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1 대한지역사회영양학회지 17(4) : 463~478, 2012 Korean J Community Nutr 17(4) : 463~478, 우리나라 50 세이상성인의소득수준과비만에따른영양건강특성분석에대한연구 년국민건강영양조사자료분석 - 안소현 손숙미 김혜경 가톨릭대학교생활과학부식품영양학전공 A Study on the Health and Nutritional Characteristics according to Household Income and in Korean Adults Aged over 50 -Based on 2005 KNHANES- So Hyun Ahn, Sook Mee Son, Hye Kyeong Kim Department of Food Science & Nutrition, The Catholic University of Korea, Bucheon, Korea Abstract This study investigated the health and nutritional characteristics according to household level and obesity in Koreans aged over 50 years based on the 2005 National Health and Nutrition Examination Survey. Subjects were classified into 3 groups by average household with reference to the minimum monthly living expenses (MLE): low (n = 319, < 100% MLE), middle (n = 222, < 200% MLE), high (n = 411, 200% MLE) and each group was compared by BMI index. With increasing level, the prevalence of systolic hypertension and hyperlipidemia was increased. In the low group, serum total cholesterol, triglycerides, and fasting glucose were higher in the obese compared with the normal. In the middle and high groups, the prevalence of hyperlipidemia and diastolic hypertension were higher in the obese. Subjects had nutritional imbalance, such as inadequate intake of calcium and potassium. With increasing level, the percentages of protein and fat to total calorie were increased in addition to the intakes and density of nutrients. The obese in the low group had higher intakes of energy, protein, phosphorus and higher consumption frequency of cereals and potatoes compared with the normal. It was shown that the obese of the middle and high groups tended to have lower consumption frequency of Korean cabbage and higher frequency of fruits. The obese of high group also had binge drinking habit. Therefore, this study suggests that specific approaches based on economic status should be considered in developing nutrition education program for the elderly. (Korean J Community Nutr 17(4) : 463~478, 2012) KEY WORDS : elderly nutritional status obesity 서 개인과집단의건강상태는인종, 성별, 교육수준, 소득수준, 문화적배경등이중요한인자로작용하며 (US Department of Health and Human Services 2000), 접수일 : 2012 년 5 월 25 일접수수정일 : 2012 년 7 월 21 일수정채택일 : 2012 년 7 월 30 일채택 Corresponding author: Hye-Kyeong Kim, Department of Food Science & Nutrition, The Catholic University of Korea, 43-1 Yeokgok 2-dong, Wonmi-gu, Bucheon, Gyeonggi-do , Korea Tel: (02) , Fax: (02) hkyeong@catholic.ac.kr 론 특히식생활양상은사회경제적환경요인의변화와밀접한관련성이있는것으로보고되었다 (Jelliffe 1966). 소득은사회경제적지표의대표적인것으로, 선행연구 (Moon & Kim 2004; Hwang 등 2009; Park & Cho 2011) 에따르면소득수준이영양상태및식품섭취현황, 경제활동, 건강상태및건강위험도, 유병률등에다양한영향을미치는요인임을알수있다. 일반적으로경제수준이높을수록사람들의영양상태가양호하고영양소섭취량이증가하는것으로보고된바 (Moon & Kim 2004; Choi & Moon 2008), 이는가계소득이높을수록다양한식품선택이가능하고, 질높고영양적으로우수한식품을구매할수있어영양상태와건강상태에영향을미친다고볼수있다 (Drewnowski & 463

2 464 소득수준에따른영양건강특성 Darmon 2005; Nord 등 2006). 우리나라는 2018년고령인구비율이 14% 이상, 2026년에는 20% 이상으로예상되어, 빠른속도로고령사회, 초고령사회로의진입이전망되고있으며 (Korea National Statistical Office 2010), 노년기이전인 50대부터만성질환의유병률이높아지므로 (Minsitry of Health & Welfare, Korea Centers for Control & Prevention 2010) 중년기부터의건강관리가중요하다. 아직구체적인현장적용단계는아니지만, 보건복지부에서 2030 건강투자전략 을발표하고그일환으로노년기건강투자지원사업실시계획을발표하였고 (Korea Health Indstry Development Institute 2009), 미국에서도 Healthy People 2020 에서베이비부머세대가노인인구로전입됨에따라 2030 년에는미국인구의 60% 가노인연령층이될것으로예상하여노인대상건강및질환관리에중점을두고있다. 이러한시대적흐름에비추어볼때, 노인대상의맞춤형영양지원및관리에대한관심이나필요성은점차증가될것으로예상된다. 또한노년기에있어고혈압, 관상동맥질환, 비만등의만성질환의치유과증상완화등은대부분이영양과관련이있는데 (Kang 등 2008), 이중에서도비만은지방이체내에과량축적되는것으로유전, 대사, 환경, 정신적, 사회경제적요인및잘못된식습관, 운동부족등과같은개인의행동요인이상호관련되어있으며 (Kook 등 1997), 고지혈증, 고혈압, 당뇨등다른만성질환과의관련성이매우높아 (Savage 등 2007) 적정체중유지를위한관리가필요하다. KNHANES Ⅳ-3 의조사결과소득수준별비만유병률은소득수준이 하 인경우 34.7%, 중하 인경우 39.6%, 중상 인경우 33.1%, 상 인경우 36.0% 로 (MOHW & KCDC 2010) 이제더이상비만이고소득층만의문제는아니다. 경제성장과더불어식품섭취가풍족해졌으나, 저소득층은낮은교육수준으로인한잘못된식품선택때문에, 중고소득층에서는과식이나폭식등의잘못된식습관이나서구형식생활패턴, 사무직이나전문직종사자들의운동량부족등을원인으로각기다른이유에서비만이문제시되고있다. 최근전세계적으로비만유병률이증가하고있는추세이며 (Drewnowski & Specter 2004; Woo 등 2008), 2009년국민건강 영양조사결과에따르면, 우리나라비만유병률은 (BMI 25) 1998년 25.8% 에서 2009년 31.9% 로지속적으로증가하고있고, 연령별비만유병률은 20대가 22.1%, 30대가 29.5%, 30대가 29.5%, 40대가 34.7%, 50대가 40.0%, 60대가 37.0%, 70대이상이 31.1% 로연령증가에따라비례적인증가추세를보이고, 특히 50대의비만유병률이가장높았다 (MOHW & KCDC 2010). 이는 2005년국민건강 영양조사에서도유사한결과를나타내 50대이상의건강관리가중요하다하겠다. 경제수준에따라식사패턴의차이를보인다고하였으나 (Choi & Moon 2008), 저소득층이나독거노인을대상으로진행된연구보고들 (Park & Son 2003; Hwang 등 2009; Yoon & Jang 2011) 이대부분이고, 사회경제적지표와영양상태전반에대한연구결과들은 (Park 등 2006; Choi & Moon 2008; Moon & Kong 2010) 주로 20세이상성인을대상으로시행되었거나영양상태파악에초점을둔경우가많아, 아직까지중장년층이나노인을대상으로소득수준에따른식생활차이와영양건강특성을파악한연구는부족하며, 일부대상증후군과의관련성을살펴본논문 (Park 등 2006; Moon & Kong 2010) 만이있을뿐, 비만과의관련성을살펴본국내연구는드문편이다. 따라서, 본연구에서는 50세이상의성인을대상으로소득수준에따른영양건강특성을파악해보고이를토대로문제점에대한해결방안을모색해보고자하였다. 특히, 비만이노년기의심혈관질환, 고지혈증, 당뇨및대사증후군, 동맥경화나암등의관련성에기초하여 (Zhang 등 2008; Guh 등 2009; Zhao 등 2011), 소득계층별로비만군과정상군의특성을비교해보고이를통해각소득계층의주된영양건강문제점을파악하여영양정책마련및영양교육의방향을설정하고, 대상에따른눈높이식접근및맞춤형영양관리를위한기반을마련하고자한다. 연구대상및방법 1. 연구대상 본연구는 2005년국민건강영양조사원자료 ( 전체대상자 34,152명 ; 남자 17,209명, 여자 16,943명 ) 중소득데이터가있고검진조사결과신장, 체중을이용한체질량지수 (Body Mass Index) 값의산출이가능한 50세이상성인을대상으로하였다. 보다정확한식이요인과의관련성파악을위해현재식사요법을실시한다고응답한경우는제외하여, 본연구에활용된최종대상자수는 952명 ( 정상군 504 명, 비만군 448명 ) 이었다. 2. 분석내용및방법 1) 대상자군분류기준 소득기준은 2005년보건복지부도시가구최저생계비 (Ministry of Health & Welfare 2006) 를기준으로하여 100% 미만을저소득군, 100~200% 를중소득군, 200% 이상을고소득군 3개군으로분류하여각각 319명, 222명,

3 안소현 손숙미 김혜경 명이분석대상으로선정되었다. 100% 미만으로경계를정할때에, 2인가구기준최저생계비인 668,540원을반올림하여 67만원미만을기준으로하였다. 비만군분류는각각의소득군을체질량지수 (Body Mass Index: BMI, 체중 (kg)/ 신장 (m) 5 ) 를이용한비만판정기준에따라 BMI 25이상을비만군으로하였고, BMI 18.5이상 23미만을정상군으로분류하였다 (Jeon 2005). BMI 18.5 미만의저체중대상자는분석에서제외하였으며, 소득군에따른비만군과정상군간영양상태를파악하고각소득군별로비만과관련된건강특성과식사성요인을규명하고자하였다. 2) 건강설문조사하루흡연개피와평소음주빈도 ( 회 / 월 ), 1회순수알코올섭취량 (g), 일상생활활동수준에대해원시데이터를이용하여분석하였다. 일상생활활동수준은거의누워있거나앉아서지내는경우 안정상태, 사무관리, 기술직종사자, 가사노동시간이적은주부나이와유사한직종의경우 가벼운활동, 가사작업량이많은주부나제조업, 가공업 판매업종사자, 교사등은 보통활동, 농업 어업 토목업 건축업종사나이와유사한내용의직종은 심한활동, 운동선수나목재운반또는농번기농업종사자등과유사한힘쓰는육체노동직종자는 격심한활동 으로분류하였다. 3) 검진조사 WHO의아시아-태평양지역성인의비만진단기준을참고하여 BMI 25이상, 대한비만학회기준으로남자 90 cm 이상, 여자 85 cm 이상의허리둘레를비만으로판정하였다. 고혈압은수축기혈압 (140 mmhg 이상 ), 이완기혈압 (90 mmhg 이상 ) 의각기준치를적용하였고, LDL-콜레스테롤은총콜레스테롤 -(HDL-콜레스테롤 + 중성지방 /5) 의계산식으로 (Friedwald 등 1972) 산출하였다. 4) 영양조사 2005년 KNHANES III 영양부문원시데이터를이용하여영양소섭취량과식품섭취빈도등을분석하였다. 영양소섭취량은 24시간회상법을이용하여조사된결과이며 (MOHW & KCDC 2007), 각영양소섭취량및영양섭취기준대비영양소섭취비율 (DRI%) 및 1000 kcal 당영양소섭취량, Na/K 비를군간비교분석하였다. 식품섭취빈도는 63 가지항목을개별분석하고, 11 가지대분류에따라합산하여식품군별식품섭취빈도를비교하였다. 식품섭취빈도결과는 1일 1회섭취를 1점으로하여 10 단계로구분하였다. 3. 자료처리및분석 자료는 SAS(Statistical Analysis System, version 9.2) package program 을이용하여통계처리및분석을실시하였다. chi-square test 를이용하여빈도와백분율을구하였고, 각각평균과표준편차를구한후 t-test 및분산분석, 사후검정을통해유의성검증을실시하였다. 대상자의소득수준과비만도에따른영향을보기위해이원분산분석을실시하였고각소득수준에따른정상군과비만군의비교를위해성별, 연령별보정을하였다. 이때 p < 0.05 미만인경우유의한것으로판정하였다. 결 1. 소득수준과비만여부에따른대상자특성 대상자들의일반적인특성을나타낸결과는 Table 1과같다. 전체대상자중저소득군은 319명, 중소득군은 222명, 고소득군은 411명이었으며, 각군의평균소득은 35만원, 95만원, 284만원이었고, 전체대상자의평균소득은 156만원이었으며, 연령은 68세, 64세, 58세로군간유의적인차이를보였다 (p < 0.001). 고소득군일수록평균연령이낮았으며 ( 저소득군 68세, 고소득군 58세 ), 남자의비율이유의하게높고 ( 남자비율저소득군 49.8%, 고소득군 86.4%), 고학력의비율이유의하게높았으며 (p < 0.001), 고소득군의평소활동량이더많은것으로파악되었다 (p < 0.001). 또한, 고소득군의하루흡연량이유의하게더많았고 ( 저소득군 12개피, 고소득군 18개피, p < 0.001), 고소득군의 1회알코올섭취량이저소득군에비해유의하게더높았다 ( 저소득군 36 g, 고소득군 47 g, p < 0.001). 전체대상자를정상군과비만군으로나누어비교하였을때, 비만군의평균소득이정상군에비해유의하게높았으며 ( 정상군 149만원, 비만군 162만원, p < 0.05), 연령과월음주빈도는비만군이정상군에비해유의하게낮았다 ( 연령 : 정상군 64세, 비만군 62세, 음주빈도 : 정상군 7.2회, 비만군 5.3회, p < 0.01). 각소득군내에서정상군과비만군사이의소득이나연령등의차이는없었으나, 저소득비만군에서여자가 56.6% 로정상군의여자 44.9% 보다유의하게높았다 (p < 0.05). 중고소득군에서는남자의비만율이높아중소득군에서는비만군의 73.5% 가, 고소득군에서는비만군의 84.9% 가남자였다. 음주빈도는고소득일수록증가하는경향만관찰되었는데, 각소득수준에서살펴보았을때에는중, 고소득군에서만비만군이유의하게음주빈도가더적게나타났다. 그러나 1 회알코올섭취량은소득이높을수록유의하게증가하며, 특 과

4 Table 1. General characteristics of subjects Total 1) (n = 952) Lower Income group Middle Higher (n = 504) group (n = 448) Lower- (n = 176) (n = 143) Middle- (n = 109) (n = 113) (n = 219) Higher- Income level/month (manwon) ± ± 0.9 a 94.6 ± 1.2 b ± 7.6 c ± 6.4 b ± 7.7 a 35.3 ± 1.2 2) 34.0 ± ± ± ± ± 11.7 Age (years) ± ± 0.5 c 63.6 ± 0.5 b ± 0.3 a ± 0.4 a ± 0.4 b 69.0 ± ± ± ± ± ± 30.5 Smoking & Drinking Current smoking (cigarettes/day) ± ± 0.8 b 15.6 ± 1.0 a ± 0.8 a ± ± ± ± ± ± ± ± 31.4 Frequency of usual drinking (times/month) ± ± 0.6 ba 55.5 ± 0.6 b ± 0.5 a ± 10.5 a ± 0.4 b 56.0 ± ± ± ± 0.6** ± ± 30.6** (n = 192) Pure alcohol intake (g/time) 3) ± ± 1.9 b 41.1 ± 1.8 b ± 1.3 a ± ± ± ± ± ± ± ± 32.3* Sex Male 681 (71.5) 4) 159 (49.8) 167 (75.2) 355 (86.4) 373 (74.0) 308 (68.8) 97 (55.1) 62 (43.4)* 84 (77.1) 83 (73.5) 192 (97.7) 163 (84.9) Female 271 (27.5) 160 (50.2) 55 (24.8) 56 (13.6) 131 (26.0) 140 (31.3) 79 (44.9) 81 (56.6)* 25 (22.9) 30 (26.6) 27 (12.3) 29 (15.1) Education level No school 139 (14.6) 111 (34.8) 19 (58.6) 9 (52.2) 77 (15.3) 62 (13.8) 64 (36.4) 47 (32.9)* 8 (57.3) 11 (59.7) 5 (52.3) 4 (52.1) Elementary school 286 (30.0) 125 (39.2) 83 (37.4) 78 (19.0) 156 (31.0) 130 (29.0) 67 (38.1) 58 (40.6)* 40 (36.7) 43 (38.1) 49 (22.4) 29 (15.1) Middle school 180 (18.9) 41 (12.9) 46 (20.7) 93 (22.6) 86 (17.1) 94 (21.0) 20 (11.4) 21 (14.7)* 25 (22.9) 21 (18.6) 41 (18.7) 52 (27.1) High school 242 (25.4) 34 (10.7) 52 (23.4) 156 (38.0) 132 (26.2) 110 (24.6) 21 (11.9) 13 (59.1)* 25 (22.8) 27 (23.9) 86 (39.3) 70 (36.5) University (College) 91 (59.6) 6 (51.9) 19 (58.6) 66 (16.1) 46 (59.1) 45 (10.0) 3 (51.7) 3 (52.1)* 10 (59.2) 9 (58.0) 33 (15.1) 33 (17.2) Over graduate 14 (51.5) 2 (50.6) 3 (51.4) 9 (52.2) 7 (51.4) 7 (51.6) 1 (50.6) 1 (50.7)* 1 (50.9) 2 (51.8) 5 (52.3) 4 (52.1) 466 소득수준에따른영양건강특성 The degree of usual activity 5) Stable status 39 (54.2) 22 (57.0) 8 (53.6) 9 (52.2) 18 (53.6) 21 (54.8) 12 (58.5) 10 (55.8)* 4 (53.7) 4 (53.6) 4 (51.9) 5 (52.7) Light 447 (47.8) 174 (55.2) 106 (48.2) 89 (41.4) 229 (46.1) 218 (49.7) 85 (60.0) 89 (51.5)* 51 (46.8) 55 (49.6) 89 (41.4) 78 (41.9) Moderate 278 (29.7) 66 (21.0) 58 (26.4) 81 (37.7) 144 (29.0) 134 (30.5) 31 (21.8) 35 (20.2)* 28 (25.7) 30 (27.0) 81 (37.7) 73 (39.3) Hard 162 (17.3) 52 (16.5) 46 (20.9) 64 (16.0) 100 (20.1) 62 (14.1) 14 (59.9) 38 (22.0)* 24 (22.0) 22 (19.8) 38 (17.7) 26 (14.0) Severe 10 (51.1) 1 (50.3) 2 (50.9) 7 (51.8) 6 (51.2) 4 (50.9) 0 (50.0) 0 (50.6)* 2 (51.8) 0 (50.0) 3 (51.4) 4 (52.2) 1) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: Mean values are significantly different between normal group and obesity group ( : p < 0.05, : p < 0.01, : p < 0.001) 2) Mean ± SE: Mean values are significantly different between normal and obesity in each group by t-test or χ 2 -test (*: p < 0.05, **: p < 0.01, ***: p < 0.001) 3) Pure alcohol intake (g/time) : a glass of Soju = 45 g, alcohol concentration in a glass of soju-20%, quantity of pure alcohol in a glass of Soju = = 9 g 4) N (%) 5) The degree of usual activity 1. Stable status : almost lying down or spending a sedentary life 2. Light : a white-collar worker, a office manager, a technical worker, a housewife do light household cores or a worker in a similar position 3. Moderate : a housewife doing heavy household chores 4. Hard : who works in farming, fishing, civil engineering, building industry or something like this 5. Severe : a very heavy blue-collar worker such as transporting wooden or an athlete and so on. Means without a common letter (a, b, c) differ significantly among groups.

5 Table 2. Anthropometric measurement and biochemical factors of subjects Total 1) (n = 952) Lower Income group Middle Higher (n = 504) group (n = 448) (n = 176) Lower- (n = 143) (n = 109) Middle- (n = 113) (n = 219) Higher- Anthropometric measurement Weight (kg) ± ± 0.6 c ± 0.7 b ± 0.5 a ± 0.3 a ± 0.4 b ± 0.4 2) ± 0.5*** ± ± 0.6*** ± ± 50.4*** Height (cm) ± ± 0.5 c ± 0.5 b ± 0.4 a ± ± ± ± ± ± ± ± 50.4 BMI (kg/m 2 ) 3) ± ± ± ± ± 0.1 b ± 0.1 a ± ± 0.1*** ± ± 0.2*** ± ± 50.1*** (n = 192) Waist (cm) ± ± 0.6 b ± 0.6 a ± 0.4 ba ± 0.3 b ± 0.3 a ± ± 0.6*** ± ± 0.6*** ± ± 50.4*** SBP (mmhg) ± ± 1.1 a ± 1.2 b ± 0.8 b ± 0.9 b ± 0.8 a ± ± ± ± ± ± 51.2*** DBP (mmhg) ± ± 0.6 b ± 0.7 ba ± 0.5 a ± 0.5 b ± 0.5 a ± ± 0.9** ± ± 0.9*** ± ± 50.7*** Biochemical factors ALT (IU/L) 4) ± ± 0.9 b ± 1.0 ba ± 1.3 a ± 1.1 b ± 0.8 a ± ± 51.2** ± ± 1.4* ± ± 51.9 AST (IU/L) 5) ± ± ± ± ± ± ± ± ± ± ± ± 51.5 BUN 6) ± ± ± ± ± ± ± ± 50.4* ± ± ± ± 50.4 Creatinine (mg/dl) ± ± ± ± ± ± ± ± ± ± ± ± 50.0 Total cholesterol (mg/dl) ± ± ± ± ± 1.6 b ± 1.6 a ± ± 53.0** ± ± 3.2** ± ± 52.6 HDL (mg/dl) 7) ± ± 0.7 a ± 0.6 b ± 0.5 ba ± 0.5 a ± 0.5 b ± ± 51.0***544.4 ± ± 0.9** ± ± 50.8*** LDL (mg/dl) 8) ± ± ± ± ± ± ± ± ± ± 3.0* ± ± 52.7 Total cholesterol/hdl 9) ± ± ± ± ± 0.1 b ± 0.1 a ± ± 50.1***554.2 ± ± 0.1*** ± ± 50.1*** Triglyceride (mg/dl) ± ± 7.0 b ± 7.2 b ± 7.2 a ± 4.4 b ± 7.3 a ± ± 10.2***125.9 ± ± 9.8** ± ± 10.4*** FBS (mg/dl) 10) ± ± ± ± ± 1.1 b ± 1.3 a ± ± 52.0** ± ± 2.5* ± ± 52.0 Hemoglobin (g/dl) ± ± 0.1 c ± 0.1 b ± 0.1 a ± 0.1 b ± 0.1 a ± ± 50.1** ± ± ± ± 50.1*** Hematocrit (%) ± ± 0.2 c ± 0.3 b ± 0.2 a ± 0.2 b ± 0.2 a ± ± 50.3* ± ± ± ± 50.3** 1) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: Mean values are significantly different between normal group and obesity group ( : p < 0.05, : p < 0.01, : p < 0.001) 2) Mean ± SE: Mean values adjusted by age and sex are significantly different between normal and obesity in each group by t-test or χ 2 -test (*: p < 0.05, **: p < 0.01, ***: p < 0.001) 3) BMI (kg/m 2 ) = weight (kg)/height (m 2 ), 4) ALT = Alanine aminotransferase (IU/L), GPT, 5) AST = Aspartate transminase, GOT (IU/L), 6) BUN = Blood urea nitrogen (mg/dl), 7) HDL = low density lipoprotein, 8) LDL (low density lipoprotein) = Total cholesterol-hdl-cholesterol-triglyceride/5, 9) Total cholesterol/hdl = Total cholesterol/ HDL-cholesterol ratio, 10) FBS = Fasting blood sugar (mg/dl) Means without a common letter (a, b, c) differ significantly among groups. 안소현 손숙미 김혜경 467

6 468 소득수준에따른영양건강특성 히고소득군에서는유의하게비만군의 1회알코올섭취량이정상군보다높게나타나는특성을나타냈다. 저소득군에서는비만군이정상군에비해 가벼운활동정도 의비율은낮고 심한활동정도 의비율은유의하게높았으나중고소득군에서는이와같은비만군, 정상군간유의적인차이가나타나지않았다. 2. 신체계측및생화학검사결과신체계측과생화학적검사결과는 Table 2와같다. 신체계측결과고소득군일수록키와체중이유의하게높음을알수있는데각소득군의평균체중과키는저소득군이 59.5 kg, cm, 중소득군이 64.0 kg, cm, 고소득군이 65.7 kg, cm였다. 그러나 BMI 계산결과는모두 24 수준으로소득수준에따른차이를보이지않았고, 허리둘레만저소득군에비해중 고소득군이약간높았다 (p < 0.05). 또한, 수축기혈압은저소득군에서더높은반면, 이완기혈압은고소득군에서유의하게더높았다. 전체대상자를정상군과비만군으로나누어비교하였을때, 체중과 BMI, 허리둘레, 수축기혈압및이완기혈압이두군간유의적인차이를보였다. 각소득군내에서정상군과비만군을살펴보면, 저소득군과중소득군에서는비만군의체중, BMI, 허리둘레및이완기혈압이유의하게높음을알수있고, 고소득군에서도이와유사한결과를나타냈는데, 차이점은다른소득군에서는유의적인차이를보이지않은수축기혈압에서도고소득군에서는비만군 mmhg, 정상군 mmhg 로크게차이가남을알수있다. 각소득군내에서의비만군과정상군비교에서는모두성별과연령을보정한결과를이용하였으며, 보정전결과와큰차이없이거의유사한경향을나타내었다 ( 각소득군내에서의정상군과비만군의비교결과는모두연령과성별에대해보정한결과이며, 이에대한보정전결과는표에제시하지않음, 표의각주참고 ). 생화학검사결과에서는고소득군의혈청 ALT, 중성지방및헤모글로빈, 헤마토크리트치가저, 중소득군에비해유의하게높았고, 각군내에서는공통적으로비만군의혈청 HDL- 콜레스테롤은낮고중성지방농도및총콜레스테롤 /HDL- 콜레스테롤비가유의하게높았다. 전체정상군과비만군을비교해보면, ALT, 총콜레스테롤, HDL- 콜레스테롤과총콜레스테롤 /HDL- 콜레스테롤비, 중성지방, 공복혈당, 헤모글로빈과헤마토크리트치에서두군간유의적인차이를보였다. 이중 HDL- 콜레스테롤수치를제외한모든항목에서비만군이정상군에비해유의적으로높게나타났다. 각소득군별로나누어보았을때정상군에비해차별적으로유의성 을보인항목은저소득비만군에서는혈청 ALT, BUN, 크레아티닌, 총콜레스테롤, 헤모글로빈, 헤마토크리트치가높았으며, 중소득비만군에서는혈청 ALT, 총콜레스테롤, LDL- 콜레스테롤, 공복혈당이정상군에비해높았으며, 고소득비만군에서는혈청헤모글로빈과헤마토크리트치가정상군에비해높게나타났다. 신체계측과생화학검사결과에따른대상자들의분포를 Table 3에제시하였다. 이상지질혈증및고혈압의유병률을보면고소득일수록수축기고혈압비율이낮고, 중성지방 200 mg/dl 이상의고중성지방혈증의비율이유의하게높았다. 또한전체비만군은허리둘레기준비만비율이 71.2%, 수축기고혈압비율이 30.4%, 이완기고혈압비율이 26.3%, 고중성지방혈증의비율이 25.8%, 저 HDL- 콜레스테롤혈증비율이 51.5% 로정상군에비해유의하게높았다. 각소득군내에서의정상군과비만군의비교를보면, 중소득군에서는이완기고혈압유병률이정상군 13.8% 에비해비만군이 30.1% 로큰차이를보였고, 고소득군에서는수축기고혈압유병률비율 ( 정상군 19.2%, 비만군 28.1%) 및이완기고혈압유병률비율 ( 정상군 17.4%. 비만군 30.2%), 저HDL-콜레스테롤혈증비율이 ( 정상군 28.1%, 비만군 53.5%) 비만군에서유의적인차이를보였다. 또한허리둘레는 BMI에의한비만판정결과와일치도가높아각소득군별비만군은허리둘레에의한비만비율이 70% 수준으로매우높았다. 3. 식사섭취량을통한영양상태비교영양소섭취량은 24시간회상법을토대로하여대상집단의소득수준과비만여부에따른영양소섭취량을비교하였고한국인영양섭취기준 (DRI) 대비섭취비율을계산하는한편, 식사의질을파악하기위하여 1000 kcal당영양소섭취량을계산하여비교하였다. 소득군별영양소섭취량을비교해보면저소득군은 kcal, 중소득군은 kcal, 고소득군은 kcal를섭취하고있었으며, 소득수준이증가함에따라열량을포함한모든영양소섭취량이유의하게높게나타났으며, 영양소섭취기준대비섭취비율을비교한결과에서도유사한결과가나타났다. 또한저소득군의영양결핍비율은 18.1% 인반면고소득군의영양결핍비율은 6.5% 로낮았고 (p < 0.001), 영양밀도를분석한결과에서도섬유소, 인, 나트륨, 카로틴, 알코올을제외한탄수화물, 단백질, 지방, 칼슘, 철, 칼륨, 비타민 A, 티아민, 리보플라빈, 나이아신, 비타민 C의섭취가고소득층에서모두유의하게높았다 (Table 4, Table 5, Table 6).

7 Table 3. Distribution of the subjects according to anthropometric measurement and biochemical factors of subjects Total (n = 952) Lower Income group Middle Higher group (n = 504) (n = 448) Lower- (n = 176) (n = 143) Middle- (n = 109) (n = 113) (n = 219) Higher- (n = 192) BMI (kg/m 2 ) (18.5~< 23) 504 (52.9) 176 (55.2) 1) 109 (49.1) 219 (53.3) ( 25) 448 (47.1) 143 (44.8) 113 (50.9) 192 (46.7) Waist (cm) (Male < 90, Female < 85) 578 (60.7) 198 (62.1) 126 (56.8) 254 (61.8) 449 (89.1) 2) 129 (28.8) 161 (91.5) 3) 537 (25.9)*** 96 (88.1) 30 (26.6)*** 192 (87.7) 562 (32.3)*** (Male 90, Female 85) 374 (39.3) 121 (37.9) 596 (43.2) 157 (38.2) 555 (10.1) 319 (71.2) 515 (58.5) 106 (74.1) 13 (11.9) 83 (73.5) 527 (12.3) 130 (67.7) SBP (mmhg) < (72.7) 214 (67.1) 163 (73.4) 315 (76.6) 380 (75.4) 312 (69.6) 119 (67.6) 595 (66.4) 84 (77.1) 79 (69.9) 177 (80.8) 138 (71.9)* (27.3) 105 (32.9) 559 (26.6) 596 (23.4) 124 (24.6) 136 (30.4) 557 (32.4) 548 (33.6) 25 (22.9) 34 (30.1) 542 (19.2) 554 (28.1) DBP (mmhg) < (79.2) 266 (83.4) 173 (77.9) 315 (76.6) 424 (84.1) 330 (73.7) 149 (84.7) 117 (81.8) 94 (86.2) 79 (69.9)** 181 (82.7) 134 (69.8)** (20.8) 553 (16.6) 549 (22.1) 596 (23.4) 580 (15.8) 118 (26.3) 527 (15.3) 526 (18.2) 15 (13.8) 34 (30.1) 538 (17.4) 558 (30.2) Total cholesterol (mg/dl) < (57.4) 522 (57.3) 514 (56.6) 531 (7.9) 531 (56.5) 536 (58.4) 559 (55.5) 513 (59.5) 54 (53.9) 10 (9.2) 518 (58.6) 513 (57.0) 200 ~ < (28.5) 598 (32.5) 550 (23.5) 111 (28.1) 136 (28.4) 123 (28.5) 549 (29.7) 549 (35.8) 24 (23.1) 26 (23.9) 563 (30.0) 548 (26.0) (64.2) 182 (60.3) 149 (70.0) 253 (64.1) 312 (65.1) 272 (63.1) 107 (64.9) 575 (54.7) 76 (73.1) 73 (67.0) 129 (61.4) 124 (67.0) Triglyceride (mg.dl) < (64.7) 196 (64.9) 149 (70.0) 244 (61.8) 349 (72.9) 240 (55.7) 118 (71.5) 578 (56.9)*** 82 (78.9) 67 (61.5)* 149 (71.0) 595 (51.4)*** 150 ~ < (16.4) 559 (19.5) 529 (13.6) 561 (15.4) 569 (14.4) 580 (18.6) 533 (20.0) 526 (19.0) 10 (9.6) 19 (17.4) 526 (12.4) 535 (18.9) (18.9) 547 (15.6) 535 (16.4) 590 (22.8) 561 (12.7) 111 (25.8) 514 (58.5) 533 (24.1) 12 (11.5) 23 (21.1) 535 (16.7) 555 (29.7) HDL cholesterol (mg/dl) < (40.8) 122 (40.5) 591 (42.7) 158 (40.0) 149 (31.2) 222 (51.5) 557 (34.8) 565 (47.5) 33 (31.7) 58 (53.2) 559 (28.1) 599 (53.5)*** 40 ~ < (51.1) 143 (47.5) 111 (52.1) 210 (53.2) 278 (58.2) 186 (43.2) 581 (49.4) 562 (45.3) 65 (62.5) 46 (42.2) 132 (62.9) 578 (42.2) (58.1) 536 (12.0) 511 (55.2) 527 (56.8) 551 (10.7) 523 (55.3) 526 (15.9) 510 (57.3) 56 (55.8) 55 (54.6) 519 (59.1) 558 (54.3) 1) N (%): by χ 2 -test among the groups ( : p < 0.05, : p < 0.01, : p < 0.001) 2) N (%): by χ 2 -test between normal group and obesity group ( : p < 0.05, : p < 0.01, : p < 0.001) 3) N (%): by χ 2 -test between normal and obesity in each group (*: p < 0.05, **: p < 0.01, ***: p < 0.001) 안소현 손숙미 김혜경 469

8 Table 4. Nutrient intakes of subjects Total 1) (n=952) Lower Income group Middle Higher (n = 504) group (n = 448) (n = 176) Lower- (n = 143) (n = 109) Middle- (n = 113) (n = 219) Higher- Water (200 ml) ± ± a1) ± b ± a ± ± ± ) ± ± ± ± ± Energy (kcal) ± ± c ± b ± a ± ± ± ± 551.8** ± ± ± ± Carbohydrate (g) ± ± b ± a ± a ± ± ± ± ± ± ± ± Protein (g) ± ± c ± b ± a ± ± ± ± 553.1** ± ± ± ± Fat (g) ± ± c ± b ± a ± ± ± 551.6* ± 551.8** ± ± ± ± Fiber (g) ± ± c ± b ± a ± ± ± ± ± ± ± ± Calcium (mg) ± ± b ± b ± a ± ± ± ± ± ± ± ± Phosphorus (mg) ± ± c ± b ± a ± ± ± ± 550.2* ± ± ± ± Iron (mg) ± ± b ± b ± a ± ± ± ± ± ± * ± ± Na (mg) ± ± b ± b ± a ± ± ± ± ± ± ± ± K (mg) ± ± c ± b ± a ± ± ± ± 106.7* ± ± ± ± Na/K ± ± ± ± ± ± ± ± ± ± ± ± Vitamin A (R.E) ± ± b ± b ± a ± ± ± ± ± ± ± ± Carotene (µg) ± ± b ± b ± a ± ± ± ± ± ± ± ± Thiamin (mg) ± ± c ± b ± a ± ± ± ± 550.1** ± ± ± ± Riboflavin (mg) ± ± c ± b ± a ± ± ± ± 550.1* ± ± ± ± Niacin (mg) ± ± c ± b ± a ± ± ± ± 550.8* ± ± ± ± Vitamin C (mg) ± ± c ± b ± a ± ± ± ± ± ± ± ± Alcohol (g) ± ± b ± b ± a ± ± ± ± ± ± 552.1* ± ± ) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: There were no significance between normal group and obesity group. 2) Mean ± SE: Mean values adjusted by age and sex are significantly different between normal and obesity in each group by t-test or χ 2 -test (*: p < 0.05, **: p < 0.01, ***: p < 0.001) Means without a common letter (a, b, c) differ significantly among groups. (n = 192) 470 소득수준에따른영양건강특성

9 Table 5. Nutrient intakes per 1000kcal of subjects Total 1) (n = 952) Lower Income group Middle Higher (n = 504) group (n = 448) (n = 176) Lower- (n = 143) (n = 109) Middle- (n = 113) (n = 219) Higher- Carbohydrate (g) ± ± c1) ± b ± a ± ± ± ) ± ± ± ± ± Protein (g) ± ± b ± b ± a ± ± ± ± ± ± ± ± Fat (g) ± ± c ± b ± a ± ± ± ± ± ± ± ± Fiber (g) ± ± ± ± ± ± ± ± ± ± ± ± Calcium (mg) ± ± ba ± b ± a ± ± ± ± ± ± ± ± Phosphorus (mg) ± ± ± ± ± ± ± ± ± ± ± ± Iron (mg) ± ± ba ± b ± a ± ± ± ± ± ± ± ± Na (mg) ± ± ± ± ± ± ± ± ± ± ± ± K (mg) ± ± b ± b ± a ± ± ± ± ± ± ± ± Vitamin A (R.E) ± ± b ± b ± a ± ± ± ± ± ± ± ± Carotene (µg) ± ± ± ± ± ± ± ± ± ± ± ± Thiamin (mg) ± ± b ± a ± a ± ± ± ± ± ± ± ± Riboflavin (mg) ± ± c ± b ± a ± ± ± ± ± ± ± ± Niacin (mg) ± ± c ± b ± a ± ± ± ± ± ± ± ± Vitamin C (mg) ± ± b ± a ± a ± ± ± ± ± ± ± ± Alcohol (g) ± ± ± ± ± ± ± ± ± ± 221.1* ± ± ) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: There were no significance between normal group and obesity group. 2) Mean ± SE: Mean values adjusted by age and sex are significantly different between normal and obesity in each group by t-test or χ 2 -test (*: p<0.05, **: p < 0.01, ***: p < 0.001) Means without a common letter (a, b, c) differ significantly among groups. (n = 192) 안소현 손숙미 김혜경 471

10 Table 6. Proportion of nutrients intake of subjects Total 1) (n = 952) Lower Income group Middle Higher (n = 504) group (n = 448) (n = 176) Lower- (n = 143) (n = 109) Middle- (n = 113) (n = 219) Higher- (n = 192) Proportion of caloric nutrients intake Protein ± ± 60.3 b1) ± 60.3 b ± 60.2 a ± ± ± ) ± ± ± ± ± 60.4 Fat ± ± 60.4 c ± 60.6 b ± 60.5 a ± ± ± ± ± ± ± ± 60.7 Carbohydrate ± ± 60.6 a ± 60.7 b ± 60.6 a ± ± ± ± ± ± ± ± 60.8 CPF ratio 71:15:14 74: 14: 12 71: 15: 14 67: 16: 17 71:15:14 70:15:15 75: 14: 11 73: 14: 13 71: 14: 15 72: 15: 14 68: 16: 16 67: 16: 17 DRI% Energy ± ± 61.9 b ± 62.4 b ± 61.9 a ± ± ± ± 62.8**699.9 ± ± ± ± 62.6 Protein ± ± 64.3 c ± 65.2 b ± 64.3 a ± ± ± ± 66.4**150.4 ± ± ± ± 66.2 Calcium ± ± 63.6 b ± 63.4 b ± 63.9 a ± ± ± ± ± ± ± ± 65.8 Phosphorus ± ± 64.9 c ± 65.2 b ± 64.5 a ± ± ± ± 67.2* ± ± ± ± 66.6 Iron ± ± 67.2 b ± 67.3 b ± 67.5 a ± ± ± ± ± ± 10.5* ± ± 11.1 Sodium ± ± 13.2 b ± 16.9 b ± 18.6 a ± ± ± ± ± ± ± ± 27.3 Potassium ± ± 61.5 c ± 62.1 b ± 61.7 a ± ± ± ± 62.3* ± ± ± ± 62.5 Vitamin A ± ± 68.2 b ± 67.1 b ± 69.4 a ± ± ± ± ± ± ± ± 13.8 Thiamin ± ± 62.6 c ± 63.7 b ± 63.5 a ± ± ± ± 63.9**695.5 ± ± ± ± 65.1 Riboflavin ± ± 63.1 c ± 63.0 b ± 62.5 a ± ± ± ± 64.7* ± ± ± ± 63.7 Niacin ± ± 63.4 c ± 63.9 b ± 63.6 a ± ± ± ± 65.1* ± ± ± ± 65.3 Vitamin C ± ± 63.8 c ± 65.7 b ± 64.1 a ± ± ± ± ± ± ± ± 66.2 Level of nutrients intake Lack of some nutrient intake 4) 103 (12.3) 652 (18.1) 3) 628 (14.5) 623 (66.5) 654 (11.9) 649 (12.8) 628 (17.5) 624 (18.8) 13 (12.9) 15 (16.3) 613 (66.7) 610 (66.2) Overintake of energy/fat 5) 627 (63.2) 666 (62.1) 666 (63.1) 615 (64.2) 613 (62.9) 614 (65.7) 662 (61.3) 664 (63.1) 64 (64.0) 62 (62.2) 667 (63.6) 668 (64.9) 706 (84.5) 230 (79.9) 159 (82.4) 317 (89.3) 387 (85.3) 319 (83.5) 130 (81.3) 100 (78.1) 84 (83.2) 75 (81.5) 173 (89.6) 144 (88.9) 1) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: There were no significance between normal group and obesity group. 2) Mean ± SE: Mean values adjusted by age and sex are significantly different between normal and obesity in each group by t-test or x 2 -test (*: p < 0.05, **: p < 0.01, ***: p < 0.001) 3) N (%): : p < 0.05, : p < 0.01, : p < 0.001, by χ 2 -test 4) The subjects consuming below 75% EER (estimated energy requirement) and below EAR (estimated average requirement) in Ca, Fe, Vit A, riboflavin. 5) The subjects consuming over 125% EER and beyond optimal proportion of fat to energy. Means without a common letter (a, b, c) differ significantly among groups. 472 소득수준에따른영양건강특성

11 Table 7. Food consumption frequency of subjects Total (n = 952) Lower Income group Middle Higher group (N = 504) (N = 448) Lower- (n = 176) (n = 143) Middle- (n = 109) (n = 113) Higher- (n = 219) (n = 192) Barley 1.5 ± ± 0.1 b 1) 1.5 ± 0.1 ba 1.6 ± 0.1 a 1.4 ± 0.1 b 1.6 ± 0.1 a 1.1 ± ± 0.1** 2) 1.4 ± ± ± ± 0.1 Ramyeon 0.1 ± ± 0.0 b 0.1 ± 0.0 ba 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± ± ± 0.0 Cereals 4.8 ± ± 0.1 b 4.8 ± 0.1 ba 5.0 ± 0.1 a 4.7 ± ± ± ± 0.1** 4.7 ± ± ± ± 0.1 Soybean curd 0.3 ± ± 0.0 b 0.3 ± 0.0 b 0.4 ± 0.0 a 0.3 ± ± ± ± ± ± ± ± 0.0 Legumes 1.0 ± ± 0.1 b 1.0 ± 0.1 ba 1.1 ± 0.1 a 1.0 ± ± ± ± ± ± ± ± 0.1 Soymilk 0.1 ± ± 0.0 a 0.1 ± 0.0 a 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± ± ± 0.0 Potato 0.2 ± ± 0.0 b 0.1 ± 0.0 b 0.2 ± 0.0 a 0.1 ± 0.0 b 0.2 ± 0.0 a 0.1 ± ± 0.0** 0.1 ± ± ± ± 0.0 Sweet potato 0.1 ± ± 0.0 a 0.1 ± 0.0 a 0.1 ± 0.0 a 0.1 ± ± ± ± 0.0** 0.1 ± ± 0.0* 0.1 ± ± 0.0 Legumes Potatoes 1.7 ± ± 0.1 b 1.6 ± 0.1 b 1.9 ± 0.1 a 1.6 ± ± ± ± 0.1* 1.6 ± ± ± ± 0.1 Pork 0.1 ± ± 0.0 b 0.1 ± 0.0 b 0.2 ± 0.0 a 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± 0.0 Meats & Eggs 0.5 ± ± 0.0 b 0.5 ± 0.0 b 0.7 ± 0.0 a 0.5 ± ± ± ± ± ± ± ± 0.0 Small fish fermented with salt 0.1 ± ± 0.0 a 0.2 ± 0.0 a 0.2 ± 0.0 a 0.1 ± ± ± ± ± ± ± ± 0.0 Fishes shellfishes 1.1 ± ± 0.1 b 1.0 ± 0.1 b 1.5 ± 0.1 a 1.1 ± ± ± ± ± ± ± ± 0.1 Korean cabbage 2.5 ± ± ± ± ± ± ± ± ± ± ± ± 0.1* Radish leaves 0.2 ± ± ± ± ± ± ± ± ± ± 0.0* 0.2 ± ± 0.0* Mushroom 0.2 ± ± 0.0 c 0.2 ± 0.0 b 0.3 ± 0.0 a 0.2 ± ± ± ± ± ± ± ± 0.1 Vegetables 5.7 ± ± 0.2 b 5.4 ± 0.2 b 6.2 ± 0.1 a 5.7 ± ± ± ± ± ± ± ± 0.2 Sea mustard 0.2 ± ± 0.0 b 0.1 ± 0.0 b 0.2 ± 0.0 a 0.2 ± ± ± ± ± ± ± ± 0.0 Seaweeds 0.8 ± ± 0.0 b 0.7 ± 0.1 b 1.0 ± 0.0 a 0.7 ± ± ± ± ± ± ± ± 0.1 Citrus fruit 0.2 ± ± 0.0 b 0.2 ± 0.0 b 0.3 ± 0.0 a 0.2 ± 0.0 b 0.2 ± 0.0 a 0.1 ± ± 0.0** 0.2 ± ± ± ± 0.0 Persimmon 0.1 ± ± ± ± ± ± ± ± ± ± 0.0* 0.1 ± ± 0.0 Pear 0.1 ± ± 0.0 b 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± 0.0* Melon, yellow 0.1 ± ± 0.0 b 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± 0.0 Strawberry 0.1 ± ± 0.0 b 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± 0.0 b 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± 0.0** Peach 0.1 ± ± 0.0 b 0.1 ± 0.0 b 0.1 ± 0.0 a 0.10 ± 0.0 a 0.1 ± 0.0 a 0.1 ± ± ± ± ± ± 0.0 Fruit 1.4 ± ± 0.1 b 1.2 ± 0.1 b 1.7 ± 0.1 a 1.2 ± 0.1 b 1.5 ± 0.1 a 1.0 ± ± ± ± ± ± 0.1* Vegetables+Seaweeds+Fruits 7.8 ± ± 0.2 b 7.3 ± 0.3 b 8.8 ± 0.2 a 7.6 ± ± ± ± ± ± ± ± 0.3 Milk Dairy products 0.7 ± ± 0.0 b 0.6 ± 0.1 b 0.8 ± 0.1 a 0.6 ± ± ± ± ± ± ± ± 0.1 Green tea 0.4 ± ± 0.0 b 0.5 ± 0.1 a 0.6 ± 0.0 a 0.4 ± 0.0 b 0.5 ± 0.0 a 0.2 ± ± 0.0* 0.4 ± ± ± ± 0.1** Beverages 1.6 ± ± 0.1 b 1.7 ± 0.1 a 2.0 ± 0.1 a 1.5 ± 0.1 b 1.7 ± 0.1 a 1.0 ± ± ± ± ± ± 0.1 Soju 0.2 ± ± ± ± ± 0.0 b 0.2 ± 0.0 a 0.2 ± ± ± ± 0.0* 0.3 ± ± 0.0* Makkoli 0.1 ± ± ± ± ± ± ± ± ± ± ± ± 0.0 Alcohol beverage 0.3 ± ± 0.0 b 0.3 ± 0.0 b 0.4 ± 0.0 a+ 0.4 ± 0.0 b 0.3 ± 0.0 a 0.3 ± ± ± ± ± ± 0.1 1) By two-way analysis, Mean ± SE: Mean values are significantly different among the groups by DUNCAN's multiple range test ( : p < 0.05, : p < 0.01, : p < 0.001) Mean ± SE: Mean values are significantly different between normal group and obesity group ( : p < 0.05, : p < 0.01, : p < 0.001) 2) Mean ± SE: Mean values adjusted by age and sex are significantly different between normal and obesity in each group by t-test or χ 2 -test (*: p < 0.05, **: p < 0.01, ***: p < 0.001) Score: 3 times/day = 3.0, 2 times/day = 2.0, 1 time/day = 1.0, 4-6 times/week = 0.71, 2-3 times/week = 0.36, 1 time/week = 0.14, 2-3 times/month = 0.09, 1 time/month = 0.04, 6-11 times/year = 0.02, seldom = 0 Means without a common letter (a, b, c) differ significantly among groups. 안소현 손숙미 김혜경 473

12 474 소득수준에따른영양건강특성 전체대상자의비만군과정상군의비교에서는영양소섭취량, 1000 kcal당영양소섭취량, % DRI 결과에서모두유의적인차이를보인항목이없었다. 각소득군내에서비만군과정상군의영양소섭취를비교한결과, 저소득비만군은단백질, 지방, 인, 칼륨, 티아민, 리보플라빈과나이아신섭취량이정상군에비해유의적으로높았으며, 이는 %DRI 를비교한결과에서도동일하였다. 중소득비만군은철과알코올섭취량에서유의적인차이를나타냈고 %DRI 결과에서는철에대해서만유의한결과를보였다. 고소득에서는비만군과정상군비교에서영양소섭취량이나 %DRI 결과에서유의적인차이를보인영양소가없었다. 4. 식품섭취빈도분석을통한식사요인분석 63 종의식품에대한섭취빈도조사결과를간략히하여 Table 7에제시하였다. 각식품종은각각의항목에대해비교하는한편곡류, 두류 서류, 고기 계란류, 생선 조개류, 채소류, 해조류, 과일류, 섬유소 ( 채소류 + 해조류 + 과일류 ), 우유및유제품, 음료, 주류의 11 개군으로묶어서비교분석하였다 (Table 7). 전체대상자는하루에평균곡류를 4.8회, 두류 서류를 1.7회, 고기 계란류를 0.5회, 생선 조개류를 1.1회, 채소류를 5.7회, 해조류를 0.8회, 과일류를 1.4회, 유제품을 0.7 회섭취하고있는것으로조사되었으며, 고소득일수록잡곡, 라면류, 곡류, 두부, 콩류, 감자, 두류 서류, 과일류등대부분의식품항목에대한섭취빈도가유의하게높았다. 전체대상자의정상군과비만군의비교결과에서는, 비만군의잡곡, 감자, 과일, 녹차등의섭취빈도가정상군에비해유의하게높았다. 각각의소득수준내에서정상군과비만군을비교한결과, 저소득비만군은잡곡, 곡류, 감자, 고구마, 두류 서류, 감귤류및녹차섭취빈도가유의하게높았다. 중소득비만군은고구마와무청, 소주섭취빈도는낮은반면감섭취빈도가높게나타났으며, 고소득비만군은배추와소주섭취빈도는낮은반면무청, 배, 딸기, 과일류및녹차섭취빈도가유의하게높게나타나소득군간다른특성을보였다. 고 본연구는국민건강영양조사의데이터를이용하여만성질병이증가하는 50대이상의성인을대상으로각소득수준별건강상태및영양섭취실태등을살펴봄으로써각소득군별영양건강위험인자를규명하고비만유무에따른차이를비교하였다. 식사요법을시행하는경우는제외하고월가계소득과검진조사결과값이있는대상자 952명을분석에이용 찰 하였다. 본연구의결과에서보면, 소득수준이높을수록학력이더높고평소활동량도더높은것으로나타났는데, 이는고소득군이저소득군에비해 10세가량연령이낮고남자의비율도 2배가까이차이가나기때문인것으로볼수있고, 이로인해고소득일수록키와체중이유의하게높은것으로보인다. 그러나성별과연령에대해보정한각소득수준별결과에서도여전히고소득군에서키와체중이큰것으로보아성별과연령의차이를배제하고도고소득일수록키와체중이높은것으로볼수있으며, 각소득수준에서키와체중의유의적인차이에도불구하고 BMI가 24수준으로비슷하게나타나고소득일수록체격조건이더좋은것으로판단된다. 고소득일수록수축기혈압이낮고이완기혈압이높은경향을보이는것역시연령증가에따라수축이혈압은높아지고이완기혈압은낮아지는연령의영향을받았을것으로보인다. 전체적으로보았을때대상자의 47.1% 가 BMI 기준에따른비만이고, 허리둘레를기준으로한비만의비율도 40% 수준으로비만유병률이매우높은데, 이는 Lee 등 (2006) 의연구결과에서 50대이상 BMI가 25 이상인사람의비율이 39.1% 라고한것에비해높은수준이다. 수축기고혈압유병률이 23~33%, 이완기고혈압비율이 17~23%, 고중성지방혈증의비율이 15~23% 로 20% 수준인데반하여, 콜레스테롤농도가 240 mg/dl 이상인고콜레스테롤혈증의유병률은 60~70% 수준으로소득수준에따른유의적인차이를보이지않으나매우심각한수준임을알수있다. 또한, 이와동시에좋은콜레스테롤로알려진 HDL- 콜레스테롤이 40 mg/dl 미만인비율은소득수준과상관없이 40% 수준으로 50세이상성인의이상지질혈증위험이매우높음을시사하였다. 특히소득수준과무관하게총콜레스테롤수준이높고고밀도콜레스테롤이낮아이에대한집중적인영양관리및교육이공통적으로필요하다. 본연구결과에따르면비만과고중성지방혈증의강한연관성을시사하였는데, 최근 1998년부터 2007년까지국민건강영양조사의자료를이용하여체질량지수와유의한상관성을갖는질환들의이환율을살펴본연구결과에따르면체질량지수는고혈압, 당뇨병, 고콜레스테롤혈증이환율과유의한상관성을나타내는것으로보고되었고, BMI 23.0~24.5 사이가이환율이유의하게증가하는변별점인것으로추정하였다 (Park 2011). 본연구의전체비만군은저, 중, 고소득군모두 BMI 27 수준이므로대사증후군의위험이증가된상태라할수있고, 혈중총콜레스테롤및중성지방, 공복혈당수치등이유의적으로정상군에비해높을뿐만아니라, 허리둘레기준비만율이 71.2%, 수축기고혈압비율이

13 안소현 손숙미 김혜경 %, 이완기고혈압비율이 26.3%, 혈중농도 200mg/ dl 이상의고중성지방혈증의비율이 25.8% 로질병위험도가매우증가된상태라고할수있다. 각소득수준에따라차이를보인부분은, 고소득군에서연령이더낮음에도불구하고오히려혈중중성지방농도가저소득군과매우큰차이를보였는데 ( 저소득군 mg/dl, 고소득군 mg/dl), 전체적으로고소득군의영양소섭취량및영양소섭취비율이높은것을감안하면열량과잉에의한것으로의심된다. 한편, 각소득수준에서비만군과정상군의비교를한결과에서는공통적으로비만군의혈청총콜레스테롤치가높고 HDL- 콜레스테롤치가낮으며, 총콜레스테롤 /HDL- 콜레스테롤비가높았다. 소득수준에따른성인여성의심혈관질환건강에대한연구에서저소득층여성의대사증후군위험인자 ( 혈압 130/85 mmmhg, 고밀도지단백 < 50 mg/ dl, 중성지방 150 mg/dl, 공복혈당 100 mg/dl, 허리둘레 85 cm) 유병률이 37~47% 수준으로비저소득층여성의 17~30% 수준인것에비해유의한차이를보인것으로보고하였고특히저소득층에서는고중성지방유병률이 (47.6%), 비저소득층에서는공복혈당 100 mg/dl 이상의유병률이 (47.8%) 높게나타났다 (Park 등 2010). 본연구의저, 중소득군에서는비만군의공복혈당이유의하게더높았고, 중소득군에서는비만군의 LDL-콜레스테롤이유의하게더높았으며, 고소득군에서는비만군의수축기혈압과 HDL-콜레스테롤분포가정상군에비해유의적인차이를보여, 각소득수준에따라건강관리에주요목표를달리하는것이필요하겠다. 우리나라노인의영양상태를살펴보면, 연구방법의차이가있기는하나대부분영양섭취량이영양권장량에미치지못하는경우가많다 (Kwon 등 2002; Kim & Kwon 2004; Yang & Kim 2005; Choi 등 2007). 본연구결과에서는저, 중, 고소득군의에너지섭취량이권장량대비 90% 이상으로심한영양불량수준은아닌것으로보이나, 저소득군에서는칼슘, 칼륨, 티아민, 리보플라빈, 비타민 C의섭취비율이낮은편이고, 중소득군에서도칼슘, 칼륨, 리보플라빈의평균섭취비율이부족한수준이며, 고소득군에서도칼륨의섭취비율이 70% 로낮은편이었다. 전체영양소결핍비율이저소득군에서 18.1% 로고소득군보다낮아, 독거노인을대상으로한연구 (Park & Son 2003) 에서영양소섭취부족비율이 30% 대인것으로보고한결과에비해양호하나, 여전히영양관리필요성을시사하였다. 더욱이비만이라하여도저, 중소득군에서는 DRI 대비칼슘, 인, 리보플라빈, 비타민 C의섭취비율이여전히낮고, 고소득군에서칼륨의 섭취비율이낮아이에대한영양중재가필요할것으로생각된다. 특히칼슘과칼륨은소득수준이나비만에관계없이적절한섭취를위한지도가필요함을알수있다. 이는우리나라성인대상연구 (Lee 등 2006) 에서비만인이열량섭취량이높음에도칼슘, 리보플라빈등이권장량에못미친다고한결과와는일치하나, 비만군에서영양밀도가낮은경향을보였다고보고한결과와는일치하지않는다 (Lee 등 2006). 본연구에서는 1000 kcal당영양소섭취량을비교한결과에서도대체로비만군이정상군에비해영양밀도가높은경향을나타냈다. 선행연구에따르면, 소득수준이증가함에따라영양소섭취량이유의하게증가하고단백질과지방섭취비율이증가하는등의특징을보고하였고 (Yang & Kim 2005), 소득수준에따른우리나라성인의식품및영양소섭취수준을비교한다른연구에서도소득수준이증가함에따라모든영양소의섭취량이유의적으로증가되고에너지섭취량에대한지방과단백질기여율은증가되는반면탄수화물에너지비는감소되는것으로보고하였다 (Kim 등 2005). 이는본연구의소득에따른비교결과에서소득이증가함에따라모든영양소섭취량및 DRI 기준대비영양소섭취비율이유의적으로증가하고, 탄수화물 : 단백질 : 지방의비율이고소득일수록탄수화물에너지비는감소하고단백질과지방의에너지비는증가한결과와일치한다. 또한고소득군의 1000 kcal 당영양소섭취량이저소득군에비해대부분높은것으로나타났는데, 이는저소득층에서는상대적으로식재료비가저렴한탄수화물급원식품을많이이용하고중고소득일수록육류, 생선등단백질급원식품의소비가증가함에따라이와함께지방의섭취또한증가하기때문으로사료된다. 비만은개인적요인과더불어그릇된식사와생활습관을유발하는사회환경적요인간의상호적작용으로발생한다 (Yoon & Jang 2011). 따라서소득은개인의교육수준이나식사의질, 운동량및생활패턴등다양한측면에서개인의환경에영향을미칠수있고, 이에따라소득계층에따라각기다른비만의위험요인이존재할것으로생각된다. 경제수준에따른비만발생율을비교한선행연구에서소득수준이높은백인여성에서비만도가낮은경향을보였으나유색인종여성에서는관련성이없었다고보고한바있고 (Dietz 2000), 우리나라에서는남성의비만율은소득수준과무관한반면여성은소득수준이낮을수록비만율이증가한다고도보고하였다 (Park & Yoon 2005). 흔히비만은부자병이라고하여돈많은사람들이나잘먹는사람들만의문제라고생각하기쉽고산업사회에서소득수준의향상, 생활양식

14 476 소득수준에따른영양건강특성 의변화및식생활풍요로증가한다는견해가지배적이었으나 (Woo 등 2008), 외국의연구에서비만이경제력과교육수준이낮은집단, 주거환경이열악한집단에서도증가하고있음을보고하였다 (Drewnowski & Specter 2004). 본연구연구결과에서보면각소득수준에따라영양소섭취량등식생활패턴에서는차이를보임에도불구하고비만율은저소득층 44.83%, 중소득층 50.90%, 고소득층 46.72% 로크게차이가나지않는다. 이는단지질좋은식사나열량과잉, 지방과잉등이비만의원인이되는것이아니라, 다른여러가지요인에의해서도비만을유래할수있음을의미한다하겠다. 이는저소득층을대상으로한많은연구 (Gyeonggi Research Institute 2008; Hwang 등 2009; Yoon & Jang 2011) 를통해서도뒷받침되고있다. 저소득층의비만관련요인으로는비만여성에서칼슘의낮은영양소적정섭취비율, 흰쌀류의높은섭취빈도, 커피의섭취가보고된바있고, 저소득층비만남성에서는비타민 A, 비타민 C를제외한모든영양소에서섭취비율이높게보고되었다 (Park & Yoon 2005). 본연구에서는저소득층비만군에서잡곡과곡류, 감자, 고구마, 두류 서류의섭취빈도가높게나타나저소득층의비만원인은탄수화물에너지비가높은식사를하고그급원식품으로상대적으로식사의질이낮은감자나고구마등의잦은섭취에기인한것일가능성을제시하였다. 선행연구에서도 (Choi & Moon 2008) 이와유사하게경제수준에따라식사패턴을비교하였을때시골이나경제수준이낮을수록밥과김치위주의기본식사패턴의비율이높은반면, 대도시일수록밥 + 국 + 김치나밥 + 찌개 + 김치보다는김치외에구이나볶음등다른반찬이추가된식사패턴의비율이높게나타났다고보고하였다. 물론본연구는단면연구로원인과결과를명확히하기에는제한점이있고, 비만이후이러한식사를한것인지이러한식사패턴으로인해비만을유발하게된것인지에대해확언을할수는없으나이에대한추후연구방향성을제시할수는있을것이다. 중소득층의비만군은정상군에비해낮은철섭취량과높은배, 과일섭취빈도를나타내는것으로분석되었는데, 국민건강영양조사에나타난영양소별주요급원식품에대한자료에서철의주요급원식품이쌀, 김, 무청등식물성식품의기여도가높은것을감안하면 (Kim 등 2005), 비만군이정상군에비해육류 어류등동물성식품뿐만아니라식물성식품섭취빈도가낮은경향에기인할수도있음을고려해볼만하다. 또한중고소득군의경우, 어느정도교육수준이높아본인이비만이라는것을인지하고있어실제식사섭취량보다적게보고하였을가능성도생각해볼수있다. 중소득 층만을대상으로한연구는매우드문편이나, 일반적인성인이나노인을대상으로한연구결과를보면, 비만군의특징으로영양과잉뿐만아니라일부비타민과무기질의섭취부족을보고하였고, 동물성식품섭취증가에크게기여한것은육류섭취량이라하였다 (Lee 등 2006). 고소득층에서의비만관련요인으로는고소득으로갈수록알코올섭취량이늘어났는데, 비만군에서특히더폭음경향이관찰되었고, 중고소득층비만군에서공통적으로배추김치의섭취빈도가낮고과일류의섭취빈도가높은경향을나타내어과일이나알코올섭취가비만과관련이있을것으로생각된다. 이는국민건강영양조사심층분석에서성인남자비만집단에서음주가과잉영양섭취를유발하는요인이라고한것과관련지어볼수있다. 그러므로특히비만한남성집단을대상으로건전한음주문화정착을위한영양교육의필요성을고려해보고이에대한대책마련을검토해보아야한다. 중장년기이후의성인은노화로인해체지방율이증가하고근육량이감소하면서운동량은줄어들고이에따라비만의위험도도증가한다. 또한미각이둔화되어짠맛을선호하면서밥이나탄수화물섭취는늘고짠맛위주의반찬몇가지만으로열량은높으나영양적으로는부실한식사를하게될수있다. 소득이증가하면충분한식품구매능력을가지게되는데, 이를과일이나음료, 주류등기호식품의소비증가로연결시킬경우비만의초래하는원인이될수있을것으로생각된다. 현재우리나라는영양섭취량이높고만성질환의위험이증가되는계층에대한영양관리필요성이증가하는한편영양섭취량이기준대비부족한영양불량계층에대한관리및지원필요성도강조되는양면의상반된특성이공존한다 (Kim 등 2005). 그러므로 50대이후성인에서도각소득계층에따른영양적인특성, 건강위험도의차이를바탕으로, 소득군에따른비만예방및영양관리를달리접근하는것이필요할것으로사료된다. 특히본연구의결과에서전체비만군과정상군의비교에서는영양소의섭취와관련해서유의적인차이가관찰되지않았으나각소득군별로비만군과정상군을나누어분석한결과에서는특징적인부분이관찰되었음을감안할때, 비만군에대한분석시소득수준에대한고려가필요할것으로보인다. 전체비만군의경우소득과무관하게잡곡이나감자, 과일, 녹차의섭취빈도가유의하게높았으므로이에대한추후연구가필요하며, 탄수화물에너지비율이나미량영양소, 과일섭취, 음주패턴등에대해추가적인연구결과를토대로소득계층별다른비만관리지도를시도해볼수있을것으로보인다.

15 안소현 손숙미 김혜경 477 요약및결론 2005 국민건강영양조사자료를기반으로 50세이상성인의소득수준에따른영양건강특성분석및비만관련요인을분석한결과는다음과같다. 1. 전체대상자는 47.1% 가 BMI 기준비만유병률을보였고, 허리둘레기준비만율도 39.3% 수준으로비만유병률이높았으며, 저소득군에서는여자의비만율이, 고소득군에서는남자의비만율이더높았다. 전체비만군의경우허리둘레기준유병률이 71.2% 로복부비만율이높았다. 2. 저소득, 중소득, 고소득군의평균연령은 69세, 64세, 58세였으며, 고소득일수록남성의비율이높고교육정도가높았으며, 평소활동강도가높고영양소섭취량및영양소기준대비섭취비율, 1000 kcal 당영양소섭취량이높은경향을나타냈다. 전체비만군은정상군에비해월평균소득이높고 ( 정상군 145만원, 비만군 162만원 ), 연령이유의적으로낮았으나, 교육정도나평소활동강도에는유의적인차이가없었다. 3. 중, 고소득비만군은음주빈도가유의적으로적었으나고소득비만군은 1회음주량이많아폭음의가능성을시사하였고중소득비만군에서도비슷한경향을나타냈다. 4. 전체대상자는소득이증가함에따라수축기고혈압과고중성지방혈증인사람의비율이높아지고혈중 HDL-콜레스테롤농도가낮은사람의비율은낮아져건강위험도가증가하였다. 저소득비만군은정상군에비해유의적으로총콜레스테롤과총콜레스테롤 /HDL-콜레스테롤비, 중성지방, 공복혈당은높고 HDL-콜레스테롤은낮았으며, 중고소득비만군은정상군에비해고중성지방혈증과이완기고혈압유병률이더높았다. 5. 영양소섭취량은소득증가에따라증가하였으나전반적으로칼슘, 칼륨, 티아민, 리보플라빈의영양소섭취비율이부족한편이었고, 영양밀도면에서는정상군과비만군간유의적인차이가없어열량섭취가높은비만군에서도영양소의불균형적섭취가문제점으로판단되었다. 저소득군의영양결핍비율은 18.1%, 고소득군의영양결핍비율은 6.5% 로전반적인영양관리와함께저소득군에대한영양지원이필요할것으로사료되었다. 6. 저소득비만군은정상군에비해높은단백질, 인, 칼륨, 티아민, 리보플라빈, 나이아신섭취와높은곡류, 감자, 감귤류섭취빈도가, 중소득비만군은정상군에비해낮은철분섭취량및높은배, 과일섭취빈도가, 고소득비만군은정상군에비해폭음경향및높은딸기섭취빈도가유의적인차이 로나타났다. 결론적으로 50세이상성인은공통적으로영양불균형문제에대한관리가필요할것으로판단되며, 비만인경우에도일부영양소들의결핍이여전히우려되는바이므로, 높은비만율과고콜레스테롤혈증유병률을고려한지속적인영양지도가병행되어야할것이다. 본연구의결과를토대로할때, 저소득층에서는높은탄수화물에너지비율이나질낮은탄수화물급원식품섭취에따른열량과잉, 중고소득층에서는음주나과일류섭취패턴등을고려하여체중관리영양교육프로그램을개발하고지도방향을설정하는것이바람직할것으로사료된다. 참고문헌 Choi JH, Moon HK (2008): Comparison of dietary patterns by sex and urbanization in different economic status. Korean J Community Nutr 13(3): Choi YJ, Kim C, Park YS (2007): The effect of nutrition education program in physical health, nutritional status and health-related quality of life of the elderly in Seoul. Korean J Nutr 40(3): Dietz WH (2000): Birth weight, socioeconomic class, and adult adiposity among African Americans. Am J Clin Nutr 72(2): Drewnowski A, Darmon N (2005): Food choices and diet costs: an economic analysis. Korean J Nutr 135(4): Drewnowski A, Specter SE (2004): Poverty and obesity : The role of energy density and energy cost. Am J Clin Nutr 79(1): 6-16 Friedwald WT, Levy RI, Fredrickson DS (1972): Estimation of the concentration of low density lipoprotein cholesterol without use of the preoperative ultra centrifuge. Clin Chem 18(6): Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH (2009): The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9: Gyeonggi Research Institute (2008): An analysis on the actual conditions of the low- and strategies to overcome their poverty in GyeongGi-Province Hwang JY, Ru SY, Ryu HK, Park HJ, Kim WY (2009): Socioeconomic factors relating to obesity and inadequate nutrient intake in women in low families residing in Seoul. Korean J Nutr 42(2): Jelliffe DB (1966): The assessment of the nutritional status of the community, WHO, Geneva Jeon HS (2005): Analysis of obesity factors in Korean middle aged men and women : 2001 Korean National Health and Nutrition Examination Survey. Dissertation, Catholic University of Korea, pp Kang YH, Kim MY, Eliza L (2008): The relationship of perceived health status, activities of daily living and nutrition status in the community-dwelling Korean elderly. Korean J Adult Nurs 38(1):

16 478 소득수준에따른영양건강특성 Kim BH, Lee JW, Lee YN, Lee HS, Jang YA, Kim CI (2005): Food nutrient consumption patterns of the Korean adult population by level-2001 National Health and Nutrition Survey. Korean J Community Nutr 10(6): Kim KM, Kwon JS (2004): Nutritional and health status of the elderly living in Songnam-II. Dietary habits and nutrient intake-. Korean J Food & Nutr 17(4): Kook SR, Park YS, Ko WK, Kim SM, Lee DJ, Kang HC, Yoon BB(1997): Relationship of body fat, lipid, blood pressure, glucose in serum to waist-hip ratio between obese and normal body mass index group. J Korean Acad Fam Med 18(3): Korea Health Industry Development Institute (2009): 2010 Elderly Statistics Korea National Statistical Office (2010): Dependency ratios & agedchild ratio. population projections 2010 Kwon JH, Yoon HJ, Lee JM, Lee SK (2002): Dietary behavior and nutritional status of the elderly women attending at the health promotion program in an urban community. Korean J Community Nutr 7(6): Lee YN, Lee HS, Jang YA, Lee HJ, Kim BH, Kim CI (2006): Dietary intake pattern of the Korean adult population by weight status National Health and Nutrition Survey-. Korean J Community Nutr 11(3): Ministry of Health & Welfare (2006): The minimum cost of living for household - Notification No of Ministry of Health & Welfare in 2005 Ministry of Health & Welfare, Korea Centers for Disease Control & Prevention (2007): Guidelines of The 3rd National Health and Nutritional Examination Survey Ministry of Health & Welfare, Korea Centers for Disease Control & Prevention (2010): 2009 National Health Statics, Korea National Health and Nutrition Examination Survey (KNHANES IV-3) Moon HK, Kim EG (2004): Food intake of Koreans by economic status using 1998 Korean National Health Examination Nutrition Survey. Proceedings of 2004 Fall Symposium of the Korean Nutrition Society of Community Nutrition, p.228 Moon HK, Kong JE (2010): Assessment of nutrient intake for middle aged with and without metabolic syndrome using 2005 and 2007 Korean National Health and Nutrition Survey. Korean J Nutr 43(1): Nord M, Andrews M, Carison S (2006): Measuring food security in the United States: household food security in the United Status, U.S. Department of Agriculture, Economic Research Service, Economic Research Report No. 29 Park HA, Cho JJ (2011): Economic activities and socioeconomic status of morbidly obese Korean adults. Korean J Obes 20(4): Park JA, Yoon JS (2005): Dietary behaviors and status of nutrient intakes by the obesity levels of housewives in Daegu, Korean J Community Nutr 10(5): Park JH (2011): Measuring BMI cutoff points of Korean adults using morbidity of BMI-related diseases. Korean J Obes 20(1): Park JK, Son SM (2003): The dietary behaviors, depression rates and nutrient intakes of the elderly females living alone. Korean J Community Nutr 8(5): Park MJ, Yun KE, Lee GE, Cho HJ, Park HS (2006): The relationship between socioeconomic status and metabolic syndrome among Korean adults. Korean J Obes 15(1): Park YJ, Shin NM, Yoon JW, Choi J, Lee SJ (2010): Comparison of cardiovascular health status and health behaviors in Korean women based on household. J Korean Acad Nurs 40(6): Savage DB, Petersen KF, Shulman GI (2007): Disordered lipid metabolism and the pathogenesis of insulin resistance. Physiol Rev 87(2): US Department of Health and Human Services (2000): Healthy people nd ed. Understanding and improving health and objectives for improving health. 2 Vols. Washington CD : US Goverment Printing Office, pp Woo J, Cheung B, Ho S, Shan A, Lam TH (2008): Influence of dietary pattern on the development of overweight in a Chinese population. Eur J Clin Nutr 62(4): Yang DJ, Kim WY (2005): Nutritional status of Korean elderly. Korean J Gastroenterol 15(1): 1-10 Yoon JS, Jang HK (2011): Diet quality and food patterns of obese adult women from low classes -based on 2005 KNHANES-. Korean J Community Nutr 16(6): Zhang C, Rexroce KM, van Eam RM, LI TY, Hu FB (2008): Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circ 117(13): Zhao G, Ford ES, Li C, Tsai J, Dhingra S, Balluz LS (2011): Waist circumference, abdominal obesity, and depression among overweight and obese US adults: National Health and Nutrition Examination Survey BMC Pyschiatry 11: 130