한국 성인을 위한 영양지수 개발과 타당도 검증

Purpose: This study was conducted to develop a nutrition quotient (NQ) to assess overall dietary quality and food behaviors of Korean adults. Methods: The NQ was developed in three steps: item generation, item reduction, and validation. Candidate items of the NQ checklist were derived from a systematic literature review, expert in-depth interviews, statistical analyses of the Korea National Health and Nutrition Examination Survey (2010 ~ 2013) data, and national nutrition policies and recommendations. A total of 368 adults (19 ~ 64 years) participated in a one-day dietary record survey and responded to 43 items in the food behavior checklist. Pearson's correlation coefficients between responses to the checklist items and nutritional intake status of the adults were calculated. Item reduction was performed, and 24 items were selected for a nationwide survey. A total of 1,053 nationwide adult subjects completed the checklist questionnaires. Exploratory and confirmatory factor analyses were performed to develop a final NQ model. Results: The 21 checklist items were used as final items for NQ. Checklist items were composed of four factors: nutrition balance (seven items), food diversity (three items), moderation for the amount of food intake (six items), and dietary behavior (five items). The four-factor structure accounted for 41.8% of the total variance. Indicator tests of the NQ model suggested an adequate model fit (GRI = 0.9693, adjusted GFI = 0.9617, RMR = 0.0054, SRMR = 0.0897, p < 0.05), and item loadings were significant for all subscales. Standardized path coefficients were used as weights of the items. The NQ and four-factor scores were calculated according to the obtained weights of the questionnaire items. Conclusion: NQ for adults would be a useful tool for assessing adult dietary quality and food behavior. Further investigations of adult NQ are needed to reflect changes in their food behavior, environment, and prevalence of chronic diseases. 본 연구는 생애주기 중 성인 대상 영양지수 (NQ for adults) 개발을 목표로 수행되었다. 성인의 식행동과 영양섭취 관련 문헌, 국민건강영양조사 자료, 식생활지침 및 국가 영양정책, 전문가 및 포커스 집단을 대상으로 심층면접을 통해 파일럿 조사용 체크리스트를 개발하였다. 성인 368명을 대상으로 1일의 식사섭취조사와 체크리스트 설문조사를 수행하고, 체크리스트 평가항목과 식사섭취조사결과인 영양섭취 수준 간의 상관관계가 높은 24개 항목을 전국단위 조사용 체크리스트로 선정하여 사용하였다. 전국단위 조사는 주민등록인구통계자료를 활용하여 기본 층화변수로 6개 권역을 설정하고 권역별로 성별, 연령군별 성인 인구수를 기준으로 비례 배분하여 총 1,053명을 대상으로 인터넷 조사를 수행하였다. 탐색적 요인분석을 실시하여 성인 영양지수 평가항목을 21개 항목, 4개 요인으로 분류하고, 구조방정식 모형을 이용해 평가항목의 구성타당도를 검증한 후 추정된 경로계수를 적용하여 가중치를 산출하였다. 성인 NQ를 위한 4개