Journal List > J Nutr Health > v.47(3) > 1081336

J Nutr Health. 2014 Jun;47(3):186-192. Korean.
Published online June 30, 2014.
© 2014 The Korean Nutrition Society
The effect of high-carbohydrate diet and low-fat diet for the risk factors of metabolic syndrome in Korean adolescents: Using the Korean National Health and Nutrition Examination Surveys (KNHANES) 1998-2009
Mi-Rhan Han,1 Jeong Hyun Lim,2 and YoonJu Song1
1Major of Food & Nutrition, School of Human Ecology, The Catholic University of Korea, Bucheon 420-743, Korea.
2Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul 110-744, Korea.

To whom correspondence should be addressed. tel: +82-2-2164-4681, Email:
Received February 21, 2014; Revised March 21, 2014; Accepted May 21, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The prevalence of metabolic syndrome has increased in both the adult population and in adolescents. How-ever, few studies have been conducted for adolescents. The aim of this study was to examine the association of metabolic syndrome and its risk factors with high carbohydrate diet and high fat diet using data from the Korea National Health and Nutrition Examination Survey (1998-2009).


Using the Acceptable Macronutrient Distribution Range for Korean Dietary Reference Intakes, subjects whose energy intake from carbohydrate was greater than 70% and from fat was less than 15% were classified as the 'High-carbohydrate & low-fat diet (HCLF)' group and subjects whose energy intake from carbohydrate was less than 60% and from fat was 25% or more were classified as the 'Low-carbohydrate & high-fat Diet (LCHF)' group. Among 5,931 eligible subjects, HCLF included 853 subjects and LCHF included 1,084 subjects.


The mean age in both groups was 14 years and significant difference in age, BMI, sex, physical activity, and household income was observed between the HCLF and LCHF groups. Regarding the energy intake compared to Estimated Energy Re-quirement, the HCLF group met 79.0% and the LCHF group met 100.3%. Regarding nutrient intake per 1,000 kcal, carbo-hydrate, iron, potassium, and vitamin C intake in the HCLF group were significantly higher, but protein, fat, calcium, phos-phorus, vitamin A, thiamin, riboflavin, and niacin intakes were significantly lower in the HCLF group compared to the LCHF group. After adjusting for age, sex, BMI, study year, household income, physical activity, and energy intake, the serum tri-glycerides level and systolic blood pressure were slightly higher, while the serum HDL-cholesterol level was significantly lower in HCLF than LCHF. The odds ratio of metabolic syndrome did not differ significantly between HCLF and LCHF.


Our findings indicate an association of a high carbohydrate diet with increased risks for metabolic syndrome components. Conduct of future studies would be necessary in order to explore the underlying mechanism and to confirm our findings in a prospective study.

Keywords: adolescents; high carbohydrate diet; high fat diet; metabolic syndrome; KNHANES


Fig. 1
The percent of energy intake (per EER) of study subjects. HCLF: High-carbohydrate & low-fat Diet, LCHF: Low-carbohydrate & high-fat Diet.
Click for larger image


Table 1
General characteristics of study subjects and macronutrient intakes
Click for larger image

Table 2
Nutrient intake (per 1,000 kcal) of study subjects
Click for larger image

Table 3
Anthropometric and biochemical parameters of study subjects
Click for larger image

Table 4
The odd ratios of metabolic syndrome on study subjects
Click for larger image


This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2013R1A1A3010359).

1. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143–3421.
2. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003;157(8):821–827.
3. Lim S, Jang HC, Park KS, Cho SI, Lee MG, Joung HJ, Mozumdar A, Liguori G. Changes in metabolic syndrome in American and Korean youth, 1997-2008. Pediatrics 2013;131:e214–e222.
4. Wang Q, Yin J, Xu L, Cheng H, Zhao X, Xiang H, Lam HS, Mi J, Li M. Prevalence of metabolic syndrome in a cohort of Chinese schoolchildren: comparison of two definitions and assessment of adipokines as components by factor analysis. BMC Public Health 2013;13:249.
5. Yoshinaga M, Tanaka S, Shimago A, Sameshima K, Nishi J, Nomura Y, Kawano Y, Hashiguchi J, Ichiki T, Shimizu S. Metabolic syndrome in overweight and obese Japanese children. Obes Res 2005;13(7):1135–1140.
6. Ryu SY, Kweon S, Park H, Shin J, Rhee J. Obesity and the metabolic syndrome in Korean adolescent. J Korean Med Sci 2007;22(3):513–517.
7. Morrison JA, Friedman LA, Wang P, Glueck CJ. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 year later. J Pediatr 2008;152(2):201–206.
8. Ferreira I, Twisk JW, van Mechelen W, Kemper HC, Stehouwer CD. Development of fatness, fitness, and lifestyle from adolescence to the age of 36 years: determinants of the metabolic syndrome in young adults: the amsterdam growth and health longitudinal study. Arch Intern Med 2005;165(1):42–48.
9. Carnethon MR, Loria CM, Hill JO, Sidney S, Savage PJ, Liu K. Coronary Artery Risk Development in Young Adults study. Risk factors for the metabolic syndrome: The Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985-2001. Diabetes Care 2004;27(11):2707–2715.
10. Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: The atherosclerosis risk in communities study. Circulation 2008;117(6):754–761.
11. 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.
12. Cho YA, Kim J, Cho ER, Shin A. Dietary patterns and the prevalence of metabolic syndrome in Korean women. Nutr Metab Cardiovasc Dis 2011;21(11):893–900.
13. Lee CJ, Joung H. Milk intake is associated with metabolic syndrome: Using data from the Korea National Health and Nutrition Examination Survey 2007~2010. Korean J Community Nutr 2012;17(6):795–804.
14. Park SH, Lee KS, Park HY. Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: Analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III). Int J Cardiol 2010;139(3):234–240.
15. Song Y, Joung H. A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis 2012;22(5):456–462.
16. The Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: The Korean Nutrition Society; 2010.
17. Korea Centers for Disease Control and Prevention. The Korean Pediatric Society. The Committee for the Development of Growth Standard for Korean Children and Adolescents. The growth standard for Korean children and adolescents 2007. Cheongwon: Korea Centers for Disease Control and Prevent; 2007.
18. Jung HJ, Song WO, Paik HY, Joung HJ. Dietary characteristics of macronutrient intake and the status of metabolic syndrome among Koreans. Korean J Nutr 2011;44(2):119–130.
19. Song Y, Park MJ, Paik HY, Joung H. Secular trends in dietary patterns and obesity-related risk factors in Korean adolescents aged 10-19 years. Int J Obesity (Lond) 2010;34(1):48–56.
20. Chung HK, Yang EJ, Song WO. Carbohydrate intake associated with risk factors of coronary heart disease in the Adults: NHANES III. Korean J Nutr 2000;33(8):873–881.
21. Moon HK, Kong JE. Assessment of nutrient intake for middle aged with and without metabolic syndrome using 2005 and 2007 Korean National Health and Nutrition Survey. Korean J Nutr 2010;43(1):69–78.
22. Kim K, Yun SH, Choi BY, Kim MK. Cross-sectional relationship between dietary carbohydrate, glycaemic index, glycaemic load and risk of the metabolic syndrome in a Korean population. Br J Nutr 2008;100(3):576–584.
23. Parks EJ, Hellerstein MK. Carbohydrate-induced hypertriacylglycerolemia: Historical perspective and review of biological mechanisms. Am J Clin Nutr 2000;71:412–433.
24. Choi H, Song S, Kim J, Chung J, Yoon J, Paik HY, Song Y. High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults. Nutr Res 2012;32:100–106.
25. Kim BH, Lee JW, Lee Y, Lee HS, Jang YA, Kim CI. Food and nutrient consumption patterns of the Korean adult population by income level - 2001 National Health and Nutrition Survey. Korean J Community Nutr 2005;10(6):952–962.