Effect of Insulin Resistance on Abdominal Obesity, Liver Fat Infiltration, and Body Mass Index in Youngsters.

AIM: Evaluate insulin resistance (IR) as a mediator of the effect of body fat distribution on liver fat infiltration and stiffness (LSt) in young adults using structural equation modeling (SEM). METHODS: We invited 500 first year students from two universities and evaluated their family history to determine the risk for cardiometabolic disease. Of these, 174 students (age 19 ± 1 years) were assessed for total body fat percentage (BF%), LSt, fat infiltration (Coefficient attenuated parameter CAP), and serum biochemical analysis. We performed a mediation analysis using two different structural equation models to determine the relationship between BMI, BF%, abdominal obesity (AO), IR, LSt, and fat infiltration using standardized ß coefficients. The symbol "->" means "explains/causes". RESULTS: Model#1 supported that mediation analysis and had a better fit than the direct effect. AO->IR (b = 0.62, p = 0.005), AO->CAP (b = 0.63, p <0.001), and CAP->IR (b = 0.23, p = 0.007), with negligible effect of BMI on CAP and IR. Model#2 showed direct effect of BMI on LSt was a better fit than mediation. BMI->LSt (b = 0.17, p = 0.05) but no effect AO->LSt. Interestingly, LSt->IR (b = 0.18, p = 0.001), but bi-directional IR->LSt (b = 0.23, p = 0.001). CONCLUSIONS: AO and BMI in young adults have differential phenotypic effects on liver CAP and LSt. Visceral fat had a direct effect on IR and CAP. Meanwhile, BMI was associated with LSt. Our findings shed light on the complex interplay of factors influencing liver stiffness, particularly in young individuals. Further research is needed to elucidate the precise mechanisms underlying these associations and their implications for liver health.

Fibromialgia en Chile: revisión de la literatura y propuesta para una futura política pública en atención primaria de salud / Fibromyalgia in Chile: literature review and proposal for a future public policy the primary healthcare system

Introducción: la fibromialgia (FM) es una enfermedad crónica caracterizada por dolor musculoesquelético y un espectro de síntomas somáticos. Se asocia a un alto costo y compromiso en la calidad de vida de los pacientes, razón por la que es necesaria una política pública en atención primaria de salud (APS) en Chile, que contribuya con el diagnóstico temprano, tratamiento y seguimiento. Métodos: revisión bibliográfica narrativa centrada en las características de la FM, tratamiento y políticas públicas vigentes (Chile, España y Uru-guay), utilizando PubMed, Cochrane, Epistemonikos, Google Scholar y GreyLit. La búsqueda se realizó desde el 3 de septiembre al 11 de diciembre de 2020. Resultados: la prevalencia global de la FM alcanza el 2,7%, con una proporción mujeres y hombres de 3:1. Se estima una prevalencia entre 1 a 2% y un alto impacto en la calidad de vida y un alto costo asociado a discapacidad. Uruguay y España han implementado políticas públicas para FM, con enfoque principal en atención de salud integral y plan de reinserción laboral. En Chile, no existe la incorporación de la FM en ningún programa de salud que garantice el acceso y tratamiento. Conclusión: la FM es una enfermedad polisintomática, que impacta en la calidad de vida de los pacientes. Dada su prevalencia a nivel nacional, retraso en el diagnóstico e inicio de un tratamiento, se ve justificada una política pública. En el presente artículo se propone la creación de Unidades de Fibromialgia en APS, cuyas características consideren aspectos de interdisciplinaridad y territorialidad que permitan un acceso rápido a diagnóstico, tratamiento, seguimiento, derivación oportuna a especialistas y educación a los pacientes y profesionales.

Introduction: Fibromyalgia (FM) is a chronic musculoskeletal disease related to a somatic symptoms spectrum. It is associated with high economic costs and the deterioration of patients' quality of life. That explains why a public policy in the primary healthcare system (PHS) is necessary for Chile to contribute to early diagnosis, treatment, and follow-up. Methods: Narrative bibliographic review, focused on the FM clinical characteristics, their treatment, and current public policies about FM in Chile, Spain, and Uruguay. We utilized PubMed, Cochrane, Epistemonikos, Google Scholar, and Greylist as search engines from September 3rd to December 11th, 2020. Results: The FM global prevalence is 2.7%, with a proportion female: male 3:1, and in Chile is between 1.1% to 3.9%, with a high impact on the quality of life and high cost related to disability. Uruguay and Spain have implemented public policies about FM, especially in diagnosis and treat-ment. In Chile, there are not any health programs that guarantee access and early treatment to FM. Conclusion: FM is a polysymptomatic disease, which impacts to quality of life of patients. Given its prevalence in Chile, and the delay in diagnosis and treatment, a public policy is justified. This article proposes the creation of Fibromyalgia Units in PHC whose characteristics consider aspects of interdisciplinary and territorial that allow access and opportune treatment to FM, follow-up, timely referral to specialists, and pain education to patients.