운동학학술지제 18 권제 4 호 DOI : 근감소증진단지표의효용성에관한연구 * 공성아 1) 성순창 2) 김현수 2)** 1) 성

운동학학술지제 18 권제 4 호 http://kak.co.kr http://e-ajk.org DOI : http://dx.doi.org/10.15758/jkak.2016.18.4.15 근감소증진단지표의효용성에관한연구 * 공성아 1) 성순창 2) 김현수 2)** 1) 성균관대학교 2) 서울과학기술대학교 ABSTRACT Sunga Kong Soonchang Sung Hyunsoo Kim. Efficacy in methods of sarcopenia diagnosis index. KINESIOLOGY, 2016, 18(4): 15-23. [PURPOSE] Sarcopenia is a term utilized to define the loss of muscle mass and strength that occurs with aging. Sarcopenia is believed to play a major role in the pathogenesis of frailty and functional impairment that occurs with old age. The aim of this study was to compared the prevalence of sarcopenia assessed using different diagnostic tools. [METHODS] This study included 131 women elderly subjects aged over 65 years. Body composition was measured by bioelectrical impedance. Physical fitness was evaluated with 8 tests (grip and leg strength, sit-and-reach, chair sit to stand, one leg stand with open eyes, timed up and go, 4- and 10 m walking speed). Sarcorpenia was assessed by three methods (ASM/Ht 2, SMI%, and MAMC). ASM/Ht 2 was defined as ASM(appedicular skeletal mass) divided by body height in meters squared. SMI(skeletal muscle index)(%) was computed as (SMM/weight(kg) 100), to determine relative sarcopenia, after calculation of SMM(skeletal muscle mass) as above from BI-derived ASM. MAMC(mid-arm muscle circumference) was calculated using the following standard formula (MAMC=mid-arm circumferenc-(3.14 triceps skinfold thickness). ASM/Ht 2 or SMI% were <- 2 SD from the mean of the young reference group. [RESULTS] The prevalence of sarcopenia was 28(21.4%) by ASM (kg/ht 2 ) and 12(9.1%) by SMI(%). ASM/Ht 2 (r=.884) and SMI(%) (r=.443) showed the high correlation with skeletal muscle. Nevertheless SMI(%) was higher correlation between BMI, SMM(kg) and %BF than MAMC and ASM/Ht 2. [CONCLUSION] Our paper summarises currently available data defining sarcopenia cut-off point by ASM/Ht 2, SMI(%), Anthropometry(mid-arm, calf, thigh) and AWGS(asian working group for sarcopenia) algorithm for sarcopenia. Key words : sarcopenia, elderly women, muscle function, skeletal muscle mass, physical function 주요어 : 근감소증, 여성노인, 근기능, 골격근량, 신체기능 서론 사회경제적발전과의료기술의발달로평균수명이증가하여최근노인인구의비율이급격하게늘고있다. 이와같이평균수명의증가는바람직한현상이지만, 한편으로는허약, 요실금, 전도, 그리고치매와같은노인증후군도많이발생하고있다 (Hong et al., 2015). 노인의일상생활과관련이깊은최대유산소성능력과근력은나이와함께저하하며 (Taylor & Johnson, 2008), 뼈손실과함께골무기질이감소하고근기능이떨어진다. 이러한변화는결국자립능력과삶의질을떨어뜨린다. 특히노화에따른골격근량의감소는신체활동의감소와일상생활수행능력의저하의원인이되며 (Thompson et al, 2007), 사망을초래할수 있어 (Goodspaster et al., 2006), 노인의골격근량이일정수준이하로감소된경우를근감소증 (sarcopeina) 으로정의하며, 그예방을위한다양한노력이이루어지고있다 (Cruz-jentoft et al., 2010; Chen et al., 2014). 일반적으로근감소증을건강한젊은성인의골격근량의평균값의표준편차 2 이하보다저하된경우로정의하고있지만 (Baumgartner et al., 1998), 근감소증에대한정의나기준은아직확정되어있지않다 (Ryu et al., 2003; Kim et al., 2010; Marzetti et al., 2012; Chen et al., 2016). 최근, 근감소증을골격근량의감소 (Baumgartner et al., 1998) 외에근기능저하가동반된경우로정의하고있다 (Cruz-jentoft et al., 2010; Chen et al., 2014). 골격근량의측정은 dual energy x-ray absorptiometry (DEXA) 법, computed tomography (CT) 법, magnetic * 이연구는서울과학기술대학교교내학술연구비지원으로수행되었습니다. ** 교신저자 : hskim@seoultech.ac.kr

16 근감소증진단지표의효용성에관한연구 resonance imaging (MRI) 법, 그리고 bio-electrical impedance analys(bia) 법으로측정한후사지골격근량을신장의제곱으로나누거나 (Baumgartner et al., 1998), 체중으로나누어 100을곱한값 (Jassen & Ross, 2005) 으로평가하고있다. 그밖에상완둘레 (Landi et al., 2012) 나허벅지및종아리둘레 (Rolland et al., 2003; Berit et al., 2009; Marzetti et al., 2012) 등인체계측을이용하는방법도있다. 근감소증의유병률이유럽은 13.5~24%(Baumgartner et al., 1998), 홍콩과일본은 6~12%(Lee et al., 2007; Sanada et al., 2010), 한국은 4.1~11.6% 였다 (Kim et al., 2009; Lee et al., 2014). 이러한차이는연구에따른진단법및절단값 (Cruz-jentoft et al., 2010; Chen et al., 2016) 과인종, 성별이달랐기때문이다. 특히국내여성노인의근감소증연구의제한점은노인세대에비해젊은세대의신장은크고근육량은적어서, 신장제곱으로골격근량을나눈값이국외연구에비해낮게발표되고있는것도제한점으로지적되고있다 (Kim et al., 2014). 근기능의평가기준은유럽연합근감소증평가위원회 (european working group on sarcopenia in older people: EWGSOP, 2010) 에서처음제시하였으며, 이후국제근감소평가위원회 (international working group in sarcopenia: IWGS) 와아시아근감소증평가위원회 (asian working group for sarcopenia; AWGS) 에서보행능력과악력을이용한근감소진단알고리즘을발표하였다 (Sayer et al., 2007; Fielding et al., 2011; Landi et al., 2012; Lee et al., 2013; Chen et al., 2016). 즉, 4m 걷기속도가 <0.8m/s(Laurentani et al., 2003), 또는 6m 걷기속도가 <1.0m/s(Cesari et al., 2009) 보다느리고, 악력이 <30kg( 여성 : <20kg, <18kg) 이하이면 (Cruz-jentoft et al., 2010; Yuki et al., 2015) 근기능저하로진단하고있다. 이러한근기능지표도골격근량과마찬가지로인종및체격의영향을많이받기때문에진단을위한절단값은연구에따라차이를보인다. 특히동양인은서양인에비해상대적으로마른체형이많으며, 마른동양인의경우비교적적은양의근육손실로현저한근력저하가일어날수있기때문에 (Ellis, 1990; Visser, et al., 1998; Yamada et al., 2007), 한국고령자에게적용가능한근감소증진단지표의확립이필요하다. 실제로악력의경우백인의악력이아시아인 에비해남성은 25%, 여성은 27% 나높다 (Chen et al., 2014). 그러나아직까지국내에서는사지골격근량만을기준으로한근감소연구가일부진행된바있으며 (Kim et al., 2010; Lee et al., 2014; Chen et al., 2015), 근기능지표를이용한알고리즘을적용한연구가없었다. 이연구는 BIA법이나인체계측지표를통한근감소증진단의효용성을확인하고, 근기능알고리즘이국내여성노인에게적용가능한지를알아보기위하여 BIA법을이용하여골격근량을측정하였고, 상 하지의둘레및피하지방두께, 근력및보행능력등을측정하여근감소증진단지표로서의유용성을검토하였다. 연구대상 연구방법 대상자는서울시 N구에있는시립노인복지관 2곳과요양원 1곳을이용하는여성노인 170명중근 골격계이상으로인해체력측정이불가능한자를제외한 131명의자료만을분석하였다. 대상자의신체적특성은 <Table 1> 과같다. Table 1. Physical characteristics of subjects (M±SD) Height (cm) Weight (kg) BMI (kg/m 2 ) SMM (kg) FFM (kg) BF (%) 150.0 ±5.2* 53.7 ±7.8* 23.8 ±3.2 18.5 ±2.9 36.1 ±5.1 32.1 ±9.6* BMI:body mass index, SMM: skeletal muscle mass, FFM:fat-free mass, %BF: percentage body fat 체격및체력측정및방법 신장은신장계의세움대에등을댄후직립자세에서, 체중과신체구성즉체지방률과골격근량 (skeletal muscle mass; SMM) 은다주파수임피던스기기 (Inbody 230, Inbody Co, Korea) 를이용하여측정하였다. 신체둘레는상완의중간부위 (Landi et al., 2012), 종아리는가장굵은부위 (Rolland et al., 2003) 를측정하였다. 피하지방두께는상완과허벅지의중앙을캘리퍼를이용하여계측하였다 (Pollock & Jackson, 1984). 각 2회측정하여

공성아 성순창 김현수 17 평균값으로기록하였다. 체력은 Rehm-Gelin et al.(1997) 의방법으로측정하였다. 악력은좌우평균값을 0.1kg 단위로기록하였고, 하지각근력은 Nicholas MMT를사용하여무릎신전력 (kg) 으로평가하였다. 유연성은좌전굴로, 평형성은눈뜨고한발서기로, 하지근기능은 30초의자에앉았다일어서기로, 그리고동적평형성은 3m 반환점돌아와의자에앉는데걸린시간을측정하였다. 보행능력검사는 4m와 10m 보행 (sec) 검사를실시하였고, 모두평상시속도와빠른속도로걷게하였다. 근감소증진단법 자료처리방법본연구의모든자료는 STATA(version 14.0) 통계프로그램을이용하여분석하였으며, 모든변인은평균과표준편차로제시하였다. 근감소증진단방법에따른집단구분후집단간의체격과체력의차이를분석하기위해독립 t-test 와 one-way ANOVA 로분석하였고, 사후분석은 scheffe 로하였다. 근감소증관련변인인골격근량과인체계측지수및근기능은 Pearson's 상관분석을하였다. 유의수준은 α=.05 로제시하였다. 골격근량의추정방법첫번째는, BIA 법으로측정한 골격근량 (appedicular skeletal mass: ASM) 을신장제 곱으로나눈값, 즉 ASM/Ht 2 을구하였다. 두번째는, 골격근량 (ASM) 을체중으로나눈후 100 을곱하여 SMI%(percentage of skeletal muscle index, SMM/Wt 100) 를산출하였다 (Janssen et al., 2002). 이두가지의경우근감소절단값은 20~40대평균의표준편차 2 에해당하는 7.64 kg/m 2 과 30% 로집단을구분하였다. 그외에인체계측지표중상완둘레와상완두께를이용한 MAMC(mid-arm muscle circumference) 지수를이용하여집단을구분하였다. 이지표는선행연구에제시된 19.2cm를절단값으로하였다 (Landi et al., 2012). 마지막으로골격근량과더불어근기능을이용한 EWGSOP 와 AWGS 진단알고리즘과절단값을활용하였다 (Lee et al., 2013). AWGS 와 EWGSOP 알고리즘은보행능력과근력수준으로평가하였다. 즉, 근기능이정상이면서골격근량이정상이거나, 근기능이저하가되었더라도, 골격근량이정상수준이면정상집단으로, 근기능과더불어골격근량이낮으면근감소증으로진단한다. 이연구에서는보행속도는 <0.8m/s 이고, 악력은 <18kg 를근기능저하로정의하였다 (Lee et al., 2013). 계산식은 <Table 2> 와같다. Table 2. Diagnosis of sarcopenia ASM ASM(kg)/Height 2 (m 2 ) SMI% SMI% = SMM(kg)/weight(kg) 100 MAMC (mid-arm circumference - 3.14) triceps thickness ASM: appendicular skeletal muscle, SMI: skeletal muscle index, SMM: skeletal muscle mass, MAMC: mid-arm muscle circumference 결과 근감소증은 ASM/Ht 2 과 SMI(%) 로추정한경우각각 41명 (31.3%), 11명 (8.4%) 이었다 <Table 3>. 두방법모두집단사이에서나이차이는없었으며, 체중 (p=.001, p=.001) 과 BMI(p=.001, p=.002), 골격근량 (p=.001, p=.001) 은두가지방법모두집단간차이를보였다. 그러나신장을제곱하여나눈 ASM/Ht 2 에따른집단구분에서는신장과체지방률 (%) 의차이는없었으나, 골격근량이유의하게낮았다 (p=.001). 체중을고려한 SMI(%) 법에따른집단구분에서는골격근량 (p=.001) 과체지방률 (p=.001) 의차이는유의하였다. 그러나체력항목은두방법모두차이가없었다. 체격지표를이용한근감소진단항목과체격및체력간의상관분석을실시한결과 ASM/Ht2와 SMI(%) 지수는골격근량 (r=.895, r=478) 과체지방량 (r=-.291 r=-.904) 과상관을보였고, 특히 ASM/Ht 2 (r=.895) 은골격근량과 SMI(%)(r=-.904) 는체지방률과각각매우높은상관을보였다 <Table 4>. 근기능을평가하기위해, 아시아근감소증평가위원회 (AWGS, 2016) 의알고리즘을활용하였다. 근기능은보행속도 (<0.8m/s) 와악력 (<18kg) 으로평가하였고, 골격근량은 ASM/Ht 2 와 SMI(%) 을사용하였다. 집단간체격과체력을비교한결과는 <Table 5> 와같다. 근기능이정상인집단 (G1) 과근기능이낮고, 근육량이정상인집단 (G2) 으로세분화하였으며, 골격근량과근기능이모두감소한집단을근감소집단 (G3)

18 근감소증진단지표의효용성에관한연구 으로비교하였다. ASM/Ht 2 을기준으로한근감소증집단은 41명 (31.3%) 이였으나 <Table 3>, 근기능을추가함으로서 13명 (9.9%) 으로감소하였다 <Table 5>. SMI(%) 을기준으로한경우에도, 근감소집단이 11명 (8.3%) 이였으나 <Table 3>, 5명 (3.8%) 으로줄었다 <Table 5>. ASM/Ht 2 를이용한경우근감소집단 (G3) 에서정상집단 (G1, G2) 에비해체중과 BMI, 골격근량이유의하게낮았으나 (p=.010, p=.003, p=.002), 체지방률은차이가없었다. SMI(%) 를이용한경우근감소집단 (G3) 이정상집단 (G1, G2) 에비하여 BMI 와체지방률이유의하게높았다 (p=.008, p=.011). 두방법모두체력에서집단간유의한차이를보였다 (p>.05). 논의 신장을제곱하여사지골격근량에신장을제곱하여나눈방법 (ASM/Ht 2 ) 은 41명 (31.3%) 이, 사지골격근량을체중으로나눈후 100을곱한 SMI(%) 방법은 11명 (8.4%) 이근감소증으로분류되었다. 타이완사람을대상으로한연구에서 ASM/Ht 2 는 7.8%, SMI(%) 는 16.6% 가근감소증으로나타나 (Lee et al. 2013), SMI(%) 적용시더높은유병률을보여, 이연구와는상반된결과를보였다. SMI(%) 지표를이용할경우일본노인여성이 20.2%(Yuki et al., 2015), 국내노인이 8.8%(Kim, et al., 2010) 의유병률을보였다. 이와같이유병률에차이를보이는것은사용된측정기기, Table 3. Comparison between normal and sarcopenia groups by ASM/Ht 2 and SMI(%) (M±SD) Variable Group ASM/Ht 2 SMI (SMM/Weight*100, %) Normal (n=90) Sarcopenia (n=41) p Normal (n=120) Sarcopenia (n=11) p Age (years) 77.0±7.2 78.0±7.3.496 77.2±7.3 79.6±5.8.447 Height (cm) 150.2±5.1 149.6±5.4.502 150.2±5.2 147.0±3.7.180 Weight (kg) 56.4±7.1 47.7±5.8.000*** 53.4±7.8 60.8±2.5.001* BMI (kg/m 2 ) 25.0±2.8 21.3±2.6.000*** 23.7±3.1 28.2±2.1.002* SMM (kg) 19.6±2.6 16.0±15.5.000*** 18.5±2.9 16.6±0.5.000*** %BF (%) 32.2±9.6 31.9±9.6.862 31.5±9.4 46.2±1.5.000*** Grip strength (kg) 21.5±5.2 20.7±5.3.398 21.2±5.2 21.5±7.4.901 Leg strength (kg) 15.7±5.8 15.1±6.6.716 15.4±6.0 18.0±7.4.479 Sit & reach (cm) 12.5±8.2 11.3±7.3.456 12.1±7.9 12.1±9.3.990 CSS (rep/30 sec) 16.2±6.3 17.3±11.0.532 16.6±8.1 13.8±2.7.080 One leg stand (sec) 18.5±21.3 22.4±23.4.361 20.1±22.1 11.6±17.6.404 TUG (sec) 8.5±3.0 9.9±8.3.351 9.0±5.4 8.8±3.2.952 10m walk (sec) 6.9±2.0 7.8±3.7.141 7.15±2.7 7.25±1.3.933 BMI: body mass index, SMM: skeletal muscle mass, CSS: chair sit to stand, TUG: timed up and go * p<..05, ** p<..001 Table 4. Correlation between sarcopenia diagnostic criteria and functional fitness variables Variable Item ASM/Ht 2 SMI (%) (SMM/Weight 100) MAMC CC (cm) TT (mm) BMI (kg/m 2 ).527** -.4964** 0.17 -.110 -.098 SMM (kg).895**.478**.103.055.089 %BF (%) -.291** -.904** -.106 -.119 -.244** grip strength (kg).030.121.381**.354**.083 Sit and reach (cm).080.115.171.201*.140 CSS (rep/30 sec).049.075.052.105.149 One leg stand (sec).003.039.214*.224*.003 TUG (sec) -.009 -.181 -.068 -.265** -.211* 10m walk (sec) -.092 -.153 -.103 -.239** -.194* BMI: body mass index, SMM: skeletal muscle mass, %BF: percentage body fat ASM: Appendicular skeletal muscle, CC: calf circumference; CSS: chair sit to stand, TUG: timed up and go; MAMC: mid-arm muscle circumferenc; ASM/Ht 2 was defined as ASM divided by body height in meters squared. SMI(%) was computed as (SMM/weight(kg) 100), to determine relative sarcopenia, after calculation of SMM. * p<..05, ** p<..01

공성아 성순창 김현수 19 Table 5. Comparison between in both body composition and physical fitness by ASM/Ht 2 and SMI(%) (M±SD) ASM/Ht 2 SMI (SSM/Wt 100, %) Variable Group Normal (G1) Normal (G2) Sarcopenia (G3) p Normal (G1) Normal (G2) Sarcopenia (G3) p (n=96) (n=22) (n=13) (n=96) (n=30) (n=5) Age (years) 78.0±7.8 75.3±7.5 75.9±7.5.214 78.0±7.8 75.1±7.6 78.0±6.1.155 Height (cm) 150.1±5.3 149.9±4.7 149.8±5.2.975 150.1±5.3 150.4±5.4 146.7±5.5.334 Weight (kg) 53.4±8.0 57.5±6.4a 49.4±6.6b.010* 53.4±8.0 53.4±7.2 60.1±6.7.118 BMI (kg/m2) 23.7±3.2a 25.6±3.1b 22.0±2.5a.003** 23.7±3.2a 23.6±3.1a 28.3±2.3b.008** SMM (kg) 18.5±2.9a 19.6±2.7a 16.1±1.5b.002** 18.5±2.9 18.5±3.0 17.2±1.9.607 %BF (%) 31.8±9.5 33.2±9.5 32.0±10.9.827 31.8±9.5a 30.8±9.3a 44.4±1.9b.011* Grip strength (kg) 23.7±3.5a 14.6±2.7b 14.1±2.3b.000*** 23.7±3.5a 14.3±2.7b 15.2±1.8b.000*** Leg strength (kg) 18.1±5.4a 12.3±4.3b 10.6±5.4b.000*** 18.1±5.4a 11.8±4.6b 11.2±6.3b.000*** Sit & reach (cm) 13.3±6.7a 8.2±10.6b 9.8±9.2ab.014* 13.3±6.7a 7.8±9.7b 16.2±10.1a.002** CSS (rep/30sec) 17.8±8.4a 12.8±5.6b 12.3±4.8ab.005** 17.8±8.4a 12.3±5.5b 14.7±1.7a.005** One leg stand (sec) 24.5±22.9a 5.9±11.5b 4.4±4.4b.000*** 24.5±22.9a 6.0±10.3b 2.3±1.6a.000*** TUG (sec) 7.3±1.8a 10.9±3.7b 15.6±12.7c.000*** 7.3±1.8a 12.4±8.6b 13.5±5.8b.000*** 10m walk (sec) 6.3±1.4a 8.6±2.4b 11.0±5.2c.000*** 6.3±1.4a 9.5±4.1b 9.6±2.3b.000*** a, b, c: Different letter indicate significant difference BMI: body mass index, SMM: skeletal muscle mass, CSS: chair sit to stand, TUG: timed up and go * p<..05, ** p<..01, *** p<..001 절단값, 그리고, 인종차이에도불구하고, 동일하게젋은연령층의골격근량을기준점으로사용하고있는것이원인이었을것으로사료된다. 이연구의절단값은 7.64kg/m 2 로 Lee et al.(2013) 의 5.44kg/m 2, Kim et al.(2010) 의 5.27kg/m2 보다약간높았고, SMI(%) 로할경우 Lee et al.(2013) 의 28%, Kim et al.(2012) 의 25.1% 보다이연구 (30%) 가높아선행연구에비하여 ASM/Ht 2 와 SMI(%) 모두약간높았다 (Kim et al., 2012; Lee et al., 2013). 사지골격근량을신장의제곱으로나눈 ASM/Ht 2 방법은골격근량이정상집단에비해유의하게낮았으나, 체중을이용한 SMI(%) 방법은근감소집단의골격근량외에체지방률이유의하게높았다. 이러한결과는체중을보정하는 SMI(%) 집단구분시비만근감소증의예측이가능하다고보고한연구결과와일치하였다 (Tyrovolas et al., 2016). 즉, 사지골격근량을체중으로나누는계산식 SMI(%) 의경우근육량이적고체중이많은대상자가선별될수있는계산법이기때문이다. 체중을이용한근감소집단구분의경우근감소집단이인슐린저항성지표가높고, 대사증후군의유병률이 64.4% 나높았다 (Zambomi et al., 2008). 이것은근감소와더불어체지방량의증가가상승작용으로대사기능장애의위험을높이기때문이다 (Jang, 2011). 여성의경우남성보다체지방률이높기 때문에체지방량을고려할필요가있다 (Newman et al., 2003). 따라서사지골격근량을체중으로나누어계산하는 SMI(%) 지수가노인여성의근감소진단방법으로적절하다고사료된다. 일부선행연구는 DEXA법이나 BIA법외에인체계측을활용한근감소진단법을제시하였다 (Rolland et al., 2003; Landi et al., 2012). 이연구는인체측정값과신체구성및체력과의상관을비교한결과허벅지피하지방두께가클수록체지방량과체지방률이낮아, 역상관계를보였다. 실제로허벅지근육량은보행능력과상관관계가있고, 노인의허벅지근육량은심혈관계질환및사망률의예측인자로활용될수있는지표이다 (Marzetti et al., 2012). 특히허벅지근육량은현장에서특별한장비없이도간편하게추정이가능하며, 허벅지의둘레와두께모두를이용할경우추정도가높아진다. 종아리둘레는신체구성변인과상관은낮았으나, 체력과는상관관계가높았다. 이결과는종아리둘레가작을수록전도위험이높고, 신체적기능및이동능력이낮다는선행연구와일치한다 (Rolland et al., 2003). 보행능력및근력의저하, 그리고종아리둘레가절단값이하이면전도발생위험이높으며, 종아리둘레가 31cm 미만이면전도위험이높다고하였다 (Landi et al., 2012). 상완의둘레와두께를이용한

20 근감소증진단지표의효용성에관한연구 MAMC 지수는유럽에서근감소를진단하는데활용되었고, 절단값을여성노인의경우 19.2cm로제시하였다 (Landi et al., 2012). 이연구에서 MAMC 지수와전신근육량 (r=.103) 및체지방량 (r=-.106) 과는낮은상관을보인반면, 악력 (r=.381) 및평형성 (r=.214) 과는높은상관을보였다. 그러나일부연구에서사용하고있는인체계측치를통한근감소진단방법은인종이나성별에따른체격차이로인해국내여성노인의체지방과근육량과의상관성이낮아근감소진단방법으로적용하기는어려울것으로판단된다. 기존근감소진단방법중에서 SMI(%) 지표가국내여성노인의근육량과체지방률을고려한근감소증진단지표로활용가능성이높았다. 이에근육량뿐만아니라근기능이노인의신체적능력과삶의질, 그리고사망위험과도관련이높아 (Delmonico et al., 2007; Goodpaster et al., 2006), 이를고려한아시아근감소진단알고리즘을구분하였다 (AWGS, Chen et al., 2016). 이연구에서근감소진단알고리즘에의해근육량과근기능이정상인집단 (G1) 과근육량은정상이지만, 근기능이저하된정상인집단 (G2), 근기능과근육량이모두저하된근감소집단 (G3) 으로구분하였다. 그결과 ASM/Ht 2 을적용한경우근감소집단이 41명 (31.3%) 에서 13명 (9.9%) 으로, SMI(%) 을적용한경우 11 명 (9.3%) 에서 5명 (3.8%) 으로감소하였다. 그이유는근육량은낮지만, 근기능이높은여성노인이정상군에포함되었기때문이다. 정상집단 (G1, G2) 과근감소집단 (G3) 사이에체격및체력특성을비교한결과근기능은저하하였으나, 근육량이정상인집단 (G2) 이근감소집단 (G3) 보다상 하지근력과유연성이낮거나비슷한수준이었다. 이러한결과는 G2집단이 G1보다전도위험율이 3.3% 더높다고한 Landi et al.(2012) 의연구결과와도일치하는것으로, 근육량은정상범위에있지만근기능이저하된 G2 집단의경우걷기속도와악력이낮아전도위험이높을것으로판단된다 (Landi et al., 2012). 따라서근육량은정상이고근기능이저하된경우에는근감소위험집단으로분류할필요가있으며, 따라서이러한집단을대상으로근감소예방프로그램을적극적으로도입해야할것이다. 결론 이연구에서는근감소증집단구분을위해 BIA법으로측정된사지골격근량을신장또는체중으로나눈값을이용하였다. 그결과신장으로나눈 ASM/Ht 2 에비해체중으로나눈 SMI(%) 지수가근육량외에체지방량을반영한집단구분이가능하였다. 상완둘레및두께, 종아리둘레및허벅지두께는체력변인과상관이높았다. 또한골격근외근기능을이용한집단구분에서는근감소집단으로분류된수가감소하였다. 그러나이연구는대상자수가적었으며, 여성노인에국한된연구였다. 따라서추후대규모집단을대상으로한연구가필요할것으로사료된다. 참고문헌 Baumgartner, R. N., Koehler, K. M., Gallagher, D., Romero, L., Heymsfield, S. B., Ross, R. R., Garry, P. J. & Lindeman, R. D. (1998). Epidemiology of sarcopenia among the elderly in New Mexico. American Journal of Epidemiology, 147: 755-763. Berit, L., Heitmann, & Peder Frederiksen. (2009). Thigh circumference and risk of heart disease and premature death: prospective cohort study. British Medical Journal, 339: b3292. Cesari, M., Pahor, M., & Lauretani, F. (2009). Skeletal muscle and mortality results from the InCHIANTI study. Journal of Gerontology America Biological Sciences Medicine Science, 64: 377-384. Chen, L K., Liu, L. K., Woo, J., Assantachai, P., Auyeung, T. W., Bahyah, K. S., Chou, M. Y., Chen, L. Y., Hsu, P. S., Krairit, O., Lee, J., Lee, W. J., Lee, Y., Liang, C. K., Limpawattana, P., Lin, C. S., Peng, L. N., Satake, S., & Suzuki, T. (2014). Sarcopenia

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