Fuerza de prensión manual. Un sencillo, pero fuerte predictor de salud en población adulta y personas mayores / Handgrip strength as a predictor of adverse health outcomes

Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults.

Calidad de vida en personas mayores con depresión y dependencia funcional: validez del cuestionario SF-12 / Quality of life of older people with depression and dependence: validity of the SF-12 (short form health survey) questionnaire

Background: Depression and dependence have a great impact on the quality of life of older people. Aim: To validate the SF-12 (short-form) health related quality of care questionnaire (HRQOL) as an alternative of the SF-36 to estimate health-related quality of life (HRQoL) and its association with depression and dependence in Chilean older people living in the community. Material and Methods: The questionnaire was answered by 4,124 Chilean older people (61% women). HRQoL was evaluated with the SF-36 questionnaire. The SF-12 questionnaire includes 12 items from the SF-36. Results: The internal consistency of the SF-12 questionnaire was high (0.88). The effect size of the differences in the averages of the SF-12 and SF-36 scales was small (0.06-0.41). Good agreement was found between the physical and mental components of the SF-12 and SF-36 (0.94 and 0.89). Logistic regressions determined that people with dependence and depression have a higher risk of poor HRQoL. The figures for the physical component were, mild depression: odds ratio (OR) (95% confidence intervals (CI) = 3.28 (2.74-3.93), severe depression: OR (IC95%CI) = 4.66 (3.55-6.11), mild to moderate dependence: OR (95CI%) = 3.67 (2.97-4.54), severe dependence: OR (95%CI) = 13.06 (7.23-23.61). For the mental component, the figures were: mild depression: OR (95CI%) = 6.11(5.05-7.38), severe depression: OR (95CI%) = 22.01(14.47-33.49), mild to moderate dependence: OR (95CI%) = 1.59 (1.28-1.97), severe dependence: OR (95CI%) = 1.60 (1.04-2.47), adjusting for sociodemographic and health-related variables. Conclusions: The validity of the SF-12 for measuring HRQoL was demonstrated. People with depression and dependence have a worse physical and mental quality of life.

Prevalencia de fragilidad en personas mayores de Chile: resultados de la Encuesta Nacional de Salud 2016-2017

Background: The assessment of frailty among older people could help to reduce its social and health burden. Aim: To determine and characterize the prevalence of frailty in Chilean older adults. Material and Methods: We studied 233 participants, aged > 60 years, participating in the Chilean National Health Survey 2016-2017. Frailty was assessed using modified Fried criteria. Thus, people classified as frail should meet at least 3 out of the 5 criteria (low strength, low physical activity, low body mass index, slow walking pace and tiredness). Results: The prevalence of frailty was 10.9% (7.7% for men and 14.1% for women). The prevalence of pre-frailty was 59.0% whereas 30.1% of participants were classified as robust. At the age of 80 years 58 and 62% of men and women were frail, respectively. These figures increased to 90 and 87% at the age of 90 years. The prevalence of pre-frailty increased from 43 to 92.1% among men and from 76% and 78% among women from the ages of 60 to 90 years, respectively. Conclusions: The prevalence of frailty increased markedly with age. It is important to implement prevention strategies to allow an early identification of high-risk individuals.

El envejecimiento de la población chilena y los desafíos para la salud y el bienestar de las personas mayores / The aging of the chilean population and the challenges for health and wellbeing of older people

El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior. Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años. Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores. En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos CONCLUSIONES Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona.

The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context. In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years. The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults. In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter CONCLUSIONS Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care.

Calidad de Vida Relacionada con Salud Oral y Autopercepción de Salud: Encuesta Nacional de Calidad de Vida y Salud 2015-2016 en Chile / Quality of Life Related to Oral Health and Self-Perception of Health: National Survey of Quality of Life and Health 2015-2016 in Chile

RESUMEN: La calidad de vida relacionada con salud oral permite evaluar como los problemas bucodentales pueden ser determinantes el estado de su salud, relaciones sociales, trabajo y bienestar. El objetivo del estudio es determinar la asociación entre la percepción de calidad de vida relacionada a salud oral y la autopercepción de la salud. Estudio transversal de datos de la Encuesta Nacional de Calidad de Vida y Salud (ENCAVI 2015-2016) del Ministerio de Salud, de personas mayores de 15 años de las 15 regiones de Chile. La calidad de vida relacionada con salud oral se midió a través de la versión abreviada del instrumento Oral Health Impact Profile (OHIP-7). La autopercepción de salud se midió con una pregunta única. Se ajustaron modelos de regresión logística para identificar la asociación en términos de Odds Ratio utilizando STATA v15.0. De 7041 encuestas el 50,8 % son mujeres, la media de edad fue de 42,3 años (d.t. 0,41), el 60,3 % tiene menos de 12 años de educación, el 36 % declara tener alguna enfermedad crónica. El 18,5 % percibe que sus problemas de salud oral impactan en su calidad de vida. Los factores que se asociaron significativamente con una mala percepción de calidad de vida relacionada con salud oral fueron mala autopercepción de salud general OR=4,84 (IC95 % 3,51; 6,67), edad (45-54 años) OR=1,98 (IC95 % 1,26;3,12) y uso frecuente de medicamentos (>3) OR=3,67 (IC95 % 2,17;6,). La calidad de vida relacionada con salud oral está asociada con la autopercepción en salud, es decir que una mala autopercepción de salud tiene probablemente más riesgo de tener una peor calidad de vida asociada a salud oral, siendo más fuerte a medida que avanza la edad y con el uso frecuente de medicamentos.

ABSTRACT: Quality of life related to oral health assessment oral problems affect an individual´s health, social relations, work and well-being. The objective of the study is to determine the association between the perception of the quality of life related with oral health and self-perception of health. A cross-sectional study of data from the National Survey of Quality of Life and Health (2015-2016) of the Ministry of Health was carried out, for people older than 15 years of age, reported from the 15 regions of Chile. Impact profile in oral health (OHIP-7) used to measure Quality of life related to oral health. The self-perception of health was measured with one question. Logistic regression models were adjusted to identify the association in terms of Odds Ratio using STATA v15.0. Out of 7041 surveys, 50.8 % were women, the average age was 42.3 years (d.s., 0.41), 60.3 % had less than 12 years of education, 36 % reported having a chronic disease. 18.5 % perceive that their oral health problems impact on their quality of life. Factors that are associated with poor perception of the quality of life related to oral health, were a poor self-perception of health OR = 4.84 (95 % CI 3.51, 6.67), age (45-54) years) OR = 1.98 (95 % CI 1.26, 3.12) and frequent use of medications (> 3) OR = 3.67 (95 % CI 2.17, 6,). In conclusion, quality of life related to oral health, is directly related to poor selfperception of health and becomes significantly worse with age, as well as with the frequent use of medications.

Validez y confiabilidad del cuestionario Eating Assessment Tool 10 (EAT-10) para detectar disfagia en adultos mayores chilenos / Validation of the eat-10 score to detect dysphagia in older people

Background: In Chile, comprehensive geriatric assessment does not include the identification of dysphagia, despite being considered a geriatric syndrome. The Eating Assessment Tool 10 (EAT-10) questionnaire is a 10-question instrument that specifically describes the perception of dysphagia and has a Spanish translation. Aim: To validate and test the reliability of the EAT-10 questionnaire in Chilean older people living in the community. Material and Methods: The EAT-10 score was applied to 80 participants aged 75 ± 14 years (51 women). Other observer, blinded to the result of the score, performed the volume-viscosity swallow test as the gold standard to assess dysphagia. Results: The translated version of the EAT-10 had a strong internal consistency (Cronbach alfa =0.89) and interobserver consistency (100%). Using a score of seven as cutoff point, the EAT-10 had a sensitivity of 75%, specificity of 86% to detect dysphagia, when compared with the volume-viscosity swallow test. Conclusions: The EAT-10 questionnaire is valid and reliable and can be used as a clinical instrument in primary care in our country to identify older people with dysphagia.

Effect of summer holidays on anthropometric measures and body composition of older adults, inadequacy of body mass index to detect changes during a critical period: a pilot study / Efecto de las vacaciones de verano en la composición corporal de adultos mayores, insuficiencia del índice de masa corporal para detectar cambios durante un período crítico: un estudio piloto

Obesity is a major health problem worldwide. Obesity prevalence in Chilean older adults (OA) is increasing, associated with several negative health outcomes. Therefore, determining critical periods of adiposity increase is relevant in OA. The aim of the study was to assess body composition changes in OA during summer holidays. This observational study involved two test visits, without a control group. Twelve OA (9 females) with an average age of 71.92±6.97 years participated in an initial evaluation (E1) and final evaluation (E2) at the beginning and at the end of the summer in 2015. Weight, height, and body mass index (BMI) were assessed; fat-free mass (FFM), fat mass (FM), and muscular mass (MM) data were collected through foot-to-foot bioimpedance analysis. No significant variations were reported in weight and BMI between E1 and E2. This prevalence was maintained between E1 and E2. The FM significantly increased between E1 (27.63±10.91) and E2 (28.64±11.39) (p= 0.007), while the FFM significantly decreased between E1 (45.38±5.89) and E2 (44.33±5.36) (P= 0.006), also the MM between E1 (43.08±5.62) and E2 (42.07±5.10). Both, weight and BMI are insufficient measures for detecting changes during this critical summer holiday period. However, the body composition measures identified significant changes in the OA during the study.

La obesidad es el principal problema de salud en todo el mundo. La prevalencia de obesidad en adultos mayores (AM) chilenos es cada vez mayor, lo que se ha asociado con varios efectos negativos para la salud. Por lo tanto, la determinación de períodos críticos de aumento de la adiposidad es relevante en AM. El objetivo fue evaluar los cambios de la composición corporal en adultos mayores AM durante las vacaciones de verano. Doce AM participaron en una evaluación inicial (E1) y final (E2) del verano 2015. Se evaluó: peso, talla, índice de masa corporal (IMC), masa libre de grasa (MLG), masa grasa (MG) y masa muscular (MM). No hubo diferencias significativas en peso e IMC. La MG aumentó entre E1 (27,63±10,91) y E2 (28,64±11,39) (p= 0,007), la MLG disminuyó significativamente entre E1 (45,38±5,89) y E2 (44,33±5,36), como también la MM entre E1 (43,08±5,62) y E2 (42,07±5,10). Tanto el peso como el IMC son medidas insuficientes para detectar cambios durante este período crítico de vacaciones de verano. Sin embargo, las medidas de la composición corporal identificaron cambios significativos en AM durante el estudio.

Sensory Peripheral Nerve Function in Chilean Elderly Consuming Folic Acid Fortified Flour: Relationship to Plasma Folate and a Novel Combined Biomarker of B12 Status. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 1067-1068.

Objectives: It has been reported that low vitamin B12 status and high serum folate is associated with anemia and cognitive impairment. However, few data are available on neurophysiological outcomes, such as peripheral neurophysiology. The objective was to assess associations between folate, B12 and sensory peripheral nerve conduction in Chilean elderly exposed to folic acid fortification. Methods: The average of the left and right distal sensory conduction latency of the sural nerve, and conduction velocity of the right peroneus nerve were measured in 159 community-dwelling older Chilean. Serum folate, B12, Hcy, MMA, and holoTC were determined. B12 status was defined based on: w=log_10 (holoTC*B12)/(MMA*Hcy)-(age factor) (Fedosov SN, Clin. Chim. Acta. 2013). Nerve conduction, folate and B12 status were divided into tertiles. Results: Age was 70-78y (57% women). 62.9%, 10.7% and 26.4% were classified as having B12 adequacy (w>-0.5), transitional status (-1.5< w<-0.5) and deficiency (w<-1.5) respectively, while 15.1% presented high folate (>45.3 nmol/L). Nerve conduction velocity of the right peroneus nerve positively correlated with B12 status (r=0.21, p<0.05). In the highest tertile of both B12 (w) and folate only 6% were in lowest tertile of sural nerve conduction vs. 31.5% (p<0.001) with low B12 and high folate. In the highest tertile of both B12 (w) and folate 25% were in lowest tertile of peroneal nerve conduction velocity as compared with 63.2% with low B12 and high folate (p<0.001). Conclusions: Elderly with both high B12 and folate status were less likely to have poor sensory peripheral nerve conduction than those with low B12 and high folate.

An update on aging and dementia in Chile / Atualização em envelhecimento e demência no Chile

Chile is in an advanced demographic transition stage with the population over 60 years of age representing 15% of the total population and whose number of elderly has more than doubled between 1990 and 2014. Rapid economic advancement has promoted significant changes in social organization to which the country is not accustomed. The mental health problems of the elderly are particularly challenging to the countrys present social and health structures. The prevalence of dementia in people over 60 years exceeds 8% and is even higher in the rural population. There is more training on dementia in the local medical and scientific community, increased awareness within the civilian community but insufficientresponsiveness from the state to the broad diagnostic and therapeutic requirements of patients and caregivers. The objective of the present study was to provide an update of the information on dementia in the context of the ageing process in Chile.

O Chile está num avançado estágio de transição epidemiológica, com a população de 60 anos ou mais representando 15% da população total e o número de idosos tem mais que dobrado entre 1990 e 2014. O rápido avanço econômico tem promovido significantes mudanças na organização social para as quais o país não está habituado. Os problemas de saúde mental em idosos são particularmente desafiadores para as estruturas sociais e de saúde atuais do país. A prevalência de demência entre aqueles com idade superior a 60 anos excede 8% e é mais elevada na população rural. Há mais treinamento em demência na população médica e comunidade científica locais, aumentando o conhecimento dentro da comunidade civil, porém, com insuficiente resposta do estado às necessidades diagnósticas e terapêuticas de pacientes e cuidadores. O objetivo deste estudo foi providenciar uma atualização da informação sobre demência no contexto de envelhecimento cerebral do Chile.

Efecto sobre la salud de las desigualdades socioeconómicas en el adulto mayor: Resultados basales del estudio expectativa de vida saludable y discapacidad relacionada con la obesidad (Alexandros) / Socioeconomic inequalities in active life expectancy and disability related to obesity among older people

Background: The rapid increase in life expectancy in Chile, with obesity as the main nutritional problem in all age groups, makes it necessary to ask whether the years gained are healthy. Aim: To study the trajectories of disability associated with obesity in Chilean elderly groups from different socio-economic and demographic backgrounds. Material and Methods: Longitudinal study of 3 cohorts of older adults from Santiago: the SABE cohort including 1235 people born before 1940; the Alexandros cohort including 950 people born between 1940 and 1948 from Primary Health Care centers and the ISAPRES cohort of 266 people from private health insurance registries (ISAPRES) born before 1947. An interview yielded socio demographic data and history of diseases. Anthropometric measurements and hand dynamometry were performed. Cognitive status was assessed by the mini mental state examination, depressive symptoms through the geriatric depression socore-5 and functional limitations through self-reporting of basic (ADL), instrumental (IADL) and advanced daily living (AADL) activities. Results: We report here baseline results from ISAPRES and SABE cohorts. Important social and gender differentials were observed. After adjustment by age and gender, a significant lower frequency of limitations in ADL (odds ratio (OR) = 0.17; 95 percent confidence intervals (CI): 0.079-0.343), IADL (OR = 0.27; 95 percentCI: 0.159-0.452), and AADL (OR = 0.42; 95 percentCI: 0.298-0.599) persisted in the ISAPRE cohort, compared to the SABE cohort. Obesity was associated with functional limitations only in AADL (OR = 1.65; 95 percentCI: 1.18-2.31) and hand dynamometry was associated with lower functional limitation in ADL, IADL and AADL. Conclusions: This study demonstrates profound socio-economic and gender inequalities in older people, thus showing that the years of healthy life gained are not the same for the whole society.

Prevalencia de las deficiencias de zinc y cobre en adultos mayores de la Región Metropolitana de Santiago / Prevalence of zinc and copper deficiencies in older subjects living in Metropolitan Santiago

Background: Older subjects have a high risk of developing zinc and copper deficiencies. Aim: To determine the prevalence of copper and zinc deficiencies in adults aged over 60 years, living in Metropolitan Santiago. Subjects and Methods: Analyses were performed using anonymous serum samplesfrom older subjects living in Santiago, Chile, who participated in the multicenter project SABE. Of the studied subjects, 49.3 percent had enough left over serum to measure serum zinc and copper concentrations by atomic absorption spectrometry. Results: A total of444 men and 198 women were studied. A positive correlation between serum zinc and copper was found in both women (r = 0.44, p < 0.001) and men (r = 0.48, p < 0.001). There were no differences in serum zinc concentration by sex and age. The prevalence of subnormal serum zinc valúes was 66.9 percent in women and 66.7 percent in men. Women had a significantly higher serum copper valúes than men (p < 0.02) and there were no differences by age. Prevalence of subnormal serum copper valúes was higher in women than in men (32.9 and 23.7 percent respectively, p < 0.05). Women had significantly higher copper I zinc serum ratio than men (p < 0.001). Conclusions: Older people living in Metropolitan Santiago have a high prevalence of copper and zinc deficiencies.

Déficit de vitamina B-12 en adultos mayores: ¿Un problema de salud pública en Chile? / Prevalence of vitamin B-12 deficiency in older adults

Background: There is a correlation between aging and the decrease of plasma levels of vitamin B-12. Aim: To determine the prevalence of vitamin B-12 and folate deficiency and its hematological impact among older adults (AM). Material and Methods: Cross-sectional study, in 1028 subjects aged 65 to 87years, living in community and evaluated between 2005 and 2008. Percentile distribution of vitamin B-12, folate, hemoglobin, packed red cell volume and mean cell volume by gender and age were analyzed. Deficiency was defined as vitamin B-12 levels < 148 pmol/L, marginal deficiency as vitamin B-12 levels < 221 pmol/L, anemia was defined as a hemoglobin < 13 and 12 g/dL among men and women, respectively. Results: The prevalence of vitamin B-12 deficiency was 12 percent and the figure for marginal deficiency was 25.4 percent. Males were more affected than females (p < 0.001). The frequency of anemia was 8.6 percento, and was higher among women (p = 0.004). Conclusions: There is a high prevalence of full blown and marginal deficit of vitamin B-12 among the elderly. This deficiency should be considered for correction through public nutrition policies.

Cumplimiento de la guía clínica de manejo ambulatorio de la neumonía adquirida en la comunidad en personas mayores en centros de atención primaria de salud de Santiago / Compliance with guidelines for the management of community acquired pneumonia at primary health care centers

Background: Community acquired pneumonia (CAP) has a high mortality rate among older people. To increase its treatment efficiency, the Chilean Ministry of Health elaborated a clinical management guideline for CAP. Aim: To assess the degree of compliance with the clinical guidelines for CAP among professionals working at primary health care centers. Material and methods: A follow up of a cohort of 2,797 subjects aged 67 years or more, incorporated to a clinical study. All cases of bronchopneumonia or pneumonia diagnosed at primary health care centers between September 2005 and June 2008 were recorded. Results: During the follow up period, 192 cases of CAP were diagnosed. A chest X-ray was requested in 81 percent of cases and a confirmation consultation was done in 58 percent. Amoxicillin/ Clavulanic acid was the most common antimicrobial prescription in 61 percent of cases, followed by Clarithromycin in 17 percent and Amoxicillin in 12 percent. The antimicrobial used was not registered in 5 percent of cases. Conclusions: The clinical guidelines improve the efficiency of CAP treatment and decrease complications. However, these guidelines must been complemented with an adequate training and supervision of health care teams.

Valores normativos de resistencia a la insulina mediante HOMA-IR en adultos mayores de Santiago de Chile / Homeostasis model assessment (HOMA) values in Chilean elderly subjects

Background: The homeostasis assessment model for insulin resistance (HOMA-IR) estimates insulin resistance using basal insulin and glucose values and has a good concordance with values obtained with the euglycemic clamp. However it has a high variability that depends on environmental, genetic and physiologic factors. Therefore it is imperative to establish normal HOMA values in different populations. Aim: To report HOMA-IR values in Chilean elderly subjects and to determine the best cutoff point to diagnose insulin resistance. Material and methods: Cross sectional study of 1003 subjects older than 60 years of whom 803 (71 percent women) did not have diabetes. In 154 subjects, an oral glucose tolerance test was also performed. Insulin resistance (IR) was defined as the HOMA value corresponding to percentile 75 of subjects without over or underweight. The behavior of HOMA-IR in metabolic syndrome was studied and receiver operating curves (ROC) were calculated, using glucose intolerance defined as a blood glucose over 140 mg/dl and hyperinsulinemia, defined as a serum insulin over 60 µU/ml, two hours after the glucose load. Results: Median HOMA-IR values were 1.7. Percentile 75 in subjects without obesity or underweight was 2.57. The area under the ROC curve, when comparing HOMA-IR with glucose intolerance and hyperinsulinemia, was 0.8 (95 percent confidence values 0.72-0.87), with HOMA-IR values ranging from 2.04 to 2.33. Conclusions: HOMA-IR is a useful method to determine insulin resistance in epidemiological studies. The HOMA-IR cutoff point for insulin resistance defined in thi spopulation was 2.6.

Medicina Interna y Salud Pública: Claves para una relación virtuosa / Internal Medicine and Public Health

A special Committee on Internal Medicine and Public Health was established by Sociedad Médica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiológica! features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families.

Diagnóstico, evaluación y tratamiento no farmacológico del paciente con sobrepeso u obesidad / Statement about diagnosis assessment ano non pharmacological treatment of obesity

The risk of complications of obesity is proportional to body mass index and is higher in severe or morbid obesities and when abdominal or visceral fat is predominant. In Chile the prevalence of obesity is increasing. According to the World Health Organization, obese subjects must reduce at least a 5 percent of their weight to reduce the risk of complications. Although this amount of reduction is seldom achieved with non pharmacological treatments, better results are obtained with multidisciplinary/ approaches that include a medical, psychosocial and laboratory assessment, to determine obesity level and different factors involved and the associated complications. In a second stage, goals of treatment are set and a personalized treatment is designed including dietary changes and physical activity. The aim is to obtain perdurable lifestyles modifications.

Tratamiento farmacológico o quirúrgico del paciente con sobrepeso u obesidad / Statement about the medical and surgical treatment of overweight and obesity

This is an updated review of the available treatments for obesity, which can be used when lifestyles modifications fail. Using the available information and the experience of the members of this advisory group, a recommendation is given about the most useful treatments, according to the severity of obesity and its complications. With regards to pharmacological treatments, only sibutramine and orlistat are approved on a worldwide basis for the treatment of obesity. These medications achieve a 10 percent higher weight reduction than lifestyles modification. A third medication, rimonobant, is also more effective than lifestyles modifications, but it was withdrawn due to psychological safety issues. The indications for surgical treatment and a brief description of the available techniques, success rates and complications are outlined. Finally, the need to have followed up protocols for patients and the formation of multidisciplinary treatment teams is underscored.

Differences in lipogenesis and lipolysis in obese and non-obese adult human adipocytes

It has been proposed that differences in adipocyte function and/or metabolism between obese and lean individuáis may manifest themselves in functional adipose tissue abnormalities that lead to metabolic disorders in obesity. We studied lipogenesis and lipolysis of omental adipocytes from obese (OB) and non-obese (NOB) humans. The specific activity of the lipogenic marker enzyme G3PDH was 50 percent lower in total adipocytes of OB compared to that of NOB subjects. Omental adipocytes from OB subjects also had lower basal lipolytic levéis, and a lower lipolytic response to p-adrenergic stimulus. Cholesterol depletion of adipocyte plasma membrane using methyl β-cyclodextrin caused a lipolytic effect on adipocytes of both groups together, but when obese and lean subjects were analyzed separately, the response was significant only in the obese. We present evidence of a different lipogenic and lipolytic profile in obese individuáis' omental adipocytes, and propose a relevant role of plasma membrane cholesterol, where the impact of its removal in OB and NOB adipocyte lipolysis differs.