Folatos y riesgo de cáncer de mama: revisión sistemática / Folate and breast cancer risk: A systematic review

An increased folate intake may be beneficial in deficient populations. However, in women with adequate levels it may not deliver additional benefits while it may increase the risk for some forms of cancer. A systematic literature review of benefits or risks of folate in the development of breast cancer was performed using MEDLINE, systematic review of selected articles and references of the selected articles looking specifically at serum folate levels, dietary folate intake or total folate intake and the risk of developing breast cancer. Fourteen case-control studies, fourteen cohort studies, seven case-control nested studies, two randomized trials and two meta-analyses were selected for analysis based on pre-established criteria. The reviewed evidence does not support the hypothesis that higher intakes of dietary folate reduce the risk for breast cancer. Some studies showed a higher risk of breast cancer in populations exposed to high folate intake post fortification, especially when folic acid is used. The results support the need to be cautious and to limit the exposure of women to high intakes of folic acid, especially in countries with mandatory food fortification.

Encuesta nacional online aplicada en pacientes con enfermedad celíaca en Chile / A national online survey applied to patients with celiac disease in Chile

Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1 percent. Aim: To analyze epidemiological aspects and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Material and Methods: Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.fundacionconvivir.cl. The answers were reinforced with a telephone interview. Results: The survey was answered by 1212 subjects (79 percent females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9 percent, only by intestinal biopsy in 17.5 percent, and by a combination of both methods in 70 percento. Conditions associated with CD were reported by 30 percent> of subjects and 20 percent> had relatives with CD. The GFD was strictly adhered to by 70 percent>, occasionally by 27 percent> and never by 3 percent>. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42 percent> of those with incomplete or lack of adherence (odds ratio 4.0, 95 percent> confidence intervals 2.8-5.7p < 0.01). Conclusions: In 30 percent of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25 percent> did not experience a clinical improvement despite a strict GFD, a finding which requires further study.

Fortificación de la harina de trigo con ácido fólico en Chile: Consecuencias no intencionadas / Flour fortifcation with folic acid in Chile: Unintended consequences

Background: High daily intake of folic acid (FA) could determine health risks in some populations. Aim: To review the Chilean FA wheat four fortifcation and to identify the existence of populations at risk. Material and Methods: We categorized the FA levels in four samples (percentil P) (2005-2008) and estimated intake of FA (mg/d) in adults from apparent bread consumption according to different levels (P20, 50 and 95) and children consumption (8-13 years) considering socioeconomic status (SES), bread/g/d intake (P20, 50 and 75) and regulated level of four fortifcation (2.2 mg FA/100 g). Daily Dietary Folate Equivalent (DFE) consumption was estimated from serum folate in adults and elderly people (both sexes). We calculated the percentage of population with FA intakes over the estimated average requirement (EAR) and maximum level (UL) pre and post-fortifcation. Results: There is great variability in FA four: 10-20 percent samples without FA and 10-30 percent with levels > 2.2 mg/100 g. Adult daily consumption (2-4 day/loaves) could determine FA intakes close to UL. Children daily bread consumption (low socioeconomic level) > P75 have intakes close to UL. Post-fortifcation estimated daily DFE from serum folate in women, men and elderly people show: 99 percent of women, 100 percent of men and the elderly people have intakes higher than EAR. Additionally 2.3 percent of women and 6 percent of men would have intakes near the UL. Conclusions: The four FA levels and serum folate levels in some populations show increased FA post-fortifcation intakes, which could lead to greater risk suggesting a revision of the fortifcation level.

Costo de una canasta básica de alimentos para celíacos en Chile / Costs of a basic food basket for celiac patients in Chile

Celiac disease requires a strict gluten free diet for life for proper recovery. This results in higher feeding costs. Aim: To analyze the cost of basic food basket (BFB) compared to a basket especially designed for celiac patients in Chile and to estimate the increment in food spending that these patients experience. Material and Methods: The cost of a daily BFB was calculated using the National Socioeconomic Characterization Enquiry (CASEN) methodology of the Ministry of Planning and the food prices delivered by the National Institute of Statistics for consumers, adjusted according to consumer prices at june 2007. To calculate the cost of the basket for celiac disease, equivalent foods without gluten were considered. Their daily and monthly values and the percentage difference between them were analyzed, by food groups and type of basket. Results: The monthly value of BFB and a basket for a celiac is, at june 2007, Ch $ 30.251 and Ch $ 57.250, respectively. This represents an increase in feeding costs for celiac patients of 89 percent. Conclusions: The greater cost of food without gluten represents a ¡imitation in the budget of celiac patients.

Evaluación de un modelo de intervención para fomentar estilos de vida saludables en preescolares / Evaluation of an intervention model to stimulate healthy life habits in preeschool children

El propósito del estudio fué probar un modelo de intervención orientado a fomentar estilos de vida saludables en preescolares con énfasis en hábitos alimentarios y actividad física. La muestra estuvo constituida por 100 preescolares (50 intervenidos y 50 controles) de 4 centros INTEGRA de la Región Metropolitana. El modelo consideró educación alimentaria y fomento de la actividad física, desarrollada por el personal institucional previamente capacitado y en una modificación de la alimentación institucional. Para validar la metodología de evaluación de impacto se determinó estado nutricional, ingesta alimentaria, desarrollo motor, conocimientos alimentarios maternos y hábitos alimentarios del niño en el hogar. Para la evaluación del proceso se realizaron visitas de observación y entrevistas. El 35 por ciento de los niños estudiados presentaba exceso de peso. Se observó un bajo consumo de verduras, frutas, pescados, calcio y fibra y alto consumo de golosinas. Las madres mostraron un buen nivel de información. Las modificaciones a la alimentación no produjeron problemas ni de aceptación ni adminstrativos. La promoción de alimentación y actividad física saludable se incorporó a la rutina diaria. Se demostró la necesidad de capacitación y asesoría en terreno. Se concluye que el modelo es factible de aplicar con los esquemas de funcionamiento y recursos institucionales y solo se deben modificar algunos instrumentos de evaluación por su baja sensibilidad para medir impacto

Propuesta de un nuevo estándar de evaluación nutricional en embarazadas / Proposal of a new standard for the nutritional assessment of pregnant women

Background: There is evidence to suggest that the criterial for nutritional assessment of pregnant women, uses by the Chilean Ministry of Health, overestimates nutritional disturbances. Aim: To propose a new reference table to assess the nutritional status of pregnant women, based on body mass index. Material and metbods: The table was theoretically defined using criteria for normality proposed by FAO and the weight increase during pregnancy that is associated with a lower maternal and fetal morbidity and mortality. In 665 pregnant women, weight, height, mid arm circumference and skinfolds were measured using standard techniques. Body mass index, arm fat and muscle area and percentage of body fat were calculated. Body composition for each nutritional category, derived from the body mass index or "Rosso-Mardones classification", was analyzed. Results: According to the new table, under weight women had lower percentage of body fat and mid arm circunference and overweight women had higher weight, skinfold thickness and percentage of body fal than the homologous groups defined according to Rosso-mardones tables. Conclusions: The proposed reference table may be useful to correct distortions generated by the current norms for nutritional assessment of pregnant women, proposed by the Chilean Ministry of Health. It has to be validated, analyzing its sensitivity, specificity and predictive value to predrict fetal and maternal variables

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

Alimentación del menor de 18 meses: relación con el estado nutricional / Feeding of the infant under 18 months: relation with nutricional level

Con el propósito de determinar la prevalencia de lactancia materna en Chile y su relación con el estado nutricional, se estudió una muestra representativa de 9330 menores de 18 meses controlados en el Sistema Nacional de Servicios de Salud. Se determinó la alimentación del día anterior (lactancia exclusiva, lactancia más solidos, lactancia más fórmula, fórmula exclusiva, fórmula mas sólidos) y el estado nutricional respecto a las normas del Centro Estadounidense de Estadísticas de Salud y la OMS, considerando riesgo un valor inferior a una desviación estándar. La prevalencia de de lactancia exclusiva fue 86,5; 66,7 y 25,3 porciento al primer, tercer y sexto mes respectivamente. El 12,1 y 30,7 porciento de la muestra presentó déficit de peso y talla y el 35,7 porciento sobre peso según peso/talla (>1 DE). El déficit de peso/edad fue 1.2 a 5.0 veces mayor con lactancia artificial en relación a natural, en los distintos grupos de edad (

Malnutrición de la embarazada: ¿un problema sobreestimado? / Malnutrition in pregnancy woman: an overestimated problem?

The aim of this work was to compare the nutritional classification of pregnant women and their predictive value for the low birth weight, using the criteria of the Ministry of health (Rosso-Mardones curves) with the curves developed at the Department of Nutrition of the Faculty of Medicine and the body mass index. One thousand eight hundred four pregnancy women of the Metropolitan Region, that were devoid of factors affecting birth weight, were studied retrospectively. Initial and final nutritional status was calculated according to the three criteria in study. Results showed that 47 to 75 percent of women classified as undernourished using Rosso-Mardones curves, were normal according to the curves of the Department of Nutrition and body mass index. Rosso-Mardones curves had the lower predictive value, relative risk and risk attributable to maternal nutritional deficit, for low birth weight. Also these curves showed a higher of obesity and a low predictive value for macrosomia. It is concluded that the curves used by the Ministry of Health must be revised

Estado nutricional de la poblaci{on infantil y programa nacional de alimentación complementaria 1990-1991 / Nutritional status of infant population and complementary feeding national programme 1990-1991

Se analizó el efecto de la modificación del Programa Nacional de Alimentación Complementaria que mejoró la calidad y cantidad de los productos entregados en niños de 12 a 23 meses a partir de 1991. Se compararon población bajo control, retiro de productos, prevalencia de desnutrición y kilos distribuidos según subprograma en todo el país, durante 5 meses de los años 1990 y 1991 y los cambios ocurridos en niños de esas edades con respecto a los de edades para las que el programa no fue modificado. En 1991 aumentó la población bajo control (2,3 por ciento) y la que retiraba alimentos del programa básico (9,6 por ciento), especialmente en niños de 12 a 23 meses (54 por ciento). La prevalencia de desnutrición por peso/edad (Sempé), peso/talla (NCHS/OMS) y roesgo a desnutrir disminuyó en 7,8, 2,7 y 4,2 por ciento respectivamente. La mejoría se observó en todos los grupos, siendo mas positiva la tendencia en los menores de 6 meses y menor la reducción de 12 a 23 meses. Se concluye que hubo mayor adhesión al programa, pero escaso efecto nutricional. Considerando la magnitud de los recursos invertidos debieran estudiarse alternativas de focalización que mejoren la efectividad de esta intervención nutricional