일부 농촌 노인의 고혈압 유무에 따른 식이섭취 변화

국문 초록 (Abstract)

노인의 건강은 영양섭취 상태에 영향을 받으며 국민건강영양조사에서(2005) 노인은 전체적으로 대부분의 영양소 섭취량과 질이 낮은 것으로 나타났다. 농촌 노인의 경우 도시지역 노인과 도시의 일부 저 소득층 노인의 영양섭취보다 상대적으로 빈약하게 나타나, 농촌 노인의 영양섭취가 문제가 있음을 알 수 있다. 2000년 우리나라는 이미 고령화 사회에 진입하였으며, 농가 인구의 고령화율은 33.3%로 전국 인구 고령화율 10.3%에 비해 23% 높게 나타났다. 만성퇴행성 질환은 고령인구와 함께 증가하고 있으며, 그 중 고혈압은 만 30세 이상 유병율이 전체의 25.6%, 남자는 26.8%, 여자는 24.4%로 남자가 높으며, 남녀 모두 연령이 많을수록 증가하는 현상을 보이는 질환이다. 농촌노인의 경우 여성일수록, 비만과 연령이 증가할수록 고혈압 유병율이 높은 것으로 보고 되었다. 이렇게 성인과 노인계층에 유병율이 높은 고혈압은 식생활 형태와 매우 관련성이 높으며, 식생활 개선 시 특히 소금섭취를 감소하였을 때 혈압 감소효과를 볼 수 있다. 본 연구에서는 농촌 노인의 고혈압 유병율이 높고 식생활 중 과잉의 나트륨 섭취가 문제가 되고 있음을 인식하고, 조사대상자를 고혈압 유, 무 그룹으로 판정 후 영양소 섭취 변화와 다빈도, 다소비 음식 및 식품과 나트륨 기여 음식을 분석하였다. 조사지역은 농촌 지역 장수마을 4곳(충남연기군, 강원 홍천군, 전남 담양군, 경북 안동시)의 65세 이상의 노인을 대상으로 2007년 6월 16부터 2009년 2월까지 1～4차에 걸쳐 조사하였다. 1차 조사에 영양 상태를 판정하였고, 3차 조사의 영양교육은 개인별 영양섭취 결과지를 배부하며 1인 상담을 해 주었고, 마을회관(노인정) 실내 벽면에 포스터 전시, 1회 집단교육을 실시하였다. 그 후 4차 조사 때 영양 상태를 다시 평가하였으며, 이 모든 조사와 교육에 참여한 51명을 대상으로 분석을 실시하였다. 대상자의 개인별 면담을 통해 24시간 회상법을 통한 식이섭취조사와 신체계측을 하였으며, 1·4차 조사에서 수축기 혈압 140mmHg이상 이완기 혈압 90mmHg 이상으로 둘 중에 하나라도 높으면 고혈압 대상자 그룹으로 판정하였다. 분석은 식이섭취상태조사는 Can-pro 3.0을, 수집된 자료는 SPSS(Statistical Package for Science Version 14.0)와 SAS를 이용하였고 통계적 유의성은 α=0.05 수준에서 검정하였다. 1·4차 전체 대상자는 51명이며, 고혈압 유 그룹은 34명, 고혈압 무 그룹은 17명으로 나타났다. 일반적 특성을 살펴보면 연령, 신장, 이완기 혈압은 유의하게 증가하였고, 허리둘레, 엉덩이 둘레, WHR은 유의하게 감소하였다. 영양상태 변화는 전체 대상자에서는 당질, 고혈압 유 그룹에서는 열량과 당질, 고혈압 무 그룹에서는 비타민 A를 제외한 모든 영양소 섭취가 교육 전보다 교육 후에 증가하였으며, 대부분 영양소의 섭취는 부족한 반면 나트륨의 섭취량은 높은 편이며, 고혈압 유 그룹에서는 열량이 감소하였음에도 불구하고 나트륨섭취는 증가였다. 고혈압 유 그룹에서는 비타민 E, C, B2, 엽산, 인, 칼륨이, 고혈압 무 그룹에서는 단백질, 비타민 E, B6, 칼슘, 인, 철분이 유의적으로 증가하였다. 다빈도 식품은 모든 그룹에서 순위에 약간의 차이는 있지만, 쌀- 마늘 - 파로 나타났으며, 상위 순위에 양념류가 많았고, 다소비 식품은 모든 그룹에서 쌀이 1순위이며, 고혈압 유 그룹 순위에서는 주류가, 고혈압 무 그룹 순위에서는 우유와 요구르트가 나타났으며, 교육 후 장류가 순위에 나타나지 않았고, 상위순위에 기호식품, 유제품, 채소와 과일 등이 나타났다. 다빈도 음식은 모든 그룹에서 배추김치가 1순위로 배추김치-잡곡밥-쌀밥 등의 순이었으며, 다소비 음식은 밥 종류가 1순위로 나타났으며, 그룹별 순위의 차이는 있으나 2,3위에 과일과 배추김치가 나타났다. 교육 전 된장을 이용한 국, 찌개 종류가 순위에 나타났으나, 교육 후 채소를 이용한 나물종류와 두부와 생선을 이용한 찌개 종류나 채소를 이용한 나물과 유제품등이 순위에 나타났다. 전체 대상자의 나트륨 공급 음식 순위를 살펴보면 교육 전·후 배추김치가 1순위로 나타났으며, 주요 음식군 순위는 교육 전·후 순위의 차이는 있으나 국 및 탕류 , 김치류가 1, 2위에 있었으며, 교육 전 3위 장류가 교육 후 순위에 없었다.
이상의 결과를 보면 농촌노인들은 영양교육 후 전체대상자 영양소의 섭취가 증가하였고, 고혈압 유 그룹은 고혈압 무 그룹보다 우유와 요구르트 섭취가 부족한 반면 주류의 섭취는 많은 것으로 나타나, 고혈압 유 그룹에는 적절한 식품 선택 요령과 섭취요령에 대한 지속적인 영양교육이 반드시 필요하다고 생각되며, 나트륨 공급 음식 순위에서는 영양교육 후 된장을 이용한 음식의 가짓수가 줄고, 식재료가 다양하게 나타났으며, 장류가 순위에 나타나지 않음을 볼 때, 소금 섭취를 줄일 수 있는 식재료의 선택이나 조리방법, 유제품을 포함한 균형 잡힌 식단의 구성 등, 식생활 개선에 도움이 되며, 농촌 노인의 실생활을 배려한 영양교육 및 상담이 차후 이루어 져야 한다고 사료 된다.

다국어 초록 (Multilingual Abstract)

Elders' health is affected by the condition of nutrition and according to a survey on the national health and nutrition(2005), most elders had low nutrition and low quality of it. In case of those in rural areas, it was poorer than those in urban areas and low-income class in cities, which shows a problem in their nutrition. In 2000, Korea already entered into an aging society and the ratio of the aged in rural population was 33.3%, which was 23% higher than 10.3%, the national average ratio. Chronic degenerative diseases are increasing with the aged populations, among which hyper-tension has prevalence of 25.6% of all populations in those with over age of 30; male 26.8% and female 24.4%, slightly higher in male; and increasing as age gets higher. In case of elders in rural areas, it was reported that female has higher prevalence of hyper-tension as obesity and age increase. Like this, hyper-tension of which prevalence is higher in adults and elders is closely related to dietary life patterns and blood pressure may be decreased if the dietary life is improved, especially when salt intake is reduced.
This study recognized that elders in rural areas have higher prevalence of hyper-tension and sodium intake among their dietary life is problematic and divided the subjects of survey into a group with hyper-tension and one without it, and analyzed the changes in their nutrient intake, foods that they consume frequently and much and that contribute to sodium intake.
The survey were carried out for elders over 65 years old four villages of the long-lived (Yeongi-gun, Chungnam; Hongcheon-gun, Gangwon; Damyang-gun, Jeonnam; and Andong-si, Gyeongbuk) from June 16, 2007 to February, 2009, over the first to fourth surveys.
The first survey decided their nutrition status, distributed result sheets to the individual for nutrition education consulting one by one and then displayed posters on the wall inside Community Center(Elders' Hall) and had a group meeting. And then their nutrition status was assessed four times, analyses of the results of 51 participants in all surveys and educations were carried out. Through individual interviews with the subjects, dietary survey through 24 hour recalling method and physical measurement were done, and those whose blood pressure is either higher than 140mmHg in contraction and 90mmHg in relaxation during first to fourth surveys were put into the group with hyper-tension. For the analysis of dietary intake status, Can-pro 3.0 was used and for the data collected, SPSS(Statistical Package for Science Version 14.0) and SAS were used, and statistical significance was tested at α=0.05. The number of subjects for the fourth survey was 51 persons: the group with hyper-tension was 34 persons and that without it, 17.
To examine the general characteristics, age, height, and blood pressure in relaxation increased significantly while waist measurement, hip measurement, and WHR decreased significantly. For the changes in their nutrition status, all nutrient intake increased in the entire subjects, except saccharinity; the group with hyper-tension, calory and saccharinity; that without it, Vitamin A after the education however most nutrient intake was lacking while sodium intake tended to be high and in the group with hyper-tension, calory decreased while sodium intake increased. In the group with hyper-tension, Vitamins E, C, B2, folic acid, phosphorus, potassium significantly increased while that without it, protein, Vitamins E, B6, Calcium, phosphorus and iron.
Frequent foods were in the order of rice, garlic and green onion with a slight difference in all groups and much seasonings appeared in upper ranking, and in all groups, rice was at the top; in the group with hyper-tension, alcohol and in that without hyper-tension, milk and yogurt, and there were no sauces and pastes in the ranking after the education, and favorite foods, dairy products and vegetables and fruits appeared at upper ranking. For frequent foods, cabbage Kimchi was at the first place in all groups followed by Kimchi, boiled rice and cereals, and boiled rice, and for the most consumption foods, boiled-rices took the first place and with difference between the groups, followed by fruits and cabbage Kimchi appearing at the second and third places. Soup and pot stew appeared in the ranking before the education however after the education, seasoned vegetables and pot stews using Tofu and fish and dairy products appeared in the ranking. To examine the order of sodium supply for the entire subjects, cabbage Kimchi occupied the first place before and after the education and for the ranking of major food groups, soups and hot pots and Kimchi were at the first and second places with difference in ranking before and after the education while sauces and pastes were not in the ranking after the education.
In the above results, elders in rural areas took in more nutrients and the group with hyper-tension has less milk and yogurt while more alcohol than that without hyper-tension so it is necessary to educate constantly the group how to choose appropriate foods and to take in them and in the order of foods supplying sodium, judging from the fact that, after the education, the number of the kinds of foods using soybean paste(Doenjang) decreased, ingredients got more diverse, and sauces and pastes disappeared from the ranking, it may be helpful for improving dietary life such as selecting ingredients or the art of cooking and making balanced menu including dairy products, and it seems that education and consulting about nutrition considering the life of elders in rural areas should be done in the future.
Elders' health is affected by the condition of nutrition and according to a survey on the national health and nutrition(2005), most elders had low nutrition and low quality of it. In case of those in rural areas, it was poorer than those in urban areas and low-income class in cities, which shows a problem in their nutrition. In 2000, Korea already entered into an aging society and the ratio of the aged in rural population was 33.3%, which was 23% higher than 10.3%, the national average ratio. Chronic degenerative diseases are increasing with the aged populations, among which hyper-tension has prevalence of 25.6% of all populations in those with over age of 30; male 26.8% and female 24.4%, slightly higher in male; and increasing as age gets higher. In case of elders in rural areas, it was reported that female has higher prevalence of hyper-tension as obesity and age increase. Like this, hyper-tension of which prevalence is higher in adults and elders is closely related to dietary life patterns and blood pressure may be decreased if the dietary life is improved, especially when salt intake is reduced.
This study recognized that elders in rural areas have higher prevalence of hyper-tension and sodium intake among their dietary life is problematic and divided the subjects of survey into a group with hyper-tension and one without it, and analyzed the changes in their nutrient intake, foods that they consume frequently and much and that contribute to sodium intake.
The survey were carried out for elders over 65 years old four villages of the long-lived (Yeongi-gun, Chungnam; Hongcheon-gun, Gangwon; Damyang-gun, Jeonnam; and Andong-si, Gyeongbuk) from June 16, 2007 to February, 2009, over the first to fourth surveys.
The first survey decided their nutrition status, distributed result sheets to the individual for nutrition education consulting one by one and then displayed posters on the wall inside Community Center(Elders' Hall) and had a group meeting. And then their nutrition status was assessed four times, analyses of the results of 51 participants in all surveys and educations were carried out. Through individual interviews with the subjects, dietary survey through 24 hour recalling method and physical measurement were done, and those whose blood pressure is either higher than 140mmHg in contraction and 90mmHg in relaxation during first to fourth surveys were put into the group with hyper-tension. For the analysis of dietary intake status, Can-pro 3.0 was used and for the data collected, SPSS(Statistical Package for Science Version 14.0) and SAS were used, and statistical significance was tested at α=0.05. The number of subjects for the fourth survey was 51 persons: the group with hyper-tension was 34 persons and that without it, 17.
To examine the general characteristics, age, height, and blood pressure in relaxation increased significantly while waist measurement, hip measurement, and WHR decreased significantly. For the changes in their nutrition status, all nutrient intake increased in the entire subjects, except saccharinity; the group with hyper-tension, calory and saccharinity; that without it, Vitamin A after the education however most nutrient intake was lacking while sodium intake tended to be high and in the group with hyper-tension, calory decreased while sodium intake increased. In the group with hyper-tension, Vitamins E, C, B2, folic acid, phosphorus, potassium significantly increased while that without it, protein, Vitamins E, B6, Calcium, phosphorus and iron.
Frequent foods were in the order of rice, garlic and green onion with a slight difference in all groups and much seasonings appeared in upper ranking, and in all groups, rice was at the top; in the group with hyper-tension, alcohol and in that without hyper-tension, milk and yogurt, and there were no sauces and pastes in the ranking after the education, and favorite foods, dairy products and vegetables and fruits appeared at upper ranking. For frequent foods, cabbage Kimchi was at the first place in all groups followed by Kimchi, boiled rice and cereals, and boiled rice, and for the most consumption foods, boiled-rices took the first place and with difference between the groups, followed by fruits and cabbage Kimchi appearing at the second and third places. Soup and pot stew appeared in the ranking before the education however after the education, seasoned vegetables and pot stews using Tofu and fish and dairy products appeared in the ranking. To examine the order of sodium supply for the entire subjects, cabbage Kimchi occupied the first place before and after the education and for the ranking of major food groups, soups and hot pots and Kimchi were at the first and second places with difference in ranking before and after the education while sauces and pastes were not in the ranking after the education.
In the above results, elders in rural areas took in more nutrients and the group with hyper-tension has less milk and yogurt while more alcohol than that without hyper-tension so it is necessary to educate constantly the group how to choose appropriate foods and to take in them and in the order of foods supplying sodium, judging from the fact that, after the education, the number of the kinds of foods using soybean paste(Doenjang) decreased, ingredients got more diverse, and sauces and pastes disappeared from the ranking, it may be helpful for improving dietary life such as selecting ingredients or the art of cooking and making balanced menu including dairy products, and it seems that education and consulting about nutrition considering the life of elders in rural areas should be done in the future.

목차 (Table of Contents)

• Ⅰ. 서론 1
• Ⅱ. 문헌고찰 4
• 1. 노인의 영양상태 4
• 2. 고혈압 7
• 3. 나트륨 섭취 9
• Ⅲ. 연구내용 및 방법 11
• 1. 조사대상 및 기간 11
• 2. 영양상태 판정 11
• 2.1 혈압 및 신체계측치 측정 11
• 2.2 식이섭취조사 11
• 3. 영양교육실시 12
• 4. 연구 분석 방법 12
• 4.1 신체계측 평가 12
• 4.2. 영양소 섭취 평가 13
• 4.2.1 영양의 질적 지수( INQ ) 13
• 4.2.2 한국인 영양섭취 기준(KDRIs)과 개인섭취량 비교 13
• 4.3. 식품섭취평가 13
• 4.3.1 다빈도 다소비 식품 음식 빈도 섭취량 및 비율 13
• 4.3.2 나트륨 섭취에 기여하는 음식 14
• 5. 통계처리 14
• Ⅳ. 결과 및 고찰 15
• 1. 조사대상자의 일반적 특성 15
• 2. 농촌 노인의 영양교육 후 영양소 섭취 변화 17
• 2.1 영양교육 후 고혈압 유무에 따른 영양소 섭취 변화 17
• 2.2 영양교육 후 고혈압 유무에 따른 열량 1000Kcal당 영양소 섭취변화 21
• 2.3 농촌 노인의 영양교육 후 고혈압 유무에 따른 INQ 24
• 2.4 농촌 노인의 영양교육 후 고혈압 유무에 따른 DRIs 28
• 3. 농촌 노인의 영양교육 후고혈압 유무에 따른 다빈도, 다소비 식품 및 음식 변화 32
• 3.1 농촌 노인의 영양교육 후 고혈압 유무에 따른 다빈도 식품 32
• 3.2 영양교육 후 고혈압 유무에 따른 다소비 식품 36
• 3.3 영양교육 후 고혈압 유무에 따른 다빈도 음식 40
• 3.4 영양교육 후 고혈압 유무에 따른 다소비 음식 44
• 4. 농촌 노인의 영양교육 후 나트륨 섭취에 기여하는 음식 48
• 4.1. 나트륨 섭취에 기여하는 음식 48
• 4.2. 나트륨 섭취에 기여하는 주요 음식군 53
• 4.3 음식군별 음식의 나트륨 섭취량 57
• Ⅴ. 요약 및 결론 70
• Ⅵ. 참고문헌 77
• ABSTRACT 86
• 부록 90