Nutritional and health consequences are associated with food insecurity among Korean elderly: Based on the fifth (2010) Korea National Health and Nutrition Examination Survey (KNHANES V-1)

Seungjae Lee; Kyung Won Lee; Ji Eun Oh; Mi Sook Cho

doi:10.4163/jnh.2015.48.6.519

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Lee, Lee, Oh, and Cho: Nutritional and health consequences are associated with food insecurity among Korean elderly: Based on the fifth (2010) Korea National Health and Nutrition Examination Survey (KNHANES V-1)

Research Article

J Nutr Health 2015;48(6):519-529.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.6.519

Nutritional and health consequences are associated with food insecurity among Korean elderly: Based on the fifth (2010) Korea National Health and Nutrition Examination Survey (KNHANES V-1)

Seungjae Lee, Kyung Won Lee, Ji Eun Oh, Mi Sook Cho^†

Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea

^†To whom correspondence should be addressed. tel: +82-2-3277-2826, e-mail: misocho@ewha.ac.kr

Received 9 June 2014 Revised 29 July 2014 Accepted 23 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 purpose of this study was to examine the prevalence of food insecurity in Korean elderly and to analyze the health status as well as food and nutrient intakes according to food insecurity status.

Methods:

A total of 939 elderly subjects (over 65 years old) were used in our analysis from the fifth 2010 Korean National Health and Nutrition Examination Survey (KNHANES V-1). The variables consisted of general characteristics, physical and mental health, nutrient intake, rate of deficient intake of energy and nutrients compared with Dietary Reference Intakes for Koreans (KDRIs) and food quality and diversity according to the status of food insecurity. Food insecurity status was measured using a self-reported food security questionnaire on the dietary situation in the previous year, and participants were classified according to three groups: food secure group, mildly food insecure group, and moderately/severely food insecure group.

Results:

The proportion of the food insecure group was approximately 67% and the food insecure group had lower income and educational status than the food secure group. Food insecurity was associated with worse physical and mental health status after adjusting potentially confounding variables. The results showed that food insecurity in Korean elderly significantly affected mental health (including stress cognition, depression experience, and suicide thoughts) which exceeded stages of physical health. In addition, food insecurity showed significant association with low nutrient intake and high rate of deficient intakes of energy and nutrients compared with KDRIs, and a reduction of dietary quality and diversity was indicated in the food insecure group.

Conclusion:

This study concludes that the prevalence of food insecurity may affect the physical and mental health as well as dietary intake of the elderly Korean population. Therefore, food insecurity should be considered as an important public health issue in Korea.

Keywords: food insecurity, elderly, physical and mental health, nutrients intake, food quality and diversity

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Table 1.

General characteristics of the subjects according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	Total (n = 939)	p-value¹⁾
Gender
Male	156 (47.62)²⁾	259 (41.38)	21 (34.94)	436 (43.19)	0.0611
Female	171 (52.38)	303 (58.62)	29 (65.06)	503 (56.81)	0.0611
Age (years)	72.21 ± 0.43^3)a4)	72.19 ± 0.33^a	74.03 ± 0.73^b	72.27 ± 0.28	0.0465⁵⁾
≥ 65 years	327 (33.1)	562 (61.4)	50 (5.5)	939 (100.0)	-
The presence of a spouse
No	83 (26.65)	170 (38.42)	27 (54.88)	280 (35.23)	0.0021
Yes	244 (73.35)	392 (61.58)	23 (45.12)	659 (64.77)	0.0021
Education
≤ Elementary school	175 (61.51)	376 (71.84)	41 (85.97)	592 (68.69)
Middle school	46 (12.66)	77 (10.82)	2 (4.25)	125 (11.09)	0.0070
≥ High school	106 (27.27)	109 (17.34)	7 (9.78)	222 (20.22)
Economic status
Low	51 (15.40)	161 (29.77)	23 (40.69)	235 (25.38)
Middle-low	61 (18.04)	136 (21.98)	18 (40.32)	215 (21.62)	< .0001
Middle-high	95 (28.71)	142 (23.96)	7 (13.41)	244 (25.03)	< .0001
High	120 (37.85)	123 (24.29)	2 (5.58)	245 (27.97)
Type of family
Living alone	33 (8.72)	76 (12.43)	23 (42.23)	132 (12.77)
1 generation with others	161 (46.53)	274 (41.76)	18 (36.25)	453 (43.12)	0.0866
2 or 3 generations with unmarried children	84 (29.38)	135 (27.83)	5 (14.71)	224 (27.65)	0.0866
2 or 3 generations etc.	49 (15.37)	77 (17.97)	4 (6.81)	130 (16.46)

¹⁾ p-value from chi-square test

²⁾ n (weighted %)

³⁾ Age- and sex-adjusted mean ± SD

⁴⁾ a, b: Means with different superscripts are significantly different by Tukey's multiple range test

⁵⁾ p-value from ANOVA

Table 2.

Physical health of the subjects according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	p-value¹⁾
Physical health
Obesity	1.00	0.91 (0.63 - 1.30)²)	0.86 (0.39 - 1.91)	0.8282
Abdominal obesity	1.00	1.03 (0.77 - 1.39)	0.95 (0.52 - 1.73)	0.9552
Hypertension	1.00	1.08 (0.71 - 1.63)	1.95 (0.98 - 3.89)	0.1627
Elevated triglycerides	1.00	1.19 (0.83 - 1.69)	0.80 (0.34 - 1.92)	0.4022
Low HDL cholesterol	1.00	1.12 (0.82 - 1.54)	1.30 (0.70 - 2.39)	0.6541
Diabetes	1.00	0.86 (0.55 - 1.33)	0.83 (0.35 - 1.94)	0.7588
Metabolic syndrome³⁾	1.00	0.95 (0.68 - 1.33)	1.34 (0.70 - 2.58)	0.5682

¹⁾ p-value from multiple logistic regression analysis 2) OR (95% CI), ORs from FI 1, FI 2 relative to the FS 3) Metabolic syndrome (MS) is diagnosed by the modified NCEP ATP III criteria (any 3 of 5 constitutes, for waist circumstances ≥ 90 cm in men, ≥ 85 cm in women, for blood pressure ≥ 130 mmHg systolic blood pressure or ≥ 85 mmHg diastolic blood pressure or on antihypertensive drug treatment, for triglyceride ≥ 150 mg/dL or on drug treatment for elevated triglyceride, for HDL-cholesterol < 40 mg/dL in men, < 50 mg/dL in women or on drug treatment for reduced HDL-cholesterol, for fasting glucose ≥ 100 mg/dL or on drug treatment for elevated glucose).

Table 3.

Mental health of the subjects according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	p-value¹⁾
Mental health
Stress cognition	1.00	1.69 (1.13 - 2.53)²⁾	3.81 (1.78 - 8.12)	0.0009
Depression experience	1.00	1.38 (0.82 - 2.30)	3.19 (1.52 - 6.72)	0.0091
Suicide thoughts	1.00	2.20 (1.44 - 3.38)	2.14 (1.01 - 4.56)	0.0013

¹⁾ p-value from multiple logistic regression analysis

²⁾ OR (95% CI), ORs from FI 1, FI 2 relative to the FS

Table 4.

Nutrients intake and CPF ratio of the subjects according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	Total (n = 939)	p-value¹⁾
CPF ratio
Carbohydrate (%)	74.70 ± 0.59²⁾	76.23 ± 0.49	76.00 ± 1.89	75.99 ± 0.39	0.1073
Protein (%)	13.57 ± 0.22^a3)	12.51 ± 0.17^b	12.52 ± 0.43^b	12.76 ± 0.14	0.0002
Fat (%)	11.73 ± 0.44	11.26 ± 0.38	11.48 ± 1.51	11.24 ± 0.29	0.6870
Nutrients intake
Energy (kcal)	1,823.12 ± 38.72	1,739.63 ± 35.05	1,692.09 ± 106.03	1,726.48 ± 28.86	0.2370
Carbohydrate (g)	184.03 ± 1.76	188.14 ± 1.43	186.57 ± 4.94	187.77 ± 1.10	0.1726
Protein (g)	33.26 ± 0.57^a	30.73 ± 0.42^b	30.55 ± 1.04^b	31.41 ± 0.35	0.0005
Fat (g)	12.78 ± 0.47	12.27 ± 0.40	12.41 ± 1.66	12.28 ± 0.31	0.6660
Fiber (g)	4.52 ± 0.25	4.07 ± 0.12	3.81 ± 0.28	4.18 ± 0.12	0.1080
Calcium (mg)	285.62 ± 13.45^a	238.27 ± 8.71^b	230.91 ± 25.77^b	253.36 ± 7.13	0.0134
Phosphorus (mg)	612.46 ± 9.67^a	570.33 ± 6.33^b	572.41 ± 11.36^b	582.96 ± 5.38	0.0009
Iron (mg)	8.73 ± 0.47^a	8.20 ± 0.61^ab	6.78 ± 0.58^b	8.31 ± 0.42	0.0184
Sodium (mg)	2,505.60 ± 113.47	2,483.11 ± 80.79	2,390.47 ± 226.42	2,468.73 ± 61.82	0.8853
Potassium (mg)	1,558.30 ± 48.30^a	1,467.91 ± 27.77^a	1,331.82 ± 42.16^b	1,481.48 ± 25.00	0.0008
Vitamin A (μgRE)	384.34 ± 36.97	335.02 ± 19.19	283.31 ± 25.28	349.04 ± 20.06	0.0794
Vitamin B₁ (mg)	0.63 ± 0.02^a	0.58 ± 0.01^b	0.58 ± 0.02^b	0.59 ± 0.01	0.0126
Vitamin B₂ (mg)	0.53 ± 0.02^a	0.47 ± 0.01^b	0.46 ± 0.03^b	0.48 ± 0.01	0.0034
Niacin (mg)	7.76 ± 0.16^a	7.41 ± 0.12^b	7.55 ± 0.27^ab	7.48 ± 0.10	0.1383
Vitamin C (mg)	49.87 ± 2.46	48.86 ± 2.05	45.47 ± 4.30	48.44 ± 1.60	0.5798

¹⁾ p-value from ANOVA

²⁾ Age- and sex- adjusted mean ± SD

³⁾ a, b : Means with different superscripts are significantly different by Tukey's multiple range test.

Table 5.

The rate of deficient intakes of energy and nutrients compared with dietary reference intakes for Koreans (KDRIs) of the elderly over 65 according to food insecurity status

	FS	FI 1	FI 2	Total
	(n = 327)	(n = 562)	(n = 50)	(n = 939)
Energy¹⁾	172 (52.6)²⁾	346 (61.57)	32 (64.00)	550 (58.57)
Protein	62 (18.96)	156 (27.76)	22 (44.00)	240 (25.56)
Fiber	317 (96.94)	557 (99.11)	50 (100.00)	924 (98.40)
Calcium	222 (67.89)	449 (79.89)	45 (90.00)	716 (76.25)
Phosphorus	36 (11.01)	80 (14.23)	13 (26.00)	129 (13.74)
Iron	41 (12.54)	113 (20.11)	14 (28.00)	168 (17.89)
Sodium	16 (4.89)	36 (6.41)	3 (6.00)	55 (5.86)
Potassium	238 (72.78)	456 (81.14)	46 (92.00)	740 (78.81)
Vitamin A	165 (50.46)	328 (58.36)	38 (76.00)	531 (56.55)
Vitamin B₁	140 (42.81)	316 (56.23)	30 (60.00)	486 (51.76)
Vitamin B₂	225 (68.81)	453 (80.60)	41 (82.00)	719 (76.57)
Niacin	128 (39.14)	283 (50.36)	28 (56.00)	439 (46.75)
Vitamin C	162 (49.54)	320 (56.94)	35 (70.00)	517 (55.06)

¹⁾ Energy deficiency was defined as energy intake less than 75% of the estimated energy requirement according to sex and age for Koreans; Nutrient deficiency was defined as nutrient intake less than the estimated average requirement (exceptively, fiber, sodium and potassium was used to adequate intake) according to sex and age for Koreans.

²⁾ n (weighted %)

Table 6.

Index of nutritional quality of the elderly over 65 according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	Total (n = 939)	p-value¹⁾
INQ²⁾
Protein	1.26 ± 0.02^3)a4)	1.16 ± 0.02^b	1.15 ± 0.04^b	1.18 ± 0.01	0.0008
Fiber	0.36 ± 0.02	0.33 ± 0.01	0.30 ± 0.02	0.33 ± 0.01	0.1080
Calcium	0.73 ± 0.03^a	0.61 ± 0.02^b	0.58 ± 0.06^b	0.64 ± 0.02	0.0105
Phosphorus	1.58 ± 0.03^a	1.47 ± 0.02^b	1.47 ± 0.03^b	1.48 ± 0.02	0.0013
Iron	1.84 ± 0.10^a	1.73 ± 0.12^ab	1.42 ± 0.12^b	1.74 ± 0.09	0.0133
Sodium	3.76 ± 0.17	3.76 ± 0.13	3.55 ± 0.32	3.67 ± 0.10	0.7876
Potassium	0.80 ± 0.03^a	0.76 ± 0.01^a	0.68 ± 0.02^b	0.75 ± 0.01	0.0006
Vitamin A	1.06 ± 0.10	0.93 ± 0.05	0.78 ± 0.07	0.96 ± 0.05	0.0768
Vitamin B₁	0.99 ± 0.03^a	0.90 ± 0.02^b	0.90 ± 0.03^b	0.92 ± 0.01	0.0112
Vitamin B₂	0.71 ± 0.02^a	0.62 ± 0.01^b	0.62 ± 0.04^ab	0.65 ± 0.01	0.0034
Niacin	0.93 ± 0.02	0.89 ± 0.01	0.90 ± 0.03	0.89 ± 0.01	0.1609
Vitamin C	0.89 ± 0.04	0.88 ± 0.04	0.81 ± 0.08	0.86 ± 0.03	0.5620

¹⁾ p-value from ANOVA

²⁾ INQ: Index of Nutritional Quality

³⁾ Age- and sex- adjusted mean ± SD

⁴⁾ a, b : Means with different superscripts are significantly different by Tukey's multiple range test.

Table 7.

Dietary variety score (DVS) and dietary diversity score (DDS) of the elderly over 65 according to food insecurity status

	FS (n = 327)	FI 1 (n = 562)	FI 2 (n = 50)	Total (n = 939)	p-value¹⁾
DVS²⁾	10.11 ± 0.20^4)a5)	9.27 ± 0.16^b	9.28 ± 0.58^ab	9.42 ± 0.13	0.0012
DDS³⁾	3.47 ± 0.07^a	3.18 ± 0.05^b	2.85 ± 0.15^c	3.24 ± 0.05	0.0002

¹⁾ p-value from ANOVA

²⁾ DVS: Dietary Variety Score

³⁾ DDS: Dietary Diversity Score

⁴⁾ Age- and sex-adjusted mean ± SD

⁵⁾ a, b: Means with different superscripts are significantly different by Tukey's multiple range test.

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