건강한 한국 성인 남성에서 흡연 상태와 인슐린 저항성과의 연관성
Association between Smoking Status and Insulin Resistance in Apparently Healthy Korean Men
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연구배경: 흡연이 인슐린 저항성과 연관되어 있다는 많은 연 구 결과들이 발표되었지만 그 연관성에 대해 논란이 많으며 국내의 연구는 없는 실정이다. 본 연구는 한국 성인 남성을 대 상으로 흡연 상태와 인슐린 저항성과의 연관성에 대해 알아 보고자 하였다. 방법: 본 연구는 2005년부터 2006년까지 2년간 삼성서울병원 건강의학센터를 방문한 20세 이상의 성인 남성(n=5,969)을 대 상으로 흡연 설문, 신체검진, 검사실 항목 등을 통해 시행되었 다. HOMA (homeostasis model assessment)법을 사용하여 흡연 과 인슐린 저항성과의 연관성에 대해 알아보았고, 인슐린 저 항성과 관련이 있다고 알려진 요소에 대해 일반 선형 모델을 통해 보정을 하였다. 결과: HOMA-IR (homeostasis model assessment of insulin resistance)값은 과거흡연자 및 현재흡연자가 비흡연자에 비해 통계적으로 유의하게 높은 값을 나타내었다(2.09±0.94, 2.04± 0.90 vs. 1.96±0.86, 각각 P<0.01). 인슐린 저항성에 영향을 줄 수 있는 요소들(나이, 운동 정도, 알코올 섭취, 체질량지수, 복부 둘레, 체지방, 수축기 혈압, 이완기 혈압) 에 대해 보정을 시행 한 결과 과거흡연자는 보정 후에도 유의하게 HOMA-IR 값이 높았으며(P=0.008), 40갑년 이상의 흡연자는 비흡연자에 비해 유의하게 높은 HOMA-IR값을 나타내었다. 결론: 인슐린 민감성에 영향을 줄 수 있는 요소를 보정한 후에 HOMA값을 기준으로 평가한 결과, 과거흡연 및 만성흡연은 인슐린 저항성과 유의한 연관성을 가졌다.
Abstract
Background: Several studies have suggested that smoking may cause insulin resistance. However, the association between smoking and insulin resistance is still controversial. The purpose of this study was to investigate the association between smoking status and insulin resistance in Korean nondiabetic male population. Methods: A total of 5,969 men, aged > 20 years were recruited from those who visited the Health Promotion Center, Samsung Medical Center between 2005 and 2006. All subjects were divided into three categories: on-smokers (n = 2,594), ex-smokers (n = 1,580), and current-smokers (n = 1,795). Fasting values for glucose and insulin were used to estimate insulin resistance by HOMA (homeostasis model assessment). An independent association between smoking status and HOMA-IR (homeostasis model assessment of insulin resistance) was assessed after adjustment for factors infl uencing insulin sensitivity such as age, exercise, alcohol, body mass index, abdominal circumference, and blood pressure. Results: HOMA-IR was signifi cantly higher in ex-smokers and current-smokers than in non-smokers (2.09 ± 0.94 vs. 2.04 ± 0.90, 1.96 ± 0.86, P < 0.01, respectively). After adjustment for factors potentially affecting insulin sensitivity (age, alcohol intake, exercise, BMI, body fat, abdominal circumference, and blood pressure), the association persisted for ex-smokers (P = 0.008). And HOMA-IR was signifi cantly higher in ≥ 40 pack-years smokers than in non-smokers Conclusion: Based on HOMA-IR, previous-smoking and chronic smoking were significantly associated with insulin resistance in apparently healthy Korean nondiabetic men.
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