Journal List > J Nutr Health > v.47(6) > 1081360

J Nutr Health. 2014 Dec;47(6):403-415. Korean.
Published online December 31, 2014.
© 2014 The Korean Nutrition Society
Evaluation of nutrient and food intake status, and dietary quality according to abdominal obesity based on waist circumference in Korean adults: Based on 2010-2012 Korean National Health and Nutrition Examination Survey
Myeong Seong Kim,1,2 Dae Cheol Kweon,3 and Yun Jung Bae4
1Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul 151-742, Korea.
2Department of Radiology, Korean National Cancer Center, Goyang-si, Gyeonggi 410-769, Korea.
3Department of Radiologic Science, Shinhan University, Gyeonggi 480-701, Korea.
4Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 483-777, Korea.

To whom correspondence should be addressed. tel: 82-31-870-0463, (Email: )
Received August 13, 2014; Revised November 12, 2014; Accepted November 21, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



This study was conducted in order to investigate the nutrient and food intake status, and dietary quality in Korean adults according to abdominal obesity based on waist circumference.


We analyzed data from the combined 2010~2012 KNHANES (Korean National Health and Nutrition Examination Survey). The analysis included 6,974 adults aged 40 to 64 years. In this study, according to abdominal obesity based on waist circumference (male ≥ 90 cm, female ≥ 85 cm), we classified the subjects into the obesity group (male, n = 775, female, n = 1,113) and control group (male, n = 2,038, female, n = 3,048). The nutrient and food group intake, ND (nutrient density), NAR (nutrient adequacy ratio), MAR (mean adequacy ratio), INQ (index of nutritional quality), DDS (dietary diversity score), and DVS (dietary variety score) were analyzed using data from the 24-recall method.


For male, no significant difference in quality index of the diet was observed between the obesity group and the normal group. In female, in diet quality (ND, NAR, and INQ), vitamin B2 (ND, NAR, and INQ) calcium (NAR), phosphorous (ND, INQ) and potassium (ND) of the obesity group was significantly lower than those of the control group. DDS and DVS in the obesity group (3.57, 30.95) were significantly lower than those of the control group (3.68, 32.84) (p = 0.0043, 0.0002). DVS (DVS ≥ 39.9) showed association with lower risk of waist obesity in a logistic regression model after adjustments for multiple confounding factors including age, education, income, alcohol intake frequency, smoking, physical activity, energy intake, and body mass index (OR: 0.616, 95% CI: 0.420-0.903).


In conclusion, females with abdominal obesity had lower micronutrient intake quality, DVS than those of the control group. In Korean females, food intake variety can adversely affect waist circumference.

Keywords: waist circumference; obesity; dietary quality; food and nutrient intake; adults


Table 1
General characteristics, metabolic parameters, dietary habits and lifestyles of the subjects
Click for larger image

Table 2
Energy and nutrient intakes per 1,000 kcal of the subjects
Click for larger image

Table 3
Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) of the subjects
Click for larger image

Table 4
Index of Nutritional Quality (INQ) of the subjects
Click for larger image

Table 5
Food intakes from each food group of the subjects
Click for larger image

Table 6
Dietary diversity score (DDS) and dietary variety score (DVS) of the subjects
Click for larger image

Table 7
Adjusted odd radios (ORs) and 95% confidence intervals (CIs) of waist obesity by dietary diversity
Click for larger image


*The present research has been conducted by the Research Grant of Shinhan University in 2014.

1. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANES V-3). Cheongwon: Korea Centers for Disease Control and Prevention; 2013.
2. Kang JH, Jeong BG, Cho YG, Song HR, Kim KA. Medical expenditure attributable to overweight and obesity in adults with hypertension, diabetes and dyslipidemia : evidence from Korea National Health and Nutrition Examination Survey Data and Korea National Health Corporation Data. J Agric Med Community Health 2010;35(1):77–88.
3. Kuk JL, Lee S, Heymsfield SB, Ross R. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005;81(6):1330–1334.
4. Lim U, Ernst T, Buchthal SD, Latch M, Albright CL, Wilkens LR, Kolonel LN, Murphy SP, Chang L, Novotny R, Le Marchand L. Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index. Nutr Diabetes 2011;1:e6.
5. Luo W, Guo Z, Hu X, Zhou Z, Wu M, Zhang L, Liu J. 2 years change of waist circumference and body mass index and associations with type 2 diabetes mellitus in cohort populations. Obes Res Clin Pract 2013;7(4):e290–e296.
6. Mohammadifard N, Nazem M, Sarrafzadegan N, Nouri F, Sajjadi F, Maghroun M, Alikhasi H. Body mass index, waist-circumference and cardiovascular disease risk factors in Iranian adults: Isfahan healthy heart program. J Health Popul Nutr 2013;31(3):388–397.
7. Aleixandre A, Miguel M. Dietary fiber in the prevention and treatment of metabolic syndrome: a review. Crit Rev Food Sci Nutr 2008;48(10):905–912.
8. Houston DK, Nicklas BJ, Zizza CA. Weighty concerns: the growing prevalence of obesity among older adults. J Am Diet Assoc 2009;109(11):1886–1895.
9. Astrup A, Kristensen M, Gregersen NT, Belza A, Lorenzen JK, Due A, Larsen TM. Can bioactive foods affect obesity? Ann N Y Acad Sci 2010;1190:25–41.
10. Martínez-Augustin O, Aguilera CM, Gil-Campos M, Sánchez de, Gil A. Bioactive anti-obesity food components. Int J Vitam Nutr Res 2012;82(3):148–156.
11. Drewnowski A, Henderson SA, Shore AB, Fischler C, Preziosi P, Hercberg S. Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc 1996;96(7):663–669.
12. Pate RR, Taverno Ross SE, Liese AD, Dowda M. Associations among physical activity, diet quality, and weight status in U.S. adults. Med Sci Sports Exerc. 2014
13. Lassale C, Galan P, Julia C, Fezeu L, Hercberg S, Kesse-Guyot E. Association between adherence to nutritional guidelines, the metabolic syndrome and adiposity markers in a French adult general population. PLoS One 2013;8(10):e76349.
14. Jennings A, Welch A, van Sluijs EM, Griffin SJ, Cassidy A. Diet quality is independently associated with weight status in children aged 9-10 years. J Nutr 2011;141(3):453–459.
15. Bae YJ. Evaluation of nutrient and food intake status, and dietary quality in Korean female adults according to obesity : based on 2007-2009 Korean National Health and Nutrition Examination Survey. Korean J Nutr 2012;45(2):140–149.
16. Walls HL, Magliano DJ, McNeil JJ, Stevenson C, Ademi Z, Shaw J, Peeters A. Predictors of increasing waist circumference in an Australian population. Public Health Nutr 2011;14(5):870–881.
17. Arabshahi S, van der Pols JC, Williams GM, Marks GC, Lahmann PH. Diet quality and change in anthropometric measures: 15-year longitudinal study in Australian adults. Br J Nutr 2012;107(9):1376–1385.
18. Azadbakht L, Akbari F, Esmaillzadeh A. Diet quality among Iranian adolescents needs improvement. Public Health Nutr 2014:1–7.
19. Jayawardena R, Byrne NM, Soares MJ, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. BMC Public Health 2013;13:314.
20. Lee S, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, Cho GJ, Han JH, Kim SR, Park CY, Oh SJ, Lee CB, Kim KS, Oh SW, Kim YS, Choi WH, Yoo HJ. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obes 2006;15(1):1–9.
21. Hansen RG. An index of food quality. Nutr Rev 1973;31(1):1–7.
22. Kant AK. Indexes of overall diet quality: a review. J Am Diet Assoc 1996;96(8):785–791.
23. Krebs-Smith SM, Smiciklas-Wright H, Guthrie HA, Krebs-Smith J. The effects of variety in food choices on dietary quality. J Am Diet Assoc 1987;87(7):897–903.
24. Sim KW, Lee SH, Lee HS. The relationship between body mass index and morbidity in Korea. J Korean Soc Study Obes 2001;10(2):147–155.
25. Lee RD, Nieman DC. In: Nutritional assessment. 5th edition. Dubuque (IA): McGraw-Hill; 2010.
26. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79(3):379–384.
27. Mamtani M, Kulkarni H, Dyer TD, Almasy L, Mahaney MC, Duggirala R, Comuzzie AG, Blangero J, Curran JE. Waist circumference independently associates with the risk of insulin resistance and type 2 diabetes in mexican american families. PLoS One 2013;8(3):e59153.
28. Gröber-Grätz D, Widhalm K, de Zwaan M, Reinehr T, Blüher S, Schwab KO, Wiegand S, Holl RW. Body mass index or waist circumference: which is the better predictor for hypertension and dyslipidemia in overweight/obese children and adolescents? Association of cardiovascular risk related to body mass index or waist circumference. Horm Res Paediatr 2013;80(3):170–178.
29. Lee YE, Park JE, Hwang JY, Kim WY. Comparison of health risks according to the obesity types based upon BMI and waist circumference in Korean adults: the 1998-2005 Korean National Health and Nutrition Examination Surveys. Korean J Nutr 2009;42(7):631–638.
30. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002;162(18):2074–2079.
31. Kim JH, Lee JE, Jung IK. Dietary pattern classifications and the association with general obesity and abdominal obesity in Korean women. J Acad Nutr Diet 2012;112(10):1550–1559.
32. Seo KH, Lee HJ, Lim BD, Choi YJ, Oh H, Yoon JS. Association of nutritional status with obesity by body mass index and waist circumference among hypertensive elderly patients. Korean J Community Nutr 2009;14(6):831–845.
33. Shin D, Joh HK, Kim KH, Park SM. Benefits of potassium intake on metabolic syndrome: The fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Atherosclerosis 2013;230(1):80–85.
34. World Health Organization (CH). WHO technical report series 916. Geneva: World Health Organization; 2003.
35. Azadbakht L, Mirmiran P, Azizi F. Dietary diversity score is favorably associated with the metabolic syndrome in Tehranian adults. Int J Obes (Lond) 2005;29(11):1361–1367.
36. Kim SH, Kim JY, Ryu KA, Sohn CM. Evaluation of the dietary diversity and nutrient intakes in obese adults. Korean J Community Nutr 2007;12(5):583–591.
37. Lee JE, Ahn Y, Kimm K, Park C. Study on the associations of dietary variety and nutrition intake level by the number of survey days. Korean J Nutr 2004;37(10):908–916.
38. Gao SK, Beresford SA, Frank LL, Schreiner PJ, Burke GL, Fitzpatrick AL. Modifications to the Healthy Eating Index and its ability to predict obesity: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 2008;88(1):64–69.
39. Tardivo AP, Nahas-Neto J, Nahas EA, Maesta N, Rodrigues MA, Orsatti FL. Associations between healthy eating patterns and indicators of metabolic risk in postmenopausal women. Nutr J 2010;9:64.
40. Assmann KE, Lassale C, Galan P, Hercberg S, Kesse-Guyot E. Dietary quality and 6-year anthropometric changes in a sample of French middle-aged overweight and obese adults. PLoS One 2014;9(2):e87083.
41. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for crossnational comparison of diet quality as illustrated by China and the United States. J Nutr 2003;133(11):3476–3484.