한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 DOI /kjn 식품으로인한유해물질노출조사를위한 식생활설문지의타당도평가 * 김혜미 1 최슬기 1,2 신상아 1 이경윤 1 신상희 1,3 이정원 1

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1 한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 DOI /kjn 식품으로인한유해물질노출조사를위한 식생활설문지의타당도평가 * 김혜미 1 최슬기 1,2 신상아 1 이경윤 1 신상희 1,3 이정원 1 유수현 1 남혜선 4 김미경 4 정효지 1,2 서울대학교보건대학원보건영양학교실, 1 서울대학교보건환경연구소, 2 삼성서울병원영양팀, 3 식품의약품안전평가원 4 Validation Study of a Dietary Questionnaire for Assessing Exposure to Food-Borne Hazards* Kim, Hyemi 1 ㆍ Choi, Seul Ki 1,2 ㆍ Shin, Sangah 1 ㆍ Lee, Kyung Youn 1 ㆍ Shin, Sanghee 1,3 Lee, Jung Won 1 ㆍ Yu, Soo Hyun 1 ㆍ Nam, Hye-Soen 4 ㆍ Kim, Mi-Gyeong 4 ㆍ Joung, Hyojee 1,2 1 Department of Public Health Nutrition Graduate School of Public Health, Seoul National University, Seoul , Korea 2 Institute of Health and Environment, Seoul National University, Seoul , Korea 3 Department of Dietetics, Samsung Medical Center, Seoul , Korea 4 National Institute of Food and Drug Safety Evaluation, Osong , Korea ABSTRACT Assessing human exposure to food-borne hazards requires standardized assessment tools. The objective of this study was to validate a newly developed dietary assessment questionnaire to assess human exposure to food-borne hazards, which include dietary behavior and food consumption patterns such as eating frequency, types of food containers and cooking methods. A total of 216 adults were recruited for two questionnaire surveys (questionnaire 1 and 2) about 1 week apart with a 3 day diet record. Reproducibility was evaluated by comparing responses from questionnaires 1 and 2, and validity was checked by comparing responses from questionnaire 2 and the 3 day diet record. Comparisons were based on the percent agreement and Spearman s rank correlation coefficient. The mean exact agreement of food containers at purchase between questionnaires 1 and 2 was 73.5%, for storing containers it was 71.9%, and for cooking methods it was 83.0%. The mean correlation coefficient for food intake frequency between questionnaires 1 and 2 was 0.71 (range, 0.50?0.83). The mean correlation coefficient of the food intake frequency between questionnaire 2 and the 3 day diet record was 0.21 (range, ). The exact and adjacent agreement of food intake frequency quartile assessed by questionnaire 2 and the 3 day diet record was 65.4% (range, %). Although the correlation coefficient for food intake frequency between questionnaire 2 and the 3 day diet record was low, the exact and adjacent food intake frequency agreement was higher than 50% and reproducibility of the dietary behaviors exceeded 70%. Therefore, the questionnaire developed in this study could be applied to assess diets for the human exposure to food-borne hazards as a qualitative assessment in a large population. (Korean J Nutr 2011; 44(2): 171 ~ 180) KEY WORDS: dietary questionnaire, food-borne hazard, exposure assessment, validation. 서 식품으로인한건강문제는선진국과개발도상국모두가 접수일 :2011 년 1 월 15 일 / 수정일 :2011 년 4 월 11 일채택일 :2011 년 4 월 12 일 *This research was supported by the grant from the Korea Food and Drug Administration (KFDA ). To whom correspondence should be addressed. hjjoung@snu.ac.kr 론 가지는건강문제로경제적인손실이크다. 1) 급속한산업화로인한환경오염의가중은대기, 토양, 식수를오염시키고, 식품의유해물질오염을증가시켰다. 식품내유해물질은식품의생산, 가공, 조리, 유통과정을거쳐체내로유입되며, 체내로유입된유해물질은여러가지건강문제의원인이되고있다. 식품으로인한유해물질은잔류농약, 중금속, 식품첨가물, 동물의약품, 가공과정에서발생한유해물질과환경오염물질등이포함되고, 용기포장으로인한유해물질에는미반 2011 The Korean Nutrition Society

2 172 / 유해물질노출평가설문지타당도평가 응모노머, 첨가제, 반응부산물, 잔류용제등이포함된다. 화 학적유해물질은때로는급성효과를유발하고, 일부식품첨 가물, 농약잔류물, 잔존의약물질, 환경오염물질등은만성 적으로누적되어건강문제를야기한다. 2) 국내에서수행된식품으로인한유해물질노출평가는주 로식생활에대한설문조사와식품내유해물질함량을직 접분석하는방법으로이루어졌다. 식품의약품안전청에서는 2000 년이후매년한국인다소비대표식품목록을선정하여 대표식품중오염물질함량을분석하고, 식품을통한오염 물질섭취량분석은국민건강영양조사의 24 시간회상법자 료를이용하여추정하는방법을이용해왔다. 3-10) 또한식품 포장용기, 캔제품, 비닐랩의사용실태, 11) 한약복용, 식수 이용 12) 등에따른유해물질노출량평가가선행연구에서이 루어진바있다. 식품을통한유해물질노출량평가를위해식품섭취량 조사를이용한연구에서는 24 시간회상법을이용한 1 일식품 섭취량조사, 13) 유해물질노출기여식품으로알려진제한된 식품의섭취빈도조사 14) 를이용하는경우가대부분이어서장 기간의통합적인노출수준을파악하는것은제한점이많 았다. 또한조사에이용된식품섭취빈도조사지는타당도평 가가이루어지지않아, 조사결과의신뢰성에한계가있었다. 최근들어유해물질과건강에대한관심이증가하면서, 유 해물질의주요노출경로인식품으로인한노출측정에대한 요구가높아지고있다. 따라서식생활로인한유해물질노 출조사를위한타당도가검증된설문지가완성된다면, 식품 으로인한유해물질노출수준과건강과의관련성에관한연 구에활용될수있을것이다. 이에본연구진은식품으로부 터의유해물질노출을평가하기위해식품구매및보관시 이용하는용기, 조리방법, 식품의섭취빈도에대한문항이포 함된식생활조사지를개발하여신뢰도와타당도평가를시 행하였다. 연구방법 조사대상 (Fig. 1) 서울및수도권지역에거주하는성인을남녀별성비가유 사하도록편의추출방법으로모집하였다. 대상자모집은연 구윤리기준에맞도록공고를통하여모집하였으며, 연구 프로토콜에대한서울대학교생명윤리심의위원회의승인을 받은후모집하였다. 선행연구에따르면식생활조사지의타 당도검증을위해서는개인내변이와개인간변이를고려 하여통상적으로 100~200 명정도를대상으로한다. 15) 따라 서최종자료완성대상자를 200 명, 연구기간중탈락률을 1 st questionnaire survey Reproducibility 20% 로예상하여조사대상을모집하였고, 전체참여자 218 명중식생활조사지가완료되지않은 1 명과 3 일간의식사기 록이미비한 1 명을제외하여, 216 명의자료를분석하였다. 식생활조사지의구성식생활조사지는대상자의일반적특성과 99 개식품에대 한구매, 보관시주로사용하는용기및주로사용하는조리 방법에대한질문, 식품섭취빈도조사로구성되었다. 99 개의 식품목록은한국영양학회식품분류코드, 국민건강영양조 사의식품섭취빈도조사지, 질병관리본부의유전체코호트 에서사용하는식품섭취빈도조사지, 국립암센터에서개발한 식품섭취빈도조사지자료를바탕으로다빈도, 다소비식품과 식품중유해물질의농도를고려하여식품을선택하고, 재분 류하여사용하였다. 포장용기를통해유해물질이유래된다 고알려진캔 / 통조림, 플라스틱, 비닐팩 / 랩등에대해서는 각식품별로구매할때와보관할때어떠한재질의용기를 이용하는지질문하였다. 그리고유해물질노출가능성이있 는조리방법의이용여부조사를위해직화구이 / 훈제, 팬구 이 / 볶음 / 조림 / 오븐, 튀기기, 삶기 / 찌기 / 끓이기, 그대로먹기 중각식품별로주로사용하는조리방법에대해응답하도록 하였다. 식품섭취빈도조사는지난 1 년동안의평균식품섭 취횟수를조사하였다. 2 nd questionnaire survey 3 days foodrecord Validity Fig. 1. Design of validation study for a developed questionnaire. 식생활조사지의타당도평가식생활조사지의신뢰도평가 (reproducibility) 를위해식 생활조사지에일주일정도의시간간격을두고두번응답 하도록하고그결과를비교하였다. 타당도평가 (validity) 는 2 차식생활조사지와 3 일식사기록의결과를비교평가 하였다. 이를위하여 2 차식생활조사이전에 3 일간 ( 주중 2 일, 주말 1 일 ) 의식사기록방법설명서와실제크기의음식사 진, 식품크기를측정할수있는사각형과원형의그림을제 공하여대상자들이스스로식사기록을할수있도록하였다. 신뢰도평가는식생활조사지에 2 회응답한결과의일치도 (agreement) 를계산하여, 개발한조사지의재현성 (reproducibility) 을검증하였다. 각식품별구매, 보관시주로사용

3 한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 / 173 하는용기, 조리방법에대해응답분포의일치도를분석하였고, 식품섭취횟수의일치도는두식품섭취빈도지에응답한섭취횟수의 Spearman s rank correlation coefficient 값을산출하였다. 또한대상자들의지난 1년동안의각식품별평균섭취횟수를사분위 (quartile) 로구분하고, 1차및 2차식생활조사지의식품섭취빈도의일치도 (exact agreement) 와인접일치도 (adjacent agreement) 값을산출하였다. 개발한조사지의타당도를평가하기위해식생활조사지를이용한 2차식품섭취빈도와식사기록법으로조사한 3일 식사기록결과의섭취빈도를비교하였다. 식품섭취빈도지의타당도검증을위해서는평소식사에대한조사가필요하며, 개방형식사조사를이용할경우여러날조사를하는것이바람직하다. 그러나기존의식품섭취빈도조사지의타당도평가연구에서 16-18) 3일간의식사조사를기준으로사용한경우도많았으므로, 본연구에서도 3일간의식사기록결과를기준으로사용하였다. 현재우리나라에서활용가능한, 식품을통한유해물질의함량 DB가없으므로, 식품섭취빈도조사지를이용한정량적평가는불가능하다. 따라서본연구는각식품의섭취빈도만을조사하는단순식품섭취빈도조사 Table 1. Food groups used in analysis for validation study Cereals (11)* Food group Noodles and dumpling (11) Breads (11) Snacks (4) Potatoes, Sweet potatoes and starches (15) Sugars and Sweeteners (9) Pulses (9) Nuts and Seeds (6) Vegetables (13) Kimchi (2) Mushrooms (2) Fruits (2) Meats (34) Eggs (4) Fishes and canned fishes (14) Other seafoods and Seafood products (9) Salted-fermented seafoods (1) Seaweeds (4) Milk (1) Milk products (5) Beverages (3) Coffee and tea (3) Alcohol (2) Food and dish items Cooked rice, multi grain rice, pilaff, bibimbab, raw fish with rice, sushi, cereal, rice cake, topokki, corn, popcorn Ramyeon, cup ramyeon, noodle, calguksu, jajangmyeon, jjamppong, Maengmyeon, buckwheat noodle, dumpling soup, rice cake with dumpling soup, rice cake soup White bread, red bean bread, steamed bread, steusel bun, hamburger, sandwich, castella, cake, muffin, croquette, doughnut, pizza Snacks, cookie, cracker, biscuit Boiled potato, baked potato, steamed potato, potato soup, potato stew, fried potato, pan-fried potato, potato boiled in soy sauce, french fried, potato chip, steamed sweet potato, baked sweet potato, fried sweet potato, mattang, japchae Honey, jam, syrup, gum, candy, jelly, caramel, yeot, chocolate Soybean boiled with soy sauce, soybean curd, soybean milk, soybean paste stew, fermented soybean paste stew, canned bean, red bean, red bean flour, rice gruel with red bean Peanut, almond, walnut, pine nut, pistachio nut, macadamia nut Radish, carrot, balloom flower root, codonopsis lanceolata, onion, ssam vegetables, namuls, cucumber, red pepper, welsh onion, wakegi, tomato, canned vegetables Chinese cabbage kimchi, other kimchi Mushroom, canned mushroom Eat with peel fruits, eat without peel fruits Roasted beef, beef rib, beef bulgogi, beef boiled in soy sauce, beef-rib stew, pork cutlet, beef cutlet, chicken cutlet, bossam, boiled beef, stir-fried spicy pork, pork bulgogi, pork-rib stew, pork boiled in soy sauce (jangjorim), samgyetang, boiled chicken soup, chicken boiled with rice, duck stew, pork belly, sweet and sour pork, beef with sauce, fired chicken, stir-fried chicken rib, chicken boiled in soy sauce, braised chicken, jjimdak, pork feet, intestine, sundae, duck, ham, sausage, sliced beef with sauce and dried, canned silkworm pupa Boiled egg, steamed egg (include quail s egg), fried egg, folded egg Mackerel, pacific saury, spanish mackerel, hair tail, yellow croaker, raw fish, tuna, salmon, shark, whale meat, fresh water fishes, anchovy, stir-fried anchovy, canned fish Shellfishes, shrimp, crab, lobster, squid, octopus, whip-arm octopus, hanchi, webfoot octopus, seafood products Salted-fermented seafoods Sea mustard, sea tangle, laver, sea lettuce Milk Curd type yoghurt, liquid type yoghurt, cheese, ice cream, cream Carbonated beverages (coke, clean soda pop), sweetened beverages (sikhye, icetea etc), fruit juices Coffee drinks, canned coffee, tea Wine, canned beer *: food group (The number of food and dish items)

4 174 / 유해물질노출평가설문지타당도평가 지를개발하였고, 이를 3일간의식사기록법에서조사된식품섭취빈도결과와비교하였다. 식품섭취빈도조사는지난 1년간의식품섭취를제한된식품목록내에서질문하였고, 식사기록법은 3일간의식품섭취를개방형으로조사하였기때문에두조사간의비교를위해서는동일한기준의식품구분이필요하였다. 3일식사기록지결과와식품섭취빈도조사의식품목록을농촌진흥청의 18개식품군분류기준과유해물질의노출특성을토대로, 유사한식품끼리재분류하였고일부식품군은더세분화하여, 분석에이용된식품군은총 23개였다 (Table 1). 2차식생활조사지와식사기록법에서산출된대상자들의각식품별평균섭취횟수를각각사분위 (quartile) 로구분하고, 두방법에의한식품섭취횟수분포가같은분위수또는인접분위수에있는비율을계산하였다. 두가지방법에서산출된식품섭취횟수의상관성은 Spearman s rank correlation coefficient 값을이용하여분석하였다. 자료의분석은 SAS 9.2 (SAS Institute INS, Cary, NC) 를이용하였다. 결과 연구대상자의일반적특성은 Table 2 에서보는바와같이 남자 103명 (47.7%), 여자 113명 (52.3%) 이었고, 평균 47.3 세였다. 대상자의 96.3% 는고등학교졸업이상의학력이었다. 식품구매, 보관시주로사용하는용기와조리방법에대해반복하여조사하였을때응답의일치도는 Table 3과같다. 구매시주로사용하는용기에대해동일한응답을한비율은전체식품의평균이 73.5% 였다. 버섯통조림이 91.4% 로가장높은일치도를보였고, 기타통조림식품들역시일치도가 80% 이상으로높았다. 통조림식품은통조림통으로판매되기때문에응답의일치도가높게나타난것으로보인다. 그외에도채소, 생선, 캔음료, 와인등상대적으로포장용기가다양하지않은식품에대한구매용기의응답일치도가높았다. 반면, 다양한포장용기를사용하여판매하는면류와조리된음식에대한구매용기의응답일치도는낮은편이었다. 반복된조사에서보관시주로사용하는용기에대한질문에동일한응답을한비율은전체식품의평균이 71.9% 였다. 땅콩버터, 팝콘, 버섯통조림, 육포, 와인, 레토르트식품등구매후에가공된상태로보관하는식품의보관용기일치도는높았고, 감자를이용한요리, 돼지고기요리, 난류등조리후보관을하는식품에대한용기의일치도는낮았다. 각식품조리시주로사용하는조리방법에대한응답의일 Table 2. General characteristics of study subjects Variables Classification n % Sex Male Female Age (years) less than Equal to or greater than Marital status Unmarried Married Bereavement/divorce/separation Number of household family members Equal or less than Equal to or greater than Current address Metropolitan area Others Monthly household income Less than 990 thousand won ,000-2,990 Thousand won ,000-5,990 Thousand won Equal to or greater than 6,000 thousand won Education attainment Completed middle school Completed high school Completed university More than graduated school

5 한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 / 175 Table 3. Response agreement for containers and cooking methods between first and second questionnaire survey (%) Food groups Foods to purchase to store Cooking methods mainly used Rice Multi grain rice Cooked rice Pilaff, bibimbab Raw fish with rice, sushi Corn Corn Noodles, dumpling and rice cake Breads and snacks Potatoes, starches Popcorn Ramyoen Noodle, kalguksu, udong, sujebi, spaghetti Jajangmyeon, jjamppong Naengmyeon, buckwheat noodle Dumpling soup, rice cake with dumpling soup, rice cake soup Rice cake, topokki White bread Red bean bread, steamed bread, streusel bun Castella, cake, muffin Croquette, doughnut Pizza Hamburger, sandwich Cookie, cracker, biscuit Snack Cereal Boiled potato, baked potato, steamed potato, potato soup, potato stew Fried potato, pan-fried potato, potato boiled in soy sauce French fried, potato chip Steamed sweet potato, baked sweet potato Fried sweet potato, mattang Japchae Sugar Honey, jam, syrup Gum, candy, jelly, caramel, yeot Chocolate Pulses Soybean boiled with soy sauce Tofu Soymilk Soybean paste stew, fermented soybean paste stew Canned bean Red bean, red bean flour, rice gruel with red bean Nuts and seeds Peanut, almond, walnut, pine nut, pistachio nut, macadamia nut Vegetables Ssam vegetables (lettuce, perilla leaves, cabbage, kale, chicory, pak choi) Radish (raw, pickled radish, dried radish cubes) *except kimchi Carrot (raw) Balloom flower root, codonopsis lanceolata Namuls (soybean sprout, spinach, hobaknamul, chiwnamul etc.) Tomato (raw) Raw cucumber *except kimchi Raw red pepper

6 176 / 유해물질노출평가설문지타당도평가 Table 3. Continued Food groups Foods to purchase to store Cooking methods mainly used Vegetables Welsh onion, wakegi *except kimchi Onion Chinese cabbage kimchi Other kimchi (kkakduki, yeolmukimchi, nabakkimchi, godeulppaegi, gatkimchi, pakimchi etc.) Canned vegetables (canned tomato, canned pickle, cucumber preserved with salt, jalapeno, canned salad) Mushrooms Mushrooms Fruits Canned mushrooms Eat with peel (strawberry, plum, cherry, jujube, olive, wild grape, blueberry, korean cherry, cranberry) Eat without peel (citrus fruit, banana, apple, pear, watermelon, oriental melon, peach, persimmon, orange, apricot, lemon, pineapple, melon, mango, actinidia arguta) Canned fruits (apricot, fruit cocktail, grape, mango, rambutan, caper) Fruit juices (orange juice, grape juice, apricot juice, apple juice, strawberry juice etc) Meats Roasted beef, beef rib Beef bulgogi, beef-rib stew, beef boiled in soy sauce (jangjorim) Pork belly Bossam, boiled beef Stir-fried spicy pork, pork bulgogi, pork-rib stew, pork boiled in soy sauce (jangjorim) Samgyetang, boiled chicken soup, chicken boiled with rice, duck stew Fried chicken Stir-fried chicken rib, chicken boiled in soy sauce, braised chicken, jjimdak Duck (roasted) Sweet and sour pork, beef with sauce Pork cutlet, beef cutlet, chicken cutlet Ham, sausage Sliced beef with sauce and dried Pork feet, intestine, sundae Eggs Fishes Canned silkworm pupa Boiled egg, steamed egg *include quail s egg Fried egg, folded egg Mackerel, pacific saury, spanish mackerel * include baked, boiled in soy sauce Hair tail, yellow croaker * include baked, boiled in soy sauce Raw fish Tuna, salmon, shark, whale meat Fresh water fish (cat fish, crucian carp, israeli carp, loach etc.) Anchovy, stir-fried anchovy Shrimp, crab, lobster Squid, octopus, whip-arm octopus, hanchi, webfoot octopus Shellfishes (hard-shelled mussel, little neck clam, scallop, marsh snail etc.)

7 한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 / 177 Table 3. Continued Food groups Foods Salt-fermented fishes (salt-fermented shrimp, salt-fermented squid, salt-fermented viscera, salt-fermented roe, salt-fermented anchovy, salt-fermented shellfish etc.) to purchase to store Cooking methods mainly used Fish products (fish paste, crab flavored fish paste, fish sausage) Canned fish (canned tuna, canned mackerel, canned pacific saury, canned anchovy) Seaweeds Sea mustard, sea tangle, laver, sea lettuce Milk and dairy products Milk Yogurt Cheese Ice cream Cream (whipping, fresh) Fats Peanut butter Beverages Prepared foods Carbonated beverages (coke, clean soda pop) Sweetened beverages (sikhye, icetea etc.) Coffee drinks (except canned coffee) Canned coffee Tea (cassia tora L tea, boxthorn tea, green tea, roasted barley tea, ginger tea etc.) Wine Canned beer Retort pouched foods, instant foods (instant cooked rice, instant soup etc.) Mean 치도는전체식품의평균이 83.0% 였다. 일치도가높은식품은음료 (78.1~100%), 유제품 (95.1~100%), 과일 (97.8~ 99.5%) 등주로조리하지않고그대로먹는식품들이었다. 그러나떡류 (61%), 고구마튀김 맛탕 (62.7%), 버섯통조림 (60.7%) 등조리하지않고그대로먹거나다양한조리방법을이용할수도있는식품들은일치도가낮았다. 식품섭취빈도조사와식사기록법으로조사된식품섭취횟수의상관관계는 Table 4와같다. 1차와 2차식품섭취빈도조사의식품군별상관계수는평균이 0.71 (range: 0.50~ 0.83) 이었고, 2차식품섭취빈도조사와식사기록법은결과는상관계수의평균이 0.21 (range: 0.04~0.48) 이었다. 식품섭취빈도조사와식사기록법으로산출된각식품군별식품섭취횟수를사분위수 (quartile) 로나누었을때일부식품군을제외한대부분의식품군에서일치도와근접일치도의합이 60% 이상이었으며, 모든식품군에서일치도와근접일치도의합이 50% 이상이었다. 식품섭취횟수의일치도가낮은식품군은젓갈류 (52.4%) 와육류가공품 (51.1%) 이었으며, 우유 (82.1%), 면및만두류 (76.3%), 빵류 (75.1%), 커피 차류 (75%) 의일치도가높았다 (Table 5). 고찰 본연구는식생활로부터의유해물질노출평가를위해개발한식생활조사지의타당도를평가하기위해수행하였다. 음식구매시용기, 보관용기, 조리방법에대한두차례의조사결과응답일치도는각각 73.5%, 71.9%, 83.0% 로매우높았으며, 식품섭취횟수에대한일치도는평균상관계수가 0.71 로높았으나식품에따라큰차이가있었다 ( 상관계수 0.50~0.83). 식품섭취빈도조사와식사기록법의상관계수는 0.04~0.48, 식품섭취횟수의일치도및근접일치도의합은모든식품에서 50% 이상이었다. 우리나라에서수행된식품섭취빈도조사의타당도연구결과를보면, 영양소별섭취량의상관계수는 Hong 등 19) 0.269~0.740, Ji 등 20) 0.03~0.56, Ahn 등 21) 0.23~0.64 로매우낮은편이다. 식품섭취빈도지와식사기록법으로조사한식품군별섭취량의상관계수를분석한연구에서식품군을 6가지로분류할경우 0.39~0.64, 29가지식품군으로분류할경우 0.01~0.69 이었다. 22) 대부분의연구가영양소섭취량과식품섭취량에대한타당도평가로,

8 178 / 유해물질노출평가설문지타당도평가 Table 4. Correlation coefficients between diet records and 2nd FFQ or 1st FFQ and 2nd FFQ 식품섭취횟수에대해평가한본연구와직접적인비교를 할수없지만, 국내선행연구에서의식품및영양소섭취량 에대한상관계수보다본연구의결과가낮았다. 일반적으 로식품섭취량에대한타당도는영양소섭취에대한평가 보다상관관계가낮은편이다 15) Spearman's rank correlation coefficient DR-FFQ2 FFQ1-FFQ2 Grains Noodle and dumpling Bread Snack Potatoes and starches Sugars and sweeteners Pulses Nuts and seeds Vegetable Mushroom Kimchi Fruits and their products Meats and poultry Meat products Eggs Fishes and shellfishes Other seafoods and products Salt-fermented foods Seaweed Milk Milk products Peanut butter Beverages (including fruit juice) Coffee and tea Alcoholic beverages Prepared foods Mean 식품의종류에따라타당도가다르게나타나는데, 선행연 구에서자주먹는식품은상관계수가높고, 자주먹지않는 식품은상관계수가낮은것으로알려져있다. 23,24) 프랑스인 을대상으로한연구에서식품섭취조사와식사기록법간의 식품섭취량 (g) 의상관계수값은 0.10~0.71 ( 보정전 ) 이었 다. 상관계수가낮게나온식품은주기적으로먹지않는식 품 ( 해당연구에서는콩류와생선 ) 과양념류였다. 25) Salvini 등 26) 의연구에서는 1 차및 2 차식품섭취빈도조사와식사기 록법의상관계수값이각각 0.09~0.83, 0.08~0.90 이었다. 상관계수가낮은식품은호박과시금치, 높은식품은맥주와 차였다. 식품섭취빈도조사지를 2회반복측정할경우에도자주또는습관적으로먹는식품 ( 음료, 커피, 주류등 ) 은신뢰도가높고, 고구마, 반조리고기파이 (ready made meat pie) 와같이자주먹지않는식품의신뢰도가낮았다. 24,27) 한국노인을대상으로식품섭취빈도조사지의타당도를검증한연구에서는식사기록과식품섭취빈도조사지의식품별섭취량의상관계수가높은식품은곡류, 우유류, 음료류였고, 낮은상관계수를보인식품은빵류, 떡류, 가금류, 녹색채소류, 버섯류, 차류, 조리가공식품류였다. 22) 본연구에서상대적으로높은상관계수를나타낸식품군은주로면류, 만두류, 빵류, 우유, 주류, 커피 차류였으며, 당류, 채소류, 육류, 젓갈류는상관계수가낮았다. 선행연구에서와마찬가지로상관계수가높은식품군은자주섭취하거나, 섭취횟수를파악하기쉬운식품들이었으며, 상관계수가낮은식품군은섭취횟수가적거나, 음식의재료로이용되어 ( 채소, 육류등 ) 정확한섭취횟수를파악하기어려운식품들이었다. 특히젓갈의경우, 개인에따라자주먹거나 / 먹지않는등의차이가크고, 1회섭취분량이적기때문에섭취횟수인지를제대로못하여상관계수가낮은것으로생각된다. 음식구매및보관용기, 조리방법문항의타당도에비해식품섭취빈도에대한타당도가상대적으로낮게나타난이유는식품섭취빈도조사방법자체의제한점을들수있다. 대상자들이식품섭취빈도조사지에응답할때, 조사지에제시된식품을고려하는방법이다르고, 음식의재료로사용된식품의섭취를누락시킬가능성이있다. 본연구에서이용한식품섭취빈도조사지는 1회섭취분량에대한정보를제시하지않고섭취횟수만을질문하였다. 개인별로 1회섭취분량에대한기준이다르기때문에식품섭취빈도조사지에응답한기준이다양할수있다. 한국의식생활은여러재료가섞여있는음식을여러명이나눠먹는형태이기때문에특정식품의 1회섭취분량파악이어렵다. 이러한특성으로인해식품섭취빈도조사지를이용하여조사한결과와식사기록간의상관성이서양에서보고된연구보다낮은것으로알려져있다. 21) 또한본연구에서식사기록지를분석할때섭취분량과관계없이, 섭취횟수만을고려하였기때문에소량을여러번섭취한대상자의섭취횟수가다량을한번섭취한대상자에비해과대평가되었을가능성이있다. 본연구는여름에한차례 3일간의식사섭취에대해조사하여 1년간의식품섭취빈도조사와비교하였으므로, 식사기록방법이계절적특성을반영한평소식사를충분히대표하지못한다는제한점이있다. 현재여러역학연구에서이용되고있는다양한식사조사

9 한국영양학회지 (Korean J Nutr) 2011; 44(2): 171 ~ 180 / 179 Table 5. Percentage of exact agreement and adjacent agreement according to quartile of intake frequency of food groups based on the diet records and food-frequency questionnaire DR-FFQ 2 Exact agreement Adjacent agreement Exact + adjacent Grains Noodles and dumpling Breads Snacks Potatoes and starches Sugar and sweeteners Purses, nuts and seeds Vegetables Mushrooms Kimchi Fruits and Products Meats Meat products Eggs Fishes and shellfishes Other seafoods and their products Salt-fermented seafoods Seaweeds Milks Milk products Beverages (include juice) Coffee and tea Alcoholic beverages Mean 방법들은각각제한점을가지고있다. 식사조사를통해식품, 영양소, 식품매개물질의절대섭취량을정확히조사하는방식에더큰의미를부여할수있으나, 현실적으로실행하는것이어려운경우가많다. 장기간의식생활노출에따른건강결과와의관련성분석은상대적인섭취수준의비교로도가능하므로, 식품섭취빈도조사지를이용하여유해물질의상대적인노출수준을평가할수있다면연구목적에따라서는의미있는결과를도출해낼수있을것이다. 본연구는식생활로부터의유해물질노출평가를위한식품섭취빈도와사용용기, 조리방법을조사하기위한통합적인설문지를개발하고신뢰도와타당도를검증한첫연구이다. 현재국내에는식품및용기, 조리과정으로부터노출되는유해물질에대한정보가부족하고, 각식품별유해물질의함량에대한데이터베이스가매우부족하다. 이러한현실을감안하였을때개인의식생활을반영할수있는타당도가검증된조사지를사용하여상대적인유해물질노출수준을파악하고건강과의관련성을연구할수있다면매우의미있는일이라하겠다. 본연구에서개발한조사지는포장용기, 보관용기, 조리방 법에대한질문과식품의섭취빈도만을포함하여정량적인유해물질노출평가에는한계가있으나, 개인의노출순위등의정성적인평가에는유용하게활용될수있을것이다. 특히정성적인수준이긴하지만대규모역학조사에서유해물질노출의위험집단선별이가능하므로, 조사결과를유해물질노출예방을위한프로그램이나정책의개발에이용할수있을것이다. 요약 식품으로부터의유해물질노출평가를위해개발한식생활조사지의신뢰도와타당도를평가하고자 216명을대상으로식생활조사를 2회반복실시하여비교하였고, 3일식사기록결과와도비교하였다. 1) 식품구매시주로사용하는용기에대해동일한응답을한비율은전체식품평균 73.5% 였다. 상대적으로포장용기가다양하지않은식품에대한구매용기응답일치도가높게나타났으며, 판매시다양한포장용기를사용하는식품에대한구매용기응답일치도는낮게나타났다.

10 180 / 유해물질노출평가설문지타당도평가 2) 식품보관시주로사용하는용기에대한응답일치도는 평균 71.9% 였다. 가공된식품을구매하여보관하는식품에 대한보관용기일치도가높았으며, 조리후보관을하는식 품에대한용기일치도는낮게나타났다. 3) 주로사용하는조리방법에대한응답의일치도는평균 83.0% 였다. 조리방법이다양한식품들에대한일치도가낮 게나타났으며, 조리하지않고그대로먹는식품에대한일치 도가높게나타났다. 4) 식품섭취빈도조사를 2 회실시하였을때, 평균상관계 수가 0.71 (range: 0.50~0.83) 이었고, 2 차식품섭취빈도조 사와식사기록법의식품섭취횟수의평균상관계수는 0.21 (range: 0.04~0.48) 이었다. 5) 식품섭취빈도조사와식사기록법으로산출된각식품군 별식품섭취횟수를사분위수로나누었을때모든식품군 의일치및근접일치도의합은 50% 이상이었다. 6) 본연구에서개발한조사지는식생활항목의신뢰도가 높고, 섭취빈도의순위를분류하는타당도가높으므로, 대규 모역학조사에서질적인노출수준평가에활용할수있을 것으로사료된다. Literature cited 1) World Health Organization. Food safety risk analysis: A guide for national food safety authorities; ) Joung H. Developing a questionnaire for exposure assessment of food-borne hazards. Research Report of Korea Food & Drug Administration (KFDA); p.5-6 3) Cho YH. Dietary intake and risk assessment of contaminants (KFDA); p ) Choi DW. Dietary intake and risk assessment of contaminants (KFDA); p ) Choi DW. Dietary intake and risk assessment of contaminants (KFDA); p ) Choi DW. Dietary intake and risk assessment of contaminants (KFDA); p ) Lee HS. Dietary intake and risk assessment of contaminants in Korean foods. Research report of Korea Food & Drug Administration (KFDA); p ) Moon JS. Dietary intake and risk assessment of contaminants (KFDA); p ) Moon JS. Dietary intake and risk assessment of contaminants (KFDA); p ) Park SO. Dietary intake and risk assessment of contaminants in Korean foods. Research report of Korea Food & Drug Administration (KFDA); p ) Park SY, Kim S, Kim C, Lee S, Yoo KY, Yang M. Biological monitoring in a Korean population. Research report of Korea Food & Drug Administration (KFDA); p ) Roh JH. Biological monitoring exposure to lead and lifestyle factors as determinants of blood lead level. Research report of Korea Food & Drug Administration (KFDA); p ) Park JD. Assessment of exposure to arsenic in Korean. Research Report of Korea Food & Drug Administration (KFDA); p ) Choi KH. Human exposure assessment for antibiotics in the water environment. Research report of Korea Food & Drug Administration (KFDA); p ) Willet WC. Nutritional epidemiology. 2 ed. New York: Oxford University Press; ) Ambrosini GL, Klerk NH, O Sullivan TA, Beilin LJ, Oddy WH, The reliabiliity of a food frequency questionnaire for use among adolescents. Eur J Clin Nutr 2009; 63: ) Huybreechts I, De Backer G, De Bacquer D, Maes L, De Henauw S. Relative validity and reproducibility of a food-frequency questionnaire for estimating food intakes among Flemish preschoolers. Int J Environ Res Pub Health 2009; 6: ) Zhang B, Wang P, Chen CG, He QQ, Zhuo SY, Chen YM, Su YX, Validation of an FFQ to estimate the intake of fatty acids using erythrocyte membrane fatty acids and multiple 3d dietary records. Pub Health Nutr 2009; 13(10): ) Hong SB, Choi YJ, Lee HJ, Kim SH, Oe YJ, Lee SY, Nam MS, Kim YS. Development and validation of a semi-quantitative food frequency questionnaire to assess diets of korean type 2 diabetic patients. Korean Diabetes J 2010; 34: ) Ji SK, Kim HS, Choi HM. Study on development and validation of food frequency questionnaire for estimating energy intake of women in child-bearing age. Korean J Community Nutr 2008; 13(1): ) Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, Park C, Kim DH. Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr 2007; 61(12): ) Won HS, Kim WY. Development and validation of a semi - quantitative food frequency questionnaire to evaluate nutritional status of Korean elderly. Korean J Nutr 2000; 33(3): ) Nomura A, Hankin JH, Rhoads GG. The reproducibility of dietary intake data in a prospective study of gastrointestinal cancer. Am J Clin Nutr 1976; 29(12): ) Jacobsen BK, Bonaa KH. The reproducibility of dietary data from a self-administered questionnaire. The Tromso Study. Int J Epidemiol 1990; 19(2): ) Van Liere MJ, Lucas F, Clavel F, Slimani N, Villeminot S. Relative validity and reproducibility of a French dietary history questionnaire. Int J Epidemiol 1997; 26(suppl): S128-S136 26) Salvini S, Hunter DJ, Sampson L, Stampfer MJ, Colditz GA, Rosner B, Willett WC. Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol 1989; 18: ) Colditz G, Stampfer MJ, Sampson L, Rosner B, Hennekens CH, Speizer FE. The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol 1987; 16(3):