Calidad de Vida en Pacientes Hemodializados de la Comuna de Chillán Viejo / Quality of Life in Hemodialyzed Patients From the Commune of Chillán Viejo

Resumen Introducción: La enfermedad renal crónica afecta a los riñones de forma irreversible, generando un gran impacto emocional en el paciente y su entorno familiar y social; determina cambios en los hábitos alimentarios, físicos y sociales perturbando, de esta manera, su calidad de vida. Objetivo: Valorar la calidad de vida de pacientes que se encuentran en tratamiento hemodialítico de la comuna de Chillán Viejo. Material y métodos: Diseño descriptivo, de corte transversal, no experimental. Fue implementado en una población de 62 pacientes en tratamiento de hemodiálisis en Chile. Se utilizó el cuestionario Kidney Disease and Quality of Life (KDQOL), que presenta puntajes de satisfacción entre 0 a 100, para evaluar calidad de vida en hemodializados. Resultados: Según sus medias de logros, las dimensiones más afectadas son: salud general (30,65 ±21,81), rol físico (23,15 ±31,4), carga de la enfermedad renal (25,46±20,49), situación laboral (23,15±35,97), función cognitiva (22,59±20,70) y calidad de las relaciones sociales (22,22±23,13).Conclusiones: Es importante poner en práctica actividades educativas y de prevención destinadas a pacientes que realizan diálisis, para evitar posibles complicaciones asociadas a la enfermedad renal y sus comórbidas, disminuir el deterioro de su calidad de vida y promover el apoyo al paciente y su familia.

Abstract Introduction: Chronic kidney disease affects the kidneys irreversibly, creating a great emotional impact on the patient and their family and social environment, and making changes in eating, physical and social habits, which disturb, in this way, their quality of life. Objective: To assess the quality of life of patients undergoing hemodialysis treatment in the commune of Chillán Viejo. Methods: A descriptive, cross-sectional, non-experimental study was conducted. It was implemented in a population of 62 patients undergoing hemodialysis treatment in Chile. The Kidney Disease and Quality of Life (KDQOL) survey, which presents satisfaction scores between 0 and 100, was used to assess quality of life in hemodialysis patients. Results: According to their average of achievement, the most affected dimensions are: general health (30.65 ± 21.81), physical role (23.15 ± 31.4), burden of kidney disease (25.46 ± 20,49), employment status (23.15 ± 35.97), cognitive function (22.59 ± 20.70) and quality of social relations (22.22 ± 23.13). Conclusions: It is important to implement educational and prevention activities aimed at patients who are on dialysis, so as to avoid possible complications associated with kidney disease and its comorbid diseases, reduce the deterioration of their quality of life and promote support for the patient and their family.

Rescue flap: alternativa de colgajo en cirugía de base de cráneo / Rescue flap: alternative in skull base surgery

RESUMEN Introducción: La elaboración de colgajos ha representado un cambio en reconstrucción de defectos resultantes de exéresis de tumoraciones de base de cráneo. No siempre indispensables, existen circunstancias, planificados o no, donde debemos emplearlos. Preservando los pedículos de la mucosa, damos cobertura a urgencias intraquirúrgicas, como fístula LCR no sospechada, así como reintervenciones. Objetivo: Presentar nuestra experiencia en pacientes, a quienes hemos realizado colgajo tipo rescue flap. Material y método: Se diseña este colgajo, sin comprometer su pedículo. En caso de fístula, sospecha de ésta o herniación del diafragma selar, se extiende, cubriendo el defecto. Resultados: De 34 pacientes intervenidos de patología hipofisaria endoscópicamente, en 18 diseñamos colgajo tipo rescue flap. 12 casos se elaboraron, no utilizándolos. En 4 pacientes con extenso tumores lo empleamos preventivamente. En 1 caso, de reintervención, previamente con colgajo Hadad izquierdo, realizamos colgajo de mucosa contralateral. En otro, diseñamos un rescue flap derecho, al objetivar salida de LCR, sellamos con este colgajo. No evidenciamos fístulas. Discusión: Esta técnica consiste en levantar parcialmente mucosa del potencial colgajo, preservando su pedículo, pudiendo utilizarse en casos de fístula LCR no programada, o reintervenciones. Sin realizar colgajos innecesariamente. Conclusión: La técnica rescue flap favorece un corredor quirúrgico, menos invasivo, manteniendo mucosa para eventuales reintervenciones.

ABSTRACT Introduction: The development of flaps has represented a change in reconstruction of defects resulting from excision of skull base tumors. It not always indispensable, there are circumstances, planned or not, where we must use them. Preserving the pedicles of the mucosa, we cover intraoperative emergencies, such as unsuspected CSF fistula, as well as reinterventions. Aim: We present our experience where we performed rescue flap. Material and method: This flap is designed without compromising its pedicle. In case of fistula, suspicion of this or herniation of the selar diaphragm, it extends, covering the defect. Results: Of 34 patients who underwent endoscopic surgery for pituitary pathology, in 18 we designed a rescue flap. 12 cases were made, not using them. In 4 patients with extensive tumors we used it preventively. In 1 case, of reintervention previously with left Hadad flap, we performed contralateral mucosa flap. In another, we designed a right rescue flap, when we observed LCR output, we seal with this flap. We did not show fistulas. Discussion: This technique consists in partially lifting the mucosa of the potential flap, preserving its pedicle, and may be used in cases of unscheduled CSF fistula, or reinterventions. Without flapping unnecessarily. Conclusions: The Rescue Flap technique favors a less invasive surgical corridor, maintaining mucosa for posible reinterventions.

Effects of Two Training Modalities on Body Fat and Insulin Resistance in Postmenopausal Women.

Henríquez, S, Monsalves-Alvarez, M, Jimenez, T, Barrera, G, Hirsch, S, de la Maza, MP, Leiva, L, Rodriguez, JM, Silva, C, and Bunout, D. Effects of two training modalities on body fat and insulin resistance in postmenopausal women. J Strength Cond Res 31(11): 2955-2964, 2017-Our objective was to compare the effects of a low-load circuit resistance training protocol and usual aerobic training in postmenopausal women. Postmenopausal women with at least 1 feature of the metabolic syndrome were randomly allocated to a low-load circuit resistance training protocol or traditional aerobic training in a braked cycle ergometer. The intervention consisted in supervised sessions lasting 40 minutes, 3 times per week, during 6 months. At baseline and at the end of the intervention, fasting serum lipid levels, serum interleukin 6, C-reactive protein, 8 isoprostanes, and insulin resistance (assessed through QUICKI and HOMA-IR) were measured. Body fat was measured by double-beam X-ray absorptiometry and by computed tomography densitometric quantification at lumbar 3 vertebral level. Twenty-one women aged 58 (54-59) years were allocated to aerobic training and 21 women aged 55 (52-61) years were allocated to the low-load circuit resistance training protocol. Eighteen and 16 women in each group completed the 6 months training period. Women in both groups experienced significant reductions in blood pressure, total body, subcutaneous, and intraabdominal body fat. Reductions in total cholesterol and triacylglycerol levels were also observed. No changes in insulin resistance indexes, 8 isoprostanes, C-reactive protein, or interleukin 6 were observed in either group. No significant differences between treatment groups were observed in any of the measured parameters. We conclude that low-load circuit resistance training and aerobic training resulted in the same reductions in body fat and serum lipid levels.

Glucocorticoid resistance in chronic diseases.

Glucocorticoids are involved in several responses triggered by a variety of environmental and physiological stimuli. These hormones have a wide-range of regulatory effects in organisms. Synthetic glucocorticoids are extensively used to suppress allergic, inflammatory, and immune disorders. Although glucocorticoids are highly effective for therapeutic purposes, some patients chronically treated with glucocorticoids can develop reduced glucocorticoid sensitivity or even resistance, increasing patient vulnerability to exaggerated inflammatory responses. Glucocorticoid resistance can occur in several chronic diseases, including asthma, major depression, and cardiovascular conditions. In this review, we discuss the complexity of the glucocorticoid receptor and the potential role of glucocorticoid resistance in the development of chronic diseases.

FACTORS RELATED TO TOTAL ENERGY EXPENDITURE IN OLDER ADULTS (CHILE).

AIM: to asses Total Energy Expenditure (TEE) in healthy Chilean institutionalized or independently older people Methods: twenty seven young (27-30 years), 27 institutionalized (> 65 years old) and 27 free-living older (> 65 years old) participants were studied. Body composition was estimated by dual energy X-ray absorptiometry. Physical activity energy expenditure (AEE) and TEE were assessed using Actiheart accelerometers. The Mini Nutritional Assessment (MNA) was applied and Timed Up and Go (TUG) was measured. RESULTS: AEE was 171, 320 and 497 kcal/day in institutionalized, free living older and young participants, respectively (p < 0.01 between young and older participants). Both absolute TEE and TEE/RMR was higher in young people. Multiple regression analysis accepted age, MNA and TUG as significant predictors of AEE (r2 = 0.24 p < 0.01). CONCLUSION: AEE and PAL were lower among older people, with no differences by institutionalization.

Objetivo: evaluar el Gasto Energético Total (GET) en ancianos sanos que viven institucionalizados o independientes en Chile. Método: se evaluaron veintisiete jovenes (27-30 años), 27 adultos mayores institucionalizados (> 65 años ) y 27 ancianos independientes (> 65 años). Se midió la composición corporal utilizando absorciometría bifotónica de rayos X. Se calculó el gasto energético por actividad física (GEAF) y el gasto energético total (GET) utilizando acelerómetros Actiheart; se aplicó Mini Nutritional Assessment (MNA) y se midió el Timed Up and Go (TUG). Resultados: el GEAF fue 171, 320 y 497 kcal/día en ancianos institucionalizados, independientes y jóvenes, respectivamente (p.

Factors related to total energy expenditure in older adults (Chile) / Factores relacionados con el gasto energético total en adultos mayores (Chile)

Aim: to asses Total Energy Expenditure (TEE) in healthy Chilean institutionalized or independently older people Methods: twenty seven young (27-30 years), 27 institutionalized (> 65 years old) and 27 free-living older (> 65 years old) participants were studied. Body composition was estimated by dual energy X-ray absorptiometry. Physical activity energy expenditure (AEE) and TEE were assessed using Actiheart accelerometers. The Mini Nutritional Assessment (MNA) was applied and Timed Up and Go (TUG) was measured. Results: AEE was 171, 320 and 497 kcal/day in institutionalized, free living older and young participants, respectively (p< 0.01 between young and older participants). Both absolute TEE and TEE/RMR was higher in young people. Multiple regression analysis accepted age, MNA and TUG as significant predictors of AEE (r2 = 0.24 p< 0.01). Conclusion: AEE and PAL were lower among older people, with no differences by institutionalization (AU)

Objetivo: evaluar el Gasto Energético Total (GET) en ancianos sanos que viven institucionalizados o independientes en Chile. Método: se evaluaron veintisiete jóvenes (27-30 años), 27 adultos mayores institucionalizados (> 65 años) y 27 ancianos independientes (> 65 años). Se midió la composición corporal utilizando absorciometría bifotónica de rayos X. Se calculó el gasto energético por actividad física (GEAF) y el gasto energético total (GET) utilizando acelerómetros Actiheart; se aplicó Mini Nutritional Assessment (MNA) y se midió el Timed Up and Go (TUG). Resultados: el GEAF fue 171, 320 y 497 kcal/día en ancianos institucionalizados, independientes y jóvenes, respectivamente (p <0,01 entre jóvenes y ancianos). Tanto el valor absoluto de GET como GET/GER fue más alto entre los jóvenes. El análisis de regresión múltiple aceptó la edad, el MNA y el TUG como predictores significativos de GEA (r2 = 0,24 p < 0,01). Conclusión: el GEAF y el nivel de actividad física (PAL) fueron más bajos en los adultos mayores, sin diferencias por institucionalización (AU)

Reduction of serum advanced glycation end-products with a low calorie Mediterranean diet.

UNLABELLED: Dietary intake of advanced glycation end-products (AGEs) increases circulating and tissue levels of these substances, contributing to a state of increased oxidative stress and inflammation. A low dietary AGE intervention has been shown to reduce body AGE content. Mediterranean diets (MD) are theoretically considered low in AGEs, but the specific effects of a MD on AGEs serum levels has not been tested. METHODOLOGY: Forty-seven overweight and obese premenopausal women underwent a three-month calorie restriction treatment (20 kcal/kg initial weight) with a Mediterranean-type diet that excluded wine intake. The adherence to the MD was assessed before and at the end of treatment using an on-line questionnaire, which scores from 0 to 14 (minimal to maximal adherence). Body composition, insulin resistance, lipoproteins and carboxymethyl-lisine (CML) serum levels were measured at both time periods. Serum CML was assessed through ELISA (enzyme-linked immunosorbent assay). Compliance to calorie restriction was assessed according to weight loss (< or > 5% initial weight). RESULTS: Mean body weight, body fat, waist circumference, total cholesterol, triglycerides and serum CML fell significantly, together with an increase in the Mediterranean score, although none of the patients reached the highest score. Significant changes in CML and insulin resistance were observed in 17 women classified as compliant to caloric restriction, but not in the 27 participants who were considered adherent to the MD (according to improvement of the Mediterranean Score). CONCLUSIONS: CML serum levels can be reduced through calorie restricted-Mediterranean-type diet. We could not reach a high enough MD score, so we cannot conclude whether the MD itself has an additive effect to caloric restriction.

La ingesta dietaria de productos finales de glicación avanzada (AGEs) aumenta los niveles séricos y tisulares de estas sustancias, lo que contribuye a un estado de mayor estrés oxidativo e inflamación. Una intervención dietaria con bajo contenido de AGEs ha demostrado reducir el contenido de AGEs en el cuerpo. La dieta mediterránea (DM) se considera teóricamente baja en AGEs, pero los efectos específicos de este tipo de intervención en los niveles séricos de AGEs no ha sido probado. Metodología: cuarenta y siete mujeres premenopáusicas con sobrepeso u obesidad se sometieron a tres meses de restricción calórica (20 kcal por kg de peso corporal inicial) con una dieta de tipo mediterráneo que excluía la ingesta de vino. La adherencia a la DM se evaluó al comienzo y al final del tratamiento utilizando una encuesta on-line, con puntuaciones de 0 a 14 (mínima a máxima adherencia a la DM). La composición corporal, la resistencia a la insulina, los niveles séricos de lipoproteínas y carboximetil-lisina (CML) se midieron en ambos períodos. El CML sérico se evaluó mediante ELISA (ensayo inmunoenzimático). La adherencia a la restricción calórica se evaluó de acuerdo con la pérdida de peso (< o > 5% del peso inicial). Resultados: la media de peso corporal, grasa corporal, circunferencia de la cintura, colesterol total, triglicéridos y CML sérica disminuyeron significativamente, junto con un aumento en el puntaje de adherencia a la DM, aunque ninguno de los pacientes alcanzó la máxima puntuación. Hubo cambios significativos en los niveles de CML y de resistencia a la insulina en 17 mujeres clasificadas como adherentes a la restricción calórica, pero no en las 27 participantes que fueron consideradas adherentes a la DM (de acuerdo con la mejoría en el puntaje de la encuesta). Conclusiones: los niveles séricos de CML disminuyeron tras la restricción calórica con una dieta tipo mediterránea. Dado que no se pudo alcanzar la puntuación máxima en la encuesta de DM, no podemos concluir si la propia DM tiene un efecto aditivo a la restricción calórica.

Reduction of serum advanced glycation end-products with a low calorie Mediterranean diet / Reducción sérica de productos finales de glicación avanzada séricos con una dieta baja en calorías tipo mediterráneo

Dietary intake of advanced glycation end-products (AGEs) increases circulating and tissue levels of these substances, contributing to a state of increased oxidative stress and inflammation. A low dietary AGE intervention has been shown to reduce body AGE content. Mediterranean diets (MD) are theoretically considered low in AGEs, but the specific effects of a MD on AGEs serum levels has not been tested. Methodology: forty-seven overweight and obese premenopausal women underwent a three-month calorie restriction treatment (20 kcal / kg initial weight) with a Mediterranean-type diet that excluded wine intake. The adherence to the MD was assessed before and at the end of treatment using an on-line questionnaire, which scores from 0 to 14 (minimal to maximal adherence). Body composition, insulin resistance, lipoproteins and carboxymethyl-lisine (CML) serum levels were measured at both time periods. Serum CML was assessed through ELISA (enzyme-linked immunosorbent assay). Compliance to calorie restriction was assessed according to weight loss (< or > 5 % initial weight). Results: mean body weight, body fat, waist circumference, total cholesterol, triglycerides and serum CML fell significantly, together with an increase in the Mediterranean score, although none of the patients reached the highest score. Significant changes in CML and insulin resistance were observed in 17 women classified as compliant to caloric restriction, but not in the 27 participants who were considered adherent to the MD (according to improvement of the Mediterranean Score). Conclusions: CML serum levels can be reduced through calorie restricted - Mediterranean-type diet. We could not reach a high enough MD score, so we cannot conclude whether the MD itself has an additive effect to caloric restriction (AU)

La ingesta dietaria de productos finales de glicación avanzada (AGEs) aumenta los niveles séricos y tisulares de estas sustancias, lo que contribuye a un estado de mayor estrés oxidativo e inflamación. Una intervención dietaria con bajo contenido de AGEs ha demostrado reducir el contenido de AGEs en el cuerpo. La dieta mediterrá- nea (DM) se considera teóricamente baja en AGEs, pero los efectos específicos de este tipo de intervención en los niveles séricos de AGEs no ha sido probado. Metodología: cuarenta y siete mujeres premenopáusicas con sobrepeso u obesidad se sometieron a tres meses de restricción calórica (20 kcal por kg de peso corporal inicial) con una dieta de tipo mediterráneo que excluía la ingesta de vino. La adherencia a la DM se evaluó al comienzo y al final del tratamiento utilizando una encuesta on-line, con puntuaciones de 0 a 14 (mínima a máxima adherencia a la DM). La composición corporal, la resistencia a la insulina, los niveles séricos de lipoproteínas y carboximetil-lisina (CML) se midieron en ambos períodos. El CML sérico se evaluó mediante ELISA (ensayo inmunoenzimático). La adherencia a la restricción calórica se evaluó de acuerdo con la pérdida de peso (< o > 5% del peso inicial). Resultados: la media de peso corporal, grasa corporal, circunferencia de la cintura, colesterol total, triglicéridos y CML sérica disminuyeron significativamente, junto con un aumento en el puntaje de adherencia a la DM, aunque ninguno de los pacientes alcanzó la máxima puntuación. Hubo cambios significativos en los niveles de CML y de resistencia a la insulina en 17 mujeres clasificadas como adherentes a la restricción calórica, pero no en las 27 participantes que fueron consideradas adherentes a la DM (de acuerdo con la mejoría en el puntaje de la encuesta). Conclusiones: los niveles séricos de CML disminuyeron tras la restricción calórica con una dieta tipo mediterránea. Dado que no se pudo alcanzar la puntuación máxima en la encuesta de DM, no podemos concluir si la propia DM tiene un efecto aditivo a la restricción calórica (AU)

Rectus femoris (RF) ultrasound for the assessment of muscle mass in older people.

BACKGROUND: Simple and reliable methods to evaluate muscle mass in older people are lacking. AIM: To evaluate ultrasound as a measure of RF muscle mass and quality in healthy subjects of different ages and gender, assessing its concordance with dual energy X-ray densitometry (DEXA) and association with muscle strength and walking capacity. METHODS: We selected 54 adults of both genders, aged 20-55 years and 51 adults older than 60 years. Ultrasound images of the RF were obtained at the mid-thigh to measure its thickness and ultrasonographic density using a GE Logiq e equipment. Body composition was assessed by DEXA. Quadriceps isometric strength and 12 minutes' walk were also measured and gender specific t scores for older adults were calculated using the values obtained in adults. RESULTS: RF ultrasound measurements correlated significantly with lean body mass assessed by DEXA (Double energy X-ray absorptiometry). The concordance between both measures was also adequate. Older people had lower muscle mass and worse ultrasound parameters than adults. Older males with a t score for quadriceps strength of -2 or less, had a significantly higher RF grayscale density. Older males with a 12 minutes' walk t score of -2 or less and old males and females with a walking speed of 1m/s or less had a lower RF thickness. DISCUSSION: There is a good concordance between RF ultrasound and DEXA. CONCLUSIONS: Assessment of RF using ultrasound appears to be a reliable and accurate method to evaluate muscle mass in older people.

Central obesity and not age increases skeletal muscle lipids, without influencing lean body mass and strength / La obesidad central y no la edad aumenta la grasa intramiocelular, sin afectar la masa y funcion muscular

Background/Aims: To measure skeletal muscle lipid infiltration, its association with insulin resistance (IR) lean mass and function, in Chilean men differing in age and body composition. Our hypothesis was that muscle lipid accumulation would be higher among older and heavier individuals and this would deteriorate insulin sensitivity (IS) and decrease muscle mass and function, both features of the ageing process. Methods: Healthy men (38 < 55 and 18 > 65 years), underwent anthropometric measurements, body composition assessment through radiologic densitometry, Nuclear Magnetic Resonance spectroscopy at the tibialis anterioris muscle to measure intra (IMCL) and extramyocellular lipids (EMCL), quadriceps and handgrip strength, 12 minute walking distance and serum biochemistry (haemoglobin, lipoproteins, creatinine, ultrasensitive C Reactive Protein, fasting and post glucose insulin and glucose concentrations, to assess IS). Physical activity was estimated by actigraphy. Results: 23 men were eutrophic, 26 were overweight and 7 were obese and mostly sedentary, independent of age. Both IMCL and EMCL were higher in overweight/ obese men. Abdominal fat was negatively associated with IS and positively correlated with muscle lipid accretion (both IMCL and EMCL), but not with age. As expected, older individuals had lower muscle mass and strength, but not more adipose tissue nor intramyocellular lipids, yet were more glucose intolerant. Conclusions: central obesity was associated with IMCL and EMCL infiltration and IR. This type of lipid accretion was not related with ageing nor age-related sarcopenia. Older individuals were more glucose intolerant, which was explained by a decrease of insulin secretion more than adiposity-related IR (AU)

Introducción/Objetivos: medir la infiltración grasa en el músculo esquelético, su asociación con resistencia a la insulina (RI) y con masa y función muscular, en hombres chilenos de diferente edad y composición corporal. Nuestra hipótesis era que habría mas acumulación de grasa en el tejido muscular entre las personas de mayor edad y peso, lo cual deterioraría la sensibilidad a la insulina (SI) y afectaría negativamente la masa y la función muscular, ambas características del proceso de envejecimiento. Métodos: se estudiaron hombres sanos (38 < 55 anos y 18 > 65 anos), que fueron sometidos a mediciones antropométricas, evaluación de la composición corporal mediante densitometría radiológica (DEXA), espectroscopia de resonancia nuclear magnética en el músculo tibial anterior para medir lípidos intra (LIM) y extramiocelulares (LEM), fuerza de mano y cuadriceps, test de 12 minutos y bioquímica sérica (glicemia, hemoglobina, lipoproteínas, creatinina y proteína C reactiva ultrasensible en ayunas, ademas de glucosa e insulina post carga de glucosa para evaluar SI). La actividad física se estimo mediante actigrafía. Resultados: 23 hombres eran eutróficos, 26 tenían sobrepeso y 7 eran obesos, todos eran sedentarios según el registro actigráfico, independiente de la edad. Tanto LIM como LEM resultaron mas altos entre los hombres con sobrepeso / obesidad. La grasa abdominal se asocio negativamente con la SI y se correlaciono positivamente con la acumulación de grasa en el músculo (tanto LIM como LEM), pero no con la edad. Como era de esperar, las personas mayores tenían menor masa magra y fuerza, pero no mas tejido adiposo ni lípidos intramiocelulares, aunque eran mas intolerantes a la glucosa. Conclusiones: La obesidad central se asocio con infiltración de grasa intramuscular y con RI. Esta distribución adiposa no se relaciono con edad ni con sarcopenia asociada al envejecimiento. Las personas mayores resultaron mas intolerantes a la glucosa, explicable por una disminución de la secreción de insulina mas que por RI relacionada con mayor adiposidad (AU)

[Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity]. / Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad.

BACKGROUND: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). AIM: To evaluate the impact of PASAF on nutritional status and metabolic parameters. PATIENTS AND METHODS: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. RESULT: We evaluated 526 subjects aged ≥18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was <50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥5% of their initial weight. CONCLUSIONS: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad / Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity

Background: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). Aim: To evaluate the impact of PASAF on nutritional status and metabolic parameters. Patients and Methods: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. Result: We evaluated 526 subjects aged ≥ 18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was < 50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥ 5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥ 5% of their initial weight. Conclusions: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

Posta de Salud Stella Maris: una apuesta por un modelo de atención más humano, integral y democrático / . Stella Maris post health: A commitment for a more human, more integrative and more democratic care model

Posta de Salud Stella Maris es un dispositivo de cuidados en domicilio, que trabaja pensando la accesibilidad como encuentro entre usuarios, donde lo vincular supera otras barreras. Hemos puesto a las personas delante de las enfermedades, acercando un plan de cuidados integral para las familias en sus hogares y su barrio. Trabajamos desde 2012 en el barrio Stella Maris. Cuentan con un hospital interzonal y tres unidades sanitarias en un radio de 1 km. Los vecinos describen dificultades para acceder a la atención dado el gran tamaño poblacional, que es de 370 familias. La posta realiza visitas domiciliarias de primer contacto y de Seguimiento familiar. Además, se llevan a cabo jornadas especiales de promoción de la salud. Creemos que hemos podido revalorizar la visita domiciliaria y el espacio en el barrio como espacio de trabajo de los equipos de salud del como lugar más idóneo que el centro de salud para abordar el Proceso Salud Enfermedad.

The Stella Maris post health care is a device that works at home thinking about accesibility as the meeting betwen health workers and users, where linking it overcome the barriers of accessibility. We had put the people before disease, approaching a plan of integral cares in their home and in their neighborhood. Since 2012 we are working in Stella Maris neighborhood, where we canfind an intezone hospital and three health units around a mile. Neighbors decribed difficuties in accesing the care given to the large population size, that is 370 families. The post makes home visits and familiy first contact monitoring. The post also conducts special sessions of health promotion We believe we could reassess the home visits and the space in the neighborhood as workspace health team as more appropriate that the health center place to address the process of health - disease.

Central obesity and not age increases skeletal muscle lipids, without influencing lean body mass and strength.

BACKGROUND/AIMS: To measure skeletal muscle lipid infiltration, its association with insulin resistance (IR) lean mass and function, in Chilean men differing in age and body composition. Our hypothesis was that muscle lipid accumulation would be higher among older and heavier individuals and this would deteriorate insulin sensitivity (IS) and decrease muscle mass and function, both features of the ageing process. METHODS: Healthy men (38 < 55 and 18 > 65 years), underwent anthropometric measurements, body composition assessment through radiologic densitometry, Nuclear Magnetic Resonance spectroscopy at the tibialis anterioris muscle to measure intra (IMCL) and extramyocellular lipids (EMCL), quadriceps and handgrip strength, 12 minute walking distance and serum biochemistry (haemoglobin, lipoproteins, creatinine, ultrasensitive C Reactive Protein, fasting and post glucose insulin and glucose concentrations, to assess IS). Physical activity was estimated by actigraphy. RESULTS: 23 men were eutrophic, 26 were overweight and 7 were obese and mostly sedentary, independent of age. Both IMCL and EMCL were higher in overweight/ obese men. Abdominal fat was negatively associated with IS and positively correlated with muscle lipid accretion (both IMCL and EMCL), but not with age. As expected, older individuals had lower muscle mass and strength, but not more adipose tissue nor intramyocellular lipids, yet were more glucose intolerant. CONCLUSIONS: central obesity was associated with IMCL and EMCL infiltration and IR. This type of lipid accretion was not related with ageing nor age-related sarcopenia. Older individuals were more glucose intolerant, which was explained by a decrease of insulin secretion more than adiposity-related IR.

Introducción/Objetivos: medir la infiltracion grasa en el musculo esqueletico, su asociacion con resistencia a la insulina (RI) y con masa y funcion muscular, en hombres chilenos de diferente edad y composicion corporal. Nuestra hipotesis era que habria mas acumulacion de grasa en el tejido muscular entre las personas de mayor edad y peso, lo cual deterioraria la sensibilidad a la insulina (SI) y afectaria negativamente la masa y la funcion muscular, ambas caracteristicas del proceso de envejecimiento. Métodos: se estudiaron hombres sanos (38 < 55 anos y 18 > 65 anos), que fueron sometidos a mediciones antropometricas, evaluacion de la composicion corporal mediante densitometria radiologica (DEXA), espectroscopia de resonancia nuclear magnetica en el musculo tibial anterior para medir lipidos intra (LIM) y extramiocelulares (LEM), fuerza de mano y cuadriceps, test de 12 minutos y bioquimica serica (glicemia, hemoglobina, lipoproteinas, creatinina y proteina C reactiva ultrasensible en ayunas, ademas de glucosa e insulina post carga de glucosa para evaluar SI). La actividad fisica se estimo mediante actigrafia. Resultados: 23 hombres eran eutroficos, 26 tenian sobrepeso y 7 eran obesos, todos eran sedentarios segun el registro actigrafico, independiente de la edad. Tanto LIM como LEM resultaron mas altos entre los hombres con sobrepeso / obesidad. La grasa abdominal se asocio negativamente con la SI y se correlaciono positivamente con la acumulacion de grasa en el musculo (tanto LIM como LEM), pero no con la edad. Como era de esperar, las personas mayores tenian menor masa magra y fuerza, pero no mas tejido adiposo ni lipidos intramiocelulares, aunque eran mas intolerantes a la glucosa. Conclusiones: La obesidad central se asocio con infiltracion de grasa intramuscular y con RI. Esta distribucion adiposa no se relaciono con edad ni con sarcopenia asociada al envejecimiento. Las personas mayores resultaron mas intolerantes a la glucosa, explicable por una disminucion de la secrecion de insulina mas que por RI relacionada con mayor adiposidad.

Variability of formulas to assess insulin sensitivity and their association with the Matsuda index.

OBJECTIVE: To assess the individual variability of HOMA and QUICKI indexes for the assessment of insulin resistance, using three fasting blood samples obtained within 30 minutes. RESEARCH METHODS & PROCEDURES: Data from 80 participants aged 41.5 ± 15 years (26 females), who underwent an oral glucose tolerance test to calculate Matsuda index, were used. Every participant had three fasting blood samples obtained within 30 minutes and four blood samples obtained at 30, 60, 90 and 120 minutes after a 75 g oral glucose load. Insulin and glucose were measured in each sample. HOMA and QUICKI indexes were calculated using the nine possible combinations of the three fasting blood samples. Matsuda index was calculated with all samples obtained. RESULTS: Median values of HOMA-IR, HOMA-ß, QUICKI and Matsuda indexes were 1.9, 117.9, 0.35 and 3.71 arbitrary units, respectively. The individual variation coefficients of HOMA-IR, HOMA-ß and QUICKI were 11.8 (7.8-18.9), 15 (10.2-22.9) and 1.8 (8.8-21.9) % respectively. When compared with Matsuda index, the R squared values of HOMA-IR, HOMA-ß and QUICKI were 0.46, 0.2 and 0.71, respectively. CONCLUSIONS: Among fasting indexes for insulin resistance, QUICKI had the lower variation coefficient and the higher correlation with Matsuda index.

Objetivo: Evaluar la variabilidad individual de los índices HOMA y QUICKI para resistencia a insulina, utilizando tres muestras de sangre en ayunas obtenidas en un período de 30 minutos. Material y métodos: Se utilizaron datos provenientes de 80 participantes de 41.5 ± 15 años de edad (26 mujeres) a quienes se les efectuó una prueba de tolerancia a glucosa oral para calcular el índice de Matsuda. A cada participante se le tomaron tres muestras de sangre en ayunas en un período de 30 minutos y cuatro muestras a los 30, 60, 90 y 120 minutos después de una carga oral de 75 g de glucosa. En cada muestra se midieron los niveles de insulina y glucosa. Los índices HOMA y QUICKI se calcularon utilizando las nueve combinaciones posibles con las tres muestras obtenidas en ayunas. El índice de Matsuda se calculó utilizando todas las muestras. Resultados: Las medianas de los índices HOMA-IR, HOMA-?, QUICKI y Matsuda fueron 1,9, 117,9, 0,35 and 3,71 unidades arbitrarias, respectivamente. Los coeficientes de variación individual del HOMA-IR, HOMA-??y QUICKI fueron 11,8 (7,8-18,9), 15 (10,2-22,9) and 1,8 (8,8-21,9) %, respectivamente. Comparados con el índice de Matsuda, los valores de R2 para el HOMA-IR, HOMA-??y QUICKI fueron 0,46, 0,2 y 0,71, respectivamente. Conclusiones: De los índices que utilizan muestras en ayunas para determinar resistencia a insulina, el QUICKI es el que tiene el menor coeficiente de variación y la mejor correlación con el índice de Matsuda.

Variability of formulas to assess insulin sensitivity and their association with the Matsuda index / Variabilidad de las fórmulas que evalúan la sensibilidad a la insulina y su asociación con el Índice Matsuda

Objective: To assess the individual variability of HOMA and QUICKI indexes for the assessment of insulin resistance, using three fasting blood samples obtained within 30 minutes. Research methods & procedures: Data from 80 participants aged 41.5 ± 15 years (26 females), who underwent an oral glucose tolerance test to calculate Matsuda index, were used. Every participant had three fasting blood samples obtained within 30 minutes and four blood samples obtained at 30, 60, 90 and 120 minutes after a 75 g oral glucose load. Insulin and glucose were measured in each sample. HOMA and QUICKI indexes were calculated using the nine possible combinations of the three fasting blood samples. Matsuda index was calculated with all samples obtained. Results: Median values of HOMA-IR, HOMA-β, QUICKI and Matsuda indexes were 1.9, 117.9, 0.35 and 3.71 arbitrary units, respectively. The individual variation coefficients of HOMA-IR, HOMA-β and QUICKI were 11.8 (7.8-18.9), 15 (10.2-22.9) and 1.8 (8.8-21.9) % respectively. When compared with Matsuda index, the R squared values of HOMA-IR, HOMA-β and QUICKI were 0.46, 0.2 and 0.71, respectively. Conclusions: Among fasting indexes for insulin resistance, QUICKI had the lower variation coefficient and the higher correlation with Matsuda index (AU)

Objetivo: Evaluar la variabilidad individual de los índices HOMA y QUICKI para resistencia a insulina, utilizando tres muestras de sangre en ayunas obtenidas en un período de 30 minutos. Material y métodos: Se utilizaron datos provenientes de 80 participantes de 41.5 ± 15 años de edad (26 mujeres) a quienes se les efectuó una prueba de tolerancia a glucosa oral para calcular el índice de Matsuda. A cada participante se le tomaron tres muestras de sangre en ayunas en un período de 30 minutos y cuatro muestras a los 30, 60, 90 y 120 minutos después de una carga oral de 75 g de glucosa. En cada muestra se midieron los niveles de insulina y glucosa. Los índices HOMA y QUICKI se calcularon utilizando las nueve combinaciones posibles con las tres muestras obtenidas en ayunas. El índice de Matsuda se calculó utilizando todas las muestras. Resultados: Las medianas de los índices HOMA-IR, HOMA-β, QUICKI y Matsuda fueron 1,9, 117,9, 0,35 and 3,71 unidades arbitrarias, respectivamente. Los coeficientes de variación individual del HOMA-IR, HOMA-β y QUICKI fueron 11,8 (7,8-18,9), 15 (10,2-22,9) and 1,8 (8,8-21,9) %, respectivamente. Comparados con el índice de Matsuda, los valores de R2 para el HOMA-IR, HOMA-β y QUICKI fueron 0,46, 0,2 y 0,71, respectivamente. Conclusiones: De los índices que utilizan muestras en ayunas para determinar resistencia a insulina, el QUICKI es el que tiene el menor coeficiente de variación y la mejor correlación con el índice de Matsuda (AU)