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An unvaccinated pregnant two-year-old Anglo- Nubian ­ Alpine crossed doe presented to The University of the West Indies School of Veterinary Medicine in lateral recumbency with bilaterally stiff hind limbs. The owner indicated that he had dewormed the animal three days prior with 380mg of Albendazole per os and that the doe started experiencing seizures two days later. On clinical physical examination, the animal was bloated and had severe ocular lesions to the right eye including corneal oedema and ulceration and a miotic and non-responsive pupil. Abdominal ultrasound suggested the presence of two foetuses but their viability could not be confirmed as only one heartbeat was detected. The doe was initially treated with tetanus antitoxin, parenteral antibiotics, non-steroidal anti-inflammatory medication, intravenous fluids and anticonvulsants. Two days later, she aborted two foetuses. Once the doe was stabilized, physiotherapy and hydrotherapy were performed. Within two weeks of initial presentation, she had regained a healthy appetite and was able to stand and walk unassisted. Despite the similarities between the initial clinical signs to that of tetanus, the abortion, subsequent case progression and eventual resolution of clinical signs are more consistent with the final diagnosis of albendazole toxicity. This case is important as it demonstrates how the indiscriminate use of anthelmintics and the lack of proper deworming strategies can potentially result in animal fatalities. Appropriate anthelmintic use is essential for both animal health and continued drug efficacy. Veterinarians should also be aware of the striking similarities in clinical signs of albendazole toxicity with those of tetanus.

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La disminución de la obesidad es un objetivo sanitario para la década. Objetivo: Evaluar respuesta antropométrica, metabólica y adherencia a corto plazo, a un modelo de intervención en obesidad infantil. Sujetos y Método: Niños(as) obesos, 6-19 años, ingresados a un programa piloto; intervención multidisciplinaria, de 4 meses de duración. Se evaluó al ingreso y 4 meses 1MC, perímetro de cintura (PC), lípidos plasmáticos, glicemia e insulinemia. Resultados: Ingresaron 402 pacientes, 12,2 años (6,3 a 18,2 años); 56,5% mujeres, zIMC al ingreso 2,92 (1,7 a 7,7); PC 92,3 ± 11,1cm; HOMA 2,45 (0,37 a 17,79). El 39,1% presentaba un CT > 170 mg/dL; 26,5%; LDL > 110 mg/dL; 30,9% HDL < 40 mg/dL y 37%; TG > 110 mg/dl. El 66,9% completó el programa, 68,4% de éstos bajó el zIMC (3,13 ingreso vs 2,77 cuarto mes, p < 0,05) sin relación con edad, sexo, ni zIMC inicial. El grupo que completó el programa tenía un zIMC al ingreso significativamente mayor (3,1 ví 2,74, p < 0,05). Del grupo con exámenes alterados al ingreso y repitieron al cuarto mes, 54% disminuyeron HOMA, 59% bajaron el CT y 66% los TG, sin relación con descenso ponderal, disminución de PC, ni HOMA. Conclusión: Un alto porcentaje de los niños(as) completa el programa, presentando mayor adherencia quienes tienen zIMC más alto al ingreso. El programa logra mejoría en estado nutricional y variables metabólicas a corto plazo, y justificaría su aplicación en atención primaria de salud.

Reducing the prevalence of childhood obesity is a sanitary goal for the decade. Objective: To evaluate a short time intervention model in childhood obesity on its anthropometric and metabolic impact. Methods: Prospective evaluation of obese children and adolescents, 6 to 19 years of age. A pilot treatment program from the Public Health System and FONASA was conducted as a multidisciplinary, non-pharmacologic intervention, during a 4-month follow-up period. Body Mass Index (BM1), waist circumference, lipid profile, plasma glucose and HOMA index were evaluated. In a subset of the subjects the blood profile was repeated on the 4th month. Results: 402 patients entered the program, 56,5% females, age 12,2 years (range 6,3-18,2). Baseline mean BMl z score was 2,92 (1,7 to 7,7), mean waist circumference was 92,3 ±11,1 cm. A total cholesterol (TC) >170 mg/dL was founded in 39,1% of patients; LDL >110 mg/ dL, 26,5%; HDL < 40 mg/dL, 30,9%, and TG > 110 mg/ dL in 37% of patients. The median HOMAwas 2,45 (0,37 to 17,79). The program was completed by 66,9% of patients, 68,4% of these reduced z score BMl at the 4-month evaluation (3,13 baseline vs 2,74, p < 0.05), without correlation with age, gender, or baseline BMl z score. The group who completed the program showed a BMl z score at baseline significantly higher than their counterparts (3,1 vs 2,74, p < 0,05). 118 subjects were reevaluated, 59 % of them showed a decrease in HOMA index. From the group of patients with high TC levels at baseline, 54% reduced the TC and 66% TG, without relation to weight, waist circumference or HOMA reduction. Conclusion: a high percentage of children succeeded in completing the program, showing better adherence those who were more overweight at the entrance of the program. The program showed an improvement in the nutritional state and in metabolic factors.

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La historia familiar (HF) de Enfermedades Crónicas no Transmisibles (ECNT), aumentaría el riesgo de síndrome metabólico (SM). En Chile, el SM afecta al 27% de niños con sobrepeso, y la hiperglicemia de ayuno (HA) es el trastorno menos prevalente (4.0%). El objetivo fue estudiar la prevalencia del SM y de los factores de riesgo cardiovascular (FRCV) en niños con sobrepeso e HF de ECNT analizando su asociación con el número de parientes afectados y con la historia parental (HP). En 183 niños con IMC ≥p85 de 11,8 ± 1,8 años (86 varones) e HF (padres y/o abuelos) de ECNT, se evaluó el z IMC (CDC / NCHS), el perímetro de cintura, la presión arterial, la glicemia, la insulina, los triglicéridos y el colesterol-HDL. El SM y los FRCV fueron diagnosticados por el criterio de Cook y la insulinoresistencia (IR) por el HOMA-IR. Se utilizaron Chi², ANOVA, t Student y Willcoxon. La HF de DM2, hipertensión arterial y dislipidemia fue de 81,4 %, 88,0 % y 71,6 % respectivamente. La prevalencia del SM fue de 46,5%, asociándose a la magnitud del sobrepeso y a la HP de ECNT. La prevalencia de hipertrigliceridemia y de hiperglicemia de ayuno fueron de 54,6% y 31,4% respectivamente. No hubo asociación entre el número de parientes con HF y el perfil cardiovascular y metabólico del niño. Se concluye, que la HF de ECNT, se asocia a una mayor prevalencia del SM, de dislipidemia y de hiperglicemia de ayuno que la observada en población general de niños con sobrepeso.

Metabolic syndrome prevalence in Chilean children and adolescent with family history of chronic noncommunicable diseases. . Family history (FH+) of non transmisible chronic diseases (NTCD) increase MetS risk. In Chile, the MetS affects 27% of overweight children, and fasting hyperglycemia is very low prevalent (4,0%). The objective was to study the prevalence of MetS and the cardiovascular risk factors (CVRF) in overweight children with a family background of NTCD and analyze its association with the number of relatives witth NTCD and with parental history (PH). In 183 overweight children (BMI ≥p85) mean age 11,8 ± 1,8 (86 males) with a FH+ (parental or grandparental) of NTCD, were assessed the BMI z (CDC / NCHS), waist circumference, blood arterial pressure, fasting Glucose and Insulin (RIA), triglycerides, HDL chol. The MetS and the CVRF were diagnosed using the Cook phenotype and the insulin resistance (IR) through the HOMA-IR. Chi², ANOVA, t Student and Willcoxon test were performed. The frequency of FH+ of DM2, hypertension and dyslipidemia were 81,4 %, 88,0 % and 71,6 % respectively. The MeTS prevalence was 46,5 % associated to overweight magnitude an parental history of NTCD. The prevalence of hypertriglyceridemia was 54,6%, while fasting hyperglycemia affected 31,4% of the sample. There was no association between number of relatives with NTCD and CV risk profile. We conclude that in overweight children with FH+ of NTCD, the prevalence of MetS, dyslipidemia and fasting hyperglycemia are significantly higher, than those observed in the general population of obese children.

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BACKGROUND: In the last decades, a seven to nine fold increase in the prevalence of teenage obesity and overweight has occurred. AIM: To assess energy intake and metabolism in a sample of overweight and obese adolescents. MATERIAL AND METHODS: In a sample of 113 overweight and obese Chilean adolescents (aged 13 to 16 years, 67 females) we studied anthropometry, body composition by deuterium isotope dilution water, resting energy expenditure by indirect calorimetry and 24-h diet and physical activity recalls. RESULTS: Most participants (87% of men and 67.2% of women) had an intake that was adequate compared to requirements (fAO/WHO 2005). However, 82.6% of men and 83.6% of women showed reduced energy expenditure. The sample was classified as sedentary, with a physical activity level of 1.29. CONCLUSIONS: In our sample of overweight and obese adolescents there was a sedentary behavior, resulting in low energy expenditure that would explain a sustained caloric retention. Preventive and therapeutic interventions should encourage the increase in physical activity.

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Background: In the last decades, a seven to nine fold increase in the prevalence of teenage obesity and overweight has occurred. Aim: To assess energy intake and metabolism in a sample of overweight and obese adolescents. Material and Methods: In a sample of 113 overweight and obese Chilean adolescents (aged 13 to 16 years, 67 females) we studied anthropometry, body composition by deuterium isotope dilution water, resting energy expenditure by indirect calorimetry and 24-h diet and physical activity recalls. Results: Most participants (87 percent of men and 67.2 percent of women) had an intake that was adequate compared to requirements (fAO/WHO 2005). However, 82.6 percent of men and 83.6 percent of women showed reduced energy expenditure. The sample was classifed as sedentary, with a physical activity level of 1.29. Conclusions: In our sample of overweight and obese adolescents there was a sedentary behavior, resulting in low energy expenditure that would explain a sustained caloric retention. Preventive and therapeutic interventions should encourage the increase in physical activity.

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Reducing the prevalence of childhood obesity is a sanitary goal for the decade. Objective: To evaluate a short time intervention model in childhood obesity on its anthropometric and metabolic impact. Methods: Prospective evaluation of obese children and adolescents, 6 to 19 years of age. A pilot treatment program from the Public Health System and FONASA was conducted as a multidisciplinary, non-pharmacologic intervention, during a 4-month follow-up period. Body Mass Index (BM1), waist circumference, lipid profile, plasma glucose and HOMA index were evaluated. In a subset of the subjects the blood profile was repeated on the 4th month. Results: 402 patients entered the program, 56,5 percent females, age 12,2 years (range 6,3-18,2). Baseline mean BMl z score was 2,92 (1,7 to 7,7), mean waist circumference was 92,3 +/-11,1 cm. A total cholesterol (TC) >170 mg/dL was founded in 39,1 percent of patients; LDL >110 mg/dL, 26,5 percent; HDL < 40 mg/dL, 30,9 percent, and TG > 110 mg/dL in 37 percent of patients. The median HOMA was 2,45 (0,37 to 17,79). The program was completed by 66,9 percent of patients, 68,4 percent of these reduced z score BMl at the 4-month evaluation (3,13 baseline vs 2,74, p < 0.05), without correlation with age, gender, or baseline BMl z score. The group who completed the program showed a BMl z score at baseline significantly higher than their counterparts (3,1 vs 2,74, p < 0,05). 118 subjects were reevaluated, 59 percent of them showed a decrease in HOMA index. From the group of patients with high TC levels at baseline, 54 percent reduced the TC and 66 percent TG, without relation to weight, waist circumference or HOMA reduction. Conclusion: a high percentage of children succeeded in completing the program, showing better adherence those who were more overweight at the entrance of the program. The program showed an improvement in the nutritional state and in metabolic factors.

La disminución de la obesidad es un objetivo sanitario para la década. Objetivo: Evaluar respuesta antropométrica, metabólica y adherencia a corto plazo, a un modelo de intervención en obesidad infantil. Sujetos y Método: Niños(as) obesos, 6-19 años, ingresados a un programa piloto; intervención multidisciplinaria, de 4 meses de duración. Se evaluó al ingreso y 4 meses 1MC, perímetro de cintura (PC), lípidos plasmáticos, glice-mia e insulinemia. Resultados: Ingresaron 402 pacientes, 12,2 años (6,3 a 18,2 años); 56,5 por ciento mujeres, zIMC al ingreso 2,92 (1,7 a 7,7); PC 92,3 +/- 11,1cm; HOMA 2,45 (0,37 a 17,79). El 39,1 por ciento presentaba un CT > 170 mg/dL; 26,5 por ciento; LDL > 110 mg/dL; 30,9 por ciento HDL < 40 mg/dL y 37 por ciento; TG > 110 mg/dl. El 66,9 por ciento completó el programa, 68,4 por ciento de éstos bajó el zIMC (3,13 ingreso vs 2,77 cuarto mes, p < 0,05) sin relación con edad, sexo, ni zIMC inicial. El grupo que completó el programa tenía un zIMC al ingreso significativamente mayor (3,1 ví 2,74, p < 0,05). Del grupo con exámenes alterados al ingreso y repitieron al cuarto mes, 54 por ciento disminuyeron HOMA, 59 por ciento bajaron el CT y 66 por ciento los TG, sin relación con descenso ponderal, disminución de PC, ni HOMA. Conclusión: Un alto porcentaje de los niños(as) completa el programa, presentando mayor adherencia quienes tienen zIMC más alto al ingreso. El programa logra mejoría en estado nutricional y variables metabólicas a corto plazo, y justificaría su aplicación en atención primaria de salud.

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Background: Disrupted eating behaviors and psychological issues can have a role in the development of childhood obesity. Aim: To assess the effects of psychological support as an adjunct to the treatment of obesity among children. Material and Methods: Retrospective analysis of a group of 152 obese children aged 3 to 16 years, who received medical, Nutritional and physical training treatment. Seventy three (Group I) were invited to participate in a protocol of psychological support and 79 formed the control group (Group 2). Body mass index, body fat mass, waist circumference, insulin sensitivity, lipid profile, eating and physical activity habits were evaluated. Family structure, history of food rejection, psychological, physical and social development, and adherence to the program were also analyzed. To analyze responses to treatment, Group I was further divided into those who attended the psychology sections (intervened group) and those who did not attend (non intervened group). Results: At baseline, there were no differences in anthropometric, metabolic, familial and psychological profile among Groups I and 2. Family structure, eating behaviors and physical and social development were normal. Those associated with lack of control appeared as negative characteristics. There was a significant improvement in eating habits and physical activity among intervened children of Group 1 and Group 2. No significant change in weight was recorded in all three groups. Compliance with the program was significantly better among intervened children in Group 1 (62.1 percent at sixth months), compared with non intervened children of Group 1 (15.9 percent) and Group 2 (30.3 percent). Conclusions: Obese children who attended psychological support therapy as an adjunct to a weight reducing program, had a better compliance with treatment but did not achieve a higher weight loss.

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BACKGROUND: There is a worldwide tendency towards an earlier appearance of puberal development among children, associated with an increase in weight and height. AIM: To study the trends in puberal development in Chilean school age children, between the years 1986 and 2001 and correlate it with weight and height changes. SUBJECTS AND METHODS: In two representative samples of school age children, collected between years 1985 and 1987 (m-1986) and another between years 2000 and 2002 (m-2001), girls between 7 and 15years (958 and 935, respectively) and boys between 9 and 15 years (842 and 870 respectively), were selected. Breast development (B) in females and genital development (G) in males were classified according to Tanner stages. Weight, height, body mass index (BMI) and nutritional status (according to Centers for Disease Control/ National Center for Health Statistics (CDC/NCHS) standards) were assessed. RESULTS: The prevalence of obesity increased four fold between 1986 and 2001. The 2001 generation had a significantly higher degree of puberal development than their counterparts studied in 1986. Compared to m-1986, m-2001 subjects had a lower mean age at puberal development stage two and three, but no differences at puberal stages 4 and 5. BMI of m-2001 subjects was significantly higher than that of m-1986 subjects at all puberal stages. The m-2001 males showed highest stature than m-1986 in all puberal stage, however, in females there is no difference in height between m-2001 and m-1986. CONCLUSIONS: The highest BMI observed in the cohort of 2001, could be facilitating an earlier puberal development and ethnic factors could explain the sexual dimorphism in stature.

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Background: There is a worldwide tendency towards an earlier appearance of puberal development among children, associated with an increase in weight and height. Aim: To study the trends in puberal development in Chilean school age children, between the years 1986 and 2001 and correlate it with weight and height changes. Subjects and Methods: In two representative samples of school age children, collected between years 1985 and 1987 (m-1986) and another between years 2000 and 2002 (m-2001), girls between 7 and 15years (958 and 935, respectively) and boys between 9 and 15 years (842 and 870 respectively), were selected. Breast development (B) in females and genital development (G) in males were classified according to Tanner stages. Weight, height, body mass index (BMI) and nutritional status (according to Centers for Disease Control/ National Center for Health Statistics (CDC/NCHS) standards) were assessed. Results: The prevalence of obesity increased four fold between 1986 and 2001. The 2001 generation had a significantly higher degree of puberal development than their counterparts studied in 1986. Compared to m-1986, m-2001 subjects had a lower mean age at puberal development stage two and three, but no differences at puberal stages 4 and 5. BMI of m-2001 subjects was significantly higher than that of m-1986 subjects at all puberal stages. The m-2001 males showed highest stature than m-1986 in all puberal stage, however, in females there is no difference in height between m-2001 and m-1986. Conclusions: The highest BMI observed in the cohort of 2001, could be facilitating an earlier puberal development and ethnic factors could explain the sexual dimorphism in stature.

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BACKGROUND: Disrupted eating behaviors and psychological issues can have a role in the development of childhood obesity. AIM: To assess the effects of psychological support as an adjunct to the treatment of obesity among children. MATERIAL AND METHODS: Retrospective analysis of a group of 152 obese children aged 3 to 16 years, who received medical, Nutritional and physical training treatment. Seventy three (Group I) were invited to participate in a protocol of psychological support and 79 formed the control group (Group 2). Body mass index, body fat mass, waist circumference, insulin sensitivity, lipid profile, eating and physical activity habits were evaluated. Family structure, history of food rejection, psychological, physical and social development, and adherence to the program were also analyzed. To analyze responses to treatment, Group I was further divided into those who attended the psychology sections (intervened group) and those who did not attend (non intervened group). RESULTS: At baseline, there were no differences in anthropometric, metabolic, familial and psychological profile among Groups I and 2. Family structure, eating behaviors and physical and social development were normal. Those associated with lack of control appeared as negative characteristics. There was a significant improvement in eating habits and physical activity among intervened children of Group 1 and Group 2. No significant change in weight was recorded in all three groups. Compliance with the program was significantly better among intervened children in Group 1 (62.1% at sixth months), compared with non intervened children of Group 1 (15.9%) and Group 2 (30.3%). CONCLUSIONS: Obese children who attended psychological support therapy as an adjunct to a weight reducing program, had a better compliance with treatment but did not achieve a higher weight loss.

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BACKGROUND: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. AIM: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. MATERIAL AND METHODS: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. RESULTS: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). CONCLUSIONS: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.

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Background: An appropriate measurement of physical activity (PA) in children is useful, since inactivity is associated to obesity, cardiovascular and metabolic risk. Aim: To assess the reliability of the INTA questionnaire of PA, to compare the derived PA score with accelerometry and to assess its ability to identify excessively inactive children. Material and methods: One hundred eighty children aged 8 to 13 years answered an interviewer-administered questionnaire about their usual PA, consisting in 5 items (recumbent, seated, walking, playing outdoor, sports). The answers were converted to a PA score with a 0-10 points scale. Reliability was tested in 87 children by test/retest conducted 3-5 days apart. The PA score was compared with 3-day accelerometry in 77 of 93 children (35 obese and 42 non obese). Receiver operating characteristic (ROC) curves were used to determine the optimal cut-point for identify an excessively sedentary child. Results: The test/retest reliability of the questionnaire was 0.69 to 0.93 (Lin coefficient). Accelerometry was significantly associated with PA score (RHO: 0.60, p =0.008), outdoor plays (RHO: 0.37, p =0.0009) and practicing of sports (RHO: 0.33, p =0.003). Obese children were less active than non obese children, according both to PA score and to accelerometry. The optimal cut-point for classifying a child as too sedentary was a score of 5 (sensitivity =0.89). Conclusions: The INTA-test is a valuable instrument for measuring usual PA in clinical practice and is easy to administer.

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BACKGROUND: The increased infantile obesity rates are related to faulty dietary intake (DI) and physical activity (PA) habits, that are probably related to a prolonged stay at school during the day. AIM: To investigate DI and PA among elementary and high school students and their association with type of school that they attend. MATERIAL AND METHODS: Quality of DI and PA was assessed, using specially designed questionnaires, in 1136 elementary school and 1854 high school children attending public schools managed by city halls (ME), subsidized private (SE) and private (PE) of the Metropolitan Region. The responses to the questionnaires, were qualified using a numeric scale that ranged from 0 to 10 points. A higher score indicated a better habit. RESULTS: Percentile 25 (p 25 th) PA score was 4 and 3 in elementary and high school children respectively and the p 25 th for DI were 5.7 and 4.3, respectively. No differences in DI scores, according to the type of school, were observed. However, physical activity scores were significantly lower in children and adolescents from ME schools than from PE schools. Sixty percent of ME schools had less than 2 hours per week of programmed physical activity compared to more than 3 hours, in 70% of PE schools. Elementary school children and high school adolescents expended 8 and 11 hours per day, respectively, in minimum expenditure activities. CONCLUSIONS: There is a greater deterioration of PA than DI among school age children and adolescents. Those attending ME schools have the worst physical activity scores. This fact must be addressed in future healthy lifestyle encouragement policies.

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Background: The increased infantile obesity rates are related to faulty dietary intake (DI) and physical activity (PA) habits, that are probably related to a prolonged stay at school during the day. Aim: To investigate DI and PA among elementary and high school students and their association with type of school that they attend. Material and Methods: Quality of DI and PA was assessed, using specially designed questionnaires, in 1136 elementary school and 1854 high school children attending public schools managed by city halls (ME), subsidized private (SE) and private (PE) of the Metropolitan Region. The responses to the questionnaires, were qualified using a numeric scale that ranged from 0 to 10 points. A higher score indicated a better habit. Results: Percentile 25 (p 25 th) PA score was 4 and 3 in elementary and high school children respectively and the p 25 th for DI were 5.7 and 4.3, respectively. No differences in DI scores, according to the type of school, were observed. However, physical activity scores were significantly lower in children and adolescents from ME schools than from PE schools. Sixty percent of ME schools had ¡ess than 2 hours per week of programmed physical activity compared to more than 3 hours, in 70 percent of PE schools. Elementary school children and high school adolescents expended 8 and 11 hours per day, respectively, in minimum expenditure activities. Conclusions: There is a greater deterioration of PA than DI among school age children and adolescents. Those attending ME schools have the worst physical activity scores. This fact must be addressed in future healthy lifestyle encouragement policies.

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BACKGROUND: In Chile between 1986 and 1998, the prevalence of obesity has increased from 4.6% to 24% in prepuberal and from 2.3% to 17% in puberal children. AIM: To assess the prevalence of metabolic syndrome (MS) in a sample of obese and overweight Chilean children. PATIENTS AND METHODS: Descriptive study in 489 children (273 females), aged from 6 to 16 years, consulting in an obesity program. Body mass index, Tanner puberal development, waist circumference, blood pressure, fasting blood glucose, insulin and lipid levels were measured. Insulin sensitivity was calculated using the mathematical models QUICKI and HOMA. MS was diagnosed when three or more of the following criteria were met: a waist circumference over percentile 90, a blood pressure over percentile 90, serum triglycerides over 110 mg/dl, HDL cholesterol of less than 40 mg/dl or a fasting blood glucose level over 100 mg/dl. RESULTS: MS was present in 4% of children with overweight and 30% of obese children. No differences in prevalence were observed for sex or puberal development. The most prevalent cardiovascular risk factors were abdominal obesity, present in 76% of the sample and high triclycerides levels in 39%. The less prevalent risk factor was a fasting blood glucose over 100 mg/dl in 3.7%. The risk for MS increased ten fold in children with severe obesity, compared with those with overweight. Those with abdominal obesity had a 17 times higher risk of MS. Basal insulin sensitivity was significantly associated with the number of cardiovascular risk factors and the presence of MS. CONCLUSIONS: In this sample of children, fat distribution and the severity of obesity were strong determinants of MS. Waist circumference had a higher impact on MS than body mass index.

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Background: In Chile between 1986 and 1998, the prevalence of obesity has increased from 4.6 percent to 24 percent in prepuberal and from 2.3 percent to 17 percent in puberal children. Aim: To assess the prevalence of metabolic syndrome (MS) in a sample of obese and overweight Chilean children. Patients and methods: Descriptive study in 489 children (273 females), aged from 6 to 16 years, consulting in an obesity program. Body mass index, Tanner puberal development, waist circumference, blood pressure, fasting blood glucose, insulin and lipid levels were measured. Insulin sensitivity was calculated using the mathematical models QUICKI and HOMA. MS was diagnosed when three or more of the following criteria were met: a waist circumference over percentile 90, a blood pressure over percentile 90, serum triglycerides over 110 mg/dl, HDL cholesterol of less than 40 mg/dl or a fasting blood glucose level over 100 mg/dl. Results: MS was present in 4 percent of children with overweight and 30 percent of obese children. No differences in prevalence were observed for sex or puberal development. The most prevalent cardiovascular risk factors were abdominal obesity, present in 76 percent of the sample and high triclycerides levels in 39 percent. The less prevalent risk factor was a fasting blood glucose over 100 mg/dl in 3.7 percent. The risk for MS increased ten fold in children with severe obesity, compared with those with overweight. Those with abdominal obesity had a 17 times higher risk of MS. Basal insulin sensitivity was significantly associated with the number of cardiovascular risk factors and the presence of MS. Conclusions: In this sample of children, fat distribution and the severity of obesity were strong determinants of MS. Waist circumference had a higher impact on MS than body mass index.

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Backgrounds: There is a high prevalence of obesity and hyperinsulinism among Chilean prepuberal children. Aim: To evaluate insulin sensitivity (IS) using fasting insulin, the Homeostasis Model Assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) in Chilean children. Material and Methods: Body mass index (BMI), total body fat percentage ( percentTBF) using the sum of 4 skin folds, abdominal obesity determined through waist circumference (WC), pubertal maturation using five Tanner stages, fasting glucose (Glu) and insulin (Ins), were measured in 354 children aged 6 to 15 years (173 males). IS was evaluated using HOMA and QUICKI. Results: IS was strongly associated with percentTBF and WC. Ins, HOMA and QUICKI were significantly correlated with BMI (r =0.412; 0.405 y -0.442, respectively), percentTBF (r =0.370; 0.367 y -0.394, respectively), and WC (r =0.452; 0.446 y -0.481, respectively). Ins and HOMA increased and QUICKI decreased significantly (p <0.0001) with age. Children in a similar Tanner stage did not have differences in Ins, HOMA and QUICKI. No differences in Ins, HOMA and QUICKI were observed between children in Tanner stages 1 and 2. However, children in Tanner stages 1 and 2, had significantly lower Ins and HOMA and higher QUICKI than those in Tanner 3 to 5 stages. The highest Ins quartile for Tanner stages 1 and 2 was 10.0 æUI/dl; for Tanner stages 3 to five, the figure was 15.6 æUI/dl. Conclusions: These results confirm the relationship of IS with BMI, percentTBF, WC and pubertal maturation. IS decreases significantly and fasting Ins levels increase approximately 50 percent with puberty. This fact must be considered for the diagnosis of hyperinsulinism and insulin resistance in children.

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BACKGROUND: There is a high prevalence of obesity and hyperinsulinism among Chilean prepuberal children. AIM: To evaluate insulin sensitivity (IS) using fasting insulin, the Homeostasis Model Assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) in Chilean children. MATERIAL AND METHODS: Body mass index (BMI), total body fat percentage (%TBF) using the sum of 4 skin folds, abdominal obesity determined through waist circumference (WC), pubertal maturation using five Tanner stages, fasting glucose (Glu) and insulin (Ins), were measured in 354 children aged 6 to 15 years (173 males). IS was evaluated using HOMA and QUICKI. RESULTS: IS was strongly associated with %TBF and WC. Ins, HOMA and QUICKI were significantly correlated with BMI (r =0.412; 0.405 y -0.442, respectively), %TBF (r =0.370; 0.367 y -0.394, respectively), and WC (r =0.452; 0.446 y -0.481, respectively). Ins and HOMA increased and QUICKI decreased significantly (p <0.0001) with age. Children in a similar Tanner stage did not have differences in Ins, HOMA and QUICKI. No differences in Ins, HOMA and QUICKI were observed between children in Tanner stages 1 and 2. However, children in Tanner stages 1 and 2, had significantly lower Ins and HOMA and higher QUICKI than those in Tanner 3 to 5 stages. The highest Ins quartile for Tanner stages 1 and 2 was 10.0 micro UI/dl; for Tanner stages 3 to five, the figure was 15.6 microUI/dl. CONCLUSIONS: These results confirm the relationship of IS with BMI, %TBF, WC and pubertal maturation. IS decreases significantly and fasting Ins levels increase approximately 50% with puberty. This fact must be considered for the diagnosis of hyperinsulinism and insulin resistance in children.

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Background:Infantile obesity is associated with metabolic disturbances (hiperinsulinism, impaired glucose, dislypidemia) that determine a higher risk of type 2 diabetes, high blood pressure and atherosclerotic vascular disease in adulthood. Insulin resistance is a central mechanism of complications of obesity and is associated to body fat mass. Aim: To investigate insulin sensitivity and its association with anthropometric and metabolic variables in obese children. Patients and methods: We studied 314 children aged 6 to 15 years. Of these, 235 had a body mass index (BMI) over the 95 percentile for age and sex (classified as obese) and 79 had a normal body mass index; 161 were pre-pubescent and 153 were pubescent. Weight, height, percentage of total body fat (% TBF) using the sum of 4 skinfolds, blood pressure (BP), waist circumference (WC), basal glucose (Glu) and insulin (Ins) were measured. Insulin sensitivity (IS) was calculated with the homeostasis model assessment (HOMA) and QUICKI index. Serum lipids, postprandial Glu and Ins were measured only in obese children. Results: BMI, WC and % TBF had an inverse and significant correlation with basal IS (p <0.001). Obese children had higher BP, basal Ins, and HOMA and a lower QUICKI index, compared to normal weight children. A low basal IS was present in 58% of obese children. Obese children with low IS had higher WC, % TBF, triglycerides, total/HDL-cholesterol ratio, basal and 2-h post glucose Gli and Ins and lower HDL-cholesterol than obese children with normal IS. In prepubescent children, the risk of a low IS was 2.43 times higher with a TBF over 33%. In pubescent children, it was 2.92 times higher with a TBF over 37%. Conclusions: Low IS in prepubescent and pubescent obese children is associated with central obesity and a higher cardiovascular risk.

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