Eduardo Atalah

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.

Estilos de vida y estado nutricional de trabajadores en empresas públicas y privadas de dos regiones de Chile

Feeding habits werecharacterized by a low consumption of fruits, vegetables, fish and dairy products and a highconsumption of fat and sugar. Forty five percent smoked and 88% were sedentary. Forty two percentwere overweight, 18% were obese, 39% had high blood cholesterol, 23% hypertension and 4%diabetes. There was a positive relationship between obesity and hypertension with an odds ratio (OR)adjusted for sex and educational levels of 2.6 (95% confidence intervals (CI) 1.9-3.7) and diabeteswith an OR of 2.8 (95% CI 1.6-4.7). Eighty two percent of obese and 28% of overweight subjectsunderestimated their nutritional status.

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.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

Does Chile's nutritional situation constitute a double burden?

BACKGROUND Chile has probably experienced Latin Americas 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.

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 Preventions 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.

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.

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.

Análisis de la aceptabilidad, consumo y aporte nutricional del programa alimentario del adulto mayor

Background: During 2005, the Chilean Ministry of Health included a fortified milk beverage to the Elderly Food Supplementation Program, to improve the compliance with the program and to increase the provision of micronutrients. This beverage was added to a soup that was distributed since 1999. Aim: To evaluate the long term acceptability, tolerance and consumption of the Milk Beverage and analyze the nutritional contribution of the products provided by the supplementation program to the usual diet of the elderly. Material and methods: One hundred twenty five elderly subjects, aged 77 ± 4 (52 males) living in Metropolitan Santiago, aged over 70 years, beneficiaries of the food supplementation program, were interviewed. The acceptability, consumption and tolerance of the Milk Beverage were evaluated by specially designed surveys. The contribution of the food suplementation products to daily nutrient intake was also analyzed by 24 hours dietary recalls. Results: The mean body mass index of the interviewed elderly subjects was 27.0 ±4.5 Kg/m2. Monthly delivery of the products included in the program increased significantly after the incorporation of the Milk Beverage to the program. The milk beverage had a significantly higher daily consumption and a lower family dilution than the soup. The consumption of supplementation products increased significantly the daily intake of energy and most micronutrients. Noteworthy was the case for vitamin B12, C, E and zinc, whose intake doubled (p <0.01). Conclusions: The Milk Beverage had an excellent approval and consumption rate. The consumption of food supplementation products improved daily intake of most nutrients in elderly subjects

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.Background: Hypertension is associated with elevated sodium and low potassium intakes. The determination of sodium and potassium intake by die- tary 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/m 2 (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 in- take 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. (Rev Med Chile 2014; 142: 687-695)

Propuesta de un nuevo índice de calidad global de la alimentación

Se han propuesto diversas metodologias para evaluar la calidad global de la alimentacion, pero no existen indices especificos en Latinoamerica. El objetivo de este trabajo fue proponer un Indice de Alimentacion Saludable de acuerdo a recomendaciones del Ministerio de Salud de Chile y validar su aplicacion en una muestra nacional de estudiantes universitarios. Se utilizo 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 (recomendacion ministerial) y el puntaje total se clasifico: saludable (90-120), necesita cambios (60-89) y poco saludable (< 60). Se encuestaron 9.452 estudiantes universitarios de diferentes y se evaluo el indice segun 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 segun estado nutricional (p< 0,05). A menor edad menos saludable (p< 0,005). El instrumento fue facil de aplicar por profesionales de la salud y puede ser adaptado a las recomendaciones de cada pais. Existen graves deficiencias en la calidad de la alimentacion en estudiantes universitarios, independientemente de su estado nutricional y sexo.