The framingham risk score, diet, and inflammatory markers in Korean men with metabolic syndrome

  • Sohn, Cheong-Min (Major in Food and Nutrition, Wonkwang University) ;
  • Kim, Ju-Yong (Health Promotion Center, Seoul National University of Bundang Hospital) ;
  • Bae, Woo-Kyung (Health Promotion Center, Seoul National University of Bundang Hospital)
  • Received : 2011.11.03
  • Accepted : 2012.05.24
  • Published : 2012.06.30


The Framingham risk score (FRS) has been used to assess the risk of a cardiovascular event and to identify patients for risk factor modifications. Therefore, the purpose of this study was to evaluate the relationship of the FRS with dietary intake and inflammatory biomarkers. We conducted a cross-sectional study of 180 men ($49.2{\pm}10.2$ years) with MS. Serum levels of high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and adiponectin were examined. Participants were asked to complete the food frequency questionnaire (FFQ) using the previous 1 year as a reference point. The absolute cardiovascular disease (CVD) risk percentage over 10 years was calculated to estimate the FRS, which was classified as low risk (< 10%), intermediate risk (10-20%), and high risk (> 20%). Mean intake of polyunsaturated fatty acids was lower in subjects who had > 20% FRS than in subjects who had < 10% FRS ($3.7{\pm}1.9$ g/day vs. $4.7{\pm}1.9$ g/day; P < 0.05). Significant differences in the Index of Nutritional Quality of protein, phosphorus, iron, vitamin A, vitamin $B_1$, niacin, vitamin $B_6$, and vitamin C were observed between the > 20% FRS group and the < 10% FRS group (P < 0.05). IL-6 concentrations were significantly lower in subjects with a < 10% FRS than in subjects who were 10-20% FRS or > 20% FRS ($0.91{\pm}0.26$ vs. $1.48{\pm}033$ vs. $2.72{\pm}0.57$ pg/mL, respectively; P < 0.05). IL-6 and dietary intake of polyunsaturated fatty acids together explained 6.6% of the variation in FRS levels in a stepwise multiple regression model. Our results provide some evidence that dietary intake in the higher CVD risk group was inferior to that in the lower risk group and that dietary fat intake and IL-6 were associated with FRS and MS in Korean men.


  1. de Wit NJ, Bosch-Vermeulen H, Oosterink E, Muller M, van der Meer R. Supplementary dietary calcium stimulates faecal fat and bile acid excretion, but does not protect against obesity and insulin resistance in C57BL/6J mice. Br J Nutr 2011;105:1005-11.
  2. Huang RF, Hsu YC, Lin HL, Yang FL. Folate depletion and elevated plasma homocysteine promote oxidative stress in rat livers. J Nutr 2001;131:33-8.
  3. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 2006;48:677-85.
  4. Martensson J, Meister A. Glutathione deficiency decreases tissue ascorbate levels in newborn rats: ascorbate spares glutathione and protects. Proc Natl Acad Sci U S A 1991;88:4656-60.
  5. Moreau KL, Gavin KM, Plum AE, Seals DR. Ascorbic acid selectively improves large elastic artery compliance in postmenopausal women. Hypertension 2005;45:1107-12.
  6. Schectman G, Byrd JC, Gruchow HW. The influence of smoking on vitamin C status in adults. Am J Public Health 1989;79:158-62.
  7. Lecomte E, Herbeth B, Pirollet P, Chancerelle Y, Arnaud J, Musse N, Paille F, Siest G, Artur Y. Effect of alcohol consumption on blood antioxidant nutrients and oxidative stress indicators. Am J Clin Nutr 1994;60:255-61.
  8. The Korean Nutrition Society. Dietary Reference Intakes for Koreans. Seoul: Hanaleum Publisher Co.; 2010.
  9. Massaro M, Scoditti E, Carluccio MA, De Caterina R. Nutraceuticals and prevention of atherosclerosis: focus on omega-3 polyunsaturated fatty acids and Mediterranean diet polyphenols. Cardiovasc Ther 2010;28:e13-9.
  10. Laugerette F, Vors C, Peretti N, Michalski MC. Complex links between dietary lipids, endogenous endotoxins and metabolic inflammation. Biochimie 2011;93:39-45.
  11. Ahn Y, Lee JE, Cho NH, Shin C, Park C, Oh BS, Kimm K. Validation and calibration of semi-quantitative food frequency questionnaire: with participants of the Korean Health and Genome Study. Korean J Community Nutr 2004;9:173-82.
  12. Hansen RG, Wyse BW. Expression of nutrient allowances per 1,000 kilocalories. J Am Diet Assoc 1980;76:223-7.
  13. Choi MC, Song YH, Rhee SY, Woo JT. Framingham risk scores by occupational group: based on the 3rd Korean National Health and Nutrition Examination Survey. Korean J Occup Environ Med 2009;21:63-75.
  14. Kim KA, Kim JS, Kim MS. Predictors of coronary heart disease risk in healthy men and women. J Korean Acad Nurs 2007;37:1039-48.
  15. Lim DM, Park KY, Kim BJ, Lee KW, Lee MJ, Yom YS, Koh GP. Cardiovascular risk according to the components of metabolic syndrome in type 2 diabetes. Korean Clin Diabetes 2009;10:196-203.
  16. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest 2005;115:1111-9.
  17. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 2004;114:1752-61.
  18. Palmieri VO, Grattagliano I, Portincasa P, Palasciano G. Systemic oxidative alterations are associated with visceral adiposity and liver steatosis in patients with metabolic syndrome. J Nutr 2006;136:3022-6.
  19. Ford ES, Giles WH. Serum C-reactive protein and fibrinogen concentrations and self-reported angina pectoris and myocardial infarction: findings from National Health and Nutrition Examination Survey III. J Clin Epidemiol 2000;53:95-102.
  20. Brindle P, Beswick A, Fahey T, Ebrahim S. Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review. Heart 2006;92:1752-9.
  21. D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001;286:180-7.
  22. Nishida M, Moriyama T, Ishii K, Takashima S, Yoshizaki K, Sugita Y, Yamauchi-Takihara K. Effects of IL-6, adiponectin, CRP and metabolic syndrome on subclinical atherosclerosis. Clin Chim Acta 2007;384:99-104.
  23. Danesh J, Kaptoge S, Mann AG, Sarwar N, Wood A, Angleman SB, Wensley F, Higgins JP, Lennon L, Eiriksdottir G, Rumley A, Whincup PH, Lowe GD, Gudnason V. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS Med 2008;5:e78.
  24. Matsuzawa Y, Funahashi T, Kihara S, Shimomura I. Adiponectin and metabolic syndrome. Arterioscler Thromb Vasc Biol 2004;24:29-33.
  25. Van der Vijver LP, van der Waal MA, Weterings KG, Dekker JM, Schouten EG, Kok FJ. Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants. Int J Epidemiol 1992;21:36-9.
  26. Panagiotakos DB, Dimakopoulou K, Katsouyanni K, Bellander T, Grau M, Koenig W, Lanki T, Pistelli R, Schneider A, Peters A; AIRGENE Study Group. Mediterranean diet and inflammatory response in myocardial infarction survivors. Int J Epidemiol 2009;38:856-66.
  27. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440-6.
  28. Min C, Noh H, Kang YS, Sim HJ, Baik HW, Song WO, Yoon J, Park YH, Joung H. Skipping breakfast is associated with diet quality and metabolic syndrome risk factors of adults. Nutr Res Pract 2011;5:455-63.
  29. Kang M, Joung H, Lim JH, Lee YS, Song YJ. Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr 2011;44:152-61.
  30. Yoo HJ, Kim Y. A study on the characteristics of nutrient intake in metabolic syndrome subjects. Korean J Nutr 2008;41:510-7.
  31. Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001;103:1813-8.
  32. de Ferranti SD, Rifai N. C-reactive protein: a nontraditional serum marker of cardiovascular risk. Cardiovasc Pathol 2007;16:14-21.
  33. Herder C, Schottker B, Rothenbacher D, Roden M, Kolb H, Muller H, Brenner H. Interleukin-6 in the prediction of primary cardiovascular events in diabetes patients: results from the ESTHER study. Atherosclerosis 2011;216:244-7.
  34. Ai M, Otokozawa S, Asztalos BF, White CC, Cupples LA, Nakajima K, Lamon-Fava S, Wilson PW, Matsuzawa Y, Schaefer EJ. Adiponectin: an independent risk factor for coronary heart disease in men in the Framingham offspring study. Atherosclerosis 2011;217:543-8.
  35. Alissa EM, Bahjri SM, Al-Ama N, Ahmed WH, Ferns GA. High cardiovascular risk in young Saudi males: cardiovascular risk factors, diet and inflammatory markers. Clin Chim Acta 2006;365:288-96.
  36. Kim M, Kim J, Bae W, Kim S, Lee Y, Na W, Sohn C. Relationship between nutrients intakes, dietary quality, and serum concentrations of inflammatory markers in metabolic syndrome patients. Korean J Community Nutr 2011;16:51-61.
  37. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.
  38. Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ, Pio JR, Williams GR. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004;110:1245-50.
  39. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-16.
  40. Ministry of Health and Welfare. Korean National Health and Nutrition Examination Survey Report. Seoul: Ministry of Health and Welfare; 2005.
  41. Oh SW. Obesity and metabolic syndrome in Korea. Diabetes Metab J 2011;35:561-6.
  42. Leaverton PE, Sorlie PD, Kleinman JC, Dannenberg AL, Ingster-Moore L, Kannel WB, Cornoni-Huntley JC. Representativeness of the Framingham risk model for coronary heart disease mortality: a comparison with a national cohort study. J Chronic Dis 1987;40:775-84.
  43. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.
  44. Liew SM, Doust J, Glasziou P. Cardiovascular risk scores do not account for the effect of treatment: a review. Heart 2011;97:689-97.
  45. Albert MA, Glynn RJ, Ridker PM. Plasma concentration of C-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation 2003;108:161-5.
  46. Ford ES, Giles WH, Mokdad AH. The distribution of 10-year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol 2004;43:1791-6.
  47. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH, Kromhout D, Nedeljkovic S, Punsar S, Seccareccia F, Toshima H. The diet and 15-year death rate in the seven countries study. Am J Epidemiol 1986;124:903-15.
  48. Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS. Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study. Am J Clin Nutr 1997;65:1882-6.
  49. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
  50. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004;292:1433-9.
  51. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005;28:1769-78.
  52. Garber AJ. The metabolic syndrome. Med Clin North Am 2004;88:837-46.
  53. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9.

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