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.

Fatores preditores do desfecho do Teste de Provocação Oral na Alergia à Proteína do Leite de Vaca: in natura vs. alimentos processados / Predictors of the outcome of the Oral Food Challenge for Cow's Milk Protein Allergy: raw vs. processed foods

RESUMO: Objetivos: Descrever uma população de crianças com alergia à proteína do leite de vaca (APLV) IgE mediada, submetidas ao teste de provocação oral (TPO) com alimentos processados vs. in natura, e comparar características clínico-epidemiológicas e laboratoriais, avaliando preditores de desfecho ao uso dessas diferentes apresentações de proteína. Métodos: Estudo transversal realizado em ambulatório de alergia de um hospital terciário em Fortaleza, Ceará. A coleta dos dados foi realizada entre outubro de 2018 a setembro de 2019. O questionário foi preenchido com os dados epidemiológicos, clínicos e laboratoriais encontrados no prontuário; amostra total de 49 crianças, com APLV IgE mediada tolerantes ao TPO com alimentos processados ou in natura. Resultados: Na comparação das características clinico-epidemiológicas das populações tolerantes a alimentos in natura vs. processados (respectivamente), a maioria apresentou dados semelhantes, como sexo masculino (60% vs. 57,9%), etnia parda (73,3% vs. 68,4%), idade gestacional a termo (80% vs. 77,8%), sem intercorrências durante a gestação (58,3% vs. 80,0%) ou parto (70% vs. 78,9), média de idade materna (32 anos vs. 35 anos), escolaridade materna (ensino médio completo - 43,3% vs. 47,4%), idade de início dos sintomas de APLV entre 1 e 6 meses (76,7% vs. 68,4%), aleitamento materno exclusivo entre 4 e 6 meses (60% vs. 68,45%), histórico de alergia familiar alimentar (73% vs. 68,4%), sendo as principais comorbidades alérgicas as respiratórias (38,9% vs. 35,7%) e alimentares (38,9% vs. 35,7%). Em relação aos dados laboratoriais, a maioria das frações de proteína no grupo tolerante a alimentos in natura e a alimentos processados apresentou valores ≤ 10 kU/L. Foi constatado que a idade materna (p = 0,006) e a idade de introdução de fórmula complementar (p = 0.020) se correlacionam de forma estatisticamente significante no grupo de pacientes tolerantes a alimentos processados. Conclusões: Foi observado que a idade materna (p = 0,006) e a idade de introdução de fórmula complementar (p=0.020) se correlacionam de forma estatisticamente significante no grupo de pacientes tolerantes alimentos processados. Os dados laboratoriais seguiram distribuição proporcionais entre os dois grupos, com maior frequência de valores ≤ 10 kU/L para todas as frações de proteína do leite de vaca, sem significância estatística. Estudos populacionais semelhantes em populações APLV IgE mediada são importantes para caracterizar melhor esse fenótipo e otimizar ferramentas diagnósticas e protocolos de tratamento. Destaca-se também o papel da terapia baked, que auxilia na aquisição de tolerância a diferentes apresentações da PLV de forma mais breve, melhorando, portanto, a qualidade de vida desses pacientes. (AU)

ABSTRACS: Objectives: To describe the population of children with IgE-mediated CMPA tolerant to processed or raw CMP in the OFC, comparing their clinical, epidemiological and laboratory characteristics and evaluating the possible predictors of outcomes associated with these different presentations of CMP. Methods: Cross-sectional study carried out in an allergy clinic of a tertiary hospital in Fortaleza, Ceará. Data collection was carried out between October 2018 and September 2019. The questionnaire was filled out with epidemiological, clinical and laboratory data found in the medical records. The total sample was composed of 49 children with IgE-mediated CMPA tolerant to processed or raw foods in the OFC. Results: The comparison of the clinical and epidemiological characteristics of populations tolerant to raw foods vs. processed (respectively) showed similarities, such as the predominance of the male gender (60% vs. 57.9%); mixed ethnicity (73.3% vs. 68.4%); delivery at term (80% vs. 77 .8%); no complications during pregnancy (58.3% vs. 80.0%) or childbirth (70% vs. 78.9); mean maternal age (32 years vs. 35 years); level of education of the mothers (complete high school - 43.3% vs. 47.4%); age of onset of CMPA symptoms between 1 and 6 months (76.7% vs. 68.4%); exclusive breastfeeding for 4 to 6 months (60% vs. 68.45%); family history of food allergy (73% vs. 68.4%); and respiratory (38.9% vs. 35.7%) and food allergies (38.9% vs. 35.7%) as the main allergic comorbidities. Regarding laboratory data, most protein fractions had values ≤ 10 kU/L in both groups. It was found that maternal age (p = 0.006) and age of introduction of formula (p = 0.020) were statistically significant in the group of patients tolerant to processed foods. Conclusions: It was observed that maternal age (p = 0.006) and age of introduction of formula (p = 0.020) were statistically significant in the group of patients tolerant to processed foods. Laboratory data were proportionally distributed across the two groups, with a higher frequency of values lower than or equal to 10 kU/L for all CMP fractions, with no statistical significance between the groups. Similar population studies in IgE-mediated CMPA populations are important to better characterize this phenotype and optimize diagnostic tools and treatment protocols. The role of baked therapy is also noteworthy, as it helps patients to develop tolerance to different presentations of CMP more quickly, improving their quality of life. (AU)

Indicators of full value feeding rations for dairy cows / Indicadores de rações de valor total para vacas leiteiras

This article presents the results of the level of feeding and the health status of dairy cows in a commercial dairy farm on the content of the main components in milk (fat, protein, urea). The aim of the research was to study the milk productivity and composition of milk of cows, to analyze the level of feeding and the content of basic nutrients in the diet of the farm. The farm breeds purebred Holstein cattle with a high genetic potential for productivity. The milking herd was formed in 2009 on the basis of 600 heads of Holstein-Friesian heifers imported from Hungary, as well as 65 heads of Holsteinized heifers of Ukrainian selection from Ukraine in 2015. Today the livestock numbers about 1,500 head of cattle, of which there are about 900 breeders. On the territory of the farm there are: 3 cowsheds for keeping cows, an insemination room, a milking parlor with a parallel installation of the Delaval company, in which 48 cows are milked for one milking, the ABK, where the manager’s office, livestock technician, accounting is located, and a mini-hotel with dining room and lounges. Dairy bases are equipped with auto-drinkers, ventilation, plumbing, electric lighting, manure removal mechanisms, and a milking installation. The object of the research was Holstein cows in the amount of 483 heads of Aina Dairy Farm LLP. The studies were carried out according to generally accepted zootechnical methods using modern equipment for conducting analyzes and interstate and state standards. The research results showed that the milk productivity of cows averaged 19.5 kg per day, the fat content 4.3%, the protein 3.9%, the number of somatic cells 230.5 thousand units / ml, urea 45.3 mg / 100 ml respectively. Analyzing the [...].

Este artigo apresenta os resultados do nível de alimentação e do estado de saúde de vacas leiteiras em uma fazenda comercial leiteira sobre o conteúdo dos principais componentes do leite (gordura, proteína, ureia). O objetivo da pesquisa foi estudar a produtividade e composição do leite de vacas, analisar o nível de alimentação e o teor de nutrientes básicos na dieta da fazenda. A fazenda produz gado holandês de raça pura com alto potencial genético de produtividade. O rebanho leiteiro foi formado em 2009 com base em 600 cabeças de novilhas Holstein-Friesian importadas da Hungria, bem como 65 cabeças de novilhas holsteinizadas da seleção ucraniana em 2015. Hoje o gado totaliza cerca de 1.500 cabeças de gado, das quais existem cerca de 900 criadores. No território da fazenda existem: 3 estábulos para criação de vacas, uma sala de inseminação, uma sala de ordenha com instalação paralela da empresa Delaval, na qual são ordenhadas 48 vacas para cada ordenha, a ABK, onde fica o escritório do gestor, pecuária técnica, a contabilidade está localizada, e um mini-hotel com refeitório e salões. As bases leiteiras são equipadas com bebedouros automáticos, ventilação, encanamento, iluminação elétrica, mecanismo de remoção de esterco e instalação de ordenha. O objeto da pesquisa foram vacas da raça holandesa no valor de 483 cabeças da Aina Dairy Farm LLP. Os estudos foram realizados de acordo com métodos zootécnicos geralmente aceitos, utilizando equipamentos modernos para a realização de análises e padrões interestaduais e estaduais. Os resultados da pesquisa mostraram que a produtividade do leite das vacas era em média 19,5 kg por dia, o teor de gordura 4,3%, a proteína 3,9%, o número de células somáticas 230,5 mil unidades / ml, ureia 45,3 mg / 100 ml respectivamente. A análise do nível de ureia no leite [...].

Supplementation of crossbred cows with maize and urea in tropical pasture / Suplementação de vacas mestiças com milho e ureia em pastagem tropical

This research article aims to evaluate the effect of total replacement of corn by soybean meal and urea on intake and apparent digestibility of dry matter and its components, production and composition of milk and feeding behavior of lactating cows grazing, with intermittent stocking Mombaça grass (Megathyrsus maximus cv. Mombaça). Twelve milking cows were distributed in a triple 4 x 4 latin square. Experimental treatments consisted of four soybean meal replacement levels by corn more urea (0; 33; 66; 100%). The grass has an average content of crude protein and neutral detergent fiber of 19% and 59%, respectively. The replacement of soybean meal by corn and urea did not affect the intake and digestibility of nutrients. A linear reduction of milk production was observed, but there was no change in milk production corrected to 4.0% of fat. The milk components (g/kg) of fat, protein, lactose, and total solids were not altered, as well as feeding behavior. Under the conditions of this study, the replacement of the diets is suitable for crossbred dairy cows in lactation third medium, producing in average of 12.5 kg/day-1 when kept in quality pastures.(AU)

Este artigo de pesquisa tem como objetivo avaliar o efeito da substituição total do milho pelo farelo de soja e ureia sobre o consumo e a digestibilidade aparente da matéria seca e de seus componentes, a produção e a composição do leite e o comportamento alimentar de vacas em lactação mantidas em pastos capim-mombaça (Megathyrsus maximus cv. Mombaça) manejado sob lotação intermitente. Doze vacas em lactação foram distribuídas em um quadrado latino triplo 4 x 4. Os tratamentos experimentais consistiram de quatro níveis de substituição do farelo de soja pelo milho mais ureia (0; 33; 66; 100%). O capim-mombaça apresentou um teor médio de proteína bruta e de fibra em detergente neutro de 19% e 59%, respectivamente. A substituição do farelo de soja por milho e ureia não afetou o consumo e a digestibilidade dos nutrientes. Observou-se redução linear da produção de leite, mas não houve alteração na produção de leite corrigida para 4,0% de gordura. Os componentes do leite (g/kg): gordura, proteína, lactose e sólidos totais não foram alterados, assim como o comportamento ingestivo dos animais. Nas condições deste estudo, a substituição total do milho pelo farelo de soja e ureia nas dietas é adequada para vacas mestiças leiteiras em terço médio de lactação, produzindo, em média, 12,5 kg / dia-1 quando mantidas em pastagens de qualidade.(AU)

Macronutrients of mothers milk of very low birth weight infants: analysis according to gestational age and maternal variables / Macronutrientes do leite materno de recém-nascidos de muito baixo peso: análise segundo idade gestacional e variáveis maternas

ABSTRACT Objective: To analyze the composition of macronutrients present in the milk of mothers of preterm newborn infants (PTNB) - protein, fat, carbohydrate, and calories - by gestational age (GA), chronological age (CA) and maternal variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from May/2013-January/2014. Milk collection was performed by pickup pump, on a fixed day of each week until discharge. The spectrophotometric technique with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative analysis. A sample of 7 mL of human milk was taken from the total volume of milk extracted by the mother. The data was grouped by GA (25-27, 28-31, 32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change, with no difference among groups of GA. When the macronutrients were analyzed by groups of CA, protein decreased, with significant difference between the first two groups of CA. Carbohydrates, fat and calories presented increasing values in all groups, without significant differences. Weight gain during pregnancy, maternal hypertension and maternal age were associated with changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first eight weeks after birth. CA may be an important factor in the composition of human milk.

RESUMO Objetivo: Analisar a composição dos macronutrientes presentes no leite de mães de recém-nascidos pré-termo (RNPT) - gorduras, carboidratos e calorias - por idade gestacional (IG), idade cronológica (IC) e variáveis maternos. Métodos: Estudo longitudinal para analisar 215 amostras de leite de 51 mães de RNPT admitidos em três unidades neonatais do Rio de Janeiro de maio/2013 a janeiro/2014. A coleta de leite foi realizada por bomba coletora, em dia fixo a cada semana até a alta. Utilizou-se a técnica espectrofotométrica com análise de infravermelho (MilkoScan Minor 104) para a análise quantitativa. Uma amostra de 7 mL de leite humano foi retirada do volume total de leite extraído pela mãe. Os dados foram agrupados por IG (25-27, 28-31, 32-36 e 37-40 semanas) e por IC (0-4, 5-8, 9-12 e 13-16 semanas). Resultados: Proteínas, carboidratos, gorduras e calorias não apresentaram nenhum padrão de mudança, não havendo diferença entre os grupos de IG. Quando os macronutrientes foram analisados por grupos de IC, a proteína diminuiu, com diferença significante entre os dois primeiros grupos de IC. Carboidratos, gorduras e calorias apresentaram valores crescentes em todos os grupos, sem diferença estatística. O ganho de peso durante a gestação, a presença de hipertensão arterial e a idade materna foram associados a alterações de gordura e calorias no primeiro momento da análise do leite. Conclusões: Observou-se redução estatisticamente significante nos níveis de proteína durante as primeiras oito semanas após o nascimento. A IC pode ser um fator importante na composição do leite humano.

Alergia a la proteína de la leche de vaca: reporte de un caso infrecuente en el período neonatal / Cow's milk protein allergy, a rare case report in the neonatal period

La alergia alimentaria se define como una reacción adversa que resulta de una respuesta inmunológica específica y reproducible desencadenada por la exposición al alimento. La respuesta inmune puede ser mediada por inmunoglobulina E, no mediada por inmunoglobulina E o mixta. Durante el primer año de vida, la proteína de la leche de vaca es la primera proteína a la cual se enfrentan los niños alimentados mediante lactancia materna o artificial, motivo por el cual constituye la forma de alergia alimentaria más frecuente en los primeros meses de la vida. El objetivo de este trabajo es presentar un caso clínico grave y poco frecuente de alergia a la proteína de la leche de vaca en el período neonatal.

Food allergy is defined as a reproducible adverse reaction that results from a specific and reproducible immune response triggered by exposure to food. The immune response can be mediated by immunoglobulin E, not mediated by immunoglobulin E or both. During the first year, cow´s milk protein is the first protein faced by children fed with breast milk or artificial milk. For that reason, it constitutes the form of food allergy most frequent in the first months of life. The objective of this paper is to describe a serious and rare clinical case of milk hypersensitivity in the neonatal period.

Detección de trazas de soja y de leche en productos libres de gluten: desarrollo de dos enzimoinmunoensayos competitivos / Detection of traces of soy and milk in gluten-free products: development of two competitive enzyme immunoassays / Detecção de vestígios de soja e leite em produtos livres de glúten: desenvolvimento de dois enzimoimunoensaios competitivos

Resumen El objetivo del presente trabajo fue el desarrollo de dos enzimoinmunoensayos competitivos (EIC) para la detección de trazas de soja y de leche en productos libres de gluten. Como anticuerpos primarios se utilizaron antisueros policlonales de conejo específicos contra proteínas de soja o de leche. Se determinaron las concentraciones óptimas de antígenos a inmovilizar en la placa y las concentraciones de anticuerpos primarios a utilizar en la competencia. Las curvas de calibración se ajustaron utilizando concentraciones crecientes de un extracto de producto de soja y de un extracto de leche descremada en polvo. El producto de soja y la leche descremada se extrajeron con buffer Tris-HCl 0,0625 M con dodecilsulfato de sodio al 3% y sulfito de sodio 0,1 M al 2%. Se evaluaron los parámetros de validación: linealidad, límites de detección y de cuantificación, recuperación y precisión en el día y entre días, los cuales resultaron adecuados. Se analizaron 9 productos libres de gluten con los EIC desarrollados y con kits de ELISA comerciales. Ambos EIC se comportaron de manera similar con respecto a los kits comerciales. Los EIC permitieron confirmar la presencia de leche en las muestras que la declaraban. En algunas muestras que no declaraban ni leche ni soja, ambos EIC detectaron su presencia (resultados confirmados con los kits comerciales). Los EIC desarrollados poseen menor costo que los kits y, por lo tanto, éstos podrían utilizarse como métodos de screening. Cuando esta metodología resulte negativa, debe confirmarse con un método más sensible (comercial) para garantizar la ausencia de proteínas de soja o de leche.

Abstract The aim of this study was to develop two competitive enzyme immunoassays (CEI) to detect the presence of traces of soy and milk in gluten-free products. Specific rabbit polyclonal antiserums against soy protein and other against elemilk protein were used as primary antibodies. Optimal antigen concentrations to be immobilized on the plate and primary antibody concentrations to be used in competition were determined. The calibration curves were fitted using increasing concentrations of an extract of soy product and of defatted milk powder. The soy product and the defatted milk were extracted with Tris-HCl buffer 0,0625 M with 3% sodium dodecyl sulfate and 2% sodium sulfite 0.1 M. The validation parameters were evaluated: linearity, limit of detection and quantification, recovery and precision on the day and in between days. They were appropriate. Nine commercial samples of gluten-free products were analyzed with these developed CEI and commercial ELISA kits. It was observed that both CEI behaved similarly with respect to the commercial kits. The enzyme immunoassays confirmed the presence of milk in samples that declared it. In some samples that did not declare the presence of milk or soy, both enzyme immunoassays detected their presence -these results were confirmed using commercial kits. The developed CEI have a lower cost than the commercial kits, so these could be used as screening methods. When this methodology is negative, it should be confirmed with a more sensitive (commercial) method to ensure the absence of soy or milk protein.

Resumo O objetivo do presente trabalho foi o desenvolvimento de dois enzimoimunoensaios competitivos (EIC), para a detecção de vestígios de soja e leite em produtos livres de glúten. Antissoros policlonais de coelho específicos contra proteínas de soja ou de leite foram utilizados como anticorpos primários. Foram determinadas as concentrações ótimas de antígenos a serem imobilizados na placa e as concentrações de anticorpos primários a serem utilizadas na competição. As curvas de calibração foram ajustadas usando concentrações crescentes de um extrato de produto de soja e de um extrato de leite em pó desnatado. O produto de soja e o leite desnatado foram extraídos com tampão Tris-HCl 0,0625 M com dodecil sulfato de sódio a 3% e sulfito de sódio 0,1 M a 2%. Os parâmetros de validação foram avaliados: linearidade, limite de detecção e quantificação, recuperação e precisão no dia e entre os dias, os quais resultaram adequados. Nove produtos livres de glúten foram analisados com os EIC desenvolvidos e com kits de ELISA comerciais. Os dois EICs se comportaram de maneira semelhante em relação aos kits comerciais. Os EIC permitiram confirmar a presença de leite nas amostras que o declararam. Em algumas amostras que declaravam nem leite nem soja, ambos os EIC detectaram sua presença (resultados confirmados usando kits comerciais). Os EIC desenvolvidos têm um custo menor que os kits, portanto, eles poderiam ser utilizados como métodos de triagem. Quando esta metodologia é negativa, deve ser confirmada com um método mais sensível (comercial) para garantir a ausência de proteínasda soja ou do leite.

Effect of maternal immune level at different pregnancy stages on cow's milk protein allergy in infants / 中国当代儿科杂志

OBJECTIVE@#To study the association between maternal Th1/Th2 immune level at different pregnancy stages and cow's milk protein allergy (CMPA) in infants.@*METHODS@#The healthy women with a singleton pregnancy, as well as their offspring, who attended Yidu Central Hospital of Weifang and Qingzhou Traditional Chinese Medicine Hospital from July 2016 to December 2018 were enrolled. The maternal levels of interleukin-2 (IL-2), interferon gamma (IFN-γ), interleukin-4 (IL-4), and interleukin-10 (IL-10) at the second and third trimesters of pregnancy were measured. A CMPA questionnaire survey was conducted within one year after birth. Food avoidance and cow's milk oral challenge tests were performed in infants suspected of CMPA. The 48 infants who met the diagnostic criteria for CMPA were included in the observation group, and the remaining 977 normal infants were included in the control group. A univariate analysis was performed on the infants with CMPA. A Poisson regression analysis was used to determine the association between maternal Th1/Th2 immune factors at different pregnancy stages and CMPA.@*RESULTS@#The detection rate of CMPA was 4.68%. The clinical manifestations included the symptoms of the digestive system, skin, and respiratory system and other symptoms. The univariate analysis showed that compared with the control group, the observation group had significantly higher incidence rates of maternal food allergy and maternal history of allergic diseases (P<0.05) and a significantly lower breastfeeding rate (P<0.05). The observation group had significantly lower maternal levels of IL-2 (second and third trimesters) and IFN-γ (third trimester) than the control group (P<0.05). Maternal low IFN-γ at the third trimester and maternal low IL-2 at the second and third trimesters were significantly associated with CMPA in infants (P<0.05). After correction of the factors of breastfeeding, maternal food allergy, and maternal history of allergic diseases, it was found that maternal low IL-2 and IFN-γ at the third trimester were still significantly associated with CMPA in infants (P<0.05).@*CONCLUSIONS@#The maternal decrease in Th1 level at the third trimester of pregnancy may lead to the change in fetal immunity and thus increase the risk of CMPA in offspring.

Alergia a la proteína de la leche de vaca: enfoque diagnóstico y terapéutico / Diagnostic and therapeutic approach to cow's milk protein allergy

Resumen La prevalencia de la alergia a las proteínas de la leche de vaca (APLV) en el ámbito mundial es, aproximadamente, de 1,9 a 4,9 %. En Colombia, esta cifra se desconoce. En un alto porcentaje de los casos, no existe la sospecha por parte del personal de salud, y, por lo tanto, el diagnóstico y el tratamiento se retrasan. Esto acarrea un aumento en el tiempo y en los recursos que emplean los profesionales de la salud y los padres en procura de establecer la etiología del padecimiento de los niños que presentan esta enfermedad. Dentro de este contexto, la historia clínica es fundamental en la sospecha de la APLV, y es especialmente relevante la evaluación de antecedentes, en los cuales se destacan la presencia de la exposición temprana a la proteína, así como la atopia en familiares en primer grado de consanguinidad. La presentación de la APLV puede manifestarse con reacciones inmediatas a nivel digestivo (vómitos, diarrea aguda), cutáneo (urticaria, dermatitis, angioedema) y, con menos frecuencia, a partir de signos respiratorias y sistémicos. Sin embargo, la amplia variedad de manifestaciones clínicas y signos puede ser un reto para el profesional que no se encuentre sensibilizado con la patología, e incluso soslayar este diagnóstico retrasa la suspensión de la proteína de la leche de vaca de la dieta y demora el acceso a un tratamiento eficaz. El tratamiento ideal reconocido es la dieta de exclusión, la cual requiere un estricto cumplimiento. En los niños alimentados con lactancia materna exclusiva, será necesaria la dieta restrictiva de leche y sus derivados en la madre. En quienes no reciben lactancia, se deberá tratar mediante fórmulas de proteínas lácteas extensamente hidrolizadas (FEH) o a base de aminoácidos (FAA). Así bien, el pronóstico es favorable y la mayoría de niños tolerarán las proteínas de la leche de vaca a los 2 años, mientras que en pacientes con polisensibilización el proceso puede prolongarse. En el caso de no alcanzar la tolerancia, la inmunoterapia oral es una opción disponible.

Abstract The worldwide prevalence of cow's milk protein allergy (CMPA) is approximately 1.9% to 4.9%. Its prevalence in Colombia is unknown. A high percentage of cases are unsuspected by medical personnel resulting in delayed diagnosis and treatment which increase the time and resources used to establish the etiology of this condition in children. The clinical history is fundamental for diagnosis of CMPA, especially the background evaluation. Of special importance are early exposure to the protein and atopy in first degree relatives. CMPA's initial presentation may be digestive, cutaneous or respiratory. Digestive symptoms can include vomiting and acute diarrhea, and cutaneous symptoms include hives, dermatitis and angioedema. Respiratory and systemic manifestations occur less frequently. The wide variety of clinical manifestations and signs can challenge health care professionals who are not alert to this pathology to the point that the diagnosis is not even considered event though delaying the suspension of cow's milk protein from the diet delays access to an effective treatment. The well-recognized ideal treatment is an exclusion diet which requires strict compliance. For children who are exclusively breastfed, the mother's diet must restrict milk and its derivatives. Children who are not breastfed, should be fed formulas of extensively hydrolyzed milk proteins based on amino acids. The prognosis is favorable, and most children will tolerate cow's milk proteins at two years. The process may take more years for polysensitive patients. Oral immunotherapy is an option that is available for patients who do not achieve toleration.

Risk factors for cow's milk protein allergy in infants: a multicenter survey / 中国当代儿科杂志

OBJECTIVE@#To investigate the risk factors for cow's milk protein allergy (CMPA) among infants through a multicenter clinical study.@*METHODS@#A total of 1 829 infants, aged 1-12 months, who attended the outpatient service of the pediatric department in six hospitals in Shenzhen, China from June 2016 to May 2017 were enrolled as subjects. A questionnaire survey was performed to screen out suspected cases of CMPA. Food avoidance and oral food challenge tests were used to make a confirmed diagnosis of CMPA CMPA. A multivariate logistic regression analysis was used to investigate the risk factors for CMPA.@*RESULTS@#Among the 1 829 infants, 82 (4.48%) were diagnosed with CMPA. The multivariate logistic regression analysis showed that maternal food allergy (OR=4.91, 95%CI: 2.24-10.76, P6 months (OR=0.38, 95%CI: 0.17-0.86, P<0.05) were protective factors.@*CONCLUSIONS@#The introduction of complementary food at an age of <4 months, maternal food allergy, and antibiotic exposure during pregnancy are risk factors for CMPA in infants.

Ocitocina na produção e composição do leite / Oxytocin application in production and milk composition

Objetivou-se analisar a aplicação da ocitocina influenciando na eficiência da ejeção do leite; ao ponto de ocorrer um aumento da produção e mudanças na composição. Foram utilizados 45 animais, durante 105 dias, divididos em três tratamentos, no tratamento 1 (T1) os animais receberam 0,5ml de soro fisiológico, logo após realizava-se a ordenha destes animais, sendo considerado o tratamento controle, no T2 os animais receberam ocitocina antes do início da ordenha, e logo após ordenhava-se estes animais; no T3 os animais receberam ocitocina ao final da ordenha e reordenhava-se estes animais. Para aferir a produção das vacas foram usados medidores de leite, com pesagens de produção realizadas quinzenalmente. Após aferido a produção de todos os animais, as amostras de leite foram coletadas e encaminhadas para as análises posterior. As variáveis físico-químicas do leite analisadas foram: porcentagem de gordura, lactose e proteína. Os resultados foram submetidos à análise de variância e posteriormente, ao teste de comparação de médias, com diferença estatística significativa de 5%. De acordo com os resultados obtidos a ocitocina influenciou na produção leiteira com um aumento na produtividade diária por animal, mas não se observou diferenças significativas nas médias de porcentagem de gordura, lactose e proteína do leite.

This study aimed to analyze the application of oxytocin influence in the milk ejection efficiency; as to occur an increase in production and changes in milk composition. 45 animals were used for 105 days, divided into three treatments, the treatment one received 0.5ml of physiological saline, in the treatment two were given oxytocin to the animals before the milking; and in treatment theree the animals received oxytocin at the end of milking. To measure the cow's milk production, milk meters were used, and were performed fortnightly. After measured the production of all animals, samples were collected and sent for analysis. The physico-chemical variables analyzed were: percentage of fat, lactose and protein. The results were submitted to ANOVA and subsequently the mean comparison test, with statistical significance of 5%. According to obtained results oxytocin influence the milk production with a significant increase in daily productivity per animal, but there was no significant difference in percentage of fat, lactose and milk protein.

Influência da fase de lactação e do intervalo entre as ordenhas sobre a composição e produção de leite de cabras no semiárido / Influence of lactation and the interval between milkings on the composition and production of milk goats in the semiarid

Objetivou-se com esse trabalho avaliar a influência da fase de lactação e do intervalo de tempo entre as ordenhas sobre os constituintes e a produção de leite de cabras no semiárido da Paraíba. Foram utilizados 28 animais da raça Anglo Nubiana distribuídos em um delineamento inteiramente casualizado em arranjo fatorial do tipo 3 x 2, três fases de lactação e dois turnos de ordenha. A análise de variância não revelou efeito (P>0,05) de fase de lactação para proteína, gordura e sólidos totais. Contudo, houve diferença significativa (P<0,05) para lactose e produção de leite dentro das fases de lactação e intervalo entre ordenhas. Para acidez e densidade houve efeito (P<0,05) de fase de lactação e do turno da ordenha. Houve correlação negativa entre o turno da ordenha para produção de leite, acidez, lactose, densidade, proteína e gordura. Com relação à fase de lactação observou-se correlação negativa para produção de leite e lactose e correlação positiva para acidez e proteína. A composição do leite de cabra sofre influência da fase de lactação e do intervalo entre ordenhas. Intervalo de tempo igual entre as ordenhas favorece a produção de um leite com uma composição mais uniforme.

The objective of this study was to evaluate the influence of lactation stage and the time interval between milking on ingredients and the production of milk goats in the semiarid region of Paraíba. We used 28 animals of Anglo Nubian breed distributed in a completely randomized design in a factorial arrangement of type 3 x 2, three stages of lactation and two milking shifts. Analysis of variance revealed no effect (P>0.05) were lactating for fat, protein and total solids. However, there was significant difference (P<0.05) for lactose and milk production within the phases of lactation and the interval between milking. For acidity and density was no effect (P<0.05), lactation stage and the milking turn. There was a negative correlation between the shift milking for milk, acidity, lactose, density, protein and fat. With respect to stage of lactation negative correlation was observed for milk and lactose positive correlation for acidity and protein. The goat milk composition is influenced by the stage of lactation and the interval between milking. Equal time interval between milking favors the production of milk with a more uniform composition.

Clinical features of cow's milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases / 中国当代儿科杂志

OBJECTIVE@#To investigate the epidemiological and clinical features of cow's milk protein allergy (CMPA) in infants presenting mainly with gastrointestinal symptoms.@*METHODS@#A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms.@*RESULTS@#Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants (61.1%), hematochezia in 149 infants (53.2%), vomiting in 71 infants (25.4%), eczema in 57 infants (20.4%), malnutrition in 42 infants (15%) and constipation in 13 infants (4.6%). Of the 280 infants, 258 (92.1%) had mild-to-moderate CMPA and 22 (7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition (50.0% vs 12.0%) and a significantly lower incidence rate of hematochezia (22.7% vs 55.8%). The breastfeeding CMPA group had significantly lower incidence rates of malnutrition (10.3% vs 24.6%) and severe CMPA (4.4% vs 18.0%) than the artificial feeding CMPA group, and the artificial feeding CMPA group had a significantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups (37.7% vs 56.6%/59.0%).@*CONCLUSIONS@#CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artificial feeding is more likely to cause malnutrition and severe CMPA.

Milk fat globule-epidermal growth factor 8 (MFG-E8) attenuates sepsis-induced acute kidney injury by inhibiting NF-κB signaling pathway1

Abstract Purpose: To explore the effect of milk fat globule-epidermal growth factor 8 (MFG-E8) on sepsis-induced acute kidney injury (SAKI). Methods: Male C57BL/6 mice were randomized to control, sham, CLP, CLP+PBS, and CLP+rmMFG-E8 groups. SAKI was induced by cecal ligation and puncture (CLP). Recombinant mouse MFG-E8 (rmMFG-E8) (20 μg/kg) or PBS (vehicle) was administered intraperitoneally. Blood, urine and renal tissue were collected at 24 h after CLP. Blood samples were tested for serum kidney injury biomarker and cytokines. Urine samples were collected to detect KIM-1, and NGAL. Real-time PCR was tested for Bax and Bcl-2. TUNEL staining was used to determine renal apoptosis. Western blot was used to detect the expression of Bax, Bcl-2, and proteins in the NF-κB pathway. Results: MFG-E8 alleviated SAKI by decreasing serum Cre, BUN, urine KIM-1 and NGAL and by mitigating renal pathological changes significant (p < 0.05). IL-1β, IL-6, TNF-α were significantly inhibited by MFG-E8 (p < 0.05). Apoptosis induced by SAKI was markedly suppressed by MFG-E8. Finally, MFG-E8 attenuated the activation of the NF-��B signaling pathway in SAKI. Conclusion: MFG-E8 has beneficial effects on SAKI, which may be achieved by inhibiting the NF-κB pathway.

Knowledge and practice of pediatricians and nutritionists regarding treatment of cow's milk protein allergy in infants / Conhecimento e prática de pediatras e nutricionistas sobre o tratamento da alergia às proteínas do leite de vaca em lactentes

ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow's milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow's milk protein allergy, including goat's milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow's milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow's milk protein allergy.

RESUMO Objetivo Este estudo avaliou o conhecimento e práticas de pediatras e nutricionistas sobre alergia às proteínas do leite de vaca em lactentes, com ênfase em questões relacionadas à dieta de exclusão e ao estado nutricional. Métodos Estudo transversal, descritivo, realizado com uma amostra de conveniência de 204 pediatras e 202 nutricionistas, convidados aleatoriamente em eventos científicos na cidade de São Paulo, de novembro de 2014 a março de 2016. Resultados Entre 1,5% e 21,0% dos entrevistados indicaram produtos inadequados para o tratamento da alergia às proteínas do leite de vaca, incluindo leite de cabra, bebidas ou sucos à base de extrato de soja, fórmula de leite sem lactose e fórmula parcialmente hidrolisada. A recomendação diária de cálcio para crianças entre zero e 36 meses de idade foi corretamente indicada por 27,0% de pediatras e 46,0% de nutricionistas (p=0,001). Além disso, 96,1% dos pediatras e 82,7% dos nutricionistas (p<0,001) forneceram orientação sobre os rótulos dos produtos industrializados. Conclusão Pediatras e nutricionistas apresentam lacunas no conhecimento sobre o tratamento da alergia às proteínas do leite de vaca em lactentes. Estratégias educacionais que aumentam o conhecimento dos profissionais são importantes para o gerenciamento da alergia às proteínas do leite de vaca.

Dieta de restrição à proteína do leite de vaca: aderência e rotulagem dos alérgenos / Cow's milk protein elimination diet: adherence and allergen labeling

Introdução: Alergia alimentar é uma grande preocupação de saúde pública, pois afeta 3-5% dos adultos e 8% das crianças mundialmente. Alergia à proteína do leite de vaca (APLV) é a alergia alimentar mais comum em crianças. Reações alérgicas graves e fatais podem ocorrer em qualquer idade, e o tratamento consiste em remover o leite de vaca e seus derivados da dieta. A rotulagem adequada dos alimentos fornece informações sobre os ingredientes alergênicos. Objetivos: Avaliar a eficácia da dieta de eliminação em pacientes com APLV IgE-mediada e características dos sintomas após exposição acidental. Método: Estudo prospectivo com portadores de APLV IgE-mediada atendidos no Serviço de Imunologia Clínica e Alergia do HC-FMUSP, sob dieta de restrição à proteína do leite de vaca. Os pacientes foram avaliados inicialmente através de entrevista oral e por contato telefônico, após 6 meses. Este estudo foi realizado antes que os atuais regulamentos brasileiros de rotulagem de alimentos entrassem em vigor. Resultados: Foram incluídos 23 pacientes. A idade média foi de 10,1 anos, e 14 (60,8%) eram do sexo masculino. Após 6 meses, 7 apresentaram reação alérgica após exposição acidental. Destes, 2 apresentaram reações graves após contato com baixos níveis de proteínas do leite. Os cuidadores de todos os pacientes confirmaram fazer leitura regular dos rótulos. No primeiro contato, 14 pacientes estavam sob restrição de alimentos com a informação "pode conter traços de leite" nos rótulos. Após 6 meses, apenas 7 ainda estavam mantendo esta restrição. Conclusão: Um grupo de pacientes permaneceu com dieta de restrição, inclusive a traços de leite, reiterando a importância da padronização e transparência em relação aos ingredientes alergênicos nos rótulos. Algumas reações ocorreram após a ingestão de alimentos derivados do leite, enfatizando a necessidade de reforço periódico da adesão à dieta de restrição e da prevenção em situações de risco, como festas e escola.

Introduction: Food allergy is a major public health concern, as it affects up to 3-5% of adults and 8% of children worldwide. Cow's milk protein allergy (CMPA) is the most common food allergy in young children. Severe and fatal allergic reactions may occur at any age, and treatment consists of removing cow's milk and its derivatives from the diet. Proper food labeling provides clear and accurate information about allergenic ingredients. Objectives: To evaluate the effectiveness of an elimination diet in IgE-mediated CMPA patients and features of symptoms after accidental exposure. Method: A prospective study with IgE-mediated CMPA patients treated at HC-FMUSP Clinical Immunology and Allergy Service, undergoing a cow's milk protein elimination diet. The patients were first evaluated through oral interview, then by telephone contact after 6 months. This study was conducted before current Brazilian food labeling regulations came into effect. Results: Twenty-three patients were enrolled. The mean age was 10.1 years, and 14 (60.8%) were male. After 6 months, 7 patients presented with allergic reaction after accidental exposure. Of those, 2 presented with severe reactions after exposure to low levels of milk protein. All patients' caregivers confirmed they read labels regularly. At the first contact, 14 patients were under restriction of foods which read "may contain traces of milk" on their label. After 6 months, 7 patients were still under such restriction. Conclusion: A group of patients still needed an elimination diet, including traces of milk, reinforcing the importance of standardization and transparency regarding allergenic ingredients in all labels. Some reactions occurred after intake of milk derivatives, emphasizing the need for periodic reinforcement of adherence to elimination diet and prevention in potentially risky situations, such as at parties and at school.

Prevalencia de alergia a la proteína de la leche de vaca en niños en un hospital universitario de comunidad / Prevalence of cow's milk protein allergy among children in a university community hospital

La alergia a la proteína de la leche de vaca (APLV) es la alergia alimentaria más frecuente en pediatría. Existen pocos estudios que han evaluado la prevalencia de esta enfermedad en Argentina. Objetivos. Estimar la prevalencia de la APLV y describir su variación durante un período de 11 años. Pacientes y métodos. Se realizó un estudio de cohorte retrospectivo en recién nacidos vivos pertenecientes al programa de atención médica de un hospital universitario de comunidad. Resultados. Se identificaron 116 casos de niños con APLV. La prevalencia acumulada fue de 0,8% (intervalo de confianza -le- 95%: 0,65-0,95). Se observó un incremento porcentual de casos por año, de 0,4% en 2004 a 1,2% en 2014. Conclusión. La prevalencia de APLV fue del 1,2% en 2014, tres veces superior a la prevalencia en 2004.

Cow's milk protein allergy (CMPA) is the most common food allergy in pediatrics. In Argentina, the prevalence of this dis-ease has been evaluated in a few trials.Objectives. To estimate the prevalence of CMPA and describe its variation throughout a period of 11 years.Population and methods. A retrospective cohort study was carried out in live newborn infants enrolled in a health care program of a university community hospital.Results. One hundred and sixteen cases of children with CMPA were identified. Cumulative prevalence was 0.8% (95% confi-dence interval [CI]: 0.65-0.95). A percent increase of 0.4% in 2004 to 1.2% in 2014 was observed in the number of cases per year.Conclusion. In 2014, CMPA prevalence was 1.2%, i.e. three times that of 2004.

Actualización en manejo de alergia a la proteína de leche de vaca: fórmulas lácteas disponibles y otros brebajes / Update on management of cow's milk protein allergy: available milk formulas and other juices

La alergia a la proteína de leche de vaca (APLV) es una enfermedad frecuente, con una prevalencia entre 2-7%, cifras que van en aumento. Se caracteriza por una reacción alérgica a una o más pro teínas de la leche de vaca. No existen manifestaciones clínicas patognomónicas, y éstas dependerán del tipo de reacción inmunológica involucrada. Una buena aproximación diagnóstica evita el sub y sobre diagnóstico y por lo tanto, sub y sobre tratamiento. El tratamiento de la APLV es la eliminación de la proteína de leche de vaca de la dieta. Una dieta de restricción en un niño que no la requiere o que ha desarrollado tolerancia, puede alterar el crecimiento, la calidad de vida y producir costos innecesarios. El objetivo de esta actualización es presentar las diferentes fórmulas y brebajes usados en Chile para tratar la APLV en aquellos casos en que no sea posible la lactancia materna con dieta de exclusión. Para ello se revisó la composición nutricional, ingredientes y otras características relevan tes de todas aquellas fórmulas o brebajes que se comercializan en Chile como tratamiento de APLV. La información se obtuvo desde los distribuidores o vendedores oficiales, o en su defecto, desde las páginas web oficiales. Se puede concluir que existen y se usan múltiples fórmulas y brebajes para el tratamiento de APLV, no todas ellas del todo adecuadas desde el punto de vista nutricional y de seguridad. Conocerlas en detalle ayudará al pediatra a indicarlas de manera más informada de acuerdo a sus beneficios y sus carencias para el manejo adecuado de esta patología.

Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.

Effect of somatic cell count on composition and hygiene indicators of bulk tank milk / Efeito da contagem de células somáticas sobre a composição e indicadores de higiene do leite de tanque

This study evaluated the effect of somatic cell count (SCC) on composition and hygienic quality of dairy herd bulk tank milk ­ specifically, the effect of SCC of bulk tank of dairy herds on composition (fat, protein, total solids, nonfat dry solids) and on total bacterial count (TBC), psychrotrophic count (PC) and coliform count (CC) were evaluated. A total of 230 dairy herds located south of Minas Gerais and west of São Paulo were selected based on SCC geometric mean obtained from five monthly analyses preceding the start of the sampling. The dairy farms were classified according to SCC in three groups: low (< 250,000 cells/mL, n = 84), medium (> 250,000 and < 750,000 cells/mL, n = 79) and high SCC (> 750,000 cells/mL, n = 67). After herd selection, bulk tank milk samples were collected every 14 days for three months totaling 1380 samples, which were subjected to analysis of composition, TBC, PC, and CC. A decrease of TBC and CC was observed in herds with low SCC; however, herds with medium and high SCC had an increase in fat, crude protein, and total solids contents. A medium correlation was observed between TBC and PC (r = 0.6215), and also between PC and CC (r = 0.3692). Based on hygiene indicators and milk composition, a low and negative correlation between TBC and fat (r = -0.0585), PC and fat (r = -0.0585), and PC and total solids (r = -0.0662) was observed. Dairy herds with SCC < 250,000 cells/mL had higher bulk tank milk hygienic quality; however, considering the composition, herds with higher SCC produced higher milk fat and protein concentration.(AU)

Este trabalho avaliou o efeito da contagem de células somáticas (CCS) na composição e na qualidade higiênica do leite de tanque de rebanhos leiteiros. Especificamente, foram avaliados o efeito da CCS do tanque de rebanhos leiteiros na composição (gordura, proteína, sólidos totais, extrato seco desengordurado) e nas contagens bacteriana total (CBT), de psicrotróficos (CP) e de coliformes (CC). Um total de 230 rebanhos leiteiros localizados no sul de Minas Gerais e oeste de São Paulo foram selecionados com base na média geométrica da CCS obtida de cinco análises mensais anteriores ao início das coletas das amostras. As fazendas foram classificadas de acordo com a CCS em três grupos: baixa (< 250.000 células/mL, n = 84), média (> 250.000 e < 750.000 células/mL, n = 79) e alta CCS (> 750.000 células/mL, n = 67). Após a seleção dos rebanhos, amostras de leite do tanque foram coletadas a cada catorze dias durante três meses, totalizando 1.380 amostras, as quais foram submetidas às análises de composição, CBT, CP e CC. Uma redução da CBT e da CC foi observada em rebanho com baixa CCS; entretanto, rebanhos com média e alta CCS tiveram aumento nos teores de gordura, proteína bruta e sólidos totais. Uma média correlação foi observada entre CBT e CP (r = 0,6215) e também entre CP e CC (r = 0,3692). Com base nos indicadores de higiene e na composição do leite, foi observada uma correlação baixa e negativa entre CBT e gordura (r = -0,0585), CP e gordura (r = -0,0585) e CP e sólidos totais (r = -0,0662). Os rebanhos leiteiros com CCS < 250.000 células/mL apresentaram maior qualidade higiênica do leite de tanque; entretanto, considerando a composição, rebanhos com maior CCS tiveram maiores concentrações de gordura e proteína.(AU)

Avances en el conocimiento de las proteínas de la leche materna / Advances in the knowledge about human milk proteins

La glándula mamaria y la leche materna son el resultado de millones de años de una evolución que llevó a una composición óptima para el crecimiento y desarrollo de recién nacidos y lactantes; la leche materna favorece el crecimiento, la adaptación y la supervivencia de su organismo y de sus órganos inmaduros. Análisis recientes han demostrado en ella la presencia de 1606 proteínas que en su mayoría son sintetizadas en los acinos de la glándula mamaria aunque otras proteínas y péptidos provienen de órganos como el sistema linfático y el aparato digestivo. La composición de la leche materna incluye enzimas que modifican sus proteínas y originan péptidos antimicrobianos, antihipertensivos y estimuladores del metabolismo. Esta actividad proteolítica actúa en sitios específicos de las cadenas peptídicas de la proteína de la leche. La activación extemporánea de estos enzimas en los acinos es regulada por péptidos inhibidores y activadores que previenen procesos inflamatorios. Algunos enzimas de la leche actúan en el tubo digestivo de recién nacidos y lactantes y complemen tan la menor concentración y actividad de sus propios enzimas digestivos. Así, la enteroquinasa de la leche estimula la liberación de enzimas pancreáticos (mediada por el estímulo de la colecistoquinina-pancreozimina); la lipasa activada por las sales biliares complementa la baja producción de lipasa pancreática. Estas actividades probablemente facilitan la nutrición de los prematuros, cuyo tubo di gestivo es más permeable a las proteínas parcialmente hidrolizadas y cuyas actividades enzimáticas y factores defensivos locales no han alcanzado su plena madurez. Esto también puede estimular en ellos la tolerancia inmunológica. En este artículo se presentan los aspectos fisiológicos relevantes de la leche materna, y los avances en el conocimiento de su composición, para el cabal conocimiento del pediatra de esta importante materia.

The mammary gland and maternal milk are the product of millions of years of evolution that resul ted in an optimal composition that sustains the growth and development of newborns and infants. Maternal milk supports the growth, adaptation and survival of this immature organism. Recent studies have detected 1606 different proteins in human milk, most of them synthesized in the acini of the glandular tissue while others originate from distant organs such as the lymphoid tissue and the digestive tract. Maternal milk enzymes modify its proteins and liberate peptides with antimicrobial, antihypertensive or stimulatory activities. This proteolytic activity occurs at specific sites in peptide chains. To prevent the extemporaneous activation of these proteolytic enzymes, that would result in inflammatory processes, maternal milk also contains inhibitory peptides that together with the stimulatory peptides conform a complex regulatory system. Some enzymes in maternal milk main tain their activity in the gastrointestinal tract of infants and compensate for the decreased activity of digestive tract enzymes in newborns. Thus, the milk enterokynase stimulates the release of pancreatic proteases as it induces the liberation of cholecystokynin/pancreozymin. The bile salt-activated lipase of human milk is activated in the duodenum by the infants' bile salts and partially compensates for the low levels of pancreatic lipase in newborns. These milk enzymes probably contribute to the nutrition of premature infants as they increase the availability of amino acids and peptides in their upper gastrointestinal tract; furthermore, as their intestinal epithelium is more permeable to peptides and partially digested protein this may help induce immune tolerance. The most relevant issues in the physiology and composition of the maternal milk are presented in this review.