Anticorpos neutralizantes contra o vírus SARS-coV-2 no sangue e leite humano de lactantes previamente vacinadas / Neutralizing antibodies against the SARS-coV-2 virus in the blood and human milk of previously vaccinated infants

Introdução: Alguns estudos verificaram que a vacinação contra o coronavírus SARS COV-2 induz resposta efetiva de titulação de anticorpos neutralizantes no sangue e leite materno. No entanto, a maioria dos artigos publicados considerou a transferência de imunidade mãe-feto em mulheres recuperadas da COVID-19 e não vacinadas e/ou analisaram leite e/ou sangue isoladamente. Objetivo: Comparar o quantitativo de anticorpos neutralizantes contra o SARS-CoV-2 no leite e no sangue das lactantes vacinadas em relação àquelas não vacinadas. Métodos: Revisão sistemática nas bases de dados Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science e Scopus de acordo com as diretrizes do PRISMA e registrada no PROSPERO sob o n° CRD42021287554. Foram elegíveis estudos de coorte, caso-controle e transversal que avaliaram a presença de anticorpos neutralizantes contra o SARS-CoV-2 no leite e no sangue de lactantes vacinadas e que tiveram como grupo controle lactantes não vacinadas. Por sua vez, foram excluídos relatos de casos, revisão sistemática com ou sem meta-análise, artigos que analisaram os anticorpos em mulheres infectadas ou não lactantes, e ainda aqueles que não trouxeram nos seus resultados os dados de comparação entre os grupos que receberam ou não a vacina. Foi avaliado o risco de viés de todos os artigos incluídos através da ferramenta de avaliação Newcastle-Ottawa Scale. Resultados: As buscas nas bases de dados identificaram 233 registros. Após a remoção de 128 que estavam duplicados, foram lidos os títulos e resumos de 105 e excluídos 94 destes. Com a leitura na íntegra de 11 artigos, 4 estudos de coorte foram considerados elegíveis e, incluídos nesta revisão sistemática. Os resultados destes estudos apontaram que, após a vacinação com os imunizantes Pfizer-BioNTech e Moderna, as lactantes apresentaram níveis elevados de anticorpos neutralizantes IgG e IgA anti-SARS-CoV-2 tanto no sangue quanto no leite materno, sendo o nível sanguíneo consideravelmente maior. Conclusão: Como ainda não existem vacinas disponíveis para uso em menores de seis meses e as lactantes vacinadas contra o vírus SARS-CoV-2 apresentam maior expressão de anticorpos em relação àquelas não vacinadas, é provável que, além da proteção materna contra COVID-19, a imunização também forneça imunidade neonatal através da amamentação.

Introduction: Some studies have found that vaccination against the SARS-COV-2 coronavirus induces an effective titration response of neutralizing antibodies in blood and breast milk. However, most published articles considered the transfer of mother fetus immunity in women recovered from COVID-19 and not vaccinated and/or analyzed milk and/or blood alone. Objective: To compare the amount of neutralizing antibodies in the milk and blood of vaccinated infants for SARS-CoV-2. Methods: Systematic review in the Virtual Health Library, Pubmed, Embase, Web of Science and Scopus databases in accordance with PRISMA guidelines and registered in PROSPERO under number CRD42021287554. Cohort, case-control and cross-sectional studies that evaluated the presence of neutralizing antibodies against SARS-CoV-2 in the milk and blood of vaccinated infants and that had unvaccinated infants as a control group were eligible. In turn, case reports, systematic review with or without meta-analysis, articles that analyzed antibodies in infected or non-lactating women, and even those that did not bring in their results data for comparison between the groups that received or not the vaccine. The risk of bias of all included articles was assessed using the Newcastle Ottawa Scale assessment tool. Results: Database searches identified 233 records. After removing 128 that were duplicates, the titles and abstracts of 105 were read and 94 were excluded. With the full reading of 11 articles, 4 cohort studies were considered eligible and included in this systematic review. The results of these studies showed that, after vaccination with the immunizers Pfizer-BioNTech and Moderna, the nursing mothers had high levels of anti-SARS-CoV-2 IgG and IgA neutralizing antibodies both in the blood and in breast milk, with the blood level considerably bigger. Conclusion: As there are still no vaccines available for use in infants under six months of age and lactating women vaccinated against the SARS-CoV-2 virus have a higher expression of antibodies compared to those not vaccinated, it is likely that, in addition to maternal protection against COVID-19, immunization also provides neonatal immunity through breastfeeding.

Immunology of breast milk / Imunologia do leite materno

Summary In the critical phase of immunological immaturity of the newborn, particularly for the immune system of mucous membranes, infants receive large amounts of bioactive components through colostrum and breast milk. Colostrum is the most potent natural immune booster known to science. Breastfeeding protects infants against infections mainly via secretory IgA (SIgA) antibodies, but also via other various bioactive factors. It is striking that the defense factors of human milk function without causing inflammation; some components are even anti-inflammatory. Protection against infections has been well evidenced during lactation against, e.g., acute and prolonged diarrhea, respiratory tract infections, including otitis media, urinary tract infection, neonatal septicemia, and necrotizing enterocolitis. The milk’s immunity content changes over time. In the early stages of lactation, IgA, anti-inflammatory factors and, more likely, immunologically active cells provide additional support for the immature immune system of the neonate. After this period, breast milk continues to adapt extraordinarily to the infant’s ontogeny and needs regarding immune protection and nutrition. The need to encourage breastfeeding is therefore justifiable, at least during the first 6 months of life, when the infant’s secretory IgA production is insignificant.

Resumo Na fase crítica de imaturidade imunológica do recém-nascido, em especial do sistema imune de mucosas, o lactente recebe grandes quantidades de componentes bioativos através do colostro e do leite materno. O colostro é o reforço imunológico natural mais potente conhecido pela ciência. O aleitamento materno protege o lactente de infecções principalmente por meio dos anticorpos IgA secretores (IgAS), mas também por meio de vários outros fatores bioativos. É surpreendente que os fatores de defesa do leite humano ajam sem causar inflamação e alguns componentes são, de fato, anti-inflamatórios. A proteção contra infecções tem sido bem evidenciada durante a lactação, combatendo, por exemplo, diarreia aguda e prolongada, infecções do trato respiratório, incluindo otite média, infecção do trato urinário, sepse neonatal e enterocolite necrosante. O conteúdo imunológico do leite evolui ao longo do tempo: nas fases iniciais de lactação, IgAS, fatores anti-inflamatórios e, mais provavelmente, as células imunologicamente ativas provêm ajuda adicional para o sistema imune imaturo do neonato. Depois desse período, o leite materno continua a adaptar-se extraordinariamente à ontogenia infantil, às suas necessidades de proteção imune e nutricionais. Entende-se, portanto, a necessidade de se estimular o aleitamento materno pelo menos durante o primeiro semestre de vida, período em que a produção própria de IgA secretória é ainda pouco significativa.

Inmunología perinatal / Perinatal immunology

Se ha considerado que el útero gestante es un lugar inmunológicamente privilegiado, donde el feto es protegido del rechazo por el sistema inmune materno, mediante un amplio repertorio de estrategias de evasión que contribuye a la sobrevivencia del feto. La gestación en sí misma constituye un acontecimiento de equilibrio inmunológico y la tolerancia inmunológica permite la progresión del embarazo, donde participan una secuencia sincronizada de eventos que se inicia desde la concepción y fertilización para dar lugar a la implantación y progresa hasta alcanzar un embarazo a término. El sistema inmune es la principal barrera que poseemos para protegernos de las infecciones. Durante la vida intrauterina, el feto está protegido por la madre de las agresiones externas, por lo que no necesita que su sistema inmunológico sea operativo, sin embargo, al nacer, recibe una avalancha de elementos extraños, por lo que necesitará disponer de cierta protección, así como una preparación para ejecutar las defensas necesarias para su protección inmunológica. La inmunidad sérica durante la vida fetal queda limitada a la transferencia a través de la placenta de IgG materna, a pesar de que el feto tiene la facultad de sintetizar inmunoglobulinas desde las primeras etapas de la gestación. Al nacimiento, el niño tiene su sistema inmunológico completo, aunque inmaduro, pero es capaz de responder a los estímulos antigénicos. Tiene múltiples anormalidades en el desarrollo de su sistema inmune, que involucran a los anticuerpos/inmunoglobulinas, complemento y granulocitos pudiendo contribuir a la alta incidencia de sus infecciones. El recién nacido carece de memoria inmunológica debido a que, en condiciones normales, el feto está exento de estímulos producidos por antígenos extraños. Dicha memoria se va adquiriendo a medida que entra en contacto con los diferentes antígenos. Se obtendrá cierta protección a las infecciones entéricas gracias a las IgA que aporta la lactancia materna. La exposición prenatal y postnatal a productos microbianos ambientales que pueden activar la inmunidad innata, puede acelerar el proceso de maduración del sistema inmune.(AU)

It has been considered the pregnant women`s womb as an immunological exceptional place, where fetus is protected against been rejected because of maternal immune system by means of a wide groups of evasive strategies that help in its survival. Pregnancy itself is an immunological equilibrium state and the immunological tolerance allow the progression of this event, where participate a synchronized sequence of biological events started from conception and fertilization to allow the implantation, and progress until to reach the pregnancy end. The immune system is our main barrier against infections. During intrauterine life fetus is protected by the mother against external aggressions, therefore he don`t need an operative immune system, nevertheless, at birth the new organisms receive an avalanche of strange elements needing some kind of protection as well as a preparation to carry out the necessary defense for his immunological protection. Serum immunity during fetal life is limited to the transference of maternal IgG through placenta, despite fetus capability to synthesize immunoglobulins from first stages of gestation. At birth the babe has a complete immunological system although immature but capable to respond to antigenic stimulus. He has multiples abnormalities in the immune system development that take account antibodies/immunoglobulin, complement and granulocytes contributing to his high incidence of infections. Newborn lack immunological memory because in normal conditions fetus is not stimulated by odd antigens. This memory is acquired through the contact with different antigens. It will be obtained some protection against enteric infections because IgA from maternal lactation. The prenatal and postnatal exposition to environmental microbial products that activate the innate immunity can accelerate the immune system maturing process.(AU)

Does breastfeeding influence the risk of developing diabetes mellitus in children? A review of current evidence / O aleitamento materno influencia o risco de desenvolvimento de diabetes mellitus na criança? Uma análise das evidências atuais

OBJECTIVE: The aim of this study was to perform a review to investigate the influence of breastfeeding as a protective agent against the onset of diabetes in children. SOURCES: Non-systematic review of SciELO, LILACS, MEDLINE, Scopus, and VHL databases, and selection of the 52 most relevant studies. A total of 21 articles, specifically on the topic, were analyzed (nine related to type 1 diabetes and 12 to type 2 diabetes). DATA SYNTHESIS: The duration and exclusivity of breastfeeding, as well as the early use of cow's milk, have been shown to be important risk factors for developing diabetes. It is believed that human milk contains substances that promote the maturation of the immune system, which protect against the onset of type 1 diabetes. Moreover, human milk has bioactive substances that promote satiety and energy balance, preventing excess weight gain during childhood, thus protecting against the development of type 2 diabetes. Although the above mentioned benefits have not been observed by some researchers, inaccuracies on dietary habit reports during childhood and the presence of interfering factors have been considered responsible for the lack of identification of beneficial effects. CONCLUSION: Given the scientific evidence indicated in most published studies, it is believed that the lack of breastfeeding can be a modifiable risk factor for both type 1 and type 2 diabetes. Strategies aiming at the promotion and support of breastfeeding should be used by trained healthcare professionals in order to prevent the onset of diabetes. .

OBJETIVO: Realizar uma análise crítica da literatura para avaliar a influência da amamentação no risco de desenvolvimento de diabetes mellitus. FONTE DOS DADOS: Revisão não sistemática nas bases de dados SciELO, LILACS, MEDLINE, Scopuse BVS, selecionando-se 52 referências mais relevantes. Especificamente sobre o tema, foram analisadas 21 (sendo 9 para diabetes tipo 1 e 12 para diabetes tipo 2). SÍNTESE DOS DADOS: A duração, a exclusividade do aleitamento materno e uso precoce do leite de vaca têm sido apresentados como fatores de risco para o desenvolvimento de diabetes. Acredita-se que o leite humano contenha substâncias que promovem a maturação do sistema imunológico protegendo contra o diabetes tipo 1. Além disso, ele possui substâncias bioativas, que promovem o equilíbrio energético e a saciedade, prevenindo o ganho de peso excessivo da criança e protegendo, consequentemente, contra o aparecimento do diabetes tipo 2. Apesar dos benefícios anteriormente citados não terem sido constatados por alguns pesquisadores, a imprecisão no relato dos hábitos dietéticos da infância e a presença de fatores interferentes têm sido responsabilizadas pela falta de identificação dos efeitos benéficos. CONCLUSÃO: Diante das evidências científicas pautadas em grande parte dos estudos, acredita-se que a ausência da amamentação seja um possível fator de risco modificável para diabetes tipo 1 e tipo 2. Estratégias que visem à promoção e ao suporte ao aleitamento materno devem ser adotadas por profissionais de saúde devidamente treinados como forma de prevenir a manifestação da doença. .

Leite de mulheres brasileiras apresenta anticorpos IgA secretores (SIgA) que neutralizam o rotavírus G9P[5] / Milk from Brazilian women presents secretory IgA antibodies and neutralizes rotavirus G9P[5]

OBJETIVO: Verificar a presença de SIgA anti-rotavírus sorotipo G9P[5] e a capacidade de neutralização do vírus de amostras de leite de mulheres brasileiras. MÉTODOS: Foram determinados os níveis de anticorpos SIgA reativos contra rotavírus G9 em 30 amostras de leite materno por ELISA usando suspensões purificadas do vírus. A capacidade das amostras de neutralizarem o rotavírus G9P[5] foi analisada em ensaio de de Neutralização utilizando células MA-104. RESULTADOS: Foram observadas grandes variações individuais referentes aos níveis de SIgA e títulos de neutralização, mas todas as amostras mostraram certa capacidade de neutralizar o G9P[5]. Verificamos uma correlação positiva altamente significativa entre os níveis de anticorpos e os títulos de neutralização. CONCLUSÕES: A alta correlação entre níveis de anticorpos anti-rotavírus e a capacidade neutralizante das amostras de leite sugere um possível papel protetor desses anticorpos contra a infecção. Esses resultados também apoiam o incentivo à prática do aleitamento materno.

OBJECTIVE: To verify the presence of anti-rotavirus serotype G9P[5] SIgA and the virus neutralization capacity of milk samples from Brazilian women. METHODS: SIgA antibody levels reactive to rotavirus G9 were determined in 30 maternal milk samples by enzyme-linked immunosorbent assay (ELISA) using purified virus suspensions. The samples' capacity to neutralize rotavirus G9P[5] was analyzed using the MA-104 cells neutralization assay. RESULTS: Great individual variations were observed regarding the SIgA levels and neutralization titers, but all samples showed some G9P[5] neutralizing ability. A highly significant positive correlation was observed between antibody levels and neutralization titers. CONCLUSIONS: The high correlation between anti-rotavirus antibody levels and neutralizing capacity of the milk samples suggests a possible protective role of these antibodies against infection. These results also support the encouragement of the breast-feeding practice.

Lactancia materna en la prevención de la obesidad / Breastfeeding on obesity prevention

El ambiente intrauterino y los primeros años de vida, son fundamentales para la programación de una serie de situaciones en nuestro organismo. Son muchas las teorías que indican que la lactancia materna (LM) puede tener beneficio en la prevención de la obesidad. Esto hace referencia a que la LM posee una serie de componentes hormonales, que favorecen la maduración o la forma de interpretación de ciertas áreas del cerebro, que tienen que ver con los mecanismos de saciedad y hambre. Existen estudios bastante clásicos que demuestran cómo ésta se regula en el niño alimentado con LM, y la impor tancia que el lo representa, en consideración del efecto de la insulina en la formación de tejido adiposo. La variedad metodológica de los estudios sobre LM hace compleja una buena homologación de los resultados, e incluso hasta indicar que la LM es perjudicial. En conclusión, la LM parece disminuir el riesgo de obesidad hacia la vida adulta; sin que los mecanismos biológicos de estas asociaciones estén totalmente definidos; y además del efecto directo de los nutrientes, existen otros mecanismos que podrían explicar esta asociación.

The intrauterine environment and early life are fundamental to programming a series of situations in our body. There are many theories that suggest that breastfeeding (BF) can have benefits in preventing obesity. This refers to the BF has a number of hormonal components that promote maturation or manner of interpretation of certain brain areas, which have to do with the mechanisms of satiety and hunger. There are enough classic studies showing how it is regulated in the BF, and the importance it represents, in consideration of the effect of insulin in adipose tissue formation. The variety methodological studies complicates BF approval good results, and even indicate that the BF is harmful. In conclusion, the BF seems to decrease the risk of obesity into adulthood, but the biological mechanisms of these associations to be fully defined, and in addition to the direct effect of nutrients, there are other mechanisms that could explain this association.

Lactancia materna: [revisión] / Breast feeding: [review]

La leche materna constituye el alimento natural ideal para los recién nacidos y lactantes. Sus características nutricionales permiten el crecimiento armónico del niño y la prevención de la morbi-mortalidad infantil, especialmente por enfermedades diarreicas. Los diferentes tipos de leche que se producen en la glándula mamaria (pre-calostro, calostro, leche de transición, leche de pretérmino, y madura), se adaptan a los requerimientos del niño en el tiempo, permitiendo que los elementos constitutivos (grasas carbohidratos, proteínas y enzimas) se absorban y digieran fácilmente, favoreciendo la formación de un sistema inmunitario eficiente. La leche materna contiene componentes que conforman su función protectora contra virus, bacterias y parásitos. Factores Constitutivos: Quelantes: Lactoferrina, Proteína fijadora de Vitamina B12 (Haptocorrina), Proteína fijadora de Acido Fólico; Enzimas: Lactoperoxidasa, Lizosima con efecto bactericida y bacteriostático. Factores anti-infecciosos: Factor Bífido (N-acetilglucosamina), Factor de crecimiento epidérmico; Factor estimulante de fibroblastos; Gangliósidos y Oligosacáridos, Lactadherina, Factor de resistencia antiestafilococo. Factores Inducidos: son inducidos por antígenos presentes en el tubo digestivo y en el árbol bronquial: macrófagos, linfocitos T y B; Inmunoglobulinas A, G, M, K-caseína que inhibe la adherencia de Helicobacter Pylori. Varios estudios indican que algunos factores de la leche humana inducen una maduración más rápida del sistema inmunológico en relación a niños alimentados artificialmente. Se recomienda que el niño alimentado al pecho no suspenda la lactancia si presenta algún trastorno diarreico; por el contrario, debe aumentar el número de mamadas para garantizar una adecuada ingesta calórica y de nutrientes. Esto se ha demostrado en estudios que reportan menor incidencia de enfermedad diarreica en lactantes alimentados con lactancia materna.

Breast milk is the ideal food for infants from birth. Its nutritional features allow an armonic child development and the prevention of morbidity and mortality in infants, especially from diarrheal illness. The different types of milk produced by the mammary glands (pre-calostral, calostral, transitional, pre-term milk, and mature), adapt to the child’s requirements, changing its composition, energy content, volume and density. This facilitates absorption of fats, carbohydrates, proteins, and enzymes, and builds an efficient immune system to grant optimal child health. Breast milk has huge amounts of immunological components which contribute to the protective function against virus, bacteria, and parasites: Constituent factors: 1.-Binders: Lactoferin, binding proteins for vitamin B12 (Haptocorin) and Folic Acid. 2.-Enzymes: Lactoperoxidase and Lisozims, with bactericide and bacteriostatic effects. Anti-infection factors: Bífidus Factor (N-Acetil-glucosamine), Epidermal Development Factor, gangliosides and oligosaccharides, Lactadherin and Anti-staphylococcal factor. Induced Factors: The anti-infective activity is specific for each woman; these factors are induced by antigens in the digestive system and respiratory tract: macrophages, T and B lymphocytes, A, G, M immunoglobulins. Also K-casein, related with anti-adhesive action of Helicobacter Pylori. Human milk induces the maturation of the child’s immune system earlier than formula. It is recommended not to withhold breastfeeding in infants affected by diarrhea. On the contrary, the number and duration of feedings should be increased to guarantee an adequate nutritional and caloric intake. Clinical trials which compare the morbidity in infants according with the feeding pattern show a lower incidence of diarrhea in breast fed children.

Evaluación del conocimiento de las madres sobre lactancia materna: estudio multicéntrico en las áreas metropolitanas de Caracas y Maracaibo / Assessment of knowledge of mothers on breastfeeding: multicenter study in the metropolitan areas of Caracas and Maracaibo

Determinar los conocimientos básicos que poseen las madres sobre la práctica de la lactancia materna y relacionarlos con el inicio, la duración y forma de implementación del amamantamiento. Se realizó un estudio transversal y descriptivo, mediante la aplicación de una encuesta a 502 madres que acudieron a centros hospitalarios públicos y privados de Caracas y Maracaibo, entre julio y diciembre de 2007. El 90,64% (n: 455) de las madres amamantaron a sus hijos; la mayoría tenía un promedio de 2 ó menos hijos y provenía de áreas urbanas. El grupo etario que prevaleció fue de 26-35 años. El 55,12% (n: 113) de los niños recibió lactancia materna por un período de 6 meses o más. Sólo el 5,93% (n: 27) inició la lactancia materna antes de la primera hora post-parto. El 81,4% (n: 409) de las madres conocía las ventajas de la lactancia materna, sin embargo, la mayoría de ellas conocía sólo los beneficios para el niño. El 55,18% (n: 277) de las madres tenía información sobre alguna forma de conservación de la leche materna una vez extraída. El porcentaje de madres que practican la lactancia materna es alto, y esto se relaciona con la edad de las madres, procedencia y paridad. Sin embargo, la duración y la forma del amamantamiento no es la esperada, debido a la falta de información sobre aspectos fundamentales de la alimentación natural.

To determine the basic knowledge that mothers have about the practice of breast-feeding and to relate this knowledge to the beginning, the duration and forms of implementation of breast-feeding. A cross-sectional and descriptive study was made, by means of the application of a survey to 502 mothers who attended the outpatient clinic of public and private hospital centers of Caracas and Maracaibo during July to December 2007. 90.64% (n: 455) of the mothers nursed their children; most of these mothers had an average of 2 or less children and came from urban areas. The group of age that prevailed was the one between 26 and 35 years. 55.12% (n: 113) of the children received maternal milk by a period of 6 months or more. Only 5.93% (n: 27) initiated breast-feeding before the first hour post-childbirth. 81.4% (n: 409) of the mothers knew the advantages of breast-feeding, although, most of them only knew the benefits for the baby. Only 55.18% (n: 277) of the mothers had information about some conservation form of maternal milk once extracted. The percentage of mothers who practice breast-feeding is high, and this is related directly to the age of the mothers, origin and parity. Nevertheless, the duration of breast-feeding is not as expected, neither the way to practice it; this is explained by the lack of information of fundamental issues about natural feeding.

Long chain polyunsaturated fatty acids and immunity in infants.

An infant is usually born with a deficient immune system, and the long chain polyunsaturated fatty acids (LC-PUFA) in breast milk plays an important role in the development and maturation of infant’s immune system. This article reviews the role of LC-PUFA in breast milk in the development of immunity and prevention of atopic manifestations in infants. The review also attempts to assess the correct proportion of these nutrients that needs to be present in infant formulae for babies in whom breast milk is unavailable and formula milk is unavoidable. It was concluded that LC-PUFA plays a vital role in overall development of immunity in the infant. Clinicians should ensure that LC-PUFA are supplied to the term and preterm infant in the form of breastmilk or provided in right proportions in formula, if breast milk is unavailable.

Efeitos a curto e longo prazo do aleitamento materno na saúde infantil / Effects of breastfeeding on children's health in the short and long run

The objective of this study was to present a literature review concerning the effects of breastfeeding on infantile health in the short and long run.The information was obtained from articles published in scientifi c journalsindexed in the following data bases: Highwire, Science Direct, Scielo andMedline. The research was carried out over the period from 1980 to 2008,whereas other articles were identifi ed from the bibliographical referencesmentioned in the fi rst articles. The following keywords were entered:"breastfeeding", "children", "obesity", "hypertension", "dyslipidemias","diabetes" and "cancer". The studies emphasize the importance ofbreastfeeding in infantile health, since besides its advantages alreadyelucidated in the available literature in the short run, some benefi cialeffects on the child's health have been also observed in the long run, such asreduced incidence of obesity, arterial hypertension, dyslipidemias, diabetesand cancer. However, the results in the long run still remain controversial.The limitations of the scientifi c works are mainly due to the reduced samplesize, biased recalls concerning the duration of breastfeeding, biasedpublication, confusing factors and different breastfeeding defi nitions(exclusive, total or both). In addition, our understanding of the physiologicmechanisms related to breastfeeding and to cardiovascular risk factors isstill limited. Although the studies present a modest protecting effect of thebreast milk, there is a need for accurate measures and defi nitions amongthe studies for a better understanding about the complexity of this food inreducing the emergence of chronic diseases during childhood.

El objetivo de este estudio fue revisar en la literatura los efectos, a corto y largo plazo, de la lactancia materna sobre la salud infantil. La colecta de informaciones fue realizada en revistas científi cas indexadas en las bases de datos Highwire, Science Direct, Scielo y Medline. Fue comprendido el intervalo de 1980 a 2008, incluyendo también artículos seleccionados a partir de las referencias bibliográfi cas de losprimeros trabajos analizados. Las palabrasclave usadas ueron: "lactancia materna", "niño", "obesidad", "hipertensión", "dislipidemias", "diabetes" y "cáncer". Los estudios destacan la importancia de la lactancia materna en la salud infantil, ya que, junto con los benefi cios de corto plazo, ampliamente divulgados en la literatura, también se observan efectos benéfi cos a largo plazo en la salud de los niños, tales como menorincidencia de obesidad, de hipertensión arterial, de dislipidemias, de diabetes y de cáncer. Sin embargo, todavía existen controversias sobre los resultados de largo plazo. Las limitaciones de los trabajos científi cos ocurren, principalmente por el reducido tamaño de la muestra, laincerteza en relación al recordatorio del tiempo de lactancia y las diferentes defi niciones de lactancia, (exclusiva o total o ambas). Además,nuestra comprensión cuanto a los mecanismos fisiológicos relacionados a la lactancia y los factores de riesgo cardiovascular son aun muylimitados. Aunque los estudios revelen un modesto efecto protector de la leche materna, son necesarias defi niciones y medidas precisas entre los estudios que permitan un mejor entendimiento de la compleja relación de este alimento en la reducción del aparecimiento de enfermedades crónicas en la infancia.

O objetivo deste estudo foi apresentar uma revisão da literatura sobre os efeitos a curto e longo prazo do aleitamento materno na saúde infantil. As informações foram coletadas a partir de artigos publicados em revistas científicas indexadas nas bases de dados Highwire, Science Direct, Scielo e Medline. A pesquisa foi conduzida no período de 1980 a 2008, sendo que outros artigos foram identificados a partir das referências bibliográfi cas citadas nos primeiros artigos. Foram digitadas as palavras-chave: "aleitamento materno", "criança", "obesidade", "hipertensão arterial", "dislipidemias", "diabetes" e "câncer". Os estudos ressaltam a importância do aleitamento materno para a saúde infantil, pois, além de seus benefícios a curto prazo já bem esclarecidos na literatura disponível, têm-se observado efeitos benéficos também a longo prazo na saúde da criança, tais como redução na incidência de obesidade, hipertensão arterial, dislipidemias, diabetes e câncer. No entanto, os resultados a longo prazo ainda permanecem controversos. As limitações dos trabalhoscientífi cos ocorrem devido, principalmente, ao reduzido tamanho amostral, viés do recordatório quanto à duração da amamentação, viés depublicação, fatores de confusão existentes e diferentes definições de amamentação (exclusiva ou total ou ambas). Além disso, nossa compreensão quanto aos mecanismos fisiológicos ligados à amamentação e aos fatores de risco cardiovascular ainda são limitados. Embora osestudos mostrem modesto efeito protetor do leite materno, são necessárias defi nições e medidas precisas entre os estudos no sentido de um melhor entendimento sobre a complexidade deste alimento na redução do aparecimento de doenças crônicas na infância.

IgA1 levels in milk and serum samples from intestinal parasite-infected or normal puerperae

In this study, IgA1 levels in the milk and serum of puerperae were compared and a correlation was established between the levels of this immunoglobulin and the occurrence of parasitism. Eighty-three paired milk and serum samples were obtained from puerperal and IgA1 levels were analyzed. In addition, the presence of intestinal parasites in stool samples from these puerperae was determined. Twelve puerperae tested positive for intestinal parasites and all their samples presented an IgA1 ELISA Index > 1. There was a correlation between serum and milk IgA1 levels and puerperae with any parasite in their stool (r = 0.6723; p = 0.0166). This finding may reinforce the importance of breast-feeding for the protection of neonates.

O papel do aleitamento materno, da dieta e do estado nutricional no desenvolvimento de asma e atopia / The role of breastfeeding, diet and nutritional status in the development of asthma and atopy

O aumento na prevalência da asma e atopia, observado em diversas populações nos anos recentes, contribui para torná-las importantes problemas de saúde pública. A possível influência de fatores relacionados à nutrição humana tem sido demonstrada em crescente número de estudos. O entendimento do papel do aleitamento materno, da dieta, e do estado nutricional, particularmente da obesidade, assim como as respostas imunológicas desencadeadas, ajuda a melhorar a compreensão sobre a relação entre estresse oxidativo, inflamação brônquica, e o desenvolvimento de sintomas asmáticos e atópicos. Este artigo apresenta uma revisão da literatura publicada sobre os aspectos da relação entre nutrição, asma, e atopia, nas duas últimas décadas.

In many populations, the prevalence of asthma and atopy has increased in recent years. As a result, both conditions have become major public health problems. The possible influence of nutrition-related factors has been demonstrated in an increasing number of studies. Information regarding the role of breastfeeding, diet, nutritional status (obesity in particular), as well as regarding the immunologic responses triggered, helps to improve our understanding of the correlation between oxidative stress, bronchial inflammation, and the development of atopic and asthma symptoms. The article presents a review of the published literature on the relationships established between and among nutrition, asthma, and atopy over the last two decades.

Effect of evaporation and pasteurization in the biochemical and immunological composition of human milk

OBJETIVO: Avaliar os efeitos da evaporação e da pasteurização do leite humano na sua composição bioquímica e imunológica e em sua osmolaridade. MÉTODOS: As amostras de leite humano maduro foram divididas em quatro grupos de estudo: leite humano in natura, leite humano pasteurizado, leite humano evaporado a 70 por cento do volume inicial e leite humano pasteurizado e evaporado a 70 por cento, com 12 diferentes amostras de leite em cada grupo. Das amostras dos grupos, foram dosadas as concentrações de sódio, potássio, cálcio, fósforo, magnésio, proteína, gordura, lactose, imunoglobulina A e osmolaridade. RESULTADOS: A pasteurização do leite humano não mostrou alterações estatisticamente significantes na concentração dos elementos sódio, potássio, cálcio, fósforo, magnésio, proteína, gordura, lactose, nem na osmolaridade; no entanto, mostrou redução significante na concentração média de imunoglobulina A. A evaporação mostrou aumento estatisticamente significativo de 38 por cento em média na concentração dos elementos sódio, potássio, cálcio, fósforo, magnésio, proteína, gordura e lactose e redução média de 45 por cento na concentração da imunoglobulina A, sem alteração significativa da osmolaridade em relação ao leite sem processamento. CONCLUSÃO: Através da evaporação a 70 por cento do volume inicial do leite humano, pode ser obtido leite humano com condições de satisfazer as necessidades nutricionais preconizadas para o recém-nascido pré-termo, com exceção do cálcio e do fósforo.

OBJECTIVE: To assess the effects of evaporation and pasteurization of human milk on its biochemical and immunological composition and on its osmolarity. METHODS: The samples of mature human milk were categorized into four study groups: in natura human milk, pasteurized human milk, human milk evaporated at 70 percent of the baseline volume and human milk pasteurized and evaporated at 70 percent, with 12 different samples of milk in each group. The samples were used to determine the concentrations of sodium, potassium, calcium, phosphorus, magnesium, protein, fat, lactose, immunoglobulin A and osmolarity. RESULTS: The pasteurization of human milk did not show statistically significant changes in the concentration of sodium, potassium, calcium, phosphorus, magnesium, protein, fat, lactose, or in osmolarity; however, it showed remarkable reduction in the mean concentration of immunoglobulin A. Evaporation had a mean increase of 38 percent in the concentration of sodium, potassium, calcium, phosphorus, magnesium, protein, fat and lactose and mean reduction of 45 percent in the concentration of immunoglobulin A, without significant change in osmolarity in unprocessed milk. CONCLUSION: By evaporation at 70 percent of the baseline value of human milk, it is possible to obtain human milk that meets the nutritional requirements recommended for preterm infants, except for calcium and phosphorus.

Evaluation of the secretory immunoglobulin A levels in the colostrum and milk of mothers of term and pre-trerm newborns

OBJECTIVE: To determine and to compare the levels of secretory immunoglobulin A in samples of colostrum and milk of mothers of term and preterm neonates. MATERIAL AND METHODS: The levels of secretory immunoglobulin A of 10 mothers of term neonates and 10 mothers of preterm neonates were determined from 5mL of colostrum or milk collected on the 1st, 4th, 10th and 15th days of the puerperal period, using the radial immunodifusion technique. We employed anamnesis, as well as physical and gynecological exams in women in the puerperal period. All the patients were attended at the Januário Cicco Maternity College. RESULTS: The secretory immunoglobulin A levels were significantly higher in the colostrum and milk of mothers of preterm neonates when compared with the levels found in colostrum and milk of mothers of term neonates (Mann-Whitney test, p<0.0001). There was a significant decline in the secretory immunoglobulin A levels of the colostrum and milk of the mothers of term and preterm neonates during the four periods (Kruskal-Wallis test, p<00001). CONCLUSIONS: The secretory immunoglobulin A levels in colostrum and milk of mothers of preterm neonates were significantly higher than in the mothers of term neonates, demonstrating immunological adaptation in preterm neonate breast-feeding.

IgA secretora total e específica no colostro e leite de mães da cidade do Natal-Rio Grande do Norte, Brasil / Total and specific IgA in colostrum and milk of mothers of Natal-Rio Grande do Norte, Brasil

PURPOSE: To determine the concentration of total secretory IgA and evaluate the repertoire of IgA antibodies to enteropathogenic Escherichia coli and Shigella flexneri antigens in colostrums and milk from mothers in Natal, RN. METHODS: The sample was constituted by 22 healthy clinically women whose babies were born at public hospital in Natal, RN. To determine total secretory IgA a radial immunedifusion tecnique (Mancini et al, 1965), was employed and to detect specific antibodies, immuneenzimatic assays, ELISA was used. RESULTS: The median values of total secretory IgA concentration presented individual variations with high levels in colostrums samples, decreasing during lactation, it was observed a p < 0.001 among the samples from the first day of lactation, to the thirtieth for total IgA concentration. All the donators present in colostrum and milk specific antibodies to Escherichia coli enteropathogenic (EPEC) and Shigella flexneri with titles higer in colostrum. There was parallel and directional pattern between total IgA and IgA anti-EPEC and Shegella flexneri, during period. CONCLUSION: The concentrations of total SIgA and specific antibodies to enteropathogenic Escherichia coli and Shigella flexneri in colostrums and milk in our study do not differ from others accomplished among populations with the same social and econimic features, stressing the importance of human milk as a protector agent against pathogens.

Nutrição enteral em Pediatria / Enteral nutrition in Pediatrics

O autor conceitua o que se entende por nutriçäo enteral, apresenta os diferentes tipos de dietas, fórmulas completas, modulares, artesanais e comerciais, analisa as condiçöes que requerem o uso de fórmulas lácteas especiais (prematuridade, imaturidade e inflamaçäo intestinal, alergia ao leite de vaca), as vias e a técnica de administraçäo e de passagem de sonda, cuidados com a dieta enteral e sua monitorizaçäo, particularidades do RN e complicaçöes, finalizando com estudo da interaçäo entre drogas e nutrientes