건강의개념 (Health Definition) 건강, 노인성질환, 신체활동 Health, Diseases, and Physical Activity 1. 일회성의학 (Episodic health care) - 질병, 통증으로부터의해방 (the absence of illness, disease, or injury) 2. 예방의학 (Preventive medicine) - 질병의위험으로부터해방 (the condition with low risk levels of having certain diseases) 국민건강보험공단건강검진 ( 일반검진, 암검진, 생애전환기건강검진, 영유아건강검진 ) 3. 건강증진 (Health promotion) - 삶의질향상 (a better life quality) 건강이란? 단순히신체의질병이나손상이없을뿐만아니라신체적, 정신적, 사회적으로완전한상태 Health ( 건강 ) for Life More than the absence of Illness Death Rates (Mortality) in Korea, 2010 1
건강의의미 운동과건강 신체적건강 정신적건강 사회적건강 지적건강 정서적건강 운동의필요성 - 좀더나은외모 - 자신의체력을단련시키기위해 - 증가된체중때문 - 의사가건강상의이유로운동을권유 - 자신이참여하는사회적활동영역을넓히고싶어서 - 기분향상과에너지를얻고싶어서 웰니스 (Wellness) 최근에는단순히질병이없는소극적인개념의건강보다는개인의행복을증진시킬수있는최고수준의건강을추구해야한다는웰니스 (wellness) 개념을강조 신체활동을통한건강증진 질병의감소와예방 삶의질향상 운동과건강 운동의생리적효과 - 생리적기능의변화 ( 호흡계, 순환계, 운동능력 ) - 순환기능의향상 신진대사, 긴장과피로의감소 건강을지키기위해소식 ( 小食 ), 다동 ( 多動 ), 금연 ( 禁煙 ), 절주 ( 節酒 ), 긍정적사고 이중에서다동이가장중요 - 생명력의근원인근력을향상 - 생명현상에가장중요하다고볼수있는심폐기능의향상 - 운동을하면근육과그안의모세혈관이수축돼우리몸전반의혈액순환을원활하게해신진대사를촉진 - 열발생 암세포억제효과 - 과잉칼로리를소모해비만예방에도움 - 정신건강을향상시키고의욕과자신감향상 신체활동과건강 신체활동 (physical activity): 에너지소비를가져오는근육이나골격의움직임에의한신체움직임 체력 (physical fitness): 신체활동을수행할수있는개인의능력 운동 (exercise): 건강유지, 증진시킬목적으로한신체활동의계획적, 구조적, 반복적인형태, 개인의구체적인목적달성을위한체계적, 반복적인신체활동 스포츠 (sports): 자기또는타인과경쟁혹은자연의장애와의대결을포함하는운동 ( 경쟁이있는운동 ) 오늘날최적의건강개념 : 신체적, 정서적, 지적, 사회적, 정신적, 환경적영역에서최적의기능과높은삶의질을추구하는적극적인건강실천을포함 체력 (Physical Fitness) 4 대요소 1. Cardiorespiratory endurance (fitness, 심폐지구력 ) 2. Muscular fitness ( 근력, 근지구력 ) - Strength vs. endurance 심폐지구력 3. Body composition ( 체성분 ) 근지구력체성분 4. Flexibility ( 유연성 ) 근력 유연성 1. Cardiorespiratory Endurance ( 심폐지구력 ) 일정기간 ( 운동, 일 ) 우리몸속에산소를공급해주는심장, 폐, 혈관등순환계의능력 (ability of the heart, lungs, and blood vessels to process and transport oxygen (O 2 ) over a period of time (work, exercise) 중강도 - 고강도의운동을할수있는능력 (ability of the body to perform prolonged, large muscle, dynamic exercise at moderate-to-high levels of intensity) Examples: brisk walking, jogging, cycling Most important health related components of physical fitness A healthy heart is essential to high levels of fitness and wellness, as well as to a long and healthy life. 2
Cardiorespiratory System (CRS) Cardiorespiratory Functions Cardio means heart - 심 Respiratory means lungs - 폐 The CR system consists of the 1) heart ( 심장 ), 2) blood vessels ( 혈관 ), and 3) the lung ( 폐, respiratory, 호흡 ) system. The CR system picks up and transports oxygen, nutrients, and other substances to the organs and tissues that need them. ( 영양분과산소를필요한기관, 조직등에운반하는역할담당 ) 조직으로의산소및영양분운반 (Delivery of oxygen and other nutrients) 이산화탄소 / 노폐물등제거 (Removal of carbon dioxide and other metabolic waste) 호르몬전달 (Transport of hormones) 체온조절 (Thermoregulation) The Heart 심장은근육질로둘러싸여있고펌프기능을가지고있음 (a very muscular organ with pump functions) 4 개의방 (four chambered) 무게 : 200~300g 가슴의왼쪽에자리잡고있음 (lies slightly to the left of center in the chest) beat 100,000 times (at rest). Purpose is to pump oxygen-poor blood to the lungs, and oxygen-rich blood to the rest of the body 혈액펌프 - At rest, about 5L of blood are circulated each minute (70ml/beat at rest) With exercise about 19L or more of blood are pumped out per minute. Blood Vessels ( 혈관 ) Arteries ( 동맥 ) = vessels that carry blood away from the heart Veins ( 정맥 ) = vessels that carry blood to the heart Capillaries ( 모세혈관 ) = very small blood vessels that distribute blood to all parts of the body Blood ( 혈액 ) Compositions Total volume of blood in human body 5 to 6 liters Components - Plasma ( 혈장 ) 55-60 % - Blood cells 40-45 % - 고형성분 (formed element) - Red Blood Cells (RBC, 적혈구 ) - White Blood Cells (WBC, 백혈구 ) - Platelets ( 혈소판 ) 3
Blood Pressure (BP) Respiratory System 혈압은혈관을따라흐르는혈액이혈관의벽에주는압력 - 주요한생명의징후 Systolic blood pressure (SBP, 최고혈압 ) is the highest pressure within the vascular system generated during cardiac contraction Diastolic blood pressure (DBP, 최저혈압 ) is the lowest pressure within the vascular system when the heart is relaxed Alveoli ( 폐포 ) = tiny air sacs in the lungs through whose walls gases such as oxygen and carbon dioxide diffuse in and out of the blood 가스교환이가능하도록폐속에무수히나있는작은구멍 Lungs expand and contract about 12 20 times a minute at rest millimeters of mercury (mmhg) Cardiorespiratory Endurance: Training Factors FITT Principles 1. Frequency ( 횟수 ) 2. Intensity ( 강도 ) 3. Time (Duration, 시간 - 기간 ) 1. Frequency ( 횟수 ) 건강한성인기준 3~5 days/week 체력수준이높은경우는 daily activity. 2-3 days/week training 은심폐지구력향상에도움을주지못할수도있음 ( 운동강도에따라 ) 4. Type (Mode, 종류 ) 2. Intensity ( 강도 ) Intensity is inversely related to duration. ( 높은강도 짧은시간 / 낮은강도 긴시간 ) To determine intensity follow one of these methods: A. MET / VO 2 max B. Percentage of Max Heart Rate C. Percentage of Heart Rate Reserve D. Rate of Perceived Exertion (RPE) 3. Time ( 시간 ) Time (Duration) The length of time depends upon the intensity. 낮은강도 (Lower Intensity) More time (45-60 Min.) 높은강도 (Higher Intensity) Less time (20-30 min.) ACSM recommends about 60 minutes of continuous daily aerobic/resistance activity. 4
4. Type (Mode of Activity) Aerobic exercise ( 유산소운동 ): endurance type exercise, rhythmic, sustained walking, jogging, running, cycling, swimming, etc Strength (Resistance) exercise ( 저항성운동 ): weight training with free weight, machine, elastic rope, calisthenics, etc Flexibility exercise ( 유연성운동 ): stretching exercise. Continuous activity Using large muscle groups Enjoyable Cross-train and/or vary activities to maintain motivation Physical Activity Recommendations for Adults > 150min/week of moderate-intensity physical activity OR > 75min/week vigorous-intensity physical activity AND 2 or more days a week of muscular strength activities - 중강도활동 : 빨리걷기, 자전거타기, 배드민턴, 축구, 농구연습 - 고강도활동 : 달리기, 줄넘기, 인라인스케이트, 배드민턴, 축구, 농구시합 2013 년도국민건강영양조사중등도이상 ( 걷기포함 ) 신체활동실천율 (19 세이상 ) 2. Muscular Fitness ( 근력 ) 중등도이상 ( 걷기포함 ) 신체활동실천율 : 최근 1 주일동안 - 격렬한신체활동을 1 회 10 분이상, 1 일총 20 분이상, 주 3 일이상실천 - 중등도신체활동을 1 회 10 분이상, 1 일총 30 분이상, 주 5 일이상실천 - 걷기를 1 회 10 분이상, 1 일총 30 분이상주 5 일이상실천한분율 Strength: Ability to contract skeletal muscles to a maximal level ( 근력 ) Endurance: Ability to contract skeletal muscles repeatedly over a long period of time ( 근지구력 ) Improved by performing repeated contractions at less than maximal levels Major Muscle Group Types of Muscles Smooth ( 평활근 ) Involuntary muscle ( 불수의근 ); controlled by the autonomic nervous system ( 자율신경계 ) Located in the walls of blood vessels and throughout internal organs Cardiac ( 심장근 ) Involuntary muscle ; controlled by the autonomic nervous and endocrine systems Located only in the heart Skeletal ( 골격근 ) Voluntary muscle ( 수의근 ); controlled consciously by the somatic nervous system ( 체신경계 ) More than 600 different skeletal muscles located throughout the body 5
Muscle Fiber Types 운동이근육계에미치는효과 Slow-twitch fibers ( 지근섬유 ), Type I (~50%), oxidative Fast-twitch fibers ( 속근섬유 ), Type II Type IIa (25%), fast oxidative/glycolytic (FOG) Type IIx in humans (~25%) ~ IIb in animals, fast glycolytic (FG) Type IIc (1-3%) The percentage of each fiber type is variable among muscles, among individuals, and with exercise training 지근섬유 ( 운동시피로에대한높은저항력 ) 속근섬유 ( 무산소능력 ) 1) 근육의크기증가 2) 근력의증대 3) 모세혈관분포증가 4) 젖산축적감소 골격계의정의 골격계란? Skeletal System ( 골격계 ) 우리인체중가장단단한구조물로뼈, 연골, 인대로구성 206 개의뼈 (bones) 와연골 (cartilages) 로이루어져있으며특히둘이상의뼈는인대 (ligaments) 등의결합조직에의해기능적으로연결 Skeletal System Types of Bones Axial division 몸통골격 ( 구간골, 체간골, 80 bones) - Skull and associated bones ( 두개골 ) - Thoracic cage ( 흉추 ) - Vertebral column ( 요추 ) Appendicular division - 사지골격 ( 체지골, 126 bones) - Pectoral girdle ( 견대 ) - Upper limbs ( 상지골 ) - Pelvic girdle ( 하지대 ) - Lower limbs ( 하지골 ) Long Bones ( 장골 ) : metacarpals, metatarsals, phalanges, humerus, ulna, radius, tibia, fibula Short Bones ( 단골 ): carpals, tarsals Flat Bones ( 편평골 ): rib, scapula, skull, sternum Irregular Bones ( 불규칙골 ) : vertebrae, some facial bones Sesamoid ( 종자골 ): patella 6
Composition of Bone 결합조직이변형된형태로주로세포간질로되어있음 세포간질속에무기질이침체되어있어뼈의단단한성질을나타냄 65-70% calcium, magnesium & phosphorus salts (Inorganic matter - 무기질 ) 30-35% Proteins, Fats, Carbohydrates (Organic matter - 유기질 ) Children Less amount of inorganic matter Old Age Less amount of organic matter Joint Functions ( 관절의기능 ) 인대 - 관절의뼈가서로결합하도록도와줌 관절강 - 관절의움직임을매끄럽게하는체액이가득차있으며, 뼈와뼈사이에주머니처럼존재 관절연골 - 뼈의끝부분으로활액과함께관절의자유로운움직임을돕고뼈의마찰을감소시킴 건 - 결합조직으로, 근육이뼈에부착되는것을도우며관절을지지하는역할을함 1. 경첩관절 (hinge joint) - 문을열고닫는원리와같이움직임예 ) 손가락, 무릎, 발목, 발가락등 2. 차축관절 (pivot joint) - 한뼈가다른뼈주위를옆으로회전하도록함 - 뼈가만날때하나의뼈가다른뼈를감쌈예 ) 팔꿈치, 목등 3. 평면관절 (sliding joint) - 관절면이편평하여운동성이비교적적음예 ) 손목이나발에있는뼈사이의관절 4. 구상관절 (ball and socket joint) - 어깨와엉덩이뼈와같이한뼈의둥근끝이다른뼈의구멍에끼워져있어볼과소켓관절이라고도함예 ) 어깨, 엉덩이등 운동이골격계에미치는영향 1) 뼈의성장규칙적인운동 : 뼈가굵어지고길이도늘어남 운동을하지않고오랫동안움직이지않은경우 : 뼈의칼슘이분해되어소변을통해배설되어뼈가약해짐 지나치게심한운동 : 뼈의성장을방해 2) 관절기능의발달규칙적인운동 : 관절안쪽에있는연골과관절을잇는인대가강화됨 / 연골이두꺼워지면뼈끼리의충격도완화됨 유연성운동 : 관절의가동성이커지고, 인대가튼튼해짐 39 Muscular Fitness Frequency: 2 times/week One set of 8-12 repetitions (10-15 repetitions for adults over 50) of 8-10 exercises Multiple sets could provide greater benefits Sufficient resistance to fatigue major muscle groups (legs, arms, shoulders, chest, back) Obesity ( 비만 ) 7
비만 (Obesity) 진단방법 신체구성의개념 수중체중측정 스킨폴더 체질량지수측정 임피던스측정법 조직과화학성분 ( 탄수화물, 지방, 단백질, 체액, 미네랄 ) 지방조직과제지방조직의비율 신체의상대적인비만정도 (% Body Fat) 신체구성모델 (4 가지 화학적모델, 해부학적모델, 지방모델 물속에서체중을재어실제체중과비교하는방법 피부주름을측정하여체지방을산출 신장과체중을기준으로한체중을수치로표시 (kg/m 2) 신체에전류를흘려전기저항으로체지방량측정 기타 : DEXA, MRI, CT, Ultrasound Imaging techniques 44 비만 (Obesity) - 체질량지수측정 체질량지수 (Body Mass Index, BMI, kg/m 2 ) 체중 (Body Weight, kg) 신장 2 (Height Squared, m 2 ) 예 ) 나이 : 27 세, 성별 : 남자체중 : 75 kg, 신장 : 168 cm 체질량지수 (BMI) = 75 / (1.68) 2 = 26.6 WHO: Obesity Preventing & Managing. (2000) 체질량지수 (BMI) 진단기준 BMI WHO Korea Category < 18.5 < 18.5 저체중 Underweight) 18.5-24.9 18.5-22.9 정상체중 (Healthy Weight) 25.0-29.9 23.0 24.9 과체중 (Overweight) 30 25 비만 (Obese) Obesity class Category WHO Korea 30.0-34.9 25.0-29.9 ( 경도비만 ) Class I 35.0-39.9 30.0-34.9 ( 중등도비만 ) Class II 40.0 35.0 ( 고도비만 ) Class III Prevalence of Obesity Korea 지방세포 (Fat Cell) Development Hypertrophy Hyperplasia (increase in size) (increase in number) During growth, fat cells increase in number. When energy intake exceeds expenditure, fat cells increase in size. When fat cells have reached their maximum size and energy intake continues to exceed expenditure, fat cells increase in number again. When fat loss, the size of the fat cells shrinks, but not the number. BMI 25 kg/m 2 ( 19 years) CDC Korea (2011) Hausman et al. Obesity Reviews (2001) 2, 239 254 8
비만의유형 비만과질병 증식형비만 비만의유형 비대형비만 Pulmonary disease ( 호흡기질환 ) Nonalcoholic fatty liver disease ( 지방간 ) Stroke Depression Cataracts Cardiovascular disease Diabetes 지방세포가비정상적으로많은경우. 성장기동안에비만세포의수가결정됨 ( 정상 :250~300 억개, 비만 :420~1060 억개 ). 성인에게서발생되는비만의형태. 지방세포의크기로비만이결정됨 ( 비만인의지방세포크기는정상인의 40 배 ). Gall bladder disease ( 담낭질환 ) Gynecologic abnormalities ( 부인과질병 ) Osteoarthritis ( 골다공증, 관절염 ) Skin Gout ( 통풍 ) Cancer Phlebitis ( 정맥염 ) 비만의유형 비만의원인 남성형비만 Android Obesity 여성형비만 Gynoid Obesity 유전적요인 (Genetics) 환경적요인 (Environment) ( 에너지섭취의증가 ) Energy Intake 비만과비만관련질환의증가 신체활동의감소 Physical Activity Vague J. Presse Med 1947;30:339 340. Energy Balance No Weight Change 비만의치료 Energy Intake Energy Expenditure Surgery Calorie Consumption Resting (Sleeping) Thermic Effect of Food Physical Activity Pharmacotherapy Lifestyle Modification No Weight Change Diet Physical Activity 9
Selecting Obesity Treatment BMI Category (kg/m 2 ) Treatment 25 26.9 27 29.9 30 34.9 35 39.9 > 40 Surgery Pharmacotherapy Lifestyle Modification With co morbidities With co morbidities The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH. Randomized Controlled Trials Study Purpose: To examine the effects of exercise and diet with/without weight loss on abdominal obesity in obese adults Subject Randomization 1. Control 2. Diet Induced Weight Loss (700 kcal/d) 3. Exercise Induced Weight Loss (700 kcal/d) 4. Exercise without Weight Loss 12 14 weeks of exercise training (moderate to vigorous intensity) (50~60 min of daily aerobic exercise under supervision) Daily energy requirement Balanced Diet Ross R et al. Ann Intern Med 2000;133:92 103 Ross R et al. Obes Res 2004;12:789 98 Effects of Diet- verses Exercise-Induced Weight Loss on Health Outcomes Effects of Exercise alone (without weight Loss) on Health Outcomes Weight Loss Strategies Diet vs. Exercise Body Weight - 6.3 kg - 6.8 kg Total Fat - 13% - 17% Visceral Fat - 24% - 30% Waist Circumference - 5.7 cm - 6.5 cm Cardiorespiratory fitness - + 20% Insulin sensitivity + 30% + 47% Weight Loss Strategies Diet vs. Exercise Body Weight - 6.3 kg - 6.8 kg Total Fat - 13% - 17% Visceral Fat - 24% - 30% Waist Circumference - 5.7 cm - 6.5 cm Cardiorespiratory fitness - + 20% Insulin sensitivity + 30% + 47% EWD -0.5 kg -5.4% - 15.8 % -2.5 cm + 19.5 % + 20.1 % The Leading Causes of Death in the United States in 2003 Cardiovascular disease ( 심혈관질환 ) Data from American Heart Association, 2006. 10
Deaths due to CVD in Europe Deaths due to CVD in Korea Cardiovascular diseases (CVD) coronary heart disease (CHD) coronary artery disease (CAD) - 관상동맥질환 hypertension (high blood pressure) - 고혈압 cerebrovascular disease (stroke) 뇌혈관질환 ( 뇌졸증 ) heart failure - 심부전 peripheral vascular disease - 말초동맥질환 rheumatic heart disease 심장류머티즘 cardiomyopathies (structural abnormalities) 심근증 Coronary Artery Disease (CAD) Coronary artery disease (CAD) 관상동맥질환 ( 심근산고공급 ) : involves atherosclerosis ( 동맥경화 ) in the coronary arteries Atherosclerosis: progressive narrowing of the arteries due to plaque formation Ischemia ( 국소빈혈 ): a deficiency of blood flow to the heart caused by CAD Angina pectoris ( 협심증 ): chest pain ( 관상동맥이좁야져통증유발 ) Myocardial infarction ( 심근경색 ): a heart attack due to ischemia leading to irreversible damage and necrosis ( 완전히막힘 ) Atherosclerosis ( 동맥경화증 ) Not a disease of the aged Pathological changes in the blood vessels begin in infancy and progress during childhood Rate of progression is determined by genetics and lifestyle factors (smoking, diet, physical activity, and stress) 11
Primary Risk Factors for CAD 흡연 (Tobacco smoking) 고혈압 (Hypertension) 혈중지질 (Abnormal blood lipids and lipoproteins) 낮은신체활동 (Physical inactivity) 비만 (Obesity and overweight) 당뇨, 인슐린저항성 (Diabetes and insulin resistance) Uncontrollable Sex Hereditary Age Controllable High blood pressure High blood cholesterol Smoking Physical activity Obesity Diabetes Stress and anger Hypertension - 고혈압 Lipoproteins Lipoproteins: proteins that carry blood lipids Low-density lipoproteins (LDL-C) - 저밀도지단백 High-density lipoproteins (HDL-C) 고밀도지단백 Very low-density lipoproteins (VLDL-C) Ratio of total cholesterol to HDL-C is possibly the most accurate lipid index of risk for CAD > 5.0 = increased risk - 고지혈증 < 3.0 = low risk Stroke ( 뇌졸증 ) Cardiovascular disease that affects the cerebral arteries Ischemic stroke ( 허혈성뇌졸증 / 뇌경색, 뇌혈관의막힘 ) Cerebral thrombosis ( 뇌혈전 ) : a blood clot forms in a cerebral vessel, most often at the site of atherosclerotic damage Cerebral embolism ( 색전증 ): an undissolved mass of material breaks loose from another site in the body and lodges in a cerebral artery Hemorrhagic stroke ( 출혈성뇌졸증 ) Cerebral hemorrhage ( 뇌일혈 ): rupture of one of the cerebral arteries Subarachnoid hemorrhage ( 지주막하출혈 ): surface vessel on the brain ruptures, bleeding into the space between the brain and the skull 12
Relative risk for CHD in men: evidence for dose response Effect of exercise (three or seven sessions/week) on blood pressure in hypertensive Source: Health Professionals Follow-up Study (2002). Diabetes Mellitus Diabetes ( 당뇨병 ) Characterized by high blood glucose concentrations Type 1 (Insulin Dependent Diabetes Mellitus): inability of the -cells in the pancreas to produce insulin 베타세포파괴로인한인슐린분비장애 5-10% of all diabetes cases Type 2 (Non-Insulin Dependent Diabetes Mellitus): ineffectiveness of insulin to facilitate the transport of glucose into the cells (insulin resistance) 90-95% of all diabetes cases Gestational: diabetes that develops during pregnancy (24-26 weeks), 4% of all pregnancies Pre-diabetes: impaired fasting glucose and/or impaired glucose tolerance 제 1 형당뇨병과제 2 형당뇨병의특징 Energy Fuels 특징 제1형당뇨병 제2형당뇨병 발생연령 일반적으로 40세이전에발생 일반적으로 40세이후에발생 체 중 과체중이아님. 마른체격 일반적으로과체중 증 상 갑자기나타남 증상이없거나서서히나타남 인슐린분비 분비되지않음 소량분비 인슐린치료 반드시필요 경우에따라필요 발병비율 전체당뇨병의 10% 전체당뇨병의 90% GLUCOSE (Intestinal Absorption, Blood Stream, Liver and Muscle) The basic carbohydrate for energy production Readily transferred between bloodstream and liver or muscle GLYCOGEN (Muscle and Liver) Storage form of carbohydrate (glucose) in muscle and liver Fuel source that is readily mobilized providing glucose TRIGLYCERIDES (Adipose Tissue and Muscle) High yield-slow release form of energy storage Provides twice the energy per gram than carbohydrate LYPOLYSIS yields free fatty acids and glycerol 13
Hormonal Regulation of Energy Metabolism Defining type 2 diabetes INSULIN : LOWERS BLOOD GLUCOSE Fasting plasma glucose test (FPG) results GLUCAGON : RAISES BLOOD GLUCOSE CATECHOLAMINES : RAISE BLOOD GLUCOSE CORTISOL : RAISES BLOOD GLUCOSE GROWTH HORMONE : RAISES BLOOD GLUCOSE diabetes pre-diabetes normal 126 mg/dl or greater 125 mg/dl to 100 mg/dl less than 100 mg/dl Risk factors for type 2 diabetes Type 2 is more common in people who: Are overweight. Are 45 or older. Are physically inactive. Have a parent or sibling with type 2 diabetes. Have abnormal cholesterol levels. Have had gestational diabetes, or given birth to a baby greater than 9 lbs. Have high blood pressure. Understanding Cancer Deaths due to Cancer in Korea 14
암의전이 암의종류 신체부위별 두경부구강암인두암후두암갑상선암 눈맥락막흑색종 간 / 담즙 / 췌장간암담낭, 담도암췌장암 대장암 / 소장암 내분비갑상선암 식도암 / 위암 폐암 유방암 뇌뇌종양뇌하수체선종신경교종전이성뇌종양청신경교종 부인과난소상피암자궁경부암외음부암 비뇨생식기방광암신우요관암신장암전립선암 기타혈액골수이형성증후군다발성골수종악성림프구 백혈병급성골수성백혈병급성림프구성백혈병만성골수성백혈병 조기진단 5 년생존률 Risk factors Age the most important factor; genes that increase susceptibility impaired immune function, e.g. in AIDs; diets high in fat, meat, salt or alcohol increase risk for some cancers; agents in the environment, e.g. tobacco smoke, sun, radiation, workplace hazards, asbestos; viruses can cause genetic changes in cells that make them more likely to become cancerous, e.g. hepatitis B increases risk for liver cancer. 15
노화에따른암발생증가요인 면역활성감소유전적돌연변이암유전자활성화및종양억제유전자활성감소장기간발암물질노출 DNA 수선율감소활성산소제거능감소 ( 절식효능 ) 염증반응증가 암의주요원인 국제암연구소 미국암협회 흡연 15~30% 30% 만성감염 10~25% 10% 식이습관, 영양 30% 35% 직업성노출 5% 4% 유전적요인 5% 6% 생식적요인 5% 7% 음주 3% 3% 환경오염 3% 2% 자외선, 방사선 3% 3% 음식, 생활습관이 80% 이상차지 암발생라이프스타일 음식 (Red meat, 지방, 염분, 음식물 + 발암물질, 비만 ) 스트레스 ( 자율신경과호르몬의혼란 면역력감소, 암저항력 ) 흡연 (100여종발암물질 ) 술, 술 + 담배바이러스 간염바이러스 B형, C형 - 파필로마바이러스 (papilloma : 자궁경부암 ) - Helicobacter pylori : G- 간균 ( 위암 ) 환경오염물질 : 자동차배기가스의벤조피렌, 니트로필렌, 쓰레기소각장의다이옥신방사선, 자외선, 유전 o 성격 : A타입 - 적극적, 경쟁심, 공격적, 혈압, 암발생, 스트레스는면역력 o 활성산소 : 산화됨 ( 스트레스, 과식, 담배, 자외선, 대기오염물질 ) 16