Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: Analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III)

The association between dietary patterns and cardiovascular disease risk factors in Iranian adults: a cross-sectional study

BACKGROUND

Dietary patterns are important factors associated with cardiovascular diseases (CVDs). We examined the association between dietary patterns derived from factor analysis and CVD risk factors.

METHODS

In the present cross-sectional study, a total of 3,687 adults (aged 40 to 70 years) with one or more types of CVDs were enrolled as participants. A validated semi-quantitative food-frequency questionnaire was utilized to assess food intakes, and then dietary patterns were extracted by factor analysis. Fasting blood sugar (FBS), lipid profile, anthropometric indices, and blood pressure (BP) were measured. Multivariable-adjusted logistic regression analysis was employed to ascertain the odds ratio (OR) of CVD risk factors associated with posteriori dietary patterns. In this study, healthy and unhealthy dietary patterns were identified.

RESULTS

Adherence to a healthy dietary pattern was associated with a decrease in systolic BP (SBP) (OR = 0.78; 95% confidence interval (CI): 0.62-0.99) and high-density lipoprotein cholesterol (HDL-C) levels (OR = 1.32; 95% CI: 1.06-1.64). Additionally, greater adherence to the unhealthy dietary pattern was positively associated with SBP (OR = 1.43; 95% CI: 1.13-1.80) and diastolic BP (DBP) (OR = 1.33; 95% CI: 1.01-1.76).

CONCLUSIONS

We concluded that greater adherence to an unhealthy dietary pattern was associated with an increase in SBP and DBP. On the other hand, greater adherence to a healthy dietary pattern could be effective in reducing SBP. Further investigation is recommended to validate these findings.

The association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US: A cross-sectional study

BACKGROUND

The association between dietary carbohydrate intake and hyperlipidemia remained incompletely understood. This study aimed to explore the association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US.

METHODS

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2020. Dietary intake information was assessed via interviews using 24-hour dietary recall interviews, and hyperlipidemia diagnosis adhered to the National Cholesterol Education Program guidelines. Univariate and multivariate logistic regression analyses, along with restricted cubic splines (RCS) and stratified analyses, were conducted to investigate the association between dietary carbohydrate intake and the risk of hyperlipidemia.

RESULTS

A total of 6,791 women of reproductive age, with a mean age of 34.87 (±8.57) years, were included in the final analysis. In the multivariate logistic regression model adjusting for covariates, a higher percentage of energy from carbohydrate was positively correlated with the risk of hyperlipidemia (adjusted odds ratio (AOR): 1.014, 95% CI: 1.004-1.024). Analyzing the percentage of energy from carbohydrate as a categorical variable, compared to the lowest quartile, the third quartile (AOR: 1.263, 95% CI: 1.031-1.546) and the highest quartile (AOR: 1.411, 95% CI: 1.083-1.839) were associated with increased hyperlipidemia risk. Additionally, a linear relationship (P for nonlinearity = 0.088) existed between the percentage of energy from carbohydrate and the risk of hyperlipidemia, with an inflection point identified at 49.64.

CONCLUSIONS

This study found that elevated dietary carbohydrate intake was associated with an increased the risk of hyperlipidemia in reproductive-aged women. These findings implied that reproductive-aged women should pay closer attention to reducing their carbohydrate intake.

Nutritional load in post-prandial oxidative stress and the pathogeneses of diabetes mellitus

Diabetes mellitus affected more than 500 million of people globally, with an annual mortality of 1.5 million directly attributable to diabetic complications. Oxidative stress, in particularly in post-prandial state, plays a vital role in the pathogenesis of the diabetic complications. However, oxidative status marker is generally poorly characterized and their mechanisms of action are not well understood. In this work, we proposed a new framework for deep characterization of oxidative stress in erythrocytes (and in urine) using home-built micro-scale NMR system. The dynamic of post-prandial oxidative status (against a wide variety of nutritional load) in individual was assessed based on the proposed oxidative status of the red blood cells, with respect to the traditional risk-factors such as urinary isoprostane, reveals new insights into our understanding of diabetes. This new method can be potentially important in drafting guidelines for sub-stratification of diabetes mellitus for clinical care and management.

Exploring the relationship between dietary patterns and obesity among Nigerian adults: a cross-sectional study

BACKGROUND/OBJECTIVE

No previous study has investigated the association between dietary pattern and both general and abdominal obesity risk among adults in Nigeria. This study aimed to evaluate the associations between dietary patterns and the risk of obesity among adult age 18 and above in Ekiti State, Southwestern Nigeria.

METHODS AND STUDY DESIGNS

A total of 1003 adults were included in this cross-sectional study (males = 558; females = 445). Body mass index (BMI) and waist-to-hip (WHR) were used to assess general and abdominal obesity respectively and they were categorized using WHO recommendation. Partial correlation analyses were performed to assess the associations of dietary patterns with BMI and WHR. Prevalence ratio between dietary pattern and both general and abdominal obesity were calculated using Robust Poisson Regression.

RESULTS

The prevalence of general obesity among adults was 15.9%, (11.6% among men and 20.2% among women); abdominal obesity was 32.3% (28.9% among males and 44.5% among females). Four dietary patterns were identified; diversified traditional pattern; typical traditional pattern; milk and bread pattern and egg and fish pattern. Diversified traditional pattern was negatively associated with BMI (PR = 0.571, 95%CI: 0.360 ~ 0.905, p = 0.017), and typical traditional pattern was positively associated with BMI (PR = 1.561, 95% CI: 1.043 ~ 2.339, p = 0.031) and WHR in females (PR = 1.849, 95% CI: 1.256 ~ 2.721, p = 0.005). In comparison to those in the lowest quartile, adults with the highest quartile of the typical traditional pattern had a higher risk for abdominal obesity (PR = 1.849, 95%CI = 1.256 ~ 2.721, p = 0.020).

CONCLUSION

This study reports an alarming increase in Obesity prevalence among Nigeria adults which is greatly influence by their lifestyle and eating pattern. We found out that a typical traditional food pattern was associated with a higher risk of both general and abdominal obesity, but a diverse traditional food pattern was associated to a reduced risk of general obesity.

Low-carbohydrate dietary score and the incidence of metabolically unhealthy phenotype based on BMI status: a cohort study

There is scarce research focusing on the relationship between the low-carbohydrate dietary score and the development of a metabolically unhealthy phenotype. Therefore, this cohort study was designed to assess the association between the low-carbohydrate dietary score and the risk of metabolically unhealthy phenotypes (MUP). This study included 1299 adults with healthy metabolic profiles who were followed for 5.9 years. Results indicated an inverse association between the second tertile of the low-carbohydrate dietary score and the risk of developing metabolically unhealthy obesity (MUO) (HR: 0.76, 95% CI: 0.59-0.98). In addition, we found an inverse association between the healthy low-carbohydrate dietary score and the risk of MUO (HR: 0.77, 95% CI: 0.60-0.99). Our results revealed a nonlinear inverse association between the low-carbohydrate dietary score and the risk of MUP only in subjects with overweight or obesity. This relationship was independent of animal protein and fat intake. Also, we found that a lower intake of unhealthy carbohydrates was associated with a lower risk of MUP only in subjects with overweight or obesity.

Secular trends in dietary energy, carbohydrate, fat, and protein intake among Korean adults, 2010-2020 KHANES

OBJECTIVES

The composition and balance of macronutrient intake play key roles in promoting a longer lifespan. In this study, we aimed to investigate the secular trends in carbohydrate, fat, and protein intakes in South Koreans from 2010 to 2020.

METHODS

We examined the dietary nutritional intake of South Koreans using data from the Korean National Health and Nutrition Examination Survey. A total of 60,190 adults aged ≥19 y who completed the 24-h dietary recall interviews in a single day on all survey periods were included in this study. The outcomes included changes in macronutrient intake according to subgroups, such as age; sex; and the presence of diabetes, dyslipidemia, stroke, or heart disease, as well as energy intake from macronutrients.

RESULTS

The study population showed a significant decrease in total energy intake from 2010 to 2020, with a corresponding decrease in the percentage of energy intake from carbohydrates (p-values for trend < 0.001). Conversely, the proportions of energy intake from proteins and fats increased during the same period (p < 0.001). Subgroup analyses revealed variations in macronutrient intake trends according to age, sex, obesity status, and underlying diseases. The analysis of trends in energy intake from various fat subtypes, total sugar, and fiber revealed a decrease in the energy intake percentage of total sugar from 2016 to 2020 and an increase in the energy intake percentage of all fat subtypes and fiber from 2013 to 2020.

CONCLUSIONS

In the past 10 y, the dietary patterns in Korea have shifted toward the consumption of high-fat and high-protein diets with reduced carbohydrate intake.

Trends in Prevalence of Hypertriglyceridemia and Related Factors in Korean Adults: A Serial Cross-Sectional Study

Objective

We aimed to investigate the longitudinal trends in prevalence of hypertriglyceridemia in Korean adults and hypertriglyceridemia-associated lifestyle habits, socioeconomic factors and comorbidities.

Methods

Data from the 2007-2020 Korea National Health and Nutrition Examination Survey (KNHANES) were used in this study. Two cutoff values (≥150 mg/dL and ≥200 mg/dL) for fasting serum triglyceride levels were used to estimate the age- and sex-specific prevalence of hypertriglyceridemia. Use of lipid-lowering medications, lifestyle factors such as smoking, alcohol consumption, and regular exercise, socioeconomic variables such as educational attainment and household income, and comorbidities such as obesity, abdominal obesity, hypertension, and diabetes mellitus were also investigated.

Results

The prevalence of hypertriglyceridemia among Koreans based on KNHANES 2007-2020 was 29.6% at ≥150 mg/dL and 16.1% at ≥200 mg/dL. While the rate of using lipid-lowering medications increased steadily from 2007 to 2020, changes in annual prevalence of hypertriglyceridemia were subtle. The prevalence of hypertriglyceridemia in men peaked in middle age (47.7% and 30.0% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 40s), but its prevalence in women increased throughout their lifetime (32.6% and 14.7% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 70s). Smoking and high-risk drinking exacerbated peak prevalence in both sexes. Young adults with any comorbidities had prominently increased prevalence of hypertriglyceridemia. The lowest levels of education and income were both associated with the higher prevalence of hypertriglyceridemia in both sexes.

Conclusion

It is important to understand the age- and sex-specific epidemiology of hypertriglyceridemia to establish its appropriate management plans.

The effect of combining nutrient intake and physical activity levels on central obesity, sarcopenia, and sarcopenic obesity: a population-based cross-sectional study in South Korea

BACKGROUND

This study was conducted to investigate the effects of combining nutritional and physical activity (PA) factors on four different categories, according to the presence or absence of sarcopenia and central obesity.

METHODS

From the 2008-2011 Korea National Health and Nutrition Examination Survey, 2971 older adults aged ≥ 65 years were included and divided into four groups based on their sarcopenia and central obesity status: healthy control (39.3%), central obesity (28.9%), sarcopenia (27.4%), and sarcopenic obesity (4.4%). Central obesity was defined as a waist circumference of ≥ 90 cm in men and ≥ 85 cm in women. Sarcopenia was defined as an appendicular skeletal mass index of < 7.0 kg/m2 in men and < 5.4 kg/m2 in women, and sarcopenic obesity was defined as the coexistence of sarcopenia and central obesity.

RESULTS

Participants who consumed more energy and protein than the average requirement had a lower likelihood of having sarcopenia (odds ratio (OR): 0.601, 95% confidence interval (CI): 0.444-0.814) than those who did not consume enough nutrients. The likelihood of central obesity and sarcopenic obesity decreased in groups with recommended PA levels, regardless of whether energy intake met or did not meet the average requirement. Whether PA met or did not meet the recommended level, the likelihood of sarcopenia decreased in groups with energy intake that met the average requirement. However, when PA and energy requirements were met, there was a greater reduction in the likelihood of sarcopenia (OR: 0.436, 95% CI: 0.290-0.655).

CONCLUSION

These findings suggest that adequate energy intake that meets requirements is more likely to be effective as a major prevention and treatment goal for sarcopenia, whereas PA guidelines should be prioritized in the case of sarcopenic obesity.

Snacking behaviour and nutrients intake among 11-16 years-old students from two different boarding system schools

This study's main objective was to investigate the difference between snacking behaviors and dietary nutrient intake in boarding system students. A cross-sectional study was conducted at Beijing's closed and semi closed boarding management school. The snack consumption questionnaire collected snack consumption behaviors; three-day recall periods for food consumption data were collected through the canteen weighing method and 24-h dietary recall of students' intakes. For closed and semi closed boarding management schools, the percentage of never having snacking behaviors was 12.95% and 2.69% on weekdays and 2.16% and 4.19% on weekends. A higher proportion of respondents chose unhealthy snacks in closed boarding management schools. The main problems in closed boarding management schools were the excessively low percentage of energy from carbohydrates and the excessively high percentage of energy from fat. Both deficiency and excess energy supply ratios of protein, carbohydrate, and fat were present in semi-closed boarding management schools. There was a high risk of calcium, iron, zinc, magnesium, and selenium deficiency for most students in both management schools. The closed-school girls had the highest risk of suffering from iron deficiency. Vitamin A, vitamin B1, vitamin B2, vitamin C, and vitamin E deficiencies were severe in both schools, especially vitamin C, vitamin A, and vitamin B2 deficiencies in semi-closed boarding management schoolboys. Effective nutritional interventions should be taken to improve the nutritional status of both boarding management and school students.

Effects of Interaction between SLC35F3 and Carbohydrate Intake on the Incidence of Metabolic Syndrome in Korean Middle-Aged Adults

Solute carrier family 35 member F3 (SLC35F3) mediates intracellular thiamine transport, which is crucial for carbohydrate metabolism as thiamine is required for key pathways such as glycolysis and the tricarboxylic acid cycle. This study aimed to investigate the impact of the interaction between SLC35F3 and dietary carbohydrate intake on the incidence of metabolic syndrome (MetS). The study included 3923 Korean adults over 40 years of age from the Korean Genome and Epidemiology Study. The association between dietary carbohydrate intake, SLC35F3 rs10910387 genotypes, and MetS incidence was studied using multivariable Cox proportional hazard models. Over an average of 8.5 years of follow-ups, we documented 1471 MetS cases. MetS incidence was 1.88 times greater in men with the TT genotype and the highest carbohydrate intake than in those with the CC genotype and lowest carbohydrate intake (Hazard Ratio (HR) 1.88, 95% confidence interval (CI) 1.03-3.41). MetS incidence were 2.22 and 2.53 times higher in women with the TT genotype and carbohydrate intake tertile 2 and 3, respectively, than those with the CC genotype and carbohydrate intake tertile 1 (HR 2.22, 95% CI 1.12-4.42; HR 2.53, 95% CI 1.38-4.61). In summary, we report a novel interaction between SLC35F3 rs10910387 genotypes and dietary carbohydrate intake on MetS in Koreans.

Association between dietary inflammatory index and cognitive impairment: A meta-analysis

Aims

Cognitive impairment is an increasingly urgent global public health challenge. Dietary Inflammatory Index (DII) is a literature-derived score that links diet to inflammation. The relationship between DII and cognitive impairment remains controversial. Therefore, our study aimed to analysis the role of DII on the risk of cognitive impairment by meta-analysis.

Methods

PubMed, Cochrane Library, MEDLINE, Web of Science and EMBASE databases were searched up to July 2022. Newcastle-Ottawa scale (NOS) and Joanna Briggs Institute (JBI) Checklist were performed to estimate the quality of studies.

Results

Nine observational studies with 19,379 subjects were included. Our study found that higher DII could elevate the risk of cognitive impairment (OR = 1.46, 95%CI = 1.26, 1.69). Meanwhile, the OR of cognitive impairment was 1.49 (95%CI = 1.21, 1.83) for cross-sectional studies and 1.42 (95%CI = 1.12, 1.79) for cohort studies, respectively.

Conclusion

Our meta-analysis indicated that higher DII (indicating a more pro-inflammatory diet) is related to increased risk of cognitive impairment.

Interactive effects of the low-carbohydrate diet score and genetic risk score on Hypo-HDL-cholesterolemia among Korean adults: A cross-sectional analysis from the Ansan and Ansung Study of the Korean Genome and Epidemiology Study

This cross-sectional study investigated the interaction between the genetic risk score (GRS) and abnormal high-density lipoprotein (HDL) cholesterol lipid levels, which are modified by low-carbohydrate diets (LCDs) and their effects on the prevalence of hypo-HDL-cholesterolemia (hypo-HDL-C) in Korean adults. Baseline data were obtained from the Ansan and Ansung study of the Korean Genome and Epidemiology Study (KoGES), conducted from 2001 to 2002, that targeted 8,314 Korean adults aged 40-69 years, including old men (47.6%) and women (52.4%), and whole genomic single nucleotide polymorphism (SNP) genotyping was performed. We identified 18 SNPs significantly associated with hypo-HDL-C in the proximity of several genes, including LPL, APOA5, LIPC, and CETP, and calculated the GRS. The low-carbohydrate diet score (LCDS) was calculated on the basis of energy intake information from food frequency questionnaires. Furthermore, we performed multivariable-adjusted logistic modeling to examine the odds ratio (OR) for hypo-HDL-C across tertiles of LCDS and GRS, adjusted for several covariates. Among participants in the highest GRS tertile, those in the highest tertile of the LCDS had a significantly lower risk of hypo-HDL-C (OR: 0.759, 95% CI (confidence interval): 0.625-0.923) than those in the lowest tertile of the LCDS. In the joint effect model, the group with the lowest GRS and highest LCDS was found to have the lowest risk of hypo-HDL-C prevalence. This study suggests that individuals with a high genetic risk for low HDL concentrations may have a beneficial effect on a lower intake of carbohydrates.

Association of temporomandibular disorders and tinnitus with health-related quality of life: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND

Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health-related quality of life on a national level.

OBJECTIVE

We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older.

METHODS

Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health-related quality of life were assessed using self-report data from EuroQol-5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present.

RESULTS

Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014-2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570-2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034-2.767), EQ-5D score (OR = 1.651, 95% CI: 1.121-2.431) and EQ-VAS (OR = 1.682, 95% CI: 1.246-2.269).

CONCLUSION

The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions.

The association between low-carbohydrate diet score and metabolic syndrome among Iranian adults

OBJECTIVE

Assessing the relationship between low-carbohydrate diet (LCD) score and metabolic syndrome (Mets) in Iranian adults.

DESIGN

Cross-sectional study.

SETTING

Yazd Health Study and Taghzieh Mardom-e-Yazd study.

PARTICIPANTS

Data of 2074 participants were used. Dietary intakes were assessed by a validated semi-quantitative FFQ. LCD score was calculated for each person by summing up the assigned scores to deciles of energy percentages from macronutrients. Mets was evaluated using National Cholesterol Education Program Adult Treatment Panel III. Eventually, association between LCD score and Mets was examined using logistic regression.

RESULTS

Total Mets prevalence was approximately 40·5 %. After adjustment for confounders, subjects in the higher quartile of LCD score had a significant lower chance of Mets than lower quartile among all participants (Q4 v. Q1: OR: 0·68, 95 % CI (0·50, 0·92)) and separately in men (Q4 v. Q1: OR: 0·54, 95 % CI (0·34, 0·86)) and women (Q2 v. Q1: OR: 0·53, 95 % CI (0·34, 0·82)). Furthermore, more LCD adherence in men reduced abdominal obesity by 47 % (Q3 v. Q1: OR: 0·53, 95 % CI (0·28, 0·99)). A significant inverse relation was also observed between low HDL cholesterol and LCD score in all participants (Q4 versus Q1 OR: 0·74, 95% CI: 0·56-0·99) and separately in men (Q4 versus Q1 OR: 0·63, 95% CI: 0·40-0·98).

CONCLUSIONS

More adherence to LCD might be related to lower chance of Mets and some of its components such as low HDL-cholesterol and abdominal obesity specially in men. Further studies are required to confirm the findings.

Low-Carbohydrate Diets in Korea: Why Does It Matter, and What Is Next?

In recent years, low-carbohydrate diets have become highly popular in Korea as a means to lose weight. People following this regime believe that fat and protein can be consumed in unlimited quantities, as long as carbohydrate intake is strictly restricted. However, low-carbohydrate diets are more complex than simply reducing carbohydrate intake. Meta-analyses of randomized controlled trials revealed that low-carbohydrate diets are at least as effective as low-fat diets in terms of weight loss, but their cardiovascular effects vary. Low-carbohydrate diets confer more beneficial effects on weight loss and lipid profiles such as triglycerides and high-density lipoprotein cholesterol but exhibited detrimental effects on lipid profiles such as total and low-density lipoprotein cholesterol. Korean diets are typically high in carbohydrates, where carbohydrate intake is in the range of 50%-80% of total energy. Within this range of carbohydrate intake, high carbohydrate intake was associated with an increased risk of elevated triglyceride and high-density lipoprotein cholesterol levels but with a reduced risk of elevated total and low-density lipoprotein-cholesterol levels. The optimal range of carbohydrate intake was depicted by a U-shaped relationship between carbohydrate intake and mortality, with 50%-60% of energy from carbohydrates having the lowest mortality risk. The distribution of macronutrients varied greatly according to age and sex groups in Korea. There is no single diet that can be recommended to all individuals, especially if focusing only on the quantity of macronutrients as opposed to their quality. The health benefits of low-carbohydrate or low-fat diets may depend on the source of protein and fat and the carbohydrate quality.

Association between Dietary Patterns and Low HDL-C among Community-Dwelling Elders in North China

We aimed to investigate the association between dietary patterns and low HDL-C among the elderly population living in North China. The data were from a national cross-sectional survey conducted in 2015. General information in terms of living habits, health status, and food intake using 24 h dietary recall for three consecutive days was procured, and the weight of edible oil and condiments recorded. Anthropometric index, blood pressure, and fasting serum lipids were measured using standard methods. Dietary patterns were derived from food categories by exploratory factor analysis, and multivariate logistic regression was used to estimate the odds ratios of low HDL-C across quartiles of dietary patterns. Among 3387 elderly participants, 21.9% had low HDL-C levels. After adjusting for potential confounding factors, participants with highest score versus lowest score in the balanced dietary pattern had a decreased risk of low HDL-C (OR = 0.38, 95% CI: 0.16-0.88, p for trend = 0.013) in the group with a BMI of 27.1 kg/m² and above. Compared to the lowest quartile, there was a statistically significant negative association between the highest scores of the Western dietary pattern and low HDL-C (OR = 0.37, 95% CI: 0.17-0.82, p for trend = 0.018) in the group with a BMI of 21.6-24.8 kg/m². However, greater adherence to a thrifty dietary pattern (highest quartiles vs. lowest quartiles) was associated with increased risk of low HDL-C (OR = 3.31, 95% CI: 1.05-10.40, p for trend = 0.044), especially in the subgroup with a BMI of 21.6 kg/m² and below. The study revealed that it is urgent to develop district-specific dietary improvement plans for dyslipidemia based on the nutritional status of the elderly population in North China.

Association between Carbohydrate Intake and the Prevalence of Metabolic Syndrome in Korean Women

Carbohydrates consist of a large proportion of calories in the Asian diet. Therefore, we aimed to investigate the association between carbohydrate intake and metabolic syndrome in Korean women. A cross-sectional analysis was conducted with a total of 4294 Korean women aged 40–69 years from the Korean Genomic and Epidemiology Study (KoGES). Carbohydrate intake was calculated based on a validated food frequency questionnaire. Metabolic syndrome was defined by using the National Cholesterol Education Program, Adult Treatment Panel III (NCEPIII). Logistic regression was used to estimate the association of carbohydrate intake with metabolic syndrome and its components. In this study, high carbohydrate intake seemed to be associated with low socioeconomic status and an imbalanced diet. After adjusting for confounding factors, subjects with higher carbohydrate intake showed an increased risk of metabolic syndrome (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.08–1.66, p-trend = 0.004, highest vs. lowest quartile [≥75.2 vs. <67.0% of energy]), particularly elevated waist circumference. This association was stronger among those with low levels of C-reactive protein (CRP) and those with low dairy intake. In conclusion, higher carbohydrate intake is associated with a higher risk of metabolic syndrome, particularly abdominal obesity, in Korean women. This association may differ according to individuals’ CRP level and dairy intake.

Dairy Consumption and Risk of Metabolic Syndrome: Results from Korean Population and Meta-Analysis

Dairy consumption has been associated with decreased risk of metabolic syndrome (MetS) in previous studies, but the association may be different according to each type of dairy products and its subgroups. Thus, we conducted an updated meta-analysis of observational studies to examine the association between various dairy products and risk of MetS. The PubMed and Web of Science databases were searched for eligible studies published up to February 2021. In addition, we included unpublished results from Korea National Health and Nutrition Examination Survey, 2013-2018, including 23,319 Korean adults and the elderly. A total of 35 studies (12 cohort studies and 25 cross-sectional studies) with 398,877 subjects were included in the meta-analysis. The pooled relative risks (RR) of MetS for the highest versus lowest categories of dairy consumption was 0.80 [95% confidence interval (CI): 0.72-0.88]. For the type of dairy products, there were also significant inverse associations with milk (RR: 0.83; 95% CI: 0.78-0.89) and yogurt consumption (RR: 0.89; 95% CI: 0.83-0.95). For cheese consumption, however, no significant association was found (RR: 0.98; 95% CI: 0.86-1.11). Our findings suggest that milk and yogurt consumption is inversely associated with the risk of MetS, but not cheese consumption.

TAS1R2 sweet taste receptor genetic variation and dietary intake in Korean females

Taste receptor type 1, member 2 (TAS1R2) controls the oral sensing of sweetness. Genetic variations in TAS1R2 have been shown to be associated with differential sweetness intensity and varying carbohydrate intake levels among individuals. This study examined whether rs7534618 A > C in TAS1R2 is associated with dietary behavior and energy nutrient intake in Korean females. A cross-sectional design utilizing data from the Multi-Rural Communities Cohort Study, which was a nationwide epidemiological research project in Korea, was applied in this study. In total, 2198 females were analyzed to evaluate the differences in macronutrient intake levels and intake of carbohydrate-rich and sweet-tasting foods between the rs7534618 genotypes. The findings suggest that individuals with the CC minor genotype tended to have lower carbohydrate but higher fat intake than subjects with the A* genotype (p = 0.035 and p = 0.042, respectively). Subjects with the CC genotype also exhibited less intake of total grains but greater intake of bread than those with the A* genotype (p = 0.017 and p = 0.006, respectively). However, these observed associations were statistically modest (false discovery rate adjusted p > 0.05). In conclusion, TAS1R2 rs7534618 is not a decisive genetic modifier of nutrition and dietary intake in Korean females. However, given the paucity of studies, these putative associations between the TAS1R variation and dietary intake may be referred for further sensory genetic studies in Koreans.

The relation between low carbohydrate diet score and psychological disorders among Iranian adults

BACKGROUND

Since evidence regarding to low carbohydrate diet (LCD) and psychiatric disorders is little and controversial, this study aimed to assess relation between LCD score and psychological disorders including depression, anxiety, and stress among a large representative sample of Iranian adult population in Yazd city, Iran.

METHODS

This cross-sectional analysis was conducted on data of 7165 persons who participated in the recruitment phase of Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd (TAMIZ) study. Dietary intakes were evaluated by a validated semi-quantitative food frequency questionnaire. LCD score was calculated for each person according to summing up assigned scores to deciles of percentages of energy from macronutrients. Assessment of psychological disorders was also conducted by the validated Iranian version of depression, anxiety and stress scale questionnaire (DASS 21). Eventually, association between adherence to LCD and psychological disorders was evaluated via logistic regression.

RESULTS

After adjusting the confounders, women in the third quartile of LCD score might had 38% lower chance of depression versus those in the first quartile (odds ratio (OR) = 0.62, confidence interval (CI) = 0.42-0.93). However, no significant relationship was observed for other psychological disorders.

CONCLUSIONS

More adherences to LCD might be associated with lower chance of depression only among women. Further studies special prospective studies are required to validate these results.

Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status

BACKGROUND

This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated.

RESULTS

In 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes.

CONCLUSION

The high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.

Dairy Consumption and Risk of Metabolic Syndrome in Korean Adults and Elderly People

Background: To investigate the association of dairy consumption with metabolic syndrome (MetS) in a representative sample of Korean adult and elderly population. Methods: We used data from the Korea National Health and Nutrition Examination Survey, 2013-2018. A total of 18,206 adults (19-64 years) and 5113 elderly people (≥65 years) were included in the analysis. Dairy product consumption was assessed with a 24-hr dietary recall, and the subjects were divided into three groups based on their total dairy consumption (0, <1, ≥1 serving/day). The primary outcome, MetS, was defined according to the National Cholesterol Education Program Adult Treatment Panel III and the Korean Society for the Study of Obesity. Results: After adjusting for covariates, high dairy consumption was associated with 12% lower odds of MetS in adults compared with no dairy consumption [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.998, P for trend = 0.048]. A similar inverse association was found in adult men (OR 0.84, 95% CI 0.71-0.99), but no significant association was found in adult women (OR 0.93, 95% CI 0.78-1.11). For the elderly, high dairy consumption was associated with 20% lower odds of MetS (OR 0.80, 95% CI 0.65-0.98, P for trend = 0.020); a significant inverse association was shown in elderly women (OR 0.72, 95% CI 0.56-0.94) but not in elderly men (OR 0.93, 95% CI 0.68-1.28). Conclusion: Our findings suggest that one or more servings/day of dairy products were associated with lower prevalence of MetS in Korean adult men and elderly women.

Association of Nutrient Patterns with Metabolic Syndrome and Its Components in Iranian Adults

We aimed to examine the association between nutrient patterns and metabolic syndrome (MetS) in Iranian adults. In a cross-sectional study of 850 self-certified healthy women and men aged 20-59 years old, dietary data were assessed using three 24-hour recall. Anthropometric measures were done and blood samples were collected to measure serum fasting serum glucose and lipid profile. The MetS was defined using the International Diabetes Federation. Major nutrient patterns were identified using principle competent analysis. In the first nutrient pattern, the individuals in the fifth quintile had a higher intake of vitamins B₁, B₂, B₃, B₅, B₆, B₁₂, zinc, iron, saturated fatty acids (SFAs), and protein. In the second nutrient pattern, individuals in the first quintile had lower consumption of zinc, SFAs, vitamin E, α-tocopherol, oleic acid, polyunsaturated fatty acids, β-carotene, linolenic acid, and monounsaturated fatty acids, compared to the fifth quintile. Furthermore, in the third nutrient pattern, the individuals in the fifth quintile had a higher intake of potassium, magnesium, phosphorous, calcium, protein, carbohydrate, vitamin C, and folate compared to other quintiles. We identified the second pattern had an indirect association with systolic and diastolic blood pressure, triglycerides, fasting blood sugar (p < 0.001 for all), and total cholesterol (p = 0.04) when it was controlled for body weight. Our findings showed that nutrient patterns may have an association with MetS components with mediating body weight.

Pubertal maturation and weight status are associated with dyslipidemia among children and adolescents in Northwest China

Dyslipidemia is one of major risk factors for cardiovascular disease. The early detection and treatment of dyslipidemia can reduce cardiovascular disease risk. A cross-sectional study was carried out in Ningxia, China to determine the prevalence of dyslipidemia and its association with body mass index (BMI) and pubertal stage. A total of 1783 students were selected from middle schools and high schools in September 2014 using stratified random cluster sampling. Serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured by using MOL-300 automatic biochemical analyzer with associated kits. The prevalence of adolescents with one abnormal serum lipid component was 43.2% and was significantly different across three pubertal stages (p < 0.0001). The abnormal rates of HDL-C and TG increased as the students maturated through the early, middle, and late stages of puberty (all p < 0.0001). Similar results were obtained when separate analyses were performed for boys and girls. In linear regression analysis, BMI was positively associated with serum levels of TC, LDL-C, and TG, but inversely associated with serum levels of HDL-C after the adjustment for age, sex, and race. In multivariable logistic regression analysis, obesity was associated with an increased risk of developing high TC, while pubertal maturation was associated with an elevated risk of experiencing low HDL-C and high TG (all p < 0.05). In conclusions, dyslipidemia is common in an adolescent population of Northwest China and its prevalence rates substantially vary with weight status and pubertal stage.

Psychological Stress Accompanied by a Low-Variety Diet Is Positively Associated with Type 2 Diabetes in Middle-Aged Adults

Psychological stress is generally known to affect dietary intakes and cause chronic diseases. This study aims to investigate the association between psychological stress and the risk of type 2 diabetes in relation to dietary variety. A total of 126,405 middle-aged adults were enrolled in the Korean Genome and Epidemiology Study. Stress levels were measured using the psychosocial well-being index. Dietary variety score (DVS) was defined as the number of different foods consumed over a day. Stress levels were positively associated with the risks of diabetes (odds ratio (OR) for tertile 3 compared with tertile 1, men: OR = 1.34 (95% CI: 1.24-1.45); women: OR = 1.29 (1.19-1.4)). As the stress levels rose, the intake of grains increased, and the intake of fruits and vegetables decreased. Participants with higher stress levels showed lower DVS than those with lower stress levels. Furthermore, participants with higher stress levels and lower DVS had a significantly higher OR for diabetes than those with lower stress levels and higher DVS (men: OR = 1.83 (1.58-2.12); women: OR = 1.85 (1.59-2.51)). These results suggest that the high risk of type 2 diabetes for people with high stress levels may be associated with low dietary variety.

Sex-Specific Energy Intakes and Physical Activity Levels According to the Presence of Metabolic Syndrome in Korean Elderly People: Korean National Health and Nutrition Examination Survey 2016-2018

This study aimed to analyze the differences in energy intake and physical activity (PA) levels according to sex and the presence of metabolic syndrome (MetS) among elderly people in Korea. Data of 3720 elderly people (aged >65 years) were obtained from the Korean National Health and Nutrition Examination Survey (2016–2018). We analyzed PA levels (occupational and recreational PA) and energy intakes (carbohydrate, protein, and fat). The MetS group showed lower levels of moderate intensity recreational PA and place movement than the non-MetS group (p < 0.05); in the MetS group, PA levels were significantly lower in women than in men (p < 0.05). The intakes of total energy, carbohydrate, fat, and protein were lower in the MetS group than in the non-MetS group (p < 0.001). Both the non-MetS and MetS groups showed lower energy intakes in women than men (p < 0.001). Our study shows that elderly people, especially women, with MetS have significantly lower total PA levels and total energy intakes. We confirmed the importance of increased PA and proper nutritional intake in elderly people. Therefore, it is believed that practical measures such as nutrition education and nutrition guidance and PA education are urgently needed to reduce the incidence of MetS among the elderly.

Gender and age group differences in nutrition intake and dietary quality of Korean adults eating alone: based on Korean National Health and Nutrition Examination Survey Data, 2013-2016

BACKGROUND/OBJECTIVES

This study investigated gender and age differences in nutrient intake and dietary quality of people eating alone.

SUBJECTS/METHODS

From Korean National Health and Nutrition Examination Survey 2013–2016 data, 2,305 adults aged 20 years and older that ate meals alone were included in this study. Their energy and nutrients intakes, as well as their nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ) were analyzed. Food group consumption pattern, dietary variety score (DVS), dietary diversity score (DDS) were also analyzed. All data were compared among gender and age groups.

RESULTS

Men consumed more energy and nutrients than women, except for vitamin C, and the NARs showed similar gender differences. The INQs of 4 nutrients (calcium, vitamin A, vitamin C, and riboflavin) were lower than 1.0 in men, whereas only the calcium INQ was lower than 1.0 in women. Men had a lower DDS (3.6) than women (3.9) (P < 0.001) and had more ‘undesirable’ food group consumption patterns than women (P < 0.001). The intakes of calcium, vitamin A, and vitamin C were relatively low in the young-aged group (INQs less than 1.0). In the old-aged group, the MAR level was relatively low, and the INQs of calcium, riboflavin, and niacin were below 1.0. The old-aged group consumed more menu items, but their DVS was the lowest.

CONCLUSIONS

Compared to women, the dietary quality and food diversity among men were poorer. There were poorer quality and diversity patterns in the young-aged group compared to those of the older groups. An overall low intake of nutrients and the low nutrient density of meals were the main dietary problems among the old-aged group who eat alone. Therefore, men, particularly young- and old-aged, need to be prioritized in nutritional policies directed toward those who eat alone.

Development and Validation of a Questionnaire to Measure Adherence to the Mediterranean Diet in Korean Adults

The Mediterranean diet (MD) has beneficial effects on cardiovascular diseases, cancer, and mortality. Although various attempts have been made for estimating adherence to the MD using diet quality indices, few studies involving validated questionnaires for estimating adherence have been performed in Asian populations. We aimed to develop and validate the Korean version of the Mediterranean Diet Adherence Screener (K-MEDAS) by including 211 participants that visited health check-up centers and 116 participants with overweight or hypercholesterolemia that visited obesity clinic. The participants completed both the K-MEDAS and a 106-item food frequency questionnaire (FFQ). We translated 13 questions and developed 1 question. Considering the agreement between the K-MEDAS and FFQ, nine of the 14 questions showed moderate or high kappa values (≥0.4). The total MD scores measured by the K-MEDAS and FFQ showed substantial concordance (intraclass correlation coefficient = 0.678, 95% confidence interval: 0.520, 0.785). Multiple linear regression analyses revealed significant inverse associations between MD score and the levels of serum total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol, after adjusting for confounding variables. We found that K-MEDAS is valid tool for assessing adherence to the MD in the Korean population.

Association between dairy product intake and hypertriglyceridemia in Korean adults

BACKGROUND/OBJECTIVES

Hypertriglyceridemia may be a more important predictor of cardiovascular disease in Asian population consuming carbohydrate-rich foods than in Western populations. Dairy products are known to play a beneficial role in obesity, dyslipidemia, and metabolic syndrome, but the results vary depending on gender and obesity. In this study, we investigated the associations between dairy product intake and hypertriglyceridemia in Korean adults.

SUBJECTS/METHODS

The participants were selected from the Korea National Health and Nutrition Examination Survey 2007–2012 (KNHANES IV and V). A total of 22,836 participants aged 19–64 years were included in the analysis. A food frequency questionnaire used to determine the frequency of consumption of products (milk and yogurt). Multivariable logistic regression was used to assess the associations between dairy product intake and hypertriglyceridemia.

RESULTS

A significantly decreased risk of hypertriglyceridemia was detected in the highest dairy product intake frequency group (≥ 1 time/day) (odd ratio [OR] = 0.79; 95% confidence interval [CI] 0.64–0.97, P for trend = 0.022) compared to that for the lowest dairy product intake frequency group. Among obese participants, the group with the highest intakes of milk (in men, OR = 0.64; 95% CI: 0.46–0.91, P for trend = 0.036) and yogurt (in women; OR = 0.53; 95% CI: 0.29–0.94, P for trend = 0.019) showed inverse associations with hypertriglyceridemia. No associations were detected in normal weight participants.

CONCLUSION

The association between dairy product intake and hypertriglyceridemia differed by gender and obesity status. Further prospective studies are needed to confirm these associations.

Dietary and Health Characteristics of Korean Adults According to the Level of Energy Intake from Carbohydrate: Analysis of the 7th (2016-2017) Korea National Health and Nutrition Examination Survey Data

The purpose of this study was to examine the association between the level of energy intake from carbohydrate and the dietary and health characteristics among Korean adults. We examined the diet quality and health conditions of Korean adults by segmenting them into eight groups according to the level of energy intake from carbohydrate (<45%, 45–50%, 50–55%, 55–60%, 60–65%, 65–70%, 70–75%, and ≥75%). From the data of the 7th (2016–2017) Korea National Health and Nutrition Examination Survey (KNHANES), 7566 subjects aged 19 to 64 years were analyzed. Diet quality was much lower in the groups whose energy intake from carbohydrate was <50% or ≥65%, compared to the groups whose energy intake from carbohydrate was 50–65%. Hypertension or low HDL-cholesterolemia was associated with low (<45%) or high (≥70%) energy intake from carbohydrate. We found no considerable difference in the diet quality and health conditions between the groups whose energy intake from carbohydrate was 50–55% and 55–65%. In conclusion, it is suggested to expand the current acceptable macronutrient distribution range (AMDR) for carbohydrate for Korean adults (i.e., 55% to 65%) to include 50–55%.

The Effects of Tempeh Gembus, an Indonesian Fermented Food, on Lipid Profiles in Women with Hyperlipidemia

Background:

Hyperlipidemia is the major precursor of lipid-related diseases. Consumption of high fiber foods may decrease lipid profiles. The fiber content in tempeh gembus is three times higher than regular tempeh.

Objective:

This study was conducted to investigate the effect of tempeh gembus on lipid profiles in women with hyperlipidemia.

Methods:

This research used the quasi-experimental design with nonequivalent control group design. Subjects were 41 women with hyperlipidemia, classified into 3 groups: control group, treatment group 1 given 103 g/day tempeh gembus, and treatment group 2 given 206 g/day tempeh gembus for 14 days. All of the groups received nutrition education. Total cholesterol and HDL-C were determined by CHOD-PAP method, triglyceride determined by enzymatic GPO-PAP method after subjects had been fasting for approximately 10 hours. LDL-C was calculated by Friedewald equation.

Results:

These results showed that consumption of tempeh gembus 103 g/day and 206 g/day decreased LDL-C 27.9% and 30.9% as well as decreased total cholesterol 17.7% and 19.8% respectively. However, HDL-C increased 3.91% and 8.79% and triglyceride increased 2.3% and 3.1%. Tempeh gembus given 206 g/day was more effective to decrease total cholesterol and LDL-C than 103 g/day.

Conclusion:

Increasing tempeh gembus consumption in women with hyperlipidemia should be addressed to decrease LDL-C and total cholesterol.

Associations of Dietary Intake with Cardiovascular Disease, Blood Pressure, and Lipid Profile in the Korean Population: a Systematic Review and Meta-Analysis

OBJECTIVE

Previous studies have separately reported the contributions of dietary factors to the risk of cardiovascular disease (CVD) and its markers, including blood pressure (BP) and lipid profile. This study systematically reviewed the current evidence on this issue in the Korean population.

METHODS

Sixty-two studies from PubMed and Embase were included in this meta-analysis. We performed a random-effects model to analyze pooled odds ratios (ORs) and hazard ratios (HRs) and their 95% confidence intervals (CIs) for the consumption of 14 food items, three macro- and eight micro-nutrients, two dietary patterns, and three dietary indices.

RESULTS

An analysis of pooled effect sizes from at least four individual study populations showed significant associations between coffee consumption and CVD (OR/HR, 0.71; 95% CI, 0.52-0.97) and elevated/high triglycerides (TG) (OR, 0.84; 95% CI, 0.78-0.90), sugar-sweetened beverage intake and elevated BP (OR/HR, 1.20; 95% CI, 1.09-1.33), and milk and dairy intake and elevated/high TG and low high-density lipoprotein cholesterol (HDL-C) (OR/HR, 0.82; 95% CI, 0.76-0.89 for both). Carbohydrate consumption and the low-carbohydrate-diet score were consistently related to an approximately 25% risk reduction for elevated TG and low HDL-C. A lower risk of elevated total cholesterol, but not low-density lipoprotein, was additionally observed for those with a higher low-carbohydrate-diet score. A healthy dietary pattern was only associated with a reduced risk of elevated TG in the Korea National Cancer Screenee Cohort (OR, 0.81; 95% CI, 0.67-0.98).

CONCLUSION

This study showed that milk and dairy and coffee had protective effects for CVD and its risk factors, such as BP and lipid profile, while sugar-sweetened beverages exerted harmful effects.

Selection of Target Nutrients for the Nutritional Standards of School Lunches in Korea

The purpose of this study was to select target nutrients to be included in the nutritional standards of school lunches in Korea. The dietary intake data for children and adolescents aged 6–17 years old from the Korea National Health and Nutrition Examination Survey VI were analyzed for eight groups based on gender and age (6–8, 9–11, 12–14, and 15–17 years old). First, the usual intake of 3091 subjects was estimated and assessed to identify nutrients with insufficient or excessive intake prevalence. Along with the nutrients identified by the assessment, the energy and nutrients prioritized in the meal planning procedure of the 2015 Dietary Reference Intakes for Koreans were the initial candidates; these nutrients and energy include the percentages of energy from carbohydrates, protein, and fat; vitamin A; riboflavin; niacin; vitamin C; calcium; phosphorus; sodium; and iron. Phosphorus was excluded as a result of there being little evidence of clinical symptoms caused by its insufficient intake. Sodium was excluded because reliable data on added salt were not available among the school lunch recipes in Korea. Therefore, energy; the percentages of energy from carbohydrates, protein, and fat; vitamin A; riboflavin; niacin; vitamin C; calcium; and iron were selected to be included in the nutritional standards for school lunches in Korea.

Differential Effects of Typical Korean Versus American-Style Diets on Gut Microbial Composition and Metabolic Profile in Healthy Overweight Koreans: A Randomized Crossover Trial

The Westernized diet has been associated with the pathogenesis of metabolic diseases, whereas a Korean diet has been reported to exert beneficial effects on health in several studies. However, the effects of Western and Korean diets on the gut microbiome and host metabolome are unclear. To examine the diet-specific effects on microbiome and metabolome, we conducted a randomized crossover clinical trial of typical Korean diet (TKD), typical American diet (TAD), and recommended American diet (RAD). The trial involved a 4-week consumption of an experimental diet followed by a 2-week interval before diet crossover. 16S rRNA sequencing analysis identified 16, 10, and 14 differential bacteria genera specific to TKD, RAD, and TAD, respectively. The Firmucutes-Bacteroidetes ratio was increased by TKD. Nuclear magnetic resonance metabolome profiling revealed that TKD enriched branched chain amino acid metabolism, whereas ketone body metabolism was evident in RAD and TAD. Microbiome and metabolome responses to the experimental diets varied with individual enterotypes. These findings provide evidence that the gut microbiome and host metabolome rapidly respond to different cultural diets. The findings will inform clarification of the diet-related communication networks of the gut microbiome and host metabolome in humans.

The Association between Sleep Duration and Dizziness in Korean Women: The Korea National Health and Nutrition Examination Survey

BACKGROUND

The aim of this study was to investigate the association between sleep duration and dizziness in a representative Korean population.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Surveys (2010-2012). A total of 12,499 adults who completed otolaryngologic examinations were evaluated.

RESULTS

Both men and women with severely short sleep duration (≤ 5 hours) and severely long sleep duration (≥ 9 hours) tended to have higher dizziness prevalence. However, the adjusted odds ratio (OR) for sleep duration was only significant in women with dizziness after adjusting for confounders. Compared to that in an optimal sleep group (6-8 hr/day), the OR (95% confidence interval) for dizziness prevalence after adjusting for age and health behaviors (body mass index, smoking habit, alcohol consumption, level of exercise, metabolic syndrome, and tinnitus) was 1.473 (1.194-1.818) for the severely short sleep group (≤ 5 hr/day) and 1.472 (1.078-2.009) for the severely long sleep group (≥ 9 hr/day) only in women.

CONCLUSION

In the Korean population, dizziness was associated with shorter or longer sleep durations only among women. Further epidemiologic and experimental studies are necessary to clarify the impact of dizziness on sleep disorders.

The association between metabolic syndrome and peanuts, pine nuts, almonds consumption: The Ansan and Ansung Study

BACKGROUND

Previous studies reported an inverted relationship between nut consumption and the incidence of metabolic syndrome (MetS). The present study investigated the incidental risk for MetS according to peanut, almond, and fine nut consumption in the Korean population.

METHODS

In a community-based Korean cohort, 5306 Korean adults were divided into four groups according to their peanut, almond, and fine nut intake (<1/month, 1/month-0.5/week, 0.5-1/week, and ≥1/week, in which one serving = 15 g) and were followed-up for 10 years. A Cox proportional hazard model was used to evaluate the hazard ratios (HRs) with confidence intervals (CI) for MetS in each study group. Age subgroup (≥50 or <50 years) analysis was also conducted.

RESULTS

The age and multivariable-adjusted HRs with 95% CIs for MetS showed a significant inverse dose-response relationship between peanut, almond, and fine nut intake and the incidence of MetS in men and women (multivariable-adjusted HRs [95% CI] in men; 0.91 [0.76-1.09] in 1/month-0.5/week, 1.03 [0.80-1.31] in 0.5-1/week, 0.72 [0.56-0.93] in ≥1/week and in women; 0.81 [0.65-1.003] in 1/month-0.5/week, 0.76 [0.54-1.07] in 0.5-1/week, 0.57 [0.41-0.79] ≥1/week)). Subgroup analysis showed a significant difference in middle-aged men (≥1/week) and old-aged women (≥0.5/week).

CONCLUSION

The results of the present study suggested that peanut, almond, and fine nut intake (≥15 g/week) may be inversely related to incidence risk of MetS in the Korean general population. Additionally, the association between nut consumption and MetS incidence risk may differ in sex and age subgroups.

Effect of 'rice' pattern on high blood pressure by gender and obesity: using the community-based KoGES cohort

OBJECTIVE

The present study aimed to examine the association between dietary pattern and the risk of high blood pressure (BP) and to estimate the attenuated effect by gender and obesity on the association using data from a prospective cohort study in Korea.

DESIGN

Prospective study. Diet was assessed using a validated 103-item FFQ and was input into factor analysis after adjustment for total energy intake.

SETTING

Community-based Korean Genome Epidemiology Study (KoGES) cohort.

PARTICIPANTS

Healthy individuals (n 5151) without high BP at recruitment from the community-based cohort study.

RESULTS

Dietary pattern was not associated with the risk of high BP regardless of the type of covariates, with the exception of the 'rice' pattern. The effect of the 'rice' pattern was observed in both men (Ptrend = 0·013) and women (Ptrend < 0·001), but the statistical significance remained only in women after adjustment for confounders (Ptrend = 0·004). The positive association of the 'rice' pattern with high BP risk was attenuated by obesity. After stratification by gender and obese status, in particular, the harmful effect of the 'rice' pattern was predominantly observed in obese women (Ptrend < 0·001) only.

CONCLUSIONS

This longitudinal study in Korean adults found a positive association of the 'rice' pattern with long-term development of incident high BP, predominantly in women. The association is likely to be attenuated by gender and obese status.

The Quality of a Traditional Dietary Pattern in Relation to Metabolic Syndrome in Elderly South Koreans

Background

The most beneficial dietary pattern in managing metabolic syndrome (MetS) in the elderly has not been ascertained. The aim of this study is to classify dietary patterns and to examine associations between dietary pattern, MetS and body composition in elderly Koreans.

Methods

This study was conducted among Koreans 65 years or older using data from the Korea National Health and Nutrition Examination Survey in 2009. A total of 1,567 study subjects were included. All statistical analyses were conducted using SPSS version 20.0 and dietary patterns were classified by cluster analysis.

Results

There were three dietary patterns derived by cluster analysis in this study. We observed that most South Korean elderly still maintain a traditional dietary pattern. Dietary patterns were classified as balanced (31%), imbalanced (40%), or very imbalanced (30%), with the majority of subjects having an unbalanced diet pattern in which their total energy and nutrient intake was insufficient compared with the Dietary Reference Intake for Koreans. Those in the very imbalanced group had a ratio of macronutrients (carbohydrates:fats:protein) of 81.15:7.18:11.50 and a 54% higher likelihood of having hypertriglyceridemia (P=0.025) compared with those in the balanced group.

Conclusion

The current findings indicate that the diets of South Korean elderly are nutritionally imbalanced, including high carbohydrate consumption, which confers a high risk hypertriglyceridemia. These findings highlight the effect of nutritional imbalance in elderly with MetS.

The Nutritional Characteristics of the Hypotensive WASHOKU-modified DASH Diet: A Sub-analysis of the DASH-JUMP Study

Background

We developed a WASHOKU-modified DASH diet named DASH-JUMP. We previously reported the hypotensive effect of the DASH-JUMP diet in Japanese participants with untreated high-normal Blood Pressure (BP) or stage 1 hypertension.

Objective

We aim to introduce the DASH-JUMP diet worldwide as a new lifestyle medicine. Accordingly, we prospectively assessed the nutritional characteristics of the DASH-JUMP diet.

Methods

Participants were treated with the DASH-JUMP diet for 2 months. Then, for 4 months after the intervention, they consumed their usual diets. We conducted a nutritional survey using the FFQg nutrient questionnaire at baseline and after 1, 2, 3, and 6 months. We received completed questionnaires from 55 participants (28 men and 27 women; mean age 54.2 ± 8.0 years) and analyzed them.

Results

The DASH-JUMP diet is rich in green-yellow vegetables, seaweed, milk, and mushrooms, while it has low contents of meat, eggs, confectionery, oils and fats, pickles, shellfish boiled in sweetened soy sauce, and fruits. Nutrients significantly associated with the observed change in systolic BP were niacin (P = 0.005) and carbohydrate (P = 0.033). The results of the FFQg questionnaire revealed that participants who had an increased BP at 1 month after ceasing the intervention had eating habits that broadly imitated the DASH-JUMP diet at 4 months after ceasing the intervention. Therefore, the systolic and diastolic BP values at 4 months after ceasing the intervention decreased significantly compared to those at baseline.

Conclusion

The DASH-JUMP diet may represent a new lifestyle medicine for reducing hypertension.

Association of kidney function-related dietary pattern, weight status, and cardiovascular risk factors with severity of impaired kidney function in middle-aged and older adults with chronic kidney disease: a cross-sectional population study

Background

Chronic Kidney Disease (CKD), characterized by impaired kidney function, affects over 1.5 million individuals in Taiwan. Cardiovascular disease (CVD) is commonly found in patients with CKD, and the increased prevalence of obesity can have some implications for the risk of both CKD and CVD. Since diet plays an important role in the development of obesity, CVD and CKD, our study was designed to investigate the association of kidney function-related dietary pattern with weight status, cardiovascular risk factors, and the severity of impaired kidney function in middle-aged and older adults in Taiwan.

Methods

A total of 41,128 participants aged 40 to 95 years old with an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m² and proteinuria were recruited from Mei Jau Health Institute between 2008 and 2010. The kidney function-related dietary pattern was identified using reduced rank regression (RRR) and was known as high consumption of preserved or processed food, meat, organ meats, rice/flour products, and, low consumption of fruit, dark-colored vegetables, bread, and beans. A multivariable logistic regression analysis was used to identify the association of weight status and cardiovascular risk factors with moderately/severely impaired kidney function (eGFR < 60 mL/min/1.73 m²) and the association of dietary pattern with the outcomes aforementioned.

Results

Moderately/severely impaired kidney function participants were heavier and had higher abnormality of cardiovascular risk factors compared with those with mildly impaired kidney function. Weight status (OR = 1.28, 95% CI 1.12–1.45, P <  0.001 for obesity) and cardiovascular risk factors (OR = 1.52, 95% CI 1.31–1.77, P <  0.001 for high total cholesterol/HDL-C ratio and OR = 1.56, 95% CI 1.41–1.72, P <  0.001 for hypercalcemia) were positively associated with increased risk of moderately/severely impaired kidney function. The kidney function-related dietary pattern was correlated with overweight or obese (OR = 2.07, 95% CI 1.89–2.27, P <  0.01) weight status, increased cardiovascular risk by 10–31%, and the risk of moderately/severely impaired kidney function (OR = 1.15, 95% CI 1.02–1.29, P <  0.05).

Conclusions

The RRR-derived kidney function-related dietary pattern, characterized by high intake of processed and animal foods and low intake of plant foods, predicts the risks for developing cardiovascular disease and moderately/severely impaired kidney function among middle-aged and older adults.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0452-4) contains supplementary material, which is available to authorized users.

Assessing the Carbon Emission Driven by the Consumption of Carbohydrate-Rich Foods: The Case of China

Background: Carbohydrate-rich (CR) foods are essential parts of the Chinese diet. However, CR foods are often given less attention than animal-based foods. The objectives of this study were to analyze the carbon emissions caused by CR foods and to generate sustainable diets with low climate impact and adequate nutrients. Methods: Twelve common CR food consumption records from 4857 individuals were analyzed using K-means clustering algorithms. Furthermore, linear programming was used to generate optimized diets. Results: Total carbon emissions by CR foods was 683.38g CO2eq per day per capita, accounting for an annual total of 341.9Mt CO2eq. All individuals were ultimately divided into eight clusters, and none of the popular clusters were low carbon or nutrient sufficient. Optimized diets could reduce about 40% of carbon emissions compared to the average current diet. However, significant structural differences exist between the current diet and optimized diets. Conclusions: To reduce carbon emissions from the food chain, CR foods should be a research focus. Current Chinese diets need a big change to achieve positive environmental and health goals. The reduction of rice and wheat-based foods and an increase of bean foods were the focus of structural dietary change in CR food consumption.

Influence of Living Arrangements and Eating Behavior on the Risk of Metabolic Syndrome: A National Cross-Sectional Study in South Korea

Studies on the relationships between health, different living arrangements, and eating behaviors across age groups are limited. Therefore, we investigated these associations, focusing on metabolic syndrome, among 16,015 South Koreans aged ≥19 years who completed the Korean National Health and Nutrition Examination Survey (2013⁻2016). Multivariate logistic regression revealed that younger adults (<65 years) who lived and ate alone consumed more carbohydrates than those who lived and ate with others (p < 0.01). The odds of metabolic syndrome in younger adults increased with eating alone (adjusted odds ratio (aOR) 2.11, 95% confidence interval (CI) 1.10⁻4.02) and living and eating alone (2.39, 1.25⁻4.58). Older adults (≥65 years) did not differ in dietary intake or prevalence of metabolic syndrome according to their living and eating situations. Younger adults living and eating alone may benefit from customized nutrition and health management programs to reduce their risk of metabolic syndrome.

Sarcopenic obesity can be negatively associated with active physical activity and adequate intake of some nutrients in Korean elderly: Findings from the Korea National Health and Nutrition Examination Survey (2008-2011)

BACKGROUND/OBJECTIVES

The aim of this study was to analyze the factors related to sarcopenic obesity among the elderly in South Korea.

SUBJECTS/METHODS

A total of 3,367 elderly (≥ 65 years) from the Korea National Health and Nutrition Examination Survey (2008–2011) were included in this analysis. The subjects were assessed to determine their sarcopenia and obesity status. Sarcopenia was assessed by determining their appendicular skeletal muscle mass (ASM). Obesity was defined by the waist circumference. An association of sarcopenic obesity and the related factors was analyzed using multiple logistic regression models.

RESULTS

The risk of sarcopenic obesity of the subjects was decreased by active physical activity. After adjusting for age, smoking, and alcohol consumption, the risk of sarcopenic obesity in men of the highest level group (Q4) decreased by 45% (OR = 0.550, 95% CI = 0.334–0.905, P trend 0.018) compared to that in the reference group (Q1). Among the women, the risk of sarcopenic obesity in the Q3 and Q4 groups decreased by 29.0% (OR = 0.710, 95% CI = 0.512–0,984) and 56.7% (OR = 0.433, 95% CI = 0.281–0.668), respectively, compared to that in the Q1 group (P trend < 0.001). The mean daily energy intake was higher in the non-sarcopenia group than in the sarcopenia group. The risk of sarcopenic obesity in subjects not meeting the recommended intakes of energy, riboflavin, and vitamin C increased significantly by 25.4%, and 36.6%, and 32.6%, respectively, compared to that in the subjects meeting the recommended nutrient intake.

CONCLUSION

Active physical activity as well as an adequate intake of energy and some vitamins might be negatively associated with the development of sarcopenia and sarcopenic obesity in the elderly.

Vitamin D supplementation and muscle strength in pre-sarcopenic elderly Lebanese people: a randomized controlled trial

Previous studies have shown that improving vitamin D status among the elderly may lead to an improvement in muscle mass and muscle strength. In our study, vitamin D supplementation showed significant improvements in vitamin D concentrations as well as appendicular muscle mass in pre-sarcopenic older Lebanese people. However, we found no significant effect on muscle strength.

INTRODUCTION

Improving vitamin D status might improve muscle function and muscle mass that lead to sarcopenia in older subjects. The aim of this randomized, controlled, double-blind study was to examine the effect of vitamin D supplementation on handgrip strength and appendicular skeletal muscle mass in pre-sarcopenic older Lebanese subjects. We also examined whether this effect differs in normal vs. obese subjects.

METHODS

Participants (n = 128; 62 men and 66 women) deficient in vitamin D (25(OH)D = 12.92 ± 4.3 ng/ml) were recruited from Saint Charles Hospital, Beirut, Lebanon. The participants were given a supplement of 10,000 IU of cholecalciferol (vitamin D group; n = 64) to be taken three times a week or a placebo tablet (placebo group; n = 64) for 6 months. One hundred fifteen subjects completed the study: 59 had normal weight, while 56 were obese. Strength and functional assessment and biochemical analysis were performed at the start and after 6 months.

RESULTS

Compared to placebo, the vitamin D supplemented group showed significant improvements in appendicular skeletal muscle mass (ASMM) (P < 0.001) but not in handgrip strength (P = 0.2901). ANCOVA for ASMM adjusting for obesity and including the interaction between obesity and vitamin D showed a significant interaction. The increase in ASMM with vitamin D in normal-weight subjects was higher than that of obese subjects (B = 35.09 vs. B = 2.19).

CONCLUSION

Treatment with vitamin D showed beneficial effects on appendicular muscle mass in pre-sarcopenic older Lebanese men and women. However, it had no effect on muscle strength relative to placebo. This trial was registered at isrctn.org as ISRCTN16665940.

Association between diet and measures of arterial stiffness in type 1 diabetes - Focus on dietary patterns and macronutrient substitutions

BACKGROUND AND AIMS

Increased arterial stiffness contributes to diabetic vascular complications. We identified dietary factors related to arterial stiffness in individuals with type 1 diabetes, a population with high risk of cardiovascular disease.

METHODS AND RESULTS

Altogether, 612 participants (40% men, mean ± standard deviation age 45 ± 13 years) completed a validated diet questionnaire and underwent measurements of arterial stiffness. Of these, 470 additionally completed a food record. Exploratory factor analysis was applied to identify dietary patterns from the diet questionnaires, and nutrient intakes were calculated from food record entries. Arterial stiffness was measured by applanation tonometry. Of the seven dietary factors formed, the factor scores of "Full-fat cheese and eggs" and "Sweet" patterns were negatively associated with measures of arterial stiffness. In the multivariable macronutrient substitution models, favouring carbohydrates over fats was associated with higher aortic mean arterial pressure and aortic pulse wave velocity. When carbohydrates were consumed in place of proteins, higher aortic pulse pressure, aortic mean arterial pressure, and augmentation index were recorded. Replacing energy from alcohol with proteins, was associated with lower aortic pulse pressure, aortic mean arterial pressure, and augmentation index. Relative distributions of dietary fatty acids were neutral with respect to the measures of arterial stiffness.

CONCLUSION

The macronutrient distribution of the diet is likely to affect the resilience of the arteries. Our observations suggest that reducing energy intake from carbohydrates and alcohol may be beneficial. These observations, especially those dealing with dietary patterns, need to be confirmed in a longitudinal study.

Low-carbohydrate diet and the risk of metabolic syndrome in Korean adults

BACKGROUND & AIMS

The association of low-carbohydrate diet with weight loss and the risk of cardiovascular diseases has recently been the focus of increasing research attention. However, studies on low-carbohydrate diet in the Asian population are limited. The present study was aimed to examine the association between low-carbohydrate diet and metabolic syndrome among Korean adults.

METHODS AND RESULTS

A total of 16,349 participants aged 30 years or older who participated in a 24-h dietary recall survey of the fifth and sixth Korea National Health and Nutrition Examination Survey were included in this study. Low-carbohydrate diet was evaluated using the low-carbohydrate-diet score, which was calculated based on the percentage of energy from carbohydrate, protein, and fat by sex. The association between the low-carbohydrate-diet score and metabolic syndrome was analyzed using multiple logistic regression analysis. A low-carbohydrate diet was not associated with metabolic syndrome and its components such as waist circumference, blood pressure, and triglyceride levels. However, women in the highest decile of the animal- or plant-based low-carbohydrate-diet score showed a decreased risk of reduced high-density lipoprotein (HDL)-cholesterol levels, and men in the highest decile of the animal-based low-carbohydrate-diet score showed a decreased risk of reduced HDL-cholesterol levels than those in the lowest decile of the low-carbohydrate-diet score.

CONCLUSION

These findings indicate that, in Korea, a low-carbohydrate diet did not increase the risk of metabolic syndrome among adults who typically consume a high-carbohydrate low-fat diet. However, it may moderately decrease the risk of reduced HDL-cholesterol levels.

Prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents: the CASPIAN-V Study

Introduction: This study presents the prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents. Methods: This multi-centric study was conducted in 2015 among 4200 students aged 7-18 years. They were selected by multistage cluster sampling from 30 provinces of Iran. Anthropometric indices, biochemical and clinical parameters were measured. Results: The mean of weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FBG) was higher in boys than in girls (P < 0.05). The mean of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher in girls than in boys (P < 0.05). The mean of weight, height, WC, SBP, DBP, alanine transaminase (ALT) and body mass index (BMI) was higher in urban than in rural residents (P < 0.05). Overall, 16.1%, 9.4% and 11.4% were underweight, overweight and obese. Abdominal obesity was documented in 21.6% of boys and 20.5% of girls. Low HDL-C was the most prevalent abnormality of lipid profile (29.5%) followed by high serum TGs (27.7%). Low HDL-C was more prevalent in boys than in girls (32.7% vs. 26%, respectively, P < 0.05). Prevalence of obesity and overweight were higher in girls than in boys (P < 0.05). The prevalence of obesity and overweight, abdominal obesity, and low HDL-C were higher in urban than in rural residents (P < 0.05). Conclusion: We found considerably high prevalence of some cardiometabolic risk factors including overweight and obesity, low HDL-C and hypertriglyceridemia in Iranian children and adolescents. The current findings underscore the necessity of intensifying health interventions for primordial and primary prevention of non-communicable diseases from early life.

Nutritional status of Onges of Little Andaman Island - Current state and the change over the last fifteen years

Onges, an indigenous vulnerable tribe, inhabit the Little Andaman Island. Study undertaken during 1997, recorded high prevalence of undernutrition among children. Subsequently, food rationing was modified by Andaman and Nicobar administration. In the present study, health and nutritional status of this tribe was assessed in 2013 after a gap of 15 years. All individuals in the tribe were included. Various health parameters, viz, nutritional anthropometry, haemoglobin level, fasting sugar, lipids and intestinal parasites were investigated. Prevalence of stunted growth and underweight among children of 0-5 years was 86.4%. Severe underweight were more prevalent (40%), as compared to those recorded 15 years ago (10%), and the difference was statistically significant (P < 0.05). There has been a substantial improvement in the overall nutritional status of children in the age group of <18 years. The prevalence of wasting has halved and that of stunting and wasting has come down to one-third of that observed in 1997. Prevalence of anaemia significantly declined from 87% in 1997 to 51% 15 years later.

Inflammatory potential of diet is associated with cognitive function in an older adult Korean population

OBJECTIVE

To examine the association between the inflammatory potential of diet and the quality of cognitive function in an older adult Korean population.

METHODS

A total of 239 participants (88 men and 151 women) ages ≥65 y were selected from various health centers in Korea. To assess the inflammatory potential of diet, Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed based on a single 24-h recall. Cognitive function was assessed using the Korean Mini-Mental State Examination. Multiple linear and logistic regression models were fit to estimate the association between E-DII scores and the degree of cognitive function.

RESULTS

E-DII scores were significantly inversely associated with Korean Mini-Mental State Examination score in both unadjusted and adjusted models, after controlling for sex, age, body mass index, sleep hours, supplement use, education level, self-reported health conditions, history of dementia, and physical activity (β = -1.33, 95% confidence interval [CI] = -1.95, -0.71, P <0.0001; β = -0.58, 95% CI = -1.11, -0.06, P = 0.03, respectively). Participants in the highest E-DII tertile had increased risk for mild or moderate cognitive impairment compared with those in the lowest E-DII tertile (adjusted odds ratio 6.32, 95% CI 1.18-33.78; P for trend = 0.0031).

CONCLUSIONS

Higher E-DII scores were associated with increased risk of cognitive impairment, suggesting that consuming a proinflammatory diet is associated with increased risk for cognitive impairment in the older Korean adults.

Self-management levels of diet and metabolic risk factors according to disease duration in patients with type 2 diabetes

BACKGROUND/OBJECTIVES

Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades.

SUBJECTS/METHODS

Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ≥ 30 years, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ≥ 10 years). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES.

RESULTS

In the multivariable adjusted models, patients with a longer duration (≥ 10 years) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ≥ 10 years (P for trend = 0.004).

CONCLUSION

Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.