[Dietary and physical activity practices and preferences in children: An approach from school parliaments in educational public establishments]. / Prácticas y preferencias alimentarias y de actividad física en niños y niñas: Una aproximación desde los Parlamentos Escolares en establecimientos educacionales.

In Chile, overnutrition continues to increase, especially affecting children. Solving this public health problem requires the development of promotion and prevention strategies that consider the suggestions of the communities, especially those of the children themselves. OBJECTIVE: To know the opinions and suggestions of third and fourth-grade children from schools in the southern area of Santiago, Chile, regarding their eating practices and physical activity, as part of the FONDEF IT 1810016 project. SUBJECTS AND METHOD: Seven School Meetings were held in seven schools using a participatory qualitative methodology, collecting the opinions of 176 children regarding both their food and physical activity habits and preferences. RESULTS: The most consumed and preferred foods are those easy to prepare and highly available, such as bread, pasta, and milk. Foods that require preparation or are less available, such as fish, legumes, fruits, vegetables, and homemade preparations, are less consumed and have less preference. Regarding physical activities, video games and soccer stand out. Students propose increasing the hours of physical education and recesses and improving the availability and access to healthy foods in school environments as a solution strategy. CONCLUSIONS: School Meetings as a participatory strategy contribute to the joint generation of knowledge. The need to include communities as participants in health initiatives recognizes, through their role, children as subjects of rights.

Association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children.

Introduction: Objectives: the present study examined the association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children. Methods: this cross-sectional study included 1078 Chilean children (mean age: 9.1 years [standard deviation: 1.1]; 598 boys). Physical activity was evaluated using the Physical Activity Questionnaire for Older Children. Upper and lower limb strength was evaluated using a digital dynamometer and standing long jump performance, respectively. The general strength index was calculated based on z-score values. Obesity indicators used were height, weight, body mass index, and body fat. The self-concept test was used to determine the academic, social, emotional, family, physical self-concept dimensions and total self-concept of children. Results: the mean total self-concept was 3.3 (standard deviation: 0.5). Physical activity was associated with academic (ß: 0.32; p = 0.03), social (ß: 0.24; p = 0.04), family (ß: 0.13; p = 0.01), physical (ß: 0.46; p = 0.01) self-concept dimensions and total self-concept (ß: 0.22; p = 0.01), regardless of sex and age. Upper limb strength and general strength index were negatively associated with academic self-concept dimensions (ß: -0.02; p = 0.01 and ß: -0.13; p = 0.02) and total self-concept (ß: -0.04; p = 0.01). Body weight and body mass index were negatively associated with academic (ß: -0.01; p = 0.01 and ß: -0.01; p = 0.02) and physical self-concept dimensions (ß: -0.03; p = 0.03). Conclusions: these findings suggest that physical activity is positively related with self-concept. Thus, physical activity and self-percept must be considered as an essential social cognitive perspective to provide suitable mental health in children.

Introducción: Objetivos: el presente estudio examinó la asociación de indicadores de actividad física, fuerza muscular y obesidad con el autoconcepto en niños chilenos. Métodos: este estudio transversal incluyó a 1078 niños chilenos (edad media: 9,1 años [desviación estándar: 1,1]; 598 niños). La actividad física se evaluó mediante el Physical Activity Questionnaire for Older Children. La fuerza de los miembros superiores e inferiores se evaluó utilizando un dinamómetro digital y el rendimiento en salto de longitud de pie. El índice de fuerza general se calculó en base a los valores de z-score. Los indicadores de obesidad utilizados fueron altura, peso, índice de masa corporal y grasa corporal. Se utilizó el test de autoconcepto para determinar las dimensiones académicas, social, emocional, familiar, físico y autoconcepto total. Resultados: la muestra total presento un autoconcepto promedio de 3,3 (desviación estándar: 0,5). La actividad física se asocio con autoconcepto académico (ß: 0,32; p = 0,03), social (ß: 0,24; p = 0,04), familiar (ß: 0,13; p = 0,01), físico (ß: 0,46; p = 0,01) y total (ß: 0,22; p = 0,01). La fuerza muscular de miembros superiores y el índice general de fuerza se asociaran negativamente con al autoconcepto académico (ß: -0,02; p = 0,01 y ß: -0,13; p = 0,02) y total (ß: -0,04; p = 0,01). Mientras que el peso corporal e índice de masa corporal se asociaron negativamente con autoconcepto académico (ß: -0,01; p = 0,01 y ß: -0,01; p = 0,02) y físico (ß: -0,03; p = 0,03). Conclusiones: estos hallazgos sugieren que la actividad física se relaciona positivamente con el autoconcepto. Así, la actividad física y la autopercepción deben ser consideradas como una perspectiva cognitiva social imprescindible para proporcionar una adecuada salud mental en los niños.

Association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children / Asociación de indicadores de actividad física, fuerza muscular y obesidad con el autoconcepto en niños chilenos

Objectives: the present study examined the association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children.Methods: this cross-sectional study included 1078 Chilean children (mean age: 9.1 years [standard deviation: 1.1]; 598 boys). Physical activity was evaluated using the Physical Activity Questionnaire for Older Children. Upper and lower limb strength was evaluated using a digital dynamometer and standing long jump performance, respectively. The general strength index was calculated based on z-score values. Obesity indicators used were height, weight, body mass index, and body fat. The self-concept test was used to determine the academic, social, emotional, family, physical self-concept dimensions and total self-concept of children. Results: the mean total self-concept was 3.3 (standard deviation: 0.5). Physical activity was associated with academic (β: 0.32; p = 0.03), social (β: 0.24; p = 0.04), family (β: 0.13; p = 0.01), physical (β: 0.46; p = 0.01) self-concept dimensions and total self-concept (β: 0.22; p = 0.01), regardless of sex and age. Upper limb strength and general strength index were negatively associated with academic self-concept dimensions (β: -0.02; p = 0.01 and β: -0.13; p = 0.02) and total self-concept (β: -0.04; p = 0.01). Body weight and body mass index were negatively associated with academic (β: -0.01; p = 0.01 and β: -0.01; p = 0.02) and physical self-concept dimensions (β: -0.03; p = 0.03). Conclusions: these findings suggest that physical activity is positively related with self-concept. Thus, physical activity and self-percept must be considered as an essential social cognitive perspective to provide suitable mental health in children. (AU)

Objetivos: el presente estudio examinó la asociación de indicadores de actividad física, fuerza muscular y obesidad con el autoconcepto en niños chilenos. Métodos: este estudio transversal incluyó a 1078 niños chilenos (edad media: 9,1 años [desviación estándar: 1,1]; 598 niños). La actividad física se evaluó mediante el Physical Activity Questionnaire for Older Children. La fuerza de los miembros superiores e inferiores se evaluó utilizando un dinamómetro digital y el rendimiento en salto de longitud de pie. El índice de fuerza general se calculó en base a los valores de z-score. Los indicadores de obesidad utilizados fueron altura, peso, índice de masa corporal y grasa corporal. Se utilizó el test de autoconcepto para determinar las dimensiones académicas, social, emocional, familiar, físico y autoconcepto total. Resultados: la muestra total presento un autoconcepto promedio de 3,3 (desviación estándar: 0,5). La actividad física se asocio con autoconcepto académico (β: 0,32; p = 0,03), social (β: 0,24; p = 0,04), familiar (β: 0,13; p = 0,01), físico (β: 0,46; p = 0,01) y total (β: 0,22; p = 0,01). La fuerza muscular de miembros superiores y el índice general de fuerza se asociaran negativamente con al autoconcepto académico (β: -0,02; p = 0,01 y β: -0,13; p = 0,02) y total (β: -0,04; p = 0,01). Mientras que el peso corporal e índice de masa corporal se asociaron negativamente con autoconcepto académico (β: -0,01; p = 0,01 y β: -0,01; p = 0,02) y físico (β: -0,03; p = 0,03). Conclusiones: estos hallazgos sugieren que la actividad física se relaciona positivamente con el autoconcepto. Así, la actividad física y la autopercepción deben ser consideradas como una perspectiva cognitiva social imprescindible para proporcionar una adecuada salud mental en los niños. (AU)

[Effects of COVID-19 pandemic on food insecurity perception in Chilean households]. / Inseguridad alimentaria y hábitos alimentarios durante la pandemia de COVID-19 en hogares chilenos.

BACKGROUND: The coronavirus 2 pandemic (COVID-19) has caused intense changes in lifestyles, feeding, and nutrition habits. AIM: To analyze food insecurity and eating habits during the period of quarantine in a group of Chilean individuals. MATERIAL AND METHODS: An online survey was conducted in 2,767 households with questions about the sociodemographic composition of the household, household food purchasing habits in the quarantine period for COVID-19, and perception of food insecurity. RESULTS: More than 60% of households (p < 0.01) were worried about not having enough food, especially when children under 18 years of age lived in them. This perception increased in urban households (p < 0.01) and those located in the Central-Southern and Southern regions (p < 0.01). During the pandemic, the consumption of healthy products such as milk increased in 50% of households, legumes in 72%, eggs in 79%, fruits in 54%, vegetables in 67% and water in 81%. There was also a lower consumption of unhealthy and ultra-processed foods such as hot-dogs in 90% of households, sausages in 73%, sugary drinks in 79% and ice cream in 83%. CONCLUSIONS: The COVID-19 pandemic in Chile increased the perception of food insecurity in households with vulnerable conditions. However, the consumption of healthier foods increased.

Inseguridad alimentaria y hábitos alimentarios durante la pandemia de COVID-19 en hogares chilenos / Effects of COVID-19 pandemic on food insecurity perception in Chilean households

Background: The coronavirus 2 pandemic (COVID-19) has caused intense changes in lifestyles, feeding, and nutrition habits. Aim: To analyze food insecurity and eating habits during the period of quarantine in a group of Chilean individuals. Material and Methods: An online survey was conducted in 2,767 households with questions about the sociodemographic composition of the household, household food purchasing habits in the quarantine period for COVID-19, and perception of food insecurity. Results: More than 60% of households (p < 0.01) were worried about not having enough food, especially when children under 18 years of age lived in them. This perception increased in urban households (p < 0.01) and those located in the Central-Southern and Southern regions (p < 0.01). During the pandemic, the consumption of healthy products such as milk increased in 50% of households, legumes in 72%, eggs in 79%, fruits in 54%, vegetables in 67% and water in 81%. There was also a lower consumption of unhealthy and ultra-processed foods such as hot-dogs in 90% of households, sausages in 73%, sugary drinks in 79% and ice cream in 83%. Conclusions: The COVID-19 pandemic in Chile increased the perception of food insecurity in households with vulnerable conditions. However, the consumption of healthier foods increased.

Lifestyle Habits and Health Indicators in Migrants and Native Schoolchildren in Chile.

In Chile, the migrant population has increased in the last years. Migrants adopt behaviors of this new culture, which can have an effect on their health. Contradictory results regarding differences between migrant and native children have been reported. The aim of this study was to explore the associations between nationality with health indicator and lifestyle habits among schoolchildren in Chile. A cross-sectional and observational study with a non-probabilistic sample was conducted in 1033 children (86.4% Chilean and 13.6% migrant) from second to fourth grade of seven public schools from low-income municipalities from the Metropolitan Region, Chile. Anthropometric measurements (weight, height, waist circumference, triceps and subscapular folds), handgrip strength, and standing long jump measurements, physical activity, self-esteem and food guidelines accomplishments were determined. Migrant children presented lower body mass index (BMI), Z-BMI, body fat% and waist circumference values; and higher handgrip strength, standing long jump, and more satisfactory compliance with food guidelines than natives (p < 0.05). No significant difference for physical activity and self-esteem was observed. In the adjusted models, migrants presented lower odds for overweight/obesity, risk of abdominal obesity, low handgrip strength and unsatisfactory food guidelines accomplishment in all models (p < 0.05). The nutritional and muscular fitness of migrant children was better than that of the Chilean ones.

Muscular Strength of Upper and Lower Limbs and Self-Esteem in Chilean SchoolChildren: Independent Associations with Body Composition Indicators.

The aim of this study was to analyze the relationship between muscular strength from upper and lower limbs with self-esteem among Chilean schoolchildren, drawing independent associations with body composition indicators. The sample consisted of 1078 schoolchildren. The muscular strength of the upper and lower limbs was evaluated using a digital dynamometer and long jump performance. The general strength index was calculated based on Z-score values. Rosenberg's test was used to determine the level of self-esteem of participants. Body fat and body mass index were employed as body composition indicators. Boys had significantly more upper and lower strength, and a general strength index higher than girls (11.7 vs. 10.6; 109.7 vs. 97.4; 0.19 vs. -0.24, respectively). For boys and girls combined, there were no significant associations between all muscular strength variables and self-esteem. In boys, upper and lower limb strength was positively associated with self-esteem. In girls, no association between muscular strength and self-esteem was found. In both sexes, the general strength index was not associated with self-esteem. Strategies and programs that promote mental health and muscular strength among schoolchildren, specifically in boys, are needed.

Implementing a Food Labeling and Marketing Law in Chile.

In 2012, Chile passed a law intended to reduce obesity in the country. It included several novel features, such as a front-of-package label, limitations to marketing and advertising, and policies targeting schools. The law required the creation of a regulation to address its implementation. Between 2012 and 2015, a process was carried out to generate this regulation that finally came into force in June 2016. This process confronted several difficulties: the involvement of multiple actors, political changes in national government, and endless negotiations to define the operational details of the regulation. The end result was one of the most discussed health policies of recent years in Chile. This article tells the story of the process defining this regulation, carried out between 2012 and 2015. It describes its evolution from a legal perspective but also reveals the trade-offs faced by the team in charge of providing the operational definitions for the implementation of the law. The article presents the main challenges as well the strategies used by the team at the Ministry of Health to overcome the many difficulties that arose during the process of implementing Chile's food labeling and marketing law. The experience of the Chilean reform may provide practical information and lessons for other countries and policy makers embarking on the task of preventing and reducing obesity. Although the Chilean experience has its own particularities, it also suggests common difficulties for similar reform processes in terms of technical challenges-such as the definition of concepts and the scope of regulation-and political challenges-like the opposition of the food industry and conflicts of interest among governmental institutions.

Using evidence-informed policies to tackle overweight and obesity in Chile

[ABSTRACT]. Overweight and obesity are a global epidemic with rates having risen to alarming levels in both developed and developing countries. Chile has been no exemption, with sharp increases in obesity prevalence, especially among school-age children. This paper describes the policy actions and strategies implemented to tackle this major public health concern in Chile over the last 10 years, and highlights the main challenges and nuances of the process. Chile has taken policy action that includes front-of-package labelling, advertising regulations, and school-food restrictions. New policies focus on the social determinants of health as they relate to food environments and people’s behavior. These actions are not only suitable to the current context in Chile, but are also supported by the best available scientific evidence. Moreover, the implementation of these policies has produced a broad debate involving public institutions and the food industry, with discussions issues ranging from property rights to trade barriers. Despite some differences among stakeholders, a valuable political consensus has been achieved, and several international organizations are eager to evaluate the impact of these pioneer initiatives in Latin America.

[RESUMEN]. El sobrepeso y la obesidad son una epidemia mundial, en la que se registran tasas que han aumentado hasta niveles alarmantes tanto en los países desarrollados como en los países en desarrollo. Chile no ha sido una excepción, con aumentos pronunciados de la prevalencia de la obesidad, especialmente en los niños en edad escolar. En este documento se describen las políticas y estrategias aplicadas para luchar contra este grave problema de salud pública en Chile durante los 10 últimos años, y se resaltan los principales retos y matices del proceso. Chile ha tomado medidas de política que incluyen el etiquetado frontal de los envases, la reglamentación de la publicidad y restricciones en cuanto a la alimentación en las escuelas. Las nuevas políticas se centran en los determinantes sociales de la salud pues guardan relación con el entorno en cuanto a la alimentación y el comportamiento de las personas. Estas medidas no solo son apropiadas para el contexto actual de Chile, sino que también se basan en las mejores pruebas científicas de que se dispone. Por otro lado, la aplicación de estas políticas ha generado un amplio debate con las instituciones públicas y la industria alimentaria, cuyos temas de discusión abarcan desde derechos de propiedad hasta barreras comerciales. A pesar de algunas diferencias entre los interesados directos, se ha logrado un valioso consenso político y varias organizaciones internacionales están dispuestas a evaluar la repercusión de estas iniciativas pioneras en América Latina.

[RESUMO]. O sobrepeso e a obesidade constituem uma epidemia global atingindo níveis alarmantes nos países desenvolvidos e em desenvolvimento. O Chile não é exceção: o país tem registrado uma elevação acentuada da prevalência de obesidade, sobretudo em crianças em idade escolar. Este artigo descreve as medidas envolvendo políticas e estratégias implantadas no Chile na última década para combater este importante problema de saúde pública e destaca os principais desafios e as particularidades do processo. O país adotou políticas para rotulagem nutricional na parte da frente da embalagem dos produtos alimentícios, regulamentação da publicidade e restrições aos alimentos servidos em escolas. As novas políticas são direcionadas aos determinantes sociais da saúde por estarem associados aos ambientes e aos comportamentos alimentares da população. Além de serem adaptadas ao contexto atual do Chile, estas medidas se embasam nas melhores evidências científicas. A execução destas políticas deu início a um amplo debate entre as instituições públicas e a indústria de produtos alimentícios envolvendo de questões sobre direitos de propriedade às barreiras comerciais. Apesar das suas posições divergentes sobre alguns aspectos, os interessados diretos chegaram a um consenso político importante. As organizações internacionais esperam agora conhecer o resultado da avaliação do impacto dessas iniciativas pioneiras na América Latina.

Using evidence-informed policies to tackle overweight and obesity in Chile.

Overweight and obesity are a global epidemic with rates having risen to alarming levels in both developed and developing countries. Chile has been no exemption, with sharp increases in obesity prevalence, especially among school-age children. This paper describes the policy actions and strategies implemented to tackle this major public health concern in Chile over the last 10 years, and highlights the main challenges and nuances of the process. Chile has taken policy action that includes front-of-package labelling, advertising regulations, and school-food restrictions. New policies focus on the social determinants of health as they relate to food environments and people's behavior. These actions are not only suitable to the current context in Chile, but are also supported by the best available scientific evidence. Moreover, the implementation of these policies has produced a broad debate involving public institutions and the food industry, with discussions issues ranging from property rights to trade barriers. Despite some differences among stakeholders, a valuable political consensus has been achieved, and several international organizations are eager to evaluate the impact of these pioneer initiatives in Latin America.

El sobrepeso y la obesidad son una epidemia mundial, en la que se registran tasas que han aumentado hasta niveles alarmantes tanto en los países desarrollados como en los países en desarrollo. Chile no ha sido una excepción, con aumentos pronunciados de la prevalencia de la obesidad, especialmente en los niños en edad escolar. En este documento se describen las políticas y estrategias aplicadas para luchar contra este grave problema de salud pública en Chile durante los 10 últimos años, y se resaltan los principales retos y matices del proceso. Chile ha tomado medidas de política que incluyen el etiquetado frontal de los envases, la reglamentación de la publicidad y restricciones en cuanto a la alimentación en las escuelas. Las nuevas políticas se centran en los determinantes sociales de la salud pues guardan relación con el entorno en cuanto a la alimentación y el comportamiento de las personas. Estas medidas no solo son apropiadas para el contexto actual de Chile, sino que también se basan en las mejores pruebas científicas de que se dispone. Por otro lado, la aplicación de estas políticas ha generado un amplio debate con las instituciones públicas y la industria alimentaria, cuyos temas de discusión abarcan desde derechos de propiedad hasta barreras comerciales. A pesar de algunas diferencias entre los interesados directos, se ha logrado un valioso consenso político y varias organizaciones internacionales están dispuestas a evaluar la repercusión de estas iniciativas pioneras en América Latina.

O sobrepeso e a obesidade constituem uma epidemia global atingindo níveis alarmantes nos países desenvolvidos e em desenvolvimento. O Chile não é exceção: o país tem registrado uma elevação acentuada da prevalência de obesidade, sobretudo em crianças em idade escolar. Este artigo descreve as medidas envolvendo políticas e estratégias implantadas no Chile na última década para combater este importante problema de saúde pública e destaca os principais desafios e as particularidades do processo. O país adotou políticas para rotulagem nutricional na parte da frente da embalagem dos produtos alimentícios, regulamentação da publicidade e restrições aos alimentos servidos em escolas. As novas políticas são direcionadas aos determinantes sociais da saúde por estarem associados aos ambientes e aos comportamentos alimentares da população. Além de serem adaptadas ao contexto atual do Chile, estas medidas se embasam nas melhores evidências científicas. A execução destas políticas deu início a um amplo debate entre as instituições públicas e a indústria de produtos alimentícios envolvendo de questões sobre direitos de propriedade às barreiras comerciais. Apesar das suas posições divergentes sobre alguns aspectos, os interessados diretos chegaram a um consenso político importante. As organizações internacionais esperam agora conhecer o resultado da avaliação do impacto dessas iniciativas pioneiras na América Latina.

Using evidence-informed policies to tackle overweight and obesity in Chile

Overweight and obesity are a global epidemic with rates having risen to alarming levels in both developed and developing countries. Chile has been no exemption, with sharp increases in obesity prevalence, especially among school-age children. This paper describes the policy actions and strategies implemented to tackle this major public health concern in Chile over the last 10 years, and highlights the main challenges and nuances of the process. Chile has taken policy action that includes front-of-package labelling, advertising regulations, and school-food restrictions. New policies focus on the social determinants of health as they relate to food environments and people's behavior. These actions are not only suitable to the current context in Chile, but are also supported by the best available scientific evidence. Moreover, the implementation of these policies has produced a broad debate involving public institutions and the food industry, with discussions issues ranging from property rights to trade barriers. Despite some differences among stakeholders, a valuable political consensus has been achieved, and several international organizations are eager to evaluate the impact of these pioneer initiatives in Latin America.

Does the association between birth weight and blood pressure increase with age? A longitudinal study in young adults.

OBJECTIVES: To assess whether the association between birth weight and blood pressure (BP) increases with age using three different statistical methods. METHODS: A representative sample of 1232 study participants born between 1974-1978 in Limache, Chile were assessed in 2000-2002, of whom 796 were reassessed in 2010-2012. An 'amplification effect' was assessed by the change in the ß coefficient in the two periods, the association between birth weight and the difference of BP overtime, and the interaction between birth weight and BP in the two periods. RESULTS: Birth weight was negatively associated with SBP in 2000-2002 (ß = -2.46, 95% confidence interval (CI) -3.77 to -1.16) and in 2010-2012 (ß = -3.64, 95% CI -5.20 to -2.08), and with DBP in 2000-2002 (ß = -1.26, 95% CI -2.23 to -0.29) , and 2010-2012 (ß = -1.64, 95% CI -2.84 to -0.45) after adjustment for sex, physical activity, and BMI. There was no association between birth weight and the difference in BP between the two periods or the interaction between birth weight, BP, and time interval. CONCLUSION: Birth weight is a factor associated with BP in adults. This association increased with age, but amplification was shown only with one of the three methods.

Chilean complementary feeding program reduces anemia and improves iron status in children aged 11 to 18 months.

BACKGROUND: Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age. OBJECTIVE: To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months. METHODS: Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 (n = 128) and 2000 (n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample (n = 320) from the two most populated areas of the country was performed in 2009. RESULTS: One year after fortification, the prevalence of anemia was 9%; significantly lower (p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower (p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration (r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96). CONCLUSIONS: In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.

Protección social en los programas alimentarios del Ministerio de Salud de Chile / Welfare food programs in the Ministry of Health of Chile

Los programas alimentarios existen en Chile desde hace más de medio siglo, se han desarrollado como parte de las políticas de protección de la salud, especialmente de los grupos más desprotegidos como fueron al principio el binomio materno infantil, y últimamente los adultos mayores. Uno de los propósitos fundamentales ha sido mantener y o mejorar el estado nutricional de estos grupos, en la actualidad se ha agregado, la disminución de los riesgos de contraer enfermedades crónicas no transmisibles asociadas a la alimentación y el sedentarismo. El Programa Nacional de Alimentación Complementaria PNAC, constituye un beneficio gratuito universal, establecido por ley, para todos(as) los niños(as) y embarazadas del país, sin dependencia de su condición previsional de salud. Estos programas integran la política de estado de protección de la salud y desarrollo integral de la población materno infantil y se han adaptado a los cambios epidemiológicos y demográficos, y a los avances en los conocimientos científico-tecnológicos del área alimentario-nutricional. Desde 9 y 5 años atrás se sumaron como beneficiarios, los adultos mayores, y los prematuros extremos y fenilcetonúricos respectivamente. Actualmente los programas alimentarios del Ministerio de Salud, el PNAC como integrante de la estrategia de intervención nutricional en el ciclo vital y el Programa de Alimentación Complementaria del Adulto Mayor PACAM siendo parte de actividades como promoción de envejecimiento saludable, componen la más significativa intervención alimentario-nutricional en Chile, contribución fundamental a la consecución de las metas sanitarias del país.

Food programs have existed in Chile since over half a century, they have been developed as part of the health protection policies, specially for the more vulnerable groups, regarding, initially the mother and child binomial and lately, the senior citizens. One of the main objectives has been to maintain and/or improve the nutritional state of these groups and currently, the decrease of the risk of developing non communicable chronic diseases associated to diet and a sedentary lifestyle has been added. The National Programs of Complementary Food (PNAC) is a free universal benefit, established by law for all children and pregnant women in the country, independent of their health insurance system. This programme integrates the State’s health protection policy and the comprehensive development of the mother and child population and has been adapted to the epidemiological and demographical changes as well as to the progress in the scientific-technological knowledge in the area of food and nutrition. Nine years ago, the senior citizens (the elderly) were added and since 2003, the extreme premature babies and those with Phenylketonuric.Nowadays the Food Programs of the Ministry of Health, (PNAC) as part of the nutritional intervention strategy throughout the life cycle and the Programs of Complementary Food for Seniors (PACAM) which forms part of the activities of healthy aging promotion, compose one of the most signifi cant feeding nutritional intervention in Chile which is a fundamental contribution to achieve the country’s sanitary goals.

[A proposal of guidelines for surgical management of obesity]. / Propuesta y fundamentos para una norma de manejo quirúrgico del paciente obeso: año 2004.

Obesity is a chronic disease with an increasing prevalence in all groups of age, and is associated to increased general mortality and cardiovascular risk. The multidisciplinary non surgical approach must be the treatment of choice for obese subjects. However, the results of such approach among subjects with severe or morbid obesity, are unsatisfactory. In this group of patients, bariatric surgery and specifically gastric bypass achieves good long term results, maintaining a low body mass index, reducing complications and improving quality of life. Considering the widespread practice of bariatric surgery in Chile, the Nutrition Unit of the Ministry of Health formed a task force to propose update guidelines for the surgical treatment of obesity. These guidelines were proposed after a thorough literature review and discussion with groups that practice bariatric surgery using defined protocols. This document provides a summarized version of the guidelines. The first section discusses the background for bariatric surgery and the second part give specific recommendations for patient management and the formation of reference centers for surgical management of obesity.

Programas de suplementación alimentaria y de fortificación de alimentos con micronutrientes en Chile / Programs of nutritional supplementation and micronutrient enrichment of foods in Chile

Los programas de suplementación alimentaria y de fortificación de alimentos en Chile datan de principios de siglo pasado. Estos programas han sufrido adecuaciones permanentes en el tiempo, adaptándose a los cambios epidemiológicos de nuestra población. Los programas vigentes hoy involucran a la población infantil, a las embarazadas, a los adultos mayores y a algunos grupos específicos de alto riesgo. El objetivo principal de todos los programas continúa siendo mantener óptimo el estado nutricional de nuestra población. Entre los logros más importantes se cuenta la disminución de grandes problemas de salud pública como lo son la desnutrición infantil, la anemia del lactante, la desnutrición de la embarazada, el bocio endémico y otros logros más recientes como la disminución de la prevalencia de las enfermedades del tubo neural y mejoría del estado nutricional y de la funcionalidad del adulto mayor. Como desafíos futuros se plantea continuar optimizando estos programas en cuanto a cobertura poblacional, calidad de productos según nuevas necesidades y según requerimientos especiales, y contribuir a la reducción de la obesidad y de la prevalencia de las enfermedades crónicas no transmisibles del adulto.

[Admission diagnosis and nutritional evolution of the beneficiaries of "Corporación para la Nutrición Infantil-CONIN"]. / Diagnóstico de ingreso y evolución nutricional de los beneficiarios de la Corporación para la Nutrición Infantil (CONIN).

BACKGROUND: The nutritional impact of CONIN nutritional recovery centers must be evaluated, considering the current epidemiological situation in Chile and the new therapeutic focus giving more emphasis to ambulatory treatment. AIM: To analyze the nutritional status of children treated at traditional CONIN centers, the reason for their admission and the factors associated with changes of weight for age index during the hospitalization. PATIENTS AND METHODS: During the year 2000, the records of 561 patients discharged from the traditional CONIN centers throughout the country were retrospectively analyzed. The changes in weight and height during admission and the possible factors influencing these changes, were determined. RESULTS: The average lapse of stay was 3.9 months; 78% of children had concomitant diseases at admission and 18.7% required to be admitted in a general hospital. One third was admitted with normal weight or even overweight according to the weight for age index, and 31.1% was undernourished. During admission in CONIN, the number of undernourished patients was reduced by 50%, while the proportion of children with normal nutritional status increased by 15% (p < 0.001). On admission, 7.8% of children had a low height for age, evidencing a chronic undernutrition. This figure did not change on discharge. The increase of weight/age and weight/height was substantially higher in children with a greater initial deficit (p < 0.001). CONCLUSIONS: Admission to a CONIN center had a low nutritional impact, and a high risk of a lengthy stay. The most favorable impact could be appreciated in children that were effectively undernourished. Admissions are motivated mainly by social issues, over and above nutritional problems.