Korean adults have been moving away from a traditional rice-centred diet toward Western-style eating patterns — a change that new data shows is coming with sex-specific heart health risks.

That was the main finding from a 16-year analysis of 80,036 adults using nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) that spanned 2007 to 2022.

Researchers from Duksung Women’s University, Hoseo University and the Harvard T.H. Chan School of Public Health grouped foods into 28 categories and used cluster analysis to identify three real-world dietary patterns.

These were traditional (refined white rice, legumes or soy, kimchi and salted vegetables, and seaweed), red meat and alcohol, and flour-based foods and sweets (wheat flour and bread, noodles and other flour dishes, sweets, fruit juices, and sugar-sweetened beverages).

The latter two dietary patterns are considered to have strong Western connotations and influences.

Until 2013, the traditional pattern had the largest share, before the shift began around 2014. From 2014 onward, the flour-and-sweets pattern took the lead and kept growing.

In 2022, it accounted for 52.8% of all adults, compared with 31.9% for traditional and 15.3% for red meat and alcohol.

Women were the main drivers: 59.3% of women fell into the flour-and-sweets cluster in 2022, compared to 46.3% of men.

Men showed a stronger presence in the red meat and alcohol pattern, which peaked at 24.1% in 2016, then declined to 19.9% in 2022.

Health risks split by sex

The study linked each pattern to cardiometabolic risks measured during standardised exams and blood tests.

Among men, the red meat and alcohol cluster carried the heaviest burden. Compared with the traditional pattern, men in this cluster had higher odds of chronic diseases such as hyperglycaemia, high blood pressure, hypertriglyceridemia, hypercholesterolemia, abdominal obesity and overall obesity.

Among women, the flour-and-sweets pattern stood out for lipids.

“In short, the risk pattern in men is driven by a combination of frequent alcohol intake, heavier meat portions, and more eating out – women in the red meat and alcohol pattern also show similar elevated odds but their adherence to this pattern was much lower,” said the authors.

“Instead, the larger risk for women lies in the flour-and-sweets pattern due to a higher content of lipids, leading to higher odds of hypercholesterolemia and high LDL cholesterol.”

In short, the sex-specific red flags are consistent: men face broad cardiometabolic strain under the red meat and alcohol pattern, while women face cholesterol and LDL challenges under the flour-and-sweets pattern.

Young adults lead the change

The age differences were also striking. Young adults aged 19 to 29 showed the highest reliance on flour and sweets throughout most of the period.

In 2022, 63.5% of this group were in the flour-and-sweets pattern, including 70.2% of young women and 57.3% of young men.

Adults aged 65 and older remained most likely to follow the traditional pattern, with 55.6% in 2022. Urban residence tracked with Westernised patterns, especially among women, while rural residence aligned more with traditional eating.

These shifts reflected broader social and structural changes. Busier urban lifestyles, more eating out and food delivery, and the growing presence of bakery, confectionery and ready-to-eat products have normalised flour-heavy meals and frequent sweets.

Even so, the flour-and-sweets cluster in this study was not purely indulgent. It also featured higher intake of non-salted vegetables, eggs, dairy, and plant oils than stereotypes suggested.

Sugar-sweetened beverages (SSBs )contributed about 3.7% of total energy in this group — low compared to many Western markets but rising among younger Korean consumers.

What each pattern means nutritionally

The traditional pattern remained highly carbohydrate-heavy because refined white rice alone supplied about 53% of energy.

This meant that the average carbohydrate share reached roughly 69% to 71%, which sits above Korea’s recommended range of 55% to 65%. This pattern was also associated with more family meals and less daily eating out.

The red meat and alcohol pattern paired higher intakes of beef or pork with alcohol and more frequent dining out. Men in this cluster reported the highest monthly drinking rates and had the largest share of obesity.

The flour-and-sweets pattern combined bakery products, noodles and other flour dishes, and desserts, with noticeable contributions from vegetables and dairy.

Although dietary moderation has always been the major nutritional advice given by experts, there are signals in both genders shifting towards non-traditional diets which are hard to ignore, prompting calls for more customised public guidelines.

“Implementing gender-tailored nutrition education could enhance the translation of these findings into effective public health practice,” the authors concluded.

Source: National Center for Biotechnology Information

“Secular trends in dietary patterns among Korean adults: using data from the 2007-2022 Korea National health and nutrition examination survey”

https://doi.org/10.1186/s12937-025-01235-0

Authors: Tak Eunyoung, et al.