European Journal of Clinical Nutrition (2018) 72:848–860
Carbohydrates, glycemic index, diabetes mellitus
Differential association of dietary carbohydrate intake with
metabolic syndrome in the US and Korean adults: data from the
2007–2012 NHANES and KNHANES
Ock K. Chun
Received: 21 December 2016 / Revised: 4 May 2017 / Accepted: 3 October 2017 / Published online: 16 January 2018
© Macmillan Publishers Limited, part of Springer Nature 2018
Background/objectives The risk factors for metabolic syndrome may differ between Western and Asian countries due to
their distinct dietary cultures. However, few studies have directly compared macronutrient intake and its association with the
risk of metabolic syndrome in the US and Korean adults using national survey data.
Subject/methods Based on the data from the US and Korean versions of the 2007–2012 National Health and Nutrition
Examination Survey (NHANES, KNHANES), a total of 3,324 American and 20,515 Korean adults were included. In both
countries, dietary intake was measured using a 24-h dietary recall method and metabolic syndrome was deﬁned using the
National Cholesterol Education Program Adult Treatment Panel III criteria.
Results The percentages of energy intake from carbohydrate, protein, and fat were 50:16:33 in the US adults and 66:15:19 in
the Korean adults. Regarding metabolic abnormalities, Korean adults in the highest quintile of carbohydrate intake showed
an increased risk of metabolic syndrome in men and women, with abnormalities of reduced HDL cholesterol and elevated
triglyceride levels. In contrast, the US men showed no signiﬁcant association with metabolic syndrome and its abnormalities,
while the US women showed an increased risk of reduced HDL cholesterol and elevated triglycerides.
Conclusions A high carbohydrate intake is associated with metabolic abnormalities. As Korean adults consume more
carbohydrate than American adults, stronger associations of dietary carbohydrate with metabolic syndrome were observed.
Thus, further studies are necessary to elucidate the underlying mechanisms of different contributors to developing metabolic
disease in Western and Asian populations.
Metabolic syndrome, which represents a group of metabolic
abnormalities including atherogenic dyslipidemia, raised
blood pressure, and hyperglycemia, is widely known as a
multiplex risk factor of cardiovascular diseases (CVDs) [1,
2]. Metabolic syndrome has become a global health issue
due to it increasing prevalence in both Western and Asian
countries. For example, the percentage of the US adults who
have metabolic syndrome was 32.9% in 2003–2004 and this
rate increased to 34.7% in 2011–2012 . In Korea, the
prevalence of metabolic syndrome has also shown a steady
increase, from 24.9% in 1998 to 31.3% in 2007 .
Diet is one of important factors in the development and
prevention of CVD, and numerous studies have investigated
the associations of diet such as fat and carbohydrate intake
with the risk of CVD [5, 6]. However, these studies were
conducted mostly in Western populations. Due to cultural,
climatic, and geographical differences, Western and Asian
populations show distinct dietary patterns. Western popu-
lations generally consume more fat than Asian populations.
Reportedly, over 30% of energy has been derived from total
fat among American, British, and Australian populations
* YoonJu Song
Graduate School of Public Health, Seoul National University, 1
Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
Department of Nutritional Sciences, University of Connecticut,
3624 Horsebarn Road Extension Unit 4017, Storrs, CT 06269-
Major of Food and Nutrition, School of Human Ecology, The
Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-
si, Gyeonggi-do 14662, Republic of Korea
Electronic supplementary material The online version of this article
(https://doi.org/10.1038/s41430-017-0031-8) contains supplementary
material, which is available to authorized users.