궐련흡연과 혈청 다이옥신 및 공복혈당과의 관련성 분석 = Analysis of the Relationship between Cigarette Smoking and Serum Dioxin and Fasting Blood Glucose Levels

국문 초록 (Abstract)

연구배경: 흡연은 세계적으로 심각한 공중보건 문제로 인식되며, 다양한 질병과 사망률 증가의 주요 위험 요인이다. 특히 궐련 흡연은 환경 독성 물질 노출을 통해 혈중 다이옥신 농도를 증가시키며, 이로 인해 혈당 조절 기능 저하와 당뇨병 발생 위험 증가와 연관되는 것으로 보고되었다. 그러나 흡연과 혈중 다이옥신 농도, 공복혈당 간의 연구는 부족하다. 방법: 이 연구는 건강검진을 위해 병원을 방문한 350명을 대상으로 하였다. 대상자들은 자가 보고 형식의 설문지를 작성하고 혈중 다이옥신 수치를 측정하기 위해 채혈에 참여했다. 수집된 자료는 선형회귀분석과 매개분석을 통해 분석되었으며, 각 모델에 대해 50회의 부트 스트래핑 분석(bootstrapping)을 시행하였다. 결과: 과거 흡연 경험이 있는 대상자 중 흡연 기간이 20년 미만인 경우, 공복 상태 혈당이 8.86 mg/dL (P=0.0317) 상승하였으며, 흡연 기간이 20년 이상인 경우 13.94 mg/dL (P=0.0025) 증가하였다. 전체 대상 분석에서, 혈장 다이옥신(Total Dioxins) 농도가 1단위 증가할 때마다 공복 상태 혈당이 0.39 mg/dL 증가하였다(P=0.0211). 결론: 흡연은 혈당에 직접적인 영향을 미치지만, 다이옥신을 통한 간접적인 영향은 미미한 것으로 나타났다. 하지만, 단면연구의 한계로 인해 시간적 이해를 할 수 없다는 것이 이 연구의 한계점이다. 따라서 보다 심층적인 이해를 위해서는 전향적 코호트 연구가 필요한 것으로 보인다.

다국어 초록 (Multilingual Abstract)

Background: Smoking, recognized globally as a serious public health problem, is a major risk factor for various diseases and increased mortality. Particularly, cigarette smoking reportedly increases the serum dioxin levels through exposure to environmental toxic substances, which is associated with poor blood glucose control and an increased risk of developing diabetes. However, studies on the relationship between smoking and blood dioxin and fasting blood levels are lacking. Methods: This study targeted 350 people who visited the hospital for health checkups. They completed a self-report questionnaire, and blood sampling was performed for measuring the serum dioxin levels. The collected data were examined through linear regression and mediation analyses. Fifty bootstrapping analyses were performed for each model. Results: Among the participants who had smoked in the past and who smoked for ＜20 years, the fasting blood glucose level increased by 8.86 mg/dL (P=0.0317), whereas those who smoked for ≥20 years, it increased by 13.94 mg/dL (P=0.0025). In the all-participant analysis, the fasting blood glucose level increased by 0.39 mg/dL for each unit increase in the plasma dioxin level (P=0.0211). Conclusion: Smoking has a direct effect on the blood glucose level, but the indirect effect through dioxin appears to be minimal. However, the present study is limited, as the temporal link cannot be established due to the limitations of a cross-sectional study. Therefore, it is necessary to conduct a prospective cohort study in the future.

참고문헌 (Reference)

• 1 The jamovi project, "jamovi. (Version 2.4) [Computer Software]"
• 2 World Health Organization (WHO), "World No Tobacco Day 2020:Tobacco. Fact Sheet" WHO
• 3 Chi X, "The impact of chronic disease diagnoses on smoking behavior change and maintenance : Evidence from China" 2024
• 4 Puleo GE, "The State of the Science on Cancer Diagnosis as a"Teachable Moment"for Smoking Cessation : A Scoping Review" 24 : 160-168, 2022
• 5 Lee SH, "The Association between Blood Concentrations of PCDD/DFs, DL-PCBs and the Risk of Type 2Diabetes Mellitus and Thyroid Cancer in South Korea" 19 : 8745-, 2022
• 6 GBD 2019 Chewing Tobacco Collaborators, "Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019" 6 (6): e482-e499, 2021
• 7 Keenan PS, "Smoking and weight change after new health diagnoses in older adults" 169 : 237-242, 2009
• 8 Chang CJ, "Serum concentrations of polybrominated biphenyls(PBBs), polychlorinated biphenyls(PCBs)and polybrominated diphenyl ethers(PBDEs)in the Michigan PBB Registry 40 years after the PBB contamination incident" 137 : 105526-, 2020
• 9 EFSA Panel on Contaminants in the Food Chain(CONTAM), "Risk for animal and human health related to the presence of dioxins and dioxin-like PCBs in feed and food" 16 : e05333-, 2018
• 10 Lee DH, "Relationship between serum concentrations of persistent organic pollutants and the prevalence of metabolic syndrome among non-diabetic adults : results from the National Health and Nutrition Examination Survey 1999-2002" 50 : 1841-1851, 2007
• 11 R Core Team, "R: A Language and environment for statistical computing. (Version 4.1) [Computer software]"
• 12 Hassan HF, "Persistent Organic Pollutants in Human Milk : Exposure Levels and Determinants among Lactating Mothers in Lebanon" 85 : 384-389, 2022
• 13 Zhang P, "Health shocks and changes in preventive behaviors : Results from the China Health and Retirement Longitudinal Study" 10 : 954700-, 2022
• 14 Sultana R, "Fasting Serum Glucose Level in Male Cigarette Smoker" 28 : 808-810, 2019
• 15 Haj Mouhamed D, "Effect of cigarette smoking on insulin resistance risk" 65 : 21-25, 2016
• 16 박세은 ; 서미혜 ; 조정환 ; 권혜미 ; 김양현 ; 한경도 ; 정진형 ; 박영규 ; 이은정 ; 이원영, "Dose-Dependent Effect of Smoking on Risk of Diabetes Remains after Smoking Cessation : A Nationwide Population-Based Cohort Study in Korea" 45 : 539-546, 2021
• 17 Lee DH, "Does mortality risk of cigarette smoking depend on serum concentrations of persistent organic pollutants? Prospective investigation of the vasculature in Uppsala seniors(PIVUS)study" 9 : e95937-, 2014
• 18 Nishijo M, "Dioxin and Dioxin-like Compounds and Human Health" 11 : 512-, 2023
• 19 Brown VJ, "Dioxin Exposure and Cardiovascular Disease : An Analysis of Association" 116 : A491-, 2008
• 20 Sofo V, "Correlation between dioxin and endometriosis : an epigenetic route to unravel the pathogenesis of the disease" 292 : 973-986, 2015
• 21 Sia HK, "Association between smoking and glycemic control in men with newly diagnosed type 2 diabetes : a retrospective matched cohort study" 54 : 1385-1394, 2022
• 22 Moon HJ, "Association between serum concentrations of persistent organic pollutants and smoking in Koreans : A crosssectional study" 27 : 63-68, 2017
• 23 Huang CY, "Association between Dioxin and Diabetes Mellitus in an Endemic Area of Exposure in Taiwan : A Population-Based Study" 94 : e1730-, 2015
• 24 Jeong SH, "Association Between Smoking Behavior and Insulin Resistance Using Triglyceride-Glucose Index Among South Korean Adults" 106 : e4531-e4541, 2021