Original Article J Korean Geriatr Soc 2014;18(4):185-198 http://dx.doi.org/10.4235/jkgs.2014.18.4.185 Print ISSN 1229-2397 On-line ISSN 2288-1239 노인의에너지섭취정도에따른나트륨과잉섭취와관련된인자 - 제 5 기국민건강영양조사결과를바탕으로 부산대학교의과대학가정의학교실 1, 부산대학교병원의생명연구원 2, 부산대학교의학전문대학원의학교육실 3 탁영진 1,2 이정규 1,2 김윤진 1,2 이상엽 1,3 정동욱 1 이유현 1,2 조영혜 1 최은정 1 이승훈 1 황혜림 1,2 조아라 1 Excessive Sodium Intake and Related Factors According to Energy Intakes Among Korean Elderly: A Nationwide Cross-Sectional Study Young-Jin Tak, MD 1,2, Jeong-Gyu Lee, MD 1,2, Yun-Jin Kim, MD 1,2, Sangyeoup Lee, MD 1,3, Dong-Wook Jung, MD 1, Yu-Hyeon Yi, MD 1,2, Young-Hye Cho, MD 1, Eun-Jung Choi, MD 1, Seung-Hun Lee, MD 1, Hye-Lim Hwang, MD 1,2, A-Ra Cho, MD 1 1 Department of Family Medicine, Pusan National University School of Medicine, Busan, 2 Biomedical Research Institute, Pusan National University Hospital, Busan, 3 Medical Education Unit, Pusan National University School of Medicine, Yangsan, Korea Background: Few large-scale studies have investigated sodium intake in Korean elderly. We examined excessive sodium intake and related factors according to energy intake in this population. Methods: We conducted a cross-sectional study using data from the fifth Korea National Health and Nutrition Examination Survey 2012. We analyzed the 24-hour dietary recall data from 1,496 elderly individuals (635 men, 861 women), who were then categorized into three groups according to energy intake-insufficient, appropriate, and excessive. The association between sociodemographic factors and 4 g or more of sodium intake were examined by the multivariable logistic regression model. Results: Mean sodium intake was 4.7 g/day for men and 3.3 g/day for women. Subjects who consumed excessive energy had a higher risk of consuming 4 g or more of sodium in men (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.24-5.08) and women (OR, 3.89; 95% CI, 2.21-6.85) compared with subjects who consumed an appropriate amount of energy. In men, low house income (OR, 2.36; 95% CI, 1.07-5.19) in the group with insufficient energy intake and living alone (OR, 6.30; 95% CI, 2.26-17.54) in the group with excessive energy intake were significantly associated with excessive sodium intake. In women, alcohol use (OR, 4.46; 95% CI, 1.29-15.44) and regular walking (OR, 3.22; 95% CI, 1.15-9.03) in the group with excessive energy intake were significantly associated with excessive sodium intake. Conclusion: We observed a significant association between excessive sodium intake with low income and living alone in men. Our findings suggest that dietary support to reduce sodium intake is needed in the elderly. Key Words: Aged, Diet, Population, Sodium Received: September 24, 2014 Revised: November 2, 2014 Accepted: November 27, 2014 Address for correspondence: Jeong-Gyu Lee, MD Department of Family Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: +82-51-240-7833, Fax: +82-51-240-7843, E-mail: jeklee@pnu.edu * 본논문은 2014 년도부산대학교병원임상연구비지원에의해수행되었음. Copyright 2014 Korean Geriatric Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly 서 론 대상및방법 노년기의식습관은노인건강을결정하는주요요인이다. 올바른영양섭취는고혈압, 당뇨병, 심혈관계질환등의만성질환의예방및관리에필수적이다 1). 그러나노인들은생리기능및소화기능저하, 치아상태불량, 은퇴후경제적어려움, 우울증등으로인해균형잡힌영양섭취가어려워지기쉽다 2). 따라서노인의영양적위험을조기에발견하기위해노인의식이섭취에대한지속적인평가가필요하며, 영양문제와관련된요인을파악해야한다. 나트륨의경우건강을유지하는데필요한양은 500 mg 정도이며, 과도한나트륨섭취는혈액의부피와말초혈관의저항을증가시켜혈압을높인다 3). 이로써고혈압과심뇌혈관질환의위험도를높이며, 골다공증, 신장질환, 위암및위궤양의발생과도관련이있다 4,5). 이때문에세계보건기구 (World Health Organization) 와한국영양학회는하루적정소금섭취량을 5 g ( 나트륨 2 g) 이하로제시하였다 6,7). 하지만우리나라국민들은나트륨을권장량보다훨씬많이섭취하고있다 8). 이는한국인에서고혈압 9), 위암 10) 유병률이특히높은주요요인으로꼽힌다. 노년계층은생리적으로짠맛에대한역치가높아져짜게먹을위험이크다. 또한혈관의수축력과신장에서의나트륨배설능력이저하되기때문에나트륨과잉섭취로인한건강위해가다른연령층보다크다 11). 국내노인인구와심뇌혈관질환이꾸준히증가하는실정에서고염식이는교정이가능한요인이기 12,13) 때문에노인의나트륨과잉섭취와관련된사회인구학적요소에대한파악이필요하다. 하지만노인의영양섭취와관련된요인을분석했던선행연구들은주로노인의영양소섭취부족에대한것들이었다 14,15). 대부분섭취부족의측면에서위험요인과의관련성을다루었고, 나트륨과잉섭취와관련된위험요인을파악한연구는많지않다. 또한나트륨섭취량은하루총식품섭취량에좌우되므로에너지를부족하게섭취하는노인과과잉으로섭취하고있는노인은각각나트륨과잉섭취와관련된인자가다를것이다. 이에본연구는한국인의대표표본을대상으로한국민건강영양조사의자료를이용하여노인의에너지섭취정도에따른나트륨섭취량과나트륨과잉섭취와관련된인자를확인하고자한다. 1. 대상이연구는국민건강영양조사제 5기 3차년도 (2012 년 ) 결과를분석한단면연구이다. 국민건강영양조사는한국인의건강수준과영양섭취실태를파악하기위해범국가적으로수행되는건강및영양조사이다. 전국규모의대표성과신뢰성을위해다단계층화확율표본을추출하였다. 표본조사구는아파트단지목록에서추출한아파트조사구와통반리목록에서추출한일반주택조사구로구성되어있다. 전국을시도별로 1차층화한후아파트지역은아파트시세등의기준으로, 일반지역은주민등록인구자료를기준으로 2차층화하여추출하였다. 또한국민건강영양조사는복합표본설계자료로서표본설계시에순환표본설계방식을적용하였다. 조사기간은 2012년 1월부터 2013 년 1월 (12개월) 까지며, 건강설문조사, 검진조사, 영양조사등세분야로시행되었다. 5기 3차년도에는 192 조사구, 총 8,331명이참여하였으며, 이중 7,208명 (86.5%) 이응답하였다. 이번연구의대상자는 5기국민건강영양조사의 65세이상참여자 1,585명중, 24시간회상법에의한하루식품섭취량의데이터가존재하는 1,496 명 ( 남성 635 명, 여성 861 명 ) 이다. 영양조사에대한결측치가있거나하루나트륨 500 mg 이하섭취자, 전염성질병감염자, 조사시점기준 2주이상입원및장기요양한노인은연구대상에서제외되었다. 국민건강영양조사는국민건강증진법에의해실시되는법정조사로질병관리본부연구윤리심의위원회의승인하에수행되었으며, 그결과는개인정보보호법을준수하는범위내에일반인에게공개되어있다. 2. 방법 1) 사회인구학적요인건강설문조사결과를이용하여노인의음식섭취에영향을미칠수있는사회인구학적인자인연령, 소득및교육수준, 배우자유무, 독거여부에대한정보를확인하였다. 건강설문 186 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 조사중가구조사, 질병이환, 활동제한에대한정보는이동검진센터에서면접조사로, 그외흡연, 음주, 신체활동등에대해서는설문지를이용한자기기재로조사되었다. 스스로설문지를작성하기어려운경우, 조사원에의해면접조사가실시되었다. 소득수준은가구소득을기준으로사분위 ( 하, 중하, 중상, 상 ) 로나누었고, 교육수준은무학또는초등학교졸업이하, 중학교졸업, 고등학교졸업, 대학졸업및그이상학력, 총네군으로분류하였다. 결혼상태는현재배우자와함께사는경우와미혼, 이혼, 사별등으로배우자와함께살지않거나배우자이외사람과사는경우두그룹으로나누었다. 또한동거하는가구원수에따라독거와비독거로구분하였다. 2) 만성질환이환과신체계측및임상검사만성질환유병여부는건강설문조사와검진조사결과를이용하여고혈압, 당뇨병, 이상지질혈증에대한정보를확인하였다. 고혈압은신체검진상수축기혈압 140 mmhg 이상이거나, 이완기혈압 90 mmhg 이상또는혈압조절을위해약을복용하는경우로정의하였다. 당뇨병은공복혈당이 126 mg/dl 이상혹은의사로부터진단받거나혈당조절을위해인슐린주사혹은약을복용하는경우로정의하였다. 이상지질혈증은공복혈액검사에서총콜레스테롤 240 mg/dl 이상혹은콜레스테롤약을복용하거나중성지방이 200 mg/dl 이상, 또는고밀도콜레스테롤이 40 mg/dl 미만일때로정의하였다. 신체계측과임상검사는이동검진센터에서검진조사원에의해측정되었다. 가벼운옷을입고신발은벗은상태로키와몸무게를 0.1 단위까지측정하였고, 체중을키의제곱으로나누어체질량지수를구하였다. 혈압은검사전 5분간휴식한뒤수축기혈압과이완기혈압을 30초간격으로총 3회측정하여두번째와세번째혈압의평균으로최종혈압을구하였다. 혈액검사는 8시간이상공복상태를확인한후전주정맥 (antecubital vein) 에서채취한혈액으로총콜레스테롤, 중성지방, 고밀도콜레스테롤, 혈당을측정하였다. 3) 건강관련행위건강설문조사결과를통해흡연, 음주, 걷기실천, 외식, 활동제한여부, 저작불편호소에대한정보를확인하였다. 평생담배 100개비이상피웠고, 현재담배를피우는경우현재흡 연자로정의하였다. 월간음주율은최근 1년동안한달에 1회이상음주한사람들의분율로, 걷기실천율은최근일주일에주 5회이상, 1회당 30분이상걷기를실천하는사람들의분율로정의하였다. 외식은간식외의식사를장소에상관없이가정이아닌곳에서조리한음식을먹은경우로정의하였다. 여기에는배달음식이나포장음식도포함하였다. 외식의끼니횟수를조사하여최근 1년간외식을거의하지않는다는 ( 월 1회미만 ) 군과그이상의빈도로외식을한다는군, 두그룹으로나누었다. 활동제한은 현재신체혹은정신적장애나건강상의문제로일상생활및사회활동에제한을받고계십니까? 라는질문에 예 라고대답한경우로정의하였다. 저작불편호소율은현재치아나틀니, 잇몸등입안의문제로인해저작불편을느끼는분율로정의하였다. 4) 식품섭취조사및영양소섭취량산출영양조사는건강설문및검진조사에 1명이상참여한가구의가구원을대상으로하였다. 연구대상자들의식품섭취량은 1일 24시간식이섭취회상법을통해산출되었다. 훈련된면접원이대상자의집을방문하여하루전날 24시간동안대상자가섭취한끼니별음식명과식재료명, 섭취량을조사하였다. 대상자가섭취하는형태는개별식품혹은영양소가아닌, 이들이조합된음식의형태이기때문에조사한음식의종류와섭취량을식품단위혹은영양소단위로환산하였다. 식품성분표는농촌자원개발연구소에서발행한식품성분표제 7개정판을기본으로하였고 16), 일부가공식품과수입식품에대해서는한국보건산업진흥원에서제시한데이터베이스를활용하였다 17). 대상자들의에너지와나트륨을포함한영양섭취정도는한국영양학회에서발표한 한국인영양섭취기준 (2010) 을기준으로판정하였다 7). 여기에는산업자원부기술표준원자료에근거한체위기준치를기준으로 18) 에너지필요추정량이성별과연령별로제시되어있다. 노인의에너지필요추정량은남성의경우 2,000 kcal/day, 여성은 1,600 kcal/day 이다. 에너지섭취정도는에너지필요추정량의 75% 미만으로섭취한경우를부족으로, 125% 초과섭취한경우과잉으로정의하였다. 칼륨은충분섭취량기준으로, 그외영양소에대해서는영양섭취기준중권장섭취량을사용하여노인영양섭취의적절성을판단하였다. J Korean Geriatr Soc 18(4) December 2014 187
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly 5) 통계분석국민건강영양조사는우리나라국민의대표성있는표본을확보하여국가단위의통계를산출하는데목적이있기때문에조사별로자료에가중치를부여하고있다. 따라서이번연구대상자들의결과는다단계확율층화표본의표본가중치를고려하여건강설문, 검진, 영양가중치를반영하였다. 모든통계분석은 SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA) 의복합표본분석을이용하고남녀의식품섭취량에차이가커성별로층화하여분석하였다. 변수는평균또는비율 ± 표준오차로제 시하였다. 성별에따른만성질환유무와사회인구학적인자 ( 범주형변수 ) 의차이는교차분석 (chi-square test) 으로, 영양소섭취량 ( 연속형변수 ) 의차이는일반선형분석 (general linear model) 을사용하여분석하였다. 에너지섭취량과나트륨섭취량간의상관관계를확인하기위해나이를보정한상관분석 (Pearson correlation analysis) 을시행하였다. 또한한국영양학회에서제시한에너지필요추정량을기준으로남녀별에너지부족, 적절, 과잉섭취, 세군으로분류하였다 ( 남성총에너지섭취량 1,600 kcal/day 미만, 1,600-2,500 kcal/day, 2,500 kcal/day 초과 ; 여성 1,200 kcal/day 미만, 1,200-2,000 kcal/ Table 1. Sociodemographic characteristics of elderly subjects according to sex Characteristics Total (n=1,496) Men (n=635) Women (n=861) p-value* Age (yr) 72.8±0.21 72.1±0.32 73.2±0.26 <0.001 Age group (yr) 0.001 65 74 64.5±1.8 (954) 71.2±2.6 (425) 59.7±2.2 (529) 75 35.7±1.7 (542) 27.4±2.5 (210) 37.6±2.3 (332) Body mass index (kg/m 2 ) 24.0±0.12 23.4±0.19 24.6±0.16 <0.001 Obesity (%) 34.7±1.7 (494) 27.2±2.2 (161) 40.1±2.2 (333) <0.001 Chronic diseases Hypertension (%) 55.3±1.8 (727) 49.0±2.6 (266) 59.8±2.3 (461) 0.002 Diabetes mellitus (%) 17.1±1.1 (239) 17.7±1.8 (107) 16.7±1.4 (132) 0.692 Dyslipidemia (%) 16.6±1.7 (220) 12.0±1.7 (68) 19.9±2.2 (152) 0.001 Health related behavior Current smoker (%) 10.7±1.0 (146) 22.0±1.9 (128) 2.8±0.7 (18) <0.001 Alcohol drinker (%) 35.7±1.5 (473) 59.0±2.5 (328) 19.1±1.6 (145) <0.001 Regular walker (%) 33.2±1.6 (463) 40.9±2.5 (240) 27.9±2.1 (223) <0.001 Eating out (%) 10.6±1.1 (171) 16.8±2.3 (117) 6.1±0.9 (54) <0.001 Limitation of activity (%) 19.0±1.3 (244) 14.8±1.6 (88) 22.0±2.0 (156) 0.006 Difficulty in chewing (%) 46.3±1.7 (604) 41.6±2.4 (231) 49.6±2.2 (373) 0.013 Living with spouse (%) 65.3±1.6 (996) 91.4±1.4 (577) 46.7±2.1 (419) <0.001 Living alone (%) 17.4±1.1 (294) 6.8±1.1 (44) 24.9±1.7 (250) <0.001 House income <0.001 Low 49.8±2.2 (655) 41.7±3.0 (236) 55.5±2.3 (419) Low-middle 28.6±1.9 (378) 33.0±2.6 (180) 25.6±2.1 (198) High-middle 12.2±1.1 (190) 15.2±1.7 (92) 10.8±1.2 (98) High 9.0±1.1 (127) 10.1±1.7 (57) 8.1±1.1 (70) Education level <0.001 No-elementary graduate 61.6±1.7 (797) 39.5±2.9 (214) 77.5±1.7 (583) Middle school graduate 15.1±1.0 (204) 20.4±1.9 (112) 11.3±1.2 (92) High school graduate 15.4±1.3 (213) 25.0±2.4 (138) 8.5±1.2 (75) >College 7.9±0.9 (136) 15.1±2.0 (108) 2.6±0.6 (28) Values are presented as mean±standard error or mean±standard error (number). *Calculated by general linear model or chi-square test. 188 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 day, 2,000 kcal/day 초과 ). 70% 이상의노인이하루 2 g 이상의나트륨을섭취하고있었기때문에나트륨과잉섭취의교차비 (odds ratio, OR) 는목표섭취량의 2배에해당하는 4 g 초과에대해산출하였다. 각그룹에서나트륨 4 g 초과섭취와관련된인자를확인하고자다변량로지스틱회귀분석을사용하여나이와에너지섭취량을보정한교차비와 95% 신뢰구간 (confidence interval, CI) 을산출하였다. 유의수준은 α=0.05 이하로하였다. 결과 1. 연구대상노인의일반적특성 총 1,496명 ( 남성 635명, 여성 861명 ) 의 65세이상노인이포함되었다. Table 1은연구대상자들의성별에따른일반적인특성이다. 평균연령은 72.8 세이며, 대상자의 35.7% 가 75세이상이었다. 여성이남성에비해나이가많고, 비만, 고혈압, 이상지질혈증의유병률이높았다. 또한여성에서활동제한과 저작불편이더흔했으며, 남성보다독거인경우가많았고, 수입과교육수준이낮아건강관리를위한사회인구학적요건이불리하게드러났다. 2. 성별에따른영양섭취 Table 2는성별에따른영양소섭취량을보여준다. 에너지필요추정량과비교했을때, 남성과여성모두평균적으로에너지를부족하게섭취하고있었다. 전체노인의 35% 는에너지를부족하게, 14% 는에너지를과다하게섭취하였다. 미세영양소와관련하여남녀모두칼슘과리보플라빈, 인을권장섭취량보다적게섭취하였고, 칼륨은충분섭취량보다부족하게섭취하였다. 반면나트륨은여성보다남성이더많이섭취하고 (4,701.5±156.9 mg/day vs. 3,347.6±100.5 mg/day), 남성의 85.6±1.8%, 여성의 68.2±2.0% 가목표섭취량인 2 g을초과하여섭취하고있었다. 특히남성의절반 (49.6±2.6%) 이나트륨을목표섭취량의두배에해당하는 4 g을초과하여섭취하였다. Table 2. Daily energy and nutrient intake of elderly subjects according to sex Variable DRI (male/female) Total (n=1,496) Men (n=635) Women (n=861) p-value* Energy (kcal/day) 2,000/1,600 1,650.6±26.6 1,945.0±38.4 1,432.6±24.4 <0.001 Excessive energy (%) >2,500/>2,000 14.1±1.2 14.9±1.8 13.6±1.5 0.507 Deficient energy (%) <1,600/<1,200 35.6±1.7 34.0±2.4 35.6±2.1 0.367 Protein (g/day) 50/45 53.7±1.1 64.0±1.7 46.0±1.0 <0.001 Carbohydrate (g/day) - 300.3±4.8 340.5±6.2 271.5±4.7 <0.001 Fat (g) - 23.7±0.7 29.4±1.2 19.5±0.6 <0.001 Calcium (mg/day) 700/700 418.6±12.5 474.1±22.4 378.8±17.1 <0.001 Phosphorus (mg/day) 700/700 972.8±18.6 1,148.7±27.6 846.6±17.4 <0.001 Iron (mg/day) 9/8 13.3±0.4 15.0±0.7 12.2±0.6 <0.001 Vitamin A (ng RE/day) 700/600 683.9±69.6 681.6±119.8 685.5±116.3 0.974 Thiamin (mg/day) 1.2/1.1 1.06±0.1 1.25±0.1 (1.0) 0.77±0.1 <0.001 Riboflavin (mg/day) 1.5/1.2 0.88±0.1 1.04±0.1 0.76±0.1 <0.001 Niacin (mg/day) 16/14 13.2±0.3 15.9±0.4 11.3±0.3 <0.001 Vitamin C (mg/day) 75/75 86.5±4.2 95.8±6.3 79.9±5.7 0.012 Potassium (mg/day) 3,500/3,500 2,521.6±68.6 2,908.8±99.5 2,243.8±82.6 <0.001 Sodium (mg/day) <2,000 3,913.1±101.6 4,701.5±156.9 3,347.6±100.5 <0.001 Excessive intake (%) >2 g 75.5±1.7 85.6±1.8 68.2±2.0 <0.001 Excessive intake (%) >4 g 38.1±1.7 49.6±2.6 29.8±1.7 <0.001 Sodium/potassium ratio 1:1 1.70±0.1 1.72±0.1 1.68±0.1 0.450 Values are presented as mean±standard error. DRI, dietary reference intakes for Koreans 2010 by the Korean Nutrition Society. *Calculated by general linear model or chi-square test. J Korean Geriatr Soc 18(4) December 2014 189
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly 3. 에너지섭취량과나트륨섭취량의연관성 Fig. 1은에너지섭취량과나트륨섭취량의나이를보정한상관관계를보여준다. 남녀모두에서에너지섭취량과나트륨섭취량은유의한양의상관관계를보인다 ( 남성 ; R 2 =0.249, 여성 ; R 2 =0.241). Table 3은에너지섭취정도에따른남녀나트륨 섭취량의차이를보여준다. 남녀모두에너지섭취량이과다한군에서나트륨섭취량이많았다. 에너지부족, 적절, 과잉섭취군으로갈수록나트륨을 4 g 초과섭취하는비율이남성에서 27.6±4.0%, 56.2±3.1%, 77.4±5.8%, 여성에서도 9.8±2.1%, 33.9 ±2.8%, 66.7±5.4% 로증가하였다. 에너지적절섭취군에비해에너지과잉섭취군이나트륨을 4 g 초과섭취할위험도가나이를보정한후, 남성이 2.51 배, 여성이 3.89 배로높았다. Fig. 1. Mean sodium intake according to energy intake in men (A) and women (B) by Pearson correlation analysis adjusting for age. r, partial correlation coefficient. Table 3. Sodium intakes according to energy intake status Variable Energy intake status Total Appropriate Insufficient Excessive p-value* Men Sodium intake (mg/day), mean±se 4,701.5±148.2 4,902.7±597.8 3,337.9±605.8 7,118.9±562.7 <0.001 Sodium intake >4 g/day <0.001 Mean±SE (, %) (n) 49.6±2.6 (307) 56.2±3.1 (170) 27.6±4.0 (55) 77.4±5.8 (82) OR(95% CI) - 1 0.31 (0.20 0.49) 2.51 (1.24 5.08) - Women Sodium intake (mg/day), mean±se 3,913.1±101.6 3,562.3±353.2 2,175.0±344.0 5,559.0±331.9 <0.001 Sodium intake >4 g/day <0.001 Mean±SE (, %) (n) 29.7±1.7 (255) 33.9±2.8 (147) 9.8±2.1 (25) 66.7±5.4 (83) OR(95% CI) - 1 0.22 (0.13 0.38) 3.89 (2.21 6.85) - Values are presented by the multivariate logistic regression analysis model adjusted for age. Insufficient energy intake: energy intake of <75% of estimated energy requierments; excessive energy intake: energy intake of >125% of estimated energy requirements; insufficient/appropriate/excessive intake: men, <1,600 kcal/day, 1,600-2,500 kcal/day, >2,500 kcal/day; women, <1,200 kcal/day, 1,200-2,000 kcal/day, >2,000 kcal/day. CI, confidence interval; OR, odds ratio. *Calculated by general linear model or chi-square test. 190 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 4. 나트륨과잉섭취와사회인구학적인자 Table 4는나트륨 4 g 이하섭취군과 4 g 초과섭취군간의사회인구학적인자의차이를보여준다. 남녀모두에서나트륨 4 g 초과섭취군이 4 g 이하섭취군보다나이가적고, 65세에서 74 세사이노인의비율이높았다. 남성에서나트륨 4 g 초과섭취군이 4 g 이하섭취군에비해체질량지수가다소높고걷기실천과외식을하는빈도가많았으며, 독거의비율이높았다. 반면, 여성은독거의비율이 4 g 이하섭취군에서 4 g 초과섭취군보다높았다. 또한여성에서나트륨 4 g 초과섭취군이 4 g 이하섭취군보다저작시불편감호소가적었고배우자와동거하는비율이높았다. 경제수준과교육수준은남녀모두에서나트륨섭취정도에따른그룹간의유의한차이를보이지않았다. 5. 에너지섭취정도에따른나트륨과잉섭취와관련된사회인구학적인자 Table 5와 Table 6은 4 g 초과나트륨섭취와사회인구학적인자의관련성을에너지부족, 적절, 과잉섭취군으로나누어, 나이와에너지섭취량을보정한로지스틱회귀분석결과이다. 남성에서 4 g 초과의나트륨을섭취할위험도가독거노인에서비독거노인보다약 2배가량증가하였다. 에너지섭취정도에따라세군으로나누었을때, 4 g 초과의나트륨을섭취할위험도가에너지적절섭취군 (1,600-2,500 kcal/day) 에서는 65-74세사이가 75세이상보다 1.74 배, 에너지부족섭취군 (<1,600 kcal/day) 에서는낮은가구소득이 2.63배, 에너지과잉섭취군 (>2,500 kcal/day) 에서는독거가 6.30배로높았다. 그외만성질환유병, 건강관련행태나교육수준은나트륨과잉섭취 Table 4. Characteristics of elderly subjects according to sodium intake Characteristics Men (n=635) Women (n=861) 4 g/day (n=328) >4 g/day (n=307) p-value* 4g/day (n=606) >4 g/day (n=255) p-value* Age (yr) 72.9±0.46 71.3±0.32 0.001 73.6±0.56 72.1±0.41 0.008 Age group (yr) 0.026 0.008 65 74 66.5±3.6 (210) 76.1±3.1 (215) 55.4±2.7 (340) 69.8±4.0 (189) 75 33.7±3.6 (118) 23.9±3.1 (92) 44.6±2.7 (266) 30.2±4.0 (66) Body mass index (kg/m 2 ) 23.1±0.24 23.6±0.19 0.031 24.6±0.31 24.2±0.27 0.223 Obesity (%) 26.8±2.8 (78) 27.6±3.1 (83) 0.825 42.1±2.5 (244) 34.8±3.4 (89) 0.055 Chronic diseases Hypertension (%) 52.5±3.4 (150) 45.4±4.0 (116) 0.176 62.2±2.7 (338) 54.1±4.1 (124) 0.093 Diabetes Mellitus (%) 18.3±2.4 (57) 17.0±2.7 (50) 0.722 17.0±1.7 (97) 16.5±3.3 (36) 0.901 Dyslipidemia (%) 12.0±2.6 (32) 12.1±2.5 (36) 0.973 19.1±2.2 (106) 21.4±4.0 (46) 0.541 Health related behavior Current smoker (%) 20.0±2.6 (60) 23.9±2.8 (68) 0.336 3.4±1.0 (14) 1.4±0.7 (4) 0.102 Alcohol drinker (%) 55.6±3.5 (160) 62.4±3.1 (168) 0.121 18.5±2.1 (95) 20.4±3.1 (50) 0.633 Regular walker (%) 35.4±3.2 (118) 46.5±3.3 (122) 0.012 26.5±2.4 (158) 30.8±4.2 (65) 0.360 Eating out (%) 66.2±3.4 (224) 77.1±3.1 (238) 0.013 57.6±2.6 (370) 61.7±4.0 (162) 0.344 Limitation of activity (%) 16.0±2.3 (54) 13.6±2.3 (34) 0.450 23.3±2.3 (120) 19.0±3.0 (37) 0.239 Difficulty in chewing (%) 42.7±3.3 (122) 40.6±3.1 (109) 0.622 53.0±2.6 (285) 41.4±4.5 (89) 0.030 Living with spouse (%) 93.6±1.6 (302) 89.2±2.1 (275) 0.080 43.7±2.5 (275) 54.0±3.7 (146) 0.021 Living alone (%) 4.6±1.3 (18) 9.1±1.8 (26) 0.046 27.7±2.1 (191) 18.6±2.6 (60) 0.010 House income 0.607 0.221 Low 43.6±3.9 (145) 40.8±4.0 (122) 57.1±2.4 (332) 51.5±4.5 (121) Low-middle 56.4±3.9 (178) 59.2±4.0 (177) 42.9±2.4 (268) 48.9±4.5 (130) Education level 0.507 0.484 No-Middle school 61.4±3.9 (171) 58.4±3.3 (155) 89.4±1.6 (483) 87.4±2.6 (194) High school 38.6±3.9 (124) 41.6±3.3 (122) 10.6±1.6 (67) 12.6±2.6 (36) Values are presented as mean±standard error or mean±standard error (number). *Calculated by general linear model or chi-square test. No education or elementary school or middle school graduate. J Korean Geriatr Soc 18(4) December 2014 191
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly Table 5. Odds ratio for excessive sodium intake (>4 g/day) in men according to energy intake by logistic regression Characteristic Total (n=635) Insufficient (<1,600 kcal/day) (n=207) Energy intake status Appropriate (1,600 2,500 kcal/day) (n=328) Excessive (>2,500 kcal/day) (n=100) Age group (yr) 65 74 1.21 (0.78 1.87) 0.92 (0.38 2.22) 1.74 (1.07 2.84) 0.14 (0.02 1.15) 75 1 1 1 1 Obesity 0.86 (0.56 1.32) 0.76 (0.34 1.68) 0.93 (0.54 1.62) 0.81 (0.19 3.40) Chronic diseases Hypertension 0.79 (0.51 1.22) 0.65 (0.31 1.39) 0.94 (0.53 1.66) 0.59 (0.14 2.47) Diabetes mellitus 1.03 (0.58 1.82) 0.99 (0.41 2.42) 1.14 (0.50 2.58) 0.91 (0.19 4.50) Dyslipidemia 0.88 (0.42 1.85) 0.85 (0.22 3.36) 0.88 (0.38 2.01) 0.99 (0.19 5.26) Health related behavior Current smoking 1.24 (0.77 1.99) 0.75 (0.27 2.07) 1.28 (0.67 2.47) 2.92 (0.47 17.94) Alcohol drinking 1.17 (0.78 1.74) 1.14 (0.52 2.53) 1.05 (0.59 1.87) 2.03 (0.49 8.48) Regular walking 0.74 (0.51 1.09) 1.08 (0.50 2.32) 0.69 (0.43 1.18) 0.54 (0.13 2.26) Eating out 1.34 (0.85 2.12) 1.02 (0.44 2.36) 0.60 (0.34 1.07) 1.21 (0.23 6.34) Limitation of activity 1.18 (0.70 2.01) 1.31 (0.57 3.00) 1.41 (0.70 2.85) 0.66 (0.10 4.62) Difficulty in chewing 1.15 (0.79 1.66) 0.84 (0.37 1.90) 1.39 (0.82 2.36) 0.86 (0.23 3.18) Living without spouse 1.93 (0.97 3.86) 2.55 (0.77 8.44) 2.11 (0.83 5.40) 0.63 (0.09 4.44) Living alone 2.08 (1.01 4.30) 2.72 (0.70 10.54) 1.38 (0.50 3.82) 6.30 (2.26 17.54) House income Low 1.13 (0.69 1.86) 2.36 (1.07 5.19) 0.87 (0.50 1.51) 0.61 (0.17 2.23) Low-middle 1 1 1 1 Education level No-middle school* 0.98 (0.65 1.47) 1.35 (0.63 2.89) 1.01 (0.60 1.71) 0.36 (0.12 1.08) High school 1 1 1 1 Values are presented as odds ratio (95% confidence interval) by the multivariate logistic regression analysis model adjusted for age, energy intake. Insufficient energy intake: energy intake of <75% of estimated energy requirements; excessive energy intake: energy intake of >125% of estimated energy requirements. *No education or elementary school or middle school graduates. 와유의한관련성을보이지않았다. 여성의경우, 에너지과잉섭취군에서당뇨병유병 (OR, 0.20; 95% CI, 0.07-0.60) 과음주 (OR, 4.46; 95% CI, 1.29-15.44), 그리고규칙적인걷기실천 (OR, 3.22; 95% CI, 1.15-9.03) 이나트륨과잉섭취와유의한관련이있었다. 여성에서소득과교육수준, 가족형태는나트륨과잉섭취와유의한관련성을보이지않았다. 고찰 이번연구는우리나라노인들의에너지섭취정도에따른나트륨섭취상태와나트륨과잉섭취와관련된사회인구학적인자를파악하고자우리나라노인의대표성을가지는국민건강영양조사를분석하였다. 그결과우리나라노인의대부분이 한국인영양섭취기준에서제시한목표섭취량의두배에가까운나트륨을섭취하고있으며, 특히남성과에너지섭취과잉상태인노인에서나트륨섭취량이많았다. 1998년국민건강영양조사가시작된이래나트륨과잉섭취는우리나라국민의주요영양문제로지속적으로거론되어왔다. 특히우리나라노인들은대부분의영양소섭취가부족함에도불구하고, 나트륨은과다하게섭취하는것으로보고되었다 19). 국가차원에서저염식이를정책적으로강조하고있지만이번연구결과우리나라노인의평균나트륨섭취량은남성 4.7 g, 여성 3.3 g으로 1998년국민건강영양조사의결과 ( 남성 4.3 g, 여성 3.7 g) 와비교해줄어들지않았다. 한편 2012 년국민건강영양조사결과로저자들이분석하였을때, 19세에서 64세사이성인은하루평균 5.0 g 정도의나트륨을섭취하는 192 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 Table 6. Odds ratio for excessive sodium intake (>4 g/day) in women according to energy intake by logistic regression Characteristic Total (n=861) Insufficient (<1,200 kcal/day) (n=293) Energy intake status Appropriate (1,200 2,000 kcal/day) (n=432) Excessive (>2,000 kcal/day) (n=136) Age group (yr) 65 74 1.62 (0.98 2.68) 2.46 (0.88 6.89) 1.56 (0.80 3.04) 1.25 (0.43 3.64) 75 1 1 1 1 Obesity 0.71 (0.50 1.01) 0.66 (0.21 2.02) 0.68 (0.41 1.14) 0.84 (0.33 2.17) Chronic diseases Hypertension 0.78 (0.52 1.18) 0.58 (0.20 1.68) 0.66 (0.39 1.11) 1.80 (0.73 4.42) Diabetes mellitus 1.10 (0.58 2.06) 1.15 (0.27 4.86) 1.66 (0.83 3.36) 0.20 (0.07 0.60) Dyslipidemia 0.95 (0.55 1.64) 1.77 (0.48 6.51) 0.79 (0.37 1.67) 1.03 (0.29 3.67) Health related behavior Current smoker 0.41 (0.11 1.59) 1.54 (0.61 38.67) 0.63 (0.12 3.40) 0.38 (0.02 9.20) Alcohol drinker 0.99 (0.57 1.69) 0.56 (0.14 2.30) 0.83 (0.43 1.64) 4.46 (1.29 15.44) Regular walker 0.92 (0.57 1.50) 0.63 (0.19 2.11) 0.98 (0.53 1.81) 3.22 (1.15 9.03) Eating out >1 wk 0.90 (0.60 1.35) 0.55 (0.20 1.49) 1.12 (0.65 1.92) 0.63 (0.22 1.82) Limitation of activity 0.94 (0.61 1.47) 0.39 (0.08 1.83) 1.08 (0.62 1.89) 1.73 (0.46 6.46) Difficulty in chewing 0.70 (0.44 1.12) 1.55 (0.45 4.32) 0.58 (0.33 1.03) 0.60 (0.23 1.53) Living without spouse 0.87 (0.57 1.33) 1.36 (0.44 4.17) 0.79 (0.47 1.31) 0.82 (0.30 2.28) Living alone 0.70 (0.45 1.07) 0.92 (0.30 2.78) 0.70 (0.44 1.10) 0.65 (0.24 1.78) House income Low 0.96 (0.64 1.45) 1.08 (0.36 3.25) 0.97 (0.59 1.62) 0.93 (0.37 2.31) Low-middle 1 1 1 1 Education level No-middle school * 1.13 (0.60 2.13) 1.72 (0.29 10.37) 0.96 (0.42 2.18) 1.75 (0.58 5.35) High school 1 1 1 1 Values are presented as odds ratio (95% confidence interval) by the multivariate logistic regression analysis model adjusted for age, energy intake. Insufficient energy intake: energy intake of <75% of estimated energy requirements; excessive energy intake: energy intake of >125% of estimated energy requirements. * No education or elementary school or middle school graduates. 것으로드러났다. 비노인층역시나트륨섭취량이 1998 년부터현재까지지속적으로높은실정이다 19). 이는최근저염식이를위한정책과교육프로그램이전연령대를걸쳐효과적으로적용되지못하고있다는것을의미한다. 짠맛에대한기호는식사량, 심리상태, 유전적요인등여러인자들의영향을받지만, 개인이속해있는사회의식생활문화로부터가장큰영향을받는다 20). 우리나라는전통적으로김치, 장, 장아찌등염장식품이많고탕, 찌개등국물요리가식사때마다거의빠지지않는다. 이러한식문화는한국인에서특히소금섭취가많은주요원인으로꼽힌다 21). 2008년국민건강영양조사에서도한국인나트륨의주요급원은채소류와조미료류였다 22). 그중배추김치가가장기여율이높았고이어각종절임채소와된장, 고추장, 쌈장, 간장등소금이 포함된발효식품이높은기여도를보였다 22). 이러한식품들은일상적으로거의매일끼니때마다섭취하는것들이기때문에특정식품의섭취를줄이는것으로는전체나트륨섭취량을줄이기힘들다. 또한한국인이섭취하는나트륨의대부분이짠맛을내기위해조리시나식탁에서첨가하는소금이라는연구결과가있다 23). 따라서저염식이를위해서는전반적인식생활개선이식품의선택, 조리, 섭취까지, 전과정에걸쳐필요하다. 이를위해서노인개인뿐만아니라, 식사를준비하는가족구성원들도음식섭취의종류, 조리방법, 음식구입등에대한중재가필요하다. 특히이번연구에서에너지과잉섭취시에나트륨 4 g 초과섭취위험이 2-3 배이상으로나타나전체섭취칼로리가초과되지않도록하는것이적당량의나트륨섭취를위해중요하겠다. J Korean Geriatr Soc 18(4) December 2014 193
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly 우리연구에서교육수준은나트륨과잉섭취와관련이없었는데, 이것은노인의경우짠음식이건강에좋지않다는것을알고있더라도저염식이를실천하기어렵기때문으로생각된다. 왜냐하면생리적으로는나이가들수록미각의감퇴로짠맛에대한역치가상승하고 11), 짠음식에대한선호도가현저히높아지기때문이다 20). 또한노인은수십년간고착된식습관을가지며, 삶의변화에대해소극적으로대처하는경향이있어저염식이를위한동기부여가쉽지않다 24). Bray 등 25) 의연구에서도나이가들수록저염식이실행도가현저히낮아졌다. 여러사회경제적지표중에서교육수준은직업과소득수준과관련된중요한인자이며, 건강관리와관련된정보를이해하고습득하는능력과도관련되어있다 26). 하지만노인에서는졸업이후의시간이많이경과하였고, 경제활동이나사회적활동이줄어들어교육수준이노인의식습관에미치는영향이미미할것이다. Bray 등 25) 과 Park 등 27) 의연구에서도교육수준에따른나트륨섭취량에차이가없었다. 따라서노인에서저염식이에대한교육효과가다른연령충에비해적을것이라예상되며, 지속적이고반복적인교육방식이요구된다. 또한이번연구는남성중에너지섭취가적은군을제외한남녀모두에서소득수준이나트륨과잉섭취와관련이없음을보였다. 이는이전국민건강영양조사분석결과와도 28) 일치하는부분이다. 이러한결과는나트륨의주요급원식품인김치나조미료류가일상적으로먹을수있는것이라서소득의영향을크게받지않기때문으로생각된다. 반면나트륨이외영양소에대한연구들에서는낮은소득수준이불량한영양소섭취와관련이있었다 14,15,29). 이렇게소득수준이나트륨과그외영양소섭취에미치는영향이다른이유는주요급원식품의섭취양상이다르기때문이다. 소득수준이높은경우, 미세영양소의급원식품인채소류, 과실류, 버섯류, 우유류섭취량이높은반면곡류섭취량은소득이낮거나높은군간에차이가없었다 30,31). 곡류섭취는김치나된장등을이용한식품의섭취를동반하기때문에나트륨섭취량도소득수준이다른군간의차이가적었을것이다. 반면이번연구에서에너지섭취가부족한노인남성에서는낮은소득수준이나트륨과잉섭취와관련이있었다. 이는남성이소득이낮을경우경제적인이유로식품에대한접근성과다양성에제한을받기때문으로생각된다. 이러한집단은칼로리는낮으면서짠음식의섭취가많을수있음을의미하며, 영양섭취에있어취약 한집단이기때문에영양적보조와관심이더욱필요하겠다. 이전제 3기국민건강영양조사에서도노인의소득수준에따른영양섭취의차이보다노인층자체의특성으로인해영양섭취에차이가있는것으로조사되었다 28). 우리연구에서도 75세이상의노인남성이 65-74 세의노인남성보다나트륨과잉섭취위험도가낮은것으로나타났다. 이는나이가들수록소화와저작능력이저하되어식품섭취량자체가줄어들기때문으로생각된다 32). 반면, 여성의경우에너지섭취량이과다한노인여성에서술을마시는것이나트륨과잉섭취와관련이있었다. 이는여성의경우음주시에안주류의섭취가잦고, 이를통해나트륨섭취량이증가한것으로생각된다. 이전국민건강영양조사에서도음주하는노인여성에서비음주군보다나트륨섭취량이많았다 33). 따라서음주하는노인여성의균형잡힌식습관에대한주의가필요하다. 또한에너지를과잉섭취하는노인여성에서걷기실천이오히려나트륨과잉섭취위험도증가와관련이있었다. 보통규칙적으로운동을하는경우, 식욕과신체기능이비교적양호하고전반적으로식품섭취량이높은것으로알려져있다 34). 그리고이전국민건강영양조사결과노인여성의경우, 운동을규칙적으로하는군이운동을하지않는군보다쌀, 보리등의곡류와두류, 채소류와육류의섭취량이높았다 33). 이러한결과들로미루어볼때규칙적으로걷기를실천하는노인에서증가된곡류섭취는김치나반찬류의섭취를동반하기때문에나트륨섭취량역시증가하였을것이다. 또한채소류의조리와섭취방법에있어서도나트륨섭취량이초과될수있으므로주의를기울여야한다. 반면, 고혈압등의만성질환유병여부는나트륨섭취와유의한관련이없었다. 특히고혈압은 65세이상노인에서 50 % 가넘는유병률을보이고있는데, 많은노인고혈압환자들이저염식이를제대로실천하지못하고있음을의미한다. 나트륨섭취에따른혈압상승의정도로정의되는염분민감도 (salt sensitivity) 는나이가들수록증가하여, 노인의혈압증가를더욱악화시킨다 35). 저염식이는고혈압환자에서수축기혈압을평균 11.5 mmhg 감소시키며, 고혈압이없는사람에서도 7.1 mmhg 의혈압감소효과가있어약물치료이외에가장중요한치료이다 36). 하지만 Lee 등 37) 은노인고혈압환자들이저염식이가혈압조절을위해중요하다고인식하고있지만, 가장실천하기어려운건강관련행위로보고한바있다. 194 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 Kwak 등 38) 의연구에서도노인고혈압환자들중 86% 가짠음식을먹지않는다고응답하였지만, 실상은나트륨을 4,442 mg 정도로과잉섭취하고있었다. 이는인식과실행이일치하지않음을보여주며, 저염식이를실천할수있는실질적인교육프로그램을만들어야한다. 이번연구에서남성은독거노인의경우나트륨과잉섭취와연관이있는것으로나타난반면, 여성은독거가관련이없었다. 이는나트륨섭취량은대부분식사를조리하거나준비하는과정에서결정되는데, 노인남성은본인이식사를준비하기보다배우자나자녀등의동거가족이식사를준비해주는경우가많은반면, 노인여성은직접자신의식사를준비하는경우가많기때문에여성에서는혼자사는것이나트륨섭취량과유의한관련성을보이지않은것으로생각된다. 독거하는노인남성은나트륨과잉섭취뿐아니라, 다른연구에서도영양소섭취상태가불량한것으로드러났다. 그이유로혼자사는노인남성은섭취하는음식과식품의종류가다양하지못하고, 식생활이질과양적으로불량하기때문이다 39,40). 따라서독거노인, 특히남성의나트륨과잉섭취와불량한영양소섭취에대한관심과주의가필요하겠다. 그리고우리연구에서남녀모두가칼륨은충분섭취량의약 70% 만섭취하고있었고, 나트륨 / 칼륨비가권장수준인 1:1 에비해 6) 1.7:1 로높았다. 이는우리나라사람들이칼륨의주요급원인채소류를대부분김치로섭취하기때문이다. 특히노인은소화및저작능력의저하로채소를생으로먹기보다무치거나조리는등양념한형태로섭취하는경우가많다 21). 따라서채소류를조리하고섭취할때소금을적게사용할수있는방법을모색하여야할것이다. 현재우리나라와세계보건기구는만성질환의예방과관리를위해나트륨을 2 g 이하로섭취하도록권장하고있다 6,7). 하지만한편으로는노인에게나트륨섭취를지나치게제한하였을때심혈관질환의발생과사망률이증가했다는연구결과들도발표되고있다 41). 오히려하루평균 4-6 g 정도의나트륨을섭취하였을때사망률이가장낮았다고보고하고있다 42). 이러한결과의원인으로원저자들은지나친저염식이가교감신경계와레닌-안지오텐신호르몬계 (renin-angiotensin system) 를과활성화시키고, 혈중중성지방수치가상승시키기때문이라고본다. 또한나트륨함량이많은식품들이다른유익한미네랄도함유하고있기때문에이러한식품들을제한하는 것은다른미량영양소섭취를덩달아부족하게할수있다. 더욱이노인의경우저염식단은식욕을저하시켜전체적인식품섭취량을줄일수있기때문에노인에게저염식이를권유할때는매우조심스러워야한다. 단순히싱겁게먹기를강조해서는안되며, 적절한양의나트륨섭취와함께다른영양소섭취가부족하지않도록해야한다. 본연구는국민건강영양조사를이용하여우리나라전체노인의에너지및나트륨섭취상태를반영할수있었다는장점이있지만, 단면연구이기때문에나트륨섭취와사회경제적인자간의인과관계를정확히파악할수없다는제한점을가진다. 무엇보다단하루동안의식이섭취조사만으로나트륨섭취량이산출되었기때문에평소노인들의나트륨섭취량을추정하는데에는한계가있다. 또한노인의식이섭취를 24시간회상법을통해조사하였기때문에연령대가높은노인의경우, 영양설문조사의정확성이떨어질수있다 43). 그리고에너지섭취정도에따른분류가각개인의활동량과체중, 신장을사용하여산출된필요에너지가아닌, 한국인영양협회에서제시한기준에따라나누었기때문에실제와차이가있을수있다. 결론적으로이번연구결과우리나라노인의대부분이에너지섭취량에관계없이하루 2 g 이상의나트륨을섭취하고있었다. 이는노인의나트륨과잉섭취가다른어떤사회경제학적인자에의한결과라기보다노인들이일상적으로섭취하는반찬류의선택이나조리방법에서나트륨이과도하게첨가되기때문으로생각된다. 따라서노인에서나트륨섭취를줄이기위한노력은사회경제적위치를막론하고, 전계층에걸쳐이루어져야한다. 이를위해서노인들이음식을선택하거나조리할때좀더실질적으로실천가능한방법이강구되어야할것이다. 예를들면나트륨함량이적은조미료를제공하거나저염김치를담가주고저염장을이용한음식조리방법을교육하는것이도움이될것이다. 또한저염식단의급식이나도시락, 음식가정배달프로그램도한방법이될수있다. 특히경제수준이낮고독거인노인남성의경우나트륨과잉섭취의위험이높게나타나독거인의증가추세를고려해장기적이고지속적인영양교육프로그램마련이필요하다. 요약 연구배경 : 노인들의영양소섭취부족에대한연구는많으 J Korean Geriatr Soc 18(4) December 2014 195
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly 나나트륨과잉섭취와관련된사회인구학적인자에대한연구는부족하다. 이에본연구는에너지섭취량에따른한국노인의나트륨과잉섭취상태와이와관련된사회인구학적인자를파악하고자한다. 방법 : 제 5기 3차년도 (2012 년 ) 국민건강영양조사중건강설문, 검진, 영앙조사에참여한 65세이상노인총 1,496 명 ( 남성 635명, 여성 861명 ) 을대상으로하였다. 24시간식이섭취조사결과를이용하여나트륨과에너지섭취량을산출하였다. 하루에너지섭취정도에따라남성은 1,600 kcal/day, 1,600-2,500 kcal/day, 2,500 kcal/day 초과, 여성 1,200 kcal/day, 1,200-2,000 kcal/day, 2,000 kcal/day 초과로에너지섭취부족, 적절, 과다세그룹으로분류하였다. 각그룹에서하루나트륨섭취 4 g 초과와관련된사회인구학적인자를로지스틱회귀분석으로확인하였다. 결과 : 평균나트륨섭취량은남성 4.7g/day, 여성 3.3g/day 였고, 약절반의남성이 4 g 이상의나트륨을섭취하고있었다. 에너지과잉섭취군이에너지적절섭취군에비해나트륨 4 g 초과섭취위험이남성에서 2.51 배 (95% CI, 1.24-5.08), 여성은 3.89배 (95% CI, 2.21-6.85) 로높았다. 남성의경우에너지부족섭취군에서는낮은가구소득 (OR, 2.36; 95% CI, 1.07-5.19) 이, 에너지과잉섭취군에서는독거 (OR, 6.30; 95% CI, 2.26-17.54) 가나트륨과잉섭취와관련이있었다. 여성에서는에너지과잉섭취군에서음주 (OR, 4.46; 95% CI, 1.29-15.44) 와걷기실천 (OR, 3.22; 95% CI, 1.15-9.03) 이나트륨과잉섭취와유의한관련성을보였다. 결론 : 우리나라대부분의노인이에너지는부족하게, 나트륨은과다하게섭취하고있으며, 특히남성, 소득수준이낮은경우, 독거가나트륨과잉섭취와유의한관련성을보였다. 노인에서주요영양소의충분한섭취와더불어적절한양의나트륨섭취를위해영양학적보조와관심이필요하겠다. 이해관계명시 (Conflict of Interest Disclosures) : 저자 ( 들 ) 은본논문과관련하여이해관계의충돌이없음을천명합니다. REFERENCES 1. Yu SH, Kwon MK, Lee YH, Kim HJ, Lee JJ, Park JH, et al. Effects of eating behaviors on health-related parameters in the elderly living in Seongnam city (Korean Longitudinal Study on Health and Aging study). J Korean Geriatr Soc 2008;12:138-45. 2. Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract 2006;12:110-8. 3. Adrogue HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007;356:1966-78. 4. Chobanian AV, Hill M. National heart, lung, and blood institute workshop on sodium and blood pressure: a critical review of current scientific evidence. Hypertension 2000;35: 858-63. 5. Tsugane S. Salt, salted food intake, and risk of gastric cancer: epidemiologic evidence. Cancer Sci 2005;96:1-6. 6. World Health Organization. Guideline: Sodium intake for adults and children [Internet]. Geneva: World Health Organization; c2014 [cited 2014 Jul 21]. Available from: http://www.who.int/nutrition/publications/guidelines/sodium_intake/en/. 7. The Korean Nutrition Society. Dietary reference intakes for Koreans [Internet]. Seoul: The Korean Nutrition Society; c2014 [cited 2014 Aug 14]. Available from: http://www.kns.or.kr/download/2010kdris_open_final.pdf. 8. Ministry of Health & Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics: results from Korea National Health and Nutrition Examination Survey (KNHANES V-2), 2011 [Internet]. Cheongwon: Korea Centers for Disease Control and Prevention; c2014 [cited 2014 Aug 14]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?class- Type=7. 9. Koo S, Kim Y, Kim MK, Yoon JS, Park K. Nutrient intake, lifestyle factors and prevalent hypertension in Korean adults: results from 2007-2008 Korean National Health and Nutrition Examination Survey. Korean J Community Nutr 2012;17: 329-40. 10. Nan HM, Park JW, Song YJ, Yun HY, Park JS, Hyun T, et al. Kimchi and soybean pastes are risk factors of gastric cancer. World J Gastroenterol 2005;11:3175-81. 11. Appel LJ, Espeland MA, Easter L, Wilson AC, Folmar S, Lacy CR. Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med 2001;161:685-93. 12. Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol A Biol Sci Med Sci 2001;56 Spec No 2:54-64. 13. Meydani M. Nutrition interventions in aging and age-associated disease. Ann N Y Acad Sci 2001;928:226-35. 14. Kwon SO, Oh SY. Associations of household food insecurity with socioeconomic measures, health status and nutrient in- 196 J Korean Geriatr Soc 18(4) December 2014
탁영진외 : 노인의나트륨과잉섭취와관련된인자 take in low income elderly. Korean J Nutr 2007;40:762-8. 15. Yim KS, Lee TY. Sociodemographic factors associated with nutrients intake of elderly in Korea. Korean J Nutr 2004;37: 210-22. 16. National Rural Living Science Institute. The 7th food composition table in Korea in 1996, 2001, 2006. Suwon: National Rural Living Science Institute; 2006. 17. Ministry of Health and Welfare, Korea Health Industry Development Institute. Development of recipe database for Korea health and nutrition examination (in Korean). Cheongju: Korea Health Industry Development Institute; 1998. 18. Korean Agency for Technology and Standards, Ministry of Commerce, Industry and Energy. Korea human scale. Eumseong: Ministry of Commerce, Industry and Energy; 2003. 19. Ministry of Health and Welfare, Korea Institute for Health and Social Affairs. Korea National Health and Nutrition Survey 1998, 2001, 2005, 2007-2009 (in Korean). Seoul: Korea Institute for Health and Social Affairs; 1999. 20. Nordin S, Razani LJ, Markison S, Murphy C. Age-associated increases in intensity discrimination for taste. Exp Aging Res 2003;29:371-81. 21. Lee HS, Duffey KJ, Popkin BM. Sodium and potassium intake patterns and trends in South Korea. J Hum Hypertens 2013; 27:298-303. 22. Ministry of Health and Welfare and Family Affairs, Korea Centers Disease Controls & Prevention. Analyses of the 4th national health and nutrition examination survey: The health survey part. Seoul: Korean Center for Disease Control and Prevention; 2009. 23. Lee C, Kim DI, Hong J, Koh E, Kang BW, Kim JW, et al. Cost-benefit analysis of sodium intake reduction policy in Korea. Korean J Community Nutr 2012;17:341-52. 24. Yim KS, Min YH, Lee TY, Kim YJ. Strategies of improve elderly nutrition through nutrition education: evaluation of the effectivenss of the program. Korean J Community Nutr 1999;4:207-18. 25. Bray GA, Vollmer WM, Sacks FM, Obarzanek E, Svetkey LP, Appel LJ, et al. A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. Am J Cardiol 2002;94:222-7. 26. Johansson L, Thelle DS, Solvoll K, Bjorneboe GE, Drevon CA. Healthy dietary habits in relation to social determinants and lifestyle factors. Br J Nutr 1999;81:211-20. 27. Park HS, Lee YM, Kang HJ, Choi YO, Bae ES. The effect of hypertension regulating education program on reduced blood pressure physiological parameters, self-care and selfefficacy. J Korean Gerontol Nurs 2002;4:38-48. 28. Ministry of Health and Welfare, Korea Health Industry Development Institute. Korea Centers for Disease Control and Prevention: In-depth Analysis on the 3rd (2005) Korea Health and Nutrition Examination Survey (KNHANES III) -Nutrition survey- Cheongju: Korea Health Industry Development Institute; 2007. 29. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004;79:6-16. 30. Kim MK, Kim K, Shin MH, Shin DH, Lee YH, Chun BY, et al. The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older. Nutr Res Pract 2014;8:453-62. 31. Moon HK, Choi SO, Kim JE. Dishes contributing to sodium intake of elderly living in rural areas. Korean J Community Nutr 2009;12:123-36. 32. Park JE, An HJ, Jung SU, Lee Y, Kim CI, Jang YA. Characteristics of the dietary intake of Korean elderly by chewing ability using data from the Korea National Health and Nutrition Examination Survey 2007-2010. J Nutr Health 2013;46: 285-95. 33. Ministry of Health and Welfare, Korea Health Industry Development Institute. In-depth analyses of the second national health and nutrition examination survey: Nutrition survey part I. Cheongju: Korea Health Industry Development Institute; 2003. 34. Position of the American Dietetic Association: nutrition, aging, and the continuum of care. J Am Diet Assoc 2000;100: 580-95. 35. Schiffman SS, Gatlin CA. Clinical physiology of taste and smell. Annu Rev Nutr 1993;13:405-36. 36. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10. 37. Lee YH, Kim HK, Kwon KH. Compliance with a low-salt diet, sodium intake, and preferred salty taste in the hypertensive elderly. J Korea Community Health Nurs Acad Soc 2010;24:311-22. 38. Kwak EH, Lee SL, Lee HS, Kwun IS. Relation dietary and urinary Na, K, and Ca level to blood pressure in elderly people in rural area. Korean J Nutr 2003;36:75-82. 39. Shin SK, Kim HJ, Choi BY, Lee SS. A comparison of food frequency for the elderly regarding different family types: based on community health survey for 2008. Korean J Nutr 2012;45:264-73. 40. Kharicha K, Iliffe S, Harari D, Swift C, Gillmann G, Stuck AE. Health risk appraisal in older people 1: are older people living alone an at-risk group? Br J Gen Pract 2007;57:271-6. 41. Cohen HW, Hailpern SM, Fang J, Alderman MH. Sodium J Korean Geriatr Soc 18(4) December 2014 197
Young-Jin Tak, et al: Excessive Sodium Intake and Related Factors in Elderly intake and mortality in the NHANES II follow-up study. Am J Med 2006;119:275.e7-14. 42. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011;305:1777-85. 43. Kye S, Kwon SO, Lee SY, Lee J, Kim BH, Suh HJ, et al. Under-reporting of energy intake from 24-hour dietary recalls in the Korean National Health and Nutrition Examination Survey. Osong Public Health Res Perspect 2014;5:85-91. 198 J Korean Geriatr Soc 18(4) December 2014