Dra. Troncoso-Pantoja, Claudia

Introducción: La alimentación se construye a partir de experiencias y significados adquiridos en el curso de la vida. Las personas mayores tienen un acervo importante que informa de valores y prácticas culturales aplicadas a la alimentación. El objetivo del estudio fue interpretar los significados que entregan personas mayores a la construcción de su alimentación en trayectorias del curso de vida. Material y métodos: La investigación utilizó un enfoque cualitativo de alcance exploratorio, utilizando el método de Teoría Fundamentada de Strauss y Corbin. Para la recolección de datos se aplicó una entrevista semiestructurada entre julio de 2021 y junio de 2022. El tipo de muestreo fue teórico y el análisis de los datos cualitativos respondió al proceso de codificación abierta, axial y selectiva. Resultados: Participaron 54 personas mayores (72% mujeres) con edad promedio de 68,6 años (6,9 años). Las personas mayores construyeron su alimentación con un alto significado a las comidas caseras, con influencia de género femenino durante la niñez y adolescencia. En la adultez, se reconstruye la alimentación al ingresar al mundo laboral. En la actualidad, cimentan la alimentación con un enfoque de cuidados para su salud. Reconocen transiciones y puntos de inflexión en la alimentación provocados por terremotos, pandemia por COVID-19, situación política en el país, embarazos o el diagnóstico de alguna enfermedad crónica. Discusión: Las personas mayores reconocen diversas vivencias en trayectorias vitales que han marcado sus patrones alimentarios. Estas experiencias de vida pueden ser la base de estrategias o acciones en la práctica clínica que aporten a su bienestar.

Introducción: El nuevo índice de obesidad basado en el volumen corporal (ABSI), ha sido asociado con enfermedades crónicas no transmisibles y mortalidad, independiente de los valores del índice de masa corporal (IMC); sin embargo, se desconoce su asociación con diabetes mellitus tipo 2 (DMT2) en población chilena. Objetivo: determinar la asociación entre ABSI con glicemia, hemoglobina glicosilada (HbAc1) y DMT2 en población adulta chilena. Materiales y métodos: Estudio transversal, incluyó a 4.874 participantes (edad media 43,3 años, 50,9% mujeres) de la Encuesta Nacional de Salud 2016-2017. ABSI fue calculado según la fórmula propuesta (basado en circunferencia de cintura, IMC y estatura. La Regresión de Poisson fue utilizada para investigar la asociación entre ABSI con DMT2 y regresión lineal para glicemia y HbAc1. Los análisis se ajustaron según factores sociodemográficos, de estilos de vida e IMC. Resultados: ABSI fue positivamente asociado con glicemia (p<0,001), HbA1c (p<0,001) y DMT2 (p<0,001). En el modelo más ajustado, por cada 0.025 unidad de aumento de ABSI, la glicemia aumentó en 1,78 mg/dL (95% IC: 1,21; 2,35) y la HbAc1en un 0,92% (95% IC: 0,49; 1,35). En cuanto a DMT2, la razón de prevalencia fue de 1,14 (95% IC: 1,09; 1,20), independiente de factores sociodemográficos, estilos de vida e IMC. Conclusiones: ABSI se asoció de forma lineal con una mayor probabilidad de padecer DMT2, mayores niveles de glicemia y HbA1c en adultos chilenos. En este contexto, ABSI podría ser un índice complementario, independiente del IMC, para evaluar el riesgo de alteraciones metabólicas asociadas a obesidad.

Multimorbidity patterns can lead to differential risks for all-cause mortality. Within the Chilean context, research on morbidity and mortality predominantly emphasizes individual diseases or combinations thereof, rather than specific disease clusters. This study aimed to identify multimorbidity patterns, along with their associations with mortality, within a representative sample of the Chilean population. 3,701 participants aged ≥18 from the Chilean National Health Survey 2009–2010 were included in this prospective study. Multimorbidity patterns were identified from 16 chronic conditions and then classified using latent class analyses. All-cause mortality data were extracted from the Chilean Civil Registry. The association of classes with all-cause mortality was carried out using Cox proportional regression models, adjusting by sociodemographic and lifestyle variables. Three classes were identified: a) Class 1, the healthiest (72.1%); b) Class 2, the depression/cardiovascular disease/cancer class (17.5%); and c) Class 3, hypertension/chronic kidney disease class (10.4%). Classes 2 and 3 showed higher mortality risk than the healthiest class. After adjusting, Class 2 showed 45% higher mortality risk, and Class 3 98% higher mortality risk, compared with the healthiest class. Hypertension appeared to be a critical underlying factor of all-cause morbidity. Particular combinations of chronic diseases have a higher excess risk of mortality than others.

Introduction: Recent studies have shown that low vitamin D levels constitute a potential risk factor for the development of cognitive impairment. The present study aimed to investigate the association between vitamin D levels and the suspicion of cognitive impairment in Chilean older adults. Material and Method: We performed a cross-sectional study, including 1,287 participants ≥ 65 years (56.8% were women, age range 65 to 97 years) from the Chilean National Health Survey. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE). Participants were classified into three groups according to their vitamin D levels (> 29 ng/ml sufficient, 12-29 ng/ml deficit, and < 12 ng/ml severe deficit). The association between vitamin D levels and cognitive impairment was explored using logistic regression analysis, adjusted for confounding factors. Results: The prevalence of vitamin D deficit and vitamin D severe deficit was 37.7% and 21.0%, respectively. Compared to older adults with sufficient levels of vitamin D, those with severe deficits had a 94% (OR: 1.94 [95% IC: 1.27; 1.66], p = 0.002) higher odds of cognitive impairment (unadjusted model). Adjusting according to sociodemographic factors, lifestyle, adiposity, sunlight exposure, and multimorbidity slightly attenuated the association to 61% (OR: 1.61 [95%IC: 1.03; 2.19], p = 0.046), but remain significant. Conclusion: A severe deficit of vitamin D was associated with higher odds of cognitive impairment in Chilean older adults independent of major confounding factors. Future studies are needed to provide causal evidence between vitamin D and the suspicion of cognitive impairment.

Research on morbidity and mortality often emphasizes individual diseases over the cumulative effects of multimorbidity, especially in low- and middle-income countries. This study aimed to analyze the association between multimorbidity and all-cause mortality in a representative sample of the Chilean population. This longitudinal study used data from 3701 subjects aged ≥15 years who participated in the Chilean National Health Survey conducted between 2009 and 2010. We included 16 self-reported highly prevalent morbidities. All-cause mortality data from an 11-year follow-up were collected from the Chilean Civil Registry. The Cox proportional hazard model, adjusted for confounders, determined the association between multimorbidity categories and all-cause mortality. Of the total sample, 24.3% reported no morbidity, while 50.4% two or more. After adjustment, participants with four or more morbidities had a 1.66 times higher mortality risk [95% confidence interval (CI): 1.03–2.67] than those without morbidities. The mortality risk increased by 10% for each additional morbidity [HR: 1.09 (CI: 1.04–1.16)]. Multimorbidity was common in the Chilean population and increased the mortality risk, which greatly challenges the health system to provide an integral and coordinated approach to healthcare.

Objective: To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. Design: Prospective study. Settings: The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0–2 points), moderately healthy (3–4 points) and the healthiest (5–7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. Participants: 2706 participants from the Chilean National Health Survey 2009–2010. Results: After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. Conclusion: Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.

Objetivo: Identificar la asociación entre salud oral y sospecha de deterioro cognitivo en personas mayores chilenas. Método: Estudio transversal con 1826 participantes ≥60 a ˜nos de la Encuesta Nacional de Salud de Chile, 2016-2017. La salud oral fue evaluada por el número de dientes, la presencia de caries, el uso de prótesis dental y el autorreporte de salud oral y dolor en la cavidad oral. La sospecha de deterioro cognitivo fue evaluada mediante el Mini-Mental State Examination (MMSE). Se empleó regresión logística y lineal, ajustada por variables sociodemográficas y de estilos de vida. Resultados: En comparación con personas sin sospecha de deterioro cognitivo, aquellas con sospecha de deterioro cognitivo presentaron cinco dientes menos (13,4 vs. 8,5 dientes), diferencia muy superior en mujeres que en hombres, y mayor frecuencia de dolor oral. El edentulismo y el menor número de dientes se asociaron a mayor probabilidad de sospecha de deterioro cognitivo, asociaciones que no se mantuvieron en modelos ajustados. El dolor oral se asoció a mayor probabilidad de sospecha de deterioro cognitivo (odds ratio: 1,99; intervalo de confianza del 95% [IC95%]: 1,09-3,63). Por cada diente adicional se observó un aumento del 2% (IC95%: 0,01-0,05) en la puntuación del MMSE. Conclusiones: La mala salud oral, en particular la pérdida de dientes y la presencia de dolor, se asociaron con deterioro cognitivo en personas mayores chilenas.

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016–2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

Depressive disorders are recognized as one of the most common mental health conditions across different age groups. However, the risk factors associated with depression among older people from low-and middle-income countries remains unclear. This study aims to identify socio-demographic, health and psychosocial-related factors associated with depression in Chilean older adults. A cross-sectional study was carried out in a representative sample of 1,765 adults aged ≥60 years participants from the Chilean National Health Survey 2016–2017. Depression was assessed with the Composite International Diagnostic Interview (CIDI-SF). Associations between the exposure variables and depression were investigated using Poisson regression analyses. The main findings indicated that women showed higher likelihood of depression than men (Prevalence Ratio (PR) = 2.6 [95% CI: 1.40; 4.89]). An increased likelihood of depression was found in older adults with chronic pain, multimorbidity (≥2 diseases), previous diagnose of depression, high perception of stress, financial stress, and difficulties for social participation. In women, higher likelihood of depression was found for those with the frailty phenotype (PR:8.53 [95% CI: 1.68; 43.32]), rheumatoid arthritis (PR:2.41 [95% CI: 1.34; 4.34]), insomnia (PR:2.99 [95% CI: 1.74; 5.12]) and low self-rated well-being (PR:4.94 [95% CI: 2.26; 10.79]). Men who were divorced (PR:7.10 [95% CI: 1.44; 34.90]) or widowed (PR:10.83 [95% CI: 3.71; 31.58]), obese (PR:5.08 [95% CI: 1.48; 17.42) and who had asthma (PR: 7.60 [95% CI: 2.31; 24.99]) were associated with higher odds of depression. The current findings may have clinical implications for the early identification of older adults more susceptible to depression and also suggest the need to implement cultural and age-sensitive strategies to promote mental health in late life.