OBJECTIVES: It has been suggested that the consumption of dairy products helps lower the prevalence of type 2 diabetes (T2D). We investigated the association between the consumption of dairy products and T2D events in middle-aged Korean adults. METHODS: We followed up 53,288 participants (16,895 male and 36,393 female) in the Health Examinees (HEXA) study. The consumption of dairy products was assessed using the self-administered food frequency questionnaire, and T2D was defined according to the 2015 treatment guidelines of the Korean Diabetes Association. Hazard ratios (HRs) and 95% confidence intervals (CIs) between the consumption of dairy products and the risk of T2D were calculated using Cox proportional hazards models after adjusting for potential confounders. Spline regression was used to better represent the association between the consumption of dairy products and the risk of T2D. RESULTS: Among male, those with higher consumption of dairy products had a significantly lower risk of T2D than those who consumed essentially no dairy products (HR, 0.73; 95% CI, 0.58 to 0.91). In particular, consumption of yogurt (HR, 0.75; 95% CI, 0.60 to 0.93; ptrend=0.035) and cheese (HR, 0.66; 95% CI, 0.49 to 0.89; ptrend=0.005) was negatively associated with the incidence of T2D in male. In female, daily consumption of 1 serving of yogurt decreased the risk of T2D by 11%. CONCLUSIONS The association between the consumption of dairy products and the risk of T2D differed by sex and dairy product type. Further prospective studies are needed to confirm these associations.

OBJECTIVES: This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score. METHODS: The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD. RESULTS: The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm. CONCLUSIONS This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.

OBJECTIVES: This study assessed the association of dietary patterns with the incidence of chronic kidney disease (CKD) and kidney function decline among Korean adults. METHODS: Data were collected from the records of 20,147 men and 39,857 women who participated in the Health Examinees study. Principal component analysis was used to identify 3 dietary patterns (prudent, flour-based food and meat, and white rice-based), and CKD risk was defined using the Epidemiology Collaboration equation for estimated glomerular filtration rate: (eGFR) <60 mL/min/1.73 m2. A kidney function decline was defined as a >25% decrease in eGFR from baseline. RESULTS: During the 4.2-year follow-up, 978 participants developed CKD and 971 had a 25% decline in kidney function. After adjusting for potential impact variables, compared with the lowest quartile of the prudent dietary pattern, participants in the highest quartile had a 37% lower risk of kidney function decline among men (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47 to 0.85); while higher adherence to the flour-based food and meat dietary pattern was associated with an increased risk of CKD in both men (HR, 1.63; 95% CI, 1.22 to 2.19) and women (HR, 1.47; 95% CI, 1.05 to 2.05) as well as a decline in kidney function in both men (HR, 1.49; 95% CI, 1.07 to 2.07) and women (HR, 1.77; 95% CI, 1.33 to 2.35). CONCLUSIONS Although a higher adherence to the prudent dietary pattern was inversely associated with the risk of kidney function decline in men, there was no association with CKD risk. In addition, a higher adherence to the flour-based food and meat dietary pattern increased the risk of CKD and kidney function decline. Further clinical trials are needed to confirm these associations.

PURPOSE: The aim of this study was to examine associations between marital status and vegetable intake. METHODS: Data were from participants 30 years and over (n = 18,190) in the 2007~2010 Korea National Health and Nutrition Examination Survey. Marital status was divided into three groups: married, never married, and separated/divorced/widowed. Vegetable intake was estimated from the twenty-four hour dietary recall. Data were analyzed using a chi-square test, analysis of covariance, least squares means, and logistic regression. RESULTS: Married respondents tend to consume more vegetables, including kimchi, than all other marital status groups. Vegetable intake, excluding kimchi, was lowest among 30~64 year-old respondents who had never married. Elderly men (65 years and older) who were never married/separated/divorced/widowed had significantly lower vegetable intake than elderly men who were married (p = 0.0008). When considering the Korean dietary reference intake (KDRIs), elderly men who were never married/separated/divorced/widowed, compared with elderly men who were married, had a significantly higher odds ratio for consuming fewer vegetables than the KDRIs (OR = 1.64, 95% CI: 1.13~2.37). CONCLUSION: The findings of this study indicate that marital status might influence vegetable intake and the probability of consuming fewer vegetables than the KDRIs. In particular, being never married/separated/divorced/widowed might adversely affect vegetable consumption among elderly men, although assessing the causal effect of marital status from this cross-sectional study is difficult.
Adult* ; Aged ; Cross-Sectional Studies ; Surveys and Questionnaires ; Humans ; Korea ; Least-Squares Analysis ; Logistic Models ; Male ; Marital Status* ; Nutrition Surveys* ; Odds Ratio ; Recommended Dietary Allowances ; Single Person ; Vegetables*

Purpose: Several studies have been conducted on the relationship between green tea intake and metabolic syndrome. However, compared to the studies carried out internationally, there is inadequate research on the relationship between domestic green tea consumption and metabolic syndrome. Therefore, in this study, the general characteristics of Koreans according to their green tea intake and its association with metabolic syndrome were examined. Methods: A total of 44,611 subjects were included in the study, and analysis was carried out using data from the Korean Genome and Epidemiology Study (KoGES) for Korean adults aged 40 or older. Green tea consumption was estimated using 106 verified food frequency questionnaires (FFQ). Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) parameters. After adjusting for confounding variables by performing a Cox regression analysis, the association between green tea consumption and metabolic syndrome was confirmed through the hazard ratio (HR) and 95% confidence interval (CI). Results: The average incidence of metabolic syndrome was 18.7% (20.8% in men and 17.8% in women). Compared to those who drank almost no green tea, in subject groups consuming more than one cup of green tea a day, the metabolic syndrome incidence was significantly reduced by 15% (HR, 0.85; 95% CI, 0.74–0.96; p trend = 0.0200) among men and by 19% (HR, 0.81; 95% CI, 0.73–0.90; p trend < 0.0001) among women. In addition, the biomarkers related to metabolic syndrome also tended to decrease overall in these groups. Conclusion This study concluded that as the intake of green tea increased, the incidence of metabolic syndrome and related indicators decreased. Therefore, green tea intake is believed to have a positive effect on the prevention and management of the metabolic syndrome.

Purpose: The 2020 Dietary Reference Intakes for Koreans (KDRIs) serves as a foundation for daily nutrient and energy recommendations aiming to enhance public health and prevent chronic diseases. They act as guidelines for maintaining proper nutrition and overall health.Using KDRIs is crucial for promoting healthier lifestyles and making informed dietary choices. Thus, this study explores the influence of a nutrition education program, based on the 2020 KDRIs, on the nutrition knowledge and dietary habits of undergraduates in Gyeongsangnam-do and Gyeonggi-do. Methods: The nutrition education program, designed with diverse instructional materials, was executed across a wide range of universities. The education group (n = 75) engaged in the program for a 6-week instructional period, while the control group (n = 53) underwent the survey without participating in the education program. Nutrition Quotient (NQ) and knowledge assessments were administered to both groups immediately before and after the instructional period. Results: Within the education group, the nutrition education program positively impacted responses to NQ practice items, including knowledge of nutrition, daily intake, and portion sizes (p < 0.05). In contrast, there were no significant differences between the before and after responses of the control group for most survey items. Post-program evaluations showed significantly higher self-assessment scores and increased satisfaction levels (p < 0.05), with the satisfaction rate for the education program using the 2020 KDRIs reaching 99.2%. Conclusion This study has demonstrated the positive impact of an effective nutrition education program. However, there is a need for the continuous development and implementation of nutrition education programs to sustain these outcomes and further enhance the nutritional education experience.

PURPOSE: The purpose of this study was to develop a mercury database for food commonly consumed by Koreans. METHODS: Target foods for a mercury database were selected from dietary survey data of the 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES). Data for mercury contents of foods were collected through literature review. Among 702 food items reported by 24 hr dietary recall method, the contents of mercury for 300 food items were selected with systematic evaluation from the literature, which provided analytical values, and those of 56 food items were imputed by using a conversion factor. RESULTS: The mercury database developed in this study covered 50.7% of all kinds of consumed foods and 95.1% of total amount of food intake reported by 2007-2009 KNHANES. In the database, the geometric mean of mercury contents in food items was the highest in the fishes and shellfishes group (41.13 microg/kg, n = 101) followed by mushrooms (18.93 microg/kg, n = 12) and seaweeds (5.92 microg/kg, n = 14), and the lowest in the meats group (0.15 microg/kg, n = 17). CONCLUSION: The developed mercury database can be used to estimate the dietary mercury exposure of Korean people, and the method for development of a mercury database would be helpful to researchers in development of a new database for other food borne hazardous substances.
Agaricales ; Eating ; Fishes ; Hazardous Substances ; Meat ; Nutrition Surveys ; Shellfish

BACKGROUND/OBJECTIVES: The Dietary Reference Intakes for Koreans (KDRIs), a set of reference intake values, have served as a basis for guiding a balanced diet that promotes health and prevents disease in the general Korean population. In the process of developing DRIs, a systematic review has played an important role in helping the DRI committees make evidence-based and transparent decisions for updating the next DRIs. Thus, the 2015 KDRI steering committee applied the systematic review framework to the revision process of the KDRIs. The purpose of this article is to summarize the revision process for the 2015 KDRIs by focusing on the systematic review framework. MATERIALS/METHODS: The methods used to develop the systematic review framework for 2015 KDRIs followed the Agency for Healthcare Research and Quality (AHRQ) and the Tufts Evidence-based Practice Center (EPC). The framework for systematic review of the 2015 KDRIs comprised of the 3 following steps: (1) development of an analytic framework and refinement of key questions and search terms; (2) literature search and data extraction; and, (3) appraisal of the literature and summarizing the results. RESULTS: A total of 203,237 studies were retrieved through the above procedure, with 2,324 of these studies included in the analysis. General information, main results, comments of reviewers, and results of quality assessment were extracted and organized by study design. The average points of quality appraisals were 3.0 (range, 0–5) points for intervention, 6.1 (0–9) points for cohort, 6.0 (3–9) points for nested case-control, 5.4 (1–8) points for case-control, 14.6 (0–22) points for cross-sectional studies, and 7.0 (0–11) points for reviews. CONCLUSIONS: Systematic review helped to establish the 2015 KDRIs as a useful tool for evidence-based approach. Collaborative efforts to improve the framework for systematic review should be continued for future KDRIs.
Case-Control Studies ; Cohort Studies ; Cross-Sectional Studies ; Diet ; Evidence-Based Practice ; Health Services Research ; Recommended Dietary Allowances*

Absorptiometry, Photon ; Adult ; Bone Density ; Bone Diseases, Metabolic ; Calcium ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Epidemiology ; Female ; Femur ; Femur Neck ; Hip ; Humans ; Logistic Models ; Male ; Methods ; Nutrition Surveys ; Osteoporosis ; Population Surveillance ; Potassium ; Potassium, Dietary ; Prevalence ; Retrospective Studies ; Spine ; Vitamin D

OBJECTIVES: Most cohort studies used food frequency questionnaires (FFQ) to evaluate coffee consumption as it assesses habitual dietary patterns, whereas some studies have used the 24-hour recalls (24HR) as it elicits in-depth description of foods and the amount eaten. The aim of this study was to compare FFQs and 24HR to assess the consumption of various types of coffee.METHODS: We included 25,904 participants aged 40 years or older from the Health Examinees (HEXA) Study of the Korean Genome and Epidemiologic Study (KoGES). Each participant completed one FFQ and one-day (n=11,280) or two-day 24HR (n=14,624). We classified coffee types into: black coffee, coffee with sugar and cream, and coffee with sugar alone or cream alone. We compared the proportions of nondrinkers, black coffee, and coffee with sugar and cream through FFQ and 24HR.RESULTS: Among those who completed one FFQ and one-day 24HR, 39.4% of “nondrinkers” on one-day 24HR reported that they did not drink coffee on their FFQs. Whereas among those who complete two-day 24HR, 71.2% of “nondrinkers” on two-day 24HR said that they did not drink coffee on their FFQs. Among those who completed one FFQ and oneday 24HR, 58.3% marked “black coffee” on one-day 24HR said that they drank black coffee on their FFQs. Among those who complete two-day 24HR, 58.8% marked “black coffee” on two-day 24HR said that they drank black coffee on their FFQs. The kappa coefficients and percent agreements were 0.4 and 59.6%, respectively, for the comparison of coffee intake between FFQ and one-day 24HR, and 0.6 and 72.8%, respectively, for the comparison of coffee intake between FFQ and two-day 24HR.CONCLUSIONS: We found discrepancies between FFQs and 24HR in the types of coffee consumed. Such limitations should be considered when using the 24HR data to examine the effect of coffee consumption on disease development.
Coffee ; Cohort Studies ; Epidemiologic Studies ; Genome