Francisco José Gondim Pitanga

[Anthropometric indexes of obesity as an instrument of screening for high coronary risk in adults in the city of Salvador--Bahia].

OBJECTIVE To compare some anthropometric indexes of obesity and identify among them which one best discriminates the high coronary risk (HCR). METHODS A cross-section study, with sample consisting of 968 adults, between 30 and 74 years old, being 391 (40.4%) men. Many Receiver Operating Characteristic (ROC) curves were obtained and compared to areas under them among the conicity index (C index), body mass index (BMI), waist-hip circumference ratio (WHCR), waist circumference (WC) and HCR. The sensitivity and specificity to identify and compare the best cut-off point among the many indexes of obesity to discriminate the HCR were also identified. A confidence interval of 95% was used. RESULTS The largest area under ROC curve was found between the C index and the HCR, in individuals of male sex, 0.80 (0.74-0.85), significantly differing from the other indexes of obesity. In women, the largest area found under the ROC curve was 0.76 (0.71-0.81), being equal between C, WHCR and HCR indexes. CONCLUSION Those results show that C and WHCR indexes are the best indexes of obesity to discriminate HCR. WC has intermediate discriminatory power and the BMI was the least suitable anthropometric index of obesity to discriminate HCR. Those data suggest that the indexes of abdominal obesity are better to discriminate HCR than the indexes of general obesity.

Prevalência e fatores associados ao sedentarismo no lazer em adultos

This study focused on the prevalence and determinants of leisure-time sedentary lifestyle in the city of Salvador, Bahia, Brazil. A cross-sectional design was used in a sample of 2,292 adults > or = 20 years of age, of whom 1,271 (55.0%) were females. Leisure-time sedentary lifestyle was defined by individuals who, in a live interview, stated that they performed no physical activity during their leisure time in a normal week. Initially, total prevalence of leisure-time sedentary lifestyle in the study population was calculated by variables associated and stratified by sex. Then, the prevalence ratio between leisure-time sedentary lifestyle, age, schooling, and marital status stratified by sex was calculated. A 95% confidence interval was used. Prevalence of leisure-time sedentary lifestyle was 72.5% and was more frequent in women 40-50 years of age and men over 60, individuals with limited schooling, and married, separated, and widowed individuals. The findings are relevant for public health, since they can be used both to identify high levels of leisure-time sedentary lifestyle in the Brazilian population as well as the determinants, thus allowing new intervention strategies to be implemented.

Razão cintura-estatura como discriminador do risco coronariano de adultos

OBJETIVO: Selecionar, por meio da sensibilidade e especificidade, os melhores pontos de coorte para a razao cintura-estatura (RCEst) como discriminador de risco coronariano elevado (RCE). METODOS: O desenho foi transversal com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4%) do sexo masculino. A analise 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 tambem a significância estatistica da area sob a curva ROC. Foi utilizado intervalo de confianca (IC) a 95%. RESULTADOS: A area total sob a curva ROC entre RCEst e RCE foi de 0,75, IC 95% (0,70-0,81) para homens e 0,69, IC 95% (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% e especificidade de 64%) e 0,53 (sensibilidade de 67% e especificidade de 58%). CONCLUSAO: Os resultados do estudo sugerem que a RCEst deve ser comparada aos demais indicadores antropometricos de obesidade e pode vir a ser utilizada para discriminar RCE.

Sensibilidade e especificidade do índice de conicidade como discriminador do risco coronariano de adultos em Salvador, Brasil

Abstract ObjectiveObjective: In the early nineties, the conicityindex was proposed for the assessment ofbody fat distribution based on weight, heightand waist circumference measurements.The goal of this study was to identify the sen-sitivity, specificity and the best cut-off pointfor the conicity index as a predictor of highcoronary risk. MethodsMethods: This is a cross-sec-tional study whose population comprised968 adults between 30-74 years, of which 391(40.4%) were males. Receiver OperatingCharacteristic (ROC) curves were employedto identify the sensitivity and specificity ofthe best cut-off point of the conicity index asa predictor of high coronary risk. The statis-tical significance of the area under the ROCcurve between the conicity index and a highcoronary risk was also verified and a 95%confidence interval (CI) was utilized. Results:The total area under the ROC curve betweenthe conicity index and the coronary risk was0.80, CI 95% (0.74-0.85) in males and 0.75, CI95% (0.70-0.80) in females. The best cut-offpoints to discriminate high coronary risk inmen and women were, respectively, 1.25(73.91% sensitivity and 74.92% specificity)and 1.18 (73.39% sensitivity and 61.15% speci-ficity). Conclusion: Results suggest that theconicity index may be used to identify highcoronary risk, and must be compared toother anthropometric indicators of obesity.Key Words:Key Words: Obesity. Conicity index. Coro-nary risk.OBJETIVO: No inicio da decada de 90, foi proposto o indice de conicidade para avaliacao da distribuicao da gordura corporal, com base nas medidas de peso, estatura e circunferencia da cintura. Este estudo teve como objetivo selecionar atraves da sensibilidade e especificidade os melhores pontos de corte para o indice de conicidade como discriminador de risco coronariano elevado. METODOS: Estudo de corte transversal, com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4%) do sexo masculino. A analise foi feita por curva Receiver Operating Characteristic (ROC) para identificar a sensibilidade e especificidade do melhor ponto de corte do indice de conicidade como discriminador de risco coronariano elevado. Verificou-se tambem a significância estatistica da area sob a curva ROC entre o indice de conicidade e risco coronariano elevado. Foi utilizado intervalo de confianca (IC) a 95%. RESULTADOS: A area total sob a curva ROC entre o indice de conicidade e risco coronariano foi de 0,80, IC 95% (0,74-0,85) para homens e 0,75, IC 95% (0,70-0,80) para mulheres. Os melhores pontos de corte para discriminar o risco coronariano elevado foram, para homens e mulheres, respectivamente, 1,25 (sensibilidade de 73,91% e especificidade de 74,92%) e 1,18 (sensibilidade de 73.39% e especificidade de 61,15%). CONCLUSOES: Os resultados encontrados neste estudo sugerem que o indice de conicidade deve ser comparado aos demais indicadores antropometricos de obesidade e pode vir a ser utilizado para discriminar risco coronariano elevado.

Predicting insulin resistance in children: anthropometric and metabolic indicators

OBJECTIVE To predict insulin resistance in children based on anthropometric and metabolic indicators by analyzing the sensitivity and specificity of different cutoff points. METHODS A cross-sectional study was carried out of 109 children aged 7 to 11 years, 55 of whom were obese, 23 overweight and 31 well-nourished, classified by body mass index (BMI) for age. Measurements were taken to determine BMI, waist and hips circumferences, waist circumference/hip circumference ratio, conicity index and body fat percentage (dual emission X-ray absorptiometry). Fasting blood samples were taken to measure triglyceridemia, glycemia and insulinemia. Insulin resistance was evaluated by the glycemic homeostasis method, taking the 90th percentile as the cutoff point. Receiver operating characteristic curves were analyzed to a 95% confidence interval in order to identify predictors of glycemic homeostasis, and sensitivity and specificity were then calculated. RESULTS After analysis of the area under the receiver operating characteristic curve (confidence interval), indicators that demonstrated the power to predict insulin resistance were, in the following order: insulinemia = 0.99 (0.99-1.00), 18.7 microU mL(-1); body fat percentage = 0.88 (0.81-0.95), 41.3%; BMI = 0.90 (0.83-0.97), 23.69 kg m(2-(1)); waist circumference= 0.88 (0.79-0.96), 78.0 cm; glycemia = 0.71 (0.54-0.88), 88.0 mg dL(-1); triglyceridemia = 0.78 (0.66-0.90), 116.0 mg dL(-1) and conicity index = 0.69 (0.50-0.87), 1.23 for the whole sample; and were: insulinemia = 0.99 (0.98-1.00), 19.54 microU mL(-1); body fat percentage = 0.76 (0.64-0.89), 42.2%; BMI = 0.78 (0.64-0.92), 24.53 kg m(2-(1)); waist circumference = 0.77 (0.61-0.92), 79.0 cm and triglyceridemia = 0.72 (0.56-0.87), 127.0 mg dL(-1), for the obese subgroup. CONCLUSIONS Anthropometric and metabolic indicators appear to offer good predictive power for insulin resistance in children between 7 and 11 years old, employing the cutoff points with the best balance between sensitivity and specificity of the predictive technique.

Associação entre indicadores antropométricos de obesidade e risco coronariano em adultos na cidade de Salvador, Bahia, Brasil

OBJETIVO: O estudo teve como objetivo determinar a associacao entre os diversos indicadores de obesidade e risco coronariano elevado (RCE) em adultos na cidade de Salvador-BA. METODOS: O desenho foi de corte transversal, com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40.4%) homens. A analise constou da regressao logistica, sendo calculadas as Odds Ratio (OR) entre o indice de conicidade (indice C), indice de massa corporal (IMC), razao circunferencia cintura-quadril (RCCQ), circunferencia de cintura (CC) e RCE. Utilizou-se intervalo de confianca a 95%. RESULTADOS: Apos ajustamento por idade, as OR encontradas para homens foram: a) RCCQ: 5.81 (3.00-11.23), b) indice C: 5.52 (2.94-10.36), c) CC: 4.37 (2.31-8.26), d) IMC: 3.04 (1.62-5.73). Para mulheres dos 30 aos 49 anos e 50 aos 74 anos as OR encontradas foram, respectivamente: a) RCCQ: 7.85 (2.15-28.69) e 1.81 (0.98-3.36); b) IMC: 7.28 (1.61-32.97) e 1.09 (0.61-1.96); c) indice C: 6.88 (1.89 -25.11) e 2.89 (1.58-5.27); d) CC: 6.41 (2.09-19.65) e 1.38 (0.77-2.50). CONCLUSOES: Os resultados demonstram que, entre homens e mulheres de 30-49 anos, todos os indicadores de obesidade apresentam forte associacao com RCE, destacando-se entre os homens os indicadores de obesidade central, RCCQ e IC, enquanto que para as mulheres entre 50 e 74 anos o indice C e o melhor indicador.

Anthropometric indicators as predictors of high blood pressure in adolescents

FUNDAMENTO: A hipertensao arterial esta relacionada ao incremento da gordura corporal, a qual pode ser avaliada por meio de indicadores antropometricos. OBJETIVO: Determinar o poder preditivo de indicadores antropometricos e estabelecer seus pontos de corte como discriminadores de pressao arterial elevada. METODOS: Estudo transversal realizado com uma amostra de 660 adolescentes de 14 a 19 anos sendo 51,9% mocas. Foram considerados os seguintes indicadores antropometricos: indice de massa corporal (IMC), circunferencia da cintura, razao cintura/estatura e indice de conicidade. A pressao arterial elevada foi caracterizada por valores acima do percentil 90 para pressao arterial sistolica e/ou pressao arterial diastolica. Para identificacao dos preditores de pressao arterial elevada, foi adotada a analise das curvas Receiver Operating Characteristic (ROC), com intervalo de confianca de 95%. Posteriormente, identificaram-se os pontos de corte com suas respectivas sensibilidades e especificidades. RESULTADOS: As areas sob as curvas ROC com os intervalos de confianca foram: rapazes - circunferencia de cintura = 0,80 (0,72-0,89); IMC = 0,79 (0,68-0,89); razao cintura/estatura = 0,77 (0,66-0,88); indice de conicidade = 0,69 (0,56-0,81) e para as mocas - circunferencia de cintura = 0,96 (0,92-1,00); IMC = 0,95 (0,87-1,00); razao cintura/estatura = 0,93 (0,85-1,00); indice de conicidade = 0,74 (0,50-0,98). Os diversos pontos de corte dos indicadores antropometricos com melhores poderes preditivos e suas respectivas sensibilidades e especificidades foram identificados. CONCLUSAO: Apesar de a razao cintura/estatura e de o IMC terem apresentado boas areas sob a curva ROC, sugere-se a utilizacao da circunferencia de cintura para a predicao da pressao arterial elevada.BACKGROUND Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. OBJECTIVE To determine the predictive power of anthropometric indicators and establish their cutoff points as discriminators of high blood pressure. METHODS Cross-sectional study with a sample of 660 adolescents aged 14 to 19 including 51.9% girls. We considered the following anthropometric indicators: body mass index (BMI), waist circumference, waist-to-height ratio and conicity index. High blood pressure was characterized by values above the 90th percentile for systolic and/or diastolic blood pressure. To identify predictors of high blood pressure, we adopted the analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95%. Subsequently, we identified the cutoff points with their relevant sensitivities and specificities. RESULTS The areas under the ROC curves with confidence intervals were: boys--waist circumference = 0.80 (0.72 to 0.89); BMI = 0.79 (0.68 to 0.89), waist-to-height ratio = 0.77 (0.66 to 0.88); conicity index = 0.69 (0.56 to 0.81) and for girls--waist circumference = 0.96 (0.92 to 1.00); BMI 0.95 (0.87 to 1.00), waist-to-height ratio = 0.93 (0.85 to 1.00); conicity index = 0.74 (0.50 to 0.98). The different cutoff points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. CONCLUSION Although the waist-to-height ratio and BMI have shown good areas under the ROC curve, we suggest the use of waist circumference to predict high blood pressure.

Indicadores antropométricos como preditores de pressão arterial elevada em adolescentes

FUNDAMENTO: A hipertensao arterial esta relacionada ao incremento da gordura corporal, a qual pode ser avaliada por meio de indicadores antropometricos. OBJETIVO: Determinar o poder preditivo de indicadores antropometricos e estabelecer seus pontos de corte como discriminadores de pressao arterial elevada. METODOS: Estudo transversal realizado com uma amostra de 660 adolescentes de 14 a 19 anos sendo 51,9% mocas. Foram considerados os seguintes indicadores antropometricos: indice de massa corporal (IMC), circunferencia da cintura, razao cintura/estatura e indice de conicidade. A pressao arterial elevada foi caracterizada por valores acima do percentil 90 para pressao arterial sistolica e/ou pressao arterial diastolica. Para identificacao dos preditores de pressao arterial elevada, foi adotada a analise das curvas Receiver Operating Characteristic (ROC), com intervalo de confianca de 95%. Posteriormente, identificaram-se os pontos de corte com suas respectivas sensibilidades e especificidades. RESULTADOS: As areas sob as curvas ROC com os intervalos de confianca foram: rapazes - circunferencia de cintura = 0,80 (0,72-0,89); IMC = 0,79 (0,68-0,89); razao cintura/estatura = 0,77 (0,66-0,88); indice de conicidade = 0,69 (0,56-0,81) e para as mocas - circunferencia de cintura = 0,96 (0,92-1,00); IMC = 0,95 (0,87-1,00); razao cintura/estatura = 0,93 (0,85-1,00); indice de conicidade = 0,74 (0,50-0,98). Os diversos pontos de corte dos indicadores antropometricos com melhores poderes preditivos e suas respectivas sensibilidades e especificidades foram identificados. CONCLUSAO: Apesar de a razao cintura/estatura e de o IMC terem apresentado boas areas sob a curva ROC, sugere-se a utilizacao da circunferencia de cintura para a predicao da pressao arterial elevada.BACKGROUND Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. OBJECTIVE To determine the predictive power of anthropometric indicators and establish their cutoff points as discriminators of high blood pressure. METHODS Cross-sectional study with a sample of 660 adolescents aged 14 to 19 including 51.9% girls. We considered the following anthropometric indicators: body mass index (BMI), waist circumference, waist-to-height ratio and conicity index. High blood pressure was characterized by values above the 90th percentile for systolic and/or diastolic blood pressure. To identify predictors of high blood pressure, we adopted the analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95%. Subsequently, we identified the cutoff points with their relevant sensitivities and specificities. RESULTS The areas under the ROC curves with confidence intervals were: boys--waist circumference = 0.80 (0.72 to 0.89); BMI = 0.79 (0.68 to 0.89), waist-to-height ratio = 0.77 (0.66 to 0.88); conicity index = 0.69 (0.56 to 0.81) and for girls--waist circumference = 0.96 (0.92 to 1.00); BMI 0.95 (0.87 to 1.00), waist-to-height ratio = 0.93 (0.85 to 1.00); conicity index = 0.74 (0.50 to 0.98). The different cutoff points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. CONCLUSION Although the waist-to-height ratio and BMI have shown good areas under the ROC curve, we suggest the use of waist circumference to predict high blood pressure.

Predição da resistência à insulina em crianças: indicadores antropométricos e metabólicos

OBJECTIVE: To predict insulin resistance in children based on anthropometric and metabolic indicators by analyzing the sensitivity and specificity of different cutoff points. METHODS: A cross-sectional study was carried out of 109 children aged 7 to 11 years, 55 of whom were obese, 23 overweight and 31 well-nourished, classified by body mass index (BMI) for age. Measurements were taken to determine BMI, waist and hips circumferences, waist circumference/hip circumference ratio, conicity index and body fat percentage (dual emission X-ray absorptiometry). Fasting blood samples were taken to measure triglyceridemia, glycemia and insulinemia. Insulin resistance was evaluated by the glycemic homeostasis method, taking the 90th percentile as the cutoff point. Receiver operating characteristic curves were analyzed to a 95% confidence interval in order to identify predictors of glycemic homeostasis, and sensitivity and specificity were then calculated. RESULTS: After analysis of the area under the receiver operating characteristic curve (confidence interval), indicators that demonstrated the power to predict insulin resistance were, in the following order: insulinemia = 0.99 (0.99-1.00), 18.7 µU×mL-1; body fat percentage = 0.88 (0.81-0.95), 41.3%; BMI = 0.90 (0.83-0.97), 23.69 kg×m2-¹; waist circumference= 0.88 (0.79-0.96), 78.0 cm; glycemia = 0.71 (0.54-0.88), 88.0 mg×dL-1; triglyceridemia = 0.78 (0.66-0.90), 116.0 mg×dL-1 and conicity index = 0.69 (0.50-0.87), 1.23 for the whole sample; and were: insulinemia = 0.99 (0.98-1.00), 19.54 µU×mL-1; body fat percentage = 0.76 (0.64-0.89), 42.2%; BMI = 0.78 (0.64-0.92), 24.53 kg×m2-¹; waist circumference = 0.77 (0.61-0.92), 79.0 cm and triglyceridemia = 0.72 (0.56-0.87), 127.0 mg×dL-1, for the obese subgroup. CONCLUSIONS: Anthropometric and metabolic indicators appear to offer good predictive power for insulin resistance in children between 7 and 11 years old, employing the cutoff points with the best balance between sensitivity and specificity of the predictive technique.

Padrões de atividade física em diferentes domínios e ausência de diabetes em adultos

O objetivo foi analisar os padroes de atividades fisicas (caminhada, moderada e vigorosa) em diferentes dominios (trabalho, deslocamento, atividade domestica e tempo livre) como preditores da ausencia de diabetes. O estudo foi transversal realizado na cidade de Lauro de Freitas, Brasil, com 522 individuos maiores de 18 anos, 57.8% do sexo feminino. Foram construidas curvas Receiver Operating Characteristic (ROC) e comparadas as areas entre os padroes de atividades fisicas nos diversos dominios e a ausencia de diabetes. Identificou-se tambem os pontos de corte da atividade fisica (minutos/semana) para predizer a ausencia de diabetes. Foi utilizado o intervalo de confianca a 95%. Encontrou-se maiores areas sob a curva ROC para a atividade fisica de tempo livre e para os diferentes dominios analisados conjuntamente. A caminhada nao foi boa preditora da ausencia de diabetes. Observou-se que atividades fisicas acumuladas nos diferentes dominios realizadas por 185 minutos/semana em intensidade moderada, ou ainda, realizadas por 285 minutos/semana em intensidades de caminhada, moderada ou vigorosa foram os melhores pontos de corte para predizer a ausencia de diabetes. A pratica da atividade fisica, principalmente no tempo livre ou acumulada nos diferentes dominios, deve ser sugerida em padroes adequados visando contribuir para a prevencao da diabetes.