Dietary Protein to Carbohydrate Ratio and Incidence of Metabolic Syndrome in Korean Adults Based on a Long-Term Prospective Community-Based Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Dietary Assessment
2.3. Definition of MS
2.4. Statistical Analysis
3. Results
3.1. General Characteristics
3.2. Cox Proportional Hazard Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Men (n = 3320) | Women (n = 3015) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Quintile of Intake (p/c) | 1 (Lowest) | 2 | 3 | 4 | 5 | 1 (Lowest) | 2 | 3 | 4 | 5 |
P/c ratio, median (25–75%) | 0.14 (0.129–0.148) | 0.17 (0.162–0.174) | 0.19 (0.185–0.196) | 0.22 (0.209–0.224) | 0.27 (0.247–0.290) | 0.14 (0.126–0.147) | 0.17 (0.161–0.173) | 0.19 (0.183–0.196) | 0.22 (0.208–0.225) | 0.26 (0.243–0.285) |
Metabolic syndrome (number) | 233 | 243 | 232 | 232 | 258 | 295 | 245 | 229 | 193 | 207 |
Age, years | 54.77 ± 9.32 | 52.09 ± 8.91 | 50.53 ± 8.37 | 49.68 ± 8.06 | 49.04 ± 7.97 | 54.63 ± 9.17 | 50.19 ± 8.36 | 49.77 ± 8.45 | 48.44 ± 7.42 | 47.35 ± 7.08 |
Follow-up, mo | 92.93 ± 45.35 | 91.43 ± 47.19 | 94.36 ± 46.42 | 96.36 ± 46.76 | 92.61 ± 46.00 | 81.23 ± 49.07 | 93.00 ± 49.22 | 95.19 ± 47.55 | 98.91 ± 47.15 | 95.93 ± 46.96 |
Area of residence (%) | ||||||||||
Ansung | 73.34 | 50.00 | 35.39 | 30.42 | 30.57 | 73.30 | 45.77 | 32.67 | 24.21 | 32.84 |
Ansan | 26.66 | 50.00 | 64.61 | 69.58 | 69.43 | 26.70 | 54.23 | 67.33 | 75.79 | 67.16 |
Monthly household income (%) | ||||||||||
<1000 USD | 49.32 | 32.42 | 23.79 | 16.16 | 14.42 | 59.86 | 33.62 | 30.05 | 21.51 | 18.72 |
1000–1999 USD | 30.14 | 31.52 | 30.91 | 29.61 | 30.80 | 25.56 | 34.30 | 34.56 | 27.56 | 30.02 |
2000–2999 USD | 14.00 | 18.94 | 21.82 | 23.87 | 22.31 | 8.92 | 19.52 | 18.03 | 27.56 | 25.46 |
≥3000 USD | 6.54 | 17.12 | 23.48 | 30.36 | 32.47 | 5.66 | 12.56 | 17.36 | 23.36 | 25.80 |
Education (%) | ||||||||||
≤Elementary school | 35.41 | 22.84 | 15.56 | 12.67 | 11.18 | 60.91 | 39.60 | 30.78 | 21.63 | 19.44 |
Middle-high school | 54.10 | 58.40 | 62.39 | 60.03 | 58.16 | 36.58 | 54.74 | 59.73 | 68.05 | 69.10 |
≥College | 10.49 | 18.76 | 22.05 | 27.30 | 30.66 | 2.52 | 5.66 | 9.48 | 10.32 | 11.46 |
Smoking (%) | ||||||||||
Never | 20.27 | 19.31 | 22.74 | 19.31 | 15.76 | 95.97 | 96.28 | 96.49 | 94.82 | 93.25 |
Ex-smoker | 28.14 | 28.81 | 29.97 | 30.47 | 31.36 | 0.84 | 1.35 | 0.67 | 1.84 | 1.18 |
Current smoker | 51.59 | 51.89 | 47.29 | 50.23 | 52.88 | 3.19 | 2.37 | 2.84 | 3.34 | 5.56 |
Smoking (pack-years) | 20.84 ± 18.79 | 18.76 ± 19.07 | 16.94 ± 16.59 | 18.51 ± 18.08 | 18.83 ± 17.00 | 0.43 ± 3.00 | 0.22 ± 2.31 | 0.20 ± 1.60 | 0.42 ± 2.83 | 0.46 ± 2.83 |
Alcohol consumption (%) | ||||||||||
Never | 25.04 | 19.34 | 21.08 | 14.78 | 12.08 | 75.08 | 69.88 | 64.17 | 67.22 | 61.36 |
Ex-drinker | 14.03 | 9.06 | 8.43 | 7.09 | 7.25 | 1.84 | 2.33 | 3.67 | 1.33 | 3.48 |
Current drinker | 60.94 | 71.6 | 70.48 | 78.13 | 80.66 | 23.08 | 27.79 | 32.17 | 31.45 | 35.16 |
Alcohol consumption (g/d) | 13.25 ± 26.64 | 16.69 ± 26.39 | 15.72 ± 23.68 | 20.85 ± 27.37 | 24.67 ± 32.76 | 0.86 ± 4.30 | 1.07 ± 3.63 | 1.49 ± 5.03 | 1.47 ± 4.91 | 2.66 ± 8.71 |
Physical activity (MET—min/wk) | 11575.32 ± 7076.82 | 10593.24 ± 6683.26 | 9772.38 ± 6398.75 | 9882.10 ± 6096.15 | 9262.22 ± 6146.33 | 9971.77 ± 6852.45 | 9479.45 ± 6285.19 | 8503.67 ± 5371.83 | 8555.62 ± 5239.10 | 8548.53 ± 5237.62 |
Body Mass Index (kg/m2) | 22.97 ± 2.60 | 23.37 ± 2.67 | 23.62 ± 2.69 | 23.66 ± 2.55 | 23.95 ± 2.63 | 23.5 ± 3.35 | 24.07 ± 3.01 | 24.00 ± 2.85 | 23.89 ± 2.73 | 23.89 ± 2.92 |
Waist circumference (cm) | 80.76 ± 6.84 | 81.21 ± 7.03 | 81.41 ± 6.80 | 81.32 ± 6.27 | 82.65 ± 6.33 | 78.76 ± 9.07 | 78.22 ± 8.55 | 77.45 ± 7.90 | 76.24 ± 7.74 | 76.58 ± 8.02 |
Triglycerides (mg/dL) | 148.18 ± 103.66 | 149.25 ± 81.90 | 155.74 ± 104.51 | 150.48 ± 81.94 | 151.81 ± 100.79 | 116.16 ± 44.87 | 118.15 ± 63.41 | 113.74 ± 41.47 | 111.70 ± 42.78 | 114.24 ± 58.24 |
HDL cholesterol (mg/dL) | 45.13 ± 10.01 | 45.58 ± 10.17 | 45.44 ± 9.63 | 46.26 ± 10.23 | 45.79 ± 9.95 | 49.20 ± 10.29 | 48.21 ± 10.06 | 48.36 ± 10.48 | 48.81 ± 9.67 | 49.70 ± 10.41 |
Systolic blood pressure (mmHg) | 120.88 ± 16.49 | 119.35 ± 17.03 | 117.79 ± 15.82 | 118.72 ± 15.81 | 117.67 ± 15.28 | 118.37 ± 17.2 | 113.43 ± 15.93 | 112.34 ± 15.12 | 111.53 ± 16.13 | 111.36 ± 14.86 |
Diastolic blood pressure (mmHg) | 80.18 ± 9.83 | 79.62 ± 10.70 | 79.17 ± 10.99 | 80.12 ± 10.22 | 79.90 ± 10.55 | 77.36 ± 9.99 | 74.71 ± 9.80 | 73.78 ± 9.60 | 73.63 ± 10.34 | 73.65 ± 10.27 |
Fasting plasma glucose (mg/dL) | 83.28 ± 11.58 | 85.56 ± 16.55 | 87.67 ± 20.79 | 87.48 ± 14.39 | 89.12 ± 20.10 | 80.88 ± 9.44 | 81.01 ± 11.50 | 81.94 ± 15.13 | 81.23 ± 10.54 | 81.13 ± 8.01 |
Menopausal status (yes%) | - | - | - | - | - | 69.62 | 52.83 | 48.00 | 45.23 | 39.13 |
Daily dietary intake | ||||||||||
Total energy intake (kcal/day) | 1767.95 ± 631.10 | 1870.29 ± 524.25 | 1941.12 ± 525.71 | 2066.23 ± 500.90 | 2223.07 ± 617.24 | 1674.89 ± 622.08 | 1789.61 ± 564.93 | 1872.23 ± 548.54 | 1938.75 ± 572.58 | 2021.96 ± 719.26 |
Energy from protein (%) | 0.11 ± 0.01 | 0.13 ± 0.00 | 0.14 ± 0.01 | 0.15 ± 0.01 | 0.17 ± 0.02 | 0.11 ± 0.01 | 0.12 ± 0.00 | 0.13 ± 0.01 | 0.15 ± 0.01 | 0.17 ± 0.02 |
Energy from fat (%) | 0.10 ± 0.03 | 0.13 ± 0.03 | 0.15 ± 0.03 | 0.18 ± 0.03 | 0.22 ± 0.04 | 0.08 ± 0.03 | 0.12 ± 0.03 | 0.14 ± 0.03 | 0.17 ± 0.03 | 0.21 ± 0.05 |
Energy from carbohydrate (%) | 0.79 ± 0.03 | 0.74 ± 0.03 | 0.71 ± 0.02 | 0.68 ± 0.02 | 0.61 ± 0.05 | 0.81 ± 0.03 | 0.76 ± 0.02 | 0.72 ± 0.03 | 0.69 ± 0.03 | 0.62 ± 0.05 |
Protein intake (g/d) | 48.06 ± 17.11 | 58.36 ± 16.04 | 65.57 ± 17.33 | 75.78 ± 17.93 | 94.47 ± 28.87 | 44.97 ± 17.13 | 55.42 ± 17.5 | 63.09 ± 18.38 | 71.20 ± 20.62 | 85.09 ± 32.21 |
Fat intake (g/d) | 19.83 ± 11.51 | 27.65 ± 11.22 | 33.75 ± 12.59 | 41.11 ± 13.55 | 54.48 ± 20.63 | 15.75 ± 8.55 | 23.83 ± 10.07 | 29.54 ± 11.60 | 35.97 ± 13.64 | 47.45 ± 22.41 |
Carbohydrate intake (g/d) | 349.31 ± 122.59 | 347.01 ± 94.86 | 343.78 ± 89.60 | 348.28 ± 81.32 | 338.72 ± 92.50 | 338.32 ± 124.28 | 338.37 ± 105.15 | 338.51 ± 98.35 | 332.56 ± 96.44 | 313.64 ± 109.96 |
Quintile of Intake (p/c Ratio) | Ptrend2 | ||||||
---|---|---|---|---|---|---|---|
1 (Lowest) 1 | 2 | 3 | 4 | 5 | |||
Men | Model 1 | 1.00 | 1.18 (0.98–1.41) | 1.17 (0.97–1.41) | 1.14 (0.95–1.38) | 1.31 (1.09–1.57) | 0.013 |
Model 2 | 1.00 | 1.25 (1.04–1.51) | 1.31 (1.07–1.61) | 1.34 (1.08–1.67) | 1.73 (1.33–2.24) | 0.000 | |
Model 3 | 1.00 | 1.23 (1.01–1.49) | 1.29 (1.05–1.6) | 1.26 (1.00–1.59) | 1.66 (1.26–2.18) | 0.001 | |
Model 4 | 1.00 | 1.24 (1.02–1.51) | 1.25 (1.01–1.55) | 1.25 (0.99–1.58) | 1.43 (1.09–1.89) | 0.031 | |
Women | Model 1 | 1.00 | 1.04 (0.87–1.24) | 1.04 (0.87–1.24) | 0.96 (0.79–1.17) | 1.00 (0.82–1.2) | 0.739 |
Model 2 | 1.00 | 1.07 (0.89–1.28) | 1.09 (0.9–1.32) | 1.04 (0.83–1.31) | 1.14 (0.87–1.49) | 0.434 | |
Model 3 3 | 1.00 | 1.07 (0.89–1.29) | 1.08 (0.89–1.33) | 1.05 (0.83–1.33) | 1.13 (0.85–1.49) | 0.493 | |
Model 4 3 | 1.00 | 0.91 (0.76–1.1) | 0.95 (0.78–1.16) | 0.94 (0.75–1.19) | 0.97 (0.74–1.28) | 0.912 |
Quintile of Intake (p/c Ratio) | Ptrend2 | |||||||
---|---|---|---|---|---|---|---|---|
Component | 1 (Lowest) 1 | 2 | 3 | 4 | 5 | |||
High Waist Circumference | ||||||||
Men | Model 1 | 1.00 | 1.09 (0.9–1.33) | 1.11 (0.91–1.36) | 1.06 (0.86–1.3) | 1.23 (1.01–1.5) | 0.068 | |
Model 2 | 1.00 | 1.12 (0.91–1.36) | 1.16 (0.93–1.44) | 1.11 (0.88–1.41) | 1.35 (1.02–1.79) | 0.064 | ||
Model 3 | 1.00 | 1.1 (0.89–1.35) | 1.14 (0.9–1.43) | 1.08 (0.84–1.38) | 1.28 (0.95–1.73) | 0.156 | ||
Women | Model 1 | 1.00 | 1.24 (1.02–1.5) | 1.18 (0.96–1.45) | 1.2 (0.98–1.48) | 1.11 (0.91–1.35) | 0.575 | |
Model 2 | 1.00 | 1.28 (1.05–1.57) | 1.27 (1.02–1.58) | 1.34 (1.05–1.7) | 1.30 (0.99–1.71) | 0.105 | ||
Model 3 3 | 1.00 | 1.33 (1.08–1.63) | 1.26 (1.01–1.59) | 1.37 (1.07–1.77) | 1.34 (1.01–1.77) | 0.097 | ||
High triglycerides | ||||||||
Men | Model 1 | 1.00 | 0.97 (0.78–1.21) | 1.04 (0.83–1.31) | 1.08 (0.86–1.35) | 1.15 (0.92–1.43) | 0.114 | |
Model 2 | 1.00 | 1.02 (0.81–1.28) | 1.14 (0.9–1.46) | 1.24 (0.95–1.61) | 1.44 (1.05–1.96) | 0.010 | ||
Model 3 | 1.00 | 0.97 (0.77–1.23) | 1.06 (0.83–1.37) | 1.15 (0.88–1.52) | 1.39 (1–1.93) | 0.021 | ||
Model 4 | 1.00 | 0.98 (0.78–1.24) | 1.07 (0.83–1.38) | 1.16 (0.89–1.53) | 1.36 (0.98–1.89) | 0.031 | ||
Women | Model 1 | 1.00 | 1.03 (0.86–1.24) | 0.92 (0.76–1.11) | 0.93 (0.76–1.13) | 0.84 (0.68–1.02) | 0.043 | |
Model 2 | 1.00 | 1.08 (0.89–1.3) | 0.99 (0.8–1.22) | 1.05 (0.83–1.33) | 1.01 (0.77–1.34) | 0.998 | ||
Model 3 3 | 1.00 | 1.06 (0.87–1.3) | 0.98 (0.79–1.21) | 1.03 (0.81–1.31) | 1.00 (0.75–1.33) | 0.922 | ||
Model 4 3 | 1.00 | 1.00 (0.82–1.22) | 0.94 (0.76–1.16) | 1.00 (0.79–1.27) | 0.93 (0.70–1.25) | 0.682 | ||
Low HDL-cholesterol | ||||||||
Men | Model 1 | 1.00 | 0.95 (0.80–1.14) | 0.96 (0.8–1.15) | 0.89 (0.74–1.07) | 0.89 (0.74–1.08) | 0.186 | |
Model 2 | 1.00 | 0.96 (0.80–1.15) | 0.97 (0.79–1.18) | 0.90 (0.72–1.12) | 0.90 (0.69–1.18) | 0.379 | ||
Model 3 | 1.00 | 0.94 (0.77–1.14) | 0.94 (0.77–1.16) | 0.88 (0.7–1.11) | 0.91 (0.69–1.2) | 0.479 | ||
Model 4 | 1.00 | 0.93 (0.77–1.13) | 0.93 (0.76–1.15) | 0.87 (0.69–1.10) | 0.88 (0.66–1.15) | 0.327 | ||
Women | Model 1 | 1.00 | 0.90 (0.72–1.12) | 0.95 (0.76–1.19) | 0.93 (0.74–1.18) | 0.82 (0.64–1.04) | 0.141 | |
Model 2 | 1.00 | 0.93 (0.74–1.17) | 1.00 (0.78–1.28) | 1.02 (0.77–1.35) | 0.93 (0.67–1.31) | 0.814 | ||
Model 3 3 | 1.00 | 0.94 (0.74–1.19) | 0.99 (0.76–1.28) | 1.02 (0.76–1.37) | 0.93 (0.66–1.33) | 0.825 | ||
Model 4 3 | 1.00 | 0.93 (0.73–1.18) | 0.98 (0.76–1.27) | 1.01 (0.76–1.36) | 0.93 (0.65–1.32) | 0.808 | ||
High blood pressure | ||||||||
Men | Model 1 | 1.00 | 0.96 (0.80–1.10) | 0.95 (0.78–1.16) | 1.10 (0.90–1.34) | 1.03 (0.85–1.24) | 0.483 | |
Model 2 | 1.00 | 0.98 (0.8–1.19) | 0.98 (0.79–1.21) | 1.14 (0.91–1.43) | 1.09 (0.83–1.44) | 0.330 | ||
Model 3 | 1.00 | 0.99 (0.8–1.21) | 0.98 (0.79–1.22) | 1.12 (0.88–1.43) | 1.04 (0.78–1.39) | 0.604 | ||
Model 4 | 1.00 | 0.98 (0.8–1.2) | 0.96 (0.77–1.2) | 1.13 (0.89–1.43) | 0.99 (0.74–1.32) | 0.871 | ||
Women | Model 1 | 1.00 | 1.08 (0.9–1.29) | 1.00 (0.83–1.21) | 1.16 (0.95–1.41) | 1.08 (0.89–1.32) | 0.369 | |
Model 2 | 1.00 | 1.09 (0.91–1.31) | 1.01 (0.83–1.24) | 1.18 (0.94–1.49) | 1.12 (0.85–1.47) | 0.362 | ||
Model 3 3 | 1.00 | 1.06 (0.87–1.29) | 1.02 (0.83–1.25) | 1.2 (0.94–1.52) | 1.1 (0.83–1.47) | 0.395 | ||
Model 4 3 | 1.00 | 0.98 (0.81–1.19) | 0.99 (0.80–1.21) | 1.19 (0.93–1.50) | 1.03 (0.77–1.37) | 0.540 | ||
High fasting glucose | ||||||||
Men | Model 1 | 1.00 | 1.03 (0.88–1.21) | 1.16 (0.98–1.36) | 1.22 (1.04–1.44) | 1.21 (1.03–1.42) | 0.050 | |
Model 2 | 1.00 | 1.07 (0.90–1.26) | 1.23 (1.03–1.47) | 1.34 (1.11–1.62) | 1.42 (1.13–1.78) | 0.012 | ||
Model 3 | 1.00 | 1.09 (0.92–1.30) | 1.30 (1.08–1.56) | 1.34 (1.10–1.64) | 1.41 (1.11–1.81) | 0.019 | ||
Model 4 | 1.00 | 1.09 (0.92–1.30) | 1.27 (1.05–1.53) | 1.28 (1.05–1.57) | 1.28 (1.00–1.63) | 0.084 | ||
Women | Model 1 | 1.00 | 1.06 (0.90–1.26) | 0.97 (0.81–1.15) | 1.16 (0.97–1.39) | 1.10 (0.92–1.32) | 0.282 | |
Model 2 | 1.00 | 1.06 (0.90–1.26) | 0.97 (0.81–1.17) | 1.16 (0.95–1.43) | 1.11 (0.86–1.42) | 0.375 | ||
Model 3 3 | 1.00 | 1.04 (0.87–1.24) | 1.00 (0.83–1.21) | 1.23 (0.99–1.52) | 1.14 (0.88–1.48) | 0.268 | ||
Model 4 3 | 1.00 | 0.97 (0.81–1.16) | 0.92 (0.76–1.11) | 1.14 (0.92–1.41) | 1.07 (0.83–1.39) | 0.239 |
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Paik, J.K.; Park, M.; Shin, J.E.; Jang, S.-Y.; Shin, J.-Y. Dietary Protein to Carbohydrate Ratio and Incidence of Metabolic Syndrome in Korean Adults Based on a Long-Term Prospective Community-Based Cohort. Nutrients 2020, 12, 3274. https://doi.org/10.3390/nu12113274
Paik JK, Park M, Shin JE, Jang S-Y, Shin J-Y. Dietary Protein to Carbohydrate Ratio and Incidence of Metabolic Syndrome in Korean Adults Based on a Long-Term Prospective Community-Based Cohort. Nutrients. 2020; 12(11):3274. https://doi.org/10.3390/nu12113274
Chicago/Turabian StylePaik, Jean Kyung, Mira Park, Ji Eun Shin, Suk-Yong Jang, and Ji-Yeon Shin. 2020. "Dietary Protein to Carbohydrate Ratio and Incidence of Metabolic Syndrome in Korean Adults Based on a Long-Term Prospective Community-Based Cohort" Nutrients 12, no. 11: 3274. https://doi.org/10.3390/nu12113274