The relationship between intake of nutrients and food groups and insulin resistance in Korean adults: Using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009)

SuJin Song; Hee-Young Paik; YoonJu Song

doi:10.4163/kjn.2013.46.1.61

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Song, Paik, and Song: The relationship between intake of nutrients and food groups and insulin resistance in Korean adults: Using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009)

Research Article

Korean Journal of Nutrition 2013; 46(1): 61-71.

Published online: 28 February 2013

DOI: https://doi.org/10.4163/kjn.2013.46.1.61

The relationship between intake of nutrients and food groups and insulin resistance in Korean adults: Using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009)

SuJin Song¹, Hee-Young Paik¹, YoonJu Song²

¹Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea.

²Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, Bucheon 420-743, Korea.

To whom correspondence should be addressed. (yjsong@catholic.ac.kr)

Received 31 August 2013 Revised 18 September 2012 Accepted 13 January 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The aim of this study was to examine the relationship between dietary variables and the prevalence of insulin resistance (IR) in middle-aged Korean adults using data from the 2007-2009 Korea National Health and Nutrition Examination Survey. Because IR is closely linked with metabolic syndrome, subjects were divided into three groups according to symptoms of metabolic syndrome: the 'Normal group' without any symptoms, the 'Risk group' with one or two symptoms, and the 'Metabolic syndrome (MetS) group' with three or more symptoms. Subjects between the ages of 30 and 65 years with no prior diagnosis or treatment for diabetes, hypertension, or dyslipidemia were selected. The number of subjects per group was as follows: 2,085 adults in the Normal group, 3,699 adults in the Risk group, and 1,160 adults in the MetS group. Metabolic syndrome was defined according to Adult Treatment Panel III criteria with modified waist circumference cutoff values (men ≥ 90 cm, women ≥ 85 cm). Subjects with HOMA-IR > 2.0 were classified as IR. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was calculated using the following formula: (fasting plasma glucose × fasting plasma insulin)/22.5. Nutrients and food groups intake were obtained from a single 24-hour recall. Subjects with IR in the Normal group were more obese and less physically active than non-IR subjects. In the MetS group, subjects with IR were more obese and had a lower prevalence of smoking and drinking, compared with non-IR subjects. Men with IR in the Normal group had a tendency to consume more oils and sugars than non-IR men, while women with IR in the same group had higher intake of carbohydrate, dietary glycemic index, and dietary glycemic load than non-IR women. Women with IR in the Risk group had lower energy intake but higher intake of oils and sugars than non-IR women. In the MetS group, consumption of fruits was higher in subjects with IR than in non-IR subjects. In conclusion, findings of this study suggest that dietary carbohydrate intake, including glycemic index, may be associated with IR in healthy women. Further research in prospective cohort studies in order to examine the effects of dietary carbohydrate on IR incidence will be necessary.

Keywords: HOMA-IR, insulin resistance, metabolic syndrome, carbohydrate intake, Korean adults

Figures and Tables

Fig. 1

Flow chart of subjects selection.

Fig. 2

Prevalence of insulin resistance (IR) by symptoms of metabolic syndrome. 1) Insulin resistance (IR) was defined as HOMA-IR > 2.0. Homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate measure of IR, was calculated by the following formula; [fasting plasma glucose (mmol/L) × fasting plasma insulin (µIU/mL)]/22.5. 2) Subjects without any symptoms of metabolic syndrome were defined as the normal group. 3) Subjects with 1 or 2 symptoms of metabolic syndrome were defined as the risk group. 4) Subjects with 3 or more symptoms of metabolic syndrome were defined as the MetS group.

Table 1

Comparison of general characteristics between Non-IR and IR¹⁾ subjects in the normal, risk, and MetS group

1) Insulin resistance (IR) was defined as HOMA-IR > 2.0. Homeostasis model assessment of insulin resistance (HOMAIR), a surrogate measure of IR, was calculated by the following formula; [fasting plasma glucose (mmol/L) × fasting plasma insulin (µIU/mL)]/22.5 2) Subjects without any symptoms of metabolic syndrome were defined as the normal group 3) Subjects with 1 or 2 symptoms of metabolic syndrome were defined as the risk group 4) Subjects with 3 or more symptoms of metabolic syndrome were defined as the metabolic syndrome (MetS) group 5) p-values were obtained from chi-square tests for categorical variables and from general linear model (GLM) for continuous variables after adjustment for sex (men or women), age (continuous), and BMI (continuous) 6) Current alcohol use was assigned "yes" if a subject drank a glass of alcohol or more per month over the previous year 7) Physical activity was assigned "yes" if a subject engaged in physical activity at high intensity more than 20 minutes at least 3 days or more per week over the previous week 8) Mean ± Standard error (all such values) were obtained from general linear model (GLM) after adjustment for sex (men or women), age (continuous), and BMI (continuous)

Table 2

Comparison of adjusted¹⁾ mean intake of nutrient and food groups between Non-IR and IR subjects in the normal group²⁾ (n = 2,085)

1) All values were adjusted for age (continuous), BMI (continuous), and energy intake (continuous) 2) Subjects without any symptoms of metabolic syndrome were defined as the normal group 3) IR was defined as HOMA-IR > 2.0. Homeostasis model assessment of insulin resistance (HOMAIR), a surrogate measure of IR, was calculated by the following formula; [fasting plasma glucose (mmol/L) × fasting plasma insulin (µIU/mL)]/22.5 4) p-values were obtained from general linear model (GLM) after adjustment for age (continuous), BMI (continuous), and energy intake (continuous) 5) Dietary glycemic index and dietary glycemic load were calculated using glucose as the reference food

Table 3

Comparison of adjusted¹⁾ mean intake of nutrient and food groups between Non-IR and IR subjects in the risk group²⁾ (n = 3,699)

1) All values were adjusted for age (continuous), BMI (continuous), and energy intake (continuous) 2) Subjects with 1 or 2 symptoms of metabolic syndrome were defined as the risk group 3) Insulin resistance (IR) was defined as HOMA-IR > 2.0. Homeostasis model assessment of insulin resistance (HOMAIR), a surrogate measure of IR, was calculated by the following formula; [fasting plasma glucose (mmol/L) × fasting plasma insulin (µIU/mL)]/22.5 4) p-values were obtained from general linear model (GLM) after adjustment for age (continuous), BMI (continuous), and energy intake (continuous) 5) Dietary glycemic index and dietary glycemic load were calculated using glucose as the reference food

Table 4

Comparison of adjusted¹⁾ mean intake of nutrient and food groups between Non-IR and IR subjects in the MetS group²⁾ (n = 1,160)

1) All values were adjusted for age (continuous), BMI (continuous), and energy intake (continuous) 2) Subjects with 3 or more symptoms of metabolic syndrome were defined as the MetS group 3) Insulin resistance (IR) was defined as HOMA-IR > 2.0. Homeostasis model assessment of insulin resistance (HOMAIR), a surrogate measure of IR, was calculated by the following formula; [fasting plasma glucose (mmol/L) × fasting plasma insulin (µIU/mL)]/22.5 4) p-values were obtained from general linear model (GLM) after adjustment for age (continuous), BMI (continuous), and energy intake (continuous) 5) Dietary glycemic index and dietary glycemic load were calculated using glucose as the reference food

Notes

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (2010-0004536).

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