José Bonifácio Barbosa

Metabolic syndrome and menopause: cross-sectional study in gynecology clinic

BACKGROUND In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Programs (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant. RESULTS The prevalence of metabolic syndrome during the climacteric was 34.7% (NCEP) and 49.8% (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4% (NCEP) and 61.5% (IDF) of postmenopausal women compared to 24% (NCEP) and 37% (IDF) of premenopausal women. CONCLUSION The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.

Síndrome metabólica e menopausa: estudo transversal em ambulatório de ginecologia

BACKGROUND In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Programs (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant. RESULTS The prevalence of metabolic syndrome during the climacteric was 34.7% (NCEP) and 49.8% (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4% (NCEP) and 61.5% (IDF) of postmenopausal women compared to 24% (NCEP) and 37% (IDF) of premenopausal women. CONCLUSION The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.

Prevalência da hipertensão arterial em adultos e fatores associados em São Luís - MA

BACKGROUND Little is known about the prevalence of arterial hypertension (AH) and its risk factors in the less developed regions of Brazil. OBJECTIVE To estimate the prevalence of arterial hypertension and its associated factors in the population > 18 years in São Luís, state of Maranhão according to the Seventh Report of the Joint National Committee (JNC 7) criteria. METHODS A cross-sectional study was conducted in São Luís, MA, from February to March 2003, with 835 individuals >18 years who completed a structured household questionnaire. Measurements of arterial pressure (AP), weight, height and waist circumference were taken, and other risk factors for cardiovascular disease were assessed. The Poisson regression method was used for the identification of factors associated with AH, with an estimate of the prevalence ratio (PR) and its corresponding 95% confidence interval. RESULTS Age varied from 18 and 94 years (mean age was 39.4 years), 293 (35.1%) individuals were normotensive and 313 (37.5%) were pre-hypertensive. The AH prevalence was 27.4% (95% CI--24.4% to 30.6%), and it was higher among men (32.1%) than among women (24.2%). In the adjusted analysis, the following remained independently associated with AH: male gender (PR 1.52, 95% CI, 1.25-1.84), age > or = 30 years, with PR=6.65, 95% CI, 4.40-10.05 for > or = 60 years of age, overweight (PR 2.09 95% CI 1.64-2.68), obesity (PR 2.68, 95% CI, 2.03-3.53) and diabetes (PR 1.56, 95% CI, 1.24-1.97). CONCLUSION These findings suggest the need to control overweight, obesity and diabetes, especially among women and individuals > or = 30 years of age in order to reduce the prevalence of arterial hypertension.

Efeito da perda ponderal induzida pela cirurgia bariátrica sobre a prevalência de síndrome metabólica

BACKGROUND Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS Thirty-five (35) patients who underwent surgical Rouxs Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.FUNDAMENTO: A sindrome metabolica (SM) esta frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional a intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariatrica (CB) sobre a prevalencia da SM, em medio prazo. METODOS: Foram analisados 35 pacientes submetidos a cirurgia de by-pass gastrojejunal em Y de Roux, no periodo de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5% do sexo feminino, com uma media de idade de 37,8±11,1 anos e um IMC medio de 45,0±6,2 kg/m2. Na primeira etapa da pesquisa, foram obtidos dados demograficos e clinico-antropometricos antes da realizacao da CB, incluindo os criterios para o diagnostico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto a prevalencia da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1%). Em reavaliacao 34,4±15 meses apos a cirurgia, observou-se uma queda do IMC medio para 28,3±5,0 kg/m2 e a SM foi detectada em apenas dois pacientes (5,7%) (p<0,001). A prevalencia dos criterios cintura abdominal, glicemia, pressao arterial, HDL-colesterol e triglicerideos foi reduzida em, respectivamente, 45,8%, 83%, 87,5%, 57,13% e 94%. CONCLUSAO: A SM e ocorrencia comum em obesos candidatos a CB e esse procedimento se mostrou extremamente eficaz na inducao da regressao da sindrome, verificando-se reducao expressiva da prevalencia de todos os criterios do NCEP.

Associação entre fatores de risco cardiovascular e indicadores antropométricos de obesidade em universitários de São Luís, Maranhão, Brasil

The article aims to evaluate the relation between cardiovascular risk factors (CVRF) and anthropometric indicators in a sample of university students from Sao Luis-MA, Brazil. It is a cross-sectional study conducted with 968 university students, with median age of 22. Glycemia, triglycerides, HDL-c, smoking, alcohol consumption, physical inactivity, metabolic syndrome (Joint Interim Statement criteria) and insulin resistance (IR), were associated and correlated with anthropometric indicators such as BMI, WC, WHR and WHtR. Associations were found between TGL, SH, SM and higher values of all anthropometric variables. The RI was associated with higher BMI values and WHtR in men and women. The low HDL-c was associated with higher values of all anthropometric variables in women. Consumption of alcohol was associated with higher values of BMI and WC in women and WHR in men and WHtR. Smoking was associated with higher values of WHtR in both sexes. Physical inactivity was associated with higher values of WHR in men only. The highest correlations were established for women between TGL and BMI CC, WHR and WHtR. The indicators most associated with CVRF were BMI, WC and WHtR in females and WHR and WHtR in men.The article aims to evaluate the relation between cardiovascular risk factors (CVRF) and anthropometric indicators in a sample of university students from São Luís-MA, Brazil. It is a cross-sectional study conducted with 968 university students, with median age of 22. Glycemia, triglycerides, HDL-c, smoking, alcohol consumption, physical inactivity, metabolic syndrome (Joint Interim Statement criteria) and insulin resistance (IR), were associated and correlated with anthropometric indicators such as BMI, WC, WHR and WHtR. Associations were found between TGL, SH, SM and higher values of all anthropometric variables. The RI was associated with higher BMI values and WHtR in men and women. The low HDL-c was associated with higher values of all anthropometric variables in women. Consumption of alcohol was associated with higher values of BMI and WC in women and WHR in men and WHtR. Smoking was associated with higher values of WHtR in both sexes. Physical inactivity was associated with higher values of WHR in men only. The highest correlations were established for women between TGL and BMI CC, WHR and WHtR. The indicators most associated with CVRF were BMI, WC and WHtR in females and WHR and WHtR in men.

Prevalência de verdadeiras crises hipertensivas e adequação da conduta médica em pacientes atendidos em um pronto-socorro geral com pressão arterial elevada

BACKGROUND High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated. OBJECTIVE To analyze the cases of patients seen in a general emergency room because of high blood pressure as for meeting the criteria for the diagnosis of hypertensive crisis and the appropriateness of medical management. METHODS Of the 1012 patients consecutively seen in a private referral general emergency room in the city of São Luís, State of Maranhão, between August and November 2003, 198 (19.56%) had a main diagnosis of high blood pressure in that visit. Of these, proper information could only be obtained from the patient charts of 169 patients; 54.4% of them were females with a mean age of 53.3 +/- 15.2 years. Data regarding patients and the attendant physicians were collected, and each case was classified as an urgency, emergency or pseudohypertensive crisis; the medical management was classified as appropriate or inappropriate. We also sought to identify the factors associated with the medical management and with the use of antihypertensive medication. RESULTS Criteria for the characterization of a hypertensive crisis were present in only 27 patients (16%), and all were classified as urgencies. Medical management was considered appropriate in 72 cases (42.6%), and was neither influenced by specialty (p=0.5) nor by the physicians experience (p=0.9). Blood pressure levels, but not the presence or absence of symptoms, were predictive of the use of antihypertensive medication (p<0.001). CONCLUSION In the population analyzed, less than one fifth of the patients seen in an emergency room with a presumed hypertensive crisis met defined criteria for this diagnosis. Medical management was considered appropriate in less than half of the occurrences.

Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome

BACKGROUND Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS Thirty-five (35) patients who underwent surgical Rouxs Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.FUNDAMENTO: A sindrome metabolica (SM) esta frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional a intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariatrica (CB) sobre a prevalencia da SM, em medio prazo. METODOS: Foram analisados 35 pacientes submetidos a cirurgia de by-pass gastrojejunal em Y de Roux, no periodo de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5% do sexo feminino, com uma media de idade de 37,8±11,1 anos e um IMC medio de 45,0±6,2 kg/m2. Na primeira etapa da pesquisa, foram obtidos dados demograficos e clinico-antropometricos antes da realizacao da CB, incluindo os criterios para o diagnostico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto a prevalencia da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1%). Em reavaliacao 34,4±15 meses apos a cirurgia, observou-se uma queda do IMC medio para 28,3±5,0 kg/m2 e a SM foi detectada em apenas dois pacientes (5,7%) (p<0,001). A prevalencia dos criterios cintura abdominal, glicemia, pressao arterial, HDL-colesterol e triglicerideos foi reduzida em, respectivamente, 45,8%, 83%, 87,5%, 57,13% e 94%. CONCLUSAO: A SM e ocorrencia comum em obesos candidatos a CB e esse procedimento se mostrou extremamente eficaz na inducao da regressao da sindrome, verificando-se reducao expressiva da prevalencia de todos os criterios do NCEP.

Síndrome metabólica em ambulatório cardiológico

BACKGROUND: In Brazil, the prevalence of the metabolic syndrome (MS) is little known in several regions. OBJECTIVE: To analyze the prevalence of MS, its components and the agreement between two diagnostic definitions in a population aged > 13 years. METHODS: Cross-sectional study conducted from June to October 2007 in 719 patients of outpatient cardiology clinics in the city of Sao Luis, State of Maranhao, Brazil. Blood pressure (BP), weight, height, waist circumference and lipid profile were measured. Risk factors for MS were evaluated according to the International Diabetes Federation (IDF) definition. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression. RESULTS: The prevalence of MS was higher in both genders when using IDF definition (62.3% in men and 64.6% in women) than when using that of the National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48.9% in men and 59% in women). The most prevalent MS components were: hypertension (87.2% and 86%); hypertriglyceridemia (84.4% and 82.5%); increased waist circumference (77.8% and 100%); low HDL-c (58.1% and 49.9%); and high blood glucose (59.9% and 51.9%), using NCEP ATPIII and IDF definitions, respectively. In the adjusted analysis, age > 60 years and body mass index (BMI) > 30 were associated with a higher risk of MS (p<0.001). CONCLUSION: The prevalence of MS was much higher than in the overall population, and hypertension was the most prevalent component. There was good agreement between the two definitions, very good in the female gender and moderate in the male gender.

Metabolic syndrome, insulin resistance and other cardiovascular risk factors in university students

A cross-sectional population-based study using questionnaire and anthropometric data was conducted on 968 university students of São Luís, Brazil, from which 590 showed up for blood collection. In the statistical analysis the Student t-test, Mann-Whitney and chi-square tests were used. The prevalence of metabolic syndrome by the Joint Interim Statement (JIS) criteria was 20.5%, almost three times more prevalent in men (32.2%) than in women (13.5%) (P < 0.001). The prevalence of insulin resistance was 7.3% and the prevalence of low HDL-cholesterol was high (61.2%), both with no statistically significant differences by sex. Men showed a higher percentage of smoking, overweight, high blood pressure, high blood glucose and increased fasting hypertriglyceridemia. Women were more sedentary. University students of private institutions had higher prevalences of sedentary lifestyle, obesity, abdominal obesity, elevated triglycerides and metabolic syndrome than students from public institutions. High prevalences of metabolic syndrome, insulin resistance and other cardiovascular risk factors were found in this young population. This suggests that the burden of these diseases in the future will be increased.

Síndrome metabólico y menopausia: estudio transversal en ambulatorio de ginecología

BACKGROUND In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Programs (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant. RESULTS The prevalence of metabolic syndrome during the climacteric was 34.7% (NCEP) and 49.8% (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4% (NCEP) and 61.5% (IDF) of postmenopausal women compared to 24% (NCEP) and 37% (IDF) of premenopausal women. CONCLUSION The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.