JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

1. Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Jihye Kim, PhD: Daegu University Inho Jo, PhD: Ewha Womans University Medical School JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

2. Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Study overview Background • Dietary patterns may influence the prevention and management of chronic diseases. • Metabolic syndrome is a cluster of metabolic risk factors associated with increased • risks of cardiovascular disease and type 2 diabetes. • Epidemiologic studies have found that dietary patterns are associated with the risk of metabolic syndrome or its components. • Dietary patterns vary according to age, sex, ethnicity, and culture even though similarities in food patterns are evident in several countries. • The purpose of this investigation is to identify the relationships between Korean habitual dietary patterns and metabolic syndrome due to the ethnic homogeneity inherent to the Korean population. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

3. Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults BMI & Psychosocial measures Study Objective To document associations between dietary patterns derived by factor analysis and metabolic syndrome or its components using survey data from the second and third Korean National Health and Examination Survey, the largest, nationally-representative survey in the general South Korean population. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

4. Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Correlation matrix Study Design • Cross-sectional, nationally-representative survey study: • A combination of the second and third Korean National Health Nutrition and Examination Survey (KNHANES) • A stratified multistage probability sampling design • Participants included South Korean adults who participated in the nutrition survey, examination study, and health behavior survey (N = 9,850): • Aged 19 years old and more • Exclusion: implausible energy intakes (< 500 or ≥ 8000 kcal per day) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

5. Correlation matrix Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Methods • Metabolic syndrome was defined as ≥3 of any of the following: abdominal obesity (waist circumference >90 cm in men or >80 cm in women); hyperglycemia (fasting plasma glucose ≥ 100 mg/dl or current use of insulin or oral hypoglycemia medication); hypertriglyceridemia ≥ 150 mg/dl; low high density lipoprotein (HDL)-cholesterol < 40 mg/dl in men or <50 mg/dl in women; elevated blood pressure (systolic blood pressure/diastolic blood pressure ≥130/85 mmHg) or regular use of antihypertensive medication (Grundy et al. Circulation. 2005;112(17):2735). • Dietary intake was assessed by one day 24 h recall method. • The dietary patterns were derived using factor analysis based on the 23 food groups from the Korean nutrition database. • Multivariable-adjusted logistic regression analysis was conducted to examine the odds ratios (OR) and 95% confidence intervals (CI) for metabolic syndrome or its components across the tertile categories of the dietary pattern scores. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

6. Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Figure Food grouping used in dietary pattern analysis JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

7. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Food grouping used in dietary pattern analysis (cont’d) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

8. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Factor loading matrix for major factors JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

9. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Factor loading matrix for major factors (cont’d) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

10. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Characteristics of Korean adults according to the tertile (T) categories of dietary pattern scoresa JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

11. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Characteristics of Korean adults according to the tertile (T) categories of dietary pattern scoresa (cont’d) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

12. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Nutrient intakes of Korean adults according to the tertile (T) categories of dietary pattern scoresa, b JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

13. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Nutrient intakes of Korean adults according to the tertile (T) categories of dietary pattern scoresa, b (cont’d) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

14. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Odds ratios and 95 % confidence intervals (CIs) for components of the metabolic syndrome across tertile categories of dietary pattern scoresa JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

15. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Odds ratios and 95 % confidence intervals (CIs) for components of the metabolic syndrome across tertile categories of dietary pattern scoresa (cont’d) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

16. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Odds ratios and 95 % confidence intervals (CIs) for metabolic syndrome across tertile categories of dietary pattern scoresa JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

17. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Results • These four factors explained 26.7 % of the variance in total food intake. The following four patterns were defined based on the food items that loaded highly: white rice and Kimchi pattern; meat and alcohol pattern; high fat, sweets, and coffee pattern; and grains, vegetables, and fish pattern. • Adults with high scores for the “meat and alcohol” pattern had higher intakes of total energy and energy from fat and lower intakes of energy from carbohydrate, vitamin C, vitamin A, β-carotene, and calcium (P <0.001). Adults with the “grains, vegetables, and fish” pattern had higher intakes of total energy, energy from protein and fat, fiber, vitamin A, β-carotene, vitamin C, and calcium and lower intakes of energy from carbohydrate (P <0.001). • The odds ratios for hypertriglyceridemia (P for trend=0.01) and elevated blood pressure (P for trend=0.01) increased significantly according to tertile categories of the “meat and alcohol” pattern scores after adjustment for putative risk factors. • The odds ratio for hypertriglyceridemia decreased significantly across tertile categories of the “grains, vegetables, and fish” pattern scores (P for trend=0.0002) for putative risk factors. • The odds ratio for metabolic syndrome decreased significantly according to tertile categories of the “grains, vegetables, and fish” pattern (P for trend=0.02) after adjustments for putative risk factors such as age, sex, body mass index, energy intake, alcohol intake, smoking status, and physical activity JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).

18. Figure Grains, vegetables, and fish pattern is inversely associated with the risk of metabolic syndrome in South Korean adults Conclusion • The “meat and alcohol” pattern was associated with hypertriglyceridemia and elevated blood pressure. • The “grains, vegetables, and fish” pattern was associated with a reduced risk of metabolic syndrome among Korean adults. • These findings therefore propose that specific Korean dietary patterns may have beneficial effects on metabolic syndrome. • Further research is needed to identify the causal relationships between Korean dietary patterns and metabolic syndrome in a prospective longitudinal study. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Kim J, et al. J Am Diet Assoc. 2011; 111 (August).