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Vol. 35. Issue 3.
Pages 101-109 (July - September 2018)
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Vol. 35. Issue 3.
Pages 101-109 (July - September 2018)
Original article
Waist-to-height ratio and sedentary lifestyle as predictors of metabolic syndrome in children in Ecuador
Índice cintura-altura y estilo de vida sedentario como factores predictivos del síndrome metabólico en niños de Ecuador
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F. Aguirre P.a,
Corresponding author
doctorheart00@hotmail.com

Corresponding author.
, A. Cocab, M.F. Aguirrec, G. Celisd
a Hospital Clínica Kennedy Policentro, Guayaquil, Ecuador
b Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
c Hospital Clínico Universitario de Valencia, Valencia, Spain
d Epidemiology and Clinical Investigation Center, Quito, Ecuador
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Tables (4)
Table 1. Demographic and metabolic parameters of the study subjects.
Table 2. Blood pressure percentiles of study subjects in three consecutive measurements. SBP: office systolic blood pressure; DBP: office diastolic blood pressure.
Table 3. Sensitivity and specificity values of the WHtR ratio and HOMA-IR vs. the number of criteria of the metabolic syndrome (MS) by sex.
Table 4. Risk of presenting metabolic syndrome (MS) in adolescents with different BMI and WHtR values.
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Abstract
Objective

To determine the predictors and prevalence of metabolic syndrome (MS) and the presence of vascular inflammation in apparently-normal children (10–15 years) of both sexes in Guayaquil, Ecuador.

Study design and methods

We included 395 apparently-healthy students from a middle-income school in a cross-sectional survey. Informed consent was obtained from students and parents. Anthropometric measurements including blood pressure (BP), body mass index (BMI) and waist-to-height ratio (WHtR), and blood tests were recorded. Vascular inflammation parameters were assessed. Percentiles of the different parameters were used, and MS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP-ATPIII). Waist circumference>P 75, blood pressure>P 90, glucose>100mg/dl, triglycerides>100mg/dl, HDL<45mg/dl. If 3 of the 5 criteria were present, this was considered MS.

Results

The mean age was 12 years (186 boys, 209 girls). The overall prevalence of MS was 9.37% (6.33% in girls, 3.04% in boys). Sustained hypertension was detected in 6.6% of children and pre-hypertension in 7.1%. Obesity was found in 1.8% of subjects, and overweight in 15.2%. Triglycerides has a RR 2.34 (1.97–2.76); HOMA index has a RR 1.97(1.62–2.40); HDL cholesterol has a RR 1.84(1.58–2.13); Insulin level has a RR 1.53(1.40–1.67) and interleukin 6 has RR 1.83(1.20–2.79). Serum glucose, total cholesterol and LDL-Cholesterol had no association with the metabolic syndrome.

HDL-Cholesterol<45mg/dl and triglyceride>100mg/dl were present in 70% of subjects with MS. The WHtR threshold0.5 was 100% sensitive in both sexes (67% specificity in boys and 69% in girls). There were significant associations between the WHtR and pre-hypertension and sedentary lifestyle (P<0.001 and P<0.003 respectively). A WHtR value of ≥0.50 indicated a 2.2-fold increased risk of MS compared with normal WHtR, and normal weight.

Conclusions

A WHtR0.5 was 100% sensitive in detecting MS in 10–15 year-old boys and girls in the normal or overweight range of the BMI. This assessment is a simple and practical tool for use in population-based studies of cardiovascular risk. When combined with pre-hypertension and a sedentary lifestyle, the WHtR is highly sensitive in predicting MS.

Keywords:
Metabolic syndrome
Children
Waist-to-height ratio
Sedentary lifestyle
Obesity
High-sensitivity C-reactive protein
Interleukin-6
Resumen
Objetivo

Determinar los factores predictivos y la prevalencia del síndrome metabólico (SM), así como la presencia de inflamación vascular en niños aparentemente normales (10-15 años) de ambos sexos en Guayaquil, Ecuador.

Diseño del estudio y métodos

Incluimos en una encuesta transversal a 395 estudiantes aparentemente sanos de una escuela de renta media. Se obtuvo consentimiento informado de los estudiantes y padres. Se registraron las medidas antropométricas que incluyeron presión arterial (PA), índice de masa corporal (IMC), índice cintura-altura (ICA), y hemogramas. Se valoraron los parámetros de inflamación vascular. Se utilizaron los percentiles de los diferentes parámetros, definiéndose el SM con arreglo a los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII): valores de perímetro de cintura >75, presión arterial >90, glucosa >100mg/dl, triglicéridos >10mg/dl, HDL<45mg/dl. En caso de presentar 3 de estos 5 criterios se consideró la presencia de SM.

Resultados

La edad media fue de 12 años (186 chicos, 209 chicas). La presencia general de SM fue del 9,37% (el 6,33% en chicas y el 3,04% en chicos). Se detectó hipertensión sostenida en el 6,6% de los niños, y pre-hipertensión en el 7,1%. Se encontró obesidad en el 1,8% de los sujetos, y sobrepeso en el 15,2%. Los valores de RR fueron: para triglicéridos, 2,34 (1,97-2,76); índice HOMA, 1,97 (1,62-2,4); HDL colesterol, 1,84 (1,58-2,13); nivel de insulina 1,53 (1,4-1,67) e interleucina 6, 1,83 (1,2-2,79). Los valores de glucosa sérica, colesterol total y LDL-colesterol no guardaron asociación con el síndrome metabólico.

Los valores de HDL-colesterol <45mg/dl y triglicéridos >100mg/dl se encontraron en el 70% de los sujetos con SM. El límite de ICA>0,5 reflejó una sensibilidad del 100% en ambos sexos (67% de especificidad en chicos y del 69% en chicas). Se encontraron asociaciones significativas entre ICA y pre-hipertensión y el estilo de vida sedentario (p<0,001 y p<0,003, respectivamente). El valor de ICA>0,5 indicó un incremento de 2,2 del riesgo de SM en comparación al valor normal de ICA y peso normal.

Conclusiones

El valor de ICA>0,5 reflejó un 100% de sensibilidad a la hora de detectar el SM en chicos y chicas de 10 a 15 años dentro del rango normal de IMC. Esta medida es una herramienta simple y práctica de utilizar para valorar el riesgo cardiovascular en estudios basados en la población. Al combinarse con la pre-hipertensión y el estilo de vida sedentario, el ICA es altamente sensible a la hora de predecir el SM.

Palabras clave:
Síndrome metabólico
Niños
Índice cintura-altura
Vida sedentaria
Obesidad
Proteína C reactiva de alta sensibilidad
Interleucina 6

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