Dra. Mardones-Leiva, Lorena

La obesidad es una enfermedad inflamatoria, crónica, recurrente, progresiva y de etiología multifactorial, que afecta a más 650 millones de personas en el mundo. La carga física, emocional y económica que genera la obesidad no solo guarda relación con sus manifestaciones clínicas, sino también por su impacto a nivel sistémico y a largo plazo. En Chile, el crecimiento económico, la urbanización y la globalización han modificado profundamente el modo de vivir de la población lo que ha favorecido un ambiente obesogénico. Sin embargo, ¿qué factores han repercutido en el desarrollo de obesidad en Chile? ¿cuál ha sido el rol de cada uno de estos factores en el aumento de la prevalencia de esta patología? En la parte 1 de esta revisión discutiremos los principales factores no modificables que han repercutido en su desarrollo, desde la transición epidemiológica que vivió el país en la década de los 70, hasta las patologías endocrinas relacionadas.

Background: Numerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity. Aim: To investigate the association of FTO gene with adiposity markers in Chilean adults. Material and Methods: 409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio. Results: A fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score. Conclusions: This study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.

Background: Type 2 diabetes etiology has a strong genetic component. More than 20 genetic variants have been associated with diabetes and other metabolic markers. However, the polymorphism rs7903146 of the TCF7L2 gene has shown the strongest association. Aim: To investigate the association of TCF7L2 (rs7903146) genotype with adiposity and metabolic markers in the Chilean adult population. Material and Methods: The association of TCF7L2 (rs7093146) with adiposity and metabolic markers was studied in 301 participants. The outcomes of the study were adiposity markers (body weight, body mass index (BMI), fat mass and waist circumference) and metabolic markers (blood glucose, insulin, HOMA-IR, lipid profile, high sensitivity C-reactive protein (CRP), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) and leptin). Results: There was an association between the polymorphism TCF7L2 genotype and fasting blood glucose. The latter increased by 4.86 mg/dl per each copy of the risk allele [(95% confidence intervals (CI): 0.48; 9.24), p = 0.03] in the unadjusted adjusted model. However, this association was slightly attenuated in the fully adjusted model [4.38 mg/dl (95% IC: 0.16; 8.60), p = 0.04)]. There were no associations between the TCF7L2 genotype and any other metabolic or adiposity outcome. Conclusions: These findings confirm the association between the TCF7L2 (rs7903146) and fasting glucose in the Chilean population. However, further studies are needed to confirm the association between the TCF7L2 and diabetes risk in the Chilean population.

Chile tiene una de las tasas de obesidad más altas del mundo. Se estima que para el año 2030 las muertes atribuidas a esta enfermedad alcanzarían a 204 mil personas, incrementándose además los costos económicos asociados a esta patología. Las causas y los factores de riesgo asociados al desarrollo de obesidad son diversos. Sin embargo, existe consenso que una de las maneras más eficaces de prevenir y/o disminuir su prevalencia es abordando los factores de riesgo modificables, a través del fomento de hábitos de vida saludable con un enfoque integral, centrados en la alimentación saludable, práctica de actividad física, prevención del tabaquismo y consumo de alcohol, como también en el cuidado de la salud mental del individuo. No obstante, el desafío es cómo hacer realidad estos buenos propósitos. En este contexto, el objetivo de esta revisión, parte 2, fue investigar los principales factores modificables, con énfasis en los factores individuales, que han repercutido en el desarrollo de obesidad: desde una mirada global hasta el caso particular de Chile.

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.