Research Original Research| Volume 115, ISSUE 7, P1083-1092, July 2015

A Randomized Trial on the Effects of 2010 Dietary Guidelines for Americans and Korean Diet Patterns on Cardiovascular Risk Factors in Overweight and Obese Adults



      Dietary patterns that are considered healthy (eg, the Dietary Approaches to Stop Hypertension diet and Mediterranean diet) may be more successful in reducing typical cardiovascular disease risks compared to dietary patterns considered unhealthy (eg, energy-dense diets such as the typical American diet).


      This study assessed the effects of a Korean diet, the 2010 Dietary Guidelines for Americans (DGA), and a typical American diet on cardiometabolic risk factors, including lipid levels and blood pressure, in overweight, non-Asian individuals in the United States with elevated low-density lipoprotein cholesterol.


      The study was a three-period crossover, controlled-feeding study from January 2012 to May 2012. Thirty-one subjects were randomly allocated to one of six possible sequential orders for consuming the three diets for 4 weeks, each separated by a 10-day break. Data analysis included 27 subjects on the Korean diet periods and 29 in the DGA and typical American diet periods. Subjects remained weight stable.

      Main outcome measures

      Lipid profile, blood pressure, insulin, glucose, and 24-hour urinary sodium were determined at baseline and at the end of each diet period.

      Statistical analyses performed

      The additive main effects multiplicative interactions model was used to test for a subject by diet interaction. Differences among diets were determined using a mixed-models procedure (PROC MIXED) with random intercept for each subject.


      Total cholesterol and low-density lipoprotein cholesterol significantly decreased on Korean (P<0.0001 and P<0.01, respectively) and DGA (P<0.01 and P<0.05, respectively) diets, but not on the typical American diet. Although an unfavorable outcome, high-density lipoprotein cholesterol significantly decreased on all three diets (Korean: P<0.0001; DGA: P<0.0001; typical American: P<0.05). No diet had a significant effect on serum triglycerides, but a slight increase in triglycerides in the Korean and decrease in the DGA resulted in a significant difference between these two diets (P<0.01). All three diets caused modest decreases in systolic and diastolic blood pressure, which reached statistical significance for DGA only (P<0.05 and P<0.01, respectively). No diet had significant effect on fasting insulin, whereas fasting glucose decreased significantly on the Korean (P<0.01) and typical American (P<0.05) diets only. Urinary sodium output decreased significantly on DGA (P<0.0001).


      After a 4-week feeding period, Korean and DGA diet patterns resulted in positive changes in cardiovascular disease risk factors.


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      1. Centers for Disease Control and Prevention. Heart Disease Facts. 2014 Accessed November 13, 2012.

        • Appel L.J.
        • Moore T.J.
        • Obarzanek E.
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.
        N Engl J Med. 1997; 336: 1117-1124
        • Obarzanek E.
        • Sacks F.M.
        • Vollmer W.M.
        • et al.
        Effects on blood lipids of a blood pressure-lowering diet: The Dietary Approaches to Stop Hypertension (DASH) Trial.
        Am J Clin Nutr. 2001; 74: 80-89
        • Urpi-Sarda M.
        • Casas R.
        • Chiva-Blanch G.
        • et al.
        The Mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease.
        J Nutr. 2012; 142: 1019-1025
        • Sofi F.
        The Mediterranean diet revisited: Evidence of its effectiveness grows.
        Curr Opin Cardiol. 2009; 24: 442-446
        • US Department of Agriculture and US Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th ed. US Government Printing Office, Washington, DCDecember 2010
      2. Home of the Office of Disease Prevention and Health Promotion. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. February 2015 Accessed February 28, 2015.

        • Jung S.J.
        • Park S.H.
        • Choi E.K.
        • et al.
        Benefical effects of Korean traditional diets in hypertensive and type 2 diabetic patients.
        J Med Food. 2014; 17: 161-171
        • Kim S.
        • Moon S.
        • Popkin B.M.
        The nutrition transition in South Korea.
        Am J Clin Nutr. 2000; 71: 44-53
        • Choi K.M.
        • Park H.S.
        • Han J.H.
        • et al.
        Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001.
        J Hypertens. 2006; 24: 1515-1521
        • Jang Y.A.
        • Lee H.S.
        • Kim B.H.
        • et al.
        Revised dietary guidelines for Koreans.
        Asia Pac J Clin Nutr. 2008; 17: 55-58
        • Lee Y.K.
        • Mazmanian S.K.
        Has the microbiota played a critical role in the evolution of the adaptive immune system?.
        Science. 2010; 330: 1768-1773
        • Russell D.A.
        • Ross R.P.
        • Fitzgerald G.F.
        • Stanton C.
        Metabolic activities and probiotic potential of bifidobacteria.
        Int J Food Microbiol. 2011; 149: 88-105
      3. US Department of Agriculture, Agricultural Research Service and US Department of Health and Human Services, Centers for Disease Control and Prevention. What We Eat In America, NHANES 2001-2004. Belstville, MD: US Department of Agriculture. Accessed October 13, 2011.

        • Clark R.
        • Johnson S.
        Sensory acceptability of foods with added lupin (Lupinus angustifolius) kernel fiber using pre-set criteria.
        J Food Sci. 2002; 67: 356-362
        • Bengtsson M.
        • Hammar O.
        • Mandl T.
        • Ohlsson B.
        Evaluation of gastrointestinal symptoms in different patient groups using the visual analogue scale for irritable bowel syndrome (VAS-IBS).
        BMC Gastroenterol. 2011; 11: 122
      4. US Department of Agriculture. Sample menus for a 2000 calorie food pattern. Accessed December 1, 2011.

        • Korean Nutrition Society
        Dietary Reference Intakes for Koreans.
        Seoul: Kookjin Publishing Co, 2010
        • Paik H.Y.
        Dietary reference intakes for Koreans (KDRIs).
        Asia Pac J Clin Nutr. 2008; 17: 416-419
        • Lee H.S.
        • Duffey K.J.
        • Popkin B.M.
        Sodium and potassium intake patterns and trends in South Korea.
        J Hum Hypertens. 2013; 27: 298-303
      5. Kramer M, Chen SC, Gebauer SK, et al. Estimating the subject by treatment interaction in non-replicated crossover diet studies. Proceedings of the 23rd Annual Conference on Applied Statistics in Agriculture, 2011. Accessed July 24, 2012.

        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • et al.
        Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Yu-Poth S.
        • Zhao G.
        • Etherton T.
        • Naglak M.
        • Jonnalagadda S.
        • Kris-Etherton P.M.
        Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: A meta-analysis.
        Am J Clin Nutr. 1999; 69: 632-646
        • Esposito K.
        • Marfella R.
        • Ciotola M.
        • et al.
        Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial.
        JAMA. 2004; 292: 1440-1446
        • Brien S.E.
        • Ronksley P.E.
        • Turner B.J.
        • Mukamal K.J.
        • Ghali W.A.
        Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies.
        BMJ. 2011; 342: d636
        • Richard C.
        • Couture P.
        • Desroches S.
        • Lichtenstein A.H.
        • Lamarche B.
        Effect of weight loss, independent of change in diet composition, on apolipoprotein AI kinetic in men with metabolic syndrome.
        J Lipid Res. 2013; 54: 232-237
        • Durstine J.L.
        • Grandjean P.W.
        • Cox C.A.
        • Thompson P.D.
        Lipids, lipoproteins, and exercise.
        J Cardiopulm Rehabil. 2002; 22: 385-398
        • Pattyn N.
        • Cornelissen V.A.
        • Eshghi S.R.
        • Vanhees L.
        The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: A meta-analysis of controlled trials.
        Sports Med. 2013; 43: 121-133
        • Micha R.
        • Mozaffarian D.
        Trans fatty acids: Effects on metabolic syndrome, heart disease and diabetes.
        Nat Rev Endocrinol. 2009; 5: 335-344
        • Appel L.J.
        • Sacks F.M.
        • Carey V.J.
        • et al.
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: Results of the OmniHeart randomized trial.
        JAMA. 2005; 294: 2455-2464
        • Lichtenstein A.H.
        • Ausman L.M.
        • Jalbert S.M.
        • et al.
        Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects.
        J Lipid Res. 2002; 43: 264-273
        • Willcox B.J.
        • Willcox D.C.
        • Todoriki H.
        • et al.
        Caloric restriction, the traditional Okinawan diet, and healthy aging: The diet of the world's longest-lived people and its potential impact on morbidity and life span.
        Ann N Y Acad Sci. 2007; 1114: 434-455
        • Willcox D.C.
        • Willcox B.J.
        • Todoriki H.
        • Suzuki M.
        The Okinawan diet: Health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load.
        J Am Coll Nutr. 2009; 28: 500S-516S
        • Choi I.H.
        • Noh J.S.
        • Han J.S.
        • Kim H.J.
        • Han E.S.
        • Song Y.O.
        Kimchi, a fermented vegetable, improves serum lipid profiles in healthy young adults: Randomized clinical trial.
        J Med Food. 2013; 16: 223-229
        • Kim E.K.
        • An S.Y.
        • Lee M.S.
        • et al.
        Fermented kimchi reduces body weight and improves metabolic parameters in overweight and obese patients.
        Nutr Res. 2011; 31: 436-443
        • Santos F.L.
        • Esteves S.S.
        • da Costa Pereira A.
        • Yancy W.S.
        • Nunes J.P.
        Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors.
        Obes Rev. 2012; 13: 1048-1066
        • Turley M.L.
        • Skeaff C.M.
        • Mann J.I.
        • Cox B.
        The effect of a low-fat, high-carbohydrate diet on serum high density lipoprotein cholesterol and triglyceride.
        Eur J Clin Nutr. 1998; 52: 728-732
        • Mozaffarian D.
        • Appel L.J.
        • Van Horn L.
        Components of a cardioprotective diet: New insights.
        Circulation. 2011; 123: 2870-2891
        • Stoner L.
        • Lucero A.A.
        • Palmer B.R.
        • et al.
        Inflammatory biomarkers for predicting cardiovascular disease.
        Clin Biochem. 2013; 46: 1353-1371
        • Kasim-Karakas S.E.
        • Tsodikov A.
        • Singh U.
        • Jialal I.
        Responses to inflammatory markers to a low-fat, high-carbohydrate diet: Effects of energy intake.
        Am J Clin Nutr. 2006; 83: 774-779


      N. Schroeder is a freelance consultant, Leipzig, Germany; at the time of the study, she was a research nutritionist, Beltsville Human Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, Beltsville, MD.


      Y.-H. Park is a researcher, National Academy of Agricultural Science, Rural Development Administration, Jeonju, Republic of Korea.


      M.-S. Kang is a researcher, National Academy of Agricultural Science, Rural Development Administration, Jeonju, Republic of Korea.


      Y. Kim is a researcher, National Academy of Agricultural Science, Rural Development Administration, Jeonju, Republic of Korea.


      H.-R. Kim is a senior researcher, National Academy of Agricultural Science, Rural Development Administration, Jeonju, Republic of Korea.


      G. K. Ha is a research data analyst, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.


      B. Caballero is a professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; at the time of the study, he was also a visiting scientist, Beltsville Agricultural Research Center, Beltsville, MD.


      A. A. Yates is retired; at the time of the study, she was principal investigator, Research in Agriculture Virtual Laboratory (RAVL) Nutrition Study, and director, Beltsville Human Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, Beltsville, MD.