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Sugar-sweetened beverage consumption and metabolic dysfunction-associated steatotic liver disease: a beverage type-specific analysis using Korea National Health and Nutrition Examination Survey
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Hong Jae Jeon, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Ha Neul Kim, Hei-Gwon Choi, Jaehee Seo, Hyuk Soo Eun, Sukyoung Jung
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Epidemiol Health. 2025;47:e2025038. Published online July 21, 2025
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DOI: https://doi.org/10.4178/epih.e2025038
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 Abstract
Summary
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Abstract
OBJECTIVES
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease. Evidence indicates a relationship between sugar-sweetened beverage (SSB) consumption and MASLD development; however, the effects of specific SSB types on MASLD remain underexplored. This study investigated the association between consumption of 3 distinct types of SSBs and MASLD in Korean adults.
METHODS We analyzed data from the Korea National Health and Nutrition Examination Survey 2012-2016, including 8,310 participants aged 40-64 years. SSB consumption (soft drinks, fruit drinks, and Korean traditional drinks) was assessed using a food frequency questionnaire. MASLD was defined as a hepatic steatosis index ≥36 in the presence of any cardiometabolic risk factor. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.
RESULTS Compared to non-drinkers, consumption of soft drinks (≥3 serving/wk) was associated with higher odds of MASLD (OR, 1.36; 95% CI, 1.02 to 1.81; p for trend=0.03), while consumption of Korean traditional drinks (≥3 serving/wk) was associated with lower odds of MASLD (OR, 0.63; 95% CI, 0.45 to 0.89; p for trend=0.01). No association was found between fruit drink consumption and MASLD. In sex-stratified analysis (p-interaction=0.38), an inverse association between Korean traditional drinks and MASLD was observed in male (OR, 0.57; 95% CI, 0.34 to 0.95; p for trend=0.03), but not in female (OR, 0.72; 95% CI, 0.45 to 1.14; p for trend=0.17).
CONCLUSIONS Consuming soft drinks at least 3 times per week was positively associated with MASLD, whereas an equivalent intake of Korean traditional drinks was inversely associated with MASLD.
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Summary
Korean summary
-본 연구는 국민건강영양조사에 참여한 40-64세 한국 성인 8,310명을 대상으로 가당 음료와 새롭게 정의된 대사기능장애 연관 지방간질환(MASLD) 간 연관성을 음료 유형별로 비교 분석하였다.
- 주 3회 이상의 탄산음료 섭취는 MASLD 유병 가능성이 증가한 반면, 동일한 빈도의 한국 전통음료 섭취는 유병 가능성을 낮췄다.
- 음료 유형에 따른 MASLD 유병 차이는 향후 식이 지침 개발에 중요한 근거가 될 수 있으며, 향후 개인이 건강을 위해 보다 선택적인 음료 섭취를 위한 정책 수립에 기여할 수 있다.
Key Message
Among 8,310 Korean adults aged 40-64 years, soft drink consumption (≥3 servings/week) increased the odds of MASLD, while the same intake of Korean traditional drinks decreased the odds. These findings suggest that beverage type may be an important dietary factor associated with MASLD. Given the differential associations observed, our findings may help inform dietary recommendations that enable individuals to make more selective beverage choices for better liver health.
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Trends in sustainable dietary patterns in United States adults, 2007-2018
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Sukyoung Jung, Heather Young, Barbara Braffett, Samuel Simmens, Eunice Hong Lim Lee, Cynthia Ogden
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Epidemiol Health. 2025;e2025045. Published online August 18, 2025
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DOI: https://doi.org/10.4178/epih.e2025045
[Accepted]
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Abstract
Summary
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Abstract
OBJECTIVES
Adopting sustainable diets is essential for improving both human and planetary health, and such diets should be evaluated from a multidimensional perspective. We characterized trends in sustainable dietary patterns, quantified by the Sustainable Diet Index for US adults (SDI-US), along with trends in diet quality, diet-related environmental impacts, food affordability, and food practices.
METHODS This study analyzed data from the National Health and Nutrition Examination Survey (2007–2018) for adults aged ≥20 years (n = 25,543). The SDI-US (range: 4–20 points), with higher scores indicating more sustainable diets, was calculated using 24-hour dietary recall data and responses to consumer and dietary behavior questionnaires. Mean total SDI-US scores, sub-indices, and 12 individual indicators were estimated for each survey cycle. Trends were assessed using orthogonal polynomial contrasts in regression models.
RESULTS From 2007 to 2018, total SDI-US scores showed no significant overall trend (overall mean = 13.1). Nutritional and sociocultural indicators remained relatively stable, whereas the economic indicator (food expenditures) worsened from 21.4% to 26.4% (p<0.05, linear trend) between 2007–2008 and 2017–2018. Environmental impacts initially worsened between 2007–2008 and 2013–2014 but improved through 2017–2018 (all p<0.05, quadratic trend). When stratified by age (p for interaction <0.0001), a slight decline in SDI-US was observed among adults aged ≥60 years (14.1 to 13.9, p<0.0001).
CONCLUSIONS From 2007 to 2018, total SDI-US scores largely remained unchanged, although declines occurred among adults ≥60 years and scores remained lower among adults aged 20–39 years. Ongoing monitoring and coordinated improvements across all dimensions are needed to advance sustainable diets in all age groups.
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Summary
Korean summary
- 본 연구는 미국 국민건강영양조사에 참여한 20세 성인 25,543명을 대상으로 세계식량기구의 다차원적 지속가능한 식이 지수(SDI-US)를 활용하여 12년간의 추이를 분석하였다.
- 전체 SDI-US 점수는 전체적으로 큰 변화가 없었으나, 경제적 지표는 악화되고 환경 지표는 최근 개선을 보였고, 60세 이상 성인에서는 SDI-US 점수가 감소하였으며, 20-39세 성인에서는 낮은 수준이 유지되었다.
- 지속가능한 식이로의 전환을 위해 지속적 모니터링과 연령대별 맞춤형 정책이 필요하다.
Key Message
Among 25,543 US adults aged 20 years and older, overall sustainable diet index (SDI-US) scores showed no significant change between 2007 and 2018. While food expenditure share worsened and environmental indicators recently improved, declines were observed among older adults (≥60 years) and lower scores persisted among younger adults (20–39 years). These findings highlight the need for ongoing monitoring and tailored strategies to promote sustainable diets across age groups.
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Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016-2018 Korea National Health and Nutrition Examination Survey (7th KNHANES)
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Sarang Jeong, Hajoung Lee, Sukyoung Jung, Jee Young Kim, Sohyun Park
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Epidemiol Health. 2023;45:e2023087. Published online September 19, 2023
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DOI: https://doi.org/10.4178/epih.e2023087
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12,080
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209
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4
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6
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Abstract
Summary
PDFSupplementary Material
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Abstract
OBJECTIVES
Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns (TDPs) on obesity and metabolic syndrome (MetS) in Korean adults aged 20 years to 65 years.
METHODS We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios (ORs) of obesity and MetS with different TDPs using data from the 7th Korea National Health and Nutrition Examination Survey.
RESULTS Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3 (with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for body mass index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1 (with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% confidence interval [CI], 0.97 to 1.30) and 1.19 (95% CI, 1.03 to 1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08 to 1.48) and 1.37 (95% CI, 1.17 to 1.61) when comparing Cluster 2 and Cluster 3 to Cluster 1.
CONCLUSIONS This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.
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Summary
Korean summary
본 연구는 하루 중 주요 에너지 섭취 사간에 따른 인구사회학적 특징과 건강지표의 상관성을 분석하였다. 제 7기 국민건강영양조사의 20~65세의 한국 성인을 대상으로 Dynamic Time Warping 방법을 이용하여 군집을 나누어 분석한 결과, 하루 중 저녁시간에 에너지 섭취가 높은 그룹이 그렇지 않은 그룹에 비해 연령이 낮고, 흡연자, 음주자, 스트레스를 느끼는 대상자의 비율이 높았다. 또한, 저녁에 에너지 섭취 비율이 높은 그룹이 그렇지 않은 그룹에 비해 체질량지수, 허리둘레, 혈압, 총 콜레스테롤, 중성지방이 높았으며, 식생활 평가 지수가 가장 낮았다. 마지막으로 하루 섭취하는 총 에너지 양과 생활습관 변수를 보정하고도 저녁에 섭취하는 에너지가 많은 그룹은 그렇지 않은 그룹에 비해 비만 및 대사 증후군 유병이 더 높은 것으로 나타났다.
Key Message
• This study examined the relationship between sociodemographic characteristics and health indicators based on the timing of major energy intake during the day.
• Using the Dynamic Time Warping method, the analysis revealed that the group with higher evening energy intake was younger and had a higher proportion of smokers, alcohol consumers, and individuals experiencing stress.
• Additionally, the group with higher evening energy intake exhibited higher levels of obesity and metabolic syndrome, even after adjusting for total daily energy intake and lifestyle variables.
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Citations
Citations to this article as recorded by  - Dietary calcium intake in relation to metabolic syndrome in adults: A systematic review and dose–response meta‐analysis of epidemiological studies with GRADE assessment
Roxana Nematbakhsh, Parisa Rouhani, Parvane Saneei
Obesity Reviews.2025;[Epub] CrossRef - 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association
Seth S. Martin, Aaron W. Aday, Norrina B. Allen, Zaid I. Almarzooq, Cheryl A.M. Anderson, Pankaj Arora, Christy L. Avery, Carissa M. Baker-Smith, Nisha Bansal, Andrea Z. Beaton, Yvonne Commodore-Mensah, Maria E. Currie, Mitchell S.V. Elkind, Wenjun Fan, G
Circulation.2025;[Epub] CrossRef - Circadian and temporal eating patterns in relation to metabolic syndrome in Iranian women
Azadeh Lesani, Mansooreh Sadat Mojani-Qomi
Scientific Reports.2025;[Epub] CrossRef - Interaction between chronotype and ultra-processed food intake on triglyceride-glucose index in Korean adults
Sarang Jeong, Eunjin Jang, Sukyoung Jung, Jinhyun Kim, Minjeong Jeong, Dahye Han, Sohyun Park
Nutrition Research and Practice.2025; 19(4): 591. CrossRef - Association of Dietary Fiber and Measures of Physical Fitness with High-Sensitivity C-Reactive Protein
Ming-Zhen Su, Suyeon Lee, Dayeon Shin
Nutrients.2024; 16(6): 888. CrossRef - Advances in Gut Microbiota-Targeted Therapeutics for Metabolic Syndrome
Yu Gao, Wujuan Li, Xiaoyu Huang, Yuhong Lyu, Changwu Yue
Microorganisms.2024; 12(5): 851. CrossRef
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Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets
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Sukyoung Jung, Sohyun Park
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Epidemiol Health. 2022;44:e2022063. Published online August 2, 2022
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DOI: https://doi.org/10.4178/epih.e2022063
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14,686
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289
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6
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6
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Abstract
Summary
PDFSupplementary Material
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Abstract
OBJECTIVES
Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.
METHODS This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.
RESULTS During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.
CONCLUSIONS Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.
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Summary
Korean summary
본 연구는 한국인 유전체역학조사사업의 안성안산코호트 조사에 참여한 40-69세 한국 성인 6,054명을 대상으로 식물성 기반의 식이 지수와 복부비만 간 연관성이 식이 노출 기간(기반, 최근, 누적 노출)에 따라 어떻게 다른지 비교 분석하였다.
건강하지 않은 식물성 기반의 식이 지수 점수가 높을수록 복부비만 발생 위험이 증가하였고, 식이 노출 기간에 관계없이 일관된 결과를 보였다.
식물성 기반의 식이가 반드시 건강에 유익한 것은 아니며, 정제된 곡물, 탄산음료, 사탕 등 간식류를 많이 먹는 식이 패턴은 식물성 기반 식이라 할지라도 복부비만 위험을 증가시킬 수 있으므로 주의가 필요하다.
Key Message
Unhealthy plant-based diets, including refined grains, sugar-sweetened beverages, sweets and desserts, and salty plant foods, can have a negative effect on abdominal obesity in Korean adults regardless of its exposure duration.
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Citations
Citations to this article as recorded by - Plant‐based and sustainable diet: A systematic review of its impact on obesity
Sara P. Mambrini, Claudia Penzavecchia, Francesca Menichetti, Andrea Foppiani, Alessandro Leone, Marta Pellizzari, Federica Sileo, Alberto Battezzati, Simona Bertoli, Ramona De Amicis
Obesity Reviews.2025;[Epub] CrossRef - Association Between Plant-Based Diets and Metabolic Syndrome in Zhejiang, China: A Cross-Sectional Study
Mengyi Zhou, Ya Zhao, Mengjie He, Danting Su, Dan Han, Lichun Huang, Peiwei Xu, Ronghua Zhang
Nutrients.2025; 17(13): 2159. CrossRef - Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging
Xinyi Shen, Curtis Tilves, Hyunju Kim, Toshiko Tanaka, Adam P Spira, Chee W Chia, Sameera A. Talegawkar, Luigi Ferrucci, Noel T Mueller
The American Journal of Clinical Nutrition.2024; 119(3): 628. CrossRef - Association between plant-based diets and risk of metabolic dysfunction–associated steatotic liver disease in Korean adults: A prospective cohort study
Bayarmaa Nasan Ulzii, Kyungjoon Lim, Sangah Shin
Nutrition.2024; 128: 112579. CrossRef - Adherence to the nutritional recommendations according to diabetes status in Korean adults: a cross-sectional study
Jong Han Choi, Chen Lulu, Seon-Joo Park, Hae-Jeung Lee
BMC Public Health.2024;[Epub] CrossRef - Scoping review of the association of plant-based diet quality with health outcomes
Richard M. Rosenfeld, Hailey M. Juszczak, Michele A. Wong
Frontiers in Nutrition.2023;[Epub] CrossRef
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