Obesidade e dislipidemia de funcionários de um hospital universitário

Transcription

1 Obesidade e dislipidemia de funcionários de um hospital universitário 31 Obesity and dyslipidemia among the health professionals of a university hospital Lucimara Facio Nobre Zueff¹ Fernando Bahdur Chueire 2 Júlio Sérgio Marchini 2 1. Generalist Physician and Postgraduate Student, Department of Gynecology and Obstretrics, Universirty Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo 2. Department of Internal Medicine, Discipline of Nutrology, Disciplina de Nutrologia, Faculty of Medicine of Ribeirão Preto, University of São Paulo Address for correspondence:: Lucimara Facio Nobre Zueff R. Ramos de Azevedo, 533, apto 31, Jardim Paulista Ribeirão Preto, SP Tel: (16) lucimara_nobre@yahoo.com.br

2 Abstract 32 Background: Looking at primary attention and at health workers as users of the same services they provide, it is clear that it is necessary to identify the profile of obesity morbidity and dyslipidemia of health professionals from a university hospital, attended at an outpatient service due to frequent cases of non-adherence to treatment and follow up and, in most cases, to undiagnosed diseases. It is well known that the prevalence of chronic/degenerative diseases is increasing worldwide, with obesity as one of the worst public health problems. Method: A cross-sectional epidemiological study was conducted considering consultations scheduled by health workers over a period of six months. Objectives: The goals were to analyze variables regarding the subject (gender, age, and lipid profile) as well as anthropometric data (weight, height, and BMI). Results: A total of 297 workers were assessed, 78% of them females and 24% males, divided into three age groups: 18 to 45 years, 45 to 60 years, and more than 60 years. Regarding BMI, 30% of the subjects were within the normal range, 38% were overweight, 19% presented grade I obesity, 7% grade II, and 6% grade III. Regarding lipid profile, 43% percent of all workers presented altered values, which predominated among females. Conclusion: It is necessary to be aware that lifestyle changes are much needed and that actions involving prevention, promotion, diagnosis, and early treatment should be developed when necessary, targeting reduction of morbidity-mortality. Keywords: obesity, dyslipidemia, manpower

3 Introduction 33 The prevalence of chronic-degenerative diseases is increasing every year and one of the factors contributing to this process is the aging of the population commonly observed in developed countries, but also beginning to occur in developing countries such as Brazil 1. Chronic diseases are the major causes of death in the world, corresponding to 60% of world mortality in 2005, and possibly becoming responsible for 73% of all deaths by 2020 if this scenario is not modified. In Brazil, more than 400,000 deaths occurred in In addition, these diseases have a socioeconomic impact, with high costs for the Unified Health System and interfering with the quality of life of an individual and his family when they do not cause premature death. However, these diseases are preventable and can be reduced when there is intervention in the risk factors 3,1. According to the WHO, the most important factors associated with morbidity and mortality in non-transmissible chronic diseases (NTCD) are systemic arterial hypertension, hypercholesterolemia, low intake of fruits, vegetables and legumes, overweight or obesity, physical inactivity, and smoking.. Due to its high prevalence, obesity is currently considered to be one of the greatest public health problems. According to the 1993 data of the Ministry of Health, 32% of the Brazilian population is overweight and 8% is obese. Between 1975 and 1996 there was an increase in the incidence of obesity among the adult female population 2. Two population-based studies conducted in Brazil within an interval of 15 years, the National Study of Family Expenditure (ENDEF in the Portuguese acronym) conducted between 1973 and 1974 and the National Survey of Health and Nutrition in 1989, revealed an increase of obesity from 3% to 6% among men and from 8% to 13% among women 4. In summary, obesity can be defined as the degree of fat storage in the organism associated with health risks due to its various metabolic complications 5. It is a risk factor for dyslipidemia, arterial hypertension and the development of type 2 diabetes, with this

4 risk progressively increasing with weight gain and having an impact on the progression of 34 atherosclerosis. In addition, obesity affects anti-inflammatory mechanisms such as increased production of adipokines, cytokines and inflammatory markers by the adipocytes through increased insulin resistance and changes in endothelial function, predictors of cardiovascular disease. Because of the impact of obesity on morbidity and mortality, health promotion care is recommended, preventing new cases and preventing overweight individuals from becoming obese 6. In clinical practice, the body mass index (BMI) and the waist-hip ratio are used to classify obese patients and to follow their evolution. On the basis of the above considerations, the objective of the present project is to identify the morbidity profile of obesity and dyslipidemia among the employees of a university hospital. Material and Methods This was a retrospective cross-sectional study on employees attended at SAMSP- CAMPUS. The study population was composed of employees with scheduled visits attended at SAMSP-CAMPUS by a generalist doctor. The SAMSP is located on the second floor of the University Hospital of Ribeirão Preto and provides outpatient clinic care Monday through Friday. The inclusion criteria were: being an employee of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP-USP); all age ranges; a scheduled medical visit whose motivation is unknown since there is an important variation in the practice of Family Medicine and also because the demand for urgent visits (not previously scheduled) exists and there is a considerable presence of medical records. Employees for whom a lipidogram within one year before or after the date of the visit is not available will be excluded. The service agenda, available in the computer, was consulted for a period of 6 months (January to June 2008) and the names and registrations of the employees were selected on the basis of the inclusion criteria. Anthropometric measurements and laboratory data

5 35 The medical records were analyzed for the evaluation of anthropometric data. Before the visit, the employees were weighed and measured wearing light clothing and barefoot on a WELMY electronic scale with an anthropometric scale and a precision of 50 g, bivolt, and a capacity of 200 kg. The BMI is obtained by dividing weight in kg by height squared in meters (BMI = weight (kg)/height x height (m)). Age, sex and lipid profile were obtained from the records of the employees by direct consultation in the computer using the ATHOS system. Only registered professionals can access this information using a password. The research project was approved by the Research Ethics Committee of HCRP-USP (protocol HCRP nº 8729 / 2008). Statistical analysis To fulfill the above objectives, a descriptive analysis of the sample was performed using the PROC FREQ procedure of the SAS software. RESULTS A total of 297 employees were evaluated, 78% of them females (n = 226) and 24% males (n = 71). The subjects were divided into three age groups: 18 to 45 years (38%, n = 112), 45 to 60 years (54%, n = 161), and older than 60 years (8%, n = 24). Thus, there was a predominance of the 45 to 60 year age range, with 55% of the subjects being females (n = 125) and 51% males (n = 36). Regarding BMI (Table 1), 30% of the employees (n = 88, 77% of them females) were within the normal range, 38% (n = 112, 70% of them females) were overweight, 19% (n = 57, 77% of them females) had grade I obesity, 7% (n = 22, 91% of them females) had grade II obesity, and 6% (n = 18, 89% of them females) had grade III obesity. The objective of the laboratory exams for the determination of the lipid profile were to assess whether or not their values were altered. Forty-three percent of the employees (n = 127, 78% of them females) had altered cholesterol, 27% (n = 80, 66% of them females) had altered triglycerides, 16% (n = 47, 68% of them females) had altered HDL-

6 36 cholesterol, and 13% (n = 40, 83% of them females) had altered LDL-cholesterol. The altered values of the lipid profile were found to be concentrated in the year age range, with a higher incidence among females. It should be pointed out that we did not consider scores of risk of cardiovascular disease or the use of medications (stains and fibrates). Discussion and Conclusion We detected no study in the literature assessing obesity and dyslipidemia among the staff of a university hospital attended at a generalist medical care service within the hospital itself. The prevalence of obesity agrees with the worldwide tendency and with the Brazilian panorama and the prevalence in female gender agrees with the study of LOTUFO, According to the Survey of Family Budgets (POF 2002/2003), excess weight tends to increase with age, in a more rapid manner among men and in a slower, but more prolonged, manner among women. Regarding dyslipidemia, a study conducted in 9 Brazilian capital cities in 1998 showed that 38% of men and 42% of women had a total cholesterol value of more than 200 mg/dl 8. This is due to metabolic changes caused by disorders in any phase of lipid metabolism that are reflected in serum lipoprotein levels. The stratification of risk and lipid goals for the prevention and treatment of atherosclerosis can be estimated using the Framingham Risk Score. Dyslipidemia is commonly seen in obese individuals. Data from the National Health and Nutrition Survey Examination Survey III show a 4-fold increase in the prevalence of total cholesterol increment among women and an almost 6-fold increase among men when these individuals have a BMI of more than 30 kg/m 2 compared to persons of normal weight.

7 37 The prevention of diseases and of risk conditions, as well as the promotion of health have become a challenge for the modern world. For an individual to be able to prevent dyslipidemia and obesity and to adhere to drug treatment, if indicated, he must be informed about the disease, its risk factors and its complications. It is important to be aware of the need to change life habits (weight reduction, a healthy diet, regular physical exercise, stopping smoking, avoiding abusive alcohol intake, etc.) both for the prevention and treatment of these diseases in order to exert a positive impact on the quality of life 1,3,9,10. Physical activity is a health-promoting and disease-preventing factor. The subjects are encouraged to engage in activity of moderate intensity lasting at least 30 minutes on most days (if possible all) of the week in a continuous or accumulated manner, i.e., divided into various daily sessions. Aerobic exercises such as walking, dancing, running, swimming and pedaling are recommended 11. The objective of the present study was to determine the obesity and dyslipidemia profile of the health workers. The intention is to carry out actions of prevention and of health promotion, to make an early diagnosis of diseases and to institute drug treatment when necessary according to current Brazilian Guidelines in order to reduced morbiditymortality. References 1. World Health Organization. Technical Report Series 894: Obesity: Preventing managing the global epidemic. Geneva: World Health Organization. ISBN , Brasil. Ministério da Saúde. A Vigilância, o controle e a prevenção das doenças crônicas não transmissíveis: NTCD no contexto do Sistema Único de Saúde Brasileiro Situação e Desafios Atuais. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde, Brasília, 80 p., 2005.

8 38 3. Organização Pan Americana da Saúde. Prevenção de doenças crônicas. Um investimento vital. Disponível em: disease_report/contents/en/index.html. Acesso em 10 de setembro de Lotufo PA. Doenças Cardiovasculares no Brasil: por que altas taxas de mortalidade entre mulheres? Revista da Sociedade de Cardiologia do Estado de São Paulo. 2007;17(4): World Health Organization. WHO Expert Committee on Physical Status: the use and interpretation of anthropometry physical status. Geneva: World Health Organization; (WHO Technical Report Series, vol 854). 6. World Health Organization. Report of a WHO Consultation on Obesity. Defining the problem of overweight and obesity. In: Obesity, preventing and managing the global epidemic. Geneva, SAS Institute Inc., SAS/STAT User s Guide, Version 9, Cary, NC: SAS Institute Inc., Sposito AC, Caramelli B, Fonseca FAH, Bertolami, MC et al.. IV Diretriz Brasileira sobre Dislipidemias e Prevenção da Aterosclerose. Arquivos Brasileiros de Cardiologia. 2007;88:3-13(supl I). 9. Brasil. Ministério da Saúde. Obesidade. Cadernos de Atenção Básica. Série A. Normas e Manuais Técnicos. Brasília, n. 12, 108 p., Lottemberg AM, Nóbrega AC, Marcílio CS, Nobre F, Guimarães, HP, Issa, J, et al. Guia Prático de Prevenção Cardiovascular para Médicos. Disponível em: Acesso em 18 de abril de Praxedes, JN, Negrão, CE, Lopes, H, Guimarães, AC, Monego, ET, Kalil, et al.. V Diretrizes Brasileiras de Hipertensão Arterial. Revista da Sociedade Brasileira de Hipertensão. 2006, 9(4):

9 39 Table 1. Subject characterization by gender. Gender Total F M BMI (kg/m²) % 23% 100% % 30% 100% % 23% 100% % 9% 100% >= % 11% 100% Total