Inequality, abuse of women and duration of breastfeeding, Colombia, 2010: Ecological study / Desigualdad, maltrato de la mujer y duración de la lactancia materna, Colombia, 2010: Estudio ecológico

Abstract Introduction: Breastfeeding decreases morbidity, mortality and promotes health in the mother and child. The lower morbidity in relative terms in breastfed versus non-breastfed infants reduces healthcare costs. In Colombia, the duration of breastfeeding is far from desirable times and continues to decline. Objectives: The objectives were (a) to determine economic inequality based on poverty at the ecological level during exclusive breastfeeding (EBF) and total breastfeeding (BF) and (b) to establish the social determinants of EBF and BF using the territory as a unit of analysis. Method: An ecological study was conducted based on data collected in the National Survey of the Nutritional Situation of 2010 in Colombia regarding the median duration of exclusive breastfeeding and total breastfeeding. The data was summarized in 24 departments or geodemographic units that represent the Colombian territory (n=24). Fourteen variables representing the economic, social, human and structural development levels in the territory were related by linear regression to explain the duration of EBF and BF. Results: EBF lasted 1.18 months (95% CI: 1.00 to 1.36), and BF lasted 14.79 months (95% CI: 13.50 to 16.08). Economic inequality was low, and the Gini coefficient was 0.35 for EBF and 0.10 for BF. The EBF duration is affected by the gender empowerment measure (GEM) (β =-1.94, p=0.006) and medical coverage (%) (β =-0.02, p=0.060). The BF duration is explained by the monetary poverty (β =0.12, p=0.007) GEM (β =-9.94, p=0.033) and female abuse rate x 100,000 (β =0.01, p=0.005). Conclusions: The impact of social and human development is greater than the economic aspect as a determinant of EBF and BF duration in Colombia. Exclusive and total breastfeeding are phenomena explained differently.

Resumen Introducción: La lactancia materna disminuye la morbilidad, la mortalidad y promueve la salud de la madre y del niño. La menor morbilidad en términos relativos en los niños amamantados frente a los no amamantados reduce los costes sanitarios. En Colombia, la duración de la lactancia materna está lejos de los tiempos deseables y sigue disminuyendo. Objetivos: Los objetivos fueron (a) determinar la desigualdad económica basada en la pobreza a nivel ecológico durante la lactancia materna exclusiva (LME) y la lactancia materna total (LMT) y (b) establecer los determinantes sociales de la LME y la LMT utilizando el territorio como unidad de análisis. Método: Se realizó un estudio ecológico a partir de los datos recogidos en la Encuesta Nacional de Situación Nutricional de 2010 en Colombia sobre la mediana de duración de la lactancia materna exclusiva y la lactancia materna total. Los datos se resumieron en 24 departamentos o unidades geo demográficas que representan el territorio colombiano (n=24). Catorce variables que representan los niveles de desarrollo económico, social, humano y estructural del territorio se relacionaron mediante regresión lineal para explicar la duración de la LME y la LMT. Resultados: La LME tuvo una duración de 1,18 meses (IC 95 %: 1,00 a 1,36), y la LMT tuvo una duración de 14,79 meses (IC 95 %: 13,50 a 16,08). La desigualdad económica fue baja, y el coeficiente de Gini fue de 0,35 para la LME y de 0,10 para la LMT. La duración de la LME se ve afectada por la medida de empoderamiento de género (GEM) (β =-1,94, p=0,006) y la cobertura médica (%) (β=-0,02, p=0,060). La duración de la LMT se explica por la pobreza monetaria (β =0,12, p=0,007) GEM (β =-9,94, p=0,033) y la tasa de maltrato femenino x 100 000 (β =0,01, p=0,005). Conclusiones: En Colombia el impacto del desarrollo social y humano es mayor que el aspecto económico como determinante de la LME y de la duración de la LMT. La lactancia materna exclusiva y total son fenómenos que se explican de manera diferente.

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015.

OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

Inseguridad alimentaria y desarrollo humano predicen la incidencia de cáncer colorectal en Colombia: Estudio ecológico / Food insecurity and human development predict colorectal cancer incidence in Colombia: an ecological study

Resumen Introducción: la inseguridad alimentaria (INSA) ha sido asociada a la generación de enfermedad crónica y como barrera en el tratamiento del cáncer. Ante la ausencia de estudios, establecimos a nivel ecológico la relación entre INSA y la tasa de incidencia de cáncer de colon, recto y ano x 100.000 habitantes (ICCRA). Objetivo: el objetivo fue establecer el grado de asociación entre la inseguridad alimentaria y la tasa de incidencia de cáncer colorrectal x 100.000 habitantes. Materiales y métodos: estudio ecológico realizado con información secundaria que producen regularmente las agencias del estado y que miden el nivel de desarrollo humano, social y económico en el territorio en las 33 unidades geodemográficas que conforman a Colombia. Utilizando regresión lineal múltiple con la ICCRA como la variable dependiente, la INSA como principal explicatoria y otras variables del contexto, establecimos la relación entre INSA y la ICCRA y ecuaciones predictivas de la ICCRA por sexo. La bondad de ajuste en los modelos se garantizó mediante el coeficiente de determinación (R2) y el método de Bland y Almant. Resultados: la INSA se relaciona de manera inversa y el IDH de manera directa con la ICCRA. Dos ecuaciones predicen la ICCRA; En hombres, [ICCRA=-6,38+-0,25*INSA+35,5*IDH]. En Mujeres, [ICCRA=6,47+-0,23*INSA+19,1*IDH]. El coeficiente de determinación R2 (%) en hombres es de 88 y en mujeres de 72. La diferencia media entre ICCRA observada versus la estimada fue de -0,00 en hombres (IC95 %: -3,13 a 3,13), y en mujeres de -0,00 (IC95 %: -4,08 a 4,08) Conclusión: la INSA puede estar en la vía causal de la ICCRA. La INSA y el IDH predicen con precisión la ICCRA.

Abstract Introduction: food insecurity (FI) has been associated with the generation of chronic disease and as a barrier in the treatment of cancer. Food insecurity leads to nutrient-poor diets, including dietary fiber. Colon cancer in Colombia is the third cause of death and its incidence is increasing. Objective: the objective was to establish the degree of association between food insecurity and the incidence rate of colorectal cancer x 100.000 inhabitants. Methods: ecological study carried out with information that measure the level of human, social and economic development in the territory of the 24 geodemographic units that make up Colombia. Using multiple linear regressions with colorectal cancer as the dependent variable, food insecurity as the main explanatory and other variables of the context, we established the relationship between food insecurity and colorectal cancer and predictive equations of colorectal cancer. The goodness of fit in the models was the coefficient of determination (R2) and the Bland and Alman method. Results: food insecurity is related in an inverse manner, and the human development Index is directly related to colorectal cancer. Two equations predict colorectal cancer with precision; Men, [colorectal-cancer = -6.38 + -0.25 * food-insecurity + 35.5 * human development Index]. Women, [colorectal-cancer = 6.47 + -0.23 * food-insecurity + 19.1* human development index]. The average difference between colorectal cancer observed versus the estimated, was -0.00 in men (95% CI: -3.13 to 3.13), and in women of -0.00 (95% CI: -4.08 to 4.08). Conclusion: food insecurity may be in the causal pathway of colorectal cancer. Food insecurity and the human development Index predict colorectal cancer.

Dietary patterns and breast cancer in Colombia: an ecological study.

BACKGROUND: The role that diet plays in the development of breast cancer is unclear and breast cancer continues to increase in Colombia and worldwide. The objective of this study was to assess the association between patterns of dietary consumption and the incidence of breast cancer. METHODS: An ecological study was conducted in 24 geodemographic units in which 95% of the women of Colombia live. The association between breast cancer rate (dependent variable) and three dietary patterns established with factor analysis (traditional/starch, fiber/dairy and snack) was investigated using simple and multiple linear regression. The use of variables related to socioeconomic context and the duration of breastfeeding allowed for the control of possible confounding. All information was derived from concurrent national surveys or was obtained directly over a period of time close to the period during which the study was conducted. RESULTS: There is an inverse relationship between breast cancer rate and illiteracy rate (ß=-2808.3), duration of breastfeeding (ß=-3354.1), adherence to traditional/fiber dietary patterns (ß=-30467) and adherence to the snack dietary pattern (ß=-43612). The goodness of fit for the model was R2=84%. CONCLUSIONS: Increasing the duration of breastfeeding, ensuring education to promote health and following traditional food consumption patterns, regardless of what foods are consumed, can protect against the development of breast cancer.

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015 / Brecha nutricional en niños, urbano-rural: educación y alimentos, la clave. Colombia, 2015

ABSTRACT OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

RESUMEN OBJETIVO: Analizar el estado de nutrición en menores de cinco años de áreas urbanas y rurales en Colombia. MÉTODOS: Estudio analítico, con base en datos de corte transversal, recolectados por la ENSIN-2015. La muestra fue de 12.256 niños colombianos entre cero y cuatro años. Se calcularon razones de prevalencia (RP) y sus respectivos intervalos al 95% de confianza (IC95%). Las RP se obtuvieron de modelos de regresión binomial con el déficit o el exceso, como la variable dependiente y la zona geográfica como la principal explicación. Variables del contexto se utilizaron para ajustar las RP estimadas y limpiar el efecto confusor de éstas. RESULTADOS: La prevalencia de desnutrición aguda (peso/talla) fue de 1,6%, la de exceso de 5,6%. No existieron diferencias por zona geográfica, en el indicador (peso/talla). El retraso talla/edad - desnutrición crónica - fue mayor en la zona rural (RP = 1,2; IC95% 1,00-1,53; p = 0,050). Las prevalencias ajustadas por variables que dan cuenta del desarrollo estructural, social y económico, mostraron que la escolaridad del jefe y la inseguridad alimentaria del hogar explican la desnutrición. CONCLUSIONES: El indicador talla/edad es el mejor para establecer el nivel de desarrollo. Medidas contra la cobertura, pertinencia, calidad en la educación y el acceso a los alimentos impactarán negativamente el estado de nutrición en los niños.

Cambios alimentarios en Colombia; resultados de dos encuestas nacionales de nutrición, 2010-2015 / Food changes in Colombia; results of two national nutrition surveys, 2010-2015

Resumen Introducción: Colombia experimenta una transición alimentaria sumada a la nutricional. Objetivo: Establecer en Colombia para el período 2010-2015 la prevalencia y la frecuencia/día del consumo usual de 28 alimentos y dos prácticas de interés para la nutrición pública. Además, establecer las diferencias en la prevalencia y frecuencia/día entre años. Metodología: Estudio analítico en población entre 5 y 64 años, con datos de corte transversal recolectados en las dos últimas Encuestas Nacionales de Situación Nutricional en Colombia, ENSIN-2010 y 2015. Los datos de consumo fueron los obtenidos a través de un Cuestionario de Frecuencia de Consumo. A través de modelos de regresión lineal se estimaron las diferencias crudas y ajustadas para la prevalencia y la frecuencia/día del consumo usual de 28 alimentos y dos prácticas asociadas. Resultados: En el período 2010-2015, en los niños, la prevalencia de consumo de leche, carne, atún, vísceras, leguminosas, pan, tubérculos, azúcar, gaseosas y alimentos fritos disminuyó, al igual que la de verduras y frutas. En los adultos, la prevalencia de leche, carne, atún, vísceras, pan, tubérculos, azúcar, alimentos fritos y alimentos light disminuyó, al igual que la de verduras y frutas. En niños y adultos la prevalencia de consumo de alimentos de paquete aumentó, pero su frecuencia/día disminuyó. La prevalencia de uso del salero disminuyó en niños y adultos, pero su frecuencia/día aumentó. Discusión: El cambio alimentario establecido es similar en niños y adultos confirmando que la cultura alimentaria se hereda socialmente y se transmite de manera vertical entre padres e hijos. Conclusiones: Colombia experimenta una transición alimentaria. Se requiere política pública para orientar el consumo.

Abstract Introduction: Colombia experiences a food transition coupled with nutritional transition. Objective: Establish in Colombia for the period 2010-2015 the prevalence and frequency/day of the usual consumption of 28 foods and two practices of interest for public nutrition. Also, establish differences in prevalence and frequency/day between years. Methodology: Analytical study in population between 5 and 64 years, with cross-sectional data collected in the last two National Surveys of Nutritional Situation in Colombia, ENSIN-2010 and 2015. The consumption data were obtained through a Food Frequency Questionnaire. Through linear regression models, raw and adjusted differences were estimated for the prevalence and frequency/day of usual consumption of 28 foods and two associated practices. Results: In the 2010-2015 period, in children, the prevalence of consumption of milk, meat, tuna, viscera, legumes, bread, tubers, sugar, soft drinks, and fried foods decreased, as did those of vegetables and fruits. In adults, the prevalence of milk, meat, tuna, offal, bread, tubers, sugar, fried foods, and light foods decreased, as did those of vegetables and fruits. In children and adults, the prevalence of packaged food consumption increased, but its frequency/day decreased. The prevalence of saltshaker use decreased in children and adults, but its frequency/day increased. Conclusions: The established dietary change is similar in children and adults confirming that the food culture is inherited socially and transmitted vertically between parents and children. Colombia experiences a food transition. Public policy is required to guide food consumption.

Patrones de consumo alimentario y pobreza monetaria en Colombia / Food consumption patterns and monetary poverty in Colombia

RESUMEN Se estimaron las desigualdades en tres patrones de consumo alimentario en adultos colombianos (18 y 64 años) relacionadas con la pobreza monetaria. Se realizó un estudio ecológico, que relacionó la pobreza monetaria de 33 unidades geo-demográficas con tres patrones de consumo obtenidos mediante análisis de factores de la Encuesta Nacional de Situación Nutricional en Colombia- 2010. Utilizando Epidat v. 4.2®, se calcularon índices de desigualdad basados en rangos, disparidad o dispersión, en desproporcionalidad, basados en modelos de regresión y los basados en el concepto de entropía. El coeficiente de determinación (r2) para el patrón frutaverdura/lácteos fue de 0,30; para el patrón tradicional/almidón de 0,08 y para el patrón snack de 0,00. La razón de tasas más alta fue para el patrón fruta-verdura/lácteos (2,61), seguida por la razón para el patrón tradicional/almidón (0,93) y la más baja para el patrón snack (0,85). La desigualdad, alcanzó el mayor coeficiente de Gini en el patrón de consumo snack (0,26), le sigue el alcanzado en el patrón tradicional/almidón (0,17) y el fruta-verdura/lácteos (0,12). Concluimos que la mayor desigualdad ocurrió en el patrón de consumo fruta-verdura/lácteos, es deseable aumentar la adherencia la patrón tradicional y disminuir la ingesta de proteínas en los más ricos.

ABSTRACT We estimated the inequalities in three patterns of food consumption in Colombian adults (18 and 64 years) related to monetary poverty. An ecological study was conducted, which linked the monetary poverty of 33 geo-demographic units with three consumption patterns obtained through factor analysis using the National Nutrition Situation Survey in Colombia-2010. Using Epidat v. 4.2®, inequality indexes based on ranges, disparity or dispersion were calculated, in disproportionality, based on regression models and those based on the concept of entropy. The determination coefficient (r2) for the fruit-vegetable/dairy pattern was 0.30, 0.08 for the traditional pattern/starch, 0.00 and for the snack pattern. The highest rate ratio was for the fruit-vegetable/dairy pattern (2.61), followed by the ratio for the traditional pattern/starch (0.93), and the lowest for the snack pattern (0.85). Inequality reached the highest Gini coefficient in the pattern of snack consumption (0.26), followed by that reached in the traditional pattern/starch (0.17) and the fruit-vegetable/dairy pattern (0.12). We showed that the greatest inequality occurred in the fruit-vegetable / dairy consumption pattern, it is desirable to increase the adherence to the traditional pattern and decrease the protein intake in the richest population.

Trends in Iron, Zinc, and Vitamin A Status Biomarkers Among Colombian Children: Results From 2 Nationally Representative Surveys.

BACKGROUND: Micronutrient deficiencies are still highly prevalent in countries undergoing the nutrition transition, but nationally representative data documenting their burden in children are exceedingly rare. OBJECTIVE: To examine the distribution and recent trends in micronutrient status biomarkers of Colombian children. METHODS: We compared the distributions of plasma ferritin, serum zinc, and vitamin A in Colombian children between 2005 and 2010 using 2 cross-sectional, nationally representative surveys overall and by categories of sociodemographic variables. Analysis for ferritin included boys and nonpregnant girls aged 1 to 17 years. Analyses for zinc and vitamin A included children aged 1 to 4 years. RESULTS: The mean 2010 to 2005 differences in ferritin, zinc, and vitamin A were 2.5 µg/L (95% confidence interval [CI]: 1.3 to 3.7), -34.9 µg/dL (95% CI: -39.6 to -30.2), and -11.5 µg/dL (95% CI: -12.3 to -10.7), respectively, after adjusting for sociodemographic characteristics. These differences varied significantly by region of residence. In 2010, region of residence was a significant correlate for all 3 micronutrients. Other important correlates included age and maternal education for ferritin and body mass index-for-age Z score, maternal education, wealth index, food insecurity, and urbanicity for vitamin A. CONCLUSIONS: Plasma ferritin was slightly higher in 2010 than in 2005, whereas serum zinc and vitamin A were substantially lower in 2010. In the absence of obvious causal explanations, it is uncertain whether this decline represents a worsening of micronutrient status in Colombian children or an artifact due to systematic laboratory or data management errors incurred in the surveys.

La transición alimentaria y el exceso de peso en adultos evaluados con base en la Encuesta de la Situación Nutricional en Colombia, 2010 / Dietary transition and excess weight in adults according to the Encuesta de la Situación Nutricional en Colombia, 2010

Introducción. La transición alimentaria está determinada por las transiciones demográfica y nutricional. Objetivos. Establecer la prevalencia del exceso de peso en colombianos de 18 a 64 años de edad, determinar su patrón alimentario y su relación con el exceso de peso. Materiales y métodos. Se analizó la Encuesta Nacional de la Situación Nutricional en Colombia, 2010. Los patrones alimentarios se establecieron mediante un análisis de factores en 5.217 sujetos que contestaron un cuestionario de frecuencia de consumo. La relación entre el exceso de peso y la inclusión en los cuartiles de los patrones se estableció con regresión binomial. Resultados. La prevalencia del exceso de peso en hombres fue de 47,4 % (IC 95% 44,7-50,0) y en mujeres de 57,1 % (IC 95% 54,9 59,3; p<0,0001). Se establecieron tres patrones alimentarios: proteína-fibra, bocadillo- snack y tradicional-almidón. Los modelos ajustados por edad, sexo y nivel de seguridad alimentaria del hogar, evidenciaron que los patrones de proteína-fibra y tradicional-almidón estaban asociados al exceso de peso (test de tendencia lineal para la inclusión en los cuartiles: p=0,007 y p=0,001, respectivamente). Ni la frecuencia del consumo de gaseosas y refrescos azucarados, con un sesgo relativo ajustado de 100 (IC 95% 93-109; p=0,913), ni de comidas rápidas, con un sesgo de 102 (IC 95% 89-117; p=0,759), se asociaron al exceso de peso. Conclusiones. El exceso de peso aumentó de manera constante con la edad y más en las mujeres, y se asoció con los indicadores de estatus socioeconómico y con el cambio del patrón tradicional-almidón al de proteína-fibra.

Introduction: Dietary transition is codetermined by demographic and nutritional transitions. Objectives: To establish the prevalence of overweight individuals among Colombians aged 18 to 64, identify their dietary patterns and establish the relationship between this and their excess weight. Materials and methods: We analyzed the Encuesta de la Situación Nutricional en Colombia, 2010 ( National Survey of the Nutritional Situation in Colombia, 2010). Dietary patterns were established with factor analysis in 5,217 subjects, who answered a questionnaire on food consumption frequency. The relationship between excess weight and adherence to quartiles in the patterns was established with binomial regression. Results: The prevalence of excess weight was 47.4% in men (95% CI: 44.7; 50.0) and 57.1% in women (95% CI: 54.9; 59.3, p<0.0001). Three patterns were established: protein/fiber, sandwich/snack and traditional/starch. When the models were adjusted for age, sex and level of food security in the home, the protein/fiber and traditional/starch patterns were found to be associated with excess weight (test of linear trend for quartiles of adherence, p=0.007 and p=0.001, respectively). Neither the frequency of consumption of carbonated and sugary drinks, with an adjusted relative risk of 100 (95% CI: 93 - 109; p=0.913), nor that of fast food with 102 (95% CI: 89; 117; p=0.759) were associated with excess weight. Conclusions: Excess weight increases constantly with age, particularly in women, and is associated positively with indicators of socioeconomic status and subjects changing from the traditional/starch pattern to the protein/fiber one.

Derecho a la alimentación en población en situación de desplazamiento forzado en Bucaramanga, Colombia / Right to food in population in a situation of forced displacement in Bucaramanga, Colombia

Objetivo: Se analizó el acceso a la alimentación en el marco del goce efectivo de derechos en población en situación de desplazamiento forzado en el Área Metropolitana de Bucaramanga, Colombia. Materiales y métodos: Durante el segundo semestre de 2010 y el primero de 2011, se entrevistaron 272 familias siguiendo los parámetros de las Encuestas Nacionales de Verificación (ENV2007-ENV2010). Resultados: La principal causa de desplazamiento fue la amenaza directa (71,8%), seguida de los asesinatos (11,3%). El 91,2% de las familias se encontraba en el Registro Único de Población Desplazada (RUDP). El 33,5% de las familias, afirmó consumir menos alimentos de los necesarios, porque la comida no alcanzó. En el 24,6%, dejó de consumir al menos una comida principal por falta de dinero. Estar inscrito en el RUDP no se traduce en ventajas relativas con respecto al derecho a la alimentación. Conclusión: La situación de la población del Área Metropolitana de Bucaramanga en materia del goce efectivo del derecho a la alimentación no se cumple y corrobora la existencia de un estado de cosas inconstitucional. La situación de inseguridad alimentaria que atraviesan las familias en situación de desplazamiento forzado es similar a la que se registra en el país a través de las Encuestas Nacionales de Verificación.

Objective: The access to food in the framework of the full enjoyment of rights in population in a situation of forced displacement in the Metropolitan Area of Bucaramanga, Colombia was analyzed. Materials and methods: 272 families were interviewed during the second half of 2010 and the first half of 2011 taking into account the parameters of the National Surveys of Verification (ENV2007-ENV2010). Results: The main cause of displacement was the direct threat (71.8%), followed by murder (11.3%). 91.2% of the families was registered in the Single Register of Displaced Population (RUDP). 33.5% of the families claimed they were consuming less food than needed because the food was not enough. 24.6% of the families stopped eating at least one main meal due to lack of money. Being enrolled in RUDP does not mean they have relative advantages with respect to the right to food. Conclusion: The situation of the population of the Metropolitan Area of Bucaramanga in terms of the effective enjoyment of the right to food is not fulfilled and confirms the existence of an unconstitutional state of affairs. The situation of food insecurity that families in a situation of forced displacement deal with is similar to that registered around the country through the National Surveys of Verification.

Consumo dietario y estado de nutrición en población colombiana / Dietary intake and nutritional status in a Colombian population

The objective of this study was to establish the relationship between nutritional status and dietary intake in a Colombian population. An analytical study with measurements of dietary intake of energy (calories), nutritional status, socioeconomic conditions, environmental conditions and food insecurity was carried out in 1,488 subjects. Dietary intake was calculated based on two recall of the past 24 hours and nutritional status was assessed with anthropometry. Food intake was expressed as: a) participation (%) intra-household, b) consumption per 1000 kcal usual, c) adequacy between required consumed and d) individual food insecurity. Using multinomial logistic models with nutritional status as dependent variable, we calculated adjusted prevalence ratios with 95%. For every five percentage points increase in the participation in energy consumption, the risk of deficit increased by 1.16 times (CI95 %: 1.03 to 1.30). The risk of deficit increases by living in urban areas 4.10 (CI 95 %: 1.29 to 13.02), increasing age (per 5 years) 1.32 (CI 95 %: 1.27 to 1.37) and not getting food aid 1.73 (CI 95 %: 1.10 to 2.74). The loss of discriminating power of dietary intake, explaining the nutritional status and the emergence of other variables such as food support calls for reformulation of individual and population-based care of nutritional status.

El objetivo de este estudio fue establecer la relación entre el estado de nutrición y la ingesta dietaria en la población colombiana. Se realizó un estudio analítico con datos repetidos sobre la ingesta dietaria de energía (kilocalorías) y transversales del estado de nutrición, condiciones socioeconómicas, ambientales y de inseguridad alimentaria. En 1488 sujetos se calculó el consumo usual con base en dos recordatorios de las últimas 24 horas y el estado de nutrición con antropometría. El consumo se expresó como; a) participación (%) intrahogar, b) consumo usual por cada 1000 kilocalorías, c) adecuación entre lo consumido y lo requerido y d) inseguridad alimentaria individual. Mediante modelos logísticos multinomiales con el estado de nutrición como variable dependiente, se calcularon Razones de Prevalencia ajustadas con sus IC 95 %. Por cada cinco puntos porcentuales que aumenta la participación en el consumo de energía, el riesgo de déficit aumenta en 1,16 veces (IC 95 %: 1,03 a 1,30). El riesgo de déficit es explicado consistentemente por habitar en la zona urbana 4,10 (IC 95 %: 1,29 a 13,02), el de exceso por el aumento de la edad (por cada 5 años) 1,32 (IC 95 %: 1,27 a 1,37) y por no recibir apoyo alimentario 1,73 (IC 95 %: 1,10 a 2,74). La pérdida de poder discriminante del consumo dietario, al explicar el estado de nutrición y la aparición de otras variables, como el apoyo alimentario invita a la reformulación de la atención individual y poblacional del estado de nutrición.

Genetic ancestry is associated with colorectal adenomas and adenocarcinomas in Latino populations.

Colorectal cancer rates in Latin American countries are less than half of those observed in the United States. Latin Americans are the resultant of generations of an admixture of Native American, European, and African individuals. The potential role of genetic admixture in colorectal carcinogenesis has not been examined. We evaluate the association of genetic ancestry with colorectal neoplasms in 190 adenocarcinomas, 113 sporadic adenomas and 243 age- and sex-matched controls enrolled in a multicentric case-control study in Colombia. Individual ancestral genetic fractions were estimated using the STRUCTURE software, based on allele frequencies and assuming three distinct population origins. We used the Illumina Cancer Panel to genotype 1,421 sparse single-nucleotide polymorphisms (SNPs), and Northern and Western European ancestry, LWJ and Han Chinese in Beijing, China populations from the HapMap project as references. A total of 678 autosomal SNPs overlapped with the HapMap data set SNPs and were used for ancestry estimations. African mean ancestry fraction was higher in adenomas (0.13, 95% confidence interval (95% CI)=0.11-0.15) and cancer cases (0.14, 95% CI=0.12-0.16) compared with controls (0.11, 95% CI=0.10-0.12). Conditional logistic regression analysis, controlling for known risk factors, showed a positive association of African ancestry per 10% increase with both colorectal adenoma (odds ratio (OR)=1.12, 95% CI=0.97-1.30) and adenocarcinoma (OR=1.19, 95% CI=1.05-1.35). In conclusion, increased African ancestry (or variants linked to it) contributes to the increased susceptibility of colorectal cancer in admixed Latin American population.

Alteraciones bioquímicas como marcadores predictores de gravedad en pacientes con fiebre por dengue / Biochemical alterations as prediction markers for the severity of illness in dengue fever patients

Introducción. El dengue es la infección transmitida por mosquitos más importante en el mundo. Existe información de que las alteraciones bioquímicas pueden utilizarse como herramientas predictoras de gravedad del dengue. Objetivo. Evaluar las alteraciones bioquímicas como posibles marcadores predictores de gravedad del dengue. Materiales y métodos. Se llevó a cabo un estudio de casos y controles anidado en una cohorte. Se seleccionaron al azar 125 casos con dengue grave y 120 controles con dengue no grave para evaluar los niveles séricos de lactato-deshidrogenasa (LDH), creatina cinasa (CK), proteína C reactiva (PCR) y albúmina, en sueros obtenidos en las primeras horas de la enfermedad. Para evaluar el valor diagnóstico de cada biomarcador, se establecieron puntos de corte con una sensibilidad del 90 % en la detección de casos graves. Resultados. Se observó una asociación entre los niveles de PCR por debajo de 9,8 mg/l (OR=0,04; IC 95% =0,02-0,08 ; p=0,000), de LDH inferiores a 400 U/L (OR=0,49; IC 95% =0,24-1,02; p=0,053) y de albúmina menor de 4 mg/dl (OR=3,46; IC 95% =1,96-6,12; p=0,000), con la gravedad del dengue. En contraste, los niveles de la CK no mostraron asociación con la gravedad de la enfermedad. Conclusiones. Los hallazgos de nuestro estudio sugieren una asociación de los niveles de PCR, LDH y albúmina con la gravedad del dengue. Estas pruebas bioquímicas podrían ser utilizadas como herramientas predictoras del curso clínico de la infección.

Introduction: Dengue is the most important mosquito-borne infection in the world. There is evidence supporting the use of biochemical alterations as prediction tools for severity of illness in dengue. Objective: To evaluate biochemical alterations as potential prediction markers for severity in dengue. Materials and methods: This was a case-control study nested in a cohort. We randomly selected 125 severe dengue cases and 120 controls with non-severe dengue for measuring LDH, CK, CRP and albumin serum levels using acute phase sera. To evaluate the predictive value for each biomarker, we established cut-off points with 90% sensitivity in detecting severe cases. Results: There was association among the CRP levels < 9.8 mg/L (OR=0.04; 95%CI=0.02-0.08; p=0.000), <400 U/L LDH levels (OR=0.49; 95%CI=0.24-1.02; p=0.053) and <4 mg/dl albumin levels (OR=3.46; 95%CI=1.96-6.12; p=0.000) with the severity of dengue. In contrast, the CK levels showed no association with the severity of the disease. Conclusions: Our findings suggest an association of CRP, LDH and albumin levels with the severity of dengue. These biochemical tests could be used as predictive tools in the clinical course of the infection.

Distribución de energía y macronutrientes en hogares colombianos / Intra-household distribution of energy and macronutrients in Colombian households

Introducción. Conocer la distribución del consumo dietético en el hogar es útil para establecer la política alimentaria. Objetivos. Estimar la distribución de la energía y los macronutrientes en hogares colombianos, según el parentesco. Materiales y métodos. Se aplicaron dos cuestionarios sobre el consumo dietético de las últimas 24 horas ( 24 Hours Dietary Recall , R24H) en 1.505 sujetos residentes en 432 hogares. Se calcularon la ingestión usual para cada individuo, la ingestión agregada para cada hogar y el porcentaje de participación de los integrantes del hogar. La participación en el consumo en el hogar se ajustó en modelos lineales por edad, sexo, índice de masa corporal, necesidad de energía, nivel socioeconómico, escolaridad y tamaño del hogar. Resultados. El jefe del hogar part icipa en promedio en 27,4 % (IC 95% : 26,5-28,2) del total de la energía, sin diferencia por sexo o si aporta a los ingresos del hogar o no. La participación de los sujetos sin parentesco, 30,3 % (IC 95% : 25,3-35,3), y de los hermanos del jefe, 26,0% (IC 95% : 22,7- 29,3), es equivalente a la del jefe. Al ajustar la participación, el nieto cobra importancia, 29,8% (IC 95% : 27,4-30,9). Los hombres participan más que las mujeres (p<0,05). Aun en hogares pequeños, la participación es menor si el nivel económico es bajo y reciben ayuda alimentaria (p<0,05). Conclusión. Surge la necesidad de una intervención cultural con fines nutricionales para modificar los principios de contribución, necesidad, equidad y demanda, a la luz de las estructuras de poder y autoridad. Se evidencia desigualdad en la distribución.

Introduction: Knowing the intra-household distribution of dietary intake is useful to establish food policy. Objective: To estimate the intra-household distribution of energy and macronutrients by kinship in Colombian households. Material and methods: We applied two recalls of dietary intake for the last 24 hours (R24H) in 1,505 subjects living in 432 households. Usual intake was calculated for each subject, aggregated for each household and calculated the share (%) for each of its members. Participation data was adjusted in linear models for age, gender, body mass index, energy requirement, socioeconomic levels, education and household size. Results: The head of the household participates on average in 27.4% (95% CI: 26.5 to 28.2) of the total energy, without sex differences or if they contribute to the household income or not. The participation of unrelated subjects was 30.3% (95% CI: 25.3 to 35.3), and 26.0% (95% CI: 22.7 to 29.3) of the siblings of the head of the household, which is equivalent to that of the head of the household. By adjusting participation, the grandson becomes important with 29.8% (95% CI: 27.4 to 30.9). Men participate more than women (p<0.05). Even in smaller households, participation is lower if the economic level is low and they are receiving food aids (p<0.05). Conclusion: In the context of the structures of power and authority, the need for a cultural intervention with nutritional purposes to modify the principles of contribution, necessity, equity and demand emerges. Inequality is evident in the distribution.

Inseguridad alimentaria: variables asociadas y elementos para la política social / Food insecurity: associated variables and issues for public policy

Introducción. La vigencia de las explicaciones cambia con las transiciones demográfica, epidemiológica y nutricional. Objetivo. Establecer la magnitud de inseguridad alimentaria y sus variables asociadas. Materiales y métodos . Se clasificaron 432 hogares mediante cinco métodos; se utilizaron las escalas de percepción de seguridad alimentaria (EPSA), la latinoamericana y caribeña (ELCSA), y otros tres: a) según el consumo usual de energía del jefe del hogar, b) según el consumo usual de energía de todos los miembros, y c) según un algoritmo basado en el consumo y la condición de los menores. Mediante regresión binomial, se establecieron las variables asociadas a la inseguridad alimentaria. Resultados. La inseguridad varió entre 35,9 y 87 %. Según la ELCSA y b), los hogares con menores tienen menor riesgo de inseguridad 0,51 (IC95% 0,25-0,90) y 0,72 (IC95% 0,48-0,96). Según la EPSA y la ELCSA, no pagar los servicios públicos 1,75 (IC95% 1,23-2,28) y que el jefe del hogar declare que no accede a los alimentos 1,48 (IC95% 1,20-1,68), aumentan la inseguridad. Obtener ingresos esporádicamente se asoció con el método a), 1,34 (IC95% 1,04-1,53) y el método b), 1,32 (IC95% 1,03-1,52). Pagar arriendo 1,12 (IC95% 1,01-1,16), el tiempo de permanencia en el municipio 0,59 (IC95% 0,23-0,93) y no contar con alcantarillado 1,13 (IC95% 1,01-1,16), se asociaron a la inseguridad por el método c). Conclusiones. No es pertinente o útil recomendar estos métodos con fines de elaborar la política social.

Introduction. The validity of the explanations change over time according to the state of demographic, epidemiological and nutritional transitions. Objective. Five methods were compared to establish t he magnitude of food insecurity and related variables. Material and methods. Four hundred and thirty-two households in Colombia were classified using five methods, including (1) the scale of perceptions of food safety (EPSA),(2) the Latin American and Caribbean scale (ELCSA), (3) the usual intake of energy from the head of household, (4) the usual consumption of energy of all members of the home, and (5) an algorithm based on consumption and status of children. Binomial regression established variables associated with food insecurity. Results . Insecurity varied between 35.9% and 87.0%. According ELCSA and method 3, households with children have a lower risk of insecurity, 0.51 (95% CI 0.25 to 0.90) and 0.72 (95% CI 0.48 to 0.96). Under the EPSA and ELCSA, increased insecurity is associated with nonpayment of utilities, 1.75 (95% CI: 1.23 to 2.28) and the head of household declared limited access to food, 1.48 (95% CI: 1, 20 to 1.68). Sporadic income was associated with the method 3, 1.34 (95% CI 1.04 to 1.53) and method 4, 1.32 (95% CI 1.03 to 1.52). Paying rent, 1.12 (95% CI: 1.01 to 1.16), time spent in the municipality, 0.59 (95% CI 0.23 to 0.93) and not having sewer, 1.13 (95% CI 1.01 to 1.16) were associated with the food insecurity using method 5. Conclusions . Since the country has reliable information that is obtained routinely it is not relevant or useful to use these methods with the purpose of developing social policies.

Desplazamiento forzado, niñez y adolescencia: escenarios en relación con su estabilización socioeconómica / Forced displacement, childhood and adolescence: scenarios regarding socioeconomic stability

Objetivo Describir y analizar escenarios de estabilización socioeconómica para población en situación de desplazamiento forzado, en los que se preste especial atención a la situación de niños, niñas y adolescentes. Métodos Se utiliza, a partir de talleres de expertos, el método Analytic Hierarchy Process (AHP), elaborado por el profesor Thomas Saaty con participación investigadores, ONG y de comunidades en situación de desplazamiento del Área Metropolitana de Bucaramanga. Resultados El resultado parcial de esta investigación muestra como algunos adultos mayores de comunidades en situación de desplazamiento forzado prefieren adaptarse a los centros urbanos, antes que retornar sus lugares de origen, en particular cuando se trata de la protección y el bienestar de sus hijos menores. El índice de consistencia y la relación de consistencia del método están dentro de los parámetros previstos. Conclusión Es necesario repensar los programas de estabilización socioeconómica promovidos por el gobierno en relación con la población en situación de desplazamiento forzado, en particular cuando se prevén situaciones que comprometen el bienestar de los niños, niñas y adolecentes.

Objective Describing and analysing socio-economic stabilisation scenarios for populations which have been forcibly displaced paying special attention to the situation of children and adolescents. Method The analytic hierarchy process (AHP) multi-criteria decision-making method developed by Professor Thomas Saaty was used through expert workshops, involving researchers, leaders of NGOs and displaced communities living in the city of Bucaramanga. Results The partial result of this research showed that some elderly adults from forcibly displaced communities preferred to adapt themselves to urban centres, rather than return to their places of origin, particularly when it came to protecting younger children and dealing with their welfare. The method's consistency index and consistency ratio came within the expected parameters. Conclusion Government-promoted social and economic stabilisation programmes must be rethought regarding forcibly displaced populations, particularly when situations are envisaged involving the welfare of children and adolescents.

[Design of dietary questionnaires to study the relationships between diet and cancer prevalence in Colombia]. / Diseño de cuestionarios de frecuencia de consumo para estudiar la relación dieta-cáncer en Colombia.

INTRODUCTION: In Colombia, cancer ranks third as a cause of death in the adult population. Thirty-five percent of cancer deaths are attributable to dietary factors and that 90% of colorectal cancers can be prevented by appropriate diets. OBJECTIVE: A dietary questionnaire was developed to study the relationship between diet and cancer for five cities in Colombia (Barranquilla, Cartagena, Santa Marta, Bogotá and Bucaramanga and its metropolitan area), based on 24-hour dietary survey data accumulated by the National Survey of Nutritional Status-2005. MATERIAL AND METHODS: Each questionnaire had 3 sections and involved six stages in its development. A checklist representing thirteen nutrients was formulated by means of the method of the variance maximization (Max_r); it was supplemented with nine categories of consumption frequency. The two complementary sections inquired about the consumption of food, number of meals per day, and methods of preparation, related with cancer development. RESULTS: Between 22 and 32 foods were discriminated for each questionnaire. Only nine foods were common in the checklists of each of the five cities. Nine of the thirteen nutrients are represented with correlations higher than 0.80, with a minimum 0.47 and a maximum of 1.0. CONCLUSIONS: For the first time in Colombia specific questionnaires were developed to study the diet-cancer relationship. The checklist was comprehensive and it incorporated between-person variability, as well as the habits and food culture of each city. We propose nine analysis alternatives for the questionnaire. The questionnaires will prove useful in epidemiological research, although they require calibration with studies of reproducibility and validity.

Seguridad alimentaria: un método alterno frente a uno clásico / Household food security: comparing an alternative method to a classical one

Objetivos Evaluar durante 2007-2008 el desempeño la Escala de Percepción de Seguridad Alimentaria (EPSA) frente a la inseguridad alimentaria (IA) determinada con base en la energía usualmente consumida. Métodos Participaron 211 hogares. El responsable de la preparación de los alimentos contestó la EPSA, otro integrante del hogar contestó dos veces un recordatorio del consumo de veinticuatro horas (R24H). El referente fue la IA por el R24H y la prueba la EPSA. Resultados La IA por el R24H fue del 48,8 por ciento, con la EPSA de 19,4 por ciento. La sensibilidad de la EPSA fue de 16,5 por ciento, la especificidad de 77,8 por ciento. El acuerdo según la Kappa fue de -0,06 (IC; -0,20 a -0,03). Conclusiones Bajo el supuesto de equivalencia de métodos, la EPSA subestima la inseguridad alimentaria en el hogar. Los resultados de la EPSA comparados con los del R24H no son coherentes.

Objective Establishing the performance of the US Environmental Protection Agency (EPA) household food security scale (EPSA) which is being used in Latin-America and the Caribbean, compared to a traditionally-used method (food insecurity scale) which has led to establishing food security at individual and population level. The performance of the household food security scale (EPSA) was evaluated during 2007-2008 and compared to that of the food insecurity (FI) scale based on the energy usually consumed. Methods Two hundred and eleven household participated in the study. The person responsible for preparing food in the home answered the EPSA questionnaire. Another household member filled in a form recording the last twenty-four hours' household consumption (R24H) (on two different occasions). The study was validated by food insecurity from R24H and supposed food security from the EPSA questionnaire. Results Food insecurity by R24H was 48.8 percent and 19.4 percent on the EPSA. The EPSA had 16.5 percent sensitivity and 77.8 percent specificity. Agreement between both methods according to Cohen's Kappa was -0.06 (-0.20-0.03 CI). Conclusion Assuming equivalence of methods, the EPSA greatly underestimated household food insecurity. The EPSA results compared to those arising from the R24H were not very coherent. Some implications are discussed regarding related public policy.

Análisis confirmatorio para la prueba AEQ-III en Bucaramanga, Colombia / Confirmatory analysis for the test AEQ-III in Bucaramanga, Colombia

Background: The Alcohol Expectancy Questionnaire-III (AEQ-III) test evaluates positive expectations towards alcohol consumption. Aim: To perform a confirmatory factorial analysis of the AEQ-III test. Material and Methods: During 2006-2008, 1199 adults between 18 and 60years old (588 males) answered a survey that included socio-economic variables and the AEQ-III test to determine alcohol consumption and its consequences. A factorial analysis was performed and the goodness off it of the final model was assessed. Results: "Increase in expressivity and sexuality", "decrease in physical tension", "lack of inhibition and feelings of power" and "decrease in psychological tension" were the four confirmed dimensions. This model differs of others applied in the region, has 22 variables and adjusts well. Values for median quadratic approximation error, Tucker- Lewis Index, normal adjustment index and goodness off it were 0.07, 0.93 and 0.92, respectively. The variance explained by the model increased from 62 percent in the exploratory to 76 percent in the confirmatory analysis. Infernal consistency in the exploratory and confirmatory models was 0.85 and 0.87. Conclusions: Two confirmed dimensions correspond to group behaviors and the others, to individual behaviors. All indices of relevance of grouping variables, goodness off it and parsimony were maintained and even improved and are generally optimal.

Tipología de los consumidores de alcohol y sus factores determinantes en Bucaramanga, Colombia / Categories of alcohol consumers and the criteria for classification

Introducción. En Colombia algunas consecuencias del consumo de alcohol son problemas de salud pública. Es necesario clasificar adecuadamente a los consumidores para diseñar estrategias de mitigación y control. Objetivo. Establecer los tipos de consumidores de alcohol y sus variables asociadas. Material y métodos. Se clasificaron 1.199 sujetos entre 18 y 60 años en tres tipos de consumo de alcohol: tipo A, consumo deseable; tipo B, consumo excesivo sin problemas relacionados; y tipo C, consumo problemático o dependencia. Mediante regresión logística multinomial, se establecieron las variables asociadas a los diferentes tipos. Se discute sobre la implicación de los resultados. Resultados. Los sujetos con expectativas positivas hacia el consumo ligadas con la expresividad y la sexualidad tienen 1,6 (IC95%: 1,0 a 2,5) más veces probabilidad de ser tipo C que aquéllos que sin ellas; en relación con la desinhibición y los sentimientos de poder positivos, este riesgo es mayor, de 2,2 (IC95%: 1,1 a 4,3). La edad, en una relación inversa, es factor protector para ser consumidor tipo B o C. Los hombres tienen mayor riesgo que las mujeres de tipo B o C, al igual que los sujetos que manifestaron gusto moderado o elevado por las bebidas alcohólicas. Conclusiones. Los resultados deben traducirse en intervenciones en la población, en grupos de riesgo como los escolares y preadolescentes con enfoque de género. El elemento por consolidar en la intervención es el de la autoestima.

Introduction. The consequences of alcohol intake can be public health problems. A well-constructed classification system of alcohol consumers will assist in designing strategies for mitigation and control of alcohol induced behaviors. Objective. A categorization of alcohol consumers was developed based on a set of consumer-associated variables. Material and methods. A set of 1,199 subjects between 18 and 60 years old was selected and each subject classified in three categories of alcohol intake: type A, intake desirable; type B, excessive consumption without related problems; and type C, problematic consumption or dependence. Using multinomial logistic regression model, the decisive variables of each category were fixed. Results. Subject with positive expectations associated with consumption such as “increase in expressivity and the sexuality” have 1.6 (95% CI; 1.0 - 2.5) times greater probability to be placed in the C category that those without those expectations. For relationships associated with “inhibition and feelings of power”, this risk even greater- 2.2 (95%CI; 1.1- 4.3). Age is in an inverse relationship and a protective factor to be classified type B or C. Men have a greater probability than women to be classes in B or C; this probability is the same as subjects who indicate having moderate pleasure or a rise in pleasure induced by the alcoholic drinks. Discussion. The results can be translated into programs for interventions at the population level directed to groups of higher risk, such as scholars and preteens, and with a gender focus. The personality element on which to focus the intervention is that of self-esteem. This is an element built from a behavioral-cognitive perspective within the context of the social and cultural learning process.