Síndrome Metabólica em mulheres no climatério: prevalência e fatores associados

Abstract

The Metabolic Syndrome is characterized by a cluster of components such as hyperglycemia, hypertension, elevated triglyceride levels, low levels of high density cholesterol and increased waist circumference. This syndrome is considered an important risk factor for the development of cardiovascular diseases and diabetes mellitus type II. This thesis aimed to investigate the Metabolic Syndrome in climacteric women. This is a cross-cutting study of a cross-sectional and analytical epidemiological study entitled "Aggravation of the Health of Climacteric Women". Its population involved 30,018 climacteric women, assisted by the 73 units of Family Health Strategies of the city of Montes Claros, Minas Gerais, Brazil. Probabilistic sampling was used for conglomerate, whose sample consisted of 874 women. Three studies were conducted. Study 1: The objective was to estimate and compare the prevalence of Metabolic Syndrome according to the definitions of the American Heart Association (AHA/NHLBI), International Diabetes Federation (IDF) and Joint Interim Statement (JIS). Prevalence of Metabolic Syndrome were estimated according to the three definitions. The sensitivity and specificity of the Metabolic Syndrome definition methods were calculated considering the JIS method as the gold standard. The Kappa coefficient was calculated to verify the degree of agreement between the definitions. Prevalence of Metabolic Syndrome of 56.9% (CI: 50.2% - 63.2%) by AHA/NHBI diagnosis, 61.6% (CI: 55.5% - 67.4%) by IDF and 64.8% (CI: 58.1% - 70.9%) according to the JIS definition. It was observed that the definition of AHA/NHBI was able to identify 87.4% of women with MS from the total defined by JIS (Kappa=0.835). The IDF was able to identify 95.3% of women with MS from the total cases defined by JIS (Kappa=0.934). It was observed a high prevalence of Metabolic Syndrome in climacteric women regardless of the definition used. Strong agreement was observed in the AHA/NHBI and IDF definitions in relation to the JIS definition. Study 2: The objective was to investigate the association between Metabolic Syndrome and sociodemographic, behavioral, reproductive, clinical factors in climacteric women. We adopted a Poisson regression model, with robust, hierarchical variance, whose independent variables were: distal level (sociodemographic variables), intermediate level (behavioral and reproductive variables) and proximal (clinical variables). There was a significant association between MS and the following variables: age range 46 to 51 years (RP=1.25, p=0.009) and 52 to 65 years (RP=1.39, p<0.001), schooling/elementary school (RP=1.14, p=0.033), presence of moderate or severe climacteric symptoms (RP=1.12, p=0.028) and presence of gout disease (RP=1.20, p=0.049). Women over 45 years of age, with a low level of schooling, with moderate to severe climacteric symptoms, with gout disease presented a higher prevalence of MS in climacteric. Study 3: The objective was to investigate the interrelationships between obesity, blood pressure and metabolic profile treated as latent variables (constructs) using the confirmatory factorial analysis. Structural equation modeling was used to fit the final model. It was observed that age exerts a positive and statistically significant effect on blood pressure (β=0.17, p<0.001) and obesity (β=0.17, p<0.001). It was verified also a direct and positive effect of obesity on blood pressure (β=0.27, p<0.001) and on the metabolic profile (β=0.10, p<0.001), adjusted for age. In women in the climacteric, increasing age has an effect on the increase of obesity and blood pressure, just as obesity has a positive effect on the increase in blood pressure and changes in the metabolic profile.