Effect of soluble fiber pectin on growth and intestinal iron absorption in rats during recovery from iron deficiency anemia.

The objective of this study was to verify whether soluble fiber pectin interferes in growth and intestinal iron absorption in rats during iron deficiency anemia recovery. Twenty-one-day-old Wistar rats (n = 48) were fed for 2 weeks on a diet without iron in order to induce iron deficiency anemia. The anemic animals (age = 36 days) were divided into two groups: (1) pectin, 50 g of pectin per kilogram of diet, and (2) control, diet without dietary fiber. Iron was added to the diets for the two groups in order to reverse the anemia. During the iron deficiency anemia recovery phase (3 weeks), the pectin group showed lower mean values (p < 0.05) of weekly food intake (89.18 +/- 10.82; 107.60 +/- 11.70; 114.50 +/- 16.29 g, respectively, for the pectin group and 99.56 +/- 10.60; 116.36 +/- 15.33; 125.66 +/- 17.25 g, respectively, for the control group). The body weight of the pectin group was lower (p < 0.05) during the study's second and third weeks (192.42 +/- 16.67 and 228.75 +/- 19.81 g, respectively, and 202.87 +/- 19.96 and 243.51 +/- 20.44 g for the control group). Pectin led to a reduction in food intake and growth but not to iron absorption when taking into account the regeneration of hemoglobin mass.

Conhecimento de pediatras e nutricionistas sobre o tratamento da alergia ao leite de vaca no lactente / Pediatricians and nutritionists knowledge about treatment of cow milk allergy in infants

OBJETIVO: Avaliar o conhecimento de pediatras e nutricionistas sobre a dieta de exclusão do leite de vaca e seus derivados, com ênfase em questões relacionadas à nutrição da criança. MÉTODOS: Estudo transversal descritivo, do qual participaram pediatras (n=53) e nutricionistas (n=29), vinculados a hospitais públicos do Município de São Paulo, no ano de 2005. Os dados foram coletados por questionário auto-administrado. RESULTADOS: A idade dos profissionais variou de 21 a 50 anos. Quanto ao tempo de graduação, 41,2 por cento eram formados a menos de cinco anos e 91,6 por cento possuíam especialização, mestrado e/ou doutorado. A maioria (97,5 por cento) afirmou avaliar a dieta de crianças submetidas à exclusão do leite de vaca, entretanto, somente 48 por cento o faziam de forma mais detalhadas, incluindo o cálculo da ingestão alimentar. Apenas 38,7 por cento comparam a ingestão alimentar da criança com algum padrão de recomendação. A recomendação diária da ingestão de cálcio para crianças com até 36 meses foi corretamente assinalada por 22 por cento dos pediatras e 60,7 por cento dos nutricionistas (p=0,001). Produtos não adequados como substitutos do leite de vaca seriam recomendados por 66 por cento dos pediatras e 48,3 por cento dos nutricionistas. Com relação à leitura de rótulos de produtos industrializados, 81,6 por cento dos pediatras e 96,4 por cento dos nutricionistas orientam os pais a ler todos os termos que indicam a presença das proteínas do leite de vaca. CONCLUSÕES: Os pediatras e nutricionista demonstraram erro conceitual no que se refere às principais recomendações terapêuticas na alergia às proteínas do leite de vaca.

OBJECTIVE: Evaluate the knowledge of pediatricians and nutritionists regarding the exclusion diet of cow milk and derivates, with emphasis on questions related to the nutrition of children submitted to such diet. METHODS: Cross-sectional study that enrolled pediatricians (n=53) and nutritionists (n=29) from public hospitals in São Paulo, Brazil, during 2005. Data was collected through self-administered questionnaires. RESULTS: The age of the professionals varied from 21 to 50 years old. Regarding professional experience, 41.2 percent were graduated for less than five years and 91.6 percent had a specialization course, masters and/or PhD degree. The vast majority of professionals (97.5 percent) confirmed that they regularly evaluated the diet of children that needed exclusion of cow milk. However, only 48 percent of the professionals conducted a more detailed evaluation of the diet, including calculations of food ingestion. Only 38.7 percent of the professionals compared child's food ingestion with some recommended pattern. Recommendations for daily ingestion of calcium by children up to the age of 36 months were properly mentioned by 22 percent of the pediatricians and 60.7 percent of the nutritionists (p=0.001). Inadequate cow milk substitute products were recommended by 66 percent of the pediatricians and by 48.3 percent of the nutritionists. Regarding labels of industrialized products, 81.6 percent of the pediatricians and 96.4 percent of the nutritionists advised the parents to look for all terms that could indicate the presence of cow milk protein. CONCLUSIONS: Pediatricians and nutritionists made conceptual errors in their main recommendations regarding the treatment of cow milk protein allergy.

[Nutrient intake and nutritional status of children following a diet free from cow's milk and cow's milk by-products]. / Ingestão de nutrientes e estado nutricional de crianças em dieta isenta de leite de vaca e derivados.

OBJECTIVE: To assess the food intake and the nutritional status of children on a cow's milk and cow's milk by-products free diet. METHODS: Twenty-six children receiving a cow's milk and cow's milk by-products free diet were assessed during their first visit to the Pediatric Gastroenterology Clinic (mean age = 19.1 months). Thirty children with no food restriction (mean age = 16.8 months) were also assessed. The usual daily food intake method was used to make the dietary assessment. The food intake was compared between the groups and in relation to the Dietary Reference Intakes (DRIs). The z-scores for weight/age, height/age and weight/height were used to evaluate the nutritional status. RESULTS: The cow's milk free diet group presented lower energy (p = 0.005), protein (p < 0.001), lipid (p < 0.001), calcium (p < 0.001) and phosphorous (p < 0.001) intake when compared to the control group. The number of children who had energy, calcium and phosphorous intake below the DRIs was higher in the cow's milk free diet group than in the control group. The z-score means for the cow's milk free diet and control groups were, respectively: height/age -0.81+/-1.06 vs +0.42+/-1.25 (p < 0.001), weight/age -1.03+/-1.21 vs +0.02+/-0.91 (p < 0.001), and weight/height -0.63+/-1.08 vs +0.30+/-1.11 (p = 0.004). CONCLUSION: During the cow's milk and cow s milk by-products exclusion therapy, qualitative and quantitative food intake monitoring must be carried out periodically, so as to prevent inadequacies in meeting nutritional requirements and impairment of growth and development.

[Breath methane in children with chronic constipation]. / Metano no ar expirado de crianças com constipação crônica functional.

RATIONALE: Methane is an intestinal gas which may be excreted in the expired air of about 10% of children. OBJECTIVE: The aims of this study were to investigate methane production by children with functional chronic constipation and methane concentration in the expired air before and after a bowel movement induced by a phosphate enema. METHODS: Seventy-five patients with functional chronic constipation aged from 3 to 13 years were studied. Methane concentration in the expired air was determined using a gas chromatograph (Quintron, model 12i). Methane production was considered present if the breath methane concentration was equal or greater than 3 ppm. RESULTS: Methane production was present in 44 (86.3%) of 51 patients with constipation and fecal soiling versus only 7 (29.2%) of 24 patients with constipation without fecal soiling. After six weeks of therapy for constipation, the number of methane producers decreased by 65.2%. None of the 10 children with normal intestinal habit produced methane. Expired air methane concentration was determined before and after a bowel movement induced by a phosphate enema in 20 patients with impacted stool. From these 20 patients, 12 were methane producers. The median (percentiles 25 and 75 between parenthesis) of methane concentration decreased from 21.5 (15.0-25.5) ppm before to 11.0 (4.0-12.5) ppm after the bowel movement. CONCLUSION: Methane production was associated with chronic constipation with soiling and decreased when impacted stool decreased.

Metano no ar expirado de crianças com constipação crônica funcional / Breath methane in children with chronic constipation

Methane is an intestinal gas which may be excreted in the expired air of about 10% of children. OBJECTIVE: The aims of this study were to investigate methane production by children with functional chronic constipation and methane concentration in the expired air before and after a bowel movement induced by a phosphate enema. METHODS: Seventy-five patients with functional chronic constipation aged from 3 to 13 years were studied. Methane concentration in the expired air was determined using a gas chromatograph (Quintron, model 12i). Methane production was considered present if the breath methane concentration was equal or greater than 3 ppm. RESULTS: Methane production was present in 44 (86.3%) of 51 patients with constipation and fecal soiling versus only 7 (29.2%) of 24 patients with constipation without fecal soiling. After six weeks of therapy for constipation, the number of methane producers decreased by 65.2%. None of the 10 children with normal intestinal habit produced methane. Expired air methane concentration was determined before and after a bowel movement induced by a phosphate enema in 20 patients with impacted stool. From these 20 patients, 12 were methane producers. The median (percentiles 25 and 75 between parenthesis) of methane concentration decreased from 21.5 (15.0-25.5) ppm before to 11.0 (4.0-12.5) ppm after the bowel movement. CONCLUSION: Methane production was associated with chronic constipation with soiling and decreased when impacted stool decreased

Hiperplasia nodular linfoide do colon e suas caracteristicas na infancia. / Nodular lymphoid hyperplasia of the colon and its characteristics in infants

Hiperplasia nodular linfoide do colon trata-se de entidade reconhecida desde longa data, e, embora sua etiologia ainda nao esteja esclarecida, esta definitivamente estabelecido o comportamento benigno desta lesao. Estudamos oito pacientes cujas idades variaram de dois a 20 meses para esclarecimento diagnostico da perda de sangue pelas fezes utilizando enema baritado e retossigmoidoscopia com biopsia retal.Diarreia sanguinolena foi a principal manifestacao clinica observada. O enema do colon permitiu visualizar inumeras pequenas falhas de enchimento, arredondadas com umbilicacao, representadas por areas de hipertransparencia. A retossigmoidoscopia permitiu visualizar pequenos nodulos pun tiformes difusamente distribuidos e a biopsia retal revelou presenca de grandes foliculos linfaticos com centro de reacao elevando a mucosa. Todos os pacientes apresentaram evolucao para cura confirmando o carater benigno e autolimitado destas lesoes. Ressaltamos, porem, a necessidade da realizacao de estudo retossigmoidoscopico e anatomopatologico para diferenciar hiperplasia nodular linfoide de outras afeccoes colonicas, em particular polipo adenomatoso familiar por tratar-se de lesao potencialmente maligna