Effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical development in preterm infants.@*METHODS@#A computerized search was performed in the databases including China National Knowledge Infrastructure, Wanfang Data, Weipu, PubMed, Embase, and the Cochrane Library to identify randomized controlled trials of the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants. RevMan 5.3 software was used to perform a Meta analysis for the included studies.@*RESULTS@#A total of 7 randomized controlled studies were included. The results of Meta analysis showed that compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula could reduce the risk of neonatal necrotizing enterocolitis (RR=0.40, P=0.04) and feeding intolerance (RR=0.40, P=0.005), and had no significant effect on the growth of weight, length and head circumference (P>0.05).@*CONCLUSIONS@#Compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula in preterm infants may reduce the occurrence of necrotizing enterocolitis and feeding intolerance, and can meet the nutrient requirement of physical development. However, the evidence is limited, and the results of this study cannot support the routine prophylactic use of hydrolyzed protein formula in preterm infants.

Recomendaciones sobre la utilización de las fórmulas infantiles con proteína aislada de soya en la alimentación del lactante. Documento de posición basado en la evidencia / Recommendations on the use of infant formulas with isolated soy protein in infant feeding. Evidence-Based Position Paper

Antecedentes: Las fórmulas a base de proteína de soya (FBPS) se han utilizado desde hace tiempo como una alternativa para lactantes con requerimientos nutricionales especiales. Sin embargo, las indicaciones médicas para su uso, su alergenicidad, seguridad y eficacia aún son controvertidas. Objetivo: Presentar recomendaciones del uso de FBPS basadas en la literatura existente. Métodos: Se realizó la consulta de revisiones sistemáticas y guías de práctica clínica, por medio de algoritmos de búsqueda validados, y sistemas como AGREE (Appraisal of Guidelines for REsearch and Evaluation) II y PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Para la elaboración de las recomendaciones clínicas se analizaron y discutieron los tópicos de mayor importancia, por parte de los investigadores responsables y el grupo de expertos del desarrollo de un documento de posición. Se evaluó la calidad de la evidencia utilizando el sistema GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Resultados: Se encontraron distintos reportes con calidad de evidencia variable que sustentan la eficacia de las FBPS en el manejo de la alergia a la proteína de la leche de vaca y en la tolerancia digestiva del lactante, así como su baja alergia cruzada en comparación a la leche de vaca y otras fórmulas. También se encontraron otros estudios que indican la seguridad de las FBPS sobre distintos parámetros nutricionales, inmunitarios y de desarrollo. Existe además evidencia que demuestra que las FBPS tienen ventajas importantes en cuestión de costo-beneficio, palatabilidad y efectos sobre la microbiota intestinal, en comparación con otras fórmulas. Conclusiones: Aunque existe evidencia limitada para recomendar su utilización en los trastornos digestivos funcionales, las FBPS tienen un perfil de seguridad adecuado y continúan siendo una opción válida para la alimentación del lactante.

Abstract Background: Soy infant formulas (SIF) have long been used as an alternative for infants with special nutritional requirements. However, the medical indications for their use, their allergenicity, safety and efficacy are still controversial. Objective: To present recommendations for the use of SIF based on the existing literature. Methods: We consulted systematic reviews and clinical practice guides, through validated search algorithms, and systems such as Appraisal of Guidelines for REsearch and Evaluation (AGREE)II and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For the elaboration of the clinical recommendations, the most important topics were analyzed and discussed by the responsible researchers and the group of experts in the development of a position paper. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results: Several reports with variable quality of evidence were found. They support SIF’s efficacy in the management of cow’s milk allergy and infant’s digestive tolerance, as well as its low cross allergy compared to cow’s milk and other formulas. We also found other studies that indicate the safety of SIFs on different nutritional, immune and developmental parameters. There is also evidence that demonstrates that SIFs have important advantages in terms of cost-benefit, palatability and effects on the intestinal microbiota, compared to other formulas. Conclusions: Although evidence to recommend its use in functional digestive disorders is limited, SIFs have an adequate safety profile and are still a valid option for infant feeding.

Influência da diluição, do tempo e da temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos / Influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns

RESUMO Objetivo: Analisar a influência da diluição, o tempo e a temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos (RN). Métodos: Estudo experimental e descritivo com uma amostra de diferentes fórmulas lácteas neonatais para verificar a osmolalidade do leite segundo a diluição, o tempo e a temperatura pós-preparo. Foram analisadas sete fórmulas lácteas neonatais nos seguintes tempos: imediatamente (até 5 minutos) após o preparo; 20 e 40 minutos após o preparo; de hora em hora, até completar 8 h; e após 12 e 24 h de preparo. As amostras foram avaliadas após o preparo em temperatura ambiente e depois da refrigeração. Foram elaboradas curvas de osmolalidade com a média das triplicatas de cada amostra de leite. O cálculo da osmolalidade foi aferido no Osmômetro digital A+ da Advanced Instruments, modelo 3.320. Resultados: O tempo e a temperatura em que os leites ficaram submetidos após o preparo não ultrapassaram o ponto de corte de segurança da osmolalidade na diluição 1:30 em nenhum dos tipos de leite analisados. Na diluição 1:25 a fórmula láctea que possui prebióticos em sua composição ultrapassou o limite após 4 h de preparo. Conclusões: Os leites testados não ultrapassaram o ponto de corte de 450 mOsm/kg (aproximadamente 400 mOsm/L), indicado como seguro pela Academia Americana de Pediatria (AAP) na diluição preconizada pelos fabricantes. É necessário conhecer os fatores que podem ou não contribuir com o aumento da osmolalidade, afim de se estabelecer condutas seguras e de qualidade para os RN, seguindo protocolos baseados em evidências científicas.

ABSTRACT Objective: To analyze the influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns (NBs). Methods: Experimental and descriptive study with samples of different neonatal formulas to verify the osmolality of the milk according to dilution, time, and temperature after preparation. We analyzed seven neonatal formulas in the following times after preparation: immediately (up to 5 minutes); 20 and 40 minutes; every hour up to 8 hours; and 12 and 24 hours. The samples were evaluated at room temperature and after refrigeration. Osmolality curves were designed with the mean of triplicate samples of each milk sample. The digital Osmometer A+, model 3320, from Advanced Instruments measured the osmolality. Results: The time and temperature at which the milk was subjected after preparation did not cause the osmolality to exceed its safety cut-off point at a 1:30 dilution in any of the types of milk analyzed. At a 1:25 dilution, the formula with prebiotics in its composition went over the limit after 4 hours. Conclusions: The milk tested did not exceed the cut-off point of 450 mOsm/kg (approximately 400 mOsm/L), indicated as safe by the American Academy of Pediatrics (AAP) at a dilution recommended by manufacturers. It is important to know the factors that may or may not contribute to the rise of osmolality, in order to establish safe and quality practices for NBs, following protocols based on scientific evidence.

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

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

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

Thickeners sold in Brazil: analysis of the composition and suitability for children under the age of 3 / Espessantes comercializados no Brasil: análise da composição e da adequação para crianças menores de 3 anos

Introduction: Thickeners are used in the treatment of swallowing disorders, named dysphagia. In Brazil there is no specific product for the pediatric population who under the age of 3 years. Objective: To analyze the different types of thickeners available in Brazil, considering their chemical composition and their use in pediatrics. Methods: Quantitative study, with descriptive approach based on the data collection. The brands of existing thickeners were analyzed in Brazil and their composition in relation to the Codex Alimentarius and nutritional recommendations for children from 0 to 3 years. Results: Eight brands were studied, three of which proved to be inappropriate for pediatric use because they have gum in their formulation. Other thickeners brands did not present inadequacies for use in the age group from 0 to 3 years old regarding to the type of carbohydrate, sodium content and total caloric value. Conclusion: In Brazil, 5 thickeners brands present in their composition levels of sodium and profile of carbohydrate adequate for children from 0 to 3 years, even when they are associated with infant formulas.(AU)

Introdução: Os espessantes são utilizados no tratamento dos distúrbios de deglutição, denominados disfagia, porém, no Brasil, não há produto específico para a população pediátrica menor de 3 anos. Objetivo: Analisar os diferentes tipos de espessantes disponíveis no Brasil, considerando sua composição química e sua utilização em pediatria. Método: Estudo quantitativo, do tipo descritivo com base no levantamento de dados. Foram analisadas as marcas de espessantes existentes no Brasil quanto a sua composição em relação ao Códex Alimentarius e recomendações nutricionais para crianças de 0 a 3 anos. Resultados: Foram estudadas oito marcas, das quais três mostraram-se inadequadas para utilização pediátrica, por possuírem goma em sua formulação. As demais marcas de espessantes não apresentaram inadequações para uso na faixa etária de 0 a 3 anos de idade no que se refere ao tipo de carboidrato, teor de sódio e valor calórico total. Conclusão: No Brasil, 5 marcas de espessantes apresentam em sua composição teores de sódio e perfil de carboidratos adequados para crianças de 0 a 3 anos, mesmo quando associadas a fórmulas infantis.(AU)

Fósforo fítico y actividad de fitasa en fórmulas infantiles basadas en cereales

El ácido fítico es un ácido orgánico presente en granos de cereales. El fósforo contenido en su molécula (PFi) no es absorbible por una baja solubilidad, aunque su biodisponibilidad puede incrementarse por la actividad de enzimas fitasas (AFi). Con el objetivo de cuantificar el contenido de PFi y AFi en suplementos elaborados a partir de cereales y destinados a infantes lactantes, se seleccionaron cinco fórmulas de amplia distribución en mercados locales,identificadas de acuerdo a los cereales base de su composición como: A (arroz), T (trigo), ATS (arroz, trigo y aislado de soya), ATM (arroz, trigo y maíz) y ATMS (arroz, trigo, maíz y aislado de soya). Se tomaron cinco muestras por fórmula, cada una correspondiente a un envase (400 a 500 g) elaborado en lotes diferentes y con fecha de vencimiento posterior al muestreo. La proteína cruda varió de 16,8 a 7,2%, con el mayor valor para ATS, y los menores para T y ATM (P< 0,01). El extracto etéreo mostró un rango de 0,31 a 0,75%, mientras la relación calcio:fósforo entre 1,6 en ATM y 1,1 para el resto. El PFi representó el 61,5% del fósforo total en T, con diferencias (P< 0,01) respecto al resto (39,9 ± 6,8%). Sólo se detectó AFi en ATM, T y ATS (570, 300 y 152 U/kg, respectivamente). Se concluye que la composición química se ajustó a lo reportado por los fabricantes, con un elevado contenido de PFi y una AFi fundamentalmente asociados a la presencia de trigo en las fórmulas.

Phytic phosphorus and phytase activity in cerealbased infant formulas. Phytic acid is an organic acid present in cereal grains. The phosphorus inside its molecule (PPhy) is not available because of its low solubility, though the bioavailability could be increased by the activity of phytase enzymes (PhyA). With the purpose of quantifying the PPhy and PhyA in supplements manufactured from cereals and intended for lactating infants, five formulas of wide distribution in local markets were selected and identified depending on the main vegetable ingredients as A (rice), T (wheat), ATS (rice, wheat and soy isolate), ATM (rice, wheat and maize) and ATMS (rice, wheat, maize and soy isolate). Five samples were taken from each formula, each one corresponded to a commercial brand (400 to 500 g), coming from different batches and before their expiration date. The crude protein ranged from 7.2 to 16.8%, with de highest value for ATS and the lowest for T and ATM (P< 0.01). Ether extract varied from 0.31 to 0.75%, while the calcium: phosphorus ratio from 1.6 for ATM, to 1.1 for the rest. The PPhy was 61.5% of the total phosphorus in T, with differences (P<0.01) compared to the other formulas (39.9 ± 6.8%).PhyA was only detected in ATS, T and ATM (152,300 and 570 U/kg, respectively). The chemical composition complied with the manufacturer report, with a high content of PPhy and PhyA associated to the wheat presence in the formula.

α-Lactoalbúmina como ingrediente de fórmulas infantiles

La α-lactoalbúmina es la principal proteína del lactosuero en la leche materna, alcanzando una concentración de 2,44 g/L en la leche madura. Su principal función es la síntesis de lactosa a partir de glucosa y galactosa en la glándula mamaria, aunque posee además otros efectos beneficiosos sobre la salud del lactante debido a su elevada proporción de aminoácidos esenciales (triptófano y cisteína). Según diversos estudios parece influir positivamente en la absorción de hierro en el intestino del niño, y en experimentos in vitro, unida al ácido oleico (complejo HAMLET), es efectiva frente a tumores celulares como el papiloma humano. El complejo HAMLET también presenta un claro efecto antimicrobiano frente a Streptococcus pneumoniae, Haemophilus influenzae, cepas enteropatógenas de Escherichia coli y Salmonella thypimurium, sin embargo no se ha demostrado que durante la digestión de la leche materna se forme dicho complejo en el tracto digestivo del lactante. El desarrollo de fórmulas infantiles destinadas a la alimentación del niño durante el primer año de vida ha mejorado considerablemente en las últimas décadas intentando no sólo adecuar la concentración de nutrientes a los requerimientos del lactante, sino también adicionando compuestos bioactivos de diferente naturaleza, como la α-lactoalbúmina, con el objetivo de alcanzar los efectos funcionales que se producen en los niños alimentados con leche materna.

α-Lactalbumin as an ingredient of infant formula. α-lactalbumin is the main whey protein in human milk rising 2,44 g/L in mature milk. It has a key function in the synthesis of lactose from glucose and galactose in the mammary gland although this compound has also other beneficial effects on the infant health due to the high proportion of essential aminoacids (tryptophan and cysteine). It seems also to increase iron absorption in the digestive track, and in in vitro experiments, linked to oleic acid (HAMLET complex), has shown anticarcinogenic effects against cellular tumor such as human papilloma. In addition, this complex has been reported to exhibit antimicrobial properties against Streptococcus pneumoniae,Haemophilus influenzae, enteropathogenic strains of Escherichia coli and Salmonella thypimurium. However, the in vivo synthesis of HAMLET complex during milk digestion has not been proved yet. Infant formula have been improved considerably during the last decades not only adapting nutrient concentrations to infants requirements but also by the addition of new bioactive ingredients such as α-lactalbumin, to have the same functional effect as in breast fed babies.

Probióticos e prebióticos na prevenção e no tratamento de doenças em lactentes e crianças / Probiotics and prebiotics in prevention and treatment of diseases in infants and children

OBJETIVO: Avaliar o impacto do uso de probióticos e prebióticos na saúde das crianças. FONTES DOS DADOS: Foram pesquisados os bancos de dados MEDLINE e LILACS, selecionando-se artigos relevantes em inglês e francês. SÍNTESE DOS DADOS: O leite humano é rico em oligossacarídeos prebióticos e pode conter probióticos. Não existem dados sugerindo que a adição de probióticos a fórmulas para lactentes possa ser prejudicial, mas as evidências de sua eficácia são insuficientes para que seja recomendada. Visto que dados sugerem que a adição de oligossacarídeos prebióticos específicos pode reduzir infecções e atopia em lactentes saudáveis, sua adição parece razoável. Os benefícios a longo prazo dos pro e prebióticos para o sistema imunológico em desenvolvimento ainda precisam ser comprovados. Probióticos selecionados reduzem a duração da diarreia infecciosa em 1 dia, mas faltam evidências quanto à prevenção, exceto na diarreia associada a antibióticos. Alguns probióticos específicos previnem a enterocolite necrosante, e outros micro-organismos podem ser benéficos nos casos de gastrite por Helicobacter pylori e de cólica do lactente. Não há evidências suficientes para recomendar o uso de probióticos na prevenção e no tratamento da dermatite atópica. A utilização de probióticos nos casos de constipação, síndrome do intestino irritável, doença inflamatória intestinal e infecções extraintestinais requer mais estudos. CONCLUSÕES: A duração da administração, a dosagem microbiana e as espécies utilizadas necessitam de maior validação, tanto para probióticos quanto para prebióticos. Alegações de saúde injustificadas são uma grande ameaça ao conceito de pro e prebióticos.

OBJECTIVE: To evaluate the impact of probiotics and prebiotics on the health of children. SOURCES: MEDLINE and LILACS were searched for relevant English and French-language articles. SUMMARY OF THE FINDINGS: Human milk is rich in prebiotic oligosaccharides and may contain some probiotics. No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation. Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable. Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven. Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea. Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic. Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis. The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies. CONCLUSIONS: Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics. Unjustified health claims are a major threat for the pro- and prebiotic concept.

Acolhimento e características maternas associados à oferta de líquidos a lactentes / Acogimiento y características maternas asociadas a la oferta de líquidos a lactantes / User embracement and maternal characteristics associated with liquid offer to infants

OBJETIVO: Identificar características maternas e ações de acolhimento às mães de crianças menores de seis meses associadas à oferta precoce de líquidos. MÉTODOS: Estudo transversal realizado em 2007 com amostra representativa de mães de crianças menores de seis meses (n = 1.057) usuárias de unidades básicas de saúde (UBS) na cidade do Rio de Janeiro, RJ. Para estimar a associação entre as variáveis explicativas e a oferta de líquidos utilizou-se um modelo de regressão logística multivariado com ponderação, efeito de desenho e controlado pela idade da criança. RESULTADOS: Das mães, 32 por cento não recebeu o cartão de acolhimento na maternidade, 47 por cento não recebeu orientação sobre amamentação na primeira ida à UBS após o parto e 55 por cento relatou a oferta de líquidos aos lactentes. Mulheres sem experiência pregressa em amamentar por pelo menos seis meses apresentaram chance de oferta de líquidos maior que aquelas com experiência (OR = 1,57; IC 95 por cento: 1,16;2,13)...

OBJECTIVE: To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS: Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS: Of all mothers, 32 percent did not receive the welcoming card in the maternity hospital, 47 percent did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55 percent reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95 percent CI: 1.16;2.13)...

OBJETIVO: Identificar características maternas y acciones de acogimiento en las madres de niños menores de seis meses asociadas a la oferta precoz de líquidos. MÉTODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de niños menores de seis meses (n=1.057) usuarias de unidades básicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociación entre las variables explicativas y la oferta de líquidos se utilizó un modelo de regresión logística multivariada con ponderación, efecto de diseño y controlado por la edad del niño. RESULTADOS: De las madres, 32 por ciento no recibieron la tarjeta de acogimiento en la maternidad, 47 por ciento no recibieron orientación sobre amamantamiento en la primera ida a la USB posterior al parto y 55 por ciento relataron la oferta de líquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de líquidos mayor que aquellas con experiencia (OR=1,57;IC 95 por ciento:1,16;2.13)...

Alimentação complementar: práticas inadequadas em lactentes / Complementary feeding: inappropriate practices in infants

OBJETIVO: Avaliar as práticas e o consumo alimentar de lactentes saudáveis de três metrópoles do Brasil. MÉTODOS: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, São Paulo e Recife, de 179 lactentes saudáveis, entre 4 e 12 meses, que não se encontravam em aleitamento materno (AM) exclusivo. As mães receberam orientação verbal e escrita, por nutricionista, visando a uniformização da anotação do registro alimentar. Para o cálculo de ingestão, utilizou-se o Programa de Apoio à Nutrição (NutWin). RESULTADOS: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3 por cento já não recebiam AM. Destes, 12,0 e 6,7 por cento dos menores e maiores de 6 meses, respectivamente, utilizavam fórmulas infantis em substituição ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluição da fórmula infantil foi correta em apenas 23,8 e 34,7 por cento das crianças menores e maiores de 6 meses, respectivamente. Em relação à alimentação complementar, observou-se que a mediana de idade foi de 4 meses para sua introdução e de 5,5 meses para a alimentação da família. Verificou-se elevada inadequação quantitativa na ingestão de micronutrientes para lactentes de 6 a 12 meses que não recebiam AM, destacando-se as de zinco (75 por cento) e ferro (45 por cento). CONCLUSÃO: O presente estudo mostrou elevada frequência de práticas e consumo alimentar inadequados em lactentes muito jovens. É possível que essas práticas levem a aumento no risco de desenvolvimento futuro de doenças crônicas.

OBJECTIVE: To assess feeding practices and dietary intake of healthy infants in three Brazilian municipalities. METHODS: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. RESULTS: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3 percent of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7 percent among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7 percent of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75 percent) and iron (45 percent). CONCLUSION: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

Zinc and copper concentrations in human milk and infant formulas

Available accurate data on the concentrations of copper [Cu] and zinc [Zn] in human milk throughout lactation and infant formulas is important both for formulating nutritional requirements for substances and to provide a base line for the understanding the physiology of their secretion. The objective of this study was to analyze the concentrations of zinc and copper in infant formulas and human milk during prolonged lactation. Levels of these metals were examined in relation to selected parameters such as age, weight, height, education and occupation of mothers. Thirty mothers referred to the selected clinics in Tehran entered the study. Human milk samples were collected at 2 months postpartum. Zinc and copper concentrations were determined by atomic absorption spectrophotometer. The mean values of Zn and Cu in human milk were 2.95 +/- 0.77mg/L and 0.36 +/- 0.11 mg/L. The mean values of Zn and Cu in infant formulas were 3.98 +/- 0.25 mg/L and 0.53 +/- 0.17mg/L. No significant relationship was found between levels of trace elements in human milk and evaluated parameters such as age, weight, height, education and occupation of mothers. The concentrations of zinc and copper in breast milk were lower than those reported in the literature

Absorção do ferro da fórmula para lactentes e do leite de vaca fortificado: modelo experimental em ratos recém-desmamados / Iron absorption from infant formula and iron-fortified cow's milk: experimental model in weanling rats

OBJETIVO: Comparar a absorção do ferro da fórmula de partida e do leite de vaca integral fortificado. MÉTODOS: Foram utilizados 24 ratos machos Wistar recém-desmamados, mantidos em gaiolas metabólicas durante todo o período do experimento (10 dias). No primeiro dia, os animais foram distribuídos em três grupos semelhantes quanto ao peso, comprimento, hematócrito e hemoglobina: 1) fórmula de partida para lactentes; 2) leite de vaca integral em pó fortificado com a mesma quantidade e tipo de sal de ferro da fórmula; e 3) controle - leite de vaca integral em pó não fortificado com ferro. Água e dieta foram oferecidas ad libitum com mensuração do volume consumido. Peso, hematócrito e hemoglobina foram mensurados no quinto e no 10º dia do experimento, quando foram analisados também comprimento, sangue oculto nas fezes e teor de ferro hepático. RESULTADOS: O grupo 1 ingeriu menor volume de dieta (450,5±26,50 mL) que os grupos 2 (658,8±53,73 mL) e controle (532,7±19,06 mL; p < 0,001). As concentrações de hemoglobina foram maiores (p < 0,001) no grupo 1 (12,1±1,13 g/dL) que nos grupos 2 (9,6±1,59 g/dL) e controle (6,2±0,97 g/dL). O teor de ferro hepático apresentou o mesmo comportamento da hemoglobina (p < 0,001). Não foi observada diferença de peso e comprimento nos três grupos (p = 0,342). Não foi detectado sangue oculto nas fezes de nenhum dos animais. CONCLUSÕES: Apesar do menor volume ingerido, o grupo que recebeu fórmula apresentou maior absorção de ferro e concentração de hemoglobina que o grupo que recebeu leite de vaca integral fortificado. O crescimento foi semelhante nos três grupos.

OBJECTIVE: To compare iron absorption from infant formula and iron-fortified cow's milk. METHODS: Twenty-four weanling Wistar rats were maintained in metabolic cages during the whole experiment (10 days). On the first day, the animals were divided into three similar groups according to their weight, length, hematocrit and hemoglobin levels: 1) infant formula; 2) powdered whole cow's milk fortified with iron in the same quantity and type as the formula; 3) control - powdered whole cow's milk not fortified with iron. Deionized water and diet were offered ad libitum, and the volume consumed was measured. Weight, hematocrit, and hemoglobin levels were measured on the fifth and 10th days when length, fecal occult blood, and hepatic iron levels were also analyzed. RESULTS: Group 1 consumed less diet (450.5±26.50 mL) than group 2 (658.8±53.73 mL) and control group (532.7±19.06 mL, p < 0.001). Hemoglobin levels were higher (p < 0.001) in group 1 (12.1±1.13 g/dL) than in group 2 (9.6±1.59 g/dL) and in control group (6.2±0.97 g/dL). Hepatic iron level showed the same pattern as hemoglobin (p < 0.001). There was no difference in weight and length between the three groups (p = 0.342). There was no fecal occult blood in the any of the animals. CONCLUSIONS: Despite the lower volume consumed, the group that received formula presented higher iron absorption and hemoglobin levels than the group fed with fortified whole cow's milk. Growth was similar in the three groups.

Papel de las poliaminas en la alimentación: Importancia de las poliaminas en la alimentación infantil

Durante la década de los 90 del siglo pasado comenzaron los primeros estudios que señalaban a las poliaminas como importantes factores de crecimiento de la leche materna. Sin embargo, todavía se desconoce mucho sobre el papel que desempeñan en la alimentación infantil y cual sería la ingesta recomendada para este grupo poblacional. En los últimos años va siendo cada vez mayor la atención que muestra la comunidad científica internacional hacia las poliaminas, debido no sólo al importante papel que desempeñan en el metabolismo celular, sino por su posible participación en diversas patologías y durante el desarrollo del organismo. Sería recomendable, teniendo en cuenta que el contenido en poliaminas de las fórmulas infantiles es unas 10 veces menor al de la leche materna, profundizar más en este campo, con el fin de garantizar una correcta alimentación durante la etapa de lactancia.

Role of polyamines in diet. Importance of polyamines in infant nutrition. The first studies indicating polyamines as important growth factors in breast milk began during the nineties of last century. Nevertheless, it is still not well known the role they play in infant nutrition or what the recommended intake would be for this population group. In recent years, there has been increased attention of the international scientific community towards polyamines, not only due to the important role they play in the cellular metabolism, but also to their possible implication in some diseases and during the development of the human organism. Bearing in mind that the content in polyamines of the infant formula is around tenfold less than in breast milk, it would be recommended to gain insight into this theme in order to guarantee correct nutrition during lactation.

Residuos de plaguicidas organoclorados en leches infantiles y productos lácteos y su evaluación del riesgo / Risk assessment of organochlorine pesticides residues in infant milks and milk products

Se considera que la población infantil es el grupo mas sensible a los contaminantes provenientes de la ingesta de alimentos y debido a la alta relación consumo/ peso corporal. En vista de la problemática mundial de la contaminación ambiental por plaguicidas en Argentina no existe hasta el momento información sobre ingestas deplaguicidas y evaluación del riesgo en este grupo. Los alimentos infantiles (leches y productos lácteos) cubren una parte importante de los requerimientos nutricionales diarios para esta población pero al mismo tiempo puede contribuir con la exposición a contaminantes.El presente trabajo fue realizado a fin de investigar plaguicidas en alimentos especialmente desarrollados y recomendados para neonatos y niños. Se analizaron residuos de plaguicidas organoclorados en 50 muestras de leches maternizadas y en 51 muestrasde productos lácteos (postres y yugures) recogidas en el mercado local de Buenos Aires durante el período febrero de 2001 a diciembre de 2003. La investigación fue realizada mediante cromatografía gaseosa con detector de captura de electrones e inyección automática. Los resultados fueron expresados en ng/mL y se consideraron los siguientes grupos: €Aldrinas;€Clordano; €DDT; €Endosulfán; €HCH; €Heptacloro; Endrin; HCB y Lindano. Con los resultados obtenidos se calculó la Ingesta Diaria Estimada (IDE) en base al consumo de alimentos lácteos y el peso corporal. Los resultados fueron comparados con las IDAs recomendadas por el Codex Alimentarius. De las 101 muestras analizadas el 10 % no contiene ninguno de los plaguicidas investigados, 24,8% contiene al menos un pesticida, 19,7% contiene dos y el 2 % mostró evidencia de siete u ocho plaguicidas organoclorados de los diferentes grupos. De todos los grupos de pesticidas investigados las €Aldrinas y €DDT tuvieron porcentajes representativos (32%), y el€Heptachlor y €HCH las frecuencias mas elevadas, (57%) y (53%) respectivamente...

Children population is considered the most sensitive group to contaminants by food intake due to the high ratio food consumption/ body weight. Despite the worldwide problematic of pesticides environmental pollution in Argentine untilthis moment does not exist data about pesticide intake and risk assessment in this group. Baby food (milk and milk products) cover an important part of the daily nutritional requirements of this population but as the same time could contribute with the exposure to contaminants. The present work was aimed to investigate pesticides in products specially manufactured and recommended for neonates andinfants. Organochlorine pesticides residues were assessed on 50 milk samples and 51 milk products colleted at different local markets at Buenos Aires, between February 2001 and December 2003. The pesticides determination was performed by gas chromatography electron capture detection. The results were expressed in ng/mL and it was considered the following groups:€Aldrins; €Chlordane; €DDT; €Endosulfan; €HCH; €Heptachlor; Endrin; HCB and Lindane. With the result obtained the Estimate Daily Intake (EDI) was calculated on the basis of the daily consumption and the average body weight. The result obtained wascompared with the Acceptable Dialy Intake (ADI) recommended by the Codex Alimentarius. Among 101 samples analyzed, 10% did not contain pesticides residues, 24.8% contained at least one pesticide, 19.7% containedtwo and 2% showed evidence of seven and eight organochlorine pesticides. Among all pesticides groups investigated€Aldrins and €DDT had representative percentages (32%), and €Heptachlor (57%) and €HCH (53%) were the highest frequency groups...

Alimentación del niño menor de 2 años: recomendaciones de la rama de nutrición de la Sociedad Chilena de Pediatría / Alimentation in children under 2 years: recommendations of the nutritional section of the Chilean Pediatric Society

Los patrones de alimentación adquiridos durante los primeros años son importantes en el crecimiento y desarrollo y pueden afectar las preferencias alimentarias en etapas posteriores. Los problemas nutricionales en Chile han cambiado en los últimos años, la prevalencia de obesidad infantil ha aumentado. Por otro lado, con la información científica disponible los organismos internacionales han propuesto modificaciones a los requerimientos de energía y de otros nutrientes para las distintas edades. Este artículo actualiza y propone nuevas recomendaciones de alimentación para población chilena durante los primeros dos años de vida.

Randomized, double-blind clinical trial of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea.

BACKGROUND: Refeeding of artificially fed infants with lactose-containing formula after oral rehydration therapy in the treatment of acute diarrhea was concluded to be indifferent to non-lactose formula by a meta-analysis. In Thai as well as Asian infants and children with low lactase level from genetically determinant and with rotavirus infection, lactose malabsorption is most likely to occur and cause delayed recovery. The aim of this study was to compare the effect of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea. PATIENTS AND METHOD: A randomized, double-blind clinical trial of 80 male children, formula-fed, aged 3 to 24 months, admitted with acute watery diarrhea and mild or moderate dehydration, was carried out. All children received oral rehydration therapy for the first 4 hours. After appropriate rehydration, they were fed either a lactose-free formula (Dumex Lactose-Free Formula; treatment group, n = 40) or a lactose-containing formula (Dumex Infant Formula; control group, n = 40) in adjunction with oral rehydration solution. In addition, the infants were fed rice gruel as tolerated. Comparisons of duration of diarrhea, weight gain, vomiting, biochemical changes, stool frequency and weight and unscheduled intravenous fluid were made. RESULTS: Three children (2 treatment, and 1 control) dropped out from the study. The total number of unscheduled intravenous infusions were 6 of 80 children (7.5%), including 2 (5.0%) in the treatment group and 4 (10.0%) in the control group. Three children in the control group did not resolve from diarrhea within 7 days of treatment. Rotavirus was identified in approximately 50% of the children in each group. Using survival analysis, the median duration of diarrhea was significantly shortened by 20.5 hours in the treatment group compared to the control group (77.0 hours in the treatment group vs 97.5 hours in the control group; P = 0.002). Significantly decrease in stool frequency and increase in percent weight gain were seen in the treatment group at 24 hours. Moderate acidosis cleared up to near normal at 24 hours in the treatment group but acidosis persisted in the control group. In the rotavirus diarrhea subgroup, moderate acidosis turned to be mild in treatment group, but acidosis was unchanged with increased plasma chloride level in the control at 24 hours thus suggesting that the children in the control group might have lactose malabsorption and osmotic diarrhea. Duration of rotavirus diarrhea was shortened 23.6 hours in treatment group compared to the control (P = 0.0034). CONCLUSIONS: In this study, lactose-free formula was shown to be effective in the dietary management of acute childhood diarrhea. Duration of diarrhea was shortened, weight gain was better, and stool frequency was less when compared to lactose-containing formula. Moderate acidosis cleared up spontaneously at 24 hours. Unscheduled IV could be decreased by 50%. Children receiving lactose-free formula tolerated it well. Data of subgroup analysis of rotavirus diarrhea revealed lactose-free formula scored higher than the control group for all parameters studied.