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The association between curry-rice consumption and hypertension, type 2 diabetes, and depression: The findings from KNHANES 2012-2016

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Background and aims We aim to evaluate the association between curry-rice consumption, cardiovascular diseases (CVDs), type 2 diabetes (T2DB), arthritis, and depression. Methods 17,625 aged ≥18 years were recruited to obtain data on sociodemographic characteristics, lifestyle, medical history, current medications, family history, and food consumption. The association between curry-rice consumption, CVDs, T2DB, arthritis, and depression was examined using multivariable-adjusted analyses. Results In the logistic model, risks of elevated triglyceride (OR 0.89; 95% CI, 0.82–0.97, p = 0.006), elevated HbA1c (OR 0.81; 95% CI, 0.73–0.91, p < 0.001), and elevated glucose (OR 0.86; 95% CI, 0.79–0.94, p < 0.001) were significantly lower in the high curry-rice consumption group than in the low curry-rice consumption group. Risk of hypertension (OR 0.88; 95% CI, 0.78–0.98, p = 0.044), T2DB (OR, 0.82; 95% CI, 0.68–0.98, p < 0.001), and depression (OR 0.82; 95% CI, 0.70–0.97, p = 0.026) was significantly lower among the high curry-rice consumption group than in the low curry-rice consumption group. These findings were consistent with the results of the analysis when curry-rice consumption was treated as a continuous variable. Conclusions The potential health benefits resulting from the intake of curry-rice via an ordinary diet could protect the public from the burden of non-communicable diseases (NCDs) and mental health. These results highlight an ongoing need to understand the role of curry-rice in NCDs and mental health.
Adjusted Odds Ratio (AOR) of curry-rice consumption with non-communicable diseases and metabolic risk factors by logistic regression. Curry-rice was treated as a categorical variable (A). Curry-rice was treated as a continuous variable (B). Elevated HbA1c (≥6.0%), reduced HDL-C (< 50 mg/dL, female; <40mg/dL male), elevated LDL-C (≥100 mg/dL), elevated glucose (≥ 100mg/dL), elevated total cholesterol (≥200 mg/dL), elevated triglyceride (≥ 150 mg/dL), HDL-C: High-density lipoprotein cholesterol, MI: myocardial infarction, NCDs: Non-communicable diseases. Triglyceride, Total cholesterol, HDL-C: adjusted for high-risk drinking, physical activity, age group, sex, monthly household income, family history of hyperlipidemia, dyslipidemia, BMI group, curry consumption. HbA1c, fasting glucose: adjusted for high-risk drinking, physical activity, age group, sex, monthly household income, dyslipidemia, history of diabetes, diabetes, BMI group, curry consumption. Hypertension, stroke, MI or angina, MI, and angina: adjusted for monthly household income, residential areas, age group, married status, sex, family history of CVD, BMI group, smoking status, high risk drinking, physical activity, education level, dyslipidemia, diabetes, curry consumption. Type 2 diabetes: adjusted for monthly household income, residential areas, age group, sex, history of diabetes, BMI group, smoking status, high risk drinking, physical activity, education level, dyslipidemia, curry consumption. Dyslipidemia: adjusted for monthly household income, residential areas, age group, sex, history of hyperlipidemia, BMI group, high risk drinking, physical activity, curry consumption. Osteoarthritis, Rheumatoid arthritis, Arthritis: adjusted for monthly household income, residential areas, age group, sex, BMI group, smoking status, physical activity, education level, curry consumption. Depression: adjusted for monthly household income, occupation, residential areas, age group, sex, married status, BMI group, smoking status, high risk drinking, physical activity, education level, curry consumption.
… 
Adjusted Odds Ratio (AOR) of curry-rice consumption with non-communicable diseases and metabolic risk factors by logistic regression. Curry-rice was treated as a categorical variable (A). Curry-rice was treated as a continuous variable (B). Elevated HbA1c (≥6.0%), reduced HDL-C (< 50 mg/dL, female; <40mg/dL male), elevated LDL-C (≥100 mg/dL), elevated glucose (≥ 100mg/dL), elevated total cholesterol (≥200 mg/dL), elevated triglyceride (≥ 150 mg/dL), HDL-C: High-density lipoprotein cholesterol, MI: myocardial infarction, NCDs: Non-communicable diseases. Triglyceride, Total cholesterol, HDL-C: adjusted for high-risk drinking, physical activity, age group, sex, monthly household income, family history of hyperlipidemia, dyslipidemia, BMI group, curry consumption. HbA1c, fasting glucose: adjusted for high-risk drinking, physical activity, age group, sex, monthly household income, dyslipidemia, history of diabetes, diabetes, BMI group, curry consumption. Hypertension, stroke, MI or angina, MI, and angina: adjusted for monthly household income, residential areas, age group, married status, sex, family history of CVD, BMI group, smoking status, high risk drinking, physical activity, education level, dyslipidemia, diabetes, curry consumption. Type 2 diabetes: adjusted for monthly household income, residential areas, age group, sex, history of diabetes, BMI group, smoking status, high risk drinking, physical activity, education level, dyslipidemia, curry consumption. Dyslipidemia: adjusted for monthly household income, residential areas, age group, sex, history of hyperlipidemia, BMI group, high risk drinking, physical activity, curry consumption. Osteoarthritis, Rheumatoid arthritis, Arthritis: adjusted for monthly household income, residential areas, age group, sex, BMI group, smoking status, physical activity, education level, curry consumption. Depression: adjusted for monthly household income, occupation, residential areas, age group, sex, married status, BMI group, smoking status, high risk drinking, physical activity, education level, curry consumption.
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Original Article
The association between curry-rice consumption and hypertension,
type 2 diabetes, and depression: The ndings from KNHANES
2012e2016
Hai Duc Nguyen, Hojin Oh, Min-Sun Kim
*
Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Sunchon, Jeonnam,
Republic of Korea
article info
Article history:
Received 5 July 2021
Received in revised form
20 December 2021
Accepted 22 December 2021
Keywords:
Curry-rice consumption
Non-communicable diseases
Mental health
KNHANES
abstract
Background and aims: We aim to evaluate the association between curry-rice consumption, cardiovas-
cular diseases (CVDs), type 2 diabetes (T2DB), arthritis, and depression.
Methods: 17,625 participants aged 18 years were recruited to obtain data on sociodemographic char-
acteristics, lifestyle, medical history, current medications, family history, and food consumption. The
association between curry-rice consumption, CVDs, T2DB, arthritis, and depression was examined using
multivariable-adjusted analyses.
Results: In the logistic model, risks of elevated triglyceride (OR 0.89; 95% CI, 0.82e0.97, p ¼0.006),
elevated HbA1c (OR 0.81; 95% CI, 0.73e0.91, p <0.001), and elevated glucose (OR 0.86; 95% CI, 0.79e0.94,
p<0.001) were signicantly lower in the high curry-rice consumption group than in the low curry-rice
consumption group. Risk of hypertension (OR 0.88; 95% CI, 0.78e0.98, p ¼0.044), T2DB (OR, 0.82; 95% CI,
0.68e0.98, p <0.001), and depression (OR 0.82; 95% CI, 0.70e0.97, p ¼0.026) was signicantly lower
among the high curry-rice consumption group than in the low curry-rice consumption group. These
ndings were consistent with the results of the analysis when curry-rice consumption was treated as a
continuous variable.
Conclusions: The potential health benets resulting from the intake of curry-rice via an ordinary diet
could protect the public from the burden of non-communicable diseases (NCDs) and mental health.
These results highlight an ongoing need to understand the role of curry-rice in NCDs and mental health.
©2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.
1. Introduction
Dietary and lifestyle changes contribute to an increase in the
incidence of non-communicable diseases (NCDs) such as type 2
diabetes and cardiovascular diseases. NCDs are exacerbated when
the peak of the third coronavirus disease 2019 (COVID-19) wave
occurs in South Korea. Several studies indicated that people living
with NCDs tend to be at higher risk of dying from COVID-19, and the
risks of acquiring and getting sicker from the virus could be
increased by some NCD risk factors [1,2]. Nevertheless, people who
consume a well-balanced diet appear to be healthier with robust
immune systems and a lower risk of infectious diseases and NCDs
[3]. Thus, food supply is an integral part of the health and nutrition
response to NCDs.
Curry is commonly used in South Korea as a food ingredient,
preservative, and herbal therapy for the treatment of diseases.
However, due to the Western lifestyle spreading all over the world,
people prefer consuming westernized food to traditional foods,
including in Korea. Curry-rice is a popular food that contains a high
concentration of curcumin. Increasing evidence indicates that
curcumin (1,7-bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-
2,5-dione), curcuma longa dried rhizome, may be helpful for the
prevention and/or treatment of certain cognitive impairments
associated with age, cardiovascular health, cancer, coryza, hepatic
disorders, and rheumatism [4,5]. Furthermore, curcumin has been
Abbreviations: NCDs, Non communicable diseases; CVDs, cardiovascular dis-
eases (CVDs); T2DB, Type 2 diabetes; COVID-19, Coronavirus disease 2019;
KNHANES, Korea National Health and Nutrition Examination Surveys; BMI, Body
mass index; HDL-C, High-density lipoprotein cholesterol; LDL-C, Low-density li-
poprotein cholesterol; WC, Waist circumference.
*Corresponding author. Department of Pharmacy, College of Pharmacy, Sunchon
National University, Sunchon, 57922, North Korea.
E-mail address: minsun@scnu.ac.kr (M.-S. Kim).
Contents lists available at ScienceDirect
Diabetes &Metabolic Syndrome: Clinical Research &Reviews
journal homepage: www.elsevier.com/locate/dsx
https://doi.org/10.1016/j.dsx.2021.102378
1871-4021/©2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
shown to have potent anti-inammatory and antioxidant proper-
ties, as well as anti-atherogenic agents and lipid peroxidation in-
hibitors [6e9]. However, dependingon the current condition of the
disease, the dose required to attain these biological activities can
vary [10]. Several studies indicate that the daily consumption of
200 mg of curcumin and other products derived from curcumin
decreases total blood lipid peroxides in healthy human subjects
[11]. The curcumin anti-cancer effect can require high levels
(1.5e4 g/day), but treating some inammatory conditions effec-
tively only needs less than 0,5 g of curcumin [12 e15].
Previous evidence has demonstrated the benecial effects of
curry-rice consumption on human health. For example, a cross-
sectional study of Korean adults aged 19e64 years found higher
curry-rice consumption was related to lower blood glucose and
triglyceride levels [16]. Our recent study also showed high curry-
rice consumption was associated with lower risks of metabolic
syndrome among the adult Korean population [17]. These ndings
have prompted the search for curry-rice consumption that may aid
in the prevention and control of NCDs. However, the effects of
curry-rice consumption on NCDs in Korean adults at a national level
have not been sufciently explored. Thus, we hypothesized that
high consumption of curry-rice is associated with NCDs among the
adult Korean population, independent of other covariates and po-
tential confounders. Taken together, this study aimed to further
examine the association between curry-rice consumption and
NCDs and mental health, including cardiovascular diseases, type 2
diabetes, arthritis, and depression.
2. Subjects
In this study, a multi-stage, stratied, cluster-sampling procedure
that considered the geographic area, level of urbanization, economic
growth status, and gender and age distribution was used. This survey
was derived from the Korean National Health and Nutrition Exami-
nation Survey (KNHANES) conducted by the Korean Ministry of
Health and Welfare, specically the KNHANES V (2012) and VI
(2013e2015) and the KNHANES VII (2016) [18,19]. Individuals sur-
veyed were randomly selected from 8,58 households (2012), 8018
(2013), 7550 (2014), 7380 (2015) and 8150 (2016). In this study, par-
ticipants who (1) fully participated in three parts, including a health
interview survey, a health examinationsurvey, and anutrition survey,
(2) with adequate information on curry-rice consumption, were
selected. Of the 39,156 participants who underwent the survey from
2012 to 2016, we excluded 21,531 records of missing curry-rice con-
sumption.A total of 17,625 subjects were eligiblefor the data analysis.
3. Materials and methods
3.1. Laboratory measurements
During medical check-ups, height, weight, waist circumference
(WC), and blood pressure were measured using standard proced-
ures. WC (cm) was measured at the midpoint between the bottom
of the rib cage and the iliac crest of the mid-axillary line while
exhaling. BMI (kg/m
2
) was calculated by dividing body weight (kg)
by the square of the height (m) [20]. Blood pressure was measured
three times at intervals of 5 min using a mercury sphygmoma-
nometer with a subject seated after a 5-min stabilization period.
The nal blood pressure was the average of the second and third
measurements. Blood samples were collected after 8-h fasting
and were analyzed at Neodin Medical Institute in Korea. Levels of
total cholesterol, triglycerides, high-density lipoprotein cholesterol
(HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting
glucose were then measured by an enzymatic assay using a Hitachi
automatic analyzer 7600 (Hitachi, Japan) [17,21].
3.2. Parameters
Physical activity was dichotomized as regular or irregular. Reg-
ular physical activity was dened as the following: (1) vigorous
physical activity for 20 min per session, three days a week; (2)
moderate physical activity for 30 min per session, 5 days a
week; and (3) walking for 30 min per session, ve days a week.
Alcohol intakes were classied as low and high (high-risk drinking
was dened as >5 drinks per day and 1 month). Subjects who had
smoked more than 100 cigarettes in their lifetime and still smoked
daily or on occasion were classied as current smokers; others were
classied as ex/non-smokers [17,20].
A family history of cardiovascular disease was dened as having
at least one parent or sibling with a diagnosis of hypertension,
ischemic heart disease, or stroke. A family history of diabetes or
hyperlipidemia was dened as having at least one parent or sibling
with a diagnosis of diabetes or hyperlipidemia. Type 2 diabetes
mellitus was dened as having a fasting plasma glucose of
126 mg/dl or being on anti-diabetic medication, or having HbA1c
of 6.5%. Stroke, angina, MI, MI or angina, lung cancer, asthma,
thyroid disease, thyroid cancer, stomach cancer, liver cancer, liver
cirrhosis, colon cancer, breast cancer, cervical cancer, osteoarthritis,
rheumatoid arthritis, arthritis, and kidney failure were dened as
physician's diagnosis, the current presence or treatment for these
diseases. Depression was dened as a physician's diagnosis, the
current presence or treatment of depression. Dyslipidemia was
dened as one or more of the following: LDL-C 160 mg/dL, tri-
glyceride 200 mg/dL, HDL-C <40 mg/dL. Hypertension was
dened as having either systolic blood pressure (SBP) of
140 mmHg or diastolic blood pressure of 90 mmHg or on anti-
hypertensive medication [18,22].
3.3. Curry-rice consumption
The curry-rice consumption was estimated using the KNHANES
food frequency questionnaire data conducted from 2012 to 2016.
Fig. 1 provides detailed ingredient information for curry rice. Ac-
cording to the frequency of their curry-rice consumption, subjects
were divided into three groups: the rarely or never curry-rice
consumption group (almost never,oronce a month), the oc-
casionally curry-rice consumption group (2e3 times a monthor
once a week), and the often curry-rice consumption group (2e4
times per week,or5e6 times per week). However, only 110
participants were included in the often curry-rice consumption
group. Therefore, in univariate and multivariate analysis, we com-
bined the often curry-rice consumption group into the ‘‘occasion-
ally’’ category of curry-rice consumption [17].
3.4. Statistical analysis
All statistical analyses were undertaken using STATA software
(version 16.0; StataCorp, Texas, USA). The baseline characteristics of
participants were summarized using frequency and proportion for
categorical variables; mean and standard deviation or median and
interquartile range for continuous variables. Student's t-test for
continuous variables; and
c
2
test or one-way ANOVA for categorical
variables [23,24]. Statistical tests were two-sided, p-value <0$05
was considered statistically signicant.
The associations between cardiovascular diseases, type 2 dia-
betes, arthritis, depression, and curry-rice consumption were
assessed by logistic regression. In the current study, curry-rice
consumption was treated as both a categorical and continuous
variable. Potential covariates were obtained from the literature,
chosen based on subjective prior knowledge, or shown by univar-
iate analysis to have p values of 0.25, and these variables were
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
2
entered into the full model [25,26]. Logistic regression and linear
regression models ascertained the risk factors associated with hy-
pertension, type 2 diabetes, obesity, dyslipidemia, MI, angina, MI or
angina, depression, and other diseases, including age group (<29,
30e39, 40e49, 50e59, >60e69), sex, residential area (rural vs ur-
ban), marital status (married, living alone), the education level
(middle school, high school, college), monthly household in-
come (<2000, 2000 and <4000, 4000 and <600 0, 6000),
smoking status (current smoker, non/ex-smoker), high-risk drink-
ing (yes, no), physical activity (not regular, regular), BMI groups
(<18.5, 18.5 and <25, 25 and <30, 30), and presence of hy-
pertension, hyperlipidemia, type 2 diabetes (shown in Supple-
mentary materials). A forest plot was then used to visualize the
odds ratios of cardiovascular diseases, type 2 diabetes, arthritis, and
depression. Statistical tests were two-sided, and p-values of <0.05
were considered statistically signicant.
4. Results
Our study included 17,625 participants in the KNANES
2009e2018 survey; the mean age of the participants was 43.4 (SD
12.5); 10,627 (60.3%) were women. The majority of the subjects
reported never or rarely consuming curry-rice (53%). 46% partici-
pants consumed curry-rice at least occasionally ("2e3 times a
month" or "once a week"), while only one percent (110/17,625)
participants reported often consuming curry-rice ("2e4 times per
week", or "5e6 times per week"). As shown in Fig. 2, the trend of
curry consumption among the Korean population has not changed
during the last 5 years. The percentage of subjects with higher
levels of curry-rice consumption was always lower than in subjects
who had never or rarely consumed curry-rice (p ¼0.0301).
When compared to the never or rarely consuming curry-rice
group, subjects with occasional or frequent curry-rice consump-
tion were signicantly more non/ex-smokers, females in the young
age group (39 years), better educated, married, unemployed, living
in an urban area, had a low monthly household income (4 million
Korean Won), had a healthy weight, did regular physical activity,
and drank less frequently. Compared with subjects who had never
or rarely consumed curry-rice, subjects with occasional or often
curry-rice consumption showed signicantly lower WC (79.5 ±9.8
vs 81.3 ±10.2 cm, p <0.001), total cholesterol (189.7 ±34.7 vs
191 ±36.0 mg/dL, p ¼0.03), triglyceride (125.7 ±107.7 vs
137.5 ±116.5 mg/dL, p <0.001), HbA1c (5.6 ±0.6 vs 5.7 ±0.8%,
p<0.001), fasting glucose (95.6 ±18.0 vs 99.5 ±24.8 mg/dL,
p<0.001), systolic blood pressure (113.4 ±14.5 vs
116.6 ±15.8 mmHg, p <0.001), and diastolic blood pressure
(75.2 ±10.0 vs 76.0 ±10.3 mmHg, p <0.001). In contrast, HDL-C
(52.5 ±12.3 vs 51.5 ±12.5 mg/dL, p<0.001) and energy intake
(2117.4 ±925.4 vs 2050.4 ±951.3, p<0.001) were signicantly
higher among subjects who had occasionally consumed curry-rice.
Baseline characteristics according to curry-rice consumption of the
study population are shown in Table 1.
Signicantly more subjects had elevated total cholesterol,
elevated triglyceride, reduced HDL-C, elevated HbA1c, and elevated
fasting glucose in the never or rarely curry-rice consumption group
than in the occasional or frequent curry consumption group.
Furthermore, subjects with higher levels of curry-rice consumption
were signicantly less likely to have type 2 diabetes, hypertension,
dyslipidemia, stroke, MI or angina, osteoarthritis, rheumatoid
arthritis, arthritis, or depression compared to subjects who had
never or rarely consumed curry-rice. These ndings were consis-
tent with the results of the analysis when curry-rice consumption
was treated as a continuous variable (Table 2).
After adjusting for potential confounders, the risks of elevated
triglyceride, elevated HbA1c, and elevated glucose were signi-
cantly lower in the high curry-rice consumption group than in the
low consumption group (24.6% vs 30.2%; OR 0.89; 95% CI, 0.82 to
0.97, p ¼0.006), (12.8% vs 20.8%; OR 0.81; 95% CI, 0.73 to 0.91,
p<0.001), (23.3% vs 31.6%; OR 0.86; 95% CI, 0.79 to 0.94, p <0.001),
respectively. There were no signicant differences found in subjects
with high total cholesterol and low HDL-C. The risks of hyperten-
sion (9.3% vs.16.1%; OR 0.88; 95% CI, 0.78 to 0.98, p ¼0.04) and type
2 diabetes (3.2% vs. 6.6%; OR, 0.82; 95% CI, 0.68 to 0.98, p<0.001)
were signicantly lower in the high curry-rice consumption group
than in the low consumption group. Similarly, in the high curry-rice
consumption group, the risk of depression (3.5% vs 5.1%; OR 0.82;
95% CI, 0.70 to 0.97, p ¼0.026) was also signicantly lower than
those in the low curry-rice consumption group. High curry-rice
Fig. 1. Provides detailed ingredient information for curry rice.
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
3
consumption was associated with lower risks of stroke (0.6% vs
1.4%; OR 0.83; 95% CI, 0.46 to 1.24, p ¼0.056), myocardial infraction
(0.2% vs 0.5%; OR 0.60; 95% CI, 0.30 to 1.20, p ¼0.147), and angina
(0.5% vs 1.2%; OR 0.75; 95% CI, 0.49 to 1.14, p ¼0.179). In addition,
the risk of arthritis was lower among the high curry-rice con-
sumption group (5.4% vs 9.2%; OR, 0.94; 95% CI, 0.82 to 1.08,
p¼0.406). However, no signicant differences were found (shown
in Fig. 3A).
We considered curry-rice consumption as a continuous variable
to evaluate the association of curry-rice consumption with NCDs
and metabolic risk factors. After adjusting for all covariates, curry-
rice consumption was also found to be negatively associated with
the prevalence of elevated triglyceride, elevated HbA1c, and
elevated glucose, as well as hypertension, diabetes, and depression.
More specically, an increase in curry-rice consumption was
negatively related to the prevalence of elevated triglyceride (OR
0.93; 95%CI: 0.89e0.97), elevated HbA1c (OR 0.94; 95%CI:
0.89e0.99), and elevated glucose (OR 0.93; 95%CI:0.89e0.97),
respectively. Furthermore, after adjusting for all covariates, an in-
crease in curry-rice consumption was negatively associated with
the risk of hypertension (OR 0.93; 95% CI: 0.87e0.98), type 2 dia-
betes (OR 0.87; 95%CI: 0.78e0.97), and depression (OR 0.94; 95%CI:
0.85e0.98), respectively (shown in Fig. 3B and supplementary data
Tables S1eS6).
5. Discussion
This study conrmed our hypothesis that high consumption of
curry-rice was associated with a low prevalence of type 2 diabetes,
hypertension, and depression in the adult Korean population. We
found that the risks of type 2 diabetes, hypertension, and depres-
sion were negatively associated with high curry-rice consumption.
Our ndings show that the risk of depression is low among
subjects with high curry-rice consumption, suggesting that curry-
rice consumption as part of a normal diet can act as an adjunct
treatment for depression because curry-rice may have a high cur-
cumin concentration. It has been known that inammation plays an
important role in the pathology of depression [27,28]. Curcumin not
only has antioxidant and anti-inammatory properties, but also
serotonin and dopamine modulation, monoamine oxidase (MAO)
inhibition, and hypothalamus-pituitary-adrenal axis (HPA) control
[29]. Curcumin has been linked to the inhibition of signal pathways
for transcription of several nuclear factors, including the kappa-B
nuclear factor, which results in the production of pro-
inammatory cytokines (such as interleukin-6 and interleukin-
1
b
)[30]. As a result, curcumin may have an antidepressant effect,
which is consistent with previous research that found curcumin
may reduce depressive symptoms when compared to a control or
placebo [31,32]. These ndings support the meta-analysis study
about the efcacy of curcumin in depression. In the context of the
COVID-19 pandemic, curcumin intake through an ordinary diet is a
promising potential therapy that could relieve depression.
Our analyses revealed that the risks of elevated HbA1c and
elevated fasting glucose among the high curry-rice consumption
group were reduced by 11% and 14%, respectively. These ndings
support our hypothesis about the association between high curry-
rice consumption and reducing the risk of type 2 diabetes, which
was in agreement with previous research [33]. Remarkably, pro-
inammatory cytokines and oxidative stress play an important
role in the pathogenesis of type 2 diabetes [34]. Clinical trial
research also indicated the role of curcumin in improving endo-
thelial function and reducing oxidative stress and inammatory
markers (IL-6, TNF
a
, endothelin-1) in type 2 diabetes patients [35].
Curcumin was also found to have an effect on insulin secretion in
healthy participants [36]. More recently, a randomized clinical trial
showed curcumin could help improve the function of
b
cells, with
higher homeostasis model assessment
b
, lower C-peptide levels,
lower levels of higher homeostasis model assessment insulin
resistance, and higher adiponectin among the participants of the
curcumin-treated group compared with the placebo group [37].
Therefore, curcumin is a promising therapeutic alternative for type
2 diabetes due to its anti-inammatory properties.
Dyslipidemia and hyperglycemia are common in patients with
acute and chronic coronary syndrome [38]. Our results showed the
risk of elevated triglycerides was signicantly reduced among the
high curry-rice consumption group. Although we did not nd the
effect of curry-rice on total cholesterol, and HDL-C among subjects
with high curry-rice consumption, a randomized, double-blind,
controlled trial from Jakarta suggested the benecial effects of
curcumin in reducing triglyceride, total cholesterol, LDL-C, and
increasing HDL-C in patients with the acute coronary syndrome
[39]. Our study showed levels of systolic blood pressure and dia-
stolic blood pressure, and the risk of hypertension was signicantly
lower among the high curry-rice consumption group and was
lower among subjects with high curry-rice consumption. It could
be explained by the vascular defense benets of curcumin in the
arteries. Our ndings also found the risk of stroke, MI, angina, MI or
angina was lower among subjects with high curry-rice consump-
tion. However, the effect of curry-rice consumption could not be
evaluated due to the limited number of individuals with these
diseases. Recent data indicated that curcumin has a preventive
stroke effect by reducing the amount of oxidative stress associated
with signaling uncoupling protein 2 to boost vascular endothelial
function [40]. The effect of curcumin on microglial response is
profound, promotes microglial M2 polarization, and inhibits pro-
inammatory response mediated by microglia. In addition,
Fig. 2. The trend of curry consumption among the Korean population. Error bars represent 95% CIs. Paired t-test, *p¼0.0301.
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
4
Table 1
Baseline characteristics according to curry consumption of the study population from the Korean National Health and Nutrition Examination Surveys in 2012e2016.
Characteristics No. of subjects Curry consumption p-value
Often (n, %) Occasionally (n, %) Never or rarely (n, %)
Sex (%) 17,625 <0.001
Male 6998 38 (34,5) 3129 (38.2) 3831 (41.1)
Female 10,627 72 (65,5) 5064 (61,8) 5491 (58.9)
Age (yr)
a
17,625 45.3 (13.1) 41.4 (11.4) 38.8 (11.8)
Age group (%) 17,625 <0.001
<29 2841 28 (25.5) 1298 (15,8) 1515 (16,3)
30e39 4089 35 (31.8) 2436 (29.7) 1618 (17.3)
40e49 4270 26 (23.6) 2286 (27.9) 1958 (21.0)
50e59 4387 16 (14.6) 1613 (19.7) 2758 (29.6)
>60 2038 5 (4.5) 560 (6.9) 1473 (15.8)
Marital status (%) 17,625 <0.001
Married 14,066 74 (67.3) 6611 (80.8) 7381 (79,3)
Living alone 3539 36 (32.7) 1576 (19,2) 1927 (20,7)
Residential areas (%) 17,625 <0.001
Urban 14,672 96 (87.3) 7075 (86.4) 7501 (80.5)
Rural 2953 14 (12.7) 1118 (13.7) 1821 (19.5)
Occupation (%) 15,776 <0.001
Managers, professional 2611 24 (23.3) 1467 (20.0) 1120 (13.4)
Ofce worker, clerical workers 1899 11 (10.7) 1041 (14.2) 847 (10.2)
Service workers, sales workers 2344 10 (9.7) 1017 (13.9) 1317 (15.8)
Agriculture, forestry and shing workers 576 2 (1.9) 105 (1.4) 469 (5.6)
Craft, plant and machine operators and assemblers 1680 11 (10.7) 667 (9.1) 1002 (12.0)
Elementary occupations 1243 8 (7.8) 481 (6.6) 754 (9.0)
Unemployed 5423 37 (35.9) 2546 (34.8) 2840 (34.0)
Education level (%) 15,801 <0.001
Middle school 3101 7 (6.8) 806 (11.0) 2288 (27.4)
High school 6175 48 (46.6) 2790 (38.0) 3337 (39.9)
College 6525 48 (46.6) 3741 (51,0) 2736 (32.7)
Monthly household income (%) y17,520 <0.001
<2000 3432 28 (25.5) 1117 (13.7) 2287 (24.7)
2000 and <4000 5882 37 (33.6) 2697 (33.1) 3148 (34.0)
4000 and <6000 4417 24 (21.8) 2348 (28.8) 2045 (22.1)
6000 3789 21 (19.1) 1991 (24.4) 1777 (19.2)
BMI group (%) 16,737 <0.001
<18.5 750 1 (0.9) 393 (5.1) 356 (4.0)
18.5 and <25 10,663 73 (68.9) 5105 (65.7) 5485 (61.9)
25 and <30 4520 26 (24.5) 1956 (25.2) 2538 (28.6)
30 804 6 (5.7) 311 (4.0) 487 (5.5)
Waist circumference (cm)
a
16,735 79.7 (9.6) 79.5 (9.8) 81.3 (10.2) <0.001
Total cholesterol (mg/dL)
a
16,035 188.1 (33.0) 189.7 (34.7) 191 (36.0) 0.030
LDL-C (mg/dL)
a
5014 110.3 (27.1) 117.0 (31.8) 116.2 (33.3) 0.427
Triglyceride (mg/dL)
a
16,035 117.6 (72.0) 125.7 (107.7) 137.5 (116.5) <0.001
HDL-C (mg/dL)
a
16,035 53.4 (11.6) 52.5 (12.3) 51.5 (12.5) <0.001
HbA1c (%)
a
16,003 5.7 (1.0) 5.6 (0.6) 5.7 (0.8) <0.001
Fasting glucose (mg/dL)
a
16,027 96.6 (29.3) 95.6 (18.0) 99.5 (24.8) <0.001
Systolic blood pressure (mmHg)
a
16,968 110.4 (11.6) 113.4 (14.5) 116.6 (15.8) <0.001
Diastolic blood pressure (mmHg)
a
16,968 73.8 (8.5) 75.2 (10.0) 76.0 (10.3) <0.001
CRP (mg/L)
a
6216 1.2 (2.3) 1.1 (2.1) 1.2 (2.2) 0.237
Energy intake (kcal) 17,621 2409.2 (1140.2) 2117.4 (925.4) 2050.4 (951.3) <0.001
Smoking status (%) <0.001
Current smoker 3060 18 (17.3) 1273 (16.9) 1769 (20.7)
Non/ex-smoker 13,111 86 (82.7) 6243 (83.1) 6782 (79.3)
Drinking status (%) 16,174 <0.001
Often 3319 20 (19.2) 1472 (19.6) 1827 (21.4)
Occasionally 9145 63 (60.6) 4487 (59.7) 4595 (53.7)
Never or rarely 3710 21 (20.2) 1557 (20.7) 2132 (24.9)
Physical activity (%) 17,625 <0.001
Not regular 5074 48 (43.6) 2443 (29.8) 2583 (27.7)
Regular 12,551 62 (56.4) 5750 (70.2) 6739 (72.3)
History of CVD (%) 16,247 0.647
Yes 8247 52 (49.1) 3880 (51.2) 4315 (50.5)
No 7971 54 (50.9) 3695 (48.8) 4222 (49.5)
History of diabetes (%) 0.036
Yes 3944 33 (31.4) 1900 (25.3) 2011 (23.9)
No 12,060 72 (68.6) 5602 (74.7) 6386 (76.1)
History of hyperlipidemia (%) 15,794 <0.001
Yes 1153 7 (6.7) 615 (8.3) 531 (6.4)
No 14,641 97 (93.3) 6812 (91.7) 7732 (93.6)
a
mean (standard deviation); ythousand won/month, BMI: Body mass index (kg/m
2
), CRP: C-reactive protein, CVD: Cardiovascular disease. HDL-C: High-density lipoprotein
cholesterol, LDL-C: low-density lipoprotein cholesterol.
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
5
Table 2
Odds Ratio of curry consumption with non-communicable diseases and risk factors by logistic regression.
Non-communicable disease and metabolic risk factors Categorical variables Continuous variables
95% CI p-value
a
95% CI p-value
Elevated WC (%)
No 1 (refer) 1 (refer)
Yes 0.73 (0.68e0.78) <0.001 0.86 (0.83e0.89) <0.001
Elevated triglyceride (%)
No 1 (refer) 1 (refer)
Yes 0.76 (0.71e0.81) <0.001 0.86 (0.83e0.90) <0.001
Elevated total cholesterol (%)
No 1 (refer) 1 (refer)
Yes 0.91 (0.86e0.98) 0.007 0.96 (0.92e0.99) 0.008
Elevated LDL-C (%)
Yes 1 (refer) 1 (refer)
No 1.06 (0.94e1.20) 0.327 1.05 (0.99e1.20) 0.079
Reduced HDL-C (%)
No 1 (refer) 1 (refer)
Yes 0.89 (0.84e0.96) 0.001 0.95 (0.92e0.97) 0.007
Elevated HbA1c (%)
No 1 (refer) 1 (refer)
Yes 0.56 (0.52e0.61) <0.001 0.82 (0.79e0.86) <0.001
Elevated glucose (%)
No 1 (refer) 1 (refer)
Yes 0.66 (0.62e0.71) <0.001 0.83 (0.80e0.86) <0.001
Hypertension (%)
No 1 (refer) 1 (refer)
Yes 0.53 (0.48e0.59) <0.001 0.71 (0.67e0.75) <0.001
Dyslipidemia (%)
No 1 (refer) 1 (refer)
Yes 0.63 (0.57e0.70) <0.001 0.78 (0.73e0.83) <0.001
Type 2-diabetes (%)
No 1 (refer) 1 (refer)
Yes 0.47 (0.41e0.55) <0.001 0.66 (0.59e0.72) <0.001
Stroke (%)
No 1 (refer) 1 (refer)
Yes 0.45 (0.32e0.64) <0.001 0.63 (0.50e0.78) <0.001
MI or angina (%)
No 1 (refer) 1 (refer)
Yes 0.39 (0.28e0.54) <0.001 0.61 (0.49e0.76) <0.001
MI (%)
No 1 (refer) 1 (refer)
Yes 0.34 (0.18e0.63) 0.001 0.57 (0.38e0.85) 0.006
Angina (%)
No 1 (refer) 1 (refer)
Yes 0.41 (0.28e0.60) <0.001 0.63 (0.49e0.80) <0.001
Osteoarthritis (%)
No 1 (refer) 1 (refer)
Yes 0.54 (0.47e0.61) <0.001 0.73 (0.67e0.79) <0.001
Rheumatoid arthritis (%)
No 1 (refer) 1 (refer)
Yes 0.68 (0.52e0.89) 0.006 0.85 (0.73e0.98) 0.045
Arthritis (%)
No 1 (refer) 1 (refer)
Yes 0.56 (0.49e0.64) <0.001 0.75 (0.69e0.80) <0.001
Depression (%)
No 1 (refer) 1 (refer)
Yes 0.66 (0.57e0.78) <0.001 0.66 (0.57e0.78) <0.001
Lung cancer (%)
No 1 (refer) 1 (refer)
Yes 0.48 (0.12e1.86) 0.290 0.47 (0.16e1.36) 0.162
Asthma (%)
No 1 (refer) 1 (refer)
Yes 0.87 (0.71e1.07) 0.184 0.90 (0.80e1.02) 0.101
Thyroid disease (%)
No 1 (refer) 1 (refer)
Yes 1.14 (0.97e1.33) 0.184 1.08 (0.98e1.17) 0.108
Thyroid cancer (%)
No 1 (refer) 1 (refer)
Yes 1.08 (0.77e1.51) 0.670 0.99 (0.82e1.20) 0.954
Stomach cancer (%)
No 1 (refer) 1 (refer)
Yes 1.08 (0.64e1.84) 0.763 0.95 (0.70e1.30) 0.767
Liver cancer (%)
No 1 (refer) 0.56 (0.22e1.39) 0.209
Yes 0.25 (0.50e1.16) 0.076
Liver cirrhosis (%) 1 (refer)
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
6
curcumin post-treatment decreases brain damage caused by
ischemic stroke and improves outcome functions [41]. This evi-
dence provides new proof of curcumin as a preventive strategy for
cardiovascular diseases. Our results did not nd an association
between curry-rice consumption and cancer, arthritis, or kidney
failure. It could be explained due to the limited number of in-
dividuals with these diseases, although we have only adjusted for
monthly household income, residential areas, age group, sex, BMI
group, smoking status, physical activity, education level, and curry-
rice consumption. However, given its anti-oxidant and anti-
inammatory properties, curcumin has been documented for the
treatment of several physical chronic diseases, such as arthritis,
cancer, and chronic kidney diseases [42].
While the overall mortality rate of COVID-19 is high, the risk of
serious diseases and subsequent mortality is higher for older adults
and patients with comorbidities. Diabetes, hypertension, cerebro-
vascular disease, coronary artery disease, and chronic obstructive
pulmonary disease have all been linked to an increased risk of poor
prognosis in COVID-19 patients [2]. In the context of the COVID-19
pandemic, community dwellers with co-morbidities take special
measures such as social distancing, home care, isolation, and strict
hand hygiene as an obligation [43]. People living with NCDs should
consume a well-balanced diet that appears to be healthier with
robust immune systems. In particular, people with type 2 diabetes
need to ensure good glucose control to improve their immune
response. Our results suggest that the potential health benets
stem from curcumin consumption through an ordinary diet during
the COVID-19 pandemic. Importantly, our study raises a public
health concern for people in Korea. In recent years, there has been
no change in the trend of high curry-rice consumption. Given the
gradual decline in curry-rice consumption in Korea and the effectof
curcumin in an ordinary diet on the population, which could reduce
the risks of NCDs and mental health problems, health policymakers
and public health practitioners should invest in curcumin propa-
ganda plans.
6. Limitations
To the best of our knowledge, this large-scale Korean study is the
rst to report the effect of curry-rice consumption on NCDs at a
national level. However, our study has several limitations. First, the
cross-sectional method used prevented the assessment of causality
between NCDs and curry-rice consumption. Second, since no
physiological antioxidant status markers were evaluated during
KNHANES, oxidation status in plasma and tissue was not evaluated.
Third, only a small number of people consume curry-rice on a
Table 2 (continued )
Non-communicable disease and metabolic risk factors Categorical variables Continuous variables
95% CI p-value
a
95% CI p-value
No 1 (refer) 0.84 (0.56e1.24) 0.370
Yes 0.58 (0.30e1.14) 0.116
Colon cancer (%) 1 (refer)
No 1 (refer) 0.86 (0.54e1.39) 0.054
Yes 0.75 (0.34e1.67) 0.480
Breast cancer (%) 1 (refer)
No 1 (refer) 1.13 (0.91e1.41) 0.270
Yes 1.23 (0.81e1.86) 0.327
Cervical cancer (%)
No 1 (refer) 1 (refer)
Yes 1.13 (0.70e1.81) 0.627 1.02 (0.78e1.33) 0.970
Kidney failure (%)
No 1 (refer) 1 (refer)
Yes 0.82 (0.51e1.32) 0.416 0.87 (0.56e1.15) 0.330
a
Reference with never or rarely curry consumption. WC: waist circumference; Elevated HbA1c (6.0%); reduced HDL-C (<50 mg/dL, female; <40 mg/dL male); elevated
LDL-C (100 mg/dL); elevated glucose (100 mg/dL); elevated total cholesterol (200 mg/dL); elevated triglyceride (150 mg/dL); elevated WC (80 cm, female; 90 cm,
male); HDL-C: High-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol.
Fig. 3. Adjusted Odds Ratio (AOR) of curry-rice consumption with non-communicable diseases and metabolic risk factors by logistic regression. Curry-rice was treated as a cat-
egorical variable (A). Curry-rice was treated as a continuous variable (B).
H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
7
regular basis. Fourth, the effect of curry-rice consumption could not
be evaluated in individuals without a prior history of cancer,
arthritis, rheumatoid arthritis, osteoarthritis, kidney failure, and
the limitations of individuals with these diseases. Fifth, the asso-
ciation between curry-rice consumption, CVDs, type 2 diabetes, and
depression may be affected by other factors (e.g., drugs, etc.).
7. Conclusion
In conclusion, our study found that high curry-rice consumption
was associated with a low prevalence of type 2 diabetes, hyper-
tension, and depression. Our ndings indicate that the potential
health benets resulting from the intake of curcumin protect the
public from the dual burden of NCDs and mental health. However,
our ndings highlight an ongoing need to conduct further in-
vestigations of curry-rice consumption in relation to NCDs and
mental health in longitudinally followed up cohorts of large
populations.
Credit authorship contribution statement
H.D.N.: Conceptualization, Data curation, Investigation, Writing
eoriginal draft, Writing ereview &editing. H.O.: Data curation,
Investigation. M.S.K: Conceptualization, Writing ereview &
editing.
Ethical approval
These surveys were conducted with the approval of the IRB of
the KCDC (2012-01EXP-01-2C, 2013-07CON-03-4C, 2013-12EXP-
03-5C, 2015-01-02-6C). KNHANES was conducted without approval
in 2016, according to the opinion of the IRB of the KCDC.
Funding
This study supported by grants National Research Foundation of
Korea (NRF) grant funded by the Korean government (MEST) (grant
nos. NRF2013R1A1A3008851 and 2018R1D1A1B07049610).
Data availability
Data are available on reasonable request.
Informed consent
All individuals were required to provide written informed con-
sent prior to examinations, which were conducted by the Depart-
ment of the Korea Centers for Disease Control and Prevention.
Declaration of competing interest
The authors have no potential conict of interest.
Acknowledgments
The authors are grateful to all research staff that contributed to
the data collection required for this study.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.dsx.2021.102378.
Abbreviations index
BMI body mass index
COVID-19 Coronavirus disease 2019
KNHANES Korean National Health and Nutrition Examination
Survey
HDL-C high-density lipoprotein cholesterol
LDL-C Low-density lipoprotein cholesterol
NCDs communicable diseases
WC waist circumference
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H.D. Nguyen, H. Oh and M.-S. Kim Diabetes &Metabolic Syndrome: Clinical Research &Reviews 16 (2022) 102378
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... HDL-C and total cholesterol were measured using Cholest N HDL, Pureauto SCHO-N, and Cholestest LDL agent (Sekisui, Tokyo, Japan) on a Hitachi Automatic Analyzer 7600-210 (Hitachi, Tokyo, Japan) (Nguyen et al. 2021e). In this study, the Framingham point score, which is based on HDL-C, total cholesterol, age, systolic blood pressure, and cotinine-verified smokers, was used to calculate the 10-year risk of CVDs. ...
... Because CVDs are chronic illnesses, the assessments may not have better represented chronic exposure conditions. Fourth, menopausal status was identified based on a physician's diagnosis and thus could not be validated by measuring serum follicle-stimulating hormone (FSH) or estradiol (E2) (Nguyen and Kim, 2021;Nguyen et al. 2021e). Fifth, the unequal distribution of pre-and postmenopausal women may have an impact on our final conclusions. ...
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To assess the link between a mixed heavy metal (cadmium, lead, and mercury) and the 10-year risk of cardiovascular diseases (CVDs) in pre- and post-menopausal Korean women aged ≥20 years, as well as identify potential molecular mechanisms of mixed heavy metal-induced CVDs. Multivariate linear regression, weighted quantile sum (WQS) regression, quantile g-computation (gqcomp), and Bayesian kernel machine regression (BKMR) models were used to examine the effects of mixed heavy metals and the 10-year risk of CVDs. The Comparative Toxicogenomics Database, MicroRNA ENrichment TURned NETwork, and the microRNA sponge generator and tester were used as the key data-mining approaches. In our BKMR analysis, we found that the overall effect of mixed heavy metals was linked to the 10-year risk of CVDs in postmenopausal women in the upper 20th percentiles and in premenopausal women in the upper 55th percentiles. Mercury was identified as the key chemical for the 10-year risk of CVDs in pre- and postmenopausal women. In silico analysis revealed that a heavy metal mixture interacted with six genes associated with CVD development. Physical interactions (77.6%) were found to be the most common among CVD-related genes induced by the heavy metals studied. Several pathways have been identified as the main molecular mechanisms that could be affected by studied heavy metals and are implicated in the development of CVDs (e.g., lipid and lipoprotein metabolism, lipoprotein metabolism, cholesterol metabolism, and cardiovascular disease). ALB, APOE, ATF5, and CREB3L3 were the key genes and transcription factors related to CVDs induced by the mixture of the investigated heavy metals, respectively. The two miRNAs with the highest interaction and expression in the development of CVDs were hsa-miR-199a-5p and hsa-miR-199a-3p. We also designed and tested miRNA sponge sequences for these miRNAs. The cutoff thresholds for each heavy metal level linked with the 10-year risk of CVDs were described. A mixture of heavy metal exposures, especially mercury, was more strongly linked with the 10-year risk of CVDs in postmenopausal women than in premenopausal women. Early interventions in postmenopausal women should be considered to reduce CVD risks.
... The prevalence of MetS in adults was higher than in children, especially in type 2 diabetes (T2DM) patients. Of note, MetS plays an important role in the pathology of developing non-communicable diseases (NCDs), e.g., cardiovascular disease, T2DM, and stroke, in the general population [2]. NCDs have been increasing the prevalence of morbidity and mortality, impairing quality of life and require a tailored strategy to assess the mixed effects of multiple micronutrients and macronutrients, which can help prevent and control the risk of MetS. ...
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Purpose We aim to identify the association between nutrient intake mixtures (22 micro-macro nutrients) and metabolic syndrome (MetS) or its components, including molecular mechanisms involved, among 16,807 Korean adults aged 19–80. Methods The associations of mixed nutrient intakes on MetS or its components were identified using linear regression models, WQS regression, qgcomp, and BKMR regression. Genes, transcription factors, miRNA, biological processes, and pathways were assessed using GeneMania, CHEA3, MIENTURNET, and ToppFun functions. Results We found that the overall effect of mixed nutrient intakes was also related to MetS and its components. In silico analysis, we found that a mixture of nutrients interacted with the IL6 gene and was linked with MetS. Physical interactions were the key interactions (77%) involved in the mutual genes and MetS targeted by a mixture of nutrients. IL6 related pathways, “positive regulation of type B pancreatic cell apoptotic process”, “regulation of glucagon secretion”, “LDL pathway during atherogenesis”, and “IL-10 anti-inflammatory signaling pathway” were identified as key molecular mechanisms that may be targeted by mixed nutrients implicated in MetS. The key miRNAs and transcription factors involved in the process of MetS targeted by a mixture of nutrients were also described. The cutoff levels for nutrient intake levels associated with MetS and its components were also described. Conclusion Our findings will pave the way for further research to evaluate the interactions between a mixture of nutrients and non-communicable diseases.
... As a result, increasing efforts have been made to develop natural therapies for cognitive impairment treatment, such as curcumin, aromatic turmerone, berberine, naringenin, and hesperidin (Leclerc et al. 2021). Due to its special molecular structure, curcumin, the main medicinal component of turmeric (Curcuma longa), has long been known for its potent anti-inflammatory and antioxidant properties (Duc et al. 2021a, b;Mohammadian Haftcheshmeh et al. 2021;Nguyen and Kim 2021;Nguyen et al. 2021d;Rahimi et al. 2021;Mohammadi et al. 2022;Saifi et al. 2022). It is well known that curcumin appears to be a promising neuroprotective drug against cognitive decline. ...
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We aimed to explore the molecular mechanisms of curcumin's protective action against heavy metal-related cognitive impairment (CI). In silico analysis, CTD, SwissADME, AutoDock Vina, Metascape, GeneMania, and MIENTURNET were key approaches. The server-predicted interactions (41.7%) and physical interactions (35.7%) were found to be the most important interactions in the gene network analysis. The most important pathways involved in curcumin's protective activity against heavy metals were categorized as "regulation of neuron apoptotic process” and "negative regulation of apoptotic signaling route”. These pathways were also emphasized in the protein–protein interaction enrichment analysis. Curcumin was also well-positioned inside the CASP3 binding region. Three key miRNAs linked to CI, mixed heavy metals, and curcumin (hsa-miR-34a-5p, hsa-miR-24-3p, and hsa-miR-128-3p) were observed. These miRNAs were found to be related to the important pathways related to CI and involved in curcumin's protective activity against mixed heavy metals such as "apoptosis multiple species”, “apoptosis”, and “Alzheimer’s disease”. We also created and tested in silico sponges that inhibited these miRNAs. Curcumin's physicochemical characteristics and pharmacokinetics are consistent with its therapeutic benefits in CI, owing to its high gastrointestinal absorption and ability to cross the blood–brain barrier, and it is not a P-glycoprotein substrate. Our findings emphasize the protective effects of curcumin in CI caused by heavy metal mixtures and pave the way for molecular mechanisms involved in CI pathology. Graphical Abstract
... Curcumin is one of the natural compounds that have been developed for depression therapy. Curcumin, the main therapeutic component of turmeric (Curcuma longa), has long been recognized for its significant anti-inflammatory and antioxidant properties due to its unique molecular structure [7][8][9]. Curcumin is well-known for its potential as a neuroprotective compound against depression. Curcumin has also been shown to possess physiological effects that are comparable to those of typical antidepressant medications [10]. ...
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Background We aim to identify the molecular mechanisms for curcumin's anti-depressant properties, including genes, transcription factors, and miRNAs. Methods The Comparative Toxicogenomics Database, GeneMania, Metascape, MIENTURNET, and Cytoscape software were used as important data approaches in this study. Results Curcumin may have an anti-depressant effect via the relevant genes: ADORA2A, ALB, BDNF, FGF2, GLO1, GSK3B, IL6, MIF, NOS1, PTGS2, RELN, SELP, SOD1, and NR3C1. Co-expression (50.7 %) and physical interactions (28.7 %) were the primary relationships discovered by gene network analysis. The key pathways involved in curcumin's protective function against depression were “spinal cord injury”, “regulation of apoptotic signaling pathway”, “positive regulation of protein phosphorylation”, “folate metabolism”, “neuroinflammation and glutamatergic signaling”, and “inflammation response”. We also observed 74 miRNAs associated with depression that are targeted by curcumin, with hsa-miR-146a-5p having the greatest expression and interaction. PLSCR1, SNAI1, ZNF267, ATF3, and GTF2B were the most important transcription factors that regulated four curcumin-targeted genes. Curcumin's physicochemical characteristics and pharmacokinetics are consistent with its antidepressant effects due to its high gastrointestinal absorption, which did not remove it from the CNS, and its ability to penetrate the blood-brain barrier. Curcumin also inhibits CYP1A9 and CYP3A4. Limitations A toxicogenomic design in silico was applied. Conclusions Our findings suggest that therapy optimization and further research into curcumin's pharmacological properties are required.
... Expectedly, curcumin (1-5 μM) was found to be protected against AGE induced by DAB in this study. Curcumin's anti-diabetic properties can be explained by its anti-inflammatory and antioxidant effects (Duc et al. 2021a , b ;Nguyen and Kim 2021 ; AQ8 Nguyen et al. 2021b ). ...
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We aimed to evaluate the effects of 1,2-diacetylbenzene (DAB) and curcumin on neuroinflammation induced by DAB via triggering receptor expressed on myeloid cells 1 (TREM-1), Toll-like receptor 4 (TLR4), and NLR family pyrin domain containing 3 (NLP3)/calcium-dependent activator protein for secretion 1 (CAPS1)/interleukin 1 beta (IL1B) pathways; tau hyperphosphorylation; reactive oxygen species (ROS); and advanced glycation end-product (AGE) in microglia cells; and explore the molecular mechanisms involved in the key genes induced by DAB and targeted by curcumin in silico analysis. In this study, Western blot, quantitative polymerase chain reaction, and immunocytochemistry were used as the key methods in vitro. In silico analysis, GeneMANIA, ToppFun feature, Metascape, CHEA3, Cytoscape, Autodock, and MIENTURNET were the core approaches used. Curcumin inhibited both the DAB-induced TREM-1/DAP12/NLRP3/caspase-1/IL1B pathway and the TLR4/NF-κB pathway. In BV2 cells, curcumin inhibited ROS, AGE, hyperphosphorylation, glycogen synthase kinase-3β (GSK-3β), and β-amyloid while activating nuclear factor erythroid 2–related factor 2 (Nrf2) expression. In silico studies showed that tumor necrosis factor (TNF), IL6, NFKB1, IL10, and IL1B, as well as MTF1 and ZNF267, were shown to be important genes and transcription factors in the pathogenesis of cognitive impairment produced by DAB and curcumin. Three significant miRNAs (hsa-miR-26a-5p, hsa-miR-203a-3p, and hsa-miR-155-5p) implicated in the etiology of DAB-induced cognitive impairment and targeted by curcumin were also identified. Inflammation and cytokine-associated pathways, Alzheimer’s disease, and cognitive impairment were characterized as the most significant biological processes implicated in genes, miRNAs, and transcription factors induced by DAB and targeted by curcumin. Our findings provide new insight into fundamental molecular mechanisms implicated in the pathogenesis of cognitive impairment caused by DAB, particularly the effects of neuroinflammation. Furthermore, this study suggests that curcumin might be a promising therapeutic molecule for cognitive impairment treatment through modulating neuroinflammatory responses.
... Information on demographics, social characteristics, lifestyle, current medications, medical and family history (e.g., age group, education level, occupation, family history of diabetes, cardiovascular diseases, hyperlipidemia), and laboratory measurements were defined elsewhere (Duc et al., 2021d;Nguyen et al., 2021e;Yun et al., 2021). Confounding variables were defined based on subjective knowledge or by literature review, as well as variables with p values of ≤ 0.25 by univariate analysis. ...
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Background We aim to identify the association between a mixture of vitamin B1, B2, and B3 intakes and depression. Methods Daily intake of vitamins was measured by a one-day 24 h recall. Multivariate logistic regression, weighted quantile sum (WQS), quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were used. Results Of 9,848 adults included in the final analysis, 4.38% had depression. In the logistic regression model, daily vitamin B1 and B3 intakes were associated with depression, and significant trends were observed for these vitamin intake tertiles (p < 0.001). The WQS index was significantly associated with depression (OR = 0.24, 95% CI: 0.23–0.24). The gqcomp index also found a significant association between a mixture of vitamin B1 and B3 intake and depression (OR = 0.67, 95% CI: 0.44–0.98). Vitamin B1 intake was the most heavily weighed vitamin intake in this model. In BKMR analysis, the overall effect of vitamin B1 and B3 intake mixture was negatively associated with depression. Vitamin B1 and B3 intake showed negative trends and was observed as the most important factor associated with depression. The cutoff levels for B vitamin intake levels related to depression were reported. Limitations A 24-hour recall and cross-sectional design were used. Conclusions Given the rising prevalence of depressive symptoms in Korea, an increase in daily intake of vitamin B1 and/or B3 through regular diets may help to reduce the risk of depression. Therefore, there is an ongoing need to investigate these associations between B vitamin supplementation and depression, either separately or jointly, in well-characterized cohorts of depression population.
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There is a scarcity of studies on the interactions between heavy metals and non-alcoholic fatty liver disease (NAFLD). Using a variety of statistical approaches, we investigated the impact of three common heavy metals on liver enzymes and NAFLD markers in a Korean adult population. We observed that cadmium, mercury, and lead all demonstrated positive correlations with liver enzymes and NAFLD indices. Our findings were mostly robust in secondary analysis, which included three novel mixture modeling approaches (WQS, qgcomp, and BKMR) as well as in silico investigation of molecular mechanisms (genes, miRNAs, biological processes, pathways, and illnesses). The 16 genes interacted with a mixture of heavy metals, which was linked to the development of NAFLD. Co-expression was discovered in nearly half of the interactions between the 18 NAFLD-linked genes. Key molecular pathways implicated in the pathogenesis of NAFLD generated by the heavy metal combination include activated oxidative stress, altered lipid metabolism, and increased cytokines and inflammatory response. Heavy metal exposure levels were related to liver enzymes and NAFLD indices, and cutoff criteria were revealed. More studies are needed to validate our findings and gain knowledge about the effects of chronic combined heavy metal exposure on adult and child liver function and the likelihood of developing NAFLD. To reduce the occurrence of NAFLD, early preventative and regulatory actions (half-yearly screening of workers at high-risk facilities; water filtration; avoiding excessive amounts of seafood, etc.) should be taken.
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Background and aims There is growing evidence that thiamine supplementation could reverse non-communicable diseases such as diabetes and cardiovascular diseases. However, the role of thiamine in metabolic syndrome (MetS) remains unclear. We hypothesized whether an increased intake of thiamine diminishes the risk of MetS in the Korean population with various comorbidities. This study aimed to assess the association between thiamine intake and MetS among adults with comorbidities. Methods 57,523 eligible participants aged over 18 years between 2009 and 2019 were recruited to obtain data on sociodemographic characteristics, medical history, current medications, lifestyle, and family history. A 24-h recall was used to determine thiamine intake. Odds ratio (OR) for MetS was calculated for log2-transformed thiamine intake values, subsequently predicting the risk of MetS based on the marginal effect. Results The risk of MetS was significantly higher in subjects with comorbidities than in those without comorbidities. A doubling of daily thiamine intake was significantly associated with a decrease in MetS among adults with comorbidities by 7% (OR 0.93; 95%CI 0.89–0.97). Conclusions The potential health benefits result from the intake of thiamine through an ordinary diet in the clinical management of MetS. Therefore, there is an ongoing need to look into these links between thiamine supplementation and MetS in well-characterized cohorts of participants with comorbidities.
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The public health burden of depression is tremendous, with over 264 million people worldwide affected. Depression can result in suicide and is also known as the second-most common cause of death in people aged 15–29 years (1). Remarkably, South Korea has the highest suicide rate among the Organization for Economic Cooperation and Development (OECD) countries (2). A data set of 83,170 participants (45% males, mean age 41.46±22.85 years) collected between 2009 and 2019 observed that the prevalence of depression was 2.83% (95%CI: 2.50%−3.15%) in 2009 and 3.93% (95%CI: 3.50%−4.40%) in 2019 (Figure 1 and Table S1&S2). Growing evidence found that the prevalence of depression was high during the COVID-19 pandemic in Korea (Table S3) as well as in the world (3). We believe that the prevalence of depression was still higher compared with the most recent population-based estimates of depression in Korea because of the impact of social distancing, stay-at-home orders, and COVID-19-associated morbidity and mortality (4). As of November 21, 2021, South Korea had recorded 347,529 confirmed cases of COVID-19, and the number of cases had been decreasing in the last few months (5). However, successful management of the pandemic is not adequate to protect the general public from depression. This means that although the pandemic is under control, the general population is at high risk of depression. Of note, depressed patients are often not diagnosed correctly, and others who are not suffering from depression are too frequently misdiagnosed and given antidepressants (6). Recent guidelines recommend a combination of pharmacological and psychological therapies for depression management depending on the severity of depression (7). Therefore, it is crucial to develop a prevention strategy targeting the population to slow down this progression to postpone risk factors related to depression and reduce prevalence. In this paper, we outline an overview of the key aspects of the action plan. Figure 1 Download : Download high-res image (184KB)Download : Download full-size image Figure 1. Prevalence of depression in Korea population (n=83,170), Korean National Health and Nutrition Examination Survey (2009-2019). The action plan addresses six core features at the national level. First, routine screening and evaluation of depression; health workers can establish plans to screen and evaluate depression conditions using the online questionnaire surveys (PHQ-9, DASS-42) on vulnerable populations such as healthcare workers, older or pregnant people, students, and people working in the hardest-hit areas (8). These methods are fast, cheap, quick to analyze, and easy to use for participants. Second, the implementation of psychological assistance hotlines; health workers could conduct depression assessments and provide supportive counseling 24 hours a day (9). Individuals are linked to specialized healthcare facilities for proper treatment after being identified as high-risk depression groups. Third, establish community treatment (CTC) centers to prevent and control the dual effects of COVID-19 and depression (10). Patients with minor illnesses can be cared for at the CTC, and those with severe illnesses can be transferred to hospitals. During this time, the CTC could provide psychosocial support for these patients. Fourth, depression interventions. COVID-19 can have greater psychological effects on people who already have mental problems. Therefore, early detection of depression could ensure prompt care, reduce the treatment gap, disease worsening, and the likelihood of suicide in those suffering from depression. Of note, clinicians should carefully consider the history of mental illness when managing COVID-19 patients. Fifth, encourage citizens as well as foreigners to join the national health insurance system. The cost of treating Covid-19 with comorbidities is extremely expensive, thus health insurance can help patients with this financial crisis and give them access to more health services. Finally, public education on the management of depression. It is necessary to provide appropriate information and support to the general population as well as vulnerable populations. In this context, psychiatrists, healthcare workers, and universities play a vital role in implementing timely and effective psychiatric interventions during a pandemic. COVID-19 continues to affect the lives of people worldwide, so comprehensive public health efforts are needed to reduce depression and suicide prevalence, especially among people at high risk of depression and those with pre-existing depression but at risk of relapse.
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We aim to examine the association between chemical mixtures and obesity. Blood and urinary levels of tween-six chemicals were measured in adults who participated in the KoNEHS. We identified the associations of chemicals with obesity using linear regression models. Weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were conducted as secondary analyses. Of the 3,692 participants included in the analysis, 18.0% had obesity. In the logistic regression model, mercury (Hg), lead (Pb), and 3PBA levels were associated with obesity, and significant trends were observed for these chemical tertiles (p < 0.001). Hg, Pb, and 3PBA levels were also associated with BMI. The WQS index was significantly associated with both obesity (OR = 2.15, 95% CI: 2.11-2.20) and BMI (β = 0.39, 95% CI: 0.37-0.51). The qgcomp index also found a significant association between chemicals and both obesity (OR = 1.70, 95% CI: 1.56-1.85) and BMI (β = 0.40, 95% CI: 0.39-0.41). Hg, Pb, and 3PBA were the most heavily weighed chemicals in these models. In BKMR analysis, the overall effect of the mixture was significantly associated with obesity. Hg, Pb, and 3PBA showed positive trends and were observed as the most important factors associated with obesity. Given increasing exposure to chemicals, there is a need to investigate the associations between chemical exposures, either separately or together, and incident obesity risk factors in well-characterized cohorts of different populations, and to identify potential approaches to chemical exposure prevention.
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Little is known about the association between a mixture of heavy metals and obesity among individuals ≥50 years of age with comorbidities. Thus, we identified the associations of serum cadmium (Cd), lead (Pb), and mercury (Hg) with obesity using linear regression models; weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were conducted as secondary analyses. Of the 6434 subjects included in the analysis, 13.8% had obesity and 44.6% had abdominal obesity. In the logistic regression model, serum Hg was associated with obesity and abdominal obesity, and significant trends were observed for these heavy metal tertiles (p < 0.001). Serum Hg levels were also associated with body mass index (BMI) and waist circumference (WC). The WQS index was significantly associated with both obesity (OR = 1.43, 95% CI: 1.40–1.46) and abdominal obesity (β = 1.51, 95% CI: 1.48–1.54). The qgcomp index also found a significant association between heavy metals and both obesity (OR = 1.35, 95% CI: 1.12–1.63) and abdominal obesity (OR = 1.34, 95% CI: 1.12–1.60). Serum Hg was the most heavily weighed heavy metal in these models. In BKMR analysis, the overall effect of the mixture was significantly associated with obesity, BMI, and WC. Serum Hg showed positive trends and was observed as the most important factor associated with obesity, BMI, and WC. Our findings were largely robust to secondary analyses that used three novel mixture modeling approaches: WQS, qpcomp, and BKMR. Given increasing exposure to heavy metals, well-characterized cohorts of individuals aged ≥50 years are required to determine the mixed effects of heavy metals on obesity and related diseases.
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Little is known about associations between depression and serum heavy metal levels, dietary vitamin intakes. Thus, we sought to determine the nature of these associations and to predict risks of depression using marginal effects. A data set of 16,371 individuals aged ≥10 years that participated in Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2009 to 2017 (excluding 2014 and 2015) was used to obtain information on sociodemographics, family histories, lifestyles, serum heavy metal levels, food intakes, and depression. Serum cadmium (Cd) and lead (Pb) levels were analyzed by graphite furnace atomic absorption spectrometry and mercury (Hg) levels using a mercury analyzer. Daily vitamin intakes were calculated by 24-h dietary recall. The results obtained showed that females are at higher risk of depression than males. A doubling of serum Cd was associated with a 21% increase in depression (AOR 1.21, 95% CI: 1.07–1.37, p = 0.002), whereas twofold increases in daily vitamin B1, B3 and vitamin A intakes reduced the risk of depression by 17% (0.83, 95% CI: 0.73–0.95, p = 0.005), 20% (0.80, 95% CI: 0.70–0.91, p = 0.001), and 8% (0.92, 95% CI: 0.85–0.99, p = 0.020), respectively. Interactions between heavy metals, vitamin intakes, and sex did not influence the risk of depression. The result shows that increased daily dietary vitamin intake might protect the public against depression. Further studies are needed to reduce the risks posed by heavy metals and to determine more comprehensively the effects of daily dietary vitamin intake on depression.
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Objective: To examine the associations between serum cadmium, lead, and mercury and hypertension in pre- and postmenopausal women. Methods: Serum heavy metal (cadmium, lead, and mercury) levels were analyzed in 7,226 randomly selected women who participated in Korean National Health and Nutrition Examination Surveys from 2009 to 2017. Odds ratios (ORs) for hypertension were calculated for log2-transformed serum heavy metal levels, median tertile levels of serum cadmium, mercury, and lead, and for interactions between heavy metal levels and tertiles, after covariate adjustment. Results: A doubling of serum cadmium was associated with hypertension in premenopausal (OR 2.47; 95% CI, 1.01-6.10, P = 0.049) and postmenopausal women (OR 1.70; 95% CI, 1.02-2.84, P = 0.043), and significant trends were observed for cadmium tertiles (P < 0.01). In premenopausal women, a two-fold increase in serum mercury increased the OR of hypertension by 3.08 (95% CI, 1.12-8.43, P = 0.029), and significant trends were also observed for serum mercury tertiles (P < 0.01). Interactions between serum cadmium, lead, and mercury levels in pre- and postmenopausal women were found to impact the prevalence of hypertension. Conclusion: Given increasing exposure to heavy metals in Korea, further prospective study is needed to identify associations between heavy metal exposures, both separately and in combination, with the prevalence of cardiovascular disease risk factors in well-characterized cohorts of different populations and to determine means of preventing heavy metal exposure.
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The prevalence of cardiovascular diseases (CVDs) in Korea tends to be increasing. It has worsened during the COVID-19 pandemic. Increasing evidence shows heavy metals are associated with increased CVD risk. We aimed to determine the association between the serum heavy metal levels and 10-year risk of CVDs and to predict risks of CVDs based on marginal effects. Heavy metals were measured by a graphite furnace atomic absorption spectrometry and direct mercury analyzer. The results show a significant relationship between the increase in cadmium, lead, mercury, hs-CRP levels and the 10-year risk of CVD after adjustment for serum cotinine, age group, sex, body mass index, a family history of CVDs, diabetes or hyperlipidemia, high-risk drinking, physical activity, and diabetes. A doubling of serum cadmium, lead, mercury, and hs-CRP was associated with the increase in the 10-year risk of CVD by 0.14%, 0.10%, 0.11% and 0.22%, respectively. Therefore, a special concern should be given to the harmful impacts of heavy metals on the 10-year risk of CVD. It is important to develop a prevention strategy targeting the high-risk population to slow down this progression to risk factors related to heavy metals and reduce prevalence. Remarkedly, hs-CRP is the most validated and widely used inflammatory marker, and could be a potential clinical value in predicting and monitoring CVDs.
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Objective: To determine the associations between metabolic syndrome (MetS) during menopause and serum heavy metal levels and vitamin and curry consumption. Methods: A data set of 7,131 pre- and postmenopausal women aged ≥ 20 years collected between 2009 and 2017 was used to obtain information on sociodemographic, lifestyles, family histories, food intakes, and serum heavy metal levels and MetS. Logistic regression was used to identify associations between the presence of MetS and risk factors and to predict risks of MetS based on marginal effects. Results: Our results show that postmenopausal women had a higher risk of MetS than premenopausal women. During postmenopause elevations in the levels of serum cadmium by one unit increased the risk of MetS by 33% (OR 1.33; 95% CI, 1.03-1.72, P = 0.028). Risks of MetS in pre- and postmenopausal women, when serum Hb levels increased by 1 unit increased 21% (OR 1.21; 95% CI, 1.09-1.33, P < 0.001) and 26% (OR 1.26; 95% CI, 1.16-1.38, P < 0.001), respectively. Furthermore, the risk of MetS risk in pre- and postmenopausal women was increased 2.49-fold and 2.79-fold by a 1% increase in HbA1c level (OR 2.49; 95% CI, 1.97-3.16, P < 0.001) and (OR 2.79; 95% CI, 2.30-3.38, P < 0.001), respectively. High curry consumption reduced the risk of MetS significantly more than low curry consumption (OR 0.60; 95% CI, 0.39-0.91, P = 0.017) in premenopausal women. Furthermore, an increase in daily vitamin B2 intake by 1 mg reduced the risk of MetS by 45% (OR 0.55; 95% CI, 0.32-0.94, P = 0.028) in postmenopausal women. Conclusion: Vitamin B2 and curry supplementation may protect against MetS. Further work is needed to reduce risk factors associated with heavy metals and determine the effects of vitamins and curry consumption on MetS during menopause. Video Summary:http://links.lww.com/MENO/A791.
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The burden of metabolic syndrome (MetS) has increased worldwide, especially during the COVID-19 pandemic, and this phenomenon is related to environmental, dietary, and lifestyle risk factors. We aimed to determine the association between the levels of serum heavy metals, hs-CRP, vitamins, and curry intake and to predict risks of MetS based on marginal effects. A data set of 60,256 Koreans aged ≥ 15 years between 2009 and 2017 was used to obtain information on socio-demographic, lifestyle, family history characteristics, MetS, food intake survey, and serum heavy metals. Daily intake of vitamins was measured by a one-day 24 h recall, and curry consumption was calculated using a food frequency questionnaire. Serum heavy metal levels were quantified by graphite furnace atomic absorption spectrometry and using a mercury analyzer. We found that vitamin B1, B2, B3, C, and A intakes were significantly lower in subjects with than without MetS. In contrast, serum levels of Pb, Hg, Cd, vitamin A, E, and hs-CRP were significantly higher in subjects with MetS. The risk of MetS was significantly lower for high curry consumers than low curry consumers (adjusted odds ratio 0.85, 95%CI 0.74-0.98). The risks of MetS were reduced by 12% and 1%, when vitamin B1 and C intakes increased by one mg, respectively, but were increased by 14%, 3%, and 9%, when serum levels of Pb, Hg, and hs-CRP increased by one unit. These results show that the potential health benefits resulting from vitamin and curry intakes could protect the public against the dual burden of communicable and non-communicable diseases. Further studies are required to reduce risk factors associated with serum heavy metal levels and to determine whether interactions between vitamin and curry consumption influence the presence of MetS.
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People with underlying noncommunicable diseases (NCDs) are more likely to acquire severe COVID-19 disease and to die from COVID-19. An urgent need for potential therapy to prevent and control NCDs is critical. We hypothesized that higher intakes of multiple individual nutrients, fruits, or vegetables would be linked with a low risk of NCDs in the Korean population. Thus, we aim to explore the association between NCDs, including cardiovascular diseases, type 2 diabetes mellitus (T2DM), arthritis, depression, and dietary factors. 56,462 adults aged 18 years (2009-2019) were included. Dietary factors, including intakes of multiple individual nutrients, fruits, and vegetables, were assessed. Multivariable-adjusted logistic regression models were used to explore the associations between dietary factors and NCDs. Interactions were found between intakes of multiple individual nutrients and sex for T2DM, hypertension, stroke, myocardial infarction, arthritis, and osteoarthritis. Only in women was a two-fold increase in daily multiple individual nutrient intake (vitamin A, B1, B2, B3, C, potassium, protein, phosphorus, calcium, iron, MUFA, PUFA, n-3 fatty acid, n-6 fatty acid, and water) associated with a lower prevalence of T2DM, hypertension, stroke, myocardial infarction, arthritis, and osteoarthritis. In both women and men, high fruit or vegetable consumption was linked with a lower risk of T2DM, hypertension, dyslipidemia, osteoarthritis, and depression than low consumption. Our findings found higher intakes of fruits, vegetables, and multiple individual nutrients are linked with a lower risk of NCDs in the Korean adult population. Further work is needed to identify whether interactions between intake of multiple individual nutrients, vegetables, and fruits affect the presence of NCDs.
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There is a scarcity of studies on the effects of mixed chemicals on total IgE. We aim to assess whether there is a link between chemical mixtures (blood and urine of 26 chemicals including lead, mercury, cadmium, t,t-muconic acid, benzylmercapturic acid , 1-hydroxypyrene, 2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-n-butyl phthalate, mono-benzyl phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, mono-carboxyoctyl phthalate, mono-carboxy-isononly phthalate, mono (3-carboxypropyl) phthalate, bisphenol A, bisphenol F, bisphenol S, triclosan, methylparaben, ethylparaben, propylparaben, 3-phenoxybenzoic acid, and cotinine), and total IgE in 3,642 Korean adults aged ≥ 19. The effects of mixed chemical exposure on total IgE were identified using linear regression models, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR). The most relevant factors linked with IgE, according to the linear regression models, were blood or urine mercury and urine bisphenol A levels, with significant trends detected for these chemical tertiles (p < 0.01). The WQS index was significantly linked with ln2-transformed levels of serum total IgE (β = 0.30, 95 %CI 0.25–0.32). The qgcomp index also found a significant link between chemicals and ln2-transformed levels of serum total IgE (β = 0.52, 95 %CI 0.21–0.82), and elevated serum total IgE levels (OR = 2.55, 95 %CI 1.14–5.71). In BKMR analysis, the overall effect of the mixture was significantly associated with ln2-transformed levels of serum total IgE. The cutoff levels for exposure levels related to serum total IgE levels/elevated serum total IgE levels were reported. We discovered that whole-body exposure to 26 chemicals was associated with serum total IgE levels after assessing the findings of these four models. More research is needed in the future to gain a better understanding of the impact of mixed chemical exposure on allergic disorders and how to minimize chemical exposure, especially for people under the age of 18.