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Longitudinal Relationships between Cigarette Smoking and Increases Risk for Incident Metabolic Syndrome: 16-year Follow-up of the Korean Genome and Epidemiology Study (KOGES)
Biomed Sci Letters 2023;29:355-362
Published online December 31, 2023;  https://doi.org/10.15616/BSL.2023.29.4.355
© 2023 The Korean Society For Biomedical Laboratory Sciences.

Sang Shin Pyo†,*

Department of Biomedical Laboratory Science, Jungwon University, Goesan-gun, Chungbuk 28204, Korea
Correspondence to: Sang Shin Pyo. Department of Biomedical Laboratory Science, Jungwon University, Goesan-gun, Chungbuk 28204, Korea.
Tel: +82-43-830-8965, Fax: +82-43-830-8559, e-mail pyoss@jwu.ac.kr
*Professor.
Received November 26, 2023; Revised December 2, 2023; Accepted December 5, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
This study aimed to determine whether smoking affects the metabolic syndrome and its components through long-term follow-up. Of the 10,030 cohort subjects in the community-based Korean Genome and Epidemiology Study (KoGES) from 2001 to 2018, 2,848 people with metabolic syndrome and 4,854 people with insufficient data for analysis were excluded for this study. The study population comprised 2,328 individuals (1,123 men, 1,205 women) who were eligible for inclusion. The mean age of the participants was 49.2±7.5 years, and 21.9% were current smoker. In log rank test, current smoker had a significantly higher cumulative incidence of metabolic syndrome compared with non smoker (P<0.001). In the Cox proportional hazards model adjusted for key variables, metabolic syndrome (hazard ratio [HR] 1.57, P<0.001), high fasting glucose (HR 1.40, P<0.01), hypertriglyceridemia (HR 1.60, P<0.001), low HDL-cholesterol (HR, 1.30, P<0.01), and abdominal obesity (HR 1.32, P<0.01) in current smoker compared with non smoker were statistically significant, respectively, but not hypertension (HR 1.00, P>0.05). After adjustment for confounders, the time (P-time<0.001) and group (P-group<0.001) effects on metabolic syndrome score change were statistically significant. Furthermore, the interaction analysis of time and smoking group on the change in metabolic syndrome score was statistically significant (P-interaction<0.001). In long-term follow-up, smoking worsens metabolic syndrome.
Keywords : Abdominal obesity, Inflammation, Metabolic syndrome, Obesity, Smoking
꽌 濡

떞諛 씉뿰 땲肄뷀떞 쓽議댁꽦怨 븰뒿맂 뻾룞뿉 쓽빐 쑀吏릺뒗 留뚯꽦 옣븷씠떎(Rigotti et al., 2022). 2019뀈 쟾 꽭怨꾩쟻쑝濡 빟 11뼲 1,400留뚮챸씠 쁽옱 씉뿰옄쑝硫, 씠뱾 빟 7.41議 媛쒖쓽 떞諛곕 냼鍮꾪븯떎(GBD 2019 Tobacco Collaborators, 2021). 씉뿰 룓븫쓣 룷븿븳 떎뼇븳 븙꽦醫낆뼇怨 留뚯꽦 룓뇙꽦 룓吏덊솚쓣 쑀諛쒗븷 肉먮쭔 븘땲씪 쓽猷 떆뒪뀥怨 궗쉶 쟾泥댁뿉 긽떦븳 寃쎌젣쟻 遺떞쓣 二쇰ʼn, 珥 씉뿰 鍮꾩슜 援媛 쓽猷 떆뒪뀥 吏異쒖쓽 1.5~6%瑜 李⑥븳떎(Rezaei et al., 2016). 씉뿰 뿬쟾엳 쟾 꽭怨꾩쟻쑝濡 吏덈퀝怨 議곌린 궗留앹쓽 二쇱슂 썝씤 以 븯굹濡 궓븘 엳떎(West, 2017). 쟾 꽭怨 꽦씤 以 빟 10뼲 紐(궓꽦 32.0%, 뿬꽦 7.0%)씠 떞諛 씉뿰쓣 븯怨 엳怨, 留ㅻ뀈 궓꽦 궗留앹쓽 11%, 뿬꽦 궗留앹쓽 6%媛 떞諛곕줈 씤븳 寃껋쑝濡 異붿젙맂떎(Gowing et al., 2015). 떞諛곗 떞諛 뿰湲곕뒗 9,500媛吏媛 꽆뒗 솕븰 솕빀臾쇱쓽 蹂듭옟븳 샎빀臾쇱씠 룷븿릺뼱 엳쑝硫, 洹 以 79媛쒓 븫쓣 쑀諛쒗븯뒗 寃껋쑝濡 븣젮졇 엳떎. 洹몃윭誘濡 떞諛 씉뿰쑝濡 씤븳 嫄닿컯긽쓽 쐞뿕 二쇰줈 땲肄뷀떞씠 븘땲씪 떞諛곕 깭슱 븣 깮꽦릺뒗 솕븰 臾쇱쭏뿉 湲곗씤븳떎(Li and Hecht, 2022). 씉뿰븯뒗 뾼留덉뿉寃뚯꽌 깭뼱궃 옄넀 鍮꾪씉뿰옄 뾼留덉쓽 옄넀蹂대떎 옉寃 깭뼱굹怨, 씠 븘씠뱾 굹以묒뿉 怨쇱껜以묒씠굹 鍮꾨쭔씠 맆 쐞뿕씠 뜑 넂떎怨 븣젮졇 엳떎(Rogers, 2019). 듅엳 媛꾩젒 씉뿰쓽 끂異쒖 뼱由곗씠, 뿬꽦 鍮꾪씉뿰옄, 洹몃━怨 궓꽦 鍮꾪씉뿰옄뿉寃 샇씉湲 媛먯뿼, 뿀삁꽦 떖옣 吏덊솚, 泥쒖떇 벑怨 媛숈 吏덈퀝 遺떞쓣 媛뽮쾶 븷 닔 엳떎(Oberg et al., 2011). 씠 紐⑤뱺 寃껋쓣 룷븿븯硫 씉뿰 留됰븳 寃쎌젣쟻 鍮꾩슜씠 뱾뼱媛 닔 엳떎. 븳 洹쒕え 醫낅떒쟻 肄뷀샇듃 뿰援ъ뿉꽌 떞諛 뿰湲곗뿉 끂異쒕맂 궗엺씠 洹몃젃吏 븡 궗엺蹂대떎 궗 利앺썑援(metabolic syndrome)쓽 쐞뿕씠 1.35諛 넂떎怨 븳떎(Choi et al., 2022). 씉뿰 二쇰줈 蹂듬 吏諛⑹쓽 異뺤쟻怨 씤뒓由 빆꽦쓣 쑀諛쒗븯뒗 寃껋쑝濡 븣젮議뚯留 븘吏 씉뿰怨 궗 利앺썑援곗쓽 諛쒖깮뿉 誘몄튂뒗 쁺뼢씠 紐낇솗븯吏 븡떎(Cena et al., 2011). 洹몃윭誘濡 씉뿰씠 궗 利앺썑援 삉뒗 洹 슂냼뱾쓽 諛쒖깮뿉 엳뼱, 뼱뼸寃 옉슜븯뒗吏 16뀈 룞븞 옣湲곌컙 異붿쟻 愿李곗쓣 넻빐 븣븘蹂닿퀬옄 븳떎.

옱猷 諛 諛⑸쾿

뿰援 긽

븳援씤 쑀쟾泥 뿭븰議곗궗 궗뾽(Korean Genome and Epidemiology Study; KoGES) 븞꽦/븞궛 吏뿭궗쉶瑜 湲곕컲쑝濡 2001뀈遺꽣 2018뀈源뚯 吏꾪뻾맂 쟾뼢쟻 肄뷀샇듃 궗뾽씠떎(Kim et al., 2016). 슦由щ굹씪뿉꽌 쓷엳 諛쒖깮븯뒗 留뚯꽦 吏덊솚쓽 썝씤쓣 洹쒕챸븯怨, 씠뱾 吏덈퀝쓽 삁諛⑹쓣 쐞븳 怨쇳븰쟻 洹쇨굅瑜 젣怨듯븯뒗 以묒슂븳 湲곕컲옄猷뚯쓽 뿭븷쓣 빐삤怨 엳떎. 2뀈뿉 븳 踰덉뵫 媛곸쥌 꽕臾몄, 떊泥닿궗, 삁븸寃궗, 냼蹂寃궗 벑쓣 肄뷀샇듃 긽옄뿉寃 떆뻾븯硫 옣湲곗쟻쑝濡 異붿쟻븳떎. 씠瑜 넻빐 쓷엳 諛쒖깮븯뒗 留뚯꽦 吏덊솚쓽 쐞뿕씤옄瑜 뙆븙븯怨, 吏덈퀝쓽 삁諛⑹쓣 쐞븳 怨쇳븰쟻 洹쇨굅瑜 젣怨듯븳떎. 蹂 뿰援ъ뿉꽌 궗 利앺썑援곗쓽 諛쒖깮瑜좎쓣 議곗궗븯湲 쐞빐 湲곗옄猷(baseline)뿉꽌 궗 利앺썑援 吏덊솚뿉 빐떦븯뒗 2,848紐낆쓽 肄뷀샇듃 긽옄瑜 젣쇅븯떎. 2뀈留덈떎 吏꾪뻾릺뒗 異붿쟻 寃궗뿉꽌 븳 踰덉씠씪룄 李몄뿬븯吏 븡쑝硫 뿰援щ긽옄뿉꽌 젣쇅떆耳곕떎(4,286紐). 뿰援ъ뿉 븘슂븳 뜲씠꽣媛 늻씫맂 568紐낆쓣 젣쇅떆耳곕떎. 理쒖쥌쟻쑝濡 蹂 뿰援ъ뿉꽌뒗 2,328紐낆쓣 遺꾩꽍뿉 궗슜븯떎(Fig. 1). 蹂 뿰援щ뒗 以묒썝븰援 뿰援ъ쑄由ъ떖쓽쐞썝쉶쓽 떖쓽硫댁젣 듅씤쓣 諛쏆 썑 닔뻾릺뿀떎(IRB approval number: 1044297-HR-202109-007-01).

Fig. 1. Flow chart of research samples.

궗 利앺썑援곗쓽 젙쓽

궗 利앺썑援곗 National Cholesterol Education Program Expert Panel III on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-III)쓽 3李 蹂닿퀬꽌 븳鍮꾨쭔븰쉶뿉꽌 젣떆븳 븳援씤 蹂듬鍮꾨쭔 湲곗쓣 궗슜븯떎(Huang, 2009; Kim et al., 2021). 5媛쒖쓽 궗 利앺썑援 吏꾨떒 湲곗 떎쓬怨 媛숇떎. 떎쓬 湲곗 以 3媛 씠긽쓣 異⑹”븯뒗 寃쎌슦 궗 利앺썑援곗쑝濡 젙쓽븯떎.

  • 넂 怨듬났 삁떦(high fasting glucose): 100 mg/dL 씠긽 삉뒗 빆떦눊蹂묒젣 궗슜

  • 怨좏삁븬(hypertension): 닔異뺢린/씠셿湲 삁븬 130/85 mmHg 씠긽 삉뒗 빆怨좏삁븬젣 궗슜

  • 怨좎쨷꽦吏諛⑺삁利(hypertriglyceridemia): 150 mg/dL 씠긽 삉뒗 빆怨좎삁利앹젣 궗슜

  • 궙 HDL-肄쒕젅뒪뀒濡(low HDL-cholesterol): 궓꽦 40 mg /dL 誘몃쭔, 뿬꽦 50 mg/dL 誘몃쭔

  • 蹂듬 鍮꾨쭔(abdominal obesity): 뿀由щ몮젅媛 궓꽦 90 cm, 뿬꽦 85 cm 씠긽

媛 궗 利앺썑援곗쓽 吏꾨떒 湲곗뿉 빐떦븯뒗 媛쒖닔瑜 젏닔솕븯뿬 궗 利앺썑援 젏닔(metabolic syndrome score)瑜 0~5젏源뚯 遺꾨쪟븯떎.

떎뿕떎 寃궗

뿰援щ긽옄뱾쓽 삁븸寃궗뒗 湲곗옄猷뚯뿉꽌 Hitachi-7600 (Hitachi, Tokyo, Japan)쑝濡 遺꾩꽍릺뿀吏留 湲곗옄猷뚯쓽 以묎컙 떆젏씤 2002뀈 9썡遺꽣뒗 ADVIA 1650 (Siemens, Tarrytown, NY, USA)쑝濡 寃궗옣鍮꾧 蹂寃쎈릺뼱 4李 肄뷀샇듃源뚯 궗슜릺뿀떎. 洹 썑 5李 肄뷀샇듃뿉꽌뒗 ADVIA 1800 (Siemens, Tarrytown, NY, USA)쑝濡 寃궗옣鍮꾧 蹂寃쎈릺뿀떎. 씠뿉 븳 삤李⑤ 以꾩씠湲 쐞빐 吏덈퀝愿由ъ껌뿉꽌 젣怨듯븳 寃궗옣鍮 삉뒗 寃궗諛⑸쾿쓽 蹂룞꽦쓣 諛섏쁺븳 쟾솚 媛믪쓣 蹂꾨룄濡 궗슜븯떎. 蹂 뿰援ъ뿉꽌뒗 삁떦, 以묒꽦吏諛, 洹몃━怨 HDL-肄쒕젅뒪뀒濡ㅼ뿉 븳 寃궗 뜲씠꽣瑜 ADVIA 1650 湲곗쑝濡 遺꾩꽍븯떎.

씤援ъ궗쉶븰쟻 듅꽦

듅젙 떊泥 솢룞쓣 닔뻾븯뒗 룞븞 븘슂븳 뿉꼫吏굹 紐몄뿉꽌 븘슂븳 궛냼쓽 뼇쓣 떊吏꾨궗 빐떦移섎씪 븳떎(Edwards et al., 2022). 떊吏꾨궗 빐떦移섎뒗 吏덈퀝愿由ъ껌뿉꽌 젣怨듯븳 닔移섎 궗슜븯怨, 씠瑜 넻빐 떊泥 솢룞웾(physical activity)쓣 굹궡떎. 援먯쑁 닔以(education level) 珥덉「 씠븯(elementary school or lower), 以묒「(middle school), 怨좎「(high school), 移쇰━吏(college), 븰(university), 洹몃━怨 븰썝(graduate school)쑝濡 遺꾨쪟븯떎. 寃고샎 뿬遺(marital status)뒗 誘명샎(unmarried), 湲고샎(married), 誘몃쭩씤(widowed), 蹂꾧굅(separated), 씠샎(divorced), 洹몃━怨 湲고(other)濡 遺꾨쪟븯떎. 썡닔엯(monthly income) 100留뚯썝 誘몃쭔, 100留뚯썝뿉꽌 200留뚯썝 궗씠, 200留뚯썝뿉꽌 300留뚯썝 궗씠, 300留뚯썝뿉꽌 400留뚯썝 궗씠, 400留뚯썝뿉꽌 600 썝 궗씠, 600留뚯썝 씠긽쑝濡 遺꾨쪟븯떎. 쓬二 뿬遺(alcohol drinking)뒗 鍮꾩쓬二쇱옄(non-drinker), 怨쇨굅 쓬二쇱옄(former drinker), 洹몃━怨 쁽옱 쓬二쇱옄(current drinker)濡 遺꾨쪟븯떎.

넻怨 遺꾩꽍

뿰냽삎 蹂닔씤 寃쎌슦 젙洹쒖꽦 寃젙씤 깶뵾濡-쐧겕 寃젙(Shapiro-Wilk test)瑜 떎떆븳 썑 씪썝諛곗튂 遺꾩궛遺꾩꽍(one-way ANOVA)怨 궗썑 寃젙(post hoc test) 삉뒗 겕猷⑥뒪移 솃由ъ뒪 寃젙(Kruskal Wallis test)瑜 닔뻾븯떎. 踰붿<삎 蹂닔씤 寃쎌슦 移댁씠젣怨 寃젙(Chi-square test)瑜 떆뻾븯떎(Table 1). 궗 利앺썑援곗쓽 늻쟻 諛쒖깮瑜좎 濡쒓렇-닚쐞踰(log-rank method)쓣 궗슜븯뿬 씉뿰 뿬遺뿉 븳 꽭 吏묐떒 궗씠쓽 넻怨꾩쟻 쑀쓽꽦쓣 異붿젙븯떎(Fig. 2). 移댁씠젣怨 寃젙瑜 떆뻾븯뿬 궗 利앺썑援곌낵 媛 슂냼쓽 湲곌컙 쑀蹂묐쪧쓣 援ы븯떎(Table 2). 궗 利앺썑援 諛쒖깮쓽 삁痢 씤옄 遺꾩꽍쓣 쐞빐 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎(Cox proportional hazard model)쓣 궗슜븯뿬 궗 利앺썑援 諛쒖깮뿉 븳 삁痢 씤옄쓽 쐞뿕鍮(hazard ratio; HR) 95% 떊猶곌뎄媛(confidence interval; CI)쓣 異붿젙븯떎. 씠븣 넻怨꾩쟻쑝濡 蹂댁젙(adjustment)쓣 븯吏 븡 떒닚 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎(simple Cox proportional hazard model)怨 뿬윭 씤옄뱾쓣 蹂댁젙븳 떎以 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎(multiple Cox proportional hazard model)쓣 궗슜븯뿬 궗 利앺썑援, 넂 怨듬났 삁떦, 怨좏삁븬, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡, 洹몃━怨 蹂듬 鍮꾨쭔뿉 븳 遺꾩꽍쓣 닔뻾븯떎(Table 2). 삉븳 諛섎났痢≪젙 씪諛섏꽑삎紐⑦삎(repeated measures general linear model)쓣 궗슜븯뿬 씉뿰 뿬遺뿉 븳 꽭 吏묐떒怨 16뀈 異붿쟻 愿李곗뿉 븳 떆媛 寃쎄낵뿉 뵲瑜 룊洹 궗 利앺썑援 젏닔瑜 異붿젙븯떎(Fig. 2). 遺꾩꽍 SPSS 24.0 (IBM Corp., Armonk, NY, USA) GraphPad Prism 9 (GraphPad Software, San Diego, CA, USA)瑜 씠슜븯떎. 紐⑤뱺 遺꾩꽍 뼇痢 寃젙 P<0.05瑜 넻怨꾩쟻쑝濡 쑀쓽븳 寃껋쑝濡 뙋젙븯떎.

Fig. 2. Cumulative incidence for the metabolic syndrome according to smoking status.

Baseline characteristics according to the smoking status

Characteristic Non smoker (n = 1,431) Former smoker (n = 387) Current smoker (n = 510) P-value
Age (years) 49.1짹7.4 50.3짹7.9 48.6짹7.1 0.004
Sex (male) 260 (18.2) 379 (97.9) 484 (94.9) <0.001
BMI (kg/m2) 24.2짹2.8 24.0짹2.4 23.6짹2.7 <0.001
Physical activity (MET /week) 9646.8짹5848.7 9714.1짹5868.2 9896.9짹6425.2 0.742
Total energy (kcal/day) 1911.0짹659.3 2021.8짹515.9 1999.3짹628.2 <0.001
Usual sleep duration 6.6짹1.2 6.7짹1.2 6.8짹1.3 0.004
Education level <0.001
Elementary school 365 (25.5) 45 (11.6) 65 (12.7)
Middle school 353 (24.7) 80 (20.7) 96 (18.8)
High school 520 (36.3) 158 (40.8) 239 (46.9)
College 53 (3.7) 27 (7.0) 37 (7.3)
University 115 (8.0) 64 (16.5) 64 (12.5)
Over graduate school 25 (1.8) 13 (3.4) 9 (1.8)
Marital status <0.001
Unmarried 13 (0.9) 8 (2.1) 9 (1.7)
Married 1316 (92.0) 373 (96.4) 480 (94.1)
Widowed 77 (5.4) 3 (0.8) 8 (1.6)
Separated 10 (0.7) 1 (0.2) 6 (1.2)
Divorced 15 (1.0) 2 (0.5) 7 (1.4)
Other
Monthly income (10,000 won) 0.015
< 100 353 (24.7) 64 (16.5) 116 (22.7)
100~200 464 (32.4) 133 (34.4) 150 (29.4)
200~300 332 (23.2) 85 (22.0) 127 (24.9)
300~400 165 (11.5) 59 (15.2) 62 (12.2)
400~600 91 (6.4) 33 (8.5) 39 (7.7)
600~ 26 (1.8) 13 (3.4) 16 (3.1)
Alcohol drinking <0.001
Non-drinker 890 (62.2) 54 (13.9) 75 (14.7)
Former drinker 43 (3.0) 46 (11.9) 20 (3.9)
Current drinker 498 (34.8) 287 (74.2) 415 (81.4)

Abbreviation: BMI, body mass index; MET, metabolic equivalent task

All values were presented as 'mean 짹 standard deviation' or 'n (%)'

P<0.05, bonferroni post-hoc, [Non smoker] vs. [Former smoker]

P<0.05, bonferroni post-hoc, [Non smoker] vs. [Current smoker]



The hazard ratio of the development risk for metabolic syndrome over the 16-year follow-up

Variable Hazard ratio (95% confidence interval)
Non smoker (n = 1,431) Former smoker (n = 387) Current smoker (n = 510) P-value
Metabolic syndrome, n (%) 728 (50.9) 189 (48.8) 307 (60.2) <0.001
Unadjusted 1.00 0.96 (0.82~1.12) 1.29 (1.13~1.47)*** <0.001
Adjusted, Model 1 1.00 1.03 (0.83~1.27) 1.43 (1.19~1.73)*** <0.001
Adjusted, Model 2 1.00 1.04 (0.83~1.29) 1.57 (1.28~1.91)*** <0.001
High fasting glucose, n (%) 530 (37.0) 222 (57.4) 297 (58.2) <0.001
Unadjusted 1.00 1.87 (1.60~2.19)*** 1.86 (1.62~2.15)*** <0.001
Adjusted, Model 1 1.00 1.37 (1.11~1.69)** 1.39 (1.14~1.69)** 0.002
Adjusted, Model 2 1.00 1.36 (1.10~1.69)** 1.40 (1.14~1.70)** 0.004
Hypertension, n (%) 870 (60.8) 271 (70.0) 382 (74.9) <0.001
Unadjusted 1.00 1.28 (1.11~1.46)*** 1.35 (1.19~1.52)*** <0.001
Adjusted, Model 1 1.00 0.92 (0.77~1.10) 1.06 (0.90~1.25) 0.206
Adjusted, Model 2 1.00 0.86 (0.72~1.04) 1.00 (0.84~1.18) 0.151
Hypertriglyceridemia, n (%) 917 (64.1) 273 (70.5) 408 (80.0) <0.001
Unadjusted 1.00 1.33 (1.16~1.52)*** 1.67 (1.49~1.88)*** <0.001
Adjusted, Model 1 1.00 1.21 (1.01~1.45)* 1.53 (1.30~1.80)*** <0.001
Adjusted, Model 2 1.00 1.21 (1.01~1.46)* 1.60 (1.35~1.90)*** <0.001
Low HDL-cholesterol, n (%) 1197 (83.6) 262 (67.7) 385 (75.5) <0.001
Unadjusted 1.00 0.60 (0.53~0.69)*** 0.74 (0.66~0.83)*** <0.001
Adjusted, Model 1 1.00 1.01 (0.84~1.21) 1.21 (1.03~1.43)* 0.021
Adjusted, Model 2 1.00 1.05 (0.87~1.26) 1.30 (1.10~1.54)** 0.003
Abdominal obesity, n (%) 762 (53.2) 167 (43.2) 265 (52.0) 0.002
Unadjusted 1.00 0.74 (0.62~0.87)*** 0.92 (0.80~1.06) 0.002
Adjusted, Model 1 1.00 0.94 (0.75~1.17) 1.22 (0.99~1.48) 0.017
Adjusted, Model 2 1.00 0.92 (0.73~1.15) 1.32 (1.08~1.63)** <0.001

Abbreviation: BMI, body mass index; HDL, high density lipoprotein

Model 1: adjusted for age, sex

Model 2: adjusted for age, sex, BMI, physical activity, total energy, usual sleep duration, education level, marital status, monthly income, alcohol drinking

*P <0.05, **P <0.01, ***P <0.001


寃 怨

뿰援щ긽옄쓽 씪諛섏쟻 듅꽦

씉뿰 뿬遺뿉 뵲瑜 湲곗옄猷 뿰援щ긽옄쓽 엫긽쟻 듅吏뺤 Table 1怨 媛숇떎. 뿰援щ긽옄뒗 遺꾩꽍뿉 궗슜븳 2,328紐낆씠뿀怨, 룊洹 뿰졊 49.2짹7.5꽭떎. 씠 以 궓꽦 1,123紐(48.2%), 뿬꽦 1,205紐(51.8%)씠떎. 뿰援щ긽옄瑜 씉뿰 뿬遺뿉 뵲씪 鍮꾪씉뿰옄, 怨쇨굅 씉뿰옄, 洹몃━怨 쁽옱 씉뿰옄濡 굹닠 遺꾩꽍븯떎. 鍮꾪씉뿰옄뒗 1,431紐(61.5%)씠뿀怨, 怨쇨굅 씉뿰옄뒗 387紐(16.6%)씠뿀怨, 쁽옱 씉뿰옄뒗 510紐(21.9%)씠뿀떎. 쁽옱 씉뿰옄쓽 떊泥대퉬留뚯닔(body mass index; BMI)뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 넻怨꾩쟻쑝濡 쑀쓽븯寃 궙븯吏留(P<0.05), 쁽옱 씉뿰옄쓽 꽠痍 珥 뿉꼫吏(total energy) 룊洹 닔硫댁떆媛(usual sleep duration)뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 넻怨꾩쟻쑝濡 쑀쓽븯寃 넂븯떎(P<0.05). 怨쇨굅 씉뿰옄쓽 굹씠 꽠痍 珥 뿉꼫吏뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 넻怨꾩쟻쑝濡 쑀쓽븯寃 넂븯떎(P<0.05). 씉뿰 뿬遺뿉 븳 꽦蹂(P<0.001), 援먯쑁 닔以(P<0.001), 寃고샎 뿬遺(P<0.001), 썡닔엯(P=0.015), 쓬二 뿬遺(P<0.001)뒗 넻怨꾩쟻쑝濡 쑀쓽븳 鍮꾩쑉 李⑥씠瑜 蹂댁떎. 듅엳 쓬二 뿬遺뿉꽌 쁽옱 씉뿰옄 以 쁽옱 쓬二쇱옄媛 415紐(81.4%)쑝濡 넂 鍮덈룄瑜 蹂댁떎.

궗 利앺썑援곗쓽 늻쟻 諛쒖깮瑜

2001뀈遺꽣 2018뀈源뚯 16뀈 룞븞 異붿쟻맂 뿰援щ긽옄 以 鍮꾪씉뿰옄뒗 珥 1,431紐낆씠뿀떎. 鍮꾪씉뿰옄쓽 늻쟻 諛쒖깮瑜좎 1,431紐 以 728紐(50.9%)씠뿀怨, 怨쇨굅 씉뿰옄쓽 늻쟻 諛쒖깮瑜좎 387紐 以 189紐(48.8%)씠뿀怨, 쁽옱 씉뿰옄쓽 늻쟻 諛쒖깮瑜좎 510紐 以 307紐(60.2%)씠뿀떎. 쁽옱 씉뿰옄쓽 늻쟻 諛쒖깮瑜좎 鍮꾪씉뿰옄뿉 鍮꾪빐 넻怨꾩쟻쑝濡 쑀쓽븯寃 넂븯떎(P<0.001) (Fig. 2).

궗 利앺썑援곌낵 洹 슂씤뱾뿉 븳 湲곌컙 쑀蹂묐쪧怨 쐞뿕鍮 遺꾩꽍

Table 2뿉 16뀈 異붿쟻 愿李 湲곌컙 룞븞 궗 利앺썑援곌낵 洹 슂씤뱾뿉 븳 湲곌컙 쑀蹂묐쪧怨 쐞뿕鍮 遺꾩꽍쓣 븯떎. 16뀈 룞븞 궗 利앺썑援(P<0.001), 넂 怨듬났 삁떦(P<0.001), 怨좏삁븬(P<0.001), 怨좎쨷꽦吏諛⑺삁利(P<0.001), 궙 HDL-肄쒕젅뒪뀒濡(P<0.001), 洹몃━怨 蹂듬 鍮꾨쭔(P=0.002)뿉 븳 湲곌컙 쑀蹂묐쪧 媛곴컖 넻怨꾩쟻쑝濡 쑀쓽븳 鍮꾩쑉 李⑥씠瑜 蹂댁떎.

蹂댁젙쓣 븯吏 븡 떒닚 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎뿉꽌 궗 利앺썑援(HR 1.29, P<0.001), 넂 怨듬났 삁떦(HR 1.86, P< 0.001), 怨좏삁븬(HR 1.35, P<0.001), 怨좎쨷꽦吏諛⑺삁利(HR 1.67, P<0.001), 洹몃━怨 궙 HDL-肄쒕젅뒪뀒濡(HR 0.74, P<0.001)뿉 븳 쁽옱 씉뿰옄쓽 쐞뿕鍮꾨뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 媛곴컖 넻怨꾩쟻쑝濡 쑀쓽븯吏留 蹂듬 鍮꾨쭔(HR 0.92, P>0.05) 쑀쓽븯吏 븡븯떎. 洹몃윭굹 굹씠, 꽦蹂, BMI, 떊泥 솢룞웾, 꽠痍 珥 뿉꼫吏, 룊洹 닔硫댁떆媛, 援먯쑁 닔以, 寃고샎 뿬遺, 썡닔엯, 洹몃━怨 쓬二 뿬遺濡 蹂댁젙븳 떎以 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎뿉꽌 궗 利앺썑援(HR 1.57, P<0.001), 넂 怨듬났 삁떦(HR 1.40, P<0.01), 怨좎쨷꽦吏諛⑺삁利(HR 1.60, P<0.001), 洹몃━怨 궙 HDL-肄쒕젅뒪뀒濡(HR, 1.30, P<0.01), 洹몃━怨 蹂듬 鍮꾨쭔(HR 1.32, P<0.01)뿉 븳 쁽옱 씉뿰옄쓽 쐞뿕鍮꾨뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 媛곴컖 넻怨꾩쟻쑝濡 쑀쓽븯吏留, 怨좏삁븬(HR 1.00, P>0.05) 쑀쓽븯吏 븡븯떎. 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎뿉꽌 蹂댁젙븯吏 븡뒗 紐⑤뜽怨 뿬윭 蹂닔濡 蹂댁젙븳 紐⑤뜽 2 궗씠뿉꽌 겙 李⑥씠瑜 蹂댁씠뒗 蹂닔뒗 怨좏삁븬(unadjusted vs. model 2; HR 1.35, P<0.001 vs. HR 1.00, P>0.05)怨 궙 HDL-肄쒕젅뒪뀒濡(unadjusted vs. model 2; HR 0.74, P<0.001 vs. HR 1.30, P<0.01) 洹몃━怨 蹂듬 鍮꾨쭔(unadjusted vs. model 2; HR 0.92, P>0.05 vs. HR 1.32, P<0.01)씠 愿李곕릺뿀떎.

궗 利앺썑援 젏닔뿉 븳 룊洹 李⑥씠 遺꾩꽍

씉뿰 뿬遺뿉 븳 꽭 吏묐떒怨 16뀈 異붿쟻 愿李곗뿉 븳 떆媛 寃쎄낵뿉 뵲瑜 궗 利앺썑援 젏닔瑜 諛섎났痢≪젙 씪諛섏꽑삎紐⑦삎쓣 궗슜븯뿬 異붿젙븯떎(Fig. 3). 듅엳 二쇱슂븳 蹂닔뱾쓣 蹂댁젙븳 썑 궗 利앺썑援 젏닔 蹂솕뿉 븳 떆媛(P-time<0.001)怨 洹몃9(P-group<0.001) 媛곴컖 넻怨꾩쟻쑝濡 쑀쓽븯떎. 뜑슧씠 궗 利앺썑援 젏닔 蹂솕뿉 븳 떆媛꾧낵 씉뿰 洹몃9쓽 긽샇옉슜 遺꾩꽍 넻怨꾩쟻쑝濡 쑀쓽븯떎(P-interaction<0.001).

Fig. 3. Adjusted average difference of metabolic syndrome score over 16 years of follow-up by smoking status. P-values were derived from repeated measures general linear model adjusting for age, sex, BMI, physical activity, total energy, usual sleep duration, education level, marital status, monthly income, and alcohol drinking. P-time and P-group indicate the effect of time on change in metabolic syndrome score over 16 years and the effect of groups on metabolic syndrome score across time, respectively; P-interaction indicates significance of whether the change in metabolic syndrome score over time differs by groups.
怨 李

蹂 뿰援щ뒗 옣湲 異붿쟻 愿李곗쓣 넻빐 씉뿰씠 궗 利앺썑援곌낵 洹 슂냼뿉 쁺뼢쓣 誘몄튂뒗吏 븣븘蹂닿퀬옄 뻽떎. 16뀈 異붿쟻 愿李 湲곌컙 룞븞 쁽옱 씉뿰옄뒗 鍮꾪씉뿰옄뿉 鍮꾪빐 궗 利앺썑援곗쓽 늻쟻 諛쒖깮瑜좎씠 쑀쓽븯寃 넂븯떎. 뿬윭 二쇱슂 씤옄뱾쓣 蹂댁젙븳 썑 떎以 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎뿉꽌 쁽옱 씉뿰옄뿉 븳 궗 利앺썑援곗쓽 쐞뿕鍮꾧 1.57諛, 넂 怨듬났 삁떦쓽 쐞뿕鍮꾧 1.40諛, 怨좎쨷꽦吏諛⑺삁利앹쓽 쐞뿕鍮꾧 1.60諛, 궙 HDL-肄쒕젅뒪뀒濡ㅼ쓽 쐞뿕鍮꾧 1.30諛, 蹂듬 鍮꾨쭔쓽 쐞뿕鍮꾧 1.32諛곕줈 媛곴컖 굹궗떎. 洹몃윭굹 씠 肄뺤뒪 紐⑤뜽뿉꽌 蹂댁젙맂 떎瑜 씤옄濡 씤빐 쁽옱 씉뿰씠 怨좏삁븬뿉 넻怨꾩쟻쑝濡 쑀쓽븯吏 븡븯떎. 뿬윭 二쇱슂 씤옄뱾쓣 蹂댁젙븳 썑 諛섎났痢≪젙 씪諛섏꽑삎紐⑦삎뿉꽌 궗 利앺썑援 젏닔 蹂솕뿉 븳 떆媛 슚怨쇱 洹몃9 슚怨쇰뒗 넻怨꾩쟻쑝濡 쑀쓽븯떎. 뜑슧씠 궗 利앺썑援 젏닔 蹂솕뿉 엳뼱 떆媛 슚怨쇱 씉뿰 슚怨쇨 넻怨꾩쟻쑝濡 긽샇옉슜븯떎. 씠 媛숈 긽샇옉슜 옣湲 異붿쟻 愿李곗뿉꽌 쁽옱 씉뿰 궗 利앺썑援곗쓣 븙솕떆궓떎뒗 寃껋쓣 솗씤븯떎.

궗 利앺썑援곗씠 뾾뒗 궓꽦 2,994紐낆쓣 7뀈 룞븞 異붿쟻 議곗궗븳 뿰援ъ뿉꽌 씪蹂 以묐뀈 吏곸옣씤쓽 씉뿰 궗 利앺썑援, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡, 洹몃━怨 蹂듬 鍮꾨쭔뿉 넻怨꾩쟻쑝濡 쑀쓽븯떎(Takeuchi et al., 2009). 씠 뿰援ъ뿉꽌뒗 씉뿰씠 넂 怨듬났 삁떦뿉 넻怨꾩쟻쑝濡 쑀쓽븯吏 븡븯吏留, 蹂 뿰援ъ뿉꽌뒗 씉뿰씠 넂 怨듬났 삁떦뿉 넻怨꾩쟻쑝濡 쑀쓽븯뒗뜲, 씠뒗 蹂댁젙맂 蹂닔 뿰援 吏묐떒쓽 李⑥씠濡 씤븳 寃껋쑝濡 깮媛곷맂떎. 뿬윭 뿭븰 뿰援ъ뿉꽌 씉뿰怨 젣2삎 떦눊蹂 諛쒕퀝 궗씠쓽 뿰愿꽦씠 엯利앸릺뿀湲 븣臾몄뿉 씉뿰씠 넂 怨듬났 삁떦 諛쒖깮뿉 以묒슂븳 슂냼씪뒗 蹂 뿰援ъ쓽 寃곌낵瑜 뮮諛쏆묠븳떎(Willi et al., 2007). 떞諛곕 걡쑝硫 泥댁쨷씠 留롮씠 利앷븯뒗 寃껋쑝濡 쓷엳 븣젮졇 엳떎(Lycett et al., 2011). 蹂 뿰援ъ뿉꽌룄 쁽옱 씉뿰옄쓽 BMI媛 鍮꾪씉뿰옄蹂대떎 궙 寃껋쓣 솗씤븷 닔 엳뿀떎. 씠 媛숈 젏 씉뿰 以묐떒怨 愿젴맂 泥댁쨷 利앷媛 젣2삎 떦눊蹂 諛쒕퀝 쐞뿕쓽 珥덇린 利앷뿉 썝씤씠 맆 媛뒫꽦쓣 蹂댁뿬以떎(Walicka et al., 2022).

씉뿰 援먭컧떊寃 湲댁옣룄, 삁냼뙋 젏李⑹꽦 諛 諛섏쓳꽦, 솢꽦궛냼 깮꽦, 궡뵾 넀긽, 룞留μ븬 긽듅쓣 利앷떆耳 삁愿 넀긽 쐞뿕쓣 利앷떆궓떎怨 븣젮졇 엳떎(Sleight, 1993). 씉뿰 끂異쒓낵 怨좏삁븬 궗씠쓽 씤怨 愿怨꾨뒗 븘吏 紐낇솗븯寃 엯利앸릺吏 븡븯떎(Balhara, 2012). 씉뿰 삁븬쓣 利앷떆궎吏留 紐 떆媛 룞븞 씉뿰쓣 以묐떒븳 썑뿉 珥ъ쁺븳 湲곕줉뿉꽌 씉뿰옄媛 鍮꾪씉뿰옄뿉 鍮꾪빐 삁븬씠 뜑 궙 寃껋쑝濡 굹궗뒗뜲(Ward et al., 1995; Oncken et al., 2001), 씠뒗 떞諛곕 뵾슦뒗 룞븞씠굹 媛꾩젒 씉뿰뿉 끂異쒕릺뿀쓣 븣 援먭컧 떊寃쎄퀎쓽 옄洹뱀쑝濡 씪떆쟻쑝濡 삁븬怨 떖諛뺤닔媛 利앷븯湲 븣臾몄씠떎. 뿭꽕쟻씠寃뚮룄 뿬윭 뿰援ъ뿉꽌 鍮꾪씉뿰옄뿉 鍮꾪빐 珥덇린 씉뿰옄쓽 삁븬씠 뜑 궙 寃껋쑝濡 굹궗떎(Li et al., 2017). 留뚯꽦 씉뿰옄뒗 삁븬씠 媛먯냼븳 寃껋쑝濡 蹂댁씠뒗 紐 뀈씠 吏궃 썑 썑湲 븞젙삎 怨좏삁븬씠 諛쒖깮븯뒗뜲, 씠뒗 궡뵾 湲곕뒫 옣븷媛 怨좏삁븬怨 諛젒븳 愿젴꽦씠 엳뒗 寃껋쑝濡 蹂댁씤떎(Leone, 2011). 蹂 뿰援ъ쓽 蹂댁젙븯吏 븡뒗 떒닚 肄뺤뒪 鍮꾨 쐞뿕 紐⑦삎뿉꽌 씉뿰 怨좏삁븬뿉 넻怨꾩쟻쑝濡 쑀쓽뻽吏留, 뿬윭 蹂닔濡 蹂댁젙븳 紐⑤뜽2뿉꽌뒗 쑀쓽븯吏 븡븯뒗뜲, 씠뒗 씉뿰씠 怨좏삁븬쓽 諛쒖깮뿉 誘몄튂뒗 룆由쎌쟻씤 씤옄媛 븘땶 寃껋쑝濡 蹂댁씤떎(Papathanasiou et al., 2015).

쁽옱 씉뿰옄媛 궗 利앺썑援 諛쒖깮뿉 뜑 겙 쁺뼢쓣 誘몄튂寃좎留 怨쇨굅 씉뿰옄룄 넂 怨듬났 삁떦쓽 諛쒖깮怨 怨좎쨷꽦吏諛⑺삁利앹쓽 諛쒖깮뿉 썝씤씠 맆 닔 엳쓬쓣 蹂 뿰援ъ뿉꽌 솗씤븯떎. 2010뀈遺꽣 2012뀈源뚯 援誘쇨굔媛뺤쁺뼇議곗궗뿉 李몄뿬븳 19꽭 씠긽 궓꽦 6,032紐낆쓣 긽쑝濡 븳援 궓꽦쓽 湲덉뿰 湲곌컙怨 궗 利앺썑援곌낵쓽 뿰愿꽦쓣 遺꾩꽍븳 뿰援ъ뿉꽌 怨쇨굅 씉뿰옄 쁽옱 씉뿰옄 媛꾩쓽 궗 利앺썑援곗쓽 愿젴꽦쓣 鍮꾧탳븳 寃곌낵瑜 蹂대㈃ 怨쇨굅 씉뿰옄 쁽옱 씉뿰옄 紐⑤몢 怨듬났 삁떦怨 以묒꽦 吏諛⑹씠 넂 寃껋쓣 蹂 닔 엳떎(Shin et al., 2018). 씠 媛숈 뿰援 寃곌낵뒗 蹂 뿰援 寃곌낵 媛숈 씪愿꽦쓣 媛뽯뒗떎.

蹂듬 鍮꾨쭔 泥댁諛⑹씠 二쇰줈 蹂듬 쁺뿭뿉 異뺤쟻릺뼱 엳뒗 긽깭瑜 留먰븳떎. 蹂듬 鍮꾨쭔 鍮꾩쟾뿼꽦 留뚯꽦 吏덊솚뿉 엳뼱 鍮꾨쭔蹂대떎 썾뵮 뜑 媛뺣젰븳 쐞뿕 슂냼씠떎(Recio-Rodriguez et al., 2012). 꽦씤쓣 긽쑝濡 떎떆맂 씠쟾 뿰援ъ뿉꽌 씉뿰웾씠 利앷븿뿉 뵲씪 궗쟻쑝濡 遺덈━븳 吏諛⑸텇룷媛 뜑 留롮씠 굹궗뿀怨, 씉뿰씠 쟾諛섏쟻씤 泥댁쨷쓣 利앷떆궎吏 븡븯떎(Kim et al., 2012). 釉뚮씪吏 泥냼뀈쓣 긽쑝濡 븳 뿰援ъ뿉꽌 꽦씤 肉먮쭔 븘땲씪 泥냼뀈 以묒뿉꽌룄 떞諛 냼鍮꾩 蹂듬 鍮꾨쭔쓽 쑀蹂묐쪧 궗씠뿉 湲띿젙쟻씤 뿰愿꽦씠 엳떎怨 蹂닿퀬븯떎(Bertoni et al., 2018). 씠 愿젴빐꽌 蹂 뿰援ъ뿉꽌룄 蹂듬 鍮꾨쭔쓽 諛쒖깮뿉 씉뿰씠 룆由쎌쟻씤 씤옄濡 옉슜븳떎뒗 寃껋쓣 솗씤븯떎.

蹂 뿰援щ뒗 쁽옱 씉뿰 궗 利앺썑援곗쓣 옣湲곗쟻 愿李곗뿉꽌 븙솕떆궓떎뒗 寃껋쓣 솗씤뻽吏留 紐 媛吏 젣븳젏쓣 媛吏꾨떎. 泥レ㎏, 솚옄쓽 紐⑤뱺 湲곗 吏덊솚쓣 怨좊젮븯吏 紐삵뻽떎. 몮吏, 궗 利앺썑援곌낵 諛젒븯寃 愿젴맂 寃궗떎 寃궗뱾쓣 怨좊젮븯吏 紐삵븯떎. 뀑吏, 洹몃9쓽 몴蹂 겕湲곌 옉븘꽌 넻怨꾩쟻쑝濡 쑀쓽誘명븳 李⑥씠瑜 깘吏븯뒗 뒫젰씠 젣븳릺뼱 怨좏삁븬쓽 쐞뿕鍮꾩뿉 븳 떊猶곌뎄媛꾩씠 꼻뼱議뚯쓣 寃껋쑝濡 깮媛곷맂떎. 씠 媛숈 젏쓣 怨좊젮븯뿬 異붽쟻씤 쟾뼢쟻 꽕怨꾩뿉 湲곕컲븳 洹쒕え 肄뷀샇듃 뿰援щ줈 쁽옱 씉뿰쓽 쁺뼢젰쓣 떎떆 솗씤빐빞 븳떎. 씠윭븳 젣븳뿉룄 遺덇뎄븯怨 씉뿰 궗 利앺썑援 諛쒖깮怨 궗 利앺썑援 以 怨좏삁븬쓣 젣쇅븳 넂 怨듬났 삁떦, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡, 洹몃━怨 蹂듬 吏諛⑹쓽 諛쒖깮뿉 엳뼱 룆由쎌쟻씤 씤怨 愿젴꽦씠 엳떎怨 깮媛곷맂떎.

ACKNOWLEDGEMENT

None.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

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