Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents

Farias, Camilla Ribeiro Lima de; Medeiros, Carla Campos Muniz; Souza, Diogo Rodrigues; Costa, Ivelise Fhrideraid Alves Furtado da; Simões, Mônica Oliveira da Silva; Carvalho, Danielle Franklin de

doi:10.1590/0034-7167-2016-0564

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 71 (3) • May-Jun 2018 • https://doi.org/10.1590/0034-7167-2016-0564 copy

Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents

Síndrome metabólico infantojuvenil persistente y relación con el riesgo de enfermedad cardiovascular

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score.

Method:

a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression.

Results:

persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS.

Conclusion:

persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

Descriptors:
Metabolic X Syndrome; Cardiovascular Diseases; Obesity; Adolescent; Child

Variable	Enrollment		Month 24		p value
Variable	n	%	n	%	p value
Metabolic syndrome (NCEP/ATPIII)
Present	82	61.7	81	60.9	1.00
Absent	51	38.3	52	39.1	1.00
Nutritional state (z-score)
Obesity	108	81.2	102	76.7	0.46
Overweight^* * at the end four were eutrophic	25	18.2	31	23.3	0.46
Waist circumference (cm)
Altered	86	64.7	94	70.7	0.22
Normal	47	35.3	39	29.3	0.22
Systolic blood pressure (mmHg)
Increased	49	36.8	13	9.8	<0.01
Normal	84	63.2	120	90.2	<0.01
Diastolic blood pressure (mmHg)
High	86	64.7	42	31.6	<0.01
Normal	47	35.3	91	68.4	<0.01
HDL-cholesterol (mg/dL)
Low	106	79.7	119	89.5	0.03
Normal	27	20.3	14	10.5	0.03
Non HDL-cholesterol (mg/dL)
High	52	39.1	57	42.9	0.18
Normal	81	60.9	76	57.1	0.18
Triglycerides (mg/dL)
High	77	57.9	85	63.9	0.30
Normal	56	42.1	48	36.1	0.30
Fasting blood glucose (mg/dL)
High	2	1.5	1	0.8	1.00
Normal	131	98.5	132	99.2	1.00

Variables	Persistence of metabolic syndrome				RP	p value	CI 95%
	Yes		No
	n	%	n	%
Sex
Male	23	45.1	29	35.4	1.50	0.26	0.74-3.06
Female	28	54.9	53	64.6	1.50	0.26	0.74-3.06
Age group (years)
Children (2-9)	15	29.4	15	18.3	1.86	0.14	0.82-4.24
Adolescents (10-19)	36	70.6	67	81.7	1.86	0.14	0.82-4.24
Color
White	16	31.4	27	32.9	0.93	0.85	0.44-1.99
Nonwhites	35	68.6	55	67.1	0.93	0.85	0.44-1.99
Income^* * minimum salary in 2012 = R$622.00;
≤ One minimum salary	07	13.7	11	13.4	1.03	0.96	0.37-2.85
> One minimum salary	44	86.3	71	86.6	1.03	0.96	0.37-2.85
Maternal education level
≤ 8 years of schooling	27	52.9	47	57.3	0.84	0.62	0.42-1.69
> 8 years of schooling	24	47.1	35	42.7	0.84	0.62	0.42-1.69
Physical activity
<149 minutes/week	26	51.0	37	45.1	1.26	0.51	0.63-2.54
≥150 minutes/week	25	49.0	45	54.9	1.26	0.51	0.63-2.54
Sedentarism
Present	33	64.7	49	59.8	1.24	0.57	0.60-2.55
Absent	18	35.3	33	40.2	1.24	0.57	0.60-2.55
Nutritional states (z-score)^† † Four cases of eutrophy were registered at the end of the study; Data regarding smoking were not included in the table because there were no cases of this.
Obesity	47	92.2	55	67.1	5.77	<0.01	1.88-17.68
Overweight	4	7.8	27	32.9	5.77	<0.01	1.88-17.68
Non HDL-cholesterol (mg/dL)
Altered	26	51.0	31	37.8	1.71	0.14	0.84-3.47
Normal	25	49.0	51	62.2	1.71	0.14	0.84-3.47
HDL-cholesterol (mg/dL)
Altered	50	98.0	69	84.1	9.42	0.01	1.19-74.38
Normal	1	2.0	13	15.9	9.42	0.01	1.19-74.38
Fasting blood glucose (mg/dL)
Altered	1	2.0	0	0.0	2.64	0.38	2.12-3.28
Normal	50	98.0	82	100.0	2.64	0.38	2.12-3.28
Glycated hemoglobin HbA1c (%)
Altered	1	2.0	0	0.0	2.64	0.38	2.12-3.28
Normal	50	98.0	82	100.0	2.64	0.38	2.12-3.28
Arterial pressure (mmHg)
Altered	23	45.1	25	30.9	1.84	0.09	0.89-3.80
Normal	28	54.9	56	69.1	1.84	0.09	0.89-3.80
PDAY cardiovascular risk score
Moderate/high risk	39	76.5	67	81.7	0.73	0.46	0.31-1.71
Low risk	12	23.5	15	18.3	0.73	0.46	0.31-1.71

Metabolic syndrome	Cardiovascular risk score - PDAY				RP	p value	CI 95%
	M/H		Low
	n	%	N	%
Waist circumference (cm)
Altered	75	70.8	19	70.4	1.02	0.97	0.40-2.57
Normal	31	29.2	8	29.6	1.02	0.97	0.40-2.57
Systolic arterial pressure (mmHg)
Altered	12	11.3	1	3.7	3.32	0.47	0.41-26.72
Normal	94	88.7	26	96.3	3.32	0.47	0.41-26.72
Diastolic arterial pressure (mmHg)
Altered	42	39.6	0	0	1.42	<0.01	1.24-1.63
Normal	64	60.4	27	100.0	1.42	<0.01	1.24-1.63
Triglycerides (mg/dL)
Altered	64	60.4	21	77.8	0.44	0.09	0.16-1.17
Normal	42	39.6	6	22.2	0.44	0.09	0.16-1.17
HDL-cholesterol (mg/dL)
Altered	98	92.5	21	77.8	3.50	0.04	1.10-11.15
Normal	8	7.5	6	22.2	3.50	0.04	1.10-11.15
Fasting blood glucose (mg/dL)
Altered	0	0	1	3.7	5.08	0.20	3.60-7.17
Normal	106	100.0	26	96.3	5.08	0.20	3.60-7.17
Persistence of metabolic syndrome
Yes	39	36.8	12	44.4	0.73	0.46	0.31-1.71
No	67	63.2	15	55.6	0.73	0.46	0.31-1.71

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[1] CORRESPONDING AUTHOR: Camilla Ribeiro Lima de Farias E-mail: camilla_ribeiro@hotmail.com

Univariate	Persistence of MetS
Independent variables	Exp(B)	SD	R²	p value	CI 95%	H&L
Nutritional state	0.182	0.575	0.139	0.003	0.059-0.561	-
Non HDL-cholesterol	1.915	0.373	0.060	0.082	0.921-3.979
HDL-cholesterol	9.247	1.061	0.103	0.036	1.157-73.930
Multivariate	Persistence of MetS
Independent variables	Exp(B)	SD	R²	p value	CI 95%	H&L
Nutritional state	0.155	0.602	0.234	0.002	0.048-0.505	0.537
Non HDL-cholesterol	0.446	0.409		0.048	0.200-0.994
HDL-cholesterol	0.119	1.081		0.049	0.014-0.987