Metabolic Syndrome Risk by Intake Ratio and Intake Pattern of Proteins in Middle-aged Men Based on the 2012–2013 Korean National Health and Nutrition Examination Survey Data

Minkyoung Jang; Eunsil Her; Kyunghea Lee

doi:10.5720/kjcn.2016.21.4.366

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Research Article: Korean Journal of Community Nutrition 2016;21(4):366-377.
DOI: https://doi.org/10.5720/kjcn.2016.21.4.366
Published online: January 20, 2016

¹⁾Department of Food and Nutrition, Changwon National University, Changwon, Korea

²⁾Department of Food and Nutriton, Changshin University, Changwon, Korea

†Corresponding author Kyunghea Lee Department of food and nutrition, Changwon, National University, 20 Changwondaehak-ro, Uichang-gu, Changwon, Gyeongnam 51140, Korea Tel: (055) 213-3514 Fax: (055) 281-7480 E-mail: khl@changwon.ac.kr ORCID: 0000-0003-0444-4824

• Received: July 14, 2016 • Revised: August 19, 2016 • Accepted: August 25, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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Abstract

Objectives
The purpose of the study was to compare intake of energy nutrients, physical characteristics, and the prevalence of metabolic syndrome according to protein intake group. Methods: Subjects were 827 men aged 40–65 years. The results presented were based on data from the 2012–2013 National Health and Nutrition Examination Survey and analyzed using SPSS. The odds ratio (OR) of metabolic syndrome was assessed according to the protein intake group and intake pattern of protein-rich foods. Results: The mean of protein intake was 73.96 ± 0.71 g. According to level of protein intake, four groups (deficient, normal, excess 1, excess 2) were created and their percentages were 8.3%, 39.6%, 37.1%, and 15.0% respectively. The mean of daily energy intake was 2,312.33 ± 24.08 kcal. It was higher in excess group 2 than in the deficiency group (p<0.001). Moreover, the intake of all energy nutrients increased significantly with protein intake group (p < 0.001). The main contribution to daily protein included mixed grains (10.96 ± 0.32 g), milled rice (7.14 ± 0.30 g), chicken (3.50 ± 0.21 g), and grilled pork belly (3.04 ± 0.16 g). With regard to physical characteristics, and blood pressure and blood test results, only body mass index increased significantly according to protein intake groups (p<0.05). The prevalence of metabolic syndrome in subjects was 38.5%, and there was no significant correlation with protein intake group. The OR of metabolic syndrome increased with protein intake, and was higher 4.452 times in excess group 2 than in the normal group (p<0.05). Conversely, the OR of metabolic syndrome according to the frequency of protein-rich food intake did not show a significant correlation. Conclusions: The results of this study can be used as significant supporting data to establish guidelines for protein intake in middle-aged men.
Keywords: middle-aged men; protein intake; OR of metabolic syndrome

Table 1.

Distribution of protein intake ratio among study participants

Independent variable	Items	N (%)	Mean ± SD
Protein intake group¹⁾	Deficiency group (< RNI 75%)	72 (558.3)	562.6 ± 1.2²⁾
	Moderate group (RNI 75∼< 125%)	325 (539.6)	102.0 ± 0.9
	Excessive group 1 (RNI 125∼< 200%)	316 (537.1)	154.2 ± 1.4
	Excessive group 2 (≥ RNI 200%)	114 (515.0)	247.1 ± 4.2
	Total	827 (100.0)	162.0 ± 2.6

¹⁾Protein intake ratio: (Protein intake/recommended protein intake)×100 2) %

Table 2.

General characteristics of the subjects by protein intake group

Variables	Items	Protein intake group				χ² or F value	Total
Variables	Items	Deficiency group	Moderate group	Excessive group 1	Excessive group 2	χ² or F value	Total
Income	Low	16 (21.4)¹⁾	87 (32.6)	70 (25.2)	24 (21.7)	16.155	197 (27.3)
	Middle low	24 (35.5)	90 (27.3)	77 (26.9)	24 (22.3)		215 (27.0)
	Middle high	16 (22.5)	70 (20.0)	74 (21.0)	34 (28.2)		194 (21.8)
	High	16 (20.6)	78 (20.1)	95 (26.9)	32 (27.8)		221 (23.9)
Education level	≤ Primary school	10 (15.0)	46 (11.9)	34 (59.4)	7 (56.1)	14.672	97 (10.4)
	Middle school	7 (57.9)	47 (15.3)	25 (58.8)	13 (59.2)		92 (11.4)
	High school	30 (39.3)	115 (39.0)	123 (42.3)	46 (45.6)		314 (41.2)
	≥ College	25 (37.8)	117 (33.8)	134 (39.5)	48 (39.1)		324 (37.0)
Occupation	Professionals or technicians	19 (29.7)	61 (16.8)	81 (25.4)	26 (23.5)	41.635∗	187 (22.0)
	Clerical support workers	4 (55.1)	44 (12.8)	35 (10.9)	11 (59.7)		94 (11.0)
	Salesperson service workers	8 (59.6)	32 (59.7)	50 (16.1)	19 (18.6)		109 (13.4)
	Skilled agricultural, forestry and fishery workers	4 (53.2)	35 (58.6)	23 (57.4)	6 (53.6)		68 (57.0)
	Plant and machine operators, and assemblers	20 (32.3)	84 (28.6)	65 (23.2)	37 (33.6)		206 (27.6)
	Elementary occupations	7 (57.0)	28 (58.5)	30 (59.3)	7 (55.2)		72 (58.2)
	Inoccupation	10 (13.1)	41 (15.0)	32 (57.7)	8 (55.8)		91 (10.8)
Marital status	Married	69 (94.5)	314 (95.2)	308 (97.2)	110 (95.9)	52.077	801 (96.0)
Marital status	Unmarried	3 (55.5)	11 (54.8)	8 (52.8)	4 (54.1)	52.077	26 (54.0)
Age (years)		50.48 ± 0.78²⁾	49.58 ± 0.40	49.95 ± 0.43	49.83 ± 0.68	50.417	49.96 ± 0.33

¹⁾N (%) 2) Mean ± SD ∗: p < 0.05

Table 3.

Energy nutrient intake by protein intake group¹⁾

Variables		Protein intake group				F-value	Total (N=827)
Variables	Deficiency group (N=72)	Deficiency group (N=72)	Moderate group (N=325)	Excessive group 1 (N=316)	Excessive group 2 (N=114)	F-value	Total (N=827)
Energy (kcal)		1,158.49 ± 35.91²⁾	1,715.60 ± 18.38	2,347.33 ± 22.62	3,313.20 ± 549.33	381.140∗∗∗ 2	2,133.66 ± 16.35
Energy nutrient intake	Protein (g)	32.25 ± 50.73	53.65 ± 50.52	80.55 ± 50.78	129.38 ± 124.83	1041.739∗∗∗	73.96 ± 50.71
	Fat (g)	15.78 ± 50.94	27.38 ± 50.55	46.15 ± 50.83	82.97 ± 552.25	464.921∗∗∗	43.07 ± 50.73
	Carbohydrate (g)	219.63 ± 58.32	312.13 ± 54.06	400.28 ± 54.54	508.49 ± 558.76	249.490∗∗∗	360.13 ± 53.46
Energy ratio	Carbohydrate (%)	75.02 ± 50.84	72.41 ± 50.35	68.07 ± 50.31	61.41 ± 550.54	92.386∗∗∗	69.23 ± 50.28
	Protein (%)	11.66 ± 50.28	12.75 ± 50.10	13.93 ± 50.11	15.82 ± 550.18	68.392∗∗∗	13.54 ± 50.91
	Fat (%)	13.31 ± 50.67	14.83 ± 50.28	18.00 ± 50.24	22.77 ± 550.45	68.890∗∗∗	17.23 ± 50.23

¹⁾Adjusted for occupation in total subjects 2) Mean ± SD ∗∗∗: p < 0.001

Table 4.

Major sources and frequency of protein intake per week (N=827)

Rank	Food	Daily intake(g)	Food	Frequency of intake per week
1	Mixed grains	10.96 ± 0.32¹⁾	Cabbage kimchi	13.20 ± 0.27
2	Milled rice	7.14 ± 0.30	Mixed grains	9.74 ± 0.28
3	Fried chicken	3.50 ± 0.21	Milled rice	8.01 ± 0.30
4	Grilled pork belly	3.04 ± 0.16	Milk	1.89 ± 0.11
5	Noodles	1.96 ± 0.10	Fried eggs	1.70 ± 0.07
6	Milk	1.81 ± 0.11	Soy bean paste stew	1.31 ± 0.06
7	Ramen	1.80 ± 0.08	Kimchi stew	1.28 ± 0.06
8	Stir-fried pork	1.77 ± 0.13	Soy bean paste soup	1.24 ± 0.06
9	Fried eggs	1.72 ± 0.07	Ramen	1.08 ± 0.04
10	Squid	1.51 ± 0.11	Grilled pork belly	0.76 ± 0.03
11	Bibimbap	1.51 ± 0.09	Noodles	0.63 ± 0.03
12	Black bean sauce noodle	1.50 ± 0.10	Bibimbap	0.61 ± 0.04
13	Beef bulgogi	1.50 ± 0.10	Stir-fried pork	0.47 ± 0.03
14	Steamed pork	1.33 ± 0.11	Squid	0.45 ± 0.03
15	Kimchi stew	1.27 ± 0.06	Black bean sauce noodle	0.40 ± 0.03
16	Soy bean paste stew	1.11 ± 0.05	Fried chicken	0.34 ± 0.02
17	Stir-fried chicken	1.04 ± 0.16	Steamed pork	0.24 ± 0.02
18	Cabbage kimchi	1.02 ± 0.03	Stir-fried chicken	0.23 ± 0.02
19	Soy bean paste soup	1.01 ± 0.05	Roast beef	0.23 ± 0.02
20	Roast beef	1.00 ± 0.08	Beef bulgogi	0.20 ± 0.02

¹⁾Mean ± SD

Table 5.

Exploratory factor analysis for food sources¹⁾

Factors	Items	Factor loading	Communalities	Eigen values (% of variance)
Grain	White rice	0.893	0.824	2.872 (9.894)²⁾
Grain	Multi grain rice	0.876	0.787	2.872 (9.894)²⁾
Meat1	Grilled pork	0.544	0.484	1.666 (9.846)
Meat1	Chicken	0.661	0.533	1.666 (9.846)
Meat2	Roast beef	0.895	0.756	1.421 (9.098)
Meat2	Beef bulgogi	0.708	0.615	1.421 (9.098)
Stew	Soy bean paste soup	0.613	0.420	1.212 (8.669)
	Soy bean paste stew	0.742	0.672
	Kimchi stew	0.650	0.578
Meat3	Stir-fried pork	0.511	0.488	1.058 (8.507)
	Stir-fried chicken	0.665	0.515
	Squid	0.626	0.442
Noodle	Ramen	0.443	0.573	1.032 (7.957)
	Noodles	0.812	0.690
	Black bean sauce noodle	0.615	0.506
Egg & Milk	Fried eggs	0.574	0.676	1.014 (6.468)
Egg & Milk	Milk	0.810	0.717	1.014 (6.468)
	Total score			(60.440)

¹⁾Adjusted for occupation in total subjects 2) KMO and Bartlett's test 0.681 (p < 0.001)

Table 6.

Anthropometric measurement and blood pressure by protein intake group¹⁾

Variables	Protein intake group				F-value	Total (N=827)
	Deficiency group	Moderate group	Excessive group 1	1 Excessive group 2
	(N=72)	(N=325)	(N=316)	(N=114)
Height(cm)	168.99 ± 1.06²⁾	169.69 ± 0.52	170.53 ± 0.35	169.91 ± 0.50	3.359∗∗∗	169.78 ± 0.34
Weight (kg)	67.95 ± 1.86	69.37 ± 0.89	69.51 ± 0.67	70.31 ± 0.92	3.797∗∗∗	69.28 ± 0.56
Body mass index (kg/m²)³⁾	23.78 ± 0.58	24.09 ± 0.30	23.85 ± 0.18	24.29 ± 0.26	2.750∗∗	24.00 ± 0.17
Waist circumference (cm)	81.49 ± 1.52	83.16 ± 0.75	83.49 ± 0.59	85.47 ± 0.75	2.466∗∗	83.40 ± 0.49
Systolic blood pressure (mmHg)	119.27 ± 2.86	118.45 ± 1.45	121.96 ± 0.99	121.54 ± 1.32	1.995∗	120.30 ± 0.92
Diastolic blood pressure (mmHg)	80.84 ± 1.58	79.36 ± 1.13	82.11 ± 0.66	81.31 ± 0.97	1.206	80.90 ± 0.54

¹⁾Adjusted for occupation, energy intake, carbohydrate intake and fat intake in total subjects 2) Mean ± SD 3) BMI (Body mass index)=Weight(kg)÷{Height (m)×{Height(m)} ∗: p < 0.05

Table 7.

Biochemical factors related to metabolic syndrome by protein intake group¹⁾

Variables	Protein intake group				F-value	Total (N=827)
Variables	Deficiency group (N=72)	Moderate group (N=325)	Excessive group 1 (N=316)	Excessive group 2 (N=114)	F-value	Total (N=827)
Fasting blood sugar (mg/dL)	593.74 ± 2.44²⁾	96.29 ± 1.23	100.63 ± 1.20	102.14 ± 51.45	1.506	98.20 ± 0.82
HDL-cholesterol (mg/dL)	5 44.88 ± 1.76	47.15 ± 0.87	48.60 ± 0.77	50.15 ± 51.14	1.638	47.70 ± 0.53
Triglyceride (mg/dL)	153.29 ± 20.42	143.82 ± 9.74	166.43 ± 8.11	177.50 ± 10.22	2.543∗∗	160.26 ± 5.72

¹⁾Adjusted for occupation, energy intake, carbohydrate intake and fat intake in total subjects 2) Mean ± SD

Table 8.

Metabolic syndrome index and the prevalence by protein intake group¹⁾

Variables	Items	Protein intake group				χ² value	Total
Variables	Items	Deficiency group	Moderate group	Excessive group 1	Excessive group 2	χ² value	Total
Waist circumference (cm)	< 90	61 (982.4)¹⁾	254 (979.3)	250 (979.8)	80 (969.9)	6.377	645 (978.3)
	≥ 90	11 (917.6)	71 (920.7)	66 (920.2)	34 (930.1)		182 (921.7)
	Total	72 (100.0)	325 (100.0)	316 (100.0)	114 (100.0)		827 (100.0)
Systolic blood pressure (mmHg)	< 130	52 (970.8)	263 (980.1)	241 (978.3)	78 (968.6)	8.399	634 (976.9)
	≥ 130	19 (929.2)	61 (919.9)	75 (921.7)	36 (931.4)		191 (923.1)
	Total	71 (100.0)	324 (100.0)	316 (100.0)	114 (100.0)		825 (100.0)
Diastolic blood pressure (mmHg)	< 85	46 (963.3)	219 (966.6)	206 (965.6)	72 (958.9)	2.551	543 (964.8)
	≥ 85	25 (936.7)	105 (933.4)	110 (934.4)	42 (941.1)		282 (935.2)
	Total	71 (100.0)	324 (100.0)	316 (100.0)	114 (100.0)		825 (100.0)
Fasting blood glucose (mg/dL)	< 100	48 (968.8)	218 (967.1)	185 (963.1)	64 (960.4)	2.655	515 (964.7)
	≥ 100	23 (931.2)	105 (932.9)	124 (936.9)	50 (939.6)		302 (935.3)
	Total	71 (100.0)	323 (100.0)	309 (100.0)	114 (100.0)		817 (100.0)
Triglyceride (mg/dL)	< 150	46 (963.4)	185 (954.7)	182 (955.8)	67 (958.6)	1.990	480 (956.4)
	≥ 150	25 (936.6)	138 (945.3)	127 (944.2)	47 (941.4)		337 (943.6)
	Total	71 (100.0)	323 (100.0)	309 (100.0)	114 (100.0)		817 (100.0)
HDL-cholesterol (mg/dL)	< 40	24 (932.4)	102 (930.6)	99 (934.2)	27 (922.9)	5.399	252 (930.9)
	≥ 40	47 (967.6)	221 (969.4)	210 (965.8)	87 (977.1)		565 (969.1)
	Total	71 (100.0)	323 (100.0)	309 (100.0)	114 (100.0)		817 (100.0)
Retention numbers of metabolic syndrome components	< 3	47 (965.7)	208 (962.6)	190 (962.7)	59 (953.7)	4.014	504 (961.5)
	≥ 3	23 (934.3)	115 (937.4)	119 (937.3)	55 (946.3)		312 (938.5)
	Total	70 (100.0)	323 (100.0)	309 (100.0)	114 (100.0)		816 (100.0)

¹⁾N (%)

Table 9.

Odds ratio for metabolic syndrome by protein intake group¹⁾³⁾

Variables	Unadjusted	Adjusted
Variables	OR (95% CI)	OR (95%CI)
Protein intake group
Deficiency group	0.874 (0.445 − 1.717)	0.768 (0.345 − 1.712)
Moderate group	1.000 (reference)³⁾	1.000 (reference)²⁾
Excessive group 1	0.993 (0.688 − 1.435)	1.315 (0.761 − 2.272)
Excessive group 2	1.442 (0.874 − 2.377)	4.452 (1.544 − 12.835)

¹⁾Adjusted for energy intake (continuous variable), carbohydrate intake (continuous variable), fat intake (continuous variable) and BMI (continuous variable) in total subjects 2) Odds ratio of deficiency, excessive 1, excessive 2 group based on the risk of moderate group 3) Calculated by Complex Samples Logistic Regression

Table 10.

Odds ratio for metabolic syndrome by the frequency of intake of proteins per week¹⁾²⁾

Variables		Unadjusted	Adjusted
Variables		OR (95% CI)	OR (95% CI)
Major sources of protein intake patterns	Grain	1.028 (0.990 − 1.068)	1.050 (1.000 − 1.102)
	Meat1	1.036 (0.931 − 1.154)	1.086 (0.935 − 1.262)
	Meat2	1.063 (0.925 − 1.221)	1.073 (0.870 − 1.322)
	Stew	1.017 (0.965 − 1.073)	1.026 (0.967 − 1.089)
	Meat3	1.052 (0.791 − 1.678)	1.029 (0.774 − 2.158)
	Noodle	1.022 (0.939 − 1.111)	1.032 (0.927 − 1.148)
	Egg & Milk	1.000 (0.930 − 1.075)	1.025 (0.927 − 1.134)

¹⁾Adjusted for energy intake, carbohydrate intake, fat intake and BMI in total subjects 2) Calculated by Complex Samples Logistic Regression

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Metabolic Syndrome Risk by Intake Ratio and Intake Pattern of Proteins in Middle-aged Men Based on the 2012-2013 Korean National Health and Nutrition Examination Survey Data

Korean J Community Nutr. 2016;21(4):366-377. Published online August 31, 2016

DOI: https://doi.org/10.5720/kjcn.2016.21.4.366

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Metabolic Syndrome Risk by Intake Ratio and Intake Pattern of Proteins in Middle-aged Men Based on the 2012-2013 Korean National Health and Nutrition Examination Survey Data

Table 1.

Distribution of protein intake ratio among study participants

Independent variable	Items	N (%)	Mean ± SD
Protein intake group¹⁾	Deficiency group (< RNI 75%)	72 (558.3)	562.6 ± 1.2²⁾
	Moderate group (RNI 75∼< 125%)	325 (539.6)	102.0 ± 0.9
	Excessive group 1 (RNI 125∼< 200%)	316 (537.1)	154.2 ± 1.4
	Excessive group 2 (≥ RNI 200%)	114 (515.0)	247.1 ± 4.2
	Total	827 (100.0)	162.0 ± 2.6

¹⁾Protein intake ratio: (Protein intake/recommended protein intake)×100 2) %

Table 2.

General characteristics of the subjects by protein intake group

Variables	Items	Protein intake group				χ² or F value	Total
Variables	Items	Deficiency group	Moderate group	Excessive group 1	Excessive group 2	χ² or F value	Total
Income	Low	16 (21.4)¹⁾	87 (32.6)	70 (25.2)	24 (21.7)	16.155	197 (27.3)
	Middle low	24 (35.5)	90 (27.3)	77 (26.9)	24 (22.3)		215 (27.0)
	Middle high	16 (22.5)	70 (20.0)	74 (21.0)	34 (28.2)		194 (21.8)
	High	16 (20.6)	78 (20.1)	95 (26.9)	32 (27.8)		221 (23.9)
Education level	≤ Primary school	10 (15.0)	46 (11.9)	34 (59.4)	7 (56.1)	14.672	97 (10.4)
	Middle school	7 (57.9)	47 (15.3)	25 (58.8)	13 (59.2)		92 (11.4)
	High school	30 (39.3)	115 (39.0)	123 (42.3)	46 (45.6)		314 (41.2)
	≥ College	25 (37.8)	117 (33.8)	134 (39.5)	48 (39.1)		324 (37.0)
Occupation	Professionals or technicians	19 (29.7)	61 (16.8)	81 (25.4)	26 (23.5)	41.635∗	187 (22.0)
	Clerical support workers	4 (55.1)	44 (12.8)	35 (10.9)	11 (59.7)		94 (11.0)
	Salesperson service workers	8 (59.6)	32 (59.7)	50 (16.1)	19 (18.6)		109 (13.4)
	Skilled agricultural, forestry and fishery workers	4 (53.2)	35 (58.6)	23 (57.4)	6 (53.6)		68 (57.0)
	Plant and machine operators, and assemblers	20 (32.3)	84 (28.6)	65 (23.2)	37 (33.6)		206 (27.6)
	Elementary occupations	7 (57.0)	28 (58.5)	30 (59.3)	7 (55.2)		72 (58.2)
	Inoccupation	10 (13.1)	41 (15.0)	32 (57.7)	8 (55.8)		91 (10.8)
Marital status	Married	69 (94.5)	314 (95.2)	308 (97.2)	110 (95.9)	52.077	801 (96.0)
Marital status	Unmarried	3 (55.5)	11 (54.8)	8 (52.8)	4 (54.1)	52.077	26 (54.0)
Age (years)		50.48 ± 0.78²⁾	49.58 ± 0.40	49.95 ± 0.43	49.83 ± 0.68	50.417	49.96 ± 0.33

¹⁾N (%) 2) Mean ± SD ∗: p < 0.05

Table 3.