Lim, Jiyeon
(Department of Preventive Medicine, Seoul National University College of Medicine)
,
Lee, Yunhee
(Department of Preventive Medicine, Seoul National University College of Medicine)
,
Shin, Sangah
(Department of Preventive Medicine, Seoul National University College of Medicine)
,
Lee, Hwi-Won
(Department of Preventive Medicine, Seoul National University College of Medicine)
,
Kim, Claire E
(Department of Preventive Medicine, Seoul National University College of Medicine)
,
Lee, Jong-koo
(JW Lee Center for Global Medicine, Seoul National University College of Medicine)
,
Lee, Sang-Ah
(Department of Preventive Medicine, Kangwon National University Scool of Medicine)
,
Kang, Daehee
(Department of Preventive Medicine, Seoul National University College of Medicine)
BACKGROUND/OBJECTIVES: Diet quality scores or indices, based on dietary guidelines, are used to summarize dietary intake into a single numeric variable. The aim of this study was to examine the association between the modified diet quality index for Koreans (DQI-K) and mortality among Health Examine...
BACKGROUND/OBJECTIVES: Diet quality scores or indices, based on dietary guidelines, are used to summarize dietary intake into a single numeric variable. The aim of this study was to examine the association between the modified diet quality index for Koreans (DQI-K) and mortality among Health Examinees-Gem (HEXA-G) study participants. SUBJECTS/METHODS: The DQI-K was modified from the original diet quality index. A total of 134,547 participants (45,207 men and 89,340 women) from the HEXA-G study (2004 and 2013) were included. The DQI-K is based on eight components: 1) daily protein intake, 2) percent of energy from fat, 3) percent of energy from saturated fat, 4) daily cholesterol intake, 5) daily whole-grain intake, 6) daily fruit intake, 7) daily vegetable intake, and 8) daily sodium intake. The association between all-cause mortality and the DQI-K was examined using Cox proportional hazard regression models. Hazard ratios and confidence intervals were estimated after adjusting for age, gender, income, smoking status, alcohol drinking, body mass index, and total energy intake. RESULTS: The total DQI-K score was calculated by summing the scores of the eight components (range 0-9). In the multivariable adjusted models, with good diet quality (score 0-4) as a reference, poor diet quality (score 5-9) was associated with an increased risk of all-cause mortality (hazard ratios = 1.23, 95% confidence intervals = 1.06-1.43). Moreover, a one-unit increase in DQI-K score resulted in a 6% higher mortality risk. CONCLUSIONS: A poor diet quality DQI-K score was associated with an increased risk of mortality. The DQI-K in the present study may be used to assess the diet quality of Korean adults.
BACKGROUND/OBJECTIVES: Diet quality scores or indices, based on dietary guidelines, are used to summarize dietary intake into a single numeric variable. The aim of this study was to examine the association between the modified diet quality index for Koreans (DQI-K) and mortality among Health Examinees-Gem (HEXA-G) study participants. SUBJECTS/METHODS: The DQI-K was modified from the original diet quality index. A total of 134,547 participants (45,207 men and 89,340 women) from the HEXA-G study (2004 and 2013) were included. The DQI-K is based on eight components: 1) daily protein intake, 2) percent of energy from fat, 3) percent of energy from saturated fat, 4) daily cholesterol intake, 5) daily whole-grain intake, 6) daily fruit intake, 7) daily vegetable intake, and 8) daily sodium intake. The association between all-cause mortality and the DQI-K was examined using Cox proportional hazard regression models. Hazard ratios and confidence intervals were estimated after adjusting for age, gender, income, smoking status, alcohol drinking, body mass index, and total energy intake. RESULTS: The total DQI-K score was calculated by summing the scores of the eight components (range 0-9). In the multivariable adjusted models, with good diet quality (score 0-4) as a reference, poor diet quality (score 5-9) was associated with an increased risk of all-cause mortality (hazard ratios = 1.23, 95% confidence intervals = 1.06-1.43). Moreover, a one-unit increase in DQI-K score resulted in a 6% higher mortality risk. CONCLUSIONS: A poor diet quality DQI-K score was associated with an increased risk of mortality. The DQI-K in the present study may be used to assess the diet quality of Korean adults.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
문제 정의
In this study, we examined the association of all-cause mortality with the diet quality index for Koreans (DQI-K). We hypothesize that low diet quality is associated with increased risk of mortality.
The DQI-K has adapted the components of these indicators, which are based on American dietary recommendations, to the Korean model. The index is based on Korean dietary recommendations and dietary reference intakes for Koreans. As shown in Table 1, the DQI-K consists of eight components from the original DQI and replaces carbohydrates with whole grains.
가설 설정
In this study, we examined the association of all-cause mortality with the diet quality index for Koreans (DQI-K). We hypothesize that low diet quality is associated with increased risk of mortality. This assumption is based on evidence from association studies between individual foods as well as nutrients and mortality.
1) Values are n (%) or mean ± SD.
제안 방법
The first multivariable model was adjusted for age (continuous), gender, income (< 2,000,000 and ≥ 2,000,0000 won), smoking (never and ever), alcohol drinking (never, past, and current), BMI (continuous, kg/m2), and total calories (continuous, kcal).
To compare diet quality, the participants were divided into two groups based on their DQI-K (scores 0-4 and 5-9). A high DQI-K score indicates poor diet quality.
However, we used an FFQ that has shown considerable validity and reliability [45]. Third, the subjects were asked about their dietary intake for the year preceding the diagnosis using the FFQ. Thus, measurement errors likely occurred due to poor recall despite the validity and reproducibility evidence of the questionnaire.
대상 데이터
This study was based on a large-scale genomic cohort study known as the Health Examinees (HEXA) study. For the baseline study, a total of 169,718 subjects aged between 40-69 years old were recruited from 38 general hospitals and health examination centers throughout Korea between 2004 and 2013. HEXA data are publicly available for use.
From the HEXA-G population, we excluded subjects who were missing information in the food frequency questionnaire (FFQ) (n = 2,511) and who reported implausible energy intakes (outside the range of 800-4,000 kcal for men or 500-3,500 kcal for women, n = 2,290). A total of 134,541 subjects remained eligible (Fig. 1).
In our study, 2,165 subjects died during the 6.6-year follow-up period (1,309 men and 856 women). The mean age at enrolment was 53.
데이터처리
2) P-values for differences among DQI-K scores were calculated by chi-square tests for categorical variables and linear regression for continuous variables.
이론/모형
This study was based on a large-scale genomic cohort study known as the Health Examinees (HEXA) study. For the baseline study, a total of 169,718 subjects aged between 40-69 years old were recruited from 38 general hospitals and health examination centers throughout Korea between 2004 and 2013.
Chi-square tests (for categorical variables) and linear regressions (for continuous variables) were used to analyze the selected characteristics of the study population based on DQI-K scores.
성능/효과
DQI-K scores of 0, 1, and 2 or 0 and 1 were assigned to each component, and scores for individual components were summed to determine each participant’s overall DQI-K score, which ranged from 0 to 9; a lower DQI-K score reflects a higher quality diet.
1) The RNI for protein among people aged < 65 years is 60 g for men and 50 g for women, ≥ 65 years is 55 g for men and 45 g for women.
The baseline characteristics of the study subjects are summarized in Table 2. In this study, subjects with high scores were more likely to have ever been smokers and drinkers, were less likely to be physically active, and more likely to have higher energy intake compared to those with low scores.
11). The highest DQI-K scores (7-9) were associated with an increased risk of mortality compared to the lowest scores (0-2) (multivariable-adjusted HR = 1.69, 95% CI = 1.15-2.48). Among the components of the DQI-K, the percentage of energy from fat was the most influential factor on the results.
1 Lachat C Otchere S Roberfroid D Abdulai A Seret FM Milesevic J Xuereb G Candeias V Kolsteren P Diet and physical activity for the prevention of noncommunicable diseases in low- and middle-income countries: a systematic policy review PLoS Med 2013 10 e1001465 23776415
2 Basiotis PP Guthrie JF Bowman SA Welsh SO Construction and evaluation of a diet status index Fam Econ Rev 1995 8 2 13
3 Jacobs DR Jr Steffen LM Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy Am J Clin Nutr 2003 78 Suppl 508S 513S 12936941
4 Willett W Nutritional epidemiology Third edition Oxford Oxford University Press 2013 ix 529
5 Patterson RE Haines PS Popkin BM Diet quality index: capturing a multidimensional behavior J Am Diet Assoc 1994 94 57 64 8270756
6 Gil Á Martinez de Victoria E Olza J Indicators for the evaluation of diet quality Nutr Hosp 2015 31 Suppl 3 128 144 25719781
7 McCullough ML Feskanich D Stampfer MJ Giovannucci EL Rimm EB Hu FB Spiegelman D Hunter DJ Colditz GA Willett WC Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance Am J Clin Nutr 2002 76 1261 1271 12450892
8 Wrobleski MM Parker EA Hurley KM Oberlander S Merry BC Black MM Comparison of the HEI and HEI-2010 diet quality measures in association with chronic disease risk among low-income, African American urban youth in Baltimore, Maryland J Am Coll Nutr 2018 37 201 208 29313747
10 Trichopoulou A Kouris-Blazos A Wahlqvist ML Gnardellis C Lagiou P Polychronopoulos E Vassilakou T Lipworth L Trichopoulos D Diet and overall survival in elderly people BMJ 1995 311 1457 1460 8520331
11 Russell J Flood V Rochtchina E Gopinath B Allman-Farinelli M Bauman A Mitchell P Adherence to dietary guidelines and 15-year risk of all-cause mortality Br J Nutr 2013 109 547 555 22571690
12 Huijbregts P Feskens E Räsänen L Fidanza F Nissinen A Menotti A Kromhout D Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study BMJ 1997 315 13 17 9233319
13 Knoops KT Groot de LC Fidanza F Alberti-Fidanza A Kromhout D van Staveren WA Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project Eur J Clin Nutr 2006 60 746 755 16418742
14 Reedy J Krebs-Smith SM Miller PE Liese AD Kahle LL Park Y Subar AF Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults J Nutr 2014 144 881 889 24572039
15 Buckland G Agudo A Travier N Huerta JM Cirera L Tormo MJ Navarro C Chirlaque MD Moreno-Iribas C Ardanaz E Barricarte A Etxeberria J Marin P Quirós JR Redondo ML Larrañaga N Amiano P Dorronsoro M Arriola L Basterretxea M Sanchez MJ Molina E González CA Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain) Br J Nutr 2011 106 1581 1591 21736834
16 Schwingshackl L Bogensberger B Hoffmann G Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies J Acad Nutr Diet 2018 118 74 100 29111090
17 Yun S Kim HJ Oh K Trends in energy intake among Korean adults, 1998-2015: results from the Korea National Health and Nutrition Examination Survey Nutr Res Pract 2017 11 147 154 28386388
18 Health Examinees Study Group The Health Examinees (HEXA) study: rationale, study design and baseline characteristics Asian Pac J Cancer Prev 2015 16 1591 1597 25743837
19 Kim Y Han BG KoGES group Cohort profile: The Korean Genome and Epidemiology Study (KoGES) consortium Int J Epidemiol 2016 46 1350
20 Shin S Lee HW Kim CE Lim J Lee JK Lee SA Kang D Egg consumption and risk of metabolic syndrome in Korean adults: results from the Health Examinees Study Nutrients 2017 9 E687 28671590
21 Kom EL Graubard BI Midthune D Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale Am J Epidemiol 1997 145 72 80 8982025
23 McNaughton SA Ball K Crawford D Mishra GD An index of diet and eating patterns is a valid measure of diet quality in an Australian population J Nutr 2008 138 86 93 18156409
24 Shannon J Shikany JM Barrett-Connor E Marshall LM Bunker CH Chan JM Stone KL Orwoll E Osteoporotic Fractures in Men (MrOS) Research Group Demographic factors associated with the diet quality of older US men: baseline data from the Osteoporotic Fractures in Men (MrOS) study Public Health Nutr 2007 10 810 818 17381915
25 Reeves MM Healy GN Owen N Shaw JE Zimmet PZ Dunstan DW Joint associations of poor diet quality and prolonged television viewing time with abnormal glucose metabolism in Australian men and women Prev Med 2013 57 471 476 23827722
26 Tobias DK Hu FB Chavarro J Rosner B Mozaffarian D Zhang C Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus Arch Intern Med 2012 172 1566 1572 22987062
27 InterAct Consortium Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study Diabetologia 2014 57 321 333 24196190
28 Azadbakht L Mirmiran P Esmaillzadeh A Azizi F Dietary diversity score and cardiovascular risk factors in Tehranian adults Public Health Nutr 2006 9 728 736 16925878
29 George SM Ballard-Barbash R Manson JE Reedy J Shikany JM Subar AF Tinker LF Vitolins M Neuhouser ML Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: evidence to inform national dietary guidance Am J Epidemiol 2014 180 616 625 25035143
30 Fung TT McCullough M van Dam RM Hu FB A prospective study of overall diet quality and risk of type 2 diabetes in women Diabetes Care 2007 30 1753 1757 17429059
31 Verger EO Mariotti F Holmes BA Paineau D Huneau JF Evaluation of a diet quality index based on the probability of adequate nutrient intake (PANDiet) using national French and US dietary surveys PLoS One 2012 7 e42155 22870293
32 Osler M Heitmann BL Gerdes LU Jørgensen LM Schroll M Dietary patterns and mortality in Danish men and women: a prospective observational study Br J Nutr 2001 85 219 225 11242490
33 Kant AK Schatzkin A Harris TB Ziegler RG Block G Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study Am J Clin Nutr 1993 57 434 440 8382446
35 Seymour JD Calle EE Flagg EW Coates RJ Ford ES Thun MJ Diet quality index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort Am J Epidemiol 2003 157 980 988 12777361
36 Sjögren P Becker W Warensjö E Olsson E Byberg L Gustafsson IB Karlström B Cederholm T Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden Am J Clin Nutr 2010 92 967 974 20826627
37 Jankovic N Geelen A Streppel MT de Groot LC Orfanos P van den Hooven EH Pikhart H Boffetta P Trichopoulou A Bobak M Bueno-de-Mesquita HB Kee F Franco OH Park Y Hallmans G Tjønneland A May AM Pajak A Malyutina S Kubinova R Amiano P Kampman E Feskens EJ Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States Am J Epidemiol 2014 180 978 988 25318818
39 Jensen OM Wahrendorf J Rosenqvist A Geser A The reliability of questionnaire-derived historical dietary information and temporal stability of food habits in individuals Am J Epidemiol 1984 120 281 290 6465126
40 Lindsted KD Kuzma JW Long-term (24-year) recall reliability in cancer cases and controls using a 21-item food frequency questionnaire Nutr Cancer 1989 12 135 149 2710656
41 Mursu J Steffen LM Meyer KA Duprez D Jacobs DR Jr Diet quality indexes and mortality in postmenopausal women: the Iowa Women's Health Study Am J Clin Nutr 2013 98 444 453 23783291
42 Sijtsma FP Meyer KA Steffen LM Shikany JM Van Horn L Harnack L Kromhout D Jacobs DR Jr Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study Am J Clin Nutr 2012 95 580 586 22301926
43 Thompson FE Metzner HL Lamphiear DE Hawthorne VM Characteristics of individuals and long term reproducibility of dietary reports: the Tecumseh Diet Methodology Study J Clin Epidemiol 1990 43 1169 1178 2243254
44 Strazzullo P D'Elia L Kandala NB Cappuccio FP Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies BMJ 2009 339 b4567 19934192
45 Ahn Y Kwon E Shim JE Park MK Joo Y Kimm K Park C Kim DH Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study Eur J Clin Nutr 2007 61 1435 1441 17299477
※ AI-Helper는 부적절한 답변을 할 수 있습니다.