Influencia del síndrome metabólico en los resultados de la cirugía del sector aorto-iliaco / Influence of the metabolic syndrome on the results of the surgery of the aortic-iliac sector

Introducción: El síndrome metabólico está relacionado con el incremento de la morbilidad y mortalidad de las enfermedades. Objetivo: Determinar la influencia del síndrome metabólico sobre los resultados de la cirugía revascularizadora del sector aorto-ilíaco. Métodos: Se realizó un estudio descriptivo en dos etapas, en 114 pacientes atendidos en un período de cuatro años (2010-2014) en el Hospital Hermanos Ameijeiras con el diagnóstico de aneurisma de la aorta infrarrenal o enfermedad esteno-oclusiva aorto-ilíaca. Las variables fueron: presencia del síndrome metabólico y tipo de sus criterios positivos, enfermedad al ingreso, complicaciones posoperatoria, condición al alta (vivo /fallecido) y estancia hospitalaria. Se realizó el análisis estadístico correspondiente. Resultados: El 64 por ciento presentó el síndrome metabólico (p= 0,004), que predominó en la enfermedad esteno-oclusiva (48,2 por ciento) y en el aneurisma de la aorta abdominal infrarrenal (15,8 por ciento) sin diferencias significativas entre ambas entidades (p= 0,466). El 43,8 por ciento presentó cuatro criterios positivos, donde la hipertensión arterial fue la más frecuente (94,5 por ciento). Las complicaciones posquirúrgicas (relacionadas con la cirugía y respiratorias) se produjeron en el 64,4 por ciento. Hubo cinco fallecidos (5,3 por ciento) por enfermedades cardiovasculares y vasculares periféricas. El 50,7 por ciento de los enfermos con síndrome metabólico complicado acumuló más de 10 días de estadía posoperatoria. Conclusiones: El síndrome metabólico influye de forma negativa en los resultados de la cirugía revascularizadora del sector aorto-ilíaco en los pacientes con aneurisma de la aorta abdominal infrarrenal o con enfermedad esteno-oclusiva aorto-ilio-femoral, por el incremento de la frecuencia de complicaciones posoperatorias(AU)

Introduction: The metabolic syndrome is related to the increase of the morbidity and the mortality of diseases. Objective: To determine the influence of the metabolic syndrome on the results of the revascularization surgery performed in the aortic-iliac sector. Methods: A two-phase descriptive study was conducted in 114 patients, who were diagnosed with infrarenal aortic aneurysm or steno-occlusive aortic-iliac disease and treated in Hermanos Ameijeiras hospital from 2010-2014. The study variables were presence of metabolic syndrome and type of positive criteria of the same, disease on admission, postoperative complications, patient´s condition on discharge (alive/dead) and hospital length of stay at hospital. The corresponding statistical analysis was made. Results: Sixty four percent presented with the metabolic syndrome (p= 0.004), predominating in steno-occlusive disease (48.2 percent) and the infrarenal abdominal aorta aneurysm (15.8 percent) without significant differences between the two conditions (P= 0.466). In the group, 43.8 percent showed four positive criteria, being hypertension the most common (94.5 percent). Post-surgical complications (related to surgery and respiratory problems) occurred in 64.4 percent. There were five deaths (5.3 percent) due to cardiovascular disease and peripheral vascular diseases. The 50.7 percent of patients with complicated metabolic syndrome had stayed more than 10 days at hospital after surgery. Conclusions: The metabolic syndrome has negative impact on the results of the revascularization surgery of the aortic-iliac sector in patients with infrarenal abdominal aorta aneurysm or with aortic-iliac-femoral steno-occlusive disease, due to increased frequency of postoperative complications(AU)

Associação Entre a Obesidade Central e a Incidência de Doenças e Fatores de Risco Cardiovascular / Association of Central Obesity with The Incidence of Cardiovascular Diseases and Risk Factors

Fundamento: A obesidade tem sido apontada como um dos principais fatores de risco para doenças cardiovasculares. Objetivo: Avaliar a associação da obesidade central com a incidência de doenças e fatores de risco cardiovascular. Métodos: Estudo transversal, realizado com pacientes atendidos em um ambulatório de síndrome metabólica, que apresentavam índice de massa corporal ≥ 24,9 kg/m2 . Foram analisados o estado nutricional, os exames laboratoriais (perfil lipídico e glicemia) e o uso de anti-hipertensivos. Os participantes foram estratificados em grupos em relação à presença ou à ausência dos seguintes fatores de risco: diabetes, hipertensão e dislipidemia. Resultados: Mulheres (n = 39), com idade média de 44,18 ± 14,42 anos, sendo 70% obesos e 38% hipertensos corresponderam à maioria da amostra estudada. A circunferência abdominal encontrada foi de 110,19 cm ± 15,88 cm; os triglicerídeos de 153,72 mg/dL ± 7,07 mg/dL; a glicemia de jejum de 188,6 mg/dL ± 116 mg/dL. Foi encontrada associação significativa entre a relação cintura/estatura e os achados de hipertensão (p = 0,007); entre o volume de gordura visceral e diabetes (p = 0,01); entre o índice de conicidade e os achados de hipertensão (p = 0,009) e diabetes (p = 0,006). Não foi encontrada associação significativa entre o índice de massa corporal e circunferência abdominal com os achados de hipertensão, diabetes e dislipidemia. Conclusão: A obesidade central esteve associada a uma maior incidência de desenvolvimento de fatores de risco relacionados a doenças cardiovasculares

Background: Obesity has been identified as a major risk factor for cardiovascular disease. Objective: To evaluate the association of central obesity with the incidence of cardiovascular diseases and risk factors. Methods: This was a cross-sectional study, carried out with patients treated at a metabolic syndrome outpatient clinic, with body mass index ≥ 24.9 kg/m2 . Nutritional status, laboratory tests (lipid and glycemic profile) and blood pressure status were analyzed. Participants were stratified into groups regarding the presence or absence of risk factors: diabetes, hypertension, and dyslipidemia. Results: Women (n = 39), mean age of 44.18 ± 14.42 years, of which 70% were obese and 38% were hypertensive, corresponded to most of the studied sample. Abdominal circumference was 110.19 cm ± 15.88 cm; levels of triglycerides were 153.72 mg/dL ± 7.07 mg/dL; and fasting glycemia was 188.6 mg/dL ± 116 mg/dL. A significant association was found between the waist/height ratio and the findings of hypertension (p = 0.007); between visceral fat volume and diabetes (p = 0.01); between the conicity index and the findings of hypertension (p = 0.009) and diabetes (p = 0.006). No significant association was found between body mass index and waist circumference with findings of hypertension, diabetes and dyslipidemia. Conclusion: Central obesity was associated with a higher incidence of development of risk factors related to cardiovascular diseases

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study.

BACKGROUND: Prior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain. METHODS AND RESULTS: We characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987-2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow-up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P<0.001). After adjustment for participant demographics and clinical factors other than components of the metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37-2.12, P<0.001). This relationship was not modified by sex (interaction P=0.10) or race (interaction P=0.62) and was mediated by the metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19-1.44, P<0.001). Of the 5 components, elevated blood pressure, impaired fasting glucose, and low high-density lipoprotein were independently associated with sudden cardiac death. CONCLUSIONS: We observed that the metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components.

Impact of the Metabolic Syndrome on Mortality is Modified by Objective Short Sleep Duration.

BACKGROUND: To examine whether objective sleep duration is an effect modifier of the impact of metabolic syndrome (MetS) on all-cause and cardiovascular disease/cerebrovascular mortality. METHODS AND RESULTS: We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1344 men and women (48.8±14.2 years) who were studied in the sleep laboratory and followed up for 16.6±4.2 years. MetS was defined by the presence of 3 or more of obesity (≥30 kg/m2), elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), fasting glucose (≥100 mg/dL), and blood pressure (≥130/85 mm Hg). Polysomnographic sleep duration was classified into clinically meaningful categories. Among the 1344 participants, 22.0% of them died during the follow-up. We tested the interaction between MetS and polysomnographic sleep duration on mortality using Cox proportional hazard models controlling for multiple potential confounders (P<0.05). The hazard ratios (95% CI) of all-cause and cardiovascular disease/cerebrovascular mortality associated with MetS were 1.29 (0.89-1.87) and 1.49 (0.75-2.97) for individuals who slept ≥6 hours and 1.99 (1.53-2.59) and 2.10 (1.39-3.16) for individuals who slept <6 hours. Interestingly, this effect modification was primarily driven by the elevated blood pressure and glucose dysregulation components of MetS. CONCLUSIONS: The risk of mortality associated with MetS is increased in those with short sleep duration. Short sleep in individuals with MetS may be linked to greater central autonomic and metabolic dysfunction. Future clinical trials should examine whether lengthening sleep improves the prognosis of individuals with MetS.

Prevalencia del síndrome metabólico en pre-eclampsia / Metabolic syndrome prevalence in preeclampsia

OBJETIVO: Determinar la prevalencia del síndrome metabólico (SM) en mujeres embarazadas con preeclampsia, Hospital Materno Infantil de la Caja Nacional de Salud, La Paz-Bolivia. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal de 181 mujeres embarazadas durante un periodo de 22 meses. Se determinó el índice de masa corporal (IMC) y la presión arterial sistémica en el brazo derecho. El diagnóstico de SM fue realizado de acuerdo con el consenso de la IDF y NCEP ATP III; de los 5 criterios para diagnóstico de SM, se excluyó la circunferencia abdominal debido al cambio fisiológico del útero. Los datos fueron procesados con paquetes estadísticos SPSS 15.0 y Epi Info 3.5. Los resultados fueron correlacionados con tablas de contingencia 2 x 2 y evaluados con la prueba del Chi cuadrado. RESULTADOS: De las 181 mujeres embarazadas con pre-eclampsia, 49.7% presentaron SM, 80.1% hipertrigliceridemia, 60.9% colesterol HDL menor a 50 mg/ dl, 19.2% glucemia mayor a 110 mg/dl y 75.6% de IMC mayor a 25. Se encontró asociaciones estadísticamente significativas entre SM/preeclampsia y IMC mayor a 25/preeclampsia (X²:12,83, p<0,05). CONCLUSIONES: La prevalencia de SM en mujeres con preeclampsia es alta, existe una asociación estadísticamente significativa entre ambas variables.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) in pregnant women with preeclampsia at Materno Infantil Hospital, Caja Nacional de Salud in La Paz-Bolivia. MATERIAL AND METHODS: It was conducted an observational, descriptive and transversal study in 181 pregnant patients over a period of 22 months. Body mass index (BMI) and systemic blood pressure on rightarm were measured. MS diagnosis was based on the IDF and NCEP ATP III consensus, considering 5 criteria of MS diagnosis, it was excluded waist circumference due to the uterine physiological changes. All data were processed with SPSS 15.0 and Epi Info 3.5 statistical packages. Results were correlated with 2x2 contingency tables and evaluated with the chi-square test. RESULTS: Pregnant women displayed a 49.7% of metabolic syndrome, 80.1% hypertriglyceridemia, 60.9% HDL cholesterol less than 50 mg/dl, 19.2% of glucose higher than 110 mg/dl and 75.6% of BMI higher than 25. Statistically significant associations between SM/preeclampsia and BMI over 25/ preeclampsia (J² 12, 83, p<0, 05) were found. CONCLUSIONS: There is a higher prevalence of metabolic syndrome in women with preeclampsia, stating a statistically significant relationship between variables.

Effects of metabolic syndrome on kidney transplantation outcomes: a systematic review and meta-analysis.

Metabolic syndrome (MS) has been associated with proteinuria and reduced glomerular filtration rate. Immunosuppressive agents increase the incidence of traditional risk factors for cardiovascular disease (CVD) and have known effects on MS components after kidney transplantation. The purpose of this meta-analysis was to evaluate the impact of MS on relevant outcomes after kidney transplantation. MEDLINE, EMBASE, and Cochrane Library were searched up to November 7, 2015. Papers that compared patients with and without MS and assessed one of the following outcomes, graft loss, death by cardiovascular disease, and all-cause mortality, were included. Of 585 studies identified, five studies including 1269 patients were evaluated. MS was identified as a risk factor for graft loss [relative risk, 3.06; 95% confidence interval (CI), 2.17, 4.32; I² = 0%; P heterogeneity = 0.72] and death by CVD (relative risk, 3.53; 95% CI, 1.27, 9.85; I² = 0%; P heterogeneity = 0.40). Results on the association between MS and all-cause mortality were inconclusive (relative risk, 2.61; 95% CI, 0.70, 9.81; I² = 58%; P heterogeneity = 0.09). Graft loss and death by CVD were associated with the presence of MS after transplantation. Randomized clinical trials should be conducted to define whether interventions on each MS component would result in better outcomes after transplantation.

Medición de la circunferencia abdominal en autopsias / Measurement of the abdominal circumferences in autopsies

Objetivo: evaluar la relación de la medida de la circunferencia abdominal con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, especialmente las relacionadas con el síndrome metabólico.Métodos: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica, entre 2008 y 2011, 420 autopsias en las que se midió la circunferencia abdominal a nivel del ombligo. Se crearon tres grupos de estudio según la circunferencia, con un número similar de casos: 54-81,2 cm, 82,3-96,5 cm y 97-161 cm. Resultados: en el grupo de mayor circunferencia disminuyó el promedio de edad y fue de más de 65 años; el 60,4 por ciento correspondió al sexo masculino y el 67,1 por ciento al femenino. Entre las causas de muerte aumentó la bronconeumonía, de 20,1 por ciento a 10,1 por ciento, el cáncer, la falla/daño múltiple de órgano y, en especial, el infarto agudo del miocardio; y disminuyó la enfermedad cerebrovascular. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar.Conclusiones: la medición de la circunferencia abdominal en las autopsias resulta un indicador apropiado para precisar la obesidad, así como su relación con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico(AU)

Objective: to evaluate the association of the abdominal circumference index with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome. Methods: the Automated System of Registration and Control of Pathological Anatomy processed 420 autopsies from 2008 through 2011, in which the abdominal circumference was measured at the navel. Three circumference-dependent study groups with similar number of cases were created: 54-81.2 cm; 82.3-96.5 cm and 97-161 cm. Results: in the group with the biggest circumference value, the average age decreased, being over 65 years old; 60.4 percent were men and 67.1 percent were women. Among the causes of death, the incidence of bronchial pneumonia, cancer, multiple organ failure/damage and especially acute myocardial infarction rose whereas that of cerebrovascular diseases decreased. Increased blood hypertension and diabetes mellitus were found to be contributing factors. As to the metabolic syndrome-related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. Conclusions: measurement of the abdominal circumference in autopsies is an adequate indicator to determine obesity and its association with age, sex, hospital parameters, causes of death and other diagnosed diseases, mainly those that are part of the metabolic syndrome(AU)

Medición de la circunferencia abdominal en autopsias / Measurement of the abdominal circumferences in autopsies

OBJETIVO: evaluar la relación de la medida de la circunferencia abdominal con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, especialmente las relacionadas con el síndrome metabólico. MÉTODOS: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica, entre 2008 y 2011, 420 autopsias en las que se midió la circunferencia abdominal a nivel del ombligo. Se crearon tres grupos de estudio según la circunferencia, con un número similar de casos: 54-81,2 cm, 82,3-96,5 cm y 97-161 cm. RESULTADOS: en el grupo de mayor circunferencia disminuyó el promedio de edad y fue de más de 65 años; el 60,4 % correspondió al sexo masculino y el 67,1 % al femenino. Entre las causas de muerte aumentó la bronconeumonía, de 20,1 % a 10,1 %, el cáncer, la falla/daño múltiple de órgano y, en especial, el infarto agudo del miocardio; y disminuyó la enfermedad cerebrovascular. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar. CONCLUSIONES: la medición de la circunferencia abdominal en las autopsias resulta un indicador apropiado para precisar la obesidad, así como su relación con la edad y sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico.

OBJECTIVE: to evaluate the association of the abdominal circumference index with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome. METHODS: the Automated System of Registration and Control of Pathological Anatomy processed 420 autopsies from 2008 through 2011, in which the abdominal circumference was measured at the navel. Three circumference-dependent study groups with similar number of cases were created: 54-81.2 cm; 82.3-96.5 cm and 97-161 cm. RESULTS: in the group with the biggest circumference value, the average age decreased, being over 65 years old; 60.4 % were men and 67.1 % were women. Among the causes of death, the incidence of bronchial pneumonia, cancer, multiple organ failure/damage and especially acute myocardial infarction rose whereas that of cerebrovascular diseases decreased. Increased blood hypertension and diabetes mellitus were found to be contributing factors. As to the metabolic syndrome-related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. CONCLUSIONS: measurement of the abdominal circumference in autopsies is an adequate indicator to determine obesity and its association with age, sex, hospital parameters, causes of death and other diagnosed diseases, mainly those that are part of the metabolic syndrome.

Are metabolic syndrome and its components associated with 5-year mortality in chronic obstructive pupmonary disease patients?

The aim of this study was to evaluate the risk of mortality according to the presence of metabolic syndrome in chronic obstructive pulmonary disease (COPD) patients who were followed for 5 years. We did not establish the influence of metabolic syndrome on mortality rate. However, an increase of 100 mg of triglycerides was associated with a 39% increase in the probability of death in the period of the study (hazard ratio 1.39, 95% confidence interval 1.06-1.83).

Medición del panículo adiposo abdominal en autopsias / Measument of the panniculus adiposus abdominis in autopsies

Objetivo: evaluar la relación de la medida del panículo adiposo abdominal con la edad y el sexo, los parámetros hospitalarios, las causas de muerte y otras enfermedades diagnosticadas.Métodos: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica 591 autopsias, en las que se midió el panículo adiposo abdominal a nivel del ombligo. Se crearon tres grupos de estudio según el grosor, con un número similar de casos: 0,1-1,6 cm; 1,7-2,6 cm y 2,7-9,2 cm.Resultados: en el grupo de mayor grosor el promedio de edad fue de 65 años; el 33,3 por ciento correspondió al sexo masculino y el 62,6 por ciento al femenino. Entre las causas de muerte aumentó el infarto agudo del miocardio y disminuyó la enfermedad cerebrovascular. Los tumores malignos se incrementaron en correspondencia con el aumento del grosor del panículo adiposo. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar. Conclusiones: el grosor del panículo adiposo abdominal resulta un indicador apropiado para precisar la grasa abdominal y su importancia; así como su relación con la edad y el sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico(AU)

Objective: to evaluate the relationship among the size of panniculus adiposus abdominis , age, sex, hospital parameters, causes of death and other diagnosed diseases Methods: using the automated system of registry and control of pathological anatomy, 591 autopsies were processed in which the abdominal fatty panniculus adiposus abdominis around the navel. Three study groups were created according to thickness, with a similar number of cases: 0.1-1.6 cm: 1.7-2.6 cm and 2.7-9.2 cm. Results: the average age in the group with the thickest panniculus adiposus abdominis was 65 years: 33.3 percent in males and 62.6 percent in females. Acute myocardial infarction increased whereas the cerebrovascular disease decreased. The number of malignant tumors increased as the panniculus adiposus thickness increases too. The contributing causes were high blood pressure and diabetes mellitus. Regarding the metabolic syndrome related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. Conclusions: the panniculus adiposus abdominis thickness is an adequate indicator to measure abdominal adiposity and its importance, as well as its relationship with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome(AU)

Medición del panículo adiposo abdominal en autopsias / Measument of the panniculus adiposus abdominis in autopsies

OBJETIVO: evaluar la relación de la medida del panículo adiposo abdominal con la edad y el sexo, los parámetros hospitalarios, las causas de muerte y otras enfermedades diagnosticadas. MÉTODOS: se procesaron por el Sistema Automatizado de Registro y Control de Anatomía Patológica 591 autopsias, en las que se midió el panículo adiposo abdominal a nivel del ombligo. Se crearon tres grupos de estudio según el grosor, con un número similar de casos: 0,1-1,6 cm; 1,7-2,6 cm y 2,7-9,2 cm. RESULTADOS: en el grupo de mayor grosor el promedio de edad fue de 65 años; el 33,3 % correspondió al sexo masculino y el 62,6 % al femenino. Entre las causas de muerte aumentó el infarto agudo del miocardio y disminuyó la enfermedad cerebrovascular. Los tumores malignos se incrementaron en correspondencia con el aumento del grosor del panículo adiposo. Como causas contribuyentes se encontraron la elevación de la hipertensión arterial y la diabetes mellitus. En los trastornos relacionados con el síndrome metabólico, los órganos más afectados fueron las arterias, el páncreas, el hígado, el corazón y la vesícula biliar. CONCLUSIONES: el grosor del panículo adiposo abdominal resulta un indicador apropiado para precisar la grasa abdominal y su importancia; así como su relación con la edad y el sexo, parámetros hospitalarios, causas de muerte y otras enfermedades diagnosticadas, principalmente aquellas que forman parte del síndrome metabólico.

OBJECTIVE: to evaluate the relationship among the size of panniculus adiposus abdominis , age, sex, hospital parameters, causes of death and other diagnosed diseases METHODS: using the automated system of registry and control of pathological anatomy, 591 autopsies were processed in which the abdominal fatty panniculus adiposus abdominis around the navel. Three study groups were created according to thickness, with a similar number of cases: 0.1-1.6 cm: 1.7-2.6 cm and 2.7-9.2 cm. RESULTS: the average age in the group with the thickest panniculus adiposus abdominis was 65 years: 33.3 % in males and 62.6 % in females. Acute myocardial infarction increased whereas the cerebrovascular disease decreased. The number of malignant tumors increased as the panniculus adiposus thickness increases too. The contributing causes were high blood pressure and diabetes mellitus. Regarding the metabolic syndrome related disorders, the most affected organs were arteries, pancreas, liver, heart and gallbladder. CONCLUSIONS: the panniculus adiposus abdominis thickness is an adequate indicator to measure abdominal adiposity and its importance, as well as its relationship with age and sex, hospital parameters, causes of death and other diagnosed diseases, mainly those related to the metabolic syndrome.

Metabolic syndrome criteria as predictors of insulin resistance, inflammation and mortality in chronic hemodialysis patients.

UNLABELLED: Abstract Background: Chronic kidney disease (CKD) and metabolic syndrome are characterized by overlapping disorders, including glucose intolerance, hypertension, dyslipidemia, and, in some cases, obesity. However, there are no specific criteria for the diagnosis of metabolic syndrome in CKD. Metabolic syndrome can also be associated with increased risk of mortality. Some traditional risk factors may protect dialysis patients from mortality, known as "reverse epidemiology." Metabolic syndrome might undergo reverse epidemiology. The objectives were to detect differences in frequency and metabolic characteristics associated with three sets of diagnostic criteria for metabolic syndrome, to evaluate the accuracy of insulin resistance (IR) and inflammation to identify patients with metabolic syndrome, and to investigate the effects of metabolic syndrome by three sets of diagnostic criteria on mortality in chronic hemodialysis patients. METHODS: An observational study was conducted. Diagnostic criteria for metabolic syndrome proposed by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonizing the Metabolic Syndrome (HMetS) statement were applied to 98 hemodialysis patients. RESULTS: The prevalence of metabolic syndrome was 51%, 66.3%, and 75.3% according to NCEP ATP III, IDF, and HMetS criteria, respectively. Diagnosis of metabolic syndrome by HMetS was simultaneously capable of revealing both inflammation and IR, whereas NCEP ATP III and IDF criteria were only able to identify IR. Mortality risk increased in the presence of metabolic syndrome regardless of the criteria used. CONCLUSIONS: The prevalence of metabolic syndrome in hemodialysis varies according to the diagnostic criteria used. IR and inflammation predict metabolic syndrome only when diagnosed by HMetS criteria. HMetS was the diagnostic criteria that can predict the highest risk of mortality.

Cardiovascular risk, atherosclerosis and metabolic syndrome after liver transplantation: a mini review.

Liver transplantation is the standard of care for acute and chronic end-stage liver disease. Advances in medical therapy and surgical techniques have transformed the long-term survival of liver-transplant (LT) recipients. The prevalence of post-transplant cardiovascular complications has been rising with increased life expectancy after liver transplantation. Currently, deaths related to cardiovascular complications are one of the main causes of long-term mortality in LT recipients, as cardiovascular disease is the reason of 19-42% of non-liver-related mortality after transplant. On the other hand, metabolic syndrome is common among LT recipients before and after transplantation. In fact, their components (abdominal obesity, diabetes mellitus, hypertension and dyslipidemia) are often exacerbated by transplant-specific factors, such as immunosuppression, inappropriate diet, smoking and a sedentary lifestyle, and add a significant risk of developing atherosclerosis. These aspects are discussed in this article.

Gravidade da doença arterial coronariana e síndrome metabólica: exste associação? / Severity of coronary artery disease and metabolic syndrome: is there an association?

Fundamentos: A síndrome metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiovascular, usualmente relacionados à resistência à insulina.Objetivo: Avaliar a associação entre a síndrome metabólica e a gravidade da doença arterial coronariana. Métodos: Estudo transversal com 322 pacientes submetidos à cineangiocoronariografia eletiva. Avaliaram-se dados laboratoriais e fatores de risco para a doença arterial coronariana, assim como informações obtidas na cineangiocoronariografia. A síndrome metabólica foi identificada segundo os critérios doNCEP-ATPIII. Para a gravidade da doença arterial coronariana consideraram-se dois aspectos: o número de vasos acometidos e o grau de oclusão da artéria. Investigou-se a associação entre as variáveis estudada se a síndrome metabólica utilizando-se o teste do qui-quadrado; a determinação dos fatores de risco por meio do OR e associação com a gravidade pela regressão de Poisson. Considerou-se significativo p<0,05.Resultados: A prevalência da síndrome metabólica foi 58,07 %, sendo 59,13 % nos portadores de doença arterial coronariana, sem significado estatístico. A síndrome metabólica não se constituiu fator de risco independente para a presença de doença arterial coronariana. Tanto na avaliação do número de vasos acometidos quanto no grau de oclusão observou-se, nos pacientes com síndrome metabólica, tendência de maior gravidade, porém sem significância estatística. Na avaliação dos componentes da síndrome metabólica, apenas a hipertensão arterial se apresentou como fator de risco para doença arterial coronariana. Conclusão: Não se observou associação entre a síndrome metabólica e a gravidade da doença arterial coronariana.

Background: Metabolic syndrome is a complex disorder with a set of cardiovascular risk factors, usually related to insulin resistance.Objective: To assess the association between metabolic syndrome and the severity of coronary artery disease. Methods: Cross sectional study with 322 patients undergoing elective coronary angiography. Laboratory data and risk factors were evaluated for coronary artery disease, as well as information obtained during the angiography. Metabolic syndrome was diagnosed according to the NCEP ATPIII criteria, using two aspects to rate CAD severity: the number of vessels involved and the level of occlusion in the artery. The association between these variables and metabolic syndrome was investigated, using the chi-square test; risk factors were defined through the OR and the association with severity was measured through the Poisson regression, with p<0.05 considered as significant. Results: The prevalence of metabolic syndrome reached 58.07%, and 59.13% in patients with coronary artery disease, with no statistical difference. Metabolic syndrome was not an independent risk fact for the presence of coronary artery disease. When assessing occlusion levels and the number of vessels involved, a trend towards greater severity was notedin patients with metabolic syndrome, but with no statistical significance. Among the metabolic syndrome components, hypertension was the only risk factor for coronary artery disease. Conclusion: No association was noted between metabolic syndrome and the severity of coronary artery disease.

Treinamento de força e síndrome metabólica: uma revisão sistemática / Resistance training and metabolic syndrome: a systemic review

Intervenções não farmacológicas, como o treinamento de força (TF), vêm sendo recomendadas por diversas instituições de saúde para prevenção e tratamento de doenças crônicas não transmissíveis. Este trabalho tem por objetivo realizar uma revisão sistemática da literatura em relação aos efeitos crônicos do TF sobre os fatores de risco cardiovascular, força muscular, e massa livre de gordura em indivíduos com síndrome metabólica (SM). Foram utilizadas as bases de dados PubMed, SciELO e LILACS. A busca foi restrita ao período de 1988 a 2012. Os termos utilizados para a pesquisa, selecionados segundo a classificação dos Descritores em Ciências da Saúde (DeCS), foram: treinamento resistido, doenças metabólicas e resistance training e metabolic diseases para os idiomas português e inglês, respectivamente. Foram encontrados apenas cinco artigos que demonstraram pouca ou nenhuma alteração na circunferência da cintura, lipídeos séricos, glicemia e pressão arterial. No entanto, grande parte dos artigos evidenciou aumento da força muscular e da massa livre de gordura. A revisão fornece dados que permitem concluir que a SM é uma doença que esta relacionada a diversas doenças cardiovasculares, diabetes, câncer e maior probabilidade de mortalidade. Por outro lado, apesar de a força muscular estar inversamente relacionada ao desenvolvimento da SM, o TF foi pouco efetivo para redução dos fatores de risco cardiovascular em indivíduos com SM.

Non-pharmacological interventions such as resistance training (RT) have recommended by several health organizations for the prevention and treatmentof non-transmissible chronic diseases. This paper offers a systemic review of the literatura adressing the on going effects of RT on cardiovascular risk factors, muscle strength and fat-free mass in individuals with metabolic syndrome (MetS), using the PubMed, Scielo and LILACS database. The search was limited to the period between 1988 and 2012. The search terms consisted of Portuguese and English keywords selected according to the Descriptors in Health Sciences classification: treinamento resistido, doenças metabólicas, and resistance training and metabolic diseases. Only five papers were found that demonstrated few or no alterations to waist circunference, serum lipids, glycemia and blood pressure, although most of them, reported increased muscle strenght and fat-free mass. This review leads to the conclusion that MetS is a disease related to several cardiovascular diseases, diabetes and cancer, higher probable mortality rates. Although muscle strenght is inversely related to the development of MetS, RT was not particularly effective for reducing cardiovascular risk factors in individuals with MetS.

Síndrome Metabólico: un problema de salud con múltiples definiciones / Metabolic syndrome: a health problem with many definitions

El síndrome metabólico comprende un conjunto de factores de riesgo cardiovascular representado por obesidad central, dislipidemias, anormalidades en el metabolismo de la glucosa e hipertensión arterial, estrechamente asociado a resistencia a la insulina; actualmente no existe un criterio único para definirlo. La presente revisión se propuso mostrar los diferentes grupos de criterios diagnósticos que más se utilizan para definir a este síndrome, y las variaciones que existen en su prevalencia en dependencia del criterio utilizado, con posicionamiento de los autores. Se exponen diferentes valoraciones relacionadas con los criterios propuestos por cinco organismos internacionales o locales de expertos, y los resultados de investigaciones internacionales que los utilizan. Se concluyó que a pesar de existir diferentes grupos de criterios para diagnosticar este síndrome, el más utilizado en estudios poblacionales es el del Tercer Reporte del Programa de Educación sobre el colesterol, actualizado en el año 2005; que la prevalencia del síndrome varía en dependencia del criterio que se utiliza, aún en una misma población, y de la población objeto de estudio; que la importancia clínica de su diagnóstico se relaciona con el potencial impacto que tiene en la morbilidad y mortalidad al constituir un indicador de elevado riesgo cardiovascular; y que se necesita un consenso internacional sobre el uso de un mismo criterio para diagnosticar este síndrome de manera uniforme(AU)

The metabolic syndrome comprises a group of cardiovascular risk facts represented by central obesity, dyslipidemias, anomalies in the glucose metabolism and arterial hypertension, tightly associated to the insulin resistance; at the present there is not a unique criteria to define it. The current review was aimed to show the different groups of diagnostic criteria that are used the most to define this syndrome, and the existent variation in its prevalence in dependence of the used criteria, with authors positioning. We expose different valuations related with the criteria proposed by five international or local experts organisms, and the results of the international investigations that use them. We concluded that in spite of that there are different groups of criteria to diagnose this syndrome, the most used one in population studies is the Third Report of the Educational Program on cholesterol, updated in 2005; that the syndrome prevalence changes in dependence of the used criteria; that the clinical importance of the research is related with the potential impact it has in the morbidity and mortality because it is an indicator of high cardiovascular weight; and that we need an international consensus on the usage of a same criteria to diagnose this syndrome in a uniformed way(AU)

Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community.

BACKGROUND: Liver disease continues to be a major cause of morbidity and mortality in sub-Saharan Africa, including Nigeria, due to the high endemicity of viral hepatitis B. However non-alcoholic fatty liver disease may be an important contributory factor. The impact of fatty liver disease in our region has not been evaluated. AIM: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD) among a population of diabetic (DM) subjects attending the endocrine clinic of LASUTH compared with non-diabetic subjects; ascertain other contributing factors and compare the occurrence of the metabolic syndrome in subjects with and without NAFLD. METHODOLOGY: Consecutive patients who satisfy the study criteria were enrolled. An investigator- administered questionnaire was used to determine symptoms of liver disease, followed by physical examination to obtain anthropometric indices as well as signs of liver disease. Abdominal scan was performed to determine radiologic evidence of fatty liver and fasting blood samples were collected from for the measurement of fasting lipid profile, glucose, liver biochemistry and serology for hepatitis B and C markers. RESULTS: One hundred and fifty subjects, mean age 56 years (standard deviation = 9, range 20-80 yr) and gender ratio (F: M) of 83:67(55%:45%), were recruited. 106 were diabetics and 44 non-diabetics. The overall prevalence of NAFLD amongst all study subjects was 8.7%. The prevalence rate of NAFLD was higher in the DM cases than in the Control subjects but this difference was not statistically significant (9.5 vs. 4.5%, p = 0.2). Only one of the subjects with fatty liver disease had elevated transaminase levels (steatohepatitis) and also had type 2 DM. Central obesity as measured by waist circumference (WC) and SGPT levels were significantly higher in people with fatty liver. The mean body mass index (BMI) of diabetic and non-diabetic patients was similar (31 vs. 30 kg/m(2)). The prevalence of the metabolic syndrome was higher in the subjects with NAFLD than in those without fatty liver disease but this difference was not statistically significant (p = 0.8). CONCLUSION: Non-alcoholic fatty liver disease is present in Africa but is less than what one would expect based on American and European studies.

Morbilidad por Síndrome Metabólico en adultos mayores de cinco consultorios / Morbility by metabolic syndrome in elderly patients from five family doctors

La prevalencia actual del Síndrome Metabólico (SM) está aumentando en varios países de diferentes latitudes, convirtiéndose dichas regiones en un problema de salud relevante. De particular interés es la asociación del SM, con el riesgo elevado de mortalidad prematura por enfermedad de las arterias coronarias y cerebrovasculares en ambos sexos y con la incidencia de DM2 en adultos mayores.Objetivo de este trabajo fue caracterizar la morbilidad por Síndrome Metabólico en los adultos mayores, en consultorios seleccionados del Área de Salud Norte de la ciudad de Sancti-Spíritus. Se realizó una investigación descriptiva, observacional y transversal en una muestra probabilística de 116 adultos de 60 y más años de edad, para caracterizar el Síndrome Metabólico en cinco consultorios del área de salud Norte en la ciudad de Sancti-Spíritus, entre noviembre del 2007 y noviembre del 2008.Las variables estudiadas fueron morbilidad, los antecedentes personales y familiares de factores de riesgo y de enfermedades crónicas no trasmisibles, los datos fueron recogidos en un formulario, el análisis estadístico incluyó cálculo de porcentajes, estimación de parámetros y las pruebas de diferencia de proporciones (x2). La prevalencia de Síndrome Metabólico de 40,5 por ciento, principalmente del grupo clínico B (19,8 por ciento), su estratificación mostró predominio entre 65-69 años de edad (47,6 por ciento), sexo femenino (53,2 por ciento), los de piel blanca, con 95,7 por ciento y la escolaridad para la categoría baja (55,3 por ciento). Los antecedentes patológicos personales, para enfermedades crónicas no transmisibles registrados, fueron la hipertensión arterial, con 63,8 por ciento y la diabetes mellitus tipo 2, con 19,1 por ciento, en los antecedentes familiares fueron la cardiopatía isquémica y la enfermedad cerebrovascular, con igual comportamiento (57,4 por ciento) (AU)

Introduction: Nowadays the prevalence of metabolic síndrome (MS) has increased in many countries from different latitudes, becoming a health rpobelm in tose areas. It is particularly interesting the association of MS with the increased risk of premature death by disease of coronary arteries and cerebrovascular diseases, in both genders and with the incidence of DM2 in the elderly.Objectives: To characterize morbility by metabolic syndrome in the elderly in the doctor´s offices selected from the North Health area in the city of sancti Spiritus.Material and method: A descriptive observational and trasversal investigation was done in a probabilistic sample of 116 adults aged 60 or more to characterize the metabolic syndrome in five doctors offices from the north health area of Sancti spiritus city, between November 2007 and November 2008.The variables under study were morbility, sociodemographic, personal and familial antecedents with respect to risk factors and non- transmissible chronic diseases. The data were collected in a form and the statistics analysis included the calculation of percentages, the appraisal of parameters and the test of proportion differences (x2)(AU)Results: the prevalence of the metabolic syndrome of 40,5 por center, mainly in the clinical group B (19,8 por center). Its stratification showed the predominance of the age between 65- 69 years (47,6 por center), the female gender (53,2 por center), the wite race with 95,7 por center and the school level for a low category (55,3 por center).The pathologic antecedents for non- transmissible diseases were hypertension, with 63,8 por center and diabetes mellitus type 2 with 19,1por center. In the familial antecedents it was found out that both ischemic cardiopathies and cerebrovsacular disease had the same behaviour (57,4 por center)(AU)

Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults.

BACKGROUND: To determine socioeconomic status (SES) gradients in the different dimensions of health among elderly Costa Ricans. HYPOTHESIS: SES disparities in adult health are minimal in Costa Rican society. METHODS: Data from the Costa Rican Study on Longevity and Healthy Aging study: 8,000 elderly Costa Ricans to determine mortality in the period 2000-2007 and a subsample of 3,000 to determine prevalence of several health conditions and biomarkers from anthropometry and blood and urine specimens. RESULTS: The ultimate health indicator, mortality, as well as the metabolic syndrome, reveals that better educated and wealthier individuals are worse off. In contrast, quality of life-related measures such as functional and cognitive disabilities, physical frailty, and depression all clearly worsen with lower SES. Overall self-reported health (SRH) also shows a strong positive SES gradient. Traditional cardiovascular risk factors such as diabetes and cholesterol are not significantly related to SES, but hypertension and obesity are worse among high-SES individuals. Reflecting mixed SES gradients in behaviors, smoking and lack of exercise are more common among low SES, but high calorie diets are more common among high SES. CONCLUSIONS: Negative modern behaviors among high-SES groups may be reversing cardiovascular risks across SES groups, hence reversing mortality risks. But negative SES gradients in healthy years of life persist.