Propuesta de un nuevo índice de calidad global de la alimentación / A proposed new index of global food quality

Various methodologies have been proposed to assess the overall quality of diet, but there are no specific indicators in Latin America. The purpose of this work was to propose a Healthy Eating Index according to the recommendations of the Chilean Ministry of Health and to validate their application in a national sample of students. A food frequency survey with 12 variables was used: 5 healthy foods, 4 unhealthy foods and 3 main meals. Each variable was rated from 1 (less healthy) to 10 (recommended by the Ministry of Health). Total scores were used to classify diets as healthy (90-120), in need of changes (60-89) and unhealthy (<60). The questionnaire was administered to 9,452 university students and was evaluated according to sex, age and nutritional status. The median score was 65.5 (54.5 to 77.9: p25-75) and 9.2% had healthy diets, 55.3% needed changes and 35.5% had unhealthy diets, without differences by sex and modest differences by nutritional status (p< 0.05). Younger age related to an unhealthy diet (p< 0.005). The instrument is easily applied by health professionals and can be adapted to the recommendations of each country. There are serious deficiencies in diet quality among college students, regardless of their nutritional status and sex.

Se han propuesto diversas metodologías para evaluar la calidad global de la alimentación, pero no existen índices específicos en Latinoamérica. El objetivo de este trabajo fue proponer un Índice de Alimentación Saludable de acuerdo a recomendaciones del Ministerio de Salud de Chile y validar su aplicación en una muestra nacional de estudiantes universitarios. Se utilizó la encuesta de frecuencia de consumo con 12 variables: 5 alimentos saludables, 4 no saludables y 3 de comidas principales. Cada variable fue evaluada de 1 (menos saludable) a 10 (recomendación ministerial) y el puntaje total se clasificó: saludable (90-120), necesita cambios (60-89) y poco saludable (< 60). Se encuestaron 9.452 estudiantes universitarios de diferentes y se evaluó el índice según sexo, edad y estado nutricional. La mediana fue solo 65,5 puntos (p25-75= 54,5-77,9); 9,2% saludable; 55,3% necesitaba cambios y 35,5% poco saludable, sin diferencias por sexo y muy leves según estado nutricional (p< 0,05). A menor edad menos saludable (p< 0,005). El instrumento fue fácil de aplicar por profesionales de la salud y puede ser adaptado a las recomendaciones de cada país. Existen graves deficiencias en la calidad de la alimentación en estudiantes universitarios, independientemente de su estado nutricional y sexo.

Does Chile's nutritional situation constitute a double burden?

BACKGROUND: Chile has probably experienced Latin America's fastest nutritional transition, as evidenced by very low rates of stunting, but the country shows a high prevalence of obesity in most population groups. OBJECTIVE: The aim was to assess the existence of a double burden of nutritional problems in Chile on the basis of available data. DESIGN: Secondary analyses were conducted on data collected by the Health Ministry (height and weight for children aged <6 y and for adults aged ≥65 y), the Education Ministry (height and weight in the first year of primary school and the first year of high school), the 2003 and 2009-2010 National Health Surveys [body mass index (BMI) and anemia prevalence], the 2010-2011 National Food Consumption Survey (ENCA; food consumption, height, and weight), and a Food Insecurity Survey of elderly adults (aged 65-74 y) in Santiago (height, weight, and food insecurity). RESULTS: In 2011 the prevalence of stunting (height-for-age < -2 z scores) was 1.9% for children <6 y old and 3.6% among children in the first year of primary school. This situation was in contrast with a high prevalence of obesity in children (22.1% of children in the first year of primary school; BMI ≥2 z scores) and among adults, especially women, increasing with age (44.8% of women 45-64 y old had a BMI ≥30 kg/m(2)). The prevalence of anemia in women aged 15-64 y was low (5.1%). In the ENCA survey, women showed a high prevalence of below-average intakes of vitamin A, vitamin B-12, vitamin C, calcium, and zinc, irrespective of BMI. Elderly persons who were underweight and those who were obese had a significantly greater perception of food insecurity in relation to those with a normal weight (61%, 50%, and 33%, respectively). CONCLUSIONS: The data showed high rates of obesity with very low frequency of stunting and, although more information is needed, the double burden of malnutrition probably does not exist in Chile, unlike in other countries in the region. Among specific groups there are low intakes of critical nutrients and food insecurity. Surveys that include anthropometric and biochemical measurements at the family level are needed to correctly evaluate the double burden of malnutrition in Chile.

Obesidad en mujeres chilenas en edad fértil / Prevalence of obesity among Chilean women in childbearing ages

Background: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. Aim: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. Material and Methods: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. Results: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. Conclusions: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.

[Assessment of dietary intake and urinary excretion of sodium and potassium in adults]. / Evaluación de la ingesta dietética y excreción urinaria de sodio y potasio en adultos.

BACKGROUND: Hypertension is associated with elevated sodium and low potassium intakes. The determination of sodium and potassium intake by dietary records is inaccurate, being its measurement from 24-h urine collection the reference method. AIM: To determine urinary sodium and potassium excretion in adults. To compare dietary sodium and potassium intake and their excretion from an isolated urine sample against the reference method. MATERIAL AND METHODS: Seventy healthy adults aged 35 ± 8 years with a body mass index 25 ± 2 kg/m² (36 women) were studied. Urine was collected over 24 h, including an isolated urine sample taken in fasting conditions. Additionally, three 24-h dietary records were performed. RESULTS: Reported sodium and potassium intake was 2,720 ± 567 and 1,068 ± 433 mg/day, respectively. In turn, urinary excretion of sodium and potassium was 4,770 ± 1,532 and 1,852 ± 559 mg/day, respectively. These latter values were significantly higher than those obtained by dietary records. Furthermore, the urinary sodium and potassium excretion estimated from an isolated urine sample was 4,839 ± 1,355 and 1,845 ± 494 mg/day, respectively. These values were similar to those obtained with a 24 h urine collection. CONCLUSIONS: Dietary records underestimated electrolyte intake when compared with the reference method. Using an isolated urine sample to estimate electrolyte intake may be a reliable alternative.

Embarazo adolescente: características maternas y su asociación con el peso al nacer del neonato / Adolescent pregnancy: maternal characteristics and their association with birth weight of the newborn

En Colombia, el embarazo adolescente es un problema de salud pública, con serias implicaciones en la salud y nutrición del binomio madre-hijo. El objetivo del estudio fue evaluar características sociodemográficas, económicas, de seguridad alimentaria, de salud y el estado nutricional por antropometría en adolescentes en el tercer trimestre de embarazo y asociar estos factores con el peso de los recién nacidos. Se realizó un estudio analítico de corte transversal con 294 embarazadas (semana 27-40) del programa de control prenatal de la Red Pública Hospitalaria de Medellín-Colombia. Se buscó asociación del peso al nacer del neonato con las variables explicativas. El bajo peso en embarazadas se presentó en mayor proporción en adolescentes cuyas familias devengaron menos de un Salario Mínimo Mensual -SMMLV-, en las que tenían 15 años o menos y con edad ginecológica menor de cinco años. La mayor proporción de pequeños para la edad gestacional se presentó en adolescentes con infecciones, bajo peso gestacional e ingresos menores a un SMMLV. Devengar menos de un SMMLV disminuye 118 gramos el peso del recién nacido (IC95%:-2,5a-234,7) y por cada kilogramo que aumentó el peso pregestacional materno, el peso al nacer aumentó 10,3 g (IC95%: 2,0 - 18,5). Los ingresos económicos inferiores a un SMMLV se asociaron con bajo peso materno y con recién nacidos pequeños para la edad gestacional. El peso pregestacional, el índice de masa corporal bajo en tercer trimestre de gestación y la presencia de infecciones urinarias y/o vaginales de la madre se asociaron con recién nacidos pequeños para la edad gestacional.

In Colombia, adolescent pregnancy is a public health problem, with serious implications for the health and nutrition of the binomial mother-child. Objective: assess socio-demographic, economic, food security, health and maternal nutritional status characteristics by anthropometric measures in a group of pregnant adolescents in Medellin-Colombia on their third trimester of pregnancy and associate them with the newborns weight. Methods and materials: A cross sectional analytical study was made with 294 pregnant women (week 27 to 40), who participating in prenatal control program of the public hospital network in Medellin-Colombia. We sought Association of weight at birth with the explanatory variables. Results: underweight in pregnant women was presented in families that had lower income wages than the Standard Minimum Wage Income - SMWI-, adolescents who were younger than 15 years old and those who had a gynecological age less than five years. In newborns, the highest proportion of small children for pregnancy age was found in mothers who presented infections, low pregnancy weight and low family income less than the minimum wage. For those whose earnings was less than the minimum income the newborn weight decreased 118g (CI95%:-2,5 a - 234,7), in addition, for each kilogram that increased the prepregnancy weight, newborn weight increased in 10,26g (CI95%:1,98 a -18,5). Conclusions: low-weight pregnancy and low-weight newborns are associated with low family income. Pre-pregnancy weight, body mass index in the third trimester of pregnancy and mother`s presence of urinary tract and vaginal infections were associated with the newborn´s weight.

Evaluación de la ingesta dietética y excreción urinaria de sodio y potasio en adultos / Assessment of dietary intake and urinary excretion of sodium and potassium in adults

Background: Hypertension is associated with elevated sodium and low potassium intakes. The determination of sodium and potassium intake by dietary records is inaccurate, being its measurement from 24-h urine collection the reference method. Aim: To determine urinary sodium and potassium excretion in adults. To compare dietary sodium and potassium intake and their excretion from an isolated urine sample against the reference method. Material and Methods: Seventy healthy adults aged 35 ± 8 years with a body mass index 25 ± 2 kg/m² (36 women) were studied. Urine was collected over 24 h, including an isolated urine sample taken in fasting conditions. Additionally, three 24-h dietary records were performed. Results: Reported sodium and potassium intake was 2,720 ± 567 and 1,068 ± 433 mg/day, respectively. In turn, urinary excretion of sodium and potassium was 4,770 ± 1,532 and 1,852 ± 559 mg/day, respectively. These latter values were significantly higher than those obtained by dietary records. Furthermore, the urinary sodium and potassium excretion estimated from an isolated urine sample was 4,839 ± 1,355 and 1,845 ± 494 mg/day, respectively. These values were similar to those obtained with a 24 h urine collection. Conclusions: Dietary records underestimated electrolyte intake when compared with the reference method. Using an isolated urine sample to estimate electrolyte intake may be a reliable alternative.

[Prevalence of obesity among Chilean women in childbearing ages]. / Obesidad en mujeres chilenas en edad fértil.

BACKGROUND: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. AIM: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. MATERIAL AND METHODS: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. RESULTS: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. CONCLUSIONS: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.

[Adolescent pregnancy: maternal characteristics and their association with birth weight of the newborn]. / Embarazo adolescente: características maternas y su asociación con el peso al nacer del neonate.

UNLABELLED: In Colombia, adolescent pregnancy is a public health problem, with serious implications for the health and nutrition of the binomial mother-child. OBJECTIVE: assess socio-demographic, economic, food security, health and maternal nutritional status characteristics by anthropometric measures in a group of pregnant adolescents in Medellin-Colombia on their third trimester of pregnancy and associate them with the newborns weight. METHODS AND MATERIALS: A cross sectional analytical study was made with 294 pregnant women (week 27 to 40), who participating in prenatal control program of the public hospital network in Medellin-Colombia. We sought Association of weight at birth with the explanatory variables. RESULTS: underweight in pregnant women was presented in families that had lower income wages than the Standard Minimum Wage Income--SMWI-, adolescents who were younger than 15 years old and those who had a gynecological age less than five years. In newborns, the highest proportion of small children for pregnancy age was found in mothers who presented infections, low pregnancy weight and low family income less than the minimum wage. For those whose earnings was less than the minimum income the newborn weight decreased 118g (CI 95%: -2.5 a - 234.7), in addition, for each kilogram that increased the pre-pregnancy weight, newborn weight increased in 10,26g (CI 95%: 1.98 a-18.5). CONCLUSIONS: low-weight pregnancy and low-weight newborns are associated with low family income. Pre-pregnancy weight, body mass index in the third trimester of pregnancy and mother's presence of urinary tract and vaginal infections were associated with the newborn's weight.

Impacto de una intervención en alimentación y actividad física sobre la prevalencia de obesidad en escolares / Impact of an intervention on diet and physical activity on obesity prevalence in schoolchildren

En Chile la obesidad infantil es un creciente problema de salud pública. Los programas de intervención al interior de las escuelas han mostrado resultados variables, con mejores resultados cuando se incluyen diversas variables y a toda la comunidad educativa. El objetivo del estudio fue evaluar el efecto sobre el estado nutricional de un programa realizado al interior de las escuelas, de 2 años de duración (Programa Vive Sano). Se estudiaron 2.527 escolares de primero a cuarto año de educación básica, de 3 comunas de la Región Metropolitana de Chile, que fueron intervenidos en alimentación, nutrición, actividad física y autocuidado de la salud con un equipo de Nutricionistas y Profesores de educación física. Se evaluó peso y talla al ingreso al programa y al final del primer y segundo año de intervención, en condiciones estandarizadas. Se calculó puntaje Z del IMC y estado nutricional según la referencia OMS 2007. Al final del segundo año 1.453 niños fueron reevaluados. Hubo una disminución significativa en puntaje Z del IMC-edad en los escolares obesos (-0,3 DE) y la prevalencia global de obesidad disminuyó de 21,8% a 18,4% al final de la intervención. El 75% de los escolares con obesidad y 60,5% con sobrepeso disminuyó su Z score IMC, siendo mayor la reducción en el sexo masculino y en los cursos superiores. El 51,9% de los estudiantes con peso normal aumentó su puntaje Z de IMC-edad, aunque mayoritariamente menos de 0,5 DE. Se puede concluir que la educación en alimentación y actividad física realizada por profesionales fue efectiva en reducir la prevalencia de obesidad (-3,4 puntos porcentuales). El gran desafío es buscar mecanismos para darle continuidad al programa y evaluar los efectos a largo plazo (AU)

In Chile childhood obesity is a growing public health problem. Intervention programs within schools have shown variable results, with better impacts when multiple aspects are involved and included the entire educational community. The objective of the study was to evaluate the effect on the nutritional status of children in intervention schools within 2 years of duration (Healthy Living Program). The sample included 2,527 students first through fourth grade of 3 counties of Santiago. The students were intervened and followed for a period of two years in their food and nutrition habits, physical activity and self-care practices, by a team of nutritionists and physical education teachers. Weight and height were measured at start of program, end of the first and second years of intervention, under standardized conditions and calculated the Z score of BMI and nutritional status according to the WHO reference 2007. At the end of the second year 1,453 children were reassessed. There was a significant decrease in BMI Z score in obese children (-0.3 SD) and obesity decreased from 21.8% to 18.4% at the end of the intervention. 75% of schoolchildren obese and 60.5% overweight decreased their BMI Z score, reduction that was greater in men and students in the upper grades. 51.9% of normal weight children increased their BMI Z-score age, although most less than 0.5 SD. The intervention in education, nutrition and physical activity among schoolchildren in three communes of Greater Santiago was effective in reducing the prevalence of obesity (-3.4 percentage points). The big challenge is to find mechanisms to give continuity to the program and evaluate long-term effects (AU)

[Impact of strength training exercise on secondary prevention of childhood obesity; an intervention within the school system]. / Impacto del ejercicio de fuerza muscular en la prevención secundaria de la obesidad infantil; intervención al interior del sistema escolar.

INTRODUCTION: The physical exercise is an important therapeutic tool to prevent and treat obesity, as well as reducing metabolic alterations and the risk of non-communicable diseases. OBJECTIVE: To evaluate the impact of a strength training exercise intervention within the school system, this includes muscular strength exercise, dietary education and psychological support in obese children. METHODS: We worked with 120 obese schoolchildren, between 8 and 13 years, recruited from 3 schools. Group 1 (n = 60) participated in the intervention, which included physical exercise, dietary education, and psychological support, for 3 months. Group 2 (n = 60) received only the educational intervention and psychological support for the first 3 months, and then received the exercise intervention from months 3 to 6. Participants were evaluated for BMI, waist circumference, body fat, presence of metabolic syndrome and cardiovascular risk factors. RESULTS: At 3 months, there were significant differences between the groups for change in BMI z-score, waist circumference, and body fat as well as prevalence of metabolic syndrome, abdominal obesity, hypertriglyceridemia, and fasting hyperglycemia. In group 1, these parameters decreased and increased, in group 2. From months 3 to 6, Group 2 showed a significant decrease in abdominal obesity, high blood pressure, and hypertriglyceridemia, while Group 1 showed a significant increase in high blood pressure and no change in other cardiovascular risk factors. CONCLUSION: This study demonstrates the positive impact of a strength training physical exercise program on reduction of body fat, metabolic syndrome and cardiovascular risk factors. This study supports the use of exercise as a treatment for obesity and its comorbidities in schoolchildren.

Introducción: El ejercicio físico es una importante herramienta terapéutica para prevenir y tratar la obesidad y disminuir las alteraciones metabólicas asociadas al desarrollo de las enfermedades crónicas no transmisibles. Objetivo: Evaluar el impacto de una intervención al interior del sistema escolar, que incluye el ejercicio de fuerza muscular, educación alimentaria y apoyo psicológico en escolares obesos. Métodos: Se trabajó con 120 escolares obesos, entre 8 y 13 AÑOs, reclutados en 3 colegios. El Grupo 1 (n = 60), fueron intervenidos simultáneamente con ejercicio físico, educación alimentaria y apoyo psicológico durante 3 meses. El Grupo 2 (n = 60), durante el mismo período, recibió sólo la intervención educativa y el apoyo psicológico, siendo intervenido con ejercicio entre los 3 y los 6 meses. Se evaluó IMC, perímetro de cintura, grasa corporal, síndrome metabólico y factores de riesgo cardiovasculares. Resultados: A los 3 meses, hubo diferencias significativas entre ambos grupos en la variación del zIMC, circunferencia cintura, grasa corporal, síndrome metabólico, obesidad abdominal, hipertrigliceridemia e hiperglicemia de ayuno. En el grupo 1, estos parámetros disminuyeron y aumentaron, en el grupo 2. Entre los 3-6 meses, en el grupo 2, hubo una disminución significativa en la obesidad abdominal, presión arterial elevada e hipertrigliceridemia, en tanto en el grupo 1, aumento significativo de la presión arterial elevada sin variaciones en los otros factores de riesgo cardiovasculares. Conclusiones: Se demostró el impacto positivo del ejercicio físico de fuerza muscular en la reducción de la grasa corporal, del síndrome metabólico y de los factores de riesgo cardiovasculares. Este trabajo refuerza el uso del ejercicio como tratamiento de la obesidad y de sus comorbilidades en escolares.

[Residual effect of muscle strength exercise in secondary prevention of children obesity]. / Efecto residual del ejercicio de fuerza muscular en la prevención secundaria de la obesidad infantil.

INTRODUCTION: The high prevalence of the obesity in Chilean students (23,1%), necessitates the application of interventions that incorporate muscle strength exercise, as this shows great efficacy in obese children. OBJECTIVE: To evaluate the residual effect of muscle strength exercise on body fat, metabolic syndrome and physical fitness in obese schoolchildren. METHODS: The sample included 111 obese schoolchildren, between 8 and 13 years, of 3 schools in the city of Santiago. Early intervention (n = 60) participated in parallel intervention that included muscle strength exercise, nutrition education and psychological support for 3 months. The late intervention (n = 51) incorporated the first 3 months, only the educational intervention and psychological support, and exercise was added between 3 and 6 months. At 9 months post intervention, we evaluated the residual effect of exercise. Body fat was determined by anthropometric equations. The metabolic syndrome was diagnosed by the criteria of Cook. Physical fitness was assessed by the distance walked in six minutes test. RESULTS: The body fat percentage decreased at the end of the intervention and post intervention increased with the exception of the men of early intervention. The distance traveled increased at the end of the intervention but declined in the post intervention. Metabolic syndrome, decreased at the end of the intervention increased post intervention (p < 0,05). CONCLUSION: The sustainability of the exercise is essential to maintain the changes, which is checked to determine the residual effect of exercise on body fat, metabolic syndrome and physical condition.

Introducción: La elevada prevalencia de la obesidad en escolares chilenos (23,1%), hace necesario la aplicación de intervenciones que incorporen el ejercicio físico de fuerza muscular, pues éste muestra gran eficacia en niños obesos. Objetivo: Evaluar el efecto residual del ejercicio físico de fuerza muscular sobre la grasa corporal, el síndrome metabólico y la condición física en escolares obesos. Métodos: La muestra incluyó 111 escolares obesos, entre 8 y 13 AÑOs, de 3 colegios de la ciudad de Santiago. La intervención temprana (n = 60) ejecutó en paralelo ejercicio físico de fuerza muscular, educación alimentaria y apoyo psicológico durante 3 meses. La intervención tardía (n = 51), incorporó los primeros 3 meses, sólo la intervención educativa y el apoyo psicológico, y el ejercicio se agregó entre los 3 y 6 meses. A los 9 meses post-intervención, se evaluó el efecto residual del ejercicio físico. La grasa corporal se determinó por ecuaciones antropométricas. El síndrome metabólico se diagnóstico por el criterio de Cook. La condición física se evaluó por la distancia recorrida en el test de seis minutos. Resultados: El porcentaje grasa corporal disminuyó al final de la intervención y aumentó post-intervención, con la excepción de los hombres de la intervención temprana. La distancia recorrida se incrementó al final de la intervención, pero se redujo en la post-intervención. El síndrome metabólico, disminuyó al término de la intervención incrementando post-intervención (p < 0,05). Conclusiones: La sustentabilidad del ejercicio es fundamental para mantener los cambios, lo que se comprueba al evaluar el efecto residual del ejercicio físico sobre la grasa corporal, el síndrome metabólico y la condición física.

Zinc in plasma and breast milk in adolescents and adults in pregnancy and pospartum: a cohort study in Uruguay.

OBJECTIVE: To assess if age is a risk factor for low zinc nutritional status in pregnancy, postpartum and in breast milk concentration, and the association between mother zinc plasma level with zinc milk concentration. DESIGN: Cohort study comparing adolescents with adult women, with < 14 weeks of gestation at first prenatal care. Socio demographic and plasma zinc data were collected at that moment and at postpartum time (4 + 1 month). Milk zinc concentrations were also measured at 4 th month postpartum. SETTING: Women were recruited from 16 public primary health care services in Uruguay Subjects: 151 adolescents and 161 adult women. RESULTS: Adolescent average plasma zinc at < 14 weeks of gestation was 84.4 ± 3.6 ug /dl and did not differ significantly from that for adult women (85.2 ± 13.6 ug/dl). Prevalence of hypozincemia was relatively low with but with no difference by age (14.6% in adolescents and 12.3% in adults). Zinc concentrations in breast milk were similar for adolescents, 1.24 mg. /L (CI 1.06 to 1.44) and adult women, 1.27 mg./L (CI .1.0-1.46). There was no correlation between plasma zinc and breast milk zinc concentrations in adults and a weak correlation in adolescents (- 0.27, P <0.05). CONCLUSIONS: Prevalence of hypozincemia in pregnancy was relatively low but similar in adolescents and adult women. Neither pregnancy nor age had negative consequences over postpartum plasma zinc, nor over breast milk zinc concentrations. No correlation was found between mother s plasma zinc and breast milk levels.

Objetivo: Evaluar la edad como factor de riego para el déficit nutricional de zinc en el embarazo y en el posparto y la correlación entre la concentración de zinc plasmático y de la leche materna. Diseño: Estudio de cohorte de 151 embarazadas adolescentes y 161 adultas con < 14 semanas de gestación al primer control prenatal, seleccionadas en 16 centros públicos de salud de primer nivel de atención de Uruguay. Se obtuvieron datos socio demográficos y se determinó zinc plasmático al primer control prenatal y 4 meses posparto (± 1 mes). En el último control se midió también la concentración de zinc en la leche materna. Resultados: La media de concentración de zinc plasmático a las 14 semanas de gestación fue 84.4 ± 3.6 ug. /dl sin diferencias significativas con las adultas (85.2 ± 13.6 ug/dl). La prevalencia de hipozincemia fue relativamente baja, sin diferencias entre los grupos (14.6% en adolescentes y 12.3% en adultas). La concentración de zinc en la leche materna fue similar en adolescentes y adultas (1.2 CI 1.1-1.4 mg. /L en el grupo total). No se encontró correlación entre el nivel plasmático de zinc materno y la concentración en la leche en adultas y una débil correlación en el grupo de adolescentes (-0.27, P <0.05). Conclusión: La prevalencia de hipozincemia en el embarazo es relativamente baja y similar entre adultas y adolescentes. No se observó relación entre la edad materna y los niveles plasmáticos de zinc post parto en la madre ni en la leche materna. La concentración de zinc plasmático materno no se correlacionó con el zinc en la leche materna.

Efecto residual del ejercicio de fuerza muscular en la prevención secundaria de la obesidad infantil / Residual effect of muscle strength exercise in secondary prevention of childhood obesity

Introducción: La elevada prevalencia de la obesidad en escolares chilenos (23,1%), hace necesario la aplicación de intervenciones que incorporen el ejercicio físico de fuerza muscular, pues éste muestra gran eficacia en niños obesos. Objetivo: Evaluar el efecto residual del ejercicio físico de fuerza muscular sobre la grasa corporal, el síndrome metabólico y la condición física en escolares obesos. Métodos: La muestra incluyó 111 escolares obesos, entre 8 y 13 años, de 3 colegios de la ciudad de Santiago. La intervención temprana (n = 60) ejecutó en paralelo ejercicio físico de fuerza muscular, educación alimentaria y apoyo psicológico durante 3 meses. La intervención tardía (n = 51), incorporó los primeros 3 meses, sólo la intervención educativa y el apoyo psicológico, y el ejercicio se agregó entre los 3 y 6 meses. A los 9 meses post-intervención, se evaluó el efecto residual del ejercicio físico. La grasa corporal se determinó por ecuaciones antropométricas. El síndrome metabólico se diagnóstico por el criterio de Cook. La condición física se evaluó por la distancia recorrida en el test de seis minutos. Resultados: El porcentaje grasa corporal disminuyó al final de la intervención y aumentó post-intervención, con la excepción de los hombres de la intervención temprana. La distancia recorrida se incrementó al final de la intervención, pero se redujo en la post-intervención. El síndrome metabólico, disminuyó al término de la intervención incrementando post-intervención (p < 0,05). Conclusiones: La sustentabilidad del ejercicio es fundamental para mantener los cambios, lo que se comprueba al evaluar el efecto residual del ejercicio físico sobre la grasa corporal, el síndrome metabólico y la condición física (AU)

Introduction: The high prevalence of the obesity in Chilean students (23,1%), necessitates the application of interventions that incorporate muscle strength exercise, as this shows great efficacy in obese children. Objective: To evaluate the residual effect of muscle strength exercise on body fat, metabolic syndrome and physical fitness in obese schoolchildren. Methods: The sample included 111 obese schoolchildren, between 8 and 13 years, of 3 schools in the city of Santiago. Early intervention (n = 60) participated in parallel intervention that included muscle strength exercise, nutrition education and psychological support for 3 months. The late intervention (n = 51) incorporated the first 3 months, only the educational intervention and psychological support, and exercise was added between 3 and 6 months. At 9 months post intervention, we evaluated the residual effect of exercise. Body fat was determined by anthropometric equations. The metabolic syndrome was diagnosed by the criteria of Cook. Physical fitness was assessed by the distance walked in six minutes test. Results: The body fat percentage decreased at the end of the intervention and post intervention increased with the exception of the men of early intervention. The distance traveled increased at the end of the intervention but declined in the post intervention. Metabolic syndrome, decreased at the end of the intervention increased post intervention (p < 0,05). Conclusion: The sustainability of the exercise is essential to maintain the changes, which is checked to determine the residual effect of exercise on body fat, metabolic syndrome and physical condition (AU)

Impacto del ejercicio de fuerza muscular en la prevención secundaria de la obesidad infantil; intervención al interior del sistema escolar / Impact of strength training exercise on secondary prevention of childhood obesity; an intervention within the school system

Introducción: El ejercicio físico es una importante herramienta terapéutica para prevenir y tratar la obesidad y disminuir las alteraciones metabólicas asociadas al desarrollo de las enfermedades crónicas no transmisibles. Objetivo: Evaluar el impacto de una intervención al interior del sistema escolar, que incluye el ejercicio de fuerza muscular, educación alimentaria y apoyo psicológico en escolares obesos. Métodos: Se trabajó con 120 escolares obesos, entre 8 y 13 años, reclutados en 3 colegios. El Grupo 1 (n = 60), fueron intervenidos simultáneamente con ejercicio físico, educación alimentaria y apoyo psicológico durante 3 meses. El Grupo 2 (n = 60), durante el mismo período, recibió sólo la intervención educativa y el apoyo psicológico, siendo intervenido con ejercicio entre los 3 y los 6 meses. Se evaluó IMC, perímetro de cintura, grasa corporal, síndrome metabólico y factores de riesgo cardiovasculares. Resultados: A los 3 meses, hubo diferencias significativas entre ambos grupos en la variación del zIMC, circunferencia cintura, grasa corporal, síndrome metabólico, obesidad abdominal, hipertrigliceridemia e hiperglicemia de ayuno. En el grupo 1, estos parámetros disminuyeron y aumentaron, en el grupo 2. Entre los 3-6 meses, en el grupo 2, hubo una disminución significativa en la obesidad abdominal, presión arterial elevada e hipertrigliceridemia, en tanto en el grupo 1, aumento significativo de la presión arterial elevada sin variaciones en los otros factores de riesgo cardiovasculares. Conclusiones: Se demostró el impacto positivo del ejercicio físico de fuerza muscular en la reducción de la grasa corporal, del síndrome metabólico y de los factores de riesgo cardiovasculares. Este trabajo refuerza el uso del ejercicio como tratamiento de la obesidad y de sus comorbilidades en escolares (AU)

Introduction: The physical exercise is an important therapeutic tool to prevent and treat obesity, as well as reducing metabolic alterations and the risk of non-communicable diseases. Objective: To evaluate the impact of a strength training exercise intervention within the school system, this includes muscular strength exercise, dietary education and psychological support in obese children. Methods: We worked with 120 obese schoolchildren, between 8 and 13 years, recruited from 3 schools. Group 1 (n = 60) participated in the intervention, which included physical exercise, dietary education, and psychological support, for 3 months. Group 2 (n = 60) received only the educational intervention and psychological support for the first 3 months, and then received the exercise intervention from months 3 to 6. Participants were evaluated for BMI, waist circumference, body fat, presence of metabolic syndrome and cardiovascular risk factors. Results: At 3 months, there were significant differences between the groups for change in BMI z-score, waist circumference, and body fat as well as prevalence of metabolic syndrome, abdominal obesity, hypertriglyceridemia, and fasting hyperglycemia. In group 1, these parameters decreased and increased, in group 2. From months 3 to 6, Group 2 showed a significant decrease in abdominal obesity, high blood pressure, and hypertriglyceridemia, while Group 1 showed a significant increase in high blood pressure and no change in other cardiovascular risk factors. Conclusion: This study demonstrates the positive impact of a strength training physical exercise program on reduction of body fat, metabolic syndrome and cardiovascular risk factors. This study supports the use of exercise as a treatment for obesity and its comorbidities in schoolchildren (AU)

Zinc in plasma and breast milk in adolescents and adults in pregnancy and pospartum: a cohort study in Uruguay / Zinc en el plasma y leche materna en embarazadas adolescentes y adultas y en el postparto; estudio de cohorte en Uruguay

Objective: To assess if age is a risk factor for low zinc nutritional status in pregnancy, postpartum and in breast milk concentration, and the association between mother zinc plasma level with zinc milk concentration. Design: Cohort study comparing adolescents with adult women, with < 14 weeks of gestation at first prenatal care. Socio demographic and plasma zinc data were collected at that moment and at postpartum time (4 + 1 month). Milk zinc concentrations were also measured at 4th month postpartum. Setting: Women were recruited from 16 public primary health care services in Uruguay Subjects: 151 adolescents and 161 adult women Results: Adolescent average plasma zinc at < 14 weeks of gestation was 84.4 ± 3.6 ìg /dl and did not differ significantly from that for adult women (85.2 ± 13.6 ug/dl). Prevalence of hypozincemia was relatively low with but with no difference by age (14.6% in adolescents and 12.3% in adults). Zinc concentrations in breast milk were similar for adolescents, 1.24 mg. /L (CI 1.06 to 1.44) and adult women, 1.27 mg./L (CI .1.0-1.46). There was no correlation between plasma zinc and breast milk zinc concentrations in adults and a weak correlation in adolescents (-0.27, p <0.05).Conclusions: Prevalence of hypozincemia in pregnancy was relatively low but similar in adolescents and adult women. Neither pregnancy nor age had negative consequences over postpartum plasma zinc, nor over breast milk zinc concentrations. No correlation was found between mother s plasma zinc and breast milk levels (AU)

Objetivo: Evaluar la edad como factor de riego para el déficit nutricional de zinc en el embarazo y en el posparto y la correlación entre la concentración de zinc plasmático y de la leche materna. Diseño: Estudio de cohorte de 151 embarazadas adolescentes y 161 adultas con < 14 semanas de gestación al primer control prenatal, seleccionadas en 16 centros públicos de salud de primer nivel de atención de Uruguay. Se obtuvieron datos socio demográficos y se determinó zinc plasmático al primer control prenatal y 4 meses posparto (± 1 mes). En el último control se midió también la concentración de zinc en la leche materna. Resultados: La media de concentración de zinc plasmático a las 14 semanas de gestación fue 84.4 ± 3.6 ug. /dl sin diferencias significativas con las adultas (85.2 ± 13.6 ug/dl). La prevalencia de hipozincemia fue relativamente baja, sin diferencias entre los grupos (14.6% en adolescentes y 12.3% en adultas). La concentración de zinc en la leche materna fue similar en adolescentes y adultas (1.2 CI 1.1-1.4 mg. /L en el grupo total). No se encontró correlación entre el nivel plasmático de zinc materno y la concentración en la leche en adultas y una débil correlación en el grupo de adolescentes (-0.27, p <0.05). Conclusión: La prevalencia de hipozincemia en el embarazo es relativamente baja y similar entre adultas y adolescentes. No se observó relación entre la edad materna y los niveles plasmáticos de zinc post parto en la madre ni en la leche materna. La concentración de zinc plasmático materno no se correlacionó con el zinc en la leche materna (AU)

Birth weight and obesity risk at first grade of high school in a non-concurrent cohort of Chilean children.

OBJECTIVE: To determine the association of birth weight with obesity risk at first grade of high school in Chilean children after accounting for potential confounding factors. DESIGN: National non-concurrent cohort of newborns. Sociodemographic information, height, weight and anthropometric measurements at first grade of high school were analysed. Birth weight was classified as macrosomia (≥4000 g), by gestational age and by ponderal index. The relationship between birth weight and obesity at first grade of high school (BMI ≥ 95th percentile of the US Centers for Disease Control and Prevention's reference) was assessed using logistic regression models adjusted for sociodemographic information at delivery. SETTING: First grade of public high school of low and middle socio-economic status in the whole country (about 77 % of Chilean children in this age group). SUBJECTS: Newborns (n 119 070) and the same number of high-school students. RESULTS: A positive relationship of high ponderal index (OR = 1·86, 95 % CI 1·69, 2·03), birth weight ≥4000 g (OR = 1·66, 95 % CI 1·54, 1·78) and large for gestational age (OR = 1·69, 95 % CI 1·58, 1·81) with obesity at adolescence (P < 0·001) was found. Macrosomic children had a higher risk of being obese at first grade of high school after controlling for prenatal confounding variables (OR = 1·63, 95 % CI 1·52, 1·76; P < 0·001). CONCLUSIONS: A direct relationship between high birth weight and obesity at first grade of high school was observed in this group of Chilean children. The results highlight the significance of birth weight as a simple tool to be used as an indicator of obesity risk for children by health-care providers.

Nutrition in Colombian pregnant women.

OBJECTIVE: The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics. DESIGN: Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia. SETTING: Bogotá, Colombia. SUBJECTS: Pregnant adolescents aged 13-19 years (n 430) and pregnant women aged 20-49 years (n 1272). RESULTS: The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight. CONCLUSIONS: Underweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.

[Metabolic syndrome prevalence in Chilean children and adolescent with family history of chronic noncommunicable diseases]. / Prevalencia del sindrome metabolico en niños y adolescentes chilenos con historia familiar de enfermedades cronicas no transmisibles.

Family history (FH+) of non transmisible chronic diseases (NTCD) increase MetS risk. In Chile, the MetS affects 27% of overweight children, and fasting hyperglycemia is very low prevalent (4,0%). The objective was to study the prevalence of MetS and the cardiovascular risk factors (CVRF) in overweight children with a family background of NTCD and analyze its association with the number of relatives witth NTCD and with parental history (PH). In 183 overweight children (BMI > or = p85) mean age 11,8 +/- 1,8 (86 males) with a FH+ (parental or grandparental) of NTCD, were assessed the BMI z (CDC / NCHS), waist circumference, blood arterial pressure, fasting Glucose and Insulin (RIA), triglycerides, HDL chol. The MetS and the CVRF were diagnosed using the Cook phenotype and the insulin resistance (IR) through the HOMA-IR. Chi2, ANOVA, t Student and Willcoxon test were performed. The frequency of FH+ of DM2, hypertension and dyslipidemia were 81,4%, 88,0% and 71,6 % respectively. The MeTS prevalence was 46,5 % associated to overweight magnitude an parental history of NTCD. The prevalence of hypertriglyceridemia was 54,6%, while fasting hyperglycemia affected 31,4% of the sample. There was no association between number of relatives with NTCD and CV risk profile. We conclude that in overweight children with FH+ of NTCD, the prevalence of MetS, dyslipidemia and fasting hyperglycemia are significantly higher, than those observed in the general population of obese children.

[Food quality and nutritional status in university students of eleven Chilean regions]. / Calidad de la alimentación y estado nutricional en estudiantes universitarios de 11 regiones de Chile.

BACKGROUND: The Chilean population has inadequate lifestyles and high prevalence of chronic diseases. AIM: To analyze eating behaviors, nutritional status and history of previous diseases, in students of higher education. MATERIAL AND METHODS: Cross-sectional study in students of 54 higher education centers across the country. They answered a survey about dietary habits, physical activity, smoking, previous diseases and opinion of their nutritional condition. Weight and height were measured under standardized conditions and nutritional status classified according to body mass index. RESULTS: We studied 6,823 students aged 17 to 29 years. Forty seven percent did not have breakfast and 35% did not have lunch every day. A low proportion had a daily consumption of vegetables (51.2%), fruits (39.4%) and dairy products (57.5%). There was a high frequency of soft drinks, chips, cakes and sweets consumption. Seventy six percent were sedentary, 40.3% smokers and 27.4% overweight or obese. The latter had a significantly higher frequency of diabetes, hypertension and hypercholesterolemia. There was a poor agreement between actual nutritional status and self-perception, especially in males (Kappa index 0.38). Recipients of a food scholarship provided by the Ministry of Education ate lunch usually with a higher frequency (p < 0.05). CONCLUSIONS: A high prevalence of inadequate eating and physical activity patterns in these young subjects with good educational level was observed. The food scholarship has some positive effects, although differences in socioeconomic levels limited comparisons.