'염장 김치-신선 채소·과일 섭취 부족-붉은 고기' 순으로 암 부담에 영향
"덜 짜게 먹고, 채소·과일은 충분히, 가공육 소비는 경계해야"

한국인의 밥상
[AI 이미지]

(서울=연합뉴스) 김길원 기자 = 밥과 국, 김치 등으로 대표되는 한국인의 식탁은 오랫동안 건강한 식문화의 상징처럼 여겨져 왔다. 그러나 이 익숙한 밥상이 우리 건강에 남긴 흔적을 숫자로 들여다보면 이야기는 결코 단순하지 않다.

최근 국제학술지 '역학과 건강(Epidemiology and Health)'에 실린 국내 연구에 따르면, 한국에서 발생하는 암의 약 6%, 암 사망의 약 5.7%는 식습관과 직접적으로 연관된 것으로 분석됐다. 우리가 매일 반복해온 '먹는 선택'이 암 발생과 사망의 상당 부분을 설명한다는 의미다.

이번 연구에서 서울의대 예방의학교실, 서울대 식품영양학과 공동 연구팀은 국민건강영양조사와 국내 코호트 연구 자료를 토대로, 2015년부터 2030년까지 한국인의 식습관이 암 발생과 사망에 기여하는 비중(인구집단기여위험도·PAF)을 추정했다.

그 결과 2020년 기준 전체 암 발생의 6.08%, 암 사망의 5.70%가 특정 식이 요인에 기인한 것으로 나타났다. 암 발생만 보자면 미국(5.2%)·프랑스(5.4%)보다는 높고 영국(9.2%)·독일(7.8%)보다는 낮은 수치다.

식습관의 영향은 남성에서 더 컸다. 남성 암 발생의 8.43%, 사망의 7.93%가 식습관과 연관됐지만, 여성은 각각 3.45%, 2.08%였다.

한국인의 식습관 가운데 암 부담에 가장 크게 기여한 요인은 김치와 각종 절임 채소를 아우르는 '염장 채소'로 지목됐다. 연구팀은 2020년 기준 염장 채소 섭취로 인한 암 발생과 사망 기여도를 각각 2.12%, 1.78%로 추산했다. 이는 일본의 기여도(암 발생 1.6%, 사망 1.4%)보다 높은 수준이다.

특히 염장 채소 섭취는 위암과의 연관성이 두드러졌다.

식습관과 관련된 암 발생 사례 가운데 위암이 차지하는 비중은 44%를 넘었고, 사망에서도 37% 이상을 차지했다. 짠맛 위주의 식생활이 한국에서 위암 부담을 키워온 구조적 배경을 수치로 확인한 셈이다.

다만 희망적인 변화도 감지된다. 국내에서 염장 채소 섭취는 점차 줄어드는 추세로, 2030년에는 관련 암 발생 기여도가 1.17%까지 낮아질 것으로 예측됐다.

연구팀은 "나트륨 저감 정책과 식습관 변화가 일정 부분 효과를 내고 있다"고 평가했다.

반면 좀처럼 개선되지 않는 문제도 확인됐다.

바로 탄수화물 비중이 낮은 비전분성 채소와 과일 섭취의 부족이다. 이에 따른 2020년 기준 암 발생 기여도는 1.92%, 사망 기여도는 2.34%로 각각 나타났으며, 이런 추세는 2030년까지도 큰 변화 없이 유지될 것으로 전망됐다.

한국인의 하루 채소·과일 섭취량은 평균 340g 수준으로, 국제적으로 권장되는 490∼730g에 크게 못 미친다. 이 부족분이 대장암과 위암, 일부 호흡·소화기계 암의 위험을 높이는 요인으로 작용한다는 것이 연구팀의 해석이다.

연구팀은 "염장 채소를 줄이는 것만으로는 충분하지 않다"며 "신선한 채소와 과일 섭취를 늘리지 않으면 식습관 개선의 효과는 제한적일 수밖에 없다"고 지적했다.

주목되는 점은 흔히 암 발생과 밀접한 관련이 있는 것으로 알려진 붉은 고기와 가공육의 기여도가 상대적으로 낮았다는 사실이다. 2020년 기준 붉은 고기로 인한 암 발생 기여도는 0.10%, 가공육은 0.02%에 머물렀다. 서구 국가에서 이들 식품이 주요 위험 요인으로 꼽히는 것과는 다른 양상이다.

이는 한국인의 고기 섭취량이 아직 서구보다 적은 데 따른 결과로 풀이된다. 그러나 연구진은 안심하기는 이르다고 경고한다. 가공육 섭취가 빠르게 늘고 있어, 2030년에는 암 사망 기여도가 현재보다 크게 증가할 가능성이 있다는 것이다.

서울대 식품영양학과 이정은 교수는 "이번 연구는 한국의 암 예방 전략이 '한국인의 식탁'을 정면으로 바라봐야 함을 보여준다"면서 "덜 짜게 먹고, 채소와 과일을 충분히 섭취하며, 가공육 소비 증가를 경계해야 암 발생과 사망을 줄일 수 있다"고 말했다.

이 교수는 이어 "식습관은 개인의 선택이면서 동시에 사회·문화적 산물"이라며 "영양 교육과 식생활 가이드라인 개선, 식품 환경 변화가 함께 이뤄져야 암 부담을 실질적으로 낮출 수 있다"고 강조했다.

bio@yna.co.kr

'Sayuran asin-kekurangan asupan sayuran segar dan buah-daging merah' dalam urutan ini mempengaruhi beban kanker
"Makan lebih sedikit garam, cukupi asupan sayuran dan buah-buahan, dan waspada terhadap konsumsi daging olahan"

Meja makan Korea
[Gambar AI]

(Seoul=Yonhapnews) Wartawan Kim Gil-won = Meja makan Korea yang diwakili oleh nasi, sup, dan kimchi telah lama dianggap sebagai simbol budaya makanan yang sehat. Namun ketika melihat jejak kesehatan yang ditinggalkan oleh meja makan yang familiar ini melalui angka-angka, ceritanya sama sekali tidak sederhana.

Menurut penelitian domestik yang dipublikasikan di jurnal akademik internasional 'Epidemiology and Health' baru-baru ini, sekitar 6% kanker yang terjadi di Korea dan sekitar 5,7% kematian akibat kanker terkait langsung dengan kebiasaan makan. Ini berarti 'pilihan makan' yang telah kita ulangi setiap hari menjelaskan bagian yang signifikan dari kejadian dan kematian akibat kanker.

Dalam penelitian ini, tim peneliti bersama dari Departemen Kedokteran Pencegahan Universitas Medis Seoul dan Departemen Ilmu Gizi dan Makanan Universitas Seoul memperkirakan kontribusi kebiasaan makan Korea terhadap kejadian dan kematian kanker (population attributable fraction, PAF) dari 2015 hingga 2030 berdasarkan data Survei Kesehatan dan Gizi Nasional Korea dan penelitian kohort domestik.

Hasilnya menunjukkan bahwa pada tahun 2020, 6,08% dari seluruh kejadian kanker dan 5,70% dari kematian kanker disebabkan oleh faktor diet tertentu. Jika hanya melihat kejadian kanker, angka ini lebih tinggi dari Amerika Serikat (5,2%) dan Prancis (5,4%), tetapi lebih rendah dari Inggris (9,2%) dan Jerman (7,8%).

Dampak kebiasaan makan lebih besar pada pria. 8,43% dari kejadian kanker pria dan 7,93% dari kematian terkait dengan kebiasaan makan, sementara pada wanita masing-masing 3,45% dan 2,08%.

Di antara kebiasaan makan Korea, faktor yang paling besar berkontribusi pada beban kanker adalah 'sayuran asin' yang mencakup kimchi dan berbagai sayuran acar. Berdasarkan tahun 2020, tim peneliti memperkirakan kontribusi asupan sayuran asin terhadap kejadian kanker dan kematian masing-masing sebesar 2,12% dan 1,78%. Ini lebih tinggi dari kontribusi Jepang (kejadian kanker 1,6%, kematian 1,4%).

Khususnya, asupan sayuran asin menunjukkan asosiasi yang menonjol dengan kanker lambung.

Di antara kasus kanker terkait kebiasaan makan, kanker lambung menyumbang lebih dari 44% kasus, dan lebih dari 37% dari kematian. Ini adalah konfirmasi numerik dari latar belakang struktural di mana pola makan yang berat rasa asin telah meningkatkan beban kanker lambung di Korea.

Namun, perubahan yang menggembirakan juga terdeteksi. Asupan sayuran asin di Korea menunjukkan tren penurunan, dan diproyeksikan akan turun menjadi 1,17% pada tahun 2030 dalam kontribusi kejadian kanker terkait.

Tim peneliti mengevaluasi bahwa "kebijakan pengurangan natrium dan perubahan kebiasaan makan memiliki efek tertentu."

Sebaliknya, masalah yang kurang meningkat juga teridentifikasi.

Yaitu kurangnya asupan sayuran non-pati dengan rasio karbohidrat rendah dan buah-buahan. Kontribusi kejadian kanker berdasarkan tahun 2020 adalah 1,92%, dan kontribusi kematian adalah 2,34%, dan tren ini diproyeksikan akan tetap tanpa perubahan besar hingga tahun 2030.

Asupan harian sayuran dan buah-buahan Korea rata-rata 340g, jauh di bawah 490-730g yang direkomendasikan secara internasional. Menurut interpretasi tim peneliti, kekurangan ini bertindak sebagai faktor yang meningkatkan risiko kanker kolon, kanker lambung, dan beberapa kanker pernapasan dan pencernaan.

Tim peneliti menunjukkan bahwa "mengurangi sayuran asin saja tidak cukup" dan "jika asupan sayuran segar dan buah-buahan tidak ditingkatkan, efek peningkatan kebiasaan makan akan terbatas."

Poin yang patut diperhatikan adalah bahwa kontribusi daging merah dan daging olahan, yang umumnya diketahui memiliki hubungan erat dengan kejadian kanker, relatif rendah. Berdasarkan tahun 2020, kontribusi kejadian kanker dari daging merah adalah 0,10%, dan daging olahan adalah 0,02%. Ini berbeda dengan negara-negara Barat di mana makanan ini dianggap sebagai faktor risiko utama.

Ini diinterpretasikan sebagai hasil dari asupan daging Korea yang masih lebih rendah daripada Barat. Namun, peneliti memperingatkan bahwa terlalu dini untuk merasa tenang. Karena asupan daging olahan meningkat dengan cepat, ada kemungkinan bahwa kontribusi kematian kanker pada tahun 2030 akan meningkat secara signifikan dari saat ini.

Prof. Lee Jung-eun dari Departemen Ilmu Gizi dan Makanan Universitas Seoul berkata, "Penelitian ini menunjukkan bahwa strategi pencegahan kanker Korea harus secara langsung melihat 'meja makan Korea'," dan "mengurangi kejadian kanker dan kematian adalah mungkin jika kita makan lebih sedikit garam, cukupi asupan sayuran dan buah-buahan, dan waspada terhadap peningkatan konsumsi daging olahan."

Prof. Lee selanjutnya mengatakan, "Kebiasaan makan adalah pilihan individu sekaligus produk sosial dan budaya," dan menekankan bahwa "pendidikan gizi, peningkatan pedoman diet, dan perubahan lingkungan makanan harus dilakukan bersama-sama untuk secara nyata mengurangi beban kanker."

bio@yna.co.kr

'Salted vegetables—insufficient intake of fresh vegetables and fruits—red meat' in order of impact on cancer burden
"Eat less salty, consume enough vegetables and fruits, and be cautious about processed meat consumption"

Korean dining table
[AI Image]

(Seoul=Yonhap News) Reporter Kim Gil-won = The Korean dining table, represented by rice, soup, and kimchi, has long been regarded as a symbol of healthy food culture. However, when we examine the traces this familiar table has left on our health through the numbers, the story is far from simple.

According to a recent domestic study published in the international academic journal 'Epidemiology and Health,' approximately 6% of cancers occurring in Korea and approximately 5.7% of cancer deaths are directly related to dietary habits. This means that the 'eating choices' we have repeated daily explain a significant portion of cancer incidence and death.

In this study, a joint research team from the Department of Preventive Medicine at Seoul National University School of Medicine and the Department of Food and Nutrition Science at Seoul National University estimated the contribution of Korean dietary habits to cancer incidence and death (Population Attributable Fraction·PAF) from 2015 to 2030 based on the National Health and Nutrition Examination Survey and domestic cohort research data.

As a result, as of 2020, 6.08% of all cancer incidence and 5.70% of cancer deaths were attributed to specific dietary factors. Looking at cancer incidence alone, this is higher than the United States (5.2%) and France (5.4%), but lower than the United Kingdom (9.2%) and Germany (7.8%).

The impact of dietary habits was greater in men. While 8.43% of male cancer incidence and 7.93% of deaths were related to dietary habits, women showed 3.45% and 2.08%, respectively.

Among Korean dietary habits, the factor that contributed most significantly to cancer burden was identified as 'salted vegetables,' which includes kimchi and various pickled vegetables. Based on 2020 data, the research team estimated the contribution to cancer incidence and death from salted vegetable intake at 2.12% and 1.78%, respectively. This is higher than Japan's contribution (1.6% for cancer incidence and 1.4% for death).

In particular, the intake of salted vegetables showed a prominent association with gastric cancer.

Among cancer cases related to dietary habits, gastric cancer accounted for over 44% of incidence and over 37% of deaths. This confirms numerically the structural background of how a salty diet has increased the burden of gastric cancer in Korea.

However, encouraging changes are also being detected. Salted vegetable intake in Korea is gradually decreasing, and it is predicted that the contribution to related cancer incidence will drop to 1.17% by 2030.

The research team evaluated that "sodium reduction policies and changes in dietary habits are having some effect."

On the other hand, problems that remain largely unimproved have also been identified.

These are the lack of intake of non-starchy vegetables and fruits with low carbohydrate content. Based on 2020 data, the contribution to cancer incidence is 1.92% and to death is 2.34%, and this trend is expected to continue without major change through 2030.

The average daily vegetable and fruit intake for Koreans is around 340g, far below the internationally recommended 490-730g. The research team interprets this shortfall as a factor that increases the risk of colorectal cancer, gastric cancer, and some respiratory and digestive system cancers.

The research team pointed out that "simply reducing salted vegetables is not enough," and "without increasing the intake of fresh vegetables and fruits, the effect of dietary habit improvements will inevitably be limited."

It is noteworthy that the contribution of red meat and processed meat, which are commonly known to be closely related to cancer development, was relatively low. Based on 2020 data, the contribution to cancer incidence from red meat was 0.10%, while processed meat accounted for only 0.02%. This is a different pattern from Western countries where these foods are identified as major risk factors.

This is interpreted as a result of Koreans' meat consumption still being lower than in Western countries. However, the researchers warn that it is premature to be reassured. Since processed meat consumption is increasing rapidly, there is a possibility that the contribution to cancer death by 2030 could significantly increase from current levels.

Professor Lee Jung-eun from the Department of Food and Nutrition Science at Seoul National University said, "This study demonstrates that Korea's cancer prevention strategy must directly address 'the Korean dining table,'" and added, "Cancer incidence and death can be reduced by eating less salty foods, consuming sufficient vegetables and fruits, and being cautious about the increasing consumption of processed meat."

Professor Lee continued, "Dietary habits are both individual choices and social and cultural products," and emphasized, "Nutritional education, improvements in dietary guidelines, and changes in the food environment must be implemented together to substantially reduce the cancer burden."

bio@yna.co.kr