Carolina Cunha de Oliveira

Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly.

Background Visceral obesity is associated with higher occurrence of cardiovascular events. There are few studies about the accuracy of anthropometric clinical indicators, using Computed Tomography (CT) as the gold standard. We aimed to determine the accuracy of anthropometric clinical indicators for discrimination of visceral obesity. Methods Cross-sectional study with 191 adults and elderly of both sexes. Variables: area of visceral adipose tissue (VAT) identified by CT, Waist-to-Height Ratio (WHtR), Conicity index (C index), Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI). ROC analyzes. Results There were a strong correlation between adiposity indicators and VAT area. Higher accuracy of C index and WHtR (AUC≥0.81) than the LAP and the VAI was observed. The higher AUC of LAP and VAI were observed among elderly with areas of 0.88 (CI: 0.766–0.944) and 0.83 (CI: 0.705–0.955) in men and 0.80 (CI: 0.672–0.930) and 0.71 (CI: 0.566–0.856) in women, respectively. The cutoffs of C index were 1.30 in elderly, in both sexes, with sensitivity ≥92%, the LAP ranged from 26.4 to 37.4 in men and from 40.6 to 44.0 in women and the VAI was 1.24 to 1.45 (sens≥76.9%) in men and 1.46 to 1.84 in women. Conclusion Both the anthropometric indicators, C Index and WHtR, as well as LAP and VAI had high accuracy in visceral obesity discrimination. So, they are effective in cardiovascular risk assessment and in the follow-up for individual and collective clinical practice.

Bioimpedância elétrica e sua aplicação em avaliação nutricional

A busca por metodos de estimativa da composicao corporal e uma preocupacao constante da comunidadecientifica, com vistas a obtencao de um acurado diagnostico do estado nutricional de individuos e populacoes.A bioimpedância eletrica tem sido uma alternativa atraente na avaliacao da composicao corporal, pelapossibilidade de se trabalhar com equipamento nao invasivo, portatil, de facil manuseio, boa reprodutibilidadee, portanto, viavel para a pratica clinica e para estudos epidemiologicos. Sua utilizacao, que tem como finalidadedeterminar o fracionamento da composicao corporal, tem sido apontada como uma tecnica capaz de superaralguns desafios encontrados em outros metodos para avaliar o estado nutricional. Entre os componentes dabioimpedância eletrica, o ângulo de fase consiste em uma ferramenta cada vez mais utilizada na praticaclinica, sendo estudado como indicador prognostico e de estado nutricional. Esse ângulo indica alteracoes nacomposicao corporal e na funcao da membrana celular, portanto, no estado de saude de individuos. Dada acarencia de estudos brasileiros sobre determinadas aplicacoes da bioimpedância eletrica, a proposta desteestudo, buscando contribuir com a literatura, e tracar um panorama sobre o emprego dessa tecnica e, ainda,apresentar trabalhos que a comparam com outros metodos de avaliacao nutricional e composicao corporal.

Indicators of Adiposity Predictors of Metabolic Syndrome in the Elderly

Background: Adiposity indicators can be used as predictors of cardiovascular risk in the elderly. However, there are only a very few studies that deal with the accuracy of adiposity indicators as predictors of metabolic syndrome (MS) in the elderly. We evaluated the performance of adiposity indicators of MS prediction in the elderly. Methods: A cross-sectional study with 203 elderly people of both genders. Variables: MS defined by harmonized criteria, waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), lipid accumulation product (LAP), and visceral adiposity index (VAI). Area under the receiver operating characteristic curve (AUC), sensitivity (sens) and specificity (spec). Results: The WC, WHtR, and LAP indicators showed the highest AUC, with values greater than 0.84. For the general population, WHtR and LAP had the highest Youden index values, identifying a point of approximately 0.55 (sens: 85.6%; spec: 80.4%) for WHtR and 32.3 (sens: 81.1%; spec: 75.0%) for LAP. When analyzed by gender, it was observed that the WC and WHtR had the highest Youden index values for prediction of MS in both genders. The CI and VAI showed the lowest discriminatory power for MS. Conclusion: Both the adiposity indicators, WC and WHtR, as well as LAP, had high accuracy in MS discrimination. Therefore, they are effective in MS assessment in the elderly and during follow-up for individual and collective clinical practice.

Discriminatory power of indicators predictors of visceral adiposity evaluated by computed tomography in adults and elderly individuals

INTRODUCTION Identifying anthropometric methods of abdominal adiposity, predictors of excess area of visceral adipose tissue (VAT) allows rapid and low cost evaluation for the risk of cardiovascular diseases in the elderly. OBJECTIVE To evaluate the discriminatory power of anthropometric indicators for detection of excess of the area of VAT. METHODS Cross-sectional study comprising 194 adults and elderly individuals for comparison of both sexes and age groups. Anthropometric variables: waist-to-height Ratio (WHtR), waist-tothigh Ratio (WTR), Abdominal Diameter Index (ADI) and Sagittal Abdominal Diameter Height Index (SAD/Height). The VAT area was identified by computed tomography (CT). Analysis with the ROC curve. RESULTS There was a high correlation between the VAT area and most of the anthropometric indicators (p ≤0.001). Among elderly men, WHtR showed areas under the ROC curve over 0.90 and cutoff of 0.55 (sens: 85.7%; spec: 82.4%, PPV: 99.9%). For older women, the WHtR cutoff was 0.58 (sens: 81.0%; spec: 78.6%). For the SAD/Height, the areas under the ROC curve were ≥0.83 (p ≤0.01), with cutoffs of 0.12 for men and 0.13 for women. CONCLUSION There was a strong discriminatory power of the anthropometric indicators abdominal visceral obesity. The WHtR and SAD/Height showed better performance to predict the VAT area of risk in elderly, without the need of measuring it by computed tomography.

Bioimpedância elétrica e gordura visceral: uma comparação com a tomografia computadorizada em adultos e idosos

OBJECTIVE: To evaluate the association between electrical bioimpedance analysis (BIA) and visceral fat (VF) in adult and elderly patients. SUBJECTS AND METHODS: This was a cross-sectional study, with a sample of 191 subjects (52% women, 49% elderly) stratified by sex, age and body mass. Computerized tomography (VF area) and BIA (percentage of total body fat (%TBF-BIA), phase angle, reactance and resistance) data were generated. Statistical analysis was based on Pearsons Correlation Coefficient, Anova, Pearsons Chi-square, and ROC curves. RESULTS: VF areas > 130 cm2 were more prevalent among the elderly and among men. Adult females showed a stronger correlation between GV and %TBF-BIA. The other groups showed similar results and statistically significant correlations. Correlations between GV and phase angle were weak and not statistically significant. ROC Curves analyzes showed the following %TBF-BIA, which identified excess VF: for male subjects: 21.5% (adults) and 24.25% (elderly); for female subjects: 35.05% (adults) and 38.45% (elderly) with sensitivity of 78.6%, 82.1%, 83.3%, and 66.7%, and specificity of 70.6%, 62.5%, 79.1%, and 69%, respectively. CONCLUSION: BIA was found to have satisfactory sensitivity and specificity to predict VF; however, other devices and other techniques should be investigated to improve VF prediction.

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.O artigo teve como objetivo analisar criticamente estudos que avaliaram a habilidade dos indicadores antropometricos e clinicos enquanto capazes de predizer a SM em idosos. Foi realizado uma pesquisa bibliografica nas bases de dados Medline/PubMed, LILACS e SciELO, alem das referencias de artigos selecionados e contato com autores. Foram analisados 21 artigos envolvendo indicadores antropometricos e clinicos em idosos, atraves de diferentes criterios da SM. Catorze estudos reportam aos indicadores antropometricos, sendo a circunferencia da cintura (CC) e a razao cintura-estatura (RCEst) descritos como os melhores preditores de SM, com area sob a curva ROC (AUC) superior a 0,70 (p < 0,05). A circunferencia do pescoco tambem foi descrita como indicador alternativo, porem com menor poder discriminatorio. Para os indicadores clinicos, o lipid product accumulation (LAP) foi o parâmetro com melhor desempenho em identificar a SM em idosos, com AUC superior 0,85 e eficiencia superior a 70%. Os indicadores CC, RCEst e LAP foram os mais sensiveis na predicacao da SM. Desta forma, o emprego desses parâmetros podem facilitar a identificacao precoce da SM atraves de metodos diagnosticos de facil aplicacao, boa precisao e baixo custo. Alem disso, e importante a determinacao de pontos de corte especificos para idosos, uma ver que a obesidade por si so, parece nao ser forte preditor de SM em idosos.

Blood count parameters as a marker for metabolic syndrome in older adults

Background and aim Blood count parameters are associated with the metabolic syndrome (MS). However, few studies have evaluated the precision of blood count components to identify MS in older adults. We evaluated the accuracy of blood count components as a screening method and a marker of MS in older adults. Methods and results A cross‐sectional study with 203 older adults of both sexes was conducted. The following variables were used: MS as defined by harmonized criteria, hemoglobin, hematocrit, leukocytes and platelets. Area under the receiver operating characteristic (ROC) curve, sensitivity (sens), specificity (spec) and logistic regression were adjusted for age and sex. Leukocyte count showed the highest Youdens index value for MS screening, with an optimal cut‐off point of 7.514 103/mm3 (sens: 66.7%; spec: 72.0%) for men and 5.626 103/mm3 (sens: 73.1%; spec: 42.4%) for women. Older adults with leukocyte count higher than these cut‐off points presented a 2.4 times greater chance of developing MS. Conclusion Leukocyte count can be used as a screening indicator to identify individuals with a higher risk of developing MS. Older adults with high leukocyte count and no associated chronic diseases should receive attention, as they are individuals with a potential risk for MS. HighlightsEvaluation of blood count components of metabolic syndrome prediction in older adultsThe leukocyte count can be used as a screening indicator to identify individuals with a higher risk of metabolic syndrome.Leukocyte count presented a relation with metabolic syndrome components (TG, glycemia and DBP).Early use of indicators in older adults allows a better clinical evaluation.Effective intervention to prevent and treat risks related to metabolic syndrome.