Submandibular Skinfold Thickness Cut-off Values in Relation to Body Mass Index and Percentage Body Fat Among Chilean Adolescents.

The present study evaluates submandibular skinfold (SMS) cutoff values to estimate excess weight for BMI and percentage body fat (%BF) among Chilean adolescents. The results show an optimal area under the cutoff curve value of 83% among girls and 91% in boys to estimate SMS concerning %BF and BMI. The SMS cutoff value estimating obesity by %BF was 10 mm among girls and 9 mm among boys, 10 mm among girls, and 7 mm among boys by BMI. Our results showed that SMS is significantly associated with anthropometric parameters for obesity.

Anthropometric and bioimpedance equations for fat and fat-free mass in Chilean children 7-9 years of age.

Assessing children's growth adequately is important due to the necessary prevention of adequate body composition, especially at pre-pubertal age. Simpler measurements such as anthropometry or bioimpedance, using equations validated in Caucasian children, have been demonstrated to overestimate or underestimate fat mass percentage (FM%) or fat-free mass (FFM) in Chilean children. In a sample of 424 children (198 boys and 226 girls) of 7-9 years old, the three component (3C) model was assessed, where total body water was determined by 2H dilution and body volume by air displacement plethysmography, in order to design and validate anthropometry and bioimpedance equations. The FM (%) equation specific for Chilean children was validated as (1·743 × BMI z-score) + (0·727 × triceps skinfold) + (0·385 × biceps skinfold) + 15·985, against the 3C model (R2 0·79). The new FFM equation (kg) generated was (log FFM = (0·018 × age) + (0·047 × sex) + (0·006 × weight) + (0·027 × resistance) + 2·071), with an R2 0·93 (female = 1 and male = 2). The Bland-Altman analysis shows a mean difference of 0·27 (sd 3·5) for the FM% in the whole group as well as 0·004 (sd 0·9) kg is the mean difference for the bioelectrical impedance analysis (BIA) FFM (kg) equation. The new equations for FM (%) and FFM (kg) in Chilean children will provide a simple and valid tool for the assessment of body composition in cohort studies or to assess the impact of nutritional programmes or public policies.

Women's perceptions about changes in food-related behaviours at home during COVID-19 pandemic in Chile.

OBJECTIVE: To explore women's perceptions of changes in specific food habits at home, specifically the food budget and shopping, and food preparation, during the COVID-19 period. DESIGN: Non-probabilistic, exploratory study. Participants completed an online self-administered questionnaire. Perceptions of food habit changes were measured on a five-point Likert scale (strongly disagree to strongly agree). Data analysis was conducted in STATA v16.0. SETTING: Chile. PARTICIPANTS: Adult women between 25 and 65 years old (n 2047). RESULTS: Of the participants, 72 % were responsible for cooking, 69 % for buying food and 85 % for child care. Difficulties in organising and doing food budget works were observed in groups with a lower educational level, lower income and single mothers with children. Younger participants, dependent workers, women from biparental families with children and those in mandatory quarantine perceived more changes in their food shopping and budget management tasks. Participants more educated, with higher income and non-mandatory quarantine perceived to cook and eat healthier. Older participants perceived minor changes in their food preparation tasks at home; in contrast, more educated women and women from biparental families with children perceived more changes. If women were in charge of the kids or grocery shopping, more food environment changes were noticed. CONCLUSIONS: Women perceived changes in their food environments. Some of these changes are perceived worse in the more vulnerable population. COVID-19 presents a challenge for the food system and gender perspectives. This information should be considered in the design of food-related interventions.

ASSOCIATION BETWEEN BODY COMPOSITION, SOMATOTYPE AND SOCIOECONOMIC STATUS IN CHILEAN CHILDREN AND ADOLESCENTS AT DIFFERENT SCHOOL LEVELS.

This study examined the association between body composition, somatotype and socioeconomic status (SES) in Chilean children and adolescents by sex and school level (grade). The cross-sectional study was conducted on 1168 schoolchildren aged 6-18 years (572 males) from Valparaíso, Chile. Body composition, as assessed by percentage body fat (BF%) and somatotype, was evaluated using Ellis equations and the Heath-Carter method, respectively. The socioeconomic status of respondents was assessed using the ESOMAR survey. Obesity was defined as BF% ≥25 for boys and ≥30 for girls; 'high endomorph' somatotype was defined as a somatotype endomorph component (EC) of at least 5.5. Logistic regression analysis was used to assess the relationship between high adiposity and SES, potential confounding factors and school level. In females, the results indicated that the groups with lower SES had higher EC. At the 1st (youngest) school level (1-4th grades), males exhibited similar trends in their BF% and EC. High adiposity was associated with the female sex (BF%: OR=3.39; 95% CI 2.60, 4.41; high EC: OR=2.31; 95% CI 1.80, 2.98). In addition, low SES increased the risk of high adiposity compared with high SES (BF%: OR=2.25; 95% CI 1.40, 3.61; high EC: OR=2.19; 95% CI 1.37, 3.47). An association was observed between increased adiposity and lower SES, mainly in females, which indicates that females with low SES might be at greater risk of obesity.

Impact of a school-based intervention on nutritional education and physical activity in primary public schools in Chile (KIND) programme study protocol: cluster randomised controlled trial.

BACKGROUND: Chile has suffered a fast increase in childhood obesity in the last 10 years. As a result, several school programmes have been implemented, however the effectiveness of these needs to be evaluated to identify and prioritize strategies to curve this trend. METHODS: Cluster randomized controlled trial. Twelve primary public schools chosen at random over three regions of the country will take part in this study. The sample size consisted of a total of 1,655 children. For each region one school will be selected for each of the three nutritional intervention modes and one school will be selected as the control group. The intervention modes consist of the following: Healthy Kiosk and nutritional education (KSEAN); Optimized physical activity (AFSO); Healthy Kiosk and nutritional education (KSEAN) + optimized physical activity (AFSO); Control group. The effectiveness of each intervention will be evaluated by determining the nutritional condition of each child by measuring percentage of body fat, BMI and the z-score of the BMI. This study will also identify the eating behaviours, nutritional knowledge and fitness of each child, along with the effective time of moderate activity during physical education classes. DISCUSSION: A protocol to evaluate the effectiveness of a school based intervention to control and/or reduce the rates of childhood obesity for children between 6 and 10 years of age was developed. The protocol was developed in line with the Declaration of Helsinski, the Nüremberg Code and the University of Chile Guidelines for ethical committees, and was approved by the INTA, Universidad de Chile ethical committee on Wednesday 12 March 2014. There is consensus among researchers and health and education personnel that schools are a favourable environment for actions to prevent and/or control childhood obesity. However a lack of evidence on the effectiveness of interventions to date has led some to question the wisdom of allocating resources to programmes. This is the first study of this kind in Chile and could be an important first step to provide guidance to political authorities in relation to which food and nutrition strategies to prioritize to curve this alarming trend. TRIAL REGISTRATION: ISRCTN32136790 , registered retrospectively on 05 September 2014.

Brain development and scholastic achievement in the Education Quality Measurement System tests in Chilean school-aged children.

BACKGROUND: Head circumference (HC), the anthropometric index of both brain development and nutritional background, has been described to be significantly associated with scholastic achievement (SA). The aim of this study was to determine the impact of nutritional background and current nutritional status parameters on SA in the Education Quality Measurement System (SIMCE) tests. METHODS: A representative sample of 33 schools was randomly chosen in the Metropolitan Region of Chile. The sample consisted of 1,353 school-aged children of both sexes, from the fifth grade of elementary school and from the first grade of high school who in 2009 took the SIMCE tests. Nutritional status was assessed through anthropometric parameters. Brain development was measured through the HC expressed as HC-for-age Z-score (Z-HC). RESULTS: Students with Z-HC < -2 SD and >2 SD obtained low and high SA, respectively, both in the language and the mathematics tests (P < 0.001). In general, in both grades, those students with Z-HC ≥ 0 SD increase more than double the probability to obtain language and mathematics SA scores ≥ the median (P < 0.0001). CONCLUSION: We confirm the hypothesis that HC is the most relevant physical index associated with SA; therefore, children with the lowest scores in the SIMCE tests probably have lower brain development.

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.

[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.

Cognitive Outcomes in Congenital Hypothyroidism: Impact of Socioeconomic Status - A Case-Control Study.

OBJECTIVE: Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS: We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS: No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS: These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.

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.

Development and Validation of a Set of Instruments to Measure Food Environments.

BACKGROUND: There is worldwide interest in measuring local food environments (FEs). The aim of this study was to develop and validate a set of instruments to evaluate FEs in Chile. METHODS: Based on the development and validation of four instruments to measure FEs, a literature review, an evaluation by experts, and the implementation of a pilot tool in the FEs of schoolchildren from nine public schools in the commune of Chillán, Chile, were used. RESULTS: A tool to evaluate FEs was provided, based on three dimensions: availability, variety, and advertising of healthy foods. A total of 1928 foods points of purchase were evaluated. The reliability was evaluated by Cronbach's alpha. Some 74% of the foods' points of purchase were store locations. The reliability of the four instruments was high to acceptable (store: 0.90; institution: 0.77; street food: 0.74; restaurant: 0.68). Unhealthy foods were highlighted by the scores obtained: store (6.08 ± 4.07; range: 0-13), restaurant (3.95 ± 1.75; range: 0-10), street food (1.18 ± 1.56; range: 0-7), and institution FEs (3.38 ± 2.78; range: 0-9). CONCLUSIONS: The results of this tool can provide information to governments for incorporating structural measures to ensure adequate availability, variety, and advertising of healthy foods in different FEs.

[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.

Impact of the COVID-19 Pandemic on Teacher Quality of Life: A Longitudinal Study from before and during the Health Crisis.

BACKGROUND: Prior to the COVID-19 pandemic, teachers were already reporting a low quality of life (QoL) perception, with a significant impact on mental and physical health due to various stress factors associated with work overload. The objective of this study was to evaluate the QoL impact on Chilean teachers before and during the COVID-19 pandemic. The analysis was performed following a longitudinal design on a sample of 63 Chilean teachers in pre-pandemic and COVID-19 pandemic timeframes. QoL perception, along with teachers' sociodemographic data, was evaluated via the Short-Form 36 Health Survey (SF-36) questionnaire. Sociodemographic variables presented no significant variations in pre-pandemic and pandemic comparisons. QoL, however, showed a significant decrease during the pandemic compared to the pre-pandemic measurement (p < 0.01). In each gender, there were significant differences between pre-pandemic and pandemic timeframes, with a greater impact among women in the mental and physical component summary variables and seven of the eight QoL scales (p < 0.01). Between age categories, people under 45 presented significant differences (p < 0.05) between pre-pandemic and pandemic timeframes in all summary dimensions and measurements. In conclusion, Chilean teachers' QoL perception has been affected by the COVID-19 pandemic. These findings could be related to work overload due to teleworking or feelings of uncertainty, loneliness, and fear that the pandemic and its associated confinements will worsen.

Musculoskeletal Disorders Associated With Quality of Life and Body Composition in Urban and Rural Public School Teachers.

Introduction: Teachers have been reported to be a labor group with high rates of musculoskeletal disorders (MSDs), stress, and strong deterioration of quality of life (QoL). However, little information exists about the association between MSD, QoL, and body composition in rural and urban teachers. Objective: The aim was to study the association of MSD with QoL perception and body composition of urban and rural teachers. Participants and Methods: Participants are comprised a representative sample of urban and rural public schoolteachers from the Valparaiso Region, Chile. MSDs were evaluated with the Standardized Nordic Questionnaire for Musculoskeletal Symptoms validated for the Chilean population. QoL perception was evaluated with the 36-Item Short-Form Survey (SF-36). Body composition was measured via bioimpedance. A logistic regression model was used to evaluate the association between MSD, QoL, and body composition, adjusted for age and gender. Results: A total of 88.9% (urban 90%; rural 87%) of teachers felt pain in some body area, 71.2% of them with limitations; 39% of teachers presented body fat obesity, with the highest rate in rural women. The body area with the greatest MSD prevalence was the neck and shoulders (68.6%). Significant differences were observed between teachers with >p75 of MSD (over six pain regions) and those with ≤p75 (six or fewer painful regions; p < 0.05) on six QoL scales and on physical health components (PCSs) and mental health (MCS) in urban teachers. However, rural teachers presented no differences. The association between teachers with >p75 MSD and low QoL perception was significant (p < 0.05) in PCS and MCS. Furthermore, the regression model presents a significant association between rural areas and low PCS perception. Conclusions: Urban and rural teachers present high rates of MSD and obesity. Teachers with higher rates of MSD have their mental and physical QoL affected, making workplace intervention in MSD necessary to prevent teacher health deterioration.

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.

Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades.

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994-2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children.

OBJECTIVE: Obesity prevalence among Chilean children is 19.4%. The present study aimed to assess the effectiveness of a school-based obesity prevention programme. DESIGN: Non-randomized controlled study. The intervention included activities in nutrition and physical activity, fully applied the first year and partially in the second one. Primary outcomes were BMI Z-score (BMIZ) and obesity prevalence; secondary outcomes were waist circumference and triceps skinfold thickness. Time effects were assessed by changes in BMI-related variables by gender and period (ANOVA and Tukey test), while intervention effects were determined by comparing changes in (i) obesity prevalence by gender and period (PROC GENMOD) and (ii) BMIZ according gender, age and period (PROC MIXED). SETTING: Primary schools in the Chilean cities of Casablanca (intervention group) and Quillota (control group). SUBJECTS: One thousand seven hundred and fifty-nine children from three schools (intervention group) and 671 from one school (control group). RESULTS: Over the two years, obesity prevalence and BMIZ declined significantly in the intervention group; from 17.0% to 12.3% and 14.1% to 10.3% in boys and girls, respectively, and from 0.62 to 0.53 and 0.64 to 0.58, respectively. In the control group, obesity remained stable at about 21% and 15%, while BMIZ increased significantly in the second year. BMIZ declined in both genders and all age categories in the intervention group during the first year (significant only in younger boys). No changes occurred during the summer, while during the second year, BMIZ increased in boys and girls from both groups (significant only in the younger control boys). Obesity declined significantly only in boys during the first year. CONCLUSION: Effectiveness was greater in the first school year and more evident in younger boys.

[Obesity prevention in preschool and schoolchildren attending public schools from a district of Santiago, Chile: pilot project 2006]. / Prevención de obesidad en preescolares y escolares de escuelas municipales de una Comuna de Santiago de Chile: proyecto piloto 2006.

Childhood obesity in Chile has been recognized as a public health problem. In 2006, we developed a school-based obesity prevention pilot project to intervene during 5 months preschool and schoolchildren from 1st to 4th grades attending 7 public schools located in a district of Santiago, Chile of medium-low and low SES. The objective of this project was to evaluate the feasibility of implementing a longer intervention giving recommendations to the educational authorities to better implement it. We trained teachers to apply educational activities ( in nutrition and physical activity) for the children in the 7 schools, but additionally in 4 of these schools, teachers of those grades participated in a Counselling program on healthy lifestyle applied individually, anthropometric evaluation and blood tests. The initiatives were evaluated on a sample of 522 schoolchildren (nutritional status and physical fitness), 38 teachers with Counselling (BMI, waist circumference or WC, blood sugar, HDL, triglycerides, cholesterol) and 19 teachers with no counselling (BMI and WC). Additionally, we evaluated the quality of PE classes. The results on the children show a trend on only the younger ones to decrease the % obesity, improving significantly their physical fitness. In teachers with counselling, a trend toward decreasing BMI and WC was observed, while biochemical parameters remained unchanged. We showed that it is feasible to implement a longer intervention recommending improving the quality of PE classes and allowing more time to train teachers and for individual counselling.

Demographic, Social and Health-Related Variables that Predict Normal-Weight Preschool Children Having Overweight or Obesity When Entering Primary Education in Chile.

We determined which variables are predictive of normal-weight (N) Chilean 4-year-olds developing overweight/obesity when entering primary school. This study used national data of preschoolers (PK, age 4) in 2011 through 2015, and the same children in the first grade (1st G, age 6) in 2013 through 2017. We formed longitudinal cohorts considering PK as the baseline and 1st G as the follow-up and included anthropometric, socio-demographic, and health variables in PK and anthropometry in the 1st G. We report the percentage N who remained N at follow-up (N-N) or gained excessive weight (N-OW) and (N-OB), by sex. We ran univariate logistic regressions to determine for each variable, its association with gaining excessive weight (N-OW + OB), incorporating significant variables (p < 0.001) in multivariate logistic regression. A total of 483,509 (251,150 girls) of PK had anthropometry in the 1st G. In PK, 22% of the children were obese; in the 1st G (24.8% and 19.7% in boys and girls, respectively). Of normal-weight children, 30% developed OW + OB. The predictive variables were: Being born macrosomic, attending a very vulnerable school, being indigenous, the mother's low schooling, and the child being cared for by the grandmother after school. In this study, the factors predicting that normal-weight preschoolers gain excessive weight gain in a short period of time are mostly related to poverty. Prevention should focus on this population.