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Park, Suh, and Chung: Comparison of chronic disease risk by dietary carbohydrate energy ratio in Korean elderly: Using the 2007–2009 Korea National Health and Nutrition Examination Survey
Research Article

J Nutr Health 2014;47(4):247-257.

Published online: 20 January 2014

DOI: https://doi.org/10.4163/jnh.2014.47.1.247

Comparison of chronic disease risk by dietary carbohydrate energy ratio in Korean elderly: Using the 2007–2009 Korea National Health and Nutrition Examination Survey

Min Seon Park1, Yoon Suk Suh2, Young-Jin Chung1

1Department of Food and Nutrition, College of Human Ecology, Chungnam National University, Daejeon 305–764, Korea

2Graduate School of Education, Chungnam National University, Daejeon 305–764, Korea

Received 22 January 2014       Revised 12 February 2014       Accepted 12 August 2014

Copyright © 2014 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

Purpose

It is reported that most senior people consume a high carbohydrate diet, while a high carbohydrate diet could contribute to the risk of chronic disease. The aim of this study is to determine whether a high carbohydrate diet can increase the risk of chronic disease in elderly Koreans. Methods: Using the 2007–2009 Korean National Health Nutrition Examination Survey data, out of a total of 3,917 individuals aged 65 and above, final 1,535 subjects were analyzed, divided by dietary carbohydrate energy ratio into two groups of moderate carbohydrate ratio (MCR, 55–70%) and excessive carbohydrate ratio (ECR, > 70%). All data were processed after the application of weighted value, using a general linear model or logistic regression. Results: Eighty one percent of elderly Koreans consumed diets with carbohydrate energy ratio above 70%. The ECR group included more female subjects, rural residents, lower income, and lower education level. The ECR group showed lower waist circumference, lower diastolic blood pressure, and lower frequency of consumption of meat and egg, milk, and alcohol. The intake of energy and most nutrients, with the exception of fiber, potassium, vitamin A, and carotene, was lower in the ECR group compared to the MCR group. When analyzed by gender, the ECR group showed lower risk of dyslipidemia in male and obesity in female subjects, even though the ECR group showed low intake of some nutrients. No difference in the risk of hypertension, diabetes, and anemia was observed between the two groups in male or female subjects. Conclusion: This result suggested that a high carbohydrate diet would not be a cause to increase the risk of chronic disease in the elderly. Further study is needed in order to determine an appropriate carbohydrate energy ratio for elderly Koreans to reduce the risk of chronic disease.

Keywords: Korean elderly, carbohydrate energy ratio, risk, chronic disease, acceptable macronutrient distribution range.

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Table 1.
General characteristics and distribution of energy intake by dietary carbohydrate energy ratio in total subjects
Variable Dietary carbohydrate energy ratio χ2-value 2)
MCR 1) ECR
Sex Men
Women		 149 (52.3) 3)
136 (47.7)		 527 (42.2)
723 (57.8)		 7.12∗
Age (yrs) 65–74
75–84
≥ 85		 213 (74.7)
59 (20.7)
13 (04.6)		 861 (68.9)
344 (27.5)
45 (03.6)		 1.84
Residential area Urban
Rural		 169 (59.3)
116 (40.7)		 564 (45.1)
686 (54.9)		 15.70∗∗
Income Low
Middle low
Middle high
High		 54 (19.7)
62 (22.6)
73 (26.6)
85 (31.0)		 365 (30.5)
320 (26.7)
265 (22.1)
247 (20.6)		 18.25∗
Education level Primary school
Middle school
High school
College		 173 (61.3)
43 (15.2)
39 (13.8)
27 (09.6)		 991 (80.4)
116 (09.4)
86 (07.0)
39 (03.2)		 65.79∗∗∗
Energy intake <EER 4)
≥EER
Total		 191 (27.7)
91 (32.3)
285 (18.6)		 945 (76.0)
299 (24.0)
250 (81.4)		 14.57∗∗

1) MCR: Moderate carbohydrate energy ratio group, ECR: Excessive carbohydrate energy ratio group

2) Calculated by Complex Samples χ2-test

3) n (%)

4) Estimated Energy Requirements

∗ : p < 0.05,

∗∗ : p < 0.01,

∗∗∗ : p < 0.001

Table 2.
Anthropometric, blood pressure and blood biochemical indices by carbohydrate energy ratio in total subjects 1)
Variable Dietary carbohydrate energy ratio F-value 3)
n MCR 2) n ECR
Anthropometric
Height 282 158.04 ± 0.714) 1,244 155.65 ± 0.35 0.40
Weight 282 058.68 ± 0.69 1,245 55.39 ± 0.36 6.32∗
Body mass index (kg/m2) 282 023.44 ± 0.20 1,244 22.82 ± 0.11 2.83
Waist circumference (cm) 283 083.35 ± 0.69 1,241 81.20 ± 0.34 5.87∗
Blood pressure
Systolic blood pressure (mmHg) 285 128.13 ± 1.44 1,250 127.72 ± 0.83 0.31
Diastolic blood pressure (mmHg) 285 079.14 ± 0.74 1,250 76.46 ± 0.46 5.53∗
Blood biochemical indices
Total cholesterol (mg/dl) 274 199.14 ± 3.34 1,174 194.24 ± 1.35 2.84
Triglyceride (mg/dl) 274 133.55 ± 7.05 1,174 137.92 ± 3.21 0.07
HDL-cholesterol (mg/dl) 274 048.64 ± 0.96 1,174 46.72 ± 0.53 1.46
Hemoglobin (g/dl) 272 013.82 ± 0.13 1,162 13.60 ± 0.05 0.14
Hematocrit (%) 272 041.22 ± 0.38 1,162 40.59 ± 0.15 0.25
Serum ferritin (ng/ml) 273 104.57 ± 7.15 1,177 100.76 ± 6.35 0.02
Glu-FBS (mg/dl) 273 096.20 ± 1.04 1,174 96.42 ± 0.61 0.07
Blood urea nitrogen (mg/dl) 274 016.64 ± 0.41 1,177 16.03 ± 0.17 2.67

1) Adjusted for sex, residential area, income, and education level

2) MCR: Moderate carbohydrate energy ratio group, ECR Excessive carbohydrate energy ratio group

3) Calculated by Complex Samples General Linear Model ANOVA

4) Mean ± SE

∗ : p < 0.05

Table 3.
Daily food group consumption frequency by carbohydrate energy ratio in total and male and female subjects 1)
Food group Total Male Female
MCR 2)
(n = 285)		 ECR
(n = 1,250)		 F-value 3) MCR
(n = 149)		 ECR
(n = 527)		 F-value MCR
(n = 136)		 ECR
(n = 723)		 F-value
Total grain 5.07 ± 0.10 4) 4.93 ± 0.06 0.01 4.94 ± 0.14 4.96 ± 0.09 0.92 5.21 ± 0.15 4.91 ± 0.07 0.57
Staples 4.77 ± 0.11 4.72 ± 0.06 0.34 4.66 ± 0.14 4.70 ± 0.09 0.72 4.88 ± 0.16 4.74 ± 0.07 0.03
Snacks 0.30 ± 0.03 0.21 ± 0.01 3.25 0.27 ± 0.03 0.26 ± 0.02 0.37 0.33 ± 0.05 0.17 ± 0.01 8.16∗∗
Potatoes 0.21 ± 0.01 0.22 ± 0.01 4.35∗ 0.20 ± 0.02 0.22 ± 0.02 3.64 0.21 ± 0.02 0.22 ± 0.01 1.40
Beans 1.63 ± 0.10 1.43 ± 0.05 1.38 1.60 ± 0.13 1.39 ± 0.07 0.20 1.66 ± 0.14 1.46 ± 0.07 0.85
Meats and eggs s 0.58 ± 0.03 0.39 ± 0.02 9.62∗∗ 0.63 ± 0.04 0.47 ± 0.03 4.63∗ 0.52 ± 0.06 0.33 ± 0.02 4.66∗
Fishes 0.79 ± 0.05 0.64 ± 0.03 0.35 0.84 ± 0.06 0.72 ± 0.05 0.08 0.74 ± 0.06 0.59 ± 0.03 1.30
Salted fishes 0.14 ± 0.02 0.11 ± 0.01 1.36 0.17 ± 0.03 0.15 ± 0.02 0.48 0.11 ± 0.04 0.08 ± 0.01 0.88
Total vegetables s 4.99 ± 0.14 4.54 ± 0.09 0.62 5.04 ± 0.20 4.86 ± 0.12 0.38 4.94 ± 0.18 4.30 ± 0.11 2.82
Green and yellow 1.21 ± 0.08 1.01 ± 0.03 1.17 1.24 ± 0.08 1.06 ± 0.05 0.49 1.18 ± 0.14 0.98 ± 0.04 0.48
White 3.12 ± 0.10 3.02 ± 0.07 0.08 3.16 ± 0.13 3.25 ± 0.09 1.55 3.08 ± 0.14 2.86 ± 0.09 0.50
Mushrooms 0.14 ± 0.01 0.11 ± 0.01 0.73 0.13 ± 0.01 0.13 ± 0.01 2.67 0.14 ± 0.02 0.09 ± 0.01 0.22
Seaweeds 0.51 ± 0.04 0.39 ± 0.02 3.81 0.50 ± 0.04 0.42 ± 0.02 0.12 0.53 ± 0.06 0.36 ± 0.02 5.77∗
Fruits 1.20 ± 0.15 0.83 ± 0.03 1.52 0.97 ± 0.08 0.84 ± 0.05 0.50 1.46 ± 0.29 0.83 ± 0.04 2.42
Milk products 0.42 ± 0.04 0.24 ± 0.02 8.73∗∗ 0.38 ± 0.04 0.25 ± 0.02 2.28 0.46 ± 0.06 0.24 ± 0.02 8.89∗∗
Drinks 1.24 ± 0.07 1.16 ± 0.04 0.45 1.52 ± 0.10 1.40 ± 0.06 0.002 0.94 ± 0.11 0.99 ± 0.05 0.85
Alcohols 0.31 ± 0.04 0.20 ± 0.02 4.11∗ 0.49 ± 0.06 0.37 ± 0.03 3.09 0.12 ± 0.04 0.07 ± 0.01 1.61
Fast food 0.04 ± 0.00 0.02 ± 0.00 2.81 0.04 ± 0.01 0.03 ± 0.00 2.05 0.03 ± 0.01 0.02 ± 0.00 0.81

1) Adjusted for sex, residential area, income, and education level in total subjects, and adjusted for the same variables except sex in male and female subjects

2) MCR: Moderate carbohydrate energy ratio group, ECR: Excessive carbohydrate energy ratio group

3) Calculated by Complex Samples General Linear Model ANOVA

4) Mean ± SE

∗ : p < 0.05,

∗∗ : p < 0.01

Table 4.
Daily nutrients intake and macronutrient energy ratio by carbohydrate energy ratio in total and male and female subjects 1)
Nutrients Total Male Female
MCR 2)
(n = 285)		 ECR
(n = 1,250)		 F-value 3) MCR
(n = 149)		 ECR
(n = 527)		 F-value MCR
(n = 136)		 ECR
(n = 723)		 F-value
Energy (kcal)4) 1,722 ± 39 5) 1,492 ± 22 11.98∗∗ 1,836 ± 47 1,645 ± 30 6.66∗ 1,601 ± 57 1,375 ± 28 4.91∗
Protein (g) 69.2 ± 1.88 43.7 ± 0.69 228.93∗∗∗ 74.1 ± 2.37 50.0 ± 1.02 137.77∗∗∗ 62.9 ± 2.56 38.9 ± 0.79 105.55∗∗∗
Fat (g) 36.5 ± 1.07 14.2 ± 0.35 587.45∗∗∗ 39.1 ± 1.36 16.6 ± 0.59 319.63∗∗∗ 33.7 ± 1.60 12.4 ± 0.36 272.03∗∗∗
Fiber (g) 7.36 ± 0.38 6.22 ± 0.17 0.45 7.86 ± 0.52 6.71 ± 0.22 0.076 6.83 ± 0.49 5.84 ± 0.24 0.62
Calcium (mg) 530 ± 28.9 342 ± 8.94 30.79∗∗∗ 540 ± 30.7 397 ± 16.2 9.67∗∗ 520 ± 43.1 301 ± 9.66 28.26∗∗∗
Phosphorus (mg) 1,147 ± 34.2 858 ± 13.1 66.48∗∗∗ 1,221 ± 37.0 972 ± 20.2 34.17∗∗∗ 1,069 ± 51.0 772 ± 15.3 36.48∗∗∗
Iron (mg) 14.9 ± 0.78 11.1 ± 0.42 3.95∗ 14.8 ± 0.83 12.4 ± 0.58 0.54∗∗ 15.0 ± 1.30 10.2 ± 0.55 5.71∗
Sodium (mg) 4,977 ± 235 3,579 ± 99 15.88∗∗∗ 5,587 ± 235 4,205 ± 147 12.08∗∗ 4,328 ± 332 3,104 ± 116 6.93∗
Potassium (mg) 2,819 ± 102. 2,282 ± 50.7 2.60 3,080 ± 128 2,508 ± 67.1 2.62 2,543 ± 129 2,110 ± 67.3 0.84
Vitamin A (μgRE) 727 ± 44.5 535 ± 36.3 0.07 790 ± 57.4 549 ± 35.6 1.40 660 ± 66.5 524 ± 52.9 0.20
Retinol (μg) 76.7 ± 6.63 25.3 ± 2.28 33.04∗∗∗ 73.8 ± 8.51 32.1 ± 4.09 6.76∗ 79.8 ± 9.03 20.2 ± 2.15 35.35∗∗∗
β-carotene (μg) 3,777 ± 253 3,039 ± 217 0.42 4,115 ± 313 3,078 ± 210 0.29 3,418 ± 397 3,009 ± 316 1.24
Thiamin (mg) 1.22 ± 0.05 0.83 ± 0.02 46.17∗∗∗ 1.34 ± 0.07 0.93 ± 0.02 22.90∗∗∗ 1.08 ± 0.06 0.76 ± 0.02 30.14∗∗∗
Riboflavin (mg) 1.11 ± 0.04 0.67 ± 0.02 77.61∗∗∗ 1.18 ± 0.05 0.75 ± 0.02 46.56∗∗∗ 1.03 ± 0.06 0.60 ± 0.02 44.95∗∗∗
Niacin (mg) 15.9 ± 0.53 10.5 ± 0.17 80.04∗∗∗ 17.5 ± 0.70 11.9 ± 0.24 62.09∗∗∗ 14.1 ± 0.65 9.42 ± 0.20 31.08∗∗∗
Vitamin C (mg) 86.6 ± 4.87 79.9 ± 3.0 4.95∗ 93.2 ± 7.04 87.4 ± 4.61 3.136 79.5 ± 6.35 74.3 ± 3.75 2.03
Water (g) 865 ± 40.2 591 ± 15.3 13.09∗∗∗ 966 ± 55.6 693 ± 22.9 6.87∗∗ 758 ± 52.7 514 ± 18.1 7.00∗∗
Carbohydrate (%) 64.88 ± 0.31 79.87 ± 0.19 522.78∗∗∗ 64.58 ± 0.44 79.12 ± 0.27 644.54∗∗∗ 65.20 ± 0.41 80.45 ± 0.26 939.08∗∗∗
Protein (%) 16.18 ± 0.25 11.66 ± 0.08 266.62∗∗∗ 16.36 ± 0.30 12.06 ± 0.13 165.04∗∗∗ 15.98 ± 0.39 11.36 ± 0.10 109.82∗∗∗
Fat (%) 18.94 ± 0.31 8.46 ± 0.15 771.09∗∗∗ 19.06 ± 0.42 8.81 ± 0.21 409.80∗∗∗ 18.82 ± 0.42 8.19 ± 0.20 155.30∗∗∗

1) Adjusted for sex, residential area, income, and education level in total subjects, and adjusted for the same variables except sex in male and female subjects

2) MCR: Moderate carbohydrate energy ratio group, ECR: Excessive carbohydrate energy ratio group

3) Calculated by Complex Samples General Linear Model ANOVA

4) Adjusted not for energy intake

5) Mean ± SE

∗ : p < 0.05,

∗∗ : p < 0.01,

∗∗∗ : p < 0.001

Table 5.
Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) by carbohydrate energy ratio in total and male and female subjects 1)
NAR Total F-value 3) Male F-value Female F-value
MCR 2)
(n = 285)		 ECR
(n = 1,250)		 MCR
(n = 149)		 ECR
(n = 527)		 MCR
(n = 136)		 ECR
(n = 723)
Protein 0.96 ± 0.01 4) 0.81 ± 0.01 117.95∗∗∗ 0.98 ± 0.01 0.85 ± 0.01 80.04∗∗∗ 0.94 ± 0.02 0.78 ± 0.01 34.24∗∗∗
Calcium 0.65 ± 0.02 0.46 ± 0.01 61.02∗∗∗ 0.69 ± 0.01 0.52 ± 0.02 29.23∗∗∗ 0.60 ± 0.04 0.41 ± 0.01 45.01∗∗∗
Phosphorus 0.98 ± 0.01 0.92 ± 0.00 19.88∗∗∗ 0.99 ± 0.00 0.95 ± 0.02 22.12∗∗∗ 0.96 ± 0.02 0.89 ± 0.01 5.04∗
Iron 0.94 ± 0.01 0.81 ± 0.01 49.22∗∗∗ 0.96 ± 0.01 0.83 ± 0.01 38.39∗∗∗ 0.92 ± 0.02 0.80 ± 0.01 15.96∗∗∗
Vitamin A 0.72 ± 0.02 0.53 ± 0.01 26.25∗∗∗ 0.76 ± 0.03 0.53 ± 0.02 37.04∗∗∗ 0.67 ± 0.04 0.53 ± 0.02 4.28∗
Thiamin 0.83 ± 0.02 0.67 ± 0.01 71.65∗∗∗ 0.87 ± 0.02 0.71 ± 0.01 49.75∗∗∗ 0.80 ± 0.03 0.64 ± 0.01 21.46∗∗∗
Riboflavin 0.74 ± 0.02 0.48 ± 0.01 138.49∗∗∗ 0.72 ± 0.02 0.49 ± 0.01 61.88∗∗∗ 0.73 ± 0.03 0.48 ± 0.01 48.44∗∗∗
Niacin 0.86 ± 0.02 0.67 ± 0.01 70.55∗∗∗ 0.89 ± 0.02 0.71 ± 0.01 67.03∗∗∗ 0.83 ± 0.03 0.65 ± 0.01 19.36∗∗∗
Vitamin C 0.67 ± 0.03 0.60 ± 0.01 1.66 0.71 ± 0.03 0.64 ± 0.02 2.51∗∗∗ 0.62 ± 0.04 0.57 ± 0.02 0.71
MAR 0.82 ± 0.01 0.66 ± 0.01 98.92∗∗∗ 0.84 ± 0.01 0.69 ± 0.01 82.56∗∗∗ 0.79 ± 0.02 0.64 ± 0.01 27.79∗∗∗

1) Adjusted for sex, residential area, income, and education level in total subjects, and adjusted for the same variables except sex in male and female subjects

2) MCR: Moderate carbohydrate energy ratio group, ECR: Excessive carbohydrate energy ratio group

3) Calculated by Complex Samples General Linear Model ANOVA

4) Mean ± SE

∗ : p < 0.05,

∗∗∗ : p < 0.001

Table 6.
Index of nutrient quality (INQ) by carbohydrate energy ratio in total and male and female subjects 1)
INQ Total F-value 3) Male F-value Female F-value
MCR 2)
(n = 285)		 ECR
(n = 1,250)		 MCR
(n = 149)		 ECR
(n = 527)		 MCR
(n = 136)		 ECR
(n = 723)
Protein 1.53 ± 0.03 4) 1.09 ± 0.01 274.71∗∗∗ 1.64 ± 0.03 1.21 ± 0.01 165.17∗∗∗ 1.42 ± 0.04 1.01 ± 0.01 111.64∗∗∗
Calcium 0.81 ± 0.04 0.59 ± 0.01 28.92∗∗∗ 0.85 ± 0.04 0.69 ± 0.03 7.89∗∗ 0.77 ± 0.06 0.51 ± 0.01 26.49∗∗∗
Phosphorus 1.73 ± 0.04 1.46 ± 0.01 65.16∗∗∗ 1.92 ± 0.03 1.69 ± 0.02 33.46∗∗∗ 1.53 ± 0.05 1.29 ± 0.01 31.79∗∗∗
Iron 1.85 ± 0.09 1.53 ± 0.05 6.48∗ 1.80 ± 0.09 1.65 ± 0.08 1.29 1.90 ± 0.16 1.45 ± 0.06 7.90∗∗
Vitamin A 1.17 ± 0.07 0.92 ± 0.05 3.99∗ 1.26 ± 0.10 0.91 ± 0.05 4.27∗ 1.07 ± 0.10 0.93 ± 0.07 0.51
Thiamin 1.09 ± 0.03 0.86 ± 0.01 53.57∗∗∗ 1.21 ± 0.04 0.94 ± 0.02 32.57∗∗∗ 0.97 ± 0.04 0.81 ± 0.01 26.83∗∗∗
Riboflavin 0.86 ± 0.02 0.58 ± 0.01 109.27∗∗∗ 0.87 ± 0.03 0.60 ± 0.01 57.28∗∗∗ 0.86 ± 0.03 0.57 ± 0.01 61.83∗∗∗
Niacin 1.11 ± 0.03 0.84 ± 0.01 79.66∗∗∗ 1.20 ± 0.03 0.91 ± 0.01 71.67∗∗∗ 1.10 ± 0.04 0.78 ± 0.01 26.88∗∗∗
Vitamin C 0.90 ± 0.05 0.92 ± 0.03 2.12 1.02 ± 0.07 1.03 ± 0.05 1.28 0.76 ± 0.05 0.84 ± 0.04 1.07

1) Adjusted for sex, residential area, income, and education level in total subjects, and adjusted for the same variables except sex in male and female subjects

2) MCR: Moderate carbohydrate energy ratio group, ECR: Excessive carbohydrate energy ratio group

3) Calculated by Complex Samples General Linear Model ANOVA

4) Mean ± SE

∗ : p < 0.05,

∗∗ : p < 0.01,

∗∗∗ : p < 0.001

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