ABC | Volume 110, Nº5, May 2018

Original Article Ramires et al Prevalence of metabolic syndrome in Brazil Arq Bras Cardiol. 2018; 110(5):455-466 Table 2 – Prevalence (%) of comorbidities and burden of diseases (risk factors for MS), by sex, of adults and elderly. National Health Survey (NHS), Brazil, 2013 Disease, burden and MS Sex Total N = 59.402 Male N = 25.920 Female N = 33.482 %* CI 99% % * CI 99% % * CI 99% Diabetes 7,1 6,6 - 7,6 6,3 5,6 - 7,2 7,8 7,1 - 8,5 High BP 40,7 39,6 - 41,7 46,9 45,5 - 48,3 34,9 33,7 - 36,3 Hypercholesterolemia 14,7 14,0 - 15,5 11,9 10,9 - 13,1 16,9 16,0 - 17,9 High WC 65,2 64,4 - 65,9 55,6 54,0 - 57,1 73,9 72,7 - 75,0 Disease burden 0 23,8 22,9 - 24,7 28,0 26,7 - 29,4 19,9 18,8 - 21,1 1 38,1 37,2 - 39,0 34,8 33,5 - 36,2 41,0 39,8 - 42,3 2 29,2 28,3 - 30,1 29,7 28,4 - 31,0 28,7 27,6 - 29,9 3 7,5 7,1 - 8,1 6,5 5,8 - 7,3 8,5 7,8 - 9,3 4 1,4 0,9 - 1,2 1,0 0,7 - 1,3 1,8 1,5 - 2,2 MS Condition † 8,9 8,4 - 9,5 7,5 6,7 - 8,3 10,3 9,6 - 11,2 MS: metabolic syndrome; N: number of individuals in the database; CI 99%: confidence interval 99%; BP: blood pressure; WC: waist circumference; (*) Generated considering the sample weight; (†) MS Condition, sum of disease burden ≥ 3 factors. and present IRC (RP 1.85 [IC99% 2.23-2, 76]), overweight (RR 3.58 [IC99% 2.73‑4.70]) and depression (RP 1.41 [IC99% 0.98‑2.02]) (Table 5). Regarding the physical activity variable, in order not to compromise analysis, we chose not to include it in the model, given the low prevalence of physically active individuals (1.8%), which would result in inaccurate estimates, due to large standard error (Table 4 and 5). In addition, considering the referential adopted, such comparisons become unnecessary, since almost entire Brazilian population is characterized as physically inactive (98.1%) (Table 1). Discussion MS is a multidimensional phenomenon determined by an interaction factor set that affects people quality of life. 3 Despite the existence of studies on chronic diseases and their risk factors in Brazilian population, 15 as the Adult Health Longitudinal Study, we do not yet have MS prevalence national representativeness in the country. Thus, the present study evaluated for the first time the factors associated with MS in a Brazilian population representative sample aged over 18 years, representing a milestone in the MS investigation in Brazil, collaborating in construction of evidence capable of directing resolute strategies for prevention and control of this problem. We identified that approximately 9% Brazilian population presented MS status, according to consensuses harmonization definition. 4 Nevertheless, our study reveals worrying data, accounting that only 23.8% of population does not present any MS component, and that 67.3% have between one and two components to characterize this outcome, which demonstrates high number of individuals under developing MS risk. Considering sex, highest MS occurrence was found among female population (10.3%, CI 99% 9.6-11.2), fact that has been widely recorded in scientific literature, 16,17 especially among those with age > 59 years, which can be explained by hormonal changes that occurred after menopause. 17 At this moment of life, there is tendency to accumulate abdominal fat and also to increase density of LDL particles circulating in bloodstream that become more atherogenic, known condition associated to increased risk of CVD. 18 It is also possible to highlight the high number of morbidity found among women in this study, who presented higher prevalence of diabetes, hypercholesterolemia and abdominal obesity in relation to masculine sex. Considerable differentiation in MS abnormalities prevalence and combinations between the sexes suggests different physiopathology between men and women 19 possibly explained by sex hormones different levels that influence metabolism regulatory mechanisms. 20 The greater androgenic activity found among men as well as postmenopausal estrogen levels reduction among women are conditions that favor an increase in visceral abdominal fat and in bloodstream lipids concentration, which is correlated with insulin resistance, hypertension, and increased cardiovascular risk. 20 Among MS components, high WC results (65.2%, CI 99% 64.4-65.9) are highlighted in the study population. Abdominal obesity plays an important role in MS, 21,22 because it is associated with a metabolic disorder capable of damaging the artery wall, leading to vasoconstriction deregulation, inflammatory cascades activation, and adipokines effects elevation, considered to be factors that induce CVD. 22 Cohort study conducted by Lee et al. 22 showed that the additional 500 cm 3 volume increase of subcutaneous and visceral fat is associated with MS incidence and risk factors aggravation for CVD. 22 A obese individuals cohort study conducted in Italy showed that abdominal obesity contributed to MS prevalence in obese women, but not in men. 19 459