Multiple events case-control study in a prospective cohort to identify systemic, cellular, and molecular biomarkers of obesity-induced accelerated aging in 30-years-olds: the ObAGE study protocol

Background

Aging is characterized by a progressive loss of capacities linked to fundamental alterations/damage in multiple cellular and molecular pathways. It is the most significant risk factor for all non-communicable diseases (NCDs). Another contributing factor to the rise in NCDs is obesity. It has been suggested that obesity not only accelerates the onset of metabolic imbalances but also decreases lifespan and impacts cellular and molecular processes in a manner similar to aging. Obesity might accelerate the pace of aging. Guided by a lifecourse approach, we will explore how exposure to obesity in critical developmental stages disrupt homeostatic resilience mechanisms that preserve physiological integrity, inducing an early expression of aging phenotypes. Also, we will determine whether exposure to early psychosocial adversity influences vulnerability to obesity as a risk factor for accelerated aging.

Methods

Multiple events case–control study embedded in a prospective cohort of Chileans at 30-31y, 50% females, of low- to-middle socioeconomic status, who participated in nutrition research since birth. At 23y, 25% had obesity and cardiometabolic risk was high. We will use a multi-layer approach including: anthropometric assessment; DXA scan for body composition; abdominal ultrasound of the liver; stool samples collection and sequencing of the ribosomal RNA 16S gene to characterize the gut microbiome; determination of age-related pro-inflammatory cytokynes and anti-inflammatory miokynes. For the first time in Chile, we will address age-related epigenetic changes using the Horvath´s epigenetic clock. In a subset we will conduct a controlled physical challenge to characterize physical resilience (autophagy).

Discussion

ObAGE is in an excellent position to: approach aging as a process whose expression involves multiple factors from the early stages of a person's life; understand how longitudinal changes in health trajectories impact the biological mechanisms of aging; identify potential resilience mechanisms that help prevent unhealthy aging. Because SLS participants are still young, our research setting combined with advanced scientific techniques may identify individuals or groups at risk of early onset health issues. Results from ObAGE may pave the way to address the contribution of obesity to aging through lifespan from cells to systems and might be instrumental to developing interventions to improve health span in the Chilean population.

Trial registration

The proposed study does not consider any health care intervention on human participants.

Prevalence of Sarcopenia in Community-Dwelling Chilean Elders According to an Adapted Version of the European Working Group on Sarcopenia in Older People (EWGSOP) Criteria

BACKGROUND

Sarcopenia is the progressive loss of mass and skeletal muscle strength and has serious consequences on older people's health. The Chilean older population has a high life-expectancy, but the prevalence of functional dependence is also high.

OBJECTIVE

To determine the prevalence of sarcopenia in Chilean older adults and its relationship with age, gender, and body mass index (BMI).

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

1,006 non-disabled, community-dwelling subjects aged 60 years or older living in Santiago.

MEASUREMENTS

Anthropometric measurements, handgrip strength, physical performance tests, and dual-energy-x-ray-absorptiometry (DXA) scan were performed. Sarcopenia was defined using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP). Muscle mass was measured with DXA scan; skeletal muscle mass index (SMI) and hand dynamometry were defined with cut-off points obtained for the Chilean population. For a 3m walking speed we used the cut-off point of the EWGSOP definition. Nutritional status and obesity were defined according to World Health Organization standards. Association between sarcopenia and age, gender, BMI and lean/fat mass ratio was estimated by logistic regression models.

RESULTS

The prevalence of sarcopenia was 19.1% (95%CI: 16.8%-21.8%), similar in men and women. There was an increasing trend of sarcopenia by age group and a decreasing trend with nutritional status. After logistic regression, sarcopenia was positively associated with age (OR=1.10; 95%CI:1.06-1.15) and falls (OR=1.83; 95%CI:1.07-3.15) and negatively associated with overweight (OR=0.31; 95%CI:0.16-0.59), obesity (OR=0.02; 95%CI:0.004-0.11), lean mass/fat mass ratio (OR=0.69; 95%CI:0.48-0.9997), knee height (OR=0.78; 95%CI:0.68-0.89) and calf circumference (OR=0.87; 95%CI:0.77-0.97).

CONCLUSIONS

The total prevalence of sarcopenia was 19.1% increasing with age reaching 39.6% in people of 80 or more years of age. A negative association of sarcopenia with overweight, obesity and lean/fat mass ratio was observed. Although the high prevalence of obesity (35.9%), only 2% of obese people were sarcopenic.

Low muscle mass is associated with cardiometabolic risk regardless of nutritional status in adolescents: A cross-sectional study in a Chilean birth cohort

BACKGROUND

Increased cardiometabolic risk (CMR) is documented in obese and non-obese adolescents with low muscular fitness. However, the association of low muscle mass (LMM) with CMR, independent of weight status, has not been examined. We analyzed the relationship of LMM with CMR in adolescents, regardless of their weight status.

MATERIALS AND METHODS

Observational study in 660 adolescents. BMI, waist circumference (WC), arterial blood pressures (ABP) were measured. Total fat mass (TFM), total lean tissue (TLT), and appendicular skeletal muscle mass (ASM) were estimated (DXA). Fasting lipid profile, glucose, and insulin were measured. HOMA-IR was estimated. Metabolic Syndrome (MetS) was diagnosed (AHA/NHLBI/IDF). ROC analysis was performed to find the optimal cutoffs of TLT percentage for MetS diagnosis. Values below these cutoffs defined LMM. ANCOVA examined the association of LMM with selected cardiometabolic biomarkers.

RESULTS

In both sexes, TLT showed better sensitivity and specificity than ASM for MetS diagnosis. In males and females, TLT of 66.1% and 56.3%, respectively, were the optimal cutoff for MetS diagnosis. In the sample, 17.3% of males and 23.7% of females had LMM. In both sexes, adolescents with LMM had significantly higher values of WC, ABP, TG, TC/HDL, HOMA-IR, and MetS z-score than non-LMM participants. Adolescents with LMM, regardless nutritional status, had significantly increased values of MetS z-score, ABP, TG, TC/HDL-chol, and HOMA-IR than non-obese non-LMM adolescents. Adolescents having both obesity and LMM had the unhealthiest CMR profile.

CONCLUSION

In adolescents, LMM was associated with higher CMR, regardless of nutritional status. In obese adolescents, LMM increased obesity-associated CMR.

Breastfeeding as the sole source of milk for 6 months and adolescent bone mineral density

Little is known regarding the relationship between early life factors and bone mineral density (BMD). We found a positive association between breastfeeding for at least 6 months, without formula supplementation, and whole body adolescent BMD z-score.

INTRODUCTION

The aim of the study is to assess the role of breastfeeding BF on adolescent bone mineral density (BMD) in a cohort prospectively followed since infancy.

METHODS

We studied 679 participants from an infancy iron deficiency anemia preventive trial in Santiago, Chile, followed to adolescence. Breast and bottle feeding were ascertained weekly from 4 to 12 months. At 16 years, whole body BMD was assessed by DEXA. Using linear regression, we evaluated associations between BF duration and BF as the sole source of milk and adolescent BMD z-score, adjusting for possible infancy, adolescent, and background confounders.

RESULTS

Mean birth weight and length were 3.5 (0.3) kg and 50.7 (1.6) cm. For at least 6 months, BF was the sole source of milk for 26.3% and with supplementation for 36.7%. For 37%, BF was provided for less than 6 months. Mean 16-year BMD z-score was 0.25 (1.0). Covariates included male sex, birth length, and gestational age. BF as the sole source of milk ≥6 months, compared to BF < 6 months, was associated with higher adolescent BMD z-score adjusting for covariates (β = 0.29, p < 0.05). Mixed BF was not significantly related to adolescent BMD z-score (β = 0.06, p = 0.47). For every 30 days of BF as the sole source of milk, adolescent BMD z-score increased by 0.03 (p = 0.01).

CONCLUSION

BF without formula supplementation for at least 6 months was associated with higher adolescent BMD z-score and a suggestive trend in the same direction for BMD suggests that exclusivity and duration of BF may play a role in adolescent bone health.

Mini Nutritional Assessment Short-Form: Validation in Five Latin American Cities. SABE Study

OBJECTIVES

To validate the short-form of the MNA (MNA-SF) and the cut-off point of 31 cm for calf circumference (CC) in older people in Latin America.

METHODS

A cross-sectional study was conducted with 5,722 community-dwelling older subjects (range: 60-102 years) in Latin America´s five main cities: Sao Paulo (Brazil), Santiago (Chile), Havana (Cuba), Mexico DF (Mexico) and Montevideo (Uruguay). All participants underwent an interview, which included anthropometric measurements, completing the MNA and obtaining socio-demographic, nutrition and health information. The short-form of the MNA consists of only six questions from the original 18. It has two versions: one using body mass index (BMI) and the second using CC as a surrogate. Cohen's Kappa was calculated to assess the agreement between the MNA and the MNA-SF; diagnostic tests were performed, and Receiver-operating characteristic (ROC) curves were developed. Criterion-related validity was assessed in the Chilean sample.

RESULTS

Both version of the MNA-SF showed high sensitivity and specificity with the MNA, showing good accuracy (0.88), although higher values were estimated for malnutrition and risk of malnutrition in the total sample by sex. The cut-off point of 31 cm for CC showed high sensitivity (74.6-94.4%), specificity (72.6-100%) and good area under the ROC curve (0.87-0.95) when compared with BMI. There was good agreement between MNA and both version of MNA-SF for identifying persons with malnutrition or a risk of malnutrition in the five cities (Kappa coefficient: 0.6193-0.7852).

CONCLUSION

Both versions of the MNA-SF are population-screening tools of easy and fast application, with good accuracy for assessing malnutrition and risk of malnutrition in Latin American older people.

Healthy Chilean Adolescents with HOMA-IR ≥ 2.6 Have Increased Cardiometabolic Risk: Association with Genetic, Biological, and Environmental Factors

OBJECTIVE

To determine the optimal cutoff of the homeostasis model assessment-insulin resistance (HOMA-IR) for diagnosis of the metabolic syndrome (MetS) in adolescents and examine whether insulin resistance (IR), determined by this method, was related to genetic, biological, and environmental factors.

METHODS

In 667 adolescents (16.8 ± 0.3 y), BMI, waist circumference, glucose, insulin, adiponectin, diet, and physical activity were measured. Fat and fat-free mass were assessed by dual-energy X-ray absorptiometry. Family history of type 2 diabetes (FHDM) was reported. We determined the optimal cutoff of HOMA-IR to diagnose MetS (IDF criteria) using ROC analysis. IR was defined as HOMA-IR values above the cutoff. We tested the influence of genetic, biological, and environmental factors on IR using logistic regression analyses.

RESULTS

Of the participants, 16% were obese and 9.4 % met criteria for MetS. The optimal cutoff for MetS diagnosis was a HOMA-IR value of 2.6. Based on this value, 16.3% of participants had IR. Adolescents with IR had a significantly higher prevalence of obesity, abdominal obesity, fasting hyperglycemia, and MetS compared to those who were not IR. FHDM, sarcopenia, obesity, and low adiponectin significantly increased the risk of IR.

CONCLUSIONS

In adolescents, HOMA-IR ≥ 2.6 was associated with greater cardiometabolic risk.

Adherence to a physical activity intervention among older adults in a post-transitional middle income country: a quantitative and qualitative analysis

OBJECTIVES

The effectiveness of community level interventions depends to a great extent on adherence. Currently, information on factors related to adherence in older adults from developing countries is scarce. Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country.

DESIGN, SETTING AND PARTICIPANTS

Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects (65-67.9 years at baseline) with low to medium socioeconomic status from 10 health centers randomized to receive a physical activity intervention as part of the CENEX cluster trial (ISRCTN48153354).

MEASUREMENTS

Using a multilevel regression model, the relationship between adherence (defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months) and individual, intervention-related and contextual factors was evaluated. We also conducted 40 semi-structured interviews with older adults (n=36) and instructors (n=4). Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence.

RESULTS

Adherence to physical activity intervention was 42.6% (CI 95% 39.5 to 45.6). Depression, diabetes mellitus, percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence (p<0.05) while being retired, participation in physical activity prior to the intervention, and green areas per habitant were positively associated with adherence (p<0.05). The qualitative interviews identified three primary barriers to adherence: current health problems, lack of time due to commitments for caring for family members, and being employed, and two primary facilitators to adherence: the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others.

CONCLUSION

In order to enhance effectiveness of community exercise interventions, strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions.

Adiposity and bone mineral density of Chilean elderly women in relation to toll-like receptor 4 gene polymorphisms

BACKGROUND

It has been proposed that the toll-like receptor-4 gene (TLR4) may participate in the development of obesity and osteoporosis, in addition to its well-known role in the immune response. On the other hand, the adipose tissue of obese subjects shows an increased expression of the proinflammatory cytokine, tumour necrosis factor-alpha (TNF-alpha), which is released after lipopolysaccharide recognition by TLR4.

AIM

To estimate the allele/genotype frequencies and linkage disequilibrium measures of Asp299Gly and Thr399Ile polymorphisms of the TLR4 gene in the Chilean elderly population, and to screen for their association with variables related to adiposity or bone mineral density.

SUBJECTS AND METHODS

The study group included 227 unrelated Chilean elderly women (61-95 years) recruited from a population-based sample. Adiposity and bone mineral density measures were obtained using dual-energy X-ray absorptiometry.

RESULTS

The allele frequencies for TNF -308A, TLR4 299Gly and TLR4 -399Ile were 9.3%, 4.6% and 4.4%, respectively, with Asp299Gly and Thr399Ile being in strong linkage disequilibrium (D' = 0.88). Although seriously restricted by the low frequency of the allele variants, no relevant association between genotypes and adiposity-related variables were found. Likewise, no significant association between osteoporosis status (categorized as osteoporosis, osteopenia or normal status) with TLR4 Asp299Gly or TNF -308G>A genotypes was found.

CONCLUSION

It is unlikely that TLR4 Asp299Gly, TLR4 Thr399Ile or TNF -308G>A polymorphisms have a major influence on adiposity, bone mineral density or osteoporosis status in Chilean elderly women.

Lack of association between the fatty acid binding protein 2 (FABP2) polymorphism with obesity and insulin resistance in two aboriginal populations from Chile

The aim of this study was to assess the frequency of fatty acid binding protein 2 (FABP2) Ala54Thr genetic polymorphism and to evaluate its association with obesity and insulin resistance in Chilean aboriginal populations. A sample of 96 urban Aymara and 111 urban Mapuche subjects aged 20-80 years were recruited for this cross-sectional study. Glucose, insulin and lipid profile were measured in fasting plasma samples. Insulin resistance was estimated through the HOMA-IR model. FABP2 Ala54Thr genotypes were determined by PCR followed by RFLP analysis. The allele frequency of Thr54 variant was estimated as 18.2% in Aymara subjects, which is one of the lowest reported to date. The corresponding frequency in Mapuche subjects was 31.9% (p<0.002). Regarding genotype-phenotype associations, no significant differences were found in any of the anthropometric or metabolic variables according to Ala54Thr genotypes. After adjustment by BMI and metabolic variables through a logistic regression analysis, the association of the FABP2 polymorphism with ethnic group persisted (Mapuche group: OR=2.37, 95% CI 1.319-4.277, p=0.004) It is unlikely that Ala54Thr polymorphism of the FABP2 gene plays a relevant role in obesity and insulin resistance in Chilean ethnic groups.

Anthropometric measurements in the elderly population of Santiago, Chile

OBJECTIVE

There are few studies on anthropometry and nutritional status in large and representative samples of elderly populations in Chile and South America. We describe age and sex differences in weight, height, body mass index, knee height, waist circumference, midarm circumference, triceps skinfold thickness, arm muscle area, and calf circumference in Chilean elderly subjects.

METHODS

This was a population-based, cross-sectional study. A total of 1220 elderly persons (819 women and 411 men; age range, 60-99 y) were recruited in the city of Santiago (Chile) through a probabilistic sampling procedure carried out from October to December 1999.

RESULTS

Men were significantly heavier and taller than women in all age groups, whereas body mass index values were significantly higher in women than in men. All anthropometric variables showed a decrease in average values with aging in men and women. The apparent negative slopes for the decline in average values of body weight with aging was of greater magnitude in women than in men (-0.42 kg/y and -0.54 kg/y in male and female subjects, respectively). However, significant age x sex interaction was detected only for triceps skinfold thickness. In women, quadratic terms for age provided a significantly better fit than did the simple linear model for the association between age and weight, body mass index, waist circumference, triceps skinfold thickness, calf circumference, or midarm circumference.

CONCLUSION

These observations indicated that body weight changes associated with aging might be more severe in Chilean women than in men, probably determining a differential pattern of lean and fat mass loss.

Trends in overweight and obesity prevalence in Chilean children: comparison of three definitions

OBJECTIVE

To compare trends in prevalence of overweight and obesity among Chilean children using three different criteria.

METHODS

Descriptive cross-sectional school-based study to analyse these trends in 6-y-old boys and girls who entered first grade in 1987, 1990, 1993, 1996 and 2000. Gender-specific prevalence of overweight and obesity were determined with three criteria: weight for height (W-H) Z-scores compared to NCHS 1977; present reference used by the Ministry of Health; and body mass index (BMI) compared to the revised US CDC Growth Charts with cut-off values of P85-95 and P-95 and IOTF reference with cut-offs extrapolated from an adult BMI of 25 and 30.

RESULTS

The prevalence of overweight determined by W-H (WHO) increased from 15% in 1987 to 20% in 2000 for boys and from 17.2 to 21.8% for girls. With BMI-CDC, the increase was from 13.2 to 19.2% for boys and 12 to 18.5% for girls. With BMI-IOTF, rates were very similar. Prevalence of obesity using W-H (WHO) increased from 6.5% in 1987 to 17% in 2000 for boys and from 7.8 to 18.6% for girls. Using BMI-CDC, the increase was from 5.1 to 14.7% for boys and from 4 to 15.8% for girls; using BMI-IOTF prevalence estimates were much lower.

CONCLUSIONS

Obesity prevalence in children has increased over time, and trends are similar independent of criteria. The reference used to define prevalence is important since it provides different estimates. Policy makers should be aware that a spurious drop in prevalence may appear if the IOTF reference is compared to the other criteria.

Transmission of high-risk HLA-DQB1 alleles in Chilean type 1 diabetic patients and their parents: stratification by the presence of ICA or GAD65 autoantibodies

AIM

The purpose of this study was to assess whether the transmission of DQB1*0201 and DQB1*0302 alleles from heterozygous parents to Chilean type 1 diabetic patients depends on the presence of antibodies such as glutamic acid decarboxilase (GAD65) or Islet Cell (ICA) autoantibodies in the affected case.

MATERIAL AND METHODS

A study of incident type 1 diabetic cases and parents was carried out in Santiago, Chile during 1997-98. The use of the case-parental design eliminates the possibility that case-controls differences are due to selection of controls whose genetic backgrounds differ systematically from those of cases. HLA-DQB1 polymorphisms were determined in cases and parents from n = 83 families using polymerase chain reaction and oligonucleotide dot-blot analysis. Detection of GAD65 antibodies was performed using a simple radio-binding asssay. Conventional ICA were detected by indirect immunofluorescence.

RESULTS

Transmission disequilibrium test indicate a strong association between DQB1*0201 and DQB1*0302 and type I diabetes. When comparing the two subsets of families defined by having an affected child tested negative or positive for GAD65 antibodies (39 and 44 case-parent trios respectively) the probability of transmission of DQB1*0201 significantly differed between such strata (p-value=0.025). The pattern of transmission of DQB1*201 allele was also significantly different in the two subsets of families defined by ICA-or ICA+ cases (23 and 60 trios respectively) (p-value = 0.028). No differences were found in the transmission of DQB1*0302 allele in the different strata defined by the autoimmunity status of the proband.

CONCLUSION

Our results reveal that DQB1*0201 allele may display distinct associations with type I diabetes depending on the autoimmunity to ICA and GAD65 autoantibodies.

Low prevalence of type 2 diabetes despite a high average body mass index in the Aymara natives from Chile

The aim of this study was to estimate the prevalence of type 2 diabetes mellitus (DM2), impaired glucose tolerance (IGT), and the frequency of dyslipidemia, obesity, and hypertension in the rural Aymara population from Northern Chile. In this cross-sectional study, 196 Aymara adult subjects were characterized with respect to their reported physical activity, fasting plasma glucose levels, insulin concentrations, blood pressures, body mass indexes, and plasma lipid profiles. The participants also underwent a 2-h oral glucose tolerance test. The diagnostic criteria for DM2 and IGT followed those of the World Health Organization. The overall prevalence of DM2 was estimated as 1.5% (95% confidence interval: 0.3--4.5). Overall prevalence of IGT was calculated as 3.6% (1.5--7.3). The occurrence of obesity and dyslipidemia was relatively high in the Aymara population, although the frequency of sedentary habits, and the prevalence of hypertension were low. In conclusion, the prevalence of DM2 in the rural Aymara population living at high altitudes in Northern Chile, was much lower than that of other Amerindian groups that adopted lifestyles from industrialized Western societies. Despite a relatively high prevalence of a body mass index of at least 30 kg/m(2), especially in women (23.5%), high physical activity levels and low plasma-insulin concentrations may have been responsible in part for the low prevalence of DM2 in the Aymara population.

Nutrition transition in Latin America: the case of Chile

The nutritional situation of Latin America is changing rapidly from one characterized by underweight and stunting to one where chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes are increasingly prevalent. In Chile, under-nutrition has virtually disappeared, but rising obesity rates and risk factors for chronic diseases indicate the need to modify existing programs and emphasize prevention of diet-related chronic diseases.

[Auto-antibody profile and breast feeding in type 1 diabetic patients]

BACKGROUND

Islet cell-specific autoantibodies such as islet cell antibody (ICA), antiinsulin (IAA), anti-glutamic acid decarboxylase (GAD) and anti-tyrosine phosphatase (IA2) can be present in patients with type I diabetes. Breast feeding duration and the early exposure to milk substitutes are environmental factors associated to etiology of type 1 diabetes.

AIM

To study the frequency of the anti-GAD, anti-IA-2 e ICA antibodies in Chilean type 1 diabetic patients and determine the possible modulator effect of the breast feeding.

PATIENTS AND METHODS

One hundred thirty four type 1 diabetic patients, aged one to 15 years old, were studied at the moment of their diagnosis. Patients were classified according to the duration of exclusive breast feeding. IA-2 and GAD were determined by radio immuno assay and ICA by means of indirect immunofluorescence.

RESULTS

Subjects with three months or less and those with more than three months of breast feeding were positive for ICA in 78.8 and 90.6% of cases respectively, for GAD in 75 and 54.6% of cases respectively (p = 0.024) and for IA-2 in 73 and 43.8% of cases respectively (p = 0.001). All three antibodies were positive in 53.9 and 21.8% of children with less or more than three months of breast feeding (p = 0.001).

CONCLUSION

Both IA-2 and GAD antibodies are less frequently positive in type 1 diabetic patients who have been breast fed for more than three months. These findings suggest a possible attenuating role of exclusive breast feeding on pancreatic aggression events in patients with type 1 diabetes.

Association between HLA-DQB1 alleles and type 1 diabetes in a case-parents study conducted in Santiago, Chile

The human leukocyte antigen (HLA) system plays a crucial role in the autoimmune process leading to childhood diabetes. The purpose of this study was to evaluate the association between type 1 diabetes and the polymorphism encoded by the HLA-DQB1 gene by using case-parents trios. The study area was the metropolitan region of Santiago, Chile, and cases were ascertained from March 1997 to August 1998. Genotyping was performed in 94 trios comprising incident cases less than 17 years of age at the time of diagnosis and their parents. The transmission/disequilibrium test was used to detect differential transmission in the HLA-DQB1 locus. The authors found that alleles DQB1(*)0302 and DQB1(*)0201 were strongly associated with the disease. By using 1:3 matched sets of cases-pseudosibs and conditional logistic regression models, allelic relative risks were estimated for DQB1(*)0302 (r = 7.2, 95% confidence interval: 2.8, 18.5) and DQB1(*)0201 (r = 4.7, 95% confidence interval: 1.9, 11.6); DQB1(*)0301 was considered the baseline allele. When case-parents trios were used, alleles DQB1(*)0302 and DQB1(*)0201 were strongly associated with a higher risk of type 1 diabetes in the population of SANTIAGO:

Obesity trends in Latin America: transiting from under- to overweight

Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted overweight children. Providing food to low income stunted populations may be beneficial for some, although it may be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present imperative.

Prevalence of type 2 diabetes and obesity in rural Mapuche population from Chile

The aim of this study was to estimate the prevalence of Type 2 diabetes, impaired glucose tolerance (IGT), and obesity in the Mapuche natives from rural areas in Chile. This cross-sectional study involved men (n = 95) and women (n = 224) older than 20 y from an aboriginal ethnic group (Mapuches), residing in rural communities from the south of Chile. Prevalence of Type 2 diabetes and IGT was calculated according to the World Health Organization criteria. Data on age, degree of ancestral purity, obesity, and hypertension were also obtained. The prevalence of Type 2 diabetes in rural Mapuche natives was estimated as 3.2% (95% CI: 0.7--9.0) in men and 4.5% (95% CI: 2.2--8.1) in women. The overall prevalence of obesity was 56.1% (95% CI: 50.5--61.6): 40.0% (95% CI: 30.1--40.8) in men and 62.9% (95% CI: 56.3--69.3) in women (P value < 0.001). These data suggest that the prevalence of obesity and Type 2 diabetes has been increasing during recent years in the Mapuche communities. The prevalence estimated in this study is higher than that reported 15 y ago. This suggests an important role of lifestyle changes as a possible explanation for epidemiologic transition.

Incidence rate and spatio-temporal clustering of type 1 diabetes in Santiago, Chile, from 1997 to 1998

OBJECTIVE

To estimate the incidence rate of type 1 diabetes in the urban area of Santiago, Chile, from March 21, 1997 to March 20, 1998, and to assess the spatio-temporal clustering of cases during that period.

METHODS

All sixty-one incident cases were located temporally (day of diagnosis) and spatially (place of residence) in the area of study. Knox's method was used to assess spatio-temporal clustering of incident cases.

RESULTS

The overall incidence rate of type 1 diabetes was 4.11 cases per 100,000 children aged less than 15 years per year (95% confidence interval: 3.06 - 5.14). The incidence rate seems to have increased since the last estimate of the incidence calculated for the years 1986 - 1992 in the metropolitan region of Santiago. Different combinations of space-time intervals have been evaluated to assess spatio-temporal clustering. The smallest p-value was found for the combination of critical distances of 750 meters and 60 days (uncorrected p-value = 0.048).

CONCLUSIONS

Although these are preliminary results regarding space-time clustering in Santiago, exploratory analysis of the data method would suggest a possible aggregation of incident cases in space-time coordinates.

Apolipoprotein E polymorphism in elderly Chilean people with Alzheimer's disease

As a part of the WHO Age-Associated Dementia Project, Chile has been participating in a cross-national survey on dementia frequency and determinants since 1989. In the present study, apolipoprotein E (ApoE) polymorphism genotypes have been compared in 95 patients with Alzheimer's disease (AD) (mean age 80.7; 95% CI 79.2-82.2, range 66-97) and 187 healthy people (mean age 78.2; 95% CI 77.2-79.2, range 65-93). Isoelectric focusing and immunoblotting with anti-human ApoE polyclonal antibody were used to determine the distribution of ApoE genotypes. Dementia was diagnosed according to DSM-III-R and ICD-10 clinical criteria. The diagnosis of probable or possible AD was made according to the NINCDS-ADRDA criteria. The ApoE allele frequencies in healthy people were calculated to be epsilon2 = 0.07, epsilon3 = 0.74 and epsilon4 = 0.19. In the probable AD disease group, the frequencies were epsilon2 = 0.08, epsilon3 = 0.52 and epsilon4 = 0.40. The odds ratio (OR) for epsilon4 carriers compared with non-epsilon4 carriers was estimated to be 2.9 (95% CI 1.7-5.1). Taking the genotype epsilon3/epsilon3 as the reference group, the OR for the epsilon4/epsilon4 genotype was estimated to be 12.8 (95% CI 3.9-47.6) and for epsilon3/epsilon4 subjects it was 2.4 (1.3-4.5). These results support the association between ApoE epsilon4 allele with late-onset AD in a Chilean population.

Dietary isoflavones affect sex hormone-binding globulin levels in postmenopausal women

The studies presented in this report were designed to further investigate the causal association between phytoestrogen action and increase in sex hormone-binding globulin (SHBG) levels. Phytoestrogens include isoflavones that bind to estrogen receptors and therefore exert estrogenic action. This study included 20 postmenopausal women that ingested 30 g soy milk daily for 10 weeks. Plasma concentrations of isoflavones and SHBG were measured. Total isoflavones significantly increased from 0.014 +/- 0.01 micromol/L (baseline) to 0.53 +/- 0.19 ,micromol/L, and paired responses showed that some subjects clearly increased their SHBG levels. The percent change in SHBG showed a positive correlation with phytoestrogen concentration; all women who had circulating phytoestrogen levels above 0.6 micromol/L increased by at least 30% their SHBG values. Results suggest that phytoestrogens may significantly increase SHBG in subjects whose SHBG concentrations are in the low end of the concentration range.

Associations between HLA-DQB1 high-risk alleles and type I diabetes do not depend on cytomegalovirus antibody status at onset: a case-parent study conducted in Chile

The purpose of the present study is to ascertain whether the associations between HLA-DQB1*0201 and DQB1*0302 alleles and childhood diabetes depend on the presence of antibodies to human cytomegalovirus (CMV). A study of incident type I diabetes cases and parents was conducted in Santiago, Chile. HLA-DQB1 polymorphisms were determined in 85 case-parent trios (255 subjects), while the detection of CMV was carried out only in the incident cases. As expected, HLA-DQB1 polymorphisms are strongly associated with type I diabetes, with crude odds ratios of 3.7 (95% confidence interval (CI) 1.8-7.7) for the DQB1*0201 allele and 10.3 (95% CI 5.0-21.4) for the DQB1*0302 allele. In the subset of families with CMV+ cases, the odds ratios were estimated as 3.7 (95% CI 1.6-8.6) for the DQB1*0201 allele and 11.1 (95% CI 4.8-25.8) for the DQB1*0302 allele. In families with patients who tested negative for CMV antibodies, the odds ratios were calculated as 3.5 (95% CI 0.7-16.8) for the DQB1*0201 allele, and 8.0 (95% CI 1.8-34.7) for the DQB1*0302 allele. There was no evidence of statistical interaction between CMV antibodies and the DQB1*0201 allele (P value = 0.9) or the DQB1*0302 allele (P value = 0.7). In conclusion, alleles DQB1*0302 and DQB1*0201 do not display distinct associations with type I diabetes depending on the presence of antibodies for CMV.

Plasma leptin and insulin levels in Aymara natives from Chile

The purpose of this study was to examine the relationship of plasma leptin levels with respect to obesity, gender, age and insulin levels in the native Aymara population. The Aymara natives live at high altitudes in isolated regions in the north of Chile, and they maintain distinctive genetic and cultural characteristics. Plasma leptin and insulin levels were correlated with body mass index (BMI), sex and age in a sample of 147 adult Aymara subjects who participated in a cross-sectional study. Multivariate analysis showed significant differences in leptin levels (dependent variable: natural log of leptin) by gender (p < 0.0001), and by BMI (p < 0.001), without significant statistical interaction between gender and BMI. The effect of age achieved statistical significance in the multivariate analysis (p = 0.02). Gender, BMI and insulin are independently associated with plasma leptin levels. On the other hand, the multivariate analysis of the plasma insulin concentration (dependent variable: natural log of insulin levels) shows that insulin is strongly associated with BMI (p < 0.0001), although non-statistically significant differences of insulin levels by sex (p = 0.07) or age (p = 0.9) were detected at alpha 0.05 level. Thus, in the special ecosystem where the Aymara population live, a strong and independent association between sex, obesity and insulin levels with plasma leptin levels has been detected.

Nutrition policy in the Chilean transition

OBJECTIVE

This paper examines socioeconomic, demographic, epidemiological and nutrition changes that have occurred in Chile in the last decades using concepts of epidemiological and nutrition transition, and discusses policies related to nutrition.

DESIGN AND SETTING

This is a descriptive, population-based study to analyse changes in the Chilean diet and nutrition situation including some of the main demographic, socioeconomic and epidemiological variables. Data came from the FAO, the National Institute of Statistics, the Ministry of Health and national surveys. RESULTS AND POLICY IMPLICATIONS: In Chile, the epidemiological and nutrition situation shifted from a pretransition stage with high rates of undernutrition to a post-transition stage with increasing rates of obesity in all groups aged less than 20 years. However, changes were not accompanied by modifications in nutrition policy, which had been successful in reducing undernutrition. Despite changes in diet to a 'western' diet and in nutritional status of the population from undernutrition to obesity, food and nutrition programmes have been maintained unaltered. Governmental and university organizations were created in 1994 and 1995 to address the current food and nutrition problems. The accomplishments of these institutions have been the elaboration of dietary guidelines, reformulating the food and nutrition programmes and the promulgation of the Food Sanitary Regulations for Chile.

CONCLUSIONS

Education for the prevention of nutrition excess problems should be a main food and nutrition policy in developing countries.

[Relationship between leptin and insulin blood levels in obese and lean Chilean women]

BACKGROUND

Leptin, a product of ob gene and insulin blood levels, are proportional to the amount of adipose tissue. Insulin could have an independent regulatory effect on leptin secretion.

AIM

To assess the relationship between serum leptin and plasma insulin levels in obese and lean Chilean women.

MATERIAL AND METHODS

One hundred forty five women, aged 20 to 60 years old, were studied. Weight, height, waist and hip circumference, fasting blood glucose, insulin and leptin levels were measured. Insulin resistance was assessed using the homeostasis model assessment. The relationship between different variables was determined using multiple linear regression, variance analysis and non parametric correlation.

RESULTS

Leptin serum concentrations were positively correlated with body mass index, insulin plasma levels and degree of insulin resistance. The association of leptin with insulin was independent of body mass index and persisted after adjustments by body fat distribution and age.

CONCLUSIONS

Insulin and insulin resistance are associated to high blood leptin levels and this association is independent of the degree of adiposity and body fat distribution.

[Obesity and leptin association in three Chilean aboriginal populations]

BACKGROUND

Although there is a clear relationship between body mass index and leptin levels, few authors have addressed the possible influence of ethnic factors on these levels.

AIM

To measure serum leptin in three different Chilean aboriginal populations.

SUBJECTS AND METHODS

Fasting serum leptin and insulin levels were measured by radioimmunoassay in 345 rural mapuche individuals, 247 rural aymara subjects and 162 urban mapuche subjects. A body mass index of 27.5 kg/m2 was used as cutoff point to classify study subjects.

RESULTS

Among the three ethnic groups, women had serum leptin levels three times higher than men. In all three ethnic groups, there was a significant association between leptin levels, body mass index and gender (r2 = 0.32 and 0.5 p < 0.001, in rural mapuche, r2 = 0.32 and 0.5 p < 0.001, in aymara and r2 = 0.24 and 0.49, p < 0.001 in urban mapuche populations). No differences in leptin levels were observed for the interaction between age and insulin. The increments per quartile in leptin levels were lower among mapuche than aymara individuals.

CONCLUSIONS

Rural mapuche individuals have a high frequency of obesity. However their leptin levels are lower than those of aymara or urban mapuche populations. The higher leptin levels observed in urban mapuche subjects could be due to environmental influences.

[Prevalence of obesity, hypertension and dyslipidemia in rural aboriginal groups in Chile]

BACKGROUND

Chilean aboriginal ethnic groups (mapuche and aymaras) have a very low prevalence rate of type 2 diabetes. The investigation of a possible relationship between this low prevalence of diabetes and obesity, hypertension and serum lipid profiles in both groups is worthwhile.

AIM

To study the prevalence of obesity, hypertension and lipid profile in two Chilean aboriginal communities.

SUBJECTS AND METHODS

The prevalence of obesity, hypertension, fasting serum total cholesterol, HDL cholesterol, triglycerides, glucose, insulin, leptin and oral glucose tolerance test were measured in 345 mapuche (106 male) and 247 aymara (100 male) individuals.

RESULTS

Sixty three percent of mapuche women, 37.9% of mapuche men, 39.7% of the aymara women and 27.0% of aymara men had a body mass index over 27 kg/m2. Twenty percent of mapuche men, 18.0% of mapuche women, 9.0% of aymara men and 4.8% of the aymara women had high blood pressure values. Serum HDL cholesterol was below 35 mg/dl in 16% of mapuche women, 14% of mapuche men, 25% of the aymara women and 27% of aymara men. No differences in total cholesterol levels were observed between mapuches and aymaras.

CONCLUSION

Mapuche women have higher prevalence of obesity and high blood pressure than aymara women. Low serum HDL cholesterol has a higher prevalence among aymara individuals.

[Television publicity and food preferences of school age children of the metropolitan region]

BACKGROUND

There is an alarming increase in the prevalence of child obesity in Chile. Lack of exercise and bad feeding habits strongly strongly contribute to the problem.

AIM

To investigate the influence of television publicity on school age children food preferences.

MATERIAL AND METHODS

A semi structured interview was applied to a representative sample of 786 school age children aged 6 to 11 years old, living in Metropolitan Santiago. Time watching television during week days and the attitude towards food and beverage commercials was analyzed and related to food preferences.

RESULTS

Ninety nine percent of school age children watch television during week days and 20% watches more the three hours daily. Snack commercials such as those about potato chips, chocolates, cookies and ice cream, are preferred by 35% of children. Soda commercials are preferred by 33% and yoghurt commercials by 12%. Eighty five percent of children had money to buy food. Of these, 66% bought snacks, 15% bought sodas and 7% yoghurt. The same tendency was observed in school collations.

CONCLUSIONS

The high percentage of children, watching television and the influence of commercials in their food preferences, requires an urgent educational strategy to promote healthy feeding habits.

Applicability of the case-parent design in the etiological research of Type 1 diabetes in Chile and other genetically mixed populations

In case-control studies, spurious associations between Human Leukocyte Antigen (HLA) alleles and Type 1 diabetes could arise as a result of population stratification, if there are ethnic differences between cases and non-related controls. The Chilean population has several unique features which make it ideal for the study of the effect of stratification by ethnicity on genetic epidemiological research. The incidence rates of Type 1 diabetes in Chilean Aboriginal populations are very low compared to Caucasian populations, while the frequency of the alleles in HLA loci also vary across ethnic groups. In order to avoid the confounding effect of ethnicity, one possible remedy would be the use of cases and their parents in place of non-related controls. The case-parent design offers an adequate framework for the study of the association between HLA polymorphisms and Type 1 diabetes in the Chilean population and can also be applicable to other genetically mixed populations especially in the Americas.

Leptin levels distribution and ethnic background in two populations from Chile: Caucasian and Mapuche groups

OBJECTIVE

Leptin, the product of the human ob gene is increased in obese individuals, suggesting resistance to its effect. We examined the relationship of serum leptin levels with respect to obesity, gender and insulin levels in two populations with different ethnic compositions in Chile.

METHODS

Leptin and insulin levels were determined by radioimmunoassay (RIA) and correlated with body mass index (BMI), gender and ethnic background. 79 Caucasian subjects from Santiago and 65 Mapuche natives from the Araucania region, Chile, were included in this study.

RESULTS

Leptin concentrations in obese subjects were significantly increased in both ethnic groups in relation to lean status: Caucasian and Mapuche obese 19.3 +/- 11.6 and 10.1 +/- 5.8 (P < 0.001), respectively vs Caucasian and Mapuche lean 10.4 +/- 5.8 and 4.7 +/- 2.9 (P < 0.001, respectively). When we compared Mapuche and Caucasian groups, similar leptin levels were observed among the males of the two populations in both metabolic states (lean and obese). In contrast, the leptin level distributions between women showed a marked difference, having a minor value in the Mapuche women with a comparable value with the male group in this ethnic population.

CONCLUSIONS

The leptin concentrations are associated with obesity in both ethnic groups in Chile. However, the leptin levels between the Mapuche natives were significantly decreased compared to the Caucasian group. The gender distribution does not seem to be important in the Mapuche natives. The ethnic composition seems to be important in the leptin distribution in the analysed populations.

[Obesity, an unresolved challenge in Chile]

Socioeconomic and demographic changes in Chile, have modified its epidemiological profile. At the present time, the most important public health problems are non communicable chronic diseases, specially cardiovascular ailments. The prevalence of cardiovascular risk factors has also increased and obesity stands out. This review analyzes the present situation of obesity and other cardiovascular risk factors of nutritional origin, in Chile, and proposes intervention alternatives. At the present time 7% preschool children, 12% of school children, 24% of pregnant women, 10% of male adults and 24% of female adults are obese. This higher prevalence is even more pronounced in women of low socioeconomic level. Risk factors associated to obesity are an inadequate diet, with a higher consumption of fats and refined foods, sedentariness and hyperlipidemia. Primary and secondary care strategies must be devised to face this growing problem.

[Lipid composition of eggs from hens fed with marine protein and fat products]

This study describes the composition of shell eggs produced by hens fed marine sources of feeds and eggs from hens fed only vegetable ingredients, as a control group. The nutritional characteristics of eggs, yolk fatty acids profile and their cholesterol, triglyceride and phospholipid contents, were determined. Hens fed marine feeds produced eggs with significantly less cholesterol and more triglycerides and phospholipids, than those produced by hens fed only vegetable feeds. Even though there were no significant differences between saturated, mono and polyunsaturated fatty acids, marine products significantly increased n-3 fatty acids (7.13 +/- 0.83 in marine fed hen's eggs vs. 1.77 +/- 0.55 g/100 g in vegetable fed hen's eggs) and n-6 fatty acids (15.71 +/- 2 in marine fed hen's eggs vs. 20.88 +/- 2.32 g/100 in all vegetable fed hen's eggs). The eggs produced from hens fed marine products compares favorably with eggs known as "enriched" can have an important place in the diet especially for high risk population groups.

[Obesity in Chilean preschool children: anthropometric evolution and socioeconomic determinants]

BACKGROUND

The prevalence of obesity among low-income preschool children has increased in Chile.

AIM

To compare the anthropometric evolution of obese and non obese children from birth and to determine the influence of maternal body composition and socioeconomic variables with childhood obesity.

SUBJECTS AND METHODS

Using a case control design, 237 obese, 449 normal and 54 overweight 4 year old low income children, attending 8 public outpatient clinics in Santiago, were studied. Anthropometric data since birth to the moment of the study was gathered from the clinical charts at the clinics.

RESULTS

Z scores for height/age and weight/height were significantly higher at all ages, excepting height/age in boys at the moment of birth. At the moment of the study, obese and overweight children were four and one cm taller than the normal weight controls. Maternal body mass index (odds ratio 3.07), being a first child, having a working mother, to have a telephone at home and birth weight were the variables significantly associated with obesity, according to an adjusted effects analysis.

CONCLUSIONS

The strong association of maternal and offspring obesity implies that the prevention of childhood obesity must consider health actions directed towards mothers as well.

Different statistical models used in the calculation of the prevalence of insulin-dependent diabetes mellitus according to the polymorphism of the HLA-DQ region

The use of three statistical models yielded different estimates of the odds ratio relative to the association between the polymorphism in the HLA-DQ region and insulin-dependent diabetes mellitus (IDDM). The models used were: (1) the allele-dosage model which assumes that the number of susceptibility alleles has a linear effect on the logarithm of the odds; (2) the reference cell coding method used with alleles of susceptibility as a risk factor; or (3) a model that uses a classification of alpha/beta heterodimers as a susceptibility factor. We suggest that models which imply a log-linear relationship between a susceptibility marker and disease such as the first model are not appropriate in the assessment of the HLA-IDDM association. In contrast, although both latter models are valid, the third model is more compatible with current hypotheses of the pathological process of the disease. Once an estimation of the odds ratio is chosen, we use such an estimation to calculate an approximation of the prevalence of IDDM according to the polymorphism in HLA-DQ region using the iterative procedure of Newton-Raphson. These approaches are illustrated with data from a case-control study previously conducted in the city of Santiago, Chile.

[Copper intake and blood levels as risk factors for atheromatous disease]

BACKGROUND

Copper is part of antioxidant enzymes and could have a cardiovascular protective effect. A higher cardiovascular risk has been associated with high as well as low plasma copper levels.

AIM

To search for differences in copper intake and plasma levels between patients with coronary artery or cerebrovascular diseases and normal subjects.

PATIENTS AND METHODS

Zinc and copper intake, plasma levels and serum lipid levels were measured in 20 patients with cerebrovascular disease, 20 patients with an acute myocardial infarction and 40 subjects hospitalized for elective surgery, that served as controls.

RESULTS

Copper and zinc intake was below recommended allowances in all subjects. Serum zinc and copper levels did not differ in the three study groups. In patients with myocardial infarction a weak correlation was found between serum copper and total cholesterol (r = 0.24; p < 0.05) and LDL cholesterol (r = 0.31; p < 0.05).

CONCLUSIONS

No differences in copper levels were found in subjects with atherosclerosis and controls. The correlation between serum copper and cholesterol deserves further investigation.

[Epidemiological transition in Latin America: a comparison of four countries]

BACKGROUND

In the last decade, Latin America has experienced important transformations in its health conditions, due to demographic changes and a rapid urbanization process.

AIM

To analyze socioeconomic, demographic and epidemiological changes in Chile, Guatemala, Mexico and Uruguay and relate them to the different stages in the demographic and epidemiological transition of these countries.

MATERIAL AND METHODS

Data was obtained from official information of local and international organizations such as Pan-American Health Organization, United Nations, Latin American Center for Demography (CELADE) and World Bank.

RESULTS

Guatemala is in a pre-transition stage with a high proportion of communicable diseases as causes of death (61%) as compared with Mexico (22%), Chile (13%) and Uruguay (7%). Mexico is in a prolonged transition situation and Chile is close to Uruguay in a post-transitional stage. Despite decreasing rates of mortality, the proportion of deaths represented by chronic diseases and injuries has increased to over 30% in all countries, except Uruguay. Adjusted mortality rates for cardiovascular diseases are lower in Latin American countries, as compared to Canada. However, excepting Guatemala, there are differences in the pattern of cardiovascular disease, with a higher mortality due to cerebrovascular and a lower mortality due to coronary artery diseases.

CONCLUSIONS

An increment in non communicable diseases is expected for the next decades in Latin America. Analysis of demographic and epidemiological transition is crucial to define health policies and to adequate health systems to the new situations.

Obesity as a protective factor for postmenopausal osteoporosis

BACKGROUND

Obesity is considered a protective factor for osteoporosis improving bone mass and maintaining higher levels of estrogen during menopause.

OBJECTIVE

To determine the association of obesity with bone mineral density (BMD), and its relationship with sex hormone levels.

DESIGN

A case-control study in Caucasian obese and non obese postmenopausal women.

SUBJECTS

113 obese and 50 non-obese postmenopausal women.

MEASUREMENTS

BMD (dual-photon X-ray absorptiometry) at cervical femur. Ward's triangle, proximal radius and lumbar spine. Plasma levels of glucose, insulin, total estrogen, follicle stimulating hormone (FSH), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHA-S) and testosterone.

RESULTS

Mean BMD at femoral sites were significantly higher in obese women (femoral neck: 0.849 +/- 0.124 g/cm2 vs 0.753 +/- 0.095 g/cm2, P < 0.001; Ward's triangle: 0.634 +/- 0.134 g/cm2 vs. 0.553 +/- 0.100 g/cm2, P < 0.001). Mean BMD at lumbar spine was 0.906 +/- 0.138 g/cm2 in obese women and 0.849 +/- 0.137 g/cm2 in non obese, P < 0.017. A decreased risk of osteopenia in femoral neck (Age adjusted OR = 0.36, 95%CI 0.17-0.75) and in lumbar spine (Age adjusted OR = 0.43, 95%CI 0.20-0.91) in obese women was observed. Although total estrogen were similar in both groups, in obese women, SHBG was lower (68.6 +/- 26.84 nmol/l vs. 85.1 +/- 31.18 nmol/l, P < 0.001), and postglucose load insulin levels were higher, than in non obese (77.2 +/- 50.4 Ul/ml vs. 49.4 +/- 24.1 Ul/ml, P < 0.0005).

CONCLUSION

The findings confirm a higher BMD in obese women and suggest that obesity exerts protection due to a decreased SHBG thus increasing free sex steroids. Besides, hyperinsulinemia may produce a decline in the production of IGFBG-1, leading to an increase of IGF-1, that may stimulate the proliferation of osteoblasts.

[Methods to estimate body composition in the elderly: a critical analysis]

The objective of this study was to compare the values obtained for total body fat obtained with deuterium dilution, anthropometry and bioimpedance in 41 institutionalized elderly individuals (65-90 years old). The values obtained with each technique were compared using the graphic analysis proposed by Bland and Altman, that plots the difference between measurements with both methods against their average. In men (n = 20) and women (n = 21), the best degree of agreement was obtained between the values measured by deuterium dilution and those calculated from skinfolds (mean difference = 1.4% and 6.9%, respectively). The limits of agreement (+/-2SD), for skinfolds reached a maximum of 14.8% in men, and 16.8% in women. These values tend to underestimate fat in the obese and overestimate it in thinner subjects. For bioimpedance and deuterium dilution, the inter-method difference is significantly greater: 9.3% in men and 14.7% in women. This lack of agreement is attributed to the fact that the bioimpedance equipment utilizes equations validated for younger adults. In conclusion, estimation of body composition using skinfoids has the smallest difference compared to deuterium dilution, even though individual measurements are not clinically acceptable. Caution is recommended when using measurements of body composition in the elderly, due to large errors in the determinations.