Consumo de açúcares de adição por adolescentes em estudo de base populacional / Added sugar intake by adolescents: A population-based study

Resumo Objetivou-se estimar a prevalência de ingestão de açúcares de adição dentro do limite máximo de 5% da energia total da dieta, segundo variáveis demográficas, socioeconômicas, de comportamentos relacionados à saúde e estado nutricional, em adolescentes. Trata-se de estudo transversal de base populacional, com amostra por conglomerados e em dois estágios. A quantidade de açúcar livre da dieta foi estimada por meio do Recordatório de 24 horas. Dos 924 adolescentes avaliados, apenas 20,1% (IC95%: 16,8-23,9) se enquadraram na recomendação de não exceder 5% das calorias totais com açúcares de adição. Maiores prevalências de atendimento à recomendação foram verificadas no sexo masculino (22,0%), nos adolescentes de 15-19 anos (24,3%), nos não naturais do estado de São Paulo (30,4%), nos que tinham menor tempo de tela (27,5%), nos que possuíam menor número de equipamentos domésticos (0-7: 29,5%; 8-15: 20,3%) e naqueles com escores superiores de qualidade da dieta (tercil 2: 17,7%, tercil 3: 37,2%). Os resultados apontam os fatores associados ao consumo de açúcares de adição numa perspectiva epidemiológica, revelando uma simultaneidade de comportamentos inadequados, ou seja, os adolescentes que ingerem mais açúcares também apresentam maior tempo de tela e pior qualidade global da dieta.

Abstract The aim of the present study was to estimate the prevalence of added sugar intake within the maximum limit of 5% of the total energy of the diet and test associations with demographic/socioeconomic characteristics, health-related behaviors and nutritional status in adolescents. A population-based, cross-sectional study was conducted with two-stage cluster sampling. The amount of free sugar in the diet was estimated using a 24-hour dietary recall. Among the 924 adolescents evaluated, only 20.1% (95% CI: 16.8-23.9) met the recommendation of not exceeding 5% of total calories with added sugar. Higher prevalence rates of adherence to the recommendation were found among males (22.0%), adolescents aged 15 to 19 years (24.3%), those born outside the state of São Paulo (30.4%), those with less screen time (27.5%), those with a lower number of household appliances (0-7: 29.5%; 8-15: 20.3%) and those with higher diet quality scores (2nd tertile: 17.7%; 3rd tertile: 37.2%). The findings demonstrate factors associated with added sugar intake from an epidemiological perspective, revealing the simultaneity of inappropriate behaviors, that is, the adolescents who consume more sugar also have longer screen time and worse overall diet quality.

Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005 / Asociación entre el consumo de alimentos ultraprocesados y el perfil nutricional de la dieta de los colombianos en 2005

Abstract: Objective: To evaluate the consumption of ultra-processed food and drink products and its association with the nutrient profile of the Colombian diet in 2005. Materials and methods: Food consumption based on 24-hour dietary records from 38 643 men and women was classified into four NOVA groups according to the extent and purpose of food processing. Results: Ultra-processed food and drink products represented 15.9% of the total energy daily intake, compared to 63.3% from minimally processed food, 15.8% from processed culinary ingredients, and 4.9% from processed food. Non-ultra-processed food items had a healthier nutritional profile compared to ultra-processed items in terms of contribution to total calories from protein, carbohydrates, total fat, saturated fat, free sugar, fiber and energy density. Conclusions: Ultra-processed food products have a less healthy nutrient profile than non-ultra-processed ones. An increase in the consumption of these foods must be prevented within Colombia.

Resumen: Objetivo: Evaluar el consumo de alimentos y bebidas ultraprocesadas y su asociación con el perfil nutricional dentro de la Encuesta Nacional de Nutrición de 2005 en Colombia. Material y métodos: El consumo de alimentos basados en registros alimentarios de 24 horas de 38 643 individuos se clasificó en cuatro grupos de NOVA. Resultados: Los productos de alimentos y bebidas ultraprocesados representaron 15.9% de la ingesta diaria total de energía, en comparación con 63.3% de los alimentos mínimamente procesados, 15.8% de los ingredientes culinarios procesados y 4.9% de los procesados. Los alimentos mínimamente procesados tenían un perfil nutricional más saludable en comparación con los artículos ultraprocesados en términos de contribución a las calorías totales, de proteínas, carbohidratos, grasa total, grasa saturada, azúcar libre, densidad de fibra y densidad de energía. Conclusiones: Los alimentos ultraprocesados tienen un perfil nutricional menos saludable que los alimentos no procesados.

Consumo de bebidas açucaradas, leite e sua associação com o índice de massa corporal na adolescência: uma revisão sistemática / Intake of sugar-sweetened beverages, milk and its association with body mass index in adolescence: a systematic review

RESUMO Objetivo: Sistematizar as referências da literatura relacionadas à associação entre consumo de bebidas açucaradas não alcoólicas, leite e índice de massa corporal (IMC) em adolescentes. Fontes de dados: Realizou-se a pesquisa dos artigos nos portais PubMed (US National Library of Medicine National Institutes of Health) e BVS (Biblioteca Virtual em Saúde). Os descritores foram: adolescente, adulto jovem, bebidas, ingestão de líquidos, obesidade, sobrepeso, IMC e estado nutricional. Utilizaram-se os filtros: idade entre 10 e 19 anos e artigos em português e inglês, publicados entre 2011 e 2015. Síntese dos dados: Trinta estudos foram selecionados (22 transversais, 4 coortes, 1 ensaio clínico aleatório, 1 caso-controle e 1 quase experimental). Dos 20 estudos que abordaram bebidas açucaradas em geral, 55% encontraram associação entre consumo e aumento do IMC. Em relação aos estudos sobre a ingestão de refrigerantes, todos apresentaram associação entre consumo e aumento do IMC. Dos estudos sobre leite, somente um demonstrou associação entre consumo e aumento do IMC. Três artigos mostraram proteção entre consumo de leite e aumento do IMC, e três trabalhos não encontraram associação de seu consumo com aumento do IMC. Dezenove estudos possuíam amostras representativas e outros 20 declararam ter amostras aleatórias. Dos artigos com questionários, 84% eram validados. Conclusões: Verifica-se que não há consenso na literatura pesquisada sobre a associação entre consumo de bebidas açucaradas não alcoólicas, leite e IMC de adolescentes.

ABSTRACT Objective: To systematize literature references addressing the association of sugar-sweetened beverage (SSB) and milk intake with body mass index (BMI) in adolescents. Data source: A search was carried out in PubMed (US National Library of Medicine National Institutes of Health) and BVS (Virtual Library in Health). The descriptors used were: adolescents, young adult, beverages, drinking, obesity, overweight, BMI, and nutritional status. The following filters were applied: age ranging from 10 to 19 years, studies published in Portuguese or English language between 2011-2015. Data synthesis: Thirty studies were selected (22 cross-sectional studies, 4 cohort studies, 1 randomized clinical trial, 1 case-control study, and 1 quasi-experimental study). There was association between the intake of these beverages and increase in BMI in 55% of all 20 studies that dealt with sugary drinks. When it came to soft drinks, 100% of studies reported association with increase in BMI. As to milk intake, only one article showed association with increased BMI. Three articles reported milk as a protection factor against increase in BMI; three studies found no association between this intake and BMI. Nineteen studies had representative samples and 20 surveys reported random samples. Among papers using questionnaires, 84% had been validated. Conclusions: There is no consensus in the literature about the association between SSB or milk intake and BMI in adolescents.

Consumo actual de edulcorantes naturales (beneficios y problemática): Stevia / Current consumption of natural sweeteners (benefits and problems): Stevia

La estevia [Stevia rebaudiana (Bertoni)] es un arbusto de tipo perenne de la familia de las Asteraceas que crece en áreas tropicales y subtropicales de Suramérica. Hoy en día, su cultivo se ha extendido a otras regiones del mundo, incluyendo Canadá y algunas partes de Asia, Europa y México, donde sus hojas se han utilizado tradicionalmente como edulcorante natural durante cientos de años. En la actualidad, el uso potencial y las implicaciones prácticas de la estevia como un edulcorante se muestran en una serie de alimentos procesados, ya que contiene glucósidos de esteviol como ingrediente activo, que puede ser bajo o no calórico, y hasta 100-300 veces más dulce que la sacarosa. Además, las hojas secas de estevia contienen también minerales, vitaminas, compuestos fenólicos, flavonoides y otros compuestos antioxidantes, con propiedades antimicrobianas y antioxidantes. Stevia acumula hasta un 30 % de los glucósidos de esteviol (SGs por su sigla en inglés) del peso seco de las hojas. El esteviósido y el rebaudiósido A son las principales SGs. Desde diciembre de 2011, los SGs (E 960) se han autorizado como aditivo alimentario y edulcorante en Estados Unidos. Su uso en diversas categorías de alimentos está regulado como por ejemplo en suplementos alimenticios y alimentos dietéticos para propósitos médicos especiales y control de peso. Sin embargo, la información ofrecida al consumidor es engañosa y dista de ser confiable. Este artículo ofrece al público interesado, datos que deben de ser evaluados al comprar productos adicionados con estevia (AU).

Stevia [Stevia rebaudiana (Bertoni)] is a perennial shrub belonging to the Asteraceae family that grows in tropical and subtropical areas of South America. Today its cultivation has spread to other regions of the world, including Canada and some parts of Asia, Europe and México, where its leaves have been used traditionally as a natural sweetener for hundreds of years. Nowadays, the potential use and practical implications of Stevia as a sweetener are shown in a number of processed foods, because it contains steviol-glycosides, which are low- or non-caloric ingredients, up to 100­300 times sweeter than sucrose. In addition, dry Stevia leaves also contain minerals, vitamins, phenolic compounds, flavonoids and other antioxidant compounds, with antimicrobial and antioxidant properties. Stevia accumulates up to 30% of diterpenoid steviol glycosides (SGs) of the leaf dry weight. Stevioside and rebaudioside A are the major SGs. Since December 2011, SGs (E 960) have been permitted for use as food additive and a sweetener in the United States. Its use in various food categories is regulated, e.g. food supplements and dietary foods for special medical purposes and weight control. However, the information offered to the consumers is misleading and far from reliable. This article offers the interested public, data that should be evaluated when buying products added with Stevia (AU).

A method for the assessment of facial hedonic reactions in newborns / Método para a avaliação de reações faciais hedônicas em recém-nascidos

Abstract Objective: This study describes a quantitative and qualitative methodology to assess hedonic responses to sweet stimulus in healthy newborns. Methods: A descriptive, cross-sectional, observational study, with healthy newborns (up to 24 h of life), between 37 and 42 gestational weeks, vaginally born and breastfed previously to all tests. The evaluation of the newborns reactions was performed by hedonic facial expression analysis, characterized by facial expressions with rhythmic serial tongue protrusion after neutral or sweet solution intake. Initially, 1 mL of water solution was provided to the newborn, followed by a 1-minute recording. Afterwards, the same amount of 25% sucrose solution was provided, performing a second recording. The concordance between researchers was analyzed by the Bland-Altman statistical method. Results: A total of 100 newborns (n = 49 males, n = 51 females; mean lifetime = 15 h 12 min ± 6 h 29 min) were recorded for neutral and sucrose solution intake, totaling 197 videos (n = 3 missing in the water treatment). These videos were double-blind analyzed and the test revealed a 90% concordance between the two trained researchers, in relation to both solutions. The intraclass correlation coefficient was 0.99 for both solutions, with a significant increase in frequency of hedonic expressions evoked by sucrose solution intake. Conclusions: These results confirm that the proposed method has an efficient power to detect significant differences between neutral and sucrose stimuli. In conclusion, this evaluation method of hedonic facial reactions in newborns reflects the response to a specific taste.

Resumo Objetivo: Descrever quantitativamente e qualitativamente uma metodologia para avaliar as respostas faciais hedônicas, em recém-nascidos saudáveis, ao estímulo doce. Métodos: Trata-se de um estudo descritivo, transversal e observacional, com recém-nascidos saudáveis (com até 24 horas de vida), entre 37-42 semanas gestacionais, nascidos por parto vaginal e alimentados previamente aos testes. A avaliação das reações hedônicas dos recémnascidos foi considerada pelas expressões faciais com séries rítmicas de protrusões de língua após a ingestão de solução neutra ou doce. Inicialmente, 1 mL de solução neutra (água) foi fornecida para o recém-nascido, seguido de uma filmagem de 1 minuto. Sequencialmente, a mesma quantidade de solução de sacarose 25% foi fornecida, realizando-se uma segunda gravação. A concordância entre os pesquisadores foi analisada pelo método estatístico de Bland-Altman. Resultados: Um total de 100 recém-nascidos (n = 49 do sexo masculino, n = 51 do sexo feminino, tempo de vida média = 15 h 12 min ± 6 h 29 min) foram registrados para a ingestão de solução neutra e de sacarose, totalizando 197 vídeos (n = 3 perdas para o tratamento água). Estes vídeos foram analisados em duplo-cego e o teste revelou uma concordância de 90%, para ambas as soluções, entre os pesquisadores treinados. O coeficiente de correlação intraclasse foi de 0,99 para as duas substâncias, com um aumento significativo nas frequências das expressões faciais hedônicas evocadas pela ingestão de sacarose. Conclusões: Estes resultados confirmam que o método proposto possui poder estatístico eficiente para detectar diferenças entre estímulos neutros e sacarose. Em conclusão, este método de avaliação de reações faciais hedônicas em recém-nascidos reflete a resposta para um gosto específico.

Gene cloning, expression, and characterization of the Bacillus amyloliquefaciens PS35 lipase

Abstract Lipases are enzymes of immense industrial relevance, and, therefore, are being intensely investigated. In an attempt to characterize lipases at molecular level from novel sources, a lipase gene from Bacillus amyloliquefaciens PS35 was cloned, heterologously expressed in Escherichia coli DH5α cells and sequenced. It showed up to 98% homology with other lipase sequences in the NCBI database. The recombinant enzyme was then purified from E. coli culture, resulting in a 19.41-fold purification with 9.7% yield. It displayed a preference for long-chain para-nitrophenyl esters, a characteristic that is typical of true lipases. Its optimum pH and temperature were determined to be 8.0 and 40 °C, respectively. The half-lives were 2.0, 1.0 and 0.5 h at 50 °C, 60 °C and 70 °C, respectively. The metal ions K+ and Fe3+ enhanced the enzyme activity. The enzyme displayed substantial residual activity in the presence of various tested chemical modifiers, and interestingly, the organic solvents, such as n-hexane and toluene, also favored the enzyme activity. Thus, this study involves characterization of B. amyloliquefaciens lipase at molecular level. The key outcomes are novelty of the bacterial source and purification of the enzyme with desirable properties for industrial applications.

Asociación entre edulcorantes no nutritivos y riesgo de obesidad en estudiantes universitarios de Latinoamérica / Association between non-nutritive sweeteners and obesity risk among university students in Latin America

Background: The association between non-nutritive sweeteners and obesity is controversial. Aim: To determine whether the consumption of non-nutritive sweeteners is related to higher risk for overweight or obesity among university students in Chile, Panama, Guatemala and Peru. Material and Methods: A total of 1,224 (472 from Chile, 300 from Panama, 248 from Guatemala and 204 from Peru) male and female university students aged between 18 and 26 years participated in the study. Each student reported their food intake (frequency of weekly consumption) in a survey that contained photos of foods containing non-nutritive sweeteners adapted for each country. Anthropometry was also measured. Results: More than 80% of students consumed at least one product containing non-nutritive sweeteners. Females who ate acesulfame potassium and sucralose had a lower risk of overweight or obesity with an odds ratio (OR) of 0.5 (confidence intervals (CI) = 0.3-0.9; p = 0.003) and OR = 0.4 (IC = 0.2-0.8; p = 0.01), respectively. Conclusions: In this sample of Latinamerican university students, consumption of non-nutritive sweeteners was associated with lower risk of overweight only in females.

Efeitos dos diferentes tipos de adoçantes dietéticos isolados nos parâmetros nutricionais e bioquímicos de ratos / Effects of different types of isolated dietary sweeteners on nutritional and biochemical parameters of rats

OBJECTIVE: This study aimed to evaluate the effects of using different types of isolated sweeteners in nutritional and biochemical parameters of rats. METHODS: We used 36 adult male rats, maintained on diet for 42 days and divided into six groups: Group C - Control, Group AS - Aspartame; Group ES - Stevia; Group SU - Sucralose; Group CI - Cyclamate; group SA - Saccharin. The animals were fed a standard AIN 93M with replacement of sucrose by its sweetener and water ad libitum. The animals were kept in metabolic cages in a controlled environment and were recorded body weight, food and water consumption, urinary and fecal excretion. At the end of the study the animals were anaesthetized intraperitoneally with a combination of ketamine, hydrochloride xylazine and acepromazine and euthanized by cardiac puncture. Theserum was used to determine glucose, lipid, liver and kidney profiles. RESULTS: Animals receiving sweeteners had lower food intake compared to Group C, highlighting the SA Group. The results indicated that the sweeteners used in this study and the maximum proportion suggested by ANVISA, particularly saccharin, stevia, sucralose and cyclamate, decreased the animals food intake. Sweeteners did not influence the other study variables. CONCLUSIONS: The sweeteners reduced food intake, but no change was noticed in the animal's final weight gain and other variables. We suggest additional long term research

OBJETIVO: Avaliar os efeitos do uso de diferentes tipos de adoçantes isolados nos parâmetros nutricionais e bioquímicos de ratos. MÉTODOS: Foram utilizados 36 ratos machos, Wistar, adultos, mantidos sob dieta durante 42 dias e distribuídos em seis Grupos: Grupo C ­ Controle; Grupo AS ­ Aspartame; Grupo ES ­ Estévia; Grupo SU ­ Sucralose; Grupo CI ­ Ciclamato; Grupo SA ­ Sacarina. Os animais receberam dieta padrão AIN 93M com substituição da sacarose pelo respectivo adoçante e amido, com água ad libitum. Os animais foram mantidos em ambiente controlado e foram registrados peso corporal, consumo alimentar e hídrico, excreção urinária e fecal. Os animais foram anestesiados via intraperitoneal, com Cloridrato de Cetamina, Cloridrato de Xilazina e Acepromazina. A eutanásia foi realizada por punção cardíaca. O soro foi utilizado para determinar perfil glicídico, lipídico, hepático e renal. RESULTADOS: Os animais que receberam adoçante apresentara menor consumo alimentar em relação ao Grupo C, destacando-se o Grupo SA. Os resultados indicaram que os adoçantes utilizados no presente estudo e na proporção máxima sugerida pela ANVISA, principalmente sacarina, estévia, sucralose e ciclamato, diminuíram o consumo alimentar dos animais. Os adoçantes não influenciaram as demais variáveis do estudo. CONCLUSÕES: Os adoçantes reduziram o consumo alimentar, porém sem alteração no ganho de peso final dos animais e nas demais variáveis estudadas. Sugere-se a realização de pesquisas adicionais em longo prazo

Palatabilizantes em dietas de leitões recém-desmamados / Flavors in diets for weanling pigs

Com o intuito de verificar a eficácia do açúcar e do edulcorante à base de sacarina sódica e neoesperidina nas dietas de leitões, foram realizados dois experimentos, ambos com 42 leitões recém-desmamados aos 21 dias de idade. Foram oferecidas três dietas: dieta controle (DC), dieta com açúcar (DA) e dieta com edulcorante (DE). Os experimentos foram em blocos ao acaso, sendo o primeiro com sete repetições e dois animais por unidade experimental e o segundo com seis repetições, um animal por unidade experimental, e arranjo fatorial 3 x 2 + 1 (três dietas, duas épocas de abate: aos 28 e 35 dias de idade e um abate no dia do desmame). No primeiro experimento, os animais permaneceram nas instalações de creche até 63 dias de idade para avaliação do desempenho e da viabilidade econômica das dietas. No segundo experimento, os animais foram abatidos para se proceder à pesagem de órgãos, medição do comprimento do intestino delgado e coleta dos segmentos do duodeno e jejuno para realização da morfometria intestinal. Não houve diferenças entre as dietas para consumo diário de ração (CDR), ganho diário de peso (GDP) e conversão alimentar (CA) nos períodos 1 (21 aos 28 dias), 3 (21 aos 50 dias) e 4 (21 aos 63 dias de idade). No período 2 (21 aos 35 dias), os animais que consumiram a DE apresentaram maior (P<0,05) CDR e GDP, se comparados aos que consumiram a DA. Nos períodos 1, 2 e 3, foi observado menor custo da dieta por kg de peso vivo ganho e melhores índices econômico e de custo para os animais que consumiram DE. Ao se avaliar a morfometria intestinal e o peso de órgãos, não se observou diferença entre as dietas, com exceção para o peso do estômago, que foi maior nos animais que consumiram DE. A inclusão de edulcorante é eficaz em melhorar o desempenho no período 2, além de ser viável sob o ponto de vista econômico...

In order to verify the effectiveness of sugar and sweeteners containing saccharin and neohesperidin in diets of piglets, two experiments were conducted, both with 42 newborn piglets weaned at 21 days old. Were offered three diets: control diet (DC), diet with sugar (DA) and diet with sweetener (DE). The experiments were done in randomized blocks, the first of which had seven replicates and two animals per experimental unit and the second, six replicates and one animal per experimental unit comprising a factorial 3 x 2 + 1 design (three diets, two slaughter ages: at 28 and 35 days of age and slaughter on the day of weaning). In the first experiment, the animals remained in the nursery facilities until 63 days of age to evaluate the performance and the economic viability of the diets. In the second experiment, the animals were slaughtered to weigh the organs, measure the length of the small intestine and collect segments of the duodenum and jejunum to determine intestinal morphology. There were no differences between diets for the average dairy feed intake (ADFI), average dairy gain (ADG) and gain:feed (G:F) in Periods 1 (21 to 28 days), 3 (21 to 50 days) and 4 (21 to 63 days old). In Period 2 (21 to 35 days), animals that consumed DE had higher (P<0.05) ADFI and ADG, compared to those fed the DA. In Periods 1, 2 and 3 a lower cost per kg of the diet of live weight gain and better economic indicators for the animals fed DE were observed. No differences were observed between the diets when evaluating intestinal morphology and organ weights, except for the weight of the stomach, which was higher in animals fed DE. The inclusion of sweetener is effective in improving performance in Period 2, and is viable under the economical point of view...

Anticariogenic properties and effects on periodontal structures of Stevia rebaudiana Bertoni: narrative review / Propiedades anticariogénicas y efectos a nivel periodontal de Stevia rebaudiana Bertoni: revisión narrativa

Introduction: Stevia rebaudiana Bertoni is a natural non-caloric sweetener, withmore sweetness than sucrose, without adverse effects, which has demonstrated to have multiples benefits to the systemic health and recently to the oral health. This review’s objective is to describe anti-cariogenic and anti-periodontophatics properties of its extracts. Results: Stevioside and rebaudioside A are the most important glycosides of the Stevia and none is cariogenic. In vitro researches have shown that Stevia extracts have anti-bacterial activity on Streptococcus mutans, Streptococcus sobrinus and Lactobacillus acidophilus, organisms that are closely related to the production and development of tooth decay. In vivo and in vitro it has been observed that the production of bacterial acids decrease attributing it a low acidogenic potential and a lesser effect of the demineralization of the enamel in comparison with others sweeteners. Furthermore, in vivo it has been proved an anti-plaque effect mainly due to a decrease in the production of bacterial insoluble polymers. These characteristics in combination with antiinflammatory properties could result potentially effective in the treatment of periodontal diseases in significant numbers, as it has been observed in studies conducted in animals. Conclusion: Stevia presents properties that potentially are anti-caries and anti periodontal diseases. However, in vivo studies are necessary to confirm these assumptions and provide a greater understanding of the mechanisms of action of this plant and the components involved. Notwithstanding, with the existing background, this sweetener can be postulated as a potential therapeutic complement in the odontological care, especially in patients that present base conditions such as obesity, diabetes and high blood pressure.

Introducción: Stevia rebaudiana bertoni es un edulcorante natural no calórico, con mayor dulzor que la sacarosa, sin efectos adversos, que ha demostrado tener múltiples beneficiosos para la salud sistémica y recientemente para la salud oral. El objetivo de esta revisión es describir propiedades anticariogénicas y antiperiodontopáticas de sus extractos. Resultados: Esteviósido y rebaudiósido A son los glicósidos más importantes de Stevia y ninguno es cariogénico. Estudios in vitro han demostrado que extractos de Stevia presentan actividad antibacteriana sobre Streptococcus mutans, Streptococcus sobrinus y Lactobacillus acidophillus, organismos estrechamente relacionados en la producción y desarrollo de caries. In vivo e in vitro se ha observado que disminuye la producción de ácidos bacterianos atribuyéndosele un bajo potencial acidogénico y un menor efecto de desmineralización del esmalte en comparación con otros edulcorantes. Además, in vivo se ha comprobado un efecto antiplaca principalmente debido a una disminución en la producción de polímeros insolubles bacterianos. Estas características, más sus propiedades antiinflamatorias y cicatrizantes, podrían resultar potencialmente efectivas en el tratamiento de enfermedades periodontales en cifras significativas, como se ha observado en estudios desarrollados en animales. Conclusión: Stevia presenta propiedades potencialmente anti-caries y anti-enfermedades periodontales. Sin embargo, son necesarios estudios in vivo que confirmen estos postulados y proporcionen una mayor comprensión de sus mecanismos de acción y de los componentes que intervienen. No obstante, con los antecedentes existentes, se puede postular a este edulcorante como un potencial complemento terapéutico en la atención odontológica, sobre todo en pacientes que presentan condiciones de base como obesidad, diabetes e hipertensión.

Los edulcorantes y su uso en Niños / Sweeteners and use in children

Los carbohidratos simples como el azúcar, se encuentran en una gran cantidad de alimentos como tortas,caramelos, helados, refrescos, gaseosas y bocadillos. Los edulcorantes son sustancias artificiales que se clasifican en nutritivos, y no nutritivos o no calóricos. Para que los edulcorantes fueran aprobados por la Food Drugs Administration (FDA), han pasado por una serie de pruebas farmacológicas y toxicológicas paradeterminar si su uso es seguro. Las dosis o cantidades seguras de consumo se denominan ingesta diariaaceptable o admisible que puede ser consumida por las personas en forma mantenida sin riesgo apreciable para la salud. Su uso de manera moderada, puede ser de gran utilidad en el manejo de una dieta balanceada o con disminución en las calorías totales, para conservar el peso adecuado o controlar la ganancia y mantenerniveles de glicemia lo más cercano a lo normal. Aún queda mucho por investigar en relación con los edulcorantes y los datos hasta el momento indican que son seguros.

Carbohydrates as the simple sugar found in a variety of foods such as cakes, candy, ice cream, soft drinks and snacks. Artificial sweeteners are substances that are classified as nutritive and non-nutritive or non-caloric. For sweeteners are approved by the Food Drugs Administration (FDA), have gone through a series of pharmacological and toxicological tests to determine if their use is safe. Safe doses or quantities ofconsumption are called acceptable daily intake or intake (ADI) that can be consumed by people in theform maintained without appreciable health risk. Its use in moderation, can be very useful in managing abalanced diet or decrease in total calories, to keep the weight or gain and maintain control of blood glucoselevels as close to normal. Much remains to be investigated in relation to sweeteners and the data so farindicate they are safe.

O uso correto dos adoçantes / The correct use of artificial sweeteners

Os subtítulos do Açúcar ou adoçante são muito populares pelo seu consumo em todo o mundo. Neste artigo foi realizada uma revisão bibliográfica sobre os adoçantes mais utilizados na indústria alimentícia mundial, enfatizando suas indicações, contra-indições, origem e doses de ingestão recomendadas. Após breve histórico de cada uma deles, são esclarecida suas composições e particularidades e ao posicionam, ente dos principais órgãos mundial reconhecidos na área de saúde, em relação às controvérsias e mitos que envolvem a industria de adoçantes. Cabe ao leitos avaliar, a partir do que será exposto, os riscos e benefícios que a inclusão dos adoçantes na dieta poderá trazer a curto e longo prazo.

Effects of sucralose ingestion on fetal and placental weights and umbilical-cord length: experimental study / Efectos de la ingestión de sucralosa sobre el peso fetal y placentario y la longitud del cordón umbilical: estudio experimental

Sucralose is a sweetener of general use in over three thousand products (beverages, foods and medical diets), with utilization currently permitted for the general population in more than 80 countries, including for women of reproductive age. There is little information on the safe use of sucralose, and experimental studies have suggested that the administration of some sweeteners, by diverse routes, retards not only fetal and placental development but also umbilical cord size. The present study aimed to estimate the fetal and placental weights and umbilical-cord length in fetuses from rat dams, after ingestion and non-ingestion of sucralose. In the treated group (5 dams), sucralose was administered (via gavage) at the dose of 30 mg/kg/day, from the 10th to 14th day of pregnancy. In the control group (5 dams), saline solution was administered, at the same dose and by the same route. On the 20th gestation day, both groups were sacrificed for weighing of the fetuses and placentas and measurement of umbilical-cord length. Mean values of fetal weight and umbilical-cord length of the treated group were significantly lower than controls (Mann-Whitney Test, p<0.001). Placental weight did not differ statistically between treated and control groups. It can be concluded from the present work that sucralose ingestion at 30 mg/kg/day, from days 10 to 14 of pregnancy, diminished fetal weight and umbilical-cord length, which suggests passage of sucralose through the placental membrane.

La sucralosa es un edulcorante de uso general en más de tres mil productos (bebidas, alimentos y dietas médicas), con permisos de utilización para la población general en más de 80 países, entre ellos mujeres en edad reproductiva. Hay poca información sobre el uso seguro de la sucralosa, y los estudios experimentales han sugerido que la administración de algunos edulcorantes, por diversas vías, no sólo retrasa el desarrollo del feto y la placenta, sino también el tamaño del cordón umbilical. Este estudio tuvo como objetivo estimar el peso fetal y placentario y la longitud del cordón umbilical de los fetos de ratas madres después de la ingestión y la no ingestión de sucralosa. En el grupo tratado (5 crías), la sucralosa se administró (a través de sonda) en una dosis de 30 mg/kg/día, desde el día 10 hasta 14 de la preñez. En el grupo control (5 crías), se administró solución salina, con la misma dosis y por la misma vía. En el día 20 de la gestación, ambos grupos fueron sacrificados, para determinar el peso de los fetos y de las placentas y la medición de la longitud del cordón umbilical. Los valores medios del peso fetal y la longitud del cordón umbilical en el grupo tratado fueron significativamente más bajos que los controles (U de Mann-Whitney, p <0,001). El peso de la placenta no difirió estadísticamente entre los grupos tratados y los controles. Se puede concluir de este trabajo que el consumo de sucralosa en 30 mg/kg/día, desde lel día 10 al 14 de la preñez, disminuye el peso fetal y la longitud del cordón umbilical, lo que sugiere el paso de la sucralosa través de la membrana placentaria.

Use of chewing gum containing 15 percent of xylitol and reduction in mutans streptococci salivary levels

Frequent use of Xylitol may decrease the S. mutans levels. However, very little is known about whether this effect on the levels of cariogenic bacteria is maintained after the interruption of short-term usage of xylitol. This study aimed at evaluating changes in mutans streptococci (MS) salivary levels after using a chewing gum containing xylitol. Twelve volunteers harboring > 10(5) CFU MS/ml saliva levels were asked to chew Happydent-xylit® for 5 minutes, 5 X/day, for 30 days. Saliva samples were collected at baseline, at 30 days after xylitol usage began, and at 30 days beyond its interruption. MS salivary levels were estimated. The average salivary levels of MS in the ten subjects who completed the study were 13.17 (NL-CFU) at baseline (A). After the 30 days experimental period (B), this average decreased to 9.45 (NL-CFU). Nine of ten subjects studied showed a reduction in MS salivary levels in relation to baseline, whereas salivary levels were maintained in the remaining subject. At thirty days beyond the interruption of xylitol usage (C), the average levels of MS were still reduced to 10.31 (NL-CFU). Multiple sample comparison using the Bonferroni test revealed that the decrease in MS levels observed from baseline (A) to the time immediately after 30 days of xylitol usage (B) was statistically significant (p < 0.05), and those levels were still decreased between baseline and 30 days beyond the interruption of xylitol usage (C). So, the use of xylitol induced a reduction in MS salivary levels after a short period of usage which persisted beyond its interruption.

Revisão da literatura sobre recomendações de utilização de edulcorantes em gestantes portadoras de diabetes mellitus / Literature Review about recommendations of use of sweeteners in pregnant women with diabetes mellitus

Trata-se de uma revisão narrativa do conhecimento disponível na literatura sobre a recomendação de edulcorantes nos casos de diabetes na gestação, com consulta às seguintes bases de dados: Medline, Lilacs e PubMed, tendo como base os períodos de 1978 a 2009. Os edulcorantes são classificados em nutritivos e não-nutritivos. Atualmente, o aspartame é alvo de várias críticas, porém a American Diabetes Association (ADA), revisando as evidências científicas acerca da inocuidade do aspartame, declara que o edulcorante não é carcinogênico e não está associado a desordens neurológicas. Quanto à sacarina, alguns autores recomendam restrição do consumo desta por gestantes, devido à falta de informações conclusivas sobre possíveis efeitos no desenvolvimento fetal, além das poucas evidências sobre seu efeito transplacentário e transmamário. A ADA não recomenda o uso do esteviosidio como edulcorante. Os edulcorantes não-calóricos atualmente aprovados para uso pela população em geral, incluindo as gestantes são: aspartame, acesulfame-K, sacarina, sucralose e neotame. Na orientação dietética, deve-se considerar a quantidade permitida por dia e esclarecer à cliente sobre a importância de controlar a dose utilizada, além de revisar periodicamente os tipos de edulcorantes presentes nos adoçantes e produtos dietéticos disponíveis no mercado.

The present narrative review article accounts for the available knowledge about the recommended use of sweeteners in cases of gestational diabetes, according to the Medline, Lilacs and PubMed databases from 1978 to 2009. Sweeteners are classified as nutritive and non-nutritive. Currently, aspartame is being strongly criticised despite the American Diabetes Association (ADA) having stated that it is not carcinogenic nor associated with neurological disorders. As for saccharin, some authors recommend a restricted intake by pregnant women due to the lack of conclusive information about its possible effects on fetal development, and to the little evidence of its transplacental and transmammary effects. The ADA does not recommend the use of stevioside as a sweetener. The approved low-calorie sweeteners for all population, including pregnant women, are aspartame, acesulfame-K, saccharin, sucralose and neotame. During diet orientation, the allowed daily intake should be considered, the importance of controlling the dose should be explained to the patient, and the sweeteners used in diet products available in the market should be frequently revised.

Consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde em Ribeirão Preto, SP / Consumption of sweeteners and dietetic foods by individuals with type 2 diabetes mellitus, assisted by the National Health System in Ribeirão Preto, SP

OBJETIVO: Analisar o consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde (SUS) em Ribeirão Preto, SP. SUJEITOS E MÉTODOS: Por meio de questionário, foram entrevistados 120 pacientes, estratificados por sexo, faixa etária e nível de atendimento. RESULTADOS: Os resultados mostram que o uso de adoçantes é frequente na população em estudo, com predomínio do tipo líquido, e o uso de produtos dietéticos é menor, com predomínio dos refrigerantes. O diagnóstico do DM foi determinante para o uso dos produtos e o critério de seleção mais utilizado foi o sabor. É pequena a porcentagem da amostra que sabe a diferença entre diet e light, que tem o hábito de ler o rótulo dos alimentos e que se preocupa com a quantidade utilizada de adoçante. CONCLUSÃO: É uma necessidade a inclusão de informações sobre o uso adequado desses produtos nas atividades assistenciais aos pacientes com DM nos diversos níveis do SUS.

OBJECTIVE: To analyze the consumption of sweeteners and dietetic foods by individuals with type 2 diabetes, assisted by the Brazilian National Health System, in the city of Ribeirão Preto, SP. SUBJECTS AND METHODS: Through a questionnaire were interviewed 120 patients were interviewed, stratified by sex, age and level of health care. RESULTS: The use of sweeteners is very frequent by the population in study, with predominance of the liquid type, and the use of dietetic foods is less common, with predominance of soft drinks. The diagnosis of diabetes was determinant for starting the use of both and the used criterion for selection of the sweetener is its flavor. The percentage of the population that knows the difference between diet and light products, that has the habit to read labels, and that is worried with the amount used of sweetener, is small. CONCLUSION: There is a need to include information about the adequate use of these products in the health care activities for patients with diabetes in the different levels of the Brazilian National Health System.

Processo de desenvolvimento de um questionário para avaliação de abuso e dependência de açúcar / Development of a questionnaire to evaluate sugar abuse and dependence

Este estudo descreve o processo de desenvolvimento de um questionário para avaliação de possível abuso e dependência de açúcares extrínsecos não lácticos. Pesquisas recentes mostram que o consumo excessivo de açúcares extrínsecos não lácticos pode levar a alterações no sistema nervoso central a partir da influência destas substâncias no sistema neuroquímico de recompensa. O desenvolvimento desse instrumento ocorreu com base na adaptação do módulo "L" do questionário MINI-Plus por quatro grupos focais, e pela avaliação feita por uma comissão de especialistas na área de dependência química. O questionário apresenta algumas modificações de conteúdo em relação ao instrumento original, como substituições de palavras que estariam de melhor acordo com a substância em estudo; entretanto, manteve a estrutura original com vinte questões sobre abuso e dependência. Um instrumento de avaliação de dependência e abuso de açúcares extrínsecos não lácticos poderá no futuro ajudar os profissionais da saúde a prevenir e tratar problemas relacionados ao consumo de açúcar. É importante salientar que o diagnóstico de abuso e dependência de açúcar ainda deverá ser melhor avaliado pela comunidade científica, assim como as propriedades psicométricas desse instrumento.

This study describes the development of a questionnaire to evaluate the potential abuse of (and dependence on) non-milk extrinsic sugar (NMES). Recent studies have shown that excessive NMES consumption can cause alterations in the central nervous system due to the influence of these substances in the neurochemical reward system. The questionnaire was originally developed from a summary of reports from four focus groups utilizing the "L" module of the MINI-Plus questionnaire. Addiction specialists subsequently evaluated the draft of the questionnaire and altered the original instrument's content, substituting terms in order to better fit the substance used in this study. However, the original structure of 20 questions on abuse and dependence was maintained. It is hoped that an instrument to evaluate NMES abuse and dependence will help health professionals prevent and treat problems related to over-consumption of sugars. However, the diagnosis of sugar abuse and dependence and the instrument's potential psychometric properties require further study by the scientific community.

Hypoglycemia in the newborn.

Hypoglycemia in a neonate has been defined as blood sugar value below 40mg/dL. Hypoglycemia is encountered in a variety of neonatal conditions including prematurity, growth retardation and maternal diabetes. Screening for hypoglycemia in certain high-risk situations is recommended. Supervised breast-feeding may be an initial treatment option in asymptomatic hypoglycemia. However, symptomatic hypoglycemia should always be treated with a continuous infusion of parenteral dextrose. Neonates needing dextrose infusion rates above 12 mg/Kg/min should be investigated for the cause of hypoglycemia. Hypoglycemia has been linked to poor neuro-developmental outcome, and hence aggressive screening and treatment is recommended.

The effect of xylitol chewing gum on mutans streptococci in saliva and dental plaque.

Dental caries are one of the most common infectious diseases occurred in Thai children. The chewing of xylitol, sorbitol, and even sugar gum has been suggested to reduce caries rates. The aim of the present investigation was to evaluate the effect of xylitol chewing gum on mutans streptococci (MS) in saliva and dental plaque. Ninety-one children, aged 10-12 years, with more than 1 x 10(5) MS per milliliter of saliva were included in this study. They were divided into three groups balanced according to their MS counts at baseline: one control group (no supervised gum use), and two xylitol groups (supervised 55% and 100% xylitol gum use). Whole saliva and pooled plaque samples were obtained after 90 school days. When comparing the MS counts between the groups, those chewing 100% and 55% xylitol gum showed significant reductions (p < 0.025), but a dose response effect was not demonstrated. Chewing 100% xylitol gum caused significant reductions on salivary MS scores (p < 0.025) which was little different from the 55% xylitol group. The results suggest that the use of xylitol chewing gum can reduce the levels of MS in plaque and saliva.