An association between diet quality index for Koreans (DQI-K) and total mortality in Health Examinees Gem (HEXA-G) study

Association Between Coffee Consumption and Glucose Metabolism Markers in Korean Adults

Background/Objectives: Studies examining the association between coffee consumption and glucose metabolism markers have reported inconsistent findings, and few have considered coffee type. We investigated the association between coffee consumption and glucose metabolism markers in Korean adults. Methods: A cross-sectional analysis was conducted using data from the Korea National Health and Nutrition Examination Survey (2019-2021), including 7453 adults aged 19-64 years. Coffee consumption was assessed using a 24 h dietary recall and categorized as black coffee or coffee with sugar and/or cream (non-drinkers, ≤1 cup/day, 2 cups/day, and ≥3 cups/day). Multivariable logistic regression models were used to assess the associations with glucose metabolism markers, including the homeostasis model assessment of insulin resistance (HOMA-IR). Results: The mean age of participants was 40.6 years (standard error: 0.19). After full adjustment for covariates, in women, consuming two or more cups of black coffee per day was inversely associated with elevated HOMA-IR (2 cups/day: OR = 0.73, 95% CI: 0.56-0.96; ≥3 cups/day: OR = 0.66, 95% CI: 0.44-0.99) and fasting insulin levels (2 cups/day: OR = 0.70, 95% CI: 0.54-0.91; ≥3 cups/day: OR = 0.64, 95% CI: 0.43-0.93), compared to no consumption, showing a significant linear trend (p-trend ≤0.01 for all cases). By coffee type, women who consumed more black coffee had lower odds of elevated HOMA-IR and fasting insulin levels (p-trend ≤0.02). In men or those consuming coffee with sugar and/or cream, no significant associations with glucose metabolism markers were observed. Conclusions: Our findings indicate that consuming two or more cups of black coffee per day is inversely associated with insulin resistance in Korean women.

Association between the Korean Healthy Diet Score and Metabolic Syndrome: Effectiveness and Optimal Cutoff of the Korean Healthy Diet Score

OBJECTIVES

Although the prevalence of metabolic syndrome has increased among Koreans, the specific health benefits of the Korean Healthy Diet score remain unexplored. This study aimed to evaluate the association between the Korean Healthy Diet score and metabolic syndrome and to identify the optimal cutoff of the Korean Healthy Diet score for reducing metabolic syndrome prevalence.

METHODS

This cross-sectional study used data from 11,403 participants of the seventh and eighth Korea National Health and Nutrition Examination Survey. The Korean Healthy Diet score was calculated based on adherence to 13 dietary components. A logistic regression analysis was used to determine the association between the Korean Healthy Diet score and metabolic syndrome, as well as to identify the optimal cutoff values for the Korean Healthy Diet score.

RESULTS

The average Korean Healthy Diet score was significantly lower in participants with metabolic syndrome than in those without metabolic syndrome (5.03 vs. 5.14, p = 0.016). A one-point increase in the Korean Healthy Diet score was associated with a reduction in metabolic syndrome prevalence (odds ratio: 0.95, 95% confidence interval: 0.91-0.98). The optimal cutoff for the Korean Healthy Diet score was identified as >7 points, particularly showing significantly decreased prevalence of hypertriglyceridemia and low high-density lipoprotein cholesterol.

CONCLUSIONS

The Korean Healthy Diet score was inversely associated with metabolic syndrome prevalence, and the identified optimal cutoff values can serve as a practical tool for public health interventions aimed at reducing the risk of metabolic syndrome.

Association between coffee consumption and metabolic syndrome in Korean adults

BACKGROUND/OBJECTIVES

Studies examining the association between coffee consumption and metabolic syndrome (MetS), considering different coffee types, have reported inconsistent results. We investigated the relationship between coffee consumption and MetS, taking into account coffee types, using data from the Korea National Health and Nutrition Examination Survey conducted from 2016 to 2021 among 14,631 adults aged 19-64 years.

SUBJECTS/METHODS

We used a 24-h dietary recall method to assess diet, including the type and quantity of coffee consumed. Coffee was categorized into black coffee and coffee with sugar and/or cream (non-drinkers, ≤1, 2-3, and >3 cups/day). Multivariable logistic regression models were utilized to investigate the relationship between coffee consumption and MetS, defined by the harmonized criteria.

RESULTS

After adjusting for potential covariates, for women, 2-3 cups/day of black coffee were inversely associated with MetS (OR = 0.66; 95% CI = 0.46-0.96). Three or fewer cups per day of black coffee were inversely associated with low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides in women. Coffee consumption was not significantly associated with MetS in men. Consumption of coffee with sugar and/or cream or more than three cups per day of coffee was not significantly associated with MetS overall.

CONCLUSION

Our findings suggest that moderate of 2-3 cups/day of black coffee consumption is inversely associated with MetS in women, possibly due to its favorable impact on HDL-C and triglycerides. Further prospective studies examining the consumption of different coffee types in relation to MetS are warranted to offer definitive evidence.

Association between coffee consumption and high C-reactive protein levels in Korean adults

The findings of studies investigating the relationship between coffee consumption and C-reactive protein (CRP) levels have been inconsistent, and few researchers considered the type of coffee. We examined the association between coffee consumption and high CRP levels, using data from the Korea National Health and Nutrition Examination Survey, 2016-2018, with 9337 adults aged 19-64 years. A 24-h diet recall was used to assess diet, including the amount and type of coffee consumed. We classified coffee into black coffee and coffee with sugar and/or cream (non-drinkers, or ≤ 1, 2-3, > 3 cups/d) and used multivariable logistic regression models with high CRP levels (≥ 2·2 mg/l). After the adjustment for potential confounders, 2-3 cups/d of coffee consumption were inversely associated with high CRP levels, compared with no consumption (OR = 0·83, 95 % CI 0·69, 0·99). By type of coffee, the inverse association was stronger in subjects consuming black coffee (OR = 0·61, 95 % CI 0·45, 0·84), while the inverse association was much weaker in those consuming coffee with sugar and/or cream (OR = 0·92, 95 % CI 0·74, 1·14). By sex, the inverse association of 2-3 cups of black coffee was found both in men (OR = 0·65, 95 % CI 0·41, 1·03) and women (OR = 0·55, 95 % CI 0·36, 0·83). More than three cups/d of heavy coffee consumption were not significantly associated with high CRP levels. Our findings indicate that moderate black coffee consumption of 2-3 cups/d is inversely associated with high CRP levels in Korean adults. Further prospective studies are warranted to provide definitive evidence.

Associations Between Modifiable Risk Factors and Changes in Glycemic Status Among Individuals With Prediabetes

OBJECTIVE

To examine the associations between modifiable risk factors and glycemic status changes in individuals with prediabetes.

RESEARCH DESIGN AND METHODS

A total of 10,358 individuals with prediabetes defined by their fasting blood glucose and HbA1c levels from the Health Examinees-Gem study were included in the present study. Modifiable factors, including BMI, abdominal obesity, smoking status, physical activity, alcohol consumption, diet quality, hypertension, and dyslipidemia, were examined to determine their associations with changes in glycemic status during follow-up. In addition, modifiable-factor scores were calculated, and their association with changes in glycemic status was also analyzed.

RESULTS

The median follow-up time for this study was 4 years (range, 1-7 years). BMI ≥25 kg/m2 (adjusted odds ratio [OR] 0.71 [95% CI 0.63-0.79]), abdominal obesity (OR 0.76 [95% CI 0.68-0.86]), heavy drinking (OR 0.74 [95% CI 0.60-0.91]), hypertension (OR 0.71 [95% CI 0.64-0.79]), and dyslipidemia (OR 0.78 [95% CI 0.70-0.85]) were associated with a lower possibility of normoglycemia reversion. BMI ≥25 kg/m2 (OR 1.58 [95% CI 1.29-1.94]), abdominal obesity (OR 1.31 [95% CI 1.11-1.55]), current smoking (OR 1.43 [95% CI 1.07-1.91]), and hypertension (OR 1.26 [95% CI 1.07-1.49]) were associated with a higher probability of type 2 diabetes progression. Having more favorable modifiable factors was also associated with normoglycemia reversion (OR 1.46 [95% CI 1.30-1.64]) and type 2 diabetes progression (OR 0.62 [95% CI 0.49-0.77]).

CONCLUSIONS

More favorable modifiable factors were related to a higher probability of returning to normoglycemia and a lower probability of progression to type 2 diabetes.

Ideal cardiovascular health metrics and the risk of nonalcoholic fatty liver disease in Korean adults

BACKGROUND

The association between cardiovascular risk factors and nonalcoholic fatty liver disease (NAFLD) is well established, but whether cardiovascular health (CVH) metrics is associated with NAFLD had not been fully studied. Thus, we examined the association between CVH metrics and NAFLD in the middle-aged Korean population.

METHODS

We used data of 2,928 (851 men and 2,077 women) participants aged 30-64 years from the Cardiovascular and Metabolic Disease Etiology Research Center study. CVH metrics were measured using a modified version of Life's Simple 7 by the American Heart Association. NAFLD diagnosis was based on the fatty liver index or liver-to-spleen ratio on computed tomography. A multiple logistic regression model was used to investigate the cross-sectional and longitudinal associations between CVH metrics and NAFLD.

RESULTS

In the cross-sectional analysis, the odds ratio for NAFLD was lower in participants with ideal CVH (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.08-0.18), while it was higher in individuals with poor CVH (OR, 2.87; 95% CI, 2.13-3.86). Similarly, the risk of new-onset NAFLD was lower in participants with ideal CVH (OR, 0.28; 95% CI, 0.11-0.74), and higher in individuals with poor CVH (OR, 2.20; 95% CI, 0.50-9.72) in the longitudinal analysis of a subgroup.

CONCLUSIONS

Ideal CVH was associated with a lower risk of NAFLD while poor CVH was associated with a higher risk of NAFLD. These findings suggest that making efforts to encourage people to manage their CVH to the ideal level may prevent and manage NAFLD.

Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review

Importance

The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)?

Objective

To ascertain the association between dietary patterns consumed and ACM.

Evidence Review

Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements.

Findings

A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings.

Conclusions and Relevance

In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.

Relationship between diet quality and sarcopenia in elderly Koreans: 2008-2011 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008-2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken.

RESULTS

The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points (P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003-3.254, P < 0.05).

CONCLUSIONS

This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.

Lifestyle risk score and mortality in Korean adults: a population-based cohort study

Individual lifestyle risk factors have been associated with an increased risk of mortality. However, limited evidence is available on the combined association of lifestyle risk factors with mortality in non-Western populations. The analysis included 37,472 participants (aged ≥19 years) in the Korea National Health and Nutrition Examination Surveys (2007–2014) for whom the data were linked to death certificates/medical records through December 2016. A lifestyle risk score was created using five unhealthy behaviors: current smoking, high-risk alcohol drinking, unhealthy weight, physical inactivity, and insufficient/prolonged sleep. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (CI). During up to 9 years of follow-up, we documented 1,057 total deaths. Compared to individuals with zero lifestyle risk factor, those with 4–5 lifestyle risk factors had 2.01 times (HR = 2.01, 95% CI = 1.43–2.82) and 2.59 times (HR = 2.59, 95% CI = 1.24–5.40) higher risk of all-cause and cardiovascular mortality, respectively. However, higher lifestyle risk score was not significantly associated with cancer mortality (p-trend >0.05). In stratified analyses, the positive associations tended to be stronger in adults aged <65 years, unemployed, and those with lower levels of education. In conclusion, combined unhealthy lifestyle behaviors were associated with substantially increased risk of total and cardiovascular mortality in Korean adults.

Association of Smoking-Related Knowledge, Attitude, and Practices (KAP) with Nutritional Status and Diet Quality: A Cross-Sectional Study in China

Background

Smoking is the second leading cause of death. Limited studies are available about smoking and overall diet quality. The current study was aimed at finding an association of s-KAP (smoking-related knowledge, attitude, and practices) with nutritional status and diet quality.

Methodology

The current study was a cross-sectional community-based study conducted in Jurong city, China. Validated questionnaires were used for the collection of data regarding s-KAP and dietary intake. Correlation and multivariate linear regression analysis were used for the association of s-KAP scores with diet quality scores and nutritional status.

Results

The total numbers of participants were 7998 with a mean age of 59.3±11.4 years, including 38.5% males and 41.5% females. s-KAP scores were categorized into two groups, i.e., High s-KAP group and low s-KAP group. The High s-KAP group had significantly higher (P<0.05) diet scores and BMI but lower (P<0.05) WC (waist circumference) and WHR (waist to hip ratio) than the Low s-KAP group. Independent positive association (P<0.05) of s-KAP scores with diet scores was observed after the adjustment for age, gender, physical activity, alcohol consumptions, monthly income, and anthropometric measures (BMI, WC, and WHR). Similarly, smoking was positively associated (P<0.05) with diet scores after adjustment for covariates.

Conclusion

In conclusion, the higher s-KAP scores indicated more knowledge regarding the harmful consequences of the smoking outcomes, positive attitude, less smoking practices, and having a good plan to quit smoking. Individuals with high s-KAP scores had good diet quality and lower adiposity measures. Furthermore, s-KAP scores and smoking status were having an independent positive association with diet scores.

Association between family history of diabetes and clusters of adherence to healthy behaviors: cross-sectional results from the Health Examinees-Gem (HEXA-G) study

OBJECTIVES

This study evaluated whether individuals with affected family member adhered to healthy behaviours.

DESIGN AND SETTING

This was a cross-sectional study of participants selected from health examinees who underwent the national health check-up programme of Korea in 39 centres between 2004 and 2013.

PARTICIPANTS

The baseline data of 128 520 participants enrolled in the Health Examinees-Gem study were used for analysis.

MAIN OUTCOMES AND MEASURES

Associations of family history of diabetes with adherence to regular exercise, healthy diet and body composition, and clusters of healthy behaviours were evaluated while adjusting for potential confounders selected by a directed acyclic graph.

RESULTS

Participants with a family history of diabetes were more likely to adhere to a regular exercise regimen (OR=1.12, 95% CI 1.06 to 1.18 for men and OR=1.10, 95% CI 1.07 to 1.14 for women) and healthy diet (OR=1.06, 95% CI 1.01 to 1.12 for men and OR=1.06, 95% CI 1.01 to 1.12 for women) but were less likely to have a normal body composition (OR=0.83, 95% CI 0.78 to 0.87 for men and OR=0.83, 95% CI 0.80 to 0.86 for women). These associations were strengthened when the affected family members were siblings, the number of affected members was increased or the age at diagnosis of the affected member was younger than 50 years. In men and women, having a normal body composition is important in determining the cluster of behaviours, and those with a family history of diabetes were less likely to adhere to the normal body composition cluster.

CONCLUSIONS

The group with high risk of diabetes showed healthy behaviors, but they did not have a normal body composition. Policies and campaigns targeting integrated health behaviors will be needed to reduce the burden of diseases and improve public health.

Impact of handgrip strength on cardiovascular, cancer and all-cause mortality in the Korean longitudinal study of ageing

OBJECTIVE

To examine whether reduced handgrip strength, as a marker of muscle weakness, is linked with the risk of cardiovascular, cancer and all-cause mortality among older adults.

DESIGN

We used data from the 2006 to 2014 Korean longitudinal study of ageing study. Estimates of handgrip strength were collected using a handheld dynamometer. Cox proportional hazard models with time-varying covariates were used to estimate HRs and their 95% CIs for all-cause mortality. The cause-specific hazards regression analysis was also used to model cardiovascular and cancer mortality, by treating deaths from the cause of interest as events and other causes of death as censored.

PARTICIPANTS

5859 participants aged 50 years or older were followed up until death or until the date of censoring (31 December 2014).

PRIMARY OUTCOME MEASURES

The study outcomes of interest were all-cause, cardiovascular and cancer mortality.

RESULTS

Of the participants included in analyses, 515 individuals (8.8%) died, reflecting an overall crude mortality rate of 11.0 deaths per 1000 person-years. Participants in the lowest handgrip strength tertile showed an increased risk of all-cause and cardiovascular mortality evidenced by a multivariable adjusted HRs of 1.90 (95% CI 1.33 to 2.73) and 1.59 (95% Cl 1.08 to 2.34), respectively. However, there were no significant differences in the rates of cancer-related death, with HR of 1.29 (95% CI 0.92 to 1.81 [lowest vs highest tertile; p trend=0.21]).

CONCLUSION

These results demonstrate that lower handgrip strength is an independent predictor of mortality among a population-based sample of Korean elderly; highlighting the importance of interventions targeted at enhancing muscle strength for improvements in survival at older ages.