O objetivo do estudo foi avaliar o desempenho de detecção do índice de disfunção metabólica (IDM) construído a partir dos valores de circunferência abdominal, triglicerídeos e índice de massa corporal. Foram estudados 829 indivíduos (327 homens, 60,4±19,8 anos), estableceram-se os diagnósticos de resistência à insulina (RI) e síndrome metabólica de acordo com os critérios de HOMA-RI, NCEP-ATP III (SM) e NCEP-ATP III revisado (SM-R). A área sob as curvas ROC (ABC), os pontos de corte ótimo (PCO), sensibilidade (SEN), especificidade (ESP), valor preditivo positivo e valor preditivo negativo (VPN) foram utilizados para avaliar o desempenho do IDM. Verificou-se que o IDM possui uma capacidade de detecção aceitável, visto que uma ABC>0,75 foi observada em todos os casos. Valores maiores (p<0,01) de IDM foram encontrados nos grupos com SM, SM- R e RI em comparação com grupos que não sofrem com as patologias. Além disso, os PCOs para a RI (IDM>21.01), SM (IDM>16.01) e SM-R (IDM>19.51), relataram valores de ESP, SEN, VPN maiores que 0,70. Portanto, a partir de um índice composto por três variáveis de um estudo médico de rotina, duas patologias podem ser diagnosticadas que levam ao desenvolvimento de diabetes e doenças cardiovasculares.

The objective of the study was to evaluate the performance of metabolic dysfunction index (MDI) detection constructed from the values of abdominal circumference, triglycerides and body mass index. A total of 829 subjects (327 males, 60.4±19.8 years), diagnosed with insulin resistance (IR) and metabolic syndrome according to the HOMA-IR, NCEP-ATP III (SM) and NCEP -ATP III revised (SM-R) criteria were studied. The area under the ROC curves (AUC), the optimal cut-off points (OCP), sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value (NPV) were used to evaluate the performance of the MDI. It was found that the MDI has an acceptable detection capacity since an AUC>0.75 was observed in all cases, and higher values (p<0.01) of MDI were found in the groups with SM, SM-R and IR compared to groups that do not suffer from the pathologies. Additionally, the OCPs for IR (MDI>21.01), SM (MDI>16.01) and SM-R (MDI>19.51) reported values of SPE, SEN, NPV greater than 0.70. Therefore, from an index composed of three variables taken from a routine medical study, two pathologies can be diagnosed that lead to the development of diabetes and cardiovascular diseases.

El objetivo del estudio fue evaluar el desempeño de detección del índice de disfunción metabólica (IDM) construido a partir de los valores de circunferencia abdominal, triglicéridos e índice de masa corporal. Se estudiaron 829 sujetos (327 de sexo masculino, 60,4±19,8 años). Se establecieron los diagnósticos de resistencia a la insulina (RI), y síndrome metabólico según los criterios del HOMA-IR, NCEP-ATP III (SM) y NCEP-ATP III revisado (SM-R). Se usó el área bajo las curvas ROC (ABC), los puntos de corte óptimo (PCO), sensibilidad (SEN), especificidad (ESP), valor predictivo positivo y valor predictivo negativo (VPN) para la evaluación del desempeño del IDM. Se pudo constatar que el IDM tiene una capacidad de detección aceptable puesto que se observó un ABC>0,75 en todos los casos. Además, se encontraron valores mayores (p<0,01) de IDM en los grupos con SM, SM-R y RI en comparación con los grupos que no padecían las patologías. Adicionalmente, los PCO para la RI (IDM>21,01), SM (IDM>16,01) y el SM-R (IDM>19,51) reportaron valores de ESP, SEN, VPN mayores que 0,70. Por tanto, a partir de un índice compuesto por tres variables tomadas de un estudio médico de rutina, se pueden diagnosticar dos patologías que conllevan al desarrollo de la diabetes y enfermedades cardiovasculares.

O objetivo do trabalho consistiu em determinar a relação entre as transaminases séricas e os componentes da Síndrome Metabólica (SM) numa população de adultos de mais de 65 anos da serra equatoriana. A população esteve constituída por 387 adultos idosos da Bacia-Equador. O diagnóstico de SM foi feito com base nos critérios do ATPIII-2005. Para a quantificação das transaminases alanina aminotransferase (ALT) e aspartato aminotransferase (AST) utilizou-se o espectrofotômetro Genesis 20 com o reagente de Wiener lab. Foram comparados os grupos com e sem SM utilizando o teste t de Student. Utilizou-se a correlação de Pearson para medir a associação entre os componentes da SM e das transaminases. A prevalência de SM foi de 57,4% e para transaminases alteradas de 12,4% e 9,0% para AST e ALT, respectivamente. Embora tenha sido encontrada correlação entre AST, triglicérides e C-HDL, não foi encontrada associação direta entre a SM e as transaminases. Estes resultados indicam que é necessário fazer mais estudos sobre o papel das transaminases séricas na população idosa.

The objective of the present work was to determine the relationship between serum transaminases and the Metabolic Syndrome (MS) components in an elderly population from the Ecuadorian highlands. Said population was composed of 387 elderly people from Cuenca-Ecuador. The diagnosis of MS was made using the ATPIII-2005 criteria. For the quantification of transaminases alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the Genesis 20 spectrophotometer was used with the reactive from the commercial house Wiener lab. The groups with and without MS were compared using Student’s t test. Pearson’s correlation was used to measure the association between SM components and transaminases. The prevalence of MS was 57.4%, for impaired transaminases 12.4% and 9.0% for AST and ALT respectively. Although a correlation was found between AST, triglycerides and C-HDL, no direct association between SM and transaminases was found. These results indicate that it is necessary to make more studies in the role of serum transaminases in the elderly population.

El objetivo del trabajo consistió en determinar la relación entre las transaminasas séricas y los componentes del Síndrome Metabólico (SM) en una población adulta mayor de 65 años de la sierra ecuatoriana. La misma estuvo formada por 387 adultos mayores de Cuenca-Ecuador. El diagnóstico de SM se realizó mediante los criterios del ATPIII-2005. Para la cuantificación de las transaminasas, alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST) se usó el espectrofotómetro Génesis 20 con el reactivo de Wiener lab. Se compararon los grupos con y sin SM mediante el test t de Student. La correlación de Pearson se usó para medir la asociación entre los componentes del SM y de las transaminasas. La prevalencia del SM fue de 57,4% y de transaminasas alteradas del 12,4% y 9,0% para AST y ALT, respectivamente. Aunque se halló una correlación entre las AST, triglicéridos y C-HDL, no se encontró asociación directa entre el SM y las transaminasas. Estos resultados indican que es necesario profundizar el rol de las transaminasas séricas en la población de adultos mayores.

RESUMEN Objetivo Determinar la prevalencia del síndrome metabólico, el nivel de actividad física y la asociación de estos factores en los adultos mayores de la sierra ecuatoriana. Métodos Estudio transversal que evaluó 387 adultos mayores de Cuenca-Ecuador, quienes desearon participar y firmaron el consentimiento informado. El diagnóstico de síndrome metabólico se realizó mediante los criterios del Programa Nacional de Educación sobre el Colesterol y el Panel de Tratamiento del Adulto III, para el valor de la Circunferencia Abdominal se consideró los criterios usados para la población asiática. El nivel de actividad física fue evaluado por la versión corta del Cuestionario Internacional de Actividad Física. Se compararon los grupos con y sin síndrome metabólico mediante el test Chi-cuadrado y el test t de student. El análisis de variancia fue usado para evaluar la asociación entre los componentes del síndrome metabólico y el nivel de actividad física. Resultados La prevalencia de síndrome metabólico fue alta (59,9 %), así como el nivel alto de actividad física (45 %), sin embargo no se evidenció asociación significativa entre el síndrome metabólico y nivel de actividad física. Conclusión Los adultos mayores diagnosticados con síndrome metabólico presentaron el mismo nivel de actividad física que los individuos sin este diagnóstico. Es necesario confirmar los presentes hallazgos usando instrumentos de medición directa de actividad física.

ABSTRACT Objective Determine the prevalence of the metabolic syndrome, the level of physical activity and the association with these factors in the elderly from the Ecuadorian highlands. Methods Cross-sectional study that evaluated 387 older adults from Cuenca-Ecuador, who wished to participate and signed the informed consent. The diagnosis of metabolic syndrome was made using the criteria of the National Program of Education on Cholesterol and the Adult Treatment Panel III, for the value of Abdominal Circumference the criteria used for the Asian population was considered. The level of physical activity was evaluated by the short version of the International Physical Activity Questionnaire. The groups with and without metabolic syndrome were compared using the chi-square test and student's t-test. The analysis of variance was used to evaluate the association between the components of the metabolic syndrome and the level of physical activity. Results The prevalence of metabolic syndrome was high (59.9 %), as well as the high level of physical activity (45 %), however, there was no significant association between the metabolic syndrome and physical activity level. Conclusions Older adults diagnosed with metabolic syndrome presented the same level of physical activity as individuals without this diagnosis. It is necessary to confirm the present findings using direct measurement instruments of physical activity.

ABSTRACT Objective Determine the prevalence of the metabolic syndrome, the level of physical activity and the association with these factors in the elderly from the Ecuadorian highlands. Methods Cross-sectional study that evaluated 387 older adults from Cuenca-Ecuador, who wished to participate and signed the informed consent. The diagnosis of metabolic syndrome was made using the criteria of the National Program of Education on Cholesterol and the Adult Treatment Panel III, for the value of Abdominal Circumference the criteria used for the Asian population was considered. The level of physical activity was evaluated by the short version of the International Physical Activity Questionnaire. The groups with and without metabolic syndrome were compared using the chi-square test and student's t-test. The analysis of variance was used to evaluate the association between the components of the metabolic syndrome and the level of physical activity. Results The prevalence of metabolic syndrome was high (59.9 %), as well as the high level of physical activity (45 %), however, there was no significant association between the metabolic syndrome and physical activity level. Conclusions Older adults diagnosed with metabolic syndrome presented the same level of physical activity as individuals without this diagnosis. It is necessary to confirm the present findings using direct measurement instruments of physical activity.

RESUMEN Objetivo Determinar la prevalencia del síndrome metabólico, el nivel de actividad física y la asociación de estos factores en los adultos mayores de la sierra ecuatoriana. Métodos Estudio transversal que evaluó 387 adultos mayores de Cuenca-Ecuador, quienes desearon participar y firmaron el consentimiento informado. El diagnóstico de síndrome metabólico se realizó mediante los criterios del Programa Nacional de Educación sobre el Colesterol y el Panel de Tratamiento del Adulto III, para el valor de la Circunferencia Abdominal se consideró los criterios usados para la población asiática. El nivel de actividad física fue evaluado por la versión corta del Cuestionario Internacional de Actividad Física. Se compararon los grupos con y sin síndrome metabólico mediante el test Chi-cuadrado y el test t de student. El análisis de variancia fue usado para evaluar la asociación entre los componentes del síndrome metabólico y el nivel de actividad física. Resultados La prevalencia de síndrome metabólico fue alta (59,9 %), así como el nivel alto de actividad física (45 %), sin embargo no se evidenció asociación significativa entre el síndrome metabólico y nivel de actividad física. Conclusión Los adultos mayores diagnosticados con síndrome metabólico presentaron el mismo nivel de actividad física que los individuos sin este diagnóstico. Es necesario confirmar los presentes hallazgos usando instrumentos de medición directa de actividad física.

Este trabalho apresenta uma metodologia para o estudo da Variabilidade da Frequência Cardíaca (VFC) e Sensibilidade à Insulina (SI) durante o Teste de Oral de Tolerância à Glicose (TOTG) em indivíduos com Síndrome Metabólica (SM). Para isso, foi projetado um protocolo clínico que inclui a aquisição de sinais ECG durante o TOTG em 15 pacientes com SM e 10 indivíduos do grupo controle. Os parâmetros da VFC foram obtidos a partir de registros eletrocardiográficos. Diferenças significativas nos valores de RR foram encontradas entre os grupos na fase de 30 minutos do TOTG. No grupo controle os valores de RR foram maiores em comparação com indivíduos com SM. Os valores normalizados de baixas frequências entre as fases da linha de base e a fase de 30 minutos em pacientes com SM mostraram um aumento significativo no tônus simpático durante o TOTG, não observado no grupo controle. Os seguintes métodos foram implementados para a quantificação de SI: integral, índice de sensibilidade à insulina, sensibilidade à insulina, metabólicos, HOMA e QUICKI. Valores significativamente menores de IS foram encontrados no grupo com MS. Podemos concluir que existem alterações na VFC e SI nos indivíduos com MS, caracterizando uma doença pré-diabética. Estas descobertas sugerem que a VFC e SI podem ser usados para o diagnóstico da SM e prevenção da Diabetes Mellitus.

This work presents a methodology for studying the Heart Rate Variability (HRV) and Insulin Sensitivity (IS) during the Oral Glucose Tolerance Test (OGTT) in subjects with Metabolic Syndrome (MS). For this, it was designed a clinical protocol that includes the acquisition of ECG signals during OGTT for 15 subjects with MS and 10 subjects for control group. HRV parameters were obtained from electrocardiographic recordings. Significant differences in RR values were found between groups in the 30 minutes stage of the OGTT. In control subjects the RR values were higher compared with subjects with MS. The values of normalized low frequencies between baseline stages and the stage at 30 minutes in subjects with MS showed a significant increase in sympathetic tone during the OGTT, that was not observed in group control. The following methods were implemented for quantification of IS: integral equation, insulin sensitivity index, insulin sensitivity, metabolic, HOMA and QUICKI. We found significantly lower values of IS in the group with MS. It was concluded that there are changes in the HRV and the IS in the subjects with MS, which is a pre-diabetic disease. These findings suggest that HRV and IS can be used for diagnosis of MS and prevention of Diabetes Mellitus.

En este trabajo se evalúan tres algoritmos de segmentación automática del intervalo RT. Estos algoritmos son: el algoritmo basado en un filtro derivador, el algoritmo basado en la descomposición de ondículas y el algoritmo basado en la modelización de la onda T. La evaluación se efectuó sobre señales electrocardiográficas sintéticas y reales. En la primera evaluación se contaminó un electrocardiograma (ECG) sintético con cuatro tipos de ruido en cuadro condiciones de Relación Señal a Ruido (SNR) (10, 15, 20 y 25 dB), en la segunda evaluación se compararon los resultados arrojados por los algoritmos con las anotaciones de dos expertos. Los resultados obtenidos muestran comportamientos satisfactorios de los tres enfoques en condiciones favorables de SNR. Sin embargo se observó un aumento de la variabilidad del intervalo RT inducida por el ruido.

Three automatics methods for the extraction of RT intervals are compared: the algorithm based on a derivate filter, the algorithm based on wavelets decomposition and the algorithm based on T wave modelization. The evaluation was carried on computer-generated and on real ECG signals. In the first evaluation, a synthetic electrocardiogram was contaminated with four types of noise in four conditions of Signal to Noise Ratio (SNR) (10, 15, 20 and 25 dB), in the second evaluation the algorithm’s results were compared with the annotations of two experts. The achieved performance shows a satisfying behavior of these approaches in favorable conditions of SNR. Nevertheless an increase of RT beat-to-beat variability induced by the artifacts was observed.