Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009-2010.

OBJECTIVE: To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. DESIGN: Prospective study. SETTINGS: The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0-2 points), moderately healthy (3-4 points) and the healthiest (5-7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. PARTICIPANTS: 2706 participants from the Chilean National Health Survey 2009-2010. RESULTS: After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. CONCLUSION: Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.

[ABSI obesity index and its association with type 2 diabetes mellitus in Chilean adults: a cross-sectional study of the ENS 2016-2017]. / Índice de obesidad ABSI y su asociación con diabetes mellitus tipo 2 en adultos chilenos: un estudio transversal de la ENS 2016-2017.

INTRODUCTION: A Body Shape Index (ABSI) is a new obesity index based on body volume; this has been associated with chronic non-communicable diseases and mortality, independent of the values of the body mass index (BMI); however, its association with type 2 diabetes mellitus (T2DM) in the Chilean adult population is unknown. OBJECTIVE: To determine the association between ABSI, glycemia, glycosylated hemoglobin (HbAc1), and self-reported T2DM in the Chilean adult population. MATERIALS AND METHODS: In a cross-sectional study, 4,874 participants were included (mean age 43.3 years, 50.9% women) from the 2016-2017 National Health Survey. ABSI was calculated according to the proposed formula (based on waist circumference, BMI, and height). The Poisson regression was used to investigate the association between ABSI and T2DM, and linear regression was used to investigate the association between ABSI, glycemia, and HbAc1. Sociodemographic factors, lifestyle, and BMI adjusted the analyses. RESULTS: ABSI was positively associated with glycemia (p < 0.001), HbA1c (p < 0.001), and DMT2 (p < 0.001). In the most adjusted model, for every 0.025 unit increase in ABSI, glycemia increased by 1.78 mg/dL (95% CI: 1.21, 2.35) and HbAc1 by 0.92% (95% CI: 0.49, 1.35). Regarding T2DM, the prevalence ratio was 1.14 (95% CI: 1.09, 1.20), independent of sociodemographic factors, lifestyles, and BMI. CONCLUSIONS: ABSI was linearly associated with a higher probability of suffering from T2DM and higher levels of glycemia and HbA1c in Chilean adults. In this context, ABSI could be a complementary index, independent of BMI, to assess the risk of metabolic disorders associated with obesity.

[Water intake in the Chilean population: Findings from the 2016-17 National Health Survey]. / Caracterización del consumo de agua en población chilena: resultados de la Encuesta Nacional de Salud 2016-2017.

BACKGROUND: Water is an essential nutrient for cellular homeostasis and life. Drinking ≥ 6 glasses (1.5 L/day) is the recommendation of daily water intake (RIAD). AIM: To characterize water intake, according to sociodemographic, anthropometric and lifestyles variables, in the Chilean adult population. MATERIAL AND METHODS: Analysis of data from 5,520 participants of the 2016-17 National Health Survey. Compliance with RIAD by population groups according to sociodemographic, anthropometric and lifestyle characteristics was studied through logistic regression analyses. RESULTS: Only 27.8% of the national population met the RIAD. Women, people over than 56 years of age, housewives, retired people, widowers, and non-smokers were less likely to meet the RIAD. The likelihood of not complying with RIAD in these segments of the population ranged from 28% to 62%. Conversely, participants who presented a higher likelihood of meeting RIAD were those who co-habiting, had a medium and higher educational level, followed a diet plan, and those who reported a good health and well-being. The likelihood of meeting with the RIAD for these population groups ranged from 47% to 116%. CONCLUSIONS: The likelihood of meeting the RIAD varied according to different sociodemographic, anthropometric, and lifestyle variables. Therefore, public policies for promoting water consumption should be focused on all age groups, but especially in those groups with the highest risk of underconsumption.

[Legume consumption in chileans: findings from the 2016-2017 national health survey]. / Caracterización del consumo de legumbres en población chilena: resultados de la Encuesta Nacional de Salud 2016-2017.

BACKGROUND: Legumes are low cost and high-quality nutritional foods. In Chile, a twice per week legume consumption is recommended to promote health and prevent disease. AIM: To characterize the consumption of legumes according to sociodemographic and anthropometric variables in the Chilean adult population. MATERIAL AND METHOD: Analysis of data from 5,473 participants of the 2016-2017 National Health Survey. The compliance with legume consumption was studied in population groups, according to sociodemographic and anthropometric characteristics, through logistic regression analyses. RESULTS: Only 24% of all participants (51.4% of women) fulfilled legume intake recommendations. After adjusting for sociodemographic variables, the participants who were less likely to comply with the recommendation were widowers (Odds Ratio (OR): 0.58 [95% confidence intervals (CI): (0.40; 0.85]). On the contrary, people between 70-80 years (OR: 1.78 [95% CI: 1.11; 2.88]), those who resided in rural areas (OR: 1.62 [95% CI: 1.25; 2.10]) and those who resided in the Maule region (OR: 2.11 [95% CI: 1.37, 3.25]) had a higher likelihood of compliance. CONCLUSIONS: One out of four Chileans complied with the recommendations of legume consumption. Even though the results differed when stratified by sex, it is highlighted that living in rural areas increased the probabilities of an adequate legume consumption.

[Comparison between self-reported and device measured physical activity according to nutritional status]. / Comparación de los niveles de actividad física medidos con cuestionario de autorreporte (IPAQ) con medición de acelerometría según estado nutricional.

BACKGROUND: It is unknown if nutritional status could influence the accuracy of self-reported physical activity (PA) levels. AIM: To compare PA measured using the international physical activity questionnaire (IPAQ) and by accelerometry (ActiGraph) according to nutritional status in Chilean adults. MATERIAL AND METHODS: This is an observational cross-sectional study that used information from the GENADIO project carried out in Chile between 2009-2011. The sample consisted of 322 people. PA levels and sitting time were determined through the IPAQ self-report questionnaire and ActiGraph accelerometers (GTM1). The nutritional status was determined according to body mass index (BMI). RESULTS: Compared with the measurement made with accelerometry, the IPAQ self-report questionnaire underestimated the levels of light PA, total PA and sedentary time in -171.5, -54.8 and -40.6 min / day, respectively. However, IPAQ overestimated the levels of moderate PA and vigorous PA in 91.0 and 47.3 min/day respectively, compared with accelerometry. Compared with normal weight, obese subjects reported higher levels of moderate PA (105.5 and 48.9 min/day, respectively) and vigorous PA (54.1 and 38.3 min/day respectively). Total PA had a greater delta of underestimation between IPAQ and accelerometer measurements in normal weight than in obese subjects (-122.1 vs -16.5 min/day, respectively). CONCLUSIONS: The measurement of PA by means of a self-report questionnaire was discrepant with its objective measurement with an accelerometer. The discrepancy is even higher in obese people.

[Physical activity and sedentary behaviors among people with cancer]. / Nivel de actividad física y sedentarismo en personas con diagnóstico de cáncer en Chile.

BACKGROUND: One of the side effects of cancer treatment is a low level of physical activity (PA) due to fatigue and pain. AIM: To quantify PA levels in Chilean people with cancer. MATERIAL AND METHODS: Analysis of the National Health Survey 2016-2017 including 6,233 participants, comparing those with and without a self-report of cancer was conducted. Levels of PA and sitting time were assessed using the Global Physical Activity Questionnaire. RESULTS: 3% of participants [confidence intervals (CI): 2.6; 3.9] reported having cancer and 34% [95% CI: 22.7; 46.7] of these reported being physically inactive, compared to 25% [95% CI: 22.5; 27,3] of those without cancer. Participants with cancer performed 56 and 77 minutes/day lower vigorous and total PA than participants without cancer. No differences between groups were observed for commuting PA, moderate PA and sedentary time. Lower level of PA was independent of the years elapsed since the diagnosis of cancer. CONCLUSIONS: People with cancer are less physically active than their counterparts without the disease.

[Association of menopause with cardiovascular risk. Analysis of data from the 2016-17 Chilean national health survey]. / Menopausia y factores de riesgo cardiovascular en mujeres chilenas.

BACKGROUND: Menopause exposes women to an increased cardiovascular risk. AIM: To determine the association between menopause and cardiovascular risk factors in Chilean adult women using data from the National Health Survey (NHS) 2016-2017. MATERIAL AND METHODS: Data from 2,139 women over 40 years of age participating in the NHS 2016-2017, with information about menopause and cardiovascular risk factors was used. Expansion factors were applied to this sample, obtaining an expanded sample of 3,733,191 participants. Laboratory values (blood glucose, triglycerides, HDL and total cholesterol) and anthropometric measurements (body weight, height and waist circumference) were analyzed. The presence of hypertension, diabetes, and metabolic syndrome (MetS) were also recorded. RESULTS: Sixty seven percent of surveyed women were menopausal and had higher systolic blood pressure than non-menopausal participants. Menopause was significantly associated with hypertension (Odds ratio (OR): 2.43 [95% confidence intervals (CI): 1.71; 3.45], p < 0.01) and diabetes (OR: 2.05 [95% CI: 1.32; 3.19], p < 0.01). However, no association was observed with obesity, abdominal obesity or MetS. CONCLUSIONS: In these women, a positive association was identified between menopause and hypertension as well as diabetes.

[Association between sleep duration and cognitive impairment in older people]. / ¿Cuál es la asociación entre el tiempo destinado a dormir y el desarrollo de deterioro cognitivo en adultos mayores chilenos?

Background Sleep duration may be a risk factor for cognitive impairment. Aim To investigate the association between sleep duration and cognitive function in Chilean older adults. Material and Methods We analyzed information from 1,384 participants aged > 60 years participating in the National Health Survey 2009-2010 who were assessed with the Mini Mental State Examination (MMSE) and self-reported their average daily sleep hours. Logistic regression analysis was performed to investigate the association between MMSE and sleep duration. Results Compared to those participants who reported sleeping 7 hours per day, those that reported sleeping < 5 hours had a higher odd for cognitive impairment (Odds ratio (OR): 3.66 [95% confidence intervals (CI: 1.69; 7.95], p < 0.01). Similarly, those who reported sleeping > 8 hours per day also showed a higher odd for cognitive impairment (OR: 2.56 [95% CI: 1.32; 4.95], p < 0.01). This association was even stronger for people who reported more than 10 hours of sleep per day (OR: 4.46 [95% CI: 1.32; 4.95], p < 0.01). Conclusions Long and short sleep duration is associated with cognitive impairment in older adults in Chile independent of major confounding 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.

[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.

[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.

[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.

[Being physically active modifies the detrimental effect of sedentary behavior on obesity and cardiometabolic markers in adults]. / Ser físicamente activo modifica los efectos nocivos del sedentarismo sobre marcadores de obesidad y cardiometabólicos en adultos.

BACKGROUND: Sedentary behavior is a major risk factor for cardiovascular disease and mortality. AIM: To investigate whether the associations between sedentary behavior and cardiometabolic markers differs across physical activity levels. MATERIALS AND METHODS: Cross sectional study of 314 participants aged 18 to 65 years. Body mass index (BMI) and waist circumference were measured, and body fat was derived from the sum of four skinfolds. Physical activity was measured objectively using accelerometers (Actigraph GT1M, USA®). A fasting blood sample was obtained to measure glucose, insulin, HOMA-IR, lipid profile and high sensitive C reactive protein (hsCRP). Those participants with an activity level > 600 MET.min-1.week-1 were classified as physically active. RESULTS: Thirty four percent of participants were physically inactive and spent an average of 8.7 h.day-1 in sedentary pursuits. Physically inactive individuals had poorer cardiometabolic health than their physically active counterparts. Per one hour decrease in overall sedentary behavior, there was a significant improvement in glucose (-8.46 and -4.68 mg.dl-1), insulin (-2.12 and -1.77 pmol.l-1), HOMA-IR (-0.81 and -0.56) BMI (-0.93 and -0.62 kg.m-2) and waist circumference (-2.32 and -1.65 cm) in physically active and inactive participants, respectively. CONCLUSIONS: Being physically active may modify the detrimental effects of sedentary behavior on cardiometabolic and obesity-related traits.

[Inverse association of cardiorespiratory fitness with cardiovascular risk factors in Chilean adults]. / Fitness cardiorrespiratorio se asocia a una mejora en marcadores metabólicos en adultos chilenos.

BACKGROUND: A high level of cardiorespiratory fitness (CRF) is an important protector against cardiovascular and metabolic diseases. AIM: To explore the association of CRF with several metabolic markers and estimate the variation of these parameters by an increase of 1 MET change in CRF. MATERIAL AND METHODS: Cross-sectional study of 447 adults (56% women) without medical history of cardiometabolic diseases. Physical activity evaluated using accelerometry, body mass index (BMI), blood pressure, blood glucose and insulin and lipid profile were measured. HOMA-IR was calculated with fasting glucose and insulin levels. The submaximal Chester Step Test was used to measure CRF. RESULTS: CRF was significantly associated with the level and intensity of physical activity, and all metabolic markers (p-trend < 0.05), except with diastolic blood pressure. It was estimated that 1-MET increase in CRF is associated with waist circumference (ß -0.32 cm), fat mass (ß -0.22%), insulin (ß -0.67 pmol.l-1), HOMA-IR (ß -0.17) and HDL cholesterol (ß +1.46 mg.dl-1). All these associations were independent of main covariates such as age, sex, education, smoking and body mass index. CONCLUSIONS: A higher level of CRF is inversely associated with several metabolic markers that are risk factors for cardiovascular disease.

[Higher physical activity levels are associated with lower prevalence of cardiovascular risk factors in Chile]. / Un mayor nivel de actividad física se asocia a una menor prevalencia de factores de riesgo cardiovascular en Chile: resultados de la Encuesta Nacional de Salud 2009-2010.

BACKGROUND: Little is known about the relationship between physical activity (PA) and cardiovascular risk factors in the Chilean population. AIM: To investigate the association between different levels and intensities of PA and the prevalence of cardiovascular (CV) risk factors in Chilean adults. MATERIAL AND METHODS: Data from the National Health Survey 2009-10 including 5157 participants, provided by the Epidemiology Department of the Ministry of Health, was analyzed in this study. The prevalence of type 2 diabetes mellitus, hypertension, metabolic syndrome and dyslipidemia were determined using international criteria. PA levels were determined using the Global Physical Activity Questionnaire (GPAQ v2) and different levels of PA were derived from it (transport-related, moderate and vigorous PA). Quartiles of PA were determined to investigate the association between PA and cardiovascular risk factors. RESULTS: Twenty three percent of women and 17.1% of men did not meet the PA recommendation (≥ 600 METs.min.week-1). When prevalence of CV risk factors were compared between inactive individuals (< 600 METs.min.week-1) and active individuals (≥ 9500 METs.min.week-1) a significantly lower prevalence of diabetes mellitus (6.2% and 10%), hypertension (18.0% and 12.4%) and metabolic syndrome (8.9% and 12.1%) for women and men, respectively, was found in the active participants. Similar results were found for high versus low transport-related PA. CONCLUSIONS: Increasing levels of PA are associated with a significantly lower frequency of cardiovascular risk factors in Chilean adults.