Associations of diabesity with all-cause and cardiovascular disease mortality: Findings from the Mexico City Prospective Study.

AIM: To investigate the joint associations of diabetes and obesity with all-cause and cardiovascular disease (CVD) mortality in the Mexico City Prospective Study. MATERIALS AND METHODS: In total, 154 128 participants (67.2% women) were included in this prospective analysis. Diabetes was self-reported, while body mass index was used to calculate obesity. Using diabetes and obesity classifications, six groups were created: (a) normal (no diabetes and normal weight); (b) normal weight and diabetes; (c) overweight but not diabetes (overweight); (d) overweight and diabetes (prediabesity); (e) obesity but not diabetes (obesity); and (f) obesity and diabetes (diabesity). Associations between these categories and outcomes were investigated using Cox proportional hazard models adjusted for confounder factors. RESULTS: During 18.3 years of follow-up, 27 197 (17.6%) participants died (28.5% because of CV causes). In the maximally adjusted model, participants those with the highest risk {hazard ratio (HR): 2.37 [95% confidence interval (CI): 2.24-2.51]}, followed by those with diabesity [HR: 2.04 (95% CI: 1.94-2.15)]. Similar trends of associations were observed for CVD mortality. The highest CV mortality risk was observed in individuals with diabesity [HR: 1.80 (95% CI: 1.63-1.99)], followed by normal weight and diabetic individuals [HR: 1.78 (95% CI: 1.60-1.98)]. CONCLUSION: This large prospective study identified that diabetes was the main driver of all-cause and CVD mortality in all the categories studied, with diabesity being the riskiest. Given the high prevalence of both conditions in Mexico, our results reinforce the importance of initiating prevention strategies from an early age.

Predictive ability of both the healthy aging index and the frailty index for all-cause mortality.

AIM: We aimed to develop and assess a modified healthy aging index (HAI) among Chileans aged 60 years and older and compare its predictive ability for all-cause mortality risk with the frailty index (FI). METHODS: This prospective study analyzed data from the Chilean National Health Survey (CNHS) conducted in 2009-2010. We included 847 adults with complete data to construct the HAI and FI. The HAI comprised five indicators (lung function, systolic blood pressure, fasting glucose, cognitive status, and glomerular filtration rate), while the FI assessed frailty using a 36-item scale. HAI scores were calculated by summing the indicator scores, ranging from 0 to 10, with higher scores indicating poorer health. Receiver operating curves (ROC) and area under the curve (AUC) were used to assess predictive validity. Associations with all-cause mortality were assessed using Cox proportional hazard models adjusted by confounders. RESULTS: The mean HAI score was 4.06, while the FI score was 0.24. The AUC for mortality was higher for the HAI than the FI (0.640, 95% confidence interval (CI) 0.601 to 0.679 vs. 0.586, 95% CI 0.545 to 0.627). After adjusting for confounders, the FI showed a higher mortality risk compared to the HAI (2.63, 95% CI 1.76 to 3.51 vs. 1.16, 95% CI 1.08 to 1.26). CONCLUSION: The FI and HAI were valid predictors for all-cause mortality in the Chilean population. Integrating these indices into research and clinical practice can significantly enhance our capacity to identify at-risk individuals.

Adaptation and validation of the Weight Efficacy Lifestyle Questionnaire (WEL) in a Chilean sample.

Self-efficacy is a cognitive-emotional factor that is consistently associated with behavioral change and, in particular, with changes in health behavior. Eating self-efficacy, understood as adopting and maintaining behaviors such as controlling one's weight and trusting in one's ability to control one's eating behavior, has been proposed for managing obesity. This study aimed to validate the Chilean version of the Weight Efficacy Lifestyle Questionnaire (WEL) in a sample of adults from the general population. Four hundred sixty-nine individuals (69.08% women, mean age = 38.02; SD = 10.31) participated in the study. An instrumental design was used geared toward developing tests and psychometric instruments, including adapting existing ones. Exploratory and confirmatory factor analyses were performed. The instrument version validated in Spain was applied in the study. The analysis obtained an instrument of 11 items with adequate psychometric properties allowing its use in clinical and research settings. It can help assess eating self-efficacy in the general population.

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.

Association of Sitting Time With All-Cause and Cardiovascular Mortality: How Does Frailty Modify This Association?

To investigate how frailty modifies the association of sitting time with all-cause and cardiovascular mortality in Chilean adults. This prospective study included 2,604 participants aged ≥35 from the Chilean National Health Survey 2009-2010. Sitting time was self-reported, while frailty was assessed using a 36-item Frailty Index. Sitting time was categorized as low, medium, and high. Cox proportional hazard models were used to estimate the risk of mortality stratified for the sitting time categories. Over a median follow-up of 8.9 years, 311 participants died, 28% of them due to cardiovascular events. Frail people with prolonged sitting time were at higher risk of all-cause and cardiovascular mortality (hazard ratio 3.13; 95% confidence interval [2.06, 4.71] and hazard ratio 2.41; 95% confidence interval [1.50, 3.64], respectively). The observed risk was higher in women than men. Public health and individual strategies should be implemented to decrease sitting time across the population, with special attention on frail people.

Multimorbidity and 11-year mortality in adults: a prospective analysis using the Chilean National Health Survey.

Research on morbidity and mortality often emphasizes individual diseases over the cumulative effects of multimorbidity, especially in low- and middle-income countries. This study aimed to analyze the association between multimorbidity and all-cause mortality in a representative sample of the Chilean population. This longitudinal study used data from 3701 subjects aged ≥15 years who participated in the Chilean National Health Survey conducted between 2009 and 2010. We included 16 self-reported highly prevalent morbidities. All-cause mortality data from an 11-year follow-up were collected from the Chilean Civil Registry. The Cox proportional hazard model, adjusted for confounders, determined the association between multimorbidity categories and all-cause mortality. Of the total sample, 24.3% reported no morbidity, while 50.4% two or more. After adjustment, participants with four or more morbidities had a 1.66 times higher mortality risk [95% confidence interval (CI): 1.03-2.67] than those without morbidities. The mortality risk increased by 10% for each additional morbidity [HR: 1.09 (CI: 1.04-1.16)]. Multimorbidity was common in the Chilean population and increased the mortality risk, which greatly challenges the health system to provide an integral and coordinated approach to healthcare.

Latent class analyses of multimorbidity and all-cause mortality: A prospective study in Chilean adults.

Multimorbidity patterns can lead to differential risks for all-cause mortality. Within the Chilean context, research on morbidity and mortality predominantly emphasizes individual diseases or combinations thereof, rather than specific disease clusters. This study aimed to identify multimorbidity patterns, along with their associations with mortality, within a representative sample of the Chilean population. 3,701 participants aged ≥18 from the Chilean National Health Survey 2009-2010 were included in this prospective study. Multimorbidity patterns were identified from 16 chronic conditions and then classified using latent class analyses. All-cause mortality data were extracted from the Chilean Civil Registry. The association of classes with all-cause mortality was carried out using Cox proportional regression models, adjusting by sociodemographic and lifestyle variables. Three classes were identified: a) Class 1, the healthiest (72.1%); b) Class 2, the depression/cardiovascular disease/cancer class (17.5%); and c) Class 3, hypertension/chronic kidney disease class (10.4%). Classes 2 and 3 showed higher mortality risk than the healthiest class. After adjusting, Class 2 showed 45% higher mortality risk, and Class 3 98% higher mortality risk, compared with the healthiest class. Hypertension appeared to be a critical underlying factor of all-cause morbidity. Particular combinations of chronic diseases have a higher excess risk of mortality than others.

A scoping review of food and nutrition literacy programs.

The impact of food literacy (FL) and nutrition literacy (NL) programs on lifestyles and health is recognized in the literature, yet few studies systematize it. This study aims to deepen the understanding of FL/NL from the characterization of programs in terms of (i) theoretical foundations, conceptualization and measuring instruments; (ii) characterization of the FL/NL programs and results and (iii) limitations and future directions declared. A scoping review of original articles addressing FL/NL programs from the Web of Science, Scopus and PubMed databases published between 2015 and 2023. There was a somewhat restricted view of the construct and the absence of a clear boundary between FL and NL. Half of the studies reported theoretical foundations. The most used model was Social Cognitive Learning Theory. More significant development of programs was observed in Australia, using quasi-experimental designs. Most of the studies informed positive results. Limitations of the studies related to the sampling process, absence of a control group and lack of follow-up. It is suggested that long-term interventions consider economic, social and cultural factors. Despite that theoretical and empirical aspects should be revised, FL/NL programs are a suitable strategy to mitigate the social and health effects of inadequate nutrition.

[Association between oral health and cognitive decline in older Chileans]. / Asociación entre salud oral y deterioro cognitivo en personas mayores chilenas.

OBJECTIVE: To identify the association between oral health and suspected cognitive impairment in older adults in Chile. METHOD: Cross-sectional study including 1826 people ≥60 years who participated in the National Health Survey of Chile, 2016-2017. Oral health was evaluated by the number of teeth, presence of caries, use of dental prostheses, self-reported oral health, and pain and/or discomfort in the oral cavity. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). The association was evaluated by logistic and linear regression, adjusted for sociodemographic and lifestyle variables. RESULTS: Compared with people without suspicion of cognitive impairment, people with suspected impairment had five fewer teeth (13.4 vs. 8.5 teeth), a much higher difference in women than in men, and a higher frequency of oral pain. Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment, associations that were not maintained in adjusted models. Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model (odds ratio: 1.99; 95% confidence interval [95%CI]: 1.09-3.63). In linear models, an increase of 2% (95%CI: 0.01-0.05) in the MMSE score was observed for each additional tooth. CONCLUSIONS: Poor oral health, particularly tooth loss and the presence of pain, was associated with cognitive impairment in older adults in Chile.

Frailty Index as a Predictor of Mortality in Middle-Aged and Older People: A Prospective Analysis of Chilean Adults.

We aimed to investigate the association between frailty status and all-cause mortality in middle-aged and older people. We included 2661 individuals aged ≥ 35 from the Chilean National Health Survey 2009−2010. Mortality was determined through linkage with the Chilean Civil Registry and Identification. A 36-item frailty index (FI) was used to assess the frailty status. Associations between frailty status and all-cause mortality were assessed using Kaplan−Meier and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. A non-linear association was investigated using penalized cubic splines fitted in the Cox models. During an 8.9 median follow-up (interquartile range of 8.6−9.0), 308 individuals died (11.5%). Lower survival rates were observed in frail individuals compared to pre-frail and robust people (log-rank < 0.001). Compared with robust individuals, frail people had a higher mortality risk (HR: 2.35 [95% CI: 1.57 to 3.51]). Frail middle-aged individuals had a higher risk of dying independently of major risk factors.

[Association between low vitamin D levels and cognitive impairment in Chilean older adults: findings of the National Health Survey 2016-2017]. / Asociación entre bajos niveles de vitamina D y deterioro cognitivo en personas mayores chilenas: Resultados de la Encuesta Nacional de Salud 2016-2017.

INTRODUCTION: Recent studies have shown that low vitamin D levels constitute a potential risk factor for the development of cognitive impairment. The present study aimed to investigate the association between vitamin D levels and the suspicion of cognitive impairment in Chilean older adults. MATERIAL AND METHOD: We performed a cross-sectional study, including 1,287 participants ≥ 65 years (56.8% were women, age range 65 to 97 years) from the Chilean National Health Survey. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE). Participants were classified into three groups according to their vitamin D levels (> 29 ng/ml sufficient, 12-29 ng/ml deficit, and < 12 ng/ml severe deficit). The association between vitamin D levels and cognitive impairment was explored using logistic regression analysis, adjusted for confounding factors. RESULTS: The prevalence of vitamin D deficit and vitamin D severe deficit was 37.7% and 21.0%, respectively. Compared to older adults with sufficient levels of vitamin D, those with severe deficits had a 94% (OR: 1.94 [95% IC: 1.27; 1.66], p = 0.002) higher odds of cognitive impairment (unadjusted model). Adjusting according to sociodemographic factors, lifestyle, adiposity, sunlight exposure, and multimorbidity slightly attenuated the association to 61% (OR: 1.61 [95%IC: 1.03; 2.19], p = 0.046), but remain significant. CONCLUSION: A severe deficit of vitamin D was associated with higher odds of cognitive impairment in Chilean older adults independent of major confounding factors. Future studies are needed to provide causal evidence between vitamin D and the suspicion of cognitive impairment.

Asociación entre salud oral y deterioro cognitivo en personas mayores chilenas / Association between oral health and cognitive decline in older Chileans

Objetivo: Identificar la asociación entre salud oral y sospecha de deterioro cognitivo en personas mayores chilenas. Método: Estudio transversal con 1826 participantes ≥60 años de la Encuesta Nacional de Salud de Chile, 2016-2017. La salud oral fue evaluada por el número de dientes, la presencia de caries, el uso de prótesis dental y el autorreporte de salud oral y dolor en la cavidad oral. La sospecha de deterioro cognitivo fue evaluada mediante el Mini-Mental State Examination (MMSE). Se empleó regresión logística y lineal, ajustada por variables sociodemográficas y de estilos de vida. Resultados: En comparación con personas sin sospecha de deterioro cognitivo, aquellas con sospecha de deterioro cognitivo presentaron cinco dientes menos (13,4 vs. 8,5 dientes), diferencia muy superior en mujeres que en hombres, y mayor frecuencia de dolor oral. El edentulismo y el menor número de dientes se asociaron a mayor probabilidad de sospecha de deterioro cognitivo, asociaciones que no se mantuvieron en modelos ajustados. El dolor oral se asoció a mayor probabilidad de sospecha de deterioro cognitivo (odds ratio: 1,99; intervalo de confianza del 95% [IC95%]: 1,09-3,63). Por cada diente adicional se observó un aumento del 2% (IC95%: 0,01-0,05) en la puntuación del MMSE. Conclusiones: La mala salud oral, en particular la pérdida de dientes y la presencia de dolor, se asociaron con deterioro cognitivo en personas mayores chilenas. (AU)

Objective: To identify the association between oral health and suspected cognitive impairment in older adults in Chile. Method: Cross-sectional study including 1826 people ≥60 years who participated in the National Health Survey of Chile, 2016-2017. Oral health was evaluated by the number of teeth, presence of caries, use of dental prostheses, self-reported oral health, and pain and/or discomfort in the oral cavity. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). The association was evaluated by logistic and linear regression, adjusted for sociodemographic and lifestyle variables. Results: Compared with people without suspicion of cognitive impairment, people with suspected impairment had five fewer teeth (13.4 vs. 8.5 teeth), a much higher difference in women than in men, and a higher frequency of oral pain. Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment, associations that were not maintained in adjusted models. Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model (odds ratio: 1.99; 95% confidence interval [95%CI]: 1.09-3.63). In linear models, an increase of 2% (95%CI: 0.01-0.05) in the MMSE score was observed for each additional tooth. Conclusions: Poor oral health, particularly tooth loss and the presence of pain, was associated with cognitive impairment in older adults in Chile. (AU)

Asociación entre velocidad de marcha y deterioro cognitivo en personas mayores: resultados de la Encuesta Nacional de Salud 2016-2017

Antecedentes: La velocidad de la marcha podría considerarse un marcador temprano de riesgo de deterioro cognitivo en personas mayores. Objetivo: Determinar la asociación entre velocidad de la marcha y sospecha de deterioro cognitivo en población mayor chilena. Métodos: Se incluyeron 1788 personas mayores de la Encuesta Nacional de Salud (ENS) 2016-2017 que tenían información sobre velocidad de marcha y sospecha de deterioro cognitivo. La velocidad de la marcha fue autorreportada y categorizada como marca lenta, normal y rápida. Sospecha de deterioro cognitivo fue evaluado a través del cuestionario Mini Mental abreviado. La asociación entre marcha y deterioro cognitivo fue investigada mediante análisis de regresión logística. Resultados: En comparación a las personas mayores que reportaron una velocidad de marcha rápida, aquellas que reportaron una marcha lenta presentaron 2,67 veces mayor probabilidad de tener deterioro cognitivo (OR: 2,67 [95% IC:1,62; 4,42], p<0,001). Al ajustar los modelos por variables de confusión sociodemográficas, estilos de vida y salud, la asociación disminuyó, pero, permaneció significativa (OR: 1,78 [95% IC:1,15; 3,17], p=0,047). Mientras que las personas mayores que reportaron tener una velocidad de marcha normal no presentaron asociación con deterioro cognitivo. Conclusión: Personas mayores que reportan una velocidad de marcha lenta presentaron una mayor probabilidad de sospecha de deterioro cognitivo. Considerando que el deterioro cognitivo es un síndrome geriátrico con alta prevalencia en población mayor, existe la necesidad de enfatizar en estrategias para un diagnóstico temprano, por lo cual la velocidad de marcha podría ser un instrumento útil.

Background: Walking pace could be considered an early risk marker of cognitive impairment in older people. Objective: To determine the association between walking pace and cognitive impairment in older Chilean adults. Methods: 1,788 adults older than 60 years from the 2016-2017 Chilean National Health Survey with data available in the exposure and outcome were included in this cross-sectional study. Walking pace was self-reported and categorised as slow, average and brisk. Cognitive impairment was assessed using the Abbreviated Mini-Mental questionnaire. Logistic regression analyses were performed to investigate the association between walking pace and cognitive impairment, logistic regression analyses - adjusted for sociodemographic, lifestyle and health-related covariates. Results: In the minimally adjusted model and compared to older adults who self-reported a brisk walking pace, those in the slow walking pace category were 2.67 times more likely to have cognitive impairment (OR: 2.67 [95% CI: 1.62, 4.42]). When the analyses were adjusted, the association was attenuated but remained significant (OR: 1.78 [95% CI: 1.15 3.17]). No associations were found between average pace walkers and cognitive impairment. Conclusion: Older adults who self-reported a slow walking pace having a higher likelihood of cognitive impairment than their counterparts who had a brisk walking pace. Considering that cognitive impairment is a geriatric syndrome with a high prevalence in the elderly, there is a need to emphasise strategies for an early diagnosis. Therefore, walking pace may be a useful marker to identify individuals at high risk of cognitive impairment.

Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017 / Association between educational level and suspicion of cognitive imparirment in Chilean older people

BACKGROUND: A low education level has been associated with cognitive impairment in older adults. AIM: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. MATERIAL AND METHODS: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. RESULTS: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. CONCLUSIONS: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Association between bodyweight perception, nutritional status, and weight control practices: A cross-sectional analysis from the Chilean Health Survey 2016-2017.

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016-2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

Relationships between Individual and Social Resources, Anxiety and Depression in the Early Lockdown Stage by the COVID-19 in Chile.

The coronavirus disease has exposed the population to psychosocial threats that could increase mental health problems. This research analyzed the relationships between emotional states (negative [−EWB] and positive [+EWB] experienced well-being), personal resources (resilient coping [RC]), dispositional resources (control beliefs about stress [BAS]), and social resources (social support [SS]), and anxiety and depressive symptoms in a sample of the Chilean population (n = 592), who answered an online questionnaire. Multiple and moderated multiple regression analyses were carried out. Depressive symptoms showed a positive relationship with −EWB (ß = 0.805; p < 0.001) and negative relationship with +EWB (ß = −0.312; p < 0.001), RC (ß = −0.089; p < 0.01), BAS (ß = −0.183; p < 0.001) and SS (ß = −0.082; p < 0.001). Anxiety symptoms showed a positive relationship with −EWB (ß = 0.568; p < 0.001), and a negative relationship with +EWB (ß = −0.101; p < 0.03) and BAS (ß = −0.092; p < 0.001). BAS moderated the relationship between experienced well-being and depression symptoms, and RC moderated the relationship between experienced well-being with both depression and anxiety symptoms. Findings confirm the buffering effect of personal and dispositional resources when facing a sanitary and social crisis. Moreover, they help to understand the role of internal psychological processes during a crisis and how to cope with life-threatening events.

Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review.

eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. OBJECTIVE: Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. METHOD: An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. RESULTS: Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. CONCLUSIONS: eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.

Estado afectivo, regulación emocional y estilos de alimentación en adultos en Chile

RESUMEN El comportamiento alimentario está intrínsecamente asociado al estado afectivo y las emociones dominantes. Esta investigación se propuso analizar la asociación entre afectividad, sintomatología ansiosa y depresiva, regulación emocional, estilos de alimentación desadaptativos: alimentación restrictiva, emocional y externa, y alimentación intuitiva. Se realizó un estudio transversal, de tipo correlacional, en el que participaron 648 adultos de ambos sexos, residentes en Chile. Se recogieron datos de las siguientes variables e instrumentos: afecto dominante con el Positive Affect and Negative Affect Schedule (PANAS); síntomas de depresión y ansiedad con dos preguntas de respuesta cerrada, dificultades de regulación emocional, con Difficulties in Emotion Regulation Scale (DERS); estilos de alimentación con el Dutch Eating Behaviour Questionnaire (DEBQ) y alimentación intuitiva con la Intuitive Eating Scale (IES-2). Se realizaron análisis de correlación y regresión lineal multivariada. Ser mujer y presencia de afecto negativo predijeron los estilos de alimentación desadaptativo emocional y restrictivo. El afecto positivo se asoció a un estilo de alimentación externo. Los tres estilos de alimentación desadaptativos evaluados se asociaron a dificultades de regulación emocional. Por el contrario, la alimentación intuitiva se asoció a ser hombre, afectividad positiva y ausencia de dificultades de regulación emocional. Se confirma la asociación entre la experiencia emocional y los estilos de alimentación y se enfatiza el rol de la regulación emocional como recurso psicológico relevante para prevenir el potencial efecto disfuncional de las emociones en el comportamiento alimentario.

ABSTRACT Eating behavior is intrinsically associated with the affective state and dominant emotions. This research set out to analyze the association between affectivity, anxious and depressive symptoms, emotional regulation, maladaptive eating styles, and intuitive eating. A cross-sectional, correlational study was carried out. Participants were 648 adults of both sexes, residents of Chile. Data were collected on the following variables and instruments: dominant affect with the Positive Affect and Negative Affect Schedule (PANAS); emotional regulation difficulties, with Difficulties in Emotion Regulation Scale (DERS); eating styles with the Dutch Eating Behavior Questionnaire (DEBQ) and intuitive eating with the Intuitive Eating Scale (IES-2). Correlation analysis and multivariate linear regression were performed. Being a woman and the presence of negative affect predicted emotional and restrictive eating styles. Positive affect was associated with an external eating style. The three maladaptive eating styles evaluated were associated with emotional regulation difficulties. On the contrary, intuitive eating was associated with being a man, positive affectivity, and the absence of emotional regulation difficulties. The association between emotional experience and eating styles was confirmed emphasizing the role of emotional regulation as a relevant psychological resource to prevent the potential dysfunctional effect of emotions on eating behavior.