아동기 인구 집단의 비만과 심혈관건강: 제5기 국민건강영양조사 자료 이용
Childhood Obesity and Cardiovascular Health: Using 2010-2012 Dataof the Korea National Health and Nutrition Examination Survey
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연구배경: 아동기 인구 집단에서 허리둘레/신장 비율을기준으로 한 복부비만이 체질량지수를 기준으로 한 전체비만보다 심혈관건강과 더 강력한 부적관련성을 보고하고 있으나, 아직 그 근거가 부족하다. 이에 본 연구는 아동기 인구 집단에서 체질량지수는 물론이고 ‘허리둘레/신장 비율’ 과 심혈관건강 간의 관련성을 규명하고자 한다. 방법: 본 연구는 제5기 국민건강영양조사 원시자료(2010-2012년)를 활용한 횡단적 역학연구설계에 의해, 10-18세인 2,363명을 대상으로 성별(소년/소녀 집단)과 연령별 집단(10-12세/13-18세)으로 구분하여 분석하였다. 전체비만은 체질량지수 백분위수에 의해 비과체중군(<85), 과체중군(≥85)과 비만군(≥95)으로, ‘허리둘레/신장 비율’을기초로 정상군(<0.5)과 복부비만군(≥0.5)으로 구분하였다. 심혈관건강은 7개 하부지표와 통합지표인 심혈관건강점수(표준화점수, z-score)로 분석하였다. 아동의 인구사회학적특성과 부모의 사회경제적 특성을 보정한 후 복합표본 일반선형회귀분석을 수행하였다. 결과: 체질량지수를 기준으로, 비만군은 비과체중군에 비해 7개 심혈관개별지표와 심혈관건강점수 모두에서 통계적으로 유의하게 심혈관건강이 악화되어 있었다(P<0.05). ‘허리둘레/신장 비율’을 기준으로, 그 관련성 또한 위와 유사한패턴을 보였으나(P<0.05), 이는 체질량지수 비만도를 보정한 후에도 여전히 13-18세 인구 집단에서는 심혈관건강점수가 비만군에서 비과체중군에 비해 통계적으로 유의하게악화되어 있었으며, 이 패턴은 특히 남학생에서 유의하게나타났다(P<0.01). 결론: 국내 13-18세의 소년 집단에서 ‘허리둘레/신장 비율’ 복부비만 지표는 체질량지수를 보정한 후에도 심혈관건강과 밀접한 관련성이 있었다. 이에 늦은 청소년 집단에서 ‘허리둘레/신장 비율’은 체질량지수보다 강력한 심혈관건강을 반영할 수 있으므로, 학령기 청소년 집단을 위한 심혈관질환 조기 예방과 건강증진 차원에서 복부비만 지표는간호사정의 지표로 고려될 필요가 있겠다.
Abstract
Background:Abdominal obesity as measured by waist-to-height ratio (WHtR) may have stronger and inverse associations with cardiovascular (CV) health than overall obesity as measured by body mass index (BMI). However, there was some challenges for controversies. We aimed to examine the associations of WHtR and BMI with CV health among Korean children using data of the 2010-2012 Korea National Health and Nutrition Examination Survey. Methods:A cross-sectional study was conducted with the sample of 2,363 children by analyzing by gender and two-age groups (10-12 and 13-18 years). Overall obesity was categorized into 3 groups by BMI percentile: non-overweight (<85), overweight (≥85), and obesity groups (≥95). Abdominal obesity was categorized into 2 groups by WHtR: normal (<0.5) and abdominal obesity groups (≥0.5). The CV health score was defined as a z-score by calculating the sum of 7 CV factors. Results:The overweight/obesity groups had significantly lower CV health scores than the normal group (P<0.05) in boys and girls aged either 10-12 years or 13-18 years after adjusting for covariates. The abdominal obesity group also showed significantly lower CV health scores than the normal group (P<0.05) in all the groups; this significant association remained significant in boys aged 13-18 years even after further adjusting for BMI category (P<0.01). Conclusions:Among boys aged 13-18 years, abdominal obesity as measured by WHtR was significantly and inversely associated with CV health, independent of BMI category. Therefore, it should be considered to assess the level of abdominal obesity as a measure of CV health in late adolescent boys.
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