Grip Strength Trajectories and Cognition in English and Chilean Older Adults: A Cross-Cohort Study.

Growing evidence about the link between cognitive and physical decline suggests the early changes in physical functioning as a potential biomarker for cognitive impairment. Thus, we compared grip-strength trajectories over 12-16 years in three groups classified according to their cognitive status (two stable patterns, normal and impaired cognitive performance, and a declining pattern) in two representative UK and Chilean older adult samples. The samples consisted of 7069 UK (ELSA) and 1363 Chilean participants (ALEXANDROS). Linear Mixed models were performed. Adjustments included socio-demographics and health variables. The Declined and Impaired group had significantly lower grip-strength at baseline when compared to the Non-Impaired. In ELSA, the Declined and Impaired showed a faster decline in their grip strength compared to the Non-Impaired group but differences disappeared in the fully adjusted models. In ALEXANDROS, the differences were only found between the Declined and Non-Impaired and they were partially attenuated by covariates. Our study provides robust evidence of the association between grip strength and cognitive performance and how socio-economic factors might be key to understanding this association and their variability across countries. This has implications for future epidemiological research, as hand-grip strength measurements have the potential to be used as an indicator of cognitive performance.

Exploring the Association between Vitamin D and Changes in Cognitive Function in Chilean Older Adults: Evidence from the ALEXANDROS Cohort Study.

Background: The increasing aging of the population with the consequent increase of age-associated cognitive disorders pose the challenge of controlling its preventable risk factors, among which vitamin D deficit is a putative factor. Thus, our objective is to explore the association between vitamin D and cognitive performance in a cohort study of community-dwelling Chilean older people. Material and Methods: Cohort study of 955 (69.7% female), community-dwelling older Chileans free of cognitive impairment from the Alexandros cohorts, with 25(OH)D measurement at baseline. Cognitive Function was evaluated with the Mini Mental State Examination (MMSE) short-form questionnaire. Plasma levels of 25(OH)D were classified as Normal > 30 ng/mL Insufficiency 20−29 ng/mL, Deficiency 20−12 ng/mL and Severe Deficiency < 12 ng/mL. Penalized regressions models were made to assess associations. Results: Mean age of the sample was 66.6 + 4.5 years, with 8.5 + 4.7 years of education. After a mean follow-up of 9.6 years, 54 new cases of Mild Cognitive Impairment (MCI)were identified (Incidence density rate = 5.9 per 1000 person/years). Mean vitamin D plasma levels were lower in people with MCI than in the normal cognitive ones (23.0 + 12.75 vs. 28.35 + 15.17 ng/mL, p < 0.01). In the fully adjusted model only severe deficiency of vitamin D was associated with MCI (RR = 2.33; 95% CI: (1.03−5.26). Conclusions: In this longitudinal study, our results confirm that low Vitamin D is a risk factor for MCI, and that people with severe deficiency have more than double the risk of MCI people with normal Vitamin D levels. Considering the high frequency of vitamin D deficiency in older people, and its preventability, these results are very valuable for future public health programmes.

Depression, Anxiety, and Stress among Teachers during the Second COVID-19 Wave.

There is a strong background indicating that the teaching profession is one of the most stressful and that their mental health has deteriorated even further during the pandemic. However, there is a little background about the impact of the COVID-19 infection peaks and teachers' mental health. To this end, 313 teachers were recruited. Via online questionnaires, an evaluation was performed on their depression, anxiety, and stress symptoms on the DASS-21 scale. Teachers' sociodemographic and socio-personal data were also analyzed. A binary logistic regression was used to analyze the variables which could be associated with each of the symptoms. High rates of depression, anxiety, and stress symptoms were observed among teachers (67%, 73%, and 86%, respectively). Among teachers who were affected by the work-family balance (89%), there was also an increased risk of symptoms of anxiety (OR: 3.2) and stress (OR: 3.5). Depression symptom risk was higher among women (OR: 2.2), and teachers under 35 years old had a risk of presenting all three symptoms (depression OR: 2.2; anxiety OR: 4.0; stress OR 3.0). In contrast, teaching in private educational establishments was a protective factor for anxiety symptoms (OR: 0.3). The results suggest that the second COVID-19 wave profoundly affected teachers' mental health. Urgent interventions are thus needed to aid teachers' mental health.

Forecasting Healthy Life Expectancy Among Chilean Community-Dwelling Older Adults With and Without Sarcopenia.

BACKGROUND: Sarcopenia is an important risk factor for disability and dependency at old age. The prevalence of sarcopenia among the Chilean older population is high. OBJECTIVE: To estimate life expectancy, healthy life expectancy and unhealthy life expectancy among sarcopenic and non-sarcopenic older adults from Santiago, Chile. METHODS: A sample of 1,897 community-dwelling older adults aged 60 years or more, living in Santiago, was observed between 5-15 years. Disability was defined as the unhealthy state, assessed through self-reported difficulties in activities of daily living. Sarcopenia was determined via HTSMayor software. Total and marginal life expectancies were estimated using the Interpolated Markov Chain method "IMaCh". RESULTS: At 60 years, estimated life expectancy for sarcopenic and non-sarcopenic older adults was similar (22.7 and 22.5 years, respectively). The proportion of years to be lived with disability was three times greater in sarcopenic adults, compared to non-sarcopenic people. This difference was observed up to 80 years. Non-sarcopenic women had a higher proportion of years to be lived with disabilities compared to non-sarcopenic men of the same age, but this proportion was higher among sarcopenic men, compared to sarcopenic women until 70 years of age. DISCUSSION: People with sarcopenia expect to live a higher proportion of years with disabilities. Sarcopenic men until 70 years expected to live a higher proportion of years with disability, compared to sarcopenic women. Monitoring sarcopenia among older people may help to identify individuals with higher risk of disability onset. Future research should focus on disentangling the mechanisms explaining sex differences.

Sarcopenic metabolomic profile reflected a sarcopenic phenotype associated with amino acid and essential fatty acid changes.

INTRODUCTION: Although sarcopenia greatly affects health and quality of life in older people, its pathophysiological causes are not fully elucidated. To face this challenge, omics technologies can be used. The metabolome gives a vision of the interaction between the genome and the environment through metabolic networks, thus contributing in clarifying the pathophysiology of the sarcopenic phenotype. OBJECTIVES: The main goal of this study was to compare the plasma metabolome of sarcopenic and non-sarcopenic older people. METHODS: Cross-sectional study of 20 sarcopenic and 21 non-sarcopenic older subjects with available frozen plasma samples. Non-targeted metabolomic study by ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) analysis with later bioinformatics data analysis. Once the significantly different metabolites were identified, the KEGG database was used on them to establish which were the metabolic pathways mainly involved. RESULTS: From 657 features identified, 210 showed significant differences between the study groups, and 30 had a FoldChangeLog2 > 2. The most interesting metabolic pathways found with the KEGG database were the biosynthesis of amino acids, arginine and proline metabolism, the biosynthesis of alkaloids derived from ornithine, linoleic acid metabolism, and the biosynthesis of unsaturated fatty acids. CONCLUSIONS: The study results allowed us to confirm that the concept of "sarcopenic phenotype" is also witnessed at the plasma metabolite levels. The non-targeted metabolomics study can open a wide view of the sarcopenic features changes at the plasma level, which would be linked to the sarcopenic physiopathological alterations.

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.

Musculoskeletal Disorders Associated With Quality of Life and Body Composition in Urban and Rural Public School Teachers.

Introduction: Teachers have been reported to be a labor group with high rates of musculoskeletal disorders (MSDs), stress, and strong deterioration of quality of life (QoL). However, little information exists about the association between MSD, QoL, and body composition in rural and urban teachers. Objective: The aim was to study the association of MSD with QoL perception and body composition of urban and rural teachers. Participants and Methods: Participants are comprised a representative sample of urban and rural public schoolteachers from the Valparaiso Region, Chile. MSDs were evaluated with the Standardized Nordic Questionnaire for Musculoskeletal Symptoms validated for the Chilean population. QoL perception was evaluated with the 36-Item Short-Form Survey (SF-36). Body composition was measured via bioimpedance. A logistic regression model was used to evaluate the association between MSD, QoL, and body composition, adjusted for age and gender. Results: A total of 88.9% (urban 90%; rural 87%) of teachers felt pain in some body area, 71.2% of them with limitations; 39% of teachers presented body fat obesity, with the highest rate in rural women. The body area with the greatest MSD prevalence was the neck and shoulders (68.6%). Significant differences were observed between teachers with >p75 of MSD (over six pain regions) and those with ≤p75 (six or fewer painful regions; p < 0.05) on six QoL scales and on physical health components (PCSs) and mental health (MCS) in urban teachers. However, rural teachers presented no differences. The association between teachers with >p75 MSD and low QoL perception was significant (p < 0.05) in PCS and MCS. Furthermore, the regression model presents a significant association between rural areas and low PCS perception. Conclusions: Urban and rural teachers present high rates of MSD and obesity. Teachers with higher rates of MSD have their mental and physical QoL affected, making workplace intervention in MSD necessary to prevent teacher health deterioration.

Besides Sarcopenia, Pre-Sarcopenia Also Predicts All-Cause Mortality in Older Chileans.

PURPOSE: Many studies have demonstrated that Sarcopenia causes a serious impact on health, including death in older adults. The objective of this study was to determine the association of sarcopenia and pre-sarcopenia with all-cause mortality in older Chileans. SUBJECTS AND METHODS: Follow-up of 2311 community-dwelling people ≥ 60y from the Alexandros cohort. Anthropometric measurements, handgrip strength, mobility, and physical performance tests were performed. Sarcopenia, pre-sarcopenia, and severe sarcopenia were defined using the 2010 European Working Group on Sarcopenia in Older People (EWGSOP1) algorithm. Muscle mass was estimated using a prediction model with cut-off points validated for the Chilean population. Physical performance was determined by 3 m walking speed or five chair-stands or time up go test (TUG). Mortality data were obtained from death certificates of the National Civil Registry. Life tables for survival data, Kaplan Meier estimations, and Cox regression were calculated. RESULTS: The prevalence of sarcopenia was 20.2% (95% CI:18.6% to 21.9%) and similar in both sexes; pre-sarcopenia was identified in 20.4% (95% CI:18.8% to 22.1%) of the sample. Kaplan Meier survival estimates demonstrated lower survival rates for the people with sarcopenia and pre-sarcopenia (Log rank test for equality of survivor functions: p<0.0001). A dose-response was observed in the survival rates according to the stages of sarcopenia, showing the lowest survival rates for the people with severe sarcopenia, followed by older adults with sarcopenia, pre-sarcopenia, and without sarcopenia (Log rank test for equality of survivor functions: p<0.0001). After adjusting for age, sex, nutritional status, and number of chronic diseases, hazard ratios for death showed higher risk for subjects with sarcopenia (HR=1.47, 95% CI:1.17-1.83) and pre-sarcopenia (HR=1.35, 95% CI:1.03-1.78) in comparison with people without sarcopenia. CONCLUSION: The results confirm a dose-response increase in the risk of all-cause death in older adults with sarcopenia and pre-sarcopenia compared to non-sarcopenic individuals.

Impact of the COVID-19 Pandemic on Teacher Quality of Life: A Longitudinal Study from before and during the Health Crisis.

BACKGROUND: Prior to the COVID-19 pandemic, teachers were already reporting a low quality of life (QoL) perception, with a significant impact on mental and physical health due to various stress factors associated with work overload. The objective of this study was to evaluate the QoL impact on Chilean teachers before and during the COVID-19 pandemic. The analysis was performed following a longitudinal design on a sample of 63 Chilean teachers in pre-pandemic and COVID-19 pandemic timeframes. QoL perception, along with teachers' sociodemographic data, was evaluated via the Short-Form 36 Health Survey (SF-36) questionnaire. Sociodemographic variables presented no significant variations in pre-pandemic and pandemic comparisons. QoL, however, showed a significant decrease during the pandemic compared to the pre-pandemic measurement (p < 0.01). In each gender, there were significant differences between pre-pandemic and pandemic timeframes, with a greater impact among women in the mental and physical component summary variables and seven of the eight QoL scales (p < 0.01). Between age categories, people under 45 presented significant differences (p < 0.05) between pre-pandemic and pandemic timeframes in all summary dimensions and measurements. In conclusion, Chilean teachers' QoL perception has been affected by the COVID-19 pandemic. These findings could be related to work overload due to teleworking or feelings of uncertainty, loneliness, and fear that the pandemic and its associated confinements will worsen.

Socioeconomic inequalities in life expectancy and disability-free life expectancy among Chilean older adults: evidence from a longitudinal study.

BACKGROUND: Chile has one of the longest life expectancies of Latin America. The country is characterised by an important macroeconomic growth and persisting socioeconomic inequalities. This study analyses socioeconomic differences in life expectancy (LE) and disability-free life expectancy (DFLE) among Chilean older people. METHODS: The sample of the Social Protection Survey, a longitudinal study, was analysed. Five waves, from 2004 to 2016, were considered. The indicator was disability, defined as having difficulties to perform at least one basic activity of daily living. Type of health insurance was used to determine socioeconomic position (SEP). Total LE and DFLE were estimated with multistate life table models. RESULTS: At age 60, men in the higher SEP could expect to live 3.7 years longer (22.2; 95% CI 19.6-24.8) compared to men of the same age in the medium SEP (18.4; 95% CI 17.4-19.4), and 4.9 years longer than men of the same age in the lower SEP (17.3; 95% CI 16.4-18.2). They also had a DFLE (19.4; 95% CI 17.1-21.7) 4 (15.4; 95% CI 14.6-16.1) and 5.2 (14.2; 95% CI 13.4-14.9) years longer, compared to the same groups. Women aged 60 years in the higher SEP had a LE (27.2; 95% CI 23.7-30.8) 4.6 (22.7; 95% CI 21.9-23.5) and 5.6 (21.6; 20.6-22.6) years longer, compared to women in the medium and the lower SEP. The difference in DFLE, for the same age and groups was 4.9 and 6.1 years, respectively (high: 21.4; 95% CI 19.5-23.3; medium: 16.5; 95% CI 15.8-17.1; low: 15.3; 95% CI 14.6-16.0). Socioeconomic differences in LE and DFLE were observed among both sexes until advanced age. DISCUSSION: Socioeconomic inequalities in LE and DFLE were found among Chilean older men and women. Older people in the highest SEP live longer and healthier lives. CONCLUSION: A reform to the Chilean health system should be considered, in order to guarantee timely access to care and benefits for older people who are not in the wealthiest group.

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

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.

Osteosarcopenia Predicts Falls, Fractures, and Mortality in Chilean Community-Dwelling Older Adults.

OBJECTIVES: The objective of this study was to describe the prevalence of osteosarcopenia and its association with falls, fractures, and mortality in community-dwelling older adults. DESIGN: Follow-up of ALEXANDROS cohorts designed to study disability associated with obesity in older adults. SETTING AND PARTICIPANTS: Community-dwelling people aged 60 years and older living in Chile. MEASURES: At baseline, 1119 of 2372 participants had a dual-energy X-ray absorptiometry scan and the measurements for the diagnosis of sarcopenia. World Health Organization standards for bone mineral density were used to classify them as normal, osteopenia, and osteoporosis. Sarcopenia was identified using the algorithm from the European Working Group on Sarcopenia in Older People 1, validated for the Chilean population. Osteosarcopenia was defined as having sarcopenia plus osteoporosis or osteopenia. RESULTS: The sample of 1119 participants (68.5% female) had a mean age of 72 years. At baseline, osteoporosis was identified in 23.2%, osteopenia in 49.8%, sarcopenia in 19.5%, and osteosarcopenia in 16.4% of the sample. The prevalence of osteosarcopenia increases with age, reaching 33.7% for those older than 80 years. Sarcopenia was found in 34.4% of osteoporotic people and osteoporosis in 40.8% of those with sarcopenia. After 5640 person-years of follow-up, 86 people died. The mortality was significantly higher for the group with osteosarcopenia (15.9%) compared with those without the condition (6.1%). After an adjusted Cox Regression analysis, the hazard ratio for death in people with osteosarcopenia was 2.48. Falls, fractures, and functional impairment were significantly more frequent in osteosarcopenic patients. CONCLUSIONS AND IMPLICATIONS: Osteosarcopenia is a common condition among older adults and is associated with an increased risk of falls, fractures, functional impairment, and mortality. Considering the high proportion of sarcopenia among osteoporotic patients and vice versa, screening for the second condition when the first is suspected should be advised.

Aplicación y efectividad de un modelo educativo en hábitos saludables con entrega de fruta y programa de actividad física en escolares

RESUMEN El objetivo fue evaluar una intervención educativa en hábitos de alimentación saludable basada en el programa Colación BKN en pre-escolares y escolares entre los años 2013-2018. Diseño longitudinal con comparación de cortes trasversales en escolares de prekínder a cuarto año básico durante 4 años en 14 escuelas de la Región Metropolitana de Chile. El programa consistió en entrega de fruta como colación, educación alimentaria, mejora de la actividad física y kioscos escolares, con participación de profesores y familias. Como resultado se observó una mejoría de los conocimientos en alimentación saludable de los niños, con una excelente satisfacción de usuarios. Sobrepeso y obesidad se mantuvieron el 2016 y 2018, pero aumentaron el 2015 y 2017. En escuelas similares no intervenidas el exceso de peso fue mayor con respecto a las del programa. Hubo una tendencia a disminuir el consumo de dulces y bebidas azucaradas en prekínder y kínder entre 2014 y 2017 y el consumo de 3 porciones al día de frutas y verduras en niños intervenidos fue superior al promedio nacional de 2 porciones al día.Conclusiones: Hubo un aumento exitoso en el consumo de frutas y verduras, educación alimentaria y actividad física para el cambio hacia hábitos más saludables.

ABSTRACT The objective was to evaluate an educational intervention for healthy eating habits based on the Colación BKN program, among preschool and schoolchildren, carried out in 2013-2018. We conducted a longitudinal study with cross-sectional data among preschool and school-age children (up to the fourth grade) over four years in 14 schools in the Metropolitan Region of Chile. The intervention program consisted of fruit delivery, nutrition education and improvements in physical activity and school food kiosks, with active participation of teachers and parents. There was an improvement in knowledge of healthy foods in children and excellent user satisfaction. Overweight and obesity did not increase during 2016 and 2018, but increased in 2015 and 2017. In similar not-intervened schools there was an increase of overweight and obesity compared with Colación BKN schools. For food consumption, there was a decrease in consumption of candy and soft drinks in preschool students and all children consumed more than three portions of fruits and vegetables per day, which is greater than the national average of two portions per day in the general population. Conclusions: There was a successful increase in fruit and vegetable consumption with nutrition education and promotion of healthy habits, such as physical activity and healthy food consumption.

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.

[Delphi method to reach consensus on education methods to promote healthy eating behaviors in adolescents]. / Método Delphi para consensuar metodologías educativas para promover la alimentación saludable en adolescentes.

INTRODUCTION: Background: adolescence is a relevant period to educate in healthy eating behaviors. For this purpose it is necessary to obtain expert opinions and reach consensus and prioritize the best methodologies available to educate adolescents on healthy eating. Methods: the Delphi method was chosen to get consensus through repeated iterations of anonymous opinions in two rounds. Participants were experts in nutrition (24), education (14), and cooking (2), selected with the following inclusion criteria: outstanding professional career; interest shown in their knowledge area, and expertise in healthy eating education. The 40 experts in the first round were reduced to 37 in the second round. The questionnaire was mailed in the first round and the results were sent to establish priorities in the second round. The analysis was done with descriptive statistics (%). Consensus was reached if ≥ 75th percentile. Cronbach's alpha coefficient was used to analyze internal consistency, which was considered good for an alpha value higher than 0.7, and moderate for values between 0.6 and 0.7. Results: there was 90% consensus for food habits, culinary skills, and methodologies. In food habits experts prioritized improving access to healthy food and curricular changes at school. In culinary skills they agreed on healthy breakfast and healthy snack preparations; in methodologies the consensus was to educate in healthy eating at breakfast and lunch at school, and on participative activities such as cooking workshops. Conclusions: the Delphi method was useful to obtain consensus and priorities on the methodologies to educate adolescents in healthy eating.

INTRODUCCIÓN: Antecedentes: la adolescencia es un período importante para reforzar la educación sobre alimentación saludable. Para ello se requiere consensuar y establecer prioridades con expertos sobre las mejores metodologías para educar a los adolescentes en alimentación saludable. Métodos: se escogió el método Delphi para obtener consenso a través de opiniones anónimas repetidas en dos rondas. Se seleccionaron expertos en nutrición (24), educación (14) y cocina (2) con los siguientes criterios de inclusión: carrera profesional relevante; mostrar interés en su área de conocimiento y experiencia en educación en alimentación saludable. Los 40 expertos de la primera ronda disminuyeron a 37 en la segunda ronda. El cuestionario enviado por correo en la primera ronda y sus resultados fueron reenviados para establecer prioridades. El análisis se efectuó con estadísticas descriptivas (%). Se consideró consenso el valor ≥ percentil 75. La consistencia interna se analizó con el coeficiente alfa de Cronbach (se considera buena si alfa es mayor de 0,7 y moderada si se sitúa entre 0,6 y 0,7). Resultados: hubo más de un 90 % de consenso en las metodologías para hábitos alimentarios, habilidades culinarias y estrategias metodológicas. En los hábitos alimentarios se consideró como prioritario mejorar el acceso a la comida saludable y cambiar los currículos en la escuela. En las habilidades culinarias, la preparación de un desayuno saludable y colaciones saludables, y en las estrategias metodológicas, educar en hábitos alimentarios durante el desayuno y el almuerzo, y desarrollar actividades participativas tales como talleres de cocina. Conclusiones: el método Delphi fue útil para obtener el consenso y las prioridades en cuanto a las metodologías para educar a los adolescentes en alimentación saludable.

Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016.

BACKGROUND: Chile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences. METHODS: Data from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method. RESULTS: In both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0-58.8] for men and 37.6% [95% CI 34.3-40.8] for women in 2009; 46.1% [95% CI 42.6-49.7] for men and 38.5% [95% CI 35.6-41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4-10.3] in 2009; 11.5 years [95% CI 10.7-12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2-69.4] for men and 44.9% [95% CI 41.9-47.9] for women in 2009; 71.9% [95% CI 68.7-75.0] for men and 61.1% [95% CI 58.5-63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3-3.4] for men and 6.0 years [95% CI 5.4-6.7] for women). CONCLUSIONS: Women expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.

Software for the Diagnosis of Sarcopenia in Community-Dwelling Older Adults: Design and Validation Study.

BACKGROUND: The usual diagnosis of sarcopenia requires a dual-energy x-ray absorptiometry (DXA) exam, which has low accessibility in primary care for Latin American countries. OBJECTIVE: The aim of this study is to design and validate software for mobile devices (Android, IOS) and computers, based on an adapted version of the diagnostic algorithm of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). METHODS: Follow-up exams were conducted on 430 community-dwelling Chileans 60 years and older (mean 68.2 years, SD 4.9) participating in the IsaMayor and Alexandros cohorts designed to study sarcopenia and disability associated with obesity, respectively. All the participants from the cohorts were randomly selected from the registries of primary health care centers and, for this study, must have a DXA scan at baseline. The software (HTSMayor) was designed according to an adapted version of the algorithm proposed by the EWGSOP and was divided into four phases: longitudinal validation of diagnostic algorithm of sarcopenia, alpha version, beta version, and release version. The software estimates appendicular skeletal muscle mass (ASM) using an anthropometric equation or DXA measurements with Chilean cut-off points. The predictive validation of the algorithm was estimated, comparing functional limitations (at least one activity of daily living, two instrumental activities of daily living, or three mobility limitations), falls, and osteoporosis at follow-ups in patients with and without sarcopenia at baseline, using adjusted logistic models. RESULTS: After a median follow-up of 4.8 years (2078.4 person-years), 37 (9.9%) new cases of sarcopenia, out of the 374 patients without sarcopenia at baseline, were identified (incidence density rate=1.78 per 100 person-years). ASM estimated with the anthropometric equation showed both a high sensitivity and specificity as compared with those estimated by DXA measurements, yielding a concordance of 0.96. The diagnostic algorithm of sarcopenia considered in the software with the equation showed both a high sensitivity (82.1%) and specificity (94.9%) when compared with DXA (reference standard). Adults without sarcopenia (at baseline) showed better physical performance (after approximately 5 years) than adults with sarcopenia. Loss of functionality was greater in adults with sarcopenia (OR 5.0, 95% CI 2.2-11.4) than in adults without sarcopenia. In addition, the risks of falls (OR 2.2, 95% CI 1.1-4.3) and osteoporosis (OR 2.8, 95% CI 1.2-6.6) were higher in older persons with sarcopenia than those without sarcopenia. The measurements and results were completed for the beta and release tests with a mean time of 10 minutes and 11 minutes, respectively. CONCLUSIONS: We developed and validated a software for the diagnosis of sarcopenia in older Chilean adults that can be used on a mobile device or a computer with good sensitivity and specificity, thus allowing for the development of programs for the prevention, delay, or reversal of this disease. To our knowledge, HTSMayor is the first software to diagnose sarcopenia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13657.

Factors related to depressive symptoms and self-reported diagnosis of depression in community-dwelling older Chileans: A national cross-sectional analysis.

AIM: The aims of this study were to describe the prevalence of screening-positive depression and to identify the frequency and factors related to self-reported depression diagnosis in people with screen-positive depression. METHODS: Using the Geriatric Depression Scale (GDS-15), 4065 older Chileans were screened for depression. Social and health variables were included. Self-reported depression diagnosis and antidepressant use were analyzed according to screen-positive depression (GDS-15 ≥ 5). Chi-square and logistic regression analyses were conducted to identify factors related to screen-positive depression, and self-reported diagnosis and current antidepressant use. RESULTS: Overall, mean age was 71.0 years, 60.9% women, and 71.4% had ≤8 years of education. 28.3% of the population screened positive for depression (mild: 21.7%; moderate-severe: 6.5%). Only 35.9% of screen-positive depression individuals self-reported a depression diagnosis (mild: 32.6%; moderate-severe: 47.0%), with significant differences between the sexes (women: 42.2%; men: 22.5%; P < .01). No education (OR = 2.00, 95% CI = 1.20-3.32), multimorbidity (OR = 1.88, 95% CI = 1.42-2.48), dependence (OR = 4.14, 95% CI = 3.11-5.51) and pain (OR = 2.49, 95% CI = 2.01-3.07) were related to screen-positive depression. In people screen-positive depression, men (OR = 0.48, 95% CI = 0.35-0.65) and 80 years or older were less likely to self-report depression diagnosis (OR = 0.35, 95% CI = 0.23-0.54), and current antidepressant use (OR = 0.31, 95% CI = 0.14-0.70). CONCLUSIONS: A high prevalence of depressive symptoms and low agreement with self-reported depression is observed. There is a need to increase the diagnosis of depression especially in men and people 80 years or older.

[Prevalence of frailty among Chilean older people]. / 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.

Life expectancy with and without cognitive impairment among Chilean older adults: results of the National Survey of Health (2003, 2009 and 2016).

BACKGROUND: Chile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator. METHODS: We estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method. RESULTS: At age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively). CONCLUSIONS: Longer life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.