Association of Nutritional Status with Obesity by Body Mass Index and Waist Circumference among Hypertensive Elderly Patients

노년기 고혈압 관리 대상자의 체질량지수, 허리둘레에 의한 비만정도와 영양소 섭취 상태 비교 연구

  • Seo, Kyung-Hee (KHyDDI (Korea Hypertension Diabetes Daegu Initiative) Project Su-seong Intervention Center) ;
  • Lee, Hye-Jin (Division of Chronic Disease Surveillance, Korea Centers for Disease Control & Prevention) ;
  • Lim, Bu-Dol (Division of Chronic Disease Surveillance, Korea Centers for Disease Control & Prevention) ;
  • Choi, Yun-Jung (KHyDDI (Korea Hypertension Diabetes Daegu Initiative) Project Metropolitan Center Intervention Center) ;
  • Oh, Hyun-Mee (Department of Food and Nutrition, Keimyung University) ;
  • Yoon, Jin-Sook (Department of Food and Nutrition, Keimyung University)
  • 서경희 (대구광역시 심뇌혈관질환 고위험군 등록관리 시범사업단 수성구교육정보센터) ;
  • 이혜진 (질병관리본부 만성병조사과) ;
  • 임부돌 (질병관리본부 만성병조사과) ;
  • 최윤정 (대구광역시 심뇌혈관질환 고위험군 등록관리 시범사업단 광역교육정보센터) ;
  • 오현미 (계명대학교 식품영양학과) ;
  • 윤진숙 (계명대학교 식품영양학과)
  • Published : 2009.12.31

Abstract

Hypertension and obesity are important modifiable risk factors for cardiovascular disease, the leading cause of death in Korea. Therefore, we assessed the association between dietary pattern and obesity in hypertensive patients to formulate health promotion strategies for the older population. Dietary information was collected from hypertensive patients visiting community health education and information center by using 24 hour recall method. The 2005 DRIs for Koreans was used to evaluate the dietary adequacy. When subjects were categorized by body mass index (BMI) as normal, overweight and obese, no significant difference in energy intake was found among groups. Dietary intakes of folate, and vitamin C in obese hypertensive patients were significantly lower than in normal weight patients (p < 0.05). When we compare the nutritional status by waist circumferences, dietary intakes of zinc, vitamin A, thiamin, vitamin C and folate were significantly lower in the obese group. Vegetable intake was significantly lower in the obese group according to BMI as well as waist circumference. Energy intake from carbohydrate was significantly higher in obese hypertensive patients (p < 0.05). Obese hypertensive patients had a higher risk of nutritional inadequacy compared to normal weight patients. Our results indicated the need for developing interventions that encourage greater consumption of vegetables while cutting down salt intake with wise selection of staple foods, for obese hypertensive patients.

Keywords

References

  1. Ahn SH, Son SM, Park JK (2009): Health and nutritional factors related to hypertension of subjects aged over 50 in high income class: Based on the 2005 Korea national health and nutrition examination survey. Korean J Diet Assoc 15(3): 311-327
  2. Alexander C, Landsman P, Teutsch S, Haffner S (2003): NECPdefinde metabolic syndrome, diabetes and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 52(2): 1210-1214 https://doi.org/10.2337/diabetes.52.5.1210
  3. American Diabetes Association (2008): Diabetes, the Heart and Exercise-At the Intersection of Endocrinology and Cardiovascular Medicine. June 6-10 San Francisco, CA
  4. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM (2006): Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 47(2): 296-308 https://doi.org/10.1161/01.HYP.0000202568.01167.B6
  5. Bazzano LA, Li TY, Joshipura KJ, Hu FB (2008): Intake of fruit, vegetable, and fruit juices and risk of diabetes in women. Diabetes Care 31(7): 1311-1317 https://doi.org/10.2337/dc08-0080
  6. Biolo G, Toigo G, Guarnieri G (2001): Slower activation of insulin action in upper body obesity. Metabolism 50(1): 19-23 https://doi.org/10.1053/meta.2001.17726
  7. Choi HJ, Jung MH, Kim YS (2004): A study on the relationship between health behavior factors and blood pressure of workers. Korean J Comm Health Nur Acad Soc 18(2): 312-329
  8. Choi MK, Lee WY, Park JD (2005): Relation among mineral (Ca, P, Fe, Na, K, Zn) intakes, blood pressure, and blood lipids in Korean adults. Korean J Nutr 38(10): 827-835
  9. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997): Effect of calcium and vitamin D supplementation on bone density in men women 65 years of age older. N Engl J Med 337(10): 670-676 https://doi.org/10.1056/NEJM199709043371003
  10. Eom JS, Lee TR, Park SJ, Ahn Y, Chung YJ (2008): The risk factors of the pre-hypertension and hypertension of rural inhabitants in Chungnam-do. Korean J Nutr 41(8): 742-753
  11. Esmaillzabeh A, Kimiagar M, Mehrabi Y, Azabakht L, Hu FB, Willett WC (2006): Fruit and vegetable intake, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 84(6):1489-1497
  12. Ford ES, Giles WH, Dietz WH (2002): Prevalence of the metabolic syndrome among US adults findings from the third national health and nutrition examination survey. JAMA 287(3): 356-359 https://doi.org/10.1001/jama.287.3.356
  13. Gus M, Fuchs SC, Moreira LB, Moraes RS, Wiehe M, Si1va AF, A1bers F, Fuchs FD (2004): Association between different measurements of obesity and the incidence of hypertension. Am J Hypertens 17 (1): 50-53 https://doi.org/10.1016/j.amjhyper.2003.08.010
  14. Hajjar IM, Grim CE, George V, Kotchen TA (2001): Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Arch Intern Med161(4): 589-593 https://doi.org/10.1001/archinte.161.4.589
  15. Hamet P (1995). The evaluation of the scientific evidence for a relationship between calcium and hypertension. LSRO report. J Nutr 125(2): 311S-400S
  16. He FJ, MacGregor GA (2008): Beneficial effects of potassium on human health. Physiol Plant 133(4): 725-735 https://doi.org/10.1111/j.1399-3054.2007.01033.x
  17. Ho SY, Lam TH, Janus EJ (2003): Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. AEP 13 (10): 683-691 https://doi.org/10.1016/S1047-2797(03)00067-X
  18. Hseih SD, Muto T (2005): The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 40(2): 216-220 https://doi.org/10.1016/j.ypmed.2004.05.025
  19. Jelliffe DB (1966): The assessment of the nutritional status of the community. WHO Geneva
  20. Jeong EG (2004): National Goals and Strategies for Major Chronic Diseases. Korean Centers for Disease Control and Prevention
  21. Katan MB, Grundy SM, Sillett WC (1997): Should a low-fat, highcarbohydrate diet be recommended for everyone? Beyond low-fat diets. N Engl J Med 337(8): 563-566
  22. Karppanen H, Mervaala E (2006): Sodium intake and hypertension. Prog Cardiov Dis 49(2): 59-75 https://doi.org/10.1016/j.pcad.2006.07.001
  23. Kim MK, Yun YM, Kim Y (2008): Developing dish-based food frequency questionnaire for the epidemiology study of hypertension among Korean. Korean J Community Nutr 13(5):701-712
  24. Kim SR, Yoon GH (2009): Management of metabolic syndrome: Recent update for treatment. Proceedings Korean Soc Community Nutr pp. 31-36
  25. Klein BE, Klein R, Lee KE (2002): Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in beaver dam. Diabetes Care 25(10): 1790-1794 https://doi.org/10.2337/diacare.25.10.1790
  26. Korean Centers for Disease Control and Prevention (2007a): Korea National Health and Nutrition Examination Survey III (2005) - Depth Analysis(Health Examination).
  27. Korea National Statistical Office (2008): Deaths and Causes of Death in 2007
  28. Lakka HM, Lakka TA, Tuomilehto J, Salonen JT (2002): Abdominal obesity is associated with increased risk of acute coronary events in men. Eur Heart J 23(9): 701-713 https://doi.org/10.1053/euhj.2001.2889
  29. Lee GY, Park MS, Park TJ (2001): Association of hypertension with body mass index in the rural elderly. J Korean Acad Fam Med 22(7): 1086-1094
  30. Lee HJ, HS Lee, Lee YN, Jang YA, Moon JJ, Kim Cl (2007): Nutritional environment influences hypertension in the middleaged korean adults : Based on 1998 & 2001 National Health and Nutrition Survey. Korean J Community Nutr 12(3): 272-283
  31. Lee JH, Jang YS, Kim Y (2004): Dietary habits, obesity status and cardiovascular risk factors in Koreans. International Congress Series 1262: 538-541 https://doi.org/10.1016/j.ics.2003.11.034
  32. Lee KM (2000): Waist circumference as a screening tool for cardiovascular risk factors in Korea: Evaluation of receiver operating characteristics (ROC). J Korean Acad Fam Med 21(3): 395-40
  33. Lee WY, Park JS, Noh SY, Rhee EJ, Kirn SW, Zimmet PZ (2004): Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 65(2): 143-149 https://doi.org/10.1016/j.diabres.2003.12.007
  34. Lee WY, Bea HJ, (2009): Models and actual of stroke unit services in developed countries . J Korean Neurol Assoc 27(3): 195 - 205
  35. Lim YH, Park BH, Kim SZ, Cho CG (2007): Waist circumference may be more important than body mass index (BMI) in determinants of left ventricular mass in korean hypertensive patients. J Kor Diabetes Assoc 31(2): 130-135 https://doi.org/10.4093/jkda.2007.31.2.130
  36. Liu S, Willet WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE. (2000): A prospective study of dietary glycemic load, carbohydrate intake of coronary heart disease in US women. Am J Clin Nutr 71(6): 1455-1461
  37. Ministry of Health and Welfare (1999): Report on 1998 National Health and Nutrition Survey
  38. Ministry of Health and Welfare (2006): Report on 2005 National Health and Nutrition Survey
  39. Ministry of Health and Welfare (2006): In-depth Analysis on 2005 National Health and Nutrition Survey
  40. Ministry of Health and Welfare (2008): Report on 2007 National Health and Nutrition Survey
  41. Ministry of Health Welfare and Family Affairs, Korea Centers for Disease Control & Prevention, Daegu Metropolitan City (2008): KHyDDI (Korea Hypertension Diabetes Daegu Initiative) Project Reports, pp.19-47
  42. Moon EH (2004): Implementation and evaluation of nutrition education program for hypertensive patients among adults aged 50 and over. MS thesis, Department of Nutrition. The Graduate School of Seoul Women's University Seoul
  43. Moon HK, Kim EG (2005): Comparing validity of body mass index, waist to hip ratio, and waist circumference to cardiovascular disease Risk Factors 'in Korean elderly. Korean Nutr Soc 38(6):445-454
  44. Moon HK, Park JH (2007): Comparative analysis and evaluation of dietary intake between with and without hypertension using 2001 Korea national health and nutrition examination survey(KNHANES). Korean J Nutr 40(4): 347-361
  45. Nieves JW (2005) Osteoporosis : The role of micronutrients. Am J Nutr 81(5): 1232S-1239S
  46. Ninomiya JK, L`italien G, Criqui MH, Whyte JL, Gamst A, Chen RS(2004): Association of the metabolic syndrome with history of myocardial infarction and stroke in the third national health and nutrition examination survey. Circulation 109(1): 42-46 https://doi.org/10.1161/01.CIR.0000108926.04022.0C
  47. Park JK, Kim CB, Kim KS, Kang MG, Jee SH (2001): Meta analysis of hypertension as a risk factor of cerebrovascular disorders in Koreans. J Korean Med Sci 16(1): 2-8
  48. Park SH, Lee KS, Park HY (2008): Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: Analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III) IJCA 11270: 1-7 https://doi.org/10.1016/j.ijcard.2008.10.011
  49. Reaven GM (1997): Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Curr Opin Lipidol 8(1): 23-27 https://doi.org/10.1097/00041433-199702000-00006
  50. Sandmaier M (2007): The Health Heart Handbook for Women National Heart, Lung, and Blood Institute, US Department of Health and Human Services, NIH, USA
  51. Son SM, Huh GY (2006): Dietary risk factors associated with hypertension in patients. Korean J Community Nutr 11(5): 661-672
  52. Song Y, Sesso HD, Manson JE, Cook NR, Buring JE, Liu S (2006): Dietary magnesium intake and risk of incident hypertension among middle-aged and older US women in a 10-year follow-up study. Am J Cardio 98(12): 1616-1621 https://doi.org/10.1016/j.amjcard.2006.07.040
  53. Wang Y, Wang QJ (2004): The prevalence of pre-hypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med 164(19): 2126-2134 https://doi.org/10.1001/archinte.164.19.2126
  54. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, Klag MJ (1997): Effects of oral potassium on blood pressure meta-analysis of randomized controlled clinical trials. JAMA 277(10): 1624-1632
  55. Willett WC (1998): Dietary fat and obesity: an unconvincing relation. Am Clin Nutr 68(6): 1149-1159
  56. Yim JE, Cho MR, Yin CS, Seo BK, Koh HG, Choue RW (2005): Nutrients and salt consumption of hypertension patients according to treatment status. Korean J Nutr Soc 38(9): 706-716