This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in
With the promulgation of the National Health Promotion Act in 1995, the Korea National Health and Nutrition Examination Survey (KNHANES) evolved out of the National Nutrition Survey (NNS) and the Health Interview Survey (HIS). Based on the issues and problems indicated through past several NNSs and HISs, KNHANES was devised allowing individual level data collection for diet, health behavior, and health examination. In 1998, KNHANES was conducted for the first time and the analysis on factors interrelating individual dietary intake, health status, and health behavior became possible since then.
The 2nd KNHANES was conducted in 2001 and an in-depth analysis of the result was performed in 2003. A poor nutritional intake status of preschool children from low socio-economic households was noted (
In this paper, we report the development of the
Based on the aforementioned urgent needs, a study was undertaken to develop a national scale supplemental nutrition care program for women, infants, and children adopting US WIC program as a benchmark (
In addition to that, several studies reported much higher anemia prevalence of 33-56% among pregnant women who visits public health centers (
Dietary intake data analysis revealed some target nutrients to be considered in the supplemental nutrition care program for economically and/or nutritionally deprived children and women (
Based on the list, candidates for supplemental foods were listed according to their target nutrient density and frequency of use in the Korean usual diet (
Additional analysis on the food intake of young children revealed that their milk and dairy product intake was too low not only to ensure a proper calcium intake but also for coping with the dietary guidelines set in 2003. As shown in
A total of 6 different kinds of supplemental food packages (I through VI) were developed (
Another point considered regarding food packages was how to provide supplemental foods to beneficiary. Because living environment in Korea is quite different from that of US, we were reluctant in adopting voucher system for benefit transfer. For most of households with income less than 100% MLE, private car was not available for grocery shopping, and for some remote areas, stores were rather distant from residence. And more than 90% of retail stores were too small in business to handle vouchers (
Although the supplemental food packages are important in improving nutritional status of beneficiaries, the importance of nutrition education as a core component of the
The exclusive breastfeeding rate of young children under 3 years in 1998 during their infancy was only 15.3% at 4 months (
Although WHO recommends to introduce complementary food to infants at 4-6 months of age, about 20% of young children under 3 years in 1998 had been given complementary food before 4 months of age (
Even though we were not able to analyze dietary intake data for pregnant and/or lactating women from 1998 and 2001 survey (KNHANES) due to small numbers of corresponding subjects (
In addition to the women, pregnant and postpartum up to 1 year, young children's age for eligibility needed to be set. Since the Ministry of Education & Human Resources Development were responsible for school lunch program and any nutrition education within school premises, preschool children under 6 years were chosen to be cared for by
Once the aforementioned 3 criteria are met, they were eligible to apply for the screening process for nutritional vulnerability, the final criterion. Anemia, stunting, underweight, and inadequate nutrient intake comprised the nutritional risk factors, and anyone with one or more risk factors became eligible to participate.
For nutritional screening, objective measures were devised especially because this step was the critical point in determining eligibility. More weights were given to biochemical and/or anthropometric parameters over simple nutrient intake insufficiency to avoid unnecessary dispute. Based on the Standard Growth Curve developed for Korean children (
For nutrient intake insufficiency, anyone with intake less than 75% of RDA (
Because the budget was limited and small compared to the estimated number of possible beneficiaries, a priority setting was necessary among various categories of women and children. Through an advisory committee, priority was set as follows (
Priority I: Pregnant women, lactating women, and infants with anemia or anthropometric risk(s) Priority II: Infants from women with clinical nutritional problems during pregnancy Priority III: Young children with anemia or anthropometric risk(s) Priority IV: Pregnant women, lactating women, and infants with inadequate nutrient intake Priority V: Young children with inadequate nutrient intake Priority VI: Non-breastfeeding postpartum women with one or more risk factor(s)
For the long-standing sustainability of the program we devised a protocol to evaluate and/or assess the process and outcome of the program. This was especially important for proving the program effect and securing the necessary budget (Health Promotion Fund) through convincing those responsible for compilation of government program budget.
The protocol was proposed in 2 parts, one for process and the other for outcome of the program along with establishing an agency or board to oversee the program management at public health center level and administer the protocol. For the outcome of the program, evaluation of the nutritional status change (enhancement in anthropometry and nutrition knowledge, improvement in dietary behavior and nutrient intake) was proposed for short-term measure and sample forms are shown in
A program,
The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk, which determined the priority in participation. A small-scale pilot study to examine the feasibility of the program implementation was run for the period of April through November 2005 in 3 public health centers, and 15 and 20 in following 2 years. The result of 3-year pilot study including some modification in program will be reported in a separate paper along with the ultimate nationwide implementation of the
Nutrient intake comparison among preschool children of 1-5 years by household income (
Change in total fertility rate (
Sample evaluation forms
Comparison of nutrient intake among children of 1-2 years by household income (
*Lowest: Income<100% of Minimum Living Expenses (MLE) **Low: 100~199% MLE
***Middle: 200~299% MLE ****High: 300%~ MLE
Comparison of nutrient intake among children of 3-6 years by household income (
*Lowest: Income<100% of Minimum Living Expenses (MLE) **Low: 100~199% MLE
***Middle: 200~299% MLE ****High: 300%~ MLE
Proportion of children and women with nutrient intake less than 75% of RDA (
Comparison of food group intake among children of 1-6 years in 2001 by household income and age (
*Lowest: Income<100% of Minimum Living Expenses (MLE) **Low: 100~199% MLE
***Middle: 200~299% MLE ****High: 300%~ MLE
Food source of target nutrients by food package (
Amount of food provided per person per day by food package (
Amount of target nutrient provided per person per day by food package (
Proportion of breastfeeding and bottle feeding by age during infancy of children under 3 years in 2001 (
Mean duration of breastfeeding and age at introduction of complementary food during infancy of children under 3 years in 2001 (
Distribution of children under 3 years in 2001 by age at introduction of complementary food during infancy (
Comparison of nutrient intake per capita per day by household income (
*Lowest: Income<100% of Minimum Living Expenses (MLE) **Low: 100~199% MLE
***Middle: 200~299% MLE ****High: 300%~ MLE