Misung Kim; Juyoung Kim; Wookyung Bae; Sohye Kim; Yesong Lee; Woori Na; Cheongmin Sohn

doi:10.5720/KJCN.2011.16.1.51

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Original Article
Relationship between Nutrients Intakes, Dietary Quality, and Serum Concentrations of Inflammatory Markers in Metabolic Syndrome Patients: Misung Kim¹⁾, Juyoung Kim, Wookyung Bae, Sohye Kim, Yesong Lee¹⁾, Woori Na¹⁾, Cheongmin Sohn^†,1)†; Korean Journal of Community Nutrition 2011;16(1):51-61.
DOI: https://doi.org/10.5720/KJCN.2011.16.1.51
Published online: January 18, 2011

Health Promotion Center, Seoul National Universitiy of Bundang Hospital, Seongnam, Korea

¹⁾Major in Food and Nutrition, Wonkwang University, Iksan, Korea

Health Promotion Center, Seoul National Universitiy of Bundang Hospital, Seongnam, Korea

¹⁾Major in Food and Nutrition, Wonkwang University, Iksan, Korea

†Corresponding author: Cheongmin Sohn, Major in Food and Nutriton, Wonkwang University, 344-2 Sinyong-Dong, Iksan, Jeonbuk 570-749, Korea Tel: (063) 850-6656, Fax: (063) 850-7301 E-mail: ccha＠wku.ac.kr

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Abstract
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Abstract

Elevated serum concentration of inflammation markers is known as an independent risk factor of metabolic syndrome (MS) and dietary intake is an important factor to control MS. The purpose of this study was to investigated the hypothesis that inflammatory indices are associated with dietary intake and diet quality index-international (DQI-I) in subjects with MS. A cross-sectional study was conducted on 156 men and 73 postmenopausal women with MS, defined by three or more risk factors of the modified Adult Treatment Panel III criteria. Serum levels of high sensitive C-reactive protein (hs-CRP), adiponectin were examined and nutrients intake and DQI-I were assessed using a semiquantitative food frequency questionnaire. The total DQI-I score was significantly higher in female subjects (65.87 ± 9.86) than in male subjects (62.60 ± 8.95). There was a positive association between hs-CRP and polyunsaturated fatty acid intake (p < 0.05) and a negative association between adiponectin and lipid (p < 0.05), total sugar (p < 0.01), and total fatty acids (p < 0.05). When the subjects were divided into 5 groups by quintile according to serum adiponectin and hs-CRP level, there was no association between DQI-I score and hs-CRP levels. Moderation score of DQI-I was significantly higher in highest quintile group than the lower quintile groups. Therefore, our results provide some evidence that dietary intake and diet quality are associated with inflammation markers and dietary modification might be a predictor to decrease risk for metabolic syndrome complications. However further research is needed to develop the dietary quality index reflecting the inflammatory change by considering the dietary habit and pattern of Koreans. (Korean J Community Nutr 16(1) : 51~61, 2011)
Keywords: metabolic syndrome; diet quality index-international; hs-CRP; adiponectin; nutrients intake

Fig. 1.

Comparison of nutrient intakes of the two groups with KDRIs¹⁾(%) DRI for reference : Energy EER²⁾, Protein EAR³⁾, Fiber AI⁴⁾, Calcium EAR, Phosphorus EAR, Iron EAR, Sodium AI, Zinc EAR, Vitamin A EAR, Vitamin B₁ EAR, Vitamin B₂ EAR, Vitamin B₆ EAR, Niacin EAR, Vitamin C EAR, Folate EAR, Vitamin E AI 1) KDRIs : Dietary Reference Intakes for Koreans 2) EER : Estimated energy requirement 3) EAR : Estimated average requirement 4) RNI : Recommended nutrient intake Significantly different between men and women groups by student's t test at ∗: P < 0.05, ∗∗: P < 0.01 and ∗∗∗: P < 0.001

Table 1.

Comparison of anthropometric measurements, blood pressure and biochemical indices in men and women groups

	Men (n = 156)	Women (n = 73)	t-score
Age (years)	49.39 ± 10.10¹⁾	48.72 ± 81.02	0.542
Height (cm)	172.86 ± 6.37	157.13 ± 5.16	18.454∗∗∗
BMI (kg/m²)²⁾	26.66 ± 2.85	26.00 ± 3.80	1.315
Weight (kg)	79.79 ± 10.85	64.17 ± 9.82	10.450∗∗∗
WC (cm)³⁾	93.48 ± 7.11	88.05 ± 7.56	5.274∗∗∗
SBP (mmHg)⁴⁾	128.14 ± 13.94	129.75 ± 14.40	0.807
DBP (mmHg)⁵⁾	81.03 ± 10.68	77.41 ± 9.06	2.505∗
GGT (IU/L)⁶⁾	56.60 ± 31.52	42.33 ± 43.98	2.644∗∗
Glucose (mg/dL)	106.44 ± 22.33	99.16 ± 17.52	2.453∗
Cholesterol (mg/dL)	196.72 ± 36.16	212.01 ± 36.14	2.983∗∗
Triglyceride (mg/dL)	175.92 ± 74.40	159.71 ± 58.22	1.790
HDL-C (mg/dL)⁷⁾	43.64 ± 9.22	46.18 ± 9.70	1.911
LDL-C (mg/dL)⁸⁾	109.37 ± 29.77	121.90 ± 32.23	2.888∗∗
hs-CRP (µg/mL)⁹⁾	1.82 ± 2.55	1.97 ± 2.78	0.406
Adiponectin (µg/mL)	8.10 ± 2.75	12.10 ± 4.79	6.663∗∗∗

1) Values are Mean ± SD, 2) BMI: Body Mass Index, 3) WC: Waist Circumference, 4) SBP: Systolic Blood Pressure, 5) DBP: Diastolic Blood Pressure, 6) GGT: Gamma Glutamyl Transferase, 7) HDL-C: high-density lipoprotein cholesterol, 8) LDL-C: low-density lipoprotein cholesterol, 9) hs-CRP: High-sensitivity C-reactive protein, Significantly different between men and women groups by student's t test at ∗: P < 0.05, ∗∗: P < 0.01 and ∗∗∗: P < 0.001

Table 2.

Correlation of inflammatory markers and metabolic syndrome factors

Factors	log hs-CRP	log Adiponectin
WC	−0.184∗∗	−0.165∗
Glucose	−0.056	−0.147∗
Triglyceride	−0.078	−0.193∗∗
HDL-C	−0.028	−0.222∗∗
SBP	−0.037	−0.110
DBP	−0.091	−0.020

Significantly different at ∗: P < 0.05 and ∗∗: P < 0.01 Serum hs-CRP and Adiponectin concentrations were logarithmically transformed because of their right-skewed deviation.

Table 3.

Comparison of daily nutrients intake in men and women groups

	Men (n = 156)	Women (n = 73)	Total (N = 229)	t-score
Energy (kcal)¹⁾	1859.28 ± 7613.14	1721.94 ± 7731.72	1815.50 ± 7654.80	1.483
Protein (g)	7769.97 ± 7734.85	7763.95 ± 7732.02	7768.05 ± 7734.02	1.250
Fiber (g)	7717.73 ± 7779.26	7719.44 ± 7710.85	7718.28 ± 7779.80	1.228
Calcium (mg)	7471.56 ± 7311.86	7528.36 ± 7338.89	7489.67 ± 7321.07	1.249
Phosphorus (mg)	7977.00 ± 7451.78	7956.00 ± 7457.85	7970.31 ± 7452.82	0.326
Iron (mg)	7711.27 ± 7776.33	7711.19 ± 7776.28	7711.25 ± 7776.30	0.088
Sodium (mg)	2845.75 ± 1827.75	2639.56 ± 1699.65	2780.02 ± 1786.78	0.813
Zinc (mg)	7779.73 ±777 5.93	7778.59 ± 7774.50	7779.36 ± 7775.53	1.455
Vitamin A (µgRE)	7533.74 ± 7403.36	7579.57 ± 7441.79	7548.35 ± 7415.58	0.777
Vitamin B₁ (mg)	7771.16 ± 7770.60	7771.05 ± 7770.55	7771.12 ± 7770.59	1.345
Vitamin B₂ (mg)	7771.06 ±777 0.57	7771.01 ± 7770.58	7771.04 ± 7770.57	0.539
Vitamin B₆ (mg)	7771.73 ±777 0.85	7771.70 ± 7770.92	7771.72 ± 7770.87	0.228
Niacin (mg)	7716.47 ± 7778.32	7714.84 ± 7777.56	7715.95 ± 7778.11	1.418
Vitamin C (mg)	7101.81 ± 7773.44	7119.30 ± 789.40	7107.38 ± 779.10	1.564
Folate (µg)	7232.05 ± 7137.35	7249.42 ± 7155.88	7237.59 ± 7143.40	0.853
Vitamin E (mg)	7778.57 ± 7774.43	7779.38 ± 7776.89	7778.83 ± 7775.34	1.067

1) Values are Mean ± SD All values are not significantly different between the two groups by student's t-test

Table 4.

Correlation of inflammatory markers and nutrients Intake

Factors	log hs-CRP¹⁾	log Adiponectin²⁾
Lipid	0.071	0.125∗
Total sugar	0.025	0.167∗∗
Fiber	0.023	0.076
β-carotene	0.015	0.101
Vitamin C	0.011	0.049
Cholesterol	0.105	0.082
Total fatty acid	0.082	0.128∗
Saturated fatty acids	s −0.067	0.099
Monounsaturated fa	tty acids −0.073	0.116∗
Polyunsaturated fatty	y acids −0.122∗	0.194∗∗

1) Adjustment for waist circumference

2) Adjustment for waist circumference, glucose, triglyceride, and HDL-cholesterol

Significantly different at ∗: P < 0.05 and ∗∗: P < 0.01

Table 5.

Comparison of Diet Quality index-international(DQI-I) in men and women groups

	Score ranges (points)	Men (n = 156)	Women (n = 73)	t-score
Overall food group variety	0 − 15	10.48 ± 2.22¹⁾	10.89 ± 2.37	1.272
Within-group variety for protein source	0 − 5	83.00 ± 1.93	82.68 ± 2.05	1.127
Variety	0 − 20	13.48 ± 3.26	13.58 ± 3.66	0.197
Vegetable group	0 − 5	82.68 ± 1.41	82.97 ± 1.55	1.422
Fruits group	0 − 5	81.90 ± 1.71	82.52 ± 1.94	2.347∗
Grain group	0 − 5	84.29 ± 1.01	84.21 ± 1.04	0.618
Fiber	0 − 5	83.28 ± 1.27	83.60 ± 1.28	1.774
Protein	0 − 5	84.95 ± 0.32	84.97 ± 0.23	0.574
Iron	0 − 5	83.88 ± 1.16	83.85 ± 1.29	0.207
Calcium	0 − 5	82.44 ± 1.43	82.56 ± 1.38	0.625
Vitamin C	0 − 5	83.37 ± 1.50	83.68 ± 1.38	1.506
Adequacy	0 − 40	26.79 ± 5.94	28.37 ± 6.14	1.850
Total fat	0 − 6	85.02 ± 1.64	85.10 ± 1.63	0.330
Saturated fat	0 − 6	85.63 ± 1.10	85.42 ± 1.38	1.140
Cholesterol	0 − 6	83.85 ± 2.48	84.44 ± 2.07	1.893
Sodium	0 − 6	82.68 ± 0.61	82.44 ± 0.72	2.582∗∗
Empty calorie foods	0 − 6	82.23 ± 2.52	84.44 ± 2.07	7.001∗∗∗
Moderation	0 − 30	19.46 ± 4.95	21.73 ± 4.00	3.378∗∗∗
Macronutrient ratio (Carbohydrate : Protein : Fat)	0 − 6	82.13 ± 2.10	81.89 ± 2.31	0.773
Fatty acid ratio (PUFA : MUFA : SFA)	0 − 4	80.41 ± 0.96	80.30 ± 0.86	0.828
Overall balance	0 − 10	82.54 ± 2.09	82.19 ± 2.31	1.131
Total	100	62.60 ± 8.95	65.87 ± 9.86	2.525∗

1) Values are Mean ± SD

Significantly different between men and women groups by student's t test at ∗: P < 0.05, ∗∗: P < 0.01 and ∗∗∗: P < 0.001

Table 6.

Comparison of DQI-I in the subjects according to serum hs-CRP and Adiponectin level

	hs-CRP (µg/mL)
	Q 1 (n = 47)	Q 2 (n = 44)	Q 3 (n = 47)	Q 4 (n = 45)	Q 5 (n = 46)	Total (N = 229)
Variety	13.51 ± 83.872¹⁾	13.27 ± 3.252	13.26 ± 82.952	13.64 ± 3.524	13.87 ± 3.344	13.51 ± 3.382
Adequacy	27.68 ± 86.058	27.23 ± 5.665	27.00 ± 85.912	26.22 ± 6.153	28.33 ± 6.415	27.30 ± 6.036
Moderation	21.34 ± 84.620	20.43 ± 4.133	19.23 ± 85.230	19.69 ± 4.709	20.27 ± 4.901	20.18 ± 4.757
Balance	82.34 ± 81.970	82.82 ± 2.414	82.64 ± 81.961	82.67 ± 2.132	82.70 ± 1.942	82.63 ± 2.075
Total	64.84 ± 10.163	64.38 ± 8.307	62.12 ± 89.504	62.22 ± 8.468	65.45 ± 9.959	63.77 ± 9.338
	Adiponectin (µg/mL)
	Q 1 (n = 45)	Q 2 (n = 46)	Q 3 (n = 46)	Q 4 (n = 46)	Q 5 (n = 46)	Total (N = 229)
Variety	13.67 ± 83.268	13.26 ± 3.587	13.65 ± 83.261	13.17 ± 3.440	13.80 ± 3.442	13.51 ± 3.382
Adequacy	28.73 ± 85.561	26.70 ± 6.397	26.48 ± 86.257	26.24 ± 6.201	28.37 ± 5.511	27.30 ± 6.036
Moderation	19.71 ± 84.883^a	19.96 ± 4.871^ab	19.47 ± 85.459^a	19.93 ± 4.590^ab	21.93 ± 3.502^b	20.18 ± 4.757
Balance	82.98 ± 81.840	82.35 ± 1.946	82.83 ± 82.407	82.57 ± 2.051	82.43 ± 2.105	82.63 ± 2.075
Total	65.08 ± 89.253^ab	62.57 ± 8.457^a	62.68 ± 10.394^a	61.82 ± 9.504^a	66.88 ± 8.349^b	63.77 ± 9.338

1) Values are Mean ± SD

a, b values with different letters within the same line are significantly different from each other by Duncan's test at P = 0.05

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Relationship between Nutrients Intakes, Dietary Quality, and Serum Concentrations of Inflammatory Markers in Metabolic Syndrome Patients

Korean J Community Nutr. 2011;16(1):51-61. Published online February 28, 2011

DOI: https://doi.org/10.5720/KJCN.2011.16.1.51

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Relationship between Nutrients Intakes, Dietary Quality, and Serum Concentrations of Inflammatory Markers in Metabolic Syndrome Patients

Fig. 1. Comparison of nutrient intakes of the two groups with KDRIs1)(%) DRI for reference : Energy EER2), Protein EAR3), Fiber AI4), Calcium EAR, Phosphorus EAR, Iron EAR, Sodium AI, Zinc EAR, Vitamin A EAR, Vitamin B1 EAR, Vitamin B2 EAR, Vitamin B6 EAR, Niacin EAR, Vitamin C EAR, Folate EAR, Vitamin E AI 1) KDRIs : Dietary Reference Intakes for Koreans 2) EER : Estimated energy requirement 3) EAR : Estimated average requirement 4) RNI : Recommended nutrient intake Significantly different between men and women groups by student's t test at ∗: P < 0.05, ∗∗: P < 0.01 and ∗∗∗: P < 0.001

Fig. 1.

Relationship between Nutrients Intakes, Dietary Quality, and Serum Concentrations of Inflammatory Markers in Metabolic Syndrome Patients

Table 1.

Comparison of anthropometric measurements, blood pressure and biochemical indices in men and women groups

	Men (n = 156)	Women (n = 73)	t-score
Age (years)	49.39 ± 10.10¹⁾	48.72 ± 81.02	0.542
Height (cm)	172.86 ± 6.37	157.13 ± 5.16	18.454∗∗∗
BMI (kg/m²)²⁾	26.66 ± 2.85	26.00 ± 3.80	1.315
Weight (kg)	79.79 ± 10.85	64.17 ± 9.82	10.450∗∗∗
WC (cm)³⁾	93.48 ± 7.11	88.05 ± 7.56	5.274∗∗∗
SBP (mmHg)⁴⁾	128.14 ± 13.94	129.75 ± 14.40	0.807
DBP (mmHg)⁵⁾	81.03 ± 10.68	77.41 ± 9.06	2.505∗
GGT (IU/L)⁶⁾	56.60 ± 31.52	42.33 ± 43.98	2.644∗∗
Glucose (mg/dL)	106.44 ± 22.33	99.16 ± 17.52	2.453∗
Cholesterol (mg/dL)	196.72 ± 36.16	212.01 ± 36.14	2.983∗∗
Triglyceride (mg/dL)	175.92 ± 74.40	159.71 ± 58.22	1.790
HDL-C (mg/dL)⁷⁾	43.64 ± 9.22	46.18 ± 9.70	1.911
LDL-C (mg/dL)⁸⁾	109.37 ± 29.77	121.90 ± 32.23	2.888∗∗
hs-CRP (µg/mL)⁹⁾	1.82 ± 2.55	1.97 ± 2.78	0.406
Adiponectin (µg/mL)	8.10 ± 2.75	12.10 ± 4.79	6.663∗∗∗

Table 2.

Correlation of inflammatory markers and metabolic syndrome factors

Factors	log hs-CRP	log Adiponectin
WC	−0.184∗∗	−0.165∗
Glucose	−0.056	−0.147∗
Triglyceride	−0.078	−0.193∗∗
HDL-C	−0.028	−0.222∗∗
SBP	−0.037	−0.110
DBP	−0.091	−0.020

Significantly different at ∗: P < 0.05 and ∗∗: P < 0.01 Serum hs-CRP and Adiponectin concentrations were logarithmically transformed because of their right-skewed deviation.

Table 3.

Comparison of daily nutrients intake in men and women groups

	Men (n = 156)	Women (n = 73)	Total (N = 229)	t-score
Energy (kcal)¹⁾	1859.28 ± 7613.14	1721.94 ± 7731.72	1815.50 ± 7654.80	1.483
Protein (g)	7769.97 ± 7734.85	7763.95 ± 7732.02	7768.05 ± 7734.02	1.250
Fiber (g)	7717.73 ± 7779.26	7719.44 ± 7710.85	7718.28 ± 7779.80	1.228
Calcium (mg)	7471.56 ± 7311.86	7528.36 ± 7338.89	7489.67 ± 7321.07	1.249
Phosphorus (mg)	7977.00 ± 7451.78	7956.00 ± 7457.85	7970.31 ± 7452.82	0.326
Iron (mg)	7711.27 ± 7776.33	7711.19 ± 7776.28	7711.25 ± 7776.30	0.088
Sodium (mg)	2845.75 ± 1827.75	2639.56 ± 1699.65	2780.02 ± 1786.78	0.813
Zinc (mg)	7779.73 ±777 5.93	7778.59 ± 7774.50	7779.36 ± 7775.53	1.455
Vitamin A (µgRE)	7533.74 ± 7403.36	7579.57 ± 7441.79	7548.35 ± 7415.58	0.777
Vitamin B₁ (mg)	7771.16 ± 7770.60	7771.05 ± 7770.55	7771.12 ± 7770.59	1.345
Vitamin B₂ (mg)	7771.06 ±777 0.57	7771.01 ± 7770.58	7771.04 ± 7770.57	0.539
Vitamin B₆ (mg)	7771.73 ±777 0.85	7771.70 ± 7770.92	7771.72 ± 7770.87	0.228
Niacin (mg)	7716.47 ± 7778.32	7714.84 ± 7777.56	7715.95 ± 7778.11	1.418
Vitamin C (mg)	7101.81 ± 7773.44	7119.30 ± 789.40	7107.38 ± 779.10	1.564
Folate (µg)	7232.05 ± 7137.35	7249.42 ± 7155.88	7237.59 ± 7143.40	0.853
Vitamin E (mg)	7778.57 ± 7774.43	7779.38 ± 7776.89	7778.83 ± 7775.34	1.067

1) Values are Mean ± SD All values are not significantly different between the two groups by student's t-test

Table 4.

Correlation of inflammatory markers and nutrients Intake

Factors	log hs-CRP¹⁾	log Adiponectin²⁾
Lipid	0.071	0.125∗
Total sugar	0.025	0.167∗∗
Fiber	0.023	0.076
β-carotene	0.015	0.101
Vitamin C	0.011	0.049
Cholesterol	0.105	0.082
Total fatty acid	0.082	0.128∗
Saturated fatty acids	s −0.067	0.099
Monounsaturated fa	tty acids −0.073	0.116∗
Polyunsaturated fatty	y acids −0.122∗	0.194∗∗

1) Adjustment for waist circumference

2) Adjustment for waist circumference, glucose, triglyceride, and HDL-cholesterol

Significantly different at ∗: P < 0.05 and ∗∗: P < 0.01

Table 5.

Comparison of Diet Quality index-international(DQI-I) in men and women groups

	Score ranges (points)	Men (n = 156)	Women (n = 73)	t-score
Overall food group variety	0 − 15	10.48 ± 2.22¹⁾	10.89 ± 2.37	1.272
Within-group variety for protein source	0 − 5	83.00 ± 1.93	82.68 ± 2.05	1.127
Variety	0 − 20	13.48 ± 3.26	13.58 ± 3.66	0.197
Vegetable group	0 − 5	82.68 ± 1.41	82.97 ± 1.55	1.422
Fruits group	0 − 5	81.90 ± 1.71	82.52 ± 1.94	2.347∗
Grain group	0 − 5	84.29 ± 1.01	84.21 ± 1.04	0.618
Fiber	0 − 5	83.28 ± 1.27	83.60 ± 1.28	1.774
Protein	0 − 5	84.95 ± 0.32	84.97 ± 0.23	0.574
Iron	0 − 5	83.88 ± 1.16	83.85 ± 1.29	0.207
Calcium	0 − 5	82.44 ± 1.43	82.56 ± 1.38	0.625
Vitamin C	0 − 5	83.37 ± 1.50	83.68 ± 1.38	1.506
Adequacy	0 − 40	26.79 ± 5.94	28.37 ± 6.14	1.850
Total fat	0 − 6	85.02 ± 1.64	85.10 ± 1.63	0.330
Saturated fat	0 − 6	85.63 ± 1.10	85.42 ± 1.38	1.140
Cholesterol	0 − 6	83.85 ± 2.48	84.44 ± 2.07	1.893
Sodium	0 − 6	82.68 ± 0.61	82.44 ± 0.72	2.582∗∗
Empty calorie foods	0 − 6	82.23 ± 2.52	84.44 ± 2.07	7.001∗∗∗
Moderation	0 − 30	19.46 ± 4.95	21.73 ± 4.00	3.378∗∗∗
Macronutrient ratio (Carbohydrate : Protein : Fat)	0 − 6	82.13 ± 2.10	81.89 ± 2.31	0.773
Fatty acid ratio (PUFA : MUFA : SFA)	0 − 4	80.41 ± 0.96	80.30 ± 0.86	0.828
Overall balance	0 − 10	82.54 ± 2.09	82.19 ± 2.31	1.131
Total	100	62.60 ± 8.95	65.87 ± 9.86	2.525∗

1) Values are Mean ± SD

Significantly different between men and women groups by student's t test at ∗: P < 0.05, ∗∗: P < 0.01 and ∗∗∗: P < 0.001

Table 6.

Comparison of DQI-I in the subjects according to serum hs-CRP and Adiponectin level