Dra. Troncoso-Pantoja, Claudia

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.

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.

Background: A low education level has been associated with cognitive impairment in older adults. Aim: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. Material and Methods: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. Results: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. Conclusions: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Chile es uno de los países de Latinoamérica que exhibe un mayor envejecimiento poblacional, por lo que es necesario visualizar distintas herramientas que direccionen estilos de vida saludables en esta etapa de la trayectoria vital. Las Guías Alimentarias Basadas en Alimentos (GABA) entregan recomendaciones que permiten mejorar la calidad de vida de personas mayores. Por lo anterior, el objetivo del estudio fue determinar el nivel de cumplimiento de recomendaciones de las GABA y su asociación con variables antropométricas, metabólicas y de estilos de vida en 1.789 personas mayores de 60 años que participaron en la Encuesta Nacional de Salud 2016-2017. Se realizó un estudio descriptivo de corte transversal, en donde los participantes se subdividieron en cuatro grupos según cumplimiento de las GABA: no cumple, cumple con 1, 2 o a lo menos 3 recomendaciones de consumo de legumbres, frutas y verduras, lácteos, agua y pescado. Como resultado, el 43,8% de las personas mayores que participaron no cumplieron ninguna de las recomendaciones GABA evaluadas; estos últimos, realizaban menos actividad física y presentaban, además, una mayor probabilidad de pasar más tiempo sentados (p-tendencia: <0,001). Como conclusión, se destaca que cerca del 50% de las personas mayores en Chile no adhieren a las recomendaciones de las GABA, lo que podría repercutir en implicaciones en la salud y bienestar de la población mayor.

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.

El cumplimento de las Guías Alimentarias Basadas en Alimentos (GABA) vigentes en Chile, asegura una alimentación suficiente y equilibrada.  Objetivo: Determinar el cumplimiento de 5 recomendaciones de las GABA y su asociación con variables antropométricas, de estilo de vida y metabólicas, en adolescentes que participaron en la Encuesta Nacional de Salud 2016-2017.  Sujetos y Método: Estudio transversal que incluyó 355 adolescentes entre 15 a 19 años. Los participantes se dividieron en 4 grupos (cumple ninguna, 1, 2 o ≥ 3 recomendaciones) utilizando 5 mensajes de las GABA (consumo de leguminosas, pescado, lácteos, frutas y verduras y agua). Las asociaciones entre GABA y las variables de salida: peso corporal, índice de masa corporal, perímetro de cintura, actividad física, horas de sueño, variables metabólicas, fueron investigados utilizando análisis de regresión lineal ajustado por variables sociodemográficas.  Resultados: El 5,6% de adolescentes cumplían con tres o más recomendaciones GABA. De las recomendaciones medidas, presentaron un mayor cumplimiento el consumo de agua (85%) y legumbres (78,7%), reconociendo diferencias entre mujeres y hombres para el consumo de legumbres (58,6% vs. 86,4%), agua (69,6% vs. 91%) y lácteos (92,9% vs. 39,1%). Los adolescentes con mayor cumplimiento de las GABA, presentaban una menor glicemia (p = 0,025). No se identificaron otras asociaciones significativas en estilos de vida y mediciones antropométricas.  Conclusiones: Los adolescentes participantes en este estudio presentaron dificultades en la adhesión a recomendaciones de las GABA.

Introducción: La lactancia materna (LM) es un factor protector contra la obesidad infantil; sin embargo, los mecanismos a través de los cuales ejerce este efecto aún no están claros. El objetivo fue describir los mecanismos asociados al efecto protector que ejerce la lactancia materna contra la obesidad infantil. Métodos: Se utilizaron los buscadores PUBMED, SCOPUS, Cochrane Library y Scielo para desarrollar una revisión descriptiva de la evidencia científica. Las palabras clave fueron: lactancia materna, obesidad, mecanismo y dieta. Se revisaron artículos en español e inglés, desde 1977 hasta el 2020. Resultados: El efecto protector de la LM contra la obesidad infantil está dado por una combinación de varios mecanismos, se destaca su composición nutricional y el aporte de sustancias bioactivas, algunas de ellas reguladoras de la ingesta energética. Los lactantes que reciben LM por más tiempo seleccionan alimentos más saludables en etapa preescolar, independiente de factores sociodemográficos. También han sido descritos efectos en la adiposidad, el control del peso corporal y la ingesta energética mediante regulación de la programación epigenética y de la microbiota intestinal. Conclusión: La LM es un proceso único, que interacciona de forma compleja con factores del crecimiento y desarrollo de los lactantes y preescolares. Su rol protector contra la obesidad ha sido asociado a diversos mecanismos. Sin embargo, se requiere de nuevas investigaciones para comprender los alcances que puede presentar la LM en la etapa pediátrica y su rol en la prevención de la obesidad.

Introduction: The average life expectancy, as well as the prevalence of Type 2 diabetes (T2D), is increasing worldwide. Population-based studies have demonstrated that the duration of T2D has been associated with cognitive impairment. However, despite the high prevalence of T2D and cognitive impairment in Chile, the association between years with T2D and suspicion of cognitive impairment has not yet been investigated. The objective of this study was to investigate the association between duration of T2D and suspicion of cognitive impairment in Chilean older adults. Material and Methods: 1,040 older adults aged ≥60 years from the Chilean National Health Survey (2009-2010) were included. Suspicion of cognitive impairment was assessed by the abbreviated Mini-Mental State Examination (MMSE). The number of years with T2D was self-reported and categorised into four groups. Poisson Regression analysis was used to assess the association between altered MMSE and the number of years with DM2, adjusted by potential confounders including socio-demographic, lifestyle, adiposity and health-related factors. Results: When the analyses were adjusted for socio-demographic factors, people who had T2D for 15 to 24 and ≥25 years had 2.2-times (95%CI: 1.07; 3.33) and 5.8-times (95%CI: 3.81; 11.0) higher relative risk (RR) of cognitive impairment, compared to those without T2D. When the analyses were additionally adjusted for lifestyle and health-related covariates, the RR for cognitive impairment was 1.76-times (95%CI: 1.02; 2.50) and 4.54-times (95%CI: 2.70; 6.38) higher for those who had T2D for 14-24 years and ≥25 years, respectively. Conclusions: Number of years with T2D was associated with suspicion of cognitive impairment. A longer duration of T2D was associated with a higher likelihood of cognitive impairment in the Chilean older population, independently of confounder factors included in the study.

Background: Adiposity and education are two independent risk factors for type 2 diabetes (T2D). However, there is limited evidence whether both education and adiposity are associated with T2D in an additive manner in the Chilean population. Aim: To investigate the joint association between adiposity and education with T2D in the Chilean adult population. Material and Methods: Analysis of data of the Chilean National Health Survey 2016-2017, which included 5,033 participants with a mean age of 43 years, (51% women). Poisson regression analyses with robust standard error were used to investigate the joint association of the education level and general and central adiposity with T2D. The results were reported as Prevalence Ratio and their 95% confidence intervals (PR, 95% CI). Results: Obesity was associated with a higher probability of having T2D in men than in women, however central adiposity was associated with a higher probability of having T2D in women than in men. Compared with men who had higher education (> 12 years) and had normal body weight, those with the same educational level and who were obese had 2.3-times higher probability of having T2D (PR: 2.35 [95% CI: 1.02; 5.39]). For women, having a low education and being obese was associated with 4.4-times higher probability of having T2D compared to those with higher education and normal body mass index (BMI) (PR: 4.47 [95% IC: 2.12; 9.24]). Similar results were observed when waist circumference was used as a marker of obesity rather than BMI. Conclusions: Women and men with higher BMI and low education had a higher risk of T2D. However, this risk was higher in women than in men.

Background: Water is an essential nutrient for cellular homeostasis and life. Drinking ≥ 6 glasses (1.5 L/day) is the recommendation of daily water intake (RIAD). Aim: To characterize water intake, according to sociodemographic, anthropometric and lifestyles variables, in the Chilean adult population. Material and Methods: Analysis of data from 5,520 participants of the 2016-17 National Health Survey. Compliance with RIAD by population groups according to sociodemographic, anthropometric and lifestyle characteristics was studied through logistic regression analyses. Results: Only 27.8% of the national population met the RIAD. Women, people over than 56 years of age, housewives, retired people, widowers, and non-smokers were less likely to meet the RIAD. The likelihood of not complying with RIAD in these segments of the population ranged from 28% to 62%. Conversely, participants who presented a higher likelihood of meeting RIAD were those who co-habiting, had a medium and higher educational level, followed a diet plan, and those who reported a good health and well-being. The likelihood of meeting with the RIAD for these population groups ranged from 47% to 116%. Conclusions: The likelihood of meeting the RIAD varied according to different sociodemographic, anthropometric, and lifestyle variables. Therefore, public policies for promoting water consumption should be focused on all age groups, but especially in those groups with the highest risk of underconsumption