Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 84
Filtrar
1.
PLoS Med ; 17(7): e1003220, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32722710

RESUMEN

BACKGROUND: In June 2016, the first phase of the Chilean Food Labelling and Advertising Law that mandated front-of-package warning labels and marketing restrictions for unhealthy foods and beverages was implemented. We assess foods and beverages reformulation after this initial implementation. METHODS AND FINDINGS: A data set with the 2015 to 2017 nutritional information was developed collecting the information at 2 time periods: preimplementation (T0: January-February 2015 or 2016; n = 4,055) and postimplementation (T1: January-February 2017; n = 3,025). Quartiles of energy and nutrients of concern (total sugars, saturated fats, and sodium, per 100 g/100 mL) and the proportion of products with energy and nutrients exceeding the cutoffs of the law (i.e., products "high in") were compared pre- and postimplementation of the law in cross-sectional samples of products with sales >1% of their specific food or beverage groups, according to the Euromonitor International Database; a longitudinal subsample (i.e., products collected in both the pre- and postimplementation periods, n = 1,915) was also analyzed. Chi-squared, McNemar tests, and quantile regressions (simple and multilevel) were used for comparing T0 and T1. Cross-sectional analysis showed a significant decrease (T0 versus T1) in the proportion of product with any "high in" (from 51% [95% confidence interval (CI) 49-52] to 44% [95% CI 42-45]), mostly in food and beverage groups in which regulatory cutoffs were below the 75th percentile of the nutrient or energy distribution. Most frequent reductions were in the proportion of "high in" sugars products (in beverages, milks and milk-based drinks, breakfast cereals, sweet baked products, and sweet and savory spreads; from 80% [95% CI 73-86] to 60% [95% CI 51-69]) and in "high in sodium" products (in savory spreads, cheeses, ready-to-eat meals, soups, and sausages; from 74% [95% CI 69-78] to 27% [95% CI 20-35]). Conversely, the proportion of products "high in" saturated fats only decreased in savory spreads (p < 0.01), and the proportion of "high in" energy products significantly decreased among breakfast cereals and savory spreads (both p < 0.01). Quantile analyses showed that most of the changes took place close to the cutoff values, with only few exceptions of overall left shifts in distribution. Longitudinal analyses showed similar results. However, it is important to note that the nonexperimental nature of this study does not allow to imply causality of these findings. CONCLUSIONS: Our results show that, after initial implementation of the Chilean Law of Food Labelling and Advertising, there was a significant decrease in the amount of sugars and sodium in several groups of packaged foods and beverages. Further studies should clarify how food reformulation will impact dietary quality of the population.


Asunto(s)
Bebidas , Etiquetado de Alimentos/legislación & jurisprudencia , Nutrientes , Publicidad/legislación & jurisprudencia , Chile , Estudios Transversales , Productos Lácteos , Ingestión de Energía , Comida Rápida , Embalaje de Alimentos , Valor Nutritivo , Estudios Prospectivos , Azúcares
2.
Nutr J ; 19(1): 69, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32650775

RESUMEN

BACKGROUND: Consumption of non-nutritive sweeteners (NNS) is becoming increasingly more frequent, particularly in the context of obesity prevention policies. The aim of this study was to describe the consumption of NNS in an ongoing cohort of pre-schoolers (4-6-year-old) before the implementation of the Chilean Food Labelling and Advertising Law, identify sociodemographic and anthropometric characteristics associated with their consumption, and describe the main dietary sources of each NNS sub-type. METHODS: In 959 low-medium income pre-schoolers from the Food and Environment Chilean Cohort (FECHIC), dietary data from a single 24-h recall was linked to NNS content information obtained from packaged foods (n = 12,233). The prevalence of NNS consumption was estimated by food source and characterized by child and maternal sociodemographic and anthropometric variables. Intakes and main dietary sources were described for the six most prevalent NNS in Chile: Sodium Cyclamate, Saccharin, Aspartame, Acesulfame Potassium, Sucralose, and Steviol glycosides. RESULTS: Sixty-eight percent of the pre-schoolers consumed at least one source of NNS on the day of the dietary recall; most of them consumed NNS from foods and beverages (n = 532), while only 12% (n = 119) also consumed table-top sweeteners. The prevalence of NNS consumption was significantly higher among children whose mothers had a high educational level compared to children whose mothers did not complete high school (p < 0.05); however, it did not differ by any other variable studied. The highest intakes of NNS were observed for Aspartame [2.5 (1.4-3.7) mg/kg per consumer], followed by Sodium Cyclamate [1.6 (1.3-2.6) mg/kg per consumer] and Steviol glycosides [1.2 (0.2-2.1) mg/kg per consumer]. Beverages were the only food group that contributed to the intake of the six NNS studied, accounting for 22% of the overall intake of Saccharine and up to 99% of Aspartame intake. CONCLUSIONS: Before the implementation of the Food Labelling and Advertising Law, NNS consumption was highly prevalent among a cohort of low-middle income Chilean pre-schoolers. Continuous monitoring of NNS consumption is essential given potential food reformulation associated with the implementation of this set of obesity-prevention policies.

3.
Am J Clin Nutr ; 2020 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-32692805

RESUMEN

BACKGROUND: Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited. OBJECTIVE: We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile. METHODS: This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care. RESULTS: At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes. CONCLUSIONS: Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.

4.
Nutrition ; 77: 110803, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32442830

RESUMEN

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

5.
Am J Public Health ; 110(7): 1054-1059, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32437274

RESUMEN

Objectives. To study changes in food advertising on television after Chile's food marketing restriction was implemented in June 2016.Methods. Food advertisements shown between 6 am and 12 am on the 4 primary broadcast and 4 cable channels with the largest Chilean youth audiences during 2 random weeks in April and May 2016 and 2017 were analyzed for product nutrition and child-directed marketing.Results. The percentage of ads for foods high in energy, saturated fats, sugars, or sodium (HEFSS) decreased from 41.9% before the regulation to 14.8% after the regulation (P < .001). This decrease occurred in programs intended for children (from 49.7% to 12.7%; P < .001) as well as general audiences (from 38.5% to 15.7%; P < .001). The largest declines were seen for sodas, desserts, breakfast cereals and industrialized fruit- and vegetable-flavored drinks. Fewer HEFSS ads featured child-directed content (a decrease from 44.0% to 12.0%; P < .001), and the remaining child-directed HEFSS ads primarily aired on internationally owned cable channels.Conclusions. The significant postregulation decrease in the prevalence of HEFSS television ads suggests that children in Chile are now less exposed to unhealthy food advertising. However, television originating from national and international outlets should still be monitored for compliance.


Asunto(s)
Publicidad/estadística & datos numéricos , Alimentos , Valor Nutritivo , Televisión/estadística & datos numéricos , Adolescente , Publicidad/legislación & jurisprudencia , Bebidas , Niño , Preescolar , Chile , Industria de Alimentos/legislación & jurisprudencia , Humanos , Mercadotecnía/legislación & jurisprudencia , Mercadotecnía/estadística & datos numéricos
6.
Artículo en Inglés | MEDLINE | ID: mdl-32419140

RESUMEN

CONTEXT: Transient thelarche (TT), that is, the appearance, regression and subsequent reappearance of breast buds, is a frequent phenomenon, but little is known about pubertal transition in these girls. OBJECTIVE: To describe pubertal progression, growth, genotypes, reproductive hormones and growth factors in girls with TT compared to those who do not present TT (non-TT). DESIGN: Retrospective analysis of a longitudinal population-based study. PATIENTS OR OTHER PARTICIPANTS: Girls (n = 508) of the Chilean Growth and Obesity cohort. MEASUREMENTS: Pubertal progression, reproductive hormones, follicle stimulating hormone (FSH) beta subunit/FSH receptor gene single nucleotide polymorphisms and growth. RESULTS: Thirty-seven girls (7.3%) were presented TT. These girls entered puberty by pubarche more frequently (51%) than girls with normal progression (non-TT; n = 471; 23%, P = .005). Girls with TT who were under 8 years old had lower androgens, anti-Müllerian hormone (AMH), luteinizing hormone (LH) and oestradiol (all P < .05) than older girls with TT. At the time of Tanner breast stage 2 (B2), girls with TT had higher androgens, LH, FSH, IGF1, LH, insulin and oestradiol (P < .01) than at the time of TT. TT girls were older at B2 (10.3 ± 1.1 vs. 9.2 ± 1.2 years, P < .001) and menarche (12.3 ± 0.8 vs. 12.0 ± 1.0 years, P = .040) than their counterparts (non-TT). No differences in anthropometric variables or FSHB/FSHR genotypes were detected. CONCLUSION: Transient thelarche is a frequent phenomenon that does not appear to be mediated by hypothalamic-pituitary-gonadal axis activation or by adiposity. Hormonal differences between earlier TT and later TT suggest that their mechanisms are different.

7.
Sci Rep ; 10(1): 6636, 2020 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-32313106

RESUMEN

The effect of excessive gestational weight gain (EGWG) is related to adverse health outcomes in the offspring; however, its effect on the daughters' breast density is unclear. We aimed to assess the association between EGWG and daughters' breast composition (% of fibroglandular volume (%FGV) and absolute fibroglandular volume (AFGV)) at Tanner stage 4 (Tanner B4)). We included 341 girls and their mothers from an ongoing cohort of low-income Chilean girls born from 2002-2003. Maternal gestational weight gain was self-reported in 2007, and breast density by digital mammography was measured in 2010. Weight, height and breast composition by dual X-ray absorptiometry (DXA) were measured in daughters at Tanner B4. Logistic regression models were run to assess the association between EGWG and the 80th percentile of %FGV and AFGV. Mean gestational weight gain was 13.7 kg (SD = 6.9 kg). Women with pregestational overweight or obesity exceeded the recommended gestational weight gain (58.8% vs. 31.8%, respectively). Daughters of women who had EGWG had higher levels of AFGV (OR: 2.02; 95%CI 1.16-3.53) at Tanner B4, which could be explained by metabolic and hormonal exposure in utero. However, we did not observe an association with %FGV.

8.
Public Health Nutr ; : 1-10, 2020 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-32338229

RESUMEN

OBJECTIVES: To assess the consumption of ultra-processed foods and its association with the overall dietary content of nutrients related to non-communicable diseases (NCD) in the Chilean diet and to estimate the population attributable fraction of ultra-processed food consumption on the unhealthy nutrient content. DESIGN: Cross-sectional analysis of dietary data collected through a national survey (2010). SETTING: Chile. PARTICIPANTS: Chilean population aged ≥2 years (n 4920). RESULTS: In Chile, ultra-processed foods represented 28·6 % of the total energy intake. A significant positive association was found between the dietary share of ultra-processed foods and NCD-promoting nutrients such as dietary energy density (standardised regression coefficient (ß) = 0·22), content of free sugars (ß = 0·45), total fats (ß = 0·26), saturated fats (ß = 0·19), trans fats (ß = 0·09) and Na:K ratio (ß = 0·04), while a significant negative association was found with the content of NCD-protective nutrients such as K (ß = -0·19) and fibre (ß = -0·31). The content of Na (ß = 0·02) presented no significant association. Except for Na, the prevalence of inadequate intake of all nutrients (WHO recommendations) increased across quintiles of the dietary share of ultra-processed foods. With the reduction of ultra-processed foods consumption to the level seen among the 20 % lowest consumers (3·8 % (0-9·3 %) of the total energy from ultra-processed foods), the prevalence of nutrient inadequacy would be reduced in almost three-fourths for trans fats; in half for energy density (foods); in around one-third for saturated fats, energy density (beverages), free sugars and total fats; in near 20 % for fibre and Na:K ratio and in 13 % for K. CONCLUSIONS: In Chile, decreasing the consumption of ultra-processed foods is a potentially effective way to achieve the WHO nutrient goals for the prevention of diet-related NCD.

9.
Public Health Nutr ; 23(S1): s39-s50, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32131930

RESUMEN

OBJECTIVE: To assess the relationship between malnutrition, socioeconomic status (SES) and ethnicity in Chilean adult population. DESIGN: Nationally representative survey (ENS) conducted in 2016-2017. Sociodemographic information, weight, height and hemoglobin (Hb) were measured (2003 ENS). Excess weight was defined as BMI ≥25 kg/m2. Undernutrition included underweight (BMI <18·5 kg/m2), short stature (height <1·49 m in women and <1·62 m in men) or anaemia (Hb <12 g/l). Education and household income level were used as indicators of SES; ethnicity was self-reported. We applied linear combinations of estimators to compare the prevalence of excess weight and undernutrition by SES and ethnicity. SETTING: Chile. PARTICIPANTS: In total, 5082 adults ≥20 years (64 % women) and 1739 women ≥20 years for anaemia analyses. RESULTS: Overall, >75 % of women and men had excess weight. Low SES women either by income or education had higher excess weight ((82·0 (77·1, 86·1) v. 65·0 (54·8, 74·1)) by income; (85·3 (80·6, 89·0) v. 68·2 (61·6, 74·1) %) by education) and short stature (20-49 years; 31(17·9, 48·2) v. 5·2 (2·2,11·4) by education); obesity was also more frequent among indigenous women (20-49 years; 55·8 (44·4, 66·6) v. 37·2 (32·7, 42·0) %) than non-indigenous women. In men, excess weight did not significantly differ by SES or ethnicity, but short stature concentrated in low SES (20-49 years; 47·6 (24·6, 71·6) v. 4·5 (2·1, 9·5) by education) and indigenous men (21·5 (11·9, 5·5, 11·9) v. 8·2 (5·5, 11·9)) (P < 0·05 for all). CONCLUSIONS: In Chile, malnutrition is disproportionately concentrated among women of low SES and indigenous origin; these inequalities should be considered when implementing prevention policies.

10.
Health Educ Behav ; 47(3): 439-448, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32188283

RESUMEN

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.

11.
PLoS Med ; 17(2): e1003015, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32045424

RESUMEN

BACKGROUND: Chile's Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. METHOD AND FINDINGS: In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as "high-in" or "not high-in" according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law's warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] -22.9 to -22.7; p < 0.001), or 23.7% (95% CI -23.8% to -23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (-28.7%, 95% CI -28.8% to -28.6%) compared to low-educated households (-21.5%, 95% CI -21.6% to -21.4%), likely because of the high-educated households' lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI -12.0 to -11.9; p < 0.001) or 27.5% (95% CI -27.6% to -27.5%). Calories purchased from beverages classified as "not high-in" increased 5.7 kcal/capita/day (95% CI 5.7-5.7; p < 0.001), or 10.8% (10.8%-10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI -7.4 to -7.3; p < 0.001), or 7.5% (95% CI -7.6% to -7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. CONCLUSIONS: Purchases of high-in beverages significantly declined following implementation of Chile's Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile's policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.


Asunto(s)
Publicidad/legislación & jurisprudencia , Comportamiento del Consumidor/estadística & datos numéricos , Etiquetado de Alimentos/legislación & jurisprudencia , Bebidas Azucaradas/legislación & jurisprudencia , Adolescente , Adulto , Niño , Preescolar , Chile , Escolaridad , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , México , Clase Social , Impuestos/legislación & jurisprudencia
12.
Endocr Res ; 45(2): 102-110, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31668099

RESUMEN

Purpose: Recent reports show that girls with higher body mass index (BMI) have an earlier puberty onset (thelarche). It has been suggested that earlier puberty is a consequence of higher levels of estrogen due to increased aromatization of androgens in adipose tissue. Thus, we aimed to assess the relation between serum levels of estrogen and excess weight (BMI ≥1SD) and central adiposity (>75th percentile for waist circumference) in prepubertal girls at age 7.Materials and Methods: We conducted a cross-sectional study within the Growth and Obesity Cohort Study of 1190 low-middle income children from Santiago, Chile. We selected a random sample of 107 prepubertal girls at age 7. A trained dietitian measured weight, height and waist circumference. Additionally, a fasting blood sample was collected to measure serum levels of estradiol equivalents (via ultrasensitive recombinant cell bioassay), dehydroepiandrosterone sulfate (DHEAS), insulin, insulin-like growth factor 1 (IGF-1), and leptin.Results: Excess weight was observed in 40% of our sample; 11.2% had high central adiposity, and the mean level of estradiol equivalents was 3.6 ± 2.3 pg/ml. In the univariate and multivariate analyzes, we did not observe an association between excess weight, central adiposity and estradiol equivalent levels; however, insulin was inversely associated with the serum level of estradiol equivalents.Conclusions: Our participants had a mean level of estradiol equivalents of 3.6 pg/ml (±2.3 pg/ml) at the pre-pubertal stage. However, with the exception of insulin, we did not observe an association between estradiol equivalents and markers of adiposity and metabolic and hormonal factors.

13.
Lancet ; 395(10217): 65-74, 2020 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-31852602

RESUMEN

The double burden of malnutrition (DBM), defined as the simultaneous manifestation of both undernutrition and overweight and obesity, affects most low-income and middle-income countries (LMICs). This Series paper describes the dynamics of the DBM in LMICs and how it differs by socioeconomic level. This Series paper shows that the DBM has increased in the poorest LMICs, mainly due to overweight and obesity increases. Indonesia is the largest country with a severe DBM, but many other Asian and sub-Saharan African countries also face this problem. We also discuss that overweight increases are mainly due to very rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs, and major reductions in physical activity at work, transportation, home, and even leisure due to introductions of activity-saving technologies. Understanding that the lowest income LMICs face severe levels of the DBM and that the major direct cause is rapid increases in overweight allows identifying selected crucial drivers and possible options for addressing the DBM at all levels.


Asunto(s)
Desnutrición/epidemiología , Obesidad/epidemiología , Sobrepeso/epidemiología , África del Sur del Sahara/epidemiología , Calidad de los Alimentos , Humanos , Indonesia/epidemiología , Desnutrición/etiología , Estado Nutricional , Valor Nutritivo , Obesidad/etiología , Sobrepeso/etiología , Pobreza , Prevalencia , Factores Socioeconómicos
14.
J Pediatr Gastroenterol Nutr ; 70(1): 93-98, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31880680

RESUMEN

Nonalcoholic fatty liver disease (NAFLD), defined as fat accumulation greater than 5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults. OBJECTIVE: The aim of the study was to identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. METHODS: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002 to 2003, with yearly anthropometric data collected over a 10-year period. The presence of intrahepatic fat in the livers of subjects 14 to 16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. RESULTS: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 kPa) had greater weight, BMI z-score, waist and hip circumference, and altered liver enzymes (P < 0.05). CONCLUSION: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.

15.
Artículo en Inglés | MEDLINE | ID: mdl-31731577

RESUMEN

Food marketing has been identified as a contributing factor in childhood obesity, prompting global health organizations to recommend restrictions on unhealthy food marketing to children. Chile has responded to this recommendation with a restriction on child-directed marketing for products that exceed certain regulation-defined thresholds in sugars, saturated fats, sodium, or calories. Child-directed strategies are allowed for products that do not exceed these thresholds. To evaluate changes in marketing due to this restriction, we examined differences in the use of child-directed strategies on breakfast cereal packages that exceeded the defined thresholds vs. those that did not exceed the thresholds before (n = 168) and after (n = 153) the restriction was implemented. Photographs of cereal packages were taken from top supermarket chains in Santiago. Photographed cereals were classified as "high-in" if they exceeded any nutrient threshold described in the regulation. We found that the percentage of all cereal packages using child-directed strategies before implementation (36%) was significantly lower after implementation (21%), p < 0.05. This overall decrease is due to the decrease we found in the percentage of "high-in" cereals using child-directed strategies after implementation (43% before implementation, 15% after implementation), p < 0.05. In contrast, a greater percentage of packages that did not qualify as "high-in" used child-directed strategies after implementation (30%) compared with before implementation (8%), p < 0.05. The results suggest that the Chilean food marketing regulation can be effective at reducing the use of child-directed marketing for unhealthy food products.


Asunto(s)
Desayuno , Grano Comestible , Legislación Alimentaria , Mercadotecnía/métodos , Niño , Chile , Ingestión de Energía , Femenino , Etiquetado de Alimentos , Humanos , Masculino , Mercadotecnía/legislación & jurisprudencia , Valor Nutritivo , Prevalencia
16.
Nat Med ; 25(11): 1667-1679, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31700182

RESUMEN

Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Enfermedades Metabólicas/epidemiología , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/patología , Países en Desarrollo , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patología , Política de Salud , Humanos , Enfermedades Metabólicas/metabolismo , Enfermedades Metabólicas/patología , Factores de Riesgo
17.
Artículo en Inglés | MEDLINE | ID: mdl-31651803

RESUMEN

Non-alcoholic fatty liver disease (NAFLD), defined as fat accumulation >5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults. OBJECTIVE: To identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. METHODS: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002-2003, with yearly anthropometric data collected over a 10 year period. The presence of intra-hepatic fat in the livers of subjects 14-16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. RESULTS: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 Kpa) had greater weight, BMI z-score, waist and hip circumference and altered liver enzymes (p < 0.05). CONCLUSION: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.

18.
J Pediatr Adolesc Gynecol ; 32(6): 579-583, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31445142

RESUMEN

STUDY OBJECTIVE: To assess pubertal events in a Hispanic female population and to create normograms of puberty. DESIGN: Longitudinal. SETTING: University facility. PARTICIPANTS: Five hundred forty-nine girls from the Growth and Obesity Chilean Cohort study. INTERVENTIONS: Follow-up twice a year beginning at age 6 years. MAIN OUTCOME MEASURES: Breast development, pubic hair development, and age. Breast development (B2, B3, and B4) and pubarche (P2) were determined. Age at menarche was obtained from the adolescents and their mothers. Age and growth velocity at peak height velocity were calculated. RESULTS: In girls, B2, B3, and B4 occur at median ages of 9.2, 10.2, and 10.9 years, respectively. The median age at P2 was 9.7 years. The mean age at peak height velocity and the growth velocity were 10.6 years (SD = 1.1) and 8 cm/y, respectively. The mean age at menarche was 11.9 years (SD = 1.1); only 2.8% (15 /530) of girls experienced menarche after 14 years and 1.9% before 10 years. The mean interval time between B2 and menarche was 2.5 ± 1.0 years. Transient thelarche occurred in 8.6% of girls. CONCLUSION: This longitudinal cohort shows that thelarche occurred 1.2 months later than previously reported in cross-sectional studies. Conversely, we found that pubic hair appeared 12 months earlier and menarche occurred 9 months earlier than previously reported. These findings are important in setting normalcy data and avoiding unnecessary clinical consultations.


Asunto(s)
Factores de Edad , Hispanoamericanos/estadística & datos numéricos , Menarquia , Pubertad , Adolescente , Niño , Chile , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Obesidad/fisiopatología , Maduración Sexual
19.
Nutrients ; 11(7)2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31340559

RESUMEN

BACKGROUND: Food source and eating location are important factors associated with the quality of dietary intake. In Chile the main food sources and eating locations of preschool children and adolescents and how these relate to dietary quality are unknown. METHODS: We analyzed 24 h dietary recalls collected in 2016 from low- and middle-income Chilean preschool children (3-6 years, n = 839) and adolescents (12-14 years, n = 643) from southeastern Santiago. Surveys collected the food source and eating location for each food reported during the recall. We estimated the mean intake of calories and key nutrients of concern, such as saturated fats, total sugars, and sodium, by food source and eating location. RESULTS: Foods obtained and eaten at home contributed the greatest proportion of total calories and the key nutrients of concern. Foods obtained at home tended to have lower caloric densities but higher sugar and sodium densities than foods obtained away from home in both age groups. With regard to location, for preschool children foods consumed at home had lower caloric and sugar densities than foods eaten at school, while for adolescents foods consumed at home had lower caloric, saturated fat, and sugar densities than foods eaten at school. For both children and adolescents, home was the primary source of sugar-sweetened beverages (SSBs) calories. SSBs were important calorie contributors among foods across all settings, but the highest absolute amount of calories from these beverages was consumed at home. CONCLUSIONS: While most of Chilean youths' calories and key nutrients of concern are obtained and consumed at home, these foods tended to have lower caloric densities than foods obtained and consumed away from home. Home was the main food source for SSBs, but the relative consumption of these beverages was high in all eating locations. More research will be needed to inform and evaluate policies and interventions to improve children's dietary quality across settings.


Asunto(s)
Conducta del Adolescente , Conducta Infantil , Dieta , Conducta Alimentaria , Servicios de Alimentación , Abastecimiento de Alimentos , Renta , Adolescente , Factores de Edad , Niño , Preescolar , Chile , Encuestas sobre Dietas , Ingestión de Energía , Femenino , Humanos , Masculino , Comidas , Valor Nutritivo , Ingesta Diaria Recomendada
20.
BMC Public Health ; 19(1): 906, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31286910

RESUMEN

BACKGROUND: Front-of package (FoP) nutrition labels are an option to guide consumer's decision at the point of food purchase. Chile was the first country worldwide to implement a FoP warning label and thereafter several countries have followed this model. The objective of this study is to describe the process of development of the Chilean FoP warning label. METHODS: A stepwise study was conducted including literature review, qualitative phase (lay audience & expert group meetings) and quantitative phase in women/adolescents from low-middle-socioeconomic status neighborhoods, Santiago, Chile (2 sub-studies, using point-of-sale questionnaires). Outcomes were prototype visualization, ease of understanding, and ability to modify purchase behavior. RESULTS: The literature review and qualitative phase provided information on general text (e.g. short wording) and design characteristics (e.g. use of a logo, use of red or black colors); based on these characteristics 15 prototypes were created and quantitatively tested. In the first survey, a black-&-white stop sign and a black-&-white hand were preselected; in the second survey, the stop sign stating 'Excess of ' had significantly better performance than the hand in terms of visualization, intention to purchase, and ability to modify intended purchase. Due to legal reasons the "excess of" was replaced by "high-in" in the final implementation of the law. CONCLUSIONS: A simple black-&-white stop sign warning label was the best option to flag pre-packaged foods with an excess of energy or nutrients of concern for non-communicable diseases; this FoP warning label was implemented in Chile in June 2016 as part of the Chilean Food Labeling and Marketing Law.


Asunto(s)
Comportamiento del Consumidor , Etiquetado de Alimentos/métodos , Preferencias Alimentarias/psicología , Adolescente , Adulto , Chile , Femenino , Etiquetado de Alimentos/legislación & jurisprudencia , Implementación de Plan de Salud , Humanos , Mercadotecnía/métodos , Persona de Mediana Edad , Investigación Cualitativa , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA