Peso e altura autorreferidos são medidas válidas para determinar o estado nutricional: resultados da Pesquisa Nacional de Saúde (PNS 2013)

Moreira, Naiara Ferraz; Luz, Verônica Gronau; Moreira, Caroline Camila; Pereira, Rosângela Alves; Sichieri, Rosely; Ferreira, Márcia Gonçalves; Muraro, Ana Paula; Rodrigues, Paulo Rogério Melo

doi:10.1590/0102-311X00063917

Brasil

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ARTICLE • Cad. Saúde Pública 34 (5) • 2018 • https://doi.org/10.1590/0102-311X00063917 linkcopiar

Peso e altura autorreferidos são medidas válidas para determinar o estado nutricional: resultados da Pesquisa Nacional de Saúde (PNS 2013)

Autoria SCIMAGO INSTITUTIONS RANKINGS

As medidas autorreferidas têm sido utilizadas em alguns inquéritos epidemiológicos para obter informações sobre peso e altura. A validação dessas informações é necessária para garantir a qualidade dos dados. Este estudo avaliou a validade do peso e altura autorreferidos para determinar o nível de peso corporal. Os dados foram obtidos da Pesquisa Nacional de Saúde (PNS), um inquérito domiciliar com abrangência nacional, realizado em 2013. Na PNS, 40.366 indivíduos (idade ≥ 18 anos) forneceram dados autorreferidos sobre peso e altura. O teste t de Student foi usado para verificar as diferenças entre os dados autorreferidos e os diretamente mensurados. A concordância entre as medidas foi obtida pelo coeficiente de correlação intraclasse (CCI) e pelo método de Bland-Altman. Para avaliar as categorizações de peso corporal, foram utilizados o coeficiente kappa ponderado e a concordância exata. Foram estimadas a sensibilidade e a especificidade dos dados autorreferidos na classificação dos indivíduos com sobrepeso e obesidade. Houve alta concordância entre peso, altura e índice de massa corporal auto-referidos e os mesmos indicadores medidos diretamente (CCI > 0,88). As médias de concordância estimadas pelo método de Bland-Altman foram 99,6% para peso e 100,6% para altura. O coeficiente kappa ponderado mostrou concordância substancial entre as categorias de peso corporal (> 0,66); a concordância exata era 77%. A sensibilidade e especificidade para sobrepeso (83% e 87,5%, respectivamente) e obesidade (73,4% e 96,7%, respectivamente) foram consideradas altas para as características sociodemográficas avaliadas. De acordo com nossos resultados, o peso e altura autorreferidos podem ser utilizados com cautela, enquanto alternativas válidas para determinar o nível de peso corporal.

Palavras-chave: Autorrelato; Antropometria; Inquéritos de Saúde; Reprodutibilidade dos Testes

Characteristics	Weight (kg)		Height (m)		Body mass index (kg/m²)
Characteristics	Measured	Self-reported	Measured	Self-reported	Measured	Self-reported
Total	71.59	71.27	1.65	1.66	26.48	26.12
Sex
Male	76.68	76.75	1.72	1.72	26.28	26.17
Female	66.88	66.21	1.59	1.60	26.70	26.06
Age
Adolescents	64.52	63.82	1.68	1.68	22.94	22.68
Adults	72.51	72.12	1.66	1.67	26.55	26.23
Elderly	69.27	69.37	1.62	1.64	27.06	26.46
Education level
No education/Some elementary school	69.94	69.74	1.63	1.65	26.79	26.41
Elementary school/Some high school	71.38	71.14	1.65	1.66	26.43	26.08
High school/Some college	72.54	72.31	1.67	1.67	26.28	25.99
College degree	73.84	72.89	1.67	1.68	26.42	25.89
Household location
Urban area	72.10	71.79	1.66	1.66	26.56	26.19
Rural area	68.11	67.71	1.64	1.65	25.79	25.43
	Weight (kg)		Height (m)		Body mass index (kg/m²)
	Difference *	Relative difference (%)	Difference *	Relative difference (%)	Difference *	Relative difference (%)
Total	-0.32	0.45	0.01	0.61	-0.36	1.38
Sex
Male	0.07	0.09	0.00	0.00	-0.11	0.43
Female	-0.67	1.00	0.01	0.63	-0.64	2.37
Age
Adolescents	-0.70	1.08	0.00	0.00	-0.26	1.10
Adults	-0.39	0.53	0.01	0.60	-0.32	1.22
Elderly	0.10	0.14	0.02	1.23	-0.60	2.25
Education level
No education/Some elementary school	-0.20	0.28	0.02	1.23	-0.38	1.40
Elementary school/Some high school	-0.24	0.33	0.01	0.60	-0.35	1.31
High school/Some college	-0.23	0.32	0.00	0.00	-0.29	1.12
College degree	-0.95	1.28	0.01	0.60	-0.53	2.07
Household location
Urban area	-0.31	0.43	0.00	0.00	-0.37	1.39
Rural area	-0.40	0.59	0.01	0.61	-0.36	1.40

	Weight		Height		BMI
	ICC		ICC		ICC
	Value	95%CI	Value	95%CI	Value	95%CI
Total	0.94	0.94-0.94	0.95	0.95-0.95	0.90	0.90-0.90
Sex
Male	0.93	0.93-0.93	0.92	0.92-0.92	0.90	0.90-0.90
Female	0.92	0.92-0.92	0.90	0.90-0.90	0.90	0.90-0.90
Age
Adolescents	0.95	0.95-0.95	0.95	0.95-0.95	0.91	0.91-0.91
Adults	0.93	0.93-0.93	0.95	0.95-0.95	0.90	0.90-0.90
Elderly	0.93	0.93-0.93	0.92	0.92-0.92	0.88	0.88-0.88
Education level
No education/Some elementary school	0.92	0.92-0.92	0.91	0.91-0.91	0.88	0.88-0.88
Elementary school/Some high school	0.95	0.95-0.95	0.95	0.95-0.95	0.91	0.91-0.91
High school/Some college	0.94	0.94-0.94	0.96	0.96-0.96	0.91	0.91-0.91
College degree	0.94	0.94-0.94	0.97	0.97-0.97	0.91	0.91-0.91
Household location
Urban area	0.93	0.93-0.93	0.95	0.95-0.95	0.90	0.90-0.90
Rural area	0.94	0.94-0.94	0.92	0.92-0.92	0.90	0.90-0.90
	Weight		Height		BMI
	Correlation		Correlation		Correlation
	r	p-value	r	p-value	r	p-value
Total	0.88	< 0.001	0.90	< 0.001	0.82	< 0.001
Sex
Male	0.87	< 0.001	0.85	< 0.001	0.82	< 0.001
Female	0.85	< 0.001	0.82	< 0.001	0.82	< 0.001
Age
Adolescents	0.91	< 0.001	0.90	< 0.001	0.84	< 0.001
Adults	0.88	< 0.001	0.91	< 0.001	0.82	< 0.001
Elderly	0.86	< 0.001	0.85	< 0.001	0.78	< 0.001
Education level
No education/Some elementary school	0.85	< 0.001	0.84	< 0.001	0.79	< 0.001
Elementary school/Some high school	0.90	< 0.001	0.90	< 0.001	0.84	< 0.001
High school/Some college	0.89	< 0.001	0.92	< 0.001	0.83	< 0.001
College degree	0.89	< 0.001	0.93	< 0.001	0.81	< 0.001
Household location
Urban area	0.88	< 0.001	0.90	< 0.001	0.82	< 0.001
Rural area	0.89	< 0.001	0.85	< 0.001	0.82	< 0.001

	Mean agreement (%)	LOA *	β **	p-value ***
Weight ^#
All	99.6	82.0-120.9	-0.011	< 0.01
Sex
Male	100.3	83.5-120.4	-0.032	< 0.01
Female	98.9	80.8-121.2	-0.021	< 0.01
Age
Adolescents	99.1	83.2-117.9	-0.043	< 0.01
Adults	99.5	82.1-120.6	-0.005	0.04
Elderly	100.1	81.4-123.0	-0.033	< 0.01
Education level
No education/Some elementary school	99.7	80.7-123.1	-0.009	0.02
Elementary school/Some high school	99.6	82.3-120.5	-0.010	0.07
High school/Some college	99.5	82.7-119.8	-0.008	0.03
College degree	99.1	81.9-119.8	0.000	0.94
Household location
Urban area	99.5	81.6-121.4	-0.008	< 0.01
Rural area	99.4	82.5-119.6	-0.012	0.02
Height *
All	100.5	95.3-105.9	0.008	< 0.01
Sex
Male	100.3	95.5-105.4	0.037	< 0.01
Female	100.7	95.2-106.4	0.056	< 0.01
Age
Adolescents	100.2	95.3-105.3	0.014	0.25
Adults	100.4	95.5-105.5	0.016	< 0.01
Elderly	101.1	94.8-107.9	0.009	0.23
Education level
No education/Some elementary school	100.7	94.3-107.5	0.028	< 0.01
Elementary school/Some high school	100.5	95.2-106.0	0.014	0.02
High school/Some college	100.4	96.0-105.0	0.002	0.63
College degree	100.3	96.3-104.5	-0.010	0.03
Household location
Urban area	100.5	95.4-105.9	0.002	0.35
Rural area	100.5	94.7-106.7	0.033	< 0.01
BMI ^#
All	98.6	80.0-121.6	-0.025	< 0.01
Sex
Male	99.7	82.0-121.2	-0.026	< 0.01
Female	97.7	78.4-121.7	-0.024	< 0.01
Age
Adolescents	98.7	81.9-119.0	-0.069	< 0.01
Adults	98.8	80.3-121.5	-0.024	< 0.01
Elderly	97.9	78.1-122.6	-0.018	0.03
Education level
No education/Some elementary school	98.5	78.3-123.9	-0.014	0.02
Elementary school/Some high school	98.7	80.0-121.9	-0.033	< 0.01
High school/Some college	98.8	81.1-120.3	-0.031	< 0.01
College degree	98.5	80.9-119.9	-0.022	< 0.01
Household location
Urban area	98.7	80.0-121.6	-0.025	< 0.01
Rural area	98.5	79.9-121.3	-0.024	0.01

	Kappa **	Exact agreement (%)	Sensitivity		Specificity
	Kappa **	Exact agreement (%)	Overweight (%)	Obesity (%)	Overweight (%)	Obesity (%)
Total	0.70	77.0	83.0	73.4	87.5	96.7
Sex
Male	0.71	78.0	85.1	75.7	86.2	96.5
Female	0.70	76.0	80.8	71.6	88.9	96.8
Age
Adolescents	0.68	87.0	70.6	55.7	95.1	99.2
Adults	0.70	77.0	84.4	73.8	86.4	95.7
Elderly	0.66	76.0	75.6	***	89.3	***
Education
No education/Some elementary school	0.68	75.0	81.7	73.9	85.6	96.8
Elementary school/Some high school	0.71	78.0	83.6	72.6	88.5	95.8
High school/Some college	0.71	78.0	83.9	72.2	87.6	93.9
College degree	0.74	81.0	83.0	76.6	90.2	97.5
Household location
Urban area	0.70	77.4	83.3	73.4	87.5	96.7
Rural area	0.68	75.7	79.3	74.2	87.8	96.3

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[TFN1] * Self-reported minus measured weight as tested by paired Student’s t-test. All differences had p-values of < 0.01.