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1 대한지역사회영양학회지 18(4) : 354~364, 2013 Korean J Community Nutr 18(4) : 354~364, 서울지역여대생의비만도및식습관에따른혈중 adiponectin 농도의차이 김미정 전현영 라혜복 서울여자대학교자연과학대학식품영양학과 Comparison of Serum Adiponectin Levels According to Body Mass Index and Dietary Behaviors of Female University Students in Seoul Mi Joung Kim, Hyun Young Jun, and Hye Bog Rha Department of Food and Nutrition, College of Natural Sciences, Seoul Women's University, Seoul, Korea Abstract This study was conducted to determine whether dietary factors could be related with serum adiponectin concentrations in 243, year-three female university students living in Seoul. The mean of body mass index (BMI) and adiponectin levels of all subjects were kg/m 2 and µg/ml, respectively. When the subjects were divided into 3 groups based on BMI (underweight: < 18.5, normal: 18.5 < 23, overweight and obesity: 23), serum adiponectin levels in underweight group was significantly higher than that in normal or overweight and obesity groups. Also when the subjects were divided into two groups by mean adequacy ratio (MAR), serum adiponectin concentration of the high MAR group (MAR > 75) was slightly higher than that the low MAR group (MAR 75). Serum adiponectin levels showed a negative correlation with body weight (p < 0.01) or BMI (p < 0.001) and a positive correlation with intakes of of animal or total protein (please clarify) or vegetable protein.among the dietary behaviors, serum adiponectin levels of females who answered yes to the question about eating breakfast was significantly higher than that of those who answered sometimes or No (p < 0.05) and serum adiponectin levels were higher among those who reported higher fruit intakes. Overall, our results suggested that healthy lifestyle including acceptable BMI, eating breakfast and higher fruit consumption might play an important role in the prevention of obesity and enhancement of blood adiponectin levels. (Korean J Community Nutr 18(4) : 354~364, 2013) KEY WORDS : adiponectin body mass index (BMI) body weight obesity dietary behavior 서 최근들어우리나라는급속한경제성장과식생활패턴및 접수일 : 2012 년 12 월 21 일접수수정일 : 2013 년 62 월 61 일수정채택일 : 2013 년 67 월 63 일채택 *This research was supported by a research grant from Seoul Women's University. Corresponding author: Hye Bog Rha, Department of Food and Nutrition, College of Natural Sciences, Seoul Women's University, #126 Kongneung 2-dong, Nowon-gu, Seoul , Korea Tel: (02) , Fax: (02) hbna@swu.ac.kr This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License( creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 론 생활습관의서구화, 활동량감소등으로의해비만인구가급속하게증가하였다. 2009년우리나라성인전체의비만유병률은 30.8% 로약 10년전인 1998년에비해 4.8% 가증가하였으며, 또한비만은당뇨병, 고혈압및심혈관질환과같은만성질환을일으키는주요건강문제로대두되고있다 (Ministry of Health and Welfare 2010). 비만이란섭취량에비해소모하는열량이적은에너지불균형에의해발생되는대사성질환으로단순한체중의증가가아닌지방조직의증가를의미하며, 식습관및운동부족뿐만아니라환경적, 유전적요인등이다양하게작용하는복합증후군이다 (Albu 등 1997; Grundy 1998). 비만으로인하여과도하게증가된지방세포는유전자발현및신호전달시스템의변화를야기하고아디포카인의분비이상을초래하여제2형당뇨병, 지단백대사이상, 고혈압, 심혈관계질환, 암등만성퇴행성질환의주요발병원인으로알려지고있다 (Pi-Sunyer 1993). 2009년국민건강영양조사에따 354

2 김미정 전현영 라혜복 355 르면정상체중인사람에비해비만인사람에게서고혈압, 당뇨병, 이상지질혈증의위험이 2배이상높게나타났으며, 그밖에도비만은동맥경화증, 호흡기계장애, 암, 관절염, 지방간등의발생과관련성이높다고조사되었다 (Ministry of Health and Welfare 2010). 지방세포에서분비되는대표적인아디포카인중하나인아디포넥틴은내분비인자의역할을하는단백질로성인의혈중수준은약 3 30 µg/ml 이며, 체지방량이많고비만도가높은사람일수록혈중아디포넥틴농도가감소하는것으로알려져있다 (Arita 등 1999; Motoshima 등 2002; Corbetta 등 2005). 비만으로인해감소된혈중아디포넥틴은인슐린저항성, 동맥경화, 심혈관계질환등의발생과관련성이있으며, 나아가대사증후군의새로운지표로여겨지고있다 (Matsuzawa 등 2004). 아디포넥틴은간과근육에서지방산의산화를촉진하고, 포도당의이용률을증가시켜혈당을감소시키며 (Yamauchi 등 2001; Choi 등 2004), 혈관평활근세포에서혈소판유래성장인자 (Platelet derived growth factor) 의발현을감소시켜동맥경화및고지혈증등심혈관질환을예방하는독립적인요인으로작용한다 (Okamoto 등 2002; Ohashi 등 2006). 또한, 혈중아디포텍틴의농도는혈압과음의상관관계가있어아디포넥틴의저하와고혈압발생이관련성이있다는연구가보고되고있다 (Adamczak 등 2003; Huang 등 2003). 감소된혈중아디포넥틴농도가다시높아지는기전에대해서는명확히밝혀지지않았으나일부지방섭취량을 35% 에서 15% 로감소시켰을때혈중아디포넥틴농도가증가하였다는연구나하루 4잔이상의카페인함유커피섭취시커피를하루 4잔미만으로섭취하는경우에비해혈중아디포넥틴농도가 20% 더높았다는연구등이보고되고있어혈중아디포넥틴농도가식이섭취와관련성이있음이보고되고있다 (Kasim-Karakas 등 2006; Williams 등 2008). 심혈관질환의예방효과를가지고있는혈중아디포넥틴농도가식습관의개선이나식사패턴의변화에의해증가하는것은만성질환예방을위해매우의미가있다. 하지만식습관및식사패턴과아디포넥틴농도와의관련성에대한연구는아직부족한실정이다. 일부당뇨환자를대상으로혈청아디포넥틴과섬유소섭취와의관련성을조사한연구나지중해식식사패턴에의한혈청아디포넥틴농도에관한외국연구는있지만 (Qi 등 2005; Mantzoros 등 2006) 국내성인을대상으로한연구는거의없는실정이다. 특히, 20대는청소년기에서성인기로이행하는과도기로정신적, 육체적으로활동이왕성하고, 신체적성장이완료되는시점으로 (Lee & Woo 1999) 이시기에확립된식습관은중년기및노년기 까지지속되기때문에건강을유지하기위한올바른영양관리및영양교육이필요한시기이다. 그러나 20대여대생의경우체형에대한왜곡된인식으로인해과도한다이어트, 증가된패스트푸드의섭취, 불규칙한식사패턴, 여러가지의스트레스등으로균형된식사가어려운현실이다 (Lee 등 2001; Cheong 등 2002; Seo 등 2005). 20대에확립된바람직하지않은식습관은중년기및노인기에지속되면서전생애에있어서건강을위협하는중요한영양문제를야기할것으로여겨진다. 그러므로성인기식습관의확립초기단계에있는 20대여대생을대상으로당뇨병, 동맥경화및고혈압등만성질환의예방인자로작용할수있는아디포넥틴과관련성이있는요인을분석하는것은영양섭취개선이나식습관교정을통한만성질환예방과건강수명연장에중요한자료로이용될것으로기대된다. 따라서본연구에서는여대생을대상으로여대생의체중및비만도분포양상을살펴보고, 비만도, 영양섭취수준및식습관에따른혈중아디포넥틴농도를비교하여, 신체계측, 생화학적지표, 영양소섭취량, 식습관및건강관련생활습관중혈중아디포넥틴과관련성이있는요인을평가하고자하였다. 연구대상및방법 1. 조사대상자 본연구는 2009년 6월서울소재여자대학교에재학중인건강검진에참여한 3학년여대생중연구의목적과취지를이해하고참여에동의한 243명을대상으로실시하였다. 대상자들에게는본연구의목적과주의사항을자세히설명하였고, 건강검진을위한혈액채취시대상자의동의하에임상병리사가채취한혈액시료를일부수거하여이용하였으며, 신장, 체중및혈압을측정하였고, 식사섭취량및식습관평가를위하여설문지를배포, 수거하였다. 설문지조사방법은연구목적과주의사항을대상자들에게설명하고, 훈련된조사자가대상자에게기록방법을교육한후대상자가직접기재하는자기기입방식으로실시되었다. 2. 신체계측 신장과체중은훈련된연구보조원이직접측정하였으며체질량지수 (BMI:Body Mass Index) 는 BMI = 체중 (kg)/( 신장 (m)) 5 과같이계산하여, WHO 아시아태평양의비만기준 (Korean Society for the Study of Obesity 2000) 에따라저체중 (Underweight, BMI <18.5 kg/ m 5 ), 정상체중 (Normal weight, 18.5 kg/m 5 BMI <

3 356 여대생의비만도및식습관과혈중 adiponectin 23.0 kg/m 5 ), 과체중 (Overweight, 23.0 kg/m 5 BMI < 25.0 kg/m 5 ), 비만 (Obesity, 25.0 kg/m 5 BMI) 으로분류하였으나대상자중과체중 (14 명, 5.8%) 과비만 (12명, 4.9%) 의비율이낮아 BMI 23 이상인대상자를 과체중및비만 군으로통합하였다. 혈압은 10분이상안정상태를유지시킨후자동혈압계 (TM-2655P) 를이용하여수축기혈압 (SBP; Systolic Blood Pressure) 과이완기혈압 (DBP; Diastolic Blood Pressure) 을측정하였다. 3. 생화학검사채혈은 12시간공복시혈액을상완정맥에서채혈하였으며, 혈액은실온에서약 1시간방치한후 4 r C, 3000 rpm 에서 20분간원심분리하여혈청을분리하였다. 혈중총콜레스테롤 (Total cholesterol) 과공복혈당 (Glucose) 은생화학분석기를 (selectra E, Vital Scientific, Netherlands) 이용하여분석하였다. 혈중아디포넥틴농도는 의료법인네오딘 에서분석되었으며, Human adiponectin ELISA (Enzyme Linked-Immuno-Sorbent Assay) kit (BioVender, Brno, Czech Republic) 을이용하여 microplate reader(versamax, Molecular Device, USA) 로측정하였다. 4. 식사섭취량조사식사섭취량은 24시간회상법을이용한자가기록법으로주중인조사 1일전체섭취한식품내용을작성하게하여조사하였다. 조사된식품섭취량에따른영양소섭취량분석은한국영양학회의영양평가프로그램 CAN-Pro 3.0을이용하여영양소섭취수준을분석하였다. 또한, 2010년한국인영양섭취기준을이용하여열량은필요추정량에대한백분율 (%EER) 을계산하였고, 권장섭취량이설정된단백질, 비타민 A, 비타민 B 4, 비타민 B 5, 비타민 B 9, 나이아신, 엽산, 비타민 C, 칼슘, 인, 철분, 아연은권장섭취량에대한백분율 (%RI) 을계산하였다. 조사대상자의영양소섭취실태를평가하기위해영양소적정섭취비율 (Nutrient Adequacy Ratio: NAR) 을계산하였다. NAR은영양소별권장섭취량 ( 한국인영양섭취기준, 2010년개정 ) 에대한영양소섭취량비율로그값이 1을넘는경우 1로계산하였고, 각영양소 NAR의평균값인평균영양소적정섭취비율 (Mean Adequacy Ratio: MAR) 을계산하였으며, MAR 값이 0.75 이하인군과초과인군으로나누어영양소섭취실태에따른신체계측및생화학적결과의차이를비교분석하였다. 5. 식습관및건강관련생활습관평가 본연구의식습관및건강관련생활습관평가는대한영양사회의전반적인식생활습관을진단하는식습관진단표 ( 대한영양사협회 ) 를일부수정한설문지를제작하여사용하였다 (Lee 등 2006). 설문문항으로는현재자신의식사에대한인식을조사하는식태도문항, 각식품군별섭취빈도및생활습관문항등총 18문항으로구성되었으며, 각식습관및건강관련생활습관에따른혈중아디포넥틴농도를비교하였다. 6. 자료분석및통계처리 수집된모든자료는 SAS(Statistical Analysis System ver 9.1) 를이용하여통계처리하였다. 모든결과는평균 ± 표준편차로표시하였으며, BMI 분류에따른신체계측및생화학적지표비교에대한결과및식습관에따른혈중아디포넥틴농도비교에대한결과는 ANOVA 와 Duncan's multiple range test로유의성검증을실시하였고, 영양소섭취실태에따른결과의유의성검증은 t-test를이용하였다. 또한, 아디포넥틴과신체계측, 생화학적지표및영양섭취량과의상관관계는 Pearson's correlation coefficients 로유의성을검증하였으며, 모든결과의통계적유의성은 p<0.05를기준으로검정하였다. 결 1. 조사대상자의비만도에따른신체계측및생화학적비교 본연구의조사대상자는서울에소재하는여대 3학년생중혈액채취, 신체계측, 식이섭취조사및식습관설문에응답한 243명을대상으로진행하였다. 전체대상자들의평균신장은 cm, 평균체중은 kg이었으며, BMI 는 kg/m 5 으로조사되었다. 또한전체대상자의평균혈중총콜레스테롤농도와공복혈당은각각 mg/dl 와 mg/dl로모두정상범위에속하였으며, 평균혈중아디포넥틴의농도는 ± 3.57 µg/ml( 범위 : 3.7~ 22.1 µg/ml) 로나타났다 (Table 1). BMI 분류기준에따라 저체중군, 정상체중군, 과체중및비만군 등세군으로나눈결과, 대상자중정상체중에해당되는사람이 165명 (67.90%) 으로가장많았고, 저체중 52명 (21.40%), 과체중및비만 26 명 (10.70%) 순으로조사되었다. 비만도에따른신체계측및생화학지표를분석한결과, 신장은비만도에따른차이가없었으나체중과 BMI는과체중및비만인사람에게서저체중이나정상체중인사람에비해유의적으로높았고, 이완기혈압역시과체중및비 과

4 김미정 전현영 라혜복 357 만인사람에게서유의하게높았다. 또한, 혈중총콜레스테롤및공복혈당도과체중및비만인사람이정상체중이하인사람에비해유의적으로높았고, 혈중아디포넥틴농도는저체중 (12.63 µg/ml) 인사람에게서정상체중 (10.79 µg/ ml) 인사람이나과체중및비만 (9.71 µg/ml) 인사람에비해유의하게높았다 (Table 1). 2. 혈중아디포넥틴과신체계측및생화학지표와의상관관계혈중아디포넥틴과신체계측및생화학지표와의상관관계를조사한결과, 혈중아디포넥틴농도는체중및 BMI와유의한음의상관관계가있는것으로나타났다 ( 각각 p <0.01, p<0.001). 그밖에도 BMI와체중은혈중총콜레스테롤 (p <0.05, p <0.01), 수축기 (p <0.01, p <0.01) 및이완기혈압 (p <0.001, p <0.001) 과유의한양의상관성이있었다. 그러나혈중아디포넥틴과혈중총콜레스테롤농도, 공복혈당및혈압과의상관성은나타나지않았다 (Table 2). 군 (MAR 0.75) 으로나누어본결과, 조사대상자중영양소섭취가양호한사람은 35.8%, 그렇지않은사람은 64.2% 이었으며, 전체조사대상자의평균열량섭취량은 kcal로매우낮은수준이었다. MAR을이용하여영양소섭취실태에따른신체계측및생화학적지표를비교한결과, 영양소섭취가양호한군에서그렇지않은군에비해 BMI가유의하게낮았으며, 유의적이지는않지만혈중총콜레스테롤및공복시혈당의평균값이약간낮고, 혈중아디포넥틴수준은약간높았다 (Table 3). 4. 혈중아디포넥틴과영양소섭취량과의상관관계혈중아디포넥틴농도는에너지섭취량, 지방, 비타민및무기질등의영양소섭취량과유의한상관성은없었으나, 단백질섭취량 (p <0.05) 및식물성단백질섭취량 (p<0.01) 과유의한양의상관관계를나타냈다 (Table 4). 3. 영양소섭취실태에따른신체계측및생화학적비교 조사대상자의 MAR 값을계산한후 0.75 를기준으로영양소섭취상태가양호한군 (MAR >0.75) 과그렇지않은 5. 식습관및건강관련생활습관에따른혈중아디포넥틴농도비교 대상자의식습관및건강관련생활습관행태에따른혈중 Table 1. Comparison of anthropometric characteristics and blood biochemical indices on BMI groups in female university students Underweight 1) (n = 52) Normal 2) (n = 165) Overweight & Obesity 3) (n = 26) Total (n = 243) Height (cm) ± )NS ± ± ± Weight (kg) ± c ± b ± a ± BMI 5) (kg/m 2 ) ± c ± b ± a ± SBP 6) (mmhg) ± NS ± ± ± DBP 7) (mmhg) ± b ± b ± a ± Total cholesterol (mg/dl) ± b ± b ± a ± Glucose (mg/dl) ± b ± b ± a ± Adiponectin (µg/ml) ± a ± b ± b ± ) Underweight: body mass index is less than ) Normal: 18.5 body mass index < 23 3) Overweight & Obesity: body mass index 23 4) Mean ± SD 5) BMI: Body mass index 6) SBP: systolic blood pressure 7) DBP: diastolic blood pressure NS: not significant abc: Means with the different superscripts are significantly different at p < 0.05 by Duncan's multiple range test. Table 2. Correlation coefficient among adiponectin level, antrophometric and biochemical indices in university students Adiponectin Height Weight BMI T-Chol Glucose SBP Height Weight 0.191** 0.504*** BMI 1) 0.254*** *** T-chol 2) * 0.197** Glucose SBP 3) ** 0.174** DBP 4) *** 0.231*** *** 1) BMI: body mass index, 2) T-chol: total cholesterol, 3) SBP: systolic blood pressure, 4) DBP: diastolic blood pressure *: p < 0.05, **: p < 0.01, ***: p < by pearson's correlation coefficient

5 358 여대생의비만도및식습관과혈중 adiponectin Table 3. Comparison of serum adiponectin level and antrophometric and biochemical indices by low and high mean adequacy ratio (MAR) groups in female university students Low MAR 1) (n = 156) High MAR 2) (n = 87) Total (n = 243) Height (cm) ± )NS ± ± Weight (kg) ± ± ± BMI 4) (kg/m 2 ) ± 32.40** ± ± SBP 5) (mmhg) ± ± ± DBP 6) (mmhg) ± ± ± Total cholesterol (mg/dl) ± ± ± Glucose (mg/dl) ± ± ± Adiponectin (µg/ml) ± ± ± ) Low MAR; low mean adequacy ratio group ( 0.75) 2) High MAR; high mean adequacy ratio group (> 0.75) 3) Mean ± SD 4) BMI: Body mass index 5) SBP: systolic blood pressure 6) DBP: diastolic blood pressure NS; not significant by t-test, **: p < 0.01 Table 4. Correlation coefficient among nutritional intakes and serum adiponectin levels in female university students Intake Energy Vegetable protein Animal protein Total Protein Vegetable fat Animal fat Total Fat Vitamin A Retinol β-carotene Adiponectin ** * Intake Vitamin B 1 Vitamin B 2 Vitamin B 6 Niacin Vitamin C Folate Ca P Fe Zn Adiponectin ** * *: p < 0.05, **: p < 0.01 by pearson's correlation coefficient Table 5. Comparison of serum adiponectin levels according to dietary behaviors in female university students N Adiponectin (µg/ml) Frequency of meals a day 3 times/day ± ) 1 2 times/day ± 3.36 Irregular ± 3.73 Eating breakfast Yes ± 3.87 a sometimes ± 3.42 b No ± 3.18 b Regularity of meal time Regular ± 4.02 sometimes Irregular ± 3.48 Irregular ± 4.15 Speed of eating meals Slow ± 3.79 Moderate ± 3.48 Quick ± 3.61 Overeating Yes ± 2.83 sometimes ± 3.71 No ± 3.50

6 김미정 전현영 라혜복 359 Table 5. Comparison of serum adiponectin levels according to dietary behaviors in women university students (continued) N Adiponectin (µg/ml) Frequency of eating grains 3 times/day ± times/day ± 3.83 Less than once a day ± 3.48 Frequency of eating protein foods 3 times/day ± times/day ± 3.42 Less than once a day ± 3.72 Frequency of eating vegetable & seaweed 3 times/day ± times/day ± 3.55 Less than once a day ± 3.59 Frequency of eating fried food & oily sauces More than 1 time a day ± 3.76 Almost never ± 3.41 Frequency of eating dairy products 6 7 times/week ± times/week ± times/week ± 2.94 Frequency of eating fruits 6 7 times/week ± 4.02 a 3 5 times/week ± 3.38 ab 0 2 times/week ± 2.86 b Often eat sugary foods Yes ± 3.43 No ± 3.84 Often eat a salty foods Yes ± 3.68 No ± 3.51 Often eat fat meat, ham, or butter Yes ± 3.32 No ± 3.83 Often eat food containing cholesterol Yes ± 3.45 No ± 3.66 Drinking More than 2 times a week ± 3.09 Less than once a week ± 3.66 Exercise More than 3 times a week ± 3.62 Less than 2 times a week ± 3.59 Smoking None-smoking ± 3.63 Smoking ± ) Mean ± SD ab: Means with the different superscripts are significantly different among dietary behavior groups at p < 0.05 by Duncan's multiple range test 아디포넥틴농도의차이는 Table 5에제시하였다. 식습관에대한문항중 아침식사여부 에대한질문에서 먹는다 라고 응답한사람들의혈중아디포넥틴농도가 가끔먹는다 또는 먹지않는다 라고응답한사람에비해유의하게높았으

7 360 여대생의비만도및식습관과혈중 adiponectin 며, 과일섭취빈도에대한질문에대해 1주일에 6~7회 로응답한사람들의혈중아디포넥틴농도가 1주일에 0~2회 로응답한사람들의혈중아디포넥틴농도에비해유의하게높았다. 고 본연구에서는 243명의여대생을대상으로비만도, 영양소섭취상태및식습관에따른혈중아디포넥틴농도를비교하여, 혈중아디포넥틴농도에영향을미치는요인을알아보고자하였다. 아디포넥틴은지방세포에서만생성분비되는특이적인단백질호르몬으로, 체지방량이많은비만인사람일수록혈중아디포넥틴의농도가감소하는것으로알려져있다 (Motoshima 등 2002). 본연구대상자의평균혈중아디포넥틴농도는 ± 3.57 µg/ml 이었으며, Arita 등 (1999) 과 Ryu 등 (2005) 도비만과당뇨가없는건강한여성의혈중아디포넥틴의농도는약 10 µg/ml(range: 1.9~ 17.0 µg/ml) 라고보고하였다. 혈중아디포넥틴농도는남성에비해여성에게서유의적으로높고 (Arita 등 1999), 연령이증가할수록감소되므로 (Ryo 등 2004) 본연구대상자가 20대초반의건강한여대생임을고려할때유사한결과인것으로사료된다. Motoshima 등 (2002) 의연구에의해비만인사람일수록혈중아디포넥틴의농도가정상인에비해낮은수치를나타내는것이보고되었고, Arita 등 (1999) 도혈장아디포넥틴농도와 BMI 간에강한음의상관성을보고하였다. 본연구에서도저체중인사람의혈중아디포넥틴농도가정상체중이나과체중및비만인사람의혈중아디포넥틴농도에비해유의하게높았고, BMI와혈중아디포넥틴사이에강한음의상관성 (p < 0.001) 을보여혈중아디포넥틴과 BMI 사이의상관성에대한결과를뒷받침하였다. 최근혈중아디포넥틴이인슐린저항성을개선하여포도당이용율을증가시키고혈당을감소시켜제2형당뇨병을억제하며 (Yamauchi 등 2001; Choi 등 2004), TNF-α (tumor necrosis factor α) 와같은염증성사이토카인의발현을감소하여동맥경화및고지혈증과같은심혈관질환을예방할수있다는연구결과가발표되고있다 (Okamoto 등 2002; Ohashi 등 2006). 또한, 혈중아디포넥틴의농도는혈압과음의상관관계가있어아디포넥틴의저하와고혈압발생사이에관련성이있다는연구가보고되고있다 (Adamczak 등 2003; Huang 등 2003). 고혈압환자를대상으로한 Adamczak 등 (2003) 의연구에서는고혈압환자 찰 의혈장아디포넥틴의농도가정상인에비해유의적으로낮았고, 혈압과아디포넥틴농도사이에음의상관성이있다고보고한반면, 정상성인을대상으로한 Yang 등 (2002) 은혈압과혈청아디포넥틴과의관련성을밝혀내지못하였다. 본연구에서도혈장아디포넥틴과혈압사이에유의한상관성은없었으며, 이는본연구의조사대상자가건강한 20대여대생이며혈압및혈중아디포넥틴농도가모두정상범위에있었기때문인것으로사료된다. 또한, 본연구의혈중총콜레스테롤농도및공복혈당과아디포넥틴농도사이에유의한상관성을보이지않은결과역시모든대상자의혈중총콜레스테롤및혈당농도가모두정상범위에있는건강한 20대초반여대생이었기때문에당뇨병환자및심혈관계질환자들을대상으로아디포넥틴과혈당및혈중 chelesterol 간의음의상관성을보고한 Yamauchi 등 (2001) 및 Kumada 등 (2003) 의결과와차이를보이는것으로사료된다. 성인기는신체적, 정신적인변화가적은안정된시기로, 특히대부분의신체조직의기능은 20대에최대의기능을발휘하며, 그후서서히기능이감퇴하게된다 (Koo 등 2011). 이처럼본연구대상자는건강한 20대로당뇨, 고혈압, 심혈관계질환등만성질환의발병이매우낮으며, 혈당과혈중콜레스테롤농도에있어서항상성이원활하게유지되고있고, 본대상자의혈중아디포넥틴농도역시정상수준이었기때문에이러한결과가나타난것으로사료된다. 영양소섭취량과혈중아디포넥틴농도와의관련성에대한연구는미비한실정이나고열량식이와고지방식이섭취시혈중아디포넥틴의농도가감소한다는여러연구 (Kasim- Karakas 등 2006; Kamari 등 2007) 가보고되고있다. 그러나비만여성을대상으로한 Garaulet 등 (2004) 은 4주동안 800 kcal 의초저열량식이공급을하였을때혈중아디포넥틴의농도가유의적이지않지만약간감소하는것으로보고되었고, 여대생을대상으로식이섭취상태와혈청아디포넥틴농도와의상관성을연구한 Lee & Kim(2010) 의연구에서도혈중아디포넥틴농도가높은군에서에너지섭취량이높아지는경향을보였다고보고하였다. 본연구대상자전체의평균에너지섭취량은 kcal로이는 2010 년한국인영양섭취기준의에너지필요추정량의 61.1% 수준에해당하는것으로 Lee & Kim(2010) 의수준이나여대생의에너지섭취량을 1,622 kcal로보고한 Yeon & Bae(2010) 의수준과비교할때매우낮은수준인것으로여겨진다. 2009년국민건강영양조사결과보고서 (Ministry of Health and Welfare 2010) 에의하면 19~29세여성의평균에너지섭취량은약 1,600 kcal 수준이며, 평균필요량의 75% 미만으로섭취하는사람의비율이 46.6% 였다

8 김미정 전현영 라혜복 361 고보고하였고, 아침결식률은 38.5% 로 19.9% 인전체인구아침결식률보다높아 19~29 세여성의영양소섭취실태및식습관불량을문제점으로보고하였다. 본연구에서도결과에제시하지는않았지만하루세끼식사하는사람의비율은전체대상자의 39.7% 로불규칙적으로식사를하거나하루 1~2끼정도의식사를하는사람의비율이매우높았으며, 아침식사를전혀하지않는사람의비율이 19.7%, 가끔아침식사를하는경우가 47.5% 로아침결식률이국민건강영양조사의수준보다높은것을볼수있었다. 또한 2009년국민건강영양조사에서 19~29 세여성중저체중비율은 16.8%, 비만률은 14.3% 로저체중비율 21.4%, 과체중및비만인사람의비율 10.7% 로나타난본연구결과와비교할때본연구대상자가저체중비율이높고비만율은낮은것을알수있다. 이는본연구대상자인여대생의식생활이불규칙하고영양섭취수준이낮아저체중비율이높았던것으로여겨지며, 전체에너지섭취량역시낮았던것으로사료되어열량섭취가불량한경우에는식사의질이높아질수록혈중아디포넥틴농도가증가할가능성이있는것으로사료된다. 본연구결과에서 MAR이 0.75 보다높은영양소섭취가양호한대상자에게서유의하지는않지만혈중아디포넥틴농도는약간높고, BMI는유의하게낮게나타나에너지섭취가낮은경우에단백질, 비타민및무기질등영양소섭취가양호한것이혈중아디포넥틴농도증가와관련성이있을것을시사한다. 또한, 본연구에서단백질섭취량및식물성단백질섭취량이혈중아디포넥틴농도와유의한양의상관성을보이고있으며, 과일의섭취빈도가높은사람에게서혈중아디포넥틴농도가유의하게높게나타난것역시이러한가능성을뒷받침하는것으로여겨진다. 특히여대생의경우자신의체중및신체이미지에매우민감한시기로체중조절에대한관심이높고체중조절에관련된행동을많이하는것으로알려져있으며 (Franzoi & Koehler 1998), 무분별한체중조절로인한불규칙한식습관이중요한영양문제중하나로여겨지고있어 (Chin & Chang 2005) 여대생들을위한올바른체형인식이나식습관에관한영양교육및지속적실천방안을제시함으로써식사의질을높이는것이중요하다. 연구대상자의혈중아디포넥틴에따른군간의식습관및생활습관을분석한결과, 아침식사여부 에대한답변으로 아침을먹는다 라고응답한대상자의혈중아디포넥틴농도가 가끔아침을먹는다 또는 아침을안먹는다 고응답한대상자에비해유의적으로높게나타났다. 아침식사는전날의식사후긴공복시간을거치고에너지를공급할수있는시간으로정상적인혈당을유지할수있도록도와준다 (Choi 등 2003). 규칙적인아침식사를하는사람일수록아침식사 를결식하는사람보다체지방량이적으며, 하루세끼를규칙적으로먹는것이체지방수준을조절하여정상체중을유지하는데도움이된다 (Lee & Choi 1994). 또한, 아침결식이나불규칙한식사는비만과인슐린저항성을높이는것으로알려져있으며 (Shigeta 등 2001), 인슐린저항성이주요발병원인으로알려진 2형당뇨환자에게서혈중아디포넥틴의농도가감소되는것으로보고되고있다 (Ryu 등 2005). 따라서본연구의불규칙한식사및아침결식으로인한비만및인슐린저항성의증가가낮은혈중아디포넥틴농도와관련성이있을것으로사료된다. 과식 역시잠재적인비만유발식행동으로여러연구에의하면비만인사람일수록폭식을하는이상식행동을나타내는경우가많으며, 폭식의경향이높은대상자인경우결식후다음식사시평소보다과도한열량을섭취하게될위험이높은것으로알려져있다 (Schlundt 등 1990; Lee & Hyun 2001). 본연구결과에서도유의적이지는않지만과식을하거나가끔과식을하는대상자의혈중아디포넥틴농도가과식을하지않는다고응답한대상자에비해약간낮았다. 혈중아디포넥틴과식사패턴에대한연구는부족하며, 특히우리나라성인을대상으로한연구는없는실정이다. 본연구에서도 곡류, 단백질식품 및 채소및해조류 등각식품군별섭취빈도에따른혈중아디포넥틴농도의유의한차이는나타나지않았으나 과일 섭취빈도의경우섭취빈도가일주일에 6-7회인경우에 0-2회의경우보다혈중아디포넥틴농도가유의적으로높았다. 당뇨환자를대상으로식이패턴과혈중아디포넥틴농도와의관련성에대한연구에서혈중아디포넥틴농도가높은군에서섬유소섭취가높았고 (Qi 등 2005), 과일, 전곡류등식물성급원식품이풍부하게포함된지중해식식이를하는사람에게서혈중아디포넥틴농도가높았다고보고되고있어과일섭취빈도에대한본연구결과와일치하며, 섬유소및비타민이풍부한식물성식품섭취등이아디포넥틴과관련성이있을것으로사료된다. 이처럼아디포넥틴은비만관련요인들과관련성이있으며, 특히규칙적이지않은식사섭취, 아침결식및과식은비만을유발할가능성이있고, 혈중아디포넥틴의농도저하와관련성이있을것으로사료된다. 당뇨병및심혈관계질환과같은만성질환에있어서아디포넥틴이혈당강하및항동맥경화효과를가지는것으로보고되고있으나 (Yamauchi 등 2002) 혈중아디포넥틴증가와관련된식습관에대한연구는부족하다. 비록본연구는건강한 20대여대생을대상으로진행되었기때문에아티포넥틴농도과혈중 cholesterol 및 glucose 농도와의상관성을발견하지못했으나아침결식

9 362 여대생의비만도및식습관과혈중 adiponectin 및과식과같은잘못된식습관이지속적으로이어진다면비만의비율이높아지고혈중아디포넥틴의농도가낮아져만성질환의위험성이높아질것으로사료된다. 대학생시기는성인기로전환되는시점으로이시기에형성된식습관은성인기및노인기에도지속되기때문에대학생시기의올바른식습관형성은건강한삶을유지를위해필수적이다 (Jung 등 2005). 따라서여대생을위한규칙적식사및올바른식습관을실천할수있는구체적인영양교육이필요할것으로사료된다. 또한, 본연구의제한점으로는여대생의영양섭취량이매우낮게조사되었고, 저체중비율은높고비만율은낮아혈중아디포넥틴에따른영양소섭취량이나식사패턴의차이를분석하지못한점이다. 하지만과일섭취빈도가높은군에서혈중아디포넥틴농도가유의적으로높게나타나혈중아디포넥틴과의일부식사패턴과의관련성에있을것으로사료되며, 우리나라성인여성을대상으로한식품군별섭취와혈중아디포넥틴과의관련성에관한더많은연구가필요할것으로사료된다. 요약및결론 본연구는여대생을대상으로비만도, 영양섭취수준및식습관에따른혈중아디포넥틴농도를비교하여, 신체계측, 생화학적지표, 영양소섭취량, 식습관및건강관련생활습관중혈중아디포넥틴과관련성이있는요인을평가하고자서울소재여대생 243명을대상으로실시하였다. 1. 전체대상자들의평균신장은 cm, 평균체중은 kg이었으며, BMI는 kg/m 5 으로조사되었고, 평균혈중총콜레스테롤농도, 공복혈당및혈중아디포넥틴농도는각각 mg/dl, mg/dl, ± 3.57 µg/ml로모두정상범위에속하였다. 2. 대상자중 BMI 분포는정상체중에해당되는사람이 67.90% 로가장많았고, 저체중 21.40%, 과체중및비만 10.70% 순으로조사되었다. 3. 비만도에따른신체계측및생화학지표를분석한결과, 신장은비만도에따른차이가없었으나체중과 BMI는과체중및비만인사람에게서저체중이나정상체중인사람에비해유의적으로높았고, 혈중아디포넥틴농도는저체중인사람에게서정상체중이거나과체중및비만인사람에비해유의하게높았다. 4. 혈중아디포넥틴농도는체중및 BMI와유의한음의상관관계가있는것으로나타났다 ( 각각 p < 0.01, p < 0.001). 그밖에도 BMI와체중은혈중총콜레스테롤 (p <0.05, p<0.01), 수축기 (p <0.01, p <0.01) 및이완기혈압 (p <0.001, p <0.001) 과유의한양의상관성이있었다. 5. MAR 값 0.75 를기준으로영양소섭취상태가양호한군 (MAR >0.75) 과그렇지않은군 (MAR 0.75) 으로나누어본결과, 조사대상자중영양소섭취가양호한사람은 35.8%, 그렇지않은사람은 64.2% 이었으며, 영양소섭취가양호한군에서그렇지않은군에비해 BMI가유의적으로낮았으며, 혈중아디포넥틴수준은유의하지는않지만약간높았다. 6. 혈중아디포넥틴농도는에너지섭취량, 지방, 비타민및무기질등의영양소섭취량과유의한상관성은없었으나, 단백질섭취량 (p<0.05) 및식물성단백질섭취량 (p <0.01) 과유의한양의상관성이있었다. 7. 식습관에대한문항중 아침식사여부 에대한질문에서 먹는다 라고응답한사람들의혈중아디포넥틴농도가 가끔먹는다 또는 먹지않는다 라고응답한사람에비해유의하게높았으며, 과일섭취빈도에대한질문에대해 1주일에 6~7회 로응답한사람들의혈중아디포넥틴농도가 1주 일에 0~2회 로응답한사람들의혈중아디포넥틴농도에비해유의하게높았다. 이상의결과에서 20대여대생의혈중아디포넥틴의농도는 BMI와유의한음의상관성이있었으며, 아침결식과과식과같이비만유발식습관이혈중아디포넥농도저하와관련성이있는것으로조사되었다. 비록본연구는건강한 20 대여대생을대상으로진행되었기때문에아티포넥틴농도에따른혈중총콜레스테롤농도및혈당과같은생화학적차이는나타나지않았으나, 아침결식및과식과같은잘못된식습관이지속적으로이어진다면비만의비율이높아지고, 혈중아디포넥틴의농도가낮아져만성질환의위험성이높아질것으로사료된다. 또한, 열량섭취가불량한여대생의경우단백질섭취및섬유소나비타민이풍부한과일의섭취가혈중아디포넥틴농도증가와관련성있을것으로사료되어식사의질을높이는것이필요하다. 따라서장년기뿐만아니라중년기및나아가노인기에이르는전체생애주기에있어비만을예방하고, 만성질환에대한유병율을낮추기위해서는자신의잘못된식행동에대하여인지하고, 올바른식습관을실천할수있는구체적인영양교육이건강한 20대부터필요할것으로사료된다. REFERENCES Adamczak M, Wiecek A, Funahashi T, Chudek J, Kokot F, Matsuzawa Y (2003): Decreased plasma adiponectin concentration in patients with essential hypertension. Am J Hypertens 16(1): 72-75

10 김미정 전현영 라혜복 363 Albu J, Allison D, Boozer CN, Heymsfield S, Kissileff H, Kretser A, Krumhar K, Leibei R, Nonas C, Pi-Sunyer X, Vanltallie T, Wedral E (1997): Besity solutions: report of ameeting. Nutr Res 55(5): Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, Hotta K, Shimomura I, Nakamura T, Miyaoka K, Kuriyama H, Nishida M, Yamashita S, Okubo K, Matsubara K, Muraguchi M, Ohmoto Y, Funahashi T, Matsuzawa Y (1999): Paradoxical decrease of an adipose-specific protein, adiponectin in obesity. Biochem Biophys Res Commun 257(1): Cheong SH, Kwon WJ, Chang KJ (2002): A comparative syudyon the dietary attitudes, dietary behaviors and diet qualities of food and nutrition major non-major female university students. Korean J Community Nutr 7(3): Chin JH, Chang KJ (2005): College students' attitude toward body weight control, health -related lifestyle and dietary behavior by self- perception on body image and obesity index. J Korean Soc Food Sci Nutr 34(10): Choi KM, Lee J, Lee KW, Seo JA, Oh JH, Kim SG, Kim NH, Choi DS, Baik SH (2004): Serum adiponectin concentrations predict the developments of type 2 diabetes and the metabolic syndrome in elderly Koreans. Clin Endocrinol 61(1): Choi MY, Park DY, Rhie SG (2003): Rice preference differences in subjects taking breakfast regularly and skipping breakfast in Kyeonggi-do residence. Korean J Community Nutr 8(4): Corbetta S, Bulfamante G, Cortelazzi D, Barresi V, Cetin I, Mantovani G, Bondioni S, Beck-Peccoz P, Spada A (2005): Adiponectin expression in human fetal tissues during mid- and late gestation. J Clin Endocrinol Metab 90(4): Franzoi SL, Koehler V (1998): Age and gender differences in body attitudes: a comparison of young and elderly adults. Int J Aging Hum Dev 47(1): 1-10 Garaulet M, Viguerie N, Porubsky S, Klimcakova E, Clement K, Langin D, Stich V (2004): Adiponectin gene expression and plasma values in obese women during very-low-calorie diet. Relationship with cardiovascular risk factors and insulin resistance. J Clin Endocrinol Metab 89(2): Grundy SM (1998): Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr 67(3): 563S-572S Huang KC, Chen CL, Chuang LM, Ho SR, Tai TY, Yang WS (2003): Plasma adiponectin levels and blood pressures in nondiabetic adolescent females. J Clin Endocrinol Metab 88(9): Jung YM, Chung KS, Lee SE (2005): Comparison of health behavior, body composition and body image in college women by BMI (Body Mass Index). Korean J Health Educ Promot 22(1): Kamari Y, Grossman E, Oron-Herman M, Peleg E, Shabtay Z, Shamiss A, Sharabi Y (2007): Metabolic stress with a high carbohydrate diet increases adiponectin levels. Horm Metab Res 39(5): Kasim-Karakas SE, Tsodikov A, Singh U, Jialal I (2006): Responses of inflammatory markers to a low-fat, high-carbohydrate diet: effects of energy intake. Am J Clin Nutr 83(4): Koo JO, Kim JH, Byun KW, Sohn CM, Lee JW, Lee JH, Choi YS (2011): Nutrition through the life cycle. Powerbook, Seoul, pp Korean Society for the Study of Obesity (2000): Diagnosis and therapy of obesity: the Asia-Pacific area guideline. Seoul Kumada M, Kihara S, Sumitsuji S, Kawamoto T, Matsumoto S, Ouchi N, Arita Y, Okamoto Y, Shimomura I, Hiraoka H, Nakamura T, Funahashi T, Matsuzawa Y (2003): Association of hypoadiponectinemia with coronary artery disease in men. Arterioscler Thromb Vasc Biol 23(1): Lee JH, Kim JS, Lee MY, Chung SH, Chang KJ (2001): A study on seight-control experience eating disorder and nutrient intake of college students attending web class via the internet. Korean J Community Nutr 16(1): Lee JW, Lee MS, Kim JH, Son SM, Lee BS (2006): Nutritional assessment. Kyomunsa, Paju, pp Lee MS, Woo MK (1999): Changes in food habit, nutritional knowledge and nutrition attitude of university students during nutrition course. Korean J Nutr 32(6): Lee MY, Kim JH (2010): Association of serum lipids and dietary intakes with serum adiponectin level in overweight and obese Korean women. Korean J Community Nutr 15(1): Lee SH, Hyun MH (2001): The effects of obesity, body image satisfaction, and binge eating on depression in middle school girls. Korean J Health Psychology 6(1): Lee YN, Choi HM (1994): A study on the relationship between body mass index and the food habits of collage students. Korean J Dietary Culture 9(1): 1-10 Mantzoros CS, Williams CJ, Manson JE, Meigs JB, Hu FB (2006): Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women. Am J Clin Nutr 84(2): Matsuzawa Y, Funahashi T, Kihara S, Shimomura I (2004): Adiponectin and metabolic syndrome. Arterioscler Thromb Vasc Biol 24(1): Ministry of Health and Welfare (2010) : Report of 2009 Korean National Health and Nutritional Examination Survey, KNHANES IV, Available from sjb030301vw.jsp?par_menu_id=03&menu_id=031604&co NT_SEQ=264574&page=1[cited 2011 April 13] Motoshima H, Wu X, Sinha MK, Hardy VE, Rosato EL, Barbot DJ, Rosato FE, Goldstein BJ (2002): Differential regulation of adiponectin secretion from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone. J Clin Endocrinol Metab 87(12): Ohashi K, Kihara S, Ouchi N, Kumada M, Fujita K, Hiuge A, Hibuse T, Ryo M, Nishizawa H, Maeda N, Maeda K, Shibata R, Walsh K, Funahashi T, Shimomura I (2006): Adiponectin replenishment ameliorates obesity-related hypertension. Hypertension 47(6): Okamoto Y, Kihara S, Ouchi N, Nishida M, Arita Y, Kumada M, Ohashi K, Sakai N, Shimomura I, Kobayashi H, Terasaka N, Inaba T, Funahashi T, Matsuzawa Y (2002): Adiponectin reduces atherosclerosis in apolipoprotein e-deficient mice. Circulation 106(22): Pi-Sunyer FX (1993): Medical hazards of oesity. Ann Intern Med 119(2): Qi L, Rimm E, Liu S, Rifai N, Hu FB (2005): Dietary glycemic

11 364 여대생의비만도및식습관과혈중 adiponectin index, glycemic load, cereal fiber, and plasma adiponectin concentration in diabetic men. Diabetes Care 28(5): Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, Nagai M, Matsuzawa Y, Funahashi T (2004): Adiponectin as a biomarker of the metabolic syndrome. Circ J 68(11): Ryu ST, Park SO, Kim SH (2005): The relation of serum adiponectin and resistin concentrations with metabolic risk factors. J Korean Endocr Soc 20(5): Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Kasser T (1990): Obesity: A biogenetic or biobehavioral problem. Int J Obes 14(9): Seo DH, Park GS, Shin YJ (2005): The dietary habits and preference of food on skin types of women college students. Korean J Food Culture 20(1): Shigeta H, Shigeta M, Nakazawa A, Nakamura N, Yoshikawa T (2001): Lifestyle, obesity, and insulin resistance. Diabetes care 24(3): 608 Williams CJ, Fargnoli JL, Hwang JJ, van Dam RM, Blackburn GL, Hu FB, Mantzoros CS (2008): Coffee consumption is associated with higher plasma adiponectin concentrations in women with or without type 2 diabetes: a prospective cohort study. Diabetes Care 31(3): Yamauchi T, Kamon J, Minokoshi Y, Ito Y, Waki H, Uchida S, Yamashita S, Noda M, Kita S, Ueki K, Eto K, Akanuma Y, Froguel P, Foufelle F, Ferre P, Carling D, Kimura S, Nagai R, Kahn BB, Kadowaki T (2002): Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase. Nat Med 8(11): Yamauchi T, Kamon J, Waki H, Terauchi Y, Kubota N, Hara K, Mori Y, Ide T, Murakami K, Tsuboyama-Kasaoka N, Ezaki O, Akanuma Y, Gavrilova O, Vinson C, Reitman Ml, Kagechika H, Shudo K, Yoda M, Nakano Y, Tobe K, Nagai R, Kimura S, Tomita M, Froguel P, Kadowaki T (2001): The fat derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 7(8): Yang WS, Lee WJ, Funahashi T, Tanaka S, Matsuzawa Y, Chao CL, Chen CL, Tai TY, Chuang LM (2002): Plasma adiponectin levels in overweight and obese Asians. Obes Res 10(11): Yeon JY, Bae YJ (2010): Evaluation of nutrient and food intake status, and dietary quality -Focused on comparison with overweight and normal female university students-. Korean J Food Nutr 23(4):