The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Skeletal Muscle Mass as a Predictor of Mortality in the Elderly Population

노인 건강검진 수검자에서 골격근량과 사망률의 관계

  • Jung, Hee Won (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Sun Wook (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chin, Ho Jun (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Cheol Ho (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Kwang Il (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 정희원 (분당서울대학교병원 내과, 서울대학교 의과대학 내과학교실) ;
  • 김선욱 (분당서울대학교병원 내과, 서울대학교 의과대학 내과학교실) ;
  • 진호준 (분당서울대학교병원 내과, 서울대학교 의과대학 내과학교실) ;
  • 김철호 (분당서울대학교병원 내과, 서울대학교 의과대학 내과학교실) ;
  • 김광일 (분당서울대학교병원 내과, 서울대학교 의과대학 내과학교실)
  • Received : 2012.11.09
  • Accepted : 2013.02.04
  • Published : 2013.08.01
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Abstract

Background/Aims: A U-shaped relationship between body mass index (BMI) and mortality has been reported. However, controversy exists as to whether skeletal muscle mass affects mortality in healthy older adults. We evaluated the independent association of BMI or appendicular skeletal muscle mass (ASM) with mortality in elderly people. Methods: A total of 4,261 consecutive subjects older than 65 years who underwent health examinations at Seoul National University Gangnam Center between 2005 and 2009 were included in the analysis. ASM, $ASM/height^2$ and ASM/weight were estimated by bioelectrical impedance analysis. Sarcopenia was defined as a relative skeletal muscle mass of 1-2 SD below (class I) or more than 2 SD below (class II) the gender-specific mean for healthy young adults. BMI was grouped into five groups (A-E). Results: During the follow-up period (27.2 ${\pm}$ 13.5 months), 63 subjects died. The subjects who died were significantly older and had a male predominance, increased levels of inflammatory markers and poor nutritional statuses. In a fully adjusted Cox proportional hazards model, BMI was not associated with mortality. However, class I sarcopenia (HR 2.11, 95% CI 1.17-3.79) and class II sarcopenia (HR 3.47, 95% CI 1.62-7.43), defined by $ASM/height^2$, were related to all-cause mortality. This association was not observed when sarcopenia was defined by ASM/weight. Class II sarcopenia defined by $ASM/height^2$ was associated with cancer-related mortality (HR 5.73, 95% CI 2.22-14.78), but not with cardiovascular mortality (HR 1.56, 95% CI 0.17-14.27). Conclusions: This study indicates that lower skeletal muscle mass is a risk marker for cancer-related and all-cause mortality in Korean elderly people.

목적: BMI와 사망의 U자형 관계는 널리 알려져 있으나 건강한 노인에서 골격근량이 사망과 연관되어 있는지에 대해서는 논란이 있는 상태이다. 이에 본 연구에서는 골격근량, BMI와 사망 간의 연관성을 각각 분석하고자 하였다. 방법: 2005년부터 2009년까지 서울대학교병원 강남센터에서 건강검진을 시행받은 4,261명의 수검자 중 중복된 예를 제외한 3,903명의 자료를 분석하였다. bioelectrical impedence analysis 자료를 이용하여 ASM, ASM/height2, ASM/weight를 계산하였다. 국민건강영양조사 자료에 따라 젊고 건강한 20-39세 남, 여의 성별별 근육량 평균과 표준편차를 이용하여 평균에서 1-2 표준편차 부족인 경우를 class I 근감소증, 2 표준편차 이상 부족한 경우를 class II 근감소증으로 분류하였고 BMI는 다섯 가지로 분류하였다. 결과: 27.2 ${\pm}$ 13.5개월의 기간 동안 63명이 사망하였고 사망자는 유의하게 연령이 높고 남성인 경우가 많았으며 염증 지표가 증가되었으며 영양학적 지표가 나쁜 경향을 보였다. 보정된 Cox 회귀분석에서 $ASM/height^2$에 따른 class I (HR: 2.11, 95% CI: 1.17-3.79), class II (HR: 3.47, 95% CI: 1.62-7.43)의 근감소증은 사망의 증가와 연관되어 있었으나 ASM/weight나 BMI는 사망과 유의한 연관성이 없었다. $ASM/height^2$에 따른 Class II 근감소증은 종양과 연관된 사망의 증가와 유의한 관련성을 보였지만 심혈관계 질환 사망과는 유의한 관련성을 나타내지 않았다. 결론: 한국의 노인 인구에서 낮은 골격근량은 전체 사망률과 종양 연관 사망과 유의한 연관성을 보였다.

Keywords

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