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Chu, Lee, Cho, and Park: Relationships between obesity, blood and urinary compositions, and dietary habits and depressed mood in Koreans at the age of 40, a life transition period*
Original Article

J Nutr Health 2012;46(3):261-275.

Published online: 10 January 2012

DOI: https://doi.org/10.4163/jnh.2012.46.3.261

Relationships between obesity, blood and urinary compositions, and dietary habits and depressed mood in Koreans at the age of 40, a life transition period*

Ji Eun Chu1, 2, Ji Min Lee3, Han-Ik Cho2, 4, Jung Yoon Park1, 3, §

1 Department of Clinical Health Sciences, Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 120–750, Korea

2 Korea Association of Health Promotion, Seoul 157–705, Korea

3 Department of Food and Nutrition, College of Health Science, Ewha Womans University, Seoul 120–750, Korea

4 College of Medicine, Seoul National University, Seoul 151–742, Korea

§ To whom correspondence should be addressed. E-mail: park.yoonjung@ewha.ac.kr

* This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2012018819). The authors acknowledge Mr. Cheong-Ha Yoon, Korea Association of Health Promotion, for the valuable suggestions.

Received 26 March 2013       Revised 11 April 2013       Accepted 30 April 2013

Copyright © 2013 The Korean Nutrition Society

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

This study was designed to investigate the relationships of depressed mood with obesity, blood and urinary compositions, and dietary habits in Koreans at the age of 40, a critical transition to the middle adulthood stage. A total of 27,684 people who have taken the Life Transition Period Health Examination at the Korea Association of Health Promotion in 2011 were divided into two groups; the depressed mood group (DG) and the non-depressed group (NG) according to results of the primary questionnaire for mental health. The results were analyzed using the health examination criteria of the National Health Insurance Corporation. Women and medicaid recipients showed higher incidence of depressed mood than men and health insurance subscribers. People with underweight in BMI or abdominal obesity showed correlation with depressed mood, while there was no significant relationship with metabolic syndrome. Regarding blood and urinary compositions, DG was related to a higher level of hemoglobin and lower levels of HDL-cholesterol and triglyceride, although the relationships diminished after adjustment for other confounder effects. According to dietary habits, more people in DG were categorized as a group for “Needs Much Improvement”, and the odds ratio of the depressed mood showed a significant increase. Significant difference regarding the frequency of food items such as milk products, animal proteins, Kimchi, and fruits was observed between DG and NG. In addition, a higher portion of subjects in DG did not consume regular meals and various kinds of food. In conclusion, the depressed mood of 40 year-old adults was significantly related to underweight, higher waist measurement, and undesirable dietary habits. Results of our study can be applicable as a basic resource for development of effective nutrition counseling and education programs for improvement of mental health promotion during the critical transition to the middle adulthood stage. (J Nutr Health 2013; 46(3): 261 – 275)

Keywords: depressed mood, dietary habits, bmi, abdominal obesity.

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Fig. 1.
Flowchart of sample for analysis. 1) MDA: Mini Dietary Assesment.
jnh-46-261f1.tif
Table 1.
Social environment factor, existing disease, family history, obesity and metabolic syndrome assessment of non-depressed and depressed mood group
Variables Category Non-depressed Depressed mood Total p value
n % n % n %
Sex Male 11,485 95.7 520 4.3 12,005 100.0 ＜ 0.001***
Female 14,418 92.0 1,261 8.0 15,679 100.0
Total 25,903 93.6 1,781 6.4 27,684 100.0
National health care system Health insurance subscribers 25,372 93.7 1,701 6.3 27,073 100.0 ＜ 0.001***
Medicaid recipients 531 86.9 80 13.1 611 100.0
Total 25,903 93.6 1,781 6.4 27,684 100.0
Areas Gangwon-do 1,098 95.4 53 4.6 1,151 100.0 ＜ 0.001***
Gyeonggi-do 1,723 92.2 145 7.8 1,868 100.0
Gyeongsangnam-do 1,777 95.9 76 4.1 1,853 100.0
Gyeongsangbuk-do 1,375 94.6 78 5.4 1,453 100.0
Daegu 1,384 94.7 78 5.3 1,462 100.0
Busan 3,464 94.9 188 5.1 3,652 100.0
Seoul 4,292 90.5 449 9.5 4,741 100.0
Ulsan 1,220 95.8 53 4.2 1,273 100.0
Incheon 1,319 92.6 105 7.4 1,424 100.0
Jeollanam-do 1,762 94.5 102 5.5 1,864 100.0
Jeollabuk-do 1,964 94.7 109 5.3 2,073 100.0
Jeju 1,531 93.9 99 6.1 1,630 100.0
Chungcheongnam-do 1,997 91.9 177 8.1 2,174 100.0
Chungcheongbuk-do 997 93.5 69 6.5 1,066 100.0
Total 25,903 93.6 1,781 6.4 27,684 100.0
Existing disease 1) No 23,156 93.8 1,538 6.2 24,694 100.0 ＜ 0.001***
Yes 2,710 91.9 240 8.1 2,950 100.0
Total 25,866 93.6 1,778 6.4 27,644 100.0
Family history 2) No 13,813 94.4 813 5.6 14,626 100.0 ＜ 0.001***
Yes 12,052 92.6 965 7.4 13,017 100.0
Total 25,865 93.6 1,778 6.4 27,643 100.0
BMI 3) Underweight 801 3.1 83 4.7 884 3.2 ＜ 0.001***
Normal 11,139 43.0 796 44.7 11,935 43.2
Overweight 5,832 22.5 374 21.0 6,206 22.4
Obesity 8,106 31.3 528 29.6 8,634 31.2
Total 25,878 100.0 1,781 100.0 27,659 100.0
Waist circumference 4) Normal 21,965 84.9 1,492 83.8 23,457 84.8 ＜ 0.001**
Abdominal obesity) 3,908 15.1 289 16.2 4,197 15.2
Total 25,873 100.0 1,781 100.0 27,654 100.0
Metabolic syndrome 5) No 24,415 94.4 1,692 95.0 26,107 94.5 ＜ 0.301
Yes 1,442 5.6 89 5.0 1,531 5.5
Total 25,857 100.0 1,781 100.0 27,638 100.0

1) Have been diagnosed by a medical doctor with any of the following diseases; brain stroke/paralysis, heart disease, high blood pressure, diabetes, dyslipidemia, tuberculosis, others such as cancer

2) Has anyone in their family died from or gotten the any following diseases; brain stroke/paralysis, heart disease, high blood pressure, diabetes, dyslipidemia, tuberculosis, others such as cancer

3) BMI: Body Mass Index, Underweight: ＜ 18.5 kg/m2, Normal: 18.5–22.9 kg/m2, Overweight: 23–24.9 kg/m2, Obesity: ＜ 25 kg/m2

4) Abdominal obesity: ≥ 90 cm for men, ≥ 85 cm for women

5) Metabolic Syndrome: modified NCEP-ATP III and waist circumference: ≥ 90 cm for men, ≥ 85 cm for women

** p ＜ 0.01

*** p ＜ 0.001 by chi-square

Table 2.
Odds ratio (OR) and 95% confidence interval (CI) of depressed mood according to BMI, waist circumference, and metabolic syndrome
    Model 11) Model 22) Model 33)
OR 95% CI p value OR 95% CI p value OR 95% CI p value
BMI 4) Underweight 1.45 (1.14–1.84) 0.002** 1.37 (1.08–1.74) 0.009** 1.36 (1.07–1.73) 0.012**
Normal 1     1     1    
Overweight 0.90 (0.79–1.02) 0.095 1.04 (0.91–1.18) 0.604 1.05 (0.92–1.20) 0.449
Obesity 0.91 (0.81–1.02) 0.912 1.09 (0.97–1.23) 0.147 1.10 (0.98–1.24) 0.105
Waist Normal 1     1     1    
Circumference 5) Abdominal obesity 1.09 (0.96–1.24) 0.202 1.21 (1.06–1.38) 0.006** 1.18 (1.02–1.35) 0.019*
Metabolic syndrome 6) No 1     1     1    
Yes 1.02 (0.85–1.23) 0.813 1.05 (0.87–1.26) 0.640 0.99 (0.82–1.20) 0.910

1) Model 1: Unadjusted

2) Model 2: adjusted for sex, national Health care system group, existing disease, family history

3) Mode 3: adjusted for the same set of variables as in Model 2 plus alcohol drinking, smoking, physical activity

4) BMI: Body Mass Index, Underweight: < 18.5 kg/m2, Normal: 18.5–22.9 kg/m2, Overweight: 23–24.9 kg/m2, Obesity: ＞ 25 kg/m2

5) Abdominal obesity: ≥90 cm for men, ≥ 85 cm for women

6) Metabolic Syndrome: modified NCEP-ATP III and waist circumference: ≥ 90 cm for men,≥ 85 cm for women

OR: Odds ratio, CI: confidence interval

* p ＜ 0.05

** p ＜ 0.01 by multiple logistic regression

Table 3.
Blood pressure, blood biochemical analysis, and urinalysis results of non-depressed and depressed mood group
Variables Category Non-depressed Depressed mood Total p value
n % n % n %
Blood pressure Normal A1) 16,960 65.5 1,195 67.1 18,155 65.6 ＜ 0.239
Normal B2) 7,799 30.1 521 29.3 8,320 30.1
Abnormal 3) 1,121 4.3 65 3.6 1,186 4.3
Total 25,880 100.0 1,781 100.0 27,661 100.0
Fasting glucose Normal A 21,034 81.3 1,484 83.3 22,518 81.4 ＜ 0.077
Normal B 4,091 15.8 246 13.8 4,337 15.7
Abnormal 760 2.9 51 2.9 811 2.9
Total 25,885 100.0 1,781 100.0 27,666 100.0
Total cholesterol Normal A 18,108 70.0 1,281 71.9 19,389 70.1 ＜ 0.113
Normal B 6,083 23.5 380 21.3 6,463 23.4
Abnormal 1,694 6.5 120 6.7 1,814 6.6
Total 25,885 100.0 1,781 100.0 27,666 100.0
HDL cholesterol Normal A 10,204 39.4 788 44.2 10,992 39.7 ＜ 0.001***
Normal B 15,287 59.1 970 54.5 16,257 58.8
Abnormal 394 1.5 23 1.3 417 1.5
Total 25,885 100.0 1,781 100.0 27,666 100.0
Triglycerides Normal A 20,506 79.2 1,475 82.8 21,981 79.5 ＜ 0.001**
Normal B 2,536 9.8 133 7.5 2,669 9.6
Abnormal 2,843 11.0 173 9.7 3,016 10.9
Total 25,885 100.0 1,781 100.0 27,666 100.0
LDL cholesterol Normal A 20,395 79.9 1,436 81.8 21,831 80.0 ＜ 0.085
Normal B 3,982 15.6 239 13.6 4,221 15.5
Abnormal 1,148 4.5 80 4.6 1,228 4.5
Total 25,525 100.0 1,755 100.0 27,280 100.0
Hemoglobin Normal A 1) 21,654 90.1 1,473 88.3 23,127 90.0 ＜ 0.003**
Normal B 2) 1,783 7.4 131 7.9 1,914 7.4
Abnormal 3) 598 2.5 64 3.8 662 2.6
Total 24,035 100.0 1,668 100.0 25,703 100.0
AST Normal A 24,863 96.1 1,708 95.9 26,571 96.0 ＜ 0.254
Normal B 505 2.0 29 1.6 534 1.9
Abnormal 517 2.0 44 2.5 561 2.0
Total 25,885 100.0 1,781 100.0 27,666 100.0
ALT Normal A 22,122 85.5 1,551 87.1 23,673 85.6 ＜ 0.152
Normal B 1,624 6.3 103 5.8 1,727 6.2
Abnormal 2,139 8.3 127 7.1 2,266 8.2
Total 25,885 100.0 1,781 100.0 27,666 100.0
Creatinine Normal 25,850 99.9 1,781 100.0 27,631 99.9 ＜-4)5)
Abnormal 35 0.1 0 0.0 35 0.1
Total 25,885 100.0 1,781 100.0 27,666 100.0
r-GTP Normal A 21,994 86.0 1,517 86.2 23,511 86.0 ＜ 0.947
Normal B 1,071 4.2 71 4.0 1,142 4.2
Abnormal 2,517 9.8 172 9.8 2,689 9.8
Total 25,582 100.0 1,760 100.0 27,342 100.0
Proteinuria Normal A 25,441 98.8 1,747 98.6 27,188 98.8 ＜-4)
Normal B 4 0.0 1 0.1 5 0.0
Abnormal 304 1.2 24 1.4 328 1.2
Total 25,749 100.0 1,772 100.0 27,521 100.0

1) Normal A: good

2) Normal B: normal but have the result of boundary value so need prevention of disease

3) Abnormal; 1), 2), and 3) are categorized by the Health Examination Criteria from KNIH (amended on 2010. 12. 20)

4) More than 20% of cells have expected values less than 5. Chi-Square may not be a valid test

5) The cell has an expected value less than 1. Chi-Square may not be a valid test

** p ＜ 0.01 by chi-square

Table 4.
Odds ratio (OR) and 95% confidence interval (CI) of depressed mood according to blood pressure, blood biochemical analysis, and urinalysis results
    Model 11) Model 22) Model 33)
OR 95% CI p value OR 95% CI p value OR 95% CI p value
Blood pressure Normal A 4) 1     1     1    
Normal B 5) 0.95 (0.85–1.05) ＜ 0.326 1.10 ( (0.99–1.23) 0.090 1.08 (0.97–1.21) 0.172
Abnormal 6) 0.82 (0.64–1.06) ＜ 0.137 0.97 ( (0.75–1.26) 0.832 0.90 (0.69–1.18) 0.443
Fasting glucose Normal A 1     1     1    
Normal B 0.85 (0.74–0.98) ＜ 0.024* 0.94 ( (0.82–1.09) 0.408 0.90 (0.78–1.04) 0.166
Abnormal 0.95 (0.71–1.27) ＜ 0.733 1.00 ( (0.74–1.34) 0.980 0.88 (0.65–1.19) 0.400
Total cholesterol Normal A 1     1     1    
Normal B 0.88 (0.79–0.99) ＜ 0.039* 0.98 ( (0.87–1.11) 0.778 0.96 (0.86–1.08) 0.464
Abnormal 1.00 (0.83–1.22) ＜ 0.989 1.21 ( (0.99–1.47) 0.061 1.14 (0.93–1.39) 0.205
HDL cholesterol Normal A 1     1     1    
Normal B 0.82 (0.75–0.91) ＜ 0.001*** 0.95 ( (0.86–1.05) 0.304 0.96 (0.87–1.07) 0.458
Abnormal 0.76 (0.50–1.16) ＜ 0.199 0.98 ( (0.64–1.51) 0.939 0.95 (0.61–1.47) 0.807
Triglycerides Normal A 1     1     1    
Normal B 0.73 (0.61–0.88) ＜ 0.001** 0.923( (0.77–1.11) 0.406 0.85 (0.71–1.03) 0.107
Abnormal 0.85 (0.72–1.00) ＜ 0.043* 1.15 ( (0.97–1.64) 0.119 0.99 (0.83–1.19) 0.947
LDL cholesterol Normal A 1     1     1    
Normal B 0.85 (0.74–0.98) ＜ 0.027* 0.94 ( (0.81–1.08) 0.371 0.94 (0.81–1.09) 0.397
Abnormal 0.99 (0.78–1.25) ＜ 0.931 1.15 ( (0.91–1.45) 0.258 1.12 (0.88–1.43) 0.344

1) Model 1: Unadjusted

2) Model 2: adjusted for sex, national Health care system group, existing disease, family history

3) Model 3: adjusted for the same set of variables as in Model 2 plus BMI, alcohol drinking, smoking, physical activity

4) Normal A: good

5) Normal B: normal but have the result of boundary value so need prevention of disease

6) Abnormal; 4), 5), and 6) are categorized by the Health Examination Criteria from KNIH (amended on 2010. 12. 20) OR: Odds Ration, CI: Confidence Interval

* p ＜ 0.05

** p ＜ 0.01

*** p ＜ 0.001 by multiple logistic regression

Table 5.
Evaluation of dietary patterns of non-depressed and depressed mood group
Component of MDA Category Non-depressed Depressed mood Total p value
n % n % n %
Total score of dietary patterns 1) ＜ 28 points 574 5.7 85 11.4 659 6.1 ＜ 0.001***
28–38 points 5,177 51.4 420 56.3 5,597 51.7
＞ 39 points 4,329 42.9 241 32.3 4,570 42.2
Total 10,080 100.0 746 100.0 10,826 100.0
I drink dairy products such as milk, soybean milk, or others more than one glass (over 200 mL) every day. Always 1,564 15.5 91 12.1 1,655 15.3 ＜ 0.007**
Usually 3,766 37.3 265 35.4 4,031 37.2
Seldom 4,767 47.2 393 52.5 5,160 47.6
Total 10,097 100.0 749 100.0 10,846 100.0
I eat food like meat, fish, egg, bean, or tofu more 3 times a day. Always 1,487 14.7 95 12.7 1,582 14.6 ＜ 0.001***
Usually 6,522 64.6 440 58.7 6,962 64.2
Seldom 2,090 20.7 214 28.6 2,304 21.2
Total 10,099 100.0 749 100.0 10,848 100.0
I include vegetables (other than Kimchi) in every meal. Always 3,583 35.5 242 32.3 3,825 35.3 ＜ 0.001***
Usually 5,478 54.2 388 51.8 5,866 54.1
Seldom 1,038 10.3 119 15.9 1,157 10.7
Total 10,099 100.0 749 100.0 10,848 100.0
I eat fruit (more than 1 serving) or drink fruit juice every day. Always 2,628 26.0 170 22.7 2,798 25.8 ＜ 0.001***
Usually 4,797 47.5 330 44.1 5,127 47.3
Seldom 2,673 26.5 249 33.2 2,922 26.9
Total 10,098 100.0 749 100.0 10,847 100.0
How often do you have fried or stir-fried food? Over 4 times a week 518 5.1 53 7.1 571 5.3 ＜ 0.019**
2–3 times a week 4,968 49.2 338 45.2 5,306 48.9
Less than 1 time a week 4,610 45.7 356 47.7 4,966 45.8
Total 10,096 100.0 747 100.0 10,843 100.0
How aften do you have food containing cholesterol such as bacon, egg yolk, squid, etc? Over 4 times a week 358 3.5 35 4.7 393 3.6 ＜ 0.268
2–3 times a week 3,802 37.7 275 36.8 4,077 37.6
Less than 1 time a week 5,937 58.8 437 58.5 6,374 58.8
Total 10,097 100.0 747 100.0 10,844 100.0
I eat one of these, ice cream, cake, snack or drinks (coffee, cola, sweet drinks) every day. Always 3,575 35.4 276 36.8 3,851 35.5 ＜ 0.538
Usually 2,643 26.2 183 24.4 2,826 26.1
Seldom 3,879 38.4 290 38.7 4,169 38.4
Total 10,097 100.0 749 100.0 10,846 100.0
I eat salted fish, soy sauce seasoned dried vegetables, other salty foods. Always 309 3.1 29 3.9 338 3.1 ＜ 0.218
Usually 2,766 27.4 219 29.2 2,985 27.5
Seldom 7,023 69.5 501 66.9 7,524 69.4
Total 10,098 100.0 749 100.0 10,847 100.0
I have three regular meals a day. Always 3,904 38.7 181 24.2 4,085 37.7 ＜ 0.001***
Usually 4,488 44.4 338 45.1 4,826 44.5
Seldom 1,706 16.9 230 30.7 1,936 17.8
Total 10,098 100.0 749 100.0 10,847 100.0
Do you eat at least one of each of the food groups such as dairy products, meat or fish, fruits, vegetables, grain every day? 5 types 1,041 10.3 77 10.3 1,118 10.3 ＜ 0.001***
4 types 5,340 52.9 340 45.5 5,680 52.4
Less than 3 types 3,713 36.8 331 44.3 4,044 37.3
Total 10,094 100.0 748 100.0 10,842 100.0
How often do you eat out? (without in a workplace) Over 5 times a week 498 4.9 46 6.1 544 5.0 ＜ 0.323
2–4 times a week 3,603 35.7 268 35.8 3,871 35.7
Less than 1 a week 5,989 59.4 434 58.0 6,423 59.3
Total 10,090 100.0 748 100.0 10,838 100.0

1) Total score of Dietary Patterns ＜ 28 points: Needs much improvement, 28–38 points: Normal, ＞ 39 points: Can prevent disease and maintain health

** p ＜ 0.01

*** p ＜ 0.001 by chi-square

Table 6.
Odds ratio (OR) and 95% confidence interval (CI) of depressed mood according to dietary patterns
    Model 11) Model 22) Model 33)
OR 95% CI p value OR 95% CI p value OR 95% CI p value
Total score of diet habits 4) ＜ 28 points 1.83 (1.42–2.34) ＜ 0.001*** 1.96 (1.52–2.52) ＜ 0.001*** 1.75 (1.36–2.26) ＜ 0.001***
28–38 points 1     1     1    
＞ 39 points 0.70 (0.58–0.81) ＜ 0.001*** 0.66 (0.56–0.78) ＜ 0.001*** 0.70 (0.59–0.82) ＜ 0.001***
I drink dairy products such as milk, soybean milk, or others more than one glass (over 200 mL) every day. Always 1     1     1    
Usually 1.21 (0.95–1.55) ＜ 0.129 1.21 (0.95–1.55) ＜ 0.122 1.18 (0.92–1.51) ＜ 1.188
Seldom 1.42 (1.12–1.79) ＜ 0.004** 1.42 (1.13–1.80) ＜ 0.003** 1.38 (1.09–1.75) ＜ 0.008**
I eat food like meat, fish, egg, bean, or tofu more 3 times a day. Always 1     1     1    
Usually 1.06 (0.84–1.33) ＜ 0.641 1.08 (0.86–1.36) ＜ 0.517 1.08 (0.85–1.36) ＜ 0.536
Seldom 1.60 (1.25–2.06) ＜ 0.001*** 1.60 (1.24–2.05) ＜ 0.001*** 1.57 (1.22–2.02) ＜ 0.001**
I include vegetables (other than Kimchi) in every meal. Always 1     1     1    
Usually 1.05 (0.89–1.24) ＜ 0.575 1.09 (0.93–1.29) ＜ 0.298 1.06 (0.89–1.25) ＜ 0.529
Seldom 1.70 (1.35–2.14) ＜ 0.001*** 1.77 (1.40–2.23) ＜ 0.001*** 1.66 (1.31–2.10) ＜ 0.001***
I eat fruit (more than 1 serving) or drink fruit juice every day. Always 1     1     1    
Usually 1.06 (0.88–1.29) ＜ 0.528 1.13 (0.93–1.37) ＜ 0.218 1.09 (0.89–1.32) ＜ 0.411
Seldom 1.44 (1.18–1.76) ＜ 0.001*** 1.60 (1.31–1.97) ＜ 0.001*** 1.44 (1.16–1.77) ＜ 0.001**
How often do you have fried or stir-fried food? over 4 times a week 1     1     1    
2–3 times a week 0.67 (0.49–0.90) ＜ 0.008** 0.69 (0.51–0.93) ＜ 0.017* 0.70 (0.52–0.96) ＜ 0.025*
less than 1 time a week 0.76 k (0.56–1.02) ＜ 0.068 0.81 (0.60–1.10) ＜ 0.174 0.83 (0.61–1.12) ＜ 0.225
I have three regular meals a day. Always 1     1     1    
Usually 1.62 (1.35–1.96) ＜ 0.001*** 1.64 (1.36–1.97) ＜ 0.001*** 1.57 (1.30–1.90) ＜ 0.001***
Seldom 2.91 (2.37–3.56) ＜ 0.001*** 2.97 (2.42–3.64) ＜ 0.001*** 2.69 (2.19–3.31) ＜ 0.001***
Do you eat at least one of each of the food groups such as dairy products, meat or fish, fruits, vegetables, grain every day? 5 types 1     1     1    
4 types 0.86 (0.67–1.11) ＜ 0.251 0.87 (0.67–1.12) ＜ 0.285 0.87 (0.667–1.12) ＜ 0.276
Less than 3 types 1.21 (0.93–1.56) ＜ 0.155 1.23 (0.95–1.59) ＜ 0.117 1.18 (0.91–1.53) ＜ 0.219

1) Model 1: Unadjusted

2) Model 2: adjusted for sex, national Health care system group, existing disease, family history

3) Model 3: adjusted for the same set of variables as in Model 2 plus BMI, alcohol drinking, smoking, physical activity

4) Total score of Dietary Patterns ＜ 28 points: Needs much improvement, 28–38 points: Normal, ＞ 39 points: Can prevent disease and maintain health OR: Odds ration, CI: confidence interval

** p ＜ 0.01

*** p ＜ 0.001 by multiple logistic regression

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