Evaluation of ultrasonographic approaches aimed at determining distinct abdominal adipose tissue depots

ABSTRACT Objective: To analyze different anatomical sites in the abdominal region, in order to determine the positional parameter that identifies a higher level of visceral adipose tissue (VAT) and confers a greater cardiometabolic risk. Materials and methods: This is a methodological study in which VAT was evaluated by ultrasonography (USG) in three anatomical sites in the abdomen, while the abdominal circumference (AC) was measured using seven different protocols. Additionally, the glycemic and lipid profile, C-reactive protein, and the presence of systemic arterial hypertension were evaluated. Results: One hundred and six individuals with an average age of 42 (36.8-46.2) years were included. The evaluation of the calibration of the ultrasound procedure for the analysis of VAT by intra- and inter-evaluators showed high reproducibility. The pattern of abdominal fat distribution differed between sexes, with higher mean VAT in males (p < 0.05) and higher mean SAT (subcutaneous adipose tissue) in females (p < 0.005). In the abdominal scan applied to women, higher levels of VAT and lower levels of SAT were observed in the narrower waist region, between the iliac crest and the last rib (p < 0.001). In males, the profile of adipose disposition along the abdomen was uniform (p > 0.05). Correlations between VAT measured by USG and cardiometabolic parameters were relatively stronger in the upper abdomen (p < 0.05). Conclusion: Women accumulate more VAT in the narrower waist region, while men accumulate VAT uniformly across the abdomen. There was relative superiority in predicting cardiometabolic risk in the upper abdomen for both sexes.

The applicability of the Visceral Adiposity Index (VAI) for predicting visceral fat / Aplicabilidade do Índice de Adiposidade Visceral (IAV) como preditor de gordura visceral

Abstract As obesity has reached epidemic proportions and given the current recognition of central adiposity as an important cardiometabolic risk factor, several researchers have focused on developing and validating predictive indexes and equations to evaluate Visceral Adipose Tissue (VAT). This study evaluates the applicability of the Visceral Adiposity Index (VAI) for predicting cardiometabolic risk in individuals treated in a hospital In the northeast region of Brazil. The VAT was evaluated by computed tomography (CT) and the VAI was calculated through specific equations for each gender. The sample involved adult and elderly patients of both genders followed up in a cardiology outpatient clinic. The following cardiometabolic parameters were collected: fasting glycemia, glycated hemoglobin, lipid profile, C-reactive protein (CRP) and uric acid. The simple linear regression was used to evaluate the explanatory power of the VAI in relation to the volume of VAT determined by CT. The predictive capacity of VAI in relation to the volume of VAT determined by CT was 25.8% (p=0.004) for males and 19.9% (p<0.001) for females. VAI correlated strongly with the triglyceride (TG) (p<0.001) and TG/high-density lipoprotein (HDL) ratio (p<0.001) and inversely correlated with HDL (p<0.001). Moreover, VAI showed low correlation with the following variables: abdominal circumference, total cholesterol, low density lipoprotein, fasting glycemia, and glycated hemoglobin (p<0.05). VAI was associated with variables considered as cardiometabolic risk factors, but exhibited a low predictive capacity regarding the volume of VAT determined by CT. Thus, caution is recommended in its use in Brazilian individuals.

Resumo Em razão de a obesidade ter alcançado proporções epidêmicas e dado ao atual reconhecimento da adiposidade central como um importante fator de risco cardiometabólico, diversos pesquisadores têm se dedicado em desenvolver e validar índices e equações preditivas para avaliar o Tecido Adiposo Visceral (TAV). Este estudo avaliou a aplicabilidade do Índice de Adiposidade Visceral (IAV) como preditor de risco cardiometabólico em indivíduos atendidos em um hospital no nordeste brasileiro. O TAV foi avaliado por tomografia computadorizada (TC) e o IAV foi calculado através de equações específicas para cada sexo. A amostra envolveu pacientes adultos e idosos de ambos os sexos acompanhados no ambulatório de cardiologia. Os seguintes parâmetros cardiometabólicos foram coletados: glicemia de jejum, hemoglobina glicada, perfil lipídico, proteína C-reativa e ácido úrico. Regressão linear simples foi empregada para avaliar o poder explicativo do IAV em relação ao volume de TAV determinado por TC. A capacidade preditiva do IAV em relação ao volume de TAV determinado pela TC foi de 25,8% (p=0,004) para o sexo masculino e 19,9% (p<0,001) para o sexo feminino. O IAV se correlacionou fortemente com as variáveis TG (r=0,916, p< 0,001) e TG/HDL (r=0,952, p<0,001) e inversamente com o HDL (r=-0,441, p<0,001), além disso, apresentou baixa correlação com as variáveis: circunferência abdominal, colesterol total, lipoproteína de baixa densidade, glicemia de jejum e hemoglobina glicada (p<0,05). O IAV associou-se com variáveis consideradas fatores de risco cardiometabólico, porém exibiu baixa capacidade preditiva em relação ao volume de TAV determinado pela TC, sendo recomendada cautela em sua utilização em indivíduos brasileiros.

Visceral adiposity indicators and cardiovascular risk in hemodialytic patients

ABSTRACT Objective: Cardiovascular diseases represent the main cause of death in chronic kidney disease (CKD). We aimed to evaluate the prevalence and association of the hypertriglyceridemia-waist phenotype (HWP) and visceral adiposity index (VAI) with cardiometabolic risk factors (CR) in patients with CKD on hemodialysis (HD). Materials and methods: The study is based on a cross-sectional design with 265 HD patients in two cities in northeastern Brazil. The VAI was calculated considering the variables body mass index (BMI), waist circumference (WC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c). HWP was defined as the concomitant elevation of WC and TG. The Poisson Regression Model with robust variance estimation was adjusted considering a hierarchical approach for explanatory variables. Prevalence ratios (PR) were also estimated. The level of significance adopted was 5%. Results: In our study HWP and VAI prevalence's were 29.82% and 58.49%, respectively. In the final model, there was an association between VAI and female gender (PR = 1.46; p < 0.0001) and high body fat (% BF) (PR = 1.33; p < 0.0019). HWP was associated with females (PR = 1.80; p = 0.002), alcohol consumption (PR = 1.58; p = 0.033), obesity (PR = 1.89; p = 0.0001), high %BF (PR = 1.76; p = 0.012) and reduced HDL-c (PR = 1.48; p = 0.035). Conclusion: The HWP stood out as the association with more CR factors, representing a promising method for tracking cardiometabolic risk in HD patients, mainly female.

The impact of visceral fat and levels of vitamin D on coronary artery calcification

SUMMARY OBJECTIVE: To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS: A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS: The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5-39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4-11.7), hypertension (OR: 4.8; 95%CI 1.5-15.3), and age (OR: 10.4; 95%CI 3.9-27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS: Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.

Glomerular filtration rate and its relationship with visceral and subcutaneous adiposity: a study with patients from Northeast Brazil / Tasa de filtración glomerular y su relación con la adiposidad visceral y subcutánea: un estudio con pacientes del noreste brasileño

ABSTRACT Objective: evaluate the relationship between visceral/subcutaneous adipose tissue (VAT/SAT) and glomerular filtration rate (GFR). Methods: A case series study was conducted with 146 male and female adult outpatients at a hospital in Northeast Brazil. VAT and SAT were quantified using computed tomography and GFR was estimated using the formula proposed by the CKD Epidemiology Collaboration. The conceptual model also considered socio-demographic, clinical, anthropometric and lifestyle variables. Results: Females accounted for 71.9% of the sample and mean age was 52.5±13.2 years. Mean body mass index indicated obesity in both sexes (men:30.4±5.9 kg/m2; women: 31.6±6.1 kg/m2). For the same mean age and BMI, men had more VAT and a higher VAT/SAT ratio. Mean GFR was similar between sexes and within the normal range. Simple linear regression analysis revealed that 21.8% of the reduction in GFR in males could be explained by the VAT/SAT ratio (p=0.002). Among females, both VAT alone and the VAT/SAT ratio were predictors of GFR reduction (r2=4.8%, p=0.025 and r2=5.3%, p=0.019, respectively). Conclusion: Mean VAT and VAT/SAT ratio were compatible with abdominal obesity in both sexes and were related to a reduction in GFR.

RESUMEN Objetivo: Evaluar la relación entre el tejido adiposo visceral (TAV) y subcutáneo (TAS) con la tasa de filtración glomerular. Métodos: Estudio tipo serie de casos, en 146 pacientes adultos de ambos sexos, atendidos en un ambulatorio de un hospital de referencia en el Nordeste brasileño. El TAV y el TAS se cuantificaron por tomografía computadorizada y la tasa de filtración glomerular (TFG) estimada por la fórmula del grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). El modelo conceptual también consideró variables sociodemográficas, clínicas, antropométricas y de estilo de vida. Resultados: Pacientes con edad promedio de 52,5 ± 13,2 años y el 71,9% de sexo femenino. El promedio del IMC en ambos sexos se encuentra en el rango de obesidad (hombres= 30,4 ± 5,9 kg/m2 vs mujeres= 31,6 ± 6,1 kg/m2). Para un mismo promedio de edad e IMC, los hombres presentaron mayor TAV y mayor razón TAV/TAS que las mujeres. El promedio de la TFG fue similar entre los sexos y se encuentra en el rango normal. A través de regresión lineal simple, se evidenció que, en el sexo masculino, la disminución de la TFG puede explicarse en el 21,8% por la razón TAV/TAS (p=0,002). En el sexo femenino, tanto el TAV aislado como la razón TAV/TAS fueron predictores de disminución de la TFG (r2= 4,8%; p=0,025 e r2= 5,3%; p=0,019), respectivamente. Conclusión: Se evidenciaron valores muy elevados de los parámetros antropométricos de obesidad abdominal y promedio de TAV y de la razón TAV/TAS compatible con obesidad visceral en ambos sexos, siendo que estos dos últimos parámetros estuvieron relacionados al descenso de la TFG.

Asociación del ángulo de fase con parámetros de evaluación del estado nutricional en pacientes en hemodiálisis / Association of the phase angle with nutritional status assessment parameters in hemodialysis patients

RESUMEN La desnutrición energético-proteica es altamente prevalente en pacientes en tratamiento con diálisis, siendo un importante marcador de riesgo para morbimortalidad. Entre los diversos parámetros disponibles para evaluación de la condición nutricional, la medida del Ángulo de Fase (AF) se ha señalado como marcador útil para evaluar a pacientes en hemodiálisis (HD). Objetivo: Evaluar la asociación del AF con parámetros de evaluación del estado nutricional en pacientes en HD. Métodos: Se realizó un estudio transversal entre febrero y julio de 2016 en dos unidades de hemodiálisis, de Recife, Nordeste brasileño. Resultados: Se evaluó a 101 pacientes, con edades de 51,7±16,8 años e IMC de 24,3±4,5 kg/m². El promedio del AF fue 5,6±1,7° y se correlacionó inversamente con la edad (r= −0,222; p= 0,024) y con el % grasa (r= −0,219; p= 0,026) y directamente con la altura (r= 0,286; p= 0,003), con el índice de masa muscular esquelética (r= 0,269; p= 0,006), con la fuerza de agarre palmar (r= 0,627;p <0,001), velocidad de marcha (r= 0,263; p= 0,008), masa libre de grasa (r= 0,303; p= 0,002) y creatininemia (r= 0,278; p= 0,004). Conclusiones: El AF presentó asociación con algunos parámetros de evaluación nutricional, que puede ser una medida útil adicional para reflejar la condición nutricional y evaluar la sarcopenia en pacientes en HD.

ABSTRACT Energy-protein malnutrition is highly prevalent in dialysis patients, being an important marker of risk for morbidity and mortality. Among the various parameters available for assessing nutritional status, the phase angle (PA) measurement has been indicated as a useful marker for evaluating patients on hemodialysis (HD). Objective: To evaluate the association of PA with parameters of nutritional status in patients on HD. Methods: We performed a cross-sectional, observational study from February to July, 2016, in two hemodialysis units, in the city of Recife, Northeastern Brazil. Results: A total of 101 patients were evaluated, with a mean age of 51.7±16.8 years and mean BMI of 24.3±4.5kg/m². The mean PA was 5.6±1.7°. PA was inversely correlated with age (r= −0.222; p= 0.024), fat% (r= −0.219; p= 0.026) and positively with height (r= 0.267; p= 0.003), velocity speed (r= 0.267; p= 0.003), skeletal muscle mass index (r= 0.269; p= 0.006), fat free mass (r= 0.303; p= 0.002) and serum creatinine (r= 0.278; p= 0.004). Conclusions: PA was associated with some parameters of nutritional status. Thus, it may be an additional useful measure to reflect nutritional status and to evaluate sarcopenia in patients on HD.

Association between anthropometricparameters and coronary calcification / Associação entre parâmetros antropométricos e calcificação coronariana

Several studies have reported an association between obesity and the presence of coronary artery calcification (CAC), but it is still unclear which parameter would be most useful in screening for coronary calcification. This study aimed to evaluate the association between anthropometric parameters and coronary calcification. A cross-sectional study was developed involving patients attended by outpatient care, without previous diagnosis of coronary disease. The CAC was evaluated by computerized tomography, considering the coronary calcium score (CCS)> 0 as the presence of calcification and 0 as absence. The anthropometric variables studied were: body mass index, waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (Et al.), conicity index (CI), neck circumference, neck-thigh ratio, waist-thigh ratio (WThR) and body adiposity index. A total of 129 patients were evaluated, with a mean age of 55.6±11.7 years. CAC was observed in 41.9% of patients. In the male sex, the CCS had a higher correlation with the WHR (r=0.416, p=0.016) and in females, the CI and WThR (r=0.305, p=0.003 and r=0.328, p=0.001, respectively). In the logistic regression model, the only anthropometric parameter that remained associated to CAC was WC (OR=3.9). In conclusion, it was observed that several anthropometric parameters were associated with CAC, and WC was the only anthropometric parameter that remained associated to CAC in the adjusted analysis

Vários estudos têm registrado associação entre obesidade e a presença da calcificação das artérias coronárias (CAC), porém ainda não está claro qual parâmetro seria mais útil na triagem da calcificação coronariana. Este estudo teve como objetivo avaliar a associação entre parâmetros antropométricos com a calcificação coronariana. Foi realizado um estudo transversal envolvendo pacientes atendidos ambulatorialmente, sem diagnóstico prévio de doença coronariana. A CAC foi avaliada por tomografia computadorizada, considerando-se o escore de cálcio coronariano (ECC)>0 como presença de calcificação e igual a 0 como ausência. As variáveis antropométricas estudadas foram: índice de massa corpórea, circunferência abdominal (CA), razão cintura quadril (RCQ), razão cintura estatura, índice de conicidade (IC), circunferência do pescoço, razão pescoço-coxa, razão cintura-coxa (RCC) e índice de adiposidade corporal. Foram avaliados 129 pacientes, com média de idade de 55,6±11,7 anos. A CAC foi evidenciada em 41,9% dos pacientes. No sexo masculino, o ECC apresentou maior correlação com a RCQ (r=0,416; p=0,016) e no feminino, com o IC e com a RCC (r=0,305; p=0,003 e r=0,328; p=0,001, respectivamente). No modelo de regressão logística o único parâmetro antropométrico que permaneceu associado à CAC foi a CA (OR=3,9). Em conclusão, observou-se que vários parâmetros antropométricos foram associados à CAC, sendo CA o único parâmetro antropométrico que se manteve associado à CAC na analise ajustada

Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction / Relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos hospitalizados com infarto agudo do miocárdio

ABSTRACT Objective: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Methods: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. Results: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). Conclusion: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.

RESUMO Objetivo: Verificar a relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos com infarto agudo do miocárdio internados. Métodos: Estudo transversal envolvendo pacientes idosos com infarto agudo do miocárdio, hospitalizados no período de abril a julho de 2015, em serviço público, no Nordeste brasileiro. A sarcopenia foi determinada por meio das medidas de massa muscular, força muscular e desempenho físico. Foram utilizados os marcadores de risco cardiovascular e de prognóstico, como os valores de troponina e da isoenzima MB da creatinina quinase, classificação do infarto agudo do miocárdio de acordo com a elevação do segmento ST e o escore de risco de trombólise em infarto do miocárdio. Resultados: Foram avaliados 99 pacientes, com média de idade de 71,6 (±7,4) anos. Verificou-se prevalência de sarcopenia de 64,6% e 35,4% de obesidade sarcopênica. A sarcopenia foi mais prevalente no sexo masculino (p=0,017), na faixa etária >80 anos (p=0,008). Dentre os marcadores de risco cardiovascular, apenas o escore de risco trombólise em infarto do miocárdio esteve estatisticamente associado à sarcopenia (p=0,002). Conclusão: A prevalência da sarcopenia foi elevada e se associou com o escore de risco de trombólise em infarto do miocárdio. A obesidade sarcopênica acometeu cerca de um terço dos pacientes e não se associou a nenhum parâmetro preditor prognóstico.

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Prevalência e fatores associados à obesidade abdominal em indivíduos na faixa etária de 25 a 59 anos do Estado de Pernambuco, Brasil / Prevalence of abdominal obesity and associated factors among individuals 25 to 59 years of age in Pernambuco State, Brazil / Prevalencia y factores asociados a la obesidad abdominal en individuos en una franja de edad de 25 a 59 años del estado de Pernambuco, Brasil

Com o objetivo de estimar a prevalência de obesidade abdominal e avaliar os fatores associados em adultos do Estado de Pernambuco, Brasil, foi realizado, em 2006, um estudo transversal, de base populacional, envolvendo 1.580 indivíduos na faixa etária de 25-59 anos. A obesidade abdominal foi determinada pela circunferência da cintura ≥ 80cm para mulheres e ≥ 94cm para homens. O modelo conceitual considerou variáveis socioeconômicas, demográficas, reprodutivas e comportamentais. A prevalência de obesidade abdominal foi de 27,1% (IC95%: 23,8-30,7) no sexo masculino e 69,9% (IC95%: 66,8-72,8) no feminino (p < 0,001). A análise ajustada revelou maior prevalência em homens a partir de 50 anos, da região metropolitana, de maior renda, ex-fumantes e consumidores de bebidas alcoólicas. Entre as mulheres, foi mais prevalente a partir de 30 anos, em ex-fumantes e naquelas com a primeira gestação antes de 18 anos. Fica evidente a gravidade e a multifatorialidade do problema da adiposidade central no Estado de Pernambuco, além de ser possível destacar que os determinantes da obesidade são diferentes entre os sexos.

In order to estimate the prevalence of abdominal obesity and associated factors in Pernambuco State, Brazil, a cross-sectional population-based study was conducted in 2006, including 1,580 adults 25 to 59 years of age. Abdominal obesity was defined as waist circumference (WC) ≥ 80cm in women and ≥ 94cm in men. The conceptual model included demographic, socioeconomic, reproductive, and behavioral variables. Prevalence of abdominal obesity was 27.1% (95%CI: 23.8-30.7) in males and 69.9% (95%CI: 66.8-72.8) in females (p < 0.001). Multivariate analysis showed higher prevalence in men 50 years or older in the metropolitan area and those with higher income, former smokers, and drinkers. Among women, obesity was more prevalent above 30 years of age, in former smokers, and in women with first pregnancy before age 18. Central adiposity is clearly a multifactor condition in the State of Pernambuco, and the determinants of obesity differ between the sexes.

Con el objetivo de estimar la prevalencia de obesidad abdominal y evaluar los factores asociados en adultos del estado de Pernambuco, Brasil, se realizó, en 2006, un estudio transversal, de base poblacional, involucrando a 1.580 individuos en una franja de edad de 25-59 años. La obesidad abdominal fue determinada por la circunferencia de la cintura ≥ 80cm para mujeres y ≥ 94cm para hombres. El modelo conceptual consideró variables socioeconómicas, demográficas, reproductivas y de comportamiento. La prevalencia de obesidad abdominal fue de un 27,1% (IC95%: 23,8-30,7) en el sexo masculino y un 69,9% (IC95%: 66,8-72,8) en el femenino (p < 0,001). El análisis ajustado reveló mayor prevalencia en hombres a partir de 50 años, de la región metropolitana, de mayor renta, ex-fumadores y consumidores de bebidas alcohólicas. Entre las mujeres, fue más prevalente a partir de 30 años, en ex-fumadoras y en aquellas con la primera gestación antes de los 18 años. Es evidente la gravedad y la multifactorialidad del problema de la adiposidad central en el estado de Pernambuco, además de ser destacable que los determinantes de la obesidad son diferentes entre los sexos.

Diabetes mellitus em pacientes coronariopatas: prevalência e fatores de risco cardiovascular associado / Diabetes mellitus in patients with coronary artery disease: prevalence and associated cardiovascular risk factors

JUSTIFICATIVA E OBJETIVOS: A prevalência mundial do diabetes mellitus (DM) tipo 2 vem crescendo dramaticamente nos últimos anos e sua associação com as doenças cardiovasculares está bem estabelecida na literatura. A presença de outros fatores de risco em pacientes diabéticos representaria um efeito multiplicador nos desfechos cardiovasculares adversos. O objetivo deste estudo foi, em pacientes coronariopatas, estimar a prevalência do DM e avaliar os fatores de risco cardiovascular associados. MÉTODO: Estudo transversal envolvendo 323 pacientes com idade ≥ 30 anos, internados em hospital de referência em Cardiologia no período de maio a setembro de 2010. Foram estudadas as variáveis clínicas (hipertensão arterial), sócio-demográficas (idade, sexo, escolaridade e renda), estilo de vida (tabagismo, atividade física e seguimento de dieta) e antropométricas. As análises estatísticas foram realizadas no software SPSS, versão 12.0, considerando-se significância estatística quando p < 0,05. RESULTADOS: A prevalência de DM foi 33,1% (IC95%:28,0-38,6), sendo maior entre as mulheres (42,6% versus 26,8%;p = 0,005). O excesso de peso foi verificado em 76,6% dos diabéticos, e 76,6%, 88,8% e 88,8% apresentaram circunferência da cintura (CC), razão cintura quadril (RCQ) e razão cintura estatura (RCE) elevadas, respectivamente. Entre os fatores de risco que se associaram ao DM destacam-se: sexo feminino (RP: 1,6;IC95%:1,1-1,5), idade ≥ 60 anos (RP:1,6; IC95%:1,1-2,2), hipertensão arterial (RP: 2,6; IC95%: 1,2-5,5), EP (RP: 1,4; IC95%:1,0-2,0), CC elevada (RP :1,9;IC95%:1,3-2,7) e RCE elevada (RP :1,8; IC95%:1,1-3,1). CONCLUSÃO: Os resultados evidenciaram elevada prevalência de DM e que múltiplos fatores de risco cardiovascular foram associados à doença.

BACKGROUND AND OBJECTIVES: The worldwide prevalence of type 2 diabetes mellitus (DM) has increased dramatically in recent years and its association with cardiovascular disease is well established in the literature. The presence of other risk factors in diabetic patients would represent a multiplier effect on adverse cardiovascular outcomes. The aim of this study was to estimate the prevalence of DM in patients with coronary artery disease and evaluate the associated cardiovascular risk factors. METHOD: Cross-sectional study involving 323 hospitalized patients aged ≥ 30 years admitted to cardiology reference hospitals from May to September 2010. Clinical (hypertension), sociodemographic (age, sex, education and income), anthropometric and lifestyle (smoking, physical activity and diet) variables were studied. Statistical analyses were performed with SPSS software,version 12.0, considering statistical significance at p < 0.05. RESULTS: The prevalence of DM was 33.1% (95% CI:28.0-38.6), being higher among women (42.6% vs 26.8%; p = 0.005). Overweight (OW) was observed in 76.6% of diabetics and 76.6%, 88.8% and 88.8% had high waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHR), respectively. Risk factors that were associated with DM include: female gender (PR: 1.6, 95% CI: 1.1-1.5), age ≥ 60 years (PR: 1.6, 95% CI: 1.1 to 2.2), hypertension (PR: 2.6, 95% CI: 1.2-5.5), OW (PR: 1.4, 95% CI: 1.0-2.0), high WC (PR: 1.9, 95% CI:1.3-2.7) and high WHR (PR: 1.8, 95%CI: 1.1-3.1). CONCLUSION: The results showed a high prevalence of DM, and multiple cardiovascular risk factors were associated with the disease.

Consumo de alimentos protetores e preditores do risco cardiovascular em adultos do estado de Pernambuco / Consumption of foods that protect against and promote cardiovascular disease by adults from Pernambuco State, Brazil

OBJETIVO: Avaliar o consumo de alimentos protetores e preditores do risco cardiovascular e os fatores associados na população adulta do Estado de Pernambuco. MÉTODOS: Estudo transversal, de base populacional, envolvendo 1.820 adultos de 25 a 59 anos. Foram constituídos 3 grupos de alimentos: fontes em fibras (protetores), em carboidratos simples e em gorduras saturadas (risco para doenças cardiovasculares e ganho excessivo de peso). O consumo alimentar foi avaliado por um questionário de frequência alimentar com mensuração convertida em escores. O modelo conceitual considerou variáveis socioeconômicas, demográficas, comportamentais e antropométricas. RESULTADOS: O escore médio do consumo de alimentos-fonte em carboidratos simples foi maior que o consumo de alimentos-fonte de fibras e gorduras saturadas (p<0,001). Um menor consumo do grupo de alimentos de risco foi observado em indivíduos de maior idade, provenientes de área rural, com menor renda e escolaridade. Maior consumo de carboidratos simples foi identificado entre indivíduos com baixo peso, e o consumo mais elevado de gorduras saturadas foi verificado em indivíduos não fumantes e naqueles que relataram o consumo de álcool. O consumo de fibras foi superior em indivíduos não fumantes e naqueles de maior renda e escolaridade. CONCLUSÃO: O maior consumo de carboidratos simples, em detrimento do consumo de fibras, está relacionado à suscetibilidade do indivíduo a doenças provocadas pela má alimentação e configura o processo de transição nutricional experimentado pelo Brasil nas últimas décadas.

OBJECTIVE: The present study assessed the consumption of foods that protect against and promote cardiovascular diseases and associated factors by adults from Pernambuco. METHODS: This cross-sectional, population-based study done in 2006 involved 1820 adults aged 25 to 59 years. Foods were divided into three groups: high-fiber (protective foods), sugary foods and high-saturated fat foods (risk of cardiovascular disease and excess weight gain). Food intake was assessed by a food frequency questionnaire and amounts were converted into scores. The model included demographic, socioeconomic, behavioral and anthropometric variables. RESULTS: The mean sugary food intake score was higher than the high-fiber and high-saturated fat intake scores (p<0.001). Older country people with lower income and education level consumed less sugary foods and saturated fats. The highest high-fiber food scores were associated with higher income and education level. Low-birth weight individuals presented a high intake of simple carbohydrates; nonsmokers and those who reported consuming alcoholic beverages presented a high intake of saturated fats. Fiber intake was higher among nonsmokers and individuals with higher income and education level. CONCLUSION: Higher intake of sugary foods instead of high-fiber foods makes people more susceptible to diet-related diseases and reflects the nutritional transition that has been going on in Brazil in the last decades.

Excesso de peso em adultos do Estado de Pernambuco, Brasil: magnitude e fatores associados / Overweight among adults in Pernambuco State, Brazil: prevalence and associated factors

Com o objetivo de avaliar a magnitude do excesso de peso e fatores associados em adultos do Estado de Pernambuco, Brasil, foi realizado estudo transversal, de base populacional, em 2006, envolvendo 1.580 adultos, na faixa etária de 25-59 anos. O excesso de peso foi determinado pelo índice de massa corporal > 25kg/m². O modelo conceitual considerou variáveis socioeconômicas/demográficas, reprodutivas e comportamentais. A prevalência de excesso de peso foi de 51,1 por cento (IC95 por cento: 48,6-53,6). A análise multivariada mostrou que o excesso de peso foi maior a partir de 40 anos (RP = 1,27; IC95 por cento: 1,10-1,46), em mulheres (RP = 1,29; IC95 por cento: 1,16-1,43), em ex-fumantes (RP = 1,42; IC95 por cento: 1,20-1,69), em indivíduos com maior renda (RP = 1,49; IC95 por cento: 1,30-1,71) e em mulheres com primeira gestação com idade < 18 anos (RP = 1,25; IC95 por cento: 1,11-1,66). Não houve associação com o consumo de álcool, com a atividade física e com o consumo alimentar. A expressiva prevalência do excesso de peso corrobora os níveis epidêmicos que este problema tem assumido em todo o mundo e a associação com vários fatores e reforçam a multifatorialidade de sua etiologia.

In order to evaluate the prevalence of overweight and associated factors in Pernambuco State, Brazil, a cross-sectional population-based study was conducted in 2006, including 1,580 adults 25 to 59 years of age. Overweight was defined as body mass index > 25kg/m2. The conceptual model included demographic, socioeconomic, reproductive, and behavioral variables. Prevalence of overweight was 51.1 percent (95 percentCI: 48.6-53.6) and was statistically associated with age over 40 years (PR = 1.27; 95 percentCI: 1.10-1.46), female gender (PR = 1.29; 95 percentCI: 1.16-1.43), former smoking (PR = 1.42; 95 percentCI: 1.20-1.69), higher income (PR = 1.49; 95 percentCI: 1.30-1.71), and history of early pregnancy (< 18 years) (PR = 1.25; 95 percentCI: 1.11-1.66). There was no association with alcohol consumption, level of physical activity, or specific foods. The high prevalence of overweight is consistent with epidemic levels of this problem elsewhere in world, and the association with several factors supports its multifactor etiology.

Sensibilidade da creatinina sérica como marcador da função renal em pacientes coronariopatas / Sensitivity of serum creatinine as a maker of renal function in patients with coronary artery disease

JUSTIFICATIVA E OBJETIVOS: Na prática clínica a avaliação da função renal costuma ser realizada através da dosagem da creatinina. No entanto, este constitui um parâmetro relativamente tardio para detecção da lesão renal. O objetivo deste estudo foi avaliar a sensibilidade da creatinina sérica como marcador da função renal em pacientes coronariopatas, e identificar os fatores associados à hipercreatinemia e à redução da taxa de filtração glomerular (TFG).MÉTODO: Estudo transversal com 969 pacientes de ambos os sexos e idade ≥ 20 anos com diagnóstico de coronariopatia (firmado pelo cateterismo cardíaco ou cintilografia do miocárdio), internados em enfermaria de hospital universitário cardiológico. Avaliaram-se dados demográficos, clínicos, bioquímicos e antropométricos. A TFG foi estimada pela equação proposta por Cockcroft Gault, sendo considerada disfunção renal quando TFG < 60 mL/min/1,73m2. RESULTADOS: A mediana de idade foi 61 anos, com predomínio do sexo masculino (60,9%) e de pacientes com excesso de peso (47,7%). A prevalência de hipercreatinemia foi 19,6%e de TFG < 60 mL/min/1,73m2 foi 30,9%. A sensibilidade da creatinina na detecção do comprometimento renal foi 54,2%, sendo menor nas mulheres e nos idosos, e a especificidade foi 95,8%. Um paciente com creatinina normal apresentou probabilidade de 17,6% de ter TFG diminuída. Maior acurácia da creatinina na avaliação da função renal foi observada nos adultos e no sexo masculino. Foi identificada associação da TFG diminuída com a idade > 60 anos (p < 0,001), diabetes (p =0,003), hipertensão arterial (p = 0,004) e com o baixo peso (p < 0,001).(...)

BACKGROUND AND OBJECTIVES: In clinical practice, assessment of renal function is usually performed by creatinine dosage. However, this is a relatively late parameter for detection of renal injury. The aim of this study was to assess the sensitivity of serum creatinine as a maker of renal function in patients with coronary artery disease and identify the factors associated with hipercreatinemy and reduced glomerular filtration rate (GFR). METHOD: Cross-sectional study with 969 patients of both sexes and aged ≥ 20 years with a diagnosis of coronary arterydisease (signed by cardiac catheterization or myocardial scintigraphy), admitted to a cardiology university hospital's ward. Demographic, clinical, biochemical and anthropometric data were evaluated. The glomerular filtration rate (GFR) was estimated by the equation proposed by Cockcroft Gault with renal dysfunction considered when GFR < 60 mL/min/1.73m2. RESULTS: The median age was 61 years with male predominance (60.9%) and overweight (47.7%). The hipercreatinemy was found in 19.6% of patients and GFR < 60 mL/min/1,73m²in 30.9%. The creatinine sensitivity was 54.2% in the rena limpairment detection and 95.8% specificity. Less sensitivity was observed in women and elderly. One patient with normal creatinine showed 17.6% probability to have impaired GFR.Greater creatinine accuracy was observed in adults and males. GFR association was decreased with age > 60 years (p < 0.001), diabetes (p = 0.003), hypertension (p = 0.004) and low weight(p < 0.001). CONCLUSION: Serum creatinine dosage as marker of renal function in patients with coronary artery disease, especially inthe elderly and women, had low sensitivity compared to the GFR estimated by the Cockcroft Gault equation. Diabetic, hypertensive, elderly and low weight patients who had higher prevalence of renal dysfunction should have their FG rate monitored routinely.