Adolescents' perception of dietary behaviour in a public school in Chile: a focus groups study.

BACKGROUND: The objective of this study was to assess dietary behavior among sixth- to eighth-grade students to inform the delivery and content of nutrition education. METHODS: This was a qualitative study through focus groups. Subjects were 57 adolescents 10-14 years old, 30 males and 27 females distributed in six groups. To compare group responses, transcriptions were coded using the original question guide. The information was analyzed using the content analysis technique. RESULTS: The main findings showed that adolescents knew dietary guidelines, but they consumed non-healthy food. They liked to cook but preferred fast food preparations. They increased fast food consumption on weekends and with friends. In utilization of Information Communication Technologies (ICT), all students had access to technology through mobile phones, tablets and computers and were open to have an interactive program with personal information about diet and behavior. CONCLUSIONS: Adolescents dietary behavior is not healthy and can be changed with interactive programs considering participation, personal information and utilizing ICT.

Management of expatriate medical assistance in Mozambique

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence; in a troubled context of war; lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance. Different scenarios; partnerships and contract schemes that have evolved since independence are briefly described; as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed; and realistic figures of cost planning are highlighted; as determined by the overall health system necessities and budget limitations

Nutritional status, food consumption and physical activity among Chilean school children: a descriptive study.

OBJECTIVE: To assess the nutritional status, food consumption and physical activity (PA) habits of Chilean school children, as a baseline for developing an educational intervention. DESIGN: Cross-sectional study. SUBJECTS: A total of 1701 children from 3rd to 7th grade in nine schools located in three geographical regions. METHODS: We determined body mass index, food consumption (quantified FFQ which we categorised into five groups), PA in terms of TV viewing and frequency of after school PA. The data were analysed according to age, nutritional status and gender. A logistic regression analysis was performed using obesity as outcome. RESULTS: Obesity was higher among boys; younger children presented higher prevalence in both genders. Daily intake of dairy products varied between 240 and 308 g, fruits/vegetables, between 197 and 271 g, energy-dense foods between 343 and 460 g. In all, 22.3 and 47% of the children watched over 3 h of TV during the week and weekend, respectively. Older children watched significantly more TV during the week, while on weekends all children increased this time significantly. Boys were more active than girls after school. The logistic regression analysis showed a significant association between obesity and low intake of dairy products. CONCLUSIONS: Prevalence of obesity among Chilean children is high. Although TV time, intake of energy dense foods and fruits/vegetables appeared as risk factors for obesity, only dairy consumption was significantly associated with obesity. SPONSORSHIP: FAO

School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study.

OBJECTIVE: To assess the impact of a 6 months nutrition education and physical activity intervention on primary school children through changes in adiposity and physical fitness. DESIGN: Longitudinal school-based controlled evaluation study. SUBJECTS: Children from 1st to 8th grade, 2141 in intervention and 945 in control schools. INTERVENTION: Nutrition education for children and parents, 'healthier' kiosks, 90 min of additional physical activity (PA) weekly, behavioral PA program and active recess. MEASUREMENTS: Adiposity indices (BMI, BMI Z-score, triceps skinfold thickness (TSF), waist circumference and physical fitness (20 m shuttle run test and lower back flexibility). RESULTS: Positive effect on adiposity indices (except TSF) was observed in boys (P<0.001 for BMI Z), while both physical fitness parameters increased significantly in both boys (P<0.001 for each test) and girls (P<0.0001 for each test). A differential effect in BMI Z was observed according to baseline nutritional status. CONCLUSIONS: This intervention showed a robust effect on physical fitness in both genders and decreased adiposity only in boys.

Trends in overweight and obesity prevalence in Chilean children: comparison of three definitions.

OBJECTIVE: To compare trends in prevalence of overweight and obesity among Chilean children using three different criteria. METHODS: Descriptive cross-sectional school-based study to analyse these trends in 6-y-old boys and girls who entered first grade in 1987, 1990, 1993, 1996 and 2000. Gender-specific prevalence of overweight and obesity were determined with three criteria: weight for height (W-H) Z-scores compared to NCHS 1977; present reference used by the Ministry of Health; and body mass index (BMI) compared to the revised US CDC Growth Charts with cut-off values of P85-95 and P-95 and IOTF reference with cut-offs extrapolated from an adult BMI of 25 and 30. RESULTS: The prevalence of overweight determined by W-H (WHO) increased from 15% in 1987 to 20% in 2000 for boys and from 17.2 to 21.8% for girls. With BMI-CDC, the increase was from 13.2 to 19.2% for boys and 12 to 18.5% for girls. With BMI-IOTF, rates were very similar. Prevalence of obesity using W-H (WHO) increased from 6.5% in 1987 to 17% in 2000 for boys and from 7.8 to 18.6% for girls. Using BMI-CDC, the increase was from 5.1 to 14.7% for boys and from 4 to 15.8% for girls; using BMI-IOTF prevalence estimates were much lower. CONCLUSIONS: Obesity prevalence in children has increased over time, and trends are similar independent of criteria. The reference used to define prevalence is important since it provides different estimates. Policy makers should be aware that a spurious drop in prevalence may appear if the IOTF reference is compared to the other criteria.

Nutrition transition in Latin America: the case of Chile.

The nutritional situation of Latin America is changing rapidly from one characterized by underweight and stunting to one where chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes are increasingly prevalent. In Chile, under-nutrition has virtually disappeared, but rising obesity rates and risk factors for chronic diseases indicate the need to modify existing programs and emphasize prevention of diet-related chronic diseases.

Energy requirements in Chilean infants.

AIM: To evaluate the energy requirements of breast fed infants. METHODS: The study was conducted in 17 healthy exclusively breast fed infants of normal birth weight (mean (SD) 3332 (280) g). Energy expenditure by the doubly labelled water method and milk intake by the dose to infant method were measured at 34 (4) days. A dose of 0. 2 g/kg deuterium oxide (99.8%) and 2.0 g/kg 10% (18)O labelled water was given to the infants, and urine samples were collected for seven consecutive days after dosing. RESULTS: The mean (SD) weight of the infants during the period of evaluation was 4617 (343) g and weight gain 34.0 (7.5) g/day. Daily milk intake was 728 (101) g and its metabolisable energy content 2.71 kJ/g. The energy expenditure of the infants was 1205 (312) kJ/day and energy required for growth was 607 (130) kJ/day. When combined this produced an energy requirement of 391 kJ/kg/day for these infants. CONCLUSION: These data agree with those from other studies in the United Kingdom and the United States and suggest that adequate growth can be achieved with 19.4% less energy than recommended by FAO/WHO/UNU.

Nutrition policy in the Chilean transition.

OBJECTIVE: This paper examines socioeconomic, demographic, epidemiological and nutrition changes that have occurred in Chile in the last decades using concepts of epidemiological and nutrition transition, and discusses policies related to nutrition. DESIGN AND SETTING: This is a descriptive, population-based study to analyse changes in the Chilean diet and nutrition situation including some of the main demographic, socioeconomic and epidemiological variables. Data came from the FAO, the National Institute of Statistics, the Ministry of Health and national surveys. RESULTS AND POLICY IMPLICATIONS: In Chile, the epidemiological and nutrition situation shifted from a pretransition stage with high rates of undernutrition to a post-transition stage with increasing rates of obesity in all groups aged less than 20 years. However, changes were not accompanied by modifications in nutrition policy, which had been successful in reducing undernutrition. Despite changes in diet to a 'western' diet and in nutritional status of the population from undernutrition to obesity, food and nutrition programmes have been maintained unaltered. Governmental and university organizations were created in 1994 and 1995 to address the current food and nutrition problems. The accomplishments of these institutions have been the elaboration of dietary guidelines, reformulating the food and nutrition programmes and the promulgation of the Food Sanitary Regulations for Chile. CONCLUSIONS: Education for the prevention of nutrition excess problems should be a main food and nutrition policy in developing countries.

[Obesity, an unresolved challenge in Chile]. / Obesidad: un desafío pendiente en Chile.

Socioeconomic and demographic changes in Chile, have modified its epidemiological profile. At the present time, the most important public health problems are non communicable chronic diseases, specially cardiovascular ailments. The prevalence of cardiovascular risk factors has also increased and obesity stands out. This review analyzes the present situation of obesity and other cardiovascular risk factors of nutritional origin, in Chile, and proposes intervention alternatives. At the present time 7% preschool children, 12% of school children, 24% of pregnant women, 10% of male adults and 24% of female adults are obese. This higher prevalence is even more pronounced in women of low socioeconomic level. Risk factors associated to obesity are an inadequate diet, with a higher consumption of fats and refined foods, sedentariness and hyperlipidemia. Primary and secondary care strategies must be devised to face this growing problem.

[Effect of maternal smoking on offspring growth]. / Efecto del tabaquismo materno en el crecimiento de sus hijos.

BACKGROUND: Maternal smoking negatively affects birth weight, breast milk volume and growth at one month of age. AIM: To study the effect of maternal smoking on the growth of three month old infants. SUBJECTS AND METHODS: Ten smoking and 10 non smoking mothers with one month old children, under exclusive breast feeding, were selected for the study. Urinary cotinine levels in the mothers and children were measured to assess smoking. Two months later, children were reassessed. RESULTS: Smoking mothers consumed a mean of 6.5 cigarettes/day. Compared to non smokers, urinary cotinine levels were higher in these mothers (60 +/- 21 and 1428 +/- 716 ng/ml respectively, p < 0.001) and their offspring (21 +/- 20 and 156 +/- 101 ng/ml respectively p < 0.001). Compared with smokers, at three months of age, children of non smoking mothers had a higher average weight (5829 +/- 498 and 6325 +/- 427 g, p < 0.02). CONCLUSIONS: Measurement of urinary cotinine levels is a reliable and objective measure of maternal smoking and nicotine transfer to the offspring. It also allows the assessment of passive smoking. Maternal smoking adversely affects child growth at three months of age.

[Copper intake and blood levels as risk factors for atheromatous disease]. / Estudio de ingesta y niveles séricos de cobre como factor de riesgo de enfermedad ateromatosa.

BACKGROUND: Copper is part of antioxidant enzymes and could have a cardiovascular protective effect. A higher cardiovascular risk has been associated with high as well as low plasma copper levels. AIM: To search for differences in copper intake and plasma levels between patients with coronary artery or cerebrovascular diseases and normal subjects. PATIENTS AND METHODS: Zinc and copper intake, plasma levels and serum lipid levels were measured in 20 patients with cerebrovascular disease, 20 patients with an acute myocardial infarction and 40 subjects hospitalized for elective surgery, that served as controls. RESULTS: Copper and zinc intake was below recommended allowances in all subjects. Serum zinc and copper levels did not differ in the three study groups. In patients with myocardial infarction a weak correlation was found between serum copper and total cholesterol (r = 0.24; p < 0.05) and LDL cholesterol (r = 0.31; p < 0.05). CONCLUSIONS: No differences in copper levels were found in subjects with atherosclerosis and controls. The correlation between serum copper and cholesterol deserves further investigation.

[Epidemiological transition in Latin America: a comparison of four countries]. / Transición epidemiológica en América Latina: comparación de cuatro países.

BACKGROUND: In the last decade, Latin America has experienced important transformations in its health conditions, due to demographic changes and a rapid urbanization process. AIM: To analyze socioeconomic, demographic and epidemiological changes in Chile, Guatemala, Mexico and Uruguay and relate them to the different stages in the demographic and epidemiological transition of these countries. MATERIAL AND METHODS: Data was obtained from official information of local and international organizations such as Pan-American Health Organization, United Nations, Latin American Center for Demography (CELADE) and World Bank. RESULTS: Guatemala is in a pre-transition stage with a high proportion of communicable diseases as causes of death (61%) as compared with Mexico (22%), Chile (13%) and Uruguay (7%). Mexico is in a prolonged transition situation and Chile is close to Uruguay in a post-transitional stage. Despite decreasing rates of mortality, the proportion of deaths represented by chronic diseases and injuries has increased to over 30% in all countries, except Uruguay. Adjusted mortality rates for cardiovascular diseases are lower in Latin American countries, as compared to Canada. However, excepting Guatemala, there are differences in the pattern of cardiovascular disease, with a higher mortality due to cerebrovascular and a lower mortality due to coronary artery diseases. CONCLUSIONS: An increment in non communicable diseases is expected for the next decades in Latin America. Analysis of demographic and epidemiological transition is crucial to define health policies and to adequate health systems to the new situations.

PIP: This work compares four Latin American countries representing different stages of the epidemiologic transition. In recent decades, demographic changes, rapid urbanization and industrialization, and improved health care and nutrition have combined to produce the long-term changes in patterns of health and disease that are known as the epidemiologic transition. Conditions related to demographic aging and changing risk factors have gradually displaced infectious diseases as the principal cause of death. Chronic and degenerative diseases have emerged as the principal causes of death in most Latin American countries. Socioeconomic, demographic, and epidemiologic data were obtained from the Pan American Health Organization, Latin American Demographic Center, World Bank, government records, and other sources for Chile, Guatemala, Mexico, and Uruguay, as well as the US and Canada. Comparison of demographic indicators for 1970 and 1990-95 shows the countries to be in different phases of their demographic transitions. Guatemala's general mortality rates are declining, but fertility indicators and natural increase rates are still high. Mortality and fertility rates in Chile and Mexico are in decline. Uruguay's demographic indicators are similar to those of Canada and the US. The segment of population under age 15 has declined in all the countries, although it is still 40% in Guatemala. The urban population has increased in all four countries, but 60% of Guatemalans still live in rural areas. Access to potable water and sanitary sewage disposal is still limited in Guatemala and Mexico, and the illiteracy rate in Guatemala is a high 45%. Per capita gross national product has been stable and health spending low in all the countries over the past 2 decades. Guatemala is in a pre-epidemiologic transition stage, with 61% of deaths caused by communicable diseases, compared to 22% in Mexico, 13% in Chile, and 7% in Uruguay. Communicable diseases are declining in Mexico, but they are still the second major cause of death after cardiovascular diseases. Chile and Uruguay have cancer death rates similar to Canada and the US. Mexico and Guatemala have the lowest mortality rates for cancer and cardiovascular diseases.

[Methods to estimate body composition in the elderly: a critical analysis]. / Métodos de estimación de la composición corporal de ancianos: análisis crítico.

The objective of this study was to compare the values obtained for total body fat obtained with deuterium dilution, anthropometry and bioimpedance in 41 institutionalized elderly individuals (65-90 years old). The values obtained with each technique were compared using the graphic analysis proposed by Bland and Altman, that plots the difference between measurements with both methods against their average. In men (n = 20) and women (n = 21), the best degree of agreement was obtained between the values measured by deuterium dilution and those calculated from skinfolds (mean difference = 1.4% and 6.9%, respectively). The limits of agreement (+/-2SD), for skinfolds reached a maximum of 14.8% in men, and 16.8% in women. These values tend to underestimate fat in the obese and overestimate it in thinner subjects. For bioimpedance and deuterium dilution, the inter-method difference is significantly greater: 9.3% in men and 14.7% in women. This lack of agreement is attributed to the fact that the bioimpedance equipment utilizes equations validated for younger adults. In conclusion, estimation of body composition using skinfoids has the smallest difference compared to deuterium dilution, even though individual measurements are not clinically acceptable. Caution is recommended when using measurements of body composition in the elderly, due to large errors in the determinations.

Epidemiological transition in Latin America: the case of Chile.

To describe Chile's stage of epidemiological transition, a descriptive study of the changes to the demographic and economic profile of this country during the last 20 years is presented. The decline in the total fertility rate from 3.4 in 1970 to 2.6 in 1992 and the important decrease in general and infant mortality rate has led to an increase of life expectancy of 8 years for men and 9 years for women. This has resulted in changes to the age structure and causes of mortality and morbidity of the population. A reduction of 82% in the proportion of deaths among children < 1 year and a 73% increase of mortality amongst those 65 years and older can be observed. In line with these changes non-communicable diseases have increased from 53.7% of all deaths in 1970 to 74.9% in 1991. In the same period mortality rates from cardiovascular causes have decreased from 189.6 to 161.1 per 100,000 population, whilst their relative proportion of all causes has increased from 22.3% to 29%. High prevalence of risk factors should lead to a significant increase of chronic diseases in future years. Regarding morbidity, a high incidence rate for tuberculosis persists together with an increase of infections of the digestive system and of sexually transmitted diseases. A decrease in the rates of diseases preventable by immunisation has been noted. It is concluded that, as defined by population mortality statistics, Chile is in a post-transition stage but with a persistence of some infectious diseases corresponding to a transitional stage of development.

Smoking and its effects on maternal body composition in late pregnancy.

OBJECTIVE: To assess the possible impact of smoking on body composition at the 34-39 weeks of pregnancy, and its consequences on birth weight. SUBJECTS: 31 smokers and 31 non-smokers matched by age, gestational age and percentage of standard weight (PSW). Smoking mothers had 5 cigarettes or more per day during the whole period of pregnancy and non-smoking mothers never smoked. METHODS: A cross-sectional study was conducted in an urban Public Health Center. Anthropometry and the deuterium dilution technique were used to determine body composition. The statistical analysis used a t-test for matched pairs to assess significance of the means difference for each variable. RESULTS: Suprailiac and subscapular skinfolds were found to be larger in non-smokers; this difference was significant for the suprailiac skinfold (P < 0.05). No significant difference was found in total body fat, total body water and fat-free mass obtained with the deuterium dilution technique, or FFM determined by anthropometry. Infants' birth weight was similar in the two groups of mothers. CONCLUSION: These findings suggest that pregnancy does not modify the pattern of body fat distribution already present in smokers before conception. Infants' birth weight was similar in both groups, probably due to no difference in fat-free mass and body fat. The physiological effect of nicotine (e.g. on prolactin, micronutrients), seems to be clearer during lactation and infant growth.

Deuterium equilibration time in infant's body water.

OBJECTIVE: Equilibration time of deuterium oxide was studied in infants with no restriction of food intake, as in field work stringent conditions have to be relaxed. SUBJECTS: Ten children recovering from marasmatic undernutrition in an Infant Nutrition Centre (CONIN). METHODS: Four males and six females [mean 253 +/- 38 (SD) days old] exclusively bottle-fed were administered a deuterium dose in their first morning feed and followed for a 12 day period. The intercept method was used as the reference to validate the isotope equilibration time within the body water pool calculated with the plateau method. Mean equilibration was found to be 291 +/- 78 (SD) (4.85 +/- 1.3 h). RESULTS: Total body water (TBW) values calculated with both methods differed only by 0.6%, confirming that the deuterium oxide was homogeneously distributed within the body water pool at the plateau equilibration time (4.85 +/- 1.3 h). This period is much larger than the one commonly utilized, 120-180 min (2-3 h). CONCLUSION: Regarding TBW measurements, the intercept method provides the same information as the plateau method. However, the intercept method seems more suitable for field studies when working conditions cannot be controlled. The plateau method can be useful for specific short studies providing a faster assessment of the body water pool in infants.

[The epidemiological transition in Chile]. / La transicion epidemiológica en Chile.

Aiming to describe the place that Chile has in the epidemiological transition, a descriptive study of the changes in demographic and epidemiological profiles of the country during the last 30 years is presented. The important decrease in general and child mortality rates, that has lead to an increase in life expectancy and ageing of the population, is emphasized. A 82% reduction in the proportion of deaths among less than one year old children and a 62% increase in mortality among people 65 years or older is observed. In agreement with these changes, non transmissible chronic diseases appear as the principal cause of mortality (65% of all deaths). However, regarding morbidity, an increase in digestive infectious and sexually transmitted diseases and a decrease in immuno-preventable diseases, excepting measles, is noted. It is concluded that, according to mortality, Chile is in a post transition stage, but there is persistence of some infectious diseases, typical of a pre-transition stage.

Smoking during pregnancy and lactation and its effects on breast-milk volume.

The influence of cigarette smoking on daily breast-milk volume was measured by the dose-to-mother deuterium-dilution method in 10 smoking and 10 nonsmoking mothers. After administration of deuterium to the mother, breast milk and infant saliva were sampled over 14 d and analyzed by mass spectrometry. Nonsmoking mothers had a significantly greater breast-milk volume than did smokers [961 +/- 120 vs 693 +/- 110 g/d, mean +/- SD; t = 5.21, P less than 0.0001). Growth rates of the infants were also measured. Weight increase of infants of non-smoking mothers was 550 +/- 130 g whereas of infants of smoking mothers it was only 340 +/- 170 g (t = 3.11, P less than 0.01). These results indicate that cigarette smoking has a negative influence on breast-milk volume whereas the lower infant-growth rates of the smoking mothers suggest also that their breast-milk output was insufficient to support the energy requirements of their infants.

The dose-to-mother method to measure milk intake in infants by deuterium dilution: a validation study.

A validation study of the dose-to-mother deuterium dilution method to measure breast-milk intake has been carried out on ten infants from a Nutrition Recovery Centre in Santiago, Chile. Formula milk labelled with exponentially decreasing doses of deuterium oxide represented milk from a 'pseudo mother' of these exclusively bottle-fed infants. Unlabelled formula represented milk from other sources. Deuterium levels in the infants' body water were measured on saliva samples by mass spectroscopy. The data were fitted in a two-compartment steady-state model of the mother-child system to estimate the flow of labelled water from the 'mother' to the infant and the 'mother' and infant's water elimination constants. A dose-to-child experiment was also carried out on each infant to determine the deuterium dilution space and total daily water intake. Total and labelled water flows from deuterium dilution were used to calculate total, labelled and unlabelled formula milk intakes which were compared to the same quantities measured by bottle weighing. Water elimination constants calculated from the dose-to-mother experiments underestimated by 17 per cent the initially set mother constant and overestimated by 21 per cent the infant constants calculated from the dose-to-child experiments. Rate constants, however, have little effect on the estimated water flows so that there was good agreement between values from deuterium dilution and from direct weighing. Mean (SD) total formula, labelled formula and unlabelled formula intakes were 865 (129) g/d, 417 (74) g/d and 448 (106) g/d, respectively, when measured by deuterium dilution, compared with 856 (116) g/d, 414 (71) g/d and 441 (68) g/d when measured by direct weighing. The mean per cent differences were 1.1 per cent, 0.7 per cent and 1.6 per cent and the mean absolute differences for individuals, 4.3 (1.9) per cent, 4.8 (3.1) per cent and 9.7 (6.6) per cent, respectively.

[Some recent determinants of breast feeding in Chile]. / Algunos determinantes recientes de la lactancia materna en Chile.

Four factors that could explain in great part breast milk production difficulties in Chilean mothers are analyzed according to recent studies. Maternal nutritional status, positively influences breast milk volume and duration, thus adequate weight increment during pregnancy should be encouraged. Maternal work has been negatively correlated with breast-feeding duration in various local studies, by the contrary post-partum rest and direct care of infant show protective effects. Mothers that smoke during pregnancy and lactation have shorter breast-feeding periods than non smokers, meanwhile the latter have lower malnutrition rates. Elimination of health team practices that interfered with physiological lactation have increased breast-feeding time. New programs in this regard are encouraged. The presence at the national level of each of the four determinants is discussed according to available data.