Epidemiology

A modified Mediterranean diet score is inversely associated with metabolic syndrome in Korean adults

European Journal of Clinical Nutrition volume 72, pages1682–1689(2018)Cite this article

Subjects

Abstract

Background/objectives

Findings from studies in Western countries showed that Mediterranean diet is inversely associated with metabolic syndrome, but little is known about this association in Asian countries. To evaluate the association between Mediterranean diet and metabolic syndrome in Korean population, this study was conducted.

Subjects/methods

A total of 8387 adults 19–64 years of age from the Korea National Health and Nutrition Examination Survey 2012–2015 were assessed. A 112-item dish-based semiquantitative food frequency questionnaire was used to assess dietary intakes. Mediterranean diet was assessed by a modified Mediterranean diet score, which was based on the alternate Mediterranean diet score of Fung et al. Multivariable logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for other dietary and lifestyle variables.

Results

Participants with 5–6 and 7 or higher modified Mediterranean diet scores had a lower prevalence of metabolic syndrome by 27% (OR = 0.73, 95% CI: 0.56–0.96) and 36% (OR = 0.64, 95% CI: 0.46–0.89; P-trend = 0.0031), compared with those with 2 or lower modified Mediterranean diet scores, respectively. Higher modified Mediterranean diet scores were associated with a lower prevalence of abdominal obesity and hypertriglyceridemia, which are components of metabolic syndrome

Conclusions

Our findings suggest that diet rich in fruit, vegetables, whole grains, legumes, peanuts and fish is associated with a lower prevalence of metabolic syndrome in Korean adults.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

Rent or Buy

All prices are NET prices.

Fig. 1

References

  1. 1.

    Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61:1402S–6S.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Barros R, Moreira A, Fonseca J, de Oliveira JF, Delgado L, Castel-Branco MG, et al. Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control. Allergy. 2008;63:917–23.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies. Cancer Med. 2015;4:1933–47.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9:1–24.

    Article  CAS  Google Scholar 

  5. 5.

    Koloverou E, Esposito K, Giugliano D, Panagiotakos D. The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metabolism. 2014;63:903–11.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.

    Article  PubMed  Google Scholar 

  7. 7.

    Godos J, Zappala G, Bernardini S, Giambini I, Bes-Rastrollo M, Martinez-Gonzalez M. Adherence to the Mediterranean diet is inversely associated with metabolic syndrome occurrence: a meta-analysis of observational studies. Int J Food Sci Nutr. 2017;68:138–48.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57:1299–313.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Tousoulis D, Toutouza M, et al. Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study. Am Heart J. 2004;147:106–12.

    Article  PubMed  Google Scholar 

  10. 10.

    Alvarez Leon E, Henriquez P, Serra-Majem L. Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands. Public Health Nutr. 2006;9:1089–98.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Babio N, Bullo M, Basora J, Martinez-Gonzalez MA, Fernandez-Ballart J, Marquez-Sandoval F, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardiovasc Dis. 2009;19:563–70.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Gouveri ET, Tzavara C, Drakopanagiotakis F, Tsaoussoglou M, Marakomichelakis GE, Tountas Y, et al. Mediterranean diet and metabolic syndrome in an urban population: the Athens Study. Nutr Clin Pract. 2011;26:598–606.

    Article  PubMed  Google Scholar 

  13. 13.

    Kesse-Guyot E, Ahluwalia N, Lassale C, Hercberg S, Fezeu L, Lairon D. Adherence to Mediterranean diet reduces the risk of metabolic syndrome: a 6-year prospective study. Nutr Metab Cardiovasc Dis. 2013;23:677–83.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Grosso G, Marventano S, Galvano F, Pajak A, Mistretta A. Factors associated with metabolic syndrome in a mediterranean population: role of caffeinated beverages. J Epidemiol. 2014;24:327–33.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Grosso G, Stepaniak U, Micek A, Topor-Madry R, Stefler D, Szafraniec K, et al. A Mediterranean-type diet is associated with better metabolic profile in urban Polish adults: results from the HAPIEE study. Metabolism. 2015;64:738–46.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Pimenta AM, Toledo E, Rodriguez-Diez MC, Gea A, Lopez-Iracheta R, Shivappa N, et al. Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: the SUN project. Clin Nutr. 2015;34:508–14.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Steffen LM, Van Horn L, Daviglus ML, Zhou X, Reis JP, Loria CM, et al. A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Br J Nutr. 2014;112:1654–61.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Yang J, Farioli A, Korre M, Kales SN. Modified Mediterranean diet score and cardiovascular risk in a North American working population. PLoS ONE. 2014;9:e87539.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Pan WH, Yeh WT, Weng LC. Epidemiology of metabolic syndrome in Asia. Asia Pac J Clin Nutr. 2008;17(Suppl 1):37–42.

    CAS  PubMed  Google Scholar 

  20. 20.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    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.

    CAS  Article  Google Scholar 

  22. 22.

    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  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Kim DW, Song S, Lee JE, Oh K, Shim J, Kweon S, et al. Reproducibility and validity of an FFQ developed for the Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr. 2015;18:1369–77.

    Article  PubMed  Google Scholar 

  24. 24.

    Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, et al. Diet and overall survival in elderly people. BMJ . 1995;311:1457–60.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82:163–73.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Kim JY, Yang YJ, Yang YK, Oh SY, Hong YC, Lee EK, et al. Diet quality scores and oxidative stress in Korean adults. Eur J Clin Nutr. 2011;65:1271–8.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Lee JE, McLerran DF, Rolland B, Chen Y, Grant EJ, Vedanthan R, et al. Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies. Am J Clin Nutr. 2013;98:1032–41.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Rural Development Administration, National Academy of Agricultural Science. 8th revision Standard Food Composition Table. 2013. http://koreanfood.rda.go.kr/eng/fctFoodSrchEng/engMain. Assessed 21 Dec 2017.

  29. 29.

    Beydoun MA, Canas JA, Beydoun HA, Chen X, Shroff MR, Zonderman AB. Serum antioxidant concentrations and metabolic syndrome are associated among U.S. adolescents in recent national surveys. J Nutr. 2012;142:1693–704.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Wei J, Zeng C, Gong QY, Li XX, Lei GH, Yang TB. Associations between dietary antioxidant intake and metabolic syndrome. PLoS ONE. 2015;10:e0130876.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Davidson MH. Mechanisms for the hypotriglyceridemic effect of marine omega-3 fatty acids. Am J Cardiol. 2006;98:27i–33i.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Weintraub HS. Overview of prescription omega-3 fatty acid products for hypertriglyceridemia. Postgrad Med. 2014;126:7–18.

    Article  PubMed  Google Scholar 

  33. 33.

    Jenkins DJ, Axelsen M, Kendall CW, Augustin LS, Vuksan V, Smith U. Dietary fibre, lente carbohydrates and the insulin-resistant diseases. Br J Nutr. 2000;83(Suppl 1):S157–163.

    CAS  PubMed  Google Scholar 

  34. 34.

    Lia A, Hallmans G, Sandberg AS, Sundberg B, Aman P, Andersson H. Oat beta-glucan increases bile acid excretion and a fiber-rich barley fraction increases cholesterol excretion in ileostomy subjects. Am J Clin Nutr. 1995;62:1245–51.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT and Future Planning (NRF-2015R1A1A1A05001362). The sponsor had no role in the design of the study, data collection and analysis, preparation of the manuscript or decision to publish.

Author information

Affiliations

  1. Department of Food and Nutrition, Kyung Hee University, Seoul, South Korea

    Youngyo Kim & Youjin Je

Authors
  1. Youngyo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Youjin Je
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Youjin Je.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, Y., Je, Y. A modified Mediterranean diet score is inversely associated with metabolic syndrome in Korean adults. Eur J Clin Nutr 72, 1682–1689 (2018). https://doi.org/10.1038/s41430-018-0156-4

Download citation

Further reading

Search

Quick links