Seong-Ah Kim; Yang Hei; Shinyoung Jun; Gyung-Ah Wie; Sangah Shin; Eunju Hong; Hyojee Joung

doi:10.4163/jnh.2017.50.4.391

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Kim, Hei, Jun, Wie, Shin, Hong, and Joung: Estimated flavonoid intakes according to socioeconomic status of Korean adults based on the Korea National Health and Nutrition Examination Survey 2007∼2012∗

Research Article

J Nutr Health 2017;50(4):391-401.

Published online: 20 January 2017

DOI: https://doi.org/10.4163/jnh.2017.50.4.391

Estimated flavonoid intakes according to socioeconomic status of Korean adults based on the Korea National Health and Nutrition Examination Survey 2007∼2012^∗

Seong-Ah Kim^∗∗,¹, Yang Hei^∗∗,¹, Shinyoung Jun¹, Gyung-Ah Wie², Sangah Shin^3,⁴, Eunju Hong, Hyojee Joung^5,^†

¹Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea

²Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang-si 10408, Korea

³Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea

⁴Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea

⁵Department of Economics and Finance, Hanyang Cyber University, Seoul 04763, Korea

⁶Institute of Health and Environment, Seoul National University, Seoul 08826, Korea

^†To whom correspondence should be addressed. tel: +82-2-880-2781, E-mail: hjjoung@snu.ac.kr

^∗ This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIP) (NRF-2014R1A2A2A01003138).

^∗∗ Co-first author

Received 7 June 2017 Revised 9 July 2017 Accepted 14 August 2017

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

The purpose of this study was to estimate the dietary flavonoid intakes of Korean adults according to socioeconomic status. Methods: Using data from the 2007∼2012 Korea National Health and Nutrition Examination Survey, a total of 31,112 subjects aged over 19 years were included in this study. We estimated individuals' daily intakes of total flavonoids and seven flavonoid subclasses, including flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, proanthocyanidin, and isoflavones, by linking food consumption data with the flavonoids database for commonly consumed Korean foods. We compared intakes of flavonoids according to the levels of household income and education. Results: Average dietary flavonoid intakes of the study subjects were 321.8 mg/d in men and 308.3 mg/d in women. Daily flavonoid intakes were positively associated with household income level (p < 0.0001) and education level (p < 0.0001). The subjects in the highest household income and highest education level group (OR 0.37, 95% CI 0.30∼0.45, p < 0.0001 in men, OR 0.50, 95% CI 0.41∼0.60, p < 0.0001 in women) had a lower likelihood of having low total flavonoid intake (less than 25 percentile) compared to the lowest household income and lowest education level group. The food group that contributed to total flavonoid intake with the biggest difference between the lowest and highest groups for both household income level and education level was beverages. Conclusion: This study shows that socioeconomic status was positively associated with flavonoid intake in a representative Korean population. Further research is needed to analyze the association of flavonoid intake with health outcomes according to socioeconomic status such as household income and education level.

Keywords: Flavonoids intake, socioeconomic status, household income, education, KNHANES

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Fig. 1.

Total flavonoid intake from food groups according to the household income and education level by sex: (a) Total flavonoid intake by household income level, (b) Total flavonoid intake by education level. ∗Adjusted for age, obesity, current smoking status, alcohol drinking status and energy intake.

Fig. 2.

The odds ratio for daily total flavonoid intake < 25 percentile in study population according to the household income and education level by sex. ∗Adjusted for age, obesity, current smoking status, alcohol drinking status and energy intake. 1) ‘Low' meant first and second quartile, and ‘High' meant third and fourth quartile.

Table 1.

Total flavonoid intakes according to characteristics of study subjects by sex

	Men					Women
	n	%	Total flavonoid intake (mg/d)			n	%	Total flavonoid intake (mg/d)
	n	%	Mean	SE¹⁾	p value²⁾	n	%	Mean	SE¹⁾	p value²⁾
Total	12,4140	–	321.8	11.9	–	18,698	–	308.3	10.6	–
Age (yr)
19 ∼ 29	1,367	11.0	275.0	22.0		2,143	11.5	397.5	31.9
30 ∼ 49 50 ∼ 64	4,327 3,443	34.9 27.7	385.5 300.1	21.5 17.5	< 0.0001	7,161 4,867	38.3 26.0	349.5 278.4	17.8 13.5	< 0.0001
65+	3,277	26.4	202.6	12.9		4,527	24.2	140.2	8.7
Household income³⁾
Low	2,464	20.2	208.4	20.3		4,049	22.1	188.4	16.8
Middle-low Middle-high	3,126 3,307	25.6 27.1	267.1 323.9	25.3 19.0	< 0.0001	4,623 4,815	25.2 26.3	289.7 322.2	24.1 18.3	< 0.0001
High	3,302	27.1	429.1	25.4		4,845	26.4	390.4	19.3
Education
≤ Elementary school	2,533	20.9	168.1	10.4		6,188	33.8	154.5	7.6
Middle school High school	1,560 4,296	12.9 35.4	207.9 281.5	14.8 15.9	< 0.0001	1,877 5,820	10.2 31.8	271.9 326.1	21.8 19.0	< 0.0001
≥ College	3,745	30.9	459.3	27.3		4,437	24.2	449.5	25.2
Regular alcohol consumption⁴⁾
Yes No	8,631 3,486	71.2 28.8	324.2 319.3	14.4 20.3	0.8384	6,691 11,601	36.6 63.4	305.8 313.4	14.5 14.7	0.7058
Current smoking⁵⁾
Yes No	6,999 5,142	42.4 57.7	275.4 389.8	13.1 22.2	< 0.0001	1,288 17,038	7.0 93.0	288.6 312.4	33.3 11.2	0.4967
Physical activity⁶⁾
Active Inactive	1,463 10,652	12.1 87.9	350.4 318.7	31.2 12.9	0.3408	2,019 16,281	11.0 89.0	266.0 315.7	19.6 11.6	0.0253
Obesity⁷⁾
Underweight	433	3.5	168.0	21.8		1,023	5.5	367.5	41.0
Normal Overweight	4,444 3,246	36.0 26.3	268.1 363.1	15.0 28.2	< 0.0001	8,030 4,069	43.2 21.9	319.9 299.6	14.2 18.8	0.2326
Obese	4,229	34.2	356.0	20.8		5,482	29.5	284.1	23.1

¹⁾ Standard error 2) p value was from student's t-test and ANOVA using the SURVEYREG procedure. 3) low (first quartile), middle-low (second quartile), middle-high (third quartile) high (fourth quartile) 4) ‘yes' meant drank more than once a month over the past year. 5) ‘yes' meant smoked > 100 cigarettes over lifetime and still smoking. 6) ‘active' meant performed moderate-intensity physical activity which requires a moderate amount of effort and causes slightly rapid breathing for ≥ 30 minutes once for ≥ 5 days a week. 7) ‘Underweight' meant body mass index (BMI) < 18.5 kg/m², ‘Normal' meant 18.5 kg/m² ≤ BMI < 23 kg/m², ‘Overweight' meant 23 kg/m² ≤ BMI < 25 kg/m², and ‘Obese' meant BMI ≥ 25 kg/m². ∗Number of missing values was 581, 656, 703, 645, 697, and 156 for household income, education level, regular alcohol consumption, current smoking, physical activity and obesity.

Table 2.

Intakes of flavonoids and nutrients according to household income level¹⁾

	Men					Women
Dietary intakes	Low	Middle-low	Middle-high	High	p for trend²⁾	Low	Middle-low	Middle-high	High	p for trend²⁾
Nutrients
Total energy (kcal/d)	2,046.1 ± 24.3	2,280.8 ± 19.2	2,382.0 ± 19.1	2,379.3 ± 18.5	< 0.0001	1,496.4 ± 12.9	1,653.4 ± 12.4	1,710.9 ± 11.5	1,736.9 ± 11.6	< 0.0001
Carbohydrate (% of total energy)	67.0 ± 0.5	63.4 ± 0.3	62.1 ± 0.3	61.5 ± 0.3	< 0.0001	73.8 ± 0.3	68.9 ± 0.2	67.4 ± 0.2	66.9 ± 0.2	< 0.0001
Protein (% of total energy)	13.4 ± 0.1	14.3 ± 0.1	14.6 ± 0.1	15.1 ± 0.1	< 0.0001	13.0 ± 0.1	14.1 ± 0.1	14.5 ± 0.1	14.7 ± 0.1	< 0.0001
Fat (% of total energy)	6.7 ± 0.1	7.9 ± 0.1	8.4 ± 0.1	8.5 ± 0.1	< 0.0001	5.9 ± 0.1	7.6 ± 0.1	8.1 ± 0.1	8.3 ± 0.1	< 0.0001
Dietary fiber (g/d)	7.2 ± 0.1	7.9 ± 0.1	8.2 ± 0.1	8.6 ± 0.1	< 0.0001	6.1 ± 0.1	6.6 ± 0.1	7.0 ± 0.1	7.3 ± 0.1	< 0.0001
Vitamin A (μg RE/d)	722.7 ± 30.2	870.5 ± 20.6	966.2 ± 25.7	1,004.2 ± 22.8	< 0.0001	591.6 ± 16.6	732.4 ± 17.3	808.8 ± 29.5	862.4 ± 21.4	< 0.0001
Vitamin C (mg/d)	89.1 ± 2.0	108.3 ± 2.0	115.3 ± 1.9	124.4 ± 2.5	< 0.0001	79.2 ± 1.5	99.5 ± 1.9	108.8 ± 2.0	115.9 ± 2.0	< 0.0001
Flavonoids (mg/d)
Flavonols (mg/d)	36.1 ± 4.1	47.9 ± 6.0	60.5 ± 4.6	85.1 ± 6.1	< 0.0001	30.5 ± 3.9	49.6 ± 5.8	55.6 ± 4.3	69.6 ± 4.6	< 0.0001
Flavones (mg/d)	1.0 ± 0.0	1.3 ± 0.0	1.5 ± 0.1	1.5 ± 0.0	0.0553	0.9 ± 0.0	1.0 ± 0.0	1.4 ± 0.3	1.1 ± 0.0	0.6627
Flavanones (mg/d)	4.7 ± 0.5	7.2 ± 0.7	8.3 ± 0.6	10.0 ± 0.9	< 0.0001	5.8 ± 0.5	9.6 ± 0.6	11.2 ± 0.6	12.5 ± 0.8	< 0.0001
Flavan-3-ols (mg/d)	73.2 ± 15.2	90.6 ± 18.4	127.4 ± 13.9	196.4 ± 18.6	< 0.0001	61.3 ± 12.6	114.7 ± 17.6	131.7 ± 13.4	169.1 ± 14.2	< 0.0001
Anthocyanins (mg/d)	25.7 ± 2.1	36.8 ± 1.7	41.9 ± 1.6	43.6 ± 1.9	< 0.0001	21.9 ± 1.3	30.5 ± 1.3	33.1 ± 1.1	40.0 ± 1.7	< 0.0001
Proanthocyanidin (mg/d)	47.7 ± 5.5	61.8 ± 4.1	61.5 ± 3.5	68.5 ± 4.3	0.0021	53.3 ± 3.6	67.7 ± 4.5	71.6 ± 3.7	80.7 ± 4.3	< 0.0001
Isoflavones (mg/d)	20.0 ± 1.0	21.5 ± 0.8	22.8 ± 0.7	23.9 ± 0.7	0.0091	14.7 ± 0.5	16.7 ± 0.5	17.6 ± 0.5	17.3 ± 0.5	0.6478
Total flavonoids (mg/d)	208.4 ± 20.3	267.1 ± 25.3	323.9 ± 19.0	429.1 ± 25.4	< 0.0001	188.4 ± 16.8	289.7 ± 24.1	322.2 ± 18.3	390.4 ± 19.3	< 0.0001

¹⁾ low (first quartile), middle-low (second quartile), middle-high (third quartile), high (fourth quartile) 2) P for trend value was from GLM (generalized linear model) analysis and adjusted for current smoking status, alcohol drinking status, physical activity and energy intake except for total energy, carbohydrate, protein, and fat variables.

Table 3.

Intakes of flavonoids and nutrients according to education level

Men					Women
Dietary intakes	≤ Elementary school	Middle school	High school	≥ College p	p for trend1)	≤ Elementary school	Middle school	High school	≥ College p	p for trend¹⁾
Nutrients
Total energy (kcal/d)	2,012.8 ± 21.1	2,205.7 ± 24.4	2,362.3 ± 17.3	2,374.4 ± 17.4	< 0.0001	1,472.4 ± 10.0	1,651.7 ± 17.5	1,692.1 ± 10.5	1,806.6 ± 12.2	< 0.0001
Carbohydrate (% of total energy)	69.9 ± 0.4	65.8 ± 0.5	61.7 ± 0.3	61.2 ± 0.3	< 0.0001	76.3 ± 0.2	71.0 ± 0.4	66.2 ± 0.2	64.4 ± 0.2	< 0.0001
Protein (% of total energy)	12.9 ± 0.1	13.8 ± 0.1	14.6 ± 0.1	15.1 ± 0.1	< 0.0001	12.7 ± 0.1	14.1 ± 0.1	14.7 ± 0.1	15.0 ± 0.1	< 0.0001
Fat (% of total energy)	5.5 ± 0.1	6.5 ± 0.1	8.5 ± 0.1	8.8 ± 0.1	< 0.0001	5.1 ± 0.1	6.7 ± 0.1	8.5 ± 0.1	9.3 ± 0.1	< 0.0001
Dietary fiber (g/d)	7.7 ± 0.1	8.3 ± 0.2	7.9 ± 0.1	8.3 ± 0.1	< 0.0001	6.4 ± 0.1	7.5 ± 0.2	6.9 ± 0.1	6.9 ± 0.1	< 0.0001
Vitamin A(μg RE/d)	703.0 ± 29.9	858.4 ± 29.8	908.5 ± 21.1	1,023.3 ± 22.7	< 0.0001	624.4 ± 22.1	769.6 ± 20.7	810.4 ± 26.1	829.4 ± 15.3	< 0.0001
Vitamin C (mg/d)	95.1 ± 2.4	109.4 ± 3.1	110.8 ± 1.9	121.6 ± 1.9	< 0.0001	84.0 ± 1.5	106.7 ± 2.5	106.4 ± 1.8	114.5 ± 2.0	< 0.0001
Flavonoids (mg/d)
Flavonols (mg/d)	25.6 ± 2.1	35.7 ± 3.4	51.2 ± 3.7	91.3 ± 6.6	< 0.0001	22.5 ± 1.6	43.6 ± 5.1	57.4 ± 4.6	82.3 ± 6.0	< 0.0001
Flavones (mg/d)	1.2 ± 0.0	1.4 ± 0.1	1.4 ± 0.1	1.5 ± 0.0	0.8056	0.9 ± 0.0	1.1 ± 0.0	1.3 ± 0.2	1.1 ± 0.0	0.9518
Flavanones (mg/d)	5.2 ± 0.6	6.6 ± 1.0	8.3 ± 0.6	9.1 ± 0.6	0.8551	5.8 ± 0.4	11.1 ± 0.8	10.8 ± 0.6	13.1 ± 0.8	0.6653
Flavan-3-ols (mg/d)	29.7 ± 6.2	50.9 ± 10.0	100.2 ± 11.4	223.5 ± 20.5	0.0009	30.6 ± 4.7	90.2 ± 15.5	139.5 ± 14.3	213.2 ± 18.7	0.0169
Anthocyanins (mg/d)	21.2 ± 2.3	29.2 ± 2.2	41.4 ± 1.4	45.0 ± 1.5	< 0.0001	20.1 ± 1.1	28.7 ± 1.4	36.0 ± 1.4	40.3 ± 1.5	< 0.0001
Proanthocyanidin (mg/d)	62.5 ± 5.2	59.8 ± 5.8	57.6 ± 3.3	65.6 ± 3.8	0.5073	58.0 ± 3.4	78.1 ± 6.2	65.0 ± 3.1	82.2 ± 4.4	0.1556
Isoflavones (mg/d)	22.6 ± 1.1	24.3 ± 1.3	21.4 ± 0.6	23.2 ± 0.6	0.4884	16.6 ± 0.5	19.1 ± 1.0	16.0 ± 0.4	17.3 ± 0.5	0.0715
Total flavonoids (mg/d)	168.1 ± 10.4	207.9 ± 14.8	281.5 ± 15.9	459.3 ± 27.3	< 0.0001	154.5 ± 7.6	271.9 ± 21.8	326.1 ± 19.0	449.5 ± 25.2	< 0.0001

¹⁾ P for trend value was from GLM (generalized linear model) analysis and adjusted for current smoking status, alcohol drinking status, physical activity and energy intake except for tota energy, carbohydrate, protein, and fat variables.

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