{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T11:03:00Z","timestamp":1773486180547,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T00:00:00Z","timestamp":1555286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea grant","award":["NRF-2018R1A2B6002486"],"award-info":[{"award-number":["NRF-2018R1A2B6002486"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>It remains unclear whether cholesterol intake can increase serum cholesterol. Therefore, the present study aimed to investigate the hypothesis that the risk for hypercholesterolemia was not associated with intake of dietary cholesterol after adjusting for saturated fatty acid (SFA). Based on the data from the 2012\u20132016 KNHANES, dietary cholesterol was positively associated with the risk for abnormalities in total cholesterol (TC) (odds ratio (OR): 1.153, 95% confidence interval (CI): 0.995\u20131.337; p = 0.028) and low-density lipoprotein cholesterol (LDL-C) (OR: 1.186, 95% CI: 1.019\u20131.382; p = 0.018) levels before adjusting for SFA; after adjusting for SFA, no significant associations were found between these variables. The mediation analysis showed that dietary cholesterol had no direct effects on the serum levels of TC and LDL-C; in contrast, SFA had significant indirect effects on the association between dietary cholesterol and serum levels of TC and LDL-C. Furthermore, processed meats, but not eggs and other meats, were positively associated with the risk for abnormalities in both TC (OR: 1.220, 95% CI: 1.083\u20131.374; p = 0.001) and LDL-C (OR: 1.193, 95% CI: 1.052\u20131.354; p = 0.004) levels. The present study suggested that higher intake of processed meats with high SFA, but not dietary cholesterol was associated with higher risk for abnormalities in TC and LDL-C levels.<\/jats:p>","DOI":"10.3390\/nu11040846","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T11:15:58Z","timestamp":1555326958000},"page":"846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Association between Dietary Cholesterol and Their Food Sources and Risk for Hypercholesterolemia: The 2012\u20132016 Korea National Health and Nutrition Examination Survey"],"prefix":"10.3390","volume":"11","author":[{"given":"Dongjoo","family":"Cha","sequence":"first","affiliation":[{"name":"Department of Food and Nutrition, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5110-5716","authenticated-orcid":false,"given":"Yongsoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1001\/archinte.1992.00400190110021","article-title":"Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial","volume":"152","author":"Neaton","year":"1992","journal-title":"Arch. Intern. Med."},{"key":"ref_2","unstructured":"Statistics Korea (2017). The Annual Report on the Causes of Death Statistics, Statistics Korea."},{"key":"ref_3","unstructured":"Korea Centers for Disease Control and Prevention (2017). Korea Health Statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES \u2166-1), Korea Centers for Disease Control and Prevention."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s11883-016-0615-0","article-title":"Does dietary cholesterol matter?","volume":"18","author":"Grundy","year":"2016","journal-title":"Curr. Atheroscleros. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pang, S.J., Jia, S.S., Man, Q.Q., Song, S., Li, Y.Q., Song, P.K., Zhao, W.H., and Zhang, J. (2017). Dietary cholesterol in the elderly Chinese population: An analysis of CNHS 2010\u20132012. Nutrients, 9.","DOI":"10.3390\/nu9090934"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhu, Z., Wu, F., Lu, Y., Wang, Z., Zang, J., Yu, H., Guo, C., Jia, X., Shen, X., and Ding, G. (2018). The association of dietary cholesterol and fatty acids with dyslipidemia in Chinese metropolitan men and women. Nutrients, 10.","DOI":"10.3390\/nu10080961"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lin, H.P., Baghdasarian, S., Singer, M.R., Mott, M.M., Bradlee, L., Pickering, R.T., and Moore, L.L. (2018). Dietary cholesterol, lipid levels, and cardiovascular risk among adults with diabetes or impaired fasting glucose in the framingham offspring study. Nutrients, 10.","DOI":"10.3390\/nu10060770"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Soliman, G. (2018). Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients, 10.","DOI":"10.3390\/nu10060780"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1093\/ajcn\/65.6.1747","article-title":"Plasma lipid and lipoprotein responses to dietary fat and cholesterol: A meta-analysis","volume":"65","author":"Howell","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9931","DOI":"10.1021\/acs.jafc.7b04829","article-title":"Do we no longer need to worry about dietary cholesterol?","volume":"65","author":"Zhu","year":"2017","journal-title":"J. Agric. Food Chem."},{"key":"ref_11","unstructured":"Federation of American Societies for Experimental Biology Report on Nutrition Monitoring in the United States (1995). Federation of American Societies for Experimental Biology."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1017\/S0029665115004255","article-title":"Processed meat: The real villain?","volume":"75","author":"Rohrmann","year":"2016","journal-title":"Proc. Nutr. Soc."},{"key":"ref_13","first-page":"113","article-title":"Lean meat and heart health","volume":"14","author":"Li","year":"2005","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s41387-018-0033-1","article-title":"Longitudinal association between egg consumption and the risk of cardiovascular disease: Interaction with type 2 diabetes mellitus","volume":"8","author":"Jang","year":"2018","journal-title":"Nutr. Diabetes"},{"key":"ref_15","first-page":"153","article-title":"Egg consumption and dyslipidemia in a Mediterranean cohort","volume":"35","author":"Zazpe","year":"2018","journal-title":"Nutr. Hosp."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2568","DOI":"10.1093\/jn\/136.10.2568","article-title":"A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women","volume":"136","author":"Wenzel","year":"2006","journal-title":"J. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1093\/jn\/136.10.2519","article-title":"Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations","volume":"136","author":"Goodrow","year":"2006","journal-title":"J. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s00394-008-0730-y","article-title":"Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss","volume":"47","author":"Harman","year":"2008","journal-title":"Eur. J. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5097","DOI":"10.3390\/nu5125097","article-title":"Impact of breakfasts (with or without eggs) on body weight regulation and blood lipids in university students over a 14-week semester","volume":"5","author":"Rueda","year":"2013","journal-title":"Nutrients"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3177\/jnsv.62.361","article-title":"The effect of the consumption of egg on serum lipids and antioxidant status in healthy subjects","volume":"62","author":"Kishimoto","year":"2016","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jnim.2018.11.004","article-title":"The consumption of 12 Eggs per week for 1 year does not alter fasting serum markers of cardiovascular disease in older adults with early macular degeneration","volume":"15","author":"Aljohi","year":"2019","journal-title":"J. Nutr. Intermed. Metab."},{"key":"ref_22","first-page":"57","article-title":"Total red meat intake of \u22650.5 servings\/d does not negatively influence cardiovascular disease risk factors: A systemically searched meta-analysis of randomized controlled trials","volume":"105","author":"Kim","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jacl.2012.01.001","article-title":"A meta-analysis of randomized controlled trials that compare the lipid effects of beef versus poultry and\/or fish consumption","volume":"6","author":"Maki","year":"2012","journal-title":"J. Clin. Lipidol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1161\/CIRCULATIONAHA.109.924977","article-title":"Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: A systematic review and meta-analysis","volume":"121","author":"Micha","year":"2010","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.nut.2015.09.015","article-title":"The impact of red and processed meat consumption on cardiovascular disease risk in women","volume":"32","author":"Bovalino","year":"2016","journal-title":"Nutrition"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jacl.2017.01.021","article-title":"The association between dietary cholesterol intake and subclinical atherosclerosis in Korean adults: The Kangbuk Samsung Health Study","volume":"11","author":"Rhee","year":"2017","journal-title":"J. Clin. Lipidol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/ije\/dyt228","article-title":"Data resource profile: The Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"43","author":"Kweon","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge","volume":"18","author":"Friedewald","year":"1972","journal-title":"Clin. Chem."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4070\/kcj.2016.46.3.275","article-title":"2015 Korean guidelines for the management of dyslipidemia: Executive summary (English translation)","volume":"46","author":"Kim","year":"2016","journal-title":"Korean Circ. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1017\/S1368980014001712","article-title":"Reproducibility and validity of an FFQ developed for the Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"18","author":"Kim","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kim, Y., and Je, Y. (2018). Meat consumption and risk of metabolic syndrome: Results from the Korean population and a meta-analysis of observational studies. Nutrients, 10.","DOI":"10.3390\/nu10040390"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/NNR.0b013e3182533403","article-title":"Navigating complex sample analysis using national survey data","volume":"61","author":"Saylor","year":"2012","journal-title":"Nurs. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1146\/annurev-publhealth-031914-122559","article-title":"Statistical foundations for model-based adjustments","volume":"36","author":"Greenland","year":"2015","journal-title":"Annu. Rev. Public Health"},{"key":"ref_34","unstructured":"Hayes, A.F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, The Guliford Press."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1111\/j.1365-2362.1993.tb00726.x","article-title":"Dietary saturated fatty acids increase cholesterol synthesis and fecal steroid excretion in healthy men and women","volume":"23","author":"Glatz","year":"1993","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Afonso, M.S., Machado, R.M., Lavrador, M., Quintao, E.C.R., Moore, K., and Lottenberg, A. (2018). Molecular pathways underlying cholesterol homeostasis. Nutrients, 10.","DOI":"10.3390\/nu10060760"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Blesso, C., and Fernandez, M. (2018). Dietary cholesterol, serum lipids, and heart disease: Are eggs working for or against you?. Nutrients, 10.","DOI":"10.3390\/nu10040426"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1080\/07315724.2017.1366878","article-title":"Effects of egg consumption on blood lipids: A systematic review and meta-analysis of randomized clinical trials","volume":"37","author":"Rouhani","year":"2018","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/B978-0-12-024922-0.50008-4","article-title":"Hypo-and hyperresponders: Individual differences in the response of serum cholesterol concentration to changes in diet","volume":"22","author":"Beynen","year":"1987","journal-title":"Adv. Lipid Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3177\/jnsv.42.87","article-title":"Effect of egg white on serum cholesterol concentration in young women","volume":"42","author":"Asato","year":"1996","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1271\/bbb.80016","article-title":"Mechanism for the cholesterol-lowering action of egg white protein in rats","volume":"72","author":"Matsuoka","year":"2008","journal-title":"Biosci. Biotechnol. Biochem."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1001\/jama.2019.1572","article-title":"Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality","volume":"321","author":"Zhong","year":"2019","journal-title":"JAMA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/10408398.2010.493978","article-title":"Substitution of saturated fat in processed meat products: A review","volume":"52","author":"Ospina","year":"2012","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"b4567","DOI":"10.1136\/bmj.b4567","article-title":"Salt intake, stroke, and cardiovascular disease: Meta-analysis of prospective studies","volume":"339","author":"Strazzullo","year":"2009","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s11883-012-0282-8","article-title":"Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes\u2014An updated review of the evidence","volume":"14","author":"Micha","year":"2012","journal-title":"Curr. Atheroscleros. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1084\/jem.112.4.635","article-title":"Effects of chronic excess salt feeding: Elevation of plasma cholesterol in rats and dogs","volume":"112","author":"Dahl","year":"1960","journal-title":"J. Exp. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3746\/pnf.2012.17.2.093","article-title":"Dietary intake ratios of calcium-to-phosphorus and sodium-to-potassium are associated with serum lipid levels in healthy Korean adults","volume":"17","author":"Bu","year":"2012","journal-title":"Prev. Nutr. Food Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.3945\/ajcn.2009.28415","article-title":"Meat, fish, and ovarian cancer risk: Results from 2 Australian case-control studies, a systematic review, and meta-analysis","volume":"91","author":"Kolahdooz","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3575","DOI":"10.2527\/jas.2007-0565","article-title":"Effects of conventional and grass-feeding systems on the nutrient composition of beef","volume":"86","author":"Leheska","year":"2008","journal-title":"J. Anim. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1628S","DOI":"10.1093\/ajcn\/65.5.1628S","article-title":"Individual fatty acid effects on plasma lipids and lipoproteins: Human studies","volume":"65","author":"Yu","year":"1997","journal-title":"Am. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/4\/846\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:45:24Z","timestamp":1760186724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/4\/846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,15]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4]]}},"alternative-id":["nu11040846"],"URL":"https:\/\/doi.org\/10.3390\/nu11040846","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,15]]}}}