Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
권호 표지

Clustering Characteristics of Risk Variables of Metabolic Syndrome in Korean Rural Populations

일부 농촌지역 주민들의 대사인자 군집 특성

Park, Yong-Moon;Kwon, Hyuk-Sang;Lim, Sun-Young;Lee, Jin-Hee;Kim, Sung-Rae;Yoon, Kun-Ho;Cha, Bong-Yun;Son, Ho-Young;Park, Yong-Gyu;Kim, Dong-Suk;Meng, Kwang-Ho;Lee, Won-Chul
박용문;권혁상;임선영;이진희;김성래;윤건호;차봉연;손호영;박용규;김동석;맹광호;이원철

  • Published : 2006.05.30
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Abstract

Background: The risks of both type 2 diabetes mellitus and cardiovascular disease are mainly associated with the metabolic syndrome which is characterized by clustering of metabolic risk factors, including abdominal obesity, glucose intolerance, hypertension, and dyslipidemia. This study aimed to examine the relations among metabolic risk variables and the underlying structure of the metabolic syndrome that unites related components. Methods: Subjects were selected by stratified random cluster sampling among persons aged over 40 years from a rural area. Waist circumference, BMI, fasting glucose, fasting insulin, triglycerides, HDL cholesterol, systolic blood pressure, and diastolic blood pressure were used as risk variables of metabolic syndrome. Factor analysis, a multivariate correlation statistical technique, was performed on a dataset from nondiabetic 3,443 men and women without history of coronary heart disease. Results: Exploratory factor analysis identified three factors in both gender (obesity, hypertension, and dyslipidemia-insulin resistance in men; obesity-insulin resistance, hypertension, and dyslipidemia in women). Fasting insulin was a common contributor to the structure of metabolic syndrome in male subjects, smokers and alcohol drinking group. Confirmatory factor analysis based on the results of exploratory factor analysis revealed that metabolic syndrome was represented primarily by obesity factor in men, obesity-insulin resistance factor in women, and that dyslipidemia factor was highly correlated with obesity factor in men, with insulin resistance factor in women. Conclusion: Underlying structure of metabolic syndrome was different between men and women, and obesity might be a primary target for prevention of both type 2 diabetes mellitus and cardiovascular disease in Korea.

연구배경: 대사증후군은 각각의 요인들이 독립적인 기전으로 심혈관질환을 유발하는 것이 아니라, 위험요인들 상호간에 복합적인 관련성을 갖는 군집을 나타낸다. 따라서 대사인자에 대한 군집 특성을 확인하고 구조를 파악함으로써우리나라에서의 대사증후군 발생에 대해 보다 더 관련 있는 설명을 가능하게 할 것이며, 이는 심혈관질환의 고위험군에 대한 예방 혹은 개입 조치를 적용하는데 기여할 수 있을 것이다. 방법: 본 연구는 2003년과 2004년에 각각 2월부터 4월까지, 충주시 읍면 지역에서 무작위 집락 표본추출로 선정된 40세 이상의 성인을 대상으로 생활습관 관련 설문조사와 신체계측 및 혈액검사를 수행하여, 대사증후군 위험요인 관련 자료가 모두 구비된 성인 남자 1,398명과 여자 2,045명 등 총 3,443명을 대상으로 요인분석을 수행하였다. 결과: 조사 대상자의 대사인자 군집성에 대한 탐색적 요인분석결과, 남자에서는 비만 요인 (복부둘레, 신체질량지수), 고혈압 요인 (수축기혈압, 이완기혈압), 지질대사이상 및 인슐린 요인 (공복인슐린, 중성지방, HDL 콜레스테롤)의 3가지 요인으로 군집되어 나타났고, 여자에서는 비만 및 인슐린저항성 요인 (복부둘레, 신체질량지수, 공복혈당, 공복인슐린), 고혈압 요인 (수축기혈압, 이완기혈압), 지질대사 이상 요인 (중성지방, HDL 콜레스테롤) 의 3가지 요인으로 군집되어 나타났다. 연령별로 분석한 결과, 여자에서는 전 연령층에서 비만 관련변수와 인슐린저항성 관련 변수가 함께 군집되어 나타났고, 남녀모두 전 연령층에서 혈압이 별개의 요인으로 군집되어 나타났다. 생활습관별 특성 분석결과, 흡연군이나 음주군에서 공복인슐린이 다른 변수에 비해 대사증후군 위험요인 구조에 기여하는 정도가 높은 것으로 나타났다. 탐색적 요인분석을 통해 파악된 대사증후군 요인모형에 근거한 확증적 요인분석 결과, 남자에서는 비만요인이 여자에서는 비만 및 인슐린저항성 요인이 대사증후군의 가장 영향력 있는 요인으로 나타났고, 요인간 상호관련 정도는 남자에서 비만요인과 지질대사이상요인이, 여자에서 비만 및 인슐린저항성 요인과 지질대사이상요인이 상관정도가 높은 것으로 나타났다. 결론: 본 연구결과를 바탕으로 우리나라에서 심혈관질환 및 제 2형 당뇨병의 원인이 되는 대사증후군 관리를 위해서는 남녀 모두 비만 관리를 중심으로 한 접근이 필요한 것으로 사료된다.

Keywords

References

  1. Reaven GM: Role of insulin resistance in human disease. Diabetes 37:1595-607, 1988 https://doi.org/10.2337/diabetes.37.12.1595
  2. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus-provisional report of a WHO consultation. Diabet Med 15:539-53, 1998 https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S
  3. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. JAMA 285: 2486-97, 2001 https://doi.org/10.1001/jama.285.19.2486
  4. Korea national statistical office:2003년 사망원인통계 연보. 2001
  5. Hanson RL, Imperatore G, Bennett PH, Knowler WC: Components of the 'Metabolic Syndrome' and incidence of type 2 diabetes. Diabetes 51:3120-27, 2002 https://doi.org/10.2337/diabetes.51.10.3120
  6. Lindblad U, Langer RD, Wingard DL, Thomas RG, and Barrett-Connor EL: Metabolic syndrome and ischemic heart disease in elderly men and women. Am J Epidemiol 153:481-9, 2001 https://doi.org/10.1093/aje/153.5.481
  7. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The Metabolic Syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709-16, 2002 https://doi.org/10.1001/jama.288.21.2709
  8. Anderson PJ, Critchley JA, Chan JC, Cockram CS, Lee ZS, Thomas GN, Tomlinson B: Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality. Int J Obes 25:1782-8, 2001 https://doi.org/10.1038/sj.ijo.0801837
  9. Timar O, Sestier H, Levy E:Metabolic syndrome X: a review. Can J Cardiol 16: 779-89, 2000
  10. Shen BJ, Todaro JF, Niaura R, McCaffery JM, Zhang J, Spiro A 3rd, Ward KD:Are metabolic risk factors one unified syndrome- Modeling the structure of the metabolic syndrome X. Am J Epidemiol 157:701-11, 2003 https://doi.org/10.1093/aje/kwg045
  11. Meigs JB: Invited commentary: insulin resistance syndrome- Syndrome X- multiple metabolic Syndrome- A syndrome at all- Fator analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 152:908-11, 2000 https://doi.org/10.1093/aje/152.10.908
  12. Edwards KL, Austin MA, Newman B, Mayer E, Krauss RM, Selby JV: Multivariate analysis of the insulin resistance syndrome in women. Arterioscler Thromb 14:1940-5, 1994 https://doi.org/10.1161/01.ATV.14.12.1940
  13. Meigs JB, D'Agostino RB Sr, Wilson PW, Cupples LA, Nathan DM, Singer DE:Risk variable clustering in the insulin resistance syndrome. The Framingham Offspring Study. Diabetes 46:1594-600, 1997 https://doi.org/10.2337/diabetes.46.10.1594
  14. Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP: Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. Am J Epidemiol 152:897-907, 2000 https://doi.org/10.1093/aje/152.10.897
  15. Hanley AJ, Karter AJ, Festa A, D'Agostino R Jr, Wagenknecht LE, Savage P, Tracy RP, Saad MF, Haffner S: Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study. Diabetes 51:2642-7, 2002 https://doi.org/10.2337/diabetes.51.8.2642
  16. Lempiainen P, Mykkanen L, Pyorala K, Laakso M, Kuusisto J: Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 100:123-8, 1999 https://doi.org/10.1161/01.CIR.100.2.123
  17. 김영일, 김은숙, 허명회, 김상욱, 박중열, 홍성관, 김진엽, 이무송: 정읍 지역 주민에서 인슐린저항성증후군의 군집성 분석. 당뇨병 23:843-56, 1999
  18. Choi KM, Lee J, Kim KB, Kim DR, Kim SK, Shin DH, Kim NH, Park IB, Choi DS and Baik SH: Factor analysis of the metabolic syndrome among elderly Koreans-the South-west Seoul Study. Diabet Med 20:99-104, 2003 https://doi.org/10.1046/j.1464-5491.2003.00890.x
  19. 권혁상, 박용문, 이혜정, 이진희, 최윤희, 고승현, 이정민, 김성래, 강소영, 이원철, 안명숙: 한국 성인에서의 NCEP-ATP 3 기준을 적용한 대사증후군 유병률과 임상적 특징. 대한내과학회지 68:359-68, 2005
  20. 이혜정, 권혁상, 박용문, 전한나, 최윤희, 고승현, 이정민, 윤건호, 차봉연, 이원철, 이광우, 손호영, 강성구, 안명숙, 강진모: 한국인40세 이상의 성인에서 대사증후군의 위험인자로서의 허리둘레; 5가지 진단기준으로부터의 고찰. 대한당뇨병학회지 229:48-56, 2005
  21. Friedewald WT, Levy RI, Fredrickson DS:Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499-502, 1972
  22. Dallongeville J, Cottel D, Arveiler D, Tauber JP, Bingham A, Wagner A, Fauvel J, Ferrieres J, Ducimetiere P, Amouyel P: The Association of metabolic disorders with the metabolic syndrome is different in men and women. Ann Nutr Metab 48:43-50, 2004 https://doi.org/10.1159/000075304
  23. Kaiser HF:The application of electrionic computers to factor analysis. Educational and Psychological Measurement 20:141-51, 1960 https://doi.org/10.1177/001316446002000116
  24. Manly BFJ: Factor analysis. In Manly BFJ, editors. Multivariate statistical methods. p. 93-106, London, Chap-man & Hall, 1994
  25. Hu LT, Bentler: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 6:1-55, 1999 https://doi.org/10.1080/10705519909540118
  26. 김계수: 구조방정식 모형분석.p. 458-466, (주)데이타솔루션, 2004
  27. Zimmet P: The pathogenesis and prevention of diabetes in adults. Genes, autoimmunity, and demography. Diabetes Care 18:1050-64, 1995 https://doi.org/10.2337/diacare.18.7.1050
  28. Laakso M: How good a marker is insulin level for insulin resistance- Am J Epidemiol 137:959-65, 1993
  29. Pyorala M, Miettinen H, Halonen P, Laakso M, Pyorala K:Insulin resistance syndrome predicts the risk of coronary heart disease and stoke in healthy middle-aged men. Arterioscler Thromb Vasc Biol 20:538-44, 2000 https://doi.org/10.1161/01.ATV.20.2.538
  30. Reaven GM:The metabolic syndrome or the insulin resistance syndrome- Different names, different concepts, and different goals. Endocrinol Metab Clin North Am 33:283-303, 2004 https://doi.org/10.1016/j.ecl.2004.03.002
  31. Chen CH, Lin KC, Tsai ST, Chou P: Different association of hypertension and insulin-related metabolic syndrome between men and women in 8,437 nondiabetic Chinese. Am J Hypertens 13:846-53, 2000 https://doi.org/10.1016/S0895-7061(00)00255-7
  32. Oh JY, Hong YS, Sung YA, Barrett-Connor E: Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 27;2027-32, 2004 https://doi.org/10.2337/diacare.27.8.2027
  33. Gray RS, Fabsitz RR, Cowan LD, Lee ET, Howard BV, Savage PJ: Risk factor clustering in the insulin resistance syndrome. The Strong Heart Study. Am J Epidemiol 148:869-78, 1998 https://doi.org/10.1093/oxfordjournals.aje.a009712
  34. Lawlor DA, Ebrahim S, May M, and Davey Smith G: (Mis)use of Factor analysis in the study of insulin resistance syndrome. Am J Epidemiol 159:1013-8, 2004 https://doi.org/10.1093/aje/kwh150
  35. Smith U: Smoking elicits the insulin resistance syndrome: new aspects of the harmful effect of smoking. J Intern Med 237:435-7, 1995 https://doi.org/10.1111/j.1365-2796.1995.tb00867.x
  36. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM:Insulin resistance and cigarette smoking. Lancet 339:1128-30, 1992 https://doi.org/10.1016/0140-6736(92)90730-Q
  37. Vgontzas AN, Bixler EO, Chrousos GP: Metabolic disturbances in obesity versus sleep apnea: the importance of visceral obesity and insulin resistance. J Intern Med 254:32-44, 2003 https://doi.org/10.1046/j.1365-2796.2003.01177.x
  38. Grundy SM:What is the contribution of obesity to the metabolic syndrome- Endocrinol Metab Clin North Am 33:267-82, 2004 https://doi.org/10.1016/j.ecl.2004.03.001
  39. Hong YS, Kim BG, Jeong BG, Park YW, Park JT, Jung KY, Kim JY:Prevalence of Metabolic Syndrome and Waist Circumference Estimation in Some Korean Adults. J Prev Med Public Health 37:51-8, 2003
  40. 김상만, 김성수, 윤수진, 심경원, 최희정, 김광민, 이득주: 복부 내장지방량을 가장 잘 표현할 수 있는 단순비만지표는- - 체질량지수 , 허리둘레 , 엉덩이둘레비-. 대한비만학회지 7:157-68, 1998
  41. Despres JP: Abdominal obesity as important component of insulin-resistance syndrome. Nutrition 9:452-9, 1993
  42. Hair JF Jr, Anderson RE, Tatham RL, Black WC: Multivariate data analysis. 5th ed. Prentice-Hall International, 1998
  43. Michels KB, Greenland S, Rosner BA: Does body mass index adequately capture the relation of body composition and body size to health outcomes- Am J Epidemiol 147:167-72, 1998 https://doi.org/10.1093/oxfordjournals.aje.a009430
  44. Kronmal RA:Spurious correlation and the fallacy of the ratio standard revisited. J Roy Statist Soc A 156:379-92, 1993 https://doi.org/10.2307/2983064