Association between the Korean Healthy Eating Index sub-domains and the risk of metabolic syndrome in Korean adults: data from the 2022–2023 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES:To evaluate the association between the Korean Healthy Eating Index (KHEI) scores and metabolic syndrome (MetS) and its risk factors in Korean adults, focusing on 3 KHEI domains.SUBJECTS/METHODS: Data from 9,161 adults (3,985 men, 5,176 women) aged 19-64 yrs who participated in the 2022-2023 Korea National Health and Nutrition Examination Survey were analyzed.MetS was diagnosed using the National Cholesterol Education Program-Adult Treatment Panel III criteria.The KHEI scores were calculated using the revised 2022 KHEI.Statistical analysis was performed using complex sample design methods, including the Rao-Scott χ 2 test, analysis of covariance, and survey logistic regression, with adjustments for relevant covariates.RESULTS: The risk of MetS was significantly lower in the group with highest total KHEI score than in the group with lowest score in men (odds ratio, 0.658; 95% confidence interval [CI], 0.492-0.881).Among the 3 domains, Adequacy was the most effective predictor of MetS.The highest score group exhibited significantly decreased odds of MetS in men (0.689; 95% CI, 10.523-0.909)and women (0.665; 95% CI, 0.456-0.969).Total KHEI scores were significantly lower in the MetS group than in the non-MetS, in both men and women (P < 0.001).Within the adequacy, scores for breakfast, fruit, and milk/dairy product intake were lower for individuals with MetS (P < 0.05).In the Moderation, gender-specific patterns in MetS risk were observed, as women in the highest score group exhibited a higher risk.The Balance was generally not associated with MetS.CONCLUSION: These findings reveal that a high quality diet, particularly in the Adequacy domain, is associated with a lower risk of MetS.Dietary patterns within each KHEI domain may differentially influence MetS risk.Therefore, future nutritional strategies for the prevention of MetS should focus on improving the adequacy of essential food groups.