Limitaciones y oportunidades para la adopción de la dieta mediterránea en adultos chilenos con elementos diagnósticos del síndrome metabólico / Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome

Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menorprevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporanpropuestas de este patrón alimentario en su vida cotidiana.Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile.Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnósticode síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudesy las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo elenfoque de teoría fundada usando el softwar e ATLAS.ti.Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificaciónde algunos alimentos aislados) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunosalimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiereesfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas.Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clavepara diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para elenfrentamiento de las enfermedades crónicas en Chile.(AU)

Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lowerprevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals foradherence to this food pattern in their daily lives.Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile.Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterionof metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated withchanges and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out underthe grounded theory approach using the ATLAS.ti software.Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foodsitems) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routineadoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but alsorelational effort as it implies modifications of family and collective practices.Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implementnutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.(AU)

[Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome]. / Limitaciones y oportunidades para la adopción de la dieta mediterránea en adultos chilenos con elementos diagnósticos del síndrome metabólico.

Introduction: Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lower prevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals for adherence to this food pattern in their daily lives. Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile. Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterion of metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated with changes and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out under the grounded theory approach using the ATLAS.ti software. Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foods items) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routine adoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but also relational effort as it implies modifications of family and collective practices. Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implement nutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.

Introducción: Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menor prevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporan propuestas de este patrón alimentario en su vida cotidiana. Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile. Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnóstico de síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudes y las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo el enfoque de teoría fundada usando el software ATLAS.ti. Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificación de algunos alimentos aislados, dinámica familiar) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunos alimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiere esfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas. Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clave para diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para el enfrentamiento de las enfermedades crónicas en Chile.

Healthy Eating as Potential Mediator of Inverse Association between Purpose in Life and Waist Circumference: Emerging Evidence from US and Chilean Cohorts.

High sense of purpose in life, a fundamental domain of eudaimonic well-being, has been consistently associated with lower risk for various obesity-related chronic diseases. Although this psychological feature correlates with some health behaviors as potential mediators, its association with healthy eating remains less explored. In addition, studies of these psycho-behavioral and health relationships in the South American population are lacking. This research sought to assess: (1) the cross-sectional association between self-reported purpose in life and overall healthy eating patterns, and (2) healthy food intake as a potential mediator of the inverse relationship between purpose in life and waist circumference. Data collected of 2060 US adults from the MIDUS study (5 ± 12 years, 55% women, mostly white people, and 42.5% obese) and 223 Chilean adults from the CHILEMED study (46.6 ± 9 years, 58.3% women, and 71.3% obese) were used. Anthropometric and sociodemographic variables were collected. Sense of purpose was assessed using the purpose in life subscale of the Ryff's psychological well-being questionnaire. Diet quality was evaluated using healthy eating or low-fat diet indexes, according to extant food intake data in each cohort. The relationship between these variables was estimated by bivariate and multivariate linear regressions with appropriate adjustments. To establish whether a better diet quality could mediate a link of purpose in life and improved nutritional status (assessed by waist circumference), the association between these three variables was tested by bootstrapping-based mediation analysis. Our results show significant associations of sense of purpose with healthy eating and low-fat dietary patterns in both US and Chilean cohorts, respectively, even after adjusting for sociodemographic variables. According to the mediation analysis, the relationship between sense of purpose and waist circumference, as an indicator of abdominal obesity, appears to be partially mediated by healthier food intake in both samples. In conclusion, our findings suggest a plausible mechanism underlying the favorable impact of this well-being dimension on physical health. Given its protective effects, interventions aimed at increasing purpose in life may facilitate adherence to better dietary patterns, which, in turn, will reduce the risk for obesity-related chronic diseases.

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial).

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

The Role of Diet Related Short-Chain Fatty Acids in Colorectal Cancer Metabolism and Survival: Prevention and Therapeutic Implications.

Colorectal Cancer (CRC) is a major cause of cancer-related death worldwide. CRC increased risk has been associated with alterations in the intestinal microbiota, with decreased production of Short Chain Fatty Acids (SCFAs). SCFAs produced in the human colon are the major products of bacterial fermentation of undigested dietary fiber and starch. While colonocytes use the three major SCFAs, namely acetate, propionate and butyrate, as energy sources, transformed CRC cells primarily undergo aerobic glycolysis. Compared to normal colonocytes, CRC cells exhibit increased sensitivity to SCFAs, thus indicating they play an important role in cell homeostasis. Manipulation of SCFA levels in the intestine, through changes in microbiota, has therefore emerged as a potential preventive/therapeutic strategy for CRC. Interest in understanding SCFAs mechanism of action in CRC cells has increased in the last years. Several SCFA transporters like SMCT-1, MCT-1 and aquaporins have been identified as the main transmembrane transporters in intestinal cells. Recently, it was shown that acetate promotes plasma membrane re-localization of MCT-1 and triggers changes in the glucose metabolism. SCFAs induce apoptotic cell death in CRC cells, and further mechanisms have been discovered, including the involvement of lysosomal membrane permeabilization, associated with mitochondria dysfunction and degradation. In this review, we will discuss the current knowledge on the transport of SCFAs by CRC cells and their effects on CRC metabolism and survival. The impact of increasing SCFA production by manipulation of colon microbiota on the prevention/therapy of CRC will also be addressed.

Early-Onset Invasive Infection Due to Corynespora cassiicola Associated with Compound Heterozygous CARD9 Mutations in a Colombian Patient.

PURPOSE: CARD9 deficiency is an inborn error of immunity that predisposes otherwise healthy humans to mucocutaneous and invasive fungal infections, mostly caused by Candida, but also by dermatophytes, Aspergillus, and other fungi. Phaeohyphomycosis are an emerging group of fungal infections caused by dematiaceous fungi (phaeohyphomycetes) and are being increasingly identified in patients with CARD9 deficiency. The Corynespora genus belongs to phaeohyphomycetes and only one adult patient with CARD9 deficiency has been reported to suffer from invasive disease caused by C. cassiicola. We identified a Colombian child with an early-onset, deep, and destructive mucocutaneous infection due to C. cassiicola and we searched for mutations in CARD9. METHODS: We reviewed the medical records and immunological findings in the patient. Microbiologic tests and biopsies were performed. Whole-exome sequencing (WES) was made and Sanger sequencing was used to confirm the CARD9 mutations in the patient and her family. Finally, CARD9 protein expression was evaluated in peripheral blood mononuclear cells (PBMC) by western blotting. RESULTS: The patient was affected by a large, indurated, foul-smelling, and verrucous ulcerated lesion on the left side of the face with extensive necrosis and crusting, due to a C. cassiicola infectious disease. WES led to the identification of compound heterozygous mutations in the patient consisting of the previously reported p.Q289* nonsense (c.865C > T, exon 6) mutation, and a novel deletion (c.23_29del; p.Asp8Alafs10*) leading to a frameshift and a premature stop codon in exon 2. CARD9 protein expression was absent in peripheral blood mononuclear cells from the patient. CONCLUSION: We describe here compound heterozygous loss-of-expression mutations in CARD9 leading to severe deep and destructive mucocutaneous phaeohyphomycosis due to C. cassiicola in a Colombian child.

El concepto de trauma en Freud y la ley de víctimas de la guerra en Colombia / Freud's concept of trauma and Colombia's victims' Law

Usando las estrategias de investigación cualitativa denominadas revisión documental y triangulación de datos, en el artículo se describe el origen y evolución del concepto de "trauma psicológico" en la Obra de S. Freud, mostrando la actualidad y operatividad de la teoría psicoanalítica del trauma en la lectura de múltiples fenómenos en los que los factores sexuales no son el agente etiológico principal; especialmente se examinaran los efectos de la violencia producida durante la guerras mundiales. Se reseñan diversos autores (locales e internacionales) que aplican los conceptos psicoanalíticos para estudiar fenómenos de violencia, tales como: la violencia intrafamiliar, la criminalidad en la infancia, la guerra entre bandas criminales y en la comuna trece de Medellín, y la violencia entre barras de fútbol. Se mostrará que en el ámbito internacional el enfoque psicoanalítico ha sido utilizado ampliamente, por lo cual se señala la conveniencia de implementar este modelo teórico en los programas de atención a víctimas de la guerra en nuestro país, algunas de las cuales padecen las denominadas "neurosis de guerra", categoría diagnóstica que, según se mostrara, actualmente es nombrada como desorden por estrés postraumático. Con base en la revisión teórica efectuada se aportan críticas y reflexiones psicoanalíticas sobre los dispositivos de atención psicológica que se utilizan actualmente en Colombia para brindar atención psicosocial a las víctimas de la guerra.

Based on a documentary review and triangulation of data used in qualitative research, this article describes the origin and evolution of the concept of "psychological trauma" in Freud's work, showing the present and operability of the psychoanalytic theory of trauma in the interpretation of multiple phenomena in which the sex factors are not the main etiologic agent; in particular, the effects of the violence produced during the world wars are examined here. It provides an overview of various authors (local and international) who apply the psychoanalytic concepts to study phenomena of violence, such as: domestic violence, criminality in childhood, the battle between criminal gangs and in the Comuna 13 of Medellín, and violence between football hooligans. It will be shown that at the international level the psychoanalytic approach has been used extensively, which points out the desirability of implementing this theoretical model in the programs of care for war victims in our country, some of which suffer from the so-called "neurosis of war", a diagnostic category now named as post-traumatic stress disorder. The article presents criticism and psychoanalytic reflections on psychological care devices that are currently used in Colombia to provide psychosocial support to victims of war.

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction.

BACKGROUND: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. AIMS: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients lives and related factors affecting stent patency, clinical success and complications. METHODS: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. RESULTS: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). CONCLUSIONS: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction / Mejoría mantenida durante el resto de la vida de los síntomas obstructivos en pacientes con obstrucciones malignas colorrectales trás la colocación de prótesis metálicas expandibles

Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients’ lives and related factors affecting stent patency, clinical success and complications. Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients’ lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality(AU)