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Associations between Low-Carbohydrate Diets from Animal and Plant Sources and Dyslipidemia among Korean Adults

      Abstract

      Background

      The traditional Korean diet is relatively high in carbohydrate and low in fat and protein compared with diets of non-Asian populations. In recent decades, the rapid economic growth in Korea has led to lifestyle and dietary changes, with an increase in the prevalence of dyslipidemia, a risk factor for chronic diseases.

      Objective

      To examine the association between a low carbohydrate diet (LCD) score and dyslipidemia in Korean adults.

      Design

      The Korea National Health and Nutrition Examination Survey is an ongoing nationally representative population-based cross-sectional survey that is conducted annually.

      Participants/setting

      A total of 12,199 Korea National Health and Nutrition Examination Survey participants aged ≥20 years from 2010 to 2016 were included in this study.

      Main outcome measures

      Individual components of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels, were defined based on fasting blood test results.

      Statistical analyses

      Participants were classified by sex into quintiles of LCD scores calculated using 1-day 24-hour dietary recall data. A multivariable logistic regression model was used to examine the association between LCD score and each dyslipidemia component after adjusting for potential confounders.

      Results

      A higher LCD score was significantly associated with higher odds of hypercholesterolemia (odds ratio 1.36, 95% CI, 1.05 to 1.78; P for trend=0.031) and lower odds of low high-density lipoprotein cholesterol levels (odds ratio 0.72, 95% CI 0.55 to 0.94; P for trend=0.002) in women. However, in men, higher LCD scores were significantly associated with lower odds of hypertriglyceridemia (odds ratio 0.70, 95% CI 0.52 to 0.95; P for trend=0.012). More specifically, animal-based LCD scores were negatively associated with the odds of hypertriglyceridemia (odds ratio 0.65, 95% CI 0.48 to 0.87; P for trend=0.010) in men.

      Conclusions

      These results suggest that the complicated and integrated effects of macronutrient composition on individual lipid components should be considered for preventing dyslipidemia in Korean adults.

      Keywords

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      References

        • Song Y.
        • Joung H.
        A traditional Korean dietary pattern and metabolic syndrome abnormalities.
        Nutr Metab Cardiovasc Dis. 2012; 22: 456-462
        • Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention
        Korea Health Statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2017
        • Lee S.
        Association of whole grain consumption with socio-demographic and eating behavior factors in a Korean population: Based on 2007-2008 Korea National Health and Nutrition Examination Survey.
        Korea J Community Nutr. 2011; 16: 353-363
        • Kang M.
        • Joung H.
        • Lim J.H.
        • Lee Y.-S.
        • Song Y.J.
        Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korea National Health and Nutrition Examination Survey.
        Korea J Nutr. 2011; 44: 152-161
        • Lim S.
        • Shin H.
        • Song 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: 1323-1328
        • Shai I.
        • Schwarzfuchs D.
        • Henkin Y.
        • et al.
        Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.
        N Engl J Med. 2008; 359: 229-241
        • Appel L.J.
        • Moore T.J.
        • Obarzanek E.
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure.
        N Engl J Med. 1997; 336: 1117-1124
        • Nutrition and Your Health
        Dietary Guidelines for Americans 2015-2020.
        US Government Printing Office, Washington, DC2015
        • Brehm B.J.
        • Seeley R.J.
        • Daniels S.R.
        • D’alessio D.A.
        A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.
        J Clin Endocrinol Metab. 2003; 88: 1617-1623
        • Yancy W.S.
        • Olsen M.K.
        • Guyton J.R.
        • Bakst R.P.
        • Westman E.C.
        A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: A randomized, controlled trial.
        Ann Intern Med. 2004; 140: 769-777
        • Nordmann A.J.
        • Nordmann A.
        • Briel M.
        • et al.
        Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: A meta-analysis of randomized controlled trials.
        Arch Intern Med. 2006; 166: 285-293
        • Stern L.
        • Iqbal N.
        • Seshadri P.
        • et al.
        The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial.
        Ann Intern Med. 2004; 140: 778-785
        • Halton T.L.
        • Willett W.C.
        • Liu S.
        • et al.
        Low-carbohydrate-diet score and the risk of coronary heart disease in women.
        N Engl J Med. 2006; 355: 1991-2002
        • Fung T.T.
        • van Dam R.M.
        • Hankinson S.E.
        • Stampfer M.
        • Willett W.C.
        • Hu F.B.
        Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort studies.
        Ann Intern Med. 2010; 153: 289-298
        • Lagiou P.
        • Sandin S.
        • Weiderpass E.
        • et al.
        Low carbohydrate–high protein diet and mortality in a cohort of Swedish women.
        J Intern Med. 2007; 261: 366-374
        • Lagiou P.
        • Sandin S.
        • Lof M.
        • Trichopoulos D.
        • Adami H.O.
        • Weiderpass E.
        Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study.
        BMJ. 2012; 344e4026
        • Trichopoulou A.
        • Psaltopoulou T.
        • Orfanos P.
        • Hsieh C.
        • Trichopoulos D.
        Low-carbohydrate–high-protein diet and long-term survival in a general population cohort.
        Eur J Clin Nutr. 2007; 61: 575-581
        • Li S.
        • Flint A.
        • Pai J.K.
        • et al.
        Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors.
        J Am Heart Assoc. 2014; 3e001169
        • Nilsson L.M.
        • Winkvist A.
        • Eliasson M.
        • et al.
        Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort.
        Eur J Clin Nutr. 2012; 66: 694-700
        • Mohammed N.H.
        • Wolever T.M.
        Effect of carbohydrate source on post-prandial blood glucose in subjects with type 1 diabetes treated with insulin lispro.
        Diabet Res Clin Pract. 2004; 65: 29-35
        • Wolever T.M.
        • Mehling C.
        Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triacylglycerol, and free fatty acid concentrations in subjects with impaired glucose tolerance.
        Am J Clin Nutr. 2003; 77: 612-621
        • Grundy S.M.
        • Denke M.A.
        Dietary influences on serum lipids and lipoproteins.
        J Lipid Res. 1990; 31: 1149-1172
        • Pérez-López F.R.
        • Larrad-Mur L.
        • Kallen A.
        • Chedraui P.
        • Taylor H.S.
        Gender differences in cardiovascular disease: Hormonal and biochemical influences.
        Reproduct Sci. 2010; 17: 511-531
        • Magkos F.
        • Wang X.
        • Mittendorfer B.
        Metabolic actions of insulin in men and women.
        Nutrition. 2010; 26: 686-693
        • Wang X.
        • Magkos F.
        • Mittendorfer B.
        Sex differences in lipid and lipoprotein metabolism: It's not just about sex hormones.
        J Clin Endocrinol Metab. 2011; 96: 885-893
        • Korea Centers for Disease Control and Prevention
        The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2010
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2011
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2012
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-1).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2013
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2014
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-3).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2015
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Korea Centers for Disease Control and Prevention
        The Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2016
        https://knhanes.cdc.go.kr/knhanes/
        Date accessed: January 31, 2018
        • Kweon S.
        • Kim Y.
        • Jang M.
        • et al.
        Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES).
        Int J Epidemiol. 2014; 43: 69-77
        • Chung S.
        • Ha K.
        • Lee H.S.
        • et al.
        Soft drink consumption is positively associated with metabolic syndrome risk factors only in Korean women: Data from the 2007-2011 Korea National Health and Nutrition Examination Survey.
        Metabolism. 2015; 64: 1477-1484
        • Shin S.
        • Joung H.
        A dairy and fruit dietary pattern is associated with a reduced likelihood of osteoporosis in Korean postmenopausal women.
        Br J Nutr. 2013; 110: 1926-1933
      1. Food Composition Table 7th Revision. Rural Development Administration, Suwon, Korea2006
      2. Dietary Reference Intakes for Koreans 2015. Ministry of Health and Welfare, The Korean Nutrition Society, Sejong, Korea2015
        • Wylie-Rosett J.
        • Aebersold K.
        • Conlon B.
        • Isasi C.R.
        • Ostrovsky N.W.
        Health effects of low-carbohydrate diets: Where should new research go?.
        Curr Diab Rep. 2013; 13: 271-278
        • Kirk J.K.
        • Graves D.E.
        • Craven T.E.
        • Lipkin E.W.
        • Austin M.
        • Margolis K.L.
        Restricted-carbohydrate diets in patients with type 2 diabetes: A meta-analysis.
        J Am Diet Assoc. 2008; 108: 91-100
        • Committee for the Korean Guidelines for the Management of Dyslipidemia
        2015 Korean Guidelines for the Management of Dyslipidemia: Executive Summary.
        Korean Circ J. 2016; 46: 275-306
        • International Obesity Task Force and World Health Organization
        The Asian-Pacific Perspective: Redefining Obesity and its Treatment.
        Health Communications Australia, Melbourne, Victoria, Australia2000
        • Korean Centers for Disease Control and Prevention
        Korean National Health and Nutrition Examination Survey Data Analysis Guide, 2013
        http://knhanes.cdc.go.kr/
        Date accessed: November 28, 2018
      3. SAS [computer program]. Version 9.4.
        SAS Institute Inc, Cary, NC2014
        • Hokanson J.E.
        • Austin M.A.
        Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: A meta-analysis of population-based prospective studies.
        J Cardiovasc Risk. 1996; 3: 213-219
        • Kitamura A.
        • Iso H.
        • Naito Y.
        • et al.
        High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men.
        Circulation. 1994; 89: 2533-2539
        • Blackburn G.
        • Phillips J.
        • Morreale S.
        Physician's guide to popular low-carbohydrate weight-loss diets.
        Cleve Clin J Med. 2001; 68: 761-774
        • Lichtenstein A.H.
        • Appel L.J.
        • Brands M.
        • et al.
        Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee.
        Circulation. 2006; 114: 82-96
        • Bazzano L.A.
        • Hu T.
        • Reynolds K.
        • et al.
        Effects of low-carbohydrate and low-fat diets: A randomized trial.
        Ann Intern Med. 2014; 161: 309-318
        • Yokokawa H.
        • Yasumura S.
        • Tanno K.
        • et al.
        Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7-year cohort study of a Japanese northern rural population.
        J Atheroscler Thromb. 2011; 18: 89-98
        • Okamura T.
        • Hayakawa T.
        • Kadowaki T.
        • Kita Y.
        • Okayama A.
        • Ueshima H.
        The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population.
        Atherosclerosis. 2006; 184: 143-150
        • 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
        • Parks E.J.
        Effect of dietary carbohydrate on triglyceride metabolism in humans.
        J Nutr. 2001; 131: 2772S-2774S
        • Mensink R.P.
        • Zock P.L.
        • Kester A.D.
        • Katan M.B.
        Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: A meta-analysis of 60 controlled trials.
        Am J Clin Nutr. 2003; 77: 1146-1155
        • Freedman D.S.
        • Jacobsen S.J.
        • Barboriak J.J.
        • et al.
        Body fat distribution and male/female differences in lipids and lipoproteins.
        Circulation. 1990; 81: 1498-1506
        • Park J.H.
        • Lee M.H.
        • Shim J.-S.
        • Choi D.P.
        • Song B.M.
        • Lee S.W.
        • et al.
        Effects of age, sex, and menopausal status on blood cholesterol profile in the Korean population.
        Korea Circ J. 2015; 45: 141-148
        • Kim H.C.
        Epidemiology of dyslipidemia in Korea.
        J Korea Med Assoc. 2016; 59: 352-357
        • Knopp R.H.
        • Paramsothy P.
        • Retzlaff B.M.
        • et al.
        Gender differences in lipoprotein metabolism and dietary response: Basis in hormonal differences and implications for cardiovascular disease.
        Curr Atheroscler Rep. 2005; 7: 472-479
        • Palmer B.F.
        • Clegg D.J.
        The sexual dimorphism of obesity.
        Mol Cell Endocrinol. 2015; 402: 113-119
        • Kritchevsky D.
        History of recommendations to the public about dietary fat.
        J Nutr. 1998; 128: 449S-452S
        • Katan M.B.
        • Grundy S.M.
        • Willett W.C.
        Should a low-fat, high-carbohydrate diet be recommended for everyone? Beyond low-fat diets.
        N Engl J Med. 1997; 337: 562-567
        • Knopp R.H.
        • Walden C.E.
        • Retzlaff B.M.
        • et al.
        Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men: The Dietary Alternatives Study.
        JAMA. 1997; 278: 1509-1515
        • Coulston A.M.
        • Liu G.C.
        • Reaven G.M.
        Plasma glucose, insulin and lipid responses to high-carbohydrate low-fat diets in normal humans.
        Metabolism. 1983; 32: 52-56
        • Ullmann D.
        • Connor W.E.
        • Hatcher L.F.
        • Connor S.L.
        • Flavell D.P.
        Will a high-carbohydrate, low-fat diet lower plasma lipids and lipoproteins without producing hypertriglyceridemia?.
        Arterioscler Thromb Vasc Biol. 1991; 11: 1059-1067
        • Hunninghake D.B.
        • Stein E.A.
        • Dujovne C.A.
        • et al.
        The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia.
        N Engl J Med. 1993; 328: 1213-1219
        • Schaefer E.J.
        • Lichtenstein A.H.
        • Lamon-Fava S.
        Efficacy of a National Cholesterol Education Program Step 2 diet in normolipidemic and hypercholesterolemic middle-aged and elderly men and women.
        Arterioscler Thromb Vasc Biol. 1995; 15: 1079-1085
        • Dehghan M.
        • Mente A.
        • Zhang X.
        • et al.
        Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): A prospective cohort study.
        Lancet. 2017; 390: 2050-2062
        • Jurek A.M.
        • Greenland S.
        • Maldonado G.
        • Church T.R.
        Proper interpretation of non-differential misclassification effects: expectations vs observations.
        Int J Epidemiol. 2005; 34: 680-687
        • Fewell Z.
        • Davey Smith G.
        • Sterne J.A.
        The impact of residual and unmeasured confounding in epidemiologic studies: A simulation study.
        Am J Epidemiol. 2007; 166: 646-655
        • Kaczmarczyk M.M.
        • Miller M.J.
        • Freund G.G.
        The health benefits of dietary fiber: Beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon cancer.
        Metabolism. 2012; 61: 1058-1066
        • Rutishauser I.H.
        Dietary intake measurements.
        Public Health Nutr. 2005; 8: 1100-1107
        • National Institutes of Health
        • National Cancer Institute
        24-hour dietary recall (24HR) at a glance.
        • Tokudome Y.
        • Imaeda N.
        • Nagaya T.
        • et al.
        Daily, weekly, seasonal, within-and between-individual variation in nutrient intake according to four season consecutive 7 day weighed diet records in Japanese female dietitians.
        J Epidemiol. 2002; 12: 85-92
        • Marr J.
        • Heady J.
        Within-and between-person variation in dietary surveys: Number of days needed to classify individuals.
        Human Nutr Appl Nutr. 1986; 40: 347-364

      Biography

      S.-A. Kim is a post-doctoral researcher, Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, Korea.

      Biography

      S. Shin is an assistant professor, Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, Korea.

      Biography

      K. Lim is an associated professor, Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Australia.