Korean Journal of Family Medicine

"Energy Intake"

Original Articles

Differences and determinants of dietary intake according to living arrangements in older adults: a cross-sectional study using the 2019, 2021, and 2023 Korea National Health and Nutrition Examination Surveys: Hyun-young Noh, Kang-in Seo, Kyae-hyung Kim; Received November 5, 2025 Accepted January 6, 2026 Published online June 26, 2026; DOI: https://doi.org/10.4082/kjfm.25.0331 [Epub ahead of print]

Abstract
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Background
The nutritional status of older adults is closely related to their living arrangements and reflects social support and food accessibility. This study aimed to compare dietary intake between older adults living alone and those living with others and to identify the key socioeconomic, behavioral, and psychosocial determinants influencing nutrient intake.
Methods
Data were obtained from the 2019, 2021, and 2023 Korea National Health and Nutrition Examination surveys. Older adults aged ≥65 years were classified according to their living arrangements (living alone vs. living with others). Dietary intake was assessed using 24-hour dietary recall data. Group differences in daily energy and nutrient intake were analyzed using analysis of covariance, adjusted for age. Differences in energy and nutrient intake and their associated factors were examined according to the living arrangement (living alone vs. living with others).
Results
Older adults living alone had significantly lower daily energy and carbohydrate, protein, fat, and calcium intake than those living with others (all P<0.05). In the non-living-alone group, smoking status, quality of life, and food abundance were the key determinants of energy and nutrient intake. Among adults living alone, economic activity, smoking status, and food abundance were the most influential factors.
Conclusion
Living arrangements are a crucial contextual factor influencing dietary intake among older Koreans. Nutritional programs that improve food security and social participation may mitigate these disparities and support healthy aging.

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Effect of energy intake expenditure balance on sleep duration: a cross-sectional study concerning the 2019, 2020, and 2022 Korea National Health and Nutrition Examination Surveys: Minchung Suh, Ha Jin Kim, Minseon Park; Received September 6, 2024 Accepted October 9, 2025 Published online February 25, 2026; DOI: https://doi.org/10.4082/kjfm.24.0228 [Epub ahead of print]

Background
Diet and physical activity influence sleep duration; however, the association between energy intake expenditure balance (EIEB) and sleep duration has not been fully investigated. This study examined the relationship between EIEB and sleep duration among Korean adults.
Methods
This cross-sectional study included 13,164 adults aged ≥19 years (5,707 males and 7,457 females) from the 2019, 2020, and 2022 Korea National Health and Nutrition Examination Surveys. EIEB was defined as the difference between daily energy intake and energy expenditure. Energy intake was assessed using a 24-hour dietary recall, and energy expenditure was calculated by summing basal metabolic rate and physical activity. Participants were categorized into sex-specific EIEB quartiles (Q1–Q4). Logistic regression analyses were performed to evaluate the association between EIEB quartiles and short sleep duration (≤6 hours), adjusting for socioeconomic status, body mass index, lifestyle factors, and comorbidities.
Results
Among women, those in the Q2 EIEB group (−260.45 to 90.81 kcal) had a significantly lower risk of short sleep (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.60–0.84). Reduced odds were also observed in Q3 (OR, 0.75; 95% CI, 0.63–0.91) and Q4 (OR, 0.76; 95% CI, 0.62–0.94), with a significant trend across quartiles (P for trend=0.03). No significant associations were observed among men.
Conclusion
A balanced EIEB was inversely associated with short sleep duration in women but not in men, suggesting that sex-specific strategies for energy balance may be needed to support adequate sleep.

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Gender Difference of the Association between Energy Intake Expenditure Balance and Depression among Korean Adults: A Cross-Sectional Study from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey: Eunho Lee, Ha Jin Kim, Jusam Hwang, Minseon Park; Korean J Fam Med 2023;44(6):319-326. Published online August 31, 2023; DOI: https://doi.org/10.4082/kjfm.22.0165

Background
Diet and physical activity are key factors related to depressive mood. Previous studies have demonstrated the effects of diet and physical activity on depression. However, the effect of energy intake-expenditure balance (EIEB) on mental health has not been fully evaluated. This study aimed to analyze the association between EIEB and depression.
Methods
A total of 13,460 participants (5,660 men and 7,800 women) aged ≥19 years were obtained from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey (KNHANES). EIEB was defined as the difference between the daily energy intake and energy expenditure. Energy intake was calculated and provided by the KNHANES using a 24-hour recall survey. Energy expenditure was estimated as the sum of basal metabolic rate and physical activity. Logistic regression analyses were used to investigate the association between sex-specific quartile groups (Q1–Q4) of EIEB and depression after adjusting for socioeconomic status, body mass index, lifestyle factors, and underlying diseases.
Results
Women in Q3 of EIEB (211–669 kcal) had a significantly lower risk of depression (odd ratio [OR], 0.78; 95% confidence interval [CI], 0.67–0.92) than those in Q1 of EIEB (<-167 kcal). The adjusted ORs of depression were 0.87 (95% CI, 0.75–1.02) in Q2 and 0.86 (95% CI, 0.74–1.01) in Q4, with P for trend=0.030. There were no significant associations between the EIEB quartile groups and depression in men after adjusting for potential confounders (P for trend=0.564).
Conclusion
Our results suggested that the EIEB is negatively associated with depression in Korean women.

Citations

Citations to this article as recorded by

Sex- and Age-Specific Differences in the Joint Effects of Diet Quality and Physical Activity on Depressive Symptoms in Adults: A Cross-Sectional Study
Soyoung Kim, Minseon Park
Nutrients.2026; 18(6): 915. CrossRef
Comparative Associations of Aerobic Exercise and Resistance Exercise With Depression and Anxiety in Korean Adults: A Nationwide Propensity Score Matching Analysis
Ye-Jin Yun, Yaeji Lee, Yu-Jin Kwon, Ji-Won Lee
Journal of Korean Medical Science.2026;[Epub] CrossRef
A Lower Energy Balance is Associated With Higher Severity and Odd of Depression Based on the Beck Depression Inventory‐13 (BDI‐13) in a Retiring Age Population: A Population‐Based Cross‐Sectional Study
Mohammad Reza Shadmand Foumani Moghadam, Mostafa Shahraki Jazinaki, Zohre Hosseini, Fatemeh Rajabi, Sharif Etemdi, Melika Hadizadeh, Parnian Pezeshki, Mohammad Amushahi, Reza Rezvani
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Sinyoung Cho, Minseon Park
Nutrients.2024; 16(16): 2583. CrossRef

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The Association between the Ratio of Energy Intake to Basal Metabolic Rate and Physical Activity to Sarcopenia: Using the Korea National Health and Nutrition Examination Surveys (2008–2011): Yu Jin Cho, Mi Hee Cho, Bomi Han, Minji Park, Seolah Bak, Minseon Park; Korean J Fam Med 2020;41(3):167-174. Published online May 20, 2020; DOI: https://doi.org/10.4082/kjfm.18.0127

Abstract
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Background
Sarcopenia is an important health problem, the risk factors of which a few studies have reported on. The purpose of this study was to evaluate the correlation between sarcopenia and the ratio of total energy intake to basal metabolic rate (BMR) as well as physical activity, and determine whether the relationship was different between younger and older age groups using data from the 2008–2011 Korea National Health and Nutrition Examination Survey.
Methods
We analyzed 16,313 subjects older than 19 years who had dual energy X-ray absorptiometry data. Sarcopenia was defined as an appendicular lean mass/weight (%) ratio of 1 standard deviation below the sex-specific mean value for a younger reference group, and BMR was calculated using the Harris–Benedict equation. A chi-squared test and logistic regression analyses were performed to evaluate the factors associated with sarcopenia.
Results
In this study, 15.2% of males and 15.4% of females had sarcopenia. Energy intake/BMR as well as physical activity was negatively related to sarcopenia risk. In stratified analysis by age and sex, strength exercises showed an inverse association with sarcopenia only in males under the age of 50 years (odds ratio, 0.577; P<0.0001), whereas higher energy intake/BMR was negatively associated with sarcopenia in each age and sex group.
Conclusion
Our findings suggest that adequate energy intake is important to prevent sarcopenia regardless of whether one exercises.

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Comparing the Trend of Physical Activity and Caloric Intake between Lipid-Lowering Drug Users and Nonusers among Adults with Dyslipidemia: Korean National Health and Nutrition Examination Surveys (2010–2013): Jin-Young Oh, Lan Chekal, Se-Won Kim, Jee-Yon Lee, Duk-Chul Lee; Korean J Fam Med 2016;37(2):105-110. Published online March 25, 2016; DOI: https://doi.org/10.4082/kjfm.2016.37.2.105

Abstract
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Background

The purpose of this study was to compare the physical activity and caloric intake trends of lipid-lowering drug users with those of non-users among Korean adults with dyslipidemia.

Methods

This study was a repeated cross-sectional study with a nationally representative sample of 2,635 Korean adults with dyslipidemia based on the 2010–2013 Korea National Health and Nutrition Examination Survey. Physical activity was assessed using the International Physical Activity Questionnaire, and caloric intake was estimated through 24-hour dietary recall. All statistical analyses were conducted using IBM SPSS ver. 21.0 (IBM Co., Armonk, NY, USA). The changes in physical activity and caloric intake were investigated for lipid-lowering drug users and non-users using generalized linear models.

Results

The proportion of lipid-lowering drug users in the 2010–2013 survey population increased from 3.5% to 5.0% (P<0.001). Among adults of dyslipidemia, total of 1,562 participants (56.6%) reported taking lipid-lowering drugs, and 1,073 (43.4%) reported not taking lipid-lowering drugs. Drug users were more likely to be older and less educated and to have a diagnosis of diabetes, higher body mass index, and lower low density lipoprotein cholesterol level. Physical activity trends were tested separately for the lipid-lowering drug users and non-users, and a significant decrease was found among the drug users during the study period. Physical activity among the drug users in 2013 was 38% lower (1,357.3±382.7 metabolic equivalent [MET]; P for trend=0.002) than in 2010 (2,201.4±442.6 MET). In contrast, there was no statistically significant difference between drug users and non-users in the trend of caloric intake during the same period.

Conclusion

Physical activity significantly decreased among lipid-lowering drug users between 2010 and 2013, which was not observed among non-users. The importance of physical activity may need to be re-emphasized for lipid-lowering drug users.

Citations

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Are Lipid-Lowering and Antihypertensive Medications Used as Complements to Heart-Healthy Diets? A Scoping Review
Clémence Desjardins, Marie Cyrenne-Dussault, Olivier Barbier, Amélie Bélanger, Anne Gangloff, Line Guénette, Jacinthe Leclerc, Jean Lefebvre, Arsène Zongo, Jean-Philippe Drouin-Chartier
Advances in Nutrition.2023; 14(4): 870. CrossRef
Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid‐Lowering Medication: A Cohort Study
Maarit J. Korhonen, Jaana Pentti, Juha Hartikainen, Jenni Ilomäki, Soko Setoguchi, Danny Liew, Mika Kivimäki, Jussi Vahtera
Journal of the American Heart Association.2020;[Epub] CrossRef