Prevalência de síndrome metabólica em uma área rural do semi-árido baiano

Patterns of metabolic syndrome and associated factors in women from the ELSA-Brasil: a latent class analysis approach

This study aimed to identify patterns of metabolic syndrome among women and estimate their prevalence and relationship with sociodemographic and biological characteristics. In total, 5,836 women were evaluated using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Patterns of metabolic syndrome were defined via latent class analysis, using the following metabolic abnormalities as indicators: abdominal obesity, hyperglycemia, hypertension, hypertriglyceridemia, and reduced HDL cholesterol. The relationship between these patterns and individual characteristics was assessed using latent class analysis with covariates. Three patterns of metabolic syndrome were identified: high metabolic expression, moderate metabolic expression, and low metabolic expression. The first two patterns represented most women (53.8%) in the study. Women with complete primary or secondary education and belonging to lower social classes were more likely to have higher metabolic expression. Black and mixed-race women were more likely to have moderate metabolic expression. Menopausal women aged 50 years and older were more often classified into patterns of greater health risk. This study addressed the heterogeneous nature of metabolic syndrome, identifying three distinct profiles for the syndrome among women. The combination of abdominal obesity, hyperglycemia, and hypertension represents the main metabolic profile found among ELSA-Brasil participants. Sociodemographic and biological factors were important predictors of patterns of metabolic syndrome.

Metabolic Syndrome and Associated Factors in Farmers in Southeastern Brazil: A Cross-Sectional Study

(1) Background: Metabolic syndrome is a strong predictor of cardiovascular disease thus the objective of the study was to verify the prevalence of metabolic syndrome in farmers, as well as to verify the association with sociodemographic, work and lifestyle factors. (2) Methods: Cross-sectional, observational study, conducted with 790 individuals. For the diagnosis of metabolic syndrome, the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria were used. Pearson's chi-square test and binary logistic regression were used to verify factors associated with metabolic syndrome (3) Results: The prevalence of MS according to the IDF criteria was 16.3% overall, with 9.7% of women (95% CI: 6.66-16.16) and 6.6% of men (95% CI: 5.17-11.97). According to the NCEP/ATP III criterion, it was 12.3% overall, with 7.5% corresponding to women (95% CI: 6.62-13.13) and 4.8% to men (95% CI: 3.5-8.70). With regard to the conditions that make up metabolic syndrome, it was found that high density lipoprotein, high blood pressure and high waist circumference were the most prevalent. (4) Conclusions: The prevalence of metabolic syndrome is considerable in the population when compared to other regions, both rural and urban, in Brazil.

Accuracy of the triglyceride-glucose index as a surrogate marker for identifying metabolic syndrome in non-diabetic individuals

OBJECTIVES

This study aimed to verify the performance of the triglyceride-glucose (TyG) index in predicting metabolic syndrome (MetS) using three different criteria in healthy individuals living in rural areas. In addition, it aimed to estimate the TyG index cutoff point in the prediction of MetS.

METHODS

The study was a cross-sectional study of healthy individuals (aged ≥18 y) living in rural areas of southern Brazil. Individuals with diabetes mellitus were excluded. The variables investigated were waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, fasting glucose, and TyG index. MetS was defined using three criteria: harmonized, International Diabetes Foundation, and National Cholesterol Education Program Adult Treatment Panel III. The Poisson regression model was used for the multivariate analysis. The performance of the TyG index in identifying MetS was determined by receiver operating characteristic curves.

RESULTS

A total of 133 individuals were included in this study, with a mean age of 49.0 ± 13.5 y; 54.1% were female. The TyG index performed better in predicting MetS through the harmonized criteria, with area under the curve (AUC) = 0.889 (95% confidence interval [CI], 0.829-0.949), followed by the International Diabetes Foundation criteria, with AUC = 0.877 (95% CI, 0.814-0.940), and the National Cholesterol Education Program criteria, with AUC = 0.867 (95% CI, 0.797-0.937). The TyG index cutoff points defined for the harmonized and International Diabetes Foundation criteria were ≥ 8.61, and ≥ 8.79 for the National Cholesterol Education Program Adult Treatment Panel III.

CONCLUSIONS

The TyG index proved to be valid for diagnosing MetS. The largest AUC of the TyG index was identified for the harmonized criteria. Thus, the TyG index can be used to diagnose MetS in individuals living in rural areas.

Prevalence and determinants of obesity and abdominal obesity among rural workers in Southeastern Brazil

The objectives of this study were to assess the nutritional status of rural workers from a municipality in Southeastern Brazil and estimate the association of sociodemographic, labor, lifestyle, and dietary pattern factors with obesity and abdominal obesity of men and women of this rural area. This is a cross-sectional, epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females). The sociodemographic, labor, lifestyle and dietary patterns determinants were assessed. Food intake data were obtained by applying three 24-hour recalls and dietary patterns were determined by Principal Component Analysis with Varimax orthogonal rotation. Poisson regression with robust variance stratified by sex was applied. The general prevalence of overweight status was 31.5% (95% CI 28.2-34.8%), 19.7% of obesity (95% CI 16.8-22.6%) and 31.5% of abdominal obesity (95% CI 28.2-34.8%), with higher rates in women (P < 0.001). Men of higher socioeconomic class had a 2.3 times higher prevalence of obesity (95% CI 1.08-4.90). In addition, the shorter travel time to purchase food increased the prevalence of abdominal obesity in males. For women, the older the age group, the greater the general and central obesity. A lower adherence to traditional dietary patterns (approximately PR [prevalence ratio] 1.6 for general obesity and PR 1.3 for abdominal obesity) and a greater number of places to buy food were associated with higher rates of obesity in women. Finally, women farmers with a higher workload had a 20% lower prevalence of central obesity (PR 0.80; 95% CI 0.65-0.97). Such findings demonstrate that obesity must be an issue in the health care of remote and rural populations. There is a need to promote healthier environments that respect traditional food culture through multiple approaches that consider the heterogeneity of rural areas and the differences between sexes.

Prevalence of the metabolic syndrome according to different criteria in the male population during the Blue November Campaign in Natal, RN, Northeastern Brazil

BACKGROUND

Metabolic syndrome (MetS) is an aggregation of risk factors associated with increased incidence of cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality. Information on MetS prevalence is scarce in the northeast region, Brazil. This study aims to estimate the prevalence of MetS according to different diagnostic criteria in a community sample of men during the November Blue Campaign living in the metropolitan area of Natal, Rio Grande do Norte, Brazil.

METHODS

This is a cross-sectional study on 500 men aged 40 years or older invited by the Blue November Campaign of 2015, an awareness program aimed at the prevention of male diseases. The evaluation included blood pressure, anthropometric measurements (weight, height, and waist circumference), fasting blood glucose, and blood lipid profile. The diagnosis of MetS was made according to the criteria of International Diabetes Federation (IDF)/American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI), IDF, and National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPIII).

RESULTS

The prevalence was high by considering the following three criteria: IDF/AHA/NHLBI (66.8%), IDF (60.0%), and NCEP-ATPIII (46.4%). Concordance between diagnostic criteria measured by the kappa statistic (k) was excellent between IDF/AHA/NHLBI and IDF (k=0.85, P<0.0001) and moderate between IDF/AHA/NHLBI and NCEP-ATPIII (k=0.59) and IDF and NCEP-ATPIII (k=0.54).

CONCLUSION

Prevalence of MetS in the male population was high using the three diagnostic criteria. IDF/AHA/NHLBI and IDF criteria have a high level of agreement, but NCEP-ATPIII criteria identify a lower number of MetS cases.

Metabolic syndrome and its components in postmenopausal women living in southern Italy, Apulia region

OBJECTIVES

The goal of our study was to determine the prevalence of metabolic syndrome (MetS) and all its components, in a population of postmenopausal women aged over 45 years, consecutively accessed to our Heart Station, during 2014, for their first cardiac examination,furthermore to estimate their cardiovascular risk and the achievement of target blood values of main risk factors, according to current Guidelines.

METHODS

We screened 1257 postmenopausal women. MetS was assessed according to the National-Cholesterol-Education-Program-Adult-Treatment-Panel III definition. Cardiovascular risk was calculated by the Systematic Coronary Risk Evaluation (<65 years).

RESULTS

MetS was assessed on 834 women (66.4%). Prevalence of each component was: hypertension on 767 women (91.9%), central obesity 758 women (90.9%), low high-density lipoproteins cholesterol (HDLc) increased levels 612 women (73.3%), high triglyceride levels 428 women (51.3%), glucose levels higher than 110mg/dl or diabetes 404 women (48.5%). Cardiovascular risk was moderate until 65 years, but it increases after. Metabolic control in postmenopausal women was poor for glucose, only 82 women (9.8%) presented glucose levels lower than 110mg/dl, it was better for systolic blood pressure, that was normal in 564 women (67.6%) and worse for lipid levels.

CONCLUSION

The prevalence of metabolic syndrome in our population of postmenopausal women is high. Hypertension and central obesity are the more common components. The cardiovascular risk is moderate-high, the achievement of target values for glycemic and lipid levels is unsatisfactory, while systolic blood pressure is enough well controlled but however it is mandatory to improve this goal. An early MetS diagnosis and an early educational intervention are useful to decrease cardiovascular risk of postmenopausal women affected by metabolic syndrome.

Waist circumference measures: cutoff analyses to detect obesity and cardiometabolic risk factors in a Southeast Brazilian middle-aged men population--a cross-sectional study

Background

Low-cost practical and reliable tools to evaluated obesity-related cardiometabolic diseases are of clinical practice and public heath relevance worldwide. The aims of this cross-sectional study were to determine the anatomical point of waist circumference that best identify overweight, obesity and central obesity in Southeast Brazilian middle-aged men and to test the relationships of its cutoff points with metabolic syndrome (MetS), insulin resistance (IR) and cardiometabolic risk factors.

Methods

Three hundred men [age: 51 (47–54)] underwent anthropometric, body composition, clinical, sociodemographic and blood plasma biochemical evaluations.

Results

The umbilical line circumference (WC_UL) was the best predictor for overweight (total body fat ≥ 20%; cutoff point: 88.8 cm), obesity (total body fat ≥ 25%; cutoff point: 93.4 cm) and central obesity (abdominal area fat ≥ 34.6%; cutoff point: 95.6 cm) as measured by dual beam X-ray absorptiometry. Subjects with WC_UL ≥ 88.8 cm or ≥ 93.4 cm showed significantly higher values for MetS, IR and cardiometabolic risk factors (i.e. glucose and lipid profiles, blood pressure). The occurrence of WC_UL ≥ 88.8 cm was positively associated (p <0.01) with the prevalence of MetS and cardiometabolic risk factors and increased the central obesity prevalence by 19.3% while that of WC_UL ≥ 93.4 cm was associated with the prevalence of MetS, IR and cardiometabolic risk factors.

Conclusions

WC_UL measure seems to be the best predictor for overweight, obesity and central obesity in urban residents Southeast Brazilian middle-aged men; and the WC_UL cutoff point (88.8 cm) is significantly associated with MetS, IR and cardiometabolic risk factors in the studied population.

Prevalence of metabolic syndrome and associated factors in women aged 35 to 65 years who were enrolled in a family health program in Brazil

OBJECTIVE

The aims of this study were to estimate the prevalence of metabolic syndrome among women aged 35 to 65 years and to identify associated factors.

METHODS

This was a cross-sectional study. We randomly selected 581 women (aged 35-65 y) from among those enrolled in a family health program in the city of Pindamonhangaba, Brazil. Metabolic syndrome was identified in accordance with the definition of the National Cholesterol Education Program Adult Treatment Panel III. Health conditions and lifestyle habits were evaluated by a survey, and anthropometric measurements were obtained. The prevalence of metabolic syndrome was estimated, and Poisson regression was used to evaluate the associations between metabolic syndrome `and the factors investigated.

RESULTS

The prevalence of metabolic syndrome was 42.2% (95% CI, 38.1-46.2). The most common metabolic syndrome component was abdominal obesity (60.6%), followed by low levels of high-density lipoprotein cholesterol (51.3%), high levels of triglycerides (41.4%), high blood pressure (31.7%), and diabetes (13.9%). The following factors were associated with metabolic syndrome: the 45- to 54-year age group (prevalence ratio, 1.54; 95% CI, 1.08-2.01), the 55- to 65-year age group (prevalence ratio, 3.51; 95% CI, 1.49-3.10), hyperuricemia (prevalence ratio, 2.95; 95% CI, 1.15-1.86), and sleep apnea risk (prevalence ratio, 2.41; 95% CI, 1.16-1.82). We found an inverse association between metabolic syndrome and having had more than 5 years of schooling (prevalence ratio, 0.65; 95% CI, 0.65-1.04).

CONCLUSIONS

The prevalence of metabolic syndrome is high, and the associated clinical factors are hyperuricemia and risk of sleep apnea.

Prevalence of metabolic syndrome in Brazilian adults: a systematic review

Background

The metabolic syndrome (MS) is a complex of risk factors for cardiovascular disease. This syndrome increases the risk of diabetes, cardiovascular disease and all-cause mortality. It has been demonstrated that the prevalence of MS is increasing worldwide. Despite the importance of MS in the context of metabolic and cardiovascular disease, few studies have described the prevalence of MS and its determinants in Latin America. The present study aims to assess studies describing the prevalence of MS in Brazil in order to determine the global prevalence of the syndrome and its components.

Methods

Systematic review. Searches were carried out in PubMed and Scielo from the earliest available online indexing year through May 2013. There were no restrictions on language. The search terms used to describe MS were taken from the PubMed (MeSH) dictionary: “metabolic syndrome x”, “prevalence” and “Brazil”. Studies were included if they were cross-sectional, described the prevalence of MS and were conducted in apparently healthy subjects, from the general population, 19-64 years old (adult and middle aged) of both genders. The titles and abstracts of all the articles identified were screened for eligibility.

Results

Ten cross-sectional studies were selected. The weighted mean for general prevalence of MS in Brazil was 29.6% (range: 14.9%-65.3%). Half of the studies used the criteria for clinical diagnosis of MS proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2001). The highest prevalence of MS (65.3%) was found in a study conducted in an indigenous population, whereas the lowest prevalence of MS (14.9%) was reported in a rural area. The most frequent MS components were low HDL-cholesterol (59.3%) and hypertension (52.5%).

Conclusions

Despite methodological differences among the studies selected, our findings suggested a high prevalence of MS in the Brazilian adult population.

The prevalence of metabolic syndrome and its predominant components among pre-and postmenopausal Ghanaian women

BACKGROUND

Metabolic Syndrome (MetS) is a clump of risk factors for development of type 2 diabetes mellitus and cardiovascular diseases. Menopause and age are thought to predispose women to the development of metabolic syndrome. This study aimed to estimate the prevalence of MetS and identify its predominant components among pre-and postmenopausal women in the Kumasi Metropolis, Ghana.Two hundred and fifty (250) Ghanaian women were randomly selected for the study. They were evaluated for the prevalence of metabolic syndrome using the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF) and Harmonization (H_MS) criteria.

RESULTS

Out of the total subjects, 143 (57.2%) were premenopausal and 107 (42.8%) menopausal. The study population was between the ages of 20-78 years. The overall percentage prevalence of MetS were 14.4%, 25.6%, 29.2% and 30.4% according to the WHO, NCEP-ATP III, IDF and H_MS criteria, respectively. The prevalence was found to increase with age, irrespective of criterion used. Generally, MetS was significantly higher among postmenopausal women (p < 0.05 by all criteria) compared to their premenopausal cohort, but with marked inter-criteria variations. Abdominal obesity, blood pressure, fasting blood glucose, triglyceride, very low density lipoprotein cholesterol, and triglyceride-high density lipoprotein cholesterol ratio were significantly (p < 0.05) different among the two groups of women.Central obesity, higher blood pressure and raised fasting blood glucose were the predominant components that contributed to the syndrome in Ghanaian women.

CONCLUSION

The higher prevalence of the metabolic syndrome in postmenopausal women is an indication that they are at risk of developing cardiovascular disease and type 2 diabetes. Therefore women in that group should be monitored for the two conditions and also be advised to adopt healthy lifestyles to minimize the incidence of these conditions.

Rational use of medicines: prescribing indicators at different levels of health care

This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1%) were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

Clustering and combining pattern of metabolic syndrome components in a rural Brazilian adult population

CONTEXT AND OBJECTIVE Metabolic syndrome is characterized by clustering of cardiovascular risk factors such as obesity, dyslipidemia, insulin resistance, hyperinsulinemia, glucose intolerance and arterial hypertension. The aim of this study was to estimate the probability of clustering and the combination pattern of three or more metabolic syndrome components in a rural Brazilian adult population. DESIGN AND SETTING This was a cross-sectional study conducted in two rural communities located in the Jequitinhonha Valley, Minas Gerais, Brazil. METHODS The sample was composed of 534 adults (both sexes). Waist circumference, blood pressure and demographic, lifestyle and biochemical characteristics were assessed. The prevalences of metabolic syndrome and its components were estimated using the definitions of the National Cholesterol Education Program - Adult Treatment Panel III. A binomial distribution equation was used to evaluate the probability of clustering of metabolic syndrome components. The statistical significance level was set at 5% (P < 0.05). RESULTS Metabolic syndrome was more frequent among women (23.3%) than among men (6.5%). Clustering of three or more metabolic syndrome components was greater than expected by chance. The commonest combinations of three metabolic syndrome components were: hypertriglyceridemia + low levels of HDL-c + arterial hypertension and abdominal obesity + low levels of HDL-c + arterial hypertension; and of four metabolic syndrome components: abdominal obesity + hypertriglyceridemia + low levels of HDL-c + arterial hypertension. CONCLUSION The population studied presented high prevalence of metabolic syndrome among women and clustering of its components greater than expected by chance, suggesting that the combination pattern was non-random.

Prevalência de Síndrome Metabólica em uma área rural de Santa Rosa

Síndrome Metabólica (SM) é uma condição de prevalência elevada e crescente. Este artigo tem como objetivo descrever os determinantes e também a prevalência deste importante fator de risco para doenças cardiovasculares em uma área rural do município de Santa Rosa. Foi realizado um estudo transversal, em uma população de abrangência da Estratégia Saúde da Família, constituída de adultos jovens na faixa etária de 20 a 49 anos. Foi aplicado um questionário pré-codificado com variáveis sociodemográficas, comportamentais, histórico pessoal e familiar de doenças crônicas, bem como obtidas medidas antropométricas e laboratoriais pertinentes. Para a classificação da Síndrome Metabólica, esta pesquisa seguiu os critérios da National Cholesterol Education Program’s Adult Treatment Panel (NCEP/ATP III) e da International Diabetes Federation. Foram descritos componentes isolados da SM, encontrando alta prevalência de obesidade abdominal e HDL - colesterol baixo em mulheres, bem como alta prevalência de níveis pressóricos aumentados em homens. A prevalência global da SM encontrada foi de 8,5% em homens e 22% em mulheres pelos critérios da NCEP/ATP III, e 15,9% em homens e 25,3% em mulheres pelos critérios da IDF.

Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil

INTRODUCTION

Metabolic syndrome (MetS), a risk factor for atherosclerosis and coronary heart disease, is related to an inadequate food intake pattern. Its incidence is increasing among Brazilian adults, including those living in rural areas. Our aim was not only to describe the frequency of MetS in adults with or without MetS but also to compare their food intake pattern as assessed by the healthy eating index (HEI) and serum albumin and C reactive protein (CRP) levels.

METHODS

Men and women (n = 246) living in a small village in Brazil were included. MetS was characterized according to the adult treatment panel (ATP III) criteria. Groups were compared by chi-square, student t or Mann-Whitney tests.

RESULTS

MetS was diagnosed in 15.4% of the cases. The MetS group showed higher CRP (1.8±1.2 vs. 1.0±0.9 mg/dl) and lower albumin (4.3±0.3 vs. 4.4±0.3 g/dl) serum levels compared to the control group. Additionally, the MetS group showed lower scores (median[range]) in the HEI compared to the control group (53.5[31.2-78.1] vs 58[29.7-89.5], respectively). The MetS group also had decreased scores for total fat and daily variety of food intake.

CONCLUSIONS

The results suggest that adults with MetS displayed chronic mild inflammation and a poorer food intake pattern than the control group.

Nitric oxide enhancement and blood pressure decrease in patients with metabolic syndrome using soy protein or fish oil

OBJECTIVE: To verify the effects of fish oil and soy on nitric oxide (NO) and blood pressure in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: Sixty women with MS were investigated in a parallel randomized design study. The first group maintained their usual diet; the second group received 25 g/day of soy; the third group received 3 g/day of n-3 fatty acids, and the fourth group the same amount previously cited of n-3 fatty acids and soy. RESULTS: Serum nitric oxide metabolites showed significant increase after 90 days in the fish oil and soy groups. Systolic pressure reduced after 45 days of treatment with fish oil, whereas diastolic pressure decreased significantly throughout the study in the soy group. CONCLUSIONS: NO increase and blood pressure reduction with fish oil or soy protein reinforce the importance of the influence of NO on blood pressure in patients with MS.

Percepções de pacientes sobre alimentação no seu processo de adoecimento crônico por síndrome metabólica: um estudo qualitativo

OBJETIVO: Investigar aspectos psicoculturais que envolvem as práticas alimentares e a imagem corporal no processo de adoecimento crônico por síndrome metabólica. MÉTODOS: Estudo clínico-qualitativo realizado por meio de entrevistas semidirigidas de questões abertas, submetidas à técnica de análise de conteúdo e interpretação dos dados com base no referencial teórico psicodinâmico. Foram entrevistados nove indivíduos em tratamento ambulatorial para síndrome metabólica em hospital universitário em Campinas (SP). RESULTADOS: Os resultados foram organizados empiricamente em três categorias: "Quem é gordo é horrível"; "O peso é muito e a gordura estorva demais"; "Como muito pouco. Ninguém acredita". Os sujeitos do estudo revelaram rejeição à obesidade, reforçada pela cultura de enaltecimento da magreza. A insatisfação com a imagem corporal leva os pacientes a um desvio de foco do problema, o que interfere no desenvolvimento do autocuidado e no manejo do tratamento dos distúrbios que caracterizam a síndrome metabólica. Tanto a dissociação entre as práticas alimentares e o excesso de peso quanto a utilização dos alimentos para preencher lacunas de ordem emocional expressam dificuldades de enfrentamento dos conflitos, o que colabora com o desvio de foco acima referido. CONCLUSÃO: O cuidado nutricional e as propostas dietéticas para portadores de síndrome metabólica devem estabelecer escuta acurada das demandas emocionais, que se manifestam por meio da insatisfação com a imagem corporal, das dificuldades para estabelecer mudanças nas práticas alimentares e/ou dos episódios de compulsão alimentar.

HOMA1-IR and HOMA2-IR indexes in identifying insulin resistance and metabolic syndrome: Brazilian Metabolic Syndrome Study (BRAMS)

OBJECTIVE

To investigate cut-off values for HOMA1-IR and HOMA2-IR to identify insulin resistance (IR) and metabolic syndrome (MS), and to assess the association of the indexes with components of the MS.

METHODS

Nondiabetic subjects from the Brazilian Metabolic Syndrome Study were studied (n = 1,203, 18 to 78 years). The cut-off values for IR were determined from the 90th percentile in the healthy group (n = 297) and, for MS, a ROC curve was generated for the total sample.

RESULTS

In the healthy group, HOMA-IR indexes were associated with central obesity, triglycerides and total cholesterol (p < 0.001). The cut-off values for IR were: HOMA1-IR > 2.7 and HOMA2-IR > 1.8; and, for MS were: HOMA1-IR > 2.3 (sensitivity: 76.8%; specificity: 66.7%) and HOMA2-IR > 1.4 (sensitivity: 79.2%; specificity: 61.2%).

CONCLUSION

The cut-off values identified for HOMA1-IR and HOMA2-IR indexes have a clinical and epidemiological application for identifying IR and MS in Westernized admixtured multi-ethnic populations.

Efeito dos ácidos graxos n-3 no perfil glicêmico e lipídico, no estresse oxidativo e na capacidade antioxidante total de pacientes com síndrome metabólica

OBJETIVO: A síndrome metabólica (SM) é um conjunto de fatores que favorecem o desenvolvimento de doenças cardiovasculares. Estudos prévios demonstram que os ácidos graxos poliinsaturados (PUFAs) podem melhorar alguns desses fatores. O objetivo foi avaliar o efeito do óleo de peixe rico em PUFAs nos perfis glicêmico e lipídico, no estresse oxidativo e na capacidade antioxidante total (TRAP) no plasma em pacientes com SM. SUJEITOS E MÉTODOS: Foi realizado um ensaio clínico em 40 pacientes com SM (20 controles e 20 pacientes que consumiram 3 g/dia de PUFAs). RESULTADOS: O grupo que recebeu tratamento apresentou redução significativa nos níveis de triacilgliceróis e aumento no TRAP, mas sofreu aumento nos níveis de LDL, glicose e na resistência à insulina. CONCLUSÃO: Conclui-se que a ingestão de óleo de peixe foi capaz de diminuir os níveis de triacilgliceróis e aumentar o TRAP de pacientes com SM, porém verificou-se aumento nos níveis de LDL e na resistência à insulina.

[Prevalence of HIV-associated lipodystrophy in Brazilian outpatients: relation with metabolic syndrome and cardiovascular risk factors]

Lipodystrophy in HIV-infected patients (LDHIV) affects 40-50% of HIV-infected patients, but there are no data on its prevalence in Brazil. The aim of this study was to assess the LDHIV prevalence among HIV-infected adult Brazilian individuals, as well as to evaluate LDHIV association with cardiovascular risk factors and the metabolic syndrome (MS). It was included 180 adult HIV-infected outpatients consecutively seen in the Infectology Clinic of Universidade Estadual de Londrina. Anthropometric and clinical data (blood pressure, family and personal comorbidities, duration of HIV infection/AIDS, antiretroviral drugs used, CD4+ cells, viral load, fasting glycemia and plasma lipids) were obtained both from a clinical interview as well as from medical charts. LDHIV was defined as the presence of body changes self-reported by the patients and confirmed by clinical exam. MS was defined using the NCEP-ATPIII criteria, reviewed and modified by AHA/NHLBI. A 55% prevalence of LDHIV was found. Individuals with LDHIV presented a longer infected period since HIV infection, longer AIDS duration and longer use of antiretroviral drugs. In multivariate analysis, women (p=0.006) and AIDS duration >8 years (p<0.001) were independently associated with LDHIV. Concerning MS diagnostic criteria, high blood pressure was found in 32%, low HDL-cholesterol in 68%, hypertriglyceridemia in 55%, altered waist circumference in 17% and altered glycemia and/or diabetes in 23% of individuals. Abnormal waist and hypertriglyceridemia were more common in LDHIV-affected individuals. MS was diagnosed in 36%. In multivariate analysis, the factors associated with MS were: BMI >25 kg/m(2) (p<0.001), family history of obesity (p=0.01), indinavir (p=0.001) and age >40 years on HIV first detection (p=0.002). There was a trend to higher frequency of LDHIV among patients with MS (65% versus 50%, p=0.051). LDHIV prevalence among our patients (55%) was similar to previous reports from other countries. MS prevalence in these HIV-infected individuals seems to be similar to the prevalence reported on Brazilian non-HIV-infected adults.

Estado nutricional e prevalência de síndrome metabólica em praticantes amadores de futebol

O objetivo do estudo foi avaliar o estado nutricional e identificar a prevalência de síndrome metabólica em praticantes amadores de futebol. Foram estudados 32 homens (39,0 ± 6,4anos) com prática habitual de futebol. O estado nutricional foi avaliado por meio do índice de massa corporal (IMC) e a classificação da World Health Organization; a síndrome metabólica, pelo critério da International Diabetes Federation, que considera para o sexo masculino, além da obesidade central (circunferência da cintura > 90cm), duas ou mais das seguintes condições: trigliceridemia > 150mg/dl; níveis de HDL < 40mg/dl; pressão sistólica > 130mmHg ou diastólica > 85mm/Hg; e glicemia em jejum > 100mg/dl. A análise estatística processou dados descritivos de percentuais, média, mínimo, máximo, desvio padrão e inferência de correlações entre pares de variáveis por meio do coeficiente r de Pearson. O nível de significância adotado foi de p < 0,05. Os resultados encontrados mostraram que 43,8% dos futebolistas são eutróficos, 43,8% têm sobrepeso e 12,5%, obesidade. A ocorrência de síndrome metabólica foi de 37,5% e seus componentes mais prevalentes foram: 59,4% obesidade abdominal, 40,6% hipertensão, 34,4% hipertrigliceridemia, 28,1% HDL-C e 15,6% glicemia em jejum. O IMC apresentou correlação mais robusta com a circunferência da cintura (r = 0,918). CONCLUSÃO: Os futebolistas investigados apresentaram ocorrência de sobrepeso e obesidade em seu estado nutricional e, apesar de a frequência de síndrome metabólica se apresentar inferior a de outros estudos epidemiológicos, acredita-se que, além da prática de atividade física, esses desportistas devem aderir a outros comportamentos promotores de saúde, como a adesão a bons hábitos alimentares e ao controle do estresse.

Uma exploração multidimensional dos componentes da síndrome metabólica

O objetivo deste estudo foi verificar os padrões de agrupamento das variáveis antropométricas e metabólicas relacionadas com a síndrome metabólica, de acordo com o sexo. Foram coletados dados de 579 moradores de duas comunidades rurais brasileiras, com idades entre 18 e 94 anos. A análise fatorial foi realizada utilizando-se o método de extração de componentes principais e rotação ortogonal varimax. Este estudo reduziu um grupo complexo de fatores de risco cardiovascular que caracterizam a síndrome metabólica em três fatores independentes, cada um refletindo um aspecto diferente da síndrome metabólica. Em ambos os sexos, o fator 1 esteve relacionado à obesidade e dislipidemia, o fator 2 à obesidade e pressão arterial e o fator 3 à obesidade e resistência à insulina. As variâncias totais explicadas para os sexos masculino e feminino foram, respectivamente, 66,61% e 68,98%. Esses achados corroboram com a hipótese de que pelo menos três processos fisiopatológicos atuam no agrupamento dos fatores de risco cardiovasculares na população rural estudada.

[Metabolic syndrome, its phenotypes, and insulin resistance by HOMA-IR]

The diagnosis of the metabolic syndrome (MS) according to the National Cholesterol Education Program Adult Treatment Panel III does not reflect necessarily the presence of insulin resistance (IR), a potential therapeutical target for type 2 diabetes and cardiovascular disease prevention. Based on previous prevalence data, a cross-sectional study was conducted to determine the HOMA-IR relationship to the MS and some associated abnormalities. HOMA-IR > was higher in individuals with the MS (2.8+/-1.6 vs. 1.8+/-1.4) (p < 0.001). HOMA-IR >or= 2.5 allied good specificity and sensitivity levels for the association of MS and IR. Hyperglycemia, hypertrigliceridemia, and abdominal obesity, the MS components best related to IR, were statistically associated with HOMA-IR > 2.5, but not hypertension neither low HDL-c. The demonstration that some of MS phenotypes or associated abnormalities were more predictive for IR could point out to the possibility of the use of the index as a marker of the presence of IR associated to MS.

Metabolic syndrome in patients with prostate cancer

CONTEXT AND OBJECTIVE

Prostate cancer (PCa) is the second most common cancer among men in Brazil. Recently, several studies have hypothesized a relationship between PCa and metabolic syndrome (MS). The aim here was to identify an association between MS and PCa.

DESIGN AND SETTING

Cross-sectional study, Fundação de Beneficência Hospital de Cirurgia (FBHC) and Universidade Federal de Sergipe.

METHODS

Laboratory and anthropometric parameters were compared between PCa patients (n = 16) and controls (n = 16).

RESULTS

The PCa patients showed significantly greater frequency of MS than did the controls (p = 0.034). Serum glucose was higher and high-density lipoprotein-cholesterol was lower than in the controls, although without significant differences. There were significant differences in blood pressure (p = 0.029) and waist-to-hip ratio (p = 0.004). Pearson linear correlation showed a positive association between waist-to-hip ratio and prostate specific antigen (r = 0.584 and p = 0.028). Comparing subgroups with and without MS among the PCa patients, significant differences (p < 0.05) in weight, height, body mass index, hip circumference and lean body mass were observed, thus showing higher central obesity in those with MS. The serum glucose values were also higher in MS patients (p = 0.006), thus demonstrating that insulin resistance has a role in MS physiopathology.

CONCLUSIONS

Our study suggests that MS may exert an influence on the development of PCa. However, it would be necessary to expand the investigation field with larger sample sizes and cohorts studied, to test the hypothesis generated in this study.

Distúrbios metabólicos e adiposidade em uma população rural

O objetivo deste estudo transversal foi investigar a prevalência de sobrepeso e adiposidade central (AC) e suas relações com alterações no metabolismo de lipídeos, glicose e níveis pressóricos em uma amostra de 287 indivíduos adultos residentes em uma comunidade rural do Estado de Minas Gerais. Foram realizadas comparações de médias dos indicadores metabólicos: lipoproteínas, glicose e níveis pressóricos, segundo categorias de sobrepeso e AC, usando análise de variância e teste de Tukey. A prevalência de sobrepeso foi de 24,8% (37,4% no sexo feminino; 11,5% no sexo masculino). A AC esteve presente em 28,1% das pessoas (50,3% no sexo feminino; 4,3% no sexo masculino). Indivíduos com AC apresentaram maiores valores médios de pressão arterial (HA), colesterol total, LDL, triglicérides e glicemia de jejum; e menores valores médios de HDL. Foram verificadas associações entre AC e HA, dislipidemia e hiperglicemia. Associações significativas entre sobrepeso e HA, dislipidemia e hiperglicemia também foram evidenciadas. Esses resultados confirmam o potencial efeito das alterações na composição corporal, principalmente em nível central, sobre o metabolismo lipídico e de glicose, e também sobre o aumento dos níveis pressóricos em populações da área rural.

Prevalência de síndrome metabólica em estudo de base populacional, Vitória, ES - Brasil

Síndrome Metabólica (SM) é um transtorno representado pela agregação de fatores predisponentes para desenvolvimento de doenças cardiovasculares e diabetes. Apesar da importância da SM, há carência de dados sobre as características epidemiológicas desta condição na população brasileira. Determinamos a prevalência da SM por sexo, faixa etária e nível socioeconômico na população da cidade de Vitória, ES, Brasil, utilizando os critérios do NCEP/ATPIII. Foram coletados dados socioeconômicos, bioquímicos, antropométricos e hemodinâmicos em 1.663 indivíduos de amostra randômica da população (25-64 anos) de Vitória. A prevalência foi de 29,8% (IC95 = 28-32%), sem diferença entre sexos. De 25 a 34 anos, a prevalência foi 15,8%, alcançando 48,3% na faixa de 55 a 64 anos. Verificou-se aumento progressivo de prevalência em mulheres do maior para o menor nível socioeconômico. O parâmetro da SM mais freqüente em homens foi hipertensão, seguido de hipertrigliceridemia, baixo HDL-colesterol, hiperglicemia e obesidade abdominal. Nas mulheres, hipertensão em primeiro lugar, seguida do baixo HDL-colesterol, obesidade abdominal, hipertrigliceridemia e hiperglicemia. Conclui-se que a prevalência de SM é elevada, inclusive nos mais jovens, com grande contribuição da hipertensão para o seu diagnóstico. Controle dos fatores de risco deve ser promovido visando reduzir o impacto das doenças cardiovasculares na mortalidade geral.

Metabolic syndrome: from global epidemiology to individualized medicine

The metabolic syndrome (MetS) encompasses a constellation of metabolic abnormalities that are thought to place patients at higher risk for the development of diabetes and cardiovascular (CV) disease. The underlying pathophysiology is still a point of contention among various professional organizations leading to inconsistencies in the manner in which MetS is defined. Each definition has its advantages and disadvantages. Nonetheless, there is an agreement that insulin resistance and obesity are likely the central contributing factors. Because the prevalence of obesity has been increasing at a frightening rate in the past few decades, MetS represents a major public health problem that should be identified clinically in individual patients. This review describes the changing epidemiology of obesity and of MetS and discusses its importance in CV disease. We outline the existing controversies that surround MetS and discuss the role of lifestyle, pharmacological, surgical, and novel approaches in its management.

Metabolic syndrome in women with polycystic ovary syndrome: prevalence, characteristics and predictors

The aim of this study was to determine the prevalence of metabolic syndrome in women with polycystic ovary syndrome, as well as its characteristics and predictors. Seventh-three women, with body mass index of 30.4 ± 7.8 kg/m² and 25.0 ± 6.0 years old, subdivided according to body mass index, were studied retrospectively. There was no significant mean age difference among body mass index groups (p = 0.228). Prevalence of metabolic syndrome was 38.4%, with a null prevalence for normal (n = 18), 23.8% for overweight (n = 17), 62.9% for obese (n = 28), and 85.5% for morbidly obese women (n = 7). Women with metabolic syndrome were older than women without metabolic syndrome (27.3 ± 5.3 vs. 24.2 ± 4.6 vs. years old; p = 0.031) and presented a higher body mass index (36.3 ± 7.7 vs. 26.9 ± 5.4; p < 0.001). There was no difference for degree of hirsutism and menstrual patterns between women with and without metabolic syndrome (p = 0.593 and p = 0.119, respectively). Regarding laboratory parameters, DHEAS was lower (1,646 ± 1,007 vs. 2,594 ± 1,563; p = 0.007) and HOMA-IR were higher (9.9 ± 9.7 vs. 4.6 ± 4.7; p = 0.004) in women with metabolic syndrome (p = 0.031 and p < 0.001, respectively). The best predictors of metabolic syndrome were waist circumference > 88 cm, HDL-cholesterol < 50 mg/dL and triglycerides > 150 mg/dL.