Journal of Nutrition and Health

  • 제52권4호
  • /
  • Pages.354-368
  • /
  • 2019
  • /
  • 2288-3886(pISSN)
  • /
  • 2288-3959(eISSN)
한국영양학회 (The Korean Nutrition Society)
권호 표지
DOI QR코드

DOI QR Code

GL 예측모델 (estimated Glycemic Load, eGL)을 활용한 한국 성인의 식사 평가 및 대사질환 지표와의 연관성 연구 : 2013~2016년 국민건강영양조사 자료를 활용하여

Estimated glycemic load (eGL) of mixed meals and its associations with cardiometabolic risk factors among Korean adults: data from the 2013~2016 Korea National Health and Nutrition Examination Survey

  • 하경호 (서울대학교 보건대학원 보건학과) ;
  • 남기선 ((주)풀무원 풀무원기술원) ;
  • 송윤주 (가톨릭대학교 생활과학부 식품영양학전공)
  • Ha, Kyungho (Department of Public Health, Graduate School of Public Health, Seoul National University) ;
  • Nam, Kisun (Health & Nutrition Research Center, Pulmuone Co., Ltd.) ;
  • Song, YoonJu (Major of Food and Nutrition, The Catholic University of Korea)
  • 투고 : 2019.03.20
  • 심사 : 2019.06.27
  • 발행 : 2019.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구는 2013 ~ 2016년 국민건강영양조사 자료를 이용하여 우리나라 만 19세 이상 성인의 식사내 다량영양소 및 식이섬유 구성성분을 이용하여 혼합식 섭취에 따른 혈당반응인 당흡수지수를 추정하였고, 1일 총 당흡수지수를 이용하여 한국 성인의 영양소 및 식품군 섭취량을 평가하고, 당흡수지수와 대사질환 지표와의 연관성을 확인하였다. 당흡수지수는 탄수화물 및 식이섬유 섭취량과는 양의 상관관계를 나타냈고, 지방 및 단백질 섭취량과는 음의 상관관계를 나타냈다. 당흡수지수가 증가할수록 탄수화물 섭취량이 두드러지게 증가하였으나, 탄수화물에 비해 식이섬유가 차지하는 비율은 현저히 감소하였다. 또한, 연구대상자의 곡류 및 과일류 섭취량은 당흡수지수가 증가함에 따라 유의하게 증가한 반면, 고기 생선 달걀 콩류의 섭취량은 당흡수지수가 증가함에 따라 유의하게 감소하였다. 당흡수지수는 이상지질혈증 위험도와 양의 연관성을 나타냈으며, 당흡수지수가 가장 높은 그룹의 남성은 가장 낮은 그룹의 남성에 비해 고콜레스테롤혈증 교차비가 유의하게 높았다. 이상과 같은 연구결과를 종합하여 보았을 때, 한국 성인의 혼합식 섭취에 기초한 당흡수지수는 다량 영양소 및 식이섬유의 섭취량을 함께 반영하므로 기존의 탄수화물 섭취량만을 평가한 지표에 비해 전반적인 식사계획 및 평가에 적합한 지표인 것으로 사료된다. 일부 대사질환 지표가 당흡수지수와 유의한 연관성을 나타냈으므로, 향후 식사의 질과 대사질환 지표와의 관련성을 고려한 당흡수지수의 적절한 수준이 모색된다면 식이 조절을 위한 식단계획, 영양교육 및 식품표시에 유용한 도구로 사용될 수 있을 것으로 기대된다.

Purpose: This study evaluated the glycemic response of diets using estimated glycemic load (eGL), which had been developed for mixed meals for Korean adults, and examined its associations with cardiometabolic risk factors among Korean adults. Methods: A total of 4,655 men and 6,760 women aged 19 years and above were included from the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey. eGL was calculated by each meal (breakfast, lunch, dinner, and snack) and then summed to give daily total eGL. A multiple logistic regression analysis was used to examine the association. Results: Mean daily total eGL was 112.6 in men and 99.3 in women. Daily total eGL was positively associated with carbohydrate and fiber intakes, but negatively associated with protein and fat intakes in both men and women (p < 0.05 for all). Daily total eGL showed an inverse association with HDL-cholesterol level in both men and women (p = 0.0036 for men and p = 0.0008 for women). Men in the highest quintile of daily total eGL showed a 66% increased risk of hypercholesterolemia (OR, 1.66; 95% CI, 1.10 ~ 2.50; p for trend = 0.0447) compared with those in the lowest quintile. Conclusion: These findings suggest that eGL based on carbohydrate, protein, fat and fiber intakes can reflect glycemic response and therefore can be used as an index for dietary planning, nutrition education and in the food industry.

키워드

참고문헌

  1. Barasi M. Human nutrition: a health perspective. 2nd edition. Boca Raton (FL): CRC Press; 2003.
  2. Choi H, Song S, Kim J, Chung J, Yoon J, Paik HY, et al. High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults. Nutr Res 2012; 32(2): 100-106. https://doi.org/10.1016/j.nutres.2011.12.013
  3. Feng R, Du S, Chen Y, Zheng S, Zhang W, Na G, et al. High carbohydrate intake from starchy foods is positively associated with metabolic disorders: a cohort study from a Chinese population. Sci Rep 2015; 5(1): 16919. https://doi.org/10.1038/srep16919
  4. Song S, Song WO, Song Y. Dietary carbohydrate and fat intakes are differentially associated with lipid abnormalities in Korean adults. J Clin Lipidol 2017; 11(2): 338-347. e3. https://doi.org/10.1016/j.jacl.2017.01.016
  5. Ha K, Kim K, Chun OK, Joung H, Song Y. Differential association of dietary carbohydrate intake with metabolic syndrome in the US and Korean adults: data from the 2007-2012 NHANES and KNHANES. Eur J Clin Nutr 2018; 72(6): 848-860. https://doi.org/10.1038/s41430-017-0031-8
  6. Song S, Lee JE, Song WO, Paik HY, Song Y. Carbohydrate intake and refined-grain consumption are associated with metabolic syndrome in the Korean adult population. J Acad Nutr Diet 2014; 114(1): 54-62. https://doi.org/10.1016/j.jand.2013.08.025
  7. Villegas R, Liu S, Gao YT, Yang G, Li H, Zheng W, et al. Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. Arch Intern Med 2007; 167(21): 2310-2316. https://doi.org/10.1001/archinte.167.21.2310
  8. Sluijs I, van der Schouw YT, van der A DL, Spijkerman AM, Hu FB, Grobbee DE, et al. Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study. Am J Clin Nutr 2010; 92(4): 905-911. https://doi.org/10.3945/ajcn.2010.29620
  9. Nanri A, Mizoue T, Noda M, Takahashi Y, Kato M, Inoue M, et al. Rice intake and type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study. Am J Clin Nutr 2010; 92(6): 1468-1477. https://doi.org/10.3945/ajcn.2010.29512
  10. Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, et al. White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med 2010; 170(11): 961-969. https://doi.org/10.1001/archinternmed.2010.109
  11. Ha K, Joung H, Song Y. Inadequate fat or carbohydrate intake was associated with an increased incidence of type 2 diabetes mellitus in Korean adults: a 12-year community-based prospective cohort study. Diabetes Res Clin Pract 2019; 148: 254-261. https://doi.org/10.1016/j.diabres.2019.01.024
  12. Sakurai M, Nakamura K, Miura K, Takamura T, Yoshita K, Nagasawa SY, et al. Dietary carbohydrate intake, presence of obesity and the incident risk of type 2 diabetes in Japanese men. J Diabetes Investig 2016; 7(3): 343-351. https://doi.org/10.1111/jdi.12433
  13. Song S, Song Y. Three types of a high-carbohydrate diet are differently associated with cardiometabolic risk factors in Korean adults. Eur J Nutr 2018.
  14. Fung TT, Hu FB, Pereira MA, Liu S, Stampfer MJ, Colditz GA, et al. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 2002; 76(3): 535-540. https://doi.org/10.1093/ajcn/76.3.535
  15. Kyro C, Tjonneland A, Overvad K, Olsen A, Landberg R. Higher Whole-Grain intake is associated with lower risk of type 2 diabetes among middle-aged men and women: the Danish diet, cancer, and health cohort. J Nutr 2018; 148(9): 1434-1444. https://doi.org/10.1093/jn/nxy112
  16. Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000; 71(6): 1455-1461. https://doi.org/10.1093/ajcn/71.6.1455
  17. Beulens JW, de Bruijne LM, Stolk RP, Peeters PH, Bots ML, Grobbee DE, et al. High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middleaged women: a population-based follow-up study. J Am Coll Cardiol 2007; 50(1): 14-21. https://doi.org/10.1016/j.jacc.2007.02.068
  18. Burger KN, Beulens JW, Boer JM, Spijkerman AM, van der A DL. Dietary glycemic load and glycemic index and risk of coronary heart disease and stroke in Dutch men and women: the EPIC-MORGEN study. PLoS One 2011; 6(10): e25955. https://doi.org/10.1371/journal.pone.0025955
  19. Yu D, Shu XO, Li H, Xiang YB, Yang G, Gao YT, et al. Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. Am J Epidemiol 2013; 178(10): 1542-1549. https://doi.org/10.1093/aje/kwt178
  20. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 2004; 80(2): 348-356. https://doi.org/10.1093/ajcn/80.2.348
  21. Sakurai M, Nakamura K, Miura K, Takamura T, Yoshita K, Morikawa Y, et al. Dietary glycemic index and risk of type 2 diabetes mellitus in middle-aged Japanese men. Metabolism 2012; 61(1): 47-55. https://doi.org/10.1016/j.metabol.2011.05.015
  22. Hermansen ML, Eriksen NM, Mortensen LS, Holm L, Hermansen K. Can the Glycemic Index (GI) be used as a tool in the prevention and management of type 2 diabetes? Rev Diabet Stud 2006; 3(2): 61-71. https://doi.org/10.1900/RDS.2006.3.61
  23. Venn BJ, Green TJ. Glycemic index and glycemic load: measurement issues and their effect on diet-disease relationships. Eur J Clin Nutr 2007; 61 Suppl 1: S122-S131. https://doi.org/10.1038/sj.ejcn.1602942
  24. Sun L, Ranawana DV, Leow MK, Henry CJ. Effect of chicken, fat and vegetable on glycaemia and insulinaemia to a white rice-based meal in healthy adults. Eur J Nutr 2014; 53(8): 1719-1726. https://doi.org/10.1007/s00394-014-0678-z
  25. Meng H, Matthan NR, Ausman LM, Lichtenstein AH. Effect of macronutrients and fiber on postprandial glycemic responses and meal glycemic index and glycemic load value determinations. Am J Clin Nutr 2017; 105(4): 842-853. https://doi.org/10.3945/ajcn.116.144162
  26. Camps SG, Lim J, Ishikado A, Inaba Y, Suwa M, Matsumoto M, et al. Co-ingestion of rice bran soymilk or plain soymilk with white bread: effects on the glycemic and insulinemic response. Nutrients 2018; 10(4): 449. https://doi.org/10.3390/nu10040449
  27. Park MH, Chung SJ, Shim JE, Jang SH, Nam KS. Effects of macronutrients in mixed meals on postprandial glycemic response. J Nutr Health 2018; 51(1): 31-39. https://doi.org/10.4163/jnh.2018.51.1.31
  28. Nam KS, Nam SW, Shim JE, Yeo IH, Jang EH, inventors. Pulmuone Holdings Co. Ltd., assignee. Development of food calorie index and food nutrition labelling system. Korean patent KR20150135917; 2014 May 26.
  29. Willett W. Nutritional epidemiology. 3rd edition. New York (NY): Oxford University Press; 2012.
  30. Yeon JY, Bae YJ. Evaluation of the meal variety with eating breakfast together as a family in Korean children: based on 2013 - 2015 Korean National Health and Nutrition Examination Survey. J Nutr Health 2018; 51(1): 50-59. https://doi.org/10.4163/jnh.2018.51.1.50
  31. Yeon S, Oh K, Kweon S, Hyun T. Development of a dietary fiber consumption table and intakes of dietary fiber in Korea National Health and Nutrition Examination Survey (KNHANES). Korean J Community Nutr 2016; 21(3): 293-300. https://doi.org/10.5720/kjcn.2016.21.3.293
  32. Ministry of Health and Welfare; The Korean Nutrition Society. Dietary reference intakes for Koreans 2015. Seoul; The Korean Nutrition Society; 2015.
  33. Freeman MW. Lipid metabolism and coronary artery disease. In: Runge M, Patterson C, editors. Principles of Molecular Medicine. Totowa (NJ): Humana Press; 2006. p.130-137.
  34. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-2752. https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  35. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007; 75(1): 72-80. https://doi.org/10.1016/j.diabres.2006.04.013
  36. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the 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). JAMA 2001; 285(19): 2486-2497. https://doi.org/10.1001/jama.285.19.2486
  37. Roh E, Ko SH, Kwon HS, Kim NH, Kim JH, Kim CS, et al. Prevalence and management of dyslipidemia in Korea: Korea national health and nutrition examination survey during 1998 to 2010. Diabetes Metab J 2013; 37(6): 433-449. https://doi.org/10.4093/dmj.2013.37.6.433
  38. Park HS, Oh SW, Cho SI, Choi WH, Kim YS. The metabolic syndrome and associated lifestyle factors among South Korean adults. Int J Epidemiol 2004; 33(2): 328-336. https://doi.org/10.1093/ije/dyh032
  39. Min H, Chang J, Balkrishnan R. Sociodemographic risk factors of diabetes and hypertension prevalence in republic of Korea. Int J Hypertens 2010; 2010: 410794.
  40. Song S, Choi H, Lee S, Park J, Kim BR, Paik H, et al. Establishing a table of glycemic index values for common Korean foods and an evaluation of the dietary glycemic index among the Korean adult population. Korean J Nutr 2012; 45(1): 80-93. https://doi.org/10.4163/kjn.2012.45.1.80
  41. Murakami K, Sasaki S. Glycemic index and glycemic load of the diets of Japanese adults: the 2012 National Health and Nutrition Survey, Japan. Nutrition 2018; 46: 53-61. https://doi.org/10.1016/j.nut.2017.08.012
  42. Du H, van der A DL, van Bakel MM, van der Kallen CJ, Blaak EE, van Greevenbroek MM, et al. Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. Am J Clin Nutr 2008; 87(3): 655-661. https://doi.org/10.1093/ajcn/87.3.655
  43. Mendez MA, Covas MI, Marrugat J, Vila J, Schroder H. Glycemic load, glycemic index, and body mass index in Spanish adults. Am J Clin Nutr 2009; 89(1): 316-322. https://doi.org/10.3945/ajcn.2008.26444
  44. Lee YJ, Song S, Song Y. High-carbohydrate diets and food patterns and their associations with metabolic disease in the Korean population. Yonsei Med J 2018; 59(7): 834-842. https://doi.org/10.3349/ymj.2018.59.7.834
  45. Mente A, Dehghan M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. Lancet Diabetes Endocrinol 2017; 5(10): 774-787. https://doi.org/10.1016/S2213-8587(17)30283-8
  46. Goff LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and metaanalysis of randomised controlled trials. Nutr Metab Cardiovasc Dis 2013; 23(1): 1-10. https://doi.org/10.1016/j.numecd.2012.06.002
  47. Radulian G, Rusu E, Dragomir A, Posea M. Metabolic effects of low glycaemic index diets. Nutr J 2009; 8(1): 5. https://doi.org/10.1186/1475-2891-8-5
  48. Kim J, Jo I. Grains, vegetables, and fish dietary pattern is inversely associated with the risk of metabolic syndrome in South Korean adults. J Am Diet Assoc 2011; 111(8): 1141-1149. https://doi.org/10.1016/j.jada.2011.05.001
  49. Woo HD, Shin A, Kim J. Dietary patterns of Korean adults and the prevalence of metabolic syndrome: a cross-sectional study. PLoS One 2014; 9(11): e111593. https://doi.org/10.1371/journal.pone.0111593