Original Article Fam. Environ. Res. Vol.51, No.5, October 2013: ISSN (Print) ISSN

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1 Original Article Fam. Environ. Res. Vol.51, No.5, October 2013: ISSN (Print) ISSN X(Online) 류지혜 노정옥전북대학교식품영양학과 Need for Development of a List of Meals for Diabetic Patients and Development of Barley-Based Diabetic Meals Ji Hye Ryu Jeong Ok Rho Department of Food Science and Human Nutrition, Chonbuk National University, Jeonju, Korea Family and Environment Research Abstract The aim of this study was to develop and apply a list of meals and standard recipes using barley for diabetic patients. The degree of interest and requirements of diabetic patients were investigated for the development of meals. The ingredients of the meals were selected through the diabetic literature and previous research. While developing a list of meals, dietetic therapies for diabetic patients were considered. After developing 15 kinds of meals and modifying them through sensory evaluation, a standard recipe was completed. In the standard recipe, the menu name, the ingredients, quantity, and recipe were stated and the nutritional components were indicated. Photographs of the meals were included. The calorie prescription for the diabetic patients was aimed at elderly women, that is, those 65 years old or above, based on research showing this to be the average age of diabetics. The prescribed calories were 1,500 kcal based on the food exchange list. Weekly lists of meals including the developed dishes were made for diabetic patients. The list were modified after consultation with a clinical nutritionist. When completed, one meal item was selected for each day and cooked. A photograph was taken and presented diabetic patients. This article presents the standardized recipes of the developed list of meals and applies them to modifying the diabetic diet, with an aim to be of service to diabetic patients attempting to meet their dietetic therapy goals. We also provide basic data on institutional food services for diabetic patients and nutrition education. Received: April 26, 2013 Revised: June 19, 2013 Accepted: June 19, 2013 This article is a part of Ji Hye Ryu s master s thesis in It was awarded as the best master s thesis and shown as a poster presentation at the 65th Conference of Korean Home Economics Association in Corresponding Author: Jeong Ok Rho Department of Food Science and Human Nutrition, Chonbuk National University, 567 Baekje-daero, Deokjingu, Jeonju , Korea Tel: Fax: jorho@chonbuk.ac.kr Keywords diabetic patient, barley, meals 서론 생활수준의향상과식생활이서구화되면서발병률이증가되고있는당뇨병, 고혈압, 동맥경화증등은환자개인뿐만아니라국가적의료비증가를가져오는국민보건상의중요한문제로대두되고있다. 보건복지부의국민건강영양조사결과에따르면우리나라의만 30세이상의당뇨병유병률은 2001년 8.6% 에서 2007년 9.6% 로증가하였으나 2010년 10.1% 로남자 11.3%, 여자 9.0% 로남자가더높은것으로보고되었다 [22]. 당뇨병환자는섭취하는식품의선택과식습관에따라혈당반응의차이가크게나타나기때문에혈당관리에있어서식이요법이필수적이다. 식이섭취및식습관에관한연구에서당뇨병환자는식사속도가빠르고과식하는경향이있으며밥양과육류의기름기를많이섭취하는것으로조사되었고 [8], 과반수이상이식사시간이불규칙하고식사를거르는경우간식으로지방함유율이높은음식을섭취하며비타민과무기질같은미량영양소의섭취는적다고보 Copyright 2013 by the Korean Home Economics Association 551

2 류지혜 노정옥 Table 1. The Need to Develop a List of Appropriate Meals for Diabetic Patients Variable Mean (SD) Male Female t-value Degree of interests in diabetic meals 3.87± ± * Necessity of meals development Difficulty of cooking 4.13± ± ** Lack of academically knowledge 4.47± ± *** No family for cooking 2.53± ± Lack of cooking time 2.53± ± Important properties for diabetic meals Taste 4.53± ± *** Nutritional value 4.47± ± ** Hygiene 4.60± ± *** Additive free of MSG 3.53± ± Packing 4.67± ± *** Using regional foods 4.67± ± *** Ease for storage 4.60± ± ** Diversity 4.53± ± ** Preference of foods 4.53± ± ** Ease of purchase 4.53± ± ** Meals needs by recipes Rice Porridge 4.00± ± * Soup Stews 2.93± ± Steamed food 3.13± ± Grilled food 3.27± ± Pan-fried food 3.07± ± Stirred fried food 3.07± ± Boiled food in soy sauce 3.33± ± Namul muchim 3.33± ± Kimchi 3.13± ± Beverage 3.40± ± Desserts 3.47± ± Response: 5 point Likert scale (5, very much - 1, never). * p<.05, ** p<.01, *** p<.001. 고하였다 [3]. 또한, 당뇨병환자는기존의치료방법과식이요법외에도건강기능식품이나대체요법에도많은관심을보이고있다 [6, 27]. 그러나이러한방법들가운데는과학적으로효과가입증되지않은민간요법들이포함되어있어오남용할경우증상을더욱악화시키고합병증을유발하는등의부작용을초래할수있다 [24]. 지금까지보고된보리관련선행연구에따르면보리는항당뇨및혈당조절효과가있는것으로알려져있다. 보리는분자량이크고수용성의점성이매우높은성분인 b-glucan을함유하고있는데, 이는소화흡수에관여하여혈당을조절하는기능을나타낸다 [16]. 이밖에도 b-glucan은항산화효과및항암활성 [18, 28], 현재보리의기능성에관한연구로는 in vitro 실험을통해보리또는그추출물이혈당조절효과를나타내는지에대한연구와 [20, 30], 보리를이용한단일식품급여가혈당변화에미치는영향에대한연구 [13-15, 34] 등이있으나보리를환자의치료식이나식이요법에적용한연구사례는미흡한실정이다. 따라서본연구에서는당뇨병환자에게기존메뉴를활용한식단을작성하여환자에게적용한기존의연구형태와는달리, 보리를첨가하거나가공한메뉴를개발하고, 이를식단에포함시킴으로서실제로당뇨병환자가이용가능한일주일분의식단을제안하고자하였다. 항돌이변이원성 [19], 면역증강 [25], 콜레스테롤감소효과 [32] 를 비롯하여혈당조절및지질대사에긍정적영향을미친다는연구결과 [34] 가있다. 연구방법 552 Vol.51, No.5, October 2013:

3 1. 당뇨병환자의메뉴개발요구도 1) 조사대상자및조사기간조사대상은전북지역의당뇨병이환노인 50인으로병 의원에서당뇨병을진단받은환자를대상으로하였다. 조사대상자는남자 30.6%, 여자 69.4% 이며평균연령은남자 66.0세, 여자 65.9세이었다. 조사기간은 2010년 7월 13일-7월30일까지이루어졌으며조사는병원의담당임상영양사가연구원과함께조사를하였으며설문지를회수하여분석에이용될수없는것을제외한 49부 (98%) 를분석에사용하였다. 2) 설문조사내용및분석방법설문지는선행연구 [21, 33] 를참고하여본연구목적에맞게수정하였으며당뇨식단에대한관심정도, 당뇨식단필요이유, 당뇨식단개발시중요속성, 조리법별개발요구도로구성하였다. 본조사결과는 Likert 5점척도로 매우그렇다 5 점- 전혀그렇지않다 1 점으로점수화하였다. 설문조사시에는대상자의이해수준을고려하여질문자가직접질의하는방식으로이루어졌다. 수집된자료의통계처리는 SPSS ver (SPSS Inc., Chicago, IL, USA) 을이용하여평균, 표준편차를구하고, 남녀차이에대해 t-test로통계적유의성을검증하였다. 조사도구의신뢰도검정을실시하였으며당뇨식단필요이유의 Cronbach s alpha값은 0.723이었으며, 당뇨식단개발시중요속성의 Cronbach s alpha 값은 0.967, 조리법별개발요구도의 Cronbach s alpha값은 0.965이었다. 이기위하여양념류를향신료나식초, 인공감미료등으로대체하여사용하였다. 식재료와의조화에있어서는생보리와보리가루를메뉴를포함시킬경우음식재료와부조화를이루거나음식의맛에거부감을줄수있는메뉴는배제하였으며소금의사용은최소한으로하고식재료자체의염분을이용하는것으로원칙으로하였다. 3) 보리이용메뉴개발및전문가평가메뉴는다수의예비조리를통해일정한재료의분량과조리방법을일차적으로결정하고, 조리된메뉴를임상영양및교육, 단체급식, 조리과학및식품가공분야의전문가 10명이평가한후최종적으로개발메뉴를완성하였다. 평가는맛, 모양, 영양적균형및식재료의조화의 4가지항목에대해 Likert 5점척도 (5점매우좋다-1점매우좋지않다 ) 로평가한후그결과를반영하여조리법을수정 보완하였다. 통계처리는 SPSS ver. 12.0을이용하여 one-way ANOVA 를실시하여집단별로유의한차이를분석하였다. 개발메뉴는조리가가능한식재료의최소량을고려하여 4인을기준으로하였으며, 메뉴명, 식재료및분량, 조리법을명시하였다. 개발된메뉴는한국영양학회에서고안한영양분석프로그램 CAN pro (computer aided nutritional analysis program) 3.0을이용하여 4인기준분량에 25% 의섭취율을적용하여열량및당질, 단백질, 지방, 식이섬유, 나트륨, 콜레스테롤함량을산출하였다. 2. 보리이용메뉴및당뇨식단개발 1) 식재료에관한문헌고찰메뉴개발에이용된보리를제외한식재료는문헌고찰 [5, 11] 을통해효능과조리과학적특성을확인하였고, 당뇨병식단과관련한서적과선행연구 [12, 17, 26, 29] 를참고하여선별하였다. 2) 메뉴개발의원칙보리를이용한메뉴는주식, 부식, 국 찌개로분류하였고, 열량을낮추는조리법과당뇨식조리원칙에따라저열량, 저염, 저지방의영양소로구성하였으며당뇨를예방할수있는식재료를포함하도록메뉴를개발하였다. 개발된메뉴는조리의재현성을위해당뇨병환자및보호자뿐만아니라일반인이따라하기쉬운조리법을선택하였다. 환자의급격한혈당상승을억제하기위하여주식은흰밥이나죽류를배제하고잡곡밥이나섬유소함량이높은식품을위주로첨가하였다. 메뉴에대한환자의기호도를높 4) 보리이용메뉴를이용한당뇨식단개발보리를이용하여개발된메뉴는실제적인당뇨병환자의식단에활용하고자일일식단의열량을 1,500 kcal로구성하여환자에맞게열량조절이가능하도록 1주일분당뇨식단을작성하였다. 작성된당뇨식단은전북소재대학병원의임상영양사의자문을받아완성하였다. 식품교환표의단위수를계산하여산출된 3대영양소비율은당뇨병진료지침의임상영양요법에서권고한탄수화물, 단백질, 지방의섭취비율인 50-60%:15-20%:25% 를벗어나지않도록하였으며 [17], 당뇨병환자의경우아침에인슐린저항이상승하는증상을고려하여 [1] 아침식사의양은점심식사와저녁식사에비해적게섭취하도록식사의양을배분하였다. 1끼식단에는개발메뉴가 2가지이상포함되도록구성하고, 식품군의구성은채소류 3단위 (1,500 kcal의경우 2.5단위로배분 ), 어육류 2단위가반드시포함되도록하고, 간식을섭취하는경우당질의함량을최소 Vol.51, No.5, October 2013:

4 류지혜 노정옥 화하기위해탄수화물로이루어진간식은제한하도록하였다. 보리가주재료가아닐경우양념이나소스에는 10 g 이하로포함되도록하였다. 당뇨식단은일별로영양분석을실시하여열량, 탄수화물, 단백질, 지질, 콜레스테롤, 비타민B1, 비타민C, 칼슘, 철분, 나트륨, 식이섬유의함량과 3대영양소비율 (%) 을한국인영양섭취기준 [31] 과비교가가능하도록하였다. 완성된식단은일별로개발메뉴가포함되어있는 1끼의식단을선정하고식단의균형을위해간식을추가구성하였다. 연구결과및고찰 1. 당뇨병환자의메뉴개발요구도조사대상자의당뇨식단개발에대한요구도는 Table 1과같다. 당뇨식단에대한관심도는남자 3.87점, 여자 3.29점으로남자의관심도가유의적으로높았다 (p<.05). 당뇨식단개발의필요성에서는조리의어려움 (p<.01) 과전문지식의부족 (p<.001) 항목에서유의적차이를보였다. 조리가어려움은남자 4.13점, 여자 3.44 점로남자가조리의어려움을더느끼는것으로나타났다. 전문지식의부족도남자 4.47점, 여자 3.44점으로남자가더높게나타났다. 조리할사람없음과조리시간부족은각항목에대해남자 2.53점, 여자 3.21점으로여자가높게나타났지만유의적인차이는없었다. 당뇨식단을개발할때의중요속성에대해서는조미료무첨가항목을제외한맛 (p<.001), 영양성분표시 (p<.01), 위생 (p<.001), 청결한포장상태 (p<.001), 국내산재료사용 (p<.001), 보관의용이성 (p<.01), 메뉴의다양성 (p<.01), 기호도반영 (p<.01), 구매의용이성 (p<.01) 의모든항목에서유의적인차이를보였고, 중요도점수도 조미료무첨가 항목을제외한모든항목에서남자가높게나타났다. 가정배달치료식개발에대한연구에서식사요법실천의제한요인으로환자만을위한별도의조리에서오는번거로움을가장큰어려움으로평가하였고, 그다음으로는제한된조리법과식재료맛의하락, 치료식조리방법의어려움이라고보고하였다 [33]. 본연구에서도당뇨병식단을이용시그이유에대해전문지식부족과조리의어려움이높게나타나이러한요인이개별적으로식사요법실천을어렵게하기때문에외부에서제공되는당뇨병식단에대해높은기대를보인것으로판단된다. 조리법에따른개발요구도는밥 죽류에대해남자 4.00, 여 자 3.18로남자가높아유의적인차이를보였다 (p<.05). 조사대상자중남성의경우대체로식사를직접조리하지않고외식빈도가여성보다많기때문에당뇨병식단에대한관심정도가높게나타난것으로판단된다. 개발요구도가높게나타난메뉴는밥 죽류로메뉴개발시주식에초점을맞추었으며, 맛, 영양성분표시, 위생, 국내산재료사용, 메뉴의다양성등을고려하였다. 2. 보리이용당뇨식단개발 1) 보리이용메뉴개발메뉴개발을위하여선별된식재료는곡류 두류 서류에서는보리, 현미, 찹쌀, 밀, 완두콩, 두부, 토란이며채소류에서는애호박, 단호박, 고추, 가지, 오이, 피망, 브로콜리, 당근, 배추, 양배추, 양상추, 무청, 쑥갓, 아욱, 숙주나물, 표고버섯, 양송이버섯, 느타리버섯, 팽이버섯, 양파등이다. 어육류는새우, 닭고기, 돼지고기, 쇠고기, 계란이며, 해조류는곤약, 다시마, 과일류는배, 감, 키위, 견과류로는흑임자, 참깨, 은행, 밤, 대추, 잣, 들깨를선별하였다. 양념류는카레, 참기름, 간장, 된장, 후추, 겨자, 식초등이다. 현미는탄수화물대사에필요한비타민 B1이풍부하고 [23] 콩류와두부는여성호르몬과유사한기능을하여골다공증, 유방암, 자궁암, 난소암등의여성질환발생을감소시키는 isoflavone [9], 천연혈당강하효과를나타내는 pinitol [4], 무기질과결합된형태로존재하여산화반응을억제와항암작용을하는 phytic acid [2] 등의생리활성물질을함유한것으로보고되었다. 채소류는식이섬유의함량이높아혈당과혈중지질의농도를낮추고비교적열량이낮기때문에당뇨환자의 1끼식단에 3단위이상이포함되도록권장하고있다 [17]. 채소류중 1단위당 6 g 이상의당질을함유한고춧잎, 연근, 우엉, 쑥, 풋마늘등은메뉴개발에포함되지않도록하였다 [17]. 항산화기능을가진것으로널리알려진파, 마늘, 양파등의 allium속채소류는황휘발성물질을함유하여특유의독특한향과함께항암활성및암세포증식억제효과 [7], 항균활성 [3] 등이보고되어있다. 고추가함유한 capsaicin 성분은체액성면역증강작용, 암유전자발현조절작용의기능을하는것으로보고되었으며 [35] 이들식품을활용한다양한메뉴가개발되어있다. 저열량 고식이섬유의대표적식품으로이용률이높은버섯류는느타리버섯, 양송이버섯, 표고버섯, 영지버섯, 송이버섯, 팽이버섯등이있는데, 혈중콜레스테롤농도저하효과, 항동맥경화효과등의생리활성이보고되어있다 [10]. 해조류는바다에서나는채소라할만큼비타민과무기질이풍부하고암예방과치료, 저급콜레스테롤을제거하는성분을함유하고있 554 Vol.51, No.5, October 2013:

5 Table 2. A List of Meals of Using Barley Table 2. A List of Meals of Using Barley (continued) Name of meals Barley lotus leaf rice Ingredients & 4 portions Non-glutinous rice 1 C, glutinous rice 1/2 C, barley 1/2 C, black soy bean 1/3 C, pine nut 2 T, lotus leaf 4 leaves Name of meals Barley seobshancheok Ingredients & 4 portions Beef 400 g, onion 1/4 ea, roasted barley flour 3 T, crushed green onion 1 t, crushed garlic 1/3 t, sugar 2 t, sesame oil 1 t, soy sauce 2 T, cooking oil, powdered black pepper a little, pine nut 1 T Steamed autumn squash barley rice Autumn squash 1 ea, rice 1 C, brown glutinous rice 1/2 C, barley 1/2 C, black rice 2 T, ginkgo nut 8 ea, chest nut 7 ea, jujube 5 ea, cooking oil a little Barley rice ball Brown barley rice 3 bowl, dried radish greens 150 g, onion 1/2 ea, roasted black sesame 1 T, red, bell pepper 1/3 ea, salt 1 t, powdered black pepper a little, sesame oil 1 T, soy sauce 1 T,crushed green onion 1/2 T, crushed garlic 1 t, sesame salt 1 t, oligosaccharide 1 t Curry shrimp barley stir-fried rice Brown barley rice 3 bowl, shrimp 100 g, fragrant mushroom 3 ea, red-green bell pepper 1/2 ea, pea 2 T, brocoli 1/2 ea, curry powder 2 T, green onion 1/3 ea, grape seed oil 1 T, black pepper a little Barley sujebi Roasted barley flour 4 T, whole-wheat 3 C, green pumpkin 1/3 ea, soy sauce 1 T, crushed garlic 1 t, anchovy kelp stock 5 C, fragrant mushroom 3 ea, carrot 1/4 ea, green onion 1/5 ea Plum barley-sauce stuffed cucumber Cucumber 2 ea, egg 1 ea, fragrant mushroom 2 ea, beef 100 g, crushed garlic 1/2 t, crushed green onion 1 t, soy sauce 1/2 T, sugar 1 t, pepper, sesame oil, vinegar, salt a little, plum barley-sauce: roasted barley flour 1/2 T, plum juice 3 T, soy sauce 1/2 T, crushed garlic 1/2 t, crushed green onion 1/2 T, sesame oil 1 t, sesame salt 1 t, water 1/2 T, powdered black pepper 1/3 t Eggplant hard-boiled pork Eggplant 2 ea, whole-wheat flour a little, pork tenderloin 200 g, roasted barley flour 1 T, crushed green onion 1 T, crushed garlic 1/2 T, cooking wine 1 T, sesame oil 1/2 T, salt 1t, powdered black pepper a little, braising seasoning: kelp stock 1/3 C, oyster sauce 1 T, soy sauce 1t, red chilli 1/2 ea, oligosaccharide 1 T, cooking wine 1 T, crushed garlic 1 t, sesame oil 1 T Barley konjac japchea Konjac 300 g, onion 1ea, cucumber 1 ea, fragrant mushroom 3 ea, mungbean sprouts 50 g, beef 100 g, carrot 1/4 ea, grape seed oil 1 T, salt 1 t, oil sauce, sesame oil 1 T, soy sauce 1 t, mixed seasoning sauce: soy sauce 1 T, sugar 1/2 T, roasted barley flour 1/2 T, sesame oil 2 t, crushed garlic 1/2 t, crushed green onion 1 t, oligosaccharide 1 t, sesame salt powdered black pepper a little Dangjo-chili pepper & chicken breast salad Chicken breast 200 g, yellow rad paprika 1/2 ea, Dangjo-chili pepper 5 ea, lettuce 3 leaves, chicory 7 leaves, cooking wine 2 T, garlic juice 1 T, salt, powdered black pepper a little, dressing: soy sauce 1 T, oligosaccharide 5 T, sesame oil 1 T, roasted barley flour 1 T, crushed garlic 1 t, hot chili pepper 1 T, ginger juice 1 t Barley mustard dressing salad Pear 1/2 ea, persimmon 1ea, chest nut 5 ea, carrot 1/2 ea, cucumber 2/3 ea, cabbage 100 g, pine nut 1/2 T, beef 150 g, egg 1 ea, roasted barley flour 1 T, mustard 1 T, soy sauce 1 T, kiwi 2 ea, vinegar 1 T, oligosaccharide 1 T, mayonnaise 2 T Mysid mallow soup Dried mysid 1/2 C, mallow 200 g, barley soybean paste 3 T, crushed garlic 1 T, red chili pepper 1/2 ea, water 7 C, kelp (5 5 cm) 2 slices Vol.51, No.5, October 2013:

6 류지혜 노정옥 Table 2. A List of Meals of Using Barley (continued) Name of meals Mushroom barley perilla soup Ingredients & 4 portions Oyster mushroom 200 g, fragrant mushroom 200 g, winter mushroom 50 g, mung-bean sprouts 50 g, red chili pepper 1/2 ea, crown daisy 20 g, barley flour 3 T, powdered perilla 5 T, anchovy kelp stock 7 C, crushed garlic 1 T, soy sauce 1 t Chicken barley quenelle stew Chicken breast 200 g, onion 1/2 ea, ginger 10 g, Chinese cabbage leaf 2 leaves, fragrant mushroom 2 ea, tofu 1/2 ea, salt 1 t, powdered black pepper a little, roasted barley flour 1 T, water 7 C, kelp (5 5 cm) 2 slices, barley soy bean paste 2 T, crushed garlic 1 T, green onion 1/4 ea Barley taro soup Taro 200 g, button mushroom 100 g, broccoli 50 g, kelp stock 7 C, crushed garlic 1 T, soy sauce 1 T, powdered perilla 1/2 C, roasted barley flour 2 T 으며, 곤약은대부분식이섬유로이루어져있고열량이거의없기때문에포만감을높일수있는식품이다 [11]. 음식에양념으로사용되는조미료는식사조절이중요한당뇨환자의식단구성에있어서식욕을돋우고식사요법을지속하게하는요소이다. 짠맛을내는조미료로는소금대신간장, 된장등을이용하거나식재료자체의짠맛을이용할수있는마른새우, 멸치, 다시마등을이용하여맛을낼수있다. 단맛을낼때는설탕을피하고저열량감미료나급격한혈당상승을막는올리고당을대체하여사용한다. 신맛은미각을자극하여짠맛과단맛을보완하여식욕을돋운다 [11]. 이같은식재료를이용하여개발한메뉴는 Table 2와같다. 2) 전문가평가개발된메뉴에대하여총 10명의전문가가개별메뉴의전반적인평가및개선방안을 Table 3과 4에제시하였다. 메뉴에대한평가결과보리수제비를제외한모든메뉴의평가값은 5.0점기준으로 4.0점이상으로높은경향을보였다. 맛의항목에서는보리겨자드레싱샐러드가가장높은평가를받았고, 모양, 영양적균형, 식재 료조화의항목에서는보리곤약잡채의평가가가장높았으나평가항목별메뉴간의유의적인차이는없었다. 메뉴평가시각분야의전문가들에의해수집된의견을바탕으로메뉴를수정보완하였다. Table 3. Sensory Evaluation Score for Each Meal Menu name Taste Appearance Nutritional balance Harmony of ingredients Barley sujebi 3.78± ± ± ±0.67 Curry shrimp barley stir-fried rice 4.67± ± ± ±0.73 Barley rice ball 4.67± ± ± ±0.53 Steamed autumn squash barley rice 4.56± ± ± ±0.44 Barley lotus leaf rice 4.44± ± ± ±0.44 Dangjo-chili pepper & chicken breast salad 4.44± ± ± ±0.67 Plum barley-sauce stuffed cucumber 4.78± ± ± ±0.73 Eggplant hard-boiled pork 4.44± ± ± ±0.50 Barley seobshancheok 4.67± ± ± ±0.71 Barley konjac japchea 4.89± ± ± ±0.00 Barley mustard dressing salad 5.00± ± ± ±0.53 Chicken barley quenelle stew 4.00± ± ± ±0.71 Mushroom barley perilla soup 4.67± ± ± ±0.44 Mysid mallow soup 4.67± ± ± ±0.33 Barley taro soup 4.78± ± ± ±0.44 F-value a) a) a) a) Response: 5 point Likert scale (5, very good - 1, very bad). Not significant. 556 Vol.51, No.5, October 2013:

7 Table 4. Modifications of Cooking Methods of Menu Menu name Feedbacks Steamed autumn squash barley rice Extend steaming time for about minutes so that autumn squash can be boiled thoroughly. Curry shrimp barley stir-fried rice Taste of curry is very strong, and in oder to reduce sodium intakes, added a very small amount of salt. Plum barley-sauce stuffed cucumber Generally, the stuffed cucumber uses salt water, but vinegar water can be used to reduce the sodium intakes for the patient. Dangjo-chili pepper & chicken breast salad The amount of chili pepper added to the barely dressing is dependent on the preference of each person. Barley mustard dressing salad Mustard sauce is strong when it is prepared by fermenting only with mustard. In order to give a fresh soft taste, add lemon juice and kiwi. Mustard sauce enhances the dressing taste. Table 5. Food Exchange List for Diabetes (1,500 kcal) Grains Meat, fish, eggs, beans Low-fat Midium-fat Vegetables Oils, fats, sugars Milk & dairy products Units Breakfast Lunch Dinner Fruits 3) 당뇨식단의예당뇨식단은활동량이많지않은 60세이상의노인을대상으로 1,500 kcal 을기준으로하였다 (Table 5). 식품교환표의단위수를계산하여산출된 3대영양소비율은탄수화물 55.1%, 단백질 20.0%, 지방 24.9% 로당뇨병진료지침의임상영양요법에서권고한섭취비율기준을벗어나지않는비율이었다. 당뇨병환자가식단에서이용할수있도록개발메뉴 15가지를포함한 1주일식단의예는 Table 6과 Figure 1에제시하였다. 1 일째식단은개발된메뉴중부식 1종, 국 찌개 1종이포함되었고, 2일째식단은주식 1종, 국 찌개류 1종, 3일째식단은주식 1종, 국 찌개 1종, 4일째식단은부식 2종, 5일째식단은주식 1 종, 부식 1종, 6일째식단은주식 1종, 부식 1종, 7일째식단은주식 1종, 부식 1종, 국 찌개 1종으로총 15가지의메뉴가모두포함되었다. 도조사를통하여보리이용메뉴와조리법을개발하고이를당뇨병환자의일주일식단계획에적용함으로써그활용도를높이는데목적이있다. 조사대상자는대부분 65세이상노인기의당뇨병환자로서대체로당뇨식단개발에대한관심정도가높은경향이었다. 남성의경우대체로식사를직접조리하지않고전문지식이높지않기때문에당뇨식단에대한관심정도와구매의향이높게나타났다. 개발필요성이높게나타난메뉴는밥 죽류로메뉴개발시주식에초점을맞췄으며, 맛, 영양성분표시, 위생, 국내산재료사용, 메뉴의다양성등을고려하여메뉴를개발하였다. 메뉴개발은문헌과선행연구고찰을통해식재료를선별하고, 당뇨병의식사요법과조리시주의사항을고려하여주식, 부식, 국 찌개의 3종류로분류하여메뉴를개발하고총 15가지메뉴를선별하였다 : 보리연잎밥, 단호박보리찜밥, 보리주먹밥, 카레 새우보리볶음밥, 보리수제비, 매실보리소스오이선, 보리섭산적, 4) 개발된당뇨식단영양소분석개발된당뇨식단의영양소분석결과는 Table 7에제시하였다. 식단의 1일평균열량은 1,493.4±23.5 kcal이었고, 탄수화물 : 단백질 : 지질 3대영양소비율은 57.1:19.5:23.3로당뇨병임상영양요법기준 [17] 과한국인영양섭취기준 [31] 을충족하였다. 가지돼지고기조림, 보리곤약잡채, 당조닭가슴살샐러드, 보리겨자드레싱샐러드, 보리새우아욱국, 버섯보리들깨국, 닭고기보리완자전공, 보리알토란탕. 예비조리를통해일차적으로완성된메뉴는임상영양, 단체급식, 조리과학, 식품가공분야의전문가를통해각개발메뉴에대해맛, 모양, 영양적균형및식재료의조화에 대한평가를실시하였으며, 평가후의견을수집하여조리법을수 결론 본연구는당뇨병환자를대상으로환자메뉴개발에대한요구 정 보완하고메뉴의조리법을최종적으로완성하였다. 이상의개발된메뉴는영양분석프로그램을이용하여영양성분함량을표시하였다. 당뇨병환자가식단에서이용할수있도록개발메뉴를 1일 2가 Vol.51, No.5, October 2013:

8 류지혜 노정옥 Table 6. A List of Meals for a Week Days Breakfast Lunch Dinner Snacks a) 1 Brown barley rice Small octopus soup Bean sprouts rice Mysid mallow soup b) Barley bean rice Frozen pollack stew Sweet persimmon yogurt salad Plum barley-sauce stuffed cucumber b) Braising autumn squash pork Sea mustard vinegar salad Braising hairtail radish Steamed anchovy perilla leaf Shredded radish 2 Barley black rice Beef sea mustard soup Small green onion & green lentil jelly salad Barley rice ball b) Soy bean paste soup Roasted button mushroom Brown barley rice Mushroom barley perilla soup b) Quail egg jangjorim Boiled brocoli squid Soybean milk Apple 3 Glutinous millet barley rice Chicken barley quenelle stew b) Stir fried beef bok choy Stuffed cucumber pickles 4 Danjo-chili pepper & chicken breast salad b) Steamed sweet potatoes Cherry tomato 5 Five grains barley rice Blue crab soup Brisp laver Stir-fried king oyster mushroom 6 Sorghum brown rice Clear bean sprout soup Pumpkin leaf ssam Freshwater snail bean paste stew 7 Gondre greens rice Barley taro soup b) Mushroom bulgogi Roasted cutlassfish a) Offer between breakfast-lunch or lunch-dinner. b) Barley-based meals. Acorn jelly rice Chili pepper jeon Cockle spinach salad Sorghum brown rice Pork bulgogi Steamed cabbage Young pumpkin greens Baechu geotjeori Barley noodles Taro-stem jeon Young radish kimchi Steamed cockle Barley sujebi b) Barley seobshancheok b) Baechu geotjeori Barley konjac japchea b) Steamed autumn squash Mussel stew Young radish kimchi Steamed autumn squash barley rice b) Young chinese cabbage soybean paste soup Roasted tofu Stir-fried ground cherry chilli dried shrimp Barley bean rice Kimchi bean sprout soup Eggplant hard-boiled pork b) Cucumber chives salad Stir-fried fish cake Barley lotus leaf rice b) Squid radish soup Balloon flower root vinegar salad Lotus root beef braising Nabak kimchi Kidney bean barley rice Made dish mushroom stew Stir-fried cabbage fish cake Korean lettuce kimchi Curry shrimp barley fried rice b) Tofu egg stew Onion vinegar curing Low-fat yogurt Pear Low-fat milk Tangerine Barley mustard dressing salad b) Low-fat yogurt Orange salad Plain yogurt Banana milk Tomato cheese salad 지이상포함한일주일분의당뇨식단을작성하였다. 당뇨병의임상영양요법과식품교환표를활용하여식단을작성한후현직임상영양사의자문을받아수정보완하여식단을완성하였다. 식단에대한이해도를높이기위해개발메뉴가포함된한끼식단을직접조리하여사진으로제시하였다. 본연구에서는많은선행연구를통해기능성이입증된보리를이용하여메뉴를개발하고, 개발메뉴를당뇨식단에포함시켜실제당뇨병환자가개발메뉴를식단에활용할수있도록함으로써식사요법실행에도움이될수있을것이다. 또한보리가함유한 성분과그기능성으로는지질대사조절과항산화효과를나타냄으로서당뇨식단뿐만아니라당뇨합병증의예방과비만, 고혈압등의성인병예방식으로의미가있을것으로생각한다. 당뇨병환자들은전문적인치료식조리의어려움이큰것으로조사된점을볼때본연구의당뇨병환자메뉴요구도를바탕으로개발된보리이용메뉴와이를활용한당뇨식단은환자본인및보호자의치료식조리의어려움해소에크게기여할것으로판단된다. 또한본연구결과는지역의병원이나보건소에서당뇨병예방관리의교육자료로활용이가능하겠다. 558 Vol.51, No.5, October 2013:

9 Figure 1. A list of meals including barley-based meals. Vol.51, No.5, October 2013:

10 류지혜 노정옥 Table 7. Nutritive Value List of Meals Nutrient Mean±SD Range DRIs (50 yr ) a) Male Female Energy (kcal) 1,493.4±23.5 1, , ,000-2,200 1,600-1,800 Carbohydrates (g) 211.2± Proteins (g) 72.7± Lipids (g) 38.3± Carbohydrates:proteins:lipids (%) 57.1:19.5: :7-20:15-25 Cholesterol (mg) 211.5± <300 <300 Vitamin B1 (mg) 1.3± Vitamin C (mg) 158.4± Calcium (mg) 769.3± , Iron (mg) 16.0± Sodium (g) 3,051.9± , , Dietary fiber (g) 27.6± a) DRIs, dietary reference intakes for Koreans. Energy: estimated energy requirement; Proteins, Vitamin B1, Vitamin C, Calcium, Iron: recommended intake; Dietary fiber: adequate intake; Cholesterol, Sodium: intake goal. Declaration of Conflicting Interests The authors declared that they had no conflicts of interest with respect to their authorship or the publication of this article. References 1. Ahn, H. J., Han, K. A., Koo, B. K., Kim, H. J., Kim, H. J., Park, S. K., et al. (2008). Analysis of meal habits from the viewpoint of regularity in Korean type 2 diabetic patients. Korean Diabetes Journal, 32(1), Anderson, R. L., & Wolf, W. J. (1995). Compositional changes in trypsin inhibitor, phytic acid, saponins and isoflavones related to soybean. Journal of Nutrition, 125(3 Suppl), 581S-588S. 3. Avato, P., Tursil, F., Vitali, C., Miccolis, V., & Candido, V. (2000). Allylsulfide constituents of garlic volatile oil as antimicrobial agents. Phytomedicine, 7(3), Bates, S., Jones, R. B., & Bailey, C. J. (2000). Insulin-like effect of pinitol. British Journal of Pharmacology, 130(8), Cho, J. S. & Hwang, S. Y. (2005). Foodmaterials. Seoul: Munundang. 6. Cui, C. B., Choi, H. T., Lee, H. J., Moon, S. Y., Kim, S. H., Lee, B. G., et al. (2004). Hypoglycemic effect of the functional food manufactured by fermented soybean as main materials in streptozotocin: Induced diabetic rats. Journal of the Korean Society of Food Science and Nutrition, 33(7), Hwang, W. I. (1980). A study on the anticancer activity of garlic extracts. Korean Biochemical Journal, 13(4), Jun, J., Lee, Y., & Oh, Y. J. (2009). A factor analysis study on blood glucose control in diabetics mellitus patients (1): Focus on blood glucose control and lifestyle factors. Korean Journal of Community Nutrition, 14(2), Kennedy, A. R. (1995). The evidence for soybean products as cancer preventive agents. Journal of Nutrition, 125(3 Suppl), 733S-743S. 10. Kim, B. K., Shin, G. G., Jeon, B. S., & Cha, J. Y. (2001). Cholesterollowering effect of mushrooms powder in hyperlipidemic rats. Journal of the Korean Society of Food Science and Nutrition, 30(3), Kim, J. H. (2010). Best diet for diabetic patients. Seoul: Dongailbosa. 12. Kim, M. A., Kim, Y. S., & Yoon, S. K. (1999). Recipes for dishes controlling diabetes and its blood glucose response effect. The Journal of Korean Society of Food & Cookery Science, 15(4), Kim, M. A., & Yoon, S. K. (2000). Study on quality and blood glucose response of roll breads for diabetes mellitus. The Korean Journal of Food and Nutrition, 13(5), Kim, M. A., & Yoon, S. K. (2001). Organoleptic characteristics of roll bread mixed with soybean and barley flour for diabetes mellitus. Dongduk Journal of Life Science Studies, 6, Kim, M. Y., & Yoon, S. K. (2003). Quality of steam bread mixed with soybean and barley flour for diabetes mellitus. Dongduk Journal of Life Science Studies, 8, Kim, S. R., Choi, H. D., Seog, H. M., Kim, S. S., & Lee, Y. T. (1999). Physico chemical characteristics of b-glucan isolated from barley. Korean Journal of Food Science and Technology, 31(5), Korean Diabetes Association. (2011). Treatment Guideline for Diabetes Seoul: Korean Diabetes Association. 560 Vol.51, No.5, October 2013:

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