DOI QR코드

DOI QR Code

Relationship of sodium consumption with obesity in Korean adults based on Korea National Health and Nutrition Examination Survey 2010~2014

2010년~2014년 국민건강영양조사 자료를 이용한 성인의 나트륨 섭취와 비만과의 관련성

  • Cheon, Se Young (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation) ;
  • Wang, Hye Won (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation) ;
  • Lee, Hwa Jung (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation) ;
  • Hwang, Kyung Mi (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation) ;
  • Yoon, Hae Seong (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation) ;
  • Kang, Yoon Jung (Nutrition and Functional Food Research Team, National Institute of Food and Drug Safety Evaluation)
  • 천세영 (식품의약품안전평가원 영양기능연구팀) ;
  • 왕혜원 (식품의약품안전평가원 영양기능연구팀) ;
  • 이화정 (식품의약품안전평가원 영양기능연구팀) ;
  • 황경미 (식품의약품안전평가원 영양기능연구팀) ;
  • 윤혜성 (식품의약품안전평가원 영양기능연구팀) ;
  • 강윤정 (식품의약품안전평가원 영양기능연구팀)
  • Received : 2016.12.26
  • Accepted : 2017.02.03
  • Published : 2017.02.28

Abstract

Purpose: Excess sodium intake may contribute to the etiology of hypertension and cardiovascular disease risk. World Health Organization (WHO) recommends a daily sodium intake of less than 2 g. The aim of this study was to estimate the association of sodium intake with obesity in Korean adults. Methods: This study used Dietary intake and Health data on 22,321 subjects aged 30 years and over from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010~2014. Information on dietary intake was obtained by the one day 24-hour recall method in KNHANES, and sodium intake was classified into five groups (< 2,000 mg, 2,000~4,000 mg, 4,000~6,000 mg, 6,000~8,000 mg, ${\geq}8,000mg$). Obesity was defined as having a body mass index (BMI) higher than $25kg/m^2$. Intake of sodium and obesity status were analyzed by logistic regression with SPSS Statistics 23. Results: Men tended to have a higher sodium intake than women (p < 0.001). After adjusting for age, sex, year, daily energy intake, education level, smoking status, drinking status, physical activity, and chronic diseases and comparing the highest sodium intake group (${\geq}8,000mg$) with the lowest intake group (< 2,000 mg), the OR of obesity was 1.351 (95% CI: 1.032~1.767) in men. The OR of obesity in the sodium intake group (4,000~6,000 mg) was 1.232 (95% CI: 1.063~1.427) in women. Conclusion: Our findings suggest an independent relationship between sodium intake and as increased risk of obesity in Korean adults, implying the necessity for future research on low-sodium diet intervention in relation to obesity.

본 연구는 국가적으로 시행된 대규모 국민건강영양조사 자료를 이용하여 나트륨 섭취량과 비만과의 연관성을 알아보기 위하여 나트륨 섭취량을 5그룹 (2,000 mg 미만, 2,000 mg 이상~4,000 mg 미만, 4,000 mg 이상~6,000 mg 미만, 6,000 mg 이상~8,000 mg 미만, 8,000 mg 이상)으로 분류하여 비만과의 연관성을 분석하였다. 연구대상자의 성별에 따른 일반적인 특징에서 신장과 체중, 체질량지수(BMI), 총 에너지섭취량은 남성이 여성보다 유의적으로 높게 확인되었고, 질병관련 변수에서 비만, 고혈압, 당뇨병, 뇌졸중 유병률 또한 남성이 여성보다 유의적으로 높은 값을 보였다. 성별에 따른 교육수준 (p < 0.001), 흡연여부 (p < 0.001), 음주여부 (p < 0.001)에서도 유의한 차이가 확인되었다. 나트륨 섭취량에 따른 신체계측치 및 건강관련 습관에 대해 분석한 결과, 전체 대상자에서 나트륨 섭취량이 증가할수록 신장, 체중, BMI, 총에너지섭취량이 유의적으로 높아지는 것을 확인할 수 있었으며, 남성과 여성에서도 같은 결과를 보였다. 비만, 고콜레스테롤혈증과 고중성지방혈증 유병률은 나트륨 섭취량이 높아짐에 따라 증가하는 경향을 보였고, 남성에서도 유사한 결과가 나타났다. 나트륨 섭취량에 따른 교육수준, 걷기실천율, 흡연여부, 음주여부에서도 유의한 차이가 확인되었다. 성별에 따른 나트륨 섭취량이 비만 유병에 미치는 영향을 교란변수 보정 전후로 비교하여 분석한 결과, 전체 대상자에서는 나트륨섭취량이 증가할수록 2,000 mg 미만 섭취자 대비 비만의 오즈비가 증가하였으며, 남성의 경우 4,000 mg 이상 섭취자부터 유의한 OR값을 보였다. 성별, 나이, 연도, 에너지밀도, 교육수준, 흡연여부, 음주여부, 만성질환 유병여부, 신체활동을 보정하였을 때, 4,000~6,000 mg 섭취그룹 및 8,000 mg 이상 섭취그룹이 2,000 mg 미만 섭취자보다 비만 유병위험이 높게 나타났으며, 남성은 8,000 mg 이상 섭취그룹에서, 여성은 4,000~6,000 mg 섭취자 그룹에서 각각 비만의 유의한 오즈비를 나타내었다.

Keywords

References

  1. Mundstock E, Sarria EE, Zatti H, Mattos Louzada F, Kich Grun L, Herbert Jones M, Guma FT, Mazzola In Memoriam J, Epifanio M, Stein RT, Barb-Tuana FM, Mattiello R. Effect of obesity on telomere length: systematic review and meta-analysis. Obesity (Silver Spring) 2015; 23(11): 2165-2174. https://doi.org/10.1002/oby.21183
  2. Kopelman PG. Obesity as a medical problem. Nature 2000; 404(6778): 635-643. https://doi.org/10.1038/35007508
  3. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, Goldman L. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010; 362(7): 590-599. https://doi.org/10.1056/NEJMoa0907355
  4. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70(1): 3-21. https://doi.org/10.1111/j.1753-4887.2011.00456.x
  5. Khang YH, Park MJ. Trends in obesity among Korean children using four different criteria. Int J Pediatr Obes 2011; 6(3-4): 206-214. https://doi.org/10.3109/17477166.2010.490270
  6. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. 2013-2014 National Health Nutrition Examination Survey Report [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2014 [cited 2015 Dec 1]. Available from: https://knhanes.cdc.go.kr/knhanes/index.do.
  7. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315(21): 2284-2291. https://doi.org/10.1001/jama.2016.6458
  8. Comuzzie AG, Allison DB. The search for human obesity genes. Science 1998; 280(5368): 1374-1377. https://doi.org/10.1126/science.280.5368.1374
  9. Lee JH, Reed DR, Price RA. Familial risk ratios for extreme obesity: implications for mapping human obesity genes. Int J Obes Relat Metab Disord 1997; 21(10): 935-940. https://doi.org/10.1038/sj.ijo.0800498
  10. Slochower J, Kaplan SP, Mann L. The effects of life stress and weight on mood and eating. Appetite 1981; 2(2): 115-125. https://doi.org/10.1016/S0195-6663(81)80005-0
  11. Lahti-Koski M, Pietinen P, Heliövaara M, Vartiainen E. Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. Am J Clin Nutr 2002; 75(5): 809-817. https://doi.org/10.1093/ajcn/75.5.809
  12. Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, Engell RE, Lim SS, Danaei G, Mozaffarian D; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (Nutri-CoDE). Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013; 3(12): e003733. https://doi.org/10.1136/bmjopen-2013-003733
  13. Song DY, Park JE, Shim JE, Lee JE. Trends in the major dish groups and food groups contributing to sodium intake in the Korea National Health and Nutrition Examination Survey 1998-2010. Korean J Nutr 2013; 46(1): 72-85. https://doi.org/10.4163/kjn.2013.46.1.72
  14. Bray GA, Popkin BM. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care 2014; 37(4): 950-956. https://doi.org/10.2337/dc13-2085
  15. Ma Y, He FJ, MacGregor GA. High salt intake: independent risk factor for obesity? Hypertension 2015; 66(4): 843-849. https://doi.org/10.1161/HYPERTENSIONAHA.115.05948
  16. Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, Loustalot F, Dai S, Gunn JP, Tian N, Cogswell ME, Merritt R. Sodium intake and blood pressure among US children and adolescents. Pediatrics 2012; 130(4): 611-619. https://doi.org/10.1542/peds.2011-3870
  17. Larsen SC, Angquist L, Sorensen TI, Heitmann BL. 24h urinary sodium excretion and subsequent change in weight, waist circumference and body composition. PLoS One 2013; 8(7): e69689. https://doi.org/10.1371/journal.pone.0069689
  18. Navia B, Aparicio A, Perea JM, Perez-Farinos N, Villar-Villalba C, Labrado E, Ortega RM. Sodium intake may promote weight gain; results of the FANPE study in a representative sample of the adult Spanish population. Nutr Hosp 2014; 29(6): 1283-1289.
  19. Song HJ, Cho YG, Lee HJ. Dietary sodium intake and prevalence of overweight in adults. Metabolism 2013; 62(5): 703-708. https://doi.org/10.1016/j.metabol.2012.11.009
  20. Oh HW, Kim HJ, Jun DW, Lee SM. Associations between 24-hour urine sodium excretion level and obesity-related metabolic risk factors. Korean J Community Nutr 2015; 20(6): 460-467. https://doi.org/10.5720/kjcn.2015.20.6.460
  21. Oh SW, Han KH, Han SY, Koo HS, Kim S, Chin HJ. Association of sodium excretion with metabolic syndrome, insulin resistance, and body fat. Medicine (Baltimore) 2015; 94(39): e1650. https://doi.org/10.1097/MD.0000000000001650
  22. Kim JH, Lim GE, Kang S, Lee K, Park TJ, Kim J. The relationship between daily sodium intake and obesity in Korean adults. Korean J Health Promot 2015; 15(4): 175-184. https://doi.org/10.15384/kjhp.2015.15.4.175
  23. World Health Organization Western Pacific Region; International Association for the Study of Obesity; International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia Pty Limited; 2000.
  24. Chobanian AV, Hill M. National Heart, Lung, and Blood Institute Workshop on sodium and blood pressure: a critical review of current scientific evidence. Hypertension 2000; 35(4): 858-863. https://doi.org/10.1161/01.HYP.35.4.858
  25. Blaustein MP, Hamlyn JM. Role of a natriuretic factor in essential hypertension: an hypothesis. Ann Intern Med 1983; 98(5 Pt 2): 785-792. https://doi.org/10.7326/0003-4819-98-5-785
  26. Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World J Gastroenterol 2009; 15(18): 2204-2213. https://doi.org/10.3748/wjg.15.2204
  27. Park B, Shin A, Park SK, Ko KP, Ma SH, Lee EH, Gwack J, Jung EJ, Cho LY, Yang JJ, Yoo KY. Ecological study for refrigerator use, salt, vegetable, and fruit intakes, and gastric cancer. Cancer Causes Control 2011; 22(11): 1497-1502. https://doi.org/10.1007/s10552-011-9823-7
  28. World Health Organization. Guideline. Sodium intake for adults and children. Geneva: World Health Organization; 2012.
  29. Cocores JA, Gold MS. The salted food addiction hypothesis may explain overeating and the obesity epidemic. Med Hypotheses 2009; 73(6): 892-899. https://doi.org/10.1016/j.mehy.2009.06.049
  30. Fonseca-Alaniz MH, Brito LC, Borges-Silva CN, Takada J, Andreotti S, Lima FB. High dietary sodium intake increases white adipose tissue mass and plasma leptin in rats. Obesity (Silver Spring) 2007; 15(9): 2200-2208. https://doi.org/10.1038/oby.2007.261
  31. Fonseca-Alaniz MH, Takada J, Andreotti S, de Campos TB, Campana AB, Borges-Silva CN, Lima FB. High sodium intake enhances insulin-stimulated glucose uptake in rat epididymal adipose tissue. Obesity (Silver Spring) 2008; 16(6): 1186-1192. https://doi.org/10.1038/oby.2008.69
  32. Grimes CA, Riddell LJ, Campbell KJ, Nowson CA. Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics 2013; 131(1): 14-21. https://doi.org/10.1542/peds.2012-1628
  33. Libuda L, Kersting M, Alexy U. Consumption of dietary salt measured by urinary sodium excretion and its association with body weight status in healthy children and adolescents. Public Health Nutr 2012; 15(3): 433-441. https://doi.org/10.1017/S1368980011002138
  34. Yoon YS, Oh SW. Sodium density and obesity; the Korea National Health and Nutrition Examination Survey 2007-2010. Eur J Clin Nutr 2013; 67(2): 141-146. https://doi.org/10.1038/ejcn.2012.204
  35. Park YS, Son SM, Lim WJ, Kim SB, Chung YS. Comparison of dietary behaviors related to sodium intake by gender and age. Korean J Community Nutr 2008; 13(1): 1-12.
  36. Jeong YS, Lim HJ, Kim SB, Kim HJ, Son SM. Blood pressure and dietary related risk factors associated with high sodium intake assessed with 24-hour urine analysis for Korean adults. Korean J Community Nutr 2014; 19(6): 537-549. https://doi.org/10.5720/kjcn.2014.19.6.537

Cited by

  1. Association between Sodium Excretion and Obesity of Adults in Gwangju vol.23, pp.1, 2018, https://doi.org/10.5720/kjcn.2018.23.1.38
  2. 소아청소년 체중상태에 따른 식사의 질 평가 및 비만과의 연관성 분석 vol.23, pp.3, 2017, https://doi.org/10.14373/jkda.2017.23.3.263
  3. The salt-taste threshold in untreated hypertensive patients vol.23, pp.None, 2017, https://doi.org/10.1186/s40885-017-0079-8
  4. Impacts of High Sodium Intake on Obesity-related Gene Expression vol.28, pp.5, 2017, https://doi.org/10.17495/easdl.2018.8.28.5.364
  5. Trends of Food Supply and Nutrient Intake in South Korea Over the Past 30 Years vol.7, pp.1, 2017, https://doi.org/10.12944/crnfsj.7.1.09
  6. 2016년 국민건강영양조사에 나타난 식사 횟수에 따른 영양 및 식품섭취 실태조사 - 20, 30대 여자를 중심으로 - vol.33, pp.3, 2017, https://doi.org/10.9799/ksfan.2020.33.3.237