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Background & Aims: Several reports inform an association between vascular aging and sarcopenia. However, both conditions appear along with aging. Therefore, their association may be circumstantial and not casually linked. Our aim was to determine if individuals with higher-than-expected vascular aging have a higher frequency of sarcopenia., Methods: In 802 participants we calculated the association between pulse wave pressure and carotid intima media thickness and age and blood pressure, to derive predictive regression equations. In 161 of these participants we measured body composition by double beam X ray absorptiometry (DEXA), hand grip strength, rectus femoris thickness by ultrasound, activity energy expenditure by actigraphy and peak oxygen consumption and workload in an incremental exercise test. We calculated their expected values for pulse wave velocity and carotid intima media thickness and compared muscle mass and function between those with higher or lower than expected parameters. In 60 of these participants, we measured body composition sequentially to assess its change over time., Results: Age and blood pressure predicted the variance of pulse wave velocity and carotid intima media thickness with R 2 values of 0.94-0.97 and 0.54 to 0.66, respectively. No differences in the frequency of sarcopenia and in muscle mass and strength were observed between participants with higher or lower than expected pulse wave velocity and carotid intima media thickness. In the group with sequential assessments, no differences in the change of muscle mass over time were observed in participants with and without accelerated vascular aging., Conclusions: We were not able to find an association between vascular aging and sarcopenia., Competing Interests: Declaration of competing interest The authors declare not having any conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

There are concerns about muscle and bone health in patients with Phenylketonuria (PKU). Our aim was to compare muscle mass, function, and bone health among young adults with PKU who maintained or suspended dietary treatment., Methods: Three groups were considered-PKU-1: 10 patients who used a protein substitute (PS) without phenylalanine (Phe); PKU-2: 14 patients who used the PS without Phe until eighteen years old and then practiced mostly a vegan diet; and 24 matched healthy controls. A 24 h recall survey, blood parameters, body composition and bone mineral density through DEXA, rectus femoris thickness by ultrasound, hand grip strength, submaximal exercise test, and walking speed were assessed., Results: PKU-1 patients had lower hand grip strength than their matched controls, but no other differences. Compared to controls, the PKU-2 group had lower fat-free mass ( p = 0.01), less spine and femoral bone mineral density ( p = 0.04 and p < 0.01, respectively), and peak workload on the incremental test ( p = 0.03). When comparing PKU groups, blood Phe levels were significantly lower in the PKU-1 group ( p = 0.02)., Conclusions: Among PKU patients, abandoning the dietary treatment and maintaining high blood Phe concentrations could be deleterious for muscles and bones. However, we cannot discard other causes of bone and muscle damage in these patients.

The hypocaloric Mediterranean diet (MD) mainly reduces fat mass but inevitably causes a loss of skeletal muscle mass. High-intensity interval training (HIIT) seems to have advantages in preserving muscle mass during a hypocaloric regime. Our study compares body composition and metabolic changes in overweight and obese Chilean women and men after 3 months of weight loss treatment with a Mediterranean-type hypocaloric diet, HIIT, or a combination of both. The study included 83 overweight or obese women and men between the ages of 25 and 50. The subjects were randomly assigned to one of the three intervention groups: (1) MD, (2) EX, and (3) MD + EX. Baseline and post-intervention measurements included: (a) body composition by dual-beam densitometry, muscle, and fat measurements by thigh ultrasound and computed tomography; (b) handgrip and quadriceps muscle strength; (c) exercise performance by peak oxygen consumption, peak load, work efficiency, and exercise energy expenditure; and (d) metabolic parameters. Out of 83 participants, the retention rate was 49% due to low compliance with the interventions. As expected, the MD group resulted in significantly greater weight loss (MD -7%, EX -0.6% and MD + EX -5.3%) and appendicular fat mass loss (MD -11.1%, EX -2.9, MD + EX -10.2%) but was associated with significant lean tissue loss (2.8%), which was prevented by HIIT (EX -0.1 and MD + EX -0.6%). Metabolic and glycoxidative parameters remained unchanged, irrespective of changes in body composition. Hypocaloric diets remain the most effective means to lose weight and body fat. However, it induces a loss of lean body mass when not accompanied by exercise training. This study shows that HIIT prevents the loss of muscle mass caused by a hypocaloric Mediterranean diet., Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships construed as a potential conflict of interest., (Copyright © 2023 Monsalves-Álvarez, Jiménez, Bunout, Barrera, Hirsch, Sepúlveda-Guzman, Silva, Rodriguez, Troncoso and de la Maza.)

Background & Aims: Ultrasound can be used to measure the pennation angle between muscle fiver and the presumed axis of force generation and muscle echogenicity as an indicator of muscle fat infiltration. We aimed to assess the association of the rectus femoris pennation angle and echogenicity with muscle functional measures. Also, to assess the concordance of rectus femoris echogenicity with muscle fat infiltration as determined by CT scan., Methods: Rectus femoris ultrasound pennation angle and thickness were measured in 78 participants aged 69 (65,73) years (37 women). Also hand grip strength, gait speed in 4 m, the 12 min' walk and body composition by DEXA were measured. In a different group of 114 participants aged 44 (31,52) years (80 females), non-dominant rectus femoris echogenicity and thickness were measured by ultrasound and muscle fat infiltration was assessed by CT scan. Handgrip strength and quadriceps torque were also measured., Results: There was a weak correlation between the pennation angle and rectus femoris thickness in men (r = 0.31 p = 0.05) but not in women (r = 0.29 NS). Women, but not men with a low pennation angle covered a longer distance during the 12 min' walk. The concordance between the z scores of rectus femoris echogenicity and CT radiological density was 0.43 (p < 0.01) and 0.01 (NS) in men and women, respectively. Men and women with an echogenicity below the 25th percentile had a higher quadriceps torque. Men with an echogenicity 25th percentile below 25th percentile had also a higher handgrip strength., Conclusions: Rectus femoris pennation angle had a weak or absent association with muscle performance. Rectus femoris echogenicity had a moderate overall concordance with radiological density by CT scan and was inversely associated with quadriceps torque. Therefore, echogenicity was associated with muscle strength, but pennation angle measurement did not contribute to the assessment of muscle function., Competing Interests: Declaration of competing interest All authors or their affiliations did not receive any financial support or service from a third party related to the subject matter or materials discussed in the manuscript. All authors do not have any relevant conflict of interest. There is no condition/circumstance that may present a potential conflict of interest., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Phenylketonuria (PKU) is an autosomal recessive inborn error of metabolism where high phenylalanine (Phe) concentrations cause irreversible intellectual disability that can be prevented by newborn screening and early treatment. Evidence suggests that PKU subjects not adherent to treatment could be at risk of insulin resistance (IR). We studied how Phe concentrations (PheCs) relate to IR using machine learning (ML) and derived potential biomarkers. In our cross-sectional study, we analyzed subjects with neonatal diagnoses of PKU, grouped as follows: 10 subjects who adhered to treatment (G1); 14 subjects who suspended treatment (G2); and 24 control subjects (G3). We analyzed plasma biochemical variables, as well as profiles of amino acids and acylcarnitines in dried blood spots (DBSs). Higher PheCs and plasma insulin levels were observed in the G2 group compared to the other groups. Additionally, a positive correlation between the PheCs and homeostatic measurement assessments (HOMA-IRs) was found, as well as a negative correlation between the HOMA-Sensitivity (%) and quantitative insulin sensitivity check index (QUICKI) scores. An ML model was then trained to predict abnormal HOMA-IRs using the panel of metabolites measured from DBSs. Notably, ranking the features' importance placed PheCs as the second most important feature after BMI for predicting abnormal HOMA-IRs. Our results indicate that low adherence to PKU treatment could affect insulin signaling, decrease glucose utilization, and lead to IR.

Aim: We investigated the relation of time of onset and length of obesity with biomarkers of β-cell function in early adulthood in an infancy cohort., Material and Methods: In 1039 23-year-olds, body-mass index (BMI) was measured at multiple time-points from enrollment. BMI trajectories were interpolated with cubic polynomials. Fasting glucose, insulin and adiponectin were measured at 23 years. Homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-S, HOMA-β, HOMA-adiponectin (AD) and disposition index (DI) were estimated. IR and non-alcoholic fatty liver (NAFL) were diagnosed. According to the BMI trajectory, five groups were defined: participants who were never obese (NOB); participants with obesity starting in adolescence and remained obese into adulthood (recent-onset obesity, ROB); participants who were obese in early childhood but transitioned to non-obesity as preadolescents (former obesity, FOB); participants who were obese in early childhood and remained obese into adulthood (persistent obesity, POB); participants with obesity starting in preadolescence and transitioned to non-obesity as adolescents (transient obesity; TOB)., Results: Obesity was present in 47% of participants during at least one time-point. ROBs and POBs had higher insulin, HOMA-IR and HOMA-β, lower HOMA-S and DI, and higher prevalence of IR and NAFL at 23 years than NOBs, TOBs and FOBs. No differences were found in the β-cell functionality of NOBs, TOBs and FOBs., Conclusions: Persistent and recent obesity are both related to IR, NAFL and a decline of β-cell function in emerging adulthood. Defeating obesity in childhood or adolescence allows reaching emerging adulthood with β-cell functioning similar to that of subjects who were NOB., (© 2020 John Wiley & Sons Ltd.)

Objective: Omega-3 fatty acids may reduce albuminuria and cardiovascular risk factors in patients with chronic kidney disease (CKD). We aimed to assess the effects of omega-3 fatty acid supplementation on albuminuria, blood pressure, pulse wave velocity, and inflammatory markers in patients with CKD., Methods: Patients with CKD and a urine albumin excretion of at least 30 mg/g creatinine were supplemented for 3 months with 3,666 mg/day of docosahexaenoic and eicosapentaenoic acids or a corn oil supplement. The study was double blind. At baseline, 6 weeks, and 12 weeks, fasting blood and morning spot urine samples were obtained. Blood pressure, carotid intima media thickness, and pulse wave velocity were measured. The main outcome measure was a reduction of ≥20% in urine albumin., Results: One hundred patients were randomized (50 received omega-3 fatty acids and 50 received corn oil). Four patients who received omega-3 fatty acids and 5 who received vegetable oil were lost to follow-up. In patients receiving omega-3 fatty acids, the omega-3 index increased from 3.08 (2.32-3.81) to 5.48 (3.045-7.04) percent. A 20% reduction in urine albumin excretion was observed in 13 participants of the control group and 19 participants of omega-3 group (Fisher's exact P = .274). However, the supplement had a significant and positive effect on pulse wave velocity and triglyceride level., Conclusion: An omega-3 fatty acid supplement of 3,666 mg/day did not modify urine albumin excretion in patients with CKD but did improve pulse wave velocity and serum triglyceride levels., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: Predictive equations are frequently used to estimate resting energy expenditure (REE) because indirect calorimetry (IC) is not always available and is expensive. The aim of this study was to determine the concordance between the estimation of REE using predictive equations and its measurement by IC., Methods: This was an analysis of the registry of indirect calorimetry performed in non-hospitalized participants. Harris-Benedict, FAO/WHO/UNU, Mifflin St. Jeor, and European Society for Clinical Nutrition and Metabolism (ESPEN) equations were used to estimate REE in these individuals. The concordance between measured and estimated REE using real, ideal, and adjusted weight was calculated using the concordance coefficient analysis of Lin and Bland- Altman plots in all participants and in subgroups separated according to their body mass index., Results: We retrieved 680 measurements and discarded 247 that did not comply with the inclusion criteria. Thus, we studied 433 participants ages 36 y (29-48 y). Of the participants, 341 were women (79%) and the participants had a body mass index (BMI) of 30 kg/m 2 (26.7-33.1 kg/m 2 ). All predictive equations had concordance values <0.90. The proportion of participants in which the difference was >10% ranged from 36% to 87%. The ESPEN equation had the greater proportion of erroneous estimations of REE in all participants and BMI subgroups when real weight was used., Conclusions: We observed a low level of concordance between REE estimated using predictive equations and measured by IC. These results should alert clinicians about the inaccuracy of predictive equations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

An inexpensive and simple method to determine non-alcoholic fatty liver disease (NAFLD) is the abdominal ultrasound, but there are still doubts about its accuracy. We assessed the precision of a semi-quantitative ultrasound method to determine liver fat infiltration, using magnetic resonance spectroscopy (MRS) as the reference. The study was conducted in youths from an ongoing cohort study. Clinical validation was performed, using receiver operating characteristic analysis, in n = 60 participants (22.6y; 50% males). Abdominal ultrasound was carried out with liver brightness (score 0-3), diaphragm attenuation (0-2) and liver vessel blurring (0-1) scored by two observers. Liver fat was estimated using MRS. Then, analytical validation was conducted in the remaining participants ( n = 555; 22.7y; 51% males) using effects size estimates. An ultrasound score ≥4.0 had the highest sensitivity (78%) and specificity (85%) for NAFLD diagnosis. An area under the curve of 86% denotes a good diagnostic performance of the test, whereas a Kappa of 0.63 suggests substantial agreement of ultrasound vs. MRS. The analytical validation showed that participants having NAFLD according to ultrasound had an unhealthier cardiometabolic profile than participants without the condition. Abdominal ultrasound, combined with a semi-quantitative score system, is a reliable method to determine liver fat infiltration in young adults and should be encouraged whenever MRS is unavailable.

Introduction: Background: protein restriction is the mainstay of dietary management of chronic kidney disease. Aim: to assess the usefulness of urine urea nitrogen measurement as a marker of protein restriction. Methods: healthy young participants were randomly divided in two groups. During 14 days, one group received a diet containing 30 kcal/kg body weight and 1 g protein/kg body weight and the other group received a diet with the same amount of calories and 0.6 g/kg of proteins. At baseline, seven days and 14 days, 24 h dietary recalls were answered by the participants. They collected 24 hour urine and provided spot urine samples at baseline and at the end of the intervention, to measure creatinine and urea nitrogen. Results: forty-one participants aged 29 ± 5 years completed the follow-up. According to 24h dietary recalls, the group receiving 0.6 g/kg protein reduced significantly the protein intake during the intervention from 0.88 ± 0.06 to 0.59 ± 0.05 g/kg/day. A significant reduction in 24 h urea nitrogen excretion was also observed in this group. In the group receiving 1 g/kg of protein, no significant changes in 24 h urea nitrogen excretion were observed. Among all participants, the odds ratio of observing a reduction in protein intake in the dietary survey was 5.75 (95% confidence intervals 1.29-25.55, p = 0.02), when a reduction in 24 h urea nitrogen excretion corrected by creatinine was observed. No changes were observed in urea nitrogen excretion in spot urine samples. Conclusions: repeated urea nitrogen excretion measured in 24 h urine samples can be a reliable indicator of dietary protein restriction.

Several investigations have found that industry-funded studies tend to inform results favoring the sponsored products. The pressure to demonstrate that a drug or a product causes a favorable outcome may result in investigation biases from industry-funded research. One example of this could be found in the probiotic research funded by the industry. The aim of this study was to assess the effect of industry funding on positive outcomes of the use of probiotics in the management of acute diarrhea. A systematized review of clinical trials on the use of probiotics in the management of acute diarrhea was performed. The associations between the source of funding, clinical outcomes, probiotic genus, and quality of the study were assessed using the χ-test and Fisher's exact test. Sixty-six clinical trials were included; 27 were industry funded, 18 were nonindustry funded, and 21 did not disclose their funding source. There were 48 positive and 30 negative clinical outcomes. There was no significant association between the source of funding and clinical outcomes (P=0.491). No association between the rest of the studied variables and outcomes was observed either (P>0.05). In clinical trials on the use of probiotics in the management of acute diarrhea, the source of funding has no influence on positive clinical outcomes.

Objectives: International cutoff points for the diagnosis of sarcopenia are not applicable to the Chilean population due to previous evidence of a lower lean mass and strength in this population. Dual-energy x-ray absorptiometry is used to establish fat-free mass cutoff points to define sarcopenia in the Chilean population and analyze its association with handgrip strength in older adults., Methods: Appendicular fat-free mass (AFFM) was calculated from 4062 dual-energy x-ray absorptiometries of healthy Chileans, ages 18 to 99 y. Possible cutoff points for sarcopenia were obtained using four methods: A) Normative, -2 standard deviation (SD) below mean AFFM/height 2 (AFFMI) of adults age <40 y; B) normative -1 SD, -1 SD under the average AFFMI of adults age <40 y; C) stratification, 25th percentile of the residual distribution obtained with the regression equation to predict AFFM in the entire sample; and D) percentage, -2 SD under the average skeletal muscle mass/total body mass of individuals age <40 y. Additionally, in a subsample of elderly subjects, the correlation between handgrip strength and the four calculated cutoff points was analyzed., Results: Using the normative method, sarcopenia was defined as an AFFMI <6.4 kg/m 2 in men and <4.8 kg/m 2 in women and at -1 SD, the cutoff points were <7.5 kg/m 2 and <5.6 kg/m 2 , respectively. With the stratification method, sarcopenia was defined as -1.33 kg and -1.05 kg of AFFM with respect to the expected value according to the regression equation in men and women, respectively. According to the percentage method, the cutoff points for sarcopenia were <30% and <22.9% in men and women, respectively. The concordance of the four methods was slight to moderate. Only the percentage method showed a progressive increase in the proportion of subjects with sarcopenia as age increased. The latter and the normative -1 DS predicted lower handgrip strength in elderly women, unlike the other diagnostic methods. For elderly men, only the normative -1 DS method predicted weaker handgrip strength., Conclusions: The AFFM of young Chileans is lower than that reported in Western countries but similar to Latin American data; therefore, the use of the traditional normative method would not be appropriate with -2 SD to establish cutoff points, and using -1 DS resulted in values that are higher than Baumgartner's. Stratification is advantageous because this method throws expected values of AFFM for each population; however, overdiagnosis of sarcopenia is a possibility and thus the method requires a representative sample. The percentage method is simple and showed the expected decrease of muscle mass with age, and also correlated well with handgrip strength in elderly women. Thus, this method represented our method of choice to detect sarcopenia., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Sedentariness may be an important risk factor for sarcopenia. The aim of this work was to assess the association between muscle mass and strength and markers of usual physical activity such as activity energy expenditure and peak oxygen uptake., Methods: Young and old participants were assessed measuring body composition by DEXA (double beam X ray absorptiometry), handgrip strength, peak oxygen consumption and workload during an exercise calorimetry in a braked cycle ergometer and a 72 h activity energy expenditure using Actiheart actigraphs. A heart rate/energy expenditure curve derived from the exercise calorimetry was used to calibrate each actigraph. Sarcopenia was defined as having an appendicular fat free mass index below 7.5 kg/m 2 and 5.6 kg/m 2 in men and women respectively, or a handgrip strength z score below 1, using local normal data or having both parameters below the cutoff points., Results: We analyzed data from 192 assessments performed in participants aged 22 to 88 years (106 women). Sarcopenic participants (as determined by muscle mass, strength or both) had a significantly lower peak oxygen uptake and work load and a significantly lower activity energy expenditure. When analyzing lean mass and strength as continuous variables, peak oxygen consumption was a significant predictor of fat free mass in men. Among women, the association was observed only when percentage of muscle mass was expressed as a z score., Conclusions: Activity energy expenditure and peak oxygen consumption are associated with a lower muscle mass and the presence of sarcopenia and should be considered as risk factors for this condition.

Background: Even before the onset of age-related diseases, obesity might be a contributing factor to the cumulative burden of oxidative stress and chronic inflammation throughout the life course. Obesity may therefore contribute to accelerated shortening of telomeres. Consequently, obese persons are more likely to have shorter telomeres, but the association between body mass index (BMI) and leukocyte telomere length (TL) might differ across the life span and between ethnicities and sexes., Objective: A collaborative cross-sectional meta-analysis of observational studies was conducted to investigate the associations between BMI and TL across the life span., Design: Eighty-seven distinct study samples were included in the meta-analysis capturing data from 146,114 individuals. Study-specific age- and sex-adjusted regression coefficients were combined by using a random-effects model in which absolute [base pairs (bp)] and relative telomere to single-copy gene ratio (T/S ratio) TLs were regressed against BMI. Stratified analysis was performed by 3 age categories ("young": 18-60 y; "middle": 61-75 y; and "old": >75 y), sex, and ethnicity., Results: Each unit increase in BMI corresponded to a -3.99 bp (95% CI: -5.17, -2.81 bp) difference in TL in the total pooled sample; among young adults, each unit increase in BMI corresponded to a -7.67 bp (95% CI: -10.03, -5.31 bp) difference. Each unit increase in BMI corresponded to a -1.58 × 10(-3) unit T/S ratio (0.16% decrease; 95% CI: -2.14 × 10(-3), -1.01 × 10(-3)) difference in age- and sex-adjusted relative TL in the total pooled sample; among young adults, each unit increase in BMI corresponded to a -2.58 × 10(-3) unit T/S ratio (0.26% decrease; 95% CI: -3.92 × 10(-3), -1.25 × 10(-3)). The associations were predominantly for the white pooled population. No sex differences were observed., Conclusions: A higher BMI is associated with shorter telomeres, especially in younger individuals. The presently observed difference is not negligible. Meta-analyses of longitudinal studies evaluating change in body weight alongside change in TL are warranted.

Background: the prognostic value of maximal inspiratory and expiratory pressures on functional capacity and mortality of hospitalized patients are not well established., Aim: to evaluate the prognostic value of respiratory pressures in hospitalized patients., Methods: patients admitted to a general hospital in Santiago-Chile were prospectively studied. Within 48 hours of admission, handgrip strength and inspiratory and expiratory pressures were measured. Subjective global assessment of nutritional status (SGA) was determined and Apache II score was calculated. Functional status was assessed using the Karnofski index. Patients were followed for a period of 30 days. Mortality and decline in functional capacity, defined as a reduction in at least two stages of the Karnofski index were determined. Normal values for handgrip strength and respiratory pressures were obtained in 366 healthy subjects aged 20 to 89 years, thus the results obtained in patients were expressed as age and sex matched z-scores., Results: one hundred and eight patients were recruited and 18 had to be excluded. Thus, 90 patients aged 58 ± 16 years (46 females) were studied. During the observation period, six patients died and nine experienced a decline in functional status. Patients who died had significantly lower maximal inspiratory and expiratory pressures, hand grip strength and worse SGA. Logistic regression analysis only accepted maximal expiratory pressure expressed as z-score as a predictor of mortality. In addition, it was the only significant predictor of death or functional decline., Conclusions: maximal expiratory pressure on admission was a predictor of death or functional decline at 30 days.

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.

To assess if there is an association between socioeconomic status and quality of life, functional status and markers of aging, we studied 86 women aged 73 ± 7 years, who answered the WHO Qol Bref quality of life survey. Mini mental state examination, timed up and go test, 12 minutes' walk, hand grip and quadriceps strength, dual X-ray absorptiometry (DEXA), carotid intima-media thickness and telomere length in peripheral leukocytes were measured. Successful aging was defined as a walking speed, handgrip strength, appendicular lean body mass, timed up and go and minimental values above cutoff points for disability. Participants with successful aging had a higher quality of life score and were more likely to live in rich municipalities. There was a positive correlation between telomere length, right handgrip strength and total fat free mass. Therefore, there is an association between socioeconomic status, successful aging and quality of life., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To determine if irisin plasma levels are associated with regular physical activity, body composition and metabolic parameters in women subjected to calorie restriction., Subjects and Methods: We studied 42 women aged 34 ± 13 years with a body mass index of 27.7 ± 1.8 kg/m2, who were subjected to a calorie restriction for three months. At baseline and at the end of the study, weight, waist and hip circumference, laboratory parameters, body composition by DEXA, resting and activity energy expenditure by indirect calorimetry and 72 hours actigraphy were measured. Fasting serum irisin was quantified using an ELISA kit., Results: After the intervention period, participants lost 1.5 (0.4-3.4) kg and irisin levels did not change. Irisin baseline levels were positively but weakly correlated with the level of physical activity. This association was lost at the end of the intervention. No association was found between irisin levels and body composition or insulin sensitivity or their changes after calorie restriction. No association between serum irisin levels and PGC-1αexpression in peripheral blood mononuclear cells and serum irisin was observed., Conclusions: Fasting serum irisin was weakly associated with usual physical activity and did not change after calorie restriction.

Problem: Up to 35% of hospitalized patients may experience functional decline during or after hospitalization. Subjective Global Assessment (SGA) and handgrip strength at admission, have been proposed as simple and accessible tools to predict functional decline, but there are few studies in hospitalized patients to confirm these findings., Objective: To assess the predictive value of handgrip strength at hospital admission, on functional decline after 30 days., Methods: 125 non-critical patients hospitalized for medical and surgical conditions, were studied in El Pino hospital in Santiago, Chile. Upon admission, nutritional status was assessed by SGA, functional status through the Karnofsky index (KI), and handgrip strength by dynamometry. Change in functionality was assessed by the difference between KI at admission and 30 days later. Multivariate logistic regression models were used to establish associations between the variables at hospital admission, and subsequent functional decline., Results: Thirty days post-hospital admission, 28.8% of the sample showed functional decline. In a multivariate analysis, only handgrip strength was associated with this decline (β = -0.025, OR = 0.974 (CI 0.956-0.992), p = 0.007)., Conclusions: Handgrip strength upon hospital admission can be a useful independent and early method to predict deterioration of functional status during hospitalization., (Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Chronic renal disease (CRD) in its pre-dialysis stage is an important risk factor for mortality among adults. The aim of this study was to assess the effects of CRD on mortality among consultants in Chilean public primary care clinics. We obtained information about serum creatinine, urinary albumin excretion (UAE), blood pressure, and body mass index of 5224 consultants [3379 females aged 67 (59-75) years and 1845 males aged 68 (59-75) years] in three clinics of Metropolitan Santiago. Kaplan-Meier curves and Cox proportional hazard regression models were used to determine risk factors for mortality, determined 41 months after obtaining the blood samples. During the follow-up period, 262 patients died (33% due to circulatory causes and 29% due to tumors). Kaplan-Meier curves showed that there was a significant association between survival, estimated glomerular filtration rate, and UAE. Cox models showed that serum creatinine, UAE, a lower body mass index, and a history of diabetes were significant mortality predictors. A sensitivity analysis performed eliminating extreme ages (less than 50 and more than 80 years), included high diastolic pressure as a predictor of survival. We conclude that among patients with CRD in its pre-dialysis stage, UAE is an important predictor of survival, along with serum creatinine. A low body mass index was associated with a higher mortality.

Background: L-methionine, the principal sulfur-containing amino acid in proteins, plays critical roles in cell physiology as an antioxidant and in the breakdown of fats and heavy metals. Previous studies suggesting the use of L-methionine as a treatment for depression and other diseases indicate that it might also improve memory and propose a role in brain function. However, some evidence indicates that an excess of methionine can be harmful and can increase the risk of developing Type-2 diabetes, heart diseases, certain types of cancer, brain alterations such as schizophrenia, and memory impairment., Results: Here, we report the effects of an L-methionine-enriched diet in wild-type mice and emphasize changes in brain structure and function. The animals in our study presented 1) higher levels of phosphorylated tau protein, 2) increased levels of amyloid-β (Aβ)-peptides, including the formation of Aβ oligomers, 3) increased levels of inflammatory response,4) increased oxidative stress, 5) decreased level of synaptic proteins, and 6) memory impairment and loss. We also observed dysfunction of the Wnt signaling pathway., Conclusion: Taken together, the results of our study indicate that an L-methionine-enriched diet causes neurotoxic effects in vivo and might contribute to the appearance of Alzheimer's-like neurodegeneration.

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., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

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., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Folic acid (FA) consumption at high levels has been associated with colon cancer risk. Several mechanisms have been proposed to explain this association. The Notch signal pathway has been implicated in the regulation of cellular proliferation. Our aim was to demonstrate that high concentrations of FA or its reduced form, 5-methyltetrahydrofolic acid (5-MTHF), increase colorectal carcinoma HT29 cell proliferation through an increase of Notch1 activation and to prove if the inhibition of Notch1 activation by gamma secretase inhibitor, reduce the effect of folic acid. HT29 cells were cultured in high (400 nM), low (20 nM), or 0 nM FA or 5-MTHF concentrations during 96 h with or without DAPT (gamma secretase inhibitor). Cell proliferation was determined by the methylthiazole tetrazolium method, and Notch1-intracellular domain (NICD) was analyzed by flow cytometry. HT29 cells exposed to 400 nM FA or 5-MTHF showed higher proliferation rate than those exposed to 20 nM of FA or 5-MTHF (P < 0.01) during 96 h. NICD expression increased at higher FA or 5-MTHF concentrations compared with lower concentrations (P < 0.01). This effect on proliferation was partially reversible when we blocked Notch1 activation with the inhibitor of γ-secretase (P < 0.05).These data suggest that high concentration of FA and 5-MTHF induce HT29 cell proliferation activating Notch1 pathway.

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., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Aim: To explore the usefulness of carotid ultrasound examination as a marker of aging and predictor of disability among older people., Methods: Carotid ultrasound, measuring carotid intima media thickness (CIMT) and recording the presence of plaques, was carried out in 152 adults aged 29-59 years (47 women) and in 107 older adults aged 61-88 years (86 women). In all, clinical routine laboratory parameters and lymphocyte telomere length as T/S ratio were measured. Among older adults, 12-min walk, timed up and go, hand grip and quadriceps strength were determined., Results: CIMT was significantly higher among older people and T/S ratio was significantly higher in young women. Carotid plaques were found in one adult and 17 older people. A multiple regression analysis accepted age, systolic blood pressure and T/S ratios as independent predictors of CIMT (R(2) = 0.51). Among older people, a logistic regression accepted age and the presence of carotid plaques as significant predictors of a 12-min walk speed below 1 m/s., Conclusions: An abnormal 12-min walk as an indicator of functional decline among older people is associated with the presence of carotid artery plaques. CIMT is independently associated with age., (© 2013 Japan Geriatrics Society.)

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., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background: Obesity has long been associated with an increased risk of cardiovascular disease (CVD). The aim of this study was to evaluate the impact of substantial weight loss induced by bariatric surgery on carotid intima media thickness (C-IMT) (surrogate marker of early atherosclerosis) and classic factors of cardiovascular risk (CVRFs)., Methods: thirty-one obesity patients were evaluated for bariatric surgery. Twenty-seven were undergone surgery, 14 Roux-en-Y gastric bypass surgery (GBS) and 13 sleeve gastrectomy. The four obese patients who did not undergo surgery, were performed the same evaluations., Measurements: Body weight, BMI, blood pressure, total cholesterol, TC levels, LDL-C, HDL-C, TG, fasting plasma glucose and insulin, HOMA IR, and US B-mode C-IMT was measured., Results: After 354 ± 92 days follow up, 27 patients that underwent bariatric surgery evidenced a mean body mass index decrease from 38 to 27 k/m² (p < 0.001), simultaneously was observed improvement in CVRFs, 10 years Framingham risk and a significant reduction of therapeutic requirements. C-IMT diminished from a mean of 0.58 ± 0.14 mm to 0.49 ± 0.09 mm (p = 0.0001). Four patients that did not undergo surgery increased C-IMT from 0.52 ± 0.12 to 0.58 ± 0.13 mm (p = 0.03) with no significant changes in CVRFs., Conclusion: Weight loss, one year after bariatric surgery, GBS and sleeve gastrectomy, decreases C-IMT; improve CVRFs and 10 years Framingham risk., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Objectives: Folate supplementation may be associated with an increased risk of developing several types of cancer and a derangement of immune function. Among the latter, Natural killer (NK) cells are involved in non-MHC-restricted natural immunity against malignant target cells. Abnormalities in NK cell number or function have been associated with a higher cancer risk. The aim of this study was to study in vitro the possible effect of different concentrations of 5-methyltetrahydrofolic acid (5-MTHF) or folic acid on NK cell cytotoxic function, and expression of the stimulatory and inhibitory receptors KIRDL4, KIRDL3, and NKG2D., Methods: Volunteer-derived peripheral mononuclear cells (PBMC) and highly enriched NK cells (95% CD56+ CD16+) were grown in folic acid free-RPMI 1640, supplemented either with folic acid or 5-MTHF (15-100 nM) during 72 h to 96 h., Results: No differences in the cytolytic activity of PBMC and enriched NK cells were observed. After 96 h of in vitro culture without folate or supplemented with FA or 5-MTHF (30 or 100 nM), there were no changes in the percentage of HPNK receptor-positive cells., Conclusions: Our data indicate that a high dose of 5-MTHF or folic acid does not influence NK cell function in vitro., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background and Aims: Sleep problems are common in older adults. They have been associated with reduced physical functionality affecting their health, well-being, and consequently their overall quality of life. We conducted this study to examine the association between sleep/wake patterns and functional capacity in hypertensive older adults., Methods: Participants were recruited from the study "Effect of the angiotensin-converting enzyme inhibitors over grip strength and functionality of older adults" and accepted to be part of this cross-sectional study. Subjects were 97 older adults with a mean age of 74.8 ± 3.3 years and 77 % were women. Sleep/wake patterns were determined through actigraphic data and the following variables were determined: total sleep time, number of awakenings and wake after sleep onset within the nocturnal period, and number of naps and total sleep time during the diurnal period. Functional performance measurements included short physical performance battery and grip strength. Differences in physical performance according to sleep/wake patterns were explored, and the association between the sleep/wake patterns and functionality adjusting by sex, age, body mass index, use of angiotensin-converting enzyme, number of diseases, and hypnotic intake was studied using logistic regression analysis., Results: Subjects sleeping <7.0 h or having fragmented sleep with >2.0 awakenings/night had a slightly but significant higher odds ratio of having functional performance impairment (p < 0.05)., Conclusion: Our results suggest that a better nighttime sleep consolidation might help improve daytime physical performance of older people.

Aim: To test the variability within and between subject of glycemic response test following the ingestion of a standard food., Material and Methods: Glucose and insulin response of a standard meal (white bread) was performed in ten healthy volunteers and repeated under identical conditions for 6 times. Blood glucose and insulin levels were measured in the fasted state and over the 180 min following commencement of consumption of the foods The Area Under the Curve (AUC) for glucose and insulin was calculated for the values above baseline for the 3-hour period following the standard meal. Within and between coefficient of variation was calculated., Results: The total intra-individual variation of the gAUC was 51.8% range 24.9 to 91.4%. The inter-individual variation of the gAUC in the complete study was 75.2% . The total intra-individual variation of the iAUC was 51.9%. ranged: 7.7 to 103%. The inter-individual variation in the complete study was 86%., Conclusion: Glucose and insulin response to a reference food has low reliability, therefore limits its clinical utility for individual dietary prescription., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis., Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis., Material and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band(®) elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor α and interleukin 6. Quadriceps muscle strength, six minutes' walk and quality of life using the SF-36 questionnaire, were also measured., Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes' walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life., Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

Aim: To evaluate the association between loss of fat-free mass and mortality among older people., Methods: Information of healthy Chilean older people evaluated by dual energy X-ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables., Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow-up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat-free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex-specific quartile for appendicular fat-free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years., Conclusion: A low fat-free mass was predictive of mortality in older people., (© 2011 The Authors. Australasian Journal on Ageing © 2011 ACOTA.)

Background: The WHOQOL-BREF is a generic questionnaire to measure quality of life created by the Study Group on Quality of Life of the World Health Organization., Aim: To adapt and evaluate the psychometric properties of the Spanish version of the WHOQOL-BREF instrument in a group of Chilean older subjects living in Metropolitan Santiago., Material and Methods: A linguistic-cultural adaptation of the Spanish version of the WHOQOL-BREF was performed and tested in a pilot study. Subsequently, the modified scale was applied to a group of 1186 older women aged 72 ± 8 years and 334 men aged 72 ± 7 years. The psychometric properties such as internal consistency, item-total correlation of responses, and construct validity were evaluated. A confirmatory factor analysis was done to check if the dimensions described in the original version, were evaluated. Analyses were performed with STA-TA statistical software 10.0 and LISREL 8.50., Results: Confirmatory factor analysis confirmed that the dimensions physical health, psychological, social relationships and environment, described by the authors in their original description, were maintained. The instrument had a good internal consistency with a Cronbach alpha of 0.88 for the total scale and ranging from 0.70 to 0.79 in each of the dimensions., Conclusions: The evaluated version of the WHOQOL-BREF has an acceptable reliability and validity, and suggests that it is suitable for the assessment of Quality of Life in elderly people in Chile.

Introduction: The inhibition of angiotensin-converting enzyme could be useful to avoid sarcopenia in the elderly., Materials and Methods: We compared in a prospective double blind trial, the effects of treatment with enalapril or nifedipine on muscle performance in hypertensive elderly subjects. Patients were followed for nine months, and at baseline, 4.5 months and the end of follow-up, quadriceps and hand grip muscle strength, walking capacity, timed up and go and the short physical performance test were measured., Results: During follow-up, more subjects on nifedipine than on enalapril discontinued the medication due to side-effects. No differences in the evolution of muscle strength, walking capacity or functional measures were observed. At nine months, plasma angiotensin-converting enzyme activity decreased by 6.0+/-2.5 U/L among patients on enalapril and increased by 8.5+/-4.2 U/L (p<0.001) among patients on nifedipine., Conclusion: In this group of elderly subjects, enalapril was not superior to nifedipine with regard to the age-related decline of muscle performance.

Background: The study of the effects of bariatric surgery on quality of life in patients of different socioeconomic levels (SEL) is worthwhile., Aim: To study quality of life (QoL), eating behavior, depressive symptoms and sexuality in patients subjected to a gastric bypass (GBP) more than 1 year before., Material and Methods: The sample was composed of 33 GPB patients (19 high SEL and 14 low SEL), and 27 non-operated women (18 high SEL and 9 low SEL) of similar weight and age, as controls. Assessment included medical history anthropometry radiological densitometry. Eating behavior was assessed using the three factor eating questionnaire, quality of life using SF-36 and the Bariatric Analysis of Reporting Outcome System (BAROS) depressive symptoms were assessed using the Beck scale version II and sexual behavior using the female sexual function index (FSFI)., Results: QoL was lower in operated patients from low SEL, especially when compared to high SEL control women. Operated patients had a predominantly restrictive pattern of eating behavior Eating behavior disorders were detected in 5 of 33 operated patients versus 4 of 27 controls (p =ns). Sexual function was absent or dysfunctional in 22 operated versus 8 controls (p =0,02). No significant differences were observed for depressive symptoms, between operated patients and controls., Conclusions: In the long term, QoL of bariatric patients, especially those from low SEL, is inferior to control women and Chilean general population. Operated patients have restrictive eating patterns and lower sexual satisfaction indexes. Frequency of depressive symptoms was high both in bariatric and control women.

A blood sample and muscle biopsies were obtained from 54 elderly subjects. Twenty-seven subjects aged 77+/-3 years, had experienced a change in fat free mass (FFM) of +194+/-282g/year (lean body mass maintainers) and 27 subjects aged 78+/-3 years, had a change in FFM of -487+/-209g/year (lean body mass losers). Muscle biopsies were also obtained from 10 healthy subjects aged 34+/-4 years. In muscle, the ratio of mitochondrial DNA (mtDNA) to nuclear DNA (nDNA) and telomere length were assessed and deposition of 4-hydroxy-2-nonenal adducts (4HNE) was visualized by electron microscopy. In FFM maintainers, losers and young controls, the ratio of mtDNA to nDNA was 2.1 (95% confidence intervals (CI), 0.1-31.7), 1.5 (95% CI, 0.2-15.7) and 18.6 (95% CI, 2.8-46.2), respectively. 4HNE deposition was 5.9 (95% CI, 1.5-28), 4.9 (95% CI, 0.9-13) and 3.4 (95% CI, 1.1-4.6) gold particles/microm(2), respectively. Telomere length, expressed as T/S ratio, was 0.06 (95% CI, 0.01-0.16), 0.06 (95% CI, 0.03-0.27) and 0.34 (95% CI, 0.1-1.34), respectively (p<0.02 or less for all comparisons between elderly and young subjects).

Background: Folate depletion is associated with an increased risk of colorectal carcinogenesis. A temporal association between folic acid fortification of enriched cereal grains and an increase in the incidence of colorectal cancer in the USA and Canada has, however, been recently reported., Aim: To compare the rates of hospital discharges owing to colon cancer in Chile before and after the start of the mandatory flour fortification program with 220 microg of synthetic folic acid/100 g of wheat flour., Methods: Cancer and cardiovascular hospital discharge rates were compared using rate ratios between two study periods, 1992-1996, before folic acid fortification and 2001-2004, after the flour fortification with folic acid was established in the country. Standard errors of the log rate ratio to derive confidence intervals, and to test the null hypothesis of no difference, were calculated., Results: The highest rate ratio between the two periods was for colon cancer in the group aged 45-64 years (rate ratio: 2.6, confidence interval: 99% 2.93-2.58) and in the 65-79 years (rate ratio: 2.9, confidence interval: 99% 3.25-2.86)., Conclusion: Our data provide new evidence that a folate fortification program could be associated with an additional risk of colon cancer.

Background: Tissue accumulation of advanced glycation end products (AGEs) is associated with ageing, both in diabetics and nondiabetic subjects., Aim: The purpose of this study was to assess immunostaining for AGEs, specifically carboxymethyl-lysine (CML) and receptor for AGEs (RAGE), in muscle tissue of healthy male subjects differing in age and weight stability., Methodology: Muscle tissue was obtained during hernia surgery in middle-aged men reporting weight maintenance (WM, n = 10) or weight gain (WG, n = 7), and also in 4 elderly men. Tissue inmunostaining for CML and RAGE was performed., Results: Intensity of CML and RAGE staining were highly correlated (r = 0.84) and also significantly associated with weight change and age. Muscle AGEs accretion was statistically associated with muscle expression of oxidative injury (8-hydroxy-deoxyguanosine and 4-hydroxy-2-nonenal) and inflammatory markers (tumor necrosis factor-alpha)., Discussion: The increase of skeletal muscle AGEs/RAGE and markers of inflammation and oxidative injury in association with weight gain and old age suggest a pathogenic role of AGEs in weight gain and in sarcopenia of aging.

Background: Endothelial dysfunction is a key process in atherosclerosis. Hypomethylation is one of the postulated mechanisms involved in atherogenesis and is mainly secondary to a decrease in essential factors such as, folate and vitamin B12 for the biosynthesis of S-adenosylmethionine (SAM), the main methyl-group donor for methylation reactions., Aim: To investigate in an animal model, whether hypomethylation, secondary to folate or vitamin B12 deficiency, affects endothelium-dependent relaxation (EDR) induced by acetylcholine (ACh)., Methods: Adult male Wistar rats were divided into 4 groups of 12 rats each: folate and B12 deficiency (FB12D 0mg folate/kg, 0 microg/kg B12), folate deficiency (FD 0mg folate/kg and 50 microg/kg B12), B12 deficiency (B12D: 8 mg/kg folate and 0 microg/kg B12 and control diet (CD)). After eight weeks the animals were killed and thoracic aorta and liver removed. Serum concentration of homocysteine, folate and vitamin B12 were determined. Hepatic levels of SAM and S-adenosylhomocysteine (SAH) were measured, as indicator of hypomethylation. ACh-induced EDR and sodium nitroprusside (SNP)-induced endothelium-independent relaxation (EIR), in isolated aorta rings were evaluated., Results: Hcy concentrations were significantly increased in the folate and B12 deficient groups. SAM and the SAM/SAH ratio were lower in the FD and FB12D than in the control and B12D group. Folate, B12 deficiency, serum Hcy levels and hepatic SAM/SAH ratio did not affect EDR neither EIR., Conclusions: In adult Wistar rats, chronic folate or folate plus vitamin B12 deficiency generates hypomethylation which is not related to an alteration of endothelial function.

Objective: We assessed the impact of high serum folate concentration on erythrocyte S-adenosylmethionine (SAM), S-adenosylhomocysteine (SAH) concentrations, SAM/SAH ratio, CpG methylation levels across the promoter region of the extracellular superoxide dismutase (ec-SOD) gene, and ec-SOD activity in healthy men., Methods: Serum folate levels were measured in 111 subjects who were categorized in quintiles according to their folate status. Subjects located at the lowest, middle, and upper quintiles were selected for assessment of SAM and SAH by high-performance liquid chromatography, C677T genotype of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, ec-SOD methylation of CpG sites in lymphocytes genomic DNA by bisulfate treatment, and ec-SOD activity by a chemical assay., Results: Sixteen subjects were in the lowest serum folate quintile (<23.6 nmol/L), 17 in the middle (>34-<42 nmol/L), and 14 in the highest (>45nmol/L). SAM concentration was higher in the upper than in the middle and lowest quintiles (5.57 +/- 1.58, 2.52 +/- 0.97, 2.29 +/- 1.2 micromol/L; P < 0.0001). SAH concentration was higher in the upper compared with the lowest quintile (0.76 +/- 0.24 versus 0.52 +/- 0.23 micromol/L, P < 0.001). There were no differences in the SAM/SAH ratio, ec-SOD activity, methylation status of CpG sites of the ec-SOD gene, and TMTHFR C677T genotype between groups., Conclusion: Serum folate concentrations in the highest quintile among healthy humans are associated with increased erythrocyte SAM and SAH concentrations, but not with SAM/SAH ratio or with methylation levels of CpG sites across the promoter region of the ec-SOD gene. Further research is required to determine if these findings are beneficial or harmful.

Background: Roux-en-Y gastric bypass (RYGBP) has had a posilive impact on co-mobidities associated with obesity. However, in the long-term it can induce micronutrient deficiencies., Aim: To petform a complete nutritional assessment in a group of women previously operated of RYGBP from different socioeconomic levels (SEL)., Patients and Methods: Thirtyy three women (19 high SEL and 14 low SEL), were assessed by dietary recalls, anthropometric measurements, muscle strength, bone mineral density, routine clinical laboratory, semm leeds of vitamin B12, 25OH-vitamin D, folate, calcium, ferritine ceruloplasmin and indicators of bone tutnoter (paratbohormone, osteocalcin and urinary pyridinolines). Their values were compared to those of 30 control women (18 high SEL and 12 low SEL)., Results: Low SEL operated women consumed fewer vitamin and mineral supplements compared with their high SEL pairs. No cases of vitamin B12, folic acid or copper deficiencies were detected. Frequency of iron deficiency was similar in patients and controls. Vitamin D insufficiency was higher among patients than in controls (p = 0.047), regardless SEL. Patients had also a higher frequency of high senum P771 and osteocakin and urinary pyridinoline levels. However, no differences in bone mineral density were obseived between operated women and controls., Conclusions: Vitamin and mineral deficiencies were lower than expected among operated women. However problems associated with vitamin D deficiency were highly prevalent among patients operated of RYGBP, irrespective SEL. These alterations were only detectable through specific markers at this stage, because they did not translate into lower bone mineral density (BMD) of sutgical patients, probably due to the higher pre-operative BMD of these moibid obese patients

Background: Antibiotic-associated diarrhea is one of the most common adverse effects of antimicrobials. Any antimicrobial can potentially produce diarrhea but beta-lactamics have a higher risk. Among these, amoxicillin is widely indicated in ambulatory practice. One of the alternatives suggested to prevent antibiotic-associated diarrhea, is the use of the probiotic Saccharomyces boulardii., Aim: To evaluate whether the concomitant use of Saccharomyces boulardii and amoxicillin can prevent antibiotic associated diarrhea in ambulatory adults with acute infections diseases, without provoking other adverse effects., Material and Methods: Eighty six adults (aged 15 to 81 years) with acute infectious diseases, excluding those arising in the gastrointestinal tract, that received a prescription of oral amoxicillin for 5 to 10 days, were included. In a controlled randomized, double blind trial, 41 patients were assigned to receive lyophilized Saccharomyces boulardii (500 mg/day) during 12 days, and 45 patients were assigned to placebo for the same period., Results: Ten percent of patients (9/86) reported acute diarrhea, 9,8% (4/41) in the experimental group and 11.196 (5/45) in the control group (p = 100). No adverse effects were associated to the use of the probiotic., Conclusions: Saccharomyces boulardii (500 mg/day) did not prevent diarrhea related to amoxicillin.

Objective: We assessed the value of height reduction, calculated using knee height measurement, as a risk factor or predictive sign for osteoporosis in healthy elderly women., Methods: In 181 healthy women 76 +/- 5 y of age, height, weight, and knee height were evaluated. Femoral and spine bone mineral densities and body compositions were measured using dual-energy X-ray absorptiometry. In 76 young women 27 +/- 4 y of age, a regression equation to predict height, based on knee height, was derived. Using this equation, maximum attained height and height loss were calculated in elderly women, which was correlated to bone mineral density., Results: The equation to predict height was height (cm) = knee height (cm) x 2.22 + 50.54. The calculated height loss in elderly women was -6.1 +/- 3.8 cm or -0.08 +/- 0.05 cm/y of age. Height loss and hip circumference were significant predictors of spine bone mineral density. In the case of femoral bone mineral density, to the same predictors, a negative effect of waist circumference was added. Women in the highest quintile of height reduction (>0.199 cm/y) had an odds ratio of 4.5 (95% confidence interval 1.56-13.3, P < 0.02) for femoral osteoporosis., Conclusion: Knee height can be used as an accurate measurement of height loss in the elderly, which is a significant predictor of femur and spine bone mineral densities, in addition to hip circumference.

Although in medical research the use of longitudinal data to analyze short time periods is frequently required, it does not permit the use of classic statistical methods for chronological series. The objective of this study is to present the possibility and plausibility of using the STATIS method (Structuration des Tableaux A Trois Indices de la Statistique), an explorative method for data analysis, in a study of the body composition of a sample of 57 women over 68 years of age in Santiago, Chile who were observed over a period of 30 months. The variables analyzed (measured every 6 months) were the following anthropometric measurements: weight, height, arm circumference, calf circumference, waist circumference, hip circumference and knee height. The results obtained suggested a regular chronological evolution during the first 24 months of observation with a change in structure after 30 months of the study, thereby classifying subjects according to body composition.

Background and Aims: An accurate diagnosis of sarcopenia is required. The aim of this study is to correlate the results of two methods to define sarcopenia using cross sectional body composition data, with actual loss of fat free mass., Methods: Healthy older subjects (926 females and 381 males aged 70 years or more) and healthy young adults (425 females and 151 males aged 20 to 40 years) were studied. Body composition was assessed by double beam X ray absorptiometry (DEXA). Among older subjects, a contemporary subsample of 148 females and 45 males had two or more measurements, separated by 4.8+/-1.5 years and loss of fat free mass per year was calculated. In the whole sample, total and appendicular lean body mass index were calculated as total or appendicular lean body mass/height. Using data from young people, sex specific t scores were obtained. In older subjects residuals were derived from a regression equation, using total or appendicular fat free mass as the dependent variable and height, fat free mass and age as independent variables., Results: The concordance between residuals and t scores to define sarcopenia was 68 and 72%, respectively. Among subjects with two or more measurements, men and women lost a mean of 521+/-454 and 221+/-399 g/year of fat free mass, respectively. The odds ratio of losing more than 822 g lean body mass /year among men or 514 g lean body mass /year among women was 2.63 and 2.64 for subjects classified in the two lowest quintiles of sarcopenia, using t scores or residuals, respectively., Conclusions: Cross sectional body composition data can predict loss of fat free mass among older people.

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients., Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product., Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial (casein peptide based formula), Peptamen, (whey peptide based formula), Glytrol (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times., Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p <0.02) compared with the standard meal. The GI response did not appear to be due to enhanced insulin secretion. The other tested formulas had lower GI than the standard meal, but in addition they exhibited increased II The whey based peptide formulation produced the highest insulin response (p <0.03)., Conclusions: Both GI and II are related to the concentration, form and type of protein contained in the enteral formula. The whey peptide formulation produced a low GI with the highest insulin index. Based on the low GI of these enteral products, all can be useful to provide nutritional support during metabolic stress, without adding an additional challenge to blood glucose management.

Background: Functional limitations limit the independence and jeopardize the quality of life of elderly subjects., Aim: To assess the association between anthropometric measures and body composition with functional limitations in community-living older people., Material and Methods: Cross-sectional survey of 377 people > or = 6 5 years old (238 women), randomly selected from the SABE/Chile project. Complete anthropometric measurements were done. Handgrip muscle strength was measured using dynamometers. Body composition was determined using Dual-Energy X-Ray Absorptiometry. Functional limitations were assessed using self reported and observed activities., Results: Body mass index was strongly associated with fat mass (men r =0.87; women r =0.91) and with lean mass (men r =0.55; women r =0.62). Males had significantly greater lean mass (48.9 kg vs 34.9 kg), and bone mass than females (2.6 kg vs 1.8 kg) and women had higher fat mass than men (26.3 kg vs 22.9 kg). The prevalence of functional limitations was high, affecting more women than men (63.7% vs 37.5%, p <0.01). Functional limitations were associated with lower handgrip strength in both sexes. In the multiple regression models, with functional limitations as dependent variable and anthropometric measures as contributing variables, only hand grip strength had a significant association (negative) with functional limitations in both genders. Age was also a significant risk factor for functional limitations among women., Conclusions: Hand grip strength was strongly and inversely associated with functional limitations. Handgrip dynamometry is an easy, cheap and low time-consuming indicator for the assessment of functional limitations and the evaluation of geriatric interventions aimed to improve functional ability.

Background and Aims: Weight maintenance within normal standards is recommended for prevention of conditions associated with oxidative injury. To compare oxidative damage in a post mitotic tissue, between adults differing in long-term energy balance., Methods: During hernia surgery, a sample of skeletal muscle was obtained in 17 non-obese adults. Subjects were divided into two groups according to their self-reported weight change: weight maintainers (WM) reported <4kg increase, and weight gainers (WG) reported >5kg increment. Muscle immunohistochemistry for 8-hydroxy-deoxyguanosine (8OHdG), 4-Hydroxy-2-nonenal (4HNE), and TNF-alpha, as markers of oxidative injury and inflammation, were performed. As known positive controls for oxidative injury, we included 10 elderly subjects (66-101yr). Anthropometric measures and blood samples for clinical laboratory and serum cytokines (TNF-alpha and IL-6) were obtained., Results: 8OHdG was higher in WG compared with WM (149.1+/-16.2 versus 117.8+/-29.5, P=0.03), and was associated with anthropometric indicators of fat accumulation. 4HNE was similar in WG compared with WM (10.9+/-7.6 versus 9.8+/-6.3) but noticeably higher in elderly subjects (21.5+/-15.3, P=0.059). TNF-alpha protein in WG was higher compared with WM (114.0+/-41.7 versus 70.1+/-23.3, P=0.025), and was associated with weight increase., Conclusions: Moderate self-reported weight increase, and body fat accumulation, suggesting long-term positive energy balance is associated with muscle DNA oxidative injury and inflammation.

The aim was to assess the effects of resistance training and vitamin D supplementation on physical performance of healthy elderly subjects. Ninety-six subjects, aged 70 years or more with 25 OH vitamin D levels of 16 ng/ml or less, were randomized to a resistance training or control group. Trained and control groups were further randomized to receive in a double blind fashion, vitamin D 400 IU plus 800 mg of calcium per day or calcium alone. Subjects were followed for nine months. Serum 25 OH vitamin D increased from 12.4+/-2.2 to 25.8+/-6.5 ng/ml among subjects supplemented with vitamin D. Trained subjects had significant improvements in quadriceps muscle strength, the short physical performance test and timed up and go. The latter improved more in trained subjects supplemented with vitamin D. At the end of the follow up, gait speed was higher among subjects supplemented with vitamin (whether trained or not) than in non-supplemented subjects (838+/-147 and 768+/-127 m/12 min, respectively, p=0.02). Romberg ratio was lower among supplemented controls than non-supplemented trained subjects (128+/-40% and 144+/-37%, respectively, p=0.05). In conclusion, vitamin D supplementation improved gait speed and body sway, and training improved muscle strength.