성인 여자에서 대사증후군과 만성 신질환과의 관계 = Metabolic Syndrome and the Risk for Chronic Kidney Disease among Korean Women

다국어 초록 (Multilingual Abstract)

Background: Metabolic syndrome (MetS), characterized by abdominal obesity, hypertriglyceridemia, low highdensity
lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose level, is a common risk factor for
cardiovascular diseases and associated complications. We examined the relationship between the metabolic syndrome
and risk of chronic kidney disease (CKD) in Korean women.
Methods: We used data from 10,170 women, aged 30-89 years, who had visited a health examination center at a tertiary
care hospital in 2006. The data were studied cross-sectionally. MetS was identified using the modified criteria of the National
Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATP Ⅲ). CKD was defined as an estimated GFR < 60 ㎖/
min per 1.73 ㎡. The multivariable-adjusted (adjustment for age, education, body mass index (BMI), alcohol drinking,
smoking, previous coronary heart disease, menopauses and physical inactivity) odds ratio of CKD (95% CI) associated
with each component of the metabolic syndrome was calculated using the logistic regression models.
Results: A total of 1,039 participants have MetS. The multivariable-adjusted odds ratios (OR) of CKD in participants with
MetS, hypertriglyceridemia and high blood pressure compared with participants without such factors were 2.68 (95% CI,
1.77-4.06), 1.96 (95% CI, 1.34-2.88), and 2.00 (95% CI, 1.38-2.89). Compared with the participants with no MetS traits,
those with one, two, equal to or more than three traits of MetS had OR of CKD of 1.24 (95% CI, 0.75-2.06), 1.56 (95% CI,
0.89-2.75), and 2.18 (95% CI, 1.21-3.93), respectively.
Conclusion: We found that Korean women with MetS had an increased risk for developing CKD. Finally, earlier identification
and management of MetS might improve patient health and prevent progression of CKD.

국문 초록 (Abstract)

연구배경: 대사증후군은 복부 비만, 높은 중성지방, 낮은
HDL-콜레스테롤, 높은 혈압, 높은 혈당을 특징으로 하며 관
련 합병증을 발생시킨다. 본 연구는 성인 여성에서 대사증후
군과 만성 신질환과의 관련성을 살펴보고자 하였다.
방법: 2006년 1월부터 12월까지 서울아산병원 검진센터를 방
문한 30세에서 89세의 여성 10,170명으로의 자료를 토대로 단
면 연구를 시행하였다. 대사증후군의 정의는 미국 국립 콜레
스테롤 교육 프로그램 위원회, 제3차보고서(NCEP ATP Ⅲ)의
기준을 이용하였고, 허리둘레는 85 ㎝ 이상을 기준으로 하였
고 만성 신질환의 정의는 사구체 여과율<60 ㎖/min per 1.73 ㎡
로 정의하였다. 연령, 교육 수준, 체질량 지수, 음주력, 흡연력,
관상 동맥 질환, 폐경, 운동 여부를 보정하여 교차비와 95% 신
뢰구간을 구하였다.
결과: 최종 연구 대상 10,170명 중 1,039명이 대사증후군으로
진단되었다. 대사증후군, 높은 중성지방, 높은 혈압을 나타낸
군에서 만성 신질환의 교차비가 2.68 (1.77-4.06), 1.96 (1.34-
2.88), 2.00 (1.38-2.89)으로 증가하였다 (P<0.05). 대사인자
수에 따른 만성 신질환의 교차비는 위험인자의 수가 없을 때
에 비해 1개, 2개, 3개 이상으로 많아질수록 1.24 (0.75-2.06),
1.56 (0.89-2.75), 2.18 (1.21-3.93)로 증가하는 경향을 보였다
(P<0.001).
결론: 성인 여자에서 대사증후군은 사구체 여과율의 감소를
초래하여 만성 신질환의 위험과 연관되어 있다. 결론적으로
대사증후군의 관리가 만성 신질환의 예방에 기여할 수 있을
것이다.

참고문헌 (Reference)

1 이상엽, "심혈관계 질환의 위험인자 예측 지표로서 체질량지수와 허리둘레의 유용성 검토 : 국가간 비교" 대한임상건강증진학회 5 (5): 97-113, 2005

2 Whelton PK, "The role of blood pressure as a risk factor for renal disease: a review of the epidemiologic evidence" 10 : 683-689, 1996

3 Lakka HM, "The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men" 288 : 2709-2716, 2002

4 Chen J, "The metabolic syndrome and chronic kidney disease in U.S.adults" 140 : 167-174, 2004

5 International Diabetes Federation, "The IDF consensus worldwidedefinition of the metabolic syndrome" The Federation

6 Coresh J, "Prevalenceof chronic kidney disease and decreased kidney function in theadult US population: Third National Health and Nutrition ExaminationSurvey" 41 : 1-12, 2003

7 Park HS, "Prevalence and trends of metabolic syndrome in Korea: Korean National Health and Nutrition Survey 1998-2001" 9 : 50-58, 2007

8 Hunsicker LG, "Predictors of the progression of renal diseasein the Modification of Diet in Renal Disease Study" 51 : 1908-1919, 1997

9 Muntner P, "Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study" 58 : 293-301, 2000

10 Mykkänen L, "Microalbuminuria is associated with insulin resistance in nondiabetic subjects: the insulin resistance atherosclerosis study" 47 : 793-800, 1998

11 Lee JE, "Metabolic syndrome, C-reactive protein, and chronic kidney disease in nondiabetic, nonhypertensive adults" 20 : 1189-1194, 2007

12 Kurella M, "Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults" 16 : 2134-2140, 2005

13 Laaksonen DE, "Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study" 156 : 1070-1077, 2002

14 Tanaka H, "Metabolic syndrome and chronic kidney disease in Okinawa, Japan" 69 : 369-374, 2006

15 National Kidney Foundation, "K/DOQI clinical practice guidelinesfor chronic kidney disease: evaluation, classification, andstratification" 39 (39): 1-266, 2002

16 Fujikawa R, "Insulin resistance precedes the appearance of albuminuria in non-diabetic subjects:6 years follow up study" 53 : 99-106, 2001

17 Mänttäri M, "Effects of hypertensionand dyslipidemia on the decline in renal function" 26 : 670-675, 1995

18 Tonelli M, "Effect ofpravastatin on loss of renal function in people with moderatechronic renal insufficiency and cardiovascular disease" 14 : 1605-1613, 2003

19 Fried LF, "Effect of lipid reduction on the progression of renal disease: a meta-analysis" 59 : 260-269, 2001

20 Grundy SM, "Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement" 112 : 2735-2752, 2005

21 Nelson RG, "Development and progression of renal disease in PimaIndians with non-insulin-dependent diabetes mellitus" DiabeticRenal Disease Study Group 335 : 1636-1642, 1996

22 Kim SY, "Current status of dialytic therapy in Korea" 8 : 2-9, 2003

23 Humphrey LL, "Chronic renal failure in non-insulin-dependent diabetes mellitus: a population-based study in Rochester, Minne sota" 111 : 788-796, 1989

24 Hoehner CM, "Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans: The Inter-Tribal Heart Project" 13 : 1626-1634, 2002

25 Lee JE, "Association of metabolic syndrome with microalbuminuria in nonhypertensive type 2 diabetic patients" 106 : c98-c103, 2007

26 Chen J, "Association between the metabolic syndrome and chronic kidney disease in Chinese adults" 22 : 1100-1106, 2007

27 Palaniappan L, "Association between microalbuminuria and the metabolic syndrome: NHANES III" 16 : 952-958, 2003

28 Lee SY, "Appropriate waist circumference cutoff points for central obesity in Korean adults" 75 : 72-80, 2007

29 Levey AS, "Amore accurate method to estimate glomerular filtration rate fromserum creatinine: a new prediction equation. Modification ofDiet in Renal Disease Study Group" 130 : 461-470, 1999

30 임열리, "ATP III의 진단기준에 따른 대사증후군의 유병률과 관련위험요인 분석 -일개 대학병원 건강증진센터 수진자를 대상으로-" 대한가정의학회 24 (24): 135-143, 2003

31 Perneger TV, "A prospective study of blood pressure and serum creatinine. Results from the ‘Clue’ Study and the ARIC Study" 269 : 488-493, 1993