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Background: In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago., Methods: This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends., Results: The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17)., Conclusions: Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates., (© 2022 Wiley Periodicals LLC.)

Objective: To analyse serum folate levels in women of childbearing age in the Metropolitan Region (MR) of Chile., Design: Cross-sectional design as part of the 2016-2017 National Health Survey (Encuesta Nacional de Salud, ENS 2016-2017), using a household-based multistage stratified random sample. Serum folate levels measured by electrochemiluminescence immunoassay in fasting venous blood samples were classified as deficient (<4·4 ng/ml), normal (4·4-20 ng/ml) or supraphysiological (>20 ng/ml)., Setting: The MR of Chile., Participants: Women of reproductive age (15-49 years, n 222) from the MR participated in the ENS 2016-2017., Results: The mean, median and range of serum folate were 14·2 (se 0·4), 13·9 and 2·1-32·2 ng/ml, respectively. Folate deficiency was detected in 0·9 % of women, while 7·0 % had supraphysiological levels of the vitamin. No significant effects of age, educational level, marital status, parity, smoking status or nutritional status on serum folate levels were detected by univariate or multivariate analyses. Intake of folic acid supplements showed a significant association with serum folate levels, but only 1·2 % of women used supplements., Conclusions: Folate deficiency in women of reproductive age living in the MR of Chile is almost inexistent according to the ENS 2016-2017, suggesting that the current population-wide mandatory folic acid fortification of flour is an effective and equitable measure to prevent folate deficiency. These results support the option of maintaining current folic acid fortification in Chile, particularly based on the low adherence to supplementation regimes evidenced in other populations.

Objectives: To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial., Study Design: Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified (12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group., Results: At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high., Conclusions: Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear., Trial Registration: Clinicaltrials.gov: NCT01166451., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: It is uncertain whether vitamin B-12 supplementation can improve neurophysiologic function in asymptomatic elderly with low vitamin B-12 status or whether folate status affects responses to vitamin B-12 supplementation., Objective: We assessed the effects of a single intramuscular injection of 10 mg vitamin B-12 (which also contained 100 mg vitamin B-6 and 100 mg vitamin B-1) on vitamin B-12 status and neurophysiologic function in elderly community-dwelling Chileans with low serum vitamin B-12 concentrations who were consuming bread fortified with folic acid., Design: A pretreatment and posttreatment study was conducted in 51 participants (median ± SD age: 73 ± 3 y; women: 47%) with serum vitamin B-12 concentrations <120 pmol/L at screening. Vitamin B-12 status was defined by combining vitamin B-12, plasma total homocysteine (tHcy), methylmalonic acid (MMA), and holotranscobalamin into one variable [combined indicator of vitamin B-12 status (cB-12)]. The response to treatment was assessed by measuring cB-12 and neurophysiologic variables at baseline and 4 mo after treatment., Results: Treatment increased serum vitamin B-12, holotranscobalamin, and cB-12 (P < 0.001) and reduced plasma tHcy and serum MMA (P < 0.001). Treatment produced consistent improvements in conduction in myelinated peripheral nerves; the sensory latency of both the left and right sural nerves improved on the basis of faster median conduction times of 3.1 and 3.0 ms and 3.3 and 3.4 ms, respectively (P < 0.0001). A total of 10 sensory potentials were newly observed in sural nerves after treatment. Participants with high serum folate at baseline (above the median, ≥33.9 nmol/L) had less improvement in cB-12 (P < 0.001) than did individuals whose serum folate was less than the median concentration (i.e., with a concentration <33.9 nmol/L)., Conclusion: Asymptomatic Chilean elderly with poor vitamin B-12 status displayed improved conductivity in myelinated peripheral nerves after vitamin B-12 treatment and an interaction with folate status, which was detected only with the use of cB-12. This trial was registered at www.controlled-trials.com as ISRCTN02694183., (© 2016 American Society for Nutrition.)

Background: Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age., Objective: To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months., Methods: Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 (n = 128) and 2000 (n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample (n = 320) from the two most populated areas of the country was performed in 2009., Results: One year after fortification, the prevalence of anemia was 9%; significantly lower (p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower (p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration (r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96)., Conclusions: In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.

Background: Congenital malformations (CMF) have an important role in infant mortality. Neural tube defects (NTD) have great relevance from both social and public health points of view. The ECLAMC (Collaborative Latin American Study of Congenital Malformations) maintains in Chile an epidemiological surveillance of CMF prevalence rate at birth since 1969., Aim: To assess the effect of wheat flour folic acid fortification on the prevalence of NTD., Patients and Methods: Only Anencephaly, Spina bifida and Cephalocele were considered as NTD. All children born in the maternities incorporated to ECLAMC between 1969 and 1999 were considered as belonging to the pre folic acid fortification period and those who were born from 2001 to 2010 were considered as belonging to the post fortification period., Results: The NTD prevalence rate at birth in the pre fortification period was 17.03/10,000. In the second period, there were 291,996 births and among them, 280 newborns were affected by a form of NTD (9.59 in 10,000 births). This represents a 44% decrease (p < 0.01). Anencephaly rate fell from 7.16/10,000 to 3.67/10,000, representing a 49% lower rate (p < 0.01). Spina bifida rate decreased from 8.61/10,000 to 4.49/10,000, representing a 48% lower rate (p < 0.01). Cephalocele had a 20% non-significant reduction., Conclusions: Wheat flour fortification with folic acid reduced by 44% the prevalence rate of NTD at birth. This means that NTDs were prevented in 185 Chilean newborns each year.

Background: The Chilean Ministry of Health has combated iron deficiency through the delivery of fortified milk by the National Complementary Feeding Program (NCFP)., Objective: To assess iron status and associations between biomarkers of iron status and serum C-reactive protein (CRP) in 218 beneficiaries of the NCFP aged 19 to 72 months in Santiago and Valparaiso, Chile., Methods: Blood was collected from a cross-sectional representative sample. Iron status (measured by hemoglobin, zinc protoporphyrin, and serum ferritin levels) and inflammation (according to CRP level) were determined., Results: Serum CRP level was positively associated with serum ferritin and zinc protoporphyrin levels (r = 0.16 and r = 0.15; p = .0168 and p = .0290, respectively). Serum ferritin was higher among children with high CRP (> 10 mg/dL) than among those with low CRP (< or = 10 mg/dL) (p = .003). After adjustment for 10, 6, and 5 mg/L CRP, the prevalence of low serum ferritin changed from 56.4% without adjustment to 60.6%, 61.5%, and 42.7%, respectively, and the prevalence of high zinc protoporphyrin changed from 22.9% to 21.6%, 17.4%, and 17.9%, respectively. There were no differences between regions in biomarkers of iron status. There was no association between consumption of fortified milk and the prevalence of abnormal serum ferritin (< 15 microg/L) after adjustment for sex, age, and breastfeeding (OR, 1.00; 95% CI, 0.99 to 1.01; p = .288). After adjustment for 10 mg/L CRP, 5.5% were classified as having iron-deficiency anemia, 42.7% as having iron-deficiency erythropoiesis, 17.9% as having depleted iron stores, and 35.8% as having normal iron status. CONCLUSIONS. CRP level was positively associated with: serum ferritin and zinc protoporphyrin levels. Chilean children aged 19 to 72 months from Santiago and Valparaiso who were beneficiaries of the NCFP had a low prevalence of iron-deficiency anemia, a high prevalence of iron-deficiency erythropoiesis, and a moderate prevalence of depleted iron stores.

Background: In 1974/75, the prevalence of anemia in Chilean preschoolers was 18.8%. Since 2000, the Chilean Ministry of Health has combated anemia through the delivery of iron-fortified milk by the National Complementary Feeding Program (NCFP)., Objective: To determine the prevalence of anemia in children aged 19 to 72 months who are beneficiaries of the NCFP., Methods: A cross-sectional representative sample of 224 beneficiaries of the NCFP aged 19 to 72 months from the Santiago and Valparaiso regions was recruited., Results: The mean (+/- SD) hemoglobin concentration was 12.3 +/- 1.0 g/dL. Four percent of all children studied were anemic. In simple linear regression analysis, it was observed that hemoglobin concentration was positively correlated with age (r = 0.23, p = .001). There was no association between hemoglobin concentration and duration of breastfeeding (r = -0.12, p = .175). The prevalence of anemia among the 69% of children consuming iron-fortified milk delivered by NCFP was 2.6%, as compared with 7.1% among children not consuming iron-fortified milk (p = 0.227). Consumption of iron-fortified milk did not show a positive significant relationship with hemoglobin concentration (r = 0.063, p = .529). Similarly, multiple logistic regression did not show an association between consumption of fortified milk and anemia, after adjusting for sex, age, and breastfeeding (p = .150; OR = 0.98; 95% CI, 0.95 to 0.10)., Conclusions: In 2009 anemia was not a public health problem in Chilean children aged 19 to 72 months from Santiago and Valparaiso.

In January 2000, Chilean Ministry of Health mandated the addition of folic acid (FA) to wheat flour in order to reduce the risk of neural tube defects (NTDs). This policy resulted in significant increases in serum and red cell folate in women of fertile age 1 year after fortification. To evaluate the effect of wheat flour fortification on the prevalence of NTDs in Chile we designed a prospective hospital-based surveillance program to monitor the frequency of NTDs in all births (live and stillbirths) with birth weight≥500 g at the nine public maternity hospitals of Santiago, Chile from 1999 to 2009. During the pre-fortification period (1999-2000) the NTD rate was 17.1/10,000 births in a total of 120,566 newborns. During the post-fortification period (2001-2009) the NTD rate decreased to 8.6/10,000 births in a total of 489,915 newborns, which translates into a rate reduction of 50% (RR: 0.5; 95% CI: 0.42-0.59) for all NTDs. The rate reduction by type of NTD studied was: 50% in anencephaly (RR: 0.5; 95% CI: 0.38-0.67), 42% in cephalocele (RR: 0.58; 95% CI: 0.37-0.89), and 52% in spina bifida (RR: 0.48; 95% CI: 0.38-0.6). Rates showed significant reduction both in stillbirths and live births: 510.3 to 183.6/10,000 (RR=0.36; 95% CI: 0.25-0.53) and 13.3 to 7.5/10,000 (RR=0.56; 95% CI: 0.47-0.68), respectively. In Chile, fortification of wheat flour with FA has proven to be an effective strategy for the primary prevention of NTDs., (Copyright © 2012 Wiley Periodicals, Inc.)

There is no doubt that folic acid fortification can be effective for reducing the incidence of neural tube defects. The degree of efficacy depends on both the level of folate depletion and other, yet to be fully characterized, genetic and/or environmental factors. This article summarizes briefly data on neural tube defect reduction and other benefits of folic acid fortification as these have been reviewed in more detail elsewhere. More attention is drawn to questions that have been raised about the possible adverse effects of folic acid fortification including the incidence of colorectal cancer and immune function. The main question addressed here is whether folic acid fortification can exacerbate the adverse effects of vitamin B12 deficiency. Most analyses of this question have been conducted in wealthier countries based on data from elderly populations - which have the highest prevalence of vitamin B12 deficiency. However, of potentially greater concern is the increasingly common practice of folic acid fortification in developing countries, where folate status is probably often adequate even prior to fortification, and vitamin B12 depletion or deficiency is common. To add to this information, data from a group of Chilean elderly with a range of vitamin B12 status and exposed to high levels of folic acid fortification will be presented., (Copyright © 2012 S. Karger AG, Basel.)

Background: Older people have a high risk of vitamin B12 deficiency; this can lead to varying degrees of cognitive and neurological impairment. CBL deficiency may present as macrocytic anemia, subacute combined degeneration of the spinal cord, or as neuropathy, but is often asymptomatic in older people. Less is known about subclinical vitamin B12 deficiency and concurrent neuroconduction and cognitive impairment. A Programme of Complementary Feeding for the Older Population (PACAM) in Chile delivers 2 complementary fortified foods that provide approximately 1.4 μg/day of vitamin B12 (2.4 μg/day elderly RDA). The aim of the present study is to assess whether supplementation with vitamin B12 will improve neuroconduction and cognitive function in older people who have biochemical evidence of vitamin B12 insufficiency in the absence of clinical deficiency., Methods: We designed a cluster double-blind placebo-controlled trial involving community dwelling people aged 70-79 living in Santiago, Chile. We randomized 15 clusters (health centers) involving 300 people (20 per cluster). Each cluster will be randomly assigned to one of three arms: a) a 1 mg vitamin B12 pill taken daily and a routine PACAM food; b) a placebo pill and the milk-PACAM food fortified to provide 1 mg of vitamin B12; c) the routine PACAM food and a placebo pill.The study has been designed as an 18 month follow up period. The primary outcomes assessed at baseline, 4, 9 and 18 months will be: serum levels of vitamin B12, neuroconduction and cognitive function., Conclusions: In view of the high prevalence of vitamin B12 deficiency in later life, the present study has potential public health interest because since it will measure the impact of the existing program of complementary feeding as compared to two options that provide higher vitamin B12 intakes that might potentially may contribute in preserving neurophysiologic and cognitive function and thus improve quality of life for older people in Chile., Trial Registration: ISRCTN: ISRCTN02694183.

This article outlines the rationale for reducing dietary salt and some of the Pan American Health Organization actions to facilitate reductions in dietary salt in the Americas. Excessive dietary salt (sodium chloride and other sodium salts) is a major cause of increased blood pressure, which increases risk for stroke, heart disease, and kidney disease. Reduction in salt intake is beneficial for people with hypertension and those with normal blood pressure. The World Health Organization recommends a population salt intake of less than 5 grams/person/day with a Pan American Health Organization expert group recommendation that this be achieved by 2020 in the Americas. In general, the consumption of salt is more than 6 grams/day by age 5 years, with consumption of salt averaging between 9 and 12 grams per day in many countries. Recent salt intake estimates from Brazil (11 grams of salt/day), Argentina (12 grams of salt/day), Chile (9 grams of salt/day) and the United States (8.7 grams of salt/day) confirm that high salt intakes are prevalent in Americas. Sources of dietary salt vary, from 75% of it coming from processed food in developed countries, to 70% coming from discretionary salt added in cooking or at the table in parts of Brazil. The Pan American Health Organization has launched a regionwide initiative called the ?Cardiovascular Disease Prevention Through Dietary Salt Reduction,? led by an expert working group. Working closely with countries, the expert group developed resources to aid policy development through five subgroups: (a) addressing industry engagement and product reformulation; (b) advocacy and communication; (c) surveillance of salt intake, sources of salt in the diet, and knowledge and opinions on salt and health; (d) salt fortification with iodine; and (e) national-level health economic studies on salt reduction.

The aim of the present investigation was to search for a reduction in birth prevalence estimates of 52 selected types of congenital anomalies, associated with folic acid fortification programs in Chile, Argentina, and Brazil. The material included 3,347,559 total births in 77 hospitals of the three countries during the 1982-2007 period: 596,704 births (17 hospitals) in Chile, 1,643,341 (41 hospitals) in Argentina, and 1,107,514 (19 hospitals) in Brazil. We compared pre- and post-fortification rates within each hospital and the resulting Prevalence Rate Ratios (PRRs) were pooled by country. Statistically significant reductions in birth prevalence estimates after fortification were observed for neural tube defects (NTDs), septal heart defects, transverse limb deficiencies, and subluxation of the hip. However, only the reduction of NTDs appeared to be associated with folic acid fortification and not due to other factors, because of its consistency among the three countries, as well as with previously published reports, and its strong statistical significance. Among the NTDs, the maximum prevalence reduction was observed for isolated cephalic (cervical-thoracic) spina bifida, followed by caudal (lumbo-sacral) spina bifida, anencephaly, and cephalocele. This observation suggests etiologic and pathogenetic heterogeneity among different levels of spina bifida, as well as among different NTD subtypes. We concluded that food fortification with folic acid prevents NTDs but not other types of congenital anomalies., (Copyright © 2010 Wiley-Liss, Inc.)

Unlabelled: EPA and DHA consumption in Chile is markedly below international daily intake recommendations. For improvement of such low intake level, we developed a fortified powdered dairy drink, containing 60 mg/serving of DHA and 14 mg/serving of EPA., Objectives: to evaluate the effects of DHA consumption during pregnancy, parturition, and in the newborn, on lipid composition of red blood cell membranes and levels of DHA and EPA on human milk during lactation. One hundred and seventy five (175) pregnant women received 2 kg/month of the fortified powdered dairy drink (GE), and 177 received the regular milk provided by the Ministry of Health (GC). We monitored daily intake of the dairy drink and all other sources of DHA and EPA in the diet, and measured general biological indicators during pregnancy, parturition, and in the new born. On a subsample of 14 women on each group (GE and GC), we measured fatty acid composition of red blood cell membranes after 0 and 60 days of consumption with the fortified dairy drink, and levels of DHA and EPA on human milk after 2 months of lactation. Of all women in the study, 16% had no consumption of fish, and 53% had no consumption of sea food. Less than 25% of all women had fish on a weekly basis. Consumption of the fortified dairy drink tripled intake of DHA, from 48.8 mg/day (CI 38.7-57.5) to 147.8 mg/day (CI 128.4-167.9) (p<0.001). The GE group had a higher content of DHA on the phospholipids of red blood cell membranes: 11.1% (CI 10.2-13.0) versus 17.9% (CI 12.9-23.0) (p<0.002). Concentration of DHA and omega-3 fatty acids increased 50% in milk of women consuming the fortified dairy drink (p<0.06). There was alower incidence of preterm parturitions on the GE group (2.8 vs 10.6%), but without statistical significance. The consumption of the fortified dairy drink produced a significant increase of DHA consumption during pregnancy and lactation, and an improved composition of red blood cell membranes, as well as in human milk, proving to be an appropriate intervention strategy for the target population.

Objective: To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes., Design: Non-blinded, randomised controlled study., Setting: Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile., Subject: Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495)., Results: Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5-126 g; P = 0.03) and the incidence of very preterm birth (0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19-0.96 cm; P = 0.003)., Conclusions: The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.

Background: The effects of folic acid fortification on neural tube defects is well known. Other reports show a beneficial effect of the fortification on orofacial clefts, urinary malformations and defects caused by limb reduction., Aim: To determine the changes in prevalence of congenital malformations after the start of flour folic acid fortification in Chile., Material and Methods: The rates of 22 malformations occurring in the maternity of the University of Chile Clinical Hospital and other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were compared before and after the start of flour folic acid fortification., Results: After the start of folic acid fortification a significant reduction in the rates of anencephalia, spina bifida and diaphragmatic hernia, was observed. The rates of all other malformations remained stable or increased. The rates of all malformations at the University of Chile Clinical Hospital had a steady increase until 2005 and were significantly higher than in the rest of hospitals participating in ECLAMC., Conclusions: Folic acid fortification was associated with an expected reduction in rates of spina bifida and anencephalia and an unexpected reduction in the rates of diaphragmatic hernia.

Background: In Chile, flour is fortified with folic acid since 2000, and the incidence of neural tube defects has decreased. Cranio-encephalic congenital defects (CECD) have a wider clinical scope, includind classical neural tube defects (NTD) such as anencephalia and acrania, but also incorporating other defects. Therefore, the effects of folic acid fortification on the incidence of CECD could be different., Aim: To study the effect of folic acid fortification on the incidence of CECD., Material and Methods: All prenatal diagnoses of CECD and cases registered locally in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were reviewed. The obtained data were crossed with all death certificates of newborns or stillborns of more than 500 g in the Sixth Region, in Central Chile. All cases were classified again in four subtypes, according to their phenotype. The incidences of all subtypes prior (1996-2000) and after folic acid supplementation (2001-2004), were compared., Results: Between 1996 and 2004, there were 64 cases of CEDC among 109,176 infants born alive. The global rate was 8.86 per 10,000 born alive in the period prior to fortification and 3.03 per 10,000 born alive after fortification. Comparing both periods, there was a 66% reduction in all CECD and a 77 and 100% reduction in subtypes A and B of CECD, respectively (p <0.05). No significant reductions in type C and D CECD, were observed., Conclusions: After the start of flour folic acid fortification, there was a global reduction in the incidence of CECD. However, only types A and B CECD, supposedly more responsive to folic acid, were reduced.

Background: A significant increase in the frequency of twins has been described in the literature as a secondary effect of perinatal supplementation with folic acid., Aim: To verify if the frequency of twins increased in a Chilean hospital, after the start of flour folic acid supplementation., Material and Methods: The frequency of twins was compared in the University of Chile Clinical Hospital, before and after the start of flour fortification with folic acid., Results: There was a 34% increase in the frequency of twins during the post fortification period (2001-2004) as compared with the previous period (1998-2000). A decrease in the frequency of male twins, when compared with single newborns, was also observed in the post fortification period. There was a higher frequency of stillborns among twins, when compared with single newborns., Conclusions: The frequency of twin pregnancies increased after flour folic acid supplementation in sample of Chilean population.

To verify whether the decreasing neural tube defects birth prevalence rates in Chile are due to folic acid fortification or to pre-existing decreasing trends, we performed a population survey using a network of Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC, Latin American Collaborative Study of Congenital Malformations) maternity hospitals in Chile, between the years 1982 and 2002. Within each maternity hospital, birth prevalence rates of spina bifida and anencephaly were calculated from two pre-fortification periods (1982-1989 and 1990-2000), and from one fortified period (2001-2002). There was no historical trend for spina bifida birth prevalence rates before folic acid fortification, and there was a 51% (minimum 27%, maximum 66%) decrease in the birth prevalence rates of this anomaly in the fortified period. The relative risks of spina bifida were homogeneous among hospitals in the two period comparisons. There was no historical trend for the birth prevalence of anencephaly comparing the two pre-fortified periods, but the relative risks were heterogeneous among hospitals in this comparison. There was a 42% (minimum 10%, maximum 63%) decrease in the birth prevalence rate of anencephaly in the fortified period as compared with the immediately pre-fortified period, with homogeneous relative risks among hospitals. Within the methodological constraints of this study we conclude that the birth prevalence rates for both spina bifida and anencephaly decreased as a result of folic acid fortification, without interference of decreasing secular trends., (Copyright (c) 2005 Wiley-Liss, Inc.)

The term "folate" is a generic way to name the different forms derived from folic acid, one of the B vitamins (specifically B9 vitamin). They are essential in the metabolism when they act as cofactors in the transfer reactions of one carbon. However, only plants and microorganisms are able to synthesize them de novo, in such a way that both animals and human beings have to intake them through their diet. Folic acid is widely spread in nature, mainly in vegetables, liver ans cereals. However, nowadays, the lack of folates in the diet is one of the most common nutritional deficiencies in the world, and it has serious consequences on human health. There is evidence that even in developed countries folate intake is usually low; and even, is some cases, below optima levels. The authorities in several countries have adapted different norms related to folic acid, fortifying staple food such as dairy products or cereals, mandatory (U.S.A., Canada or Chile) or voluntary (most of the European countries).

Neural tube defects (open spina bifida, anencephaly, and encephalocele) represent the first congenital malformations to be preventable through public health measures such as supplementation and/or food fortification with folic acid. In Chile, starting in January 2000, the Chilean Ministry of Health legislated to add folic acid to wheat flour (2.2 mg/kg) to reduce the risk of NTDs. This policy resulted in an estimated mean additional supply of 427 microg/d in significant increases in serum folate and red cell folate of 3.8 and 2.4-fold, respectively, in women of fertile age, one year after fortification. The impact on the rate of NTDs is presently being studied in all births, both live births and still births, with birth weight >500 g in the city of Santiago. Preliminary results show a reduction of 40% in the rates on NTDs from the pre-fortification period (1999-2000) to post-fortification period (2001-June 2002). Fortification of wheat flour with folic acid in Chile is effective in preventing NTDs in Chile.

Objective: Chilean infants are at risk for isolated zinc and iron deficiencies because of a low consumption of animal products in low socioeconomic sectors. In 1999, the National Complementary Food Program of Chile manufactured a new milk (2 kg of powdered milk/mo) fortified with iron (Fe; 10 mg/L), zinc (Zn; 5 mg/L), and copper (0.5 mg/L) to be provided to infants until age 18 mo and to pregnant women. We analyzed the nutrition status of zinc and iron at age 18 mo in infants who consumed the fortified cow's milk., Methods: Forty-two healthy male children with normal growth and from lower socioeconomic groups were studied. A nutrition survey was conducted; blood and hair samples for Zn in plasma and hair, hemoglobin, hematocrit, and serum ferritin were obtained., Results: Mean intakes were: energy, 106 +/- 27 kcal. kg(-1). d(-1); protein, 3.8 +/- 1.1 g. kg(-1). d(-1); Zn, 5.2 +/- 1.9 g/d (0.98 mg Zn/MJ; 68% of World Health Organization recommendations); Fe, 11.2 +/- 5.5 mg/d; and dietary fiber, 9.8 +/- 3.9 g/d. Plasma Zn in 54.8% of children was no greater than 12.3 microM/L; 36% had hair Zn level no greater than 1.23 microM/g and 39% had serum ferritin levels no greater than 10 microg/dL (12% were anemic). Hair Zn was correlated to socioeconomic level (Spearman's rank correlation, r = -0.53; P < 0.001) and plasma Zn was correlated to the z weight/length (r = 0.47; P < 0.05), subscapular skinfold (r = 0.46; P < 0.05), and Zn intake (r = 0.46; P < 0.05)., Conclusions: The fortified powdered cow's milk provided to infants until age 18 mo by the Complementary Food Program in Chile favorably affects the Fe status of these children, but possibly not the Zn nutrition; we suggest re-evaluation of the levels of Zn fortification.

Hyperhomocysteinemia is considered a risk factor for cardiovascular disease and is prevalent in the elderly. Supplementation with folic acid, vitamin B-6 and B-12 lowers homocysteine levels. In January 2000, the Chilean government initiated a flour folic acid fortification program to decrease the occurrence of neural tube defects. The aim of this study was to evaluate the effect of this program on serum homocysteine and folate levels in elderly subjects after 6 mo. A total of 108 elderly people were studied. We measured serum folate, homocysteine and vitamin B-12 levels before the fortification started and 6 mo later. At baseline, folate deficiency (<6.8 nmol/L) was present in 1.8%, vitamin B-12 deficiency (<165 pmol/L) in 27.6% and hyperhomocysteinemia (>14 micromol/L) in 31% of the sample. Six months later, serum folate levels increased from 16.2 +/- 6.2 to 32.7 +/- 7.1 nmol/L (P < 0.001), homocysteine levels decreased from 12.95 +/- 3.7 to 11.43 +/- 3.6 micromol/L (P < 0.001) and vitamin B-12 levels were unchanged. Flour fortification with folic acid had a moderate lowering effect on homocysteine levels. Given that vitamin B-12 deficiency was more common than folate deficiency, it may be more appropriate to add vitamin B-12 to food, at least in foods for this age group.

Background: Fortification of wheat flour with folic acid in Chile, started in January 2000. This fortification should decrease the incidence of neural tube defects., Aim: To study the incidence of neural tube defects among Chilean newborns, during 1999., Material and Methods: The records of all newborns and stillbirths with a birth weight over 500 g from 9 public maternity hospitals in Santiago in 1999, were reviewed. All neural tube defects, associated or not to other malformations were taken into account., Results: During the study period, 59.627 newborns and 455 stillbirths were analyzed. The global incidence of neural tube defects was 1.56 per 1.000 born (57% women, 42% men and 1% ambiguous sex). Spina bifida was the most frequent neural tube defect found., Conclusion: These baseline data will be useful to assess the impact of folic acid fortification of wheat flour.

Background: Although endemic goiter is an easily controlled chronic disease, it continues to be a serious global public health problem., Aim: To study iodine nutrition in school age children from different areas of Chile., Subjects and Methods: Thyroid gland was palpated in 4181 school age children from Calama, Santiago, Temuco and Punta Arenas. Urinary iodine excretion was measured to 9% of these children and iodine concentration in salt for human consumption obtained in each of these areas was determined., Results: A 9% goiter prevalence in boys and 11% prevalence in girls was detected. The prevalence of goiter Ia was 6.5% and the figure in different geographic areas was similar. Iodine concentration in salt for human consumption was adequate according to Chilean legislation (82.6, 95.7, 96.8 and 93.2 micrograms ugI/g salt in Calama, Santiago, Temuco and Punta Arenas respectively). Urinary iodine excretion in boys and girls was 1695 and 1802 micrograms l/g creatinine in Calama, 680 and 732 in Santiago, 574 and 690 in Temuco, 570 and 528 in Punta Arenas. These values are well above recommendations., Conclusions: Endemic goiter is no longer a problem in Chile. The importance of a continuous surveillance of iodine nutrition in Chile and the reduction of salt iodine concentration required by Chilean legislation is underscored.

A 1.8 ml iron supplementation of ferrous sulfate is administered for 90 days to 76 Mapuche infants, 12 months of age, male and female, from the rural area of the Cautin province of Chile. The iron nutrition is evaluated before and after the supplementation, through: hemoglobin, haematocrit, transferrin saturation and seric ferritin. Stools test are taken at the infant's home, to confirm the supplement intake and to measure the iron excreted. To study the contained of dietary Fe a Recordatory 24 hour Inquest (RI) is applied moreover a Proximal Chemical Analysis (PCHA) to meal test proceeding from the infant's homes. At 12 months before starting the supplementation, the anemia prevalence was of 28.3%, but it disappear as a result of the intervention. Also 65.3% of the infants showed and increase of 1 g or more on their hemoglobin, which indicates that they were anemic at the beginning of the iron supplementation. By means of this therapeutic test it was find 31% more of anemic infants, indicating more sensibility of this method. The high levels of anemia prevalence are due to the low iron intake, characteristic of the non lactious foods, which according results of the RI reaches an average of 2.8 +/- 1.2 mg of Fe/day, versus 4.8 +/- 4.0 mg of Fe/day according to PCHA. The observed difference between both test showed that there is a process of food environmental contamination, by the use of iron utensils and great soil contact. The high environmental contamination could also be proved by the high iron excretion stools (140 mg of Fe/100 g of stools). This method used to measure the Fe excretion of the supplement, would not be valid in rural population groups with similar characteristics to those of the studied group, because it does not discriminate between the intake and the extremely high environmental contamination. To prevent anemia due to iron absence in infants, it is absolutely necessary to have some iron fortified food starting at 6 months of age, as a complement for breast milk.

To address the hypothesis that increased infectious morbidity is associated with iron supplementation, 783 randomly selected infants were provided with a powdered full fat cow's milk (non-fortified group) and 872 with a powdered acidified full fat cow's milk fortified with 15 mg of iron as ferrous sulfate (fortified group). All infants were followed from birth to 15 months of age with a monthly home visit by a nurse who recorded morbidity occurring during the previous 30 days. At 9 months of age, 15% of infants in each cohort were receiving breast milk only; data for these infants were segregated to make the third group. Episodes (mean +/- SD) of diarrhea/infant/year were 1.06 +/- 1.29, 1.14 +/- 1.37, and 0.82 +/- 1.04 for the fortified, non-fortified and breast-fed groups, respectively; the fortified and non-fortified bottle-fed groups had a very similar incidence of respiratory illness; 2.66 +/- 2.07 and 2.74 +/- 2.24 episodes/infant/year, respectively. The incidence of respiratory illness for both bottle-fed groups was significantly higher than that for the breast-fed group (2.22 +/- 1.84 respiratory episodes/infant/year). We conclude that for the infants the tested form of iron fortified milk, which is sufficient to lower iron deficiency anemia, does not result in an increased incidence of diarrhea or respiratory illness.

The effects of a nucleotide-supplemented formula on diarrhoeal disease was studied in 141 infants (group 1) who belonged to the low socioeconomic stratum; 148 controls (group 2) received the same formula but unsupplemented. Group 1 experienced less episodes of diarrhoea (109 versus 140), including less first episodes (74 versus 102; chi-square = 8.19, p < 0.004; odds ratio 2.01) and for a lesser number of days (807 versus 996 days); 45.0% and 31.1% of infants in groups 1 and 2, respectively, never developed episodes of diarrhoea. There were no differences in the clinical characteristics of the episodes or in the enteropathogens isolated from symptomatic or asymptomatic infants. The mechanisms through which nucleotides decrease the incidence of diarrhoeal disease in infants remain unclear.

The content and bioavailability of iron contained in Chilean bread was studied in a random sample from 301 bakeries. A wet digestion procedure followed by a colorimetric method was used. Iron bioavailability was examined in 9 adult women using the extrinsic radioactive tag method. The iron content of bread was 2.4 +/- 0.7 mg/100 g (normally distributed) and 71% of bakeries used wheat flour with adequate iron content. The geometric mean of iron absorption was high (10.5%). Simultaneous ingestion of milk or tea decreased iron absorption by 26 and 35%, respectively. These data suggest that bread represents an important source of iron in the diet of the Chilean population. Iron fortification of bread should be supported and improved nationwide.

The objective of this study was to evaluate the benefit of screening for anemia in infants in relation to their previous diet. The iron status of 854 nine-month-old infants on three different feeding regimens and on a regimen including iron dextran injection was determined by analysis of hemoglobin, serum ferritin, and erythrocyte protoporphyrin levels and of serum transferrin saturation. Infants were categorized as having iron deficiency if two or three of the three biochemical test results were abnormal and as having iron deficiency anemia if, in addition, the hemoglobin level was less than 110 gm/L. The prevalence of iron deficiency was highest in infants fed cow milk formula without added iron (37.5%), intermediate in the group fed human milk (26.5%), much lower in those fed cow milk formula with added iron (8.0%), and virtually absent in those injected with iron dextran (1.3%). The corresponding values for iron deficiency anemia were 20.2%, 14.7%, 0.6%, and 0%, respectively. The use of iron supplements is therefore justified in infants fed cow milk formula without added iron, even when there is no biochemical evidence of iron deficiency. The low prevalence of iron deficiency in the group fed iron-fortified formula appears to make it unnecessary to screen routinely for anemia in such infants. These results also support the recommendation that infants who are exclusively fed human milk for 9 months need an additional source of iron after about 6 months of age.

We evaluated the effect of iron-supplemented milk on 86 healthy infants who were followed from 3 to 12 months of age. Whole milk was supplemented with 15 mg elementary iron as ferrous sulphate and 100 mg ascorbic acid per 100 g powder. 104 infants received the same milk with no supplement and served as control. All iron nutritional parameters were higher in the supplemented group at 9 and 12 months of treatment (p < 0.01). Iron-deficiency anemia was shown in 34% of the control as compared to 0% of the treatment group. The product exhibited excellent tolerance and could therefore be used to eradicate iron-deficiency anemia of the infant.

The 1973 FAO/WHO Joint Expert Committee on Energy and Protein Requirements has recommended two methods to adjust the safe level of protein intake according to protein quality: chemical score and net protein utilization (NPU). However, the effect of protein concentration on protein utilization is not considered. The results of the present work, as well as those obtained by other investigators, show that there is an inverse relationship between protein concentration and protein utilization. The net protein utilization (NPU) at 10% of protein-calories or the chemical score adjusted by the nitrogen digestibility can be applied when results are to be projected to national average diets, which have values ranging between 9 and 13%. When it is necessary to evaluate the diet of specific relatively homogeneous population groups, the recommended method should use the NPU determined or calculated in each meal considering the level of protein concentration of the diet as eaten (NPU op). This method takes into account the amino acid complementation in each meal. The data on which these conclusions are based have been presented and discussed.

In a longitudinal study from age 3 to 15 mo, 276 term, healthy, spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and 278 control infants received milk without additives. At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group (p less than 0.001). Anemia (Hg less than 110 g/L) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified at age 15 mo. Saturation of transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/L in 39.1% of the nonfortified infants. The figures for the fortified group were 7 and 8.5% respectively. The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world.

Pre-school Children acceptability of a high nutritive value and low cost new food product (Fortesán) was studied. This mixture is formed by W.S.B. powdered milk and cacao. The purpose was to establish its a acceptability by the children and their mothers, in the Santiago population. A similar study had been already performed in 1972 in another marginal urban area and in rural areas. Inicial and final heights and weights were measured, and a socio-economical and acceptability survey was performed in all cases. The same experimental group was used as a control of it self. The study lasted 4 months, from April-May 1973 until August-September 1973. The sample was formed by children from 1 to 6 years old, coming from different socioeconomical levels. Results showed a good acceptability of the product both by the mothers and their children. It also showed a good influence in the height and weight that the children reached.

Six varieties of triticale and two varieties of wheat flours were analyzed for their proximal composition. The protein content of triticale flours ranged from 7.2 to 11.0%, and that of wheat flours, was 10.8 and 10.9%, respectively. The biological quality of Tca 8-74, measured as PER in Wistar rats, was 1.14, while that of commercial wheat flour was 0.85 (P less than 0.05). Amino acid supplementation of triticale flour with 0.2% L-lysine or 0.4% DL-threonine did not improve the biological quality of the protein. Supplementation with both amino acids, however, significantly improved both weight gain and PER. The value for the latter was 2.59 as compared to 2.62 for the standard casein diet. A panification assay was carried out using triticale, wheat and triticale: wheat blends in the following proportions: 1:0; 3:1; 1:1; 1:3; 0:1, and all of the breads were tested for their PER in rats. The PER for wheat bread and triticale bread was 1.05 and 1.25, respectively. None of the breads made from the wheat and triticale blends improved its protein quality beyond that of the wheat or triticale breads. The results of this study indicate that triticale has a better protein quality than wheat; furthermore, it may be used either alone or mixed with wheat in panification without affecting its protein value.

Two approaches in the care of malnourished children were evaluated in order to ascertain both their medical and economical effectiveness. One was a group of 745 children under an ambulatory nutritional rehabilitation program that included health care, supplementary foods and nutrition education; a second group of 420 children attended Day Care Centers (8 hours a day and five days per week) where they received a balanced diet, psychomotor stimulation according to age, and health care. The evolution of nutritional status was followed up and plotted against the NCHS/WHO weight-for-height tables. The rate of recovery was unsatisfactory; below 50% in mild cases of malnutrition, and even less in the more severe cases. The average length of time for attaining normality was longer for moderate malnutrition and for the ambulatory program. When the calculation included a correction for the probability of recovery for each system, the advantage of the Day Care Centers became even more evident: the mean length of time for recovery was 33.2% less than the ambulatory program. The social cost per child, per day, was substantially lower in the ambulatory program. The integral calculus of social cost per child, per day, and the corrected mean time for recovery provided the social cost-effectiveness of nutritional recovery. This figure was clearly adventageous for the ambulatory program for all ages and degrees of malnutrition, exception made for moderately malnourished children below two years of age. In this case, the Day Care Centers appeared to be the most effective therapeutic alternative. This type of analysis is a contribution to the evaluation of medico-social programs for the recuperation of malnutrition. The advantage lies in the fact that it allows an optimization in the allocation of resources, when the previous step is the choice of best therapeutic alternative based upon the patient's age and nutritional status.

The small amount of vitamin A in the diet of people living in some regions of Chile can be increased by adding this vitamin to sugar. In order to evaluate the effectiveness of a sugar fortification program, vitamin A fortified sugar was distributed to four indian villages in the mountainous region of Africa, whose inhabitants showed a severe vitamin A deficiency. The results of this study demonstrate that sugar fortification program is able to correct vitamin A deficiency by elevating the vitamin intake and consequently improve the circulating retinol, without substantially increasing the cost or modigying the organoleptic characteristics of sugar.

The effects on pregnancy outcome and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in a group of underweight gravidas. These take-home products were distributed during regular prenatal visits. Women in the V-N group had greater weight gain (12.29 vs 11.31 kg, p less than 0.05) and mean birth weights (3178 vs 3105 g, p less than 0.05) than those in the PUR group. Values for various indicators of maternal Fe status were also higher in the V-N group. Compared with self-selected noncompliers, similar in all control variables to compliers, children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g, respectively. Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth.

A large proportion of the milk consumed by infants in Chile is distributed by a National Food Supplementary Program. Efforts to prevent iron deficiency by milk fortification started several years ago. Initially a field study involving the simple addition of ferrous sulfate to a low-fat powdered milk was only partially successful due to the relatively low iron absorption from this product. Following the observation that the enrichment of milk with ascorbic acid markedly improved iron bioavailability, a new fortified formula was developed and has been tested in the field since 1976. This is powdered full-fat milk, biologically acidified and fortified with 15 mg Fe, as ferrous sulfate, and 100 mg ascorbic acid per 100 g powder. In a pilot study, 276 infants spontaneously weaned before 3 months of age received the fortified milk, and 278 infants receiving unfortified milk served as controls. At the end of the study (15 months of age) anemia (Hb less than 11 g/dl) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified. Saturation of Transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/l in 39.1% of the nonfortified infants. The figures for the fortified group were 7% and 8.5% respectively. Acceptance of the fortified formula was good. Following these observations, and as a previous step to the use of the fortified milk in the national program, the formula was tested in 7 National Health Service inner city community clinics under regular milk distribution.(ABSTRACT TRUNCATED AT 250 WORDS)