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OBJECTIVE: To monitor coverage and outcomes associated with the activities of the integrated protection system for early childhood Chile Grows with You (CHCC), which includes the comprehensive psychosocial development of children between 18 months and 3 years old, in each of the 29 Health Services of the country, as well as the changes observed after 4 years. MATERIAL AND METHOD: Database analysis of all local public networks in the country between 2008 and 2011 was performed. The application of the test regarding psychomotor development, prevalence of development delay and risk, participation of mothers in educational workshops, home visits and recovery rate of deficient children by age were studied. Median and observed changes of each indicator were analyzed developing a ranking based on the results observed. RESULTS: Approximately 75% of children were evaluated, with a prevalence of delay or risk of about 5% and a rate of recovery close to 50%. The participation of mothers in educational workshops increased from 7.6 to 11.0% (p<0.001) and home visits to developmentally delayed children increased 6 times between 2009 and 2011 (p<0.001). Most changes were positive, although the prevalence of developmentally delayed children under 2 years slightly increased (0.6%), and the recovery of 3 year olds decreased (-14.4%). A great variability was observed among the Health Services. CONCLUSIONS: There are some positive results in relation to psychomotor development, with significant regional differences. A lower than expected deficit rate regarding psychomotor development was observed, which implies the need to further analyze the instrument used or the conditions of application.

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The purpose of the study was to determine the association of birth weight as a risk factor for obesity at first grade in a cohort of elementary school Chilean children. Height and weight at birth and follow up measurements at first grade were analyzed from a national cohort of 119,070 new borns. Subjects were classified by anthropometric characteristics: new born weight in kilograms, Ponderal Index, (birth weight/height³ x 100), and gestational age (physical maturity) categories at birth. The study tested the hypothesis that a macrocosomic newborn (≥ 4,000 g or > 8.8 pounds) or Large for Gestational Age, would be at higher risk to be obese at first grade. A positive relationship between birth weight ≥ 4,000 g, (O.R. =1.55), (p < 0.001), high Ponderal Index (O.R. = 1.39), (p < 0.001), large for gestational age (O.R. = 1.51), (p < 0.001), and obesity at first grade was found. Macrosomic children were more likely to be obese at first grade after controlling for the effects of confounding prenatal variables (O.R. = 1.67, (p < 0.001). When weight gain between birth and first grade was ≥ 120% of reference value, the obesity risk was 20 times higher (p < 0.001). A direct and statistically significant relationship between high birth weight and obesity at first grade in this group of Chilean children were observed. These results highlight the significance of birth weight as an important tool for healthcare providers that can be used as an indicator of obesity risk for children.

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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 per cent of children had concomitant diseases at admission and 18.7 per cent 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 per cent was undernourished. During admission in CONIN, the number of undernourished patients was reduced by 50 per cent, while the proportion of children with normal nutritional status increased by 15 per cent (p < 0.001). On admission, 7.8 per cent 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.

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BACKGROUND: The Chilean Ministry of Health proposed the use of "Mini Nutritional Assessment", to identify elders at nutritional risk. This score considers anthropometric, dietary and quality of life items. AIM: To assess the concordance of the mini nutritional assessment with body mass index and dietary parameters in Chilean free living elders. MATERIAL AND METHODS: Subjects aged 70 years old or more, coming from four public outpatient clinics were studied. In all, the mini nutritional assessment, dietary intake using 24 h recalls and anthropometric parameters, were measured. Energy intake was evaluated using FAO/WHO/UNU guidelines. Micronutrient intake was evaluated using the Dietary Recommended Intakes (DRI) from USA. Kappa index was used to determine diagnostic concordance. RESULTS: Forty three percent of subjects were overweight or obese. There was a substandard intake of calcium, folate, zinc, vitamin A, C, E, B6, B12 and energy. Seventy nine percent of subjects had a deficient or regular food intake. Mini nutritional assessment score was normal in 66% of subjects. Fifty eight percent of those with a deficient food intake had a normal mini nutritional assessment. On the other hand, 73% of those considered at nutritional risk, had a normal or excessive weight. CONCLUSIONS: Mini nutritional assessment did not identify elders at nutritional risk in this sample.

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BACKGROUND: Epidemiological studies have suggested that smoking, nutrition and sexual patterns are major risk factors for cervical cancer. AIM: To study the association between food consumption patterns, smoking and sexual behavior and the risk of cervical cancer. MATERIAL AND METHODS: A matched case control study of 170 cases and 340 controls. Food and nutrient intakes were assessed by a food frequency questionnaire considering 58 antioxidant rich food items. Median daily intake of vegetables, fruits, antioxidant vitamins and fiber was calculated. A conditional logistic regression model was used to determine odds ratios associated with variations in nutritional intake and no nutritional factors (age at first delivery, parity, body mass index, family history of cancer and smoking). RESULTS: High intakes of vegetables, fruits, beta carotene, vitamin C, E and fiber were associated with a lower risk of cervical cancer (Odds ratios ranging from 0.56 to 0.78). The risk for cancer was inversely associated with the age at first delivery and directly associated with the total number of pregnancies and smoking. Multivariate analysis model showed a protective effect for vegetable and vitamin E consumption (odds ratio of 0.6 with confidence intervals of 0.5 to 0.8 p < 0.001) and a higher risk associated to smoking (odds ratio 2.8, confidence intervals 1.5-5.5 p < 0.002) and a younger age at the first delivery (odds ratio 3.37 confidence intervals 2-5.3 p < 0.001). CONCLUSIONS: Cervical cancer is associated with reproductive and food consumption behaviors. A higher intake of vegetables and foods rich in vitamin E can reduce its risk.

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BACKGROUND: Epidemiological studies suggest a relation between breast cancer, diet and life styles. AIM: To analyze the association between food patterns, obesity, smoking, alcohol consumption and breast cancer risk in women of Santiago. PATIENTS AND METHODS: A case-control study design (170 cases and 340 controls), matched by age and sex, was used. Through a food frequency questionnaire the average daily intake of vegetables, fruits, beta-carotene, vitamin A, C, E and fiber was analyzed. Other exposures to non-nutritional risks (parity, smoking, cancer history) were also studied. Conditional logistic regression was calculated to determine the odds ratio associated with variations in food and nutrient intake and non-nutritional factors. RESULTS: Cases had a greater BMI and a higher prevalence of obesity than controls (p < 0.02). No differences were observed in either group food patterns. The ORs for breast cancer associated with obesity and alcohol consumption were 1.65 (95% CI 1.06-2.64) and 1.61 (95% CI 1.06-2.54) respectively (p < 0.05). Multiparity had a protective effect with 0.66 less risk (95% CI 0.44-0.99). No protective effect associated to a greater intake of vegetables, fruits or natural antioxidants was observed. Multivariate analysis model disclosed obesity as a risk factor (OR 1.79, p < 0.02) and parity > or = 4 as protective (OR 0.62, p < 0.02). CONCLUSIONS: This study does not support a protective role for natural antioxidants against breast cancer but indicate a weak association with obesity.

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BACKGROUND: The higher life expectancy of the Chilean population has required a greater concern about health and nutrition of elderly people. AIM: To assess the alimentation of people over 65 years old, living in communities of the Metropolitan Region with high social vulnerability. MATERIAL AND METHODS: A random and representative sample of 257 elders living in the poorest communities of santiago was studied. They were interviewed in their homes about feeding patterns, the alimentation of the day before and their nutritional status. Mean energy and nutrient consumption and their fitting to FAO/WHO energy and National Research Council micronutrient recommendations were calculated. A feeding quality index, that considers the adequacy of consumption of all nutrients, was calculated. RESULTS: Except for bread, median consumption of all groups of foods was below recommendations. Median energy and protein consumption was 1438 Kcal and 53.9 g in men and 1118 Kcal and 37.7 g in women. Adequacy of consumption of all nutrients was low and the intake of energy, protein, calcium, iron and folate was significantly lower in women than in men. The factors associated with feeding quality in these subjects were a last meal of the day before different from supper, more than 15 hours of morning fasting and sex. CONCLUSIONS: Alimentation of elders living in poor communities of Santiago is severely deficient. Focalized intervention models to improve this situation should be devised.

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Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

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The access to information is crucial to plan, define and evaluate nutritional interventions. Analyzing the main nutritional indices proposed by international fora for food and nutrition surveillance, the usefulness of anthropometry is underscored due to its simplicity and low cost. The height/age index has advantages and limitations, considering that height may be influenced by genetic factors. The joint analysis of different indicators allows a correct individual or population nutritional assessment. It is concluded that height continues to be a good index of nutritional status and of standard of living in countries where nutritional problems are relevant.

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AIMS: To assess the intake of foods and nutrients in a group of adults of the Metropolitan Region of Chile and to identify food intake patterns which may need to be modified according to the guidelines of health promotion. METHODS: A non-randomly selected group of 859 adults (410 men) from 120 health care centers of the National Health System (October 1995) was studied. Food intake was assessed by 24-hour recall applied by well-trained standardized nutritionists. Both frequency and food and nutrients intake were calculated. RESULTS: The mean age was 35.8 +/- 10.6 years old. Median energy, protein and fat intake in male were 2324 kcal, 84 g y 70 g, respectively. For women, medians intake were: 1668 kcal, 59 g and 53 g respectively. From the total sample 72%, 53% y 71% reported consumption of less than two servings of milk product, vegetables and fruits. Likewise 42%, 36% y 22% of subjects had calcium, vitamin A and C intake below than 50% of the corresponding recommended dietary allowances (RDA). On the other hand 24% of the sample had daily salt consumption higher than 5 g, 37% had energy intake derived from fat higher than 30% of total calories and 15% had more than 10% of the energy supplied by sugar. CONCLUSIONS: A significant part of the adult population had inadequate patterns of food intake which confirms the need to promote a healthier diet.

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BACKGROUND: There is evidence to suggest that the criteria for nutritional assessment of pregnant women, used by the Chilean Ministry of Health, overestimates nutritional disturbances. AIM: To propose a new reference table to assess the nutritional status of pregnant women, based on body mass index. MATERIAL AND METHODS: The table was theoretically defined using criteria for normality proposed by FAO and the weight increase during pregnancy that is associated with a lower maternal and fetal morbidity and mortality. In 665 pregnant women, weight, height, mid arm circumference and skinfolds were measured using standard techniques. Body mass index, arm fat and muscle area and percentage of body fat were calculated. Body composition for each nutritional category, derived from the body mass index or "Rosso-Mardones classification", was analyzed. RESULTS: According to the new table, under weight women had lower percentage of body fat and mid arm circumference and overweight women had higher weight, skinfold thickness and percentage of body fat than the homologous groups defined according to Rosso-Mardones tables. CONCLUSIONS: The proposed reference table may be useful to correct distortions generated by the current norms for nutritional assessment of pregnant women, proposed by the Chilean Ministry of Health. It has to be validated, analyzing its sensitivity, specificity and predictive value to predict fetal and maternal variables.

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The work reported here sought to describe the feeding patterns of Chilean children up to 18 months old and their relation to nutritional status. To this end, a survey was conducted in 1993 of 9330 Chilean children under 18 months old who were receiving care through the National Health Service System-which provides care for 75% of all children under age 6. The children, whose mothers or caretakers were interviewed, constituted 94% of a sample selected at random from 102 of the 320 urban health clinics located throughout the country. The interview served to identify the type of feeding (exclusive breast-feeding, breast-feeding plus bottle-feeding, breast-feeding plus solid food, exclusive bottle-feeding, or bottle-feeding plus solid food) and to determine the nutritional status of the participants in terms of standards used by the United States National Center for Health Statistics and the World Health Organization. Children were deemed at risk of malnutrition if they had z scores on the weight-for-age distribution between 1.0 and 2.0 standard deviations below the US/WHO standard and as actually malnourished if they had z scores of over 2.0 standard deviations below the standard. The survey found exclusive breast-feeding prevalences of 86.5%, 66.7%, and 25.3% among infants 1, 3, and 6 months old. Some 12.1% of the participants were found to have a weight-for-age deficiency, 30.7% exhibited a height-for-age deficiency, and 35.7% were found to be over-weight. The prevalence of weight-for-age and height-for-age deficiencies were found to be considerably higher among bottle-fed children than among breast-fed children. In general, the results demonstrated the benefits of exclusive breast-feeding through the first 6 months of life, the need to complement exclusive breast-feeding with solid food after that time, and the superior nutritional status of breast-fed children within the age groups studied.

PIP: In September 1993 in Chile nationwide, 9330 mothers or caretakers of children 18 months or younger were interviewed and the children's weight and height measured to examine the breast feeding patterns of these children and their nutritional status. The children attended 102 Ministry of Health-supervised urban primary health care facilities. Exclusive breast feeding was prevalent up to 4 months of age (86.5% at 0-0.9 months and 59.4% at 3-3.9 months), then fell rapidly to 1.6% at 7 months of age. 83%, 59%, and 31% of the children 3, 6, and 12 months old, respectively, still received breast milk. 12.1% of all children showed a weight-for-age deficiency, 30.7% showed a height-for-age deficiency, and 35.7% were overweight. Overall, the percentage of malnourished children in terms of height-for-age increased steadily with age (p 0.001). In terms of weight-for-age, it was low in the first 6 months but increased in the next 6 months (p 0.001). In terms of weight-for-height, few children showed any severe nutritional deficiency but many showed excess weight (not significant). Among children younger than 6 months, the level of nutritional deficiency ( -1 standard deviation for weight-for-age) was higher among children who received breast milk and infant formula than among children who were exclusively breast fed (p 0.01 for 0-2 months and p 0.001 for 3-5 months). On the other hand, among children 6-8 months old, those who were exclusively breast fed and had never received solid foods were more likely to be malnourished than those who had received both breast milk and solid foods (p 0.01). In the first 6 months of life, exclusively bottle fed children faced a 1.6-1.8 times significantly higher risk of height-for-age deficiency than exclusively breast fed children. Among children older than 3 months, excess weight-for-height was significantly more common among exclusively breast fed children than other children. These findings revealed benefits of exclusive breast feeding during the first 6 months, the need to supplement it with solid food thereafter, and the superior nutritional status of breast fed children.

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The purpose of this work was to describe the diet of children under 18 months of age and its relationship to nutritional status. For this purpose, in 1993 a prevalence study was carried out on children who received care from the National Health Services System of Chile. The Chilean public health system provides care to 75% of children under 6 years of age and especially to children of families in the lower strata of income distribution in the country. Participants in the study were 9330 children under 18 months old who were randomly selected from 102 of the 320 urban clinics throughout the country. The type of food these infants had received the day prior to the interview (breast milk exclusively, breast milk plus solid food, formula exclusively, formula plus solid food) and their nutritional status relative to the standards of the National Center for Health Statistics (United States of America) and of WHO were determined. Children with z values for weight-for-age between -1.0 and -2.0 standard deviations were considered at risk for malnutrition, and those with z values under 2 standard deviations were classified as malnourished. The prevalences of exclusive breast-feeding at the first, third, and sixth months of life were 86.5%, 66.7%, and 25.3%, respectively. Some 12.1% of the participants showed low weight for age; 30.7%, low height for age; and 35.7%, overweight. The magnitude of weight-for-age deficiency was 1.2 to 5 times greater among children who were fed milk substitutes than among those who received breast milk. Breast-feeding also had a positive effect on height. These results confirm the benefits of exclusive breast-feeding until 6 months of age, the need to supplement the child's diet with solid food after that age, and the breast-feeding's protective effect on the nutritional status of children of all the ages studied.

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The aim of this work was to compare the nutritional classification of pregnant women and their predictive value for low birth weight, using the criteria of the Ministry of Health (Rosso-Mardones curves) with the curves developed at the Department of Nutrition of the Faculty of Medicine and the body mass index. One thousand eight hundred four pregnant women of the Metropolitan Region, that were devoid of factors affecting birth weight, were studied retrospectively. Initial and final nutritional status was calculated according to the three criteria in study. Results showed that 47 to 75% of women classified as undernourished using Rosso-Mardones curves, were normal according to the curves of the Department of Nutrition and body mass index. Rosso-Mardones curves had the lower predictive value, relative risk and risk attributable to maternal nutritional deficit, for low birth weight. Also these curves showed a higher of obesity and a low predictive value for macrosomia. It is concluded that the curves used by the Ministry of Health must be revised.

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Aiming to assess the association between carotenes and vitamin A intake and lung cancer, a case control study was performed. Sixty one male subjects with lung cancer and 61 controls paired for age, sex and smoking habits from 6 hospitals in Santiago were analyzed. Based on a consumption tendency enquiry, the mean weekly intake of food groups, carotenes and vitamin A was calculated, considering seasonal variations. Results showed that cases consumed less "winter" vegetables than controls (chard, beet, chicory, spinach and cabbage) but no differences between groups in carotene and retinol consumption. It is concluded that patients with lung cancer have a lower consumption of carotene rich vegetables.

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The prevalence of dental fluorosis, a manifestation of chronic fluoride toxicity on ameloblasts, is increasing in communities with or without fluoride supplementation of drinking water. The aim of this work was to study the prevalence and severity of fluorosis in Chile and its relationship to socioeconomic level and fluoride content of drinking water. Six hundred ninety three children aged 7 to 12 years old, coming from four cities with drinking water fluoride levels of 0, 0.3, 1 and 2.2 ppm were subjected to a standardized odontological examination looking for clinical manifestations of fluorosis. The global prevalence of fluorosis was 32%, being 61.4% in the city with the highest drinking water fluoride concentration and 20% in the city without fluoride in the drinking water. Likewise, the prevalence of fluorosis was higher in children of high socioeconomic level. It is concluded that the high prevalence of fluorosis, although generating only mild lesions, should be object of epidemiological surveillance.

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The aim of this work was to analyze the nutrimental situation of people living in Santiago, reviewing the recent published information on this topic. There was profuse information about deficiency nutrimental problems among maternal and infantile groups, but fairly less in other age groups and about surplus disease. Considering food purchasing capacity, an important percentage of the population is located below the line of poverty. Child mortality has a low and decreasing rate and the general mortality structure shows a decline of infections causes. There is a low prevalence and degree of undernutrition among preschool children and a low proportion of low birth weight newborns. Instead, low stature affects a high proportion of school age children and its prevalence increases in puberal ages. Obesity predominates among adults and its risk factors are female sex, low stature and a low socio-economical level. Iron deficiency anemia is the most important specific deficiency. Outstanding features are the degree of communal development, a relatively better situation of Santiago compared with the national average and the lack of information and specific policies towards overfeeding related problems.

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The prevalence of enamel fluorosis and its severity was studied in 118 young men of 2 socio-economic levels. The subjects were born and resided for at least 6 years in Chilean communities with different natural levels of fluoride in drinking water. There was a high prevalence of enamel defect overall (54%) most of it of mild degree (36%). This was not related to the level of fluoride in drinking water, however further studies are needed since Chilean children are receiving fluoride from other sources. A national program to supplement drinking water with fluoride should take this information into account.

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BACKGROUND: Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. METHODS: Neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from "high-violence" and three from "low-violence" neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. RESULTS: Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR = 5.0; 95% CI = 1.9-12.6; p less than 0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. CONCLUSION: Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women.

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The purpose of this investigation was to evaluate the effect of a modified cow's milk formula on growth, tolerance and acceptability, which was studied in 2,097 infants selected from those controlled in primary health centers at Santiago, Chile: 1,119 were fed a modified cow's milk formula (LPM), while an unmodified powdered cow's milk (LP) was given to 978 controls of the same age and conditions, as well as solid foods after 4 months of age. Both experimental and control groups were followed along a 4 months period for records of anthropometric data, morbidity, acceptability and tolerance for LP and LPM. We did not find significant differences in growth (values ranging 95 to 100% of NCHS standards W/A or H/A). A slightly higher energy intake and lower protein intake was observed with LPM. Gastrointestinal symptoms were infrequently seen and of similar frequency and character in both 0 to 4 month old groups (4.3% with LPM vs. 5.3% with LP at first control). These gastrointestinal signs were more frequently recorded under LPM than with LP in the 8 to 12 months old group only at first control (colics 8% vs. 4% p < 0.01 and abnormal stools 9.4% vs. 5.5% p < 0.01). Acute acceptability expressed as percentage withdrawal from study was not significantly lower with LPM than LP (5 to 15% vs. 2% N.S.). The proposed modified formula seems to be a good alternative to powdered cow's milk for infants.

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