Derecho a la alimentación: ¿Qué dicen las constituciones de América y el Caribe?

RESUMEN Introducción: Numerosos países de América y el Caribe cuentan con el derecho constitucional a la Alimentación. Chile no cuenta con este derecho constitucionalizado. Objetivo: Describir comparativamente cómo se encuentra explícito el derecho a la alimentación (DA) en la Constitución de los países de América y el Caribe, generando insumos para aquellos países que no cuentan con este derecho explícito, como en Chile. Fuentes de datos: Esta búsqueda se realizó en las plataformas: Seguridad Alimentaria y Nutricional (SAN-CELAC), Derecho a la Alimentación en el Mundo (FAO) y Constitute Project que presenta las constituciones del mundo. Método de revisión: Se realizó una revisión todas las constituciones disponibles de los países independientes de América y el Caribe y de países con territorios dependientes y departamentos de ultramar en la Región. Posteriormente, en aquellos países que presentan el DA de forma explícita en su texto constitucional, se realizó una revisión sobre las características generales del texto constitucional y de los conceptos asociados a la definición del DA, sugeridos por la FAO. La revisión se llevó a cabo entre los meses de junio y septiembre de 2020. Resultados: Del total de los países revisados (n= 42), solo el 40,5% presentó el DA explícito en su texto constitucional. La seguridad alimentaria es el concepto que aparece con mayor frecuencia. Conclusión: La mayor parte de las constituciones acompañan el DA con características de seguridad alimentaria, disponibilidad y accesibilidad, e incluyen alguna forma de judicialización, conceptos que deberían ser incorporadas la nueva Carta Magna de Chile.

ABSTRACT Introduction: Many American and Caribbean countries consider the right to food as constitutional right. Chile does not have this explicit right in the Constitution. Objective: To describe comparatively how the right to food is explicit in the constitutions of American and Caribbean countries, generating inputs for those countries that do not have this constitutional right, such as the case of Chile. Data sources: This research was carried out on platforms: Food and Nutritional Security (SAN-CELAC), Right to Food in the World (FAO) and Constitute Project which presents constitutions of the world. Revision method: A revision was made of all available constitutions of American and independent Caribbean countries, dependent territories and overseas departments in the Region. Subsequently, in those countries which explicitly consider the right to food in constitutional texts, a review of general characteristics and right to food-associated concepts, suggested by FAO, was carried out. The review was carried out between June and September 2020. Results: Of the total of countries reviewed (n= 42), 40.5% presented the right to food in constitutional text. The most frequently associated concept was food security. Conclusion: Most of the revised constitutions accompany the right to food with food safety, availability and accessibility characteristics, and include kinds of judicialization, concepts that should be incorporated into the new Magna Carta of Chile.

Impact of the change of the Atalah standard cut-off point to classify underweight nutritional status during pregnancy

ABSTRACT Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)<20 kg/m2 and normal weight: pre-pregnancy BMI= 20-24.9 kg/m2) differ from those recommended by the US Institute of Medicine (IOM2009) (underweight: BMI<18.5 kg/m2 and normal weight: 18.5-24.9 kg/m2). Using a large population database from a Chilean public hospital, we compared the prevalence of underweight and normal weight at the beginning of pregnancy with Atalah and IOM2009 standards. Additionally, we evaluated the performance of both standards in detecting adverse neonatal outcomes and gestational weight gain. Methods: Data from clinical records of single birth pregnancies (n= 59,476) at the Sótero del Río Hospital, between 2003-2012 were collected. We compared 1. nutritional status, 2. proportion of excessive gestational weight gain, 3. association between nutritional status and neonatal outcomes (large/small for gestational age, low birth weight, preterm birth and macrosomia), using logistic regression models, and 4. Sensitivity, specificity, and predictive values to predict adverse neonatal outcomes per nutritional status. Results: Pre-pregnancy underweight decreased from 8.6% to 2.5% and women with BMI between 18.5-19.9kg/m2, who exceeded the recommended gestational weight gain increased from 32.7% to 49.2% when using IOM2009 instead of Atalah. Both standards showed low sensitivity, but the IOM2009 cut-off points showed better specificity for identifying healthy newborns. Conclusion: The cut-off points recommended by the IOM2009 better identify the prevalence of underweight and normal weight during pregnancy without increasing neonatal risk. This study supports the recent change of the Ministry of Health in adopting the WHO cut-off points during pregnancy.

RESUMEN Chile y diversos países Latinoaméricanos utilizan el estándar de Atalah para evaluar el estado nutricional (EN) durante el embarazo. Sin embargo, los puntos de corte de este estándar (bajo peso, BP: índice de masa corporal pre-gestacional (IMC)<20 kg/m2 y normal, NP: IMC pregestacional= 20-24,9 kg/m2) difieren de los recomendados por el Instituto de Medicina de EE.UU. (IOM2009) (BP: BMI<18.5kg/m2 and NP: 18,5-24,9 kg/m2). Con datos obtenidos desde el Hospital Sótero del Río, nosotros evaluamos la prevalencia de BP y NP al comienzo del embarazo con los estándares de Atalah e IOM2009. Adicionalmente, nosotros comparamos el comportamiento de ambos estándares en detectar resultados neonatales (RN) adversos y en la clasificación de la ganancia de peso gestacional (GPG). Métodos: Se obtuvieron datos de embarazos simples entre 2003-2012, (n= 59.476). Nosotros comparamos: 1. Prevalencia de EN, 2. Proporción de excesiva GPG, 3. Asociación entre EN y RN, usando modelos de regresión logística, y 4. Sensibilidad, especificidad y valores predictivos para predecir RN según EN. Resultados: La prevalencia de BP pregestacional disminuyó de 8,6% a 2,5% y las mujeres con IMC entre 18,5-19,9 kg/m2 que excedieron la GPG recomendada, incrementaron desde 33% a 50% cuando se utilizó el estándar IOM2009 en vez de Atalah. Ambos estándares mostraron baja sensibilidad, pero IOM2009 mostró mejor especificidad para identificar recién nacidos saludables. Conclusión: Estandar IOM2009 identifica con mayor precisión la prevalencia de BP y NP durante la gestación sin incrementar el riesgo neonatal. Este estudio respalda el reciente cambio del MINSAL al adoptar los puntos de corte de la OMS durante el embarazo.

Comparison of bio-sociodemographic, obstetric and perinatal characteristics among immigrant and native women in the Metropolitan Region in Chile.

BACKGROUND: International migration is an increasing public health concern, particularly regard to maternal and neonatal health. OBJECTIVE: To compare obstetric and neonatal variables among native and immigrant childbearing women in a clinical hospital in Santiago, Chile. METHOD: A cross-sectional, analytic study with 2598 childbearing women and their newborn examined between January and July 2015. Data were collected from clinical records by students who had previously been trained. Ethical approval was obtained from the local Ethics Committee at the hospital. All participants signed an informed consent form. A descriptive and comparative analysis was performed. For comparison, a Chi-square test was used for categorical variables, and Student t-test was used for quantitative variables. RESULTS: Among the included women, 41.5% (n = 1078) were immigrants. The immigrants' mean age was 28.1 ±â€¯6.4 years, and that of natives was 26.8 ±â€¯6.9 (p < 0.001). Among natives, the obesity rate was 38.3%, as compared to 19.3% among immigrants (p < 0.001). A significantly higher rate of caesarean section was seen among natives (36.8%) than among immigrants (31.7%). Obstetric morbidity, pre-eclampsia, gestational diabetes and prematurity were significantly higher among natives. There was no difference regarding low birth weights. CONCLUSION: In general, immigrants present better maternal and neonatal indicators than native women. Controversially, this is known as the 'healthy immigrant' phenomenon in the literature.

Effectiveness of an Intervention of Dietary Counseling for Overweight and Obese Pregnant Women in the Consumption of Sugars and Energy.

OBJECTIVE: Evaluate if an intervention based on nutritional counseling decreases total sugars and energy consumption in overweight and obese pregnant women, compared to their previous consumption and compared to women who only received routine counseling. METHODS: Randomized study of two groups: dietary counseling (Intervention Group: IG) and routine counseling (Control Group: CG). The intervention consisted of three educational sessions focused on decreasing intake of foods that most contribute to sugars consumption. Changes in sugars and energy consumption were evaluated by a food frequency questionnaire before and after the intervention. RESULTS: We evaluated 433 pregnant women, 272 in IG and 161 in CG, who before intervention had a mean consumption of 140 g total sugars and 2134 kcal energy per day. At the end of the intervention, the IG showed 15 g/day lower consumption of total sugars (95% CI: -25 and -5 g/day), 2% less total energy from sugars (95% CI: -3% and -1% g/day), and 125 kcal/day less energy than the CG (95% CI: -239 and -10 kcal/day). Table sugar, sweets, and soft drinks had the greatest reduction in consumption. CONCLUSIONS: The intervention focused on counseling on the decrease in consumption of the foods that most contribute to sugars consumption in overweight and obese pregnant women was effective in decreasing total sugars and energy consumption, mainly in the food groups high in sugars. Future studies should examine if this intervention has an effect on maternal and fetal outcomes.

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.

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

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.

[Consumption of a DHA-enriched milk drink by pregnant and lactating women, on the fatty acid composition of red blood cells, breast milk, and in the newborn]. / Efecto de una bebida láctea con DHA en la composición de ácidos grasos del glóbulo rojo, de la leche materna y en el recién nacido.

UNLABELLED: EPA and DHA consumption in Chile is markedly below international daily intake recommendations. For improvement of such low intake level, we developed a fortified powdered dairy drink, containing 60 mg/serving of DHA and 14 mg/serving of EPA. OBJECTIVES: to evaluate the effects of DHA consumption during pregnancy, parturition, and in the newborn, on lipid composition of red blood cell membranes and levels of DHA and EPA on human milk during lactation. One hundred and seventy five (175) pregnant women received 2 kg/month of the fortified powdered dairy drink (GE), and 177 received the regular milk provided by the Ministry of Health (GC). We monitored daily intake of the dairy drink and all other sources of DHA and EPA in the diet, and measured general biological indicators during pregnancy, parturition, and in the new born. On a subsample of 14 women on each group (GE and GC), we measured fatty acid composition of red blood cell membranes after 0 and 60 days of consumption with the fortified dairy drink, and levels of DHA and EPA on human milk after 2 months of lactation. Of all women in the study, 16% had no consumption of fish, and 53% had no consumption of sea food. Less than 25% of all women had fish on a weekly basis. Consumption of the fortified dairy drink tripled intake of DHA, from 48.8 mg/day (CI 38.7-57.5) to 147.8 mg/day (CI 128.4-167.9) (p<0.001). The GE group had a higher content of DHA on the phospholipids of red blood cell membranes: 11.1% (CI 10.2-13.0) versus 17.9% (CI 12.9-23.0) (p<0.002). Concentration of DHA and omega-3 fatty acids increased 50% in milk of women consuming the fortified dairy drink (p<0.06). There was alower incidence of preterm parturitions on the GE group (2.8 vs 10.6%), but without statistical significance. The consumption of the fortified dairy drink produced a significant increase of DHA consumption during pregnancy and lactation, and an improved composition of red blood cell membranes, as well as in human milk, proving to be an appropriate intervention strategy for the target population.

Efecto de una bebida láctea con DHA en la composición de ácidos grasos del glóbulo rojo, de la leche materna y en el recién nacido / Consumption of a DHA-enriched milk drink by pregnant and lactating women, on the fatty acid composition of red blood cells, breast milk, and in the newborn

En Chile el consumo de EPA y DHA es mucho menor a las recomendaciones internacionales. Para mejorar el aporte de omega-3 en el embarazo y lactancia desarrollamos una bebida láctea fortificada con 60 mg de DHA y 14 mg de EPA por 200/ml. El objetivo del estudio fue evaluar su efecto en embarazo, parto y recién nacido, composición lipídica de los glóbulos rojos y de la leche materna. Se estudió una cohorte de embarazadas que recibieron dos Kg/mes del nuevo producto (GE n = 175) o la misma cantidad de la leche en polvo que distribuye el Ministerio de Salud (GC n =177). Se analizó consumo de la bebida láctea y otros alimentos fuentes de EPA y DHA y las características del embarazo, parto y recién nacido. En una submuestra de cada grupo se analizó al ingreso y a los 60 días la composición de los ácidos grasos de membranas del glóbulo rojo de la madre y de la leche materna a los 2 meses post parto. El 16 y 53 por ciento de la muestra no consumía pescado o mariscos respectivamente y menos del 25 por ciento consumía pescado en forma semanal. La intervención aumentó el aporte diario de DHA de 48,8 mg (IC 38,7 - 57,5) a 147,8 mg (IC 128,4 - 167,9) (p < 0,001). El GE tuvo mayores niveles de DHA en los fosfolípidos de la membrana del glóbulo rojo materno: 17,9 por ciento (IC 12,9 - 23,0) versus 11,1 por ciento (IC10,2 - 13,0) p < 0,002 y aumentó en 50 por ciento la concentración de ácidos grasos omega-3 en la leche materna (p 0,06). Se observó menor prevalencia de partos pretérminos en el GE (2,8 vs 10,6 por ciento), aunque sin significación estadística. La bebida láctea logró un aumento significativo del consumo de DHA en el embarazo y lactancia y una mejoría de la composición de ácidos grasos en el glóbulo rojo y leche materna, sugiriendo que es una buena estrategia de intervención en esta población.

EPA and DHA consumption in Chile is markedly below international daily intake recommendations. For improvement of such low intake level, we developed a fortified powdered dairy drink, containing 60 mg/serving of DHA and 14 mg/serving of EPA. Objectives: to evaluate the effects of DHA consumption during pregnancy, parturition, and in the newborn, on lipid composition of red blood cell membranes and levels of DHA and EPA on human milk during lactation. One hundred and seventy five (175) pregnant women received 2 kg/month of the fortified powdered dairy drink (GE), and 177 received the regular milk provided by the Ministry of Health (GC). We monitored daily intake of the dairy drink and all other sources of DHA and EPA in the diet, and measured general biological indicators during pregnancy, parturition, and in the new born. On a subsample of 14 women on each group (GE and GC), we measured fatty acid composition of red blood cell membranes after 0 and 60 days of consumption with the fortified dairy drink, and levels of DHA and EPA on human milk after 2 months of lactation. Of all women in the study, 16 percent had no consumption of fish, and 53 percent had no consumption of sea food. Less than 25 percent of all women had fish on a weekly basis. Consumption of the fortified dairy drink tripled intake of DHA, from 48.8 mg/day (CI 38.7-57.5) to 147.8 mg/day (CI 128.4-167.9) (p<0.001). The GE group had a higher content of DHA on the phospholipids of red blood cell membranes: 11.1 percent (CI 10.2- 13.0) versus 17.9 percent (CI 12.9-23.0) (p<0.002). Concentration of DHA and w-3 fatty acids increased 50 percent in milk of women consuming the fortified dairy drink (p<0.06). There was a lower incidence of preterm parturitions on the GE group (2.8 vs 10.6 percent), but without statistical significance. The consumption of the fortified dairy drink produced a significant increase of DHA consumption during pregnancy and lactation, and an improved composition...

Desarrollo, consumo y aceptabilidad de una bebida láctea con DHA para embarazadas y nodrizas / Development, intake and acceptability of a DHA-enriched milk drink for pregnant and lactating women

El DHA es un nutriente crítico en mujeres embarazadas y en lactancia, con importantes beneficios en el desarrollo cerebral y agudeza visual del lactante. En Chile el consumo de DHA representa menos del 30% de las recomendaciones internacionales para el embarazo. El objetivo del estudio fue diseñar y evaluar una bebida láctea para embarazadas y nodrizas adicionada de 60 mg de DHA y 11 de EPA por porción de consumo (200 mi), además de estar fortificada con vitaminas y minerales. Se estudió una cohorte de 177 embarazadas que recibieron 2 Kg. mensuales de bebida láctea en comparación con un grupo control de 175 embarazadas que recibió el producto actualmente en uso en el Programa Nacional de Alimentación Complementaria (leche 26% de materia grasa, fortificada con Fe, Zn y vit C). Se evaluó aceptabilidad, tolerancia y consumo de ambos productos en dos oportunidades en el embarazo y a los 2 meses posparto. Ambos alimentos fueron bien evaluados en sus características organolépticas. El consumo promedio de ambos grupos fue 1,8 +/- 1,0 tazas diarias, inferior a las 3 tazas programadas. Durante el embarazo la evaluación sensorial y el consumo fueron mayores para la leche entera, aunque las diferencias no fueron importantes desde el punto de vista biológico. Durante la lactancia no hubo diferencias en ninguno de los parámetros evaluados. Se concluye que la bebida láctea es una buena alternativa para mejorar el consumo de DHA durante el embarazo y lactancia.

DHA is a critical nutrient for pregnant and lactating women, with important functions in brain development and sight acuity of the newborn. In Chile, DHA intake represents less than 30% of the international recommendation for pregnancy. The objective of this study was to design and evaluate a milk drink for pregnant and lactating women, containing 60 mg of DHA and 11 mg of EPA per 200 mi portion, plus other added vitamins and minerals. A cohort of 177 pregnant women received 2 kg/month of the milk drink and compared to a group ofl75 women receiving the regular milk distributed by the National Complementary Feeding Program (PNAC), consisting of whole milk powder (26% fat) fortified with Fe, Zn, and Vitamin C. Evaluation included acceptability tests, tolerance, and intake of both milks, and measurements were performed at two moments during pregnancy, and after two months of lactation. Both milks had good evaluations in their organoleptic characteristies. Average intake for both groups was 1.8 +/- 1 cup per day, lower than the three cups per day that were originally defined for the study. During pregnancy, sensory evaluation was better, and intake was higher, than with the regular whole milk, although these differences were not significant from a biological standpoint. During lactation, there were no differences among any of the evaluated parameters. The developed milk drink constitutes a good alternative for improving DHA intake during pregnancy and lactation.

Calidad de las espirometrías en un estudio epidemiológico de terreno: Factores determinantes de la necesidad de repetir el examen en el estudio Platino-Chile / Spirometries in a population based study: factors determining the need of test repetition, in Chile's Platino study

Spirometry, the most used test to evaluate pulmonary function, is only occasionally measured in field epidemiological studies. Our aim was to determine which of the following factors in the Platino study can be associated low quality spirometries in the first session: sex, age, socioeconomic level, educational level, body mass index, cold chill, smoking, operating technician, date and subject's previous spirometric experience. 1.168 individuals were evaluated with spirometry. Fifteen nurses and 1 midwife were trained according to NIOSCH standards. Easy One NDD spirometers were used. 1.037 subjects (88.8 percent) performed a satisfactory spirometry in the first session, and 131 (11.2 percent) failed to do so. Only two significant predictors of this failure were identified: age and educational level. Causes for test repetition were 1) Non satisfactory acceptability (77.1 percent); 2) lack of reproducibility (67.9 percent); 3) decline of post bronchodilator CVF without concomitant change in VEF1 (36.6 percent). Eighty nine of the 131 subjects accepted to repeat the test. A satisfactory spirometry was obtained in 79 subjects. Hence, at the end of the study 95.5 percent of the subjects attained a satisfactory test. We conclude that personnel without experience, with appropriate training, can perform high quality field spirometries. Acceptability and repoducibility were the most sensitive factors associated with a bad performance of spirometry. Age and schooling were the main factors related with a low quality spirometry. No association was detected regarding technician as a predictor of low quality spirometries carried out in a population setting.

La espirometría es el examen más utilizado para evaluar la función pulmonar y ocasionalmente se usa en estudios epidemiológicos. Evaluamos si las variables: sexo, edad, nivel socioeconómico, escolaridad, IMC, cursar concomitantemente con resfrío, tabaquismo, fecha del examen, haberse efectuado espirometría anteriormente y técnico responsable, se asociaban con la probabilidad de espirometrías insatisfactorias en una primera sesión. Quince enfermeras y una matrona que recibieron capacitación realizaron las espirometrías en 1.168 sujetos empleando un espirómetro Easy One NDD. En la primera sesión 1.037 individuos (88,8 por ciento) efectuaron una espirometría satisfactoria fracasando 131 (11,2 por ciento). Se identificaron dos variables predictoras del fracaso: edad y años de instrucción. Las causas más frecuentes de espirometrías insatisfactorias fueron: 1) No cumplir con criterios de aceptabilidad (77,1 por ciento); 2) Falta de reproducibilidad (67,9 por ciento); 3) Caída de CVF post broncodilatador sin cambio en el VEF1 (36,6 por ciento). De los 131 sujetos cuya espirometría fue insatisfactoria en la primera sesión, ochenta y nueve aceptaron repetirla, lográndose al final del estudio una espirometría satisfactoria en el 95,5 por ciento de la muestra. Personal técnico sin experiencia previa y adecuadamente entrenado, es capaz de lograr espirometrías de buena calidad en un estudio epidemiológico de campo. Las causas más frecuentes de repetición de examen guardan relación con dificultad de alcanzar criterios de aceptabilidad y reproducibilidad de la prueba. Factores gravitantes en la repetición son la edad y el nivel de instrucción de los sujetos examinados. El desempeño de los técnicos no constituyó un factor limitante para obtener una adecuada calidad de la espirometría en terreno.

Factores que determinan la selección de alimentos en familias de sectores populares / Factors which determine food choice in poor families

Objetivo: Analizar los factores que determinan la selección de alimentos en familias pobres de 3 comunas de Santiago. Metodología: Encuesta en 150 familias atendidas por la Fundación Rodelillo respecto a estructura familiar, ingresos, alimentación y motivaciones para seleccionar alimentos. Se clasificó el NSE según línea de pobreza de MIDEPLAN. Resultados: el 41 por ciento de las familias eran indigentes, el 42 por ciento pobres no indigentes y el 17 por ciento no pobres. El ingreso promedio per cápita fue $26.200 ñ 15.760 y el 55,9 ñ 24,6 por ciento de los ingresos se destinaba a alimentación. El 27 por ciento había recibido infor mación sobre alimentación en el colegio y el 37 por ciento en el consultorio, especialmente por dietoterapia. Las guías y la pirámide alimentaria eran conocidas por el 4 y 26 por ciento de las madres respectivamente. Sobre el 80 por ciento de las familias consumía bebidas gaseosas y golosinas. Los principales factores para seleccionar los alimentos fueron: económicos, preferencias sensoriales, comodidad, mejor alimentación familiar o mejor crecimiento de los hijos. En las familias pobres la razón económica tuvo mayor importancia (84,6 por ciento) y disminuyó la motivación por mejorar alimentación (8,3 por ciento) y por preferencias sensoriales (7,1 por ciento) (p <0,05). Conclusiones: Un bajo porcentaje de estas madres conoce las guías y pirámide alimentaria. La principal razón para seleccionar los alimentos en estas familias son los factores económicos. Aún en estas condiciones tan adversas sería posible orientar una mejor selección de alimentos con educación alimentaria