Consensus Conference Series on Dysglycemia‑Based Chronic Disease (DBCD) in Latin America: The Chilean Transculturalization

T2D: men 1.3%, women 1.7%.

IGT: men 2.6%, women 4.3%.

Obesity: men 12.8%, women 23.5%.

High total cholesterol (≥ 200 mg/dl): men 36.8%, women 37.4%.

Hypertension: men 19.2%, women 17.7%.

Sedentariness: men 5.1%, women 3.4%.

T2D prevalence: 17.3%

Higher prevalence of cognitive impairment with vs. without T2D: 30.7% vs. 13.9%

Risk of cognitive impairment: 2.8 times higher with vs. without T2D

HOMA‑IR (significant ethnicity x environment interaction: P = 0.0003):

• ◦ Rural Mapuche: 1.65 ± 2.03

• ◦ Urban Mapuche: 4.90 ± 3.05

• ◦ Rural European: 0.82 ± 0.61

• ◦ Urban European: 1.55 ± 1.34

The effect of urbanization on HOMA‑IR was greater in Mapuche compared to European individuals

Ethnicity (significant interactions for all P < 0.004):

• ◦ Adiposity on HOMA‑IR

• ◦ Sedentary time on HOMA‑IR

• ◦ PA on HOMA‑IR

The effects of adiposity, sedentary time, and PA on HOMA‑IR were greater in Mapuche compared to European individuals

PA levels:

• ◦ Men: 3731 ± 3923 METs‑minutes/week

• ◦ Women: 1360 ± 2303 METs‑minutes/week

Insufficient PA levels:

• ◦ 50% of women

• ◦ 21.5% of men

Intense PA levels:

• ◦ 60% of men

• ◦ 23.4% of women

Inverse association PA and insulin resistance

High PA was protective against low HDL‑c and high TGs, particularly among men

A1C levels:

• ◦ INT: 8.3 ± 2.3% to 8.5 ± 2.2% (maintained, P = NS)

• ◦ CON: 7.4 ± 2.3% to 8.8 ± 2.3% (deteriorated, P < 0.001)

Perception of self‑efficacy:

• ◦ INT: improved, P < 0.001

• ◦ CON: unchanged (P = NS)

INT and CON: no change in adherence to medication, PA, and foot care

INT: increased attendance with clinic visits and decreased emergency care visits

T2D prevalence: 12.3% (majority were women 58.1%)

Medication’s use among patients with diabetes: 60.7%

• ◦ Higher medication’s use in women

• ◦ Lower medication’s use in younger age groups <65 years old

• ◦ Lower medication’s use among indigenous peoples

• ◦ Medication use increased with more years of study

With effective coverage for diabetes management, 54.2% had their disease controlled

Medications:

• ◦ Oral agents 79%; metformin 58%; glyburide 65%; tolbutamide 8%

  • ▪ Using one oral agent: 49%

  • ▪ Using two oral agents: 40%

• ◦ Insulin: 3%

CVD program visits:

• ◦ Met the target of two visits in the past 6 months: 33%

• ◦ Made more than three visits: 32%

• ◦ Inadequate program contact: 27% (many in poor health)

Program impact:

• ◦ Greater use of CVD program associated with higher patient satisfaction (after controlling for confounders)

• ◦ Many participants had difficulties with lifestyle changes

• ◦ Greater use of CVD program not associated with healthier behaviors

Telephone access:

• ◦ Reported telephone access: 95%

• ◦ Used telephone to contact clinic: 37%

• ◦ Majority willing to use telephone care for behavior change and emotional support

Subjects with vs. without T2D had lower educational level, lower SES, and higher BMI and WC

Subjects with T2D reported:

• ◦ Lower total PA

• ◦ Greater consumption of salt, fruits, and vegetables

• ◦ Higher overall dietary score

• ◦ Higher prevalence of ex‑smokers or non‑smokers

• ◦ Poor to fair perception of their health/wellness.

• ◦ Increased metabolic complications

• ◦ Higher incidence of family history of T2D

Greater risk for T2D with:

• ◦ Overweight/obesity

• ◦ Sleep > 9 hours nightly

• ◦ Physical inactivity

• ◦ Hypertension

Lowed risk for T2D with:

• ◦ Intermediate or higher educational level

• ◦ Good perception of well‑being/health

263 non‑diabetic adults, minor allele of SLC16A11 gene prevalence 29.7%

Higher BMI is independently associated with polymorphic SLC16A11 genotypes

Survey completed by 1,000 patients with obesity and 200 HCPs, 74% of patients with obesity and 95% of HCPs view obesity as a chronic disease

Most patients with obesity believe they are personally responsible for their weight loss

Patients identified lack of exercise and cost of weight management as significant barriers to weight loss

Among 6823 students 17–29 years old, 47% skipped breakfast and 35% skipped lunch daily

Daily consumption of vegetables, fruits, and dairy products was low; consumption of soft drinks, chips, cakes, and sweets was high

76% of students were sedentary, 40.3% were smokers, and 27.4% were overweight/ obese, with the latter group having more diabetes, hypertension, and hypercholesterolemia

There was poor agreement between actual nutritional status and self‑perception, particularly among males

Students with a food scholarship from the Ministry of Education had a higher frequency of eating lunch

NHS conducted in 2016–2017, over 75% with excess weight

Women with lower SES had higher excess weight and shorter stature

In men, excess weight did not vary significantly by SES, but short stature was more common with low SES

Obesity more frequent in indigenous women and men

Chilean population aged ≥2 years (n 4920) from a NHS (2010)

Ultra‑processed foods are 28.6% of total energy intake

Positive association between ultra‑processed food consumption and higher intake of nutrients that promote non‑communicable diseases (e.g., free sugars, total fats, saturated fats, trans fats, and increased Na:K ratio; negative association with protective nutrients (e.g., potassium and fiber)

Apart from sodium, inadequate nutrient intake increased with higher consumption of ultra‑processed foods

Reducing ultra‑processed food intake to the lowest quintile could significantly reduce nutrient inadequacy

Chilean NHS (2009–2010), 5434 persons aged ≥15 years (59% women), 19.8% did not meet PA recommendations (≤600 MET min/week)

PA was more prevalent among subjects ≥65 years old, and women exhibited higher rates than men

Subjects with higher education or income levels showed lower PA

The overall prevalence of sedentary behavior (>4 hours sitting per day) was 35.9%

Chilean NHS (2009–2010), 4,457 adults aged ≥18 years, the OR for T2D increased by 1.10 for men and 1.08 for women for each additional hour of sitting time, independent of age, education, smoking, BMI, and total PA

The prevalence of T2D was 10.2% with lowest sitting time and 17.2% with highest sitting time

Chilean NHS (2009–2010), n = 5,157. Inactive men and women had higher ORs (1.77 and 1.25, respectively) for obesity than physically active peers

Inactive men and women had higher ORs (2.47 and 1.72, respectively) for T2D than physically active peers

Inactive men and women had higher ORs (1.66 and 1.83, respectively) for hypertension than physically active peers

An association between physical inactivity and central obesity (OR: 1.92) and metabolic syndrome (OR: 1.74) was observed only in men

Retrospective analysis of 1,815 OGTTs in non‑diabetic adults aged 18–75. 75th percentiles for serum insulin levels: 60 minutes ‑ 127 μU/mL; 120 minutes ‑ 81 μU/mL

High correlation (r = −0.89) between HOMA‑IR and composite whole‑body insulin sensitivity index

Chilean NHS (2003, 2009–2010, 2016–2017), 8,182 persons aged ≥15 years.

Optimal cut‑off points for WC defining metabolic syndrome were 92.3 cm for men and 87.6 cm for women

344 adults (55.8% women). Sociodemographic covariates did not significantly predict BMI

Physiological covariates, behavioral variables, and weight stigma were associated with BMI

Weight stigma was the predictor explaining the most BMI variance