RESUMO
OBJETIVO: Verificar a diferença na proporção de adolescentes com síndrome metabólica, diagnosticados por três diferentes critérios, bem como com a utilização da resistência à insulina no lugar da glicemia de jejum. MÉTODOS: Estudo transversal com 121 adolescentes obesos, de 10 a 14 anos de idade, da rede municipal de ensino de Porto Alegre, em 2011. Foram realizadas avaliações antropométricas, de pressão arterial e bioquímicas. A síndrome metabólica foi definida por três critérios diagnósticos diferentes: International Diabetes Federation, Cook e de Ferranti. Todos eles incluem cinco componentes: perímetro abdominal, pressão arterial, lipoproteína de alta densidade (HDL) colesterol, triglicerídeos e glicemia em jejum, sendo necessária a alteração de pelo menos três para o diagnóstico da síndrome. Para a caracterização da resistência à insulina, foi utilizado o índice Homeostasis Model Assessment - Insulin Resistance. A análise de concordância entre os critérios foi realizada pela estatística de Kappa. RESULTADOS: A síndrome metabólica foi observada em 39,7, 51,2 e 74,4% dos adolescentes, de acordo com as definições da International Diabetes Federation, Cook e de Ferranti, respectivamente. Houve concordância do diagnóstico para os três critérios, simultaneamente, em 60,3% da amostra. O componente mais prevalente foi o perímetro abdominal elevado (81,0, 81,0 e 96,7%), e o menos prevalente foi a glicemia em jejum elevada (7,4, 1,7 e 1,7%). A utilização do Homeostasis Model Assessment - Insulin Resistance aumentou significativamente a proporção de diagnósticos positivos para a síndrome. CONCLUSÃO: Os resultados mostraram considerável diferença entre os três critérios diagnósticos. Enquanto não houver consenso em relação aos critérios da síndrome metabólica, serão frequentes as divergências quanto à prevalência da doença em populações pediátricas.
OBJECTIVE: To investigate the difference in the proportion of adolescents with metabolic syndrome diagnosed based on three different criteria, as well as the use of insulin resistance instead of fasting glucose. METHODS: Cross-sectional study with 121 obese adolescents, between 10 and 14 years old, from public schools of the city of Porto Alegre, Brazil, in 2011. Anthropometric, blood pressure, and biochemical variables were assessed. Metabolic syndrome was defined using three different diagnostic criteria: the International Diabetes Federation (IDF), Cook and de Ferranti. All of them include five components: waist circumference, blood pressure, high-density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose, and there should be at least three abnormal results for the diagnosis of the syndrome. The Homeostasis Model Assessment - Insuline Resistance (HOMA-IR) was used for the characterization of insulin resistance. The analysis of agreement among the criteria was performed using Kappa statistics. RESULTS: Metabolic syndrome was diagnosed in 39.7, 51.2, and 74.4% of adolescents, according to the IDF, Cook and de Ferranti criteria, respectively. There was agreement for the three diagnostic criteria in 60.3% of the sample. Waist circumference was the most prevalent component (81.0, 81.0, and 96.7%), whereas high fasting glucose was the least prevalent (7.4, 1.7, and 1.7%). The use of HOMA-IR significantly increased the proportion of positive diagnoses for the syndrome. CONCLUSION: The results showed significant differences between the three diagnostic criteria. While there is no consensus on the diagnostic criteria for metabolic syndrome, differences in the prevalence of the disease in pediatric population will be frequent.
Assuntos
Adolescente , Criança , Feminino , Humanos , Síndrome Metabólica , Obesidade , Glicemia/análise , Brasil/epidemiologia , Estudos Transversais , Técnicas de Diagnóstico Endócrino , Jejum/sangue , Resistência à Insulina , Insulina/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Setor Público , Fatores de Risco , Instituições AcadêmicasRESUMO
OBJECTIVE: To investigate the difference in the proportion of adolescents with metabolic syndrome diagnosed based on three different criteria, as well as the use of insulin resistance instead of fasting glucose. METHODS: Cross-sectional study with 121 obese adolescents, between 10 and 14 years old, from public schools of the city of Porto Alegre, Brazil, in 2011. Anthropometric, blood pressure, and biochemical variables were assessed. Metabolic syndrome was defined using three different diagnostic criteria: the International Diabetes Federation (IDF), Cook and de Ferranti. All of them include five components: waist circumference, blood pressure, high-density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose, and there should be at least three abnormal results for the diagnosis of the syndrome. The Homeostasis Model Assessment - Insuline Resistance (HOMA-IR) was used for the characterization of insulin resistance. The analysis of agreement among the criteria was performed using Kappa statistics. RESULTS: Metabolic syndrome was diagnosed in 39.7, 51.2, and 74.4% of adolescents, according to the IDF, Cook and de Ferranti criteria, respectively. There was agreement for the three diagnostic criteria in 60.3% of the sample. Waist circumference was the most prevalent component (81.0, 81.0, and 96.7%), whereas high fasting glucose was the least prevalent (7.4, 1.7, and 1.7%). The use of HOMA-IR significantly increased the proportion of positive diagnoses for the syndrome. CONCLUSION: The results showed significant differences between the three diagnostic criteria. While there is no consensus on the diagnostic criteria for metabolic syndrome, differences in the prevalence of the disease in pediatric population will be frequent.
Assuntos
Síndrome Metabólica , Obesidade , Adolescente , Glicemia/análise , Brasil/epidemiologia , Criança , Estudos Transversais , Técnicas de Diagnóstico Endócrino , Jejum/sangue , Feminino , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Setor Público , Fatores de Risco , Instituições AcadêmicasRESUMO
Empirical treatment is indicated for young children with febrile urinary tract infection (UTI). In this clinical setting, oral antibiotics are as safe and effective as intravenous therapy. The aim of this study was to investigate in children with febrile UTI whether there were longitudinal changes in the prevalence of bacteria and in the pattern of Escherichia coli susceptibility to oral antimicrobial agents. Two hundred and eighty-seven positive urine cultures from children (1 month to 12 years) with febrile UTI collected over three periods (1986-1989, 1990-1991, and 1997) were studied. E. coli was the most-prevalent microorganism in all three study-periods ( n=228). The susceptibility pattern of E. coli to nitrofurantoin (92%, 95%, 94%) and nalidixic acid (85%, 92%, 95%) did not present any statistically significant differences ( P>0.05) over time. There was a significant increase ( P<0.05) in E. coli susceptibility to cephalexin (65%, 54%, 81%). The E. coli susceptibility to trimethoprim-sulfamethoxazole (40%, 85%, 40%) behaved differently. Initially there was a significant rise ( P<0.05), followed by a significant decrease ( P<0.05). Empirical oral treatment with nitrofurantoin or nalidixic acid can safely be started in children with febrile UTI seen in the Emergency Department, Hospital de Clínicas de Porto Alegre, Brazil.