Nutr Res Pract.  2020 Aug;14(4):384-400. 10.4162/nrp.2020.14.4.384.

Impact of dietary risk factors on cardiometabolic and cancer mortality burden among Korean adults: results from nationally representative repeated cross-sectional surveys 1998–2016

• Jo G
• Oh H
• Singh GM
• Park D
• Shin MJ

• KMID: 2504754
• DOI: http://doi.org/10.4162/nrp.2020.14.4.384

Abstract

BACKGROUND/OBJECTIVES
Dietary factors are important contributors to cardiometabolic and cancer mortality. We examined the secular trends of nine dietary factors (fruits, vegetables, whole grains, nuts and seeds, milk, red meat, processed meat, sugar-sweetened beverages, and calcium) and the associated burdens of cardiometabolic and cancer mortality in Korea using representative cross-sectional survey data from 1998 to 2016.
SUBJECTS/METHODS
Using dietary data from Korean adults aged ≥ 25 years in the Korea National Health and Nutrition Examination Survey (KNHANES), we characterized secular trends in intake levels. We performed comparative risk assessment to estimate the population attributable fraction and the number of cardiometabolic and cancer deaths attributable to each dietary factor.
RESULTS
A total of 231,148 cardiometabolic and cancer deaths were attributable to nine dietary risk factors in Korea from 1998 to 2016. Suboptimal intakes of fruits and whole grains were the leading contributors. Although the intakes of fruits, vegetables, and whole grains moderately improved over time, the intake levels in 2016 (192.1 g/d, 225.6 g/d, and 10.9 g/d, respectively) remained far below the optimal levels. Deaths attributable to the low intakes of nuts and seeds (4.5 g/d), calcium (440.5 mg/d), and milk (37.1 g/d) and the high intakes of red meat (54.7 g/d), processed meat (4.7 g/d), and sugar-sweetened beverages (33.0 g/d) increased since 1998. Compared with older age groups (≥ 45 years), more unfavorable changes in dietary patterns were observed in the younger population aged 25–44 years, including more sharply increased intakes of processed meat.
CONCLUSIONS
We observed improvement in the intakes of fruits, vegetables, and whole grains and unfavorable changes in the intakes of processed meat and sugar-sweetened beverages over the past few decades. Our data suggest that to reduce the chronic disease burden in Korea, more effective nutritional policies and interventions are needed to target these dietary risk factors.

Keyword

Diet; chronic disease; mortality; cross-sectional survey; Korea

Figure

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  Fig. 1 Population attributable fractions and attributable cardiometabolic and cancer deaths by individual dietary risk factors in 1998, 2008, and 2016.The error bars represent the standard deviations of the number of deaths from each risk factor. The error bar for the standard deviation of the estimate derived from the low intake of calcium is not visible.IHD, ischemic heart disease; DM, diabetes mellitus; SSB, sugar-sweetened beverages.

• 

  Fig. 2 Population attributable fractions of the individual risk factors across years stratified by age group.The estimated population attributable fractions of each risk factor to its related diseases were divided into six groups by age: 25–34 years, 35–44 years, 45–54 years, 55–64 years, 65–74 years, and 75 years and older. Darker colors indicate younger age groups. Orange lines indicate ischemic heart disease, green lines stroke, yellow lines diabetes mellitus, and blue lines cancer.SSB, sugar-sweetened beverages.

• 

  Fig. 3 Comparison of population attributable fraction and total disease burden due to each risk factor by year.24RD_total indicates that the 24-hour recall data included all food items used for the analyses. 24RD_adj indicates that the 24-hour recall data included only food items that were also included in the FFQ for the analyses. Error bars represent standard deviations. Bar graphs represent the number of deaths attributable to each factor. Line graphs represent the PAF for each factor.FFQ, food frequency questionnaire; PAF, population attributable fraction.

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