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Effect of a balanced Korean diet on metabolic risk factors among overweight/obese Korean adults: a randomized controlled trial

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Abstract

Purpose

This study was to see the effects of a balanced Korean diet (BKD) on metabolic risk factors in overweight or obese Korean adults, comparing with those of a typical American diet (TAD) and a diet recommended by the 2010 Dietary Guidelines for Americans (2010DGA).

Methods

The study was designed as a randomized crossover controlled trial, in which 61 overweight or obese volunteers were divided into six groups and each consumed the BKD, 2010DGA, and TAD in a random order for 4 weeks separated by 2-week washout intervals. Anthropometric indices, blood pressure, blood lipid content, fasting blood glucose, and blood insulin level were measured at the beginning and end of each diet period.

Results

A total of 54 participants completed the trial. The BKD caused more significant reductions of body mass index (BMI) (p < 0.001), body fat percent (p < 0.001), blood total cholesterol (p < 0.001), and low-density lipoprotein (LDL) cholesterol (p = 0.007) compared with the 2010DGA or TAD (all p values for differences between diets < 0.05). All three diets significantly lowered blood triglyceride levels (p < 0.05). The BKD decreased high-density lipoprotein (HDL) cholesterol (p = 0.001) and increased fasting blood glucose (p = 0.018), whereas TAD and 2010DGA increased HDL cholesterol and did not affect blood glucose levels. Furthermore, the BKD significantly decreased the proportion of individuals with elevated total cholesterol (p < 0.001) and LDL cholesterol (p < 0.01), whereas the 2010DGA significantly reduced the number of obese individuals (p < 0.05), and the TAD decreased the number of participants with elevated triglyceride levels (p < 0.05), but increased that of those with elevated LDL cholesterol (p < 0.05).

Conclusions

The Korean diet based on dietary guidelines improved metabolic risk factors such as BMI, body fat percent, and blood lipid profiles in overweight or obese Korean adults. These results provide evidence to recommend the Korean diet for preventing various metabolic diseases.

Clinical trial registration

The trial was registered at the Clinical Research Information Service (CRIS) in Korea, the primary registry of the World Health Organization (WHO) international clinical trial registry platform, under number KCT0002437.

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Abbreviations

BKD:

Balanced Korean diet

TAD:

Typical American diet

2010DGA:

Diet recommended by the 2010 Dietary Guidelines for Americans

HDL:

High density lipoprotein

LDL:

Low density lipoprotein

CVD:

Cardiovascular disease

BMI:

Body mass index

DASH:

Dietary approaches to stop hypertension

References

  1. Song Y, Joung H (2012) A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis 22:456–462

    Article  CAS  PubMed  Google Scholar 

  2. Kim SH, Kim MS, Lee MS, Park YS, Lee HJ, Kang SA, Lee HS, Lee KE, Yang HJ, Kim MJ, Kwon DY, Lee YE (2016) Korean diet: characteristics and historical background. J Ethn Foods 3(1):26–31

    Article  Google Scholar 

  3. Patra JK, Das G, Paramithiotis S, Shin H-S (2016) Kimchi and other widely consumed traditional fermented foods of Korea: a review. Front Microbiol 7(1493):1–15

    Google Scholar 

  4. Shin D, Jeong D (2015) Korean traditional fermented soybean products: Jang. J Ethn Foods 2(1):2–7

    Article  Google Scholar 

  5. Kim HJ, Kim Y, Cho Y, Jun B, Oh KW (2014) Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: results from the Korea National Health and Nutrition Examination Survey, 1998–2012. Int J Cardiol 174:64–72

    Article  PubMed  Google Scholar 

  6. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention (2016) Korea Health Statistics 2015: Korea National Health and Nutrition Examination Survey (KNHANES VI-3). Korea Centers for Disease Control and Prevention, Cheongwon

    Google Scholar 

  7. Korea Rural Economic Institute (2019) Trends in operation and management of the food industry, 2018. https://www.atfis.or.kr/fip/article/M000010300/view.do?articleId=3646. Accessed 27 Feb 2019

  8. Kwon YS, Ju SY (2014) Trends in nutrient intakes and consumption while eating-out among Korean adults based on Korea National Health and Nutrition Examination Survey (1998–2012) data. Nutr Res Pract 8(6):670–678

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kang M, Joung H, Lim JH, Lee YS, Song YJ (2011) Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr 44(2):152–161

    Article  Google Scholar 

  10. Halton TL, Willett WC, Liu S, Manson JE, Stampfer MJ, Hu FB (2006) Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr 83(2):284–290

    Article  CAS  PubMed  Google Scholar 

  11. Flock MR, Kris-Etherton PM (2011) Dietary guidelines for Americans 2010: implications for cardiovascular disease. Curr Atheroscler Rep 13:499–507

    Article  CAS  PubMed  Google Scholar 

  12. Grotto D, Zied E (2010) The standard American diet and its relationship to the health status of Americans. Nutr Clin Pract 25(6):603–612

    Article  PubMed  Google Scholar 

  13. Hintze KJ, Benninghoff AD, Ward RE (2012) Formulation of the total western diet (TWD) as a basal diet for rodent cancer studies. J Agric Food Chem 60(27):6736–6742

    Article  CAS  PubMed  Google Scholar 

  14. Adlercreutz H (1990) Western diet and western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest 50(sup201):3–23

    Article  Google Scholar 

  15. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Yoon JW, Choi SH, Cho SI, Park KS, Lee HK (2011) Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998–2007. Diabetes Care 34:1323–1328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kim SA, Jun S, Hong E, Joung H (2016) Estimated macronutrients and antioxidant vitamins intake according to Hansik consumption rate among Korean adults: based on the Korea National Health and Nutrition Examination Survey 2007 ~ 2012. J Nutr Health 49(5):323–334

    Article  CAS  Google Scholar 

  17. Korean Nutrition Society (2010) Dietary reference intakes for Koreans. Kookjin Publishing Co, Seoul

    Google Scholar 

  18. Paik HY (2008) Dietary reference intakes for Koreans (KDRIs). Asia Pac J Clin Nutr 17(suppl 2):416–419

    PubMed  Google Scholar 

  19. Paik HY, Kim CI, Moon HK, Yoon JS, Joung H, Shim JE, Jung HJ (2008) 2008 dietary goals and dietary guidelines for Korean adults. Korean J Nutr 41(8):887–899

    Google Scholar 

  20. DeSalvo KB, Olson R, Casavale KO (2016) Dietary guidelines for Americans. JAMA 315(5):457–458

    Article  CAS  PubMed  Google Scholar 

  21. Schwingshackl L, Hoffmann G (2015) Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet 115(5):780–800

    Article  PubMed  Google Scholar 

  22. Wang DD, Li Y, Chiuve SE, Hu FB, Willett WC (2015) Improvements in US diet helped reduce disease burden and lower premature deaths, 1999–2012; overall diet remains poor. Health Aff 34(11):1916–1922

    Article  Google Scholar 

  23. Shin HJ, Cho E, Lee HJ, Fung TT, Rimm E, Rosner B, Manson JE, Wheelan K, Hu FB (2014) Instant noodle intake and dietary patterns are associated with distinct cardiometabolic risk factors in Korea. J Nutr 144(8):1247–1255

    Article  CAS  PubMed  Google Scholar 

  24. Lee KW, Cho MS (2014) The traditional Korean dietary pattern is associated with decreased risk of metabolic syndrome: findings from the Korean National Health and Nutrition Examination Survey, 1998–2009. J Med Food 17(1):43–56

    Article  PubMed  Google Scholar 

  25. Lee JE, Kim JH, Son SJ, Ahn Y, Lee J, Park C, Jung IK (2011) Dietary pattern classifications with nutrient intake and health-risk factors in Korean men. Nutrition 27(1):26–33

    Article  CAS  PubMed  Google Scholar 

  26. Hong S, Song Y, Lee KH, Lee HS, Lee M, Jee SH, Joung H (2012) A fruit and dairy dietary pattern is associated with a reduced risk of metabolic syndrome. Metabolism 61:883–890

    Article  CAS  PubMed  Google Scholar 

  27. Jung SJ, Park SH, Choi EK, Cha YS, Cho BH, Kim YG, Kim MG, Song WO, Park TS, Ko JK (2014) Beneficial effects of Korean traditional diets in hypertensive and type 2 diabetic patients. J Med Food 17:161–171

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fuller NR, Lau NS, Denyer G, Simpson AE, Gerofi J, Wu M, Holmes A, Markovic TP, Kang JH, Caterson ID (2012) A 12-week, randomised, controlled trial to examine the acceptability of the Korean diet and its effectiveness on weight and metabolic parameters in an Australian overweight and obese population. Obes Res Clin Pract 6:e71–e83

    Article  Google Scholar 

  29. Schroeder N, Park Y-H, Kang M-S, Kim Y, Ha GK, Kim H-R, Yates AA, Caballero B (2015) A randomized trial on the effects of 2010 Dietary Guidelines for Americans and Korean diet patterns on cardiovascular risk factors in overweight and obese adults. J Acad Nutr Diet 115:1083–1092

    Article  PubMed  Google Scholar 

  30. International Obesity Task Force & World Health Organization (2000) The Asian–Pacific perspective: redefining obesity and its treatment. Health Commun Austr, Melbourne

    Google Scholar 

  31. Kim SM (1999) Treatment guideline of obesity in the world. J KSSO 8(3):31–35

    Google Scholar 

  32. Kang M, Jung HJ, Joung H, Shim JE, Lee SE, Park YH, Paik HY (2014) Development of Han-sik database utilizing an expert focus group and assessment of Han-sik effects on diet quality. Korean J Food Cult 29(1):9–17

    Article  Google Scholar 

  33. US Department of Agriculture and US Department of Health and Human Services (2010) Dietary guidelines for Americans, 2010, 7th edn. US Government Printing Office, Washington

    Google Scholar 

  34. US Department of Agriculture (2011) Sample menus for a 2000 calorie food pattern. http://www.choosemyplate.gov/food-groups/downloads/Sample_Menus-2000Cals-DG2010.pdf. Accessed 1 Dec 2011

  35. US Department of Agriculture, Agricultural Research Service and US Department of Health and Human Services, Centers for Disease Control and Prevention (2001) What we eat in America, NHANES 2001–2004. US Department of Agriculture, Belstville. http://www.ars.usda

  36. Choi K, Hong T, Lee J (2014) On comparison of SAS codes with GLM and MIXED for the crossover studies with QT interval data. Transl Clin Pharmacol 22(2):78–82

    Article  Google Scholar 

  37. Kang M, Park Y-H, Baik HW, Paik HY, Joung H (2014) The effects of healthy Han-sik nutrition education on metabolic syndrome in Korean adults with metabolic syndrome risk factors. FASEB J 28(1 supplement):626.626

    Google Scholar 

  38. Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton PM (2008) Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol 51(1):59–67

    Article  CAS  PubMed  Google Scholar 

  39. Poppitt SD, Keogh GF, Prentice AM, Williams DE, Sonnemans HM, Valk EE, Robinson E, Wareham NJ (2002) Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr 75:11–20

    Article  CAS  PubMed  Google Scholar 

  40. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ, Bucher HC (2006) Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 166(3):285–293

    Article  CAS  PubMed  Google Scholar 

  41. Lichtenstein AH, Appel LJ, Brands M et al (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114(1):82–96

    Article  PubMed  Google Scholar 

  42. Bazzano LA, Hu T, Reynolds K, Yao L, Bunol C, Liu Y, Chen CS, Klag MJ, Whelton PK, He J (2014) Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med 161(5):309–318

    Article  PubMed  PubMed Central  Google Scholar 

  43. Knuiman JT, West CE, Katan MB, Hautvast JG (1987) Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake. Arterioscler Thromb Vasc Biol 7:612–619

    CAS  Google Scholar 

  44. Choi H, Song S, Kim J, Chung J, Yoon J, Paik H-Y, Song Y (2012) High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults. Nutr Res 32:100–106

    Article  CAS  PubMed  Google Scholar 

  45. Song SJ, Lee JE, Paik H-Y, Park MS, Song YJ (2012) Dietary patterns based on carbohydrate nutrition are associated with the risk for diabetes and dyslipidemia. Nutr Res Pract 6(4):349–356

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Joung H, Hong S, Song Y, Ahn BC, Park MJ (2012) Dietary patterns and metabolic syndrome risk factors among adolescents. Korean J Pediatr 55(4):128–135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Song S, Paik HY, Park M, Song Y (2016) Dyslipidemia patterns are differentially associated with dietary factors. Clin Nutr 35:885–891

    Article  CAS  PubMed  Google Scholar 

  48. Yokokawa H, Yasumura S, Tanno K, Ohsawa M, Onoda T, Itai K, Sakata K, Kawamura K, Tanaka F, Yoshida Y, Nakamura M, Terayama Y, Ogawa A, Okayama A (2011) Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7-year cohort study of a Japanese northern rural population. J Atherosc Thromb 18:89–98

    Article  CAS  Google Scholar 

  49. Hokanson JE, Austin MA (1996) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 3:213–219

    Article  CAS  PubMed  Google Scholar 

  50. Fernandez ML, Webb D (2008) The LDL to HDL cholesterol ratio as a valuable tool to evaluate coronary heart disease risk. J Am Coll Nutr 27(1):1–5

    Article  CAS  PubMed  Google Scholar 

  51. Hu EA, Pan A, Malik V, Sun Q (2012) White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 344:e1454

    Article  PubMed  PubMed Central  Google Scholar 

  52. Shi ZM, Taylor AW, Hu G, Gill T, Wittert GA (2012) Rice intake, weight change and risk of the metabolic syndrome development among Chinese adults: the Jiangsu Nutrition Study (Jin). Asia Pac J Clin Nutr 21:35–43

    CAS  PubMed  Google Scholar 

  53. Villegas R, Liu S, Gao Y-T, Yang G, Li H, Zheng W, Shu XO (2007) Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. Arch Intern Med 167(21):2310–2316

    Article  PubMed  Google Scholar 

  54. Astrup A, Ryan L, Grunwald GK, Storgaard M, Saris W, Melanson E, Hill JO (2000) The role of dietary fat in body fatness: evidence from a preliminary meta-analysis of ad libitum low-fat dietary intervention studies. Br J Nutr 83(S1):S25–S32

    Article  CAS  PubMed  Google Scholar 

  55. Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD (2012) Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 345:e7666

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  56. Park KY, Jeong JK, Lee YE, Daily JW III (2014) Health benefits of kimchi (Korean fermented vegetables) as a probiotic food. J Med Food 17(1):6–20

    Article  CAS  PubMed  Google Scholar 

  57. Marshall TA (2011) Dietary guidelines for Americans, 2010: an update. J Am Dent Assoc 142:654–656

    Article  PubMed  Google Scholar 

  58. De Souza RJ, Swain JF, Appel LJ, Sacks FM (2008) Alternatives for macronutrient intake and chronic disease: a comparison of the omniheart diets with popular diets and with dietary recommendations. Am J Clin Nutr 88:1–11

    Article  PubMed  Google Scholar 

  59. McAuley K, Hopkins C, Smith K, McLay R, Williams S, Taylor R, Mann J (2005) Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia 48:8–16

    Article  CAS  PubMed  Google Scholar 

  60. Wellek S, Blettner M (2012) On the proper use of the crossover design in clinical trials: part 18 of a series on evaluation of scientific publications. Deutsch Ärztebl Int 109(15):276

    Google Scholar 

  61. Zambón D, Sabaté J, Munoz S, Campero B, Casals E, Merlos M, Ros E (2000) Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women: a randomized crossover trial. Ann Intern Med 132(7):538–546

    Article  PubMed  Google Scholar 

  62. Jenkins DJ, Kendall CW, Marchie A, Parker TL, Connelly PW, Qian W, Lapsley KG (2002) Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein (a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation 106(11):1327–1332

    Article  CAS  PubMed  Google Scholar 

  63. Verhoef P, Van Vliet T, Olthof MR, Katan MB (2005) A high-protein diet increases postprandial but not fasting plasma total homocysteine concentrations: a dietary controlled, crossover trial in healthy volunteers. Am J Clin Nutr 82(3):553–558

    Article  CAS  PubMed  Google Scholar 

  64. Jenkins DJ, Kendall CW, Garsetti M, Rosenberg-Zand RS, Jackson C-J, Agarwal S, Faulkner D (2000) Effect of soy protein foods on low-density lipoprotein oxidation and ex vivo sex hormone receptor activity—a controlled crossover trial. Metabolism 49(4):537–543

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported by the Research Program for Agricultural Science and Technology Development, National Academy of Agricultural Science, Rural Development Administration (Project no. PJ013475022018).

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Authors and Affiliations

  1. Institute of Health and Environment, Seoul National University, Seoul, 08826, Korea

    Seong-Ah Kim & Hyojee Joung

  2. Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Korea

    Sangah Shin

  3. Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, 08826, Korea

    Kyungho Ha & Hyojee Joung

  4. Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Korea

    Young Hwang, Young-Hee Park & Min-Sook Kang

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  1. Seong-Ah Kim
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  2. Sangah Shin
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Correspondence to Hyojee Joung.

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All human studies have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Kim, SA., Shin, S., Ha, K. et al. Effect of a balanced Korean diet on metabolic risk factors among overweight/obese Korean adults: a randomized controlled trial. Eur J Nutr 59, 3023–3035 (2020). https://doi.org/10.1007/s00394-019-02141-y

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