Pontos de corte de circunferência da cintura de acordo com o estadiamento puberal para identificar sobrepeso em adolescentes / Cut off values for waist circumference to predict overweight in brazilian adolescents, according to pubertal staging

RESUMO Objetivo: Elaborar pontos de corte de circunferência da cintura de acordo com o estadiamento puberal para identificar sobrepeso em adolescentes. Métodos: Trata-se de um estudo longitudinal, aprovado pelo Comitê de Ética em Pesquisa, com 557 adolescentes, de 10 a 15 anos de idade, selecionados em escolas públicas. Aferiram-se as medidas de circunferência de cintura, braço, pescoço e quadril, percentual de gordura, massa corporal, estatura e pressão arterial. Para determinar a maturação sexual, foi utilizada a autoavaliação da escala de Tanner. Aplicou-se a curva ROC (Receiver Operating Characteristic Curve) para determinar: poder preditivo, sensibilidade, especificidade e os pontos de corte de circunferência de cintura para identificação de sobrepeso. Resultados: Observou-se correlação positiva entre circunferência de cintura e massa corporal, índice de massa corporal (IMC), circunferência do braço e quadril, razão cintura/quadril e pressão arterial em ambos os sexos. Os pontos de corte para circunferência de cintura de acordo com o estadiamento puberal para identificação de sobrepeso que apresentaram maior desempenho na curva ROC foram: 71,65 cm para meninas pré-púberes, 67,90 cm para meninas púberes, 70,25 cm para meninas pós-púberes e 66,45 cm para meninos púberes. Faixa etária, massa corporal, estatura, IMC, porcentagem de gordura, circunferência do braço e do quadril foram considerados fatores preditores da circunferência da cintura alterada. Conclusões: Os pontos de corte de circunferência da cintura de acordo com o estadiamento puberal demonstraram excelente desempenho para a identificação de sobrepeso, podendo ser considerados fidedignos para a população de adolescentes brasileiros, uma vez que utilizar apenas a idade cronológica na adolescência pode subestimar o estado nutricional.

ABSTRACT Objective: To establish waist circumference cut off points according to pubertal staging to identify overweight in adolescents. Methods: Longitudinal study approved by the Ethics Research Committee and conducted with 557 adolescents, aged 10 to 15 years old, selected from public schools. Waist, arm, neck and hip circumferences, body fat percentage, body mass index (BMI), height and blood pressure were measured. Pubertal staging was evaluated by Tanner self assessment scale. The Receiver Operating Characteristic Curve (ROC curve) was used to determine predictive power, sensitivity, specificity and waist circumference cut off points to detect overweight. Results: There was a positive correlation between waist circumference and weight, BMI, upper arm and hip circumferences, waist-to-hip ratio and blood pressure in both sexes. Cut off points for waist circumference according to pubertal stage as related to overweight in adolescents with the best performances in ROC curve were: 71.65 cm for prepubescent girls, 67.90 cm for pubescent girls, 70.25 cm for post pubescent girls, and 66.45 cm for pubescent boys. Age, weight, height, BMI, body fat percentage, arm and hip circumferences were associated to altered waist circumference. Conclusions: The establishment of cut off points for waist circumference according to pubertal staging was proven a good means to identify overweight. These cut off points can be considered reliable for the Brazilian adolescent population, as the isolated use of chronological age in adolescents may underestimate their nutritional status.

Preditores de Síndrome Metabólica em Idosos: Uma Revisão / Predictors of Metabolic Syndrome in the Elderly: A Review

O artigo teve como objetivo analisar criticamente estudos que avaliaram a habilidade dos indicadores antropométricos e clínicos enquanto capazes de predizer a SM em idosos. Foi realizado uma pesquisa bibliográfica nas bases de dados Medline/PubMed, LILACS e SciELO, além das referências de artigos selecionados e contato com autores. Foram analisados 21 artigos envolvendo indicadores antropométricos e clínicos em idosos, através de diferentes critérios da SM. Catorze estudos reportam aos indicadores antropométricos, sendo a circunferência da cintura (CC) e a razão cintura-estatura (RCEst) descritos como os melhores preditores de SM, com área sob a curva ROC (AUC) superior a 0,70 (p < 0,05). A circunferência do pescoço também foi descrita como indicador alternativo, porém com menor poder discriminatório. Para os indicadores clínicos, o lipid product accumulation (LAP) foi o parâmetro com melhor desempenho em identificar a SM em idosos, com AUC superior 0,85 e eficiência superior a 70%. Os indicadores CC, RCEst e LAP foram os mais sensiveis na predicação da SM. Desta forma, o emprego desses parâmetros podem facilitar a identificação precoce da SM através de métodos diagnósticos de fácil aplicação, boa precisão e baixo custo. Além disso, é importante a determinação de pontos de corte específicos para idosos, uma ver que a obesidade por si só, parece não ser forte preditor de SM em idosos

Application of alternative anthropometric measurements to predict metabolic syndrome

OBJECTIVE: The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome. METHODS: We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c. RESULTS: The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome. ...

Assessment of Body Mass Index and Waist Hip Ratio for development of Type II Diabetes in rural area of RRMCH, Bangalore.

Background: Diabetes is a syndrome characterized by chronic hyperglycaemia and relative deficiency of insulin. In urban population its figure are quoted to be high. Now in rural area incidence of diabetes is increasing. Methodology: Study setting: Rural field practice area, Ittamadu. Study population: All adults above 20 yrs of age. Study design: Cross Sectional study. Study duration: Two months. Sampling technique: Purposive sampling. Sample size: 165 subjects. Study variables: Socio‐demographic profile, measurement of height, weight, waist circumference, hip circumference. Results: Out of 165 subjects 33% of the participants are males 23.6% of them are pre‐obese and 11.5% are obese, which was more for females. 9.1% of the male participants have Waist to Hip ratio of >1 while 48.2% of female have Waist to Hip ratio of >0.8. Conclusion: Indian Diabetes Risk Score is an appropriate tool in the Community to identify the risk groups for the development of Type II Diabetes, which were used to identify the risk factors with respect to Body Mass Index and Waist To Hip ratio for the development of Type II Diabetes.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos / Central obesity index and cardiovascular risk factors in polycystic ovary syndrome

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalência em mulheres com síndrome dos ovários policísticos (SOP) e está associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acurácia da circunferência da cintura (CC), da relação cintura-quadril (RCQ), da relação cintura-estatura (RCEST) e do índice de conicidade (índice C), no que se refere à detecção de fatores de risco cardiovascular (FRCV) em mulheres com SOP. MÉTODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnóstico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerídeos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia após teste oral de tolerância à glicose (TOTG) e a pressão arterial (PA) foram avaliados em todas as pacientes, além das variáveis antropométricas. RESULTADOS: A relação cintura-estatura foi o marcador que apresentou correlações positivas significativas com o maior número de FRCV (PA, TG e glicemia após TOTG), destacando-se ainda a correlação negativa com HDL-C. Todos os marcadores antropométricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlação positiva também com TG. No tocante à acurácia para detecção de FRCV, os indicadores antropométricos considerados apresentaram taxas de sensibilidade superiores a 60 por cento, com destaque para a RCEST, que apresentou sensibilidade superior a 70 por cento. CONCLUSÃO: A RCEST demonstrou ser o indicador antropométrico com a melhor acurácia para a predição de FRCV. Nesse sentido, propõe-se a inclusão desse parâmetro de fácil mensuração na avaliação clínica para o rastreamento de mulheres com SOP e FRCV.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS: The present transversal study allocated 102 women (26.5 ± 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60 percent, especially the WHtR, which had a sensibility > 70 percent. CONCLUSION: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Relação de indicadores antropométricos com fatores de risco para doença cardiovascular / Relation between anthropometric indicators and risk factors for cardiovascular disease

FUNDAMENTO: Estudos têm sido realizados para identificar o melhor preditor antropométrico de doenças crônicas em diferentes populações. OBJETIVO: Verificar a relação entre medidas antropométricas e fatores de risco (perfil lipídico e pressão arterial) para doenças cardiovasculares. MÉTODOS: Estudo transversal com 180 homens e 120 mulheres, idade média de 39,6±10,6 anos. Avaliou-se: índice de massa corporal (IMC), circunferência da cintura (CC), percentual de gordura corporal ( por centoGC), relação cintura quadril (RCQ), perfil lipídico, glicemia e pressão arterial. RESULTADOS: IMC, CC e RCQ foram maiores nos homens e por centoGC nas mulheres (p<0,001). A proporção de casos alterados de RCQ e por centoGC em relação a LDL-c e CT foi maior no sexo masculino. Indivíduos normais para CC tiveram alteração para LDL-c, CT e HDL-c. Houve correlação entre IMC e CC (homens: r=0,97 e mulheres: r=0,95; p<0,001). Nos homens a melhor correlação (p<0,001) foi entre CC e RCQ (r=0,82) e nas mulheres por centoGC e CC (r=0,80). Triglicerídeos (TG) teve correlação com RCQ (masculino: r=0,992; feminino: r= 0,95; p<0,001), e com CC (masculino: r=0,82; feminino: r=0,79; p<0,001). Na análise múltipla (Razão de prevalência - RP, Intervalo de Confiança - IC), o IMC esteve associado ao colesterol total (RP=1,9; IC95 por cento 1,01-3,69; p=0,051) no sexo masculino e fracamente associado com TG/HDL-colesterol (RP= 1,8; IC95 por cento 1,01-3,45; p=0,062) no sexo feminino. CONCLUSÃO: O IMC e a RCQ foram os indicadores antropométricos com maior correlação com o perfil lipídico em ambos os sexos. Esses dados suportam a hipótese de que o IMC e a RCQ podem ser considerados como fatores de risco para a doença cardiovascular.

BACKGROUND: Studies have been carried out to identify the best anthropometric predictor of chronic diseases in different populations. OBJECTIVE: To verify the relation between anthropometric measures and risk factors (lipid profile and blood pressure) for cardiovascular diseases. METHODS: Transversal study carried out with 180 males and 120 females, with mean age 39.6±10.6 years old. Body mass index (BMI), waist circumference (WC), body fat percentage ( percentBF), waist-to-hip ratio (WHR), lipid profile, glycemia and blood pressure were the variables assessed. RESULTS: BMI, WC and WHR were higher among males, and percentBF were higher among females (p<0.001). The proportion of altered cases of WHR and percentBF in relation to LDL-cholesterol and total cholesterol (TC) was higher among males. The individuals considered normal for WC presented alteration in the values of LDL-c, TC and HDL-cholesterol. There was a correlation between BMI and WC (males: r=0.97 and females: r=0.95; p<0.001). Among males, the best correlation (p<0.001) was presented between WC and WHR (r=0.82) and among females, percentBF and WC (r=0.80). Triglycerides (TG) presented correlation to WHR (males: r=0.992; females r=0.95; p<0.001), and to WC (males: r=0.82; females r=0.79; p<0.001). In the multiple analysis (Prevalence ratio - PR, Confidence interval - CI), the BMI were associated with total cholesterol (PR=1.9; 95 percentCI 1.01-3.69; p=0.051) among males and slightly associated with TG/HDL-cholesterol (PR= 1.8; IC95 percent 1.01-3.45; p=0.062) among females. CONCLUSION: BMI and WHR were the anthropometric indicators with strongest relation to lipid profile in both sex groups. This data support the hypothesis that BMI and WHR may be considered as risk factors for cardiovascular disease.

Eotaxin and other immunological markers, metabolic and anthropometric factors in relation to circulating adiponectin level in type 2 diabetic patients and individuals with impaired glucose metabolism

Hypoadiponectinemia is associated with insulin resistance and predicts the incidence of type 2 diabetes and coronary artery disease. Chronic subclinical inflammation and activation of innate immunity are involved in the pathogenesis of type 2 diabetes. Since obesity is associated with hypoadiponectinemia and with increased circulating levels of various immunological markers, which are both major risk factors for the development of type 2 diabetes, so the aim of this study was to investigate the association of hypoadiponectinemia and low grade systemic inflammation in type 2 diabetic patients as well as subjects with impaired glucose tolerance. Sixty male age matched subjects were included in the study. They were divided into 3 groups each of twenty as follows: newly diagnosed patients with type 2 diabetes mellitus [group I], patients with impaired glucose tolerance [group II] and healthy subjects with normal glucose tolerance [group Ill] as a control group. Patients and controls were subjected to full history taking, clinical examination stressing on blood pressure, BMI and WHR; laboratory investigations including FPG, PPG, HbA1C, fasting insulin and HOMA-IR index, lipid profile [TG, total cholesterol, HDL-C, LDL-C], serum uric acid, serum adiponectin and some immunological markers including WBC, acute phase reactants [CRP], TN F-alpha and eotaxin. In type 2 diabetic patients, plasma adiponectin levels were strongly negatively correlated with CRP, fasting TG, fasting insulin, HOMA-IR and fasting glucose [P < 0.001] and strongly positively correlated with HDL-cholesterol [P < 0.001]. Inverse correlations were found between adiponectin levels and WHR, postprandial glucose, and TNF-alpha [P < 0.05]. No significant correlation was found between adiponectin level and eotaxin [P > 0.05]. In subjects with IGT, an inverse relation was found between adiponectin and fasting glucose [P < 0.05]. The mean values of immunological markers [eotaxin, TNF-alpha, CRP and WBC] were significantly higher in type 2 diabetics versus control group. Subjects with IGT showed significant lower levels of eotaxin and TNF-alpha than diabetic patients, while they showed significant higher levels of eotaxin, TN F-alpha and CRP than controls [P < 0.05]. The mean value of adiponectin was significantly lower in type 2 diabetic patients than in subjects with IGT and the control group [P < 0.05]. The studied clinical and anthropometric parameters, lipid profile, parameters of glycemic control, fasting insulin and HOMA-IR were significantly higher in group I versus group II and the control group [P < 0.05]. Our results support the hypothesis that hypoadiponectinemia may be associated with low grade inflammation, metabolic abnormalities and dyslipidemia. Therefore, adiponectin may be an important link between inflammation and type 2 diabetes as it was negatively correlated with markers of inflammation in such patients

Study of plasma visfatin level in women with gestational diabetes mellitus during and after pregnancy and its relation to insulin sensitivity

The insulin-mimetic adipocytokine visfatin is highly expressed in visceral fat and whose blood levels correlate with obesity. It lowers blood glucose, improves insulin sensitivity, and recently found to act as an insulin analogue on the insulin receptors. It has been associated with insulin resistance in some studies and regulated by glucose. To evaluate the role of visfatin in GDM, typically associated with increased insulin resistance, we determined visfatin levels in women with GDM and in healthy pregnant controls. Furthermore, visfatin concentrations were investigated after delivery in a subgroup of women with GDM. 30 women with GDM [group I] and 15 age-matched healthy pregnant controls [group II] at 24-28 weeks of gestation were included in the study. All women were subjected to full history taking, complete physical examination and anthropometric measures including BMI and WHR. Venous blood samples for lipid profile, glucose, insulin and visfatin concentrations were taken 1 hour before a standard 75g OGTT and was carried out after overnight fast. Venous blood samples were repeated for glucose, insulin and visfatin 30, 60, 120 minutes after an oral glucose load. Insulin sensitivity was estimated using ISI derived from OGTT. A subgroup of 15 women with GDM [group III] was investigated for all these parameters 2 weeks after delivery. Fasting plasma visfatin concentrations were significantly higher in the gestational diabetes mellitus group during the course of pregnancy [69.04 +/- 18.41 ng/ml] than in healthy pregnant control group [31.22 +/- 24.74 ng/ml] [P<0.05]. The fasting plasma levels of visfatin showed significant drop in GDM women 2 weeks after labour [45.86 +/- 6.89 ng/ml] than during the course of pregnancy [69.04 +/- 18.41 ng/dl] [P<0.05]. The glucose-induced changes in visfatin and insulin calculated by AUC were significantly higher in GDM group during pregnancy than in healthy normal controls. The mean values of the area under the curve for glucose, insulin and visfatin curves showed significant reduction in GDM women 2 weeks after labour [P<0.05]. Significant positive correlations were detected between fasting visfatin and WHR, fasting glucose, as well as fasting insulin in GOM women during pregnancy and 2 weeks after labour. Fasting visfatin levels were negatively and significantly correlated with peripheral insulin sensitivity index in the three studied groups [P<0.05]. The precise significance of our findings indicates that adipocytokine visfatin may play a role in the pathogenesis of gestational diabetes mellitus. However, the study of the regulation of visfatin in GDM merits further considerations and further experiments are needed to clarify its role in such disease

Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute patients with polycystic ovary syndrome

PCOS is a heterogeneous clinical syndrome characterized by a spectrum of symptomatology, pathology and laboratory findings. It is now accepted that polycystic ovary syndrome has important long-term health implications, including metabolic disorders and increased risk factors for cardiovascular disease like insulin resistance, abdominal obesity, dyslipidemia, hypertension and markers of abnormal vascular function. The aim of this work was to study the effect of metformin on the clinical, metabolic and endocrine parameters in hirsute women secondary to polycystic ovary syndrome. The study was conducted on 30 Egyptian hirsute patients suffering from polycystic ovary syndrome. Clinical examination included anthropometric measurements [BMI and WHR] and Ferriman and Gallwey scoring for hirsutism. Fasting serum insulin and fasting blood glucose were measured from which insulin resistance [IR] was assessed by HOMA. The glucose to insulin ratio [GIR] was calculated. Lipid profile was estimated. Serum luteinizing hormone [LH] and follicle stimulating hormone [FSH] were estimated in the early follicular phase. Total serum testosterone and sex hormone-binding globulin [SHBG] were measured. Ultrasonographgy was done on the pelvis for examination of the ovaries. The patients were instructed to do diet and physical exercise. They received metformin 1500 mg/day for 6 successive months. Clinical, metabolic and endocrine parameters were reevaluated after the medication. A significant 31% improvement in the frequency of the menstrual cycle was observed. Hirsutism improved by 19%. BMI was reduced by 8%. WHR decreased by 2.3%. Insulin resistance decreased by 54%. Total serum cholesterol, LDL-cholesterol, serum triglyceride and total cholesterol/H DL-cholesterol ratio showed slight decrease [3%, 6%, 9% and 9%, respectively], while HDL-cholesterol showed a slight increase by 7%. Total serum testosterone decreased by 32% and LH/FSH ratio improved by 28%. SHBG levels increased by 9%. There was a positive correlation between BMI and HOMA-IR, serum cholesterol and serum TG. There was a highly significant positive correlation between BMI and FBG as well as fasting serum insulin and HOMA-IR. On the other hand, there was a significant negative correlation between BMI and GIR. A highly significant positive correlation was found between BMI and total cholesterol and TG. Also, there was a significant positive correlation between BMI and total cholesterol/HDL-cholesterol ratio. Again, BMI showed a highly significant positive correlation with LH/FSH ratio. There was a highly significant positive correlation between WHR and the frequency of the menstrual cycle and fasting serum insulin. There was a significant positive correlation between WHR and HOMA-IR, serum total cholesterol and TG. There was a significant negative correlation between WHR and SHBG. HOMA-IR showed a significant positive correlation with GIR. Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute women with polycystic ovary syndrome. This is associated with improvement in menstrual abnormalities. Metformin has additional benefit in reducing hair growth in Egyptian hirsute young women with polycystic ovary syndrome

Critério de obesidade central em população brasileira: impacto sobre a síndrome metabólica / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome

OBJETIVO: Identificar e propor os melhores pontos de corte da circunferência da cintura (CCp) para diagnosticar obesidade central numa população brasileira; compará-los àqueles recomendados pelo ATPIII (CC-ATPIII) e estimar diferenças nas prevalências da síndrome metabólica (SM) usando os dois critérios. MÉTODOS: Estudo transversal, realizado em subgrupo populacional de 1.439 adultos, Salvador, Brasil. Foram construídas curvas ROC da circunferência da cintura (CC) para identificar diabete melito (DM) e obesidade. Valores >60 por cento da sensibilidade e da especificidade da curva ROC e mais próximos entre si foram usados para definir o CCp. A prevalência da SM foi estimada pelos CCp e pelos CC-ATPIII. RESULTADOS: As 829 mulheres compuseram 57,7 por cento da amostra. Os CCp selecionados foram 84 cm para mulheres e 88 cm para homens. Esses pontos detectaram DM com sensibilidade de 68,7 por cento e 70 por cento, respectivamente, e especificidade de 66,2 por cento e 68,3 por cento. Para obesidade, a sensibilidade e a especificidade foram 79,8 por cento e 77,6 por cento nas mulheres, e 64,3 por cento e 71,6 por cento nos homens. Pelos CC-ATPIII, 88 cm (mulheres) e 102 para (homens), as sensibilidades foram de 53,3 por cento e 26,5 por cento, para diagnosticar DM. Para obesidade, a sensibilidade foi 66,5 por cento (mulheres) e 28,6 por cento (homens). A prevalência da SM, pelos CCp foi 23,7 por cento, IC 95 por cento (21,6 - 25,9) e pelos CC-ATPIII de 19,0 por cento, IC 95 por cento (17,1- 20,9), 1,2 vezes maior pelo CCP. CONCLUSÃO: As CC-ATPIII foram inapropriados e subestimam a prevalência da SM nessa população, particularmente entre os homens. Sugerimos que os pontos de corte da CC de >84 cm nas mulheres e > 88 cm nos homens sejam testados em outras populações brasileiras.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60 percent and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7 percent of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7 percent and 70 percent sensitivity, and a 66.2 percent and 68.3 percent specificity, respectively. For obesity, sensitivity and specificity were 79.8 percent and 77.6 percent in women and 64.3 percent and 71.6 percent in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3 percent and 26.5 percent, respectively, to diagnose DM. For obesity, sensitivity was 66.5 percent (for women) and 28.6 percent (for men). The prevalence of MS using WCp was 23.7 percent, 95 percentCI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0 percent, 95 percentCI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

Razão cintura-estatura como discriminador do risco coronariano de adultos / Waist-to-height ratio as a coronary risk predictor among adults

OBJETIVO: Selecionar, por meio da sensibilidade e especificidade, os melhores pontos de coorte para a razão cintura-estatura (RCEst) como discriminador de risco coronariano elevado (RCE). MÉTODOS: O desenho foi transversal com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4 por cento) do sexo masculino. A análise foi feita por curva Receiver Operating Characteristic (ROC) para identificar a sensibilidade e especificidade do melhor ponto de coorte da RCEst como discriminador de RCE. Verificou-se também a significância estatística da área sob a curva ROC. Foi utilizado intervalo de confiança (IC) a 95 por cento. RESULTADOS: A área total sob a curva ROC entre RCEst e RCE foi de 0,75, IC 95 por cento (0,70-0,81) para homens e 0,69, IC 95 por cento (0,64-0,75) para mulheres. Os melhores pontos de coorte para discriminar o RCE foram para homens e mulheres, respectivamente: 0,52 (sensibilidade de 68 por cento e especificidade de 64 por cento) e 0,53 (sensibilidade de 67 por cento e especificidade de 58 por cento). CONCLUSÃO: Os resultados do estudo sugerem que a RCEst deve ser comparada aos demais indicadores antropométricos de obesidade e pode vir a ser utilizada para discriminar RCE.

Does endothelial dysfunction correlate better with waist-to-hip ratio than with body mass index or waist circumference among obese patients?

OBJETIVO: A obesidade é associada a doenças cardiovasculares e compromete tanto a macro como a microcirculação. As medidas da cintura e do índice de massa corpórea são rotineiramente empregadas para avaliação do risco cardiovascular em obesos, enquanto a relação cintura-quadril é pouco utilizada. O objetivo do trabalho foi determinar que medida antroprométrica, entre as rotineiramente usadas, avalia melhor o risco cardiovascular em obesos. MATERIAL E MÉTODO: Oitenta e quatro voluntários (21 homens/ 66 mulheres), idade entre 20 e 55 anos foram avaliados quanto ao diâmetro da cintura, ao índice de massa corpórea, à relação cintura-quadril e à função endotelial pela técnica de pletismografia com oclusão venosa para medida do fluxo sanguíneo braquial, em resposta a injeção intrabraquial de três doses de acetilcolina (7,5; 15 e 30 mg/min) ou de nitroprussiato de sódio (2; 4 e 8 mg/min), para avaliação da vasodilatação endotélio-dependente e -independente. RESULTADO: Houve correlação inversa entre o índice de massa corpórea, diâmetro da cintura e aumento do fluxo sanguíneo após injeção de acetilcolina e nitroprussiato de sódio, enquanto que a relação cintura-quadril mostrou uma correlação negativa apenas com o aumento no fluxo de sangue no antebraço, após as infusões de acetilcolina. Quando os indivíduos com mais de 40 anos foram retirados da análise, não observamos mais a relação inversa entre índice de massa corpórea e aumento do fluxo sanguíneo após injeção de acetilcolina, enquanto que a cintura e a relação cintura-quadril mantiveram os resultados observados anteriormente.CONCLUSÃO: A relação cintura-quadril é provavelmente um melhor índice para estimar a disfunção endotelial, e consequentemente o risco cardiovascular, que o índice de massa corpórea e esses achados reforçam a importância da aferição da circunferência do quadril como um índice de obesidade e para estimativa do risco cardiovascular.