Relationship between metabolic syndrome and intake of ultraprocessed foods in Korean adults:based on 6th and 7th Korea National Health and Nutrition Examination Survey (2013–2018)

BACKGROUND/OBJECTIVES@#Metabolic syndrome is closely associated with lifestyle factors, including diet and nutritional intake. Modern trends show a shift in food consumption from healthy home-cooked meals to processed and instant foods. Therefore, this study analyzed the association between ultra-processed food intake and the development of metabolic syndrome in Korean adults based on the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013–2018. @*SUBJECTS/METHODS@#The subjects of this study were 17,414 adults aged 19–80 years who participated in the 6th–7th KNHANES. Processed food was classified into four categories, NOVA1 to NOVA4, using 24-h recall data. The higher the NOVA category, the more processed the food. Statistical analysis was conducted using logistic regression to investigate the prevalence of metabolic syndrome according to the consumption of ultra-processed foods. @*RESULTS@#Among the diagnostic criteria for metabolic syndrome, hypertension (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.85; Q4 vs. Q1, P-trend < 0.001) and high triglycerides (OR, 0.83; 95% CI, 0.72–0.94; Q4 vs. Q1, P-trend < 0.001) showed a correlation with the percentages of energy consumed from ultra-processed foods. The OR for metabolic syndrome, according to the percentages of energy consumed from ultra-processed foods, is shown only for men. The OR showed that the percentages of energy consumed from ultraprocessed foods were associated with increased metabolic syndrome. @*CONCLUSIONS@#This study suggests that consumption of ultra-processed foods raises the risk of metabolic syndrome especially among men. To prevent metabolic syndrome, it is necessary to prepare appropriate dietary guidelines for Korean adults.

Survey of Foodservice Management Status according to Welfare Facility Type for Disabled Persons

This study aimed to determine foodservice and hygiene management statuses at welfare facilities catering to disabled persons by facility type to provide basic data for foodservice management guidelines. An online survey was distributed to workers at 1,984 welfare facilities for disabled persons in Korea, and 531 facilities responded, which represented a response rate of 26.8%. The survey requested general information about the facilities, facility users, meals, hygiene, and management. Statistical analyses were performed, and frequency analysis and the chi-square test were used to investigate responses by facility type. The survey results revealed that daycare centers were most common and accounted for 27.4% of responses. Residential facilities for the severely disabled and sheltered workshops accounted for 16.9% and 16.4%, respectively, and residential facilities by disability type accounted for 13.0%. The presence of dietitians at welfare facilities varied by facility type. Welfare centers for the disabled (94.7%) had the highest percentage of dietitians, followed by residential facilities for the severely disabled (87.8%). On the other hand, sheltered workshops and daycare centers for disabled persons had the lowest percentages of dietitians (10.3% and 4.1%, respectively). This study highlights the variations that exist in foodservice management across different welfare facilities for disabled persons and emphasizes the challenges faced by those responsible for managing foodservices and maintaining hygiene, particularly in large facilities with no dietitians. Therefore, we recommend tailored meal management guidelines be developed for each type of welfare facility for disabled persons.

Evaluation of medical nutrition therapy using the food-based index of dietary inflammatory potential (FBDI) in diabetes mellitus patients

BACKGROUND/OBJECTIVES@#Inflammation is often associated with chronic diseases, and numerous studies suggest that certain foods can modulate inflammatory status. This study aimed to assess the impact of intensive nutrition education on glycemic control and inflammation in patients with diabetes mellitus using the Korean food-based index of dietary inflammatory potential (FBDI). @*SUBJECTS/METHODS@#A total of 120 patients (male: 70, 58.3%) were randomly divided into two groups of 60 each, to be given intensive nutritional education (IE) and basic nutritional education (BE), respectively. As part of the nutrition education intervention, basic diabetesrelated nutrition education was provided to both groups initially. In addition, the IE was provided two face-to-face nutrition education sessions based on FBDI over six months, and text transmissions were made at least eight times. We surveyed the anthropometric measurements, biochemical indicators, inflammatory markers, and dietary intake before and after the interventions. We analyzed the effects of the intensive nutrition education using the t-test, χ 2 test and paired t-test. @*RESULTS@#Of the subjects, 76.7% (46/60) of the IE and 86.7% (52/60) of the BE completed the study. The results of the paired t-test to evaluate the effectiveness of nutrition education using FBDI showed that high density lipoprotein-cholesterol increased significantly from 42.6 mg/dL before intervention to 49.2 mg/dL after intervention (P = 0.009), tumor necrosis factor-α significantly decreased from 1.25 pg/mL before intervention to 1.11 pg/mL after intervention (P =.012) in the IE. Also, glycated hemoglobin decreased from 8.0% to 7.5% in the IE but increased from 7.4% to 7.7% in the BE, and the differences between the groups were significant (P= 0.008). @*CONCLUSION@#These findings suggest that providing intensive FBDI-based education on antiinflammatory foods positively affected glycemic control and inflammatory status in diabetes patients. Therefore, practical dietary plans using FBDI should be considered for diabetes patients to prevent increased inflammation.

Effectiveness of a mobile health intervention on weight loss and dietary behavior changes among employees with overweight and obesity: a 12-week intervention study investigating the role of engagement / 대한지역사회영양학회지

Objectives@# This study aimed to determine whether a mobile health (mhealth) intervention is effective in reducing weight and changing dietary behavior among employees with overweight and obesity. The study also investigated whether engagement with the intervention affected its effectiveness. @*Methods@# The intervention involved the use of a dietary coaching app, a wearable device for monitoring physical activity and body composition, and a messenger app for communicating with participants and an intervention manager. A total of 235 employees were recruited for a 12-week intervention from eight workplaces in Korea. Questionnaire surveys, anthropometric measurements, and 24-h dietary recalls were conducted at baseline and after the intervention. @*Results@# After the intervention, significant decreases in the mean body weight, body mass index, body fat percentage, and waist circumference were observed. Furthermore, the consumption frequencies of multigrain rice and legumes significantly increased, whereas those of pork belly, instant noodles, processed meat, carbonated beverages, and fast food significantly decreased compared with those at baseline. The mean dietary intake of energy and most nutrients also decreased after the intervention. When the participants were categorized into three groups according to their engagement level, significant differences in anthropometric data, dietary behaviors, and energy intake were observed following the intervention, although there were no differences at baseline, indicating that higher engagement level led to greater improvements in weight loss and dietary behavior. @*Conclusions@# The intervention had positive effects on weight loss and dietary behavior changes, particularly among employees with higher engagement levels. These results indicate the importance of increasing the level of engagement in the intervention to enhance its effectiveness. The mhealth intervention is a promising model for health promotion for busy workers with limited time.

Comparison of the levels of energy intake from dish and food groups by gender and age among Korean obese adults: data obtained from the 2013-2018 Korea National Health and Nutrition Examination Survey / 한국영양학회지

Purpose@#To provide the primary data on dietary guidelines for the management of obesity, we analyzed the intake rate of food groups and dish groups according to obesity and age.Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANSE, 2013–2018). @*Methods@#This study analyzed the data of 21,184 adults aged 19-64 years, obtained from the KNHANSE 2013–2018. The 24-hour recall was performed and the food groups were classified into six representative food groups (grains, meat·fish·eggs·legumes, vegetables, fruits, milk and dairy, and oil and sugar), and ‘alcohol’ and ‘others’. The dish groups were classified into a total of twenty-four types. @*Results@#The normal group included 9,004 subjects (42.5%), while the obese group had 12,180 subjects (57.5%). The food groups showing significant differences according to obesity were grains (p < 0.001), meat/fish/egg/legumes (p < 0.001), and vegetables (p < 0.001); similar results were obtained in both male and female. Comparing the intake rate of food groups and dish groups targeting only the obese group according to age, the food groups showing significance between the obese group and the normal group were grains (p < 0.001) and vegetables (p < 0.001), with significantly increased intake in both genders. Considering the dish groups, significant increases were determined for stews (p < 0.001), seasoned vegetables (p < 0.001), and kimchi (p < 0.001) in male, and for rice (p < 0.001), seasoned vegetables (p < 0.001), kimchi (p < 0.001), and rice cakes (p < 0.001) in female. @*Conclusion@#The results of this study determined that the intake ratio of food and dish groups differs by age in obese adults. We believe that our results can be used as primary data for forming dietary guidelines for obese adults in the future.

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.

A Relationship between Dietary Patterns and Dyslipidemia in Urban-dwelling Middle-Aged Korean Men: Using Korean Genome and Epidemiology Study (KoGES)

An increase in the prevalence of dyslipidemia has been strongly associated with the mortality rate of cardiovascular disease. We conducted a cross-sectional analysis to determine the relationship between dietary patterns and dyslipidemia in adult men aged 40–64 years. A total of 5,643 subjects from the Korean Genome and Epidemiology Study (KoGES) were selected for the final analysis. We analyzed 24-hour dietary recall data. Using principal component analysis, 3 dietary patterns were identified: rice based Korean food pattern, flour based western dietary pattern, and convenience food dietary pattern. The flour based western dietary pattern was significantly and positively associated with total cholesterol, and low density lipoprotein (LDL) cholesterol (p for trend < 0.05). With regard to the rice based Korean food pattern, the group with the highest factor score had a significantly lower risk of hyper LDL cholesterolemia (odds ratio [OR], 0.802; 95% confidence interval [CI], 0.698–0.922) and high total cholesterol levels (OR, 0.868; 95% CI, 0.761–0.990) than the group with the lowest factor score. For the flour based western dietary pattern the group with the highest factor score showed a significantly high risk of hyper LDL cholesterolemia (OR, 1.189; 95% CI, 1.033–1.367; p for trend < 0.05) than the group with the lowest factor score. Our results showed that the rice based Korean food pattern protected against dyslipidemia. In contrast, the western staple pattern, which is rich in flour and processed foods, was independently associated with dyslipidemia in urban male residents of Korea.

Development of a food-based index of dietary inflammatory potential for Koreans and its relationship with metabolic syndrome

BACKGROUND/OBJECTIVES: Inflammation is known to be a risk factor for metabolic diseases. This study aimed to develop a Food-based Index of Dietary Inflammatory Potential (FBDI) and examine its association with metabolic biomarkers. SUBJECTS/METHODS: This study analyzed the raw data from the 2012-2014 Korean Genome and Epidemiology Study data of 17,771 people. To analyze the relationship between foods consumed by Koreans and inflammation, we conducted a correlation analysis between 51 food groups and hs-CRP levels. The FBDI was developed from 17 food groups selected by multiple regression method. We examined whether FBDI was associated with metabolic markers (waist circumference, blood pressure, fasting glucose, triglyceride, and HDL-cholesterol) in the 6th Korea National Health and Nutrition Examination Survey (KNHANES). We used binary logistic regression analysis to examine the association. RESULTS: The FBDI model included seven of the anti-inflammatory food groups and three of the pro-inflammatory food groups. The FBDI formula was calculated by multiplying the intake of food group by β-coefficients derived from the multiple regression model based on the correlation analysis. The FBDI was significantly associated with waist circumference (P < 0.001), blood pressure (P < 0.001), triglyceride level (P < 0.001), and HDL-cholesterol (P < 0.001) level among adults aged 20–64 years in the KNHANES. The prevalence of metabolic syndrome was 2.618 times higher in the group with the highest FBDI than in the group with the lowest one (95% confidence interval: 1.778–3.856, P for trend < 0.001). CONCLUSIONS: This study established an FBDI reflecting food intake patterns of Koreans, which showed a significant relationship with the prevalence of metabolic syndrome.

Effect of the Telephone-Delivered Nutrition Education on Dietary Intake and Biochemical Parameters in Subjects with Metabolic Syndrome

As prevalence of metabolic syndrome has rapidly increased over the past decade, lifestyle changes including dietary habits are considered as a therapeutic cornerstone for metabolic syndrome, cardiovascular complications and type 2 diabetes. We evaluated the effectiveness of a telephone-delivered nutrition education to improve metabolic parameters compared with a single-visit with a dietitian in subjects with metabolic syndrome. A total of seventy-one adults who met diagnostic criteria for the metabolic syndrome were randomly assigned to either the single-visit group or the in-depth nutrition education group during a 3-month intervention study period. The in-depth telephone-delivered nutrition education group had an initial visit with a dietitian and additional two telephone counseling during the first 4 weeks of the study periods. Sixty-six subjects completed a 3-month intervention study. The trial examined participant's anthropometric changes and dietary intakes as well as changes in the metabolic syndrome factors. At the end of the trial, the in-depth nutrition education group showed significantly higher reduction in weight, body fat and abdominal circumference compared with the other group (p < 0.05). In the in-depth nutrition groups, the prevalence of metabolic syndrome was decreased to 45.5%, while 69.7% of the subjects were metabolic syndrome patients in the single-visit group (p < 0.05). These results demonstrate that the telephone-intervention counseling is a feasible mean to deliver dietary intervention in patients with metabolic syndrome.

The development of a taste education program for preschoolers and evaluation of a program by parents and childcare personnel

The change in people's dietary life has led to an increase in an intake of processed foods and food chemicals, raising awareness about taste education for preschoolers whose dietary habits start to grow. This study aims to evaluate the effectiveness and satisfaction of parents and childcare personnel after developing a taste education program and demonstrating it in class. A part of the curriculum developed by Piusais and Pierre was referred for the program. After educating 524 preschoolers in child care facilities in Seoul, a satisfaction survey was conducted on the program. The data in this study were analyzed using SPSS 14.0. Statistical analysis was conducted based on the frequency after collecting the data. Mean +/- SD used to determine satisfaction with taste education, with preferences marked on a five-point scale and the alpha was set at 0.05. The program includes five teachers' guides with subjects of sweetness, saltiness, sourness, bitterness and harmony of flavor, and ten kinds of teaching tools. For the change in parents' recognition of the need for taste education based on five-point scale, the average of 4.06 +/- 0.62 before the program has significantly increased to 4.32 +/- 0.52 (P < 0.01). Regarding the change in the preferences for sweetness, saltiness, sourness, and bitterness, the average has increased to 3.83 +/- 0.61, 3.62 +/- 0.66, 3.64 +/- 0.66, and 3.56 +/- 0.75 respectively. In an evaluation of instructors in child care facilities, the average scores for education method, education effect, education contents and nutritionists, and teaching tools were at 4.15 +/- 0.63, 3.91 +/- 0.50, 4.18 +/- 0.50, and 3.80 +/- 0.56 respectively. In addition, the need for a continuous taste education scored 4.42 +/- 0.67. This program has created a positive change in preschoolers' dietary life, therefore the continuation and propagation of the taste education program should be considered.

Relationship between Nutrients Intakes, Dietary Quality, and Serum Concentrations of Inflammatory Markers in Metabolic Syndrome Patients / 대한지역사회영양학회지

Elevated serum concentration of inflammation markers is known as an independent risk factor of metabolic syndrome (MS) and dietary intake is an important factor to control MS. The purpose of this study was to investigated the hypothesis that inflammatory indices are associated with dietary intake and diet quality index-international (DQI-I) in subjects with MS. A cross-sectional study was conducted on 156 men and 73 postmenopausal women with MS, defined by three or more risk factors of the modified Adult Treatment Panel III criteria. Serum levels of high sensitive C-reactive protein (hs-CRP), adiponectin were examined and nutrients intake and DQI-I were assessed using a semi-quantitative food frequency questionnaire. The total DQI-I score was significantly higher in female subjects (65.87 +/- 9.86) than in male subjects (62.60 +/- 8.95). There was a positive association between hs-CRP and polyunsaturated fatty acid intake (p < 0.05) and a negative association between adiponectin and lipid (p < 0.05), total sugar (p < 0.01), and total fatty acids (p < 0.05). When the subjects were divided into 5 groups by quintile according to serum adiponectin and hs-CRP level, there was no association between DQI-I score and hs-CRP levels. Moderation score of DQI-I was significantly higher in highest quintile group than the lower quintile groups. Therefore, our results provide some evidence that dietary intake and diet quality are associated with inflammation markers and dietary modification might be a predictor to decrease risk for metabolic syndrome complications. However further research is needed to develop the dietary quality index reflecting the inflammatory change by considering the dietary habit and pattern of Koreans.

Association of Plasma Osteoprotegerin with Adiponectin and Difference according to Obesity in Men with Metabolic Syndrome / 대한지역사회영양학회지

Osteoprotegerin (OPG) plays a core role in bone reformation by antagonizing the effect of receptor activator of nuclear factor kappa-B ligand (RANKL), and mediates vascular calcification in cardiovascular disease patients. Thus, we aimed to examine the relationship between serum OPG levels and cardiovascular factors and inflammatory markers in metabolic syndrome patients (MS). This cross-sectional study included 96 men who visited the diet clinic between May and July 2011. Patients were classified into 2 groups based on NCEP-ATP guidelines: normal and with MS (n = 50 and 46, respectively). Physical measurements, biochemical assay were measured. Serum OPG and IL-6, diponectin and hs-CRP were assessed. MS were aged 50.02 +/- 10.85 years, and normal patients 52.07 +/- 9.56 years, with no significant differences. Significant differences were not observed in BMI between the 2 groups. Moreover, significant differences were not observed in serum OPG, however, the serum OPG level (4.41 +/- 1.86 pmol/L) differed significantly between an overweight MS (BMI > 25) and normal patients. OPG was correlated to age (r = 0.410, p = 0.000), HDL-cholesterol (r = 0.209, p = 0.015), and log adiponectin (r = 0.175, p = 0.042). Multiple regression analyses using the enter method showed that age (beta = 0.412, p = 0.000) and BMI (beta = 0.265, p = 0.000) considerably affected OPG. In conclusion, out study showed that serum OPG levels are correlated with cardiovascular risk factors, such as BMI, HDL-cholesterol and adiponectin in MS and adiponectin, suggesting that serum OPG has potential as a cardiovascular disease indicator and predictor.