¿Cuál es la prevalencia de obesidad metabólicamente saludable en población chilena? / What is the prevalence of metabolically healthy obesity in Chile?

RESUMEN La obesidad es un importante factor de riesgo cardiovascular. No obstante, no todas las personas obesas tienen un perfil metabólico alterado ni todas las personas normo-peso poseen un perfil metabólico normal. Objetivo: determinar la prevalencia de diferentes fenotipos metabólicos asocia-dos al estado nutricional en Chile. Métodos: se incluyeron 1.733 participantes de la Encuesta Nacional de Salud 2009-2010. El estado nutricional (obesidad o normo-peso) fue determinado a través del IMC mientras que la condición metabólica (saludable o no) en base a cuatro parámetros: glicemia, presión arterial, colesterol HDL y triglicéridos. Con estos parámetros de determinaron 4 fenotipos, entre ellos, MUNO: metabólicamente no saludable no obeso y MHO: obeso metabólicamente saludable. Resultados: La prevalencia de MHO fue de 3,3% mientras que un 17,4% presentaba MUNO. Adicionalmente, la prevalencia de MHO disminuyó en la medida que aumentó la edad y la mayor proporción de individuos metabólicamente saludables se encontraba en el grupo de altos ingresos y con un nivel educacional superior (técnico-universitario). Conclusión: Se evidencia una baja prevalencia de MHO, así como también una alta prevalencia de individuos MUNO en la población chilena. Futuras acciones preventivas deberían no sólo considerar el estado nutricional sino también la condición metabólica de la población.

ABSTRACT Obesity is an important cardiovascular risk factor. However, not all obese individuals have an unhealthy metabolic pro-file and vice versa. Therefore, the aim of this study was to determine the prevalence of different metabolic phenotypes by nutritional status in Chile. Methods: 1,733 individuals from the National Health Survey 2009-10 were included in this study. Nutritional status (obesity or normal-weight) was determined by BMI whereas metabolic profile was determined through four parameters: Glycaemia, blood pressure, HDL cholesterol and triglycerides. Four metabolic phenotypes were derived, among them: MUNO: metabolically unhealthy and non-obese and MHO: metabolically healthy obesity. Results: The prevalence of MHO in the Chilean population was 3.3% while the prevalence of MUNO was 17.4%. Moreover, the prevalence of MHO decreased as age increased and a greater proportion of metabolically healthy individuals were in the highest gross income group and in the technical-university educational level. Conclusion: This study shows a low prevalence of MHO and a higher prevalence of MUNO in the Chilean population. Future preventive actions should take into account not only the nutritional status, but also the metabolic profile of the population.

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.

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.

Altos niveles de adiposidad se asocian a un deterioro en la salud metabólica en adultos chilenos / Higher adiposity levels are associated with detrimental metabolic health in Chilean adults

RESUMEN Antecedentes: El exceso de grasa corporal es uno de los principales factores de riesgo de enfermedades cardiometabólicas. Objetivo: Investigar las asociaciones entre indicadores de adiposidad y metabólicos en población adulta chilena. Métodos: Estudio observacional de corte transversal en 475 adultos, a quienes se evaluó el índice de masa corporal (IMC), perímetro cintura (PC) y porcentaje de masa grasa (%MG). Se midió presión arterial, glicemia, insulina, HOMA-IR, colesterol total, triglicéridos, colesterol HDL y LDL, alanina-amino transpeptidasa, gama-glutamil transpeptidasa, leptina y proteína C-reactiva ultra sensible (PCRus). La asociación entre indicadores de adiposidad y marcadores metabólicos fue determinada mediante regresión lineal múltiple. Resultados: Los tertiles superiores de IMC, PC y %MG se asociaron significativamente (p< 0,05) con niveles bajos de colesterol HDL y altos de insulina, HOMAIR, triglicéridos, colesterol total, colesterol LDL, ALT, GGT, PCRus y leptina; esto para ambos sexos. Se observó además que los valores de presión arterial sistólica y presión arterial diastólica, fueron significativamente mayores en mujeres en relación a un mayor IMC. Conclusión: A medida que aumentó el nivel de adiposidad, se deterioran los marcadores de salud cardiovascular y metabólica, independientemente del indicador de adiposidad empleado.

ABSTRACT Background: Adiposity is positively associated with metabolic and inflammatory markers, which increase the risk of developing metabolic disease related to obesity. Aim: To investigate the association between adiposity markers and metabolic health in Chilean adults. Methods: We conducted a cross-sectional study with 475 participants. Body mass index (BMI), waist circumference (WC) and body fat (using 4 skinfold) were measured. The outcomes of interest were blood pressure, fasting glucose, insulin, HOMA-IR, total cholesterol, triglycerides (TG), HDL and LDL cholesterol,γ-glutamyltransferase (GGT), alanine aminotransferase (ALT), leptin and high sensitive C-reactive protein (hsCRP). The association between adiposity and metabolic outcomes were investigated using multiple linear regression analysis. Results: Individuals in the highest tertile for BMI, WC and body fat had a lower concentration of HDL-cholesterol and higher concentration of insulin, HOMA-IR, TG, LDL and total cholesterol, GGT, ALT, leptin and hsCRP. Blood pressure was higher with increasing BMI in females only. There was no significant association between fasting glucose and any of the adiposity markers. Conclusion: Higher adiposity levels were associated with a detrimental metabolic health. The effect of higher BMI, WC and body fat were similar across metabolic markers.

Ser físicamente activo modifica los efectos nocivos del sedentarismo sobre marcadores de obesidad y cardiometabólicos en adultos / Being physically active modifies the detrimental effect of sedentary behavior on obesity and cardiometabolic markers in adults

Background: Sedentary behavior is a major risk factor for cardiovascular disease and mortality. Aim: To investigate whether the associations between sedentary behavior and cardiometabolic markers differs across physical activity levels. Materials and Methods: Cross sectional study of 314 participants aged 18 to 65 years. Body mass index (BMI) and waist circumference were measured, and body fat was derived from the sum of four skinfolds. Physical activity was measured objectively using accelerometers (Actigraph GT1M, USA®). A fasting blood sample was obtained to measure glucose, insulin, HOMA-IR, lipid profile and high sensitive C reactive protein (hsCRP). Those participants with an activity level > 600 MET.min-1.week-1 were classified as physically active. Results: Thirty four percent of participants were physically inactive and spent an average of 8.7 h.day-1 in sedentary pursuits. Physically inactive individuals had poorer cardiometabolic health than their physically active counterparts. Per one hour decrease in overall sedentary behavior, there was a significant improvement in glucose (-8.46 and -4.68 mg.dl-1), insulin (-2.12 and -1.77 pmol.l-1), HOMA-IR (-0.81 and -0.56) BMI (-0.93 and -0.62 kg.m-2) and waist circumference (-2.32 and -1.65 cm) in physically active and inactive participants, respectively. Conclusions: Being physically active may modify the detrimental effects of sedentary behavior on cardiometabolic and obesity-related traits.

Fitness cardiorrespiratorio se asocia a una mejora en marcadores metabólicos en adultos chilenos / Inverse association of cardiorespiratory fitness with cardiovascular risk factors in Chilean adults

Background: A high level of cardiorespiratory fitness (CRF) is an important protector against cardiovascular and metabolic diseases. Aim: To explore the association of CRF with several metabolic markers and estimate the variation of these parameters by an increase of 1 MET change in CRF. Material and Methods: Cross-sectional study of 447 adults (56% women) without medical history of cardiometabolic diseases. Physical activity evaluated using accelerometry, body mass index (BMI), blood pressure, blood glucose and insulin and lipid profile were measured. HOMA-IR was calculated with fasting glucose and insulin levels. The submaximal Chester Step Test was used to measure CRF. Results: CRF was significantly associated with the level and intensity of physical activity, and all metabolic markers (p-trend < 0.05), except with diastolic blood pressure. It was estimated that 1-MET increase in CRF is associated with waist circumference (β -0.32 cm), fat mass (β -0.22%), insulin (β -0.67 pmol.l-1), HOMA-IR (β -0.17) and HDL cholesterol (β +1.46 mg.dl-1). All these associations were independent of main covariates such as age, sex, education, smoking and body mass index. Conclusions: A higher level of CRF is inversely associated with several metabolic markers that are risk factors for cardiovascular disease.

Un mayor nivel de actividad física se asocia a una menor prevalencia de factores de riesgo cardiovascular en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Higher physical activity levels are associated with lower prevalence of cardiovascular risk factors in Chile

Background: Little is known about the relationship between physical activity (PA) and cardiovascular risk factors in the Chilean population. Aim: To investigate the association between different levels and intensities of PA and the prevalence of cardiovascular (CV) risk factors in Chilean adults. Material and Methods: Data from the National Health Survey 2009-10 including 5157 participants, provided by the Epidemiology Department of the Ministry of Health, was analyzed in this study. The prevalence of type 2 diabetes mellitus, hypertension, metabolic syndrome and dyslipidemia were determined using international criteria. PA levels were determined using the Global Physical Activity Questionnaire (GPAQ v2) and different levels of PA were derived from it (transport-related, moderate and vigorous PA). Quartiles of PA were determined to investigate the association between PA and cardiovascular risk factors. Results: Twenty three percent of women and 17.1% of men did not meet the PA recommendation (≥ 600 METs.min.week-1). When prevalence of CV risk factors were compared between inactive individuals (< 600 METs.min.week-1) and active individuals (≥ 9500 METs.min.week-1) a significantly lower prevalence of diabetes mellitus (6.2% and 10%), hypertension (18.0% and 12.4%) and metabolic syndrome (8.9% and 12.1%) for women and men, respectively, was found in the active participants. Similar results were found for high versus low transport-related PA. Conclusions: Increasing levels of PA are associated with a significantly lower frequency of cardiovascular risk factors in Chilean adults.

Riesgo de suicidio en jóvenes universitarios de Bucaramanga en el año 2011 / Suicide risk in college students from Bucaramanga in the year 2011

Introducción: el suicidio es un fenómeno social con una alta tasa de mortalidad entre los jóvenes que pasan por varias etapas de cambios físicos y emocionales, con los intentos o pensamientos de suicidio común sentir miedo de lo que podría suceder en una situación difícil por la que están pasando. Santander en Colombia y las mayores tasas de suicidio son los jóvenes y la tendencia a aumentar. Todavía no sabemos la magnitud del problema en este grupo de alto riesgo, sin llegar a un suicidio total. Por lo tanto, esta investigación busca comprender este problema de una manera real de los que están vivos y en riesgo de suicidio y no esperar hasta que se trate y/o morir por esta causa Materiales y Métodos: Estudio descriptivo, observacional de corte transversal, en una muestra de 343 estudiantes de la Facultad de Ingenierías de la Universidad de Santander de Bucaramanga; mediante una encuesta utilizando la Escala de Riesgo suicida Plutchik y otras variables socio demografías conformada por 27 preguntas. Se validan en dos bases de datos del programa EPIDATA, posteriormente se exportan al programa STATA 10, para el análisis estadístico. Resultados: El 64.1% de los participantes fueron hombres, 35.9% son mujeres; prevaleciendo las edades 18 (15.7%) y 20 (14.6%); el 11.7% tenían antecedentes personales de suicidio; la ingeniería con mayor riesgo suicida fueron Civil 13%, Electrónica 6.2%, Ambiental 4.9%, Industrial 3.6%; evidenciando en los factores socio demográficos que solo el 83.4% gozan de una buena funcionalidad familiar; 51.3% consume alcohol y el 2.3% depende de éste. Discusión y Conclusiones: Los jóvenes son más vulnerables a tener riesgo suicidio debido a los múltiples factores socio demográficos: disfunción familiar, antecedentes de suicidio y consumo de alcohol, cigarrillo, sustancias psicoactivas.

Introduction: suicide is a social phenomenon with a high mortality rate among young people who go through multiple stages of physical and emotional changes, with attempts or suicidal thoughts common to feel fear of what might happen in a difficult situation by that are happening. Santander in Colombia and the highest rates of suicide are young people and the tendency to increase. Still do not know the magnitude of the problem in this high risk group, without reaching a complete suicide. Therefore, this research seeks to understand this problem in a real way of those who are alive and at risk of suicide and not wait until they try it and / or die for this cause. Materials and Methods: A descriptive, observational cross-sectional in a sample of 343 students of the Faculty of Engineering at the University of Santander in Bucaramanga, a survey using the Plutchik Suicide Risk Scale and other socio demographics consists of 27 questions . Validated in two databases EPIDATA then exported to STATA 10 for statistical analysis. Results: 64.1% of participants were men, 35.9% are women ages 18 to prevail (15.7%) and 20 (14.6%), 11.7% had a history of suicide, the more suicidality Facultad of Engineering Civil were 13% Electronics 6.2% Environmental 4.9% 3.6% Industrial, evidenced in the socio-demographic factors that only 83.4% have a good family functioning, 51.3% consumed alcohol and 2.3% dependent on this. Discussion and Conclusions: Young people are more vulnerable to having suicidal risk because of multiple socio demographic factors, family dysfunction, history of suicide and alcohol consumption, smoking, psychoactive substances.

Deficiencia de hierro y sus efectos biológicos / Deficiency and its biological effects

El trabajo se lo realizó tomando en cuenta que en la actualidad y en nuestro medio, la carencia de varios nutrientes, en especial del hierro, ha venido a constituirse en un problema socio-económico y de salud pública ya que está afectando principalmente a niños y mujeres en edad reproductiva. Considerando que es un problema de suma importancia, el Ministerio de Salud de nuestro país ha emprendido una campaña dirigida a esta población de riesgo, tratando sino bien de erradicarlo por lo menos tenerlo controlado, debido a la influencia que tiene en el aspecto laboral de las personas a las que afecta. Nuestra investigaciòn se realizó en una población de riesgo, tratando sino bien de erradicarlo por lo menos tenerlo controlado...