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Dietary Patterns and the Risk of Dyslipidemia in Korean Adults

A Prospective Cohort Study Based on the Health Examinees (HEXA) Study
Published:November 03, 2020DOI:https://doi.org/10.1016/j.jand.2020.08.090

      Abstract

      Background

      Identifying dietary patterns that contribute to dyslipidemia development can inform prevention, nutritional counseling, and other treatment recommendations.

      Objective

      This study aimed to identify major dietary patterns and examine the association between these dietary patterns and dyslipidemia incidence by sex among Koreans.

      Design

      The Health Examinees (HEXA) study is a community-based prospective cohort study. The baseline and follow-up surveys were conducted in 2004-2013, and 2012-2016, respectively, at 38 health examination centers and training hospitals located in eight regions in Korea. Dietary intake data were collected using a web-based, validated semiquantitative food frequency questionnaire (FFQ) at baseline.

      Participants/setting

      Among 65,642 participants who completed the baseline and follow-up survey, data from 38,170 participants without dyslipidemia and other related chronic diseases at baseline were analyzed.

      Main outcome measures

      Incidence of dyslipidemia and its components (hypercholesterolemia, hyper-low-density lipoprotein [LDL] cholesterolemia, hypo-high-density lipoprotein [HDL] cholesterolemia, and hypertriglyceridemia) after baseline but before the follow-up examination was examined.

      Statistical analyses

      Factor analysis was conducted on data from the semiquantitative FFQ to identify major dietary patterns for Korean adults. Cox proportional hazards regression analysis was performed to estimate the relative risk (RR) and 95% confidence interval (CI) according to the quintiles of three dietary pattern scores, after adjusting for potential confounders by sex.

      Results

      Of the three identified dietary patterns, the higher “prudent” pattern score was associated with a lower incidence of dyslipidemia (RR, 0.90; 95% CI, 0.82-0.99; P = .02) after adjusting for potential confounders in women. Higher “flour-based food and meats” pattern score was associated with a higher incidence of hypercholesterolemia (men: RR, 1.63; 95% CI, 1.21-2.20; P = .003; women: RR, 1.47; 95% CI, 1.30-1.67; P < .001), hyper-LDL cholesterolemia (men: RR, 1.45; 95% CI, 1.03-2.04, P = .06; women: RR, 1.35; 95% CI, 1.16-1.58, P < .001), and dyslipidemia (men: RR, 1.30; 95% CI, 1.09-1.54; P = .009; women: RR, 1.28; 95% CI, 1.16-1.42; P < .001) in both men and women. The “white rice” pattern score was associated with a lower incidence of hypo-HDL cholesterolemia (RR, 0.75; 95% CI, 0.58-0.96; P = .01) and dyslipidemia (RR, 0.90; 95% CI, 0.81-0.99; P = .07) in women.

      Conclusions

      Adherence to the “prudent” and “white rice” patterns was associated with a lower dyslipidemia risk in Korean women, whereas adherence to the “flour-based food and meats” pattern was associated with increased risks of dyslipidemia and its components (hypercholesterolemia and hyper-LDL cholesterolemia) in both Korean men and women.

      Keywords

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      References

        • Roth G.A.
        • Abate D.
        • Abate K.H.
        • et al.
        Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2018; 392: 1736-1788
        • Statistics Korea
        Causes of Death Statistics in 2018.
        Statistics Korea, Daejeon, Korea2019
        • Musunuru K.
        Atherogenic dyslipidemia: Cardiovascular risk and dietary intervention.
        Lipids. 2010; 45: 907-914
        • Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention
        Korea Health Statistics 2018: Korea National Health and Nutrition Examination Survey (KNHANES VII-3).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2019
        • Korean Society of Lipid and Atherosclerosis
        Dyslipidemia fact sheets in Korea, 2018.
        • Ahmed S.M.
        • Clasen M.E.
        • Donnelly J.F.
        Management of dyslipidemia in adults.
        Am Fam Physician. 1998; 57: 2192
        • Arnett D.K.
        • Blumenthal R.S.
        • Albert M.A.
        • et al.
        2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2019; 74: e177-e232
        • Panel E.D.
        • Grundy S.M.
        An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia.
        J Clin Lipidol. 2013; 7: 561-565
        • DeSalvo K.B.
        • Olson R.
        • Casavale K.O.
        Dietary guidelines for Americans.
        JAMA. 2016; 315: 457-458
        • Sacks F.M.
        • Svetkey L.P.
        • Vollmer W.M.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.
        N Engl J Med. 2001; 344: 3-10
        • McCullough M.L.
        • Feskanich D.
        • Rimm E.B.
        • et al.
        Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men.
        Am J Clin Nutr. 2000; 72: 1223-1231
        • McCullough M.L.
        • Feskanich D.
        • Stampfer M.J.
        • et al.
        Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women.
        Am J Clin Nutr. 2000; 72: 1214-1222
        • Fung T.T.
        • Chiuve S.E.
        • McCullough M.L.
        • Rexrode K.M.
        • Logroscino G.
        • Hu F.B.
        Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.
        Arch Intern Med. 2008; 168: 713-720
        • Salehi-Abargouei A.
        • Maghsoudi Z.
        • Shirani F.
        • Azadbakht L.
        Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases—incidence: A systematic review and meta-analysis on observational prospective studies.
        Nutrition. 2013; 29: 611-618
        • Kant A.K.
        Dietary patterns: biomarkers and chronic disease risk.
        Appl Physiol Nutr Metab. 2010; 35: 199-206
        • Dietary Guidelines Advisory Committee
        Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services.
        U.S. Department of Agriculture, Agricultural Research Service, Washington, DC2020
        • Health Examinees Study Group
        The Health Examinees (HEXA) study: Rationale, study design and baseline characteristics.
        Asian Pac J Cancer Prev. 2015; 16: 1591
        • Kim Y.
        • Han B.-G.
        • KoGES Group
        Cohort profile: The Korean genome and epidemiology study (KoGES) consortium.
        Int J Epidemiol. 2017; 46 (e20-e20)
        • Kim S.-A.
        • Lee J.K.
        • Kang D.
        • et al.
        Oily fish consumption and the risk of dyslipidemia in Korean adults: A prospective cohort study based on the Health Examinees Gem (HEXA-G) study.
        Nutrients. 2019; 11: 2506
        • Ahn Y.
        • Kwon E.
        • Shim J.
        • et al.
        Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study.
        Eur J Clin Nutr. 2007; 61: 1435-1441
      1. Korean Food Composition Table, 7th Revision. Rural Development Administration, Suwon, Korea2006
      2. Korean Food Composition Table, 9th Revision. Rural Development Administration, Wanju, Korea2016
        • Kim S.-A.
        • Joung H.
        • Shin S.
        Dietary pattern, dietary total antioxidant capacity, and dyslipidemia in Korean adults.
        Nutr J. 2019; 18: 37
        • Lee K.W.
        • Woo H.D.
        • Cho M.J.
        • Park J.K.
        • Kim S.S.
        Identification of dietary patterns associated with incidence of hyperglycemia in middle-aged and older Korean adults.
        Nutrients. 2019; 11: 1801
        • Antony G.
        • Rao K.V.
        A composite index to explain variations in poverty, health, nutritional status and standard of living: Use of multivariate statistical methods.
        Public Health. 2007; 121: 578-587
        • Ocké M.C.
        Evaluation of methodologies for assessing the overall diet: Dietary quality scores and dietary pattern analysis.
        Proc Nutr Soc. 2013; 72: 191-199
        • Michels K.B.
        • Schulze M.B.
        Can dietary patterns help us detect diet–disease associations?.
        Nutr Res Rev. 2005; 18: 241-248
        • The Korean Society of Lipid and Atherosclerosis
        Dyslipidemia fact sheets in Korea, 2018.
        • Kim S.-A.
        • Lim K.
        • Shin S.
        Associations between low-carbohydrate diets from animal and plant sources and dyslipidemia among Korean adults.
        J Acad Nutr Diet. 2019; 119: 2041-2054
      3. SAS [computer program]. Version 9.4. SAS Institute Inc, Cary, NC2014
        • U.S. Department of Health and Human Services and U.S. Department of Agriculture
        2015–2020 Dietary Guidelines for Americans.
        8th Edition. 2015
        • Schroeder N.
        • Park Y.-H.
        • Kang M.-S.
        • et al.
        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.
        J Acad Nutr Diet. 2015; 115: 1083-1092
        • Schwingshackl L.
        • Bogensberger B.
        • Hoffmann G.
        Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: An updated systematic review and meta-analysis of cohort studies.
        J Acad Nutr Diet. 2018; 118: 74-100
        • Patra J.K.
        • Das G.
        • Paramithiotis S.
        • Shin H.-S.
        Kimchi and other widely consumed traditional fermented foods of Korea: A review.
        Front Microbiol. 2016; 7: 1493
        • Shin D.
        • Jeong D.
        Korean traditional fermented soybean products: Jang.
        J Ethnic Foods. 2015; 2: 2-7
        • Eckel R.H.
        • Jakicic J.M.
        • Ard J.D.
        • et al.
        2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: 2960-2984
        • Jacobson T.A.
        • Maki K.C.
        • Orringer C.E.
        • et al.
        National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2.
        J Clin Lipidol. 2015; 9: S1-S122
        • Rimm E.B.
        • Appel L.J.
        • Chiuve S.E.
        • et al.
        Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association.
        Circulation. 2018; 138: e35-e47
        • McNeill S.H.
        Inclusion of red meat in healthful dietary patterns.
        Meat science. 2014; 98: 452-460
        • Kwon Y.-S.
        • Ju S.-Y.
        Trends in nutrient intakes and consumption while eating-out among Korean adults based on Korea National Health and Nutrition Examination Survey (1998-2012) data.
        Nutr Res Pract. 2014; 8: 670-678
        • Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention
        Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2).
        Korea Centers for Disease Control and Prevention, Cheongwon, Korea2018
        • Shin H.J.
        • Cho E.
        • Lee H.-J.
        • et al.
        Instant noodle intake and dietary patterns are associated with distinct cardiometabolic risk factors in Korea.
        J Nutr. 2014; 144: 1247-1255
        • Bae Y.-J.
        Evaluation of dietary intake in Korean adults according to energy intake from eating-out: Based on 2013-2014 Korea National Health and Nutrition Examination Survey.
        J Nutr Health. 2016; 49: 482-494
        • Choi H.
        • Song S.
        • Kim J.
        • et al.
        High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults.
        Nutr Res. 2012; 32: 100-106
        • Song S.J.
        • Lee J.E.
        • Paik H.-Y.
        • Park M.S.
        • Song Y.J.
        Dietary patterns based on carbohydrate nutrition are associated with the risk for diabetes and dyslipidemia.
        Nutr Res Pract. 2012; 6: 349-356
        • Song S.
        • Paik H.Y.
        • Park M.
        • Song Y.
        Dyslipidemia patterns are differentially associated with dietary factors.
        Clin Nutr. 2016; 35: 885-891
        • Erem C.
        • Hacihasanoglu A.
        • Deger O.
        • et al.
        Prevalence of dyslipidemia and associated risk factors among Turkish adults: Trabzon lipid study.
        Endocrine. 2008; 34: 36-51
        • Martinez M.E.
        • Marshall J.R.
        • Sechrest L.
        Invited commentary: Factor analysis and the search for objectivity.
        Am J Epidemiol. 1998; 148: 17-19

      Biography

      S.-A. Kim is a postdoctoral 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.