Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses / Position of the Latin American Society of Nutrition (SLAN) on the management of conflict of interest

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

Epigenética y obesidad / Epigenetics and obesity

La evidencia indica que la exposición a diversas condiciones ambientales en etapas tempranas de la vida puede inducir alteraciones persistentes en el epigenoma. Los estudios epigenómicos en sujetos obesos han permitido evaluar el papel de los mecanismos epigenéticos en el origen y desarrollo de la obesidad. La presente revisión aborda estudios que dan cuenta de la asociación entre la obesidad y metilación global del genoma (ADN), analizando el potencial impacto de intervenciones previas y posteriores al nacimiento que afectan la metilación del ADN y la obesidad en etapas más avanzadas de la vida. Estudios realizados principalmente en leucocitos, han logrado identificar sitios del ADN diferencialmente metilados asociados con obesidad. Estudios hasta la fecha no han demostrado que dichos cambios en metilación sean revertidos luego de bajar de peso. Esto contrasta con resultados iniciales en este campo, que sugieren que existirían marcadores epigenéticos presentes desde el nacimiento que permitirían definir el riesgo de obesidad durante el curso de la vida. La evidencia actual sugiere que algunas marcas epigenéticas son modificables, basándonos en la exposición en la vida intrauterina y también por los hábitos dietarios y de actividad fisica durante las etapas del crecimiento y en la adultez. Esto sugiere que existe la oportunidad de intervenir durante la gestación o en la vida posnatal temprana, que modificaría los perfiles epigenéticos desfavorables e idealmente contribuiría a prevenir la obesidad en los sujetos o poblaciones susceptibles.

Current evidence supports the notion that exposure to various environmental conditions in early life may induce permanent changes in the epigenome that persist throughout the life-course. This article focuses on early changes associated with obesity in adult life. A review is presented on the factors that induce changes in whole genome (DNA) methylation in early life that are associated with adult onset obesity and related disorders. In contrast, reversal of epigenetic changes associated with weight loss in obese subjects has not been demonstrated. This contrasts with well-established associations found between obesity related DNA methylation patterns at birth and adult onset obesity and diabetes. Epigenetic markers may serve to screen indivuals at risk for obesity and assess the effects of interventions in early life that may delay or prevent obesity in early life. This might contribute to lower the obesity-related burden of death and disability at the population level. The available evidence indicates that epigenetic marks are in fact modifiable, based on modifications in the intrauterine environment and changes in food intake, physical activity and dietary patterns patterns during pregnancy and early years of adult life. This offers the opportunity to intervene before conception, during pregnancy, infancy, childhood, and also in later life. There must be documentation on the best preventive actions in terms of diet and physical activity that will modify or revert the adverse epigenetic markers, thus preventing obesity and diabetes in suceptible individuals and populations.

Epigenética en enfermedades alérgicas y asma / Epigenetics in allergic diseases and asthma

Las enfermedades alérgicas y el asma son el resultado de complejas interacciones entre la predisposición genética y factores ambientales. El asma es una de las enfermedades crónicas más prevalentes en niños. En este artículo se revisan algunos factores ambientales como la exposición a alérgenos, tabaco, bacterias, componentes microbianos, dieta, obesidad y estrés, que intervienen durante la vida intrauterina y la infancia en la regulación epigenética de las enfermedades alérgicas y el asma. La revisión se realiza en tres tipos de modelos: in-vitro, animales y humanos.

Allergic diseases and asthma are the result of complex interactions between genetic predisposition and environmental factors. Asthma is one of the most prevalent chronic disease among children. In this article we review some environmental factors like: allergen exposition, tobacco, bacteria, microbial components, diet, obesity and stress, which influences during intrauterine and infancy life in the epigenetic regulation of asthma and allergic diseases. The review has been done in three models: in-vitro, animal and human.

Conceptos generales de epigenética: proyecciones en pediatría / General concepts of epigenetics: projections in paediatrics

La asociación entre factores ambientales presentes durante el desarrollo embrionario/fetal y enfermedades que puedan presentarse durante la vida representa un campo de creciente interés. En este contexto la evidencia actual apoya fuertemente que alteraciones en el crecimiento intrauterino y durante los primeros años de vida presentan una fuerte influencia en el riesgo de padecer enfermedades crónicas que en muchos casos pudiera ser mayor que la carga genética del paciente. La persistencia y reproducibilidad de los fenotipos asociados a alteraciones en el desarrollo temprano sugieren la participación de mecanismos moleculares que registran dichas modificaciones (i.e. mecanismos epigenéticos) generando una «reprogramación¼ celular y fisiológica. Esta revisión es la introducción a una serie de 5 artículos en torno a la participación de los mecanismos epigenéticos en el desarrollo de enfermedades crónicas (i.e. cardiovasculares, metabólicas, asma/alergias y cáncer) y su relación con el origen de dichas enfermedades en etapas tempranas del desarrollo. El objetivo de esta serie es mostrar el estado actual de esta área de la investigación y presentar los desafíos e interrogantes futuros en los cuales la pediatría tiene un papel preponderante, desarrollando estrategias para la prevención, detección precoz y seguimiento.

Current evidence supports the notion that alterations in intrauterine growth and during the first years of life have a substantial effect on the risk for the development of chronic disease, which in some cases is even higher than those due to genetic factors. The persistence and reproducibility of the phenotypes associated with altered early development suggest the participation of mechanisms that would record environmental cues, generating a cellular reprogramming (i.e. epigenetic mechanisms). This review is an introduction to a series of five articles focused on the participation of epigenetic mechanisms in the development of highly prevalent chronic diseases (i.e. cardiovascular, metabolic, asthma/allergies and cancer) and their origins in the foetal and neonatal period. This series of articles aims to show the state of the art in this research area and present the upcoming clues and challenges, in which paediatricians have a prominent role, developing strategies for the prevention, early detection and follow-up.

Sensory Peripheral Nerve Function in Chilean Elderly Consuming Folic Acid Fortified Flour: Relationship to Plasma Folate and a Novel Combined Biomarker of B12 Status. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 1067-1068.

Objectives: It has been reported that low vitamin B12 status and high serum folate is associated with anemia and cognitive impairment. However, few data are available on neurophysiological outcomes, such as peripheral neurophysiology. The objective was to assess associations between folate, B12 and sensory peripheral nerve conduction in Chilean elderly exposed to folic acid fortification. Methods: The average of the left and right distal sensory conduction latency of the sural nerve, and conduction velocity of the right peroneus nerve were measured in 159 community-dwelling older Chilean. Serum folate, B12, Hcy, MMA, and holoTC were determined. B12 status was defined based on: w=log_10 (holoTC*B12)/(MMA*Hcy)-(age factor) (Fedosov SN, Clin. Chim. Acta. 2013). Nerve conduction, folate and B12 status were divided into tertiles. Results: Age was 70-78y (57% women). 62.9%, 10.7% and 26.4% were classified as having B12 adequacy (w>-0.5), transitional status (-1.5< w<-0.5) and deficiency (w<-1.5) respectively, while 15.1% presented high folate (>45.3 nmol/L). Nerve conduction velocity of the right peroneus nerve positively correlated with B12 status (r=0.21, p<0.05). In the highest tertile of both B12 (w) and folate only 6% were in lowest tertile of sural nerve conduction vs. 31.5% (p<0.001) with low B12 and high folate. In the highest tertile of both B12 (w) and folate 25% were in lowest tertile of peroneal nerve conduction velocity as compared with 63.2% with low B12 and high folate (p<0.001). Conclusions: Elderly with both high B12 and folate status were less likely to have poor sensory peripheral nerve conduction than those with low B12 and high folate.

Trends in Early Growth Indices in the First 24 Months of Life in Uruguay over the Past Decade.

Early growth is an important indicator of health and wellbeing of children and a good predictor of adult health. The objective of this study was to examine trends and determinants of overweight and stunting among infants aged 0 to 23 month(s) over the past decade (1999-2011) in Uruguay. Data were used from four large representative samples of 11,056 infants aged 0-23 month(s), who attended public and private health services in 1999, 2003, 2007, and 2011, using a similar methodology. Linear regression analysis was used for assessing trends in early growth indices and binary logistic regression to estimate the probability of being stunted and overweight. Although prevalence of overweight fell from 12.5% (1999) to 9.5% (2011) and stunting from 13.6% to 10.9% respectively, both rates remained higher than expected. Low birthweight (LBW) was the main predictor of stunting [OR 6.5 (5.6-7.6)] and macrosomia of overweight [6.7 (5.3-8.3)]. We did not observe changes in LBW (7.8-8.8%) or macrosomia (5.9-6.7%) over the last decade. Boys showed increased chance of being overweight [OR 1.2 (1.04-1.3)]. Being stunted doubles the chances of being overweight [OR 2.5 (2.2-3.0)]. Overweight [OR 7.1 (6.1-8.3)], LBW [OR 13.2 (11.0-15.9)], and nonbreastfed infants [OR 1.9 (1.7-2.1)] showed rapid weight gain. Uruguay has taken positive steps to decline the prevalence of stunting and overweight but both remain excessively high.

Cambios en el consumo aparente de lácteos, bebidas azucaradas y jugos procesados en el Gran Santiago. Chile. 1987-2007: Changes in the consumption of dairy products, sugary drinks and processed juices in the Chilean population

Background: Nowadays, Chilean population tends to replace or eat a lower amount of food with health protective properties and a higher proportion of unhealthy foodstuff. Aim: To describe and compare the intake of dairy products, sugary drinks and processed juices among Chileans. Material and Methods: An analysis of data compiled from the Survey on Household Budget and Expenses carried out by the Chilean National Institute of Statistics (INE), using a representative sample of households. The sample was surveyed between 1987 and 2007. The analysis was performed for all households surveyed and for households belonging to the second (highest incomes) and fifth quintile (lowest incomes). The Chilean Food Guide and the international recommendations of the Institute of Medicine of the United States and the American Heart Association (in the case of sugars) were used as reference. Results: Even though the intake of dairy products increased during the period of the survey, it was lower than the intake of sugary drinks and juices, which increased. Also, calcium recommendations were not covered. On the other hand, the intake of added sugars increased to figures over current recommendations. Conclusions: The intake of dairy products and calcium is below the recommended amounts established by international organisms, and added sugars intake is greater than the advisable levels recommended by international organisms.

Obesidad en mujeres chilenas en edad fértil / Prevalence of obesity among Chilean women in childbearing ages

Background: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. Aim: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. Material and Methods: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. Results: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. Conclusions: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.

Disponibilidad de productos alimentarios listos para el consumo en los hogares de Chile y su impacto sobre la calidad de la dieta (2006-2007) / Household availability of ready-to-consume food and drink products in Chile: impact on nutritional quality of the diet

Background: Processed foodstuff may have a lower nutritional value than natural products. Aim: To analyze the impact of ready-to-consume products on diet quality of Chilean households. Material and Methods: A national representative sample of 10,096 households, based on the 6th Survey on Household Budget and Expenses (VI Encuesta de Presupuestos y Gastos Familiares, 2006-2007), was studied. Foodstuffs were classified as follows: 1) Unprocessed foods or minimally processed foods (G1); 2) Processed culinary ingredients (G2); and 3) Ready-to-consume products (G3). Calorie contribution and energy availability of each household food group, was calculated. The nutritional profile of the national food basket was calculated and compared with two simulated baskets (G3 vs G1+G2), based on international nutritional recommendations. Results: Overall energy availability was of 1,885 kcal per capita/ day; 24% derived from unprocessed foods (G1), 21% from processed culinary ingredients (G2) and 55% from ready-to-consume products (G3), whose proportion increased along with income level. The 2007 national food basket contained an excess of total fat (34% vs 30%), free sugars (16% vs 10%), energy density (2.1 vs 1.3 kcal/gram) and a low amount of fiber (8.4 vs 12.5 g/1,000 kcal). The basket consisting in ready-to-consume products (G3) had a higher percentage of carbohydrates (61% vs 46%) than the basket consisting in unprocessed foods and ingredients (G1 + G2). It also had a higher percentage of free sugars (17% vs 15%), less dietary fiber (7 vs. 10 g/1,000 kcal) and, above all, a higher energy density (2.6 vs 1.6 kcal/g). Conclusions: The Chilean dietary pattern, based on ready-to-consume products (G3), is affecting the nutritional quality of the diet.

Reflexiones sobre las recomendaciones en salud pública para la prevención del cáncer dadas por el fondo mundial para la investigación sobre cáncer (FMIC) y la situación de Chile / Analysis of the recommendations for cancer prevention given by the global fund for research on cancer (FMIC) and the situation in Chile

El cáncer representa el 13% de causas de muerte anuales a nivel mundial y es la segunda causa en las Américas con 1,2 millones de muerte en el 2008. En Chile represento el 25,6 % del total de muertes en el 2007. La obesidad se relaciona con un tercio de todos los cánceres, y está asociada con la grasa corporal, grasa abdominal, aumento de peso en la edad adulta, todos factores modificables a través de un patrón saludable de dieta y actividad física. El objetivo fue analizar las recomendaciones de Salud Pública, emitidas por el Fondo Internacional para la Investigación del Cáncer (WCRF) y el Instituto Americano de Investigación del Cáncer (AICR) en el año 2007 para la prevención del cáncer. Comparar las recomendaciones del informe Alimentación, Nutrición y actividad física y la prevención del cáncer: una perspectiva mundial“, con la situación nacional en relación a estas recomendaciones. Luego, se proponen recomendaciones nacionales en concordancia con las propuestas del WCRF. El análisis revela que Chile a nivel poblacional presenta riesgos de cáncer asociados con estilos de vida; dieta, Indice de Masa Corporal y sedentarismo. El patrón de consumo alimentario y el perfil nutricional y las conductas asociadas a los estilos de vida de la población no reflejan las recomendaciones de organismos internacionales, sobre los consumos de productos protectores (legumbres, hortalizas, frutas altos en antioxidantes, fibra) y de los de alto riesgo (bebidas y jugos azucarados, procesados altos en sodio, grasas totales). Se requiere educar a la población sobre alimentación saludable y estilos de vida que mantengan la salud.

Cancer is one of the most important causes of death in the world corresponding to 63% annually, is the second in the Americas with 1.2 million deaths in 2008 and Chile in 2007 representing 25.6% of all deaths. Obesity is associated with a third of all cancers and is associated with body fat, abdominal fat, weight gain in adulthood, all modifiable factors through a healthy diet pattern and physical activity. The aim was to analyze the recommendations of Public Health issued by the International Fund for Cancer Research (WCRF) and American Institute for Cancer Research (AICR) in 2007 to prevent cancer. Compare the recommendations of the report Food, Nutrition and physical activity and cancer prevention: a global perspective, "with the national situation regarding these recommendations. Then, we propose national recommendations in accordance with the proposals of WCRF. The analysis reveals that Chile has a population level cancer risks associated with lifestyle, diet, body mass index and physical inactivity. The pattern of food consumption and nutritional profile and behaviors associated with the lifestyles of the population does not reflect the recommendations of international organizations, on the consumption of protective (vegetables, fruits high in antioxidants, fiber) and high risk (sugary drinks and juices, processed, high in sodium, total fat). Is required to educate people about healthy eating and lifestyles to maintain health.

Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010 / Serum folate and vitamin B12 in older people: Results from the Chilean national health survey 2009-2010

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.

Obesidad y cáncer en Chile: estimación de las fracciones atribuibles poblacionales / Obesity and cancer in Chile: Estimation of population attributable fractions

Background: Obesity is a risk factor for the development of certain types of cancer. Aim: To estimate the proportion of cancers potentially attributable to obesity in men and women in Chile based on the calculation of population attributable fractions (PAF %). Material and Methods: Cancer sites studied were those where obesity is a known risk factor based on the updated World Cancer Research Fund (WCRF) analysis. Namely, colorectal, endometrium, esophagus, breast, pancreas, kidney and gallbladder cancers were analyzed. Overall and specific PAFs% were calculated for cancer sites and sex from known estimates of relative risk and national prevalence of overweight and obesity. Results: The overall estimates of cancer PAF% for obesity were approximately 20%, without differences between men and women. Highest cancer PAFs% were for endometrial (47%) in women, and esophageal (35%) and pancreatic (31%) in men. The largest sex differences in PAFs% were for gallbladder (higher in women) and colorectal (higher in men). Results are closer to those reported from developed countries (USA and United Kingdom) than those from developing countries (Brasil, China). Conclusions: In Chile about 20% of all cancers could be prevented by obesity prevention and control strategies.

Recomendaciones para la prevención del cáncer dadas por el Fondo Mundial para la Investigación sobre Cáncer (FMIC): análisis de la situación en Chile / Recommendations for cancer prevention of World Cancer Research Fund (WCRF): situational analysis for Chile

The main diet-related cancers include colorectal, lung, breast in (postmenopausal) women, stomach, esophagus, prostate and pancreas. After tobacco, obesity is the leading cause of cancer; it accounts for one third of all cancers. Cancer is associated with high total body fat, abdominal fat and weight gain in adult life. These are all potentially modifiable risk factors. Consumption of a "healthy diet" and living an "active life" can significantly reduce the risk of cancer. The aim of this study was to analyze the recommendations published by the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) for the prevention of cancer in 2007. We compared the recommendations of Food, Nutrition and Physical Activity and the Prevention of Cancer: a global perspective", with the national situation in Chile, analyzing the national report on the prevalence of risk factors. Our main finding was that the pattern of consumption and lifestyles differ markedly from the WCRF recommendations: we observed an over consumption of sugary drinks and high intake of processed foods high in sodium and total fat and low consumption of legumes, vegetables, fruits high in antioxidants and fiber that protect from cancer. Chile has an increased cancer prevalence which is associated with poor quality diets, rising mean body mass index and a sedentary behavior. We recommend the strengthening programs to promote healthy diets and active living, in order to reduce cancer risk.

Folatos y vitamina B12 en la salud humana / Folate, vitamin B12 and human health

During the past decade the role of folate and vitamin B12 in human nutrition have been under constant re-examination. Basic knowledge on the metabolism and interactions between these essential nutrients has expanded and multiple complexities have been unraveled. These micronutrients have shared functions and intertwined metabolic pathways that define the size of the "methyl donor" pool utilized in multiple metabolic pathways; these include DNA methylation and synthesis of nucleic acids. In Chile, folate deficiency is virtually nonexistent, while vitamin B12 deficiency affects approximately 8.5-51% depending on the cut-off value used to define deficiency. Folate is found naturally mainly in vegetables or added as folic acid to staple foods. Vitamin B12 in its natural form is present only in foods of animal origin, which is why deficit is more common among strict vegetarians and populations with a low intake of animal foods. Poorfolate status in vulnerable women of childbearing age increases the risk of neural tube birth defects, so the critical time for the contribution of folic acid is several months before conception since neural tube closure occurs during the first weeks of life. The absorption of vitamin B12 from food is lower in older adults, who are considered to have higher risk of gastric mucosa atrophy, altered production of intrinsic factor and acid secretion. Deficiency of these vitamins is associated with hematological disorders. Vitamin B12 deficiency can also induce clinical and sub-clinical neurological and of other disorders. The purpose of this review is to provide an update on recent advances in the basic and applied knowledge of these vitamins relative to human health.

Evolución del gasto en alimentos procesados en la población del Gran Santiago en los últimos 20 años / Changes in processed food expenditure in the population of Metropolitan Santiago in the last twenty years

Background: During recent decades household incomes have increased steadily, leading to changes in dietary habits and food expenditure. Aim: To report changes in household food expenditure focusing on trends in processed food across income quintiles in Metropolitan Santiago. Material and Methods: Information obtained from the Fourth (1986-1987), Fifth (1996-1997) and Sixth National Institute of Statistics (INE) Surveys (2006-2007) were used. Food expenditure data over the study periods was extracted from household expenditure surveys (HES) after verifying and adjusting food prices registered by the INE to current 2007prices. Results: Absolute food expenditure over the study period increased for all groups; the largest increase was found in lowest income quintiles; however, the proportion of total family budget spent on food decreased in all groups. The largest increases in food expenditure corresponded to sweetened beverages, processed fruit juices, alcoholic drinks, ready meals and "eating out". Expenditure on fish rose slightly whereas the absolute spending on legumes, eggs and oils decreased. Expenditure in processed food as percentage of total food expenditure increased from 42% to 57% of total for mean household. For the 2nd quintile it rose from 31% to 48% and for the lowest quintile increased from 53% to 68% over the three decades (1987-2007). Changes were greatest in energy rich processed foods such as bread, pastries, confectioneries and granulated sugar. These particular foods are of high energy density and contain high amounts of saturated fat, sodium and added sugars. Conclusions: These results confirm that food consumption patterns over the past decades have progressively departed from the recommended dietary guidelines given by national and international health organizations.

Folatos y riesgo de cáncer de mama: revisión sistemática / Folate and breast cancer risk: A systematic review

An increased folate intake may be beneficial in deficient populations. However, in women with adequate levels it may not deliver additional benefits while it may increase the risk for some forms of cancer. A systematic literature review of benefits or risks of folate in the development of breast cancer was performed using MEDLINE, systematic review of selected articles and references of the selected articles looking specifically at serum folate levels, dietary folate intake or total folate intake and the risk of developing breast cancer. Fourteen case-control studies, fourteen cohort studies, seven case-control nested studies, two randomized trials and two meta-analyses were selected for analysis based on pre-established criteria. The reviewed evidence does not support the hypothesis that higher intakes of dietary folate reduce the risk for breast cancer. Some studies showed a higher risk of breast cancer in populations exposed to high folate intake post fortification, especially when folic acid is used. The results support the need to be cautious and to limit the exposure of women to high intakes of folic acid, especially in countries with mandatory food fortification.

Calidad de grasa, arterioesclerosis y enfermedad coronaria: efectos de los ácidos grasos saturados y ácidos grasos trans / Quality of fat intake, atherosclerosis and coronary disease: effects of saturated and trans fatty acids

Epidemiological, clinical and metabolic research has shown a strong association between dietary fatty acids intake and cardiovascular disease (CVD) risk factors and clinical events. Saturated fatty acids (SFA) and trans fatty acids (TFA) derived from industrial hydrogenation of oils have been associated with an increased prevalence of CVD. However experimental results on the relationship between physiological pathologic effects and specific functions of individual SFA are often contradictory. Therefore a more detailed exploration of the potential benefit and risks of specific saturated and trans fatty acids is needed in order to update dietary recommendations. In the case of TFAs, the deleterious effect on CVD has been well demonstrated and a maximum accepted level of 1 percent of total energy has been agreed internationally. What is currently under discussion is what would be the best alternative to replace them in the diet.

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

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 of1089 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 percent 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 theseparameters 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 percent 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.