The mediating effect of the Korean Healthy Eating Index on the relationship between lifestyle patterns and metabolic syndrome in middle-aged Koreans: data from the 2019-2021 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

Metabolic syndrome (MetS) is closely connected to dietary and lifestyle factors, with diet being one of the primary risk factors for MetS, acting as a key factor in both prevention and management. In this study, we analyzed the mediating effect of the Korean Healthy Eating Index (KHEI) on the relationship between lifestyle patterns and MetS in middle-aged Koreans using data from the 2019-2021 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

This study examined data from 5,196 adults aged 40-64 yrs who participated in the eighth KNHANES. Data on 5 lifestyle factors-smoking, alcohol consumption, physical activity, sleep duration, and stress perception-were analyzed. The latent class analysis (LCA) was performed using Mplus 8.11, and SPSS PROCESS Macro v4.2 was used for statistical analysis to analyze the mediating effect of the KHEI.

RESULTS

The model categorized lifestyle factors into three into 3 clusters: 'Low Activity Class,' 'Low Activity and Smoking Class,' and 'Multiple Risk Class.' The KHEI mediation analysis showed significant effects: 0.0205 (95% confidence interval [CI], 0.0062-0.0363) in the 'Low Activity and Smoke Class,' and 0.0420 (95% CI, 0.0133-0.0726) in the 'Multiple Risk Class.' The mediating effect of the KHEI domain "adequacy" was significant in these groups, with effects of 0.0357 (95% CI, 0.0184-00563) and 0.0662 (95% CI, 0.0364-0.6491), for the respective groups. Balance of energy intake was significant in the group with 'Multiple Risk Class' (0.0189; 95% CI, 0.0044-0.0378).

CONCLUSION

The results suggest that a healthy diet improves health management and reduces risk factors for MetS. Nonetheless, better strategies for dietary improvement through a detailed analysis of KHEI components are warranted.

Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease

Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.

Sociodemographic and Health Characteristics Associated with Metabolic Syndrome in Men and Women Aged ≥50 Years

Background: There are limited studies on the prevalence of and risk factors for metabolic syndrome (MetS) in people aged ≥50 years. This study investigated the sociodemographic and health characteristics related to MetS prevalence in men and women aged ≥50 years to assess clustering of risk factors. Methods: This study used the 2016 survey data of 2927 people aged 50-79 years who were administered questionnaires and underwent examinations. Participants were divided into adults aged 50-64 and 65-79 years and further into four subgroups, according to sex. Differences in sociodemographic and health characteristics by sex were verified using the chi-squared test. Complex sample logistic regression analysis was performed to verify factors related to MetS. Results: The sociodemographic characteristics associated with MetS in men and women aged 50-64 years, included living without a spouse, having a middle school education or less, and reporting a low economic status. The health characteristics associated with MetS in men aged 50-64 years were current smoking status and strength training <2 times/week. The sociodemographic characteristic associated with MetS in women aged 65-79 years was living without a spouse. Hypertriglyceridemia was the risk factor most associated with MetS prevalence. Conclusions: Among men and women aged 50-64 years, living without a spouse, having a low education level, and reporting a low economic status were associated with MetS prevalence. Current smoking status and strength training <2 times/week for men and living without a spouse for women aged 65-79 years were associated with MetS.

Factors Associated with Metabolic Syndrome among Middle-Aged Women in their 50s: Based on National Health Screening Data

This study aimed to identify the risk factors associated with metabolic syndrome among middle-aged women in their 50s to provide a strategy for managing the metabolic syndrome of those whose prevalence is rapidly increasing. Secondary data from the 2012 Korean National Health Insurance Service Medical check-up cohort database were analyzed. Participants included 36,582 middle-aged women in their 50s from the cohort who received a general medical check-up. The risk factors were estimated using logistic regression analysis. Metabolic syndrome was identified in 14.6% of the surveyed persons among middle-aged women in their 50s. Working women, low household income levels, country residents, high body mass index (BMI), total cholesterol of over 240 mg/dL, non-drinker, non-exerciser, history of diabetes or hypertension, and family history of diabetes were associated with increased risk of metabolic syndrome. It is necessary to prepare a strategy to increase access to health care services so that socioeconomic vulnerability does not lead to negative health behavior such as obesity and lack of physical activity. In particular, we recommend active interventions at workplaces for the working women who have a higher risk of metabolic syndrome.

Correlations between metabolic syndrome, serologic factors, and gallstones

[Purpose] This study investigated the serologic factors associated with metabolic syndrome and gallstones. [Subjects and Methods] The study evaluated subjects who visited a health promotion center in Seoul from March 2, 2013 to February 28, 2014, and had undergone abdominal ultrasonography. Height, weight, and blood pressure were measured. Blood sampling was performed for high-density lipoprotein cholesterol, triglyceride, fasting blood glucose, total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, uric acid, total cholesterol, low-density lipoprotein cholesterol, thyroid stimulating hormone, and red and white blood cell counts. We conducted logistic regression analysis to assess the risk factors associated with metabolic syndrome. [Results] The risk factors for metabolic syndrome in men, in order of decreasing weight, were red blood cell count, body mass index, maximum size of gallstones, white blood cell count, waist circumference, and uric acid level. The factors in women, in order of decreasing weight, were red blood cell count, presence/absence of gallstones, uric acid level, body mass index, fasting blood glucose, and waist circumference. [Conclusion] Most serum biochemical factors and gallstone occurrence could be used to indicate the presence or absence of metabolic syndrome, independent of gender.

Factors affecting metabolic syndrome by lifestyle

[Purpose] The aim of this study was to explore lifestyle factors in relation to metabolic syndrome so as to be able to utilize the results as baseline data for the furtherance of health-care and medical treatment. [Subjects and Methods] This study was conducted with patients who visited a health care center located in Seoul and had abdominal ultrasonography between 2 March 2013 and 28 February, 2014. Heights, weights, and blood pressures were measured by automatic devices. Three radiologists examined the patients using abdominal ultrasonography for gallstone diagnosis. The statuses of patients with regard to smoking, alcohol, coffee, and physical activities were explored for the lifestyle investigation. For investigating baseline demographics, we first used descriptive statistics. We then used the χ² test to analyze lifestyles and gallstone prevalence with regard to the presence of metabolic syndrome. Lastly, logistic regression analysis was conducted to discover the risk factors of metabolic syndrome. [Results] For men, body mass index, maximum gallstone size, and waist circumference were revealed as risk factors for metabolic syndrome, in descending order of the degree of risk. For females, gallstone presence was the most significant risk factor, followed by waist circumference. [Conclusion] Metabolic disease mainly presents itself along with obesity, and we should become more focused on preventing and treating this disease. A large-scale prospective study is needed in the future, as the cause of nonalcoholic steatohepatitis remained unclear in this study.