RESUMO

OBJECTIVES: The fructosamine test is used in the monitoring of diabetes mellitus, particularly in cases with restrictions on the use of glycated hemoglobin (mainly in the setting of altered red blood cell lifespan and interference by hemoglobin variants). It could also provide additional information on shorter-term glycemic control. The objective of the study is to establish the reference range of the fructosamine in the Brazilian population. DESIGN AND METHODS: The reference interval was defined as suggested by the Clinical and Laboratory Standards Institute (CLSI). The study participants were from a Brazilian cohort (The Longitudinal Study of Adult Health - ELSA-Brasil) with baseline data collected between 2008 and 2010. A total of 466 subjects were selected after exclusion of diabetic individuals, and those with altered glycemic markers and renal function tests. RESULTS: The reference interval was 186-248 µmol/L for women and 196-269 µmol/L for men. Fructosamine levels were higher in men than in women (p = 0.006) and in the non-white population (p = 0.034) and had a negative correlation with the body mass index (r = -0.117; p = 0.011). CONCLUSIONS: The reference intervals for fructosamine were affected by sex. Reference intervals stratified by sex would be more adequate in the interpretation of the fructosamine test.

RESUMO

The metabolic syndrome (MetSyn) is a significant risk factor for cardiovascular events, but scarce information exists about its frequency in Venezuela. In this cross-sectional study, we quantified the prevalence of the MetSyn in a probabilistic, stratified sample of 274 subjects aged ³18 years from the Libertador district in Mérida, Venezuela. Secondary outcomes were the measurement of thyroid hormones (free T4 and TSH), leptin levels, and insulin resistance index (HOMA2-IR). The frequency of MetSyn (percentage ± 95% confidence interval) according to several diagnostic criteria was as follows: National Cholesterol Education Panel (NCEP, original): 27.4% (22.1-32.7); modified NCEP: 31.8% (26.3-37.3); International Diabetes Federation: 40.9% (35.1-46.7); Latin American Diabetes Association: 27% (21.7-32.3), and Venezuelan criteria: 31.8% (26.3-37.3). The MetSyn was more frequent in males than in females with most diagnostic criteria. The estimated prevalence of type 2 diabetes mellitus was 2.9% either according to the patients’ self reports or to fasting glucose level found to be above 126 mg/dL. Abnormal HOMA2-IR index, free T4 and TSH (above the 95th percentile) were detected in 4.5%, 4.4% and 5.1% of the sample, respectively. Free T4 and TSH levels below the 5th percentile were detected in 4.4% and 4.7% of subjects respectively. These values are presented for comparisons with forthcoming studies in specific clinical populations. While studies are being conducted about the different definitions of the MetSyn in Venezuela, we recommend analyzing and publishing local research data with all the available criteria so as to allow comparisons with the results already reported in the literature.

El síndrome metabólico (SM) es un factor de riesgo significativo en la ocurrencia de eventos cardiovasculares. Sin embargo, existe poca información sobre su frecuencia en Venezuela. En la presente investigación transversal, cuantificamos la prevalencia del SM es una muestra probabilística de 274 sujetos con edad mayor o igual a 18 años provenientes del municipio Libertador de la cuidad de Mérida, Venezuela. Como resultados secundarios, se cuantificaron los niveles de leptina, hormonas tiroideas (T4 libre y TSH), y el índice de resistencia a la insulina (HOMA2-RI). La frecuencia de SM (porcentaje ± intervalo de confianza del 95%) de acuerdo a varios criterios diagnósticos fue la siguiente: Panel para el Colesterol (original): 27,4% (22,1-32,7); Panel para el Colesterol (modificado): 31,8% (26,3-37,3); Federación Internacional de Diabetes: 40,9% (35,1-46,7); Asociación Latino-Americana de Diabetes: 27% (21,7- 32,3) y criterios Venezolanos: 31,8% (26,3-37,3). Al utilizar la mayoría de los criterios, el SM fue más frecuente en hombres que en mujeres. La prevalencia estimada de diabetes mellitus tipo 2 fue 2,9% tanto mediante el auto-reporte como mediante la detección de glicemia en ayunas > 126 mg/dL. Se detectaron niveles anormales (por encima del percentil 95) del índice HOMA2-IR, T4 libre y TSH en el 4,5%, 4,4% y 5,1% de la muestra respectivamente. Niveles de T4 y TSH por debajo del percentil 5 se detectaron en el 4,4% y 4,7% de sujetos respectivamente. Los valores del HOMA2-RI y hormonas tiroideas también se presentan con el fin de permitir comparaciones con futuros estudios en poblaciones clínicas específicas. Mientras se realizan estudios adicionales en Venezuela sobre las diversas definiciones del SM, recomendamos analizar y publicar los resultados científicos locales con todos los criterios disponibles con el fin de permitir la comparación con los estudios que ya están disponibles.

Assuntos

RESUMO

OBJECTIVE: To test the hypothesis that metabolic syndrome (MetS) is more predictive of carotid intima-media thickness (IMT) than the sum of the individual components of MetS. STUDY DESIGN: We analyzed the relationships between 2 definitions of the MetS and IMT in 461 overweight adolescents aged 10-18 years (median body mass index, 28.6 kg/m(2)). We used regression models and receiver operating characteristics (ROCs) for increased IMT (defined as ≥0.7 mm). RESULTS: The prevalence of MetS was 15.0% and 26.9% according to the 2 definitions applied. At the group level, quantitative IMT was associated with body mass index, blood pressure, glucose levels at 2 hours in an oral glucose tolerance test, and with each of the MetS components (all P < .05). At an individual level, using the MetS definitions alone as a diagnostic test for the presence of increased IMT (area under the ROC curve, 0.60-0.66) was inferior when compared with the sum of all individual components (area under the ROC curve, 0.65-0.85). Adding the presence or absence of MetS to the components did not improve the accuracy. CONCLUSION: Overweight adolescents with MetS demonstrated increased IMT values compared with overweight adolescents without MetS. The best model for diagnosing increased IMT was the sum of the quantitative components of MetS. The use of dichotomized variables reduced the diagnostic accuracy. Thus, in clinical practice, treatment of overweight adolescents should be based on weighing cardiovascular risk factors themselves, rather than on the dichotomous variable MetS.

Assuntos

RESUMO

The aim of this systematic review was to examine the association between shift work and metabolic syndrome (MetS) as well as the potential confounders investigated. A systematic search was conducted with the aim of finding original articles on the association between shift work and MetS. The included articles were chosen based on established inclusion criteria; their methodological quality was assessed using a validated quality checklist. A total of 10 articles were included in this review. The majority of the studies were classified as having a low risk of bias. The definitions of MetS and shift work varied between studies. Among the ten studies, eight found a positive association between shift work and MetS after controlling for socio-demographic and behavioral factors. Only three studies included sleep duration as a confounder, and these studies presented discordant results. We conclude that there was insufficient evidence regarding the association between shift work and prevalent MetS when the confounders are taken into account.

Assuntos