Evaluación del impacto de una intervención alimentario nutricional en niños chilenos con malnutrición por déficit / Impact evaluation of a nutritional intervention in Chilean children with malnutrition

Background: In the year 2003, the Ministry of Health replaced rice from the Complementary Nutritional National Program destined to malnourished and in risk children, for a product with higher nutritional value ("Mi Sopita"). Objective: Evaluate the effect of this intervention in the nutritional evolution of children under 6 years-old, in risk or suffering malnutrition. Method: Retrospective cohort of 1.576 children registered in the program 6 months earlier in 300 Primary Care establishments. Analysis of the evolution of anthropometric indicators for a period of 6 months, in function of the initial diagnosis and age. Logistic regressions of multiple factors to determine the variables associated to a better nutritional evolution. Results: 80 percent of cases presented nutritional risk and the rest malnutrition. In 6 months, the median value of change in Z score for weight/age was + 0,3 SD (95 percent IC 0,3-0,3), height/age +0,3 SD (0,3-0,4) and weight/height +0,5 SD (0,3-0,6) in children with initial values < -2 SD. The change was approximately 0,1 SD for the group with nutritional risk. Between 44 percent and 69 percent of the children with malnutrition got partially better or normalized their nutritional status according to the different indicators (p < 0,001). The most determinant factor for better evolution was major initial nutritional deficit (OR 4,4 IC 3,2-6,1 p < 0,001 for weight/age). Conclusions: The program has a positive effect in the recovery of malnourished children and it avoids major nutritional deterioration in children at risk.

Antecedentes: El 2003 el Ministerio de Salud introdujo un nuevo alimento de mayor valor nutricional (Mi Sopita) en el Programa Nacional de Alimentación Complementaria de refuerzo destinado a niños en riesgo nutricional y desnutridos. Objetivo: Evaluar el efecto de esta intervención en la evolución de los indicadores antropométricos y estado nutricional de menores de 6 años en riesgo y desnutridos. Material y Método: Cohorte retrospectiva de 1 576 niños ingresados al programa 6 meses atrás en 300 establecimientos de atención primaria. Análisis de la evolución de la relación peso-edad, talla-edad y peso-talla entre el ingreso y los 6 meses, en función del diagnóstico inicial y la edad. Regresiones logísticas multivariadas para determinar los factores asociados a una mejor evolución nutricional. Resultados: El 80 por ciento de la muestra presentaba riesgo nutricional y el resto desnutrición. En 6 meses la mediana de cambio del puntaje Z en niños que ingresaron con valores < - 2 DE fue de + 0,3 DE (95 por ciento IC 0,3-0,3) para peso-edad, + 0,3 DE (0,3-0,4) para talla-edad y +0,5 DE (0,3-0,6) para peso-talla. El cambio fue menor (aproximadamente + 0,1 DE para el grupo en riesgo nutricional. El 44 al 69 por ciento de los niños desnutridos mejoró parcialmente o normalizó su estado nutricional según los diferentes indicadores (p < 0,001). El factor más determinante de una mejor evolución fue un mayor déficit nutricional inicial (OR 4,4 IC 3,2-6,1 p < 0,001, para la relación peso-edad). Conclusiones: El programa tiene un efecto positivo en la recuperación de los niños con desnutrición y evita un mayor deterioro nutricional en los niños en riesgo.

Prioridades de intervención en alimentación y nutrición en Chile / Food and nutrition intervention priorities in Chile

The demographic and nutritional transition in Chile has been reflected by a high and growing prevalence of obesity and chronic illnesses related to nutrition. In spite of the efforts made, it is not likely that the country will comply with the health objectives proposals for 2010 to reduce obesity and sedentary tendencies. As part of their functions the National Health Food and Nutrition Advisory Council has recently checked and defined the national priorities in this area. In the Council's opinion, the efforts should be oriented to strengthen the nutritional intervention strategy through the vital cycle, to improve the institutional capacity of the country as far as food is concerned, to review and modernized feeding programmes and to develop a strategic alliance with food producing companies, scientific societies, academic groups and consumers. These actions are directed to promote a wider and better offer of healthier food and to regulate publicity. In order to advance in these proposals we need a major investment from public and private resources oriented to promote healthier styles of living, with special emphasis on nutrition and physical activity.

La transición demográfica y nutricional que vive Chile se ha reflejado en una prevalencia alta y creciente de obesidad y enfermedades crónicas vinculadas a la alimentación. A pesar de los esfuerzos realizados es poco probable cumplir con las metas sanitarias propuestas para el 2010 en cuanto a reducir la obesidad y el sedentarismo. Como parte de sus funciones el Consejo Asesor en Nutrición y Alimentación del Ministerio de Salud ha revisado recientemente y definido las prioridades nacionales en este campo. En la opinión del Consejo los esfuerzos debieran orientarse fundamentalmente a fortalecer la estrategia de intervención nutricional a través del ciclo vital, a mejorar la capacidad institucional del país en el ámbito de los alimentos, a revisar y modernizar la gestión de los programas alimentarios y a desarrollar una alianza estratégica con las empresas productoras de alimentos, sociedades científicas, grupos académicos y con los propios consumidores orientada a promover una mayor oferta y consumo de alimentos saludables y a regular la publicidad en este campo. Para avanzar en la meta propuesta se requiere sin duda de una mayor inversión de recursos públicos y privados fundamentalmente orientados a la promoción de estilos de vida saludable, con especial énfasis en alimentación y actividad física.

Evaluación de la aceptabilidad y consumo de un nuevo producto del Programa Nacional de Alimentación complementaria: Mi sopita / Evaluation of acceptability and consumption of a new product from the National Program of Supplementary Nutrition: Mi Sopita

Antecedentes: En Chile, aún el 3,7 por ciento de los niños(as) menores de 6 años presenta déficit nutricional, los que son incorporados a un programa de refuerzo nutricional cuya evaluación permanente ha contribuido a mejorarlo. Objetivo: Evaluar la aceptabilidad y consumo de un nuevo producto (Mi Sopita) y de los principales factores asociados a la frecuencia y cantidad consumida. Material y Método: Estudio de prevalencia en una muestra representativa de 2 885 beneficiarios de 20 Servicios de Salud. Encuesta estructurada a la madre sobre retiro, frecuencia y forma de consumo, aceptabilidad y dilución intrafamiliar. Resultados: 85 por ciento de las familias retiran regularmente el alimento, 60 por ciento de las madres consideran que al niño (a) le gusta, 50 por ciento diluye el producto en la familia. El consumo promedio fue de 4,5 ± 2,1 días semanales, 1,5 ± 0,6 raciones diarias de 39,7 ± 22,0 gramos cada una, sin diferencias significativas por edad o estado nutricional integrado. La variable más determinante para el consumo fue la opinión de la madre sobre la aceptabilidad por el niño (a) y en menor grado la frecuencia de retiro, la dilución intrafamiliar y una relación peso-edad inicial < de 2 DE. Conclusiones: El producto tiene una adecuada aceptabilidad y consumo. La dilución intrafamiliar es menor que para los alimentos tradicionales. Es fundamental reforzar la educación al equipo de salud y la familia para mejorar la valoración social, el consumo y eventualmente el impacto nutricional.

Background: 3.7 percent of Chilean children under 6 years-old present a nutritional deficit and are incorporated into a reinforcement nutritional program with permanent evaluations that have contributed to its improvement. Objective: to evaluate the acceptability and consumption of a new product (Mi Sopita) and the main factors associated to frequency and amount consumed. Method: Prevalence study in a representative sample of 2 885 children from 20 Health Services. Structured survey to the mother about frequency, acceptability and product dilution within the family. Results: 85 percent families regularly get the food, 60 percent mothers consider that the child likes it and 50 percent dilute the product within the family. The average consumption was 4.5 ± 2.1 days weekly, 1.5 ± 0.6 daily rations of 39.7 ± 22.0 g each and no significant differences in age or nutritional status. The most determinant variable for consumption was the mother’s opinion about acceptability by the child and, in a lower degree, the frequency in obtaining the product, the dilution within the family and an initial weigh for age < 2 SD. Conclusions: Mi Sopita has an adequate acceptability and consumption. The dilution of the product within the family is less than the traditional food. It is very important to reinforce education to the health team and family, improve social level, consumption grade and the nutritional impact.

Características alimentarias de adultos mayores de comunas pobres de la Región Metropolitana / Alimentary features of elders living in poor communities of the Metropolitan Region of Chile

Background: The higher life expectancy of the Chilean population has required a greater concern about health and nutrition of elderly people. Aim: To assess the alimentation of people over 65 years old, living in communities of the Metropolitan Region with high social vulnerability. Material and methods: A random and representative sample of 257 elders living in the poorest communities of Santiago was studied. They were interviewed in their homes about feeding patterns, the alimentation of the day before and their nutritional status. Mean energy and nutrient consumption and their fitting to FAO/WHO energy and National Research Council micronutrient recommendations were calculated. A feeding quality index, that considers the adequacy of consumption of all nutrients, was calculated. Results: Except for bread, median consumption of all groups of foods was below recommendations. Median energy and protein consumption was 1438 Kcal and 53.9 g in men and 1118 Kcal and 37.7 g in women. Adequacy of consumption of all nutrients was low and the intake of energy, protein, calcium, iron and folate was significantly lower in women than in men. The factors associated with feeding quality in these subjects were a last meal of the day before different from supper, more than 15 hours of morning fasting and sex. Conclusions: Alimentation of elders living in poor communities of Santiago is severely deficient. Focalized intervention models to improve this situation should be devised

Patrones alimentarios en adultos que asisten a consultorios de atención primaria en la región metropolitana / Food patterns in adult outpatients at metropolitan region

A non-randomly selected group of 859 adults (410 men) from 120 health care centers of the National Health System (oct. 1995) was studied. Food intake was assessed by 24 hours recall applied by well-trained standarized nutritionists. Both frequency and food and nutrients intake were calculated. The mean age was 35.8ñ10.6 years old. Median energy, protein and fat intake in male were 2324 kcal, 84g y 70g, respectively. For women, medians intake were: 1668 kcal, 59g and 53g respectively. From the total sample 72 percent, 53 percent y 71 percent reported consumption of less than 2 servings of milk product, vegetables and fruits. Likewise 42, 36 and 22 percent of subjects had calcium, vitamin A and C intake below than 50 percent of the corresponding recommended dietary allowances (RDA). On the other hand 24 percent of the sample had daily salt consumption higher than 5g, 37 percent had energy intake derived from fat higher than 30 percent of total calories and 15 percent had more than 10 percent of the energy supplied by sugar. A significant part of the adult population had inadequate patterns of food intake which confirms the need to promote a healthier diet