ABSTRACT Background: Confinement is an effective measure to control COVID-19, but it can have repercussions on lifestyle-related behaviors, especially among adolescents. Poor quality diet and low physical activity could trigger weight gain and the appearance of chronic non-communicable diseases at an early age. Aim: To investigate the changes in eating and physical activity patterns before and during the first COVID-19 confinement in Chilean adolescents. Material and Methods: Chilean adolescents aged between 10 and 19 years were invited to answer an online survey with 47 questions about dietary habits and physical activity. Results: The survey was answered by 420 participants and only four adolescents declined to answer it. Changes in eating patterns were evidenced, such as an increase in lunch consumption from 54.1 to 83%, and a decrease in the consumption of both healthy and unhealthy foods. Also, significant changes were observed in physical activity patterns, and an increase in the time spent sitting, from 4.7 to 5.8 hours during confinement. Conclusions: The first confinement for COVID-19 modified eating and physical activity patterns in Chilean adolescents towards unhealthy habits, which if maintained, could negatively affect their health and quality of life.

RESUMEN Introducción: La lactancia materna (LM) es un factor protector contra la obesidad infantil; sin embargo, los mecanismos a través de los cuales ejerce este efecto aún no están claros. El objetivo fue describir los mecanismos asociados al efecto protector que ejerce la lactancia materna contra la obesidad infantil. Métodos: Se utilizaron los buscadores PUBMED, SCOPUS, Cochrane Library y Scielo para desarrollar una revisión descriptiva de la evidencia científica. Las palabras clave fueron: lactancia materna, obesidad, mecanismo y dieta. Se revisaron artículos en español e inglés, desde 1977 hasta el 2020. Resultados: El efecto protector de la LM contra la obesidad infantil está dado por una combinación de varios mecanismos, se destaca su composición nutricional y el aporte de sustancias bioactivas, algunas de ellas reguladoras de la ingesta energética. Los lactantes que reciben LM por más tiempo seleccionan alimentos más saludables en etapa preescolar, independiente de factores sociodemográficos. También han sido descritos efectos en la adiposidad, el control del peso corporal y la ingesta energética mediante regulación de la programación epigenética y de la microbiota intestinal. Conclusión: La LM es un proceso único, que interacciona de forma compleja con factores del crecimiento y desarrollo de los lactantes y preescolares. Su rol protector contra la obesidad ha sido asociado a diversos mecanismos. Sin embargo, se requiere de nuevas investigaciones para comprender los alcances que puede presentar la LM en la etapa pediátrica y su rol en la prevención de la obesidad.

ABSTRACT Background and aim: Breastfeeding (BF) is a protective factor against childhood obesity; however, the mechanisms associated with this effect have not yet been elucidated. This study aimed to describe the mechanisms related to the protective effect of breastfeeding against childhood obesity. Methods: A search on PUBMED, SCOPUS, Cochrane Library and SCIELO databases was carried out to develop a descriptive review of the scientific evidence. The key words were breastfeeding; obesity; mechanism and diet. Articles were reviewed in Spanish and English from 1977 to 2020. Results: The protective effect of BF against childhood obesity is given by a combination of several mechanism. Its nutritional composition and the contribution of bioactive substances stand out, some of them regulated by the energy intake. Infants who are breastfed choose healthier foods in preschool, regardless of sociodemographic factors. Effects on adiposity, control of body weight and energy intake have also been described by epigenetic regulation programming and the intestinal microbiota. Conclusion: BF is a unique process that interacts in a complex way with infants and preschoolers’ growth and developmental factors Its protective role against childhood obesity has been associated with various mechanisms. New research is still required to understand the implications of BF in pediatric age and its role in preventing obesity.

Background: Depression is a highly prevalent disease in Chilean adults. Aim: To identify sociodemographic, biomedical, and psychosocial factors related with depression in a representative sample of the Chilean adult population. Material and Methods: Analysis of data from the National Health Survey 2016-2017 which included 5,291 participants aged > 15 years. Depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Association between sociodemographic data, health and psychosocial variables and depression was analyzed using Poisson regression with robust error. Results: The probability of depression was higher in women than in men (prevalence ratio (PR) = 2.13 [95% confidence intervals (CI): 1.65, 2.75]). In both genders, the probability was higher in people with frailty (women: PR = 10.0 [95% CI: 1.86, 18.1] and men: PR = 3.38 [95% CI: 2.72; 4.20]), severe chronic pain (women: PR = 2.84 [95% CI: 1.93, 4.18 and men: PR = 6.41 [95% CI: 3.59, 9.40]), presence of two or more diseases (women: PR = 4.15 [95% CI: 2.78, 6.20 and men: PR = 2.60 [95% CI: 1.39, 3.81]), perception of permanent stress (women: PR = 11.0 [95% CI: 6.13, 16.0], men: PR = 21.0 [95% CI: 10.2, 31.7]), financial stress (women: PR = 2.57 [95% CI: 1.87, 3.27] men: PR = 4.27 [95% CI: 2.48, 6.06] and poor or very poor perception of health (women: PR = 5.02 [95% CI: 1.92, 8.12], men: 2.09 [95% CI: 0.49, 3.69]). In men, the probability of depression was higher for widowers than married man (PR = 5.58 [95% CI: 2.5, 8.25]), presence of goiter (PR = 4.03 [95% CI: 1.99, 6.07]) and low social support (PR = 1.95 [95% CI: 1.18; 2.72]). Conclusions: The factors associated with a higher probability of depression are diverse in nature. Among these being women, frailty, chronic pain, multimorbidity and high perception of stress are important factors.

Abstract Introduction The average life expectancy, as well as the prevalence of Type 2 diabetes (T2D), is increasing worldwide. Population-based studies have demonstrated that the duration of T2D has been associated with cognitive impairment. However, despite the high prevalence of T2D and cognitive impairment in Chile, the association between years with T2D and suspicion of cognitive impairment has not yet been investigated. The objective of this study was to investigate the association between duration of T2D and suspicion of cognitive impairment in Chilean older adults. Material and Methods 1,040 older adults aged ≥60 years from the Chilean National Health Survey (2009-2010) were included. Suspicion of cognitive impairment was assessed by the abbreviated Mini-Mental State Examination (MMSE). The number of years with T2D was self-reported and categorised into four groups. Poisson Regression analysis was used to assess the association between altered MMSE and the number of years with DM2, adjusted by potential confounders including socio-demographic, lifestyle, adiposity and health-related factors. Results When the analyses were adjusted for socio-demographic factors, people who had T2D for 15 to 24 and ≥25 years had 2.2-times (95%CI: 1.07; 3.33) and 5.8-times (95%CI: 3.81; 11.0) higher relative risk (RR) of cognitive impairment, compared to those without T2D. When the analyses were additionally adjusted for lifestyle and health-related covariates, the RR for cognitive impairment was 1.76-times (95%CI: 1.02; 2.50) and 4.54-times (95%CI: 2.70; 6.38) higher for those who had T2D for 14-24 years and ≥25 years, respectively. Conclusions Number of years with T2D was associated with suspicion of cognitive impairment. A longer duration of T2D was associated with a higher likelihood of cognitive impairment in the Chilean older population, independently of confounder factors included in the study.

RESUMEN Introducción: La esperanza de vida está aumentando en todo el mundo, así como la diabetes tipo 2 (DM2). Estudios poblacionales han demostrado que la duración de la DM2 se ha asociado con el deterioro cognitivo. Sin embargo, a pesar de la alta prevalencia de DM2 y deterioro cognitivo en Chile, aún no se ha investigado la asociación entre años con DM2 y la sospecha de deterioro cognitivo. El objetivo del estudio fue investigar la asociación entre la duración de la DM2 y la sospecha de deterioro cognitivo en personas mayores chilenas. Material y Métodos Participaron 1.040 personas ≥60 años de la Encuesta Nacional de Salud de Chile (2009-2010). El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental abreviado (MMSE). El número de años con DM2 fue categorizado en cuatro grupos. Para valorar la asociación entre MMSE alterado y el número de años con DM2, se utilizó una regresión de Poisson, ajustados a posibles factores de confusión sociodemograficos, de estilos de vida, adiposidad y salud. Resultados Cuando se ajustaron los análisis por factores sociodemográficos, las personas con 15 a 24 y ≥25 años con DM2 presentaron 2,2 veces (IC95%: 1,07; 3,33) y 5,8 veces (IC95%: 3,81; 11,0) riesgo relativo (RR) de deterioro cognitivo, en comparación con aquellas sin DM2. Luego de ajustar adicionalmente los análisis para las covariables relacionadas con el estilo de vida y la salud, el RR para deterioro cognitivo fue 1,76 veces (IC95%: 1,02; 2,50) y 4,54 veces (IC95%: 2,70; 6,38) más alto para aquellas personas con 14-24 y ≥25 años de DM2. Conclusiones Se asoció el número de años con DM2 con la sospecha de deterioro cognitivo. Una mayor duración de la DM2 se asoció con una mayor probabilidad de deterioro cognitivo en la población mayor chilena.

ABSTRACT Background: Falls among older adults are associated with important changes in lifestyle. However, there is no evidence about the physical activity levels of older adults who have experienced falls. The aim of this study, therefore, was to describe physical activity levels in older adults who have experienced falls in the last 12 months. Methods: 1,254 older adults (aged ≥60 years) from the National Health Survey 2009-2010 were included in this study. Number of falls during the last 12 months was self-reported and physical activity was measured using the Global Physical Activity Questionnaire (GPAQ). The association between falls and physical activity was investigated using regression analyses. Results: 70.5% [95% CI: 68.0; 72.8] of the older adults included in this study did not report any falls during the last 12 months. However, 19.4% [95% CI: 17.4; 21.5] reported 1-2 falls and 10% [95% CI: 8.4; 11.8] reported ≥3 falls in the last 12 months. In comparison to those who reported no falls, those who experienced ≥3 falls in the last 12 months did 79.2 fewer minutes/day of physical activity. Similar results were found for moderate and transport-related physical activity, but no associations were found for vigorous or sedentary behaviours. Conclusion: Older adults who suffered falls in the last 12 months reported doing less physical activity than their counterparts who did not experience any falls. In the middle and long term, these changes in physical activity could contribute to adverse health outcomes in an already frail population.

RESUMEN Antecedentes: Las caídas limitan las actividades de la vida diaria. Actualmente se desconoce cómo los niveles de actividad física (AF) varían luego de sufrir una caída. Objetivo: investigar los niveles de práctica de actividad física de personas mayores que han reportado caídas en los últimos 12 meses. Métodos: Se incluyeron 1.254 participantes ≥ 60 años de Encuesta Nacional de Salud (ENS) 2009-2010. La prevalencia de caídas en los últimos 12 meses se determinó mediante auto reporte. Los niveles de AF y el tiempo sedente se determinaron a través del cuestionario Global Physical Activity Questionnaire (GPAQ). La asociación entre caídas y AF fue investigada mediante regresión lineal. Resultados: El 70,5% [95% IC: 68,0; 72,8] de las personas mayores no reportaron caídas, mientras que un 19,4% [95% IC: 17,4; 21,5] reportó haber sufrido entre 1-2 caídas y un 10% [95% IC: 8,4; 11,8] ≥3 caídas en los últimos 12 meses. En comparación al grupo que reportó no sufrir caídas, aquellos que sufrieron ≥3 caídas realizaban 79,2 minutos menos de AF total/día. Resultados similares fueron observados para AF de transporte y AF moderada. No se encontraron diferencias para tiempo sedente o AF vigorosa. Conclusión: Personas mayores que sufrieron caídas en los últimos 12 meses reportaron realizar menos actividad física que sus contrapartes que no experimentaron caídas. A mediano y largo plazo, estos cambios en la actividad física podrían contribuir a resultados de salud adversos en una población.

Background: Adiposity and education are two independent risk factors for type 2 diabetes (T2D). However, there is limited evidence whether both education and adiposity are associated with T2D in an additive manner in the Chilean population. Aim: To investigate the joint association between adiposity and education with T2D in the Chilean adult population. Material and Methods: Analysis of data of the Chilean National Health Survey 2016-2017, which included 5,033 participants with a mean age of 43 years, (51% women). Poisson regression analyses with robust standard error were used to investigate the joint association of the education level and general and central adiposity with T2D. The results were reported as Prevalence Ratio and their 95% confidence intervals (PR, 95% CI). Results: Obesity was associated with a higher probability of having T2D in men than in women, however central adiposity was associated with a higher probability of having T2D in women than in men. Compared with men who had higher education (> 12 years) and had normal body weight, those with the same educational level and who were obese had 2.3-times higher probability of having T2D (PR: 2.35 [95% CI: 1.02; 5.39]). For women, having a low education and being obese was associated with 4.4-times higher probability of having T2D compared to those with higher education and normal body mass index (BMI) (PR: 4.47 [95% IC: 2.12; 9.24]). Similar results were observed when waist circumference was used as a marker of obesity rather than BMI. Conclusions: Women and men with higher BMI and low education had a higher risk of T2D. However, this risk was higher in women than in men.

ABSTRACT Objective: To study the association of SLC16A11 gene variants with obesity and metabolic markers in nondiabetic Chilean adults. Materials and methods: This cross-sectional study included 263 non-diabetic adults. The genotype of the rs75493593 polymorphism of SLC16A11 gene was performed by real-time PCR. It's association with adiposity markers (body weight, BMI, waist circumference and fat mass percentage), metabolic markers (glucose, insulin, HOMAIR, leptin, total cholesterol, LDLc, HDLc, triglycerides, ALT, GGT and hsCRP) and blood pressure was analyzed by linear regression. Results: The minor allele (T) of the SLC16A11 gene (rs75493593) has a frequency of 29.7% among Chileans. Risk genotypes (GT and TT) were associated with a significant 1.49 mU/l increase in plasmatic insulin for each copy of the minor allele (95% CI: 0.12, 2.87, p < 0.05). This association remained significant after adjusting for socio-demographic variables, physical activity and smoking (1.36 mU/l, 95% CI: 0.16, 2.58 p < 0.05), but was lost when BMI was included as a confounding factor. Higher BMI was also significantly associated with polymorphic genotypes in SLC16A11, independent of socio-demographic variables. Conclusion: The minor allele of the SLC16A11 gene (T) is highly prevalent among Chileans and is associated with increased insulin and BMI in nondiabetic individuals. These findings suggest that the genetic variant in SLC16A11 is not only associated with type 2 diabetes as previously shown in Mexicans, but is also related to early metabolic alterations in healthy subjects that may lead to type 2 diabetes.

Background: Legumes are low cost and high-quality nutritional foods. In Chile, a twice per week legume consumption is recommended to promote health and prevent disease. Aim: To characterize the consumption of legumes according to sociodemographic and anthropometric variables in the Chilean adult population. Material and Method: Analysis of data from 5,473 participants of the 2016-2017 National Health Survey. The compliance with legume consumption was studied in population groups, according to sociodemographic and anthropometric characteristics, through logistic regression analyses. Results: Only 24% of all participants (51.4% of women) fulfilled legume intake recommendations. After adjusting for sociodemographic variables, the participants who were less likely to comply with the recommendation were widowers (Odds Ratio (OR): 0.58 [95% confidence intervals (CI): (0.40; 0.85]). On the contrary, people between 70-80 years (OR: 1.78 [95% CI: 1.11; 2.88]), those who resided in rural areas (OR: 1.62 [95% CI: 1.25; 2.10]) and those who resided in the Maule region (OR: 2.11 [95% CI: 1.37, 3.25]) had a higher likelihood of compliance. Conclusions: One out of four Chileans complied with the recommendations of legume consumption. Even though the results differed when stratified by sex, it is highlighted that living in rural areas increased the probabilities of an adequate legume consumption.

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

Cancer is a chronic non-communicable disease associated with a high mortality burden. The prevalence of cancer is increasing rapidly worldwide. However, this scenario will be worse in low and middle-income countries such as Chile, where 70% of cancer deaths occur. The aim of this review was to assess the epidemiological scenario of cancer and its projection for the Chilean population. In Chile, 53,365 new cases of cancer were diagnosed in 2018, led by prostate, colorectal, breast, stomach, lung and gallbladder cancer. From 1986 to 2016, cancer increased by 109%. When we reviewed mortality by sex, stomach and prostate cancer were responsible for more than 30% of cancer deaths among men. However, for women the first three places were occupied by breast, colorectal and lung cancer, as in the rest of the world. Considering that 40% of cancers are related to unhealthy lifestyles, working on the prevention of modifiable risk factors represents an opportunity for the creation of public health policies that allow changes at the environmental and individual level.

Background: The assessment of frailty among older people could help to reduce its social and health burden. Aim: To determine and characterize the prevalence of frailty in Chilean older adults. Material and Methods: We studied 233 participants, aged > 60 years, participating in the Chilean National Health Survey 2016-2017. Frailty was assessed using modified Fried criteria. Thus, people classified as frail should meet at least 3 out of the 5 criteria (low strength, low physical activity, low body mass index, slow walking pace and tiredness). Results: The prevalence of frailty was 10.9% (7.7% for men and 14.1% for women). The prevalence of pre-frailty was 59.0% whereas 30.1% of participants were classified as robust. At the age of 80 years 58 and 62% of men and women were frail, respectively. These figures increased to 90 and 87% at the age of 90 years. The prevalence of pre-frailty increased from 43 to 92.1% among men and from 76% and 78% among women from the ages of 60 to 90 years, respectively. Conclusions: The prevalence of frailty increased markedly with age. It is important to implement prevention strategies to allow an early identification of high-risk individuals.

ABSTRACT Introduction: In the last years, there has been an exponential increase in childhood obesity rates worldwide. Although eating behavior depends on multiple factors, there is agreement on the impact of socio-environmental aspects in which the family has a central role. Identifying the influence of parents and caregivers on child eating behavior can help to generate effective strategies for controlling obesity, especially at early stages. Aim: To review recent scientific evidence on the association between parental feeding attitudes and practices, eating behavior and nutritional status of the child. Method: Narrative review of 40 empirical articles published between 2011 and 2019. Results: Parents tend to underestimate body weight in overweight children. Weight concern and pressure to eat are associated with the nutritional status of the child. Restrictive feeding and the use of food for instrumental purposes and as a mean of controlling emotions, would not be effective practices, possibly because they interfere with the child's ability to self-regulate intake. Positive practices included monitoring, modelling healthy eating patterns and creating non-obese environments. Conclusion: Consistent findings support the notion that coercive practices could have negative effects on child eating behavior. Moreover, practices that promote structured and a positive environment could be more functional. However, international evidence is consistent in the relevance of parents and caregivers in promoting healthy eating behavior and the nutritional status of children.

RESUMEN Introducción: si bien la conducta alimentaria depende de múltiples factores, existe acuerdo en la importancia de aspectos socio-ambientales en los que la familia tiene un rol central, especialmente en edades tempranas. Objetivo: sistematizar evidencia científica actualizada sobre la asociación entre actitudes y prácticas de alimentación infantil, conducta alimentaria y estado nutricional del niño. Método: revisión narrativa de 40 artículos empíricos publicados entre los años 2011 y 2019. Resultados: se identificó tendencia en los padres a subestimar el peso corporal en niños con sobrepeso, y asociación entre preocupación por el peso, presión para comer y estado nutricional del niño. La alimentación restrictiva y el uso de la alimentación para fines instrumentales y controlar emociones, no serían prácticas efectivas, posiblemente porque interfieren en la capacidad de autorregulación del niño. Prácticas positivas incluyeron monitoreo, modelado de patrones alimentarios saludables y creación de ambientes no obesogénicos. Conclusión: existen hallazgos consistentes respecto a que prácticas coercitivas pueden ejercer efectos negativos en la conducta alimentaria infantil y prácticas que promueven la estructuración en la alimentación y un entorno positivo, serían más funcionales. La evidencia internacional es consistente en la relevancia de padres y cuidadores en la promoción de una conducta alimentaria saludable y la condición nutricional de niños.

Background: Depression has been previously associated with cognitive impairment in high income country populations. However, its association in the Chilean population has not been investigated. Aim: To investigate the association between depression and cognitive impairment. Material and Methods: Data from 1384 Chilean adults aged > 60 years, participating in the National Health Survey 2009-2010 was analyzed. Cognitive impairment was assessed using the Mini Mental Examination score. The medical diagnosis of depression was self-reported. The association between depression and cognitive impairment was assessed using a logistic regression. Results: Depression was positively associated with cognitive impairment. However, the magnitude of the association was higher in men (Odds ratio (OR) = 4.02 [95% confidence intervals (CI): 1.44; 6.61], p < 0.01]) than in women (OR = 2.23 [95%CI: 1.03; 3.43], p = 0.04). Older adults who were diagnosed for the first time with depression after 65 years of age, showed a stronger association with cognitive impairment (OR = 6.65 [95% CI: 2.39; 10.9], p < 0.01) than those diagnosed before 55 years. Conclusions: Our study confirms the association between depression and cognitive impairment. Further research is needed to elucidate the nature and potential mechanisms that link depression with cognitive impairment.