Résumé
La alta prevalencia de hipotiroidismo subclínico en Chile puede deberse a que el límite superior normal de la hormona estimulante del tiroides (TSH) sérica es bajo. Personas con TSH levemente mayor al límite superior pueden ser metabólicamente similares a personas sanas. Se compararon marcadores de acción tiroidea (gasto energético en reposo [GER] y lipoproteína de baja densidad [LDL]) en adultos con hipotiroidismo subclínico leve y con función tiroidea normal con o sin tratamiento con levotiroxina. Se midió GER, perfil lipídico y tiroideo en personas sanas con función tiroidea normal (TSH ≥0,4-<4,5 µUI/ml; n=91); con hipotiroidismo subclínico leve (TSH ≥4,5-≤6,5 µUI/ml; n=5); y con hipotiroidismo clínico tratado con levotiroxina y TSH normal (n=13). Se analizó la LDL en 838 personas sanas con función tiroidea normal y 89 con hipotiroidismo subclínico leve de la Encuesta Nacional de Salud 2016/17 (ENS). El GER, ajustado por peso, sexo y edad, fue similar entre grupos (p=0,71). La LDL fue similar entre personas con función tiroidea normal e hipotiroidismo subclínico leve (91±24 vs. 101±17 mg/dl; p=0,67), y menor en hipotiroidismo tratado (64±22 mg/dl; p<0,01). La LDL no se asoció con TSH pero si inversamente con T4L en mujeres (r=-0,33; p=0,02; n=53). En la ENS, ambos grupos tuvieron similar LDL (p=0,34), la que se asoció inversamente con T4L en mujeres (r=-0,12; p=0,01; n=569) pero no con TSH. Personas sanas con función tiroidea normal y con hipotiroidismo subclínico leve tienen similar GER y LDL. Esto apoya la idea de redefinir el límite superior normal de TSH.
The high prevalence of subclinical hypothyroidism in Chile may be due to the low normal upper limit of serum thyroid-stimulating hormone (TSH). People with TSH slightly higher than the upper limit may be metabolically similar to healthy people. Thyroid action markers (resting energy expenditure [REE] and low-density lipoprotein [LDL]) were compared in adults with mild subclinical hypothyroidism and with normal thyroid function with or without levothyroxine treatment. REE, lipid and thyroid profile were measured in healthy people with normal thyroid function (TSH ≥0,4-<4,5 µUI/ml (n=91); with mild subclinical hypothyroidism (TSH ≥4,5-≤6 µUI/ml; n=5); and with clinical hypothyroidism treated with levothyroxine and normal TSH (n=13). LDL was analyzed in 838 healthy people with normal thyroid function and 89 with mild subclinical hypothyroidism from the 2016/17 National Health Survey (NHS). REE, adjusted for weight, sex and age, was similar between the groups (p=0,71). LDL was similar between people with normal thyroid function and mild subclinical hypothyroidism (91±24 vs. 101±17 mg/dl; p=0,67), and lower in treated hypothyroidism (64±22 mg/dl; p<0,01). LDL was not associated with TSH but was inversely with FT4 in women (r=-0,33; p=0,02; n=53). In the NHS, both groups had similar serum LDL (p=0,34), which was inversely associated with FT4 in women (r=-0,12; p=0,01; n=569), but not with TSH. Healthy people with normal thyroid function and mild subclinical hypothyroidism have similar REE and LDL. These results support the idea of redefining the normal upper limit of TSH.
Résumé
BACKROUND: Physical inactivity and sedentariness are independent risk factors for mortality. Physical inactivity is defined as engaging in insufficient moderate/vigorous physical activity (i.e. not meeting the WHO's recommendations). Sedentariness is defined according to sedentary behavior; evidence suggests that > 8 h/d could serve to consider a person as sedentary. The Chilean National Health Survey 2016-2017 (NHS), using a single question (Question-NHS), considered as "sedentary" those who did not engage in sports or physical activity for ≥ 30 min, ≥ 3 times/wk. Thus, it attempted to estimate sedentariness without considering sedentary behavior. AIM: To determine the prevalence of physical inactivity and sedentariness in Chile, and to contrast such results with the Question-NHS. Material and Methods: We analyzed data from 5564 participants of the 2016-2017 NHS, aged ≥ 18 years. The Global Physical Activity Questionnaire was used to determine moderate/vigorous physical activity and sedentary behavior. We defined physical inactivity as having 8 h/d of sedentary behavior. RESULTS: The prevalences [95% confidence intervals] of physical inactivity and sedentariness were 32% [29-34] and 6% [5-7] respectively, while 3% [2-4] were both physically inactive and sedentary. The Question-NHS classified 88% [86-89] as "sedentary", but among them, 35% were physically inactive and 6% were sedentary. CONCLUSIONS: One third of adults are inactive, one out of ten is sedentary, and one out of twenty is inactive and sedentary. The Question-NHS overestimates the population at risk.
Sujets)
Humains , Adulte , Exercice physique , Mode de vie sédentaire , Chili/épidémiologie , Prévalence , Études transversales , Enquêtes de santéRésumé
Introducción: El linfedema es una alteración del sistema linfático cuyo tratamiento convencional es la terapia descongestiva. Para evaluar la respuesta al tratamiento, es necesario medir el volumen el miembro superior. Objetivo: Determinar el nivel de concordancia entre el perómetro y las mediciones perimetrales en la estimación de volumen del miembro superior. Métodos: Estudio transversal. El volumen de ambos miembros superiores se estimó con tres métodos: [a] perómetro, [b] perímetro cada 4cm (método 4cm), y [c] con puntos anatómicos (método 5cm). Resultados: En comparación al perómetro, el método 4cm subestimó, en promedio, 315 mL (límites de concordancia: - 875 mL a 243 mL). El método 5cm subestimó, en promedio, 394 mL (límites de concordancia: - 975 mL a 186 mL), y la subestimación aumentó a medida que aumentaba el volumen del miembro superior. Conclusiones: El perómetro y las mediciones perimetrales tienen un bajo nivel de concordancia en la estimación del volumen del miembro superior.
Introduction: Lymphedema is an alteration of the lymphatic system and the conventional treatment is decongestive therapy. The upper limb measurement is needed to evaluate the treatment results. Objective: To determine the concordance between perometer and perimeter measurements in the upper limb volume. Methods: Cross-sectional study. The volume of both upper limbs was estimated with three methods: [a] perometer, [b] perimeter every 4cm (4cm method), and [c] with anatomical points (method 5cm). Results: Compared to the perometer, the 4cm method underestimated, on average, 315 mL (concordance limits ± 875 mL to 243 mL). The 5cm method underestimated, on average, 394 mL (concordance limits: ± 975 mL to 186 mL), and underestimation increased as the upper limb volume increased. Conclusions: The perometer and perimeter measurements have a low level of concordance in the estimation of upper limb volume.