BACKGROUND/OBJECTIVES: The long-term health impacts of dietary sugar have begun to be reported. The committee on the 2020 Dietary Reference Intakes for Koreans for sugar intended to update the scientific evidence on the association of added sugar intake with health outcomes, including mortality. This study evaluated the evidence on the association of dietary sugar with the all-cause and cardiovascular disease mortality from cohort studies. SUBJECTS/METHODS: The PubMed and ScienceDirect databases were searched until July 2021. The search terms were based on multiple combinations of keywords, such as added sugar, beverage, and mortality, included in the title or abstract. Two authors independently assessed the eligibility criteria of study selection and extracted the information from each selected article for this systematic review. RESULTS: The literature search identified 276 articles. Seventeen cohort studies met the inclusion criteria and were included in this systematic review. This study extracted information on the cohort and participants, dietary assessment methods, exposure and its comparison groups, health outcomes, and risk measures. Five articles reported added sugar intake, and 15 articles reported the food sources of the added sugar in the association with mortality. Increased mortality was observed in higher added sugar intake and a lower intake of less than 5% of energy, while higher discrepancies between gender, age groups, and countries were noted. In addition, nutritious sugary foods and beverages did not increase mortality. CONCLUSIONS A ‘U’ or ‘J’ shaped relationship between the added sugar intake and mortality was estimated. The observed discrepancy indicated the need for more evidence to establish the dose-response relationship for Koreans.

OBJECTIVES: This study investigated dietary and lifestyle factors associated with the weight status among Korean adolescents in multicultural families.METHODS: This cross-sectional study analyzed 1,751 multicultural families' adolescents who participated in the 2017–2018 Korea Youth Risk Behavior Surveys. Information on dietary and lifestyle factors was self-reported using a web-based questionnaire and this information included breakfast and foods consumption, perceived health status, alcohol drinking, smoking, physical activity, and weight control efforts. Body mass index (BMI) was calculated based on the self-reported height and body weight (kg/m²). Weight status was assessed according to the 2017 Korean National Growth Chart: underweight (weight-for-age <5(th) percentiles), overweight (85(th)≤ BMI-for-age <95(th) percentiles), and obese (BMI-for-age ≥95(th) percentiles). Multiple logistic regression analysis was performed to examine the dietary and lifestyle factors associated with weight status after adjustment for covariates.RESULTS: Among Korean adolescents from multicultural families, the prevalence of overweight/obesity was 20.9%, whereas about 7% of adolescents were underweight. The weight status did not show differences according to gender, school level, area of residence, and household income. Compared to adolescents who did not have breakfast during the previous week, those who had breakfast 3–4 days/week and ≥5 days/week had a 42% (p=0.021) and a 37% (p=0.009) lower prevalence of overweight/obesity, respectively. The adolescents who frequently consumed carbonated soft drinks (≥5 times/week) showed an odds ratio (OR) of 1.69 (95% CI=1.01–2.83) for overweight/obesity relative to those adolescents who did not consume carbonated soft drinks. The OR of being underweight for adolescents who ate fast food ≥3 times/week was 1.97 (95% CI=1.04–3.71) compared to those adolescents who had not eaten fast food during the previous week.CONCLUSIONS: Dietary and lifestyle factors were associated with overweight/obesity as well as underweight among Korean adolescents in multicultural families. Our findings could be used to design and provide nutrition interventions for this specific population.
Adolescent ; Alcohol Drinking ; Body Mass Index ; Body Weight ; Breakfast ; Carbon ; Carbonated Beverages ; Cross-Sectional Studies ; Family Characteristics ; Fast Foods ; Growth Charts ; Humans ; Korea ; Life Style ; Logistic Models ; Motor Activity ; Odds Ratio ; Overweight ; Prevalence ; Risk-Taking ; Smoke ; Smoking ; Thinness

Background: Low-density lipoprotein (LDL) cholesterol is a strong predictor of cardiovascular disease, resulting in the promotion of low-fat diets that emphasize the need to lower LDL cholesterol levels. We investigated the relationship between dietary carbohydrate intake and cardiovascular risk factors according to LDL cholesterol levels in Korean adults who typically consumed high-carbohydrate, low-fat diets. Methods: A total of 25,925 Korean adults were selected from the 2007-2015 Korea National Health and Nutrition Examination Surveys. Dietary carbohydrate intake was grouped into quintiles and cardiovascular risk factors included obesity, metabolic syndrome, type 2 diabetes, and dyslipidemia. Multiple logistic regression models were used to examine association between carbohydrate intake and cardiovascular risk factors by sex and LDL cholesterol levels. Results: Subjects with LDL cholesterol ≥130 mg/dL had significantly less energy and fat intake than those with LDL cholesterol <130 mg/dL both in men and women. In men, a higher carbohydrate intake was related to increased prevalence of atherogenic dyslipidemia and low high-density lipoprotein (HDL) cholesterol regardless of LDL cholesterol levels. Meanwhile, dietary carbohydrate intake was positively associated with low HDL cholesterol but inversely associated with hypercholesterolemia only in women with LDL cholesterol <130 mg/dL. Conclusions High carbohydrate intake in Korean adults is associated with low HDL cholesterol or atherogenic dyslipidemia regardless of LDL cholesterol levels. Carbohydrate intake should be carefully recommended according to the lipid profiles of individuals for the prevention and management of cardiovascular disease.

Background: Low-density lipoprotein (LDL) cholesterol is a strong predictor of cardiovascular disease, resulting in the promotion of low-fat diets that emphasize the need to lower LDL cholesterol levels. We investigated the relationship between dietary carbohydrate intake and cardiovascular risk factors according to LDL cholesterol levels in Korean adults who typically consumed high-carbohydrate, low-fat diets. Methods: A total of 25,925 Korean adults were selected from the 2007-2015 Korea National Health and Nutrition Examination Surveys. Dietary carbohydrate intake was grouped into quintiles and cardiovascular risk factors included obesity, metabolic syndrome, type 2 diabetes, and dyslipidemia. Multiple logistic regression models were used to examine association between carbohydrate intake and cardiovascular risk factors by sex and LDL cholesterol levels. Results: Subjects with LDL cholesterol ≥130 mg/dL had significantly less energy and fat intake than those with LDL cholesterol <130 mg/dL both in men and women. In men, a higher carbohydrate intake was related to increased prevalence of atherogenic dyslipidemia and low high-density lipoprotein (HDL) cholesterol regardless of LDL cholesterol levels. Meanwhile, dietary carbohydrate intake was positively associated with low HDL cholesterol but inversely associated with hypercholesterolemia only in women with LDL cholesterol <130 mg/dL. Conclusions High carbohydrate intake in Korean adults is associated with low HDL cholesterol or atherogenic dyslipidemia regardless of LDL cholesterol levels. Carbohydrate intake should be carefully recommended according to the lipid profiles of individuals for the prevention and management of cardiovascular disease.

BACKGROUND/OBJECTIVES: The prevalence of obesity has been increasing in Korean children. As an unhealthy diet is known as one of the major determinants of childhood obesity, assessing and monitoring dietary fat intake of children is needed. SUBJECTS/METHODS: This analysis included 9,998 children aged 3–11 yrs from the 2007– 2017 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained from a single 24-h dietary recall. Intakes of total fat and fatty acids, including saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) were evaluated as the absolute amount (g) and proportion of energy from each fatty acid (% of energy). The total fat and SFA intake were also assessed according to compliance with dietary guidelines. Linear trends in the dietary fats intake across the survey period were tested using multiple regression models. RESULTS: Total fat intake significantly increased from 38.5 g (20.3% of energy) to 43.4 g (23.3% of energy) from 2007 to 2017. This increase was mainly accounted for the increases in intakes of SFA (7.2% to 8.4% of energy) and MUFA (6.2% to 7.5% of energy). PUFA intake increased from 4.4 to 4.7% of energy during the 11-yrs period: from 0.57 to 0.63% of energy for n-3 FA and from 3.8 to 4.1% of energy for n-6 FA. The proportions of children who consumed amounts exceeding the dietary guidelines for total fat and SFA significantly increased from 2007 to 2017, with increases from 9.8% to 17.4% for total fat and from 36.9% to 50.9% for SFA. CONCLUSIONS Prominent increasing trends in the consumption of total fat and SFA but tiny change in n-3 FA intake were observed in Korean children. The healthy intake of dietary fats should be emphasized in this population.

BACKGROUND/OBJECTIVES: This study examined the changes in food behaviors of dietary fatty acids over 2007–2018 among Korean adults. SUBJECTS/METHODS: This study used data from the 4th (2007–2009), 5th (2010–2012), 6th (2013–2015), and 7th (2016–2018) Korea National Health and Nutrition Examination Surveys. A total of 46,307 adults aged 19–64 yrs were selected and dietary data were obtained from a single 24-h recall. In the 4th and 7th data, the major food sources for each fatty acid based on the contributing percentage of the food item were compared. The consumption trends in the major food sources were presented as grams per day over 2007–2018 and compared across the survey periods using the multiple regression model. RESULTS: From 2007 to 2018, for total fat, saturated fatty acid (SFA), and monounsaturated fatty acid, the contribution of animal food sources, including beef, chicken, and eggs increased but plant food sources (e.g., tofu, soybean, and plant oil) decreased. As polyunsaturated fatty acid sources, mayonnaise, eggs, and bread showed higher contributions, whereas soybean and tofu showed lower contributions in the 7th data compared to the 4th data. For n-3 fatty acids, the contribution of fish decreased between the 4th and 7th data. Over 12 yrs, the significant increases in the absolute amount of consumption from animal sources were observed. In contrast, decreases in the consumption from plant sources and fish were seen across the survey periods. CONCLUSIONS In Korean adults, increases in the intake of dietary fatty acids along with changes in the food behaviors during 2007–2018 have evoked great concern for SFA intake, which is a cardiovascular disease risk factor. Healthy food sources of dietary fatty acids should be emphasized in this population.

Objectives: This study examined regional differences in the intake of dietary total fat and saturated fatty acid (SFA) and their food sources among Korean adults. We also investigated the associations of SFA intake with metabolic diseases by region. Methods: This study included 13,926 adults ( 19y) who participated in the 2016 ~ 2019 Korea National Health and Nutrition Examination Surveys. The regions were divided into urban and rural areas according to the administrative districts where the participants lived. Using dietary data obtained from a 24-h recall, intake of total fat and SFA and their food sources were assessed by region. Metabolic diseases included obesity, abdominal obesity, and elevated total cholesterol and their association with SFA intake by region were examined using multiple logistic regression. Results Of the participants, 19.6% lived in rural areas. In urban areas, the total fat and SFA intakes were higher than in rural areas: 21.2% of energy (%E) came from total fat and 6.9%E from SFA in urban areas, whereas 18.0%E came from total fat and 5.8%E from SFA in rural areas. The percentage of participants who exceeded the dietary reference intakes for total fat and SFA in urban areas was 16.5% and 41.9%, respectively, but 43.4% of participants in rural areas showed lower intake levels for total fat compared to the reference level. Young adults did not show regional differences in fat intake, and the percentage of subjects who exceeded the reference for SFA was high both in urban (58.5%) and rural (55.7%) areas. Among middle-aged and older adults, intake of fatty acids except for n-3 fatty acid was significantly higher in urban areas than in rural areas. About 69% of older adults in rural areas showed a lower intake of total fat compared to the reference level. The food sources for total fat and SFA were meat, soybean oil, eggs, and milk in both areas. The intake of fat from eggs, milk, mayonnaise, and bread was higher in urban areas, but the intake of fat from white rice and coffee mix was higher in rural areas. The SFA intake was positively associated with elevated serum total cholesterol in urban areas (4th quartile vs. 1st quartile, OR: 1.22, 95% CI: 1.06-1.40, P for trend: 0.043), but not in rural areas.

OBJECTIVES: This study evaluated dietary intakes of total fat and fatty acids among the Korean adult population. METHODS: This cross-sectional study used the 2016–2017 Korea National Health and Nutrition Examination Survey data. A total of 10,772 subjects aged ≥19 y for which dietary data were available were selected. Data pertaining to energy and nutrient intakes were obtained by a 24-h recall method. Total fat and fatty acids intakes were evaluated based on the Acceptable Macronutrient Distribution Ranges (AMDR) of 2015 Dietary Reference Intakes for Koreans by sex and age groups. All statistical analyses accounted for the complex sampling design effect and sampling weights. RESULTS: The mean intakes of energy and total fat were 1,952 kcal (95% CI: 1928–1977) and 46.1 g (45.2–47.1), respectively, and about 21% of the energy was obtained from fat in this study population (21.7% in men and 20.2% in women). The mean percentages of energy from saturated, monounsaturated, and polyunsaturated fatty acids were 6.4%, 6.7%, and 5.2%, respectively. About 18% of adults exceeded the AMDR for fat (30% of energy), whereas 37.6% exceeded the AMDR for saturated fatty acids (7% of energy). The proportions of subjects who consumed more than the AMDR for fat and saturated fatty acids decreased across age groups in both sexes. Among young adults (19–29 y), about 63% of the subjects obtained ≥7% of their energy from saturated fatty acids. About 61% of older adults obtained less than 15% of their energy from total fat. CONCLUSIONS: Increased intake of fat energy was prominent in saturated fatty acids. Our findings suggest current information on total fat and fatty acids intakes in Korean adults and can be used to provide dietary guidelines for the improvement of public health.
Adult ; Cross-Sectional Studies ; Dietary Fats ; Fatty Acids ; Fatty Acids, Unsaturated ; Humans ; Korea ; Male ; Methods ; Nutrition Policy ; Nutrition Surveys ; Public Health ; Recommended Dietary Allowances ; Weights and Measures ; Young Adult

PURPOSE: The aim of this study was to evaluate the dietary behaviors of preschoolers in Daejeon using the Nutrition Quotient for Preschoolers (NQ-P). METHODS: The study subjects were recruited from child-care centers and kindergartens located in Daedeok-gu, Daejeon between August and September 2018. A total of 411 preschoolers aged 3 ~ 6 years were included in the data analyses. A questionnaire of NQ-P, which consisted of 14 checklist items on dietary behaviors, was completed by the parents or guardians of the study subjects. The NQ-P scores and its three factors, including “balance”, “moderation”, and “environment” factors, were calculated according to sex, age, and weight status. Differences in the NQ-P scores and their factors according to sex, age, and weight status were tested using a student's t-test. RESULTS: The mean NQ-P score of the total subjects was 58.5 ± 9.2, which was within the medium-low grade. The NQ-P score was 58.5 ± 9.4 in boys and 58.6 ± 9.0 in girls (p = 0.955). The NQ-P score was similar regardless of the age groups (57.8 ± 9.4 in 3 ~ 4 years vs. 59.2 ± 9.0 in 5 ~ 6 years, p = 0.124), whereas subjects aged 5 ~ 6 years showed a significantly higher scores of environment factors than those aged 3 ~ 4 years (67.9 ± 16.8 vs. 61.7 ± 17.3). The mean score of the moderation factor was lower in the overweight/obese children compared to the non-overweight/obese children (46.6 ± 13.3 vs. 51.0 ± 16.2, p = 0.012). Compared to children aged 3 ~ 4 years, children aged 5 ~ 6 years had higher intakes of vegetable dishes and processed meat. The overweight/obese group showed a higher consumption of processed beverages than the non-overweight/obese group. CONCLUSION: The current study indicates that the dietary behaviors of preschoolers residing in Daejeon need to be improved. These findings suggest that nutrition education or health interventions targeting young children is necessary for improving their nutritional health status.
Beverages ; Checklist ; Child ; Child, Preschool ; Education ; Feeding Behavior ; Female ; Food Habits ; Humans ; Meat ; Parents ; Statistics as Topic ; Vegetables

Objectives: This study examined the association between the dietary behavior and weight status of preschool children and their mothers in Daejeon, Korea. Methods: A total of 301 mother–preschool children (aged 3~6 years) dyads were included in this study. The dietary behavior of children and their mothers was assessed using the Nutrition Quotient (NQ) questionnaire for preschoolers and adults, respectively. The NQ questionnaires were completed by the mothers. The overweight/ obesity status of children and their mothers was determined using data on height and body weight reported by the mothers. Multiple logistic regression was performed to examine the relationship between the dietary behavior and weight status of children and their mothers. Results: The mean NQ score was 58.9 ± 9.7 in children and 55.6 ± 9.2 in mothers. The NQ score was higher in boys than girls but did not vary by age. The prevalence of overweight/obesity was 27.5% in children and 46.5% in mothers. The physical activity level of mothers and their NQ scores were positively associated with the NQ scores of the children. After adjustment for covariates, the mothers in the highest tertile of NQ scores showed a lower odds ratio (OR) for the unhealthy dietary behavior of children (OR = 0.24, 95% CI = 0.11~0.53, P< 0.001) compared to those in the lowest tertile.The obese mothers showed a higher OR for children’s overweight/obesity (OR = 3.38, 95% CI = 1.68~6.80, P = 0.001) compared to normal weight mothers. Conclusions The dietary behavior and weight status of young children and their mothers were closely linked. Nutrition education programs targeting mothers are necessary for improving maternal and child nutrition. Specifically, these programs need to be tailored to the socioeconomic characteristics or weight status of mothers.