Eduardo Atalah S

Factores de riesgo de obesidad en escolares de primer año básico de Punta Arenas

Objetivo: Determinar la prevalencia de obesidad en escolares de Punta Arenas y los principales factores de riesgo asociados. Material y Metodo: Muestra aleatoria, estratificada, proporcional de 361 escolares. Se determino peso, talla y se clasifico el estado nutricional de acuerdo a IMC segun normas del MINSAL (CDC/NCHS). Se aplico una encuesta al escolar y su familia sobre variables biosociales, actividad fisica y consumo alimentario. Resultados: La prevalencia de obesidad fue 23,8% y 22% de sobrepeso. Los escolares ven en promedio 3,0 ± 1,7 horas de TV/dia y solo practican actividad fisica extra programatica 0,7 ± 1,4 horas/semana. La alimentacion es poco saludable. Los analisis multivariados demostraron mayor riesgo de obesidad con un IMC materno ³ 25 (OR 2,8 IC 1,6-5,0), edad materna 4 horas/dia frente a TV (OR 1,7 IC 1,0-2,9) y tener 1 hermano o ser hijo unico (OR 1,8 IC 1,1-3,1). Conclusiones: Existe una alta prevalencia de obesidad en escolares de Punta Arenas y es posible identificar a los grupos de mayor riesgo para focalizar las intervenciones

Obesidad materna y riesgo reproductivo

Background: The prevalence of obesity in school children and pregnant women, a known risk factor of the reproductive cycle, has increased significantly over the last few years. Aim: To analyze the association between maternal obesity and the outcome of pregnancy and newborn health. To quantify the attributable population risk of obesity in relation to negative events of pregnancy. Material and methods: A prospective study in 883 pregnant women of 6 public health centers in Santiago. Weight, height, arm circumference, skinfold thicknesses, body mass index (BMI) and fat mass were determined in each trimester. Maternal socio demographic history, smoking habits, incidence of diseases during pregnancy, labor and newborn characteristics were analyzed. Logistic regressions of multiple factors were used to determine nutritional and non-nutritional variables associated to negative events, to determine the population attributable risk of each variable that the model retained. Results: Controlling the effect of other variables, a BMI ≥30 or initial body fat mass ≥35% determined a greater risk for assisted labor with an odds ratio (OR) of 1.9 (95% confidence interval (CI) 1.3-2.9), gestational diabetes with an OR of 6.4 (95% CI 2.1-19.6), hypertension with an OR of 7.8 (95% CI 3.0-20.4), late fetal mortality with an OR of 3.4 (95% CI 1.2-10.0), p <0.001. The risk was mostly associated with the initial maternal nutritional status and in a lesser degree, with the weight gained during pregnancy. Conclusions: Maternal obesity is an important risk factor during pregnancy. The prenatal control obesity could reduce approximately 10% of the cesarean sections and late fetal deaths and half of the hypertension and gestational diabetes cases (Rev Med Chile 2004; 132: 923-30). (Key Words: Diabetes, gestational; Fetal death; Obesity; Pregnancy complications)

Propuesta de una metodología de análisis de la calidad global de la alimentación

Background: Several studies have attempted to assess the global quality of diet. One of such initiatives is the Healthy Eating index (HEI), developed in the Unites States. However, its application in other countries requires certain adaptations. Aim: To adapt the HEI to the Chilean population and to assess its value in Chilean school age children and adults. Material anal methods: A random sample of 264 school age children aged 13.4 ± 0.7 years and 264 adults aged 35.7 ± 0.6 years was studied. A 24 hours food recall was done and the HEI seas calculated considering 10 variables based in the Feeding Guides for the Chilean population. Feeding habits were classified as healthy when the score was over 80 (of a maximum of 100), as requiring changes when the score was between 51 and 80 and as unhealthy when the score was 50 or less. Results: The mean scores for children and adults were 58.4 ± 11.3 and 56.2 ± 11.1 respectively (p< 0.02). The variables with lower scores were vegetables, fruits, dairy products and sodium. Only 1.5% of the population had healthy feeding habits, without differences by sex or age. Feeding quality was significantly worse among obese subjects. Conclusions: The HEI is a tool that can be used in the Chilean population and can be used to assess the effectiveness of health promotion initiatives. It also can help to focalize educational programs to specific nutrients (Rev Med Chile 2005; 133: 175-82)

Alimentación, tabaquismo e historia reproductiva como factores de riesgo del cáncer de cuello del útero

Background: Epidemiological studies have suggested that smoking, nutrition and sexual patterns are major risk factors for cervical cancer. Aim: To study the association between food consumption patterns, smoking and sexual behavior and the risk of cervical cancer. Material and methods: A matched case control study of 170 cases and 340 controls. Food and nutrient intakes were assessed by a food frequency questionnaire considering 58 antioxidant rich food items. Median daily intake of vegetables, fruits, antioxidant vitamins and fiber was calculated. A conditional logistic regression model was used to determine odds ratios associated with variations in nutritional intake and no nutritional factors (age at first delivery, parity, body mass index, family history of cancer and smoking). Results: High intakes of vegetables, fruits, beta carotene, vitamin C, E and fiber were associated with a lower risk of cervical cancer (Odds ratios ranging from 0.56 to 0.78). The risk for cancer was inversely associated with the age at first delivery and directly associated with the total number of pregnancies and smoking. Multivariate analysis model showed a protective effect for vegetable and vitamin E consumption (odds ratio of 0.6 with confidence intervals of 0.5 to 0.8 p<0.001) and a higher risk associated to smoking (odds ratio 2.8, confidence intervals 1.5-5.5 p<0.002) and a younger age at the first delivery (odds ratio 3.37 confidence intervals 2-5.3 p<0.001). Conclusions: Cervical cancer is associated with reproductive and food consumption behaviors. A higher intake of vegetables and foods rich in vitamin E can reduce its risk (Rev Med Chile 2001; 129: 597-603)

Factores de riesgo de enfermedades crónicas no transmisibles en funcionarios de una empresa de servicios financieros de la Región Metropolitana

Background: The epidemic of cardiovascular diseases in Chile, requires the development of strategies in health promotion and prevention. Aim: To assess the prevalence of risk factors for chronic non communicable diseases among workers of a financial company in Metropolitan Santiago. Material and Methods: Assessment of 2,225 workers (1,383 males with a median age of 49 years and 842 females with a median age of 43 years). All answered an enquiry about education, medical history, smoking habits and physical activity. Body mass index and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipid levels. Logistic repression models were used to determine the main risk factors for hypertension, diabetes, obesity, hypercholesterolemia and hyperuricemia. Results: Sixteen percent of studied subjects were obese, 49% had overweight, 57% had hypercholesterolemia, 28% had high blood pressure, 4% were diabetic, 4% had hyperuricemia, 45% smoked and 83% were sedentary. Each worker had a mean of 2.4±1.1 risk factors. This figure was significantly higher among men, obese subjects, those older than 40 years and those with a lower educational level. Conclusions: There is an important disease burden among the studied subjects, specially among obese and older individuals. Healthy lifestyles should be promoted in this population

Autopercepción del estado nutricional en adultos de Santiago

Background: The prevalence of obesity is growing in Chile. The personal perception about the own nutritional status is associated to the risk of obesity. Aim: To analyze the personal perception about their nutritional status among adults living in Santiago and to compare it to the objective diagnosis obtained according to Chilean Health Ministry norms. Material and methods: The body image was explored in 735 people between the ages of 20 and 90. The weight and height were obtained under standard conditions, and the body mass index (BMI) was calculated (kg/m 2 ) and classified according to the criteria of the Health Ministry. The concordance and Kappa index between both criteria in function of age, gender, nutritional status and height were analyzed. The model that best explained the weight subestimation was determined with multivariate logistic regressions. Results: Fifty two percent of subjects classified correctly their nutritional status, 30% subestimated, and 18% overstimated the nutritional status (Kappa 0.27). The multivariate analysis showed greater subestimation in obese (OR 5.8 95% IC 4.2-7.9), in men (OR 4.5 95% IC 2.7-7.3), people younger than 60 years old (OR 2.0 95% IC 1.3-3.1) and people of small stature (OR 3.1 95% IC 1.9-4.9). Conclusions: Half of the studied subjects had an inadequate perception of the body image. Educative campaigns are needed to reinforce the concept of adequate weight. This may contribute to promote

Factores asociados a la lactancia materna exclusiva

Introduccion: Existe limitada informacion de los factores que contribuyen a una lactancia materna exclusiva hasta el sexto mes, datos necesarios para disenar adecuadas politicas de intervencion. Pacientes y Metodo: Estudio de corte transversal. Se aplico una encuesta sobre caracteristicas socio-demograficas, informacion recibida, inicio y duracion de la lactancia y causas de destete. Por regresiones logisticas multivariadas se determinaron factores asociados a lactancia exclusiva de 6 meses. Resultados: 256 madres del sector publico y 158 del sector privado fueron incluidas. Se observo mayor escolaridad, primiparidad, cesareas y trabajo fuera del hogar en sistema privado (p < 0,02); 45,8% de madres mantuvo lactancia exclusiva hasta 6 meses, sin diferencias entre grupos. Principales causas de destete: decision materna (27,2%), percepcion de hambre (24,1%), factores esteticos (17,3%) y enfermedad del nino (13,0%). La lactancia exclusiva hasta los 6 meses se asocio con una lactancia previa exitosa (OR 5,4, 95% IC 2,2-13,2) sexo femenino del hijo (OR 5,5, IC 2,5-12,3), menor escolaridad materna (OR 5,4, IC 2,4-11,7) y sistema publico de salud (OR 2,1, IC 1,0-4,5). Conclusion: El destete muchas veces esta relacionado con percepciones maternas mas que con datos objetivos. Variables socio-demograficas influyen en lactancia exitosa. Mayor educacion en controles de salud y clinicas de lactancia mejorarian esta situacion.

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 ofchronic diseases. Aim: To analyze eating behaviors, nutritional status and history ofprevious 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 oftheir 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 ofdiabetes, 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.

Factores que determinan la selección de alimentos en familias de sectores populares

Objetivo: Analizar los factores que determinan la seleccion de alimentos en familias pobres de 3 comunas de Santiago. Metodologia: Encuesta en 150 familias atendidas por la Fundacion Rodelillo respecto a estructura familiar, ingresos, alimentacion y motivaciones para seleccionar alimentos. Se clasifico el NSE segun linea de pobreza de MIDEPLAN. Resultados: el 41% de las familias eran indigentes, el 42% pobres no indigentes y el 17% no pobres. El ingreso promedio per capita fue

Factores de riesgo del cáncer de mama en mujeres de Santiago

26.200 ± 15.760 y el 55,9 ± 24,6% de los ingresos se destinaba a alimentacion. El 27% habia recibido infor macion sobre alimentacion en el colegio y el 37% en el consultorio, especialmente por dietoterapia. Las guias y la piramide alimentaria eran conocidas por el 4 y 26% de las madres respectivamente. Sobre el 80% de las familias consumia bebidas gaseosas y golosinas. Los principales factores para seleccionar los alimentos fueron: economicos, preferencias sensoriales, comodidad, mejor alimentacion familiar o mejor crecimiento de los hijos. En las familias pobres la razon economica tuvo mayor importancia (84,6%) y disminuyo la motivacion por mejorar alimentacion (8,3%) y por preferencias sensoriales (7,1%) (p <0,05). Conclusiones: Un bajo % de estas madres conoce las guias y piramide alimentaria. La principal razon para seleccionar los alimentos en estas familias son los factores economicos. Aun en estas condiciones tan adversas seria posible orientar una mejor seleccion de alimentos con educacion alimentaria