Conocimientos básicos para la preparación y uso de fórmulas magistrales en oftalmología

Los colirios fortificados o reforzados son fórmulas magistrales que reciben ese nombre por la vigorización que se les realiza a los colirios industriales con principios activos de antibióticos, antivirales, citostáticos y antimicóticos, en dependencia de los requerimientos individuales de los pacientes. Por tanto, la utilización de la formulación magistral es, por su capacidad y flexibilidad, un potencial para concebir nuevas pautas terapéuticas y posibilitar la creación de nuevas formulaciones o bien la actualización de antiguas fórmulas con principios activos más modernos, con el fin de lograr una alternativa a los colirios industriales de manera potente, eficaz y segura. El objetivo de este trabajo es describir los fundamentos teóricos, las tendencias nacionales e internacionales de la preparación y el uso oftalmológico de los colirios fortificados. Se realizó una revisión bibliográfica y documental actualizada, se utilizaron fuentes primarias, secundarias y terciarias y experiencias nacionales. La utilización de los colirios fortificados es cada día más frecuente en la especialidad de oftalmología, lo que obliga al farmacéutico hospitalario y al oftalmólogo a estar actualizado en temas como elaboración segura, composición, indicación y uso correctos.

Fortified or reinforced eye drops are masterful formulas that receive such name due to the industrial eye drops' invigoration with antibiotic, antiviral, cytostatic and antifungal active ingredients, depending on the patients' individual requirements. Therefore, the use of a masterful formulation is, due to its capacity and flexibility, a potential for conceiving new therapeutic guidelines and also for making possible the creation of new formulations or the updating of old formulations with more modern active ingredients, in order to achieve an alternative to industrial eye drops in a potent, effective and safe way. The objective of this work is to describe the theoretical foundations, the national and international trends in the preparation of fortified eye drops, as well as their ophthalmologic use. An updated bibliographic and documentary review was carried out, using primary, secondary and tertiary sources, together with national experiences. The use of fortified eye drops is becoming increasingly frequent in the ophthalmology specialty, which obliges the hospital pharmacist or the ophthalmologist to be updated on issues such as safe preparation, composition, prescription and correct use.

Aplicación del perfil de nutrientes de la OPS en productos ultraprocesados, inclusive en alimentos fortificados / Application of PAHO's nutrient profile in ultra-processed products, including fortified foods

Resumen Introducción: en la actualidad se recomienda limitar el consumo de productos ultraprocesados por su alto contenido en azúcar, grasas totales, grasas saturadas, grasas trans y sodio. El etiquetado frontal es una estrategia destinada a fortalecer en el consumidor su capacidad de elegir, pero la estrategia de adición de micronutrientes realizada por la industria alimentaria contribuye a que los consumidores sobrestimen su calidad nutricional. El objetivo de este estudio fue analizar según el modelo del Perfil de Nutrientes (PN) de la Organización Panamericana de la Salud (OPS), un grupo de productos ultraprocesados disponibles en el mercado argentino y aplicar el modelo de forma diferenciada en productos fortificados por la industria alimentaria. Materiales y método: estudio de campo, transversal, descriptivo. Se aplicó el perfil de nutrientes considerando: azúcares libres, grasas totales, grasas saturadas, grasas trans y sodio, en productos fortificados y sin fortificación. Cada una de las categorías generales de alimentos: galletitas dulces, alfajores, chocolates, golosinas, helados, cereales, bebidas, dulces untables, snacks salados y lácteos, fueron divididas en subcategorías, integradas por diferentes productos. Se realizó un análisis estadístico descriptivo por subcategorías. Resultados: la muestra se conformó por 682 productos y todos superaron el punto de corte de al menos un nutriente en cantidad excesiva. El 100% de los productos fortificados (n=146) presentó cantidad excesiva de algún nutriente, el 41,1% tuvo un nutriente en cantidad excesiva y el 50,7% dos nutrientes. 95,7-100% de los productos de los grupos cereales de desayuno, chocolatadas, yogures bebibles y en pote, se categorizaron como con cantidad excesiva de azúcares libres. Conclusiones: todos los productos analizados presentaron al menos un nutriente del PN de referencia, en cantidad excesiva. Los mismos productos tenían adición de vitaminas, minerales o fibra. Se visibiliza la necesidad de realizar estudios que investiguen si esta estrategia induce confusión en el consumidor al momento de elegir.

Abstract Introduction: it is currently recommended to limit the consumption of ultra-processed products because of their high content of sugar, total fats, saturated fats, trans fats and sodium. Front labelling is a strategy aimed at strengthening consumer choice, but the micronutrient addition strategy carried out by the food industry contributes to consumers overestimating their nutritional quality. The objective of this study was to analyze, following the model of the Nutrient Profile (PN) of the Pan American Health Organization (PAHO), a group of ultra-processed products available in the Argentine market and apply the model in a differentiated way in products fortified by the food industry. Materials and method: field study, cross-sectional, descriptive. The nutrient profile was applied considering: free sugars, total fats, saturated fats, trans fats and sodium, both in fortified and unfortified products. Each of the general food categories: sweet cookies, alfajores, chocolates, sweets, ice cream, cereals, beverages, spreadable sweets, salty snacks and dairy products, were divided into subcategories, made up of different products. A descriptive statistical analysis by subcategories was performed. Results: the sample consisted of 682 products and all exceeded the cut-off point of at least one nutrient in excessive quantity. 100% of the fortified products (n=146) had an excessive amount of some nutrient, 41.1% had an excess nutrient and 50.7% two nutrients. 95.7-100% of the products of the breakfast cereals, chocolate, drinking and potted yogurts groups were categorized as having excessive amounts of free sugars. Conclusions: all the products analyzed presented at least one nutrient from the reference NP, in excessive quantity. The same products had added vitamins, minerals or fiber. The need for studies to research whether this strategy induces confusion in the consumer when choosing is made visible.

Formulación de galletas fortificadas por sustitución parcial de harina de moringa y suero lácteo / Formulation of fortified cookies by partial substitution of moringa flour and whey

El suero lácteo y la moringa poseen alto valor nutricional; sin embargo, su uso en la elaboración de productos alimenticios es una alternativa viable pero poco utilizada. Objetivo. Elaborar una galleta fortificada por sustitución parcial de harina de moringa (HM) y polvo de suero lácteo (PSL). Materiales y métodos. Durante septiembre-diciembre 2021, se desarrollaron cuatro formulaciones con sustitución parcial de harina de trigo por HM y PSL (F0=100:0:0; F1=90:5:5; F2=80:10:10; F3=70:15:15). La aceptación del producto se determinó mediante una evaluación sensorial considerando los atributos sabor, olor, color, textura y aceptación general. Se realizó el análisis químico proximal a la HM, al PSL, a la formulación de mayor aceptación y a F0. Se compararon los distintos parámetros químico proximales y de aceptación mediante una anova de una vía, seguido de una prueba de comparación de medias de Tukey (p<0,05). Resultados. Conforme se incrementa el porcentaje de sustitución de harina de trigo por HM y PSL se obtiene menor aceptación de las galletas, siendo F1 la más aceptada. F1 registró un contenido proteico de 6,90±0,04%, significativamente mayor al observado en F0. Conclusiones. La buena aceptabilidad de F1 indica que la sustitución parcial por HM y PSL no influyen en su aceptación; además, F1 mostró un enriquecimiento de proteinas, lípidos y cenizas, así como contenido adecuado de humedad y carbohidratos(AU)

Introduction. Whey and moringa have high nutritional value; however, their use in the production of food products is a viable but rarely used alternative. Objective. To make a biscuit fortified by partial substitution of moringa flour (MF) and whey powder (WP). Materials and methods. During September-December 2021, four formulations were developed with different degrees of partial substitution of wheat flour for MF and WP (F0=100:0:0; F1=90:5:5; F2=80:10:10; F3=70:15:15). The acceptance of the product was determined through a sensory evaluation considering the attributes taste, odor, color, texture and general acceptance. A proximal chemical analysis was performed on the MF, WP, the most widely accepted formulation and F0. Proximal chemical parameters and acceptance attributes were compared using a one-way anova, followed by a Tukey mean comparison test (p<0.05). Results. As the percentage of substitution of wheat flour by MF and WP increases less acceptance of the biscuits is obtained, with F1 as the most accepted formulation. F1 registered a protein content of 6.90±0.04%, significantly higher than that observed in F0. Conclusions: The good acceptability of F1 indicates that the partial substitution of wheat flour for MF and WP do not influence its acceptance; in addition, F1, showed an enrichment of protein, lipid and ash, as well as adequate moisture and carbohydrate content(AU)

The impact of amphotericin B-fortified preservation media on donor rim cultures and posttransplant infection

Purpose: To determine the impact of amphotericin B supplementation to donor cornea preservation solutions on the rates of positive donor rim fungal cultures and postkeratoplasty fungal infections. Methods: This was a retrospective analysis of cases undergoing corneal transplantations at a single tertiary referral center from 2016 to 2021. Patients undergoing corneal transplantations with and without amphotericin B supplementation to the storage media were reviewed for donor rim culture results and postoperative infection. The primary outcome measures were positive donor rim fungal culture results and postkeratoplasty fungal infection. Results: A total of 1238 corneal transplants were analyzed. Of these, 849 were stored in preservation solution without amphotericin B, while 389 had amphotericin B included. There was a lower incidence of positive donor rim fungal cultures in cases with amphotericin B supplementation (1.8%) compared to the cases without amphotericin B (2.9%), although this difference was not statistically significant (P = 0.24). Of the 389 cases with amphotericin B supplementation, one (0.25%) went on to develop clinically significant infection, while three of 849 (0.35%) cases without amphotericin B developed infection. The sample size was too small to determine the effect of amphotericin B on the incidence of postkeratoplasty fungal infection. Conclusion: The addition of amphotericin B to donor cornea preservation solution resulted in a downward trend of positive donor rim fungal cultures and postkeratoplasty fungal infections, although these differences did not reach statistical significance. Further studies with larger sample sizes are necessary to appropriately determine the impact of amphotericin B supplementation in the storage solution on positive donor rims and postkeratoplasty fungal infections.

Large-scale Staple Food Fortification as a Complementary Strategy to Address Vitamin and Mineral Vulnerabilities in India: A Critical Review

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling?up scientifically proven, cost?effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost?effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large?scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.

Diethylcarbamazine citrate-fortified salt for lymphatic filariasis elimination in India

Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC–iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.

Contribución de la harina de trigo enriquecida y derivados a los requerimientos de hierro en niños de 6 meses a 7 años / Contribution of enriched wheat flour and flour products to iron requirements in children aged 6 months to 7 year

Introducción. El enriquecimiento de la harina de trigo es una de las estrategias de salud pública recomendadas para prevenir las deficiencias de micronutrientes, entre ellos el hierro. El objetivo de este trabajo fue determinar el contenido de hierro en harina de trigo enriquecida y sus derivados, y la contribución de estos a las recomendaciones nutricionales en niños. Población y métodos. Estudio observacional, analítico, de corte transversal, basado en la metodología de estudio de dieta total. Se analizaron la harina de trigo enriquecida (según la ley 25630) y sus derivados más consumidos. Para seleccionar los alimentos, se realizó un cuestionario de frecuencia de consumo y recordatorio de 24 horas a los padres de niños con edades entre 6 meses y 7 años. Se determinó la concentración de hierro en los alimentos mediante absorción atómica y se evaluó su contribución al requerimiento promedio estimado. Resultados. La harina enriquecida y sus derivados tuvieron la cantidad de hierro esperada, excepto el pan francés y el pan rallado. La contribución a los requerimientos de hierro de los alimentos evaluados fue el 7 % en niños de 6 meses a 1 año, el 81 % en el grupo de 1 a 3 años y el 45 % en los mayores de 4 años. Conclusiones. Excepto el pan francés y el pan rallado, las harinas y sus derivados analizados presentaron el nivel de enriquecimiento esperado. El consumo de estos alimentos no aporta cantidades significativas de hierro en los lactantes, pero sí en los niños mayores de 1 año.

Introduction. Wheat flour enrichment is a public health strategy recommended to prevent micronutrient deficiencies, including iron deficiency. The objective of this study was to determine iron content in enriched wheat flour and flour products and their contribution to nutritional recommendations for children. Population and methods. Observational, analytical, cross-sectional study based on the total diet study method. Enriched wheat flour (as per Law no. 25630) and the most frequently consumed flour products were analyzed. Products were selected using a questionnaire on the frequency of food intake and a 24-hour recall interview with the parents of children aged 6 months to 7 years. Food iron levels were determined based on atomic absorption spectrometry and their contribution to the estimated average requirement was assessed. Results. Enriched flour and flour products showed the expected iron amount, except for French bread and breadcrumbs. The contribution of studied products to iron requirements was 7 % in children aged 6 months to 1 year, 81 % in those aged 1-3 years, and 45 % in those older than 4 years. Conclusions. Except for French bread and breadcrumbs, studied flour and flour products showed the expected enrichment level. The consumption of this type of food does not provide significant amounts of iron to infants, but it does to children older than 1 year.

Diversidad de dieta y anemia en mujeres post parto que asisten a un hospital público de La Plata, Buenos Aires / Diet diversity and anemia in postpartum women attending a state hospital in La Plata, Buenos Aires

Resumen Introducción: no se cuenta con información a nivel local de la relación entre la diversidad de dieta y la anemia en mujeres postparto, por lo que se propuso analizar dicha relación en un hospital público de La Plata. Materiales y método: se realizó un estudio analítico transversal en mujeres asistidas durante el primer año postparto, en un Observatorio de Salud del Hospital Sor María Ludovica de la ciudad de La Plata, entre agosto de 2018 y septiembre de 2019. Se obtuvieron datos personales y de laboratorio de las historias clínicas. Los alimentos relevados mediante recordatorios de 24 hs fueron categorizados en 10 grupos. Se consideró diversidad de dieta al consumo ≥5 grupos según el instrumento "Mínimo de diversidad dietaria para mujeres". Se definió anemia como hemoglobina <12 g/dL. La asociación entre la anemia y diversidad de dieta se analizó mediante test exacto de Fisher y se comparó la media de hemoglobina utilizando test de Student. Resultados: se incluyeron 137 mujeres postparto, edad 26 (22;31) años, 53,7% argentinas. 12,4% presentó anemia. 63,5% tuvo diversidad de dieta. "Granos y cereales" fue el grupo más consumido (100%), seguido por "Carne, pollo y pescado" (92,7%) y "Otros vegetales" (85,4%). Los menos consumidos fueron "Legumbres" (6,6%) y "Nueces y semillas" (0,7%). No se halló una asociación estadísticamente significativa entre diversidad de dieta y anemia (p=0,18). Tampoco se halló diferencia en las medias de hemoglobina en mujeres con y sin diversidad de dieta (p=0,99). Conclusiones: la diversidad de dieta no se halló asociada a anemia en mujeres postparto que asisten a un hospital público, esto podría relacionarse a la alta frecuencia de consumo de carnes y cereales fortificados.

Abstract Introduction: there is no information at local level on the relationship between diet diversity and postpartum anemia of women, so we intended to analyze this relationship in a state hospital in La Plata. Materials and method: a cross-sectional analytical study was carried out in women assisted during the first year postpartum, in the Health Observatory of Sor María Ludovica Hospital in La Plata city, between August 2018 and September 2019. Personal and laboratory data were obtained from medical records. Foods surveyed by 24-hour reminders were categorized into 10 groups. Dietary diversity was considered to be the consumption ≥5 groups, according to the "Minimum dietary diversity for women" instrument. Anemia was defined as hemoglobin <12 g / dL. The association between anemia and diet diversity was analyzed using Fisher's exact test and mean hemoglobin was compared using Student's test. Results: 137 postpartum women were included, age 26 (22; 31), 53.7% Argentinian. 12.4% presented anemia. 63.5% had diet diversity. "Grains and cereals" was the most consumed group (100%), followed by "Meat, chicken and fish" (92.7%) and "Other vegetables" (85.4%). The least consumed were "Legumes" (6.6%) and "Nuts and seeds" (0.7%). No statistically significant association was found between diet diversity and anemia (p = 0.18). No difference was found in the hemoglobin means in women with and without diet diversity (p = 0.99). Conclusions: diet diversity was not associated with anemia in postpartum women attending a state hospital, this could be related to the high frequency of consumption of meats and fortified cereals.

Hierro y ácido fólico: natural, enriquecido, fortificado y suplementos. Análisis de las fuentes alimentarias en la Ciudad de Buenos Aires / Iron and folic acid: natural, enriched, fortified, and supplements. Analysis of food sources in the Autonomous City of Buenos Aires

Introducción. La fortificación y suplementación son estrategias para la prevención de carencias de micronutrientes. El objetivo fue describir la procedencia de la ingesta del hierro y ácido fólico a lo largo del ciclo vital de la población de la Ciudad Autónoma de Buenos Aires. Población y métodos. Análisis de la información de la Primera Encuesta Alimentaria y Nutricional de la Ciudad Autónoma de Buenos Aires 2011, que tomó una muestra probabilística por conglomerados. El consumo se recabó con recordatorio de 24 horas. Se calculó el aporte de hierro y ácido fólico, y se categorizó en contenido natural, harina de trigo enriquecida, leche del Plan Materno Infantil, alimentos fortificados y suplementos. Resultados. De los 5369 individuos evaluados, prácticamente, la totalidad obtenía hierro y ácido fólico de contenido natural (el 58 % y el 29 % del consumo, respectivamente). Más del 90 % consumía harina de trigo enriquecida, que aportaba el 28 % del hierro y el 54 % del ácido fólico. Los alimentos fortificados mostraron consumo y aporte muy variable. La leche del Plan Materno Infantil mostró muy baja participación, inclusive en grupos específicos. El aporte de suplementos fue bajo, excepto en < 2 años (el 30 % consumía suplementos de hierro, que aportaban el 38 % de este).Conclusión. Además del aporte natural de los alimentos, la harina de trigo enriquecida representó una importante contribución en el consumo de ácido fólico y hierro de esta población; los alimentos fortificados y los suplementos tuvieron una participación diferente según el grupo etario.

Introduction. Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires.Population and methods. Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements.Results. Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron).Conclusion. In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.

Nutritional composition and acceptance of cake elaborated with beauregard potato biofortified with carotenoids / Composição nutricional e aceitação de bolo elaborado com batata beauregard biofortificada com carotenoides

Beauregard biofortified sweet potato is a tuberous root with a high content of carotenoids whose consumption can bring beneficial effects on human health related to the biological actions of these substances. The objectives of this study were to evaluate the acceptance of cake made with sweet potato biofortified with carotenoids by school children enrolled in a school of the municipal education network of the city of Teresina PI. The sweet cake containing biofortified potato (Beauregard) (PC) was compared with standard sweet wheat flour (WC) cake formulation. The PC and WC products and the Beauregard potato were analyzed for centesimal composition (moisture, ashes, proteins, lipids and carbohydrates) and total carotenoid content. Acceptance of PC was assessed by means of an acceptance test with a hedonic scale of five points applied to 100 children from 08 to 10 years of age. The evaluation of the centesimal composition showed protein content corresponding to 2.1% in WC and 3.57% in PC, and of lipids of 5.16% in WC and 8.95% inPC. Regarding the moisture content, WC presented 32.5% and PC 38.44%. The content of fixed minerals (ash) found in formulations was 1.9% and 1.26%, respectively, in WC and PC. The carotenoid content (µg of ß-carotene.g-1) was significantly higher (p <0.05) in the biofortified potato (3,200.01 ± 0.02) and in the PC formulations (3,666.17 ± 2.55) and WC (3,066.53 ± 1.88) for common sweet potatoes (2.200,23 ± 1.63). In the five-point facial hedonistic acceptance test, the formulation containing biofortified potato (PC) obtained a significantly higher score (p <0.05) (4.24 ± 0.93) when compared to the WC formulation (3.75 ± 1.19). The biofortified potato and the cake containing the biofortified potato presented some characteristics related to the centesimal composition similar to those found in WC and the content of carotenoids in PC larger than those of WC. Because sweet cake is a food product, generally well accepted by children and adults, PC's greateracceptance of WC suggests its promising potential for consumption by the population.

A batata-doce Beauregard biofortificada é uma raiz tuberosa com alto teor de carotenoides, cujo consumo pode trazer efeitos benéficos na saúde humana relacionados com as ações biológicas dessassubstâncias. Os objetivos deste estudo foram avaliar a aceitação de bolo elaborado com batata doce biofortificada com carotenoides por crianças em idade escolar matriculados em uma escola da rede municipal de ensino da cidade de Teresina PI. O bolo doce contendo batata biofortificada (Beauregard) (BB) foi comparado com formulação padrão de bolo doce de farinha de trigo (BT). Os produtos BB e BT e a batata Beauregard foram analisados quanto à composição centesimal (umidade, cinzas, proteínas, lipídeos e carboidratos) e conteúdo de carotenóides totais. A aceitação do BB foi avaliada por meio de teste de aceitação com escala hedônica facial de cinco pontos aplicado em 100 crianças de 08 a 10 anos de idade. A avaliação da composição centesimal mostrou conteúdo protéico correspondendo 2,1% no BT e 3,57% no BB, e de lipídiosde 5,16% no BT e 8,95% no BB. Em relação ao teor de umidade, o BT apresentou 32,5% e BB 38,44%. O teor de minerais fixos (cinzas) encontrado nas formulações foi de 1,9% e 1,26%, respectivamente, no BT e BB. O conteúdo de carotenoides (µ g de ß-caroteno.g-1) foi significativamente maior (p<0,05) na batata biofortificada (3.200,01 ± 0,02) e nas formulações BB (3.666,17 ± 2,55) e BT (3.066,53 ± 1,88) em relação à Figure 1. Acceptance rate of Beauregard potato and wheat cake formulations.. batata doce comum (2.200,00 ± 1,63). No teste de aceitação escala hedonica facial de cinco pontos a formulação contendo batata biofortificada (BB) obteve nota significativamente maior (p<0,05) (4,24± 0,93) quando comparada com a formulação BT (3,75± 1,19). A batata biofortificada e o bolo contendo a batata biofortificada apresentaram algumas características relacionadas à composição centesimal semelhantes àquelas encontradas no BT e conteúdo de carotenoides no BB maiores que os do BT. Por ser o bolo doce um produto alimentício, de modo geral, bem aceito por crianças e adultos, a maior aceitação do BB em relação ao BT sugere seu potencial promissor para consumo pela população.

Daily intake of a bean-fiber fortified bar reduces oxidative stress

as been proposed that the consumption of common beans (Phaseolus vulgaris L.) reduces cardiovascular risk, and prevents and controls both chronic and degenerative diseases. The aim of this study was to compare the antioxidant capacity of a bean-fiber fortified bar (BFB) versus a commercial bar (CB) in 60 Mexican men and women (18-65 years old), who were randomly distributed in two groups: BFB or CB; individuals consumed a bar a day for one month. Anthropometric data, food intake and blood samples were collected. Glucose tolerance (GTT), lipid profile (PL), and lipid peroxidation (TBARS) tests were performed; carbonyls groups in serum oxidized proteins were also measured. GTT and PL were not different between both groups in either the 15 or 30-day follow-up of bar consumption assessments. There were no significant differences in either TBARS or carbonyl concentration between groups; BFB group showed higher levels of serum lipid peroxidation in basal and fifteen days measurements; these levels decreased at the final evaluation: No differences were detected on carbonyl levels between groups. In conclusion, 30 days of fiber bean bar consumption did not alter glucose or PL levels, while, in the BFF group, oxidative stress decreased within 30 days of the consumption of the fortified bar(AU)

Se ha propuesto que el consumo de frijol común (Phaseolus vulgaris L.) reduce el riesgo cardiovascular, y previene y controla las enfermedades crónicas y degenerativas. El objetivo del presente estudio fue comparar la capacidad antioxidante de una barra fortificada con fibra de frijol (BFB) versus una barra comercial (CB) en 60 hombres y mujeres mexicanos (18-65 años de edad), quienes aleatoriamente fueron distribuidos en dos grupos: El grupo BFB y el CB que consumieron la barras fortificada con frijol y la barra comercial, respectivamente, durante un mes. Se recopilaron datos antropométricos, ingesta de alimentos y muestras de sangre. Se realizó prueba de tolerancia a la glucosa (GTT), el perfil de lípidos (PL), la peroxidación de lípidos (TBARS) y la cuantificación de carbonilos en proteínas oxidadas como pruebas de bioquímica sanguínea. GTT y PL no fueron diferentes entre ambos grupos en la evaluación de seguimiento de 15 y 30 días del consumo de la barra. No hubo diferencias significativas en los TBARS o la concentración de carbonilo entre los grupos, el grupo BFB mostró niveles más altos de peroxidación de lípidos en suero en la fase basal y a los quince días del consumo de la barra; curiosamente, estos niveles disminuyeron en la evaluación final. No se detectaron diferencias en los niveles de carbonilo entre los grupos. En conclusión, 30 días de consumo de barras de fibra de frijol no alteraron los niveles de glucosa o PL; mientras que, en el grupo BFB, el estrés oxidativo disminuyó a los 30 días del consumo de la barra fortificada(AU)

A study on efficacy of oral administration of colostrum fortified lactoferrin in the weight gain of low birth weight infants

Background: Low birth weight babies is the result of being small for gestational age (i.e. under 10th percentile of the reference population) and preterm (i.e. before 37 weeks of gestation. Preterm infants have higher protein, calorie requirement, which cannot be met with unfortified breast milk feeds.Methods: This study was conducted prospectively in the Department of Pediatrics, Rajah Muthiah Medical College and Hospital, Chidambaram from October 2016 to April 2018. 20 low birth weight babies were selected by randomization technique and they were administered with 2 grams of oral colostrum fortified lactoferrin daily for 4 weeks. The rate of weight gain, length gain and head circumference gain were assessed prospectively for a period of 4 weeks. They were analysed statistically by ANOVA and tabulated. Babies weighing less than 2.5 kg and on exclusive breast feeding, were included. Babies more than 2.5kg and less than 1kg, at risk for neonatal sepsis, congenital heart disease, necrotizing enterocolitis were excluded from the study.Results: In the present study, 20 low birth weight babies were included. 11 maternal risk factors were identified. Out of which anemia stands as a single risk factor. The rate of weight gain in oral colostrum fortified lactoferrin, is 320 grams with P value of 0.703 which is not statistically significant. The rate of length gain is 3.3cm, p value is 0.093 which is statistically insignificant. The rate of head circumference gain in oral colostrum fortified lactoferrin is 2.8cm, with the p-value of 0.001 which is statistically significant.Conclusions: The rate of weight and length gain was normal, but the rate of head circumference gain is significantly increased in oral colostrum fortified lactoferrin supplementation.

Prevalencia de anemia en niños del proyecto EquiDar de la región de Azuay-Ecuador / Prevalence of anemia in children of EquiDar project in Azuay region, Ecuador

Introducción: La anemia y su erradicación es una prioridad de organizaciones de salud. La implementación de programas de suplementación nutricional para su disminución es realizada por diversas instituciones. Objetivo: Caracterizar la anemia en niños beneficiarios del proyecto EquiDar, Azuay-Ecuador. Métodos: Investigación con diseño no experimental, prospectivo, observacional, de corte descriptivo-asociativo y transversal, realizada en el período 2015-2016 en el Cantón Cuenca, Azuay- -Ecuador. La muestra probabilística correspondió a 1 091 niños beneficiarios del proyecto EquiDar. Se realizó biometría mediante equipo automatizado. Los índices hematológicos obtenidos se normalizaron según la altura. Los datos se procesaron con SPSS 23.0 mediante estadística descriptiva e inferencial para la comparación de medias y proporciones (H Kruskall Wallis, U de Mann Whitney y Ji-cuadrada). Resultados: La prevalencia de anemia fue de 23,96 por ciento con predomino en la edad preescolar y en zona rural de residencia. El incremento de la edad corrigió el padecimiento mediante asociación inversa. El principal tipo de anemia en la muestra fue de tipo normocítica hipocrómica, seguida de anemia macrocítica. El nivel de macrocitosis en la población fue alto (56 por ciento) en individuos anémicos y no anémicos sugiriendo la concurrencia de otras enfermedades como agente causante. Conclusiones: La prevalencia de anemia en la muestra es un problema moderado de salud pública influido por variables sociodemográficas. La reversión del fenómeno sobrepasa la dimensión nutricional, por lo que es necesario políticas con enfoque multifactorial que integren el área nutricional, educativa y de salud pública(AU)

Introduction: Anemia and its eradication is a priority of health organizations. The implementation of nutritional supplemental programs for its reduction is carried out by several institutions. Objective: To characterize anemia in the children who were beneficiaries of EquiDar project, in Azuay, Ecuador from 2015 to 2016. Methods: Prospective approach with non-experimental, observational, descriptive-associative and cross-sectional design carried out in the period 2015-2016 in Canton Cuenca, Azuay, Ecuador. The probabilistic sample corresponded to 1091 children who are benefit from EquiDar project. Biometry was performed using automated equipment. The hematologic indices obtained were normalized according to the height. Data were processed with SPSS 23.0 and using descriptive and inferential statistics with methods for the comparison of means and proportions (H Kruskall Wallis, Mann Whitney U and square-Ji). Results: The prevalence of anemia was 23.96 percent, predominantly in the preschool ages and in the rural areas. Increasing age corrects the condition by inverse association. The main type of anemia in the sample is hypocromic normocytic, followed by macrocytic anemia. The level of macrocytosis in the population was high (56 percent) in both anemic and non-anemic individuals, suggesting the concurrence of other pathologies as causative agent. Conclusions: The incidence of anemia in the sample is a moderate public health problem influenced by sociodemographic variables. The reversion of the phenomenon surpasses the nutritional dimension being necessary policies with multifactorial approach that integrate the nutritional, educative and public health areas(AU)

Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions

Nutrient requirements and recommended dietary allowances (RDAs) are set and revised periodically by the Indian Council of Medical Research. These are meant to guide the population and provide policy directions regarding nutrient requirements corresponding to a healthy population. This review article provides an overview of the current recommendations (RDA, 2010) and the challenges faced by the committee to contextualize RDA to the Indian scenario which has a background of double burden of malnutrition, diverse dietary habits but predominantly home-based cereal-pulse vegetarian diet with low bioavailability of several nutrients and lower consumption of packaged fortified foods. The need for country-specific requirements and harmonization of methodologies related to nutrient requirements and RDA are also discussed. The recommendations fixed for iron have been provided in detail as an example. The measures to carry forward RDA revisions to ensure its sustainability have been emphasized.

Impacto del Ácido Fólico en la Incidencia de Fisuras Labiopalatinas de la Población Occidente de la Región Metropolitana, Chile / Impact of Folic Acid on the Incidence of Cleft Lip and Palate of the Western Population of the Metropolitan Region, Chile

RESUMEN: La fisura labiopalatina ha tenido una alta frecuencia en la población chilena. A partir del 2000 se inició el programa de fortificación de la harina con ácido fólico a fin de disminuir los defectos del tubo neural. El objetivo de este estudio fue determinar el impacto que presenta la incorporación del ácido fólico en la incidencia de fisuras labiopalatinas de la población del área occidente de la Región Metropolitana. Se recopiló información a partir de las fichas clínicas de la Fundación Gantz seleccionando a los recién nacidos entre 1990 y 2009, correspondientes a las comunas del Servicio de Salud Occidente de la Región Metropolitana. Desde el 2000 hasta el 2004 se observó una disminución importante en las tasas de fisura labiopalatina, con una tasa de 0,88 fisurados por 1000 recién nacidos vivos. Posteriormente se observó un incremento a partir del 2005 hasta el 2009 llegando a una tasa de 1,52 fisurados por 1000 recién nacidos vivos. En conclusión, el efecto protector del ácido fólico se evidencia en la disminución de las tasas de los recién nacidos con fisuras durante los primeros años de su implementación. Sin embargo, posteriormente se observó un aumento de dichas tasas, lo cual podría deberse al incumplimiento de la norma.

ABSTRACT: Cleft lip and palate has had a high frequency in the Chilean population. From the year 2000 a flour fortification program with folic acid was initiated in order to reduce the defects of the neural tube. The objective of this study was to determine the impact of the incorporation of folic acid in the incidence of cleft lip and palate of the population of the western area of the Metropolitan Region. Information was collected from clinical records of the Gantz Foundation, selecting newborns from 1990 to 2009, corresponding to the districts of the western sector of the Metropolitan Region. From 2000 to 2004 there was a significant decrease in cleft lip and palate rates, with a rate of 0.88 cases per 1000 live births. Subsequently, an increase was observed from 2005 to 2009, reaching a rate of 1.52 cases per 1000 live births. In conclusion, the protective effect of folic acid is evidenced in the reduction of the rates of newborns with cleft palate during the first years of its implementation. However, an increase in these rates was subsequently observed, which could be due to noncompliance with the standard.

National Consultation-cum-Brain Storming Session on Fortification of Edible Salt with Micronutrients

Micronutrient malnutrition (MNM) can affect all age groups, but young children and women of reproductive age tend to be among those most at risk of developing micronutrient deficiencies. In India, Iodine Deficiency Disorders and Iron Deficiency Anaemia are important Public Health problems.No state in India is free from iodine deficiency. Out of 343 districts surveyed, 286 are reported have Iodine Deficiency Disorders. Iron Deficiency Anaemia is reported in about 60% population across all age groups. The magnitude of vitamin B12 Deficiency is reported to be about 47% in urban population of Delhi while Zinc Deficiency is reported in about 44% amongst Indian children. In addition, there are other micronutrients and minerals like folic acid which are of public health concern.

Assessment and Comparison of Microbiological Efficacy of Moxifloxacin plus Vancomycin Combined Therapy with Fortified Vancomycin in Bacterial Conjunctivitis

Background: Bacterial Conjunctivitis or red eye being highly communicable need to be tackle at the earliest. Newer antibiotics may kill bacteria more rapidly. Thus, we aim to assess and compare microbiological efficacy of Moxifloxacin (0.5%) plus Vancomycin (2.5%) combined therapy to Fortified Vancomycin (5%) in relation to organism isolated in positive culture of bacterial conjunctivitis. Methods: The present study was conducted on patients who presented at Ophthalmology OPD, Jawaharlal Nehru Medical College Hospital, Aligarh and Gandhi Eye Hospital, Aligarh. The patients with bilateral conjunctivitis were included in the study. Right eyes were instilled moxifloxacin plus vancomycin combination therapy and Left eyes were instilled fortified vancomycin. Microbiological outcomes were recorded on first visit and on follow up visits during course of treatment. Results: A total of 35 patients were included in the study. At first visit, 14 cases were positive with coagulase negative Staphylococcus (CoNS) being the most common organisms. All the positive smears became negative in first follow-up (3rd day) in both the groups. No significant difference was found in microbiological study outcome between the two-study groups. Conclusions: We conclude that both the drugs, i.e. moxifloxacin (0.5%) plus vancomycin (2.5%) combined therapy and fortified vancomycin (5%) had good efficiency in microbial elimination in cases of bacterial conjunctivitis with equivalent outcome and can be considered as an alternative to other antimicrobial therapy in bacterial conjunctivitis.

Diseño de un alimento infantil listo para consumir fortificado con hierro a base de arveja (Pisum sativum) / Design of a ready-to-eat child food fortified with pea-based iron (Pisum sativum)

Resumen Introducción: La deficiencia de hierro es uno de los problemas nutricionales más prevalentes a nivel mundial y afecta principalmente a la población vulnerable como niños menores de 5 años. Los alimentos fortificados de consumo infantil hacen parte de las estrategias de intervención y se elaboran a partir de la mezcla ingredientes como cereales, frutas, leguminosas, entre otros. La arveja, es una leguminosa que puede ser empleada con el fin de aprovechar sus propiedades nutricionales. Objetivo: Diseñar un alimento infantil con arveja (Pisum sativum) listo para consumir, fortificado con hierro e higienizado por pasteurización. Materiales y métodos: Se seleccionó el porcentaje de arveja adecuado en el alimento mediante análisis sensorial. La selección de la sal de hierro se realizó mediante análisis fisicoquímico y sensorial empleando sulfato ferroso y hierro aminoquelado. Posteriormente se evaluó el crecimiento de microorganismos mesófilos con el fin de seleccionar el tratamiento térmico de pasteurización. La evaluación de vida útil se llevó a cabo a través de pruebas sensoriales. Finalmente se realizó la evaluación fisicoquímica, composicional y microbiológica del alimento higienizado. Resultados: La adición de arveja en porcentajes no mayores al 6,5% dentro de la formulación del alimento resultó aceptable para los padres de niños menores de 5 años. Por otra parte la sal seleccionada por generar menos cambios sobre el color y la acidez del alimento durante el almacenamiento fue hierro aminoquelado. Los resultados de tratamiento térmico mostraron que para reducir la concentración inicial de mesófilos y obtener un alimento de buena calidad de acuerdo con la normativa colombiana vigente fue necesario someter el alimento a 85°C durante 13 minutos (0,45 D), con lo que se consiguió mantener la calidad inicial del alimento durante 12 días bajo refrigeración. Conclusiones: El alimento desarrollado cumple con los criterios sensoriales y microbiológicos exigidos en la normativa colombiana vigente y es apto para el consumo, además se puede catalogar como alto en hierro y buena fuente de proteína, aportando el 25% y el 15% de la recomendación diaria en Colombia respectivamente.

Abstract Introduction: Iron deficiency is one of the most prevalent nutritional problems at the global level which mainly affects the vulnerable population as children under 5 years of age. Fortified foods of child consumption are part of the intervention strategies, which are made from the mixture of ingredients such as cereals, fruits, legumes, among others. Pea is a legume that can be used in order to take advantage of its nutritional properties. Objective: To design a ready-to-eat child food with peas (Pisum sativum), fortified with iron and sanitized by pasteurization. Materials and methods: The appropriate percentage of peas in the food was selected by sensory analysis. The selection of iron salt was made by physicochemical and sensory analysis using ferrous sulphate and chelate iron. Subsequently, the growth of mesophilic microorganisms was evaluated in order to select the pasteurization heat treatment. The useful life evaluation was carried out through sensory tests. Finally, the physico-chemical, compositional and microbiological evaluation of the sanitized food was implemented. Results: The addition of peas in percentages not greater than 6.5% within the food formulation was acceptable for parents of children under 5. On the other hand, the selected salt to generate less changes on the color and acidity of the food during storage was chelate iron. The results of heat treatment showed that for reducing the initial concentration of mesophiles and obtaining a good quality food according to the Colombian regulations in force, it was necessary to submit the food to 85 °C for 13 minutes (0.45 D), which managed to maintain the initial quality of the food for 12 days under refrigeration. Conclusions: The developed food complies with the sensory and microbiological criteria demanded in the Colombian regulations in force and is suitable for consumption. Besides, it can be catalogued as high in iron and a good source of protein, contributing with 25% and 15% of the daily recommendation in Colombia, respectively.

Sociodemographic factors and overweight in children participating in a government program for fortified milk distribution / Fatores sociodemográficos e excesso de peso em crianças participantes de programa governamental de distribuição de leite fortificado

INTRODUCTION: Previous studies have shown the effectiveness of the VIVALEITE Project for promoting weight gain in children under two years old. Given the program´s effectiveness, children whose weight on entry was close to the normal limit for age may have become overweight during their participation OBJECTIVE: To analyze the association between sociodemographic factors and overweight in participants of the VIVALEITE Project METHODS: A cohort study with data on 1,039 infants from low-income families in the state of São Paulo enrolled on the Vivaleite Program at six months of age with a weight near the upper limit of adequacy between January 2003 and September 2008 was conducted. The proportion of children that became overweight during participation in the program and associations with sociodemographic conditions of each child (breastfeeding at six months, sex and birth weight) and mother/guardian (marital status, age, employment status and education) were investigated. Modeling was performed using multilevel logistic regression of socioeconomic variables and ages at weighing. The Stata program version 10.1 was used for analysis RESULTS: On multilevel analysis, the "yes" category of breastfeeding at six months (OR = 0.29, p = 0.001) and maternal employment (OR = 0.36, p = 0.012) were significantly associated with overweight in the children. The variables birth weight, sex, marital status, maternal age and education were not statistically associated with overweight CONCLUSIONS: The sociodemographic factors "not breastfeeding at six months" and "maternal unemployment" were positively associated with overweight among the infants participating in the program

INTRODUÇÃO: Estudos anteriores mostraram a efetividade do programa VIVALEITE para o ganho de peso de crianças menores de dois anos. Como o programa é efetivo, é possível que crianças ingressantes com peso próximo ao limite considerado adequado para idade o ultrapassem no decorrer de sua participação OBJETIVO: Analisar a associação entre fatores sociodemográficos e excesso de peso em participantes do programa VIVALEITE MÉTODO: Estudo de coorte com dados de 1.039 crianças de famílias de baixa renda do interior do Estado de São Paulo, ingressantes no programa com seis meses de idade e peso próximo ao limite superior de adequação, entre janeiro/2003 e setembro/2008. Investigou-se a proporção de crianças que ficam com excesso de peso durante a participação no programa e associações com as condições sociodemográficas de cada criança (amamentação aos seis meses, sexo, peso ao nascer) e dos respectivos responsáveis (condição conjugal, idade, situação de trabalho, escolaridade). A modelagem foi feita por meio de regressão logística multinível das variáveis socioeconômicas e o conjunto das idades de pesagem. O processamento foi feito com o pacote estatístico Stata 10.1 RESULTADOS: Conforme análise multinível, a categoria sim da variável aleitamento materno aos seis meses (OR=0,29, p=0,001) e a categoria trabalha da variável situação de trabalho materno (OR=0,36, p=0,012) foram associadas significantemente ao excesso de peso das crianças. As demais variáveis não foram associadas estatisticamente a excesso de peso CONCLUSÃO: Não amamentação aos seis meses e ausência de trabalho materno são fatores sociodemográficos positivamente associados ao excesso de peso das crianças participantes do programa

Folic Acid in Stroke Prevention in Countries without Mandatory Folic Acid Food Fortification: A Meta-Analysis of Randomized Controlled Trials / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Additional folic acid (FA) treatment appears to have a neutral effect on reducing vascular risk in countries that mandate FA fortification of food (e.g., USA and Canada). However, it is uncertain whether FA therapy reduces stroke risk in countries without FA food fortification. The purpose of this study was to comprehensively evaluate the efficacy of FA therapy on stroke prevention in countries without FA food fortification. METHODS: PubMed, EMBASE, and clinicaltrials.gov from January 1966 to August 2016 were searched to identify relevant studies. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between FA supplementation and risk of stroke, after pooling data across trials in a random-effects model. RESULTS: The search identified 13 randomized controlled trials (RCTs) involving treatment with FA that had enrolled 65,812 participants, all of which stroke was reported as an outcome measure. After all 13 RCTs were pooled, FA therapy versus control was associated with a lower risk of any future stroke (RR, 0.85; 95% CI, 0.77 to 0.95). FA alone or combination of FA and minimal cyanocobalamin (≤0.05 mg/day) was associated with a lower risk of future stroke (RR, 0.75; 95% CI, 0.66 to 0.86) whereas combination of FA and cyanocobalamin (≥0.4 mg/day) was not associated with a lower risk of future stroke (RR, 0.95; 95% CI, 0.86 to 1.05). CONCLUSIONS: FA supplement reduced stroke in countries without mandatory FA food fortification. The benefit was found mostly in patients receiving FA alone or combination of FA and minimal cyanocobalamin.