Anthropometric and adiposity indicators for screening diabetes mellitus: A study with Community Health Agents (CHA) from Vitória, Espírito Santo

Martins, Haysla Xavier; Siqueira, Jordana Herzog; Oliveira, Ana Maria Abreu de; Jesus, Hanna Carolina de; Alvim, Rafael de Oliveira; Mill, Jose Geraldo; Pereira, Taisa Sabrina Silva; Molina, Maria del Carmen Bisi

doi:10.1590/1414-462X202533040243

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Artigo Original • Cad Saúde Colet. 33 (4) • 2025 • https://doi.org/10.1590/1414-462X202533040243 linkcopy

Anthropometric and adiposity indicators for screening diabetes mellitus: A study with Community Health Agents (CHA) from Vitória, Espírito Santo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Community Health Agents (CHA) are professionals who work in Primary Health Care (PHC), but they face generalized illness, with high prevalences of Non-Communicable Chronic Diseases (NCDs). Diabetes mellitus (DM) is an NCD characterized by persistent hyperglycemia, caused by changes in insulin action and/or secretion. Among the risk factors for developing DM is obesity. Therefore, investigating the use of adiposity indicators for early screening of the disease in these professionals is relevant.

Objective: To identify the discriminatory power of anthropometric indicators (Waist Circumference [WC] and Body Mass Index [BMI]) and adiposity (Body Adiposity Index [BAI] and Visceral Adiposity Index [VAI]) for Diabetes Mellitus (DM) in female community health agents (CHA) from Vitória/ES.

Methods: Cross-sectional analysis of baseline data from an intervention study. Clinical examinations and interviews were performed between October/2018 and March/2019, at the Cardiovascular Investigation Clinic of the Federal University of Espírito Santo. Association tests were performed according to the sample design. Receiver Operating Characteristic (ROC) curves were constructed to evaluate the performance models, and the area under the curve (AUC) was used to measure the discriminatory power for DM, with the GraphROC for windows software. Sensitivity and specificity values for each adiposity indicator were determined by analysis of ROC curves, and these values were used to establish the ideal cut-off points. Statistical Package for the Social Sciences (SPSS) version 21.0 was used, adopting p<0.05.

Results: There was a prevalence of DM in 17% of the CHA evaluated (n 247; mean age 46.4±9.2 years). WC (AUC=0.79) showed greater power to discriminate the disease compared to BAI (AUC=0.66), VAI (AUC=0.67), and BMI (AUC=0.74).

Conclusion: WC showed better discriminatory power for DM, reinforcing the use of a tool already widely used in the assessment of nutritional status and central obesity; in addition, it is essential for the screening of this clinical condition.

Keywords:
diabetes mellitus; nutritional status; adiposity; obesity; community health workers

Variáveis		Diabéticos	Não diabéticos	Valor p
Variáveis		(n=42)	(n=205)	Valor p
Idade (anos)		50,9±9,3	45,5±8,9	<0,001 ***
Idade
	25 a 39	13 (31)	106 (51,7)	0,017 *
	40 a 59	22 (52,4)	85 (41,5)
	≥60	7 (16,7)	14 (6,8)
Raça/cor da pele
	Branca	5 (11,9)	42 (20,5)	0,466*
	Preta	14 (33,3)	62 (30,2)
	Parda	23 (54,8)	101 (49,3)
Escolaridade
	Ensino fundamental	2 (4,8)	8 (3,9)	0,670**
	Ensino médio	36 (85,7)	166 (81)
	Ensino superior	4 (9,5)	31 (15,1)
Classe socioeconômica
	A e B	14 (33,3)	81 (39,5)	0,245**
	C	26 (61,9)	121 (59)
	D e E	2 (4,8)	3 (1,5)
Tabagismo
	Não fumantes	33 (78,6)	163 (79,5)	0,387**
	Ex-fumantes	9 (21,4)	34 (16,6)
	Fumantes	0 (0)	8 (3,9)
Bebidas alcoólicas
	Consome	14 (33,3)	87 (42,4)	0,305*
	Não consome	28 (66,7)	118 (57,6)	0,305*
Bebidas açucaradas
	Consome	32 (76,2)	164 (80)	0,676*
	Não consome	10 (23,8)	41 (20)	0,676*
Atividade física
	Ativos	5 (11,9)	64 (31,4)	0,021 *
	Insuficientemente ativos	6 (14,3)	18 (8,8)
	Sedentários	31 (73,8)	122 (59,8)

Variáveis		IMC (kg/m²)	Valor p	CC (cm)	Valor p	IAC	Valor p	IAV	Valor p
Variáveis		Média±dp	Valor p	Média±dp	Valor p	Média±dp	Valor p	Média±dp	Valor p
Diabetes mellitus
	Sim	32,7±4,9	<0,001 **	102,8±12,2	<0,001 **	38,7±4,8	<0,001**	7,8±4,7	<0,001 **
	Não	28,3±5,3	<0,001 **	88,4±14,1	<0,001 **	35,6±4,9	<0,001**	5,4±2,8	<0,001 **
Raça/cor da pele
	Branca	28,8±5,0	0,328*	90,8±14,6	0,500*	35,8±4,7	0,580*	6,1±3,2^a,b	0,017 *
	Preta	29,8±5,6		92,4±14,8		36,7±4,7		4,8±2,3^b
	Parda	28,6±5,6		89,8±14,9		36,0±5,4		6,2±3,7^a
Escolaridade
	Ensino fundamental	32,7±3,7^a	0,014 *	102,4±7,7^a	0,007 *	37,3±3,5^a,b	0,009 *	7,4±2,4^a	0,002 *
	Ensino médio	29,2±5,5^a,b		91,1±15,0^b		36,5±5,0^a		5,8±3,2^a
	Ensino superior	27,1±5,4^b		85,9±13,3^b		33,8±5,4^b		4,9±3,8^b
Atividade física
	Ativos	27,6±4,7^a	0,022 *	87,2±12,6^a	0,032 *	35,1±4,8	0,097*	5,0±2,8^a	0,008 *
	Insuficientemente ativos	28,4±6,4^a,b		89,7±15,3^a,b		36,2±5,6		7,5±4,0^b
	Sedentários	29,8±5,6^b		92,7±15,4^b		36,7±5,0		5,8±3,3^a,b

Indicadores		Glicemia de jejum		Glicemia de 2h após sobrecarga de dextrosol		HOMA-IR
Indicadores		r	Valor p	r	Valor p	r	Valor p
Antropométricos
	IMC	0,436	<0,001	0,290	<0,001	0,490	<0,001
	CC	0,504	<0,001	0,273	<0,001	0,547	<0,001
Adiposidade
	IAC	0,325	<0,001	0,225	0,002	0,307	<0,001
	IAV	0,243	<0,001	0,151	0,037	0,439	<0,001

Indicadores		Ponto de corte	Sensibilidade (%)	Especificidade (%)	VPP (%)	VPN (%)
Antropométricos
	IMC	27,6	92,8	52,2	28,4	97,2
	CC	92	80,9	67,8	33,9	94,5
Adiposidade
	IAC	34	88,1	40,9	23,4	94,4
	IAV	7	50	77,6	31,4	88,3

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[TFN1] Variáveis categóricas foram expressas em n (%) e as contínuas em média±desvio padrão;

[TFN2] ^*
Teste χ²;

[TFN3] ^**
Teste Exato de Fisher;

[TFN4] ^***
Teste t-Student. Valores em negrito são estatisticamente significativos (p<0,05); CACEA: Capacitação de Agentes Comunitários de Saúde em Educação Alimentar.