Prevalencia de síndrome metabólico en individuos de etnia Mapuche residentes en zonas rurales y urbanas de Chile / Prevalence of metabolic syndrome in Mapuche individuals living in urban and rural environment in Chile

Background: Metabolic Syndrome (MS) increases the risk of diabetes and mortality associated with cardiovascular disease. However, the prevalence of MS could differ by ethnicity and lifestyle factors. Aim: To determine the prevalence of MS in Mapuche individuals living in urban and rural environments in Chile and to investigate whether the prevalence and risk of MS in urban and rural environments differs by sex, age and nutritional status. Material and Methods: A total of 1077 Mapuche participants were recruited from urban (MU = 288) and rural (MR = 789) settings. Body mass index, waist circumference and blood pressure were measured. A fasting blood sample was obtained to measure serum glucose, HDL cholesterol and triacylglycerol. The prevalence of MS was determined using the unified IDF and ATP-III criteria. Results: An environment and sex interaction was found for the prevalence of MS (p = 0.042). The prevalence was significantly lower in male MR (13%) compared to other groups (22, 23 and 25% among female MR, female MU and male MU respectively). Also, the prevalence of central obesity and low HDL-cholesterol were significantly lower in male MR. MU are at an increased risk of developing MS compared to MR, with an odds ratio of 1.59 (95% confidence intervals 1.1 to 2.2). This risk increases along with age or body mass index of the population. Conclusions: The adoption of an urbanized lifestyle increases the risk of developing MS in Mapuche individuals. This risk is enhanced by age and nutritional status.

Síndrome Metabólica, Strain e Redução da Função Miocárdica: Multi-Ethnic Study of Atherosclerosis / Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

Fundamento: A doença cardiovascular subclínica é prevalente em pacientes com síndrome metabólica (SM). O strain circunferencial (εCC) e o strain longitudinal (εLL) do ventriculo esquerdo (VE), avaliados pelo ecocardiograma com speckle tracking (STE), são índices de função sistólica: o encurtamento das fibras circunferenciais e longitudinais do VE é indicado por um valor negativo do strain. Portanto, quanto mais negativo o strain, melhor a função sistólica do VE. O εCC e o εLL têm sido usados para demonstrar disfunção ventricular subclínica em vários distúrbios clínicos. Objetivo: Levantamos a hipótese de que a SM está associada com comprometimento da função miocárdica, quando avaliada pelo STE. Métodos: Este estudo analisou participantes do Multi-Ethnic Study of Atherosclerosis (MESA) que realizaram o STE e foram avaliados para todos os componentes da SM. Resultados: Entre os 133 participantes incluídos (mulheres: 63%; idade: 65 ± 9 anos), a prevalência de SM foi de 31% (41/133). Indivíduos com SM apresentaram valores menores do εCC e do εLL que aqueles sem SM (-16,3% ± 3,5% vs. -18,4% ± 3,7%, p < 0,01; e -12,1% ± 2,5% vs. -13,9% ± 2,3%, p < 0,01, respectivamente). A fração de ejeção do VE (FEVE) foi semelhante nos dois grupos (p = 0,09). Na análise multivariada, a SM associou-se a um valor mais baixo do strain circunferencial (B = 2,1%, IC 95%: 0,6-3,5; p < 0,01), mesmo após ajuste para idade, etnia, massa VE e FEVE. De maneira semelhante, a presença de SM (B = 1,3%, IC 95%: 0,3-2,2; p < 0,01) e a massa do VE (B = 0,02%, IC 95%: 0,01 0,03; p = 0,02) associaram-se a um valor menor do strain longitudinal após ajuste para etnia, FEVE e creatinina. Conclusão: O εCC ...

Background: Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (εCC) and longitudinal strain (εLL), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders. Objective: We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE. Methods: We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components. Results: Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower εCC and lower εLL than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative εCC (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative εLL after adjustment for ethnicity, LVEF, and creatinine. Conclusion: Left ventricular εCC and εLL, markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%. .

Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Khisêdjê do Parque Indígena do Xingu, Brasil / Degree of physical activity and metabolic syndrome: a cross-sectional study among the Khisêdjê group in the Xingu Indigenous Park, Brazil

Este estudo objetivou verificar a existência de associação entre o grau de atividade física e a presença de síndrome metabólica entre indígenas Khisêdjê. Foram avaliados 170 indivíduos com 20 anos ou mais. Obtiveram-se dados sociodemográficos, de testes físicos e análise de material biológico. Para análise dos dados, utilizou-se a estatística do qui-quadrado (p < 0,05), razões de prevalências (por ponto e por intervalo de 95% de confiança) brutas e ajustadas e teste t de Student. Resultados satisfatórios foram observados em relação aos testes de resistência cardiorrespiratória, flexibilidade, flexão de braço e tronco, além de na avaliação do nível de atividade física segundo o número de passos/dia. A prevalência de síndrome metabólica foi de 27,8%, sendo maior entre mulheres, entre indígenas nas faixas etárias de 39-49 anos e 50 anos ou mais e entre aqueles com desempenho inferior no teste de resistência cardiorrespiratória, impulso horizontal e número de passos/dia. Os resultados indicam a necessidade de maior vigilância no controle e prevenção dos fatores de risco que compõem a síndrome metabólica.

This study aimed to verify the existence of an association between degree of physical activity and presence of metabolic syndrome in the Khisêdjê indigenous group. The authors evaluated 170 individuals 20 years or older, based on demographic data, physical examination, and laboratory tests. The data were analyzed with the chi-square test (p < 0.05), crude and adjusted prevalence ratios (point and 95% confidence intervals), and Student's t-test. Satisfactory results were observed in relation to cardiorespiratory endurance, flexibility, bending of arms and trunk, and measurement of physical activity according to the number of steps/day. Prevalence of metabolic syndrome was 27.8% and was higher in women, the 39-49-year and ≥ 50-year age groups, and in individuals with lower performance on the cardiorespiratory endurance test, horizontal impulse, and number of steps/day. The results indicate the need for greater surveillance in the control and prevention of risk factors for metabolic syndrome.

A behavioral intervention in a cohort of Japanese-Brazilians at high cardiometabolic risk / Intervenção comportamental em nipo-brasileiros com alto risco cardiometabólico

OBJECTIVE: To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS: A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS: During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, p<0.001], systolic blood pressure [-4.6(17.9) vs. 1.8(4.3) mmHg per year, p<0.001], 2-hour plasma glucose [-1.2(2.1) vs. -0.2(0.6) mmol/L per year, p<0.001], LDL-cholesterol [-0.3(0.9) vs. -0.1(0.2) mmol/L per year, p<0.001] and Framingham coronary heart disease risk score [-0.25(3.03) vs. 0.11(0.66) per year, p=0.02] but not in triglycerides [0.2(1.6) vs. 0.1(0.42) mmol/L per year, p<0.001], and fasting insulin level [1.2(5.8) vs. -0.7(2.2) IU/mL per year, p<0.001] compared with the pre-intervention period. Significant reductions in the prevalence of impaired fasting glucose/impaired glucose tolerance and diabetes were seen during the intervention (from 58.4% to 35.4%, p<0.001; and from 30.1% to 21.7%, p= 0.004, respectively). CONCLUSIONS: A one-year community-based health promotion program brings cardiometabolic benefits in a high-risk population of Japanese-Brazilians.

OBJETIVO: Avaliar o efeito do programa de promoção de saúde no perfil de risco cardiometabólico de nipobrasileiros. MÉTODOS: Um total de 466 participantes de estudo de prevalência de diabetes em Bauru, SP, no ano de 2000 completou um programa de intervenção de um ano (2005-2006) baseado em aconselhamento sobre dieta saudável e prática de atividade física. Alterações em pressão arterial e parâmetros metabólicos entre 2005 e 2006 foram comparados com alterações anuais nessas mesmas variáveis entre 2000 e 2005. RESULTADOS: Durante a intervenção, foram observadas maiores reduções anuais médias (dp) na circunferência da cintura [-0,5(3,8) vs. 1,2(1,2) cm/ano, p < 0,001], pressão arterial sistólica [-4,6(17,9) vs. 1,8(4,3) mmHg/ano, p < 0,001], glicemia 2h pós-sobrecarga de glicose [-1,2(2,1) vs. -0,2(0,6) mmol/L/ano, p < 0,001], LDL-c [-0,3(0,9) vs. -0,1(0,2) mmol/L/ano, p < 0,001] e escore de Framingham [-0,25(3,03) vs. 0,11(0,66)/por ano, p = 0,02], mas não em triglicérides [0,2(1,6) vs. 0,1(0,42) mmol/L/ano, p < 0,001] e insulinemia de jejum [1,2(5,8) vs. -0,7(2,2) UI/mL/ano, p < 0,001], comparado com o período pré-intervenção. Ocorreram reduções significativas na prevalência de glicemia de jejum alterada e tolerância à glicose diminuída após um ano de intervenção (de 58,4% para 35,4%, p < 0,001; e de 30,1% para 21,7%, p = 0,004, respectivamente). CONCLUSÕES: O programa de intervenção de um ano em hábitos de vida traz benefícios ao perfil de risco cardiometabólico em indivíduos nipobrasileiros de alto risco.

Factores asociados a síndrome metabólico en la comuna de Temuco, Chile / Risk factors for metabolic syndrome in a case control study in Temuco, Chile

Background: Metabolic syndrome is becoming an important public health problem in affluent societies. Aim: To identify factors associated to metabolic syndrome in a Southern Chilean city. Material and methods: Using a case control design, 200 participants, aged 35 to 70 years with at least three criteria for metabolic syndrome according to the National Cholesterol Education Program (NCEP_ATPIII) and 200 subjects with less than three criteria, were studied. Both groups were compared in terms of ethnic background, educational level, family history of diabetes and coronary artery disease, menopausal status, smoking, stress and depression, physical activity, changes in body mass index in the last five years and diet. Results: Among subjects aged more than 54 years, among males and among overweight individuals, having a Mapuche origin was a risk factor with odds ratios (OR) of 7.2; 88 and 3.9 respectively. Among subjects aged more than 54 years, among women and among overweight individuals, a family history of diabetes was a risk factor with OR of 17.7; 3.2 and 3.9 respectively. Among subjects aged more than 54 years and among women a change in body mass index of more than three points was a risk factor with OR of 12.5 and 7.4, respectively. Depression also was a risk factor among subjects aged more than 54 years (OR 3.3). Regular consumption of wine was a protective factor among participants of more than 54 years, with an OR of 0.17. Conclusions: The risk factors for metabolic syndrome detected in this group of participants, were having a Mapuche origin, a family history of diabetes mellitus and depression. Wine consumption was associated with a lower risk.

Cut-Off Values of Visceral Fat Area and Waist-to-Height Ratio: Diagnostic Criteria for Obesity-Related Disorders in Korean Children and Adolescents

PURPOSE: The aim of this study was to study the appropriate cut-off value of visceral fat area (VFA) and waist-to-height ratio (WTHR) which increase the risk of obesity-related disorders and to validate the diagnostic criteria of abdominal obesity and metabolic syndrome in Korean children and adolescents. MATERIALS AND METHODS: A total 314 subjects (131 boys and 183 girls) were included in this study. The subjects were selected from Korean children and adolescents who visited three University hospitals in Seoul and Uijeongbu from January 1999 to December 2009. All patients underwent computed tomography to measure VFA. RESULTS: The cut-off value of VFA associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 68.57 cm2 (sensitivity 59.8%, specificity 76.6%, p=0.01) for age between 10 to 15 years, and 71.10 cm2 (sensitivity 72.3%, specificity 76.5%, p<0.001) for age between 16 to 18 years. By simple regression analysis, the WTHR corresponding to a VFA of 68.57 cm2 was 0.54 for boys and 0.61 for girls, and the WTHR corresponding to a VFA of 71.10 cm2 was 0.51 for boys and 0.56 for girls (p=0.004 for boys, p<0.001 for girls). CONCLUSION: Based on the results of this study, VFA which increases the risk of obesity-related disorders was 68.57 cm2 and the WTHR corresponding to this VFA was 0.54 for boys and 0.61 for girls age between 10-15 years, 71.70 cm2 and the WTHR 0.51 for boys and 0.56 for girls age between 16-18 years. For appropriate diagnostic criteria of abdominal obesity and obesity-related disorders in Korean children and adolescents, further studies are required.

Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil / Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population / Influencia del color de la piel autodeclarado en la prevalencia del síndrome metabólico en una población urbana de Brasil

Fundamento: A síndrome metabólica tem uma elevada prevalência em diferentes partes do mundo, com variações entre diferentes grupos étnicos. Objetivo: Este estudo pretende explorar a influência da cor de pele auto-referida sobre a prevalência da SM. Métodos: Estudo transversal, realizado em subgrupo populacional em Salvador, Brasil. Utilizou-se auto-definição de cor de pele (branca, parda e negra) e o critério de SM do ATP-III. Foi usado o quiquadrado para tendência a fim de analisar gradiente das prevalências entre os grupos e a regressão logística para análises de associações. Resultados: A prevalência geral da SM, ajustada por variáveis potencialmente confundidoras, não diferiu entre brancos (23,3 por cento), pardos (23,3 por cento) e negros (23,4 por cento,). A análise por sexo mostrou entre os homens redução da prevalência da SM dos brancos, 26,2 por cento IC95 por cento(20,7-31,7), em comparação aos negros, 17,5 por cento IC95 por cento (12,3-22,8), e uma prevalência intermediária entre os pardos, 21,9 por cento IC95 por cento (18,6 - 25,1), p tend= 0,002. Entre as mulheres, a tendência foi inversa, maior nas negras, 27,0 por cento IC95 por cento (22,2-31,8), e menor nas brancas, 20,5 por cento IC95 por cento(15,6-25,4), p tend= 0,02. Na análise multivariada da associação entre cor de pele e SM (branco=grupo de referência), a cor negra entre os homens foi fator de proteção, razão de prevalência (RP)= 0,60 (0,36 - 0,97), enquanto que nas mulheres tendeu a ser fator de risco, RP= 1,33 (0,94 - 1,78). Conclusão: A prevalência da SM variou em função da cor de pele de modo inverso entre homens e mulheres. Ser negro foi fator de proteção entre homens e de risco nas mulheres.

Background: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. Objective: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS. Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. Results: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3 percent), mulattos (23.3 percent) and blacks (23.4 percent). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2 percent, 95 percentCI: 20.7-31.7), in comparison to blacks (17.5 percent, 95 percentCI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9 percent, 95 percentCI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0 percent, 95 percentCI: 22.2-31.8, and lower among the whites, 20.5 percent, 95 percentCI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). Conclusion: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Fundamento: El síndrome metabólico tiene una elevada prevalencia en diferentes partes del mundo, con variaciones entre diferentes grupos étnicos. Objetivo: Este estudio pretende explorar la influencia del color de la piel autodeclarado sobre la prevalencia del SM. Métodos: ESTUDio transversal, realizado en subgrupo poblacional en Salvador, Brasil. Se utilizó la autodefinición de color de la piel (blanca, parda y negra) y el criterio de SM del ATP-III. Se usó el test chi-cuadrado para tendencia a fin de analizar gradiente de las prevalencias entre los grupos y la regresión logística para análisis de asociaciones. Resultados: La prevalencia general del SM, ajustado por variables potencialmente confusas, no difirió entre blancos (23,3 por ciento), pardos (23,3 por ciento) y negros (23,4 por ciento,). El análisis por sexo mostró entre los hombres reducción de la prevalencia del SM de los blancos, el 26,2 por ciento IC95 por ciento(20,7-31,7), en comparación con los negros, 17,5 por ciento IC95 por ciento (12,3-22,8), y una prevalencia intermedia entre los pardos, 21,9 por ciento IC95 por ciento (18,6 - 25,1), p tend= 0,002. Entre las mujeres, la tendencia fue inversa, mayor en las negras, 27,0 por ciento IC95 por ciento (22,2-31,8), y menor en las blancas, 20,5 por ciento IC95 por ciento(15,6-25,4), p tend= 0,02. En el análisis multivariado de la asociación entre color de la piel y SM (blanco=grupo de referencia), el color negro entre los hombres fue factor de protección, razón de prevalencia (RP)= 0,60 (0,36-0,97), mientras que en las mujeres tendió a ser factor de riesgo, RP= 1,33 (0,94-1,78). Conclusión: LA Prevalencia del SM varió en función del color de la piel de modo inverso entre hombres y mujeres. Ser negro fue factor de protección entre hombres y de riesgo en las mujeres.

Variable Association between Components of the Metabolic Syndrome and Electrocardiographic Abnormalities in Korean Adults

BACKGROUND/AIMS: Resting electrocardiogram (ECG) abnormalities have been strongly associated with cardiovascular disease mortality. Little is known, however, about the association between individual components of metabolic syndrome and ECG abnormalities, especially in Asian populations. METHODS: We examined clinical and laboratory data from 31,399 subjects (age 20 to 89 years) who underwent medical check-ups. ECG abnormalities were divided into minor and major abnormalities based on Novacode criteria. Ischemic ECG findings were separately identified and analyzed. RESULTS: The overall prevalence rates of ECG abnormalities were significantly higher in subjects with than in those without metabolic syndrome (p < 0.01). Ischemic ECG was strongly associated with metabolic syndrome in all age groups of both sexes, except for younger women. In multiple logistic regression analysis, metabolic syndrome was independently associated with ischemic ECG (odds ratio, 2.30 [2.04 to 2.62]; p < 0.01), after adjusting for sex, age, smoking, and family history of cardiovascular disease. Of the metabolic syndrome components, hyperglycemia in younger subjects and hypertension in elderly subjects were major factors for ischemic ECG changes, whereas hypertriglyceridemia was not an independent risk factor in any age group. The association between ischemic ECG findings and central obesity was weaker in women than in men. CONCLUSIONS: Metabolic syndrome was strongly associated with ECG abnormalities, especially ischemic ECG findings, in Koreans. The association between each component of metabolic syndrome and ECG abnormalities varied according to age and sex.

União interétnica de nipo-brasileiros associada a hábitos alimentares menos saudáveis e ao pior perfil de risco cardiometabólico / Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile

OBJETIVO: Casamento interétnico entre brasileiros nikkeis e não nikkeis pode favorecer a ocidentalização da dieta. Compararam-se consumo alimentar, dados clínico-laboratoriais e frequências de doenças metabólicas em população nipo-brasileira, com casamento intraétnico ou interétnico. MÉTODOS: Empregaram-se teste t, Mann-Whitney, qui-quadrado e coeficiente de Pearson. RESULTADOS: Em 1009 nipo-brasileiros havia 18,9 por cento de casamentos interétnicos, mais frequentes entre homens nikkeis. Estes apresentaram maiores médias de IMC, cintura, pressão arterial, glicemia e triglicérides que mulheres. As frequências de obesidade, hipertrigliceridemia e síndrome metabólica foram 47,7 por cento, 68,1 por cento e 45,2 por cento, sendo maiores nos casamentos interétnicos comparados aos intraétnicos. Comparando-se indivíduos com casamento interétnico, hipertrigliceridemia foi mais frequente nos homens e HDL-c baixo nas mulheres. O consumo de calorias, gorduras e dos grupos de álcool, doces e óleos foram maiores nos casamentos interétnicos. Indivíduos casados intraetnicamente consumiam mais carboidratos, proteínas, fibras, vitaminas, minerais, hortaliças, frutas/sucos, cereais e missoshiru. Comparando-se indivíduos com casamento interétnico, homens nikkeis apresentavam padrão mais ocidental que mulheres nikkeis. CONCLUSÃO: Casamento interétnico associa-se a hábitos alimentares menos saudáveis e pior perfil de risco cardiometabólico.

OBJECTIVE: Interethnic marriage between nikkey Brazilians and non-nikkey Brazilians may favor the westernization of diet. Dietary consumption, clinical data and frequencies of metabolic diseases were compared in a Japanese-Brazilian population, with intraethnic or interethnic marriage. METHODS: T test, Mann-Whitney, chi-square and Person coefficient were used. RESULTS: Among 1009 Japanese-Brazilians there were 18.9 percent of interethnic marriage, being more frequent among nikkey men. These showed higher means of BMI, waist, blood pressure, glycemia and triglyceridemia than women. Overall frequencies of obesity, hypertrigliceridemia and metabolic syndrome were 47.7 percent, 68.1 percent and 45.2 percent, being higher in interethnic than intraethnic marriage. Comparing individuals with interethnic marriages, hypertriglyceridemia was more common among men while low-HDL among women. Energy, fat, groups of alcohol, sweets and oils were higher in interethnic marriage. Individuals with intraethnic marriage consumed more carbohydrate, proteins, fibers, vitamins, minerals, vegetables, fruits/juice, cereals and missoshiru. Comparing individuals with interethnic marriages, nikkey men showed a more westernized dietary pattern than nikkey women. CONCLUSION: Interethnic marriage was associated with less healthy food habits and worse cardiometabolic profile.

Associação do eletrocardiograma com diabete melito e síndrome metabólica em nipo-brasileiros / Relationship between electrocardiogram with diabetes mellitus and metabolic syndrome in Japanese-Brazilians / Asociación del electrocardiograma con diabetes mellitus y síndrome metabólico en nipobrasileños

Fundamento: Ao migrarem para as Américas, os japoneses submeteram-se a processo de ocidentalização, com estilo de vida, especialmente dieta, muito diferente, podendo explicar o aumento de diabete melito (DM), síndrome metabólica (SM) e doenças cardiovasculares. Objetivo: Analisar a presença de necrose miocárdica e hipertrofia ventricular esquerda (HVE) pelo ECG e sua relação com DM e SM em população de nipo-brasileiros. Métodos: Estudo transversal que avaliou 1.042 nipo-brasileiros acima de 30 anos, 202 nascidos no Japão (isseis) e 840 nascidos no Brasil (nisseis), provenientes da segunda fase do estudo Japanese-Brazilian Diabetes Study Group iniciado em 2000. A SM foi definida pelos critérios da NCEP-ATP III modificados para os japoneses. A presença de DM e SM se associou ao encontro de necrose miocárdica pelo critério de Minnesota e de HVE pelo critério de Perugia no ECG. Utilizou-se o método estatístico do qui-quadrado para rejeição da hipótese de nulidade. Resultados: Dos 1.042 participantes 35,3% tinham DM (38,6% entre os isseis e 34,5% nos nisseis); 51,8% tinham SM (59,4% nos isseis e 50,0% nos nisseis). A presença de zona inativa nos isseis diabéticos não foi estatisticamente significante quando comparada com os não-diabéticos, porém entre os nisseis diabéticos a zona inativa estava presente em 7,5%. Houve correlação estatisticamente significante entre a SM e HVE nos isseis e nisseis. Conclusão: Distúrbios metabólicos tiveram alta prevalência em nipo-brasileiros com correlações significantes com necrose e hipertrofia pelo ECG.

Background: When the Japanese immigrated to the Americas, they were subjected to Westernization, with a great change in lifestyle, specially in dietary habits, and this may explain the increase in the incidence of diabetes mellitus (DM), metabolic syndrome (MS) and cardiovascular disease among them. Objective: To study the presence of myocardial necrosis and left ventricular hypertrophy (LVH) in a population of Japanese-Brazilians, using the ECG and its relationship with DM and MS. Methods: This was a cross-sectional study which evaluated 1,042 Japanese-Brazilians aged 30 or over, 202 of them born in Japan (Issei) and 840 of them born in Brazil (Nissei), from the second phase of the Japanese-Brazilian Diabetes Study Group initiated in 2000. MS was defined according to the NCEP-ATP III criteria modified for the Japanese. DM and MS were associated with the presence of myocardial necrosis (according to the Minnesota criteria) and LVH (according the Perugia score on the ECG). The statistic chi square method was used to reject the null hypothesis. Results: Of the 1,042 participants, 35.3% had DM (38.6% of the Issei and 34.5% of the Nissei); 51.8% had MS (59.4% of the Issei and 50.0% of the Nissei). The presence of an inactive zone in the diabetic Issei group was not statistically significant when compared to the non-diabetic group, but among the diabetic Nissei group an inactive zone was present in 7.5% of them. There was a statistically significant correlation between MS and LVH in the Issei and Nissei groups. Conclusion: Metabolic disorders presented a high prevalence in Japanese-Brazilians with significant correlations with necrosis and hypertrophy on the ECG.

Fundamento: Al migrar hacia las Américas, los japoneses se sometieron a un proceso de occidentalización, con estilo de vida, y especialmente dieta, muy diferente, lo que puede explicar el aumento de diabetes mellitus (DM), síndrome metabólico (SM) y enfermedades cardiovasculares. Objetivo: Analizar la presencia de necrosis miocárdica e hipertrofia ventricular izquierda (HVI), indicada en ECG, y su relación con DM y SM en población de nipobrasileños. Métodos: Estudio transversal que evaluó a 1.042 nipobrasileños con edad superior a 30 años: 202 nacidos en Japão (iseis) y 840 nacidos en Brasil (niseis), provenientes de la segunda fase del estudio Japanese-Brazilian Diabetes Study Group iniciado en 2000. Se definió el SM desde los criterios de la NCEP-ATP III, modificados para los japoneses. La presencia de DM y SM se asoció a la formación de necrosis miocárdica, según el de Minnesota, y de HVI según el criterio de Perugia, ambas reveladas en el ECG. Se utilizó el método estadístico del Chi-cuadrado para rechazo de la hipótesis de nulidad.Resultados: De los 1.042 participantes, el 35,3% presentaba DM (el 38,6% entre los iseis y el 34,5% en niseis); el 51,8% tenían SM (el 59,4% entre iseis y el 50,0% en niseis). La presencia de zona inactiva en los iseis diabéticos no se mostró estadísticamente significante, si se la compara a los no diabéticos; sin embargo, entre los niseis diabéticos la zona inactiva se presentaba en el 7,5%. Hubo correlación estadísticamente significante entre el SM y la HVE entre iseis y niseis. Conclusión: Disturbios metabólicos tuvieron alta prevalencia en nipobrasileños con correlaciones significantes con necrosis e hipertrofia reveladas por el ECG.

Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management.

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medical institutions, hospitals, government funded research institutions, and policy making bodies. It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as overweight/obese and would require appropriate management. Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases. ©

Distúrbios no perfil lipídico são altamente prevalentes em população nipo-brasileira / Lipid profile disturbances are highly prevalent in Japanese-Brazilians

Alta prevalência de diabetes em população nipo-brasileira de Bauru/SP foi previamente relatada. Visando a complementar a avaliação do risco cardiometabólico, este estudo analisou distúrbios no perfil lipídico de 1.330 nipo-brasileiros (46 por cento homens) > 30 anos. Definiu-se hipercolesterolemia por níveis de colesterol total > 240 mg/dL; hipertrigliceridemia por valores > 150 mg/dL e HDL-colesterol baixo por valores < 40 mg/dL e < 50 mg/dL para homens e mulheres, respectivamente. A prevalência desses distúrbios foi comparada pelo qui-quadrado, estratificando-se por sexos e categorias glicêmicas. As médias dos lipídeos e lipoproteínas foram comparadas entre sexos pelo teste t de Student. A prevalência de hipertrigliceridemia foi de 66,0 por cento (IC95 por cento:63,5 - 68,5 por cento), sendo mais comum em homens e aumentando com a piora da categoria glicêmica; a trigliceridemia média foi 235,7 ± 196,3 mg/dL. A prevalência de hipercolesterolemia foi 24,4 por cento (IC95 por cento:22,1 - 26,7 por cento); HDL-C baixo foi observado em 43,0 por cento (IC95 por cento:39,4 - 46,6 por cento] das mulheres e 17,5 por cento (IC95 por cento:14,5 - 20,5 por cento) dos homens, porém a razão colesterol total/HDL-C foi menor em mulheres (4,23 ± 0,68 vs. 4,40 ± 0,73; p < 0,001). Em nipo-brasileiros, a hipertrigliceridemia é a anormalidade lipídica mais comum, em concordância com a elevada prevalência de diabetes. Os homens apresentaram pior perfil lipídico que as mulheres. Sugere-se que hábitos de vida ocidental possam estar deteriorando a saúde desses indivíduos.

High prevalence of diabetes has been previously reported in Japanese-Brazilians. In an attempt to better estimate the cardiometabolic risk, this study evaluated lipid disorders in 1,330 Japanese-Brazilians (46 percent men) aged >30 years. Hypercholesterolemia was defined as serum cholesterol > 240 mg/dL, hypertriglyceridemia as values > 150 mg/dL and low-HDL-C as values <40 mg/dL and <50 mg/dl for men and women respectively. The prevalence of dyslipidemias was compared by the chi-square test between gender and glycemic category. Mean and Standard Deviation of lipids and lipoproteins were compared by the Student t-Test between gender. Hypertriglyceridemia was detected in 66.0 percent [95 percent CI: 63.5-68.5] of the population, being more common in men and increasing with deterioration of glucose metabolism. Mean level of triglycerides was 235.7±196.3 mg/dL. The prevalence of hypercholesterolemia was 24.4 percent [95 percent CI: 22.1- 26.7]. Low HDL-C was observed in 17.5 percent [95 percent CI: 14.5-20.5] of men and 43.0 percent [95 percent CI: 39.4- 46.6] of women but total / HDL-cholesterol ratio was lower in women (4.23 ± 0.68 vs. 4.40 ± 0.73, p<0.001). In Japanese-Brazilians, hypertriglyceridemia is the commonest dyslipidemia, in agreement with the high prevalence of diabetes. Men showed a worse lipid profile than women; it was suggested that the Western diet and living habits could be deteriorating their health.

Sindrome metabólica na infância e na adolescência / Metabolic syndrome in childhood and adolescence

A síndrome metabólica é uma condição que altera a homeostasia lipídica, glicídica e circulatória, cuja etiologia está relacionada com a obesidade. Em pacientes pediátricos, tem se tornado um problema de saúde pública conforme essa faixa etária adquire um estilo de vida pouco saudável.

Obesidad como Factor de Riesgo para Trastornos Metabólicos en Adolescentes Mexicanos, 2005 / Obesity as risk factor for metabolic disorder in Mexican adolescents, 2005

Objetivo: Determinar la prevalencia y estimar el riesgo de obesidad para dislipidemias e hiperinsulinemia en adolescentes. Asimismo, evaluar la asociación lineal de medidas antropométricas y lípidos con insulina. Material y Métodos: Se realizó un estudio transversal comparativo entre adolescentes obesos (índice de masa corporal=IMC>percentil 95 para edad y sexo; n=120) y no obesos (IMC< percentil 85 para edad y sexo; n=120) de 10-19 años. Se aplicó una encuesta estructurada con datos sociodemográficos y antropométricos y se determinaron glucosa, insulina y perfil de lípidos. Resultados: La prevalencia de una o más dislipidemias fue de 56,6 por ciento en adolescentes c/obesidad, en comparación con 20,8 por ciento en adolescentes s/obesidad (p<.001). La hiperinsulinemia se presentó en el 50 por ciento del primer grupo mientras que en el segundo, en 4 por ciento (p<.001). La obesidad incrementó el riesgo de hiperinsulinemia con una razón de momios de (RM) de 23 (IC 95 por ciento: 8,3-68,9) y de por lo menos una dislipidemia (RM=5,0; IC95 por ciento: 2,7-9,2). El nivel de insulina se correlacionó significativamente con IMC (r=0,57), triglicéridos (r=0,57), VLDL (r=0,57), HDL (-0,37), relación cintura cadera (r=0,29), colesterol (r=0,22), y LDL (r=0,13). Conclusiones: Se evidenció a la obesidad en adolescentes como factor predisponente para el desarrollo de trastornos metabólicos y la asociación lineal de medidas antropométricas y lípidos con insulina.

Objective: Determining the prevalence and estimating the risk of obesity for dyslipidemia and hyperinsulinemia in adolescents. The existence of a linear association betweenanthropometric measures, lipids and insulin was also evaluated. Material and Methods: A comparative study was carried out amongst obese (body mass index=BMI >95th percentile for age and gender; n=120) and non-obese adolescents (BMI <85th percentile for age and sex; n=120) aged 10-19. A structured questionnaire was used for collecting anthropometric and demographic data. Glucose, insulin and lipid profiles were obtained for each adolescent. Results: Prevalence of at least one dyslipidemia was 56,6 percent among obese adolescents and 20,8 percent amongst non-obese ones (p<.001). The former registered 50 percent prevalence of hyperinsulinemia, the latter 4 percent (p<.001). Obesity increased hyperinsulinemia risk having a 23 odds ratio (8.3-68.9 95 percent CI) and for at least one dyslipidemia (OR=5,0; 2,7-9,2 95 percent CI). Insulin level significantly correlated with BMI (r=0,57), triglycerides (r=0,57), VLDL (r=0,57), HDL (-0,37), waist-hip circumference index (r=0,29), cholesterol (r=0,22), and LDL (r=0,13). Conclusions: Obesity can be considered to be a risk factor for developing metabolic disorders in adolescents. In fact, there was a linear relationship between anthropometric measurement, lipids and insulin. Prevention should focus on improving predisposing environments for obesity amongst families having children and teenagers. Emphasising life-styles and healthy behaviour is essential, as well as training and treatment options for complete care of individuals in this age-group.

Prevalence of metabolic syndrome in a rural area of Brazil

CONTEXT AND OBJECTIVE: Metabolic syndrome (MS) is recognized worldwide as an important public health concern. However, little information is available for rural populations in Brazil. The aim was to determine the prevalence and risk factors associated with MS in a rural village in Brazil in 2004. DESIGN AND SETTING: Cross-sectional population-based study, in Virgem das Graças, a rural community in the Jequitinhonha Valley, State of Minas Gerais. METHODS: MS was the dependent variable, defined as any three of these risk factors: arterial hypertension, high glucose or triglyceride concentrations, low high-density lipoprotein cholesterol and abdominal obesity. MS prevalence, according to selected socioeconomic and demographic variables (age, skin color, marital status, schooling and smoking habits), was determined in 251 subjects aged 20-88 years. Multivariate logistic regression was used to estimate odds ratios (OR) and 95 percent confidence intervals. RESULTS: MS prevalence was 21.6 percent (7.7 percent for men and 33.6 percent for women); the age-adjusted prevalence was 19.0 percent. The highest prevalences were observed for women > 60 years of age (52.9 percent) and women with body mass index (BMI) > 25 kg/m² (64 percent). Age, sex and BMI were associated risk factors for MS, while skin color was only significantly associated with MS for women. The models were adjusted for age, smoking habits, marital status, skin color and schooling. CONCLUSIONS: BMI and age were independently associated factors for MS in this rural community. These findings provide important evidence on the prevalence of MS as a public health problem, particularly for women and overweight individuals.

OBJETIVO E CONTEXTO: A síndrome metabólica (SM) é reconhecida mundialmente como importante problema de saúde pública e tem apresentado prevalência crescente. Entretanto, existe pouca informação sobre prevalência da SM em populações rurais brasileiras. Este estudo objetivou determinar a prevalência e os fatores associados a SM em uma comunidade rural do Brasil, em 2004. TIPO DE ESTUDO E LOCAL: Estudo transversal de base populacional, conduzido em Virgem das Graças, comunidade rural localizada no Vale do Jequitinhonha, Estado de Minas Gerais, Brasil, 2004. MÉTODOS: SM foi definida pelo critério do National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP III) como a co-ocorrência de pelo menos três dos seguintes fatores: hipertensão arterial, altos níveis séricos de glicose ou triglicérides, baixos níveis da lipoproteína de alta densidade, e obesidade abdominal. A prevalência de SM foi calculada segundo variáveis socioeconômicas e demográficas em 251 pessoas (117 homens, 134 mulheres) com idades entre 20-88 anos. Utilizou-se regressão logística para estimar odds ratio (OR) e seus intervalos de confiança de 95 por cento. RESULTADOS: Prevalência da SM foi 21,6 por cento (7,7 por cento para os homens e 33,6 por cento para as mulheres). A prevalência global ajustada por idade foi 19,0 por cento. Prevalências altas foram encontradas em mulheres > 60 anos (52,9 por cento) e em mulheres com índice de Massa Corporal (IMC) > 25 (64 por cento). A análise ajustada por hábito de fumar, status marital, cor de pele e escolaridade revelou que o sobrepeso e sexo feminino e a idade como principais fatores de risco relacionado à SM. CONCLUSÕES: A síndrome metabólica representa um potencial problema de saúde pública particularmente em mulheres e indivíduos com sobrepeso na área rural estudada. O sobrepeso, a idade acima de 60 anos e o sexo feminino foram considerados fatores independendentes associados a essa condição.

Evaluation critique of state of the art dyslipidemia management in general and with a special emphasis on the Indian population.

Classically, there have been three well established major cardiovascular risk factors, hypercholesterolemia, hypertension and tobacco abuse. With accumulating clinical evidence, diabetes can now be added as a fourth major risk factor. Much interest in various other risk factors and possible causative factors has been generated, but it should be remembered that of all these, low density lipoproteins (LDL) remains the gold standard for evaluating risk. The common perception is that only caucasians in the western world have significant cardiovascular (CV) risk. However, much clinical information to the contrary has accumulated and now it is realized that many other ethnic groups also have significant CV disease, such as in India, especially in the urban population. Dyslipidemias of specific lipoproteins and their treatment is an important part of understanding and managing CV disease and risk. Various plasma factors such as homocysteine and lipoprotein (a) [(a)] have been considered to have definite associations with CV disease, but any treatment benefit remains in doubt. In addition, inflammatory risk factors are considered to be of significant clinical interest, especially high sensitivity C-Reactive protein (hsCRP). Where do these factors fit into routine clinical practice still awaits clarification. Only two of these inflammatory risk (Lp-factors can be tested commercially on a routine clinical basis and these are hsCRP and Lipoprotein-associated Phospholipase A2 Lp-PLA2). Their clinical utillity is not established and acceptance is limited: some third party health coverage organizations refuse to pay for such analyses. In the past, women have been looked upon as not having significant CV disease. More recently, evidence suggests that women may have more CV disease than men, and that physicians may have failed to realize this and act accordingly. The true situation is that women have less CV disease than men prior to menopause and then they slowly catch up. However, some women under age 50 have an especially malignant form of CV disease and in these cases, myocardial infarction mortality is twice that of men. The explanation and management is the subject of much clinical investigation. In both India and the western world, perhaps the most important medical problem is the metabolic syndrome (MS) and this combination of CV risk factors multiplies the significance of each. For the difficult patient not tolerant of or sufficiently responsive to conventional therapy, alternative diets and medications can frequently offer just enough benefit in lowering LDL to allow the patient to attain their target level. Future treatments undoubtedly will involve genetics, but for now, aggressive medication use can favorably modify risk although not eliminate it.

Prevalência de síndrome metabólica em uma área rural do semi-árido baiano / Prevalence of metabolic syndrome in a semi-arid rural area in Bahia

O crescimento de alterações da tolerância à glicose em populações rurais e a carência de dados nacionais sobre ocorrência de Síndrome Metabólica (SM) motivaram o desenvolvimento deste estudo de prevalência de SM no distrito rural de Cavunge, semi-árido baiano. Amostra aleatória de base populacional foi constituída por 240 indivíduos com idade > 25 anos, 102 (42,5 por cento) homens e 138 (57,5 por cento) mulheres, idade média 49,5 ± 14,9, variando de 25 a 87 anos. Para diagnóstico, utilizou-se a I Diretriz Brasileira de Diagnóstico e Tratamento da SM. A prevalência bruta foi de 30,0 por cento e, após ajustamento por idade, 24,8 por cento. Freqüência de SM foi maior em mulheres (38,4 por cento) que em homens (18,6 por cento), mais elevada entre aqueles com idade > 45 anos (41,4 por cento) que naqueles com idade < 45 anos (15,9 por cento). Estratificação por sexo e idade revelou prevalência maior entre mulheres com idade > 45 anos (56,9 por cento), possivelmente associada à menopausa. Presença de SM na ausência de seus componentes melhor estabelecidos, alteração da glicemia e obesidade, sugere a importância do diagnóstico sindrômico, sinalizado pelo elevado valor preditivo encontrado para algumas alterações metabólicas isoladas. A alta prevalência justifica atenção ao tratamento do conjunto da síndrome, retardando ou evitando conseqüências futuras, como diabetes e doença cardiovascular.