Nutrition 29 (2013) 213218

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Nutrition
journal homepage: www.nutritionjrnl.com

Applied nutritional investigation

Academic stress levels were positively associated with sweet food

consumption among Korean high-school students
Yeonsoo Kim Ph.D. a, Hye Young Yang MED b, Ae-Jung Kim Ph.D. c, Yunsook Lim Ph.D. b, d, *
a
Nutrition and Dietetics Program, School of Human Ecology, Louisiana Tech University, Ruston, Louisiana, USA
b
Nutrition Education major, Graduate School of Education, Kyunghee University, Seoul, Korea
c
Department of Alternative Medicine, Kyunggi University, Seoul, Korea
d
Department of Food and Nutrition, Research Institute of Human Ecology, Kyunghee University, Seoul, Korea

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The objectives of the present study were to identify the association among levels of
Received 21 February 2012 persistent academic stress, appetite, and dietary habits and to determine the specic types of
Accepted 7 August 2012 sweet foods consumed by Korean high-school students according to their academic stress levels.
Methods: The study participants included 333 high-school students in the 10th to 12th grades in
Keywords: Kyunggi Province, Korea. The level of academic stress was scored with a 75-item academic stress
Academic stress
scale and was categorized as high, medium, or low. A food-frequency questionnaire was used to
Sweet food
measure the sugar intake from sweet foods.
Sugar intake
Korean high school students Results: Korean high-school students with a high academic stress level had larger meals than the
Overeating other students. Compared with students with low academic stress, the students with high
academic stress had a higher frequency of sugar intake from the following food types: confec-
tionaries, candies and chocolates, breads, and avored milk. Moreover, compared with students
with low academic stress, the students with high academic stress had a higher total intake of sugar
from the following food types: confectionaries, candies, chocolates, avored milk, traditional
Korean beverages, and spicy, sweet, and fried rice cakes.
Conclusion: Unhealthy stress-related food choices may compromise high-school students health
and contribute to their morbidity. The ndings of the present study could be used to help nutri-
tionists develop effective strategies for nutritional education and counseling to improve adolescent
health.
2013 Elsevier Inc. All rights reserved.

Introduction healthy foods, stress, a social environment lacking support from

Adolescence is a critical period for growth and development,
so adolescents need a healthy, balanced diet to meet their
increased demands for energy and nutrients [1]. The importance
of healthy eating habits during adolescence has been empha-
sized to prevent and decrease the incidence of diet-related
chronic disease later in life [1]. Despite the importance of
nutritional health during adolescence, adolescents have adopted
a high-fat, high-sugar diet with a limited intake of fruits and
vegetables [2]. Various individual inuences are known to be
major barriers to healthy eating patterns, including a taste
preference for high-sugar and high-fat foods, the convenience of
less healthy foods, limited time and availability to consume
* Corresponding author. Tel.: 82-2-961-0262; fax: 82-2-968-0260.
E-mail address: ylim@khu.ac.kr (Y. Lim).
0899-9007/$ - see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.nut.2012.08.005
parents, the school environment, and the mass media [3,4].
In addition to unhealthy eating habits, adolescents have
extreme stress owing to academic and social demands in high
school, especially in Korea. Korean adolescents are under intense
academic pressure because of the competitive college entrance
examination. This nationwide college entrance examination is
administered only once a year. Entering and graduating from
a high-ranking university in Korea means a greater chance of
obtaining a good job with high wages, a high social status, and
a good spouse with a high salary and high social status [5]. In
2011, results of the Shanghai Academy of Social Science showed
that Korean high-school students spent as many as 14 to 18 h/d
studying at school and private tutoring institutes [6]. Many
students use private tutoring to devote every minute to prepare
for the comprehensive college examination [6]. A very well-
known saying in Korean 12th graders is sleep four hours pass,
214 Y. Kim et al. / Nutrition 29 (2013) 213218

sleep ve hours fail, which refers to the number of hours of
sleep allowable during the examination preparation [5]. In 2010,
7 of 10 Korean high-school students responded that they had
been stressed because of academic demands. The top reason for
wanting to commit suicide (54%) was the pressure and anxiety
related to academic performance, including high academic
expectations, academic workload, and academic competition
among peers [7].
Numerous studies have shown that the level of psychological
stress results in changes in food-intake patterns, including the
amount and types of food chosen [811]. An increased intake of
month on a food-frequency questionnaire, which was developed and validated
by Sim et al. [14]. The food-frequency questionnaire for sweet food intake was
used to measure the sugar intake of high-school students during stressful
conditions. To determine the frequency of intake, students were asked to select
one of nine categories, ranging from never or less than once a month to at least
three times per day. Moreover, to measure the amount of intake of each food
item, the students were asked to select one of three categories, ranging from
smaller than a specied serving size to larger than a specied serving size. For
each food item, the participants indicated their average frequency and amount of
consumption over the previous month.
The Korean food composition database was used to convert food intakes to
nutrient values. A list of total sugar contents in sweet foods [15] was used to
calculate the sugar amounts.

energy-dense foods containing high fat or sugars has been

observed under stressful conditions [10,11]. Wansink et al. [12]
reported different comfort-food preferences across different
ages and genders. Male subjects preferred warm, meal-type
comfort foods, whereas female subjects preferred more
snack-related comfort foods. Moreover, younger adults preferred
more snack-related foods than those older than 55 y [12].
Although previous studies [8,11] have shown that people
increase their intake of sweet foods during persistently stressful
situations, to date, no study has specically examined which
types of sweet foods are increased. Furthermore, research is
limited regarding individual differences in coping with persis-
tent academic stress through eating behaviors. The objectives of
the present study were to identify the relations among persistent
academic stress, appetite, and dietary habits, and the intake of
specic types of sweet foods in Korean high-school students. In
the present study, it was hypothesized that high academic stress
in Korean high-school students would be positively related to
a more frequent and a higher intake of sweet foods.
Materials and methods
Subjects
The study participants were recruited through their high schools, which
agreed to the students participation after the study was advertised by the
Kyunggi Provincial Ofce of Education. This cross-sectional study recruited 385
high-school students from grades 10 through 12 in Kyunggi Province, Korea. A
total of 333 students (202 boys and 131 girls) completed the study. The study was
deemed exempt by the Kyung Hee University institutional review board (Seoul,
Korea). Informed consent was obtained from all participants before the start of
the study. This study followed Good Clinical Practice guidelines.
Questionnaire
Statistical analyses
All analyses were performed with SPSS 12.0 (SPSS, Inc., Chicago, IL, USA).
Data were presented as mean  standard deviation. Descriptive statistics were
used to report the subjects average age and gender. The chi-square test was used
to determine relations among academic stress level, academic performance, and
changes in dietary habits under stress. Analysis of variance was conducted to test
for the global signicant differences in the total amount of sugar intake from
sweet foods by academic stress level and the differences in the frequency of sugar
intake from sweet foods by academic stress level. If the global results of analysis
of variance were signicant, a post hoc analysis with the Duncan multiple range
test was used to perform pairwise comparisons. Age- and sex-adjusted Spearman
partial correlation coefcients were used to evaluate the association between the
daily frequency or the daily amount of sugar intake and the academic stress scale
scores in Korean high-school students. The results were considered statistically
signicant only if the P value of an analysis was less than 0.1.
Results
The mean age of the 333 participants (202 boys and 131
girls) who completed the study was 17.4  1.2 y. The mean score
on the academic stress scale was 190.5  37.8. Two-thirds of the
participants parents (67.3%) were college educated, and
approximately half (49.2%) of the participants net monthly
household income was higher than $3500.
School life satisfaction, class rank, grade point average satis-
faction, and perceived stress are presented in Table 1 according
to the students academic stress level. School life satisfaction was
signicantly different according to the academic stress level
(P 0.001). Approximately one-fourth (27%) of participants with
Table 1
School life according to academic stress levels

Academic stress level Total P

The questionnaire consisted of four different categories: 1) demographic
information, such as gender, age, parents educational background, and house- High Medium Low
hold income; 2) a 75-item academic stress scale; 3) dietary habits; and 4) a 28-
School life satisfaction 0.001
item food-frequency questionnaire to measure sugar intake.
Very dissatised 5 (4.5) 2 (1.8) 1 (0.9) 8 (2.4)
The 75-item academic stress scale, developed and validated by Kim et al. [13],
Dissatised 25 (22.5) 12 (10.8) 10 (9.0) 47 (14.1)
was used to measure the extent of academic stress, concern, and anxiety across
Neutral 49 (44.1) 54 (48.6) 39 (35.1) 142 (42.6)
three subscales: school-related factors, inter-personal relationships, and
Satised 27 (24.3) 32 (28.8) 41 (36.9) 100 (30.0)
academic stress. The school-related factors subscale included 35 items on stress-
Very satised 5 (4.5) 11 (9.9) 20 (18.0) 36 (10.8)
related academic performance, tests, taking classes, and studying. The inter-
Class rank 0.001
personal relationships subscale consisted of 19 items on relationships with
Very high 7 (6.3) 15 (13.5) 29 (26.1) 52 (15.3)
teachers, family members, and friends. The academic stress subscale consisted of
High 29 (26.1) 36 (32.4) 32 (28.8) 97 (29.1)
21 items on physical, psychological, and behavioral symptoms of stress. For the
Middle 46 (41.4) 42 (37.8) 38 (34.2) 126 (37.8)
academic stress scale, the participants were asked to indicate the extent to which
Low 29 (26.1) 18 (16.2) 12 (10.8) 59 (17.7)
they had experienced stress over the previous week. It was a self-reported
Grade point average <0.001
measurement using a 5-point severity Likert scale from 1 (not at all) to 5
satisfaction
(applied strongly to me), and the item responses were summed.
Very dissatised 42 (37.8) 30 (27.0) 20 (18.0) 92 (27.6)
Participants were assigned to one of three groups based on the total scores on
Dissatised 48 (43.2) 53 (47.7) 40 (36.0) 141 (42.3)
the academic stress scale. Students with the highest tertile of total scores on the
Neutral 16 (14.4) 20 (18.0) 30 (27.0) 66 (19.8)
academic stress scale were categorized as the high academic stress group,
Satised 5 (4.5) 6 (5.4) 15 (13.5) 26 (7.8)
students with the second highest tertile were categorized as the medium
Very satised 0 (0) 2 (1.8) 6 (5.4) 8 (2.4)
academic stress group, and the remaining students who had the lowest tertile of
Perceived stress <0.001
total scores were categorized as the low academic stress group.
Yes 107 (96.4) 90 (81.1) 79 (71.1) 276 (81.9)
Questions regarding dietary habits involved dietary practices, such as
No 4 (3.6) 21 (18.9) 32 (28.8) 57 (17.1)
changes in meal size, appetite, eating speed, and taste preference under stress.
Participants were asked to report their intake of sweet foods over the previous Values are presented as number (percentage).
 Y. Kim et al. / Nutrition 29 (2013) 213218 215

high academic stress were very dissatised or dissatised with high academic stress consumed avored milk more frequently
their school life, whereas only 10% of participants with low than the other students (P 0.006).
academic stress were very dissatised or dissatised with their Students with high academic stress consumed larger
school life. In contrast, more than half (54.9%) the participants amounts of high-sugar cereal (P 0.028), candies (P 0.006),
with low academic stress expressed satisfaction with their school caramels (P 0.029), moon cakes (P 0.092), avored milk
life. Class rank was also associated with the academic stress level (P < 0.001), traditional Korean drinks (P 0.068), and spicy,
(P < 0.001); 26.1% of the participants with high academic stress sweet, and fried rice cakes (P 0.054) than the other students
were in the low class rank, and the same percentage of partici- (Table 4).
pants with low academic stress was in the very high class rank. In the correlation analyses adjusted for age and sex (Table 5),
Only 4.5% of participants with high academic stress were satis- signicant correlations were found for the daily frequencies of
ed or very satised with their grade point average, whereas 19% sugar intake from confectionaries (r 0.161, P 0.004), candies
of participants with low academic stress were satised or very and chocolates (r 0.176, P 0.002), breads (r 0.117, P 0.034),
satised with their grade point average (P < 0.001). The and drinks (r 0.133, P 0.02) and for the total daily frequencies
academic stress level was related to the presence of perceived of sugar intake from sweet foods with the scores on the academic
stress (P < 0.001); 107 of the 111 participants with a high stress scale. Furthermore, there were signicant correlations
academic stress level perceived stress, whereas 79 of the 111 between the daily amount of sugar intake from confectionaries
participants with a low academic stress level perceived stress. (r 0.13, P 0.021) and candies and chocolates (r 0.144,
Changes in dietary habits under stress are presented in P 0.011) with the scores on the academic stress scale.
Table 2 according to the students academic stress levels. Fifty-
eight percent of students with high academic stress and 49% of Discussion
students with low academic stress experienced a huge increase
or an increase in meal size (P 0.005). The preferred taste during The present study showed that academic stress in Korean
normal and stressful conditions was not related to the academic high-school students was positively associated with the
stress level of Korean high-school students. The results of this frequency and intake of sugar from sweet foods, meaning that
study indicated that approximately half the participants Korean high-school students with high academic stress had
preferred sweet tastes during normal and stressful situations. a higher frequency of intake and a higher total intake of sugar
Although the result was not signicantly different, during from sweet foods than students with low academic stress.
normal situations, 19% of the participants preferred spicy avors, In the present study, 52% of the participants reported an
whereas 33% of the participants preferred spicy avors when increase in total food intake under stress. An increased intake of
under stress. food may be caused by an increase in appetite. The extent to
The daily frequency and the amount of sweet food consumed which appetite is altered during stressful conditions is different
by the students according to their academic stress levels are from the duration of stressors. For example, under acute stress,
presented in Tables 3 and 4, respectively. Overall, students with an instant physical response occurs and suppresses appetite [16].
high academic stress consumed sweet foods (P 0.057), In contrast, during persistent stressful situations, such as
including confectionaries (P 0.018), candies and chocolates persistent academic stress in the present study, an increased
(P 0.057), and breads (P 0.085), more frequently than cortisol response is related to an increase in ad libitum food
students with low academic stress. In addition, students with intake [16]. Several cross-sectional studies have supported the
increased intakes of food and total calories under persistent
Table 2
stress [1719]. Korean adults with a high stress score [19] and
Dietary habits according to academic stress levels British students with high anxiety owing to examination stress
[20] also showed an increased appetite.
Academic stress level Total P
Several studies have reported positive relations between
High Medium Low stress and unhealthy eating habits, including an increase in total
Changes in meal size 0.005 calories [10,21], and in the consumption of high-fat foods, sweet
Increased a lot 25 (22.5) 10 (9.0) 12 (10.8) 47 (14.1) foods [20], and snacks and fast food [22]. Although the present
Increased 39 (35.1) 47 (42.3) 42 (37.8) 128 (38.4)
No change 26 (23.4) 32 (28.8) 45 (40.5) 103 (30.9)
study focused particularly on sweet food intake, most sweet
Decreased 16 (14.4) 12 (10.8) 10 (9.0) 38 (11.4) foods, such as chocolate and ice cream, are also high in fat [8]. In
Decreased a lot 5 (4.5) 10 (9.0) 2 (1.8) 17 (5.1) students, stress-induced negative emotions stimulate an
Eating speed 0.321 increased preference for sweet foods [2326] to ameliorate
Fast (<10 min) 58 (52.3) 50 (45.0) 43 (38.7) 151 (45.3)
their mood [27]. Researchers have suggested that increased
Average (1030 min) 46 (41.4) 50 (45.0) 58 (52.3) 154 (46.2)
Slow (>30 min) 7 (6.3) 11 (9.9) 10 (9.0) 28 (8.4) brain serotonin concentrations and increased pain tolerance
Preferred taste after the consumption of sweet foods, such as chocolate chips,
Under normal 0.732 contribute to improving mood [26]. Moreover, when stressed,
situations people have attenuated sweet taste perception, which results in
Sweet 57 (51.4) 62 (55.9) 63 (56.8) 182 (54.7)
Salt 21 (18.9) 22 (19.8) 20 (18.0) 63 (18.9)
compensatory consumption, such as an increased intake of
Sour 6 (5.4) 10 (9.0) 10 (9.0) 26 (7.8) sweet foods [28].
Bitter 0 (0) 0 (0) 0 (0) 0 (0) Previously, Wansink et al. [12] reported different comfort-
Spicy 27 (24.3) 17 (15.3) 18 (16.2) 62 (18.6) food preferences by gender. Male subjects preferred warm,
Under stress 0.928
meal-type foods (e.g., casseroles, soup, pizza), whereas female
Sweet 53 (47.7) 56 (50.5) 62 (55.9) 171 (51.4)
Salt 14 (12.6) 11 (9.9) 11 (9.9) 36 (10.8) subjects preferred snack-type foods (e.g., chocolate, ice cream).
Sour 4 (3.6) 5 (4.5) 4 (3.6) 13 (3.9) However, the present study did not show any gender differences
Bitter 1 (0.9) 0 (0) 1 (0.9) 2 (0.6) in food preferences (data not shown).
Spicy 39 (35.1) 39 (35.1) 33 (29.7) 111 (33.3) Stress affects health deleteriously through direct physiologic
Data are expressed as number (percentage). responses and modications in health behaviors, such as diet.
216 Y. Kim et al. / Nutrition 29 (2013) 213218

Table 3
Daily frequency of sugar intake from sweet foods according to academic stress levels (times)

Academic stress levels Total P

High Medium Low

Confectionaries
Biscuit, cookies 0.5  0.6a 0.3  0.4b 0.4  0.5ab 0.4  0.5 0.026
Chips 0.4  0.4 0.3  0.4 0.3  0.4 0.3  0.4 0.549
High-sugar cereals 0.3  0.4a 0.2  0.4b 0.2  0.4b 0.3  0.4 0.033
Chocolate-containing snacks 0.8  1.0a 0.5  0.9b 0.5  0.9b 0.6  0.9 0.042
Subtotal 2.0  1.9a 1.3  1.6b 1.4  1.7b 1.6  1.8 0.018
Candies and chocolates
Candies 0.4  0.5a 0.3  0.4b 0.2  0.3b 0.3  0.4 0.002
Caramels 0.3  0.5a 0.1  0.3b 0.1  0.3b 0.2  0.3 0.004
Jelly 0.2  0.4a 0.1  0.3b 0.1  0.3b 0.2  0.4 0.074
Chocolates 0.5  0.6 0.4  0.8 0.4  0.6 0.4  0.7 0.276
Subtotal 1.3  1.7a 1.0  1.7ab 0.8  1.3b 1.0  1.6 0.057
Breads
Breads 0.4  0.5a 0.3  0.4ab 0.3  0.4b 0.3  0.5 0.091
Stuffed breads 0.3  0.5a 0.2  0.4ab 0.2  0.3b 0.7  0.4 0.084
Mufns, cakes 0.2  0.3 0.2  0.4 0.2  0.2 0.2  0.3 0.321
Subtotal 1.0  1.3a 0.7  1.2ab 0.6  1.1b 1.2  1.2 0.085
Milk and dairy products
Flavored milk 0.4  0.5a 0.3  0.4b 0.3  0.5b 0.3  0.5 0.006
Drinking yogurt 0.9  1.1 0.8  1.2 0.6  1.2 0.8  1.2 0.318
Yogurt tubes 0.2  0.4 0.1  0.4 0.1  0.2 0.1  0.3 0.511
Yogurt 0.3  0.4 0.2  0.3 0.2  0.3 0.2  0.3 0.279
Ice cream 0.7  0.8 0.7  0.8 0.6  0.8 0.7  0.8 0.904
Subtotal 2.4  3.3 2.1  3.25 1.9  3.1 2.1  3.3 0.370
Beverages
Soymilk 0.3  0.5 0.2  0.4 0.2  0.5 0.2  0.5 0.402
Juice 0.4  0.5 0.3  0.4 0.3  0.6 0.3  0.5 0.231
Carbonated drinks 0.3  0.4 0.2  0.4 0.2  0.4 0.3  0.4 0.174
Sports drinks 0.3  0.4 0.3  0.5 0.2  0.4 0.3  0.4 0.146
Traditional Korean beverages* 0.2  0.3 0.1  0.4 0.1  0.3 0.1  0.3 0.309
Subtotal 1.5  2.0 1.2  2.1 1.1  2.1 1.2  2.1 0.134
Spicy, sweet, and fried rice cakes 0.1  0.3 0.2  0.4 0.1  0.2 0.1  0.3 0.133
Total 8.4  11.7a 6.3  10.5b 6.1  10.8b 7.2  11.1 0.057

Data are expressed as mean  SD. Values with different superscript letters within a row are signicantly different (P < 0.1) after the Duncan multiple range test.
* Traditional Korean beverages include sweet rice drink and sweet persimmon punch.

Stress results in slowed gastric emptying, use of energy stores,
and decreased blood ow to the gastrointestinal system [16].
Moreover, stress-induced hormones directly affect appetite.
Noradrenaline and corticotropin-releasing hormone repress the
appetite under stress, whereas cortisol has been reported to
stimulate appetite during recovery from stress [16,29].
However, results in human studies in which changes in food
intake were measured under acute and constant stressful
conditions have been inconsistent. Discrepancies in the results
could be due to different stressors, different durations of
exposure to various stressors, and individual differences in the
responses to stressors [10].
Eating habits that develop during adolescence affect a childs
short- and long-term health. It has been proposed that increased
cortisol concentrations in the process of coping with stress cause
an increase in the intake of sweet foods and energy-dense foods
[1]. Vicennati et al. [30] also reported the positive relation
between the urinary cortisol concentration and intakes of
energy, fat, and starchy foods. Furthermore, cortisol results in the
accumulation of visceral fat tissues by the activation of lipopro-
tein lipase [31], ultimately leading to a higher risk of chronic
diseases, such as obesity, metabolic syndrome, cardiovascular
disease, and cancer [1,31,32]. Importantly, the eating habits that
develop during adolescence continue into adulthood. A previous
report has shown that subjects who had disordered, unhealthy
eating habits during adolescence had a higher risk of continuing
these behaviors 10 y later [33]. The results of this study sug-
gested the importance and need for early prevention to stop
unhealthy eating behaviors from developing and the need for
early treatment interventions that aim to break any bad eating
habits [33].
The present study had strengths and limitations. Previous
studies measured the types of foods consumed before and after
exposure to a stressful stimulus in the laboratory and could not
investigate changes in food intake and taste preference during
persistent stress conditions. Furthermore, the present study used
a specic food-frequency questionnaire to estimate the intake of
sweet foods.
There are several limitations in the present study. First,
because the present study had a cross-sectional design, causal
associations between academic stress level and sweet food
intake could not be explained. Second, only one ethnic group,
Koreans, was included in the present study, so the present
results may not be extrapolated to other ethnic groups. Third,
the participants obesity level, which could be a potential
confounder, was not adjusted for in the present study. Most
subjects (95%) in the present study had a normal body mass
index, and the obesity level, as measured by the body mass
index, was not considered because of the very limited number
of overweight and obese subjects. Fourth, there were low
correlations of the daily frequency of intake and the daily
amount of sugar intake with the scores of the academic stress
scale. A larger sample could have provided stronger correla-
tions. Fifth, it would have been better if the relations between
the physiologic mechanisms and the modication of taste and
food intake were measured.
 Y. Kim et al. / Nutrition 29 (2013) 213218 217

Table 4
Daily sugar intake from sweet foods according to academic stress levels (grams)

Academic stress levels Total P

High Medium Low

Confectionaries
Biscuit, cookies 4.2  5.7 2.9  3.5 3.3  4.2 3.5  4.6 0.105
Chips 1.4  1.9 1.2  1.3 1.4  1.8 1.3  1.7 0.574
High-sugar cereals 1.5  2.4a 0.8  2.4b 1.0  1.8b 1.1  2.0 0.028
Chocolate-containing snacks 7.8  9.9 5.5  8.6 5.5  11.3 6.2  10.0 0.161
Subtotal 14.9  15.6 10.5  12.6 11.2  16.9 12.2  15.2 0.079
Candies and chocolates
Candies 3.2  4.8a 2.0  3.2b 1.7  2.9b 2.3  3.8 0.006
Caramels 1.4  2.4a 0.7  1.6b 0.7  1.9b 0.9  2.0 0.029
Jelly 0.8  1.8 0.4  1.2 0.5  1.2 0.6  1.4 0.0152
Chocolates 6.1  8.8 4.9  8.2 4.5  8.7 5.2  8.6 0.394
Subtotal 10.7  15.3 8.4  13.1 7.4  13.7 8.7  14.1 0.226
Breads
Breads 3.3  4.3 2.75  4.4 2.5  4.5 2.9  4.4 0.399
Stuffed breads 4.1  7.5 3.1  6.3 2.5  6.1 3.3  6.7 0.192
Mufns, cakes 2.9  4.3 2.5  5.5 2.1  3.32 2.5  4.5 0.401
Subtotal 10.3  16.1 8.4  16.2 7.1  13.9 8.6  15.6 0.308
Milk and dairy products
Flavored milk 7.9  10.1a 4.3  5.9b 4.4  6.3b 5.6  7.9 <0.001
Drinking yogurt 8.6  10.6 8.0  11.7 6.3  11.3 7.6  11.2 0.300
Yogurt tubes 1.7  3.6 1.4  3.5 1.3  3.0 1.5  3.4 0.732
Yogurt 7.0  10.7 5.5  8.1 5.0  6.9 5.8  8.7 0.227
Ice cream 15.8  20.4 14.7  15.1 14.4  19.5 15.0  18.5 0.859
Subtotal 40.5  59.0 33.8  48.4 31.8  49.8 35.0  53.2 0.945
Beverages
Soymilk 1.8  3.2 1.4  2.4 1.3  3.2 1.5  2.9 0.452
Juice 8.4  11.4 5.9  9.0 7.7  14.0 7.3  11.6 0.270
Carbonated drinks 8.7  10.9 6.0  10.4 6.2  10.5 7.0  10.6 0.116
Sports drinks 6.57  7.9 5.2  8.8 4.2  8.6 5.3  8.5 0.121
Traditional Korean beverages* 2.5  4.9a 1.4  3.4b 1.37  3.4b 1.8  4.0 0.068
Subtotal 28.0  38.3 19.9  33.9 20.7  39.6 22.9  37.6 0.692
Spicy, sweet, and fried rice cakes 1.2  2.4a 0.9  2.3ab 0.5  1.0b 0.9  2.0 0.054
Total 106.6  156.0 81.1  131.8 79.4  143.6 88.8  146.1 0.790

Data are expressed as mean  SD. Values with different superscript letters within a row are signicantly different (P < 0.1) after the Duncan multiple range test.
* Traditional Korean beverages include sweet rice drink and sweet persimmon punch.

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