Estimating change in cardiovascular disease and diabetes burdens due to dietary and metabolic factors in Korea 1998-2011: a comparative risk assessment analysis

Abstract

Objectives: Over the past 10 years, the burden of chronic diseases in Korea has increased. However, there are currently no quantitative estimates of how changes in diet and metabolic factors have contributed to these shifting burdens. This study aims to evaluate the contributions of dietary and metabolic risk factors to death from cardiometabolic diseases (CMDs) such as cardiovascular conditions, strokes and diabetes in Korea, and to estimate how these contributions have changed over the past 10 years (1998-2011).

Design and methods: We used data on 6 dietary and 4 metabolic risk factors by sex, age and year from the Korea National Health and Nutrition Examination Survey. The relative risks for the effects of the risk factors on CMD mortality were obtained from meta-analyses. The population-attributable fraction attributable to the risk factors was calculated by using a comparative risk assessment approach across sex and age strata (males and females, age groups 25-34, 35-44, 45-54, 55-64, 65-74 and 75+ years) from 1998 to 2011.

Results: The results showed that a suboptimal diet and high blood pressure were the main risk factors for CMD mortality in Korea. High blood pressure accounted for 127 096 (95% uncertainty interval (UI): 121 907 to 132 218) deaths from CMD. Among the individual dietary risk factors, a high intake of sodium (42 387 deaths; 95% UI: 42 387 to 65 094) and a low intake of fruit (50 244 deaths; 95% UI: 40 981 to 59 178) and whole grains (54 248 deaths; 95% UI: 47 020 to 61 343) were responsible for the highest number of CMD deaths in Korea.

Conclusions: Indicating the relative importance of risk factors in Korea, the results suggest that metabolic and dietary risk factors were major contributors to CMD mortality.

Keywords: burden of disease; cardiometabolic disease; cardiovascular disease; dietary risk; metabolic risk.

Figure 1

Trends in (A) diet and (B) metabolic risk factors in Korea from 1998 to 2011. Each plot and error bar indicate intake mean and SE, respectively. A squared dashed line indicates the optimal level for each risk factor. A dotted line indicates the trend of risk distribution across years. p Values were derived from non-parametric trend tests (p<0.05). BMI, body mass index; PFG, plasma fasting glucose; SBP, systolic blood pressure; TC, total cholesterol.

Figure 2

Mortality from cardiometabolic disease attributable to individual dietary and metabolic risk factors, by disease and year in Korea. Data are shown for all adults. See table 2 for actual values of risk factor attributable deaths and 95% uncertainty intervals. Note that the number of deaths attributable to individual risk factors cannot be included because of multi-causality and mediated effects. BMI, body mass index; DM, diabetes; HSTK, haemorrhagic stroke; IHD, ischaemic heart disease; ISTK, ischaemic stroke; PFG, plasma fasting glucose; SBP, systolic blood pressure; TC, total cholesterol; TSTK, total strokes; WG, whole grains.