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| Author(s): |
Nivea Fazanaro Marra
Total Authors: 1
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| Document type: | Master's Dissertation |
| Press: | São Paulo. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) |
| Defense date: | 2018-06-12 |
| Examining board members: |
Beatriz Helena Carvalho Tess;
Heraclito Barbosa de Carvalho;
Angela Maria Spinola e Castro;
Sandra Roberta Gouvea Ferreira Vivolo
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| Advisor: | Beatriz Helena Carvalho Tess |
| Abstract | |
Introduction: The Body Mass Index (BMI) has limitations for assessment of health risks; the literature suggests that this index be used in association with metabolic measures, recommending classification in anthropometric-metabolic phenotypes. The evaluation of insulin resistance has been identified as an important factor to identify unfavorable metabolic phenotypes, but this marker is not commonly considered in the definitions of metabolically healthy obesity phenotype. Prevalence studies report that heterogeneous estimates depending on the criteria of the definition. These studies bring relevant contributions to the understanding of this phenotype in the treatment, planning of health services and understanding of the epidemiology of obesity and its different manifestations. Objective: To investigate the impact of insulin resistance on the estimated prevalence of metabolically healthy obesity phenotype in obese adolescents seeking treatment. Methodology: This is a cross-sectional study based on secondary data, on 418 obese adolescents, who were treated at Childhood Obesity League of Hospital das Clínicas, University of São Paulo between January 2009 and December 2013. Two definitions were used to classify adolescents into \"metabolically healthy\" and \"metabolically unhealthy\" phenotypes. The first one was based on the values proposed by the International Diabetes Federation to diagnose metabolic syndrome in children and adolescents. The second one, the measure of insulin resistance determined by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was added. The cut-off value for HOMA-IR was 3.16. The descriptive analysis included the distribution of the absolute and relative frequencies of the independent variables sex, age, pubertal stage and z-score for Body Mass Index (Z-BMI). The prevalence of metabolically healthy obesity was calculated with intervals of 95% of confidence and the X² test at 5% significance level was applied to associations between exposure variables and outcome. The same analyzes was performed for both settings. Approval of the Research Ethics Committee of the Hospital das Clínicas (Process Number: 1.230.024). Results: Of the 418 participants, 217 (52%) were female. The mean age was 13 years (± 2) and Z-BMI 3.2 (± 0.5). Half of the participants were pubertal and 39% post-pubertal according to the Tanner scale. The prevalence of the metabolically healthy phenotype was 43% (CI 95%: 38-48) by definition I and 13% (CI 95%: 9-16) by definition II. In the multivariate analysis using definition I, male gender [prevalence ratio (PR), 0.32; 95% CI, 0.16-0.62], pubertal stage (PR, 0.24; 95% CI, 0.14-0.43) and severe obesity (PR, 0.40; 95% CI, 0.16-0.62) were independently and significantly associated with lower MHO prevalence. When definition II was used, similar results were observed for pubertal stage (PR, 0.34; 95% CI, 0.19-0.59) and severe obesity (PR, 0.39; 95% CI, 0.20-0.79), but male gender (PR, 0.63; 95% CI, 0.32-1.23) was not significantly associated with lower MHO prevalence. No association was found between MHO phenotype and skin color. Conclusion: The inclusion of insulin resistance in the definition criteria of metabolically healthy obesity in this population, led to a significant decrease in the prevalence of this phenotype. Insulin resistance may be an important marker of the negative repercussion of obesity in the health of these adolescents (AU) | |
| FAPESP's process: | 15/23559-9 - Prevalence and associated factors with phenotype "metabolically health obesity" in a population of obese children and adolescents treated at the Children Obesity League HC-FMUSP |
| Grantee: | Nivea Fazanaro Marra |
| Support Opportunities: | Scholarships in Brazil - Master |