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Title Page

Contents

국문요지 8

BACKGROUNDS AND INTRODUCTION 11

PURPOSE OF THE STUDY 17

1. Educational difference in fruit and vegetable intake in terms of quantity and quality intake 18

SUBJECTS AND METHODS 18

Study population and data sets 18

Dietary information 19

Socioeconomic position and other factors 32

Statistical analysis 32

RESULTS 33

2. The mediation of Fruit and vegetable intake in the relationship between education and Metabolic Syndrome (MetS) 44

SUBJECTS AND METHODS 44

Study population and data sets 44

Definition of metabolic syndrome 44

Dietary and health behavior factors 45

Statistical analysis 45

RESULTS 48

DISCUSSION 62

IMPLICATIONS 75

REFERENCES 77

ABSTRACT 93

List of Tables

TABLE 1. Definition of fruit and vegetables (Total amount and frequency) 24

TABLE 2. Fruit and vegetable groups classified by botanical family 26

TABLE 3. Fruit and vegetables high in carotene, vitamin C and folate 28

TABLE 4. Fruit and/or vegetable groups classified by colors 29

TABLE 5. Vegetables classified by cooking method 31

TABLE 6. General characteristics of subjects: KNHANES IV (2007-9) 36

TABLE 7. Age-adjusted daily mean consumption of total fruit and/or vegetable by education level among middle-aged adults 37

TABLE 8. Age-adjusted daily mean consumption according to botanical family of vegetables by education level among middle-aged adults 38

TABLE 9. Age-adjusted daily mean consumption according to categories of fruits by education level among middle-aged adults 39

TABLE 10. Age-adjusted daily mean consumption according to carotene-, folate-, and vitamin C-rich fruits and/or vegetables by education level among middle-aged adults 40

TABLE 11. Age-adjusted daily mean consumption of fruit and vegetables according to colors by education level among middle-aged adults 41

TABLE 12. Age-adjusted daily mean of variety scores according to varieties of fruits or vegetables by education level among middle-aged adults 42

TABLE 13. Age-adjusted percentages of cooking methods by education level among middle-aged adults 43

TABLE 14. Summarization of the relationship between education level and fruit and vegetable group 51

TABLE 15. Age-adjusted prevalence of metabolic syndrome (MetS) and its components 52

TABLE 16. Age-adjusted prevalence of metabolic Syndrome (MetS) and its components of study participants by education level 53

TABLE 17. Age-adjusted prevalence of selected general characteristics of study participants according to education level 54

TABLE 18. The relationship between fruit and vegetable groups and metabolic syndrome (MetS) 55

TABLE 19. The relationship between fruit and vegetable groups and metabolic syndrome (MetS) 56

TABLE 20. The relationship between fruit and vegetable groups and metabolic syndrome (MetS) 57

TABLE 21. Summirization of the relationship between fruit and vegetable groups and education level and/or MetS 58

TABLE 22. Summirization of the relationship between fruit and vegetable groups and education level and/or MetS 59

TABLE 23. Effect of adjustment for selected food groups of fruit and vegetables on the relation between education and MetS 60

TABLE 24. Effect of adjustment for selected food groups of fruit and vegetables on the relation between education and MetS 61

List of Figures

Fig 1. Mediation model of fruit and vegetable 47

초록보기

연구배경: 사회경제적 위치에 따른 건강 불평등은 식생활, 흡연, 운동, 음주와 같은 건강행위로 일부 설명할 수 있다. 식이 요인은 심뇌혈관질환, 암 등 만성질환과의 관련성이 잘 알려져 있으며, 그 중 과일과 채소는 항산화 영양소를 비롯한 비타민, 무기질, 여러 유용한 물질 등을 함유하고 있어 가장 주목 받는 식이요인 중 하나로 그 종류도 다양하여 만성질환과의 관련성 역학연구에서 양적 섭취뿐만 아니라 질적 섭취를 고려한 다양한 분류가 이용된다. 사회경제적 위치에 따른 건강 불평등에 미치는 과일과 채소섭취의 영향을 파악하기 위해서는 만성질환과의 관련성 분석에 활용되는 양적, 질적 분류를 모두 이용하여, 사회경제적 위치에 따른 불평등을 보이는 분류를 확인하고 불평등에 대한 매개효과가 있는지 규명할 필요가 있다. 이 연구에서는 중년 성인에서 사회경제적 위치 지표 중 교육수준을 이용하여, 1) 사회경제적 위치에 따라 불평등을 보이는 과일과 채소의 양적, 질적 섭취를 파악하고, 2) 교육수준에 따른 대사증후군 불평등에 매개효과가 있는지를 파악하고자 한다.

연구방법: 과일과 채소의 섭취량과 빈도는 국민건강영양조사 4기(2007-9) 자료 중 24시간 회상조사와 식품빈도조사 자료를 이용하였다. 이러한 식이조사를 모두 마치고 교육수준에 대한 정보를 제공하는 중년 성인(40-64세) 6,667 명을 분석대상으로 교육수준에 따른 과일과 채소 섭취 불평등을 분석하였다. 이러한 과일과 채소가 대사증후군 불평등을 매개하는지를 분석하기 위해서, 2007-8년 자료를 이용하여, 열량(500 ~ 4500 kcal/d) 범위를 벗어난 대상자, 심혈관질환, 암, 심근경색의 유병경험이 있는 대상자, 교육수준 정보가 없는 대상자를 제외한 3,415명을 분석에 이용하였다. 사회경제적 위치 지표로는 교육수준을 사용하였고, 중졸 이하, 고졸, 초대졸 이상으로 분류하였다. 교육수준에 따른 과일과 채소의 총 섭취량 또는 빈도를 양적 섭취로 구분하고, 질적 섭취 즉, 식물학적 분류(Botanical family), 색에 따른 분류, 엽산, 비타민 C, 캐로틴이 풍부한 식품에 따른 분류, 다양성, 조리법에 따른 분류를 이용하였다. 연령을 보정한 평균(표준오차)과 분율에 대한 계산은 회귀분석을 이용하여 추정하였고 (PROC SURVEYREG), 교육수준에 따른 대사증후군 불평등에 대한 과일과 채소의 매개효과를 위해서는 로지스틱 회귀분석(PROC SURVEYLOGISTIC)을 이용하였다. 혼란변수로는 현재흡연, 알코올 섭취, 정기적 운동, 종합비타민제 복용, 그리고 체질량지수, 에너지와 탄수화물 섭취량을 고려하였다. 혼란변수를 보정했을 때의 위험도를 기준으로 하여 선택된 과일과 채소 그룹을 넣었을 때의 변화된 백분율(percentage change)을 상대적 설명력으로 평가하였다. 대사증후군은 NCEP ATP III를 기본으로 하여 한국인에 적합한 허리둘레(남자: 90cm, 여자: 85cm)와 공복혈당(100mg/dl)을 사용하였다. 위험요인이 3개 이상인 경우를 대사증후군으로 정의하였다.

연구결과: 교육수준이 낮은 군에서 교육수준이 높은 군에 비해 높게 섭취하는 것은 김치의 총 섭취량 및 김치를 통한 조리법 이용율이었다. 반면, 교육수준이 낮은 군에서 낮게 섭취하는 것들은 다음과 같다: 1) 남녀 모두에서 과일과 채소의 총 섭취량 및 빈도, 과일의 총 섭취량 및 빈도, 김치를 제외한 채소 섭취량, 채소의 섭취빈도, 여자에서는 추가적으로 채소의 총 섭취량; 2) 식물학적 분류(botanical family)를 이용한 채소군은 남자에서는 버섯섭취량, 여자에서는 (배추와 무를 제외한) 십자화과 채소, 알리움 채소, 과일군은 남녀모두 이과 과일과 멜론, 남자에서 추가적으로 감귤류; 3) 남녀 모두에서 캐로틴이 풍부한 과일과 채소, 여자에서 엽산이 풍부한 과일과 채소; 4) 색을 이용한 분류로는 남녀 모두의 경우 적색 과일과/또는 채소, 녹색 잎채소, 녹황색채소로 나타났고, 추가적으로 남자에서 유의한 차이를 보이는 군은 황색 과일과 채소, 황색 과일과/또는 채소; 5) 다양성으로는 남녀 모두에서는 나물 음식의 가짓수과 채소 음식(나물, 생채, 김치) 가짓수의 총합, 과일의 다양성, 남자에서 추가적으로 생채 음식의 가짓수; 6) 조리방법으로는 남녀 모두에서 볶음과 익혀먹는(cooked) 채소의 섭취, 여자에서 추가적으로 생채로 먹는 채소 섭취에서 나타났다.

본 연구 대상자들의 대사증후군의 유병률은 남자 32.6%, 여자 24.6% 이었고, 교육수준에 따른 대사증후군 불평등은 여자에서만 관찰되었다. 여자의 경우, 과일과 채소 분류 중 교육수준에 따른 불평등이 있으면서 대사증후군과 관련성을 보이는 것은 과일과 채소의 총 섭취량, 김치를 제외한 채소 섭취량, 과일의 총 섭취량 및 섭취빈도, 과일의 최소 섭취량(100g/일) 및 섭취빈도(1회/일), (배추와 무를 제외한) 십자화과 채소, 녹황색채소, 적색 과일과/또는 채소, 엽산 또는 캐로틴이 풍부한 과일과 채소, 채소 음식의 다양성, 과일의 다양성, 조리법 중 생채 이용율이었다. 이러한 식품군 각각의 매개효과는 작았지만, 이러한 식품군을 동시에 모델에 넣었을 때 대사증후군의 불평등 감소에 대한 기여 정도가 증가하였다 (교육수준이 낮은 두 그룹의 기여정도 평균: 최대 16%). 이때의 다변량 모델에서 녹황색채소와 (배추와 무를 제외한) 십자화과 채소, 과일의 총 섭취 빈도의 경우 대사증후군과 유의미한 음의 상관성을 유지하였다. 또한, 과일의 섭취 빈도가 증가할수록 대사증후군 불평등 감소에 대한 기여 정도는 16%였고, 적어도 하루에 1회 이상 섭취할 경우 13% 의 감소를 기대할 수 있었다. 이러한 대사증후군 불평등에 대한 감소 효과는 특히, 교육수준이 낮은 집단(중학교 졸업이하)에서 더 증가하는 것처럼 보였다 (15~20%).

결론: 과일과 채소의 총 섭취량 및 빈도를 나타내는 양적 섭취뿐만 아니라 과일과 채소를 식물학적 분류, 특정 영양소의 함유, 색, 조리방법, 및 다양성에 따른 분류를 통한 질적 섭취에서도 교육수준에 따른 불평등이 관찰되었다. 교육수준에 따른 대사증후군 불평등을 매개하는 과일과 채소 분류로는 적색 과일과 채소, 적색 채소, 녹황색 채소, (배추와 무를 제외한) 십자화과 채소, 과일의 섭취빈도, 과일의 최소 섭취빈도(1회/일)로 나타났다. 위 연구는 과일과 채소 섭취가 대사증후군 불평등을 매개할 가능성이 있음을 연구한 첫 연구로, 위의 결과를 통해 생활습관 중 식이요인이 대사증후군 불평등을 매개할 가능성이 있으며, 만성질환 위험과 관련된 식생활 요인의 매개효과를 파악하는데 유용할 수 있음을 보여준다.

참고문헌 (151건) : 자료제공( 네이버학술정보 )

참고문헌 목록에 대한 테이블로 번호, 참고문헌, 국회도서관 소장유무로 구성되어 있습니다.
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47 Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. 네이버 미소장
48 Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. 네이버 미소장
49 Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. 네이버 미소장
50 Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index United States, 2003–2006. Natl Health Stat Report 2009, 131-7. 미소장
51 Prevalence of metabolic syndrome and its risk factors in adult Malaysians: Results of a nationwide survey 네이버 미소장
52 Educational inequalities in metabolic syndrome vary by ethnic group: Evidence from the SUNSET study 네이버 미소장
53 Educational disparities in the metabolic syndrome in a rapidly changing society—the case of South Korea 네이버 미소장
54 A traditional Korean dietary pattern and metabolic syndrome abnormalities 네이버 미소장
55 伊朗Babol中年婦女的飲食模式及代謝症候群 네이버 미소장
56 The Effect of Mediterranean Diet on Metabolic Syndrome and its Components: A Meta-Analysis of 50 Studies and 534,906 Individuals 네이버 미소장
57 Food consumption, nutrient intake and the risk of having metabolic syndrome: the DR's EXTRA Study. 네이버 미소장
58 Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. 네이버 미소장
59 High consumptions of grain, fish, dairy products and combinations of these are associated with a low prevalence of metabolic syndrome 네이버 미소장
60 Pathways between Socioeconomic Determinants of Health 네이버 미소장
61 Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. 네이버 미소장
62 A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study. 네이버 미소장
63 Education and Occupational Social Class: Which Is the More Important Indicator of Mortality Risk? 네이버 미소장
64 Modern and healthy?: socioeconomic differences in the quality of diet. 네이버 미소장
65 A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables 네이버 미소장
66 Korea Centers for Disease Control and Prevention Korean National Health and Nutrition Examination Survey. From http//knhanescdcgokr/ Accessed 20 October, 2009. 미소장
67 Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. 네이버 미소장
68 Vegetables, Fruit, and Cancer Prevention: A Review 네이버 미소장
69 Effect of dietary garlic (Allium Sativum) on the blood pressure in humans--a pilot study. 네이버 미소장
70 Cholesteryl ester transfer protein activity and atherogenic parameters in rabbits supplemented with cholesterol and garlic powder 네이버 미소장
71 Major Dietary Factors and Prostate Cancer Risk: A Prospective Multicenter Case-Control Study 네이버 미소장
72 Onions: a source of unique dietary flavonoids. 네이버 미소장
73 Bioaccessibility of flavonoids and total phenolic content in onions and its relationship with antioxidant activity. 네이버 미소장
74 Dietary Mushroom Intake and the Risk of Breast Cancer Based on Hormone Receptor Status 네이버 미소장
75 Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. 네이버 미소장
76 A case–control study on the dietary intake of mushrooms and breast cancer risk among Korean women 네이버 미소장
77 Algae consumption and risk of type 2 diabetes Korean National Health and Nutrition Examination Survey in 2005. J Nutr Sci Vitaminol (Tokyo) 2010, 56(1)13-18. 미소장
78 A case-control study on seaweed consumption and the risk of breast cancer. 네이버 미소장
79 Cholesterol-lowering nutraceuticals and functional foods. 네이버 미소장
80 Could dietary seaweed reverse the metabolic syndrome? Asia Pac J Clin Nutr 2009,18(2)145-154. 미소장
81 Ministry of Health and Welfare and Korea Centers for Disease Control and Prevention 2008 National Health statistics. In The 4th National health and nutrition survey (2008). Seoul Korea Centers for Disease Control and Prevention; 2009. 미소장
82 Estimated dietary intakes of flavonols, flavanones and flavones in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24 hour dietary recall cohort. 네이버 미소장
83 Frequency of Citrus Fruit Intake Is Associated With the Incidence of Cardiovascular Disease: The Jichi Medical School Cohort Study 네이버 미소장
84 Dietary factors and pancreatic cancer: the role of food bioactive compounds. 네이버 미소장
85 Associations of dietary flavonoids with risk of type 2 diabetes, and markers of insulin resistance and systemic inflammation in women: a prospective study and cross-sectional analysis. 네이버 미소장
86 Fruit and vegetable intake and risk of acute coronary syndrome. 네이버 미소장
87 A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. 네이버 미소장
88 Food synergy an operational concept for understanding nutrition. Am J Clin Nutr 2009, 89(5)1543S-1548S. 미소장
89 Fruit and Vegetables in Cancer Prevention 네이버 미소장
90 Colours of fruit and vegetables and 10-year incidence of CHD. 네이버 미소장
91 Vegetables, fruits and phytoestrogens in the prevention of diseases 네이버 미소장
92 Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: a pilot community study in Hong Kong. 네이버 미소장
93 Comparison of Dietary Patterns by Sex and Urbanization in Different Economic Status. 네이버 미소장
94 The importance of composite foods for estimates of vegetable and fruit intakes. 네이버 미소장
95 Ministry of Health and Welfare Health Plan 2010. In Ministry of Health and Welfare. Seoul, Korea; 2002. 미소장
96 The Korean Nutrition Society Dietary Reference Intakes for Koreans. In. Seoul, Korea The Korean Nutrition Society; 2005. 미소장
97 Dietary Intake, Eating Habits, and Metabolic Syndrome in Korean Men 네이버 미소장
98 Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. 네이버 미소장
99 Historical perspective on garlic and cardiovascular disease. 네이버 미소장
100 Rural Resources Development Institute Food composition table. 2006. 미소장
101 Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults. 네이버 미소장
102 The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet. 네이버 미소장
103 The role of folate, antioxidant vitamins and other constituents in fruit and vegetables in the prevention of cardiovascular disease: the epidemiological evidence. 네이버 미소장
104 Dietary factors that affect the bioavailability of carotenoids. 네이버 미소장
105 Lycopene is more bioavailable from tomato paste than from fresh tomatoes. 네이버 미소장
106 Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands 네이버 미소장
107 Appropriate waist circumference cutoff points for central obesity in Korean adults 네이버 미소장
108 Follow-up report on the diagnosis of diabetes mellitus. 네이버 미소장
109 Nutritional epidemiology Oxford University Press, Inc.; 1998. 미소장
110 The nutrition transition in South Korea. 네이버 미소장
111 Nutrition policy in South Korea. 네이버 미소장
112 Korea Rural Economic Institute Food supply and demand table. Korea Rural Economic Institute 2006. 미소장
113 A National Statistics Publication by the Department for Environment and Food and Rural Affairs Family Food in 2005-06. In. London, UK A National Statistics Publication by the Department for Environment, Food and Rural Affairs; 2006. 미소장
114 Japanese Ministry of Health and Labour and Welfare Outline for the Results of the National Health and Nutrition Survey Japan, 2007. 2007. 미소장
115 Socio-economic differences in the consumption of vegetables, fruit and berries in Russian and Finnish Karelia 1992-2007. Eur J Public Health 2010. 미소장
116 Cholesterol-Lowering Effect and Anticancer Activity of Kimchi and Kimchi Ingredients 소장
117 Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey 네이버 미소장
118 Variation in fruit and vegetable consumption among adults in Britain. An analysis from the dietary and nutritional survey of British adults. 네이버 미소장
119 Greater variety in fruit and vegetable intake is associated with lower inflammation in Puerto Rican adults 네이버 미소장
120 Diet and socioeconomic position does the use of different indicators matter? Int J Epidemiol 2001, 30(2)334-340. 미소장
121 Trends in nutritional inequality by educational level: A case of South Korea 네이버 미소장
122 A review of factors affecting the food choices of disadvantaged women. 네이버 미소장
123 Do Health Behaviors Moderate the Effect of Socioeconomic Status on Metabolic Syndrome? 네이버 미소장
124 Social gradient in the metabolic syndrome not explained by psychosocial and behavioural factors: evidence from the Copenhagen City Heart Study∗ 네이버 미소장
125 A Cross-Sectional Study of Socioeconomic Status and the Metabolic Syndrome in Korean Adults. Ann Epidemiol 2007, 17(4)320-326. 미소장
126 Cardiovascular disease and nutrition Na and dietary risk factors. In Symposium on national Health investment and chronic disease management 4.3 2007; The Korea Chamber of Commerce and Industry The Ministry of Health-Welfare, Korea Centers for Disease Control and Prevention; 2007. 미소장
127 A Factor of Fasting Blood Glucose and Dietary Patterns in Korean Adults Using Data From the 2007, 2008 and 2009 Korea National Health and Nutrition Examination Survey. J Prev Med Public Health 2011, 44(2)93-100. 미소장
128 Alcohol consumption and the metabolic syndrome in Korean adults the 1998 Korean National Health and Nutrition Examination Survey. Am J Clin Nutr 2004, 80(1)217-224. 미소장
129 Chronic Stress At Work And The Metabolic Syndrome: Prospective Study 네이버 미소장
130 Social gradient in the metabolic syndrome not explained by psychosocial and behavioural factors: evidence from the Copenhagen City Heart Study∗ 네이버 미소장
131 Socioeconomic Disparities in Metabolic Syndrome Differ by Gender: Evidence from NHANES III 네이버 미소장
132 Preventive effects of diets supplemented with sweetie fruits in hypercholesterolemic patients suffering from coronary artery disease 네이버 미소장
133 Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands. 네이버 미소장
134 Fruit and vegetable consumption and risk factors for cardiovascular disease 네이버 미소장
135 Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: the Bogalusa Heart Study. 네이버 미소장
136 Role of physical activity and diet in incidence of hypertension: a population-based study in Portuguese adults 네이버 미소장
137 Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial 네이버 미소장
138 Cholesterol-lowering effects of dietary fiber: a meta-analysis. 네이버 미소장
139 Inverse association of serum carotenoids with prevalence of metabolic syndrome among Japanese 네이버 미소장
140 Associations of serum carotenoid concentrations with the metabolic syndrome: interaction with smoking. 네이버 미소장
141 Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer 네이버 미소장
142 The association of fruits, vegetables, antioxidant vitamins and fibre intake with high-sensitivity C-reactive protein: sex and body mass index interactions 네이버 미소장
143 Plasma C-reactive protein and homocysteine concentrations are related to frequent fruit and vegetable intake in Hispanic and non-Hispanic white elders. 네이버 미소장
144 Anti-inflammatory effects of plant-based foods and of their constituents. 네이버 미소장
145 Measuring socio-economic position in dietary research: is choice of socio-economic indicator important? 네이버 미소장
146 Nutrition knowledge and food consumption can nutrition knowledge change food behaviour? Asia Pac J Clin Nutr 2002, 11 Suppl 3S579-585. 미소장
147 Control constructs: Do they mediate the relation between educational attainment and health behaviour? 네이버 미소장
148 Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling. 네이버 미소장
149 Does social class predict diet quality? Am J Clin Nutr 2008, 871107-1117. 미소장
150 Public health nutrition. 네이버 미소장
151 Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. 네이버 미소장

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