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Bloque sin PMID: sale de las fuentes legales y del Ministerio de Salud citadas al pie

Lo que dice la ley sobre los colegios

La Ley 20.606 prohíbe vender, promocionar y publicitar alimentos «ALTO EN» dentro de jardines infantiles y colegios de básica y media, y también en sus puntos de acceso. La misma ley prohíbe regalarlos a menores de 14 años y dirigirles publicidad [1].

La prohibición es para lo que se vende o se regala en el colegio. Para la colación que va desde la casa, el Ministerio de Salud recomienda alimentos frescos y naturales, sin sellos o con menos sellos, y acompañarla con agua [2].

Según la guía del Ministerio, la colación es un complemento: se sugiere una sola por jornada, en porción pequeña, sobre todo cuando pasan más de 4 horas sin comer [3]. Algunos ejemplos de esa guía [3]:

Fuentes legales y del Ministerio de Salud

Ley 20.606 en el kiosco · PMID 31318604 · Journal Article

1. En los kioscos escolares, los productos sobre el límite bajaron de 90 % a 15 %

Resumen propuesto

En 21 colegios públicos de Santiago se revisaron las etiquetas de lo que vendían los kioscos en 2014 y en 2016, seis meses después de que la ley empezó a regir. Los alimentos que superaban algún límite bajaron de 90,4 % a 15,0 %. En los productos líquidos, el sodio subió, por cambios en lo que se ofrecía.

Qué significa para ti. Cambió lo que se ofrece en el colegio. Los autores dicen que falta medir si cambió lo que comen los niños y su salud.

Estudio antes y después, sin grupo de comparación · 21 colegios · Massri C et al. Am J Public Health, 2019

Abstract original

Impact of the Food-Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014-2016.

Objectives. To evaluate the impact of a national law banning sales of competitive food and beverages (CF&B) in schools on the availability of CF&B sold at school kiosks.Methods. This study was uncontrolled before and after study. We evaluated public schools in Santiago de Chile (n = 21; 78% response rate) in 2014 and 2016 (6 months after the law came into force). Trained personnel collected data on calories, total sugars, saturated fat, and sodium from food labels. The outcome was the percentage of foods exceeding the cutoff levels defined in the law and the mean difference between 2014 and 2016.Results. Foods exceeding any cutoffs decreased from 90.4% in 2014 to 15.0% in 2016. Solid products had a substantial reduction in calories, sugar, saturated fat, and sodium. Liquid products had a reduction in calories, total sugar, and saturated fat, whereas sodium increased. This was a result of changes in product mix.Conclusions. A ban on sales of CF&B reduced the availability of CF&B at Santiago's school kiosks. Further research should examine the impact of this ban on food intake and health outcomes.
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Colaciones en Chile · PMID 31124768 · Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't

2. Las colaciones aportan más de un cuarto de la energía del día

Resumen propuesto

En dos grupos chilenos, uno de 958 niños de 4 a 6 años y otro de 752 adolescentes de 12 a 14 años, el 95,2 % de los niños y el 89,9 % de los adolescentes comió al menos una colación en el día, con un promedio de 2,3 diarias. Las colaciones dieron el 29,0 % de la energía del día en niños y el 27,4 % en adolescentes. Lo que más aportó fueron postres de masa, snacks salados, dulces, lácteos y cereales.

Qué significa para ti. La colación pesa en el día de tus hijos. Los autores proponen estudiar si esto cambió con la ley.

Estudio de una sola medición: lo que comieron el día anterior · 958 niños y 752 adolescentes · Jensen ML et al. Public Health Nutr, 2019

Abstract original

Snacking patterns among Chilean children and adolescents: is there potential for improvement?

OBJECTIVE: To examine snacking patterns, food sources and nutrient profiles of snacks in low- and middle-income Chilean children and adolescents. DESIGN: Cross-sectional. Dietary data were collected via 24 h food recalls. We determined the proportion of snackers, snacks per day and energy from top food and beverage groups consumed. We compared the nutrient profile (energy, sodium, total sugars and saturated fat) of snacks v. meals. SETTING: South-east region of Chile. PARTICIPANTS: Children and adolescents from two cohorts: the Food Environment Chilean Cohort (n 958, 4-6 years old) and the Growth and Obesity Cohort Study (n 752, 12-14 years old). RESULTS: With a mean of 2·30 (se 0·03) snacks consumed daily, 95·2 % of children and 89·9 % of adolescents reported at least one snacking event. Snacks contributed on average 1506 kJ/d (360 kcal/d) in snacking children and 2218 kJ/d (530 kcal/d) in snacking adolescents (29·0 and 27·4 % daily energy contribution, respectively). Grain-based desserts, salty snacks, other sweets and desserts, dairy foods and cereal-based foods contributed the most energy from snacks in the overall sample. For meals, cereal-based foods, dairy beverages, meat and meat substitutes, oils and fats, and fruits and vegetables were the top energy contributors. CONCLUSIONS: Widespread snacking among Chilean youth provides over a quarter of their daily energy and includes foods generally considered high in energy, saturated fat, sodium and/or total sugars. Future research should explore whether snacking behaviours change as the result of Chile's national regulations on food marketing, labelling and school environments.
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Reglas escolares · PMID 29596440 · Meta-Analysis, Systematic Review

3. Las reglas sobre lo que se vende en el colegio sí cambian lo que se come

Resumen propuesto

Esta revisión juntó 91 intervenciones de Estados Unidos, Canadá, Europa y Nueva Zelanda. Los estándares sobre lo que se vende en el colegio bajaron el consumo de bebidas azucaradas y de snacks poco saludables. Entregar fruta y verdura en el colegio subió su consumo. En el peso, en general no se vieron bajas significativas.

Qué significa para ti. Las reglas del colegio ayudan con hábitos concretos. Su efecto en el peso todavía no está claro, según los autores.

Revisión sistemática y metaanálisis · 91 intervenciones · Micha R et al. PLoS One, 2018

Abstract original

Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis.

BACKGROUND: School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. OBJECTIVE: To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. METHODS: We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias. RESULTS: From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. CONCLUSIONS: Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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Lo que va desde la casa · PMID 38876395 · Meta-Analysis, Systematic Review

4. El almuerzo que va desde la casa: la fruta suele estar, las verduras no tanto

Resumen propuesto

Esta revisión reunió 28 estudios, sobre todo de Estados Unidos, sobre lo que los niños llevan desde la casa para almorzar. Llevaban fruta la mitad de las veces, verduras solo un 17 % y lácteos un 25 %. También eran frecuentes los snacks (50 %), los dulces (48 %) y las bebidas azucaradas (31 %).

Qué significa para ti. Es otro país y otra comida del día, pero da una pista útil: fíjate si la colación lleva verdura o lácteo, no solo fruta.

Revisión sistemática y metaanálisis · 28 estudios, 16 en el metaanálisis · Song S et al. Adv Nutr, 2024

Abstract original

The Quality of Lunches Brought from Home to School: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis, spanning studies published between 1995 and 2021, investigates various aspects of lunches brought from home (LBFH) to school by children. These meals, in contrast to those provided by the National School Lunch Program (NSLP), lack strict nutritional standards. Despite the availability of NSLP lunches, ∼40% of US children opt for LBFH. This review aims to assess the food content and nutritional quality of LBFH, their adherence to NSLP standards in terms of nutrition and cost, effectiveness of intervention programs designed to enhance their nutritional quality and parental and student perceptions of LBFH. The comprehensive literature search yielded 28 eligible papers, with 16 included in meta-analysis. LBFH commonly include fruits (50%), yet vegetables (17%) and dairy (25%) are less prevalent. They frequently contain snacks (50%), sweets (48%), and sugar-sweetened beverages (31%). Compared with school lunches, LBFH exhibit lower levels of calcium, protein, iron, fiber, and vitamin A, and higher levels of carbohydrates and saturated fat. Intervention programs had no effect on quality of LBFH. On average, LBFH ($1.81) cost slightly less than lunches served at school ($1.98), without accounting for free/reduced-price meals in the calculation. The cost of school lunch for pre-k and kindergarten children became $11.32, nearly 4 times higher than that of LBFH ($2.92), after replicating the meal at home and accounting for meal preparation time. Parents preferred LBFH over school lunches because of concerns related to the quality of school meals served. This study concludes that LBFH are generally less nutritious compared with lunches provided by NSLP. Future research needs to further explore ways to improve parent perception of NSLP. Especially with many states making free meals available to all children, identifying effective ways in promoting and increasing NSLP participation can ensure more children have access to nutritionally balanced and affordable lunches.
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Ley 20.606 y peso infantil · PMID 42276088 · Journal Article, Research Support, Non-U.S. Gov't

5. Primera evidencia de que la ley bajó el exceso de peso en niños pequeños

Resumen propuesto

Con datos nacionales de 321.597 niños de 4 a 6 años en colegios públicos y subvencionados, se comparó a quienes vivieron la primera fase de la ley con quienes no. Los expuestos durante 18 meses tuvieron menos probabilidad de exceso de peso: 2,85 % menos en niñas y 2,40 % menos en niños.

Qué significa para ti. Los autores lo describen como un efecto «plausiblemente» causado por la ley. Es una buena noticia sobre el entorno de los niños, no una tarea más para ti.

Estudio de cohortes que compara antes y después · 321.597 escolares · Paraje G et al. Lancet, 2026

Abstract original

The impact of Chile's multipronged food labelling and advertising law on early childhood excess weight: a cohort difference-in-differences study.

BACKGROUND: The 2016 Chilean Food Labelling and Advertising Law (FLAL), featuring black octagonal front-of-package warning labels and marketing and school restrictions, was among the first sets of multiple healthy food policies globally. In spite of its relevance, no study has causally linked the FLAL implementation to health outcomes. We aimed to estimate the plausible causal effect of the implementation of phase 1 of the FLAL on the relevance of excess weight among young children. METHODS: In this cohort difference-in-differences approach, we assessed the effect of phase 1 of the FLAL on children's BMI when initital thresholds for critical nutrients were subsequently increased and implemented. Our analysis used national administrative data from the Chilean National Board of School Aid and Scholarships covering more than 300 000 school children aged 4-6 years across public and publicly subsidised schools nationwide from 2012 to 2017. We primarily used the Nutritional Map (Mapa Nutricional), available beginning in 2012, complemented with the Vulnerability Survey (Encuesta de Vulnerabilidad), available beginning in 2019. We defined cohorts by the year students entered prekindergarten, and compared unexposed cohorts (2012 and 2013, control group) with cohorts exposed to phase 1 (2014 and 2015, treatment group) during prekindergarten, kindergarten, and first grade. The primary outcome was a binary indicator of excess weight (ie, overweight or obesity) analysed using logit models and reported as marginal effects. We conducted subgroup analyses by children's school type, school area, maternal education and age at childbirth, birthweight, and gender. FINDINGS: The final analytical sample included 321 597 students (of cohorts 2012-15) covering the years 2012 to 2017 across prekindergarten, kindergarten, and first grade. Exposure to phase 1 of the FLAL led to significant reductions in the probability of a child having excess weight. Children exposed during both kindergarten and first grade (ie, 18 months of exposure) had the largest effects. Girls had a 2·85% lower probability of excess weight (95% CI -0·0407 to -0·0163), while boys had a 2·40% lower probability (-0·0358 to -0·0122). We also observed significant effects after 6 months of exposure (ie, first grade only): 1·91% lower probability (-0·0315 to -0·0068) for girls and 2·24% (-0·0345 to -0·0104) lower probability for boys. INTERPRETATION: Phase 1 of Chile's comprehensive FLAL plausibly caused a measurable decrease in the prevalence of excess weight among young school children. The results provide crucial, evidence-based support for policy makers worldwide who are considering food environment policies as a scalable, impactful strategy to combat the childhood obesity epidemic. FUNDING: Bloomberg Philanthropies Grant.
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