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Original Articles
Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study
Khongorzul Ganbat, Bayarmaa Nasan Ulzii, Sangah Shin
Epidemiol Health. 2024;46:e2024035.   Published online February 28, 2024
DOI: https://doi.org/10.4178/epih.e2024035
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  • 39 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.
METHODS
The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.
RESULTS
The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm.
CONCLUSIONS
This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.
Summary
Korean summary
본 연구는 한국 남성의 관상 동맥 심장 질환(CHD) 위험을 줄이는데 있어서 식이 패턴, 특히 건강한 식물성 식이 지수의 역할이 중요함을 강조한다. 높은 hPDI지수를 가진 사람이 CHD 위험이 유의미하게 19% 감소하는 것은 건강한 식물성 기반 식단 선택이 심혈관 건강에 미칠 수 있는 잠재된 영향력을 강조한다.
Food literacy and its relationship with food intake: a comparison between adults and older adults using 2021 Seoul Food Survey data
Seulgi Lee, Sohyun Park, Kirang Kim
Epidemiol Health. 2023;45:e2023062.   Published online July 3, 2023
DOI: https://doi.org/10.4178/epih.e2023062
  • 3,695 View
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  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake.
METHODS
In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire.
RESULTS
With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile.
CONCLUSIONS
Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.
Summary
Korean summary
건강정보 이해능력(health literacy)은 노인에서 만성질환이나 인지능력과의 관련성이 보고되고 있으나 영양정보 이해능력(food literacy)에 대한 연구는 미비하다. 급변하는 식이 환경에서 식사 및 영양과 관련된 정보를 올바르게 이해하고 판단할 수 있는 영양정보 이해능력은 노인성 질환 예방에 중요하다. 본 연구에서 영양정보 이해능력과 식품군 섭취와의 상관성을 분석한 결과 영양정보 이해능력이 높은 노인이 건강한 식품 섭취 부족 위험이 낮았다. 특히 과일 섭취 부족 위험은 영양정보 이해능력이 높은 노인에서 뚜렷하게 낮았다. 국내 영양정보 이해능력 연구는 초기 단계로 주로 성인 대상으로 연구가 이루어져서 본 연구에서의 결과는 그 의의가 크며, 영양정보 이해능력 향상은 성인과 마찬가지로 노인에서도 건강한 식품 섭취를 위한 중요한 요인으로서 이를 위한 프로그램 개발이 필요할 것으로 사료된다.
Key Message
The study on food literacy among older adults in Korea is significant as previous research has mostly focused on adults. The results showed that older adults with higher food literacy score had lower risk of insufficient food intake as compared with those with lower food literacy score. Specifically, the risk of insufficient fresh fruits intake was the lowest among older adults with higher food literacy score. Therefore, improving food literacy is an important factor for promoting healthy food consumption among older adults.

Citations

Citations to this article as recorded by  
  • Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults
    Kentaro Murakami, Nana Shinozaki, Tsuyoshi Okuhara, Tracy A. McCaffrey, M. Barbara E. Livingstone
    Appetite.2024; 196: 107281.     CrossRef
Epidemiologic Investigation
Epidemiological investigation of a food-borne outbreak in a kindergarten, Jeju Province, Korea
Kyoung Mi Kim, Eun Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae
Epidemiol Health. 2023;45:e2023047.   Published online April 17, 2023
DOI: https://doi.org/10.4178/epih.e2023047
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.
METHODS
The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thursday) and September 6 (Monday), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis (PFGE) for genetic fingerprint analysis was also performed.
RESULTS
There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 hours. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, B. cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of B. cereus showed that there was no genetic homology.
CONCLUSIONS
Our results indicated that this outbreak was simultaneously caused by various strains of B. cereus from the environment.
Summary
Korean summary
모 유치원에서 제공한 급식 취식아동에서 발열이 없고 구토형의 주증상인 식중독이 발생되었다. 평균 잠복기 2.6시간 (최소 0.8, 최대 4.5시간)이며, 인체 및 환경 검체에서 바실러스 세레우스 균이 분리되었다. 이에 해당 집단발생은 구토형 바실러스 세레우스 감염증에 의한 식중독을 결론지었다.
Key Message
A large number of children in a kindergarten vomited suddenly. The average incubation period was 2.6 hours (min 0.8, max 4.5 hours) with uni-modal shape in the epidemic curve. Bacillus cereus and entertoxin were detected in rectal smear and environmental samples.
COVID-19: Health Statistics
Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey
Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong
Epidemiol Health. 2023;45:e2023015.   Published online February 1, 2023
DOI: https://doi.org/10.4178/epih.e2023015
  • 4,966 View
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  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).
METHODS
A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.
RESULTS
In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).
CONCLUSIONS
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.
Summary
Korean summary
코로나19 유행 전, 후 비교 시, 외식 감소, 가정식 섭취 증가 등 식생활은 변화가 있었으나 주요 식품 및 영양소 섭취는 큰 변화없이 최근 10년간의 추이가 지속되고 있었다.
Key Message
Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years in Korean adults.

Citations

Citations to this article as recorded by  
  • Comparative study on the health and dietary habits of Korean male and female adults before and after the coronavirus disease 2019 pandemic: utilizing data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021)
    Chaemin Kim, Eunjung Kim
    Korean Journal of Community Nutrition.2024; 29(1): 65.     CrossRef
Original Article
Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets
Sukyoung Jung, Sohyun Park
Epidemiol Health. 2022;44:e2022063.   Published online August 2, 2022
DOI: https://doi.org/10.4178/epih.e2022063
  • 6,297 View
  • 268 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.
METHODS
This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.
RESULTS
During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.
CONCLUSIONS
Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.
Summary
Korean summary
본 연구는 한국인 유전체역학조사사업의 안성안산코호트 조사에 참여한 40-69세 한국 성인 6,054명을 대상으로 식물성 기반의 식이 지수와 복부비만 간 연관성이 식이 노출 기간(기반, 최근, 누적 노출)에 따라 어떻게 다른지 비교 분석하였다. 건강하지 않은 식물성 기반의 식이 지수 점수가 높을수록 복부비만 발생 위험이 증가하였고, 식이 노출 기간에 관계없이 일관된 결과를 보였다. 식물성 기반의 식이가 반드시 건강에 유익한 것은 아니며, 정제된 곡물, 탄산음료, 사탕 등 간식류를 많이 먹는 식이 패턴은 식물성 기반 식이라 할지라도 복부비만 위험을 증가시킬 수 있으므로 주의가 필요하다.
Key Message
Unhealthy plant-based diets, including refined grains, sugar-sweetened beverages, sweets and desserts, and salty plant foods, can have a negative effect on abdominal obesity in Korean adults regardless of its exposure duration.

Citations

Citations to this article as recorded by  
  • Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging
    Xinyi Shen, Curtis Tilves, Hyunju Kim, Toshiko Tanaka, Adam P Spira, Chee W Chia, Sameera A. Talegawkar, Luigi Ferrucci, Noel T Mueller
    The American Journal of Clinical Nutrition.2024; 119(3): 628.     CrossRef
  • Scoping review of the association of plant-based diet quality with health outcomes
    Richard M. Rosenfeld, Hailey M. Juszczak, Michele A. Wong
    Frontiers in Nutrition.2023;[Epub]     CrossRef
Epidemiologic Investigation
Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018
Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed
Epidemiol Health. 2022;44:e2022048.   Published online May 18, 2022
DOI: https://doi.org/10.4178/epih.e2022048
  • 6,957 View
  • 322 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.
METHODS
This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.
RESULTS
Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.
CONCLUSIONS
Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.
Summary
Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

Citations

Citations to this article as recorded by  
  • Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
    Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
    Emerging Microbes & Infections.2024;[Epub]     CrossRef
  • Native circulating Brucella melitensis lineages causing a brucellosis epidemic in Qinghai, China
    Hongmei Xue, Zhijun Zhao, Jianling Wang, Li Ma, Jiquan Li, Xuxin Yang, Lingling Ren, Liqing Xu, Zhiguo Liu, Zhenjun Li
    Frontiers in Microbiology.2023;[Epub]     CrossRef
Original Article
Association between dietary and suicidal behaviors in adolescents in Korea based on the Youth Risk Behavior Survey (2015-2020)
Youngrong Lee, Ye Jin Jeon, Jee-Seon Shim, Sun Jae Jung
Epidemiol Health. 2022;44:e2022033.   Published online March 12, 2022
DOI: https://doi.org/10.4178/epih.e2022033
  • 9,921 View
  • 394 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study explored the association between dietary and suicidal behaviors of Korean adolescents and investigated differences in this association in children of immigrant parents.
METHODS
The sample (n=368,138) was collected from the Korea Youth Risk Behavior Survey from 2015 to 2020. Participants who agreed to provide family information (n=313,689) were classified according to their parents’ nationality. The study variables were 11 self-reported dietary behaviors, and their composite dietary behaviors (i.e., nutrient deprivation and unhealthy food consumption) that resulted from principal component analysis. The association between study variables and suicide-related outcomes (i.e., suicidal ideation, suicide planning, and suicide attempts) was analyzed by multiple logistic regression with adjustment for covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
Participants who skipped key meals and foods were more likely to have attemped suicide (aOR [95% CI]: skipping breakfast ≥5 days/wk, 1.28 [1.21 to 1.35]; consuming fruits <1 times/wk: 1.42 [1.32 to 1.52]; consuming vegetables <1 times/wk: 1.72 [1.53 to 1.93]; consuming milk <3 times/wk: 1.07 [0.99 to 1.16]). The associations were prominent in third culture kids (TCKs) (aOR [95% CI]: 2.23 [1.61 to 3.09]; 2.32 [1.61 to 3.35]; 2.63 [1.50 to 4.60]; 1.69 [1.09 to 2.63], respectively). Participants who consumed unhealthy foods (fast food, caffeinated and sugary drinks) more frequently were more likely to have attempted suicide (aOR, 1.55; 95% CI, 1.38 to 1.73). This association was also more prominent in TCKs (aOR, 2.08; 95% CI, 1.08 to 4.01).
CONCLUSIONS
Our findings indicate a positive association between unfavorable dietary behaviors and outcomes related to suicide, and this association appears to be notable in adolescents with immigrant parents.
Summary
Korean summary
• 한국 청소년의 식이 행동과 자살 행동 사이의 연관성과 한국인 부모와 이민자 부모 자녀에서 위의 연관성 차이를 조사하였다. • 청소년의 결식 빈도 증가, 과일, 야채, 우유 섭취 감소는 자살 행동과 유의한 연관성이 있었으며 이민자 부모를 둔 청소년에서 연관성의 크기가 더 컸다. • 패스트푸드, 카페인, 가당 음료, 인스턴트 음식을 더 자주 섭취하는 청소년은 자살을 시도할 가능성이 더 높았으며 이민자 부모를 둔 청소년에서 더 큰 연관성을 보였다.
Key Message
The study found positive associations between undesirable dietary behaviors (e.g., skipping breakfast, increased consumption of fast food or instant food product) and outcomes related to suicide (i.e., suicide ideation, planning, and attempt) in Korean adolescents, and these associations appear to be prominent in adolescents with immigrant parents than those with Korean parents.

Citations

Citations to this article as recorded by  
  • Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017–2021: focusing on the comparisons before and during the COVID-19 pandemic
    Mi-Sun Lee, Dong Jun Kim, Hooyeon Lee
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Association between body shape misperception and unhealthy eating behaviors among Korean adolescents
    Yejin Kim, Bomgyeol Kim, Vasuki Rajaguru, Sang Gyu Lee, Tae Hyun Kim
    Nutrition Research and Practice.2023; 17(6): 1143.     CrossRef
Epidemiologic Investigation
An outbreak of hepatitis A associated with salted clams in Busan, Korea
Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim
Epidemiol Health. 2022;44:e2022003.   Published online December 29, 2021
DOI: https://doi.org/10.4178/epih.e2022003
  • 11,610 View
  • 570 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.
METHODS
A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.
RESULTS
From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.
CONCLUSIONS
To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.
Summary
Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.
Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

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Original Article
Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey
Sanghui Kweon, Jin Young Park, Myungsook Park, Yangha Kim, So Yeong Yeon, Leena Yoon, Sungha Yun, Suyeon Park, Ji Eun Yang, Youngtaek Kim, Ok Park, Kyungwon Oh
Epidemiol Health. 2021;43:e2021027.   Published online April 19, 2021
DOI: https://doi.org/10.4178/epih.e2021027
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We aimed to examine the current status and trends of food and nutrient intake in the Korean population over the past 20 years using the data from the Korea National Health and Nutrition Examination Survey (KNHANES).
METHODS
We conducted a survey of 116,284 subjects over the age of one year in Korea, who participated in the KNHANES between 1998 and 2018. We collected data on the subjects’ intake for the day before using the 24-hour recall method. The annual percent change (APC) in the food groups and nutrient intake were calculated using SAS and Joinpoint software.
RESULTS
The intake of grains (APC=-0.4, p<0.05) and vegetables (APC=-0.8, p<0.05) was observed to decrease. In contrast, the intake of beverages, meat, dairy, and eggs increased. In particular, beverage intake increased by more than four times (APC=9.2, p<0.05). There was no significant change in energy intake. However, the proportion of energy intake from carbohydrates decreased by approximately 5%p (APC=-0.3, p<0.05), whereas that from fat increased by approximately 5%p (APC= 1.1, p<0.05). Additionally, there were decreases in the proportion of energy intake from breakfast and homemade meals and increases in the energy intake from snacks, dining out, and convenience food. The intake of vitamin C (APC=-3.2, p<0.05) and sodium (APC=-2.3, p<0.05) significantly decreased.
CONCLUSIONS
Over the past 20 years, there has been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat. Since nutritional status is an important factor in the prevention and management of chronic diseases, it should be continuously monitored.
Summary
Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리 국민의 지난 20년간의 식품 및 영양소 섭취 현황 및 추이를 분석한 결과, 곡류, 채소류, 탄수화물, 나트륨, 비타민 C 섭취 감소, 음료류, 우유류, 육류, 난류, 지방 섭취 증가 등 식품 및 영양소 섭취에 변화가 있었다.
Key Message
We examined the current status and trends of food and nutrient intake in the Korean population using the data from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, there have been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat.

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    Hyein Jung, Ye-Rang Yun, Sung Wook Hong, Sangah Shin
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Systematic Review
Food frequency questionnaires developed and validated in Iran: a systematic review
Arezoo Rezazadeh, Nasrrin Omidvar, Katherine L. Tucker
Epidemiol Health. 2020;42:e2020015.   Published online March 30, 2020
DOI: https://doi.org/10.4178/epih.e2020015
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AbstractAbstract PDF
Abstract
OBJECTIVES
To systematically review and identify food frequency questionnaires (FFQs) developed for the Iranian population and their validation and reproducibility in order to determine possible research gaps and needs.
METHODS
Studies were selected by searching for relevant keywords in the PubMed, Scopus, Science Direct, Google Scholar, SID, and Iranmedex databases, unpublished data, and theses in November 2016 (updated in September 2019). All English-language and Persian-language papers were included. Duplicates, articles with unrelated content, and articles only containing a protocol were excluded. The FFQs were categorized based on: (1) number of food items in to short (≤80 items) and long (>80 items) and; (2) the aim of the FFQ to explore total consumption pattern/nutrients (general) or to detect specific nutrient(s)/food group(s) (specialized).
RESULTS
Sixteen reasonably validated questionnaires were identified. However, only 13 presented a reproducibility assessment. Ten FFQs were categorized as general (7 long, 3 short) and 6 as specialized (3 long, 3 short). The correlation coefficients for nutrient intake between dietary records or recalls and FFQs were 0.07-0.82 for long (general: 0.07-0.82 and specialized: 0.26-0.67) and 0.20-0.67 for short (general: 0.24-0.54 and specialized: 0.20-0.42) FFQs. Long FFQs showed higher validity and reproducibility than short FFQs. Reproducibility of FFQs was acceptable (0.32-0.89). The strongest correlations were reported by studies with shorter intervals between FFQs.
CONCLUSIONS
FFQs designed for the Iranian population appear to be appropriate tools for dietary assessment. Despite their acceptable reproducibility, their validity for assessing specific nutrients and their applicability for populations other than those they were developed for may be questionable.
Summary

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Original Article
A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea
Youngduck Eun, Hyesun Jeong, Seungjin Kim, Wonseo Park, Byoungseon Ahn, Dongkeun Kim, Eunhee Kim, Eunhee Park, Sunhee Park, Inyeong Hwang, Hyunjin Son
Epidemiol Health. 2019;41:e2019002.   Published online January 9, 2019
DOI: https://doi.org/10.4178/epih.e2019002
  • 17,114 View
  • 414 Download
  • 29 Web of Science
  • 34 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.
METHODS
This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.
RESULTS
Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.
CONCLUSIONS
The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.
Summary
Korean summary
이 연구는 2018년 9월 부산광역시 10개 학교에서 급식으로 제공된 초콜릿 케익으로 인해 발생한 살모넬라 톰슨 감염증 대규모 유행의 역학 조사 결과이다. 학교 급식과 같은 대규모 집단급식은 원재료에서 급식 제공까지 안전하게 관리되어야 하며 식품매개감염병 집단 발생 역학조사에 있어 오염원에 대한 체계적 역추적 조사와 기관 간 협업의 중요성을 강조하였다.

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Epidemiologic Investigation
A foodborne outbreak of gastroenteritis caused by Vibrio parahaemolyticus associated with cross-contamination from squid in Korea
Sun-Wha Jung
Epidemiol Health. 2018;40:e2018056.   Published online November 13, 2018
DOI: https://doi.org/10.4178/epih.e2018056
  • 14,588 View
  • 245 Download
  • 21 Web of Science
  • 24 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Water-borne diseases caused by Vibrio parahemolyticus are often known to cause gastritis when raw or undercooked seafood is eaten. It is very rare that Vibrio gastritis caused by ingesting non-seafood products occurs on a large scale. On September 19, 2017, a large-scale Vibrio gastritis occurred after the city residents consumed food at a bazaar held in a welfare center in Jungnang-gu, Seoul.
METHODS
The total number of visitors was approximately 299, and 237 (79.3%) of them showed symptoms. Among those who showed symptoms, 116 (48.9%) consulted the hospital, and 53 (45.6%) were hospitalized. Among the 299 exposed individuals, 174 (58.1%) responded to this survey: 163 (93.6%) with and 11 (6.4%) without symptoms. This study was retrospectively conducted by investigating the exposed individuals. To investigate the spread of infection, medical staff of hospitals in the epidemic area were interviewed, exposed individuals surveyed, microbiological testing conducted, and ingredient handling and cooking processes investigated.
RESULTS
A total of 237 individuals, including 6 food handlers, were affected (prevalence, 79.2%). During the microbiological testing, V. parahemolyticus was found in 34 patients and 4 food handlers. In the consumption analysis, the relative risk of kimbap was 6.79 (confidence interval 1.10 to 41.69). In-depth investigation found that squid, an ingredient of Korean pancake, and egg sheets, an ingredient of kimbap, were prepared using the same cutting board and knife, which were thought to be the cause of cross-contamination that led to a large-scale outbreak of Vibrio gastritis.
CONCLUSIONS
A recent large-scale outbreak of Vibrio gastritis occurred due to the cross-contamination with kimbap during the preparation process of squid rather than the actual consumption of seafood. Thus, a more stringent hygiene management is necessary during the processing and management of food to prevent infections associated with V. parahemolyticus.
Summary
Korean summary
비브리오 장염은 흔히 날 것이나 덜 익힌 해산물을 섭취하였을 경우 잘 생기는 것으로 알려져 있다. 그러나 해산물을 처리하는 과정에서 생긴 교차 감염에 의해서도 비브리오 장염이 생길 수 있으며 이로 인하여 대규모의 유행이 발생할 수 있다. 이에 보다 철저한 위생관리와 교육이 필요하다

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Brief Communication
Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study
Jong-Myon Bae
Epidemiol Health. 2017;39:e2017041.   Published online September 6, 2017
DOI: https://doi.org/10.4178/epih.e2017041
  • 13,190 View
  • 226 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Confirmation of <i>Kudoa septempunctata</i> (<i>K. septempunctata</i>) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with <i>K. septempunctata</i> would result in increased diagnosis of food poisoning by <i>K. septempunctata</i>, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of <i>K. septempunctata</i> food poisoning in 2015, Korea.
METHODS
Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of <i>Kudoa</i> food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted.
RESULTS
Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman’s rho and Kendall’s tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively.
CONCLUSIONS
An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of <i>K. septempunctata</i> caused acute food poisoning.
Summary
Korean summary
질병관리본부가 보고한 2015년도 쿠도아 식중독 발생 사례의 월별 분포와, 같은 기간에 제주도 수산협동조합이 국내 시장에 제공한 출하량 간의 상관성 (correlation)을 알아보았을 때, 유의한 관련성이 없었다. 이는 칠성 쿠도아충이 급성식중독을 일으킨다는 주장을 의심케 하는 근거의 하나이다.

Citations

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  • An update of the species of Myxosporea (Cnidaria, Myxozoa) described from Indian fish
    Jorge C. Eiras, Gyan Deb Barman, Sukanya Chanda, Ashis Kumar Panigrahi
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  • Additional experimental and epidemiologic studies for evaluating pathogenecity of Kudoa septempunctata should be needed
    Jong-Myon Bae
    International Journal of Food Microbiology.2018; 266: 222.     CrossRef
Epidemiologic Investigation
Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis
Sung Uk Lee
Epidemiol Health. 2017;39:e2017014.   Published online March 31, 2017
DOI: https://doi.org/10.4178/epih.e2017014
  • 14,981 View
  • 272 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Recently <i>kudoa septempuctata</i> in olive flounders is suggested as a cause of food poisoning, however whether <i>kudoa septempuctata</i> can affect human gastrointestinal systems is controversial and its pathogenecity remains unclear. In view of the field epidemiology, food poisonings caused by <i>kudoa septempuctata</i> should be distinguished from those caused by staphylococcus aureus and bacillus cereus.
METHODS
The statistics of food poisoning investigations published by Korea Centers for Disease Control and Prevention in 2013-2015 were reviewed. The characteristics of <i>kudoa septempuctata</i> food poisoning reported by Korea Centers for Disease Control and Prevention were reviewed. Information regarding clinical symptoms or epidemiology was extracted.
RESULTS
Total eleven <i>kudoa septempuctata</i> food poisoning cases were analyzed. Food poisonings caused by <i>kudoa septempuctata</i>, staphylococcus aureus and bacillus cereus have clinical and epidemiological similarities. Forty five percent of food poisoning outbreaks occurred in Korea was concluded as unknown. The food poisoning caused by staphylococcus aureus and bacillus cereus accounted for 4.5% (50/1,092) of all food poisoning outbreaks in Korea between 2013 and 2015.
CONCLUSIONS
This study suggests the possibilities of misdiagnosis in the investigations of food poisoning by staphylococcus aureus and bacillus cereus with <i>kudoa septempuctata</i>.
Summary
Korean summary
최근 광어 섭취 후 발생한 식중독의 한 원인으로 쿠도아충이 지목되고 있다. 하지만 쿠도아충에 의한 식중독은 인체 감염에 대한 근거가 부족하고, 황색포도알균이나 바실루스 세레우스 식중독과 감별이 어려워 진단에 있어 주의를 요한다.

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  • Molecular detection and genotype analysis of Kudoa septempunctata from food poisoning outbreaks in Korea
    Gyung-Hye Sung, In-Ji Park, Hee-Soo Koo, Eun-Hee Park, Mi-Ok Lee
    Parasites, Hosts and Diseases.2023; 61(1): 15.     CrossRef
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    A Özer, S Okkay, CT Gürkanlı, Y Çiftçi, V Yurakhno
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  • Foodborne Illness Outbreaks in Gyeonggi Province, Korea, Following Seafood Consumption Potentially Caused by <italic>Kudoa septempunctata</italic> between 2015 and 2016
    Joon Jai Kim, Sukhyun Ryu, Heeyoung Lee
    Osong Public Health and Research Perspectives.2018; 9(2): 66.     CrossRef
  • Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis
    Ji-Hyuk Park
    Epidemiology and Health.2017; 39: e2017037.     CrossRef
  • Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study
    Jong-Myon Bae
    Epidemiology and Health.2017; 39: e2017041.     CrossRef
Perspective
Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning?
Young-Bae Chung, Jong-Myon Bae
Epidemiol Health. 2017;39:e2017004.   Published online January 30, 2017
DOI: https://doi.org/10.4178/epih.e2017004
  • 18,500 View
  • 345 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with <i>Kudoa septempunctata</i> (<i>K. septempunctata</i>) spores, the Korea Centers for Disease Control and Prevention reported 11 events of “<i>Kudoa</i> food poisoning” in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of <i>K. septempunctata</i>. Academic articles showing evidence of the pathogenicity of <i>K. septempunctata</i> were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of <i>K. septempunctata</i>, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of <i>K. septempunctata</i>. Further studies evaluating the pathogenicity of <i>K. septempunctata</i> are needed urgently.
Summary
Korean summary
“질병관리본부는 2015년 쿠도아충 환자 사례조사 (cases reports)를 발표하였다. 제주산 광어에서 발견되는 칠성쿠도아충이 급성 식중독을 일으키는 병인 원충이라는 주장과 관련한 병인성 (pathogenicity) 근거들을 정리한 결과 실험실적 근거에 일관성이 없었다. 이렇게 실험실적 근거가 불충분한 상황에서, 오직 환자사례 결과들만으로 칠성쿠도아충을 급성식중독의 역학적 인과성 (epidemiologic causality)을 부여하는 것은 과학적 타당성이 떨어진다.”

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  • Additional experimental and epidemiologic studies for evaluating pathogenecity of Kudoa septempunctata should be needed
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  • Foodborne Illness Outbreaks in Gyeonggi Province, Korea, Following Seafood Consumption Potentially Caused by <italic>Kudoa septempunctata</italic> between 2015 and 2016
    Joon Jai Kim, Sukhyun Ryu, Heeyoung Lee
    Osong Public Health and Research Perspectives.2018; 9(2): 66.     CrossRef
  • Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis
    Sung Uk Lee
    Epidemiology and Health.2017; 39: e2017014.     CrossRef
  • Production of a novel monoclonal antibody applicable for an immunochromatographic assay for Kudoa septempunctata spores contaminating the raw olive flounder ( Paralichthys olivaceus )
    Michio Jinnai, Takao Kawai, Tetsuya Harada, Yasutaka Nishiyama, Hiroshi Yokoyama, Sho Shirakashi, Hiroshi Sato, Junko Sakata, Yuko Kumeda, Yutaka Fukuda, Kikuyo Ogata, Kentaro Kawatsu
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  • Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study
    Jong-Myon Bae
    Epidemiology and Health.2017; 39: e2017041.     CrossRef

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