Following the rapid economic development with good food supply, Koreans have changed their lifestyle and food habits. Intake trends illustrate the fall in whole grain intake with the significant rise in animal sources, edible oils and added sugar. Fat-derived energy intake increased rapidly, from about 6% in 1969 to 19% in 1998; however, average calorie intake, approximately 2000 kcal, has changed little over the same period. The 1998 survey showed that the obesity rate among adults was 1.7% for men and 3.0% for women. Although mean values of BMI has only slightly increased from 22.5 kg/m2in 1988 to 23.3 kg/m2in 1998, the prevalence of the high waist to hip ratio has markedly increased. Similarly, a rapid increase (140%) in mortality rates as a result of CAD was observed. This indicates that obesity is not considered to be of major clinical importance in Korea. Rather, the ability of an individual to cope with an increase in central fat distribution and dietary transition may be important in the development of CAD. Many Koreans appear to be susceptible to the development of excessive abdominal fatness even at low levels of BMI. In addition, the health consequences of visceral fat accumulation including postprandial lipemia, lipid peroxidation and negative antioxidant system appear to occur at much lower levels of BMI and are more intense than in those of European origin. The exact reasons for these ethnic variations in the development of CAD remain unclear. It is likely that genetic differences contribute to this variation in CAD risk, but different dietary and physical activity patterns may also play a role. Therefore, the major goal to prevent CAD should be the reduction of visceral fat through physical exercise and heart-healthy nutrition guidelines, including minimally refined grains and frequent consumption of vegetables and legumes, even for those subjects who are considered at low risk of CAD based on the BMI values.
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