¿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.

[Association of physical inactivity with obesity, diabetes, hypertension and metabolic syndrome in the chilean population]. / No cumplir con las recomendaciones de actividad física se asocia a mayores niveles de obesidad, diabetes, hipertensión y síndrome metabólico en población chilena.

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.

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.

Higher levels of self-reported sitting time is associated with higher risk of type 2 diabetes independent of physical activity in Chile.

Background: Sitting behaviours have increased markedly during the last two decades in Chile. However, their associations with health outcomes such as diabetes have not been reported. Therefore, the aim of this study was to investigate the independent association of self-reported sitting time with diabetes-related markers and diabetes prevalence in Chile. Methods: This cross-sectional study included participants (aged ≥18 years) from the Chilean National Health Survey 2009-10 (n = 4457). Fasting glucose and haemoglobin A1c (HbA1c) were measured by standardized protocols. The prevalence of type 2 diabetes (T2D) was determined using WHO criteria. Physical activity (PA) and time spent sitting were determined using the Global Physical Activity Questionnaire (GPAQ). Results: The odds ratio for T2D was 1.10 [95% CI: 1.04-1.16, P = 0.002] and 1.08 [1.02-1.14, P = 0.002] per 1 h increase in sitting time in men and women, respectively, independent of age, education, smoking, BMI and total PA. Overall, prevalence of T2D was 10.2 and 17.2% in individuals classified in the lowest and highest categories of sitting time, respectively. No significant associations were found between sitting time and glucose or HbA1c. Conclusions: Sitting time is positively associated with diabetes risk, independent of socio-demographic, obesity and PA levels, in the Chilean population.

[Risk factors associated with hypertension. Analysis of the 2009-2010 Chilean health survey]. / Factores de riesgo asociados al desarrollo de hipertensión arterial en Chile.

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.

[Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010]. / 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.

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.

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.

[Effects of a lower body weight or waist circumference on cardiovascular risk]. / 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.

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.

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.