Emerging Trends in

Cultural Competence:
Menu considerations for a Korean
Emily Schmidt diet
Ryan Schwarz
Karishma Shah Image courtesy of https://fromkoreawithlove.wordpress.com/tag/korean-housewarming-
gifts/
General Introduction

Korean Americans > 1 million 1

Food acculturation dependent on geographic location 2

Low diet compliance

Lack of Korean food availability
 Traditional Meal Patterns
and Dishes
Plant-based foods, Animal products3 Free images. Available at
https://www.vecteezy.com/vector-art/97126-korean-foo
d-vector-illustration. Accessed April 23,2017
Carbohydrates as major energy source
rice consumption
Food not specific to meals 4

Up to Fresh Fruit
Rice Soup Kimchi 12 side (after
dishes meals)

Sweet desserts for special occasions

Health Beliefs and Practices

Very close with family and tradition

Emphasis on natural remedies
Care for ill family at home
Avoid nursing homes/outside care

Funeral services held in home country 6

Image courtesy of
https://us.123rf.com/450wm/iqoncept/iqoncept1701/iqoncept170100026/68584437-culture-language-beliefs-heritage-va
lues-cubes-3d-illustration.jpg?ver=6
Barriers to Good Nutrition 8
Lack of health insurance coverage
Cultural beliefs
Language barriers
Education

Traditional Korean diet linked to chronic disease

Diabetes, cardiovascular disease,
gastrointestinal disease 7

Free images. Available at https://www.vecteezy.com/vector-art/97126-korean-food-vector-illustration. Accessed April 23,2017

Communication
Guidelines

Be clear and concise

Staff of same gender as patient

Treat patient with respect (e.g. Sir or Maam)

Understand cultural beliefs and practices

Display hard work

Nutrition Counseling
Considerations
Encourage healthy cultural foods

Choose whole grains

Increase calcium intake

Decrease salt and sugar intake

Choose variety of fruits and vegetables

Lean meat

Free Images. Available at: http://www.freeimages.com/search/korean-medicine. Accessed December 15, 2016.

Menu Substitutions
Diets Modified:
Regular
Heart Healthy (HH)
Carbohydrate Controlled
Consistent Carbohydrate
 Menu Substitutions (Cont.)
# Meal Original Menu Item New Menu Item

1 Breakfast Scrambled eggs Grilled sesame tofu

2
Breakfast French toast Beef barley vegetable soup
3
Breakfast Blueberry muffin Fresh honeydew
4
Breakfast Pancakes Sweet chili tofu saut
5
Lunch Macaroni & cheese Sesame noodle salad
6
Lunch Roast turkey Grilled salmon
7
Lunch Gravy Lemon dill sauce
 Menu Substitutions (Cont.)
# Meal Original Menu Item New Menu Item

8 Lunch Grilled chicken sandwich Goulash, beef

9
Lunch Apple crisp Mandarin oranges
10 Chicken & vegetable
Lunch Dijon chicken noodle bowl
11
Dinner Honey baked chicken Ginger sauce pork chop
12
Dinner Meatloaf Shrimp & broccoli stir-fry
13
Dinner Mashed potatoes Roasted red potatoes
14
Dinner Swedish meatballs Baked tilapia
Menu Substitutions (Cont.)

14 total substitutions
Across all four diets
Strengthened menus cultural relevance
Saturday Heart Healthy
Saturday Breakfast Saturday Lunch Saturday Dinner

Orange Juice Goulash, beef Tossed Salad

Tilapia, baked, garden
Total Lettuce and Tomato style
WW French Toast Carrots Green Beans
Skim Milk Chilled Pears Fresh Apple
Coffee WW Roll
Margarine Skim Milk Skim Milk
Non Dairy Creamer Pepper Margarine
Sugar Herb Seasoning Diet French Dressing
Syrup Lite Mayo Pepper
Herb Seasoning
Meal Item Breakfast Serving Size Recipe Number KCAL PRO TOTAL FAT CHO NA FIBER K+ P
Orange Juice ea PM20421 53.3 0.9 0.1 13.6 11.6 0.2 190.8 13.6
Total box PM17569 77.1 2 0.5 18 113.2 2.2 73.7 0
WW French Toast 2 slice PM18467 169.7 11.8 1.8 28 341.8 3.4 238.3 166.5
Syrup ea PM17605 114 0 0 28.5 23.6 0 0 0
Margarine Each PM17539 56 0 6.4 0 61 0 2.9 0
Skim Milk 8oz PM17621 83.3 8.3 0.2 12.2 102.9 0 382.2 247.5
Decaf Coffee 8oz PM294 0 0.2 0 0 4.7 0 128 2.4
Non Dairy Creamer Each PM20218 12.2 0.1 1.2 0.3 1.9 0 0 7.1
Sugar 2 ea PM20205 46.4 0 0 12 0.1 0 0.2 0

Meal Subtotal 612 23.3 10.2 112.6 660.8 5.8 1016.1 437.1

Percent of Goal 29% 29% 15% 39% 33% 24% 27% 35%

Meal Item Lunch Serving Size Recipe Number KCAL PRO TOTAL FAT CHO NA FIBER K+ P
Goulash, beef ea M2515 271.437 29.03 11 12.96 310.23 2.724 656.38 293.26
Lettuce & Tomato ea PM10667 7.2 0.4 0.1 1.5 5.4 0.5 94.7 10.9
Lite Mayonnaise ea PM20214 26.2 0.1 2.6 0.8 96.7 0 0.7 0
Carrots 1/2 cup PM9903 29.9 0.5 0.5 6.2 47.7 2.7 155.1 25
Sliced Pears 1/2 cup PM13713 48.2 0 0 11.2 8.1 1.6 64.3 12
Skim Milk 8oz PM17621 83.3 8.3 0.2 12.2 102.9 0 382.2 247.5
Pepper ea PM20238 0.3 0 0 0.1 0 0 1.3 0.2
Salt Free Seasoning 1 EACH PM20234 1.9 0.1 0 0.4 0.5 0.1 7.6 1.3

Meal Subtotal 468.437 38.43 14.4 45.36 571.53 7.624 1362.28 590.16

Percent of Goal 23% 53% 13% 21% 31% 32% 29% 49%

Meal Item Dinner Serving Size Recipe Number KCAL PRO TOTAL FAT CHO NA FIBER K+ P
Tossed Salad 2 oz PM17012 10.1 0.6 0.1 2.1 7.4 1 115.3 14.6
Diet French Dressing ea PM20220 16.5 0 0 4 17.5 0 40.8 0.3
Garden-Style Baked Tilapia ea M18832 189.5 23.4 6.4 10.8 183.2 0.7 379.6 190.7
Green Beans 1/2 cup PM10175 18.6 1 0.1 4.3 0.7 2 105.8 19.3
Wheat Roll 1 EACH PM20371 100.8 2.6 1.4 19.6 176.5 1.7 16.2 14
Margarine Each PM17539 56 0 6.4 0 61 0 2.9 0
Fresh Apple Each PM13727 62.2 0.3 0.2 16.5 1.2 2.9 128 13.2
Skim Milk 8oz PM17621 83.3 8.3 0.2 12.2 102.9 0 382.2 247.5
Pepper ea PM20238 0.3 0 0 0.1 0 0 1.3 0.2
Salt Free Seasoning 1 EACH PM20234 1.9 0.1 0 0.4 0.5 0.1 7.6 1.3
Critical Thinking
What are components of:
Swedish Meatballs
Grilled Chicken Sandwich
What are components of:
Beef goulash
Baked tilapia

How might nutritional content change?

Nutritional Analysis
Consequences of changing just two items:
Decreased:
Total fat, sodium, calories, protein, fiber, and K+
Increased:
Nothing
Unchanged:
Phosphorous
Saturday Heart Healthy

How much of a difference was there?

How does this affect the patient?
Positives and negatives to both sides

Kcal Pro Total Fat CHO Na Fiber K+ P

New Menu 78% 129% 48% 84% 91% 89% 88% 124%
House HH 96% 140% 75% 98% 103% 99% 92% 124%
References
1. Lee SK, Sobal J, Frongillo EA. Acculturation, food consumption, and diet-related factors among
Korean Americans. J Nutr Educ Behav. 1999;31:321-330

2. Shin Rim, Kyung. Shin Chol. Blanchette Lanoie, Patricia. Health and Health Care of Korean-
American Elders. Stanford.edu; http://web.stanford.edu/group/ethnoger/korean.html.

3. Kim KK, Yu ES, Chen EH, Cross N, Kim J, Brintnall RA. Nutritional status of Korean Americans:
Implications for cancer risk. Oncol Nurs Forum. 2000;27:1573-1583.

4..Kim SH, Oh SY. Cultural and nutritional aspects of traditional Korean diet. World Rev Nutr
Diet.1996;79:109-132.

5.Kim S, Moon S, Popkin B. The nutrition transition in South Korea. Am J Clin Nutr. 2000;71:44-
53.9.Academy of Nutrition and Dietetics. Nutrition Care Manual. Traditional Korean Meal Plan

6. Shin Rim, Kyung. Shin Chol. Blanchette Lanoie, Patricia. Health and Health Care of Korean-
American Elders. Stanford.edu; http://web.stanford.edu/group/ethnoger/korean.html.

7. Ward BW, Clarke TC, Nugent CN, Schiller JS. Early release of selected estimates based on data
from the 2015 National Health Interview Survey. National Center for Health

8. Han, H-R, Kang, J, Kim, KB, Ryu, JP, Kim, MT. Barriers to and Strategies for Recruiting Korean
Americans for Community-Partnered Health Promotion Research. J Immigrant Health. 2007;9:137-
146.

9. Merkin S, Rebecca. Cross-Cultural Communication Patterns - Korean and American

Communication. Journal of Intercultural Communication. 2009; 1404-1634.