Nutritional composition of human milk and its association with maternal and perinatal factors / Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

ABSTRACT Objective: The objective of this study was to evaluate the influence of maternal and perinatal factors on the nutritional composition of human milk. Methods: A cross-sectional study was conducted between November 2018 and January 2020, with 181 donors selected in Tertiary Health Units of the Unified Health System — from one collection station and five Human Milk Banks. Data were collected through a standardized questionnaire. To be fit to be a donor in a Human Milk Banks and produce mature milk were the eligibility criteria to participate in the study. We excluded milk samples with Dornic acidity above 8° D. The dependent variables were the macronutrients of human milk (i.e., carbohydrates, proteins, lipids, and total energy), that were analyzed using spectroscopy with the Miris Human Milk Analyzer™. The maternal and perinatal factors were the independent variables. Results: Women with pre-gestational obesity and gestational weight gain above the recommendation showed a lower protein concentration compared to eutrophic women (median=0.8, interquartile range (IQR): 0.7-0.9 vs. median=0.8, and IQR: 0.8-1.0) and those with adequate gestational weight gain (median=0.8, IQR: 0.7-0.9 vs. median=0.9, and IQR: 0.8-1.0), respectively. The other analyzed factors (i.e., maternal habits, comorbidities, and perinatal factors) were not associated with the nutritional composition of human milk. Conclusions: The assessment of factors associated with the nutritional composition of human milk is extremely important to assist postpartum care. Pre-gestational obesity and inadequate gestational weight gain were the only factors statistically associated with the nutritional composition of human milk as they impacted its protein content.

RESUMO Objetivo: Avaliar a influência de fatores maternos e perinatais na composição nutricional do leite humano. Métodos: Estudo transversal, realizado entre novembro de 2018 e janeiro de 2020, com 181 doadoras selecionadas em Unidades Terciárias de Saúde do Sistema Único de Saúde de um Posto de Coleta e cinco Bancos de Leite Humano. Foram coletados dados das variáveis maternas e dos recém-nascidos por meio de questionário padronizado. Estar apta para ser doadora em um Banco de Leite Humano e produzir leite maduro foram os critérios de elegibilidade para participar do estudo. As amostras de leite com acidez Dornic acima de 8° D foram excluídas. Os macronutrientes do leite humano, variáveis dependentes (carboidratos, proteínas, lipídeos, energia total) foram analisados pela técnica de espectroscopia de transmissão no infravermelho médio com o Miris Human Milk Analyzer™. Os fatores maternos e perinatais foram as variáveis independentes. Resultados: Mulheres com obesidade pré-gestacional e ganho de peso gestacional acima do recomendado apresentaram menor concentração proteica em relação às eutróficas (mediana=0,8, intervalo interquartil [IQR]: 0,7-0,9 vs. mediana=0,8, IQR: 0,8-1,0) e aquelas com ganho de peso gestacional adequado (mediana=0,8, IQR: 0,7-0,9 vs. mediana=0,9, IQR: 0,8-1,0), respectivamente. Os demais fatores analisados (hábitos maternos, comorbidades, fatores perinatais) não se associaram com a composição nutricional do leite humano. Conclusões: A avaliação dos fatores associados à composição nutricional do leite humano é de extrema importância para auxiliar os cuidados pós-parto. A obesidade pré-gestacional e o ganho de peso gestacional inadequado foram os únicos fatores estatisticamente associados com a composição nutricional do leite humano por terem impactado o seu teor de proteína.

Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Relação entre desmame precoce e alergias alimentares / Relationship between early weaning and food allergies / Relación entre el destete precoz y las alergias alimentarias

Objetivo: Analisar a relação entre o desmame precoce e o desenvolvimento de alergias alimentares por meio de uma revisão integrativa. Método:Revisão integrativa da literatura realizada através das bases de dados Pubmed, Mesh e Scielo.Resultados:Através da busca pelos descritores determinados, foram selecionados 25 estudos científicos que atenderam aos critérios de inclusão. Devido sua grande composição, o leite humano é responsável pela promoção do crescimento das bactérias com efeito bifidogênico, estando em quantidades superiores nos lactentes em AME. Conclusão: Apesar de alguns dos estudos não mostrarem resultados significativos em relação ao leite materno ser um fator protetor contra as alergias alimentares, nenhum deles deixoude incentivar o AM ou mostrar os seus benefícios já cientificamente comprovados.

Objective: To analyze the relationship between early weaning and the development of food allergies through an integrative review. Method: Integrative literature review performed through the Pubmed, Mesh and Scielo databases. Results: Through the search for the descriptors determined, 25 scientific studies that met the inclusion criteria were selected. Due to its large composition, human milk is responsible for promoting the growth of bacteria with bifidogenic effect, being in higher amounts in infants in EBF. Conclusion: Although some of the studies did not show significant results regarding breast milk being a protective factor against food allergies, none of them failed to encourage BF or show its scientifically proven benefits.

Objetivo: Analizar la relación entre el destete precoz y el desarrollo de alergias alimentarias a través de una revisión integradora. Metodo:Revisión integradora de la literatura realizada a través de las bases de datos Pubmed, Mesh y Scielo. Resultados: A través de la búsqueda de los descriptores determinados, se seleccionaron 25 estudios científicos que cumplieron con los criterios de inclusión. Debido a su gran composición, la leche humana es responsable de promover el crecimiento de bacterias con efecto bifidogénico, estando en mayores cantidades en bebés en LME. Conclusión:Aunque algunos de los estudios no mostraron resultados significativos con respecto a que la leche materna sea un factor protector contra las alergias alimentarias, ninguno de ellos falló en fomentar la BF o mostrar sus beneficios científicamente probados.

Polyphenol analysis in human milk by a rapid, cost-effective, and accurate micromethod: translational development / Análise de polifenóis no leite humano por meio de um micrométodo rápido, econômico e preciso: desenvolvimento translacional

ABSTRACT Objective: To develop a rapid method for analysing polyphenols, which are potentially active antioxidants against neonatal oxidative stress, from small human milk (HM) volumes. Methods: Acid and alkaline extractions were compared using two dyes: Folin-Ciocalteu and Fast Blue BB. Linearity, sensitivity, recovery percentage, polyphenol content, precision, and stability were assessed in 14 HM samples and compared using the Kruskal-Wallis H test (p<0.05). The best technique was applied to 284 HM samples to determine their polyphenolic content and its association with maternal diet by multifactorial linear regression. Results: Acidic extraction successfully recovered the gallic acid reference standard, whereas alkaline extraction overestimated it. Calibration curves for all methods were linear (R2>0.96) up to 500 mg/L. All bicarbonate-based Folin-Ciocalteu methods assayed were stable and repeatable, whereas Fast Blue BB-based variants were not. HM polyphenols (mean=94.68 mg/L) positively correlated to the dietary intake of hydroxycinnamic acids, the most consumed polyphenolic family in this population. Conclusions: A bicarbonate-based Folin-Ciocalteu micromethod allowed the accurate determination of polyphenols in HM, which might be useful for translational research settings and HM banks.

RESUMO Objetivo: Desenvolver um método rápido para analisar polifenóis, que são antioxidantes potencialmente ativos contra o estresse oxidativo neonatal, em pequenos volumes de leite humano (LH). Métodos: Foram comparadas extrações ácidas e alcalinas usando dois corantes: Folin-Ciocalteu e Fast Blue BB. Foram avaliadas variáveis como linearidade, sensibilidade, percentagem de recuperação, teor de polifenóis, precisão e estabilidade em 14 amostras de LH, comparadas usando o teste de Kruskal-Wallis H (p<0,05). A melhor técnica foi aplicada a 284 amostras de LH para determinar seu teor polifenólico e sua associação com a dieta materna por regressão linear multifatorial. Resultados: A extração ácida recuperou com sucesso o padrão de referência do ácido gálico, enquanto a extração alcalina o superestimou. As curvas de calibração para todos os métodos foram lineares (R2>0,96) até os 500 mg/L. Todos os métodos testados baseados em Folin-Ciocalteu com bicarbonato foram estáveis e repetíveis, enquanto as variantes baseadas em Fast Blue BB não. Os polifenóis do HM (média=94,68 mg/L) correlacionaram-se positivamente com a ingestão dietética de ácidos hidroxicinâmicos, a família de polifenóis mais consumida nesta população. Conclusões: Um micrométodo baseado em bicarbonato de Folin-Ciocalteu permitiu a determinação precisa de polifenóis no HM, o que pode ser útil para configurações de pesquisa translacional e bancos de HM.

Partial purification of linoleic acid isomerase enzyme from Lactobacillus paracasei bacteria isolated from milk / Purificação parcial da enzima isomerase do ácido linoleico da bactéria Lactobacillus paracasei isolada do leite

Conjugated Linoleic Acid (CLA) has attracted the attention of many researchers, especially that of microbial origin due to its biological importance to the consumer. The current study aims to extract LA Isomerase enzyme from Lactobacillus paracasei bacteria from milk and to use the enzyme in the production of CLA. Selective media, including MRS and MRS-Dagatose, were used in isolating local strains. The selected bacterial isolates were tested for their ability to produce LA-Isomerase enzyme. The isolate with high enzymatic activity was selected. After extraction and partial purification of the enzyme, the optimal conditions for the production of conjugated fatty acid were studied, and the reaction products were diagnosed using GC-MS technology. It was found that 11 isolates have the ability to produce CLA at different concentrations, H1 isolate showed the highest production of conjugated fatty acid at a concentration of 120.45 g.ml-1, this isolate was selected as the source for enzyme extraction. The enzymatic activity of the crude extract and partially purified with ammonium sulfate was estimated using color methods at wavelength of 233 nm. The effect of the optimum conditions (pH, temperature, linoleic acid concentration and enzyme concentration) on the CLA product was studied using the partially purified LA Isomerase enzyme, the optimum conditions for production were 6.5, 45 °C, 100 µg.ml-1 and 0.7 ml, respectively. The GC-MS technique showed the presence of a number of reaction products that are isomers of conjugated linoleic acid (C9T11, T9T12, T10C12) with different concentrations.

O Ácido Linoleico Conjugado (CLA) tem chamado a atenção de diversos pesquisadores, principalmente aquele de origem microbiana, devido à sua importância biológica para o consumidor. O presente estudo visa extrair a enzima LA Isomerase da bactéria Lactobacillus paracasei do leite e usar essa enzima na produção de CLA. Meios seletivos, incluindo MRS e MRS-Dagatose, foram usados no isolamento de cepas locais. Os isolados bacterianos selecionados foram testados quanto à sua capacidade de produzir a enzima LA-Isomerase. Foi selecionado o isolado com alta atividade enzimática. Após a extração e purificação parcial da enzima, as condições ideais para a produção de ácido graxo conjugado foram estudadas e os produtos da reação foram identificados usando a tecnologia GC-MS. Verificou-se que 11 isolados possuem capacidade de produzir CLA em diferentes concentrações. O isolado H1 apresentou a maior produção de ácido graxo conjugado, na concentração de 120,45 g.ml-1, e este isolado foi selecionado como fonte para extração enzimática. A atividade enzimática do extrato bruto e parcialmente purificado com sulfato de amônio foi estimada por métodos de coloração em comprimento de onda de 233 nm. O efeito das condições ótimas (pH, temperatura, concentração de ácido linoleico e concentração de enzima) no produto CLA foi estudado usando a enzima LA Isomerase parcialmente purificada e as condições ótimas para produção foram 6,5, 45 °C, 100 µg.ml-1 e 0,7 mL, respectivamente. A técnica de GC-MS mostrou a presença de uma série de produtos de reação que são isômeros do ácido linoleico conjugado (C9T11, T9T12, T10C12) com diferentes concentrações.

Partial purification of linoleic acid isomerase enzyme from Lactobacillus paracasei bacteria isolated from milk

Abstract Conjugated Linoleic Acid (CLA) has attracted the attention of many researchers, especially that of microbial origin due to its biological importance to the consumer. The current study aims to extract LA Isomerase enzyme from Lactobacillus paracasei bacteria from milk and to use the enzyme in the production of CLA. Selective media, including MRS and MRS-Dagatose, were used in isolating local strains. The selected bacterial isolates were tested for their ability to produce LA-Isomerase enzyme. The isolate with high enzymatic activity was selected. After extraction and partial purification of the enzyme, the optimal conditions for the production of conjugated fatty acid were studied, and the reaction products were diagnosed using GC-MS technology. It was found that 11 isolates have the ability to produce CLA at different concentrations, H1 isolate showed the highest production of conjugated fatty acid at a concentration of 120.45 g.ml-1, this isolate was selected as the source for enzyme extraction. The enzymatic activity of the crude extract and partially purified with ammonium sulfate was estimated using color methods at wavelength of 233 nm. The effect of the optimum conditions (pH, temperature, linoleic acid concentration and enzyme concentration) on the CLA product was studied using the partially purified LA Isomerase enzyme, the optimum conditions for production were 6.5, 45 °C, 100 g.ml-1 and 0.7 ml, respectively. The GC-MS technique showed the presence of a number of reaction products that are isomers of conjugated linoleic acid (C9T11, T9T12, T10C12) with different concentrations.

Resumo O Ácido Linoleico Conjugado (CLA) tem chamado a atenção de diversos pesquisadores, principalmente aquele de origem microbiana, devido à sua importância biológica para o consumidor. O presente estudo visa extrair a enzima LA Isomerase da bactéria Lactobacillus paracasei do leite e usar essa enzima na produção de CLA. Meios seletivos, incluindo MRS e MRS-Dagatose, foram usados no isolamento de cepas locais. Os isolados bacterianos selecionados foram testados quanto à sua capacidade de produzir a enzima LA-Isomerase. Foi selecionado o isolado com alta atividade enzimática. Após a extração e purificação parcial da enzima, as condições ideais para a produção de ácido graxo conjugado foram estudadas e os produtos da reação foram identificados usando a tecnologia GC-MS. Verificou-se que 11 isolados possuem capacidade de produzir CLA em diferentes concentrações. O isolado H1 apresentou a maior produção de ácido graxo conjugado, na concentração de 120,45 g.ml-1, e este isolado foi selecionado como fonte para extração enzimática. A atividade enzimática do extrato bruto e parcialmente purificado com sulfato de amônio foi estimada por métodos de coloração em comprimento de onda de 233 nm. O efeito das condições ótimas (pH, temperatura, concentração de ácido linoleico e concentração de enzima) no produto CLA foi estudado usando a enzima LA Isomerase parcialmente purificada e as condições ótimas para produção foram 6,5, 45 °C, 100 g.ml-1 e 0,7 mL, respectivamente. A técnica de GC-MS mostrou a presença de uma série de produtos de reação que são isômeros do ácido linoleico conjugado (C9T11, T9T12, T10C12) com diferentes concentrações.

Dificuldades com amamentação e sua relação com a prática alimentar na alta hospitalar / Breastfeeding difficulties and their relationship with eating habits at hospital discharge / Dificultades con la lactancia y su relación con la práctica alimentaria en el alta hospitalaria

Objetivo: descrever as frequências das dificuldades com aleitamento materno durante a internação em alojamento conjunto e sua relação com a prática alimentar na alta hospitalar. Método: estudo transversal conduzido a partir de dados de uma coorte, realizada entre março de 2017 e abril de 2018, mediante entrevistas face a face e coleta de dados de prontuários hospitalares de um hospital de referência nacional para alto risco fetal e infantil. Utilizou-se a estatística descritiva por meio de frequências absolutas, relativas e teste qui-quadrado em todas as análises. Resultados: de 686 mães e seus recém-nascidos, 50,6% das mulheres apresentaram dificuldades com aleitamento materno, com destaque para: pega, sucção, tipo de mamilo, trauma mamilar. Dentre os recém-nascidos que receberam aleitamento materno exclusivo na alta hospitalar, 51,3% não apresentaram dificuldades com amamentação durante a internação. Conclusão: apesar da dificuldade apresentada em metade da amostra estudada, ressalta-se a necessidade do suporte precoce ao aleitamento materno exclusivo ainda no ambiente hospitalar.

Objective: to describe the frequencies of breastfeeding difficulties during hospitalization in rooming-in and their relationship with eating habits at hospital discharge. Method: cross-sectional study conducted from data from a cohort, carried out between March 2017 and April 2018, through face-to-face interviews and data collection from hospital records of a national reference hospital for high fetal and infant risk. Descriptive statistics were used through absolute and relative frequencies and the chi-square test in all analyses. Results: of 686 mothers and their newborns, 50.6% of the women had difficulties with breastfeeding, with emphasis on: attachment, suction, type of nipple, nipple trauma. Among newborns who were exclusively breastfed at hospital discharge, 51.3% had no breastfeeding difficulties during hospitalization. Conclusion: despite the difficulty presented by half of the studied sample, the need for early support for exclusive breastfeeding is highlighted, even in the hospital environment.

Objetivo: describir las frecuencias de dificultades para amamantar durante la hospitalización en alojamiento conjunto y su relación con los hábitos alimentarios al alta hospitalaria. Método: estudio transversal realizado a partir de datos de una cohorte, realizada entre marzo de 2017 y abril de 2018, a través de entrevistas cara a cara y recolección de datos de registros hospitalarios de un hospital de referencia nacional de alto riesgo fetal e infantil. Se utilizó estadística descriptiva a través de frecuencias absolutas y relativas y la prueba de chi-cuadrado en todos los análisis. Resultados: de 686 madres y sus recién nacidos, el 50,6% de las mujeres presentaron dificultades para amamantar, con énfasis en: agarre, succión, tipo de pezón, traumatismo en el pezón. Entre los recién nacidos que recibieron lactancia materna exclusiva al alta hospitalaria, el 51,3% no tuvo dificultades para amamantar durante la hospitalización. Conclusión: a pesar de la dificultad presentada por la mitad de la muestra estudiada, se destaca la necesidad de apoyo temprano para la lactancia materna exclusiva, incluso en el ámbito hospitalario.

Alergia a la leche de vaca: ¿se pueden evitar las pruebas de provocación oral? Un análisis probabilístico basado en datos clínicos / Cow's milk allergy: Can oral food challenges be avoided? A probabilistic analysis based on clinical data

Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.

Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.

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.

New formulations of fermented milk drinks with fruit pulp added: Physicochemical characteristics during storage and nutritional profile

The aim of this study was to evaluate the nutritional profile and the physicochemical characteristics during storage of newly developed formulations of fermented milk drinks with added pineapple, mango and passion fruit pulp. The fermented drinks showed a high content of protein, iron, and calcium. The passion fruit milk drink had the lowest pH (4.13) and highest acidity (0.95%, expressed in % of lactic acid), which was significantly different (p<0.05) from the pineapple and mango drinks. As for syneresis and sedimentation, the pineapple milk drink had the highest rates at 14 days storage, with 34.33% and 6.50%, respectively and was significantly different (p≤0.05) when compared to the mango and passion fruit milk drinks. In conclusion, newly developed fermented milk drinks with added fruit pulp were a source of several nutrients. We observed physical-chemical characteristics suitable for a fermented milk product during storage.

El objetivo de este estudio fue el desarrollo de nuevas formulaciones de bebidas lácteas fermentadas adicionadas de piña, mango y maracuyá, para evaluar el perfil nutricional y las características fisicoquímicas durante el almacenamiento. Las bebidas fermentadas mostraron un alto contenido en proteínas, hierro y calcio. En cuanto a las características fisicoquímicas durante el almacenamiento, la bebida láctea de maracuyá presentó el pH más bajo (4,13) y la acidez más alta (0,95%, expresada en % de ácido láctico), con una diferencia significativa (p < 0,05), en comparación con las bebidas de piña y mango. En cuanto a sinéresis y sedimentación, la bebida láctea de piña presentó los mayores índices a los 14 días de almacenamiento, con 34,33% y 6,50%, respectivamente, y con diferencia significativa (p ≤ 0,05) al compararla con las bebidas lácteas de mango y maracuyá. En conclusión, las bebidas lácteas fermentadas con adición de pulpa de fruta son una fuente de varios nutrientes, y de características físico-químicas adecuadas para un producto lácteo fermentado durante el almacenamiento.

Alimentación complementaria en lactantes y su relación con el estado nutricional / Complementary feeding of Mexican infants and its relation to the nutritional status

Background: Apropiate introduction to complementary feeding (CF) decreases the risk of nutritional diseases in infants; however there is a paucity of information about the characteristics of CF in mexican children. Objective: To characterize the complementary feeding of Mexican infants and its relation to the nutritional status. Methodology: Transversal, analytical and retrospective study in dyads that required medical care. We performed a nutritional evaluation of the infants and characterized the type of lactation, type and texture of initial solid foods and the subsequent feeding. Results: Final sample consisted of 141 children in which, 59.6% reported that feeding was provided exclusively with formula and only 40% received breast milk. 14.1% of the infants showed low weight-for-height, 17.7% low weight-for-age, and 24.1% low height-for-age. We observed that 55.3% of the infants did not receive complementary feeding with appropriate texture; 58.9% did not receive the appropriate amount; and 44.7, 62.4% and 11.3% received inappropriate amounts of carbohydrates, proteins and fats respectively. Conclusion: A high proportion of infants do not receive appropriate complementary feeding.

Introducción: La introducción apropiada a la alimentación complementaria (AC) disminuye las enfermedades nutricionales en los niños; sin embargo, actualmente, no contamos con una caracterización apropiada de la AC que reciben los lactantes mexicanos. Objetivo: Caracterizar la alimentación complementaria de los lactantes mexicanos y su relación con el estado nutricional. Métodos: Estudio transversal, analítico, retrospectivo en diadas (madre y lactantes de cinco a 12 meses de edad) que acudieron a la consulta externa en la IMF No 82 y la guardería infantil IMSS 001. Se realizó una valoración nutricional de los niños y se analizó la lactancia, el tipo y textura de los alimentos sólidos de inicio y subsecuentes. Resultados: la muestra consistió en 141 niños. Unicamente el 40% de los lactantes recibían leche materna. 14.1% de los lactantes presentaron bajo peso para la talla, 17.7% bajo peso para la edad y 24.1% baja talla para la edad. Observamos que 55.3% de los niños no recibían alimentación complementaria con textura apropiada; 58.9% no recibían cantidad apropiada; y 44.7%, 62.4% y 11.3% recibían cantidades inapropiadas de carbohidratos, proteínas y grasas respectivamente. Conclusión: nuestros datos indican que una alta proporción de los lactantes no reciben alimentación complementaria apropiada.

Maternal obesity and its repercussions on melatonin and cortisol in breast milk and human colostrum

Introduction: scientific evidence has highlighted the role of chronobiological disruptions in promoting obesity through mechanisms involving important circadian rhythm hormones: melatonin and cortisol. These hormones are present in human colostrum and serve as crucial maternal and child protection mechanisms against obesity and childhood infections, owing to the intense interaction between mother and child during pregnancy and breastfeeding. Consequently, the melatonin and cortisol hormones present in human colostrum hold promise as potential candidates for yielding clinically applicable results and supporting future intervention strategies aimed at reducing obesity and neonatal infections. However, there is a scarcity of literature on this subject. Objective: the objective of this study is to to analyze the impact of maternal obesity on the levels and functions of melatonin and cortisol in colostrum and breast milk. Methods: a systematic review of the scientific literature was conducted following the recommendations outlined in the PRISMA protocol. Original articles published in English were searched in the PubMed, Medline, Lilacs, and Scopus databases. There were no restrictions on the publication year. Results: a total of 37 articles were identified from the searched databases. After removing duplicates and applying the inclusion and exclusion criteria, only five studies were relevant to the topic: two studies addressing melatonin and three studies analyzing cortisol. This review revealed that melatonin levels are elevated in the colostrum of obese women, and for this particular group, it has the potential to restore phagocyte activity and increase lymphocyte proliferation. Studies on cortisol have demonstrated that maternal obesity does not alter the levels of this hormone in breast milk. Conclusion: breastfeeding should be encouraged for all populations, and further original research should be conducted to elucidate the protective mechanisms of colostrum and breast milk.

Introdução: evidências científicas enfatizam que disrupções cronobiológicas podem promover a obesidade por mecanismos envolvendo ação de importantes hormônios marcadores do ritmo circadiano: a melatonina e cortisol. Estes hormônios estão presentes no colostro humano e representam importante mecanismo de proteção materno infantil frente à obesidade e infecções infantis, devido à intensa interação entre mãe e filho durante a gravidez e amamentação. Assim, os hormônios melatonina e cortisol presentes no colostro humano representam promissores candidatos para fornecer resultados com capacidade de aplicação clínica e de embasamento de futuras estratégias de intervenção com enfoque na redução da obesidade e de infecções neonatais. Entretanto, são escassos os estudos na literatura sobre o tema. Objetivo: analisar as repercussões da obesidade materna sobre os níveis e as ações da melatonina e do cortisol no colostro e leite materno. Método: foi realizada uma revisão sistematizada da literatura científica seguindo as recomendações do protocolo Prisma. Foram pesquisados artigos originais, publicados em inglês, nas bases de dados PubMed, Medline, Lilacs e Scopus. Não houve restrição quanto ao ano de publicação. Resultados: foram identificados 37 artigos nas bases de dados pesquisados, 15 artigos foram excluídos por estarem duplicados, após aplicação do critério de inclusão e exclusão apenas 5 estudos tiveram relação ao tema, sendo 2 estudos abordando sobre melatonina e 3 pesquisas que analisaram o cortisol. Esta revisão mostrou que a melatonina está elevada em colostro de obesas e para este grupo ela possui potencial de restaurar atividade de fagócitos e de elevar a proliferação de linfócitos. Os estudos sobre o cortisol ilustraram que os níveis deste hormônio no leite materno não foram alterados pela obesidade materna. Conclusão: o aleitamento materno deve ser encorajado para todos os públicos, assim como mais pesquisas originais devem ser desenvolvidas para descrever os mecanismos protetores do colostro e leite materno

Conocimientos de madres y padres sobre lactancia materna exclusiva / Knowledge level of parents on exclusive breast feeding i:en

Introducción: La leche materna es considerada la vacuna perfecta de todos los tiempos y la mejor fuente de nutrición para los niños. Objetivo: Determinar el nivel de conocimientos de madres y padres sobre lactancia materna exclusiva. Métodos: Se realizó un estudio descriptivo y transversal de 27 madres y 27 padres de lactantes con destete precoz, pertenecientes al área de salud del Policlínico Docente Camilo Torres Restrepo de Santiago de Cuba, desde enero hasta diciembre del 2021, para lo cual el instrumento empleado fue la encuesta. Resultados: Se halló que los conocimientos sobre lactancia materna fueron considerados altos en 13 madres (48,1 %) y medios en 11 padres (40,7 %). Todos los integrantes de la serie recibieron información sobre el tema y las vías fundamentales para ello fueron los medios de difusión masiva (85,0 %), seguidos de los familiares y amigos (55,0 %). Conclusiones: El conocimiento acerca de la lactancia materna exclusiva en los padres resultó insuficiente y, en las madres, fue necesario ampliar dichos conocimientos sobre las técnicas para amamantar.

Introduction: Breast milk is considered the perfect vaccine of all times and the best nutrition source for children. Objective: To determine the knowledge level of mothers and fathers on exclusive breast feeding. Methods: A descriptive and cross-sectional study was carried out of 27 mothers and 27 fathers of early weaning infants. They were from the health area of Camilo Torres Restrepo Teaching Polyclinic in Santiago de Cuba, from January to December, 2021, for which the survey was used. Results: It was found that knowledge on breast feeding was considered high in 13 mothers (48.1 %) and medium in 11 fathers (40.7 %). All members of the series received information on the topic and the fundamental ways were mass media (85.0 %), followed by relatives and friends (55.0 %). Conclusions: The knowledge about exclusive breast feeding in fathers was insufficient and, in mothers, it was necessary to increase this knowledge on the techniques to breastfeed.

Evaluating the Effectiveness of Low Pressure Carbon Dioxide as a Hurdle in Raw Milk Storage

Aims: To evaluate the effectiveness of low pressure carbon dioxide as a hurdle in raw milk storage. Study Design: Milk samples were stored at under low pressure carbon dioxide at 29°C for 6 hours and the microbial quality of milk was compared with control milk. Place and Duration of Study: Department of Dairy Microbiology, Verghese Kurien Institute of Dairy and Food Technology (VKIDFT), Kerala Veterinary and Animal Sciences University, Mannuthy between January 2020 and December 2020. Methodology: Milk samples were collected from an organized farm. The initial microbial quality of milk was determined and samples were carbonated to a pressure of 20 psi and stored for six hours 29°C, uncarbonated milk sample kept at 29°C acted as the control. The microbial quality of the carbonated milk and uncarbonated milk was determined after storage in terms of total viable count, coliform count and gram negative organism count. Results: Significant growth suppression (P=0.05) of bacteria was observed in the carbonated milk. Total Viable count showed a suppression of 1.05 log cfu/ml while coliforms showed a suppression of 1.3 log cfu/ml. The greatest log reduction was observed in gram negative organisms with a difference of 2.2 log cfu/ml and psychrotrophic organisms with 1.54 log cfu/ml. Conclusion: Carbon dioxide was found to be an effective bacteriostatic agent which could be used for extending the keeping quality of raw milk. The bacteriostatic action could be due to anaerobic conditions developed by carbon dioxide and also due to the increased acidity of the medium.

Evaluación del valor de acidez Dornic de la leche humana según el tiempo de conservación en freezer y el lugar de extracción / Assessment of Dornic acidity in breast milk based on storage time in the freezer and place of expression

Introducción. El grado de acidez Dornic (AD), medida indirecta del grado de contaminación de la leche humana cruda (LHC), proporciona información sobre la calidad de esta. Recién extraída, el valor oscila entre 1,0° y 4,0° (óptimo). Descalifica el consumo si es >8,0 °D. Se evaluó la correlación de la AD de la LHC de donantes internas (DI) y externas (DE) según el tiempo de conservación hasta la pasteurización, y se determinó la prevalencia de AD ≤4 ºD. Población y método. Estudio retrospectivo analítico. Resultados. Sobre 13 203 muestras, la AD a partir del día 14 de conservación fue menor en las donantes internas, de 2,92; (IC95% 2,69-3,15) versus 4,01 (IC95%: 3,94-4,08); p <0,001] con mayor proporción de AD ≤4 ºD (88 % en DI versus 76 % en DE); OR: 2,30 (IC95%: 1,25-4,24); p = 0,003. Coeficiente de correlación para las DI: R 2 :0; p = 1). Conclusión. La AD a partir del día 14 fue menor en DI, presentando mayor prevalencia de AD ≤ 4ºD. No existió correlación entre el tiempo de conservación y la AD en las DI.

Introduction. The degree of Dornic acidity (DA) is an indirect measure of milk contamination and quality. In freshly expressed milk, DA ranges between 1.0 and 4.0 (optimal). If DA is > 8.0 °D, it should be discarded. The correlation between DA in raw breast milk from internal donors (ID) and external donors (ED) based on storage time until pasteurization was assessed. Population and method. Retrospective, analytical study. Results. In 13 203 samples, DA was lower in IDs as of 14 days of storage: 2.92 (95% CI: 2.69­3.15) versus 4.01 (95% CI: 3.94­4.08), with a higher proportion of DA ≤ 4 °D (88% in IDs versus 76% in EDs); odds ratio: 2.30 (95% CI: 1.25­4.24). Conclusion. DA as of 14 days of storage was lower in IDs, with a higher prevalence of DA ≤ 4 °D. No correlation was observed between storage time and DA in ID samples.

Conhecer antes de incorporar: um retrato dos programas para alergia ao leite implementados no Brasil / Understanding before incorporating: a portrait of milk allergy programs implemented in Brazil

Este trabalho objetiva caracterizar a assistência ofertada às crianças com alergia ao leite em programas públicos, e os desafios enfrentados na sua implantação, no contexto da pré-incorporação no Sistema Único de Saúde, de três fórmulas infantis para alergia ao leite. Estudo exploratório, transversal e abordagem quantitativa. Foram avaliados 21 programas/serviços de todas as regiões brasileiras. O principal indutor da criação destes programas foi a judicialização (80,9%), e o fornecimento destas fórmulas especiais foi realizado para crianças com até 2 anos de idade. Os principais desafios para a criação e execução destes programas foram a falta de recursos humanos e financeiros, a falta da contrapartida da União, protocolo unificado para o diagnóstico (Teste de Provocação Oral), e a escolha dos tipos das fórmulas. A estratégia mais adotada para redução dos custos foi a adequação das normas e protocolos (61,9%). Não houve diferença significativa entre os programas estaduais e municipais. Este estudo apresenta uma avaliação inédita e detalhada sobre os programas, trazendo discussões que corroboram a tomada de decisões, o uso racional de recursos públicos, a melhor assistência às crianças e o fortalecimento do sistema de saúde nacional.

This paper aims to characterize the assistance offered to children with cow's milk allergy in public programs and challenges to their implementation, specifically assessing the pre-incorporation phase in the Brazilian Unified Health System of 3 formulas for infants with milk allergy. This exploratory, cross-sectional study with a quantitative approach assessed 21 programs/services from all regions of the country. The main motivation for the creation of these programs was judicialization (80.9%), and these special formulas were provided for children up to 2 years of age. The main challenges to creating and implementing these programs were a lack of human and financial resources, no counterpart federal program, no unified protocol for diagnosis (oral provocation test), and the selection of formula types. The most common strategy for reducing costs was updating norms and protocols (61.9%), which did not differ significantly between state and municipal programs. This study presents an unprecedented and detailed evaluation of the programs, raising discussion about decision-making, the rational use of public resources, better care for children, and means of strengthening of the national health system.

A Conceptual Recapture of Stanya Kshaya and Role of Stanya-Janan Mahakashaya in its Management

Breast milk is the prime source of nourishment and immunity of the baby. Stanya Kshaya, which appears to be a fairly simple ailment but is really problematic for children's health, is one of the problems of present era. Lactation insufficiency is 30–40% prevalent in Asian and tropical nations like India. In Ayurveda certain herbs are specifically indicated for increasing breast milk and Acharya Charaka has described Stanya-janana Mahakashaya for it. Few explorations have been conducted regarding above, but no one has covered all aspects comprehensively thus this paper aim to collect and comprehensive review information available regarding concept of Stanya, its Kshaya and role of Stanya-janana Mahakashaya in its management. Methodology: This review is in a narrative format and done from literature and publications relevant to Stanya Kshaya and role of Stanya-janana Mahakashaya. Results: Stanya has been described in detail along with opinion of various Acharyas, Stanya sampata and the reasons for Stanyakshya mentioned then finally role of Stanya-janana Mahakashaya of Acharya Charaka which includes 10 herbs as- Veerana, Shali, Shasthik, Ekshuvalika, Darbha, Kusha, Kaasha, Gundra, Ithkata, Katruna. Drugs in this Kashaya help in increasing quantity of milk. Discussion: Stanya-janana Mahakashaya has active principles which increase quantity of milk, so can be used in Stanya Kshaya and leads to healthy Stanya.

Análisis de posibles peligros en leche materna donada. Revisión / Analysis of potential hazards in donated breast milk. Review

La leche materna donada es un recurso de alto valor que puede ser utilizado para la alimentación de neonatos hospitalizados y a término, por tanto, garantizar su inocuidad es imperativo. Esta revisión de literatura reúne los principales peligros de naturaleza física, química y microbiológica identificados en leche materna, con la intención de proveer una referencia que los consolide de tal forma que la información pueda ser utilizada por bancos de leche humana, gobiernos y agencias regulatorias para establecer mecanismos para su prevención y control. Se realizó una revisión de literatura entre agosto del 2021 y octubre del 2022, utilizando buscadores y descriptores específicos para peligros de transmisión alimentaria en leche materna. Se incluyeron estudios publicados en español o en inglés. Se identificaron 31 agentes biológicos patógenos incluyendo bacterias, virus y parásitos. Como peligros químicos se reportaron medicamentos, drogas, cafeína, infusiones herbales, micotoxinas, alérgenos, especias, suplementos nutricionales, contaminantes ambientales y desinfectantes. Se alerta sobre la presencia potencial de plástico y vidrio de tamaño menor a 7 mm proveniente del ambiente de extracción y recipientes. La presencia de peligros microbiológicos y químicos en leche materna puede darse por transmisión vertical, temperaturas inadecuadas durante el almacenamiento y contaminación en el proceso. La presencia de peligros físicos se relaciona con la manipulación de los implementos en etapas posteriores a la extracción. Se requiere prestar atención a los hábitos de la madre para prevenir peligros químicos, así como más investigación relacionada con micotoxinas en leche materna(AU)

Donated breast milk is a highvalue resource which can be used to feed hospitalized neonates and full-term infants, therefore, ensuring its safety is imperative. This literature review presents the main hazards of physical, chemical and microbiological nature identified in human milk, with the intention of providing a reference that consolidates the reported hazards reported, so the information can be used by human milk banks, governments and regulatory agencies to establish prevention and control mechanisms. A literature review was carried out between August 2021 and October 2022, using search engines and specific descriptors for foodborne hazards in breast milk. Studies published in Spanish and English were considered. 31 pathogenic biological agents including bacteria, viruses and parasites were identified. Medications, drugs, caffeine, herbal infusions, mycotoxins, allergens, spices, nutritional supplements, contaminants of environmental origin and disinfectants were reported as chemical hazards. No physical hazards were identified, however the potential presence of plastic and glass smaller than 7 mm from the extraction environment or containers is alerted. Presence of microbiological and chemical hazards can be due to vertical transmission, inadequate temperature of storing, contamination during extraction, packaging, and infant feeding. Whereas presence of physical hazards is related to implements handling after extraction. Attention to hygiene and habits of the mother to prevent chemical hazards and further research related to mycotoxins in human milk is required(AU)

Aleitamento materno de prematuros internados em Unidade de Terapia Intensiva neonatal: coorte prospectiva / Breastfeeding of premature infants hospitalized in a neonatal Intensive Care Unit: a prospective cohort / Lactancia materna de bebés prematuros hospitalizados en la Unidad de Cuidados Intensivos neonatales: cohorte prospectiva

Identificar variáveis com potencial de intervenção que estejam associadas ao volume de leite esgotado das mães de recém-nascidos prematuros. Trata-se de um estudo de coorte, descritivo e exploratório. A coleta de dados ocorreu em um hospital materno-infantil do Sul do Brasil no período de julho de 2021 a janeiro de 2022, por meio de entrevistas a 20 mães de recém-nascidos prematuros. Verificou-se que, em relação ao número de vezes ao dia que foi realizado o esgotamento hospitalar e domiciliar, a mediana foi de 4 vezes. A maioria das mães utilizou dois métodos de esgotamento das mamas (manual e com bomba de sucção). O estudo identificou que o volume de leite esgotado foi abaixo do esperado pelo Ministério da Saúde. Destaca-se a falta de procura do banco de leite para o esgotamento, problemas relacionados à mama, como exemplo o método utilizado para esgotamento.

To identify variables with intervention potential that are associated with the volume of depleted milk from mothers of premature newborns. This is a cohort, descriptive, and exploratory study. Data collection occurred in a maternal-infant hospital in southern Brazil from July 2021 to January 2022, through interviews with 20 mothers of premature newborns. It was verified that, in relation to the number of times per day that hospital and home milk expression was performed, the median was 4 times. Most mothers used two methods of breast milk expression (manual and with suction pump). The study found that the volume of expressed milk was lower than expected by the Ministry of Health. We highlight the lack of demand of the milk bank for expression, problems related to the breast, as an example of the method used for expression.

Identificar variables con potencial de intervención que se asocian al volumen de leche agotada de madres de recién nacidos prematuros. Se trata de un estudio de cohortes, descriptivo y exploratorio. La recolección de datos ocurrió en un hospital materno-infantil en el sur de Brasil de julio de 2021 a enero de 2022, a través de entrevistas con 20 madres de recién nacidos prematuros. Se verificó que, en relación al número de veces por día que se realizaba el agotamiento hospitalario y domiciliario, la media fue de 4 veces. La mayoría de las madres utilizaron dos métodos de depleción mamaria (manual y con succión apretada). El estudio identificó que el volumen de leche empobrecida fue menor de que lo esperado por el Ministerio de Salud. Destacamos la falta de demanda del banco de leche por agotamiento, problemas relacionados con la mama, como ejemplo del método utilizado para el agotamiento.

Osmoregulatory Appraisal of Some Osmoprotectants on Hydrolytic Activities of Some Enzymes on Seeds of Two Water Stressed Cultivars of Sorghum bicolor (Moench)

Enzymes play significant roles in metabolic processes of seeds. Therefore, this study evaluated osmoregulatory potential of some osmoprotectants on activities of some hydrolytic enzymes in the seeds of two cultivars (SOSAT.C-88 and CV. LCIC 9702) of sorghum bicolor. Matured seeds of the two cultivars were harvested and prepared for alpha, beta, total amylase and proteinase activities assay. The osmoprotectants produced significant variations on the enzymes at 10 and 14 days (DA) of 8 weeks after treatments (WAT). Seeds of well-watered SOSAT.C-88 produced higher alpha (2.10 IU/ml), beta (1.70 IU/ml) and total amylase activities (3.30 IU/ml) at 14 days (DA). Higher alpha (2.01 IU/ml and total amylase activities (2.61 IU/ml) were recorded in the seeds of CV. LCIC 9702 well-watered at 14 days DA 8WAT. Furthermore, total amylase activities (3.87 IU/ml) were recorded in the seeds produced by CV. LCIC 9702 well-watered at 14 days DA. Significant increase was noticed in beta (1.14 IU/ml) and alpha amylase (1.58 IU/ml) in the seeds of CV. LCIC 9702 treated with mycorrhiza. CV. LCIC 9702 well watered produced highest proteinase activities (1.57 U/ml) while least of the parameters were recorded in SOSAT.C-88 and CV. LCIC 9702 droughted. In conclusion, the osmoprotectants had regulatory effects on the activities of hydrolytic enzymes therefore the use of the osmoprotectants in farming should be encouraged.