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Que relação entre a razão apoB/apoA1, a Síndrome Metabólica e a história familiar de doença cardiovascular em adolescentes obesos?
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Introdução – A Síndrome Metabólica (SM) tornou-se num dos maiores desafios mundiais de saúde pública. Ultimamente tem-se dado uma importância crescente ao papel das apolipoproteínas como marcadores de aterosclerose e risco cardiovascular.
Objectivos – Comparar os percentis de perímetro da cintura de Fernandez et al. com os de Sardinha et al., específicos para os adolescentes portugueses; Comparar os valores da razão apoB/apoA1 de adolescentes obesos com e sem SM; Estudar a relação entre a razão apoB/apoA1 em adolescentes obesos e a presença de antecedentes familiares de doença cardiovascular (DCV).
Metodologia – Estudo transversal, observacional e analítico, em adolescentes obesos e pré-obesos, entre os 12 e os 18 anos de idade, acompanhados entre Março de 2010 e Outubro de 2013, na Consulta de Obesidade Pediátrica do Departamento de Pediatria do Hospital de Santa Maria. Os valores das variáveis antropométricas e restantes marcadores bioquímicos foram recolhidos à data da consulta mais próxima das análises do perfil lipídico, independentemente de se tratar de uma consulta de primeira vez ou de seguimento.
Resultados – A amostra incluiu 108 indivíduos entre os 12 e 18 anos (14,73 ± 1,51 anos) sendo 52,8% do sexo feminino e 87,6% preenchendo critérios de obesidade (IMC ≥ P97). O critério de diagnóstico de SM mais prevalente foi o perímetro da cintura ≥ P90. A prevalência de SM utilizando-se os percentis de Sardinha (25,9%), foi superior à encontrada utilizando os de Fernandez (21,3%) (p=0,025), verificando-se também diferenças entre géneros, com prevalência superior no sexo masculino (p=0,038). Os adolescentes com SM apresentaram valores significativamente superiores de peso (p=0,019), IMC (p=0,012), perímetro da cintura (p= 0,021), pressão arterial sistólica (0,000), coltotal/HDL (p=0,002), triglicéridos (p=0,000), e inferiores de HDL (p=0,007). Encontraram-se diferenças significativas na prevalência de SM entre os quartis da razão apoB/apoA1 (p=0,004). Não se verificaram diferenças significativas entre os valores das apolipoproteínas dos indivíduos com e sem antecedentes familiares de DCV.
Conclusão – Sugere-se a necessidade de investigações futuras de base populacional, que investiguem a associação entre as apolipoproteínas e a SM na população pediátrica portuguesa.
Background – Metabolic Syndrome (MS) has become a major public health challenge. Apolipoproteins have been linked to atherosclerosis and recently suggested as an alternative to lipoproteins in prediction of cardiovascular risk. Aims – To compare the different age- and gender-specific waist circumference references curves, proposed by Fernandez including European-American and by Sardinha including Portuguese adolescents; to compare apolipoproteins concentrations between obese adolescents with or without MS; to assess whether apoB/apoA1 ratio is associated or not with family history of heart disease; Methods – Observational cross-sectional study, including adolescents between 12 and 18 years old attending an Obesity Management Program specifically designed for overweight and obese adolescents in a central hospital. Gender, age, anthropometric and biochemical markers were collected and all blood evaluations were performed at least after a 12 hour fasting period. Results – Of the 108 adolescents studied, median age 14,7 years, 52,8% were girls, 87,6% were classified as obese (BMI≥P97) and the remaining as overweight. Increased waist circumference was the most prevalent MS criteria and no adolescent presented hyperglycemia or fulfilled the five MS criteria. 25,9% of the adolescents presented MS according to Sardinha’s reference curves. This value was significantly higher than when Fernandez’s percentiles were used (p=0,025). There was a significant difference of MS prevalence between genders, with males showing a higher prevalence (p=0,038). Adolescents with MS presented significantly higher weight (p=0,019), BMI (p=0,012), waist circumference (p= 0,021), systolic blood pressure (0,000), total cholesterol/HDL ratio (p=0,002) and triglycerides (p=0,000), and lower HDL (p=0,007). Significantly MS prevalence differences were found between apoB/apoA1 quartiles (p=0,004). No differences were found according to a positive family history of heart disease. Conclusions – There is need for a populational-based study that aims to assess whether the apoB/apoA1 ratio is associated with metabolic syndrome in the Portuguese pediatric population.
Background – Metabolic Syndrome (MS) has become a major public health challenge. Apolipoproteins have been linked to atherosclerosis and recently suggested as an alternative to lipoproteins in prediction of cardiovascular risk. Aims – To compare the different age- and gender-specific waist circumference references curves, proposed by Fernandez including European-American and by Sardinha including Portuguese adolescents; to compare apolipoproteins concentrations between obese adolescents with or without MS; to assess whether apoB/apoA1 ratio is associated or not with family history of heart disease; Methods – Observational cross-sectional study, including adolescents between 12 and 18 years old attending an Obesity Management Program specifically designed for overweight and obese adolescents in a central hospital. Gender, age, anthropometric and biochemical markers were collected and all blood evaluations were performed at least after a 12 hour fasting period. Results – Of the 108 adolescents studied, median age 14,7 years, 52,8% were girls, 87,6% were classified as obese (BMI≥P97) and the remaining as overweight. Increased waist circumference was the most prevalent MS criteria and no adolescent presented hyperglycemia or fulfilled the five MS criteria. 25,9% of the adolescents presented MS according to Sardinha’s reference curves. This value was significantly higher than when Fernandez’s percentiles were used (p=0,025). There was a significant difference of MS prevalence between genders, with males showing a higher prevalence (p=0,038). Adolescents with MS presented significantly higher weight (p=0,019), BMI (p=0,012), waist circumference (p= 0,021), systolic blood pressure (0,000), total cholesterol/HDL ratio (p=0,002) and triglycerides (p=0,000), and lower HDL (p=0,007). Significantly MS prevalence differences were found between apoB/apoA1 quartiles (p=0,004). No differences were found according to a positive family history of heart disease. Conclusions – There is need for a populational-based study that aims to assess whether the apoB/apoA1 ratio is associated with metabolic syndrome in the Portuguese pediatric population.
Descrição
Tese de mestrado, Doenças Metabólicas e Comportamento Alimentar, Faculdade de Medicina, Universidade de Lisboa, 2014
Palavras-chave
Síndrome metabólica Adolescentes Obesidade pediátrica Apolipoproteínas Risco cardiovascular Teses de mestrado - 2014