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

Article information

Korean J Community Nutr. 2020;25(1):61-70

Publication date (electronic) : 2020 January 20

doi : https://doi.org/10.5720/kjcn.2020.25.1.61

¹⁾Department of Food and Nutrition, Graduate School, Sungshin Women's University, Seoul, Korea, Master's graduate

²⁾Department of Food and Nutrition, Sungshin Women's University, Seoul, Korea, Associate Professor

^†Corresponding author Seungmin Lee Department of Food and Nutrition, Sungshin Women's University, 55, Dobong-ro 76ga-gil, Gangbuk-gu, Seoul 01133, Korea Tel: (02) 920-7671 Fax: (02) 920-2076 E-mail: smlee@sungshin.ac.kr

Received 2020 February 10; Revised 2020 February 17; Accepted 2020 February 19.

Abstract

Objectives

This study examined the association of the total diet quality with the incidence risk of metabolic syndrome constituents and metabolic syndrome among Korean adults.

Methods

Based on a community-based cohort of the Korean Genome and Epidemiology Study (KoGES) from 2001 to 2014, data from a total of 5,549 subjects (2,805 men & 2,744 women) aged 40∼69 years at the baseline with a total follow-up period of 38,166 person-years were analyzed. The criteria of the National Cholesterol Education Program Adult Treatment Panel was employed to define metabolic syndrome. The total diet quality was estimated using the Korean Healthy Eating Index (KHEI). Hazard ratios (HR) and 95% confidence intervals (CI) for risk of metabolic syndrome constituents and metabolic syndrome in relation to KHEI quintile groups was calculated by multivariate Cox proportional hazards regression model.

Results

After adjusting for age, energy intake, income, education, physical activity, smoking, and drinking, the incidence of abdominal obesity and high blood pressure was significantly lower, by approximately 29.7% (P < 0.01) and 25.2% (P < 0.01), respectively, in the fifth KHEI quintile compared to the first quintile in men. A significant decreasing trend of the metabolic syndrome incidence was observed across the improving levels of KHEI (HRq5vs.q1: 0.775, 95% CIq5vs.q1: 0.619∼0.971, P for trend<0.01). In women, the incidence of abdominal obesity and metabolic syndrome was significantly lower, by approximately 29.8% (P < 0.01) and 22.5% (P < 0.05), respectively, in the fifth KHEI quintile compared to the first quintile adjusting for multiple covariates. On the other hand, the linear trend of metabolic syndrome risk across the KHEI levels did not reach the significance level.

Conclusions

A better diet quality can prevent future metabolic syndrome and its certain risk factors among Korean men and women.

Keywords: diet quality; Korean Healthy Eating Index; metabolic syndrome; prospective cohort

Table 1.

Subjects' general characteristics at baseline

Table 2.

Nutrient and food group intakes for first and fifth quintiles of Korean Healthy Eating Index scores

Table 3.

Incidence risk of metabolic syndrome components for first and fifth quintiles of Korean Healthy Eating Index scores in men (N=2,805)

Table 4.

Incidence risk of metabolic syndrome components for first and fifth quintiles of Korean Healthy Eating Index scores in women (N=2,744)

Table 5.

Incidence risk of metabolic syndrome across quintiles of Korean Healthy Eating Index scores in men (N=2,805)

Table 6.

Incidence risk of metabolic syndrome across quintiles of Korean Healthy Eating Index scores in women (N=2,744)

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Table 1.

Subjects' general characteristics at baseline

Characteristics	Men (N=2,805)	Women (N=2,744)	P-value¹⁾
Age group
40∼49 (year)	1,535 (54.7)	1,594 (58.1)	0.007
50∼59 (year)	679 (24.2)	631 (23.0)
60∼69 (year)	591 (21.1)	519 (18.9)
Education			< 0.001
Elementary school graduate or less	547 (19.6)	980 (35.9)
Middle school graduate	631 (22.6)	697 (25.6)
High school graduate	1,022 (36.6)	854 (31.3)
College graduate or more Income (10,000 won)	594 (21.3)	197 (97.2)	< 0.001
< 100	751 (27.0)	899 (33.5)	< 0.001
100∼199	862 (31.0)	830 (30.9)
200∼399	920 (33.1)	774 (28.8)
≥ 400	250 (99.0)	182 (96.8)
Drinking status
Non-drinker	791 (28.2)	1,913 (69.7)
Drinker	2,014 (71.8)	831 (30.3)
Alcohol intake (g/day)	17.6 ± 27.9	1.6 ± 5.8	< 0.001
Smoking status			< 0.001
Non-smoker	1,354 (48.3)	2,639 (96.2)	< 0.001
Smoker	1,451 (51.7)	105 (93.8)
Cumulative smoking (pack-year)	18.0 ± 17.6	0.4 ± 2.6
Physical activity			< 0.001
METs²⁾ < 20	1,560 (57.3)	1,787 (66.9)
20 ≤ METs < 40	536 (19.7)	425 (15.9)
40 ≤ METs	627 (23.0)	458 (17.2)

n (%) or Mean ± SD 1) Calculated from chi-square test or student t-test 2) Metabolic equivalents

Table 2.

Nutrient and food group intakes for first and fifth quintiles of Korean Healthy Eating Index scores

Dietary component	Men (N=2,805)			Women (N=2,744)
			Quintiles of KHEI scores		P-value
	1st	5th	P-value¹⁾ 1st	5th	P-value
Total KHEI⁴⁾ score	1,943.79 ± 1,995.19¹⁾	1,977.72 ± 1,994.61	< 0.001 1,949.13 ± 1,996.03	1,984.47 ± 1,993.68	< 0.001
Nutrients
Energy (kcal/day)²⁾	1,650.96 ± 1,467.96	2,312.56 ± 1,558.42	< 0.001 1,546.58 ± 1,519.37	2,159.27 ± 1,618.44	< 0.001
Energy from carbohydrates (%)²⁾	1,973.83 ±1,99 8.27	1,966.58 ±1,99 4.54	< 0.001 1,976.04 ± 1,997.84	1,967.69 ± 1,994.32	< 0.001
Energy from fat (%)²⁾	1,912.36 ±1,99 6.58	1,917.78 ± 1,993.35	< 0.001 1,910.71 ± 1,996.35	1,916.72 ± 1,993.32	< 0.001
Dietary fiber (g/day)³⁾	1,995.21 ± 1,992.44	1,998.50 ± 1,993.15	< 0.001 1,995.15 ± 1,992.55	1,998.44 ± 1,993.33	< 0.001
Alcohol (g/day)³⁾	1,932.68 ± 1,931.70	1,917.64 ± 1,926.22	< 0.001 1,998.18 ± 1,913.49	1,992.49 ± 1,992.63	< 0.001
Sodium (mg/day)³⁾	2,967.20 ± 1,617.31	3,686.14 ± 1,632.86	0.009 2,564.25 ± 1,333.82	3,392.21 ± 1,671.25	0.064
Food groups
Fruits (servings/day)³⁾	1,990.94 ± 1,991.37	1,992.67 ± 1,992.20	< 0.001 1,991.44 ± 1,992.20	1,992.87 ±1,99 2.49	0.103
Vegetables (servings/day)³⁾	1,992.46 ± 1,991.80	1,995.33 ±1,99 2.61	< 0.001 1,992.67 ± 1,992.24	1,995.90 ± 1,993.32	< 0.001
Dairy products (servings/day)³⁾	1,990.17 ±1,99 0.48	1,991.08 ±1,99 0.80	< 0.001 1,990.21 ±1,99 0.49	1,991.34 ±1,99 0.99	< 0.001
Protein foods (servings/day)³⁾	1,991.77 ±1,99 1.37	1,994.11 ± 1,991.63	< 0.001 1,991.52 ±1,99 1.25	1,993.99 ±1,99 1.68	< 0.001
Empty calorie foods (servings/day)	)³⁾ 1,994.47 ±1,99 3.86	1,992.94 ± 1,992.89	< 0.001 1,991.38 ±1,99 1.62	1,991.20 ±1,99 0.95	< 0.001
Whole grains (servings/day)³⁾	1,990.53 ±1,99 1.04	1,991.87 ± 1,991.37	< 0.001 1,990.80 ± 1,991.27	1,992.25 ±1,99 1.21	< 0.001
Refined grains (servings/day)³⁾	1,992.58 ± 1,991.23	1,991.37 ± 1,991.40	< 0.001 1,992.20 ± 1,991.33	1,990.79 ± 1,991.13	< 0.001

Mean ± SD 1) Calculated from general linear model adjusted for age (year) or adjusted for age (year) and energy intake (kcal/day) 2) Adjusted for age (year) 3) Adjusted for age (year) and energy intake (kcal/day) 4) Korean Healthy Eating Index

Table 3.

Incidence risk of metabolic syndrome components for first and fifth quintiles of Korean Healthy Eating Index scores in men (N=2,805)

Metabolic syndrome components	Quintiles of	No. of	Total		Crude			Model 1²⁾			Model 2³⁾
Metabolic syndrome components	KHEI⁴⁾ scores	cases	person-years	HR⁴⁾	95% CI⁴⁾	P-value¹⁾	HR	95% CI	P-value	HR	95% CI	P-value
Abdominal obesity	1st	183	3,884	1.000	–		1.000	–		1.000
Abdominal obesity	5th	156	4,231	0.796	0.643∼0.985	0.036	0.665	0.528∼0.837	< 0.001	0.703	0.553∼0.895	0.004
Hypertriglyceridemia	1st	287	2,964	1.000	–		1.000	–		1.000	–
Hypertriglyceridemia	5th	273	3,383	0.866	0.733∼1.022	0.088	0.813	0.680∼0.972	0.023	0.931	0.773∼1.122	0.453
Low HDL-cholesterolemia	1st	477	3,009	1.000	–		1.000	–		1.000
Low HDL-cholesterolemia	5th	464	3,039	1.009	0.882∼1.156	0.893	1.017	0.879∼1.177	0.817	1.001	0.858∼1.166	0.995
High blood pressure	1st	317	2,978	1.000	–		1.000	–		1.000	–
High blood pressure	5th	265	3,513	0.725	0.616∼0.853	< 0.001	0.662	0.555∼0.789	< 0.001	0.748	0.623∼0.897	0.002
Hyperglycemia	1st	244	3,507	1.000	–		1.000	–		1.000	–
Hyperglycemia	5th	202	3,935	0.746	0.619∼0.899	0.002	0.669	0.548∼0.818	< 0.001	0.811	0.657∼1.000	0.051

¹⁾

Calculated from Cox proportional hazards model 2) Adjusted for adjusted for age (year) and energy intake (kcal/day) 3) Adjusted for age (year), energy intake (kcal/day), income (< 100; 100∼199; 200∼3990; ≥ 400 (10,000 won)), education (elementary school graduate or less; middle school graduate; high school graduate; college graduate or more), physical activity (METs), smoking (pack-years), and alcohol intake (g/day) 4) KHEI: Korean Healthy Eating Index, HR: hazard ratio, CI: confidence interval

Table 4.

Incidence risk of metabolic syndrome components for first and fifth quintiles of Korean Healthy Eating Index scores in women (N=2,744)

Metabolic syndrome components	Quintiles of KHEI⁴⁾ scores	No. of cases	Total person-years	Crude			Model 1²⁾			Model 2³⁾
Metabolic syndrome components	Quintiles of KHEI⁴⁾ scores	No. of cases	Total person-years	HR⁴⁾	95% CI⁴⁾	P-value¹⁾	HR	95% CI	P-value	HR	95% CI	P-value
Abdominal obesity	1st	263	3,073	1.000	–		1.000	–		1.000	–
Abdominal obesity	5th	179	4,066	0.547	0.452∼0.661	< 0.001	0.526	0.430∼0.643	< 0.001	0.702	0.569∼0.867	0.001
Hypertriglyceridemia	1st	243	3,535	1.000	–		1.000	–		1.000	–
Hypertriglyceridemia	5th	226	3,958	0.828	0.691∼0.993	0.041	0.934	0.772∼1.131	0.486	0.952	0.780∼1.163	0.631
Low HDL-cholesterolemia	1st	524	1,613	1.000	–		1.000	–		1.000	–
Low HDL-cholesterolemia	5th	509	2,013	0.822	0.722∼0.935	0.003	0.834	0.726∼0.957	0.009	0.869	0.753∼1.004	0.056
High blood pressure	1st	242	3,448	1.000	–		1.000	–		1.000	–
High blood pressure	5th	183	3,941	0.672	0.554∼0.814	< 0.001	0.768	0.627∼0.941	0.011	0.898	0.725∼1.112	0.325
Hyperglycemia	1st	143	4,115	1.000	–		1.000	–		1.000	–
Hyperglycemia	5th	122	4,430	0.792	0.622∼1.008	0.058	0.843	0.653∼1.089	0.190	0.992	0.757∼1.299	0.953

¹⁾

Table 5.

Incidence risk of metabolic syndrome across quintiles of Korean Healthy Eating Index scores in men (N=2,805)

Quintiles of KHEI⁵⁾ scores	No. of cases	Crude			Model 1³⁾				Model 2⁴⁾
Quintiles of KHEI⁵⁾ scores	No. of cases	Total person-years	HR⁵⁾	95% CI⁵⁾	P-value¹⁾	HR	95% CI	P-value	HR	95% CI	P-value
1st	208	3,738	1.000	–		1.000	–		1.000	–
2nd	202	3,696	0.985	0.811∼1.195	0.876	0.945	0.777∼1.150	0.574	0.952	0.781∼1.161	0.628
3rd	180	3,800	0.851	0.697∼1.039	0.113	0.792	0.645∼0.972	0.026	0.840	0.681∼1.037	0.105
4th	178	3,984	0.801	0.656∼0.979	0.030	0.727	0.590∼0.897	0.003	0.791	0.637∼0.984	0.035
5th	180	4,040	0.799	0.655∼0.976	0.028	0.691	0.557∼0.858	< 0.001	0.775	0.619∼0.971	0.027
P-value for trend^1),2)				0.005			< 0.001			0.009

¹⁾

Calculated from Cox proportional hazards model 2) P-value for trend was calculated by treating the KHEI quintile as a continuous variable after substitution each quintile value with its medium value 3) Adjusted for adjusted for age (year) and energy intake (kcal/day) 4) Adjusted for age (year), energy intake (kcal/day), income (< 100; 100∼199; 200∼3990; ≥ 400 (10,000 won)), education (elementary school graduate or less; middle school graduate; high school graduate; college graduate or more), physical activity (METs), smoking (pack-years), and alcohol intake (g/day) 5) KHEI: Korean Healthy Eating Index, HR: hazard ratio, CI: confidence interval

Table 6.

Incidence risk of metabolic syndrome across quintiles of Korean Healthy Eating Index scores in women (N=2,744)

Quintiles of KHEI⁵⁾ scores	⁾ No. of cases	Crude				Model 1³⁾			Model 2⁴⁾
Quintiles of KHEI⁵⁾ scores	⁾ No. of cases	Total person-years	HR⁵⁾	95% CI⁵⁾	P-value¹⁾	HR	95% CI	P-value	HR	95% CI	P-value
1st	218	3,556	1.000	–		1.000	–		1.000	–
2nd	191	3,752	0.829	0.683∼1.007	0.059	0.839	0.689∼1.021	0.080	0.931	0.759∼1.142	0.492
3rd	203	3,671	0.905	0.747∼1.095	0.305	0.898	0.739∼1.093	0.283	1.036	0.846∼1.268	0.734
4th	180	3,781	0.781	0.641∼0.952	0.014	0.799	0.650∼0.981	0.032	0.976	0.787∼1.211	0.825
5th	151	4,148	0.593	0.482∼0.729	< 0.001	0.606	0.486∼0.755	< 0.001	0.774	0.615∼0.975	0.030
P-value for trend^1),2)			< 0.001			< 0.001			0.093

¹⁾

Calculated from Cox proportional hazards model 2) P for trend was calculated by treating the KHEI quintile as a continuous variable after substitution each quintile value with its medium value 3) Adjusted for adjusted for age (year) and energy intake (kcal/day) 4) Adjusted for age (year), energy intake (kcal/day), income (< 100; 100∼199; 200∼3990; ≥ 400 (10,000 won)), education (elementary school graduate or less; middle school graduate; high school graduate; college graduate or more), physical activity (METs), smoking (pack-years), and alcohol intake (g/day) 5) KHEI: Korean Healthy Eating Index, HR: hazard ratio, CI: confidence interval