ISSN 1229-8565 (print) 한국지역사회생활과학회지 Korean J Community Living Sci http://dx.doi.org/10.7856/kjcls.2016.27.4.875 ISSN 2287-5190 (on-line) 27(4): 875~889, 2016 27(4): 875~889, 2016 아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 권용석ㆍ김양숙 ㆍ안은미ㆍ강현주ㆍ박영희ㆍ김영농촌진흥청국립농업과학원 Dietary Assessment and Factors Related to Prevalence of Metabolic Syndrome in Korean Youth: Based on the Korea National Health and Nutrition Examination Survey 2007~2013 Yong-Suk Kwon Yangsuk Kim Eun-Mi Ahn Hyun Ju Kang Young-Hee Park Young Kim National Institute of Agricultural Science, Rural Development Administration, Wanju, Korea 1) ABSTRACT The aim of this study was to assess a dietary status and to examine the factors related to the prevalence of metabolic syndrome in Korean children and adolescents. For this study, 5,576 subjects aged 10~18 years, who participated in the health and dietary intake survey (24h recall method) of the 2007~2013 Korea National Health and Nutrition Examination Survey (KNHANES), were sampled. The five components for the diagnosis of metabolic syndrome in the subjects were taken from the modified NCEP-ATP III. The total prevalence of metabolic syndrome among the subjects was 4.6%. The total prevalences of the metabolic syndrome components among the subjects were central obesity 8.4%, hypertriglyceridemia 18.8%, low HDL-cholesterol 13.4%, hypertension 22.4%, and hyperglycemia 5.2%. The gender, age, weight status, frequency of daily meals and eating-out frequency of subjects affected the prevalence of metabolic syndrome. Based on these results, There should be to improve the dietary guidelines and nutrition education to decrease the prevalence of metabolic syndrome for Korean children and adolescents. Key words: child, adolescent, metabolic syndrome, dietary assessment, KNHANES This study was supported by the grant from the Cooperative Research Program for Agriculture Science & Technology Development (no. PJ01142702), Rural Development Administration, Republic of Korea. Received: 17 October, 2016 Revised: 16 November, 2016 Accepted: 23 November, 2016 Corresponding Author: Yangsuk Kim Tel: +82-63-238-3578 E-mail: kagatha@korea.kr 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.
876 한국지역사회생활과학회지제 27 권 4 호 2016 I. 서론 대사증후군 (metabolic syndrome) 은복부비만, 이상지혈증, 고혈압및당뇨등과같은대사이상들이서로군집을이루는질환을말하며 (Isomaa et al. 2001; Park et al. 2006; Lutsey et al. 2008), 공복혈당장애, 복부비만, 이상지혈증, 저HDL 혈증및혈압상승중 3가지이상을가지고있으면대사증후군으로판정한다 (Kim et al. 2016). 이러한대사증후군을일으키는원인에대해서는아직까지완전하게밝혀지지않았지만, 잘못된식습관이주된영향요인으로보고되었다 (Carnethon et al. 2004; Lobstein et al. 2004; Kim & Jo 2011; Han et al. 2014). 그러나최근들어청소년기의비만을포함한대사이상현상이여러나라에서빠른속도로증가하는것으로보고되었다 (Lobstein et al. 2004; Back 2008). 이러한청소년기대사이상의원인으로는서구화된식생활의유입, 맞벌이부부의증가, 매식의증가로인한식습관의변화및학업의과중으로인한신체활동의감소가그원인으로지적되고있다 (Kwon & Kim 2015; Yu & Song 2015). 또한, 청소년이하세대의대사이상으로인한대사증후군은성인기까지만성질병및다양한합병증으로이어질수있는위험성을내포하고있으며 (Back 2008; Kim 2012; Yu & Song 2015), 이시기에대사증후군과관련된대사이상요인의수가적으면성인기에대사증후군의유병률이낮은것으로보고되었다 (Chen et al. 2005). 그러므로아동및청소년기의대사증후군관련요인은성인기의질병과관련이높아이에대한예방이필요할것 (Nam & Choi 2014) 으로보인다. 대사증후군과관련된요인을파악하고개선하기위한방안및아동, 청소년기의올바른식습관형성을위해서는이에영향을미치는요인들을분석하는것이필요할것으로생각된다. 현재까지수행된아동및청소년관련대사증후군관련연구들을살펴보면대사증후군패턴과식이요인과의연관성을연구한 Yu & Song(2015) 의연구가보고되었고, Kwon et al.(2013) 의연구에서는어머니의대사증후군여부에따라청소년자녀의대사위험지표및식생활요인에대한연구를수행하였다. 또한, Nam & Choi(2014) 의연구에서는아동및청소년을대상으로대사증후군및대사이상지표의분포와영양소섭취를성별, 연령및비만여부에따라분석하였고, Han et al.(2014) 의연구에서는 1998~2009 년국민건강영양조사자료를이용하여청소년의고탄수화물식사와고지방식사가대사증후군위험요인에미치는영향을조사한것으로보고되었다. 그러나아직까지아동및청소년을대상으로대사증후군유병여부에따라식습관및관련된영향요인에대해분석한연구는성인을대상으로한연구 (Song et al. 2015) 를제외하고는거의진행되지않은것으로나타났다. 따라서본연구에서는 2007~2013 국민건강영양조사자료를활용하여만 10~18 세아동및청소년들의대사증후군유병여부에따라일반적사항및식생활양상의차이를분석하고자한다. 또한, 대사증후군유병률에영향을주는요인에대해서도분석하고자한다. 이를통해아동및청소년들의식생활개선을위한가이드라인및식생활교육관련자료개발을위한기초를제공하고자한다. Ⅱ. 연구방법 1. 조사대상자및항목본연구는 2007~2013 년실시한국민건강영양조사 (KNHANES; Korea National Health And Nutrition Examination Survey) 원시자료를이용하였다. 이들자료의조사대상자들가운데검진조사및건강설문조사중대사증후군유병관련검진및설문에모두참여하였고, 식생활조사및식이섭취조사 (24 시간회상법 ) 역시참여한만 7~18 세대상자 8,177 명을 1 차대상자로선정하였다. 다시 2차대상자는한국청소년의대사증후군에대해연구한 Ko et al.(2013) 과 Yu & Song(2015) 의연구를토대로만 10~18 세아동
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 877 및청소년을대상으로하였다. 이중 1일섭취한총열량이 500 kcal 미만이거나 5,000 kcal 를이상인경우를제외한최종조사대상자는총 5,776 명이었다. 본연구에활용된국민건강영양조사는질병관리본부연구윤리심의위원회승인 (2007-02CON-04-P, 2008-04EXP-01-C, 2009-01CON-03-2C, 2010-02CON-21-C, 2011-02CON-06-C, 2012-01EXP-01-2C, 2013-07CON- 03-4C) 을받아수행하였다. 2. 일반적사항조사대상자의일반적인사항으로는성별, 연령, 가구소득, 거주지역및스트레스여부를분석하였다. 이중거주지역은도시및읍면지역으로분류하였고, 연령은 Ko et al.(2013) 의연구와같이 10-14 세와 15-18 세로나누었다. 가구소득은소득사분위수 ( 변수명 : Ho_incm) 문항을이용하여하, 중하, 중상, 상으로분류하였다. 스트레스여부 ( 만 12 세이상의대상자를설문한문항 ) 역시국민건강영양조사의문항분류를그대로이용하였다. 비만관련사항은대한소아과학회에서제공하는한국소아 청소년표준성장도표를활용하여성별에따른연령별 BMI 백분위수를산출하여적용하였다 (Moon et al. 2008). BMI 백분위수가 85 백분위수미만인경우에는보통 / 저체중으로, 85 백분위수이상 95 백분위수미만은과체중으로, 95 백분위수이상인경우비만으로판정하였다. 3. 식생활관련사항식생활관련사항은끼니, 간식섭취여부, 1일섭취끼니횟수, 외식횟수및식품안정성여부를분석하였다. 이중끼니 ( 아침, 점심, 저녁 ) 와간식섭취여부는끼니변수 ( 변수명 : N_meal) 를이용하여섭취자와비섭취자로분류하였고, 주당외식횟수는외식여부변수 [ 변수명 : l_out_fq, 매식 ( 배달음식, 포장음식포함 ), 급식, 종교단체등의제공음식포함 ] 를이용하여 하루 1회이상, 주 1~6 회, 월 1~3 회 ', ' 거의 안함 ' 으로분류하였다. 가정식섭취횟수는매식여부변수를이용하여분류하였다. 식품안정성여부는국민건강영양조사의식생활조사항목에서 다음중지난 1년동안귀댁의식생활형편을가장잘나타낸것은어느것입니까 라는문항을선행연구 (Shim et al. 2008; Lee et al. 2015) 들을이용하여다음과같이분류하였다. 우리식구모두가원하는만큼의충분한양과다양한종류의음식을먹을수있었다 는 enough food secure 그룹으로분류하였다. 우리식구모두가충분한양의음식을먹을수있었으나다양한종류의음식을먹지못했다 는 mildly food insecure 그룹으로, 경제적으로어려워서가끔먹을것이부족했다 와 경제적으로어려워서자주먹을것이부족했다 는 moderately/severely food insecure 그룹으로분류하여분석에이용하였다. 4. 아동및청소년의대사증후군진단기준본연구에활용된아동및청소년의대사증후군진단기준은선행연구 (Ko et al. 2013; Nam & Choi 2014; Yu & Song 2015) 들과같이 Cook et al.(2003) 과 Ford et al.(2005) 이미국의국립콜레스테롤교육프로그램 (National Cholesterol Education Program, NCEP) 의성인치료패널 (Adult Treatment Panel, ATP) Ⅲ 기준을변형한 Modified NCEP-ATP Ⅲ 기준을이용하였다. 공복혈당기준은 100 mg/dl 이상, 복부비만은대한소아과학회에서제공하는한국소아 청소년표준성장도표를활용하여성별및연령 90 백분위수이상을이용하였고 (Moon et al. 2008), 혈압기준은 2007 년소아청소년정상혈압기준치 (Lee et al. 2008) 를활용하여성별, 연령및신장 90 백분위수이상을사용하였다. 중성지방기준은 110 mg/dl 이상, HDL- 콜레스테롤기준은 40 mg/dl 이하로사용하였다. 이들 5가지기준중 3가지이상에해당되면대사증후군유병그룹으로, 3가지미만이면정상그룹으로분류하였다.
878 한국지역사회생활과학회지제 27 권 4 호 2016 5. 식품 / 영양소섭취량식품섭취량은식품코드 ( 변수명 : n_fcode2) 를이용하여총 18가지식품으로분류하였다. 영양소섭취량역시식이섭취조사 (24 시간회상법 ) 에수록된조사대상자의영양소섭취량을이용하였으며, 모든섭취자료는개인별로 1일식품및영양소섭취량변수를통합하여분석에활용하였다. 에대한유의성검정은일반선형모형 (general linear model) 을이용하였고, 성별, 연령및에너지섭취량을보정변수로이용하였다. 또한, 대사증후군유병여부에영향을미치는일반적사항과식생활요인을살펴보기위해다중로지스틱회귀분석 (multiple logistic regression analysis) 을실시하였다. 이때보정변수로에너지섭취량을이용하였다. 6. 통계분석국민건강영양조사자료는단순랜덤추출자료가아닌층화다단확률추출에의한자료이므로가중치 (Weight), 층화변수 (KSTRATA), 집락변수 (PSU: Primary Sampling Unit) 를포함하여분석하였다. 모든분석은 SUDAAN ver 10.01 프로그램을이용하였다. 연령별대사증후군유병여부에따른일반적인사항과끼니의섭취유무, 간식섭취, 가정식섭취빈도및주당외식횟수와같은범주형변수는빈도분석을실시하여빈도와가중치가고려된백분율 (Weighted %) 로나타냈고, 유의성검정은 χ 2 검정을실시하였다. 대사증후군의구성요소, 즉혈중콜레스테롤, 중성지방, 이완기및수축기혈압, 저밀도지단백질, 체질량지수, 허리둘레등과연령및 1일섭취끼니횟수및식품 / 영양소섭취량은기술통계분석을실시하여평균과표준오차로나타냈다. 이에대한유의성검정은 t-test 를실시하였고, 식품 / 영양소섭취 Ⅲ. 결과및고찰 1. 조사대상자의연령별체질량지수및대사증후군관련생화학지표조사대상자의연령별체질량지수및대사증후군관련생화학지표에대한사항은 Table 1과같다. 체질량지수는연령에따라 10-14 세는 19.7 kg/m 2, 15-18 세는 21.5 kg/m 2 로나타났고, 평균허리둘레는 10-14 세, 15-18 세각각 66.6 cm, 71.9 cm 로나타났으며, 체질량지수와허리둘레는모두유의적인차이를보였다 (p<0.001). 대사증후군관련생화학지표중첫번째로평균수축기혈압이 10-14 세, 15-18 세각각 102.3 mmhg, 106.5 mmhg 이었고, 평균이완기혈압은각각 62.7 mmhg, 68.0 mmhg 로수축기, 이완기혈압모두유의적이었다 (p<0.001). 중성지방은연령에따라 10-14 세는 87.6 mg/dl, 15-18 세는 84.8 mg/dl 로나타났고, 평균콜레스테롤은연령 Table 1. Components of metabolic syndrome in the study subjects Total (n=5,776) 10~14y (n=3,794) 15~18y (n=1,982) Mean SE Mean SE Mean SE p-value 1) Body mass index (kg/m 2 ) 20.5 0.1 19.7 0.1 21.5 0.1 <0.0001 Waist circumference (cm) 69.1 0.2 66.6 0.2 71.9 0.3 <0.0001 Fasting blood glucose (mg/dl) 89.2 0.2 90.6 0.2 87.8 0.2 <0.0001 Cholesterol (mg/dl) 157.8 0.5 160.3 0.6 155.3 0.8 <0.0001 Triglycerides (mg/dl) 86.2 1.0 87.6 1.3 84.8 1.3 0.1104 High-density lipoprotein (mg/dl) 49.8 0.2 50.6 0.2 49.0 0.3 <0.0001 Systolic blood pressure (mmhg) 104.2 0.3 102.3 0.3 106.5 0.4 <0.0001 Diastolic blood pressure (mmhg) 65.1 0.2 62.7 0.3 68.0 0.3 <0.0001 1) p-value by t-test
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 879 Table 2. Prevalence of metabolic syndrome components in the study subjects Total (n=5,776) 10~14y (n=3,794) 15~18y (n=1,982) n % 1) n % n % Prevalence of metabolic syndrome components 2) Abdominal obesity 471 8.4 294 7.6 177 9.3 Hypertriglyceridemia 1093 18.8 737 19.6 356 17.9 Low HDL cholesterolemia 754 13.4 445 11.9 309 15.2 Hyperglycemia 297 5.2 226 6.5 71 3.7 Hypertension 1183 22.4 686 19.2 497 26.1 Prevalence of metabolic syndrome Non-metabolic syndrome ( 2) 5541 95.4 3655 95.8 1886 94.9 Metabolic syndrome ( 3) 235 4.6 139 4.2 96 5.1 1) Weighted % 2) Abdominal obesity- Waist circumference 90 th percentile for gender and age; Hyperglycemia- Fasting blood glucose 100 mg/dl; Hypertriglyceridemia- Triglycerides 110 mg/dl; Low HDL cholesterolemia- High-density lipoprotein 40 mg/dl; Hypertension- Systolic or Diastolic blood pressure 90th percentile for gender, age and height 별로각각 160.3 mg/dl, 155.3 mg/dl 로나타났고, HDL 콜레스테롤은연령별로각각 50.6 mg/dl, 49.0 mg/dl 나타났다. 마지막으로공복혈당은 10-14 세, 15-18 세각각 90.6 mg/dl, 87.8 mg/dl 의수치를보였다. 2. 연령별대사이상지표및대사증후군유병률분포대사이상지표및대사증후군유병률분포에대한결과는 Table 2에나타냈다. Ko et al.(2013) 의연구와같이 10-14 세, 15-18 세로나누어서대사이상지표의분포를분석한결과연령별복부비만은전체의경우 8.4%, 10-14 세, 15-18 세는각각 7.6%, 9.3% 로나타났다. 고중성지방혈증은전체조사대상자가 18.8%, 연령별로는각각 19.6%, 17.9% 로 10-14 세에비해 15-18 세가약 1.7% 낮았다. 저HDL- 콜레스테롤혈증은전체조사대상자가 13.4%, 연령별로각각 11.9%, 15.2% 로나타났으며, 공복혈당장애분포는다른대사이상지표보다낮은비율인 5.2%( 전체 ) 로나타났다. 연령별로는각각 6.5%, 3.7% 였다. 고혈압분포는전체조사대상자가 22.4%, 연령별로는각각 19.2%, 26.1% 로나타났다. 대사이상지표중 3가지이상이해당되는대사증후군의유병률은전체조사 대상자가 4.6%, 10-14 세연령은 4.2%, 15-18 세는 5.1% 로 15-18 세연령이약 0.9% 높은수치로나타났다. 선행연구들의결과를살펴보면 Cook et al.(2003) 에의해수정된 NCEP-ATP III 기준을활용하여국민건강영양조사제II 기 (2001) 10-19 세아동및청소년들을연구한결과에서전체대사증후군유병률은 7.1% 였다 (Seo et al. 2006). 동일한기준을활용하여제IV 기 1차 (2007), 2차 (2008) 국민건강영양조사의만 10-18 세연령의대사증후군유병률을분석한 Ko et al.(2014) 의연구에서는남성전체는 4.7%, 여성전체는 4.3% 로보고되었다. Ford et al.(2005) 의변형된기준을활용한국민건강영양조사제IV 기 2차 (2008) 의 10-18 세아동및청소년대상자를중심으로연구한 Nam & Choi(2014) 의연구에서는전체대상자의대사증후군유병률이 5.8% 였으며, 연령별대사증후군유병률은 10-11 세는 9.8%, 12-14 세는 3.9%, 15-18 세는 5.0% 로나타났다. 또한, International Diabetes Federation (IDF) 기준을이용하여제I 기 (1998) 부터제IV 기 1차 (2007) 까지국민건강영양조사의 10-19 세소아청소년의대사증후군유병률을분석한 Huh(2010) 의연구에서는 1998 년 3.0%, 2001 년 5.3%, 2005 년 2.4%, 2007 년 4.2% 였으며, 동일한기준을활용하여제IV 기 (2007-2009) 부터
880 한국지역사회생활과학회지제 27 권 4 호 2016 제V 기 1차 (2010) 국민건강영양조사자료의아동및청소년대상자를분석한 Jin(2013) 의연구에서는 2007 년 3.1%, 2008 년 1.2%, 2009 년 1.3%, 2010 년 1.0% 인것으로보고되었다. 본연구의결과와아동및청소년의대사증후군유병률을연구한선행연구모두 10% 이하의유병률을보였으나연구에따라조 금씩차이를보이고있는데이는연구에활용된대사증후군의진단기준의차이에기인된것으로사료된다. 추후성인들의대사증후군판정기준인 NCEP- ATP III 기준과같이아동및청소년의통일된기준이마련되어보다심도있는연구가수행되어야할것으로사료된다. Table 3. Prevalence of metabolic syndrome according to general characteristics of study subjects Variables Total (n=5,776) With 1) (n=235) Without 1) (n=5,541) p- value 3) 10~14y (n=3,794) With 1) (n=139) Without 1) (n=3,655) p- value 3) 15~18y (n=1,982) With 1) (n=96) Without 1) (n=1,886) n % 2) n % n % n % n % n % Total 235 4.6 5541 95.4-139 4.2 3655 95.8-96 5.1 1886 94.9 - p- value 3) Age (Mean, SE) 14.3 0.2 14.0 0.04 0.1441 4) 12.2 0.1 11.9 0.03 0.1407 4) 16.3 0.1 16.4 0.03 0.3542 4) Gender (%) Boy 146 63.4 2885 52.9 0.0082 79 56.9 1930 52.4 0.3577 67 69.4 955 53.5 0.0109 Girl 89 36.6 2656 47.1 60 43.1 1725 47.6 29 30.6 931 46.5 Region (%) City 191 85.7 4594 83.2 0.3709 110 82.7 3031 83.6 0.8152 81 88.5 1563 82.8 0.1212 Rural area 44 14.3 947 16.8 29 17.4 624 16.4 15 11.5 323 17.2 Household income (%) Low 30 14.4 624 13.2 13 9.0 370 11.7 17 19.5 254 14.9 Middle-low 63 26.2 1360 27.4 0.9553 42 28.8 890 27.0 0.7514 21 23.8 470 27.8 0.7040 Middle-high 65 30.0 1752 30.8 41 31.7 1197 32.6 24 28.3 555 28.8 High 75 29.4 1725 28.6 42 30.5 1146 28.7 33 28.4 579 28.5 Mother's education level (%) Middle school 17 8.2 251 6.9 10 6.0 111 4.2 7 10.2 140 10.0 0.2637 0.2354 0.8281 High school 76 44.1 1614 38.4 43 41.9 994 35.1 33 46.1 620 42.3 College 114 47.8 2949 54.7 70 52.1 2092 60.7 44 43.7 857 47.7 Stress status (%) 5) Feel it very much 10 4.4 142 3.9 7 9.5 66 3.4 3 1.7 76 4.3 Feel a lot 37 23.5 873 22.7 0.9802 16 19.0 429 20.5 0.4147 21 26.0 444 24.2 0.5611 Feel a little 98 57.3 2290 57.8 39 50.5 1203 57.7 59 61.0 1087 57.9 Do not feel much 31 14.7 628 15.5 18 21.0 375 18.4 13 11.3 253 13.6 Weight status (%) Normal (BMI < 85 th ) 76 33.3 4802 87.1 43 37.0 3158 86.8 33 30.0 1644 87.3 Over weight (85 th BMI < 95 th ) <.0001 <.0001 <.0001 78 32.4 512 9.4 43 26.4 339 9.3 35 38.0 173 9.5 Obesity (BMI 95 th ) 81 34.2 211 3.6 53 36.6 149 3.9 28 32.0 62 3.2 Sleeping hours (Mean, SE) 7.2 0.1 7.3 0.03 0.1277 4) 8.0 0.1 7.8 0.03 0.3991 4) 6.7 0.2 6.8 0.04 0.8566 4) 1) With: Metabolic Syndrome Group, Without: Normal (Non-Metabolic Syndrome) Group, 2) Weighted %, 3) p-value by chi-square test, 4) p-value by t-test, 5) Age under the 12y didn t take part in this survey
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 881 Table 4. Prevalence of metabolic syndrome according to dietary behavior of study subjects Variables Daily meal Breakfast Total (n=5,776) With 1) (n=235) Without 1) (n=5,541) p- value 3) 10~14y (n=3,794) With 1) (n=139) Without 1) (n=3,655) p- value 2) 15~18y (n=1,982) With 1) (n=96) Without 1) (n=1,886) n % 2) n % n % n % n % n % p- value 2) Eaten 173 71.9 4265 73.8 0.5929 110 78.2 2999 80.6 0.5109 63 66.1 1266 66.0 0.9826 Skipped 62 28.1 1276 26.2 29 21.8 656 19.4 33 33.9 620 34.0 Lunch Eaten 223 92.8 5226 93.4 0.7936 137 98.8 3481 95.0 0.3540 86 87.2 1745 91.5 0.2472 Skipped 12 7.2 315 6.6 2 1.2 174 5.0 10 12.8 141 8.5 Dinner Eaten 219 92.0 5245 94.2 0.3406 135 97.5 3513 96.1 0.5202 84 87.0 1732 92.1 0.1345 Skipped 16 8.0 296 5.8 4 2.5 142 3.9 12 13.0 154 7.9 Frequency of daily meal 1/day 12 7.0 186 4.3 1 1.0 72 2.2 11 12.5 114 6.7 2/day 66 29.3 1511 29.8 0.2995 33 23.7 828 23.9 0.6576 33 34.6 683 36.6 0.1724 3/day 157 63.7 3844 65.9 105 75.4 2755 73.9 52 52.9 1089 56.7 Average (Mean, SE) 2.6 0.1 2.6 0.01 0.3462 4) 2.7 0.04 2.7 0.01 0.6644 4) 2.4 0.08 2.5 0.02 0.2575 4) Snack Yes 215 90.2 5075 91.4 0.6084 131 92.6 3388 92.7 0.9854 84 87.9 1687 90.0 0.5896 No 20 9.8 466 8.6 8 7.4 267 7.3 12 12.1 199 10.0 Food insecurity Enough food secure 99 42.5 2371 41.3 Mildly food insecure Moderately/Severely food insecure 58 41.1 1629 43.3 41 43.7 742 39.0 124 51.6 2879 53.3 77 55.2 1864 51.8 47 48.3 1015 54.9 0.2159 0.4586 0.0028 12 6.0 267 5.4 4 3.8 154 4.9 8 7.9 113 6.1 Frequency of home meal per day by 24 h-recall Not eating 21 10.0 554 11.6 8 5.6 239 6.8 13 14.2 315 17.0 1/day 78 36.7 1763 34.1 0.7503 35 29.0 981 27.7 0.9436 43 43.8 782 41.5 0.792 2/day 105 40.6 2537 43.1 76 50.8 1915 51.9 29 31.1 622 33.1 3/day 31 12.6 683 11.1 20 14.6 520 13.6 11 10.9 163 8.3 Frequency of eating-out per week 5) 1/day 61 28.0 1716 34.7 20 16.7 755 21.1 41 38.6 961 50.3 1~6 times a week 166 66.8 3731 63.6 0.0604 115 79.5 2865 78.2 0.1966 51 55.1 866 46.8 0.1215 <1/week 8 5.1 78 1.7 4 3.8 29 0.7 4 6.4 49 2.9 1) With: Metabolic Syndrome Group, Without: Normal (Non-Metabolic Syndrome) Group, 2) Weighted %, 3) p-value by chi-square test, 4) p-value by t-test, 5) Including meal prepared in institutional foodservice
882 한국지역사회생활과학회지제 27 권 4 호 2016 3. 조사대상자의연령및대사증후군유병여부에따른일반적사항조사대상자의연령및대사증후군유병여부에따른일반적사항에대한내용은 Table 3에제시하였다. 평균연령, 거주지역, 교육여부, 가구소득, 어머니의교육수준, 스트레스여부및수면시간등의대부분일반적사항에서유의적인차이가나타나지않았다 ( 성별분포및전체및모든연령대의비만여부를제외 ). 이중통계적으로유의적인차이가있는성별을살펴보면전체대상자대사증후군유병그룹은남성이 63.4% 여성은 36.6% 로남성이여성에비해약 26.8% 정도높았으며, 정상그룹은남성이 52.9%, 여성이 47.1% 로대사증후군유병그룹에비해차이가크지않은것으로나타났다 (p=0.0082). 10-14 세그룹은정상그룹과유병그룹간에남녀의비율이유의적인차이는없었고, 15-18 세연령의경우, 대사증후군유병그룹의남성은 69.4% 여성은 30.6% 로남성이약 38.8% 정도높은것으로나타났다. 그러나정상그룹의경우에는남성이 53.5%, 여성이 46.5% 로유병그룹에비해차이가크지않았다 (p=0.0109). 비만여부는전체및모든연령대에서유병여부에따라유의적인차이가있었으며 (p<0.001), 세부적으로살펴보면전체대상자의경우, 대사증후군유병그룹은비만, 과체중및보통 / 저체중그룹모두 32~35% 의비율을보였고, 정상그룹은보통 / 저체중은 87.1%, 과체중은 9.4%, 비만은 3.6% 의비율로나타났다. 10-14 세대상자는대사증후군유병그룹은비만, 과체중및보통 / 저체중그룹모두 26-37% 의비율을보였고, 정상그룹은보통 / 저체중은 86.8%, 과체중은 9.3%, 비만은 3.9% 의비율로나타났다. 마지막으로 15-18 세대상자는대사증후군유병그룹은비만, 과체중및정상 / 저체중모두 30~38% 의비율을보였고, 정상그룹의보통 / 저체중은 87.3%, 과체중은 9.5%, 비만은 3.2% 의비율로나타났다. 4. 연령및대사증후군유병여부에따른식생활관련사항연령및대사증후군유병여부에따른식생활관련사항은 Table 4에나타냈다. 식생활관련사항중 15-18 세의식품안정성에대한사항에서만유의적인차이가있었고 (p=0.0028), 그외에끼니여부, 끼니횟수, 간식여부, 가정식횟수, 주당외식횟수에대한사항의경우에는대사증후군여부에따라유의적인차이가없는것으로나타났다. 15-18 세에서통계적으로유의한식품안정성에대한사항을살펴보면전체조사대상자와 10-14 세연령에서 Enough food secure 은 41-44% 의비율을보였고, Mildly food insecure 은모든대상자에서 50-56%, Moderately/ Severely food insecure 은모두 10% 미만의비율을보였다. 15-18 세의경우에는대사증후군유병그룹의 Enough food secure 및 Mildly food insecure 에서 43-49% 의비율을보였고, Moderately/Severely food insecure 은 7.9% 의비율을보였다. 정상그룹의경우에는 Enough food secure (39%) 에비해 Mildly food insecure (54.9%) 에서약 15.9% 정도높은비율을보였다. 5. 영양소섭취량연령및대사증후군유병여부에따른영양소섭취량에대한사항은 Table 5에제시하였다. 에너지및다량영양소중단백질, 지방섭취량과미량영양소중칼슘, 비타민 C를제외한나머지영양소의경우에는전체대상자및모든연령에서대사증후군유병여부에따라유의적인차이가없는것으로나타났다. 첫번째로전체조사대상자의경우에는비타민 C 섭취량에서대사증후군유병여부에따라보정되지않은경우에유의적인차이가있었다 (Crude p-value= 0.0028). 두번째로 10-14 세연령은칼슘섭취량에서대사증후군유병여부에따라보정여부에관계없이유의적인차이가있었다 (Crude p-value=0.0338, Adjusted p-value=0.0042). 세번째로 15-18 세연령
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 883 은에너지 (Adjusted p-value=0.0056) 와단백질섭취량 (Adjusted p-value=0.0372) 의경우에는대사증후군유병여부에따라보정된경우에유의적인차이가있었으며, 지방섭취량은보정되지않은경우에유의적인차이가있었다 (Crude p-value=0.0292). 또한, 비타민 C 섭취량의경우에는보정여부에관계없이모두유의적인차이가있는것으로나타났다 ((Crude p-value=0.0091, Adjusted p-value=0.0390). 마지막으로나트륨의경우에는유의적인차이는없었으나전체대상자와모든연령에서 3,700-4,250 mg 사이의섭취량을보였다. 이는 2015 년에개정된한국인영양소섭취기준 (Ministry of Health and Welfare 2015) 과 World Health Organization(World Health Organization & Food and Agriculture Organization 2003) 의목표섭취량인 2,000 mg 에비해약 1.8-2.1 배정도높은것으로나타났다. 높은나트륨섭취와같은식습관은아동및청소년기에서성인기까지이어질수있고, 또한, 성인기의만성질병 (Cutler et al. 1997; Karppanen & Mervaala 2006; Strazzullo et al. 2009) 과도관련이있으므로나트륨저감화를위한식생활교육및가이드라인이필요할것으로사료된다. 6. 식품섭취량연령및대사증후군유병여부에따른식품섭취량에대한사항은 Table 6에나타냈다. 당류섭취량, 종실류 / 견과류섭취량, 과일섭취량, 육류섭취량, 유제품류섭취량및기타식품섭취량을제외한나머지식품섭취량의경우에는전체대상자및모든연령에서대사증후군유병여부에따라유의적인차이가없는것으로나타났다. 첫번째로전체대상자의경우에당류및과일류섭취량은성별및에너지섭취량으로보정되지않은경우에대사증후군유병여부에따라유의적인차이가있었으며 (Crude p-value <0.05). 종실류 / 견과류및기타식품섭취량의경우에는보정여부에관계없이대사증후군유병여부에따라유의적인차이가있었다 (Crude p-value<0.05, Adjusted p-value<0.05). 두번째로 10-14 세연령은 대사증후군유병여부에따라종실류 / 견과류, 과일류및유제품섭취량에서보정여부에관계없이유의적인차이가있었다 (Crude p-value<0.05, Adjusted p-value<0.01). 15-18 세의경우에는당류, 유제품류및기타식품섭취량에서대사증후군유병여부에따라보정되지않은경우에유의적인차이가있었다 (Crude p-value<0.05). 한편, 연령및대사증후군유병여부에따른식품섭취량에대한사항중채소및과일섭취량의경우전체대상자, 10-14 세및 15-18 세대상자모두대사증후군유병여부와관계없이채소및과일을합친총섭취량이 WHO(World Health Organization & Food and Agriculture Organization 2003) 및 WCRF (World Cancer Research Fund 2007) 의기준인 400g 이상보다낮은것으로나타났다. 이들식품섭취량중채소및과일을합친평균섭취량의경우, 2006, 2011 청소년건강행태온라인조사를수행한청소년들의채소및과일섭취를분석한 Kim et al.(2015) 의연구에서는청소년들의하루 1회이상채소및과일섭취빈도는 2006 년에비해 2011 년에김치가제외된채소는약 13% 정도, 주스가제외된과일은약 12% 정도감소하는것으로보고하였다. 또한, 제IV 기 (2007-2009) 부터제VI 기 1차 (2013) 까지국민건강영양조사의만 7-19 세아동및청소년을분석한 Kwon & Kim(2015) 의결과에서는아동및청소년의채소및과일섭취량이 400g 미만인것으로보고되었다. 선행연구와본연구의결과를토대로보았을때추후채소및과일섭취를증진시키기위한식생활교육이필요할것으로사료된다. 7. 대사증후군유병여부와관련된영향요인대사증후군유병여부와관련된영향요인에대한사항은 Table 7에제시하였다. 첫번째로전체조사대상자중성별의경우에는남성에비해여성의대사증후군확률은 55.8%(OR=0.442) 로감소하였으며 (p<0.01), 연령은 1세증가할때마다대사증후군
884 한국지역사회생활과학회지제 27 권 4 호 2016
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 885
886 한국지역사회생활과학회지제 27 권 4 호 2016 Table 7. Factors related to prevalence of metabolic syndrome in children and adolescents 1) Total 10~14y 15~18y Gender (Ref.=Boy) Girl 0.442( 0.273-0.716) 2),** 0.656(0.324-1.328) 0.338( 0.176-0.649) ** Age 1.136( 1.012-1.275) * 1.742(1.199-2.531) * 0.990( 0.797-1.231) Mother s education level (Ref.= Middle school or lower) High school graduate 1.347( 0.688-2.639) 1.032(0.372-2.858) 1.450( 0.585-3.591) College or higher 0.820( 0.443-1.516) 0.432(0.154-1.212) 1.106( 0.480-2.547) Household Income (Ref.= Low) Middle-low 0.673( 0.358-1.265) 1.417(0.449-4.472) 0.420( 0.176-1.000) Middle-high 0.582( 0.311-1.087) 0.893(0.235-3.394) 0.462( 0.195-1.095) High 0.724( 0.363-1.445) 1.175(0.369-3.747) 0.494 0.196 1.244 Weight status (Ref.= Normal or lower) Overweight 9.477( 5.854-15.343) *** 5.089(2.247-11.526) *** 12.158( 6.720-21.997) *** Obesity 20.954(12.412-35.377) *** 20.634(9.827-43.327) *** 22.480(10.249-49.310) *** Stress level (Ref.= Feel it very much) Feel a lot 0.784( 0.337-1.825) 0.554(0.169-1.823) 1.106( 0.299-4.096) Feel a little 0.901( 0.413-1.966) 0.457(0.137-1.524) 1.475( 0.441-4.934) Do not feel much 1.283( 0.514-3.205) 1.095(0.292-4.100) 1.622( 0.409-6.428) Sleeping hour 1.136( 0.973-1.327) 1.220(0.982-1.517) 1.142( 0.927-1.407) Breakfast (Ref.= Skipped) Eaten 0.967( 0.456-2.053) 0.272(0.071-1.034) 1.331( 0.404-4.387) Frequency of daily meal (Ref.= 3/day) 2/day 1.167( 0.589-2.312) 0.637(0.084-4.841) 1.157( 0.429-3.122) 1/day 2.189( 0.680-7.042) 1.078(0.303-3.836) 4.300( 1.077-17.169) ** Snack (Ref.= No) Yes 1.401( 0.693-2.831) 2.305(0.658-8.075) 1.235( 0.543-2.809) Food insecurity (Ref.= Enough food secure) Mildly food insecure 0.913( 0.594-1.403) 0.878(0.421-1.832) 0.944( 0.536-1.662) Moderately/Severely food insecure 0.998( 0.355-2.809) 0.977(0.231-4.132) 0.895( 0.201-3.987) Frequency of home meal per day by 24 h-recall (Ref.= Not eating) 1/day 1.574( 0.745-3.328) 2.354(0.482-11.496) 1.167( 0.448-3.043) 2/day 1.875( 0.866-4.058) 3.329(0.789-14.045) 1.180( 0.410-3.397) 3/day 1.733( 0.633-4.744) 1.324(0.223-7.866) 1.573( 0.466-5.307) Frequency of eating-out per week (Ref.= 1/day) 1~6 times a week 1.220( 0.768-1.937) 0.886(0.384-2.044) 1.309( 0.732-2.340) <1/week 1.744( 0.619-4.915) 6.070(1.599-23.045) ** 0.998( 0.243-4.101) 1) Adjusted for energy intake 2) Odd ratio (95% Confidence Interval) p<0.05, ** p<0.01, *** p<0.001 유병확률은 1.14 배 (OR=1.136) 증가하는것으로나 타났다 (p<0.05). 비만여부의경우에는보통 / 저체중 에비해과체중의대사증후군유병확률은 9.48 배 (OR=9.477) 증가하였고 (p<0.001), 비만은 20.95 배
아동및청소년의대사증후군유병여부에따른식생활평가및관련요인 : 2007~2013 국민건강영양조사자료를중심으로 887 (OR=20.954) 증가하는것으로나타났다 (p<0.001). 외식여부의경우에는하루 1회이상외식을하는경우에비해주 1회미만외식을하는경우에대사증후군유병확률이 6.07배 (OR=6.070) 증가하였다 (p<0.01). 마지막으로 15-18 세의연령중성별의경우, 남성에비해여성의대사증후군유병확률은 66.2%(OR=0.338) 감소한것으로나타났다 (p<0.01). 비만여부의경우에는보통 / 저체중에비해과체중의대사증후군유병확률은 12.16 배 (OR=12.158) 증가하였고 (p<0.001), 비만은 22.48 배 (OR=22.480) 증가하는것으로나타났다 (p<0.001). 끼니횟수의경우에는하루 3끼니모두섭취하는경우에비해하루 1끼니를섭취하는경우에대사증후군유병확률이약 4.3배 (OR=4.300) 증가하였다 (p<0.01). 전체적으로대사증후군유병여부와관련된영향요인결과들을종합해보면남성보다는여성이, 연령이증가할수록, 비만여부가과체중이상의경우에대사증후군의유병확률이높은것으로볼수있으며, 10-14 세연령에서는외식횟수의감소에따라대사증후군유병확률이증가하였다. 그러나선행연구들에서상업적외식의증가는지방과에너지섭취량이높아질수있으므로비만과같은만성질환의증가와관련이있는것으로보고되었다 (Binkely et al. 2000; Lin & Frazao 1997; Nielsen et al. 2002ab). 본연구의결과가선행연구결과와상이한것은주 1회미만외식횟수의경우모든집단에서 10% 미만의비율인것이하나의이유로생각된다. 또한, 국민건강영양조사에수록된외식횟수문항항목의경우에는단체급식을포함했기때문에이와같은결과가나타난것으로사료된다. 급식은선행연구 (Chung et al. 2006) 의결과에따르면대부분영양전문가에의해관리되고있는것이상업적외식과다른점중에하나이며, 가정식과상업적외식에서제공된식사보다영양학적으로우수한것으로보고되었다. 그러나조사대상자개개인의외식과급식에서제공된식사의이용횟수가정확히어느정도인지는본연구의결과로는알수없기때문에국민건 강영양조사와같은대규모조사의외식 / 급식설문문항의확장된개발이필요하며, 이를이용한연구의활성화역시필요할것으로생각된다. 또한, 끼니횟수의경우 3끼니를모두먹는경우에비해 1끼니를먹는 15-18 세연령에서유병확률이증가하였는데이는끼니를대신해서간식으로대체하는경우와제대로섭취하지못하는경우인것으로생각된다. 따라서아동및청소년을중심으로한끼니의중요성에대한연구들이앞으로더욱필요할것으로생각된다. Ⅳ. 요약및결론 본연구는만 10-18 세아동및청소년들의대사증후군유병여부에따라일반적사항및식생활양상의차이를분석하고, 유병률에영향을주는요인에대해서도조사하고자하였다. 본연구의주요결과를요약하면다음과같다. 대사증후군관련생화학지표중평균수축기혈압은 10-14 세, 15-18 세각각 102.3 mmhg, 106.5 mmhg 이었고, 평균이완기혈압은각각 62.7 mmhg, 68.0 mmhg 로수축기, 이완기혈압모두유의적인차이가있었다 (p<0.001). 중성지방은연령에따라 10-14 세는 87.6 mg/dl, 15-18 세는 84.8 mg/dl 로, 평균콜레스테롤는연령별로각각 160.3 mg/dl, 155.3 mg/dl, HDL 콜레스테롤은각각 50.6 mg/dl, 49.0 mg/dl 나타났다. 또한, 공복혈당은 10-14 세, 15-18 세각각 90.6 mg/dl, 87.8 mg/dl의수치를보였다. 대사이상지표및대사증후군유병률분포는연령별복부비만은각각 7.6%, 9.3% 로나타났다. 고중성지방혈증은 19.6%, 17.9% 로, 저HDL- 콜레스테롤혈증의경우에는연령별로각각 11.9%, 15.2% 로나타났으며, 공복혈당장애분포는다른대사이상지표보다낮은비율인 6.5%, 3.7% 였다. 고혈압분포는 19.2%, 26.1% 로나타났다. 이들대사이상지표중 3가지이상이해당되는대사증후군의유병률은전체조사대상자는 4.6%, 10-14 세는 4.2%, 15-18 세는 5.1%
888 한국지역사회생활과학회지제 27 권 4 호 2016 로 15-18 세연령이약 0.9% 높은수치로나타났다. 대사증후군유병여부와관련된영향요인에대한 사항에서는전체조사대상자와 15-18 세연령에서남 성에비해여성의대사증후군유병확률이감소하였 다. 전체조사대상자와 10-14 세에서연령이 1 세증 가할때마다대사증후군유병확률은증가하는것 으로나타났다. 모든조사대상자에서비만여부의 경우에는보통 / 저체중에비해과체중, 비만의대사 증후군유병확률은증가하였다. 또한, 10-14 세연령 에서는하루 1 회이상외식을하는경우에비해주 1 회미만외식을하는경우에대사증후군유병확률 이 6.07 배 (OR=6.070) 증가하였다. 15-18 세의경우, 끼니횟수에서하루 3 끼니모두섭취하는경우에비 해하루 1 끼니를섭취하는경우에대사증후군유병 확률이약 4,3 배 (OR=4.300) 증가하였다. 이러한결과들을토대로보았을때아동및청소 년을중심으로한대사증후군연구에있어서다양한 식생활변수들의개발을통해보다확장된연구가 더욱필요할것으로보이며, 앞으로의연구에서이 러한결과들을토대로대사증후군예방을위한식생 활교육및가이드라인구축이필요할것으로사료 된다. References Back S(2008) Do obese children exhibit distinguishable behaviors from normal weight children? - Based on literature review. Korean J Community Nutr 13(3), 386-395 Carnethon MR, Loria CM, Hill JO, Sidney S, Savage PJ, Liu K(2004) Coronary artery risk development in young adults study. Risk factors for the metabolic syndrome: the Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985-2001. Diabetes Care 27(11), 2707-2715 Chen W, Xu J, Srinivasan SR, Berenson GS, Li S(2005) Metabolic syndrome variables at low levels in childhood are beneficially associated with adulthood cardiovascular risk. Diabetes Care 28(1), 138-143 Chung SJ, Kang SH, Song SM, Ryu SH, Yoon J(2006) Nutritional quality of Korean adults' consumption of lunch prepared at home, commercial places, and institutions: analysis of the data from the 2001 National Health and Nutrition Survey. Korean J Nutr 39(8), 841-849 Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH(2003) Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 157(8), 821-827 Cutler JA, Follmann D, Allender PS(1997) Randomized trials of sodium reduction: An overview. Am J Clin Nutr 65(S2), 643S-651S Ford ES, Ajani UA, Mokdad AH(2005) The metabolic syndrome and concentrations of C-reactive protein among U.S. youth. Diabetes Care 28(4), 878-881 Han MR, Lim JH, Song Y(2014) The effect of high-carbohydrate diet and low-fat diet for the risk factors of metabolic syndrome in Korean adolescents: Using the Korean National Health and Nutrition Examination Surveys(KNHANES) 1998-2009. J Nutr Health 47(3), 186-192 Huh K(2010) Metabolic syndrome in Korean children and adolescents; from the Korean NHANES 1998~2007 data analysis. Master's Thesis, Inje University, pp1-26 Isomaa B, Almgren P, Tuomi T, Forwen B, Lahti K, Nissen M, Taskinen MR, Groop L(2001) Cardiovascular morbidity and mortality associated with the Metabolic syndrome. Diabetes Care 24(4), 683-689 Jin SY(2013) Prevalence and associated factors of the metabolic syndrome in Korean children and adolescents finding from the Korean National Health and Nutrition Examination Survey, 2007-2010. Master's Thesis, Kangwon National University, pp 1-69 Karppanen H, Mervaala E(2006) Sodium intake and hypertension. Prog Cardiovasc Dis 49(2), 59-75 Kim HJ, Ju SY, Park CR, Park YK(2016) Relationship between Kimchi and Metabolic Syndrome in Korean Adults: Data from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2007 2012. J Korean Diet Assoc 22(3), 151-162 Kim J, Jo I(2011) Grains, vegetables, and fish dietary pattern is inversely associated with the risk of metabolic syndrome in South Korean adults. J Am Diet Assoc 111(8), 1141-1149 Kim MH(2012) Eating habit, body image, and weight control behavior by BMI in Korean female high school students: using Korea youth risk behavior web-based survey 2010 data. Korean J Food Nutr 25(3), 579-589 Kim Y, Kwon YS, Park YH, Choe JS, Lee JY(2015) Analysis of consumption frequencies of vegetables and fruits in Korean adolescents based on Korea youth risk behavior web-based survey (2006, 2011). Nutr Res Pract 9(4), 411-419 Ko MJ, Lee EY, Kim K(2013) Characteristics of metabolic
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