Estresse percebido em mulheres com síndrome metabólica: um estudo transversal / Perceived stress in women with metabolic syndrome: a cross-sectional study / Estrés percibido en mujeres con síndrome metabólico: un estudio transversal

Introdução: o estresse percebido foi sugerido como um fator de risco para o desenvolvimento da Síndrome Metabólica (SM). No entanto, pouco se sabe desta associação entre mulheres. Objetivo: avaliar o estresse percebido em mulheres com SM. Materiais e Métodos: estudo transversal, a partir do recorte de um ensaio clínico não-randomizado, com pacientes de um centro de saúde público (RBR-43K52N). A variável de desfecho foi a SM, utilizando os critérios do NCEP/ATPIII. Foram coletados dados sociodemográficos, antropométricos, bioquímicos, hemodinâmicos e aplicação da PSS. Resultados: A amostra constituiu-se de 75 mulheres acometidas por SM (47,69±8,15 anos de idade; 155,65±0,07 cm; 82,43±17,79 kg; IMC de 33,54±7,28). Encontrou-se valores elevados de RCQ entre as mulheres estressadas e não-estressadas. A pontuação média da PSS foi de 27,73±9,17. Nos agrupamentos, verificou-se diferença significativa para PSS entre as mulheres estressadas e não-estressadas (35,24±5,22 e 20,42±5,53, respectivamente; p=0,001). Observou-se também que mulheres estressadas tinham níveis mais elevados de triglicerídeos e níveis mais baixos de HDL-c quando comparadas com mulheres não estressadas, embora sem diferença estatística. Discussões: Os achados sugerem que as mulheres categorizadas como estressadas tinham maior pontuação da PSS, níveis mais elevados de triglicerídeos e níveis mais baixos de HDL-c quando comparadas com mulheres não estressadas. Conclusões: a pontuação da PSS foi significativamente maior entre mulheres com parâmetros lipídicos da SM alterados, com menores níveis de HDL- e aumento de triglicerídeos.

Introduction: Perceived stress has been suggested as a risk factor for the development of Metabolic Syndrome (MS). However, little is known about this association among women. Objective: to evaluate perceived stress in women with Metabolic Syndrome (MS). Materials and Methods: cross-sectional study, based on a non-randomized clinical trial, with patients from a public health center (RBR-43K52N). The outcome variable was MS, using the NCEP/ATPIII criteria. Sociodemographic, anthropometric, biochemical, hemodynamic data and PSS application were collected. Results: The sample consisted of 75 women affected by MetS (47.69± 8.15 years old; 155.65±0.07 cm; 82.43±17.79 kg; BMI of 33.96±6 ,42). High WHR values were found among stressed and non-stressed women. The average PSS score was 27.73±9.17. In the groups, there was a significant difference for PSS between stressed and non-stressed women (35.24±5.22 and 20.42±5.53, respectively; p=0.001). It was also observed that stressed women had higher levels of triglycerides and lower levels of HDL-c when compared to non-stressed women, although without statistical difference. Discussions: The findings suggest that women categorized as stressed had higher PSS scores, higher levels of triglycerides and lower levels of HDL-c when compared to non-stressed women. Conclusions: the PSS score was significantly higher among women with altered MS lipid parameters, with lower levels of HDL- and increased triglycerides.

Introducción: El estrés percibido ha sido sugerido como un factor de riesgo para el desarrollo del Síndrome Metabólico (SM). Sin embargo, poco se sabe sobre esta asociación entre las mujeres. Objetivo: evaluar el estrés percibido en mujeres con Síndrome Metabólico (SM). Materiales y Métodos: estudio transversal, basado en un ensayo clínico no aleatorizado, con pacientes de un centro de salud pública (RBR-43K52N). La variable resultada fue SM, utilizando los criterios NCEP/ATPIII. Se recogieron datos sociodemográficos, antropométricos, bioquímicos, hemodinámicos y aplicación de PSS. Resultados: La muestra estuvo compuesta por 75 mujeres afectadas por SMet (47,69± 8,15 años; 155,65±0,07 cm; 82,43±17,79 kg; IMC de 33,96±6,42). Se encontraron valores altos de WHR entre mujeres estresadas y no estresadas. La puntuación media de PSS fue de 27,73±9,17. En los grupos, hubo una diferencia significativa para PSS entre mujeres estresadas y no estresadas (35,24±5,22 y 20,42±5,53, respectivamente; p=0,001). También se observó que las mujeres estresadas tenían niveles más altos de triglicéridos y niveles más bajos de HDL-c en comparación con las mujeres no estresadas, aunque sin diferencia estadística. Discusiones: Los hallazgos sugieren que las mujeres categorizadas como estresadas tenían puntajes PSS más altos, niveles más altos de triglicéridos y niveles más bajos de HDL-c en comparación con mujeres no estresadas. Conclusiones: la puntuación de PSS fue significativamente mayor entre las mujeres con parámetros lipídicos de SM alterados, con niveles de HDL más bajos y triglicéridos elevados.

Poor Trunk Flexibility is Associated with Cardiovascular Risk Factors

Abstract Background: Poor flexibility is a predictor of reduced physical activity. The association between trunk flexibility and cardiovascular risk factors (CVRFs) is not well understood. Objective: To identify the prevalence of CVRFs and their association with trunk flexibility in individuals participating in a community-based health education program. Methods: Volunteers (51 men, 48 women) aged 20-85 years old, participants in a community-based health education program in the city of Santo Antônio de Goiás, Brazil, were selected for this study. Anthropometric measures including body mass, height, body mass index (BMI), waist circumference (WC) and waist/height ratio (WHtR) were evaluated. Physical activity level was evaluated based on leisure activity participation, and trunk flexibility was evaluated by the sit and reach test. Data distribution was assessed using the Shapiro-Wilk test; Pearson's chi-square or Fisher's exact and Student t tests were performed for comparisons. To analyze the association between trunk flexibility and concomitant CVRFs, Spearman's correlation test and linear regression were employed. Statistical significance was defined as p < 0.05. Results: 7.2% of the volunteers had no CVRF, 10.3% had only one CVRF and 82.5% had two or more CVRFs, with no differences between sexes. Increased abdominal adiposity, as assessed by WHtR (p = 0.0097), and systemic arterial hypertension (p = 0.0003) were the most prevalent CVRFs, with differences between age groups. A strong negative correlation was found between mean trunk flexibility and the number of concomitant CVRFs (r = -0.96, p < 0.0028). Conclusion: The strong negative correlation between trunk flexibility and concomitant CVRF indicates an increased risk for cardiovascular events. Therefore, trunk flexibility measurement may be an additional tool for health promotion and prevention of cardiovascular and associated diseases in community health programs.

Associação entre ingestão de bebida alcoólica e estado antropométrico de universitários / Association between alcohol consumption and anthropometric status of university students

Introdução: objetivamos avaliar associação entre ingestão de bebida alcoólica e estado antropométrico em estudantes que frequentam Restaurante Universitário. Metodologia: estudo transversal com 155 universitários em que foi avaliado o consumo de bebida alcoólica, frequência do consumo, tempo de consumo, quantidade e hábitos adotados enquanto bebiam. As medidas antropométricas realizadas foram estatura, peso, circunferência da cintura, circunferência do quadril e quatro dobras cutâneas (tricipital, bicipital, subescapular e suprailíaca). Para análise, realizamos estatística descritiva, o teste de qui-quadrado de independência para as proporções entre os grupos e a diferença entre as médias das medidas antropométricas de acordo a quantidade de bebida alcoólica consumida foi avaliada pelo teste ANOVA. Foram considerados significantes valores de p<0,05. Resultados: dos universitários, 63,87% eram bebedores, 23,2% dos bebedores estavam com excesso de peso, 21,2% apresentaram circunferência da cintura com risco elevado e percentual de gordura em excesso em ambos os grupos (77,8% vs. 73,2). Identificamos diferença estatisticamente para a circunferência da cintura entre o tempo de consumo (p=0,003) e entre o percentual de gordura corporal de acordo com a quantidade de bebida alcoólica consumida (p=0,001). Conclusão: o estado antropométrico dos universitários que consumiam bebida alcoólica apresentou alta frequência de excesso de peso e risco de complicações metabólicas associadas à obesidade, mesmo que sem significações estatísticas para as associações testadas.

Introduction: we aimed to evaluate the association between alcohol intake and anthropometric status in students who attend the University Restaurant. Methodology: cross-sectional study with 155 university students in which the consumption of alcoholic beverages, frequency of consumption, consumption time, quantity and habits adopted while drinking were evaluated. The anthropometric measurements taken were height, weight, waist circumference, hip circumference and four skinfolds (triceps, biceps, subscapular and suprailiac). For analysis, we performed descriptive statistics, the chi-square test of independence for proportions between groups and the difference between the means of anthropometric measures according to the amount of alcoholic beverage consumed was evaluated by the ANOVA test. Significant values of p<0.05 were considered. Results: of the college students, 63.87% were drinkers, 23.2% of the drinkers were overweight, 21.2% high risk waist dissipation and fat percentage in both groups (77.8% vs. 73 ,two). We identified a statistically significant difference for waist circumference between consumption time (p = 0.003) and between body fat percentage according to the amount of alcoholic beverage consumed (p = 0.001). Conclusion: the anthropometric status of college students who drank alcoholic beverages presented a high frequency of weight and risk of metabolic complications associated with obesity, even if without statistical significance for the tested associations.

Lifestyle Intervention in Reducing Cardiometabolic Risk Factors in Students with Dyslipidemia and Abdominal Obesity: A Randomized Study

Abstract Background The long incubation periods of cardiovascular diseases offer opportunities for controlling risk factors. In addition, preventive interventions in childhood are more likely to succeed because lifestyle habits become ingrained as they are repeated. Objective To investigate the effects of recreational physical activities, in combination or not with a qualitative nutritional counseling, in cardiometabolic risk factors of students with dyslipidemia and abdominal obesity. Methods Students (8-14 years old) were randomly divided into three groups (n=23 each): i ) Control; ii ) PANC, students undergoing Physical Activity and Nutritional Counseling, and iii ) PA, students submitted to Physical Activity, only. Blood samples (12-h fasting) were collected for biochemical analysis and anthropometric markers were also assessed. Two-Way RM-ANOVA and Holm-Sidak's test, and Friedman ANOVA on Ranks and Dunn's test were applied. P ≤ 0.05 was considered significant. Effect sizes were evaluated by Hedges' g and Cliff's δ for normal and non-Gaussian data, respectively. Results Compared to the control group and to baseline values, both interventions caused significant average reductions in total cholesterol (11%; p <0.001), LDL-c (19%; p=0.002), and non-HDL-c (19%; p=0.003). Furthermore, students in the PANC group also experienced a significant decrease in body fat compared to baseline (p=0.005) and to control (5.2%; g=0.541). Conclusions The proposed strategies were effective to reduce cardiometabolic risk factors in children and adolescents. The low cost of these interventions allows the implementation of health care programs in schools to improve the students' quality of life.

Association between Deep Subcutaneous Adipose Tissue Estimated by DAAT Index and Dietary Intake in Patients with Acute Coronary Syndrome

Abstract Background: Abdominal obesity has been associated with cardiovascular disease and may be modulated by dietary intake. The deep abdominal subcutaneous adipose tissue (dSAT) is a body fat compartment that can be estimated by using mathematical formulas. Objectives: To evaluate the association between dSAT estimated by the Deep-Abdominal-Adipose-Tissue (DAAT) index and dietary intake in patients with acute coronary syndrome (ACS). Methods: This is a cross-sectional study conducted with patients ≥ 18 years of age admitted to a tertiary hospital. Sociodemographic, clinical, and anthropometric (body weight [kg], height [m], waist, hip and neck circumferences [cm]) data were evaluated. A food frequency questionnaire was applied to identify each patient's nutrient intake. The DAAT index was calculated according to specific formulas for men and women. Possible association between food intake and the DAAT index was evaluated by multiple linear regression. The level of significance adopted was 0.05. Results: This study evaluated 138 patients, with a mean age of 61.2±10.8 years. Prevalence of obesity was 29.4% in men and 37.7% in women. Regarding waist circumference, 83% of the women showed values considered to be very high. The DAAT index was significantly higher in men when compared to woman (P < 0.0001) and proved to be positively correlated with proteins (r= 0.22, P= 0.01) and monounsaturated fatty acid (r= 0.18, P= 0.04) intake in the entire sample. After adjustment for sex, alcohol consumption, and levels of physical activity, the DAAT index was associated with the female sex (B= −129.84, P <0.001) and a sedentary lifestyle (B= 57.99, P <0.001). Conclusion: dSAT estimated by the DAAT index was not associated with dietary intake in patients with ACS.

Anthropometric markers of abdominal adiposity and its relation to dyslipidemia and insulin resistance among overweight/obese schoolchildren and adolescents / Marcadores antropométricos de adiposidade abdominal e sua relação com dislipidemia e resistência à insulina em escolares e adolescentes com sobrepeso/obesidade

ABSTRACT: Objective: to assess the relationship between anthropometric indicators and laboratorial markers of cardiovascular risk in overweight/obese children and adolescents, in order to verify whether any anthropometric indicator has a better potential for use in screening cardiovascular risk in the population. Method: retrospective cross-sectional study enrolling 237 individuals aged 7 to 18 years. Body mass index (BMI), waist circumference (WC), waist circumference/height index (WC/H), glucose, HOMA-IR, total cholesterol (TC), LDL, HDL, triglycerides and TC/HDL and LDL/HDL indexes were obtained. Associations between anthropometric and laboratory markers were tested in contingency tables using the chi-square test. Correlations were tested by Spearman's correlation. Results: higher WC (Freedman cutoffs) was associated with lower levels of HDL and higher score in the TC/HDL and LDL/HDL indexes, but, using +2 z-scores as the cutoff, there were associations with low HDL and higher HOMA-IR. WC/H indicator (0.5 cutoff) was not associated with any of the outcomes, but, using +2 z-scores, an association was found with HOMA-IR. Z-scores of WC, WC/H and BMI showed positive correlation with HOMA-IR, TC/HDL and HOMA-IR, respectively. Negative correlations were found between WC and WC/H z-scores with HDL. WC and WC/H z-score were related to changes in HDL and HOMA-IR. Conclusions: there seems to be an advantage in using WC alone as a possible predictor of dyslipidemia and insulin resistance in children and adolescents. It is not possible to state that WC, WC/H or BMI measurements differ in their abilities to identify Brazilian children and adolescents with risk factors for cardiovascular diseases. (AU)

RESUMO:Objetivo: avaliar a relação entre indicadores antropométricos e marcadores laboratoriais de risco cardiovascular em crianças e adolescentes com sobrepeso / obesidade, a fim de verificar se algum indicador antropométrico tem melhor potencial para uso no rastreamento de risco cardiovascular na população. Método: estudo transversal retrospectivo com 237 indivíduos com idades entre 7 e 18 anos. Índice de massa corporal (IMC), circunferência da cintura (CC), índice de circunferência da cintura / altura (CC / H), glicose, HOMA-IR, colesterol total (CT), LDL, HDL, triglicerídeos e índices CT/HDL e LDL/HDL foram obtidos. As associações entre marcadores antropométricos e laboratoriais foram testadas em tabelas de contingência por meio do teste do qui-quadrado. As correlações foram testadas pela correlação de Spearman. Resultados: CC mais elevado (pontos de corte de Freedman) foi associado a níveis mais baixos de HDL e maior pontuação nos índices TC/HDL e LDL/HDL, mas, usando +2 escores z como ponto de corte, houve associações com HDL baixo e HOMA-IR mais alto. O indicador CC/H (0,5 ponto de corte) não foi associado a nenhum dos desfechos, mas, usando +2 escores z, foi encontrada associação com o HOMA-IR. Os escores Z de CC, CC/E e IMC mostraram correlação positiva com HOMA-IR, TC/HDL e HOMA-IR, respectivamente. Correlações negativas foram encontradas entre CC e escores z de CC/H com HDL. CC e escore z de CC/H foram relacionados a mudanças em HDL e HOMA-IR. Conclusões: parece haver vantagem em usar a CC isoladamente como possível preditor de dislipidemia e resistência à insulina em crianças e adolescentes. Não é possível afirmar que as medidas de CC, CC/E ou IMC diferem na capacidade de identificar crianças e adolescentes brasileiros com fatores de risco para doenças cardiovasculares. (AU)

Adiposidad abdominal y resistencia a la insulina al finalizar el primer trimestre de la gestación / Abdominal Adiposity and Insulin Resistance at the End of the First Trimester of Gestation

Introducción: La adiposidad central como factor desencadenante de resistencia a la insulina precoz constituye una amenaza potencial de riesgo metabólico y cardiovascular en el embarazo. Objetivo: Determinar la capacidad discriminante de las grasas abdominales sobre la resistencia a la insulina, diagnosticada por el índice triglicéridos/glucosa-IMC al finalizar el primer trimestre del embarazo. Métodos: Se realizó un estudio observacional analítico de 526 gestantes con embarazo simple y edad gestacional entre 12 y 13 semanas, entre los años 2016 y 2020. Se estudió el test de triglicéridos/glucosa-IMC y las grasas abdominales por ultrasonido. Se utilizaron las curvas ROC (Receiver operating characteristic Curve) para discriminar la resistencia a la insulina al finalizar el primer trimestre de la gestación, cuando aumentan las grasas abdominales. Resultados: La grasa subcutánea fue la que presentó mayor área bajo la curva en la discriminación de la resistencia a la insulina, con un nivel de sensibilidad y especificidad aceptable. Conclusiones: La grasa subcutánea, aunque con bajo valor discriminativo, puede considerarse como augurio de resistencia a la insulina y de diabetes gestacional. Se requiere profundizar en el estudio de las grasas abdominales dado el conocimiento de su impacto en los desórdenes metabólicos en el curso avanzado de la gestación(AU)

Introduction: Central adiposity as a triggering factor for early insulin resistance is a potential threat of metabolic and cardiovascular risk in pregnancy. Objective: To determine the discriminating capacity of abdominal fat over insulin resistance, diagnosed by the triglyceride/glucose-BMI index at the end of the first trimester of pregnancy. Methods: An analytical and observational study was carried out with 526 pregnant women of singleton pregnancy and gestational age between twelve and thirteen weeks, between 2016 and 2020. The triglyceride/glucose-BMI test was studied, together with abdominal fats by ultrasound. ROC (receiver operating characteristic) curves were used to discriminate insulin resistance at the end of the first trimester of gestation, when abdominal fats increase. Results: Subcutaneous fat presented the highest area under the curve in the discrimination of insulin resistance, with an acceptable level of sensitivity and specificity. Conclusions: Subcutaneous fat, although with low discriminative value, can be considered as a harbinger of insulin resistance and gestational diabetes. Further study of abdominal fat is required, given the knowledge of its impact on metabolic disorders in late gestation(AU)

Association between frequency of physical education classes and heart rate variability in adolescents boys: a cross-sectional study / Associação entre frequência de aulas de educação física e variabilidade de frequência cardíaca em meninos adolescentes: um estudo transversal

ABSTRACT Physical inactivity is associated with low heart rate variability (HRV) in adolescents. However, whether the number of physical education (PE) classes impact HRV remains unclear. This cross-sectional study verified the association between the frequency of PE classes and HRV parameters in male adolescents. This study included 1152 boys (16.6 ± 1.2 years). The quantity of PE classes was assessed though questionnaire and the adolescents were stratified accordingly (no PE class; one PE class/wk; ≥2 PE classes/wk). Time- (SDNN, RMSSD, PNN50) and frequency-domains (LF, HF, sympathovagal balance) of HRV were obtained. Generalized Linear Models were used for comparing the HRV parameters according to the quantity of PE classes, adjusting for confounders. There was no difference in HRV measures of time: (SDNN, p = 0.77; RMSSD, p=0.72; PNN50, p=0.83) and frequency (LF, p=0.61; HF, p=0.61; sympathovagal balance, p=0.60) between the different frequencies of PE classes. The frequency of PE classes in not associated with HRV parameters of male adolescents.

RESUMO A inatividade física está associada à baixa variabilidade da frequência cardíaca (VFC) em adolescentes. Entretanto, não está claro se o número de aulas de Educação Física (EF) causa impacto na VFC. Este estudo transversal verificou a associação entre a frequência das aulas de EF com parâmetros de VFC em adolescentes do sexo masculino. Foram incluídos 1.152 meninos (16,6 ± 1,2 anos). A quantidade de aulas de EF foi avaliada através de questionário e os adolescentes foram estratificados de acordo (nenhuma aula de EF; uma aula de EF / sem; ≥2 aulas de EF / sem). Os domínios do tempo (SDNN, RMSSD, PNN50) e da frequência (LF, HF, balanço simpático-vagal) da VFC foram obtidos. Modelos Lineares Generalizados foram usados ​​para comparar os parâmetros da VFC de acordo com a quantidade de aulas de EF, ajustando para fatores de confusão. Não houve diferença nas medidas de VFC de tempo: (SDNN, p = 0,77; RMSSD, p = 0,72; PNN50, p = 0,83) e frequência (LF, p = 0,61; HF, p = 0,61; balanço simpatovagal, p = 0,60) entre as diferentes frequências das aulas de EF. A frequência das aulas de EF não está associada aos parâmetros de VFC de adolescentes do sexo masculino.

Consumo de bebidas alcoólicas e obesidade abdominal: resultados da linha de base do ELSA-Brasil / Consumption of alcoholic beverages and abdominal obesity: cross-sectional analysis of ELSA-Brasil

Resumo Objetivou-se analisar a associação entre consumo de bebidas alcoólicas e adiposidade abdominal em adultos. Estudo transversal realizado com dados da linha de base do ELSA-Brasil (2008-2010). A amostra foi constituída por 15.065 servidores públicos de seis instituições de ensino e pesquisa (35 a 74 anos, ambos os sexos). Para identificar adiposidade central por meio das medidas de circunferência da cintura (CC) e relação cintura/quadril (RCQ), utilizou-se os pontos de corte preconizados pela Organização Mundial da Saúde. Para as análises estatísticas foi utilizado o teste qui-quadrado e modelos de regressão de Poisson ajustados por variáveis potencialmente confundidoras. Cerca de 40% da amostra apresentava CC e RCQ elevadas. A probabilidade de apresentar CC elevada foi 5% e 3% maior no grupo mais exposto de consumo de cerveja em homens e mulheres quando comparado ao grupo de referência [RP = 1,05 (IC 95% 1,02-1,08) e RP = 1,03 (IC 95% 1,00-1,07)]. Também foi encontrada maior probabilidade de apresentar RCQ elevada entre os maiores consumidores de cerveja [RP = 1,03 (IC 95% 1,00-1,07) em homens e RP=1,10 (IC 95% 1,04-1,15) em mulheres]. Maior número de doses/semana de bebida alcoólica aumentou a probabilidade de ocorrência de CC e RCQ elevadas, sendo mais importante a contribuição da cerveja.

Abstract The objective was to analyze the association between alcohol consumption and abdominal adiposity in adults. Cross-sectional study conducted at baseline data from ELSA-Brasil (2008- 2010). The sample consisted of 15,065 civil servants from six education and research institutions (35 to 74 years old, both sexes). To identify central adiposity by measuring waist circumference (WC) and waist-to-hip ratio (WHR), the cutoff points recommended by the World Health Organization were used. Poisson regression models adjusted for potentially confounding variables were tested. About 40% of the sample had elevated WC and WHR. The probability of having elevated WC was 5% and 3% higher in the most exposed group of beer consumption in men and women when compared to the reference group [PR= 1.05 (95% CI 1.02-1.08) and P R= 1.03 (95% CI 1.00-1.07)]. A higher probability of having a high WHR was also found among the highest beer consumers [PR = 1.03 (95% CI 1.00-1.07) in men and PR = 1.10 (95% CI 1.04-1.15) in women]. A greater number of doses/week of alcoholic drink increased the probability of occurrence of high WC and WHR, with the beer contribution being more important.

Prevalence of and risk factors for dynapenic abdominal obesity in community-dwelling older adults: a cross-sectional study / Prevalência e fatores de risco para obesidade abdominal dinapênica em idosos residentes na comunidade: um estudo transversal

Abstract This article aims to identify the prevalence of and factors associated with dynapenic abdominal obesity (DAO) in older adults in a city in the northern region of Brazil. A cross-sectional study was conducted with 382 community-dwelling older adults in Macapa, Amapa, Brazil. Socioeconomic, clinical, and health information were collected using a structured form. DAO was defined as a combination of dynapenia (handgrip strength of < 26 kgf for men and < 16 kgf for women) and abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). Descriptive and inferential analyses were performed using chi-squared tests, Student's t-tests, and a Poisson regression. The prevalence of DAO was 10.73%. In the preliminary bivariate analysis, the variables of age range, marital status, number of diseases, functional disability for basic and instrumental activities of daily living, gait speed, and level of physical activity met the established criterion. The final model indicated that only gait speed was a predictor of DAO in older adults. DAO affects nearly 11% of community-dwelling older adults from northern Brazil; gait speed was a predictor of DAO and could be a useful tool for managing and monitoring this population's health.

Resumo O objetivo deste artigo é identificar a prevalência e os fatores associados à obesidade abdominal dinapênica (OAD) em idosos de uma cidade da região Norte do Brasil. Estudo transversal realizado com 382 idosos comunitários residentes em Macapá, Amapá, Brasil. As informações socioeconômicas, clínicas e de saúde foram coletadas por meio de um formulário estruturado. A OAD foi definida pela combinação de dinapenia (força de preensão manual < 26 kgf para homens e < 16 kgf para mulheres) e obesidade abdominal (circunferência abdominal > 102 cm para homens e > 88 cm para mulheres). As análises descritivas e inferenciais foram realizadas utilizando os testes qui-quadrado, t de Student e regressão de Poisson. A prevalência de OAD foi de 10,73%. Na análise bivariada preliminar, as variáveis faixa etária, estado conjugal, número de doenças, incapacidade funcional para atividades básicas e instrumentais de vida diária, velocidade da marcha e nível de atividade física atenderam ao critério estabelecido. O modelo final indicou que apenas a velocidade da marcha foi um preditor para a OAD em idosos. A OAD afeta quase 11% dos idosos residentes nessa comunidade do Norte do Brasil; e a velocidade de marcha é um preditor que pode ser uma ferramenta útil para gerenciar e monitorar a saúde desta população.

The prevalence and associated factors of metabolic syndrome among Tibetan pastoralists in transition from nomadic to settled urban environment / 中华流行病学杂志

Objective: To study the prevalence and associated factors of metabolic syndrome (MS) among Tibetan pastoralists in transition from high altitude nomadic to settled urbanized environment, especially dietary factors. Methods: The community-based cross-sectional study included 920 Tibetan adults (men 419, women 501). Data were collected using questionnaires, anthropometric measurements, and biomarker tests. Questionnaires included socio-economic, lifestyle characteristics and food consumption. Principal component analysis was used to identify dietary patterns. The risk factors of MS and its components were analyzed by logistic regression model. Results: The prevalence rates of MS and its components were 32.8% (MS), 83.7% (decreased HDL-C), 62.1% (central obesity), 36.7% (elevated blood pressure), 11.8% (elevated TG), and 7.9% (elevated blood glucose), respectively. The prevalence of overweight was 31.2%, obesity 30.3%. Multivariate analysis showed smoking was associated factor for both of decreased HDL-C (OR=1.239, 95%CI: 1.025-1.496) and elevated TG (OR=1.277, 95%CI: 1.038-1.571). Alcohol drinking appeared as associated factor of elevated TG (OR=1.426, 95%CI: 1.055-1.927). However, physical activity showed as a protective factor for central obesity, decreased HDL-C, and elevated TG. With the increase of age, the adherence to the urban and western dietary patterns decreased, and that to the pastoral dietary pattern increased. By quintiles of dietary pattern scores, the urban dietary pattern was significantly associated with MS (trend test P=0.016). Conclusions: Tibetan pastoralists had high prevalence of both MS and obesity. Smoking, alcohol drinking, the transition from pastoral dietary pattern to urban dietary pattern and inadequate physical activity served as associated factors for MS and its components.

Influence of visceral lipids obesity on the early postoperative complications after radical gastrectomy / 中华胃肠外科杂志

Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm2 was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm2, n=96) group and low VFA (VFA-L, VFA<100 cm2, n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ2 test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ2=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ2=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm2 is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.

Relações entre a Redução de Estrogênio, Obesidade e Insuficiência Cardíaca com Fração de Ejeção Preservada / Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction

Resumo A prevalência de obesidade e insuficiência cardíaca com fração de ejeção preservada (ICFEP) aumenta significativamente em mulheres na pós-menopausa. Embora a obesidade seja um fator de risco para disfunção diastólica do ventrículo esquerdo (DDFVE), o mecanismo que liga a interrupção da produção de hormônios ovarianos, especialmente o estrogênio, ao desenvolvimento da obesidade, DDFVE, e ICFEP em mulheres em processo de envelhecimento não é claro. Estudos clínicos e epidemiológicos demonstram que mulheres na pós-menopausa com obesidade abdominal (definida pela circunferência de cintura) têm risco maior de desenvolver a ICFEP do que homens ou mulheres sem obesidade abdominal. Este estudo analisa dados clínicos que corroboram a existência de uma ligação de mecanismo entre a perda de estrogênio mais obesidade e o remodelamento ventricular esquerdo com ICFEP. Ele também discute os possíveis mecanismos celulares e moleculares para a proteção mediada por estrogênio contra tipos de células, depósitos de tecidos, função e metabolismo de adipócitos negativos que podem contribuir para a DDFVE e a ICFEP.

Abstract The prevalence of obesity and heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women. Although obesity is a risk factor for left ventricular diastolic dysfunction (LVDD), the mechanisms that link the cessation of ovarian hormone production, and particularly estrogens, to the development of obesity, LVDD, and HFpEF in aging females are unclear. Clinical, and epidemiologic studies show that postmenopausal women with abdominal obesity (defined by waist circumference) are at greater risk for developing HFpEF than men or women without abdominal obesity. The study presents a review of clinical data that support a mechanistic link between estrogen loss plus obesity and left ventricular remodeling with LVDD. It also seeks to discuss potential cell and molecular mechanisms for estrogen-mediated protection against adverse adipocyte cell types, tissue depots, function, and metabolism that may contribute to LVDD and HFpEF.

Adolescentes rurais: comportamento de risco para excesso de peso e aumento da circunferência da cintura / Rural adolescents: risky behavior for overweight and increased waist circunference / Adolescentes rurales: comportamiento de riesgo para el sobrepeso y aumento de la circunferencia de la cintura

Este estudo tem como objetivo investigar os fatores sociodemográficos, econômicos e comportamentais associados ao excesso de peso e aumento da circunferência da cintura em adolescentes cursando o ensino médio em comunidades rurais. Trata-se de estudo epidemiológico, transversal e observacional. As informações foram coletadas por meio de versão adaptada do questionário da Pesquisa Nacional de Saúde do Escolar, proposto pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Por meio da análise exploratória de dados e análise de regressão logística múltipla, foi possível estimar as razões de chances brutas e ajustadas e seus respectivos intervalos de confiança de 95%. O excesso de peso corporal mostrou associações significativas com o sexo masculino (p = 0,042), faixa etária (p = <0,003), baixa escolaridade materna (p = 0,018) e aumento da circunferência da cintura (p = <0.001). Já a elevação da circunferência da cintura (CC) mostrou-se também associada ao sexo masculino (p = 0,033), à baixa escolaridade materna (p = 0,016) e à quantidade de banheiros com chuveiro por domicílio (p = 0,025). Ser do sexo masculino mostrou-se como fator de proteção para o excesso de peso e obesidade abdominal, e as piores condições socioeconômicas mostraram-se associadas ao aumento de risco cardiovascular nessa população.

This epidemiological, cross-sectional and observational study investigates the sociodemographic, economic, and behavioral factors associated with overweight and increased waist circumference in high schoolers from rural communities. Data were collected by an adapted version of the National School Health Survey questionnaire, proposed by the Brazilian Institute of Geography and Statistics (IBGE). Exploratory data analysis and multiple logistic regression analysis estimated the gross and adjusted odds ratios, and their respective 95% confidence intervals. Overweight showed significant association with male gender (p = 0.042), age group (p = <0.003), low maternal schooling (p = 0.018) and increased waist circumference (p = < 0.001). In turn, increased waist circumference (WC) was associated with male gender (p = 0.033), low maternal schooling (p = 0.016), and the number of bathrooms with treated water per household (p = 0.025). Being male was shown to be a protective factor against overweight and abdominal obesity, whereas poor socioeconomic conditions were associated with increased cardiovascular risk in this population.

Este estudio tiene como objetivo investigar los factores sociodemográficos, económicos y de comportamiento asociados con el sobrepeso y el aumento de la circunferencia de la cintura en adolescentes que asisten a la escuela secundaria en comunidades rurales. Se trata de un estudio epidemiológico, transversal y observacional. La información fue recabada de una versión adaptada del cuestionario de la Encuesta Nacional de Salud Escolar, propuesto por el Instituto Brasileño de Geografía y Estadística (IBGE). Se realizaron un análisis de datos exploratorios y análisis de regresión logística múltiple, lo que permitió estimar los odds ratios brutos y ajustados, y sus respectivos intervalos de confianza del 95%. El sobrepeso mostró asociaciones significativas con los hombres (p = 0,042), grupo de edad (p = <0,003), baja educación materna (p = 0,018) y aumento de la circunferencia de la cintura (p = <0,001). El aumento de la circunferencia de la cintura (CC) también se asoció con el género masculino (p = 0,033), la baja escolaridad materna (p = 0,016) y el número de baños con ducha por hogar (p = 0,025). Ser hombre fue un factor protector contra el sobrepeso y la obesidad abdominal, y las peores condiciones socioeconómicas se asociaron con un mayor riesgo cardiovascular en esta población.

O Efeito Direto do Índice de Massa Corporal nos Resultados Cardiovasculares entre Participantes sem Obesidade Central pela Estimativa por Máxima Verossimilhança Direcionada / The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. Resultados: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. Conclusão: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886)

Background: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. Objective: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. Methods: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. Results: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. Conclusion: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886)

Desempenho Individual e Combinado de Indicadores de Obesidade Geral e Central para Estimar Risco Coronariano em Participantes do ELSA-Brasil / Individual and Combined Performance of Indicators of Overall and Central Obesity to Estimate Coronary Risk in ELSA-Brasil Participants

Resumo Fundamento: Indicadores antropométricos são utilizados na prática clínica e em estudos epidemiológicos para rastreamento de fatores de risco à saúde. Objetivo: Avaliar o poder discriminatório individual do Índice de Adiposidade Corporal (IAC), do Índice de Massa Corporal (IMC), da Circunferência da Cintura (CC) e da Razão Cintura-Quadril (RCQ) para identificar risco coronariano e investigar se a combinação de indicadores antropométricos de obesidade geral e central melhora a capacidade preditiva em adultos. Métodos: Avaliou-se 15 092 participantes (54,4% mulheres) com idades entre 35-74 anos na linha de base do ELSA-Brasil. Indivíduos em risco coronariano foram identificados pelo Escore de Risco de Framingham, e divididos em risco muito alto (RMA20%) e risco alto (RA10%). Medidas de acurácia diagnóstica e áreas sob curvas ROC (AUC) foram analisadas. Associações foram testadas por regressão de poisson com variância robusta, conforme sexo e idade. Foi adotada significância estatística de 5%. Resultados: A RCQ apresentou melhor poder discriminatório para RMA20% em todos os grupos, com maior capacidade preditiva nas mulheres (AUC: 0,802; IC95%: 0,748-0,856 vs 0,657; IC95%: 0,630-0,683 nas faixas etárias 35-59 anos e AUC: 0,668; IC95%: 0,621-0,715 vs 0,611; IC95%: 0,587-0,635 nas faixas etárias 60-74 anos). As combinações IAC+RCQ e IMC+RCQ apresentaram melhor poder preditivo em homens e mulheres, respectivamente. Combinações entre indicadores de obesidade geral e central estiveram mais fortemente associadas com RMA20% e RCA10% em todos os estratos. Conclusões: Indicadores combinados tiveram melhor capacidade preditiva do que um indicador isoladamente, sendo IAC+RCQ e IMC+RCQ melhores estimadores de risco coronariano em homens e mulheres, respectivamente. RCQ teve melhor desempenho individual.

Abstract Background: Anthropometric indicators have been used in clinical practice and epidemiological studies for screening of health risk factors. Objectives: To evaluate the individual discriminatory power of body adiposity index (BAI), body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) to identify individuals at risk for coronary heart disease and to evaluate whether combinations of anthropometric indicators of overall obesity with indicators of central obesity improve predictive ability in adults. Methods: A total of 15,092 participants (54.4% women) aged 35-74years were assessed at baseline of the ELSA-Brasil study. Individuals at risk for coronary heart disease were identified using the Framingham risk score and divided into very-high risk (VHR 20%) and high risk (HR10%). Measures of diagnostic accuracy and area under the ROC curves (AUC) were analyzed. Associations were tested using Poisson regression analysis with robust variance, according to age and sex. Statistical significance was set at 5%. Results: WHR showed the highest discriminatory power for VHR20% in all groups, with higher predictive ability in women (AUC: 0.802; 95%CI: 0.748-0.856 vs 0.657; 95%CI: 0.630-0.683 in the age range of 35-59 years, and AUC: 0.668; 95%CI: 0.621-0.715 vs 0.611; 95%CI: 0.587-0.635 in the age range of 60-74 years). BAI + WHR and BMI + WHR had the highest predictive power in men and women, respectively. Combinations of indicators of overall obesity with indicators of central obesity were more strongly associated with VHR20% and HR10% in all subgroups. Conclusion: Combined indicators had greater predictive ability than indicators taken individually. BAI+ WHR and BMI + WHR were the best estimators of coronary risk in men and women, respectively, and WHR had the best individual performance.

Prevalencia del síndrome metabólico en adolescentes de tres institutos de educación diversificada del Municipio Iribarren, Barquisimeto, Estado Lara, Venezuela / Prevalence of metabolic syndrome in adolescents from three institutes of diversified education in Iribarren Municipality, Barquisimeto, Lara State, Venezuela

INTRODUCCIÓN: la obesidad infantil es un importante problema de salud pública, por su prevalencia y consecuencias sobre las expectativas y la calidad de vida. En población infantil y adolescente, no hay consenso para diagnosticar el síndrome metabólico, esto explica las diferentes prevalencias reportadas. OBJETIVO: Determinar la prevalencia del síndrome metabólico en estudiantes de tres instituciones de educación diversificada del Municipio Iribarren Barquisimeto Estado Lara mediante los criterios establecidos por Adult Treatment Panel III. MATERIAL Y MÉTODO: se realizó una investigación transversal, descriptiva, donde se evaluó las medidas antropométricas, los parámetros clínicos y paraclínicos que se incluyen en los criterios establecidos para el diagnóstico de síndrome metabólico. La muestra estuvo conformada por 108 adolescentes pertenecientes a la U.E. Colegio "Inmaculada Concepción", U.E. "Rafael Villavicencio" y "Escuela Técnica Industrial Lara". Los resultados obtenidos fueron analizados mediante frecuencias absolutas y porcentajes. RESULTADOS: Se encontró que 4,6% de adolescentes presentó 3 o más criterios establecidos para el diagnóstico de síndrome metabólico. La dislipidemia (27,78%) y la hipertensión (19,4%) fueron los factores más frecuentes, seguidos por la obesidad abdominal. CONCLUSIÓN: la prevalencia de síndrome metabólico en adolescentes fue de 4,6% lo que refleja la importancia de identificar los factores de riesgo en edades tempranas para promover cambios de estilos de vida más saludable con el fin de prevenir enfermedades cardiometabólicas en la edad adulta.

INTRODUCTION: childhood obesity is an important public health problem, due to its prevalence and consequences on expectations and quality of life. In children and adolescents, there is no consensus to diagnose metabolic syndrome, this explains the different reported prevalences. OBJECTIVE: To determine the prevalence of metabolic syndrome in students from three diversified educational institutions in the Municipality of Iribarren Barquisimeto, Lara State, using the criteria established by Adult Treatment Panel III. METHODS: a cross-sectional, descriptive investigation was carried out, where the anthropometric measures, the clinical and paraclinical parameters that are included in the criteria established for the diagnosis of metabolic syndrome were evaluated. The sample consisted of 108 adolescents belonging to the U.E. Colegio "Inmaculada Concepción", U.E. "Rafael Villavicencio" and "Lara Industrial Technical School". The results obtained were analyzed using absolute frequencies and percentages. RESULTS: It was found that 4.6% of adolescents presented 3 or more established criteria for the diagnosis of metabolic syndrome. Dyslipidemia (27.78%) and hypertension (19.4%) were the most frequent factors, followed by abdominal obesity. CONCLUSION: the prevalence of metabolic syndrome in adolescents was 4.6%, which reflects the importance of identifying risk factors at an early age to promote healthier lifestyle changes in order to prevent cardiometabolic diseases in adulthood.