Capacidade de índices antropométricos para discriminar síndrome metabólica em mulheres nas diferentes fases do climatério

Abstract

Introduction: During the climacteric, there are endocrine and metabolic changes that lead to important repercussions for women's health, among which the increased prevalence of the metabolic syndrome. Anthropometric indices have been proposed to facilitate the early diagnosis of the metabolic syndrome. The identification of climacteric women predisposed to develop an important comorbidity, through simple and low-cost ways is essential to improve the assistance to women assisted by the public health system. Objective: To evaluate the capability of anthropometric indices (Body Mass Index, Abdominal Circumference, Body Roundness Index, Body Shape Index and Visceral Adiposity Index) to discriminate the metabolic syndrome in women in the different climacteric phases. Methods: This is a crosssectional study, developed with women between 40 and 65 years old, assisted by the Family Health Strategy of the municipality of Montes Claros, between August 2014 and August 2015. The sampling was probabilistic type and the selection of the sample occurred in two stages. The units of the Family Health Strategy were selected by conglomerates, making a total of 20 units, in the sequence, a proportional number of women was randomly selected, obeying the stratification criterion, according to the climacteric period. Data collection included sociodemographic characteristics and lifestyle habits. The metabolic syndrome was assessed according to the criteria of the International Diabetes Federation, 2006. The anthropometric variables were calculated using their respective formulas. The descriptive statistics were performed, and the chi-square test was used to compare the distribution of categorical variables by the climacteric period. Binary logistic regression assessed the association between anthropometric measurements and metabolic syndrome and its components. In order to verify the discriminatory capacity of anthropometric indices in the identification of climacteric women with metabolic syndrome, the analysis of the ROC curve was adopted. Sensitivity, specificity and cutoff points of the curves for the detection of metabolic syndrome were estimated using the Youden index. Results: The sample consisted of 874 menopausal women, with the metabolic syndrome being more prevalent in postmenopausal women (66.1%). All anthropometric indices were associated with the syndrome in the pre and post menopause and the Visceral Adiposity Index was associated with a greater number of components of the metabolic syndrome. This Index also obtained a higher value of area under the ROC curve in the pre (AUC: 0.821) and post menopause (AUC: 0.812). Despite having a smaller area under the ROC curve, AC and BRI were classified as reasonable to discriminate the syndrome in the pre (AUC CA: 0.794; AUC BRI: 0.792) and post menopause (AUC CA: 0.728; AUC BRI: 0.727). The markers with the smallest areas under the curve were ABSI and BMI in the pre (AUC ABSI: 0.663; AUC BMI: 0.697) and post menopause (AUC ABSI: 0.640; AUC BMI: 0.666). The measure that showed the highest sensitivity value for the identification of the metabolic syndrome on both climacteric phases was BRI, (pre: 87.16%; post 96.50%). Conclusion: AC, BRI and VAI can be used to identify women, in different climacteric phases, with a predisposition to develop the metabolic syndrome, and may be considered important tools for the screening of this comorbidity in primary care.