Michaela Eickemberg

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.

Hypertriglyceridemic waist phenotype: association with metabolic disorders and visceral fat in adults

OBJECTIVE To evaluate the association of Hypertriglyceridemic waist with metabolic disorders and visceral fat in adults. METHODS Cross-sectional study with 191 individuals of both sexes. Subjects were grouped according to Waist Circumference (WC) ratings (Men: > 90 cm; Women: > 80 cm) and triglycerides (TG) (> 150 mg/dl) in Group 1 (HTW Phenotype): elevated WC and TG; Group 2 (absence of HTW Phenotype): elevated WC and normal TG or normal WC and elevated TG or normal WC and TG. Metabolic alternations, visceral adipose tissue (VAT) and visceral/subcutaneous fat index (VF/SF) measured by computed tomography were evaluated as cardiovascu - lar risk factors between the groups. RESULTS Individuals with HTW phenotype, 82% had three or more cardiovascular risk factors. The association between cardiovascular risk factors with HTW phenotype revealed that among men 73.7% had hypercholesterolemia, 94.9% elevated non-HDLc and 78.9% excess of VAT area (p = 0.001). Among women, 65% had elevated Sistolic Blood Plessure, 80% hypercholesterolemia and 90% elevated non-HDLc (p < 0.02). CONCLUSION The HTW phenotype associated with the metabolic alternations and VAT excess. Individuals with HTW had higher number of cardiovascular risk factors. The Hypertriglyceridemic waist can be used in clinical practice for investigating cardiovascular risk and visceral adipose tissue in individuals.

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.

Factors Associated with Anemia in the Institutionalized Elderly.

As a common problem in long-term care facilities (LTCFs), anemia affects 25–63% of the elderly. The aim of the present study was to describe the prevalence and characteristics of anemia and its associated factors in the institutionalized elderly. The cross-sectional study was carried out with three hundred thirteen individuals aged ≥ 60 years, of both genders, living in long-term care facilities for the elderly in Salvador, Bahia, Brazil. Poisson regression (PR) with robust variance estimates was used to assess the factors related to anemia. The prevalence of anemia was 38%. Mild anemia was predominant in both genders (male: 26.8%; female: 21.1%), as normocytic and normochromic anemia, with no anisocytosis (69.75%). Anemia was associated with thinness (PR: 1.68; 95% CI: 1.04–2.72) and with moderate (PR: 1.98; 95% CI: 1.07–3.63) and total (PR: 2.61; 95% CI: 1.34–5.07) dependence in the final model. Severe dependence exhibited borderline significance (PR: 1.94; 95% CI: 1.00–3.77). The prevalence of anemia was high in the institutionalized elderly in both genders, with characteristics suggesting chronic diseases as the causal factor, and the frequency of occurrence was higher in thinness elderly with moderate to total dependence.

Factors associated with sarcopenia in institutionalized elderly

INTRODUCTION The sarcopenia is a negative aspect for the health of the elderly, increased the risk for disease and mortality. Additionally can contributes greatly to functional reducing capacity and quality of life. OBJECTIVE To identify the prevalence and factors associated with sarcopenia in institutionalized elderly. METHODS This is a cross-sectional study, conducted with 216 elderly people, aged ≥ 60 years, of both sexes, residents in long-term care facilities in Salvador-Bahia, Brazil. To identify sarcopenia was used the skeletal muscle Index. Covariates were considered: gender, age, time of institutionalization, type of institution, body mass index and functional capacity. The Association between sarcopenia and covariates was evaluated using the Poisson regression model with robust variance. RESULTS The prevalence of sarcopenia in the elderly was 72.2% and this condition was associated with male sex (PR = 1,33; CI 95% = 1,081,65), thinness (PR = 1,29; CI 95% = 1,16-1,43) and obesity (PR = 0,37; CI 95% = 0,23-0,61). CONCLUSION The prevalence of sarcopenia was high among the elderly living in long-term institutions, especially among men. Elderly with thinness showed greater impairment of muscle reserves, while the state of obesity was protective.