Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Actividad física y perfil de estilos de vida promotores de la salud en adultos mayores chilenos / Association of sedentariness and health promoting lifestyles in older adults

Background Part of having healthy lifestyles should be a regular practice of physical activities. Aim To evaluate the association between the practice of physical activity and healthy lifestyles in older people. Material and Methods The Health-Promoting Lifestyle Profile survey was applied to 1688 older people living in the community, aged 72 ± 7 years (61% women). This survey includes questions about regular physical activity. Results Twenty four percent of surveyed participants declared to practice physical activities at least three times per week, without gender differences. Sedentariness increased along with age. There was a negative association between low physical activity and healthy lifestyles (odds ratio (OR): 3.2 confidence intervals (CI): 2.3-4.5). There was also an association between sedentariness and low self-realization (OR 2.4 CI: 1.8-3.3), low responsibility with health (OR 1.6 CI: 1.22.1), low concern about nutrition (OR 1.8 CI: 1.4-2.4), low stress management (OR 2.0 CI: 1.5-2.7) and low interpersonal support (OR 2.0 CI: 1.5-2.6). Conclusions Sedentariness is negatively associated with health promoting lifestyles in this group of older people.

Caracterización del estado nutricional, hábitos alimentarios y estilos de vida de estudiantes universitarios chilenos: estudio multicéntrico / Lifestyles, body mass index and sleep patterns among university students

Background Health surveys in Chile show a worrisome high prevalence of unhealthy lifestyles among adults. Aim To characterize the nutritional status, food intake and sleep patterns in university students of both genders. Material and Methods Cross sectional study in seven Chilean universities. Students from six universities answered a feeding habits survey, the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. All were weighed and their height was measured. Results A total of 1,418 students aged 21 ± 3 years (22% males) were evaluated. Three percent were classified as underweight, 68% as normal weight, 24% as overweight and 4% as obese. Thirty three percent of males and 28% of females smoked. Twenty six percent consumed at least one glass of alcoholic beverages on the weekend, and only 18% of males and 5% of females were physically active. Men consumed unhealthy foods with a significantly higher frequency than females. Twenty seven percent had mild daytime somnolence, 24% had moderate daytime somnolence, 50% had subclinical insomnia, 19% moderate insomnia, and 1.4% had severe insomnia. Conclusions In this group of students a high frequency of unhealthy lifestyles and malnutrition caused by excess was observed. Also a high prevalence of insomnia, daytime somnolence, and inadequate sleep amounts were recorded.

[Association of sedentariness and health promoting lifestyles in older adults]. / Actividad física y perfil de estilos de vida promotores de la salud en adultos mayores chilenos.

Background Part of having healthy lifestyles should be a regular practice of physical activities. Aim To evaluate the association between the practice of physical activity and healthy lifestyles in older people. Material and Methods The Health-Promoting Lifestyle Profile survey was applied to 1688 older people living in the community, aged 72 ± 7 years (61% women). This survey includes questions about regular physical activity. Results Twenty four percent of surveyed participants declared to practice physical activities at least three times per week, without gender differences. Sedentariness increased along with age. There was a negative association between low physical activity and healthy lifestyles (odds ratio (OR): 3.2 confidence intervals (CI): 2.3-4.5). There was also an association between sedentariness and low self-realization (OR 2.4 CI: 1.8-3.3), low responsibility with health (OR 1.6 CI: 1.22.1), low concern about nutrition (OR 1.8 CI: 1.4-2.4), low stress management (OR 2.0 CI: 1.5-2.7) and low interpersonal support (OR 2.0 CI: 1.5-2.6). Conclusions Sedentariness is negatively associated with health promoting lifestyles in this group of older people.

Body fat and its relationship with clustering of cardiovascular risk factors.

BACKGROUND: Body mass index (BMI) and waist circumference (WC) are the most commonly measured anthropometric parameters given their association with cardiovascular risk factors (RFs). The relationship between percentage body fat (%BF) and cardiovascular risk has not been extensively studied. AIMS: This study evaluated %BF and its relationship with cardiometabolic RFs in healthy subjects and compared these findings with the relationship between BMI/ WC and cardiovascular RFs. METHODS: This was a cross-sectional study of 99 males and 83 females (mean age 38 ± 10 years) evaluated in a preventive cardiology program. All subjects completed a survey about RFs and lifestyle habits. Anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting lipid profile, and blood glucose were collected. Body fat was determined using four skinfold measurements. Fat mass index (FMI) was also calculated. RESULTS: Percentage body fat was significantly and directly associated with total cholesterol (R(2)=0.11), triglycerides (R(2)=0.14), low-density lipoprotein cholesterol (R(2)=0.16), non-high-density lipoprotein cholesterol (R(2)=0.24), fasting blood glucose (R(2)=0.16), SBP (R(2)=0.22), and DBP (R(2)=0.13) (p<0.001 for all) and inversely related to high-density lipoprotein cholesterol (R(2)=0.32; p<0.001). When the models of %BF, FMI, WC, and BMI were compared, all of them were significantly related to the same cardiometabolic RFs and the clustering of them. CONCLUSION: Percentage body fat and FMI were significantly associated with biochemical variables and to the clustering of RFs. However, these associations were similar but not better than WC and BMI.

Introducción: El índice de masa corporal (IMC) y la circunferencia de cintura (CC) son los parámetros antropométricos que se miden con mayor frecuencia dada su asociación con los factores de riesgo cardiovascular (RC). La relación entre el porcentaje de grasa corporal (%GC) y el riesgo cardiovascular no se ha estudiado ampliamente. Objetivo: Evaluar el %GC y su relación con los FR cardiometabólico en sujetos sanos y comparar estos resultados con la relación IMC/CC y FR cardiovascular Métodos: Se realizó un estudio transversal en 99 hombres y 83 mujeres participantes asistentes a un programa de cardiología preventiva (edad 38 ± 10 años). Todos los sujetos completaron una encuesta sobre los FR y hábitos de estilos de vida. Se evaluaron antropométricamente , se les tomo presión arterial sistólica (PAS) y diastólica (PAD), perfil lipídico y glicemia en ayunas. La grasa corporal se determinó a través de cuatro mediciones de pliegues cutáneos. También se calculó el índice de masa grasa (IMG). Resultados: El porcentaje de grasa corporal se asoció significativamente y directamente con el colesterol total (R2=0,11), triglicéridos (R2=0,14), colesterol LDL (R2=0,16), colesterol VLDL (R2=0,24), glicemia (R2=0,16), PAS (R2=0,22) y PAD (R2=0,13) (p.

Body fat and its relationship with clustering of cardiovascular risk factors / Grasa corporal y su relación con la agregación de factores de riesgo cardiovascular

Background: Body mass index (BMI) and waist circumference (WC) are the most commonly measured anthropometric parameters given their association with cardiovascular risk factors (RFs). The relationship between percentage body fat (%BF) and cardiovascular risk has not been extensively studied. Aims: This study evaluated %BF and its relationship with cardiometabolic RFs in healthy subjects and compared these findings with the relationship between BMI/ WC and cardiovascular RFs. Methods: This was a cross-sectional study of 99 males and 83 females (mean age 38 ±10 years) evaluated in a preventive cardiology program. All subjects completed a survey about RFs and lifestyle habits. Anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting lipid profile, and blood glucose were collected. Body fat was determined using four skinfold measurements. Fat mass index (FMI) was also calculated. Results: Percentage body fat was significantly and directly associated with total cholesterol (R2 =0.11), triglycerides (R2 =0.14), low-density lipoprotein cholesterol (R2 =0.16), non-high-density lipoprotein cholesterol (R2 =0.24), fasting blood glucose (R2 =0.16), SBP (R2 = 0.22), and DBP (R2 =0.13) (p<0.001 for all) and inversely related to high-density lipoprotein cholesterol (R2 = 0.32; p<0.001). When the models of %BF, FMI, WC, and BMI were compared, all of them were significantly related to the same cardiometabolic RFs and the clustering of them. Conclusion: Percentage body fat and FMI were significantly associated with biochemical variables and to the clustering of RFs. However, these associations were similar but not better than WC and BMI (AU)

Introducción: El índice de masa corporal (IMC) y la circunferencia de cintura (CC) son los parámetros antropométricos que se miden con mayor frecuencia dada su asociación con los factores de riesgo cardiovascular (RC). La relación entre el porcentaje de grasa corporal (%GC) y el riesgo cardiovascular no se ha estudiado ampliamente. Objetivo: Evaluar el %GC y su relación con los FR cardiometabólico en sujetos sanos y comparar estos resultados con la relación IMC/CC y FR cardiovascular Métodos: Se realizó un estudio transversal en 99 hombres y 83 mujeres participantes asistentes a un programa de cardiología preventiva (edad 38 ± 10 años). Todos los sujetos completaron una encuesta sobre los FR y hábitos de estilos de vida. Se evaluaron antropométricamente , se les tomo presión arterial sistólica (PAS) y diastólica (PAD), perfil lipídico y glicemia en ayunas. La grasa corporal se determinó a través de cuatro mediciones de pliegues cutáneos. También se calculó el índice de masa grasa (IMG). Resultados: El porcentaje de grasa corporal se asoció significativamente y directamente con el colesterol total (R2=0,11), triglicéridos (R2=0,14), colesterol LDL (R2=0,16), colesterol VLDL (R2=0,24), glicemia (R2=0,16), PAS (R2=0,22) y PAD (R2=0,13) (p<0,001 para todos) e inversamente relacionada con HDL (R2=0,32; p<0,001). Cuando se compararon los modelos de %GC, IMG, CC e IMC, todos ellos se asociaron en forma significativa a los mismos FR cardiometabólico y a la agregación de los mismos. Conclusión: El %GC e IMG se asociaron en forma significativa con las variables bioquímicas y la agregación de FR. Sin embargo, estas asociaciones eran similares pero no mejor que la CC y el IMC (AU)

[Nutrient intake of Chilean older people according to body mass index]. / Comparación del consumo de vitaminas y minerales en adultos mayores chilenos según estado nutricional.

BACKGROUND: An adequate consumption of micro and macro nutrients is essential to maintain an adequate health among older people. AIM: To compare the consumption of micro- and macronutrients in older people from three Chilean cities, according to their nutritional status. MATERIAL AND METHODS: Body mass index (BMI) was assessed and a food consumption tendency survey was applied to 976 non-disabled older people, living in the community. Thinness was defined as a BMI < 23 kg/m². RESULTS: Twenty percent of females and 17% of males had a BMI < 23 kg/m². Participants with a higher BMI had a greater intake of micro- and macronutrients. In females, micronutrient intake was adequate among those with higher BMI, although mean intake of calcium and vitamin B-12 were below recommendations. In males, iron, zinc, calcium, magnesium, vitamin A, vitamin B6, vitamin B12 and pantothenic acid intake were below recommendation. CONCLUSIONS: Thin older adults, regardless of sex, had a lower intake of calories and micro- and macronutrients. Additionally, an overall low consumption of zinc, calcium, magnesium and vitamin B12 was detected.

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)

[Sleep deprivation as a risk factor for obesity]. / La reducción del sueño como factor de riesgo para obesidad.

Nocturnal sleep patterns may be a contributing factor for the epidemic of obesity. Epidemiologic ana experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity. Moreover, sleep restriction is significantly associated with incidence and prevalence of obesity and several non-transmissible chronic diseases. Experimental sleep restriction is related to altered plasma leptin and ghrelin concentrations. Both hormones are directly related to appetite and satiety mechanisms. Also, a higher activity of the orexin/hypocretin system has been reported, as well as changes in glucose metabolism and autonomic nervous system. Some studies indicate that these endocrine changes could be associated with a higher diurnal food intake and preference for energy- dense foods. All these changes could result in a positive energy balance, leading to weight gain and a higher obesity risk in the long-term. The present article summarizes the epidemiologic and experimental evidence related to sleep deprivation and higher obesity risk. The possible mechanisms are highlighted.

La reducción del sueño como factor de riesgo para obesidad / Sleep deprivation as a risk factor for obesity

Nocturnal sleep patterns may be a contributing factor for the epidemic of obesity. Epidemiologic ana experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity. Moreover, sleep restriction is significantly associated with incidence and prevalence of obesity and several non-transmissible chronic diseases. Experimental sleep restriction is related to altered plasma leptin and ghrelin concentrations. Both hormones are directly related to appetite and satiety mechanisms. Also, a higher activity of the orexin/hypocretin system has been reported, as well as changes in glucose metabolism and autonomic nervous system. Some studies indicate that these endocrine changes could be associated with a higher diurnal food intake and preference for energy- dense foods. All these changes could result in a positive energy balance, leading to weight gain and a higher obesity risk in the long-term. The present article summarizes the epidemiologic and experimental evidence related to sleep deprivation and higher obesity risk. The possible mechanisms are highlighted.

Sleep alterations and iron deficiency anemia in infancy.

Iron deficiency anemia (IDA) continues to be the most common single nutrient deficiency in the world. An estimated 20-25% of the world's infants have IDA, with at least as many having iron deficiency without anemia. Infants are at particular risk due to rapid growth and limited dietary sources of iron. We found that infants with IDA showed different motor activity patterning in all sleep-waking states and several differences in sleep states organization. Sleep alterations were still apparent years after correction of anemia with iron treatment in the absence of subsequent IDA. We suggest that altered sleep patterns may represent an underlying mechanism that interferes with optimal brain functioning during sleep and wakefulness in former IDA children.

Sleep and neurofunctions throughout child development: lasting effects of early iron deficiency.

Iron-deficiency anemia (IDA) continues to be the most common single nutrient deficiency in the world. Infants are at particular risk due to rapid growth and limited dietary sources of iron. An estimated 20% to 25% of the world's infants have IDA, with at least as many having iron deficiency without anemia. High prevalence is found primarily in developing countries, but also among poor, minority, and immigrant groups in developed ones. Infants with IDA test lower in mental and motor development assessments and show affective differences. After iron therapy, follow-up studies point to long-lasting differences in several domains. Neurofunctional studies showed slower neural transmission in the auditory system despite 1 year of iron therapy in IDA infants; they still had slower transmission in both the auditory and visual systems at preschool age. Different motor activity patterning in all sleep-waking states and several differences in sleep states organization were reported. Persistent sleep and neurofunctional effects could contribute to reduced potential for optimal behavioral and cognitive outcomes in children with a history of IDA.