Journal List > J Nutr Health > v.50(2) > 1081488

J Nutr Health. 2017 Apr;50(2):142-157. Korean.
Published online April 30, 2017.
© 2017 The Korean Nutrition Society
Development of NQ-A, Nutrition Quotient for Korean Adolescents, to assess dietary quality and food behavior
Hye-Young Kim,1,** Jung-Sug Lee,2,** Ji-Yun Hwang,3 Sehyug Kwon,4 Hae Rang Chung,5 Tong-Kyung Kwak,6 Myung-Hee Kang,7 and Young-Sun Choi8
1Department of Food & Nutrition, Yongin University, Yongin 17092, Korea.
2Department of Food & Nutrition, Kookmin University, Seoul 02707, Korea.
3Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.
4Department of Statistics, Hannam University, Daejeon 34430, Korea.
5Nutrition for the Future Inc., Seoul 08788, Korea.
6Department of Food & Nutrition, Yonsei University, Seoul 03722, Korea.
7Department of Food & Nutrition, Hannam University, Daejeon 34430, Korea.
8Department of Food & Nutrition, Daegu University, Daegu 38453, Korea.

To whom correspondence should be addressed. tel: +82-53-850-6833, Email:

**These authors contributed equally to this article.

Received February 22, 2017; Revised February 28, 2017; Accepted March 27, 2017.

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.



The purpose of this study was to develop a nutrition quotient for adolescents (NQ-A) to assess overall dietary quality and food behavior of Korean adolescents.


Development of the NQ-A was undertaken in three steps: item generation, item reduction, and validation. Candidate items of the NQ-A checklist were selected based on literature reviews, results of the fifth Korea National Health and Nutrition Examination Survey data, dietary guidelines for Korean adolescents, expert in-depth interviews, and national nutrition policies and recommendations. A total of 213 middle and high school students participated in a one-day dietary record survey and responded to 41 items in the food behavior checklist. Pearson's correlation coefficients between the responses to the checklist items along with nutritional status of the adolescents were calculated. Item reduction was performed, and 24 items were selected for the nation-wide survey. A total of 1,547 adolescents from 17 cities completed the checklist questionnaire. Exploratory factor and confirmatory factor analyses were performed to develop a final NQ-A model.


Nineteen items were finalized as the checklist items for the NQ-A. Checklist items were composed of five factors (balance, diversity, moderation, environment, and practice). The five-factor structure accounted for 47.2% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-A and five-factor scores were calculated based on the obtained weights of the questionnaire items.


Nutrition Quotient for adolescents (NQ-A) would be a useful instrument for evaluating dietary quality and food behavior of Korean adolescents. Further research on NQ-A is needed to reflect changes in adolescent's food behavior and environment.

Keywords: nutrition quotient; adolescent; dietary quality; food behavior; checklist


Fig. 1
Process of NQ-A development. 1) FBC, Food behavior checklist, 2) DR, Dietary record
Click for larger image

Fig. 2
Weights and path coefficients of five-factor structure model of NQ-A
Click for larger image

Fig. 3
Comparison of percentage of nutrient intake of the adolescents to recommended nutrient intake (RNI) or adequate intake (AI) according to NQ-A score three-grade criterion of samples from the pilot survey. a,b: Different alphabets are significantly different by Duncan's multiple range test (p < 0.05).
Click for larger image

Fig. 4
ROC curve for the NQ-A model
Click for larger image


Table 1
Checklist items selected for pilot survey
Click for larger image

Table 2
Items selected for a nationwide survey checklist and selection rationales
Click for larger image

Table 3
Results of exploratory factor analysis of the 19 items selected by LISREL analysis (n = 1,547)
Click for larger image

Table 4
NQ-A score and group score calculation using response point of the checklist
Click for larger image

Table 5
Nutrition Quotient checklist for adolescents
Click for larger image

Table 6
NQ-A score and sub-group score range by the three-grade criterion
Click for larger image


This research was supported by a grant (14162MFDS126) from Ministry of Food and Drug Safety in 2014.

1. Bae YJ. Evaluation of nutrient intake and food variety by age in Korean adolescents: based on 2010-2012 Korean National Health and Nutrition Examination Survey. J Nutr Health 2015;48(3):236–247.
2. Kim MJ, Song S, Park SH, Song Y. The association of snack consumption, lifestyle factors, and pediatric obesity with dietary behavior patterns in male adolescents. J Nutr Health 2015;48(3):228–235.
3. Woo T, Lee HJ, Lee KA, Lee SM, Lee KH. Gender differences in adolescents' dietary perceptions and practices. Korean J Community Nutr 2016;21(2):165–177.
4. Bae YJ, Yeon JY. A Study on nutritional status and dietary quality according to carbonated drink consumption in male adolescents: based on 2007-2009 Korean National Health and Nutrition Examination Survey. J Nutr Health 2015;48(6):488–495.
5. Kwak S, Woo T, Lee KA, Lee KH. A comparison of dietary habits and influencing factors for vegetable preferences of adolescents in Gyeongnam province. Korean J Community Nutr 2015;20(4):259–272.
6. Kwon JE, Park HJ, Lim HS, Chyun JH. The relationships of dietary behavior, food intake, and life satisfaction with family meal frequency in middle school students. Korean J Food Cult 2013;28(3):272–281.
7. Bae YJ. Evaluation of nutrient intake and meal variety with breakfast eating in Korean adolescents: analysis of data from the 2008-2009 National Health and Nutrition Survey. Korean J Community Nutr 2013;18(3):257–268.
8. Bae YJ. Evaluation of nutrient intake and anthropometric parameters related to obesity in Korean female adolescents according to dietary diversity score: from the Korean National Health and Nutrition Examination Surveys, 2007-2009. Korean J Community Nutr 2012;17(4):419–428.
9. Jo JE, Park HR, Jeon SB, Kim JS, Park GE, Li Y, Lim YS, Hwang J. A study on relationship between socio-demographic factors and food consumption frequencies among adolescents in South Korea: using the Korea Youth Risk Behavior Web-based Survey from 2011. Korean J Community Nutr 2013;18(2):165–176.
10. Kim SH, Cho SW, Hwang SS, Ahn M, Lee D, Kang SW, Park YK. Increased whole grain, fruits and vegetable intake reduced oxidative stress in high school students. Korean J Nutr 2012;45(5):452–461.
11. Heo GJ, Nam SY, Lee SK, Chung SJ, Yoon JH. The relationship between high energy/low nutrient food consumption and obesity among Korean children and adolescents. Korean J Community Nutr 2012;17(2):226–242.
12. Kang MH, Lee JS, Kim HY, Kwon S, Choi YS, Chung HR, Kwak TK, Cho YH. Selecting items of a food behavior checklist for the development of nutrition quotient (NQ) for children. Korean J Nutr 2012;45(4):372–389.
13. Kim HY, Kwon S, Lee JS, Choi YS, Chung HR, Kwak TK, Park J, Kang MH. Development of a nutrition quotient (NQ) equation modeling for children and the evaluation of its construct validity. Korean J Nutr 2012;45(4):390–399.
14. Yoo JS, Choi YS. Evaluation of items for the food behavior checklist and nutrition quotient score on children in rural areas of Gyeongbuk. J Nutr Health 2013;46(5):427–439.
15. Boo MN, Cho SK, Park K. Evaluation of dietary behavior and nutritional status of elementary school students in Jeju using nutrition quotient. J Nutr Health 2015;48(4):335–343.
16. Lim H, Kim J, Wang Y, Min J, Carvajal NA, Lloyd CW. Child health promotion program in South Korea in collaboration with US National Aeronautics and Space Administration: improvement in dietary and nutrition knowledge of young children. Nutr Res Pract 2016;10(5):555–562.
17. Kim JR, Lim HS. Relationships between children's nutrition quotient and the practice of the dietary guidelines of elementary school students and their mothers. J Nutr Health 2015;48(1):58–70.
18. Huang YC, Kim HY. Assessment of dietary behavior of Chinese children using nutrition quotient for children. J Nutr Health 2014;47(5):342–350.
19. Lee SJ, Kim Y. Evaluation of the diet and nutritional states of elementary and middle school students in the Daegu area by using nutrition quotient for children. J Nutr Health 2013;46(5):440–446.
20. Lazarou C, Newby PK. Use of dietary indexes among children in developed countries. Adv Nutr 2011;2(4):295–303.
21. Kant AK. Dietary patterns and health outcomes. J Am Diet Assoc 2004;104(4):615–635.
22. Marshall S, Burrows T, Collins CE. Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents. J Hum Nutr Diet 2014;27(6):577–598.
23. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994;94(1):57–64.
24. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. J Am Diet Assoc 1995;95(10):1103–1108.
25. Shim JE, Paik HY, Lee SY, Moon HK, Kim YO. Comparative analysis and evaluation of dietary intake of Koreans by age groups: (4) the Korean diet quality index. Korean J Nutr 2002;35(5):558–570.
26. Yook SM, Park S, Moon HK, Kim K, Shim JE, Hwang JY. Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data. J Nutr Health 2015;48(5):419–428.
27. Branscum P, Sharma M, Kaye G, Succop P. An evaluation of the validity and reliability of a food behavior checklist modified for children. J Nutr Educ Behav 2010;42(5):349–352.
28. Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 2004;7(7):931–935.
29. 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.
30. Ministry for Health, Welfare and Family Affairs (KR). Dietary guidelines for Korean adolescents. Seoul: Ministry for Health, Welfare and Family Affairs; 2010.
31. Jöreskog KG, Sörbom D. In: LISREL 8: structural equation modeling with the SIMPLIS command language. Chicago (IL): Scientific Software International; 1993.
32. The Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: The Korean Nutrition Society; 2010.
33. Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: a systematic review. Maturitas 2011;70(3):266–284.
34. Kleiser C, Mensink GB, Scheidt-Nave C, Kurth BM. HuSKY: a healthy nutrition score based on food intake of children and adolescents in Germany. Br J Nutr 2009;102(4):610–618.
35. Marshall S, Watson J, Burrows T, Guest M, Collins CE. The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study. Nutr J 2012;11:96.
36. Feskanich D, Rockett HR, Colditz GA. Modifying the Healthy Eating Index to assess diet quality in children and adolescents. J Am Diet Assoc 2004;104(9):1375–1383.
37. Lee JS, Kang MH, Kwak TK, Chung HR, Kwon S, Kim HY, Hwang JY, Choi YS. Development of nutrition quotient for Korean preschoolers (NQ-P): item selection and validation of factor structure. J Nutr Health 2016;49(5):378–394.
38. Townsend MS, Kaiser LL, Allen LH, Joy AB, Murphy SP. Selecting items for a food behavior checklist for a limited-resource audience. J Nutr Educ Behav 2003;35(2):69–77.