304 Kyung-A Shin. Metabolic Syndrome Risk Factors according to Obesity, Abdominal Obesity ORIGINAL ARTICLE Korean J Clin Lab Sci. 2016;48(4):304-311 https://doi.org/10.15324/kjcls.2016.48.4.304 pissn 1738-3544 eissn 2288-1662 The Differences of Metabolic Syndrome Risk Factors according to Obesity and Abdominal Obesity in Elderly Korean Women Kyung-A Shin Department of Clinical Laboratory Science, Shinsung University, Dangjin 31801, Korea 한국노인여성의비만, 복부비만기준에따른대사증후군위험요인의차이 신경아 신성대학교임상병리과 The study was performed to examine the metabolic syndrome risk factors in accordance with the obesity types based on body mass index (BMI) and waist circumference cutoffs. The diagnosis of metabolic syndrome closely adhered to the NCEP-ATP III criteria, and obesity was defined using the WHO Asian-Pacific criteria. We used the data from 591 elderly women, all aged over 65 years. They were divided into four groups: The normal group (n=272), the obesity group (n=124), abdominal obesity group (n=19), and obesity-abdominal obesity group (n=176). The obesity-abdominal obesity group was the most prevalent group of low HDL-cholesterol (p=0.009), hypertriglyceridemia (p=0.025), abdominal obesity (p<0.001), and metabolic syndrome (p<0.001). Logistic regression analysis demonstrated that the obesity-abdominal obesity group had the highest odds ratio in predicting metabolic syndrome (OR: 10.638, 95% CI: 6.053 18.697). Therefore, the obesity-abdominal obesity group was the strongest predictive factor of metabolic syndrome risk in Korean elderly women. Key words: Metabolic syndrome, Obesity, Abdominal obesity Corresponding author: Kyung-A Shin Department of Clinical Laboratory Science, Shinsung University, 1 Daehak-ro, Jeongmi-myeon, Dangjin 31801, Korea Tel: 82-41-350-1408 Fax: 82-41-350-1355 E-mail: mobitz2@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2016 The Korean Society for Clinical Laboratory Science. All rights reserved. Received: October 17, 2016 Revised 1 st : November 11, 2016 Revised 2 nd : November 23, 2016 Accepted: November 23, 2016 서론대사증후군은이상지질혈증, 고혈압, 내당능장애, 비만과같은제 2형당뇨병및심혈관질환을유발하는위험요인들이동일한환자에게서동시에발생하며, 병태생리학적원인으로비만과인슐린저항성이제시되고있다 [1,2]. 지방조직은지방의저장기관이라는것외에도호르몬및사이토카인과같은물질을분비하는내분비기관으로인식되며 [2], 비만은고혈압, 당뇨병, 고지혈증등의성인 병빈도를증가시켜관상동맥및뇌혈관질환발생률을증가시킨다 [3]. 노인에서는대사이상으로인한비만및심혈관질환의유병률이높게보고되며, 특히여성노인에서비만및복부비만유병률은남성보다높게나타난다 [4-6]. 여성은폐경기이후에스트로겐감소로지방조직의대사변화에따른체지방분포변화로복부비만및내장지방의증가가가속화되고, 인슐린저항성및지질대사이상을유발해대사증후군유병률이증가하게된다 [7-11]. 중심성비만 (central obesity) 은내장지방의지방분해활성증가로유리지방산
Korean J Clin Lab Sci. Vol. 48, No. 4, December 2016 305 (free fatty acid) 을증가시키고, 이는간으로유입되어간에서의인슐린제거율과인슐린감수성이저하한다 [12,13]. 따라서지방, 근육등의말초조직에서는유리지방산의증가로포도당이용률이낮아져인슐린저항성이증가하며, 고인슐린혈증이야기된다 [12,13]. 또한노인비만의특징은체질량지수가낮음에도불구하고복부비만의빈도가높게나타나며, 특히여성노인은남성에비해복부비만유병률이두배가량증가하는것으로보고된다 [6,14]. 비만을측정하는지표중허리둘레는체질량지수보다내장지방및대사장애와더불어심혈관질환에대한위험도예측에더유용한지표로알려져있다 [15]. 현재우리나라는비만인구증가에따른대사증후군과심혈관질환의유병률이증가하는추세에있으며, 서양인과달리체질량지수가낮음에도심혈관질환이환율이높은특성을보이고있다 [16,17]. 지속적으로증가하는국내노인비만에서비만과대사증후군간의관련성을파악하고관리하는것은보건정책에있어중요하다고할수있다. 그럼에도불구하고국내노인에대한비만지표들과대사증후군위험요인간의관련성에대한연구는미비한실정이다. 특히체질량지수는성별, 인종에따라체내성분분석결과의차이를보일수있어, 성별과연령을고려한연구가필요하다고생각된다 [18,19]. 본연구에서는우리나라노인여성의체질량지수와허리둘레로평가한비만, 복부비만의비만유형에따른대사증후군위험요인에차이를비교하여그경향성을파악하고자하였다. 대상및방법 1. 연구대상연구대상자는 2012년 1월부터 2014년 12월까지경기지역일개종합병원에서건강검진을실시한 65세이상노인여성을대상으로하였다. 전체대상자 771명중에서결측치를포함한 180명을제외한 591명을최종대상자로선정하였다. 비만과복부비만기준에따른대사증후군위험요인의차이를규명하기위해대상자들을체질량지수 (body mass index, BMI) 와허리둘레기준에따라정상군 (normal group; BMI<25 kg/m 2, 허리둘레<85 cm), 단순비만군 (obesity group; BMI 25 kg/m 2, 허리둘레<85 cm), 복부비만군 (abdominal obesity group; BMI<25 kg/m 2, 허리둘레 85 cm), 비만-복부비만군 (obesity-abdominal obesity group; BMI 25 kg/m 2, 허리둘레 85 cm) 의 4군으로분류하였다. 비만기준은세계보건기구아시아태평양기준에서제시한비만기준에따라 BMI 25 kg/m 2 을비만으로정의하였으며 [20], 복부비만기준은대한비만학회 (Korean Society for the Study of Obesity) 에서제시한여성의허리둘레 85 cm 이상을복부비만으로적용하였다 [21]. 연 구대상자가복용하는약물에대해서는설문지로조사하였으며, 본연구는기관생명윤리위원회의승인을받아시행되었다 (IRB No: D-1205-008-2460). 2. 연구방법 1) 진단기준대사증후군은 The National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) 의진단기준에따라분류하였으며, 아래의 5가지기준중 3개이상해당될경우대사증후군으로정의하였다. 1) 중성지방 150 mg/dl 또는고중성지방혈증약을복용하는경우 2) HDL-콜레스테롤은여성 <50 mg/dl 3) 혈압 130/85 mmhg 또는고혈압약을복용하는경우 4) 공복혈당 >110 mg/dl 5) 허리둘레는여성 88 cm으로정의하고있으나, 복부비만은국내기준에적합한대한비만학회 (Korean Society for the Study of Obesity) 에서제시한기준을적용하였다 [21,22]. 고혈압진단기준은 60세이상의경우 2014년미국고혈압합동위원회 8차보고서 (eighth joint national committee, JNC 8) 에따라 150/90 mmhg를고혈압으로 [23], 당뇨진단기준은 2010년미국당뇨병협회에서제시한공복혈당 126 mg/dl, 당화혈색소기준으로는 6.5% 을당뇨병으로진단하였다 [24]. 이상지질혈증진단기준은 2015년제3판한국지질동맥경화학회이상지질혈증치료지침에따라고LDL-콜레스테롤혈증 ( 160 mg/dl 또는콜레스테롤약을복용중인자 ), 고중성지방혈증 ( 200 mg/dl), 저HDL-콜레스테롤혈증 (<40 mg/dl) 의 3가지지표중한가지라도해당되는경우이상지질혈증으로진단하였다 [25]. 2) 신체계측및혈압측정신장과체중은 DS-103M (Jenix, Seoul, Korea) 장비로계측하였으며, 체질량지수 (body mass index, BMI) (kg/m 2 ) 는체중 (kg) 신장의제곱 (m 2 ) 으로제시하였다. 허리둘레는양발을 25 30 cm 정도벌리고숨을내쉰상태에서갈비뼈가장아래위치와골반의가장높은위치의중간부분을측정하였으며, 엉덩이둘레는옆에서보았을때엉덩이의가장높은부분을줄자로측정하였다. 허리-엉덩이둘레비율 (waist to hip ratio, WHR) 은허리둘레 엉덩이둘레이며, 키-허리둘레비율 (waist to height ratio, WHtR) 은키 엉덩이둘레를의미한다. 또한수축기와이완기혈압은앉은자세로 10분동안안정후수은혈압계로측정하였다. 3) 혈액검사혈액검사는 8시간공복후오전에채혈을실시하여, TBA-200FR NEO (Toshiba, Tokyo, Japan) 생화학자동분석기로총콜레스테
306 Kyung-A Shin. Metabolic Syndrome Risk Factors according to Obesity, Abdominal Obesity 롤, 중성지방, HDL-콜레스테롤, LDL-콜레스테롤, 공복혈당, 고감도 C-반응단백질 (high sensitivity C-reactive protein, hs-crp) 을측정하였다. 당화혈색소 (hemoglobin A1c, HbA1c) 검사는 EDTA 전혈검체로 Variant II (Bio Rad, CA, USA) 장비를이용하여고성능액체크로마토그래피법 (high performance liquid chromatography, HPLC) 의원리로측정하였다. 또한인슐린은 Modular Analytics E170 (Roche, Mannheim, Germany) 장비로전기화학발광면역분석법 (electrochemiluminescence immunoassay, ECLIA) 의원리로검사하였으며, 인슐린저항성지표인 HOMA-IR (homeostasis model assessment-insulin resistance) 은공복혈당과인슐린농도를이용하여다음공식으로계산하였다 [26]. HOMA-IR= ( 공복시인슐린 IU/mL 공복시혈당 mg/dl)/405. 3. 통계분석본연구의자료분석은 Windows SPSS 21.0 (IBM, Armonk, USA) 통계프로그램을사용하였으며, 비만, 복부비만기준에따른네군간의대사증후군위험요인의차이를비교하기위해일원배치분산분석 (one way ANOVA) 을실시하였다. 또한비만, 복부비만기준에따른집단간당뇨, 고혈압, 이상지질혈증과대사증후군위 험요인의유병률을비교하기위해 chi-square test를시행하였다. 비만, 복부비만의지표가되는체질량지수, 허리둘레와대사증후군위험요인간의상관성을알아보기위해피어슨상관분석 (Pearson correlation coefficient) 을실시하였다. 비만, 복부비만기준에따른비만유형과대사증후군및대사증후군개별위험요인간의관련성을알아보기위해로지스틱회귀분석 (logistic regression) 을실시하였으며, 오즈비 (odds ratio, OR) 와 95% 신뢰구간 (confidence interval, CI) 을제시하였다. 본연구결과에대한통계적유의수준은 p<0.05 로설정하였다. 결과 1. 비만, 복부비만에따른대상자의의학적특징연구대상자 591명중비만, 복부비만에따라비만유형을분류한결과정상군 272명, 단순비만군 124명, 복부비만군 19명, 비만- 복부비만군 176명이었다. 연령은집단간차이를보였다 (p=0.029). 체중, 체질량지수, 허리둘레및엉덩이둘레, WHR, WHtR은집단간차이가있었으며, WHR을제외하고는비만-복부비만군이가장높게나타났다 ( 각각 p<0.001). 혈액변인중 HDL- Table 1. Subjects clinical characteristics according to the obesity, abdominal obesity Variable Normal (n=272) Obesity (n=124) Abdominal obesity (n=19) Obesity-abdominal obesity (n=176) p-value Age (yr) 70.45±4.81 69.40±4.15 70.21±4.39 71.01±4.43 0.029 Height (cm) 152.46±5.78 152.38±4.72 153.94±5.73 152.01±5.70 0.513 Weight (kg) 51.92±5.67 60.15±4.22 56.00±4.50 63.86±6.04 <0.001 Body mass index (kg/m 2 ) 22.31±1.67 25.94±1.09 23.50±0.86 27.67±2.24 <0.001 Waist circumference (cm) 75.38±4.82 80.42±2.94 88.63±3.82 89.35±4.33 <0.001 Hip circumference (cm) 88.99±4.19 93.98±3.17 92.67±6.05 97.63±4.86 <0.001 Systolic blood pressure (mmhg) 118.27±17.59 119.55±16.03 116.58±17.16 121.82±15.81 0.145 Diastolic blood pressure (mmhg) 73.42±9.91 74.15±9.60 73.42±7.83 76.02±10.26 0.055 WHR 0.85±0.05 0.86±0.04 0.96±0.08 0.92±0.05 <0.001 WHtR 0.50±0.04 0.53±0.03 0.58±0.04 0.59±0.04 <0.001 Total cholesterol (mg/dl) 198.36±37.71 202.06±37.40 209.58±42.24 201.83±35.80 0.482 HDL-cholesterol (mg/dl) 57.87±13.40 53.98±12.56 57.53±14.23 53.82±13.19 0.004 LDL-cholesterol (mg/dl) 123.40±34.63 126.66±33.71 133.74±40.46 128.43±31.72 0.329 Triglyceride (mg/dl) 114.20±66.03 129.15±77.68 123.84±60.12 138.91±70.69 0.003 Fasting glucose (mg/dl) 93.76±17.56 96.23±18.28 90.74±20.44 98.06±18.15 0.056 hs-crp (mg/dl) 0.10±0.35 0.09±0.28 0.08±0.29 0.15±0.45 0.670 HbA1c (%) 6.00±0.80 6.11±0.72 6.05±0.71 6.17±0.78 0.029 Insulin (uu/ml) 4.30±2.64 5.53±3.48 5.00±2.37 7.59±5.04 <0.001 HOMA-IR 0.36±0.65 0.48±0.83 0.71±0.83 0.68±1.25 0.003 Diabetes mellitus* 37 (13.6) 19 (15.3) 3 (15.8) 42 (23.9) 0.040 Hypertension* 32 (11.8) 13 (10.5) 1 (5.3) 27 (15.3) 0.420 Hyperglycemia* 74 (27.2) 38 (30.6) 7 (36.8) 51 (29.0) 0.766 Calculated by one way ANOVA. Values are presented as mean±sd. *Calculated by 2 -test. Data are presented as number (%). Abbreviation: WHR, waist hip ratio; WHtR, waist height ratio; HDL, high density lipoprotein; LDL, low density lipoprotein; hs-crp, high sensitivity C-reactive protein; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model assessment-insulin resistance.
Korean J Clin Lab Sci. Vol. 48, No. 4, December 2016 307 Table 2. Prevalence of risk factors according to the obesity, abdominal obesity Metabolic syndrome criteria Normal (n=272) Obesity (n=124) Abdominal obesity (n=19) Obesity-abdominal obesity (n=176) p-value High blood pressure 84 (30.9) 36 (29.0) 5 (26.3) 67 (38.1) 0.281 Low HDL-cholesterol 80 (29.4) 48 (38.7) 5 (26.3) 78 (44.3) 0.009 Elevated fasting glucose 34 (12.5) 17 (13.7) 3 (15.8) 34 (19.3) 0.251 High triglyceride 59 (21.7) 34 (27.4) 6 (31.6) 61 (34.7) 0.025 Abdominal obesity 0 0 19 (100) 176 (100) <0.001 Metabolic syndrome 18 (6.6) 8 (6.5) 6 (31.6) 76 (43.2) <0.001 Calculated by 2 -test. Values are presented as Number (%). Abbreviation: LDL, low density lipoprotein. p=0.019) 와이완기혈압 (r=0.101, p=0.014), 중성지방 (r=0.154, p<0.001), 공복혈당 (r=0.104, p=0.012) 과양의상관관계를보였으며, HDL-콜레스테롤 (r= 0.183, p<0.001) 과는음의상관관계를보였다. 허리둘레역시수축기 (r=0.092, p=0.026) 와이완기혈압 (r=0.096, p=0.019), 중성지방 (r=0.187, p<0.001), 공복혈당 (r=0.113, p=0.006) 과양의상관관계를나타냈으며, HDL-콜레스테롤 (r= 0.192, p<0.001) 과는음의상관관계를보였다. 그러나총콜레스테롤과 LDL-콜레스테롤은 BMI 및허리둘레와상관성이없는것으로나타났다 (Table 3). Fig. 1. The number of components of metabolic syndrome according to the obesity and abdominal obesity. Obesity and obesity-abdominal obesity rate were increased with increasing number of components of the metabolic syndrome. 콜레스테롤 (p=0.004), 중성지방 (p=0.003), HbA1c (p=0.029), 인슐린 (p<0.001), HOMA-IR (p=0.003) 은집단간차이를보였으며, 중성지방, HbA1c, 인슐린은비만-복부비만군이가장높게나타났으며, HDL-콜레스테롤은비만-복부비만군이가장낮게나타났다. 또한당뇨는집단간유병률의차이를보였으며, 비만-복부비만군에서가장높은유병률을보였다 (p=0.040) (Table 1). 2. 비만, 복부비만에따른대사증후군위험요인유병률 비만, 복부비만기준에따른대사증후군위험요인의유병률차이를비교한결과낮은 HDL-콜레스테롤혈증 (p=0.009), 고중성지방혈증 (p=0.025), 복부비만 (p<0.001), 대사증후군진단유병률 (p<0.001) 은집단간차이를보였으며, 비만-복부비만군에서의유병률이높게나타났다 (Table 2). 대사증후군위험요인의개수가낮을수록단순비만군의비율이높았으며, 위험요인의개수가증가할수록복부비만군, 비만-복부비만군의비율이높게나타났다 (Fig. 1). 3. 체질량지수및허리둘레와대사증후군위험요인간의상관성 체질량지수는대사증후군각각의위험요인중수축기 (r=0.097, 4. 비만, 복부비만기준에따른비만유형과대사증후군및대사증후군위험요인간의관련성로지스틱회귀분석을통해복부비만기준에따른비만유형과대사증후군각각의위험요인및대사증후군진단간의관련성을분석한결과, 정상군에비해단순비만군에서낮은 HDL-콜레스테롤혈증의발생이 1.6배높았으며 (odds ratio, OR: 1.576, 95% confidence interval, 95% CI: 1.006 2.469), 비만-복부비만군에서는 1.9배높은양상을보였다 (OR: 1.882, 95% CI: 1.266 2.799). 고중성지방혈증은정상군보다비만-복부비만군에서 1.9배높았다 (OR: 1.904, 95% CI: 1.246 2.910). 또한정상군보다복부비만군에서대사증후군발생이 6.6배높았으며 (OR: 6.579, 95% CI: 2.233 19.385), 비만-복부비만군의경우 10.6배높은양상을보였다 (OR: 10.638, 95% CI: 6.053 18.697) (Table 4). 고찰이연구는노인여성을대상으로비만, 복부비만기준에따라정상군, 단순비만군, 복부비만군, 비만-복부비만군의 4군으로분류하여대사증후군위험요인의차이를알아보고, 비만, 복부비만기준에따른비만유형과대사증후군위험요인과의관련성을규명하고자하였다.
308 Kyung-A Shin. Metabolic Syndrome Risk Factors according to Obesity, Abdominal Obesity Table 3. Correlation between metabolic syndrome risk factors and BMI, waist circumference Metabolic syndrome risk factors Body mass index Waist circumference r p r p Systolic blood pressure (mmhg) 0.097 0.019 0.092 0.026 Diastolic blood pressure (mmhg) 0.101 0.014 0.096 0.019 Total cholesterol (mg/dl) 0.036 0.377 0.035 0.401 HDL-cholesterol (mg/dl) 0.183 <0.001 0.192 <0.001 LDL-cholesterol (mg/dl) 0.061 0.147 0.066 0.116 Triglyceride (mg/dl) 0.154 <0.001 0.187 <0.001 Fasting glucose (mg/dl) 0.104 0.012 0.113 0.006 Calculated by Pearson correlation coefficient. Abbreviation: HDL, high density lipoprotein; LDL, low density lipoprotein. Table 4. Odds ratios of having metabolic syndrome risk factors Metabolic syndrome criteria Normal Obesity Abdominal obesity Obesity-abdominal obesity High blood pressure 1 1.018 (0.632 1.639) 0.814 (0.279 2.378) 1.326 (0.882 1.993) Low HDL-cholesterol 1 1.576 (1.006 2.469) 0.864 (0.301 2.486) 1.882 (1.266 2.799) Elevated fasting glucose 1 1.111 (0.593 2.081) 1.312 (0.363 4.741) 1.677 (0.997 2.819) High triglyceride 1 1.380 (0.845 2.255) 1.671 (0.609 4.587) 1.904 (1.246 2.910) Metabolic syndrome 1 1.000 (0.422 2.372) 6.579 (2.233 19.385) 10.638 (6.053 18.697) Calculated by logistic regression. Values are presented as odds ratio (95% confidence interval). Abbreviation: HDL, high density lipoprotein. 대사증후군은이상지질혈증, 고혈압, 내당능장애및비만과같은제2형당뇨병과심혈관질환의위험인자가한개인에게함께나타나는증후군으로발생기전은명확하지않았으나인슐린저항성이핵심적인역할을하는것으로알려져있다 [1,2]. 대사증후군위험요인중비만은체지방이증가하면서인슐린감수성이감소되고, 특히복부비만은세포가혈액으로부터포도당을흡수하는능력이저하되는포도당불내성 (glucose intolerance) 과관련이있다 [2,3]. 최근식습관의변화로인해에너지섭취량은증가하고신체활동량은감소하면서비만유병률은점차증가하고있으며, 비만이만성질환의위험요인으로인식되고있다 [27]. 현재비만을측정하는가장보편적이고간편한방법으로체질량지수가이용되고있으며, 세계보건기구에서는체질량지수를기준으로비만을분류하여제시하고있다 [20]. 그러나최근비만을평가하는데단순히체지방양뿐만아니라체지방분포의중요성이인식되면서복부비만을평가하는허리둘레가체질량지수와함께비만관련질환의위험예측인자로사용되고있다 [22]. 여성에있어서복부비만은인슐린저항성과고인슐린혈증, 고중성지방혈증, 고혈압, 내당능장애와관련이있는것으로보고된다 [28]. 특히노인비만의경우체질량지수가정상이더라도복부비만인경우가성인보다높은빈도로나타나고이러한특성은심혈관질환및대사증후군 의발병위험의증가와관련이있어, 단순비만측정보다복부의체지방분포에대한관심이높아지고있다 [29]. 이에따라 2001년미국국립콜레스테롤교육프로그램제 3차개정 (National Cholesterol Education Program Adult Treatment Panel III, NCEP-ATP III) 에서는허리둘레를복부비만진단기준에포함시켰으며, 2005년세계당뇨병연맹 (International Diabetes Federation, IDF) 에서도복부비만을대사증후군진단기준의필수요소로설정하고허리둘레를이용하여복부비만을측정하고있다 [22,30]. 본연구결과단순비만군, 복부비만군보다비만-복부비만군에서중성지방, HbA1c, 인슐린이가장높게나타났으며, HDL-콜레스테롤은비만-복부비만군에서가장낮게나타났다. 또한비만-복부비만군에서대사증후군위험요인중낮은 HDL-콜레스테롤혈증, 고중성지방혈증, 복부비만의빈도가높았으며, 그에따른대사증후군유병률은높은빈도를보였다. 대사증후군위험요인의개수가적을수록단순비만군의비율이높았으며, 위험요인의개수가증가할수록복부비만군, 비만-복부비만군의비율이높게나타났다. 허리둘레는비만과관련된만성질환의독립적예측인자이며, 체질량지수보다관상동맥질환과더관련이있다고보고된다 [31]. Janssen 등 [32] 은미국국민건강영양조사 (Third National Health and Nutrition Examination Survey, NHANES III) 자료를토대로
Korean J Clin Lab Sci. Vol. 48, No. 4, December 2016 309 복부비만군에서고혈압, 당뇨병, 이상지질혈증과대사증후군발병위험이높으며, 특히복부비만은남성보다는여성에게큰영향을미치는것으로보고하였다. 또한체질량지수와는무관하게허리둘레측정만으로도비만뿐아니라심혈관질환을예측할수있다는결과가보고되고있으나 [31], 본연구결과는노인여성에서단순비만측정보다는체질량지수와허리둘레를모두측정하는것이대사증후군위험을좀더효과적으로반영하는것으로나타났다. 복부비만기준에따른비만유형과대사증후군각각의위험요인및대사증후군진단간의관련성을분석한본연구결과, 낮은 HDL-콜레스테롤혈증은정상군보다단순비만군에서 1.6배높은발병률을보였으며, 비만-복부비만군에서는 1.9배높은양상을보였다. 고중성지방혈증은정상군보다비만-복부비만군에서 1.9배높았다. 대사증후군발병은정상군보다복부비만군에서 6.6배높았으며, 비만-복부비만군의경우 10.6배높은양상을보였다. 이는이율의등 [33] 의연구에서대사증후군위험도가체질량지수측정군인단순비만군보다복부비만군과비만-복부비만군에서높게나타난연구결과와일치한다. 노인여성은폐경에따른에스트로겐감소로지방대사에변화가나타나며, 에스트로겐이둔부와대퇴부에지방을축적시켰던폐경전과달리폐경후에는체내지방의재분포로복부비만및복부내장형비만이가속화된다 [7-11]. 복부비만은하체비만에비해혈중중성지방및콜레스테롤은높고, HDL-콜레스테롤은낮은것으로보고된다 [34]. 또한복부비만은내장지방의과잉축적을잘반영하는지표이다 [34]. 내장지방은혈중중성지방을증가시키며, 간에서의초저밀도지단백 (very low density lipoprotein, VLDL) 및인슐린저항성증가로인해혈액내중성지방의유리가증가되어결국지방산의증가가나타난다 [35]. 그러므로만성질환을유발하는비만을구분하는기준은단순히형태학적문제에국한된것이아니라대사이상을반영하는결과이다. 본연구에서대사증후군위험요인에허리둘레가포함되어있어나타난결과라고는하지만, 노인여성에서단순비만군보다복부비만혹은비만-복부비만군에해당하는경우대사증후군발병위험이높게나타나복부비만은대사증후군위험도예측에강력한지표로사용될수있을것으로생각된다 [33]. 여성노인은남성에비해두배가량높은복부비만유병률을보이고있으며 [6], 비만과관련된만성질병을관리하는데적절한비만측정지표를선택하여사용하는것이노인여성의건강관리에효과적일것으로생각된다 [34]. 결론적으로본연구결과에서노인여성에서단순비만측정보다는체질량지수와허리둘레를모두측정하는것이대사증후군위험을좀더효과적으로반영하는것으로 나타났으며, 대사증후군발병은단순비만군보다복부비만군과비만-복부비만군에서높게나타났다. 본연구의제한점은노인여성을대상으로하였으므로그외의대상자에게결과를적용하기곤란하다. 또한일상적인신체활동및식이조절이나식사의질평가와같은혼란변수에대한평가가이루어지지못했다는점이다. 그럼에도불구하고본연구를통해노인여성에서체질량지수와허리둘레를모두평가하는것이인슐린저항성을포함한대사증후군위험을예측하는지표로활용될수있을것으로사료된다. 요약이연구는노인여성을대상으로비만, 복부비만기준에따른대사증후군위험요인의차이를알아보고, 비만유형과대사증후군위험요인과의관련성을규명하고자하였다. 비만기준은세계보건기구아시아태평양기준에서제시한비만기준을따랐으며, 대사증후군은 The National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) 의진단기준에따라분류하였다. 연구대상자 591명중정상군 272명, 단순비만군 124명, 복부비만군 19명, 비만-복부비만군 176명이었다. 비만, 복부비만기준에따른대사증후군위험요인의유병률차이를비교한결과낮은 HDL- 콜레스테롤혈증 (p=0.009), 고중성지방혈증 (p=0.025), 복부비만 (p<0.001), 대사증후군진단유병률 (p<0.001) 은집단간차이를보였으며, 비만-복부비만군에서의유병률이높게나타났다. 로지스틱회귀분석을통해복부비만기준에따른비만유형과대사증후군각각의위험요인및대사증후군진단간의관련성을분석한결과, 정상군에비해단순비만군에서낮은 HDL-콜레스테롤혈증의발생이 1.6배높았으며 (odds ratio, OR: 1.576, 95% confidence interval, 95% CI: 1.006 2.469), 비만-복부비만군에서는 1.9배높은양상을보였다 (OR: 1.882, 95% CI: 1.266 2.799). 고중성지방혈증은정상군보다비만-복부비만군에서 1.9배높았다 (OR: 1.904, 95% CI: 1.246 2.910). 또한정상군보다복부비만군에서대사증후군발생이 6.6배높았으며 (OR: 6.579, 95% CI: 2.233 19.385), 비만-복부비만군의경우 10.6배높은양상을보였다 (OR: 10.638, 95% CI: 6.053 18.697). Acknowledgements: None Funding: None Conflict of interest: None
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