Cumplimiento de las Guías Alimentarias en personas mayores chilenas: Un estudio descriptivo de la Encuesta Nacional de Salud 2016-2017

RESUMEN 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.

ABSTRACT Chile is one of the Latin American countries that exhibits the greatest increase in the aging population, thus it is necessary to visualize different tools that guide healthy lifestyles at this stage of life. Food-Based Dietary Guidelines (abbreviated as GABA, for initials in Spanish) provide recommendations that allow improving the quality of life in older people. This study aimed to determine the level of compliance with GABA recommendations and their association with anthropometric, metabolic and lifestyles factors in 1,789 people over 60 years who participated in the 2016-2017 National Health Survey. A descriptive cross-sectional study was carried out, in which participants were subdivided into four groups according to compliance with GABA: does not comply, complies with 1, 2 or at least 3 recommendations for consumption of legumes, fruits, vegetables, dairy, water and fish. As a result, 43.8% of older participants did not meet any of the GABA recommendations evaluated. These participants also performed less physical activity and had a longer sitting time (P-trend: <0.001). In conclusion, we highlight that close to 50% of elderly Chileans do not adhere to GABA recommendations, which could have implications for the health and well-being.

Lactancia materna y su asociación con obesidad: Mecanismos que podrían explicar el rol protector en la infancia

RESUMEN 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.

ABSTRACT Background and aim: Breastfeeding (BF) is a protective factor against childhood obesity; however, the mechanisms associated with this effect have not yet been elucidated. This study aimed to describe the mechanisms related to the protective effect of breastfeeding against childhood obesity. Methods: A search on PUBMED, SCOPUS, Cochrane Library and SCIELO databases was carried out to develop a descriptive review of the scientific evidence. The key words were breastfeeding; obesity; mechanism and diet. Articles were reviewed in Spanish and English from 1977 to 2020. Results: The protective effect of BF against childhood obesity is given by a combination of several mechanism. Its nutritional composition and the contribution of bioactive substances stand out, some of them regulated by the energy intake. Infants who are breastfed choose healthier foods in preschool, regardless of sociodemographic factors. Effects on adiposity, control of body weight and energy intake have also been described by epigenetic regulation programming and the intestinal microbiota. Conclusion: BF is a unique process that interacts in a complex way with infants and preschoolers' growth and developmental factors Its protective role against childhood obesity has been associated with various mechanisms. New research is still required to understand the implications of BF in pediatric age and its role in preventing obesity.

Niveles de actividad física y tiempo sedente según ingreso económico en Chile: resultados de la Encuesta Nacional de Salud 2016-2017

Background: The Chilean population reports high levels of physical inactivity. The relationship between income level, physical activity (PA) and sedentary behaviors is not well known. Aim: To describe the levels of PA and sedentary time, according to income levels in the Chilean population. Material and Methods: Analysis of data from the Chilean National Health Survey 2016-2017, which included 5,130 participants (52.9% women). The levels of PA and sedentary time were measured by the Global Physical Activity Questionnaire. Income levels were established according to the self-reported income per capita of the households and presented as quintiles. PA levels according to income levels were estimated by linear regression analyses. Results: Transport-related PA was higher in the lowest income quintiles (p = 0.039). There were no trends for income levels and PA domains including moderate, vigorous, total, occupational and leisure PA. The prevalence of leisure and occupational physical inactivities were higher in the lowest quintiles of income. Sitting time was higher in the higher income levels (p < 0.01). Conclusions: People in the lowest quintile for income spent more time in transport-related PA and less time sitting. However, physical inactivity prevalence during leisure and work time were higher in people with lower income.

Nivel de actividad física en personas mayores chilenas que han sufrido caídas

RESUMEN Antecedentes: Las caídas limitan las actividades de la vida diaria. Actualmente se desconoce cómo los niveles de actividad física (AF) varían luego de sufrir una caída. Objetivo: investigar los niveles de práctica de actividad física de personas mayores que han reportado caídas en los últimos 12 meses. Métodos: Se incluyeron 1.254 participantes ≥ 60 años de Encuesta Nacional de Salud (ENS) 2009-2010. La prevalencia de caídas en los últimos 12 meses se determinó mediante auto reporte. Los niveles de AF y el tiempo sedente se determinaron a través del cuestionario Global Physical Activity Questionnaire (GPAQ). La asociación entre caídas y AF fue investigada mediante regresión lineal. Resultados: El 70,5% [95% IC: 68,0; 72,8] de las personas mayores no reportaron caídas, mientras que un 19,4% [95% IC: 17,4; 21,5] reportó haber sufrido entre 1-2 caídas y un 10% [95% IC: 8,4; 11,8] ≥3 caídas en los últimos 12 meses. En comparación al grupo que reportó no sufrir caídas, aquellos que sufrieron ≥3 caídas realizaban 79,2 minutos menos de AF total/día. Resultados similares fueron observados para AF de transporte y AF moderada. No se encontraron diferencias para tiempo sedente o AF vigorosa. Conclusión: Personas mayores que sufrieron caídas en los últimos 12 meses reportaron realizar menos actividad física que sus contrapartes que no experimentaron caídas. A mediano y largo plazo, estos cambios en la actividad física podrían contribuir a resultados de salud adversos en una población.

ABSTRACT Background: Falls among older adults are associated with important changes in lifestyle. However, there is no evidence about the physical activity levels of older adults who have experienced falls. The aim of this study, therefore, was to describe physical activity levels in older adults who have experienced falls in the last 12 months. Methods: 1,254 older adults (aged ≥60 years) from the National Health Survey 2009-2010 were included in this study. Number of falls during the last 12 months was self-reported and physical activity was measured using the Global Physical Activity Questionnaire (GPAQ). The association between falls and physical activity was investigated using regression analyses. Results: 70.5% [95% CI: 68.0; 72.8] of the older adults included in this study did not report any falls during the last 12 months. However, 19.4% [95% CI: 17.4; 21.5] reported 1-2 falls and 10% [95% CI: 8.4; 11.8] reported ≥3 falls in the last 12 months. In comparison to those who reported no falls, those who experienced ≥3 falls in the last 12 months did 79.2 fewer minutes/day of physical activity. Similar results were found for moderate and transport-related physical activity, but no associations were found for vigorous or sedentary behaviours. Conclusion: Older adults who suffered falls in the last 12 months reported doing less physical activity than their counterparts who did not experience any falls. In the middle and long term, these changes in physical activity could contribute to adverse health outcomes in an already frail population.

Estilos de vida y cumplimiento de las Guías Alimentarias Chilenas: resultados de la ENS 2016-2017 / Lifestyles and adherence to the Chilean Dietary Guidelines: results of the Chilean National Health 2016-2017 Survey

RESUMEN Cumplir las recomendaciones incluidas en las Guías Alimentarias permite un acercamiento hacia un estilo de vida saludable. El objetivo de este estudio fue caracterizar los estilos de vida de la población chilena y su asociación al cumplimiento de 5 recomendaciones de las Guías Alimentarias Basadas en Alimentos (GABA) chilenas. Se utilizaron datos de la Encuesta Nacional de Salud 2016-2017. Los participantes fueron divididos en 4 grupos: aquellos que no cumplieron con ninguna recomendación, los que cumplían una, los que cumplían con 2 y los que cumplían con 3 o más recomendaciones saludables, estableciendo a este último como grupo de referencia. El 43,3% de la muestra no cumplió ninguna de las recomendaciones incorporados en esta investigación. De los que cumplían a lo menos 3, el 35,9% presentó un estado nutricional normal, el 38,9% reportó nunca haber fumado y el 82% se auto percibía como saludable. Además, los que cumplían las recomendaciones, presentaron niveles más altos de actividad física. Personas que incorporan y aplican las recomendaciones de las GABA, tienden a presentar conductas de vida más saludable. Estrategias comunicacionales efectivas y formativas en educación alimentaria sobre estas recomendaciones son claves para prevenir el acelerado y temprano crecimiento de las patologías crónicas.

ABSTRACT Compliance with dietary guidelines is essential for adoopting a healthy lifestyle. This study aimed to characterise the lifestyles of the Chilean population according to the fulfilment of 5 recommendations of the Food-Based Dietary Guidelines (GABA in Spanish) established in Chile according to WHO definition. Data from the 2016-2017 National Health Survey were used. Participants were divided into four groups: those who did not meet any recommendations, those who met one, those who met two and those who met three or more (reference group) GABA health recommendations. 43.3% of the sample did not meet any of the recommendations incorporated into this study. Of those who fulfilled at least three recommendations, 35.9% had a normal nutritional status, 38.9% reported never having smoked, and 82% perceived themselves as healthy. In addition, those who fulfilled the recommendations presented higher levels of physical activity (1343.5 MET/min/day [95% CI: 1049.9 - 1637.2]). From the results, it is inferred that people who incorporate and apply GABA recommendations tend to present healthier life behaviours. Consequently, effective and formative communication strategies in food education on these recommendations are crucial to preventing a fast and early growth of chronic diseases.

Actitudes y prácticas parentales de alimentación infantil: Una revisión de la literatura / Parental attitudes and feeding practices: A scoping review

RESUMEN Introducción: si bien la conducta alimentaria depende de múltiples factores, existe acuerdo en la importancia de aspectos socio-ambientales en los que la familia tiene un rol central, especialmente en edades tempranas. Objetivo: sistematizar evidencia científica actualizada sobre la asociación entre actitudes y prácticas de alimentación infantil, conducta alimentaria y estado nutricional del niño. Método: revisión narrativa de 40 artículos empíricos publicados entre los años 2011 y 2019. Resultados: se identificó tendencia en los padres a subestimar el peso corporal en niños con sobrepeso, y asociación entre preocupación por el peso, presión para comer y estado nutricional del niño. La alimentación restrictiva y el uso de la alimentación para fines instrumentales y controlar emociones, no serían prácticas efectivas, posiblemente porque interfieren en la capacidad de autorregulación del niño. Prácticas positivas incluyeron monitoreo, modelado de patrones alimentarios saludables y creación de ambientes no obesogénicos. Conclusión: existen hallazgos consistentes respecto a que prácticas coercitivas pueden ejercer efectos negativos en la conducta alimentaria infantil y prácticas que promueven la estructuración en la alimentación y un entorno positivo, serían más funcionales. La evidencia internacional es consistente en la relevancia de padres y cuidadores en la promoción de una conducta alimentaria saludable y la condición nutricional de niños.

ABSTRACT Introduction: In the last years, there has been an exponential increase in childhood obesity rates worldwide. Although eating behavior depends on multiple factors, there is agreement on the impact of socio-environmental aspects in which the family has a central role. Identifying the influence of parents and caregivers on child eating behavior can help to generate effective strategies for controlling obesity, especially at early stages. Aim: To review recent scientific evidence on the association between parental feeding attitudes and practices, eating behavior and nutritional status of the child. Method: Narrative review of 40 empirical articles published between 2011 and 2019. Results: Parents tend to underestimate body weight in overweight children. Weight concern and pressure to eat are associated with the nutritional status of the child. Restrictive feeding and the use of food for instrumental purposes and as a mean of controlling emotions, would not be effective practices, possibly because they interfere with the child's ability to self-regulate intake. Positive practices included monitoring, modelling healthy eating patterns and creating non-obese environments. Conclusion: Consistent findings support the notion that coercive practices could have negative effects on child eating behavior. Moreover, practices that promote structured and a positive environment could be more functional. However, international evidence is consistent in the relevance of parents and caregivers in promoting healthy eating behavior and the nutritional status of children.

Obesidad en lactantes: efecto protector de la lactancia materna versus fórmulas lácteas / Childhood obesity: the benefits of breastfeeding versus formula feeding

El objetivo del trabajo fue analizar el posible efecto protector de la lactancia materna respecto a la obesidad infantil versus fórmulas lácteas. Se consultaron las bases de datos PubMed, Web of Science y Scielo, considerándose los artículos más actualizados sobre el tema. La evidencia analizada señala que los menores alimentados con lactancia materna exclusiva reportan bajos niveles de sobrepeso y obesidad, a diferencia de los alimentados con fórmulas lácteas infantiles. Se concluye que la lactancia materna exclusiva, hasta el sexto mes de vida del lactante, y complementada con alimentación solida (no láctea) hasta los dos o más años, es recomendada y podría proteger contra la obesidad infantil y sus comorbilidades asociadas en la vida adulta.

The aim was to review the evidence supporting the possible health benefits for obesity of breastfeeding versus formula feeding in infants. The search for studies addressing this topic was conducted in PubMed, Web of Science and Scielo databases. "Breastfeeding", "formula feeding" and "obesity" were the keywords used in the search. Only studies with a full version of the manuscript were included. The evidence analyzed indicated that children fed exclusively through breastfeeding reported low levels of overweight and obesity in comparison to those fed by infant milk formulas. To conclude, exclusive breastfeeding until the sixth month of life, and supplementation with solid (non-dairy) food until two years and more, is the gold standard and could protect against childhood obesity and its associated comorbidities in adult life.

Desde una mirada global al contexto chileno: ¿Qué factores han repercutido en el desarrollo de obesidad en Chile? (Parte 2) / From a global view to the Chilean context: which factors have influenced the development of obesity in Chile? (Chapter 2)

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.

Chile has one of the highest rates of obesity worldwide. Deaths attributed to obesity are likely to increase to 204,000 by 2030. There will be also a higher economic burden associated with this disease. There are many factors associated with obesity; however, it is known that one of the most effective strategies to decrease its prevalence is reducing modifiable risk factors, such as improving dietary patterns, performing physical activity, avoiding smoking and drinking alcohol as well as improving mental health. Nevertheless, how to make realize these changes is one of the biggest challenges. In this context, the aim of this literature review, chapter 2, was to investigate the main modifiable risk factors, with emphasis on individual factors, associated with the development of obesity in Chile: from a global view to the Chilean context.

Auto reporte de la velocidad de marcha y su asociación con marcadores de adiposidad y riesgo cardiovascular en Chile / Association of self-reported walking speed with markers of adiposity and cardiovascular risk in Chile

Background Walking speed is a strong predictor of non-communicable diseases and mortality. Aim To investigate the association of self-reported walking pace with adiposity, metabolic and cardiovascular markers in the Chilean population. Material and Methods Analysis of data from 5,077 participants of the 2009-2010 National Health Survey (ENS 2009-2010). Walking speed was self-reported as average or slow pace. Body mass index (BMI), waist circumference (WC), blood pressure, blood glucose, glycosylated hemoglobin and lipid profile were the outcome. Results In Chile, 11% (95% confidence intervals [CI]: 10.0; 12.7) of the population reported a slow walking pace. Compared with average walking people, those reporting a slow pace had a higher body weight (difference (∆) 5.65 kg [95% CI: 3.22; 8.09], p < 0.01), BMI (D 2.48 kg/m 2 [95% CI: 1.53; 3.44], p < 0.01), WC (D 6.23 cm [95% CI: 4.12; 8.34], p < 0.01), serum triglycerides (D 30,9 mg/dl [95% CI: 5,31; 57,5], p = 0.018), and lower HDL cholesterol (D -2.32 mg/dl [95% CI: -4,24; -0,34], p = 0.022). Those reporting a slow pace had also a higher odd of being obese (odds ratio (OR): 2.46 [95% CI: 1.82; 3.33], p < 0.01), being diabetic (OR: 1.54 [95% CI: 1.02; 2.40], p = 0.018) and having metabolic syndrome (OR: 2.03 [95% CI: 1.30; 3.18], p = 0.002). Conclusions In Chilean adults, slow walking pace is associated with and unfavorable adiposity and lipid profile, including a higher probability of being obese, diabetic and having metabolic syndrome.

Menopausia y factores de riesgo cardiovascular en mujeres chilenas / Association of menopause with cardiovascular risk. Analysis of data from the 2016-17 Chilean national health survey

Background: Menopause exposes women to an increased cardiovascular risk. Aim: To determine the association between menopause and cardiovascular risk factors in Chilean adult women using data from the National Health Survey (NHS) 2016-2017. Material and Methods: Data from 2,139 women over 40 years of age participating in the NHS 2016-2017, with information about menopause and cardiovascular risk factors was used. Expansion factors were applied to this sample, obtaining an expanded sample of 3,733,191 participants. Laboratory values (blood glucose, triglycerides, HDL and total cholesterol) and anthropometric measurements (body weight, height and waist circumference) were analyzed. The presence of hypertension, diabetes, and metabolic syndrome (MetS) were also recorded. Results: Sixty seven percent of surveyed women were menopausal and had higher systolic blood pressure than non-menopausal participants. Menopause was significantly associated with hypertension (Odds ratio (OR): 2.43 [95% confidence intervals (CI): 1.71; 3.45], p < 0.01) and diabetes (OR: 2.05 [95% CI: 1.32; 3.19], p < 0.01). However, no association was observed with obesity, abdominal obesity or MetS. Conclusions: In these women, a positive association was identified between menopause and hypertension as well as diabetes.

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.

¿Existe asociación entre asma y adiposidad en la población adulta chilena? / Association between adiposity and asthma

Background: In people with asthma, adiposity is associated with more symptoms and less control of the disease whereas on those without asthma adiposity is associated with a higher risk of developing the disease. Aim: To investigate the association between asthma and adiposity markers in Chilean adults. Material and Methods: Data from 5,499 adults older than 15-years-old from the Chilean National Health Survey 20162017 were analyzed. Quintiles of body-mass index (BMI) and waist circumference (WC) were used as a proxy of adiposity. The association between asthma and quintiles of BMI and WC was determined by logistic regression. Results: A higher BMI and WC was associated with a higher odds for asthma. This trend remained significant even after adjusting the models for socio-demographic factors, physical activity and smoking (Odds Ratio [OR] BMI: 1.13 [95% confidence intervals (CI): 1.04; 1.22], p < 0.01 and OR WC: 1.15 [95% IC: 1.06; 1.25], p < 0.01). Conclusions: A higher BMI and WC were positively associated with asthma.