Shinyoung Jun; Eunju Hong; Hyojee Joung

doi:10.4163/jnh.2015.48.6.507

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Jun, Hong, and Joung: Flavonoid intake according to food security in Korean adults: Based on the Korea National Health and Nutrition Examination Survey 2007~2012∗

Research Article

J Nutr Health 2015;48(6):507-518.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.6.507

Flavonoid intake according to food security in Korean adults: Based on the Korea National Health and Nutrition Examination Survey 2007~2012^∗

Shinyoung Jun¹, Eunju Hong², Hyojee Joung^1,^3,^†

¹Division of Public Health Nutrition, Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea

²Department of Economics and Finance, Hanyang Cyber University, Seoul 04763, Korea

³Institute of Health and Environment, Seoul National University, Seoul 08826, Korea

^†To whom correspondence should be addressed. tel: +82-2-880-2781, e-mail: hjjoung@snu.ac.kr

^∗ This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2014R1A2A2A01003138).

Received 13 May 2015 Revised 6 July 2015 Accepted 12 November 2015

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 aim of this study was to examine the association of food security with the total and individual flavonoid intakes among Korean adults.

Methods:

Study subjects were 13,454 men and 19,563 women aged 19 years and older who participated in the 2007~2012 Korea National Health and Nutrition Examination Survey. Subjects were classified into food-secure and food-insecure groups using the answers to a self-reported question on food sufficiency of subjects' household. The total and individual flavonoid intakes were calculated by linking 24-h dietary recall data of subjects with a flavonoid database. Mean differences in dietary outcomes by food security status, and major food sources of total flavonoids were examined.

Results:

In this cross-sectional study, 5.8% of male adults and 6.6% of female adults were in food insecure households. Mean daily intakes of total flavonoids, flavonols, flavones, flavanones, flavan-3-ols, isoflavones, and proanthocyanidins were significantly lower in food-insecure groups than food-secure groups among both male and female adults. The differences were maintained in total flavonoids, flavones, flavanones, and flavan-3-ols after adjusting for total energy intake. Mean intakes of fruits and vegetables were significantly lower in food-insecure groups and the total flavonoid intake from fruits and vegetables was also significantly lower in food-insecure groups. The major food sources of total flavonoids were apples (20.7%), mandarines (12.0%), and tofu (11.5%) in the food-secure group, and apples (14.9%), tofu (13.3%), and mandarines (12.6%) in the food-insecure group.

Conclusion:

This study showed that food insecurity was associated with lower intakes of flavonoids and reduced intakes of fruits and vegetables in a representative Korean population.

Keywords: flavonoids, food security, KNHANES

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Fig. 1.

Mean intakes of total flavonoids and flavonoid density by food security status stratified by gender among Korean adults. 1) “Full” meant able to eat an adequate amount and variety of food, “marginal” meant able to eat an adequate amount but not variety of food, “low” meant sometimes unable to afford enough food, “very low” meant often unable to afford enough food. 2) A is for total flavonoid intake; B is for flavonoid density, obtained by dividing flavonoid intake by 1000 kcal of caloric intake. 3) P-value calculated by weighted GLM is < 0.0001 for both A and B. 4) Small alphabets are used to compare the mean intakes.

Table 1.

Characteristics of study subjects by food security status

Characteristic¹⁾	Males		P-value³⁾	Females		P-value
Characteristic¹⁾	Food Secure²⁾ (n = 12,677)	Food Insecure (n = 777)	P-value³⁾	Food Secure (n = 18,272)	Food Insecure (n = 1,291)	P-value
Age (%)
19 ~ 29	20.3³⁾	17.4	< .0001	19.3	11.6	< .0001
30 ~ 49	45.5	31.0		43.0	27.5
50 ~ 64	23.1	28.8		22.8	25.3
65 ~ 74	7.8	13.8		9.3	19.4
75 +	3.3	9.0		5.7	16.2
Survey phase (%)
IV (2007 ~ 2009)	43.8	62.4	< .0001	43.2	62.8	< .0001
V (2010 ~ 2012)	56.2	37.6	< .0001	56.8	37.2	< .0001
Household Income⁴⁾ (%)
Low	12.6	48.5	< .0001	15.6	50.2	< .0001
Middle-Low Middle-High	25.8 30.8	29.5 16.1		26.2 29.0	31.6 13.9
High	30.8	5.9		29.2	4.3
Education level (%)
≦Elementary	11.6	35.1	< .0001	23.6	55.1	< .0001
Middle school	10.0	15.7		9.8	13.2
High school	42.5	34.9		37.9	25.7
≧ College	35.9	14.3		28.6	6.0
Alcohol consumption⁵⁾ (%)
yes	73.7	62.2	< .0001	40.4	32.2	0.0002
Smoking⁶⁾ (%)
yes	43.6	47.0	0.1645	5.8	9.5	0.0003
Supplement use (%)
yes	24.4	16.6	< .0001	33.7	20.9	< .0001
Breakfast consumption⁷⁾ (%)
yes	72.4	75.6	0.2144	74.7	77.5	0.1527
Eating out (%)
^>= 1 time a day	10.8	15.7	< .0001	22.2	22.4	< .0001
1 ~ 6 times a week	51.6	65.0		64.0	70.0
^<= 3 time a month	37.6	19.3		13.8	7.6
Nutrient intakes (mean ± SE)
Energy (kcal/d)	2,319.0 ± 10.9	1,999.0 ± 43.0	< .0001	1,675.3 ± 6.9	1,471.3 ± 22.5	< .0001
Carbohydrate (g/d)	352.3 ± 1.6	324.9 ± 6.4	< .0001	282.8 ± 1.2	262.0 ± 3.7	< .0001
Protein (g/d)	84.8 ± 0.5	66.1 ± 1.6	< .0001	60.0 ± 0.3	48.8 ± 1.0	< .0001
Fat (g/d)	49.0 ± 0.4	34.6 ± 1.5	< .0001	33.9 ± 0.3	24.6 ± 1.3	< .0001

%, Mean ± SE are weighted to represent the Korean population.

¹⁾ Number of missing values are 557, 606, 653, 595, 8 and 11 for household income, education level, alcohol consumption, smoking, breakfast consumption and eating out.

²⁾ “Food secure” meant able to eat enough and adequate amount of food, “Food insecure” meant unable to afford enough food.

³⁾ Prevalence assessment were analyzed by weighted Rao-Sott chi-square test and nutrient intake comparisons were completed by weighted t-test.

⁴⁾ Household income: low (first quartile), middle-low (second quartile), middle-high (third quartile), high (fourth quartile)

⁵⁾ Alcohol consumption: “yes” meant drank more than once a month over the past year

⁶⁾ Smoking: “yes” meant smoked >100 cigarettes over lifetime and still smoking

⁷⁾ Breakfast consumption: “yes” meant had breakfasts for both of the 2 days before the interview

Table 2.

Daily flavonoid intake, and flavonoid density among Korean adults by food security status

	Males		P-value²⁾	Females		P-value
	Food Secure¹⁾	Food Insecure	P-value²⁾	Food Secure	Food Insecure	P-value
Flavonoid intake (mg/d)
Flavonols	73.7 ± 1.1³⁾	59.8 ± 4.2	0.0013	55.6 ± 0.8	47.3 ± 2.5	0.0017
Flavones	1.0 ± 0.1	0.5 ± 0.1	< .0001	1.0 ± 0.1	0.5 ± 0.1	< .0001
Flavanones	34.0 ± 3.0	16.8 ± 5.5	0.0047	39.9 ± 2.4	22.3 ± 5.0	0.0008
Flavan-3-ols	43.6 ± 1.8	22.7 ± 3.6	< .0001	62.2 ± 2.1	28.5 ± 3.8	< .0001
Anthocyanidins	33.9 ± 1.4	28.0 ± 4.4	0.1857	42.0 ± 2.1	26.3 ± 2.5	< .0001
Isoflavones	67.8 ± 1.4	57.7 ± 5.0	0.0484	48.7 ± 0.9	37.6 ± 3.3	0.0011
Proanthocyanidins	69.1 ± 2.1	50.7 ± 5.0	0.0279	76.6 ± 2.0	51.1 ± 4.4	< .0001
Total Flavonoids	322.8 ± 5.4	236.1 ± 15.6	< .0001	325.8 ± 5.4	213.6 ± 10.4	< .0001
Flavonoid density (mg/1,000 kcal/d)⁴⁾
Flavonols	31.8 ± 0.5	30.2 ± 2.2	0.4880	33.3 ± 0.5	33.6 ± 1.9	0.8803
Flavones	0.4 ± 0.0	0.3 ± 0.0	< .0001	0.6 ± 0.0	0.4 ± 0.0	0.0003
Flavanones	14.8 ± 1.2	6.7 ± 2.0	0.0002	23.9 ± 1.5	13.5 ± 2.7	0.0005
Flavan-3-ols	19.2 ± 0.8	11.4 ± 1.9	0.0001	36.9 ± 1.3	17.9 ± 2.3	< .0001
Anthocyanidins	14.7 ± 0.6	14.3 ± 2.3	0.8850	23.4 ± 0.8	18.0 ± 2.2	0.0175
Isoflavones	30.4 ± 0.6	28.3 ± 2.1	0.3313	29.8 ± 0.6	25.8 ± 2.1	0.0679
Proanthocyanidins	30.7 ± 0.9	27.0 ± 4.8	0.4428	45.7 ± 1.1	34.8 ± 3.2	0.0013
Total Flavonoids	141.9 ± 2.2	118.3 ± 8.0	0.0039	193.4 ± 2.9	144.0 ± 6.7	< .0001

¹⁾ “Food secure” meant able to eat enough and adequate amount of food, “Food insecure” meant unable to afford enough food.

²⁾ P-value are for the difference between food secure group and food insecure group, obtained by t-test using surveyreg procedure.

³⁾ Mean ± SE 4) Calculated by dividing flavonoid intake by 1000 kcal of caloric intake.

Table 3.

Daily food group intake among Korean adults by food security status

	Males				P-value ³⁾	Females				P-value
	Food Secure¹⁾		Food Insecure			Food Secure		Food Insecure
	n²⁾	Mean ± SE	n	Mean ± SE		n	Mean ± SE	n	Mean ± SE
Food group intake (g/d)
Grains	11,651	337.4 ± 1.9	713	339.5 ± 9.3	0.8189	17,392	271.3 ± 1.5	1,243	269.5 ± 5.2	0.7356
Potatoes and starches	4,720	77.4 ± 2.1	185	72.4 ± 8.6	0.5766	7,167	90.7 ± 2.2	376	84.5 ± 7.0	0.3995
Sugars and sweets	8,844	13.8 ± 0.3	412	12.9 ± 0.9	0.3123	12,714	9.4 ± 0.2	719	8.4 ± 0.6	0.0921
Legumes and legume products	7,973	68.1 ± 1.5	434	61.3 ± 5.3	0.2102	11,319	53.0 ± 1.0	685	50.7 ± 3.4	0.4975
Nuts and seeds	8,295	6.8 ± 0.8	385	4.5 ± 1.0	0.0697	12,213	5.5 ± 0.2	695	3.7 ± 0.5	0.0018
Vegetables	11,635	377.3 ± 2.9	708	324.9 ± 11.5	< .0001	17,332	288.3 ± 2.3	1,231	247.1 ± 6.7	< .0001
Mushrooms	2,411	22.0 ± 1.1	72	13.6 ± 2.4	0.0013	4,249	18.8 ± 0.6	153	20.7 ± 3.0	0.5292
Fruits	6,382	311.3 ± 5.6	237	246.7 ± 19.3	0.0015	11,676	307.1 ± 4.9	560	251.1 ± 13.1	< .0001
Meats and poultry	8,300	156.6 ± 2.5	347	124.6 ± 9.2	0.0008	11,032	106.1 ± 1.6	536	100.2 ± 9.6	0.5439
Eggs	5,515	52.6 ± 0.9	212	50.1 ± 4.1	0.5423	8,070	39.2 ± 0.6	342	44.4 ± 5.6	0.3547
Fish and shellfish	10,040	83.9 ± 1.4	547	67.8 ± 5.3	0.0026	14,388	53.9 ± 0.8	900	39.5 ± 2.2	< .0001
Seaweeds	5,863	10.2 ± 0.4	274	10.4 ± 1.5	0.8861	8,951	9.8 ± 0.3	496	11.3 ± 1.1	0.1840
Milk and dairy products	3,310	242.5 ± 4.5	111	296.9 ± 48.2	0.2627	6,239	215.6 ± 2.8	257	225.4 ± 11.2	0.3880
Oils and fats	10,398	11.3 ± 0.1	525	8.7 ± 0.5	< .0001	15,281	7.3 ± 0.1	903	5.6 ± 0.3	< .0001
Beverage and alcohols	9,523	399.8 ± 7.6	471	348.1 ± 41.7	0.2173	12,229	202.6 ± 4.4	671	138.6 ± 13.3	< .0001
Seasonings	11,501	45.0 ± 0.5	683	36.0 ± 2.1	< .0001	17,113	30.3 ± 0.3	1,181	24.6 ± 0.9	< .0001
Prepared foods	205	116.2 ± 11.6	10	87.4 ± 35.6	0.4478	304	84.5 ± 6.7	23	107.1 ± 22.8	0.3382
Others	510	8.5 ± 1.4	20	5.0 ± 1.4	0.0857	933	7.3 ± 2.4	39	7.1 ± 3.7	0.9607

¹⁾ “Food secure” meant able to eat enough and adequate amount of food, “Food insecure” meant unable to afford enough food.

²⁾ Stratified sample size

³⁾ P-value are for the difference between food secure group and food insecure group, obtained by t-test using surveyreg procedure.

Table 4.

Contribution of food groups to the total flavonoid intake among Korean adults by food security status

	Males				P-value ³⁾	Females				P-value
	Food Secure¹⁾		Food Insecure			Food Secure		Food Insecure
	%²⁾	Mean ± SE	%	Mean ± SE		%	Mean ± SE	%	Mean ± SE
Food group intake (g/d)⁴⁾
Grains	4.4	14.3 ± 0.7	4.5	10.7 ± 1.5	0.0282	4.0	12.9 ± 0.6	5.8	12.4 ± 1.7	0.7968
Legumes and legume products	19.5	62.8 ± 1.8	22.8	53.8 ± 5.7	0.1190	13.3	43.4 ± 1.0	18.0	38.4 ± 3.8	0.2048
Nuts and seeds	0.3	0.9 ± 0.1	0.1	0.2 ± 0.0	< .0001	0.2	0.7 ± 0.1	0.1	0.1 ± 0.0	< .0001
Vegetables	25.0	80.7 ± 1.0	28.9	68.3 ± 4.3	0.0051	17.4	56.8 ± 0.7	23.5	50.1 ± 2.5	0.0103
Fruits	46.3	149.5 ± 4.9	38.9	91.7 ± 12.5	< .0001	60.8	198.0 ± 5.0	50.6	108.1 ± 9.4	< .0001
Beverage and alcohols	3.4	11.0 ± 1.3	1.6	3.7 ± 0.8	< .0001	3.5	11.3 ± 1.5	1.1	2.3 ± 0.4	< .0001
Seasonings	1.0	3.2 ± 0.1	1.2	2.9 ± 0.3	0.2155	0.7	2.2 ± 0.1	1.0	2.1 ± 0.2	0.6532

¹⁾ “Food secure” meant able to eat enough and adequate amount of food, “Food insecure” meant unable to afford enough food.

²⁾ Percentage of the food group contributing to the total flavonoid intake

³⁾ P-value are for the difference between food secure group and food insecure group, obtained by t-test using surveyreg procedure.

⁴⁾ Food groups of which the contributions were neglectable are not suggested in the table.

Table 5.

Top 10 major food items contributing to the total flavonoid intake among Korean adults by food security status

Food Secure¹⁾
Rank	Food items²⁾ T	Total Flavonoid Content (mg/100g)	Average Intake (mg/d)	Contribution ³⁾ (%)	Cum %⁴⁾ (%)	Rank	Food Items	Total Flavonoid Content (mg/100g)	Average Intake (mg/d)	Contribution	Cum %
Rank	Food items²⁾ T	Total Flavonoid Content (mg/100g)	Mean ± SE	Contribution ³⁾ (%)	Cum %⁴⁾ (%)	Rank	Food Items	Total Flavonoid Content (mg/100g)	Mean ± SE	Contribution	Cum %
1	Apples	108.5	63.9 ± 2.0	20.7	20.7	1	apples	108.5	32.1 ± 3.7	14.9	14.9
2	Mandarines	152.5	37.3 ± 2.4	12.0	32.7	2	tofu	181.0	28.7 ± 2.2	13.3	28.2
3	Tofu	181.0	35.6 ± 0.7	11.5	44.2	3	mandarines	152.5	27.0 ± 5.5	12.6	40.8
4	Onions	66.8	32.6 ± 0.5	10.5	54.7	4	onions	66.8	23.9 ± 1.3	11.1	51.9
5	Grapes	86.7	22.6 ± 2.1	7.3	62.0	5	grapes	86.7	13.1 ± 3.4	6.1	58.0
6	Strawberries	209.3	12.0 ± 1.0	3.9	65.9	6	radish	7.6	9.8 ± 0.8	4.5	62.5
7	Radish	7.6	9.9 ± 0.2	3.2	69.1	7	radish leaves	43.7	9.3 ± 1.1	4.3	66.8
8	Sorghum⁵⁾	1,952.1	9.3 ± 0.4	3.0	72.1	8	strawberries	209.3	8.5 ± 2.0	3.9	70.7
9	Persimmons	30.0	7.2 ± 0.5	2.3	74.4	9	soybean⁵⁾	481.42	7.4 ± 1.7	3.4	74.1
10	Grape juice	127.9	6.9 ± 0.9	2.2	76.6	10	sorghum⁵⁾	1952.1	6.7 ± 1.1	3.1	77.2
	Total food item(n = 235)		324.4 ± 4.4	100.0	100.0		Total food items (n = 168)		223.6 ± 9.0	100.0	100.0

¹⁾ “Food secure” meant able to eat enough and adequate amount of food, “Food insecure” meant unable to afford enough food.

²⁾ Secondary food items from KNHANES (n = 789)

³⁾ Percentage of the food item contributing to the total flavonoid intake

⁴⁾ Cumulative percentage of the food items contributing to the total flavonoid intake

⁵⁾ mostly consisted of dried form

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