Fitness cardiorrespiratorio estimado mediante ecuación y su caracterización sociodemográfica en población chilena: Resultados de la Encuesta Nacional de Salud 2016-2017

Background: Cardiorespiratory fitness is a strong predictor of mortality and chronic diseases. However, its estimation is costly and time consuming which may limit it broad use in population-based studies. Aim: To estimate the cardiorespiratory fitness of the Chilean population by using equations and to characterize fitness levels of the Chilean population by sociodemographic factors. Material and Methods: This cross-sectional study included 5,958 adults from the Chilean Health Survey conducted between 2016 and 2017. Cardiorespiratory fitness was estimated from sex-specific equations for men and women and expressed as METs (Energy Metabolic Equivalent). Fitness levels were characterized by sociodemographics factors (age, sex, education, income and area of residency). Results: Fitness levels were higher in men (9.01 METs) than in women (6.76 METs) and in average decrease by 0.59 and 0.34 METs per each year increment in age for men and women, respectively. Fitness levels were 12.7 METs and 7.8 METs for 20-year-old men and women, respectively. However, fitness levels decreased to 7.8 METs and 4.3 METs in 90-year-old men and women, respectively. Fitness levels were also higher in individuals living in urban setting, those with higher education or income levels and lean individuals. Conclusions: This study reports fitness levels in a nationally representative sample of Chile. Fitness levels were higher in men than women however, its decline with age was more pronounce in men than women.

Prevalencia de debilidad muscular en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017

Background: Handgrip strength is an indicator of frailty in older people. Aim: To determine the prevalence of low handgrip strength in older Chilean adults. Material and Methods: A cross-sectional analysis of 244 individuals aged 60 years or more, participating in the 2016-2017 Chilean National Health Survey, was carried out. Handgrip strength was evaluated by a hand dynamometer and low grip strength was determined as a grip strength ≤ 15 kg and ≤ 27 kg for women and men, respectively. Results: Twenty nine percent of participants had low grip strength. The average grip strength among 60-year-old men and women was 34.7 and 22.1 kg, respectively. These figures decreased to 28.8 kg and 17.2 kg among 90-year-old men and women, respectively. The prevalence of low grip strength in men and women aged 60 years was 18%. In 90-year-old men and women, these figures increased to 79% and 56.3%, respectively. Conclusions: The prevalence of low grip strength increased substantially with age.

Comparación entre el auto-reporte de actividad física y la medición con acelerómetro según factores sociodemográficos / Comparison of self-reported and accelerometer-measured physical activity according to sociodemographic factors

RESUMEN Introducción: La determinación del nivel de actividad física (AF) puede realizarse a través de acelerómetro o mediante cuestionario de auto-reporte. El objetivo de este estudio fue comparar los niveles de AF entre un cuestionario de auto-reporte y la medición con acelerómetro de movimiento según factores sociodemográficos en la población chilena. Métodos: Estudio de corte transversal que incluyó a 230 adultos chilenos participantes del proyecto Genes, Ambiente, Diabetes y Obesidad (GENADIO). Niveles de AF fueron medidos mediante el cuestionario Internacional Physical Activity Questionnaire (IPAQ) y acelerómetro de movimiento (ActiGraph). Resultados: IPAQ subestimó los niveles de AF total en comparación a la medición con acelerómetro (delta [IPAQ-Acel.]= −55,7 min/día). Según nivel educacional, se evidenció que el cuestionario IPAQ sobreestimó los niveles de AF total en personas con bajo nivel educacional (delta [IPAQ-Acel.]= 70,4 min/día), pero subestimó la AF total en personas con enseñanza media o técnico universitaria (delta [IPAQ-Acel.]= −67,9 y −135,6 min/día, respectivamente). Resultados similares fueron observados para los distintos niveles de ingreso socioeconómico (NSE). Conclusión: El cuestionario de auto-reporte IPAQ subestimó los niveles de AF total en comparación a la medición por acelerómetro; sin embargo, estas diferencias variaron según factores sociodemográficos.

ABSTRACT Introduction: Determining level of physical activitY (PA) can be done with objective measurement, through accelerometer, or by subjective measurement through self-report questionnaire. The aim of this study was to compare PA measurements derived from a self-reported questionnaire and accelerometer according to sociodemographic factors in the Chilean population. Methods: This was a cross-sectional study which included 230 Chilean adults participating in the GENADIO study (Genes, Environment, Diabetes and Obesity). PA levels were measured through the International Physical Activity Questionnaire (IPAQ) and GT1M accelerometer (ActiTrainer, ActiGraph). Results: IPAQ questionnaire underestimated the total PA levels compared to the accelerometer measurement (delta[IPAQ-Acel.]= −55.7 min/day). According to educational level, IPAQ questionnaire overestimated PA level in people with low educational level (delta[IPAQ-Accel.]= 70.4 min/day), but underestimated total PA in people with secondary education or university technician (delta[IPAQ-Accel.]=-67.9 and-135.6 min/day, respectively). Similar results were observed for the different levels of socioeconomic income. Conclusion: The IPAQ questionnaire underestimated total PA levels compared to accelerometer; however, these differences varied according to sociodemographic factors.

Nivel educativo y su asociación con niveles de actividad física en Chile / Association of physical inactivity with low levels of education

Background: A higher educational level is associated with healthier lifestyles. Aim: To assess the association between the level of compliance with physical activity recommendations and years of formal education in Chilean adults. Material and Methods: Analysis include 6,174 participants from the National Health Survey 2016-2017. Physical activity levels were assessed through the Global Physical Questionnaire (GPAQ v2). Physical inactivity was defined as < 600 MET/minute/week. Results: Among subjects without education, 44% and 27% of women and men respectively, were physically inactive. Among women and men with the highest number of years of education (> 16) the figures for physical inactivity were 27% and 15% respectively. The odds for not meeting the physical activity recommendations was 2.3 [95% confidence intervals (CI): 1.57; 3.38] and 3.9 [95% CI: 2.27; 6.95] in women and men without any formal education respectively, as compared with those who reported 12 years of education. Women and men who reported a high level of education ≥ (16 years) did not show significant differences compared to the reference group. Conclusions: People with low levels of education are were likely to be physically inactive.

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

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

Caracterización de los estilos de vida en dueñas de casa chilenas: análisis de la Encuesta Nacional de Salud 2009-2010 / Lifestyles of Chilean housewives: analysis of the 2009-2010 Chilean Health Survey

Background: Housewives represent a important proportion of the Chilean population. However, there is limited evidence about their lifestyles. Aim: To characterize lifestyles and determine the level of compliance with healthy lifestyles guidelines of housewives in Chile. Material and Methods: Housewives from the 2009-2010 National Health Survey were included. The variables studied included levels of physical activity (PA), sedentary behavior, diet, hours of sleep and smoking. Compliance with healthy lifestyle behaviors was evaluated through logistic regression, granting a value of 1 for compliance and 0 for non-compliance. A healthy lifestyle was defined as meeting at least four healthy behaviors. Results: Housewives aged > 55 years had a higher BMI and waist circumference compared to those aged < 40 years. Housewives were also more likely to report moderate alcohol consumption and were more likely to meet a healthier lifestyle score (Odds ratio = 1.52 [95% confidence intervals: 1.09 to 2.11], p = 0.013). No significant age trends were observed for other lifestyle behaviors. Conclusions: Housewives had high levels of central obesity, excess body weight and high levels of salt intake but low alcohol intake. Their healthy lifestyles behaviors increased along with increasing age.

Asociación de un índice de estilos de vida saludable con factores de riesgo cardiovascular en población chilena / Association of a healthy lifestyle index with cardiovascular risk factors in Chileans adults

Background: Healthy lifestyles are associated with a better metabolic and cardiovascular health profile. Aim: To investigate the association between a lifestyle score and cardiovascular risk in Chilean adults. Material and Methods: A healthy lifestyle score was derived for 2,774 participants in the Chilean National Health Survey 2009-2010 and based on seven modifiable behaviors (salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviors). A high score represented a healthier lifestyle whereas a low score represents an unhealthy lifestyle. The association between the lifestyle score and cardiovascular risk factors (obesity, hypertension, diabetes, dyslipidemia and metabolic syndrome), was explored using logistic regression models. Results: One quartile increment in the healthy lifestyle score was associated with a lower risk for obesity (Odds ratio (OR): 0.82 [95% confidence intervals (CI): 0.75 to 0.90], p < 0.01), central obesity (OR: 0.88 [95% CI: 0.81 to 0.96], p < 0.01), diabetes (OR: 0.84 [95% CI: 0.75 to 0.95], p < 0.04) and dyslipidemia (OR: 0.90 [95% CI: 0.83 to 0.98], p = 0.01). These results were independent of major confounding factors. Conclusions: The adherence to a healthy lifestyle is associated with lower cardiovascular risk.

Asociación entre el polimorfismo rs9939609 del gen FTO con la ingesta energética, macronutrientes y consumo de alcohol en población chilena / Association of the FTO (rs9939609) genotype with energy intake

Background: Fat-mass-associated-gene (FTO) is associated with higher energy intake and specific food preferences. Aim: To investigate the association of the FTO genotype with energy intake, macronutrient and alcohol consumption. Material and Methods: Four hundred and nine participants of the GENADIO (Genes, Environment, Diabetes and Obesity) study were included. Energy intake, macronutrient and alcohol consumption were the outcomes of interest. The association of FTO (rs9939609) genotype with these outcomes was investigated using linear regression analyses, adjusting for confounding variables. Results: After adjusting for socio-demographic factors, being a carrier of the risk allele for the FTO gene was associated with a higher energy intake (173 kcal per each extra copy of the risk variant [95% confidence intervals (CI): 45; 301], (P = 0.008). After adjusting for lifestyle factors and body mass index, the association was slightly attenuated but remained significant (144 kcal [95% CI: 14; 274], p = 0.030). Conclusions: The FTO genotype is associated with a higher energy intake.

Asociación entre diabetes mellitus tipo 2, historia familiar de diabetes y deterioro cognitivo en adultos mayores chilenos / Risk of cognitive impairment among older people with diabetes or family history of the disease

Background: Although cardiovascular risk factors are associated with an impaired cognitive function, the impact of diabetes on cognitive function in Chilean adults is unknown. Aim: To investigate the association of diabetes or family history of the disease with cognitive impairment in older adults. Materials and Methods: Data from the 2009-2010 Chilean National Health Survey including 1,384 participants aged ≥ 60 years were included in this study. A score below 13 points for the Mini Mental State Examination (MMSE) was considered an indication of cognitive impairment. Logistic regression analyses were performed to assess the association between MMSE, diabetes and family history of the disease. Results: Cognitive impairment increased with age (Odds ratio (OR): 1.83 [95% confidence intervals (CI): 1.53; 2.19], p < 0.01, per 5 years increment in age). This trend was greater in individuals with diabetes (OR: 2.37 [95% CI: 1.68; 3.35], p < 0.01) compared to those without the disease. A similar trend was identified among individuals with a family history of diabetes compared to those without. Conclusions: Older adults with diabetes are more susceptible to develop cognitive impairment.

Asociación entre el polimorfismo rs9939609 del gen FTO y marcadores de adiposidad en población adulta chilena / Association between FTO (ns9939609) genotype and adiposity markers in Chilean adults

Background: Numerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity. Aim: To investigate the association of FTO gene with adiposity markers in Chilean adults. Material and Methods: 409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio. Results: A fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score. Conclusions: This study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.

No cumplir con las recomendaciones de actividad física se asocia a mayores niveles de obesidad, diabetes, hipertensión y síndrome metabólico en población chilena / Association of physical inactivity with obesity, diabetes, hypertension and metabolic syndrome in the chilean population

Background: Physical inactivity is an important cardiovascular risk factor. Aim: To investigate the association of physical inactivity with obesity, metabolic markers, type 2 diabetes mellitus, hypertension and metabolic syndrome in Chilean adults. Material and Methods: Participants from the National Health Survey 2009-10 (n = 5,157) were included in this study. Body mass index, waist circumference, metabolic markers (blood glucose, glycosylated hemoglobin and lipid profile) were the outcomes. Type 2 diabetes, hypertension and metabolic syndrome were determined using international criteria. Physical activity levels were determined using the Global Physical Activity Questionnaire and physical inactivity was defined as < 600 METs/minutes/week. Results: Compared to their physically active peers, inactive men and women had a higher odds ratio (OR) for obesity (OR: 1.77 [95% confidence intervals (CI): 1.29-2.42], p < 0.01 and 1.25 [95% CI: 102-1.54], p < 0.035, respectively), diabetes (OR: 2.47 [1.80-3.38], p < 0.01 and 1.72 [1.35-2.19], p = 0.002, respectively) and hypertension (OR: 1.66 [1.31-2.09], p < 0.01 and 1.83 [1.54-2.18] respectively. An association of physical inactivity with central obesity and metabolic syndrome was observed only in men (OR: 1.92 [1.42- 2.58], p < 0.01 and 1.74 [1.23-2.47], p < 0.01, respectively). Conclusions: Not meeting the physical activity recommendations is associated with obesity, diabetes, hypertension and metabolic syndrome, which are important cardiovascular risk factors.

Efectos de la actividad física sobre la asociación entre obesidad y diabetes mellitus tipo 2: resultados de la Encuesta Nacional de Salud 2009-2010 / The association between adiposity and diabetes is modified by physical activity

Background Physical inactivity and obesity are major risk factors for type 2 diabetes (T2D). Aim To investigate whether if the association between obesity and diabetes is modified by levels of physical activity in the Chilean population. Material and Methods Cross-sectional study including 4,712 participants from the 2009-2010 National Health Survey. Diabetes was determined when participants referred having the disease or had a fasting glucose ≥ 126 mg/dl. Physical activity level was assessed using the Global Physical Activity Questionnaire. The association between diabetes, obesity and physical activity was determined using logistic regression analysis. Results Compare to active and normal weight subjects (reference group), the risk for T2D was higher in active individuals with overweight (Odds ratio (OR): 2.85 [95% confidence intervals (CI): 1.76- 4.61] p < 0.01). The risk among inactive but normal weight participants (OR: 2.12 [95% CI: 1.49- 3.01], p < 0.01) was of lower magnitude and was even higher among inactive and overweight individuals (OR: 3.22 [95% CI: 2.10 - 4.93], p < 0.01). Similar results were found for obesity and central obesity. Conclusions Individuals who are physically inactive and have a high adiposity level have an increased risk for T2D compared to active individuals with normal BMI.

Factores de riesgo asociados al desarrollo de hipertensión arterial en Chile / Risk factors associated with hypertension: analysis of the 2009-2010 Chilean health survey

Background: High blood pressure is one of the major risk factors for the development of cardiovascular disease, affecting 27% of the Chilean population in 2010. Aim: To determine the risk factors associated with the development of hypertension. Material and Methods: Analysis of the database of the 2009-2010 National Health Survey in which 4,901 participants were included. Socio-demographic factors, physical activity, eating habits, well-being and comorbidities were analyzed. Results: Women had a lower risk of developing hypertension than men (Odds ratio (OR): 0.69, 95% confidence intervals (CI): 0.59-0.81, p < 0.01). In both men and women, the risk is greater over the age of 25 years (OR: 2.90, 95% CI: 1.55-5.43, p < 0.01). The risk is greater in subjects who were overweight (OR: 1.61, 95% CI: 1.31-1.98, p < 0.01), obese (OR: 3.18, 95% CI: 2.56-3.95, p < 0.01), or had central obesity (OR: 2.25, 95% CI: 1.85-2.72, p < 0.01). Subjects with a family history of hypertension and diabetes also have a higher risk. Conclusions: Identifying the risk factors associated with hypertension allows public health policies to be tailored to its prevention.

Mayores niveles de transporte activo se asocian a un menor nivel de adiposidad y menor riesgo de obesidad: resultados de la Encuesta Nacional de Salud 2009-2010 / Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010

Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p < 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p < 0.01]. The odds of having a BMI > 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes' increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p < 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults.

Factores asociados al desarrollo de obesidad en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Risk factors for obesity: analysis of the 2009-2010 Chilean health survey

Background: Chile has one of the highest obesity rates in Latin America. However, the factors that could explain this high prevalence of obesity are unknown. Aim: To determine the main risk factors for the development of obesity in Chile. Material and Methods: We included 1,398 obese and 1,478 normal weight participants of the National Health Survey 2009-2010. The risk factors considered were socioeconomic variables, diet, physical activity, comorbidities and general wellbeing. Results: The main factors associated with a higher risk of being obese were age, high salt consumption and high alcohol intake. Education, income and living in rural settings were protective for women and risk factors for men. The probability of being obese increases in women that sleep less than seven hours per day or have a poor health. Sedentariness and lack of physical activity were risk factors among men. Conclusions: The identification of these risk factors may help to implement public health interventions to tackle obesity in Chile.