2023 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association.

In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.

Individual Postprandial Glycemic Responses to Meal Types by Different Carbohydrate Levels and Their Associations with Glycemic Variability Using Continuous Glucose Monitoring.

This study aimed to investigate individual postprandial glycemic responses (PPGRs) to meal types with varying carbohydrate levels and examine their associations with 14-day glycemic variability using continuous glucose monitoring (CGM) in young adults. In a two-week intervention study with 34 participants connected to CGM, four meal types and glucose 75 g were tested. PPGRs were recorded for up to 2 h with a 15 min interval after meals. Data-driven cluster analysis was used to group individual PPGRs for each meal type, and correlation analysis was performed of 14-day glycemic variability and control with related factors. Participants had a mean age of 22.5 years, with 22.8% being male. Four meal types were chosen according to carbohydrate levels. The mean glucose excursion for all meal types, except the fruit bowl, exhibited a similar curve with attenuation. Individuals classified as high responders for each meal type exhibited sustained peak glucose levels for a longer duration compared to low responders, especially in meals with carbohydrate contents above 50%. A meal with 45% carbohydrate content showed no correlation with either 14-day glycemic variability or control. Understanding the glycemic response to carbohydrate-rich meals and adopting a meal-based approach when planning diets are crucial to improving glycemic variability and control.

High intakes of iodine among women during pregnancy and the postpartum period has no adverse effect on thyroid function.

PURPOSE: Given the high consumption of seaweed soup by pregnant and lactating Korean women, concerns have been raised about excessive iodine intake. We evaluated the effects of maternal iodine intake on maternal thyroid function and birth outcomes. We also evaluated iodine intake via seaweed soup during late pregnancy and the early postpartum period. METHODS: A total of 349 pregnant women of the Ideal Breast Milk cohort were recruited in late pregnancy, of whom 302 revisited after delivery. Three-day dietary records were assessed at each visit. Blood was collected for thyroid function test. Obstetrical and birth outcomes were obtained. RESULTS: The median dietary iodine intake was 459 µg/day (interquartile range [IQR] 326.5-647.4 µg/day) during pregnancy. Dietary iodine intake by quartile was not significantly associated with maternal thyroid status, or obstetrical or neonatal outcomes. However, the dietary iodine intake in the early postpartum period was 1759 µg/day (IQR 1026.7-2491.1 µg/day) because of a marked increase in seaweed soup consumption. Of all women, 25.8% consumed seaweed soup more than once over the 3 days of dietary records when pregnant, but the figure rose to 93.4% postpartum. Of postpartum women who consumed seaweed soup daily, the median dietary iodine intakes were 1355, 2394, and 3063 µg/day (soup at one, two, and three-or-four meals). CONCLUSIONS: In these iodine-replete pregnant women, dietary iodine intake during pregnancy showed no effect on maternal thyroid function or birth outcomes. However, iodine intake in the early postpartum period was markedly increased by the frequency of seaweed soup consumption.

Early Time-Restricted Eating Reduces Weight and Improves Glycemic Response in Young Adults: A Pre-Post Single-Arm Intervention Study.

INTRODUCTION: Time-restricted eating (TRE) has cardiometabolic health benefits by optimizing circadian rhythms. However, limited data are available on the effect of early TRE in young adults. The objective of this pre-post single-arm trial was to test the effect of TRE on body composition and cardiometabolic risk factors and to evaluate changes in meal and sleep timing by TRE among young adults with typically late bedtime. METHODS: This 4-week intervention was conducted in healthy young adults aged 18-39 years. Dietary records with time logs were collected before and during the intervention, and nutrient intake and meal timing were evaluated. Snack packages containing 20 g of protein per day were provided weekly. Body composition was measured weekly using bioelectrical impedance analysis. Blood samples were collected before and after the intervention, and cardiometabolic parameters were evaluated. RESULTS: Of the 36 screened participants, 34 completed the study (completion rate 94.4%). The average age was 23.4 ± 2.9 years with 64.7% female. The mean wake-up time and bedtime were 09:16 ± 01:26 and 01:51 ± 01:39 with average sleep duration of 7.4 ± 1.4 h. Body weight and fat mass, excluding muscle mass, were significantly reduced over 4 weeks compared to baseline only in the early TRE group starting before noon. The early TRE group also showed significantly reduced fasting glucose, fasting insulin, and serum triglyceride (TG) levels after 4 weeks. However, the late TRE group starting after noon showed no significant changes except a reduced TG level. The meal timing was changed by TRE, where the first meal was delayed and the last meal was shifted. Neither sleep duration nor timing was significantly changed by TRE. Energy intakes were not different, but protein intake increased from 19.2% to 22.6% due to snack packages during intervention. However, no significant correlation between nutrient intakes and body composition changes was found. There were no adverse events related to study participation. CONCLUSIONS: An early TRE regimen may be a feasible and effective strategy to manage body composition and cardiometabolic risk factors in young adults without altering the sleep-wake cycle.

Association of added sugar intake with all-cause and cardiovascular disease mortality: a systematic review of cohort studies.

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.

Low-Carbohydrate Diets in Korea: Why Does It Matter, and What Is Next?

In recent years, low-carbohydrate diets have become highly popular in Korea as a means to lose weight. People following this regime believe that fat and protein can be consumed in unlimited quantities, as long as carbohydrate intake is strictly restricted. However, low-carbohydrate diets are more complex than simply reducing carbohydrate intake. Meta-analyses of randomized controlled trials revealed that low-carbohydrate diets are at least as effective as low-fat diets in terms of weight loss, but their cardiovascular effects vary. Low-carbohydrate diets confer more beneficial effects on weight loss and lipid profiles such as triglycerides and high-density lipoprotein cholesterol but exhibited detrimental effects on lipid profiles such as total and low-density lipoprotein cholesterol. Korean diets are typically high in carbohydrates, where carbohydrate intake is in the range of 50%-80% of total energy. Within this range of carbohydrate intake, high carbohydrate intake was associated with an increased risk of elevated triglyceride and high-density lipoprotein cholesterol levels but with a reduced risk of elevated total and low-density lipoprotein-cholesterol levels. The optimal range of carbohydrate intake was depicted by a U-shaped relationship between carbohydrate intake and mortality, with 50%-60% of energy from carbohydrates having the lowest mortality risk. The distribution of macronutrients varied greatly according to age and sex groups in Korea. There is no single diet that can be recommended to all individuals, especially if focusing only on the quantity of macronutrients as opposed to their quality. The health benefits of low-carbohydrate or low-fat diets may depend on the source of protein and fat and the carbohydrate quality.

The Effect of Four Weeks Dietary Intervention with 8-Hour Time-Restricted Eating on Body Composition and Cardiometabolic Risk Factors in Young Adults.

Recently, intermittent fasting, also known as time-restricted eating (TRE), has become a popular diet trend. Compared to animal studies, there have been few studies and inconclusive findings investigating the effects of TRE in humans. In this study, we examined the effects of 8 h TRE on body weight and cardiometabolic risk factors in young adults who were mainly active at night. A total of 33 young adults completed the 8 h TRE for 4 weeks. Body composition was measured by bioelectrical impedance analysis at baseline and every 2 weeks, and blood samples were collected at baseline and week 4. Daily dietary records were logged throughout the intervention period. Participants experienced significant changes in body weight (-1.0 ± 1.4 kg), body mass index (-0.4 ± 0.5 kg/m2), and body fat (-0.4 ± 1.9%) after 4 weeks of TRE. When participants were divided into weight loss/gain groups based on their weight change in week 4, fat mass reduction was significantly higher in the weight loss group than in the weight gain group. Regarding cardiometabolic risk factors, levels of fasting insulin and insulin resistance improved in the weight loss group after intervention, but not in the weight gain group. All subjects showed late-shifted sleeping patterns, but no significant differences in sleep duration, sleep quality, or psychological measures between the two groups. When meal frequency and energy proportion were evaluated, the average meal frequency was 2.8 ± 0.5 and energy proportions of breakfast, lunch, dinner, and snacks were 4.5, 39.2, 37.6, and 18.5%, respectively; there were no significant differences between the two groups. However, the saturated fat intake at dinner was lower in the weight loss group (3.1 ± 3.2%, 6.0 ± 2.5% respectively). In conclusion, 8 h TRE can be applied as a lifestyle strategy to manage body weight and cardiometabolic risk factors among young adults with late chronotypes.

Evaluation of Iodine Status among Korean Patients with Papillary Thyroid Cancer Using Dietary and Urinary Iodine.

BACKGROUND: Concerns have been raised regarding thyroid disorders caused by excessive iodine in Koreans, who have iodine-rich diets. This study evaluated iodine status using dietary iodine intake and urinary iodine in papillary thyroid cancer (PTC) patients. METHODS: Dietary data of PTC patients were assessed using a 24-hour recall and food frequency questionnaire (FFQ), and urinary iodine concentrations (UICs) were also obtained. To compare the iodine status of PTC patients, Korean adults with or without thyroid disease from the Korea National Health and Nutrition Examination Survey, which had 24-hour recall data and urinary iodine measurements, were analyzed. RESULTS: The median daily iodine intake by 24-hour recall was 341.7 µg/day in PTC patients, similar to the levels of other Korean adults. Based on UICs, the prevalence of excessive iodine was 54.4% in PTC patients, which was similar to the prevalence among subjects with thyroid disease (55.4%) but slightly higher than that in subjects without thyroid disease (47.7%). Based on dietary iodine by 24-hour recall, the prevalence of excessive iodine intake was 7.2%, which was higher than that among subjects with (4.4%) or without (3.9%) thyroid disease. The dietary iodine intake based on 24-hour recall was closely correlated with the UIC (r=0.4826) in PTC patients, but dietary iodine by FFQ was not significantly correlated with either 24-hour recall or UIC-based dietary iodine. CONCLUSION: Excessive iodine intake was more common in PTC patients than in subjects without thyroid disease. Further longitudinal research is necessary to elucidate the role of dietary iodine in PTC.

Dietary Fiber and Its Source Are Associated with Cardiovascular Risk Factors in Korean Adults.

We examined the associations of dietary fiber and its source with cardiovascular risk factors in Korean adults. This cross-sectional study involved 16,792 adults from the 2013-2018 Korea National Health and Nutrition Examination Survey data. Dietary data were obtained using a 24 h recall method and used to evaluate intakes of total dietary fiber and its source and fruit consumption. Cardiovascular risk factors included obesity, abdominal obesity, metabolic syndrome, hypercholesterolemia, hypertension, and type 2 diabetes. Multiple logistic regression was used to examine the associations of dietary fiber and its source with cardiovascular risk factors by sex. Total fiber and fruit fiber intake in men were inversely associated with metabolic syndrome (Q5 vs. Q1: odds ratios (OR) = 0.69, 95% confidence intervals (CI) = 0.53-0.92 for total fiber; Q4 vs. Q1: OR = 0.76, 95% CI = 0.61-0.93 for fruit fiber). Among women, a higher intake of fruit fiber was related to a reduced prevalence of obesity (Q4 vs. Q1: OR = 0.85, p trend = 0.029) and abdominal obesity (Q4 vs. Q1: OR = 0.82, p trend = 0.026). Total fruit and whole fruit consumption was inversely associated with obesity, abdominal obesity, and metabolic syndrome in men and hypertension in women. The amount and sources of fiber are associated with metabolic diseases in Korean adults and should be considered in the context of overall dietary quality.

Association between Iron Intake and Diabetic Peripheral Neuropathy in Type 2 Diabetes: Significance of Iron Intake and the Ratio between Iron Intake and Polyunsaturated Fatty Acids Intake.

We aimed to investigate the association of iron and polyunsaturated fatty acid (PUFA) intake with diabetic peripheral neuropathy (DPN) in individuals with type 2 diabetes. This cross-sectional study included 147 individuals with type 2 diabetes. Dietary intake was assessed using three-day food records. DPN was diagnosed on the basis of a Michigan Neuropathy Screening Instrument-Physical Examination score ≥2.5. Adjusted for total energy intake, iron intake was significantly higher in individuals with DPN than in those without DPN (10.9 ± 4.0 mg vs. 9.9 ± 3.6 mg, p = 0.041). In addition, the iron/PUFA ratio was significantly higher in individuals with DPN (1.4 ± 0.8 vs. 1.1 ± 0.4, p = 0.005). Logistic regression analyses showed that iron intake (odds ratio (OR): 1.152; 95% confidence interval (CI): 1.012, 1.311) and iron/PUFA ratio (OR: 2.283; 95% CI: 1.066, 4.887) were associated with DPN after adjustment for total energy intake, sex, age, body mass index, systolic blood pressure, diabetes duration, estimated glomerular filtration rate, glycated hemoglobin, low-density lipoprotein cholesterol, and smoking. In conclusion, high dietary iron intake and an elevated iron/PUFA ratio were associated with the presence of DPN. The present study suggests the importance of the dietary pattern of iron and PUFA intake in individuals with type 2 diabetes.

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

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.

A moderate-carbohydrate diet with plant protein is inversely associated with cardiovascular risk factors: the Korea National Health and Nutrition Examination Survey 2013-2017.

BACKGROUND: Because a moderate-carbohydrate diet reportedly has minimal risks, the substitution of carbohydrate for protein has been emphasized. Few studies have explored the effect of moderate-carbohydrate diets with higher protein intake in Asians, who typically consume a high-carbohydrate low-fat diet. Therefore, this study evaluated the associations of moderate- versus high- carbohydrate diets with cardiovascular risk factors among Korean adults by protein source. METHODS: This study included 7965 adults (3196 men, 4769 women) aged ≥ 19 years who participated in the 2013-2017 Korea National Health and Nutrition Examination Survey. Dietary intake was assessed by a 24-h recall method and four types of diet were defined: a moderate-carbohydrate diet with plant protein (MCP) or animal protein (MCA) and a high-carbohydrate diet with plant protein (HCP) or animal protein (HCA). RESULTS: Compared with the MCP group, men in the other three groups had significantly higher odds ratios (ORs) for elevated total cholesterol, reduced high-density lipoprotein (HDL)-cholesterol, and metabolic syndrome. Among women, only the HCP group had an increased OR for reduced HDL-cholesterol, compared with the MCP group. Similar associations were observed in younger adults (19-49 years). In addition, younger adults in the MCA group exhibited higher ORs for elevated triglycerides in men and elevated total cholesterol in women, compared with those in the MCP group. CONCLUSIONS: A moderate-carbohydrate diet with a high intake of plant protein was inversely associated with cardiovascular risk factors, especially among younger Korean adults. Further intervention studies are required to confirm this relationship and develop the optimal diet for cardiovascular health in the Korean population.

Associations of Meal Timing and Frequency with Obesity and Metabolic Syndrome among Korean Adults.

Emerging studies indicate that meal timing is linked to cardiometabolic risks by deterioration of circadian rhythms, however limited evidence is available in humans. This large-scale cross-sectional study explored the associations of meal timing and frequency with obesity and metabolic syndrome among Korean adults. Meal timing was defined as nightly fasting duration and morning, evening, and night eating, and meal frequency was estimated as the number of daily eating episodes using a single-day 24-hour dietary recall method. Meal frequency was inversely associated with prevalence of abdominal obesity, elevated blood pressure, and elevated triglycerides in men only. Independent of the nightly fasting duration and eating episodes, morning eating was associated with a lower prevalence of metabolic syndrome (odds ratio (OR), 0.73; 95% confidence interval (CI), 0.57-0.93 for men and OR, 0.69; 95% CI, 0.54-0.89 for women) than no morning eating, whereas night eating was associated with a 48% higher prevalence of metabolic syndrome (OR, 1.48; 95% CI, 1.15-1.90) than no night eating in men only. Longer fasting duration and less sleep were associated with obesity and metabolic syndrome. These findings suggest that overall eating patterns, including energy distribution across the day, eating frequency, and sleep duration, rather than fasting duration alone, are related to cardiometabolic risks in free-living Korean adults.

Frequency of Consumption of Whole Fruit, Not Fruit Juice, Is Associated with Reduced Prevalence of Obesity in Korean Adults.

BACKGROUND: Fruit consumption is known to be beneficial to health. However, the health benefits of fruit juice are controversial due to its high sugar content. OBJECTIVES: To examine the associations of frequency of consumption of whole fruit and fruit juice with obesity and metabolic syndrome. DESIGN: This cross-sectional study used data from the 2012-2015 Korea National Health and Nutrition Examination Survey. PARTICIPANTS: A total of 10,460 adults (4,082 men and 6,378 women) aged 19 to 64 years were included in the study. MAIN OUTCOME MEASURES: Frequency of consumption of whole fruit and fruit juice was evaluated using a food frequency questionnaire, and dietary sugar intake was calculated using a 24-hour recall. Obesity and abdominal obesity were determined using body mass index and waist circumference, respectively. Metabolic syndrome was defined on the basis of the National Cholesterol Education Program Adult Treatment Panel III. STATISTICAL ANALYSES PERFORMED: Multiple logistic regression analysis was performed to examine the associations between frequency of whole fruit or fruit juice consumption and obesity and metabolic syndrome abnormalities. RESULTS: The percentage of participants who consumed whole fruit daily was 32.6%, whereas 52.3% consumed fruit juice rarely. The average intake of total sugars was 14.9% of total energy, which was within the recommend range (<20% of total energy) for Koreans. Consuming whole fruit ≥1 time/day was associated with reduced prevalence of obesity, abdominal obesity, and elevated blood pressure compared with consuming whole fruit ≤1 time/wk. However, frequency of fruit juice consumption showed no association with obesity, abdominal obesity, and metabolic syndrome. CONCLUSIONS: Frequency of whole fruit consumption was associated with reduced prevalence of obesity and metabolic syndrome abnormalities among Korean adults with average total sugar intake within the recommended range.

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.

AIMS: Few studies have focused on the relationship between long-term fat intake and type 2 diabetes mellitus (T2D) risk in Asia where fat intake is relatively lower than the Western countries. We examined association of dietary fat and carbohydrate intake with incidence of T2D among Korean adults. METHODS: Based on the data from the Korean Genome and Epidemiology Study, a total of 5595 adults aged 40-69 years without diabetes, cardiovascular diseases or any cancer at baseline were included. Dietary intake was measured by the validated semi-quantitative food frequency questionnaire. Cox proportional hazards regression analysis was used to calculate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: During a median follow-up of 138-months, 1010 cases of T2D were newly determined. The proportion of participants with fat intake less than 15% of total energy and with carbohydrate intake more than 65% of total energy was 59.0% and 88.9%, respectively. After adjusting for confounders, a very-low-fat intake was associated with an increased risk of T2D (RR of Quartile 1 vs Quartile 4, 1.74; 95% CI, 1.18-2.57; p for trend = 0.0058) in women. A very-high-carbohydrate intake was associated with an increased risk of T2D in men (RR of Quartile 4 vs Quartile 1, 1.54; 95% CI, 1.03-2.30; p for trend = 0.0124) and women (RR of Quartile 4 vs Quartile 1, 1.69; 95% CI, 1.08-2.67; p for trend = 0.0376). CONCLUSIONS: A very-low-fat or very-high-carbohydrate intake may increase the T2D risk and might be associated with lower intake of various nutrients and unbalanced macronutrient composition.

Three types of a high-carbohydrate diet are differently associated with cardiometabolic risk factors in Korean adults.

PURPOSE: Although a high-carbohydrate diet typically shows low-fat intake, the prevalence of metabolic abnormalities in Asian countries has increased. We evaluated three types of a high-carbohydrate diet and its association with cardiometabolic risk factors in the Korean adult population. METHODS: A total of 14,438 adults (5813 men and 8625 women) who participated in the 2008-2012 Korea National Health and Nutrition Examination Surveys were selected. Dietary data were obtained by a single 24-h recall method. High-carbohydrate diets were defined using three carbohydrate variables, including total carbohydrate intake, proportion of energy from carbohydrate, and white rice consumption as dietary exposures. Cardiometabolic risk factors included obesity, abdominal obesity, hypercholesterolemia, atherogenic dyslipidemia, impaired fasting glucose, and elevated blood pressure. A multivariate-adjusted logistic regression was performed to examine the associations between high-carbohydrate diets and cardiometabolic risk factors by sex. RESULTS: Three types of high-carbohydrate diets showed different energy intakes and food group consumption when individuals in the highest quintile of each type were compared. In men, intakes of total carbohydrate and white rice were inversely associated with obesity, impaired fasting glucose, and elevated blood pressure and proportion of energy from carbohydrate and white rice consumption were inversely related to hypercholesterolemia. In women, a high consumption of white rice was positively associated with impaired fasting glucose. All three types of high-carbohydrate diets were positively associated with the prevalence of atherogenic dyslipidemia in both sexes. CONCLUSIONS: Three types of high-carbohydrate diets show different associations with cardiometabolic risk factors except for unfavorable effects on atherogenic dyslipidemia.

High-Carbohydrate Diets and Food Patterns and Their Associations with Metabolic Disease in the Korean Population.

PURPOSE: Although an Asian diet is typically high in carbohydrate and low in fat, there has been a steady increase in the rate of cardiometabolic disease in Asian countries over the past decade. We evaluated food patterns of a high-carbohydrate diet and examined their associations with metabolic disease. MATERIALS AND METHODS: Using data from the 2013-2015 Korean National Health and Nutrition Examination Survey, we included a total of 13106 subjects aged 20 years or older in this study. Diet was divided into seven groups according to the percentage of energy from carbohydrates. Food patterns were evaluated as individual servings per food group. Multivariate logistic regression was conducted to estimate odds ratios (OR) for metabolic disease. RESULTS: The proportions of men and women exceeding the recommended range of carbohydrate intake were 58.0% and 60.0%, respectively. A higher carbohydrate diet was associated with intake of low energy and saturated fats, with more grains and fruit, but less meat, fish, egg, bean (MFEB), and dairy consumption. Carbohydrate intake decreased by 3.0-3.4% per serving of MFEB and milk. In men, the highest carbohydrate group showed an OR of 1.35 [95% confidence interval (CI), 0.91 to 1.99] for metabolic syndrome, although this failed to show statistical significance. In women, the highest carbohydrate group had an OR of 1.38 (95% CI, 1.06 to 1.80) for a reduced level of high-density lipoprotein cholesterol. CONCLUSION: This study suggests that a very-high-carbohydrate diet for the Korean population is attributable to lower consumption of MFEB and dairy products and is associated with several metabolic risk factors. The appropriate distribution of macronutrients for the prevention and management of metabolic disease should be explored.