Síndrome metabólica e fatores de risco relacionados em crianças e adolescentes com excesso de peso na cidade do Natal

Nas últimas décadas, houve grande aumento da prevalência de obesidade, inclusive na faixa etária pediátrica. Com isso, aumentou o número de crianças e adolescentes afetados por síndrome metabólica (SM), diabetes tipo 2 (DM2) e doenças cardiovasculares (DCV), doenças anteriormente consideradas quase exclusivas de adultos. Os objetivos do estudo foram identificar e correlacionar marcadores antropométricos (IMC- índice de massa corpórea, CA- circunferência abdominal, RCQ- razão cintura/quadril, RCArazão cintura altura e PSE- prega subescapular), PAS e PAD- pressão arterial sistólica e diastólica, respectivamente, e laboratoriais (CT- colesterol total, HDL, LDL, TGL- triglicérides, I/G- razão insulina glicose, HOMA- homeostatic model assessment for insulin resistance) de risco para o desenvolvimento de SM e observar a sua prevalência em crianças e adolescentes com excesso de peso. Foi conduzido estudo transversal, em amostra aleatória, de conveniência, onde foram avaliadas 60 crianças e adolescentes com excesso de peso, atendidas no ambulatório de endocrinologia pediátrica do Hospital de Pediatria da Universidade Federal do Rio Grande do Norte (UFRN) com idade mínima e máxima de 7 e 15 anos, de maio de 2009 a abril de 2010. Foram admitidos os indivíduos que apresentavam sobrepeso (IMC P > 85 e < 95) ou obesidade (IMC P > 95) (CDC, 2000) e história familiar positiva para DM2 em parentes de primeiro ou segundo grau ou algum dos sinais de resistência insulínica (acantose, hipertensão arterial, dislipidemia, síndrome de ovários policísticos). 2 O componente individual para SM mais prevalente foi o percentil da CA ≥ 90 (58,3%), seguido de HDL ≤ 40 mg/dl (36,6%). Na regressão linear simples, observaram-se as variações para mais nos parâmetros laboratoriais e de PA para cada unidade de aumento de IMC, CA, RCA, RCQ e PSE, sendo significantes as seguintes correlações: CA com TGL, HOMA IR, I/G, PAS e PAD; RCQ com TGL, HOMA, I/G, LDL e glicemia; RCA com TGL; PSE com TGL, HOMA-IR, I/G e PAS; e IMC com HOMA IR, I/G, PAS e PAD. De acordo com os critérios da IDF (Federação Internacional de Diabetes International Diabetes Federation) 2007, o diagnóstico de SM foi encontrado em seis indivíduos (10%). Do total, oito (13,3%), estavam em situação de sobrepeso e 52 (86,6%), obesos. As evidências de correlação CA e RCQ, medidas de obesidade centrípeta, com vários marcadores como TGL e HOMA, já sabidamente relacionados à SM, chamam atenção para a necessidade de utilização dessas medidas de forma mais rotineira na prática pediátrica, por serem de fácil obtenção, baixo custo e método não invasivo. Os valores de CA, RCQ, RCA e PSE, quando elevados devem justificar maior detalhamento na avaliação laboratorial de possível resistência insulínica. É importante a identificação de crianças e adolescentes que preencham os requisitos para o diagnóstico da SM, pois são indivíduos de maior risco metabólico e devem ser adequadamente acompanhados.

Hipertensão arterial e fatores de risco em servidores atendidos pelo departamento de assistência da Universidade Federal do Rio Grande do Norte

Systemic arterial hypertension is a multifactorial disease that contributes to the country´s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15¨%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers