Sagittal Abdominal Diameter as a Surrogate Marker of Insulin Resistance in an Admixtured Population—Brazilian Metabolic Syndrome Study (BRAMS)

<div><p>Background</p><p>Sagittal abdominal diameter (SAD) has been proposed as a surrogate marker of insulin resistance (IR). However, the utilization of SAD requires specific validation for each ethnicity. We aimed to investigate the potential use of SAD, compared with classical anthropometrical parameters, as a surrogate marker of IR and to establish the cutoff values of SAD for screening for IR.</p><p>Methods</p><p>A multicenter population survey on metabolic disorders was conducted. A race-admixtured sample of 824 adult women was assessed. The anthropometric parameters included: BMI, waist circumference (WC), waist-to-hip ratio and SAD. IR was determined by a hyperglycemic clamp and the HOMA-IR index.</p><p>Results</p><p>After adjustments for age and total body fat mass, SAD (r = 0.23 and r = -0.70) and BMI (r = 0.20 and r = -0.71) were strongly correlated with the IR measured by the HOMA-IR index and the clamp, respectively (p < 0.001). In the ROC analysis, the optimal cutoff for SAD in women was 21.0 cm. The women with an increased SAD presented 3.2 (CI 95%: 2.1-5.0) more likelihood of having IR, assessed by the HOMA-IR index compared with those with normal SAD (p < 0.001); whereas women with elevated BMI and WC were 2.1 (95% CI: 1.4-3.3) and 2.8 (95% CI: 1.7-4.5) more likely to have IR (p < 0.001), respectively. No statistically significant results were found for waist-to-hip ratio.</p><p>Conclusions</p><p>SAD can be a suitable surrogate marker of IR. Understanding and applying routine and simplified methods is essential because IR is associated with an increased risk of obesity-related diseases even in the presence of normal weight, slight overweight, as well as in obesity. Further prospective analysis will need to verify SAD as a determinant of clinical outcomes, such as type 2 diabetes and cardiovascular events, in the Brazilian population.</p></div

Scatter plots demonstrating the bivariate correlations between the HOMA-AD index with the clinical and metabolic components related to the metabolic syndrome.

<p>*p < 0.001.</p

Clinical, anthropometric and metabolic characteristics of the study participants.

<p>Clinical, anthropometric and metabolic characteristics of the study participants.</p

Receiver operating characteristic curves for the HOMA-AD and HOMA1-IR indices in identifying insulin resistance by the hyperglycemic clamp and metabolic syndrome in the total sample.

<p>Receiver operating characteristic curves for the HOMA-AD and HOMA1-IR indices in identifying insulin resistance by the hyperglycemic clamp and metabolic syndrome in the total sample.</p

Correlation coefficients non adjusted and adjusted for age and total body fat mass between anthropometric parameters and HOMA-R index (A) and insulin sensitivity index obtained in the hyperglycemic clamp test (B).

<p>A: total sample n = 824; B: subsample n = 50. *Adjusted for age and total body fat.</p

Bivariate correlation coefficients between the surrogate markers of insulin resistance, HOMA-AD (A) and HOMA1-IR (B), with the insulin sensitivity index obtained in the hyperglycemic clamp test.

<p>Subsample n = 49.</p

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

<div><p>ABSTRACT CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.</p></div