한국 성인 비만평가를 위한 체질량지수 분별점의 유효성
Usefulness and Validation of Cutoff Points of Body Mass Index for Overweight and Obesity in Korean Adults
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초록
이 연구는 한국 성인의 비만을 평가하기 위해 체지방률의 기준치와 동등한 체질량지수의 분별점을 확인하고, 체질량지수에 대한 유용성을 판단하고자 하였다. 이를 위해 한국성인 929명(남성 364명, 여성 565명, 18~64세)을 대상으로 신체구성의 준거방법인 DXA를 이용하여 체지방률을 구하고, 신장과 체중을 이용하여 체질량지수(BMI)를 산출하였다. 체질량지수와 체지방률에 대한 관계를 분석하기 위해 상관분석과 회귀분석을 실시하였으며, 체질량지수 분별치의 설정을 위해 ROC 곡선과 일치도 검사를 실시하였다. 연구결과, 체질량지수는 체지방률에 대하여 남녀 모두에서 높은 정적 상관관계를 나타내었다(남자 r=0.816, %fat=1.437×BMI－14.397, p<0.01; 여자: r=0.751, %fat=1.609×BMI－4.567, p<.01). 그리고 ROC 곡선을 이용하여 분석한 체질량지수의 과체중은 남자는 23kg․m-2, 여자는 22kg․m-2를 나타내었고, 비만 기준은 남자와 여자 모두 체질량지수 25kg․m-2인 것으로 분석되었다. 한편, 기존의 국제 체질량지수 분별치와 아시아 권장 체질량지수 분별치를 체지방률 진단법에 대한 일치도로 분석한 결과, 남자는 63.2%, 여자는 72.6%이고, Kappa 계수는 남자가 0.440(p<.001) 여자가 0.570(p<.001)로 나타났다. 이상의 결과를 종합해 보면 우리나라 성인 BMI의 비만진단 기준은 아시아태평양 권장 BMI 비만진단기준인 23kg․m-2과 25kg․m-2가 적합하다. 그러나 BMI가 신체구성성분(체지방)이 아닌 신체계측지수인 것을 고려할 때 향후 현장에서 체지방을 쉽고 정확하게 측정하는 방안이 필요할 것으로 사료된다.
Abstract
The World Health Organization consensus proposed ethnically specific criteria of body mass index(BMI) for abnormally accumulated fatness(obesity). However, the nationwide definition of BMI is still debated in Korea. Therefore, this study aimed to determine the cut-off points of body mass index for overweight and obesity in Korean adults by the ROC curve analysis. For this study, we recruited 929 Korea adults(364 men, 565 women) aged 18 to 64. Body compositions including body fat, fat-free mass, and percentage body fat were measured by DXA and body mass index was also assessed by weight and height. The correlation, regression analysis, ROC curve, agreements and Kappa test were performed for the relationships between %fat and BMI, determination of BMI cutoff points for overweight and obesity and final confirmation of usefulness of BMI for obesity diagnosis. As results, BMI and percentage body fat were closely associated in both men(r=0.861, p<.01) and women(r=0.751, p<.01) with the regression equation in %fat＝1.437×BMI－14.397 for men and %fat＝1.609×BMI－4.567(p<.01). According to the ROC curve, 23kg⋅m-2 and 23kg⋅m-2 of BMI in men and women had highest sensitivity and specificity in related to optimal sensitivity and specificity in relation with obesity of body fat. Overall percentage agreements between %fat-based obesity diagnosis and BMI-based obesity diagnosis were located into 0.368~726. In conclusion, the profit cutoffs of BMI for obesity for Korean adults were 23kg⋅m-2 for overwieght and 25kg⋅m-2 for obeisty in both men and women in this study. However, there were limitations and needs for using BMI such as percentage body fat. Further studies were needed to develop usuful and practical percentage body fat for obesity diagnosis.
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