J Nutr Health.  2018 Jun;51(3):215-227. 10.4163/jnh.2018.51.3.215.

Effects of Korean diet control nutrition education on cardiovascular disease risk factors in patients who underwent cardiovascular disease surgery

• Jung SJ
• Chae SW

• KMID: 2415218
• DOI: http://doi.org/10.4163/jnh.2018.51.3.215

Abstract

PURPOSE
This study was conducted to verify the effects of increases in consuming Korean food in patients who underwent cardiovascular disease (CVD) surgery based on a Korean diet control education program and to investigate the effects of Korean diet control nutrition education on risk factors of CVD, changes in amounts of medication, and nutritional intakes.
METHODS
The subjects consisted of 15 patients who have undergone CVD surgery within three years and continuously taken cardiovascular drugs. The Korean traditional diet (KTD) emphasizes intake of vegetables and fermented foods to lower saturated fat and cholesterol intake. We applied a KTD education program that included a modified DASH (The dietary approaches to stop hypertension) diet for cardiovascular disease patients. Korean diet control education was then applied to the patients for 12 weeks to evaluate the risk factors of CVD and the state of nutritional intakes.
RESULTS
The Korean diet control compliance score increased significantly (p < 0.001) as Korean diet control education was implemented. Additionally, the obesity indexes, waist circumference (WC) (p = 0.002) and waist-to-hip ratio (WHR) decreased significantly (p < 0.001) after subjects received the education. Moreover, the glycemic control index, HbA1c, was significantly decreased (p < 0.05) from 7.3 ± 1.0% before the education to 7.0 ± 1.1% after the education. Changes in the amounts of Korean diet intake consisted of significant increases in cooked rice with whole grains, narmuls (vegetables either raw or cooked), kimchi, and traditional fermented foods following the education. Moreover, the nutritional intake after the education showed significant decreases (p < 0.05) in animal protein, animal lipids, and cholesterol. However, the intakes of Na, K, dietary fiber, vitamin A, vitamin B6, vitamin C, and folic acid were significantly increased.
CONCLUSION
The active encouragement of consuming Korean food and the intervention of implementing diet control education positively affected nutritional intake, the obesity index and glycemic control of patients who have undergone CVD surgery.

Keyword

Korean diets; cardiovascular disease; risk factor; nutrition and diet education

MeSH Terms

Animals
Ascorbic Acid
Cardiovascular Agents
Cardiovascular Diseases*
Cholesterol
Compliance
Diet*
Dietary Fiber
Education*
Folic Acid
Humans
Obesity
Risk Factors*
Vegetables
Vitamin A
Vitamin B 6
Waist Circumference
Waist-Hip Ratio
Whole Grains
Ascorbic Acid
Cardiovascular Agents
Cholesterol
Folic Acid
Vitamin A
Vitamin B 6

Reference

1. Yu SY, Hong HS, Lee HS, Choi YJ, Huh KB, Kim WY. The association of insulin resistance with cardiovascular disease risk and dietary factors in Korean type 2 DM patients. Korean J Nutr. 2007; 40(1):31–40.

2. Stehouwer CD, Gall MA, Twisk JW, Kundsen E, Emeis JJ, Parving HH. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes. 2002; 51(4):1157–1165.

3. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339(4):229–234.

4. Pyun WB. Primary prevention of cardiovascular disease. J Korean Acad Fam Med. 2002; 23(12):1405–1411.

5. Fisher ND, Williaums GH. Hypertensive vascular disease. In : Kasper DL, Braunwald E, Fauci A, Hause S, Longo D, Jameson JL, editors. Harrison's Principles of International Medicine. 16th edition. New York: McGraw-Hill;2004. p. 1463–1480.

6. Jun TW, Park ST, Kang HJ, Eum Ws, Lee DG, Park IL, Jeon BH, Kim EK. The effect of submaximal exercise with different intensities on the blood lipid peroxidation and antioxidant enzymes activities. Exerc Sci. 2004; 13(4):413–421.

7. Korean Endocrine Society. Korean Diabetes Association. Intensive glycemic control and the prevention of cardiovascular disease in type 2 diabetes mellitus: a review and consensus. J Korean Endocr Soc. 2010; 25(1):22–24.

8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003; 289(19):2560–2572.

9. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH, Aickin M, Most-Windhauser MM, Moore TJ, Proschan MA, Cutler JA. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001; 344(1):3–10.

10. Sim JH. The effects of diet health education program for prehypertension group on the diet habit and blood pressure. J Korean Soc Health Educ Promot. 2006; 23(4):1–12.

11. Son JM. Symposium 4: advancement of drug or diet therapy; DASH (Dietary Approach to Stop Hypertension). J Korean Soc Lipidol Atheroscler. 2002; 12(3):290–296.

12. Lee SM, Chung HK, Kang JH, Yoon YW, Kim HS. Effects of modified DASH diet education program on Korean middle-aged and elderly cardiovascular disease patients. Korean J Clin Geriatr. 2004; 5(2):199–207.

13. Ju K, So H. Effects of the nutrition education program on self-efficacy, diet behavior pattern and cardiovascular risk factors for the patients with cardiovascular disease. J Korean Acad Nurs. 2008; 38(1):64–73.

14. Kim YO. Dietary patterns associated with hypertension among Korean males. Nutr Res Pract. 2009; 3(2):162–166.

15. Jung EJ, Son SM, Kwon JS. The effect of sodium reduction education program of a public health center on the blood pressure, blood biochemical profile and sodium intake of hypertensive adults. Korean J Community Nutr. 2012; 17(6):752–771.

16. Song Y, Joung H. A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis. 2012; 22(5):456–462.

17. Kim J, Jo I. Grains, vegetables, and fish dietary pattern is inversely associated with the risk of metabolic syndrome in South Korean adults. J Am Diet Assoc. 2011; 111(8):1141–1149.

18. Kim J, Jo I, Joung H. A rice-based traditional dietary pattern is associated with obesity in Korean adults. J Acad Nutr Diet. 2012; 112(2):246–253.

19. Cho SS, Qi L, Fahey GC Jr, Klurfeld DM. Consumption of cereal fiber, mixtures of whole grains and bran, and whole grains and risk reduction in type 2 diabetes, obesity, and cardiovascular disease. Am J Clin Nutr. 2013; 98(2):594–619.

20. Kim SA, Jun S, Hong E, Joung H. Estimated macronutrients and antioxidant vitamins intake according to Hansik consumption rate among Korean adults: based on the Korea National Health and Nutrition Examination Survey 2007 ~ 2012. J Nutr Health. 2016; 49(5):323–334.

21. Lee KW, Cho MS. The development and validation of the Korean Dietary Pattern Score (KDPS). Korean J Food Cult. 2010; 25(6):652–660.

22. Oh HS, Jang M, Hwang MO, Cho SW, Paek YM, Choi TI, Park YK. Effect of 1 year e-mail nutrition education after face-to face encounter at worksite: changes in cardiovascular risk factors. Korean J Nutr. 2009; 42(6):559–566.

23. Hwang HS. Nutrition in the prevention and treatment of cardiovascular disease. J Korean Acad Fam Med. 2003; 24(10):869–876.

24. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18(6):499–502.

25. Jung SJ, Park SH, Choi EK, Cha YS, Cho BH, Kim YG, Kim MG, Song WO, Park TS, Ko JK, So BO, Chae SW. Beneficial effects of Korean traditional diets in hypertensive and type 2 diabetic patients. J Med Food. 2014; 17(1):161–171.

26. Lee HJ, Lee JJ, Hwang TY, Kam S. Development and evaluation of a community staged education program for the cardiovascular disease high risk patients. J Agric Med Community Health. 2012; 37(3):167–180.

27. Sikaris K. The correlation of hemoglobin A1c to blood glucose. J Diabetes Sci Technol. 2009; 3(3):429–438.

28. Schulze MB, Schulz M, Heidemann C, Schienkiewitz A, Hoffmann K, Boeing H. Fiber and magnesium intake and incidence of type 2 diabetes: a prospective study and meta-analysis. Arch Intern Med. 2007; 167(9):956–965.

29. Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000; 342(19):1392–1398.

30. Lee C, Shin JS. Effects of different fiber content of rice on blood glucose and triglyceride levels in normal subject. J Korean Soc Food Sci Nutr. 2002; 31(6):1048–1051.

31. Lim EJ, Kim MJ, Han JS. Effects of nutrition education on improvement of blood glucose in type 2 diabetic patients with low income. J Korean Soc Food Sci Nutr. 2014; 43(1):141–150.

32. Shin KN, Lee HS, Kwon CS. Effects of nutrition education in type 2 diabetes mellitus on diabetes control and blood antioxidant status. J Korean Soc Food Sci Nutr. 2011; 40(5):689–695.

33. Kwon JY, Chung HY. Study on the correlation between the nutrient intakes and clinical indices of type 2 diabetes patients. Korean J Food Nutr. 2013; 26(4):909–918.

34. Malik S, Wong ND, Franklin S, Pio J, Fairchild C, Chen R. Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes, and elevated C-reactive protein. Diabetes Care. 2005; 28(3):690–693.

35. Lee Y, Kang D, Lee SA. Effect of dietary patterns on serum C-reactive protein level. Nutr Metab Cardiovasc Dis. 2014; 24(9):1004–1011.

36. Yoon JG, Song S, Cho JA. Association between nutrient intake and serum high sensitivity C-reactive protein level in Korean adults: using the data from 2015 Korea National Health and Nutrition Examination Survey. J Nutr Health. 2017; 50(6):565–577.

37. Ajani UA, Ford ES, Mokdad AH. Dietary fiber and C-reactive protein: findings from National Health and Nutrition Examination Survey data. J Nutr. 2004; 134(5):1181–1185.

38. Soltani S, Chitsazi MJ, Salehi-Abargouei A. The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials. Clin Nutr. 2018; 37(2):542–550.

39. The Korean Nutrition Society. Dietary reference intakes for Koreans, 1st revision. Seoul: The Korean Nutrition Society;2010.

40. Mun EG, Sohn HS, Kim MS, Cha YS. Antihypertensive effect of Ganjang (traditional Korean soy sauce) on Sprague-Dawley rats. Nutr Res Pract. 2017; 11(5):388–395.

41. O'Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, McQueen M, Sleight P, Sharma AM, Dans A, Probstfield J, Schmieder RE. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011; 306(20):2229–2238.

42. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovský J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA. European Project on Genes in Hypertension (EPOGH) Investigators. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011; 305(17):1777–1785.

43. Mente A, O'Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, Morrison H, Li W, Wang X, Di C, Mony P, Devanath A, Rosengren A, Oguz A, Zatonska K, Yusufali AH, Lopez-Jaramillo P, Avezum A, Ismail N, Lanas F, Puoane T, Diaz R, Kelishadi R, Iqbal R, Yusuf R, Chifamba J, Khatib R, Teo K, Yusuf S. PURE Investigators. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med. 2014; 371(7):601–611.

44. McGorrian C, Yusuf S, Islam S, Jung H, Rangarajan S, Avezum A, Prabhakaran D, Almahmeed W, Rumboldt Z, Budaj A, Dans AL, Gerstein HC, Teo K, Anand SS. INTERHEART Investigators. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score. Eur Heart J. 2011; 32(5):581–589.

45. O'Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, Yan H, Lee SF, Mony P, Devanath A, Rosengren A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Yusoff K, Iqbal R, Ilow R, Mohammadifard N, Gulec S, Yusufali AH, Kruger L, Yusuf R, Chifamba J, Kabali C, Dagenais G, Lear SA, Teo K, Yusuf S. PURE Investigators. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014; 371(7):612–623.