INVESTIGACION EN NUTRICION Y ALIMENTACIÓN PEDIÁTRICAS (Revista on-line) INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1. #1-35. http:// www.seinap.org CONSEJO DE REDACCIÓN EDITORES - Director: M. Bueno M. Moya - Secretaria: M. Juste E. Cortés - Consejeros: A. Carrascosa, A. Gil, D. Infante, R. Leis y L. Ros ISSN: 1988-5997 SUMARIO DE ESTE NÚMERO Numeral Editorial: - M. Moya. Editorial. #1 Índice Glicémico: - M. Moya. Índice Glicémico. Tablas de índice glicémico. #2 Artículos: - M. Bueno. Colesterol y patología embriofetal. - M. Moya. Polisacáridos dietéticos. #3-#4 Abstracts SEINAP 03 #5-#35
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INVESTIGACION EN NUTRICION Y ALIMENTACIÓN PEDIÁTRICAS (Revista on-line)
M. Moya. Editorial. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 001. http:// www.seinap.org El Boletín Electrónico de Nutrición y Alimentación Pediátricas nace y se desarrollará en el nuevo contexto que permite Internet, marcado por la accesibilidad y el dinamismo de preguntas-respuestas. Ha sido diseñado como boletín y no como revista porque su contenido en estos momentos no podría cumplir los requisitos que una revista seria exige. Ello no quiere decir que el nivel científico que tendrá será menor o personalista, cualquier “artículo” que aparezca en él será evaluado por dos referees ad hoc. Siguiendo la tendencia actual, podrá ser referenciado, de tal forma que el presente número es el Bol E Nutr Alm Pediatr 2003 (1) y el texto (editorial, actualidad nutricional,…) viene identificado por el numeral # 00 – que se le asigne, una vez aceptado. La previsión es de dos números por año.Las normas, flexibles, de publicación estarán marcadas por la concisión (no más de 500 palabras, no más de 2 referencias) del comentario o de la presentación de datos originales. Por la cobertura que permite la red, el lenguaje preferible será el inglés, pero en el momento actual ambos idiomas, español e inglés, serán los utilizados.El contenido del Boletín estaría estructurado bajo cuatro epígrafes: Editorial, Actualidad Nutricional, Tendencias en Alimentación Pediátrica y Abstracts de los Congresos de SEINAP. En la red estaría el último número, pero se podrá acceder a los anteriores en formato PDF.Como es norma de SEINAP, la apertura de pensamiento es el determinante principal de esta publicación y si usted querido compañero decide ser un autor o correlator, verá como no se sentirá decepcionado.
- M. Moya. Indice Glicémico. Interés práctico de ésta creciente información.Indice Glicémico. Interés práctico de ésta creciente información. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 002. http:// www.seinap.org Lo que comenzó como una curiosidad informativa en el etiquetado de algunos alimentos en Australia, se va extendiendo por el mundo occidentalizado. Ello suscita numerosas cuestiones de tipo práctico pero también de índole científica y que requieren unos conceptos claros sobre este parámetro que ha rebasado el límite de las dietas para diabéticos para entrar en el campo de la dieta más saludable del niño y del adolescente, en nuestro caso El IG es una forma de valorar los efectos de un alimento sobre los niveles de glucemia. Se define como el incremento del área debajo de la curva de glicemia que sigue al consumo del alimento que proporciona 50 g de carbohidratos, y se expresa como la proporción de la respuesta que produce la ingestión de 50 g de glucosa pura (antiguamente 50 g de pan blanco). El índice glicémico de alimentos con varios componentes, se obtiene por sumación de los IG de cada alimento individual. Nótese que el IG es de los alimentos y no de las personas. El término de “carga de carbohidratos” (IG por gramos ingeridos), se correlaciona en el adulto con complicaciones cardiovasculares.En principio la altura y duración de la curva del IG, depende del tipo de azúcar (sacarosa, fructosa) de la naturaleza y forma de los almidones, del tipo de cocinado así como de la presencia de otros principios inmediatos (grasa) y por último de la situación metabólica del individuo. Siempre se ha pensado que productos que se metabolizan rápidamente tras la digestión (el arroz) tendrían un IG alto y por el contrario aquellos con un metabolismo más lento (legumbres) liberarían glucosa más lentamente al torrente sanguíneo. Sin embargo la medición de este parámetro ha deshecho algunos mitos. Algunos carbohidratos complejos (arroz, pan, patatas) con pretendida absorción y liberación lentas, se ha visto que no es el caso y que éstas son rápidas e incluso mayores que la de la sacarosa de algunos dulces que muestran un IG moderado. Existe una clasificación de todos los alimentos en tres grupos: Alimentos con un IG bajo (< 55) tal como los fideos, pasta, lentejas...; con un IG medio (55-70), plátano no maduro oinclusolasacarosayconunIGalto(>70), pan, patatas, arroz blanco. Todo ello no pasaría de ser una curiosidad fisiológica sino fuera porque los alimentos con IG alto, comportan una mayor secreción de insulina con los riesgos que ello conlleva, como son los estados crónicos de hiperinsulinismo. Es bien conocida la relación de la alimentación con IG alto (e hiprerinsulinismo) en el mantenimiento de la diabetes y enfermedad cardiovascular. Quizás de mayor impacto en nuestro trato diario con pacientes esté el hecho de que alimentos con IG bajo producen mayor sensación de saciedad. El consumo de dietas con IG bajo disminuyen el nivel de triglicéridos y aumentan el HDL colesterol según la experiencia finlandesa reciente. Otro aspecto digno de tenerse en cuenta es que las dietas ricas en alimentos con IG bajos decrecen los niveles plasmáticos postprandiales de ácidos grasos libres, con la consiguiente optimización de la incorporación al músculo de glucosa mediada por la insulina. Esto sería de mayor aplicación a la creciente población de diabéticos infantiles, pero también está dentro de las acciones para reducir peso en la obesidad infantil. A modo de conclusión se puede decir que los alimentos con IG bajo probablemente son beneficiosos pero ello no debe desplazar la atención sobre la calidad y cantidad de grasas, de proteínas o de la sal de la dieta habitual. Irwin T. A new glycemic index labelling programme for Australia. Nutrition Bulletin 2001; 26: 317-8 Foster- Powell K. Holt SHA, Brand-Meller JC. International tables of glycemic index and glycemic load values . Am J Clin Nutr 2002; 76: 5-56
CORRESPONDIENTE, ASÍ COMO SU CONTENIDO EN GRASA Y CARBOHIDRATOS
AZÚCARESFructosa, pura, 10g 23 0 10Lactosa, pura, 10 g 46 0 10Maltodextrina, pura, 10 g 105 0 10Miel, 1 cucharada, 20g 58 0 16Sacarosa, 1 cucharada 65 0 5BEBIDAS SINCola-Cola, 1 lata, 375 ml 63 0 51Deportiva 'Gatorade', 250 ml 78 0 15Deportiva 'Isostar', 250 ml 70 0 18Fanta, 375 ml 68 0 51Lucozade, original, 1 botella, 300 ml 95 <1 56BOLLERÍABagel (bollo salado) 1 blanco, 70g 72 1 35Bizcocho, 1 ración, 60g 46 16 32Bollo para hamburguesa, 1, 50g 61 3 24Bollo, 1 tostado, 50g 69 0 22Croissant, 1 67 14 27Doughnut con canela y azúcar, 40g 76 8 16Magdalena, 1, 80g 59 8 41Magadelana integral, 1, 80g 60 8 34Magdalena de manzana, 1, 180 g 44 10 44CEREALES DESAYUNOCheerios, 30g 74 2 20Coco Pops, 30g 77 0 26Cornflakes, 30g 84 0 26All-Bran, 40g 42 1 22Mini Wheats (trigo entero), 30g 58 0 21Muesli, sin tostar, 60g 56 6 32Muesli, tostado, 60g 43 9 33Rice Krispies, 30g 82 0 27Trigo hinchado, 30g 80 1 22Weetabix, 2 galletas, 30g 69 1 19Special K, 30g 54 0 21CEREALES EN GRANO Y MOLIDOSArroz blanco basmati cocido, 180g 58 0 50Arroz blanco glutinoso al vapor, 174g 98 0 37Avena cocida con agua, 245g 42 2 24Avena, cruda, 1 cucharada, 10g 55 1 7Cebada, cocida, 80g 25 1 17Gachas de avena, hechas con agua, 245 g 42 2 24Harina maíz integral, cocida, 40g 68 1 30Maíz dulce cocido, 80g 55 1 16Mijo, cocido, 120 g 71 0 12Salvado de arroz, 1 cucharada, 10 g 19 2 3Salvado de avena, 1 cucharada, 10g 55 1 7Salvado de avena, cruda, 1 cucharada, 10 g 55 1 7Sémola, cocida, 230 g 55 0 17Tapioca, cocida al vapor durante 1 hora, 100 g 70 6 54Tapioca, cocida con leche, 250g 81 10.5 51CHOCOLATEChocolate con leche, 6 onzas, 30g 49 8 19Barritas Mars, 60g 68 11 41FRUTAS Y ZUMOS
Albaricoques en lata, con poco jugo, 125 g. 64 0 13Albaricoques frescos, 3 medianos, 100g 57 0 7Albaricoques secos, 5-6 piezas, 30 g. 31 0 13Cerezas, 20 unidades, 80g 22 0 10Ciruelas, 2-4 pequeñas, 100g 39 0 7Higos chumbos, pequeño, mitad, 200g 58 0 14Kiwi, 1, pelado, 80g 52 0 8Lychee, en lata, escurridos, 7, 90g 79 0 16Macedonia frutas, en lata con jugo natural, 125g 55 0 15Mango, 1 pequeño, 150g 55 0 19Manzana, 1 mediana,150g 38 0 18Melocotón, en lata, jugo natural, 25g 30 0 12Melocotón, en lata, jugo espeso, 25g 52 0 18Melocotón, en lata, jugo ligero, 25g 58 0 19Melón Cantaloupe, crudo,1/4 pequeño, 200g 65 0 10Naranja, 1, mediana, 130g 44 0 10Pasas de Corinto, 40g 64 0 28Pasas sultanas, 40g 56 0 30Pera, cruda, 1, mediana, 150g 38 0 21Pera, en lata, con jugo de pera, 125g 44 0 13Piña, fresca, 2 rodajas, 125g 66 0 10Plátano, crudo, 1 mediano, 150g 55 0 32Pomelo, mediano, 1/2, 100g 25 0 5Sandía, 150g 72 0 8Uvas verdes, 100g 46 0 15Zumo de piña, sin azúcar, en lata, 250ml 46 0 27Zumo manzana s/azúcar, 250 ml 40 0 33Zumo naranja, 250ml 46 0 21Zumo pomelo, sin azúcar añadido, 250 ml 48 0 16GALLETAS DULCESDigestives, 2 galletas completas, 30g 59 6 21Mantequilla, 2 galletas, 30g 64 8 19María, 20g 55 3 16Wafers de vainilla, 6 galletas, 30g 77 5 21Galletas Avena, 3 galletas, 30g. 54 6 19Galletas Trigo, 2 galletas, 16g 62 2 12GALLETAS SALADASGalletas arroz, 2 galletas 82 1 21Galletas Pretzels, 50 g 83 1 22Premium soda crackers, 3 galletas, 25g 74 4 17GOLOSINASGominolas, 10 g 80 0 9HELADOSHelado, 2 bolas, 50g 61 6 10Helado, desnatado, 2 bolas, 50g 50 2 13LECHE Y DERIVADOS LÁCTEOSLeche con chocolate bajo en grasa, 250g 34 3 23Leche evaporada, azucarada, 160g 61 15 90Leche, desnatada, 250ml 32 0 13Leche, entera, 250ml 27 10 12Natillas, 175g 43 5 24Yoghurt con frutas, bajo en grasa, 200g 33 0 26Yoghurt, desnatado, 200g 14 0 12LEGUMBRES
Alubia de soja, cocida, 90 g 18 7 10Alubia de soja, en lata, 100 g 14 6 12Alubias cocidas en lata con salsa de tomate, 120g 48 1 13Alubias negras cocidas, 120g 30 1 26Alubias pintas, cocidas, 120g 42 1 24Alubias, cocidas, 90g 38 0 11Fríjoles, cocidos, 90 g 27 0 18Fríjoles, en lata, escurridos, 95 g 52 0 13Garbanzos cocidos, 120g 33 3 22Garbanzos en lata, escurridos, 95g 42 2 15Guisantes verdes, frescos, congelados, cocidos, 80 g 48 0 5Guisantes, secos, cocidos, 70 g 22 0 4Habas congeladas y cocidas, 80g 79 1 9Lentejas, verdes y marrones, secas y cocidas, 120 g 26 1 21Habichuelas, cocidas, 70g 31 0 13MIELMiel, 1 cucharada, 20g 58 0 16PANAcido de centeno, 1 rebanada, 50g 57 2 23Baguette francés, 30g 95 1 15Blanco de trigo, 1 rebanada, 30g 70 1 15De centeno integral, 2 rebanadas 41 2 35De centeno, 1 rebanada, 50g 65 1 23De centeno, light, 1 rebanada, 50g 68 1 23De frutas, 1 rebanada, 35g 47 1 18De frutas, 120g 68 1 17De miel y avena, 1 rebanada, 40g 55 3 17Integral de trigo, 1 rebanada, 35g 69 1 14Negro de centeno, 1rebanada, 50g 76 1 21Negro de centeno, Schinkenbröt, 1rebanada, 50g 86 1 22Pitta, 1, 65g 57 1 38Sin gluten, 1 rebanada, 30g 90 1 14Pan Tostada Melba, 4, 30g 70 1 19Pan Vogel´s de miel y avena, 1 rebanada, 40g 55 3 17PASTACouscous, cocido, 120g 65 0 28Fettucini, cocidos, 180g 32 1 57Macarrones con queso, en paquete, cocidos, 220 g 64 24 30Macarrones, cocidos, 180 g 45 1 56Ravioli, relleno de carne, cocido, 220 g 39 11 30Spaghetti, blanco, cocido, 180 g 43 1 56Spaghetti, integral, cocido, 180 g 37 1 48Tortellini, con queso, cocida, 180 g 50 8 21Vermicelli, 180 g 35 0 45Gnocchi, cocida, 145 g 68 0 71Linguine, fina, cocida, 180 g 55 1 56Linguine, gruesa, cocida, 180 g 46 1 56PATATASEn puré instantáneo 83 1 18Piel clara al vapor, 1 mediana, 120 g 65 0 17Piel clara, al microondas, 1 mediana, 120 g 82 0 17Piel clara, machacada, 120 g 70 0 16Piel clara, peladas y al horno s/grasa, 1 med, 120 g 85 0 14Piel clara, peladas y cocidas, 1 med, 120 g 56 0 16
Fritas de bolsa, 50 g 54 16 24Fritas, 120g 75 26 49Nuevas, en lata, escurridas, 5 peq., 175 g 61 0 20Nuevas, peladas y cocidas, 5 peq., 175 g 62 0 23PESCADOBarritas de pescado al horno, 5x25g 38 14 24PIZZAcon queso y tomate, 2 raciones, 230 g 60 27 57SOPASDe alubias negras, 220ml 64 2 82De guisantes y jamón enlatada, 220 ml 66 2 13De guisantes, en lata, preparada para servir, 220 ml 66 1 22De lentejas enlatada, 220 ml 44 0 14De tomate, en lata, 220 ml 38 1 15De guisantes verdes en lata, para servir, 220 ml 66 1 22TARTASAngel food cake, 30g 67 trazas 17Postre de Tofu helado, sin leche, 100g 115 1 13Pudding de tapioca, cocida con leche, 250 g 81 10.5 51Pastel plátano, 1ración, 80g 47 7 46Bizcocho esponjoso, 1 ración, 60g 46 16 32VERDURASRemolacha en lata, escurridas, 2-3 rodajas, 60g 64 0 5Calabaza, pelada, cocida, 85 g 75 0 6Chirivía, cocidas, 75 g 97 0 8Perejil, cocido, 80 g 25 1 17Zanahoria, cocida, 70g 49 0 3OTROSSalchichas, fritas, 2, 120 g 28 21 6Taco shells, 2, 26g 68 6 16Palomitas de maíz, light, 20g 55 2 10
Brand-Miller J, Foster-Powell K, Gilbertson H, Leeds A. The Pocket Guide to the Glucose Revolution. Hodderand Stoughton. London 2002
ARTÍCULOS
- M. Bueno. Colesterol y patología embriofetal. INVEST NUTR ALIM PEDIATR (Rev on-line) : 2003; 1 # 003. http // www.seinap.org El colesterol se ha ganado una pésima reputación en los últimos 30 años, ya que se ha identificado como el máximo contribuyente de la enfermedad aterosclerótica. Ello ha originado múltiples programas de intervención dietética plasmáticos. Dentro de las
diferentes fracciones del colesterol, incluso, se distinguió entre la fracción 'mala' (LDL-colesterol) y 'buena' (HDL-colesterol).A nivel bioquímico se ha reproducido la tragedia bíblica Cain vs. Abel. La eliminación del colesterol también se ha realizado en lapreparación de algunas fórmulas lácteas de inicio, aduciéndosedistintas justificaciones científicas añadidas, como la mejorabsorción de la grasa vegetal. El mejor conocimiento de la biosíntesis del colesterol ha permitidocomprender su importante rol en los primeros estadios del desarrolloembriofetal. Las evidencias actuales parecen excluir el paso placentario del colesterol en cantidades significativas. Diversos enzimas intervienen en la vía metabólica de la síntesis delos esteroles. Se han identificado distintas mutaciones de los genes que expresan estas proteínas, que originan importantes alteraciones del desarrollo. Este es el caso del síndrome de Smith-Lemli-Opitz, que a veces se asocia con holoprosencefalia. Probablemente tambiénpueden incluirse en este grupo ciertas osteocondrodisplasias (Síndrome de Conradi-Hünerman, síndrome CHILD, síndrome 'Greenberg' y desmosterolosis). La mayoría de los errores innatos del metabolismo en la víacatabólica son asintomáticos durante la etapa prenatal, dada la posibilidad de atravesar la placenta de aminoácidos y ácidos orgánicos, que compensan posibles necesidades embriofetales.Este no es el caso de los desórdenes anteriormente citados,en los que no existe un adecuado intercambio entre madre y feto de los esteroles correspondientes. Ello permite especularsobre la significación que pueda tener desde un punto de vistapreventivo administrar suplementos maternos de LDL-colesterol durante la etapa del desarrollo embrionario.
- M. Moya. Polisacáridos dietéticos: Perspectivas biológicas. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 004. http:// www.seinap.org La clasificación química de los polisacáridos dietéticos en almidones y no almidones va siendo suplantada por otra más biológica que los divide en glicémicos y no glicémicos (PNG). Esta es mucho más útil desde el punto de vista nutricional toda vez que permite valorar el índice glicémico de diversos alimentos y edulcorantes comúnmente utilizados. Si consideramos ahora los no glicémicos es decir la fibra, se hace preciso conocer algunos aspectos más específicos en relación con su acción biológica. Básicamente éstos son el lugar y la cuantía de la fermentación, la proporción relativa de los productos fermentados, el efecto sobre la flora y la capacidad de unión de la fibra no fermentada. El primer factor a conocer no es sólo la composición química del polisacárido sino su estructura. Ésta depende de la planta utilizada así como del tratamiento post-recolección pero también de un proceso tan biológico como puede ser la masticación. La viscosidad de la fibra modifica su estructura y por ende el grado de digestión. Los beneficiosos efectos de los beta-glucanos de los cereales, fundamentalmente reduciendo la respuesta insulínica post-prandial depende de la viscosidad en que se encuentre en los alimentos. Hoy se conocen los efectos de los polisacáridos no glicémicos, especialmente sobre el colon, tales como el aumento de volumen que ocasionan los PNG insolubles o el efecto hipocolesterolizante o laxante de los PNG solubles, o el de sus derivados fermentativos. Por todo ello probablemente es el momento de pensar que el término de fibra dietética ha quedado obsoleto y debería ir aceptándose el de polisacáridos no glucémicos pero con su identificación biológica.
Genetically modified foods (GM foods) are those in the design of which genetic engineering technology has been used. This very broad definition has a clear implication: what differentiates GM foods is not that they are necessarily genetically improved but that their improvement has been obtained via the use of genetic engineering. For hundreds of years man has improved animal, plant and microbial species using breeding and mutagenesis techniques. However, it is only in the last few decades that has it become possible to achieve improvements by directly manipulating specific DNA sequences in vitro using so-called genetic engineering technology. This technology in conjunction with our increasing understanding of the physiology, biochemistry and genetics of organisms of food-related importance has made it feasible to develop improved organisms in a way that was unthinkable only a few years ago. Despite the fact that new varieties and hence new genetic combinations have been being created over centuries using such hit and miss techniques as mutagenesis, it has been the appearance of GM foods that has opened a considerable debate concerning the safety of these new foods. Major international organisations involved in food safety issues such as the FOA, OCDE and OMS have set up their own study groups to look at the safety of GM foods for the consumer, putting priority on the establishment of scientific criteria for the evaluation of these foods. The result of their work is the development of the concept of ‘substantial equivalence’. This criterion, used by the European regulatory authorities for the commercialisation of GM foods, applies to those GM foods whose nutritional properties and organoleptical characteristics are the same as the original food, the only exception being the new characteristic introduced by genetic engineering.
All GM foods commercialised to-date have been subject to health risk assessment focussed on three criteria: nutritional value (substantial equivalence), allergenicity, and toxicity. From all the studies carried out it has been concluded that there is absolutely no scientific basis to indicate that these foods present a greater health risk to the consumer than that of the corresponding non-GM food. From a different viewpoint, the question can be asked whether GM foods can offer enhanced food safety compared to conventional foods. Transgenic plants that produce the insect-killing toxin Bt in some of their tissues have been found to be less susceptible to attack by mycotoxin-producing fungi and as a result exhibit lower levels of these compounds compared to conventional foods. These observations should stimulate consideration of where the current challenges in food safety lie and what role GM foods may play in addressing those challenges.
2. SEGURIDAD MICROBIOLÓGICA EN LA ALIMENTACIÓN. INVEST NUTR ALIM PEDIATR (Rev on-line) 2006; 1 # 002. http:// www.seinap.org
1Molina-Font JA, 1Jiménez-Torres M, 2Olea MF, 3Olea N, 1Campoy C.
1Dept. of Paediatrics. School of Medicine. 2Dept. of Nutrition and Bromatology. School of Pharmacy. 3Dept. of Radiology and Nuclear Medicine. School of Medicine. University of Granada.
Introduction: In different biological tissues has been proved the presence of organochlorine pesticides (OP) with endocrine disruption activity. In animals, the OP could influence the neonatal anthropometrical parameters such birth weight and height, or the brain development.
Aims: a) To demonstrate the presence of OP in serum from umbilical cord (UV), and in serum (M) and adipose tissue (AT) from pregnant women; b) To investigate the relationship between the OP content in UV, in M and AT from mothers at delivery and their newborn infant anthropometrical parameters.
Material & Methods: Subjects: A total of 199 samples were studied. 66 from UV, 66 from M and 67 from AT, at delivery. All samples were obtained from healthy and volunteers women, aged between 17 and 35 years, whose deliveries finished by caesarean section due to different causes. After birth a neonatal exploration and anthropometrical parameters were measured. All neonates born at term and with a birth weight according to gestational age (GA).
Biochemistry: The OP were measured using gas chromatography with electron capture (GC/ECD) and gas chromatography/mass spectrometry (GC/MS). The neonatal anthropometrical data (first two days after delivery): birth weight (BW), height (H) and pondered index (PI).
Statistical analysis: The Shapiro-Wilk test or Kolmogorov-Smirnov test were done to demonstrate the normality of the variables. When a variable was not followed a normal distribution, the Ln was applied. ANOVA, multiple comparative analyses (Bonferroni, Tahmane), correlation analysis and fixing curves were also done. Serum data in: ng/ml; tisular data in: ng/g of fat.
Results: Different concentrations of OP were found in all serum samples analysed and expressed as mean±SD: p,p´DDT (5,26±7,19 in M vs 3,38±6,26 UV), p,p´DDE (31,44±34,69 in M vs 23±48,12 UV), Endosulfan eter (7,24±13,03 in M vs 7,90±18,68 UV). Regarding the OP found in AT, the concentrations were also varying, v.g.: pp´DDE (2603.27±1917.68); endosulfan-lactona (7.7±16.78 ng/g of fat), and also regarding the frequency of presence from 12.4% for endosulfan alfa to 39.1% for endosulfan eter or 100% for the p,p’DDE or Aldrín. Different inverse significant correlations were found between the BW and GA and the different OP concentrations from UV or M or AT (v.g. Aldrín M-IP: r:-0.40, p<0.01; Dieldrín UV-GA: r:-0.41, p<0.01; HBC AT-IP: r:-0.44, p<0.01; p,p’DDE UV-BW: r-0.46, p<0.001; o,pDDT UV-BW: r:-0.42, p<0.01).
Discussion and conclusions:The rapid turnover of OP from AT during pregnancy and their presence in the mother’s serum determine the foetal exposure to these molecules with endocrine disruption capacity. Different authors have demonstrated that the foetal exposure to some xenobiotics with in vivo and in vitro proved hormone activity play an important role in the normal behaviour of foetal development. The high exposure to the endocrine disruptors action has been related to a high incidence of endocrine dysfunctions, and disorders on the brain and foetal development. The present study confirms once more time, that the foetal exposure to these molecules is correlated to the neonatal birth weight, height and nutritional status. The correlation established between the OP and the neonatal anthropometrical parameters suggest the endocrine disruption capacity of these molecules that could interfere on the foetal metabolism or even improve prematurity or low birth weight infants.
**European Project EDEN: QRLT-UE-2001-00603.
4. Food and food habits characters of immigrants children and adolescents in Spain. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 008. http:// www.seinap.org
Ros Mar L., Sayed Esa Afifi N., Garagorri Otero JM. Zaragoza
In the last years, Spain has been converted to an immigrant’s receptor country, who are from developing countries. As a consequence, the number of immigrants children who were be born or not in Spain is shown to be increased too, these children have different characters from the Spanish people. The aim of this communication is to study the food and /or food habits of theses different populations, and to evaluate the Spanish immigrant’s influence about them.
A study on the food habits of 493 children and adolescents (of them, 209 were be born and fed in their original country and 284 were be born and fed in Spain) coming from 195 different ethnical origins immigrants families with a residence’s time in Spain of more than 6 months. These families had been interviewed in their original language: Arabic, English or Spanish.
1.We can’t refer to immigrants as a general term, because every population has nutritional different characters. The ignorance of Spanish language and the cultural difference make difficult in their integration into the Spanish society especially in relation to the food.
2.The duration of both exclusive and supplementary breastfeeding was different in every studied population when they stayed in their original country, however their behaviours were similar when they had new sons in Spain with mean time of exclusive breastfeeding between 4 & 6 months, and reducing time of supplementary breastfeeding.
3.As regard the beginning and form of weaning (introduction of complementary food), they presented changes when they had new sons in Spain who were been attended by Spanish pediatricians. However, they still present differences, in relation to Spanish people, in the age of beginning of weaning, and the introduction of fruits, milk products, and cow’s milk.
4.Although their residence in Spain: the 39 % of the studied children and adolescents, the same as their families, only takes the known food in their dietary original culture, while the rest (61 %) of them mixes some Spanish diets and habits together with their original cultural food. The holiday day’s diet is always some typical dish of their original country. The existence of special food shops in Spain allows to them the continuity with their dietary original culture. Islamic religion affects both the meat shopping habits and food selection.
5.Only less than the 20 % of the studied immigrants children who were in the school age takes the lunch in their college dining’s rooms. Both Islamic and 7th day religion population fears from eating anything, which is prohibited by their religions, while in the other families, is because of their economic situation.
6.The residence’s time in Spain didn’t affect in neither food changes in the first year of life nor in the dietary practices changes of the studied children and adolescents.
7.In view of these facts: it is very important that the Spanish pediatricians advises the immigrants families about the correct dietary norms for the avoidance of bad food habits drive from the original culture, considering the languages difficults which are given to the grand number of immigrants mothers who don’t speak the Spanish language although their residence since long duration in Spain.
5. THE ABSORPTION OF CALCIUM AND TOTAL FAT IN BREAST FED PRETERM INFANTS. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 009. http:// www.seinap.org
Juste M, Moya M, Cortés E, Pastor J. Hospital Clínico Universitario S. Juan
Introduction. The absorption of calcium in the preterm infant, above all in those under 32 weeks of gestation age, is inferior to that of the normal term infant, even though its necessities are greater. This inferior absorption is related to several factors like the limitation of nutritional content, the normality of the absorptive mechanisms and the composition of the formulas in this case breast milk. The osteopenia in the preterm has been reduced in quantity and quality but is far from being a solved problem.
Objective. To value the calcium and fat absorption in exclusively breast fed preterm infants with the purpose of creating a reference against diverse formulas that are used.
Material and Method. A group of 7 preterm infants was studied with gestation ages of 31.0 + 1.8 weeks and a weight at birth of 1.4 + 0.3 kg without evident digestive and nutritional problems and stable from a haematological and respiratory point of view.
After four days of pre-balance a metabolic balance, according to the habitual technique, (1) was carried out on the patients (4 females and 3 males).
The measuring of calcium from the milk and faeces samples was carried out via atomic absorption after calcination and the measuring of fat via lipid extraction and quantification through gravimetry.
The excretion of fat bears an evident relation with the elimination of calcium in the faeces r2 .606 (p=0.039).
Discussion. The ingestion of calcium in exclusively breast fed preterm infants is inferior to that of those being fed with formulas (43.2 vs 112.0 mgr/kg/day). The same happens with fat (5.8 vs 6.3 gr/day) (2). The percentage of calcium absorption in the breast fed infants is greater (65.6 vs 45.2%) whereas fat is slightly lower (88.7 vs 95.3%) (3).
1.- Moya M, Domenech E. Role of calcium phosphate ratio of milk formula on calcium balance in low birth weight infants during the first three day of life. Pediatr Res 1982; 16:675-81.
2.- Moya M, Cortés E, Ballester MI, Vento M y Juste M. Short-term polycose substitution for lactose reduces calcium absorption in healthy babies. J Pediatr Gastroenterol Nutr 1992; 14;57-61.
3.- Moya M, Cortés E, Juste M, de Dios JG y Vera A. Fatty acid absorption in preterms on formulas with and withoutl long-chain polyunsaturated fatty acids and in terms on formulas without these added. Eur. J. Clin. Nut., 2001;55:7555-762
Sánchez-Caselles M, Moya M, Cortés E, Juste M Departamento de pediatría, UMH de Elche, Hospital Universitario de San Juan. Alicante. e-mail: [email protected]
I) Myth: hypercholesterolaemia / diet: familial hypercholesterolaemia (FH) is an autosomal dominant disease defined at the molecular level by the presence of mutations in the LDLR gene and characterized by markedly elevated LDL-cholesterol and total cholesterol (TC) levels, which are not secondary to environmental or dietary aspects.
II) To detect cholesterol levels alone is not sufficient to confirm a diagnosis of FH.
Identification of LDLR gene mutations facilitates follow-up of affected individuals and eliminates the problems associated with equivocal lipid profiles, especially in younger patients, in whom TC values may overlap between affected and nonaffected subjects.
In addition, the type of LDLR gene mutation has been associated with different response to statins, and risk of premature coronary heart disease.
MATERIAL AND METHOD: Genomic DNA of 63 patiens of 36 different families with FH and 14 healthy controls was analysed in our laboratory.
The promoter region and the 9 first exons with their flanking intron sequences of the LDLR gene were screened for the presence of small and point mutations by PCR-SSCP (single strand conformation polymorphism) analysis. For the SSCP analysis, electrophoresis was carried out in vertical minigel system. Samples were loaded on gels containing 12-14% acrylamide:bisacrylamide (29:1), 0-10% glycerol and 1.0×TEB. Electrophoresis was carried out at 450V for 3-4 hours at 1.5-25ºC. DNA bands were detected by silver-stain.
In addition, we tested all patients for the presence of mutations in the gene coding for apolipoprotein B 100, because familial ligand-defective apolipoprotein B100 (FDB) is an autosomal inherited disease clinically indistinguishable from FH.
RESULTS: In 27 of the 36 index cases analysed were found abnormal SSCP bands, patients number/exon: 11/6, 5/3, 3/4, 3/5, 3/1, 1/7 (Fig.1) y 1/8, the underlying mutations are being characterized by DNA sequencing.
One of the mutations that has already been characterized, it has not been previously described. It is in exon 7 and it´s a missense mutation, c.1037 T>A, p.L325Q (Fig.2). Exons 7-14 encode EGF precursor homology domain, this is required for the dissociation of lipoproteins from the receptor in the endosome during receptor recycling (possible mutation of class 5), and it also serves to position the ligand binding domain on the cell surface (possible mutation of class 2). The final class of mutations may also require in vitro testing to confirm.
None of the 36 index cases were positives for the FDB.
CONCLUSIONS: As well as in other previous studies our results demonstrate that there is a broad spectrum of mutations in the LDLR gene in the spanish population, therefore the use of the biochip technology is advisable for a fast detection of the more frequent alterations in Spain. Correct genetic diagnosis and early treatment of subjects with FH could prevent premature coronary heart disease.
REFERENCES:
1.Marks D, Thorogood M, Neil HA, Humphries SE. A review on the diagnosis, natural history, and treatment of hypercholesterolaemia. Atherosclerosis 2003 May;168(1):1-14
2.Mozas P, Cenarro A, Civeira F, Castillo S, Ros E, Pocovi M. Mutation analysis in 36 unrelated Spanish subjects with familial hypercholesterolemia: identification of 3 novel mutations in the LDL receptor gene. Hum Mutat 2000 May;15(5):483-4
3.Garcia-Garcia AB, Real JT, Puig O, Cebolla E, Marin-Garcia P, Martinez Ferrandis JI, Garcia-Sogo M, Civera M, Ascaso JF, Carmena R, Armengod ME, Chaves FJ. Molecular genetics of familial hypercholesterolemia in Spain: Ten novel LDLR mutations and population analysis.Hum Mutat 2001 Nov;18(5):458-9
7. LCP´S IN CLINICAL PATHOLOGY. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 011. http:// www.seinap.org
L. Aldamiz, P. Sanjurjo, Hospital de Cruces, Bilbao
Aim: To evaluate the existence of a specific pattern in plasmatic fatty acids in children with oxidative stress and its relation to the atherogenic risk markers.
Patients: 29 children with stable renal transplant, 17 children with AIDS undergoing treatment with protease inhibitors.
Design: Cross study.
Parameters: Total homocystein, lipid profile, plaminogen I activity inhibitor, high sensitivity PCR, insulin and HOMA rate and total fatty acids in plasma.
Results: When we compare IVH infected patients treated with PI in healthy controls, they show an important decrease in the proportion of linoleic acid(18:2w6) in IVH + patients (27.9+-4.1 vs. 31.7+-4.4 p: 0.005). The renal pathology showed a similar tendency with an increase in the activity of the delta 6 desaturase. In children with AIDS a decrease in the delta 5 desaturase could be seen.
In both pathology groups there was an increase of the deficit rate of essential fatty acids (Mead/Araquidonico). These profile modifications in fatty acids were not related to the dyslipemia, PAI-1, PCR of these children.
Conclusions: Pathologies with a high rate of oxidative stress show a fatty acid profile characteristic to resistance situations to insulin, and the mechanisms are independent of the cardiovascular risk factors normally used.
8. SHORT –CHAIN FATTY ACIDS PRODUCTION IN INFANTS FED MILK AND INULIN ADDED CEREALS. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 012. http:// www.seinap.org
Tormo R, Conde M, Infante D, Teixidor M
Pediatric and Nutrition Gastroenterology Unit, Hospital “Vall d’ Hebron”.
Pediatric and Nutrition Gastroenterology Unit, Via Augusta, Barcelona, Spain
Butyrates and other short-chain fatty acids produced in the the large bowell by bacterial fermentation of non absorbed carbohydrates, are important for the energy metabolism and normal development of colonic epithelial cells.
We studied if the starch that escape normally from the small bowell digestion in infants are enough to induce short-chain fatty acid production, and if the addition of inuline increases the production of these fatty acids. We also studied the repercussion on breath gas and stools composition.
METHODS: The stools of 20 infants (4- 6 months old), were collected and incubated in anaerobic conditions, for 5h at 38º; they have been fed only with milk and cereals; the gas produced was analyzed by solid phase microextration coupled to gas chromatography and gas spectrometry; the hydrogen, methane and CO2 in the breath air , and fat, nitrogen and water excretion in the stools were also analyzed, We repeated the same procedure adding inuline, a soluble fiber, to the cereals, in a quantity of 2%
RESULTS: no significant results were found in the breath gas or stool composition in the cereals and inuline added fed infants.
Butyrate production were found in the stools of one infant fed milk and cerelas, and in the stools of other 6 infants fed milk and inuline added cereals.
CONCLUSIONS: butyrate production can not be assured, feeding only milk and cereals; the adition of inuline induce a major production of butyrates; a quantity of inuline gretaer than 2% would be advisable; the addition of inuline has any influence in hydrogen, methane excretion and stools composition..
9. EFFECTS OF LONG-CHAIN POLYUNSATURATED FATTY ACIDS NUTRITIONAL SUPPLEMENTATION DURING
PREGNANCY ON MOTHER-BABY 25OH-VITAMIN D AND BONE MINERAL TURNOVER. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 013. http:// www.seinap.org
1Dolz V, 2Mezquita P, 1Bayés R, 1Díaz JMª, 1Jiménez M, 2Muñoz M, 1Molina-Font JA, 1Campoy C.
1Dpto. de Pediatría. Facultad de Medicina. Universidad de Granada. 2Servicio de Endocrinología. Hospital Clínico San Cecilio de Granada.
Introduction: Recently, some researches try to demonstrate the influence of arachidonic acid (AA) and docosahexaenoic acid (DHA) nutritional supplement on the growth and bone mineralisation (Weiler, 2000), and they have found that these supplements determine a significant increase in the weight and the bone mineral density in the whole body, in the lumbar spine and femur, in experimental animals. The bone answer to the AA and DHA supplements could be important, due to AA is a precursor of PGE2, which “in vivo” is one of the most strong stimulants for bone formation.
Aim: To analyse the possible influence of the nutritional intervention with DHA and/or 5-MTHF, among the pregnancy on the mother bone mineralisation and fetal growth.
Material & Methods: A total of 60 mother-infant pairs were studied, from 20 week of gestation until delivery. The pregnant were healthy women, aged 20-30 years, without pre- or postconceptional illness, which could influence on the results. The pregnant women were subdivided into 4 groups, depending on the nutritional supplements offered to them from the 20 week of gestation until delivery {DHA (n:15); 5-MTHF (n:17), DHA+5-MTHF (n:13); placebo (n:15)}. The newborn infants were term neonates with birth weight according with gestational age, and they were homogeneous between the 4 groups. Samples were obtained at 20 weeks of pregnancy, at delivery (from mother and umbilical cord) and at 6 months after delivery in the mothers.
Biochemistry: In the mothers, the following parameters were determined by RIA: Intact Parathormon intacta (iPTH) (pg/ml); 25-OH vitamin D (25OHD) (ng/ml); Insuline Growth factor I (IGF-I) (ng/ml); Osteocalcine (BGP) (ng/ml); Bone Isoenzime of alkaline phosphatase (bALP) (µg/ml). The phospholipid polyunsaturated fatty acids (PUFAs) were measured using an HPLc (Lepage, 1986) neither in the mother than in umbilical cord.. Bone densitometry (DEXA) was also performed in the mothers at 6 month after delivery.
Análisis estadístico: Kolmogorov-Smirnov test; Test for pair data, ANOVA and multiple comparisons Bonferroni’s test. Global and per groups correlation analysis.
Results: 6th month after delivery vs 20 week of gestation: BGP (increase of the bone turnover <1.8 ng/ml): 64.3% <1.8 vs 100%>1.8; 25OHD (insuficiency: <15 ng/ml): 60.4% vs 27.3%; bALP (normal >11.6±4.11 ng/ml): 19.2% vs 19%; IGF-1 did not show changes from 20 week of gestation until the 6th month after delivery. All studied groups showed a significant decrease in the BGP, except the supplemented group with DHA+5-MTHF which did not changed the concentrations in plasma from the 20 week of pregnancy until the 6th month after delivery. A number of significant correlations were demonstrated between the mother’s bone mineral turnover markers with the birth weight (v.g. vitamina D 20 week-birth weight: r:0.87, p<0.001), longitude and neonatal ponderal index; the neonates plasma phospholipid PUFAs concentrations were correlated with the bone mineral turnover parameters in their mothers at 6th month after delivery.
Conclusions:
1ª) The mothers supplemented with DHA+5-MTHF during pregnancy showed a better pattern of bone mineralisation turnover than the other groups.
2ª) The different nutritional interventions done during pregnancy in the present study, have some different effects on the mother bone mineralisation turnover, but also probably on the foetal-neonatal one.
Background: Micronutrients deficiencies, known to influence immune function, are prevalent even prior to the development of symptoms in HIV disease. Of particular importance, inadequate levels of some micronutrients have been associated with faster disease progression and increase mortality, while restoration of nutritional status has been associated with slowing of HIV disease progression.
Aims: To evaluate the micronutrients and trace elements in children with HIV and the relationship with the disease status and to determine if the zinc administration can improve the nutrition, immunity and clinic situation of the children with HIV infection.
Subjects and methodology: We accomplished a trial, to a sample of 26 children with HIV infection. It was measured antropometrical, clinical, analytical and immunological parameters and we began a clinic crossover and controlled trial with the supplement of orally zinc sulfate ( 1 mg/k/day of zinc).
Results: The trace elements zinc and copper are those wich were affected with a greatest frecuency, being the increased copper (50%of children under 10 year and 100% of the elderly), and the reduced zinc (91% of the patients). With the zinc supplement we observed a group in wich the zinc value improved and the progression of the disease is not so accelerated as it is in another group which have an important decreased of the anthropometric and analytical parameters and the zinc values decreased.
Conclusions: The trace elements, vitamins and minerals are altered in the subjets of the study: The copper increased early. The zinc is decreased (91%) and this is correlated with the clinical and immunological stage of disease. The early supplement with zinc sulfate can improve the nutritional situation of the children with infection by the HIV.
11. TRACE ELEMENT SPECIATION IN TERM INFANT FORMULA WHEY AND BREAST MILK WHEY OF TERM MOTHERS.
J.L. López Sastrea, R.R. De la Flor St Remyb, M.L. Fernández Sánchezb, M.L. Garzo Salvadora and A. Sanz-Medelb.
aServicio de Neonatología del Hospital Universitario Central de Asturias
bDepartment of Physical and Analytical Chemistry, University of Oviedo
C/ Julián Clavería 8, 33006 Oviedo, Spain.
The early childhood is characterised by the fact that milk constitutes the single source of nutrients. As a result of this, milk plays an essential role in terms of body growth and development. Thus, the right supply of all macronutrients and micronutrients from milk is necessary in order to assure baby’s health. Today is worldwide accepted that essential elements contribute to the structure a function of many metaloproteins and enzymes that are involved in very important biochemical process in terms of human´s biology. In this sense, the scientific community has shown a growing interest in the determination of the content of essential elements in milk.
However, it is well known today that the determination of the total concentration of a given trace element in biological samples is insufficient to obtain complete information about its nutritional value. In fact, the bioavailability of an element of a given food depends on the particular chemical form of such element in the sample. It is necessary to carry out speciation studies in order to determine the different chemical species of trace elements in milk (1, 2).
The aim of this work was to investigate the total concentration, chemical form, and nutritive value of trace essential (Fe, Cu, Zn, Se, I, Cr, Mn) and toxic elements (Al, Pb and Cd) in term infant formula whey and breast whey of term mothers by coupling on-line size exclusion chromatography (SEC) and ICP-MS detection. Comparative speciation results obtained for element of interest along the lactation period, colostrum and mature (4th, 14th and 28th days after the delivery), will be also presented.
The results shown that the content of some essential elements are higher in formula milk whey than in colostrum and mature human milk whey as results of excessive addition of essential element in the formulas. Also, the elemental binding patterns of essential elements in colostrum and in mature human samples are different from those obtained in formulas.
(1) P. Brätter, I. Navarro Blasco, V. E. Negretti de Brätter and A. Raab, Analyst, 1998, 123, 821.
(2) F.A. Rivero Martino, M.L. Fernández Sánchez and A. Sanz-Medel. Anal. Chim. Acta, 2001, 442, 191.
Rodríguez G, Blay MG*, Moreno LA, Blay VA*, Fleta J, Sarría A, Bueno M y grupo AVENA-Zaragoza
Departamento de Pediatría, Universidad de Zaragoza; y Servicio de Endocrinología y Nutrición, Hospital Militar de Zaragoza*.
Introduction and aims: The body mass index (BMI) is used as an adiposity parameter, in obesity and overweight definition; and predicted equations are applied to estimate the percentage of body fat-mass (%BF) by skinfold thicknesses. The aims are both, to analyse the usefulness of BMI for the definition of overweight and obesity in adolescents, and to compare %BF estimated by skinfolds (%BFS) with %BF measured by dual X-ray absorptiometry (DXA).
Methods: We have studied 280 adolescents aged 13 to 17 years (113 males and 167 females), that were representative of the city of Zaragoza (Spain). Weight, height, skinfold thicknesses were measured and %BF was assessed by DXA (%BFD). BMI and %BFS were estimated with various equations. Obesity and overweight have been defined by BMI, using the International Obesity Task Force criteria. Agreement between %BFS and %BFD was assessed with the Bland-Altman method.
Results: %BFD increases progressively and significantly in lean, overweight and obese males (13.9±7.2; 28.3±9.5; 34.1±7.2) and females (23.9±5.7; 35.1±2.9; 37.6±3.6). %BF and BMI correlations are 0.70 in males and 0.80 in females. 10% of males classified as obese/overweight have normal values of %BFD (10-25%); however, except for one case, obese/overweight females have all high %BFD values (>30%). %BFD and %BFS correlations range between 0.80 and 0.96. In male and female adolescents, %BFD and %BFS do not show good agreement because differences between both methods are excessive when adiposity increases. Agreement, mean %BF differences and confidence intervals are appropriated only for Slaughter et al equations.
Conclusions: In spite of a good correlation between %BFD and BMI or %BFS, the use of BMI as obesity/overweight definition criteria does not seem to be as useful in males than in females; and most of the %BFS prediction equations are not accurate enough for adolescents with adiposity. Slaughter et al. prediction equations have the best agreement for the assessment of %BF.
13. BREAST FEEDING AND GROWTH IN TERM NEWBORNS UP TO 6 MONTHS OF LIFE. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 017. http:// www.seinap.org
T. Alonso Ortiz, MI. Armadá Maresca.
Introduction. We have always considered each time with a greater scientific backing, that breastmilk is the ideal food for a newborn immediately following birth and for at least the first few months of life. Among its many advantages is to be considered the important factor of the prevention of a substantial proportion of newborn and child mortality, also the important bonding between mother and child, fundamental for a proper development in the child.
It is generally believed that “children who breastfeed grow better” this includes a better global development both form the psychological-maturity and anthropometric points of view. Though, as we are going to see, this is not exactly accurate and it is forcing us to delve deeper into the topic of the existing relation between the possible and supposed ideal growth obtained by breastmilk as opposed to the starting and continuation formula milks, at least for the first 6 months in life.
Aim. The aim is to provide some preliminary results from a prospective study undergone by us at the Hospital Clínico San Carlos de Madrid. A comparative study of different ethnic groups as these newborns of non-Spanish parents are in total more than half of all babies born in our hospital.
The material. 100 newborns from each ethnic group (Spanish, non-Spanish Europeans, Africans, Americans and Orientals) were monitored form birth up to 6 months and in each group 50 were exclusively breastfed and the other 50 were on starting formula for the first 4 months and continuation up to 6 months. Of each 50 there were 25 boys and 25 girls.
We studied term newborns (38-40 weeks) with normal intrauterine growth according to our own fetal growth rates. They were from pregnancies with neither pathology nor tobacco habits and the newborns remained with their mothers during their stay in our maternity wing. We weighed each of them right at birth with a digital reading which is exact up to 5 grammes and measured them.
In relation to size increase in boys (graph 1) we saw in our sample that this was slightly greater with artificial milk without differentiating ethnic race. When we did this we could wee that in the Spanish babies these differences are more marked with a significative increase in size in the artificial milk group.
In the Europeans and Orientals this was minimally greater, while in the American group, those fed with breastmilk had greater growth at 2 and 4 months. The Africans also followed this pattern up to 6 months.
In relation to size increase in girls, taken as a whole, growth is greater with artificial milk than with breastmilk at each month. When separating the different nationalities, the Spanish, Europeans, Orientals and Americans grow much more with artificial milk as opposed to the African girls whose growth rate was greater when breastfed.
Conclusion. From the analysis of our material which we will lengthen with feeding time if possible and from the size of the study we can sum up: Anthropometrically the babies exclusively breasted do not show significant differences to those fed only on formula for the first 6 months of life. Perhaps we could go so far as to say that artificial milk has a slight lead which does not suppose any failure for breastmilk but success for the Baby Food Industry, whose formulas are becoming more complete and similar to breastmilk. Because of this the idea that breastmilk exclusively is the ideal pattern for the first months of life will have to be considered with a greater number of babies and not only from our country but also from elsewhere.
GRAFICA I: TALLA NIÑOS
14. INTERACTION OF DIETARY NUCLEOTIDES AND THE INTESTINAL IMMUNE SYSTEM IN EARLY POSTNATAL LIFE.
INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 018. http:// www.seinap.org 1Gil A, 2Manzano M, 2Rueda R
1Department of Biochemistry and Molecular Biology, University of Granada, and 2International R&D-RPD, Abbott Laboratories, Granada Spain. [email protected]
The interaction of different factors, such as intestinal microbiota and nutrients at the intestinal level, can influence the inner regulatory mechanisms of the intestinal immune function, especially during the first year of life. The Gut Associated Lymphoid Tissue (GALT) is a secondary lymphoid organ, which is in charge of processing antigens that interact with the intestinal mucosa and of disseminating the immune response. Antigens present in the intestinal lumen are transported into the Peyer’s patches through M cells, which are located between the enterocytes in the epithelium. Once in the Peyer’s patches, antigens interact with antigen presenting cells (APC), which present them to immature B and T cells located in the germinal centers and in the inter-follicle regions. These immature B and T cells, after being activated by antigens are drained by the regional lymph nodes, and migrate through the thoracic duct to the blood stream. Finally, after recirculating several days, they differentiate into mature efector cells migrating to the lamina propia and to the intestinal epithelium. Thus, three main lymphocyte populations (lymphocytes from Peyer’s patches: PPL, lymphocytes from lamina propria: LPL, and intraepithelial lymphocytes: IEL) can be distinguished in the intestine. Breast milk contains several components that directly or indirectly participate in the immune function of the breast-fed infant. Our group has recently reported that dietary nucleotides modify murine intestinal lymphocyte subpopulations at weaning Dietary nucleotides positively modulate immunoglobulin production at intestinal and systemic levels in mice at weaning. B-1 cells constitute the primary population of B cells in the peritoneum, being precursors of a wide number of immunoglobulin-producing plasma cells present in serum and in the intestine. The aim of this work has been to evaluate the influence of dietary nucleotides on the expression of B-1 cell antigens by peritoneal cells from mice at weaning, trying to identify a potential mechanism by which these components modulate immunoglobulin production. Mice at weaning were fed either a semi-purified nucleotide-free diet or the same diet supplemented with a mixture of nucleotides (AMP, CMP, GMP and UMP). Animals were sacrificed at different times (0, 5 and 11 days) and peritoneal lymphocytes were isolated. The expression of CD11b (expressed by B-1a and B-1b cells) and CD5 (expressed only by B-1a cells), was analysed by flow cytometry. The percentage of peritoneal cells expressing B-1-associated markers was higher in the mice fed with a nucleotide-supplemented diet than in those mice fed with the nucleotide-free diet. Differences between control animals and the nucleotide-supplemented animals were especially significant for the percentage of peritoneal cells positive for the expression of both CD5 and CD11b (B-1a cells). In conclusion, dietary nucleotides increase the proportion of B-1 (especially B-1a) cells present in the peritoneal cavity. This is potentially one of the mechanisms by which nucleotides positively modulate immunoglobulin production at systemic and intestinal levels.
15. Serological markers, nutrition and celiac disease. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 019. http:// www.seinap.org
JC Vitoria, L Ortiz, L Castaño, JR Bilbao
Hospital de Cruces. Universidad del País Vasco/EHU. Bilbao
Celiac disease (CD) is an autoimmune enteropathy that develops in genetically susceptible individuals. It is triggered by the intake of prolamines present in several cereals, like gliadins from wheat, hordeins from barley and secalins from rye. It is now known that the toxic portion of these proteins is a 33-aminoacid peptide that cannot be digested by enzymes in the gut.
Early diagnosis of CD significantly reduces the risk of associated complications and several studies have shown a correlation between the duration of exposure to gliadin and an increased susceptibility to other autoimmune disorders. For this reason, silent forms of CD should be diagnosed as soon as possible in order to begin a protective diet early and thus achieve good compliance.
The aim of the present study is to determine the prevalence of CD in children under the age of 3 years and to establish early treatment.
We have carried out a screening of children from the general population, who were invited to participate in the study at the time of birth. As an initial screening test, a radioassay to detect autoantibodies against tissue transglutaminase (anti-tTG) that was developed in our laboratory, using a cDNA transglutaminase clone and in vitro transcription/translation of the protein. Intestinal biopsy of children that were found anti-tTG positive.
The parents of 830 children accepted to participate and 613 returned for the first control visit during the second year of life, all of which were negative in our anti-tTG test. Of these, 484 children came back for the second control during their third year of life, and 9 presented anti-tTG antibodies. Of these 9 children, 8 accepted to undergo intestinal biopsy, and diagnosis of CD was confirmed in seven patients.
In view of these results, and taking into account the 830 children that accepted to participate, prevalence of CD of 1:118 healthy newborns. This figure rises significantly to 1:69 if we consider only the 484 children that completed the study.
The prevalence of CD in our population is comparable to that observed in other European populations, and we believe that if the need for general screening of CD were accepted, the age of 2-3 years is the best time for testing for antibodies.
16. Growth factors and human milk. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 020. http:// www.seinap.org
José Manuel Moreno Villares
Unidad de Nutrición Clínica. Departamento de Pediatría. Hospital Universitario 12 de Octubre. Madrid
Human milk (HM) contains not only bioactive factors which provide infants with protection from infections; hormones and growth factors (GF) that affect development, immune-modulator and anti-inflammatory agents, but even the major nutrients have specific bioctive functions prior to be digested.
The amount of hormones and GF in HM is higher in the initial lactation, specially in the colostrum, than in the late lactation. HM hormones may be the product of local mammary synthesis, transfer from the maternal circulation, or a combination of mammary modification of blood-borne hormones. Effects in newborns may be immediate or delayed. If we consider the high growth rate of the neonate we understand the significant demand on the gut to digest and absorb nutrients efficiently. Most of the GF present in milk affect the growth and maduration of the neonatal gut.
Since 20 years ago it is well known that HM has potent mitogenic effects on cultured cells. GF must survive protolytic digestion in the stomach and small intestine and must be able to interact and bind with their specific receptors on mucosal epithelial cells. Although some of these factors can be absorbed, they have a minimal systemic action. The most significant advantage of breast milk may not be related to growth but on mucosal barrier and immune function.
Within the various factors that act on gut growth and maduration we found amino acids: glutamine and glutamate function as key respiratory fuel for the enterocytes; arginine as a nitrogen donor for nitric oxide synthesis, critical for the maintenance of mucosal blood flow and immune function. Nucleotides are precursors for nucleic acids synthesis. Short chain fatty acids, coming from the fermentation of endogenous secretions such as mucins and sloughed epithelial cells as well as malabsorbed dietary carbohydrates, work as the fuel for the colonocyte.
Some gastronintestinal hormones also have trophic effects: gastrin stimulates proliferation of parietal and enterochromafin-like cells within the gastric mucosa; cholescystokinin has as target tissues the pancreas and gallbladder; bombesin, glucagon-like peptide 2, peptide YY and neurotensin stimulates growth of the normal and damaged intestine.
Beside these factors, there are specific peptide growth factors as detailed in table.
Growth factor ActionEpidermal growth factor (EGF)
TGF-α
IGF-I, IGF-II
Insulin
Enhances cell proliferation and suppres apoptosis
Stimulates growth
All of them may play a role in mucosal growth and repair
Some systemic hormones present in HM also act on intestine: growth hormone, thyroid hormones, glucocorticoids, erithropoietin and leptin.
The better our knowledge on growth factors and their function the higher the possibilities to use them as a way to promote maduration in normal gut or as a therapeutic option in gastrointestinal insufficiency.
References
1.Hamosh M. Bioactive factors in human milk. Pediatr Clin North Am 2001; 48: 69-86.
2.Burrin DG, Stoll B. Key nutrients and growth factors for the neonatal gastrointestinal tract. Clin Perinatol 2002; 29: 65-96.
3.Cummins AG, Thompson FM. Effect of breast milk and weaning on epithelial growth of the small intestine in humans. Gut 2002; 51: 748-54.
4.Playford RJ. Macdonald CE, Johnson WJ. Colostrum and milk-derived peptide growth factors for the treatment of gastrointestinal disorders. Am J Clin Nutr 2000; 72: 5-14.
17. BONE MINERAL DENSITY OF THE LUMBAR SPINE IN 80 PREMATURE–NEWBORNS. A PROSPECTIVE AND LONGITUDINAL STUDY. INFLUENCE OF MATERNAL AND BABY FORMULA MILK FEEDING. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 021. http:// www.seinap.org
Antonio Carrascosa, Diego Yeste, Jordi Almar , María Clemente, Miguel Gussinyé, Laura Audí
BACKGROUND: Maximum bone mass accretion in fetal skeleton is acquired during the third trimester of gestation, and may be compromised in premature newborns.
OBJECTIVE: To ascertain the incidence and evolution of osteopenia, a longitudinal study to evaluate areal bone mineral density in the lumbar spine (aBMD) in premature newborns followed during the first two years of life were performed.
METHODS: aBMD values were assessed in lumbar spine (L2-L4) by DEXA and expressed as grams of hydroxyapatite/cm2 in 80 premature newborns, 41 boys and 39 girls, of gestational ages 24.5-35.7 weeks. aBMD values were evaluated at (mean+/- SD) 0.2+/-0.1 years (at discharge from the neonatal unit), 0.9+/-0.2 years and 2.0+/-0.5 years of postnatal age and compared with those of age-and sex-matched controls of full-term newborns with normal intrauterine and postnatal growth. (n=19, n=34, n=38 respectively)
Feeding regimen: Premature newborns weighing less than 1500 grams were fed by parenteral and enteral nutrition, when possible, during the first 10 days of life, and the mean estimated intakes of calcium and phosphorous were 80 mg/kg/day, and 49 mg/kg/day . From the 11th day of life, they continued mainly on enteral nutrition, whenever possible, with a caloric intake of 120 Kcal/kg/day, either by artificial premature formula or maternal milk. A protein and mineral supplement was given to maternal milk-fed patients. The mean estimated intake from then to discharge from the neonatal unit (0.2 +/- 0.1 years) was 120 mg/kg/day for calcium and 70 mg/kg/day for phosphorous.Premature newborns with birth weight over 1500 grams were fed either by maternal milk (supplemented with calcium) or baby formula. The estimated intakes of calcium and phosphorus were 130 mg/kg/day and 75 mg/kg/day, respectively, from birth to discharge from the neonatal unit (0.2+/-0.1 years). A vitamin D supplement of 450 IU/day was given to all patients of both groups during this period.
After discharge from the neonatal unit until the age of two years, all were nourished following the conventional protocol used in infant feeding (three were fed exclusively with maternal milk, 50 by formula and 27 maternal human milk and formula), which provides an estimated intake of 400-500 mg/day of calcium and 200-300 mg/day of phosphorus. A supplement of 400 IU/day of vitamin D was given to all. In addition, patients
who had aBMD values lower than –1.0 SDS of age- and sex-matched controls, either at 0.2+/-0.1 years or at 0.9+/0.2 years, received a pidolate calcium salt supplement, which represents 135 mg/day of elementary calcium.
RESULTS: aBMD values recovered progressively from the first to the third evaluations, and were 0.139 ± 0.06 gr/cm2 (-2.4 ± 1.4 SD) at 0.2+/0.1, 0.270+/-0.06 gr/cm2 (-1.0 ± 1.0 SD) at 0.9+/0.2 and 0.410 gr/cm2 (-0.08 ± 1.0 SD) at 2.0+/-0.5 years. No statistically significant differences in BMD values at any age studied according to the type of milk feeding
CONCLUSIONS: Our data show a significant catch-up of aBMD reaching values similar to those of full-term newborns at the age of 2.0+/-0.5 years regardless of their gestational age or the type of milk feeding.
KEYWORDS: premature newborn, bone mineralization, areal bone mineral density, DEXA.
18. BREAST FEEDING AND GROWTH OF THE PRETERM INFANTS. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 022. http:// www.seinap.org
E. Doménech*, NM. Díaz-Gómez**, F. Barroso*, C. Cortabarrría*
* Department of Pediatrics. Faculty of Medicine of La Laguna. University Hospital of the Canaries ([email protected])
** Nursing School, University of La Laguna(Tenerife)
The goal of the nutrition of preterm infant (PT) is to maintain the rate of intrauterine growth and the normal composition of the organism that premature infant would have achieved if the pregnancy had arrived to term -reference foetus-, and should be given the nutrients and energy enough without exceeding the metabolic capacities and kidney function of the newborn (NB). But it is not a target easy to reach, being frequently observed a postnatal growth retard.
To get an appropriate growth of PT diverse nutritional recommendations there are. An intake of unfortified human milk of 200 ml/kg/d., can provide the recommended energy intake, but not the necessary intake of proteins and minerals, that which is achieved with the administration of 150 to 180 ml/kg/day of fortified human milk or preterm formula.
Those fed to breast can have a lesser corporal mass, delay of growth and a higher percentage of fatty mass in the first year of life, however this can diminish their risk of illnesses in the future (lesser arterial tension, etc.).However, in spite of this lesser growth there is not any negative difference for the development. The natural feeding has other advantages besides of nutritious qualities (presence of taurine, docosahexanoic acid, oligosacharides, coline and inositol, etc), because in mature and premature human milk samples, it has been demonstrated the presence of many other non alimentary factors. The beneficial effects of the maternal milk are generally relate to improvements in host defense (less incidence of infections, necrotizing enterocolitis and alimentary allergies, etc.), digestion and absorption of nutrients, neurodevelopment, gastrointestinal function, as well as psychological effects on the mother.
As the goal for nutritional support is to meet the intrauterine rates of growth and nutrient retention, nutrient supplementation is necessary to optimize the use of human milk in the feeding of premature infants. Mineral supplementation of unfortified human milk may improve linear growth and bone mineralization during and beyond the neonatal period. Protein and energy supplementation have been shown to improve rates of weight gain and indices of protein nutritional status
However, despite the advantages to nutritional status, there is a concern that the addition of a large quantity of supplements may affect the intrinsic host defense properties as well as the gastrointestinal tolerance of human milk , being necessary more studies on the human milk fortifiers.
We analyzed the role that nutrition and the insulin-like growth factors IGF-I and IGFBP-3 play on neonatal growth. Full-term and preterm infants with 1 and 3 weeks of postnatal life (n = 54 and n = 33, respectively) were studied. Anthropometric variables, daily intake of energy and nutrients, and serum levels of IGF-I and IGFBP-3 were measured. Preterm infants fed with human milk supplemented with a preterm formula showed higher serum IGF-I levels than those fed exclusively with a milk formula (mean +/- SEM 48.2 +/- 9.5 micrograms/L vs. 25.4 +/- 4.4 micrograms/L, p < 0.05). In PT we have observed that the levels of IGF-1 and IGFBP-3 showed a significant correlation with anthropometric variables, postconceptional age, energy and protein intake and the percentage of human milk intake, and it was proved that 67 per cent of variation in IGF-I levels at neonatal period was explained through these variables (F=8.57;p= 0.0000).
19. DIETARY MANAGEMENT OF OBESITY. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 023. http:// www.seinap.org
M.Bueno.O.Bueno. Department of Pediatrics. Faculty of Medicine. University of Zaragoza.
Childhood obesity is considered as a major public health problem for several reasons: it can cause both medical and social problems, it tends to persist and long-standing obesity is associated with health risks in adulthood.
Whereas adult obesity is known to be resistant to treatment, intervention programmes for children show more promising results.
The types of dietary approach in common use are:
-simple nutritional counselling (SNC) or balanced normal-calorie diet (BNCD);
-balanced low-calorie diet (BLCD);
-very-low-calorie diet (VLCD).
The treatment of obesity is extremely difficult. Diets have a high failure rate. Therefore, emphasis should be placed on prevention of overweight, starting with young children. The most preventive intervention is likely a combination of parental involvement (to determine diet and physical activity practices) and school-based programmes (to help reduce sedentary behavior, as well as some dietary modifications). The apparent protective effect of breast-feeding has been noted and possible causative factors has been hyphotesized to include the macronutrient content of breast milk, the inclusion of growth factors, and the ability of the breastfed infant to better regulate energy intake.
Prescribing diets for obese children and adolescents requires evaluation of the children’s nutritional status, possibly with metabolic assessment as well. Personal, family, socio-economic and environmental factors also need evaluation. Dieting is unlikely to have much effect without other long-term lifestyle changes: increased physical activity; psychological help; and the supportive effects provided by interdisciplinary management.
REFERENCES
1. Braet C, Tanghe A, De Bode P, Franckx H, Van Winckel M. Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction. Eur J Pediatr 2003;162:391-396.
2. Bueno M, Bueno O, Sarría A. Obesidad en el niño y adolescente. En: Beas F, ed.”Endocrinología del niño y el adolescente”. 2ª ed. Santiago de Chile, Mediterráneo, 2002; 27:351-363.
3. Caroli M, Burniat W. Dietary management. En: Burniat W, Cole T, Lissau I, Poskitt E, eds. “Child and Adolescent obesity”. Cambridge, Cambridge University Press 2002;14:282-306.
20. PHARMACOLOGICAL TREATMENT OF THE OBESITY. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 024. http:// www.seinap.org
M. Pombo*, L. Castro-Feijóo
Unidad de Endocrinología Pediátrica, Crecimiento y Adolescencia.
Hospital Clínico Universitario. Universidad de Santiago de Compostela
The obesity has turned in one of the principal pandemics of our time. In fact, the World Health Organization considers obesity one of the ten principal problems of health in the world. The proportion of obese in the United States has duplicated in the last two decades until reaching a prevalence of 30% in the population, while another 35% is above the normal weight, and among children and American adolescents, the proportion of obese has grown a 36% in less than ten years. The prevalence of obesity in the Spanish population between 2 and 24 years of age is estimated in 13,9 % and the overweight is estimated in 12,4 % (1). As a whole, overweight and obesity represent the 26,3 % (1). Today, it is generally accepted that sedentary lifestyle and hypercaloric diet are the main triggers for obesity in genetically predisposed individuals and that conventional treatments (diet, exercise and behavioural modification) are not effective to achieve a substantial loss of weight in the long term (2,3). However, pharmacological treatment of obesity in children is controversial due to the potential risks of negative side effects on metabolism, growth and development. At present, Sibutramin and Orlistat are the only long-term treatment approved for adults (4). There is an increasing interest for the possible benefits of their use in children, although the experience up to now is limited. Several studies found a potential benefit in the use of Orlistat in combination with conventional therapies (5,6). Undoubtedly, the present is far from an effective therapy for obesity in children and adults. Nevertheless, new drugs that are now in different phases of investigation open new hope for better treatment. It is important to remember that obesity is a complex disease and is unlikely that can be solved with simple solutions.
1. Aranceta J, Pérez C, Ribas L, Serra L. Epidemiología de la obesidad en la población infantil y juvenil española. Hormona y factores de crecimiento 2003; 6:5-9.
2. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioural family-based treatment for childhood obesity. Health Psychol 1994; 13:373-383
3. Nuutinen O, Knip M. Weight loss, body composition and risk factors for cardiovascular disease in obese children: long term effects of two treatment strategies. J Am Coll Nutr 1992; 11:707-714
4. Weigle DS. Pharmacological therapy of obesity: Past, present, and future. J Clin Endocrinol Metab 2003; 88:2462-2469
5. McDuffie JR, Calis KA, Uwaifo GI, Sebring NG, Fallon EM, Hubbard ES, Yanovski JA. Three-month tolerability of orlistat in adolescent with obesity related comorbid conditions. Obes Res 2002; 10: 642-650
6. Norgren S, Danielsson P, Jurold R, Lötborn M, Marcus C. Orlistat treatment in obese prepubertal children: a pilot study. Acta Paediatr 2003; 92:666-670
21. PSYCHOLOGICAL TREATMENTS OF CHILDHOOD OBESITY. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 025. http:// www.seinap.org
Dra. M.A. Javaloyes Sanchis
Hospital Univ. San Juan, Alicante
Childhood obesity is an area where physical and psychological aspects are strongly linked. Psychological aspects in the management of childhood obesity have become in the last few years an essential part for a successful outcome. The psychological strategies are helpful not only for the treatment but also for prevention of childhood obesity. A multidisciplinary approach is essential and the different health professionals need to approach childhood obesity from a biopsychosocial perspective in order to achieve a positive outcome. Treatment plans should include reasonable weight-loss goals, dietary and physical activity management, cognitive and behaviour modification and family involvement.
Besides the several physical diseases linked to obesity (heart disease, diabetes, etc), childhood obesity has social, psychological and emotional consequences. We live in a society that emphasizes slimness and thinness. At the same time there are many misconceptions about overweight and obesity. The consequence is that obese children often are treated differently and very often feel isolated and lonely. This can lead to self-esteem and identity problems. It is essential in the management of obesity to include cognitive and behavioural work to improve child self-esteem, self-concept and confidence. There is also a general believe that obesity has a lot to do with the interaction that takes places between parents and children around food, and that parents need to help their children to develop proper eating habits. Therefore psychological intervention in childhood obesity has two main components: (1) family involvement, (2) individual cognitive-behavioural strategies.
Family involvement has become in the last few years an essential part of the management, with objectives are set for the entire family, promoting physical and emotional well being and not only dieting. The family is the child’s major social environment and is the context where children model behaviours and beliefs. For this reason, is essential in childhood obesity that the family acts as a good role model, in aspects like eating and exercising. Nutritional education should be aimed at both the child and the family. It has been demonstrated that the long-term effectiveness of a weight control program is significantly improved when the intervention is directed at the parents as well as the child, rather than aimed at the child alone.
The cognitive-behavioural work in childhood obesity aims to improve self-esteem and confidence in the child, modifying some of the negative perceptions and beliefs that the child has about himself and his peers. This can be done by teaching the child to turn negative self-statements into positive ones, and helping him cope with the negative remarks of others. At the same time works improving motivational levels that are the clue for successful behavioural strategies. Behaviour modification includes self-monitoring (food and activity records) and improving activity patterns. The child should help set a weekly activity goal, sign a contract to perform the activity and help determine the reward for reaching the goal. Reinforcements and rewards include verbal praise from the professionals and family members, as well as tangible rewards for achieving dietary, activity and weight-loss have a very good effect.
22. POLYUNSATURATED AND TRANS FATTY ACIDS IN PEDIATRIC POPULATIONS: THEIR RELEVANCE IN NUTRITION
AND PREVENTION OF CARDIOVASCULAR DISEASE. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 026. http:// www.seinap.org
Authors: Pablo Sanjurjo and Koldo Aldámiz-Echevarría
Object: To assess the relationship between the content of poyunsaturated and trans fatty acids in the fatty tissue and muscle of children and the cardiovascular risk factors, in particular periferic insulin resistance.
Design: A transversal study covering a three year period.
Scope of the study: Cruces Hospital Pediatric Department – Pediatric Metabolism Unit.
Subjects in the study: 120 healthy children of both sexes to be subjected to minor surgery in four age groups (0-2, 2-5, 6-9 and10-15 years old).
Tests: Voluntary muscle tissue membrane phospholipid and fatty tissue acylic composition, base levels of blood sugar, insulin, cholesterol and fractions, triglycerides, apolipoprotein E and apolipoprotein CIII genotype.
Results and Conclusions: Both glucose and sugar as well as the HOMA index gradually increase during the 4 pediatric stages included in the study (1,71± 0,84. 1,61± 0,81 2,68± 1,67 and 3,77± 1,58). However, a statistical significance is established in the older age groups (groups 3 and 4: 5-10 years and over 10 years) and the first two groups (0-2 y 2-5 years). Although a physioligical insulin resistance is conceptually possible in the puberal stage (group 4 over 10 years) it is worrying that this is already starting to be defined at a prepuberal age (5-9 years).
The study of muscle membrane fatty acids is inherently useful in infants by providing reference values by age that had not previously been reported in the literature (only one study has been published on breastfeeding children). The gradual decrease in oleic acid deserves to be highlighted (9,11±2,23, 8,93±1,79, 8,20±1,23 and 8,12±1,34) together with the increase in linoleic acid (18,14±5,01, 24±3,71, 25,61±3,63 and 27,47±3,66) and trans fat (0,27±0,11, 0,31±0,15, 0,37±0,13 and 0,35±0,14) constituting tissue proof that the mediterranean diet is being abandoned at a pediatric age..
The study of fatty tissue fatty acids is also intrinsically useful by providing reference values by age groups in infancy (there are only partial data from 1987 reported by ourselves). The increase in linoleic acid (12,38±2,16, 14,26±3,32, 15±2,96 and 14,44±2,75) and its tissue metabolite, arachidonic acid, (0,27±0,13, 0,2±0,04, 0,24±0,1 and 0,29±0,08).deserve to be highlighted. These data, together with the findings from the muscle membrane analysis, confirm the move away from the mediterranean diet in children and the excessive intake of linoleic acid.
23. LONG CHAIN POLYUNSATURATED FATTY ACIDS IN INFANT FORMULAE. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 027. http:// www.seinap.org
Dpto. de Pediatría. Facultad de Medicina. Universidad de Granada.
Long chain polyunsaturated fatty acids (LC-PUFAs) from n-6 and n-3 families have a very important functions during pregnancy, lactation and infancy; the arachidonic acid (AA) and the docosahesaenoic acid (DHA) are implied in the central nervous system structure, and particularly, the DHA are involved in the neurons synapses and in the external segments of the photoreceptors. In 1991, the ESPGHAN Committee on Nutrition recommended the supplementation of infant formulas with LCPUFAs (Agget, 1991); in 1992 was the British Nutrition Foundation (BNF), the FAO in 1994, the European Union (SCF) in 1996 and the FDA in 2001. Actually, the recommendations for infant formulas about AGPICL are: at least, 0.2% from the total fatty acids in form of DHA and a 0.35% as AA (Koletzko, 2001). Different studies tried to demonstrate that the term infant breast-fed or with DHA supplemented formula have a visual acuity higher at 2 months (Carlson, 1996; Makrides, 1996; Hoffman, 2000), 4 months (Hoffman, 2000) and at 2.5 years (Makrides, 1996) or 4.5 years (Hoffman, 2000) of life in contrast with those which received non supplemented formulas; others have not found significant differences (Innis, 1996; Auestad, 1997; Jorgersen, 1998). The controversy about these results is due to the use of different methods to evaluate the visual acuity or the different AA and DHA concentrations in the studied formulas (Singer, 2001). As there is no secondary effects demonstrated, most of the infant formulae are being supplemented with AGPICL from some years ago, based in the higher plasma concentrations and erythrocyte membranes of AGPICL and similar to breast—fed infants (Decsi, 1995; Campoy, 1998), but also because their presence in important quantities in retinal, brain and human milk (Koletzko, 2001; Koo, 2003). The increase of DHA could be done, but not by unlimited way; high supplements of DHA during lactation through the infant formula have been related to a low increment of weight at 120 days of life, to a reduction of the AA proportion in plasma phospholipids than in those fed with a formula with the low content of DHA (Auestad, 2001). Different sources of AGPICL have bee used to supplement infant formulas, and there is no statistical differences in the AGPICL from plasma phospholipids but also in the erythrocyte membrane after the nutritional intervention (Haschke-Becher, 2001; Campoy, 2002; Mathews, 2002). Experimental studies, with higher concentrations, showed that depending o the source of the AGPICL, triacylglicerols or phospholipids, a different plasma lipoprotein distribution takes place (Amate, 2001). The effect of changes in the ratios n-6/n-3 and AA/DHA on the bone mineral metabolism during early period of life, is under research (Moya, 2001; Weiler, 2002,2003). The AGPICL can be also implied in the development and immune system reactions (Calder, 2001; 2003; von Berg, 2003), but also in the interaction between hormones, specific receptors and gene expression, low explored in infancy but with potential applications in preventic medicine, embryology and clinical nutrition (Agostoni, 2001). The equilibrated intake of the ratios n-6/n-3 and AA/DHA seems to be a critical factor for an adequate global psychomotor development. The evaluation of the cognitive functions could not represent other brain functions or about the superior functions; so, the consequences to long time of partial described deficits, do not permit to establish clearly the influence of the incorporation of LCPUFAs in the suckling infant diet. However, as the studies done were not randomized, the differences found could be due to others different factors than the LC-PUFAs content (Horwookd, 1998). So, it will be very important to select and avoid biases, which can affect the nutritional intervention procedure, in order to determine the benefits and risks of LC-PUFA supplementation of infant formula (Singer, 2001).
24. LCPUFA IN HUMAN MILK. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 028. http:// www.seinap.org
L Peña Quintana, F Domínguez Ortega.
Hospital Universitario Materno-Infantil de Canarias. Las Palmas de Gran Canaria.
The lipidic fraction of mature human milk represents the main energetic component (45-55%) and the second one in terms of its quantitative value (3-5%), being about a 97-98% triglicerides and fatty acids their major constituent (88%). The arachidonic acid (ARA) (C20:4n-6) and the docosahexaenoic acid (DHA) (C22:6n-3) are the more studied long chain polyunsaturated fatty acids (LC-PUFA), given their implication for growth and neural development.
We carried out a study in our Hospital concerning fatty acid concentrations in colostrum (3 days) and transition milk (7 days) of 24 women who had undergone caesarean section and had all the same diet. Within the colostrum’s fatty acid composition, there was a range of variation for ARA between 0,4 - 1,17 (mean = 0,71), and 0 - 1,17 (mean= 0,45) for DHA; while for the transition milk, the ranges were 0,29 - 0,57 (mean = 0,57) and 0 - 1,927 (mean= 0,28), respectively. Other LC-PUFA such as the eicosapentanoic acid (EPA) (C20:5n-3) varied between 0 - 0,23 (mean = 0,45) and 0 - 0,1 (mean = 0,04); docosapentanoic acid (C22:5n-3), between 0 - 0,23 (mean = 0,07) and 0 - 0,223 (mean = 0,04); eicosadienoic acid (C20:2 n-6) between 0,5 - 1,55 (mean = 0,97) and 0,46 - 1,228 (mean = 0,78) for colostrum and transition milk, respectively. The only association found was that between cholesterol levels and c-LDL in maternal blood and concentration of ARA in milk.
In terms of percentages, both ARA and DHA levels are greater in colostrum and up to 1 month age, droping and then holding stable levels up to 12 months age; however, in absolute terms, the content (AA 12-16 mg/dl; DHA 6-8 mg/dl) remains basically the same during the whole lactancy period.
With the current knowledge, it is difficult to relate the nursing mother’s diet habits to their milk’s LC-PUFA content. It has been showed that those mothers with a high consumnption of seafood present increased levels of n-3 LC-PUFA, such as EPA and DHA, without relevant modifications in the ARA levels, suggesting that n-3 LC-PUFA levels are more diet-dependent than those of n-6 LC-PUFA levels. On the other hand, it has also been noted that the transfer to the nursing infant of these LC-PUFA through the mammary gland, is carried out mainly using maternal depots, since their circulant levels are decreased in nursing women.
Their importance do not take roots only in terms of energetic contribution but also in the synthesis and development of retinal and neural tissues, since AA is the main n-6 fatty acid in the neural tissue, apart from being a precursor for other substances, and DHA is the main n-3 fatty acid in the neural tissue and accounts up to 40% of the whole fatty acids of the retinal’s fotoreceptor membranes. These LC-PUFA, like others, are mainly found in phospholipidic membranes (specially at sinaptic terminal membranes in CNS), instead of as deposit lipids, increasing their fluidity and influencing their functioning characteristics.
Nowadays it is still controversial the role of these LC-PUFA in the growth, the visual system and the behavioral or cognoscitive development, as well as their addition to infantile formulae.
25. LONG CHAIN POLY UNSATURATED FATTY ACIDS PROFILE IN DAIRY PRODUCTS.INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 029. http:// www.seinap.org
E. Cortés. I. Ballester y M. Moya
Pediatrics Department. University Miguel Hernández. Alicante
Background. Breast milk supplies a 50-60% of the total energy because of its fat content that will assure the growth high rate in the first year of life. Arachidomic acid (AA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3) have high concentration in brain and retina. They can be synthesized from the essential ones linoleic (LA, 18:2n-6) and α-LNA, 18:3n-3) that must be supplied by diet. All these fatty acids are present in breast milk, but it´s very important to know the content in some dairy products that nowadays are replacing formula or breast milk. Our aim was to analyse the total fat content and LCPs in cow´s milk and dairy products whether yoghurt or fresh dairy products.
Methods. We have analysed total fat and fatty acid content (C8-C26, sat/unsat) in all the products shown in table. Total fat was quantified by a gravimetric method and fatty acid through gascromatography (Shimadzu GC-17A) with mass spectrometry detector (QP-5000) equipped with silica column (Omegawas 250, Supelco). Identification and quantification has been done using the appropriate standards (Nu Chek prep. Inc) (2).
Results. Only concentration higher than 0,1% are shown in the table.
Discussion. Infant yoghurts have LA (9,31%) and α-LNA (1,24%) concentration higher than cow´s milk and regular yoghurt in whatever form analysed. But they are lower than that of the starting formulas (19,06% and 1,74% respectively), which in his turn are slightly richer than mature breast milk (16,1 y 0,54% respectively) (3). Among different types of yoghurts and cow´s milk there are not important differences concerning these LCPs. Therefore and thinking in LCPs terms there would be not objection for replacing one by the others.
26. EFFECTS OF DOCOSAHEXAENOIC ACID SUPPLEMENTATION IN WOMEN FROM 20 WEEKS OF GESTATION UNTIL
Iznaola MC1, Sáez JA1, Miranda MªT2, Sierra P3, Jerez A3, Molina-Font JA3, Campoy C3.
1Neurophysiology Service. University Hospital San Cecilio. 2Dept. of Biostatistics & 3Dept. of Peadiatrics. School of Medicine. University of Granada. Spain.
INTRODUCTION: Several studies have tried to determine the effect of docosahexaonoic acid (DHA) supplementation on nervous system development and, speciffically, on visual function. To show the last effect of this functional nutrients, some researches have determined the visual acuity (VA) with comportamental techniques (preferential looking test) and with electrophysiological test like visual evoked potentials or flash electrorretinogram. The divergences of the studies has improved new lines for investigate.
AIM: This study try to determine if DHA supplementation from 20 week of pregnancy modifies visual function (contrast sensibility) in 2 months old suckling infants with visual acuity determined with the visual evoked potential (VEP) pattern.
MATERIAL AND METHODS: Subjects: In a total of 140 healthy suckling infants (74 boys and 66 girls), borned at term and with a birthweight according to the gestational age, the VA was measured at 8 weeks of life. A neuropsycomotor test was developed in all the babies at one month of life, showing that all of them were normal for their age. The babies were divided in 4 groups depending on the kind of nutritional supplements that their mother received during pregnancy from 20 weeks of pregnancy until delivery. The four types of supplements were: placebo, 5-MTHF, DHA, and DHA+5-MTHF).
Methods: To determine the AV (minutes of arc) the modified technique of Samuel Sokol (Sokol, 1978, 1983, 1992) was used. The latency (msec) and the amplitude (µvol) of P1 wave of the bi- & monocular VEP were determined.
Biostatistic analysis: The Shapiro-Wilk and Kolmogorov-Smirnov tests were done to determine the normality of the variables. A general lineal model for paired data and repeated samples were developed, considering the exploring angle as intra-subjects factor and the type of nutritional supplementation as inter-subjects factor. ANOVA test and Bonferroni’s test for multiple comparisons were also done. Correlation analysis was performed in the total sample and considering the 4 types of supplement gave to the mothers.
RESULTS: Non statistical differences were found between the 4 groups regarding latency, amplitude or VA. The latency of P1 wave is inversely proportional to stimulation visual angle in binocular exploration in the suckling infants aged 2 months, independently of the supplement received from their mothers during the pregnancy (Placebo: r:0.49; 5-MTHF: 0.36; DHA: r:0.43; DHA+5-MTHF: r:0.47; p<0.0001). The amplitude of P1 wave is directly proportional to stimulation visual angle (r: 0.43, regression S curve: Ln(y)=3.25+0.12/x; p:0.01). Monocular VA is similar between eyes. Binocular VA is similar to monocular VA.
CONCLUSSIONS: DHA supplementation from 20 week of pregnancy does not modify the latencies, the amplitudes and the VA determined with cortical VEP in babies aged 2 months.
Cortical VEP is an objective and easy technique to determine VA in suckling infants at 2 months of life, and may have important clinical implications.
References:
Carlson SE, Ford AJ, Werkman SH, Peeples JM, Koo WW: Visual acuity and fatty acid status of term infants fed human milk and formulas with and without docosahexaenoate and arachidonate from egg yolk lecithin, Pediatr Res. 1996; 39: 882-888.
Makrides M, Neumann MA, Jeffrey B, Lien EL, Gibson RA: A randomized trial of different ratios of linoleic to alpha-linoleic acid in the diet of term infants:effects on visual function and growth, Am J Clin Nutr. 2000; 71(1): 1-2.
Sokol S: Measurement of visual acuity from pattern reversal evoked potentials, Vision Res. 1978: 18: 33-39.
27.OBESITY: MEDIUM TERM FOLLOW-UP”. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 031. http:// www.seinap.org
J. Dalmau Serra* I. Vitoria Miñana**
*Hosp. Infantil La Fe Valencia. ** Hosp. Lluis Alcanyis Xàtiva (Valencia)
Obesity is a chronic disease with known biochemical disorders (dyslipemia, hemorheological changes, hypofibrinolysis, hyperinsulinaemia, etc). Medium and long term consequences of such alterations are mostly ignored, so follow-up of these patients is mandatory. Data obtained after a 6 to 12 months follow-up of several groups of obese patients are:
1.- Follow-up of 213 obese patients shows that differences in height increments are smaller in those who respond to treatment (good response, GR) (BMI decrement > 2 points/year) when compared to those did not respond (4,6 ± 3.9 vs 6,3 ± 6,2 cm p<0.03).
2.- Lipidic parameters: Obese patients with GR (n 41 out of 90) have increments in HDL-C (48,2 ± 9,1 vs 54,9 ± 12,0 mg/dl p<0.01) and Apoprotein AI (126,7 ± 17,3 vs 136,0 ± 17,4 mg/dl p<0.05). Obese patients with alterations in HDL-C and triglycerides (17,7%) in GR group show normal levels after treatment.
3.- Hemorhelogical parameters: Obese patients (n 34) have alterations in fibrinogen (317 ± 65 vs 268 ± 45 mg/dl p<0.01), erythrocyte aggregation (7,83 ± 1,27 vs 7,16 ± 1,24 p<0.05) and plasma viscosity (1,19 ± 0,06 vs 1.16 ± 0,03 mPa.s p<0.05). There is a trend of improvement in these parameters among the GR patients group (n 26), but without statistical significance.
4.-Obese patients (n 102) have a decrement in fibrinolysis due a high levels of antigenic (28 ± 14 vs 14 ± 9 ng/ml p<0.001) and functional (22 ± 11 vs 8 ± 8 u/ml p<0.001) PAI 1,and also euglobulin lysis time (217 ± 53 vs 129 ± 55 min p<0.001). PAI 1signifantly correlates with BMI, triglycerides and insulin, so it is included in X syndrome.GRpatients (70) have decrements in antigenic(28+15 vs 24 +14 ng/ml p<0.02) and functional (22+12 vs 18+10 u/ml p< 0.01) PAI 1, and subsequent higher fibrinolytic evidenced by ELT shortening (225+54 vs 205 +57 min. P<0.02).
Comments: Antropometric parameters by themselves are possibly not a reliable marker of decrement risk factors associated with obesiry. Only GR patients show improvement in lipidic, hemorheological and fibrinolytic parameters. Futher investigations are mandatory to show long term stability of these data.
INTRODUCTION: The notable rise in the incidence of type 2 diabetes in children the last decade, appears to be linked to the epidemic increase in the prevalence of obesity in children and adolescents worldwide. We determined the prevalence of glucose intolerance in a cohort of obese children studied in the paediatric endocrinology unit of our centre.
PATIENTS AND METHODS: Retrospective analysis of medical records of 100 patients (42 boys, SD score of BMI 4,8 ± 1,8, and 58 girls, SD score of BMI 3,9 ± 1,5) aged between 2 and 18 years, who underwent an oral glucose tolerance test (OGTT) between 1997 and 2002. Evaluation of OGTT was based on WHO criteria and fasting insulin resistance was estimated using the homeostasis model assessment (HOMAIR index; fasting insulin x fasting glucose/405). HOMAIR values below 2.0 were considered normal, values between 2.0 and 3.0 mild insulin resistance and values 3 or over moderate to severe insulin resistance.
RESULTS: The prevalence of glucose intolerance in our population was 25%, and that of diabetes 1%. Patients characteristics are shown in the table.
CONCLUSIONS: The prevalence of glucose intolerance in our population coincides with that found in other groups studied. A positive and statistically significant correlation was observed between HOMAIR index and BMI (r= 0,315; p: 0,002), glycaemia at 120 minutes (r= 0,275; p: 0,006) and the area under the insulin curve (r= 0,654; p: 0,000). These data show that obese patients present greater insulin resistance, which could be one of the factors involved in their glucose intolerance.
29. EFFECTS OF NUTRITIONAL SUPPLEMENTS WITH DOCOSAHEXANOIC ACID (DHA) AND/OR FOLATE DURING
PREGNANCY ON THE INFANT NEUROPSICOMOTOR DEVELOPMENT. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 033. http:// www.seinap.org
Robles C, Benitez A, Sierra P, Jerez A, Garrido FJ, Salvatierra MªT, Molina-Font JA, Campoy C.
Dept. of Paediatrics. School of Medicine. University of Granada.
Introduction: The major store of docosahexaenoic acid (DHA) in the developing brain, takes place among the third trimester of gestation, and slower follow on until the 2nd year of life. This fact occurs at the same time of a rapid increment in the synapsis number and brain cells growing. In animals has been demonstrated that n-3 fatty acids play an important role on the infant learning procedure and in the cognitive development. The long-chain polyunsaturated (LC-PUFAs) levels at birth are markers of the neurology and visual outcome. The folic acid deficiency improves changes in the platelet’s lipid fatty acids (increase of arachidonic acid and diminution of n-3 fatty acids). Böhles et al. reported that the folate supplementation during pregnancy could enhance the DHA nutritional status in the newborn infant.
Aim:To analyse the influence of DHA and/or folate nutritional supplementation during pregnancy on the neurology and psychomotor development in the neonate and infant.
Material and Methods:A total of 100 mother-babies pairs were studied, and divided into four groups, considering the type of supplement received {DHA (n:25), 5-MTHF (n:24), DHA+5-MTHF (n:25) or placebo (n:26)}, from the 20 week of gestation until delivery. The pregnant were healthy women, aged between 21 and 38 years, without pre- or post-conceptional illness known, and with a normal pregnancy.
Biochemistry: LC-PUFAs were determined in plasma phospholipids (mg/dl) from mothers and umbilical cord, using HPLC (Lepage, 1986). A neuropsicomotor test was done at 1 and 6 months of life.
Statistical Analysis: Kolmogorov-Smirnov test was performed. Descriptive and frequency analyses were done. Also, ANOVA and square Chi test were also applied.
Results: All groups were homogeneous for gestational age, weight, longitude and head circumference at birth. There were no statistical differences at 6 months of age between these parameters. The pregnant women who received DHA nutritional supplements demonstrated higher plasma levels at delivery (13.96±0.55*, 10.92±0.75, 12.9±0.75*, 10.35±0.78, *:p<0.01), but also in umbilical cord. The DHA, 5-MTHF, DHA+5-MTHF or placebo supplements were related with the follow results regarding the neuropsycomotor development, which were evaluated globally and per groups at the first and sixth months of life (Table I).
1) The infants who their mothers were supplemented with DHA+5-MTHF showed a better global neuropsicomotor development than the rest of the groups.
2) The strict obstetrical, paediatric and nutritional supervision of the mother and the infant until the 6 month of life, may had play a role determining lower differences between groups.
** Proyecto Europeo NUHEAL, QLRT-1999-00888.
30. INCOMPLETE STARCH DIGESTION IN CYSTIC FIBROSIS DETECTED BY THE 13C-CORN STARCH BREATH TEST.
*Unidad de Gastroenterología Infantil y Nutrición, Hospital “Vall d’ Hebron”
** Unidad de Gastroenterología Infantil y Nutrición “Vía Augusta”, Barcelona
Starch digestion may be incomplete in Cystic Fibrosis (CF), as it has been shown in pancreatic insufficiency of other etiologies. (1).
The 13C-corn starch breath test was used to study the starch digestion. The corn cereals have a naturally enriched 13C-labeled starch, that in the duodenum is hydrolysed into 13C-labeled glucose and partially oxidised to 13CO2. The quantity of 13CO2 in breath is and indicative of starch digestion.
METHODS: Three groups of similar ages, were studied:
1) 18 CF patients with steatorrhea and underweight
2) 16 CF patients with normal pancreatic function and normal weight
3) 24 normal children
All were given between 40 and 60 gr of corn, with the habitual enzyme replacement (4.000 Amylase units). The breath was collected before and at 1h, 2h and 3 h after the corn meal.13C was determined by Infra Red Spectroscopy Wagner analyser. The areas under curve (AUC) were calculated.
RESULTS: AUC results of the three groups: Group 1: mean 3.21 (s: 1.43). Group 2: mean 7.63 (s: 1.37). Group 3: mean: 6.177 (s: 2.99).
The difference was significative between groups 1 - 3 and 1 - 4 (p<0.05).
CONCLUSIONS: The starch digestion was impaired in the Group 1 ( steatorrhea and underweight); the impaired starch digestion may be one of the leading causes of malnutrition in CF; the improvement of starch digestion in CF merits further research.
(1) Hiele M, Ghoos Y. and cols. Gastroenterology, 1989; 96: 503-509.
31. First Times of Scientific Pediatric Nutrition. INVEST NUTR ALIM PEDIATR (Rev on-line) 2003; 1 # 035. http:// www.seinap.org
Antonio Sarría Chueca. Profesor Emérito, Facultad de Medicina, Universidad de Zaragoza
The bases of scientific nutrition began in France with the so-called “Chemical Nutrition”, at the end of the eighteenth century. The scientific pediatric nutricion, started, mainly, in Berlin at the Charité Hospital, when Heuber, named Professor and Director of the Pediatric Clinic and Polyclinic at 1894, published with Rubner the firt calorimetric studies of the energy needs of infants. Prior to these studies, if a mother could not or would not breast feed her child, the infant faced the risk of inadequate nutrient.
In France, the famous chemist Lavoissier, with Seguin (1789) measured human respiration output of carbonic acid; and the heat produced by a lighted candle using an ice calorimeter, with Laplace (1780). During the nineteenth century, active French investigators in Physiology, like Magendie and Boussingault, studied different aspects of the nitrogen that “animalize” the ingested food.
After studying in France with Gay-Lussac, Liebig became professor of Chemistry at the University of Giessen. Liebig studied protein compounds and concluded that muscular exertion by horses and humans required mainly protein, not carbohydrate and fat (Animal Chemistry, 1842). He lent his name to two commercial products: Liebig´s Infant Food and Liebig´s Fleisch Extract.
In 1709 and 1710 a devasting plague rages through northeastern Europe. It reached East Prussia and Pomerania becoming a threat to the Royal Prussian residence in Berlin. In 1713 the capital gained a Theatrum Anatomicum used for educacion of medical professions, becoming later the Charité Hospital. Its Department for Children´s Diseases was founded in 1830. Directors of the department of Pediatrics were: Henoch, Gerhardt, Heubner and Czeny.
In the Handbuch of Gerhardt is presented (according to Vierordt, 1877) the formula of the corporal surface of children at different ages to be utilized to offer the required amount of milk or food. Vierordt and Rubner were the first to investigate the metabolism on the infant. Camerer, collected a large amount of material on height and weight on infants and children and endeavored to determine in heat units needs o infants of various ages. He calculated the caloric contents of breast milks bases on Pfeiffer analysis.
Heubner in 1894 became full professor of Pediatrics at the Charité in Berlin. A Heubner´ assistant professor Finkeltstein studied the hydrolability of infants.
Czerny and Keller estimated the caloric value of human milk at 650 calories per liter and cow´s milk al 670 calories per liter. Czerny proposed a classification of nutritional disorders of infants, based on ethiology: ex alimentatione; ex infectione; ex constitucione. Keller was also known for the design of Die Malzsuppe.
Biedert, in his doctoral dissertation made a chemical comparison of human and cow´s milk (1888). Later, he gave details of the feeding sustitute that he invented himself.
A great amount of knowledge about pediatric and nutrition, iniciated at Charité, was extended over German lands, and over other countries.
Bibliografía
* Ballester R. La Historia Clínica Pediátrica durante el Siglo XIX. Cátedra de Historia de la Medicina. 1977.
* Bertholet C L. Analyse de l´alkali volatil. Mem Acad Sci. Paris , 1785:316-326.
* Carpenter K J. A Short History of Nutritional Science. Part 1 (1785-1885)
* Guggenheim K Y. Basic Issues of the History of Nutrition. Ed. Magnes Press, 1995.
REVISTA DE REVISTAS
En este número:
el Dr. A. Sarriá recomienda la lectura de:
1) Nielsen S J, Popkin B M.Patterns and Trends in Food Portion Sizes, 1977-1998. JAMA. 2003; 289:450-453.
2) Rozin P, Kabnick K, Pete E, Fischler C, Shields C. The ecology of eating. Smaller portion sizes in France than in the United States help explain the French paradox. Psychological Science 14 (5), 2003: 450–454.
Y el Dr. A. Gil recomienda la lectura de:
1) M. Manzano, AC. Abadía, E. García Olivares, A. Gil and R. Rueda. Dietary Nucleotides Accelerate Changes in Intestinal Lymphocyte Maturation in Weanling Mice. JPGN 37:453–461, 2003.
