Los programas de alimentación suplementaria y de enriquecimiento de alimentos en América Latina aspectos puntuales / Food suplementation and food fortification programs in Latin America

La suplementación alimentaria se define como la donación de uno o varios alimentos, preparados o crudos, a una colectividad necesitada de atención. Los programas de alimentación suplementaria deben ir acompañados de algún elemento educativo. Los programas de alimentación suplementaria en América Latina han sido una de las actividades más frecuentemente utilizadas en las políticas de nutrición, aunque pocas veces han sido ejecutadas con arreglo a los principios que deben regir los programas en las comunidades pobres. Durante las últimas décadas, con motivo de las medidas de ajuste adoptadas por los gobiernos, e influenciadas por Agencias Internacionales, se organizaron programas de distribución de alimentos, de forma un tanto irregular. Ante la crisis generalizada que afecta hoy, a comienzos del siglo XXI, a la mayor parte de los países latino-americanos es posible que sea necesario fortalecer de nuevo los programas de alimentación suplementaria (AU)

Food transitions in the 20th-21st century.

Food transitions in history have been fast, violent processes in some cases, while on other occasions they have taken place slowly, overlapping the traditional food culture as food items are replaced by new ones. Despite the contribution of potato and maize to avoiding famine in Europe, the exclusive crop system caused serious problems. Main food transitions are currently taking place in Asia. Emerging economies face the dilemma of improving the health and well-being of the population while avoiding excess and surplus. The challenge is twofold: on the one hand, to counteract the negative effects of food transitions and, on the other, to fight against hunger and malnutrition.

Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with both Crohn's disease and intestinal resection.

We compared the intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with Crohn's disease and resections of the small bowel. Patients were subgrouped into those with small (less than 100 cm), intermediate (100-300 cm), and large (greater than 300 cm) resections. [3H]cholecalciferol or [3H]25-hydroxycholecalciferol were given orally and serial blood samples were taken for measurement of plasma radiolabeled vitamin. Absorption of both forms of the vitamin decreased with extent of resection but 25-hydroxycholecalciferol absorption was always greater than that of cholecalciferol. When compared with normal control subjects, 25-hydroxycholecalciferol absorption in these patients was better maintained than that of cholecalciferol. These data indicate that vitamin D malabsorption reflects the extent of distal small-bowel resection in Crohn's disease. Treatment with oral cholecalciferol is sufficient in those with small or moderate resections but oral 25-hydroxycholecalciferol supplementation may be preferred in those with a severe short-bowel syndrome.

Dietary supplementation in elderly patients with fractured neck of the femur.

59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome was significantly better in the supplemented group (56% favourable course vs 13% in controls) during the stay in the convalescent hospital. The rates of complications and deaths were also significantly lower in supplemented patients (44% vs 87%). 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients (40% vs 74%). The median duration of hospital stay was significantly shorter in the supplemented group (24 vs 40 days). Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.

[Nutrition yesterday and today]. / Nutrición ayer y hoy.

The history of human nutrition from primitive times to actuality is briefly outlined. Many of the modern nutritional problems can be traced back to changes caused by the introduction of agriculture and, more recently, food technology. These developments have changed the composition of the diet to which the primitive hunter-gatherers had adapted themselves during millions of years. Changes in food habits and the beginning of the science of nutrition are discussed, and a brief review of nutritional recommendations is provided. The terms of nutritional goals and rules, so much used today, are of recent introduction. Nevertheless, norms, normal allowances and other similar expressions have since long ago been in use. Nutritional goals should be based on the vital habits of the population for which they are intended, and should be adapted to the ever emerging new findings in nutritional sciences.

Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in chronic cholestatic liver disease.

We compared the absorption of cholecalciferol and 25-hydroxycholecalciferol in normal subjects and in patients with mild and severe cholestatic liver disease. 3H-cholecalciferol and 3H-25-hydroxycholecalciferol were given orally and serial blood samples were drawn for measurement of the serum level of radiolabeled vitamin. Absorption of 25-hydroxycholecalciferol peaked earlier and was greater than absorption of cholecalciferol at all times in all three groups. Patients with mild cholestasis (normal bilirubin and fecal fat excretion) absorbed both forms of the vitamin normally. Those with severe cholestasis (jaundice and steatorrhea) had minimal absorption of cholecalciferol but relatively preserved absorption of 25-hydroxycholecalciferol. Absorption of cholecalciferol and 25-hydroxycholecalciferol was inversely related to fecal fat excretion. The superior absorption of 25-hydroxycholecalciferol may partly explain its greater efficacy in oral treatment of vitamin D deficiency in patients with severe cholestasis.

Altered fractional excretion of uric acid during total parenteral nutrition.

The presence of crystal proven podagra coincident with a 52% decrease in plasma urate after a 3-day course of total parenteral nutrition (TPN) prompted a study of urate excretion in 9 patients with Crohn's disease. By Day 9 in those receiving TPN, plasma urate decreased 58% (p less than 0.001), while fractional urate excretion increased 94% (p less than 0.005). Twenty-four hour urate excretion and serum creatinine were not significantly altered. These findings persisted for the duration of TPN. In 2 patients with ileocolitis, the addition or deletion of either lipid emulsion or multivitamin infusions during TPN had no effect on urate values. Rather, the amino acid load or a specific constituent appears to be the causal factor. These data suggest that hypouricemia due to extensive net urate excretion is common during TPN therapy. Finally, patients with established gout may be at risk for acute gouty attacks during TPN therapy.

Glycaemic response and hydrogen production to blenderised and polymeric enteral nutrition formulas.

Complete enteral nutrition preparations include blenderised formulas based on natural foods with some fibre content and also low-residue polymeric formulas. This study examines the effect of the different fibre content of two commercial formulas (6.4 g/l and 0.25 g/l) on glycaemic and insulin response and hydrogen production in the colon during constant rate administration in 11 normal subjects. No difference in serum glucose and insulin levels was found. No rise in hydrogen production was detected with either formula suggesting no carbohydrate malabsorption. The quantity or nature of fibre present in blenderised formulas does not modify the pattern of carbohydrate absorption compared to a low-residue polymeric formula. However, this does not preclude other possible physiological effects of fibre content upon gastrointestinal motility and function.

[Gastrointestinal manifestations of acquired immunodeficiency syndrome; case studies of 14 patients]. / Les manifestations gastro-intestinales du syndrome d'immunodépression acquise; casuistique sur quatorze patients.

The gastrointestinal manifestations seen in acquired immune deficiency syndrome (AIDS) are discussed based on the observation of 14 patients with a positive serology for LAV/HTLV III antibody. AIDS was confirmed in 8 cases and AIDS related complex (ARC) in 6 cases. Risk groups included 6 homosexuals, 6 drug abusers and 2 patients from Zaïre. All the AIDS cases underwent gastrointestinal endoscopy and biopsy; in 5 patients a necropsy was performed. Evaluation of the immune status showed lymphopenia and a decreased ratio of OKT4/OKT8. Clinical and pathological observations are discussed sequentially. Acute esophagitis includes cases of Candida albicans super-infection, cytomegalovirus and herpes simplex. Acute enteritis and colitis were seen in association with cryptosporidium, Isospora belli and CMV. 3 cases were found to have chronic duodenitis and malabsorption. Digestive lesions of Kaposi's sarcoma were seen in 3 cases. Diagnosis and treatment of gastrointestinal infections in AIDS is important in view of the high morbidity and serious secondary complications.

[Clinical approach to weight control]. / Approche clinique au contrôle du poids.

In defining the therapeutic strategy the clinical evaluation of obesity relies on ideal body weight tables and the calculation of the body weight index (kg/m2). The distribution of fat tissue must also be considered, since the increased risk of cardiovascular disease appears to be associated with the android type of obesity. A number of factors influence the development of obesity, including heredity, energy balance and appetite, which is under physiologic and psychological control. A balanced hypocaloric diet remains the basic approach to weight control as it alone provides nutritional education. Under medical supervision, unbalanced diets, such as the protein-sparing modified fast, have been shown to be very effective. The surgical treatment of morbid obesity is controversial, although good results are claimed for gastroplasty. Whatever the approach, appropriate supportive measures must be included in order to modify behavior towards food and maintain weight loss.