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Introduction: Vascular endothelium is a target organ in metabolic syndrome. Ultrasound measurement of intimae-media thickness (IMT) is used in adults to predict cardiovascular risk, but normal values in children are unknown. Objective: To describe arterial intima-media thickness in healthy children, by means of an ultrasonographic technique and a specific software. Subjects and Methods: Seventy-four healthy children, 39 males, ages 5-15 y.o., body mass index (BMI) 10-85 percentile were selected from an upper-middle socioeconomic background. Subjects were grouped by age. Three measurements were carried out to each subject at the middle third of the right common carotid for maximal intima-media thickness using a Phillips iU22 ultrasound system; a 12-5 MHz lineal transducer and QLAB advanced quantification software, which includes a specific program for automated IMT measurements, were used. Weight, stature, BMI, and abdominal circumference were registered. Results: No significant differences in the IMT values according to age or gender were found. Median IMT was 0.41 mm (0.40-0.56 mm); 5 children presented IMT 0.50-0.56 mm (> 75th percentile). The median IMT for those children with abdominal circumference < 50th percentile was the same for those over 50th percentile (0.41 mm). Conclusions: Measurements of carotid intima-media thickness for healthy Chilean children were found to be in the expected range, in relation with adult known values.

Adolescence is a dynamic period of the life cycle, with significant physical, psychological and social changes, leading to autonomy and independence in eating behaviors. During this time, there is an increased risk in nutritional behavior, including excessive intake of calories, increased consumption of fat, cholesterol, and simple carbohydrates, and nutrient deficiencies such as calcium. In addition, other behaviors are at risk, including disorganized mealtimes, eating outside the home, and the onset of eating behavior disorders and addictions (caffeine, alcohol). It is necessary to develop preventive educational programs including physical activity among adolescents, to promote healthy behaviors into adulthood. Significant literatee in Chile and South America is reviewed.

1. Medico- pediatra, Profesor Titular, Director Departamento de Pediatria, Facultad de Medicina Campus Centro, Universidad de Chile; Director Programa de Formacion en Especialidad Nutricion Clinica Pediatrica, Facultad de Medicina, Universidad de Chile. Miembro de la Rama de Nutricion, Sociedad Chilena de Pediatria.2. Medico Pediatra, Presidenta de la Rama de Nutricion, Sociedad Chilena de Pediatria; Profesor Asistente, Departamento de Pediatria Campus Oriente, Facultad de Medicina, Universidad de Chile.3. Medico pediatra, Secretaria Rama de Nutricion, Sociedad Chilena de Pediatria; Hospital Luis Calvo Mackenna.Trabajo recibido el 07 de enero de 2011, aceptado para publicacion el 14 de febrero de 2011.Correspondencia a:Dra. M. Luisa Aguirre C.E-mail: maguirre@med.uchile.cl

Changing the Quality of Milk of the National Complementary Food Program in Chile,2009 The National Complementary Food Programs have been one of the stratregies applied for preventing theprotein-energy undernutrition and some specific nutrient deficiencies, during the last decades in Chile. Toprovide a powdered cow‘s milk to the underprivileged families has been one targets for the first years oflife, which includes the fortification with iron, zinc, copper and vitamin C. The evident improvement inrecent years of nutritional markers (prevalence of protein- malnutrition, deficiencies of Fe, Zn and Cu)requires to reassess the Programs. Some possible ways for improving the quality of milk to be provided arediscussed, on the basis of avoiding the interference of exclusive breast milk.( Key words: Nutrition, program, PNAC, food, undernutrition).Rev Chil Pediatr 2009; 80 (6): 508-512 RESUMEN Los Programas de Alimentacion Complementaria para enfrentar la desnutricion y carencias nutricionalesespecificas de la poblacion mas vulnerable, tienen varias decadas de desarrollo en Chile. La entrega de unaleche de vaca en polvo (Purita

Introducción: Entre las modalidades de investigación científica en Medicina, los ensayos clínicos son los que tienen mayor importancia e impacto. Objetivo: Analizar los artículos científicos fase III y IV en temas pediátricos, publicados en Revistas con o sin índice de impacto, en el decenio 1994-2003. Métodos: A partir de la base electrónica de publicaciones científicas ISI de PubMed y de la revisión de las Revistas nacionales no indexadas, se analizaron los estudios clínicos Fase III o Fase IV que incluían a sujetos £ 18 años. Se consignó: autores, institución ejecutora, área pediátrica analizada. Resultados: Se encontraron 71 trabajos en revistas ISI y 11 trabajos en revistas nacionales no ISI (x = 8,2 trabajos/año). Del total, 40 artículos aparecen bajo el alero de la Universidad de Chile, 16 de la Universidad Católica, 4 de la Universidad de Santiago, 3 de la Universidad de Valparaíso, 2 de la Universidad de Concepción, 1 de la Universidad de La Frontera y 1 de la Universidad Austral. Además hubo 6 trabajos del Centro de Vacunas, 6 de Hospitales pediátricos, 2 de Clínicas privadas y 1 del Centro de Planificación Familiar. Las áreas temáticas principales fueron: Nutrición (n = 17), Endocrinología (n = 11), Broncopulmonar (n = 10), Vacunas (n = 8), Infectología (n = 6), Neonatología (n = 5) y Gastroenterología (n = 4). La mayoría de los trabajos fueron efectuados por grupos de investigación conocidos. Conclusiones: Los estudios clínicos fase III y IV son de baja frecuencia en Chile, con tendencia estacionaria en la última década. La mayoría de los trabajos han sido efectuados por las Universidades y por grupos de investigación consolidados. Las áreas temáticas más frecuentes fueron: Nutrición, Endocrinología, Vacunas y Broncopulmonar. Se requieren estrategias para mejorar el nivel de investigación científica pediátrica en Chile Introduction: The development of scientific research faces severe difficulties in Latin America, especially for those studies requiring more complex methodological designs. Objective: To analyze the clinical studies, performed in children or adolescents in Chile, published between 1994 and 2003. Methods: Review of all papers with clinical studies phase III or IV available at the PUBMED database or at the national non ISI Journals between 1994-2003, studying children or adolescents under 18 years in Chile. Results: 82 papers were published, 71 in ISI journals and 11 in non ISI journals; 82% of these were carried out at Universities; 40 at the University of Chile, 16 at the Catholic University, 4 at the University of Santiago, 3 at the University of Valparaíso, 2 at the University of Concepción, 1 at the University La Frontera, and 1 at the Austral University. Other papers were published by the Vaccination Center, 6 by Paedriatric Public Hospitals, 2 by private clinics and 1 by the Familiar Planification Center. The paedriatric specialities more frequently associated with these publications were nutrition 17, endocrinology 11, respiratory diseases 10, vaccines 8, infectious diseases 6, neonatalogy 5, and gastroenterology 4. Conclusions: We conclude that the rate of clinical studies performed in Chile is low, they are mainly performed by Universities and established academic teams. Strategies to improve the magnitude of research are required

Los patrones de alimentación adquiridos durante los primeros años son importantes en el crecimiento y desarrollo y pueden afectar las preferencias alimentarias en etapas posteriores. Los problemas nutricionales en Chile han cambiado en los últimos años, la prevalencia de obesidad infantil ha aumentado. Por otro lado, con la información científica disponible los organismos internacionales han propuesto modificaciones a los requerimientos de energía y de otros nutrientes para las distintas edades. Este artículo actualiza y propone nuevas recomendaciones de alimentación para población chilena durante los primeros dos años de vida Feeding patterns during infancy are important for growth and development and may also affect preferences and eating behavior later in childhood. The nutritional challenges have changed in Chile over the last few years, with an evident increase in childhood obesity along with a decrease in protein-energy malnutrition. Using scientific evidence international expert committees have proprosed modifications of energy requirements. This paper reviews and proposes new recommendations in children under 2 year alimentation

Objetivo: Determinar la calidad microbiológica de dos fórmulas enterales (FE): ADN® polvo (P) y ADN® líquido (L) listo para utilizar. Método: en 4 hospitales de Santiago se realizó recuento de mesófilas (Me), coliformes totales (CT) y coliformes fecales (CF) en un total de 144 muestras de FE, obtenidas a los tiempos 0, 2, 4, 6, 10, 24 y 48 horas. Los estándares de calidad microbiológica (ECM) utilizados al tiempo cero fueron: < 102 UFC/ml de Me y ausencia de CT, y a los restantes tiempos: < 103 UFC/ml de Me; < 10 UFC/ml de CT y ausencia de CF. Resultados: Los porcentajes de cumplimiento de los ECM de ADN®-P para Me fueron: 42%, 75%, 50%, 33% y 25%, y para CT fueron: 83%, 91,5%, 83%, 75% y 42% al tiempo 0, 2, 4, 6 y 10 horas respectivamente. El cumplimiento de los ECM de ADN®-L para Me fue 100% al tiempo 0, 2, 4 y 6 horas, 92% a las 10 horas; para CT fue de 100% en todos los tiempos evaluados. El recuento de CT fue significativamente superior en las muestras de ADN®-P desde las cuatro horas en adelante. El ADN® -L abierto y refrigerado a 4° C cumplió con los ECM hasta las 48 horas de estudio. Conclusiones: La mayor adhesión de las FE de ADN®-L a los ECM sugieren privilegiar su uso. Las FE de ADN®-P y de ADN®-L pueden estar colgadas a temperatura ambiente hasta por 4 y 10 horas respectivamente. La conservación de cajas Tetra Pak de ADN®-L abiertas y refrigeradas a 4° C permite su uso hasta las 48 horas Objective: to determine the microbiological quality of 2 ready to use enteral formulas ADN powder (P) and ADN liquid (L). Methods: the study was carried out in 4 hospitals in Santiago. 144 samples were cultured at time 0 preparation), 2, 4, 6, 8 and 10 hours after preparation. At 24 and 48 hours samples were taken from L kept at 4° C. Counts of mesophils (Me), total coliforms (TC) and faecal coliforms (FC) were measured. The microbial quality standards (MQS) were at time 0 < 1 x 102 UFC/ml of Me and no TC, at time 2,4,6,8 and 10 hours, < 1 x 103 UFC/ml of Me, < 10 UFC/ml TC and no FC. Results: the average that fulfilled MQS criteria for P at times 0, 2, 4, 6, 8, 10 hours were; Me: 42%, 75%, 50%, 33% and 25%. For CT 83%, 91.5%, 83%, 75% and 42%. For L at times 0,2,4,6 and 8 hours 100% and at 10 hours 92% for Me, for TC 100% at any time. After 4 hours the difference between the TC of P and L was significant (p < 0.05). Conclusions: L fulfills the MQS criteria better than P. Ready to use formulas should be used as a first option. The maximum storage time for L is 10 hours at room temperature, whereas this is 4 hours for Tetra Pak P. L can be opened and stored at 4° C and used during the first 48 hours

Se estudió la asociación entre la residencia rural o urbana y el crecimiento inicial de lactantes nacidos pretérmino (AEG) en el Hospital Herminda Martín de Chillán, Chile. Se estudiaron prospectivamente hasta los 4 meses de vida, 80 lactantes nacidos entre enero y septiembre de 1995 (35 urbano y 45 rural), con peso de nacimiento < 2 500 g y edad gestacional 2000 g rural infants from low income homes showed a lower length gain than the urban infants (12.7 vs. 15.4 cm p < 0.01). We conclude that the rural preterm babies born at the Hospital Herminda Martin in Chillán have a decreased postnatal growth than the urban infants in the first four months of age

e good to mcnitore antimicrobial resistance and oreva'en? sero'ypes. To desc'"beprevalence o~ resistant isolates of S. pneumoniae among children attending day ca'e centers and their most prevalentserotyoes, samples o~ nasopharyngeal secretions were obtained a-d cultured in sheep blooc cgar with o' withoutgentamicin 5 (ig/rri a' 37° C in c 5% CO

A decrease in food intake during the acute phase of lower respiratory tract infections may affect the course of illness. To determine if enteral feeding improves the clinical course of lower respiratory infections (LRI) we studied 42 infants (2 to 12 months of age) with LRI which were given antibiotics and salbutamol therapy based on clinical and X-ray findings. On admission to the hospital patients were randomly allocated to group A (fed by nasogastric tube as intermittent bolus); group B (infants fed by continuous drip via nasogastric tube) and group C (subjects fed ad-libitum by the oral route). Feedings consisted of powdered whole cow's milk formula, reconstituted to 7.5% (W/V), with added sucrose 5% and maltodextrin 5% (77 kcal/dl). Energy intake in group A increased from 69 to 110 kcal.kg.day; in group B, from 68 to 114 kcal.kg.day, and in group C, from 55 to 109 kcal.kg.day (ANOVA, p < 0.005 for the first three days). Infants of groups A and B had shorter hospital stays than C (8.7 and 8.4 vs. 9.8 days, ANOVA, p < 0.02) and a faster improvement of respiratory failure index (4.1 and 3.8 vs. 5.5. days, p < 0.001). Groups A and B also showed greater decrease in their heart rates (mean 170 down to 134 beats/min) than group C patients (169 down to 142 beats/min), p < 0.01 at discharge from the hospital. No differences were noted in trends of respiratory rate, weight/length, albuminemia, C-reactive protein, erythro-sedimentation rate or glycemia. No adverse effects of nasogastric tube feeding were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

ResumenSe evaluo, en forma controlada, los efectossobre el estado nutritional, tolerancia y acepta-bilidad de una leche modificada (LPM), en ungrupo representative de lactantes sanos, contro-lados en los servicios de salud del Area Metro-politana, pareados a un grupo semejante, ali-mentado con una leche de vaca en polvo (LP),con el fin de controlar la posibilidad de incorpo-rarla al PNAC. Del total de lactantes (2.097),393 lactantes entre 0 y 4 meses de edad, 747entre 4 y 8 nieses y 957 entre 8 y 12 meses.Todos fueron seguidos durante 4 meses concontroles antropometricos, de morbilidad, acep-tabilidad y tolerancia de la formula. Los resulta-dos no mostraron diferencias significativas encrecimiento medido por P/E o P/T (valores entre95 y 100% de los estandares NCHS). Se vio unaleve mayor ingesta de energia y menor de pro-teihas con LPM. La aparicion de signos gastro-intestinales fue baja y comparable entre los dosgrupos, tanto en la primera cohorte etaria (coli-cos }\% con LPM y 8% con LP al primer con-trol; 1,6 vs. 1,0% al segundo control) como enla segunda cohorte etaria (4,3% con LPM vs.Referencias

Protein-energy malnutrition is commonly observed in infants with congenital heart disease (CHD). The effect of a hypercaloric formula on nutritional recovery was evaluated in malnourished infants with congenital heart diseases. We retrospectively studied 30 infants (mean age 9 months, range 2 to 21) with CHD along 60 to 90 days in a closed nutritional recovery center. All patients were fed a hypercaloric whole cow's milk formula with sucrose, butter oil and corn starch (1.29 kcal.ml). Mean daily energy intake was 220 +/- 19.8 kcal.kg body weight.day. Mean weight gain was 2.7 g.kg.day. No effect of cyanosis, cardiac failure, degree of malnutrition or number of illness-free days was observed on nutritional recovery. Patients older than 9 months had significantly greater weight gain than younger infants. Those infants with worse CHD and severe intercurrent illnesses had the worst nutritional recovery. We suggest that a hypercaloric formula induces good nutritional weight gain infants with severe congenital heart disease.

Three cases of glycogenosis are presented. They were recognized by clinical evidence and hepatic biopsy specimens. Dietary treatment with a normocaloric diet and raw corn starch every 6 hours was given. In cases 1 and 2 hepatic size returned to normal and they showed an initial catch up growth without signs of renal disease or other complications. Case 3 showed persistent hepatomegaly, normal growth pattern and no hypoglycemic episodes independently of nutritional management. These cases represent our initial experience on nutritional intervention in glycogenosis, even though enzymatic tests were not done, which are considered essential for optimal diagnosis and nutritional therapy of glycogen storage disease.