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대한지역사회영양학회지 23(5): 431~443, 2018 https://doi.org/10.5720/kjcn.2018.23.5.431 ISSN 1226-0983 (print) / 2287-1624 (on-line) RESEARCH ARTICLE 저체중, 정상, 마른비만및비만여대생의식행동및혈액임상지표비교 이수빈 1) 김정희 2) 1) 서울여자대학교자연과학대학식품영양학과, 학생 2) 서울여자대학교자연과학대학식품영양학과, 교수 Comparison of Dietary Behaviors and Blood Clinical Indices in, Weight, Weight Obese and Obese Female College Students Su Bin Lee 1), Jung Hee Kim 2) 1) Graduate School of Seoul Women's University, Seoul, Korea, Student 2) Department of Food and Nutrition, Seoul Women's University, Seoul, Korea, Professor Corresponding author Jung Hee Kim Department of Food and Nutrition, College of Natural Sciences, Seoul Women's University, 621 Hwarangno, Nowon-gu, Seoul 139-774, Korea Tel: (02) 970-5646 Fax: (02) 976-4049 E-mail: jheekim@swu.ac.kr ORCID: 0000-0001-5435-6166 Acknowledgments This work was supported by a research grant from Seoul Women's University in 2018 Received: August 25, 2018 Revised: September 26, 2018 Accepted: September 26, 2018 ABSTRACT Objectives: weight obesity (NWO) is defined as excessive body fat in the context of a normal body mass index (BMI). This condition carries a greater risk of developing noncommunicable chronic disease and has been associated with early inflammation. This study was conducted to compare the anthropometric measurements, eating behaviors, and blood clinical indices among four groups: underweight, normal, normal weight obesity and obesity. Methods: The subjects included 215 female college students. A questionnaire was administered regarding general characteristics, dietary behaviors, food consumption frequency. Anthropometric measurements and blood clinical indices were also investigated. Results: The average BMI, body fat percentage, waist circumference, fat-free mass, and muscle mass were highest in the obesity group (p<0.05). Most subjects had tried to lose weight and perceived that their health was worse than before they became college students. The ratio of students in the NWO group who thought their health was very poor was significantly higher than in the other three groups (p<0.05). The obesity and NWO groups seemed to eat more and their eating speed was significantly faster than the other groups (p<0.001). The consumption frequency of caffeinated beverages was significantly higher in the NWO group than in the other three groups (p<0.01). WBC was significantly higher in the obesity group (p<0.05). Serum levels of TG and total cholesterol were also significantly higher in the obesity group (p<0.05). Serum GPT was significantly higher in the obesity group (p<0.05) while BUN level was highest in the NWO group (p<0.05). Conclusions: The obesity group showed the most health problems while the NWO group seemed relatively healthy. However, NWO can lead to problems such as metabolic syndrome and cardiovascular disease in later life if poor dietary habits are maintained. Therefore, education in appropriate eating habits is needed for these subjects. Korean J Community Nutr 23(5): 431~443, 2018 KEY WORDS dietary behavior, blood clinical indices, normal weight obesity, female college students This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 431

432 마른비만여대생의식행동및혈액임상지표 서 최근세계보건기구에의하면 2016년에는 18세이상의성인중 19억만명이상 (39%) 이과체중이고, 이들중 6억 5 천만명이상 (13%) 이비만이라고한다 [1]. 비만은체지방이과도하게축적된상태를의미하며이는건강을위협하는심각한원인이되고, 심혈관계질환및이상지질혈증, 제 2 형당뇨병, 고혈압, 암등의질병을증가시킨다 [2]. 과체중및비만을판정하는데간단하게사용되는객관적인지수는체질량지수 (body mass index, BMI) 이며체중 (kg) 을신장의제곱 (m 2 ) 으로나눈값이다. 그러나 BMI는단순히신장과체중으로비만도를평가하기때문에체지방량과제지방량을구분하지못하므로신체의구성성분을평가할수없다. BMI만으로판정하면 BMI가정상범위인사람들도과도한체지방을가질수있다는사실을간과할수있다 [3]. 특히 BMI는근육량이많은운동선수를 비만 으로, BMI가낮지만체지방이많은사람을 정상 으로잘못평가할수있다 [4]. 따라서 BMI 수치와체지방률을이용하여비만을평가하는것이보다더정확하고타당한것으로알려져있다 [5]. 체중이정상임에도불구하고체지방량이과도하게많은상태를마른비만 ( Weight, NWO) 이라고한다 [3]. NWO 유병률은인종간의차이와진단기준에대한합의가부족한실정으로연구마다다르게제시되고있으나, 특히여성에서성호르몬의영향으로인해 NWO 유병률이높기때문에여성을대상으로한연구가많이수행되고있다 [6]. 최근국내에서젊은여성들사이에서마른비만의문제가부각되고있다. 2009-2010년국민건강영양조사결과를토대로국내 20세이상의성인에서정상 BMI인대상자 (4,957 명 ) 중 NWO의유병률은남성과여성이각각 36%, 29% 였다. 정상체중여성의약 30% 가 NWO라고한다 [7]. 사회적으로외모지상주의적사고가만연해져젊은여성들은매력적인외모를가꾸기위해부적절한방법으로무리한다이어트를하고있다. 이는결과적으로체중은감소하지만, 운동량이줄어들면서근육량은적고체지방이많은마른비만을유발하기때문이다 [8]. 체질량지수는심혈관계질환과제 2형당뇨병의위험이증가하는것과관련이있는것으로밝혀졌다 [9]. 그러나정상체중이더라도체지방률이높은사람의경우도심혈관계질환의위험이높았다 [10-13]. 또한미국의 NWO인 20세이상의성인이 BMI와체지방이정상인성인보다대사증후 론 군의발병위험이 4배더높았다 [14]. NWO의하위개념인 metabolically obese normal weight(monw) 는정상체중이지만대사적이상을가진사람들을뜻하며, 이들은고인슐린혈증이나타나고높은인슐린저항성으로제 2형당뇨병에걸리기쉬우며조기관상동맥질환이있었다 [15]. 또한대사증후군을유발할수있는위험인자를가지고있으며, 내장지방량과혈중중성지방이높은것으로나타나 MONW 의경우비만과유사한건강문제가나타난다고보고하였다 [16]. 국내에서도한국성인을대사성비만이지만정상체중인 MONW 와대사적으로건강하지만비만인 metabolically healthy but obese(mho) 로분류하여대사증후군을예방하기위해서는나쁜건강관련행동을수정해야한다고하였다 [17]. 젊은여성들중여대생은성인초기단계로이시기에건강한식습관을형성하는것은평생건강을좌우할수있으므로매우중요하다 [18]. 특히여대생은후에모성이될가임연령층으로한가정의건강한구성원을생산하는중요한위치에있어균형적이고영양이풍부한음식섭취가중요하다. 하지만외모지상주의인사회적분위기에휩쓸려마른체형을선호하고자기만족을위해무분별하게부적절한다이어트를하고있기때문에적절한영양공급이어렵다고보고되었다 [19]. 더불어최근국내젊은여성의신체활동은지속적으로감소하는추세이다 [20]. 국내에서비만대상의연구는많이이루어진반면, 마른비만을대상으로한연구는아직미흡하고부족한실정이다. 일부연구에서 NWO와대사질환 ( 대사적장애 ) 사이의연관성을보고한연구결과도있으나 [21, 22] 젊은성인을중점적으로한연구는거의없다. 따라서본연구에서는 BMI와체지방률에따라여대생을네개의군 ( 저체중, 정상, 마른비만, 비만 ) 으로나누어신체계측결과, 식행동, 혈액임상지표를통해건강상태를평가하고, 군간의비교분석을통해특히마른비만군에서건강위험요인이무엇인지알아보고자하였다. 이를토대로건강한체형에대한젊은여성들의잘못된인식을바로잡고, 장기적으로이어질수있는질병의예방을위해식행동및생활습관변화의필요성을환기시키며, 이들을위한적절한건강교육프로그램개발의기초자료를제공하고자한다. 연구내용및방법 1. 연구대상자 본연구의대상자는서울지역에위치한한여자대학교에재학중인만 19세 ~25세의여대생이었다. 대사적이상이나

이수빈 김정희 433 의학적부적격사유가없으면서연구참여에자발적으로서면을통해동의한총 215명을연구대상자로선정하였다. 연구기간은 2015년 9월부터 2016년 5월까지였으며, 2015 년 9월에서울여자대학교인체시험심의위원회에심의를의뢰하여본연구에대한승인을받았다 (IRB-2015A-19). 표를측정하였다. 검사항목은 complete blood cell count(cbc), 혈당, 혈중지질조성지표인중성지질, 총콜레스테롤, HDL-콜레스테롤과간기능지표인 GOT와 GPT, 신장기능관련지표인 blood urea nitrogen(bun) 과크레아티닌이다. 2. 신체계측모든연구대상자의신체계측항목으로신장, 체중, 체질량지수, 체지방량, 체지방율, 제지방량, 골격근량, 근육량, 허리둘레, 복부지방률, 내장지방면적, 혈압을측정하였다. 신장과체중은신장체중비만도자동측정계 (JENIX, Seoul, Korea) 로소수점첫째자리까지측정하였고, 허리둘레는훈련받은연구조사자가줄자로허리의가장가는부위 ( 배꼽위약 2cm) 를측정하였다. 체질량지수, 체지방량, 체지방율, 제지방량, 골격근량등은생체전기저항분석법 (bioelectrical impedance analysis, BIA) 을사용하여연구대상자가최소 12시간공복상태를유지한채 Inbody 720(Biospace, Seoul, Korea) 으로측정하였으며혈압은자동혈압계 (TM- 2655P, A&D Co.; Tokyo, Japan) 로수축기혈압과이완기혈압을측정하였다. 3. 설문조사서면으로연구참여에자발적으로동의한모든연구대상자를대상으로설문조사를실시하였다. 설문지의문항은건강과영양에대한관심도, 체중감량의시도여부, 식습관및식품섭취빈도로구성되었다. 식행동은하루의식사횟수, 일주일동안먹는아침식사횟수, 섭취하는식사의양과속도, 식사의규칙성, 간식과야식및외식의섭취빈도, 대학생이전과현재의식생활습관변화에대한인식등을조사하였다. 식품섭취빈도는곡류및전분류, 고기 생선 계란 콩류, 채소류, 해조류, 우유및유제품, 과일, 기름진음식, 카페인음료, 인스턴트음식, 맵고짠음식, 단간식또는음료등의섭취빈도를조사하였다. 각음식의섭취빈도는 거의안먹음, 한달에 1-3번, 일주일에 1-3번, 일주일에 4-6번, 하루에 1번, 하루에 2번, 하루에 3번이상 의 7점척도를기준으로조사하였다 [23]. 모든설문은연구대상자가직접기입하는방식으로진행되었다. 4. 생화학적검사혈액생화학적검사는최소 12시간공복상태에서상완정맥의혈액을 1회용주사기를이용하여채혈하였다. 채혈한혈액은 꽃마을한방병원종합검진센터 에의뢰하여임상지 5. 통계분석 연구대상자를체질량지수와체지방률에따라저체중, 정상, 마른비만, 비만의네집단으로분류하였다. 이전연구의마른비만기준과 [2, 24, 25] 국민건강통계에서분류한기준 [20] 에따라본연구에서는 BMI 18.5 kg/m 2 미만을저체중, 18.5 kg/m 2 이상 25 kg/m 2 미만이면서체지방률이 30% 미만인경우를정상, 18.5 kg/m 2 이상 25 kg/m 2 미만이면서체지방률이 30% 이상인경우를마른비만, 25 kg/ m 2 이상을비만으로분류하였다. 특히국민건강통계 [20] 에서과체중군은별도로분석하지않았기때문에본연구에서도과체중군은고려하지않았다. 수집된모든자료는 SPSS 통계프로그램 (IBM SPSS Statistics version 21, SPSS Inc. Chicago, Illinois, USA) 을이용하여분석하였다. 일반사항및건강관련생활습관, 식생활습관및식행동, 식품섭취빈도항목은빈도와백분율 (%) 로표시하였고 χ 2 -test 를실시하였다. 신체계측지표와혈액임상지표는평균과표준편차로표시하였으며체질량지수및체지방률에따른네군간의비교를위하여 oneway ANOVA와 Duncan's multiple range test로유의성을검정하였다. 모든검정은 p<0.05 수준에서통계적으로유의하다고해석하였다. 연구결과 1. 대상자의신체계측 연구대상자는총 215명의여성으로평균연령은 20.2 ± 1.1세이며, 체질량지수와체지방률에따라군을나눈결과, 저체중 이 51명 (23.7%), 정상 이 84명 (39.1%), 마른비만 이 64명 (29.8%), 비만 이 16명 (7.4%) 이었다. 정상이가장많았고마른비만, 저체중, 비만순이었다 (Table 1). 대상자의평균신장과체중은각각 161.5 cm, 53.5 kg 이었으며, 평균체질량지수는 20.4 kg/m 2 로정상에해당되었다. 전체대상자의평균체지방량과체지방률은각각 15.59 kg, 28.16% 였다. 네군에서체중, 체질량지수, 체지방량, 체지방률, 허리둘레, 복부지방률 ( 허리둘레-엉덩이둘레비율 ), 내장지방면적의평균값은비만군이유의적으로가장높았고 (p<0.05) 마

434 마른비만여대생의식행동및혈액임상지표 Table 1. Anthropometric indices of subjects weight obesity (n=64) Age (years) 520.3 55± 1.1 1) 520.2 55± 1.0 520.255 ± 1.1 520.3 55± 1.5 520.2 55± 51.1 Height (cm) 160.6 55± 5.7 161.9 55± 5.4 161.855 ± 5.5 160.8 55± 3.7 161.5 55±5 5.4 Weight (kg) 544.755 ± 3.3 a 553.2 55± 5.1 b 556.8 55± 5.4 c 570.355 ± 5.7 d 553.555 ±5 8.1 BMI (kg/m 2 ) 517.355 ± 0.8 a 520.255 ± 1.3 b 521.655 ± 1.4 c 527.1 55± 1.7 d 520.455 ± 52.8 Body fat (kg) 510.465 ± 1.94 a 513.875 ± 2.29 b 518.915 ± 2.41 c 527.735 ± 4.33 d 515.595 ± 55.26 Body fat (%) 523.045 ± 3.72 a 525.625 ± 2.78 b 532.885 ± 2.10 c 538.935 ± 4.23 d 528.165 ± 55.74 Fat free mass (kg) 534.865 ± 2.94 a 540.095 ± 3.67 b 538.54 5± 3.70 b 543.315 ± 3.65 c 538.635 ±5 4.25 Skeletal muscle mass (kg) 518.525 ± 1.73 a 521.65 5± 2.19 c 520.67 5± 2.22 b 523.565 ± 2.22 d 520.765 ± 52.54 Muscle mass (kg) 532.79 5± 2.76 a 537.725 ± 3.44 b 536.20 5± 3.49 b 540.70 5± 3.41 c 536.325 ± 53.99 Waist circumference (cm) 562.355 ± 3.6 a 566.5 55± 4.2 b 570.0 55± 5.3 c 581.955 ± 7.5 d 567.755 ± 56.8 Waist-hip ratio (%) 550.753 ± 0.015 a 550.777 ± 0.015 b 550.787 ± 0.019 c 550.836 ± 0.022 d 550.779 ± 50.027 Visceral fat area (cm 2 ) 519.52 5± 8.18 a 530.075 ± 8.12 b 546.655 ± 9.70 c 579.305 ± 14.48 d 536.175 ± 18.34 Systolic BP (mmhg) 107.1 55± 7.7 108.5 55± 7.5 109.0 55± 9.5 108.4 55± 8.3 108.3 55± 58.2 Diastolic BP (mmhg) 570.155 ± 6.0 571.8 55± 5.9 572.0 55± 7.1 573.8 55± 5.9 571.655 ±5 6.3 : BMI < 18.5 kg/m 2, : 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage < 30% weight obesity: 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage 30%, : BMI 25 kg/m 2 1) Mean ± SD a, b, c, d: Means with different superscript letters are significantly different at p<0.05 among 4 groups by ANOVA and Duncan s multiple range test 른비만군, 정상군, 저체중군순이었다. 허리둘레와복부지방률은전체평균이각각 67.7 cm, 0.78% 로정상범위였다. 제지방량과근육량의평균값은비만군이유의적으로가장높았고 (p<0.05), 정상과마른비만군은같았으며저체중군이가장낮았다. 골격근량의평균값은비만, 정상, 마른비만, 저체중군순으로군간에유의적인차이가있었다 (p<0.05). 전체여학생의수축기혈압과이완기혈압의평균값은 108.3 mmhg, 71.6 mmhg로정상혈압에속하였다 (Table 1). 2. 건강과다이어트에대한관심최근 1년동안식생활교육이나건강교육경험여부에대해조사한결과전체대상자중 39명 (18.1%) 이받은적이있다고응답하였으며비만군이 6명 (37.5%) 으로다른세군에비해유의적으로 (p<0.05) 높았다 (Table 2). 교육을받은적이없다고응답한사람이 176명 (81.9%) 으로대상자의대부분이식생활교육또는건강교육의경험이없는것으로나타났다. 건강또는영양에대한관심정도에대해서 관심있다 40.0%, 매우관심있다 가 8.4% 응답한것에비해 관심없다 6.5%, 매우관심없다 가 0.9% 로대다수의여대생은건강또는영양에대한관심이있는것으로나타났다. 현재본인의주관적인건강상태는 건강한편이다 라고응답한대상자가 141명 (65.6%) 으로가장많았으나, 대학생이되기이전과현재의본인이느끼는건강상태변화에대해부정적으로인식하는대상자가총 72명 (33.5%) 으로긍정 적으로인식하는대상자총 41명 (19.1%) 보다많은것으로나타났다. 정상군은 건강해졌다 고응답한비율이높은반면마른비만군은 건강이많이안좋아졌다 고응답한비율이다른군들에비해유의적으로높았다 (p<0.05). 체중감량시도여부에대해서는체중감량을시도해본적이 있다 고응답한대상자가 146명 (67.9%) 으로 없다 고응답한대상자 69명 (32.1%) 보다많은것으로보아대다수의여대생은체중감량을시도한적이있는것으로나타났다. 특히비만군이 87.5% 로다른군보다유의적으로높았다 (p<0.001). 대학생이되기이전과현재의주관적인체중변화인식에대한문항은 체중이약간 / 많이감소하였다 고응답한비율이총 47.0% 로 체중이약간 / 많이증가하였다 고응답한비율 (30.3%) 에비해높은것으로보아, 대다수의여대생들은대학생활동안체중이감소했다고인식하는것으로나타났다. 3. 식행동및식품섭취빈도전체대상자의식습관을조사한결과, 하루에평균적으로 2.4회식사하는것으로나타났고일주일동안먹는아침의횟수는 3.7회로나타났다 (Table 3). 먹는식사량은 적당하게먹는다 라고응답한대상자가 111명 (51.6%) 으로가장많았고 배부르게먹는편이다 가 82명 (38.1%) 이었다. 저체중과정상군은적당하게먹는다고응답한대상자가가장많았으나마른비만과비만군에서는식사시배부르게먹

이수빈 김정희 435 Table 2. Interest in health and weight loss of subjects weight obesity (n=64) χ 2 -value Experience of dietary life or health education during the last year Yes 6 (11.8) 1) 19 (22.6) 8 (12.5) 6 (37.5) 39 (18.1) 57.94* No 45 (88.2) 65 (77.4) 56 (87.5) 10 (62.5) 176 (81.9) Place of education (n=39) School 5 (83.3) 18 (94.7) 6 (75.0) 5 (83.3) 34 (87.2) 54.70 Hospital 0 (50.0) 1 (55.3) 1 (12.5) 0 (50.0) 2 (55.1) Others 1 (16.7) 0 (50.0) 1 (12.5) 1 (16.7) 3 (57.7) Interest in health or nutrition 12.24 Not interested at all 1 (52.0) 1 (51.2) 0 (50.0) 0 (50.0) 2 (50.9) Not interested 1 (52.0) 4 (54.8) 7 (10.9) 2 (12.5) 14 (56.5) Average 24 (47.1) 33 (39.3) 30 (46.9) 8 (50.0) 95 (44.2) Interested 18 (35.3) 38 (45.2) 25 (39.1) 5 (31.3) 86 (40.0) Very interested 7 (13.7) 8 (59.5) 2 (53.1) 1 (56.3) 18 (58.4) Awareness of current health status Very unhealthy 1 (52.0) 1 (51.2) 0 (50.0) 1 (56.3) 3 (51.4) 12.55 Unhealthy 17 (33.3) 18 (21.4) 23 (35.9) 6 (37.5) 64 (29.8) Healthy 30 (58.8) 64 (76.2) 38 (59.4) 9 (56.3) 141 (65.6) Very healthy 3 (55.9) 1 (51.2) 3 (54.7) 0 (50.0) 7 (53.3) Awareness of health status change during college life Very unhealthy 1 (52.0) 3 (53.6) 7 (10.9) 0 (50.0) 11 (55.1) 24.39* Unhealthy 17 (33.3) 26 (31.0) 14 (21.9) 4 (25.0) 61 (28.4) No change 25 (49.0) 30 (35.7) 36 (56.3) 11 (68.8) 102 (47.4) Healthy 7 (13.7) 19 (22.6) 7 (10.9) 1 (56.3) 34 (15.8) Very healthy 1 (52.0) 6 (57.1) 0 (50.0) 0 (50.0) 7 (53.3) Experience of weight loss attempt Yes 17 (33.3) 69 (82.1) 46 (71.9) 14 (87.5) 146 (67.9) 39.07*** No 34 (66.7) 15 (17.9) 18 (28.1) 2 (12.5) 69 (32.1) Awareness of weight change during college life Severe loss 2 (53.9) 10 (11.9) 5 (57.8) 1 (56.3) 18 (58.4) 17.54 Loss 20 (39.2) 36 (42.9) 20 (31.3) 7 (43.8) 83 (38.6) No change 17 (33.3) 13 (15.5) 14 (21.9) 5 (31.3) 49 (22.8) Gain 12 (23.5) 21 (25.0) 21 (32.8) 1 (56.3) 55 (25.6) Severe gain 0 (50.0) 4 (54.8) 4 (56.3) 2 (12.5) 10 (54.7) : BMI < 18.5 kg/m 2, : 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage < 30% weight obesity: 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage 30%, : BMI 25 kg/m 2 1) Number of subjects, ( ): % of subjects *: Significantly different at p<0.05 by chi-square test 는편이라고응답한비율이유의적으로높았다 (p<0.05). 식사할때속도의경우 보통 (15분이상 30분미만 ) 이라고응답한비율이전체의 52.6%, 빠름 (15분미만 ) 이 36.3% 로대다수의대상자들은식사속도가다소빠른것으로나타났다. 식사속도가빠르다고응답한대상자에서비만군이다른군들보다많았고, 마른비만군, 정상, 저체중군의순서였다 (p<0.001). 규칙적인식사를하는지에대해조사한결과전체의 52.6% 가불규칙하게식사하는반면에규칙적으로식사하는대상 자는전체의 15.9% 를차지하여대다수의여대생들은불규칙적인식사를하는것으로나타났다. 야식 은저녁 7시이후에먹은음식으로정의하여섭취빈도를조사한결과, 거의먹지않음 이 60명 (27.9%) 으로가장많았고 일주일에 1-2회 가 54명 (25.1%) 으로그뒤를이었다. 저체중, 마른비만, 비만군에서야식을주 1-2회섭취하는비율이가장높았으나정상군에서는거의먹지않는비율이가장높았다. 야식섭취시간은야식을섭취하는대상자의 63.5% 가주로 21시이후 (63.5%) 라고응답하였으

436 마른비만여대생의식행동및혈액임상지표 Table 3. Dietary behaviors of subjects weight obesity (n=64) Number of meals per day 2.4 ± 0.7 1) 2.5 ± 0.6 2.4 ± 0.6 2.6 ± 0.5 2.4 ± 0.6 Frequency of breakfast (times/week) 3.2 ± 2.4 4.0 ± 2.1 3.7 ± 2.6 3.5 ± 2.0 3.7 ± 2.3 Size of meals Very little 1 (52.0) 2) 0 (50.0) 0 (50.0) 0 (50.0) 1 (50.5) Little 3 (55.9) 5 (56.0) 2 (53.1) 0 (50.0) 10 (54.7) Suitable 34 (66.7) 45 (53.6) 26 (40.6) 6 (37.5) 111 (51.6) Much 13 (25.5) 26 (31.0) 33 (51.6) 10 (62.5) 82 (38.1) Very much 0 (50.0) 7 (58.3) 3 (54.7) 0 (50.0) 10 (54.7) No answer 0 (50.0) 1 (51.2) 0 (50.0) 0 (50.0) 1 (50.5) Eating speed Fast (< 15 min) 12 (23.5) 29 (34.5) 28 (43.8) 9 (56.3) 78 (36.3) (15 29 min) 23 (45.1) 51 (60.7) 32 (50.0) 7 (43.8) 113 (52.6) Slow ( 30 min) 16 (31.4) 4 (54.8) 4 (56.3) 0 (50.0) 24 (11.2) Meal regularity Very irregular 11 (21.6) 11 (13.1) 8 (12.5) 2 (12.5) 32 (14.9) Irregular 20 (39.2) 31 (36.9) 22 (34.4) 8 (50.0) 81 (37.7) 17 (33.3) 29 (34.5) 18 (28.1) 4 (25.0) 68 (31.6) Regular 2 (53.9) 12 (14.3) 14 (21.9) 2 (12.5) 30 (14.0) Very regular 1 (52.0) 1 (51.2) 2 (53.1) 0 (50.0) 4 (51.9) Frequency of late-night meal Almost don t eat 11 (21.6) 33 (39.3) 14 (21.9) 2 (12.5) 60 (27.9) 1 2 times/month 11 (21.6) 20 (23.8) 14 (21.9) 3 (18.8) 48 (22.3) 1 2 times/week 12 (23.5) 17 (20.2) 20 (31.3) 5 (31.3) 54 (25.1) 3 4 times/week 11 (21.6) 8 (59.5) 10 (15.6) 4 (25.0) 33 (15.3) 5 6 times/week 4 (57.8) 4 (54.8) 3 (54.7) 1 (56.3) 12 (55.6) Everyday 2 (53.9) 2 (52.4) 3 (54.7) 1 (56.3) 8 (53.7) Time of last-night meal (n=203) (hours P.M.) 7 hours <8 1 (52.1) 16 (20.8) 3 (54.8) 1 (56.3) 21 (10.3) 8 hours <9 8 (17.0) 18 (23.4) 20 (31.7) 7 (43.8) 53 (26.1) 9 hours <10 14 (29.8) 17 (22.1) 16 (25.4) 1 (56.3) 48 (23.6) 10 hours <11 15 (31.9) 13 (16.9) 18 (28.6) 4 (25.0) 50 (24.6) Hours 11 9 (19.1) 13 (16.9) 6 (59.5) 3 (18.8) 31 (15.3) Time of sleeping after food intake Within 3 hours 20 (39.2) 21 (25.0) 14 (21.9) 2 (12.5) 57 (26.5) 3 < hours 4 16 (31.4) 29 (34.5) 30 (46.9) 8 (50.0) 83 (38.6) 4 < hours 5 11 (21.6) 22 (26.2) 14 (21.9) 5 (31.3) 52 (24.2) Hours > 5 4 (57.8) 11 (13.3) 6 (59.4) 1 (56.3) 22 (10.3) No answer 0 (50.0) 1 (51.2) 0 (50.0) 0 (50.0) 1 (50.5) Frequency of eating out Almost don t eat 2 (53.9) 17 (20.2) 9 (14.1) 1 (56.3) 29 (13.5) 1 2 times/month 22 (43.1) 37 (44.0) 27 (42.2) 5 (31.3) 91 (42.3) 1 2 times/week 19 (37.3) 21 (25.0) 21 (32.8) 6 (37.5) 67 (31.2) 3 4 times/week 6 (11.8) 8 (59.5) 6 (59.4) 4 (25.0) 24 (11.2) 5 times/week 2 (53.9) 1 (51.2) 1 (51.6) 0 (50.0) 4 (51.9) χ 2 -value 25.08* 31.93*** 11.27 14.70 26.04* 59.58 14.20

이수빈 김정희 437 Table 3. Dietary behaviors of subjects (continued) weight obesity (n=64) Change in eating habits during college life Very negative 1 (52.0) 6 (57.1) 2 (53.1) 1 (56.3) 10 (54.7) Negative 32 (62.7) 44 (52.4) 38 (59.4) 11 (68.8) 125 (58.1) No change 17 (33.3) 20 (23.8) 18 (28.1) 3 (18.8) 58 (27.0) Positive 1 (52.0) 12 (14.3) 5 (57.8) 1 (56.3) 19 (58.8) Very positive 0 (50.0) 1 (51.2) 1 (51.6) 0 (50.0) 2 (50.9) No answer 0 (50.0) 1 (50.5) 0 (50.0) 0 (50.0) 1 (50.5) : BMI < 18.5 kg/m 2, : 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage < 30% weight obesity: 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage 30%, : BMI 25 kg/m 2 1) Mean ± SD 2) Number of subjects, ( ): % of subjects *, ***: Significantly different at p<0.05, p<0.001 by chi-square test χ 2 -value 13.09 며 21시이후 에섭취하는대상자중저체중군의비율이다른세군에비해유의적으로높았고 (p<0.05), 19-20시 에섭취하는대상자중정상군의비율이다른세군에비해유의적으로높았다 (p<0.05). 대학생이되기이전과현재의식생활습관변화에대한주관적인인식을조사한결과, 좋아졌다고인식하는대상자가총 21명 (9.7%) 인반면나빠졌다고인식하는대상자가총 135명 (62.8%) 인것으로보아대다수의여대생들은대학생활동안식생활습관이나쁘게변했다고인식하였다. 전체대상자의식품섭취빈도조사결과는 Table 4에제시하였다. 우유및유제품과미역, 김, 파래등의해조류섭취빈도는 일주일에 3회이하 로섭취하는대상자가각각 53.5%, 74.8% 로 일주일에 4회이상 섭취하는대상자 ( 각각 46.5%, 25.1%) 보다많은것으로나타났다. 해조류의섭취빈도는 일주일에 1회미만 섭취하는대상자중마른비만군 (30명, 46.9%) 이세군보다많았고 매일 1회이상 섭취하는대상자중에는정상군 (11명, 13.1%) 이가장많았다. 삼겹살, 갈비, 장어와같은지방이많은육류의섭취빈도는비만군의경우 일주일에 1-6회 섭취하는비율 (13명, 81.3%) 이다른세군보다높았고, 매일 1회이상 섭취하는대상자중에서정상군 (13명, 15.5%) 이가장많았다. 커피, 에너지드링크, 홍차등의카페인음료섭취빈도는 매일 1회이상 섭취한다고답한대상자가전체의 28.2% 로가장많은가운데, 마른비만군에서 매일 1회이상 섭취하는대상자가 34.4% 로군내에서가장높은비율을차지하였다 (p<0.01). 햄버거, 피자, 치킨등의기름진음식섭취빈도는 일주일에 1-3회 라고답한대상자가전체의 56.4% 로가장많았고 매일 1회이상 섭취한다고응답한대상자중마른비만 군 (4명, 6.3%) 의비율이높은경향이있는것으로나타났다. 라면과같은인스턴트음식의섭취빈도또한 매일 1회이상 섭취하는대상자중마른비만군 (8명, 12.7%) 의비율이가장높은경향이있었고햄, 소시지, 통조림등의가공식품섭취빈도는 일주일에 4회이상 섭취하는대상자중정상군 (17명, 20.2%) 의비율이높은경향이있었다. 맵고짠음식에대한섭취빈도는 일주일에 4회이상 섭취한다고응답한대상자중마른비만군 (21명, 32.8%) 이가장많은경향이있었고단간식의섭취빈도도유의적이지는않으나 일주일에 1-6회 섭취하는대상자중마른비만군 (45명, 70.4%) 의비율이다른세군보다높았다. 4. 생화학적검사전체대상자의일반혈액검사결과평균값은모두정상범위에속하였다 (Table 5). WBC, Hb, Hct의경우, 저체중, 정상, 마른비만세군에서는차이가없었으나비만인군에서유의적으로높았다 (p<0.05). RBC의경우비만이유의적으로가장높았으며 (p<0.05) 마른비만, 저체중, 정상순이었다. 전체대상자의혈당및혈청지질관련지표들을분석한결과, 평균값은모두정상범위에속하였다. 공복혈당의평균은 87.10 mg/dl였으며, 군간의유의적인차이는나타나지않았다. 중성지질농도와총콜레스테롤은비만군이다른세군에비해유의적으로높았다 (p<0.05). HDL-콜레스테롤의평균값은 64.90 mg/dl였고군간에유의적인차이는없었다. 전체대상자의간기능및신장기능관련혈액지표를분석한결과, 평균값은모두정상범위에속하였다. 간기능관련지표인 GOT는군간에유의적인차이가없었으나, GPT 는비만군이 16.81 U/L로다른세군에비해유의적으로높

438 마른비만여대생의식행동및혈액임상지표 Table 4. Food consumption frequency of subjects weight obesity (n=64) χ 2 -value 5) Rice, bread, noodle, potato, sweet potato, etc Less than once a week 0 (50.0) 1) 1 (51.2) 3 (54.7) 0 (50.0) 4 (51.9) 9.81 1 3 times a week 7 (13.7) 13 (15.5) 6 (59.4) 3 (18.8) 29 (13.5) 4 6 times a week 8 (15.7) 10 (11.9) 10 (15.6) 5 (31.3) 33 (15.3) Everyday 36 (70.6) 60 (71.4) 45 (70.3) 8 (50.0) 149 (69.3) Meat, fish, egg, beans, etc Less than once a week 0 (50.0) 2 (52.4) 3 (54.7) 0 (50.0) 5 (52.3) 7.78 1 3 times a week 15 (29.4) 25 (29.8) 12 (18.8) 4 (25.0) 56 (26.0) 4 6 times a week 9 (17.6) 18 (21.4) 10 (15.6) 2 (12.5) 39 (18.1) Everyday 27 (52.9) 39 (46.4) 39 (60.9) 10 (62.5) 115 (53.5) Vegetables except Kimchi (n=214) Less than once a week 6 (12.0) 9 (10.7) 4 (56.3) 0 (50.0) 19 (58.9) 8.37 1 3 times a week 14 (28.0) 20 (23.8) 16 (25.0) 2 (12.5) 52 (24.3) 4 6 times a week 4 (58.0) 15 (17.9) 8 (12.5) 4 (25.0) 31 (14.5) Everyday 26 (52.0) 40 (47.6) 36 (56.3) 10 (62.5) 112 (52.3) Fruits (n=213) Less than once a week 5 (10.0) 10 (11.9) 11 (17.2) 3 (20.0) 29 (13.6) 6.30 1 3 times a week 21 (42.0) 29 (34.5) 19 (29.7) 3 (20.0) 72 (33.8) 4 6 times a week 12 (24.0) 15 (17.9) 12 (18.8) 4 (26.7) 43 (20.2) Everyday 12 (24.0) 30 (35.7) 22 (34.4) 5 (33.3) 69 (32.4) Milk and dairy product 2.06 Less than once a week 7 (13.7) 13 (15.5) 8 (12.5) 3 (18.8) 31 (14.4) 1 3 times a week 21 (41.2) 33 (39.3) 25 (39.1) 5 (31.3) 84 (39.1) 4 6 times a week 12 (23.5) 16 (19.0) 12 (18.8) 4 (25.0) 44 (20.5) Everyday 11 (21.6) 22 (26.2) 19 (29.7) 4 (25.0) 56 (26.0) Seaweed (sea mustard, laver, etc) Less than once a week 23 (45.1) 23 (27.4) 30 (46.9) 3 (18.8) 79 (36.7) 12.47 1 3 times a week 18 (35.3) 36 (42.9) 21 (32.8) 7 (43.8) 82 (38.1) 4 6 times a week 6 (11.8) 14 (16.7) 8 (12.5) 5 (31.3) 33 (15.3) Everyday 4 (57.8) 11 (13.1) 5 (57.8) 1 (56.3) 21 (59.8) Fatty meat (Samgyeopsal, Kalbi, eel, etc) Less than once a week 14 (27.5) 22 (26.2) 14 (21.9) 3 (18.8) 53 (24.7) 6.16 1 3 times a week 26 (51.0) 36 (42.9) 32 (50.0) 9 (56.3) 103 (47.9) 4 6 times a week 5 (59.8) 13 (15.5) 9 (14.1) 4 (25.0) 31 (14.4) Everyday 6 (11.8) 13 (15.5) 9 (14.1) 0 (50.0) 28 (13.0) Caffeine (coffee, energy drink, tea, etc) (n=213) Less than once a week 25 (49.0) 14 (16.7) 13 (20.3) 4 (28.6) 56 (26.3) 1 3 times a week 12 (23.5) 26 (31.0) 20 (31.3) 2 (14.3) 60 (28.2) 4 6 times a week 5 (59.8) 19 (22.6) 9 (14.1) 4 (28.6) 37 (17.4) Everyday 9 (17.6) 25 (29.8) 22 (34.4) 4 (28.6) 60 (28.2) Greasy food (hamburger, pizza, chicken, etc) (n=211) Less than once a week 17 (33.3) 20 (24.4) 17 (27.0) 4 (26.7) 58 (27.5) 1 3 times a week 28 (54.9) 46 (56.1) 35 (55.6) 10 (66.7) 119 (56.4) 4 6 times a week 6 (11.8) 12 (14.6) 7 (11.1) 1 (56.7) 26 (12.3) Everyday 0 (50.0) 4 (54.9) 4 (56.3) 0 (50.0) 8 (53.8) 23.06** 55.92

이수빈 김정희 439 Table 4. Food consumption frequency of subjects (continued) weight obesity (n=64) Instant food (ramen, etc) (n=214) Less than once a week 12 (23.5) 27 (32.1) 20 (31.7) 6 (37.5) 65 (30.4) 1 3 times a week 36 (70.6) 43 (51.2) 27 (42.9) 8 (50.0) 114 (53.3) 4 6 times a week 1 (52.0) 11 (13.1) 8 (12.7) 2 (12.5) 22 (10.3) Everyday 2 (53.9) 3 (53.6) 8 (12.7) 0 (50.0) 13 (56.1) Processed food (ham, sausage, canned food, etc) (n=214) Less than once a week 19 (37.3) 36 (42.9) 23 (36.5) 6 (37.5) 84 (39.3) 1 3 times a week 24 (47.1) 31 (36.9) 34 (54.0) 9 (56.3) 98 (45.8) 4 6 times a week 6 (11.8) 10 (11.9) 2 (53.2) 0 (50.0) 18 (58.4) Everyday 2 (53.9) 7 (58.3) 4 (56.3) 1 (56.3) 14 (56.5) Spicy and salty food (jjigae, etc) Less than once a week 10 (19.6) 19 (22.6) 15 (23.4) 5 (31.3) 49 (22.8) 1 3 times a week 30 (58.8) 42 (50.0) 28 (43.8) 7 (43.8) 107 (49.8) 4 6 times a week 8 (15.7) 13 (15.5) 15 (23.4) 2 (12.5) 38 (17.7) Everyday 3 (55.9) 10 (11.9) 6 (59.4) 2 (12.5) 21 (59.8) Sweets (chocolate, ice cream, cookies, etc) Less than once a week 8 (15.7) 16 (19.0) 7 (10.9) 4 (25.0) 35 (16.3) 1 3 times a week 18 (35.3) 35 (41.7) 28 (43.8) 5 (31.3) 86 (40.0) 4 6 times a week 12 (23.5) 19 (22.6) 17 (26.6) 4 (25.0) 52 (24.2) Everyday 13 (25.5) 14 (16.7) 12 (18.8) 3 (18.8) 42 (19.5) : BMI < 18.5 kg/m 2, : 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage < 30% weight obesity: 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage 30%,: BMI 25 kg/m 2 1) Number of subjects, ( ): % of subjects,**: Significantly different at p<0.01 by chi-square test χ 2 -value 16.73 59.49 55.27 54.70 Table 5. Serum clinical indices of subjects weight obesity (n=64) WBC ( 10 3 /μl) 556.585 ± 51.55 a1) 556.705 ± 51.60 a 557.34 5±5 1.89 a 558.145 ± 51.67 b 556.97 5± 51.74 RBC ( 10 6 /μl) 554.645 ± 50.25 ab 554.595 ± 50.29 a 554.72 5±5 0.29 b 554.86 5± 50.29 c 554.665 ± 50.29 Hb (g/dl) 513.405 ±5 0.83 a 513.14 5±5 1.05 a 513.245 ± 51.16 a 513.99 5± 50.80 b 513.305 ± 51.04 Hct (%) 540.485 ± 52.01 a 539.72 5±5 2.56 a 540.185 ± 52.75 a 541.825 ±5 2.04 b 540.195 ±5 2.51 GOT (U/L) 521.755 ± 54.00 1) 521.025 ± 54.01 519.755 ±5 3.78 521.505 ±5 6.57 520.855 ± 54.22 GPT (U/L) 559.25 5± 53.37 a 559.875 ± 53.61 a 559.395 ± 53.60 a 516.81 5± 58.94 b 510.10 5± 54.56 BUN (mg/dl) 511.075 ± 52.01 a 511.825 ± 53.19 ab 512.485 ± 52.77 b 511.065 ±5 1.68 a 511.78 5± 52.77 Creatinine (mg/dl) 550.978 ± 50.078 550.982 ± 50.070 550.994 ± 50.083 550.938 ± 50.072 550.981 ±5 0.077 Glucose (mg/dl) 587.065 ± 57.11 1) 586.69 5± 57.19 587.25 5±5 7.44 588.755 ± 58.18 587.10 5± 57.29 Triglyceride (mg/dl) 570.355 ± 26.87 a 568.11 5± 29.16 a 577.11 5± 34.27 a 105.885 ± 58.67 b 574.13 5± 34.37 Cholesterol (mg/dl) 172.80 5± 24.57 a 173.14 5± 26.32 a 178.98 5± 27.44 a 196.315 ± 34.55 b 176.53 5± 27.46 HDL-cholesterol (mg/dl) 566.025 ± 12.77 566.025 ± 13.62 564.47 5± 13.79 557.195 ± 12.86 564.90 5± 13.52 : BMI < 18.5 kg/m 2, : 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage < 30% weight obesity: 18.5 kg/m 2 BMI<25kg/m 2, body fat percentage 30%, : BMI 25 kg/m 2 1) Mean ± SD a, b C: Means with different superscript letters are significantly different at p<0.05 among 4 groups by ANOVA and Duncan s multiple range test 았다 (p<0.05). 신장기능관련지표인 BUN의경우, 마른비만군이다른세군에비해유의적으로높았고 (p<0.05) 정상군이그뒤를이었으며, 저체중과비만군은평균값이비슷 하였다. 반면에크레아티닌은네군간에유의적인차이가나타나지않았다.

440 마른비만여대생의식행동및혈액임상지표 고 본연구의대상자를저체중, 정상, 마른비만, 비만의네군으로분류하였을때마른비만여성이전체여성의 29.8%, 정상체중여성의 43.2% 로나타났다. 이는국민건강영양조사 (2009~2010년) 자료로분석한마른비만성인여성이정상체중여성의약 30% 였다 [7] 는비율보다높은수치였다. 이러한결과는본연구의대상자가 20.2 세의젊은여대생임을감안하면젊은여성의마른비만비율이증가하는추세를보여주는것으로생각된다. 대상자의신체계측을실시한결과평균체질량지수 20.4 kg/m 2 로조사되었다. 이는 2015년국민건강영양조사결과, 19-29세여자의평균체질량지수가 21.5 kg/m 2 [20] 보다약간낮았다. 비만군의체질량지수, 체지방률, 허리둘레, 복부지방률, 내장지방면적이다른세군과비교하였을때유의적으로높았다 (p<0.05). 비만군다음으로마른비만군이높았으며역시정상군보다체질량지수, 체지방률및허리둘레등이유의적으로높게나왔다. 반면마른비만군이정상군보다골격근량이유의적으로낮게나왔다 (p<0.05). 이는다른연구 [26] 에서마른비만군이정상군보다체질량지수, 체지방률, 허리둘레가유의적으로높게나온결과와유사하였다. 대다수의여대생들은체중감량을시도한적이있었다. 비만도에따라나눈여대생의체중조절인식, 생활습관및식습관을비교한연구 (27) 에서도대다수의여대생들 ( 저체중군 57.1%, 정상체중군 98.6%) 이체중감량을시도했었다. 여대생들은주로몸매관리를위해체중감량을시도한것으로생각된다. 또한여대생들은정상체중이어도과체중으로생각하는등의부적절한신체이미지를가지고있으며 [27], 이러한요인또한체중감량의원인이된다. Chaung[8] 은우리나라젊은여성들이매력적인외모를갖기위해부적절한방법으로무리한다이어트를한다고보고하였으며, 이는마른비만으로이어질가능성이높다. 젊은여성에게서체지방량에비해근육량이감소하는마른비만이증가하면죽상동맥경화증등의심혈관질환의위험이높아지고 [6] 대사증후군에걸릴확률이높아진다 [28] 고하였다. 특히정상범위의체질량지수인여성의경우심혈관질환의예방을위해추적검사가필요하다 [29]. 현재신체계측지표로는문제가없어보일지몰라도장기적으로만성질환에노출될가능성이있으므로미리예방하는것이중요하겠다. 대다수의여대생은건강또는영양에대해관심이있는것으로나타났으나최근 1년동안식생활교육이나건강교육을받은적이별로없는것으로보인다. 이는여대생을위한 찰 영양상담이나식생활및건강교육프로그램등이부족하기때문으로생각된다. 대학생이전보다건강이안좋아졌다고인식하는대상자가많은것으로나타났는데이는여대생들이시간이없거나다이어트를하기위해서또는습관적으로식사를거르고있기때문으로사료된다. 특히 건강이많이안좋아졌다 고응답한마른비만군의비율이다른세군보다유의적으로높게나왔다 (p<0.05). 본연구대상자의식행동을분석한결과, 대다수의여대생들은하루평균 2.4회식사를하며일주일에평균 3.7회아침식사를한다고답하였다. 주로아침을먹을시간이없어서거르는것으로보인다. 2015년국민건강영양조사결과도아침식사결식률이만 19-29세가 49.1% 로가장높았으며최근 2년간지속적으로증가하는추세이다 [20]. 식사속도는전체적으로다소빠르게섭취하며, 저체중과정상군에서적당하게먹는대상자가가장많았으나마른비만과비만군에서는배부르게먹는대상자가유의적으로높았다 (p<0.05). 특히마른비만군이정상군보다식사시배부르게먹는편인것을알수있었다. 야식은저체중, 마른비만, 비만군에서일주일에 1-2회섭취하는경우가가장많았고정상군은거의먹지않는경우가많았다. 야식섭취시간은저체중군은많은학생이밤 9시이후에섭취하였고, 정상군은오후 7-8시에섭취하는경우가유의적으로많아 (p<0.05) 다른군들에비해비교적이른시간에야식을섭취하는것으로나타났다. 음식섭취후취침시간은비만인여대생은 3 시간이후 5시간이내에비교적빨리취침하였고정상군은 5시간이후에취침하는학생이가장많았다. 야식을과도하게자주섭취하는습관은야식증후군으로이어질수있으며 [30] 야식증후군은비만에취약한사람들에게체중증가를유발할수있다. 이와더불어우울증및수면관련문제들이동반되어체중조절이더욱어려워지기때문에비만을악화시킬수있다 [31]. 특히오후 5시이후에섭취하는에너지의비율이 10% 증가할때유방암위험이증가하고다양한만성질환과관련있는지표인 CRP의농도가유의하게높아지는연구결과 [32] 도존재한다. 본연구에서는야식을거의먹지않는대상자 (27.9%) 가 주 1-2회 섭취하는대상자 (25.1%) 보다약간많았으나, 여대생들의영양불균형적인간식섭취와잦은야식섭취는장기적으로봤을때만성질환의위험을증가시키므로이를지양하고규칙적이고균형적인식습관의실천이강조된다. 전체대상자의식품섭취빈도를조사한결과, 대부분의대상자들은곡류군 어육류군 채소군은매일섭취하였으나우유및유제품과해조류는일주일에 3회이하로섭취하였다. 특히해조류를일주일에 1회미만으로섭취하는대상자

이수빈 김정희 441 중마른비만군이가장많았고매일섭취하는대상자중정상군이가장많았다. 지방이많은육류의섭취빈도는비만군이다른세군보다자주섭취하는경향을보였다. 커피, 에너지드링크, 홍차등의카페인음료섭취빈도도마른비만군이다른세군에비해유의적으로높은것으로나타났다 (p<0.01). 카페인의섭취는칼슘배설량을증가시켜골다공증을유발하는것으로알려져있다. 특히여성은 30대에최대골질량을형성하는시기며중년이후에흔히생길수있는골다공증예방을위해골질량형성시기에있는 20대때부터카페인의잦은섭취는지양하는것이바람직해보인다. 본연구전체대상자의혈액임상검사결과평균값은모두정상범위였다. 염증지표인백혈구수 (WBC) 는비만군에서다른세군에비해유의적으로높았다 (p<0.05). 이런결과는비만은높은총백혈구수치와연관이있다는사실을밝힌성인여성대상의다른연구와유사하였다 [33]. 비만은만성염증상태이며따라서과도한체중과관련된병적상태및위험의일부가염증성질환과관련이있을수있다 [34, 35]. 여러연구에서염증지표인백혈구수가상승하면대사증후군이나관상동맥질환및제 2형당뇨병의합병증발병가능성이높아진다고하였다 [36, 37]. 비만은급성질환과수술후인구에서더높은감염률과연관이있으며 [38], 암의과도한발병과도관련이있다 [39]. 이는비만이면역세포수또는기능의변화로인하여질병과연관될수있다. 본연구의비만여대생또한지금은정상백혈구수치에포함되지만장기적으로노후에는이러한만성질환에노출될확률이높아질수도있다. 일부연구에서체중이감소하면백혈구수가감소하고 [40], 염증성사이토카인이감소되었다고한다 [41]. 공복혈당수치는네군간에차이가없었으나혈청중성지질과총콜레스테롤농도는비만군에서유의적으로높았다 (p<0.05). 마른비만군은정상군보다는중성지질과총콜레스테롤이높은경향이있었으나유의적인차이는없었다. 그러나 Madeira 등 [28] 의연구에서는 23~25세의젊은남성과여성을대상으로한연구에서 NWO군이다른군보다평균중성지질농도와공복혈당이높았다. 또한여성만을대상으로한연구 [26] 에서마른비만군에서혈중총콜레스테롤농도가정상군보다높았다. 비만은고혈압, 당뇨병, 심혈관질환등많은성인병과관련이있는것으로밝혀졌으나 [42, 43], 마른비만역시외형상정상체중으로보여건강상문제가없어보이나정상체중보다더많은죽상경화증을가질수있고 [6], 대사증후군에걸릴확률이높아지며 [28] 장기간에걸쳐심혈관계사망률이나이환율을높일수있다 [44]. 따라서최근증가하고있는마른비만젊은여성을대상으 로한연구가지속적으로이루어져서외형상비만이아니더라도식습관및신체활동에따른몸의체구성의변화로인해잠재적인질병의위험성이있다는사실을젊은여성에게일깨워줌으로써경각심을고취시킬필요가있다. 또한마른비만군은해조류섭취빈도가낮고카페인음료, 기름지거나맵고짠음식을비교적자주섭취하는것으로나타나영양교육과상담을통하여올바른식행동으로개선되는것이바람직해보인다. 요약및결론 본연구는만 19~25 세여대생을대상으로체질량지수 (BMI) 와체지방률기준에따라네집단즉저체중군, 정상군, 마른비만군, 비만군으로분류하여이들의신체계측자료, 식행동및식품섭취빈도, 혈액생화학적검사결과를비교 분석하고자실시하였다. 특히최근에증가하고있는마른비만군에서건강위험요인이무엇인지파악하고자하였다. 연구결과를요약하면다음과같다. 1) 본연구에참여한대상자는평균 20.2 세의여대생으로평균 BMI는 20.4kg/m 2 이었다. BMI, 체지방량, 체지방률, 허리둘레율, 내장지방면적의평균은비만군이유의적으로가장높았고 (p<0.05), 마른비만, 정상, 저체중순이었다. 제지방량과근육량의평균도비만군이유의적으로가장높았다 (p<0.05). 골격근량의경우비만군이가장많고, 정상군, 마른비만군, 저체중군순으로군간에유의적인차이가있었다 (p<0.05). 2) 대부분의여대생은체중감량을시도해본적이있으며현재건강상태가건강한편이라고생각하고있었다. 그러나정상군은건강해졌다고생각하는여대생의비율이높은반면, 마른비만군은건강이많이안좋아졌다고생각하는비율이유의적으로높았다 (p<0.05). 3) 식행동조사결과저체중과정상군은적당하게먹는다고응답한비율이높았으나마른비만과비만군은배부르게먹는편이라고응답한비율이유의적으로높았다 (p<0.05). 식사속도는비만군이빠르게먹는비율이다른군들보다유의적으로높았고그다음마른비만군의순서였다 (p<0.001). 야식섭취는정상군은거의먹지않는다고응답하였으나나머지군들은일주일에 1-2회섭취하는경우가가장많았고저체중군은오후 9시이후에야식을섭취하는비율이유의적으로높은반면, 정상군은오후 7-8시에섭취하는비율이다른세군에비해유의적으로높았다 (p<0.05). 4) 식품섭취빈도조사결과해조류의섭취빈도가마른비만군이낮았고정상군은높았다. 지방이많은육류의섭취빈

442 마른비만여대생의식행동및혈액임상지표 도는비만군에서다른세군보다자주섭취하는것으로나타났다. 커피, 에너지드링크등카페인음료섭취빈도는마른비만군에서매일섭취하는대상자의비율이다른세군보다유의적으로높았다 (p<0.01). 5) 여대생의혈액생화학적임상지표대부분의평균값은모두정상범위에속하였다. 공복혈당의경우군간의유의적인차이는없었으나중성지질과총콜레스테롤은비만군에서만유의적으로높았다 (p<0.05). GPT 평균값이비만군에서유의적으로높았고 (p<0.05) BUN 평균값이마른비만군에서유의적으로가장높았다 (p<0.05). 이상의결과에서비만군이신체계측치나식행동, 생화학적임상지표등에서여전히가장문제가많은것으로나타났다. 마른비만군은아직크게혈액임상지표는나쁘지않다. 그러나마른비만군이바람직하지않은식행동을계속유지한다면노후에대사증후군이나심혈관질환등의문제를야기할수도있어이들대상의올바른다이어트방법과적절한식습관교육이필요할것으로보인다. 또한마른비만과식생활및건강과의관련성을체계적으로연구하기위해서는더많은연구대상자를이용한추적연구나종단적연구가필요하다고생각된다. References 1. World Health Organization. Overweight and obesity. Geneva: World Health Organization; 2017. 2. Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis 2014; 56(4): 426-433. 3. Franco LP, Morais CC, Cominetti C. -weight obesity syndrome: Diagnosis, prevalence, and clinical implications. Nutr Rev 2016; 74(9): 558-570. 4. Burkhauser RV, Cawley J. Beyond BMI: The value of more accurate measures of fatness and obesity in social science research. J Health Econ 2008; 27(2): 519-529. 5. Ko JH, Kim KJ. Comparison of body composition according to the obesity types based upon percent body fat, BMI and waist circumference in women. Korean J Growth Dev 2007; 15(1): 1-7. 6. Lorenzo A, Martinoli R, Vaia F, Di Renzo L. weight obese (NWO) women: An evaluation of a candidate new syndrome. Nutr Metab Cardiovasc Dis 2006; 16(8): 513-523. 7. Kim MK, Han KD, Kwon HS, Song KH, Yim HW, Lee WC et al. weight obesity in Korean adults. Clin Endocrinol 2014; 80(2): 214-220. 8. Chaung SK. Body mass index and waist circumference for screening obesity in young adult women. J Korean Acad Fundam Nurs 2009; 16(1): 14-20. 9. Dalton M, Cameron A, Zimmet P, Shaw J, Jolley D, Dunstan D et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med 2003; 254(6): 555-563. 10. Han JH, Kim SM. Relationship between percent body fat and cardiovascular risk factors for normal weight adults. J Korean Acad Fam Med 2006; 27(5): 352-357. 11. Ito H, Nakasuga K, Ohshima A, Sakai Y, Maruyama T, Kaji Y et al. Excess accumulation of body fat is related to dyslipidemia in normal-weight subjects. Int J Obes Relat Metab Disrod 2004; 28(2): 242-247. 12. Kishimoto N, Okita K, Takada S, Sakuma I, Saijo Y, Chiba H et al. Lipoprotein metabolism, insulin resistance, and adipocytokine levels in Japanese female adolescents with a normal body mass index and high body fat mass. Circ J 2009; 73(3): 534-539. 13. Tanaka S, Togashi K, Rankinen T, PErusse L, Leon AS, Rao DC et al. Is adiposity at normal body weight relevant for cardiovascular disease risk? Int J Obes Relat Metab Dsord 2002; 26(2): 176. 14. Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J et al. weight obesity: A risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 2009; 31(6): 737-746. 15. Ruderman NB, Schneider SH, Berchtold P. The "metabolicallyobese," normal-weight individual. Am J Clin Nutr 1981; 34(8); 1617-1621. 16. Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited. Diabetes 1998; 47(5): 699-713. 17. Lee KY. Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: Characteristics and health behaviors. Asia Pac J Clin Nutr 2009; 18(2): 280-284. 18. Min SH, Oh HS, Kim JH. Dietary behaviors and perceived stress of university students. Korean J Food Culture 2004; 19(2): 158-169. 19. Kim YM, Kim MH. A study of the osteoporosis-related lifestyle and health promotion behavior of university and college female student. J Rheumatol 2002; 9(1): 53-67. 20. Ministry of Health &Welfare, Korea Centers for Disease Control and Prevention. Korean National Health and Nutrition Examination survey 2016. Sejong: Ministry of Health &Welfare; 2017. 21. Di Renzo L, Galvano F, Orlandi C, Bianchi A, Di Giacomo C, La Fauci L et al. Oxidative stress in normal-weight obese syndrome. 2010; 18(11): 2125-2130. 22. Dvorak RV, DeNino WF, Ades PA, Poehlman ET. Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women. Diabetes 1999; 48(11): 2210-2214. 23. Choi KS, Shin KO, Huh SM, Chung KH. Analysis of dietary habits by MDA (mini dietary assessment) score and physical development and blood parameters in female college students in Seoul area. J East Asian Soc Dietary Life 2009; 19(6): 856-868. 24. Yoo JH, Jo HS. The effects of a compound exercise and a walking exercise program on body composition, perceived health status, and stress for thin-obesity college women. J Korean Soc Health Educ Promot 2009; 26(4): 91-103. 25. Sim SJ, Park HS. The cut-off values of body fat to identify cardiovascular risk among Korean adults. J Obes Metab Syndr

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