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Original Article J Sasang Constitut Med 2014;26(4):365-378 http://dx.doi.org/10.7730/jscm.2014.26.4.365 대사증후군에대한사상체질별허리둘레및체질량지수의절단값에대한연구 최재완ㆍ유준상 * 윤제우한의원, * 상지대학교한의과대학사상체질과 Abstract Cut-off Values of Waist Circumference and Body Mass Index for Metabolic Syndrome according to Sasang Constitution Jae-Wan Choi, Jun-Sang Yu * Yunjewoo Korean Medicine Clinic, * Dept. of Sasang Constitutional Medicine, College of Korean Medicine, Sangji University, Seoul, Korea Objectives This study was performed to investigate the cut-off values of abdominal circumference and Body Mass Index(BMI) according to Sasang Constitution. Methods A total of 1,773 persons, namely 440 male people and 1,333 female people, in ages from 40 to 69 years old, participated in this research. They are all included in the community based Genomic cohort in Wonju in years from 2006 to 2013. The diagnostic criteria of metabolic syndrome was used followed by the National Cholesterol Education Program in Adult Treatment Panel Ⅲ (NCEP ATP Ⅲ) and Asian pacific guideline for only abdominal obesity. Results The prevalence of metabolic syndrome was 34.8% for men and 37.6% for women in this research. Taeeumin was the highly significant risk type for the metabolic syndrome in both sexes. Cut-off values of abdominal circumference were 88.3 cm in men, 80.3 cm in women, and cut-off values of BMI were 24.2 kg/m 2 in men and 25.3 kg/m 2 in women. For men, cut-off values of abdominal circumference were 79.5cm in Soyangin, 88.8 cm in Taeeumin and 79.5 cm in Soeumin, and cut-off values of BMI were 23.2 kg/m 2 in Soyangin, 25.6 kg/m 2 in Taeeumin and 20.6 kg/m 2 in Soeumin. For women, cut-off values of abdominal circumference were 76.3 cm in Soyangin, 80.3 cm in Taeeumin and 76.8 cm in Soeumin, and cut-off values of BMI were 22.4 kg/m 2 in Soyangin, 24.9 kg/m 2 in Taeeumin and 21.3 kg/m 2 in Soeumin. Conclusions Although 90 cm in men, 80 cm in women as an Asian pacific guideline were regarded as quite approximate to the mean value of abdominal circumference and 25 kg/m 2 to BMI. But if the results could be allocated in terms of the Sasang constitutional method, the cut-off values for Soyangin and Soeumin should be lowered than now. Key Words : Sasang Constitutional Medicine, Metabolic Syndrome, Body Mass Index, Waist Circumference

366 Cut-off Values of Waist Circumference and BMI Received June 24, 2014 Revised July 1, 2014 Accepted October 28, 2014 Corresponding Author Jun-Sang Yu Dept. of Sasang Constitutional Medicine, Sangji University 80 Sangjidae-gil, Wonju-si, Gangwon-do, Korea Tel: +82-33-741-9203 Fax: +82-33-741-9141 E-mail: hiruok@sangji.ac.kr C The Society of Sasang Constitutional Medicine. All rights reserved. This is an open acess article distributed under the terms of the Creative Commons attribution Non-commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) Ⅰ. 緖論 우리몸의대사이상들은군집화하는경향이있고, 본래는인슐린저항성증후군으로여겨졌으나, 이후에인슐린저항성을일으키는여러가지관련요인들이밝혀져, 대표적인요인들을통해인슐린저항성을유추하기위해서대사증후군 (metabolic syndrome) 이라는용어를사용하게되었다 1. 대사증후군은심혈관이나뇌혈관질환의위험성을증가시키기때문에전세계적관심의대상이되고있다 2. 이러한대사증후군의핵심에는비만이있으며, 단순하게대사증후군의유무가아닌연속적인도구 (calculator) 를사용하면대사증후군의요소인대사이상의평가가용이하다. 이러한편의성을위해서체질량지수 (Body Mass Index, BMI), 허리둘레 (waist circumference), 허리엉덩이둘레 (waist hip ratio), 허리신장지수 (waist stature ratio) 등이내장비만의지표로서사용되고있다 3. 특히국제당뇨병연맹 (International Diabetes Federation) 에서는대사증후군이되기위해서는복부비만이필수라고여기고있으며, 민족의특수성을감안하여다양한허리둘레절단값 (cut-off value) 을제시하고있다. 국제당뇨병연맹의허리둘레기준중, 남아시아인, 중국인, 일본인에대해서남자허리둘레를 90cm, 여자허리둘레를 80cm 으로제시하고있으나 4, 일본에서는 2008년남자는 85cm, 여자는 80cm로하는것이진단오류를막을수있는절단값이라하였으며 5, 중국에서도남자는 85cm, 여자는 80cm 로제시하여 6,7 논란이있다. 우리나라에서는일반적으로 WHO 아시아태평양기준을사용해남자는 90cm, 여자는 80cm 을사용하지만, 국내의한연구에서는남자 89.8cm, 여자 86.1cm 을제시하기도하였다 8. 또한 BMI 에대해서는 1999년 WHO 에서대사증후군의요소중복부비만은 BMI 가 30kg/m 2 를초과하거나허리엉덩이둘레 (WHR) 가남자는 0.9를, 여자는 0.85를초과하면복부비만으로정의하였다 9. 복부비만의대리지수 (surrogate indicator) 로서 BMI 를사용할지, 혹은허리둘레를사용할지에대해서도논란이있다 2. 사상체질의학에서는사상체질에따라서체형기상 ( 體形氣像 ) 이다름을설명하고, 그중태음인은간대폐소 ( 肝大肺小 ) 로호산지기 ( 呼散之氣 ) 가부족하고흡취지기 ( 吸聚之氣 ) 가강하여생리적으로기육 ( 肌肉 ) 을생성하는작용이타체질에비해과도하기쉬우므로비만경향성이많은체질로여겨지며 10, 그동안대사증후군과사상체질과의관련성에대한연구에서는태음인체질에서유병률 11-13 과발생률 14 이가장높은것으로나타났다. 본연구는대사증후군과정상군을구별하는허리둘레및 BMI 의절단값이개인의체질과무관하게일률적으로적용되던것에대해서체질별차별화가필요하다고생각하여, 원주시코호트에서진행된유전체코호트사업에참여한대상자에대해, 대사증후군집단과대사증후군이아닌집단간의복부비만을나타내는지표인허리둘레와 BMI 의절단값을사상체질별로구하고자하였다. Ⅱ. 硏究對象및方法 1. 연구대상질병관리본부의과제로진행되는한국인유전체역학조사사업의일부인농촌지역사회기반유전체코호

JW Choi et al. 367 트연구사업으로연세대학교원주의과대학평생건강관리센터에서 2006년부터 2013년까지연구가진행중이다. 2006년 6월부터 2006년 8월까지사상체질관련 1차조사와 2007년 10월부터 2008년 2월까지 2차조사, 2009년 6월부터 2009년 8월까지 3차조사, 2013 년 9월부터 2013 년 10월까지 4차조사를시행하였고, 자발적으로참여한 40세이상의성인남녀를대상으로하였으며, 사상체질진단자료가있는 1929명중대사증후군관련요소들이모두갖추어진 1773명을분석대상으로하였다. 2. 검사방법 1) 사상체질진단의확정 (1) 음성체질분석사상체질음성분석기 (Phonetic System for Sasang Constitution, Voiceone, Korea) 를사용하였다. 대상자가의자에앉아서헤드셋을착용하고헤드셋과입과의거리는약 1~2cm정도를유지하도록하였고, 편안한상태에서평소말하듯이발음하도록하여 아, 이 의단모음과 우리는높은산에올라가맑은공기를마시고왔습니다 의문장을녹음하여자동으로분석된사상체질결과를얻었다. (2) 사상체질분류검사 (QSCC Ⅱ) 경희대학교와사상체질의학회에서만든사상체질분류검사 (QSCC Ⅱ: Questionnaire of Sasang Constitution Classification Ⅱ) 를대상자가직접작성하도록하였으며, 이해가어려운경우에는연구원이설명을도와주어서작성토록하였다. 이후사상체질분류검사분석프로그램을이용해체질을분류하였다. (3) 사상체질결과의진단 1명의사상체질전문의가음성체질분석과사상체질분류검사의결과를확인하여두가지가일치한경우에는해당체질로판정하고, 두가지가일치하지않을경우에는설문내용을참고하여체질을종합적으 로판단하였다. 2) 신체검사및이학검사 (1) 측정기기 1 수은혈압계 (FT-500, Jawon Medical, Korea) 2 혈액검사 ( SCL, Korea) 3 코호트설문지 4 체성분검사기 (Jawon medical, Korea) 5 신장체중측정기 (Fanics, Korea) (2) 측정방법 1 신체계측 : 신장기를이용해서키를측정하였고, 체중은체성분검사기에서표시하는숫자로표시하였으며, 이를통해서체질량지수를계산하였다. 2 허리둘레 : 얇은속옷을입은상태로서있는자세에서측정방법을표준화하여배꼽둘레와위앞장골능의중간둘레를줄자를이용해숙련된연구원이측정하였다. 3 혈압 : 10 분이상앉은상태에서안정을취한후, 수은혈압계를이용해간호사가측정하였다. 4 공복혈당 : colorimetry( 비색법 ) 를이용하여측정하였다.( SCL, Korea) 5 중성지방 : 효소법을이용하여측정하였다.( SCL, Korea) 6 고밀도지단백 : 효소법을이용하여측정하였다. ( SCL, Korea) 3) 대사증후군의진단대사증후군진단기준중비만의기준은나라나인종마다다른데, 우리나라에서는대체로 APC(Asia pacific criteria: 아시아태평양지역의비만기준 ) 를따르는데, 허리둘레는남자의경우 90 cm이상, 여자는 80 cm이상으로, 체질량지수 (BMI) 는 25 kg/m 2 이상으로제시하였다 15. 본연구에서는비만기준을허리둘레로하였다.

368 Cut-off Values of Waist Circumference and BMI 이상지질혈증과높은혈압, 높은혈당의기준은 National Cholesterol Education Program in Adult Treatment Panel Ⅲ(NCEP ATP Ⅲ) 진단기준 16 을적용하였다. 중성지방이 150 mg/ dl이상이거나고중성지방혈증치료약물을복용중인경우로하였고, 고밀도지단백이낮은경우남자의경우 40 mg/ dl미만인경우, 여자의경우 50 mg/ dl미만인경우이거나고밀도지단백이낮은경우를치료하기위한약물을복용중인경우로정의하였다. 높은혈압은 NCEP-ATPⅢ 에의하여수축기혈압이 130 mmhg이상또는이완기혈압이 85 mmhg이상또는혈압치료를하는경우로정의하였다. 높은혈당은공복시혈당이 110 mg/ dl이상또는혈당치료를하는경우로하였다. 이상의복부비만, 높은혈압, 높은혈당, 고중성지방혈증, 고밀도지단백이낮은경우의 5가지구성요소중 3가지이상을가진경우를대사증후군으로진단하였다. 3. 통계분석통계는통계패키지 IBM SPSS 19.0 을사용하였으며, 남녀별인구특성학적비교에서는독립표본 t test를시행하였고, 남녀별각각사상체질에따른혈압및 대사증후군위험요인의평균비교는일원배치분산분석을하였으며, 남녀별고혈압, 당뇨병등을가진대상자의빈도비교는교차분석을시행하였다. 남녀별및사상체질별허리둘레와 BMI 의절단값 (cut-off value) 을구하기위해서 ROC 분석 (receiver operating characteristics curve analysis) 을하였다. 허리둘레및 BMI 와다른대사증후군위험요인들간의민감도와특이도를최대로할수있는절단값을구하였다. 즉 ROC 에서 1-특이도 (specificity) 가 0에, 민감도 (sensitivity) 가 100% 에가장가까운점을찾고자하였다. 유의수준은 0.05 로하였다. Ⅲ. 硏究結果 1. 연구대상자의남녀별인체측정특성연구대상자의남녀별특성에서는연령, 허리둘레, 확장기혈압, 중성지방, 공복시혈당이남성이여성에비해서유의하게높게나타났으며, 고밀도지단백은여성이남성에비해서높게나타났다. 고혈압, 당뇨병, 고지혈증의비율은모두남성에서유의하게높게나타났다 (Table 1). 본연구에서남녀별사상체질의분포는태음인의비율이가장높았다 (Table 2). Table 1. Clinical Characteristics of the Study Subjects Male (n=440) Female (n=1,333) p value Age (yr) 56.9±8.2 54.3±8.1* <.001 Waist circumference (cm) 85.5±8.1 80.2±8.8* <.001 Body mass index (kg/m 2 ) 24.1±2.9 24.4±3.3 0.062 Systolic blood pressure ( mmhg) 134.3±18.4 132.3±19.1 0,054 Diastolic blood pressure ( mmhg) 86.0±11.1 81.1±12.1* <.001 Triglyceride ( mg / dl ) 180.8±202.5 129.0±73.2* <.001 HDL-cholesterol ( mg / dl ) 42.3±9.8 46.0±10.9* <.001 Fasting plasma glucose ( mg / dl ) 100.9±22.0 94.9±18.6* <.001 Hypertension (%) 70.5 59.0 <.001 Diabetes mellitus (%) 17.7 9.6 <.001 Dyslipidemia (%) 38.2 28.0 <.001 HDL ; high-density lipoprotein. Values are presented as mean±sd. * p <.05 vs. male, calculated by T test. p <.05, calculated by Chi-sqaure test.

JW Choi et al. 369 Table 2. Total Study Subjects by Sex and Constitution Sex Soyangin (N = 305) Taeeumin (N = 1053) Soeumin (N = 415) Total (N = 1773) Male 41(9.3) 277(63.0) 122(27.7) 440(100.0) Female 264(19.8) 776(58.2) 293(22.0) 1333(100.0) Values are presented as N(%). Table 3. Metabolic Characteristics of Male Subjects Soyangin (N=41) Taeeumin (N=277) Soeumin (N=122) p value Age (yr) 54.5±8.4 56.9±8.1 57.8±8.5 0.090 Waist circumference (cm) 82.1±5.2 b 89.3±6.1 a 77.9±6.8 c <.001 Body mass index (kg/m 2 ) 23.0±0.9 b 25.7±2.0 a 20.8±1.7 c <.001 Systolic blood pressure ( mmhg) 131.6±16.2 136.5±19.0 a 130.2±16.9 b 0.004 Diastolic blood pressure ( mmhg) 83.6±11.4 87.2±11.1 a 84.0±10.7 b 0.010 Triglyceride ( mg / dl ) 147.8±98.4 200.9±219.1 a 146.2±183.3 b 0.025 HDL-cholesterol ( mg / dl ) 43.6±8.3 40.8±9.3 b 45.5±10.6 a <.001 Fasting plasma glucose ( mg / dl ) 99.8±20.8 102.5±21.5 97.6±23.0 0.115 Hypertension (%) 63.4 74.0 64.8 0.102 Diabetes mellitus (%) 22.0 19.9 11.5 0.099 Dyslipidemia (%) 31.7 46.6 * 21.3 <.001 HDL ; high-density lipoprotein Values are presented as mean±sd. Different superscripts mean that they have statistically significant differences between them and are calculated by ANOVA. * p <.05, calculated by Chi-square test. 2. 남성대상자의사상체질별대사관련요인남성대상자들중사상체질에따른대사관련요인을살펴보았을때, 허리둘레, 체질량지수 (BMI) 는태음인, 소양인, 소음인이각각유의한차이가있었으며, 수축기혈압, 확장기혈압, 중성지방, 고밀도지단백은태음인과소음인에서유의한차이가있었다. 또한유병률에서는태음인이이상지질혈증에서가장높은비율을차지하고있었다 (Table 3). 3. 여성대상자의사상체질별대사관련요인여성대상자들중사상체질에따른대사관련요인을살펴보았을때, 연령은태음인, 소양인간에유의한차이가있었고, 허리둘레, 수축기혈압, 확장기혈압, 중성지방, 고밀도지단백에서는태음인과소음인, 태음인과소양인간에유의한차이가있었으며, 체질량지수에서는태음인, 소양인, 소음인간에유의한차이가 있었다. 또한유병률에서는태음인이고혈압, 당뇨병, 이상지질혈증에서가장높은비율을차지하고있었다 (Table 4). 4. 남녀별대사증후군의위험인자유병률전체대상자중대사증후군에포함된남성대상자는 34.8% 이었으며, 그중고혈압의유병률이 91.5% 로가장높았으며, 중성지방혈증이 79.1%, 고밀도지단백이낮은경우가 75.2% 로나타났다. 전체대상자중대사증후군에포함된여성대상자는 37.6% 이었으며, 그중고밀도지단백이낮은경우의 92.8% 로가장높게나타났으며, 고혈압의유병률이 88.8%, 복부비만의유병률은 85.8% 로나타났다. 성별에따른유의한차이는, 중성지방혈증, 고혈당에서는남성의유병률이유의하게높았으며, 복부비만, 고밀도지단백이낮은경우는여성의유병률이유의하게높게나타났다 (Table 5).

370 Cut-off Values of Waist Circumference and BMI Table 4. Metabolic Characteristics of Female Subjects Soyangin (N=264) Taeeumin (N=776) Soeumin (N=293) p value Age (yr) 52.0±7.6 b 55.4±7.8 a 53.3±8.7 <.001 Waist circumference (cm) 75.4±6.4 b 84.1±7.6 a 74.1±8.0 b <.001 Body mass index (kg/m 2 ) 22.6±1.9b 26.0±2.9a 21.6±2.5c <.001 Systolic blood pressure ( mmhg) 128.4±17.6 b 135.3±19.1 a 127.8±18.7 b <.001 Diastolic blood pressure ( mmhg) 78.4±11.1 b 83.3±11.7 a 77.58±12.8 b <.001 Triglyceride ( mg / dl ) 113.7±56.9 b 140.2±77.6 a 113.1±68.6 b <.001 HDL-cholesterol ( mg / dl ) 48.1±11.6 b 44.6±10.1 a 47.7±11.6 b <.001 Fasting plasma glucose ( mg / dl ) 91.6±10.3 b 97.7±22.1 a 90.2±11.2 b <.001 Hypertension (%) 47.3 67.5 * 46.8 <.001 Diabetes mellitus (%) 5.3 13.4 * 3.4 <.001 Dyslipidemia (%) 20.8 34.5 * 17.1 <.001 HDL ; high-density lipoprotein Values are presented as mean±sd. Different superscripts mean that they have statistically significant differences between them and are calculated by ANOVA. * p <.05, calculated by Chi-square test. Table 5. Metabolic Components Proportions by Sex and Sasang Constitution Male Female Male Female Sum Soyangin Taeeumin Soeumin Sum Soyangin Taeeumin Soeumin Sum Triglyceride 121(79.1) 308(61.5) * 429(100) 9(100) 102(78.5) 10(71.4) 121 36(75.0) 243(59.9) 29(61.7) 308 Hypertension 140(91.5) 441(88.0) 581(100) 9(100) 117(90.0) 14(100) 140 40(83.3) 361(88.9) 40(85.1) 441 High Blood Glucose 55(35.9) 114(22.8) * 169(100) 5(55.6) 42(32.3) 8(57.1) 55 10(20.8) 95(23.4) 9(19.1) 114 Abdominal Obesity 87(56.9) 430(85.8) * 517(100) 1(11.1) 83(63.8) * 3(21.4) 87 33(68.8) 367(90.4) * 30(63.8) 430 Low HDL-cholesterol 140(75.2) 465(92.8) * 580(100) 9(100) 117(90.0) 14(100) 140 46(95.8) 374(92.1) 45(95.7) 465 Metabolic Syndrome 153(100) 14(100) 153 9(100) 130(100) 14(100) 153 48(100) 406(100) 47(100) 501 Values are presented as N(%). * p <.05, calculated by Chi-square test. 5. 남성에서사상체질별대사증후군의위험인자유병률대사증후군에해당하는남성을사상체질별로분류하여대사증후군의위험요인유병률을살펴보았을때, 복부비만에서만태음인이유의하게높게나타났고, 나머지항목에서는유의한차이가없었다 (Table 5). 6. 여성에서사상체질별대사증후군의위험인자유병률대사증후군에해당하는여성을사상체질별로분류하여대사증후군의위험요인유병률을살펴보았을때, 남성과마찬가지로복부비만에서만태음인이유의하게높게나타났고, 나머지는유의한차이가없 었다 (Table 5). 7. 남성의대사증후군위험인자개수와허리둘레및 BMI 대사증후군의위험인자가없는경우에허리둘레평균이 79.3 cm이었고, 대사증후군의위험인자의개수가증가함에따라각각 81.2 cm, 86.4 cm, 89.1 cm, 92.4 cm, 97.2 cm로증가하였다 (Figure 1). 대사증후군의위험인자가없는경우에 BMI 평균이 21.8 kg/m 2 이었고, 위험인자의개수가증가함에따라서각각 22.6 kg/m 2, 24.1 kg/m 2, 25.5 kg/m 2, 26.4 kg/m 2, 28.3 kg/m 2 으로증가하였다 (Figure 2).

JW Choi et al. 371 Figure 1. Waist circumference of male subjects according to the number of metabolic components Figure 2. BMI of male subjects according to the number of metabolic components BMI ; Body Mass Index 8. 여성의대사증후군위험인자개수와허리둘레및 BMI 대사증후군의위험인자가없는경우에허리둘레평균이 71.4 cm이었고, 대사증후군의위험인자의갯수가증가함에따라각각 74.5 cm, 79.9 cm, 84.9 cm, 87.9 cm, 90.1 cm로증가하였다 (Figure 3). 대사증후군의위험인자가없는경우에 BMI 평균이 21.8 kg/m 2 이었고, 위험인자의갯수가증가함에따 라서각각 22.4 kg/m 2, 24.2 kg/m 2, 25.9 kg/m 2, 26.9 kg/m 2, 27.6 kg/m 2 으로증가하였다 (Figure 4). 9. 대사증후군에대한남녀별허리둘레및 BMI 의절단값남성의대사증후군에대한허리둘레절단값은 88.3 cm (Sensitivity 65.4%, Specificity 79.4%), BMI 의절단값은 24.2 kg/m 2 (Sensitivity 75.8%, Specificity 70.3%) 로

372 Cut-off Values of Waist Circumference and BMI Figure 3. Waist circumference of female subjects according to the number of metabolic components Figure 4. BMI of female ubjects according to the number of metabolic components BMI ; Body Mass Index 나타났다 (Figure 5). 여성의대사증후군에대한허리둘레절단값은 80.25 cm(sensitity 85.8%, specificity 76.5%), BMI 의절단값은 25.3 kg/m 2 (sensitivity 70.7%, specificity 75.3%) 으로나타났으며, 모두유의하였다 (Figure 6). 10. 대사증후군에대한남성의사상체질별허리둘레및 BMI의절단값 남성에서사상체질별로허리둘레, BMI 의절단값을살펴보았을때, 소양인은 79.5cm (Sensitivity 77.8%, Specificity 68.8%) 로나타났으나, 유의하지는않았다. BMI 는 23.2 (Sensitivity 55.6%, Specificity 68.7%) 로나타났으나유의하지는않았다 (Figure 7). 태음인에서는허리둘레 88.8cm (Sensitivity 73.1%, Specificity 63.7%), BMI 는 25.6 (Sensitivity 66.2%, Specificity 71.9%) 로나타났으며, 유의한수준이었다 (Figure 8).

JW Choi et al. 373 Figure 5. ROC curve for the waist circumference and BMI for male subjects Figure 6. ROC curve for the waist circumference and BMI for female subjects Figure 7. ROC curve of waist circumference and BMI for male Soyangin Figure 8. ROC curve of waist circumference and BMI for male Taeeumin Figure 9. ROC curve of waist circumference and BMI for male Soeumin ROC ; Receiver Operating Characteristic, BMI ; Body Mass Index Figure 10. ROC curve of waist circumference and BMI for female Soyangin

374 Cut-off Values of Waist Circumference and BMI Figure 11. ROC curve of waist circumference and BMI for female Taeeumin ROC ; Receiver Operating Characteristic, BMI ; Body Mass Index Figure 12. ROC curve of waist circumference and BMI for female Soeumin 소음인에서는허리둘레 79.5cm (Sensitivity 71.4% Specificity 67.6%), BMI 는 20.6 (Sensitivity 78.6%, Specificity 51.9%) 로나타났으며, 유의한수준이었다 (Figure 9). 11. 대사증후군에대한여성의사상체질별허리둘레및 BMI의절단값여성에서사상체질별로허리둘레, BMI 의절단값을살펴보았을때, 소양인은 79.3cm (Sensitivity 81.3%, Specificity 68.5%), BMI 는 22.4 (Sensitivity 70.8%, Specificity 56.9%) 로나타났으며유의하였다 (Figure 10). 태음인에서는허리둘레 80.3cm (Sensitivity 90.4%, Specificity 58.7%), BMI 는 24.9 (Sensitivity 77.1%, Specificity 55.4%) 로나타났으며, 모두유의한수준이었다 (Figure 11). 소음인에서는허리둘레 76.8cm (Sensitivity 78.7% Specificity 72.4%), BMI 는 21.3 (Sensitivity 76.6%, Specificity 56.9%) 로나타났으며, 모두유의한수준이었다 (Figure 12). Ⅳ. 考察 대사증후군은심혈관질환의유병률및사망률을높이는질환으로 17 미국성인 4명중 1명이대사증후군을지니고있으며, 60세이상의경우에는 40% 이상의유병률이보고되고있다 18. 2005년연구에서는우리나라도미국보다는낮은편이지만 30세이상의경우남성은 32.9%, 여성은 31.8% 로보고되었다 19. 본연구결과는중소도시인원주지역의코호트에서나온결과로, 40 세이상의성인남녀를대상으로했을때, 남성에서 34.8%, 여성에서 37.6% 의대사증후군유병률을보여, 연령이높아질수록유병률이증가추세에있는것을볼수있다. 본연구에서남녀별로기본특성을살펴보았을때, 허리둘레, 확장기혈압, 중성지방, 공복시혈당이여성에비해서남성이유의하게높게나타났고, 고밀도지단백은여성에비해서남성이유의하게낮게나타나는특성을보여주었다. 하지만, 5개의대사증후군위험인자들이 3개이상군집화하는대사증후군의경우에는여성에서높게나타나는현상을보여주었다. 이는원주코호트에거주하는대상자들의경우, 남성에서 1, 2개의위험인자들을가지고는있으나, 3개이상

JW Choi et al. 375 으로군집화하는것은여성에비해낮은것으로보이며, 여성의경우에는위험인자가있는사람은 3개이상을동시에갖고있는것으로생각된다. 또한사상체질별로는다른연구결과 11-13 와일치하는결과로서, 성별을막론하고, 허리둘레, 수축기혈압, 확장기혈압, 중성지방에서태음인체질이타체질에비해서높게나타났다. 남녀관계없이허리둘레, 체질량지수가태음인에서유의하게높게나타나므로비만은특히태음인에서관리를필요로하는요인이라생각된다. 수축기혈압, 확장기혈압, 중성지방이높고고밀도지단백이낮게나타나는대상자의비율이태음인에서높게나타나, 역시비만, 지방대사에관련된요인들및이로인한혈압문제가건강상의주요문제로대두될수있을것이다. 본연구에서남성대사증후군유병률은 34.8%, 여성은 37.6% 로비슷한수치가나타나고있다. 다만대사증후군에포함된대상자를성별로어떤위험인자의유병률이높은지를살펴보았을때는서로다른결과를나타냈는데, 성별로유의한차이가있는것은중성지방혈증, 고혈당에서는남성의유병률이유의하게높았으며, 복부비만, 고밀도지단백이낮은경우는여성의유병률이유의하게높게나타났다. 이에대해서는추후건강관리대책을강구하거나, 기전을규명할때참고할필요가있다고생각한다. 성별에따라사상체질별대사증후군위험요인의유병률은복부비만외에는유의한차이가없었는데, 그러므로복부비만은태음인에서대사증후군과깊은연관을가진항목이라여겨지며, 남성에서는중성지방혈증, 높은혈당에대해서좀더유의한관련성이보였고, 여성에서는복부비만과고밀도지단백이낮은경우와유의한관련성이있는것으로보였다. 대사증후군은사망률을높이는데, 대사증후군이있을때전체사망률이 18.0%, 대사증후군이없을때 4.6% 로나타났고, 심혈관질환으로인한사망률도대사증후군이있을때는 12.0%, 대사증후군이없을때는 2.2% 로대사증후군이있는경우에유병률과사망률이유의하게높음을알수있다 17. 따라서이러한 대사증후군을관리하기위한대책이요구되는데, 대사증후군의유병률이증가되는데는비만이중요한역할을하고있으며 20, 중심성비만은대사증후군의주요한특징이라고할수있다 21. 그중복부비만을결정하는허리둘레 (Waist Circumference) 는피하지방및내장지방과상관이깊은복부지방량의대리지수 (surrogate indicator) 로자주사용되고있으며, 당뇨병, 심혈관질환및사망률, 혈압, 혈당, 지단백 (lipoprotein) 들의중요한예측인자 (predictor) 로알려져있다 22-24. 따라서허리둘레는임상이나공중보건관련연구에서비만관련질환이있는개인을분별하는도구로서매우가치있는지표라고할수있다. 건강과관련한지표들에대한허리둘레의절단값은성별, 민족등인구학적변수에따라서영향을받게된다 25. 그렇기때문에동양권에서이루어지는대사증후군관련연구에서는대부분의대사증후군위험인자들을 NCEP ATP Ⅲ 16 를따르면서도, 오직복부비만에서는 Asian Pacific Guideline 15 을따르는데, 남자에서 90 cm이상 (35인치이상 ), 여자에서는 80 cm이상 (31인치이상 ) 을위험인자로하고있다. 또한 IDF(International diabetes federation) 에서도복부비만은인종적특성을감안해야한다고하였으며 4, 중국과일본의기준은허리둘레를남자의경우 90 cm이상, 여자의경우 80 cm이상으로설정해놓았다 4. 그러나각나라에서이루어진연구결과로는다소다른절단값을나타냈는데, 일본의경우는 2005년남자 85 cm, 여자 90 cm를거쳐 26, 2007년남자 85 cm, 여자 82 cm를제시하였으나 27, 2008년남자 85 cm, 여자 80 cm를보고하였다 7. 중국에서도남자 85cm, 여자 80 cm를제시하기도하였다 6,7. 우리나라의경우에는주로 WHO 아시아태평양기준을사용해남자 90 cm, 여자 80 cm를절단값으로사용하고있다. 유럽에서는 1999년남자 94 cm, 여자 80 cm를제시하였다. 말레이시아에서이루어진연구에서는허리둘레절단값으로남자는 87.5 cm, 여자는 84.5 cm, BMI 의절단값은남자 25 kg/m 2, 여자 23 kg/m 2 로보고하였고, 허리둘레가 80 cm이상이남녀혹은 BMI 에관계없이대사증후군의위험인자로

376 Cut-off Values of Waist Circumference and BMI 여겨야한다고하였다 28. WHO 에서는아시아인들이유럽인들과달리 25 kg/m 2 이하의 BMI 에서도복부지방이높다는연구들을종합해절단값을변경하고자하였으나, 그대로유지하고있다 29. 본연구에서는대사증후군에대한절단값으로서남성의경우 88.3 cm, BMI 는 24.2 kg/m 2, 여성의경우, 허리둘레 80.3 cm, BMI 는 25.3 kg/m 2 을제시하는데, 허리둘레에서는대략아시아태평양기준에근접하고있다고생각하며, BMI 에서도 25 kg/m 2 에근접하게나타났다. 그런데이를사상체질별로적용한다면, 남성에서소양인의경우허리둘레 79.5 cm, BMI 23.2 kg/m 2, 태음인의경우허리둘레 88.8 cm, BMI 는 25.6 kg/m 2, 소음인의경우허리둘레 79.5 cm, BMI 20.6 kg/m 2 으로나타났다. 이를본다면태음인남성의경우에는위의허리둘레 90 cm, BMI 25 kg/m 2 에가깝지만, 소양인과소음인의경우에는남성이기는하지만, 허리둘레가여성처럼 80 cm에가깝다는것이다. BMI 에서는태음인이 25.6 kg/m 2, 소양인이 23.2 kg/m 2, 소음인이 20.6 kg/m 2 으로나타나고있어서같은남성이라도사상체질에따라차이를고려할필요성이제기된다고할수있다. 여성의경우, 태음인이허리둘레 80 cm, BMI 25 kg/m 2 에근접하고있으나, 소양인과소음인의허리둘레는각각 76.3 cm, 76.8 cm 로나타났으며, BMI 도소양인의경우 22.4 kg/m 2, 소음인이 21.3 kg/m 2 로나타났다. 남성과마찬가지로여성소양인, 여성소음인의경우에는허리둘레와 BMI 를보다낮게책정할필요가있다고생각한다. 다만, ROC 분석에서 specificity 와 sensitivity가낮게나온남성소양인, 남성소음인의 BMI 와, 여성의경우 BMI 의 specificity가 55%~60% 사이로낮게나와서적용시주의를필요로한다. 본연구에서는몇가지의연구제한점을가지고있는데, 사상체질의진단에서음성분석기와사상체질분류검사지에의한간접적진단을통해서체질을확정했다는것이며, 이에따라서태양인체질은등록이되지않았다는점이다. 그럼에도현재까지보건의료분야에서아직까지는사상체질을고려한허리둘레및 BMI 에대한절단값이제시되지않은시점에서 1개 지역을연구했다는단점이있지만, 이에대한첫성과라고생각한다. 이상과같이본연구에서는성별및사상체질에따라서허리둘레와 BMI 의절단값이차이가나는것을확인하였고, 이를바탕으로보건의료에사상체질을감안한대사증후군의관리지침이향후심도있게연구되길기대한다. Ⅴ. 結論 2006년 6월부터 2013년 10월까지원주지역지역유전체코호트연구사업에서사상체질관련조사를시행하였으며, 대사증후군과관련하여사상체질별허리둘레및체질량지수 (BMI) 의절단값에대해연구하였다. 본연구에서 1773 명의대상자중남성에서대사증후군의유병률은 34.8%, 여성에서대사증후군의유병률은 37.6% 로여성에서다소높게나타났으며, 대사증후군관련요인들의숫자가증가함에따라서허리둘레와 BMI 는증가하였다. 대사증후군에대한절단값으로서남성의경우 88.3 cm ( 민감도 65.4%, 특이도 79.4%), BMI 는 24.2 kg/m 2 ( 민감도 75.8%, 특이도 70.3%), 여성의경우, 허리둘레 80.3 cm ( 민감도 85.8%, 특이도 76.5%), BMI 는 25.3 kg/m 2 ( 민감도 70.7%, 특이도 75.3%) 이었다. 대사증후군의유병률이가장높은태음인의경우절단값이남성에서는허리둘레 88.8 cm ( 민감도 73.1%, 특이도 63.7%), BMI 는 25.6 kg/m 2 ( 민감도 66.2%, 특이도 71.9%) 이었고, 여성의경우, 허리둘레 80.3 cm ( 민감도 90.4%, 특이도 58.7%), BMI 는 24.9 kg/m 2 ( 민감도 77.1%, 특이도 55.4%) 로나타났다. 결론적으로성별및사상체질에따라서허리둘레와 BMI 의절단값이차이가나는것을확인하였다. Ⅵ. Acknowledgement 이논문은 2012 년상지대학교교내연구비지원에의한것임.

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