Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Development of nutrition quotient for Korean preschoolers (NQ-P): Item selection and validation of factor structure

취학전아동 대상 영양지수 개발 : 평가항목 선정과 구성 타당도 검증

  • Received : 2016.08.19
  • Accepted : 2016.09.23
  • Published : 2016.10.31
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Abstract

Purpose: Screening of preschool-age children for nutrition programs to improve dietary intake and behaviors requires cost-effective and easily administered validated assessment tools. The purpose of this study was to develop a parent/caregiver-administered instrument for measuring diet quality and behaviors of preschoolers as a nutrition quotient for preschoolers (NQ-P). Methods: Development of NQ-P was carried out in three steps: item generation, item reduction, and validation. The 24-h dietary record was selected as the gold standard reference tool. The 38 items of the NQ-P checklist were derived from a systematic literature review, expert in-depth interviews, statistical analysis of the fifth Korean National Health and Nutrition Examination Survey data, and national nutrition policies and recommendations. Self-administered questionnaires were delivered to parents who recorded 24-h dietary intakes of 100 responders aged 3~5 yr. Pearson's correlation was used to measure the level of agreement between questionnaires. Item reduction was performed, and 20 items were selected based on survey results, expert reviews, and priorities of national nutrition policy and recommendations. The 412 nationwide subjects sampled through daycare centers completed the 20-item checklist questionnaire. The construct validity of the NQ-P was assessed using confirmatory factor analysis, LISREL. Results: After analyses of exploratory factors, NQ-P items identified three dimensions of diet (balance, moderation, and environment). The three-factor structure accounted for 49.28% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-P and three-factor scores of the subjects were calculated by the obtained weights of the questionnaire items. Conclusion: A food behavior checklist for preschoolers' NQ would be a useful and suitable instrument for evaluating nutrition adequacy and dietary quality of Korean preschoolers.

본 연구는 3~5세 취학전아동 대상 영양지수 (Nutrition Quotient for Preschoolers, NQ-P) 개발을 목표로 수행되었다. 어린이의 식행동 및 영양섭취 관련 문헌, 국민건강영양조사 자료 분석 및 전문가 대상 심층면접을 통해 38개 후보평가항목을 선정한 후, 후보 평가항목 중 식품 및 영양소 섭취량을 잘 반영해 주는 평가항목을 선정하기 위해 어린이집 3~5세반 100명의 부모/보호자를 대상으로 식사섭취조사와 체크리스트 설문조사를 수행하였으며, 평가항목과 식품 및 영양소 섭취량, 식사다양성, 체질량지수와의 상관관계 분석 결과로부터 유의한 상관관계를 나타낸 평가항목과 영유아 식생활지침과 어린이 급식관리지침서 영양관리기준에 근거하여 20개 평가항목으로 구성된 체크리스트를 도출하였다. 영양지수 모형을 설정하기 위해 전국 어린이집 목록을 활용하여 조사 대상 어린이집을 기본 층화변수로 5개 권역을 설정하여 어린이집 수를 할당하고 어린이집 당 약 10명을 표본으로 하여 총 412명을 대상으로 조사를 수행하였다. 탐색적 요인분석과 확정적 요인분석에 의해 영양지수구조 모형에 포함된 평가항목은 14개였으며, 구조방정식모형을 통해 14개의 평가항목으로 구성된 영양지수의 구성타당도를 검증하고 가중치를 계산하였다. 전문가 자문에 의한 요인 검토와 조정을 거친 결과 영양지수는 3-factor structure로서 균형, 절제, 환경의 3 영역으로 구성되었다. '균형' 영역에는 콩제품, 생선, 고기, 채소, 흰 우유 섭취의 5개 평가항목, '절제' 영역에는 가공육류, 가공음료, 과자류, 패스트푸드 섭취의 4개 평가항목, 그리고 '환경' 영역에는 아침식사 빈도, 정해진 장소에서 식사, 식사 전 손씻기, 바른 식생활을 위한 노력 정도, TV시청 스마트폰 컴퓨터 사용시간 (screen time)의 5개 평가항목이 포함되었다. 영역별 가중치는 균형 0.45, 절제 0.30, 환경 0.25로 설정하였으며, 영역 내 항목 가중치는 표준화 경로계수를 활용하여 계산하였다. 전국 3~5세 취학전아동 (n = 412명)의 NQ-P 점수는 평균 60.64점 (중앙값: 60.84점, 최소값: 34.99점, 최대값: 88.72점)이었고, 영역별 평균 점수를 보면 균형 60.49점, 절제 51.49점, 환경 71.66점을 나타내었다. 본 연구에서 개발한 NQ-P는 14개 문항의 체크리스트 설문 조사를 통하여 영양지수 점수는 물론, 균형, 절제, 환경의 3개 영역 (요인)의 점수를 산출할 수 있으며, 산출된 영양지수 점수와 영역 점수를 이용하여 어린이의 상대적인 NQ-P 등급을 부여하고, 영양상태 및 식사의 질에 대한 평가를 수행할 수 있다.

Keywords

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