Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Current evidence supports the notion that exposure to various environmental conditions in early life may induce permanent changes in the epigenome that persist throughout the life-course. This article focuses on early changes associated with obesity in adult life. A review is presented on the factors that induce changes in whole genome (DNA) methylation in early life that are associated with adult onset obesity and related disorders. In contrast, reversal of epigenetic changes associated with weight loss in obese subjects has not been demonstrated. This contrasts with well-established associations found between obesity related DNA methylation patterns at birth and adult onset obesity and diabetes. Epigenetic markers may serve to screen indivuals at risk for obesity and assess the effects of interventions in early life that may delay or prevent obesity in early life. This might contribute to lower the obesity-related burden of death and disability at the population level. The available evidence indicates that epigenetic marks are in fact modifiable, based on modifications in the intrauterine environment and changes in food intake, physical activity and dietary patterns patterns during pregnancy and early years of adult life. This offers the opportunity to intervene before conception, during pregnancy, infancy, childhood, and also in later life. There must be documentation on the best preventive actions in terms of diet and physical activity that will modify or revert the adverse epigenetic markers, thus preventing obesity and diabetes in suceptible individuals and populations.

La evidencia indica que la exposición a diversas condiciones ambientales en etapas tempranas de la vida puede inducir alteraciones persistentes en el epigenoma. Los estudios epigenómicos en sujetos obesos han permitido evaluar el papel de los mecanismos epigenéticos en el origen y desarrollo de la obesidad. La presente revisión aborda estudios que dan cuenta de la asociación entre la obesidad y metilación global del genoma (ADN), analizando el potencial impacto de intervenciones previas y posteriores al nacimiento que afectan la metilación del ADN y la obesidad en etapas más avanzadas de la vida. Estudios realizados principalmente en leucocitos, han logrado identificar sitios del ADN diferencialmente metilados asociados con obesidad. Estudios hasta la fecha no han demostrado que dichos cambios en metilación sean revertidos luego de bajar de peso. Esto contrasta con resultados iniciales en este campo, que sugieren que existirían marcadores epigenéticos presentes desde el nacimiento que permitirían definir el riesgo de obesidad durante el curso de la vida. La evidencia actual sugiere que algunas marcas epigenéticas son modificables, basándonos en la exposición en la vida intrauterina y también por los hábitos dietarios y de actividad fisica durante las etapas del crecimiento y en la adultez. Esto sugiere que existe la oportunidad de intervenir durante la gestación o en la vida posnatal temprana, que modificaría los perfiles epigenéticos desfavorables e idealmente contribuiría a prevenir la obesidad en los sujetos o poblaciones susceptibles.

Intrauterine growth restriction (IUGR) is a perinatal condition affecting foetal growth, with under the 10th percentile of the weight curve expected for gestational age. This condition has been associated with higher cardiovascular and metabolic risk and post-natal obesity. There are also major changes in placental function, and particularly in a key molecule in this regulation, nitric oxide. The synthesis of nitric oxide has numerous control mechanisms and competition with arginase for their common substrate, the amino acid L-arginine. This competition is reflected in various vascular diseases and particularly in the endothelium of the umbilical vessels of babies with IUGR. Along with this, there is regulation at the epigenetic level, where methylation in specific regions of some gene promoters, such as the nitric oxide synthase, regulating their expression. It is currently of great interest to understand the mechanisms by which diseases such as IUGR may be conditioned, particularly by maternal nutritional and metabolic conditions, and epigenetic mechanisms that could eventually be modifiable, and thus a focus of interest for health interventions.

La restricción del crecimiento intrauterino (RCIU) es una enfermedad perinatal que afecta la trayectoria de crecimiento fetal, llegando a estar bajo el percentil 10 del peso esperado para la edad gestacional. Esta condición se ha asociado con un mayor riesgo cardiovascular, metabólico y de obesidad en la vida posnatal. Junto con ello se observan cambios importantes en la función placentaria, y particularmente en una molécula clave en esta regulación, que es el óxido nítrico. La síntesis del óxido nítrico presenta numerosos mecanismos de control, así como de competencia por su sustrato común, el amino ácido L-arginina, con la arginasa. Esta competencia queda de manifiesto en diversas enfermedades vasculares, y particularmente en el endotelio de los vasos umbilicales de fetos con RCIU. Junto con ello se puede observar una regulación a nivel epigenético, donde la metilación en regiones específicas de los promotores de algunos genes, como el de la sintasa del óxido nítrico regulan su expresión. Es de gran interés en la actualidad conocer los mecanismos por los cuales enfermedades como la RCIU pudieran estar condicionadas particularmente por condiciones nutricionales y metabólicas maternas y los mecanismos epigenéticos que pudieran ser eventualmente modificables y, por tanto, foco de interés para intervenciones en salud.

Allergic diseases and asthma are the result of complex interactions between genetic predisposition and environmental factors. Asthma is one of the most prevalent chronic disease among children. In this article we review some environmental factors like: allergen exposition, tobacco, bacteria, microbial components, diet, obesity and stress, which influences during intrauterine and infancy life in the epigenetic regulation of asthma and allergic diseases. The review has been done in three models: in-vitro, animal and human.

Las enfermedades alérgicas y el asma son el resultado de complejas interacciones entre la predisposición genética y factores ambientales. El asma es una de las enfermedades crónicas más prevalentes en niños. En este artículo se revisan algunos factores ambientales como la exposición a alérgenos, tabaco, bacterias, componentes microbianos, dieta, obesidad y estrés, que intervienen durante la vida intrauterina y la infancia en la regulación epigenética de las enfermedades alérgicas y el asma. La revisión se realiza en tres tipos de modelos: in-vitro, animales y humanos.

Current evidence supports the notion that alterations in intrauterine growth and during the first years of life have a substantial effect on the risk for the development of chronic disease, which in some cases is even higher than those due to genetic factors. The persistence and reproducibility of the phenotypes associated with altered early development suggest the participation of mechanisms that would record environmental cues, generating a cellular reprogramming (i.e. epigenetic mechanisms). This review is an introduction to a series of five articles focused on the participation of epigenetic mechanisms in the development of highly prevalent chronic diseases (i.e. cardiovascular, metabolic, asthma/allergies and cancer) and their origins in the foetal and neonatal period. This series of articles aims to show the state of the art in this research area and present the upcoming clues and challenges, in which paediatricians have a prominent role, developing strategies for the prevention, early detection and follow-up.

La asociación entre factores ambientales presentes durante el desarrollo embrionario/fetal y enfermedades que puedan presentarse durante la vida representa un campo de creciente interés. En este contexto la evidencia actual apoya fuertemente que alteraciones en el crecimiento intrauterino y durante los primeros años de vida presentan una fuerte influencia en el riesgo de padecer enfermedades crónicas que en muchos casos pudiera ser mayor que la carga genética del paciente. La persistencia y reproducibilidad de los fenotipos asociados a alteraciones en el desarrollo temprano sugieren la participación de mecanismos moleculares que registran dichas modificaciones (i.e. mecanismos epigenéticos) generando una «reprogramación» celular y fisiológica. Esta revisión es la introducción a una serie de 5 artículos en torno a la participación de los mecanismos epigenéticos en el desarrollo de enfermedades crónicas (i.e. cardiovasculares, metabólicas, asma/alergias y cáncer) y su relación con el origen de dichas enfermedades en etapas tempranas del desarrollo. El objetivo de esta serie es mostrar el estado actual de esta área de la investigación y presentar los desafíos e interrogantes futuros en los cuales la pediatría tiene un papel preponderante, desarrollando estrategias para la prevención, detección precoz y seguimiento.

Background: Nowadays, Chilean population tends to replace or eat a lower amount of food with health protective properties and a higher proportion of unhealthy foodstuff. Aim: To describe and compare the intake of dairy products, sugary drinks and processed juices among Chileans. Material and Methods: An analysis of data compiled from the Survey on Household Budget and Expenses carried out by the Chilean National Institute of Statistics (INE), using a representative sample of households. The sample was surveyed between 1987 and 2007. The analysis was performed for all households surveyed and for households belonging to the second (highest incomes) and fifth quintile (lowest incomes). The Chilean Food Guide and the international recommendations of the Institute of Medicine of the United States and the American Heart Association (in the case of sugars) were used as reference. Results: Even though the intake of dairy products increased during the period of the survey, it was lower than the intake of sugary drinks and juices, which increased. Also, calcium recommendations were not covered. On the other hand, the intake of added sugars increased to figures over current recommendations. Conclusions: The intake of dairy products and calcium is below the recommended amounts established by international organisms, and added sugars intake is greater than the advisable levels recommended by international organisms.

Background: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. Aim: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. Material and Methods: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. Results: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. Conclusions: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.

Background: Processed foodstuff may have a lower nutritional value than natural products. Aim: To analyze the impact of ready-to-consume products on diet quality of Chilean households. Material and Methods: A national representative sample of 10,096 households, based on the 6th Survey on Household Budget and Expenses (VI Encuesta de Presupuestos y Gastos Familiares, 2006-2007), was studied. Foodstuffs were classified as follows: 1) Unprocessed foods or minimally processed foods (G1); 2) Processed culinary ingredients (G2); and 3) Ready-to-consume products (G3). Calorie contribution and energy availability of each household food group, was calculated. The nutritional profile of the national food basket was calculated and compared with two simulated baskets (G3 vs G1+G2), based on international nutritional recommendations. Results: Overall energy availability was of 1,885 kcal per capita/ day; 24% derived from unprocessed foods (G1), 21% from processed culinary ingredients (G2) and 55% from ready-to-consume products (G3), whose proportion increased along with income level. The 2007 national food basket contained an excess of total fat (34% vs 30%), free sugars (16% vs 10%), energy density (2.1 vs 1.3 kcal/gram) and a low amount of fiber (8.4 vs 12.5 g/1,000 kcal). The basket consisting in ready-to-consume products (G3) had a higher percentage of carbohydrates (61% vs 46%) than the basket consisting in unprocessed foods and ingredients (G1 + G2). It also had a higher percentage of free sugars (17% vs 15%), less dietary fiber (7 vs. 10 g/1,000 kcal) and, above all, a higher energy density (2.6 vs 1.6 kcal/g). Conclusions: The Chilean dietary pattern, based on ready-to-consume products (G3), is affecting the nutritional quality of the diet.

El cáncer representa el 13% de causas de muerte anuales a nivel mundial y es la segunda causa en las Américas con 1,2 millones de muerte en el 2008. En Chile represento el 25,6 % del total de muertes en el 2007. La obesidad se relaciona con un tercio de todos los cánceres, y está asociada con la grasa corporal, grasa abdominal, aumento de peso en la edad adulta, todos factores modificables a través de un patrón saludable de dieta y actividad física. El objetivo fue analizar las recomendaciones de Salud Pública, emitidas por el Fondo Internacional para la Investigación del Cáncer (WCRF) y el Instituto Americano de Investigación del Cáncer (AICR) en el año 2007 para la prevención del cáncer. Comparar las recomendaciones del informe Alimentación, Nutrición y actividad física y la prevención del cáncer: una perspectiva mundial“, con la situación nacional en relación a estas recomendaciones. Luego, se proponen recomendaciones nacionales en concordancia con las propuestas del WCRF. El análisis revela que Chile a nivel poblacional presenta riesgos de cáncer asociados con estilos de vida; dieta, Indice de Masa Corporal y sedentarismo. El patrón de consumo alimentario y el perfil nutricional y las conductas asociadas a los estilos de vida de la población no reflejan las recomendaciones de organismos internacionales, sobre los consumos de productos protectores (legumbres, hortalizas, frutas altos en antioxidantes, fibra) y de los de alto riesgo (bebidas y jugos azucarados, procesados altos en sodio, grasas totales). Se requiere educar a la población sobre alimentación saludable y estilos de vida que mantengan la salud.

Cancer is one of the most important causes of death in the world corresponding to 63% annually, is the second in the Americas with 1.2 million deaths in 2008 and Chile in 2007 representing 25.6% of all deaths. Obesity is associated with a third of all cancers and is associated with body fat, abdominal fat, weight gain in adulthood, all modifiable factors through a healthy diet pattern and physical activity. The aim was to analyze the recommendations of Public Health issued by the International Fund for Cancer Research (WCRF) and American Institute for Cancer Research (AICR) in 2007 to prevent cancer. Compare the recommendations of the report Food, Nutrition and physical activity and cancer prevention: a global perspective, "with the national situation regarding these recommendations. Then, we propose national recommendations in accordance with the proposals of WCRF. The analysis reveals that Chile has a population level cancer risks associated with lifestyle, diet, body mass index and physical inactivity. The pattern of food consumption and nutritional profile and behaviors associated with the lifestyles of the population does not reflect the recommendations of international organizations, on the consumption of protective (vegetables, fruits high in antioxidants, fiber) and high risk (sugary drinks and juices, processed, high in sodium, total fat). Is required to educate people about healthy eating and lifestyles to maintain health.

Infant feeding habits are essential for child growth and development, as well as reducing various chronic disease risks; they can also alter later preferences of food. Obesity, allergies and other chronic diseases related to nutrition have become the most frequent problems in Chilean children. There is a lot of recent evidence, both international and domestic, about infant feeding habits, which forces an update to the 2004 Chilean guidelines. This study updates and proposes new feeding recommendations for the Chilean population during the first two years of life.

Los modos de alimentación adquiridos por el lactante son centrales para su crecimiento y desarrollo, así como para la disminución del riesgo de diversas enfermedades crónicas; pueden alterar además las preferencias alimentarias en otras edades. La obesidad, las alergias y otras enfermedades crónicas asociadas a la nutrición han pasado a ser los problemas más prevalentes en los niños chilenos. Hay abundante evidencia científica reciente tanto internacional como nacional acerca de los modos de alimentación del lactante, que están haciendo indispensable una actualización de las guías chilenas de alimentación del año 2004. Este artículo actualiza y propone nuevas recomendaciones de alimentación para población chilena durante los primeros dos años de vida.

Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. Aim: To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. Material and Methods: Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and > 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and > 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. Results: SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL > 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. Conclusions: Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels.

Background: Obesity is a risk factor for the development of certain types of cancer. Aim: To estimate the proportion of cancers potentially attributable to obesity in men and women in Chile based on the calculation of population attributable fractions (PAF %). Material and Methods: Cancer sites studied were those where obesity is a known risk factor based on the updated World Cancer Research Fund (WCRF) analysis. Namely, colorectal, endometrium, esophagus, breast, pancreas, kidney and gallbladder cancers were analyzed. Overall and specific PAFs% were calculated for cancer sites and sex from known estimates of relative risk and national prevalence of overweight and obesity. Results: The overall estimates of cancer PAF% for obesity were approximately 20%, without differences between men and women. Highest cancer PAFs% were for endometrial (47%) in women, and esophageal (35%) and pancreatic (31%) in men. The largest sex differences in PAFs% were for gallbladder (higher in women) and colorectal (higher in men). Results are closer to those reported from developed countries (USA and United Kingdom) than those from developing countries (Brasil, China). Conclusions: In Chile about 20% of all cancers could be prevented by obesity prevention and control strategies.

The main diet-related cancers include colorectal, lung, breast in (postmenopausal) women, stomach, esophagus, prostate and pancreas. After tobacco, obesity is the leading cause of cancer; it accounts for one third of all cancers. Cancer is associated with high total body fat, abdominal fat and weight gain in adult life. These are all potentially modifiable risk factors. Consumption of a "healthy diet" and living an "active life" can significantly reduce the risk of cancer. The aim of this study was to analyze the recommendations published by the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) for the prevention of cancer in 2007. We compared the recommendations of Food, Nutrition and Physical Activity and the Prevention of Cancer: a global perspective", with the national situation in Chile, analyzing the national report on the prevalence of risk factors. Our main finding was that the pattern of consumption and lifestyles differ markedly from the WCRF recommendations: we observed an over consumption of sugary drinks and high intake of processed foods high in sodium and total fat and low consumption of legumes, vegetables, fruits high in antioxidants and fiber that protect from cancer. Chile has an increased cancer prevalence which is associated with poor quality diets, rising mean body mass index and a sedentary behavior. We recommend the strengthening programs to promote healthy diets and active living, in order to reduce cancer risk.