Path analysis of urinary incontinence in older adults living in nursing homes / Fatores associados à incontinência urinária em idosos institucionalizados

Objective: To investigate the factors associated with urinary incontinence in older adults living in nursing homes. Methods: This was an exploratory, cross-sectional, observational, and quantitative study using exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. Results: Urinary incontinence was associated with educational level, marital status, hypertension, one or more difficulties in basic activities of daily living, mood, insomnia, loss of appetite, fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence was directly and significantly associated with insomnia and fecal incontinence. Conclusion: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental health aspects to promote the well-being of older adults living in nursing homes. (AU)

Objetivo: Investigar os fatores associados à incontinência urinária em pessoas idosas institucionalizadas segundo a Análise de Caminhos. Metodologia: Trata-se de um estudo transversal. Foram avaliados 86 idosos em Instituições de Longa Permanência para Idosos brasileiras de Salvador (BA) e Brasília (DF), no período entre janeiro e março de 2020, período pré-pandemia de COVID-19. Os fatores analisados incluíram: sexo, faixa etária, desempenho funcional, desempenho cognitivo global, comorbidades e condições de saúde. Resultados: Observou-se que a incontinência urinária esteve associada ao nível de escolaridade, estado civil, hipertensão, uma ou mais dificuldades nas atividades básicas da vida diária, humor, insônia, perda de apetite, incontinência fecal e dificuldade de deglutição. Na Análise de Caminhos, os sintomas depressivos e as dificuldades de deglutição tiveram associação direta com a incontinência urinária, e a incontinência urinária teve associação direta e significativa com a insônia e a incontinência fecal. Conclusão: Dada a variedade de componentes sociais e de saúde associados à incontinência urinária, é necessário avaliar, prevenir, recuperar e reabilitar essa condição nas Instituições de Longa Permanência para Idosos brasileiras. Intervir na incontinência urinária requer ações integradas nos aspectos funcionais, clínicos e de saúde mental, que podem favorecer o bem-estar das pessoas idosas institucionalizadas. (AU)

Association between phase angle of bioelectrical impedance analysis and nutritional parameters in older adults

INTRODUCTION: Phase angle (PhA) is a Bioelectrical impedance analysis (BIA) parameter representing an indicator of cellular health and has been suggested as a biomarker of nutritional status. OBJECTIVE: To evaluate the association between PhA and nutritional parameters in older adults. METHODS: A cross-sectional study was conducted with community-dwelling older adults. Body mass index (BMI), arm muscle circumference (AMC), calf circumference (CC), body fat percentage (BF%), appendicular skeletal muscle mass (ASMM), serum albumin, mini-nutritional assessment (MNA), and PhA were assessed. Kolmogorov­Smirnov test, Spearman's correlation coefficient, chi-square test, and Poisson regression models were performed. RESULTS: 144 participants were included in the study, and most of them were female, aged ≥80 years, and underweight. Most older adults with lower PhA were women, aged range 80­89 years, and with reduced ASMM (p<0.05). PhA presented a significant correlation with age (r=­0.417; p<0.001), ASMM (r=0.427; p<0.001), AMC (r=0.195; p=0.019) and BF% (r=­0.223; p=0.007). Older adults with lower PhA present reduced ASMM (PR: 1.25; 95%CI: 1.04­1.50), and hypoalbuminemia (PR: 1.50; 95%CI: 1.11­2.03). CONCLUSION: PhA is related to commonly nutritional indicators used in clinical practice and could be an important biomarker of muscle mass reserves in community-living older adults of both sexes.

Phase angle as a screening method for sarcopenia in community-dwelling older adults / Ângulo de fase como método de triagem para sarcopenia em idosas ativas de comunidade

ABSTRACT Objective We investigated the utility of the phase angle as a screening tool for sarcopenia. Methods We performed a cross-sectional study that included 169 active community-dwelling elderly women. The phase angle was determined using tetrapolar bioelectrical impedance, and sarcopenia was diagnosed based on skeletal muscle mass, muscle strength, and physical performance using bioelectrical impedance analysis, a handheld dynamometer, and the gait speed test, respectively. Receiver operating characteristic curve analysis was performed to investigate the role of the phase angle as a predictor of sarcopenia. Results The prevalence of sarcopenia was 12.4%. The median phase angle was 5.30°; elderly women with sarcopenia had lower phase angles than those without sarcopenia (p=0.006). The phase angle cutoff for the detection of sarcopenia was ≤5.15°, with an area under the curve of 0.685, sensitivity 81.0%, specificity 60.8%, and accuracy 63.31%. Elderly women with a low phase angle show a high risk of presenting with reduced muscle mass. Conclusions The phase angle was shown to be a useful screening tool in elderly women with sarcopenia.

RESUMO Objetivo Avaliar o ângulo de fase como método de triagem para sarcopenia. Métodos Estudo transversal realizado com 169 idosas ativas de comunidade. O ângulo de fase foi obtido por bioimpedância elétrica tetrapolar e a sarcopenia foi diagnosticada a partir da massa muscular esquelética, força muscular e performance física utilizando bioimpedância elétrica, dinamometria manual e o teste de velocidade de marcha, respectivamente. A curva Receiver Operating Characteristic foi construída para avaliar o ângulo de fase como preditor de sarcopenia. Resultados A prevalência de sarcopenia foi de 12,4%. A mediana do ângulo de fase foi de 5,30°; idosas com sarcopenia apresentaram valores menores do ângulo de fase em relação às não sarcopênicas (p=0,024). O ponto de corte do ângulo de fase para identificar sarcopenia foi ≤5,15°, com área sob a curva de 0,685, sensibilidade de 81,0%, especificidade de 60,8% e acurácia de 63,31%. Observou-se que idosas com ângulo de fase reduzido apresentaram maior chance de terem massa muscular reduzida e sarcopenia. Conclusão O ângulo de fase se mostrou útil para triagem de idosas com sarcopenia.

A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients.

RATIONALE: Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients. METHOD: 432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann-Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL. RESULTS: 37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (ßo = - 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship. CONCLUSION: Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.

The use of bioelectrical impedance vector analysis for a nutritional evaluation of older adults in the community.

INTRODUCTION: The body composition of an older adult person is characterized by an increase in body fat, as well as by a reduction in both muscle mass and total body water. The bioelectrical impedance vector analysis (BIVA) overcomes the limits imposed by bioelectrical impedance, since it only requires the resistance (R) and reactance (Xc) values, standardized by the individual's height, which makes the method more individualized and accurate. The aim of this study was to evaluate the body composition using the BIVA of the community-living older adults, with regard to sex and body mass index (BMI) classification, and compare the results with the reference population. METHODS: Cross-sectional study with the community-living older adults of both sexes. Bioimpedance was carried out and the R and Xc data analyzed, based on height, and plotted on RXc graphs. RESULTS: One hundred and forty-four older adults (n = 33 men; n = 111 women; mean age of 80.2 ± 9.2 years) participated in the study. Low weight (<23 kg/m2) was the most prevalent in BMI classification. The older adult women presented a higher average BMI, body fat percentage and R/Height values, while the older adult men presented a higher average for fat-free mass and the phase angle (p < 0.05). The older adult, regardless of their BMI, located in the right quadrant, indicated cachexia; those with low weight were dehydrated, and those with overweight (BMI ≥ 28 kg/m2) presented hyperhydration. CONCLUSION: The majority of the older adults with normal weight or overweight has impedance vectors indicating loss of muscle mass and water imbalance (dehydration or hyperhydration).

Sarcopenic obesity in community-dwelling older women, determined by different diagnostic methods / Obesidad sarcopénica en mujeres mayores que viven en la comunidad, determinada por diferentes métodos de diagnóstico

Background: sarcopenic obesity (SO) decreases functional capacity, favors loss of autonomy, and is associated with increased mortality in the elderly. The prevalence of sarcopenic obesity differs according to the chosen diagnostic method and/or the population studied. Objective: to identify sarcopenic obesity in community-dwelling elderly women using different diagnostic methods. Methods: this is a cross-sectional study involving 138 elderly women enrolled in an Open University of the Third Age. Sarcopenia was defined according to three criteria: a skeletal muscle index (SMI) = 6.42 kg/m²; reduced muscle strength, defined by handgrip strength (HS) < 20 kg/f; and reduced physical performance, determined by a usual gait speed (GS) < 0.8 m/s. Obesity was diagnosed when body mass index (BMI)  > 28 kg/m², waist circumference (WC)  > 88 cm, total body fat percentage (TBF%) determined by bioelectric impedance analysis (BIA) = 38%, and value for triceps skinfold (TS) = 85th percentile. Sarcopenic obesity is the coexistence of sarcopenia and obesity. Results: the prevalence of sarcopenia and severe sarcopenia was 14.5% and 3.6%, respectively. The highest prevalence of obesity was found using WC (69.6%) and TBF% (52.9%) (p < 0.001). The highest prevalence of sarcopenic obesity was found using TBF% (9.4%) and WC (6.5%) (p < 0.001). Sarcopenic obesity according to BMI was only 0.7%. Conclusion: the prevalence of sarcopenic obesity was high and depended on the diagnostic criteria applied. The association of TBF% with the diagnosis of sarcopenia was the method that identified the highest prevalence of sarcopenic obesity

Antecedentes: la obesidad sarcopénica (SO) disminuye la capacidad funcional, favorece la pérdida de autonomía y se asocia a mayor mortalidad en los ancianos. La prevalencia de la obesidad sarcopénica difiere según el método de diagnóstico elegido y/o la población estudiada. Objetivo: identificar la obesidad sarcopénica en mujeres ancianas que viven en la comunidad utilizando diferentes métodos de diagnóstico. Métodos: este es un estudio transversal en el que participaron 138 mujeres ancianas inscritas en una Universidad Abierta de la Tercera Edad. La sarcopenia se definió de acuerdo con tres criterios: un índice de músculo esquelético (SMI) = 6.42 kg/m²; fuerza muscular reducida, definida por una fuerza de empuñadura (HS) < 20 kg/f, y rendimiento físico reducido, determinado por una velocidad de marcha habitual (GS) < 0,8 m/s. La obesidad se diagnosticó si: índice de masa corporal (IMC)  > 28 kg/m², perímetro de la cintura (WC)  > 88 cm, porcentaje de grasa corporal total (TBF%) determinado por análisis de impedancia bioeléctrica (BIA) = 38%, y valor de pliegue cutáneo del tríceps (TS) = percentil 85. La obesidad sarcopénica es la coexistencia de sarcopenia y obesidad. Resultados: la prevalencia de la sarcopenia y la sarcopenia severa fue del 14,5% y 3,6%, respectivamente. La mayor prevalencia de obesidad se encontró mediante el WC (69,6%) y el porcentaje de TBF (52,9%) (p < 0,001). La prevalencia más alta de obesidad sarcopénica se encontró utilizando el % de TBF (9,4%) y el WC (6,5%) (p < 0,001). La obesidad sarcopénica según el IMC fue solo del 0,7%. Conclusión: la prevalencia de la obesidad sarcopénica fue alta y dependió de los criterios diagnósticos aplicados. La asociación del TBF% con el diagnóstico de sarcopenia fue el método que identificó la prevalencia más alta de obesidad sarcopénica

Sarcopenic obesity in community-dwelling older women, determined by different diagnostic methods.

INTRODUCTION: Background: sarcopenic obesity (SO) decreases functional capacity, favors loss of autonomy, and is associated with increased mortality in the elderly. The prevalence of sarcopenic obesity differs according to the chosen diagnostic method and/or the population studied. Objective: to identify sarcopenic obesity in community-dwelling elderly women using different diagnostic methods. Methods: this is a cross-sectional study involving 138 elderly women enrolled in an Open University of the Third Age. Sarcopenia was defined according to three criteria: a skeletal muscle index (SMI) ≤ 6.42 kg/m²; reduced muscle strength, defined by handgrip strength (HS) < 20 kg/f; and reduced physical performance, determined by a usual gait speed (GS) < 0.8 m/s. Obesity was diagnosed when body mass index (BMI) > 28 kg/m², waist circumference (WC) > 88 cm, total body fat percentage (TBF%) determined by bioelectric impedance analysis (BIA) ≥ 38%, and value for triceps skinfold (TS) ≥ 85th percentile. Sarcopenic obesity is the coexistence of sarcopenia and obesity. Results: the prevalence of sarcopenia and severe sarcopenia was 14.5% and 3.6%, respectively. The highest prevalence of obesity was found using WC (69.6%) and TBF% (52.9%) (p < 0.001). The highest prevalence of sarcopenic obesity was found using TBF% (9.4%) and WC (6.5%) (p < 0.001). Sarcopenic obesity according to BMI was only 0.7%. Conclusion: the prevalence of sarcopenic obesity was high and depended on the diagnostic criteria applied. The association of TBF% with the diagnosis of sarcopenia was the method that identified the highest prevalence of sarcopenic obesity.

INTRODUCCIÓN: Antecedentes: la obesidad sarcopénica (SO) disminuye la capacidad funcional, favorece la pérdida de autonomía y se asocia a mayor mortalidad en los ancianos. La prevalencia de la obesidad sarcopénica difiere según el método de diagnóstico elegido y/o la población estudiada. Objetivo: identificar la obesidad sarcopénica en mujeres ancianas que viven en la comunidad utilizando diferentes métodos de diagnóstico. Métodos: este es un estudio transversal en el que participaron 138 mujeres ancianas inscritas en una Universidad Abierta de la Tercera Edad. La sarcopenia se definió de acuerdo con tres criterios: un índice de músculo esquelético (SMI) ≤ 6.42 kg/m²; fuerza muscular reducida, definida por una fuerza de empuñadura (HS) < 20 kg/f, y rendimiento físico reducido, determinado por una velocidad de marcha habitual (GS) < 0,8 m/s. La obesidad se diagnosticó si: índice de masa corporal (IMC) > 28 kg/m², perímetro de la cintura (WC) > 88 cm, porcentaje de grasa corporal total (TBF%) determinado por análisis de impedancia bioeléctrica (BIA) ≥ 38%, y valor de pliegue cutáneo del tríceps (TS) ≥ percentil 85. La obesidad sarcopénica es la coexistencia de sarcopenia y obesidad. Resultados: la prevalencia de la sarcopenia y la sarcopenia severa fue del 14,5% y 3,6%, respectivamente. La mayor prevalencia de obesidad se encontró mediante el WC (69,6%) y el porcentaje de TBF (52,9%) (p < 0,001). La prevalencia más alta de obesidad sarcopénica se encontró utilizando el % de TBF (9,4%) y el WC (6,5%) (p < 0,001). La obesidad sarcopénica según el IMC fue solo del 0,7%. Conclusión: la prevalencia de la obesidad sarcopénica fue alta y dependió de los criterios diagnósticos aplicados. La asociación del TBF% con el diagnóstico de sarcopenia fue el método que identificó la prevalencia más alta de obesidad sarcopénica.

Blood count parameters as a marker for metabolic syndrome in older adults.

BACKGROUND AND AIM: Blood count parameters are associated with the metabolic syndrome (MS). However, few studies have evaluated the precision of blood count components to identify MS in older adults. We evaluated the accuracy of blood count components as a screening method and a marker of MS in older adults. METHODS AND RESULTS: A cross-sectional study with 203 older adults of both sexes was conducted. The following variables were used: MS as defined by harmonized criteria, hemoglobin, hematocrit, leukocytes and platelets. Area under the receiver operating characteristic (ROC) curve, sensitivity (sens), specificity (spec) and logistic regression were adjusted for age and sex. Leukocyte count showed the highest Youden's index value for MS screening, with an optimal cut-off point of 7.514103/mm3 (sens: 66.7%; spec: 72.0%) for men and 5.626103/mm3 (sens: 73.1%; spec: 42.4%) for women. Older adults with leukocyte count higher than these cut-off points presented a 2.4 times greater chance of developing MS. CONCLUSION: Leukocyte count can be used as a screening indicator to identify individuals with a higher risk of developing MS. Older adults with high leukocyte count and no associated chronic diseases should receive attention, as they are individuals with a potential risk for MS.

Preditores de Síndrome Metabólica em Idosos: Uma Revisão / Predictors of Metabolic Syndrome in the Elderly: A Review

O artigo teve como objetivo analisar criticamente estudos que avaliaram a habilidade dos indicadores antropométricos e clínicos enquanto capazes de predizer a SM em idosos. Foi realizado uma pesquisa bibliográfica nas bases de dados Medline/PubMed, LILACS e SciELO, além das referências de artigos selecionados e contato com autores. Foram analisados 21 artigos envolvendo indicadores antropométricos e clínicos em idosos, através de diferentes critérios da SM. Catorze estudos reportam aos indicadores antropométricos, sendo a circunferência da cintura (CC) e a razão cintura-estatura (RCEst) descritos como os melhores preditores de SM, com área sob a curva ROC (AUC) superior a 0,70 (p < 0,05). A circunferência do pescoço também foi descrita como indicador alternativo, porém com menor poder discriminatório. Para os indicadores clínicos, o lipid product accumulation (LAP) foi o parâmetro com melhor desempenho em identificar a SM em idosos, com AUC superior 0,85 e eficiência superior a 70%. Os indicadores CC, RCEst e LAP foram os mais sensiveis na predicação da SM. Desta forma, o emprego desses parâmetros podem facilitar a identificação precoce da SM através de métodos diagnósticos de fácil aplicação, boa precisão e baixo custo. Além disso, é importante a determinação de pontos de corte específicos para idosos, uma ver que a obesidade por si só, parece não ser forte preditor de SM em idosos

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.

Factors associated with sarcopenia in institutionalized elderly / Factores asociados con la presencia de sarcopenia en ancianos institucionalizados

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% = 1,08- 1,65), 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 (AU)

Introducción: la sarcopenia es un aspecto negativo para la salud de las personas mayores, aumenta el riesgo de enfermedad y mortalidad. Además puede contribuir en gran medida a la reducción de la capacidad funcional y calidad de vida. Objetivo: identificar la prevalencia y los factores asociados con la sarcopenia en los ancianos institucionalizados. Métodos: se trata de un estudio transversal, realizado con 216 personas de edad avanzada (≥ 60 años), de ambos sexos, residentes en centros de atención a largo plazo en Salvador-Bahia, Brasil. Para identifi car la sarcopenia se utilizó el índice musculoesquelético. Se consideraron covariables: género, edad, tiempo de institucionalización, tipo de institución, índice de masa corporal y la capacidad funcional. La asociación entre la sarcopenia y covariables se evaluó utilizando el modelo de regresión de Poisson con varianza robusta. Resultados: la prevalencia de la sarcopenia en los ancianos fue de 72,2% y esta condición se asocia con el sexo masculino (RP = 1,33; IC del 95% = 1,08-1,65), la delgadez (RP = 1,29; IC del 95 % = 1,16-1,43) y la obesidad (RP = 0,37; IC del 95% = 0,23-0,61). Conclusión: la prevalencia de la sarcopenia fue alta entre los ancianos que viven en instituciones de larga duración, especialmente entre los hombres. Los ancianos con delgadez mostraron un mayor deterioro en las reservas musculares, mientras que los obesos mostraban una mayor protección muscular (AU)

Correction: Factors Associated with Anemia in the Institutionalized Elderly.

[This corrects the article DOI: 10.1371/journal.pone.0162240.].

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.

Anthropometric clinical indicators in the assessment of visceral obesity: an update / Indicadores clínicos antropométricos na avaliação da gordura visceral: uma atualização

Introduction: Visceral obesity is associated with an increased risk of metabolic disorders and occurrence of chronic diseases. The quantification of the visceral fat becomes necessary and advantageous in clinical practice, especially through accurate and precise methods in replacement of imaging methods as computed tomography (CT). Objective: To present the use of anthropometric indicators that have been linked to visceral fat. Methods: The selection of items was taken in from Scopus, Scielo, Lilacs, CAPES journals, PubMed/ MEDLINE and Google Scholar, in the period between 2007 and 2014. Anthropometric and clinical indicators as waist circumference (WC), waist- to- height ratio (WHtR), waist-to- thigh ratio (WTR), waist- to- hip ratio (WRH), sagittal abdominal diameter (SAD), abdominal diameter height index (SAD/ Height), abdominal diameter index (ADI), conicity index (CI), visceral adiposity index (VAI) and the lipid accumulation production (LAP) were investigated for their relationship with visceral fat measured by CT. Results: Most indicators have strong correlation (r>0.70) with visceral fat. It was observed that there are few recent studies evaluating this relationship, especially with the indices derived of the WC and the SAD, besides the LAP and the VAI. Most studies investigated the relationship between these indicators with the diseases that are consequent of the visceral obesity. Conclusion: The clinical anthropometric indicators are accurate in estimating visceral obesity, easy to use and has low cost enabling clinical nutritional assessment able to intervene earlier and more effectively in the prevention and/or treatment of this obesity (AU)

Introdução: A obesidade visceral está associada a um risco maior de distúrbios metabólicos e ocorrência de doenças crônicas. A quantificação da gordura visceral torna-se necessária e vantajosa na prática clínica, sobretudo por métodos acurados e precisos em substituição aos métodos por imagem, como a tomografia computadorizada (TC). Objetivo: Descrever a utilização de indicadores clínicos antropométricos que têm sido relacionados à gordura visceral. Métodos: A seleção dos artigos foi feita no Scopus, Scielo, Lilacs, periódicos Capes, Pubmed/Medline e Google Acadêmico, no período entre 2007 e 2014. Indicadores clínicos antropométricos como circunferência da cintura (CC), Razão cintura altura (RCA), Razão cintura coxa (RCCx), Razão Cintura Quadril (RCQ), Diâmetro abdominal sagital (DAS), Diâmetro abdominal altura (DAS/ALT), Índice Diâmetro abdominal (IDA), Índice conicidade (IC), Índice de adiposidade visceral (IAV) e o Produto de acumulação lipídica (PAL) foram investigados quanto sua relação com o tecido adiposo visceral medido pela TC. Resultados: A maioria dos indicadores tem forte correlação (r>0.70) com a gordura visceral. Observou-se que há poucos estudos recentes que avaliaram essa relação, sobretudo com os índices derivados da CC e do DAS, além do PAL e o IAV. A maioria dos estudos investigou a relação entre esses indicadores com as doenças que são consequentes da obesidade visceral. Conclusão: Os indicadores clínicos antropométricos são acurados na estimativa da gordura visceral, fáceis de utilizar e apresentam baixo custo possibilitando uma tomada de decisão na avaliação clínica nutricional capaz de intervir mais precoce e efetivamente na prevenção de risco de doenças (AU)

Nutritional status of institutionalized elderly Brazilians: a study with the mini nutritional assessment / Estado nutricional de ancianos brasileños institucionalizados: un estudio con el mini nutritional assessment

Objective: To assess the nutritional status of elderly living in nursing homes in the city of Salvador, Brazil and associated factors. Methods: Cross-sectional study performed with 359individuals of both sexes, ages equal or over 60 years old, located in Nursing Homes in the urban area of the city of Salvador, Bahia, Brazil. Results: Regarding nutritional status according to Mini Nutritional Assessment (MNA), 66.3% of the evaluated elderly were malnourished and at risk of malnutrition. When comparing sexes, it has been observed that among men the prevalence of this condition (76.6%) was higher than in women (62.4%). It has been observed, as a result of the multivariate analysis, that only the variable functional capacity for Activities of Daily Living (ADL)was statistically significant. There was moderate correlation between MNA and Mini-Mental State Examination(r=0.454; p<0.0001), as well as between MNA and the ADL scale (r=0.569; p<0.0001). There was weak negative correlation between MNA total score and age (r=0.159;p=0.002).Conclusion: Malnutrition and malnutrition risk were conditions of remarkable importance, with almost two thirds of the elderly in this situation. ADL functional capacity must be monitored given their close relationship with the nutritional status of the elderly. An interdisciplinary approach in the context of institutionalization is needed due to the association between nutritional status and variables of different dimensions (AU)

Objective: Evaluar el estado nutricional de los ancianos residentes en Hogares para Ancianos, en la ciudad de Salvador, Brasil y factores asociados. Métodos: Estudio transversal con 359 individuos mayores de 60 años, de ambos sexos y residentes en hogares de ancianos en la zona urbana de la ciudad de Salvador, Bahia, Brasil. Resultados: En cuanto al estado nutricional de acuerdo con Mini Nutritional Assessment (MNA), el 66,3% de los ancianos evaluados estaban desnutridos y en riesgo de desnutrición. La prevalencia de esta afección fue mayor entre los hombres (76,6%) en comparación con las mujeres (62,4%). Se ha observado, como resultado del análisis multivariado, que sólo la capacidad funcional variable para Actividades de la Vida Diaria (AVD) fue estadísticamente significativa. Hubo correlación moderada entre MNA y Mini Examen del Estado Mental (r = 0,454; p <0,0001), así como entre MNA y la escala AVD (r = 0,569; p <0,0001). Hubo correlación débil negativa entre la puntuación total del MNA y la edad (r = 0,159; p = 0,002). Conclusión: La desnutrición y el riesgo de desnutrición fueron de importancia excepcional de las condiciones, porque casi dos tercios de los ancianos estaban en esta situación. La capacidad funcional para AVD debe ser supervisada por su estrecha relación con el estado nutricional de las personas mayores. Un enfoque interdisciplinario en el contexto de la institucionalización es necesario debido a la asociación entre el estado nutricional y variables de diferentes dimensiones (AU)

Anthropometric indicators associated with hypertriglyceridemia in the prediction of visceral fat / Indicadores antropométricos associados a hipertrigliceridemia na predição de gordura visceral

The accumulation of visceral fat is strongly associated with cardiometabolic changes. Alternative methods, such as the association between anthropometric indicators and hypertriglyceridemia, are used as the best estimate for the accumulation of visceral fat, preventing cardiovascular diseases. The aim of this study was to evaluate the association of anthropometric indicators with hypertriglyceridemia in the prediction of visceral fat in men and women. This was a cross-sectional study conducted with 192 individuals, of both genders, submitted to anthropometric evaluation (sagittal abdominal diameter [SAD], waist circumference [WC], and waist-hip ratio [WHR]), serum dosage of triglycerides (TG), and computed tomography scan, in order to measure the visceral adipose tissue (VAT) area. Descriptive analysis, Pearson's Correlation, and multiple linear regression were performed. Anthropometric indicators had high correlation with the VAT area (p=0.000). Regardless of serum TG levels, individuals with high values of anthropometric indicators had excess VAT area (p<0.05). For every centimeter increased in SAD, there was an average increase of 12.46 cm² in the VAT area. The study showed that both SAD and WC were good indicators to explain the variability in the VAT area, independently of changes in TG levels, making it possible to identify individuals with a risk of developing cardiovascular diseases.

O acúmulo de gordura visceral está fortemente associada com alterações cardiometabólicas. Métodos alternativos, como a associação de indicadores antropométricos e hipertrigliceridemia, são usados ​​como uma melhor estimativa para o acúmulo de gordura visceral, prevenindo doenças cardiovasculares. O objetivo foi avaliar a associação entre indicadores antropométricos com a hipertrigliceridemia para predição de gordura visceral em homens e mulheres. Estudo transversal, realizado com 192 indivíduos, de ambos os sexos, que foram submetidos à avaliação antropométrica (Diâmetro Abdominal Sagital -DAS, Circunferência da Cintura -CC e Relação Cintura-quadril -RCQ), dosagem sérica de triglicérides (TG) e tomografia computadorizada, a fim de medir a área do tecido adiposo visceral (ATAV). Análise descritiva, Correlação de Pearson e Regressão Linear Múltipla foram realizados. Indicadores antropométricos apresentaram alta correlação com a ATAV (p=0,000). Independente do nível sérico de TG, os indivíduos com indicadores antropométricos elevados tinham excesso de ATAV (p<0,05). Para cada aumento de um centímetro no DAS, houve um aumento médio de 12,46 cm² de ATAV. O estudo mostrou que ao mesmo tempo, DAS e CC foram os melhores indicadores para explicar a variabilidade na ATAV, independentemente de mudanças no nível de triglicérides, o que possibilitou a identificação de indivíduos com risco de desenvolver doenças cardiovasculares.

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.

Hypertriglyceridemic waist phenotype: association with metabolic disorders and visceral fat in adults / Fenotipo cintura hipertrigliceridémica: relación entre cambios metabólicos y grasa visceral en adultos

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 cardiovascular 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 (AU)

Objetivo: Evaluar la relación entre Cintura Hipertrigliceridémica (CHT) con cambios metabólicos y grasa visceral en adultos. Métodos: Estudio transversal con 191 personas de ambos sexos. Los participantes fueron agrupados según clasificación de Circunferencia de Cintura (CC) (Hombres: > 90 cm; Mujeres: > 80 cm) y triglicéridos séricos (TG) (>150 mg/dl) en el Grupo 1 (Fenotipo CHT): Elevación en CC y TG; Grupo 2 (ausencia del Fenotipo CHT): Aumento en CC y TG normal, o CC normal y TG elevado o CC y TG normales. Cambios metabólicos, área del tejido adiposo visceral (TAV) y índice de grasa visceral/subcutáneo (GV/GS), medidas por tomografía computadorizada, fueron evaluados como factores de riesgo cardiovascular entre los grupos. Resultados: De los participantes con el Fenotipo CHT, 82% presentaban tres o más factores de riesgo cardiovascular. La relación entre los factores de riesgo cardiovascular y el Fenotipo CHT demostró que entre los hombres 73,7% presentaban hipercolesterolemia, 94,9% noHDLc elevado y 78,9% exceso de área TAV (p = 0,001). Entre las mujeres, 65% presentaban presión arterial sistólica alta, 80% hipercolesterolemia y 90% no-HDLc elevado (p < 0,02). Conclusión: El Fenotipo CHT se relacionó con cambios metabólicos y exceso de TAV. Personas con CHT presentaron más factores de riesgo cardiovascular. La Cintura Hipertrigliceridémica puede ser utilizada en la práctica clínica para investigar el riesgo cardiovascular y el depósito del tejido adiposo visceral en las personas (AU)

Discriminatory power of indicators predictors of visceral adiposity evaluated by computed tomography in adults and elderly individuals / Poder discriminatorio de los indicadores predictores de adiposidad visceral evaluados mediante tomografía en los adultos y las personas de edad avanzada

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 (AU)

Introducción: La identificación de métodos antropométricos de adiposidad abdominal, los predictores de exceso del tejido adiposo visceral (TAV) permiten una evaluación rápida y de bajo costo del riesgo de enfermedades cardiovasculares en ancianos. Objetivo: Evaluar el poder discriminatorio de los indicadores antropométricos para la detección de exceso del tejido adiposo visceral. Métodos: Estudio transversal compuesto por 194 adultos y ancianos para la comparación entre ambos sexos y por grupos de edad. Las variables antropométricas: Razón cintura/estatura (RCE), Razón cintura/muslo (RCM), el Índice Diámetro Abdominal (SAD/muslo) e el Índice diámetro abdominal altura (SAD/estatura). El área TAV fue identificado por tomografía computarizada. Análisis con la curva ROC. Resultados: Se observó una alta correlación entre el área del tejido adiposo visceral y la mayoría de los indicadores antropométricos (p ≤ 0,001). Entre los hombres de edad avanzada, la razón cintura/estatura mostró áreas bajo la curva ROC por encima de 0,90 y puntos de corte de 0,55 (sens: 85,7%, espec: 82,4%, VPP: 99,9%). Para las mujeres de edad avanzada, el corte fue de 0,58 (sens: 81,0%, espec: 78,6%). Para SAD/estatura, las áreas bajo la curva ROC fueron ≥ 0,83 (p ≤ 0,01), con puntos de corte de 0,12 para hombres y 0,13 para las mujeres. Conclusión: Había se ha observado un fuerte poder discriminatorio de los indicadores antropométricos de obesidad abdominal visceral. La Razón cintura/altura y el diámetro abdominal estatura mostraron un mejor desempeño para predecir la área de TAV de riesgo en los ancianos, sin la necesidad de medirla por tomografía computarizada (AU)

[Bioelectrical impedance and visceral fat: a comparison with computed tomography in adults and elderly]. / 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 Pearson's Correlation Coefficient, Anova, Pearson's 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.