**Background:** Hypertriglyceridemia is an important biomarker of cardiovascular disease and a risk factor for type 2 diabetes. Dietary pattern analysis is considered superior to single-nutrient approaches for evaluating diet-disease relationships. While healthy dietary patterns have been inversely associated with triglycerides in Western and multiethnic Asian populations, the relationship in Korean adults has been inconsistent. This study aimed to derive dietary patterns and examine their association with hypertriglyceridemia in a nationally representative sample of middle and older-aged Korean adults.
**Methods:** Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013–2018, a cross-sectional, nationally representative survey. From 47,217 participants, exclusions were made for those <40 years (n=20,420), missing 24-hour recall data (n=3,068), missing hypertriglyceridemia data (n=2,657), missing BMI data (n=49), and implausible energy intake (n=1,217), yielding a final analytic sample of 19,806 participants (7,933 men, 11,873 women). Dietary intake was assessed via single 24-hour recall. Food items were categorized into 24 food groups, and principal component analysis was used to derive dietary patterns. Three patterns were identified: 'oil and fats & seasoning' (high in oils, seasoning, eggs, flour; low in white rice), 'soybean paste and vegetable' (high in soybean paste, vegetables, fish, kimchi; low in pizza, bread, cereal, dairy), and 'fruit and whole-grain' (high in fruit, whole grains, dairy, potatoes; low in meat, alcohol, white rice). Hypertriglyceridemia was defined as triglyceride >200 mg/dL or use of lipid-lowering medication. Multivariable-adjusted logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Model 1 adjusted for age and other dietary pattern scores; Model 2 additionally adjusted for total energy intake, household income, smoking, alcohol, and physical activity; Model 3 further adjusted for energy-adjusted carbohydrate intake.
**Key Results:** The 'fruit and whole-grain' pattern showed a significant inverse association with hypertriglyceridemia in men. In the fully adjusted model (Model 3), men in the highest quartile (Q4) had 39% lower odds of hypertriglyceridemia compared to the lowest quartile (Q1) (OR: 0.61, 95% CI: 0.45–0.82, p for trend <0.0001). The association was dose-dependent across quartiles (Q2 OR: 0.73, 95% CI: 0.55–0.99; Q3 OR: 0.67, 95% CI: 0.50–0.90). In women, the association was significant in Model 1 (Q4 OR: 0.68, 95% CI: 0.52–0.90, p for trend = 0.0051) but became borderline after full adjustment in Model 2 (OR: 0.79, 95% CI: 0.58–1.07, p for trend = 0.0856) and Model 3 (OR: 0.78, 95% CI: 0.58–1.07, p for trend = 0.0628). No significant associations were found for the 'oil and fats & seasoning' or 'soybean paste and vegetable' patterns in either sex. Men in the highest 'fruit and whole-grain' quartile had lower triglyceride ranges (85–177 mg/dL) compared to the lowest quartile (99–218 mg/dL).
**Clinical Implications:** This study provides evidence that a dietary pattern emphasizing fruit and whole grains is associated with lower hypertriglyceridemia prevalence in middle and older-aged Korean men, with a marginal effect in women. Given that Koreans derive approximately 60% of energy from carbohydrates—largely from white rice—replacing refined grains with whole grains and increasing fruit intake may be an effective dietary strategy for managing triglyceride levels. The findings align with established heart-healthy dietary patterns such as DASH and Mediterranean diets. However, due to the cross-sectional design, causal inference is limited, and residual confounding cannot be excluded. The single 24-hour recall may not capture usual intake, and factor analysis involves subjective decisions. Prospective cohort studies or clinical trials are needed to confirm these findings and elucidate mechanisms, particularly the role of viscous fibers like β-glucans in whole grains and the potential confounding effect of fructose from fruit.