HÁBITOS E ATITUDES DE MÃES DE LACTENTES EM RELAÇÃO AO ALEITAMENTO NATURAL E ARTIFICIAL EM 11 CIDADES BRASILEIRAS / HABITS AND ATTITUDES OF MOTHERS OF INFANTS IN RELATION TO BREASTFEEDING AND ARTIFICIAL FEEDING IN 11 BRAZILIAN CITIES

RESUMO Objetivo: Analisar a relação entre hábitos e atitudes de mães com os tipos de leite oferecidos para seus filhos nos dois primeiros anos de vida. Métodos: Estudo retrospectivo incluindo 773 entrevistas de mães de 11 cidades brasileiras com filhos com até 2 anos de idade. Foram analisadas as seguintes informações: tipo de aleitamento que planejava enquanto estava na gestação e o efetivamente realizado após o nascimento; tipo(s) de leite(s) utilizado(s) no dia da entrevista e anteriormente; idade de introdução do leite de vaca integral; e origem das recomendações para usar determinado tipo de leite. Resultados: O leite materno era oferecido para 81,7% dos lactentes no primeiro semestre de vida, 52,2% no segundo semestre (p<0,001) e 32,9% no segundo ano de vida (p<0,001). Por sua vez, o consumo de leite de vaca integral aumentou de 31,1 para 83,8% (p<0,001) e 98,7% (p=0,05), respectivamente, nestas três faixas etárias. Fórmula de partida (15,0%) e de seguimento (2,3%) eram utilizadas por um número de lactentes muito menor em relação aos que recebiam leite de vaca integral. A maioria das mães não recebeu prescrição de leite de vaca integral. Os pediatras foram os profissionais da área da saúde que mais frequentemente recomendaram fórmula infantil. Conclusão: As taxas de aleitamento natural no Brasil continuam abaixo das recomendações. As mães brasileiras, com frequência, decidem oferecer leite de vaca integral por iniciativa própria. É muito baixa a utilização de fórmula infantil quando o aleitamento natural é interrompido.

ABSTRACT Objective: To analyze the relationship between habits and attitudes of mothers and the types of milk offered to their children in their first two years of life. Methods: Retrospective study including 773 interviews of mothers from 11 Brazilian cities with children under 2 years of age. Interviews were conducted in 11 cities of Brazil. The following factors were analyzed: breastfeeding method planned during pregnancy and the method actually applied after birth; type(s) of milk(s) used on the day of the interview and earlier; age at which the child was introduced to whole milk; and source of advice used to choose a certain type of milk. Results: Breast milk was offered to 81.7% of infants during their first six months of life, to 52.2% of infants during their second semester (p<0.001) and to 32.9% of infants during their second year of life (p<0.001). In contrast, cow’s milk consumption increased from 31.1 to 83.8% (p<0.001) and 98.7% (p=0.05), respectively, for these three age groups. Infant (15.0%) and follow-on (also known as toddler’s) (2.3%) formulas were used by a much smaller number of infants than whole cow’s milk. Most mothers were not prescribed whole cow’s milk. Pediatricians were the health care professionals who most often recommended infant formulas. Conclusions: Rates of breastfeeding in Brazil remain below recommended levels. Brazilian mothers often decide to feed their infants with whole cow’s milk on their own initiative. The use of infant formulas after weaning is still too low.

Caseinomacropeptide index in UHT whole milk stored under different conditions of temperature and time / Efeito das condições de armazenamento no índice de caseinomacropeptídeo de amostras de leite integral ultra alta temperatura (UAT)

Caseinomacropeptide (CMP) index is a method used to detect adulteration of milk by addition of cheese whey, since CMP is a glycopeptide characteristic produced during cheesemaking, and soluble in the whey phase. The objective of this work was to evaluate the caseinomacropeptide index of UHT milk stored under different temperatures. Six batches of recently processed UHT milk were collected and stored under three temperatures (21ºC, 6ºC, and -12ºC) and analyzed by HPLC in the day of the milk collection (day 0) and at 30, 60, 90, and 120 days of storage. The experiment was run as a randomized block design with a 3x5 factorial arrangement, and the Student-Newman-Keuls (SNK) method was used as the post-hoc test (p = 0.05). There was a progressive increase of the CMP index during the storage period of 120 days, and this indicates the possibility of false positive results if the CMP index is used as an adulteration test for long term stored UHT milk. The validity of the CMP index as an adulteration indicator is only possible soon after packaging, and sample freezing is the only alternative when immediate analysis is not possible. The method was found to be precise, with robust CV of 1.9% even with high CMP levels.

O objetivo deste trabalho foi avaliar a influência da temperatura e do tempo de armazenamento de amostras de leite UAT, em relação ao índice de caseinomacropeptídeo, por cromatografia líquida de alta eficiência, e a precisão do método de detecção. Seis lotes foram coletados e armazenados em três temperaturas (21ºC, 6ºC e -12ºC ± 1ºC) e analisadas durante o armazenamento nos dias 0, 30, 60, 90 e 120 dias. Utilizou-se o delineamento em blocos casualizados com os tratamentos em arranjo fatorial 3x5 e os resultados foram comparados por meio do teste Student-Newman-Keuls (SNK) a 5% de significância. Houve aumento progressivo do índice de CMP por CLAE durante os 120 dias; portanto, um produto conforme pode se tornar não conforme sem que ocorra adulteração. A detecção de fraude por adição de soro lácteo em leite UAT pode ser detectada somente após o envase. Caso não seja possível a análise imediata, recomenda-se que as amostras sejam congeladas. O método é muito preciso (CV=1,9%) e indiferente aos níveis de CMP encontrados nas amostras.

The Effect of Continuing Breastfeeding during Treatment of Breast Milk Jaundice / 대한주산의학회잡지

PURPOSE: Though it is a general and common method to temporarily stop breast feeding and use whole milk instead for neonatal breast milk jaundice, it may cause some difficulties in continuing breast feeding after the recovery. We study the effect of continuing breast feeding on the treatment of breast milk jaundice and the success of breast feeding afterwards. METHODS: We retrospectively analyzed the medical records of 59 neonates who were admitted to Cheil general hospital from Jan 2008 to Aug 2012 for phototherapy due to breast milk jaundice. Subjects were divided into two groups, one with continuing breast feeding (35 cases) during treatment and the other with stopping breast feeding (24 cases). We examined and compared the changes in the level of serum total bilirubin between two groups, as well as the difficulties the mothers might had in continuing or restarting breast feeding after the discharge. RESULTS: There was no significant difference in times of treatment (until reaching the level of serum total bilirubin <13 mg/dL) between two groups (P=0.066). However, the group with temporary stop of breast feeding had difficulties such as nipple confusion and breast engorgement compared to breast feeding group (P=0.001). In long-term follow up, the breast feeding duration (P=0.017) and the rate of exclusive breast feeding for 6 months (P=0.024) were also significantly higher in breast feeding group. CONCLUSIONS: We suggest that continuing breast feeding while treating breast milk jaundice is helpful both for successfully continuing breast feeding and preventing problems after discontinuing breast feeding.

Comparison of Antigenicities of Whole Milk and Partial Hydrolysate of Cow's Milk Proteins by Western Blot Analysis / 소아알레르기및호흡기학회지

For the prevention or the management of milk allergy in infancy, partial or extensive hydrolysates of cow's milk have been used in western countries for a couple of decades. Recently a Korean product of partial hydrolysate(HA-21) became available for the prevention of sensitization to cow's milk proteins. In this study, to compare the antigenicities of whole milk(WM) and HA-21, we performed the IgG and IgE western-blot analysis. Sera were obtained from 17 milk sensitive infants and 2 controls, and crude extract of WM and HA-21 and purified beta-lactoglobulin(BLG), bovine serum IgG(B-IgG), alpha-lactalbumin(ALA) were used for blot- inhibition study. After the non-reduced SDS-PAGE, western-blot studies were done using biotinylated anti-human IgG and IgE antibodies, and the reaction were detected by avidine-phosphatase system. By the SDS-PAGE analysis, WM were separated into bovine-IgG(B-IgG), bovine serum albumin(BSA), 56 KD protein, caseins(CAS), BLG and ALA, but there was no visible bands above 14 KD in the case of HA-21. In preliminary blot analysis with 4 milk sensitive sera, we found the broad and strong IgE-binding protein band in the range of 150-200 KD in all cases. This fraction, named as 'P-band' in this study, was completely inhibited by BLG and partially inhibited by B-IgG using blot-inhibition study. Using the western blot analysis of WM, the P-band revealed the most prevalent IgG and IgE binding protein in 16 of 17 tested sera. More than 15 bands were identified by IgG-blot of WM, but the IgE biding proteins were P-band(16 sera), BSA(12 sera), 56 KD protein(8 sera), and CAS(5 sera). In the case of HA-21, BSA(8 sera) was the only protein bound with IgE antibody and the reaction was very weak compared to that of WM. In conclusion, the major IgE binding protein appears to be the p-band which might contain the epitopes of B-IgG and BLG in this study. The antigenicity of HA-21 is remarkably reduced compared to WM, but still minute residual antigenicity and allergenicity are remained in the extract of HA-21.