Abstracts

INTRODUCTION

In the past three decades, the population aged over 60 years has more than doubled in Brazil¹1 . Marin MJS, Marques APM, Feres BOM, Saraiva AKH, Druzian S. Atenção à saúde do idoso: ações e perspectiva dos profissionais. Rev Bras Geriatr Gerontol 2008; 11(2): 245-58.. As a result of population aging, a predominance of chronic noncommunicable diseases (NCDs) can be observed²2 . Caldwell JC. Population health in transition. Bull World Health Organ 2001; 79(2): 159-60.

3 . Marafon LP, Cruz IBM, Schwanke CHA, Moriguchi EH. Preditores cardiovasculares da mortalidade em idosos longevos. Cad Saúde Pública 2003; 19(3): 799-808. ^{- 4}4 . Moraes EN. Aterosclerose: diagnóstico e tratamento. In: Moraes EN. Princípios básicos de geriatria e gerontologia. Belo Horizonte: Coopmed; 2008. p. 189-201.. In this context, the Metabolic Syndrome (MS) stands out as a cluster of risk factors for the development of illnesses such as diabetes and cardiovascular diseases⁵5 . Sanchez-Torres RJ, Delgado-Osório H. The metabolicsyndromeand its cardiovascular manifestations. BolAssoc Med 2005; 97(4): 271-80. ^{, 6}6 . Kolovou GD, Anagnostopoulou KK, Salpea KD, Mikhailidis DP. The prevalence of metabolic syndrome in various populations. Am J Med Sci 2007; 333(6): 362-71.. It is characterized by central obesity, dyslipidemia (hypertriglyceridemia and low HDL), insulin resistance and increased blood pressure. For the elderly individual, the consequences of this syndrome appear to be even more pronounced, mainly due to physiological changes associated with aging⁷7 . Stragmalia, DA, Greco A, Guglielmi G, De Matthaeis A, Vendemiali GL. Echocardiography and Dual Energy X-Ray Absorptiometry in the Elderly Patientes with Metabolic Syndrome: a comparasion of two different techniques to evaluate visceral fat distribution. J Nutr 2010; 14(1): 6-10..

The first reports of MS were mentioned in the literature over 80 years ago, but only since 1998 a group of consultants from the World Health Organization (WHO) proposed the first diagnostic criteria to facilitate the clinical and epidemiological investigations of MS, taking insulin resistance as its main component. Recently, the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) presented a definition in which glycemia is not considered an essential factor, being listed as only one of the diagnostic components of MS. The American Heart Association (AHA) and the National Heart, Lung and Blood Institute (NHLBI) also advocate the use of the NCEP ATP III criteria as a diagnostic tool for not emphasizing a single etiology for MS⁸8 . Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52.. The Brazilian Guideline for Diagnosis and Treatment of MS is based on this same perspective, with the same cutoffs points for the diagnosis of MS⁹9 . Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Endocrinologia e Metabologia, Sociedade Brasileira de Diabetes, Associação Brasileira para Estudos da Obesidade. I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Arq Bras Cardiol 2005; 84(1 Suppl 1): 1-28..

Data on prevalence of MS among elderly are still discordant. According to the NCEP ATP III criteria, in the U.S. study called Third National Health and Nutrition Examination Survey (NHANES III), in the 60 to 69 years old age group, a prevalence of 43.5% was observed, and the prevalence was 42% in the over 69 years old age group¹⁰10 . Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287(3): 356-9.. In other international studies, the prevalence ranged from 11.3 to 24.0% based on the same criteria (NCEP ATP III). In Brazil, studies indicate prevalence rates ranging from 30.9 to 53.4%¹⁴14 . Paula HAA, Ribeiro RCL, Rosado LEFPL, Pereira RSF, Franceschini SCC. Comparação de Diferentes Critérios de Definição para Diagnóstico de Síndrome Metabólica em Idosas. Arq Bras Cardiol 2010; 95(3): 346-53.

15 . Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114(2): 224-9. ^{- 16}16 . Rigo JC, Vieira JL, Dalacorte RR, Reichert CL. Prevalência de Síndrome Metabólica em Idosos de uma Comunidade: Comparação entre três métodos diagnósticos. Arq Bras Cardiol 2009; 93(2): 85-91..

Some studies suggest that MS may be associated with sociodemographic factors such as low educational level, age, inequality and social isolation, psychosocial stress and with a lifestyle of unhealthy dietary patterns, physical inactivity, alcohol consumption and smoking. Clinical conditions such as abdominal obesity, hypertension, low HDL cholesterol (or HDL-c) seem to be defining the onset of MS, but may vary depending on the ethnic group in question¹⁷17 . Leitão MPC, Martins IS. Prevalência e fatores associados à Síndrome Metabólica em usuários de Unidades Básicas de Saúde em São Paulo. Rev Assoc Med Bras 2012; 58(1): 60-9. ^{, 18}18 . McLellan KCP, Barbalho SM, Cattalini M, Lerário AC. Rev Nutr 2007; 20(5): 515-24..

Although there is evidence of the impact of MS on health of the elderly population, there are few studies to identify the prevalence of this clinical condition in this group⁷7 . Stragmalia, DA, Greco A, Guglielmi G, De Matthaeis A, Vendemiali GL. Echocardiography and Dual Energy X-Ray Absorptiometry in the Elderly Patientes with Metabolic Syndrome: a comparasion of two different techniques to evaluate visceral fat distribution. J Nutr 2010; 14(1): 6-10.. Given this reality, the objective of this study was to evaluate the prevalence of MS and its association with anthropometric, sociodemographic and lifestyle variables in a sample of elderly users of the Unified Health System (SUS).

METHODS

CASUISTRY

This is a cross-sectional study, conducted in Goiânia (GO), in elderly aged over 60 years. This research project is is part of a matrix project, entitled "Health Status and Anthropometric Indicators for the Assessment of Nutritional Status of Elderly Members of the Unified Health System in Goiânia (GO)". The study sample consisted of 418 elderly of both genders. Further details about the methodological procedures employed in the sampling process are described in a previous publication¹⁹19 . Ferreira CCC, Peixoto MRG, Barbosa MA, Silveira EA. Prevalência de Fatores de Risco Cardiovascular em Idosos Usuários do Sistema Único de Saúde de Goiânia. Arq Bras Cardiol 2010; 95(5): 621-8.. Seniors who have undergone care in primary health care units in the twelve months prior to sample selection were included. Individuals unable to walk were excluded.

A subsample of 133 elderly without losses or refusals, was selected by random draw, which was enough to investigate factors associated with MS in this population. For this estimate, a confidence level of 95%, power of 80%, prevalence ratio of 2 and MS prevalence of 43% were considered among those exposed⁹9 . Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Endocrinologia e Metabologia, Sociedade Brasileira de Diabetes, Associação Brasileira para Estudos da Obesidade. I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Arq Bras Cardiol 2005; 84(1 Suppl 1): 1-28..

Data collection took place during July and August 2009, in a private clinic, by trained nutritionists, who collected anthropometric data and information on sociodemographic and lifestyle variables. Blood collection was performed by a laboratory technician hired at the same location. Densitometry of the whole body was also performed by dual energy x-ray absorptiometry (DEXA) by the clinical radiologist. To give greater accuracy to anthropometric measures, standardizations were performed according to the technique described by Habicht²⁰20 . Habicht JP. Estandarizacion de métodos epidemiológicos cuantitativos sobre el terreno. Bol Oficina Sanit Panam 1974; 76(5): 375-81.. For adequacy of other information, a pilot study was conducted.

ANTHROPOMETRIC EVALUATION AND BODY COMPOSITION

Anthropometric measurements (weight, height and waist circumference) were performed in duplicate, according to the protocol of Lohman, Roche and Martorell²¹21 . Lohman TG, Roche AF, Martorell R. Anthropometricstandardizationreference manual. Illinois: Human Kinetics Books; 1988.. The weight (in kilograms) was obtained in a portable digital Tanita^(r) scale, Model 080W, with a capacity for up to 150 kg and 100 g precision. The height (in meters) was measured using an inelastic tape with 0.1 cm precision, mounted on a wall without baseboard, 50 cm from the soil, and with the aid of a frame of wood. Subsequently, the Body Mass Index (BMI = kg/m²) was calculated. Subjects were classified according to their nutritional status, using the cutoff points recommended by Lipschitz²²22 . Lipschitz DA. Screening for nutritional status in the elderly. Primary Care 1994; 21(1): 55-67.: < 22 kg/m² (low weight); ≥ 22 e ≤ 27 kg/m² (normal weight); > 27 kg/m²(overweight). Waist circumference (WC) was measured at the midpoint between the iliac crest and the lower costal margin at the time of expiration, using inelastic tape with 0.1 cm precision. It was considered increased when the result was ≥ 88 cm for women and ≥ 102 cm for men, as recommended by the NCEP ATP III⁸8 . Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52..

To determine body fat, the whole body densitometry by dual energy X-ray absorptiometry (DEXA), considered the gold standard for this type of evaluation. The examination was performed by technicians trained in the hired clinic. The model used was DPX-MD PLUS, Lunar^(r), and standard procedures were adopted for the positioning of the individuals during the exam²³23 . SBDENS: Sociedade Brasileira de Densitometria Clínica. Manual de Densitometria Óssea - Curso Oficial de Habilitação, Espírito Santo; 1997.. The images obtained were analyzed using the specific software for version 7.52.002 DPX-L^(r). The fat percentage was classified as increased when it was as above the 90^th percentile of the reference standard proposed by Kyle et al.²⁴24 . Kyle UG, Genton L, Slosman DO, Pichard C. Fat-Free and Fat Mass Percentiles in 5225 Healthy Subjects Aged 15 to 98 Years. Nutrition 2001; 17(7/8): 534-41..

BIOCHEMICAL DETERMINATIONS

In biochemical evaluation, factors measured were fasting glucose, high density lipoprotein (or HDL) cholesterol and triglycerides by enzymatic method, using the equipment Selectra 2^(r) and Doles^(r) reagent.

DETERMINATION OF ARTERIAL PRESSURE

Blood pressure was measured using the semiautomatic equipment OMRON HEM-705 CP^(r), according to standardized procedures²⁵25 . Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. VI Diretrizes Brasileiras para Hipertensão. Arq Bras Cardiol 2010; 95(1 Suppl 1): 1-51.. Two measurements were performed, with a minimum difference of five minutes between them. Blood pressure levels were considered abnormal when the average of the two measurements was ≥ 130/85 mmHg and/or when there was use of antihypertensive medications.

SOCIODEMOGRAPHIC AND LIFESTYLE VARIABLES

Through a questionnaire, the following variables were investigated: gender, age, marital status, schooling, per capita income, skin color, physical activity, food intake, smoking and alcohol consumption. Smokers were defined as those who smoked or had stopped smoking less than six months from the time of the interview. The consumption of alcoholic beverages was assessed by questions on consumption (yes/no), type of beverage, frequency and amount (dose, bottles, glasses or cups) consumed during the week preceding the interview. The amounts were converted to grams of ethanol per day, according to Franco²⁶26 . Franco G. Tabela de Composição Química dos Alimentos. 9 ed. Rio de Janeiro: Atheneu, 1999. 307 p.. Risk alcohol consumption was evaluated as follows: for men, > 30 g ethanol/day and for women, > 15 g ethanol/day²⁵25 . Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. VI Diretrizes Brasileiras para Hipertensão. Arq Bras Cardiol 2010; 95(1 Suppl 1): 1-51..

For physical activity, the short version of the International Physical Questionnaire (IPAQ), validated for the Brazilian elderly population, was used²⁷27 . Benedetti TRB, Mazo GZ, Barros MV. Aplicação do Questionário Internacional de Atividade Física para Avaliação do Nível de Atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste/reteste. Rev Bras Ciên e Mov 2004; 12(1): 23-33.. The questions concerned the frequency (days/week) and time (minutes/day) spent in walks and activities involving physical effort in the previous week. Initially, the elderly were classified as very active, active, irregularly active, irregularly active A and B and sedentary, according to Matsudo et al.²⁸28 . Matsudo SM, Matsudo, VR, Araújo T, Andrade D, Andrade E, Oliveira L. Nível de atividade física da população do estado de São Paulo: análise de acordo com o gênero, idade, nível socioeconômico, distribuição geográfica e de conhecimento. Rev Bras Cien Mov 2002; 10(4): 41-50.. For analysis, the elderly were classified as active by the sum of the first four categories, and sedentary by the sum of the last two.

Food intake was assessed by means of a Food frequency Questionnaire (FFQ) adapted from Block et al.²⁹29 . Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A data-based approach to diet questionnaire design and testing. Am J Epidemiol 1986; 124(3): 453-69., which aimed to assess the intake of protective and risk foods for MS. The FFQ, which contained 36 items (foods or food groups), was evaluated in the following categories: sources of fat (burgers, meat with visible fat, fried chicken, offal, sausages, bacon, snacks, fries, whole milk, yellow cheese and cream cheese); Fruits and Vegetables (FV) (fruits, vegetable A and vegetable B); sweets (ice cream, chocolates, homemade pastries, cakes and soft drinks); lean dairy products (skim milk and white cheese), whole dairy products (whole milk, yellow cheese and cream cheese); legumes (bean and soybean).

Foods were classified into nine categories of frequency of consumption, according to the methodology described by Fornés et al.³⁰30 . Fornés NS, Martins IS, Velásquez-Meléndez G, Latorre MRDO. Escores de consumo alimentar e níveis lipêmicos em população de São Paulo, Brasil. Rev Saúde Publ 2002; 36(1): 12-8.. So that the consumption frequency of each food over the past year could be treated as a quantitative variable, a weight (S_f) was assigned for each category of consumption frequency (f_i) based on annual consumption. The maximum weight value was defined as (S₇ = 3) for foods consumed three or more times/day. The other weights were obtained according to the equation: S_n = (1/365)[(a + b)/2], with a and b being the number of days of the frequency. The analysis of food consumption was performed according to tertiles of consumption.

METABOLIC SYNDROME

The dependent variable was the MS. We considered the presence of MS when the individual presented at least three of the following: systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mmHg or use of antihypertensive medication; fasting glucose ≥ 100 mg/dL or use of hypoglycemic; triglycerides ≥ 150 mg/dL or use of fibrate and/or nicotinic acid; HDL cholesterol < 40 mg/dL for men and < 50 mg/dL for women and/or use of fibrates and nicotinic acid; and increased WC. For the latter, the cutoff points considered were ≥ 88 cm for women and ≥ 102 cm for men⁸8 . Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52..

STATISTICAL ANALYSIS

Statistical analysis was performed using Stata^(r) 8.0 software (Stata Corporation College Station, USA). Continuous variables were described as means and standard deviations. Categorical variables were described using absolute and relative frequencies, studying the prevalence and confidence interval with significance level of 5%. Analysis of association between the independent variables and the outcome variable (presence or absence of MS) was performed using the chi-square and Fisher's, Student's t and Mann-Whitney tests. Poisson regression analysis was conducted according to a hierarchical model for the control of confounding factors. The variables that, in the bivariate analysis, were significantly lower than 20% (p < 0.20) were included in the regression. A p-value < 0.05 was used as criteria for permanence in the model.

ETHICAL ASPECTS

The study was approved by the Research Ethics Committee of Universidade Federal de Goiás (UFG) and all participants signed a free and informed consent form.

RESULTS

A total of 133 elderly patients were studied, 81 women and 52 men. The mean age was 70.2 ± 6.6 years, mean BMI was 26.7 ± 5.2 kg/m² and median per capita income was BRL 465.00, with no difference between genders.

The clinical characteristics of the study population can be seen in Table 1. There was no statistically significant difference between men and women regarding age, BMI and components of metabolic syndrome, with the exception of HDL-C, which was lower among men.

The overall prevalence of MS was 58.65% (95%CI 49.8 - 67.1); for men, 55.7% (95%CI 41.3 - 69.5) and for women, 60.5% (95%CI 49.1 - 71.2), with no significant difference between genders (p = 0.589). Regarding the components of MS, it was found that, for men, systemic hypertension was the most prevalent (80.8%; 95%CI 64.5 - 90.4), followed by decreased HDL-c (65.4%; 95%CI 50.9 - 78.0); hypertriglyceridemia (46.2%; 95%CI 32.2 - 60.5), hyperglycemia (46.2%; 95%CI 32.2 - 60.5) and central obesity (37.2%; 95%CI 24.1 - 51.9). For women, hypertension was also the most prevalent component (85.2%; 95%CI 75.5 - 92.1), followed by central obesity (60.5%; 95%CI 49.0 - 71.2), hypertriglyceridemia (51.8%; 95%CI 40.5 - 63.1), decreased HDL-C and hyperglycemia (38.3%; 95%CI 27.7 - 49.7).

Table 2 shows that the variables gender, age, ethnicity, marital status, schooling, income, smoking, alcohol consumption and physical activity were not associated with the presence of MS. However, overweight (82.7%) and high percentage of total body fat (74.3%) were factors statistically associated with MS.

Regarding food consumption, none of the food groups analyzed showed association with MS (Table 3).

The variables included in the multiple Poisson regression were: income tertiles (1^st level); overweight; increased percentage of fat; intake of FV, lean dairy and legumes (2^nd level). After performing the regression, according to the hierarchical model for the control of confounding factors, only overweight (p < 0.001) remained associated with MS (Table 4).

DISCUSSION

The prevalence of MS found in this sample of elderly users of the primary care network of SUS was high. This is a particular concern, especially the association of MS with chronic diseases, increased morbidity and mortality and impact on the health system, since SUS is responsible for 70% of spending on care of the elderly in our population³¹31 . Nóbrega OT, Faleiros VP, Telles JL. Gerontology in the developing Brazil: achievements and challengs in public policies. Geriatr Gerontol 2009; 9(2): 135-9.. Moreover, about one third of the expenses of hospitalization with elderly are intended to treat diseases such as heart failure, cerebrovascular diseases and ischemic heart diseases³²32 . Peixoto SVI, Giatti L, Afradique, ME, Lima-Costa MF. Custo das internações hospitalares entre idosos brasileiros no âmbito do Sistema Único de Saúde Epidemiol. Serv Saúde 2004; 3(4): 239-46., which are likely related to the complications inherent to MS.

Regarding the components of metabolic syndrome, hypertension showed the highest prevalence (83.5%), and that value exceeded that observed in the elderly population in other studies¹⁵15 . Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114(2): 224-9. ^{, 33}33 . Bopp M, Barbiero S. Prevalência de Síndrome Metabólica em Pacientes de um Ambulatório do Instituto de Cardiologia do Rio grande do Sul (RS). Arq Bras Cardiol 2009; 93(5): 473-7.. However, there was a similarity with the results of the study in elderly from Novo-Hamburgo (RS), with a prevalence of 84%¹⁵15 . Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114(2): 224-9., and with the study conducted in elderly Italians, whose prevalence of systemic hypertension was 85.4%¹¹11 . Athyros VG, Ganotakis ES, Elisaf M, Mikhailidis DP. The prevalence of the metabolic syndrome using the National Cholesterol Educational Program and International Diabetes Federation definitions.Curr Med Res Opin 2005; 21(8): 1157-9.. This data is really noteworthy since SH seems to have more profound impacts on the health of the elderly. A cohort study with 1,032 elderly Finnish in a 20-year follow-up found that hypertension was the strongest predictor of congestive heart failure among all components of MS alone³⁴34 . Wang J, Sarnola K, Ruotsalainen S, Moilanem L, Lepisto P, Lasskso M et al. The metabolic syndrome predicts incident congestive heart failure: A 20-year follow up study of elderly finns. Atherosclerosis 2010; 210(1): 237-42..

A wide variation in the prevalence of MS among elderly can be found in the literature, probably because of the profile of the population studied and the criteria used¹⁵15 . Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114(2): 224-9.. In the American population-based study NHANES III, conducted between 1988 and 1994, a prevalence of 43.5% was found in the 60-69 years old age group, and 42% for seniors over 69 years old, with no statistically significant difference between the genders⁹9 . Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Endocrinologia e Metabologia, Sociedade Brasileira de Diabetes, Associação Brasileira para Estudos da Obesidade. I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Arq Bras Cardiol 2005; 84(1 Suppl 1): 1-28.. Although this information is outdated, the current situation would probably surpass the results of this study, especially with the increasing trend in the prevalence of each component of MS alone. In a population-based cohort in Italy, a prevalence of MS of 27.2% was found, also among elderly aged 65 or above¹¹11 . Athyros VG, Ganotakis ES, Elisaf M, Mikhailidis DP. The prevalence of the metabolic syndrome using the National Cholesterol Educational Program and International Diabetes Federation definitions.Curr Med Res Opin 2005; 21(8): 1157-9.. In a cross-sectional study conducted in Turkey, the prevalence of MS was 61.7%³⁵35 . Akbulut GC, Ersoy G. Assessment of nutrition and life quality scores of individuals aged 65 and over from diferentesócio-economic levels in Turkey. Arch Gerontol Geriatr 2008; 47(2): 241-52.. In Brazil, in a population-based study of elderly (≥ 60 years) held in New-Hamburg (RS), the rate of MS was 53.4%¹⁵15 . Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114(2): 224-9.. Some Brazilian studies present conflicting prevalence data. In Londrina (PR), in a study that assessed geriatric outpatients, the prevalence of MS was 39.9%³⁶36 . Figueiredo Neto JA, Figuerêdo ED, Barbosa JB, Barbosa FF, Costa GRCC, Nina VJS et al. Síndrome metabólica e Menopausa: Estudo Transversal em Ambulatório de Ginecologia. Arq Bras Cardiol 2010; 95(3): 339-45., and in elderly enrolled in the Family Health Strategy of Viçosa (MG), it was 30.9%¹³13 . Lombo B, Villalobos C, Tique C, Satizabal C, Franco C. Prevalenciadelsindrome metabólico entre los pacientes que asisten al servicio de clinica de hipertension de laFundación Santa Fé de Bogotá. Rev Col Cardiol 2006; 12(7): 472-8.. Although all the above studies have used the same diagnostic criteria, NCEP ATP III⁸8 . Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52., the prevalence ranged from 27.2 to 53.4%

There was no association between income and MS, probably due to the similarity of the sample, since all subjects were users of primary care network of SUS. Another possibility is that income is not a variable that affects the distribution of MS, given its high prevalence in the elderly population of all income levels. The other sociodemographic variables (age, skin color, gender, marital status and educational level) were not associated with MS, as well as in other studies³²32 . Peixoto SVI, Giatti L, Afradique, ME, Lima-Costa MF. Custo das internações hospitalares entre idosos brasileiros no âmbito do Sistema Único de Saúde Epidemiol. Serv Saúde 2004; 3(4): 239-46. ^{, 34}34 . Wang J, Sarnola K, Ruotsalainen S, Moilanem L, Lepisto P, Lasskso M et al. The metabolic syndrome predicts incident congestive heart failure: A 20-year follow up study of elderly finns. Atherosclerosis 2010; 210(1): 237-42.. Lifestyle variables (alcohol consumption, smoking and physical activity) were not associated with MS, as well as in studies by Franco et al.³⁷ 37 . Franco GPP, Scala LCN, Alves CJ, França GVA, Cassanelli T, Jardim PCBV. Prevalência de Síndrome Metabólica em Hipertensos de Cuiabá-MG: prevalência e fatores associados. Arq Bras Cardiol 2009; 92(6): 437-42.and Freire et al.³⁸38 . Freire RD, Cardoso MA, Gimeno SGA, Ferreira SRG. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care 2005; 28(7): 1779-85..

In the present study sample, overweight was associated with MS (p < 0.01) with 1.66 times higher prevalence in this group compared to individuals without excess weight, data consistent with Franco et al.³⁷ 37 . Franco GPP, Scala LCN, Alves CJ, França GVA, Cassanelli T, Jardim PCBV. Prevalência de Síndrome Metabólica em Hipertensos de Cuiabá-MG: prevalência e fatores associados. Arq Bras Cardiol 2009; 92(6): 437-42.and Velasquez-Melendez et al.³⁹39 . Velasquez-Melendez G, Gazzinelli A, Correa-Oliveira R, Pimenta AM, Kac G. Prevalência de síndrome metabólica em área rural do Brasil. São Paulo Med J 2007; 125(3): 155-62.. This result deserves attention since obesity has a major impact on cardiovascular morbidity in the elderly and represents over 40% of the deaths recorded recently in Brazil⁴⁰40 . Góis ALB, Veras RP. Informações sobre a morbidade hospitalar em idosos nas internações do Sistema Único de Saúde do Brasil. Ciên Saúde Col 2010; 15(6): 2859-69.. The association between metabolic syndrome and overweight assessed by BMI could be explained by the fact that although BMI is not specific to predict central obesity, it may reflect the ectopic fat deposition in skeletal muscle, which could increase the resistance to insulin, subsequently limiting its secretion⁴¹41 . Schmidt MI, Duncan BB, Duncan MS. Síndrome Metabólica, Diabetes e Doenças Cardiovasculares. In: Duncan BB; Schmidt MI, Giugliani ERJ. Medicina Ambulatorial; Condutas de atenção primária baseada em evidências. 3 ed. Porto Alegre: Artmed, 2004. p. 589-95..

The increased percentage of body fat was not associated with MS in the multivariate analysis. These findings demonstrate that excess weight determined by BMI may better reflect the metabolic alterations associated with MS in the elderly than body fat. Questions concerning changes in body composition of the elderly, the redistribution of body fat, the cutoff points for assessing BMI and to fat percentage itself are still controversial and need further studies to validate the new criteria of BMI in diagnosing obesity in elderly⁴²42 . Seidel JC, Visscher TLS. Body Weight and weight change and their health implications for elederly. Eur J Clin Nutr 2000: 54: S33-9.. No other studies that evaluated the percentage of total body fat in the elderly and its association with MS were found, which makes it even more difficult to elucidate this question.

No association was observed between dietary intake and MS. The cross-sectional design of this study does not allow the identification of the precedence in time between exposure and outcome. Another aspect to be considered relates to the techniques of study of the food consumption frequency, which, despite its wide use, can be considered limited by their lack of quantitative accuracy⁴³43 . Cintra IP, von Der Heyde MED, Schmitz BAS, Franceschini SCC, Taddei JAAC, Sigulem DM. Métodos de inquéritos dietéticos. Cad Nut 1997; 13: 11-23.. On the other hand, the use of consumption tertiles favored the analysis of the average consumed portions.

CONCLUSION

It can be concluded that a high prevalence of MS was found in this sample of elderly users of SUS without association with sociodemographic and lifestyle variables. MS was only associated with the nutritional status assessed by BMI. This high prevalence of MS demonstrates the need for early identification and control of risk factors for cardiovascular diseases in the primary care level in order to promote a more efficient control of MS. This justifies the need to intensify prevention strategies and full attention to the elderly, improving their nutritional status through the prevention and treatment of obesity and promotion of healthy eating.

REFERENCES

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