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Differential association of dietary carbohydrate intake with metabolic syndrome in the US and Korean adults: data from the 2007–2012 NHANES and KNHANES

European Journal of Clinical Nutrition volume 72, pages 848–860 (2018)Cite this article

Subjects

Abstract

Background/objectives

The risk factors for metabolic syndrome may differ between Western and Asian countries due to their distinct dietary cultures. However, few studies have directly compared macronutrient intake and its association with the risk of metabolic syndrome in the US and Korean adults using national survey data.

Subject/methods

Based on the data from the US and Korean versions of the 2007–2012 National Health and Nutrition Examination Survey (NHANES, KNHANES), a total of 3,324 American and 20,515 Korean adults were included. In both countries, dietary intake was measured using a 24-h dietary recall method and metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria.

Results

The percentages of energy intake from carbohydrate, protein, and fat were 50:16:33 in the US adults and 66:15:19 in the Korean adults. Regarding metabolic abnormalities, Korean adults in the highest quintile of carbohydrate intake showed an increased risk of metabolic syndrome in men and women, with abnormalities of reduced HDL cholesterol and elevated triglyceride levels. In contrast, the US men showed no significant association with metabolic syndrome and its abnormalities, while the US women showed an increased risk of reduced HDL cholesterol and elevated triglycerides.

Conclusions

A high carbohydrate intake is associated with metabolic abnormalities. As Korean adults consume more carbohydrate than American adults, stronger associations of dietary carbohydrate with metabolic syndrome were observed. Thus, further studies are necessary to elucidate the underlying mechanisms of different contributors to developing metabolic disease in Western and Asian populations.

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References

  1. Grundy SM, Brewer HB Jr., Cleeman JI, Smith SC Jr., Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–8.

    Article  Google Scholar 

  2. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol 2010;56:1113–32.

    Article  Google Scholar 

  3. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA 2015;313:1973–4.

    Article  CAS  Google Scholar 

  4. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care 2011;34:1323–8.

    Article  CAS  Google Scholar 

  5. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2010;7:e1000252.

    Article  Google Scholar 

  6. Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, et al. Glycemic index, glycemic load, and chronic disease risk–a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627–37.

    Article  CAS  Google Scholar 

  7. Food Surveys Research Group [Internet]. Beltsville (MD): Agricultural Research Service. Energy intakes: percentages of energy from protein, carbohydrate, fat, and alcohol, by gender and age, what we eat in America, NHANES 2013-2014. http://www.ars.usda.gov/nea/bhnrc/fsrg (2016). Accessed 09 Nov 2016.

  8. Public Health England. National Diet and Nutrition Survey: Results from years 1-4 (combined) of the rolling programme (2008/2009-2011/12). London: Public Health England; 2014.

  9. Australian Bureau of Statistics [Internet]. Australian Health Survey: Usual Nutrient Intakes. Belconnen: Australian Bureau of Statistics; 2011-12. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0082011-12?OpenDocument (2015). Accessed 09 Nov 2016.

  10. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2014: Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Sejong: Ministry of Health and Welfare; 2015.

  11. Ministry of Health, Labour and Welfare [Internet]. National Health and Nutrtion Survey 2014. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2014. http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21/en/eiyouchousa/koumoku_eiyou_chousa.html. Accessed 09 Nov 2016.

  12. Zipf G, Chiappa M, Porter K, Ostchega Y, Lewis B, Dostal J. National Health and Nutrition Examination Survey: Plan and operations, 1999-2010. Hyattsville: National Center for Health Statistics; 2013.

  13. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea national health and nutrition examination survey (KNHANES). Int J Epidemiol 2014;43:69–77.

    Article  Google Scholar 

  14. Wright JD, Wang CY. Trends in intake of energy and macronutrients in adults from 1999-2000 through 2007-2008. NCHS Data Brief 2010;49:1–8.

    Google Scholar 

  15. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, D.C.: The National Academies Press; 2002.

    Google Scholar 

  16. Ministry of Health and Welfare. Dietary reference intakes for Koreans 2015. Sejong: Ministry of Health and Welfare; 2015.

    Google Scholar 

  17. Murakami K, Livingstone MB. Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003-2012. Br J Nutr 2016;115:294–304.

    Article  CAS  Google Scholar 

  18. Vandevijvere S, Chow CC, Hall KD, Umali E, Swinburn BA. Increased food energy supply as a major driver of the obesity epidemic: a global analysis. Bull World Health Organ 2015;93:446–56.

    Article  Google Scholar 

  19. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000;102:2284–99.

    Article  CAS  Google Scholar 

  20. Korea National Health and Examination Survey [Internet]. Osong (Korea): Centers for Disease Control and Prevention. Analytic guidelines for the Fifth Korea National Health and Nutrition Examination Survey. https://knhanes.cdc.go.kr/knhanes/index.do (2014). Accessed 09 Nov 2016.

  21. U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a Clinician’s guide. Bethesda: National Institue on Alcohol Abuse and Alcoholism; 2005.

    Google Scholar 

  22. Schoenborn CA, Adams PF. Health behaviors of adults: United States, 2005–2007. Washington: National Center for Health Statistics; 2010.

    Google Scholar 

  23. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington: U.S. Department of Health and Human Services; 2008.

    Google Scholar 

  24. Ministiry of Health and Welfare. The physical activity guide for Koreans. Seoul: Ministry of Health and Welfare; 2013.

    Google Scholar 

  25. National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES): Laboratory procedures manual. Hyattsville: Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  26. Korea Centers for Disease Control and Prevention. Manual for the fifth Korea National Health and Nutrition Examination Survey: Health examination. Osong: Korea Centers for Disease Control and Prevention; 2012.

    Google Scholar 

  27. Freeman MW. Lipid metabolism and coronary artery disease. In: Runge MS, Patterson C, editors. Principles of molecular medicine. 2nd ed. Totowa: Humana; 2006.

    Google Scholar 

  28. 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;112:2735–52.

    Article  Google Scholar 

  29. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. 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.

    Article  CAS  Google Scholar 

  30. Riediger ND, Clara I. Prevalence of metabolic syndrome in the Canadian adult population. CMJA 2011;183:E1127–34.

    Google Scholar 

  31. Cameron AJ, Magliano DJ, Zimmet PZ, Welborn T, Shaw JE. The metabolic syndrome in Australia: prevalence using four definitions. Diabetes Res Clin Pract 2007;77:471–8.

    Article  Google Scholar 

  32. Xi B, He D, Hu Y, Zhou D. Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the China Health and Nutrition Survey in 2009. Prev Med 2013;57:867–71.

    Article  Google Scholar 

  33. Frost G, Leeds AA, Dore CJ, Madeiros S, Brading S, Dornhorst A. Glycaemic index as a determinant of serum HDL-cholesterol concentration. Lancet 1999;353:1045–8.

    Article  CAS  Google Scholar 

  34. Ma Y, Li Y, Chiriboga DE, Olendzki BC, Hebert JR, Li W, et al. Association between carbohydrate intake and serum lipids. J Am Coll Nutr 2006;25:155–63.

    Article  CAS  Google Scholar 

  35. McKeown NM, Meigs JB, Liu S, Rogers G, Yoshida M, Saltzman E, et al. Dietary carbohydrates and cardiovascular disease risk factors in the Framingham offspring cohort. J Am Coll Nutr 2009;28:150–8.

    Article  CAS  Google Scholar 

  36. 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;32:100–6.

    Article  CAS  Google Scholar 

  37. 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;5:16919.

    Article  CAS  Google Scholar 

  38. Radhika G, Ganesan A, Sathya RM, Sudha V, Mohan V. Dietary carbohydrates, glycemic load and serum high-density lipoprotein cholesterol concentrations among South Indian adults. Eur J Clin Nutr 2009;63:413–20.

    Article  CAS  Google Scholar 

  39. Merchant AT, Anand SS, Kelemen LE, Vuksan V, Jacobs R, Davis B, et al. Carbohydrate intake and HDL in a multiethnic population. Am J Clin Nutr 2007;85:225–30.

    Article  CAS  Google Scholar 

  40. Parks EJ, Hellerstein MK. Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms. Am J Clin Nutr 2000;71:412–33.

    Article  CAS  Google Scholar 

  41. 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;71:1455–61.

    Article  CAS  Google Scholar 

  42. Yang EJ, Chung HK, Kim WY, Kerver JM, Song WO. Carbohydrate intake is associated with diet quality and risk factors for cardiovascular disease in U.S. adults: NHANES III. J Am Coll Nutr 2003;22:71–9.

    Article  Google Scholar 

  43. Kim K, Yun SH, Choi BY, Kim MK. Cross-sectional relationship between dietary carbohydrate, glycaemic index, glycaemic load and risk of the metabolic syndrome in a Korean population. Br J Nutr 2008;100:576–84.

    Article  CAS  Google Scholar 

  44. Min HS, Kang JY, Sung J, Kim MK. Blood triglycerides levels and dietary carbohydrate indices in healthy Koreans. J Prev Med Public Health 2016;49:153–64.

    Article  Google Scholar 

  45. 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;114:54–62.

    Article  Google Scholar 

  46. Park SH, Lee KS, Park HY. Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: analysis of the third Korea national health and nutrition examination survey (KNHANES III). Int J Cardiol 2010;139:234–40.

    Article  Google Scholar 

  47. Nakashima M, Sakurai M, Nakamura K, Miura K, Yoshita K, Morikawa Y, et al. Dietary glycemic index, glycemic load and blood lipid levels in middle-aged Japanese men and women. J Atheroscler Thromb 2010;17:1082–95.

    Article  CAS  Google Scholar 

  48. Sacks FM, Katan M. Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 2002;113:13S–24S.

    Article  CAS  Google Scholar 

  49. Siri PW, Krauss RM. Influence of dietary carbohydrate and fat on LDL and HDL particle distributions. Curr Atheroscler Rep 2005;7:455–9.

    Article  CAS  Google Scholar 

  50. Choi SJ, Park SH, Park HY. Increased prevalence of low high-density lipoprotein cholesterol (HDL-C) levels in Korean adults: analysis of the three Korean National Health and Nutrition Examination Surveys (KNHANES 1998-2005). Osong Public Health Res Perspect 2011;2:94–103.

    Article  Google Scholar 

  51. 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;285:2486–97.

    Article  Google Scholar 

  52. Willett W. Nutritional epidemiology. 3rd ed. New York: Oxford University Press; 2012.

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Acknowledgements

This work is carried out with the support of a grant from the National Research Foundation of Korea funded by the Korean Government (NRF-2017R1A2B1008420).

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Authors and Affiliations

  1. Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea

    Kyungho Ha & Hyojee Joung

  2. Department of Nutritional Sciences, University of Connecticut, 3624 Horsebarn Road Extension Unit 4017, Storrs, CT, 06269-4017, USA

    Kijoon Kim & Ock K. Chun

  3. Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea

    YoonJu Song

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Correspondence to YoonJu Song.

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Ha, K., Kim, K., Chun, O.K. et al. 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 72, 848–860 (2018). https://doi.org/10.1038/s41430-017-0031-8

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