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Oxidative stress results from the balance between production and removal of
reactive oxygen species (ROS) by the antioxidant system of the body. Because
ROS production increases under certain conditions such as elevated insulin
resistance (IR), the antioxidant system should be potentiated to decrease ROS.
Antioxidant capacity depends on the activity of antioxidant enzymes, such as
superoxide dismutase and glutathione peroxidase, and on the consumption of
exogenous antioxidants, such as vitamins A, C, and E, b-carotene, and lycopene.
However, the endogenous antioxidant system cannot completely offset the
production of ROS alone because antioxidant enzymes have a limited antioxidant
capacity. Therefore, dietary antioxidants play an important role in maintaining
optimal antioxidant status in the body.
Metabolic syndrome (MetS) is defined as having at least three of the five
following conditions: abdominal obesity, IR, dyslipidemia, hyperglycemia, and
hypertension, and it is a risk factor for type 2 diabetes and cardiovascular disease
(CVD). The common etiology of MetS begins with IR although the
pathophysiological mechanisms involved in the syndrome are complex. Whereas
the cause of IR remains unclear, the expansion of fat mass (FM), resulting in
energy overload, is the main initiator. Increased FM stimulates adipokines related
to inflammation and oxidative stress, leading to cell damage in the liver,
pancreatic islets, and brain. Overnutrition also ignites oxidative stress, which
contributes to IR development. Thus, oxidative stress can play a substantial role in
the etiology of MetS.
However, it is still controversial whether antioxidants prevent the development
and progression of MetS. Some studies have demonstrated that antioxidants can
prevent the development of MetS by attenuating IR. Additionally, diets rich in
antioxidants, such as vitamins A, C, and E, and b-carotene, exhibit beneficial
effects on MetS in epidemiologic studies. However, some studies showed no
significant association between intake of antioxidant-rich diets and risk for MetS.
It is thus still controversial whether consumption of antioxidants prevents and
alleviates MetS by reducing IR. The disparities in the association between MetS
and antioxidants, especially vitamins A and C, involve several factors, such as
race and sex, but previous studies did not determine sex and race specificity as an
interaction term in the logistic regression models.
We hypothesized that the intake of fruits, vegetables, vitamin A (including
carotenoids), and vitamin C are negatively associated with MetS in adults aged 20
y.
Metode Penelitian
This study was based on KNHANES data from 2007 to 2012, representing the 3 y
of the KNHANES IV survey (20072009) and the 3 y of the KNHANES V
survey (20102012), which were conducted annually using a rolling sampling
design that involved a complex, stratified, multistage, probability-cluster survey
of a representative sample from the noninstitutionalized civilian population of
South Korea. Detailed information on the design of the survey was provided
previously. Briefly, the survey had three components: a health interview survey, a
health examination survey, and a nutrition survey. The present cross-sectional
analysis was restricted to participants _20 y of age who completed the nutrition
survey and the health examination survey
Our study has some limitations. First, the cross-sectional design could not
evaluate causality between MetS and total vitamin A and

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In a large representative sample of the general South Korean population, higher
intake of total vitamin A and C and moderate and high intakes of fruit were
associated with lower risk for MetS only inwomen. These findings support the
idea that total intakes of vitamins A and C and fruit should be increased as a
primary preventive measure against MetS, especially in women.
Our hypothesis that the consumption of vitamins A and C and fruits and
vegetables are inversely associated with MetS in Korean adults was only partially
confirmed by this study. Only vitamins A and C as well as fruit (but not
vegetable) consumption was inversely associated with MetS, and only in women.
The study of dietary interventions to prevent MetS is timely and important
because the syndrome is rapidly increasing in Korea as in most of the world. This
study has practical implications in the Korean population, some of which may be
applicable to the Asian population. First, the lack of effect of vegetable intake
may be due to the relatively high consumption of cruciferous vegetables in the
Korean diet in the form of kimchi and other vegetables dishes that are a staple of
Korean cuisine. Typical consumption of vegetables in Korea may provide the
maximum protective effect and be the reason why higher consumption levels did
not confer additional benefit in contrast to other studies. Fruit, on the other hand,
was protective at higher consumption levels and are known to supply many
phytochemicals in addition to the antioxidant vitamins such as vitamins A and C.
Therefore, increased intakes of total vitamins A and C and fruit may protect
against MetS in Korean women, as shown in a representative sample of the
general South Korean population. This study has some major strengths in that it
used a large sample size representative of the general population of Korea and sex
specificity was determined by an interaction term in statistical analysis to reduce
type 2 statistical errors, instead of performing statistical analysis in men and
women separately.
To our knowledge there have been no studies that have examined sex differences
in the association between antioxidant and total vitamin A and C intakes and risk
for MetS, therefore, the present study was the first to show that vitamin A and
vitamin C intakes decrease the risk for MetS in women, but not in men. Among
the individual components of MetS, WC, serum HDL-C, and glucose had
interactions with vitamin C intake and with sex for MetS; whereas BP, serum
TGs, and glucose exhibited interactions with total vitamin A intake and sex. One
study found that plasma vitamin C levels were inversely related to BMI,
percentage of body fat, and WC in both U.S. women and men; in women, but not
men, and these associations remained significant after controlling for body
weight. Thus, the effect of vitamin C on adiposity is greater in women than in
men. Additionally, a lower intake of vitamin C increases the risk for hypertension
by 18%, and plasma vitamin C levels were significantly higher in normal versus
hypertensive Indian adults. Serum levels of carotenoids decreased significantly
with increasing numbers of MetS components in Japanese and Australian adults.
Thus, total vitamin A and C intake might be linked to individual components of
MetS.
Based on epidemiologic studies, fruit and vegetable consumption is thought to
decrease the risk for several chronic diseases, including CVDs, by suppressing
oxidative stress. However, it is still unknown whether the consumption of fruits
and vegetables containing antioxidants has a sex-specific preventive role against
MetS.