Abstract
Considering the strong correlation between carbohydrate and fat intake, we defined and assessed the association of the carbohydrate-to-fat ratio with the high-density lipoprotein cholesterol (HDL-c) level using 12-year follow-up data from the community-based cohort of the Korean Genome Epidemiology Study. We evaluated the long-term changes in HDL-c levels according to quartiles of carbohydrate-to-fat ratio using a mixed model. We also assessed the effect of the carbohydrate-to-fat ratio on the prevalence and incidence of hypo-HDL-cholesterolemia. Of 6,627 subjects, the prevalence of undiagnosed hypo-HDL-cholesterolemia at baseline was 35.3% (n = 2,339). Among the disease-free subjects, 56.8% developed hypo-HDL-cholesterolemia (incidence = 92/1,000 person-years). The prevalence and incidence of hypo-HDL-cholesterolemia were higher in females than in males. The highest carbohydrate-to-fat ratio quartile, which was characterized by high and low intake of carbohydrate and fat, was consistently associated with a lower HDL-c level during the 12-year follow up. Moreover, those in the highest quartile had a 1.14-fold greater risk of incident hypo-HDL-cholesterolemia than those in the lowest quartile, with a significant dose-response relationship. We found that high and low intake of carbohydrate and fat, respectively, was consistently associated with a low HDL-c level over a prolonged period. More research is needed to promote appropriate intake of macronutrients.
Highlights
In the 2010 Korea National Health and Nutrition Survey (KNHANES), one in two adults ≥20 years of age had dyslipidemia and hypo-HDL-cholesterolemia was the most common type (41.6%; 34.1% in males and 48.9% in females)[5]
Using long-term follow-up data, we evaluated the effect of carbohydrate-to-fat ratio on the longitudinal changes in HDL-c levels and the risk of hypo-HDL-cholesterolemia
The highest carbohydrate-to-fat ratio quartile, which was characterized by high carbohydrate and low fat intake, was consistently associated with a lower HDL-c level during the 12-year follow up
Summary
In the 2010 Korea National Health and Nutrition Survey (KNHANES), one in two adults ≥20 years of age had dyslipidemia and hypo-HDL-cholesterolemia was the most common type (41.6%; 34.1% in males and 48.9% in females)[5] These values are higher than those reported in Western countries[6,7]. A Chinese population cohort study reported that high intake of carbohydrate was associated with a decreased HDL-c level and increased triglyceride level during a 4.2-year follow up[11]. Focusing on the high prevalence of hypo-HDL-cholesterolemia in Korea, we defined the carbohydrate-to-fat ratio and evaluated its association with changes in HDL-c levels using data from a Korean cohort study with a 12-year follow up. We estimated the effect of the carbohydrate-to-fat ratio on the risk of hypo-HDL-cholesterolemia
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