Ada Cuevas M

Ingesta de nutrientes en adultos mayores de la comuna de Providencia, Santiago de Chile

Background: The information available on food intake in the elderly in Chile is restricted to individuals of low socioeconomic groups, but there is no data available on food intake in elderly of higher income groups. Aim: To assess food intake in a group of elderly people from Providencia County in Santiago, a middle income community. Subjects and methods: Forty one subjects (20 male), aged 60 to 73 years, were studied. Trained volunteers applied a 3 days food registry, to determine food intake. Intake was assessed using 1985 FAO/OMS/UNU recommendations for energy intake and USA Food and Nutrition Board recommendations for micronutrient intake. Results: The studied subjects had an adequate macronutrient intake, when compared with current recommendations. There was a relatively low intake of calories from fat (24.6% in males and 26.1% in females). Also, vitamin and mineral intake was adequate with the exception of calcium (64.5% and 57.9% of recommendation in males and in females respectively), zinc and folic acid (74.2% and 62.4% in males and females respectively). The intake of legumes and cereals was relatively low. Conclusions: Food intake in this group of individuals was substantially higher than that reported previously for poor elderly Chileans and similar to that of industrialized countries. Food intake of the elderly is probably related to socioeconomic level (Rev Med Chile 2002; 130: 1335-42)

El colesterol HDL: ¿un nuevo objetivo terapéutico en el manejo de las dislipidemias y la ateroesclerosis?

Low plasma HDL cholesterol levels are an independent risk factorfor atherosclerotic cardiovascular disease. During the past years, the study of HDL has beenstimulated by the discovery of novel genes and proteins, which have provided new insights intothe molecular and cellular mechanisms involved in HDL metabolism. In addition, recentclinical studies focused on treating low HDL as primary objective in high cardiovascular riskpatients have been very encouraging. Furthermore, new drugs for raising HDL cholesterol areunder development. This article reviews the recent progress in the HDL field and its importantimplications for the pathophysiology and treatment of atherosclerosis. In the near future, weexpect that new drugs with specific and beneficial effects on HDL metabolism and the associatedcardiovascular risk should improve the current approach to this disease with high burden onhealth systems and society (Rev Med Chile 2005; 133: 823-32).(

Disfunción endotelial como alteración primaria en las patologías vasculares

Endothelium controls vascular smooth muscle tone by secreting relaxing and contracting factors. There is a constant release of endothelium derived relaxing factors, mainly nitric oxide, a potent vasodilator, inhibitor of platelet aggregation, monocyte adhesion and smooth muscle proliferation. In addition, the endothelium may increase the release of NO in response to humoral stimulation by vasoactive substances such as acetylcholine, bradikinin or substance P. Although the endothelium releases a number of products, no single blood test has yet proved useful to determine normal endothelial function or as early abnormalities. The most useful test of endothelial function relies on the meassurement of endothelium-dependent dilatation in response to pharmacological or physiologic stimuli. The alteration of this response is known as endothelial dysfunction and has been observed in a variety of circumstances related to cardiovascular risk. This review summarizes the evidence that sustains this association and emphasizes the clinical utility of assessing endothelial function presenting two clinical cases of hypercholesterolemia in which a high-resolution vascular ultrasound in the braquial artery was used. (Rev Med Chile 2000; 128: 659-70).

Lo último en diagnóstico y tratamiento de la obesidad: ¿Hay lugar aún para la terapia conservadora?

In Chile and other countries the actual prevalence of obesity is reaching 30% in selected populations (low income women). Nowadays bariatric surgery appears to be the treatment of choice. However, it is only indicated in selected patients and is not the first line treatment, since it does not prevent or reduce the appearance of this condition, a crucial challenge in its clinical management. The contemporary medical management of obesity should include changes in lifestyle habits and diet together with a behavioral therapy. However, this optimal management requires a multidisciplinary team. A challenge for contemporary medicine is to design efficient interventional strategies to change lifestyles among the obese. These interventions are the only way to reduce the adverse health consequences of obesity.In Chile and other countries the actual prevalence of obesity isreaching 30% in selected populations (low income women). Nowadays bariatric surgeryappears to be the treatment of choice. However, it is only indicated in selected patients and isnot the first line treatment, since it does not prevent or reduce the appearance of this condition,a crucial challenge in its clinical management. The contemporary medical management ofobesity should include changes in lifestyle habits and diet together with a behavioral therapy.However, this optimal management requires a multidisciplinary team. A challenge forcontemporary medicine is to design efficient interventional strategies to change lifestyles amongthe obese. These interventions are the only way to reduce the adverse health consequences ofobesity (Rev Med Chile 2005; 133: 713-22).(

Diferencias en antioxidantes plasmáticos según nivel socioeconómico en mujeres chilenas

BACKGROUND Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). AIM To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. PATIENTS AND METHODS Blood samples were taken from 81 women for measurements of plasma ascorbic acid, beta-carotene, alpha-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). RESULTS Individuals in the lower SEL showed reduced levels of plasma beta-carotene, ascorbic acid, alpha-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. CONCLUSIONS The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL.

Evaluación ultrasonográfica de la función endotelial en niños y adultos chilenos

: Flow mediated dilation of thebrachial artery was measured by high resolution ultrasonography in healthy children (n=32)and adults (n=69) of both gender, in a group of 8 healthy women during 4 periods of pregnan-cy and late postpartum, and in 22 men and women with a history of stroke or coronary heartdisease.

Hipercolesterolemia familiar heterocigota: diagnóstico molecular y terapia combinada. Caso clínico

Heterozygous familial hypercholesterolemia affects one every 400 individuals, is caused by mutations in the LDL receptor gene and is associated with premature coronary artery disease. Nowadays, LDL cholesterol can be efficiently reduced with the new therapies to reduce blood lipids. We report a female patient who consulted in 1975, when she was 46 years old, for severe hypercholesterolemia. In 2003, a sample of leukocyte DNA was obtained and the uncommon 1705 + 1G >A mutation of the LDL receptor gene was detected. No mutations in the apolipoprotein B gene were found. The patient was treated successfully with simvastatin 80 mg/day and ezetimibe 10 mg/day and LDL cholesterol levels were reduced below 200 mg/dl

Mecanismos de hipo e hiper alfalipoproteinemia en individuos adultos chilenos

Background: High density lipoprotein (HDL) cholesterol is inversely associated to atherosclerotic cardiovascular risk. Disturbances in HDL cholesterol plasma leves are frecuent in the Chilean population, however the pathophysiological mechanisms are unknown. Aim: To evaluate the mechanisms involved in the hypo and hyper alfalipoproteinemias in Chilean subjects. Materials and Methods: Twenty three subjects with hyperalphalipoproteinemia and 12 with hypoalphalipoproteinemia, paired with control subjects (colHDL between 35 and 55 mg/dl) were studied. We measured plasma lipids, subfractions and sizing of HDL particles and enzymatic activity of cholesteryl ester transfer protein (CETP), lecithin: cholesterol acyltransferase (LCAT), lipoprotein lipase (LPL) and hepatic lipase (LH). Results: Subjects with hyperalphalipoproteinemia showed significantly higher levels of total HDL-cholesterol (70±2 vs 44±1 mg/dl), HDL 2 (30±3 vs 5±1 mg/dl), Apo A I (175±3 vs 146±4 mg/dl), lower HL activity (23,7±0,8 vs 32,4±1,8 mmol/h/l) and HDL particles of greater size, compared to their controls. Subjects with hypoalphalipoproteinemia, showed significantly lower levels of total HDL-cholesterol (26±1 vs 48±2 mg/dl), HDL 3 (21±1 vs 40±2 mg/dl), Apo A I (107±5 vs 145±7 mg/dl), lower LCAT activity (18,6±1,9 vs 26,2±1,6 nmol/h/ml) and smaller HDL particles, compared to their controls. Conclusion: Changes in hepatic lipase and lecithin cholesterol acyltransferase activities may explain the hyper and hypo alphalipoproteinemia respectively, in Chilean subjects (Rev Med Chile 2004; 132: 421-8). (Key Words: Lecithin acyltransferasa deficiency; Lipoproteins, HDL; Lipoproteins, HDL cholesterol; Lipoproteins, VLDL cholesterol)