Journal List > J Nutr Health > v.50(4) > 1081507

Ahn, Jun, Kang, Shin, Wie, Baik, and Joung: Association between intake of antioxidant vitamins and metabolic syndrome risk among Korean adults∗

Abstract

Purpose

The purpose of this study was to examine the association between intake of antioxidant vitamins and prevalence of metabolic syndrome (MetS) among Korean adults. Methods: A total of 614 subjects aged 30∼60 years were recruited from those who received a medical checkup at a general hospital in South Korea between 2009 and 2012. Presence of MetS was determined based on criteria issued by the NCEP ATP III. Intakes of antioxidant vitamins (vitamin A, retinol, carotenoids, vitamin C, and vitamin E) were estimated by combining 3-day diet records with an antioxidant vitamin database for common Korean foods. We used multiple logistic regression analysis to assess the association between dietary intakes of antioxidant vitamins and MetS. Results: Men in the highest tertile for retinol (OR = 0.40, 95% CI = 0.23∼0.71, P for trend = 0.0009), carotenoids (OR = 0.57, 95% CI = 0.32∼1.00, P for trend = 0.0470), and vitamin E (OR = 0.52, 95% CI = 0.30∼0.92, P for trend = 0.0190) intakes had a lower likelihood of having Mets than those in the lowest tertile. The OR of high fasting blood glucose among men in the highest tertile for vitamin A (µg RE: OR = 0.55, 95% CI = 0.32∼0.97, P for trend = 0.0417, µg RAE: OR = 0.52, 95% CI = 0.29∼0.92, P for trend = 0.0211), carotenoids (OR = 0.41, 95% CI = 0.23∼0.73, P for trend = 0.0036), and vitamin E (OR = 0.47, 95% CI = 0.26∼0.82, P for trend = 0.0080) intakes was lower than those in the lowest tertile. In women, subjects in the highest tertile of retinol intakes had a lower prevalence of MetS than those in the lowest tertile group (OR = 0.55, 95% CI = 0.30∼0.98). The OR for abdominal obesity was lower among women with the highest vitamin A (µg RE) intakes compared to those in the lowest tertile (OR = 0.51, 95% CI = 0.28∼0.93, P for trend = 0.0293). Conclusion: These results suggest that dietary intakes of antioxidant vitamins might be associated with reduced risk of having MetS among Korean adults.

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Table 1.
General characteristics of study subjects
  Men Women P-value5)
  Total (n = 317) MetS3) (n = 185) Control (n = 132) P-value4) Total (n = 297) MetS3) (n = 121) Control (n = 176) P-value4)
Age (years)1) 45.4 ± 7.9 45.4 ± 7.6 45.4 ± 8.3 0.9794 48.2 ± 7.2 49.0 ± 7.2 47.7 ± 7.1 0.1156 < 0.0001
BMI (kg/m2)1) 26.4 ± 2.8 27.0 ± 2.9 25.6 ± 2.5 < 0.0001 24.9 ± 3.4 26.2 ± 2.9 24.0 ± 3.5 < 0.0001 < 0.0001
Smoking status (yes)2) 136 (42.9) 84 (45.4) 52 (39.4) 0.2864 8 (2.7) 1 (0.8) 7 (4.0) 0.0994 < 0.0001
Alcohol consumption (yes)2)6) 149 (47.0) 95 (51.4) 54 (40.9) 0.0663 30 (10.1) 13 (10.7) 17 (9.7) 0.7605 < 0.0001
Physical activity (yes)2)7) 71 (22.4) 43 (23.2) 28 (21.2) 0.6846 51 (17.2) 21 (17.4) 30 (17.1) 1.0000 0.1049
Metabolic syndrome risk factors2)                  
 Abdominal obesity8) 173 (54.6) 129 (69.7) 44 (33.3) < 0.0001 192 (64.7) 107 (88.4) 85 (48.3) < 0.0001 0.0111
 Hypertriglyceridemia9) 244 (77.0) 169 (91.4) 75 (56.8) < 0.0001 117 (39.4) 75 (62.0) 42 (23.9) < 0.0001 < 0.0001
 Low HDL-cholesterol10) 95 (30.0) 70 (37.8) 25 (18.9) 0.0003 129 (43.4) 80 (66.1) 49 (27.8) < 0.0001 0.0005
 Elevated blood pressure11) 218 (68.8) 150 (81.1) 68 (51.5) < 0.0001 147 (49.5) 87 (71.9) 60 (34.1) < 0.0001 < 0.0001
 High fasting blood glucose12) 155 (48.9) 116 (62.7) 39 (29.6) < 0.0001 78 (26.3) 52 (43.0) 26 (14.8) < 0.0001 < 0.0001

1) Values are mean ± SD.

2) Values are N (%).

3) MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria with a modified waist circumference cutoff for Asian populations provided by the International Diabetes Federation.

4) P-values for the difference between MetS group and control group, obtained by chi-square test for categorical variables and t-test for continuous variables.

5) P-values for the difference between total men and total women, obtained by chi-square test for categorical variables and t-test for continuous variables.

6) Subjects who drank more than twice a week.

7) Subjects engaged in a physical activity at least 5 days or more per week and lasting at least 30 min or more at moderate intensity or at least 3 days or more per week and lasting at least 20 min or more at vigorous intensity.

8) Waist circumference ≥ 90 cm (men) or ≥ 80 cm (women)

9) Fasting triglyceride ≥ 150 μg/dL

10) Fasting HDL-cholesterol < 40 μg/dL (men) or < 50 μg/dL (women)

11) Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg

12) Fasting blood glucose ≥ 100 μg/dL

Table 2.
Comparison of daily antioxidant vitamin intakes between MetS cases and controls
  Men Women P-value4)
  Total (n = 317) MetS2) (n = 185) Control (n = 132) P-value3) Total (n = 297) MetS2) (n = 121) Control (n = 176) P-value3)
Nutrient intake1)                  
Energy (kcal) 1,959.3 ± 507.6 1,967.5 ± 512.5 1,947.8 ± 502.4 0.7335 1,559.2 ± 475.7 1,561.5 ± 534.2 1,557.6 ± 432.5 0.9461 < 0.0001
Protein (g) 80.1 ± 27.0 79.3 ± 24.9 81.2 ± 29.8 0.5384 62.8 ± 24.8 62.2 ± 26.9 63.3 ± 23.3 0.7074 < 0.0001
Lipid (g) 49.4 ± 19.6 48.9 ± 18.7 50.1 ± 20.8 0.5760 40.2 ± 19.2 39.0 ± 20.1 41.0 ± 18.5 0.3855 < 0.0001
Carbohydrate (g) 273.9 ± 71.4 270.5 ± 69.2 278.8 ± 74.5 0.3061 236.9 ± 73.4 243.5 ± 81.0 232.3 ± 67.6 0.2144 < 0.0001
Vitamin A (μg RE) 712.5 ± 469.4 711.5 ± 552.9 714.0 ± 319.6 0.9586 670.7 ± 413.6 661.2 ± 407.3 677.2 ± 418.9 0.7435 0.2408
Vitamin A (μg RAE) 413.9 ± 259.2 408.5 ± 300.4 421.6 ± 187.6 0.6340 386.2 ± 237.5 380.3 ± 241.8 390.3 ± 235.0 0.7222 0.1685
Retinol (μg) 115.4 ± 122.0 105.5 ± 125.1 129.1 ± 116.5 0.0892 101.8 ± 129.7 99.4 ± 139.8 103.4 ± 122.7 0.7961 0.1822
Carotenoids (μg) 8,866.6 ± 7,971.8 8,628.7 ± 8,833.1 9,200.0 ± 6,596.3 0.5103 9,123.8 ± 7,863.2 8,939.5 ± 7,828.0 9,250.5 ± 7907.0 0.7383 0.6877
Vitamin C (mg) 78.1 ± 62.0 77.9 ± 67.9 78.4 ± 53.0 0.9430 84.5 ± 64.3 91.0 ± 69.6 80.1 ± 60.2 0.1529 0.2083
Vitamin E (mg α-TE) 6.5 ± 2.3 6.4 ± 2.4 6.6 ± 2.2 0.3098 5.6 ± 2.4 6.0 ± 2.8 5.4 ± 2.1 0.0649 < 0.0001
Nutrient density1)                  
Protein (g/1,000 kcal) 40.8 ± 8.4 40.3 ± 7.6 41.5 ± 9.5 0.2266 40.1 ± 9.3 39.7 ± 10.8 40.4 ± 8.2 0.5653 0.3235
Lipid (g/1,000 kcal) 24.9 ± 6.4 24.6 ± 6.4 25.4 ± 6.5 0.3380 25.2 ± 7.5 24.3 ± 6.9 25.9 ± 7.8 0.0699 0.6010
Carbohydrate (g/1,000 kcal) 142.3 ± 25.8 140.2 ± 25.8 145.4 ± 25.7 0.0768 153.6 ± 22.7 158.1 ± 23.1 150.6 ± 21.9 0.0049 < 0.0001
Vitamin A (μg RE/1,000 kcal) 363.8 ± 177.9 355.7 ± 182.7 375.2 ± 170.9 0.3372 438.7 ± 272.3 437.0 ± 274.6 439.9 ± 271.5 0.9304 < 0.0001
Vitamin A (μg RAE/1,000 kcal) 211.5 ± 101.1 204.7 ± 102.7 221.2 ± 98.2 0.1524 252.4 ± 156.6 252.0 ± 171.6 252.7 ± 146.0 0.9673 0.0002
Retinol (μg/1,000 kcal) 59.2 ± 59.6 53.6 ± 59.0 67.1 ± 59.7 0.0466 66.1 ± 90.4 66.9 ± 116.4 65.6 ± 67.3 0.9122 0.2661
Carotenoids (μg/1,000 kcal) 4,614.0 ± 4,252.7 4,432.3 ± 4,374.5 4,868.6 ± 4,078.7 0.3687 6,039.8 ± 5,225.1 5,993.8 ± 5,139.1 6,071.4 ± 5,297.8 0.9001 0.0002
Vitamin C (mg/1,000 kcal) 40.1 ± 28.9 39.4 ± 30.0 41.1 ± 27.4 0.6167 55.6 ± 39.3 60.4 ± 42.7 52.4 ± 36.5 0.0843 < 0.0001
Vitamin E (mg α-TE/1,000 kcal) 3.3 ± 1.0 3.3 ± 1.0 3.5 ± 1.0 0.0731 3.6 ± 1.2 3.8 ± 1.4 3.5 ± 1.1 0.0297 0.0018

1) Values are mean ± SD.

2) MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria with a modified waist circumference cutoff for Asian populations provided by the International Diabetes Federation.

1) P-values for the difference between MetS group and control group, obtained by t-test.

4) P-values for the difference between total men and total women, obtained by t-test.

Table 3.
Odds ratios and 95% CIs for metabolic syndrome risk factors according to tertiles of antioxidant vitamin intakes
Men Women P for trend9)
  T1 T2 T3 P for trend9) T1 T2 T3
Abdominal obesity1)7)                
Vitamin A (μg RE) 1.00 0.71 (0.41–1.25) 0.91 (0.52–1.59) 0.8309 1.00 0.69 (0.37–1.29) 0.51 (0.28–0.93) 0.0293
Vitamin A (μg RAE) 1.00 0.79 (0.45–1.38) 0.90 (0.51–1.58) 0.7467 1.00 0.70 (0.38–1.29) 0.59 (0.32–1.09) 0.0958
Retinol 1.00 1.10 (0.63–1.94) 0.77 (0.44–1.34) 0.3086 1.00 0.80 (0.44–1.45) 0.89 (0.49–1.63) 0.8010
Carotenoids 1.00 1.31 (0.75–2.28) 1.17 (0.66–2.05) 0.6681 1.00 0.79 (0.43–1.43) 0.78 (0.42–1.44) 0.4821
Vitamin C 1.00 1.71 (0.97–3.01) 1.61 (0.91–2.84) 0.1442 1.00 0.65 (0.35–1.18) 0.76 (0.41–1.42) 0.5108
Vitamin E 1.00 1.02 (0.59–1.77) 1.12 (0.64–1.97) 0.6834 1.00 1.03 (0.56–1.89) 0.80 (0.43–1.46) 0.4158
Hypertriglyceridemia2)8)                
Vitamin A (μg RE) 1.00 0.85 (0.44–1.63) 1.18 (0.59–2.36) 0.5852 1.00 0.64 (0.35–1.18) 0.94 (0.52–1.68) 0.8917
Vitamin A (μg RAE) 1.00 1.13 (0.58–2.18) 1.32 (0.67–2.62) 0.4242 1.00 0.52 (0.28–0.95) 0.93 (0.52–1.67) 0.9731
Retinol 1.00 1.06 (0.52–2.17) 0.62 (0.32–1.20) 0.1161 1.00 0.78 (0.44–1.41) 0.75 (0.42–1.36) 0.3891
Carotenoids 1.00 0.75 (0.39–1.43) 1.66 (0.80–3.42) 0.1217 1.00 1.30 (0.72–2.33) 0.92 (0.50–1.68) 0.6191
Vitamin C 1.00 0.96 (0.48–1.92) 0.77 (0.39–1.52) 0.4246 1.00 0.89 (0.49–1.59) 0.70 (0.39–1.28) 0.2459
Vitamin E 1.00 1.84 (0.93–3.65) 1.09 (0.57–2.10) 0.8757 1.00 0.77 (0.43–1.40) 1.10 (0.61–1.99) 0.6589
Low HDL-cholesterol3)8)                
Vitamin A (μg RE) 1.00 1.51 (0.81–2.83) 1.54 (0.83–2.88) 0.2099 1.00 0.94 (0.52–1.71) 1.39 (0.77–2.50) 0.2568
Vitamin A (μg RAE) 1.00 1.96 (1.03–3.71) 1.84 (0.97–3.49) 0.0879 1.00 1.25 (0.69–2.28) 1.33 (0.73–2.41) 0.3654
Retinol 1.00 1.03 (0.55–1.92) 1.20 (0.65–2.21) 0.5455 1.00 0.87 (0.48–1.57) 0.77 (0.43–1.39) 0.4001
Carotenoids 1.00 0.96 (0.52–1.79) 1.02 (0.55–1.89) 0.9266 1.00 1.40 (0.78–2.52) 1.12 (0.61–2.05) 0.8732
Vitamin C 1.00 1.91 (1.02–3.58) 1.36 (0.71–2.59) 0.5207 1.00 0.86 (0.47–1.55) 1.48 (0.81–2.69) 0.1426
Vitamin E 1.00 1.23 (0.67–2.25) 0.95 (0.50–1.77) 0.8058 1.00 1.11 (0.61–2.01) 1.73 (0.94–3.18) 0.0674
Elevated blood pressure4)8)                
Vitamin A (μg RE) 1.00 1.01 (0.55–1.86) 0.89 (0.49–1.62) 0.6831 1.00 1.29 (0.70–2.37) 1.07 (0.58–1.98) 0.8549
Vitamin A (μg RAE) 1.00 0.73 (0.40–1.35) 0.74 (0.40–1.36) 0.3596 1.00 1.13 (0.61–2.08) 0.88 (0.48–1.63) 0.6459
Retinol 1.00 0.94 (0.51–1.77) 0.58 (0.32–1.06) 0.0630 1.00 0.63 (0.34–1.15) 0.79 (0.43–1.44) 0.5804
Carotenoids 1.00 1.85 (1.00–3.44) 1.11 (0.62–2.01) 0.9284 1.00 1.18 (0.64–2.16) 1.05 (0.57–1.94) 0.9568
Vitamin C 1.00 0.94 (0.51–1.73) 1.00 (0.54–1.85) 0.9749 1.00 1.38 (0.75–2.53) 1.53 (0.83–2.84) 0.2014
Vitamin E 1.00 0.78 (0.42–1.44) 0.64 (0.35–1.18) 0.1562 1.00 2.14 (1.15–3.98) 1.45 (0.78–2.73) 0.3696
High fasting blood glucose5)8)                
Vitamin A (μg RE) 1.00 0.72 (0.41–1.25) 0.55 (0.32–0.97) 0.0417 1.00 0.76 (0.37–1.54) 1.06 (0.54–2.08) 0.8323
Vitamin A (μg RAE) 1.00 0.86 (0.49–1.49) 0.52 (0.29–0.92) 0.0211 1.00 0.77 (0.38–1.55) 0.96 (0.49–1.89) 0.9527
Retinol 1.00 1.08 (0.62–1.89) 0.72 (0.41–1.26) 0.2096 1.00 0.74 (0.37–1.47) 0.86 (0.43–1.71) 0.7412
Carotenoids 1.00 0.56 (0.32–0.99) 0.41 (0.23–0.73) 0.0036 1.00 1.14 (0.57–2.27) 0.87 (0.43–1.74) 0.6136
Vitamin C 1.00 0.68 (0.38–1.19) 0.61 (0.34–1.07) 0.1026 1.00 2.11 (1.02–4.35) 1.87 (0.91–3.84) 0.1578
Vitamin E 1.00 0.75 (0.43–1.31) 0.47 (0.26–0.82) 0.0080 1.00 0.67 (0.33–1.37) 1.10 (0.56–2.18) 0.6454
Metabolic syndrome6)7)                
Vitamin A (μg RE) 1.00 0.71 (0.41–1.26) 0.63 (0.36–1.10) 0.1168 1.00 0.72 (0.40–1.29) 0.86 (0.48–1.52) 0.6299
Vitamin A (μg RAE) 1.00 0.81 (0.46–1.42) 0.65 (0.37–1.14) 0.1314 1.00 0.76 (0.43–1.36) 0.68 (0.38–1.22) 0.2008
Retinol 1.00 0.90 (0.51–1.61) 0.40 (0.23–0.71) 0.0009 1.00 0.48 (0.27–0.86) 0.55 (0.30–0.98) 0.0824
Carotenoids 1.00 0.82 (0.47–1.44) 0.57 (0.32–1.00) 0.0470 1.00 1.30 (0.73–2.32) 0.98 (0.54–1.76) 0.7816
Vitamin C 1.00 1.12 (0.64–1.97) 0.87 (0.49–1.53) 0.5580 1.00 0.76 (0.42–1.36) 1.24 (0.69–2.21) 0.3459
Vitamin E 1.00 1.00 (0.56–1.76) 0.52 (0.30–0.92) 0.0190 1.00 1.16 (0.65–2.09) 1.70 (0.94–3.08) 0.0705

1) Waist circumference ≥ 90 cm (men) or ≥ 80 cm (women) 2) Fasting triglyceride ≥ 150 μg/dL 3) Fasting HDL-cholesterol < 40 μg/dL (men) or < 50 μg/dL (women) 4) Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg 5) Fasting blood glucose ≥ 100 μg/dL 6) MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria with a modified waist circumference cutoff for Asian populations provided by the International Diabetes Federation. 7) ORs, 95% CIs, and P for trends were adjusted for age, smoking status, alcohol consumption and physical activity. 8) ORs, 95% CIs, and P for trends were adjusted for age, smoking status, alcohol consumption, physical activity and BMI. 9) P-values were from generalized linear model analysis.

Table 4.
Comparison of dietary antioxidant vitamin intakes from each food group between MetS cases and controls
  Men
  Vitamin A (μg RE) Vitamin A (μg RAE) Retinol (μg) Carotenoids (μg) Vitamin C (mg) Vitamin E (mg α-TE)
  MetS2) Control MetS2) Control MetS2) Control MetS2) Control MetS2) Control MetS2) Control
Grains 80.2 ± 53.21)3) 91.4 ± 101.5 6.2 ± 13.6 13.7 ± 39.6 4.3 ± 12.1∗ 11.9 ± 36.4 141.2 ± 368.5 222.2 ± 998.4 0.1 ± 0.4∗ 0.4 ± 1.3 0.9 ± 0.6 1.0 ± 0.9
Vegetables 422.3 ± 375.0 422.9 ± 257.9 186.1 ± 221.3 189.8 ± 129.5 1.1 ± 2.3 1.5 ± 3.1 5,347.8 ± 7,734.7 4,829.6 ± 3,765.5 37.3 ± 20.8 35.5 ± 22.1 1.3 ± 0.8 1.3 ± 0.7
Fruits 86.6 ± 218.3 81.1 ± 100.9 31.7 ± 102.8 28.0 ± 41.4 0.0 ± 0.2 0.0 ± 0.1 1 1,490.3 ± 3,715.7∗ 2,523.4 ± 5,055.7 31.1 ± 62.2 32.6 ± 47.9 0.3 ± 0.5 0.3 ± 0.4
Eggs 110.6 ± 100.0 131.6 ± 113.7 28.2 ± 34.6 31.8 ± 29.1 27.8 ± 34.3 31.3 ± 28.7 111.2 ± 99.6 133.1 ± 115.5 0.0 0.0 1.0 ± 0.9 1.2 ± 1.1
Fishes & shellfishes 99.6 ± 156.7 95.8 ± 141.6 34.6 ± 109.0 33.0 ± 72.9 34.3 ± 108.9 32.6 ± 73.0 4.2 ± 28.4 4.3 ± 15.4 0.7 ± 1.1 0.5 ± 0.8 0.9 ± 0.9 0.8 ± 1.0
Milk &dairy products 19.2 ± 36.4∗∗ 39.6 ± 63.4 14.4 ± 27.5∗∗ 29.4 ± 48.0 14.2 ± 27.3∗∗ 28.9 ± 47.5 2.0 ± 5.2∗ 6.3 ± 19.0 0.1 ± 0.5 0.1 ± 0.7 0.1 ± 0.1∗∗∗ ∗ 0.1 ± 0.2
  Women
  Vitamin A (μg RE) Vitamin A (μg RAE) Retinol (μg) Carotenoids (μg) Vitamin C (mg) Vitamin E (mg α-TE)
  MetS2) Control MetS2) Control MetS2) Control MetS2) Control MetS2) Control MetS2) Control
Grains 80.3 ± 66.5 82.8 ± 81.0 9.5 ± 17.1 14.9 ± 44.0 6.9 ± 16.0 11.8 ± 39.7 254.8 ± 712.0 290.6 ± 762.8 0.5 ± 1.9 0.5 ± 2.1 0.9 ± 0.7 0.9 ± 0.6
Vegetables 403.6 ± 317.7 424.3 ± 321.8 176.9 ± 160.2 194.1 ± 169.5 1.2 ± 2.4 1.7 ± 4.2 5,210.1 ± 5,460.6 5,790.8 ± 5,768.5 31.5 ± 23.1 35.7 ± 28.4 1.2 ± 0.8 1.1 ± 0.7
Fruits 121.3 ± 185.9 97.9 ± 156.7 40.6 ± 78.0 32.3 ± 61.0 0.0 ± 0.0 0.0 ± 0.1 2,185.9 ± 5,632.1 2,002.3 ± 4,072.4 48.3 ± 60.7∗ 34.4 ± 46.1 0.5 ± 0.7 0.4 ± 0.7
Eggs 76.8 ± 76.5 70.2 ± 69.4 20.0 ± 24.7 18.4 ± 21.5 19.7 ± 24.5 18.1 ± 21.3 78.2 ± 77.8 71.2 ± 70.6 0.0 0.0 0.7 ± 0.7 0.6 ± 0.7
Fishes & shellfishes 85.9 ± 199.9 61.1 ± 79.9 32.8 ± 123.0 16.3 ± 28.7 32.7 ± 123.0 16.2 ± 28.6 1.6 ± 6.4 2.4 ± 7.5 0.3 ± 0.4∗ 0.4 ± 0.6 0.7 ± 1.0 0.6 ± 0.8
Milk & dairy products 31.8 ± 51.0 43.1 ± 65.3 23.9 ± 38.7 32.3 ± 48.7 23.6 ± 38.2 32.0 ± 48.4 3.5 ± 10.1 3.7 ± 7.1 0.0 ± 0.3 0.2 ± 1.4 0.1 ± 0.2∗ 0.1 ± 0.2

1) Values are mean ± SD. 2) MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria with a modified waist circumference cutoff for Asian populations provided by the International Diabetes Federation. 3) The value in the MetS group is significantly different from that of the control group at

p < 0.05,

∗∗ p < 0.01, and

∗∗∗ p < 0.001 by t-test.

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