ABC | Volume 110, Nº5, May 2018

Original Article Navarro et al Metabolic Syndrome in Vegetarian and Omnivorous Men Arq Bras Cardiol. 2018; 110(5):430-437 were: 1) being female 2) history of diabetes; 3) history of dyslipidemia; 4) history of CVD or cerebrovascular diseases; 5) history of hypertension or intake of antihypertensive medication; and 6) smoking. All individuals who declared themselves to be “smokers” or “occasional smokers” at the interview or had quit smoking in the last month prior to the interview were considered smokers. Although the exclusion criteria of the research project were related to factors that are MSyn components, they were the reference of the individual on previous diagnosis, and it was verified that several individuals presented MSyn, enabling the development of the present study, which aims to compare the percentage of individuals with MSyn in the two groups according to the type of diet. Healthy participants ≥ 35 years were divided into two groups – VEG and OMN – according to their dietary patterns. Vegetarian men were defined as exclusively consuming a vegetarian diet void of meat, fish, and poultry for at least four years; these men could be lacto‑ovo‑vegetarians (consuming eggs, milk, and dairy products), lacto-vegetarians (consuming milk and dairy products) or vegans (consuming no eggs or milk or dairy products). Matched OMN men were defined as consuming any type of meat at least four or more servings per week. From June 2013 to January 2014, after applying inclusion and exclusion criteria, 88 apparently healthy men were enrolled in the study (44 VEG and 44 OMN). All 88 subjects were screened for health status with questionnaires regarding educational level, personal data, past medical history, smoking status and habitual alcohol consumption (yes or no). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured twice in the right arm after a 10-minute rest in a supine position using a calibrated and averaged digital sphygmomanometer. Subjects were interviewed, and the average of two 24-hour dietary recalls (one on weekdays and one on weekends) was used to estimate daily consumption of different nutrients. A database for Brazilian food composition was used to calculate the daily energy and nutrient intake. 21 For measuring weight, we used a 150-kg platform scale (Filizola ® ) with 100-gram divisions. The patient was positioned in the center of the scale, standing barefoot, wearing as little clothing and as few accessories as possible. To measure height, a portable stadiometer was used, positioned in an appropriate place, with the barefoot volunteer with feet together, standing erect, with the back of the head, shoulders, buttocks, calves and heels touching the wall, and the head in the Frankfurt horizontal plane (imaginary line from the external auditory canal to the lower eye socket). 22 Body mass index (BMI) was calculated by dividing body weight (kg) by the square of height (m). To measure waist circumference (WC), the individual remained upright with arms relaxed along the body, with the region for measurement unclothed. For WC, the measurement was made with a tape measure at the midpoint between the last rib and the iliac crest, with the abdomen relaxed, at the end of expiration. 23 All measures were performed in triplicate, and the mean value was used for analysis. After fasting for 10–12 hours overnight, participants had blood samples drawn from the antecubital vein. Serum lipids, including triglycerides (TG), total cholesterol (TC), and high‑density lipoprotein cholesterol (HDL-c), were assayed by using enzymatic methods with an automatic multichannel chemical analyzer (Siemens Healthcare, Newark, USA) in the central laboratory of the InCor. Low-density lipoprotein cholesterol (LDL-c) was calculated using the Friedewald formula. 24 Glycosylated hemoglobin (HbA1c) was determined using the immunoturbidimetric method certified by the NGSP-National Glycohemoglobin Standardization Program, using the Flex kit (Siemens Healthcare, Newark, USA). For apolipoprotein b (Apo b) and fasting glucosemeasurements, blood samples were centrifuged at 3000 rpm for 15 minutes within 60 minutes of collection and stored at −70°C until analysis. Fasting serum glucose (FSG) was determined by the glucose oxidase method using a Dimension RXL (Siemens Healthcare, Newark, NJ, USA) through standard laboratory techniques. Quality control assessment was performed daily for all determinations. Subjects reported activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ), 25 which measures leisure time, domestic, work-related, and transport‑related physical activities. Four domains were measured: sitting, walking, moderate-intensity activity, and vigorous-intensity activity during the previous seven days. For analysis, we considered the following categorization: physically active (≥ 20 minutes/vigorous activity sessions ≥ 3 days/week; and/or ≥ 30 minutes/moderate activity sessions or hiking ≥ 5 days/week; and/or ≥ 150 minutes/week of any added activities - vigorous or moderate or walking), and irregularly active (<150 minutes/week of any added activities - vigorous or moderate or walking). 26 Metabolic syndrome (MSyn) was defined according to the criteria of the International Diabetes Federation (IDF), that considers that an individual with MSyn must have central obesity (defined as WC with ethnicity specific values) plus any two of the following four factors: TG ≥ 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality, HDL-c < 40 mg/dL (1.03 mmol/L) in males or specific treatment for this lipid abnormality, SBP ≥ 130 mm Hg or DBP ≥ 85 mm Hg or treatment of previously diagnosed hypertension, FSG ≥ 100 mg/dL (5.6 mmol/L) or previously diagnosed type 2 diabetes. 16,17 For South and Central Americans, the IDF recommends the use of South Asian WC values until more specific data are available. Thus, this study considered the WC value to be ≥ 90 cm. 18 The BMI was categorized according to the values suggested by the World Health Organization. 27 The Framingham Heart Study provides an algorithm for assessing risk for CHD in the short term (≤ 10 years). The FRS classifies the individual CHD risk based on assigned points for 431