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Pilar Arnaiz, Luis Villarroel,
Salesa Barja,
Iván Godoy,
Berta Cassis,
Angélica Domínguez,
Oscar Castillo,
Marcelo Farías,
Jacqueline Carvajal,
Ana Cristina Tinoco,
Francisco Mardones
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ABSTRACT: Background: Cardiovascular risk factors must be controlled since childhood. Aim: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. Material and Methods: Cross sectional assessment of 299 children aged 11.5 ± 0.9years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. Results: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMTover the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) perfive units of change, respectively. Conclusions: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT.
Revista medica de Chile 10/2012; 140(10):1268-75. · 0.33 Impact Factor
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ABSTRACT: Background:Delirium is an important problem in older medical inpatients. Aim: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. Material and Methods: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. Results: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. Conclusions: Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.
Revista medica de Chile 07/2012; 140(7):847-52. · 0.33 Impact Factor
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ABSTRACT: Beneficence, respecting autonomy of patients to make their own decisions, is crucial for good physician-patient relations (PPR), a leading objective in health care.
To validate a previously designed scale to assess PPR in Chile.
A scale with 55 questions grouped in six dimensions, was applied to a convenience sample of 146 individuals, composed by physicians, patients and medical students, at the school of medicine from the Pontificia Universidad Católica de Chile (PUC). Internal consistency (Alpha of Cronbach) of answers was analyzed. The existence of correlations between answers that may justify the application of a factorial analysis was assessed using Bartlett and Kaiser-Meyer-Olkin (KMO) tests. Factorial analysis was used to identify specific dimensions and reduce the number of questions.
Factorial analysis performed in 125 subjects with complete answers allowed to reduce the scale to 28 questions, grouped in six dimensions. Cronbach alpha value was 0.78. Bartlett test was highly significant (p < 0.0001), and KMO score was 0.784, considered as meritorious.
The validated scale will allow the performance of new studies among physicians and patients, to assess and compare their respective scores.
Revista medica de Chile 02/2012; 140(2):176-83. · 0.33 Impact Factor
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ABSTRACT: In hepatocytes and enterocytes sterol uptake and secretion is mediated by Niemann-Pick C1-like 1 (NPC1L1) and ATP-binding cassette (ABC)G5/8 proteins, respectively. Whereas serum levels of phytosterols represent surrogate markers for intestinal cholesterol absorption, cholesterol precursors reflect cholesterol biosynthesis. Here we compare serum and biliary sterol levels in ethnically different populations of patients with gallstone disease (GSD) and stone-free controls to identify differences in cholesterol transport and synthesis between these groups. In this case-control study four cohorts were analyzed: 112 German patients with GSD and 152 controls; two distinct Chilean ethnic groups: Hispanics (100 GSD, 100 controls), and Amerindians (20 GSD, 20 controls); additionally an 8-year follow-up of 70 Hispanics was performed. Serum sterols were measured by gas chromatography / mass spectrometry. Gallbladder bile sterol levels were analyzed in cholesterol GSD and controls. Common ABCG5/8 variants were genotyped. Comparison of serum sterols showed lower levels of phytosterols and higher levels of cholesterol precursors in GSD patients than in controls. The ratios of phytosterols to cholesterol precursors were lower in GSD patients, whereas biliary phytosterol and cholesterol concentrations were elevated as compared with controls. In the follow-up study, serum phytosterol levels were significantly lower even before GSD was detectable by ultrasound. An ethnic gradient in the ratios of phytosterols to cholesterol precursors was apparent (Germans > Hispanics > Amerindians). ABCG5/8 variants did not fully explain the sterol metabolic trait of GSD in any of the cohorts. CONCLUSION: Individuals predisposed to GSD display increased biliary output of cholesterol in the setting of relatively low intestinal cholesterol absorption, indicating enhanced whole-body sterol clearance. This metabolic trait precedes gallstone formation and is a feature of ethnic groups at higher risk of cholesterol GSD.
Hepatology 12/2011; 55(5):1507-17. · 11.66 Impact Factor
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Salesa Barja,
Pilar Arnaiz,
Angélica Domínguez, Luis Villarroel,
Berta Cassis,
Oscar Castillo,
Gianina Salomó,
Marcelo Farías,
Manuela Goycoolea,
Teresa Quiroga,
Francisco Mardones
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ABSTRACT: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile.
To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation.
A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated.
The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 μϋ/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and II pubertal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2μϋ/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively).
The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0.
Revista medica de Chile 11/2011; 139(11):1435-43. · 0.33 Impact Factor
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ABSTRACT: To assess the nutritional status, food intake and physical activity patterns in schoolchildren attending 5th and 6th grade in basic schools from different socio-economic levels in the metropolitan region of Santiago.
Cross-sectional study in children 5th and 6th grade of eighteen basic schools in the metropolitan region of Santiago.
Boys and girls aged 9-12 years from basic schools were evaluated in terms of physical capacity. An anthropometric evaluation was also performed which included weight, height and triceps and subscapular skinfold thicknesses. Food intake was evaluated by a 24 h recall, socio-economic level by the ESOMAR method and physical activity by a questionnaire.
Boys and girls aged 9-12 years (n 1732).
The average prevalence of overweight and obesity was 40 %, with the highest prevalence in males and those from lower socio-economic level. A majority (64 %) of the children had a low level of physical activity. A higher intake of fat and protein and a higher intake of carbohydrate were found in the higher and lower socio-economic levels, respectively. Both males and females showed adequacy greater than 75 % in macronutrient intake except for fibre, with both groups showing a deficit in the consumption of fruits, vegetables, legumes, fish and milk products according to Chilean recommendations.
A high prevalence of malnutrition by excess was observed in both sexes and a better eating and physical activity pattern was seen in children from higher socio-economic level.
Public Health Nutrition 01/2011; 14(1):142-9. · 2.17 Impact Factor
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ABSTRACT: Present a methodology for evaluating cost-effectiveness in primary health care centers (PHCs) in Chile based on the family health care model promoted in Chile and evaluate the results of the first two years of operation of the first pilot center to work under this new primary-care model.
A cost-effectiveness study with a social perspective and a one-year time frame was conducted. In order to compare the university health center in question with the control (a municipal health center), a Family Health Center Composite Quality Index (FHCCQI) was devised. It combines technical indicators and user perceptions of the health centers in six areas: access, continuity of medical care, a preventive and promotional clinical approach, problem-solving capability, participation, and a biopsychosocial and family approach. In order to calculate the costs, the centers' expenses, the savings realized in the rest of the health system, and patients' out-of-pocket expenditures were considered. The incremental cost-effectiveness ratio (ICR) was estimated and a sensitivity analysis was performed.
The university health center was 13.4% more expensive (an additional US$8.93 per annum per enrollee) and was more effective (FHCCQI 13.3% greater) than the municipal one. Accordingly, the ICR is US$0.67 for each additional percentage point of FHCCQI increase.
According to the PHC evaluation model that was implemented, the centers that follow the Chilean family health care model are more effective than traditional PHC centers, as measured by both technical indicators and user ratings.
Revista Panamericana de Salud Pública 11/2010; 28(5):376-87. · 0.85 Impact Factor
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ABSTRACT: Research examining the relationship between social capital and health in Latin America has been limited. The aim of this study is to evaluate the association between social capital and tobacco use in four low-income neighborhoods in Santiago, Chile.
A multistage probability sample was used to select households in 4 of the 10 poorest neighborhoods in the district of Puente Alto, in Santiago, Chile. A cross-sectional survey of 781 participants (81.2% response rate for households) included sociodemographic variables, questions pertaining to neighborhood social capital, and questions pertaining to tobacco. Main analyses were carried out at the individual level by performing a multiple logistic regression of individual tobacco use on individual perceptions of community social capital.
The prevalence of smoking was 43.9% of the surveyed population. A five-factor structure for social capital was identified, including "perceived trust in neighbors," "perceived trust in organizations," "reciprocity within the neighborhood," "neighborhood integration," and "social participation." An inverse relationship between trust in neighbors and tobacco smoking was statistically significantly with an adjusted odds ratio of 0.95 (95% CI: 0.91-0.99). Trust in neighbors was also significantly inversely associated with the number of cigarettes smoked.
Tobacco control remains a significant challenge in global health, requiring innovative strategies that address changing social contexts as well as the changing epidemiological profile of developing regions.
Nicotine & Tobacco Research 09/2010; 12(9):927-36. · 2.58 Impact Factor
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ABSTRACT: Persistence of depressive symptoms after myocardial infarction (MI) is associated with an adverse outcome. The relationship between depression and Invasive Revascularization Therapy (IRT) is not yet fully understood.
To compare the frequency of depressive symptoms and other psychosocial variables among patients with MI, undergoing or not undergoing IRT.
Prospective evaluation of 45 patients aged 58 +/- 11 years (87% males) with a diagnosis of MI (Killip I and II). On admission to hospital and at follow up 3 months after discharge, all patients completed the Beck Depression Inventory (BDI), the Zung Anxiety Inventory (ASI), and the Medical Outcomes Study (MOS) social support survey. Depressive symptoms were considered to be present if the BDI score was over 10.
Thirty seven percent were hypertensive, 15% diabetic and 44% smokers. Sixty four percent of patients underwent IRT (11.1% revascularization surgery and 53.3% coronary angioplasty). Forty four percent of patients scored over 10 in the BDI at baseline assessment and 26.5% at 3 months follow-up (p < 0.01). At baseline BDI score was 10.2 +/- 5.1 and 9.1 +/- 4.4 among patients subjected or not subjected to IRT, respectively (NS). The figures at 3 months of follow up were 9.9 +/- 5.6 and 4.1 +/- 2.5, respectively (p < 0.01). At baseline and three months BDI, anxiety and perceived social support were significantly correlated.
Depressive symptoms were frequent after MI in this group of patients, and decreased at follow up only among patients not subjected to IRT.
Revista medica de Chile 06/2010; 138(6):701-6. · 0.33 Impact Factor
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Federico Leighton,
Gianna Polic,
Pablo Strobel,
Druso Pérez,
Carlos Martínez,
Luis Vásquez,
Oscar Castillo, Luis Villarroel,
Guadalupe Echeverría,
Inés Urquiaga,
Diego Mezzano,
Jaime Rozowski
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ABSTRACT: To evaluate the feasibility of diet mediterranisation, in a food-at-work context, and its consequence on metabolic syndrome in a mid-age unselected healthy male population group.
One-year longitudinal intervention study. Physical exercise was not modified.
All workers of the Santiago division of 'Maestranza Diesel', a metal-mechanic company servicing the mining industry, were invited to participate.
Initially, 145 workers of a total of 171, of average age 39 years, accepted to participate (sixteen women and 129 men). A subgroup of ninety-six men fully completed the controls programmed for the intervention study. Losses from the original group correspond to missing one control (sixteen), leaving the company (eleven) or blood sampling discomfort (six). The women and sixteen male workers, hired post study initiation, did participate but were excluded from this 12-month analysis.
Diet mediterranisation was successful, reflected in the daily food consumption at the canteen and the evolution of the Mediterranean diet score (MDS) from 4.8 +/- 1.4 to 7.4 +/- 1.5 (limits 0-14). Some metabolic syndrome components showed statistically significant improvement and also statistically significant correlation with the MDS: waist circumference, HDL-cholesterol, systolic and diastolic blood pressure. After 12 months, the reversion rate for metabolic syndrome was 48 % (12/23) with an incidence rate of 4.1 % for new cases (3/73). In total, metabolic syndrome decreased from 24.0 % to 15.6 % (23/96 to 15/96) (P = 0.029).
Diet mediterranisation is feasible in a food-at-work intervention, affecting lunch consumption at the workers canteen and overall consumption evaluated with MDS, together with a significant reduction in metabolic syndrome.
Public Health Nutrition 10/2009; 12(9A):1635-43. · 2.17 Impact Factor
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ABSTRACT: A common situation in the biological and social sciences is to have data on one or more variables measured longitudinally on a sample of individuals. A problem of growing interest in these areas is the grouping of individuals into one of two or more clusters according to their longitudinal behavior. Recently, methods have been proposed to deal with cases where individuals are classified into clusters through a linear model of mixed univariate effects deriving from a longitudinally measured variable. The method proposed in the current work deals with the case of clustering and then classification based on two or more variables measured longitudinally, through the fitting of non-linear multivariate mixed effect models, and with consideration given to parameter estimation for balanced and unbalanced data using an EM algorithm. The application of the method is illustrated with an example in which the clusters are identified and the classification into clusters is compared with the true membership of individuals in one of two groups, which is known at the end of the follow-up period.
Statistics in Medicine 06/2009; 28(20):2552-65. · 1.88 Impact Factor
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ABSTRACT: The health associated costs of obesity can represent between 2% and 9% of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers.
Prospective study of 4.673 men, employees of a mining company, aged 49 +/- 7 years that were followed for 24 +/- 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables.
Mean annual health care costs for obese workers were 17% higher (p <0.001) compared to workers with normal weight and 58% higher (p <0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25%o in the obese (p =0.002) and by 57%o in subjects with severe and morbid obesity (p <0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95%o confidence intervals (95% CI) 4.9 to 7.9), hypertension (OR 3-99; 95% CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95%o CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95%> CI 1.2 to 2.0), hypertension (OR 1,34, 95%> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95%o CI 1.1 to 2.1).
Obesity increases significantly health care costs and absenteeism.
Revista medica de Chile 04/2009; 137(3):337-44. · 0.33 Impact Factor
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ABSTRACT: It has been reported in Chile that obesity figures in children of 6- to 8-years-old are associated with height for age. We studied the possible influence of perinatal variables on obesity at 6- to 8-years-old controlling for height for age.
All children with 6-8 years of age attending first grade in public primary schools of Chile in year 2005 were included. An historical cohort design was used and perinatal information collected at birth was obtained from the National Registry. Obesity was defined as BMI >or=95th percentile of the CDC reference. Comparisons of obesity prevalence in contingency tables used the chi-squared test. Logistic regression was used to calculate ORs for obesity risk in univariate and multivariate categorical models.
Out of 167 494 initial subjects, 153 536 children entered the study. Obesity prevalence was higher in stunted and in tall for age children (20.1 and 26.0%, respectively) compared with those with normal height for age (17.3%) (P < 0.0001). Adjusted odds ratio for perinatal information showed that infants born male, premature and short in length at birth were more prone to obesity than their counterparts. However, birth weight (BW) had a stronger positive influence on obesity risk.
Taller and stunted children had higher obesity risk than normal height for age children. This association did not change when controlling for the influence of perinatal data; post-natal influences may be playing an independent role. Although BW was linearly associated with obesity, short and premature babies also had a higher risk of obesity.
International Journal of Epidemiology 08/2008; 37(4):902-10. · 6.41 Impact Factor
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ABSTRACT: To compare the performance of two tests for diagnosing latent tuberculosis (TB) infection in the HIV-positive population in Chile, in order to better identify the subjects who might benefit from TB chemoprophylaxis.
This was a cross-sectional study among individuals attending three HIV outpatient clinics in Santiago, tested with a 2-TU purified protein derivative, QuantiFERON((R))-TB Gold 'in-tube' (QFT-G), and a chest X-ray.
A total of 116 subjects were enrolled in the study, having a mean CD4 count of 393cells/microl (range 100-977). The tuberculin skin text (TST; 5mm cutoff) and QFT-G results were positive in 10.9% and 14.8% of the individuals, respectively, with moderate agreement between both tests (kappa=0.59). A history of both known TB exposure (odds ratio (OR) 3.46, 95% confidence interval (CI) 1.02-11.22) and past TB (OR 4.31, 95% CI 1.13-15.5) were associated with a positive QFT-G result. Only past TB was significantly associated with a positive TST result (OR 6.63, 95% CI 1.62-26.3). Among the subjects with TST<5mm, 8.2% were positive by QFT-G test. These individuals had a lower mean CD4 cell count than those detected positive by both tests (328cells/microl and 560cells/microl, respectively, p=0.03).
In this population of HIV-infected individuals, QFT-G and TST showed an acceptable level of agreement, although QFT-G appears less affected by more advanced immunosuppression.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 07/2008; 12(6):645-52. · 2.17 Impact Factor
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ABSTRACT: Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback.
To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital.
We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance.
Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlessness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334.
In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team.
Revista medica de Chile 06/2008; 136(5):561-9. · 0.33 Impact Factor
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ABSTRACT: Previous studies in Santiago, Chile have established that anemia in the earliest stages of pregnancy is a public health issue. The situation in other parts of the country is unknown. The purpose of this study is to establish the prevalence of anemia in pregnant women in the province of Concepcion and evaluate its association with maternal nutricional status and fetal growth. The study included 1782 women with singleton pregnancies who began prenatal check-ups in 2004 at the public primary health care centers. Anemia was established using the following criteria: from WHO (Hb < 11 g / dl) and from the USA Center for Disease Control (CDC) (Hb < percentile 5 for each gestational week). Anemia prevalence was compared in relation to independent study variables: maternal age, parity, morbidity and smoking habit, and mother and child anthropometry. A multivariable logistic regression model studied the possible effect of anemia on fetal growth. The prevalence of anemia was 10.9% and 14.5% using the WHO and CDC criteria, respectively. The mother's nutritional status was significantly associated with anemia. However, anemia according to WHO and CDC criteria at the beginning of pregnancy was not significantly associated to fetal growth in the univariate and multivariate analyses. The prevalence of anemia in the province of Concepcion constitutes a public health problem that needs to be addressed and it is slightly higher to that recently observed in the county of Puente Alto, Santiago.
Archivos latinoamericanos de nutrición 06/2008; 58(2):132-8. · 0.23 Impact Factor
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ABSTRACT: Tuberculosis (TB) in Chile is reaching the elimination phase; however, in HIV positive individuals the incidence of TB in still very high.
To describe the association between TB and HIV in different geographical regions in Chile, and to determine the association between TB and HIV/AIDS mortality.
A retrospective study that included individuals from the main HIV clinics from four regions with different TB prevalence in the general population (per 100,000): Arica (>30), Concepcion/Arauco (25-29), Valparaiso/San Antonio (20-24) and Metropolitana Sur-Oriente (SSMSO) (<20), attended between January 1998 and September 2004.
Nine hundred and twelve HIV positive individuals were included. Global prevalence of TB was 6.2% [95% confidence intervals (Cl) 5.2-7.2%]. TB was more common in older subjects (p =0.039) and those with lower CD4 counts (p <0.001) and higher HIV viral load (p =0.033). In 66% of cases, the disease had a pulmonary localization. TB was the recorded cause of death in 7.4% of subjects. Only 29% of patients had a tuberculin skin test performed at the moment of HIV diagnosis. The prevalence of TB in HIV positive patients, followed the trend of TB prevalence in the general population: Concepcion/Arauco (11.9%), Valparaiso/San Antonio (7.1%) and SSMSO (3.9%). However HIV positive subjects from Arica showed an unexpectedly low TB prevalence (5.5%).
TB in HIV/AIDS patients included in this study is over 300 times more prevalent than in the general population. TB prevalence in HIV positive subjects follows regional TB prevalence, excepting Arica. Effectiveness and feasibility of latent TB diagnostic strategies and treatment in HIV positive individuals should be reviewed.
Revista medica de Chile 05/2008; 136(5):578-86. · 0.33 Impact Factor
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Francisco Mardones,
Guillermo Marshall,
Paola Viviani, Luis Villarroel,
Barton R Burkhalter,
José-Luis Tapia,
Jaime Cerda,
Trinidad García-Huidobro,
Constanza Ralph,
Enrique Oyarzún,
Francisco Mardones-Restat
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ABSTRACT: The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.
Journal of Health Population and Nutrition 03/2008; 26(1):54-63. · 0.95 Impact Factor
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ABSTRACT: To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes.
Non-blinded, randomised controlled study.
Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile.
Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495).
Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5-126 g; P = 0.03) and the incidence of very preterm birth (0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19-0.96 cm; P = 0.003).
The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.
Public Health Nutrition 02/2008; 11(1):30-40. · 2.17 Impact Factor
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ABSTRACT: Apolipoprotein E (apoE) isoforms are genetic determinants of interindividual variations in lipid metabolism. To assess whether apoE is a genetic risk factor for cholesterol gallstone disease (GD), we analyzed apoE variants in populations from Chile and Germany, two countries with very high prevalence rates of this disease. ApoE genotypes were determined in Chilean gallstone patients (n = 117) and control subjects (n = 122) as well as in German gallstone patients (n = 184) and matched controls (n = 184). In addition, we studied apoE variants in subgroups of Chilean patients with strong differences in their susceptibility to acquire gallstones: 50 elderly subjects without gallstones in spite of well-known risk factors for this disease (gallstone-resistant) and 32 young individuals with gallstones but without risk factors (gallstone-susceptible). Furthermore, correlation analysis of apoE genotypes with cholesterol crystal formation times, biliary cholesterol saturation index (CSI), and gallstone cholesterol contents was performed in 81 cholecystectomized patients. In this study analyzing the largest sample set available, apoE4 genotype was not associated with an increased frequency of GD in either population. Moreover, in the Chilean population after adjusting for risk factors such as gender, age, body mass index, serum lipids, and glucose, the odds ratio for the association of the apoE4 allele and GD was significantly (P < 0.05) <1. Also, genotypes were not correlated with cholesterol crystal formation time, CSI, or gallstone cholesterol content. In contrast to previous smaller studies, apoE polymorphisms were not associated with susceptibility to cholesterol GD in high-risk populations.
The Journal of Lipid Research 07/2007; 48(6):1378-85. · 5.56 Impact Factor
