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

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

Diferenças regionais na transição da mortalidade por doenças cardiovasculares no Brasil, 1980 a 2012 / Regional differences in cardiovascular mortality transition in Brazil, 1980 to 2012

Objetivo. Estimar a tendência temporal da mortalidade por doenças cardiovasculares no Brasil no período de 1980 a 2012. Método. Realizamos um estudo ecológico de série temporal das taxas de mortalidade por doenças cardiovasculares no Brasil. Os dados sobre óbitos foram provenientes do Sistema de Informações de Mortalidade e divididos em dois grupos: óbitos por doenças isquêmicas do coração (DIC) e por doenças cerebrovasculares (DCBV). Resultados. No Brasil, houve variação de -34,73% dos coeficientes padronizados de mortalidade para as DIC; aumento de 117,98% no Nordeste e de 10,26% no Centro-Oeste; e redução no Sudeste (-53,08%), Sul (-44,56%) e Norte (-4,39%). As DCBV apresentaram uma variação de -48,05%. A maioria das regiões apresentou redução nas taxas de mortalidade: -61,99% no Sudeste, -55,49% no Sul, -26,91% no Centro-Oeste e -20,78% no Norte. Só o Nordeste apresentou aumento (13,77%). Conclusões. Observamos uma tendência geral de queda dos coeficientes de mortalidade por DIC e DCBV no Brasil de 1980 a 2012, com marcadas variações regionais, sendo que as regiões Sudeste e Sul apresentaram os maiores coeficientes para os dois grupos de doenças e as regiões Norte e Nordeste, os menores. É importante considerar, nos planos de vigilância, as desigualdades no perfil epidemiológico entre as regiões do país.

Objective. To estimate the time trend of cardiovascular mortality from 1980 to 2012. Methods. We performed an ecological time series study of cardiovascular mortality in Brazil. Data regarding deaths were obtained from the Mortality Information System and divided into two groups: deaths from ischemic heart disease (IHD) and deaths from cerebrovascular disorders (CBVD). Results. A -34.73% variation in IHD standardized mortality rates was recorded for Brazil. Concerning specific regions, an increase was observed in the Northeast (117.98%%) and the Midwest (10.26%). IHD mortality rates fell in the Southeast (-53.08%), South (-44.56%) and North (-4.39%). For CBVD, the overall variation was -48.10%. Mortality rates were reduced in most regions: -61.99% in the Southeast, -55.49% in the South, -26.91% in the Midwest, and -20.78% in the North. Only the Northeast recorded an increase in CBVD mortality (13.77%). Conclusions. We observed an overall declining trend for IHD and CBVD mortality in Brazil from 1980 to 2012, with strong regional variation. Mortality rates were highest in the Southeast and South for both groups of disorders, and lowest in the North and Northeast. Surveillance efforts should take into account the regional differences in epidemiological profile.

Proceso de atención de enfermería a un escolar con disminución del oxígeno en sangre por malformación cardíaca aplicando el modelo de Henderson / Nursing process to a school child with decreased blood oxygen by heart malformation using the Henderson model", "_i": "

En la actualidad, el cuidado de enfermería en su práctica diaria se basa en una metodología que le permite desarrollar intervenciones eficientes y de calidad, las cuales se fortalecen con la evidencia generada a través de la realización de estudios de caso. El estudio de caso es un método de investigación cualitativa que involucra el proceso de atención enfermería y las teorías de enfermería. Este artículo expone un estudio de un caso bajo el modelo de Virginia Henderson a un escolar con Tetralogía de Fallot con el objetivo de individualizar los cuidados para lograr la independencia de la persona. Se realizó durante la etapa pre, trans y postquirúrgica de la persona. Una vez obtenidos los datos de las valoraciones, se analizaron y jerarquizaron las necesidades y se aplicó la escala propuesta por Margot Phaneuf, se elaboraron diagnósticos de enfermería y planes de cuidados correspondientes a las principales alteraciones detectadas, para los cuales se buscó la evidencia científica que respaldara algunas de las intervenciones, con la finalidad de brindar mayor sustento a las mismas. Los resultados se enfocaron hacia la recuperación del niño mejorando su calidad de vida y la de su cuidador primario.

At the present time nursing care in their practice is based on a methodology that lets you develop effective interventions and quality which are strengthened on evidence generated through the case studies. The case study is a qualitative research method that involves Nursing Attention Process and nursing theories. This paper describes a case study using Virginia Henderson’s model: A school child with tetralogy of Fallot. The main objective is to individualize cares to achieve personal independence from the primary caretaker. The study was carried out throughout the preoperative, during surgery, and postoperative stages of the person. After obtaining the valuations data were analyzed and nested the needs and applied the scale proposed by Margot Phaneuf. Are developed nursing diagnoses and care plans corresponding to the main alterations detected, for which it research in the scientific evidence to support some interventions, with the purpose of provide greater sustenance to them. The results focus to the child’s recovery by improving their quality of life and his primary caregiver.

Proceso enfermero en lactante mayor con pentalogía de Cantrell con el enfoque de Virginia Henderson / Nursing process in the older infant with pentalogy of Cantrell with the approach of Virginia Henderson", "_i": "

Introducción: La pentalogía de Cantrell es un síndrome caracterizado por disrupción del esternón bajo, defectos cardíacos, diafragmáticos y abdominales, además de onfalocele y ectopia cordis parcial o total. El índice de mortalidad es alto y ocurre en los primeros meses; su principal complicación es la sepsis. Objetivo: Desarrollar un proceso enfermero aplicado a un lactante mayor con pentalogía de Cantrell con el enfoque de Virginia Henderson. Metodología: Estudio de caso clínico en un lactante mayor masculino. Se realizó un estudio descriptivo, prospectivo y longitudinal durante dos meses, basado en el Proceso de Atención de Enfermería, con el enfoque conceptual de Virginia Henderson. Se abordaron las 14 necesidades humanas con un instrumento de valoración validado y se establecieron los diagnósticos de enfermería; las intervenciones están basadas en evidencia científica; se incluyó una evaluación integral y un plan de alta. Resultados: Necesidades más alteradas: oxigenación, seguridad, movilidad y postura. Se encontraron cuatro diagnósticos reales, seis de riesgo y dos de bienestar; se generaron 63 intervenciones con niveles de recomendación científica desde la A hasta IV C. Se evitaron complicaciones al otorgar atención de calidad. Conclusión: El proceso enfermero es fundamental para otorgar cuidados de calidad, aunque no permitió disminuir la dependencia del lactante o la suplencia total de enfermería, no hubo complicaciones y se orientó al familiar. La literatura no reporta cuidados específicos para esta población dada su baja incidencia y alta mortalidad.

Introduction: Cantrell’s pentalogy is a syndrome characterized by defects in the lower part of the sternum, heart, diaphragmatic and abdominal defects. In addition, omphalocele and partial or complete ectopia cordis. The mortality rate is high and takes place in the first months of life; its main complication is septicemia. Objective: To develop a nursing procedure applied to infant higher with Cantrell’s pentalogy with the focus of Virginia Henderson. Methodology: Study of a clinical case of an elder infant. It was a descriptive, prospective and longitudinal study carried out during two months, based on the process of care, nursing, with the conceptual approach of Virginia Henderson. Fourteen human needs with validated assessment tool to establishes nursing diagnosis; the interventions were based on scientific evidence including comprehensive assessment and discharge plan. Results: The most altered aspects were: oxygenation, safety, mobility and posture. We found four real diagnostics, six at risk and two without risk; generated sixty-three interventions with degrees of scientific recommendation from A to IV C. complications were avoided by implementing quality care. Conclusion: The nursing process is fundamental to implementing quality care, even if it was not allowed to reduce the dependence of the infant to a total substitution nursing. There were no complications and the family was oriented. The literature does not report specific care for this population due to its low incidence and mortality.

Determinación del riesgo cardiovascular en la población española / Determining cardiovascular risk in the Spanish population

La medición del riesgo cardiovascular en un mismo grupo de personas del área mediterránea española arroja resultados diferentes según la herramienta que se elija, incluso aunque las herramientas empleadas utilicen los mismos parámetros para determinar el riesgo.

Disfunção precoce no controle autonômico cardiovascular em filhos de hipertensos: papel do exercício físico / Early detection on the autonomic control in offspring of hypertensive parents: role of physical exercise

A Hipertensão arterial (HA) afeta milhões de pessoas em todo o mundo, sendo que no Brasil atinge entre 22 e 44% da população urbana adulta, chegando a 65% nos indivíduos idosos. Ainda que os indivíduos apresentem pressão arterial (PA) dentro da faixa dita de normalidade, é possível notar uma correlação positiva entre os níveis de PA e a incidência de doenças cardiovasculares, renais e mortalidade. Dessa forma, acredita-se que detecções precoces da elevação da PA, e a interação desta condição com outros tantos fatores de risco genéticos pode ser muito importante no futuro para o manejo clínico de um paciente. Diversos estudos familiares vêm demonstrando a agregação familiar da HA, tanto entre irmãos, quanto entre pais e filhos. Trabalhos demonstraram que jovens normotensos, filhos de hipertensos, apresentam aumento da PA, dos níveis séricos de catecolaminas, redução da resposta barorreflexa, e anormalidades metabólicas e endócrinas quando comparados a jovens filhos de normotensos. Baseado nos estudos da literatura pode-se sugerir que pesquisas envolvendo jovens normotensos com história familiar positiva de hipertensão são modelos muito atrativos para detecção de modificações precoces e possíveis marcadores biológicos de HA. Entretanto, até o presente momento, poucos são os estudos sobre anormalidades nas respostas cardiovasculares à situação de estresse e/ou sobrecarga fisiológica, como o exercício físico, em descendentes de hipertensos. Nesta revisão serão abordadas as alterações fisiológicas observadas em indivíduos jovens com história familiar positiva de HA, bem como serão discutidas os possíveis efeitos benéficos do exercício físico nesta população.

The incidence of hypertension is high in Brazil and in the whole world. In Brazil, this disease affects 22-44% of adult urban population, and 65% of older subjects. Despite the subjects have arterial pressure (AP) inside of normality range, is interesting perceive that exist a positive correlation between AP levels and cardiovascular and kidney disease, and mortality incidence. In this way, it is possible that early detections of AP levels increase, and the interactions of this condition with other genetics risk factors can be very important in the future to clinical management of this patient. Studies were demonstrating familiar aggregation of hypertension, between brothers as well as between father and sons. Other studies demonstrated that normotensive young offspring of hypertensive parents present AP and plasmatic levels of catecholamine increase, and baroreflex responses reduction, as well as endocrine and metabolic abnormalities as compared to offspring of normotensive parents. Based in these studies it is clearly that research involving normotensive young subjects with positive family history of hypertension are very attractive models to detection of early modifications and possible biological markers of hypertension. However, until the present time, there are few studies about cardiovascular responses abnormalities to stress tests and/or to physiological situation, as physical exercise, in offspring of hypertensive parents. In this article physiological we reviewed alterations observed in young subjects with positive family history of hypertension and the possible benefits of physical exercise in this population are discussed.

La obesidad abdominal es un importante factor de riesgo cardiovascular: [revisió] / Abdominal obesity is a risk factor in cardiovascular disease: [review]

La obesidad es una enfermedad de incidencia y prevalencia creciente en todo el mundo, que se define por el peso corporal y un índice de masa corporal (IMC) superior a 25 kg/m2 (cociente entre el peso y el cuadrado de la altura). En los últimos años se ha jerarquizado la distribución de la grasa corporal como el elemento más vinculado al riesgo cardiovascular, tomándose como parámetro para definir la obesidad abdominal el índice cintura-cadera superior a 0.90 en el hombre y 0.80 en la mujer. Actualmente, se considera la obesidad, especialmente la abdominal, como un importante factor de riesgo cardiovascular cuantificable y modificable, y el tejido adiposo como un órgano endócrino que a través de la liberación de citoquinas (adipocitoquinas) y hormonas regula el equilibrio energético y calórico, influyendo en el riesgo cardiovascular metabólico.

Efectos de la resistencia a la insulina sobre el riesgo cardiovascular en pacientes hemodializados / Effects of insulin resistance on cardiovascular risk factors in hemodialysis patients

La enfermedad renal crónica (ERC) presenta variable resistencia a la insulina (RI) que impactaría sobre el riesgo cardiovascular. El objetivo fue comparar marcadores lipídicos y de inflamación en pacientes con ERC, con y sin RI estimada por HOMA-IR, con el fin de evaluar si la resistencia a la insulina acentúa el riesgo cardiovascular. Se estudiaron 50 pacientes hemodializados distribuidos según su índice HOMA-IR: < 2.9; n = 35 y > 3.0; n = 15 y 20 controles sanos. Se midieron los niveles lipídicolipoproteico, de apoproteínas A y B, de colesterol asociado a lipoproteínas de baja densidad (LDL) pequeñas y densas (pyd), actividad de lipasa hepática posheparínica (LH), ácidos grasos libres (FFA) y proteína C-reactiva de alta sensibilidad (PCRas). No hubo diferencias en el perfil lipídico-lipoproteico básico ni en FFA entre los dos grupos de pacientes. En cambio, la ERC con HOMA-IR > 3.0 presentó mayor LH (12.0 ± 1.17 μmol FFA/ml PPH.h) y LDLpyd (42.4% ± 6.2) vs. ERC con HOMA-IR < 2.9: 8.8 ± 0.66 y 27.5 ± 2.8, respectivamente, p < 0.018. La LH fue menor en la ERC con HOMA-IR < 2.9 con respecto a los controles (14.4 ± 1.15) y ambos tipos de ERC mostraron aumento de LDLpyd con respecto a los controles (19.6% ± 1.91), p < 0.04. Los niveles de PCR fueron mayores en ambos grupos de ERC con respecto a los controles, sin diferencias en relación con la RI. En los pacientes con ERC sin RI se confirmó la documentada disminución de LH en hemodiálisis; en cambio, en la ERC con RI, la mayor actividad de la LH favorecería la formación de LDLpyd con mayor capacidad aterogénica. La presencia de RI concomitante a ERC agravaría el riesgo cardiovascular, por la mayor proporción de LDLpyd.

Chronic renal failure (CRF) presents variable degrees of insulin resistance (IR) with impacts on cardiovascular risk.The aim was to compare lipid and inflammation markers in hemodialyzed patients, with and without insulinresistance estimated by HOMA-IR in order to evaluate if insulin resistance enhances cardiovascular risk. Fiftyhemodialysis patients divided into HOMA-IR < 2.9; n = 35 and > 3.0; n = 15 were studied, together with 20 healthy controls (C). Lipid-lipoprotein profile, apoproteins A and B, small dense (sd) LDL, postheparin hepatic lipaseactivity (HL), free fatty acids and reactive «C¼ protein-hs (CRP) were measured. No differences were observed in plasma lipid profile and free fatty acids between both groups of hemodialyzed patients. However, patients withHOMA-IR > 3.0 showed increased HL (12.0 ± 1.17 μmol FFA/ml PPH.h) and sdLDL (42.4% ± 6.2) vs. hemodialyzedpatients with HOMA-IR < 2.9: 8.8 ± 0.66 and 27.5 ± 2.8, respectively, p < 0.018. HL was lower in patients withHOMA-IR < 2.9 than in C (14.4 ± 1.15) and both groups of hemodialyzed patients showed an increase in sdLDLin comparison to C (19.6% ± 1.91), p < 0.04. CRP was higher in both groups of hemodialyzed patients than in C, without differences in IR. In patients without IR, the known reduction of HL in hemodialysis was confirmed. However, HL activity in patients with IR would appear to favor sdLDL formation, with increased atherogenic features. The presence of IR concomitant with chronicrenal failure under hemodialysis would seem to increase cardiovascular risk due to a higher proportion of sdLDL.