Assessment of the risk of contamination of enteral nutrition bottles based on the simulation of home use conditions and hygiene procedures.

BACKGROUND: Home-prepared enteral formulations are supplied to patients through enteral nutrition bottles, via a gravity bag or other container, which may be inadequately sanitized and reused more times than recommended by the manufacturer. Such procedures increase the risk of contamination and can compromise the patient's clinical outcome. In light of this, the present study aimed to assess the risk of contamination of enteral nutrition bottles by simulating home use conditions and hygiene procedures. METHODS: A simulation of bottle usage was conducted across the three categories of enteral nutrition (homemade enteral preparations, blended enteral preparations, and commercial enteral formulas) for 3 days, using three hygiene procedures reported by caregivers: use of detergent (DET); use of detergent and boiling water (DET+BW); and use of detergent and bleach (DET+BL). The microbiological contamination was determined by the analysis of aerobic mesophilic microorganisms. RESULTS: The bottles that were used for 3 days, regardless of the enteral nutrition category, were within the acceptable limit for aerobic mesophilic microorganisms (between <4 and 8.0 colony-forming units [CFU]/cm2) when sanitized using the DET+BW and DET+BL procedures. The enteral nutrition bottles, when cleaned using the DET procedure during the 3 days of usage, showed low microbial contamination (between <4 and 3.0 CFU/cm2) in blended preparation and commercial formula only. CONCLUSION: Thus, regardless of the enteral nutrition category, we found that the bottles can be used for 3 days, as long as the DET+BW or DET+BL hygiene procedure is applied and safe food handling measures are adopted.

Caracterización fisicoquímica, nutricional y sensorial de dos complementos alimenticios biofortificados / Physicochemical, nutritional, and sensory characterization of two biofortified food supplements

Introducción: Las ciencias de la nutrición y los alimentos innovan en la industria elaborando productos con compuestos nutricionales que contribuyan a la resolución de problemáticas en salud pública. Pero, además de las características nutricionales, son importantes las características sensoriales, siendo un factor determinante en la aceptación de estos productos. Objetivo: Evaluar características fisicoquímicas, nutricionales y sensoriales de dos complementos alimenticios, tipo sopa y bebida achocolatada, desarrollados con biofortificación. Materiales y métodos: Se consideraron 3 fases, fase 1, preparación de dos tipos complementos alimenticios (4 formulaciones), usando la liofilización para la deshidratación de algunas materias primas, complementada con otras técnicas de procesamiento y cocción. Fase 2, evaluación sensorial por panel de expertos a través de prueba descriptiva cuantitativa y hedónica, y fase 3, caracterización bromatológica. El análisis de la información se realizó con el software Jamovi 2.3.21. mediante análisis descriptivo e inferencial. Resultados: El análisis sensorial evidenció que los alimentos que contiene corazón de res en un 5% fueron los más aceptados por los panelistas en todos los atributos sensoriales en ambos complementos. La caracterización bromatológica mostró que el complemento tipo bebida achocolatada con corazón es excelente fuente de proteína, zinc y calcio y buena fuente de hierro y vitamina E, mientras que, el complemento tipo sopa con corazón es excelente fuente de proteína, zinc, hierro, tiamina, omega 3, vitamina E y buena fuente de calcio de acuerdo con la normatividad colombiana de rotulado y etiquetado nutricional. Conclusiones: Ambos complementos con corazón mostraron una aceptación sensorial satisfactoria, presentaron una importante concentración de nutrientes, que, por su fuente natural y animal, son considerados de alta biodisponibilidad(AU)

Introduction: Nutrition and food sciences innovate in the industry by elaborating products with nutritional compounds that contribute to the resolution of public health problems. But, in addition to nutritional characteristics, sensory characteristics are important, being a determining factor in the acceptance of these products. Objective: To evaluate physicochemical, nutritional and sensory characteristics of two food supplements, soup and chocolate drink, developed with biofortification. Materials and methods: Three phases were considered: phase 1, preparation of two types of food supplements (4 formulations), using freeze-drying for dehydration of some raw materials, complemented with other processing and cooking techniques. Phase 2, sensory evaluation by expert panel through quantitative descriptive and hedonic test, and phase 3, bromatological characterization. The analysis of the information was carried out with Jamovi 2.3.21. software through descriptive and inferential analysis. Results: The sensory analysis showed that foods containing 5% beef heart were the most accepted by the panelists in all sensory attributes in both supplements. The bromatological characterization showed that the chocolate drink type supplement with heart is an excellent source of protein, zinc and calcium and a good source of iron and vitamin E, while the soup type supplement with heart is an excellent source of protein, zinc, iron, thiamine, omega 3, vitamin E and a good source of calcium in accordance with Colombian regulations on nutritional labeling and labeling. Conclusions: Both supplements with heart showed a satisfactory sensory acceptance, presented an important concentration of nutrients, which, due to their natural and animal source, are considered of high bioavailability(AU)

What are Normal Defecation Patterns in Healthy Children up to Four Years of Age? A Systematic Review and Meta-Analysis.

OBJECTIVE: To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values. STUDY DESIGN: Systematic review including cross-sectional, observational, and interventional studies published in English, that reported on defecation frequency and/or stool consistency in healthy children 0-4 years old. RESULTS: Seventy-five studies were included with 16 393 children and 40 033 measurements of defecation frequency and/or stool consistency. Based on visual inspection of defecation frequency data, a differentiation was made between two age categories: young infants (0-14 weeks old) and young children (15 weeks-4 years old). Young infants had a mean defecation frequency of 21.8 per week (95 % CI, 3.9-35.2) compared with 10.9 (CI, 5.7-16.7) in young children (P < .001). Among young infants, human milk-fed (HMF) infants had the highest mean defecation frequency per week (23.2 [CI, 8.8-38.1]), followed by formula-fed (FF) infants (13.7 [CI 5.4-23.9]), and mixed-fed (MF) infants (20.7 [CI, 7.0-30.2]). Hard stools were infrequently reported in young infants (1.5%) compared with young children (10.5%), and a reduction in the frequency of soft/watery stools was observed with higher age (27.0% in young infants compared with 6.2% in young children). HMF young infants had softer stools compared with FF young infants. CONCLUSIONS: Young infants (0-14 weeks old) have softer and more frequent stools compared with young children (15 weeks-4 years old).

RUTF (ready-to-use-therapeutic-food): eficácia e segurança no tratamento de crianças com desnutrição grave / RUTF (Ready-to-use-therapeutic-food): efficacy and safety in the treatment of children with severe malnutrition

Contexto O Ministério da Saúde, por meio da Portaria GM/MS nº 28, de 20 de janeiro de 2023, declarou a Emergência em Saúde Pública de Importância Nacional (ESPIN) em decorrência de desassistência à população Yanomami. Desde então, entre 19 crianças indígenas de seis meses e cinco anos de idade com desnutrição grave que foram atendidas pela Casa de Apoio à Saúde Indígena (Casai) de Boa Vista/RR, 15 (78%) ganharam peso e estão evoluindo de quadros graves para moderados de desnutrição, a partir dos protocolos e diretrizes do Ministério da Saúde. No Brasil, a recomendação do Ministério da Saúde para o tratamento da desnutrição grave inclui esquemas para alimentação utilizando preparado alimentar inicial ­ F-75 (75 kcal e 0,9g de proteína/100ml) e o preparado alimentar para crescimento rápido - F-100 (100 kcal e 2,9g de proteína/100ml). O guia de prática clínica (GPC) da Organização Mundial da Saúde (OMS) refere que a maioria das crianças de seis meses ou mais com desnutrição aguda grave, sem complicações médicas, pode ser tratada com segurança por meio de alimentos terapêuticos prontos para uso (Ready-to-use-therapeutic-food - RUTF), sem necessidade de internação em unidade de saúde. Pergunta Qual é a segurança e eficácia de RUTF, no curto e longo prazo, para o tratamento de crianças menores de cinco anos com desnutrição grave? Métodos Após realização de protocolo de pesquisa, cinco bases da literatura eletrônica foram acessadas em março de 2023 para identificar estudos que pudessem oferecer resposta à pergunta de investigação. Utilizando atalhos de revisão rápida, foram realizados os processos de seleção de estudos, extração de dados e avaliação da qualidade metodológica das RS incluídas com a ferramenta AMSTAR 2. Resultados Duas revisões sistemáticas (RS) foram incluídas, sendo avaliadas como de confiança baixa e moderada. Uma RS realizou metanálises, indicando que não houve diferença entre os grupos RUTF e F-100 para ganho de peso e mortalidade. A maioria dos estudos primários, 3 de 5 ensaios clínicos randomizados (ECR) citados nas RS mostram que não houve diferença entre os grupos RUTF e F-100 quanto à altura, circunferência do braço e desnutrição aguda. Dois estudos primários incluídos nas RS indicam que o tratamento com RUFT apresenta os seguintes resultados positivos: maior probabilidade de atingir o escore Z de peso para altura; menor probabilidade de recaída e de recidiva; melhora no ganho de peso e redução do tempo de recuperação. Ressalta-se que um destes ECR apresenta conflito de interesses. Nenhuma RS analisou desfechos acerca da segurança do uso de RUTF. Dois GPC da Organização Mundial da Saúde foram selecionados mediante busca manual. Um GPC recomenda que o RUTF pode ser utilizado para crianças com desnutrição aguda grave que apresentam diarreia aguda ou persistente da mesma forma que crianças sem diarreia, quer sejam tratadas como pacientes internados ou ambulatoriais. O outro GPC recomenda que para tratamento ambulatorial de crianças com desnutrição aguda grave seja utilizado o RUTF padrão (com pelo menos 50% de proteína proveniente de laticínios). Considerações finais Esta revisão rápida aponta que há poucos estudos sobre o tema. As evidências são insuficientes para afirmar quais intervenções (RUTF ou F-100) são mais eficazes. As recomendações dos GPC também são baseadas em evidências escassas. Portanto, não há evidências que sustentem o uso do RUTF em detrimento da F-100, pois não há comprovação de maior eficácia e nenhum estudo abordou a segurança a longo prazo do uso de RUTF.

Context: The Ministry of Health, through Ordinance GM/MS No. 28, of January 20, 2023, declared a Public Health Emergency of National Importance (ESPIN) due to lack of assistance to the Yanomami population. Since then, among 19 indigenous children aged between six months and five years old with severe malnutrition who were assisted by the Casa de Apoio à Saúde Indígena (Casai) in Boa Vista/RR, 15 (78%) have gained weight and are evolving from serious conditions. for moderate malnutrition, based on the protocols and guidelines of the Ministry of Health. In Brazil, the recommendation of the Ministry of Health for the treatment of severe malnutrition includes feeding schemes using initial food preparation - F-75 (75 kcal and 0.9g of protein/100ml) and food preparation for rapid growth - F-100 (100 kcal and 2.9g of protein/100ml). The clinical practice guide (CPG) of the World Health Organization (WHO) states that most children aged six months or more with severe acute malnutrition, without medical complications, can be safely treated with ready-to-use therapeutic foods ( Ready-to-use-therapeutic-food - RUTF), without the need for hospitalization in a health unit. Question: What is the safety and efficacy of RUTF, in the short and long term, for the treatment of children under five with severe malnutrition? Methods: After carrying out a research protocol, five electronic literature databases were accessed in March 2023 to identify studies that could answer the research question. Using rapid review shortcuts, the processes of study selection, data extraction and methodological quality assessment of the SR included with the AMSTAR 2 tool were carried out. Results: Two systematic reviews (SR) were included, being assessed as having low and moderate confidence. An SR performed meta-analyses, indicating that there was no difference between the RUTF and F-100 groups for weight gain and mortality. Most of the primary studies, 3 out of 5 randomized clinical trials (RCTs) cited in the SR show that there was no difference between the RUTF and F-100 groups in terms of height, arm circumference and acute malnutrition. Two primary studies included in the SR indicate that treatment with RUFT has the following positive outcomes: increased likelihood of achieving weight-for-height Z-score; lower probability of relapse and recurrence; improvement in weight gain and reduced recovery time. It should be noted that one of these RCTs has a conflict of interest. No SR analyzed outcomes regarding the safety of using RUTF. Two World Health Organization CPGs were selected by manual search. A CPG recommends that RUTF can be used for children with severe acute malnutrition who have acute or persistent diarrhea in the same way as children without diarrhea, whether they are treated as inpatients or outpatients. The other CPG recommends that standard RUTF be used for outpatient treatment of children with severe acute malnutrition (with at least 50% protein from dairy products). Final considerations: This quick review points out that there are few studies on the subject. There is insufficient evidence to state which interventions (RUTF or F-100) are most effective. The CPGs recommendations are also based on sparse evidence. Therefore, there is no evidence to support the use of RUTF over F-100, as there is no evidence of greater efficacy and no study has addressed the long-term safety of using RUTF.

Recetario nutritivo para niñas y niños de 6 a 23 meses / Nutritious recipes for girls and boys from 6 to 23 months

La presente publicación trata sobre recetas nutritivas para niños menores de 1 año, en cada cartilla está la receta y la preparación, además cuenta con una pequeña tabla sobre el aporte nutricional de cada receta. Cabe indicar que dichas recetas fueron elaboradas tomando en cuenta un diagnóstico previo recogido en hogares y en mercados locales, a fin de conocer la disponibilidad, el acceso, así como los atributos positivos y negativos que las madres asignan a los alimentos que incorporan en la alimentación infantil. Cada una de las recetas ha pasado por un proceso de validación a nivel de hogares donde las madres han elaborado sus preparaciones según los alimentos disponibles localmente y con gran valor nutricional, bajo la asesoría de profesionales nutricionistas, proponiendo mejorar o crear nuevas recetas

Microbiological quality of enteral formulations handled at home: A systematic review.

BACKGROUND: Studies have shown an increase in the number of patients who use enteral nutrition at home and the benefits of this type of nutrition care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS: This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies that microbiologically analyzed homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS: Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n = 73) of the HEPs, 81.96% (n = 50) of the BEPs, and 44.87% (n = 35) of the CEFs. The presence of 10 different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION: The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling.

Macronutrients and energy in home-prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis.

BACKGROUND: The effectiveness of home enteral nutrition depends on the supply and delivery of the prescribed nutrients. This study compared the macronutrient and energy values of home-prepared enteral tube feeding analyzed in the laboratory with the same information calculated from labels and food composition tables. METHODS: A total of 107 enteral formulations were analyzed: 66 commercial enteral formulas (CEFs), 19 homemade enteral preparations, and 22 blended enteral preparations (BEPs). The values of macronutrients and energy and the ratio between the values found in the laboratory and the calculated values were all evaluated. The tolerance limit of acceptable variation was 20%. The results were subjected to chemometric methods using principal component analysis (PCA) and hierarchical cluster analysis (HCA). RESULTS: In the three categories of the enteral formulations, the calculated values for protein and fat were higher than those obtained in the laboratory. The calculated values for energy were higher than those obtained in the laboratory for the BEPs and CEFs. The CEFs had the highest percentage within the limit of acceptable variation for carbohydrate and protein, whereas the BEPs presented the lowest values for fat and energy. In the exploratory analysis of data using PCA and HCA, it was possible to verify similarities and discrepancies between the enteral formulations analyzed in the laboratory with those calculated from the labels and food composition tables. CONCLUSION: The enteral formulations showed differences between the values of macronutrients and energy analyzed in the laboratory and those calculated from labels and/or food composition tables.

Effect of adsorbents on diets with corn contaminated by mycotoxins on the productive performance and health of broilers

A total of 1,296 broiler chicken were housed, distributed in a completely randomized design with 6 treatments and 6 repetitions. The treatments consisted of a control diet formulated with corn considered adequate and without the addition of adsorbent, a diet formulated with corn naturally contaminated with mycotoxin (CCM) and four diets formulated with CCM and added with different commercial adsorbents. At the end of the first week and at 21 days of age of the birds, it was observed that the control diet resulted in greater (p < 0.05) live weight and weight gain in relation to the inclusion of CCM. The relative weight of the liver was lower for the control group compared to the groups receiving a diet with CCM and CCM + ads D. The relative weight of the proventriculus and cloacal bursa was lower for the control group compared to those who received a diet with CCM + ads B and CCM + ads C. There was no significant effect (p > 0.05) of the diets on the analysis of serum biochemistry and the occurrence of fatty and hydropic degeneration in the liver of broilers. The use of adsorbents can mitigate the harmful effects of mycotoxins, however, these products have specific binding capacity to the type of mycotoxin present in food.(AU)

Blenderized tube feeding for children: an integrative review.

OBJECTIVE: To analyze scientific evidence on the use of blenderized tube feeding in children regarding nutritional composition, family satisfaction, and health outcomes. DATA SOURCE: Survey was conducted in the PubMed, Scopus, Embase, and Virtual Health Library (VHL) databases using the following search terms: blenderized tube feeding OR blended tube feeding OR homemade OR pureed AND enteral nutrition AND enteral tube. The methodological quality of the selected articles was evaluated using the Critical Appraisal Skill Programme and Hierarchical Classification of Evidence. DATA SYNTHESIS: After analysis, 11 articles were included in the present review. Most studies demonstrated improvements in health outcomes and greater family satisfaction after replacing the commercial enteral feeding with blenderized tube feeding. CONCLUSIONS: When guided and monitored by the healthcare team, a blenderized tube feeding ensures an adequate nutritional composition. The use of this method is also associated with positive health outcomes such as reductions in gastrointestinal symptoms and hospitalizations. Moreover, a high frequency of family satisfaction was verified.

Current Practices and Challenges in the Diagnosis and Management of PKU in Latin America: A Multicenter Survey.

This study aimed to describe the current practices in the diagnosis and dietary management of phenylketonuria (PKU) in Latin America, as well as the main barriers to treatment. We developed a 44-item online survey aimed at health professionals. After a pilot test, the final version was sent to 25 practitioners working with inborn errors of metabolism (IEM) in 14 countries. Our results include 22 centers in 13 countries. Most countries (12/13) screened newborns for PKU. Phenylalanine (Phe) targets at different ages were very heterogeneous among centers, with greater consistency at the 0-1 year age group (14/22 sought 120-240 µmol/L) and the lowest at >12 years (10 targets reported). Most countries had only unflavored powdered amino acid substitutes (10/13) and did not have low-protein foods (8/13). Only 3/13 countries had regional databases of the Phe content of foods, and only 4/22 centers had nutrient analysis software. The perceived obstacles to treatment were: low purchasing power (62%), limited/insufficient availability of low-protein foods (60%), poor adherence, and lack of technical resources to manage the diet (50% each). We observed a heterogeneous scenario in the dietary management of PKU, and most countries experienced a lack of dietary resources for both patients and health professionals.

¿Cuál es el efecto de los impuestos a alimentos sólidos altos en nutrientes críticos sobre el consumo de ellos en la población general? / What is the effect of food taxes solids high in critical nutrients on the consumption of them in the general population?

INTRODUCCIÓN: La malnutrición por exceso, junto con las enfermedades crónicas no transmisibles, se han convertido en un importante problema de salud pública a nivel global. En el mundo, alrededor de un 39% de la población adulta presenta sobrepeso y un 13% obesidad (1). Una dieta insuficiente, alta en calorías, grasas y azúcares, está estrechamente relacionada con enfermedades crónicas no transmisibles (cáncer, diabetes, hipertensión, enfermedades cardiovasculares, entre otras) (2,3). Así mismo, se ha descrito que una dieta saludable podría prevenir una de cada cinco muertes a nivel mundial, independiente del sexo, edad o nivel socioeconómico (2). Chile presenta una de las prevalencias más altas de sobrepeso y obesidad en adultos a nivel mundial, con un 75%, según los datos de la última Encuesta Nacional de Salud (ENS) (4). Un 82% de la carga de enfermedad en Chile está dada por las enfermedades crónicas no transmisibles, como diabetes, cáncer, hipertensión y enfermedades cardiovasculares (5). Como ejemplo, la diabetes en Chile causó 3.426 muertes en el año 2014. La prevalencia de diabetes en personas mayores de 15 años alcanza al 10%, mientras que la prevalencia de hipertensión llega al 28% y las enfermedades cardiovasculares al 27% (5). El gasto público total relacionado con obesidad en Chile llega a un 3%, lo que equivale al 0,5% del Producto Interno Bruto (PIB) chileno, equivalente a 455 mil millones de pesos anuales (6,7). OBJETIVO DE ESTA SÍNTESIS: Informar la toma de decisiones respecto de los efectos que tendría la aplicación de un impuesto a alimentos sólidos "altos en" nutrientes críticos en la población general. Se presentan los principales hallazgos encontrados en la evidencia recopilada, además de algunas consideraciones sobre la implementación relacionadas a la intervención estudiada. RESUMEN DE HALLAZGOS: Esta síntesis busca aportar evidencia sobre el efecto que tendría un programa de impuestos a alimentos sólidos altos en nutrientes críticos (azúcar, grasas, grasas saturadas) o en calorías, sobre el consumo de ellos en la población general. Se utilizó como comparador el escenario donde no se implementan impuestos a nutrientes críticos en alimentos sólidos. Para esta síntesis, se considera la definición de alimentos sólidos del Reglamento Sanitario de los Alimentos, la que señala lo siguiente: "será sólido si su contenido neto está expresado en gramos u otra medida equivalente. En el caso de los productos alimenticios que se consuman reconstituidos, se entenderá como sólido o líquido según como sea el producto listo para consumir, de acuerdo a las instrucciones de reconstitución (17)". Al realizar la búsqueda, los títulos y resúmenes fueron seleccionados por dos revisoras independientes, discutiendo cada uno de los disensos encontrados. Se encontraron inicialmente 162 revisiones sistemáticas (RS). De éstas, se incluyeron sólo las RS que evaluaran el efecto de los impuestos sobre el consumo, independiente de si eran basadas en contextos reales o simulados. Se excluyen 150 RS por no responder a la pregunta. De esta forma, se utilizaron 12 revisiones sistemáticas (9,13,18­27) publicadas entre 2010 y 2020. De ellas, se seleccionaron los estudios primarios con intervenciones que consideraron estrategias de cambios de precios debido a los impuestos y que evaluaron el efecto del impuesto sobre el consumo de los alimentos gravados. CONSIDERACIONES DE IMPLEMENTACIÓN: Consideraciones de Aplicabilidad: La evidencia aquí contemplada se aplica solamente a impuestos a alimentos sólidos altos en los siguientes nutrientes críticos: azúcar, grasas, grasas saturadas y/o calorías y no evalúa el efecto sustitución que pudieran tener estos impuestos por sobre el consumo de otro tipo de alimentos o nutrientes (10,20,41). Del total de los estudios primarios incluidos en esta síntesis, cuatro fueron realizados en los Estados Unidos, 12 en Europa, y uno en México. La mayoría de los estudios contemplados en esta síntesis corresponden a modelos de simulaciones de impuestos ficticios o simulaciones de impuestos implementados recientemente. Solo tres de los estudios incluidos en esta síntesis mostraron resultados de impuestos reales. Consideraciones Económicas: Se ha descrito que los impuestos en alimentos y bebidas altos en nutrientes críticos muestran elasticidad en su consumo, lo que significa que la compra y consumo de estos disminuye en relación al aumento de su precio (21,22,25). Diversos estudios de costo-efectividad han mostrado que los impuestos a alimentos altos en nutrientes críticos podrían reducir los costos directos e indirectos en la salud individual, como por ejemplo disminuir el peso, disminuir la discapacidad, y mejorar la calidad de vida de las personas, además de los efectos a nivel gubernamental, como el aumento en los ingresos de las arcas fiscales (46­49). Consideraciones de Equidad: Es importante considerar el potencial impacto de las políticas fiscales en equidad. Se debe tener en cuenta si la propuesta de gravamen tendrá un impacto en restricciones de libertad de selección de productos o si aumentará inequidades, afectando de forma desproporcionadas a algunos grupos. Se ha descrito que los impuestos a alimentos y bebidas podrían tener un efecto regresivo por nivel socioeconómico (NSE), ya que las personas de menor ingreso, comparadas con las de mayor ingreso, gastan un mayor porcentaje de su sueldo en este tipo de productos. Desde una perspectiva ética, es necesario balancear el posible impacto en equidad, con la efectividad de la intervención y si la población más afectada por el aumento de impuestos es la que recibiría los mayores beneficios en salud, especialmente si las recaudaciones por los impuestos a estos alimentos son usadas para promover y sustentar programas de promoción de hábitos saludables y subvención de alimentos saludables en grupos más vulnerables (8,10,51). Consideraciones de Monitoreo y Evaluación: Es preciso considerar que existen diversos actores involucrados en la implementación de un programa de impuestos a alimentos sólidos altos en nutrientes críticos, entre los que se encuentran: Ministerio de Salud, Ministerio de Hacienda, Ministerio de Economía, Ministerio de Agricultura, productores de alimentos, industria alimentaria, sociedad de consumidores y sociedad civil. Para poder concretar un programa de impuestos exhaustivo y evaluar sus efectos es necesario incluir a todos los actores involucrados (8,10). Chile ya tiene experiencia con la implementación innovadora de impuestos a bebidas azucaradas (52,53), por lo que es crucial identificar cuáles han sido y siguen siendo los facilitadores, barreras y contratiempos que se identificaron en este proceso. Así mismo, y como lo plantea Caro et al (52), junto con Nakamura (53) et al, se recomienda efectuar evaluaciones a corto, mediano y largo plazo, desde el comienzo de la ejecución de los impuestos, idealmente, incluyendo un grupo control para comparaciones. La literatura también sugiere analizar las posibles diferencias en consumo por NSE (52­54). Finalmente, cabe destacar que el monitoreo y evaluación de impuestos a alimentos sólidos altos en nutrientes críticos debe ser de alta calidad, y libre de cualquier tipo de conflicto de interés, independiente de los desenlaces de la implementación de la estrategia (10).

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler.

BACKGROUND: Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics. METHODS: We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire. RESULTS: 82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training." CONCLUSION: Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Supply of enteral diets in the Espirito Santo state public health system in Brazil.

INTRODUCTION: Background: Brazil includes food as a social right, making the State responsible to the courts for the sufficient and adequate supply of enteral food. Objectives: to evaluate the supply of enteral diets in pharmacies in the state of Espirito Santo. Methods: to do this, we used the forms filled out by patients or legal representatives, containing medical records, to analyze the nutritional and social profiles of the users over two years, and the compliance of the administrative processes with the ordinance that instituted enteral food supplies was verified. Results: the sample was comprised of 204 patients receiving enteral nutrition, and the administrative procedures required to supply these patients were surveyed in seven (7/9) pharmacies. The data showed that the most common group was that of women (51 %), who were white (51 %), legally represented (91 %), and 73.5 years old (11 to 109 years). Information regarding missing anthropometric data, use of terms and calculations for obtaining enteral food other than those recommended, incomplete documents, alterations to the physical examinations suggestive of error, and nonobservance of inclusion and exclusion criteria were collected for this study. Conclusions: this study revealed that there were gaps in the process of enteral diet supply by the Espírito Santo pharmacies, both concerning compliance with the protocol and patient follow-up by the professional who assists both the patient and the pharmacist who provides the input.

INTRODUCCIÓN: Antecedentes: Brasil incluyó la alimentación como un derecho social, haciendo que el Estado sea responsable ante los tribunales del suministro suficiente y adecuado de alimentos. Objetivos: evaluar el suministro de dietas enterales en las farmacias estatales de Espírito Santo. Métodos: para hacer esto utilizamos los formularios cumplimentados por los pacientes y representantes legales que contienen registros médicos con el fin de analizar los perfiles nutricionales y sociales de los usuarios durante dos años; además, se verificó el cumplimiento de los procesos administrativos con la ordenanza que instituyó el suministro de alimentos. Resultados: la muestra comprendió 204 pacientes que recibieron nutrición enteral, investigándose los procedimientos administrativos requeridos para suministrar a estos pacientes en siete (7/ 9) farmacias. Los datos mostraron que el grupo más común era el de mujeres (51 %), de raza blanca (51 %) y representadas legalmente (91 %), de 73,5 años de edad (11 a 109 años). Para este estudio se recopiló información sobre los datos antropométricos faltantes, el uso de términos y cálculos para obtener alimentos distintos a los recomendados, documentos incompletos, alteraciones en los exámenes físicos sugestivos de error y la no observancia de los criterios de inclusión y exclusión. Conclusiones: este estudio reveló que había vacíos en el proceso de suministro de dietas enterales por parte de las farmacias de Espírito Santo en lo que respecta tanto al cumplimiento del protocolo como al seguimiento del paciente por el profesional que lo atiende y el farmacéutico que proporciona la información.

Dry matter, protein, and energy digestibility of diets for juvenile Pacific white leg shrimps (Litopenaeus vannamei) reared at different salinity levels / Digestibilidade da matéria seca, proteína e energia de dietas para camarão juvenil do Pacífico (Litopenaeus vannamei) cultivadas em diferentes níveis de salinidades

This study evaluated the effect of low, medium, and high-water salinity (5, 35, and 50 ppt) on the apparent dry matter, protein, and energy digestibility of two formulated and six commercial diets for juvenile whiteleg shrimp, Litopenaeus vannamei, in a 120-day trial. Digestibility was determined in vivo using chromic oxide as an inert diet marker. Hydrostability in pellets varied from 86.8% to 99.9%; dry matter digestibility varied from 49.1% to 64.1%; protein digestibility showed greater variations at all salinities (56.9%–85.8%); and energy digestibility ranged from 70.1 to 86.4%. Salinity had a significant effect on dry matter, protein, and energy digestibility. Using a principal component analysis (PCA) with a covariance matrix, our findings suggested that the E2 (fishmeal-based formulation) diet and 35 ppt salinity provided optimum hydrostability and digestibility to Pacific white leg shrimp juveniles.

Nós medimos o efeito de baixa, normal e alta salinidade (5, 35 e 50ppt) na digestibilidade aparente da matéria seca, proteína e energia em duas dietas formuladas e seis comerciais para camarão juvenil do Pacífico, Litopenaeus vannamei. Os coeficientes de digestibilidade aparente da matéria seca, proteína e energia foram determinados in vivo utilizando o óxido crômico como marcador inerte nas dietas (peso inicial médio de 4g), em um teste de 120 dias. Hidrostabilidade na dieta de 86,8% a 99,9%, os coeficientes de digestibilidade da matéria seca variaram de 49,1 a 64,1%, os coeficientes de digestibilidade da proteína apresentaram maiores variações em todas as salinidades (56,9-85,8%), enquanto os coeficientes de digestibilidade da energia variaram de 70,1 a 86,4%. Efeito significativo da salinidade na digestibilidade da matéria seca, proteína e energia foi encontrado. Esses resultados, usando a análise de componentes principais (PCA) com a matriz de covariância, sugerem que a dieta E2 (fórmula à base de farinha de peixe) e salinidade a 35 ppt é ideal para a hidrostabilidade e digestibilidade das dietas para juvenis de camarão-branco-do-Pacífico.

Dry matter, protein, and energy digestibility of diets for juvenile Pacific white leg shrimps (Litopenaeus vannamei) reared at different salinity levels / Digestibilidade da matéria seca, proteína e energia de dietas para camarão juvenil do Pacífico (Litopenaeus vannamei) cultivadas em diferentes níveis de salinidades

This study evaluated the effect of low, medium, and high-water salinity (5, 35, and 50 ppt) on the apparent dry matter, protein, and energy digestibility of two formulated and six commercial diets for juvenile whiteleg shrimp, Litopenaeus vannamei, in a 120-day trial. Digestibility was determined in vivo using chromic oxide as an inert diet marker. Hydrostability in pellets varied from 86.8% to 99.9%; dry matter digestibility varied from 49.1% to 64.1%; protein digestibility showed greater variations at all salinities (56.9%–85.8%); and energy digestibility ranged from 70.1 to 86.4%. Salinity had a significant effect on dry matter, protein, and energy digestibility. Using a principal component analysis (PCA) with a covariance matrix, our findings suggested that the E2 (fishmeal-based formulation) diet and 35 ppt salinity provided optimum hydrostability and digestibility to Pacific white leg shrimp juveniles.(AU)

Nós medimos o efeito de baixa, normal e alta salinidade (5, 35 e 50ppt) na digestibilidade aparente da matéria seca, proteína e energia em duas dietas formuladas e seis comerciais para camarão juvenil do Pacífico, Litopenaeus vannamei. Os coeficientes de digestibilidade aparente da matéria seca, proteína e energia foram determinados in vivo utilizando o óxido crômico como marcador inerte nas dietas (peso inicial médio de 4g), em um teste de 120 dias. Hidrostabilidade na dieta de 86,8% a 99,9%, os coeficientes de digestibilidade da matéria seca variaram de 49,1 a 64,1%, os coeficientes de digestibilidade da proteína apresentaram maiores variações em todas as salinidades (56,9-85,8%), enquanto os coeficientes de digestibilidade da energia variaram de 70,1 a 86,4%. Efeito significativo da salinidade na digestibilidade da matéria seca, proteína e energia foi encontrado. Esses resultados, usando a análise de componentes principais (PCA) com a matriz de covariância, sugerem que a dieta E2 (fórmula à base de farinha de peixe) e salinidade a 35 ppt é ideal para a hidrostabilidade e digestibilidade das dietas para juvenis de camarão-branco-do-Pacífico.(AU)

Eficacia y seguridad de la fórmula nutricional libre de aminoácidos de cadena ramificada en pacientes con la enfermedad de la orina con olor a jarabe de arce / Efficacy and safety of branched-chain amino acid-free nutritional formula in patients with maple syrup urine disease

INTRODUCCIÓN: El presente dictamen expone la evaluación del producto fórmula nutricional libre de aminoácidos de cadena ramificada comparado con la mejor terapia de soporte nutricional en pacientes con la enfermedad de la orina con olor a jarabe de arce. La enfermedad de la orina con olor a jarabe de arce (EOOJA) es una enfermedad congénita originada por un error innato del metabolismo de aminoácidos. La EOOJA es una enfermedad de carácter autosómico recesivo debida a mutaciones en los genes de la deshidrogenasa cetoácida de cadena ramificada (BCKAD, por sus siglas en inglés) que conduce a la acumulación de leucina, isoleucina, valina y aloisoleucina y los correspondientes cetoácidos de cadena ramificada (BCKA, por sus siglas en inglés) en los tejidos y el plasma. Los niveles elevados de estas sustancias originan problemas del crecimiento y desarrollo, cuadros agudos de encefalopatía e incluso pueden ser fatales. La enfermedad de la orina con olor a jarabe de arce (EOOJA) es una enfermedad congénita originada por un error innato del metabolismo de aminoácidos. La EOOJA es una enfermedad de carácter autosómico recesivo debida a mutaciones en los genes de la deshidrogenasa cetoácida de cadena ramificada (BCKAD, por sus siglas en inglés) que conduce a la acumulación de leucina, isoleucina, valina y aloisoleucina y los correspondientes cetoácidos de cadena ramificada (BCKA, por sus siglas en inglés) en los tejidos y el plasma. Los niveles elevados de estas sustancias originan problemas del crecimiento y desarrollo, cuadros agudos de encefalopatía e incluso pueden ser fatales. METODOLOGÍA: Se realizó una búsqueda sistemática de la literatura con el objetivo de identificar evidencia sobre el uso de la fórmula nutricional libre de BCAA en pacientes con EOOJA (conocida en inglés como Maple syrup urine disease). Para identificar documentos de interés para el presente dictamen, se buscó evidencia disponible en las siguientes bases de datos bibliográficas: PubMed, The Cochrane Library y LILACS. Adicionalmente, se realizó una búsqueda en sitios web pertenecientes a grupos que realizan evaluaciones de tecnologías sanitarias y guías de práctica clínica, incluyendo The Canadian Agency for Drugs and Technologies in Health (CADTH), Scottish Medicines Consortium (SMC), The National Institute for Health and Care Excellence (NICE), Institute for Quality and Efficiency in Health Care (IQWiG), el portal BRISA (Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas) y sitios web de organizaciones internacionales en nutrición clínica, enfermedades raras o congénitas, medicina, pediatría o de enfermedades metabólicas. Por último, se llevó a cabo una búsqueda manual en el portal ClinicalTrials.gov del National Institutes of Health. RESULTADOS: Se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad. CONCLUSIONES: El presente documento evaluó la mejor evidencia científica disponible hasta la actualidad (marzo del 2020) sobre el uso de fórmula nutricional libre BCAA en pacientes con EOOJA. La GPC elaborada por SERC y GMDI recomienda el uso de fórmulas nutricionales libres de BCAA en pacientes con EOOJA o sospecha de EOOJA, con EOOJA en fase de mantenimiento o en la fase aguda de la enfermedad. Para la fase aguda, recomienda el empleo de una fórmula nutricional con proteína libre de BCAA por vía enteral como complemento a la nutrición parenteral hasta que el paciente puedo recibir su requerimiento nutricional total por vía enteral. La GPC de SERC y GMDI considera que la evidencia disponible para el uso de esta fórmula es razonable.  Los reportes de pacientes con EOOJA señalan al empleo de la fórmula libre de BCAA como parte del manejo nutricional en pacientes con esta condición clínica. El uso de esta fórmula nutricional en los pacientes con EOOJA de estos reportes de caso se condice con la recomendación de la GPC y lo descrito en recursos de soporte a la toma de decisión clínica como UpToDate y DynaMed. La evidencia respecto al uso de la fórmula nutricional libre de BCAA en pacientes con la EOOJA es escasa. No obstante, existe plausibilidad biológica para pensar en que esta fórmula sería útil para el manejo nutricional de pacientes con EOOJA, dado que estas aportan los requerimientos nutricionales energéticos mediante una administración controlada de BCAA.  Los expertos clínicos de EsSalud señalan que en la institución no existe actualmente la disponibilidad de un producto nutricional para pacientes con EOOJA. Por otro lado, señalan tener experiencia en el empleo de fórmulas nutricionales libres de BCAA, observando beneficio en indicadores de peso, talla, desarrollo cognitivo y buena tolerancia al producto. Lo señalado por los expertos clínicos esta en línea con lo descrito en las GPC y en recursos de soporte a la toma de decisión clínica como UpToDate y DynaMed. Por lo expuesto, el Instituto de Evaluaciones de Tecnologías en Salud e Investigación ­ IETSI- aprueba el de la fórmula nutricional libre de BCAA en pacientes con EOOJA, según lo establecido en el Anexo N° 01. La vigencia del presente dictamen preliminar es de un año a partir de la fecha de publicación. Así, la continuación de dicha aprobación estará sujeta a la evaluación de los resultados obtenidos y de nueva evidencia que pueda surgir en el tiempo.

Biosurfactant produced by Candida utilis UFPEDA1009 with potential application in cookie formulation

BACKGROUND: Biosurfactants are biomolecules that have the potential to be applied in food formulations due to their low toxicity and ability to improve sensory parameters. Considering the ability of yeasts to produce biosurfactants with food-friendly properties, the aim of the present study was to apply a biosurfactant produced by Candida utilis in the formulation of cookies. RESULTS: The biosurfactant was obtained with a yield of 24.22 ± 0.23 g/L. The characterization analysis revealed that the structure of a metabolized fatty acid with high oleic acid content (68.63 ± 0.61%), and the thermogravimetric analysis demonstrated good stability at temperatures lower than 200°C, potential for food applications. The biosurfactant also exhibited satisfactory antioxidant activity at concentrations evaluated, without cytotoxic potential for cell strains, L929 and RAW 264.7, according to the (3-(4,5-dimethylthiazol-2- yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The incorporation of the surfactant into the dough of a standard cookie formulation to replace animal fat was carried out, achieving a softer, spongier product without significantly altering the physical and physicochemical properties or energy value. CONCLUSION: The thermal stability and antioxidant activity of the biosurfactant produced by C. utilis were verified, besides the positive contribution in the texture analysis of the cookies. Therefore, this biomolecule presents itself as a potential ingredient in flour-based sweet food formulations.

Reducción de sodio en salsa de tomate y mayonesa mediante la aplicación de un enfoque de umbral sensorial / Sodium reduction in tomato sauce and mayonnaise through the application of a sensory threshold approach

El consumo excesivo de sodio es causa importante de enfermedades no transmisibles incluyendo hipertensión. En esta investigación se evaluó una metodología sensorial para reducir el contenido de sodio en salsas de tomate y mayonesas, productos altamente consumidos en Costa Rica. Se caracterizaron, por triplicado, 16 salsas y 7 mayonesas comerciales para determinar los ingredientes más comunes y sus características físicoquímicas. Se comparó el contenido de sodio reportado en la etiqueta contra el valor determinado experimentalmente. Se formularon prototipos de ambos productos y se determinó el umbral de diferencia apenas perceptible (DAP) para el gusto salado utilizando el método de estímulo constante con 40 panelistas no entrenados (d'= 1, significancia de 0,05 y potencia de prueba de 0,95). Se contruyeron las curvas psicofísicas con concentraciones de sal entre 0,67% y 2,5% para salsa de tomate y 0,13% y 4,16% para mayonesa; obteniéndose DAPs de 0,51% y 0,26% respectivamente; equivalentes a 28,3% y 14,4% menos de sal en cada producto. Para la validación del umbral, se aplicó una prueba de discriminación 2-AFC con 40 panelistas comparando la formulación regular con la reducida en sodio. Los panelistas no detectaron diferencias significativas entre mayonesas (P>0,05) pero sí entre salsas (P<0,05), por lo que se aplicó una prueba de agrado con 112 consumidores y se determinó que la salsa reducida en sodio resultó de mayor o igual agrado que la contraparte. Estos resultados guiarían a la industria alimentaria regional hacia el mejoramiento del perfil nutricional de estos productos(AU)

The excessive consumption of sodium is an important cause of noncommunicable diseases including hypertension. This research aimed, using a sensorial methodology, to reduce sodium content in tomato sauces and mayonnaise, highly consumed products in Costa Rica. A total of 16 commercial sauces and 7 mayonnaises were characterized to determine their most common ingredients and physicochemical properties. The sodium content reported in the labed was compared against values obtained experimentally. Prototypes for both products were developed and the threshold for the just noticiable difference (JND) for salty flavor was determined using the constant stimulus method with 40 panelists (d'= 1, 0.05 significance and a test power of 0,95). Psychophysical curves were built with salt concentrations between 0.67% and 2.5% for tomato sauce and 0.13% and 4.16% for mayonnaise; obtaining JNDs of 0.51% and 0.26% respectively; equivalent to 28.3% and 14.4% less salt in tomato and mayonnaise. To validate the threshold, a discriminatory 2-AFC test with 40 panelists was performed to compare the regular formulations against those reduced in sodium. Panelists did not detect significant differences among mayonnaises (P>0.05) but they did found differences between sauces (P<0.05). Thus, for tomato sauce a consumer liking test with 112 consumers was performed and it was found that sodium reduced tomato sauce was equally or more liked than its counterpart. These results guide the regional food industry towards the improval of the nutritional profile of both products(AU)

Sorvete com extrato hidrossolúvel de arroz: análise físico-química e sensorial / Ice cream made with water-soluble rice extract: physicochemical and sensory analysis

Introdução: Devido ao fato de que muitas pessoas são intolerantes à lactose, novas propostas de preparações dietéticas com bons atributos sensoriais e isentas deste dissacarídeo são necessárias para garantir bem-estar e qualidade de vida para estes indivíduos. Objetivo: desenvolver sorvete com extrato hidrossolúvel de arroz. Método: Foram produzidos sorvetes com 50% e 100% de substituição do leite bovino por extrato hidrossolúvel de arroz em dois sabores (morango e chocolate). Os métodos para o desenvolvimento deste estudo basearam-se na análise físico-química do sorvete, bem como a análise sensorial para definir o nível de aceitação do produto e preferência por parte dos consumidores. Resultados: Os sorvetes de extrato hidrossolúvel de arroz, tanto de chocolate, como de morango obtiveram maiores teores de carboidratos e menores valores energéticos, devido ao fato de ter menor teor de proteína e lipídio, em comparação com o sorvete feito com leite bovino. Obteve-se boa aceitação, sendo que o sorvete de 50% extrato de arroz sabor morango não obteve diferença significativa do sorvete com 100% de leite de bovino, em relação à preferência. Conclusão: Conclui-se que o sorvete com extrato hidrossolúvel de arroz é um produto com boas características nutricionais e tem boa aceitação, podendo ser uma opção para pessoas intolerantes à lactose. (AU)

Introduction: As there are many people with lactose intolerance, new dietary preparations with good sensory aspects and free from this disaccharide need to be proposed, which would ensure these individuals' well-being and quality of life. Purpose: To develop an ice cream made with water-soluble rice extract. Method: Ice creams were produced replacing 50% and 100% of cow milk with water-soluble rice extract, in two flavors (strawberry and chocolate). The methods for developing this study were based on the physicochemical analysis of the ice cream and the sensory analysis, to establish the degree of acceptability of the product, as well as the preference on the part of the consumers. Results: Both the chocolate and the strawberry water-soluble rice extract ice creams had higher carbohydrate content and lower energy values, due to its lower protein and lipid content in comparison with cow milk ice cream. There was good acceptability; particularly, the 50% rice extract strawberry ice cream had no significant difference to the 100% cow milk ice cream, regarding preference. Conclusion: It is concluded that the water-soluble rice extract ice cream is a product with good nutritional characteristics and good acceptability. It can be considered an alternative for people with lactose intolerance. (AU)