Journal List > J Nutr Health > v.51(1) > 1081562

J Nutr Health. 2018 Feb;51(1):87-102. Korean.
Published online February 28, 2018.  https://doi.org/10.4163/jnh.2018.51.1.87
© 2018 The Korean Nutrition Society
Development of NQ-E, Nutrition Quotient for Korean elderly: item selection and validation of factor structure
Min-Jae Chung,1 Tong-Kyung Kwak,1 Hye-Young Kim,2 Myung-Hee Kang,3 Jung-Sug Lee,4 Hae Rang Chung,5 Sehyug Kwon,6 Ji-Yun Hwang,7 and Young-Sun Choi8
1Department of Food and Nutrition, Yonsei University, Seoul 03722, Korea.
2Department of Food and Nutrition, Yongin University, Yongin, Gyeonggi 17092, Korea.
3Department of Food and Nutrition, Hannam University, Daejeon 34430, Korea.
4Department of Food and Nutrition, Kookmin University, Seoul 02707, Korea.
5Nutrition for the Future Inc., Seoul 08788, Korea.
6Department of Statistics, Hannam University, Daejeon 34430, Korea.
7Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.
8Department of Food and Nutrition, Daegu University, Gyeongsan, Gyeongbuk 38453, Korea.

To whom correspondence should be addressed. tel: +82-53-850-6833, Email: yschoi@daegu.ac.kr
Received January 12, 2018; Revised February 01, 2018; Accepted February 08, 2018.

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 develop a valid instrument for measuring the dietary quality and behaviors of Korean elderly.

Methods

The development of the Nutrition Quotient for Elderly (NQ-E) was conducted in three steps: item generation, item reduction, and validation. The 41 items of the NQ-E checklist were derived from a systematic literature review, expert in-depth interviews, statistical analyses of the fifth Korean National Health and Nutrition Examination Survey data, and national nutrition policies and recommendations. Pearson's correlation was used to determine the level of agreement between the questionnaires and nutrient intake level, and 24 items were selected for a nationwide survey. A total of 1,000 nationwide elderly subjects completed the checklist questionnaire. The construct validity of the NQ-E was assessed using confirmatory factor analysis, LISREL.

Results

The nineteen checklist items were used as final items for NQ-E. Checklist items were composed of four-factors: food behavior (6 items), balance (4 items), diversity (6 items), and moderation (3 items). The standardized path coefficients were used as the weights of the items. The NQ-E and four-factor scores were calculated according to the obtained weights of the questionnaire items.

Conclusion

NQ-E would be a useful tool for assessing the food behavior and dietary quality of the elderly.

Keywords: nutrition quotient for the elderly; NQ-E; food behavior; dietary quality; checklist

Figures


Fig. 1
Process of NQ-E development. 1) FBC, Food Behavior Checklist
Click for larger image


Fig. 2
Comparison of percentage of nutrient intake of the elderly from the pilot study to recommended nutrient intake (RNI) or adequate intake (AI) according to NQ-E score four-grade criterion. a,b: Means with different alphabets are significantly different by Duncan's multiple-range test (p < 0.05).
Click for larger image

Tables


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


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


Table 3
Results of exploratory factor analysis of the 19 items selected by LISREL analysis (n = 1,000)
Click for larger image


Table 4
Weights and path coefficients of four-factor structure model
Click for larger image


Table 5
NQ-E score and group score calculation using response point of the checklist
Click for larger image


Table 7
NQ-E score range by the four-grade criterion
Click for larger image

Notes

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

References
1. Ministry of Health and Welfare (KR). Korea Institute for Health and Social Affairs. A study on the living conditions and welfare needs of older Korean persons. Cheongju: Ministry of Health and Welfare; 2014.
2. World Health Organization. Global action plan for the prevention and control of NCDs 2013-2020. Geneva: World Health Organization; 2013.
3. Oh KW, Nam CM, Park JH, Yoon JY, Shim JS, Lee KH, Suh I. A case-control study on dietary quality and risk for coronary heart disease in Korean men. Korean J Nutr 2003;36(6):613–621.
4. Ko KP, Park SK, Yang JJ, Ma SH, Gwack J, Shin A, Kim YJ, Kang D, Chang SH, Shin HR, Yoo KY. Intake of soy products and other foods and gastric cancer risk: a prospective study. J Epidemiol 2013;23(5):337–343.
5. Park B, Shin A, Park SK, Ko KP, Ma SH, Lee EH, Gwack J, Jung EJ, Cho LY, Yang JJ, Yoo KY. Ecological study for refrigerator use, salt, vegetable, and fruit intakes, and gastric cancer. Cancer Causes Control 2011;22(11):1497–1502.
6. Kim HR. A study on the association of diet quality and risk of mortality and major chronic diseases from nationally representative longitudinal data. Health Soc Welf Rev 2013;33(3):5–30.
7. 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.
8. 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.
9. 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.
10. Kim HY, Lee JS, Hwang JY, Kwon S, Chung HR, Kwak TK, Kang MH, Choi YS. Development of NQ-A, nutrition quotient for Korean adolescents, to assess dietary quality and food behavior. J Nutr Health 2017;50(2):142–157.
11. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994;94(1):57–64.
12. Haines PS, Siega-Riz AM, Popkin BM. The diet quality index revised: a measurement instrument for populations. J Am Diet Assoc 1999;99(6):697–704.
13. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Am Diet Assoc 1995;95(10):1103–1108.
14. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP. In: Development and evaluation of the healthy eating index-2005: technical report. Alexandria (VA): US Department of Agriculture, Center for Nutrition Policy and Promotion; 2007.
15. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Coditz GA, Willett WC. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 2002;76:1261–1271.
16. US Department of Agriculture; Center for Nutrition Policy and Promotion. Healthy Eating Index (HEI) [Internet]. Alexandria (VA): US Department of Agriculture, Center for Nutrition Policy and Promotion; 2016 [cited 2017 Dec 24].
17. Bailey RL, Miller PE, Mitchell DC, Hartman TJ, Lawrence FR, Sempos CT, Smiciklas-Wright H. Dietary screening tool identifies nutritional risk in older adults. Am J Clin Nutr 2009;90:177–183.
18. Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P. Overview of the MNA®-its history and challenges. J Nutr Health Aging 2006;10(6):456–463.
19. Posner BM, Jette AM, Smith KW, Miller DR. Nutrition and health risks in the elderly: the nutrition screening initiative. Am J Public Health 1993;83(7):972–978.
20. Lee HO, Lee JS, Shin JW, Lee GJ. Nutrition assessment of older subjects in a health care center by MNA (Mini Nutritional Assessment). J Korean Diet Assoc 2010;16(2):122–132.
21. Park HK, Lim BK, Choi SH, Lee HR, Lee DS. Verification of the appropriateness when a shortened version of the Mini Nutritional Assessment (MNA) is applied for determining the malnutrition state of elderly patients. J Korean Soc Parenter Enter Nutr 2009;2(1):13–18.
22. Son SM, Park JK. The changes of dish consumption frequencies, dietary attitudes and health-nutrition risk for single living female elderly on food-aid program. J Korean Diet Assoc 2005;11(3):286–298.
23. Kim HY, Kim MH, Hong SG, Hwang SJ, Park MH. A study on the nutrient intake, health risk factors, blood health status in elderly Korean women living alone. Korean J Community Nutr 2005;10(2):216–223.
24. 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.
25. Ministry of Health and Welfare (KR). Dietary guidelines for Korean elderly. Seoul: Ministry of Health and Welfare; 2010.
26. Kim OS, Ryu HS. The study on blood lipid levels according to the food habits and food intake patterns in Korean elderly. Korean J Food Nutr 2009;22(3):421–429.
27. Pala V, Sieri S, Masala G, Palli D, Panico S, Vineis P, Sacerdote C, Mattiello A, Galasso R, Salvini S, Ceroti M, Berrino F, Fusconi E, Tumino R, Frasca G, Riboli E, Trichopoulou A, Baibas N, Krogh V. Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort. Nutr Metab Cardiovasc Dis 2006;16(3):186–201.
28. Heidemann C, Hoffmann K, Spranger J, Klipstein-Grobusch K, Möhlig M, Pfeiffer AF, Boeing H. A dietary pattern protective against type 2 diabetes in the European prospective investigation into cancer and nutrition (EPIC)-Potsdam study cohort. Diabetologia 2005;48(6):1126–1134.
29. Yang KM. A Study on nutritional intake status and health-related behaviors of the elderly people in Gyeongsan area. J Korean Soc Food Sci Nutr 2005;34(7):1018–1027.
30. Kim JE, Shin S, Lee DW, Park JH, Hong EJ, Joung H. Association between compliance with dietary guidelines and Alzheimer's disease in Korean elderly. J Nutr Health 2015;48(3):221–227.
31. Kim MH. Characteristics of nutrient intake according to metabolic syndrome in Korean elderly: using data from the Korea National Health and Nutrition Examination Survey 2010. Korean J Food Nutr 2013;26(3):515–525.
32. Park YK, Lee YJ, Lee SS. The intake of food and nutrient by the elderly with chronic disease in the Seoul area. Korean J Nutr 2012;45(6):531–540.
33. Oh C, No JK, Kim HS. Dietary pattern classifications with nutrient intake and body composition changes in Korean elderly. Nutr Res Pract 2014;8(2):192–197.
34. Reedy J, Krebs-Smith SM, Miller PE, Liese AD, Kahle LL, Park Y, Subar AF. Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults. J Nutr 2014;144:881–889.
35. Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol A Biol Sci Med Sci 2001;56 Spec No 2:54–64.
36. Shatenstein B, Ferland G, Belleville S, Gray-Donald K, Kergoat MJ, Morais J, Gaudreau P, Payette H, Greenwood C. Diet quality and cognition among older adults from the NuAge study. Exp Gerontol 2012;47:353–360.
37. McNaughton SA, Ball K, Crawford D, Mishra GD. An index of diet and eating patterns is a valid measure of diet quality in an Australian population. J Nutr 2008;138(1):86–93.
38. van Lee L, Geelen A, Kiefte-de Jong JC, Witteman JC, Hofman A, Vonk N, Jankovic N, van Huysduynen EJ, de Vries JH, van 't Veer P, Franco OH, Feskens EJ. Adherence to the Dutch dietary guidelines is inversely associated with 20-year mortality in a large prospective cohort study. Eur J Clin Nutr 2016;70(2):262–268.
39. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the healthy eating index: HEI-2010. J Acad Nutr Diet 2013;113(4):569–580.
40. National Cancer Institute (US). Epidemiology and genomics research program [Internet]. Bethesda (MD): National Cancer Institute; 2017 [cited 2017 Dec 24].
41. Han KH, Choi MS, Park JS. Nutritional risk and its related factors evaluated by the mini nutritional assessment for the elderly who are meal service participants. Korean J Nutr 2004;37(8):675–687.
42. Kim SH, Choi-Kwon S. Nutritional status among elderly Korean women and related factors. J Korean Biol Nurs Sci 2012;14(1):16–24.
43. Moon HK, Kong JE. Reliability of nutritional screening using DETERMINE checklist for elderly in Korean rural areas by season. Korean J Community Nutr 2009;14(3):340–353.
44. Lee JW, Kim KE, Kim KN, Hyun TS, Hyun WJ, Park YS. Evaluation of the validity of a simple screening test developed for identifying Korean elderly at risk of undernutrition. Korean J Nutr 2000;33(8):864–872.