333.7±4.2 |
0.184 |
71.6±5.1 73.1±1.4 |
0.778 |
34.3±4.7 35.1±1.4 |
0.866 |
9.6±1.0 8.6±0.3 |
0.407 |
5062.3±377.5 5556.2±145.6 |
0.219 |
Table 6.
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±55.6 1438.4±18.5 |
0.152 |
254.0±10.6 266.9±3.7 |
0.292 |
46.6±2.6 48.4±0.7 |
0.524 |
18.9±1.5 20.1±0.5 |
0.468 |
6.7±0.5 6.8±0.2 |
0.894 |
3373.6±213.7 3582.3±70.6 |
0.373 |
| DLP (n=408, N=0.87) | ||||||||||||
|
Users Non -users |
1461.7±68.3 1555.6±33.3 |
0.252 |
265.2±13.8 283.4±6.2 |
0.265 |
54.2±3.4 54.1±1.4 |
0.969 |
23.8±2.7 24.2±1.0 |
0.899 |
6.5±0.5 7.4±0.3 |
0.187 |
3628.8±310.6 3916.7±152.6 |
0.435 |
| CAD (n=108, N=0.18) | ||||||||||||
|
Users Non -users |
1307.4±204.7 1415.2±46.6 |
0.605 |
254.3±49.0 269.1±9.9 |
0.768 |
49.4±12.4 47.5±2.1 |
0.882 |
18.4±5.7 17.9±1.3 |
0.937 |
10.2±4.0 6.3±0.3 |
0.327 |
2779.9±493.7 3575.1±207.1 |
0.148 |
| DM (n=493, N=1.01) | ||||||||||||
|
Users Non -users |
1228.6±99.0 1480.5±40.3 |
0.037 |
215.5±19.0 278.4±8.0 |
0.007 |
45.4±4.0 48.2±1.2 |
0.544 |
20.2±2.5 19.9±0.8 |
0.926 |
5.6±0.6 6.8±0.2 |
0.064 |
3779.0±399.8 3510.1±127.8 |
0.542 |
| Stroke (n=96, N=0.15) | ||||||||||||
|
Users Non -users |
1036.9±250.5 1429.9±59.9 |
0.133 |
162.2±43.2 274.8±12.4 |
0.014 |
50.1±13.0 45.4±2.1 |
0.730 |
22.8±5.0 17.1±1.1 |
0.266 |
3.5±1.0 5.8±0.3 |
0.042 |
2546.8±652.6 3279.7±207.1 |
0.285 |
| Total (n=1831, N=3.65) | ||||||||||||
|
Users Non -users |
1363.0±47.0 1467.9±16.9 |
0.049 |
249.3±8.9 272.4±3.4 |
0.023 |
47.8±2.1 49.5±0.6 |
0.472 |
20.3±1.4 20.8±0.4 |
0.735 |
6.3±0.4 6.9±0.1 |
0.242 |
3537.6±203.4 3673.1±64.6 |
0.543 |
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