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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, glice-mia 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.

Se analizó el cambio secular del retraso estatural (RE) entre los años 1986 y 1994 en escolares de 6 a 16 años de edad, de tres regiones del país (II, IX y XIII). Las muestras de cada región se obtuvo por sorteo aleatorio dando representatividad por sexo, ciclo educativo (básico o medio) y tipo de establecimiento (municipal, subvencionado o particular); quedando constituidas los años 1986 por 4 331 mujeres y 3 354 varones, en 1991 por 1 620 mujeres y 1 675 varones y en 1994 por 1 437 mujeres y 1 822 varones de las ciudades de Santiago, Calama, Antofagasta y Temuco. Se evaluó la estatura y se calificó como talla baja la adecuación estatural bajo 95% de los es-tándares OMS. En ambos sexos, se observó una disminución progresiva del porcentaje del RE al comparar los años 1986, 1991 y 1994 (de 27,8%, a 24,9% y a 13,0% en las mujeres y de 31,2%, a 29,6% y a 18,2% en los varones, respectivamente). Al separar por edad en mujeres < de 10 años (me-10), varones < de 12 años(me-12), mujeres 10 años (ma-10) y varones 12 años (ma-12); se encontró que en me-10 y me-12 el RE fue menor (27,8%, 24,9% y 13,0% en las mujeres y 31,2%, 29,6% y 18,2% en los varones) que en los ma-10 y ma-12 (41,1%, 39,8 % y 25,5% en las mujeres y 44,2%, 41,7% y 26,2% en los varones), aunque la tendencia fue la misma. El cambio secular hacia una mayor estatura, observado en escolares de estas regiones, sugiere una mejoría en la calidad del ambiente. Sin embargo, el crecimiento no se ha estabilizado y los niños en edades mayores (ma-10 y ma-12) son el grupo con mayor retraso. Es necesario investigar otros déficit para implementar programas dirigidos a continuar mejorando la calidad ambiental y de esta forma la expresión del potencial genético de crecimiento del niño chileno The sequential change of SS in 6-16 year old Chilean schoolchildren between 1986 and 1994 was analized. Random samples were analyzed for sex, school year and economic/social status. Sample sizes in 1986 were 4 331 girls, 3 354 boys, in 1991 1 620 girls, 1 675 boys and in 1994 were 1 437 girls and 1 822 boys, taken from the cities of Santiago, Calama, Antofagasta and Temuco. Height for age below the 95% according to WHO standards was classified as SS. Regardless of sex SS decreased progressively from 1986 to 1994 (27.8%, 24.9%, 13% in girls, 31.2%, 29.6%, 18.2% in boys respectively). Classifying the children according to age, girls less than 10 yrs, or 10 and above, and boys less than 12 yrs or 12 and above, the percentage of children with SS was lower in younger children (27.8%, 24.9%, 13% in girls, 31.2%, 29.6%, 18.2% in boys) compared to that in older children (41.1%, 39.8%, 25.5% in girls, 44.2% 41.7%, 26.2% in boys) with an overall decrease in all 4 age groups. The trends in SS suggest an improvement in environmental conditions, but this growth tendency has not yet stabilized, the older group being the worst affected. It is necessary to investigate other possible environmental deficits in order to improve health programmes for an improved expression of the childrens genetic potential

Brachial circumference |BC|, triceps skinfold thickness (TSTj, lean and fat braquial area [LFA and FBA] wete measured in 5 557 school children aged 6 to 1 5 years representative of the metropolitan region of Chile. Socioeconomic level (SEL) was measured by Graffar score and clasified in three levels. Results are shown by age, sex and SEL. Lower BC, 1ST, LFA and FBA were found in school age males of the lower SEL from age 6 year on. However, higher or similar BC, 1ST, LFA and FBA were found in medium, lowef and high SEL females. These resulls show a sexual Dimorphism, but do nol allow us to make conclusions on ihe amount of influence of either ethnic 01 environmental factors. Identification of local body standard measurements are not only important for the surveillance of growth and development of children belonging to different SEL and to detect the secular Irend of growth of our population but also in individual cases where I II H I f I they will allow better nutritional evaluations.

A cross-sectional study in 665 healthy children of both sexes, aged 11 to 16 years (394 girls) was done to evaluate the adecuation of their height to chronologic age (H/A), and to puberal development (H/P) by means of Tanner's scales. (Breast stages in girls and pubic hair stages in boys according to Tanner, were considered). Subjects with early puberal development showed significantly higher H/A than H/P rates resulting in normal height for age but low height for puberal stage. Children with late puberal development had lower H/A than H/P rates and thenheights were low for age but normal for puberal stage. In the evaluation of the height it is necessary to consider the attained puberal stage, in order to more accurate prognosis of expected adult heights. (

RESUMEN Se presenta un caso de un recien nacido conhipoglicemia recurrente en quien se demostrohiperinsulinismo. For la falta de respuesta altratamiento habitual y con diazoxido, se realizeuna pancreatectomia subtotal del 85% a los 6rneses de vida. En el postoperatorio evolucionocon hipoglicemias recurrentes que obligaron eluso de dosis crecientes de diazoxido, lo cualsugiere la necesidad de una reseccion casi total(99%) frente a una hiperplasia severa de lascelulas beta del tipo de la nesidioblastosis. Sediscute la etiopatogenia del cuadro y su diagnos-tico diferencial. REFERENCIAS1. Cornblath M., Poth M.: Hypoglycemia in ClinicalPodiatric and adelescent. Ed. Kaplan, A.S., W.B.Saunders Comapnay, 1982; 157-170.2. Knoblock H., Sotos J., Sherarde, Hodson IV., WehlR.: Hypoglycemia: Etiology and Prognosis. JPediatr 1967; 70: 876-884.3. Pildes R., Forbes A., O'Connor S., Cornblath M.:The incidence of neonatal hypoglyccmia: Acompleted survey. J Pediatr 1967; 70: 76-80.4. iMndan H., Perlman M., Meyer S., Sacsohn M.,Krausz M., Mayan H., Li/ovetzky G,, Schiller M,:Persistent neonatal hypoglycemia due to hyperin-sulinism: Medical aspects. Pediatrics 1982; 70:440^46.5. Aynsley-Green A.: Nesidioblastosis of the pancreasin infancy. En: Carbohydrate metabolism and itsdisorders. Eds.: Randle, P.J., Steiner, D.F., Whelan,W.J. London Academic Press. 1981; 3: 181-204.6. Schwartz S.S., Rich B.H., Wetal-Lucy A.: Familialnesidioblastosis. Severe neonatal hypoglycemia intwo families. J Pediatr 1979; 95: 44-53.7. Aynsley-Green A., Polak J.M., Bloom S.R., GoughMM., Keeling J., Ashcroft S.J.H., Turner R.C.,Baum J.D.: Nesidioblastosis of the pancreas: defini-tion of the syndrome and the management of thesevere neonatal hyperinsulinaemic hypoglycemia.Arch Dis Child 1981;56: 496-508.8. Kramer J.L., Bell M,J., DeSchryver K., Bower R.J.,Ternberg J.L., White A'.#.: Clinical and histologicindications for extensive pancreatic resection innesidioblastosis. Am J Surg 1982; 143: 116-119.326

A longitudinal study of children from teenager mothers belonging to a middle-low socioeconomic level In their first 30 months of life, was done. Weight, height, height velocity, bone age, plasmatic levels of zinc, cooper and hemoglobin, food intake, socioeconomic level, and stature of parents were studied. There were not differences in nutritional status, caloric intake, bone age, plasmatic levels of zinc, cooper and hemoglobin, and stature of parents betwen children of teenage and adult mothers. A progressive decrement in stature and in growth velocity of children of teenage compared with children of adult mothers was observed. A lower socioeconomic level and protein intake was found in children of adolescent mothers that may be playing a role at least in part in the growth failure presented by this children. Etiologycal factors of this growth failure discussed. (

RESUMEN Se analizaron algunas caracten'sticas del desa-rrollo puberal en 2.535 varones, de 8 a 16 anos,representativos de escolares de la Region Metro-politana. Se investigaron las diferencias de acuer-do al NSE. Se encontro un amplio rango en laedad de inicio y en la de termino del desarrollogenital y pubico, el cual fue mayor en escolaresde nivel bajo, al compararlos con los de nivelalto. Entre los 12 y 14 anos hubo escolares entodas las etapas del desarrollo genital y pubico.Se encontraron diferencias significativas porNSE, con respecto a la edad promedio del iniciodel desarrollo genital y pubico. El promedio deedad de inicio del desarrollo genital fue menoren escolares de niveles medios y bajos (135,84 ±14,97; 135,03 ± 17,04 y 136,84 ± 20,48 meses,respectivamente) que en los de nivel alto(141,91 ± 14,97 meses); en tanto que la edad deInicio del vello pubico fue mayor en escolares denivel bajo (147,41 ± 20,25 meses) al comparar-los con el resto (143,98 ± 13,55 en nivel alto,141,71 ± 15,85 en nivelmedioy 142,57+ 15,39en nivel medic bajo). Hubo diferencias porNSE al comparar edad de inicio de ambos even-tos puberales (desarrollo genital y pubico), ob-servandose una partida mas temprana del desa-rrollo genital que del pubico en los escolares deniveles medio y bajo, en tanto que los de nivelalto parten simultaneamente con ambos eventos.Se plantea la posible influencia de factores racia-les para explicar estas diferencias.