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Abstract Background Functional capacity is recognized as a central factor for health in old age and not all studies that seek to clarify the role of social relationships in functional capacity are conclusive. The subject has only been studied in a limited way in Latin America, a region that is aging prematurely, with evidence primarily from developed countries, which have experienced a more gradual aging of their population. This longitudinal study aimed to determine how aspects of social relationships impact the functionality of older Chileans. Methodology We conducted a cohort study of 2,265 people aged 60 years or older who lived in the community and resided in Greater Santiago, Chile. Five aspects of social relationships were considered at baseline (participation in groups, clubs, or organizations; number of people in the household; participation in recreational activities; perception of material support, help or advice, and marital status), from which a cluster analysis by conglomerate was performed and used as the exposure of interest. Functional limitation (FL) was the dependent variable, classified as a limitation in at least 1 basic activity of daily living or 1 instrumental activity or 2 advanced activities. The control variables considered were: sex, age, educational level, multimorbidity, depression and years of follow-up. Survival analyses using a Cox proportional hazard regression and multilevel logistic regressions (person level and follow-up wave level) were performed. Results The identified clusters were four: “without social participation and does not live alone”; “without a partner and without social participation”; “no perception of support and no social participation”; “with participation, partner and perception of support”. Social relationship clusters predicted FL incidence and FL reporting during follow-up. Being in the clusters "without social participation and does not live alone" and "without partner and without social participation" were risk factors for incident FL and report of FL during follow-up, compared to being in the reference cluster "with participation, partner and perception of support. Conclusions In summary, our study showed that participating in social organizations, not living alone and having a partner are protective factors for presenting and developing functional limitation in old age for community-living Chileans in an urban area.

Abstract Background Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. Objective To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. Method Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan’s method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. Results Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). Conclusions This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

Aging population has led to an increased prevalence of chronic and degenerative pathologies. A manifestation of unhealthy aging is frailty, a geriatric syndrome that implies a non-specific state of greater vulnerability. Currently, methods for frailty diagnosis are based exclusively on clinical observation. The aim of this study is to determine whether the bioenergetic capacity defined as mitochondrial oxygen consumption rate (OCR) of peripheral circulation mononuclear cells (PBMC) associates with the frailty phenotype in older adults and with their nutritional status. This is a cross-sectional analytic study of 58 participants 70 years and older, 18 frail and 40 non-frail adults, from the ALEXANDROS cohort study, previously described. Participants were characterized through sociodemographic and anthropometric assessments. Frail individuals displayed a higher frequency of osteoporosis and depression. The mean age of the participants was 80.2 ± 5.2 years, similar in both groups of men and women. Regarding the nutritional status defined as the body mass index, most non-frail individuals were normal or overweight, while frail participants were mostly overweight or obese. We observed that OCR was significantly decreased in frail men (p < 0.01). Age was also associated with significant differences in oxygen consumption in frail patients, with lower oxygen consumption being observed in those over 80 years of age. Therefore, the use of PBMC can result in an accessible fingerprint that may identify initial stages of frailty in a minimally invasive way.

Frailty and cardiovascular diseases are increasingly prevalent in aging populations, sharing common pathological mechanisms, such as oxidative stress. The evidence shows that these factors predispose frail individuals to cardiovascular diseases but also increase the risk of thrombosis. Considering this background, this review aims to explore advances regarding the relationship between oxidative stress, platelet alterations, and cardiovascular diseases in frailty, examining the role of reactive oxygen species overproduction in platelet activation and thrombosis. The current evidence shows a bidirectional relationship between frailty and cardiovascular diseases, emphasizing how frailty not only predisposes individuals to cardiovascular diseases but also accelerates disease progression through oxidative damage and increased platelet function. Thus, oxidative stress is the central axis in the increase in platelet activation and secretion and the inadequate response to acetylsalicylic acid observed in frail people by mitochondrial mechanisms. Also, key biomarkers of oxidative stress, such as isoprostanes and derivate reactive oxygen metabolites, can be optimal predictors of cardiovascular risk and potential targets for therapeutic intervention. The potential of antioxidant therapies in mitigating oxidative stress and improving cardiovascular clinical outcomes such as platelet function is promising in frailty, although further research is necessary to establish the efficacy of these therapies. Understanding these mechanisms could prove essential in improving the health and quality of life of an aging population faced with the dual burden of frailty and cardiovascular diseases.

BackgroundEthnic and racial differences in life expectancy have been well established in different societies. However, even though an important part of the population of Latin America is Indigenous, there is little knowledge about them.ObjectiveDetermine if there are ethnic differences in life expectancy at birth and at 60 years in Chile, and if the Mapuche (largest Indigenous ethnic group) have similar life expectancy to other Indigenous peoples.MethodLife tables for the Mapuche and other Indigenous groups and non-Indigenous people were built using the 2017 census. Specifically, we used the questions of the number of live children born and the number of surviving children. With this information, using the indirect method of own children we determined infantile mortality. Then, using the relational logit model and the model life table (west), we estimated the survival function for all ages.ResultsIndigenous Chileans have seven years lower life expectancy at birth than the non-Indigenous population (76.2 vs. 83.2 years). The differential at age 60 is 6 years (20.3 vs. 26.4 years). We also found that Mapuche have an even greater disadvantage in survival than other ethnic groups. This is reflected in 2 years less life expectancy, both at birth and at 60 years.DiscussionOur results ratify the existence of marked ethnic-racial inequality in the extension of life in Chile and demonstrate a greater disadvantage in terms of survival of the Mapuche compared to other Indigenous and non-Indigenous groups. It is thus of great relevance to design policies that would decrease the existing inequalities in lifespan.

Abstract Background Chile has one of the longest life expectancies of Latin America. The country is characterised by an important macroeconomic growth and persisting socioeconomic inequalities. This study analyses socioeconomic differences in life expectancy (LE) and disability-free life expectancy (DFLE) among Chilean older people. Methods The sample of the Social Protection Survey, a longitudinal study, was analysed. Five waves, from 2004 to 2016, were considered. The indicator was disability, defined as having difficulties to perform at least one basic activity of daily living. Type of health insurance was used to determine socioeconomic position (SEP). Total LE and DFLE were estimated with multistate life table models. Results At age 60, men in the higher SEP could expect to live 3.7 years longer (22.2; 95% CI 19.6–24.8) compared to men of the same age in the medium SEP (18.4; 95% CI 17.4–19.4), and 4.9 years longer than men of the same age in the lower SEP (17.3; 95% CI 16.4–18.2). They also had a DFLE (19.4; 95% CI 17.1–21.7) 4 (15.4; 95% CI 14.6–16.1) and 5.2 (14.2; 95% CI 13.4–14.9) years longer, compared to the same groups. Women aged 60 years in the higher SEP had a LE (27.2; 95% CI 23.7–30.8) 4.6 (22.7; 95% CI 21.9–23.5) and 5.6 (21.6; 20.6–22.6) years longer, compared to women in the medium and the lower SEP. The difference in DFLE, for the same age and groups was 4.9 and 6.1 years, respectively (high: 21.4; 95% CI 19.5–23.3; medium: 16.5; 95% CI 15.8–17.1; low: 15.3; 95% CI 14.6–16.0). Socioeconomic differences in LE and DFLE were observed among both sexes until advanced age. Discussion Socioeconomic inequalities in LE and DFLE were found among Chilean older men and women. Older people in the highest SEP live longer and healthier lives. Conclusion A reform to the Chilean health system should be considered, in order to guarantee timely access to care and benefits for older people who are not in the wealthiest group.

We aimed to examine the degree to which social participation is associated with mortality risk in older adults in Chile. We used the Chilean National Survey on Elderly Dependency, which is linked to vital statistics, in order to obtain death records. Four proportional risk regression models were estimated. Even with controlled sociodemographic, economic, family, and health variables, older adults who participate in social activities had a 22% lower risk of death than those who do not participate. We concluded that social participation is a strong and significant protective factor for mortality in Chilean older adults. Social participation should thus be promoted from a life course perspective considering its effect on mortality in older adults who maintained an active social life.

Resumen: El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior.Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años.Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores.En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos Conclusiones: Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona. Summary: The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context.In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years.The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults.In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter. Conclusions: Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care. Keywords: Chile, Aging, Life expectancy, Healthy life expectancy., Palabras clave: Chile, envejecimiento, expectativa de vida, expectativa de vida saludable.

BackgroundSarcopenia is an important risk factor for disability and dependency at old age. The prevalence of sarcopenia among the Chilean older population is high.ObjectiveTo estimate life expectancy, healthy life expectancy and unhealthy life expectancy among sarcopenic and non-sarcopenic older adults from Santiago, Chile.MethodsA sample of 1,897 community-dwelling older adults aged 60 years or more, living in Santiago, was observed between 5–15 years. Disability was defined as the unhealthy state, assessed through self-reported difficulties in activities of daily living. Sarcopenia was determined via HTSMayor software. Total and marginal life expectancies were estimated using the Interpolated Markov Chain method “IMaCh”.ResultsAt 60 years, estimated life expectancy for sarcopenic and non-sarcopenic older adults was similar (22.7 and 22.5 years, respectively). The proportion of years to be lived with disability was three times greater in sarcopenic adults, compared to non-sarcopenic people. This difference was observed up to 80 years. Non-sarcopenic women had a higher proportion of years to be lived with disabilities compared to non-sarcopenic men of the same age, but this proportion was higher among sarcopenic men, compared to sarcopenic women until 70 years of age.DiscussionPeople with sarcopenia expect to live a higher proportion of years with disabilities. Sarcopenic men until 70 years expected to live a higher proportion of years with disability, compared to sarcopenic women. Monitoring sarcopenia among older people may help to identify individuals with higher risk of disability onset. Future research should focus on disentangling the mechanisms explaining sex differences.

Abstract Background Chile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator. Methods We estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method. Results At age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively). Conclusions Longer life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.

We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.

In the context of accelerated aging of the population worldwide, frailty has emerged as one of the main risk factors that can lead to loss of self-sufficiency in older people. This syndrome is defined as a reduced state of physiological reserve and functional capacity. The main diagnostic tools for frailty are based on scales that show deficits compared to their clinical application, such as the Fried frailty phenotype, among others. In this context, it is important to have one or more biomarkers with clinical applicability that can objectively and precisely determine the degree or risk of frailty in older people. The objective of this review was to analyze the biomarkers associated with frailty, classified according to the pathophysiological components of this syndrome (inflammation, coagulation, antioxidants, and liver function, among others). The evidence demonstrates that biomarkers associated with inflammation, oxidative stress, skeletal/cardiac muscle function, and platelet function represent the most promising markers of frailty due to their pathophysiological association with this syndrome. To a lesser extent but with the possibility of greater innovation, biomarkers associated with growth factors, vitamins, amino acids, and miRNAs represent alternatives as markers of this geriatric syndrome. Likewise, the incorporation of artificial intelligence represents an interesting approach to strengthening the diagnosis of frailty by biomarkers.

BACKGROUND:Chile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences. METHODS:Data from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method. RESULTS:In both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0-58.8] for men and 37.6% [95% CI 34.3-40.8] for women in 2009; 46.1% [95% CI 42.6-49.7] for men and 38.5% [95% CI 35.6-41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4-10.3] in 2009; 11.5 years [95% CI 10.7-12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2-69.4] for men and 44.9% [95% CI 41.9-47.9] for women in 2009; 71.9% [95% CI 68.7-75.0] for men and 61.1% [95% CI 58.5-63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3-3.4] for men and 6.0 years [95% CI 5.4-6.7] for women). CONCLUSIONS:Women expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.

Abstract Background Changes in DNA methylation, one of the most studied epigenetic mechanisms, are considered an initial marker for early cancer detection. We evaluated how availability of dietary factors (folates and vitamin B12) involved in one-carbon metabolism may contribute to DNA methylation changes of cancer-related genes in human subjects. Methods We studied, by pyrosequencing, the methylation of tumor suppressor gene p16, DNA repair genes MLH1 and MGMT, and the repetitive element LINE-1 (as a surrogate for global DNA methylation), in blood of elderly individuals (n = 249) who had been exposed to folic acid (FA) through FA-fortified wheat flour during the last 12 years. Results We found that serum folate and to a lesser extent, vitamin B12 concentrations, were significantly correlated with DNA methylation of p16, MLH1, and MGMT, but not with LINE-1. High serum folate concentrations (>45.3 nmol/L) were present in 31.1% of the participants. Although the methylated fraction of CpG sites in p16, MLH1, and MGMT was low (1.17–3.8%), high folate concentrations were significantly associated with methylation at the 3rd tertile of specific CpG sites in all genes with OR between 1.97 and 4.17. Conclusions This study shows that a public policy, like food fortification with FA that increases circulating serum folate levels, could affect methylation levels of specific genes linked to cancer risk. Our present results deserve additional studies to clarify the real impact of high FA levels for risk of cancer in a whole population chronically exposed to a fortified food such as wheat flour. Trial registration ISRCTN 48153354 and ISRCTN 02694183

Abstract Background Chile has suffered a fast increase in childhood obesity in the last 10 years. As a result, several school programmes have been implemented, however the effectiveness of these needs to be evaluated to identify and prioritize strategies to curve this trend. Methods Cluster randomized controlled trial. Twelve primary public schools chosen at random over three regions of the country will take part in this study. The sample size consisted of a total of 1,655 children. For each region one school will be selected for each of the three nutritional intervention modes and one school will be selected as the control group. The intervention modes consist of the following: Healthy Kiosk and nutritional education (KSEAN); Optimized physical activity (AFSO); Healthy Kiosk and nutritional education (KSEAN) + optimized physical activity (AFSO); Control group. The effectiveness of each intervention will be evaluated by determining the nutritional condition of each child by measuring percentage of body fat, BMI and the z-score of the BMI. This study will also identify the eating behaviours, nutritional knowledge and fitness of each child, along with the effective time of moderate activity during physical education classes. Discussion A protocol to evaluate the effectiveness of a school based intervention to control and/or reduce the rates of childhood obesity for children between 6 and 10 years of age was developed. The protocol was developed in line with the Declaration of Helsinski, the Nüremberg Code and the University of Chile Guidelines for ethical committees, and was approved by the INTA, Universidad de Chile ethical committee on Wednesday 12 March 2014. There is consensus among researchers and health and education personnel that schools are a favourable environment for actions to prevent and/or control childhood obesity. However a lack of evidence on the effectiveness of interventions to date has led some to question the wisdom of allocating resources to programmes. This is the first study of this kind in Chile and could be an important first step to provide guidance to political authorities in relation to which food and nutrition strategies to prioritize to curve this alarming trend. Trial registration ISRCTN32136790 , registered retrospectively on 05 September 2014.

Objective: The aim was to study the role of leptin in the development of dementia. Methods: Follow-up of the ALEXANDROS cohorts, with baseline measurements in 2000. From 1,136 available subjects free of dementia at baseline, 667 subjects had frozen baseline blood samples for measuring leptin and soluble leptin receptor (sOB-R). The free leptin index (FLI) was calculated as the ratio of leptin to sOB-R. Dementia was defined as an MMSE score 5 in the Pfeffer Activities Questionnaire. Results: After 15 years of follow-up, 42 incident cases of dementia were identified. No difference in serum leptin was observed between people with and without dementia, but sOB-R was higher in demented than in nondemented subjects (sOB-R: 44.94 ± 23.97 vs. 33.73 ± 21.13 ng/ml). The adjusted risk for dementia increased, the higher the log sOB (hazard ratio = 3.58; 95% CI 1.72-7.45, p = 0.001). Conclusion: Lower availability of free leptin was found in demented than in nondemented people, suggesting a role of leptin in cognition.

This study was aimed to estimate life expectancy (LE), disability-free life expectancy (DFLE) and disabled life expectancy (DLE) among older adults from Santiago, Chile, and to determine the existence of differences by gender and by body mass index (BMI) categories in these indicators.A sample of 1216 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being was recruited in 2000; two follow-up assessments were carried out in a 10-year period. Functional limitation was assessed through self-report of difficulties in activities of daily living, instrumental activities of daily living and mobility. BMI was determined with measured weight and height. Multistate life tables were employed to estimate LE and healthy life expectancy (HLE).At 60 years, women could expect to live on average an additional 20.4 years (95% CI 19.0-21.6), and men an additional 16.4 years (95% CI 14.9-17.7). Total LE was longer among women at all ages, but they had a higher proportion of disabled years to be lived compared to men, with a difference of 14% at 60 years, and 10% at 90 years. There were no significant differences in LE, DFLE and DLE between BMI categories.Despite a longer LE, Chilean older women expect to live a higher proportion of years with disabilities, compared to men. Public health programs should address factors affecting LE of older men, and those associated with disability among older women.

Previous studies on the role of gender in the association between self-rated health and mortality have shown contrasting results. This study was aimed to determine the importance of gender in the association between self-rated health and mortality among older people in Santiago, Chile.A 10 year follow-up of 1066 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being. Self-rated health was assessed in face to face interviews through a single general question, along with socio-demographic and health status information. Cox proportional hazards and flexible parametric models for survival analyses were employed.By the end of follow-up, 30.7% of women and 39.4% of men died. Adjusted hazard ratio of poor self-rated health, compared to good self-rated health, was 1.92(95% CI 1.29-2.86). In models stratified by gender, an increased risk of mortality was observed among women who rated their health as poor (HR = 2.21, 95% CI 1.43-3.40), but not among men (HR = 1.04, 95% CI 0.58-1.86). Age was associated with mortality in both groups; for men, functional limitation and underweight were also risk factors and obesity was a protective factor.Compared to older women who rated their health as good, older women who rated their health as poor had a 2 fold increased risk of mortality over the subsequent 10 years. These findings stress the importance of considering a gender perspective into health programmes, including those focused on older people, in order to address the different elements that increase, on the long run, the risk of dying among older women and men.

Introducción: El objetivo del estudio es estimar si el déficit de B12 se asocia con el uso de la metformina en adultos mayores (AM) diabéticos. Métodos: Estudio de casos y controles en AM diabéticos. Los casos (n = 137) se definieron como AM con B12 < 221 pmol/L y los controles(n = 279) como AM con B12 > 221 pmol/L. Se definieron 4 categorías de uso de metformina: no usuarios, ≤ 850 mg/día; > 850 y < 2.550 mg/día; ≥ 2.550 mg/día. Se consideró altas dosis de metformina (≥ 2.550 mg/día). Se calcularon los OR crudos para déficit de B12 y consumo de Metformina. Se elaboraron modelos de regresión logística para explorar la asociación entre déficit B12 y dosis de metformina. El protocolo de investigación fue aprobado por el Comité de Ética del INTA. Resultados: La edad de casos y controles fue (70,2 años vs 68,6 años (p < 0,05); 62% fueron mujeres en los casos vs 74,9% en los controles (p < 0,05). El 73% de los casos y el 76% de los controles usaban metformina (p < 0,05). El promedio de uso de metformina fue de 1.954,3 mg/día (DS: 1.063,2) en los casos y 1696.6 mg/día (DS: 1.074,4) en los controles(p < 0,05). La dosis de 2.550 mg/día se observó en el 29,2% de los casos y en 19,3 de los controles (p < 0,05). Se observó que los adultos mayores que consumían altas dosis de metformina presentaban 1,9 veces más riesgo de déficit de B12 (OR:1,9; 95%IC: 1,08-3,30). Conclusión: Estos resultados muestran una fuerte asociación entre altas dosis de metformina y niveles bajos de vitamina B12.

Objetivo: Explorar la asociación entre autopercepción de salud general negativa y mortalidad en adultos mayores. Método: Revisión sistemática cuyos criterios de inclusión fueron estudios longitudinales, evaluación de la autopercepción de salud mediante una pregunta sobre salud general, muestras de personas de 60 años o más de edad que vivieran en la comunidad. Búsqueda en bases de datos electrónicas y revisión de referencias. Resultados: Se seleccionaron 18 estudios publicados entre 1993 y 2011. Seis de los siete que analizaban muestras de ambos sexos encontraban mayor riesgo de morir en las personas que calificaban su salud como mala; las covariables más frecuentes eran la edad, el sexo, las enfermedades crónicas y el estado funcional. La mitad de los estudios que analizaban sólo hombres o mujeres encontró que la asociación era significativa. El efecto de la autopercepción de la salud sobre la mortalidad se observaba en las personas menores de 75 años. El tiempo de seguimiento no influía en los resultados. Conclusiones: Los resultados apoyan los hallazgos previos respecto a que la autopercepción de la salud general negativa predice la mortalidad. Es necesario dilucidar los mecanismos por los que este indicador puede predecir la mortalidad en los adultos mayores, que pueden ser diferentes para hombres y mujeres. Se sugiere investigar el papel de la depresión, considerando que el efecto de la autopercepción de la salud sobre la mortalidad no estaba presente en los estudios que la incluían.

Objetivos: Desarrollar un modelo antropométrico de predicción de masa muscular apendicular esquelética (MMAE), en adultos mayores chilenos. Métodos: La muestra estudiada corresponde a 616 adultos > 60 años (69,9 ± 5,2 años), 64,6% mujeres, autovalentes, viviendo en la comunidad en Santiago, Chile, participantes del estudio ALEXANDROS. Se efectuaron mediciones antropométricas, dinamometría de mano, pruebas de movilidad y densitometría ósea (DEXA). Mediante modelos de regresión lineal paso a paso se relacionó la MMAE obtenida por DEXA con variables antropométricas, edad y sexo. La muestra se dividió en forma aleatoria en dos submuestras, obteniéndose ecuaciones de predicción para ambas, que se validaron mutuamente por doble validación cruzada. La alta correlación entre los valores de MMAE observados y pronosticados en ambas submuestras y el bajo grado de contracción permitieron desarrollar la ecuación de predicción final con la muestra total. Resultados: El coeficiente de validez cruzada entre las ecuaciones de predicción obtenidas en las dos submuestras fue 0,941 y 0,9409 y el grado de contracción 0,004 y 0,006. La ecuación de predicción final, en la muestra total, fue: MMAE (kg) = 0,107(peso kg) + 0,251(altura rodilla cm) + 0,197(circunferencia pantorrilla cm) + 0,047(dinamometría kg) - 0,034(circunferencia cadera cm) + 3,417(sexo) - 0,020 (edad años) - 7,646 (R² = 0,89). La MMAE estimada y la medida por DEXA fueron similares (16,8±4,0 vs 16,9±3,7) y concordantes según los métodos de Bland y Altman (IC 95%: -2,6 -2,7) y Lin (coeficiente correlación concordancia = 0,94). Conclusiones: Se obtuvo una ecuación antropométrica para determinar la masa MMEA, de gran utilidad en la pesquisa de sarcopenia en adultos mayores.

Objetivo: Evaluar la asociación entre satisfacción vital con el nivel socioeconómico y el autorreporte del estado de salud en una cohorte de adultos mayores de Santiago de Chile en los años 2005 y 2006. Métodos: Estudio transversal que incluyó 2002 sujetos entre 65 y 67,9 años de edad, registrados en 20 centros de salud primaria del Gran Santiago, autovalentes, sin deterioro cognitivo, sospecha de cáncer ni enfermedad terminal. Se evaluó la satisfacción vital mediante la adaptación abreviada de una escala de satisfacción con la vida (de 0 a 11), además de los ingresos económicos, el nivel de educación, el apoyo social y autorreporte del estado de salud y la memoria. Se utilizó un modelo log-binomial para analizar la asociación entre las variables evaluadas y los extremos del puntaje de satisfacción vital (cuartil 4 frente a 1). Resultados: Se observó una asociación significativa (análisis bivariado y multivariado) entre satisfacción vital e ingresos económicos en los hombres, y en ambos sexos con el apoyo social, el autorreporte de salud, la memoria y los diagnósticos de problemas articulares, diabetes e hipertensión. Conclusión: La situación económica, el apoyo social y el estado de salud se asocian de forma independiente con la satisfacción vital en los adultos mayores de Santiago. Se requieren nuevos estudios para evaluar la dirección temporal del efecto, así como las implicaciones de estos hallazgos en las políticas públicas de salud en esta población.Objective: To evaluate the association between life satisfaction and socioeconomic status and self-reported health in a cohort of older people in Santiago, Chile, in 2005 and 2006. Methods: We interviewed 2002 individuals aged 65 to 67.9 years registered in 20 primary care centers in the city of Santiago. Participants were living independently with no cognitive impairment, suspected cancer or terminal diseases. We assessed life satisfaction using an abbreviated adaptation of a life satisfaction scale (scored from 0 to 11), and collected self-reported information on income, education, social support, and self-reported health and memory. We used a log-binomial model to analyze the association between life satisfaction scores (fourth quartile compared with the first) and socioeconomic and health variables. Results: There was a significant association (bivariate and multivariate analyses) between life satisfaction and income in men and with social support, self-reported health, memory, and diagnosis of joint problems, diabetes and hypertension in both sexes. Conclusion: Social support, income and health status were independently associated with life satisfaction in older people aged 65-67.9 years in Santiago. Further studies are required to assess the temporal direction of the effect and the implications of these findings for public health policies in this population.

It has been proposed that differences in adipocyte function and/or metabolism between obese and lean individuáis may manifest themselves in functional adipose tissue abnormalities that lead to metabolic disorders in obesity. We studied lipogenesis and lipolysis of omental adipocytes from obese (OB) and non-obese (NOB) humans. The specific activity of the lipogenic marker enzyme G3PDH was 50% lower in total adipocytes of OB compared to that of NOB subjects. Omental adipocytes from OB subjects also had lower basal lipolytic levéis, and a lower lipolytic response to p-adrenergic stimulus. Cholesterol depletion of adipocyte plasma membrane using methyl β-cyclodextrin caused a lipolytic effect on adipocytes of both groups together, but when obese and lean subjects were analyzed separately, the response was significant only in the obese. We present evidence of a different lipogenic and lipolytic profile in obese individuáis' omental adipocytes, and propose a relevant role of plasma membrane cholesterol, where the impact of its removal in OB and NOB adipocyte lipolysis differs.

Con frecuencia en las investigaciones médicas se requiere analizar datos de tipo longitudinal que no pueden ser analizados por los métodos estadísticos clásicos de series cronológicas. El objetivo de este trabajo es presentar la factibilidad del uso del método exploratorio multivariado STATIS (Structuration des Tableaux A Trois Indices de la Statistique) en un estudio antropométrico de una muestra de 57 mujeres adultas mayores de 60 años (rango: 69-82 años) del Gran Santiago, Chile, que fueron estudiadas en 5 ocasiones durante un período de 30 meses. Las variables de interés son las mediciones antropométricas: peso, talla, circunferencia brazo, circunferencia pantorrilla, circunferencia cintura, circunferencia cadera, altura rodilla; medidas cada 6 meses. Las variables peso, circunferencia de brazo, circunferencia de pantorrilla, circunferencia de cintura y circunferencia de cadera, fueron las más correlacionadas con el primer eje de compromiso y responden fundamentalmente a medidas de composición corporal como adiposidad y masa muscular. El eje 2, caracterizado por la talla y la altura de rodilla, responde al tamaño del esqueleto. Los resultados obtenidos sugieren una evolución cronológica regular en los primeros 24 meses de observación, con un cambio de estructura a los 30 meses del estudio, así como una clasificación de grupos con diferente composición corporalMultivariate study of the evolution of body dimensions in elderly Chilean women. 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

BackgroundAgeing is associated with increased risk of poor health and functional decline. Uncertainties about the health-related benefits of nutrition and physical activity for older people have precluded their widespread implementation. We investigated the effectiveness and cost-effectiveness of a national nutritional supplementation program and/or a physical activity intervention among older people in Chile.Methods and findingsWe conducted a cluster randomized factorial trial among low to middle socioeconomic status adults aged 65-67.9 years living in Santiago, Chile. We randomized 28 clusters (health centers) into the study and recruited 2,799 individuals in 2005 (~100 per cluster). The interventions were a daily micronutrient-rich nutritional supplement, or two 1-hour physical activity classes per week, or both interventions, or neither, for 24 months. The primary outcomes, assessed blind to allocation, were incidence of pneumonia over 24 months, and physical function assessed by walking capacity 24 months after enrollment. Adherence was good for the nutritional supplement (~75%), and moderate for the physical activity intervention (~43%). Over 24 months the incidence rate of pneumonia did not differ between intervention and control clusters (32.5 versus 32.6 per 1,000 person years respectively; risk ratio = 1.00; 95% confidence interval 0.61-1.63; p = 0.99). In intention-to-treat analysis, after 24 months there was a significant difference in walking capacity between the intervention and control clusters (mean difference 33.8 meters; 95% confidence interval 13.9-53.8; p = 0.001). The overall cost of the physical activity intervention over 24 months was US$164/participant; equivalent to US$4.84/extra meter walked. The number of falls and fractures was balanced across physical activity intervention arms and no serious adverse events were reported for either intervention.ConclusionsChile's nutritional supplementation program for older people is not effective in reducing the incidence of pneumonia. This trial suggests that the provision of locally accessible physical activity classes in a transition economy population can be a cost-effective means of enhancing physical function in later life.Trial registrationCurrent Controlled Trials ISRCTN 48153354.

Obesity rates have increased markedly in Latin America, especially during the last 10-15 years, becoming a public health problem in most countries. Prevalence of obesity among preschool children remains low, while among schoolchildren it has increased considerably. Prevalence is high in the adult population, especially among women with less schooling. In developed populations, obesity occurs more frequently among the poor; the opposite occurs in less developed societies, where in households undergoing nutritional transition, underweight can coexist with obesity. The most important determinant factors involved in the increasing obesity prevalence are fetal and infant nutritional conditions (stunting), education and socioeconomic conditions, dietary changes (especially increased total energy intake), and physical inactivity. Because chronic diseases are the main causes of death in the Region and obesity is one of the main risk factors for these diseases, policies to improve economic and educational levels with the implementation of health promotion and prevention should be a priority in every country.En América Latina la obesidad ha aumentado considerablemente llegando a convertirse en un problema de salud pública en casi todos los países. La prevalencia de obesidad es baja entre los preescolares, pero ha aumentado significativamente entre los escolares. En los adultos, la prevalencia es alta, especialmente entre las mujeres con menor educación. En sociedades más desarrolladas, la obesidad aparece más frecuentemente entre los pobres, lo opuesto ocurre en poblaciones pobres, donde, además, puede coexistir la desnutrición junto a la obesidad. Los factores de riesgo más importantes relacionados con el incremento de la obesidad son: las condiciones fetales y la situación nutricional durante la infancia (talla baja), características socioeconómicas y nivel educacional, aspectos dietéticos y la inactividad física. Por ello, y debido a que las enfermedades crónicas constituyen la principal causa de muerte en todos los países de la región, y la obesidad es uno de los principales factores de riesgo de éstas, la implementación de políticas y programas que apunten mejorar la situación económica y educacional de los más pobres y al mismo tiempo cambiar los hábitos de vida de toda la población es absolutamente prioritario.

Con frecuencia en las investigaciones médicas se requiere analizar datos de tipo longitudinal que no pueden ser analizados por los métodos estadísticos clásicos de series cronológicas. El objetivo de este trabajo es presentar la factibilidad del uso del método exploratorio multivariado STATIS (Structuration des Tableaux A Trois Indices de la Statistique) en un estudio antropométrico de una muestra de 57 mujeres adultas mayores de 60 años (rango: 69-82 años) del Gran Santiago, Chile, que fueron estudiadas en 5 ocasiones durante un período de 30 meses. Las variables de interés son las mediciones antropométricas: peso, talla, circunferencia brazo, circunferencia pantorrilla, circunferencia cintura, circunferencia cadera, altura rodilla; medidas cada 6 meses. Las variables peso, circunferencia de brazo, circunferencia de pantorrilla, circunferencia de cintura y circunferencia de cadera, fueron las más correlacionadas con el primer eje de compromiso y responden fundamentalmente a medidas de composición corporal como adiposidad y masa muscular. El eje 2, caracterizado por la talla y la altura de rodilla, responde al tamaño del esqueleto. Los resultados obtenidos sugieren una evolución cronológica regular en los primeros 24 meses de observación, con un cambio de estructura a los 30 meses del estudio, así como una clasificación de grupos con diferente composición corporal

Chile is in an advanced demographic transition stage with the population over 60 years of age representing 15% of the total population and whose number of elderly has more than doubled between 1990 and 2014. Rapid economic advancement has promoted significant changes in social organization to which the country is not accustomed. The mental health problems of the elderly are particularly challenging to the country's present social and health structures. The prevalence of dementia in people over 60 years exceeds 8% and is even higher in the rural population. There is more training on dementia in the local medical and scientific community, increased awareness within the civilian community but insufficient responsiveness from the state to the broad diagnostic and therapeutic requirements of patients and caregivers. The objective of the present study was to provide an update of the information on dementia in the context of the ageing process in Chile.

Obesity rates have increased markedly in Latin America, especially during the last 10-15 years, becoming a public health problem in most countries. Prevalence of obesity among preschool children remains low, while among schoolchildren it has increased considerably. Prevalence is high in the adult population, especially among women with less schooling. In developed populations, obesity occurs more frequently among the poor; the opposite occurs in less developed societies, where in households undergoing nutritional transition, underweight can coexist with obesity. The most important determinant factors involved in the increasing obesity prevalence are fetal and infant nutritional conditions (stunting), education and socioeconomic conditions, dietary changes (especially increased total energy intake), and physical inactivity. Because chronic diseases are the main causes of death in the Region and obesity is one of the main risk factors for these diseases, policies to improve economic and educational levels with the implementation of health promotion and prevention should be a priority in every country.

Obesity rates have increased markedly in Latin America, especially during the last 10-15 years, becoming a public health problem in most countries. Prevalence of obesity among preschool children remains low, while among schoolchildren it has increased considerably. Prevalence is high in the adult population, especially among women with less schooling. In developed populations, obesity occurs more frequently among the poor; the opposite occurs in less developed societies, where in households undergoing nutritional transition, underweight can coexist with obesity. The most important determinant factors involved in the increasing obesity prevalence are fetal and infant nutritional conditions (stunting), education and socioeconomic conditions, dietary changes (especially increased total energy intake), and physical inactivity. Because chronic diseases are the main causes of death in the Region and obesity is one of the main risk factors for these diseases, policies to improve economic and educational levels with the implementation of health promotion and prevention should be a priority in every country.