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Mediating effects of metabolic factors on the association between fruit or vegetable intake and cardiovascular disease: the Korean National Health and Nutrition Examination Survey.

ABSTRACT: We assessed the mediating effects of metabolic components on the relationship between fruit or vegetable intake and cardiovascular disease (CVD).Cross-sectional study.This study was conducted using data from the 2013-2015 Korean National Health and Nutrition Examination Survey, which is a national representative cross-sectional survey to assess health and nutritional status in the Korean population.A total of 9040 subjects (3555 males and 5485 females) aged ?25 years were included in the study. Physician-diagnosed CVD via self-report was used as the outcome. Fruit or vegetable intake was measured via a dish-based semiquantitative food frequency questionnaire and grouped into categories (<1?time/day, 1 time/day, 2 times/day and ?3?times/day). Systolic blood pressure (SBP), cholesterol and fasting glucose were considered metabolic mediators, and the bootstrap method was used to assess mediating effect.About 1.8% of adults aged 25-64?years had CVD. According to the result of 'process' macro, the confounder-adjusted risk for CVD decreased by 14% (OR=0.86, 95% CI 0.74 to 0.98) as fruit, but not vegetable, intake was increased by one unit per day. After additional adjustment for three metabolic factors simultaneously, the OR was attenuated to 0.89 (95% CI 0.77 to 1.03). This result indicates that the indirect effect of three metabolic factors accounted for 21.4% of the relationship between fruit intake and CVD. SBP was a more important metabolic mediator than the other factors. The indirect effect by metabolic factors accounted for 30.0% when body mass index was additionally controlled as a mediator, and SBP still had an independent effect compared with the other mediators.Our results indicate that controlling SBP may lessen the CVD risk, and a diet rich in fruits can regulate SBP which, in turn, reduces CVD risk.

SUBMITTER: Lee HA

PROVIDER: S-EPMC5855238 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Mediating effects of metabolic factors on the association between fruit or vegetable intake and cardiovascular disease: the Korean National Health and Nutrition Examination Survey.

Lee Hye Ah HA Lim Dohee D Oh Kyungwon K Kim Eun Jung EJ Park Hyesook H

BMJ open 20180228 2

<h4>Objective</h4>We assessed the mediating effects of metabolic components on the relationship between fruit or vegetable intake and cardiovascular disease (CVD).<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>This study was conducted using data from the 2013-2015 Korean National Health and Nutrition Examination Survey, which is a national representative cross-sectional survey to assess health and nutritional status in the Korean population.<h4>Method and analysis</h4>A total of 9040 subje ...[more]

PMID: 29490964

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Project description:INTRODUCTION:The objective of this study was to investigate whether caffeine intake is associated with urinary incontinence (UI) and quality of life (QOL) in Korean postmenopausal women. MATERIALS AND METHODS:We included 4,028 postmenopausal women who had participated in the Korea National Health and Nutrition Examination Survey IV (KNHANES IV). From the KNHANES questionnaire data, we ascertained the UI status of participants, defined as self-reported or medically diagnosed UI, and calculated their total daily caffeine intake through questions regarding the frequency of food consumption. The EuroQoL-5 Dimension (EQ-5D) descriptive system was used to evaluate QOL among the study population. RESULTS:The mean age of the study population was 63.19±0.25 years. Among the 4,028 women, the prevalence of medically diagnosed UI was 2.6% (n = 151), the prevalence of self-reported UI was 11.9% (n = 483), and the lifetime prevalence of UI was 15.8% (n = 639). In the study population, the presence of UI was not significantly different by age group, but daily caffeine consumption and the percentage of caffeine consumer decreased with age (P<0.001). Higher caffeine intake led to significantly higher prevalence of both medically diagnosed UI (p = 0.012) and self-reported UI (p = 0.040) in the study population. Even after adjusting for factors including age, parity, smoking status, hypertension and diabetes in logistic regression analysis, the positive association between caffeine intake and UI prevalence was observed in both medically diagnosed UI and self-reported UI (P = 0.017) among participants. In a subgroup analysis for EQ-5D (using continuous variables) in which we categorized participants into four groups according to UI presence and caffeine consumption, the EQ-5D scores were lower in the caffeine non-user group with UI than in the caffeine consumer group with or without UI. CONCLUSION:In a sample of Korean postmenopausal women, the prevalence of UI increased with higher caffeine consumption. Additionally, QOL was lower in caffeine non-users with UI than in the caffeine consumer groups. However, additional prospective studies are required to identify clear causation between caffeine consumption, UI prevalence and QOL.

Project description:ObjectivesHigh salt intake has a harmful effect on hypertension; however, the association between major adverse cardiovascular events (MACE) and salt intake is still controversial. Rheumatoid arthritis (RA) is also characterised by excess cardiovascular risk. However, few studies have investigated the combined role of salt intake and RA in MACE in the general Korean population. Here, we evaluated this relationship among the Korean adult population.DesignRetrospective, cross-sectional.SettingPopulation-based survey in Korea.MethodsThis study was based on the data of the seventh Korean National Health and Nutrition Examination Survey (2016-2018). The estimated 24-hour urinary sodium excretion (24HUNa), a surrogate marker for daily sodium intake, was calculated using the Tanaka equation and was stratified into five groups (<3, 3-3.999, 4-4.999, 5-5.999 and ≥6 g/day). Finally, data from 13 464 adult participants (weighted n=90 425 888) were analysed; all analyses considered a complex sampling design. Multivariable logistic regression for MACE as primary dependent variable was performed and adjusted for potential covariates.ResultsParticipants with MACE had higher 24HUNa levels and RA proportion than those without MACE (p<0.001). The association of MACE with 24HUNa was J-shaped with a gradual increase from about 3 g/day. The highest 24HUNa (≥6 g/day) group was significantly associated with increased prevalence of MACE compared with the reference group (3-3.999 g/day) after adjusting for all associated covariates (OR 6.75, 95% CI 1.421 to 32.039). In the multivariate logistic regression analysis, RA (OR 2.05, 95% CI 1.283 to 3.264) and the highest 24HUNa group (OR 6.35, 95% CI 1.337 to 30.147) were significantly associated with MACE even after adjusting for baseline covariates.ConclusionsThese nationally representative data suggest that RA and extremely high sodium intake are associated with MACE in the general adult Korean population. Avoiding extremely high salt intake and considering RA as an important risk factor for MACE might help promote public cardiovascular health.

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Mediating effects of metabolic factors on the association between fruit or vegetable intake and cardiovascular disease: the Korean National Health and Nutrition Examination Survey.

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Mediating effects of metabolic factors on the association between fruit or vegetable intake and cardiovascular disease: the Korean National Health and Nutrition Examination Survey.

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