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Regional disparities related to cardiovascular diseases and diet quality in Korean adults: based on the 2013-2016 Korea National Health and Nutrition Examination Survey Data

  • Bo Young, Seo (Department of Food and Nutrition, Changshin University) ;
  • Eun Sil, Her (Department of Food and Nutrition, Changshin University)
  • Received : 2021.11.19
  • Accepted : 2021.12.30
  • Published : 2022.12.01

Abstract

BACKGROUND/OBJECTIVES: Cardiovascular diseases (CVDs) are the leading cause of death in Koreans, and eating habits, including diet quality, are among the etiologies of these diseases. Recently, various studies on regional health disparities have been conducted. However, there are limited studies on their relationship with nutritional factors. This study aimed to identify the magnitude of regional disparities in diet quality and prevalence of CVD in Korean adults. SUBJECTS/METHODS: This study included 17,646 participants aged ≥ 20 years from the 7th (2013-2016) Korean National Health and Nutrition Examination Survey. Participants were classified into four groups based on their residential areas: City 1, City 2, City 3, and non-city. Demographic characteristics, health-related factors, body mass index (BMI), metabolic syndrome index, diet quality, and CVD prevalence were evaluated. RESULTS: In terms of demographic characteristics, age (P < 0.001), marital status (P < 0.001), educational level (P < 0.001), and income (P < 0.001) were lower in the non-city category. Health-related factors such as monthly drinking rate (P < 0.01) and mental stress (P < 0.05) were the highest in City 1 and lowest in the non-city group. Conversely, the current smoking rate (P < 0.05), BMI (P < 0.05), and prevalence of metabolic syndrome (P < 0.001) were the highest in the non-city group (P < 0.05). The non-city group also had the highest prevalence of CVDs (35.6%). This group had the lowest diet quality index (68.36 ± 0.22, P < 0.01), caused by low intake of fruit and calcium, a lack of sodium moderation, and an overall imbalance in the macronutrient and fatty acid ratio. When the diet quality index was increased by 1, the odds ratio for the prevalence of CVDs was reduced by 0.991 (P < 0.001), but this was not the case in all regions. CONCLUSIONS: This study provides useful information and data in identifying and resolving the regional health disparities related to CVD prevalence and implementation of public health nutrition systems.

Keywords

Acknowledgement

This research was supported by grant from Changshin university in 2020 (Changshin-2020-042).

References

  1. Lee EH. Effect of the adult's health behaviors on disease of circulation system. J Korean Soc Hyg Sci 2009;15:153-61. 
  2. Cho IY, Lee KM, Lee Y, Paek CM, Kim HJ, Kim JY, Lee K, Han JS, Bae WK. Assessment of dietary habits using the diet quality index-international in cerebrovascular and cardiovascular disease patients. Nutrients 2021;13:542.   https://doi.org/10.3390/nu13010075
  3. Cho TY, Cho HC, Hong SY, Song YK, Lim HH. Correlation study between obesity and cardiovascular risk factors. J Korean Med Obes Res 2004;4:33-43. 
  4. Ro YM. Metabolic syndrome and cardiovascular disease. J Korea Assoc Health Promot 2004;2:71-6. 
  5. Korean Statistical Information Service. Annual report on the cause of death statistics [Internet]. Daejeon: Statistics Korea; 2020 [cited 2021 July 1]. Available from: http://kosis.kr. 
  6. Haijing T, Guo C, Yu K, Xu Y. Application of data science technology on research of circulatory system disease prediction based on a prospective cohort. Algorithms 2018;11:162.  
  7. Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN, Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011;101 Suppl 1:S149-55.   https://doi.org/10.2105/AJPH.2010.300062
  8. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, D.C.: US Government Printing Office; 2000. 
  9. Korean Law Information Center. Regional Public Health Act [Internet]. Sejong: Korean Law Information Center; 2021 [cited 2021 July 1]. Available from: https://law.go.kr. 
  10. Ministry of Health and Welfare. Health plan 2020 [Internet]. Sejong: Ministry of Health and Welfare; 2020 [cited 2021 July 1]. Available from: https://khealth.or.kr/healthplan.  
  11. Lee JH. The regional health inequality, and individual and neighborhood level health determinants. Health Soc Welf Rev 2016;36:345-84.   https://doi.org/10.15709/HSWR.2016.36.2.345
  12. Lee MS. Health Inequalities among Korean adults - socioeconomic status and residential area differences. Korean J Sociol 2005;39:183-209. 
  13. Kim I, Bahk J, Kim YY, Lee J, Kang HY, Lee J, Yun SC, Park JH, Shin SA, Khang YH. Prevalence of overweight and income gaps in 245 districts of Korea: comparison using the National Health Screening Database and the Community Health Survey, 2009-2014. J Korean Med Sci 2018;33:e3.  
  14. Park JW. Socioeconomic inequalities in health at the regional level in Korea. Health Welf Policy Forum 2018;260:7-19. 
  15. Kang HJ, Kwon SM. Regional disparity of cardiovascular mortality and its determinants. Health Policy Manag 2016;26:12-23.  
  16. Kant AK. Indexes of overall diet quality: a review. J Am Diet Assoc 1996;96:785-91.   https://doi.org/10.1016/S0002-8223(96)00217-9
  17. Gerber M. The comprehensive approach to diet: a critical review. J Nutr 2001;131 Suppl:3051S-3055S.   https://doi.org/10.1093/jn/131.11.3051S
  18. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002;13:3-9.  
  19. Oh SY. Analysis of methods on dietary quality assessment. Korean J Community Nutr 2000;5 Suppl 2:362-7. 
  20. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994;94:57-64.  
  21. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 2003;133:3476-84.  
  22. Son JH, Choe HS, Hwang JY, Song TJ, Chang YK, Kim YJ, Kim YR. Association between intakes of minerals (potassium, magnesium, and calcium) and diet quality and risk of cerebral atherosclerosis in ischemic stroke patients. J Nutr Health 2015;48:167-79.   https://doi.org/10.4163/jnh.2015.48.2.167
  23. Willet W. Nutritional Epidemiology. Moon HK, translator. 3rd ed. Paju: Kyomunsa; 2013. p.333. 
  24. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.   https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  25. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75:72-80.   https://doi.org/10.1016/j.diabres.2006.04.013
  26. House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR. The social stratification of aging and health. J Health Soc Behav 1994;35:213-34.   https://doi.org/10.2307/2137277
  27. Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004;27:87-96.   https://doi.org/10.1016/j.amepre.2004.04.011
  28. Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW Jr, Kubik M, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. JAMA 2020;324:2069-75.   https://doi.org/10.1001/jama.2020.21749
  29. Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech 2009;2:231-7.   https://doi.org/10.1242/dmm.001180
  30. Oh JS, Kim H, Kim KN, Chang N. Relationship between fruit and fish intakes and cardiovascular disease risk factors in Korean women with type 2 diabetes mellitus: based on the 4th and 5th Korea National Health and Nutrition Examination Surveys. J Nutr Health 2016;49:304-2.  
  31. Temple NJ. Fat, sugar, whole grains and heart disease: 50 years of confusion. Nutrients 2018;10:39.  
  32. Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr 2000;71:44-53.   https://doi.org/10.1093/ajcn/71.1.44
  33. Song Y, Joung H. A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis 2012;22:456-62.   https://doi.org/10.1016/j.numecd.2010.09.002
  34. Kang HJ, Kwon S. Regional disparity of cardiovascular mortality and its determinants. Health Policy Manag 2006;26:12-23.  
  35. Lim S, Jang HC, Lee HK, Kimm KC, Park C, Cho NH. A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS). J Endocrinol Invest 2006;29:313-9.  
  36. Korean Society for Equity in Health. Regional health disparity profiles [Internet]. Seoul: Korean Society for Equity in Health; 2018 [cited 2021 July 1]. Available from: http://healthequity.or.kr. 
  37. Chung SJ, Han YS, Lee SI, Kang SH. Urban and rural differences in the prevalence of gender and age specific obesity and related health behaviors in Korea. J Korean Med Sci 2005;20:713-20.   https://doi.org/10.3346/jkms.2005.20.5.713
  38. 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.  
  39. Ha K, Song Y, Kim HK. Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults. Nutr Res Pract 2020;14:519-31.   https://doi.org/10.4162/nrp.2020.14.5.519
  40. Lee H, Kim BH. Physical activity disparities by socioeconomic status among metabolic syndrome patients: the Fifth Korea National Health and Nutrition Examination Survey. J Exerc Rehabil 2016;12:10-4.   https://doi.org/10.12965/jer.150269
  41. Lee J, Sa J. Regional disparities in healthy eating and nutritional status in South Korea: Korea National Health and Nutrition Examination Survey 2017. Nutr Res Pract 2020;14:679-90.   https://doi.org/10.4162/nrp.2020.14.6.679
  42. 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;59:834-42.   https://doi.org/10.3349/ymj.2018.59.7.834
  43. Kwon JH, Shim JE, Park MK, Paik HY. Evaluation of fruits and vegetables intake for prevention of chronic disease in Korean adults aged 30 years and over: using the third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005. Korean J Nutr 2009;42:146-57. https://doi.org/10.4163/kjn.2009.42.2.146