Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Association between Korean Healthy Eating Index and abdominal obesity in Korean adults: the mediating effect of high-sensitivity C-reactive protein

한국 성인의 식생활평가지수 및 복부비만의 관계: 고감도 C-반응 단백질의 매개효과

  • Jina Yoon (Department of Food and Nutrition, Inha University) ;
  • Dayeon Shin (Department of Food and Nutrition, Inha University)
  • Received : 2023.11.16
  • Accepted : 2024.01.11
  • Published : 2024.02.28
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Abstract

Purpose: High-sensitivity C-reactive protein (hs-CRP) is primarily synthesized in the liver upon stimulation of infectious disease cytokines, such as interleukin-6 (IL-6), and is used as a biological marker of systemic inflammation. Previous studies reported that hs-CRP is closely related to diet and abdominal obesity. Furthermore, a dietary score favoring the consumption of vegetables, fruits, and whole grains over meat and saturated fat reduced inflammation and decreased the prevalence of obesity and abdominal obesity. Nevertheless, no studies have examined whether hs-CRP mediates the relationship between dietary scores and abdominal obesity, and research on the Korean Healthy Eating Index (KHEI) is lacking. Therefore, the present study examined the association between the KHEI and abdominal obesity and the mediating effect of hs-CRP. Methods: In total, 17,770 adults aged ≥19 years were included in the study using the Korea National Health and Nutrition Examination Survey 2015-2018. KHEI was developed to assess the overall diet quality of Korean adults. Multivariable linear and logistic regression analyses assessed the relationship between KHEI, hs-CRP, and abdominal obesity. The mediation analysis with the bootstrapping method was performed using SAS MACRO. Results: Among women, the odds ratio (OR) of abdominal obesity prevalence was lower in the highest KHEI compared to the lowest KHEI after adjusting for age, body mass index, educational level, income level, occupational status, marital status, household type, region type, alcohol consumption, smoking status, physical activity, total energy intake, and hsCRP (OR 0.744, 95% confidence interval 0.598-0.926). The association between KHEI and abdominal obesity was partially mediated via hs-CRP, and the mediated proportion was 68.7% in men and 38.1% in women. Conclusion: A substantial relationship was observed between the KHEI and abdominal obesity among females. Moreover, according to the KHEI, abdominal obesity may be mediated partially by hs-CRP.

본 연구는 국민건강영양조사 2015년부터 2018년도 자료를 활용하여 우리나라 만 19세 이상 성인의 KHEI와 복부비만의 관련성 및 hs-CRP의 매개 효과를 분석한 연구이다. 한국 성인 남성의 경우 허리둘레 90 cm 이상, 여성은 허리둘레 85 cm 이상인 경우에 복부비만군으로 정의하였다. 남성에서 복부비만군은 2,587명, 정상군은 5,007명이였고 여성의 복부비만군은 2,869명, 정상군은 7,307명이였다. KHEI, hs-CRP, 복부비만의 연관성 분석에서는 모든 공변량을 보정하였을 때 남성의 KHEI는 복부비만과 유의한 연관이 없었지만, hs-CRP와 음의 연관성이 있었다. 여성의 경우, 복부비만과 hs-CRP 모두 음의 연관성이 관찰되었다. 또한, 남성과 여성에서 hs-CRP 위험군 (> 1.0 mg/L) 이 hs-CRP 정상군 (≤ 1.0 mg/L)보다 복부비만 유병률이 유의하게 높았다. Bootstrapping을 이용한 매개효과 분석에서는 KHEI와 복부비만 관계에서 hs-CRP가 매개 효과를 가지는 것으로 나타났으며 공변량을 단계적으로 보정하였을때 증가하는 양상이 나타났다. 결론적으로, 본 연구 결과는 균형잡힌 식생활를 통한 높은 식사의 질이 hs-CRP에 영향을 미쳐 복부비만 예방에 중요한 영향을 미칠 수 있음을 시사한다.

Keywords

References

  1. Bae Y. Relationship among practicing healthy diet and metabolic syndrome indicators in adults - from the Korea National Health and Nutrition Examination Survey, 2013~2014. J Nutr Health 2016; 49(6): 459-470. 
  2. Yun S, Oh K. Development and status of Korean healthy eating index for adults based on the Korea national health and nutrition examination survey. Public Health Wkly Rep 2018; 11(52): 1764-1772.
  3. Huh E, Yun M, Sohn A. Waist to hip ratio by coronary artery disease diagnosis in adult women: based on 1st-9th community based cohort study. J Korea Contents Assoc 2023; 23(1): 723-731.
  4. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 2015; 373(14): 1307-1317.
  5. Jin Y. Relationship between abdominal obesity and cardiometabolic risk in schoolchildren: mediating effects of handgrip strength. Korean J Elementary Phys Educ 2023; 29(1): 69-82.
  6. Yoo JE, Han K, Jung JH, Hur YI, Kim YH, Kim ES, et al. Body mass index, waist circumference and cardiovascular diseases in transitional ages (40 and 66 years). J Cachexia Sarcopenia Muscle 2023; 14(1):369-381.
  7. Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation 2003; 108(13): 1541-1545.
  8. Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: a clinico epidemiological evidence summary. J Cardiovasc Dis Res 2011; 2(4): 199-205.
  9. Ansarimoghaddam A, Adineh HA, Zareban I, Iranpour S, HosseinZadeh A, Kh F. Prevalence of metabolic syndrome in Middle-East countries: meta-analysis of cross-sectional studies. Diabetes Metab Syndr 2018;12(2): 195-201.
  10. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377(1): 13-27.
  11. Mills CD. M1 and M2 macrophages: oracles of health and disease. Crit Rev Immunol 2012; 32(6): 463-488. 
  12. Chylikova J, Dvorackova J, Tauber Z, Kamarad V. M1/M2 macrophage polarization in human obese adipose tissue. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162(2): 79-82.
  13. Park CY, Yoo HJ. Inflammation and obesity. J Korean Soc Endocrinol 2004; 19(2): 97-108.
  14. Pereira SS, Alvarez-Leite JI. Low-grade inflammation, obesity, and diabetes. Curr Obes Rep 2014; 3(4):422-431.
  15. Sudhakar M, Silambanan S, Chandran AS, Prabhakaran AA, Ramakrishnan R. C-reactive protein (CRP) and leptin receptor in obesity: binding of monomeric CRP to leptin receptor. Front Immunol 2018; 9: 1167. 
  16. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111(12): 1805-1812. 
  17. Poggio R, Elorriaga N, Gutierrez L, Irazola V, Rubinstein A, Danaei G. Associations between dietary patterns and serum lipids, apo and C-reactive protein in an adult population: evidence from a multi-city cohort in South America. Br J Nutr 2017; 117(4): 548-555.
  18. Ebrahimi Z, Shojaeian Z, Amiri F, Esmaillzadeh A, Sadeghi O, Esteghamati A, et al. Association of major dietary patterns with advanced glycation end products and high-sensitivity C-reactive protein in people with type 1 diabetes mellitus. Nutr J 2023; 22(1): 37.
  19. Chatelan A, Castetbon K, Pasquier J, Allemann C, Zuber A, Camenzind-Frey E, et al. Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly. Int J Behav Nutr Phys Act 2018; 15(1): 115.
  20. Chang WC, Wahlqvist ML, Chang HY, Hsu CC, Lee MS, Wang WS, et al. A bean-free diet increases the risk of all-cause mortality among Taiwanese women: the role of the metabolic syndrome. Public Health Nutr 2012; 15(4): 663-672.
  21. Fock KM, Khoo J. Diet and exercise in management of obesity and overweight. J Gastroenterol Hepatol 2013; 28 Suppl 4: 59-63.
  22. Riseberg E, Tamez M, Tucker KL, Rodriguez Orengo JF, Mattei J. Associations between diet quality scores and central obesity among adults in Puerto Rico. J Hum Nutr Diet 2021; 34(6): 1014-1021.
  23. Li J, Qiu L, Ren Y, Wang W, Li M, Zhang J. The correlation of dietary inflammatory index with overweight, obesity and abdominal obesity: a meta-analysis. Chin Gen Pract 2023; 26(32): 4089-4097.
  24. Funtikova AN, Benitez-Arciniega AA, Gomez SF, Fito M, Elosua R, Schroder H. Mediterranean diet impact on changes in abdominal fat and 10-year incidence of abdominal obesity in a Spanish population. Br J Nutr 2014; 111(8): 1481-1487.
  25. Hodge AM, Karim MN, Hebert JR, Shivappa N, Milne RL, de Courten B. Diet scores and prediction of general and abdominal obesity in the Melbourne collaborative cohort study. Public Health Nutr 2021; 24(18): 6157-6168.
  26. Jung YE, Kang KY. Elevated hs-CRP level is associated with depression in younger adults: results from the Korean National Health and Nutrition Examination Survey (KNHANES 2016). Psychoneuroendocrinology 2019; 109: 104397.
  27. Lee YJ, Lee JH, Shin YH, Kim JK, Lee HR, Lee DC. Gender difference and determinants of C-reactive protein level in Korean adults. Clin Chem Lab Med 2009; 47(7): 863-869.
  28. Son DH, Song SA, Lee YJ. Association between C-reactive protein and relative handgrip strength in postmenopausal Korean women aged 45-80 years: a cross-sectional study. Clin Interv Aging 2022; 17: 971-978.
  29. Momiyama Y, Kawaguchi A, Kajiwara I, Ohmori R, Okada K, Saito I, et al. Prognostic value of plasma high-sensitivity C-reactive protein levels in Japanese patients with stable coronary artery disease: the Japan NCVC-Collaborative Inflammation Cohort (JNIC) Study. Atherosclerosis 2009; 207(1): 272-276. 
  30. Haam JH, Kim BT, Kim EM, Kwon H, Kang JH, Park JH, et al. Diagnosis of obesity: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023;32(2): 121-129.
  31. Konikowska K, Bombala W, Szuba A, Rozanska D, Regulska-Ilow B. Metabolic syndrome is associated with low diet quality assessed by the Healthy Eating Index-2015 (HEI-2015) and low concentrations of high-density lipoprotein cholesterol. Biomedicines 2022; 10(10): 2487.
  32. Shin S, Lee S. Relation between the total diet quality based on Korean Healthy Eating Index and the incidence of metabolic syndrome constituents and metabolic syndrome among a prospective cohort of Korean adults. Korean J Community Nutr 2020; 25(1): 61-70.
  33. Choi SA, Chung SS, Rho JO. Benefits of adherence to the Korea Healthy Eating Index on the risk factors and incidence of the metabolic syndrome: analysis of the 7th (2016-2018) Korea National Health and Nutrition Examination Survey. J Nutr Health 2022; 55(1): 120-140.
  34. Tutunchi H, Asghari Jafarabadi M, Hoojeghani S, Tabrizi S, Farrin N, Payahoo L, et al. General and abdominal obesity is related to socioeconomic status and food choices: a cross-sectional study. Nutr Food Sci 2020; 50(1): 61-73.
  35. Park KH, Zaichenko L, Peter P, Davis CR, Crowell JA, Mantzoros CS. Diet quality is associated with circulating C-reactive protein but not irisin levels in humans. Metabolism 2014; 63(2): 233-241.
  36. Vahid F, Jalili M, Rahmani W, Nasiri Z, Bohn T. A higher Healthy Eating Index is associated with decreased markers of inflammation and lower odds for being overweight/obese based on a case-control study. Nutrients 2022; 14(23): 5127.
  37. Ford ES, Mokdad AH, Liu S. Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988-1994. Eur J Clin Nutr 2005; 59(2): 278-283. 
  38. Marshall S, Petocz P, Duve E, Abbott K, Cassettari T, Blumfield M, et al. The effect of replacing refined grains with whole grains on cardiovascular risk factors: a systematic review and meta-analysis of randomized controlled trials with GRADE clinical recommendation. J Acad Nutr Diet 2020; 120(11): 1859-1883.e31.
  39. Jin R, Welsh JA, Le NA, Holzberg J, Sharma P, Martin DR, et al. Dietary fructose reduction improves markers of cardiovascular disease risk in Hispanic-American adolescents with NAFLD. Nutrients 2014;6(8): 3187-3201.
  40. Koebnick C, Black M, Wu J, Shu Y, Buchanan T, Xiang A. Abstract MP013: Diet high in sweets and sugarsweetened beverages but low in fruits and vegetables is associated with pro-inflammatory adipokine profile in Mexican Americans at risk for diabetes. Circulation 2017; 135(suppl_1): AMP013.
  41. Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology 2013; 57(6): 2525-2531. 
  42. Tiniakos DG, Vos MB, Brunt EM. Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol 2010; 5(1): 145-171.
  43. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 2006; 84(6): 1489-1497.
  44. Labonte ME, Couture P, Richard C, Desroches S, Lamarche B. Impact of dairy products on biomarkers of inflammation: a systematic review of randomized controlled nutritional intervention studies in overweight and obese adults. Am J Clin Nutr 2013; 97(4): 706-717.
  45. Nieman KM, Anderson BD, Cifelli CJ. The effects of dairy product and dairy protein intake on inflammation: a systematic review of the literature. J Am Coll Nutr 2021; 40(6): 571-582.
  46. Lavanya K, Ramamoorthi K, Acharya R, Madhyastha S. Association between overweight, obesity in relation to serum hs-CRP levels in adults 20-70 years. J Clin Diagn Res 2017; 11(12): OC32-OC35.
  47. Paepegaey AC, Genser L, Bouillot JL, Oppert JM, Clement K, Poitou C. High levels of CRP in morbid obesity: the central role of adipose tissue and lessons for clinical practice before and after bariatric surgery. Surg Obes Relat Dis 2015; 11(1): 148-154.
  48. Brooks GC, Blaha MJ, Blumenthal RS. Relation of C-reactive protein to abdominal adiposity. Am J Cardiol 2010; 106(1): 56-61.
  49. Song Y, Yang SK, Kim J, Lee DC. Association between C-reactive protein and metabolic syndrome in Korean adults. Korean J Fam Med 2019; 40(2): 116-123.