KOREAN DIETARY PATTERNS AND THE PREVALENCE OF DIABETES, METABOLIC SYNDROME, AND SUBCLINICAL ATHEROSCLEROSIS
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This dissertation investigates the associations between dietary patterns, diabetes, metabolic syndrome, and subclinical atherosclerosis. The literature on Asian dietary patterns and cardiovascular health is limited. For the first aim, we used a cross sectional design to identify and describe the major dietary patterns in 269,266 adult men and women who underwent a screening examination between January 2011 and December 2013 at the Kangbuk Samsung Total Healthcare Center in Seoul and Suwon, South Korea. Diet was assessed using a validated 103-item food frequency questionnaire. We used principal component analysis to derive three major dietary patterns. These patterns labelled as traditional Korean, modern Korean, and Western Korean, explained 20.7%, 11.4%, and 10.1%, of the total variation in daily dietary intakes. Traditional Korean dietary pattern was characterized by higher intakes of fruits, vegetables, soya and other beans, and fish. Modern Korean dietary pattern was characterized by higher intakes of noodles, raw or salted fish, shellfish, red meat, processed meat, poultry, soda, and alcohol. Western Korean dietary pattern was characterized by higher intakes of bread and cereals, milk and dairy products, snacks, and pizza, and lower intakes of alcohol, rice, and preserved vegetables. For the second aim, we evaluated the associations between the major Korean dietary patterns and the prevalence of diabetes and metabolic syndrome in 220,979 screening participants without any histories of cardiovascular disease, cancer, diabetes, hypertension, and dyslipidemia. We did not find any significant associations between the traditional Korean pattern and the prevalence of diabetes and metabolic syndrome (both P>0.05). Higher adherence to modern Korean dietary patterns was significantly associated with 32% and 76% increase in odds of diabetes (adjusted odds ratio, aOR, P90 vs P10 = 1.32; 95% CI 1.13, 1.55) and metabolic syndrome (aOR P90 vs P10=1.76; 95% CI 1.64, 1.88), respectively. Higher adherence to Western Korean dietary patterns was significantly associated with 22% and 27% decrease in odds of diabetes (aOR P90 vs P10 = 0.78; 95% CI 0.67, 0.91) and metabolic syndrome (aOR P90 vs P10=0.73; 95% CI 0.69, 0.78), respectively. Using those with no metabolic syndrome criteria as the base group, the prevalence ratio of three to five metabolic syndrome criteria comparing the 90th to the 10th percentiles of modern and Western Korean dietary pattern scores was 2.14 (95%CI 2.00, 2.30) and 0.67 (0.63, 0.72), respectively. For the third aim, we evaluated the association between the major Korean dietary patterns and prevalent subclinical atherosclerosis. The study population consisted of screening participants who had coronary artery calcium score and diet measured during the same screening visit. We included 27,028 screening participants without any histories of cardiovascular disease, cancer, diabetes, hypertension, and dyslipidemia. We failed to find any significant associations between the three major Korean dietary patterns and the prevalence of subclinical atherosclerosis (all P>0.05).