Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Benefits of adherence to the Korea Healthy Eating Index on the risk factors and incidence of the metabolic syndrome: analysis of the 7th (2016-2018) Korea National Health and Nutrition Examination Survey

제7기 (2016-2018년) 국민건강영양조사 자료를 이용한 식생활평가지수 준수와 대사증후군 위험요소 및 대사증후군 발생 관계 연구

  • Choi, Sun A (Department of Food Science and Human Nutrition, Jeonbuk National University) ;
  • Chung, Sung Suk (Department of Statistics, Jeonbuk National University) ;
  • Rho, Jeong Ok (Department of Food Science and Human Nutrition, Jeonbuk National University)
  • Received : 2021.11.15
  • Accepted : 2022.01.17
  • Published : 2022.02.28
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Abstract

Purpose: The purpose of the study was to investigate whether adherence to the Korea Healthy Eating Index (KHEI) was associated with metabolic syndrome and risk markers. Methods: The participants included 8,345 adults, aged 20-59 years, who took part in the 7th Korea National Health and Nutrition Examination Survey (KNHANES). The data were analyzed using a complex-sample t-test, the Rao Scott χ2-test, and logistic regression analysis on the SPSS v. 26.0 software. The participants were divided into four groups by quartiles of KHEI scores. Results: The average KHEI score was 61.06 points out of 100, and the women's score (62.50 points) was significantly higher than that of men (59.63 points). The KHEI quartiles status showed significant differences by age (p < 0.001), household income (p < 0.001), smoking status (p < 0.001), and food security. Specifically, the KHEI quartiles in the men showed significant differences in education (p < 0.001) and economic activity (p < 0.001) whereas those of women showed significant differences in alcohol-consumption (p < 0.001), depression (p < 0.01) and eating-out (p < 0.001). As the KHEI scores increased, the proportion of subjects with an energy intake below the estimated energy requirement (EER) was lower, and significantly better levels of intake were observed for carbohydrate, protein, vitamin C, calcium, vitamin B1, vitamin B2, and niacin. The incidence of the metabolic syndrome risk factors, hypertriglyceridemia and hyperglycemia for men and hypertension, and hyperglycemia for women showed significant differences. The KHEI scores were inversely associated with abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, hypertension, and metabolic syndrome. Conclusion: Based on these results, we conclude that higher adherence to the KHEI was associated with lower metabolic syndrome risk factors and incidence of the metabolic syndrome.

본 연구는 제7기 (2016-2018) 국민건강영양조사자료를 이용하여, KHEI 점수와 대사증후군 위험요소 및 대사증후군의 발생 관련성을 연구하고자 하였다. 연구대상자는 제7기 국민건강영양조사 참여자 중 20-59세의 성인으로 연구에 이용한 변수의 결측치가 없는 8,345명을 최종대상으로 분석하였다. KHEI의 총 평균은 100점 만점에 61.06점, 남성의 총 평균은 59.63점, 여성의 총 평균은 62.50점으로 여성이 남성보다 유의적으로 KHEI 총 평균이 높았다. KHEI의 3개 영역 중 '권고하는 식품 및 적정성 평가영역'과 '절제영역'에서 여성이 남성보다 유의적으로 점수가 높았다. KHEI 점수에 따른 일반적 특성을 파악하기 위하여 KHEI 점수를 4분위수로 나누었으며 남녀 모두 연령대와 가구소득이 Q1그룹에서 Q4그룹으로 갈수록 유의적으로 높았으며, 현재 흡연 비율은 유의적으로 낮았다. 남성은 교육수준과 경제활동상태에서 Q1그룹에 비해 Q4그룹이 대학교 졸업이상 비율과 경제활동 참여율이 유의적으로 높았다. 여성은 음주여부, 우울증여부, 외식횟수에서 Q4그룹이 Q1그룹보다 현재 음주, 우울증 유병자비율과 1일 1회이상 외식 비율이 유의적으로 낮았다. 식품안정성에서는 남녀 모두 Q1그룹이 Q3그룹보다 '식품안정군'이 유의적으로 낮았다. 대사증후군과 관련된 영양소 섭취 실태에서 남녀 모두 Q1 그룹의 에너지 필요 추정량 미만 섭취자 비율이 유의적으로 높았으며, 탄수화물, 단백질, 비타민 C, 칼슘, 비타민 B1, 비타민 B2, 니아신은 평균필요량 미만 섭취자 비율이 유의적으로 높았고, 식이섬유소는 충분 섭취량 미만 섭취자 비율이 유의적으로 높았다. 남성의 공복혈당은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 BMI는 Q4그룹이 Q2그룹보다 유의적으로 낮았으며, 수축기 혈압은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 총콜레스테롤은 Q4그룹이 Q1그룹보다 유의적으로 높았다. 대사증후군 위험요인에서 남성의 고중성지방혈증 유병률은 Q1그룹이 Q4그룹보다 유의적으로 높았으며, 고혈당 유병률은 Q3그룹이 Q1그룹보다 유의적으로 높았다. 여성의 고혈압 유병률은 Q3그룹이 Q1그룹보다 유의적으로 높았으며 대사증후군은 Q2그룹이 Q1그룹보다 유의적으로 높았다. KHEI 점수에 따른 대사증후군 위험요인과 대사증후군 연관성 연구결과, 남녀 모두 KHEI 총점수가 높을수록, 20-29세가 50-59세에 비해 대사증후군 위험요소 및 대사증후군의 발생위험이 유의적으로 낮았다. 교육수준, 소득수준, 흡연, 음주, 우울증 여부는 성별에 따라 다른 양상을 보였다. 교육수준에서 남성은 저HDL콜레스테롤혈증, 고혈당의 발생위험이 유의적인 차이를 보였으며, 여성은 우울증이 있는 경우가 없는 경우보다 고중성지방혈증은 1.81배, 고혈당은 1.90배, 대사증후군은 2.50배로 발생위험이 유의적으로 높았다. 남녀 모두 소득수준이 '하'일 때 '상'에 비해 고중성지방혈증, 대사증후군의 발생위험이 유의적으로 높았으며 특히, 여성은 복부비만, 고혈당, 고혈압을 남성은 저HDL콜레스테롤혈증 발생위험이 유의적으로 높았다.

Keywords

References

  1. 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(25): 3143-3421. https://doi.org/10.1161/circ.106.25.3143
  2. Korea Disease Control and Prevention Agency. Dietary and nutritional status of Koreans based on the 4th Health plan 2020 nutrition indicators. Cheongju: Korea Disease Control and Prevention Agency; 2018.
  3. Korea Disease Control and Prevention Agency. Korea Health Statistics 2019: Korea National Health and Nutrition Examination Survey (KNHANES VIII-1) [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2020 Dec 31 [cited 2021 Aug 11]. Available from: https://knhanes.kdca.go.kr/knhanes/sub04/sub04_04_01.do.
  4. Korean Society of Cardiometabolic Syndrome. Metabolic syndrome fact sheet in Korea 2021 [Internet]. Incheon: Korean Society of Cardiometabolic Syndrome; 2021 Apr 28 [cited 2021 Oct 9]. Available from: http://www.kscms.org/bbs//uploads/2021-04-28/6088c0095b48f.pdf.
  5. Kim Y, Han AL. The correlation between triglyceride to HDL cholesterol ratio and metabolic syndrome, nutrition intake in Korean adults: Korea National Health and Nutrition Examination Survey 2016. J Nutr Health 2019; 52(3): 268-276. https://doi.org/10.4163/jnh.2019.52.3.268
  6. So ES. Smoking characteristics associated with the prevalence of metabolic syndrome in Korean adults. J Humanit Soc Sci 21 2020; 11(1): 221-232.
  7. Moon WJ. The relation among adolescents metabolic syndrome, dietary life, physical activity and mental health - using 7th National Nutrition Survey of 1st year (2016). J Korea Acad Ind Coop Soc 2019; 20(6): 158-168. https://doi.org/10.5762/KAIS.2019.20.6.158
  8. Lee SB, Choi JI. Differences in indicators related to metabolic syndrome according to the physical activity level of adult males in their 30s to 60s-7th 3rd (2018) Korea National Health and Nutrition Examination Survey. J Korean Soc Wellness 2020; 15(2): 1-8.
  9. Park E. The obesity and the metabolic syndrome among Korean adults: based on National Representative Survey. Korean J Health Promot 2020; 20(4): 144-150. https://doi.org/10.15384/kjhp.2020.20.4.144
  10. Yook SM, Park S, Moon HK, Kim K, Shim JE, Hwang JY. Development of Korean Health Eating Index for adults using the Korea National Health and Nutrition Examination Survey data. J Nutr Health 2015; 48(5): 419-428. https://doi.org/10.4163/jnh.2015.48.5.419
  11. Yun S, Oh K. Development and status of Korean Healthy Eating Index for adults based on the Korea National Health and Nutrition Examination Survey [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2019 Jan 4 [cited 2021 Aug 16]. Available from: https://knhanes.kdca.go.kr/knhanes/sub04/sub04_07.do.
  12. Shin S, Lee S. Relation between the total diet quality based on Korean Healthy Eating Index and the incidence of metabolic syndrome constituents and metabolic syndrome among a prospective cohort of Korean adults. Korean J Community Nutr 2020; 25(1): 61-70. https://doi.org/10.5720/kjcn.2020.25.1.61
  13. Park S, Kim K, Lee BK, Ahn J. Association of the Healthy Eating Index with estimated cardiovascular age in adults from the KNHANES 2013-2017. Nutrients 2020; 12(10): E2912.
  14. Yoon YS, Oh SW. Relationship between psychological distress and the adherence to the Korean Healthy Eating Index (KHEI): the Korea National Health and Nutrition Examination Survey (KNHANES) 2013 and 2015. Nutr Res Pract 2021; 15(4): 516-527. https://doi.org/10.4162/nrp.2021.15.4.516
  15. Lafreniere J, Carbonneau E, Laramee C, Corneau L, Robitaille J, Labonte ME, et al. Is the Canadian Healthy Eating Index 2007 an appropriate diet indicator of metabolic health? Insights from dietary pattern analysis in the PREDISE study. Nutrients 2019; 11(7): E1597.
  16. Neelakantan N, Koh WP, Yuan JM, van Dam RM. Diet-quality indexes are associated with a lower risk of cardiovascular, respiratory, and all-cause mortality among Chinese adults. J Nutr 2018; 148(8): 1323-1332. https://doi.org/10.1093/jn/nxy094
  17. Joe H. Association between metabolic syndrome and triglyceride to HDL-cholesterol ratio according to smoking status in Korean men aged 60 years and over. Korean J Clin Geriatr 2020; 21(2): 110-116. https://doi.org/10.15656/kjcg.2020.21.2.110
  18. Hwang HJ, Han KS. The relationship of metabolic syndrome with dairy intake and physical activity in Korean adults: from the Korean National Health and Nutrition Examination Surveys, 2016-2017. J Korea Converg Soc 2020; 11(3): 109-118. https://doi.org/10.15207/JKCS.2020.11.3.109
  19. Grech A, Sui Z, Siu HY, Zheng M, Allman-Farinelli M, Rangan A. Socio-demographic determinants of diet quality in Australian adults using the validated Healthy Eating Index for Australian adults (HEIFA-2013). Healthcare (Basel) 2017; 5(1): E7.
  20. Sullivan VK, Petersen KS, Fulgoni VL 3rd, Eren F, Cassens ME, Bunczek MT, et al. Greater scores for dietary fat and grain quality components underlie higher total Healthy Eating Index-2015 scores, while whole fruits, seafood, and plant proteins are most favorably associated with cardiometabolic health in US adults. Curr Dev Nutr 2021; 5(3): b015.
  21. Korea Disease Control and Prevention Agency. 2018 Nutrition survey guidelines [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2021 Mar 19 [cited 2021 Aug 4]. Available from: https://knhanes.kdca.go.kr/knhanes/sub04/sub04_02_02.do?classType=4.
  22. Jun S, Hong E, Joung H. Flavonoid intake according to food security in Korean adults: based on the Korea National Health and Nutrition Examination Survey 2007-2012. J Nutr Health 2015; 48(6): 507-518. https://doi.org/10.4163/jnh.2015.48.6.507
  23. Ministry of Health and Welfare; The Korean Nutrition Society. Dietary reference intakes for Koreans 2020. Sejong: The Korean Nutrition Society; 2020.
  24. European Association for Cardiovascular Prevention & RehabilitationReiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32(14): 1769-1818. https://doi.org/10.1093/eurheartj/ehr158
  25. Korean Society for the Study of Obesity. Diagnosis and evaluation of obesity [Internet]. Seoul: Korean Society for the Study of Obesity; 2021 [cited 2021 Aug 16]. Available from: http://general.kosso.or.kr/html/?pmode=obesityDiagnosis.
  26. Maeng A, Lee J, Yoon E. Health and nutrition intake status of the Korean elderly according to their food security level: data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII), 2016-2018. J Nutr Health 2021; 54(2): 179-198. https://doi.org/10.4163/jnh.2021.54.2.179
  27. McInerney M, Ho V, Koushik A, Massarelli I, Rondeau I, McCormack GR, et al. Addition of food group equivalents to the Canadian Diet History Questionnaire II for the estimation of the Canadian Healthy Eating Index-2005. Health Promot Chronic Dis Prev Can 2018; 38(3): 125-134. https://doi.org/10.24095/hpcdp.38.3.03
  28. Murakami K, Livingstone MB, Fujiwara A, Sasaki S. Application of the Healthy Eating Index-2015 and the Nutrient-Rich Food Index 9.3 for assessing overall diet quality in the Japanese context: Different nutritional concerns from the US. PLoS One 2020; 15(1): e0228318. https://doi.org/10.1371/journal.pone.0228318
  29. Hu EA, Steffen LM, Coresh J, Appel LJ, Rebholz CM. Adherence to the Healthy Eating Index-2015 and other dietary patterns may reduce risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality. J Nutr 2020; 150(2): 312-321. https://doi.org/10.1093/jn/nxz218
  30. Lee S, Lee KW, Oh JE, Cho MS. Nutritional and health consequences are associated with food insecurity among Korean elderly: based on the fifth (2010) Korea National Health and Nutrition Examination Survey (KNHANES V-1). J Nutr Health 2015; 48(6): 519-529. https://doi.org/10.4163/jnh.2015.48.6.519
  31. Moraeus L, Lindroos AK, Warensjo Lemming E, Mattisson I. Diet diversity score and healthy eating index in relation to diet quality and socio-demographic factors: results from a cross-sectional national dietary survey of Swedish adolescents. Public Health Nutr 2020; 23(10): 1754-1765. https://doi.org/10.1017/S1368980019004671
  32. Looman M, Feskens EJ, de Rijk M, Meijboom S, Biesbroek S, Temme EH, et al. Development and evaluation of the Dutch Healthy Diet index 2015. Public Health Nutr 2017; 20(13): 2289-2299. https://doi.org/10.1017/S136898001700091X
  33. Farmer N, Wallen GR, Yang L, Middleton KR, Kazmi N, Powell-Wiley TM. Household cooking frequency of dinner among non-Hispanic black adults is associated with income and employment, perceived diet quality and varied objective diet quality, HEI (Healthy Eating Index): NHANES analysis 2007-2010. Nutrients 2019; 11(9): E2057.
  34. Kim H, Kim M. Analysis of the consumption behaviors and factors determining the use of delivery or take-out foods. J East Asian Soc Diet Life 2019; 29(3): 168-179. https://doi.org/10.17495/easdl.2019.6.29.3.168
  35. Kim YW. Trends in markets for home meal replacamnets. Food Sci Ind 2017; 50(1): 57-66. https://doi.org/10.23093/FSI.2017.50.1.57
  36. Motard-Belanger A, Charest A, Grenier G, Paquin P, Chouinard Y, Lemieux S, et al. Study of the effect of trans fatty acids from ruminants on blood lipids and other risk factors for cardiovascular disease. Am J Clin Nutr 2008; 87(3): 593-599. https://doi.org/10.1093/ajcn/87.3.593
  37. Jeong Y, Kim ES, Lee J, Kim Y. Trends in sodium intake and major contributing food groups and dishes in Korea: the Korea National Health and Nutrition Examination Survey 2013-2017. Nutr Res Pract 2021; 15(3): 382-395. https://doi.org/10.4162/nrp.2021.15.3.382
  38. He FJ, MacGregor GA. Potassium intake and blood pressure. Am J Hypertens 1999; 12(8 Pt 1): 849-851. https://doi.org/10.1016/S0895-7061(99)00020-5
  39. Lee JR. Risk factors analysis of prehypertension in adults: the Korean National Health and Nutrition Examination Survey 2018. J Korea Contents Assoc 2021; 21(1): 456-464. https://doi.org/10.5392/JKCA.2021.21.01.456
  40. Kim Y, Nho SJ, Woo G, Kim H, Park S, Kim Y, et al. Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey. Epidemiol Health 2021; 43: e2021028. https://doi.org/10.4178/epih.e2021028
  41. The Korean Nutrition Society. Awareness survey on dietary reference intakes for Koreans [Internet]. Seoul: Korean Food Newspaper; 2021 Nov 2 [cited 2021 Dec 16]. Available from: http://www.fsnews.co.kr/news/articleView.html?idxno=44495.