Dairy consumption is associated with a lower incidence of the metabolic syndrome in middle-aged and older Korean adults: the Korean Genome and Epidemiology Study (KoGES)

Calcium- and Sodium-Rich Food Intake among Koreans with and without Metabolic Syndrome: Cross-Sectional Analysis of the Korean Genome and Epidemiology Study

BACKGROUND

The prevalence of metabolic syndrome (MetS) is increasing. While calcium and sodium are known nutritional factors used for managing MetS, few studies have focused on food-based analyses. This cross-sectional study examined the distribution of calcium- and sodium-rich food intake among Koreans with MetS.

METHODS

This cross-sectional analysis evaluated 130,423 participants from the Health Examinees-Gem cohort study. Foods contributing up to 90% of the calcium and sodium intake were selected from the semi-quantitative food frequency questionnaire, and consumption levels were calculated. MetS was defined as satisfying three or more criteria from the National Cholesterol Education Program Adult Treatment Panel III. The results are presented as odds ratios (OR) with an interquartile range (ORIQR) and 95% confidence interval.

RESULTS

Participants with MetS showed a low calcium intake (ORIQR = 0.95 and 0.92 for men and women, respectively), low consumption of dairy products (ORIQR = 0.92 and 0.89), beverages except for coffee or green tea (ORIQR = 0.97 and 0.96), and bread (ORIQR = 0.96 and 0.94). Men with MetS consumed high total sodium (ORIQR = 1.04), and large amounts of Kimchi (ORIQR = 1.03), fermented paste (ORIQR = 1.04), and noodles (ORIQR = 1.07). Women with MetS consumed more Kimchi than those without MetS (ORIQR = 1.04). The odds ratio for the low calcium and high sodium group compared to the high calcium and low sodium group was 1.26.

CONCLUSION

The MetS group consumed less calcium-rich foods and more sodium-rich foods than those without MetS. Patients with MetS might benefit from precise recommendations of high calcium-rich and low sodium-rich foods.

Alleviation of High-Fat Diet-Induced Hyperlipidemia in Mice by Stachys sieboldii Miq. Huangjiu via the Modulation of Gut Microbiota Composition and Metabolic Function

Hyperlipidemia is a chronic disease that is difficult to cure, and long-term pharmacotherapy may have negative consequences. Dietary therapy is a very promising strategy, and Chinese rice wine (Huangjiu) will play an important role because of its many biologically active components. In this work, the alleviating effect of Stachys sieboldii Miq. Huangjiu (CSCHJ) on high-fat diet-induced hyperlipidemia in mice was investigated, which is brewed from the wheat Qu with the addition of Stachys sieboldii Miq. and contains 15.54 g/L of polysaccharides. The experimental results showed that CSCHJ inhibited appetite, reduced body weight and blood sugar levels, and downregulated the serum levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) while concurrently upregulating high-density lipoprotein cholesterol (HDL-C) in the high-fat diet-induced hyperlipidemia mice. At the same time, it was discovered that alcohol worsens hyperlipidemia symptoms and related physiological markers, implying that CSCHJ polysaccharides may play a role in hyperlipidemia treatment. Through the assessment of organ indices, liver and kidney function, and tissue staining, CSCHJ demonstrated efficacy in repairing liver, kidney, and colon mucosal damage in hyperlipidemic mice. Furthermore, 16S rDNA sequencing and gas chromatography studies revealed that CSCHJ effectively restored the intestinal microbial structure and enhanced the quantity of fecal short-chain fatty acids (SCFAs) in hyperlipidemic mice. Therefore, the alleviating effect of CSCHJ on hyperlipidemia in mice may be attributed to its regulation of energy metabolism by repairing liver, kidney, and colon mucosal damage and restoring the gut microbiota structure, among other mechanisms. Overall, our findings provide evidence that CSCHJ contains active ingredients capable of alleviating hyperlipidemia, thereby laying a theoretical foundation for the extraction of bioactive substances from Huangjiu for future medical or dietary use.

Impact of Habitual Yogurt Intake in Mother-Child Dyads on Incidence of Childhood Otitis Media: The Japan Environment and Children's Study (JECS)

Otitis media, one of the most common childhood diseases, is characterized by inflammation or infection of the middle ear. Due to their ease of access, daily probiotics are recommended for the prevention of early childhood otitis media. This study aimed to assess the impact of probiotics on the incidence of otitis media using a dataset (n = 95,380) from the Japan Environment and Children's Study, a nationwide birth cohort study. After multiple imputations, the association between the incidence of otitis media in early childhood and the daily frequency of yogurt intake in children and mothers was examined using a generalized linear model after adjusting for several confounders. Repeated incidence of otitis media during the 2 years after birth was found in 14,874 participants (15.6%). Based on participants with the lowest frequency of yogurt intake ("almost never") as the reference group, risk ratios for otitis media incidence decreased with higher frequencies of yogurt intake in children at one year of age, but also independently in mothers during pregnancy. The lowest risk ratio (95% confidence interval) for otitis media incidence at six months of age was observed with the most frequent yogurt intake (once/day or more) (0.54 [0.46-0.63]). Additionally, although a similar association was observed in the subgroup of those with cleft lip and/or palate (CL/P), a high-risk group for severe recurrent otitis media, no statistical significance was observed. Thus, increased regular yogurt intake in both children and mothers was associated with a decrease of otitis media during early childhood.

The effect of dairy products on liver fat and metabolic risk markers in males with abdominal obesity - a four-arm randomized controlled trial

BACKGROUND & AIMS

In recent years, epidemiological studies have reported links between the consumption of fermented dairy products, such as yogurt, and health; however, evidence from human intervention trials is scarce and inconsistent. We aimed to investigate the effect of consumption of four different types of dairy products (two fermented and two non-fermented) on liver fat (primary outcome) and metabolic risk markers in males with abdominal obesity.

METHODS

In this parallel randomized controlled trial with four arms, 100 males aged 30-70 years, with body mass index 28.0-45.0 kg/m2, and waist circumference ≥102 cm underwent a 16-weeks intervention where they were instructed to consume 400 g/day of either milk, yogurt, heat-treated yogurt, or acidified milk as part of their habitual diet. Liver fat was measured by magnetic resonance imaging.

RESULTS

In the complete case analyses (n = 80), no effects of the intervention or differences between groups were detected in anthropometry or body composition including liver fat. Moreover, no effects were detected in inflammatory markers. Main effects of time were detected in blood pressure (decrease; P < 0.001), insulin (decrease; P < 0.001), C-peptide (decrease; P = 0.040), homeostatic model assessment for insulin resistance (decrease; P < 0.001), total cholesterol (decrease; P = 0.016), low-density lipoprotein (decrease; P = 0.033), high-density lipoprotein (decrease; P = 0.006), and alanine transaminase (decrease; P = 0.019). Interactions between group and time failed to reach significance.

CONCLUSIONS

In conclusion, findings from our study do not confirm that fermented yogurt products are superior in reducing liver fat or improving metabolic risk markers compared to non-fermented milk products. In fact, all intervention products (both fermented yogurt products and non-fermented milk products) did not affect liver fat and caused largely similar modest favorable changes in some metabolic risk markers. The study was registered at www.

CLINICALTRIALS

gov (# NCT04755530).

Association Between Instant Coffee Consumption and the Development of Chronic Obstructive Pulmonary Disease: Results From a Community-Based Prospective Cohort

BACKGROUND

A poor diet is a risk factor for chronic obstructive pulmonary disease (COPD). The interaction between dietary factors and cigarette smoking in the development of COPD is unclear. We investigated the interactions between dietary patterns and smoking status on COPD-related outcomes.

METHODS

We used data from the Anseong-Ansan cohort that has been followed for 20 years. A total of 6,221 individuals without COPD in the baseline survey were analyzed. Five dietary patterns were identified using a semi-quantitative food frequency questionnaire. Associations of dietary patterns with COPD and forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio in different strata of smoking status were evaluated using Cox regression and linear mixed models, respectively.

RESULTS

The highest quartile of the "coffee" pattern (high coffee consumption) was associated with COPD (hazard ratio, 1.46; 95% confidence interval [CI], 1.03-2.08) and lower FEV1/FVC ratio (β = -1.2%; 95% CI, -1.9% to -0.6%) using the lowest quartile as a reference for heavy smokers, but not light or never smokers (P value for interaction = 0.035 for COPD). Regarding the associations between various consumption levels of black coffee, combined coffee, and instant coffee and COPD, an association with COPD was only observed for instant coffee in heavy smokers.

CONCLUSION

High instant coffee consumption is associated with COPD development in heavy smokers, but not in light or never smokers. This may be attributed to sugar and cream in instant coffee mixes.

Association of milk and dairy product consumption with the incidence of cardio-cerebrovascular disease incidence in middle-aged and older Korean adults: a 16-year follow-up of the Korean Genome and Epidemiology Study

BACKGROUND/OBJECTIVES

Unhealthy dietary behaviors constitute one of risk the factors for chronic and cardiovascular diseases, which are prevalent in middle-aged and older populations. Milk and dairy products are high-quality foods and important sources of calcium. Calcium protects against osteoporosis and cardiovascular disease. Therefore, this study investigated the association of milk and dairy product consumption with cardio-cerebrovascular disease incidence in middle-aged and older Korean adults.

SUBJECTS/METHODS

Data were derived from the Ansan-Anseong cohort study, and a total of 8,009 individuals aged 40-69 years were selected and followed up biennially. Cox proportional hazard models were used to examine the association of milk and dairy product consumption with cardio-cerebrovascular disease incidence.

RESULTS

During a mean follow-up period of 96.5 person-months, 552 new cases of cardio-cerebrovascular disease were documented. Milk consumers (< 1 serving/day) exhibited a 23% lower risk of cardio-cerebrovascular disease incidence than non-milk consumers (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.97; P for trend = 0.842). High yogurt consumption was associated with a 29% lower incidence risk (≥ 0.5 servings/day vs. none: HR, 0.71; 95% CI, 0.53-0.96; P for trend = 0.049), whereas high ice cream consumption was associated with a 70% higher risk of cardio-cerebrovascular disease incidence (≥ 0.5 servings/day vs. none: HR, 1.70; 95% CI, 1.01-2.88; P for trend = 0.070).

CONCLUSIONS

This study indicates that less than one serving of milk and high yogurt consumption are associated with a lower cardio-cerebrovascular disease risk in the middle-aged and older populations.

Dairy consumption in adults in China: a systematic review

BACKGROUND

Research on dairy consumption in China is lacking, however, some evidence has demonstrated significant changes in recent years, with a reported increase in the overall consumption of dairy products. To fully understand these changes, a systematic review was conducted to examine reported dairy intakes and differences between dairy consumption in different population groups in China.

METHODS

Web of Science, Embase, and PubMed databases were searched for studies published from January 2000 to September 2022. The China National Knowledge Infrastructure (CNKI) was used to retrieve papers available in Chinese. Papers reporting dietary intakes of dairy consumption across age, sex, and geographical location sub-groups were considered for inclusion in this review. In addition, this review includes the consumption of different types of dairy foods and changes in dairy intake over time.

RESULTS

Forty-seven papers were included in the present study. Twelve papers examined dairy consumption across age groups, showing that middle-aged adults tend to consume less dairy than other age groups. Studies comparing across location-specific cohorts reported dairy intakes among urban populations were higher than rural, as well as being higher than the national average. Coastal, Northern and Eastern residents consumed more dairy products than those living in other regions of China, and people in larger cities had higher reported intakes than smaller cities. Milk was the primary dairy product reportedly consumed by Chinese population, followed by yogurt. Concerning sex, evidence showed that females generally reported a greater daily dairy intake than males.

CONCLUSIONS

This review shows that, in China, several different population groups displayed significant differences in the amount and type of dairy consumed. When considering the incorporation of dairy products into healthy eating guidelines or positioning specific dairy products on the market, it is important to consider the differences and variations in consumption patterns within population groups.

Association of food intake with a risk of metabolic dysfunction-associated fatty liver disease: a cross-sectional study

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common liver disease, the risk of which can be increased by poor diet. The objective of this study was to evaluate the associations between food items and MAFLD, and to propose reasonable dietary recommendations for the prevention of MAFLD.

Methods

Physical examination data were collected from April 2015 through August 2017 at Nanping First Hospital (n = 3,563). Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. The association between food intake and the risk of MAFLD was assessed by using the inverse probability weighted propensity score.

Results

Beverages (soft drinks and sugar-sweetened beverages) and instant noodles were positively associated with MAFLD risk, adjusting for smoking, drinking, tea intake, and weekly hours of physical activity [adjusted odds ratio (ORadjusted): 1.568; P = 0.044; ORadjusted: 4.363; P = 0.001]. Milk, tubers, and vegetables were negatively associated with MAFLD risk (ORadjusted: 0.912; P = 0.002; ORadjusted: 0.633; P = 0.007; ORadjusted: 0.962; P = 0.028). In subgroup analysis, the results showed that women [odds ratio (OR): 0.341, 95% confidence interval (CI): 0.172-0.676] had a significantly lower risk of MAFLD through consuming more tubers than men (OR: 0.732, 95% CI: 0.564-0.951).

Conclusions

These findings suggest that reducing consumption of beverages (soft drinks and sugar-sweetened beverages) and instant noodles, and consuming more milk, vegetables, and tubers may reduce the risk of MAFLD.

Gene-diet interaction analysis using novel weighted food scores discovers the adipocytokine signaling pathway associated with the development of type 2 diabetes

Introduction

The influence of dietary patterns measured using Recommended Food Score (RFS) with foods with high amounts of antioxidant nutrients for Type 2 diabetes (T2D) was analyzed. Our analysis aims to find associations between dietary patterns and T2D and conduct a gene-diet interaction analysis related to T2D.

Methods

Data analyzed in the current study were obtained from the Korean Genome and Epidemiology Study Cohort. The dietary patterns of 46 food items were assessed using a validated food frequency questionnaire. To maximize the predictive power of the RFS, we propose two weighted food scores, namely HisCoM-RFS calculated using the novel Hierarchical Structural Component model (HisCoM) and PLSDA-RFS calculated using Partial Least Squares-Discriminant Analysis (PLS-DA) method.

Results

Both RFS (OR: 1.11; 95% CI: 1.03- 1.20; P = 0.009) and PLSDA-RFS (OR: 1.10; 95% CI: 1.02-1.19, P = 0.011) were positively associated with T2D. Mapping of SNPs (P < 0.05) from the interaction analysis between SNPs and the food scores to genes and pathways yielded some 12 genes (CACNA2D3, RELN, DOCK2, SLIT3, CTNNA2, etc.) and pathways associated with T2D. The strongest association was observed with the adipocytokine signalling pathway, highlighting 32 genes (STAT3, MAPK10, MAPK8, IRS1, AKT1-3, ADIPOR2, etc.) most likely associated with T2D. Finally, the group of the subjects in low, intermediate and high using both the food scores and a polygenic risk score found an association between diet quality groups with issues at high genetic risk of T2D.

Conclusion

A dietary pattern of poor amounts of antioxidant nutrients is associated with the risk of T2D, and diet affects pathway mechanisms involved in developing T2D.

Consumption of Dairy Products and the Risk of Overweight or Obesity, Hypertension, and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis and Systematic Review of Cohort Studies

Dairy products have been suggested to be related to the prevention of overweight or obesity, hypertension, and type 2 diabetes mellitus (T2DM). These associations are currently controversial, however, and a systematic quantitative meta-analysis is lacking. In this study, we examined the associations between dairy products and the risk of overweight or obesity, hypertension, and T2DM and tested for dose-response relations. We comprehensively searched PubMed, Embase, and Web of Science up to April 2021. Cohort studies were included if dairy food consumption was reported at a minimum of 3 levels or as continuous variables, and the associations were assessed with overweight or obesity, hypertension, and T2DM. Summary RRs and 95% CIs were estimated for the dose-response association. Restricted cubic splines were used to evaluate the linear or nonlinear relations. Among the 9887 articles retrieved, 42 articles were included. For overweight or obesity, a linear association was observed for total dairy, milk, and yogurt. The risk decreased by 25%, 7%, and 12% per 200-g/d increase for total dairy, high-fat dairy, and milk, respectively, and by 13% per 50-g/d increment of yogurt. For hypertension, a nonlinear association was observed with total dairy, whereas significant inverse associations were found for low-fat dairy (RR: 0.94; 95% CI: 0.90, 0.98) and milk (RR: 0.94; 95% CI: 0.92, 0.97) per 200-g/d intake increase. For T2DM, all types of dairy food consumption except for milk and low-fat dairy products showed nonlinear associations, with total dairy and yogurt intake associated with 3% and 7% lower risk per 200-g/d and 50-g/d intake increase, respectively. In conclusion, our study suggests that total dairy is associated with a low risk of overweight or obesity, hypertension, and T2DM, especially milk and yogurt for overweight or obesity, low-fat dairy and milk for hypertension, and yogurt for T2DM.

Cow's Milk Intake and Risk of Coronary Heart Disease in Korean Postmenopausal Women

Numerous studies have reported conflicting results associated with cow’s milk intake and coronary heart disease (CHD). However, studies involving postmenopausal women are very limited. This study was therefore undertaken to identify the relationship between cow’s milk intake and CHD risk in postmenopausal women, using data from the 6th period of the Korea National Health and Nutrition Examination Survey (2013−2015). A total of 1825 postmenopausal women, aged 50−64 years old, were included in the final analysis. The frequency of cow’s milk consumption for each subject was determined using the semi-quantitative food frequency questionnaire, and was classified into four groups (Q1−Q4): Q1, group that did not drink milk (no milk, n = 666); Q2, 0 < frequency of milk intake per week ≤ 1 (n = 453); Q3, 1 < frequency of milk intake per week ≤ 3 (n = 319); and Q4, frequency of milk intake >3 times per week (n = 387). General characteristics, such as education, living area, household income, and obesity level, were compared between the four groups. Percentages of daily nutrient intake compared to the dietary reference intake for Koreans (KDRIs) were determined, and the Framingham Risk Score (FRS), atherogenic index (AI), and atherogenic index of plasma (AIP) were determined as the CHD risk indicators. Except household income, no significant difference was obtained among the four groups with respect to age, education, living area, or obesity. Compared to KDRIs, the intake ratio of calcium, phosphorus, and riboflavin were significantly higher in the Q4 group than in the Q1−Q3 groups. Blood HDL-cholesterol was significantly higher in Q4 than in Q1. The CHD risk factors FRS (%), AI, and AIP were significantly lower in the Q4 group as compared to the other groups (CHD risk (%): Q1 9.4, Q4 8.5; AI: Q1 3.06, Q4 2.83; API: Q1 0.37, Q2 0.31, Q4 0.32). FRS was determined to be significantly and positively correlated to AI or AIP, and negatively correlated with the cow’s milk intake frequency and calcium intake. In conclusion, compared to women who do not consume cow’s milk, postmenopausal women who consume cow’s milk frequently have a better nutritional status of calcium, phosphorus, and vitamin B12, higher HDL levels, and a lower level of CHD risk indicators, such as FRS, AI, and AIP, contributing to decreased CHD risk in a 10-year period. Therefore, to prevent the risk of CHD in postmenopausal women, there needs to be a greater emphasis for cow’s milk consumption four or more times per week.

Dairy Product Consumption and Type 2 Diabetes among Korean Adults: A Prospective Cohort Study Based on the Health Examinees (HEXA) Study

OBJECTIVES

It has been suggested that the consumption of dairy products helps lower the prevalence of type 2 diabetes (T2D). We investigated the association between the consumption of dairy products and T2D events in middle-aged Korean adults.

METHODS

We followed up 53,288 participants (16,895 male and 36,393 female) in the Health Examinees (HEXA) study. The consumption of dairy products was assessed using the self-administered food frequency questionnaire, and T2D was defined according to the 2015 treatment guidelines of the Korean Diabetes Association. Hazard ratios (HRs) and 95% confidence intervals (CIs) between the consumption of dairy products and the risk of T2D were calculated using Cox proportional hazards models after adjusting for potential confounders. Spline regression was used to better represent the association between the consumption of dairy products and the risk of T2D.

RESULTS

Among male, those with higher consumption of dairy products had a significantly lower risk of T2D than those who consumed essentially no dairy products (HR, 0.73; 95% CI, 0.58 to 0.91). In particular, consumption of yogurt (HR, 0.75; 95% CI, 0.60 to 0.93; p_trend=0.035) and cheese (HR, 0.66; 95% CI, 0.49 to 0.89; p_trend=0.005) was negatively associated with the incidence of T2D in male. In female, daily consumption of 1 serving of yogurt decreased the risk of T2D by 11%.

CONCLUSIONS

The association between the consumption of dairy products and the risk of T2D differed by sex and dairy product type. Further prospective studies are needed to confirm these associations.

Association of age-related cataract risk high polygenetic risk scores involved in galactose-related metabolism and dietary interactions

INTRODUCTION

Cataracts are associated with the accumulation of galactose and galactitol in the lens. We determined the polygenetic risk scores for the best model(PRSBM) associated with age-related cataract(ARC) risk and their interaction with diets and lifestyles in 40,262 Korean adults aged over 50 years belonged to a hospital-based city cohort.

METHODS

The genetic variants for ARC risk were selected in lactose and galactose metabolism-related genes with multivariate logistic regression using the PLINK 1.9 version. PRSBM from the selected genetic variants was estimated by generalized multifactor dimensionality reduction (GMDR) after adjusting covariates. The interactions between the PRSBM and each lifestyle factor were determined to modulate ARC risk.

RESULTS

The genetic variants for ARC risk related to lactose- and galactose metabolism were SLC2A1_rs3729548, ST3GAL3_rs3791047, LCT_rs2304371, GALNT5_rs6728956, ST6GAL1_rs2268536, GALNT17_rs17058752, CSGALNACT1_rs1994788, GALNTL4_rs10831608, B4GALT6_rs1667288, and A4GALT_ rs9623659. In GMDR, the best model included all ten genetic variants. The highest odds ratio (OR) for a single SNP in the PRSBM was 1.26. However, subjects with a high-PRSBM had a higher ARC risk by 2.1-fold than a low-PRSBM after adjusting for covariates. Carbohydrate, dairy products, kimchi, and alcohol intake interacted with PRSBM for ARC risk: the participants with high-PRSBM had a much higher ARC risk than those with low-PRSBM when consuming diets with high carbohydrate and low dairy product and kimchi intake. However, only with low alcohol intake, the participants with high-PRSBM had a higher ARC risk than those with low-PRSBM.

CONCLUSION

Adults aged >50 years having high-PRSBM may modulate dietary habits to reduce ARC risk.

Dairy Product Consumption and Cardiovascular Health: a Systematic Review and Meta-Analysis of Prospective Cohort Studies

The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD) and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1st, 2020 to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD or stroke. We used random-effects models to calculate the pooled relative risk (RR) and 95% confidence interval (CI) for the highest vs the lowest category of intake and for 1 serving/day increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest vs lowest level of intake: 0.91, 95% CI: 0.86-0.95, I2 = 73.5%; RR for 1 serving/day increase: 0.96, 95% CI: 0.94-0.97, I2 = 66.5%), CHD (highest vs lowest level of intake: 0.96, 95% CI: 0.92-1.00, I2 = 46.6%; 1 serving/day increase: 0.98, 95% CI: 0.95-1.00, I2 = 56.7%), and stroke (highest vs lowest level of intake: 0.90, 95% CI: 0.85-0.96, I2 = 60.8%; 1 serving/day increase: 0.96, 95% CI: 0.93-0.99, I2 = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relationship between total dairy and risk of HTN and CHD were of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke, and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high vs. low intake and dose-response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD and stroke. Moderate to considerable heterogeneity was observed in the estimates and the overall quality of the evidence was low to moderate.

Dairy protein intake is inversely related to development of non-alcoholic fatty liver disease

BACKGROUND & AIMS

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and is closely related to metabolic dysfunction, including insulin resistance, obesity, and metabolic syndrome. Dairy protein, rich in casein and whey protein, could help to reduce metabolic diseases. Therefore, we investigated the relationship between dairy protein intake and incident NAFLD.

METHODS

We analyzed data for 5171 adults aged 40-69 years from the Korean Genome and Epidemiology Study.(KoGES) Participants were separated as men, women aged ≥50 years, and women aged <50 years and then divided into tertiles based on dairy protein intake. NAFLD was defined as NAFLD liver fat score >-0.640. Scores were calculated as 1.18 × metabolic syndrome (Yes: 1, No: 0) + 0.45 × diabetes mellitus (Yes: 2, No: 0) + 0.15 × serum insulin +0.04 × AST - 0.94 × (AST/ALT) - 2.89. Cox proportional hazards spline curves were drawn to visualize dose-response relationships between dairy protein intake and incident NAFLD. Multiple Cox hazard regression analysis was conducted to examine associations between dairy protein intake and incident NAFLD.

RESULTS

The Cox proportional hazards spline curves revealed a negative linear relationship between dairy protein intake and incident NAFLD. The cumulative incidence of NAFLD significantly decreased with increasing tertiles of dairy protein intake in men and women aged ≥50 years. After adjusting for confounding factors, the hazard ratios and 95% confidence intervals for NAFLD in the middle and highest tertiles, compared to the lowest tertile, were 0.80 (0.67-0.96) and 0.71 (0.57-0.88) in men, 0.89 (0.72-1.09) and 0.72 (0.56-0.92) in women aged ≥50 years, and 1.01 (0.80-1.27) and 0.91 (0.67-1.24) in women aged <50 years, respectively.

CONCLUSIONS

We found that higher dairy protein intake was significantly and inversely associated with the risk of incident NAFLD in men and women aged ≥50 years. Consumption of milk and other dairy products could help prevent the development of NAFLD.

Yogurt, cultured fermented milk, and health: a systematic review

Consumption of yogurt and other fermented products is associated with improved health outcomes. Although dairy consumption is included in most dietary guidelines, there have been few specific recommendations for yogurt and cultured dairy products. A qualitative systematic review was conducted to determine the effect of consumption of fermented milk products on gastrointestinal and cardiovascular health, cancer risk, weight management, diabetes and metabolic health, and bone density using PRISMA guidelines. English language papers in PubMed were searched, with no date restrictions. In total, 1057 abstracts were screened, of which 602 were excluded owing to lack of appropriate controls, potential biases, and experimental design issues. The remaining 455 papers were independently reviewed by both authors and 108 studies were included in the final review. The authors met regularly to concur, through consensus, on relevance, methods, findings, quality, and conclusions. The included studies were published between 1979 and 2017. From the 108 included studies, 76 reported a favorable outcome of fermented milks on health and 67 of these were considered to be positive or neutral quality according to the Academy of Nutrition and Dietetics’ Quality Criteria Checklist. Of the 32 remaining studies, the study outcomes were either not significant (28) or unfavorable (4), and most studies (18) were of neutral quality. A causal relationship exists between lactose digestion and tolerance and yogurt consumption, and consistent associations exist between fermented milk consumption and reduced risk of breast and colorectal cancer and type 2 diabetes, improved weight maintenance, and improved cardiovascular, bone, and gastrointestinal health. Further, an association exists between prostate cancer occurrence and dairy product consumption in general, with no difference between fermented and unfermented products. This article argues that yogurt and other fermented milk products provide favorable health outcomes beyond the milk from which these products are made and that consumption of these products should be encouraged as part of national dietary guidelines.

Systematic review registration: PROSPERO registration no. CRD42017068953.

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.

Association between Different Types of Plant-Based Diets and Risk of Dyslipidemia: A Prospective Cohort Study

We evaluated the associations among different types of plant-based diet indices, risk of dyslipidemia, and individual lipid disorders in Asian populations with different dietary patterns from Western populations. Participants included 4507 Korean adults aged ≥40 years without dyslipidemia and related chronic diseases at baseline (2001–2002). Dietary intakes were assessed using an average of validated food frequency questionnaires measured twice. We calculated three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 14 years, 2995 incident dyslipidemia cases occurred. Comparing the highest with lowest quintiles, the multivariable-adjusted hazard ratios (HRs) for incident dyslipidemia were 0.78 (95% CI, 0.69–0.88) for PDI, 0.63 (95% CI, 0.56–0.70) for hPDI, and 1.48 (95% CI, 1.30–1.69) for uPDI (P-trend < 0.0001 for all). Associations between PDI and individual lipid disorders differed by sex. The PDI was inversely associated with risk of developing hypertriglyceridemia in men and with risk of developing low high-density lipoprotein cholesterol in women. The hPDI was inversely associated with risk of all lipid disorders, whereas the uPDI was positively associated with individual lipid disorders. The quality of plant foods is important for prevention of dyslipidemia in a population that consumes diets high in plant foods.

Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans

In order to recapitulate the best available evidence of milk consumption and multiple health-related outcomes, we performed an umbrella review of meta-analyses and systematic reviews in humans. Totally, 41 meta-analyses with 45 unique health outcomes were included. Milk consumption was more often related to benefits than harm to a sequence of health-related outcomes. Dose–response analyses indicated that an increment of 200 ml (approximately 1 cup) milk intake per day was associated with a lower risk of cardiovascular disease, stroke, hypertension, colorectal cancer, metabolic syndrome, obesity and osteoporosis. Beneficial associations were also found for type 2 diabetes mellitus and Alzheimer's disease. Conversely, milk intake might be associated with higher risk of prostate cancer, Parkinson’s disease, acne and Fe-deficiency anaemia in infancy. Potential allergy or lactose intolerance need for caution. Milk consumption does more good than harm for human health in this umbrella review. Our results support milk consumption as part of a healthy diet. More well-designed randomized controlled trials are warranted.

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.

Polygenetic-Risk Scores Related to Crystallin Metabolism Are Associated with Age-Related Cataract Formation and Interact with Hyperglycemia, Hypertension, Western-Style Diet, and Na Intake

Age-related cataract (ARC) development is associated with loss of crystalline lens transparency related to interactions between genetic and environmental factors. We hypothesized that polygenetic risk scores (PRS) of the selected genetic variants among the ARC-related genes might reveal significant genetic impacts on ARC risk, and the PRS might have gene-gene and gene-lifestyle interactions. We examined the hypothesis in 1972 and 39,095 subjects aged ≥50 years with and without ARC, respectively, in a large-scale hospital-based cohort study conducted from 2004 to 2013. Single nucleotide polymorphisms (SNPs) of the genes related to ARC risk were identified, and polygenetic risk scores (PRS) were generated based on the results of a generalized multifactor dimensionality reduction analysis. Lifestyle interactions with PRS were evaluated. The PRS derived from the best model included the following six SNPs related to crystallin metabolism: ULK4_rs1417380362, CRYAB_rs2070894, ACCN1_rs55785344, SSTR2_rs879419608, PTN_rs322348, and ICA1_rs200053781. The risk of ARC in the high-PRS group was 2.47-fold higher than in the low-PRS group after adjusting for confounders. Age, blood pressure, and glycemia interacted with PRS to influence the risk of ARC: the incidence of ARC was much higher in the elderly (≥65 years) and individuals with hypertension or hyperglycemia. The impact of PRS on ARC risk was greatest in middle-aged individuals with hypertension or hyperglycemia. Na, coffee, and a Western-style diet intake also interacted with PRS to influence ARC risk. ARC risk was higher in the high-PRS group than in the low-PRS group, and high Na intake, Western-style diet, and low coffee intake elevated its risk. In conclusion, ARC risk had a positive association with PRS related to crystallin metabolism. The genetic impact was greatest among those with high Na intake or hypertension. These results can be applied to precision nutrition interventions to prevent ARC.

Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

BACKGROUND

Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time.

METHODS AND FINDINGS

Analyses were based on a community-based cohort of 5,646 men and women (40-69 years of age at baseline) living in Ansan and Ansung, South Korea (2001-2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31-1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%-46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70-0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding.

CONCLUSIONS

In this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

Polygenetic-Risk Scores for A Glaucoma Risk Interact with Blood Pressure, Glucose Control, and Carbohydrate Intake

Glaucoma, a leading cause of blindness, has multifactorial causes, including environmental and genetic factors. We evaluated genetic risk factors of glaucoma with gene-gene interaction and explored modifications of genetic risk with gene-lifestyles interaction in adults >40 years. The present study included 377 subjects with glaucoma and 47,820 subjects without glaucoma in a large-scale hospital-based cohort study from 2004 to 2013. The presence of glaucoma was evaluated by a diagnostic questionnaire evaluated by a doctor. The genome-wide association study was performed to identify genetic variants associated with glaucoma risk. Food intake was assessed using a semiquantitative food frequency questionnaire. We performed generalized multifactor dimensionality reduction analysis to construct polygenetic-risk score (PRS) and explored gene × nutrient interaction. PRS of the best model included LIM-domain binding protein-2 (LDB2) rs3763969, cyclin-dependent kinase inhibitor 2B (CDKN2B) rs523096, ABO rs2073823, phosphodiesterase-3A (PDE3A) rs12314390, and cadherin 13 (CDH13) rs12449180. Glaucoma risk in the high-PRS group was 3.02 times that in the low-PRS group after adjusting for confounding variables. For those with low serum glucose levels (<126 mg/dL), but not for those with high serum glucose levels, glaucoma risk in the high-PRS group was 3.16 times that in the low-PRS group. In those with high carbohydrate intakes (≥70%), but not in those with low carbohydrate intakes, glaucoma risk was 3.74 times higher in the high-PRS group than in the low-PRS group. The glaucoma risk was 3.87 times higher in the high-PRS group than in the low-PRS group only in a low balanced diet intake. In conclusion, glaucoma risk increased by three-fold in adults with a high PRS, and it can be reduced by good control of serum glucose concentrations and blood pressure (BP) with a balanced diet intake. These results can be applied to precision nutrition to reduce glaucoma risk.

Effect of Dairy Protein Intake on Muscle Mass among Korean Adults: A Prospective Cohort Study

This cohort study aimed to identify the associations of dairy protein intake with the risk of developing a low muscle mass during a 12-year follow-up period, using data from 4412 middle-aged Korean Genome and Epidemiology Study participants with a normal baseline muscle mass. Dairy protein intake at baseline was assessed using a semi-quantitative Food Frequency Questionnaire. Skeletal muscle mass index (SMI), defined as the weight-adjusted skeletal muscle mass, was measured biennially using multi-frequency bioelectrical impedance analyses. Cox proportional hazards regression analysis was used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Overall, 395 subjects developed a low SMI (%) during an average follow-up of 141 (19-152) months. The average consumption of milk and other dairy products was 73.6 and 104.1 g/day, respectively. In men, a higher dairy protein intake was associated with a decreased risk of developing a low SMI (tertile 3 [T3] vs. T1, HR: 0.63; 95% CI: 0.42, 0.94; p for trend = 0.029). In a stratified analysis according to a total protein intake, this association was stronger in the lower-protein intake group (HR: 0.59; 95% CI: 0.35, 0.99; p for trend = 0.036) but not detected in the higher-protein intake group. Men who consumed milk ≥1 time/day had a significantly lower risk of developing a low SMI (HR: 0.62; 95% CI: 0.39, 0.98; p for trend = 0.023). No significant associations were observed in women. In summary, dairy consumption appears to be beneficial for decreasing the risk of developing a low muscle mass in middle-aged Korean men.

The Effect of Smoking on the Association between Long-Term Alcohol Consumption and Dyslipidemia in a Middle-Aged and Older Population

AIMS

The joint effects of chronic alcohol consumption and smoking on dyslipidemia remain unclear in a prospective design. This study examined the effect of smoking on the association between long-term alcohol consumption and risk of incident dyslipidemia.

METHODS

A total of 4467 participants (1866 men and 2601women) aged 40-69 years without dyslipidemia were recruited at baseline. Alcohol consumption was assessed biennially using a questionnaire and classified as light, moderate or heavy drinker. Smoking status was examined at baseline and categorized into non-smokers and current smokers. Dyslipidemia was defined as the presence of one or more of following: hypertriglyceridemia (triglyceride ≥200 mg/dL), hypercholesterolemia (total cholesterol ≥240 mg/dL), low high-density lipoprotein-cholesterol (HDL-C) < 40 mg/dL, or high low-density lipoprotein cholesterol ≥160 mg/dL.

RESULTS

During a follow-up period of 12 years, 2872 (64.3%) participants developed dyslipidemia. In non-smoking men, light or moderate alcohol consumption was associated with a lower risk of incident dyslipidemia such as hypertriglyceridemia and hypercholesterolemia, whereas this association was not observed in current smoking men. Unlike non-smokers, the duration of alcohol drinking > 10 years was associated with a higher risk of hypertriglyceridemia in current smoking men (hazard ratio = 1.57, 95% confidence interval: 1.07-2.30, P = 0.020). In addition, alcohol consumption was inversely associated with low HDL-C regardless of smoking status. In women, alcohol consumption was inversely associated with dyslipidemia hypercholesterolemia and low HDL-C regardless of alcohol amount.

CONCLUSION

Smoking crucially confounds the association between long-term alcohol consumption and dyslipidemia, particularly in hypertriglyceridemia and hypercholesterolemia.

Traditional plain yogurt: a therapeutic food for metabolic syndrome?

Dairy products have an important role in a healthy diet due to their high-quality protein and rich micronutrients. Yogurt, a fermented milk product, has a similar composition to milk but is a more concentrated product in terms of group B vitamins, minerals, and proteins. It is known that bioactive metabolites and live enzymes that occur by fermentation and digestion, affect the health positively by improving gut microbiota. In recent years, the prevalence of metabolic syndrome, which threatens public health, is increasing rapidly. As with other noninfectious diseases, the diet has an important effect on the prevention and treatment of metabolic syndrome. It has been demonstrated that yogurt has a high-quality amino acid pattern, reduces energy intake by stimulating satiety, and regulates blood glucose level. In addition to the rich protein variety, yogurt also contains peptides that positively affect blood pressure. Unlike milk, increased acidity during the fermentation of yogurt positively affects calcium absorption. Calcium plays an important role in the control of blood glucose and energy metabolism through insulin-dependent and non-insulin-dependent routes. In addition to reducing inflammation, calcium has a positive effect on the regulation of the blood lipid profile by increasing fecal fat excretion. There are many lipid and lipoid nutrients such as saturated fatty acids, phospholipids, sphingolipids, and conjugated linoleic acid that may affect the blood lipid profile in yogurt positively or negatively. There are seen very few randomized controlled studies that are focused on the relationship between yogurt and metabolic syndrome, and these are based on contradictory results. In this review, based on the clinical studies conducted to date, and the nutrient content of yogurt, possible mechanisms of these contradictory results are investigated.

Association between unhealthy plant-based diets and the metabolic syndrome in adult men and women: a population-based study in South Korea

No studies have investigated the associations between established plant-based diet indices and the metabolic syndrome (MetS). We evaluated the associations between an overall plant-based diet index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI) and the MetS in a nationally representative sample using data from 14 450 Korean adults (≥19 years) in the Korea National Health and Nutrition Examination Survey 2012-2016. Dietary intakes were assessed by a semi-quantitative FFQ. In the PDI, all plant foods received positive scores. In the hPDI, only healthy plant foods received positive scores. In the uPDI, only unhealthy plant foods received positive scores. All indices reverse scored animal food intake. Multivariable logistic regression models were used to examine the associations between three PDI and the MetS by sex, adjusting for potential risk factors. A total of 23·3 % of Korean adults had the MetS. In the overall study population, individuals in the highest quintile of uPDI had greater odds (OR 1·54, 95 % CI 1·28, 1·86, Ptrend < 0·001) of the MetS than those in the lowest quintile. Higher uPDI score was associated with higher odds of hypertriacylglycerolaemia in men and abdominal obesity, high fasting glucose and hypertriacylglycerolaemia in women. No significant associations were observed between PDI, hPDI and the MetS. Greater adherence to unhealthy plant-based diets was associated with greater odds of the MetS and its components suggesting the importance of the quality of plant-based diet in South Korean adults. Sex differences may be considered when recommending plant-based diets for the prevention and management of metabolic diseases.

Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis

IMPORTANCE

Sugar-sweetened beverages (SSBs) are associated with increased risk of metabolic syndrome (MetS). However, the role of other important food sources of fructose-containing sugars in the development of MetS remains unclear.

OBJECTIVE

To examine the association of major food sources of fructose-containing sugars with incident MetS.

DATA SOURCES

MEDLINE, Embase, and Cochrane Library were searched from database inception to March 24, 2020, in addition to manual searches of reference lists from included studies using the following search terms: sugar-sweetened beverages, fruit drink, yogurt, metabolic syndrome, and prospective study.

STUDY SELECTION

Inclusion criteria included prospective cohort studies of 1 year or longer that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study.

DATA EXTRACTION AND SYNTHESIS

Study quality was assessed using the Newcastle-Ottawa Scale. Extreme quantile risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Dose-response analyses were performed using a 1-stage linear mixed-effects model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results were reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines.

MAIN OUTCOMES AND MEASURES

Pooled risk ratio (RR) of incident MetS (pairwise and dose response).

RESULTS

Thirteen prospective cohort studies (49 591 participants [median age, 51 years; range, 6-90 years]; 14 205 with MetS) that assessed 8 fructose-containing foods and MetS were included. An adverse linear dose-response association for SSBs (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86) was found. Fruit juices (mixed and 100%) had a U-shaped dose-response association with protection at moderate doses (mixed fruit juice: RR for 125 mL/d, 0.58; 95% CI, 0.42-0.79; 100% fruit juice: RR for 125 mL/d, 0.77; 95% CI, 0.61-0.97). Honey, ice cream, and confectionary had no association with MetS incidence. The certainty of the evidence was moderate for SSBs, yogurt, fruit, mixed fruit juice, and 100% fruit juice and very low for all other food sources.

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis suggest that the adverse association of SSBs with MetS does not extend to other food sources of fructose-containing sugars, with a protective association for yogurt and fruit throughout the dose range and for 100% fruit juice and mixed fruit juices at moderate doses. Therefore, current policies and guidelines on the need to limit sources of free sugars may need to be reexamined.

Fermented Dairy Products, Probiotic Supplementation, and Cardiometabolic Diseases: A Systematic Review and Meta-analysis

Fermented dairy foods (FDFs) and probiotics are promising tools for the prevention and management of cardiometabolic diseases (CMDs), respectively. The relation between the regular consumption of FDFs and CMD risk factors was assessed by prospective cohort studies (PCSs), and the effect of probiotic supplementation added into a dairy matrix on CMD parameters was evaluated by randomized controlled trials (RCTs). Moreover, the effects of probiotic supplementation added into a dairy matrix were compared with those administered in capsule/powder form. Twenty PCSs and 52 RCTs met the inclusion criteria for the systematic review and meta-analysis. In PCSs, fermented milk was associated with a 4% reduction in risk of stroke, ischemic heart disease, and cardiovascular mortality [RR (95% CI); 0.96 (0.94, 0.98)]; yogurt intake was associated with a risk reduction of 27% [RR (95% CI); 0.73 (0.70, 0.76)] for type 2 diabetes (T2D) and 20% [RR (95% CI); 0.80 (0.74, 0.87)] for metabolic syndrome development. In RCTs, probiotic supplementation added into dairy matrices produced a greater reduction in lipid biomarkers than when added into capsules/powder in hypercholesterolemic subjects, and probiotic supplementation by capsules/powder produced a greater reduction in T2D biomarkers than when added into dairy matrices in diabetic subjects. Both treatments (dairy matrix and capsules/powder) resulted in a significant reduction in anthropometric parameters in obese subjects. In summary, fermented milk consumption is associated with reduced cardiovascular risk, while yogurt intake is associated with a reduced risk of T2D and metabolic syndrome development in the general population. Furthermore, probiotic supplementation added into dairy matrices could be considered beneficial for lowering lipid concentrations and reducing anthropometric parameters. Additionally, probiotic capsule/powder supplementation could contribute to T2D management and reduce anthropometric parameters. However, these results should be interpreted with caution due to the heterogeneity of the studies and the different probiotic strains used in the studies. This trial is registered with PROSPERO (CRD42018091791) and the protocol can be accessed at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018091791.

The Effect of Smoking and Sex on the Association Between Long-term Alcohol Consumption and Metabolic Syndrome in a Middle-aged and Older Population

Background

The effect of smoking and sex on the relationship between alcohol consumption and risk of developing metabolic syndrome (MetS) and its components has not been investigated.

Methods

A total of 5,629 Korean adults aged 40–69 years without MetS were recruited at baseline. Alcohol consumption was assessed biennially, and participants were classified as never, light, moderate, or heavy drinkers. Smoking status was examined at baseline and categorized into non-smokers and current smokers. Risk of incident MetS and its components according to alcohol consumption was examined by smoking status and sex using a multivariate Cox proportional hazards model.

Results

During a follow-up of 12 years, 2,336 participants (41.5%) developed MetS. In non-smokers, light or moderate alcohol drinkers had a lower risk of developing MetS, abdominal obesity, hyperglycemia, hypertriglyceridemia, and low HDL-C compared with never drinkers. Heavy alcohol consumption was associated with a higher risk of incident elevated blood pressure (hazard ratio [HR] 1.48; 95% confidence interval [CI], 1.07–2.06; P = 0.020) in men and abdominal obesity (HR 1.86; 95% CI, 1.06–3.27; P = 0.030) in women. However, in smokers, the inverse association of light or moderate alcohol consumption with hypertriglyceridemia and abdominal obesity was not present, whereas a positive association between heavy alcohol consumption and hyperglycemia (HR 1.39; 95% CI, 1.07–1.80; P = 0.014) was observed.

Conclusions

Smoking status and sex strongly affects the association between long-term alcohol consumption and MetS and its components by the amount of alcohol consumed.

The association between milk consumption and the metabolic syndrome: a cross-sectional study of the residents of Suzhou, China and a meta-analysis

The association between milk consumption and the metabolic syndrome remains inconclusive, and data from Chinese populations are scarce. We conducted a cross-sectional study to investigate the association between milk consumption and the metabolic syndrome and its components among the residents of Suzhou Industrial Park, Suzhou, China. A total of 5149 participants were included in the final analysis. A logistic regression model was applied to estimate the OR and 95 % CI for the prevalence of the metabolic syndrome and its components according to milk consumption. In addition, the results of our study were further meta-analysed with other published observational studies to quantify the association between the highest v. lowest categories of milk consumption and the metabolic syndrome and its components. There was no significant difference in the odds of having the metabolic syndrome between milk consumers and non-milk consumers (OR 0·86, 95 % CI 0·73, 1·01). However, milk consumers had lower odds of having elevated waist circumference (OR 0·78, 95 % CI 0·67, 0·92), elevated TAG (OR 0·83, 95 % CI 0·70, 0·99) and elevated blood pressure (OR 0·85, 95 % CI 0·73, 0·99). When the results were pooled together with other published studies, higher milk consumption was inversely associated with the risk of the metabolic syndrome (relative risk 0·80, 95 % CI 0·72, 0·88) and its components (except elevated fasting blood glucose); however, these results should be treated with caution as high heterogeneity was observed. In summary, the currently available evidence from observational studies suggests that higher milk consumption may be inversely associated with the metabolic syndrome.

Grain Subtype and the Combination of Grains Consumed Are Associated with the Risk of Metabolic Syndrome: Analysis of a Community-Based Prospective Cohort

BACKGROUND

Evidence on the prospective association between grain consumption and metabolic syndrome (MetS) is lacking.

OBJECTIVE

This study explored the association between grain intake by subtype or various combinations of grain intake and the risk of developing MetS in South Korean adults using data from a community-based prospective cohort study.

METHODS

A total of 5717 participants (2984 men and 2733 women) aged 40-69 y without MetS were followed up for 10 y (2001-2012). Grain consumption was assessed using a semiquantitative FFQ at baseline (2001-2002) and a follow-up examination (2005-2006). A multivariate Cox proportional hazards model was used to examine the risk of incident MetS and its components according to grain consumption (<1, 1 to <3, or ≥3 servings/d) by sex.

RESULTS

In total, 2218 participants (38.8%) developed MetS. Frequent consumers of whole grains (≥3 servings/d) had a lower risk of incident MetS (men-HR: 0.51; 95% CI: 0.41, 0.63; P  = 0.0001; women-HR: 0.73; 95% CI: 0.60, 0.90; P = 0.0029), whereas frequent consumers of refined grains had a higher risk of incident MetS (men-HR: 1.63; 95% CI: 1.31, 2.03; P < 0.0001; women-HR: 2.25; 95% CI: 1.82, 2.78; P < 0.0001) compared with rare consumers (<1 serving/d). The combination of low whole grains (<2 servings/d) and high refined grains (≥2 servings/d) was associated with a higher risk of MetS than the combination of high whole grains and low refined grains (men-HR: 1.21; 95% CI: 1.04, 1.41; P = 0.012; women-HR: 1.43; 95% CI: 1.23, 1.66; P < 0.0001).

CONCLUSIONS

Higher consumption of whole grains was associated with lower risk of incident MetS, whereas higher refined-grain consumption was associated with a higher risk in a middle-aged and older Korean population.

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.

Important Food Sources of Fructose-Containing Sugars and Incident Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Background Sugar-sweetened beverages are associated with hypertension. We assessed the relation of important food sources of fructose-containing sugars with incident hypertension using a systematic review and meta-analysis of prospective cohort studies. Methods and Results We searched MEDLINE, EMBASE, and Cochrane (through December week 2, 2018) for eligible studies. For each food source, natural log-transformed risk ratios (RRs) for incident hypertension were pooled using pair-wise meta-analysis and linear and nonlinear dose-response meta-analyses. Certainty in our evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. We identified 26 reports, including 15 prospective cohorts (930 677 participants; 363 459 cases). Sugar-sweetened beverages showed harmful (RRper-355-mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper-240-g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper-125-g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range. One hundred percent fruit juice showed a protective association only at moderate doses (RRat-100-mL, 0.97 [95% CI, 0.94, 0.99]). The pair-wise protective association of dairy desserts was not supported by linear dose-response analysis. Fruit drinks or sweet snacks were not associated with hypertension. Certainty of the evidence was "low" for sugar-sweetened beverages, 100% fruit juice, fruit, and yogurt and "very low" for fruit drinks, sweet snacks, and dairy desserts. Conclusions The harmful association between sugar-sweetened beverages and hypertension does not extend to other important food sources of fructose-containing sugars. Further research is needed to improve our estimates and better understand the dose-response relationship between food sources of fructose-containing sugars and hypertension. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02702375.

Yogurt improves insulin resistance and liver fat in obese women with nonalcoholic fatty liver disease and metabolic syndrome: a randomized controlled trial

BACKGROUND

Because consumption of conventional yogurt has beneficial effects in a healthy population, and insulin resistance (IR) is the mutual pathogenesis in nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), we hypothesized that yogurt would ameliorate IR in patients with NAFLD and MetS.

OBJECTIVES

The aim of this study was to investigate the effects of yogurt on IR and secondary endpoints including liver fat, gut microbiota, and serum biomarkers of inflammation and oxidative stress in obese women with NAFLD and MetS.

METHODS

One hundred obese women aged 36-66 y with both NAFLD and MetS were randomly assigned to consume 220 g/d of either conventional yogurt or milk for 24 wk. At baseline and week 24, we measured anthropometric indices, serum glucose, insulin, lipids, and cytokines in all participants, and liver fat and gut microbiota in 20 participants randomly selected from each group.

RESULTS

Forty-eight participants from the yogurt group and 44 from the milk group completed the intervention. Compared with milk, yogurt significantly decreased the homeostasis model assessment of insulin resistance (-0.53; 95% CI: -1.03, -0.02), fasting insulin (-2.77 mU/L; 95% CI: -4.91, -0.63 mU/L), 2-h insulin (-25.5 mU/L; 95% CI: -33.0, -17.9 mU/L), 2-h area under the curve for insulin (-29.4 mU/L · h; 95% CI: -44.0, -14.8 mU/L · h), alanine aminotransferase (-4.65 U/L; 95% CI: -8.67, -0.64 U/L), intrahepatic lipid (-3.44%; 95% CI: -6.19%, -0.68%), and hepatic fat fraction (-3.48%; 95% CI: -6.34%, -0.63%). Yogurt also decreased serum LPS (-0.31 EU/mL; 95% CI: -0.48, -0.14 EU/mL), fibroblast growth factor 21 (-57.76 pg/mL; 95% CI: -86.32, -29.19 pg/mL), lipids, and biomarkers of inflammation and oxidative stress, and altered gut microbiota composition. Mediation analysis showed that yogurt may improve IR by reducing serum lipids, inflammation, oxidative stress, and LPS.

CONCLUSIONS

Yogurt was better than milk at ameliorating IR and liver fat in obese Chinese women with NAFLD and MetS, possibly by improving lipid metabolism, reducing inflammation, oxidative stress, and LPS, and changing the gut microbiota composition. This trial was registered at www.chictr.org.cn as ChiCTR-IPR-15006801.

Dairy Product Consumption in the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Previous meta-analyses have associated dairy products with a lower risk of metabolic syndrome (MetS). Since then, new studies evaluating not only total dairy but also different subtypes have been published in this field. The objective of the present work was to systematically review and meta-analyze the epidemiologic studies regarding the associations between the consumption of total dairy products and subtypes (milk, yogurt, and cheese) and the incidence of MetS. Relevant studies were identified through Medline and Cochrane databases. Eligible studies were prospective cohort studies that examined the association between dairy product consumption and/or different subtypes of dairy and the risk of MetS. Random-effects or fixed-effects models were assigned to calculate the pooled RR estimates with 95% CIs. From the 2994 identified articles, 12 and 11 studies were included for the qualitative and quantitative synthesis, respectively. After comparing the highest with the lowest categories, total dairy product consumption was inversely associated with the risk of MetS (9 study comparisons; RR: 0.73; 95% CI: 0.64, 0.83). Low-fat dairy and total yogurt consumption were inversely associated with the risk of MetS (low-fat dairy: 2 study comparisons; RR: 0.77; 95% CI: 0.65, 0.91; total yogurt consumption: 4 study comparisons; RR: 0.74; 95% CI: 0.66, 0.82). The linear RR per 1 serving of yogurt/d was 0.77 (95% CI: 0.60, 1.00). Low-fat yogurt and whole-fat yogurt were inversely associated with the risk of MetS (low-fat yogurt: 2 study comparisons; RR: 0.72; 95% CI: 0.62, 0.84; whole-fat yogurt: 2 study comparisons; RR: 0.81; 95% CI: 0.70, 0.94). Total milk consumption was inversely associated with the risk of MetS (6 study comparisons; RR: 0.79; 95% CI: 0.64, 0.97). Whole-fat dairy consumption was not associated with MetS risk. Our findings suggest that the consumption of total and low-fat dairy products, milk, and yogurt is inversely associated with the risk of MetS. The study protocol is available at https://www.crd.york.ac.uk/PROSPERO/ as CRD42018082480.

Food Groups and Risk of Overweight, Obesity, and Weight Gain: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

This meta-analysis summarizes the evidence of a prospective association between the intake of foods [whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSBs)] and risk of general overweight/obesity, abdominal obesity, and weight gain. PubMed and Web of Science were searched for prospective observational studies until August 2018. Summary RRs and 95% CIs were estimated from 43 reports for the highest compared with the lowest intake categories, as well as for linear and nonlinear relations focusing on each outcome separately: overweight/obesity, abdominal obesity, and weight gain. The quality of evidence was evaluated with use of the NutriGrade tool. In the dose-response meta-analysis, inverse associations were found for whole-grain (RRoverweight/obesity: 0.93; 95% CI: 0.89, 0.96), fruit (RRoverweight/obesity: 0.93; 95% CI: 0.86, 1.00; RRweight gain: 0.91; 95% CI: 0.86, 0.97), nut (RRabdominal obesity: 0.42; 95% CI: 0.31, 0.57), legume (RRoverweight/obesity: 0.88; 95% CI: 0.84, 0.93), and fish (RRabdominal obesity: 0.83; 95% CI: 0.71, 0.97) consumption and positive associations were found for refined grains (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.10), red meat (RRabdominal obesity: 1.10; 95% CI: 1.04, 1.16; RRweight gain: 1.14; 95% CI: 1.03, 1.26), and SSBs (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.11; RRabdominal obesity: 1.12; 95% CI: 1.04, 1.20). The dose-response meta-analytical findings provided very low to low quality of evidence that certain food groups have an impact on different measurements of adiposity risk. To improve the quality of evidence, better-designed observational studies, inclusion of intervention trials, and use of novel statistical methods (e.g., substitution analyses or network meta-analyses) are needed.

Novel perspectives on fermented milks and cardiometabolic health with a focus on type 2 diabetes

This review will explore the observational and mechanistic evidence supporting the hypothesis that fermented milk consumption has beneficial effects on metabolism. Live cultures in fermented dairy are thought to contribute to gut microbial balance, which is likely an instrumental mechanism that protects the host against gut dysbiosis and systemic inflammation associated with cardiometabolic diseases. Lactic acid bacteria (LAB) release bioactive metabolites, such as exopolysaccharides and peptides, that have the potential to exert a wide range of metabolic and regulatory functions. In particular, peptides derived from fermented dairy products are likely to exert greater cardiometabolic and anti-inflammatory effects than nonfermented dairy. It is hypothesized that LAB-derived bioactive peptides have the potential to protect the host against cardiometabolic diseases through antimicrobial actions and to effect changes in gene expression of glucose regulatory and anti-inflammatory signaling pathways. The peptides released through fermentation may explain some of the health effects of fermented dairy products on cardiometabolic disease risk observed in epidemiological studies, particularly type 2 diabetes; however, mechanisms have yet to be explored in detail.

Egg consumption is associated with a lower risk of type 2 diabetes in middle-aged and older men

BACKGROUND/OBJECTIVES

This prospective study examined gender-specific associations between egg intake and the risk of developing type 2 diabetes using data from a large-scale cohort study.

SUBJECTS/METHODS

A total of 7,002 Korean adults (40–69 years) without type 2 diabetes at baseline were analyzed. Dietary intake was evaluated by a food frequency questionnaire administered at baseline (2001–2002) and the second follow-up examination (2005–2006). Type 2 diabetes was diagnosed as a fasting glucose concentration ≥ 126 mg/dL or current use of glucose-lowering medications or insulin injection. Multivariate Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident type 2 diabetes according to egg consumption or cholesterol intake.

RESULTS

During a 14-year follow up period, 857 subjects developed type 2 diabetes. In men, frequent egg intake (2- < 4 servings/week) was associated with a 40% lower risk of developing type 2 diabetes than infrequent egg intake (0- < 1 serving/week) (HR = 0.60, 95% CI: 0.37–0.97), whereas no association between egg intake and incidence of type 2 diabetes was observed in women (HR = 0.61, 95% CI: 0.27–1.37). There was no association between cholesterol intake and risk of incident type 2 diabetes in either men or women.

CONCLUSIONS

Egg consumption was inversely related to the risk of incident type 2 diabetes in men, but not in women, suggesting gender differences in the relationship between diet and disease risk.

Dairy food consumption is associated with a lower risk of the metabolic syndrome and its components: a systematic review and meta-analysis

A systematic review and a meta-analysis of observational studies were performed to assess the dose–response relationship between specific types of dairy foods and the risk of the metabolic syndrome (MetS) and its components. Studies of dairy foods and the risk of the MetS and its components published up to June 2016 were searched using PubMed, EMBASE and a reference search. Random-effects models were used to estimate the pooled relative risks (RR) with 95 % CI. Finally, ten cross-sectional studies, two nested case–control studies and twenty-nine cohort studies were included for the analysis. In a dose–response analysis of cohort studies and cross-sectional studies, the pooled RR of the MetS for a one-serving/d increment of total dairy food (nine studies) and milk (six studies) consumption (200 g/d) were 0·91 (95 % CI 0·85, 0·96) and 0·87 (95 % CI 0·79, 0·95), respectively. The pooled RR of the MetS for yogurt (three studies) consumption (100 g/d) was 0·82 (95 % CI 0·73, 0·91). Total dairy food consumption was associated with lower risk of MetS components, such as hyperglycaemia, elevated blood pressure, hypertriacylglycerolaemia and low HDL- cholesterol. A one-serving/d increment of milk was related to a 12 % lower risk of abdominal obesity, and a one-serving/d increment of yogurt was associated with a 16 % lower risk of hyperglycaemia. These associations were not significantly different by study design, study location or adjustment factors. This meta-analysis showed that specific types of dairy food consumption such as milk and yogurt as well as total dairy food consumption were inversely related to risk of the MetS and its components.

Casein Hydrolysate with Glycemic Control Properties: Evidence from Cells, Animal Models, and Humans

Evidence exists to support the role of dairy derived proteins whey and casein in glycemic management. The objective of the present study was to use a cell screening method to identify a suitable casein hydrolysate and to examine its ability to impact glycemia related parameters in an animal model and in humans. Following screening for the ability to stimulate insulin secretion in pancreatic beta cells, a casein hydrolysate was selected and further studied in the ob/ob mouse model. An acute postprandial study was performed in 62 overweight and obese adults. Acute and long-term supplementation with the casein hydrolysate in in vivo studies in mice revealed a glucose lowering effect and a lipid reducing effect of the hydrolysate (43% reduction in overall liver fat). The postprandial human study revealed a significant increase in insulin secretion ( p = 0.04) concomitant with a reduction in glucose ( p = 0.03). The area under the curve for the change in glucose decreased from 181.84 ± 14.6 to 153.87 ± 13.02 ( p = 0.009). Overall, the data supports further work on the hydrolysate to develop into a functional food product.

A Healthy Beverage Consumption Pattern Is Inversely Associated with the Risk of Obesity and Metabolic Abnormalities in Korean Adults

As the use of beverages in diets is increasing, several studies have examined the effect of beverage consumption in human health. Thus, we aimed at identifying specific beverage patterns and determining their associations with obesity and metabolic syndrome (MetS) risk factors in Korean adults. Based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2012 data, 19,800 Korean adults (≥20 years) with a single 24-h dietary recall and health examination data were investigated. All beverage items consumed by participants were categorized into 15 beverage groups based on the KNHANES coding system. Three major beverage consumption patterns were identified according to factor analysis: (1) the "healthy beverage" (high intake of dairy products, 100% fruit/vegetable juices and low intake of alcoholic beverages); (2) the "sugar-sweetened beverage" (high intake of soda, sweetened coffee/tea, and fruit drink); and (3) the "unsweetened beverage" (high intake of unsweetened coffee) patterns. Multivariable logistic regression analyses were conducted to determine the odds of obesity (body mass index ≥25 kg/m²) and MetS (defined by National Cholesterol Education Program III [NCEP III]) for each beverage pattern after controlling for covariates. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations of the "healthy beverage" pattern with risks of obesity, abdominal obesity, and elevated triglycerides, fasting blood glucose (FBG), and blood pressure (BP) were 0.88 (0.79-0.98), 0.83 (0.74-0.92), 0.88 (0.78-0.99), 0.85 (0.79-0.98), and 0.81 (0.72-0.92), respectively. AORs (95% CIs) of associations of the "sugar-sweetened beverage" pattern with risks of abdominal obesity, elevated FBG and BP were 1.15 (1.03-1.30), 1.14 (1.01-1.29), and 1.18 (1.04-1.33), respectively. However, no associations were found between the "unsweetened beverage" pattern and any parameters examined. Intake of healthy beverages should be encouraged to reduce risks of obesity and metabolic abnormalities; however, individuals who consume sugar-sweetened beverages should be advised on the adverse effects of those beverages on the risk of obesity and MetS.

Association between Dietary Pattern and Incidence of Cholesterolemia in Korean Adults: The Korean Genome and Epidemiology Study

We examined the gender-specific association between dietary pattern and risk of developing cholesterolemia based on the data from the Korean Genome and Epidemiology study. A total of 7515 individuals aged 40–69 years participated in this study between 2005 and 2010. Dietary intake was assessed by a semi-quantitative food frequency questionnaire. Low HDL cholesterolemia was defined as a plasma HDL-C level <1.04 mmol/L (men) or <1.30 mmol/L (women), and high LDL cholesterolemia was defined as a plasma LDL-C level >3.37 mmol/L. Multivariate Cox proportional hazard models were used to examine the risk for incident cholesterolemia according to dietary pattern score. Four dietary patterns were derived by gender using factor analysis: prudent pattern; coffee, fat, and sweet pattern; whole grain (men) or white rice and noodle (women) pattern; and westernized pattern. A prudent pattern was inversely associated with risk of low HDL cholesterolemia in both men (Hazard ratio (HR) = 0.76, p for trend = 0.0098) and women (HR = 0.78, p for trend = 0.0324), whereas the coffee, fat, and sweet pattern was positively associated with risk of high LDL cholesterolemia in men only (HR = 1.26, p for trend = 0.0254) after adjustment for potential confounders. Specific dietary patterns were associated with risk of developing cholesterolemia suggesting gender differences.

Association between Milk Consumption and Metabolic Syndrome among Korean Adults: Results from the Health Examinees Study

It has been suggested that a greater dairy consumption, particularly of milk, may have contributed in lowering the prevalence of metabolic syndrome (MetS). A cross-sectional analysis was conducted to examine the association between milk consumption and MetS, and its components among Korean adults aged 40–69. A total of 130,420 subjects (43,682 men and 86,738 women) from the Health Examinees Study were selected for the final analysis. Milk consumption was estimated using a validated 106-item food frequency questionnaire. MetS was defined using the National Cholesterol Education Program, Adult Treatment Panel III (NCEP III). Logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) between milk consumption and MetS after adjusting for potential confounders. In this study, the average milk consumption was 77.9 g/day, with the overall prevalence of MetS being 26.1% (29.1% in men and 24.6% in women). We found that the prevalence of the MetS was significantly lower in subjects with higher milk consumption (p < 0.0001). Adjusted OR for MetS was significantly lower in the highest milk consumption category (≥1 serving/day among men; ≥2 serving/day among women) than those in the lowest milk consumption category (OR: 0.92 95%CI: 0.86–0.99, p trend = 0.0160 in men; OR: 0.68, 95%CI: 0.60–0.76, p trend < 0.0001 in women). Overall, higher milk consumption was inversely associated with the MetS components: elevated waist circumference, elevated triglyceride, and reduced high-density lipoprotein cholesterol (HDL-C) (all p trend < 0.05). This study concludes that higher milk consumption is associated with the lower odds of MetS in Korean adults.