등시간대체모형을 이용한 신체활동과 대사증후군의 관계 분석: 2014-2015 국민건강영양조사
The Association between the Isotemporal Substitution of Objectively Measured Sitting Time with Physical Activity and Metabolic Syndrome: 2014-2015 Korea National Health and Nutrition Examination Survey
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초록
본 연구는 등시간대체모형(isotemporal substitution model; ISM)의 개념을 소개하고, 좌업시간(SED)을 저강도(LPA) 및 중고강도 신체활동(MVPA)으로 대체했을 때 대사증후군 유병 위험의 차이를 계량적으로 추정하였다. 이를 위해 2014-2015 국민건강영양조사 가속도계 착용 대상자 중 30-44세와 45-65세 참가자 1,298명의 자료에 대해 로지스틱 회귀분석을 실시하였다. 30-44세 집단에서는 SED을 LPA로 대체하면 고중성지질혈증(OR=.97, 95% CI=.940-.996), 저 HDL-C혈증(OR=.97, 95% CI=.950-.999) 유병 위험이 유의하게 낮았다. 45-65세 집단에서는 SED을 LPA로 대체하면 저HDL-C혈증(OR=.98, 95% CI=.970-.999) 유병 위험이 유의하게 낮았으며, MVPA로 대체하면 복부비만(OR=.95, 95% CI=.900-.9996), 고중성지질혈증(OR=.94, 95% CI=.890-.995), 저HDL-C혈증(OR=.92, 95% CI=.870-.980), 내당능장애(OR=.94, 95% CI=.890-.990), 대사증후군(OR=.93, 95% CI=.870-.980) 유병 위험이 유의하게 낮아졌다. LPA를 MVPA로 대체하는 경우에도 복부비만(OR=.93, 95% CI=.870-.980), 저HDL-C혈증(OR=.94, 95% CI=.890-.996), 내당능장애(OR=.94, 95% CI=.890-.996), 대사증후군(OR=.93, 95% CI=.880-.990) 유병 위험이 유의하게 낮아지는 것으로 보아 신체활동 강도와 대사증후군 유병 위험 사이에 일부 용량-반응관계가 존재하는 것으로 볼 수 있다. 그러나 30-44세 집단에서 SED를 MVPA로 대체하는 경우 내당능장애(OR=1.11, 95% CI=1.010-1.220), 고혈압(OR=1.10, 95% CI=1.003-1.220) 유병 위험이, LPA를 MVPA로 대체하는 경우 내당능장애(OR=1.11, 95% CI=1.010-1.230) 유병 위험이 오히려 증가했으며, 45-65세 집단에서도 SED를 LPA로 대체하는 경우 복부비만(OR=1.02, 95% CI=1.010-1.040) 유병 위험이 유의하게 증가한 점은 연구설계, 피험자 반동의 영향은 없는지 신중히 살펴 해석해야 한다. 또한 ISM에서 좌업시간, 저강도신체활동, 총시간항을 하나의 모형에 투입하는 경우 다중공선성의 위험이 있기 때문에 주의해야 한다. 그럼에도 불구하고 ISM은 저강도 혹은 중고강도 신체활동을 추가하는 시간만큼 좌업시간을 줄이는 행동대체의 효과를 추정하기 때문에 논리적 강점이 있으며, 다양한 후속연구가 필요하다.
Abstract
This study was purposed to quantify the association between replacement of sedentary time (SED) with light-intensity physical activity (LPA) or moderate- to vigorous-intensity physical activity and metabolic syndrome using the isotemporal substitution model (ISM). Logistic regression models incorporating ISM were examined using Actigraph GT3X+ data from a total of 1,298 participants collected in the 2014-2015 Korea National Health and Nutrition Examination Survey. In the group of 30-44 years old, replacing SED with LPA was associated with lower risks of elevated serum triglyceride level (OR=.97, 95% CI=.94-.996) and low HDL-C cholesterol (OR=.97, 95% CI=.95-.999). In the age group of 45-65 years, replacing SED with LPA was associated with a lower risk of low HDL-C cholesterol (OR=.98, 95% CI=.97-.999). Replacement of SED with MVPA, was associated with lower risks for central adiposity (OR=.95, 95% CI=.90-.9996), elevated serum triglyceride level (OR=.94, 95% CI=.89-.995), low HDL-C cholesterol (OR=.92, 95% CI=.87-.98), impaired glucose tolerance (OR=.94, 95% CI=.89-.99), and metabolic syndrome (OR=.93, 95% CI=.87-.98). In addition, replacing LPA with MVPA was associated with lower risks for central adiposity (OR=.92, 95% CI=.87-.98), low HDL-C cholesterol (OR=.94, 95% CI=.89-.996), impaired glucose tolerance (OR=.94, 95% CI=.89-.996), and metabolic syndrome (OR=.93, 95% CI=.88-.99), implying that a dose-response relationship does exist between intensity of physical activity and health outcomes. In the age group of 30-44 years, meanwhile, a higher risk of impaired glucose tolerance was associated with both replacing SED with LPA (OR=1.11, 95% CI=1.01-1.22) LPA with MVPA (OR=1.11, 95% CI=1.01-1.23), and replacing SED with LPA was associate with a higher risk for high blood pressure (OR=1.10, 95% CI=1.003-1.22). In a group of 45-65 years old, replacing LPA with MVPA was also associated with a higher risk of impaired glucose tolerance (OR=1.02, 95% CI=1.01-1.04). One should be careful in interpreting these paradoxical associations due to cross-sectional study design and possible reactivity of the study participants. In the ISM, researchers should also be aware of investigating potential multicollinearity problem when SED, LPA, and total time are included in the same model as the independent variables. Nevertheless, the ISM is more logical than partition regression model in that it considers finite time and that physical activity displaces sitting time.
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