ABSTRACT Objective: To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Subjects and methods: Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results: There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion: Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity. Objective leptinadiponectin (LAR children methods GOCS (GOCS 96 immunoassays calculated HOMAIR, HOMAIR HOMA IR , (HOMA-IR) triglycerideHDL triglyceride HDL triglycerideglucose glucose (TyG (BMI TyGBMI TyG-BMI WC (WC TyGWC. TyGWC . TyG-WC) analysis Results zscore z score adiposity age th point, point point) odds OR [OR 244 2 44 2.44 95 [CI 2.052.9. 20529 2.05 2.9 05 9 2.05-2.9) zscore, score, 164 1 64 1.64 1.272.12. 127212 1.27 2.12 27 12 1.27-2.12) Conclusion (HOMA-IR 24 4 2.4 052 2.052.9 2052 205 2.0 29 2. 0 2.05-2.9 16 6 1.6 272 1.272.12 12721 127 1.2 212 2.1 1.27-2.12 2.052. 20 2.05-2. 1. 1.272.1 1272 21 1.27-2.1 2.052 2.05-2 1.272. 1.27-2. 2.05- 1.272 1.27-2 1.27-

RESUMO Objetivo. Analisar diferenças sociodemográficas em termos de conhecimento, compreensão, uso e efeito da rotulagem nutricional entre adolescentes mexicanos e chilenos. Métodos. Foram realizadas pesquisas on-line entre adolescentes de 10 a 17 anos ao longo de 2019 (n=2631). Os participantes relataram que conheciam, compreendiam e usavam as tabelas de informação nutricional e a rotulagem frontal de embalagens específicas de seus respectivos países (Chile: rotulagem de advertência; México: valores diários de referência). Além disso, os participantes relataram sua percepção sobre a saudabilidade de um suco de fruta adoçado depois de ver uma de seis versões diferentes de rotulagem frontal (controle sem rótulo, Health Star Rating, rótulos de advertência, valores diários de referência, semáforo nutricional ou Nutri-Score) durante uma tarefa experimental. Resultados. Um maior conhecimento autodeclarado sobre nutrição foi associado a maior conhecimento, compreensão e uso de tabelas de informação nutricional e rotulagem frontal, com exceção do uso de rótulos de advertência. Os rótulos de advertência foram o tipo de rotulagem frontal mais efetivo para reduzir a percepção de saudabilidade do suco de fruta adoçado em comparação com o controle sem rótulo e outros tipos de rotulagem frontal. No Chile, o efeito dos valores diários de referência variou de acordo com a renda, enquanto no México o Nutri-Score variou de acordo com a idade. Conclusões. Os resultados sugerem que o conhecimento, a compreensão, o uso e o impacto da rotulagem nutricional variam de acordo com fatores demográficos, favorecendo uma renda mais alta e conhecimento sobre nutrição. Apesar disso, é provável que os rótulos de advertência tenham um impacto positivo sobre o conhecimento e os comportamentos relativos à nutrição entre adolescentes mexicanos e chilenos, independentemente do grupo sociodemográfico a que pertencem.

RESUMEN Objetivo. Examinar las diferencias sociodemográficas por lo que respecta al conocimiento, la comprensión, el uso y el efecto de las etiquetas nutricionales en adolescentes de México y Chile. Métodos. En el 2019 se efectuó una encuesta en línea en adolescentes (10 a 17 años) (n=2631). Los participantes indicaron su conocimiento, comprensión y uso de los cuadros de información nutricional y los etiquetados frontales específicos de los empaques de su país (en el caso de Chile, las etiquetas de advertencia, y en el de México, las guías diarias de alimentación (GDA). Asimismo, se llevó a cabo un experimento en el que los participantes indicaron su percepción de lo saludable que era una bebida de fruta azucarada después de ver una de sus seis versiones con diferentes etiquetas frontales en los envases (control sin etiqueta, calificación de producto saludable mediante estrellas Health Star, etiquetas de advertencia, GDA, colores del semáforo, o sistema Nutri-Score). Resultados. El autorreporte de un mayor conocimiento sobre nutrición por parte de los participantes se asoció a un mayor conocimiento, comprensión y uso de los cuadros de información nutricional y los sistemas de etiquetado frontal, excepto en el caso del uso de las etiquetas de advertencia. Las etiquetas de advertencia fueron el sistema de etiquetado frontal más eficaz para reducir la percepción saludable del producto con respecto a la bebida de fruta azucarada, en comparación con la ausencia de etiqueta y el resto de los etiquetados frontales. En Chile, el efecto de las GDA variaba en función de la adecuación del ingreso, mientras que en México el efecto del Nutri-Score difería según la edad. Conclusiones. Los resultados sugieren que el conocimiento, el uso, la comprensión y el efecto de las etiquetas nutricionales difieren entre los distintos grupos demográficos, de tal manera que son más favorables en las personas con mayores ingresos y conocimientos de nutrición. A pesar de esto, es probable que las etiquetas de advertencia tengan un impacto positivo sobre los conocimientos y los comportamientos relacionados con la nutrición en los adolescentes de México y Chile, con independencia de los grupos sociodemográficos de los que forman parte.

ABSTRACT Objective. To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods. Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task. Results. Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions. Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.

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

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

Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.

Resumen Actualmente se recomienda el uso de cefazolina para determinar la susceptibilidad a cefalosporinas orales de primera generación en cepas de enterobacterias en ITU no complicada. Nuestro objetivo fue establecer la susceptibilidad a cefalosporinas orales en cepas urinarias según puntos de corte para cefalotina o cefazolina y la correlación de susceptibilidad entre cefazolina y cefadroxilo. Se estudió la concordancia entre cefalotina y cefazolina en 52 cepas por método de Kirby-Bauer y Vitek XL. En Escherichia coli fue de 0% para VitekXL y 50% para Kirby-Bauer. La concordancia entre cefazolina y cefadroxilo fue 95,6%. En el laboratorio debiera usarse cefazolina para determinar susceptibilidad a cefalosporinas orales de primera generación. La concordancia entre cefazolina y cefadroxilo sugiere que cefazolina podría predecir susceptibilidad para cefadroxilo.

Background: It has been shown that excess weight gain during childhood is associated with a greater risk of obesity; this relationship may be mediated by growth in height. Aim: To quantify the associations between z scores for body mass index (BMIZ) and height for age (HAZ) from birth to 5 years of age and to assess how this association varies according to age and adiposity. Material and Methods: Weight and height were recorded at 11 occasions from birth on a cohort of1089 Chilean five year-old children with a birth weight > 2500 g. BMI, BMIZ, HAZ and prevalence of obesity were calculated. We determined the cross-sectional association between BMIZ and HAZ for the total sample and by 3 BMI Z categories, using Pearson correlation. We determined the probability of obesity according to four HAZ categories. Results: Obesity increased continuously reaching approximately 16% at 5 years. Stunting was virtually nonexistent. No association between BMIZ and HAZ was observed at birth, while at 1 and 2 months, leaner infants had lower stature. No association between theseparameters was observed between 6-24 months, while after 3 years, a clear relationship was observed. Conclusions: The probability of a preschool child of being obese is less than 10% with a HAZ is < 0. Nevertheless, children with heights above the median (even within the normal range) have an increased risk of obesity, especially after 3 y of age. Between 0-5 years, the relationship between weight and height varies by age and adiposity.

This article describes the process of implementation of WHO growth standards in the Chilean National Nursery Schools Council Program (JUNJI) and how will influence the beneficiary's nutritional status estimates. Using the 2009 anthropometric data collected by the program, we compare nutritional estimates using the NCHS 1978 reference and the WHO 2006 growth standards. The use of the new WHO growth standards will determine a decrease in under nutrition (weight for height z score < -2 DS) in infants from 1.1 to 0.5% while in all children less than 5y of age will increase stunting (height for age z score < -2 SD; from 5.7 to 7.3% in children less than 2y and from 2.3 to 4.2% in children 2 to 5y), and overweight (weight for height > lSD from 19.6 to 29% in children less than 2y, and from 20.6 to 28.9 in children 2 to 5y) and obesity (weight for height>2 SD; from 8.2 to 11.4% in children less than 2y and from 8.3 to 13.5% in children 2 to 5y ). The WHO growth standards describe the growth of children that receive optimal feeding and that live in optimal conditions. The implementation of the WHO growth curves at the JUNJI program is taken place in a sequential and well-planned way that will allow not only to optimize growth monitoring at the program but also to promote short and long-term health of the beneficiaries.

En el presente artículo se describe el proceso de implementación de las nuevas curvas de crecimiento OMS a la Junta Nacional de Jardines Infantiles de Chile (JUNJI) y el efecto que tendrá esta incorporación en las estimaciones del estado nutricional de los beneficiarios. En base a la información antropométrica recolectada en el programa durante el año 2009 se realiza una comparación entre la referencia NCHS 1978 y las OMS 2006 y se muestra que con las nuevas curvas disminuirá la prevalencia de desnutrición (peso para la talla <-2 DS) en los lactantes de 1.1a 0.5% mientras que en todos los menores de 5 años aumentará la prevalencia de talla baja (< -2DS; de 5.7 a 7.3% en menores de 2 años y de 2.3 a 4.2% de 2 a 5 años), y de sobrepeso (> 1 DS peso talla, de 19.6 a 29.0% en menores de 2 años y de 20.6 a 28.9% de 2 a 5 años) y obesidad (> 2 DS peso talla, de 8.2 a 11.4% en menores de 2 años y de 8.3 a 13.5% de 2 a 5 años). Los estándares de crecimiento OMS describen la forma en que debieran crecer los niños de cualquier parte del mundo si es que fueran alimentados y vivieran en condiciones óptimas. Su implementación en la JUNJI, de manera programada y secuencial, permitirá optimizar el monitoreo del crecimiento de los beneficiarios promoviendo una mejor salud en el corto y largo plazo.

Como los resultados del estado nutricional que entregan instituciones chilenas que recolectan datos antropométricos de su población bajo control, muestran diferentes magnitudes en el incremento del porcentaje de obesidad entre preescolares de 4 años y escolares de 1er grado, quisimos verificar la real magnitud de este aumento. Este estudio se basó en una investigación longitudinal que comenzó el 2006 con 1100 niños de 3 años, evaluados por el INTA a los 4, 5 y 6 años. Se determinó el estado nutricional a esas edades según Z IMC y referencias OMS 2006/2007. La información recogida sirvió además, para determinar la concordancia entre los datos antropométricos recogidos por profesores de escuelas públicas en escolares de 1er grado el 2009 (base JUNAEB) y los mismos niños evaluados paralelamente por el INTA (base INTA). La muestra incluyó a 474 niños de 6 años. No se observaron diferencias entre los promedios de Z IMC y Z talla/edad. El grado de concordancia entre los Z IMC fue bueno (rho= 0,73), sin embargo hubo diferencias en la clasificación nutricional, ya que el porcentaje de bajo peso fue significativamente mayor en la base JUNAEB (9,5% vs 3,6% ), mientras que el porcentaje de obesidad fue menor en la base INTA, 17,5% vs 19,2% (diferencia no significativo). A los 4 y 5 años los porcentajes de obesidad de estos niños fueron 13,3% y 15,7% respectivamente (datos INTA). Por la trayectoria observada, es más probable que el alza en el porcentaje de obesidad entre los 4 y 6 años fue de 4 puntos porcentuales y no de 6, tal como indican los datos INTA.

Because the results of the nutritional status released by Chilean institutions which collect anthropometric data on their population under control, show different increments in the prevalence of obesity between preschoolers and children in 1st grade, we decided to verify the real magnitude of this increase. This study is based on a longitudinal investigation which began in 2006 and included 1100, three-year old children, which we evaluated when they were 4, 5 and 6 y. The nutritional status was determined according to BMI Z and WHO References 2006 / 2007. The information was also used to determine the concordance between the anthropometric data collected on first graders by teachers from public schools in 2009 (JUNAEB data set) and the same children assessed in parallel by INTA (INTA data set). The sample included 474, six-year olds. No differences were found between the average BMI Z and HAZ of the two data sets, and the degree of concordance between the BMI Z´s was good (rho = 0.73), however there were differences in the nutritional status, since the prevalence of low weight was significantly greater when assessed with JUNAEB´s data (9.5% vs 3.6% ), while that for obesity was lower with INTA´s data, 17.5% vs. 19.2% (not significantly different). At 4 and 5 y, obesity prevalence of the children was 13.3% and 15.7% respectively (INTA´s data). Considering the observed nutritional trajectory, it is likely that the rise in obesity between 4 and 6 y of age, was 4 percentage points and not 6, as was determined with INTA´s data.

Históricamente, el monitoreo nutricional de los programas de ayuda nutricional infantil ha utilizado indicadores de peso-edad y talla-edad para detectar deficiencias nutricionales. Recientemente, dado el aumento de la obesidad infantil se ha recomendado también incorporar mediciones de peso-talla y de circunferencia de cintura. Sin embargo, en preescolares no está claro cuál es el grado de concordancia existente entre estos indicadores. Los objetivos de este artículo son: reportar el estado nutricional de niños beneficiarios de la Junta Nacional de Jardines Infantiles de Chile y evaluar la concordancia entre medidas antropométricas de obesidad general y obesidad central en este grupo. En 574 niñas y 580 niños entre 3,0 y 5,9 años de edad se midió peso, talla, circunferencia de cintura y de cadera y 5 pliegues. Los puntajes Z se estimaron según los estándares de crecimiento OMS 2006. Se definió obesidad general como Z P/T ó Z IMC/E ≥+ 2DE y obesidad central como circunferencia de cintura ≥ percentil 90 para el sexo y la edad según NHANES III. La prevalencia de obesidad fue cercana al 16% con ambos indicadores, mientras que la de obesidad central fue 15%. La concordancia entre indicadores antropométricos de obesidad general y central fue buena (Kappa entre 0,6 y 0,7). En conclusión, en niños beneficiarios de un programa de ayuda social chileno se encontró una alta prevalencia de obesidad y obesidad central. En este grupo, existe una buena concordancia entre indicadores antropométricos de obesidad general y obesidad central, lo que sugiere que no se justificaría la incorporación de mediciones de circunferencia de cintura al monitoreo nutricional del programa.

Historically, the anthropometric assessment of nutritional welfare programs has been targeted to assess nutritional deficiencies based on weight-to-age and height-to-age indicators. Recently, given the increase on childhood obesity, it has been also recommended the measurement of indicators of obesity (i.e. weight-to-height) and central obesity (i.e. waist circumference). However, the agreement of these indicators in preschool children is unclear. The aims of this study were: 1) assess the nutritional status of children attending the Chilean National Nursery Schools Council Program (JUNJI); 2) assess the agreement between general and central obesity anthropometric measurements in these children. In 574 girls and 580 boys, 3.0 to 5.9 years old, we measured: weight, height, waist and hip circumference, and five skinfolds. We used the WHO 2006 growth standards to estimate Z-scores. We defined general obesity as WHZ or BAZ= 2, and central obesity as waist circumference ≥ 90 percentile of NHANES III. The participants were on average slightly shorter but considerably heavier and obese than the reference populations. Prevalence of general obesity was close to 16% with both indicators while prevalence of central obesity reached 15%. There was good agreement among general obesity indicators and central obesity indicators (Kappa = 0.6-0.7). In summary, we found a high prevalence of obesity and central obesity among Chilean preschool children beneficiaries of a welfare program. At this age, there was a good agreement among general obesity indicators and central obesity indicators. These results suggest that waist circumferences measurements should not be incorporated to the program.