Korean J Community Nutr.  2018 Aug;23(4):277-288. 10.5720/kjcn.2018.23.4.277.

Field Application and Evaluation of Health Status Assessment Tool based on Dietary Patterns for Middle-Aged Women

• Lee HJ
• Lee KH

• KMID: 2420090
• DOI: http://doi.org/10.5720/kjcn.2018.23.4.277

Abstract

OBJECTIVES
This study was performed to verify the validity and judgment criteria setting of a health status assessment tool based on dietary patterns for middle-aged women.
METHODS
A total of 474 middle-aged women who visited the Comprehensive Medical Examination Center at Hanmaeum Hospital in Changwon were enrolled (IRB 2013-0005). The validity was verified using clinical indicators for the diagnosis of metabolic syndrome (MS), and it was used to set the criteria for the tool. A logistic regression analysis was performed for validation. The area under-receiver operation (AUC), sensitivity, specificity, and Youden Index were calculated through ROC curve analysis. Statistical analysis was performed by SPSS 21, and p value < 0.05 was considered to be statistically significant.
RESULTS
The mean score of the group with no MS (73.3 points) was significantly higher compared to the group with MS (65.7 points) (p < 0.001). An analysis of the association between the tool scores and risk of MS showed a 0.15-fold reduction in the risk of MS every time the tool's score increased by one point. As the result of the ROC curve analysis, the assessment reference point was set to 71 points, indicating 77.0% sensitivity and 61.0% specificity. Risk of MS was significantly higher in the group with a score of less than 71.0 than a group with more than 71 points (OR=5.28, p < 0.001).
CONCLUSIONS
This study was the first attempt to develop a health status assessment tool based on the dietary patterns for middle-aged women, and this tool has proven its usefulness as an MS assessment tool through the application of middle-aged women in the field of health screening.

Keyword

health status assessment tool; dietary patterns; middle-aged women; women's health; metabolic syndrome

MeSH Terms

Diagnosis
Female
Gyeongsangnam-do
Humans
Judgment
Logistic Models
Mass Screening
ROC Curve
Sensitivity and Specificity
Women's Health

Figure

• 

  Fig. 1 Receiver-operating characteristic (ROC) curves for assessment tool score

Reference

1. Kang SW. The validity and reliability of a lifestyle evaluation tool for patients with metabolic syndrome. J Korean Acad Fundam Nurs. 2010; 17(4):487–497.

2. Cho B, Son KY, Oh BJ, Kim SJ, Kwon IS, Park BJ, et al. Development and validity and reliability of Korean comprehensive assessment tools for geriatric ambulatory care. J Korean Geriatr Soc. 2013; 17(1):18–27.

3. Kant AK, Schatzkin A, Ziegler RG. Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr. 1995; 14(3):233–238.

4. Drewnowski A, Henderson SA, Shore AB, Fischler C. Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc. 1996; 96(7):663–669.

5. Koh SB, Chang SJ, Kang MG, Cha BS, Park JK. Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean J Prev Med. 1997; 30(2):251–266.

6. Park HS, Sung SW, Ou SW, Lee KY, Kim BS, Han JH, et al. Development of Korean version of obesity-related quality of life scale. J Korean Med Obes Res. 2003; 12(4):280–293.

7. Park HS, Kim SK, Cho GY. A study on climacteric symptoms, depression and quality of life in middle-aged women. Korean J Women Health Nurs. 2003; 9(4):479–488.

8. Afshari P, Barzin P, Najar S, Haghighizade M. Prevalence of chronic diseases in middle-aged women. Jundishapur J Chronic Dis Care. 2014; 3(4):e23347.

9. Black PA. A smooth start to a new age: Helping women cope with the menopause. Prof Nurse. 1991; 6(7):407410412–413.

10. Shin HM, Jee SH, Kim JH, Kim MR. The influence on cardiovascular mortality of the metabolic syndrome in Korean postmenopausal women. J Korean Soc Menopause. 2012; 18(1):6–14.

11. Jung J, Kim NC. Risk factors, subjective symptoms, knowledge of coronary artery disease and preventive health practices in postmenopausal women. Korean J Women Health Nurs. 2006; 12(1):29–36.

12. Lee HJ, Lee KH. Health status assessment tool development based on dietary patterns in middle-aged women. Korean J Community Nutr. 2016; 21(1):37–52.

13. Levesque J, Lamarche B. The metabolic syndrome: definitions, prevalence and management. J Nutrigenet Nutrigenomics. 2008; 1(3):100–108.

14. Shin HM, Jee SH, Kim JH, Kim MR. The influence on cardiovascular mortality of the metabolic syndrome in Korean postmenopausal women. J Korean Soc Menopause. 2012; 18(1):6–14.

15. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 56(14):1113–1132.

16. Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality: a population-based study. Am J Epidemiol. 1998; 148(10):958–966.

17. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001; 24(4):683–689.

18. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2003; 163(4):427–436.

19. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004; 164(10):1066–1076.

20. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Grundy SM, Becker D, Clark LT, Cooper RS, Denke MA, Howard J, et al. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143–3421.

21. World Health Organization western pacific region. The Asia-pacific perspective: redefining obesity and its treatment. International Obesity Task Force;2000. cited 2013 May 1. Available from: http://iris.wpro.who.int/bitstream/handle/10665.1/5379/0957708211_eng.pdf.

22. Jung HY, Sung KM. The development of healthy aging scale for middle aged women: convergent approach. J Digit Converg. 2018; 16(5):361–372.

23. Lee EH, Choi SS, So AY. A study on women's health status for setting up women's health nursing center and developing health program. Korean J Women Health Nurs. 1999; 5(1):119–133.

24. Jeong GH, Yang SO, Lee KO, Pye OJ, Lee M, Baik SH, et al. Bone mineral density, health-promoting behavior, and self-efficacy in middle-aged women. Korean J Women Health Nurs. 2003; 9(2):170–178.

25. Kim JH, Mun HS. Health perception, body image, sexual function and depression in menopausal women according to menopausal stages. J Korean Acad Nurs. 2006; 36(3):449–456.

26. Lin JW, Caffrey JL, Chang MH, Lin YS. Sex, menopause, metabolic syndrome, and all-cause and cause-specific mortality-cohort analysis from the Third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2010; 95(9):4258–4267.

27. Kim JS, Cho BL. Association between self-perceived health status and health related behavior in routine health examines. Korean J Fam Med. 2010; 31(9):688–696.

28. Nuotio M, Tammela TL, Luukkaala T, Jylha M. Association of urgency symptoms with self-rated health, mood and functioning in an older population. Aging Clin Exp Res. 2007; 19(6):465–471.

29. Lee HJ, Chung YJ, Kim HJ, Suh HS, Lee HS, Shim KW, et al. Determinants of self-assessed health among elderly adults. J Korean Acad Fam Med. 2002; 23(10):1210–1218.

30. Johnson RJ, Wolinsky FD. The structure of health status among older adults: disease, disability, functional limitation, and perceived health. J Health Soc Behav. 1993; 34(2):105–121.

31. Kim JH, Jin YS, Park JT, Jee YS, Kim KS, Lee H, et al. The relationship between health related physical fitness and self-perceived health status. J Korean Soc Health Educ Promot. 1999; 16(1):83–100.

32. Ahn CS. A study on correlation among physical fitness, diet intakes and serum lipid in middle aged women. Korean J Food Nutr. 1993; 6(4):255–267.

33. Katzmarzyk PT, Gagnon J, Leon AS, Skinner JS, Wilmor JH, Rao DC, et al. Fitness, fatness, and estimated coronary heart disease risk: the heritage family study. Med Sci Sports Exerc. 2001; 33(4):585–590.

34. Lee KJ, Chang CJ, Yoo JH, Yi YJ. Factors effecting health promoting behaviors in middle-aged women. J Korean Acad Nurs. 2005; 35(3):494–502.

35. Suh JA, Lee KA. A study on feminist approach of cognitive psychology to menopause experiences. Korean J Woman Psychol. 2002; 7(1):15–28.

36. Park SE, Kim HM, Kim DH, Kim J, Cha BS, Kim DJ. The association between sleep duration and general and abdominal obesity in Koreans: data from the Korean National Health and Nutrition Examination Survey, 2001 and 2005. Obesity (Silver Spring). 2009; 17(4):767–771.

37. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of usual sleep duration with hypertension: the sleep heart health study. Sleep. 2006; 29(8):1009–1014.

38. Dew MA, Hoch CC, Buysse DJ, Monk TH, Begley AE, Houck PR, et al. Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med. 2003; 65(1):63–73.

39. Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care. 2006; 29(3):657–661.

40. Lam JC, Ip MSM. Sleep & the metabolic syndrome. Indian J Med Res. 2010; 131(2):206–216.

41. Oh JD, Lee SY, Lee JG, Kim YJ, Kim YJ. Health behavior and metabolic syndrome. Korean J Fam Med. 2009; 30(2):120–128.

42. Park HS, Oh SW, Cho SI, Choi WH, Kim YS. The metabolic syndrome and associated lifestyle factors among South Korean adults. Int J Epidemiol. 2004; 33(2):328–336.

43. Hong Y, Pedersen NL, Brismar K, de Faire U. Genetic and environmental architecture of the features of the insulin-resistance syndrome. Am J Hum Genet. 1997; 60(1):143–152.

44. Gaziano JM, Buring JE, Breslow JL, Goldhaber SZ, Rosner B, VanDenburgh M, et al. Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med. 1993; 329(25):1829–1834.

45. Djousse L, Arnett DK, Eckfeldt JH, Province MA, Singer MR, Ellison RC. Alcohol consumption and metabolic syndrome: does the type of beverage matter? Obes Res. 2004; 12(9):1375–1385.

46. Lee KS, Park CY, Meng KH, Bush A, Lee SH, Lee WC, et al. The association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from Seoul, Korea. Ann Epidemiol. 1998; 8(1):31–38.

47. Facchini F, Chen YD, Reaven GM. Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care. 1994; 17(2):115–119.

48. Jung JW, Shin HC, Park YW, Kim CH, Cheong SY, Sung EJ. The relationship between metabolic syndrome, stress and depression: among the 35–64 years old clients of comprehensive medical examination center in one university hospital. Korean J Health Promot Dis Prev. 2004; 4(1):10–17.

49. Lee MS. Relationship of the relative risks of the metabolic syndrome and dietary habits of middle-aged in Seoul. Korean J Community Nutr. 2004; 9(6):695–705.

50. Park J, Kweon SH, Kim YH, Jang MJ, Oh KW. Dietary behaviors related to metabolic syndrome in Korean adults. Korean J Community Nutr. 2012; 17(5):664–675.

51. Yoo JS, Jeong JI, Park CG, Kang SW, Ahn JA. Impact of life style characteristics on prevalence risk of metabolic syndrome. J Korean Acad Nurs. 2009; 39(4):594–601.

52. Chung HK, Kang JH, Shin MJ. Assessment for nutrient intakes in Korean women according to obesity and metabolic syndrome. Korean J Community Nutr. 2010; 15(5):694–703.

53. Seo KH, Lee HJ, Lim BD, Choi YJ, Oh HM, Yoon JS. Association of nutritional status with obesity by body mass index and waist circumference among hypertensive elderly patients. Korean J Community Nutr. 2009; 14(6):831–845.

54. Jovanovic GK, Zezelj SP, Malatestinic D, Sutic IM, Stefanac VN, Dorcic F. Diet quality of middle age and older women from Primorsko-Goranska county evaluated by healthy eating index and association with body mass index. Coll Antropol. 2010; 34:Suppl 2. 155–160.

55. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005; 28(7):1779–1785.

56. Devaraj S, Wang-Polagruto J, Polagruto J, Keen CL, Jialal I. High-fat, energy-dense, fast-food-style breakfast results in an increase in oxidative stress in metabolic syndrome. Metabolism. 2008; 57(6):867–870.

57. Yoo H, Kim YH. A study on the characteristics of nutrient intake in metabolic syndrome subjects. Korean J Nutr. 2008; 41(6):510–517.

58. Grynberg A. Hypertension prevention: from nutrients to (fortified) foods to dietary patterns: Focus on fatty acids. J Hum Hypertens. 2005; 19:Suppl 3. S25–S33.

59. Hoffmann IS, Cubeddu LX. Salt and the metabolic syndrome. Nutr Metab Cardiovasc Dis. 2009; 19(2):123–128.

60. Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic test. Prev Vet Med. 2000; 45(1-2):23–41.