KJFP Sang-Cheon Byeon, et al. Correlation between the fatty liver and cardiovascular disease of adult males who visited screening center in the region

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KJFPpISSN 2233-9019 eissn 2233-9116 Original Article 지역의료기관건강검진센터에내원한성인남성의지방간유무와심혈관계질환의상관관계 변상천, 강태석, 안성민, 김유리 * 부산광역시의료원가정의학과 Correlation between the fatty liver and cardiovascular disease of adult

1 KJFPpISSN eissn Original Article 지역의료기관건강검진센터에내원한성인남성의지방간유무와심혈관계질환의상관관계 변상천, 강태석, 안성민, 김유리 * 부산광역시의료원가정의학과 Correlation between the fatty liver and cardiovascular disease of adult males who visited screening center in the regional health care institution Sang-Cheon Byeon, Tae-Seok Kang, Sung-Min An, Yu-Lee Kim * Department of family medicine, Busan Medical Center Background: The incidence of fatty liver is higher in men than in women. In addition Korean men tend to have unhealthy habits, that may cause cardiovascular diseases (CVDs). This study investigated the correlation between fatty liver and CVD in male subjects. Methods: A total of 445 men aged 20 or older undergoing upper abdominal ultrasound at a health check-up center were enrolled in for this study. Subjects with a history of CVD, diabetes, and viral hepatitis or those without definitive diagnoses were excluded. The Framingham risk scores (FRSs) of the subjects were determined from blood pressure (BP) measurements and biochemical test results: high-sensitivity C-reactive protein (hs-crp) levels were also measured and compared between fatty liver and control groups. Results: The resulting body mass index (BMI) values, waist measurement, total cholesterol (TC) levels, systolic blood pressure (SBP) values, antihypertensive drugs useage rates, and hs-crp levels were significantly higher, and the high-density lipoprotein cholesterol (HDL-C) was levels significantly lower in the fatty liver group than in the control group. The TC, HDL-C, SBP, and total FRS were significantly higher in the fatty liver group. The 10-year CVD risk was higher in the fatty liver group than in the control group (9.0±6.3% vs. 6.6±5.3%, P<0.001). The subjects were divided into three groups based on CVD risk using either FRS or hs-crp level. In both cases, the fatty liver group had significantly higher risk of disease. Conclusion: Fatty liver in adult men may be a risk factor for CVD. Therefore, medical examinations for adult men should consider the possibility of CVD. Keywords: fatty liver, FRS, hs-crp, CVD 서론현대사회에서는생활습관병으로인한심혈관질환증가가문제가되고있다. 개인의향후심혈관질환의위험도를평가하고위험인자관리를위한전통적인점수계산형방식으로는미국의프래밍햄위험점수 (Framingham risk score, FRS) 가있다. 1) 개정된 FRS는관상동맥심장질환과당뇨병이없는 20~79세의성인에서성별에따라연령, 흡연, 수축기혈압, 총콜레스테롤및고밀도지단백콜레스테롤 (high-density lipoprotein cholesterol, HDL-C) 을점수화하여향후 10년내에심혈관계질환 (cardiovascular disease, CVD) 의위험도를평가한다. 2) CVD의위험도를평가, 예측할수있는또다른방법으로고감도 C-반응단백 (high sensitivity C-reacvtive protein, hs-crp) 이있다. hs-crp란 C-반응성단백을좀더민감하고정밀하게측정하는것이다. 미국심장학회와질병통제예방센터 (American Heart Association/ The Centers for Disease Control and Prevention, AHA /CDC) 에서는 hs-crp가과거 CVD의발생이없었던성인에서앞으로혈관질환의발생을예측할수있는표지자라는학술적성명을내놓은바있다. 3) Received February 17, 2015 Revised July 3, 2015 Accepted August 19, 2015 Corresponding Author Yu-Lee Kim Tel: @hanmail.net Copyright 2015 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 55

2 KJFP Sang-Cheon Byeon, et al. Correlation between the fatty liver and cardiovascular disease of adult males who visited screening center in the regional health care institution 정상간의경우지방이차지하는비율은 5% 정도인데이보다많은지방이축적된상태를지방간이라고하며, 현대인들의잘못된식습관, 음주습관, 운동부족, 체중과다로인해지방간유병률이증가하고있다. 역학조사에의하면지방간의발생률은여성보다남성이더높으며 4) 전통적으로여성보다사회활동참여율이높은우리나라의남성들의경우흡연, 음주, 불규칙한식습관에노출되기쉽고그에따른남성의생활습관병과심혈관질환이문제가되고있다. 지방간과심혈관질환의상관관계를연구한논문이많이있으나 CVD의 10년위험도와 hs-crp 수치를위험등급에따라집단을나눠지방간과연관성을분석한국내연구는아직부족하다. 이에본연구는남성에국한된집단에서지방간의 FRS 및 hs- CRP 수치를분석하여남성에서발생한지방간과 CVD의상관관계여부를알아보았다. 방법 1. 연구대상 2014년 3월에서 9월까지부산지역공공의료기관건강증진센터에내원한 1156명의수검자중상복부초음파검사를시행한 20세이상성인남성 534명을대상으로자가기입식설문지조사를하였다. 자가기입식설문지를통해 CVD의과거력또는현병력이있는경우, 당뇨병의현병력이있거나공복혈당측정결과 126mg/dL 이상으로당뇨병이의심되는경우, 바이러스성간염이있는경우, 자료수집결과기록이미비하였거나불성실한응답등으로통계처리가어려운경우, 상복부초음파판독결과지방간진단여부가불확실한 ' 지방간의증 또는 ' 진단미정 으로나온경우, 외상, 감염, 악성질환등 hs-crp를상승시킬수있는현병력이있는경우를제외한최종 445명을대상으로연구를하였다. 2. 연구방법초음파를통한지방간은간에코가우측신장수질에코보다높고, 간우엽의심부로갈수록에코가저하되어횡격막이잘보이지않으며, 간실질조직내에균질한에코증가로간문맥이불명확한상태일때진단할수있다. 5) 본연구에서는상복부초음파 (Lu-22, Philips, USA) 를통해 2명의숙련된영상의학과전문의가판독하였다. 초음파판독결과지방간이있는군을환자군, 없는군을대조군으로정했다. 모든수검자들은흡연력, 당뇨와고혈압병력, 고혈압약물복용여부등에대한자가기입식설문지를작성하였다. 신장및체중은신을벗고가벼운검진복을입은상태에서자동신체측정기 (DS-103, Dongsan Jenix, Korea) 로측정하였고이를토 대로체질량지수 (body mass index(bmi), kg/m 2 ) 를계산하였으며허리둘레 (cm) 는측정경험이많은간호사 1명에의해측정되었다. 수축기혈압과이완기혈압측정은수검자가 20분이상안정한후자동혈압측정계 (NEX400R, Medison Jawon, Korea) 를이용하여측정하였다. 모든수검자는 12시간이상공복상태를유지한후채혈을하였으며, 자동화학분석기 (TBA-2000FR, Toshiba Medical System Co, Japan) 를이용하여공복혈당, 총콜레스테롤 (total cholesterol, TC), 고밀도지단백콜레스테롤 (high density lipoprotein cholesterol, HDL-C), hs-crp를측정하였다. FRS는미국국립콜레스테롤교육프로그램성인패널 3차 (The National Cholesterol Education Program Adult Treatment Panel III, NCEP-ATP Ⅲ) 지침에따라나이, 성별, TC, HDL-C, 흡연, 수축기혈압, 고혈압치료유무를통해계산하였다. 지방간이있는군과없는군에각각변수별로점수를매겼고, 합산한총위험점수와이에대응하는 10년내 CVD 발병위험도를추정하였다. NCEP-ATP Ⅲ 분류기준을따라서 10년내 CVD 발병위험도가 10% 미만일경우저위험군, 10-20% 일경우중등도위험군, 20% 를초과할경우고위험군으로분류하였다. 6) hs-crp의경우 AHA /CDC의지침을따라서수치가 1mg/L 미만일경우저위험군, 1~3mg/L일경우중등도위험군, 3mg/L를초과할경우고위험군으로분류하였다. 3. 통계분석모든통계처리에는통계프로그램 SPSS 22.0(SPSS Inc., Chicago, IL, USA) for Window를사용하였으며모든자료는평균, 표준편차혹은해당값 (%) 으로표시하였다. 지방간유무에따른연속변수의평균값비교에는독립표본 t검정을이용하였고, 지방간유무와 CVD 발생위험군과의범주형변수의비교에는카이제곱검정을이용하였다. 신뢰구간은 95%, 통계유의수준은 p값 0.05 미만으로정의하였다. 결과 1. 연구대상자의특성 445명중지방간이있는사람은 253명, 없는사람은 192명이었다. 지방간군에서체질량지수 (25.6±3.2kg/m 2 vs 22.9±2.2kg/m 2, P<0.001), 허리둘레 (85.5±7.8cm vs 78.4 ±6.0cm, P =0.005), TC(201.8±35.0mg/dL vs 186.5±31.3mg/dL, P<0.001), 수축기혈압 (124.9±12.5mmHg vs 119.3±12.4mmHg, P<0.001), 혈압약복용률 (19.0% vs 10.4%, P<0.001) 이유의하게높았으며 HDL-C(44.8± 10.2mg/dL vs 52.2±12.7mg/dL, P<0.001) 는유의하게낮았다. hs-crp의경우지방간군에서유의하게높았다 (2.3±3.0mg/L 56

3 변상천외. 지역의료기관건강검진센터에내원한성인남성의지방간유무와심혈관계질환의상관관계 KJFP vs 1.6±2.0mg/L, P<0.001) Table 1. Clinical and laboratory characteristics of study subjects * 연령과흡연율에는두군간에유의한차이가없었다 (Table 1). Characteristic 2. 지방간유무에따른 FRS 및 10년내 CVD 발병위험도지방간군에서 FRS의요소중 TC 점수와 HDL-C 점수, 수축기혈압점수가유의하게높았다. ( 각각 P =0.001, P <0.001, P=0.001) 연령점수와흡연유무점수는두군간에유의한차이가없었다. 총 FRS는지방간군에서유의하게높았으며 (10.1 ±4.2 vs 8.3 ± 5.0, P<0.001) 10년내 CVD 발병위험도또한지방간군에서유의하게높았다 (9.0±6.3% vs 6.6±5.3%, P<0.001) (Table 2). 3. FRS에의한 10년내 CVD 발병위험집단의비율각군을 10년내 CVD 발병위험도에따라세집단으로나누어지방간유무에따른집단의비율을조사하였다. 지방간군에서는고위험군이 2.8%, 중등도위험군이 44.7%, 저위험군이 52.6% 였으며대조군에서는고위험군이 1.0%, 중등도위험군이 24.5% 저위험군이 74.5% 로대조군에비해지방간군에서고위험및중등도위험의비율이높았다 (P<0.001) (Table 3). Age, mean, y 49.6 ± ± Total cholesterol, mg/dl ± ±31.3 < HDL-C, mg/dl 44.8 ± ±12.7 < Systolic BP, mmhg ± ±12.4 < BMI,kg/m ± ± 2.2 < Waist circumference,cm 85.5 ± ± hs-crp, mg/l 2.3 ± ±2.0 < Current smoker, n(%) 98(38.7) 61(31.8) Anti-Hypertensive drug, n(%) 48(19.0) 20(10.4) < Abbreviations: TC: total cholesterol, HDL-C: high density lipoprotein cholesterol, BP: blood pressure, BMI: body mass index, hs-crp: high sensitivity C-reavtive protein * Values are presented as mean ±SD unless otherwise indicated. Calculated by independent t-test(age, TC, HDL-C,Systolic BP, BMI, Waist circumference, hs-crp) and chi-square test(current smoker, Anti-Hypertensive drug) Table 2. Framingham risk score according to presence of fatty liver * Variables Age score 3.66 ± ± Total cholesterol score 3.25 ± ± HDL-C score 0.98 ± ±1.03 < hs-crp에따른 CVD 발병위험집단의비율각군을 hs-crp 수치에따라세집단으로나누어지방간유무에따른집단의비율을조사하였다. 지방간군에서는고위험군이 19.4%, 중등도위험군이 48.2%, 저위험군이 32.4% 였으며대조군에서는고위험군이 12%, 중등도위험군이 33.3% 저위험군이 54.7% 로대조군에비해지방간군에서고위험및중등도위험의비율이높았다 (P<0.001) (Table 4). 고찰과거에는지방간이섬유화로진행되는경우도있지만그경과가장기간걸린다고생각하였기때문에바이러스성간질환등과비교할때예후가양호하다고하여건강상의문제로서크게심각하게여기지않는경향이많았다. 그러나근래에지방간과 CVD의연관성을입증하는연구결과가늘어나고있다. 지방간과내장지방은관련이강한것으로확인되고있으며 7) 내장주위에지방이축적하는형태의비만은고혈압, 고지혈증, 당뇨병등의생활습관병은물론관상동맥심장질환의합병률이높다는것이지적되어왔다. 8) 지방간은증상이없는동맥경화와관련이있다고보고된바있으며, 9) 많은역학연구에서는지방간이다른위험인자와는독립적으로 CVD의유병률과연관이있다고제 Smoking score 1.76 ± ± Systolic BP score 0.49 ± ± Framingham risk score ± ±5.02 < year coronary heart ds risk, % 9.00 ± ±5.25 <0.001 Abbreviations: TC: total cholesterol, HDL-C: high density lipoprotein cholesterol, BP: blood pressure, ds: disease * Values are presented as mean ±SD unless otherwise indicated. Calculated by independent t-test. Table year coronary heart disease risk for subjects with and without fatty liver * Framingham risk Table 4. hs-crp risk category for subjects with and without fatty liver hs-crp High risk(>3mg/l), n(%) 49(19.4) 23(12.0) Intermediate risk(1~3mg/l), n(%) 122(48.2) 64(33.3) Low risk(<1mg/l), n(%) 82(32.4) 105(54.7) * Values are presented as n(%). Calculated by chi-square test. High risk(>20%), n(%) 7(2.8) 2(1.0) Intermediate risk(10~20%), n(%) 113(44. 7) 47(24.5) < Low risk(<10%), n(%) 133(52.6) 143(74.5) * Values are presented as n(%). Calculated by chi-square test. < 시하고있다. 57

4 KJFP Sang-Cheon Byeon, et al. Correlation between the fatty liver and cardiovascular disease of adult males who visited screening center in the regional health care institution 지방간과 CVD의연결고리중하나가염증반응이다. 염증반응은특히지방선조의형성, 동맥경화반의형성, 혈전을동반한플라크 (plaque) 의파열등모든동맥경화에있어서핵심적이다. 혈액에서측정할수있는염증반응인자의대표는 hs-crp이며특히증상이없는 hs-crp의상승은말초혈관질환, 뇌졸중, 심근경색과연관이있다. 10) 비알콜성지방간환자의경과중단순지방침착에서지방간염내지간경화로의진행은산화스트레스와간내염증반응에기인하며일부연구에서지방간과연관된간내염증반응이혈액내염증표지자인 hs-crp 상승과연관이있다고보고하였다. 11) 이렇듯지방간과 CVD의연관성과그원인을설명해주는여러가지연구결과가존재한다. 본연구는지방간의 CVD의위험인자로서의가능성을알아보기위해 CVD 대리표지자로서 FRS 및 hs-crp 수치와의관련성을알아보았다. 본연구결과전체조사대상남성의지방간유소견율은 56.8% 로나타났다. 선행연구들의경우지방간의유병률은측정하는집단에따라 23%~45% 로보고되며 12) 알코올성지방간의유병률은 10~24%, 비만환자에게서는 57~75% 로나타나고있다. 13) 지방간유병률의경우조사대상에따라다양한결과를보이고있으므로본연구결과의높은지방간유소견율이문제가되지는않을것으로본다. 연구결과지방간군과대조군간에연령은유의한차이가없었으며연령점수또한유의한차이가없었다. 지방간군의흡연율은 38.7%, 대조군의흡연율은 31.8% 로차이가있었으나흡연점수는유의한차이가없었다. TC 수치, HDL-C 수치와그로인한점수도유의한차이가있었으며수축기혈압과그점수역시유의한차이가있다는결과를바탕으로지방간군에서 10년내 CVD 발병위험도를높이는원인은대조군에비해상대적으로높은혈압과혈중지질수치라는것을예측할수있다. 또한지방간군과대조군간에 hs- CRP 수치의유의한차이가있으며지방간군에서관상동맥심장질환발생의고위험및중등도위험의비율이높음을통해그연관성을확인하였다. 본연구의제한점으로는첫째, 알코올성지방간과비알코올성지방간을구분하지않고연구를진행한점이다. 지방간은크게과음으로인한알코올성지방간과비만, 당뇨병, 고지혈증, 약물등으로인한비알코올성지방간으로나눌수있다. 알코올성지방간은알코올을많이섭취하게되면간에서지방합성이촉진되고정상적인에너지대사가이루어지지않아발생하게된다. 비알코올성지방간의경우간내지방축적을초래하는일차적인대사장애의원인은인슐린저항성과간지방대사장애이다. 14) 알코올성지방간과비알코올성지방간은유발원인이다르며각기구분하여비교분석이필요하나연구대상자들의정확한음주섭취량과복용약물에대한자료가부족하여알코올성과비알코올성 이구분된연구를시행하지못하였다. 알코올성지방간과비알코올성지방간을구분하여각각 FRS를측정한기존의국내연구 15) 가존재하며연구결과알코올성지방간군과비알코올성지방간군의 10년내 CVD 발병위험도는각각 7.76±5.6%, 6.90±6.49% 였다. 본연구의지방간군의 10년내 CVD 발병위험도분석결과는이보다높은 9.0±6.3% 이며이는연구대상집단의성별비율이 FRS산출에영향을준것으로추측된다. ( 기존연구는성인남성과여성모두를대상으로하였으며본연구는성인남성만을대상으로하였다.) 둘째, 일반적으로상복부초음파검사에의한지방간의진단은정량적인평가가행하여지지않으며초음파를이용한지방간진단의정확도는간생검결과를기준으로할때민감도는 55~80%, 특이도는 65~95% 로진단에한계가있다. 16) 즉측정기기에의한오차를배제할수는없으며본연구에서검사자가동일한검사자가아닌 2명의영상의학과전문의로검사자간의오차또한배제할수없는한계가있어보인다. 셋째, FRS는서구인을대상으로한것이므로한국인에서 FRS의 CVD 위험도에대한인종적차이가있을가능성이있다. 국내대량연구중엔 FRS가한국인의 CVD 발생률을과대추정한다는결과도보고되고있다. 17) 넷째, 일개의료기관검진센터의자료이므로선택편견의가능성이있다. CVD 병력, 혈압약복용여부, 흡연여부또한자가기입식설문지를통해조사하여누락되거나기억에의한편견이있을수있다. 다섯째, 성별을남성으로국한하여진행한점과조사대상의개체수가많지않은점은연구결과를전체인구에적용되는일반적인결론으로내리기에한계가있어보인다. 이와관련하여더많은집단을대상으로하는대량연구가필요하다. 마지막으로본연구는지방간의중증도에따른등급을나누지않고연구를진행하였으나향후지방간의등급에따른 CVD의발생위험도에대한연구역시필요하다여겨진다. 이러한제한점에도불구하고본연구는국내남성지방간환자에게있어향후 CVD발생위험을예측할수있다는점에서의의가있다. 결론적으로성인남성의지방간은 CVD의위험인자일가능성이있으므로진료시 CVD에대한가능성을열어놓고진찰및검사를시행해야한다. 요약연구배경 : 지방간의발생률은여성보다남성이더높으며, 우리나라의남성들의경우흡연, 음주등의건강하지못한습관과그에따 58

5 변상천외. 지역의료기관건강검진센터에내원한성인남성의지방간유무와심혈관계질환의상관관계 KJFP 른 CVD 가문제가되고있다. 본연구는남성에국한된집단에서 지방간과 CVD 의상관관계여부를알아보았다. 방법 : 건강검진센터에내원하여상복부초음파를시행했던 20 세이 상남성수진자중 CVD, 당뇨병, 바이러스성간염의병력이있는 경우와초음파진단이불확실한경우를제외한최종 445 명을대상 으로하였다. 혈압측정, 생화학적검사결과를바탕으로 FRS 를산 출하고 hs-crp 를측정하여지방간군과대조군의차이를분석하 였다. 결과 : 지방간군에서체질량지수, 허리둘레, TC, 수축기혈압, 혈 압약복용률, hs-crp 가유의하게높았으며 HDL-C 는유의하 게낮았다. 또한지방간군에서 TC 점수와 HDL-C 점수, 수축기 혈압점수, 총 FRS 가유의하게높았다. 10 년내 CVD 발병위험도 또한지방간군에서유의하게높았다 (9.0 ±6.3% vs 6.6 ±5.3%, P<0.001). FRS 로계산한 10 년내 CVD 발병위험도와 hs-crp 의 수치에따른 CVD 위험도에따라세그룹으로나누어조사한결과 지방간군에서고위험군의비율이높았다. 결론 : 성인남성의지방간은 CVD 의위험인자일가능성이있으므 로진료시 CVD 에대한가능성을열어놓고진찰및검사를시행해 야한다. 중심단어 : 지방간, 프래밍햄점수, 고감도 C- 반응단백, 심혈관계 질환 REFERENCES 1. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J 1991; 121(1 Pt 2): National Cholesterol Education Program Expert Panel. Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285(19): Smith SC, Anderson JL, Cannon RO 3rd, Fadl YY, Koenig W, Libby P, et al. CDC/AHA workshop on markers of Inflammation and cardiovascular disease: application to clinical and public health practice: report from the clinical practice discussion group, Circulation 2004; 110: e550-e Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346 (16): Kang HS. Ultrasound imaging for physicians and Residency, Daehan Medical Publishers; National Cholesterol Education Program Expert Panel. Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285(19): Kobatake K, Matsuzawa Y. Tokunaga K. Metabolic improvements associated with a reduction of abdominal visceral fat caused by a new α-glucosidase inhibitor, AO-128 in zucker fatty rats. Int J Obes 1989; 13: Batman PA, Scheuer PJ. Diabetic hepatitis preceding the onset of glucose intolerance. Histopathology 1985; 9: Santos RD, Nasir K, Conceicao RD, Sarwar A, Carvalho JA, Blumenthal RS. Hepatic steatosis is associated with a greater prevalence of coronary artery calcification in asymptomatic men. Atherosclerosis 2007; 194: Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3): Ndumele CE, Nasir K, Conceicao RD, Carvalho JM, Blumenthal RS, Santos RD. Hepatic steatosis, obesity and the metabolic syndrome are independently and additively associated with increased systemic inflammation. Arterioscler Thromb Vasc Biol 2011; 31(8): Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346 (16): Marchesini G, Brizi M, Morselli-Labate AM. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999; 107: Kim HJ, Kim JH, Choe WH, Kwon SY, Lee CH. Alcoholic fatty liver disease elevates estimated coronary heart disease risk to levels comparable with those of nonalcoholic fatty liver disease in the Korean population: a cross-sectional study. Clin Mol Hepatol Jun; 20(2): Catarige JC, Scott WW, Donovan PJ, Spegelman SS, Sanders RC. Fatty infiltration of the liver; Ultrasoniographic and computed tomographic correlation. J Ultrasound Med 1984; 14(3): Ahn KA, Yun JE, Cho ER, Nam CM, Jang YS, Jee SH. Framingham equation model overestimates risk of ischemic heart disease in korean men and women, Korean Journal of Epidemiology 2006;

DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%) aged over 30 years or older had diabetes in 2010. Based on fasting g

DIABETES FACT SHEET IN KOREA 2012 Korean Diabetes Association (KDA) / Korea Centers for Disease Control and Prevention (CDC) DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%)