Examination of the utility of skin carotenoid status in estimating dietary intakes of carotenoids and fruits and vegetables: A randomized, parallel-group, controlled feeding trial.

OBJECTIVE: Optical spectroscopy-measured skin carotenoid status (SCS) has been validated for estimating fruit and vegetable (F&V) intake; however, there is limited research addressing SCS kinetics in whole-diet interventions. The aim of this controlled feeding trial was to explore SCS's response to carotenoid intake changes via whole-diet intervention, evaluating its biomarker potential. METHODS: Eighty participants ages 20 to 49 y, without underlying diseases, were randomly allocated to the high-carotenoid group (HG; n = 40) or control group (CG; n = 40). The HG consumed a high-carotenoid diet (21 mg total carotenoids/2000 kcal), whereas the CG consumed a control diet (13.6 mg total carotenoids/2000 kcal) for 6 wk. Subsequently, skin and blood carotenoid concentrations were tracked without intervention for 4 wk. SCS was measured weekly via resonance Raman spectroscopy, and serum carotenoid concentrations were analyzed biweekly using high-performance liquid chromatography. Baseline carotenoid and F&V intakes were assessed via a 3-d diet record. The kinetics of SCS and serum carotenoid concentrations were analyzed using a weighted generalized estimating equation. Pearson's correlation analyses were used to examine baseline correlations between SCS and dietary carotenoid and F&V intakes, as well as serum carotenoid concentrations. RESULTS: During the intervention, the HG showed a faster and greater SCS increase than the CG (difference in slope per week = 8.87 AU, Pinteraction <0.001). Baseline SCS had positive correlations with total carotenoid intake (r = 0.45), total F&V intake (r = 0.49), and total serum carotenoid concentration (r = 0.79; P < 0.001 for all). CONCLUSION: These results suggest that SCS is a valid biomarker for monitoring changes in carotenoid intake through whole diet, which supports using SCS for assessing carotenoid-rich F&V intake.

Association of Carbohydrate and Fat Intake with Prevalence of Metabolic Syndrome Can Be Modified by Physical Activity and Physical Environment in Ecuadorian Adults: The ENSANUT-ECU Study.

The associations of lifestyle and environment with metabolic syndrome (MetS) and cardiovascular disease have recently resulted in increased attention in research. This study aimed to examine interactive associations among carbohydrate and fat intake, physical environment (i.e., elevation and humidity), lifestyle, and MetS among Ecuadorian adults. We used data from the Ecuador National Health and Nutrition Survey 2012 (ENSANUT-ECU), with a total of 6023 participants aged 20 to 60 years included in this study. Logistic regression was used to determine the association of status of carbohydrate and fat intake, low-carbohydrate high-fat diet (LCHF) and medium-carbohydrate and fat (MCF) diet with MetS, where the high-carbohydrate low-fat (HCLF) diet was used as a reference. Women with LCHF and MCF diets showed lower prevalence of increased blood pressure (OR = 0.34, 95% CI: 0.19-0.59; OR = 0.50, 95% CI: 0.32-0.79, respectively). Women with MCF diet also showed lower prevalence of elevated fasting glucose (OR = 0.58, 95% CI: 0.37-0.91). Moreover, there were negative associations between MetS and reduced HDL cholesterol in women with MCF diet residing in low relative humidity (OR = 0.66, 95% CI: 0.45-0.98) and in women with LCHF diet residing at a high elevation (OR = 0.37, 95% CI: 0.16-0.86). Additionally, higher prevalence of increased waist circumference was observed in men with both MFC and LCHF diets who were physically inactive (OR = 1.89, 95% CI: 1.12-3.20; OR = 2.34, 95% CI: 1.19-4.60, respectively) and residing in high relative humidity (OR = 1.90, 95% CI: 1.08-2.89; OR = 2.63, 95% CI: 1.32-5.28, respectively). Our findings suggest that LCHF intake is associated with lower blood pressure, while MCF intake is associated with lower blood pressure and fasting glucose in Ecuadorian women. Furthermore, the associations of carbohydrate and fat intake with prevalence of MetS can be modified by physical activity, relative humidity, and elevation. The obtained outcomes may provide useful information for health programs focusing on dietary intake and lifestyle according to physical environment of the population to promote health and prevent metabolic diseases.

Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients.

We aimed to investigate gender differences in ischemic heart disease (IHD) according to healthcare utilization and medication adherence among newly treated Korean hypertensive adults. The National Sample Cohort version 2.0 of the National Health Insurance Service was used for analysis. Newly treated hypertensive patients ≥ 20 years and without IHD in 2002 were selected from a population that underwent health examination during 2003-2006. Of those patients, 11,942 men and 11,193 women were analyzed and followed up for 10 years. We determined the association between IHD and healthcare utilization and medication adherence using the Cox proportional hazards model. Hypertensive women patients had a lower risk of IHD than men patients (hazard ratio [HR] = 0.93, 95% confidence interval [CI] 0.88-1.00). The IHD risk was increased in patients who visited healthcare providers > 12 times/person-year (HR = 2.97, 95% CI 2.79-3.17), paid high out-of-pocket expense/person-year (HR = 1.55, 95% CI 1.41-1.69), and had medication nonadherence (HR = 1.67, 95% CI 1.58-1.77). However, the risk was decreased in patients who used both urban and rural areas (HR 0.75, 95% CI 0.67-0.84) and mixed types of providers (HR = 0.93, CI 0.88-0.99). The risk of IHD was significantly different between men and women only in the visiting frequency to healthcare providers (men, HR = 3.21, 95% CI 2.93-3.52; women, HR = 2.78, 95% CI 2.53-3.04, p for interaction = 0.0188). In summary, the risk of IHD was similar according to healthcare utilization and medication adherence between men and women, except visiting frequency to healthcare providers.

Inverse association of improved adherence to dietary guidelines with metabolic syndrome: the Seoul Metabolic Syndrome Management program.

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of "yes" responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

Associations of Relative Humidity and Lifestyles with Metabolic Syndrome among the Ecuadorian Adult Population: Ecuador National Health and Nutrition Survey (ENSANUT-ECU) 2012.

The effects of the physical environment on metabolic syndrome (MetS) are still largely unexplained. This study aimed to analyze the associations of relative humidity of residence, lifestyles, and MetS among Ecuadorian adults. Data from 6024 people aged 20 to 60 years were obtained from an Ecuador national population-based health and nutrition survey (i.e., ENSANUT-ECU, 2012) and the mean annual relative humidity (%) from the Ecuador National Institute for Meteorology and Hydrology (2012). Odds ratio (OR) with 95% confidence intervals (CI) for MetS according to groups of relative humidity were calculated using multiple logistic regression. Living in high relative humidity (>80%) increased ORs of reduced high-density lipoprotein (HDL) cholesterol (1.25; 95 % CI, 1.06-1.56) and MetS (OR = 1.20; 95 % CI,1.01-1.42) in women. Furthermore, physically active men living in high relative humidity showed lower OR of elevated triglycerides (0.56; 95 % CI,0.37-0.85) while menopausal women living in high relative humidity showed increased ORs of MetS (5.42; 95 % CI, 1.92-15.27), elevated blood pressure (3.10; 95 % CI, 1.15-8.35), and increased waist circumference (OR = 1.34; 95 % CI, 1.09-1.63). Our results show that residence in high relative humidity and menopausal status increase ORs of MetS and its components in Ecuadorian women; however, physical activity significantly reduces the OR of elevated triglycerides in men. The obtained findings may help make public health policies regarding environmental humidity management, nutritional education, menopausal care, and physical activity promotion to prevent the onset of MetS among Ecuadorian adults.

Consumption of Korean Foods with High Flavonoid Contents Reduces the Likelihood of Having Elevated C-Reactive Protein Levels: Data from the 2015-2017 Korea National Health and Nutrition Examination Survey.

This study was conducted to investigate associations between C-reactive protein (CRP) levels and Korean food (KF) consumption and flavonoid intake from the 2015-2017 Korea National Health and Nutrition Examination Survey. A total of 6025 men and 8184 women (≥19 years) who completed a 24-h dietary recall and health examination were analyzed. The individual KF consumption rate was defined as the proportion of KF of total food consumed and categorized into tertiles. Odds ratios (ORs) for elevated CRP levels (>3.0 mg/L) according to KF consumption rate and flavonoid intake/dietary total antioxidant capacity (TAC) (

Effects of lifestyle-related factors on ischemic heart disease according to body mass index and fasting blood glucose levels in Korean adults.

OBJECTIVE: To investigate the effects of lifestyle-related factors on ischemic heart disease (IHD) according to body mass index (BMI) and fasting blood glucose (FBG) levels among Korean adults. METHODS: A total of 119,929 men and 89,669 women (from National Sample Cohort version 2.0, National Health Insurance Service) aged ≥20 years who were examined during 2003-2006 and had no preexisting type 2 diabetes or circulatory diseases were followed until December 2015 to confirm IHD incident cases. Data on lifestyle-related factors (BMI, FBG, diet, smoking, alcohol consumption, and physical activity) were collected at baseline. Lifestyle-related risk factors were defined as mainly vegetable/mainly meat diet, former/current smoking, alcohol consumption ≥3 times/week, and no physical activity. Associations between these factors and IHD were examined using Cox proportional hazards regression models. RESULTS: High BMI (≥25 kg/m2), high FBG (≥100 mg/dL), mainly meat diet, and former/current smoking were associated with increased risk for IHD. Alcohol consumption ≤twice/week and physical activity ≤twice/week were associated with lower risk of IHD. With increased lifestyle-related risk factors, the risk of IHD also increased in women (hazard ratio [HR] = 3.21, 95% confidence interval [CI] 2.18-4.73) and men (HR = 1.66, 95% CI 1.48-1.85). This increase was larger in women, with a significant sex interaction (p = 0.0001). Significant interactions between BMI and alcohol consumption (p = 0.0002) and between BMI and physical activity (p = 0.0063) were observed. Interactions were seen between FBG level and meal type in both BMI<25 kg/m2 (p = 0.0106) and BMI≥25 kg/m2 (p = 0.0281) and between FBG level and alcohol consumption in BMI ≥25 kg/m2 (p = 0.0118). CONCLUSIONS: The impact of lifestyle-related factors on IHD was more pronounced in women than in men and may be modified by BMI and FBG level among Korean adults. This might be taken into account when planning individual interventions to reduce IHD risk.