24시간회상법으로 조사한 제주지역 노인의계절별 영양섭취상태에 관한 연구

Abstract

본 연구는 제주도에 거주하는 65세 이상의 노인 190명(남자 78명, 여자 112명)을 대상으로 2005년에서 2006년에 걸쳐 24시간 회상법을 이용하여 겨울, 봄, 여름, 가을 4계절 중 9일간의 식이조사를 수행하여 각 계절별 영양소섭취량과 계절별 추이를 조사하였다.

1. 조사대상자의 평균연령은 남자 71.7세, 여자 76.2세이었고, 평균 신장 및 체중은 남자 162.7㎝, 62.1㎏이며, 여자 148.5㎝, 51.3㎏이었다. 남자노인이 여자노인에 비해 교육수준 및 배우자와의 동거비율이 높은 반면 여자노인은 독거노인의 비율이 높았고 무학이 많고 경제력도 없는 비율이 낮은 것으로 나타났다.

2. 계절별 영양소 섭취량의 변화에 있어서 지방, 탄수화물, 식이섬유, 칼슘, 인, 칼륨, 비타민 A, 티아민, 비타민 C, 콜레스테롤은 계절간의 유의적인 차이가 있었으며, 비타민 A를 제외하고, 겨울이 가장 많이 섭취하고 여름이 대체로 영양섭취가 적은 것으로 나타났다. 또한 권장섭취량의 비율에서는 단백질과 인, 철, 비타민 B6을 제외하고 모두 권장섭취량미만으로 섭취하였다.

3. 계절별 영양소적정도(NAR)는 리보플라빈을 제외한 모든 영양소에서 유의적 차이를 나타내었다. 비타민 A는 여름철에 높고 나머지는 겨울철에 높았다. 그리고 칼슘과 비타민 A, 리보플라빈, 엽산의 NAR은 각 계절마다 0.6 이하로 가장 부족할 가능성이 높은 영양소로 나타났다. 영양소 질적 지수(INQ)는 모든 영양소에서 계절에 따른 유의적인 차이가 있었고, 전반적으로 봄, 여름에 높고 가을, 겨울에 낮았다. 계절별 열량 영양소 섭취량 섭취비율을 비교했을 때 고탄수화물, 저지방식이의 특성을 보였으며, 가을철에 단백질 비율이 높고 여름철에 탄수화물 비율이 높아지는 계절별 차이가 뚜렷하였다.

4. 계절별 식품군별 섭취량에 있어서 감자류, 육류, 동물성식품의 섭취량이 겨울에 높고, 당류, 과일류, 해조류, 양념류와 식물성 식품의 섭취는 여름에 높았으며, 어패류는 가을에 높아 식품군의 섭취량에 있어 계절별 차이가 뚜렷하였다. 섭취빈도가 가장 높은 식품은 마늘과 쌀이 있었으며, 다음으로 된장, 소금, 배추김치 등이 있었으며, 계절마다 돼지고기와 생선의 섭취빈도가 높았다. 영양소기여도가 높은 식품으로 쌀은 에너지, 단백질, 탄수화물, 철, 티아민, 리보플라빈에서도 1위였으며, 된장은 에너지, 단백질, 지방, 칼슘, 철에서 10위 안에 있어 영양소기여도가 높았다.

5. 식품군 점수(DDS : dietary diversity score, 유제품류, 육류, 곡류, 과일류, 채소류)는 겨울이 가장 높고 가을, 여름, 봄 순으로 계절별 유의적인 차이가 있었고, DDS가 4점일 때에 가장 높은 분포를 보였으며, 여자, 고령, 무학, 독거노인일수록 DDS가 불량한 것으로 나타났다. 주요 식품군(유제품류, 육류, 곡류, 과일류, 채소류)별 섭취패턴은 유제품이 제외된 식사(DMGFV=01111)가 가장 높았고, 다음으로 유제품과 과일류가 제외된 식사(DMGFV=01101)가 높은 비중을 차지하였다. 식품군점수(DDS)와 영양소 적정도(NAR)의 관계를 보면 식품군 점수가 증가함에 따라 영양 적정도가 증가하였고, 식품군 점수가 5점인 경우 영양소 적정도도 대부분 0.8이상이었고, 평균영양소적정도(MAR)도 0.81이었으나, 칼슘, 비타민 A, 리보플라빈, 엽산의 NAR은 0.6정도로 낮아 DDS로 식사의 질을 평가할 때 영양소에 따라 차이가 있음을 알 수 있었다.

이상의 결과를 종합해 볼 때 제주지역 일부노인들의 영양 상태는 전반적으로 충분한 영양소 섭취를 못하고 있는 것으로 나타났고, 계절적으로는 절대적 섭취량이 겨울에 높고 여름에 낮았으나 영양소 질적지수는 겨울철에 낮았다. 대부분의 영양소에서 계절에 따른 차이가 있었다. 이처럼 농촌지역에서는 계절에 따라 공급되는 식품이 달라질 수 있으므로 지역과 계절과 계층을 고려한 농촌지역 노인을 위한 영양개선방안과 영양지원정책이 필요하다.

This research targeted 190 people (78 males, 112 females) over the age of 65 residing in Jeju and a research was carried out using the 24 hour recall method for a period of 9 days through the 4 seasons of winter, spring, summer and fall from 2005 to 2006. The nutrition intake and difference in seasons were investigated accordingly.

1. The average age of the targeted group was 71.7 for males and 76.2 for females. The average height and weight were 162.7cm and 62.1kg for males and 148.5cm and 51.3kg for females respectively. The male seniors were better educated and their percentage of living together with a spouse was higher than the female seniors. On the other hand, the female seniors had a higher percentage of living alone, lower income, and had a lower level or no education compared to the male seniors.

2. In terms of changes in the nutrition intake according to seasons, there were some significant differences between seasons in intakes of fats, carbohydrates, fibers, calcium, phosphorus, vitamin A, thiamine, vitamin C and cholesterol. Except for Vitamin A, winter appeared to be the highest intake season and summer had the lowest intake in proper nutritional intake. Furthermore, in terms of ratio of recommended intake, other than the protein, phosphorus, iron and vitamin B6, it was found that they took less than RI.

3. The seasonal Nutritional Adequacy Ratio(NAR) showed a significant difference in all nutritions except for riboflavin. Vitamin A was high in summer and the rest of the NAR was high in winter. The NAR for calcium, vitamin A, riboflavin, and folic acid appeared to be the nutritions that had the highest possibility of deficiency of less than 0.6 for each season. The Index of Nutritional Quality(INQ) showed significant difference according to seasons in all nutritions. Overall, they were high in spring and summer and low in fall and winter. When the seasonal calorie nutritional intake ratio were compared, the high carbohydrates and low fat diet showed special characteristics. The seasonal difference where protein ratio was high in the fall, and carbohydrate ratio being high in the summer was vividly apparent.

4. In terms of seasonal intake of nutrition according to food groups, during winter, potato, meat, and animal food were significantly high in consumption where as during summer, sugars, fruits, seaweeds, seasoning and plant food were significantly high in consumption. Shellfish intake was high in the fall, which showed a clear contrast in seasonal differences in terms of nutritional intake in food groups. The highest frequency of food intake included garlic and rice which was followed by bean paste, salt, and bae chu (Korean cabbage for making kimchi). The frequency of food intake for pork and fish were high for each season. For food that contributed to nutritional value was rice, ranking number one for energy, protein, carbohydrate, iron, thiamine and riboflavin. The bean paste was the next highest in nutritional value among the top ten for energy, protein, fats, calcium and iron.

5. The score for food groups was the highest for winter. There were seasonal significant differences in the order of fall, summer and spring. When the Dietary Diversity Score (DDS) was 4 points, it showed the highest distribution. The DDS appeared to be more inferior pertaining to facts such as that of being a woman, advanced age, no education, and living alone. The food intake patterns for each main food groups (dairy products, meats, grains, fruits, vegetables) was highest for meals excluding dairy products (DMGFV=01111). This was followed by meals excluding dairy products and fruits (DMGFV=01101) which occupied a high percentage. If you were to look at the relationship between the Dietary Diversity Score (DDS) and Nutritional Adequacy Ratio(NAR), the NAR increased according to the increase in DDS. In the case where the DDS was 5 points, the NAR also was more than 0.8 in most cases. The Mean Adequacy Ratio (MAR) was also 0.81, but the NAR of calcium, vitamin A, riboflavin, and folic acid were as low as 0.6 which allowed us to know that there was a difference in nutrients when evaluating the quality of the meal with DDS.

When putting all these results together, the nutritional status of some seniors in Jeju appears to be generally under nourished. According to seasons, the nutritional intake was absolutely higher in the winter and lower in the summer. Most nutrients had differences depending on what season it was. As it can be seen, the food that is provided according to seasons in the agricultural areas may differ which begs for a nutritional support policy and nutritional reforms for seniors in the agricultural areas taking the region and season into consideration.