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Zanetta-Colombo NC, Scharnweber T, Christie DA, Manzano CA, Blersch M, Gayo EM, Muñoz AA, Fleming ZL, Nüsser M. When another one bites the dust: Environmental impact of global copper demand on local communities in the Atacama mining hotspot as registered by tree rings. Sci Total Environ 2024; 920:170954. [PMID: 38365039 DOI: 10.1016/j.scitotenv.2024.170954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
Assessing the impact of mining activity on the availability of environmental pollutants is crucial for informing health policies in anticipation of future production scenarios of critical minerals essential for the transition to a net-zero carbon society. However, temporal and spatial monitoring is often sparse, and measurements may not extend far enough back in time. In this study, we utilize variations of chemical elements contained in tree-rings collected in local villages from an area heavily affected by copper mining in the Atacama Desert since the early 20th century to evaluate the temporal distribution of pollutants and their relationship with local drivers. By combining time-varying data on local drivers, such as copper production and the dry tailings deposit area, we show how the surge in copper production during the 1990s, fueled by trade liberalization and increased international demand, led to a significant increment in the availability of metal(loid)s related to mining activities on indigenous lands. Our findings suggest that the environmental legislation in Chile may be underestimating the environmental impact of tailing dams in neighboring populations, affecting the well-being of Indigenous Peoples from the Atacama mining hotspot region. We argue that future changes in production rates driven by international demand could have negative repercussions on the environment and local communities. Therefore, mining emissions and the management of tailing dams should be carefully considered to anticipate their potential negative effects on human and ecosystem health.
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Affiliation(s)
- Nicolás C Zanetta-Colombo
- Department of Geography, SAI, Heidelberg University, Heidelberg, Germany; Heidelberg Center for the Environment (HCE), Heidelberg University, Heidelberg, Germany.
| | - Tobias Scharnweber
- DendroGreif, Working Group Landscape Ecology and Ecosystem Dynamics, University Greifswald, Greifswald, Germany
| | - Duncan A Christie
- Laboratorio de Dendrocronología y Cambio Global, Instituto de Conservación Biodiversidad y Territorio, Universidad Austral de Chile, Valdivia, Chile; Center for Climate and Resilience Research (CR)(2), Santiago, Chile; Cape Horn International Center (CHIC), Parque Etnobotánico Omora, Universidad de Magallanes, Puerto Williams, Chile
| | - Carlos A Manzano
- Department of Chemistry, Faculty of Science, Universidad de Chile, Santiago, Chile; School of Public Health, San Diego State University, San Diego, CA, USA
| | - Mario Blersch
- Department of Geography - Research Group for Earth Observation (rgeo), Heidelberg University of Education, Heidelberg, Germany
| | - Eugenia M Gayo
- Center for Climate and Resilience Research (CR)(2), Santiago, Chile; Departamento de Geografía, Universidad de Chile, Santiago, Chile
| | - Ariel A Muñoz
- Center for Climate and Resilience Research (CR)(2), Santiago, Chile; Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Zoë L Fleming
- Center for Climate and Resilience Research (CR)(2), Santiago, Chile; Centro de Investigación en Tecnologías para la Sociedad, Facultad de Ingeniería, Universidad Del Desarrollo, Santiago, Chile
| | - Marcus Nüsser
- Department of Geography, SAI, Heidelberg University, Heidelberg, Germany; Heidelberg Center for the Environment (HCE), Heidelberg University, Heidelberg, Germany
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González ME, Syphard AD, Fischer AP, Muñoz AA, Miranda A. Chile's Valparaíso hills on fire. Science 2024; 383:1424. [PMID: 38547262 DOI: 10.1126/science.ado5411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Mauro E González
- Instituto de Conservación, Biodiversidad y Territorio, Universidad Austral de Chile, 5090000 Valdivia, Chile
- Center for Fire and Socioecosystem Resilience (FireSES), Universidad Austral de Chile, 5090000 Valdivia, Chile
- Center for Climate and Resilience Research (CR2), 8370451 Santiago, Chile
| | - Alexandra D Syphard
- Conservation Biology Institute, Corvallis, OR 97331, USA
- Department of Geography, San Diego State University, San Diego, CA 92110, USA
| | - A Paige Fischer
- Western Forest and Fire Initiative, School for Environment and Sustainability University of Michigan, Ann Arbor, MI 48109, USA
| | - A A Muñoz
- Center for Climate and Resilience Research (CR2), 8370451 Santiago, Chile
- Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, 2340025 Valparaíso, Chile
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, 2340025 Valparaíso, Chile
| | - Alejandro Miranda
- Center for Climate and Resilience Research (CR2), 8370451 Santiago, Chile
- Laboratorio de Ecología del Paisaje y Conservación, Departamento de Ciencias Forestales, Universidad de la Frontera, 4811230 Temuco, Chile
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3
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Zapata-Hernández G, Gajardo-Rojas M, Calderón-Seguel M, Muñoz AA, Yáñez KP, Requier F, Fontúrbel FE, Ormeño-Arriagada PI, Arrieta H. Advances and knowledge gaps on climate change impacts on honey bees and beekeeping: A systematic review. Glob Chang Biol 2024; 30:e17219. [PMID: 38450832 DOI: 10.1111/gcb.17219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/08/2024]
Abstract
The Western honey bee Apis mellifera is a managed species that provides diverse hive products and contributing to wild plant pollination, as well as being a critical component of crop pollination systems worldwide. High mortality rates have been reported in different continents attributed to different factors, including pesticides, pests, diseases, and lack of floral resources. Furthermore, climate change has been identified as a potential driver negatively impacting pollinators, but it is still unclear how it could affect honey bee populations. In this context, we carried out a systematic review to synthesize the effects of climate change on honey bees and beekeeping activities. A total of 90 articles were identified, providing insight into potential impacts (negative, neutral, and positive) on honey bees and beekeeping. Interest in climate change's impact on honey bees has increased in the last decade, with studies mainly focusing on honey bee individuals, using empirical and experimental approaches, and performed at short-spatial (<10 km) and temporal (<5 years) scales. Moreover, environmental analyses were mainly based on short-term data (weather) and concentrated on only a few countries. Environmental variables such as temperature, precipitation, and wind were widely studied and had generalized negative effects on different biological and ecological aspects of honey bees. Food reserves, plant-pollinator networks, mortality, gene expression, and metabolism were negatively impacted. Knowledge gaps included a lack of studies at the apiary and beekeeper level, a limited number of predictive and perception studies, poor representation of large-spatial and mid-term scales, a lack of climate analysis, and a poor understanding of the potential impacts of pests and diseases. Finally, climate change's impacts on global beekeeping are still an emergent issue. This is mainly due to their diverse effects on honey bees and the potential necessity of implementing adaptation measures to sustain this activity under complex environmental scenarios.
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Affiliation(s)
- Germán Zapata-Hernández
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Martina Gajardo-Rojas
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Matías Calderón-Seguel
- Departamento de Ciencias Sociales, Facultad de Ciencias Sociales, Universidad de Tarapacá, Iquique, Chile
| | - Ariel A Muñoz
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Centro de Ciencia del Clima y la Resiliencia, Santiago, Chile
| | - Karen P Yáñez
- Centro de Biotecnología Dr. Daniel Alkalay Lowitt, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Fabrice Requier
- CNRS, IRD, UMR Évolution, Génomes, Comportement et Écologie, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Francisco E Fontúrbel
- Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Pablo I Ormeño-Arriagada
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- Departamento de Informática, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Héctor Arrieta
- Centro de Acción Climática, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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Muñoz AA, Klock-Barría K, Sheppard PR, Aguilera-Betti I, Toledo-Guerrero I, Christie DA, Gorena T, Gallardo L, González-Reyes Á, Lara A, Lambert F, Gayo E, Barraza F, Chávez RO. Multidecadal environmental pollution in a mega-industrial area in central Chile registered by tree rings. Sci Total Environ 2019; 696:133915. [PMID: 31461694 DOI: 10.1016/j.scitotenv.2019.133915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 05/21/2023]
Abstract
One of the most polluted areas in Chile is the Ventanas Industrial Area (VIA; 32.74°S / 71.48°W), which started in 1958 and today comprises around 16 industries in an area of ca. 4 km2. A lack of consistent long-term instrumental records precludes assessing the history of contamination in the area and also limits the evaluation of mitigation actions taken since the late 1980s. Here, we use dendrochemistry as an environmental proxy to analyze environmental changes over several decades at the VIA. We present chemical measurements of tree rings from planted, exotic Cupressus macrocarpa growing near the VIA with 4-year resolution over a period of 52 years (1960-2011). These data provide unprecedented information on regional anthropogenic pollution and are compared with a tree-ring elemental record of 48 years (1964-2011) from the Isla Negra (INE) control site not exposed to VIA emissions. For the 48 years of overlap between both sites, higher concentrations of Zn, V, Co, Cd, Ag, Fe, Cr, and Al were especially registered after the year 2000 at VIA compared to INE for the periods under study. Concentrations of Pb, Cu, As, Fe, Mo, Cr, and Zn increased through time, particularly over the period 1980-1990. Decontamination plans activated in 1992 appear to have had a positive effect on the amount of some elements, but the chemical concentration in the tree rings suggest continued accumulation of pollutants in the environment. Only after several years of implementation of the mitigation measures have some elements tended to decrease in concentration, especially at the end of the evaluated period. Dendrochemistry is a useful tool to provide a long-term perspective of the dynamics of trace metal pollution and represents a powerful approach to monitor air quality variability to extend the instrumental records back in time.
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Affiliation(s)
- Ariel A Muñoz
- Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Avenida Brasil 2241, Valparaíso, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Karin Klock-Barría
- Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Avenida Brasil 2241, Valparaíso, Chile.
| | - Paul R Sheppard
- Laboratory of Tree-Ring Research, University of Arizona, Tucson, United States of America.
| | - Isabella Aguilera-Betti
- Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Avenida Brasil 2241, Valparaíso, Chile; Centro Transdisciplinario de Estudios Ambientales y Desarrollo Humano Sostenible (CEAM), Universidad Austral de Chile, Valdivia, Chile.
| | - Isadora Toledo-Guerrero
- Laboratorio de Dendrocronología y Estudios Ambientales, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Avenida Brasil 2241, Valparaíso, Chile.
| | - Duncan A Christie
- Laboratorio de Dendrocronología y Cambio Global, Facultad de Ciencias Forestales y Recursos Naturales, Universidad Austral de Chile, Valdivia, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Tamara Gorena
- Centro de Tecnologías Ambientales, Universidad Técnica Federico Santa María, Valparaíso, Chile.
| | - Laura Gallardo
- Departamento de Geofísica, Universidad de Chile, Santiago, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Álvaro González-Reyes
- Laboratorio de Dendrocronología y Cambio Global, Facultad de Ciencias Forestales y Recursos Naturales, Universidad Austral de Chile, Valdivia, Chile; Hémera Centro de Observación de la Tierra, Facultad de Ciencias, Universidad Mayor, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Antonio Lara
- Laboratorio de Dendrocronología y Cambio Global, Facultad de Ciencias Forestales y Recursos Naturales, Universidad Austral de Chile, Valdivia, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile; Fundación Centro de los Bosques Nativos FORECOS, Valdivia, Chile.
| | - Fabrice Lambert
- Departamento de Geografía, Pontificia Universidad Católica de Chile, Santiago, Chile; Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Eugenia Gayo
- Center for Climate and Resilience Research (CR)2, Santiago, Chile.
| | - Francisco Barraza
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - Roberto O Chávez
- Laboratorio de Geo-Información y Percepción Remota, Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.
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Bowman DMJS, Moreira-Muñoz A, Kolden CA, Chávez RO, Muñoz AA, Salinas F, González-Reyes Á, Rocco R, de la Barrera F, Williamson GJ, Borchers N, Cifuentes LA, Abatzoglou JT, Johnston FH. Human-environmental drivers and impacts of the globally extreme 2017 Chilean fires. Ambio 2019; 48:350-362. [PMID: 30128860 PMCID: PMC6411810 DOI: 10.1007/s13280-018-1084-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 05/06/2023]
Abstract
In January 2017, hundreds of fires in Mediterranean Chile burnt more than 5000 km2, an area nearly 14 times the 40-year mean. We contextualize these fires in terms of estimates of global fire intensity using MODIS satellite record, and provide an overview of the climatic factors and recent changes in land use that led to the active fire season and estimate the impact of fire emissions to human health. The primary fire activity in late January coincided with extreme fire weather conditions including all-time (1979-2017) daily records for the Fire Weather Index (FWI) and maximum temperature, producing some of the most energetically intense fire events on Earth in the last 15-years. Fire activity was further enabled by a warm moist growing season in 2016 that interrupted an intense drought that started in 2010. The land cover in this region had been extensively modified, with less than 20% of the original native vegetation remaining, and extensive plantations of highly flammable exotic Pinus and Eucalyptus species established since the 1970s. These plantations were disproportionally burnt (44% of the burned area) in 2017, and associated with the highest fire severities, as part of an increasing trend of fire extent in plantations over the past three decades. Smoke from the fires exposed over 9.5 million people to increased concentrations of particulate air pollution, causing an estimated 76 premature deaths and 209 additional admissions to hospital for respiratory and cardiovascular conditions. This study highlights that Mediterranean biogeographic regions with expansive Pinus and Eucalyptus plantations and associated rural depopulation are vulnerable to intense wildfires with wide ranging social, economic, and environmental impacts, which are likely to become more frequent due to longer and more extreme wildfire seasons.
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Affiliation(s)
- David M. J. S. Bowman
- School of Natural Sciences, University of Tasmania, Private Bag 55, Hobart, TAS 7001 Australia
| | - Andrés Moreira-Muñoz
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Av. Brasil 2241 Valparaíso, Chile
| | - Crystal A. Kolden
- College of Natural Resources, University of Idaho, Moscow, ID 83844-1133 USA
| | - Roberto O. Chávez
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Av. Brasil 2241 Valparaíso, Chile
| | - Ariel A. Muñoz
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Av. Brasil 2241 Valparaíso, Chile
| | - Fernanda Salinas
- Fiscalía del Medio Ambiente (ONG FIMA), Mosqueto 491, of. 312, Santiago, Chile
| | - Álvaro González-Reyes
- Instituto de Ciencias de la Tierra, Facultad de Ciencias, Universidad Austral de Chile, Campus Isla Teja, Casilla, 567 Valdivia, Chile
| | - Ronald Rocco
- Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Av. Brasil 2241 Valparaíso, Chile
| | - Francisco de la Barrera
- Faculty of Architecture, Urbanism and Geography, Universidad de Concepcion, Victor Lamas 1290, Concepción, Chile
| | - Grant J. Williamson
- School of Natural Sciences, University of Tasmania, Private Bag 55, Hobart, TAS 7001 Australia
| | - Nicolás Borchers
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7001 Australia
| | - Luis A. Cifuentes
- Industrial and Systems Engineering Department, Pontificia Universidad Católica de Chile, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | | | - Fay H. Johnston
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7001 Australia
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Muñoz AA, Barichivich J, Christie DA, Dorigo W, Sauchyn D, González-Reyes Á, Villalba R, Lara A, Riquelme N, González ME. Patterns and drivers ofAraucaria araucanaforest growth along a biophysical gradient in the northern Patagonian Andes: Linking tree rings with satellite observations of soil moisture. AUSTRAL ECOL 2013. [DOI: 10.1111/aec.12054] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ariel A. Muñoz
- Centro de Tecnologías Ambientales; Universidad Técnica Federico Santa María; Valparaíso Chile
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
- Centro de Estudios Ambientales (CEAM); Universidad Austral de Chile; Valdivia Chile
| | - Jonathan Barichivich
- Climatic Research Unit (CRU); School of Environmental Sciences; University of East Anglia; Norwich UK
| | - Duncan A. Christie
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
- Center for Climate and Resilience Research [CR]2; Chile
| | - Wouter Dorigo
- Institute of Photogrammetry and Remote Sensing; Vienna University of Technology; Vienna Austria
| | - David Sauchyn
- Prairie Adaptation Research Collaborative (PARC); University of Regina; Regina Canada
| | - Álvaro González-Reyes
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
- Departamento de Geología; Facultad de Ciencias Físicas y Matemáticas; Universidad de Chile; Santiago Chile
| | - Ricardo Villalba
- Instituto Argentino de Nivología; Glaciología y Ciencias Ambientales (IANIGLA); CONICET; Mendoza Argentina
| | - Antonio Lara
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
- Center for Climate and Resilience Research [CR]2; Chile
| | - Natalia Riquelme
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
| | - Mauro E. González
- Laboratorio de Dendrocronología y Cambio Global; Instituto de Conservación Biodiversidad y Territorio; Facultad de Ciencias Forestales y Recursos Naturales; Universidad Austral de Chile; Valdivia 5090000 Chile
- Center for Climate and Resilience Research [CR]2; Chile
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Fuentes L L, Muñoz AA. [Results of an integral lifestyle modification program to reduce weight among overweight and obese women]. Rev Med Chil 2010; 138:974-981. [PMID: 21140054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND In Chile, the Ministry of Health implemented an integral therapeutic program to reduce cardiovascular risk and increase physical activity (PA) among the population. AIM To assess the effectiveness of the program in a group of overweight or obese adult women with a family history of Type 2 Diabetes and / or prehypertensive and / or prediabetes. MATERIAL AND METHODS A group of 128 women aged 35 ± 10 years with a mean body mass index (BMI) of 33 kg/m2 were invited to participate in a program that lasted four months and included PA sessions and workshops with psychologists and nutritionists. Weight and waist circumference were measured at baseline and at four and six months of follow up. The blood glucose was measured at baseline and at 4 months, only in the affected income. RESULTS At four months the reduction in weight and waist circumference observed, was around 2%, and at 6 months the reductions was around 3%. The largest reductions were observed at 6 months in obese patients ≥ 40 years. Women that were more compliant with PA sessions had a greater weight reduction. The blood glucose levels decreased significantly independent of the reduction of anthropometric parameters. CONCLUSIONS The program is considered successful to reduce cardiovascular risk factors and increase the practice of PA. The intervention was especially effective in patients > 40 years possibly due to higher food education, maturity and responsibility to the intervention.
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Affiliation(s)
- Leonora Fuentes L
- Sub. Departamento de Planificación de la Red, Servicio de Salud de Valdivia, Valdivia, Chile.
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