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Kang, Lee, Kim, Kwon, Choi, Chung, Kwak, and Cho: Selecting items of a food behavior checklist for the development of Nutrition Quotient (NQ) for children∗
Original Article

Korean J Nutr 2012;45(4):372-389.

Published online: 8 January 2012

DOI: https://doi.org/10.4163/kjn.2012.45.4.372

Selecting items of a food behavior checklist for the development of Nutrition Quotient (NQ) for children∗

Myung-Hee Kang1, §, Jung-Sug Lee2, Hye-Young Kim3, Sehyug Kwon4, Young-Sun Choi5, Hae Rang Chung6, Tong-Kyung Kwak7, Yang-Hee Cho8

1Department of Food & Nutrition, Daeduk Valley Campus, Hannam University, Daejeon 305-811, Korea

2FANSA (Food and Nutrition Statistical Analysis), Seoul 153-764, Korea

3Department of Food & Nutrition, Yongin University, Yongin 449-714, Korea

4Department of Statistics, Hannam University, Daejeon 306-791, Korea

5Department of Food & Nutrition, Daegu University, Daegu 712-714, Korea

6Nutrition for the Future Inc., Seoul 151-848, Korea

7Department of Food & Nutrition, Yonsei University, Seoul 120-749, Korea

8Amway Korea Ltd., Seoul 135-713, Korea

∗ This research was supported by a grant from Amway Korea Ltd. in 2011.

§To whom correspondence should be addressed. E-mail: mhkang@hnu.kr

      Revised 23 July 20122 August 2012       Accepted 6 August 2012

Copyright © 2012 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

The objective of this study is to select a simple and easy measurable food behavior checklist for the development of Nutrition Quotient (NQ) for children, which reflects children's diet quality, as well as to evaluate the validity of the items in the food behavior checklist. The first 36 items in the checklist were established by an expert review, modifying the preliminary 50 items in the checklist, which had been selected by a literature review and the Korean National Health and Nutrition Examination Survey data. 341 children in 5th and 6th grades at an elementary school participated in a one-day dietary record survey, and later responded to 36 food behavior questions of the checklist. Pearson's correlation coefficients between the responses to the food behavior checklist items along with the mean nutrient intakes of the children were calculated. From the result, in which responses of food frequency and food behavior items showed certain association with the dietary record data, a second checklist with 22 items was selected. A survey was conducted by using the second checklist. 1,393 children in the 5th and 6th grades at 12 elementary schools in metropolitan cities, such as Seoul, Busan, Gwangju, Daegu, Daejeon, and Incheon, participated in the survey. Further, an exploratory factor analysis was performed. After the analysis, 19 items (10 items from food frequency and 9 items from food behavior) were finalized as the food behavior checklist items for the NQ. The final 19 food behavior checklist items were composed of 5 factors: ‘Balance’, ‘Diversity’, ‘Moderation’, ‘Regularity’, and ‘Practice’. This study is a significant first trial to establish a comprehensive system for evaluating children's food habit and diet quality. This checklist might need continuous modification and revision reflecting the change of children's dietary life and the social environment.

Keywords: nutrition quotient, children, food behavior checklist, dietary record

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Fig. 1.
Development of the NQ checklist items.
kjn-45-372f1.tif
Fig. 2.
Percentage of average nutrient intake of the children to recommended nutrient intake (RNI) or adequate intake (AI). ∗: Nutrient intake of male subjects are significantly different from those of female subjects by Student t-test at α = 0.05 level.
kjn-45-372f2.tif
Fig. 3.
Percentage of children below Estimated Average Requirement (EAR). ∗: Nutrient intake of male subjects are significantly different from those of female subjects by Student t-test at α = 0.05 level.
kjn-45-372f3.tif
Fig. 4.
Food behavior checklist for children's NQ.
kjn-45-372f4.tif
Table 1.
The first tentative checklist of 36 food frequency and food behavior items for the nutrient survey for children
Food frequency checklist items
1. Do you eat more often cooked rice with whole grain than cooked rice?
2. How many kinds of vegetables (except Kimchi) do you eat in each meal?
3. How often do you eat Kimchi?
4. How often do you eat fruits?
5. How often do you eat fruit juice?
6. How often do you eat white milk?
7. How often do you eat flavored processed milk?
8. How often do you eat milk products (cheese, yoghurt, etc.)?
9. How often do you eat bean or bean products (tofu, soymilk, soy noodle soup, etc.)?
10. How often do you eat meat, pork or chicken?
11. How often do you eat fish (including shrimp, octopus, shellfish etc.)?
12. How often do you eat eggs?
13. How often do you eat sweet foods?
14. How often do you eat fast foods (pizza, hamburger etc.)?
15. How often do you eat oily foods (bacon or fried food)?
16. How often do you eat processed foods (ham, sausage, etc.)?
17. How often do you eat ramyeon (instant noodle)?
18. How often do you eat ramyeon soup?
Food behavior checklist items
19. How often do you eat breakfast?
20. Do you eat your meals regularly?
21. Do you eat adequate amount of meal?
22. Do you eat diverse side dishes in each meal?
23. Do you chew well whenever you eat?
24. Do you eat your meal at the table?
25. Do you spend plenty of time for each meal?
26. How often do you eat snacks?
27. How often do you eat late-night snacks?
28. Do you eat your meal always with family or with friends?
29. Do you eat your meal always in a pleasant mood?
30. How often do you eat street foods?
31. Do you check the nutrition labeling when you buy processed foods?
32. Do you take dietary supplements?
33. Do you wash your hands before meal?
34. Did you attend a nutrition education class in the last 6 months?
35. How long do you watch TV and/or play computer game a day?
36. How many hours do you spend for exercise (including walking) a day?
Table 2.
Anthropometric characteristics of the children
Total (n = 341) Male (n = 185) Female (n = 156) p-value 1)
Height (cm) 145.5 ± 10.2 2) 145.3 ± 7.4 145.8 ± 12.8 NS 3)
Weight (Kg) 43.2 ± 10.2 44.1 ± 10.6 42.2 ± 9.5 NS
BMI (Kg/m 2) 20.1 ± 3.4 20.7 ± 3.5∗ 19.5 ± 3.2 0.001
% body fat 26.2 ± 8.0 26.4 ± 8.4 26.0 ± 7.4 NS
Body weight       NS
 Under weight (%) 1.5 1.1 1.9  
 Normal (%) 73.9 70.8 77.6  
 Over weight (%) 12.9 14.6 10.9  
 Obesity (%) 11.7 13.5 9.6  

1) Student t-test

2) Mean ± SD

3) Not significant

Table 3.
Nutrient intakes of the children
Total (n = 341) Male (n = 185) Female (n = 156) p-value 1)
Energy (kcal) 1579 ± 406 2) 1631 ± 442 1517 ± 350 0.009
Protein (g) 58.1 ± 20.4 60.9 ± 22.8 54.7 ± 16.5 0.004
Fat (g) 44.7 ± 19.1 46.1 ± 20.0 42.9 ± 18.0 NS 3)
Carbohydrate (g) 236.0 ± 57.5 242.8 ± 60.3 228.1 ± 53.1 0.018
Dietary Fiber (g) 12.8 ± 3.8 12.7 ± 3.9 12.9 ± 3.7 NS
Ca (mg) 545.6 ± 219.2 568.9 ± 234.6 517.9 ± 196.6 0.030
P (mg) 836.8 ± 265.3 868.5 ± 282.8 799.2 ± 238.3 0.015
Fe (mg) 9.8 ± 5.5 9.9 ± 4.6 9.8 ± 6.5 NS
Na (mg) 2509 ± 971 2526 ± 1045 2489 ± 878 NS
K (mg) 1956 ± 597 1979 ± 656 1928 ± 518 NS
Zn (mg) 7.5 ± 2.5 7.8 ± 2.7 7.2 ± 2.1 0.012
Vitamin A (μgRE) 567.6 ± 361.1 596.8 ± 456.5 533.0 ± 191.0 NS
Vitamin B1 (mg) 0.98 ± 0.44 0.99 ± 0.44 0.97 ± 0.44 NS
Vitamin B2 (mg) 1.06 ± 0.42 1.10 ± 0.46 1.01 ± 0.37 NS
Vitamin B6 (mg) 1.96 ± 0.91 1.96 ± 0.96 1.97 ± 0.85 NS
Niacin (mg) 11.8 ± 5.9 12.2 ± 6.7 11.5 ± 4.6 NS
Vitamin C (mg) 49.5 ± 31.4 47.8 ± 30.9 51.6 ± 32.1 NS
Folate (μg DFE) 153.2 ± 68.7 152.3 ± 75.7 154.2 ± 59.5 NS
Vitamin E (mg) 9.0 ± 4.5 9.3 ± 4.5 8.8 ± 4.5 NS
Cholesterol (mg) 299.2 ± 180.1 317.7 ± 192.7 277.3 ± 161.8 0.036

1) Student t-test

2) Mean ± SD

3) Not significant

Table 4.
Nutrient intakes per 1,000 kcal of the children
Total (n = 341) Male (n = 185) Female (n = 156) p-value 1)
Protein (g) 36.6 ± 7.0 2) 37.2 ± 7.7 36.0 ± 6.0 NS 3)
Fat (g) 27.6 ± 7.1 27.5 ± 6.7 27.7 ± 7.6 NS
Carbohydrate (g) 151.3 ± 19.3 150.8 ± 18.3 151.8 ± 20.4 NS
Dietary Fiber (g) 8.3 ± 2.2 8.0 ± 2.1 8.6 ± 2.2 0.004
Ca (mg) 353.6 ± 125.7 359.8 ± 132.3 346.3 ± 117.6 NS
P (mg) 533.0 ± 104.4 536.7 ± 105.2 528.5 ± 103.6 NS
Fe (mg) 6.3 ± 3.3 6.1 ± 2.1 6.5 ± 4.2 NS
Na (mg) 1612 ± 510 1576 ± 534 1653 ± 480 NS
K (mg) 1268 ± 352 1237 ± 328 1304 ± 377 NS
Zn (mg) 4.8 ± 0.9 4.8 ± 1.0 4.8 ± 0.8 NS
Vitamin A (μgRE) 368.1 ± 198.8 377.0 ± 247.9 357.5 ± 116.3 NS
Vitamin B1 (mg) 0.61 ± 0.19 0.61 ± 0.18 0.63 ± 0.20 NS
Vitamin B2 (mg) 0.67 ± 0.18 0.67 ± 0.19 0.67 ± 0.17 NS
Vitamin B6 (mg) 1.24 ± 0.47 1.19 ± 0.43 1.30 ± 0.50 0.034
Niacin (mg) 7.4 ± 2.5 7.3 ± 2.9 7.5 ± 2.0 NS
Vitamin C (mg) 32.5 ± 21.3 30.7 ± 21.2 34.6 ± 21.3 NS
Folate (μg DFE) 99.8 ± 42.7 96.2 ± 44.6 104.1 ± 40.0 NS
Vitamin E (mg) 5.8 ± 2.6 5.8 ± 2.5 5.8 ± 2.7 NS
Cholesterol (mg) 187.9 ± 102.6 191.5 ± 104.0 183.6 ± 101.0 NS

1) Student t-test

2) Mean ± SD

3) Not significant

Table 5.
Mean scores and significant correlations of the food frequency checklist items with dietary quality variables by the 10 to 11 years-old children 1)
Food frequency items Mean scores (± SD)(n = 341) Correlation coefficients with nutrient intakes 56) and other variables (n = 341)
Intake frequency of cooked rice with 2.64 ± 0.99 2) 0.130 (Dietary fiber) 5)
  whole grain   0.120 (Potassium) 5)
Number of vegetables in each meal 3.54 ± 0.63 2) 0.130 (Sodium) 5)
    0.131 (Vitamin C) 6)
Intake frequency of Kimchi 4.50 ± 0.87 3) 0.130 (Energy)
    0.107 (Dietary fiber) 6)
    0.131 (Calcium) 6)
    0.143 (Sodium)6)
    0.108 (Potassium) 6)
    0.137 (Vitamin C) 6)
    0.111 (Folate) 5)
    0.173 (DVS) 7)
Intake frequency of fruits 3.56 ± 1.11 3) 0.131 (Dietary fiber) 5)
    0.115 (Calcium) 6)
    0.150 (Potassium) 5)
    0.186 (Vitamin C)5)
    -0.120 (% body fat)
    0.168 (DVS)
    0.155 (DDS) 8)
Intake frequency of white milk 4.04 ± 0.94 3) 0.316 (Calcium)5)
    0.160 (Potassium) 5)
    0.262 (Riboflavin) 5)
    0.139 (DDS)
Intake frequency of legumes 2.79 ± 1.12 2) 0.120 (Sodium)5)
    0.150 (Potassium)5)
    0.107 (Riboflavin) 5)
    0.140 (Vitamin C) 5)
Intake frequency of fish or shellfish 2.30 ± 0.79 2) 0.108 (Sodium)6)
Intake frequency of egg 2.75 ± 0.94 2) 0.170 (Energy)
    -0.121 (Dietary fiber) 5)
    0.131 (Protein)6)
    0.206 (Calcium) 6)
    0.136 (Sodium) 6)
    0.122 (Potassium) 6)
    0.124 (Vitamin A) 6)
    0.122 (Riboflavin)6)
Intake frequency of sweet food 3.36 ± 0.95 3,4) -0.151 (Energy)
  (cookies, chocolate, candy etc.)   -0.140 (Dietary fiber) 6)
    0.186 (Protein) 5)
    0.192 (Calcium)5)
    0.116 (Vitamin A)5)
Intake frequency of fast food 4.52 ± 0.65 3,4) -0.126 (DVS) -0.202 (Energy)
  (Pizza, hamburger etc.)   0.126 (Protein) 5)
    0.194 (Calcium)5)
    0.170 (Potassium) 5)
    0.128 (Vitamin A) 5)
    0.126 (Vitamin C) 5)
Intake frequency of oily food 4.04 ± 0.60 3,4) -0.130 (Energy)
  (bacon, fried food, fried chicken etc.) 0.197 (Dietary fiber) 5)
    0.130 (Sodium) 5)
    0.180 (Potassium) 5)
    0.121 (Vitamin C) 5)
    0.145 (Folate)5)
Intake frequency of ramyeon 3.93 ± 0.66 3,4) -0.110 (Energy)
    0.170 (Dietary fiber) 5)
    0.138 (Calcium)5)
    0.190 (Potassium) 5)
    0.163 (Vitamin A)5)
    0.111 (Vitamin C) 5)

1) The following 6 of the 18 food frequency checklist items did not show correlations with nutrients intake per 1,000kcal or % Korean DRI (RNI or AI) of the nutrient intakes of the children: fruit juice, fruit-flavor milk, milk product, meat, oily food, ramyeon soup

2) Maximum score is 4

3) Maximum score is 5

4) High scores means low intake frequency

5) Nutrients intake represents amount per 1,000 kcal of energy intake

6) % Korean DRI (RNI or AI) of the nutrient intakes

7) DVS: Dietary variety score

8) DDS: Dietary diversity score

Table 6.
Mean scores and significant correlations of the food behavior checklist items with dietary quality variables by the 10 to 11 years-old children 1)
Food behavior items Mean scores (± SD)(n = 341) Correlation coefficients with nutrient intakes 5,6) and other variables (n = 341)
Eating breakfast 3.49 ± 0.92 2) -0.110 (Energy)
    -0.112 (Protein) 6)
    -0.116 (Sodium) 6)
    -0.119 (BMI)
    -0.118 (DVS)
Meal regularity 2.94 ± 0.85 2) -0.173 (Calcium) 5)
    -0.119 (Sodium)6)
    -0.146 (Potassium) 6)
Diverse side dishes 3.08 ± 0.79 2) -0.122 (Dietary fiber) 5)
    -0.140 (Sodium)5)
    -0.117 (Vitamin C) 5)
Chewing well 3.17 ± 0.82 2) -0.110 (Energy) 5)
    -0.116 (Calcium)5)
    -0.120 (Potassium) 5)
    -0.133 (Zinc)5)
    -0.148 (BMI)
Frequent eating late-night snack 3.21 ± 0.97 2,4) -0.127 (Protein) 5)
    -0.137 (Calcium) 5)
Time for TV watching & 1.93 ± 0.89 2,4) -0.160 (Energy)
computer game   -0.116 (Dietary fiber) 5)
    -0.212 (Calcium) 5)
Frequency of eating street food 3.12 ± 0.82 2,4) -0.210 (Energy)
    -0.117 (Protein)6)
    -0.114 (Fat) 5)
    -0.122 (Calcium)5)
    -0.134 (Iron) 6)
    -0.151 (Sodium)6)
    -0.117 (Zinc) 6)
    -0.125 (Vitamin A)5)
    -0.117 (Riboflavin) 6)
Checking nutrition labeling 2.15 ± 0.91 2) -0.158 (Calcium) 5)
    -0.132 (BMI)
    -0.136 (% body fat)
Washing hands before meal 3.27 ± 0.75 2) -0.116 (Protein) 5)
    -0.140 (Calcium) 5)
    -0.140 (Potassium) 5)
    -0.133 (Vitamin C) 5)
Time for exercise 3.22 ± 0.83 2) -0.134 (Vitamin C) 6)

1) The following 8 of the 18 food behavior checklist items did not show correlations with nutrients intake per 1,000 kcal or % Korean DRI (RNI or AI) of the nutrient intakes of the children: proper amount of meal, eating at table, enough meal time, eating alone, enjoying meal time, frequency of snacks, taking dietary supplements, taking nutrition education class

2) Maximum score is 4

3) Maximum score is 5

4) High scores means low intake frequency

5) Nutrients intake represents amount per 1,000 kcal of energy intake

6) % Korean DRI (RNI or AI) of the nutrient intakes

7) DVS: Dietary variety score

8) DDS: Dietary diversity score

Table 7.
Factor loading coefficients of the survey data with 22 checklist items for NQ
Checklist items Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6
Intake frequency of legumes 0.618 0.227 -0.024 0.102 0.084 0.084
Intake frequency of fish & shellfish 0.604 0.183 -0.143 0.110 0.035 -0.013
Intake frequency of eggs 0.559 0.157 -0.175 -0.032 -0.173 0.089
Intake frequency of cooked rice with whole grain 0.442 -0.099 0.106 0.012 0.107 -0.012
Intake frequency of fruits 0.436 0.135 -0.058 0.371 0.195 0.031
Intake frequency of white milk 0.374 0.008 0.119 0.096 0.126 0.381
Number of vegetables in each meal 0.112 0.783 0.079 0.064 0.103 -0.056
Intake frequency of Kimchi 0.099 0.748 0.069 0.093 0.027 0.150
Diverse side dishes 0.193 0.692 0.147 0.045 0.272 -0.018
Intake frequency of fast foods -0.024 0.101 0.719 0.075 -0.066 -0.032
Intake frequency of oily foods -0.137 0.096 0.686 0.022 -0.032 0.178
Intake frequency of Late-night snacks -0.016 0.142 0.619 0.027 -0.071 0.099
Intake frequency of ramyeon -0.107 0.022 0.600 0.285 0.098 0.007
Intake frequency of sweet foods 0.077 -0.038 0.598 -0.143 0.160 -0.121
Intake frequency of street foods 0.151 -0.084 0.531 0.025 0.133 -0.383
Eating breakfast -0.013 0.017 0.035 0.819 0.009 0.036
Meal regularity 0.210 0.119 0.091 0.624 0.172 0.062
Time for TV watching & computer game 0.203 0.098 0.257 0.372 0.100 -0.370
Washing hands before meal 0.001 0.163 0.016 0.042 0.714 0.176
Chewing well 0.042 0.145 -0.049 0.221 0.670 -0.088
Checking nutrition labeling 0.392 0.028 0.157 0.002 0.509 0.041
Exercise 0.171 0.071 0.048 0.063 0.105 0.763
Table 8.
Factor loading coefficients of final 19 NQ checklist items
Checklist items Factor 1 balance Factor 2 diversity Factor 3 moderation Factor 4 regularity Factor 5 practice
Intake frequency of legumes 0.59 0.26 -0.06 0.14 0.10
Intake frequency of cooked rice with whole grain 0.55 -0.10 0.11 0.01 0.08
Intake frequency of eggs 0.54 0.20 -0.24 0.02 -0.16
Intake frequency of white milk 0.53 0.08 0.06 0.09 0.05
Intake frequency of fruits 0.38 0.15 -0.08 0.41 0.20
Number of vegetables in each meal 0.07 0.77 0.07 0.08 0.11
Intake frequency of kimchi 0.11 0.76 0.04 0.09 0.03
Diverse side dishes 0.15 0.70 0.15 0.07 0.27
Intake frequency of fast foods -0.02 0.13 0.70 0.08 -0.09
Intake frequency of sweet foods 0.05 -0.01 0.64 -0.12 0.12
Intake frequency of street foods 0.10 -0.09 0.61 0.07 0.07
Intake frequency of late-night snacks -0.03 0.20 0.60 0.02 -0.08
Intake frequency of ramyeon -0.10 0.04 0.60 0.27 0.08
Eating breakfast -0.03 0.02 0.02 0.80 0.00
Meal regularity 0.18 0.14 0.08 0.64 0.16
Time for TV watching & computer game 0.12 0.06 0.30 0.43 0.08
Washing hands before meal 0.02 0.17 0.01 0.02 0.74
Chewing well 0.03 0.11 -0.03 0.24 0.67
Checking nutrition labeling 0.42 0.04 0.17 0.03 0.49
Eigen value 1.29 2.09 3.39 1.10 1.05
Cronbach α 0.48 0.70 0.66 0.36 0.47
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