Journal of Korean Society of Oral Health Science Vol. 1 No. 1 pp.33~41 October 2013 ISSN : 2288-6079 저소득층을대상으로한식품함유수은과구강건강과의연관성 김정술, 조미숙 춘해보건대학교치위생과 Relationship Between Mercury contains in Foods and Oral Health in the Low Income Brackets Jung-Sool Kim, Mi-Suk Cho Department of Dental Hygiene, Choonhae College of Health Sciences ABSTRACT The purpose of this study was to investigate oral state and quality of life following to foods with mercury index. For this purpose, we examined the proper quantity of food s mercury from adults 272 living in Pusan, Ulsan. The results of this study were as follows: First, in index of snack we need to reducing take the snacks because of DMFT and subjective oral health had a statistically significant(p<.05). Second, in quality of life related oral, we need to taking the snacks properly unbiased(p<.05). Third, in, DMFT was showed orderly the foods of V, III, IV groups statistically significant(p<.05). Finally, in subjective oral health only V group had a statistically significant(p<.05), and in case quality of life totally I, II, III, IV, V groups had a statistically significant(p<.05), in index of snack only V, III groups had statistically significant(p<.05). Key words : DMFT, Index of mercury, Quality of life, Subjective oral state. Corresponding author(jskim@ch.ac.kr) - 33 -
Journal of Korean Society of Oral Health Science Vol.1 No.1 October 2013 I. 서론 인간이섭취하는식품을식품영양학회에서는다섯가지기초식품군으로분류하는데단백질이주요영양소인식품을 I군식품으로쇠고기, 돼지고기, 생선등어육류와난류, 두류등의콩제품으로분류되고, 칼슘이주요영양소인식품은 II군식품인데, 주요식품으로는멸치, 뱅어포, 요구르트등우유및유제품, 뼈채먹는잔생선등으로분류되며, I 군, II군식품을통틀어 ' 구성식품 ' 으로분류하였다. 무기질및비타민이주요영양소인 III군은 ' 조절식품 ' 으로, 시금치, 당근등채소및과일이나녹황색또는담색과일등으로분류되고, 당질이주요영양소인 IV군은쌀, 보리, 식빵, 과자류등곡류, 감자류등으로분류되며, 지질이주요영양소인 V군은참기름, 버트등유지류등으로분류되며, IV군과 V군을통틀어 ' 열량식품 ' 이라고한다 [1,2]. 본연구에서는이러한식품을섭취하는데우리가원치않게자연적으로섭취하는중금속중에서특히, 수은의섭취정도가구강상태와구강관련삶의질과어떠한관계가있는지를분석해보고자평소마트나시장에서구입하는식품들을중심으로수은섭취지수를조사하였다 [2]. 수은은환경중에존재하며순환되어물에녹은무기수은형태로산화되었다가수중생태계로유입되어혐기성세균에의해서메틸화된다. 자연적으로생긴메틸수은은플랑크톤, 식물을먹는물고기, 육식물고기, 바다포유류등과같은순서로먹이사슬을통해축적된다. 먹이사슬의꼭대기에있는큰생선의섭취가가장중요한노출경로이며인체내혈중농도를증가시키는것으로보고되고있다 [3-5]. 수은은인체대사에서어떠한생리적역할을하는지알려져있지않고, 인체가수은을능동적으로배출할수있는기전도없는것으로알려져있다 [6]. 특히수은은잘분해되지않아생태계에오랫동안잔류되면서공기, 물, 음식물등에의해체내로흡입, 섭취되어건강을위협하고있고 [7], 체내축척시잘배출되지도않을뿐만 아니라, 인체의중추신경계, 순환기계등에작용하여신경계를교란시키며과다노출시호흡기계와심혈관계그리고소화기계에독성을나타낸다고알려져있다 [8-10]. 수은노출로인하여야기되는증세는무력증으로허약, 피로, 식욕감퇴, 체중감소그리고소화불량등의증세가나타난다. 점차노출이증가하게되면미세하게근육이경련을일으키는것과마찬가지로몸서리치듯떨리는오한이신체에나타난다. 이러한증상은뇌에영향이가해지고일정량정도의수은증기에노출됨으로써신경계에영향이가해진것과밀접한관련을갖는다 [2,11]. 연구에따르면칼슘및크레아틴의농도, 백혈구및적혈구수, 혈소판수에있어유의적차이를보였고 [2], 체위반응검사중손떨림의강도와중심이동정도에서도유의적차이의결과가나타났으며 [12], 타연구들 [13,14] 에서도관련조사들이많이연구되어있다. 이와같은수은의인체독성에관한근거에기반하여여러나라에서음식에의해발생할수있는수은의건강위해성에대해인지하고음식내의수은잔류허용기준, 인체내의수은노출기준, 음식섭취로인해미성숙하고약한면역체계를가진대상자에대한권고안을제정하고있다 [15-17]. 현재까지선행연구에서는생선섭취량과혈중수은농도의관련성은보고 [18] 된바있으나식품군에함유된수은농도와주관적구강건강상태와삶의질관련성에관한연구는제시되고있지않다. 따라서본연구는저소득층의성인들이평소섭취하는식품군별의종류에따라함유된지수를중심으로본인이자각하는현재의구강건강상태와삶의질과의관계를조사하여관련성이있는식품군의섭취를조절하여구강보건교육의자료로삼고자시도되었다. II. 연구대상및방법 본연구는 2012 년 4 월 30 일에서 5 월 7 일까지울 - 34 -
Relationship Between Mercury contains in Foods and Oral Health in the Low Income Brackets 산, 부산에거주하는저소득층의일반성인 300명을대상으로무작위설문조사법으로시행되었다. 설문문항은수은지수를산출하기위해마트나시장, 슈퍼등주위에서일반적으로쉽게구할수있는식품들을대상으로김 [19] 이작성한설문지의식품들을활용하여대한식품영양학회에서제공하는수은섭취지수 [1] 들을활용하였다. 수집된자료는 SPSS 18.00 K for windows 를이용하여수은섭취지수에따른 DMFT, 구강건강상태, OHIP(Oral Health Impact Profile) 등을개인의질의와설문을통하여상관분석과회귀분석을사용하여분석하였으며통계적유의수준은 0.05로하였다. 최종설문지는부적당한응답지 28부를제외한나머지 272부를사용하였다. 1. 일반적인특성 III. 결과 본연구대상자의성별로는 남자 가 117명 (43%), 여자 는 154명 (57%) 으로나타났고, 최종학력은 고졸 (54%), 월소득은 100만원미만 (51%), 구강증상질환은 없다 (63%), 최근 6개월이내치과방문은 없다 (53%), 잇솔질교육경험은 있다 (62%), 칫솔휴대여부는 없다 (65%), 구강상태는 보통 (49%), 정기적치과방문은 전혀방문하지않았다 (49%) 가가장많이나타났다 <Table 1>. 2. 일반적특성과각군별충치지수의평균과표준편차 연령은평균 30.5세로나타났으며, DMFT는평균 6.31개, 주관적인건강은 9.90점, 평균하루동안의간식섭취지수는 7.20점, OHIP는 54.70점, I군수은섭취지수는 143.02점, II군수은섭취지수는 0.88점, III군수은섭취지수는 11.77점, IV군수은섭취지수는 3.89점, V군수은섭취지수는 2.30점으로각각나타났다 <Table 2>. 3. 각군별수은섭취지수의상관관계각군별수은섭취지수와의상관분석의결과각군별수은섭취지수는모두유의미하게나타났다 <Table 3>. 또한주요특성인주관적인구강건강은 V군수은지수와 r=-0.22로주관적인건강도가높을수록 V 군수은지수는낮아지는유의미한수준으로나타났다. 주관적인구강건강과 DMFT는 r=-0.42로유의미하여주관적인구강건강이좋을수록 DMFT가낮게나타났고, 하루간식섭취지수는 V군수은섭취지수와 r=0.17로유의미하였으며, 하루간식섭취지수와 DMFT는 r=0.35, 하루간식섭취지수와주관적구강건강과는 r=-0.34로유의미하게나타나하루간식섭취를많이할수록수은섭취가많고, DMFT 가높고주관적구강건강은좋지않은것으로나타났다, 구강관련삶의질과 DMFT는 r=-0.46, 구강관련삶의질과주관적구강건강과는 r=0.26, 구강관련삶의질과하루간식섭취지수와의관계는 r=-0.36으로유의미한관계로나타나구강관련삶의질이높을수록 DMFT가낮고주관적인구강건강은좋으며하루간식섭취는낮은것으로나타났다 (p<.01). - 35 -
Journal of Korean Society of Oral Health Science Vol.1 No.1 October 2013 <Table 1> General characteristics Classification Frequency % Men 117 43 Sex Women 155 57 Below middle 41 15 High school 147 54 Education College 81 30 Graduate school 3 1 Below 1 million 138 51 1 Million ~ 2 million 63 23 Income 2 Million ~ 3 million 40 14 3 Million ~ 4 million 22 8 Over 5 million 9 4 Yes 112 37 Oral disease No 160 63 Yes 129 47 Within 6 months visit clinics No 143 53 Yes 169 62 Experienced oral education No 103 38 Yes 95 35 Keeping toothbrush No 177 65 Very not healthy 6 2 Not healthy 62 23 Subjective oral health state Moderate 132 49 Healthy 55 20 Very healthy 17 6 Never 134 49 1/a week 5 2 Periodic visit clinics 1/ a month 14 5 1/ 3 months 29 11 1/ 6 months 90 33-36 -
Relationship Between Mercury contains in Foods and Oral Health in the Low Income Brackets <Table 2> Descriptive statistics for general characteristics and each groups. Classification Mean(M) Standard deviation(sd) Age 30.50 13.95 Number of brushing 2.63 0.55 DT 1.83 2.41 MT 0.78 1.66 FT 3.69 3.81 DMFT 6.31 5.52 Subjective oral health 9.90 2.62 Index of snack 7.23 4.38 OHIP 54.70 13.8 I group 143.02 104.14 II group 0.88 0.32 III group 11.77 6.21 IV group 3.89 1.84 V group 2.30 1.38 <Table 3> Correlation with major factors and of each groups I Group II Group III Group IV Group V Group II Group III Group IV Group V Group 0.41** 1 - - - 0.38** 0.33** 1 - - 0.54** 0.54** 0.43** 1-0.50** 0.39** 0.40** 0.73** 1 ** p <.01 4. 각수은섭취지수를독립변수로한회귀분석각수은섭취지수를독립변수로한회귀분석결과종속변수가 DMFT인경우는카라멜 (p=0.00), 김치 (p=0.00), 비스켓 (p=0.00), 치즈 (p=0.00), 수박 (p=0.00), 햄 (p=0.00), 명란젓 (p=0.00), 귤 (p=0.02), 밤 (p=0.00), 과일쥬스 (p=0.04), 무 (p=0.00), 식빵 (p=0.00), 인절미 (p=0.00), 요구르트 (p=0.02) 등으로 I 군이 3개, II군이 1개, III군이 5개, IV군이 5개로유 의한변수들이었고, 설명력은 Adj. R2 = 0.47로나타났다 (<.05). 종속변수가주관적인구강건강인경우는과일통조림 (p=.05), 명란젓 (p=0.00), 생선묵 (p=0.00), 사탕 (p=0.00). 수박 (p=0.00), 귤 (p=0.00), 치즈 (p=0.00), 햄 (p=0.00), 꽁치 (p=0.00), 호박 (p=0.00), 파인애플 (p=0.00), 건빵 (p=0.00), 고구마 (p=0.00), 우유 (p=0.00), 쇠고기 (p=0.00), 김치 (p=0.00), 메밀묵 (p=0.00) 등의수은섭취지수가통계적으로유의하였고, I군이 6개, II군이 1개, III군이 6개, IV군이 4개로그설명력은 Adj. R2 = 0.48로나타났다 (<.05). - 37 -
Journal of Korean Society of Oral Health Science Vol.1 No.1 October 2013 종속변수가 OHIP인경우는김치 (p=0.00), 닭고기 (p=0.00), 곶감 (p=0.00), 마가린 (p=0.00), 꿀 (p=0.00), 젤리 (p=0.00), 오징어 (p=0.00), 어포 (p=0.00), 아이스크림 (p=0.00), 무 (p=0.00), 카라멜 (p=0.00), 참외 (p=0.00), 생선묵 (p=0.00), 카스테라 (p=0.00), 사이다 (p=0.00), 포도 (p=0.00), 건포도 (p=0.03), 감자 (p=0.00), 오이 (p=0.00), 도넛 (p=0.00), 건빵 (p=0.00), 새우 (p=0.00), 달걀 (p=0.00), 라면 (p=0.00), 게 (p=0.00), 명란젓 (p=0.00), 요구르트 (p=0.00) 등이통계적으로유의한변수였고, I군이 8개, II군이 2개, III군이 9개, IV군이 9개, V군이 1개로, 그설명력은 Adj. R2 = 0.71로나타났다 (<.05). 종속변수가하루간식섭취지수인경우는영향을끼치는독립변수가김치 (p=0.00), 어포 (p=0.00), 달걀 (p=0.04), 메밀묵 (p=0.00), 감 (p=0.00), 바나나 (p=0.00), 사이다 (p=0.00), 치즈 (p=0.00), 무 (p=0.00), 젤리 (p=0.00), 마가린 (p=0.00), 건빵 (p=0.00), 곶감 (p=0.00), 사과 (p=0.00), 밤 (p=0.00), 초콜릿 (p=0.00), 파인애플통조림 (p=0.00), 닭고기 (p=0.00), 생선묵 (p=0.00), 라면 (p=0.00) 등이었으며, I군은 5개, III군은 7개, IV군은 4개, V군은 4개이었으며, 그설명력은 Adj. R2 = 0.63로나타났다 (p<.05) <Table 4>. <Table 4> Regression analysis based as each Dependence variable Independence variable F Adj. R 2 DMFT Caramel, Kimchi, Biscuit, Cheese, Water-mellon, Ham, Salted fish guts, Mandarin, Nut, Juice, Radish, Plain bread, Injelmi, Yakurt, 2.93 0.47 Subject oral health Fruit canning, Salted fish guts, Fish jelly, Candy, Water-mellon, Mandarin, Cheese, Ham, Saury, Pumpkin, Pineapple, Hardtack, Sweet potato, Milk, Beef, Kimchi, Buckwheat jelly 3.16 0.48 OHIP Kimchi, Chicken, Dried persimmon, Margarine, Honey, Jelly, Squid, Dried slices of fish, Icecream, Radish, Caramel, Melon, Fish jelly, Castera, Cider, Grape, Dried grape, Potato, Cucumber, Donut, Hardtack, Shrimp, Egg, Ramyon, Crab, Salted fish guts, Yakurt 8.51 0.71 Index of snack Kimchi, Dried slices of fish, Egg, Buckwheat jelly, Persimmon, Banana, Cider, Cheese, Radish, Jelly, Mandarin, Hardtack, Dried persimmon, Apple, Nut, Chocolate, Pineapple canning, Chicken, Fish jelly, Ramyon 3.42 0.63 * p<.05 IV. 고찰 인간이섭취하는식품은생태학적으로상당히중요한요소이며, 식품을섭취하지않으면유기체의에너지동화작용의감소, 성장, 생존율감소로이어지게된다 [20]. 수은을비롯한다양한형태의유 독성중금속오염물질들이배출되어수권, 대기권, 토양권, 생물권을포함하는지구화학적환경으로분산되고있고, 이로인해인간을비롯한유기생명체에피해를주고있다 [21]. 따라서수은이축적된식품의섭취로인해만성적으로수은에노출되고있어인체에위험을초래할가능성이있다 [22]. 체내에흡수된수은은혈액과조직내단백질과결합 - 38 -
Relationship Between Mercury contains in Foods and Oral Health in the Low Income Brackets 하여수은유리를어렵게만들어체내축적작용을일으킨다. 체내에축적된수은은화합물의종류에관계없이중추신경계, 순환기등에작용하여인체장해를일으키는것으로보고되고있다 [23]. 본연구는부산, 울산에거주하는주로저소득층의시민들을대상으로그들의평소음식섭취정도에따른수은섭취지수를기준으로 DMFT, 주관적인구강건강상태와삶의질및간식섭취와의연관성을분석했다. 본연구대상자는성별로는 여자 가 57% 로많았고, 최종학력은 고졸, 월소득은 100만원미만, 구강증상질환은 없다, 최근치과방문은 없다, 잇솔질교육경험은 있다, 칫솔휴대여부는 없다, 구강상태는 보통, 정기적치과방문은 전혀방문하지않았다 로보통의일반사람들과비슷한특성을나타내었다. 연령은평균 30세로, DMFT 는평균 6.31개, 하루간식섭취지수는 7.2점, OHIP 14는 54.7점, I군수은섭취지수는 143.02점, II군수은섭취지수는 0.88점, III군수은섭취지수는 11.77점, IV군수은섭취지수는 3.89점, V군수은섭취지수는 2.30점으로각각나타났다. 상관분석의결과주관적건강은 DMFT와유의미하였고, 하루간식섭취지수는 DMFT, 주관적건강과유의미하였다. 구강관련삶의질은 DMFT, 주관적건강과관련이높았고, 하루간식섭취지수와도유의미한관계로나타났다. 수은섭취지수를독립변수로한회귀분석결과종속변수가 DMFT인경우는 Caramel, Kimchi, Biscuit, Cheese, Water-mellon, Ham, Salted fish guts, Mandarin, Nut, Juice, Radish, Plain bread, Injelmi, Yakurt 등의 III, IV, V군이, 주관적인구강건강인경우는 Fruit canning, Salted fish guts, Fish jelly, Candy, Water-mellon, Mandarin, Cheese, Ham, Saury, Pumpkin, Pineapple, Hardtack, Sweet potato, Milk, Beef, Kimchi, Buckwheat jelly 등의 V군으로나타났고, 종속변수가 OHIP인경우는영향을끼치는독립변수는 Kimchi, Chicken, Dried persimmon, Margarine, Honey, Jelly, Squid, Dried slices of fish, Icecream, Radish, Caramel, Melon, Fish jelly, Castera, Cider, Grape, Dried grape, Potato, Cucumber, Donut, Hardtack, Shrimp, Egg, Ramyon, Crab, Salted fish guts, Yakurt 등의 I, II, III, IV, V군모두였고, 종속변수가하루간식섭취지수인경우는영향을끼치는독립변수는 Kimchi, Dried slices of fish, Egg, Buckwheat jelly, Persimmon, Banana, Cider, Cheese, Radish, Jelly, Mandarin, Hardtack, Dried persimmon, Apple, Nut, Chocolate, Pineapple canning, Chicken, Fish jelly, Ramyon 등의 III, V군인것으로나타났다 (P<.05). 본연구의결과구강건강상태와삶의질에영향을미치는식품군은 V군, III군, IV군의순이었고, I군과 II군은삶의질에영향을미치는것으로나타난바, 수은함량이낮은빵이나유지류군이모두유의미있게나타났고, III군인채소류역시수은함량이낮아구강건강에별영향을주지않는것으로해석되었다. 다만, 수은함량이매우높은 I 군류는삶의질에만영향을나타내어, 가끔씩육류나생선류의섭취는삶의질을높이는수단이되며수은축적에는큰문제가되지않는것으로조사되었다. 연구지역을농어촌으로구분하여생선섭취빈도에따른혈중수은농도관련성을보고한연구에서는태평양연안에접해있어생선소비가많은어촌지역이안델스산맥에위치한지역에비해혈중수은농도가 9배이상높게나타났으며 [24], 우리나라에서도남해군거주대상자와부산광역시를비교하였으며남해군이부산광역시대상자에비해혈중수은농도가높게나타났으며이는섬지역으로분류되는남해군의지역적특성때문이라고하였다 [17]. 생선섭취관련된연구에서는거두고래 (pilot whale) 를많이섭취하는북해의덴마크량파로섬연구에서산전유기수은노출은아이들의운동, 집중력, 언어검사에서결손이나타났다 [25]. 따라서생선섭취빈도량이증가하면혈중수은농도가높아져인체장애를일으켜삶의질을저하시킬것으로예상된다. 하지만이연구는식품군만을대상으로하여생선섭취량에대한조사가없어선 - 39 -
Journal of Korean Society of Oral Health Science Vol.1 No.1 October 2013 행연구와직접적인비교를하기는힘드나식품 I군류는삶의질에유의한관련성이있는것으로나타났다. 또한본연구는식품군의수은농도를추정하여분석하였기때문에연구대상자의정확한식품섭취량과수은농도를구하지못하였다. 향후식품섭취빈도설문지등을통한식품섭취빈도와생선섭취량에대한설문을더체계화하여연구를진행하여야할것이고, 앞으로식품군마다함유되어있는수은에대해조사를실시하고이를바탕으로일상적인식품섭취종류에대한수은노출및섭취기준이만들어져야할것이다. 여러제한점으로인하여결과가미흡하더라도식품군별수은섭취지수와구강건강상태와삶의질의관련성을본연구는최초이므로그의미가있다고하겠다. V. 결론 본연구는식품군별수은섭취지수와구강상태와의관련성을파악하고자부산, 울산에거주하는저소득층의일반성인 272명을대상으로분석한결과다음과같은결론을얻었다. 1. DMFT 에영향을미치는식품군은 V군, III군, IV군의순으로나타났고, 주관적인건강도가높을수록 V군수은지수는낮았고 DMFT도낮게나타났다 (p<.05). 2. 구강관련삶의질은 I, II, III, IV, V군이모두유의하였고, 구강관련삶의질이높을수록 DMFT가낮고주관적인구강건강은좋았으며하루간식섭취는낮은것으로나타났다. 하루간식섭취는 V군, III 군등이유의하게나타났고, 하루간식섭취를많이할수록수은섭취가많고, DMFT 가높고주관적구강건강은좋지않은것으로나타났다 (p<.05). 3. 구강건강상태는 DMFT, 하루간식섭취와의미가있는것으로나타나, 간식섭취를줄이는것이타당하다고생각되며, 구강관련삶의질은 DMFT, 주관적건강, 하루간식섭취지수등과의미있게나타 나, 수은함유량이많은생선류는과다섭취하지않으면서모든음식들을평소골고루섭취함이필요한것으로판단된다. 참고문헌 1. Choi HM: The dietetics of 21st, Seoul, Kyomoonsa, 2000. 2. Kim JS: Relationship among the mercury index in food groups and oral health state and quality of life. Proceedings of the Korean Data Analysis Society. April, 359-363, 2013. 3. Ratcliffe HE, Swanson GM, Fischer LJ: Human exposure to mercury: a critical assessment of the evidence of adverse health effects. J Toxicol Environ Health. 49(3):221-270, 1996. 4. World Health Organization: Children health and the environment, Mercury. http://www.who.int/ceh/capacity/mercury.pdf. 5. Grandjean P, White RF, Weihe P, Jøgensen PJ: Neurotoxic risk caused by stable and variable exposure to methylmercury from seafood. Ambul Pediatr 3(1):18-23, 2003. 6. Houston MC: The role of mercury and cadmium heavy metals in vascular disease, hypertension, coronary heart disease, and myocardial infarction. Alternative Therapies in Health and Medicine 13(2):128-133, 2007. 7. Agusa T, Kunito T, Iwata H, et al.: Mercury contamination in human hair and fish from Cambodia: levels, specific accumulation and risk assessment. Environmental Pollution 134(1): 79-86, 2005. 8. Tchounwou PB, Ayensu WK, Ninashvili N, Sutton D: Environmental exposure to mercury and its toxicopathologic implications for public health. Environmental Toxicology 18(3): 149-175, 2003. - 40 -
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