COMPARISON OF DIFFERENT CRITERIA IN THE PREVALENCE OF METABOLIC SYNDROME IN STUDENTS FROM PARANAVAÍ, PARANÁ

ABSTRACT Objective: To investigate the difference in the proportion of students with metabolic syndrome, diagnosed according to different criteria. Methods: The sample consisted of 241 students (136 boys and 105 girls) aged 10 to 14 years, from public and private schools in Paranavaí, Paraná. We used three distinct diagnostic criteria for metabolic syndrome, considering the presence of at least three of the following risk factors: increased waist circumference, hypertension, fasting hyperglycemia, low HDL-C, and elevated triglycerides. Results: The prevalence of metabolic syndrome found was 1.7% (confidence interval of 95% - 95%CI 0-3.3) for the IDF criterion; 3.3% (95%CI 1.0-5.6) for Cook; and 17.4% (95%CI 12.6-22.3) for Ferranti. Analyzing the criteria in pairs, the agreement between IDF and Cook was 97.5% (k=0.95); between IDF and Ferranti, 83.4% (k=0.67); and between Cook and Ferranti, 85.9% (k=0.72). Onlyone student (0.4%) was diagnosed with metabolic syndrome solely by the IDF criterion, while 34 (14.1%) were diagnosed exclusively by Ferranti. The comparison of the three criteria showed that Ferranti presented the highest proportion of metabolic syndrome (p<0.001), and Cook had a greater proportion than IDF (p<0.001). Conclusions: We found a significant difference in the proportion of metabolic syndrome in the three criteria. The choice of which criterion to use can compromise not only the percentage of metabolic syndrome prevalence but also interfere in strategies of intervention and prevention in children and adolescents with and without metabolic syndrome, respectively.

摘要

研究目的：探究依据不同诊断标准确诊的代谢综合征学生的比例差异。

研究方法：本研究纳入的样本为来自巴西巴拉那州巴拉纳瓦伊市公立及私立学校的241名学生，其中男生136名、女生105名，年龄介于10至14岁之间。本研究采用三项不同的代谢综合征诊断标准，若受试者满足以下五项危险因素中至少三项，则判定为代谢综合征：腰围升高、高血压、空腹血糖升高、高密度脂蛋白胆固醇（HDL-C）水平降低以及甘油三酯升高。

研究结果：采用国际糖尿病联盟（IDF）诊断标准时，代谢综合征的患病率为1.7%（95%置信区间95%CI 0~3.3）；采用库克（Cook）诊断标准时为3.3%（95%CI 1.0~5.6）；采用费兰蒂（Ferranti）诊断标准时为17.4%（95%CI 12.6~22.3）。对三项标准进行两两一致性分析：IDF与Cook的诊断一致性为97.5%（Kappa系数k=0.95）；IDF与Ferranti的一致性为83.4%（k=0.67）；Cook与Ferranti的一致性为85.9%（k=0.72）。仅1名学生（0.4%）仅通过IDF标准被确诊为代谢综合征，而34名学生（14.1%）仅通过Ferranti标准确诊。三项标准对比结果显示，Ferranti标准的代谢综合征检出比例最高（p<0.001），且Cook标准的检出比例高于IDF标准（p<0.001）。

研究结论：本研究发现三项诊断标准下的代谢综合征检出比例存在显著差异。诊断标准的选择不仅会影响代谢综合征的患病率统计结果，还会分别对合并与未合并代谢综合征的儿童青少年的干预及预防策略造成干扰。