Myeong Seong Kim; Dae Cheol Kweon; Yun Jung Bae

doi:10.4163/jnh.2014.47.5.403

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Kim, Kweon, and Bae: Evaluation of nutrient and food intake status, and dietary quality according to abdominal obesity based on waist circumference in Korean adults: Based on 2010–2012 Korean National Health and Nutrition Examination Survey

Research Article

J Nutr Health 2014;47(6):403-315.

Published online: 20 January 2014

DOI: https://doi.org/10.4163/jnh.2014.47.5.403

Evaluation of nutrient and food intake status, and dietary quality according to abdominal obesity based on waist circumference in Korean adults: Based on 2010–2012 Korean National Health and Nutrition Examination Survey

Myeong Seong Kim^1,², Dae Cheol Kweon³, Yun Jung Bae⁴

¹Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul 151–742, Korea

²Department of Radiology, Korean National Cancer Center, Goyang-si, Gyeonggi 410–769, Korea

³Department of Radiologic Science, Shinhan University, Gyeonggi 480–701, Korea

⁴Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 483–777, Korea

Received 13 August 2014 Revised 12 November 2014 Accepted 21 21 2014

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

ABSTRACT Purpose: This study was conducted in order to investigate the nutrient and food intake status, and dietary quality in Korean adults according to abdominal obesity based on waist circumference. Methods: We analyzed data from the combined 2010∼2012 KNHANES (Korean National Health and Nutrition Examination Survey). The analysis included 6,974 adults aged 40 to 64 years. In this study, according to abdominal obesity based on waist circumference (male ≥ 90 cm, female ≥ 85 cm), we classified the subjects into the obesity group (male, n = 775, female, n = 1,113) and control group (male, n = 2,038, female, n = 3,048). The nutrient and food group intake, ND (nutrient density), NAR (nutrient adequacy ratio), MAR (mean adequacy ratio), INQ (index of nutritional quality), DDS (dietary diversity score), and DVS (dietary variety score) were analyzed using data from the 24-recall method. Results: For male, no significant difference in quality index of the diet was observed between the obesity group and the normal group. In female, in diet quality (ND, NAR, and INQ), vitamin B₂ (ND, NAR, and INQ) calcium (NAR), phosphorous (ND, INQ) and potassium (ND) of the obesity group was significantly lower than those of the control group. DDS and DVS in the obesity group (3.57, 30.95) were significantly lower than those of the control group (3.68, 32.84) (p = 0.0043, 0.0002). DVS (DVS ≥ 39.9) showed association with lower risk of waist obesity in a logistic regression model after adjustments for multiple confounding factors including age, education, income, alcohol intake frequency, smoking, physical activity, energy intake, and body mass index (OR: 0.616, 95% CI: 0.420–0.903). Conclusion: In conclusion, females with abdominal obesity had lower micronutrient intake quality, DVS than those of the control group. In Korean females, food intake variety can adversely affect waist circumference.

Keywords: waist circumference, obesity, dietary quality, food and nutrient intake, adults

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Table 1.

General characteristics, metabolic parameters, dietary habits and lifestyles of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048)	Obesity (n = 1,113)	p value
Age (yrs)	50.46 ± 0.18¹⁾	50.82 ± 0.29	0.2782	49.83 ± 0.16	52.98 ± 0.26	<.0001
BMI (kg/m²)	23.09 ± 0.06	27.05 ± 0.10	<.0001	22.60 ± 0.05	27.68 ± 0.14	<.0001
<18.5	59 (2.61)²⁾	2 (0.27)	<.0001	97 (3.11)	1 (0.12)	<.0001
≥ 18.5 and <23	859 (41.92)	15 (1.80)		1,644 (54.30)	25 (2.10)
≥ 23 and <25	692 (33.03)	118 (14.99)		861 (27.83)	164 (13.88)
≥ 25	428 (22.45)	640 (82.94)		446 (14.76)	923 (83.89)
Waist circumference (cm)	81.47 ± 0.15	95.05 ± 0.22	<.0001	75.67 ± 0.14	91.37 ± 0.28	<.0001
Metabolic parameters
Total cholesterol (mg/dl)	190.20 ± 1.00	195.94 ± 1.58	0.0426	196.92 ± 0.81	201.85 ± 1.26	0.0008
Triglyceride (mg/dl)	159.04 ± 3.49	199.19 ± 5.67	<.0001	113.76 ± 2.18	149.59 ± 3.81	<.0001
HDL-cholesterol (mg/dl)	46.96 ± 0.31	43.23 ± 0.36	<.0001	52.18 ± 0.25	47.80 ± 0.41	<.0001
Glucose (mg/dl)	102.50 ± 0.67	108.64 ± 0.99	<.0001	94.74 ± 0.44	105.64 ± 1.14	<.0001
SBP (mmHg)	121.33 ± 0.45	125.39 ± 0.62	<.0001	117.14 ± 0.37	123.14 ± 0.68	<.0001
DBP (mmHg)	79.70 ± 0.31	83.00 ± 0.47	<.0001	75.20 ± 0.24	78.21 ± 0.39	<.0001
Breakfast skipper (%)	156 (8.94)	67 (10.18)	0.4259	272 (10.86)	89 (9.54)	0.3401
Frequency of alcohol
None	301 (15.15)	120 (13.78)	0.0722	1,064 (32.41)	455 (37.77)	0.0733
<1 time/month	383 (18.13)	109 (14.04)		1,251 (41.70)	403 (38.12)
2∼4 times/month	522 (24.32)	193 (24.98)		507 (17.48)	175 (16.01)
≥ 2 times/week	832 (42.38)	353 (47.21)		226 (8.41)	80 (8.10)
Smoking
Non-smoker	327 (15.74)	107 (11.38)	0.0328	2,839 (91.95)	1,037 (91.84)	0.9896
Past smoker	895 (40.81)	364 (43.51)		91 (3.58)	37 (3.70)
Current smoker	816 (43.45)	304 (45.10)		118 (4.47)	39 (4.45)
Physical activity
Low	1,124 (54.67)	457 (58.09)	0.3851	1,849 (61.50)	684 (62.54)	0.3220
Moderate	809 (39.89)	288 (37.26)		1,114 (35.68)	409 (35.61)
Vigorous	105 (5.45)	30 (4.65)		85 (2.82)	20 (1.85)
Education
Elementary school	294 (13.78)	110 (11.75)	0.5570	645 (19.58)	453 (37.05)	<.0001
Middle school	309 (15.10)	129 (15.36)		474 (15.53)	228 (22.09)
High school	755 (39.38)	264 (38.49)		1,177 (41.37)	319 (31.54)
≥ College	669 (31.74)	269 (34.40)		728 (25.52)	106 (9.32)
Household income
Low	202 (10.75)	61 (7.40)	0.0962	325 (11.16)	214 (16.44)	<.0001
Moderate low	474 (25.40)	193 (26.52)		758 (29.95)	318 (31.32)
Moderate	627 (31.36)	224 (30.00)		830 (28.14)	314 (28.67)
Upper	716 (32.49)	283 (35.98)		1,101 (33.75)	262 (23.57)

¹⁾ Mean ± SD

²⁾ N (%) All variables have been age-adjusted except age.

Table 2.

Energy and nutrient intakes per 1,000 kcal of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048)	Obesity (n = 1,113)	p value
Energy (kcal)	2,373.00 ± 22.84¹⁾	2,444.65 ± 35.39	0.0950	1,728.89 ± 15.02	1,719.05 ± 24.90	0.7214
	(/1,000 kcal)			(/1,000 kcal)
Protein (g)	35.77 ± 0.26	35.63 ± 0.42	0.7848	35.81 ± 0.25	35.10 ± 0.40	0.1475
Fat (g)	18.22 ± 0.22	18.47 ± 0.35	0.5341	18.25 ± 0.21	17.25 ± 0.33	0.0113
Carbohydrate (g)	159.61 ± 0.96	158.87 ± 1.42	0.6426	175.40 ± 0.66	177.45 ± 1.14	0.1167
Fiber (g)	3.78 ± 0.06	4.10 ± 0.11	0.0083	4.69 ± 0.08	4.54 ± 0.13	0.2797
Vitamin A (ugRE)	419.80 ± 13.41	406.12 ± 17.93	0.5505	539.62 ± 38.40	485.73 ± 18.34	0.1801
Vitamin B₁ (mg)	0.65 ± 0.01	0.67 ± 0.01	0.0772	0.68 ± 0.01	0.68 ± 0.01	0.7074
Vitamin B₂ (mg)	0.59 ± 0.01	0.60 ± 0.01	0.6743	0.66 ± 0.01	0.63 ± 0.01	0.0185
Niacin (mg)	8.60 ± 0.07	8.71 ± 0.11	0.3840	8.75 ± 0.07	8.52 ± 0.10	0.0865
Vitamin C (mg)	53.41 ± 1.05	52.52 ± 1.48	0.6185	69.94 ± 1.97	64.62 ± 1.85	0.0515
Calcium (mg)	255.47 ± 3.29	254.57 ± 6.03	0.8968	296.56 ± 4.56	284.06 ± 6.83	0.1472
Phosphorous (mg)	599.24 ± 3.64	593.00 ± 5.79	0.3630	632.74 ± 3.52	615.16 ± 5.96	0.0135
Sodium (mg)	2,585.00 ± 31.90	2,621.01 ± 57.52	0.5948	2,519.29 ± 31.92	2,572.74 ± 48.70	0.3554
Potassium (mg)	1,529.11 ± 13.37	1,551.09 ± 21.98	0.3906	1,781.72 ± 22.70	1,696.20 ± 23.13	0.0097
Iron (mg)	8.11 ± 0.25	7.76 ± 0.21	0.3115	8.80 ± 0.15	8.54 ± 0.22	0.3360
Energy distribution
% Carbohydrate	63.84 ± 0.39	63.55 ± 0.57	0.6426	70.16 ± 0.26	70.98 ± 0.45	0.1167
% Protein	14.31 ± 0.10	14.25 ± 0.17	0.7848	14.32 ± 0.98	14.04 ± 0.16	0.1475
% Fat	16.40 ± 0.20	16.62 ± 0.32	0.5341	16.42 ± 0.19	15.93 ± 0.29	0.0113

¹⁾ Mean ± SD All variables have been age-adjusted.

Table 3.

Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048)	Obesity (n = 1,113)	p value
NAR
Protein	0.96 ± 0.00¹⁾	0.96 ± 0.00	0.8415	0.93 ± 0.00	0.92 ± 0.01	0.1930
Vitamin A	0.79 ± 0.01	0.79 ± 0.01	0.7230	0.78 ± 0.01	0.76 ± 0.01	0.0610
Vitamin B₁	0.90 ± 0.00	0.92 ± 0.01	0.0590	0.84 ± 0.00	0.83 ± 0.01	0.6339
Vitamin B₂	0.79 ± 0.01	0.79 ± 0.01	0.5933	0.77 ± 0.01	0.75 ± 0.01	0.0331
Niacin	0.90 ± 0.00	0.91 ± 0.01	0.5178	0.85 ± 0.00	0.84 ± 0.01	0.3472
Vitamin C	0.80 ± 0.01	0.81 ± 0.01	0.5734	0.77 ± 0.01	0.74 ± 0.01	0.0690
Calcium	0.71 ± 0.01	0.72 ± 0.01	0.5786	0.65 ± 0.01	0.62 ± 0.01	0.0140
Phosphorous	0.99 ± 0.00	0.99 ± 0.00	0.6769	0.96 ± 0.00	0.96 ± 0.01	0.4323
Iron	0.96 ± 0.00	0.96 ± 0.00	0.6018	0.89 ± 0.00	0.88 ± 0.01	0.7561
MAR	0.87 ± 0.00	0.87 ± 0.01	0.4308	0.83 ± 0.00	0.81 ± 0.01	0.0586

¹⁾ Mean ± SD All variables have been age-adjusted.

Table 4.

Index of Nutritional Quality (INQ) of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048)	Obesity (n = 1,113)	p value
Protein	1.57 ± 0.01¹⁾	1.56 ± 0.02	0.7787	1.46 ± 0.01	1.44 ± 0.02	0.2006
Vitamin A	1.33 ± 0.04	1.28 ± 0.06	0.5415	1.60 ± 0.11	1.44 ± 0.05	0.1758
Vitamin B₁	1.23 ± 0.01	1.27 ± 0.02	0.0760	1.14 ± 0.01	1.13 ± 0.01	0.7788
Vitamin B₂	0.90 ± 0.01	0.91 ± 0.02	0.6913	1.01 ± 0.01	0.97 ± 0.01	0.0240
Niacin	1.22 ± 0.01	1.24 ± 0.02	0.3437	1.15 ± 0.01	1.12 ± 0.01	0.1217
Vitamin C	1.21 ± 0.02	1.19 ± 0.03	0.6056	1.29 ± 0.04	1.19 ± 0.03	0.0609
Calcium	0.81 ± 0.01	0.81 ± 0.02	0.8867	0.80 ± 0.01	0.77 ± 0.02	0.1876
Phosphorous	1.94 ± 0.01	1.92 ± 0.02	0.3803	1.66 ± 0.01	1.62 ± 0.02	0.0208
Iron	1.97 ± 0.06	1.89 ± 0.05	0.3091	1.68 ± 0.03	1.62 ± 0.04	0.1729

¹⁾ Mean ± SD All variables have been age-adjusted.

Table 5.

Food intakes from each food group of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048)	Obesity (n = 3,048)	p value
	(g/day)			(g/day)
Total food	1,745.43 ± 23.50¹⁾	1,827.25 ± 38.90	0.0846	1,366.31 ± 19.09	1,283.01 ± 23.89	0.0029
Cereals	347.99 ± 3.92	358.18 ± 7.01	0.1912	276.80 ± 3.22	290.23 ± 5.23	0.0272
Potato and starches	37.91 ± 2.87	37.52 ± 3.59	0.9312	43.76 ± 2.47	38.05 ± 3.71	0.2108
Sugars and sweetners	11.48 ± 0.65	12.14 ± 0.78	0.5217	7.52 ± 0.33	7.65 ± 0.48	0.8282
Pulses	49.97 ± 2.34	44.61 ± 3.95	0.2363	35.90 ± 1.51	35.59 ± 3.01	0.9277
Nuts and seeds	5.53 ± 1.02	12.97 ± 7.44	0.3675	5.97 ± 0.42	5.25 ± 0.72	0.3782
Vegetables	406.26 ± 6.64	433.95 ± 11.17	0.0347	324.46 ± 6.60	314.87 ± 7.67	0.3662
Fungi and mushrooms	4.71 ± 0.41	5.13 ± 0.76	0.6401	5.17 ± 0.38	3.84 ± 0.52	0.0447
Fruits	186.66 ± 9.21	194.57 ± 13.49	0.6348	260.02 ± 11.95	219.29 ± 10.70	0.0020
Meats	108.39 ± 4.42	109.95 ± 6.52	0.8499	65.02 ± 2.34	64.06 ± 3.66	0.8281
Eggs	23.54 ± 1.19	23.54 ± 1.73	0.9995	18.73 ± 0.73	17.34 ± 1.21	0.3051
Fish and shellfishes	78.51 ± 3.15	85.73 ± 5.22	0.2400	49.26 ± 1.72	43.02 ± 2.20	0.0318
Seaweeds	5.55 ± 0.43	6.04 ± 0.77	0.5559	5.71 ± 0.42	4.95 ± 0.46	0.2172
Milks	64.95 ± 3.58	58.76 ± 5.68	0.3649	85.43 ± 3.37	67.95 ± 4.93	0.0019
Oils and fat	9.04 ± 0.27	10.33 ± 0.44	0.0149	6.38 ± 0.20	6.65 ± 0.38	0.5481
Beverages	360.35 ± 16.10	388.17 ± 25.61	0.3858	143.46 ± 7.46	131.88 ± 12.38	0.4397
Seasoning	44.28 ± 1.09	45.53 ± 1.76	0.5524	31.76 ± 0.78	32.16 ± 1.47	0.8115
Other	0.30 ± 0.12	0.14 ± 0.09	0.2693	0.97 ± 0.75	0.23 ± 0.15	0.3441

¹⁾ Mean ± SD All variables have been age-adjusted.

Table 6.

Dietary diversity score (DDS) and dietary variety score (DVS) of the subjects

Variable	Male		p value	Female		p value
Variable	Control (n = 2,038)	Obesity (n = 775)	p value	Control (n = 3,048	Obesity (n = 1,113)	p value
DDS
Grains	0.998 ± 0.001¹⁾	0.999 ± 0.001	0.7208	0.999 ± 0.001	0.999 ± 0.001	0.9829
Meats	0.945 ± 0.006	0.930 ± 0.010	0.1818	0.902 ± 0.007	0.876 ± 0.011	0.0528
Vegetables	0.997 ± 0.001	0.994 ± 0.003	0.3483	0.986 ± 0.003	0.989 ± 0.004	0.5467
Fruits	0.542 ± 0.013	0.604 ± 0.020	0.0116	0.426 ± 0.012	0.403 ± 0.019	0.3127
Dairy	0.277 ± 0.245	0.012 ± 0.019	0.1568	0.367 ± 0.012	0.307 ± 0.017	0.0033
Distribution
0	1 (0.04)²⁾	−	−	−	−	<.0001
1	3 (0.11)	2 (0.09)		8 (0.37)	3 (0.11)
2	62 (2.89)	32 (4.27)		159 (4.74)	95 (9.01)
3	622 (30.97)	210 (26.51)		1,022 (34.48)	438 (38.68)
4	1,018 (49.47)	416 (53.78)		1,355 (43.95)	454 (39.44)
5	332 (16.52)	115 (15.35)		504 (16.46)	123 (12.76)
Mean ± SD	3.76 ± 0.02	3.77 ± 0.03	0.7136	3.68 ± 0.02	3.57 ± 0.03	0.0043
DVS
Mean ± SD	33.23 ± 0.31	33.43 ± 0.50	0.7241	32.84 ± 0.28	30.95 ± 0.42	0.0002

¹⁾ Mean ±SD

²⁾ N (%)

All variables have been age-adjusted.

Table 7.

Adjusted odd radios (ORs) and 95% confidence intervals (CIs) of waist obesity by dietary diversity

	Case	Control	Model 1	Model 2	Model 3
DDS¹⁾
Male
Q1 (DDS ≤ 3)	244	688	1	1	1
Q2 (DDS = 4)	416	1,018	1.198 (0.956–1.501)	1.136 (0.890–1.450)	0.967 (0.677–1.381)
Q3 (DDS = 5)	115	332	1.024 (0.753–1.393)	0.968 (0.694–1.350)	0.843 (0.515–1.379)
p for trend			0.2433	0.4286	0.7783
Female
Q1 (DDS ≤ 3)	536	1,189	1	1	1
Q2 (DDS = 4)	454	1,355	0.743 (0.620–0.891)	0.895 (0.734–1.091)	1.063 (0.813–1.390)
Q3 (DDS = 5)	123	504	0.642 (0.490–0.842)	0.785 (0.586–1.052)	1.123 (0.736–1.713)
p for trend			0.0004	0.2377	0.8318
DVS²⁾
Male
Q1 (DVS < 25.5)	183	466	1	1	1
Q2 (25.5 ≥ and < 33	3.5) 198	494	1.144 (0.839–1.559)	1.115 (0.808–1.539)	1.107 (0.646–1.603)
Q3 (33.5 ≥ and < 40	0.0) 157	478	0.814 (0.607–1.090)	0.749 (0.547–1.026)	0.656 (0.421–1.022)
Q4 (DVS ≥ 40.0)	237	600	1.093 (0.837–1.428)	0.957 (0.708–1.294)	0.827 (0.518–1.318)
p for trend			0.1215	0.0866	0.1250
Female
Q1 (DVS < 25.2)	372	725	1	1	1
Q2 (25.2 ≥ and < 32	2.3) 295	733	0.793 (0.643–0.978)	0.909 (0.728–1.136)	0.810 (0.584–1.128)
Q3 (32.3 ≥ and < 39	9.9) 217	737	0.632 (0.499–0.802)	0.789 (0.610–1.021)	0.768 (0.524–1.025)
Q4 (DVS ≥ 39.9)	229	858	0.541 (0.421–0.694)	0.695 (0.534–0.906)	0.616 (0.420–0.903)
p for trend			<.0001	0.0340	0.0414

¹⁾ Dietary diversity score, DDS

²⁾ Dietary variety score, DVS

Model 1: Unadjusted model; Model 2: Adjustment for age, education, income, alcohol intake frequency, smoking, physical activity (MET) and energy intake; Model 3: Model 2+body mass index

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