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BACKGROUND: As the gold standard test to quantify insulin resistance (IR) involves intravenous insulin loading and repeated blood glucose monitoring, many indexes have been developed for IR assessment for convenience. OBJECTIVE: The objective of this study was to evaluate the agreement of the Single-Point Insulin Sensitivity Estimator (SPISE) by comparing it with the homeostasis model assessment of insulin resistance (HOMA-IR) in identifying IR. METHOD: Data came from the ongoing LIMACHE BIRTH COHORT. 1,948 individuals (aged 22-28 years) were studied. We performed an agreement plot called a Bangdiwala's Observer Agreement to evaluate patterns in departures from agreement in ordinal categorical variables. RESULTS: According to the Bangdiwala-Weighted statistics, we found that the agreement between both indexes was 0.14; this value would be considered a slight agreement. Thus, we found bias in the marginal distributions, and we noticed that the SPISE has a bias toward the central quintiles of the index. CONCLUSIONS: The identification of IR in young adult individuals by the SPISE index has slight agreement with HOMA-IR. Therefore, caution would be taken when considering SPISE index among young Chilean adults.

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In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by - 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.

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The context for this review is the rapid increase in the use of non-nutritive sweeteners (NNSs) instead of sugar in foods and beverages, a situation so prevalent in some countries that consumers are finding it increasingly challenging to access foods without NNSs. The benefits of consuming NNSs on obesity and diabetes are now being questioned, and studies have shown that they may exert physiological activities, sometimes independently of sweet taste receptor stimulation. Few studies, limited mainly to North American and European countries, have described the consumption of NNSs by pregnant or lactating women and infants. Most focus on beverages rather than foods, but all agree that consumption levels have increased dramatically. Although some studies report a negative impact of NNSs on the risk of preterm birth, increased birth weight and decreased gestational age, the level of evidence is low. Several studies have also reported increased weight gain in infancy, associated with maternal NNS intake. Interestingly, several NNSs have been detected in amniotic fluid and breast milk, usually (but not always) at concentrations below their established detection limit in humans. Unfortunately, the impact of chronic exposure of the fetus/infant to low levels of multiple NNSs is unknown. In conclusion, there is a stark contrast between the galloping increase in the consumption of NNSs and the small number of studies evaluating their impact in at-risk groups such as pregnant and lactating women and infants. Clearly, more studies are needed, especially in Latin America and Asia, to fill these gaps and update recommendations.

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Studies on the effects of non-nutritive sweeteners (NNSs) among pregnant women are scarce and have produced mixed results. One of the major challenges is to accurately assess NNS intake, especially in countries that have implemented policies to prevent obesity and where many foods and beverages have been progressively reformulated to partially or totally replace sugar with NNSs. This study aimed to develop and assess the relative validity of a food frequency questionnaire (FFQ) for use in pregnant women. We developed an FFQ to examine the intake of seven NNSs (acesulfame-k, aspartame, cyclamate, saccharin, sucralose, steviol glycosides, and D-tagatose). This questionnaire was piloted in 29 pregnant women (median age = 31.2 y; 25th-75th percentile: 26.9-34.7) to assess NNS intake over the previous month, compared to 3-day dietary records (3-DR). The validity of this dietary method was assessed using Spearman's correlation coefficient, Lin´s concordance correlation coefficient (CCC), and Bland-Altman plots. Spearman's correlations between the FFQ on NNSs and 3-DR ranged from 0.50 for acesulfame K to 0.83 for saccharin. CCC ranged between 0.22 and 0.66. The Bland-Altman plots showed an overestimation of saccharin, sucralose, and steviol glycosides intake by the FFQ on NNSs compared with 3-DR, and an underestimation of acesulfame K and aspartame. Overall, the NNSs most frequently consumed were sucralose, and none of the participants exceeded the acceptable daily intake for any of the NNSs evaluated. The FFQ on NNSs seems to be reasonably valid in the assessment of NNSs among pregnant women.

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BACKGROUND: The efficacy of cholecalciferol (vitamin D3) food fortification in low- and middle-income countries near the Equator is unknown. OBJECTIVES: We examined the effects of providing cholecalciferol-fortified skim milk to adolescents and their mothers on serum total 25(OH)D, free 25(OH)D, and vitamin D-binding protein (DBP) concentrations in a randomized controlled trial. METHODS: We randomly assigned 80 Colombian families each with a child aged 12-14.5 y and their mother 1 L of skim milk daily, either fortified with 2400 IU (60 µg) cholecalciferol or unfortified, for 6 wk. We prescribed 500 mL of milk daily to adolescents; mothers consumed the remainder ad libitum. We estimated intent-to-treat effects as the between-arm difference in the change in serum total and free 25(OH)D and DBP concentrations from baseline to the end of follow-up. Secondary analyses included stratification by baseline characteristics and per-protocol comparisons. RESULTS: Among adolescents, fortification effects (95% CI) on serum total 25(OH)D, free 25(OH)D, and DBP concentrations were 5.4 nmol/L (2.1, 8.8 nmol/L), 0.6 pmol/L (-0.2, 1.4 pmol/L), and -416 nmol/L (-944, 112 nmol/L), respectively. Effects on total 25(OH)D were stronger in adolescents with lower DBP concentrations, darker skin, less sunlight exposure, and higher compliance than in their respective counterparts. Fortification increased free 25(OH)D concentrations in high compliers. Among mothers, the effects (95% CI) on total 25(OH)D and DBP concentrations were 4.0 nmol/L (0.6, 7.5 nmol/L) and -128 nmol/L (-637, 381 nmol/L), respectively. There were no adverse events. CONCLUSIONS: Provision of cholecalciferol-fortified skim milk increases serum total 25(OH)D concentrations in Colombian adolescents and adult women.

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BACKGROUND & AIMS: This study aimed to investigate the association of birth weight with developmental stages of Type 2 Diabetes among Chilean young adults. METHODS: A probabilistic sample of 1947 individuals (22-28 years) that belong to two birth cohorts (cohort 1: participants born in 1974-1978, cohort 2: participants born in 1988-1992). Multivariable logistic regressions were calculated. RESULTS: Birth weight was negatively associated with insulin resistance (IR) and dysglycaemia (prediabetes and diabetes) in adulthood (adjusted odds ratio [AOR]: 0.76 (95% confidence interval [CI]: 0.61-0.94), OR: 0.72 (95% CI: 0.60-0.89) for IR and IR plus dysglycaemia, respectively. The AOR for IR plus dysglycaemia for males was 0.72 (95% CI: 0.51-0.99) and for females was 0.77 (95% CI: 0.60-1.01). Birth weight below 3.0 kg (Cohort 2) was associated with 1.40 (95% CI: 1.01-1.95) higher likelihood of IR plus dysglycaemia. CONCLUSIONS: Our results demonstrate how a population of young adults experienced greater probability of IR, impaired fasting glucose, and diabetes as birth weight decreases. We report a novel finding of effect of suboptimal birth weight on metabolic alterations that belongs to developmental stages of Type 2 Diabetes in young adults born in a period of epidemiological and nutrition transition and grew in post-transition.

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This study aimed to assess whether weight, length, and conditional growth during the first year are associated with glycemia and insulin resistance among young adults. A non-concurrent longitudinal design was used in the study. This is a population-based cohort study, composed of people aged from 22 to 28 years. We estimated z-scores from birth to the first year and the infants were classified as stunted, underweight, overweight, obese, wasted, and at risk of wasting, using cut-offs proposed by the World Health Organization (Child Growth Standards, 2006). Conditional weight and length gain variables were estimated. Glycemia, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and single point insulin sensitivity estimator (SPISE) were evaluated in adulthood. Multiple linear regressions that includes the variables associated with glycemia and insulin resistance were used. In total, 1,070 subjects were evaluated and glycemia in adulthood was higher among subjects who were wasted or at risk of wasting at 12 months (ß coefficient = 2.77; 95%CI: 0.37; 5.21). In relation to normal weight, those subjects who were overweight at 12 months showed the lowest glycemia (ß coefficient = -2.39; 95%CI: -4.32; -0.36). Conditional weight gain in the first year was negatively associated with glycemia in adulthood (ß coefficient = -0.65; 95%CI: -1.23; -0.08). SPISE was higher among underweight subjects, and negatively associated with conditional relative weight gain and conditional linear growth in the first year. In conclusion, we found that undernutrition and suboptimal growth were associated with higher glycemia.

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OBJECTIVE: Identify and characterise the food industry's involvement in nutrition and dietetics national and regional events in Latin America and the Caribbean. DESIGN: Between February and April 2020, we conducted desk-based searches for nutrition and dietetics events held in the region between January 2018 and December 2019. Online freely accessible, publicly available information was collected on the involvement of the food industry through: sponsorship of events; sponsorship of sessions; speakers from the food industry; scholarships, fellowship, grants, awards and other prizes and; exhibition space/booths. SETTING: Nutrition and dietetics events in Latin America and the Caribbean. RESULTS: Thirty-one events held in twenty countries of the region had information publicly available online at the period of data collection. There was a lack of transparency on the involvement of industry actors in these events. When information was publicly available, we found that a total of ninety-two food industry actors sponsored 88 % of these events. CONCLUSIONS: There is a mostly unreported, but likely extensive, involvement of food industry actors in nutrition and dietetics events in Latin America and the Caribbean.

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Abstract: This study aimed to assess whether weight, length, and conditional growth during the first year are associated with glycemia and insulin resistance among young adults. A non-concurrent longitudinal design was used in the study. This is a population-based cohort study, composed of people aged from 22 to 28 years. We estimated z-scores from birth to the first year and the infants were classified as stunted, underweight, overweight, obese, wasted, and at risk of wasting, using cut-offs proposed by the World Health Organization (Child Growth Standards, 2006). Conditional weight and length gain variables were estimated. Glycemia, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and single point insulin sensitivity estimator (SPISE) were evaluated in adulthood. Multiple linear regressions that includes the variables associated with glycemia and insulin resistance were used. In total, 1,070 subjects were evaluated and glycemia in adulthood was higher among subjects who were wasted or at risk of wasting at 12 months (β coefficient = 2.77; 95%CI: 0.37; 5.21). In relation to normal weight, those subjects who were overweight at 12 months showed the lowest glycemia (β coefficient = -2.39; 95%CI: -4.32; -0.36). Conditional weight gain in the first year was negatively associated with glycemia in adulthood (β coefficient = -0.65; 95%CI: -1.23; -0.08). SPISE was higher among underweight subjects, and negatively associated with conditional relative weight gain and conditional linear growth in the first year. In conclusion, we found that undernutrition and suboptimal growth were associated with higher glycemia.

Resumen: El objetivo de este estudio fue evaluar si el peso, longitud y crecimiento condicionado durante el primer año está asociado con la glucemia y resistencia a la insulina entre adultos jóvenes. En el estudio se usó un diseño longitudinal no concurrente. Se trata de un estudio de cohorte con base poblacional, compuesto por individuos con una edad comprendida entre los 22 y 28 años de edad. Estimamos un puntaje z desde el nacimiento hasta el primer año y los niños fueron clasificados como: talla baja, con bajo peso, con sobrepeso, obesos, emaciados y con riesgo de emaciación, usando los cortes propuestos por la Organización Mundial de la Salud (Child Growth Standards, 2006). Se estimaron como variables tanto el aumento de peso condicionado, como la longitud. La glucemia, insulina, el modelo de homeostasis para evaluar la resistencia a la insulina (HOMA, en inglés) y el estimador de sensibilidad a la insulina de un solo punto (SPISE, en inglés) fueron evaluados en la etapa adulta. Usamos regresiones múltiples lineales que incluyen las variables significativamente asociadas con la glucemia y resistencia a la insulina. Se evaluaron a 1.070 individuos, la glucemia en la etapa adulta fue mayor entre individuos que estaban emaciados o con riesgo de emaciación a los 12 meses (coeficiente β = 2,77; IC95%: 0,37; 5,21). En relación con el peso normal, estos individuos que sufrían sobrepeso a los 12 meses mostraron la más baja glucemia (coeficiente β = -2,39; IC95%: -4,32; -0,36). El aumento de peso condicionado durante el primer año estuvo negativamente asociado con la glucemia en la etapa adulta (β coeficiente = -0,65; IC95%: -1,23; -0,08). El SPISE fue más alto entre los individuos con bajo peso, y estuvo negativamente asociado con el aumento relativo de peso condicionado y el crecimiento lineal condicionado durante el primer año. En conclusión, descubrimos que la desnutrición y crecimiento insuficiente estuvieron asociados con una glucemia más alta.

Resumo: O estudo teve como objetivo avaliar se o peso, estatura e crescimento condicional durante o primeiro ano de vida estão associados à glicemia e à resistência insulínica entre adultos jovens. O estudo usou um desenho longitudinal não concorrente. O estudo de coorte de base populacional analisou pessoas de idade entre 22 e 28 anos. Estimamos os escores-z desde o nascimento até o primeiro ano, e os lactentes foram classificados como: baixa estatura para idade, sobrepeso, obesidade, subnutrição e risco de subnutrição, usando os pontos de corte propostos pela Organização Mundial da Saúde (Child Growth Standards, 2006). Foram estimadas as variáveis de peso condicional e ganho de estatura. Foram avaliadas na vida adulta a glicemia, insulina e avaliação do modelo de homeostase da resistência à insulina (HOMA-IR, em inglês) e estimador de sensibilidade à insulina de ponto único (SPISE, em inglês). Utilizamos regressão linear multivariada, incluindo as variáveis com associação significativa com a glicemia e a resistência insulínica. Foram avaliados 1.070 indivíduos, e a glicemia na idade adulta foi maior naqueles com subnutrição ou riso de subnutrição aos 12 meses de idade (coeficiente β = 2,77; IC95%: 0,37; 5,21). Em relação ao peso normal, indivíduos com sobrepeso aos 12 meses mostraram a menor glicemia (coeficiente β = -2,39; IC95%: -4,32; -0,36). O ganho ponderal condicional no primeiro ano de vida mostrou associação negativa com glicemia na vida adulta (coeficiente β = -0,65; IC95%: -1,23; -0,08). O SPISE foi mais alto entre indivíduos subnutridos e mostrou associação negativa com o ganho ponderal condicional e o crescimento linear condicional no primeiro ano. Como conclusão, o estudo mostrou que a subnutrição e o crescimento baixo estiveram associados a glicemia mais elevada.

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The prevalence of obesity among Chilean adults and children is one of the highest worldwide. To fight the constant increase of non-communicable diseases and the growing sales of sugar-sweetened beverages, the Chilean government recently enacted a new Law of Food Labeling and Advertising imposing the application of front-of-package warning labels in foodstuffs whose composition exceeds limits for critical nutrients including sugar. Accordingly, food companies have been reformulating their products, incorporating non-caloric sweeteners (NCSs) in partial or total replacement of sucrose. The number of NCS-containing foods and beverages, therefore, has been increasing in the last years. This study aims to identify the NCS-containing products from different food/beverage categories currently available on the Chilean market. Nineteen supermarkets and 13 food web pages were visited by trained dietitians to carry out a systematic search of ingredient information from the different food categories. Overall, 1,489 products were analyzed, of which 815 (55.5%) contained at least one NCS, being this proportion particularly high, compared to other countries. 67.1% of the dairy products, 31.5% of the cereal products, 49% of the processed fruits, 74.3% of the non-alcoholic beverages, and 46.2% of sweets and other desserts contained NCS. Considering the food categories more specifically oriented to children, NCSs were present in 98.8% of powder juices, 98.3% of the flavored milks, 91.2% of jellies, and 79% of the dairy desserts. Sucralose and steviol glycosides were the most widely used NCSs, these sweeteners being present, alone or mixed with other, in 73.5 and 39.7% of the NCS-containing products, respectively, while the use of saccharin and cyclamate was low. In addition, 80 tabletop NCSs were available in the local market, 91.2% of them being sucralose and steviol glycosides (alone or combined). The high number of food products containing steviol glycosides makes very plausible that the daily consumption of this NCS in the pediatric populations could exceed its acceptable daily intake (ADI). The fact that there are no NCS-free foods alternatives for certain food categories, especially for children, is worrying.