Study on relationship between caffeine intake level and metabolic syndrome and related diseases in Korean adults: 2013~2016 Korea National Health and Nutrition Examination Survey

Jung-Sug Lee; Hyoung-Seop Park; Sanghoon Han; Gegen Tana; Moon-Jeong Chang

doi:10.4163/jnh.2019.52.2.227

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Lee, Park, Han, Tana, and Chang: Study on relationship between caffeine intake level and metabolic syndrome and related diseases in Korean adults: 2013~2016 Korea National Health and Nutrition Examination Survey

Research Article

J Nutr Health 2019;52(2):227-241.

Published online: 19 January 2019

DOI: https://doi.org/10.4163/jnh.2019.52.2.227

Study on relationship between caffeine intake level and metabolic syndrome and related diseases in Korean adults: 2013~2016 Korea National Health and Nutrition Examination Survey

Jung-Sug Lee, Hyoung-Seop Park, Sanghoon Han, Gegen Tana, Moon-Jeong Chang^†

Department of Food and Nutrition, Kookmin University, Seoul 02707, Korea

^† To whom correspondence should be addressed. tel: +82-2-910-4776, e-mail: cmoon@kookmin.ac.kr

Received 26 February 2019 Revised 15 March 2019 Accepted 22 March 2019

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:

This study examined the relationship between caffeine intake and metabolic syndrome in Korean adults using the 2013~2016 Korea National Health and Nutrition Examination Survey data (KNHANES).

Methods:

The caffeine database (DB) developed by Food and Drug Safety Assessment Agency in 2014 was used to estimate the caffeine consumption. The food and beverage consumption of the 24 hr recall data of 2013~2016 KNHANES were matched to items in the caffeine DB and the daily caffeine intakes of the individuals were calculated. The sample was limited to non-pregnant healthy adults aged 19 years and older, who were not taking any medication for disease treatment.

Results:

The average daily caffeine intake was 41.97 mg, and the daily intake of caffeine of 97% of the participants was from coffee, teas, soft drinks, and other beverages. Multivariate analysis showed that the caffeine intake did not affect metabolic syndrome, hypertension, low HDL-cholesterol, and abdominal obesity. Diabetes and hypertriglyceridemia, however, were 0.76 (95% CI: 0.63~0.93), and 0.87 (95% CI: 0.77~0.98) in third quintile (Q3), and 0.66 (95% CI: 0.53 ~0.82) and 0.83 (95% CI: 0.73~0.94) in fourth quintile (Q4) compared to Q1, respectively. Therefore, caffeine intake of 3.66~45.81 mg per day is related to a lower risk of diabetes and hypertriglyceridemia.

Conclusion:

The study showed that adequate caffeine intake (approximately 45 mg) was associated with a lower prevalence of diabetes and hypertriglyceridemia. Therefore, it can be used as a guideline for the adequate level of caffeine intake for maintaining health.

Keywords: caffeine, metabolic syndrome, diabetes, hypertriglyceridemia, KNHANES

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Fig. 1

The prodecure of selecting the subjects

Table 1.

General characteristics of subjects by caffeine groups

	Total	Q1	Q2	Q3	Q4	Q5	p-value
	Total	(0.00)	(0.00 < ~ 3.66)	(3.66 < ~ 12.31)	(12.31 < ~ 45.81)	(≥ 45.81)	p-value
No	20,558	5,219	2,996	4,181	4,093	4,069
Sex¹⁾
Male	8,428 (49.53)	1,905 (46.03)	1,147 (44.42)	1,594 (44.02)	2,029 (57.36)	1,753 (53.48)	< 0.0001
Female	12,130 (50.47)	3,314 (53.97)	1,849 (55.58)	2,587 (55.98)	2,064 (42.64)	2,316 (46.52)
Age (year)²⁾	46.69 ± 0.21	47.86 ± 0.39^b	51.23 ± 0.42^a	50.74 ± 0.36^a	46.40 ± 0.32^c	39.91 ± 0.31^d	< 0.0001
Height (cm)²⁾	164.22 ± 0.10	163.14 ± 0.19^c	162.67 ± 0.23^d	162.45 ± 0.19^d	165.06 ± 0.18^b	166.90 ± 0.17^a	< 0.0001
Weight (kg)²⁾	64.56 ± 0.12	63.63 ± 0.26^c	63.38 ± 0.28^c	63.13 ± 0.24^c	65.26 ± 0.25^b	66.70 ± 0.27^a	< 0.0001
BMI (kg/m²)²⁾	23.83 ± 0.04	23.79 ± 0.07	23.89 ± 0.08	23.83 ± 0.07	23.86 ± 0.07	23.82 ± 0.08	0.8933
Caffeine intake (mg/day)²⁾
Mean	41.97 ± 0.89	0.00 ± 0.00^e	1.42 ± 0.02^d	6.94 ± 0.04^c	21.65 ± 0.19^b	154.41 ± 2.33^a	< 0.0001
Median	6.68 ± 0.19	0.00 ± 0.00	1.40 ± 0.03	6.37 ± 0.03	19.10 ± 0.08	120.71 ± 2.14
Sugar intake (mg/day)^2),3)	71.29 ± 0.57	62.40 ± 0.98^d	69.21 ± 1.05^c	69.57 ± 0.97^c	75.26 ± 0.98^b	81.46 ± 1.17^a	< 0.0001
Energy intake (mg/day)^2),3)	1,963.11 ± 7.71	1,855.31 ± 14.49^c	1,938.65 ± 18.40^b	1,966.24 ± 15.16^b	2,041.39 ± 16.37^a	2,031.58 ± 18.08^a	< 0.0001
Protein intake (mg/day)^2),3)	67.59 ± 0.35	64.31 ± 0.66^d	67.60 ± 0.79^b	66.18 ± 0.67^bc	68.80 ± 0.80^b	71.81 ± 0.85^a	< 0.0001
Fat intake (mg/day)^2),3)	41.66 ± 0.29	36.81 ± 0.57^d	40.87 ± 0.76^c	40.71 ± 0.62^c	43.52 ± 0.65^b	47.30 ± 0.76^a	< 0.0001
Individual income¹⁾
Low	4,897 (24.25)	1,340 (26.11)	680 (23.36)	1,039 (25.43)	1,092 (27.61)	746 (18.93)	< 0.0001
Medium-low	5,109 (24.52)	1,326 (25.08)	785 (25.82)	1,064 (24.42)	1,055 (25.73)	879 (22.22)
Medium-high	5,167 (24.91)	1,238 (23.57)	750 (24.96)	1,093 (25.48)	1,000 (24.15)	1,086 (26.48)
High	5,286 (26.31)	1,279 (25.25)	768 (25.86)	965 (24.67)	932 (22.50)	1,342 (32.38)
House income¹⁾
Low	4,021 (15.26)	1,400 (21.15)	636 (17.70)	965 (17.90)	738 (14.53)	282 (6.38)	< 0.0001
Medium-low	5,105 (23.86)	1,305 (23.85)	772 (24.16)	1,132 (25.63)	1,056 (25.92)	840 (20.44)
Medium-high	5,478 (28.91)	1,200 (26.07)	811 (29.09)	1,048 (27.68)	1,177 (30.35)	1,242 (31.42)
High	5,855 (31.97)	1,278 (28.93)	764 (29.05)	1,016 (28.79)	1,108 (29.21)	1,689 (41.76)
Education level¹⁾
Elementary school or lower	4,467 (15.87)	1,579 (22.12)	783 (21.40)	1,144 (21.86)	752 (13.52)	209 (3.64)	< 0.0001
Middle school graduation	2,009 (8.92)	539 (9.65)	386 (12.00)	450 (10.71)	431 (9.94)	203 (4.10)
High school graduation	6,253 (36.86)	1,468 (36.80)	910 (35.09)	1,184 (34.44)	1,351 (40.11)	1,340 (37.01)
College or higher	6,296 (38.35)	1,209 (31.43)	745 (31.51)	1,068 (32.99)	1,217 (36.43)	2,057 (55.25)
Alcohol drinker^1),4)
Non drinker	9,225 (40.99)	2,742 (47.32)	1,378 (42.70)	2,009 (45.32)	1,685 (38.76)	1,411 (32.08)	< 0.0001
Drinker	10,422 (59.01)	2,197 (52.68)	1,510 (57.30)	1,976 (54.68)	2,213 (61.24)	2,526 (67.92)
Smoking^1),5)
Non smoker	16,240 (78.14)	4,393 (84.65)	2,467 (81.72)	3,362 (81.22)	2,903 (70.13)	3,115 (74.09)	< 0.0001
Smoker	3,388 (21.86)	543 (15.35)	421 (18.28)	614 (18.78)	988 (29.87)	822 (25.91)
Aerobic activity^1),6)
Non activity	10,240 (49.41)	2,663 (50.04)	1,509 (51.03)	2,168 (53.12)	2,091 (51.25)	1,809 (43.30)	< 0.0001
Activity	8,741 (50.59)	2,108 (49.96)	1,307 (48.97)	1,673 (46.88)	1,652 (48.75)	2,001 (56.70)

¹⁾ n (%)

²⁾ Mean ± SE

³⁾ Sex, age adjusted mean ± SE

⁴⁾ Current drinker: People who drink more than once a month

⁵⁾ Smoker: Smoking more than 5 packs of cigarette for lifetime and now smoking

⁶⁾ Current activity: This is the case of exercising more than 2 hours and 30 minutes with moderate intensity physical activity or more than 1 hour and 15 minutes of high intensity physical activity per week.

abc: significantly different at α = 0.05 by turkey's test

Table 2.

Food and caffeine intake by caffeine source food groups by caffeine groups

	Total	Q1	Q2	Q3	Q4	Q5	p-value
	(n = 20,558)	(n = 5,219)	(n = 2,996)	(n = 4,181)	(n = 4,093)	(n = 4,069)	p-value
Food intake¹⁾
Processed milk and Soybean milk²⁾	2.94 ± 0.29	0.00 ± 0.00^c	0.00 ± 0.00^c	0.00 ± 0.00^c	0.23 ± 0.09^b	12.40 ± 1.24^a	< 0.0001
Processed grain, sugar and cereals³⁾	0.09 ± 0.02	0.00 ± 0.00^c	0.22 ± 0.09^a	0.20 ± 0.11^a	0.02 ± 0.01^b	0.09 ± 0.04^a	0.0012
Cookie, bread, and chewing gum⁴⁾	2.62 ± 0.16	0.04 ± 0.01^d	2.12 ± 0.23^c	3.11 ± 0.33^ab	4.43 ± 0.52^a	3.57 ± 0.37^a	< 0.0001
Ice cream⁵⁾	1.55 ± 0.13	0.07 ± 0.03^b	2.32 ± 0.38^a	1.78 ± 0.27^a	2.34 ± 0.40^a	1.76 ± 0.25^a	< 0.0001
Coffee	82.11 ± 2.06	0.01 ± 0.01^e	2.18 ± 0.05^d	11.30 ± 0.10^c	26.49 ± 0.47^b	318.37 ± 5.92^a	< 0.0001
Tea	15.56 ± 0.85	0.00 ± 0.00^e	0.02 ± 0.01^d	0.06 ± 0.02^c	14.87 ± 0.99^b	53.48 ± 3.42^a	< 0.0001
Chocolate and Processed cocoa	1.75 ± 0.21	0.00 ± 0.00^e	0.49 ± 0.06^d	1.42 ± 0.13^c	2.32 ± 0.29^b	4.04 ± 0.88^a	< 0.0001
Soda and other processed drink⁶⁾	31.14 ± 1.35	0.00 ± 0.00^e	0.07 ± 0.04^d	4.44 ± 0.46^c	53.04 ± 2.39^b	82.78 ± 5.08^a	< 0.0001
Caffeine intake¹⁾
Processed milk and Soybean milk²⁾	0.81 ± 0.08	0.00 ± 0.00^c	0.00 ± 0.00^c	0.00 ± 0.00^c	0.06 ± 0.03^b	3.44 ± 0.34^a	< 0.0001
Processed grain, sugar and cereals³⁾	0.01 ± 0.00	0.00 ± 0.00^b	0.01 ± 0.01^a	0.02 ± 0.01^a	0.00 ± 0.00^b	0.01 ± 0.00^a	0.0028
Cookie, bread, and chewing gum⁴⁾	0.17 ± 0.01	0.00 ± 0.00^d	0.11 ± 0.01^c	0.20 ± 0.02^b	0.30 ± 0.04^a	0.22 ± 0.02^b	< 0.0001
Ice cream⁵⁾	0.07 ± 0.01	0.00 ± 0.00^c	0.03 ± 0.01^b	0.11 ± 0.02^a	0.13 ± 0.03^a	0.10 ± 0.02^a	< 0.0001
Coffee	35.06 ± 0.86	0.00 ± 0.00^e	1.15 ± 0.02^d	5.99 ± 0.06^c	13.62 ± 0.23^b	132.83 ± 2.46^a	< 0.0001
Tea	2.35 ± 0.13	0.00 ± 0.00^d	0.00 ± 0.00^d	0.01 ± 0.00^c	2.24 ± 0.15^b	8.06 ± 0.52^a	< 0.0001
Chocolate and Processed cocoa	0.47 ± 0.08	0.00 ± 0.00^e	0.10 ± 0.01^d	0.31 ± 0.03^c	0.52 ± 0.07^b	1.24 ± 0.32^a	< 0.0001
Soda and other processed drink⁶⁾	3.04 ± 0.14	0.00 ± 0.00^e	0.01 ± 0.00^d	0.31 ± 0.03^c	4.78 ± 0.22^b	8.52 ± 0.54^a	< 0.0001

¹⁾ Sex, age adjusted mean ± SE

²⁾ Processed milk and Soybean milk contain ingredients of green tea or chocolate or coffee or cocoa

³⁾ Processed grain, sugar and cereals contain ingredients of cocoa or chocolate

⁴⁾ Cookie, bread, and chewing gum contain ingredients of cocoa or chocolate

⁵⁾ Ice cream contains ingredients of green tea, chocolate, coffee or cocoa

⁶⁾ Processed drink is a high caffeine drink that contain guarana extract.

abc: significantly different at α = 0.05 by turkey's test

Table 3.

Blood pressure, waist circumference, blood glucose and lipid profile by caffeine groups

	Total	Q1	Q2	Q3	Q4	Q5	p-Value
	(n = 20,558)	(n = 5,219)	(n = 2,996)	(n = 4,181)	(n = 4,093)	(n = 4,069)	p-Value
Systolic blood pressure (mmHg)	118.59 ± 0.17	118.98 ± 0.29^a	119.09 ± 0.36^a	118.81 ± 0.29^a	118.47 ± 0.28^a	117.66 ± 0.29^b	0.0017
Diastolic blood pressure (mmHg)	75.08 ± 0.12	74.29 ± 0.19^b	75.54 ± 0.27^a	75.25 ± 0.21^a	75.34 ± 0.21^a	75.29 ± 0.21^a	< 0.0001
Waist circumference (cm)	62.87 ± 0.09	62.57 ± 0.20^b	62.87 ± 0.23^b	62.64 ± 0.20^b	62.51 ± 0.21^b	63.84 ± 0.23^a	0.0001
Fast blood glucose (mg/dL)	99.97 ± 0.22	100.41 ± 0.48	100.06 ± 0.51	100.14 ± 0.46	99.23 ± 0.38	99.93 ± 0.43	0.3180
Total cholesterol (mg/dL)	191.62 ± 0.37	188.20 ± 0.64^c	191.27 ± 0.93^b	190.82 ± 0.76^b	194.16 ± 0.77^a	194.12 ± 0.71^a	< 0.0001
HDL-cholesterol (mg/dL)	51.14 ± 0.12	50.51 ± 0.21^b	51.68 ± 0.31^a	51.36 ± 0.26^a	51.25 ± 0.26^a	51.15 ± 0.23^a	0.0107
Triglyceride (mg/dL)	137.90 ± 1.06	139.96 ± 2.31	136.91 ± 3.40	136.55 ± 2.22	139.06 ± 2.53	136.41 ± 2.30	0.7680

Sex, age adjusted mean ± SE

abc: significantly different at α = 0.05 by turkey's test

Table 4.

Logistic regression analysis between daily caffeine intake and metabolic syndrome

	Normal	Disease	Crude	Sex, age adjusted	Multivariate adjusted¹⁾
Hypertension
Q1 (0.00 mg)	2,945 (23.43)²⁾	2,098 (25.02)	1	1	1
Q2 (≤ 3.66 mg)	1,579 (11.81)	1,290 (15.69)	1.24 (1.10, 1.41)³⁾	1.11 (0.97, 1.27)	1.16 (1.00, 1.33)
Q3 (3.66 < ~ 12.31 mg)	2,292 (17.45)	1,716 (20.99)	1.13 (1.01, 1.26)	1.00 (0.89, 1.14)	1.00 (0.87, 1.14)
Q4 (12.31 < ~ 45.81 mg)	2,503 (20.97)	1,467 (20.49)	0.92 (0.82, 1.02)	0.94 (0.83, 1.07)	0.94 (0.82, 1.08)
Q5 (≥ 45.85 mg)	2,905 (26.34)	1,068 (17.81)	0.63 (0.57, 0.71)	0.99 (0.87, 1.13)	1.08 (0.94, 1.24)
p for trend			< 0.0001	0.3509	0.9211
Diabetes
Q1 (0.00 mg)	4,129 (22.89)	615 (29.69)	1	1	1
Q2 (≤ 3.66 mg)	2,449 (12.83)	372 (16.97)	1.02 (0.85, 1.22)	0.89 (0.74, 1.07)	0.94 (0.77, 1.14)
Q3 (3.66 < ~ 12.31 mg)	3,482 (18.56)	426 (20.70)	0.86 (0.72, 1.02)	0.76 (0.63, 0.91)	0.76 (0.63, 0.93)
Q4 (12.31 < ~ 45.81 mg)	3,553 (21.29)	341 (17.19)	0.62 (0.51, 0.75)	0.67 (0.55, 0.82)	0.66 (0.53, 0.82)
Q5 (≥ 45.85 mg)	3,672 (24.44)	244 (15.45)	0.49 (0.39, 0.60)	0.86 (0.68, 1.08)	1.00 (0.78, 1.27)
p for trend			< 0.0001	0.0062	0.0548
Abdominal obesity
Q1 (0.00 mg)	3,744 (23.61)	1,465 (25.00)	1	1	1
Q2 (≤ 3.66 mg)	2,113 (13.09)	880 (13.54)	0.98 (0.86, 1.12)	0.91 (0.80, 1.04)	0.93 (0.80, 1.07)
Q3 (3.66 < ~ 12.31 mg)	2,950 (18.29)	1,226 (20.17)	1.04 (0.92, 1.18)	0.99 (0.87, 1.12)	0.99 (0.87, 1.13)
Q4 (12.31 < ~ 45.81 mg)	3,004 (20.91)	1,082 (20.27)	0.92 (0.81, 1.04)	0.92 (0.81, 1.05)	0.94 (0.81, 1.08)
Q5 (≥ 45.85 mg)	3,106 (24.09)	956 (21.03)	0.83 (0.73, 0.94)	0.99 (0.87, 1.13)	1.06 (0.92, 1.22)
p for trend			0.0019	0.8405	0.5458
Low HDL-cholesterol
Q1 (0.00 mg)	2,483 (22.22)	2,280 (25.51)	1	1	1
Q2 (≤ 3.66 mg)	1,514 (12.46)	1,319 (14.31)	1.00 (0.88, 1.13)	0.87 (0.76, 0.99)	0.89 (0.78, 1.02)
Q3 (3.66 < ~ 12.31 mg)	2,121 (17.79)	1,798 (20.25)	0.99 (0.89, 1.11)	0.88 (0.79, 0.99)	0.89 (0.79, 1.00)
Q4 (12.31 < ~ 45.81 mg)	2,290 (21.40)	1,611 (20.19)	0.82 (0.74, 0.92)	0.89 (0.79, 1.01)	0.89 (0.79, 1.01)
Q5 (≥ 45.85 mg)	2,519 (26.13)	1,403 (19.74)	0.66 (0.59, 0.74)	0.86 (0.77, 0.98)	0.90 (0.79, 1.03)
p for trend			< 0.0001	0.0339	0.1277
Hypertriglyceridemia
Q1 (0.00 mg)	2,819 (23.04)	1,944 (24.26)	1	1	1
Q2 (≤ 3.66 mg)	1,644 (12.61)	1,189 (14.15)	1.07 (0.94, 1.20)	0.95 (0.84, 1.07)	0.93 (0.82, 1.06)
Q3 (3.66 < ~ 12.31 mg)	2,398 (18.48)	1,521 (19.18)	0.99 (0.88, 1.10)	0.90 (0.80, 1.01)	0.87 (0.77, 0.98)
Q4 (12.31 < ~ 45.81 mg)	2,434 (21.03)	1,467 (20.76)	0.94 (0.83, 1.05)	0.88 (0.78, 0.99)	0.83 (0.73, 0.94)
Q5 (≥ 45.85 mg)	2,598 (24.84)	1,324 (21.65)	0.83 (0.74, 0.93)	1.00 (0.89, 1.13)	0.99 (0.87, 1.13)
p for trend			0.0003	0.5598	0.3432
Metabolic syndrome
Q1 (0.00 mg)	3,797 (23.43)	1,422 (25.97)	1	1	1
Q2 (≤ 3.66 mg)	2,123 (12.60)	873 (15.40)	1.10 (0.97, 1.26)	1.00 (0.87, 1.14)	1.00 (0.87, 1.15)
Q3 (3.66 < ~ 12.31 mg)	3,043 (18.11)	1,138 (21.19)	1.06 (0.93, 1.20)	0.97 (0.85, 1.11)	0.93 (0.81, 1.07)
Q4 (12.31 < ~ 45.81 mg)	3,168 (21.16)	925 (19.25)	0.82 (0.72, 0.94)	0.88 (0.77, 1.02)	0.86 (0.74, 1.00)
Q5 (≥ 45.85 mg)	3,318 (24.71)	751 (18.18)	0.66 (0.58, 0.76)	1.02 (0.88, 1.17)	1.06 (0.91, 1.24)
p for trend			< 0.0001	0.5530	0.7170

¹⁾ Adjusted for age, sex (male, female), education (elementary school or lower, middle school, high school, college or higher), alcohol drinking (drinker, non-drinker), aerobic activity (activity, non-activity), smoking (smoker, non-smoker), individual income (low, medium-low, medium-high, high), total sugar intake, total energy intake

²⁾ n (%)

³⁾ Odds ratio (95% confidence intervals)

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