Maturitas 76 (2013) 160164

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Maturitas
journal homepage: www.elsevier.com/locate/maturitas

Dietary patterns and functional disability in older Korean adults

Jinhee Kim a,b , Yunhwan Lee a,b, , Soon Young Lee a,b , Young Ok Kim c ,
Yoon-Sok Chung b,d , Sat Byul Park b,e
a

Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
Institute on Aging, Ajou University Medical Center, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
Department of Food and Nutrition, College of Natural Science, Dongduk Womens University, 60 Hwarang-ro 13-gil, Seongbuk-gu, Seoul, Republic of Korea
d
Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
e
Department of Family Practice and Community Health, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
b
c

a r t i c l e

i n f o

Article history:
Received 29 March 2013
Received in revised form 2 July 2013
Accepted 8 July 2013

Keywords:
Diet
Dietary patterns
Disability
Older adults

a b s t r a c t
Objectives: This study examined the relationship between dietary patterns and disability in the Korean
elderly.
Study design: We used data from a cross-sectional study of 327 men and 460 women aged 65 years who
completed the 2005 Korea National Health and Nutrition Examination Survey.
Main outcome measures: A single 24-h dietary recall method was used to assess dietary intake and dietary
patterns were identied by cluster analysis. Functional disability was assessed by the activities of daily
living (ADL) and instrumental ADL (IADL) scales. The association of dietary patterns with ADL and IADL
disability was analyzed by logistic regression adjusting for age, marital status, education, household
income, region, chronic conditions, body mass index, smoking, alcohol drinking, physical activity, and
energy intake.
Results: Two dietary patterns were identied in both men and women: the modied traditional dietary
pattern, characterized by a relatively lower consumption of white rice, but higher consumption of fruits,
dairy products, and legumes, and the traditional dietary pattern, characterized by high consumption of
white rice. After controlling for covariates, in men, those who engaged in modied traditional dietary
pattern, compared with traditional dietary pattern, showed a lower likelihood of ADL disability (odds
ratio [OR] = 0.17, 95% condence interval [CI]: 0.050.56). In women, the modied traditional dietary
pattern compared with the traditional pattern was associated with a signicantly decreased risk of ADL
(OR = 0.45, 95% CI: 0.230.90) and IADL disability (OR = 0.45, 95% CI: 0.280.72).
Conclusions: The modied traditional dietary pattern is associated with a decreased risk of functional
disability in older Korean adults.
2013 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Koreas population is rapidly aging, with those aged 65 years
or older comprising 11.8% of the total population in 2012, and it
is projected to increase to 32.3% by 2040 [1]. With aging of the
population disability has become a critical public health issue.
Disability is a well-known predictor of health care utilization,

Abbreviations: KNHANES, Korea National Health and Nutrition Examination Survey; ADL, activities of daily living; IADL, instrumental ADL; HEI-2005, Healthy Eating
Index-2005; KDRIs, dietary reference intakes for Koreans.
Corresponding author at: Department of Preventive Medicine and Public Health,
Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443380, Republic of Korea. Tel.: +82 31 219 5085; fax: +82 31 219 5084.
E-mail addresses: jhkim06@ajou.ac.kr (J. Kim), yhlee@ajou.ac.kr (Y. Lee),
solee@ajou.ac.kr (S.Y. Lee), yok@dongduk.ac.kr (Y.O. Kim), yschung@ajou.ac.kr
(Y.-S. Chung), sbpark@ajou.ac.kr (S.B. Park).
0378-5122/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.maturitas.2013.07.011

institutionalization, and mortality in the elderly and can lead to

poor quality of life [2]. Maintaining high physical function is, therefore, considered a major contributor to successful aging [3].
Diet is discussed as an important modiable risk factor of
functional disability [4]. Previous epidemiological studies have
examined single foods or nutrients in relation to disability [5,6].
However, because people usually consume various foods with complex combinations of nutrients through meals it is difcult to
examine the effects of a single nutrient on health outcomes. The
dietary pattern approach, which examines the overall diet, is an
alternative method that can better characterize foods and nutrients consumed in combinations [7]. Only few studies have assessed
dietary patterns and their relationship with disability. In a study of
French women aged 65 and over, greater adherence to the Mediterranean diet was predictive of less functional disability [8]. In the
NHANES, Healthy Eating Index-2005 (HEI-2005) scores were associated inversely with disability among older Americans [9].

J. Kim et al. / Maturitas 76 (2013) 160164

Dietary patterns of older people in Asia tend to differ from those

in western countries. Asian populations, including Koreans, typically consume rice as a staple food and high plant foods [10,11].
Thus, results from previous studies may not directly apply to Asian
countries, including Korea. Moreover, the relationship between
dietary patterns and disability among the older Korean population
is not established. The aim of the current study was to examine the
association between dietary patterns and functional disability in
older Korean adults, using a nationally representative data source.

161

money, using the telephone, and taking medicine. The response

options to individual items included no difculty, some difculty,
were unable, or did not do the activities (never done in life or can
do the activity but chose not to), without others help or use of
aids. Individual responses were dichotomized as either not disabled (0 = no difculty or did not perform the activity) or disabled
(1 = some difculty or unable to do). ADL or IADL disability was
dened as disabled in one or more ADL or IADL items.
2.4. Covariates

2. Methods
2.1. Study population
Data came from a cross-sectional study of the 2005 Korea
National Health and Nutrition Examination Survey (KNHANES)
of non-institutionalized residents in the Republic of Korea, conducted by the Korea Centers for Disease Control and Prevention.
Detailed information of the survey design is provided elsewhere
[12]. KNHANES employs a multistage cluster sampling for the selection of household units. Prior to the survey, all participants signed
the informed consent forms.
KNHANES is composed of four surveys: the Health Interview
Survey, Health Behavior Survey, Health Examination Survey, and
Nutrition Survey. Among the 3730 aged 65 years who completed
the Health Interview Survey one third was randomly selected to
participate in the other surveys. The study sample consisted of 796
(330 men, 466 women) aged 65 years who completed four surveys. We excluded those with missing values on marital status (1
men), household income (2 women), and anthropometric measures
(2 men, 4 women). The nal sample for the analysis comprised of
327 men and 460 women.
2.2. Dietary assessment
Dietary intake was assessed by an interviewer-administered,
single 24-h dietary recall. Trained staffs instructed the participants
to describe all the foods and beverages they consumed in the previous day. Food models, bowls, cups, and spoons were used to assist in
estimating portion sizes. To conduct a dietary pattern analysis, individual foods were consolidated into 16 food groups based on the
food groups classied in the food composition table [13]: grains and
grain products, potatoes and starches, sugar and sweets, legumes,
nuts and seeds, vegetables, mushrooms, fruits, meat and its products, eggs, sh and shellsh, seaweeds, milk and dairy products,
oils, beverages, and seasoning. The food groups were then reconsolidated into 20 food groups. Because the intake of grains and grain
products is high in Koreans, this food group was divided into four
subgroups [14]: white rice, other grains, noodles and dumpling, and
our and bread. Because kimchi (traditionally fermented cabbage)
is a national side dish in Korea it was separated into a single vegetable group. Mushrooms were included as vegetables and alcohol
was separated from the beverages. Energy and nutrient intake of
each food was calculated using the food composition table [13] and
summated up for each food group. The percentage of energy contributed by each food group was calculated and used in the dietary
pattern analysis.
2.3. Functional disability
Functional disability included the activities of daily living (ADL)
and instrumental ADL (IADL). Disability in ADL was assessed by
7 items: dressing, washing, bathing, eating, transferring, using
the toilet, and incontinence. Disability in IADL was assessed by
10 items: grooming, housework, preparing meals, doing laundry,
going outside, using public transportation, shopping, managing

Sociodemographics included age (6574, 75 years), marital status (married vs. not married, including single, widowed,
divorced, or separated), education (less than elementary school
vs. elementary school or higher), monthly household income
(<50, 5099, 100 in ten thousand Korean won), region (rural,
city, or metropolitan), and physician-diagnosed chronic conditions (diabetes mellitus, hypertension, stroke, angina or myocardial
infarction, and arthritis). Smoking status (never, former, or current), drinking of alcoholic beverages (never, former, or current),
and physical activity were obtained by self-report. Physical activity
was categorized as sedentary, low (below the recommended level),
and recommended (150 min/week of moderate-intensity and/or
75 min/week of vigorous-intensity aerobic physical activity) [15].
Body mass index (BMI) was calculated as measured weight (kg)
divided by height squared (m2 ).
2.5. Statistical analysis
All data were analyzed using IBM SPSS Statistics 19.0 (International Business Machines Corp. Armonk, NY, USA), taking into
account the surveys complex sampling design. Because gender
differences in disability have been widely reported [16], and a
signicant interaction between dietary patterns and gender with
respect to disability was observed in our data, all analyses were
performed separately by gender.
Cluster analysis was conducted using the K-means method to
generate the dietary patterns. The descriptive characteristics of the
study population were presented as mean and standard deviation
(SD) or percentage. Difference in percentage of energy from food
groups and in nutrient intake by dietary patterns was analyzed
using the t test. Difference of participants characteristics between
dietary patterns was determined using the t test for continuous
variables and chi-square test for categorical variables. Using logistic
regression analysis, risks of functional disability, with the traditional dietary pattern as the reference group, were shown as odds
ratio (OR) with 95% condence interval (CI), adjusting for covariates. Signicance was dened as 2-sided P value < 0.05.
3. Results
3.1. Percentages of energy from food groups and daily nutrient
intakes by dietary patterns
In men, the modied traditional dietary pattern (41.6%) and traditional dietary pattern (58.4%) were identied by cluster analysis
(Table 1). The modied traditional dietary pattern received 34% of
energy from white rice and consumption of most food groups was
signicantly higher in this pattern than in the traditional dietary
pattern. In contrast, the traditional dietary pattern received 67%
of energy solely from white rice and consumption of white rice
and kimchi in this pattern was signicantly higher, compared with
the modied traditional pattern. With respect to nutrients, men in
the traditional dietary pattern, compared with the modied traditional dietary pattern, showed a signicantly higher percentage
of energy from carbohydrate (more than 75% of energy) but lower

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J. Kim et al. / Maturitas 76 (2013) 160164

Table 1
Percentage energy contribution from food groups and daily nutrient intakes by dietary patterns of respondents aged 65 years, 2005 KNHANES.
Men (n = 327)

Women (n = 460)

Modied
traditional (n = 136)
Mean
Percentage of energy from food groups
33.7
White rice
Other grains
9.7
Noodles and dumpling
9.0
4.0
Flour and bread
1.1
Potatoes and starches
1.4
Sugar and sweets
4.4
Legumes
1.1
Nuts and seeds
Vegetables
3.6
Kimchi
1.4
2.2
Fruits
6.9
Meat and its products
1.1
Eggs
5.3
Fish and shellsh
0.4
Seaweeds
1.8
Milk and dairy products
2.9
Oils
1.1
Beverages
Alcohol
6.0
3.3
Seasoning
Nutrient
2053.6
Energy (kcal/day)
65.0
Carbohydrate (% of energy)
Protein (% of energy)
17.0
Fat (% of energy)
18.1
310.3
Carbohydrate (g)
82.4
Protein (g)
40.8
Fat (g)
8.8
Fiber (g)

SD

P-valuea

Traditional (n = 191)

Mean

SD

Traditional (n = 309)

Modied
traditional (n = 151)

Mean

Mean

SD

P-valuea

SD

11.4
12.5
14.7
9.2
3.6
2.2
5.0
2.5
2.3
1.3
4.3
9.9
2.1
7.0
1.0
3.8
3.0
2.1
13.3
3.5

67.0
3.4
0.3
1.0
0.6
0.8
3.2
0.7
3.9
1.8
0.8
2.1
0.3
4.3
0.6
1.3
2.1
1.5
1.8
3.2

10.8
5.2
2.2
3.1
2.0
1.8
3.9
2.2
2.9
1.6
2.8
5.2
0.9
5.2
1.6
3.4
2.2
2.5
5.1
3.4

<0.001
<0.001
<0.001
0.003
0.217
0.011
0.064
0.143
0.260
0.033
0.018
<0.001
<0.001
0.171
0.137
0.292
0.014
0.152
0.002
0.885

70.7
3.8
0.4
0.5
0.5
0.8
2.7
0.6
4.0
1.8
0.8
1.9
0.4
3.5
0.7
1.0
2.2
1.1
0.3
2.9

11.1
5.5
3.0
2.1
2.1
1.9
4.4
1.4
3.8
1.9
2.9
4.6
1.6
5.3
2.0
3.0
2.9
2.6
1.8
3.1

35.2
17.2
6.2
3.3
1.4
1.2
4.2
0.9
4.1
1.4
2.6
4.9
1.2
5.3
0.6
3.0
3.1
1.3
0.4
2.9

14.6
15.9
12.8
8.8
4.4
1.8
4.5
2.9
2.9
1.3
5.0
9.8
2.0
6.9
1.1
5.2
2.9
3.2
2.3
3.3

<0.001
<0.001
<0.001
<0.001
0.005
0.052
0.009
0.165
0.774
0.010
<0.001
0.001
<0.001
0.026
0.374
0.001
0.003
0.510
0.654
0.891

739.8
9.6
4.7
7.8
118.2
39.8
28.3
4.5

1739.7
75.4
13.7
10.9
315.6
58.5
20.8
7.5

517.8
7.1
3.0
5.2
94.9
23.4
12.8
3.8

<0.001
<0.001
<0.001
<0.001
0.682
<0.001
<0.001
0.021

1433.3
77.2
13.3
9.5
269.5
47.6
15.6
6.2

497.0
7.2
3.6
5.2
90.1
23.7
11.7
3.5

1582.4
68.1
16.0
16.0
264.2
62.9
29.1
7.1

518.3
9.5
4.9
7.1
85.7
28.5
18.7
3.6

0.009
<0.001
<0.001
<0.001
0.574
<0.001
<0.001
0.071

KNHANES, Korea National Health and Nutrition Examination Survey; SD, standard deviation.
a
P value from t test.

percent of energy from protein and fat. In women, the traditional

dietary pattern (67.2%) and modied traditional dietary pattern
(32.8%) were identied by cluster analysis. The traditional dietary
pattern received 71% of energy solely from white rice and consumption of white rice, and kimchi in this pattern was signicantly
higher, compared with the modied traditional pattern. In contrast,
the modied traditional dietary pattern received 35% of energy
from white rice, and consumption of most food groups was signicantly higher, compared with the traditional pattern. With respect
to nutrients, women in the traditional dietary pattern, compared
with the modied traditional dietary pattern, showed a signicantly higher percentage of energy from carbohydrate (more than
75% of energy) but lower percent of energy from protein and fat.
3.2. Population characteristics by dietary patterns
Among men, those in the modied traditional pattern, compared with the traditional, had higher household income, lower
percentage residing in a rural area, and lower prevalence of angina
or myocardial infarction (Table 2). Women with modied traditional dietary pattern, compared with the traditional, had higher
education and household income, and tended to reside in an urban
area.
3.3. Association between dietary patterns and functional
disability
In men, there was a signicant association between dietary
patterns and ADL disability (Table 3). Even after adjusting for
confounders, compared with the traditional pattern, the modied traditional pattern showed a lower likelihood of ADL
disability (OR = 0.17, 95% CI: 0.050.56). There was, however, no

signicant association between dietary patterns and IADL disability. In women, there were signicant associations between dietary
patterns and disability. Compared with the traditional pattern, the
modied traditional pattern showed a lower likelihood of ADL
(OR = 0.45, 95% CI: 0.230.90) and IADL disability (OR = 0.45, 95%
CI: 0.280.72).
4. Discussion
Dietary patterns were signicantly associated with functional
disability in the current study among older Korean adults.
The modied traditional dietary pattern showed a lower risk
of ADL but not IADL disability than the traditional dietary
pattern in men. Also, the modied traditional dietary pattern
showed a lower risk of both ADL and IADL disability than the traditional dietary pattern in women. To our knowledge, the current
study is the rst to investigate the association between dietary
patterns and functional disability among the older population in
Korea.
There are only few studies that have examined the association
between dietary patterns and functional disability. Older French
women with the highest Mediterranean diet adherence had a 50%
relative risk reduction of incident disability than those in the lowest Mediterranean diet category [8]. In the NHANES, among older
Americans, compared with those who had HEI-2005 scores in the
lowest quartile, those who had HEI-scores in the highest quartile
were at a signicantly lower risk of disability [9].
In this study, both older men and women adopting modied traditional dietary pattern showed carbohydrate (6568% of energy),
protein (1617% of energy), and fat (1618% of energy) intake
that met the recommendations of the dietary reference intakes for

J. Kim et al. / Maturitas 76 (2013) 160164

163

Table 2
Population characteristics by dietary patterns of respondents aged 65 years, 2005 KNHANES.
Men (n = 327)
Modied
traditional
(n = 136)
Age (year) (%)
6574
76.5
75
23.5
Marital status (%)
11.3
Not marriedb
88.7
Married
Education level (%)
<Elementary school
12.9
Elementary school
87.1
Household income (10,000 won/month) (%)
<50
13.0
25.8
5099
61.2
100
Region (%)
27.1
Rural
28.2
City
44.7
Metropolitan
Diabetes mellitus (%)
13.3
38.4
Hypertension (%)
Stroke (%)
6.3
2.4
Angina or myocardial infarction (%)
16.5
Arthritis (%)
Body mass index (kg/m2 ) (%)
73.5
<25.0
25.0
26.5
62.0 (9.5)
Body weight (kg), mean (SD)
Smoking (%)
18.1
Never
56.9
Former
25.0
Current
Alcohol drinking (%)
Never
13.5
18.7
Former
67.8
Current
Physical activity (%)
49.7
Sedentary
Low level
10.4
c
39.9
Recommended level

Women (n = 460)
P-valuea

Traditional
(n = 191)

Traditional
(n = 309)

Modied
traditional
(n = 151)

P-valuea

80.2
19.8

0.493

64.8
35.2

75.7
24.3

0.083

14.0
86.0

0.556

64.8
35.2

67.5
32.5

0.585

14.4
85.6

0.745

60.3
39.7

29.9
70.1

<0.001

28.5
28.6
42.9

0.002

36.3
23.1
40.6

25.6
19.3
55.1

0.040

46.1
15.1
38.8
15.0
33.8
7.0
14.6
21.4

0.010

49.1
21.5
29.4
13.4
41.8
7.2
4.6
58.7

19.2
32.8
48.0
20.8
53.8
6.1
4.8
66.3

<0.001

66.5
33.5
53.0 (8.7)

63.1
36.9
54.9 (8.6)

0.530

0.708
0.494
0.842
<0.001
0.302

0.093
0.067
0.717
0.906
0.192

68.8
31.2
63.0 (10.0)

0.457

15.7
47.3
36.9

0.178

81.3
9.7
9.0

88.4
6.0
5.6

0.252

8.7
25.3
66.1

0.346

46.1
16.9
37.0

39.0
20.9
40.0

0.450

57.9
11.2
30.8

0.380

76.8
7.4
15.8

76.7
5.9
17.4

0.855

0.456

0.083

KNHANES, Korea National Health and Nutrition Examination Survey; SD, standard deviation.
a
P value from t test for continuous variables and chi-square test for categorical variables.
b
Single, widowed, divorced, or separated.
c
150 min/week of moderate-intensity and/or 75 min/week of vigorous-intensity aerobic physical activity [15].

Koreans (KDRIs) [17], within the acceptable macronutrient distribution ranges (AMDR) in adults (carbohydrate 5570%, protein
720%, and fat 1525%). Also, the consumption of fruits, dairy products, and legumes was higher in this pattern than the traditional
dietary pattern. In contrast, both older men and women adopting

traditional dietary pattern had more than two thirds of its percent
daily energy intake solely from white rice, with the proportion of
carbohydrate intake comprising more than 75% of energy, above the
KDRIs [17]. As derived patterns are unique to each study population and inuenced by culture, it is difcult to compare the results of

Table 3
Odds ratio (OR) with 95% condence interval (CI) for functional disability by dietary patterns of respondents aged 65 years, 2005 KNHANES.
Men (n = 327)

ADL disability
Crude
Model 1b
Model 2c
IADL disability
Crude
Model 1b
Model 2c

Women (n = 460)

Modied traditional (n = 136)

versus traditional (n = 191)

P-valuea

Modied traditional (n = 151)

versus traditional (n = 309)

P-valuea

0.19 (0.080.48)
0.17 (0.070.44)
0.17 (0.050.56)

0.001
<0.001
0.004

0.40 (0.200.80)
0.42 (0.210.86)
0.45 (0.230.90)

0.010
0.017
0.024

0.66 (0.361.19)
0.59 (0.321.10)
0.96 (0.481.92)

0.163
0.096
0.902

0.37 (0.240.56)
0.39 (0.260.58)
0.45 (0.280.72)

<0.001
<0.001
0.001

KNHANES, Korea National Health and Nutrition Examination Survey; ADL, activities of daily living; IADL, instrumental ADL.
a
P value from logistic regression analysis.
b
Adjusted for age.
c
Adjusted for age, marital status, education level, household income, region, diabetes mellitus, hypertension, stroke, angina or myocardial infarction, arthritis, body mass
index, smoking, alcohol drinking, physical activity, and energy intake.

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J. Kim et al. / Maturitas 76 (2013) 160164

dietary pattern studies. However, previous studies and the current

study suggest that a better quality diet is associated with reduced
risk of disability.
A high carbohydrate diet may increase the risk of glucose intolerance and insulin resistance. Park et al. [18], based on data from
the 2005 KNHANES, reported an increased risk of diabetes mellitus in Korean women consuming diet rich in carbohydrates (>70%
of energy). In a recent meta-analysis, high levels of white rice
consumption were associated with a signicantly increased risk
of type 2 diabetes [19]. High carbohydrate intake through white
rice may increase insulin resistance, which is a major risk factor
for sarcopenia [20] and metabolic abnormalities, including diabetes mellitus [21], which in turn may lead to functional disability
[22,23]. Further studies are needed to elucidate the detailed mechanisms.
Moreover, a high consumption of fruits in both men and women,
and of dairy products and legumes in women in the modied
traditional dietary pattern may contribute to a reduced risk of functional disability. In a cohort study, intakes of dairy and fruit were
inversely associated with risk of disability in ADL and IADL [5].
Dairy products may reduce the risk of functional disability associated with osteoporosis [24]. Antioxidants found in fruits may
prevent free radical damage and, thus, decrease the risk of functional decline [25]. In a cross-sectional study, older women with
frequent consumption of legumes and soy products demonstrated
a reduced risk of IADL disability [26]. Soy components, such as
isoavones, may positively affect muscle mass, acting as phytoestrogens [27].
In interpreting the results of this study, several limitations need
to be considered. First, one day 24-h dietary recall might not evaluate usual intake because it cannot be corrected for day-to-day
variation of participants in food consumption. Second, it is possible that there was residual confounding. Other covariates not
considered in this study, such as depressive symptoms, cognitive
impairment, and other unknown risk or protective factors, could
have affected the relationship. Finally, this was a cross-sectional
study so that caution should be exercised in making any causal
inferences.
In conclusion, we found that the Korean modied traditional
dietary pattern was associated with a decreased risk of ADL
disability in older men and ADL/IADL disability in older women
when compared with the traditional dietary pattern. Our ndings
suggest that the modied traditional dietary pattern, meeting
the current Korean diet recommendations, may play a role in the
disablement process in late life. Longitudinal studies are warranted
to better understand the relationship between dietary patterns
and disability.
Contributors
J. Kim participated in the conceptualization and design of the
study, data analysis, interpretation of data, writing of the paper,
and have seen and approved the nal version. Y. Lee participated
in the conceptualization and design of the study, interpretation of
data, writing of the paper, and have seen and approved the nal
version. S.Y. Lee participated in the design of the study, interpretation of data, and have seen and approved the nal version. Y.O. Kim
participated in the design of the study, interpretation of data, and
have seen and approved the nal version. Y-S. Chung participated
in the interpretation of data and have seen and approved the nal
version. S.B. Park participated in the interpretation of data and have
seen and approved the nal version.
Competing interest
The authors declare no conict of interest.

Funding
This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF),
funded by the Ministry of Education, Science and Technology (No.
2012R1A1B3002939). The sponsor of the study did not have roles
in study design; data collection, analysis, and interpretation; or
writing of the report.
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