Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Relationship between fruit and fish intakes and cardiovascular disease risk factors in Korean women with type 2 diabetes mellitus: Based on the 4th and 5th Korea National Health and Nutrition Examination Surveys

한국인 제2형 당뇨병 여성환자에서 심혈관질환 위험인자와 과일류 및 생선류 섭취와의 관련성: 제4기와 제5기 국민건강영양조사 자료를 이용하여

  • Oh, Ji Soo (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Kim, Hyesook (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Kim, Ki Nam (Department of Food Science and Nutrition, Daejeon University) ;
  • Chang, Namsoo (Department of Nutritional Science and Food Management, Ewha Womans University)
  • 오지수 (이화여자대학교 식품영양학과) ;
  • 김혜숙 (이화여자대학교 식품영양학과) ;
  • 김기남 (대전대학교 식품영양학과) ;
  • 장남수 (이화여자대학교 식품영양학과)
  • Received : 2016.07.25
  • Accepted : 2016.09.20
  • Published : 2016.10.31
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Abstract

Purpose: The purpose of the study was to investigate the association between food intakes and cardiovascular disease (CVD) risk factors in Korean women with type 2 diabetes mellitus (T2DM). Methods: The data were collected from the 2007~2012 Korea National Health and Nutrition Examination Survey (KNHANES). In this study, subjects were divided into two groups, the normal fasting glucose (NFG) group (n = 7,738) and the T2DM group (n = 225). Dietary intake was derived from the nutrition survey, which was collected by trained dietitians using 24-hour dietary recall through the face-to-face interview method in the sample person's home. Results: After adjustment for confounding factors, mean fruit (p = 0.0265), fruit and vegetable without kimchi (p = 0.0295), and fish (p = 0.0112) intakes were significantly lower in the T2DM group than in the NFG group. In the multiple logistic regression analysis, odds ratio (OR) for risk of high systolic blood pressure (${\geq}140mmHg$) was lower in the over the median compared to under the median for fruit intakes (OR; 0.657, 95% CI; 0.523~0.824). The OR for the risk of hypertriglyceridemia was lower in the over the median compared to under the median for fruit and vegetable without kimchi (OR; 0.828, 95% CI; 0.7111~0.963) and fish (OR; 0.783, 95% CI; 0.673~0.910) intakes. Conclusion: These results show that intakes of fruits, fish, and fruits and vegetables without kimchi have beneficial effects on CVD in Korean women with T2DM.

본 연구는 2007~2012년 국민건강영양조사 자료를 이용하여 30세 이상 제2형 당뇨병 여성 환자의 과일류 및 생선류 등의 식품섭취량과 심혈관질환 위험인자와의 관련성을 분석하였다. T2DM군이 NFG군에 비해 과일류 및 생선류의 섭취량이 유의적으로 낮았고 이들의 섭취량이 증가할수록 고중성지방혈증의 위험성이 유의적으로 감소하는 것으로 나타났다. 또한, 과일류와 생선류 섭취량은 각각 중앙값 이상으로 많이 섭취한 군 (FF3)이 각각 중앙값 이하로 섭취한 군 (FF1)에의 비해 TG 농도가 높을 위험이 유의적으로 낮았다. 이러한 결과는 과일류에 김치를 제외한 채소류, 버섯류, 해조류의 섭취량을 포함시켜 분석했을 때에도 같은 결과를 나타내었다. 따라서, 한국인 제2형 당뇨병여성 환자의 과일류 및 생선류의 섭취가 심혈관질환에 긍적적인 영향을 미치는 것으로 보이며, 과일류나 생선류 중 어느 한 종류만 많이 섭취하기보다는 두 종류를 모두 적절히 섭취하는 것이 심혈관 질환 위험성을 낮추는데 효과적일 것으로 사료된다.

Keywords

References

  1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014; 103(2): 137-149. https://doi.org/10.1016/j.diabres.2013.11.002
  2. Park IB, Kim J, Kim DJ, Chung CH, Oh JY, Park SW, Lee J, Choi KM, Min KW, Park JH, Son HS, Ahn CW, Kim H, Lee S, Lee IB, Choi I, Baik SH; Task Force Team for Basic Statistical Study of Korean Diabetes Mellitus of Korean Diabetes Association. Diabetes epidemics in Korea: reappraise nationwide survey of diabetes "Diabetes in Korea 2007". Diabetes Metab J 2013; 37(4): 233-239. https://doi.org/10.4093/dmj.2013.37.4.233
  3. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 2001; 44 Suppl 2: S14-S21. https://doi.org/10.1007/PL00002934
  4. Haffner SM, Lehto S, Rönnemaa T, Pyorala 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. https://doi.org/10.1056/NEJM199807233390404
  5. Preis SR, Pencina MJ, Hwang SJ, D'Agostino RB Sr, Savage PJ, Levy D, Fox CS. Trends in cardiovascular disease risk factors in individuals with and without diabetes mellitus in the Framingham Heart Study. Circulation 2009; 120(3): 212-220. https://doi.org/10.1161/CIRCULATIONAHA.108.846519
  6. Rhee SY, Chon S, Kwon MK, Park IB, Ahn KJ, Kim IJ, Kim SH, Lee HW, Koh KS, Kim DM, Baik SH, Lee KW, Nam MS, Park YS, Woo JT, Kim YS. Prevalence of chronic complications in Korean patients with type 2 diabetes mellitus based on the Korean national diabetes program. Diabetes Metab J 2011; 35(5): 504-512. https://doi.org/10.4093/dmj.2011.35.5.504
  7. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: metaanalysis of 37 prospective cohort studies. BMJ 2006; 332(7533): 73-78. https://doi.org/10.1136/bmj.38678.389583.7C
  8. Mellen PB, Walsh TF, Herrington DM. Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis 2008; 18(4): 283-290. https://doi.org/10.1016/j.numecd.2006.12.008
  9. Ros E. Nuts and novel biomarkers of cardiovascular disease. Am J Clin Nutr 2009; 89(5): 1649S-1656S. https://doi.org/10.3945/ajcn.2009.26736R
  10. Katz DL, Davidhi A, Ma Y, Kavak Y, Bifulco L, Njike VY. Effects of walnuts on endothelial function in overweight adults with visceral obesity: a randomized, controlled, crossover trial. J Am Coll Nutr 2012; 31(6): 415-423. https://doi.org/10.1080/07315724.2012.10720468
  11. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006; 367(9507): 320-326. https://doi.org/10.1016/S0140-6736(06)68069-0
  12. Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a metaanalysis of cohort studies. J Nutr 2006; 136(10): 2588-2593. https://doi.org/10.1093/jn/136.10.2588
  13. Zhang J, Wang C, Li L, Man Q, Meng L, Song P, Froyland L, Du ZY. Dietary inclusion of salmon, herring and pompano as oily fish reduces CVD risk markers in dyslipidaemic middle-aged and elderly Chinese women. Br J Nutr 2012; 108(8): 1455-1465. https://doi.org/10.1017/S0007114511006866
  14. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Bluher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359(3): 229-241. https://doi.org/10.1056/NEJMoa0708681
  15. Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97(3): 505-516. https://doi.org/10.3945/ajcn.112.042457
  16. Tanaka S, Yoshimura Y, Kamada C, Tanaka S, Horikawa C, Okumura R, Ito H, Ohashi Y, Akanuma Y, Yamada N, Sone H; Japan Diabetes Complications Study Group. Intakes of dietary fiber, vegetables, and fruits and incidence of cardiovascular disease in Japanese patients with type 2 diabetes. Diabetes Care 2013; 36(12): 3916-3922. https://doi.org/10.2337/dc13-0654
  17. Knekt P, Ritz J, Pereira MA, O'Reilly EJ, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Rimm EB, Ascherio A. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr 2004; 80(6): 1508-1520. https://doi.org/10.1093/ajcn/80.6.1508
  18. Kushi LH, Folsom AR, Prineas RJ, Mink PJ, Wu Y, Bostick RM. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med 1996; 334(18): 1156-1162. https://doi.org/10.1056/NEJM199605023341803
  19. Hooper L, Kroon PA, Rimm EB, Cohn JS, Harvey I, Le Cornu KA, Ryder JJ, Hall WL, Cassidy A. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2008; 88(1): 38-50. https://doi.org/10.1093/ajcn/88.1.38
  20. Moore CS, Bryant SP, Mishra GD, Krebs JD, Browning LM, Miller GJ, Jebb SA. Oily fish reduces plasma triacylglycerols: a primary prevention study in overweight men and women. Nutrition 2006; 22(10): 1012-1024. https://doi.org/10.1016/j.nut.2006.07.005
  21. Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association. Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002; 106(21): 2747-2757. https://doi.org/10.1161/01.CIR.0000038493.65177.94
  22. Lee KL, Yoon EH, Lee HM, Hwang HS, Park HK. Relationship between food-frequency and glycated hemoglobin in Korean diabetics: using data from the 4th Korea National Health and Nutrition Examination Survey. Korean J Fam Med 2012; 33(5): 280-286. https://doi.org/10.4082/kjfm.2012.33.5.280
  23. Paek KW, Chun KH, Lee SJ. A factor of fasting blood glucose and dietary patterns in Korean adults using data from the 2007, 2008 and 2009 Korea National Health and Nutrition Examination Survey. J Prev Med Public Health 2011; 44(2): 93-100. https://doi.org/10.3961/jpmph.2011.44.2.93
  24. Yuan C, Lee HJ, Shin HJ, Stampfer MJ, Cho E. Fruit and vegetable consumption and hypertriglyceridemia: Korean National Health and Nutrition Examination Surveys (KNHANES) 2007-2009. Eur J Clin Nutr 2015; 69(11): 1193-1199. https://doi.org/10.1038/ejcn.2015.77
  25. 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. https://doi.org/10.1016/j.jada.2011.05.001
  26. Kim H, Park S, Yang H, Choi YJ, Huh KB, Chang N. Association between fish and shellfish, and omega-3 PUFAs intake and CVD risk factors in middle-aged female patients with type 2 diabetes. Nutr Res Pract 2015; 9(5): 496-502. https://doi.org/10.4162/nrp.2015.9.5.496
  27. Korean Diabetes Association, Committee of Clinical Practice Guideline. Treatment guideline for diabetes: 2013 update. Seoul: Korean Diabetes Association; 2013.
  28. 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.
  29. Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. Pediatrics 1988; 82(3): 309-318.
  30. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000; 106(4): 453-458. https://doi.org/10.1172/JCI10762
  31. John JH, Ziebland S, Yudkin P, Roe LS, Neil HA; Oxford Fruit and Vegetable Study Group. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 2002; 359(9322): 1969-1974. https://doi.org/10.1016/S0140-6736(02)98858-6
  32. Broekmans WM, Klöpping-Ketelaars WA, Kluft C, van den Berg H, Kok FJ, van Poppel G. Fruit and vegetables and cardiovascular risk profile: a diet controlled intervention study. Eur J Clin Nutr 2001; 55(8): 636-642. https://doi.org/10.1038/sj.ejcn.1601192
  33. Takahashi MM, de Oliveira EP, Moreto F, Portero-McLellan KC, Burini RC. Association of dyslipidemia with intakes of fruit and vegetables and the body fat content of adults clinically selected for a lifestyle modification program. Arch Latinoam Nutr 2010; 60(2): 148-154.
  34. Bazzano LA. Dietary intake of fruit and vegetables and risk of diabetes mellitus and cardiovascular diseases. Geneva: World Health Organization; 2005.
  35. Lattimer JM, Haub MD. Effects of dietary fiber and its components on metabolic health. Nutrients 2010; 2(12): 1266-1289. https://doi.org/10.3390/nu2121266
  36. Shearer GC, Savinova OV, Harris WS. Fish oil -- how does it reduce plasma triglycerides? Biochim Biophys Acta 2012; 1821(5): 843-851. https://doi.org/10.1016/j.bbalip.2011.10.011
  37. 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. https://doi.org/10.9799/ksfan.2013.26.4.909
  38. 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(2): 146-157. https://doi.org/10.4163/kjn.2009.42.2.146
  39. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention; 2010.

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