Jaime Rozowski

Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women

OBJECTIVE To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes. DESIGN Non-blinded, randomised controlled study. SETTING Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile. SUBJECT Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495). RESULTS Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5-126 g; P = 0.03) and the incidence of very preterm birth (0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19-0.96 cm; P = 0.003). CONCLUSIONS The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.

Nutritional profile of schoolchildren from different socio-economic levels in Santiago, Chile

OBJECTIVE To assess the nutritional status, food intake and physical activity patterns in schoolchildren attending 5th and 6th grade in basic schools from different socio-economic levels in the metropolitan region of Santiago. DESIGN Cross-sectional study in children 5th and 6th grade of eighteen basic schools in the metropolitan region of Santiago. SETTING Boys and girls aged 9-12 years from basic schools were evaluated in terms of physical capacity. An anthropometric evaluation was also performed which included weight, height and triceps and subscapular skinfold thicknesses. Food intake was evaluated by a 24 h recall, socio-economic level by the ESOMAR method and physical activity by a questionnaire. SUBJECTS Boys and girls aged 9-12 years (n 1732). RESULTS The average prevalence of overweight and obesity was 40 %, with the highest prevalence in males and those from lower socio-economic level. A majority (64 %) of the children had a low level of physical activity. A higher intake of fat and protein and a higher intake of carbohydrate were found in the higher and lower socio-economic levels, respectively. Both males and females showed adequacy greater than 75 % in macronutrient intake except for fibre, with both groups showing a deficit in the consumption of fruits, vegetables, legumes, fish and milk products according to Chilean recommendations. CONCLUSIONS A high prevalence of malnutrition by excess was observed in both sexes and a better eating and physical activity pattern was seen in children from higher socio-economic level.

Is the Chilean Diet a Mediterranean-type Diet?

Food intake in Chile has changed markedly in the last decades, showing an increase in fat consumption and presently a small fruit and vegetables intake. A parallel is made between the Chilean and Mediterranean diet (mainly the one from Spain, Italy, and Greece), both currently and from 50 years ago. The main differences and similarities are based on food availability. Although Chilean diet seems to be approaching the traditional Mediterranean diet of the 60s, there is concern about changes that are moving away from Chilean traditional diet and towards a western one. A new food pyramid for Chile is proposed based on the traditional Mediterranean-type diet.

Gestational diabetes, comparison of women diagnosed in second and third trimester of pregnancy with non GDM women: Analysis of a cohort study

UNLABELLED Pregnant women are normally screened for Gestational diabetes (GDM) at week 24 of pregnancy. However some women develop the disease later on their pregnancies. No study has analyzed women developing GDM later in pregnancy. OBJECTIVE To analyze data on a cohort study and compare women diagnosed with GDM in second and third trimester of pregnancy with women without GDM. RESULTS GDM women diagnosed during their first two trimesters of pregnancy were older (p = 0.0008) and had higher body mass index (BMI) (p = 0.0007) than non GDM women. However, the only risk factor in women diagnosed in their third trimester of pregnancy was having first degree relatives with type 2 DM and this was independent of age and BMI (OR of 2.7, 95% CI 1.2 - 6.0). CONCLUSIONS Women who develop GDM in their second trimester of pregnancy have known risk factors for diabetes mellitus such as age and higher BMI, however, the only recognised risk factor between non GDM women and women developing GDM late in pregnancy is family history of type 2 DM. Two populations of GDM may exist and future studies should focus on analysing short and long term complications of these women to support the need to diagnosed and treat them all.

Serum folate, vitamin B 12 and cognitive impairment in Chilean older adults

OBJECTIVE To analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly. DESIGN We analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Students t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ 2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods. SETTING Chile. SUBJECTS Older adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ). RESULTS Multivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P<0.05). The risk of impaired cognitive function depended on different combinations of SF and vitamin B12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels. CONCLUSIONS The relationship between folate, vitamin B12 and impaired cognitive function warrants further study.

Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010

BACKGROUND Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. AIM To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. MATERIAL AND METHODS Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and > 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and > 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. RESULTS SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL > 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. CONCLUSIONS Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels.

Effect of Westernization of Nutritional Habits on Obesity Prevalence in Latin America

Key Points Nutritional habits of Latin Americans show a trend toward a Western-type diet. There is a clear tendency of increased consumption of fats, saturated fats, and animal proteins and of decreased consumption of fruits and vegetables in the diet. Prevalence of obesity is high in many countries of the region in all age groups, with a clear tendency to increase. Prevention programs should be implemented from childhood, with a strong political backing and the involvement of the community. Recommendations on objectives and goals to increase nutrition education and promote exercise in the population are proposed.

Consumo de huevo y enfermedad cardiovascular: una revisión de la literatura científica

Eggs are a highly nutritive food. They contain high quality protein and several nutrients with potential health benefi ts. Nevertheless, the appearance of cardiovascular disease as an important public health issue, with high morbidity and mortality rates worldwide, along with the identifi cation of high blood cholesterol levels as a risk factor for this disease, was responsible for the advice to limit dietary cholesterol (and, therefore, eggs) that was promoted by health care professionals and institutions during the 70s. To date, several cohort studies show that the intake of one egg a day does not increase cardiovascular risk in the general population. However, this evidence is not clear among diabetic patients, and raises the question whether its consumption in large quantities is entirely safe in this particular population. Additionally, intervention studies have shown that egg consumption does not adversely affect cardiovascular risk factors neither in healthy individuals nor in those with cardiometabolic disease. Moreover, these studies suggest that the incorporation of egg to the diet could bring additional benefits such as promoting a less atherogenic lipid profile.

Nutritional Habits and Obesity in Latin America: An Analysis of the Region

The stigma of undernutrition has been prevalent for hundreds of years in the world. More recently, obesity has become a major public health issue, present in developed and developing countries, even in those that show a high prevalence of undernutrion. In Latin America obesity is present in all countries and its prevalence varies according to their socioeconomic status. Although food habits vary in different sub-areas the traditional diets in the region have changed in the last decades to one characterized by a consumption of high fat foods, simple carbohydrates, sweetened beverages and salt. In addition, physical inactivity in children is increasing due to a combination of lack of appropiate facilities, sedentary habits and safety concerns. Although some programs to increase physycal activity have been succesful, those targeted to modify food habits have not. It is necessary to implement educational programs to improve the diet and increase physical activity in all countries of the region. This can only be accomplished with the participation of all actors involved including the community, school systems, government and food industry.

Implications of the nutrition transition in the nutritional status on pregnant women.

In most developing countries, including Chile, an epidemiologic and nutrition transition has taken place, the former characterized by an increase of the population due to a reduced mortality, followed by a decrease in fertility and an increase in longevity. The nutrition transition has been characterized by an increase in the consumption of fats and simple sugars and a decrease in fruit and vegetable intake. This, together with a decrease in physical activity, has contributed to an increase in the prevalence of obesity in fertile women. Data collected from 36 developing countries showed that in 32 of them, overweight was more prevalent than underweight in urban areas, while in 53% (19/36) underweight was more prevalent in rural areas compared to urban settings. In all of those countries, the prevalence of overweight was significantly correlated with gross national income per capita. Different surveys in Chile have shown that 90% of homes have a television set, 60% of all families own at least one car, 27.3% of women aged 17–44 are obese, and 90% of them do not perform any significant physical activity. The consequence of all this is that women are getting to pregnancy heavier than they used to, resulting in an increase in complications during pregnancy including gestational diabetes mellitus, hypertension, and delivery complications, all of which can affect the newborn at birth and in later life. This chapter defines the characteristics of the nutritional transition and concentrates in a discussion of obesity during pregnancy and its consequences at birth and in later life.