Capacidade preditiva de diferentes indicadores de adiposidade para marcadores de risco da síndrome metabólica em idosas

• Autor(a) principal: Paula, Hudsara Aparecida de Almeida
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: LOCUS Repositório Institucional da UFV
• Texto Completo: http://locus.ufv.br/handle/123456789/2709
• topic: Envelhecimento; Mulheres idosas; Antropometria; Composição corporal; Síndrome metabólica; Avaliação nutricional; Aging; Elderly women; Anthropometry; Bode composition; Metabolic syndrome; Nutritional evaluation; CNPQ::CIENCIAS DA SAUDE::NUTRICAO

Aging promotes changes in body composition as the increment of fat central distribution, which is related to metabolic and cardiovascular abnormalities, especially in women. Although a variety of body measurements to assess adiposity is suggested, it still remains controversial which is the best indicator in predicting adverse effects due to the accumulation of body fat in older people. In this context, this study had as goals: a)to compare measures of waist circumference and abdominal sagittal diameter, measured at different anatomical points of the abdomen and assess which ones present better predictive power for the risk of metabolic syndrome (MS) and for its isolated components, in elderly; b) to analyze different anthropometric measurements and body composition and discriminatory power of these to the risk of metabolic syndrome in older women; c) to evaluate the occurrence of metabolic syndrome and its components according to different definition proposals. The sample was composed by 113 women (60-83 years), included in the Family Health Program, in the municipality of Viçosa-MG, which were subjected to comparison of different anthropometric measures of body composition and derived indices, blood pressure, lipid profile, fasting plasma glucose and issues related to living habits and health conditions. Analyses were performed using the ROC curve, comparison tests (Student s t test or Mann Whitney), correlation(Pearson, Spearman and partial), chi-square and determination of Kappa coefficient. For processing and data analysis the softwares Excel, SPSS version 15.0, SigmaStat version 2.03, MedCalc version 9.3 and EpiInfo version 6.04 were used. For rejection of the null hypothesis, it was adopted as level of statistical significance p <0.05 for all comparisons. The normality of variables distribution was determined by the Kolmogorov-Smirnov test. The sample consisted of women with a median age of 65 years, most of them eutrophic (47.8%), living with a partner (55.8%), nonsmokers (85.8%), not used to having alcohol beverages (69.0%), not practitioner of regular exercise (70.8%), which never made use of hormone replacement therapy (65.5%) selfdefined as having a good health state (53, 1%). Markers of risk for the metabolic syndrome, such as the abdominal obesity (64.6%), high blood pressure (54.9%), low levels of HDL-c (35.4%) and hypertriglyceridaemia (30.1%) were highlighted. When considering the combination of all factors, the occurrence of metabolic syndrome was 30.9%, according to the definition of National Cholesterol Education Program's Adult Treatment Panel III-NCEP-ATPIII, which is used in the I Brazilian Guidelines for Diagnosis and Treatment of Metabolic Syndrome. The waist circumference (WC) at umbilical level and abdominal sagittal diameter (ASD) at the midpoint between the iliac crests presented the largest areas under the ROC curve (p <0.05) in the identification of MS (0694 ± 0079 and 0747 ± 0076, respectively). Between these two measures, the ASD showed higher predictive power. Body mass index (BMI), percentage of body fat (% BF), body fat (BF / kg) and sum of skin folds (&#931;DOC), which are indicators of overall adiposity, were less related to cardiovascular risk factors in the elderly. For the other indicators, used to characterize the central adiposity, showed significant areas under the ROC curve, with greater emphasis on the sagittal index (SI) (0807 ± 0070 p = 0.0001). In the comparison between different definitions to identify the metabolic syndrome, it was observed a higher and lower frequency in accordance with the proposal of the International Diabetes Federation (IDF) (45.1%) and modified proposal from the SM-definition IDFM (22.1% ), respectively. There was more consonance between the modified definition based on the definition of National Cholesterol Education Program's Adult Treatment Panel III-NCEP-ATPIII, SM-ATPM with NCEPATPIII and SM-IDFM (Kappa: 0.79 and 0.77; p <0.00001). The proposal SM-ATPM showed less discrepancy in the occurrence of MS compared to the definitions and had a greater proximity to the frequency obtained using the NCEP-ATPIII criteria, which has been indicated as better predictor of cardiovascular outcome in the elderly. Before the found results, it is suggested that for assessment of older women with similar characteristics to the sample under study, the umbilical level (UL) and the midpoint between the iliac crests (ASD) should be adopted for anthropometric measurement, the sagittal index should be incorporated as a marker of abdominal adiposity in the identification of cardiovascular risk and the SM-ATPM criterion for identification of metabolic syndrome.