Impact of different obesity assessment methods after acute coronary syndromes.

BACKGROUND: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. OBJECTIVE: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. METHODS: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. RESULTS: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. CONCLUSION: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.

Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes / Impacto de Diferentes Métodos de Avaliação da Obesidade Abdominal após Síndromes Coronarianas Agudas

Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes. .

Fundamento: A obesidade abdominal é relevante fator de risco cardiovascular. Portanto, a identificação do melhor método para medição da circunferência abdominal (CA) é prioritária. Objetivo: Avaliar os oito métodos de medição da CA, em pacientes com síndrome coronariana aguda, como preditor de complicações cardiovasculares durante o período de internação. Métodos: Estudo prospectivo com pacientes com síndrome coronariana aguda. A medição da CA foi realizada pelos oito métodos conhecidos: ponto médio entre a última costela e a crista ilíaca (1), ponto da circunferência mínima (2); imediatamente acima da crista ilíaca (3), cicatriz umbilical (4), uma polegada acima do umbigo (5), um centímetro acima do umbigo (6), menor costela (7), no ponto de maior circunferência em torno da cintura (8). As complicações observadas foram: angina, arritmia, insuficiência cardíaca, choque cardiogênico, hipotensão, pericardite e óbito. Para os fatores de predição foram utilizados os testes de regressão logística. Resultados: Foram avaliados 55 pacientes. Durante o período de internação, que correspondeu, em média, a sete dias, 37 (67%) pacientes apresentaram complicações, com exceção do óbito, que não foi verificado em nenhum dos casos. Destas complicações, a única que apresentou associação com a CA foi a angina, sendo que a cada centímetro de elevação da CA, o risco de apresentar angina aumentou de 7,5 a 9,9%, conforme o local de medição. É importante destacar que não houve diferença entre os diferentes métodos de medição da CA como preditor de angina. Conclusão: Os oito métodos de medição da ...

Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.