KJFPpISSN 2233-9019 eissn 2233-9116 Original Article 총신체체지방과영양표시사용의연관성 : 제 5 기국민건강영양자료 2010~2011 방명희, 이창윤, 김지현, 조경환, 김양현 * 고려대학교의료원가정의학과 The percentage of total body fat and nutrition label use in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey 2010~2011(KNHANES V) Myung Hee Bang, Chang Yun Lee, Ji Hyeon Kim, Kyung-Hwan Cho, Yang Hyeon Kim * Department of Family Medicine, Korea University School of Medicine, Seoul, Korea Background: Proper recognition and analysis of nutrition labels is one of the most important strategic approaches to eating healthily. This study examined the relationship between the total body fat and nutrition label use in the 2010~2011 Korea National Health and Nutrition Examination Survey(KNHANES). Methods: A total of 11,827 subjects(4,905 men and 6,922 women) participated in the study. Subjects were divided into 3 groups by gender, non-recognition of nutrition label(nr), recognition but non-use of nutrition label(rnu), and recognition and use of nutrition label(ru). Nutrition label use was assessed by a self-questionnaire included in the KNHANES. Multivariable logistic regression analysis was used to examine the relationship between total body fat and nutrition label use. Results: The relationship between nutrition label use and total body fat differed according to gender. After adjusting for age, household income, education level, nutrition education, smoking, drinking, and regular exercise, nutrition label use showed a statistically significant relationship with prevalence of obesity, as indicated by total body fat. Conclusion: Prevalence of obesity was associated with nutrition label use in Korean men. Therefore, a nutritional education program should be implemented in order to instruct consumers on proper use of nutrition labels. Keywords: Obesity, Total body fat, Nutrition label, Korea National Health and Nutrition Examination Survey 서론 식이를기반으로하고있으며, 이를위해올바른식이교육이필요 하다. 6, 7) 이를위해여러나라에서식품의영양표시제도를시행하고 비만은전세계적으로여러노력을하고있으나그유병률은점점높아져가고있다. 1) 비만은삶의질을떨어뜨릴뿐아니라이상지질혈증, 당뇨, 고혈압과같은대표적인질환뿐만아니라기타만성질환과심혈관질환및암의위험인자로알려져있다. 2, 3) 비만의원인으로고지방식이및고탄수화물식이를기반으로한칼로리의섭취및신체활동감소가그원인으로생각되고있다. 이러한잘못된생활습관을개선하기위해서는흡연, 음주, 운동부족과같은생활습관교정뿐만아니라올바른영양섭취가중요하다. 4, 5) 비만치료를위한영양섭취의개선은총섭취열량의감소, 저지방, 저탄수화물 있으며, 8) 한국에서도 식품위생법 에따라식품의 1회제공량에대한영양소함량과영양소기준치, 9가지의무표시영양소 ( 열량, 탄수화물, 단백질, 포화지방, 트랜스지방, 콜레스테롤, 나트륨, 기타 ) 를제품에표기하고있다. 9) 이러한영양소표시의사용은젊은연령, 높은사회경제적지표에서높게나타나며, 기저질환등여러요인에따라영향을받는다고알려져있다. 10, 11) 한국의한연구에서는이러한영양표시의사용이대사증후군의발생감소와관련이있다고보고하였다. 12) 이에본연구에서는비만의측정방법중하나인총지방으로본 Received August 24, 2015 Revised August 24, 2015 Accepted September 7, 2015 Corresponding Author Yang Hyeon Kim Tel: +82-2-920-5027 E-mail: mrchir@naver.com Copyright 2015 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 604 www.kafm.or.kr
방명희외. 총신체체지방과영양표시사용의연관성 : 제 5 기국민건강영양자료 2010~2011 KJFP 비만유병률과영양표시이용과의관계를전체한국인을대상으로알아보았다. 방법 1. 연구대상국민건강영양조사 (KNHANES) 제5기 1차, 2차년도 (2010년 ~2011년 ) 에서만 19세이상의성인 12,575명 ( 남자 5.395명, 여자 7,180명 ) 을본연구대상으로선정하였으며, 영양표시에대한질문 ( 인식, 이용문항 ) 에답하지않은대상자를제외하여총 11,827명 ( 남자 4,905명, 여자 6,922명 ) 을연구에포함시켰다. 2. 인구-사회학적요인국민건강영양조사설문지를이용하여영양표시인식과연령, 성별, 가계수입수준, 교육수준, 배우자유무, 직업의유무, 거주지의상관관계를분석하였다. 가계수입수준은가족의수를보정하여 4분위로계산하였으며교육수준은초졸이하, 중졸, 고졸, 대졸이상으로분류하여분석하였다. 배우자와직업은유무로나누어분석하였고거주지역은도시와지방으로나누어분석하였다. 3. 일반건강행태요인일반건강행태로는현재흡연유무, 음주유무, 주기적운동유무를작성된설문지를이용하여분석하였다. 현재흡연자는최근흡연을지속하고 100개피이상을담배를흡연한자로정의하였으며, 고위험음주자는하루 30g 이상의알코올을섭취하는자로정의하였다. 규칙적인운동은주 5회이상증등도의강도로 30분이상운동을하는자또는주 3회이상격렬한운동을 20분이상하는자로정의하여분석에이용하였다. 4. 신체계측과총지방량측정훈련된신체계측자로부터체중 (Kg) 과신장 (m) 을특정하였다. 총지방량은 whole-body DEXA(QDR 4500A fan-beam densitometer, Hologic Inc., Bedford, MA) 를이용하여측정하고한국골다공증학회의 Hologic Discovery Software(version 13.1, Hologic Inc., Bedford, MA) 를이용한표준방법에의해분석하였다. 총지방량은다음공식을이용하여계산하였으며 Total body fat percentage(ptbf): total body fat mass/total body mass(fat mass ±lean mass ±total body mineral content) *100. 총지방량을통한비만의기준은남성은 ptbf >25%, 여성은 ptbf >32% 로정하여분석하였다. 5. 영양섭취조사와영양표시인식국민건강영양조사의영양조사부분중 24시간회상법을통한영양소섭취기록을분석하여 1일영양소섭취량을분석하였으며, 영양표시를알고계십니까?, 가공식품을사거나고를때영양표시를읽으십니까? 에대한답변을이용하여 영양표시를알지못하는그룹 (NR), 영양표시를알고있으나사용하지않는그룹 (RNU), 영양표시를알고있고사용하는그룹 (RU) 으로나누어비만과의연관성을분석하였고 영양표시항목에서가장관심있게보는영양소는무엇입니까?; 질문을이용하여영양표시사용그룹에서관심있는영양소를정상과비만군으로나누어분석하였다. 6. 통계분석연구결과의통계분석을위하여 SAS university version을사용하였으며국민건강영양조사시사용된각개인별가중치를적용하여집착추출변수 (Psu), 분산추정치 (Kstrata) 를이용한통계처리하였다. 영양표시사용에따른대상자의기본적인특성은 chi-square test와 t-test를이용하여평균과표준오차또는백분율을사용하여제시하였으며, 다중회귀분석 (Multivariate logistic regression analyses) 을통해 odds ratios(ors) and 95 % confidence index(ci) 로영양표시와총체지방량과의관련성을분석하였다. 모든분석에서유의수준은 p<0.05로하였다. 결과연구대상자들의성별에따른영양표시인지및이용에따른일반적특성을표1에제시하였다. 남성과여성대상자모두공통적으로 NR그룹에비하여 RU 그룹에서대상군의평균연령이유의적으로감소하였으며, 가계소득수준과교육수준이증가하였으며, 도시거주자와영양교육을받은과거력이있는대상자의비율이증가하였다. 차이점으로는남성의경우배우자가있다고응답한비율이 NR군에서가장높게나타났으나 (86.8%), 여성의경우 RNU 군에서가장높게나타났다 (77.4%). 영양섭취조사에서는남녀모두 NR 군에서에너지섭취량이가장낮게나타났으며 (2347.2Kcal/day, 1538.0Kcal/day) RNU에비하여 RU 군에서에너지섭취량은감소하였으나지방과단백질의비율이증가하고당류의비율은 NR 군에비하여 RU 군에서모두유의적으로감소하는것으로나타났다 (P<0.001). Table 2에서는대상자를성별로나누어남자 ptbf 25% 이상, 여자 32% 이상을기준으로한비만의유병률을영양표시인지및활용에따라알아보았다. 남성비만의경우 RNU 군의비율이가장높았으며 (48%), RU군에서크게감소하는것으로나타났다 (14.7%), 여성에서도비만의유병률은 RNU(36.3%) 군에서가장높았고 www.kafm.or.kr 605
KJFP Myung Hee Bang, et al. The percentage of total body fat and nutrition label use in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey 2010~2011(KNHANES V) Table 1. General characteristics of study participants Male Female Characteristics NR * (n=2058) RNU (n=2236) RU (n=609) p-value NR (n=2520) RNU (n=2395) RU (n=2007) p-value Age (yrs) 61.2(0.4) 45.4(0.4) 39.6(0.6) <.001 64.5(0.3) 44.9(0.3) 39.3(0.3) <.001 Household income (quartile 1st,%) 33.1(1.2) 10.6(0.7) 8.2(1.2) <.001 42.8(1.2) 10.9(0.8) 7.5(1.7) <.001 Education (>13yrs,%) 16.0(1.1) 44.8(1.2) 53.6(2.2) <.001 4.2(0.4) 31.3(1.2) 48.4(5) <.001 Spouse (Yes,%) 86.8(0.8) 78.8(0.9) 66.2(2.0) <.001 61.0(1.1) 77.4(0.9) 74.4(1.1) <.001 Occupation (Yes,%) 64.7(1.3) 80.9(1.0) 77.0(2.0) <.001 42.0(1.3) 51.1(1.1) 47.3(1.2) <.001 Urban (%) 68.7(2.6) 83.8(1.8) 85.9(2.0) <.001 65.8(2.8) 84.7(1.7) 87.7(1.7) <.001 Current smoker (%) 37.3(1.1) 41.4(1.2) 41.1(2.1) 0.03 4.2(0.4) 4.9(0.5) 4.8(0.5) 0.45 Heavy drinking (%) 22.1(1.2) 23.8(1.0) 23.6(1.9) 0.53 2.8(0.5) 5.8(0.6) 6.8(0.7) <.001 Regular exercise (%) 7.2(0.8) 8.1(0.7) 8.6(1.2) 0.50 8.5(0.8) 6.5(0.7) 6.5(0.7) 0.04 Nutrition education history (yes, %) 3.2(0.4) 2.4(0.3) 5.7(1.0) <.001 3.4(0.4) 4.7(0.4) 6.8(0.6) <.001 Energy intake (Kcal/day) 2347.2(33.9) 2538.6(25.1) 2524.74(54.0) <.001 1538.0(18.2) 1796.0(18.3) 1771.1(19.0) <.001 Fat_per (%) 8.3(0.2) 10.6(1.3) 11.9(0.3) <.001 6.1(0.1) 9.7(0.1) 10.5(0.1) <.001 Protein_per (%) 16.1(0.2) 18.0(0.2) 18.4(0.3) <.001 13.9(0.1) 16.2(0.1) 17.0(0.1) <.001 Carbohydrate_per (%) 75.5(0.3) 71.4(0.2) 69.7(0.5) <.001 80.0(0.3) 74.1(0.2) 72.5(0.2) <.001 * NR: non-recognition of nutrition label RNU: recognition but non-use of nutrition label RU: recognition and use of nutrition label P values were obtained by chi-square test for categorical variables. Data are presented as Mean±SE or percentages(%) Table 2. Obesity percentage by the definition of total body fat according to the nutrition labels Characteristics Male Female NR * RNU RU p-value NR RNU RU p-value ptbf 37.1(1.3) 48.0(1.2) 14.7(0.8) 0.01 31.0(1.5) 36.3(1.3) 32.6(1.3) <0.001 * NR: non-recognition of nutrition label RNU: recognition but non-use of nutrition label RU: recognition and use of nutrition label P values were obtained by chi-square test for categorical variables Data are presented as Mean±SE or percentages (%) ptbf: percentage of total body fat: percentage of total body fat was calculated as follows : total body fat mass/total body mass(fat mass + lean mass + total body mineral content) * 100. (Male>25%, Female>32%) RU(32.6%) 로남성에비해영양표시사용비율은높은것으로나타났다 (14.7% vs 32.6%). Table 3에서는다중회귀분석을이용하여연령, 경제수준, 교육수준, 영양교육유뮤, 건강행태등을보정하여영양표시사용이총체지방량으로본비만유병률과통계적관련이있는지를분석하였다. 여성에서는모든그룹에서변수보정에따라체지방량에따른비만유병률과관련이없었으나, 남성에서는 RNU 군에서모든변수를보정한후에 RU 군에비해서 39% 정도비만유병이더증가하는것으로나타났다 (OR 1.39 and 95% CI 1.05~1.84). Figure 1에서는영양표시를사용한다고답한대상자 (RU군) 중비만군과정상군에서영양표시중관심영양소의차이가있는지분석 하였다. 국민건강영양조사설문지상의관심영양소 10가지를전체백분율로나누어정상과비만의경우관심도를살펴보았다. 남성의경우정상에비해비만군에서에너지와트랜스지방, 포화지방산, 나트륨의관심도가증가하였으나당류와단백질에대한관심도는감소된것으로나타났다. 여성의경우에는정상군에비해비만군에서당류과지방, 콜레스테롤, 포화지방산의관심도는증가하였으나에너지, 당류, 나트륨에대한관심도는감소하는것으로나타났다. 위결과로남녀가관심있는영양소의차이를보이고비만과관련된에너지, 당류, 지방에대해남성의경우에너지에대한관심만증가하였고, 여성은에너지에대한관심도가오히려감소된것으로나타났다. 606 www.kafm.or.kr
방명희외. 총신체체지방과영양표시사용의연관성 : 제 5 기국민건강영양자료 2010~2011 KJFP Table 3. Subject characteristic according to awareness of nutrition labels by obesity prevalence in adults Male Female Characteristics NR * OR(95% CI) RNU OR(95% CI) RU OR(95% CI) NR OR(95% CI) RNU OR (95% CI) RU OR (95% CI) Model 1 1.04(0.80-1.35) 1.15(0.93-1.42) 1 0.82(0.64-1.04) 0.89(0.74-1.06) 1 Model 2 1.07(0.81-1.40) 1.14(0.89-1.44) 1 0.83(0.65-1.08) 0.93(0.76-1.11) 1 Model 3 1.32(0.96-1.81) 1.39(1.05-1.84) 1 0.83(0.60-1.15) 0.91(0.72-1.14) 1 * NR: non-recognition of nutrition label RNU: recognition but non-use of nutrition label RU: recognition and use of nutrition label OR (95% CI) (Odd ratio(95 % confidence index)) were obtained by multivariable logistic regression analysis compared to RU Model 1 is adjusted for age. Model 2 is adjusted for model 1 plus household-income, education and nutrition education Model 3 is adjusted for model 2 plus current smoking, heavy drinking and regular exercise Figure 1. Interest nutrient in nutrition label between non-obese and obese participants in RU group. (A) Male, (B) Female. The participants who responded to use nutrition label(ru group), select the one interest nutrient in nutrition labeling, and analyzed in order to compare sex and obesity and normal (A): results of male, (B): results of female www.kafm.or.kr 607
KJFP Myung Hee Bang, et al. The percentage of total body fat and nutrition label use in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey 2010~2011(KNHANES V) 고찰 요약 본연구에서는국민건강영양조사를토대로영양표시사용과총체지방으로본비만의유병률에관한연관성을분석하였다. 남성은전체대상자중 RNU군의비율이 48% 로가장높게나타났으며그이유로남성은여성에비해보통만들어진식품이나가공식품의섭취가높기때문 1, 13) 에영양표시에따른관심이높은것으로보여진다. 하지만, 대상자중 RU군의비율이 15.5% 로실제로이러한관심이음식을주문하고섭취하는데에는영향을미치지못하고, 그결과로영양표시를사용하는그룹에비해영양표시를사용하지않는그룹에서유의적으로비만유병률이증가하는것으로생각할수있으며, 이는다른연구들의결과 14, 15) 와비슷하다. 여성비만인의경우영양표시인지비율은남성보다낮으나영양표시사용하는비율이남성보다 2배가량높게나타났으며, 이는남성보다여성에서체중에대한관심이높고, 여성의경우영양표시를사용하는것이좀더건강한식품정보를얻을수있다는믿음이크게작용하는것으로보여진다. 16, 17) 그러나여성의경우체지방으로본비만유병률과영양표시사용간에서는유의적상관성이없는것으로나타났으며, 이는체지방량으로만측정한비만의측정방법의제한성이있으며, 실제식품섭취량에대한분석이추가로필요할것으로보인다. 영양표시사용은선행연구들에서 18,19) 지방의섭취를감소시키고, 총열량섭취감소효과를보인다고하였으나본연구에서는영양표시사용에따라총열량감소효과와지방섭취감소효과는보이지않았으며, 오히려지방이나칼로리섭취가영양표시를인지하거나실천하는군에서높음을알수있었다. 이는영양표시사용유무에따른각군의평균연령의유의적차이에기인하는것으로볼수있으며, 영양표시사용그룹에서탄수화물의섭취비율이감소하고단백질의섭취비율은증가하여영양표시사용이영양소섭취비율에는영향을미치는것으로볼수있으며, 영양표시사용하는그룹에서좀더건강한식품을구매하고섭취한다는연구와비슷하다고볼수있겠다. 20) 본연구에서남성의경우에한하기는하나영양표시사용이비만유병률에영향을미치는것으로나타나영양표시사용이비만을개선하기위한방법으로사용될수있음을확인하였으며좀더적극적인활용을위해서영양표시사용을위한교육이좀더필요할것으로보인다. 이연구는단면연구로영양표시인지와체지방량의증가와의인과관계를알기어렵고, 실제식사량과영양소섭취량, 외식이나가공식품의섭취가얼마나되는지를알기어려운단점이있다. 하지만, 대규모의국민건강영양조사를사용하여한국전체인구를대상으로남녀체지방률과이를통한비만의유병률을영양표시사용을통해알아본최초의연구로그의미가있다고할수있다. 연구배경 : 비만교정에있어, 영양표시의인지는건강한식품을선 택하는중요한방법중하나이다. 이연구는 2010~2011 년국민건 강영양조사 (KNHANES) 를이용하여총체지방과영양표시사용의 연관관계를연구하였다. 방법 : 총 11,827 명의대상자 ( 남성 4,905 명과여성 6,922 명 ) 를연 구하였다. 대상자는성별로분류하고영양표시인지하지않는군 (NR), 영양표시를인지는하나사용하지않는군 (RNU), 그리고영 양표시를사용하는군 (RU) 로 3 군으로나누었다. 영양표시사용은 KNHANES 에포함된설문지를사용하였으며상관관계분석을위 해다중회귀분석을이용하였다. 결과 : 영양표시사용과비만의상관관계는성별에따라차이를보 였다. 연령, 소득수준, 교육수준, 영양교육, 건강형태를보정한후 남성에서영양표시사용과체지방으로정의된비만의유병률간의 상관관계를보였다. 결론 : 이연구를통하여남성에서영양표시의사용과비만유병률 을낮출수있음을확인하였으며, 영양표시의적극적사용을위한 올바른영양표시사용을을위한영양교육이필요하겠다. 중심단어 : 총체지방, 비만, 영양표시, 한국국민건강영양조사 REFERENCES 1. Lagerros YT, Rössner S. Obesity management: what brings success? Therapeutic Advances in Gastroenterology 2013;6:77-88. 2. Zapico AG, Benito PJ, González-Gross M, Peinado AB, Morencos E, Romero B, et al. Nutrition and physical activity programs for obesity treatment (PRONAF study): methodological approach of the project. BMC Public Health 2012;12:1100-. 3. Wirth A, Wabitsch M, Hauner H. The Prevention and Treatment of Obesity. Deutsches Ärzteblatt International 2014;111:705-13. 4. Mesas AE, Guallar-Castillon P, Leon-Munoz LM, Graciani A, Lopez-Garcia E, Gutierrez-Fisac JL, et al. Obesity-related eating behaviors are associated with low physical activity and poor diet quality in Spain. J Nutr 2012;142:1321-8. 5. Ness-Abramof R, Apovian CM. Diet modification for treatment and prevention of obesity. Endocrine 2006;29:5-9. 6. Wirth A, Wabitsch M, Hauner H. The prevention and treatment of obesity. Dtsch Arztebl Int 2014;111:705-13. 7. Safer DJ. Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspective. South Med J 1991;84:1470-4. 608 www.kafm.or.kr
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