[Breastfeeding, obesity and metabolic syndrome at school age]

INTRODUCTION

Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications.

OBJECTIVE

To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR).

PATIENTS AND METHODS

Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS).

RESULTS

3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months.

CONCLUSIONS

The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

Inverse Associations between a Locally Validated Mediterranean Diet Index, Overweight/Obesity, and Metabolic Syndrome in Chilean Adults

Obesity and metabolic syndrome (MetS) are key risk factors for chronic disease. Dietary patterns are critical in the incidence and persistence of obesity and MetS, yet there is few data linking diet to obesity and MetS in Chile. Our objective was to use a locally validated diet index to evaluate adherence to a Mediterranean dietary pattern and its correlations with overweight/obesity (OW/O) and MetS prevalence in Chilean adults. We conducted a nationwide, cross-sectional online survey of Chilean adults with complete self-reported diet and body mass index data (n = 24,882). A subsample of 4348 users (17.5%) had valid MetS data. An inverse association was observed between adherence to Mediterranean diet and OW/O and MetS prevalence. As diet quality decreased from healthy, to moderately-healthy, to unhealthy, prevalence increased from 44.8, 51.1, to 60.9% for OW/O and from 13.4, 18.5, to 28.9% for MetS (p-values < 0.001). Adjusted odds ratios for OW/O and MetS were significantly higher in moderately-healthy (OR = 1.58 and 1.54) and unhealthy (OR = 2.20 and 2.49, respectively) diet groups in comparison to the healthy diet group. This study represents the first report on the relationship between Mediterranean diet and chronic disease risk in Chile. It suggests that the Mediterranean diet may be applied to manage chronic disease risk beyond the Mediterranean basin.

[Adapting and validating the generic instrument CollaboRATE™ to measure women's participation in health related decision-making during the reproductive process]

INTRODUCTION

There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries.

OBJECTIVE

To adapt and validate for the Chilean context the instrument CollaboRATE™, to measure women's participation in medical decisions during the reproductive process.

DESIGN

Cross-sectional study to adapt and validate the instrument CollaboRATE™.

LOCATION

Maternity units in Santiago, Chile.

PARTICIPANTS

Puerperal women in maternity units of three public hospitals.

METHOD

Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women.

RESULTS

The Chilean version of CollaboRATE™ demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89.

CONCLUSIONS

This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare.

A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile

AIM

To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care.

DESIGN

A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20).

SETTING

A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated.

PARTICIPANTS

A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized.

INTERVENTION AND COMPARISON

ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406).

MEASUREMENTS

Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up.

FINDINGS

Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47).

CONCLUSION

It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

Th1 and Th17 Cells and Associated Cytokines Discriminate among Clinically Isolated Syndrome and Multiple Sclerosis Phenotypes

Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. It is a heterogeneous pathology that can follow different clinical courses, and the mechanisms that underlie the progression of the immune response across MS subtypes remain incompletely understood. Here, we aimed to determine differences in the immunological status among different MS clinical subtypes. Blood samples from untreated patients diagnosed with clinically isolated syndrome (CIS) (n = 21), different clinical forms of MS (n = 62) [relapsing–remitting (RRMS), secondary progressive, and primary progressive], and healthy controls (HCs) (n = 17) were tested for plasma levels of interferon (IFN)-γ, IL-10, TGF-β, IL-17A, and IL-17F by immunoanalysis. Th1 and Th17 lymphocyte frequencies were determined by flow cytometry. Our results showed that IFN-γ levels and the IFN-γ/IL-10 ratio were higher in CIS patients than in RRMS patients and HC. Th1 cell frequencies were higher in CIS and RRMS than in progressive MS, and RRMS had a higher Th17 frequency than CIS. The Th1/Th17 cell ratio was skewed toward Th1 in CIS compared to MS phenotypes and HC. Receiver operating characteristic statistical analysis determined that IFN-γ, the IFN-γ/IL-10 ratio, Th1 cell frequency, and the Th1/Th17 cell ratio discriminated among CIS and MS subtypes. A subanalysis among patients expressing high IL-17F levels showed that IL-17F and the IFN-γ/IL-17F ratio discriminated between disease subtypes. Overall, our data showed that CIS and MS phenotypes displayed distinct Th1- and Th17-related cytokines and cell profiles and that these immune parameters discriminated between clinical forms. Upon validation, these parameters might be useful as biomarkers to predict disease progression.

Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts

OBJECTIVES

Vitamin D (VD) enhances the immune response against Mycobacterium tuberculosis in vitro, and VD deficiency has been described in patients with active tuberculosis (TB). However, the role of hypovitaminosis D in the pathogenesis of early TB infection acquisition is unclear. We aimed to evaluate the association of VD deficiency, season of the year, and latent TB infection in household contacts (HHC), given that this is a potentially modifiable condition often related to nutritional deficiencies and lack of sun exposure.

METHODS

We prospectively enrolled new pulmonary TB cases (n = 107) and their HHC (n = 144) over a 2-year period in Santiago, Chile. We compared plasma 25-hydroxycholecalciferol (25OHD) levels and examined the influence of season, ethnic background, living conditions, and country of origin.

RESULTS

Over 77% of TB cases and 62.6% of HHC had VD deficiency (<20 ng/ml). Median 25OHD concentration was significantly lower in TB cases than in HHC (11.7 vs. 18.2 ng/ml, p<0.0001). Migrants HHC had lower 25OHD levels than non-migrants (14.6 vs. 19.0 ng/ml, p = 0.026), and a trend towards a higher burden of latent TB infection (52.9% vs. 35.2%, p = 0.066). Multivariate analysis found VD deficiency in HHC was strongly associated with being sampled in winter/spring (adOR 25.68, 95%CI 7.35-89.7), corresponding to the seasons with lowest solar radiation exposure. Spring enrollment-compared with other seasons-was the chief risk factor for latent TB infection in HHC (adOR 3.14, 95%CI 1.28-7.69).

CONCLUSIONS

Hypovitaminosis D was highly prevalent in TB cases and also in HHC. A marked seasonality was found for both VD levels and latent TB in HHC, with winter being the season with lowest VD levels and spring the season with the highest risk of latent TB infection.

Effect of cholecystectomy on bile acid synthesis and circulating levels of fibroblast growth factor 19

Background and rationale for the study. FGF19/15 is a gut-derived hormone presumably governing bile acid (BA) synthesis and gallbladder (GB) refilling. FGF19 mRNA is present in human GB cholangiocytes (hGBECs); however, the physiological significance of GB-derived FGF19 remains unknown. We investigated whether hGBECs secrete FGF19 and the effects of cholecystectomy on serum FGF19 ([FGF19]s) and BA synthesis.

MATERIAL AND METHODS

FGF19 expression was assessed by qRT-PCRs and immunostaining in hGBECs and terminal ileum, and quantified in bile and serum by ELISA. Basal and BA (chenodexycholic acid, CDCA) induced FGF19 expression and secretion was analyzed in primary cultured hGBECs and GB-d1 cell line. Pre and postprandial serum changes in [FGF19]s, 7α-hydroxy-4-cholestene-3-one (C4, a marker of BA synthesis) and BA were evaluated in plasma of gallstone disease patients at baseline and after cholecystectomy.

RESULTS

FGF19 mRNA levels were ~250-fold higher in hGBECs compared to distal ileum. GB bile contained ~23-fold higher FGF19 levels compared to serum (p < 0.0001). CDCA induced dose-dependent expression and secretion of FGF19 in hGBECs and GB-d1 cells. Cholecystectomy increased plasma BA synthesis ≥ 2-fold (p < 0.0001), and altered the diurnal rhythm and significantly reduced [FGF19]s noon peak. BA serum levels, serum cholesterol and triglyceride content remained unchanged.

CONCLUSIONS

In conclusion human GB cholangiocytes constitutively express and secrete high levels of FGF19 in a process regulated by BA. Resection of this organ doubles BA synthesis concomitantly with changes in [FGF19]s. These findings suggest a potential connection between GB cholangiocytes-derived FGF19 and BA metabolism that could lead to metabolic dysregulation following cholecystectomy.

[Spirometric values in healthy Chilean children and adolescents]

BACKGROUND

Spirometric flow and volume measurement are essential to evaluate patients with pulmonary disease. In Chile, several reference equations are used.

AIM

To measure flow and expiratory volumes in healthy children and adolescents and compare their results with theoretical values according to Knudson, Quanjer, Gutierrez and NANHES III.

SUBJECTS AND METHODS

Spirometries were performed according to international standards in 1589 healthy children and adolescents aged 6 to 18 years (861 females) who lived in Santiago, Chile.

RESULTS

The obtained values for forced vital capacity, expiratory volume in one second, peak expiratory flow, were significantly higher than those calculated according to the above mentioned standards (p < 0.0001) with differences up to 18.7%. We constructed reference formulas for ages ranging from 6 to 18 years, separated by gender, using age, weight and height as independent variables. The latter had the greater influence on formula construction.

CONCLUSIONS

The use of these new local formulas with allow the correct interpretation of spirometric results obtained in Chilean children and adolescents.

Intratask Variability As a Correlate for DRD4 and SLC6A3 Variants: A Pilot Study in ADHD

Behavioral variability may be an ADHD key feature. Currently used ex-Gaussian/Fast Fourier Transform analyses characterize general distribution and oscillatory/rhythmic components of performance but are unable to demonstrate slow cumulative changes over entire tasks.

OBJECTIVE

To explore how performance of ADHD children and unaffected sibs gradually evolves in relation to genetic variants linked to ADHD.

METHOD

A total of 40 kids (20 ADHD-discordant sib pairs) between 8 and 13 years resolved a visual Go/NoGo with 10% NoGo probability. Variable number tandem repeats (VNTRs) at DRD4 and SLC6A3 were identified following standard protocols. Performance changes were assessed by linear/logistic mixed-effect models.

RESULTS

Models exploring SLC6A3 effects demonstrated less accentuated increments of response time (RT) (p = .046) and cumulative increments in the correct responses to "NoGo" (p = .00027) in 10R/10R participants. Models for DRD4 showed faster decline of correct responses to "Go" (p = .0078) in 2R/7R carriers.

CONCLUSION

Dynamical analysis of attention/inhibition measures may unravel new correlates to DRD4 and SLC6A3 variants.

[UNHEALTHY FOOD INTAKE IS LINKED TO HIGHER PREVALENCE OF METABOLIC SYNDROME IN CHILEAN ADULT POPULATION: CROSS SECTIONAL STUDY IN 2009-2010 NATIONAL HEALTH SURVEY]

INTRODUCTION

metabolic syndrome (MS) is a clustering of risk factors known to promote cardiovascular disease and diabetes. Environmental factors, such as unhealthy diet, play a major role in the development of this condition. In this study, we evaluated the prevalence of MS and its association with food intake quality among Chilean adults.

METHODS

we analyzed data of 2 561 adults (≥ 18 years-old) included in the last National Health Survey (NHS 2009-2010) who had appropriate information to diagnose MS based on ATP III-NCEP guidelines. Consumption frequency of fish, whole grains, dairy, fruits and vegetables was also analyzed and associated with MS prevalence. Using a healthy diet score (HDS), we described the overall diet quality and further correlated it with MS prevalence.

RESULTS

we found that lower whole grain intake was associated with greater MS prevalence (OR = 1.78; 95% CI: 1.088-2.919; p = 0.022). HDS showed better diet quality among women and in subjects with increasing age and higher educational level. A HDS < 3 points was associated with an increased risk of MS (OR HDS < 3 / HDS ≥ 3 = 3.69; 95% CI 1.884-7.225, p < 0.001).

CONCLUSION

Chilean adult population exhibits a high prevalence of MS linked to a poor diet quality.

Effect of cholecystectomy on bile acid synthesis and circulating levels of fibroblast growth factor 19

Background and rationale for the study. FGF19/15 is a gut-derived hormone presumably governing bile acid (BA) synthesis and gallbladder (GB) refilling. FGF19 mRNA is present in human GB cholangiocytes (hGBECs); however, the physiological significance of GB-derived FGF19 remains unknown. We investigated whether hGBECs secrete FGF19 and the effects of cholecystectomy on serum FGF19 ([FGF19]s) and BA synthesis.

MATERIAL AND METHODS

FGF19 expression was assessed by qRT-PCRs and immunostaining in hGBECs and terminal ileum, and quantified in bile and serum by ELISA. Basal and BA (chenodexycholic acid, CDCA) induced FGF19 expression and secretion was analyzed in primary cultured hGBECs and GB-d1 cell line. Pre and postprandial serum changes in [FGF19]s, 7α-hydroxy-4-cholestene-3-one (C4, a marker of BA synthesis) and BA were evaluated in plasma of gallstone disease patients at baseline and after cholecystectomy.

RESULTS

FGF19 mRNA levels were ~250-fold higher in hGBECs compared to distal ileum. GB bile contained ~23-fold higher FGF19 levels compared to serum (p < 0.0001). CDCA induced dose-dependent expression and secretion of FGF19 in hGBECs and GB-d1 cells. Cholecystectomy increased plasma BA synthesis ≥ 2-fold (p < 0.0001), and altered the diurnal rhythm and significantly reduced [FGF19]s noon peak. BA serum levels, serum cholesterol and triglyceride content remained unchanged.

CONCLUSIONS

In conclusion human GB cholangiocytes constitutively express and secrete high levels of FGF19 in a process regulated by BA. Resection of this organ doubles BA synthesis concomitantly with changes in [FGF19]s. These findings suggest a potential connection between GB cholangiocytes-derived FGF19 and BA metabolism that could lead to metabolic dysregulation following cholecystectomy.

Prevalence of lactose intolerance in Chile: a double-blind placebo study

BACKGROUND AND STUDY AIMS

Lactase non-persistence (LNP), or primary hypolactasia, is a genetic condition that mediates lactose malabsorption and can cause lactose intolerance. Here we report the prevalence of lactose intolerance in a double-blind placebo study.

METHODS

The LCT C>T-13910 variant was genotyped by RT-PCR in 121 volunteers and lactose malabsorption was assessed using the hydrogen breath test (HBT) after consuming 25 g of lactose. Lactose intolerance was assessed by scoring symptoms (SS) using a standardized questionnaire following challenge with a lactose solution or saccharose placebo.

RESULTS

The LNP genotype was observed in 57% of the volunteers, among whom 87% were HBT⁺. In the HBT⁺ group the median SS was 9 and in the HBT⁻ group the median SS was 3 (p < 0.001). No difference was observed in the SS when both groups were challenged with the placebo. The most common symptoms included audible bowel sounds, abdominal pain and meteorism. In the ROC curve analysis, an SS ≥ 6 demonstrated 72% sensitivity and 81% specificity for predicting a positive HBT. To estimate prevalence, lactose intolerance was defined as the presence of an SS ≥ 6 points after subtracting the placebo effect and 34% of the study population met this definition.

CONCLUSIONS

The LNP genotype was present in more than half of subjects evaluated and the observed prevalence of lactose intolerance was 34%.

[Prevalence of Gilbert syndrome and its genetic determinants in Chile]

BACKGROUND

In Europeans the TATA box TA7 repeat promoter variant in the UGT1A1 gene (UGT1A1*28) is the major determinant of bilirubin levels.

AIM

To study the prevalence of Gilbert Syndrome (GS) and its genetic determinants in Chile.

MATERIAL AND METHODS

Three different studies were conducted. The prevalence of GS in Chile was assessed in 991 subjects with normal liver tests (ALT and GGT) from the 2nd National Health Survey. We defined GS as a total bilirubin (TB) between 1.4-5mg/dL. The second study assessed the genotype prevalence of SNP rs6742078 (in LD with UGT1A1*28) and rs4149056 in 500 DNA samples of non-related Hispanics. Finally, a case-control study was designed to assess the phenotype-genotype correlation. UGT1A1*28 and rs4149056 variants were determined by direct sequencing and allelic discrimination assays (TaqMan), respectively.

RESULTS

Prevalence of GS in the general Chilean population was 2.6% (4.5% in males and 0.5% in female). No correlation with age, educational level or home location was found. Genotypes for UGT1A1*28 (TA6/6 50.5%, TA6/7 37.8%, TA7/7 11.7%) and rs4149056 (TT 74.1%, CT 22.8%, and CC 3.1%) variants were similar to Europeans. In the case-control study, most patients with GS were homozygotes for UGT1A1*28 (TA7/7, 74%). Of note, 44% of patients with intermediate TB levels were also TA7/7, compared to 7% in normal subjects. SLCO1B1 genotype was not correlated with TB levels.

CONCLUSIONS

While the prevalence of GS was lower in Chile compared to Europeans (~5%), the prevalence of UGT1A1*28 homozygotes was similar (~12%). In Chilean Hispanics, the UGT1A1*28 variant explain 75% of GS phenotype.

[Subclinical atheroesclerosis and metabolic syndrome in children]

INTRODUCTION

Metabolic syndrome (MS) in children has been associated to subclinical atherosclerosis as estimated by carotid intima-media thickness (CIMT).

OBJECTIVES

We aim to ascertain the influence of MS, insulin resistance (IR) and nutritional status on CIMT. Percentiles with an increased risk of CIMT were also explored.

METHODS

A cross-sectional study of 447 children attending public schools in Santiago, Chile, was performed during years 2009-2011. This sample was selected considering the presence of one or more MS component and IR. Anthropometry and BP were assessed. A blood sample for determination of glycemia, insulinemia and lipids was taken. CIMT was assessed using high resolution ultrasonography with automated software. Pearson correlation, Student's t-test, Chisquared test, and stepwise logistic regression were computed.

RESULTS

Mean age was 11.5 ± 1.0 years old (range 10- 14); 59% girls; 93% pubertal; 72% excess weight; 24% MS; and 15% IR. Mean values of MS components in children with CIMT ≥ percentile 75 versus < percentile 75 had differences for systolic BP or diastolic BP ≥ percentile 90 (BP ≥ percentile 90) and high density lipoproteins cholesterol ≤ 40 mg/dL (CHDL ≤ 40 mg/dL). The logistic regression for CIMT ≥ percentile 75 only selected BP ≥ percentile 90 and CHDL ≤ 40 mg/dL. The logistic regression for CIMT ≥ percentile 90 did not select independent variables.

CONCLUSIONS

In this group of children BP ≥ percentile 90 and CHDL ≤ 40 mg/dL values were associated to CIMT ≥ percentile 75. Influences of IR and nutritional status on CIMT were not found.

[Blood lipids in Chilean children 10-14 years of age]

INTRODUCTION AND OBJECTIVES

Plasma lipid levels in children and adolescents are evaluated with international references. The objective was to describe them in Chilean students, to compare them with the most used reference (Lipids Research Clinics Program) and the cut-off points recommended in 2011.

METHODS

Cross-sectional study in 3325 children, 10 to 14 years of age. Anthropometry and auto-report of pubertal development were performed. A 12 hours fast blood sample was taken to measure total (TC), highdensity lipoprotein cholesterol (HDLC) and triglycerides (TG). Low-density lipoprotein cholesterol (LDLC) was calculated with Friedewald formula. Variables were described, Hochberg test for multiple comparisons and stepwise lineal regression were applied. The degree of agreement between local percentiles and the two international references was studied.

RESULTS

We studied 3,063 children, 11.4 ± 0.9 years old, 53% girls, 20.9% pre-pubertal, 22.6% had overweight, and 15.8% obesity. Averages: TC: 159.2 ± 28.3, HDLC: 51.9 ± 12.1, LDLC: 89.0 ± 31.5 and TG: 93.2 ± 60 mg/dL. Boys had higher HDLC: 53.3 ± 12.2 vs. 50.6 ± 11.8 mg/dL and lower TG: 86.2 ± 58.2 vs. 99.5 ± 61.7 mg/dL than girls (p < 0,001). Influences of nutritional status, sex and age were significant. We founded high agreement with the reference for TC and LDLC, but HDLC levels were lower and TG were higher, for their cut-off points: percentiles 10th and 95th, respectively.

CONCLUSIONS

Blood lipids were influenced by nutritional status, sex and age. Percentile values were comparable to the international reference except for HDLC and TG, showing a more atherogenic pattern.

Bioactive Furanoeremophilanes from Senecio otites Kunze ex DC

The furanoeremophilanes 6β-angeloyloxy-1, 10-dehydrofuranoeremophilan-9-one (1), 6β- hydroxy-1, 10-dehydrofuranoeremophilan-9-one (2) and 6β-propionyloxy-1, 10-dehydrofuranoeremophilan- 9-one (3) were isolated from Senecio otites, their structures elucidated by spectral analyses, and their insecticidal and phytotoxic properties evaluated. Compounds 1-3 proved to be effective aphid antifeedants against Myzus persicae and Rhopalosiphum padi and had postingestive negative effects on Spodoptera littoralis larvae. These compounds did not have any phytotoxic effects on Lactuca sativa.