kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.2.75 kjhp-15-75 Original Article The Association between Dietary Fiber Intake and Prevalence of Metabolic Syndrome in Middle-aged Adults in Gyeonggi Province LeeYou-Sin LeeSim-Yeol Department of Home Economics Education, Dongguk University, Seoul, Korea ￭ Corresponding author：Sim-Yeol Lee, PhD Department of Home Economics Education, Dongguk University, 30 Pildong-ro 1-gil, Jung-gu, Seoul 100-715, Korea Tel: +82-2-2260-3413, Fax: +82-2-2265-1170 E-mail: slee@dongguk.edu 122015 19122015 152 7582 02032015 23042015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 2015 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. Background

The aim of this study was to assess the dietary fiber intake of middle-aged adults in Gyeonggi and to evaluate its relation with the metabolic syndrome.

 Methods

From April 2013 to October 2014, 279 (60 men, 210 women) middle-aged adults subject older than 30 years of age were recruited. Two-day dietary intake data were collected from each subject using the 24-hour recall method. Metabolic syndrome was diagnosed by anthropometric measurements, blood pressure, and blood analysis.

 Results

When the subjects were divided into tertile groups by dietary fiber intake per 1,000 kcal, the middle tertile group showed higher fiber intake of 118.8% above the reference intake of 12 g/1,000 kcal, and the highest tertile group showed a higher fiber intake of 165.0% above the reference intake. The group with greater dietary fiber intake showed more mineral and vitamin intake but less energy, fat, and cholesterol intake. The major food groups that contributed to the dietary fiber in the lowest and the middle tertiles were vegetables, grains, fruits, and legumes, but in the highest tertile, legumes contributed more than fruits. The risk of metabolic syndrome (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18-0.77), abdominal obesity (OR 0.45, 95% CI 0.23-0.85,) and hypertriglyceridemia (OR 0.42, 95% CI 0.21-0.83) were significantly reduced in the middle tertile compared to the lowest tertile.

 Conclusions

The results suggest that there is a correlation between dietary fiber intake and risk factors for metabolic syndrome. It is highly expected that consuming sufficient amount of fruits and vegetables as a major source of dietary fiber can prevent and manage metabolic syndrome and chronic disease.

 Dietary fiber Metabolic syndrome Middle-aged adults REFERENCES Lee CJ Joung HJ Milk intake is associated with metabolic syndrome - using data from the Korea National Health and Nutrition Examination Survey 2007~2010 Korean J Community Nutr 2012176 795804 Kim E Oh SW Gender differences in the association of occupation with metabolic syndrome in Korean Adults Korean J Obes 2012212 10814 Timm DA Slavin JL Dietary Fiber and the Relationship to Chronic Diseases Am J Lifestyle Med 200823 23340 Yu KH Chung CE Cho SS Ly SY Analysis of dietary fiber intake in the Korean adult population using 2001 Korean National Health and Nutrition Survey Data and newly established dietary fiber database Korean J Nutr 2008411 10010 Lim S Shin H Song JH Kwak SH Kang SM Won Yoon J Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007 Diabetes Care 2011346 13238 Mozumdar A Liguori G Persistent increase of prevalence of metabolic syndrome among U.S adult NHANES III to NHANES 1999– 2006 Diabetes Care 2011;341 2169 The Korean Nutrition Society Dietary reference intakes for Koreans 1st revision. Seoul: 2010. p.1247 Lairon D Arnault N Bertrai S Planells R Clero E Hercberg S Dietary fiber intake and risk factors for cardiovascular disease in French adults Am J Clin Nutr 2005826 118594 Oh K Hu FB Cho E Rexrode KM Stampfer MJ Manson JE Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women Am J Epidemiol 20051612 1619 Behall KM Scholfield DJ Hallfrisch J Diets containing barley significantly reduce lipids in mildly hypercholesterolemic men and women Am J Clin Nutr 2004805 118593 Pittaway JK Ahuja KDK Cehun M Chronopoulos A Robertson IK Nestel PJ Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholester-ols in adult women and men Ann Nutr Metab 2006506 5128 Lim HJ Kim JI An assessment of dietary fiber intake in preschool children in Busan Korean J Community Nutr 200272 16776 Jung SH Kim JI Km SA Assessment of intake of nutrient and dietary fiber among children at the 6th grade of elementary school in Gimhae Korean J Community Nutr 2005101 1221 Yu KH Min KS Oh HI Ly SY Analysis of the relationship between dietary fiber intake & food habits in the Korean adult population - using the 2001 Korean National Health and Nutrition Survey Data and the newly established dietary fiber database Korean J Nutr 2008413 26482 Kim YH Kang YJ Lee IS Kim HS Dietary fiber intake of middle school students in Chungbuk area and development of food frequency questionnaire J Korean Soc Food Sci Nutr 201039 2 24452 Kant AK Schatzkin A Ziegler RG Nestle M Dietary diversity in the US population, NHANES Ⅱ. 1976-1980 J Am Diet Assoc 19919112 152631 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) JAMA 200128519 248697 Lee SY Park HS Kim DJ Han JH Kim SM Cho GJ Appropriate waist circumference cutoff points for central obesity in Korean adults Diabetes Res Clin Pract 2007751 7280 Ylönen K Virtanen SM Ala-Venna E Räsänen L Composition of diet in relation to fat intake of children aged 1–7 years J Human Nutr Diet 199693 20718 Lee HJ Kim YA Lee HS The estimated dietary fiber intake of Korean by age and sex J Korean Soc Food Sci Nutr 2006359 120714 Lee HJ Kim YA Lee HS Annual changes in the estimated dietary fiber intake of Korean during 1991-2001 Korean J Nutr 2006396 54959 Janssen I Katzmarzyk PT Ross R Waist circumference and not body mass index explains obesity-related health risk Am J Clin Nutr 2004793 37984 Anderson JW Baird P Davis RH Jr Ferreri S Knudtson M Koraym A Health benefits of dietary fiber Nutr Rev 2009674 188205 Du H Boshuizen HC Forouhi NG Wareham NJ Halkjær J Tjønneland A Dietary fiber and subsequent changes in body weight and waist circumference in European men and women Am J Clin Nutr 2010912 32936 Holmes BA Kaffa N Campbell K Sanders TA The contribution of breakfast cereals to the nutritional intake of the materially deprived UK population Eur J Clin Nutr 2012661 107 Jacobs DR Jr Pereira MA Meyer KA Kushi LH Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: the Iowa women's health study J Am Coll Nutr 200019Suppl 3 326S30S Choi SH Choi-Kwon S The metabolic syndrome and associated lifestyle factors among older adults J Korean Biol Nurs Sci 2011131 5360 Chen CM Zhao W Yang Z Zhai Y Wu Y Kong L The role of dietary factors in chronic disease control in China Obes Rev 20089Suppl 1 1003 Figures and Tables

Comparisons of subject characteristics by sexa

Characteristics Male (n=69) Female (n=210) Total (n=279) P
Age, y 53.7±10.1 55.0±9.6 54.7±9.7 0.343b
Education
≤Middle school 6 (8.7) 37 (17.6) 43 (15.4) 0.002c
High school 25 (36.2) 106 (50.5) 131 (46.9)
≥College 38 (55.1) 67 (31.9) 105 (37.6)
Current drinking
Yes 62 (89.9) 115 (54.8) 177 (63.4) <0.001
Current smoking
Yes Regular exercise 22 (31.9) 5 (2.4) 27 (9.7) <0.001
Yes 60 (87.0) 165 (78.6) 225 (80.6) 0.126
Components of metabolic syndrome risk factorsd
Elevated fasting blood glucose 22 (31.9) 51 (24.3) 73 (26.2) 0.213
Elevated blood pressure 39 (56.5) 67 (31.9) 106 (38.0) 0.001
Low HDL-cholesterol Hypertriglyceridemia 18 (26.1) 37 (53.6) 60 (28.6) 45 (21.4) 78 (28.0) 82 (29.4) 0.690 <0.001
Abdominal obesity 32 (46.4) 63 (30.0) 95 (34.0) 0.013
Metabolic syndrome 29 (42.0) 42 (20.2) 71 (25.4) 0.001

Abbreviation: HDL, high density lipoprotein.

Values are presented as N (%) or mean±SD.

P from t-test.

P from chi-square test.

Serum fasting blood glucose ≥100 mg/dL; Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg; Low serum HDL cholesterol <50 mg/dL for women or <40 mg/dL for men; Serum TG ≥150 mg/dL; Waist circumference ≥85 cm for women or ≥90 cm for men.

Nutrient intakes by tertile of dietary fiber intake g/1,000 kcala

T1 (lowest) (<12.2) T2 (12.2-16.0) T3 (highest) (≥16.0) P for trend
Dietary fiber, g 16.3±5.8 21.2±5.5 28.0±8.6 <0.001b
Fiber density, g/1,000 kcal % of AI 9.6±2.0 79.9±16.6 14.3±1.0 118.8±8.6 19.8±3.0 165.0±24.7 <0.001 <0.001
Energy, kcal 1,749.6±678.0 1,486.7±360.1 1,420.7±416.7 0.017
Carbohydrates, g 236.2±73.4 235.0±56.9 236.3±72.1 0.327
Fat, g 46.5±26.0 35.1±14.2 33.8±18.0 0.017
Protein, g 62.9±28.6 58.1±18.7 55.0±16.3 0.201
Vitamin A, ug RE 617.7±328.8 830.6±486.5 1,039.7±621.6 <0.001
Vitamin B1, mg 1.2±0.7 1.1±0.4 1.3±1.1 0.148
Vitamin B2, mg 1.0±0.4 1.0±0.4 1.1±0.4 0.006
Vitamin B6, mg 1.5±0.7 1.5±0.5 1.6±0.6 0.028
Vitamin C, mg 79.0±40.9 114.8±48.8 143.8±87.6 <0.001
Niacin, mg 14.0±7.2 13.1±4.0 12.7±4.0 0.979
Folic acid, ug 395.4±169.5 463.4±159.5 530.4±230.7 <0.001
Calcium, mg Phosphrous, mg 373.3±145.5 893.5±357.0 427.6±175.5 932.4±271.6 460.4±199.7 966.4±283.2 0.001 0.012
Iron, mg 11.3±4.5 13.8±4.4 15.5±6.7 <0.001
Zinc, mg 8.9±4.1 9.0±3.0 9.4±6.6 0.398
Sodium, mg 3,198.7±1,282.7 3,147.8±1,164.5 2,868.3±930.0 0.949
Potassium, mg 2,301.7±823.0 2,890.1±923.6 3,266.2±1,056.3 <0.001
Cholesterol, mg 264.7±147.3 224.8±145.8 167.3±111.3 0.001

Abbreviation: AI, adequate intake.

Values are presented as mean±SD.

Statistical difference of variables between tertile of dietary fiber intake g/1,000 kcal calculated by General linear model (GLM) and variables were adjusted by age, sex.

Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) of diets by tertile of dietary fiber intake g/1,000 kcala

Variables T1 (lowest) T2 T3 (highest) P
NAR
Protein 0.92±0.15 0.95±0.10 0.95±0.12 0.172b
Calcium 0.51±0.20A 0.59±0.23B 0.63±0.23B 0.002
Phosphorus 0.93±0.14A 0.97±0.09B 0.97±0.09B 0.007
Iron 0.87±0.19A 0.97±0.09B 0.98±0.07B <0.001
Vitamin A 0.75±0.24A 0.87±0.19B 0.92±0.17B <0.001
Vitamin B1 0.84±0.20A 0.87±0.15B 0.90±0.14B 0.015
Vitamin B2 0.70±0.22A 0.74±0.20B 0.78±0.19B 0.011
Niacin 0.81±0.21 0.84±0.18 0.82±0.18 0.361
Vitamin C 0.70±0.28A 0.87±0.19B 0.92±0.15B <0.001
MAR 0.78±0.16A 0.85±0.11B 0.87±0.10B <0.001

Values are presented as mean±SD.

Statistical difference of variables between tertile of dietary fiber intake g/1,000 kcal calculated by General linear model (GLM) and variables were adjusted by age, sex. Means with different letter (A, B) in the same row by Duncan's multiple range test are significantly different.

Contribution of each food groups to dietary fiber intakes by tertilea

Food groups T1 (lowest) T2 T3 (highest) P
g % g % g %
Vegetables 5.5±2.9A 34.2 6.9±3.3B 32.4 9±4.0C 32.1 <0.001b
Cereals & grains 4.7±2.6 29.2 5.0±2.4 23.5 4.8±2.8 17.1 0.417
Fruits 1.6±1.6A 9.9 3.1±2.6B 14.6 4.1±4.8C 14.6 <0.001
Legumes 1.1±1.7A 6.8 1.9±2.1A 8.9 4.5±5.3B 16.1 <0.001
Seasonings 1.1±0.8A 6.8 1.5±1.1B 7.0 1.4±1.1B 5.0 0.004
Potatoes & starches 0.6±1.2A 3.7 1.2±2.3A 5.6 2.0±3.5B 7.1 0.018
Seeds & nuts 0.4±0.8 2.5 0.5±0.9 2.3 0.7±1.3 2.5 0.092
Seaweeds 0.3±0.8A 1.9 0.4±0.8B 1.9 0.7±1.1B 2.5 0.020
Mushrooms 0.1±0.4A 0.6 0.3±0.7B 1.4 0.5±1.0B 1.8 0.001
Milk & milk products 0.1±.0.9 0.6 0.2±0.2 0.9 0.1±0.4 0.4 0.433
Beverages 0.3±1.2 1.9 0.3±0.9 1.4 0.1±0.5 0.4 0.385
Meats & meat products 0.2±0.7 1.2 0.0±0.0 0.0 0.0±0.0 0.0 0.073
Sweets 0.0±0.0 0.0 0.0±0.0 0.0 0.1±0.2 0.4 0.154
Fish & shellfish 0.1±0.5 0.6 0.0±0.0 0.0 0.0±0.0 0.0 0.118
Other food items 0.0±0.0 0.0 0.0±0.0 0.0 0.0±0.0 0.0 0.389

Values are presented as mean±SD unless otherwise indicated.

Statistical difference of variables between tertile of dietary fiber intake g/1,000 kcal calculated by General linear model (GLM) and variables were adjusted by age, sex. Means with different letter (A, B, C) in the same row by Duncan's multiple range test are significantly different.

The major foods contributing to dietary fiber by tertile of dietary fiber intake g/1,000 kcal

Rank T1 (lowest) T2 T3 (highest)
Food % Food % Food %
1 Kimchi 6.9 Kimchi 4.8 Sweet potato 4.7
2 Rice 5.7 Rice 4.0 Soybean 4.1
3 Red pepper powder 3.6 Apple 3.8 Pepper 3.5
4 Pepper 2.7 Red pepper powder 3.5 Apple 3.5
5 Ra myon 2.6 Sweet potato 3.3 Kimchi 3.4
6 Barley 2.4 Pepper 3.2 Black beans 3.2
7 Potato 2.3 Brown rice 2.9 Adzuki beans 3.1
8 Tofu 2.1 Barley 2.7 Barley 3.0
9 Apple 2.0 Tomato 2.1 Persimmon 2.8
10 Korean raddish 1.8 Oriental melon 2.0 Red pepper powder 2.4
Total 32.2 32.5 33.7

Association between metabolic syndrome and its components and tertile of dietary fiber intake g/1,000 kcal

Tertile (T) Odds ratio (95% CI) P for trend
T1 (lowest) T2 T3 (highest)
Fasting blood glucose
Crude 1 1.19 (0.61-2.34) 1.48 (0.76-2.85) 0.244
Age, sex adjusted 1 1.10 (0.54-2.22) 1.34 (0.65-2.75) 0.414
Triglyceride
Crude 1 0.38 (0.20-0.72) 0.45 (0.24-0.85) 0.011
Age, sex adjusted 1 0.42 (0.21-0.83) 0.59 (0.29-1.19) 0.127
HDL-cholesterol
Crude 1 0.54 (0.28-1.05) 0.95 (0.51-1.76) 0.870
Age, sex adjusted 1 0.51 (0.25-1.01) 0.87 (0.44-1.70) 0.718
Blood pressure
Crude 1 0.87 (0.49-1.57) 0.60 (0.33-1.09) 0.097
Age, sex adjusted 1 0.98 (0.53-1.82) 0.73 (0.38-1.41) 0.346
Waist circumference
Crude 1 0.47 (0.25-0.86) 0.57 (0.31-1.05) 0.064
Age, sex adjusted 1 0.45 (0.23-0.85) 0.56 (0.29-1.09) 0.718
Metabolic syndromea
Crude 1 0.36 (0.18-0.71) 0.51 (0.27-0.96) 0.030
Age, sex adjusted 1 0.38 (0.18-0.77) 0.59 (0.29-1.19) 0.123

Abbreviations: CI, confidence interval; HDL, high density lipoprotein.

Serum fasting blood glucose ≥100 mg/dL; Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg; Low serum HDL cholesterol <50 mg/dL for women or <40 mg/dL for men; Serum TG ≥150 mg/dL; Waist circumference ≥85 cm for women or ≥90 cm for men.