Índice de riesgo de obesidad infantil (IROBIC) para áreas administrativas pequeñas en Chile / Childhood obesity risk index (IROBIC) for small administrative areas in Chile

Introducción: a pesar de la alta prevalencia de la obesidad infantil (OI) globalmente, no existen índices compuestos para estimar los aspectos territoriales asociados al riesgo de OI. Objetivo: elaborar un índice de riesgo de OI (IROBIC) para unidades administrativas pequeñas (comunas) de Chile Métodos: se utilizaron datos de 2019 de fuentes públicas con información de menores de 10 años de todas las comunas de las 2 regiones más grandes. El IROBIC incluye 16 indicadores estandarizados por comuna y agrupados en cuatro dimensiones, determinadas por análisis de componentes principales (salud, socio económica, entornos comunal y educacional). Se determinó el IROBIC mediante una media geométrica ponderada y posteriormente se calcularon las diferencias entre las 10 y 5 comunas con mayores y menores IROBIC y de cada dimensión, con el coeficiente de disparidad Resultados: aun cuando los mayores IROBIC se obtuvieran en comunas más vulnerables, su valor total y el de cada dimensión, mostraron que es posible amortiguar los efectos de la desigualdad sobre la OI. Las 10 y 5 comunas con mayor IROBIC presentan un riesgo, 2,41 y 4,05 veces mayor que las de menor valor, respectivamente. Conclusiones: el IROBIC puede monitorear el riesgo de OI —y factores asociados— desde una perspectiva territorial. (AU)

Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called “comunas” in Chile Methods: we used 2019 data from public sources on children under 10 years living in “comunas” of the two largest regions. IROBIC includes 16 indicators standardized for each “comuna” and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 “comunas” with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest “comunas” having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 “comunas” with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective. (AU)

Validity of the neck circumference for the diagnosis of obesity in school children living at high altitude / Validez de la circunferencia del cuello para el diagnóstico de obesidad en escolares que viven en altura

Background: body mass index (BMI) is commonly used to diagnose overweight and obesity, and waist circumference (WC) is used to estimate visceral fat. The measurement of WC is demanding, therefore, different studies proposed the use of neck perimeter. Objective: exploring diagnostic validity of neck perimeter to diagnose overweight and obesity in 10-12 years old children in La Paz (Bolivia). Methods: this is a cross-sectional study with a random sample of school children in El Alto (Bolivia). Weight, height, abdominal circumference and neck perimeter were measured, classifying the nutritional status with BMI-z according to the cut-off point of the World Health Organization (WHO) classification. The sample size was calculated for 95 % confidence level, an alpha level of 0.05 and 80 % power for diagnosis test design. To evaluate neck perimeter validity for diagnosing obesity, sensibility, specificity and positive and negative ratio likelihood were calculated using BMI gold standard according to age and sex. Results: a number of 371 school children between 10-12 years old were included and 34 % of them presented malnutrition by excess. Sensibility and specificity of the neck perimeter to diagnose overweight and obesity were 87.5-100 % and 75.7-86.3 %, respectively. Conclusion: neck perimeter in 10-12-year-old school children is a valid indicator for carrying out obesity diagnosis.(AU)

Introducción: el índice de masa corporal (IMC) se usa comúnmente para diagnosticar el sobrepeso y la obesidad, y la circunferencia de la cintura (CC), para estimar la grasa visceral. La medición de la CC es exigente y, por ello, diferentes estudios propusieron el uso del perímetro del cuello. Objetivo: explorar la validez diagnóstica del perímetro del cuello para diagnosticar sobrepeso y obesidad en niños de 10-12 años en La Paz (Bolivia). Métodos: estudio transversal con una muestra aleatoria de escolares de El Alto (Bolivia). Se midieron peso, talla, circunferencia de la muñeca, perímetro de cuello, clasificando el estado nutricional con IMC-z según el punto de corte de la clasificación de la Organización Mundial de la Salud (OMS). El tamaño de la muestra se calculó para un nivel de confianza del 95 %, un nivel alfa de 0,05 y una potencia del 80 % para el diseño de la prueba de diagnóstico. Para evaluar la validez del perímetro del cuello para el diagnóstico de obesidad, se calcularon la sensibilidad, la especificidad y la razón de verosimilitud positiva y negativa utilizando el patrón oro del IMC según edad y sexo. Resultados: se incluyeron 371 escolares de 10-12 años, de los cuales el 34 % presentaba malnutrición por exceso. La sensibilidad y especificidad del perímetro del cuello para diagnosticar sobrepeso y obesidad estuvo entre 87,5-100 % y 75,7-86,3 %, respectivamente. Conclusión: el perímetro del cuello en escolares de 10-12 años es un indicador válido para realizar el diagnóstico de obesidad.(AU)

[Childhood obesity risk index (IROBIC) for small administrative areas in Chile]. / Índice de riesgo de obesidad infantil (IROBIC) para áreas administrativas pequeñas en Chile.

Introduction: Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called "comunas" in Chile Methods: we used 2019 data from public sources on children under 10 years living in "comunas" of the two largest regions. IROBIC includes 16 indicators standardized for each "comuna" and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 "comunas" with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest "comunas" having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 "comunas" with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective.

Introducción: Introducción: a pesar de la alta prevalencia de la obesidad infantil (OI) globalmente, no existen índices compuestos para estimar los aspectos territoriales asociados al riesgo de OI. Objetivo: elaborar un índice de riesgo de OI (IROBIC) para unidades administrativas pequeñas (comunas) de Chile Métodos: se utilizaron datos de 2019 de fuentes públicas con información de menores de 10 años de todas las comunas de las 2 regiones más grandes. El IROBIC incluye 16 indicadores estandarizados por comuna y agrupados en cuatro dimensiones, determinadas por análisis de componentes principales (salud, socio económica, entornos comunal y educacional). Se determinó el IROBIC mediante una media geométrica ponderada y posteriormente se calcularon las diferencias entre las 10 y 5 comunas con mayores y menores IROBIC y de cada dimensión, con el coeficiente de disparidad Resultados: aun cuando los mayores IROBIC se obtuvieran en comunas más vulnerables, su valor total y el de cada dimensión, mostraron que es posible amortiguar los efectos de la desigualdad sobre la OI. Las 10 y 5 comunas con mayor IROBIC presentan un riesgo, 2,41 y 4,05 veces mayor que las de menor valor, respectivamente. Conclusiones: el IROBIC puede monitorear el riesgo de OI ­y factores asociados­ desde una perspectiva territorial.

Validity of the neck circumference for the diagnosis of obesity in school children living at high altitude.

Introduction: Background: body mass index (BMI) is commonly used to diagnose overweight and obesity, and waist circumference (WC) is used to estimate visceral fat. The measurement of WC is demanding, therefore, different studies proposed the use of neck perimeter. Objective: exploring diagnostic validity of neck perimeter to diagnose overweight and obesity in 10-12 years old children in La Paz (Bolivia). Methods: this is a cross-sectional study with a random sample of school children in El Alto (Bolivia). Weight, height, abdominal circumference and neck perimeter were measured, classifying the nutritional status with BMI-z according to the cut-off point of the World Health Organization (WHO) classification. The sample size was calculated for 95 % confidence level, an alpha level of 0.05 and 80 % power for diagnosis test design. To evaluate neck perimeter validity for diagnosing obesity, sensibility, specificity and positive and negative ratio likelihood were calculated using BMI gold standard according to age and sex. Results: a number of 371 school children between 10-12 years old were included and 34 % of them presented malnutrition by excess. Sensibility and specificity of the neck perimeter to diagnose overweight and obesity were 87.5-100 % and 75.7-86.3 %, respectively. Conclusion: neck perimeter in 10-12-year-old school children is a valid indicator for carrying out obesity diagnosis.

Introducción: Introducción: el índice de masa corporal (IMC) se usa comúnmente para diagnosticar el sobrepeso y la obesidad, y la circunferencia de la cintura (CC), para estimar la grasa visceral. La medición de la CC es exigente y, por ello, diferentes estudios propusieron el uso del perímetro del cuello. Objetivo: explorar la validez diagnóstica del perímetro del cuello para diagnosticar sobrepeso y obesidad en niños de 10-12 años en La Paz (Bolivia). Métodos: estudio transversal con una muestra aleatoria de escolares de El Alto (Bolivia). Se midieron peso, talla, circunferencia abdominal y perímetro de cuello, clasificando el estado nutricional con IMC-z según el punto de corte de la clasificación de la Organización Mundial de la Salud (OMS). El tamaño de la muestra se calculó para un nivel de confianza del 95 %, un nivel alfa de 0,05 y una potencia del 80 % para el diseño de la prueba de diagnóstico. Para evaluar la validez del perímetro del cuello para el diagnóstico de obesidad, se calcularon la sensibilidad, la especificidad y la razón de verosimilitud positiva y negativa utilizando el patrón oro del IMC según edad y sexo. Resultados: se incluyeron 371 escolares de 10-12 años, de los cuales el 34 % presentaba malnutrición por exceso. La sensibilidad y especificidad del perímetro del cuello para diagnosticar sobrepeso y obesidad estuvo entre 87,5-100 % y 75,7-86,3 %, respectivamente. Conclusión: el perímetro del cuello en escolares de 10-12 años es un indicador válido para realizar el diagnóstico de obesidad.

Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago / Riesgo de déficit de vitamina D en niños asmáticos hospitalizados en el área norte de Santiago

Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization. (AU)

Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización. (AU)

Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago.

Introduction: Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization.

Introducción: Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile.

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

El papel de los comedores y merenderos sociales en la alimentación de infancias pertenecientes a familias vulnerables durante la pandemia de COVID-19 en la provincia de Mendoza, Argentina

Objetivo: Caracterizar el papel de comedores y merenderos barriales de Mendoza (Argentina) en la alimentación de infancias vulnerables durante la pandemia y comparar iniciativas gestionadas por movimientos sociales, por agrupaciones vecinales y en espacios gubernamentales. Metodología: Estudio exploratorio cualitativo con base en una muestra intencional de informantes de barrios de Gran Mendoza y Gran San Rafael con inseguridad alimentaria. Se realizaron 16 entrevistas semiestructuradas a referentes sociales, a docentes y a personal de salud entre abril y agosto de 2021. Para analizar la información se utilizó el método de comparación constante. Resultados: Comedores y merenderos difieren en la previsibilidad de recursos para proveer alimentos según sus vinculaciones con las políticas de asistencia alimentaria directa implementadas antes y durante la pandemia. Todos los espacios están a cargo de mujeres, utilizan estrategias similares para adquirir mercaderías y ofrecen preparaciones semejantes contemplando disponibilidad de insumos y preferencias de los comensales. Conclusión: Las iniciativas comunitarias contribuyeron a sostener la alimentación de niños y adolescentes de familias ligadas a la economía informal que recurrieron a ellas en razón de la merma de ingresos por efecto del aislamiento. No se identifican diferencias relevantes en los menús ofrecidos entre comedores y merenderos gestionados por movimientos sociales y en los de tipo autogestivo, vecinal. Las experiencias organizativas de comensalidad barrial, el apoyo de vecinos y relaciones de confianza previamente construidas con donantes externos fueron clave para sostener la entrega de raciones y el cuidado de personas aisladas.

The aims of the study are to characterize the role of various types of community dining centers located in the Argentinian province of Mendoza in feeding vulnerable children during the pandemic and to compare initiatives coming from social movements that facilitate the state's food assistance to the ones managed by self-directed neighborhood associations and those of governmental spaces. The methodology is qualitative and exploratory. Semi-structured interviews were conducted with 16 informants from neighborhoods located in Gran Mendoza and Gran San Rafael with food insecurity between April and August 2021. A constant comparative method was used to analyze the information. Results: There were differences in the predictability of resources to provide food between community dining centers which related to their connections with direct food assistance policies implemented before and during the pandemic. Shared characteristics included women being in charge and the deployment of combined strategies of obtaining resources to deal with higher food demand. The food offered was similar and subject to the availability of supplies and diners' preferences. Conclusion: Community initiatives contributed to sustaining the nutrition of children and teenagers from families working in the informal economy that utilized them due to isolation-related salary cuts. No relevant differences were found between menus offered in dining centers managed by social movements and the self-managed, neighborhood-based ones. The management experiences of neighborhood associations, the support of neighbors, and previously built relationships of trust with donors and external organizations were key to upholding the delivery of rations and care of isolated people.

Cross-sectional association between physical fitness and cardiometabolic risk in Chilean schoolchildren: the fat but fit paradox.

Background: Previous studies have examined the "fat but fit" paradox, revealing that greater levels of physical fitness may diminish the harmful consequences of excess weight on cardiometabolic risk. Despite the above, specific information about the "fat but fit" paradox in prepuberal population is scarce. The aim of this study was to determine the relationship between cardiometabolic risk across (individual and combined) physical fitness and excess weight status and whether the "fat but fit" paradox is met in the sample of schoolchildren analyzed. Methods: A cross-sectional study was conducted including 452 children (59.1% girls), aged 7-9 years from Santiago (Chile). Physical fitness was assessed as cardiorespiratory fitness and muscular fitness. Cardiorespiratory fitness was determined by the 6-minute-walk-test and muscle strength was assessed by the handgrip and standing long jump tests. Excess weight (overweight and obesity) was computed through body mass index (z-score). Cardiometabolic risk was established by summing the z-score of the serum glucose, triglycerides, high-density lipoprotein, insulin and waist-to-height ratio. Results: Schoolchildren with high physical fitness (individual or combined) showed the lowest cardiometabolic risk mean scores (P for trend <0.001 for all physical fitness groups). Conversely, schoolchildren with low physical fitness (individual or combined) showed the highest cardiometabolic risk mean scores (P for trend <0.001 for all categories). Additionally, schoolchildren without excess weight and with high individual or combined physical fitness status exhibits lower cardiometabolic risk mean scores compared to schoolchildren with excess weight and low physical fitness status (individual or combined) (P for trend <0.001 for all physical fitness groups). A lower odd of having high cardiometabolic risk was found in schoolchildren without excess weight and with both high physical fitness (both cardiorespiratory fitness and muscular fitness) [odds ratio (OR) =0.08; 95% confidence interval (CI): 0.04 to 0.16] in comparison to those with excess weight and low physical fitness. Conclusions: Our results suggest that improvements in both fatness and aerobic fitness could be associated with lower cardiometabolic risk.

The Chilean Diet: Is It Sustainable?

Food systems are one of the main contributors to climate change. Sustainable diets are one strategy to mitigate climate change. Assessments and estimations at a national level are lacking, especially in the Global South, probably due to a lack of national surveys of food consumption and a limited interest in sustainable diets information. The objective of this study is to estimate and describe the carbon and water footprint of the Chilean population's diet in an overall estimation desegregated by region, age, sex, socioeconomic level and their main characterizations. This study is based on a secondary data analysis from the National Survey of Food Consumption made in 2010. The carbon and water footprint of the food subgroups/person/day were estimated. The results are compared by sex, age group, socioeconomic level, and macro zone. A carbon footprint of 4.67 kg CO2eq and a water footprint of 4177 L, both per person/day, were obtained. Animal-sourced foods, such as dairy and red meat, were responsible for 60.5% of the total carbon footprint and 52.6% of the water footprint. The highest values for both footprints were found in the following groups: men, adolescents, young adults, people with a higher socioeconomic level, and residents in the southern area of the country. The carbon footprint and water footprint values in Chile generated by food consumption would be above the world averages. Transforming the Chilean food system into a more sustainable one with changes in eating patterns is urgently required to attain this transformation.

[What is currently known about the baby-led weaning method-BLW?] / ¿Qué se sabe actualmente sobre el método de alimentación guiado por el bebé -BLW?

The most used method for starting complementary feeding is the parents-led weaning with foods of puree consistency; however, in recent years, the Baby-Led Weaning (BLW) has been positioning itself as a new method of choice, in which the baby guides the feeding process. The BLW presents benefits recognized mainly by mothers who implement the method, among which are the integration of the baby into family meals, greater autonomy, and less food selectivity. On the other hand, health professionals, despite recognizing its advantages, tend to be a little more reluctant to recommend the method, expressing concern about a possible deficit in energy and nutrients intake, risk of choking, and delayed growth. However, the results between studies are mixed, and the evidence supporting both benefits and risks needs to be analyzed in more studies. The objective of this update is to know in depth the BLW as a method of introducing complementary feeding, as well as the benefits and risks defined in the studies analyzed.

[Psychomotor development trajectories according to nutritional status in breastfed children]. / Trayectoria del desarrollo psicomotor según estado nutricional en niños alimentados con lactancia materna.

OBJECTIVE: To describe psychomotor development (PMD) trajectories and nutrition in children fed with breastfeeding (BF) and to evaluate possible associations. SUBJECTS AND METHOD: Prospective co hort of full-term infants, without known pathologies, fed with BF. The intake of BF was evaluated with an isotopic technique at three months. At six successive ages, the nutritional status was evaluated according to the body mass index (BMI) for age and the PMD using the Ages and Stages Questionnai re (ASQ-3). Children who had at least two follow-up evaluations were included. Multivariate analysis of the trajectories by the PMD domain was performed according to BMI/A and BF, controlled by bio- socio-demographic variables. RESULTS: 53 children were included (60% male), 76 % were eutrophic, and 62% and 38% were fed exclusively or predominantly with BF, respectively. The nutritional and PMD trajectories were stable and within the normal range; there were no infants in the obesity ran ge. In the multivariate analysis, the Communication domain was significantly associated with BMI (p = 0.049) and BF (p = 0.032). Problem Solving domain was associated with BMI (p = 0.040). No significant associations were found in the trajectories of motor and socio-individual domains. Con clusion: The nutritional trajectories and each PMD domains were stable and within normal ranges. Exclusive BF was associated with a better Communication trajectory, while the BMI was associated with better Communication and Problem-Solving.

Handgrip strength cut-off points for early detection of cardiometabolic risk in Chilean children.

The aim of this study was to determine whether handgrip strength is associated with cardiometabolic risk in children. The secondary aim was to establish sex-specific handgrip strength cut-off points for early detection of cardiometabolic risk. A total sample of 452 Chilean children (267 girls and 185 boys) aged 7-9 years old was analyzed. Muscle fitness was measured by an adjustable dynamometer and normalized by body mass (i.e., handgrip strength/body mass). Sex-specific cardiometabolic risk scores were computed as the sum of the waist-to-height ratio (Equation 1) or waist circumference (Equation 2) and insulin, triglycerides, high-density lipoproteins, and glycemia levels. Receiver operating curve (ROC) analyses were performed to identify those with cardiometabolic risk scores > 1 standard deviation above the mean. ROC analyses showed a significant discriminating accuracy of normalized handgrip strength in identifying cardiometabolic risk in boys (≤ 0.33) and girls (≤ 0.40) using both equations. The highest sensitivity was offered by Equation 2 for boys [46%; 95% CI (32-59%)] and for girls [71%; 95% CI (60-80)]. The greatest specificity was also offered by Equation 2 for boys [82%; 95% CI (74-88)] and girls [63%; 95% CI (55-70)]. Since the values obtained by ROC analyses are low (especially in boys), caution is warranted regarding the strength of the existing evidence base.Conclusion: These specific cut-off points according to sex for possible cardiometabolic risk could be used by Chilean health professionals and school staff as an initial assessment in the field setting. What is known • There is strong evidence for the importance of muscular fitness during childhood and adolescence for cardiometabolic risk. • There has been no research to establish minimum handgrip strength capacity levels to predict cardiometabolic risk among Chilean children. What is new • Cut-off points for handgrip strength relative to body mass to identify cardiometabolic risk in Chilean children are 0.33 in boys and 0.40 in girls. • The early use of these cut-off points and its appropriate identification could have benefits of preventive and diagnostic therapeutic intervention and as a starting point to define adequate levels of handgrip strength.

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

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

¿Cómo hacer una base de datos ocupando una planilla de cálculo de Excel? / How to make a database using an Excel spreadsheet?

Una de las etapas fundamentales en el desarrollo de un protocolo de investigación es la construcción de la base de datos. Su diseño detallado y el llenado cuidadoso ayudan a mejorar la confiabilidad de los resultados obtenidos a partir del análisis estadístico de los datos ingresados. Justamente, uno de los problemas que frecuentemente deben enfrentar los profesionales de la salud, es la construcción y la digitación de los datos. Procesos que, de no ser realizados adecuadamente, pueden generar diferentes tipos de errores. Aunque existen softwares específicos para el armando de las bases de datos, no es frecuente que los profesionales de la salud sepan utilizarlos. Es por lo anterior que el objetivo de este apartado es describir algunos aspectos básicos del uso de la planilla de cálculo de Excel para que pueda ser utilizada como base de datos.

One of the fundamental stages in the development of a research protocol is the construction of the database. Its detailed design and careful filling help improve the reliability of the results obtained from the data's statistical analysis. One of the problems that health professionals must frequently face is the construction and entry of data. Processes that, if not carried out properly, can generate different types of errors. Although there is a specific software for building databases, health professionals do not know how to use them. Because of the above, the objective of this section is to describe some essential aspects of the use of the Excel spreadsheet so that it can be used as a database.