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Kim, Lee, and Kim: Dietary behaviors and nutritional status according to the bone mineral density status among adult female North Korean refugees in South Korea
Research Article

J Nutr Health 2019;52(5):449-464.

Published online: 19 January 2019

DOI: https://doi.org/10.4163/jnh.2019.52.5.449

Dietary behaviors and nutritional status according to the bone mineral density status among adult female North Korean refugees in South Korea

Su-Hyeon Kim1, Soo-Kyung Lee1, †, Sin-Gon Kim2

1Department of Food and Nutrition, Inha University, Incheon 22212, Korea

2Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea

† To whom correspondence should be addressed. tel: +82-32-860-8121, e-mail: skleenutrition@inha.ac.kr

∗ The authors thank all those who participated in this study and Dr. SY Nam for her assistance on additional statistical analyses.

Received 26 December 2018       Revised 9 July 2019       Accepted 18 August 2019

Copyright © 2019 The Korean Nutrition Society

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:

North Koreans could be at higher risk for their bone health because of previous periods of severe famine and the continuing low availability of food. This study determined the bone mineral density (BMD) status and its relationship with dietary behaviors and nutrient intake of North Korean refugees (NKR) in South Korea (SK).

Methods:

This cross-sectional study analyzed 110 female NKR from a NORNS cohort of a non-probability sample of adult NKR in Seoul. BMD examined by DEXA was used to divide participants into the normal group (NG) and the non-normal group (NNG) according to the WHO guideline. A self-administered questionnaire included questions on age, the socioeconomic situation in North Korea (NK) and SK, the food security in NK and SK, and the health behaviors, dietary behaviors, and food frequency questionnaire administered in SK. A one-day 24-hr recall was conducted and the results were analyzed by using CanPro. SPSS was used to analyze whether BMD and related dietary behaviors and nutrient intakes differed according to the groups.

Results:

NG (62.7%) was significantly younger and had a lower abdominal obesity score than NNG (p<0.001). While 14.5% of NG reported experiencing menopause, all of NNG reported experiencing menopause. The NG more frequently consumed the dairy group of foods (9.6 times a week) than did the NNG (4.8 times a week) after the statistics were adjusted for age (p<0.007). The NG consumed significantly more animal protein and animal calcium than did the NNG (p=0.01, p=0.009, respectively). Calcium intake was low with 49.3% of NG, and 78.0% of the NNG reported consuming calcium lower than the estimated average requirement. Only calcium showed an index of nutrient quality lower than one in both groups.

Conclusion:

These results showed that NKR women and possibly all North Korean women are at high risk for bone health and they consumed low levels of bone-related nutrients, and this should be considered for the nutrition policy for NKR and North Korea.

Keywords: North Korea, bone density, women, diet, nutritional status

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Table 1.
Bone mineral density and general characteristics of adult female North Korean refugees in South Korea
  Normal group1) Non-normal group2) Total p-value
69 (62.7)3) 41 (37.3) 110
Bone mineral density (gm/m3) 0.93 ± 0.094) 0.74 ± 0.09 0.87 ± 0.13 < 0.0015)
T-score -0.51 ± 0.74 -2.50 ± 0.88 -1.25 ± 1.25 < 0.001
Z-score -0.25 ± 0.71 -0.56 ± 0.81 -0.35 ± 0.75 0.052
Age (yrs) 40.8 ± 6.1 60.2 ± 8.2 48.0 ± 11.7 < 0.001
20-29 2 (2.9) 0 (0.0) 2 (1.8) < 0.0016)
30-49 62 (89.9) 3 (7.3) 65 (59.1)
50-64 5 (7.2) 25 (61.0) 30 (27.3)
65- 0 (0.0) 13 (31.7) 13 (11.8)
Urban residence in NK7) (n = 61) (n = 40) (n = 101)
  36 (59.0) 30 (75.0) 66 (65.3) 0.09988)
Education in NK
Elementary school 0 (0.0) 1 (2.4) 1 (0.9) 0.3796)
Middle/High school 38 (55.1) 21 (51.2) 59 (53.6)
Technical school 6 (8.7) 1 (2.4) 7 (6.4)
2-year college 10 (14.5) 4 (9.8) 14 (12.7)
College/Graduate school 15 (21.7) 14 (34.2) 29 (26.3)
Occupation in NK (n = 65) (n = 37) (n = 102)
Worker/Farmer 43 (66.2) 13 (35.1) 56 (54.9) 0.0098)
Office worker/Military/ Teacher/Professionals 14 (21.5) 17 (45.9) 31 (30.4)
Student/Not working/ Others 8 (12.3) 7 (18.9) 15 (14.7)
Age at leaving NK (yrs) (n = 67) (n = 40) (n = 107)
  29.5 ± 7.5 49.6 ± 9.5 37.0 ± 12.8 < 0.0015)
14 ~ 20 10 (14.9) 0 (0.0) 10 (9.3) < 0.0014)
21 ~ 29 22 (32.8) 0 (0.0) 22 (20.6)
30 ~ 39 29 (43.3) 6 (15.0) 35 (32.7)
40 ~ 49 5 (7.5) 16 (40.0) 21 (19.6)
50 ~ 59 1 (1.5) 9 (22.5) 10 (9.3)
60 ~ 69 0 (0.0) 9 (22.5) 9 (8.4)
Length of residence in SK9) (months) (n = 66) (n = 40) (n = 106)
  75.2 ± 32.8 96.4 ± 81.7 83.2 ± 57.0 0.0635)
< 36 3 (4.5) 2 (5.0) 5 (4.7) 0.3986)
36 ≤ length < 60 24 (36.4) 11 (27.5) 35 (33.0)
60 ≤ length < 84 16 (24.2) 6 (15.0) 22 (20.8)
84 ≤ length < 108 10 (15.2) 10 (25.0) 20 (18.9)
108 ≤ length < 132 8 (12.1) 4 (10.0) 12 (11.3)
≥ 132 5 (7.6) 7 (17.5) 12 (11.3)
Currently working (n = 67) (n = 39) (n = 106)
  32 (47.8) 15 (38.5) 59 (49.7) 0.4466)
Family monthly income (10,000 KRW) (n = 57) (n = 37) (n = 94)
  151.2 ± 96.5 107.1 ± 85.3 133.8 ± 94.3 0.0265)
< 100 13 (22.8) 22 (59.5) 35 (37.2) 0.0066)
100 ≤ income < 200 29 (50.9) 9 (24.3) 38 (40.4)
200 ≤ income < 300 8 (14.0) 4 (10.8) 12 (12.8)
≥ 300 7 (12.3) 2 (5.4) 9 (9.6)
Marital status in SK (n = 69) (n = 40) (n = 109)
Single 12 (17.4) 1 (2.5) 13 (11.9) < 0.0016)
Married 38 (55.1) 15 (37.5) 53 (48.6)
Divorced 13 (18.8) 4 (10.0) 17 (15.6)
Separated 2 (2.9) 2 (5.0) 4 (3.7)
Widowed 4 (5.8) 18 (45.0) 22 (20.2)
Number of family members
1 2 (2.9) 1 (2.4) 3 (2.7) 0.1316)
2 21 (30.4) 16 (39.0) 37 (33.6)
3 20 (29.0) 15 (36.6) 35 (31.8)
4 20 (29.0) 4 (9.8) 24 (21.8)
5 4 (5.8) 5 (12.2) 9 (8.2)
6 2 (2.9) 0 (0.0) 2 (1.8)

1) Normal group: T-score ≥ -1 or Z-score > -2.0

2) Non-normal group: T-score < -1 or Z-score ≤ -2.0

3) Frequency (%)

4) Mean ± SD

5) Student's T-test

6) Fisher's exact test

7) NK: North Korea

8) Chi-square test

9) SK: South Korea

Table 2.
Health and health behaviors of adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value
69 (62.7)1) 41 (37.3) 110
Height (cm) 154.7 ± 4.62) 154.2 ± 4.7 154.5 ± 4.7 0.6323)
Weight (kg) 54.3 ± 7.5 55.0 ± 7.3 54.6 ± 7.4 0.6393)
BMI (kg/m3) 22.7 ± 2.9 23.4 ± 3.1 23.0 ± 3.0 0.2103)
Underweight (BMI < 18.5) 1 (1.4) 0 (0.0) 1 (0.9) 0.4504)
Normal (18.5 ≤ BMI < 23) 40 (58.0) 19 (43.3) 59 (53.6)
Overweight (23 ≤ BMI < 25) 14 (20.3) 9 (22.0) 23 (20.9)
Obesity (25 ≤ BMI) 14 (20.3) 13 (31.7) 27 (24.5)
Percentage of body fat (%) (n = 61) (n = 39) (n = 100)
  31.5 ± 5.8 32.6 ± 6.3 31.9 ± 6.0 0.3593)
Waist circumference (cm) (n = 61) (n = 39) (n = 100)
  77.0 ± 8.6 82.1 ± 8.3 79.0 ± 8.8 0.0043)
Abdominal obesity (over 85 cm) 12 (19.7) 15 (38.5) 27 (27.0) 0.0395)
Systolic blood pressure (mmHg) (n = 66) (n = 40) (n = 106)
  115.4 ± 12.82) 125.0 ± 15.4 119.0 ± 14.5 < 0.0013)
Normal (< 120) 40 (60.6) 15 (37.5) 55 (51.9) 0.0025)
Pre-hypertension (120 ~ 139) 28 (37.9) 17 (42.5) 42 (39.6)
Hypertension (≥ 140) 7 (1.5) 8 (20.0) 9 (8.5)
Diastolic blood pressure (mmHg) (n = 66) (n = 39) (n = 105)
  75.7 ± 9.8 78.4 ± 11.5 76.7 ± 10.5 0.2033)
Normal (< 80) 44 (66.7) 21 (53.8) 65 (61.9) 0.1385)
Pre-hypertension (80 ~ 89) 17 (25.8) 10 (25.6) 27 (25.7)
Hypertension (≥ 90) 5 (7.6) 8 (20.5) 13 (12.4)
Fasting glucose (mg/dL) (n = 69) (n = 40) (n = 109)
  94.6 ± 10.1 98.5 ± 14.0 96.0 ± 11.8 0.1033)
Normal (70 ~ 99) 57 (82.6) 27 (67.5) 84 (77.1) 0.1534)
Glucose intolerance (100 ~ 125) 11 (15.9) 11 (27.5) 22 (20.2)
Diabetic (≥ 126) 1 (1.4) 2 (5.0) 3 (2.8)
Total cholesterol (mg/dL) (n = 69) (n = 40) (n = 109)
  176.0 ± 30.1 200.0 ± 35.6 184.8 ± 34.1 < 0.0013)
Normal (< 200) 54 (78.3) 23 (57.5) 77 (70.6) 0.0144)
Borderline high (200 ~ 239) 14 (20.3) 12 (30.0) 26 (23.9)
High (≥ 240) 1 (1.4) 5 (12.5) 6 (5.5)
Triglyceride (mg/dL) 78.0 ± 35.3 146.1 ± 107.8 103.4 ± 78.3 < 0.0013)
Normal (< 150) 67 (97.1) 28 (68.3) 95 (86.4) < 0.0014)
Borderline high (150 ~ 199) 1 (1.4) 4 (9.8) 5 (4.5)
High (≥ 200 mg/dL) 1 (1.4) 9 (22.0) 10 (9.1)
HDL-cholesterol (mg/dL) (n = 69) (n = 40) (n = 109)
  54.8 ± 12.2 51.8 ± 12.9 53.7 ± 12.5 0.2263)
Low (≤ 40) 4 (5.8) 7 (17.5) 11 (10.1) 0.0815)
Normal (41 ~ 59) 42 (60.9) 25 (62.5) 67 (61.5)
High (≥ 60) 23 (33.3) 8 (20.0) 31 (28.4)
ALP (IU/L) 58.9 ± 18.8 77.0 ± 20.1 65.7 ± 21.1 < 0.0013)
Practicing vigorous physical activity6) (n = 64) (n = 31) (n = 95)
  10 (15.6) 6 (19.4) 16 (16.8) 0.6495)
Drinking more than once per month last year (n = 67) (n = 38) (n = 105)
  28 (41.8) 10 (26.3) 38 (36.2) 0.1135)
Smoking status (n = 63) (n = 34) (N = 97)
Currently smoking7) 1 (1.6) 0 (0.0) 1 (1.0) 0.1204)
Past smoker 0 (0.0) 2 (5.9) 2 (2.1)
Never smoked 62 (98.4) 32 (94.1) 94 (96.9)
Age at menarche (yrs) (n = 67) (n = 39) (n = 106)
  16.2 ± 2.32) 17.1 ± 2.3 16.7 ± 2.3 0.0583)
Menopause
  10 (14.5) 41 (100.0) 51 (46.4) < 0.0015)
Age at menopause (yrs) (n = 8) (n = 41) (n = 49)
  46.4 ± 3.7 48.9 ± 4.2 48.5 ± 4.2 0.1263)
Taking estrogen (n = 58) (n = 38) (n = 96)
  6 (10.3) 3 (7.9) 9 (9.4) 1.0004)

1) Frequency (%)

2) Mean ± SD

3) Student's T-test

4) Fisher's exact test

5) Chi-square test

6) Practicing vigorous physical activity for longer than 10 minutes per session, for longer than 20 minutes total per day, more than three times per week

7) Have smoked more than 100 cigarettes and currently smoking

Table 3.
Food security in South and North Korea experienced by adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value
69 (62.7)1) 41 (37.3) 110
HFIAS score in North Korea2) 10.5 ± 8.33) 10.3 ± 9.3 10.4 ± 9.6 0.9364)
  (n = 68)   (n = 109)
Food secure 13 (19.1) 9 (22.0) 22 (20.2) 0.7975)
Food insecure
Mildly 4 (5.9) 3 (7.3) 7 (6.4)  
Moderately 7 (10.3) 6 (14.6) 13 (11.9)  
Severely 44 (64.7) 23 (56.1) 67 (61.5)  
Food security in NK by KNHANES question
Sufficient amount, diverse food 8 (11.6) 7 (17.1) 15 (13.6) 0.4736)
Sufficient amount, limited variety 17 (24.6) 14 (34.1) 31 (28.2)
Occasionally limited amount 22 (31.9) 11 (26.8) 33 (30.0)
Frequently limited amount 22 (31.9) 9 (22.0) 31 (28.2)
Food secure in NK by KNHANES question7) 25 (36.2) 21 (51.2) 46 (41.8) 0.1236)
Food security in SK by KNHANES question
Sufficient amount, diverse food 43 (62.3) 29 (70.7) 72 (65.5) 0.2065)
Sufficient amount, limited variety 19 (27.5) 9 (22.0) 28 (25.5)
Occasionally limited amount 2 (2.9) 3 (7.3) 5 (4.5)
Frequently limited amount 5 (7.2) 0 (0.0) 5 (4.5)
Food secure in SK by KNHANES question7) 62 (89.9) 38 (92.7) 100 (90.9) 0.7415)

1) Frequency (%)

2) HFIAS: Household Food Insecurity Access Scale

3) Mean ± SD

4) Student's T-test

5) Fisher's exact test

6) Chi-square test

7) Food secure by KNHANES question: “Sufficient amount, diverse food” + ”sufficient amount, limited variety”

Table 4.
Dietary behaviors in South Korea of adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value
69 (62.7)1) 41 (37.3) 110
Skipping meal
Breakfast 48.52) 25.6 40.2 < 0.0013)
Lunch 11.8 12.8 12.1 0.8204)
Dinner 8.7 20.0 12.8 0.0164)
Eating out frequency last year
More than twice a day 1 (1.4)1) 0 (0.0) 1 (0.9) 0.1014)
Once a day 3 (4.3) 1 (2.4) 4 (3.6)
5 ~ 6 times a week 0 (0.0) 0 (0.0) 0 (0.0)
3 ~ 4 times a week 3 (4.3) 1 (2.4) 4 (3.6)
1 ~ 2 times a week 5 (7.2) 9 (22.0) 14 (12.7)
1 ~ 3 times a month 17 (24.6) 4 (9.8) 21 (19.1)
Rarely 40 (58.0) 26 (63.4) 66 (60.0)
Have received nutrition counseling 5 (7.2) 6 (14.6) 11 (10.0) 0.3244)
Food label (n = 68) (n = 39) (n = 107)
Know and use 17 (25.0) 9 (23.1) 26 (24.3) 0.6453)
Know, but not use 5 (7.4) 5 (12.8) 10 (9.3)
Do not know 46 (67.6) 25 (64.1) 71 (66.4)

1) Frequency (%)

2) %: {(number of respondents without breakfast one day before) + (number of respondents without breakfast two day before)}/ {(number of respondents for breakfast one day before) + (number of respondents for breakfast two day before)} ∗ 100

3) Chi-square test

4) Fisher's exact test

Table 5.
Weekly consumption frequency of adult female North Korean refugees in South Korea1)
  Normal group Non-Normal group Total p-value Age-adjusted p-value
69 (62.7)1) 41 (37.3) 110
  Grain group (n = 67) (n = 41) (n = 108)    
  Total 27.4 ± 13.12) 30.6 ± 11.9 28.6 ± 12.7 0.2063) 0.7854)
Beans/Potatoes group (n = 69) (n = 40) (n = 109)    
  Tofu 6.0 ± 6.3 3.2 ± 4.7 4.9 ± 5.9 0.011 0.799
  Total 16.6 ± 13.8 12.9 ± 11.1 15.2 ± 13.0 0.147 0.053
Meat/Egg group
  Egg 6.2 ± 6.5 3.0 ± 4.0 5.0 ± 5.9 0.002 0.207
  Total 9.5 ± 8.5 6.0 ± 6.3 8.2 ± 7.9 0.027 0.784
Fish group (n = 68) (n = 40) (n = 108)    
  Total 11.7 ± 11.9 8.4 ± 9.5 10.5 ± 11.2 0.138 0.411
Vegetable group (n = 67) (n = 40) (n = 107)    
  Total 50.0 ± 36.4 35.0 ± 24.3 44.4 ± 33.1 0.023 0.086
Seaweed group
  Total 6.2 ± 7.2 4.1 ± 5.3 5.4 ± 6.6 0.101 0.026
Fruit group
  Total 21.2 ± 22.2 16.0 ± 20.8 19.3 ± 21.7 0.224 0.990
Dairy group (n = 68) (n = 41) (n = 109)    
  Milk 4.9 ± 6.9 1.9 ± 2.7 3.8 ± 5.9 0.001 0.030
  Yogurt 3.7 ± 5.6 2.5 ± 3.3 3.3 ± 4.9 0.158 0.015
  Ice cream 0.9 ± 2.1 0.4 ± 0.9 0.7 ± 1.8 0.135 0.600
  Total 9.6 ± 11.1 4.8 ± 4.4 7.8 ± 9.5 0.002 0.007
Beverage group (n = 68) (n = 41) (n = 109)    
  Total 11.6 ± 9.7 5.2 ± 5.1 9.2 ± 8.8 < 0.001 0.027
  Alcohol beverage grouup
  Total 1.0 ± 1.9 0.9 ± 2.5 1.0 ± 2.1 0.805 0.229
Others
  Total 0.9 ± 2.1 0.3 ± 0.9 0.7 ± 1.7 0.108 0.562

1) Frequency (%)

2) Mean ± SD

3) Student's T-test

4) p-values adjusted for age using general linear model (GLM)

Table 6.
Energy and nutrient intake of adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value Age-adjusted p-value
69 (62.7)1) 41 (37.3) 110
Energy (kcal) 1,386.6 ± 658.72) 1,296.4 ± 457.7 1,353.0 ± 591.1 0.4423) 0.2514)
Protein (g) 58.1 ± 35.6 48.6 ± 24.1 54.6 ± 32.0 0.100 0.010
  Plant protein (g) 26.5 ± 12.3 28.5 ± 13.2 27.3 ± 12.6 0.425 0.965
  Animal protein (g) 31.6 ± 20.1 20.1 ± 20.0 27.3 ± 27.1 0.018 0.030
Fat (g) 38.3 ± 38.7 28.5 ± 20.7 34.7 ± 33.4 0.134 0.562
Carbohydrate (g) 207.6 ± 85.5 207.8 ± 60.2 207.7 ± 76.8 0.991 0.704
Vitamin A (μg RE) 698.3 ± 673.3 584.1 ± 952.7 655.7 ± 786.8 0.464 0.541
Vitamin B1 (mg) 1.6 ± 1.5 1.1 ± 0.8 1.6 ± 1.0 0.843 0.417
Vitamin B2 (mg) 1.1 ± 0.6 1.0 ± 0.6 1.1 ± 0.6 0.219 0.090
Niacin (mg) 11.8 ± 6.8 10.9 ± 5.5 11.4 ± 6.6 0.517 0.044
Vitamin C (mg) 87.0 ± 87.0 96.3 ± 97.3 90.5 ± 90.6 0.602 0.906
Vitamin D (μg) 0.5 ± 1.3 0.3 ± 0.8 0.4 ± 1.1 0.321 0.179
Calcium (mg) 382.5 ± 201.4 335.5 ± 163.1 365.0 ± 188.7 0.207 0.186
  Plant calcium (mg) 236.3 ± 133.0 257.0 ± 145.0 244.0 ± 137.3 0.445 0.294
  Animal calcium (mg) 146.3 ± 143.2 78.4 ± 99.9 121.0 ± 132.5 0.004 0.009
Phosphorous (mg) 895.8 ± 431.4 809.6 ± 343.3 863.7 ± 401.4 0.278 0.006
Sodium (mg) 3,143.8 ± 2,006.5 3,301.0 ± 1,986.1 3,202.4 ± 1,991.2 0.691 0.990
Potassium (mg) 2,359.8 ± 1,212.0 2,800.1 ± 1,325.6 2,523.9 ± 1,267.7 0.078 0.524
Magnesium (mg) 11.4 ± 11.9 9.8 ± 12.7 10.8 ± 12.2 0.500 0.733
Iron (mg) 13.0 ± 9.3 12.1 ± 5.8 12.7 ± 8.2 0.576 0.377
Proportion of energy source (%)
  Protein 16.1 ± 5.1 14.7 ± 3.9 15.6 ± 4.7 0.129 0.122
  Fat 21.7 ± 10.9 18.4 ± 9.5 20.5 ± 10.5 0.108 0.793
  Carbohydrate 62.1 ± 13.5 66.9 ± 12.0 63.9 ± 13.1 0.065 0.440

1) Freuqency (%)

2) Mean ± SD

3) Student's T-test

4) p-values adjusted for age (for energy intake) and energy intake (for nutrients intake) using general linear model (GLM)

Table 7.
Comparison of energy and nutrient intake against KDRI1) among adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value Age-adjusted p-value
69 (62.7)2) 41 (37.3) 110
Energy (kcal)          
  Less than EER 58 (84.1) 36 (87.8) 94 (85.5) 0.5903) 0.1025)
  Over EER 11 (15.9) 5 (12.2) 16 (14.5)    
Protein (g)          
  Less than EAR 14 (20.3) 8 (19.5) 22 (20.0) 0.6293) 0.941
  EAR ~ 125% RNI 31 (44.9) 22 (53.7) 53 (48.2)    
  ≥ 125% RNI 24 (34.8) 11 (26.8) 35 (31.8)    
Vitamin A (μg RE)          
  Less than EAR 26 (37.7) 15 (36.6) 41 (37.3) 0.7293) 0.622
  EAR ~ 125% RNI 24 (34.8) 17 (41.5) 41 (37.3)    
  ≥ 125% RNI 19 (27.5) 9 (22.0) 28 (25.5)    
Vitamin B1 (mg)          
  Less than EAR 7 (10.1) 6 (14.6) 13 (11.8) 0.4293) 0.458
  EAR ~ 125% RNI 32 (46.4) 14 (34.1) 46 (41.8)    
  ≥ 125% RNI 30 (43.5) 21 (51.2) 51 (46.4)    
Vitamin B2 (mg)          
  Less than EAR 20 (29.0) 17 (41.5) 37 (33.6) 0.4073) 0.024
  EAR ~ 125% RNI 33 (47.8) 16 (39.0) 49 (44.5)    
  ≥ 125% RNI 16 (23.2) 8 (19.5) 24 (21.8)    
Niacin (mg)          
  Less than EAR 25 (36.2) 16 (39.0) 41 (37.3) 0.7653) 0.099
  75% EAR ~ 125% RNI 32 (46.4) 20 (48.8) 52 (47.3)    
  ≥ 125% RNI 12 (17.4) 5 (12.2) 17 (15.5)    
Vitamin C (mg)          
  Less than EAR 32 (46.4) 18 (43.9) 50 (45.5) 0.9633) 0.630
  EAR ~ 125% RNI 22 (31.9) 14 (34.1) 36 (32.7)    
  ≥ 125% RNI 15 (21.7) 9 (22.0) 24 (21.8)    
Calcium (mg)          
  Less than EAR 34 (49.3) 32 (78.0) 66 (60.0) 0.0064) 0.190
  EAR ~ 125% RNI 34 (49.3) 9 (22.0) 43 (39.1)    
  ≥ 125% RNI 1 (1.4) 0 (0.0) 1 (0.9)    
Phosphorus (mg)          
  Less than EAR 11 (15.9) 3 (7.3) 14 (12.7) 0.1153) 0.859
  EAR ~ 125% RNI 27 (39.1) 24 (58.5) 51 (46.4)    
  ≥ 125% RNI 31 (44.9) 14 (34.1) 45 (40.9)    
Iron (mg)          
  Less than EAR 17 (24.6) 3 (7.3) 20 (18.2) < 0.0013) 0.236
  EAR ~ 125% RNI 38 (55.1) 15 (36.6) 53 (48.2)    
  ≥ 125% RNI 14 (20.3) 23 (56.1) 37 (33.6)    
OINC6) 15 (21.7) 4 (9.8) 19 (17.3) 0.1083) 0.826
OCEF7) 5 (7.2) 1 (2.4) 6 (5.5) 0.4084) 0.416
Na8) 47 (68.1) 30 (73.2) 77 (70.0) 0.5763) 0.424

OINC, overall insufficient nutrient consumption; OCEF, over consumption of energy and fat

1) KDRI: Korea Dietary Reference Intake, 2015

2) Frequency (%)

3) Chi-square test

4) Fisher's exact test

5) p-values adjusted for age (for energy intake) and energy intake (for nutrients intake) using multiple logistic regression with normal bone mineral density group as reference and insufficient energy and nutrients consumption (energy intake is under 75% EER and intakes of calcium, iron, vitamin A, vitamin C, and vitamin B2 under EAR)

6) Proportion of respondents whose energy intake is under 75% EER and intakes of calcium, iron, vitamin A, vitamin C, and vitamin B2 under EAR

7) Proportion of respondents whose intake of energy and fat is over 125% EER and adequate range 8) Proportion of respondents whose intake of sodium is over 2 g a day

Table 8.
Index of Nutrient Quality1) of adult female North Korean refugees in South Korea
  Normal group Non-normal group Total p-value Age-adjusted p-value
69 (62.7)2) 41 (37.3) 110
Protein 1.5 ± 0.53) 1.3 ± 0.4 1.5 ± 0.4 0.0134) 0.0185)
Vitamin A 1.5 ± 1.5 1.4 ± 2.6 1.4 ± 2.0 0.837 0.728
Vitamin B1 1.9 ± 0.7 1.8 ± 0.6 1.8 ± 0.6 0.525 0.479
Vitamin B2 1.3 ± 0.6 1.1 ± 0.5 1.2 ± 0.6 0.043 0.109
Niacin 1.2 ± 0.5 1.0 ± 0.4 1.1 ± 0.5 0.171 0.051
Vitamin C 1.3 ± 1.6 1.2 ± 1.1 1.3 ± 1.4 0.985 0.891
Calcium 0.8 ± 0.4 0.6 ± 0.3 0.7 ± 0.4 0.007 0.270
Phosphorus 1.8 ± 0.5 1.5 ± 0.4 1.7 ± 0.5 0.019 0.011
Iron 1.3 ± 0.6 2.0 ± 0.9 1.6 ± 0.8 < 0.001 0.358

1) Nutrient intake amount per 1,000 kcal/recommended nutrient intake per 1,000 kcal

2) Frequency (%)

3) Mean ± SD

4) Student's T-test

5) p-values adjusted for age using general linear model (GLM)

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