Nutr Res Pract.  2020 Oct;14(5):519-531. 10.4162/nrp.2020.14.5.519.

Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults

• Ha K
• Song Y
• Kim HK

• KMID: 2506890
• DOI: http://doi.org/10.4162/nrp.2020.14.5.519

Abstract

BACKGROUND/OBJECTIVES
Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults.
SUBJECTS/METHODS
Based on data from the 2007–2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire.
RESULTS
Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01–1.14; OR for rural, 1.14; 95% CI, 1.05–1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76–0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67–0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74–0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02–1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants.
CONCLUSIONS
These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

Keyword

Health status disparity; carbohydrate; fruit; vegetables; obesity

Figure

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  Fig. 1 Distribution of prevalence of cardiometabolic risk factors and adherence to a healthy diet among regional types in Korea.1)Adherence to a healthy diet was defined as the fulfillment of 2 or more of the following criteria: 1) appropriate fat intake (15%–30% of energy), 2) sodium intake ≤ 2,000 mg/day, 3) fruit and vegetable intake ≥ 500 g/day, and 4) the use of nutrition labels in food selection.

Reference

1. World Health Organization. Health equity [Internet]. Geneva: World Health Organization;2019. cited 2019 December 17. Available from: https://www.who.int/topics/health_equity/en/.

2. World Health Organization. A Conceptual Framework for Action on the Social Determinants of Health. Geneva: World Health Organization;2010.

3. Rice N, Smith PC. Ethics and geographical equity in health care. J Med Ethics. 2001; 27:256–261. PMID: 11479357.

4. Institute of Medicine. Challenges and Successes in Reducing Health Disparities: Workshop Summary. Washington, D.C.: National Academies Press;2008.

5. Ministry of Health and Welfare. The National Health Plan 2020. Seoul: Ministry of Health and Welfare;2011.

6. Korean Society for Equity in Health. Regional Health Disparity Profiles. Seoul: Korean Society for Equity in Health;2018.

7. Lim S, Jang HC, Lee HK, Kimm KC, Park C, Cho NH. A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS). J Endocrinol Invest. 2006; 29:313–319. PMID: 16699297.

8. Lee HY, Won JC, Kang YJ, Yoon SH, Choi EO, Bae JY, Sung MH, Kim HR, Yang JH, Oh J, Lee YM, Park NH, Ko KS, Rhee BD. Type 2 diabetes in urban and rural districts in Korea: factors associated with prevalence difference. J Korean Med Sci. 2010; 25:1777–1783. PMID: 21165294.

9. Lee S, Shin Y, Kim Y. Risk of metabolic syndrome among middle-aged Koreans from rural and urban areas. Nutrients. 2018; 10:859.

10. Choi E, Cho HN, Seo DH, Park B, Park S, Cho J, Kim S, Park YR, Choi KS, Rhee Y. Socioeconomic inequalities in obesity among Korean women aged 19–79 years: the 2016 Korean Study of Women's Health-Related Issues. Epidemiol Health. 2019; 41:e2019005. PMID: 30917463.

11. Song YJ, Joung HJ, Paik HY. Socioeconomic, nutrient, and health risk factors associated with dietary patterns in adult populations from 2001 Korean National Health and Nutrition Survey. Korean J Nutr. 2005; 38:219–225.

12. Kang M, Joung H, Lim JH, Lee YS, Song YJ. Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr. 2011; 44:152–161.

13. Chung SJ, Han YS, Lee SI, Kang SH. Urban and rural differences in the prevalence of gender and age specific obesity and related health behaviors in Korea. J Korean Med Sci. 2005; 20:713–720. PMID: 16224141.

14. Lee Y, Choi Y, Park HR, Song KH, Lee KE, Yoo CH, Lim YS. Comparative analysis of dietary behavior and nutrient intake of elderly in urban and rural areas for development of “Village Lunch Table” program: based on 2014 Korea National Health and Nutrition Examination Survey data. J Nutr Health. 2017; 50:171–179.

15. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77. PMID: 24585853.

16. Ministry of Health and Welfare, Korea Health Promotion Foundation. The 4th Health Plan 2016–2020. Seoul: Korea Health Promotion Foundation;2015.

17. Ministry of Health and Welfare, The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2015. Seoul: The Korean Nutrition Society;2015.

18. World Health Organization, Regional Office for the Western Pacific. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Sydney: Health Communications Australia;2000.

19. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. American Heart Association. National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752. PMID: 16157765.

20. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80. PMID: 16735075.

21. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2). Sejong: Ministry of Health and Welfare;2018.

22. Li YC, Jiang B, Zhang M, Huang ZJ, Deng Q, Zhou MG, Zhao ZP, Wang YF, Wang LM. Vegetable and fruit consumption among Chinese adults and associated factors: a nationally representative study of 170,847 adults. Biomed Environ Sci. 2017; 30:863–874. PMID: 29335056.

23. Hong SA, Kim K, Kim MK. Trends in the inequality of fruit and vegetable consumption between education levels indicated by the Korea National Health and Nutrition Examination Surveys. Eur J Clin Nutr. 2012; 66:942–949. PMID: 22535135.

24. Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum N, Norat T, Greenwood DC, Riboli E, Vatten LJ, Tonstad S. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017; 46:1029–1056. PMID: 28338764.

25. Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, Dagenais G, Gupta R, Mohan V, Lear S, Bangdiwala SI, Schutte AE, Wentzel-Viljoen E, Avezum A, Altuntas Y, Yusoff K, Ismail N, Peer N, Chifamba J, Diaz R, Rahman O, Mohammadifard N, Lana F, Zatonska K, Wielgosz A, Yusufali A, Iqbal R, Lopez-Jaramillo P, Khatib R, Rosengren A, Kutty VR, Li W, Liu J, Liu X, Yin L, Teo K, Anand S, Yusuf S, Diaz R, Orlandini A, Linetsky B, Toscanelli S, Casaccia G, Cuneo JM, Rahman O, Yusuf R, Azad AK, Rabbani KA, Cherry HM, Mannan A, Hassan I, Talukdar AT, Tooheen RB, Khan MU, Sintaha M, Choudhury T, Haque R, Parvin S, Avezum A, Oliveira GB, Marcilio CS, Mattos AC, Teo K, Yusuf S, Dejesus J, Agapay D, Tongana T, Solano R, Kay I, Trottier S, Rimac J, Elsheikh W, Heldman L, Ramezani E, Dagenais G, Poirier P, Turbide G, Auger D, De Bluts AL, Proulx MC, Cayer M, Bonneville N, Lear S, Gasevic D, Corber E, de Jong V, Vukmirovich I, Wielgosz A, Fodor G, Pipe A, Shane A, Lanas F, Seron P, Martinez S, Valdebenito A, Oliveros M, Wei L, Lisheng L, Chunming C, Xingyu W, Wenhua Z, Hongye Z, Xuan J, Bo H, Yi S, Jian B, Xiuwen Z, Xiaohong C, Tao C, Hui C, Xiaohong C, Qing D, Xiaoru C, Qing D, Xinye H, Bo H, Xuan J, Jian L, Juan L, Xu L, Bing R, Yi S, Wei W, Yang W, Jun Y, Yi Z, Hongye Z, Xiuwen Z, Manlu Z, Fanghong L, Jianfang W, Yindong L, Yan H, Liangqing Z, Baoxia G, Xiaoyang L, Shiying Z, Rongwen B, Xiuzhen T, Dong L, Di C, Jianguo W, Yize X, Tianlu L, Peng Z, Changlin D, Ning L, Xiaolan M, Yuqing Y, Rensheng L, Minfan F, Jing H, Yu L, Xiaojie X, Qiang Z, Lopez-Jaramillo P, Lopez PA, Garcia R, Jurado LJ, Gómez-Arbeláez D, Arguello JF, Dueñas R, Silva S, Pradilla LP, Ramirez F, Molina DI, Cure-Cure C, Perez M, Hernandez E, Arcos E, Fernandez S, Narvaez C, Paez J, Sotomayor A, Garcia H, Sanchez G, David T, Rico A, Mony P, Vaz M, Bharathi AV, Swaminathan S, Kurpad KS, Jayachitra KG, Kumar N, Hospital HA, Mohan V, Deepa M, Parthiban K, Anitha M, Hemavathy S, Rahulashankiruthiyayan T, Anitha D, Sridevi K, Gupta R, Panwar RB, Mohan I, Rastogi P, Rastogi S, Bhargava R, Kumar R, Thakur JS, Patro B, Lakshmi PV, Mahajan R, Chaudary P, Kutty VR, Vijayakumar K, Ajayan K, Rajasree G, Renjini AR, Deepu A, Sandhya B, Asha S, Soumya HS, Kelishadi R, Bahonar A, Mohammadifard N, Heidari H, Yusoff K, Ismail TS, Ng KK, Devi A, Nasir NM, Yasin MM, Miskan M, Rahman EA, Arsad MK, Ariffin F, Razak SA, Majid FA, Bakar NA, Yacob MY, Zainon N, Salleh R, Ramli MK, Halim NA, Norlizan SR, Ghazali NM, Arshad MN, Razali R, Ali S, Othman HR, Hafar CW, Pit A, Danuri N, Basir F, Zahari SN, Abdullah H, Arippin MA, Zakaria NA, Noorhassim I, Hasni MJ, Azmi MT, Zaleha MI, Hazdi KY, Rizam AR, Sazman W, Azman A, Khatib R, Khammash U, Khatib A, Giacaman R, Iqbal R, Afridi A, Khawaja R, Raza A, Kazmi K, Zatonski W, Szuba A, Zatonska K, Ilow R, Ferus M, Regulska-Ilow B, Rózanska D, Wolyniec M, Alkamel , Ali M, Kruger MA, Voster HH, Schutte AE, Wentzel-Viljoen E, Eloff FC, de Ridder H, Moss H, Potgieter J, Roux AA, Watson M, de Wet G, Olckers A, Jerling JC, Pieters M, Hoekstra T, Puoane T, Igumbor E, Tsolekile L, Sanders D, Naidoo P, Steyn N, Peer N, Mayosi B, Rayner B, Lambert V, Levitt N, Kolbe-Alexander T, Ntyintyane L, Hughes G, Swart R, Fourie J, Muzigaba M, Xapa S, Gobile N, Ndayi K, Jwili B, Ndibaza K, Egbujie B, Rosengren A, Boström KB, Gustavsson A, Andreasson M, Snällman M, Wirdemann L, Oguz A, Imeryuz N, Altuntas Y, Gulec S, Temizhan A, Karsidag K, Calik KB, Akalin AA, Caklili OT, Keskinler MV, Erbakan AN, Yusufali AM, Almahmeed W, Swidan H, Darwish EA, Hashemi AR, Al-Khaja N, Muscat-Baron JM, Ahmed SH, Mamdouh TM, Darwish WM, Abdelmotagali MH, Awed SA, Movahedi GA, Hussain F, Al Shaibani H, Gharabou RI, Youssef DF, Nawati AZ, Salah ZA, Abdalla RF, Al Shuwaihi SM, Al Omairi MA, Cadigal OD, Alejandrino RS, Chifamba J, Gwaunza L, Terera G, Mahachi C, Murambiwa P, Machiweni T, Mapanga R. Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017; 390:2037–2049. PMID: 28864331.

26. Kim J, Kim J. Association between fruit and vegetable consumption and risk of hypertension in middle-aged and older Korean adults. J Acad Nutr Diet. 2018; 118:1438–1449.e5. PMID: 29113723.

27. Lim M, Kim J. Association between fruit and vegetable consumption and risk of metabolic syndrome determined using the Korean Genome and Epidemiology Study (KoGES). Eur J Nutr. 2020; 59:1667–1678. PMID: 31175411.

28. Kwon JH, Shim JE, Park MK, Paik HY. Evaluation of fruits and vegetables intake for prevention of chronic disease in Korean adults aged 30 years and over: using the third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005. Korean J Nutr. 2009; 42:146–157.

29. Song DY, Park JE, Shim JE, Lee JE. Trends in the major dish groups and food groups contributing to sodium intake in the Korea National Health and Nutrition Examination Survey 1998–2010. Korean J Nutr. 2013; 46:72–85.

30. Kim HJ, Lim SY, Lee JS, Park S, Shin A, Choi BY, Shimazu T, Inoue M, Tsugane S, Kim J. Fresh and pickled vegetable consumption and gastric cancer in Japanese and Korean populations: a meta-analysis of observational studies. Cancer Sci. 2010; 101:508–516. PMID: 19860848.

31. Ha K, Joung H, Song Y. Inadequate fat or carbohydrate intake was associated with an increased incidence of type 2 diabetes mellitus in Korean adults: a 12-year community-based prospective cohort study. Diabetes Res Clin Pract. 2019; 148:254–261. PMID: 30703429.

32. Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr. 2000; 71:44–53. PMID: 10617945.

33. Song Y, Joung H. A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis. 2012; 22:456–462. PMID: 21215606.

34. Yun S, Kim HJ, Oh K. Trends in energy intake among Korean adults, 1998–2015: Results from the Korea National Health and Nutrition Examination Survey. Nutr Res Pract. 2017; 11:147–154. PMID: 28386388.

35. Song S, Song Y. Three types of a high-carbohydrate diet are differently associated with cardiometabolic risk factors in Korean adults. Eur J Nutr. 2019; 58:3279–3289. PMID: 30519738.

36. Youn S, Woo HD, Cho YA, Shin A, Chang N, Kim J. Association between dietary carbohydrate, glycemic index, glycemic load, and the prevalence of obesity in Korean men and women. Nutr Res. 2012; 32:153–159. PMID: 22464801.

37. Choi A, Ha K, Joung H, Song Y. Frequency of consumption of whole fruit, not fruit juice, is associated with reduced prevalence of obesity in Korean adults. J Acad Nutr Diet. 2019; 119:1842–1851.e2. PMID: 31262696.

38. OECD. OECD Regions and Cities at a Glance 2018. Paris: OECD Publishing;2018.