Adiposidad corporal, estilos de vida y nivel de actividad física en mujeres dueñas de casa y trabajadoras remuneradas chilenas / Adiposity, healthy lifestyle and physical activity levels in housewives and women with paid employment in Chile

RESUMEN En Chile existe escasa evidencia en relación a las características de los estilos de vida en mujeres dueñas de casa versus mujeres con trabajos renumerados. El objetivo del estudio fue comparar marcadores de adiposidad, hábitos de consumo asociados a estilos de vida y nivel de actividad física (AF) en mujeres dueñas de casa y trabajadoras remuneradas chilenas. Se compararon variables de adiposidad como el índice de masa corporal (IMC), peso corporal, perímetro de cintura (PC), estilos de vida y niveles de AF (transporte, moderada y vigorosa intensidad y tiempo sedente) de 2.232 participantes de la Encuesta Nacional de Salud 2009-2010. Las dueñas de casa, en comparación con las trabajadoras renumeradas, presentaron un mayor IMC (27,9 vs. 20,0 kg/m2, <0,0001) y PC (98,3 vs. 95,6 cm, <0,0001). El tiempo destinado a la práctica de AF de trasporte (42,5 vs. 51,5 min/día, p= 0,009), moderada (94,2 vs. 128,4 min/día, <0,0001) y vigorosa (25,06 vs. 53,49 min/día, <0,0001) fue menor en dueñas de casa que en trabajadoras renumeradas. Por el contrario, las dueñas de casa destinaron menor tiempo al desarrollo de actividades sedentes (2,71 vs. 3,26 horas/día, <0,0001), además mostraron un menor consumo de alcohol (30,5 vs. 43,2 g/día, p= 0,021) en comparación a trabajadoras renumeradas.

ABSTRACT Lifestyle behaviours among women who take care of their home duties (housewives) and women who are currently working in paid employment is unknown in the Chilean population. The aim of this study was, therefore, to characterise adiposity, lifestyle behaviours and physical activity levels in housewives and women with paid employment in Chile. A total of 2,231 women from the National Health Survey 2009-2010 were included in this study. Adiposity markers (body weight, body mass index and waist circumference), lifestyle behaviors and physical activity were measured using self-reported questionnaires. The main findings of this study was that housewives had a higher body mass index (27,9 vs. 20,0 kg/m2, <0,0001) and waist circumference (98,3 vs. 95,6 cm, <0,0001) than women with paid-employment. Physical activity levels were lower (transport PA 42,5 vs. 51,5 min/day, p= 0,009, moderate PA 94,2 vs. 128,4 min/ day, <0,0001 and vigorous PA 25,06 vs. 53,49 min/day, <0,0001) and sedentary-related behaviours (2,71 vs. 3,26 hours/day, <0,0001) were higher in housewives compare to women with paid-employment. Dietary behaviors showed that housewives consume less alcohol (30,5 vs. 43,2 g/day, p= 0,021) than women with paid-employment.

Asociación del polimorfismo rs7903146, del gen TCF7L2, con marcadores de adiposidad y metabólicos en población chilena - resultados del estudio GENADIO / Association of the TCF7L2 (RS7903146) genotype with adiposity and metabolic markers in the Chilean adult population

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.

Influencia de la edad sobre el cumplimiento de las recomendaciones de actividad física: Resultados de la Encuesta Nacional de Salud en Chile 2009-2010 / Adherence to physical activity recommendations across age categories: Findings from the 2009-2010 Chilean National Health Survey

RESUMEN A pesar de que la actividad física (AF) es un factor protector contra las enfermedades crónicas no transmisibles, un gran porcentaje de la población no cumple los niveles mínimos recomendados. El objetivo fue investigar como varían los niveles de práctica de AF entre los diferentes grupos etarios en la población chilena. Se incluyeron 5.133 participantes de la Encuesta Nacional de Salud 2009-2010. La AF fue determinada utilizando el cuestionario GPAQ. La inactividad física fue definida como <600 MET/min/semana de AF moderada a vigorosa. La asociación entre AF y edad fue investigada por sexo mediante regresión logística. Las mujeres presentaron una mayor probabilidad de ser físicamente inactivas en comparación a los hombres (p<0,0001). Al analizar la prevalencia de inactividad física por sexo y grupo etario, esta cambió ligeramente entre los 20 a 59 años, pero a partir de los 60 se observó un incremento importante en la prevalencia llegando a 63% y 56% para mujeres y hombres >80 años, respectivamente. Los resultados obtenidos confirman la necesidad de seguir fomentando la práctica regular de AF física a través de todo el ciclo vital, pero en especial sobre los 60 años, ya que este grupo presenta una mayor probabilidad de ser físicamente inactivo.

ABSTRACT Although physical activity (PA) is a protective factor against non-communicable diseases, there is an important proportion of the population who do not meet PA guidelines. Our aim was to investigate how adherence to PA guidelines varies across different age groups in the Chilean population. 5,133 participants from the 2009-2010 Chilean Health Survey were included in this study. PA was measured using the Global Physical Activity Questionnaire (GPAQ). Physical inactivity was defined as <600 MET/min/week of moderate to vigorous intensity PA. Logistic regression was used to investigate the association of PA with age. The main finding of this shows that women were more likely to be inactive than men (p<0.0001). Physical inactivity prevalence varied slightly between 20 and 59 years. However, among those individuals aged >60 years the prevalence increased markedly, reaching 63% and 56% for women and men aged >80 years, respectively. These findings confirm the necessity of promoting PA across the lifespan, but more importantly, these results suggest that more promotion and opportunities for engaging in PA should be created especially for older adults, who are more likely to be physically inactive.

Asociación entre diabetes mellitus tipo 2, historia familiar de diabetes y deterioro cognitivo en adultos mayores chilenos / Risk of cognitive impairment among older people with diabetes or family history of the disease

Background: Although cardiovascular risk factors are associated with an impaired cognitive function, the impact of diabetes on cognitive function in Chilean adults is unknown. Aim: To investigate the association of diabetes or family history of the disease with cognitive impairment in older adults. Materials and Methods: Data from the 2009-2010 Chilean National Health Survey including 1,384 participants aged ≥ 60 years were included in this study. A score below 13 points for the Mini Mental State Examination (MMSE) was considered an indication of cognitive impairment. Logistic regression analyses were performed to assess the association between MMSE, diabetes and family history of the disease. Results: Cognitive impairment increased with age (Odds ratio (OR): 1.83 [95% confidence intervals (CI): 1.53; 2.19], p < 0.01, per 5 years increment in age). This trend was greater in individuals with diabetes (OR: 2.37 [95% CI: 1.68; 3.35], p < 0.01) compared to those without the disease. A similar trend was identified among individuals with a family history of diabetes compared to those without. Conclusions: Older adults with diabetes are more susceptible to develop cognitive impairment.

Asociación entre el polimorfismo rs9939609 del gen FTO y marcadores de adiposidad en población adulta chilena / Association between FTO (ns9939609) genotype and adiposity markers in Chilean adults

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.

No cumplir con las recomendaciones de actividad física se asocia a mayores niveles de obesidad, diabetes, hipertensión y síndrome metabólico en población chilena / Association of physical inactivity with obesity, diabetes, hypertension and metabolic syndrome in the chilean population

Background: Physical inactivity is an important cardiovascular risk factor. Aim: To investigate the association of physical inactivity with obesity, metabolic markers, type 2 diabetes mellitus, hypertension and metabolic syndrome in Chilean adults. Material and Methods: Participants from the National Health Survey 2009-10 (n = 5,157) were included in this study. Body mass index, waist circumference, metabolic markers (blood glucose, glycosylated hemoglobin and lipid profile) were the outcomes. Type 2 diabetes, hypertension and metabolic syndrome were determined using international criteria. Physical activity levels were determined using the Global Physical Activity Questionnaire and physical inactivity was defined as < 600 METs/minutes/week. Results: Compared to their physically active peers, inactive men and women had a higher odds ratio (OR) for obesity (OR: 1.77 [95% confidence intervals (CI): 1.29-2.42], p < 0.01 and 1.25 [95% CI: 102-1.54], p < 0.035, respectively), diabetes (OR: 2.47 [1.80-3.38], p < 0.01 and 1.72 [1.35-2.19], p = 0.002, respectively) and hypertension (OR: 1.66 [1.31-2.09], p < 0.01 and 1.83 [1.54-2.18] respectively. An association of physical inactivity with central obesity and metabolic syndrome was observed only in men (OR: 1.92 [1.42- 2.58], p < 0.01 and 1.74 [1.23-2.47], p < 0.01, respectively). Conclusions: Not meeting the physical activity recommendations is associated with obesity, diabetes, hypertension and metabolic syndrome, which are important cardiovascular risk factors.

Factores asociados a sedentarismo en Chile: evidencia de la Encuesta Nacional de Salud 2009-2010 / Correlates of sedentary behaviors in Chile: evidence from the National Health Survey 2009-2010

Background: Sedentary behaviors are one of the major risk factors for cardiovascular diseases. Aim: To identify factors associated with high sedentary behaviors in the Chilean population. Material and Methods: We included 5,040 participants from the Chilean National Health Survey 2009-2010. Physical activity level and sedentary behavior (sitting time) were measured using the Global Physical Activity Questionnaire (GPAQ v2). Highly sedentary behaviors were determined as > 4 hours per day of sitting time. Logistic regression was used to identify correlates of highly sedentary behavior. Results: Forty seven percent of the study population reported spending more than 4 hours per day sitting. The prevalence was higher in women. The main factors associated with high sedentary behavior were: high income levels (Odds ratio (OR):1.91 [95% Confidence intervals (CI:1.61-2.27]); being woman (OR:1.39 [95% CI:1.24-1.56]): having central obesity (OR:1.15 [95% CI:1.02-1.30]), being physically inactive (OR:2.35 [95% CI:2.06-2.68]), and living in an urban area (OR:1.92 [95% CI:1.63-2.26]). Other factors associates with high sedentary behavior were: being smoker, having a television set, computer and private car at their homes. Participants reporting a poor self-reported health and wellbeing and those with diabetes or metabolic syndrome were more likely to be highly sedentary. Conclusions: The main factors associated with high levels of sedentary behavior are socio-demographic issues, lifestyles and health status.

Efectos de la actividad física sobre la asociación entre obesidad y diabetes mellitus tipo 2: resultados de la Encuesta Nacional de Salud 2009-2010 / The association between adiposity and diabetes is modified by physical activity

Background Physical inactivity and obesity are major risk factors for type 2 diabetes (T2D). Aim To investigate whether if the association between obesity and diabetes is modified by levels of physical activity in the Chilean population. Material and Methods Cross-sectional study including 4,712 participants from the 2009-2010 National Health Survey. Diabetes was determined when participants referred having the disease or had a fasting glucose ≥ 126 mg/dl. Physical activity level was assessed using the Global Physical Activity Questionnaire. The association between diabetes, obesity and physical activity was determined using logistic regression analysis. Results Compare to active and normal weight subjects (reference group), the risk for T2D was higher in active individuals with overweight (Odds ratio (OR): 2.85 [95% confidence intervals (CI): 1.76- 4.61] p < 0.01). The risk among inactive but normal weight participants (OR: 2.12 [95% CI: 1.49- 3.01], p < 0.01) was of lower magnitude and was even higher among inactive and overweight individuals (OR: 3.22 [95% CI: 2.10 - 4.93], p < 0.01). Similar results were found for obesity and central obesity. Conclusions Individuals who are physically inactive and have a high adiposity level have an increased risk for T2D compared to active individuals with normal BMI.

Factores asociados a inactividad física en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Correlates of physical inactivity: Findings from the Chilean National Health Survey 2009-2010

Background: Physical inactivity is an important risk factor for cardiovascular diseases. Aim: To identify factors associated with physical inactivity in Chilean adults. Material and Methods: Participants from the Chilean Health Survey (5,133 individuals) were included in this study. Physical activity was measured using the Global physical activity questionnaire (GPAQ). Physical inactivity was defined as < 600 MET. min.week−1 of moderate to vigorous intensity physical activity. Logistic regression was used to identify correlates of physical inactivity. Results: The main finding of this study were that women (odds ratio (OR): 1.51 [95% confidence intervals (CI): 1.32-1.72]) were more likely to be inactive compared to men and that older adults were more likely to be inactive than their younger or middle age counterparts (OR: 3.06 [95% CI: 2.45-3.82]). Other correlates of physical inactivity were individuals with obesity (OR: 1.43 [95% CI: 1.20-1.70]), diabetes (OR: 1.96 [95% CI: 1.61-2.38]), hypertension (OR: 1.72 [95% CI: 1.50-1.97]), metabolic syndrome (OR: 1.42 [95% IC: 1.18-1.70]), a low education level (OR: 1.26 [95% CI: 1.06-1.49]) and higher levels of sedentary behavior (OR: 2.77 [95% CI: 2.36-3.25]). Conclusions: Women, older people and sedentary subjects with chronic non-transmissible conditions are at higher risk of being physically inactive.

Factores de riesgo asociados al desarrollo de hipertensión arterial en Chile / Risk factors associated with hypertension: analysis of the 2009-2010 Chilean health survey

Background: High blood pressure is one of the major risk factors for the development of cardiovascular disease, affecting 27% of the Chilean population in 2010. Aim: To determine the risk factors associated with the development of hypertension. Material and Methods: Analysis of the database of the 2009-2010 National Health Survey in which 4,901 participants were included. Socio-demographic factors, physical activity, eating habits, well-being and comorbidities were analyzed. Results: Women had a lower risk of developing hypertension than men (Odds ratio (OR): 0.69, 95% confidence intervals (CI): 0.59-0.81, p < 0.01). In both men and women, the risk is greater over the age of 25 years (OR: 2.90, 95% CI: 1.55-5.43, p < 0.01). The risk is greater in subjects who were overweight (OR: 1.61, 95% CI: 1.31-1.98, p < 0.01), obese (OR: 3.18, 95% CI: 2.56-3.95, p < 0.01), or had central obesity (OR: 2.25, 95% CI: 1.85-2.72, p < 0.01). Subjects with a family history of hypertension and diabetes also have a higher risk. Conclusions: Identifying the risk factors associated with hypertension allows public health policies to be tailored to its prevention.

Mayores niveles de transporte activo se asocian a un menor nivel de adiposidad y menor riesgo de obesidad: resultados de la Encuesta Nacional de Salud 2009-2010 / Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010

Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p < 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p < 0.01]. The odds of having a BMI > 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes' increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p < 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults.

Factores asociados al desarrollo de obesidad en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Risk factors for obesity: analysis of the 2009-2010 Chilean health survey

Background: Chile has one of the highest obesity rates in Latin America. However, the factors that could explain this high prevalence of obesity are unknown. Aim: To determine the main risk factors for the development of obesity in Chile. Material and Methods: We included 1,398 obese and 1,478 normal weight participants of the National Health Survey 2009-2010. The risk factors considered were socioeconomic variables, diet, physical activity, comorbidities and general wellbeing. Results: The main factors associated with a higher risk of being obese were age, high salt consumption and high alcohol intake. Education, income and living in rural settings were protective for women and risk factors for men. The probability of being obese increases in women that sleep less than seven hours per day or have a poor health. Sedentariness and lack of physical activity were risk factors among men. Conclusions: The identification of these risk factors may help to implement public health interventions to tackle obesity in Chile.

Menor peso corporal, de índice de masa corporal y de perímetro de cintura se asocian a una disminución en factores de riesgo cardiovascular en población chilena: Findings from the Chilean health surveyç / Effects of a lower body weight or waist circumference on cardiovascular risk

Background: Overall and central obesity are important risk factors for cardiovascular disease. Aim: To investigate the association of body weight, body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors in Chile. Material and Methods: We included 5,157 participants from the National Health Survey 2009-2010. Prevalence of type 2 diabetes, hypertension, metabolic syndrome and dyslipidemia (high total cholesterol and triglyceride levels and low HDL-cholesterol) were defined using international recommendations. BMI and WC were measured using standardized protocols. Results: A five percent lower body weight, BMI and WC were associated with a significant reduction in cardiovascular risk factors. For each 5% reduction in body weight, the risk for hypertension decreased by 8 and 9% in women and men respectively. Similar risk reductions were observed for diabetes (9 and 11% respectively), metabolic syndrome (23 and 30% respectively), low HDL cholesterol (13 and 13% respectively), high triglyceride levels (16 and 18% respectively) and total cholesterol (8 and 10% respectively). Similar findings were observed for BMI and WC. Conclusions: Lower body weight, BMI or WC are associated with important reductions in cardiovascular risk factors. A 5% reduction in these adiposity markers could be a perfectly feasible goal for lifestyle interventions.