Azúcar en alimentos infantiles. La normativa española y europea, ¿a quién protege? / Sugar in infant food. Spanish and European regulations, who are they protecting?

El elevado consumo de azúcar en la infancia contribuye a la actual epidemia de caries dental y de obesidad infantil, además de influir de forma negativa en las bajas tasas de lactancia materna. Entre las medidas para controlar este consumo está la determinación, por parte de las autoridades sanitarias, de la cantidad máxima de azúcar existente en los alimentos infantiles elaborados por la industria alimentaria. El presente artículo inspecciona las normas que regulan en Europa y en España la presencia de azúcar en alimentos infantiles distintos a fórmulas lácteas (preparados para lactantes o preparados de continuación): la Directiva 2006/125/CE y el Real Decreto 490/1998. Tras revisar la técnica legislativa y de compilación o refundición de normas, el respeto de plazos y la idoneidad de los procedimientos, podemos concluir que la falta de rigor es patente. Con respecto a las cifras de azúcares permitidos en alimentos infantiles, distan mucho de ser idóneas, hasta el punto de que pueden considerarse un factor obesogénico y de promoción de malos hábitos alimentarios en la infancia. Por ello, cabe preguntarse a quién protege la legislación, si a la salud infantil, o más bien a los intereses de la industria azucarera (AU)

The high level of sugar intake in infancy and childhood contributes to the current epidemic of tooth decay and childhood obesity, influencing negatively, as well, on low rates of breastfeeding. One of the measures to control this consumption is the determination by the health authorities of the maximum amount of existing sugar in infant foods produced by the food industry. This article inspects the law in Europe and Spain governing the presence of sugar in baby foods other than infant formula: Directive 2006/125/EC and Royal Decree 490/1998. After reviewing the legislative and compilation or consolidation technical rules, the respect of deadlines and the suitability of the procedures, we can conclude that the lack of accuracy is evident. Regarding the amount of sugars allowed in baby foods, they are far from ideal, to the extent that they can be considered an obesogenic factor and an issue that promote bad dietary habits throughout childhood. Therefore, we can question if the law protects infant’s health or the interest of sugary industry (AU)

Ingesta dietética de nitratos en bebés y niños españoles y riesgo de metahemoglobinemia / Dietary intake of nitrate in Spanish infants and children and risk of methemoglobinemia

Pese a que el consumo de verduras y hortalizas es recomendable tanto en adultos como en bebés y niños pequeños, existe el riesgo de que estos últimos ingieran a través de dichos alimentos cantidades elevadas de nitratos que incrementen el riesgo de padecer metahemoglobinemia. Aunque la ingesta media de nitratos en la población infantil europea no supera los márgenes de seguridad, un análisis llevado a cabo por la Autoridad Europea de Seguridad Alimentaria (EFSA) en 2010 reveló que el consumo de espinacas puede estar implicado en ciertos casos de metahemoglobinemia infantil. La Agencia Española de Seguridad Alimentaria y Nutrición (AESAN) consideró en 2011 que las acelgas, debido a su notable consumo en España, también pueden suponer un riesgo para la población infantil si su ingesta es elevada. A las recomendaciones de la AESAN, que es conveniente que conozca cualquier profesional sanitario del ámbito de la nutrición infantil, resulta prudente añadir que un elevado consumo de borraja (Borago officinalis, una hortaliza muy consumida en Navarra, La Rioja y Aragón en la elaboración de purés hechos en casa) también puede estar implicado en la metahemoglobinemia infantil. En cualquier caso, tal y como señalan tanto la EFSA como la AESAN, cuando se comparan los riesgos/beneficios de la exposición de nitratos por el consumo de verduras y hortalizas, prevalecen los efectos beneficiosos de su consumo (AU)

Although the consumption of vegetables is recommended for adults, infants and young children, there is a risk that their consumption results in a high intake of nitrates that increases the risk of methemoglobinemia. Even though the average nitrate intake in children does not exceed the European safety threshold, an analysis conducted by the European Food Safety Authority (EFSA) in 2010 revealed that the consumption of spinach may be involved in certain cases of infant methemoglobinemia. The Spanish Agency for Food Safety and Nutrition (AESAN) found in 2011 that chards, because of its remarkable consumption in Spain, may also pose a risk for children. In addition to the AESAN recommendations, that any health care professional in the field of infant nutrition should know, it is prudent to add that a high consumption of borage (Borago officinalis, a vegetable widely consumed in Navarra, La Rioja and Aragón in homemade purees) may also be involved in infant methemoglobinemia. In any case, and as EFSA and AESAN point out, the benefits of eating vegetables prevail over the risks of the exposure to nitrates linked to their consumption (AU)

Declaraciones nutricionales y de propiedades saludables aplicables a los productos de alimentación infantil en España y en la Unión Europea / Nutrition and health claims on products for infant feeding in Spain and the European Union

Las declaraciones nutricionales y de propiedades saludables son, desde hace décadas, un valor añadido que puede posicionar y diferenciar un producto o marca. El fraude en cuestiones en las que se requiere un análisis científico es difícilmente refutable por parte del consumidor. La legislación y los organismos científicos oficiales deben velar para que la comunicación sea veraz. El Reglamento 1924/2006 y la European Food Safety Authority (EFSA) tienen un papel fundamental, al ser el eje central sobre el que se desarrolla la creación y aceptación final de las declaraciones nutricionales y de propiedades saludables. Sin embargo, la coexistencia de legislación específica aplicable a los alimentos para lactantes y niños de corta edad y contemporánea al Reglamento 1924/2006, ha complicado la interpretación y aplicación del reglamento a dichos alimentos de especial consideración. Las Directivas 2006/141 y 2006/125 contienen apartados específicos de declaraciones nutricionales y de propiedades saludables no sometidas a aprobación por la EFSA y, en algunas ocasiones, el Reglamento 1924/2006 entra en conflicto con dichas directivas en esta materia. En esta revisión se desvelan algunas de las historias más accidentadas que envuelven el desarrollo de una legislación necesaria, ambiciosa y compleja (AU)

Nutrition and health claims are an added value that can position and differentiate a product or brand. Fraud issues in what scientific analysis is required are hardly refutable by the consumer. Legislation and official scientific bodies should ensure that the communication is truthful. Regulation 1924/2006 and the European Food Safety Authority (EFSA) have a key role, being the focus on the creation and final acceptance of nutrition and health claims. However, the coexistence of specific legislation applicable to foods for infants and young children to the Regulation 1924/2006, has complicated the interpretation and application of the regulation to these foods of special consideration. Directives 2006/141 and 2006/125 contain some specific sections on nutrition and health claims not subject to approval by the EFSA, and sometimes the Regulation 1924/2006 conflicts with these specific directives in this area. In this review, we reveal some of the roughest stories involving the development of a necessary, ambitious and complex legislation (AU)

High consumption foods and their influence on energy and protein intake in institutionalized older adults.

BACKGROUND: The elderly, and especially those attending nursing homes, are at great risk from certain nutritional deficiencies. OBJECTIVE: The aim of this study was to determine which food groups present the highest rates of consumption among the institutionalized elderly and study the energy density of each food group and the number of calories and amount of protein in the total diet of each resident. DESIGN: This was a multicentre observational study of a sample of the institutionalized population over the age of 65. The sample of patients was drawn from four Spanish nursing homes (Santa Coloma Gramanet, Barcelona, Madrid and Bilbao). Our final sample comprised a total of 62 individuals, of whom 22 were men and 40 women, aged between 68 and 96 years. METHODS: Dietary data were collected using the double weight method for each main meal (breakfast, lunch, afternoon snack and dinner), including food type, the quantity of food served and the amount of plate waste for each of the main meals served during 21 days. STATISTICAL ANALYSES: The characteristics of the study population were compared by Student's t-test and χ2 test. The results are expressed in terms of their median values and the interquartile range. To analyse the overall differences between sites, gender and food groups we used Kruskall-Wallis test combined with the Mann-Whitney U-test with Bonferroni correction for multiple comparisons. RESULTS: The food group that was served most was milk products (376.25 g/day). A large amount of potatoes were also served (109.64 g/day) as were sweets and pastries (62.14 g/day). The daily serving of fruit (138.34 g/day) and vegetables (239.47 g/day) was equivalent to no more than that of a daily ration in each case. Milk was the food group with the highest consumption (311 g/day). Most of the energy was provided by groups with a higher energy density like as fats and sauces, sweets and pastries and bread. The mean protein consumption was 82,6 g/day (Table 5) and no significant differences were recorded in this consumption between men and women. CONCLUSIONS: We conclude that there is a need to improve the residents' energy intake and to redistribute their energy and protein intake among the various food groups. An alternative to increasing food portions so as to improve energy intake might involve enriching certain food types.

Dietary fibre: influence on body weight, glycemic control and plasma cholesterol profile.

There have been several studies on the effects of dietary fibre on the metabolism. Epidemiologic studies have consistently reported an inverse relationship between dietary fibre and type 2 diabetes mellitus or cardiovascular mortality. This review focuses on observational and experimental studies that examine the effect of different types and sources of dietary fibre on body weight, glucose metabolism and lipid profile. From the available evidence, we conclude that clinical studies consistently show that the intake of viscous dietary fibre decreases the low density lipoprotein cholesterol and postprandial glucose levels, and induces short term satiety. However, few clinical trials have demonstrated that the intake of dietary fibre has a positive effect on the control of diabetes and body weight.

Dietary fibre: influence on body weight, glycemic control and plasma cholesterol profile / Fibra dietética: influencia sobre el peso corporal, el control glicémico y el perfil del colesterol plasmático

There have been several studies on the effects of dietary fibre on the metabolism. Epidemiologic studies have consistently reported an inverse relationship between dietary fibre and type 2 diabetes mellitus or cardiovascular mortality. This review focuses on observational and experimental studies that examine the effect of different types and sources of dietary fibre on body weight, glucose metabolism and lipid profile. From the available evidence, we conclude that clinical studies consistently show that the intake of viscous dietary fibre decreases the low density lipoprotein cholesterol and postprandial glucose levels, and induces short term satiety. However, few clinical trials have demonstrated that the intake of dietary fibre has a positive effect on the control of diabetes and body weight (AU)

Existen diversos estudios que han evaluado el efecto del consumo de fibra dietética sobre el metabolismo. Diversos estudios epidemiológicos observaron una relación inversa entre la fibra dietética y la diabetes mellitus tipo 2 o la mortalidad cardiovascular. Esta revisión se basa sobre estudios observacionales y experimentales que han valorado los efectos de diferentes tipos y fuentes de fibra dietética sobre el peso corporal, el metabolismo de la glucosa y el perfil lipídico. De la evidencia disponible, concluimos que los estudios clínicos consistentemente muestran que la ingesta de alimentos fuentes de fibra viscosa disminuye el colesterol de las lipoproteínas de baja densidad y los niveles de glucosa postprandial e induce la saciedad a corto plazo. Sin embargo, pocos ensayos clínicos han demostrado un efecto positivo sobre el control de la diabetes y el peso corporal (AU)

Comparativa de las Ingestas Dietéticas de Referencia (IDR) de los diferentes países de la Unión Europea, de Estados Unidos (EEUU) y de la Organización Mundial de la Salud (OMS) / Comparison of dietary reference intakes (DRI) between different countries of the European Union, The United States and the world health organization

Antecedentes: En España, existen varios organismos y sociedades científicas que han editado sus propios de valores de referencia sobre la ingesta recomendada de nutrientes, que no siempre coinciden en los contenidos y formas presentadas. Objetivo: Revisar los conceptos, datos y la metodología que han seguido otros países o grupos de países para obtener y documentar sus propios Valores de Referencia, con objeto de ofrecer una información básica que facilite el establecimiento de los valores de referencia que mejor puedan adaptarse a la población española, en base a la mejor evidencia científica disponible en la actualidad. Ámbito: Revisión de la información disponible en los distintos países (o grupos de países) de la Unión Europea, Estados Unidos y la Organización Mundial de la Salud. Los datos estudiados corresponden a poblaciones sanas. Conclusiones: Las ingestas de referencia difieren notablemente entre los distintos países estudiados en cuanto a grupos de población, tipo de nutrientes incluidos, metodología y periodicidad de las revisiones publicadas. Sin embargo, la mayoría definen de manera semejante los conceptos más importantes, aunque tengan distintas denominaciones en cada país. Por otro lado, en la mayoría de los casos estudiados existe un único organismo científico encargado de la publicación y actualización de los valores de ingestas dietéticas de referencia, no siendo así en España. En este contexto, parece conveniente alcanzar un acuerdo entre todos los organismos y sociedades científicas españolas implicadas en esta tarea, con objeto de establecer unos valores de referencia únicos para todo el país, con el consenso de todos (AU)

Background: In Spain, there are some organizations and scientific societies that have edited reference values of recommended nutrient intake, but whose data does not always agree in terms of format and content. Aims: To review the definitions, data and methodology that other countries or groups of countries have followed to obtain and document their own reference values in order to offer basic information to facilitate the establishment of the best reference values for the Spanish population. Field: Review of the available information in different countries (or groups of countries) from the European Union, the United States and World Health Organization. The analysed data concerned to healthy populations. Conclusions: Reference intakes differ among the examined countries according to population groups, included nutrients, methodology and frequency of published reviews. However, most of the countries define major concepts in the same way, although with different names in each country. On the other hand, most of the studied cases represent only a scientific organization in charge of the publication and update of the values of dietary reference intakes, but not in Spain. In that context, it looks convenient to reach a consensus among all Spanish organizations and scientific societies that are involved in this task, in order to establish an acceptable reference values (AU)

Análisis de un programa de pérdida de peso con sustitutivos de comidas sobre el control del peso y de parámetros bioquímicos en pacientes con sobrepeso y obesidad grado I / Analysis of a weight loss program with meal replacement products on weight and biochemical markers in overweight or type I obese patients

Introducción: Existen pocos estudios que hayan evaluado la eficacia y la seguridad de los sustitutivos de comidas para perder peso. Objetivo: Evaluar la eficacia y la seguridad de un programa de pérdida de peso que incluía productos sustitutivos de comidas. Métodos: Se evaluó el efecto de una dieta hipocalórica versus una dieta hipocalórica que incluía sustitutivos de comidas en 55 voluntarios con sobrepeso u obesidad grado I. Los sujetos fueron distribuidos en un grupo control (dieta hipocalórica) o un grupo de intervención (dieta hipocalórica con sustitutivos de comidas) durante 8 semanas. Se registraron datos antropométricos, hábito tabáquico y nivel de actividad física. También se realizaron extracciones sanguíneas para evaluar cambios bioquímicos al inicio del estudio, a las 4 semanas y al final del estudio. Resultados: El grupo control perdió 3,97 kg de media, mientras que en el grupo intervención se observó una pérdida de 4,44 kg, no siendo estas diferencias estadísticamente significativas entre grupos. Otros parámetros antropométricos como el perímetro de la cintura y el perímetro de la cadera también disminuyeron en ambos grupos, aunque sin diferencias entre grupos. Se observó una disminución estadísticamente significativa (p = 0,041) en los valores de triglicéridos, aunque también sin diferencias entre grupos. Discusión: Los sustitutivos de comidas, dentro de un programa dietético controlado, fueron tan eficaces y seguros para perder peso y modificar otros parámetros antropométricos como el tratamiento dietético convencional sin sustitutivos

Background: There are scarce data about the efficacy and security of meal replacement products as a strategy to weight loss. Aim: To evaluate the efficacy and safety of a weight loss program that includes meal replacement products. Methods: We evaluated the effect of a hypocaloric diet versus a hypocaloric diet that includes meal replacement products in 55 overweight or type I obese patients. Patients were distributed to a control group (hypocaloricdiet) or an intervention group (hypocaloric diet with meal replacement products) during 8 weeks. We registered anthropometric data, smoke habit and level of physical activity. We also studied biochemical parameters at the beginning of the study, at 4th week of the study and at the end of the same. Results: The control group lost 3.97 kg, while in the intervention group we observed a loss of 4.44 kg. These differences were not statistically significant between groups. Other anthropometric parameters as waist and hip perimeters diminished also in both groups, without differences between them. We observed also a statistically significant decrease (p = 0.041) in the values of triglycerides, without differences between groups again. Discussion: Meal replacement products were as effective and safe to lose weight and to modify other anthropometric parameters in a controlled dietetic program as a conventional dietetic treatment without meal replacement products

[Analysis of a weight loss program with meal replacement products on weight and biochemical markers in overweight or type I obese patients]. / Análisis de un programa de pérdida de peso con sustitutivos de comidas sobre el control del peso y de parámetros bioquímicos en pacientes con sobrepeso y obesidad grado I.

BACKGROUND: There are scarce data about the efficacy and security of meal replacement products as a strategy to weight loss. AIM: To evaluate the efficacy and safety of a weight loss program that includes meal replacement products. METHODS: We evaluated the effect of a hypocaloric diet versus a hypocaloric diet that includes meal replacement products in 55 overweight or type I obese patients. Patients were distributed to a control group (hypocaloric diet) or an intervention group (hypocaloric diet with meal replacement products) during 8 weeks. We registered anthropometric data, smoke habit and level of physical activity. We also studied biochemical parameters at the beginning of the study, at 4th week of the study and at the end of the same. RESULTS: The control group lost 3.97 kg, while in the intervention group we observed a loss of 4.44 kg. These differences were not statistically significant between groups. Other anthropometric parameters as waist and hip perimeters diminished also in both groups, without differences between them. We observed also a statistically significant decrease (p=0.041) in the values of triglycerides, without differences between groups again. DISCUSSION: Meal replacement products were as effective and safe to lose weight and to modify other anthropometric parameters in a controlled dietetic program as a conventional dietetic treatment without meal replacement products.

MARS en el fallo hepático fulminante. La experiencia chilena / MARS in fulminant liver failure. The Chilean experience

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