The association between walking pace and grip strength and all-cause mortality: A prospective analysis from the MAUCO cohort.

OBJECTIVE: This study investigated the individual and combined association of walking pace and grip strength with all-cause mortality in Chilean adults. STUDY DESIGN: 8813 participants (54.6 % women) from the MAUCO population-based cohort were included in this prospective study. MAIN OUTCOME MEASURES: Individual and combined associations of grip strength (normal or low grip) and walking pace (normal or slow walking) with all-cause mortality were investigated using Cox proportional-hazard models. Analyses were adjusted for sociodemographic, lifestyle, and health-related factors. RESULTS: Over a median follow-up of 4.74 years, 151 and 206 participants included in the analyses of walking pace and grip strength died. Individuals with low grip strength had a risk of dying 2.40 times (95 % CI: 1.64 to 3.51) higher than their counterparts with normal grip strength. Similar results were identified for slow walkers (HR: 1.77 [95 % CI: 1.25 to 2.50]). When the two factors were combined and the associations investigated, individuals with normal walking pace but with low grip strength had a higher risk of all-cause mortality than those with normal walking pace and normal grip strength (HR: 3.56 [95 % CI: 1.99 to 6.36]). The associations remained even after including a 1- and 2-year landmark period in the analyses. CONCLUSIONS: Slow walking pace and low grip strength were associated with a higher risk of mortality (both in isolation and combined). These factors might be early markers of all-cause mortality, and should be measured more frequently in middle-aged and older adults in clinical practice.

Processed meat consumption and associated factors in Chile: A cross-sectional study nested in the MAUCO cohort.

Processed meat consumption is increasing in Latin America. While in developed countries processed meat consumption has been associated with cardiovascular diseases and cancer, our region lacks data associated to its consumption and health impact. We characterized processed meat intake and associated factors in a population-based cohort of a Chilean agricultural county, MAUCO. We analyzed baseline dietary data of 7,841 participants, 4,358 women and 3,483 men (38-77 years), who answered an adapted Mediterranean index food frequency questionnaire. Eight percent of the participants presented high processed meat consumption (≥5 times per week). We explored associations of processed meat consumption with participant characteristics using multinomial logistic regression models. Main factors associated with higher consumption were being men, younger and currently employed, and having a high intake (>4 times per week) of red meat (Odds ratio, 2.71, 95% CI 2.10-3.48), butter/cream (1.96, 1.60-2.41), whole-fat dairy products (1.32, 1.04-1.67) and a high intake (≥1 time per day) of sugary snacks/sweets (2.49, 2.04-3.03) and sugary drinks (1.97, 1.63-2.38). Processed meat consumption associated to chronic diseases, particularly cardiovascular disease (Prevalence ratio, 2.28, 95% CI 1.58-3.29). Obesity mediated this association in a proportion of 5.0%, whereas for diabetes the proportion was 13.9%. In this population, processed meat was associated with other unhealthy dietary and lifestyle factors, as well as with chronic diseases, particularly cardiovascular disease.

The Chile Biliary Longitudinal Study: A Gallstone Cohort.

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.

The Association between Fasting Glucose and Sugar Sweetened Beverages Intake Is Greater in Latin Americans with a High Polygenic Risk Score for Type 2 Diabetes Mellitus.

Chile is one of the largest consumers of sugar-sweetened beverages (SSB) world-wide. However, it is unknown whether the effects from this highly industrialized food will mimic those reported in industrialized countries or whether they will be modified by local lifestyle or population genetics. Our goal is to evaluate the interaction effect between SSB intake and T2D susceptibility on fasting glucose. We calculated a weighted genetic risk score (GRSw) based on 16 T2D risk SNPs in 2828 non-diabetic participants of the MAUCO cohort. SSB intake was categorized in four levels using a food frequency questionnaire. Log-fasting glucose was regressed on SSB and GRSw tertiles while accounting for socio-demography, lifestyle, obesity, and Amerindian ancestry. Fasting glucose increased systematically per unit of GRSw (ß = 0.02 ± 0.006, p = 0.00002) and by SSB intake (ß[cat4] = 0.04 ± 0.01, p = 0.0001), showing a significant interaction, where the strongest effect was observed in the highest GRSw-tertile and in the highest SSB consumption category (ß = 0.05 ± 0.02, p = 0.02). SNP-wise, SSB interacted with additive effects of rs7903146 (TCF7L2) (ß = 0.05 ± 0.01, p = 0.002) and with the G/G genotype of rs10830963 (MTNRB1B) (ß = 0.19 ± 0.05, p = 0.001). Conclusions: The association between SSB intake and fasting glucose in the Chilean population without diabetes is modified by T2D genetic susceptibility.

Polypharmacy in a semirural community in Chile: Results from Maule Cohort.

PURPOSE: Although polypharmacy in younger populations is a growing public health concern, most studies addressing polypharmacy focus on elderly populations. Thus, polypharmacy is not yet well understood in younger populations. METHODS: Baseline data from the Maule Cohort (MAUCO) (adults aged 38-74 years) were used to study the prevalence of polypharmacy and associated participant characteristics using logistic and zero-inflated negative binomial regressions. Factors studied include age, sex, self-rated health, education, smoking, obesity, diabetes, hypertension, and other chronic conditions. RESULTS: Polypharmacy was reported by 10% of participants overall, with higher prevalence among older (≥60 years) vs middle aged (<60 years) participants (overall: 20.9% vs 6.0%, P < .0001; for those reporting any medication use: 30.2% vs 15.9%, P < .0001). Middle-aged adults reported different patterns of medication use by polypharmacy status, while older adults reported similar medication use patterns regardless of polypharmacy. Diabetes, hypertension, dyslipidemia, cardiovascular diseases, hypothyroidism, and osteomuscular diseases were significantly associated with polypharmacy. Analyses also revealed that there are MAUCO participants who are potentially being undertreated for conditions like depression. CONCLUSIONS: Research into medication use among younger and middle-aged adults and development of possible tools to deprescribe medications in this population are warranted. However, it is important that patients who need treatment receive it, and so both potential overtreatment and undertreatment need further study in this population.

Early left atrial dysfunction is associated with suboptimal cardiovascular health.

AIMS: Two-dimensional speckle-tracking echocardiography can assess left atrial (LA) function by measuring atrial volumes and deformation parameters (strain, strain rate). This cross-sectional analysis explores the association between ideal CV health (CVH), LA function, and systemic biomarkers in healthy individuals from the Chilean MAUCO Cohort. METHODS: We enrolled 95 MAUCO participants with different levels of CVH (mean age: 51 ± 8 years). We categorized participants into low or high CVH groups: A: 0-2, or B: 3-6 CVH risk factors. 2D echocardiography, glucose, insulin, total cholesterol, triglycerides, proBNP, hsCRP, insulin resistance index (HOMA), and right and left atrial strain (RASs and LASs, respectively) were determined. RESULTS: LASs was lower in Group A, while systolic and diastolic blood pressure (BP), body mass index (BMI), insulin, HOMA, total cholesterol, triglycerides, and LV and RV end-diastolic volume were significantly higher in Group A than Group B (P < .01). Change in LASs was inversely correlated with insulin (P = .040), HOMA (P = .013), total cholesterol (P = .039), glycemia (P = .018), and BMI (P = .0.037). CONCLUSION: LASs during the reservoir phase was diminished in subjects with a lower level of CVH. Higher insulin, HOMA, total cholesterol, glycemia, and BMI values were associated with decreased LA deformation during the reservoir phase. Morphofunctional alterations of the LA were also identified in the group with suboptimal CVH, as well as BP values in the range of hypertension. LA dysfunction in an asymptomatic population, along with metabolic syndrome, could be an early event in the continuum of CV damage.

Frailty and health risks in an agricultural population, Chile 2014-2017.

BACKGROUND: Aging presents an emerging health and social challenge. We report the prevalence of frailty, its association with chronic diseases and the risk of hospitalization or death within 29 months. METHODS: Cross-sectional and prospective study. From 2014 to 2017, we examined frailty in an agricultural population in Chile. We enrolled 619 individuals aged 60-74 years from the Maule Cohort. Measured frailty prevalence, based the presence of ≥3 of the five factors (unintentional weight loss, weakness, slowness, self-reported exhaustion, low physical activity). We explored chronic diseases as predictors of frailty with multinomial regression models (sex, age, and schooling adjusted), and the risk of hospitalization and mortality by frailty status, with Cox regression models and Kaplan-Meier survival curves. RESULTS: 6% of participants were frail; women had higher prevalence of frailty (8.2%) than men (2.3%, <0.001). Diabetes was a risk factor of frailty (Relative Risk Ratio: 3.91; 95% CI: 1.84-8.32). The incidence of hospitalization was 32% in frail (Hazard Ratio, HR: 3.68; 95% CI: 1.77-7.63), 16% in pre-frail (HR: 1.91; 95% CI: 1.19-3.08) and 9% in robust participants. Among the participants, men had higher risk of hospitalization than women (7.1 and 4.1 per 1000 person-month, p = .014). In all mortality was higher among men than women (1.0 and 0.2 per 1000 person-month, p = .031). CONCLUSIONS: In this agricultural population, diabetes was main chronic disease as risk factor of frailty. Frail older adults had higher risk of hospitalization than robust people, and especially men, had higher risk of adverse health event in a short-term.

Study protocol for the Maule Cohort (MAUCO) of chronic diseases, Chile 2014-2024.

BACKGROUND: Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. METHODS/DESIGN: MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. DISCUSSION: MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.

Prevalencia de consumo de alcohol en estudiantes de la Facultad de Medicina en la Universidad Católica del Maule / Prevalence of alcohol consumption among medical students at the Universidad Católica del Maule, Chile

Background: Teenagers and university students are an especially vulnerable population towards unhealthy alcohol consumption Aim: To assess the actual consumption of alcohol among medical students at the Universidad Católica del Maule, Chile (UCM). Material and Methods: A cross sectional study of students who entered medical school between years 2004 and 2010.We applied CAGE questionnaire along with questions about frequency of alcohol consumption. Results: From a universe of 317students, 216 (age range 17-27 years, 54% females) answered the survey (68.8%), 64.2% admitted to consume alcohol and 6% had alcohol dependence. Seventy three percent of the alcohol drinkers were males. Conclusions: The prevalence of alcohol consumption in medical students of the UCM is significantly lower than the prevalence in students of another University surveyed in 2005 (74%) and it is similar to the national statistics. Alcohol consumption was higher in men that in women.

[Prevalence of alcohol consumption among medical students at the Universidad Católica del Maule, Chile]. / Prevalencia de consumo de alcohol en estudiantes de la Facultad de Medicina en la Universidad Católica del Maule.

BACKGROUND: Teenagers and university students are an especially vulnerable population towards unhealthy alcohol consumption. AIM: To assess the actual consumption of alcohol among medical students at the Universidad Católica del Maule, Chile (UCM). MATERIAL AND METHODS: A cross sectional study of students who entered medical school between years 2004 and 2010.We applied CAGE questionnaire along with questions about frequency of alcohol consumption. RESULTS: From a universe of 317 students, 216 (age range 17-27 years, 54% females) answered the survey (68.8%), 64.2% admitted to consume alcohol and 6% had alcohol dependence. Seventy three percent of the alcohol drinkers were males. CONCLUSIONS: The prevalence of alcohol consumption in medical students of the UCM is significantly lower than the prevalence in students of another University surveyed in 2005 (74%) and it is similar to the national statistics. Alcohol consumption was higher in men that in women.

Gestational diabetes, comparison of women diagnosed in second and third trimester of pregnancy with non GDM women: Analysis of a cohort study.

UNLABELLED: Pregnant women are normally screened for Gestational diabetes (GDM) at week 24 of pregnancy. However some women develop the disease later on their pregnancies. No study has analyzed women developing GDM later in pregnancy. OBJECTIVE: To analyze data on a cohort study and compare women diagnosed with GDM in second and third trimester of pregnancy with women without GDM. RESULTS: GDM women diagnosed during their first two trimesters of pregnancy were older (p = 0.0008) and had higher body mass index (BMI) (p = 0.0007) than non GDM women. However, the only risk factor in women diagnosed in their third trimester of pregnancy was having first degree relatives with type 2 DM and this was independent of age and BMI (OR of 2.7, 95% CI 1.2 - 6.0). CONCLUSIONS: Women who develop GDM in their second trimester of pregnancy have known risk factors for diabetes mellitus such as age and higher BMI, however, the only recognised risk factor between non GDM women and women developing GDM late in pregnancy is family history of type 2 DM. Two populations of GDM may exist and future studies should focus on analysing short and long term complications of these women to support the need to diagnosed and treat them all.

Gestational diabetes, comparison of women diagnosed in second and third trimester of pregnancy with non GDM women: Analysis of a cohort study / Diabetes gestational, comparación entre mujeres diagnosticadas en el segundo y tercer trimestre del embarazo con mujeres sin diabetes gestacional: Análisis de un estudio de cohorte

Pregnant women are normally screenedfor Gestational diabetes (GDM) at week 24 of pregnancy. Howeversome women develop the disease later on their pregnancies. No study has analyzed women developing GDM later in pregnancy. Objective: To analyze data on a cohort study and compare women diagnosed with GDM in second and third trimester of pregnancy with women without GDM. Results: GDM women diagnosed during their first two trimesters of pregnancy were older (p = 0.0008) and had higher body mass Índex (BMI) (p = 0.0007) than non GDM women. However, the only risk factor in women diagnosed in their third trimester of pregnancy was having first degree relatives with type 2 DM and this was independent of age and BMI (OR of2.7, 95 percent CI 1.2 - 6.0). Conclusions: Women who develop GDM in their second trimester of pregnancy have known risk factors for diabetes mellitus such as age and higher BMI, however, the only recognised risk factor between non GDM women and women developing GDM late in pregnancy is family history of type 2 DM. Two populations ofGDM may exist andfuture studies should focus on analysing short and long term complications ofthese women to support the need to diagnosed and treat them all.

La pesquisa para diabetes gestacional (DG) se realiza normalmente en la semana 24 de embarazo. Sin embargo, muchas mujeres desarrollan la enfermedad más tardíamente durante el embarazo. No hay estudios analizando DG en tercer trimestre del embarazo. Objetivo: Analizar los datos de una cohorte para comparar mujeres con DG diagnosticada en segundo y tercer trimestre del embarazo con mujeres sin DG. Resultados: Las mujeres diagnosticadas en los primeros dos trimestres del embarazo eran mayores (p = 0,0008) y tenían mayor índice de masa corporal (IMC) (p = 0,0007) que las mujeres sin DG. El único factor de riesgo en mujeres diagnosticadas en el tercer trimestre del embarazo fue tener antecedentes familiares de DM, lo cual fue independiente de la edad e IMC (OR: 2,7, 95 por ciento CI 1,2 - 6,0). Conclusiones: Mujeres con DG diagnosticada en el segundo trimestre del embarazo tienen distintos factores de riesgo que mujeres diagnosticadas más tardíamente. Es posible que existan dos poblaciones de DG según el período de diagnóstico, por lo que debiera estudiarse si las complicaciones de estos dos subgrupos justifican el diagnóstico y tratamiento de ambos.

[Incidence of gestational diabetes and relationship to obesity in Chilean pregnant women]. / Incidencia de diabetes gestacional y su relación con obesidad en embarazadas chilenas.

BACKGROUND: Gestational diabetes (GDM) is associated to a worse outcome of pregnancy. This justifies efforts for finding possible causes of GDM that would allow implementing preventive interventions. AIM: To study incidence of GDM and its relation with obesity and other traditional risk factors. MATERIAL AND METHODS: A retrospective study was performed in 234 women who had delivered a singleton during the last 12 months, attended in an outpatient clinic in Santiago, Chile. Familiar and personal history, body mass index (BMI), obstetrical-related pathology and data about the labor and the newborn were analyzed. RESULTS: GDM was diagnosed in 11.2% of the women. BMI before pregnancy was 26.6 +/- 4.4 kg/m2 (mean +/- SD) and it was 25 or over in 37.8% of women. Women who developed GDM had significantly higher BMI in the pre-pregnancy stage and in the second and third trimester of pregnancy (p < 0.001). The average age was greater in the GDM group (31 +/- 0.2 yr versus 26 +/- 0.41 yr). Incidence of GDM was 14.4% among women 25 years old or older and increased to 21.4% when they had, in addition, a BMI of 25 or over. Age, BMI, and family history of diabetes were all independently correlated with the development of GDM. Elective caesarean sections were more common in GDM than in non-GDM women (p < or = 0.01) and complications were present in 3/23 of newborns of women with GDM and 2/199 among women without GDM (p < 0.01) CONCLUSIONS: GDM and obesity are highly prevalent in Chilean pregnant women. BMI, first degree relative with DM and age are independent risk factors for the development of GDM.