[Increasing frequency of obesity in Chile]. / Descripción de la progresión de la obesidad y enfermedades relacionadas en Chile.

BACKGROUND: An explosive increase in overweight and obesity occurred in Chile since the 90's, without an integrative national policy. AIM: To describe the current obesity situation in Chile and its consequences. MATERIAL AND METHODS: Analysis of the available anthropometric data obtained by an annual census of anthropometry for students (Nutritional Map) collected by the Ministry of Education, and three National Health Surveys (2003, 2009-2010 y 2016-2017) performed by the Ministry of Health in adults. RESULTS: According to the Nutritional Map the prevalence of obesity in 1987 was 7.5% among children of six years of age and increased to 24% in 2018 (8% with severe obesity). At 14 years of age, the frequency of obesity increased from 8 to 15% from 2011 to 2018. In children older than 15 years, overweight and obesity increased from 61 to 74% from 2003 to 2016. In the same period, total obesity increased from 23 to 34% and the frequency of diabetes duplicated from 6 to 12%. The frequency of hypertension did not change, but its prevalence is 45 and 73% after 45 and 65 years of age, respectively. CONCLUSIONS: The frequency of obesity will continue to increase, producing severe health risks for the population. Public policies addressing both structural and individual aspects are recommended.

[Socioeconomic vulnerability and obesity in Chilean schoolchildren attending first grade: comparison between 2009 and 2013]. / Vulnerabilidad socioeconómica y obesidad en escolares chilenos de primero básico: comparación entre los años 2009 y 2013.

INTRODUCTION: Although obesity is related to socioeconomic level, studies are inconclusive. OBJECTIVES: To determine obesity risk according to socioeconomic vulnerability among Chilean children (1st grade) in 2009 and 2013 and assess its change during that period, by sex and geographical area. PATIENTS AND METHOD: Cross-sectional study (N = 175,462 in 2009) and (N = 189,055 in 2013) which included: weight, height, rural / urban, gender and vulnerability obtained from JUNAEB's survey. BMI Z, % obesity and 3 categories of vulnerability (very vulnerable, moderate, non-vulnerable) were determined. For the descriptive analyses, we used t tests and for predictor variables (2 categories of vulnerability) and outcome (obesity) by sex and area, we used %2. Logistic regression models determined OR to develop obesity by. RESULTS: % obesity was 19.6% and 24.1% in 2009 and 2013, higher in boys. In urban and rural areas respectively, OR to develop obesity were: 0.85 (0.82-0.88) and 0.70 (0.64-0.75) in the most vulnerable students and 0.94 (0.91-0.97) and 0.81 (0.74-0.88) in those with moderate vulnerability in 2009 and 0.96 (0.93-0.98) and 0.89 (0.82-0.96) in the most vulnerable students and 0.99 (0.96-1.02) and 0.94 (0.86-1.02) in students with moderate vulnerability in 2013. The highest increase in obesity was observed among the most vulnerable group from rural areas (16, 6 to 24.3%). vulnerability. CONCLUSION: The non-vulnerable group had the highest % obesity. Although the most vulnerable students in rural areas had the lowest obesity risk in both years, the highest increase in obesity during the period, occurred in that group.

Smart food policies for obesity prevention.

Prevention of obesity requires policies that work. In this Series paper, we propose a new way to understand how food policies could be made to work more effectively for obesity prevention. Our approach draws on evidence from a range of disciplines (psychology, economics, and public health nutrition) to develop a theory of change to understand how food policies work. We focus on one of the key determinants of obesity: diet. The evidence we review suggests that the interaction between human food preferences and the environment in which those preferences are learned, expressed, and reassessed has a central role. We identify four mechanisms through which food policies can affect diet: providing an enabling environment for learning of healthy preferences, overcoming barriers to the expression of healthy preferences, encouraging people to reassess existing unhealthy preferences at the point-of-purchase, and stimulating a food-systems response. We explore how actions in three specific policy areas (school settings, economic instruments, and nutrition labelling) work through these mechanisms, and draw implications for more effective policy design. We find that effective food-policy actions are those that lead to positive changes to food, social, and information environments and the systems that underpin them. Effective food-policy actions are tailored to the preference, behavioural, socioeconomic, and demographic characteristics of the people they seek to support, are designed to work through the mechanisms through which they have greatest effect, and are implemented as part of a combination of mutually reinforcing actions. Moving forward, priorities should include comprehensive policy actions that create an enabling environment for infants and children to learn healthy food preferences and targeted actions that enable disadvantaged populations to overcome barriers to meeting healthy preferences. Policy assessments should be carefully designed on the basis of a theory of change, using indicators of progress along the various pathways towards the long-term goal of reducing obesity rates.

Risk factors during the prenatal period and the first year of life associated with overweight in 7-year-old low-income Chilean children.

The objective of this study was to identify in low-income Chilean children with normal birthweight which factors occurring during the prenatal period and the first year are associated with overweight (OW)/obesity at 7 years. The sample included 652 7-year-olds from a larger cohort study. We collected anthropometric data at 0, 12 and 84 months, maternal pre-pregnancy and pregnancy characteristics, early feeding practices, number of siblings, birth order, breastfeeding, and timing of solid introduction information. We determined the residuals for z-scores for body mass index (BMI) (BAZ), weight/age and height/age0-12 months , run univariate analysis (X(2) or t-test) and multivariate logistic analyses (stepwise approach); P < 0.05 was considered significant. We evaluated the goodness of fit of the model using the Hosmer-Lemeshow test and checked for overdispersion using the Pearson's X(2) . The odds of children being OW at 7 years increased if their mothers were OW before pregnancy, if born with a higher BAZ (increase of 18-74% per each additional unit of BAZ) and if their BAZ growth during the first year was higher (62-239% per each unit over the predicted BAZ increase). Higher birth order was protective (6-68% less risk for 2nd birth compared with 1st and 10-73% less for ≥3rd child). All other variables, including gender, were non-significant (P > 0.1). In low-income Chilean children with normal birth, four factors during the prenatal period and the first year were associated with OW at 7 years: pre-pregnancy BMI, BMI at birth, BMI gain between 0 and 12 months, and birth order.

Alarming weight gain in women of a post-transitional country.

OBJECTIVE: In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups. DESIGN: Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire. SETTING: Population-based cohort of low- to middle-income Chilean women. SUBJECTS: Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS). RESULTS: At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05). CONCLUSIONS: In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Breast bud detection: a validation study in the Chilean growth obesity cohort study.

BACKGROUND: Early puberty onset has been related to future chronic disease; however breast bud assessment in large scale population studies is difficult because it requires trained personnel. Thus our aim is to assess the validity of self and maternal breast bud detection, considering girl's body mass index (BMI) and maternal education. METHODS: In 2010, 481 girls (mean age = 7.8) from the Growth and Obesity Chilean Cohort Study were evaluated by a nutritionist trained in breast bud detection. In addition, the girl(n = 481) and her mother(n = 341) classified the girl's breast development after viewing photographs of Tanner stages. Concordance between diagnostics was estimated (kappa, Spearman correlation) considering girls' BMI and mother's educational level. RESULTS: 14% of the girls presented breast buds and 43% had excess weight (BMI z-score > 1, World Health Organization 2007). Self-assessment showed low concordance with the evaluator (K < 0.1) and girls with excess weight over-diagnosed more than girls of normal weight (44% vs. 24%, p-value < 0.05). Instead, mothers showed good concordance with the evaluator (K = 0.7, 95% confidence interval (CI) = 0.6-0.9), even in overweight girls and/or in mothers with low education (K = 0.7, 95% CI = 0.6-0.8). CONCLUSIONS: Mothers were able to adequately evaluate the appearance of breast bud despite low educational level and girls' excess weight. Mother could be a useful resource for defining puberty onset in epidemiological studies, particularly developing countries.

Association between childhood obesity, cognitive development, physical fitness and social-emotional wellbeing in a transitional economy.

BACKGROUND: It has been suggested that obese children have lower cognitive function, demonstrate poorer physical performance and are more susceptible to social-emotional problems. AIMS: To describe associations between human physical growth, cognitive development, physical fitness and social-emotional characteristics of obese and non-obese children and to verify the predictors of intellectual coefficient by socioeconomic status (SES). SUBJECTS AND METHODS: A sample of 107 non-obese (N-Ob) children [-1 z-score body mass index (BMI) ≤1 z-score] and 108 obese (Ob) children [2 z-score ≤BMI ≤5 z-score] from a larger cohort was evaluated. Intellectual coefficient (IQ), social-emotional wellbeing (SEW), 6-minute walk test (6MWT) and SES (mid-low, low and very low) were assessed. RESULTS: Ob children were taller, heavier and present more height for age and BMI than N-Ob children (p < 0.001). A significant correlation between IQ and SEW (r = 0.14), 6MWT and BMI z-score (r = -0.18) and 6MWT and SEW (r = 0.15) was found. Multiple regression analysis revealed that BMI z-score had a negative impact on IQ in the mid-low SES sub-group and that SEW had a positive effect on IQ in the very-low SES sub-group. CONCLUSIONS: In Chilean pre-school children from low-income families cognitive ability varied according to SES.

Association between socioeconomic vulnerability and height with obesity in low-income Chilean children in the transition from preschool to first grade.

This study determined the percentage of obesity among lower-income Chilean children 4-6 years of age, by socioeconomic vulnerability (family score assessing the children's risk of becoming poor) and height. The sample included 17,080 children with anthropometry at 4, 5, and 6 years of age, and three categories of socioeconomic vulnerability. Body mass index Z-score (BMI Z), % obesity, height/age Z-score (HAZ) by socioeconomic vulnerability/sex, the effect of socioeconomic vulnerability on BMI Z and HAZ by age/sex, and BMI Z and % obesity at 4-6 years, according to initial height, were determined. Between 4-6 years, % obesity is very high, especially among the less-vulnerable and taller children. Preventive measures should prioritize this group.

Determinants of cognitive development of low SES children in Chile: a post-transitional country with rising childhood obesity rates.

Studies conducted in developing countries have noted associations between concurrent stunting, social-emotional problems and poor cognitive ability in young children. However, the relative contribution of these variables in Latin America is likely changing as undernutrition rates decline and prevalence of childhood obesity rises. We conducted a cross-sectional study of 106 normal-weight and 109 obese preschool children to compare the relative contribution of early nutrition, sociodemographic factors and psychosocial variables on cognitive development in normal-weight and obese preschool children in Chile. The study variables were categorized as: (1) socio-demographic (age, sex, birth order and socioeconomic) (2) early nutrition (maternal height, birth weight, birth length and height at 5 years) (3) psychosocial factors (maternal depression, social-emotional wellbeing and home space sufficiency). In order to assess determinants of cognitive development at 4-5 years we measured intelligence quotient (IQ); variability in normal children was mostly explained by socio-demographic characteristics (r(2) = 0.26), while in obese children early nutritional factors had a significant effect (r(2) = 0.12) beyond socio-demographic factors (r(2) = 0.19). Normal-weight children, who were first born, of slightly better SES and height Z score >1, had an IQ ≥ 6 points greater than their counterparts (p < 0.05). Obese children who were first born with birth weight >4,000 g and low risk of socio-emotional problems had on average ≥5 IQ points greater than their peers (p < 0.05). We conclude that in Chile, a post-transitional country, IQ variability of normal children was mostly explained by socio-demographic characteristics; while in obese children, early nutrition also played a significant role.

[Childhood obesity risk index (IROBIC) for small administrative areas in Chile]. / Índice de riesgo de obesidad infantil (IROBIC) para áreas administrativas pequeñas en Chile.

Introduction: Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called "comunas" in Chile Methods: we used 2019 data from public sources on children under 10 years living in "comunas" of the two largest regions. IROBIC includes 16 indicators standardized for each "comuna" and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 "comunas" with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest "comunas" having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 "comunas" with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective.

Introducción: Introducción: a pesar de la alta prevalencia de la obesidad infantil (OI) globalmente, no existen índices compuestos para estimar los aspectos territoriales asociados al riesgo de OI. Objetivo: elaborar un índice de riesgo de OI (IROBIC) para unidades administrativas pequeñas (comunas) de Chile Métodos: se utilizaron datos de 2019 de fuentes públicas con información de menores de 10 años de todas las comunas de las 2 regiones más grandes. El IROBIC incluye 16 indicadores estandarizados por comuna y agrupados en cuatro dimensiones, determinadas por análisis de componentes principales (salud, socio económica, entornos comunal y educacional). Se determinó el IROBIC mediante una media geométrica ponderada y posteriormente se calcularon las diferencias entre las 10 y 5 comunas con mayores y menores IROBIC y de cada dimensión, con el coeficiente de disparidad Resultados: aun cuando los mayores IROBIC se obtuvieran en comunas más vulnerables, su valor total y el de cada dimensión, mostraron que es posible amortiguar los efectos de la desigualdad sobre la OI. Las 10 y 5 comunas con mayor IROBIC presentan un riesgo, 2,41 y 4,05 veces mayor que las de menor valor, respectivamente. Conclusiones: el IROBIC puede monitorear el riesgo de OI ­y factores asociados­ desde una perspectiva territorial.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile.

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

[Evaluation of an obesity prevention intervention which included nutrition education and physical activity applied in public schools of Santiago, Chile]. / Evaluación de una intervención en educación alimentaria y actividad física para prevenir obesidad infantil en escuelas públicas de Santiago de Chile.

The main objective of this study was to assess the effectiveness of an obesity prevention intervention which included nutrition education and physical activity applied to low income Chilean children in a longitudinal three-year follow-up study. Participants included all 4-7 year old children from 7 public schools located in a low socioeconomic district of Santiago. The main aspects of the intervention were: training of teachers so they could apply an educational program on healthy eating, increase in physical education classes from 3 to 4 per week, and improvement of their quality. Weight, height, waist circumference (WC) and the 6-minute walk distance (6MWD) were assessed yearly in 597 children. We calculated BMI, BMI Z, % normal (N), overweight (OW) and obesity (OB), WC > 90th percentile (NHANES III) and fitness (6MWD/height). Annual changes in BMI Z, WC, 6MWD and fitness were assessed, using repeated measures ANOVA and the test of proportions. Knowledge in healthy eating was assessed during 2 of the 3 years. Results showed that % OB remained unchanged for 2 years (17%) but increased to 19.3% at follow-up. BMI Z increased from 0.3 to 0.38 (p = 0.052) in the N, remained unchanged in the OW, while decreasing significantly in the OB (2.73 to 2.41 p < 0.0001). % WC > 90 th percentile decreased in the OW and OB; 6 MWD was higher in the OW, but the increase in distance overtime was greater among the N. Overall fitness improved, however it was only significant among the N (p = 0.0002). There was a significant increase in food knowledge. We conclude that in spite of a decrease in BMI Z of the OB, an improvement in fitness in the N and food knowledge in all the children, obesity increased at follow-up. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; otherwise this condition will continue to rise.

The influence of body composition on the six-minute walk test in Chilean preschool and school children.

INTRODUCTION: Background: the six minutes' walk test (6MWT) measures submaximal physical activity. Objective: this study determines the association of children´s nutritional status and body composition with the results of the 6MWT. Methods: a sample of 1419 Chilean children, 4 to 10 years of age, were assessed including anthropometry, body composition by validated equations, the 6MWT test, and in 50 % of the sample heart rate prior the test, at one minute into the test, and at one minute posttest with a Polar watch. Results: the distance walked ranged from 473.1 ± 47.8 meters in preschool children to 584.2 ± 65.7 meters in school children. In heart rate there was a significant difference between obese and eutrophic children. The distance walked in the 6MWT was positively associated with fat-free mass (p < 0.05) and BMI (R2 = 0.49). Body composition influences 6MWT quartile distribution, as well as nutritional status. Age and height explained 49 % of the variance (R2 = 0.42 and 0.47, respectively) in the 6MWT, and there are significant differences in this variable by sex, body composition, and nutritional status. Conclusions: body composition was associated with walking performance in children. Thus, it is important to evaluate height and body composition when assessing the six-minute walk test because of this important relationship.

INTRODUCCIÓN: Introducción: el test de la marcha de seis minutos (TM6M) mide una actividad física submáxima. Este estudio evaluó el efecto del test de la marcha sobre la composición corporal y el estado nutricional en niños. Métodos: en una muestra de 1419 niños chilenos de 4 a 10 años de edad se evaluaron la antropometría, la composición corporal por ecuaciones validadas, el TM6M y, en el 50 % de la muesta, la frecuencia cardíaca mediante un reloj Polar. Resultados: la distancia caminada varió desde 473,1 ± 47,8 metros en los niños preescolares hasta 584,2 ± 65,7 metros en los escolares. En la frecuencia cardíaca hubo una diferencia significativa entre niños obesos y eutróficos. La distancia caminada se asoció positivamente con la masa libre de grasa (R2 = 0,37) y el IMC (R2 = 0,49). Por otra parte, la composición corporal varía en función de los cuartiles de composición corporal y el estado nutricional. La edad y la altura explicaron el 49 % de la varianza de la prueba (R2 = 0,42 and 0,47, respectivamente). Existen diferencias significativas en la distancia recorrida en el TM6M en función del sexo, la composición corporal y el estado nutricional. Conclusiones: composición corporal, talla e IMC se asociaron a la distancia recorrida en el TM6M. Por tanto, se sugiere medir estas variables cuando se evalúe el test de marcha de seis minutos.

Obesity risk in 10-year-old children, based on attributes observed at 4 years of age, provides evidence on how to target interventions to lower obesity rates in mid-childhood.

Introduction: Introduction: although in Chile 75 % of obese preschool children participate in a primary health intervention, obesity rates have increased. Objective: to determine the risk of children being obese in 5th grade (10 yrs), according to biological and social attributes observed when they attended prekindergarten (PK) at 4 yrs, to determine which preschoolers should be prioritized for targeting. Method: a retrospective cohort study including 55,623 participants. The variables collected when children attended PK were age, sex, weight, height, maternal educational level and employment status, the child´s relationship with persons living at home, person in charge of the child after school, and number of household members, plus weight, height, and age in 5th grade. To determine the risk of being obese in 5th grade we did two logistic regression models-the first one included all PK children and the above variables, while the second model considered additionally the presence of obesity in PK. The rest of the variables were the same. Results: the risk of children being obese in 5th grade (10 yrs) was 1.43 times higher if their mothers had ≤ 8 yrs of schooling, 1.13 times higher if they lived with a grandparent, and slightly higher if their mothers had an occupation (1.04 times). Boys had a significantly higher risk (1.74 times). Obesity at 4 yrs constituted the highest obesity risk later on (5.3 times). Conclusions: targeting obese 4-year-old boys who participate in a primary health intervention, whose mothers have low education and who live with a grandparent, may lower obesity rates in mid-childhood.

Introducción: Introducción: aunque, en Chile, el 75 % de los preescolares obesos participan en un programa de salud primaria, la obesidad infantil ha aumentado. Objetivo: determinar el riesgo de obesidad en escolares de 5º básico (10 años), según las características biológicas y sociales observadas en prekínder (PK) a los 4 años, para determinar qué preescolares debieran ser priorizados para intervenir. Método: cohorte retrospectiva de 55.623 participantes. Las variables recolectadas en PK fueron: edad, sexo, peso, estatura, nivel educacional y situación laboral de la madre, relación del preescolar con miembros del hogar, persona que cuida al escolar y número de miembros del hogar, además de peso, estatura y edad en 5º básico. El riesgo de obesidad en 5º básico se determinó a través de 2 modelos de regresión logística: el primero incluyó a todos los preescolares en PK y las variables mencionadas anteriormente, y el segundo consideró adicionalmente la presencia de obesidad en PK. El resto de las variables fueron las mismas. Resultados: el riesgo de que los escolares presenten obesidad en 5º básico (10 años) fue 1,43 veces mayor si sus madres tenían ≤ 8 años de escolaridad, 1,13 veces mayor si vivían con un abuelo y ligeramente mayor si sus madres estaban ocupadas (1,04 veces). Los hombres tenían un riesgo significativamente mayor (1,74 veces). La obesidad a los 4 años constituyó el mayor riesgo de obesidad posteriormente (5,3 veces). Conclusión: centrar la atención en los niños obesos de 4 años que participen en una intervención de atención primaria, cuyas madres tengan menor educación y que vivan con un abuelo podría reducir la prevalencia de la obesidad.

[Association between body mass index (BMI) and height from birth to 5 years in Chilean preschool children]. / Asociación entre el índice de masa corporal y la talla desde el nacimiento hasta los 5 años en preescolares chilenos.

BACKGROUND: It has been shown that excess weight gain during childhood is associated with a greater risk of obesity; this relationship may be mediated by growth in height. AIM: To quantify the associations between z scores for body mass index (BMIZ) and height for age (HAZ) from birth to 5 years of age and to assess how this association varies according to age and adiposity. MATERIAL AND METHODS: Weight and height were recorded at 11 occasions from birth on a cohort of 1089 Chilean five year-old children with a birth weight > 2500 g. BMI, BMIZ, HAZ and prevalence of obesity were calculated. We determined the cross-sectional association between BMIZ and HAZ for the total sample and by 3 BMI Z categories, using Pearson correlation. We determined the probability of obesity according to four HAZ categories. RESULTS: Obesity increased continuously reaching approximately 16% at 5 years. Stunting was virtually nonexistent. No association between BMIZ and HAZ was observed at birth, while at 1 and 2 months, leaner infants had lower stature. No association between these parameters was observed between 6-24 months, while after 3 years, a clear relationship was observed. CONCLUSIONS: The probability of a preschool child of being obese is less than 10% with a HAZ is < 0. Nevertheless, children with heights above the median (even within the normal range) have an increased risk of obesity, especially after 3 y of age. Between 0-5 years, the relationship between weight and height varies by age and adiposity.

[Changes in food consumption pattern among Chilean school children after the implementation of a healthy kiosk]. / Cambios en el patrón de consumo de alimentos en escolares chilenos con la implementación de un kiosco saludable.

In Chilean school there is a kiosk that sells a large number of high-calorie products. The aim of this study was to determine the barriers that children have for buying healthy food and evaluate changes in the pattern of food purchases during a school year at a school where a "Healthy Space" was created. We designed implemented and assessed changes in food purchases by developing a "Healthy Space" which included a kiosk that incorporated a range of healthy food at affordable prices. The staff in charge of the kiosk was trained and we generate communication and marketing strategies to promote the consumption of healthy food. A validated survey to determine food purchases was applied to 9-12 year-old children from both schools at baseline and follow up 8 months later. The total number of schoolchildren was 477 (291 from the intervention and 115 from the control school). There weren't significant differences in the amount of money available to buy food between children of both schools. There was a significant increase in the purchase of fruit, milk, yoghurt, soft drinks and light juices, dried seeds, healthy sandwiches and non-fat ice cream (p < 0.05) of school children from the intervention school. At the control school, no change in consumption was observed. The increase in the supply of affordable healthy food, including communication and marketing strategies, significantly increases the consumption of these products among school children.

[Evolution of the nutritional status of Chilean children from preschool to school age: anthropometric results according to the source of the data]. / Evolución del estado nutricional de ninos chilenos desde la etapa preescolar a la escolar: resultados antropométricos según procedencia de las mediciones.

Because the results of the nutritional status released by Chilean institutions which collect anthropometric data on their population under control, show different increments in the prevalence of obesity between preschoolers and children in 1st grade, we decided to verify the real magnitude of this increase. This study is based on a longitudinal investigation which began in 2006 and included 1100, three-year old children, which we evaluated when they were 4, 5 and 6 y. The nutritional status was determined according to BMI Z and WHO References 2006/2007. The information was also used to determine the concordance between the anthropometric data collected on first graders by teachers from public schools in 2009 (JUNAEB data set) and the same children assessed in parallel by INTA (INTA data set). The sample included 474, six-year olds. No differences were found between the average BMI Z and HAZ of the two data sets, and the degree of concordance between the BMI Z's was good (rho = 0.73), however there were differences in the nutritional status, since the prevalence of low weight was significantly greater when assessed with JUNAEB's data (9.5% vs. 3.6% ), while that for obesity was lower with INTA's data, 17.5% vs. 19.2% (not significantly different). At 4 and 5 y, obesity prevalence of the children was 13.3% and 15.7% respectively (INTA's data). Considering the observed nutritional trajectory, it is likely that the rise in obesity between 4 and 6 y of age, was 4 percentage points and not 6, as was determined with INTA's data.

Perception that Mothers and / or Guardians of Overweight or Obese Preschool Children Have of a Text Messaging Program to Support Behaviour Change in their Children.

In most childhood obesity preventive programs, parents are targeted as they are key in achieving lifestyle behavior change in their children. Because their participation is generally low, new technologies, such as text messaging, are being tested to assess if their participation increases. The objective of this study was to determine the perception that mothers of overweight/ obese preschool children have of a textmessaging program developed to support their children's lifestyle behavior change. Text messages were sent to 60 mothers twice a week for 12 weeks; 58 of them said they received all of them. During the process mothers were contacted twice regarding their opinion on all aspects related to the messages. At follow-up, we determined perception by in depth interviews administered to participants. Results show that text messaging implemented in a personalized manner was considered successful in regards to providing useful information to support their children's behavior change.

Predictive anthropometric models of total and truncal body fat in Chilean children.

OBJECTIVES: This study aimed to develop predictive anthropometric models for total and truncal body fat in Chilean children using the following anthropometric measurements: weight, height, skinfold thickness, and circumference. METHODS: This cross-sectional study included 669 Chilean children (12.0 y ± 1.3) in Tanner stage IV from the Growth and Obesity Chilean Cohort Study. Anthropometric measurements and dual-energy X-ray absorptiometry were determined to calculate total and truncal body fat. Prediction models were fitted by linear regression analysis. RESULTS: The predictive equation for log total body fat (kg) was 0.449 + 0.049 (body mass index in kg/m2) + 0.018 (triceps skinfold in mm) + 0.012 (biceps skinfold in mm) + 0.019 (brachial circumference in cm) + 0.091 (sex: 1 = boy, 2 = girl) + 0.018 (age in y). The predictive equation for log truncal fat (kg) was -2.107 + 0.046 (waist circumference in cm) + 0.010 (subscapular skinfold in mm) + 0.259 (sex: 1 = boy, 2 = girl) + 0.006 (age in y). The test of concordance between the predictive equations of total and truncal body fat with gold standard was r = 0.85 and 0.91, respectively. CONCLUSIONS: In Chilean children, the high correlation between observed and predicted values enabled us to develop predictive equations for total and truncal body fat for children.

Academically Oriented Activity Breaks for First-Grade Chilean Students: Development and Pilot Testing Effectiveness.

We developed and pilot tested the effectiveness of a physically active academic program, Active Breaks (AB), whose objective is to increase school time moderate/vigorous physical activity (MVPA) among first graders, through daily 15-minute bouts of MVPA, at the beginning of the first lesson. Initially, 240 cards including one game each were developed and tested in first-grade students from 16 schools in Santiago. Trained observers and school teachers assessed the time, ease, and feasibility of implementation for each card. Barriers and facilitators to implementation were obtained from semistructured interviews to 14 teachers (out of 16). In eight schools (n = 556 students), we compared school time MVPA (with accelerometers) at baseline and follow-up, using test of proportions. One-hundred and twenty cards (games) complied with all aspects. AB were implemented 50% of the time with a duration of 14 minutes (SD = 5). More than 90% of the time, teachers felt competent to conduct AB, and children understood the instructions and enjoyed the activity. The main facilitators included teachers liking physical activity and considering it important, support of principal and school staff, and conducting AB inside the classroom. Barriers included teacher's workload and having to conduct AB during the first lesson. During the 4-month period of implementation, MVPA increased by 1.5 and 1.2 percentage points in boys and girls, respectively. The set of 120 cards is easy and feasible to implement. Moreover, preliminary results suggest they could be effective in increasing MVPA during school time, although studies with longer follow-ups are needed to assess the validity of these findings.