Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort.

BACKGROUND AND AIMS: Studies have revealed a positive relationship between milk consumption and hypertension. However, few researchers have investigated the association between milk consumption and changes in blood pressure (BP) in South Korean adults. Therefore, we examined the association between milk intake and the management and risk of hypertension in South Korean adults. METHODS AND RESULTS: Participants were selected from the Health Examinees study. The definition of hypertension was based on the guidelines of the Korean Society of Hypertension. The participants were divided into three groups according to changes between baseline and follow-up BP data. Milk consumption was assessed using food frequency questionnaires. In both men and women, the higher milk consumption group had increased odds of trends of BP improvement (OR: 1.249, 95% CI: 1.043-1.496, p for trend: 0.2271 in men; OR: 1.147, 95% CI: 1.014-1.297, p for trend: 0.0293 in women) and decreased odds of trends of worsening (OR: 0.861, 95% CI: 0.756-0.980, p for trend: <0.0001 in men, OR: 0.866, 95% CI: 0.794-0.943, p for trend: 0.0010 in women) compared to those of the non-consumption group. In the prospective study, milk intake was inversely associated with hypertension risk (HR: 0.900, 95% CI: 0.811-0.999, p for trend: 0.0076 in men; HR: 0.879, 95% CI: 0.814-0.949, p for trend: 0.0002 in women). CONCLUSION: Increased intake of milk was inversely related to the risk of increased BP, with a decreased risk of hypertension events.

¿Cuál es el efecto de consumir leche de vaca entera en comparación con leche reducida en grasa, en la malnutrición por exceso de niños y niñas de entre 1 a 6 años? / What is the effect of consuming whole cow's milk compared to reduced-fat milk on excess malnutrition in boys and girls between 1 to 6 years?

INTRODUCCIÓN: La obesidad es un importante problema de salud pública a nivel global y también en Chile, con un porcentaje de obesidad y sobrepeso en adultos de un 75%, y en niños y niñas preescolares de un 25% de obesidad y 26% de sobrepeso (1,2). Por otro lado, según los datos de población bajo control a diciembre 2019 de la atención primaria de salud pública, de las niñas y niños de 1 a 6 años controlados, el 35,3% presenta mal nutrición por exceso, de los cuales un 11,9% tienen obesidad y un 23,4% con sobrepeso (3). Parte de esta tendencia se podría explicar como resultado de una modificación en los patrones de consumo de la población chilena (4,5), incrementando el consumo de alimentos de alta densidad energética, con altas cantidades de azúcar añadida y grasas saturadas, junto con un bajo consumo de alimentos saludables, como frutas, verduras y leguminosas. En el caso de los lácteos, el promedio de consumo en preescolares está dentro de lo recomendado según las G

Direct Inhibition of the Allergic Effector Response by Raw Cow's Milk-An Extensive In Vitro Assessment.

The mechanisms underlying the allergy-protective effects of raw cow's milk are poorly understood. The current focus is mainly on the modulation of T cell responses. In the present study, we investigated whether raw cow's milk can also directly inhibit mast cells, the key effector cells in IgE-mediated allergic responses. Primary murine bone marrow-derived mast cells (BMMC) and peritoneal mast cells (PMC), were incubated with raw milk, heated raw milk, or shop milk, prior to IgE-mediated activation. The effects on mast cell activation and underlying signaling events were assessed. Raw milk was furthermore fractionated based on molecular size and obtained fractions were tested for their capacity to reduce IgE-mediated mast cell activation. Coincubation of BMMC and PMC with raw milk prior to activation reduced ß-hexosaminidase release and IL-6 and IL-13 production, while heated raw milk or shop milk had no effect. The reduced mast cell activation coincided with a reduced intracellular calcium influx. In addition, SYK and ERK phosphorylation levels, both downstream signaling events of the FcεRI, were lower in raw milk-treated BMMC compared to control BMMC, although differences did not reach full significance. Raw milk-treated BMMC furthermore retained membrane-bound IgE expression after allergen stimulation. Raw milk fractionation showed that the heat-sensitive raw milk components responsible for the reduced mast cell activation are likely to have a molecular weight of > 37 kDa. The present study demonstrates that raw cow's milk can also directly affect mast cell activation. These results extend the current knowledge on mechanisms via which raw cow's milk prevents allergic diseases, which is crucial for the development of new, microbiologically safe, nutritional strategies to reduce allergic diseases.

Metal (Pb, Cu, Cd, and Zn) Transfer along Food Chain and Health Risk Assessment through Raw Milk Consumption from Free-Range Cows.

BACKGROUND: Metal transfer along the food chain has raised concerns about impacts on human health due to dietary exposure to low but chronic concentrations. Soil-forage-milk-consumer is a short food chain through which metals are able to reach an organism. METHODS: Pb, Cu, Cd, and Zn were determined in water, soil, forage, and milk samples collected from free-range cattle farms situated near Baia Mare, Romania. The soil-to-forage (TFsf) and forage-to-milk (TFfm) transfer factors for metals and the health risk for three population groups (females, males, and children) through the consumption of milk containing low levels of metals were assessed. RESULTS: TFsf indicated that the uptake capabilities of the metals from soil to forage were in the following order: Zn > Cd > Cu > Pb. TFfm indicated a lack of metal accumulation through forage ingestion. Estimated daily (EDI) and provisional tolerable weekly (PTWI) intake values revealed a minimal exposure of the population to those metals through milk consumption. A noncarcinogenic hazard index indicated that milk consumption from local markets does not pose any risk for human health; however, the average cancer risk showed a high potential carcinogenic risk. CONCLUSIONS: The consumption of milk produced by small local farmers does not pose noncarcinogenic risks. More extended studies should be carried out in order to identify the potential carcinogenic risk caused by the low levels of metals in the milk consumed.

Assessment of lactase activity in humans by measurement of galactitol and galactonate in serum and urine after milk intake.

Background: Lactase is an enzyme that hydrolyzes lactose into glucose and galactose in the small intestine, where they are absorbed. Hypolactasia is a common condition, primarily caused by genetic programming, that leads to lactose maldigestion and, in certain cases, lactose intolerance. Galactitol and galactonate are 2 products of hepatic galactose metabolism that are candidate markers for the intake of lactose-containing foods. Objectives: The primary objective of the study was to explore the changes in serum and urine metabolomes during postprandial dairy product tests through the association between lactase persistence genotype and the postprandial dynamics of lactose-derived metabolites. Methods: We characterized the 6-h postprandial serum kinetics and urinary excretion of lactose, galactose, galactitol, and galactonate in 14 healthy men who had consumed a single dose of acidified milk (800 g) which contained 38.8 g lactose. Genotyping of LCT-13910 C/T (rs4988235) was performed to assess primary lactase persistence. Results: There were 2 distinct postprandial responses, classified as high and low metabolite responses, observed for galactose, and its metabolites galactitol and galactonate, in serum and urine. In all but 1 subject, there was a concordance between the high metabolite responses and genetic lactase persistence and between the low metabolite responses and genetic lactase nonpersistence (accuracy 0.92), galactitol and galactonate being more discriminative than galactose. Conclusions: Postprandial galactitol and galactonate after lactose overload appear to be good proxies for genetically determined lactase activity. The development of a noninvasive lactose digestion test based on the measurement of these metabolites in urine could be clinically useful. This trial was registered at clinicaltrials.gov as NCT02230345.

Fórmula nutricional a base de arroz para crianças com alergia à proteína do leite de vaca / Nutritional formula based on rice for children with cow's milk protein allergy

CONTEXTO: A APLV é o tipo de alergia alimentar mais comum nas crianças até vinte e quatro meses e é caracterizada pela reação do sistema imunológico às proteínas do leite. Dados internacionais mostram prevalência de crianças com APLV que variam de 0,3% a 7,5% até os dois anos de idade. Não há pesquisas ou inquéritos nacionais sobre a prevalência da APLV no Brasil. No entanto, em agosto de 2012, o MS realizou um levantamento nos municípios brasileiros, nos quais foi identificada média de acompanhamento de 0,4% (0,2% a 0,7%) de crianças com APLV em serviços/programas de atenção nutricional estruturados nesses municípios pelo SUS. A conduta na APLV baseia-se na exclusão da proteína alergênica da dieta; prescrição de dieta substitutiva que proporcione todos os nutrientes necessários em crianças até 6 meses; prescrição de alimentação complementar (de 6 a 24 meses). As fórmulas infantis para necessidades dietoterápicas específicas são indicadas para crianças de até vinte e quatro meses de idade. A CONITEC avaliou a incorporação no SUS das fórmulas nutricionais à base de proteína do leite de vaca extensamente hidrolisada (FEH), de aminoácidos (FAA) e de soja (FS). O demandante solicita a incorporação da tecnologia à base de proteína do arroz extensamente hidrolisada, recentemente aprovada pela ANVISA. TECNOLOGIA: Fórmula nutricional à base de proteína do arroz extensamente hidrolisada (Novamil® Rice). PERGUNTA: O uso de fórmula de proteína de arroz extensamente hidrolisada (FAH) é eficaz, seguro e custo-efetivo em lactentes portadores de alergia à proteína do leite de vaca (APLV) de 0 a 24 meses, quando comparado ao uso das fórmula para APLV à base de soja (FS), à base de proteína de leite de vaca extensamente hidrolisada (FEH) ou à base de aminoácidos (FAA)? EVIDÊNCIAS CIENTÍFICAS: Foram incluídos 6 ensaios clínicos prospectivos com grupo comparador, dos quais 3 eram randomizados, um era quasi-randomizado e 2 não eram randomizados. Cinco estudos foram realizados na Itália e um na Espanha (Reche). Três estudos avaliaram o crescimento dos bebês, como desfecho primário, através dos z-scores de peso por idade e de altura por idade; 2 estudos avaliaram a duração da APLV, ou o tempo para alcançar a tolerância ao leite de vaca, como desfecho primário; e um estudo avaliou a tolerabilidade como desfecho primário e o crescimento dos bebês e a duração da doença como desfechos secundários. Três estudos compararam a fórmula hidrolisada de arroz (FHA) com a fórmula de soja (FS) e com a fórmula extensamente hidrolisada a base de leite de vaca (FEH). Um estudo comparou a FHA com a FEH, outro comparou a FHA com a FS e outro comparou cinco fórmulas diferentes, FEH, FEH + lactobacillus, FHA, FS e fórmula de aminoácidos. Não foram encontradas diferenças entre a fórmula hidrolisada de arroz e as fórmulas a base de soja e extensamente hidrolisada em nenhum dos desfechos. Todas as fórmulas foram toleradas e não ocorreram reações adversas a elas. AVALIAÇÃO ECONÔMICA: O demandante realizou uma análise de custo-minimização na perspectiva do SUS, comparando a FHA com a FEH. Com o preço considerado para a FEH e o preço proposto para a FHA, os custos de tratamento foram menores com a FHA. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Na análise de impacto orçamentário, o demandante comparou a FHA com a FEH e considerou um Market share de 10% ao ano, iniciando em 10% e terminando em 50% em 5 anos. Com o preço considerado para a FEH e o preço proposto para a FHA, os custos de tratamento foram menores com a FHA e, consequentemente, a sua incorporação geraria economia para o SUS em relação à FEH. CONSIDERAÇÕES GERAIS: o uso de fórmulas hidrolisadas a base de proteína de arroz ainda é recente para se determinar sua eficácia e segurança em longo prazo, em relação às fórmulas extensamente hidrolisadas à base de proteína do leite de vaca, consideradas primeira opção de tratamento pelas principais diretrizes internacionais. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Os membros do Plenário da CONITEC recomendaram que o tema seja submetido à consulta pública com recomendação preliminar desfavorável à incorporação no SUS da fórmula nutricional à base de proteína do arroz extensamente hidrolisada para crianças de 0 a 24 meses com diagnóstico de alergia à proteína do leite de vaca (APLV). CONSULTA PÚBLICA: Foram recebidas 28 contribuições técnico-científicas e 241 contribuições de experiência e opinião durante o período de consulta pública, entre 28/04/2018 a 17/05/2018. Tanto as contribuições de experiência e opinião (51%) como as de conteúdo técnico-cientifico (61%) foram em sua maioria a favor da recomendação inicial da CONITEC. As evidências clínicas adicionadas, corroboram com a versão inicial do relatório, demonstrando que não há diferenças em eficácia e segurança entre as FHA e de proteína do leite de vaca. Outras contribuições alegaram a semelhança de eficácia e segurança entre as fórmulas. A CONITEC entendeu que não houve argumentação suficiente para alterar sua recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da CONITEC presentes na 69ª reunião ordinária, no dia 01 de agosto de 2018, deliberaram, por unanimidade, por não recomendar a incorporação da fórmula nutricional à base de proteína do arroz extensamente hidrolisada para crianças de 0 a 24 meses com diagnóstico de alergia à proteína do leite de vaca. Foi assinado o Registro de Deliberação nº 360/2018. DECISÃO: Não incorporar a fórmula nutricional a base de arroz para crianças com alergia à proteína do leite de vaca no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 40 de 11 de setembro de 2018, publicada no DOU de 12/09/2018.

Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: A systematic review.

BACKGROUND: Component-resolved diagnostics (CRD) are promising tools for diagnosing food allergy, offering the potential to determine specific phenotypes and to develop patient-tailored risk profiles. Nevertheless, the diagnostic accuracy of these tests varies across studies; thus, their clinical utility remains unclear. Therefore, we synthesized the evidence from studies investigating the diagnostic accuracy, risk assessment ability, and cost-effectiveness of CRD for food allergy. METHODS: We systematically searched 10 electronic databases and four clinical trial registries for studies published from January 2000 to February 2017. The quality of included studies was assessed using QUADAS-2. Due to heterogeneity, we narratively synthesized the evidence. RESULTS: Eleven studies met inclusion criteria, altogether recruiting 1098 participants. The food allergies investigated were cow's milk, hen's egg, peanut, hazelnut, and shrimp. The components with the highest diagnostic accuracy for each allergen, along with their sensitivity-specificity pairs, were as follows: Bos d 4 for cow's milk (62.0% and 87.5%), Gal d 1 for hen's egg (84.2% and 89.8% for heated egg, and 60.6% and 97.1% for raw egg), Ara h 6 for peanut (94.9% and 95.1%), Cor a 14 for hazelnut (100% and 93.8%), and Lit v 1 for shrimp (82.8% and 56.3%) allergy. CONCLUSION: Selected components of cow's milk, hen's egg, peanut, hazelnut, and shrimp allergen showed high specificity, but lower sensitivity. However, few studies exist for each component, and studies vary widely regarding the cutoff values used, making it challenging to synthesize findings across studies. Further research is needed to determine clinically appropriate cutoff values, risk assessment abilities, and cost-effectiveness of CRD approaches.

Exploratory study of acid-forming potential of commercial cheeses: impact of cheese type.

Due to their composition, cheeses are suspected to induce an acid load to the body. To better understand this nutritional feature, the acid-forming potential of five cheeses from different cheese-making technologies and two milk was evaluated on the basis of their potential renal acid load (PRAL) index (considering protein, P, Cl, Na, K, Mg and Ca contents) and organic anions contents. PRAL index ranged from -0.8 mEq/100 g edible portion for fresh cheese to 25.3 mEq/100 g for hard cheese Cantal and 28 mEq/100 g for blue-veined cheese Fourme d'Ambert. PRAL values were greatly subjected to interbatch fluctuations. This work emphasized a great imbalance between acidifying elements of PRAL calculation (Cl, P and proteins elements) and alkalinizing ones (Na and Ca). Particularly, Cl followed by P elements had a strong impact on the PRAL value. Hard cheeses were rich in lactate, thus, might be less acidifying than suspected by their PRAL values only.

Economic Burden of Atopic Dermatitis in High-Risk Infants Receiving Cow's Milk or Partially Hydrolyzed 100% Whey-Based Formula.

OBJECTIVE: To estimate the health and economic impact of feeding partially hydrolyzed formula-whey (PHF-W) instead of standard cow's milk formula (CMF) for the first 4 months of life among US infants at high risk for developing atopic dermatitis (AD). STUDY DESIGN: A Markov model was developed integrating published data, a survey of US pediatricians, costing sources and market data, and expert opinion. Key modeled outcomes included reduction in AD risk, time spent post AD diagnosis, days without AD flare, and AD-related costs. Costs and clinical consequences were discounted at 3% annually. RESULTS: An estimated absolute 14-percentage point reduction in AD risk was calculated with the use of PHF-W compared with CMF (95% CI for difference, 3%-22%). Relative to CMF, PHF-W decreased the time spent post-AD diagnosis by 8.3 months (95% CI, 2.78-13.31) per child and increased days without AD flare by 39 days (95% CI, 13-63) per child. The AD-related, 6-year total cost estimate was $495 less (95% CI, -$813 to -$157) per child with PHF-W ($724 per child; 95% CI, $385-$1269) compared with CMF ($1219 per child; 95% CI, $741-$1824). CONCLUSION: Utilization of PHF-W in place of CMF as the initial infant formula administered to high-risk US infants not exclusively breastfed during the first 4 months of life may reduce the incidence and economic burden of AD. Broad implementation of this strategy could result in a minimum savings of $355 million per year to society.

Policy improves what beverages are served to young children in child care.

BACKGROUND: During 2008, we conducted a statewide survey on beverages served to preschool-aged children in California child care that identified a need for beverage policy. During 2011, the US Department of Agriculture began requiring that sites participating in the Child and Adult Care Food Program (CACFP) make drinking water available throughout the day and serve only low-fat or nonfat milk to children aged 2 years and older. During 2012, the California Healthy Beverages in Childcare law additionally required that all child-care sites eliminate all beverages with added sweetener and limit 100% juice to once daily. DESIGN: To assess potential policy effects, we repeated the statewide survey in 2012. During 2008 and 2012, a cross-sectional sample of ∼1,400 licensed child-care sites was randomly selected after stratifying by category (ie, Head Start, state preschool, other CACFP center, non-CACFP center, CACFP home, and non-CACFP home). RESULTS: Responses were obtained from 429 sites in 2008 and 435 in 2012. After adjustment for child-care category, significant improvements in 2012 compared with 2008 were found; more sites served water with meals/snacks (47% vs 28%; P=0.008) and made water available indoors for children to self-serve (77% vs 69%; P=0.001), and fewer sites served whole milk usually (9% vs 22%; P=0.006) and 100% juice more than once daily (20% vs 27%; P=0.038). During 2012, 60% of sites were aware of beverage policies and 23% were judged fully compliant with the California law. CONCLUSIONS: A positive effect occurred on beverages served after enactment of state and federal policies. Efforts should continue to promote beverage policies and support their implementation.

Risky consumption habits and safety of fluid milk available in retail sales outlets in Viçosa, Minas Gerais State, Brazil.

This study aimed to assess raw milk consumption habits in the urban population of Viçosa, Minas Gerais, Brazil, and the microbiological safety and quality of the fluid milk available in retail sales outlets in the same region. A simplified questionnaire regarding raw milk consumption was applied to the persons responsible for food acquisition in 411 residences. The regular consumption of raw milk was observed by 18.5% of the interviewers, and lack of knowledge of possible risks related to this food product. Microbiological safety and quality were assessed for raw (n=69), pasteurized (n=80), and ultra-high-temperature (UHT)-treated milk (n=80) by analyzing the counts of mesophilic aerobes, coliforms, and Escherichia coli, and detection of Listeria monocytogenes and Salmonella spp.; raw milk samples were also subjected to enumeration of coagulase-positive Staphylococcus. Concerning raw milk, 59.4% of the samples were considered as produced in inadequate hygienic conditions, 5.8% of the samples presented counts of coagulase-positive Staphylococcus lower than 100 colony-forming units (CFU)/mL, and no samples presented with positive results for L. monocytogenes or Salmonella spp. All pasteurized and UHT milk samples presented with low counts of mesophilic aerobes and coliforms, while L. monocytogenes and Salmonella spp. were absent. The data demonstrated that raw milk was consumed by the population studied. Despite the absence of potential hazards, raw milk was of poor hygienic quality, in contrast with the processed fluid milk available in retail sales outlets that was safe and of good hygienic quality, highlighting the suitability of pasteurized and UHT milk for human consumption.

Attitudes, beliefs, and barriers related to milk consumption in older, low-income women.

OBJECTIVE: To determine attitudes, beliefs, and barriers related to adequate milk consumption in low-income women ages ≥ 60 years. METHODS: Nine focus groups were conducted with a convenience sample of 59 women at congregate meal sites in a metropolitan area. Grounded in Social Cognitive Theory, focus group questions were used to explore personal, behavioral, and environmental factors associated with milk consumption. RESULTS: Key response themes indicated a positive attitude for the taste of milk (except for low-fat), a primary belief that milk was important for bones and health, and a primary barrier of gastrointestinal side effects. CONCLUSIONS AND IMPLICATIONS: Knowledge regarding the benefits of milk and the dislike of its taste were not the primary reason for the lack of consumption. Instead, gastrointestinal side effects seemed to be the major barrier to adequate consumption. Future nutrition campaigns should test strategies for lactose intolerance management when communicating with low-income older women.

Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy.

OBJECTIVE: To determine clinical and follow up characteristics of children enrolled in a program to supply formulas for cow's milk allergy. METHODS: descriptive study of a convenience sample composed of 214 children up to three years old, with clinical diagnosis of cow's milk allergy and/or standardized oral challenge, referred to the Program of Formulas for Cow's Milk Allergy at a Pediatric University Hospital, in Natal, Rio Grande do Norte, Brazil (2007/2009). Clinical-epidemiological data and formula indication (soy, protein hydrolysates or aminoacid formula) were assessed at the first consultation. Clinical response and nutritional evolution (Anthro-OMS2006) were observed after three months. Chi-square and paired t-test were used, being p<0.05 significant. RESULTS: At the first consultation, mean age was 9.0±6.9 months. Digestive manifestations occurred in 81.8%; cutaneous ones, in 36.9% and respiratory ones in 23.8%. BMI Z-score <-2.0 standard deviations (SD) was found in 17.9% of children with isolated digestive symptoms, in 41.7% of those using cow's milk and in 8.7% of those using other formulas (p<0.01). The following formulas were used: soy in 61.2%, protein hydrolysates in 35.4% and aminoacids in 3.3%. Mean BMI Z-scores at initial consultation and after three months were, respectively: -0.24±1.47SD and 0.00±1.26SD (p=0.251), with soy formula, and -0.70±1.51SD and -0.14±1.36SD (p=0.322) with protein hydrolysates formula. CONCLUSIONS: Digestive manifestations of cow's milk allergy were preponderant, and lead to greater nutritional impairment. The use of replacement formulas (isolated soy protein and protein hydrolysates) was important to maintain the nutritional status.

Avaliação clínica e evolutiva de crianças em programa de atendimento ao uso de fórmulas para alergia à proteína do leite de vaca / Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy / Evaluación clínica y evolutiva de niños en programas de atención al uso de fórmulas para alergia a la proteína de leche de vaca

OBJETIVO: Determinar características clínicas e evolutivas de crianças acompanhadas em programa de referência para fornecimento de fórmulas especiais para alergia ao leite de vaca. MÉTODOS: Estudo descritivo, realizado em amostra de conveniência, com 214 crianças até três anos, com diagnóstico clínico e/ou teste padronizado de provocação oral aberto, referenciadas ao Programa de Fórmulas para Alergia ao Leite de Vaca, em Hospital Universitário Pediátrico de Natal, Rio Grande do Norte (2007/2009). Avaliaram-se dados clínico-epidemiológicos e indicação de fórmulas (soja, hidrolisado ou aminoácido) à consulta inicial, além de resposta clínica e evolução nutricional (Anthro-OMS 2006) após três meses. Aplicaram-se os testes do qui-quadrado e t pareado nas análises, considerando-se significante p<0,05. RESULTADOS: Ao primeiro atendimento, a média de idade foi de 9,0±6,9 meses. Manifestações digestórias foram observadas em 81,8%; cutâneas, em 36,9%; e respiratórias, em 23,8%. Escore Z do IMC <-2,0 desvios padrão (DP) foi encontrado em 17,9% das crianças com sintomas digestórios isolados, em 41,7% em uso de leite de vaca e em 8,7% com outras fórmulas (p<0,01). Fórmula de proteína isolada de soja foi usada em 61,2%; hidrolisados, em 35,4%; e aminoácidos, em 3,3%. As médias de escore Z do IMC ao atendimento inicial e após três meses foram, respectivamente, -0,24±1,47DP e 0,00±1,26DP (p=0,251), quando em uso de soja, e -0,70±1,51DP e -0,14±1,36DP (p=0,322), em uso de hidrolisado. CONCLUSÕES: Manifestações digestórias da alergia ao leite de vaca foram preponderantes e determinaram maior comprometimento nutricional. As fórmulas de substituição ao leite de vaca mais utilizadas foram de proteína isolada de soja e hidrolisados proteicos. O uso de ambas foi importante para a manutenção do estado nutricional.

OBJECTIVE: To determine clinical and follow up characteristics of children enrolled in a program to supply formulas for cow's milk allergy. METHODS: descriptive study of a convenience sample composed of 214 children up to three years old, with clinical diagnosis of cow's milk allergy and/or standardized oral challenge, referred to the Program of Formulas for Cow's Milk Allergy at a Pediatric University Hospital, in Natal, Rio Grande do Norte, Brazil (2007/2009). Clinical-epidemiological data and formula indication (soy, protein hydrolysates or aminoacid formula) were assessed at the first consultation. Clinical response and nutritional evolution (Anthro-OMS2006) were observed after three months. Chi-square and paired t-test were used, being p<0.05 significant. RESULTS: At the first consultation, mean age was 9.0±6.9 months. Digestive manifestations occurred in 81.8%; cutaneous ones, in 36.9% and respiratory ones in 23.8%. BMI Z-score <-2.0 standard deviations (SD) was found in 17.9% of children with isolated digestive symptoms, in 41.7% of those using cow's milk and in 8.7% of those using other formulas (p<0.01). The following formulas were used: soy in 61.2%, protein hydrolysates in 35.4% and aminoacids in 3.3%. Mean BMI Z-scores at initial consultation and after three months were, respectively: -0.24±1.47SD and 0.00±1.26SD (p=0.251), with soy formula, and -0.70±1.51SD and -0.14±1.36SD (p=0.322) with protein hydrolysates formula. CONCLUSIONS: Digestive manifestations of cow's milk allergy were preponderant, and lead to greater nutritional impairment. The use of replacement formulas (isolated soy protein and protein hydrolysates) was important to maintain the nutritional status.

OBJETIVO: Determinar características clínicas y evolutivas de niños acompañados en programa de referencia para suministro de fórmulas especiales para alergia a la leche de vaca. MÉTODOS: Estudio descriptivo, realizado en muestra de conveniencia, con 214 niños hasta tres años de edad, con diagnóstico clínico y/o prueba estandarizada de provocación oral abierta, referenciadas al Programa de Fórmulas para Alergia a la Leche de Vaca del Hospital Universitario Pediátrico en Natal, RN, Brasil (2007/2009). Se evaluaron datos clínico-epidemiológicos e indicación de fórmulas (soja, hidrolizado o aminoácido) a la consulta inicial, respuesta clínica y evolución nutricional (Anthro-OMS 2006) después de tres meses. Se aplicaron pruebas de Chi-Cuadrado y T Pareada en los análisis, siendo significante p<0,05. RESULTADOS: A la primera atención, el promedio de edad fue de 9,0±6,9 meses. Manifestaciones digestorias fueron observadas en 81,8%, cutáneas en el 36,9% y respiratorias en el 23,8%. Escore Z IMC<-2,0DE fue encontrado en 17,9% de los niños con síntomas digestorios aislados, en el 41,7% en uso de leche de vaca y en 8,7% en otras fórmulas (p<0,01). Se utilizó fórmula de proteína aislada de soja en 61,2%, hidrolizados en 35,4% y aminoácidos en 3,3%. Promedios de Escore Z IMC a la atención inicial y después de tres meses fueron -0,24±1,47DE y 0,00±1,26DE (p=0,251), cuando en uso de soja, y 0,70±1,51DE y -0,14±1,36DE (p=0,322), en uso de hidrolizado. CONCLUSIONES: Manifestaciones digestorias de la alergia a la leche de vaca fueron preponderantes y determinaron mayor comprometimiento nutricional. Las fórmulas de sustitución a la leche de vaca más utilizadas fueron de proteína aislada de soja e hidrolizados proteicos y el uso de ambas fue importante para el mantenimiento del estado nutricional.

Prevalence and factors related to dental caries among pre-school children of Saddar town, Karachi, Pakistan: a cross-sectional study.

BACKGROUND: Dental caries is highly prevalent and a significant public health problem among children throughout the world. Epidemiological data regarding prevalence of dental caries amongst Pakistani pre-school children is very limited. The objective of this study is to determine the frequency of dental caries among pre-school children of Saddar Town, Karachi, Pakistan and the factors related to caries. METHODS: A cross-sectional study of 1000 preschool children was conducted in Saddar town, Karachi. Two-stage cluster sampling was used to select the sample. At first stage, eight clusters were selected randomly from total 11 clusters. In second stage, from the eight selected clusters, preschools were identified and children between 3- to 6-years age group were assessed for dental caries. RESULTS: Caries prevalence was 51% with a mean dmft score being 2.08 (±2.97) of which decayed teeth constituted 1.95. The mean dmft of males was 2.3 (±3.08) and of females was 1.90 (±2.90). The mean dmft of 3, 4, 5 and 6-year olds was 1.65, 2.11, 2.16 and 3.11 respectively. A significant association was found between dental caries and following variables: age group of 4-years (p-value < 0.029, RR = 1.248, 95% Bias corrected CI 0.029-0.437) and 5-years (p-value < 0.009, RR = 1.545, 95% Bias corrected CI 0.047-0.739), presence of dental plaque (p-value < 0.003, RR = 0.744, 95% Bias corrected CI (-0.433)-(-0.169)), poor oral hygiene (p-value < 0.000, RR = 0.661, 95% Bias corrected CI (-0.532)-(-0.284)), as well as consumption of non-sweetened milk (p-value < 0.049, RR = 1.232, 95% Bias corrected CI 0.061-0.367). CONCLUSION: Half of the preschoolers had dental caries coupled with a high prevalence of unmet dental treatment needs. Association between caries experience and age of child, consumption of non-sweetened milk, dental plaque and poor oral hygiene had been established.

Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia.

OBJECTIVE: To perform an economic evaluation of a specific brand of partially hydrolyzed infant formula (PHF-W) in the prevention of atopic dermatitis (AD) among Australian infants. METHODS: A cost-effectiveness analysis was undertaken from the perspectives of the Department of Health and Aging (DHA), of the family of the affected subject and of society as a whole in Australia, based on a decision-analytic model following a hypothetical representative cohort of Australian newborns who are not exclusively breastfed and who have a familial history of allergic disease (i.e., are deemed 'at risk'). Costs, consequences, and incremental cost-effectiveness ratios (ICER) were calculated for PHF-W vs standard cow's milk based infant formula (SF), and, in a secondary analysis, vs extensively hydrolyzed infant formula (EHF-Whey), when the latter was used for the prevention of AD. RESULTS: From a representative starting cohort of 87,724 'at risk' newborns in Australia in 2009, the expected ICERs for PHF-W vs SF were AU$496 from the perspective of the DHA and savings of AUD1739 and AU$1243 from the family and societal perspectives, respectively. When compared to EHF-Whey, PHF-W was associated with savings for the cohort of AU$5,183,474 and AU$6,736,513 from the DHA and societal perspectives. LIMITATIONS: The generalizability and transferability of results to other settings, populations, or brands of infant formula should be made with caution. Whenever possible, a conservative approach directing bias against PHF-W rather than its comparators was applied in the base case analysis. Assumptions were verified in one-way and probabilistic sensitivity analyses, which confirmed the robustness of the model. CONCLUSIONS: PHF-W appears to be cost-effective when compared to SF from the DHA perspective, dominant over SF from the other perspectives, and dominant over EHF-Whey from all perspectives, in the prevention of AD in 'at risk' infants not exclusively breastfed, in Australia.

Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany.

OBJECTIVE: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. PATIENTS AND METHODS: Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. RESULTS: The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. CONCLUSIONS: For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.

First- and second-trimester WIC participation is associated with lower rates of breastfeeding and early introduction of cow's milk during infancy.

BACKGROUND: Existing literature suggests prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may reduce breastfeeding among low-income mothers. However, little is known about whether the timing of WIC entrance during pregnancy influences infant feeding decisions. OBJECTIVE: This study assesses the association between the timing of prenatal participation in WIC and various infant feeding practices, including breastfeeding initiation, breastfeeding for at least 4 months, exclusive breastfeeding, formula feeding, and early introduction of cow's milk and solid food. DESIGN: Cross-sectional survey matching of birth certificate data to mothers' interviews 9 months after the child's birth. Mothers provided information on participation in the WIC program, infant feeding practices, and sociodemographic characteristics. SUBJECTS: A nationally representative sample of 4,450 births in 2001 from the Early Childhood Longitudinal Survey-Birth Cohort. ANALYSES: Multivariate logistic regression techniques (using STATA 9.0 SE, Stata Company, College Station, TX) estimated the relationship between the timing of prenatal WIC participation and infant feeding practices. RESULTS: Entry into the WIC program during the first or second trimester of pregnancy is associated with reduced likelihood of initiation of breastfeeding and early cow's milk introduction; and entry during the first trimester is associated with reduced duration of breastfeeding. WIC participation at any trimester is positively related to formula feeding. CONCLUSIONS: Prenatal WIC participation is associated with a greater likelihood of providing babies infant formula rather than breastmilk after birth. Findings also indicate that there are critical prenatal periods for educating women about the health risks of early cow's milk introduction. Given the health implications of feeding infants cow's milk too early, WIC may be successful in educating women on the health risks of introducing complementary foods early, even if direct counseling on cow's milk is not provided.

A murine model of cow's milk protein-induced allergic reaction: use for safety assessment of hidden milk allergens.

BACKGROUND: Masked allergens in processed food products can lead to severe allergic reactions following unintentional ingestion. We sought to develop a murine model for the detection of hidden cow's milk proteins (CMP). This study aimed to induce cow's milk allergy in mice, to characterize the anaphylaxis induced by CMP in this model, and to validate its reliability using three margarines manufactured with (A) or without (B, C) milk, sharing the same production line. MATERIALS AND METHODS: Three-week-old BALB/c mice were sensitized intragastrically with CMP plus cholera toxin and boosted 6 times at weekly intervals. CMP-sensitization status was monitored by skin tests, and measurement of CMP-specific IgE and IgG1 levels. On day 44, the minimal threshold of clinical reactivity to CMP in terms of anaphylaxis was determined by performing a dose response of intraperitoneal CMP challenge. Under the same conditions, anaphylaxis was evaluated in CMP-sensitized mice after challenge with protein extracts of margarines A, B or C. RESULTS: Sensitization to CMP was demonstrated by positive skin tests and increased CMP-specific IgE and IgG1. The minimal clinical reactivity threshold corresponding to 0.1 mg CMP elicited detectable anaphylaxis evidenced by clinical symptoms, a decrease in breathing frequency, and increased plasma histamine upon challenge. Similarly, challenges with margarine A containing CMP demonstrated anaphylaxis, whereas those with B or C did not elicit any detectable allergic reaction. CONCLUSION: This study shows that our murine model of CMP-induced anaphylaxis is useful for investigating the allergenic activity and the assessment of margarines with respect to milk.