ERICA: prevalence of metabolic syndrome in Brazilian adolescents

Kuschnir, Maria Cristina C; Bloch, Katia Vergetti; Szklo, Moyses; Klein, Carlos Henrique; Barufaldi, Laura Augusta; Abreu, Gabriela de Azevedo; Schaan, Beatriz; Veiga, Gloria Valeria da; Silva, Thiago Luiz Nogueira da; Vasconcellos, Maurício T L de; Moraes, Ana Júlia Pantoja de; Oliveira, Ana Mayra Andrade de; Tavares, Bruno Mendes; Oliveira, Cecília Lacroix de; Cunha, Cristiane de Freitas; Giannini, Denise Tavares; Belfort, Dilson Rodrigues; Santos, Eduardo Lima; Leon, Elisa Brosina de; Oliveira, Elizabete Regina Araújo; Fujimori, Elizabeth; Borges, Ana Luíza; Magliano, Erika da Silva; Vasconcelos, Francisco de Assis Guedes; Azevedo, George Dantas; Brunken, Gisela Soares; Guimarães, Isabel Cristina Britto; Faria Neto, José Rocha; Oliveira, Juliana Souza; Carvalho, Kenia Mara B de; Gonçalves, Luis Gonzaga de Oliveira; Monteiro, Maria Inês; Santos, Marize M; Muniz, Pascoal Torres; Jardim, Paulo César B Veiga; Ferreira, Pedro Antônio Muniz; Montenegro Jr, Renan Magalhães; Gurgel, Ricardo Queiroz; Vianna, Rodrigo Pinheiro; Vasconcelos, Sandra Mary; Martins, Stella Maris Seixas; Goldberg, Tamara Beres Lederer

doi:10.1590/S01518-8787.2016050006701

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Original Article • Rev. Saúde Pública 50 (suppl 1) • 07 June 2016 • https://doi.org/10.1590/S01518-8787.2016050006701 linkcopy

ERICA: prevalence of metabolic syndrome in Brazilian adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents.

METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status.

RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides.

CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

Adolescent; Metabolic Syndrome, epidemiology; Risk Factors; Cardiovascular Diseases; Cross-Sectional Studies

Characteristic	Age group	Sample	Population	%	95%CI
Female	12-14	10,134	1,536,757	2.5	1.7-3.6
	15-17	12,365	1,788,116	2.1	1.5-2.7
	12-17	22,499	3,324,873	2.2	1.8-2.8
Male	12-14	7,016	1,552,255	2.5	2.0-3.2
	15-17	7,990	1,751,833	3.3	2.5-4.2
	12-17	15,006	3,304,088	2.9	2.5-3.4
Brazil	12-14	17,150	3,089,012	2.5	2.0-3.0
	15-17	20.355	3,539,949	2.7	2.2-3.2
	12-17	37,504	6,628,961	2.6	2.3-2.9

Regions/Sex	Age group	Sample	Population	%	95%CI
North		7,233	456,416	2.3	2.0-2.8
Female	12-14	1,979	126,869	2.0	1.3-3.0
	15-17	2,279	100,881	2.5	1.8-3.4
Male	12-14	1,458	127,856	1.6	0.9-2.8
	15-17	1,517	100,810	3.5	2.6-4.7
Northeast		11,661	1,337,676	2.7	2.3-3.1
Female	12-14	3,314	343,871	2.2	1.3-4.0
	15-17	3,722	325,047	2.3	1.7-3.3
Male	12-14	2,160	350,923	2.7	1.8-4.1
	15-17	2,465	317,835	3.4	2.6-4.4
Midwest		5,441	525,340	2.2	1.7-3.0
Female	12-14	1,543	123,669	1.9	1.1-3.1
	15-17	1,802	140,324	2.1	1.4-3.3
Male	12-14	1,060	124,867	3.2	1.8-5.4
	15-17	1,056	136,480	1.8	1.1-3.0
Southeast		8,460	3,488,424	2.4	1.9-3.0
Female	12-14	2,141	755,994	1.9	1.0-3.7
	15-17	3,024	995,770	1.9	1.1-3.1
Male	12-14	1,459	760,343	2.7	1.8-4.0
	15-17	1,836	976,317	3.1	2.0-4.8
South		4,690	821,105	3.5	2.6-4.9
Female	12-14	1,157	186,354	5.7	2.5-12.7
	15-17	1,538	226,094	2.1	1.0-4.3
Male	12-14	879	188,266	1.6	0.9-2.8
	15-17	1,116	220,391	4.8	3.3-6.9

Regions/Sex	Overweight		Obesity

	%	95%CI	%	95%CI
Brazil	3.3	2.4-4.5	21.3	18.5-24.5
Female	4.0	2.6-6.0	17.5	13.7-21.9
Male	2.6	1.6-4.1	24.5	20.1-29.6
North	3.3	2.4-4.4	24.7	20.5-29.5
Female	5.1	3.6-7.1	22.4	16.6-29.5
Male	1.3	0.7-2.6	26.3	20.1-33.6
Northeast	3.3	2.1-5.3	21.7	16.7-27.8
Female	3.5	2.2-5.6	20.1	12.2-31.2
Male	3.1	1.7-5.7	22.8	17.9-28.6
Midwest	2.1	1.2-3.0	21.7	16.1-27.9
Female	3.1	1.9-5.1	23.9	16.2-33.8
Male	1.2	0.5-2.4	20.5	14.8-27.7
Southeast	3.9	2.4-6.2	18.9	14.5-24.2
Female	4.8	2.5-9.1	11.3	7.8-16.0
Male	3.0	1.4-6.1	26.1	17.9-36.4
South	1.6	0.9-3.0	27.3	20.7-35.2
Female	1.8	0.8-4.0	31.8	19.4-47.5
Male	1.4	0.6-3.4	23.6	16.5-32.6

Characteristic	Nutritional status	%	95%CI
Brazil	Eutrophic	0.1	0.02-0.2
	Overweight	3.3	2.4-4.5
	Obese	21.3	18.5-24.5
Female	Eutrophic	0.1	0.03-0.4
	Overweight	4.0	2.6-6.0
	Obese	17.5	13.7-21.9
Male	Eutrophic	0.008	0.003-0.03
	Overweight	2.6	1.6-4.1
	Obese	24.5	20.1-29.6
12-14 years	Eutrophic	0.01	0.006-0.04
	Overweight	1.7	0.7-3.8
	Obese	19.6	15.8-24.1
15-17 years	Eutrophic	0.1	0.04-0.4
	Overweight	4.9	3.6-6.6
	Obese	23.5	19.1-28.6
North	Eutrophic	0.1	0.02-0.2
	Overweight	3.3	2.4-4.4
	Obese	24.7	20.5-29.5
Northeast	Eutrophic	0.1	0.03-0.2
	Overweight	3.3	2.1-5.3
	Obese	21.7	16.89-27.5
Midwest	Eutrophic	0.02	0.01-0.1
	Overweight	1.6	0.9-3.0
	Obese	27.3	20.7-35.2
Southeast	Eutrophic	0.02	0.0-0.1
	Overweight	2.1	1.4-3.2
	Obese	21.7	16.7-27.8
South	Eutrophic	0.1	0.01-0.4
	Overweight	3.9	2.5-6.2
	Obese	18.9	14.5-24.2

Strata	Total		Nonobese		Obese

	%	95%CI	%	95%CI	%	95%CI
North Countryside	1.8	1.3-2.5	0.7	0.4-1.1	18.4	12.2-26.9
Porto Velho	3.3	1.8-5.7	0.6	0.3-1.6	32.6	19.6-49.0
Rio Branco	1.9	1.0-3.3	0.3	0.1-1.0	19.6	12.9-28.6
Manaus	2.2	1.5-3.2	0.5	0.3-1.1	21.1	13.2-31.8
Boa Vista	1.7	0.6-5.0	0.2	0-0.8	20.1	7.2-45.1
Belem	3.8	2.7-5.2	1.0	0.6-1.5	37.3	27.2-48.7
Macapa	0.9	0.3-2.7	0.1	0-0.5	22.6	6.6-54.6
Palmas	2.1	1.0-4.3	0.3	0.1-1.1	28.4	16.1-45.2
Northeast Countryside	2.9	2.2-3.8	0.9	0.5-1.8	21.3	13.0-32.9
Sao Luis	2.4	1.5-3.7	0.4	0.2-0.8	36.5	23.1-52.5
Teresina	1.6	0.8-3.2	0.2	0.1-0.8	20.6	10.6-36.3
Fortaleza	2.6	1.7-3.8	0.4	0.2-0.9	23.4	15.8-33.3
Natal	2.3	1.2-4.1	1.0	0.4-2.6	14.4	8.3-23.6
Joao Pessoa	3.0	1.8-4.9	0.5	0.1-1.8	36.2	19.5-57.1
Recife	2.7	1.9-3.9	0.8	0.3-1.8	19.3	13.7-26.6
Maceio	2.2	1.3-3.7	0.4	0.2-1.0	23.8	12.8-40.0
Aracaju	2.2	1.4-3.6	0.3	0.1-1.1	19.5	11.2-31.7
Salvador	2.6	1.5-4.3	0.8	0.4-1.4	19.9	10.1-35.5
Midwest Countryside	2.8	1.6-4.8	0.4	0.2-0.9	30.6	19.7-44.3
Campo Grande	2.2	1.2-4.2	0.4	0.1-1.3	18.3	9.4-32.6
Cuiaba	2.6	1.7-3.9	1.1	0.7-1.7	21.2	10.9-37.3
Goiania	2.1	1.2-3.8	0.3	0.1-1.0	18.4	9.7-32.2
Brasilia	1.7	1.1-2.6	0.3	0.1-0.7	17.0	11.2-24.8
Southeast Countryside	2.6	2.0-3.5	1.0	0.5-1.8	20.6	14.4-28.6
Belo Horizonte	1.3	0.8-1.9	0.6	0.3-1.1	10.8	6.2-18.2
Vitoria	2.5	1.5-4.2	0.8	0.3-2.0	21.3	10.8-37.5
Rio de Janeiro	1.9	1.3-2.7	0.5	0.2-1.1	11.6	7.5-17.7
Sao Paulo	2.1	1.5-3.0	0.5	0.3-1.1	20.2	12.9-30.4
South Countryside	4.1	2.8-5.9	0.2	0.1-0.7	30.0	22.1-39.3
Curitiba	2.0	1.3-3.2	0.9	0.3-2.2	16.3	9.7-26.0
Florianopolis	1.8	0.8-4.0	0.1	0.0-0.7	25.0	9.7-50.7
Porto Alegre	2.2	1.3-3.6	0.8	0.3-2.5	13.9	8.7-21.5

MS components	Prevalence of the component		Prevalence of MS in adolescents with the component		Prevalence of the component in adolescents with MS

	%	95%CI	%	95%CI	%
WC^a	12.6	11.6-13.7	20.5	18.2-22.9	100
HDL-c^b	32.7	30.3-35.2	7.2	6.3-8.2	90.7
Triglycerides^a	4.6	4.1-5.1	26.8	22.4-31.7	47.6
Glucose^a	4.1	3.5-4.8	15.0	10.8-20.4	20.6
Blood pressure^a	8.2	7.6-8.9	18.7	15.6-22.1	57.6

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Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[TFN1] MS: metabolic syndrome; WC: waist circumference; HDL-c: HDL-cholesterol

[TFN2] ^a High.

[TFN3] ^b Low.