Original Article J Health Info Stat 2018;43(4):344-351 https://doi.org/10.21032/jhis.2018.43.4.344 pissn 2465-8014 eissn 2465-8022 당뇨병이없는남성근로자의건강행태특성이당화혈색소에미치는영향 박지연 1, 김건엽 2, 이수진 3 1 경북대학교보건대학원석사, 2 경북대학교의과대학교수, 3 경북대학교대학원보건학과박사과정 The Impact of Health Behaviors of Male Workers without Diabetes on HbA1c Ji-Yun Park 1, Keon-Yeop Kim 1,2, Su-Jin Lee 3 1 Graduated Student, Graduate School of Public Health, Kyungpook National University, Daegu; 2 Professor, Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu; 3 Doctoral Student, Graduate School of Department of Public Health, Kyungpook National University, Daegu, Korea Objectives: The purpose of this study is to investigate the impact of health behaviors of male workers without diabetes such as smoking, drinking and physical activities on HbA1c using 2015 and 2016 data from Korea National Health and Nutrition Examination Survey (KNHANES). Methods: The final study subjects of KNHANES were a total of 1,703 male workers in their 30s-50s who had normal levels of fasting blood sugar level, HbA1c, and hemoglobin. For the study variables, age, household income, educational level and occupation were included as socio-demographic characteristics; smoking behavior, drinking behavior, and physical activity behavior as characteristics of health behavior; and waist circumference, body mass index, systolic and diastolic blood pressures, total cholesterol, triglyceride and HDL cholesterol as medical examination characteristics were included. The analysis was conducted using independent variables t-test, one-way ANOVA, Pearson s correlation analysis and multiple regression analysis. Results: Socio-demographic factors that affect HbA1c were age, educational level, and occupation. As for HbA1c according to the status of current smoking, it was higher in order of the present, past and nonsmoking and HbA1c according to smoking amount pack-year increased linearly in between less than 1 pack-year and over 30 pack-year (p < 0.001). Muscular exercises affected the reduction of HbA1c (p < 0.05). In the multiple regression analysis with independent variables of the socio-demographic characteristics and health behavior, factors affecting HbA1c were age, occupation and smoking amount pack-year (p < 0.05). In the multiple regression analysis where the characteristics of physical examination were added, factors affecting HbA1c were age, occupation, smoking amount pack-year, waist circumference and total cholesterol (p < 0.001). Conclusions: As a result, the health behavior that had the most effect on HbA1c management for male workers without diabetes was the total lifetime smoking amount. Therefore, it is essential to prevent smoking as well as control, cholesterol to prevent diabetes for male workers. Key words: Health behavior, HbA1c, Diabetes, Male workers 서론 세계보건기구에서발표한자료에따르면 2014 년성인당뇨병환자가 30 년동안 4 배나급증하여전세계적으로 4 억 2 천만명에달하며앞으 로 20년이내에 2배정도더증가할것이라고하였다 [1]. 우리나라에서도 2005년 9.1% 이던당뇨병유병률이 2010년 9.6%, 2016년 11.3% 로계속증가하였고여자보다남자에게서더높아성인남자 8명중 1명 (12.9%) 에달하는것으로나타났다 [2]. 이러한당뇨병은미세혈관과대 Corresponding author: Keon-Yeop Kim 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea Tel:+82-53-420-4863, E-mail: pmkky@knu.ac.kr Received: October 23, 2018 Revised: November 22, 2018 Accepted: November 26, 2018 *This is a summary of Ji-Yun Park's dissertation. No potential conflict of interest relevant to this article was reported. How to cite this article: Park JY, Kim KY, Lee SJ. The impact of health behaviors of male workers without diabetes on HbA1c. J Health Info Stat 2018;43(4):344-351. Doi: https://doi.org/10.21032/jhis.2018.43.4.344 It is identical to the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) whichpermit sunrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 2018 344 http://www.e-jhis.org
Health Behaviors and HbA1c 혈관등신체여러부분에서합병증을증가시켜정확한조기진단이매우중요한데 [1] 최근당화혈색소검사방법의표준화가이루어져미국, 일본및국내당뇨병의진단기준에당화혈색소 (HbA1c) 가새로이포함되었다 [3]. 당화혈색소는적혈구의혈색소에당이결합해있는정도를측정하여최근 2-3개월간의혈당상태를판단할수있으며, 개인내변동이적고식사에영향을받지않아인슐린저항성검사나당부하검사에비해검사법이편리하여포도당의항상성검사로많이사용되어왔다 [4]. 최근들어당뇨병진단뿐만아니라당뇨병전단계 (prediadetes) 대상자에대한선별과진단에서도당화혈색소의중요성이강조되고있다 [5]. 또한당뇨병전단계대상자에서의당화혈색소증가도당뇨병환자와마찬가지로미세혈관및대혈관합병증진행과관련이있으며 [6], 당뇨병이없더라도당화혈색소가 5% 이상인성인남성은당화혈색소가 1% 증가할수록사망률이 28%, 심혈관질환위험률이 21% 증가하여당화혈색소가당뇨병이없는사람들의사망률및심혈관질환위험률을예측하고혈압이나콜레스테롤처럼심혈관질환의위험요인이될수있다는연구결과도있다 [7]. 당뇨병이없는일반인 40,155명을대상으로한국내연구에서도당화혈색소는심혈관질환위험인자가증가함에따라상승하여당화혈색소가공복혈당장애및대사증후군예측척도이며한국인의심혈관질환위험인자로서의의가있었다 [8]. 흡연, 음주, 신체활동등의건강행태특성과당화혈색소및당대사와의관계를분석한다수의연구에서흡연은직접적으로인슐린저항성을증가시켜흡연량과당뇨병발생에서용량반응관계가성립하며 [9], 당뇨병이없는남성들을 8년동안추적한연구결과비흡연자에대한흡연자의당뇨병발생상대위험도가 1.60 (95% confidence interval, 95% CI: 1.29-1.97) 으로당뇨병발생과흡연이독립적연관성이있음을시사하였다 [10]. 또한음주행태에서중등도음주는당뇨병환자의경우오히려관상동맥질환에유익한효과를나타내고 [11] 당뇨병이없는사람들에서도음주가인슐린감수성을개선시켜당화혈색소를낮추기도하지만 [12] 장기간의알코올섭취는당질을저장하고새로운포도당을만드는간의능력을손상시켜결국에는혈당관리를어렵게만들수있다 [13]. 당뇨병환자를대상으로한신체활동연구에서운동은골격근의당이용을증가시켜인슐린감수성을향상시키며, 대사장애를개선하여당화혈색소를저하시키고 [14] 당뇨병환자및당뇨병전단계대상자의혈당을낮추어심혈관질환위험인자들을개선하는것으로알려져있다 [15]. 중 노년층당뇨병환자에서의당화혈색소가중등도신체활동및고강도신체활동과역상관관계가있다고한연구 [16] 가있는반면, 제2형당뇨병환자에서총신체활동량이감소할수록당화혈색소조절이잘되었다고한연구도있다 [17]. 이처럼우리나라에서는당뇨병환자들에대한당화혈색소와건강 행태와의관련성 [15-17] 에대한연구는많으나당뇨병이없는성인들의당화혈색소관련인자에관한국내연구는고혈압, 이상지질혈증등심혈관질환위험요소와의관련성연구 [18,19] 와단순흡연및음주여부에관한관련성연구 [18,20] 로한정되어있다. 이에질병예측인자로써당뇨병이없는일반인을대상으로한연구가필요하며, 그중에서도흡연, 음주, 과도한스트레스, 운동부족등위험요소에빈번하게노출되고 [21], 당뇨병등만성질환이발견될높은위험률과과로사등심뇌혈관질환으로인한높은사망위험률을가진 [22-24] 남성성인근로자들의대한연구가필요하다. 이에본연구에서는국민건강영양조사를이용하여당뇨병이없는남성근로자를대상으로흡연, 음주, 신체활동등이당화혈색소에영향을미치는요인들을분석하여당뇨병이없는일반인에대한당화혈색소검사의활용범위를넓히고자한다. 연구방법 연구자료및대상본연구는질병관리본부에서수행한국민건강영양조사제6기 3차년도 (2015년), 제7기 1차년도 (2016년) 의원시데이터를활용하였다. 2015, 2016 년의데이터는 1월부터 12월까지조사가시행되었으며 2015 년 7,380명, 2016년 8,150명으로총 15,530명 ( 남성 7,046명, 여성 8,484명 ) 이조사되었다. 이중만 30세이상, 59세이하남성근로자 2,648명을대상으로당뇨병진단기준에해당하는공복시혈당 126 mg/dl 이상이거나당화혈색소 6.5% 이상인자 [25,26], 당뇨병약또는인슐린투여자 298명을제외하였다. 또한당화혈색소검사에영향을주는인자로알려진빈혈 [6,27] 진단기준인헤모글로빈 13.0 g/dl 미만인자 [28] 18명을제외하였다. 건강검진특성및건강행태특성설문문항에대해결측치나응답거부등이있는 629명을제외하여 1,703명을최종분석대상으로하였다. 연구도구본연구는당뇨병이없는남성근로자의흡연, 음주, 신체활동을중심으로한건강행태특성과당화혈색소와의관련성을연구하고자하며, 인구사회학적특성과건강검진특성을고려하여분석하였다. 인구사회학적특성을알아보기위해연령, 가구소득, 교육수준, 직업변수를포함하였으며, 연령은 30세이상 59세이하로구성하여 30-39세, 40-49세, 50-59세로구분하였다. 가구소득은가구균등화소득에근거한 4분위수로나누어하, 중하, 중상, 상으로구분하였다. 교육수준은최종졸업학력을기준으로초등학교졸업이하, 중학교졸 http://www.e-jhis.org 345
Ji-Yun Park, et al. 업, 고등학교졸업, 대학교졸업이상으로구분하였다. 직업은표준직업분류에따라조사한직업중관리자및전문가, 사무직, 영업및서비스직은비육체적직업으로농림어업직, 기능직, 단순노무직은육체적직업으로분류하였다. 건강행태특성을알아보기위하여흡연행태, 음주행태, 신체활동행태변수를포함하였으며, 흡연행태는다시현재흡연여부와흡연량갑년으로구분하여분석하였다. 현재흡연여부는국민건강영양조사지표산출정의에근거하여현재흡연은평생담배 5갑 (100개비 ) 이상피웠고현재도담배를피우는자, 과거흡연은평생담배 5갑 (100개비) 이상피웠으나현재는피우지않는자, 비흡연은평생담배 5갑 (100개비) 미만을피운자로하였다. 흡연량갑년 (pack year) 은현재흡연과과거흡연에서지난한달간하루평균흡연량 ( 개비 ) {365 ( 현재연령 -흡연시작연령 )} 을갑으로계산하여 30갑년이상, 20-29갑년, 10-19갑년, 1-9갑년, 1갑년미만, 비흡연으로분류하였다. 음주행태는고위험음주여부로분석했으며이는국민건강영양조사지표산출정의에근거하여음주를전혀하지않는경우를비음주, 1회평균음주량이 7잔이상이며주 2회이상음주하는경우는고위험음주, 그외의경우는비고위험음주로분류하였다. 신체활동행태는일, 여가, 걷기활동을모두포함한총신체활동량 4분위와근력운동실천여부로구분하였다. 총신체활동량은국제신체활동설문지 (International Physical Activity Questionnaire, IPAQ) 를단문형자기기입식설문방법으로조사한국민건강영양조사결과를 IPAQ 점수환산법에근거한 Metabolic Equivalent Task (MET, min/week) 로산출하였으며대상자들의 MET 값분포에따라신체활동량하위군, 신체활동량중하위군, 신체활동량중상위군, 신체활동량상위군으로분류하였다. MET 값계산은 각활동의 MET level 시행시간 minutes 주당횟수 로하였으며각활동의 MET level은걷기활동 3.3, 중강도활동은 4.0, 격렬한활동은 8.0으로하였다 [29]. 근력운동실천여부는국민건강영양조사지표산출정의에근거하여최근 1주일동안팔굽혀펴기, 윗몸일으키기, 아령, 역기, 철봉등의근력운동을 2일이상실천한경우근력운동실천, 아닌경우는비실천으로분류하였다. 건강검진특성을알아보기위한변수로허리둘레 (cm), 체질량지수 (kg/m 2 ), 수축기혈압 (mmhg), 이완기혈압 (mmhg), 총콜레스테롤 (mg/dl), 중성지방 (mg/dl), HDL콜레스테롤 (mg/dl) 을포함하였다. 이는건강검진인자와당화혈색소의관련성이심뇌혈관질환의발생률및그로인한사망률이높다는선행연구 [4,18,19] 를근거로선정하였다. 자료분석수집된자료는 SPSS 23.0 (IBM Co., Armonk, NY, USA) 프로그램을사용하여분석하였다. 인구사회학적특성및건강행태특성에대해평 균, 표준편차, 빈도와백분율을산출하였다. 인구사회학적특성, 건강 행태특성에따른당화혈색소를파악하기위해독립표본 t- 검정과일 원배치분산분석 ( 사후검정 Scheffe) 을이용하였다. 건강검진특성과당 화혈색소와의상관관계는 Pearson s 상관분석을시행하였고당화혈색 소에영향을미치는요인을파악하고자다중회귀분석을시행하였다. 단, 중성지방의경우는로그값을취해분석하였다. 모든통계적검정의 유의수준은 0.05 미만으로하였다. 연구결과 당화혈색소분포및건강검진특성 연구대상자의당화혈색소검진결과는 3.8-6.4% 의범위였으며, 평 균값은 5.47± 0.32% 이었다. 연구대상자의허리둘레검진결과는 63-127 cm 의범위를가지고평 균 86.76 ± 8.45 cm 이었고, 체질량지수검진결과는 16-40 kg/m 2 의범위 를가지고평균 24.81 ± 3.21 kg/m 2 이었다. 수축기혈압검진결과는 85-186 mmhg 의범위를가지고평균 118.77±13.34 mmhg 이었고, 이완기 혈압검진결과는 55-123 mmhg 의범위를가지고평균 80.53 ± 9.48 mmhg 이었다. 총콜레스테롤검진결과는 98-337 mg/dl 의범위를가지 고평균 198.59 ± 33.26 mg/dl 이었으며, 중성지방검진결과는 23-1,398 mg/dl 의범위를가지고평균 175.34 ± 142.14 mg/dl, HDL 콜레스테롤 검진결과는 17-100 mg/dl 의범위를가지고평균 47.49 ±11.51 mg/dl 이 었다 (Table 1). 인구사회학적특성및건강행태특성에따른당화혈색소 인구사회학적특성에따른당화혈색소는연령, 교육수준, 직업에서 통계적으로유의한차이를보였다 (Table 2). 연령에따른당화혈색소에서 30-39 세는 5.40%, 40-49 세는 5.47%, 50-59 세는 5.54% 로유의한차이가있었고 30 대, 40 대, 50 대로연령이 Table 1. Distribution of HbA1c and the characteristics of medical examination in the study subjects Variables Mean ± SD Min Range Max HbA1c (%) 5.47±0.32 3.8 6.4 Waist circumference (cm) 86.76± 8.45 63 127 Body mass index (kg/m 2 ) 24.81 ± 3.21 16 40 Systolic blood pressure (mmhg) 118.77±13.34 85 186 Diastolic blood pressure (mmhg) 80.53± 9.48 55 123 Total cholesterol (mg/dl) 198.59±33.26 98 337 Triglycerides (mg/dl) 175.34±142.14 23 1,398 HDL cholesterol (mg/dl) 47.49±11.51 17 100 SD, standard deviation; HDL, high-density lipoprotein. 346 http://www.e-jhis.org
Health Behaviors and HbA1c Table 2. HbA1c based on socio-demographic factors and health behavior factors in the study subjects Characteristics n (%) Mean±SD t / F p-value Scheffe Socio-demographic factors Age (y) 30-39 a 551 (32.4) 5.40 ± 0.29 28.13 < 0.001 a<b<c 40-49 b 612 (35.9) 5.47 ± 0.33 50-59 c 540 (31.7) 5.54 ± 0.32 Household income Low 70 (4.1) 5.46±0.35 0.18 0.911 - Middle-low 348 (20.4) 5.47 ± 0.32 Middle-high 577 (33.9) 5.47 ± 0.33 High 708 (41.6) 5.46±0.31 Education status Primary school a 74 (4.3) 5.59 ± 0.34 13.67 < 0.001 a,b > c,d Middle school b 118 (6.9) 5.55 ± 0.33 HIgh school c 543 (31.9) 5.50 ± 0.31 College d 968 (56.8) 5.43 ± 0.31 Occupation White collar 1,034 (60.7) 5.43±0.31-5.61 <0.001 - Blue collar 669 (39.3) 5.52 ± 0.32 Health behavior factors Smoking status Never smoker a 336 (19.7) 5.40 ± 0.29 12.00 < 0.001 a<b,c Former smoker b 663 (38.9) 5.46 ± 0.33 Current smoker c 704 (41.3) 5.51 ± 0.32 Pack-years of smoking 0 a 336 (19.7) 5.40 ± 0.29 16.89 < 0.001 b<f 0-1 b 92 (5.4) 5.37 ± 0.31 1-9 c 370 (21.7) 5.42 ± 0.31 10-19 d 404 (23.7) 5.47 ± 0.33 20-29 e 263 (15.4) 5.56 ± 0.30 30 f 238 (14.0) 5.58 ± 0.37 Drinking status Nondrinking 168 (9.9) 5.46±0.35 0.09 0.915 - Non-high risk drinking 1,115 (65.5) 5.47±0.31 High risk drinking 420 (24.7) 5.47±0.33 Physical activity Low 367 (21.6) 5.49±0.34 0.92 0.428 - Middle-low 482 (28.3) 5.46±0.31 Middle-high 426 (25.0) 5.46±0.31 High 428 (25.1) 5.46±0.31 Muscle exercise status Practiced 508 (29.8) 5.44±0.31-2.05 <0.050 - Unpracticed 1,195 (70.2) 5.48±0.32 SD, standard deviation. 높아질수록당화혈색소가증가하였다 (p < 0.001). 교육수준에따른당화혈색소는대학교졸업이상이 5.43%, 고등학교졸업이 5.50%, 중학교졸업이 5.55%, 초등학교졸업이하가 5.59% 로유의한차이가있었으며중학교졸업군과초등학교졸업이하군이대학교졸업이상군과고등학교졸업군보다당화혈색소의평균값이높은것으로나타났다 (p < 0.001). 직업에따른당화혈색소는육체적직업군이 5.52%, 비육체적직업군이 5.43% 로육체적직업군이비육체적직업군에비해높았다 (p < 0.001). 연구대상자의건강행태특성에따른당화혈색소는현재흡연이 5.51%, 과거흡연이 5.46%, 비흡연이 5.40% 로현재흡연군과과거흡연군이비흡연군보다당화혈색소의평균값이높았다 (p < 0.001). 흡연량갑년구분에따른당화혈색소에서는 30갑년이상이 5.58%, 20-29갑년이 5.56%, 10-19갑년이 5.47%, 1-9갑년이 5.42%, 1갑년미만이 5.37%, 비흡연이 5.40% 로흡연량갑년이많을수록당화혈색소가증가하는경향이있었다. 사후검정결과 30갑년이상군에서의당화혈색소평균이 1갑년미만군보다유의하게높았다 (p < 0.001). 음주행태에따른당화혈색소는고위험음주에서 5.47%, 비고위험음주 5.47%, 비음주 5.46% 로고위험음주여부에따른당화혈색소차이는통계적으로유의하지않았다 (p = 0.915). 신체활동량에따른당화혈색소는상위군, 중상위군, 중하위군이모두 5.46% 이었으며하위군은 5.49% 이었으나통계적으로유의하지않았다 (p = 0.428). 근력운동실천여부에따른당화혈색소는근력운동실천이 5.44%, 비실천이 5.48% 로근력운동을실천하는경우당화혈색소가더낮았다 (p < 0.05) (Table 2). http://www.e-jhis.org 347
Ji-Yun Park, et al. 건강검진특성과당화혈색소와의상관관계연구대상자의건강검진특성과당화혈색소의상관관계는허리둘레 (r = 0.22, p < 0.05), 체질량지수 (r = 0.20, p < 0.05), 수축기혈압 (r = 0.11, p < 0.05), 이완기혈압 (r = 0.12, p < 0.05), 총콜레스테롤 (r = 0.17, p < 0.05), 중성지방 (r= 0.16, p <0.05) 이증가할수록증가하였고, HDL 콜레스테롤 (r= -0.08, p < 0.05) 이증가할수록감소하였다 (Table 3). 인구사회학적특성, 건강행태특성, 건강검진특성이당화혈색소에미치는영향당화혈색소를종속변수로한다중회귀분석결과연령, 교육수준, 직 업, 흡연량갑년, 고위험음주여부, 신체활동량, 근력운동실천여부를투입한모델 1의다중회귀모형의설명력은 6.0% 이었으며 (F =13.33, p < 0.001) 당화혈색소에영향을미치는변수는연령, 직업, 흡연량갑년이었다 (p < 0.05). 즉, 연령이증가할수록, 육체적직업군에서, 흡연량갑년이증가할수록당화혈색소가유의하게증가하였다. 모델 1에건강검진특성을추가한모델 2의다중회귀모형의설명력은 13.3% 이었으며 (F =18.55, p < 0.001) 당화혈색소에영향을미치는변수는연령, 직업, 흡연량갑년, 허리둘레, 총콜레스테롤이었다 (p < 0.01). 즉, 모델 2에서는연령이증가할수록, 육체적직업군에서, 흡연량갑년, 허리둘레, 총콜레스테롤이증가할수록당화혈색소가유의하게증가 Table 3. The correlation between the characteristics of medical examination and HbA1c Variables HbA1c Waist circumference BMI SBP DBP TC TG HbA1c Waist-circumference 0.22* BMI 0.20* 0.89* SBP 0.11* 0.27* 0.28* DBP 0.12* 0.30* 0.33* 0.78* TC 0.17* 0.13* 0.12* 0.12* 0.13* TG 1 0.16* 0.31* 0.28* 0.21* 0.24* 0.31* HDL-C -0.08* -0.31* -0.29* 0.06* 0.01 0.11* -0.38* BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL-C, High-density lipoprotein cholesterol. 1 Triglycerides are calculated by logging. *p < 0.05. Table 4. Multiple regression analysis affecting HbA1c with independent variables of the socio-demographic characteristics, health behavior and physical examination variables Model 1 Model 2 B β p B β p Age (y) 0.01 0.138 <0.001 0.005 0.14 <0.001 Education status 1 (middle school/ primary school) -0.01-0.01 0.851-0.02-0.01 0.744 Education status 2 (high school/ primary school) 0.00 0.00 0.986-0.02-0.03 0.635 Education status 3 ( college/ primary school) -0.02-0.04 0.576-0.05-0.08 0.221 Occupation (blue collar/white collar) 0.04 0.06 <0.001 0.05 0.08 <0.001 Pack-years of smoking 0.00 0.12 <0.001 0.00 0.08 <0.001 High risk drinking status -0.02-0.02 0.416-0.03-0.05 0.068 Physical activity -0.02-0.03 0.218-0.01-0.01 0.781 Muscle exercise status -0.02-0.04 0.152-0.02-0.03 0.293 Waist circumference - - - 0.01 0.19 <0.001 SBP - - - 0.00 0.00 0.918 TC - - - 0.00 0.13 < 0.001 TG 1 - - - 0.06 0.05 0.686 HDL-C - - - 0.00-0.01 0.107 F = 13.33 R 2 = 0.06 Adjusted R 2 = 0.07 SBP, systolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol. 1 Triglycerides are calculated by logging. F = 18.55 R 2 = 0.13 Adjusted R 2 = 0.13 348 http://www.e-jhis.org
Health Behaviors and HbA1c 하였다 (Table 4). 고찰 본연구는 2015년, 2016년국민건강영양조사원시자료를이용하여당뇨병이없는남성근로자의흡연, 음주, 신체활동등의건강행태특성이당화혈색소에미치는영향을알아보고자하였다. 인구사회학적특성에서당화혈색소는연령과직업에영향을받았다. 연령이높을수록당화혈색소는증가하였고이는연령의증가가당화혈색소농도증가와관련이있다는선행연구결과 [18,19] 와일치하였다. 또한 Kim [30] 의연구와같이교육수준이낮을수록, 비육체적직업군보다육체적직업군에서당화혈색소가높았는데이는연령이높을수록교육수준이낮아지는것과관련이있는것으로생각된다. 육체적직업군에서당화혈색소가높은것은흡연과같은건강행태특성이육체적직업군에서많다는기존연구결과 [31] 를고려할수있다. 건강행태특성에서당화혈색소는흡연량갑년에영향을받았다. 연구대상자의흡연율은 41.3% 로 2016년우리나라전체남성흡연율 39.3% 보다높았으나같은연령대비근로자를포함한남성흡연율 43.4% 보다는낮았다 [2]. 흡연여부에따른당화혈색소는현재흡연, 과거흡연, 비흡연순으로높았으며이는흡연군이비흡연군보다당화혈색소가더높았다는 Lee [24] 의연구결과와일치하였다. 또한현재흡연보다과거흡연에서의더낮은당화혈색소는과거흡연자라하더라도금연을하면당화혈색소를낮출수있음을뒷받침하는근거가되며이는 Hur et al. [10] 의연구에서흡연을하다가도금연을하면당뇨병발생이줄어드는결과와일치하였다. 또한흡연량갑년에따른당화혈색소는 1갑년미만에서 30갑년이상까지평생흡연량증가에따라선형적으로높아져흡연이당뇨병발생과독립적인연관성이있다는기존의연구결과 [10] 와일치하였다. Willi et al. [32] 에따르면흡연은당대사이상에영향을끼쳐당뇨병발생에미치는상대위험도가 1.44 (95% 신뢰구간 1.31-1.58) 이며흡연량이비교적적은흡연자나과거흡연자에서는당뇨발생위험이줄어드는용량반응관계가관찰되었다고하였다. 따라서당뇨병이없는일반인들의당뇨병예방을위해서는적극적인금연시도가필요하고흡연을하더라도가능한흡연량을줄이는것이당뇨병예방에도움이된다. 연구대상자들의고위험음주율은 24.7% 이었으며 2016년우리나라전체남성고위험음주율 20.8% 보다높았고같은연령대비근로자를포함한남성고위험음주율 25.1% 와유사하였다 [2]. 다중회귀분석결과, 고위험음주여부에따른당화혈색소차이는유의하지않아, 당뇨병이없는사람들에게서중등도의알코올섭취가인슐린감수성을개선시켜당화혈색소를낮춘다는기존의연구결과 [12] 와상이하였고미국 당뇨병환자에서중등도의알코올섭취가더낮은당화혈색소수치와관련이있다는제3차미국국민건강영양조사결과 [33] 와도달랐다. 하지만장기간과량의음주는인슐린에의한포도당흡수를저해하고췌장에서인슐린분비를감소시키며인슐린저항성을유발하여제2형당뇨병의발생률을증가시킨다는연구결과도있다 [11,34]. 이연구에서고위험음주여부만을변수로사용하여분석하였기때문인지는다양한음주량을기준으로한추가연구가필요하다. Horowitz [35] 와 Kim [36] 에의하면운동은근육에서인슐린감수성을증가시켜당뇨병발생위험도를낮추고단기간에근육에서포도당섭취를증가시킬뿐만아니라, 장기간의운동훈련은간의포도당대사에도영향을주어체성분을변화시켜전신의인슐린저항성을개선시킨다고하였으며, Kim [37] 은운동이제2형당뇨병관리에중추적인역할을하고규칙적이고지속적인운동은혈당조절을호전시켜당뇨병의합병증을예방하거나진행을억제할수있다고하는등많은연구에서운동의혈당조절효과에대해보고하였다. 하지만신체활동량이많을수록당화혈색소가낮을것이라는기대와는달리본연구에서남성근로자들의신체활동량에따른당화혈색소는각군별간차이가없었다. 전체대상자의신체활동량평균은 1,570 MET으로 IPAQ 의신체활동범주형분류 ( 비활동그룹, 최소한의활동그룹, 건강증진형활동그룹 ) 기준중건강증진형활동그룹에속하는높은수준 [29] 이었는데이는활발한생산활동인구에속하는대상자들의특성에기인한다고생각된다. 따라서본결과가신체활동량이많은집단을대상으로한연구여서신체활동량에따른당화혈색소의유의한차이가없는것인지, 실제신체활동량과당화혈색소사이에는관련이없는것인지혹은당뇨병환자와달리일반인에서는신체활동량이당화혈색소에미치는영향이없는것인지에대해서는추후추가적인연구를통해밝혀야할것으로생각된다. 연구대상자들의근력운동실천율은 29.8% 이었으며같은연령대비근로자를포함한남성근력운동실천율 27.2% 보다높았다 [2]. 근력운동실천여부에따른당화혈색소는실천군이비실천군보다낮았는데, 저항성운동으로인한근육량의증가가포도당흡수를증가시켜혈당을감소시킨다는기존연구결과 [37] 와일치하였다. Yoon et al. [38] 과 Kim [39] 에따르면체중대비상대적근육량은인슐린저항성및공복혈당과유의한역의상관관계를보이며동양인의경우서양인에비해더낮은수준의근육감소에의해서도인슐린저항성이발생하고당뇨전단계또는당뇨가더쉽게발생하는경향이있다고하였다. 이러한근육량은연령의증가와함께감소하며 40대이후 10년마다 10-15% 감소되므로 [40] 당뇨병예방을위한당화혈색소관리를위해근력운동을통한근육량유지가필요하다. 건강검진특성에따른당화혈색소에통계적으로유의하게영향을 http://www.e-jhis.org 349
Ji-Yun Park, et al. 주는변수는허리둘레, 총콜레스테롤이었다. 다수의연구에서혈압, 체질량지수, 총콜레스테롤, 중성지방, LDL콜레스테롤, HDL콜레스테롤등대사증후군인자들과당화혈색소와의관련성을제시하였고 [4,18,19] 본연구결과와일치하였다. 결론 당뇨병이없는남성근로자에서당화혈색소관리에가장영향을주는건강행태는평생총흡연량이었다. 따라서당뇨병이없는남성근로자들의당뇨병예방을위해서는금연및흡연예방이반드시필요하며더불어혈압, 콜레스테롤관리가필요하다. 본연구는 2차자료를이용한단면적연구이므로당화혈색소와건강행태특성과의인과관계를밝히기에제한점이있고건강행태중식습관행태를변수로포함하지못해이를추가로반영하여연구해볼필요성이있다. 하지만이연구는이런연구에서의일부병원자료가아닌국내의대표건강조사인국민건강영양조사자료를활용하여당뇨병이발생하지않은일반남성근로자를대상으로당화혈색소와건강행태와의관련성을살펴보고이를관리하기위한방향을제시했다는것에의의가있다고할수있다. ORCID Keon-Yeop Kim https://orcid.org/0000-0002-1192-1767 Su-Jin Lee https://orcid.org/0000-0002-1387-0182 REFERENCES 1. World Health Organization. Global status report on noncomm- unicable diseases. 2014, p. 79-97. 2. Korea Centers for Disease Control and Prevention. The seventh stage Korea National Health and Nutrition Examination Survey (KNHANES), Cheongju: Korea Centers for Disease Control and Prevention; 2016, p. 30-34 (Korean). 3. Korean Diabetes Association. Treatment guideline for diabetes. Seoul: Korean Diabetes Association; 2015, p. 5-6 (Korean). 4. Nah EH, Cho HI. Relationship between hemoglobin A1c levels and metabolic syndrome using data collected during a medical check-ups program. Lab Med Online 2011;1(1):3-9 (Korean). 5. Kwon SY, Na YG. The cutoff value of HbA1c in predicting diabetes and impaired fasting glucose. Korean J Clin Lab Sci 2017;49(2):114-120 (Korean). 6. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008;93(7):2447-2453. 7. Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day A. Association of hemoglobin A(1c) with cardiovascular disease and mortality in adults: the european prospective investigation into cancer in norfolk. Ann Intern Med 2004;141(6):413-420. 8. Sung KC, Rhee EJ. Diabetes UK. Diabetes Med 2007;24:848-854. 9. Kim SK. Cigarette smoking and diabetes. Korea Clin Diabetes 2009; 10(2):73-76 (Korean). 10. Hur NW, Kim HC, Nam CM, Jee SH, Lee HC, Suh I. Smoking cessation and risk of type 2 diabetes mellitus : Korea medical insurance corporation study. Eur J Cardiovasc Prev Rehabil 2007;14(2):244-249. 11. Jang JE, Koh EH. The impacts of alcohol consumption on glucose metabolism. J Korean Diabetes 2012;13(2):81-85 (Korean). 12. Cho DH. Blood sugar control in alcohol-consuming diabetics. J Korean Diabetes 2012;13(2):91-95 (Korean). 13. Siler SQ, Neese RA, Christiansen MP, Hellerstein MK. The inhibition of gluconeogo following alcohol in human. Am J Physiol 1998;275(5): 897-907. 14. Delvin JT, Hirshman M, Horton ED, Horton ES. Enhanced peripheral and splanchnic insulin sensitivity in NIDDM men after single about of exercise. Diabetes 1987;36(4):434-439. 15. Sanz C, Gautier JF, Hanaire H. Physical exercise for the prevention and treatment of type 2 diabetes. Diabetes Metab 2010;36(5):346-351. 16. Cheon KH, Koh KW. Relationship between HbA1c and physical activity in Korean older adults. Korean Public Health Res 2011;37(1):59-71 (Korean). 17. Lee ES. Associated factors in the control of fasting blood sugar and HbA1c of diabetes mellitus patients-data from the 2005 Korea National Health and Nutritional Examination Survey [dissertation]. Graduate School of Public Health Korea University; Korea, 2010. 18. Hwang SW. Factor associated hemoglobin concentration in adults without diabetes. Cheju J Life Sci 2002;5(5):45-55 (Korean). 19. Kim JH, Choi SR, Lee JR, Shin JH, Lee SJ, Han MA, et al. Association of hemoglobin A1c with cardiovascular disease risk factors and metabolic syndrome in nondiabetic adults. Korean Diabetes J 2008;32(5): 435-444 (Korean). 20. Lee KJ. Correlation between glycosylated hemoglobin (HbA1c) in car- 350 http://www.e-jhis.org
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