Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
권호 표지
DOI QR코드

DOI QR Code

Association of Hemoglobin A1c with Visceral Fat Measured by Computed Tomography in Nondiabetic Adults

당뇨병이 없는 농촌지역의 건강한 성인 남녀에서 당화혈색소와 내장지방과의 관계

  • Han, A Lum (Department of Family Medicine, Hospital of Wonkwang University) ;
  • Shin, Sae-Ron (Department of Family Medicine, Hospital of Wonkwang University) ;
  • Park, Seong-Hoon (Department of Radiology Medicine, Hospital of Wonkwang University) ;
  • Lee, Jeong Mi (Department of Public Health, Wonkwang University Graduate School)
  • 한아름 (원광대학병원 가정의학과) ;
  • 신새론 (원광대학병원 가정의학과) ;
  • 박성훈 (원광대학병원 진단방사선과) ;
  • 이정미 (원광대학교 대학원 보건학과)
  • Received : 2012.06.20
  • Accepted : 2012.10.17
  • Published : 2012.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: A prediabetes hemoglobin A1c (HbA1c) level of 5.7%-6.4% is considered a risk factor for diabetes mellitus and cardiovascular disease (CVD) in the USA. In this study, we assessed the HbA1c and visceral fat levels as CVD risk factors in health check-up examinees who were not yet diagnosed with diabetes. Methods: Totally, 507 study subject were categorized as per criteria of the American Diabetes Association, depending on whether the HbA1c level was ${\geq}5.7%$ or <5.7%. Lipid levels, blood pressure, BMI (kg/$m^2$), total abdominal, and visceral fat levels were measured by computed tomography. Results: The mean of HbA1c in the male group was larger than the mean in the female group and their values were, respectively, $6.03{\pm}0.82%$ and $5.88{\pm}0.72%$(p<0.05). Only the mean values of age and visceral fat area were different between $HbA1c{\geq}5.7%$ and <5.7% in both male and female group(p<0.05). Visceral fat levels were significantly associated with HbA1c in the group of HbA1c ${\geq}5.7%$ (odds ratio=1.005, 95% CI 1.002~1.008). Conclusions: Visceral fat levels were significantly higher and correlated with the group which HbA1c level is ${\geq}5.7%$. This finding suggests that subjects who have high levels of HbA1c should be carefully monitored during prediabetes and should have chance to have health education programs.

당화혈색소 5.7%이상에서 6.4%이하인 당뇨전 단계는 당뇨와 심혈관 질환의 위험요소임이 이미 알려져 있다. 최근 미국 당뇨병 학회에서는 당화혈색소를 당뇨의 진단 기준으로 추가하였다. 이러한 배경을 바탕으로 본 연구에서는 농촌 지역 건강한 성인 남녀를 대상으로 당화혈색소와 내장지방과의 관련성을 살펴보았다. 일개 대학병원 건강 검진 수진자 중 건강한 성인 남녀 507명을 연구 대상자로 선정하였다. 연구 대상자에게 설문지를 기입하도록 하고 혈압, BMI, 혈액검사를 측정하였고, 총 복부지방, 내장지방, 피하지방은 CT를 이용하여 측정하였다. 연구 대상자를 남녀로 구분지어 평균값을 비교한 결과 내장지방, 피하지방, 중성지방, 당화혈색소가 유의한 차이를 보였다. 남녀로 구분지어 당화혈색소 5.7%를 기준으로 미만 군과 이상 군으로 분류하고 피하지방과 내장지방 및 혈액검사를 비교해보았다. 이 중 내장지방만이 남녀 모두에서 5.7%이상 군과 미만 군 사이에서 유의한 차이를 보였다. 당화혈색소 5.7%이상 군에서 5.7% 미만 군에 비해 내장지방이 높았다. 전진선택법으로 변수를 선택하여 로지스틱 회귀분석을 한 결과, 비교 위험도 1.007(95% CI1.002~1.012) 으로 복부 지방 중 내장지방이 증가함에 따라 당화혈색소가 약간 증가하는 결과를 관찰하였다. 그러므로 본 연구가 시사하는 바와 같이, 당화혈색소가 5.7% 이상처럼 정상이 아닌 경우에는 당뇨병의 유무와 상관없이 여러 심혈관질환 관련 위험 인자를 조사하여 이에 적절한 치료와 예방이 필요할 것으로 사료된다.

Keywords

References

  1. Nathan MD, Davidson MB, DeFronzo RA, Heine RJ, Pratley R, Zinman B. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007; 30:753-759 https://doi.org/10.2337/dc07-9920
  2. Santaguida PL, Balion C, Hunt D, Morrison K, Gerstein H, Raina P, Booker L, Y azdi H. Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose. AHRQ Study 2006;128:1-12
  3. Levitan EB, Song Y, Ford ES, Liu S Is non-diabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med 2004; 164:2147-2155 https://doi.org/10.1001/archinte.164.19.2147
  4. International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care July 2009 vol. 32 no. 7 1327-1334 https://doi.org/10.2337/dc09-9033
  5. Eldin WS, Emara M, Shoker A. Prediabetes: a must to recognise disease state. Int J Clin Pract 2008;62:642-648 https://doi.org/10.1111/j.1742-1241.2008.01705.x
  6. Despres JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med 2006;38: 52-63 https://doi.org/10.1080/07853890500383895
  7. Matsuzawa Y. Therapy insight: adipocytokines in metabolic syndrome and related cardiovascular disease. Nat Clin Pract Cardiovasc Med 2006;3:35-42 https://doi.org/10.1038/ncpcardio0380
  8. SjostromL, Kvist H, Cederblad A, Tyle'n U. Determination of total adipose tissue and body fat in women by computed tomography, 40K and tritium. Am J Physiol 1986:250: E736-745
  9. Jae Ryoung Seo, San Soo Bae. The Effect of Metabolic Syndrome Management Program in a Public Health Center. J Agric Med Community Health 2011:36(4):264-279 (Korean) https://doi.org/10.5393/JAMCH.2011.36.4.264
  10. Lemieux S, Tremblay A, Prud-Homme D, Bouchard C, Nadeau A, Despres JP. Sevenyear changes in body fat and visceral adipose tissue in women: associations with indexes of plasma glucose-insulin homeostasis. Diabetes Care 1996;19:983-991 https://doi.org/10.2337/diacare.19.9.983
  11. Mori Y, Hoshino K, Yokota K, Itoh Y, Tajima N. Differences in the pathology of the metabolic syndrome with or without visceral fat accumulation: a study in pre-diabetic Japanese middle-aged men. Endocrine 2006;29:149-153 https://doi.org/10.1385/ENDO:29:1:149
  12. Jazet IM, Pijl H, Meinders AE. Adipose tissue as an endocrine organ: impact on insulin resistance. Neth J Med 2003; 61:194-212
  13. Haffner SM, Miettinen H, Gaskill SP, Stern MP. Decreased Insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican- American. Diabetes 1995;44:1386-1391 https://doi.org/10.2337/diabetes.44.12.1386
  14. Avogaro A. Insulin resistance: trigger or concomitant factor in the metabolic syndrome. Panminerva Med 2006;48:3-12
  15. Abdul-Ghani MA, DeFronzo RA. Pathophysiology of prediabetes. Curr Diab Rep 2009;9:193-199 https://doi.org/10.1007/s11892-009-0032-7
  16. Basat O, Ucak S, Ozkurt H, Basak M, Seber S, Altuntas Y. Visceral adipose tissue as an indicator of insulin resistance in nonobese patients with new onset type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 2006 Feb;114(2):58-62 https://doi.org/10.1055/s-2006-923886
  17. Taniguchi A, Nakai Y, Sakai M, Yoshii S, Hamanaka D, Hatae Y, Kawata M, Yamanouchi K, Okumura T, Doi K, Tokuyama K, Nagasaka S, Fukushima M. Relationship of regional adiposity to insulin resistance and serum triglyceride levels in nonobese Japanese type 2 diabetic patients. Metabolism 2002 May;51(5):544-548 https://doi.org/10.1053/meta.2002.31984
  18. Yeo SE, Hays NP, Dennis RA, Kortebein PM, Sullivan DH, Evans WJ, Coker RH. Fat distribution and glucose metabolism in older, obese men and women. J Gerontol A Biol Sci Med Sci 2007 Dec;62(12):1393-1401 https://doi.org/10.1093/gerona/62.12.1393
  19. Yates AP, Laing I. Age-related increase in haemoglobin A1c and fasting plasma glucose is accompanied by a decrease in $\beta$ cell function without change in insulin sensitivity: evidence from a cross-sectional study of hospital personnel. Diabet Med 2002;19:254-258 https://doi.org/10.1046/j.1464-5491.2002.00644.x
  20. Kilpatrick ES, Dominiczak MH, Small M. The effects of ageing on glycation and the interpretation of glycaemic control in type 2 diabetes. Q J Med 1996;89:307-312 https://doi.org/10.1093/qjmed/89.4.307
  21. Brewer N, Wright CS, Travier N, et al. A New Zealand linkage study examining the associations between A1C concentration and mortality. Diabetes Care 2008:31:1144-1149 https://doi.org/10.2337/dc07-2374
  22. Gerstein HC, Swedberg K, Carlsson J, et al. The hemoglobin A1c level as a progressive risk factor for cardiovascular death, hospitalization for heart failure, or death in patients with chronic heart failure: an analysis of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Arch Intern Med 2008;168:1699-1704 https://doi.org/10.1001/archinte.168.15.1699
  23. Levitan EB, Liu S, Stampfer MJ, et al. HbA1c measured in stored erythrocytes and mortality rate among middle-aged and older women. Diabetologia 2008;51:267-275 https://doi.org/10.1007/s00125-007-0882-y
  24. Pradhan AD, Rifai N, Buring JE, Ridker PM. Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women. Am J Med 2007;120:720-727 https://doi.org/10.1016/j.amjmed.2007.03.022
  25. Stout RL, Fulks M, Dolan VF, Magee ME, Suarez L. Relationship of hemoglobin A1c to mortality in nonsmoking insurance applicants. J Insur Med 2007;39:174-181
  26. Blake GJ, Pradhan AD, Manson JE, et al. Hemoglobin A1c level and future cardiovascular events among women. Arch Intern Med 2004;164:757-761 https://doi.org/10.1001/archinte.164.7.757
  27. Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413-420 https://doi.org/10.7326/0003-4819-141-6-200409210-00006
  28. Lee YS, Moon SS. The use of HbA1c for diagnosis of type 2 diabetes in Korea. Korean J Med 2011 Mar;80(3):291-297 (Korean)

Cited by

  1. Correlation between Serum Osteocalcin and Hemoglobin A1c in Gwangju General Hospital Patients vol.50, pp.3, 2018, https://doi.org/10.15324/kjcls.2018.50.3.313