대사질환지표와 관련된 여성 복부비만의 DEXA 측정법과 CT 측정법의 비교
Comparison of DEXA and CT for Truncal Obesity in Adult Women Related to Metabolic Complications
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연구 배경: 비만은 인슐린저항성, 제2형 당뇨병, 고혈압, 이상지질혈증, 심혈관계질환 등 다양한 대사질환과 관련되어 있고, 이는 특히 복부 내장지방의 증가와 관련되어있다. 이 연구는 컴퓨터단층촬영(CT)으로 측정한 내장지방면적과, 체지방 직접측정법인 이중에너지 방사선흡수계측기(DEXA)로 구한 몸통지방량을 사용하여 대사질환지표와의 연관성을 비교해 보고자 하였다. 방법: 2004년 9월부터, 상계백병원 비만크리닉을 방문한 과체중 또는 비만인 여성 52명(연령 18∼59세, BMI 23.6∼36.5 kg/m2)을 대상으로 하였다. DEXA를 이용하여 총지방량 및 몸통지방량을 구하였고, CT로 복부 총지방면적을 구하여 내장지방면적과 피하지방면적으로 구분하였다. 혈액검사 및 신체계측을 통하여 대사질환 지표(수축기 혈압, 이완기 혈압, 허리둘레, 공복혈당, 요산, AST, ALT, 총콜레스테롤, 고밀도 콜레스테롤, 중성지방, 인슐린, 체질량지수)를 측정하였다. DEXA 및 CT로 구한 복부비만에 대한 측정값과 각 대사질환 지표의 상관계수를 구하고, 나이와 총지방률(%)을 보정한 후 각 대사질환 지표를 종속변수로 하여 회귀분석을 시행하였다. 결과: DEXA로 측정한 몸통지방량은 CT로 측정한 복부 총지방면적(r=0.8299, P<0.001), 복부 피하지방면적(r=0.6981, P<0.001), 복부 내장지방면적(r=0.6107, P<0.001)과 매우 높은 상관성을 보였다. 나이와 총지방률을 보정한 후, 요산에 대한 설명력은 CT로 측정한 복부 총지방면적이 가장 컸고(R2=0.259), 복부내장지방면적(R2=0.209), 몸통지방량(R2=0.197) 순이었다. AST, ALT, 총콜레스테롤, 로그변환 중성지방에 대한 설명력이 가장 큰 것은 CT로 측정한 복부 내장지방면적(R2=0.360, 0.407, 0.147, 0.339)이었다. 로그변환 인슐린에 대한 설명력이 가장 큰 것은 DEXA로 측정한 몸통지방량(R2=0.275)이었다. 결론: 성인 여성에서 DEXA로 측정한 몸통지방량은 CT로 측정한 복부 내장지방면적 및 여러 대사질환 지표와 유의한 상관성을 보여 CT 측정법과 유사하게 비만 관련 대사질환 지표를 반영하는 것으로 보인다.
Abstract
Comparison of DEXA and CT for Truncal Obesity in Adult Women Related to Metabolic ComplicationsJi Soo Kim, Sun Mi Yoo†, Kyu Nam Kim, Seon Yeong Lee Background: The metabolic risks associated with obesity are closely correlated with a central rather than a peripheral fat pattern. These complications of obesity have been attributed to increase in visceral adipose tissue. The aim of this study was to investigate whether the dual- energy X-ray absorptiometry (DEXA) method offers a good alternative to computed tomography (CT) for the prediction of visceral fat in the obese women in correlation of metabolic complication markers. Methods: The design is a cross-sectional analysis. Total body fat and truncal fat amounts were measured by using DEXA, while total abdominal fat area was measured by CT, and divided into visceral abdominal fat area and subcutaneous fat area. Partial correlation after controlling for age and multiple regression analyses after adjusting for age and total percent body fat were performed to relate the metabolic variables to the CT and DEXA body composition variables. Results: For serum uric acid, total abdominal fat area by CT had the largest R2 values (R2=0.259). For AST, ALT, total cholesterol and log triglyceride, visceral fat area had the largest R2 values (R2= 0.360, 0.407, 0.147, and 0.339), respectively, and for log insulin, truncal fat by DEXA had the largest R2 values (R2=0.275). Conclusion: Truncal fat amount measured by DEXA had a strong correlation with visceral fat area measured by CT. Truncal fat amount measured by DEXA and correlated significantly with visceral abdominal fat area measured by CT reflected most of the metabolic complication markers. (J Korean Acad Fam Med 2007; 28:675-681)
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