Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 16 a 23


Risk of metabolic syndrome in low birth weight adolescents

Riesgo de síndrome metabólico en adolescentes con bajo peso al nacer

Risco de síndrome metabólica em adolescentes com baixo peso ao nascimento

Autores: Luis Paulo Gomes Mascarenhas1; Antonio Stabelini Neto2; Cristiane Petra Miculis3; Lilian Messias Sampaio Brito4; William Cordeiro de Souza5; Margaret Cristina da Silva Boguszewski6

1. Pos-Doctorate. PhD in Child and Adolescent Health at the Federal University of Paraná (UFPR). Curitiba, PR, Brazil. Coordinator of the Postgraduate Program in Community Development, Department of Health Sciences, State University of the Center-West (UNICENTRO). Irati, PR, Brazil
2. Doctor in Physical Education, Federal University of Paraná (UFPR). Curitiba, PR, Brazil. Director of the Department of Health Sciences, State University of Northern Paraná (UENP). Jacarezinho, PR, Brazil
3. Doctorate in Child and Adolescent Health. Researcher at the Department of Pediatrics, Federal University of Paraná (UFPR). Curitiba, PR, Brazil
4. PhD student in Child and Adolescent Health through the Graduate Program in Childhood and Adolescence Health. Master in Physical Activity and Health, Federal University of Paraná (UFPR). Curitiba, PR, Brazil
5. Master's degree in Community Development at the State University of the Midwest (UNICENTRO). Irati, PR, Brazil
6. PhD in Pediatric Endocrinology from the University of Gothenburg (GU). Gothenburg , Sweden. Professor of the Postgraduate Program in Childhood and Adolescent Health, Department of Pediatrics, Federal University of Paraná (UFPR). Curitiba, PR, Brazil

Correspondência:
Luis Paulo Gomes Mascarenhas
Universidade Estadual do Centro-Oeste (UNICENTRO)
Campus de Irati, PR 153 Km 7, Riozinho
Irati, PR, Brasil. CEP: 84500-000
luismsk@gmail.com

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Keywords: Adolescent, metabolic diseases, gestational age.
Palabra Clave: Adolescente, enfermedades metabólicas, edad gestacional.
Descritores: Adolescente, doenças metabólicas, idade gestacional.

Abstract:
OBJECTIVE: Verify the prevalence of metabolic syndrome (MS) in adolescents born with low weight.
METHODS: The sample consisted of 791 adolescents between 10 to 18 years of age. Is was adopted as having low weight born (LWB) those below of the 10th percentile and those having appropriate weight at birth (AWB) between the 10th and 90th percentile. MS was diagnosed if three or more risk factors were present.
RESULTS: The prevalence of MS in LWB was 14.8% in boys and 6.3% in girls, against AWB on 4.3% in boys and 5.0% in girls. Boys born with LWB showed an odds ratio of 3.84 (CI: 1.14 to 12.86) of having MS.
CONCLUSION: High prevalence of MS was observed in male adolescents born LWB, in this sense, strategies for prevention and care for this population should be given since childhood.

Resumen:
OBJETIVO: Verificar la prevalencia de síndrome metabólico (SM) en adolescentes nascidos con bajo peso.
MÉTODOS: La muestra se constituye de 791 adolescentes de 10 a 18 años de edad. Se adoptó como teniendo bajo peso al nacer (BPN) aquellos de percentil abajo del 10º, y aquellos como teniendo peso adecuado al nacer (APN) entre el 10º y 90º percentil. SM fue diagnosticada si tres o más factores de riesgo estuvieran presentes.
RESULTADOS: La prevalencia de SM en niños BPN fue de 14,8% y en las niñas de 6,3%; contra 4,3% en los niños APN y 5,0% en las niñas APN. Los niños nacidos BPN revelaron una razón de posibilidad de 3,84 (IC: 1,14 - 12,86) de presentar SM.
CONCLUSIÓN: Alta prevalencia de SM fue observada en adolescentes masculinos nacidos con bajo peso; en este sentido, estrategias de prevención y cuidados a esta población deben ser dados desde la infancia.

Resumo:
OBJETIVO: Verificar a prevalência de síndrome metabólica (SM) em adolescentes nascidos com baixo peso.
MÉTODOS: A amostra constitui-se de 791 adolescentes de 10 a 18 anos de idade. Adotou-se como tendo baixo peso ao nascimento (BPN) aqueles percentil abaixo do 10º, e aqueles como tendo peso adequado ao nascimento (APN) entre o 10º e 90º percentil. SM foi diagnosticada se três ou mais fatores de risco estivessem presentes.
RESULTADOS: A prevalência de SM em meninos BPN foi de 14,8% e nas meninas foi de 6,3%; contra 4,3% nos meninos APN e 5,0% nas meninas APN. Os meninos nascidos BPN revelaram uma razão de chance de 3,84 (IC: 1,14 - 12,86) de apresentarem SM.
CONCLUSÃO: Alta prevalência de SM foi observada em adolescentes masculinos nascidos com baixo peso, neste sentido, estratégias de prevenção e cuidados a esta população devem ser dados desde a infância.

INTRODUCTION

Low birth weight occurs in both industrialized and developing countries, varying from 9% to 26% of live births depending on the region of the world, contributing to short- and long-term public health problems (metabolic risks)1,2. During the last decades, evidence has emerged showing that size at birth is associated with a high prevalence of metabolic and cardiovascular diseases, including hypertension, glucose intolerance, diabetes mellitus and dyslipidemias in adulthood3,4, as well as an association with increase and distribution of adipose tissue and reduction in lean mass5 and increase of blood lipids6. However, these findings did not find support in other studies7,8. Thus, the present study aimed to evaluate the prevalence of metabolic syndrome in adolescents of both sexes with different sizes at birth.


METHODS

The sample consisted of 1152 adolescents of both genders between 10 and 18 years of age. At the time of the return of the Consent Form, a questionnaire was delivered to be filled with information on conditions at birth (gestational age, weight and length at birth) and history of the young and family's illnesses. Exclusion criteria were: non-return of completed questionnaire, individuals classified as large for gestational age, family history of metabolic disease (familial familial hypercholesterolemias) or cardiovascular disease, presence of type 1 diabetes mellitus or other disease that could influence in evaluations, medications of continuous use, lack of knowledge of the conditions at birth, prematurity.

Of the 1152 young people who received the questionnaire, 352 were excluded or did not want to participate in all stages of the survey, leaving 800 adolescents with complete questionnaires. Of these, nine adolescents were excluded because they had elevated thyroid stimulating hormone (TSH) and were referred for treatment. Thus, 791 adolescents composed the final sample of the study.

The present study was approved by the human research ethics committee of the Hospital de Clinicas, in compliance with resolution CNS 196/96 and the Declarations of Helsinki, on registration 1466.131 / 2007.

Physical evaluations of students were carried out in the schools themselves. All were evaluated barefoot and wearing light clothing. Height measurements were performed in a portable vertical stadiometer (WCS®, Brazil), staggered in 0.1 cm.The weight was evaluated with portable digital scale (Filizola®, Brazil), with resolution of 100 grams. Waist circumference was performed in duplicate at the midpoint between the last costal arch and the iliac crest9. The subjects were classified according to the proposal of Freedman et al.10. Blood pressure was measured by the auscultatory method, using as reference the values of The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents11.

At the same time, a blood sample was collected from each individual. Participants were fasted and given guidance on the care to be taken the day before. The samples were centrifuged and kept frozen for further evaluation of total cholesterol, HDL-cholesterol, triglycerides, insulin and TSH. The glycemia dosage was performed locally through the glycosimeter (®abbott). The reference values for the lipid profile followed the proposal of the I Guideline for the Prevention of Atherosclerosis in Childhood and Adolescence12.

For the diagnosis of metabolic syndrome (MS), Cook et al.13, when the presence of changes in three or more of the following components define the syndrome: systolic blood pressure (SBP) and / or diastolic blood pressure (DBP), triglycerides, HDL cholesterol, fasting glucose, waist circumference.

Data were divided according to birth weight in two groups, low birth weight (LBW) and adequate birth weight (PAN), ranging from 36 to 44 weeks of gestation. In the absence of a national birth weight distribution table, we chose to perform the percentile distribution of the sample itself, with LBW being considered the individuals with birth weight ≤ 10º percentile and PAN those between the 10º and 90º percentiles. Individuals with birth weight above the 90th percentile were excluded (Table 1).




Data were expressed as mean, standard deviation and percentage, where the chi-square test was applied. The Student's t - test and the Mann-Whitney U-test for independent samples were used to compare the groups , respecting the Levene's test to assume equal variance when necessary. The Odd Ratio test was used to identify the relative risk between the LBW group and the NPC presence of metabolic syndrome. The analyzes were performed in the statistical software SPSS 13.0, adopting a level of significance of p <0.05 for all analyzes.


RESULTS

Gestational age was 39.42 ± 2.25 weeks for boys and 39.38 ± 2.28 weeks for girls (p=0.77). The respective values of birth weight were 3.29 ± 0.58 kg and 3.12 ± 0.55 kg (p = 0.001). Of the 322 males, 33 were considered low birth weight (LBW) and 289 with adequate birth weight (PAN). Among the 469 female subjects, 67 BPN and 402 PAN. Tables 2 and 3 present the characteristics of boys and girls according to birth weight, respectively. No significant differences were found in the proportions of participants with high values for metabolic syndrome variables in relation to birth weight.






Figure 1 shows the percentages of metabolic syndrome found in adolescents born with BP and AP. A higher prevalence of metabolic syndrome was observed in boys with LBW (14.8%) than in PAN (4.3%) x2 = 5.42 and p=0.02. There were no significant differences (x2 = 0.89 and p = 0.34) among the girls and BPN (6.3%) and PAN (5.0%).



Figure 1. Percentage of individuals with metabolic syndrome by gender and birth weight.



Table 4 presents the relative risks between birth weight and metabolic syndrome. It is observed a high risk of boys born with low weight to present metabolic syndrome as early as adolescence.




DISCUSSION

The classification of low weight (2,500 grams) used in the present study is recommended by the World Health Organization14 for the definition of children born with low weight. Around the world, it is estimated that between 8 and 26% of children are born with low birth weight15 and the expected rates for Brazil are around 8.19%. In Curitiba and metropolitan region, the last evaluation demonstrated a rate of 9.5% of children born with low birth weight16. The findings of height and similar body mass suggest that the BP born had growth recovery in the first years of life. Other authors have demonstrated the recovery of growth in BP born at 4 years of age5, 17.

No significant differences were found in the systolic and diastolic blood pressure levels between the BP and AP men, disagreeing with other studies that showed high BP values in youngsters18. As for the lipid profile, there were significant differences in triglyceride levels, higher in boys born with BP, as described by Reinehr, Kleber and Toschke 18 and Cianfarani, Germani and Branca19. Tenhola et al.20 and Veening et al.21 did not find significant differences for any lipid variable among boys who were small for gestational age and suitable for gestational age. The high concentration of triglycerides, mainly postprandial, has been associated with the atherogenesis process even in healthy adolescents22 being an additional risk factor for low birth weight boys.

Some studies have found similar findings21,23 while others show that low birth weight adolescents tend to accumulate more fat in the trunk region24 or increase waist circumference25. However, no significant differences were found between the anthropometric variables, blood pressure and lipid profile among the adequate and low birth weight girls in the present study. Although glycemic values did not differ significantly in median values, nor in the percentage of high values between groups. These findings contradict the literature that indicates higher values of glycemia in low birth weight infants compared to their adequate weight pairs26.

The results showed that low birth weight in boys is an important factor to be considered in the evaluation of adolescents at risk of developing the metabolic syndrome, corroborating with the findings of Chiavaroli et al.26. Studies have observed that boys present a percentage of metabolic syndrome superior to girls, corroborating the findings of the present study27,28.

The frequency of metabolic syndrome in this study was relatively high. Cook et al.13 observed a prevalence of metabolic syndrome in American adolescents of 4.2% for the studied population, whereas Agirbasli et al.29 identified the presence of metabolic syndrome in 2.2% of Turkish adolescents. Similar results to this study were found by other researchers, such as the study by Ferreira, Oliveira and França30, in which 17.3% of the obese children evaluated presented metabolic syndrome, and Buff et al.31, in which the metabolic syndrome was found in 42.4% of obese individuals. The lack of dichotomization of the sample by nutritional status may be an influence on the results found. Another important factor to be commented on is the different criteria for the definition of metabolic syndrome that make it difficult to compare the studies8,27, in addition to the blood dosages performed once, which can lead to false negatives.

The present study identified a greater male predisposition when born with low weight in manifest metabolic syndrome, directing a greater attention and care to this population.


ACKNOWLEDGMENTS

We thank the Coordination of Improvement of Higher Education Personnel (CAPES), National Council for Scientific and Technological Development (CNPq) and the Araucária Foundation for Scientific and Technological Development of Paraná - Brazil.


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