Escenarios lácteos y microbiota intestinal en los primeros 1000 días / Milk scenarios and gut microbiota in the first 1000 days of life

La leche humana es el estándar de oro para la nutrición del bebé y debe iniciarse en la primera hora de vida. La leche de vaca, de otros mamíferos o las bebidas vegetales no se deben ofrecer antes del año de vida. Sin embargo, algunos niños requieren, al menos en parte, de fórmulas infantiles. Aun con las sucesivas mejoras a lo largo de la historia mediante la incorporación de oliogosacáridos, probióticos, prebióticos, sinbióticos y postbióticos, las fórmulas infantiles siguen siendo perfectibles para reducir la brecha de salud entre los bebés amamantados y aquellos alimentados con fórmula. En este sentido, se espera que la complejidad de las fórmulas siga aumentando a medida que se conozca mejor cómo modular el desarrollo de la microbiota intestinal. El objetivo de este trabajo fue realizar una revisión no sistemática del efecto de los diferentes escenarios lácteos sobre la microbiota intestinal.

Human milk is the gold standard for infant nutrition, and breastfeeding should be started within the first hour of life. Cow's milk, other mammalian milk, or plant-based beverages should not be offered before 1 year of age. However, some infants require, at least in part, infant formulas. Even with subsequent enhancements throughout history, with the addition of oligosaccharides, probiotics, prebiotics, synbiotics, and postbiotics, infant formulas still have room for improvement in reducing the health gap between breastfed and formula-fed infants. In this regard, the complexity of infant formulas is expected to continue to increase as the knowledge of how to modulate the development of the gut microbiota is better understood. The objective of this study was to perform a non-systematic review of the effect of different milk scenarios on the gut microbiota.

Elaboração e validação de lista de verificação dos processos produtivos de dietas pediátricas em lactários hospitalares / Elaboration and validation of the checklist of the production processes of pediatric diets in hospital lactaries

Resumo Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.

Abstract This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist's practice.

Abordaje de los probióticos en pediatría: el rol de Lactobacillus rhamnosus GG / Approach to probiotics in pediatrics: the role of Lactobacillus rhamnosus GG

El parto prematuro, las cesáreas, los antibióticos y la lactancia materna limitada contribuyen al aumento de enfermedades crónicas no transmisibles. El objetivo fue realizar una revisión descriptiva del uso de probióticos en pediatría, con foco en la cepa Lactobacillus rhamnosus GG. Ciertos probióticos han demostrado ser eficaces en la diarrea aguda y en la diarrea asociada a antibióticos. L. rhamnosus GG y Saccharomyces boulardii pueden acortar la duración y los síntomas. L. reuteri DSM 17938 y L. rhamnosus GG fueron efectivos para el abordaje del cólico del lactante. El uso de esta cepa en fórmulas infantiles para alergia a las proteínas de leche de vaca promovería la adquisición más temprana de tolerancia. En la prevención de dermatitis atópica, la administración de L. rhamnosus GG durante el embarazo redujo su manifestación en el bebé. El empleo de probióticos como coadyuvantes es una posibilidad para considerar en la práctica pediátrica actual.

Preterm birth, C-sections, antibiotics, and limited breastfeeding contribute to the increase in noncommunicable diseases. Our objective was to perform a descriptive review of probiotic use in pediatrics, focused on Lactobacillus rhamnosus GG. Certain probiotics have demonstrated to be effective in acute diarrhea and antibiotic-associated diarrhea. L. rhamnosus GG and Saccharomyces boulardii may shorten their duration and symptoms. L. reuteri DSM 17938 and L. rhamnosus GG were effective to manage infant colic. The use of this strain in infant formulas for cow's milk protein allergy may promote an earlier tolerance acquisition. In relation to the prevention of atopic dermatitis, the administration of L. rhamnosus GG during pregnancy reduced its development in the infant. The use of probiotics as adjuvants is a possibility to consider in current pediatric practice.

Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Contaminación microbiólogica en fórmulas infantiles en polvo en dos hospitales de Honduras / Microbiological contamination in children's powdered formulas in two Honduran hospitals

OBJETIVOS: Determinar la existencia de contaminación por patógenos en fórmulas infantiles en polvo (FIP) procesadas en los dos hospitales públicos más grandes de Honduras y evaluar las condiciones de procesamiento de sus servicios de fórmulas infantiles (SFI). MÉTODOS: Estudio exploratorio realizado en dos etapas: ') Evaluación presencial de las condiciones de procesamiento de las FIP de los dos SFI; 2) Recolección y análisis de las muestras FIP para el aislamiento de Cronobacter spp. y enterobacterias. RESULTADOS: La evaluación de los SFI mostró debilidades en diferentes aspectos como infraestructura, almacenamiento, capacitación y registros. Cincuenta muestras fueron recolectadas en total de cinco marcas originarias de seis países. El 38% se encontraban en uso durante el muestreo y 62% fueron recolectadas de latas selladas. Se comprobó la presencia de Cronobacter spp. en 4% (2/50) del total de muestras, una proveniente de cada hospital. Se elaboró y entregó un manual de procesamiento de FIP a cada hospital participante. CONCLUSIONES: Existe contaminación de Cronobacter spp., Klebsiella y Acinetobacter en los dos hospitales hondureños; resultado similar a los estimados en Chile (5%) y Cuba (',6%). Es necesaria la implementación del manual de procesamiento FIP y el monitoreo de estos y otros microorganismos patógenos.

OBJECTIVES: Determine the existence of pathogen contamination in powdered infant formulas (PIF) processed in the two largest public hospitals in Honduras and evaluate the processing conditions of their infant formula services (IFS). METHODS: Exploratory study executed in two stages: ') faceto-face evaluation of the processing conditions of the PIF of the two IFS; 2) Collection and analysis of the PIF samples for Cronobacter spp. and Enterobacteriaceae isolation. RESULTS: The evaluation of the IFS showed weaknesses in different aspects such as infrastructure, storage, training and keeping records. In total, fifty samples were collected, representing five brands from six countries. Thirty eight percent of samples were collected from cans in use during sampling and 62% were collected from sealed cans. The presence of Cronobacter spp. was detected in 4% (2/50) of the total samples, one from each hospital. A PIF processing manual was prepared and delivered to each participating hospital. CONCLUSIONS: Contamination of Cronobacter spp., Klebsiella and Acinetobacter existed in two evaluated Honduran hospitals; results similar to others in Chile (5%) and Cuba ('.6%). It is necessary to implement the PIF processing manual and monitor these and other pathogenic microorganisms

Influência da diluição, do tempo e da temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos / Influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns

RESUMO Objetivo: Analisar a influência da diluição, o tempo e a temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos (RN). Métodos: Estudo experimental e descritivo com uma amostra de diferentes fórmulas lácteas neonatais para verificar a osmolalidade do leite segundo a diluição, o tempo e a temperatura pós-preparo. Foram analisadas sete fórmulas lácteas neonatais nos seguintes tempos: imediatamente (até 5 minutos) após o preparo; 20 e 40 minutos após o preparo; de hora em hora, até completar 8 h; e após 12 e 24 h de preparo. As amostras foram avaliadas após o preparo em temperatura ambiente e depois da refrigeração. Foram elaboradas curvas de osmolalidade com a média das triplicatas de cada amostra de leite. O cálculo da osmolalidade foi aferido no Osmômetro digital A+ da Advanced Instruments, modelo 3.320. Resultados: O tempo e a temperatura em que os leites ficaram submetidos após o preparo não ultrapassaram o ponto de corte de segurança da osmolalidade na diluição 1:30 em nenhum dos tipos de leite analisados. Na diluição 1:25 a fórmula láctea que possui prebióticos em sua composição ultrapassou o limite após 4 h de preparo. Conclusões: Os leites testados não ultrapassaram o ponto de corte de 450 mOsm/kg (aproximadamente 400 mOsm/L), indicado como seguro pela Academia Americana de Pediatria (AAP) na diluição preconizada pelos fabricantes. É necessário conhecer os fatores que podem ou não contribuir com o aumento da osmolalidade, afim de se estabelecer condutas seguras e de qualidade para os RN, seguindo protocolos baseados em evidências científicas.

ABSTRACT Objective: To analyze the influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns (NBs). Methods: Experimental and descriptive study with samples of different neonatal formulas to verify the osmolality of the milk according to dilution, time, and temperature after preparation. We analyzed seven neonatal formulas in the following times after preparation: immediately (up to 5 minutes); 20 and 40 minutes; every hour up to 8 hours; and 12 and 24 hours. The samples were evaluated at room temperature and after refrigeration. Osmolality curves were designed with the mean of triplicate samples of each milk sample. The digital Osmometer A+, model 3320, from Advanced Instruments measured the osmolality. Results: The time and temperature at which the milk was subjected after preparation did not cause the osmolality to exceed its safety cut-off point at a 1:30 dilution in any of the types of milk analyzed. At a 1:25 dilution, the formula with prebiotics in its composition went over the limit after 4 hours. Conclusions: The milk tested did not exceed the cut-off point of 450 mOsm/kg (approximately 400 mOsm/L), indicated as safe by the American Academy of Pediatrics (AAP) at a dilution recommended by manufacturers. It is important to know the factors that may or may not contribute to the rise of osmolality, in order to establish safe and quality practices for NBs, following protocols based on scientific evidence.

Modification of nutritional value during storage of infant formulas elaborated with different intact and partially hydrolyzed proteins and carbohydratese / Modificación del valor nutricional durante el almacenamiento de fórmulas infantiles elaboradas con diferentes proteínas intactas, parcialmente hidrolizadas y carbohidratos

Background: Human milk is considered the best source of nutrition for young infants. However, if mothers cannot provide adequate breast milk or if infants are premature or have a low birth weight, breast-feeding must often be replaced or complemented with infant formulas (IFs). The interactions between infant formula components (proteins, fats, carbohydrates, vitamin and minerals) mainly affect carbohydrates and proteins (Maillard reaction, MR), but those involving proteins are especially important in products used in infant feeding because of the high protein requirements of infants. On the other hand, fatty acids (FAs) are considered important in infant development. Objectives: The aim of the present work was to test the stability of IFs made with different ingredients, analyzing the available lysine losses (for protein stability) and the FAs content and the peroxide value (for fat stability) during stored at normal and adverse conditions and to propose a faster control of that stability. Methods: Available lysine analyzed by high-performance liquid chromatography (HPLC), lipid oxidation by titrimetric method and FAs profile by gas chromatography (GC) were determined in four types of IFs prepared with intact and partially hydrolyzed proteins and different carbohydrates (lactose or maltodextrins) during storage at 4, 20 and 30 ºC for 24 months at normal water activity (Aw=0.1-0.4), and at Aw of 0.65 at 20 and 30 ºC for 4 weeks. These IFs were prepared twice (IF1 and IF2) in different batches by a Spanish dietary product company. Results: At 30ºC, available lysine losses were 40-50% in all IFs analyzed. The behavior and percentage lysine loss between 1 and 4 weeks of storage at 30 °C with Aw=0.65 was similar to those obtained after 24 months of storage at 30 °C. No significant changes were observed in fatty acid profile during storage. Oxidation was only observed in opened packs and after 4 weeks/30 °C/Aw=0.65. Conclusions: The losses of available lysine increase to higher time and storage temperatures. The FAs shows a good stability for any storage condition; however peroxide values prove more sensitive than FAs changes for evaluating fat oxidation during the storage of IFs.

Antecedentes: La leche materna es la mejor fuente nutricional para niños recién nacidos. Sin embargo, cuando las madres no pueden proveer leche, o si los niños son prematuros o tienen bajo peso al nacer, la lactancia debe ser reemplazada o complementada con fórmulas infantiles (IFs). La interacción entre los componentes de las IFs (proteínas, grasas, carbohidratos, vitaminas y minerales) principalmente afecta carbohidratos y proteínas (Reacción de Maillard, MR), pero los que implican proteínas son especialmente importantes en alimentación infantil debido a los altos requerimientos de proteína de los lactantes. Por otra parte, los ácidos grasos (FAs) son considerados importantes en el desarrollo de los niños. Objetivos: El objetivo fue evaluar la estabilidad de IFs elaboradas con diferentes ingredientes, analizando lisina útil (para estabilidad de proteínas), contenido de FAs y valor de peróxidos (para estabilidad de grasas) durante el almacenamiento bajo condiciones normales y adversas, y proponer un control más rápido de la estabilidad. Metodos: Los análisis de lisina útil por cromatografía liquida de alta resolución (HPLC), oxidación lipídica por el método de titulación y el perfil de FAs por cromatografía de gases (GC) fueron determinados en cuatro tipos de IFs preparadas con proteínas intactas y parcialmente hidrolizadas con diferentes carbohidratos (lactosa y maltodextrinas) durante el almacenamiento a 4, 20 y 30ºC por 24 meses a actividad de agua normal (Aw=0,1-0,4), y a Aw de 0,65 a 20 y 30 ºC por 4 semanas. Estas IFs fueron preparadas dos veces (IF1 y IF2 ) en baches diferentes por una empresa Española de productos dietarios. Resultados: A 30ºC, las pérdidas de lisina útil fueron de 40-50% en todas las IFs analizadas. El comportamiento y porcentaje de pérdidas de lisina entre la 1 y 4 semana de conservación a 30 °C con Aw=0,65 fue similar a las obtenidas tras 24 de almacenamiento a 30 °C. No se observaron cambios significativos en el perfil de FAs durante el almacenamiento. Oxidación solo se observo en los envases abiertos y después de 4 semanas/30 °C/Aw=0.65. Conclusiones: Las pérdidas de lisina útil incrementan a mayor tiempo y temperatura de almacenamiento. Los FAs muestran una buena estabilidad para cualquiera de las condiciones de almacenamiento, sin embargo el valor de peróxidos evidencia mayor sensibilidad que los cambios en FAs para evaluar la oxidación de las grasas durante el almacenamiento de IFs.

Fósforo fítico y actividad de fitasa en fórmulas infantiles basadas en cereales

El ácido fítico es un ácido orgánico presente en granos de cereales. El fósforo contenido en su molécula (PFi) no es absorbible por una baja solubilidad, aunque su biodisponibilidad puede incrementarse por la actividad de enzimas fitasas (AFi). Con el objetivo de cuantificar el contenido de PFi y AFi en suplementos elaborados a partir de cereales y destinados a infantes lactantes, se seleccionaron cinco fórmulas de amplia distribución en mercados locales,identificadas de acuerdo a los cereales base de su composición como: A (arroz), T (trigo), ATS (arroz, trigo y aislado de soya), ATM (arroz, trigo y maíz) y ATMS (arroz, trigo, maíz y aislado de soya). Se tomaron cinco muestras por fórmula, cada una correspondiente a un envase (400 a 500 g) elaborado en lotes diferentes y con fecha de vencimiento posterior al muestreo. La proteína cruda varió de 16,8 a 7,2%, con el mayor valor para ATS, y los menores para T y ATM (P< 0,01). El extracto etéreo mostró un rango de 0,31 a 0,75%, mientras la relación calcio:fósforo entre 1,6 en ATM y 1,1 para el resto. El PFi representó el 61,5% del fósforo total en T, con diferencias (P< 0,01) respecto al resto (39,9 ± 6,8%). Sólo se detectó AFi en ATM, T y ATS (570, 300 y 152 U/kg, respectivamente). Se concluye que la composición química se ajustó a lo reportado por los fabricantes, con un elevado contenido de PFi y una AFi fundamentalmente asociados a la presencia de trigo en las fórmulas.

Phytic phosphorus and phytase activity in cerealbased infant formulas. Phytic acid is an organic acid present in cereal grains. The phosphorus inside its molecule (PPhy) is not available because of its low solubility, though the bioavailability could be increased by the activity of phytase enzymes (PhyA). With the purpose of quantifying the PPhy and PhyA in supplements manufactured from cereals and intended for lactating infants, five formulas of wide distribution in local markets were selected and identified depending on the main vegetable ingredients as A (rice), T (wheat), ATS (rice, wheat and soy isolate), ATM (rice, wheat and maize) and ATMS (rice, wheat, maize and soy isolate). Five samples were taken from each formula, each one corresponded to a commercial brand (400 to 500 g), coming from different batches and before their expiration date. The crude protein ranged from 7.2 to 16.8%, with de highest value for ATS and the lowest for T and ATM (P< 0.01). Ether extract varied from 0.31 to 0.75%, while the calcium: phosphorus ratio from 1.6 for ATM, to 1.1 for the rest. The PPhy was 61.5% of the total phosphorus in T, with differences (P<0.01) compared to the other formulas (39.9 ± 6.8%).PhyA was only detected in ATS, T and ATM (152,300 and 570 U/kg, respectively). The chemical composition complied with the manufacturer report, with a high content of PPhy and PhyA associated to the wheat presence in the formula.

Do fathers' attitudes support breastfeeding? a cross-sectional questionnaire-based study in Mumbai, India.

Context: The views of fathers have been shown to be important determinants of infant feeding decisions, but men's attitudes toward breastfeeding and formula feeding have rarely been explored. AIMS: To explore the relationship between maternal and paternal infant feeding attitudes and their impact on the duration of exclusive breastfeeding. Settings and Design: Prospective questionnaire-based cross-sectional study conducted in a tertiary care public hospital. Materials and Methods: From May 2009 to September 2010, a convenience sample of 238 parents of infants (>6 months to <1 year of age) were included. Each parent's attitude toward infant feeding was measured by the Iowa Infant Feeding Attitude Scale (IIFAS). Statistical Analysis Used: Pearson's correlation test, independent samples t-test, and one-way analysis of variance were carried out for statistical significance. Results: Only 83 (34.9%) mothers had exclusively breastfed their babies for 4-6 months. A mother's "total" infant feeding attitude score was significantly correlated with her husband's score ( r = 0.43, P < 0.01). The couples shared similar "individual" infant feeding attitudes to all but four of the 17 items. These 13 "individual" attitudes favorable toward breastfeeding were related to its optimal nutritional value, convenience of administration, ease of digestibility, unique role in mother-infant bonding, acceptability of breastfeeding in public places, and long-term health benefits to babies. Only maternal attitudes played an influential role in achieving an exclusive breastfeeding period of 4-6 months. Conclusions: Fathers' attitudes do support breastfeeding, but do not influence the time duration of exclusive breastfeeding.