Perfil lipoproteico por espectroscopia nuclear magnética en pacientes con insuficiencia cardiaca crónica comparado con controles emparejados / 1H-magnetic resonance spectroscopy lipoprotein profile in patients with chronic heart failure versus matched controls

Introducción y objetivos El fenotipado avanzado de lipoproteínas es mejor predictor del riesgo aterosclerótico que el colesterol. El perfil de lipoproteínas en la insuficiencia cardiaca (IC) no está completamente caracterizado. Nuestro objetivo fue describir el perfil de lipoproteínas en IC crónica en comparación con una población de control emparejada. Métodos Estudio transversal entre mayo 2006 y abril 2014, que incluyó pacientes ambulatorios con IC crónica. Las concentraciones de lípidos y el tamaño de las principales fracciones de lipoproteínas (lipoproteínas de alta densidad [HDL], lipoproteínas de baja densidad [LDL] y lipoproteínas de muy alta densidad) y concentración de sus subfracciones (grandes, medianas y pequeñas) se evaluaron mediante espectroscopia de resonancia magnética. Resultados 429 pacientes con IC crónica se compararon con 428 controles. Los pacientes con IC crónica presentaron menor colesterol total y menor concentración de partículas de LDL (1.115 frente a 1.352 nmol/L; p <0,001) y HDL (25,7 frente a 27,9μmol/L; p <0,001), esta última mediada principalmente por la reducción de la subfracción pequeña de HDL (15,2 frente a 18,6μmol/L; p <0,001). El tamaño medio de las partículas lipoproteínas de muy alta densidad, LDL y HDL fue significativamente mayor en los pacientes con IC. Todas las diferencias relacionadas con la partícula HDL persistieron después del ajuste por clase funcional o índice de masa corporal. Encontramos fuertes correlaciones negativas entre biomarcadores cardiacos (fracción aminoterminal del propéptido natriurético cerebral y interleucina-1 tipo de receptor 1) con concentraciones de LDL y HDL, sus subfracciones pequeñas y el tamaño de la partícula HDL. Conclusione Los pacientes con IC crónica difieren significativamente en su perfil de lipoproteínas en comparación con controles emparejados. Se necesitan más investigaciones para comprender mejor la relevancia patogénica de esta diferencia (AU)

Introduction and objectives Advanced lipoprotein phenotyping is a better predictor of atherosclerotic cardiovascular risk than cholesterol concentration alone. Lipoprotein profiling in heart failure (HF) is incompletely characterized. We aimed to describe the lipoprotein profile in patients with chronic HF compared with a matched control population. Methods This cross-sectional study was performed from May 2006 to April 2014 and included ambulatory patients with chronic HF. Lipid concentrations and the size of main lipoprotein fractions (high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very low-density lipoprotein) and the particle concentration of their 3 subfractions (large, medium and small) were assessed using 1H magnetic resonance spectroscopy. Results The 429 included patients with chronic HF were compared with 428 matched controls. Patients with chronic HF had lower total cholesterol and lower mean LDL (1115 vs 1352 nmol/L; P<.001) and HDL (25.7 vs 27.9μmol/L; P <.001) particle concentrations, with this last difference being mediated by a significantly lower concentration of the small subfraction of HDL (15.2 vs 18.6μmol/L; P <.001). Mean very low-density lipoprotein, LDL, and HDL particle size was significantly higher in patients with HF vs controls. All HDL-related differences from controls persisted after adjustment for New York Heart Association functional class or body mass index. We found strong negative correlations of known cardiac biomarkers (N-terminal pro-brain natriuretic peptide and interleukin-1 receptor-like 1) with total and small LDL and HDL fractions and HDL particle size. Conclusions Patients with chronic HF significantly differ in their lipoprotein profile compared with unaffected controls. Further research is needed to better understand the pathogenic relevance of this difference (AU)

Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries.

BACKGROUND AND AIMS: The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies. We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies. METHODS AND RESULTS: Using nationally-representative cross-sectional surveys from Brazil (2008-09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015), and the US (2015-16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified. Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies. CONCLUSIONS: Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles.

Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases.

Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF. Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile. Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B12, folate, and fiber) using multivariate regression after controlling for covariates. Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05). Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.

Particle size and cholesterol content of circulating HDL correlate with cardiovascular death in chronic heart failure.

Evidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0-8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p < 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p < 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p < 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 [95% CI 1.01-1.47], p = 0.041 and HR 1.04 [95% CI 1.01-1.07], p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.

Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study.

BACKGROUND: Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation. METHODS: Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011-August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used. RESULTS: A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively (p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35-11.39) in patients with primary ventricular fibrillation (p=0.012) and 1.72 (95% confidence interval 1.23-2.40) in patients without primary ventricular fibrillation (p=0.001). CONCLUSIONS: Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.

Serum 25-Hydroxyvitamin D associated with indicators of body fat and insulin resistance in prepubertal chilean children.

BACKGROUND: Consistent data on the relation between vitamin D, body fat and insulin resistance (IR) in children are lacking. OBJECTIVES: (1) To evaluate the association between serum 25-Hydroxyvitamin D [25(OH)D] and key indicators of: adiposity (total and central), IR, and (2) to estimate serum 25(OH)D cut-offs that best reflect IR and total and central adiposity in children. SUBJECTS/METHODS: Prepubertal children (n=435, ~53% girls; ~age 7 years) from the Growth and Obesity Chilean Cohort Study were evaluated for potential associations between serum 25(OH)D and indicators of: (1) total adiposity (body mass index by age (BAZ), body fat (including three-component model)), central adiposity (waist circumference and trunk fatness); (2) IR (homeostasis model assessment of IR) and insulin sensitive (quantitative insulin sensitivity check index) using standardized multiple regression models with standardized coefficients and receiver operating characteristic curves. RESULTS: Overall, mean serum 25(OH)D was 32.1±9.2 ng ml(-1), while 19.4% of children were obese (BAZ⩾2 s.d.). Serum 25(OH)D was inversely associated with indicators of total and central adiposity and with IR indicators. Effect sizes were moderate in girls (~0.3 for adiposity and IR indicators), while, weaker values were found in boys. Serum 25(OH)D estimated cut-offs that best predicted total, central adiposity and IR were~30 ng ml(-1). Children with suboptimal serum 25(OH)D (<30 ng ml(-1)) had a higher risk (two to three times) of being obese (high BAZ, body fat percent and/or central adiposity); and three to four times greater risk for IR. CONCLUSIONS: Serum 25(OH)D was inversely associated with adiposity (total and central) and IR indicators in prepubertal Chilean children. The conventional cut-off of vitamin D sufficiency (⩾30 ng ml(-1)) was adequate to assess obesity and IR risk in this age group.

El reto asistencial del tratamiento del infarto de miocardio en ancianos / The challenge of caring for myocardial infarction in the elderly

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Relación entre estado nutricional y sueño en escolares de la comuna de san miguel, Santiago, Chile / Relationship between nutritional status and sleep in school children from the san miguel commune, santiago, Chile

Objective: To determine the association between sleep duration and obesity in school age children between 5 and 7 years old. Methods: One hundred fifty five children from schools in san Miguel town in Santiago of Chile participated in the study. Informed consent was obtained through their parents. Anthropometric variables were measured and a sleep questionnaire was applied. Results: Obesity was present in 193 % of the subjects. 45.1% of the sample slept less than the accepted recommendation for their age (<10 hours). Sleeping more than 10 hours/ night, exercising, and not eating chocolate at night are associated factors for obesity (OR=0.7,0.1 y 0.3 respectively), whereas sleeping less than 10 hours is an associated riskfactor (OR=238). Conclusion: Sleeping less than the accepted recommended amount is an associated risk factor for obesity in this sample.

Objetivo: Determinar si existe asociación entre una menor cantidad de horas de sueño y la obesidad en escolares entre 5 y 7 años. Métodos: Se estudiaron 155 escolares de primer y segundo año básico de las escuelas municipales de la comuna de San Miguel, Santiago de Chile, a los cuales se les realizó una evaluación antropométrica y a sus padres una encuesta sobre hábitos de sueño de su hijo(a). Resultados: El 19,3% de los escolares presentó obesidad. El 45,1% de los escolares duerme menos de lo recomendado (<10 horas). Dormir más, hacer ejercicios (OR=0,7 y 0,1, respectivamente) y evitar el consumo de chocolate en la noche (OR=0,346), fueron factores protectores asociado a la presencia de obesidad en la muestra estudiada. En cambio, dormir menos de 10 horas (OR=2,38) es un factor de riesgo para obesidad en la muestra estudiada. Conclusión: La restricción de sueño es un factor de riesgo asociado con la presencia de obesidad en la muestra estudiada.

Ingesta de alimentos de origen animal versus origen vegetal y riesgo cardiovascular / Intake of animal versus vegetable food and cardiovascular risk

Cardiovascular mortality has been associated with changes in lifestyle and food habits. The occidental diet has been characterized by high intake of animal fat and meat, and it is associated whit increased risk of type 2 diabetes and high blood pressure, an increase in levels of markers of endothelial dysfunction, and presence of pro-thrombotic risk factors. We search the Pubmed database and other review references. Inclusion criteria were: papers published after 1999, randomized controled clinical studies, case-control studies, systematic reviews and methanalyses. Vegetarians groups show less cardiovascular morbidity and mortality than non-vegetarians. The evidence indicated that a decreasing intake of red meat, saturate fat, trans fat, and mainly processed meat, and an increase in the intake of whole grain cereals, fruits, vegetables and fish, are associated with a better overall cardiovascular health and survival.

El aumento de la mortalidad cardiovascular en el último tiempo está fuertemente asociado a cambios en los hábitos de alimentación. La dieta occidental caracterizada por una alta ingesta de alimentos de origen animal, presenta mayor riesgo de diabetes tipo 2 (DM 2), hipertensión arterial (HTA), aumento de marcadores de disfunción endotelial y factores protrombóticos. La búsqueda se realizó en la biblioteca online Pubmed y en referencias de otras revisiones. Los criterios de inclusión fueron: artículos de 1999 en adelante, ensayos clínicos aleatorizados-controlados, estudios caso-control, revisiones sistemáticas y meta análisis. En grupos con alto consumo de alimentos de origen vegetal se ha evidenciado una menor morbi-mortalidad cardiovascular, comparado con los grupos con alta ingesta de alimentos de origen animal. La evidencia apoya que la disminución en el consumo de carnes rojas, grasas saturadas y grasas trans, así como el aumento en el consumo de cereales integrales, frutas, vegetales y pescado, disminuye la morbi-mortalidad global y cardiovascular.

Efecto de la inflamación subclínica sobre el estado nutricional de hierro, cobre y zinc en adultos / Effects of subclinic inflammation on iron, copper and zinc nutrition status in adults

Chile is undergoing an epidemiological transition, where micronutrient deficiencies coexist with chronic diseases. The aim of this study was to determine the effect of mild infections on the prevalence of iron, copper and zinc deficiencies in apparently healthy adults. A venous blood sample was obtained from 377 apparently healthy adults, 20-55 years of age, from the south area of Peñalolén (Santiago, Chile), to measure white blood cell count, MCV and hemoglobin, free erythrocyte protoporphyrin, serum ferritin, serum copper and zinc, transaminases, and C reactive protein concentrations. The prevalence of anemia was 3.9 percent in women and 0.6 percent in men. All cases of anemia were due to iron deficiency and 20 percent of women presented depleted iron stores. Furthermore, 8.6 percent of men and 5.9 percent of women had low serum copper levels and 25.1 percent of women and 24.7 percent of men had low serum zinc concentrations. The presence of a subclinical inflammation neither modified the prevalence of anemia or the status of iron, zinc and copper in this population.

Chile se encuentra en la etapa de transición epidemiológica, en la que coexisten las deficiencias de micronutrientes con las enfermedades crónicas no transmisibles. El objetivo de este estudio fue medir el efecto de infecciones leves sobre la prevalencia de la deficiencia de hierro, cobre y zinc en adultos. Participaron 377 adultos aparentemente sanos (20-55 años), provenientes del área sur de la comuna de Peñalolén de Santiago de Chile. Se midió hemoglobina, VCM, protoporfirina libre eritrocitaria, ferritina sérica, niveles séricos de cobre y zinc, transaminasas, recuento de leucocitos y proteína C reactiva. Como resultado se obtuvo que solo el 3.9 por ciento de las mujeres y el 0,6 por ciento de los hombres presentaron anemia, todos los casos por déficit de hierro y un 20 por ciento de las mujeres mostraron depleción de depósitos de este mineral. El 8,6 por ciento de los hombres y el 5.9 por ciento de las mujeres tuvieron bajos niveles de cobre y en ambos grupos se encontraron altos porcentajes de deficiencia de zinc (25.1 por ciento en mujeres y 24,7 por ciento en hombres). El estado de inflamación sub-clínica no alteró la prevalencia de anemia o el estado nutricional de hierro, cobre y zinc en esta población.