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Chung, Tong-Kyung, Kim, Kang, Lee, Chung, Kwon, Hwang, and Choi: Development of NQ-E, Nutrition Quotient for Korean elderly: item selection and validation of factor structure∗
Research Article

J Nutr Health 2018;51(1):87-102.

Published online: 20 January 2018

DOI: https://doi.org/10.4163/jnh.2018.51.1.87

Development of NQ-E, Nutrition Quotient for Korean elderly: item selection and validation of factor structure∗

Min-Jae Chung1, Kwak Tong-Kyung1, Hye-Young Kim2, Myung-Hee Kang3, Jung-Sug Lee4, Hae Rang Chung5, Sehyug Kwon6, Ji-Yun Hwang7, Young-Sun Choi†

1Department of Food and Nutrition, Yonsei University, Seoul 03722, Korea

2Department of Food and Nutrition, Yongin University, Yongin, Gyeonggi 17092, Korea

3Department of Food and Nutrition, Hannam University, Daejeon 34430, Korea

4Department of Food and Nutrition, Kookmin University, Seoul 02707, Korea

5Nutrition for the Future Inc., Seoul 08788, Korea

6Department of Statistics, Hannam University, Daejeon 34430, Korea

7Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea

8Department of Food and Nutrition, Daegu University, Gyeongsan, Gyeongbuk 38453, Korea

† To whom correspondence should be addressed. tel: +82-53-850-6833, E-mail: yschoi@daegu.ac.kr

∗ This research was supported by a grant (14162MFDS126) from Ministry of Food and Drug Safety in 2014.

Received 12 January 2018       Revised 1 February 2018       Accepted 8 February 2018

Copyright © 2018 The Korean Nutrition Society

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

Purpose:

The purpose of this study was to develop a valid instrument for measuring the dietary quality and behaviors of Korean elderly.

Methods:

The development of the Nutrition Quotient for Elderly (NQ-E) was conducted in three steps: item generation, item reduction, and validation. The 41 items of the NQ-E checklist were derived from a systematic literature review, expert in-depth interviews, statistical analyses of the fifth Korean National Health and Nutrition Examination Survey data, and national nutrition policies and recommendations. Pearson's correlation was used to determine the level of agreement between the questionnaires and nutrient intake level, and 24 items were selected for a nationwide survey. A total of 1,000 nationwide elderly subjects completed the checklist questionnaire. The construct validity of the NQ-E was assessed using confirmatory factor analysis, LISREL.

Results:

The nineteen checklist items were used as final items for NQ-E. Checklist items were composed of four-factors: food behavior (6 items), balance (4 items), diversity (6 items), and moderation (3 items). The standardized path coefficients were used as the weights of the items. The NQ-E and four-factor scores were calculated according to the obtained weights of the questionnaire items.

Conclusion:

NQ-E would be a useful tool for assessing the food behavior and dietary quality of the elderly.

Keywords: nutrition quotient for the elderly, NQ-E, food behavior, dietary quality, checklist

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Fig. 1.
Process of NQ-E development. 1) FBC, Food Behavior Checklist
jnh-51-87f1.tif
Fig. 2.
Comparison of percentage of nutrient intake of the elderly from the pilot study to recommended nutrient intake (RNI) or adequate intake (AI) according to NQ-E score four-grade criterion. a, b: Means with different alphabets are significantly different by Duncan's multiple-range test (p < 0.05).
jnh-51-87f2.tif
Table 1.
Checklist items selected for the pilot survey
Items regarding food intakes Items regarding eating behaviors
1. Cooked rice with mixed grains 1. Meal eating frequency
2. Number of vegetable dishes excluding Kimchi at each meal 2. Meal regularity
3. Intake frequency of Kimchi 3. Intake frequency of snack
4. Intake amount of Kimchi at a meal 4. Balanced consumption of side dishes
5. Intake frequency of beans or bean products 5. Overeating behavior
6. Intake frequency of meats 6. Mood at meal time
7. Intake frequency of eggs 7. Eating alone frequency
8. Intake frequency of fishes or shellfishes 8. Dietary supplements intake
9. Intake frequency of nuts 9. Smoking
10. Intake frequency of fruits 10. Drinking frequency of more than 3 cups of alcohol a day
11. Intake frequency of milk or dairy products 11. Healthy teeth and gums
12. Intake frequency of water 12. Difficulties in chewing foods
13. Intake frequency of sugar added beverages 13. Check the expiration date when purchasing processed foods
14. Intake frequency of sweet and greasy baked products 14. Experience in nutrition education and counseling
15. Intake frequency of instant noodle, ramyeon 15. Efforts to have healthy eating habits
16. Degree of gravy and sauce consumption of main dishes 16. Exercise hours
17. Intake frequency of salted foods 17. The type of chronic diseases
18. Degree of consumption of salted foods 18. Depressed condition
  19. Perception level for one's health
  20. Regular food aid beneficiaries
  21. Proper cold holding practices for foods and meals
  22. Proper washing hands practices before eating meals
  23. Dietary life circumstances
Table 2.
Items selected for a nationwide survey checklist
      Pearson's correlation coefficients with data from the pilot survey1) Rationales of selection
Criteria Items DDS2), Nutrient intake per 1,000 kcal %RNI or %AI Significant correlation coefficient Guideline & policy
  Vegetable 1. Number of vegetable dishes excluding Kimchi at each meal Fat & oil (+0.125), protein (+0.134), dietary fiber (+0.199), vitamin A (+0.139), vitamin C (+0.160), riboflavin (+0.173), niacin (+0.219), vitamin B6 (+0.198), folate (+0.203), sodium (+0.131), potassium (+0.223), iron (+0.151) Dietary fiber (+0.170), vitamin A (+0.143), vitamin C (+0.158), riboflavin (+0.150), niacin (+0.199), vitamin B6 (+0.160), folate (+0.169), vitamin B12 (+0.129), potassium (+0.183) ○  
    2. Intake frequency of beans or bean products DDS (+0.140), protein (+0.133), dietary fiber (+0.144)   ○  
    3. Intake frequency of eggs Carbohydrate (−0.230), fat & oil (+0.202), protein (+0.223), riboflavin (+0.206), sodium (+0.148), cholesterol (+0.345) Riboflavin (+0.122), sodium (+0.155) ○  
  Fish, eggs and beans 4. Intake frequency of fishes or shellfishes Carbohydrate (−0.193), fat & oil (+0.163), protein (+0.228), riboflavin (+0.197), folate (+0.178), vitamin B12 (+0.194), calcium(+0.154), potassium (+0.164), iron (+0.164), cholesterol (+0.243) Vitamin B12 (+0.175 ○  
    5. Intake frequency of nuts DDS (+0.132), carbohydrate (−0.196), fat & oil (+0.251), protein (+0.131), dietary fiber (+0.133), riboflavin(+0.192), calcium(+0.142), potassium (+0.124) Dietary fiber (+0.131), riboflavin(+0.166), niacin (+0.122), calcium(+0.129) ○  
Food intake Fruit 6. Intake frequency of fruits DDS (+0.294), dietary fiber (+0.203), vitamin A (+0.132), vitamin C (+0.256), riboflavin (+0.290), vitamin B6 (+0.218), folate (+0.2141), calcium (+0.269), potassium (+0.292), iron (+0.154), cholesterol (+0.132) Protein (+0.133), dietary fiber (+0.199), vitamin A (+0.146), vitamin C (+0.262), riboflavin (+0.291), niacin (+0.131), vitamin B6 (+0.216), folate (+0.199), calcium(+0.258), potassium (+0.272), iron (+0.141) ○  
  MIlk and dairy products 7, Intake frequency of milk or milk products DDS (+0.181), fat & oil (+0.137), riboflavin (+0.226), calcium (+0.246), cholesterol (+0.134) Riboflavin (+0.236), calcium (+0.249) ○  
  water 8. Intake frequency of Water Protein (+0.155), dietary fiber (+0.127), vitamin C (+0.147), thiamin (+0.136), folate (+0.178), potassium (+0.132) Vitamin C (+0.155), folate (+0.174), potassium (+0.126) ○  
  Processed foods 9. Intake frequency of sugar added beverages Vitamin C (−0.176), thiamin (−0.176), niacin (−0.131), vitamin B6 (−0.205), sodium (+0.122), iron (−0.139), zinc (−0.140) Vitamin C (−0.138), riboflavin (−0.131), vitamin B6 (−0.156), sodium (+0.163), zinc (−0.143) ○  
    10. Intake frequency of sweets or greased pastries Dietary fiber (−0.172), vitamin C (−0.135), folate (−0.145), calcium (−0.133)   ○  
  Salted foods/Strong flavored foods 11. Intake frequency of ramyeon Dietary fiber (−0.131), vitamin C (−0.125), calcium (−0.177), potassium (−0.141), zinc (−0.216) Dietary fiber (−0.206), vitamin C (−0.148), vitamin B6 (−0.122), folate (−0.131), calcium(−0.156), potassium (−0.136), iron (−0.127), zinc (−0.265) ○  
    12. Intake frequency of salted foods Folate (+0.169), sodium (+0.138), iron (+0.167) Folate (+0.143), vitamin B12 (+0.141), sodium (+0.138) ○  
  Meal frequency 13. Meal frequency Protein (+0.165), thiamin (+0.175), niacin (+0.157), calcium (+0.132), sodium (+0.147) Protein (+0.206), dietary fiber (+0.124), vitamin A (+0.126), thiamin (+0.225), niacin (+0.200), folate (+0.189), vitamin B12 (+0.128), calcium (+0.208), sodium (+0.241), potassium (+0.172), iron (+0.188), zinc (+0.128) ○  
    14. Intake frequency of snack DDS (+0.343), riboflavin (+0.215) Energy (+0.151), dietary fiber (+0.144), vitamin C (+0.162), riboflavin (+0.274), niacin (+0.153), vitamin B6 (+0.141), calcium (+0.167), potassium (+0.174) ○  
  Meal alone 15. Eating alone frequency DDS (−0.146), dietary fiber (−0.126), potassium (−0.138), iron (−0.123) Energy (−0.170), protein (−0.223), dietary fiber (−0.209), vitamin C (−0.139), niacin (−0.151), vitamin B6 (−0.196), folate (−0.209), vitamin B12 (−0.145), calcium (−0.190), sodium (−0.130), potassium (−0.263), iron (−0.227), zinc (−0.191) ○  
    16. Check the expiration date when purchasing processed foods DDS (+0.153), fat & oil (+0.135), protein (+0.128), riboflavin (+0.143), niacin (+0.127) Riboflavin (+0.172), niacin (+0.122) ○ ○
  Food selection 17. Experience in nutrition education and counseling Zinc (−0.129), Vitamin B6 (−0.127), sodium (−0.170), zinc (−0.127) ○
Dietary behavior & attitude   18. Efforts to have healthy eating habits DDS (+0.125), dietary fiber (+0.165), riboflavin (+0.215), vitamin B6 (+0.173), folate (+0.129), calcium (+0.127), potassium (+0.177), iron (+0.134) Dietary fiber (+0.176), vitamin A (+0.158), vitamin C (+0.168), riboflavin (+0.210), vitamin B6 (+0.177), folate (+0.172), calcium (+0.150), potassium (+0.196), iron (+0.131) ○ ○
  Physical activity 19. Exercise hours DDS (+0.168), carbohydrate (−0.138), fat & oil (+0.142), protein (+0.126), thiamin (+0.153), calcium (+0.148) Dietary fiber (+0.127), thiamin (+0.128), calcium (+0.144), iron (+0.128) ○
  Personal hygiene 20. Proper washing hands practices before eating meals Vitamin B6 (+0.125), calcium (+0.145), potassium (+0.137), iron (+0.155), zinc (+0.179)    
    21. Difficulties in chewing foods Protein (−0.181), vitamin B12 (−0.152), calcium (−0.180), potassium (−0.126), iron (−0.154), zinc (−0.172) Protein (−0.207), dietary fiber (−0.154), niacin (−0.135), vitamin B6 (−0.146), folate (−0.130), vitamin B12 (−0.152), calcium(−0.222), sodium (−0.152), potassium (−0.202), iron (−0.198), zinc (−0.184) ○ ○
    22. Depressed condition Protein (−0.155), dietary fiber (−0.124), potassium (−0.156), zinc (−0.166) Protein (−0.138), vitamin C (−0.122), calcium (−0.134), potassium (−0.175), zinc (−0.124) ○
Others   23. Perception level for one's health 24. Dietary life circumstances DDS (+0.168), dietary fiber (+0.156), vitamin C (+0.147), calcium (+0.183), zinc (+0.159) DDS (+0.345), protein (+0.202), dietary fiber (+0.226), vitamin A (+0.152), vitamin C (+0.156), niacin (+0.168), folate (+0.155), vitamin B12 (+0.161), calcium (+0.243), potassium (+0.227), iron (+0.120), Zinc (+0.155), cholesterol (+0.125) Dietary fiber (+0.154), vitamin C (+0.170), calcium (+0.197), potassium (+0.159), zinc (+0.124) Energy (+0.260), protein (+0.327), dietary fiber (+0.343), vitamin A (+0.269), vitamin C (+0.283), thiamin (+0.178), riboflavin (+0.282), niacin (+0.290), vitamin B6 (+0.276), folate (+0.316), vitamin B12 (+0.202), calcium (+0.342), potassium (+0.374), iron (+0.329), zinc (+0.310) ○

1) p < 0.05 2) DDS, dietary diversity score

Table 3.
Results of exploratory factor analysis of the 19 items selected by LISREL analysis (n = 1,000)
Checklist items Factor 1 Factor 2 Factor 3 Factor 4
Difficulties in chewing foods 0.597 0.044 0.027 –0.020
Perception level for one's health 0.582 0.069 0.212 0.060
Depressed condition 0.578 –0.111 0.149 0.078
Washing hands practices before eating meals 0.428 0.254 –0.209 –0.233
Exercise hours 0.376 0.265 –0.024 0.013
Efforts to have healthy eating habits 0.337 0.238 0.139 –0.235
Intake frequency of milk or dairy products 0.118 0.530 0.022 –0.009
Intake frequency of fruits 0.294 0.480 –0.008 0.139
Intake frequency of eggs –0.045 0.473 0.316 –0.039
Intake frequency of snack 0.029 0.461 0.003 0.098
Intake frequency of water 0.038 0.404 –0.046 –0.054
Intake frequency of fishes or shellfishes –0.019 0.291 0.596 –0.045
Eating alone frequency 0.081 –0.197 0.553 0.121
Number of vegetable dishes excluding Kimchi at each meal 0.322 0.061 0.461 0.034
Intake frequency of beans or bean products –0.027 0.294 0.445 –0.224
Meal frequency 0.164 –0.217 0.387 0.111
Intake frequency of sweet and greasy baked products –0.153 0.317 –0.052 0.672
Intake frequency of sugar added beverages 0.237 0.073 –0.005 0.633
Intake frequency of ramyeon –0.034 –0.072 0.062 0.317
Eigen value 2.39 1.38 1.20 1.17
Cumulative % of variance 12.6 19.9 26.2 32.4
Table 4.
Weights and path coefficients of four-factor structure model
Groups and items selected for NQ-E checklist and their weights
Group (Group weight)1) Checklist items Path coefficient within each group Item weight within NQ
  1. Difficulties in chewing foods 0.227 0.068
  2. Perception level for one's health 0.201 0.060
Dietary behavior 3. Depressed condition 0.212 0.063
(0.30) 4. Washing hands practices before eating meals 0.099 0.030
  5. Exercise hours 0.122 0.037
  6. Efforts to have healthy eating habits 0.140 0.042
  1. Intake frequency of milk or dairy products 0.295 0.059
Balance 2. Intake frequency of fruits 0.432 0.086
(0.20) 3. Intake frequency of snack 0.189 0.038
  4. Intake frequency of water 0.084 0.017
  1. Intake frequency of eggs 0.147 0.029
  2. Intake frequency of fishes or shellfishes 0.198 0.040
Diversity 3. Eating alone frequency 0.209 0.042
(0.20) 4. Number of vegetable dishes excluding Kimchi at each meal 0.258 0.052
  5. Intake frequency of beans or bean products 0.135 0.027
  6. Meal frequency 0.053 0.011
Moderation (0.30) 1. Intake frequency of sweet and greasy baked products 2. Intake frequency of sugar addeed beverages 3. Intake frequency of ramyeon 0.339 0.316 0.345 0.102 0.095 0.104

1) Group weights were adjusted by opinions of expert advisors.

Table 5.
NQ-E score and group score calculation using response point of the checklist
Group group Items Scale Item score: B tem weight within group: C Item weight within NQ: D
weight: A Question Response point
Dietary behavior 0.3 Difficulties in chewing foods Never 5 (response point-1) × 100/4 0.227 0.068
Seldom 4
Moderate 3
Often 2
Always 1
Very low 1
Perception level for one's health low 2 (response point-1) × 100/4 (response point-1)
Moderate 3 0.201 0.060
High 4
Very high 5
Never 5
Seldom 4
Depressed condition Moderate 3 (response point-1) × 100/4 (response point-1) 0.212 0.063
Often 2
Always 1
Never 1
Washing hands practices before eating meals Seldom 2
Moderate 3 (response point-1) × 100/4 0.099 0.030
Often 4 × 100/4
Always 5  
Seldom 1  
Less than 30 minutes 2 (response point-1) × 100/4
Exercise hours 30 minutes ∼ 1 hour 3 0.122 0.037
1 ∼ 2 hours 4
More than 2 hours 5
Never 1
Efforts to have healthy eating habits Seldom 2 (response point-1) × 100/4
Moderate 3 0.140 0.042
Often 4
  Always 5
  Subtotal         1.000
Balance 0.2 Intake frequency of milk or dairy products Less than once every 2 weeks 1 0.295 0.059  
1 ∼ 3 times per week 2 (response point-1) × 100/4
4 ∼ 6 times per week 3
Intake frequency of fruits Once a day 4 0.432 0.086
Twice a day 5
Never 1
Intake frequency of snack Once a day 2 (response point-1) × 100/3 0.189 0.038
Twice a day 3
More than three times a day 4
Seldom 1
Intake frequency of water Once or twice a day 2 (response point-1) × 100/4
Three ∼ five times a day 3 0.084 0.017
Six ∼ seven times a day 4
More than eight times a day 5
Subtotal     1.000
Diversity 0.2 Intake frequency of eggs Once per two weeks 1 0.147 0.029
1 ∼ 3 times a week 2 (response point-1) × 100/4
4 ∼ 6 times a week 3
Intake frequency of fishes or shellfish Once a day 4 0.198 0.040
More than twice a day 5
Seldom 5
Once per 2 ∼ 3 days 4 (response point-1) × 100/4
Eating alone Once a day 3 0.209 0.042
Twice a day 2
3 times a day 1
Moderation 0.3 Number of vegetable dishes at each meal Never 1 1 2 (response point-1) × 100/4 0.258 0.052
2 3
3 4
    More than 4 5
        Once per two weeks 1
Intake frequency of beans or bean products 1 ∼ 3 times a week 2 (response point-1) × 100/4 (response point-1)    
4 ∼ 6 times a week 3 0.135 0.027
Once a day 4
More than twice a day 5
1 1
Meal frequency 2 2 (response point-1) × 100/2 0.053 0.011
More than 3 3
Subtotal     (response point-1) × 100/4 1.000 0.102
Intake frequency of sweet (candies, chocholate, etc.) or greasy baked goods Less than once per two weeks 5
1 ∼ 3 times a week 4
4 ∼ 6 times a week 3 0.339
Once a day 2
More than twice a day 1
Less than once per two weeks 5
Intake frequency of sugar added beverages 1 ∼ 3 times a week 4 (response point-1) × 100/4
4 ∼ 6 times a week 3 0.316 0.095
Once or twice a day 2
More than three times a day 1
Seldom 6
Once per two weeks 5
Intake frequency of ramyeon 1 ∼ 3 times a week 4 (response point-1) × 100/5 0.345 0.104
4 ∼ 6 times a week 3
Once a day 2
More than twice a day 1
Subtotal 1.000
Table 6.
6. NQ-E checklist
Nutrition quotient checklist for the elderly (over 65 years)
1. How many vegetable dishes (excluding kimchi) do you take at each meal? (귀하는 한 번 식사할 때 김치를 제외한 채소류를 몇 가지나 #xB4DC;십니까?)
① Never (먹지 않는다) ② 1 (1가지) ③ 2 (2가지) ④ 3 (3가지) ⑤ More than 4 (4가지 이상)
2. How often do you eat fruits? (귀하는 과일을 얼마나 자주 드십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)  
3. How often do you have milk or milk product? (귀하는 우유 또는
① Less than once every 2 weeks (2주일에 1번 이하) 유제품을 얼마나 자주 드십니까?) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)  
4. How often do you eat beans or tofu (including soymilk)? (귀하는 콩이나 콩제품을 얼마나 자주 드십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)  
5. How often do you eat eggs? (귀하는 달걀을 얼마나 자주 드십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)
6. How often do you eat fishes or shellfishes? (귀하는 생선이나 조개류를 얼마나 자주 드십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)  
7. How often do you eat ramyeon? (귀하는 라면류를 얼마나 자주 드십니까?)
① Seldom (거의 먹지 않는다) ② Once every 2 weeks (2주일에 1번)
③ 1 ∼ 3 times a week (일주일에 1 ∼ 3번) ④ 4 ∼ 6 times a week (일주일에 4 ∼ 6번)
⑤ Once a day (하루에 1번) ⑥ More than twice a day(하루에 2번 이상)
8. How often do you eat snacks (including chocolate, candies) or sweet and greasy baked goods (cake, donut, etc)? (귀하는 과자 (초콜릿, 사탕 포함) 또는 달거나 기름진 빵 (케이크, 도넛, 단팥빵 등)을 얼 마나 자주 드십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ More than twice a day (하루에 2번 이상)  
9. How often do you drink sweetened beverages? (귀하는 가당 음료를 얼마나 자주 마십니까?)
① Less than once every 2 weeks (2주일에 1번 이하) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once or twice a day (하루에 1 ∼ 2번)
⑤ More than 3 times a day (하루에 3번 이상)  
10. How often do you drink water? (귀하는 하루에 물을 얼마나 자주 마십니까?)
① Seldom (거의 마시지 않는다) ② Once or twice a day (하루에 1 ∼ 2번)
③ 3 ∼ 5 times a day (하루에 3 ∼ 5번) ④ 6 ∼ 7 times a day (하루에 6 ∼ 7번)
⑤ More than 8 times a day (하루에 8번 이상)  
11. How often do you eat meals a day? (귀하는 하루에 식사를 몇 번 하십니까?)
① Once (1번) ② Twice(2번) ③ More than 3 times (3번 이상)
12. How often do you eat snacks a day? (귀하는 하루에 간식을 몇 번 하십니까?)
① Never (하지 않는다) ② Once (1번) ③ Twice (2번) ④ More than 3 times (3번 이상)
13. How often do you eat your meals alone? (귀하는 얼마나 자주 혼자서 식사를 하십니까?)
① Seldom (혼자 식사하는 경우가 거의 없다) ② 1 ∼ 3 times a week (일주일에 1 ∼ 3번)
③ 4 ∼ 6 times a week (일주일에 4 ∼ 6번) ④ Once a day (하루에 1번)
⑤ Twice a day (하루에 2번) ⑥ 3 times a day (하루에 3번)
14. How much efforts do you make to have healthy eating habits? (귀하는 평소에 건강에 좋은 식생활을 하려고 얼마나 노력하십니까?)
① No efforts (전혀 노력하지 않는다) ② Seldom make efforts (노력하지 않는 편이다)
③ Average (보통이다) ④ Trying to make efforts (노력하는 편이다)
⑤ Trying very hard to make efforts (매우 노력한다)  
15. Do you have any difficulties in chewing foods due to the problems of your teeth, dentures, or gums? (귀하는 현재 치아나 틀니, 잇몸 등의 문제로 인해 음식을 씹는 것이 어느 정도 불편하십니까?)
① Never uncomfortable (전혀 불편하지 않는다) ② Not uncomfortable (불편하지 않는 편이다)
③ So-so (보통이다) ④ Uncomfortable (불편한 편이다)
⑤ Very uncomfortable (매우 불편하다)  
16. Do you wash your hands before eating your meals? (귀하는 음식을 먹기 전에 손을 씻으십니까?)
① Never wash (전혀 씻지 않는다) ② Do not wash (씻지 않는 편이다)
③ So-so (보통이다) ④ Trying to wash (씻는 편이다)
⑤ Wash always (항상 씻는다)  
17. How many hours do you exercise a day? (귀하는 하루에 운동을 얼마나 하십니까?)
① Seldom (거의 하지 않는다)  
② Less than 30 minutes (30분 이내)  
③ More than 30 minutes ∼ Less than 1 hour (30분 이상 ∼ 1시간 이내)
④ More than 1 hour ∼ Less than 2 hours (1시간 이상 ∼ 2시간 이 내)
⑤ More than 2 hours (2시간 이상)  
18. How often do you feel depressed condition in a day? (귀하는 평상 시 우울함을 어느 정도 느끼십니까?)
① Never (전혀 느끼지 않는다) ② Not depressed (느끼지 않는 편이다)
③ So-so (보통이다) ④ Depressed (느끼는 편이다)
⑤ Very depressed (매우 느낀다)  
19. How healthy do you think it is? (귀하는 본인이 얼마나 건강하다고 생각하십니까?)
① Never (전혀 건강하지 않다) ② Not healthy (건강하지 않는 편이다)
③ So-so (보통이다) ④ Healthy (건강한 편이다)
⑤ Very healthy (매우 건강하다)
Table 7.
NQ-E score range by the four-grade criterion
Mean score1) Grade criterion2)
  (N = 1,000) High Medium-high Medium-low Low
NQ-E score 57.6 ± 8.7 63.5–100 57.6–63.4 51.9–57.5 0–51.8
Dietary behavior 55.0 ± 14.5 64.9–100 55.1–64.8 45.2–55.0 0–45.1
Balance 41.4 ± 19.0 55.2–100 41.6–55.1 25.8–41.5 0–25.7
Diversity 50.0 ± 14.4 60.0–100 50.5–59.9 40.3–50.4 0–40.2
Moderation 76.5 ± 15.8 91.5–100 76.3–91.4 67.8–76.2 0–67.7

1) mean ± SD 2) High: 75% ≤ NQ-E percentile ≤ 100%, Medium-high: 50% ≤ NQ-E percentile < 75%, Medium-low: 25% ≤ NQ-E percentil < 50%, Low: 0% ≤ NQ-E percentile < 25%

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