This study investigated whether public senior housing mitigates the effect of low income on depression among older adults in South Korea. Data were drawn from two sources: the Public Senior Housing Residents Survey (n = 119) and the 2018 Seoul Welfare and Living Conditions of Older Adults Survey (n = 519). Regression analyses examined the independent contributions of income and housing type to depressive symptoms among older adults living alone and below the poverty line. Results indicated that low income was associated with higher levels of depression, but residence in public senior housing alleviated this detrimental effect. Public senior housing that integrates comprehensive care services and structured social activities appears to provide protective benefits. These findings suggest that public senior housing may serve as an important housing alternative for low-income older adults living alone who are particularly vulnerable to depression, underscoring its potential relevance for policy and future research on housing and well-being among older adults.

Although prior studies suggest physical activity (PA) benefits the mental health of the general population, evidence remains scarce for people with disabilities, who are comparatively less active and at greater risk of mental health disorders (MHD). This study aimed to assess the differential associations between PA and mental health outcomes among Korean adults with disabilities. This study drew on nationally representative data from the Korea Health Panel Survey (KHPS, 2019-2021, Version 2.2), including 1,890 adults with disabilities. PA levels were assessed per WHO guidelines as insufficient (< 150min/week), moderate (150-300min/week), or high (> 300min/week). In this study, participants engaging in ≥ 150min of PA per week were defined as physically active. MHD included stress, anxiety, depression, and suicide ideation. Multivariable logistic regression analyses adjusted for covariates were performed, along with stratified interaction analyses, to examine the associations between PA and each mental health outcome. Overall, 51.5% (95% CI: 49.3-53.8) of participants were physically active. Adults with disabilities engaging in moderate and/or high PA exhibited lower odds of stress (OR, 95% CI; moderate PA: 0.55, 0.36-0.85; high PA: 0.61, 0.44-0.91) and suicide ideation (OR, 95% CI; moderate PA: 0.62, 0.34-0.98) compared to those with insufficient PA. High PA was associated with a 52% reduction in the odds of depression (OR, 95% CI: 0.48, 0.25-0.93). Physically active adults with physical (suicide ideation, OR, 95% CI: 0.38, 0.20-0.84), sensory (stress, OR, 95% CI: 0.49, 0.17-0.97), and internal organ disabilities (OR, 95% CI: stress, 0.27, 0.14-0.73; anxiety, 0.60, 0.26-0.97) exhibited lower odds of MHD. Older adults, males, employed individuals, urban residents, and those with higher educational attainment or chronic health conditions who were physically active demonstrated a stronger protective association with MHD. The findings indicate a positive association between sufficient PA and mental health among adults with disabilities. Notably, the positive association between PA and mental health was particularly pronounced among individuals with physical, sensory, and internal organ disabilities. These findings support tailored PA interventions as a public health strategy to enhance mental well-being in disabled individuals, with further research needed to explore underlying mechanisms and develop accessible programs addressing diverse disability needs. Not applicable.

BackgroundHealth literacy (HL) is a key determinant of physical and mental health outcomes; however, the relationships among HL, anxiety symptoms, and health-related quality of life (HRQoL) remain unclear, and whether the effects of HL vary by age is unknown. We aimed to examine the associations among HL, anxiety symptoms, and HRQoL in Korean adults and assessed age-related differences in these associations.MethodsIn this cross-sectional study, we analyzed data from the 2023 Korea National Health and Nutrition Examination Survey, including 5,017 adults aged ≥ 19 years. HL was assessed using a validated 10-item instrument (score range: 10–40) and categorized as low, middle, or high. Anxiety symptoms and HRQoL were measured using the 7-item Generalized Anxiety Disorder Scale and the 8-item Health-related Quality of Life Instrument, respectively. Multivariable logistic regression models adjusted for potential confounders were used to estimate associations between HL and anxiety symptoms and between HL and good HRQoL. Age-stratified analyses were conducted for participants aged 19–39, 40–64, and ≥ 65 years.ResultsThe low (odds ratio [OR]: 1.93; 95% confidence interval [CI]: 1.52–2.46; p < 0.001) and middle HL (OR: 1.30; 95% CI: 1.04–1.62; p = 0.024) groups had higher odds of anxiety symptoms than the high HL group. Lower HL was associated with a reduced likelihood of good HRQoL (OR: 0.49; 95% CI: 0.36–0.66; p < 0.001), whereas the middle HL group showed a non-significant trend toward poorer HRQoL (OR: 0.77; 95% CI: 0.56–1.06). HL was associated with anxiety symptoms in young and middle-aged adults, and with HRQoL in young and older adults.ConclusionLow HL was significantly associated with increased anxiety symptoms and poor HRQoL, with a significant impact among young adults. These findings highlight the need for age-specific public health strategies to improve HL.

Health-related quality of life (HRQoL) reflects physical and mental well-being and is increasingly important in aging populations, yet traditional approaches often fail to capture the complex causal pathways among its determinants. We analyzed 2,566 adults aged 50–81 years from the Korean Genome and Epidemiology Study using the Short Form-12 (Physical Component Summary [PCS] and Mental Component Summary [MCS]). A causal Bayesian network was learned using the PC algorithm of Spirtes and Glymour with hierarchical constraints to ensure causal interpretability. We then estimated the causal effects of each variable on tail-defined outcomes—poor (bottom quartile) and good (top quartile) PCS and MCS—and quantified pairwise interaction effects. The network revealed how upstream factors propagate through direct and indirect pathways to shape HRQoL. Notably, PCS and MCS shared common upstream causes but showed no direct causal connection. Quantifying these causal pathways through relative risk (RR) estimates revealed the magnitude of individual factor effects. For poor PCS, severe insomnia (RR = 1.98), high stress (RR = 1.45), low physical activity (RR = 1.39), and multimorbidity (RR = 1.36) were the principal risk factors. For poor MCS, high stress (RR = 3.28) and severe insomnia (RR = 2.72) dominated. Notably, low BMI increased poor MCS risk (RR = 1.20), consistent with frailty pathways. The patterns for good outcomes largely mirrored these findings, with favorable levels showing protective effects. Interaction analyses revealed substantial synergistic effects: severe insomnia with high stress increased poor MCS probability by 6.44 percentage points (pp) beyond additivity, while high stress with physical inactivity added 4.77 pp. For good MCS, low insomnia with low stress (+4.72 pp) and low BMI with exercise (+4.21 pp) showed synergy, whereas stress with inactivity exhibited antagonism (–4.00 pp). These results support integrated interventions that combine sleep improvement, stress reduction, physical activity promotion, and multimorbidity management to improve HRQoL in aging populations.

Purpose This study aims to examine how self-initiated trial experiences with innovative products by older consumers influence their future choice behavior. Specifically, it investigates whether such autonomous engagement increases self-efficacy and leads to a greater tendency to make risk-taking choices in later and unrelated consumption contexts. Rather than treating chronological age merely as a demographic factor, this study views it as a proxy for underlying psychological mechanisms that shape consumers’ openness to innovation and their willingness to engage with uncertainty. This study challenges prevailing assumptions that older consumers are passive or avoidant toward technological innovation. Design/methodology/approach Three studies were conducted using both survey and experimental methods. Study 1 surveyed 85 Korean adults (Mage = 46.5) to assess the relationship between the frequency of recent self-initiated use of nine innovative services (e.g. kiosks, AI appliances and metaverse) and consumers’ current self-efficacy in using innovative technologies. Study 2 used a 2 (generation: younger vs older) × 3 (experience type: self-use vs helped by others vs control) between-subjects design (n = 186) using a scenario involving an unmanned service. Study 3 replicated the findings with a new product extension scenario (n = 198), testing the mediating role of situational self-efficacy through a bootstrapped moderated mediation analysis. Findings Across three studies using both survey and experimental methods, older consumers who independently engaged in self-initiated trial experiences with innovative services showed higher self-efficacy, which in turn increased their willingness to make riskier or more novel consumption choices. Self-efficacy played the role of a mechanism linking self-initiated engagement with innovation to subsequent risk-taking behavior. In contrast, younger consumers exhibited no significant changes in self-efficacy or choice tendencies. These results were consistently supported across survey data (Study 1) and two experimental replications (Study 2 and Study 3). Research limitations/implications This study was conducted in a single cultural context (South Korea), which may limit generalizability. Future research could explore different innovation types, long-term behavioral changes of older consumers or cross-cultural effects. Although this study used chronological age as a proxy for generation differences, considering other variables such as cognitive age, perceived control and time perspective would also provide insights into examining the impact of older adults’ engagement with innovation. Moreover, future research could examine whether other internal mechanisms, beyond differences in self-efficacy, could drive behavioral change in middle-aged and older adults. Overall, the findings contribute to age-specific consumer innovation research and provide empirical support for self-efficacy as a key psychological mechanism in transformative service experiences. Practical implications New product development marketers should design technological experiences that allow older consumers to independently experience innovative services. As new innovative technologies continue to emerge, older consumers with significant purchasing power and a growing market are becoming a key segment deserving particular attention in the marketing landscape. The findings of this study suggest that encouraging these consumers to use new technologies on their own can enhance their confidence and increase their openness to novel or unfamiliar product choices, which has meaningful practical implications. Social implications This study challenges age-based stereotypes by showing that older consumers can adopt innovative technologies and become more confident and risk-tolerant when given self-directed experiences. Crucially, even a single encounter with new technology can enhance self-efficacy, suggesting that such experiences have the potential to transform older consumers’ lives. Consequently, these findings highlight the importance of inclusive service environments that respect both chronological and psychological age diversity, support digital equity and promote active engagement in technology-driven societies. Originality/value To the best of the authors’ knowledge, this research is among the first to highlight the role of self-motivated engagement with innovation in shaping older consumers’ decision-making behaviors. It integrates self-efficacy theory with innovation adoption and risk-taking behavior, offering theoretical as well as managerial insights for designing inclusive service environments.

Marital relationships play a central role in psychological well-being across adulthood, yet prior research has rarely integrated personality, motivational, and relational factors as components of a single interpersonal system. To address this gap, this study—guided by social–cognitive and dynamic-systems perspectives—applied network analysis to examine how personality traits, approach–avoidance goals, spousal support and strain, and marital adjustment are interconnected within a dynamic interpersonal system. Flow network analysis was further used to identify how these dispositional, motivational, and relational factors were directly and indirectly linked to life satisfaction and psychological distress. Participants were 502 married South Korean adults ( M = 54.43 years; 49.4% male). The resulting network revealed a closely connected triad of approach goals, spousal support, and marital adjustment, suggesting that motivational and relational factors form a cohesive system underlying marital functioning. Marital adjustment and approach goals emerged as the most central and bridging nodes, linking dispositional, motivational, and relational domains. Flow network analysis indicated that life satisfaction was directly associated with marital adjustment, spousal support, approach goals, higher extraversion, and lower neuroticism, whereas psychological distress was directly associated with higher neuroticism, lower marital adjustment, and stronger avoidance goals. Together, these findings indicate that psychological well-being is shaped by structurally differentiated configurations of dispositional, motivational, and relational factors, rather than by additive or dominant-factor effects within any single domain.

Physical function and oral frailty severity: A cross-sectional study.

Psychological well-being during the recovery phase of the coronavirus disease 2019 pandemic: Impact of intolerance of uncertainty, stress, and coping among south Korean adults

OBJECTIVES The purpose of this study was to examine temporal trends in physical activity and metabolic syndrome (MetS) among Korean adults, and to evaluate secular trends in the association between physical activity and MetS from 2018 to 2023.METHODS This study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES) collected between 2018 and 2023. A total of 32,639 adults aged ≥ 19 years were included. Physical activity was dichotomized based on meeting the World Health Organization guidelines (≥ 150 minutes/week of moderate to vigorous physical activity). MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria with Asian-specific waist circumference cutoffs, as the presence of ≥ 3 of 5 metabolic components based on measured component values. All analyses accounted for the complex sampling design of KNHANES by applying survey weights and primary sampling units and strata. Temporal trends were tested using orthogonal polynomial contrasts. Secular changes in the association between physical activity and MetS were evaluated using random-effects meta-regression.RESULTS Physical activity levels showed no significant temporal trends from 2018 to 2023. Among MetS components, waist circumference and HDL-C showed significant linear and quadratic trends, fasting plasma glucose demonstrated a significant quadratic pattern peaking in 2021, and both triglycerides and diastolic blood pressure showed significant negative linear trends, whereas systolic blood pressure showed no significant temporal trend. Pooled analyses revealed that meeting physical activity guidelines was associated with a 25% lower odds of MetS (pooled OR = 0.75, 95% CI = 0.70–0.80). Meta-regression indicated no significant secular change in this association across survey years.CONCLUSIONS Meeting physical activity guidelines was consistently associated with lower odds of MetS among Korean adults from 2018 to 2023, with no evidence of secular change in this association. Despite stable physical activity, several MetS components showed partially unfavorable temporal trends, underscoring the need for prevention strategies beyond physical activity alone.

Association between Osteoporosis and Tinnitus with Subgroup Analysis for Sex and Age in Korean Adults

OBJECTIVES To synthesize current evidence on exercise interventions for osteoporosis prevention in Korean older adults—integrating the mechanistic and clinical effects of each modality (resistance, aerobic/weightbearing, combined, high-impact, and balance/strength) on bone mineral density (BMD), falls, physical function, and safety—in order to inform practical recommendations.METHODS We reviewed studies retrieved from international (PubMed, Google Scholar, Web of Science) and Korean (KISS/KCI) databases published since 2000. Key outcomes (lumbar spine and femoral neck BMD, fall incidence, functional indices, and adverse events) were extracted and summarized by exercise type. Findings were organized into nine thematic domains relevant to Korean older adults.RESULTS Resistance training generally maintained or increased BMD at the lumbar spine and hip, with more consistent benefits at or above moderate intensity. Aerobic exercise alone showed limited BMD effects, whereas weight-bearing aerobic activities (e.g., walking/brisk walking) provided adjunctive benefits. Combined programs (e.g., resistance plus aerobic/weight-bearing components) produced relatively greater improvements in BMD and functional outcomes than single-modality training. High-impact/weight-bearing protocols (e.g., jump/impact drills) can yield rapid, site-specific BMD gains but require cautious, individualized progression in very old or frail adults because of fracture, joint load, and fall risk. Balance and strength training significantly reduced falls, providing an important indirect pathway to fracture prevention.CONCLUSIONS For Korean older adults, a safety-first, pragmatic approach should involve centering programs on resistance training at or above moderate intensity, integrating combined exercise program with dedicated balance components to prevent falls, and introducing high-impact elements selectively and progressively with pre-exercise assessment, ongoing monitoring, and individualized tailoring.

The ambivalent sexism theory supports differences in the manifestations of sexism among individuals with diverse genders and sexual orientations. However, it still remained unclear whether individuals who share common strong cultural values endorse different levels of sexism according to their gender and sexual orientation. The current study aimed to examine differences in sexist attitudes based on gender and sexual orientation among Korean adults. We first tested measurement invariance in a Korean Multi-dimensional Sexism Inventory (K-MSI) between heterosexuals (n = 374) and sexual minorities (n = 445), and second, we compared the latent means across groups using the Multiple Indicators Multiple Causes (MIMIC) model. The results confirmed the first-order six-factor structure of the K-MSI with adequate internal consistency, and supported partial scalar invariance across heterosexual and sexual minority men and women. The MIMIC model approach revealed significant age, gender, and sexual orientation differences in most of hostile sexism (HS) and benevolent sexism (BS) components. Overall, heterosexuals reported higher levels of sexism than non-heterosexuals within each gender. Gender differences in BS have become nuanced when sexual orientation was considered. The current study also provides an overview of Korean culture that may uniquely influences individuals’ sexist attitudes, which would interest international researchers.

Dietary quality is an important lifestyle factor linked to prevention of age-related diseases and functional decline, yet its contribution to health-related quality of life (HrQoL) in later life is underappreciated. We examined the association between overall dietary quality and HrQoL among community-dwelling Korean older adults. We conducted a cross-sectional analysis of 2,104 older adults aged ≥ 65 years from the 2019-2020 Korea National Health and Nutrition Examination Survey. Dietary quality was assessed using the Korean Healthy Eating Index (KHEI), calculated from a single 24-hour dietary recall. The participants were categorized into quintile groups according to their KHEI scores. HrQoL was measured using the EuroQoL-five dimensions (EQ-5D), analyzed as an EQ-5D value and by dimension and level (i.e., any problems or no problems). We used multivariate linear regression for the EQ-5D value and multivariable logistic regression for dimension-specific outcomes, adjusting for age, sex, total energy intake, household income, education, physical activity, smoking, alcohol drinking, dietary supplement use, and the number of comorbidities. An increasing trend was observed in the EQ-5D value with the KHEI score (P for trend = 0.009), with the highest KHEI quintile having a significantly higher EQ-5D value (mean difference: 0.03, 95% CIs: 0.011, 0.049) compared with the lowest quintile. Of the five EQ-5D dimensions (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), a significant association with KHEI was observed for mobility only; the highest KHEI quintile group had lower odds of reporting any problems in mobility (odds ratio [OR]: 0.62, 95% confidence intervals [CIs]: 0.42, 0.91) compared with the lowest quintile. Among Korean older adults, higher dietary quality is associated with better HrQoL, potentially through reduced mobility problems. Improving dietary quality may be an effective strategy to enhance HrQoL in older age.

Recent interest in metabolically healthy obesity highlights the need to evaluate the relationship between adiposity and hematologic and metabolic biomarkers. With the increasing use of bioelectrical impedance analysis (BIA), measuring body composition, including percent body fat (PBF), has become more accessible. This study aimed to investigate the associations between PBF and hematologic and metabolic biomarkers related to cardiometabolic health. We conducted a retrospective, cross-sectional analysis using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES-IX), which included BIA-based body composition metrics. A total of 5,518 adults with complete records and no predefined outliers were analyzed. Survey-weighted Pearson correlation coefficients were calculated by sex and age groups, followed by multiple linear regression adjusting for sex, age, and body weight. PBF was significantly associated with alanine transaminase (β = 1.06 per % PBF), hemoglobin (β = 0.02), hematocrit (β = 0.06), total cholesterol (β = 0.48), high-density lipoprotein cholesterol (β = -0.50), low-density lipoprotein cholesterol (β = 0.62), and triglyceride (β = 2.93). No significant association was found between PBF and aspartate transaminase. Notably, the associations of PBF with alanine transaminase and triglycerides varied by sex and age group. These findings suggest that PBF may be a useful non-invasive marker for assessing cardiometabolic risk, warranting further investigation in diverse populations.

Duration of anticholinergic burden and polypharmacy and the risk of fractures in older Korean adults: a nationwide cohort study.

This study aimed to examine the forms of golf experiences as serious leisure among Korean older adults and to explore in-depth through phenomenological research the perspectives on such leisure activities and the meanings of actual experiences in the process of enjoying leisure. Using snowball sampling, a total of six research participants who enjoy golf experiences as serious leisure were selected, and data were collected and analyzed through in-depth interviews and participant observations conducted over approximately three months from May to August 2024. Based on this, the collected content was initially coded, repeatedly reviewed, and systematically organized and categorized. In the second stage, the context and meaning of the identified topics and phenomena were confirmed and classified to derive results. The analyzed results were as follows: freedom and liberation, emotional stability and stress relief, social connection and belongingness, and reconstruction of self-identity and life values emerged as themes. The findings of this study demonstrate that golf experiences as serious leisure are valuable leisure activities that positively impact the daily lives of older adults, indicating the benefits of golf experiences as serious leisure.

The availability of health information through media has raised public awareness of health literacy (HL). HL is essential for medication adherence and self-management in individuals with chronic diseases, and for those without chronic conditions, HL is important for promoting health and engaging in preventive behaviors. This study examined the role of having a regular physician in improving HL among Korean adults, both with and without chronic diseases. We conducted a retrospective, cross-sectional analysis using data from 8,322 participants in the 2021 Korea Health Panel Study. HL was measured with the 16-item European Health Literacy Survey Questionnaire. To identify factors associated with HL categories and to calculate adjusted mean HL scores, we used multiple logistic regression and weighted linear regression. Among participants with chronic diseases (n=4,627), 56.6% reported having a regular physician, with the largest group (42.7%) showing inadequate HL. After adjustment, age 75 years or older and lower education were significantly linked to lower HL levels, regardless of chronic disease status. Having a regular physician was significantly associated with higher HL levels in participants with chronic diseases (adjusted odds ratio, 1.94; 95% confidence interval, 1.42-2.63), but not in those without chronic diseases. Participants with chronic diseases who had a regular physician showed higher mean HL scores across all HL competencies and domains. Although access to health information has increased, the risk of encountering conflicting or misleading content has grown. These findings emphasize the importance of regular physicians in guiding patients and improving HL, especially among individuals with chronic diseases.

We evaluated the associations of smoking status, intensity, duration, and cumulative exposure with the risk of dental implant failure in Korean adults. This retrospective cohort study utilized the National Health Insurance Service-Health Screening Cohort (2016-2019). Overall, 23,573 individuals who had completed the dental implant process were included. Smoking status was categorized as non-smoker, ex-smoker, or current smoker. Smoking intensity, duration, and cumulative exposure were classified using standardized thresholds (>10 cigarettes per day, >10 years, and >10 pack-years). Implant failure was defined as reimplantation or removal. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, clinical, and behavioral covariates. During follow-up, 605 implant failures occurred: 344 in non-smokers, 182 in ex-smokers, and 79 in current smokers. The corresponding incidence rates per 1,000 person-years were 11.6, 16.5, and 22.3, respectively. Current smoking was significantly associated with higher implant failure risk (adjusted HR, 1.59; 95% CI, 1.20 to 2.09), while ex-smokers displayed a non-significant increase (adjusted HR, 1.16; 95% CI, 0.94 to 1.45). A dose-response relationship was observed: smoking more than 10 cigarettes per day, smoking for more than 10 years, or exceeding 10 pack-years was associated with significantly increased risk. Smoking is a significant, dose-dependent risk factor for dental implant failure in Korean adults. Current smokers have the highest risk; smoking cessation may reduce adverse outcomes. These findings emphasize the importance of detailed smoking assessments and cessation counseling in implant care and public health strategies.

Background/Objectives: Modifiable lifestyle factors, particularly diet, are important for preventing type 2 diabetes (T2D); however, the evidence regarding this from prospective studies is limited in the Asian population. We therefore evaluated whether a diet-inclusive healthy lifestyle score (HLS) predicts incident T2D in a community-based cohort. Methods: We analyzed 7185 T2D-free adults from the KoGES Ansan-Ansung cohort, constructing the HLS (range: 0-5) based on five lifestyle factors: non-smoking, ≥30 min/day of moderate-to-vigorous physical activity, low-risk alcohol consumption (≤40 g/day for men; ≤20 g/day for women), BMI of 18.5-24.9 kg/m2, and a healthy diet, defined as a healthy plant-based diet index within the top 40th percentile. Cox proportional hazards regression models were employed to examine the association between HLS and incident T2D risk. Results: During a median follow-up of 17.5 years, 1223 cases of T2D were identified. Compared to individuals with a score of 0 or 1, those with a score of 5 had a 56% lower risk of T2D after adjustment for potential confounders (HR: 0.44, 95% CI: 0.32-0.62), and these associations remained consistent across subgroups stratified by age, sex, family history of T2D, hypertension, and residential area. However, the association was stronger among non-users of anti-diabetic medication than among users. Conclusions: Adherence to a healthier lifestyle, as indicated by a higher HLS, was significantly associated with a reduced risk of developing T2D among Korean adults. These findings underscore the importance of promoting integrated healthy lifestyle behaviors to prevent T2D.

BackgroundPhysical activity and diet quality are key determinants of chronic disease prevention and overall health. However, their population-level time trends and between-year differences in cross-sectional associations remain underexplored.AimsThis study examined secular trends in physical activity and diet quality among Korean adults from 2018 to 2021 and assessed whether the cross-sectional association between adherence to WHO physical activity guidelines and diet quality varied across survey years.MethodsData were drawn from 18,976 adults aged 19-79 years participating in the Korea National Health and Nutrition Examination Survey. Physical activity was assessed using the Korean version of the International Physical Activity Questionnaire-Short Form and classified according to the WHO guideline (≥150 min/week). Diet quality was measured using the Korean Healthy Eating Index (KHEI). Logistic regression was used to examine the association between physical activity adherence and higher diet quality, adjusting for age, gender, smoking, alcohol use, and body mass index. Meta-regression evaluated the between-year variation in the cross-sectional association.ResultsPhysical activity levels remained stable across survey years, whereas diet quality significantly declined (Plinear = 0.04), particularly among women, non-smokers, alcohol consumers, and individuals with underweight or overweight. In year-specific cross-sectional models, meeting the physical activity recommendation was associated with 31% higher odds of higher diet quality (OR = 1.31, 95% CI = 1.16-2.48, p < 0.001). This association did not significantly change over time.ConclusionsFrom 2018 to 2021, diet quality declined among Korean adults despite stable physical activity levels. Although physical activity adherence was consistently associated with higher diet quality, no significant temporal trends were observed in this relationship.