La obesidad y la actividad física como predictores de la calidad de vida y la mortalidad en adultos mayores

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: 2 de Noviembre 201

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

<p>Abstract</p> <p>Background</p> <p>Evidence on the relation between leisure-time physical activity (LTPA) and health-related quality of life (HRQoL) in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons. Moreover, there is no evidence on whether leisure-time sedentary behavior (LTSB) is associated with HRQoL independently of LTPA. This study examined the longitudinal association between LTPA, LTSB, and HRQoL in older community-dwelling adults in Spain.</p> <p>Methods</p> <p>Prospective cohort study of 1,097 persons aged 62 and over. In 2003 LTPA in MET-hr/week was measured with a validated questionnaire, and LTSB was estimated by the number of sitting hours per week. In 2009 HRQoL was measured with the SF-36 questionnaire. Analyses were done with linear regression and adjusted for the main confounders.</p> <p>Results</p> <p>Compared with those who did no LTPA, subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning (β 5.65; 95% confidence interval [CI] 1.32-9.98; p linear trend < 0.001), physical role (β 7.38; 95% CI 0.16-14.93; p linear trend < 0.001), bodily pain (β 6.92; 95% CI 1.86-11.98; p linear trend < 0.01), vitality (β 5.09; 95% CI 0.76-9.41; p linear trend < 0.004) social functioning (β 7.83; 95% CI 2.89-12.75; p linear trend < 0.001), emotional role (β 8.59; 95% CI 1.97-15.21; p linear trend < 0.02) and mental health (β 4.20; 95% CI 0.26-8.13; p linear trend < 0.06). As suggested by previous work in this field, these associations were clinically relevant because the β regression coefficients were higher than 3 points. Finally, the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales, which was also clinically relevant.</p> <p>Conclusions</p> <p>Greater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults.</p

Chocolate and health-related quality of life: A prospective study

Background Chocolate consumption has been associated with a short-term reduction in blood pressure and cholesterol, and improvement of insulin sensitivity; however, participants could not be aware of presenting hypertension or hypercholesterolemia. Moreover, the effect of chocolate on mental health is uncertain. This study assessed the association of regular chocolate consumption with the physical (PCS) and mental (MCS) components of health-related quality of life (HRQL). Materials and methods We analyzed data from a cohort of 4599 individuals recruited in 2008–2010 and followed-up once prospectively to January 2013 (follow-up mean: 3.5 years). Regular chocolate consumption was assessed at baseline with a validated diet history. HRQL was assessed with the SF-12 v.2 at baseline and at follow-up. Analyses were performed with linear regression and adjusted for the main confounders, including HRQL at baseline. Results At baseline, 72% of the study participants did not consume chocolate, 11% consumed 10 g/day and 17% >10 g/day. Chocolate consumption at baseline did not show an association with PCS and MCS of the SF-12 measured three years later. Compared to those who did not consume chocolate, the PCS scores were similar in those who consumed 10g/day (beta: -0.07; 95% confidence interval (95% CI): -0.94 to 0.80) and in those who consumed >10g/day (beta: 0.02; 95% CI:-0.71 to 0.75); corresponding figures for the MCS were 0.29; 95% CI: -0.67 to 1.26, and -0.57; 95%CI: -1.37 to 0.23. Similar results were found for sex, regardless of obesity, hypertension, hypercholesterolemia, diabetes or depression Conclusions No evidence was found of an association between chocolate intake and the physical or mental components of HRQLBaseline data collection (ENRICA study) was funded by Sanofi-Aventis. Data collection during follow-up was funded by FIS grant 09/162 (Ministry of Health of Spain). Funding specific for this analysis was obtained from FIS grants PI11/01379 and PI12/ 1166 (Ministry of Health of Spain), and from the "Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular

Relationship between serotypes, age, and clinical presentation of invasive pneumococcal disease in Madrid, Spain, after introduction of the 7-valent pneumococcal conjugate vaccine into the vaccination calendar

To assess invasive pneumococcal disease (IPD) clinical presentations and relationships with age and serotype in hospitalized children (<15 years) after PCV7 implementation in Madrid, Spain, a prospective 2-year (May 2007 to April 2009) laboratory-confirmed (culture and/or PCR) IPD surveillance study was performed (22 hospitals). All isolates (for serotyping) and culture-negative pleural/cerebrospinal fluids were sent to the reference laboratory for pneumolysin (ply) and autolysin (lyt) gene PCR analysis. A total of 330 IPDs were identified: 263 (79.7%) confirmed by culture and 67 (20.3%) confirmed by PCR. IPD distribution by age (months) was as follows: 23.6% (<12), 15.8% (12 to 23), 15.5% (24 to 35), 22.4% (36 to 59), and 22.7% (>59). Distribution by clinical presentation was as follows: 34.5% bacteremic pneumonia, 30.3% pediatric parapneumonic empyema (PPE), 13.6% meningitis, 13.3% primary bacteremia, and 8.2% others. Meningitis and primary bacteremia were the most frequent IPDs in children <12 months old, and bacteremic pneumonia and PPE were most frequent in those >36 months old. Frequencies of IPD-associated serotypes were as follows: 1, 26.1%; 19A, 18.8%; 5, 15.5%; 7F, 8.5%; 3, 3.9%; nontypeable/ other 30 serotypes, 27.3%. Serotype 1 was linked to respiratory-associated IPD (38.6% in bacteremic pneumonia and 38.0% in PPE) and children of >36 months (51.4% for 36 to 59 months and 40.0% for >59 months), while serotype 19A was linked to nonrespiratory IPDs (31.1% in meningitis, 27.3% in primary bacteremia, and 51.9% in others) and children of <24 months (35.9% for children of <12 months and 36.5% for those 12 to 23 months old), with high nonsusceptibility rates for penicillin, cefotaxime, and erythromycin. After PCV7 implementation, non-PCV7 serotypes caused 95.5% of IPDs. The new 13-valent conjugate vaccine would provide 79.1% coverage of serotypes responsible for IPDs in this series

Trends in mortality from cardiovascular diseases in Chile, 2000–2020

Objective. To analyze trends in mortality caused by cardiovascular diseases (CVD) in Chile during the period 2000–2020. Methods. Data on age-adjusted mortality rates (AAMR) from CVD per 100 000 population in Chile for 2000–2020 were extracted from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the average annual percent change (AAPC) in Chile. In addition, analyses were conducted by sex and type of CVD. Results. Between 2000 and 2020, the AAMR from CVD decreased in Chile from 159.5 to 94.6 per 100 000 population, with a statistically significant decrease in the AAPC of 2.6% (95% CI [–2.8, –2.4]). No joinpoints were identified. The AAMR from CVD decreased annually by 2.6% (95% CI [–2.8, –2.4]) and 2.8% (95% CI [–3.5, –2.6]) in men and women, respectively. The AAMR from ischemic heart disease reduced annually by 3.6% (95% CI [–4.6, –2.7]) with two joinpoints in 2011 and 2015. In the case of stroke, the mortality rate decreased annually by 3.7% (95% CI [–4.5, –3.0]), with two joinpoints in 2008 and 2011. Conclusions. Cardiovascular disease mortality rates have decreased significantly in Chile, in both sexes, especially in women. This decrease could be explained mainly by a significant reduction in the case fatality in recent decades. These results could be a reference for developing primary prevention and acute management of CVD policies focused on populations with higher mortality

Results from Chile's 2016 report card on physical activity for children and youth

Background: The 2016 Chilean Report Card on Physical Activity for Children and Youth is a review of the evidence across indicators of behaviors, settings, and sources of influence associated with physical activity (PA) of Chilean children and youth. Methods: A Research Work Group reviewed available evidence from publications, surveys, government documents and datasets to assign a grade for 11 indicators for PA behavior based on the percentage of compliance for defined benchmarks. Grades were defined as follows: A, 81% to 100% of children accomplishing a given benchmark; B, 61% to 80%; C, 41% to 60%; D, 21% to 40%; F, 0% to 20%; INC, incomplete data available to assign score. Results: Grades assigned were for i) 'Behaviors that contribute to overall PA levels': Overall PA, F; Organized Sport Participation, D; Active Play, INC; and Active Transportation, C-; ii) 'Factors associated with cardiometabolic risk': Sedentary Behavior, D; Overweight and Obesity, F; Fitness, F; and iii) 'Factors that influence PA': Family and Peers, D; School, D; Community and Built Environment, C; Government Strategies and Investments, C. Conclusions: Chile faces a major challenge as most PA indicators scored low. There were clear research and information gaps that need to be filled with the implementation of consistent and regular data collection methods

Baseline characteristics for the study participants in the ENRICA cohort study (2008–2010) according to categories of chocolate consumption.

<p>SD: Standard Deviation; MET: Metabolic Equivalents; TV: television;</p><p>* Trichopoulou score.</p><p>** Hypertension was defined as systolic pressure ≥140 mm Hg, diastolic pressure ≥90mmHg, or use of antihypertensive drugs.</p><p>†Diabetes mellitus was defined as serum glucose ≥126 mg/dl or use of antidiabetic drugs.</p><p>‡Hypercholesterolemia was defined as total serum cholesterol ≥200 mg/dl or use of hypolipidemic drugs.</p><p>║Adjusted for sex, age (18–44,45–64,65 and over), educational level (no formal or primary education; secondary education; university), tobacco consumption (never smokers, former smokers, current smokers), alcohol consumption g/day (quartiles), body mass index kg/m² (quartiles), abdominal obesity (yes/no), leisure time physical activity METs-h/week (quartiles), time spent watching television h/week (quartiles), adherence to the Mediterranean diet (low adherence 0–2 points, medium adherence 3–5 points, high adherence 6–8 points), total energy kcal/day (quartiles) and prevalent diseases (coronary heart disease, stroke, cancer and depression).</p><p>Baseline characteristics for the study participants in the ENRICA cohort study (2008–2010) according to categories of chocolate consumption.</p

Linear regression coefficients (95% confidence interval) of the physical and mental components of the SF-12 in 2012–13 by chocolate consumption categories.

<p>*p <0,05;</p><p>** p <0,01.</p><p>Model adjusted for sex, age (18–44,45–64,65 and over), educational level (no formal or primary education; secondary education; university), tobacco consumption (never smokers, former smokers, current smokers), alcohol consumption g/day (quartiles), body mass index kg/m² (quartiles), abdominal obesity (yes/no), leisure time physical activity METs-h/week (quartiles), time spent watching television h/week (quartiles), adherence to the Mediterranean diet (low adherence 0–2 points, medium adherence 3–5 points, high adherence 6–8 points), total energy kcal/day (quartiles), prevalent diseases (coronary heart disease, stroke, cancer and depression), incident diseases (coronary heart disease, stroke, cancer and depression), physical or mental component summaries at baseline, as appropriate.</p><p>Linear regression coefficients (95% confidence interval) of the physical and mental components of the SF-12 in 2012–13 by chocolate consumption categories.</p