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기계적 부하 가설의 재고찰:비만은 골다공증을 예방하는가?

Reconsideration of the Mechanical Loading Hypothesis: Is Obesity Protective Against Osteoporosis?

정득|이종석|장성옥|이성화
국가데이터연구원 (Statistics Research Institute)|2014.10|통계연구 (Journal of the Korean Official Statistics)|제19권 제2호|pp. 1-29

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국민건강영양조사비만Obesity골다공증OsteoporosisInteraction Effect상호작용 효과The Korea National Health and Nutrition Examination Survey다항회귀모형Polynomial Regression Model
주제분류경제학

초록

체중과 골밀도의 양의 상관관계가 알려지면서, 전통적으로 비만은 골다공증의 보호요인이라고 여겨져 왔다. 높은 체중은 뼈에 대한 부하를 증가시켜 골 형성을 촉진시키고, 반대로 체중 감소는 부하를 감소시켜 골밀도를 낮춘다는 것이다. 따라서 대표적인 비만지표인 체지방량도 체중을 구성하는 요소이므로 체중부하를 통해 골밀도를 향상시킨다는 것이다. 이러한 비만이 골다공증을 예방한다는 믿음은 비만의 예방과 치료를 담당하는 보건의료 종사자와 환자 모두를 혼란스럽게 만드는 원인이 되어왔다. 본 연구에서는 국민건강영양조사 4개년(2008-2011) 자료를 활용하여 4,841명의 50세 이상 한국여성을 대상으로, (1) 체중 혹은 비만과 골밀도의 관계를 분석하였고 (2) 골밀도에 대한 체중의 기계적 부하(mechanical loading) 가설을 재고찰하였다. 체중은 비만지표들(체지방량, 체질량지수, 체지방률, 허리둘레)보다 골밀도와의 관련성이 더 높았으며, 노년층 여성에서 체중과 골밀도의 관계는 ∩-형태인 것으로 나타났다. 이는 저체중뿐만 아니라 과체중도 골다공증의 위험요인이라는 것을 의미하며, 체중과 골밀도의 관계에 관한 연구에서 비선형관계나 상호작용을 고려하지 않는 경우 분석결과가 왜곡될 수 있다는 것을 제시한다. 그리고 비만과 골밀도의 관계에 대한 경로분석 결과, 비만의 체중을 통한 골밀도에 대한 간접효과는 (+)이지만 비만의 골밀도에 직접효과는 (–)이었다. 따라서 지나치게 높은 체중이 골밀도와 음의 관계가 있는 것을 고려하면, 비만은 골다공증의 보호요인이 아닌 위험요인일 가능성이 높다.

Abstract

Obesity has traditionally regarded as protecting bone health, simply because mechanicalloading due to higher body weight is expected to increase bone mineral density (BMD). Thisbelief would serve to confuse healthcare professionals practicing for obesity prevention and treatment. The purpose of this study was to (1) evaluate the effect of body weight or obesity on BMD and (2) examine whether interaction and curvilinear effects in their relationships are present or not. The study population was 4,841 women aged 50-89 years who completed the body composition and BMD examinations in the Korea Health and Nutrition Examination Survey (KNHANES) 2008-2011. In terms of the magnitude of the correlation coefficient, body weight was a better marker of BMD than obesity measured as fat mass, body mass index,ratio fat mass, or waist circumference. We found that body weight was of an inverted U-shaped relationship with BMD, implying a negative effect of excess weight on BMD, in multiple regression models representing interaction effects of age and body weight and incorporating curvilinear effects of body weight with polynomials. Path analysis was used to assess the causality of direct and indirect effects of obesity on BMD. We observed that direct effects were negative whereas indirect (weight-mediated) effects were positive. Consideringexcess weight was negatively associated with BMD, therefore, obesity may be a risk, notprotective factor for osteoporosis.

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