Blood Lead Levels and Their Association with Iron Deficiency and Anemia in Children.

Lead is a ubiquitous and neurotoxic heavy metal particularly harmful to children, who are more susceptible than adults to its toxic effects. The prevalence of lead poisoning and iron deficiency (ID) is high in socioeconomically vulnerable child populations, negatively affecting neurocognitive development in children. Although numerous studies have shown the association between blood lead levels (BLL) and ID, the issue remains controversial. Here, we aimed to identify the association between BLL and iron nutritional status in children. We conducted an analytical cross-sectional study of healthy children aged 1-6 y attending periodic health checks in primary healthcare units from La Plata and its surroundings, Buenos Aires, Argentina, between 2012 and 2017. We performed anthropometric evaluations and determined BLL, hemoglobin (Hb) and serum ferritin levels. Blood lead levels ≥ 5 µg/dL were defined as elevated BLL; ferritin levels < 12 ng/ml were considered ID; Hb levels < 11 g/dL (< 11.5 g/dL for children ≥ 5 y) were defined as anemia. Data were analysed using Mann Whitney test, Student´s t-test, chi-square test and logistic regression. The R package (v. 4.2.2.) was used for the statistical analysis of data. The sample included 392 children (mean age, 2.4 ± 1.4 y; 44.6% females). The prevalence of elevated BLL, ID and anemia was 8.7%, 26.3% and 31.8%, respectively. We found a significant association between elevated BLL and ID (odds ratio [OR], 95% confidence interval [CI]: 3.16 (1.50, 6.63)). The prevalence of elevated BLL was 16.2% and 5.8% in children with and without ID, respectively (p = 0.003). We also found association between elevated BLL and anemia (OR 95% CI: 3.03 (1.49, 6.29)). In conclusion, blood lead levels ≥ 5 µg/dL were significantly associated with ID and anemia in children aged 1-6 years.

Efectividad de la administración de hierro en forma semanal y diaria para la prevención de anemia por deficiencia de hierro en lactantes / Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants

Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/ day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation(control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

Fatty Acid Percentage Distribution in Complex Lipids of Breast Milk From Mothers on a Low Docosahexaenoic Acid Diet.

The aim of this study was to assess the fatty acid (FA) percentage distribution in complex lipids of breast milk from mothers on a low docosahexaenoic acid (DHA) diet. We performed a descriptive, cross-sectional study of milk samples (n = 14) collected 90 days after delivery and analyzed them using gas chromatography, thin-layer chromatography, and the Fiske-Subbarow method. Complex lipid distribution was 40.70 ± 5.11% sphingomyelin (SM), 26.03 ± 5.98% phosphatidylethanolamine (PE), 21.12 ± 2.32% phosphatidylcholine, 7.94 ± 1.96% phosphatidylserine, and 4.22 ± 1.25% phosphatidylinositol. Median DHA and arachidonic acid values were 0.13% (0.12; 0.18) and 0.42% (0.33; 0.53), respectively. Mean FA percentage in SM and PE was as follows: palmitic acid, 34.45 ± 1.94% and 5.38 ± 0.94%; oleic acid, 16.50 ± 4.07% and 9.43 ± 4.05%; linoleic acid, 5.91 ± 4.69% and 9.05 ± 4.5%. DHA was not detectable in SM, but it was found in PE (55.33 ± 14.46). In conclusion, breast milk of mothers on a low DHA diet contained 55% DHA in PE, but no DHA in SM.

Association between Karnofsky performance status and outcomes in cancer patients on home parenteral nutrition.

BACKGROUND AND AIM: The selection of appropriate criteria is essential to accurately identify cancer patients eligible for home parenteral nutrition (HPN). In this study, the association between Karnofsky Performance Status (KPS) Scale scores and outcomes in cancer patients on HPN was evaluated. METHODS: Retrospective-observational-longitudinal-analytical study of a database of adult cancer patients on HPN. The variables analyzed were sex, age, cancer diagnosis, cancer location (digestive tract and genitourinary), nutritional status, including initial weight (IW), at the start of HPN), usual weight (UW) and IW/UW ratio, and body mass index (BMI) at the start of HPN. Performance status was assessed with the KPS scale. Type of catheter used, number of days on HPN and clinical progression of cancer patients were also studied. RESULTS: Data of 41 cancer patients (60.8% female) were evaluated. Mean age at the start of HPN was 60.45 years. Cancer location was digestive tract (n = 36; 87.8%); gynecologic (n = 4; 9.7%), urinary tract (n = 1; 2.4%). Median IW was 55 kg (45; 64) and BMI was 20 (17.58; 22.84). The IW/UW ratio was -15 kg (-20;-10). The catheters used were peripherally inserted central catheter (n = 30; 73.2%), tunneled (n = 9; 22%) and port (n = 2; 4.8%). The median duration of HPN was 72 days (30; 159). The KPS results showed that 16 cancer patients (39%) had KPS scores ≤50, 17 (41.5%) requiring HPN were discharged and 24 (58.5%) died. The association between disease progression and KPS scores ≤50 was significant (p = 0.025; OR (95% CI): 5.28 (1.07; 36.18). CONCLUSION: The KPS scale is a reliable tool to identify cancer patients eligible for HPN. Cancer patients with ≤50 scores had a five-fold increased risk of death than patients with >50 scores.

Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants. / Efectividad de la administración de hierro en forma semanal y diaria para la prevención de anemia por deficiencia de hierro en lactantes.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation (control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.

Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections.

BACKGROUND AND AIM: The aim of this study was to analyze central line-associated bloodstream infections (CLABSI) in home parenteral nutrition (HPN) patients assisted by an interdisciplinary team during the first year of the COVID-19 pandemic in Argentina. METHODS: Longitudinal, retrospective and analytical study of patients on HPN for ≥90 days during 2020. Data collection included age (adults >18 years, pediatric ≤18 years), gender, diagnosis, type of catheter, number of lumens, venous access, days on HPN, infusion modality and number of CLABSI-associated events. In COVID-19 cases, number of patients, disease progression, mortality rate and microorganisms involved were analyzed. RESULTS: A total of 380 patients were included, 120 (31.6%) pediatric and 260 (68.4%) adult patients. Median age was 44.50 years (10; 62.25). Twelve patients (3.15% of the total) had COVID-19; of these, two pediatric and seven adult patients had no complications, and three adults died of COVID-19 pneumonia. The diagnoses observed were benign chronic intestinal failure (CIF, n = 311), grouped into short bowel (n = 214, 56.3%), intestinal dysmotility (n = 56, 14.7%), intestinal fistula (n = 20, 5.3%), and extensive small bowel mucosal disease (n = 21, 5.5%); malignant tumors (n = 52, 13.7%); other (n = 17, 4.4%). Total catheter days were 103,702. Median days of PN duration per patient were 366 (176.2, 366). The types of catheters used were tunneled (317 patients, 83.4%); peripherally inserted central (PICC) line (55 patients, 14.5%) and ports (8 patients; 2.1%). A total of 111 CLABSI was registered, with a prevalence of 1.09/1000 catheter days (adult, 0.86/1000 days; pediatric, 1.51/1000 days). The microorganisms identified in infectious events were Gram + bacteria (38, 34.5%); Gram-bacteria (36, 32%); mycotic (10, 9%); polymicrobial (4, 3.6%); negative culture and signs/symptoms of CLABSI (23, 20.3%). The odds ratio between pediatric and adult patients was 2.29 (1.35, 3.90). CONCLUSION: The rate of CLABSI during the COVID-19 pandemic was within the ranges reported by international scientific societies. The risk of CLABSI was higher in pediatric patients, and mortality rate in COVID-19 infected patients was higher than in the general population.

Riesgo de deficiencia de vitamina D en pacientes pediátricos con parálisis cerebral que reciben nutrición enteral domiciliaria / Risk of vitamin D deficiency in pediatric patientes with cerebral palsy receiving home enteral nutrition

Introducción: La malnutrición y la deficiencia de micronutrientes son complicaciones frecuentes en los pacientes con parálisis cerebral (PC). Objetivo: Analizar los niveles de vitamina D (VitD) en pacientes PC en Nutrición Enteral Domiciliaria (NED). Material y Métodos: Estudio retrospectivo analítico de corte transversal. Se incluyeron pacientes PC, e/ 2-18 años, con dosaje de VitD al final del invierno 2021. Se analizó: sexo, edad, discapacidad por Gross Motor Scale (GMS), estado nutricional, drogas antiepilépticas, fórmula, aporte de VitD, volumen, vía de acceso, gasto energético basal (GEB). Se agruparon: Grupo I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Resultados: se incluyeron 34 pacientes PC, 15 femeninos (44,11 %), edad media 10,87 años (DS 4,78), todos fueron grado V (GMS). La media de Z score de IMC (OMS) fue -1,33 (DS 3,14). Todos recibieron NE diaria. El aporte medio fue de 1270 Kcal (DE:243), 1,16 (Kcal sobre lo estimado según Schofield). Las fórmulas aportaron el 80% del requerimiento de VitD. Los niveles sanguíneos de VitD mostraron: 16 pacientes ≥ de 30 ng/ml y 18 ≤ 29 ng/ml. 14 fueron deficientes y 4 insuficientes. El 59% (20) de los pacientes recibían medicación anticonvulsivante. No se encontraron diferencias significativas entre G1 y G2 para sexo, edad, Z score de IMC, aporte de VitD, calorías recibidas/ GMB y medicación anticonvulsivante. Conclusión: El alto porcentaje de pacientes PC pediátricos con niveles subóptimos de VitD muestra que se trata de una población de riesgo y sugiere la necesidad del chequeo sistemático para una adecuada prevención y tratamiento

Introduction: Malnutrition and micronutrient deficiencies are frequent complications in patients with cerebral palsy (CP). Objective: to analyze the levels of vitamin D (VitD) in CP patients receiving Home Enteral Nutrition (HEN). Material and Methods: Retrospective analytical cross-sectional study. CP patients, from 2 to 18 years old, with measured VitD at the end of winter 2021, were included. The following study variables were analyzed: sex, age, disability by Gross Motor Scale (GMS), nutritional status, antiepileptic drugs, formula, VitD intake, volume, access route, basal energy expenditure (BEE), according to Schofield P/T. They were grouped: Group I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Results: 34 CP patients were included, 15 female (44.11 %), mean age 10.87 years (SD 4.78), all grade V (GMS). The mean BMI Z score (WHO) was -1.33 (SD 3.14). EN was daily in all, 33 due to gastrostomy and 1 due to SNG. The average contribution 1270 Kcal (DS243), 1.16 (Kcal received according to Schofield). The formulas provided 80 % of the VitD requirement. VitD blood levels showed: 16 patients (47 %) ≥ 30 ng/ml and 18 (52 %) ≤ 29 ng/ml. 14 (41.17 %) were deficient and 4 insufficient (11.76 %). 59 % (20) of the patients received anticonvulsant medication. No significant differences were found between G1 and G2 for sex, age, BMI Z score, VitD intake, calories received/GMB and anticonvulsant medication. Conclusion: The high percentage of pediatric CP patients with suboptimal levels of Vit D shows that it is a population at risk and suggests the need for systematic check-up for adequate prevention and treatment

Neurodevelopmental assessment of infants born to mothers with hypertensive disorder of pregnancy at six months of age.

Infant neurodevelopment is a complex process which may be affected by different events during pregnancy, such as hypertensive disorders of pregnancy (HDP). We conducted a prospective cohort study to compare the prevalence of neurodevelopmental disorders in infants born to mothers with and without HDP at six months of age. Participants attended the Health Observatory of Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" during 2018 and 2019. Infant neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Data were analyzed using Chi-square, Student's t-test and Mann-Whitney test. Of the 132 participating infants, 68 and 64 were born to mothers with and without HDP, respectively. At six months, the prevalence of risk of neurodevelopmental delay was significantly higher in infants born to mothers with than without HDP (27.9% vs. 9.4%; p = 0.008) (odds ratio, 3.71; 95% confidence interval, 1.30; 12.28). In conclusion, infants born to mothers with HDP had three times increased risk of neurodevelopmental delay at six months of age.

Evolución de los parámetros antropométricos de niños con parálisis cerebral asistidos por un equipo especializado en soporte nutricional domiciliario / Evolution of the anthropometric parameters of children with cerebral palsy assisted by a team specialized in home nutritional support

Introducción: los niños con parálisis cerebral (PC) presentan habitualmente compromiso nutricional. Objetivos: evaluar el estado nutricional antropométrico de niños con PC con nutrición enteral (NE) asistidos por un equipo especializado en domicilio. Materiales y métodos: cohorte retrospectiva sobre datos de historia clínica, evaluados durante un año (2018-2019). Se evaluó: z score de .peso (Pz), z score de talla (Tz), z score de índice de masa corporal (IMC) (IMCz). En los que no pudo usarse pediómetro, se utilizó medición de la longitud de la tibia (LT). Se los dividió en: 10 años (Grupo 2). Se excluyeron: síndromes genéticos y/o epilepsia refractaria, y quienes no adhirieron al tratamiento nutricional. Se registraron complicaciones asociadas al tratamiento nutricional. Resultados: se analizaron 72 pacientes, Grupo 1: 38 pacientes; inicio: Tz x -2,85(-4,50;-1,41), Pz x -2,83 (-3,72;-1,59), promedio de IMCz -1,10 (DE 2,25). Final, Tz fue x -2,55 (-3,92; -1,42), el Pz x -2,15 (-3,05;-1,03), promedio IMCz: 0,93 (DE 2,21). Se observó diferencia significativa entre el inicio y el final del período en el Z score peso (p=0,030). En el Grupo 2 se incorporaron 34 pacientes (47%), 22 (64%) de sexo masculino con una mediana de 13,62 de edad (r 11,6-14,83 años). La mediana del Tz fue -3,00 (-3,81; -1,53), el score Pz -2,63 (-3,68; -2,23), la media del IMCz fue -1,75 (DE:1,73). En el final del período observado, la mediana del Tz e -2,84 (-4,13;-1,25), Pz -2,84 (-3,42; -1,83), la media del IMCz fue -1,53 (DE:2,19). Se observaron diferencias significativas entre el inicio y final del período observado en el Pz (p=0,049). No se identificaron complicaciones graves en el período observado (hospitalizaciones, broncoaspiración, fallecimientos). Conclusiones: se observó mejoría del estado nutricional y bajo índice de complicaciones en el período estudiado

Introduction: children with cerebral palsy (CP) usually present nutritional compromise. Objectives: to evaluate the anthropometric nutritional status of children with CP with enteral nutrition (EN) assisted by a specialized team at home. Materials and methods: a retrospective cohort study on clinical report data, evaluated during one year (2018-2019). The following were evaluated: weight z score (Pz), height z score (Tz), BMI z score (BMIz). In those that could not be used a pediometer, measurement of the tibia length (TL) was used. They were divided into: <10 years (Group1) and >10 years (Group2). The following were excluded: genetic syndromes and/or refractory epilepsy, and those who did not adhere to nutritional treatment. Complications associated with nutritional treatment were recorded. Results: 72 patients were analyzed, Group 1: 38 patients: baseline: Tz x -2.85 (-4.50, -1.41), Pz x -2.83 (-3.72, -1.59), BMIz 0,93 (SD 2,21). Final, Tz was x -2.55 (-3.92, -1.42), Pz x -2.15 (-3.05, -1.03), BMI x: 15.95. Significant differences were observed between the start-end in P p<0.001, T p0.001, and Pz p0.030. Group 2: 34 patients, 2018: Tz x -3.00 (-3.81, -1.53), Pz x -2.63 (-3.68, -2.23), BMIz x -1,75 (DE:1,73). Final Tz x -2.84 (-4.13, -1.25), Pz x -2.84 (-3.42,-1.83) BMI -1,53 (DE: 2,19).Significant differences were observed between the beginning and end of the period observed in the Pz (p=0.049). No severe complications were recorded (hospitalizations, bronchial aspiration, death). Conclusions: an improvement in nutritional status and no severe complications were observed in the period studied

Riesgos nutricionales en lactantes que no reciben lactancia materna exclusiva en los primeros seis meses de la vida / Nutritional risks among not exclusively breastfed infants in the first 6 months of life

La leche humana es el alimento ideal para los lactantes y sus beneficios se manifiestan en el corto y el largo plazo. En situaciones de crisis es cuando más se debe enfatizar en la lactancia materna, considerada una de las intervenciones más costo-efectivas para reducir la morbimortalidad infantil. Más allá de las múltiples ventajas que la leche humana tiene en relación con el vínculo madre-hijo y las capacidades biológicas e inmunológicas, lo más importante es que la leche materna cubre todas las necesidades nutricionales. Cuando la lactancia materna no es posible, la Organización Mundial de la Salud recomienda, como primera opción, las fórmulas infantiles. La segunda opción es leche de vaca (LV) diluida, que conlleva riesgos de deficiencias nutricionales en el lactante que deben ser monitoreadas en forma estrecha y oportunamente subsanadas. Los principales riesgos de deficiencias en el lactante que recibe LV diluida son las de hierro, cinc, vitaminas A, D, C y E, aminoácidos y ácidos grasos esenciales

Breast milk is the ideal food for infants and its benefits can be observed in the short and long term. In crisis situations, breastfeeding should be promoted the most because it is one of the most cost-effective interventions aimed at reducing infant morbidity and mortality. In addition to the multiple advantages of breast milk in the mother-child bond and biological and immune properties, the most relevant characteristic of breast milk is that it covers all nutritional needs. When breastfeeding is not possible, the World Health Organization recommends infant formula as the first option. The second option is diluted cow's milk, which entails the risk for nutritional deficiency that should be strictly monitored and timely resolved. When infants are fed with diluted cow's milk, they are mainly at risk for iron, zinc, vitamin A, D, C, and E, amino acid, and essential fatty acid deficiency.

Nutritional risks among not exclusively breastfed infants in the first 6 months of life. / Riesgos nutricionales en lactantes que no reciben lactancia materna exclusiva en los primeros seis meses de la vida.

Breast milk is the ideal food for infants and its benefits can be observed in the short and long term. In crisis situations, breastfeeding should be promoted the most because it is one of the most cost-effective interventions aimed at reducing infant morbidity and mortality. In addition to the multiple advantages of breast milk in the mother-child bond and biological and immune properties, the most relevant characteristic of breast milk is that it covers all nutritional needs. When breastfeeding is not possible, the World Health Organization recommends infant formula as the first option. The second option is diluted cow's milk, which entails the risk for nutritional deficiency that should be strictly monitored and timely resolved. When infants are fed with diluted cow's milk, they are mainly at risk for iron, zinc, vitamin A, D, C, and E, amino acid and essential fatty acid deficiency.

La leche humana es el alimento ideal para los lactantes y sus beneficios se manifiestan en el corto y el largo plazo. En situaciones de crisis es cuando más se debe enfatizar en la lactancia materna, considerada una de las intervenciones más costo-efectivas para reducir la morbimortalidad infantil. Más allá de las múltiples ventajas que la leche humana tiene en relación con el vínculo madre-hijo y las capacidades biológicas e inmunológicas, lo más importante es que la leche materna cubre todas las necesidades nutricionales. Cuando la lactancia materna no es posible, la Organización Mundial de la Salud recomienda, como primera opción, las fórmulas infantiles. La segunda opción es leche de vaca (LV) diluida, que conlleva riesgos de deficiencias nutricionales en el lactante que deben ser monitoreadas en forme estrecha y oportunamente subsanadas. Los principales riesgos de deficiencias en el lactante que recibe LV diluida son las de hierro, cinc, vitaminas A, D, C y E, aminoácidos y ácidos grasos esenciales.

Effect of cheese containing Lactobacillus delbrueckii subsp. Lactis CRL 581 on blood pressure in prehypertensive and stage 1 hypertensive subjects / Efecto de un queso con LactobacillusdelbrueckiisubspLactis CRL 581 sobre la hipertensión arterial en individuos con prehipertensión o estadio 1 de hipertensión arterial

Hypertension is one of the main risk factors for cardiovascular disease. Functional foods containing bioactive peptides have been proposed as a strategy to decrease blood pressure (BP) in subjects under no pharmacological treatment. The aim of this study was to compare the effect of low-sodium, low-fat (LSLF) cheese and LSLF cheese containing Lactobacillus delbrueckii subsp. lactis CRL 581 (LSLF581) on BP in pre-hypertensive and stage 1 hypertensive subjects. Sixty-one pre-hypertensive and stage 1 hypertensive subjects assigned to one of twos (LSLF, n= 29 and LSLF581, n= 32) participated in this 12-month prospective, randomized, double-blind, crossover trial. Twenty-four h ambulatory BP monitoring was performed at the beginning and at the end of each four-week study period. Systolic and diastolic BP decreased in both study groups, but differences between groups were not significant (systolic, -1.78 and -0.2 mmHg; diastolic, -1.54 and -0.42 mmHg in LSLF581 and LSLF, respectively). Although our results could not support a BP lowering effect of LSLF581, small BP reductions could favorably prevent cardiovascular disease development.

La hipertensión arterial es uno de los principales factores de riesgo de enfermedad cardiovascular. Los alimentos funcionales que contienen biopéptidos constituyen una estrategia útil para disminuir la presión arterial (PA) en personas que no están bajo tratamiento farmacológico. El objetivo del estudio fue comparar el efecto de un queso bajo en sodio y bajo en grasas (BSBG) y el mismo queso con Lactobacillus delbrueckii subsp. lactis CRL 581 (BSBG581) sobre la PA en personas con prehipertensión y estadio 1 de hipertensión arterial. Realizamos un estudio prospectivo, randomizado, cruzado y doble ciego durante 12 meses en 61 personas con prehipertensión y estadio 1 de hipertensión arterial, asignadas a dos grupos: BSBG (n= 29) y BSBG581 (n= 32). Se realizó monitoreo ambulatorio de la PA (MAPA) durante 24 h al comienzo y al final de cada etapa del estudio (cuatro semanas). La PA sistólica y diastólica disminuyó en ambos grupos, aunque las diferencias entre grupos no fueron significativas (sistólica, -1.78 y -0.2 mmHg; diastólica -1.54 y -0.42 mmHg en BSBG581 y BSBG respectivamente). Aunque nuestros resultados no pueden confirmar el efecto hipotensor del queso BSBG581, las reducciones moderadas de la PA podrían prevenir el desarrollo de enfermedad cardiovascular.

Deficiencia de vitamina A y factores asociados en niños preescolares de la periferia de la ciudad de La Plata, Buenos Aires / Vitamin A deficiency and associated factors in preschoolers from the outskirts of La Plata, Buenos Aires

Introducción. La deficiencia de vitamina A (DVA) ha sido reconocida como un importante problema de salud pública en países en vías de desarrollo. Los niños en edad preescolar son grupos de riesgo en poblaciones vulnerables. El objetivo fue determinar la prevalencia de DVA y los factores asociados en una muestra de niños de edad preescolar. Material y métodos. Estudio de corte transversal que incluyó a niños de 1 a 6 años beneficiarios de planes sociales, atendidos en centros de atención primaria de la periferia de la ciudad de la Plata, Buenos Aires. Se determinó el contenido de vitamina A midiendo retinol sérico, por cromatografía líquida, y se registraron parámetros antropométricos e ingesta alimentaria. Se utilizó un modelo de regresión logística multinomial para evaluar la asociación entre las variables. Resultados. Se analizaron datos de 624 niños. La media geométrica de retinol fue 23,8 pg/dl (IC 95 %: 23,3-24,3). Las prevalencias de DVA y riesgo de DVA fueron 24,3 % y 57,4 %, respectivamente. Los niveles de retinol fueron significativamente menores en niños varones, con bajo peso y aquellos con bajo consumo (menor del primer tercilo de distribución). El análisis multivariable mostró asociación significativa entre DVA y el sexo masculino (OR: 1,93; IC 95 %: 1,15-3,24) y con el bajo consumo (OR: 1,48; IC 95 %: 1,15-2,62). Conclusión. La prevalencia de DVA hallada (24,3 %) constituye un importante problema de salud pública en esta población. Los factores asociados a dicha deficiencia fueron el sexo masculino y el bajo consumo.

Introduction. Vitamin A deficiency (VAD) has been recognized as an important public health problem in developing countries. Preschoolers account for risk groups within vulnerable populations. The objective of this study was to determine the prevalence of VAD and associated factors in a sample of preschoolers. Material and methods. Cross-sectional study with children aged 1-6 years receiving social assistance and seen at primary health care centers in the outskirts of the city of La Plata, Buenos Aires. Vitamin A levels were determined by measuring serum retinol with a liquid chromatography; anthropometric parameters and dietary intake were recorded. A multinomial logistic regression model was used to assess the association among outcome measures. Results. Data from 624 children were analyzed. The geometric mean of retinol was 23.8 pg/dL (95 % CI: 23.3-24.3). The prevalence of VAD and the risk for VAD were 24.3 % and 57.4 %, respectively. Retinol levels were significantly lower among boys, low-weight children, and those with low intake (below the first tertile of distribution). The multivariate analysis showed a significant association between VAD and male sex (odds ratio: 1.93; 95 % CI: 1.15-3.24) and between VAD and low intake (odds ratio: 1.48; 95 % CI: 1.15-2.62). Conclusion. The prevalence of VAD (24.3 %) is a major public health problem in this population. VAD-associated factors were male sex and low vitamin A intake.

Vitamin A deficiency and associated factors in preschoolers from the outskirts of La Plata, Buenos Aires. / Deficiencia de vitamina A y factores asociados en niños preescolares de la periferia de la ciudad de La Plata, Buenos Aires.

INTRODUCTION: Vitamin A deficiency (VAD) has been recognized as an important public health problem in developing countries. Preschoolers account for risk groups within vulnerable populations. The objective of this study was to determine the prevalence of VAD and associated factors in a sample of preschoolers. MATERIALS AND METHODS: Cross-sectional study with children aged 1-6 years receiving social assistance and seen at primary health care centers in the outskirts of the city of La Plata, Buenos Aires. Vitamin A levels were determined by measuring serum retinol with a liquid chromatography; anthropometric parameters and dietary intake were recorded. A multinomial logistic regression model was used to assess the association among outcome measures. RESULTS: Data from 624 children were analyzed. The geometric mean of retinol was 23.8 pg/dL (95 % CI: 23.3-24.3). The prevalence of VAD and the risk for VAD were 24.3 % and 57.4 %, respectively. Retinol levels were significantly lower among boys, low-weight children, and those with low intake (below the first tertile of distribution). The multivariate analysis showed a significant association between VAD and male sex (odds ratio: 1.93; 95 % CI: 1.15-3.24) and between VAD and low intake (odds ratio: 1.48; 95 % CI: 1.15-2.62). CONCLUSION: The prevalence of VAD (24.3 %) is a major public health problem in this population. VAD-associated factors were male sex and low vitamin A intake.

Introducción. La deficiencia de vitamina A (DVA) ha sido reconocida como un importante problema de salud pública en países en vías de desarrollo. Los niños en edad preescolar son grupos de riesgo en poblaciones vulnerables. El objetivo fue determinar la prevalencia de DVA y los factores asociados en una muestra de niños de edad preescolar. Material y métodos. Estudio de corte transversal que incluyó a niños de 1 a 6 años beneficiarios de planes sociales, atendidos en centros de atención primaria de la periferia de la ciudad de la Plata, Buenos Aires. Se determinó el contenido de vitamina A midiendo retinol sérico, por cromatografía líquida, y se registraron parámetros antropométricos e ingesta alimentaria. Se utilizó un modelo de regresión logística multinomial para evaluar la asociación entre las variables. Resultados. Se analizaron datos de 624 niños. La media geométrica de retinol fue 23,8 pg/dl (IC 95 %: 23,3-24,3). Las prevalencias de DVA y riesgo de DVA fueron 24,3 % y 57,4 %, respectivamente. Los niveles de retinol fueron significativamente menores en niños varones, con bajo peso y aquellos con bajo consumo (menor del primer tercilo de distribución). El análisis multivariable mostró asociación significativa entre DVA y el sexo masculino (OR: 1,93; IC 95 %: 1,15-3,24) y con el bajo consumo (OR: 1,48; IC 95 %: 1,15-2,62). Conclusión. La prevalencia de DVA hallada (24,3 %) constituye un importante problema de salud pública en esta población. Los factores asociados a dicha deficiencia fueron el sexo masculino y el bajo consumo.

Docosahexaenoic Acid in Mature Breast Milk of Low-income Mothers.

Docosahexaenoic acid (DHA) is among the main components of synaptosomal membranes and myelin sheaths. Because DHA is essential for child neurodevelopment, breast milk DHA levels should be improved by optimizing maternal nutrition. We determined DHA percentage levels in breast milk of low-income mothers receiving care at the public healthcare sector. We performed a descriptive, cross-sectional study in breast milk samples from 39 exclusively breast-feeding adult mothers with normal fetal and neonatal history. Samples were collected 90 ±â€Š7 days after delivery. Breast milk fatty acid composition was determined by gas chromatography. The cut-off value of DHA was 0.3% of total fatty acids in milk according to recommendations. Median DHA in milk was 0.14% (0.12-0.21). Breast milk DHA levels were lower than the minimum recommended in 92% of samples. The analysis of breast milk samples from low-income exclusively breast-feeding mothers showed that they did not reach the minimum recommended DHA percentage.

Contenido de vitamina A en la leche materna madura y su adecuación a las recomendaciones nutricionales en el lactante / Vitamin A content in mature breast milk and its adequacy to the nutritional recommendations for infants

Objetivo. Determinar el contenido de vitamina A en la leche materna y evaluar si cubre las recomendaciones para lactantes. Material y métodos. Estudio observacional, prospectivo, de corte transversal. Se analizaron muestras de leche de madres asistidas en el hospital público, obtenidas entre los 30 y los 90 días posparto. Se determinó la concentración de vitamina A por cromatografía y su adecuación a la ingesta dietética recomendada. Se utilizó el coeficiente de Spearman para estudiar la correlación entre variables. Resultados. Participaron 79 madres. La concentración de vitamina A en las leches fue 1,80 µmol/L (1,36-2,30); el tiempo medio de lactancia, de 57 días. No se encontró correlación significativa entre días de lactancia y contenido de vitamina A. El contenido en 50% de las muestras no cubrió las recomendaciones de vitamina A para los lactantes. Conclusión. El contenido de vitamina A fue insuficiente para cubrir las recomendaciones en la mitad de los casos.

Objective. To determine vitamin A content in breast milk and evaluate whether it satisfies the recommendations for infants. Material and methods. Observational, prospective, cross sectional study. Milk samples were obtained between 30 and 90 days postpartum from mothers seen in public hospitals, and analyzed. Vitamin A concentration was determined by chromatography and its adequacy to the recommended dietary intake. The correlation between outcome measures was analyzed using Spearman's correlation coefficient. Results. A total of 79 mothers participated. Vitamin A concentration in milk samples was 1.80 umol/L (1.36-2.30) and the mean breastfeeding time was 57 days. No significant correlation between breastfeeding days and vitamin A content was observed. In 50% of the samples, vitamin A content did not satisfy the recommendations for infants. Conclusion. Vitamin A content was not enough to satisfy the recommendations in half of the cases.

Vitamin A content in mature breast milk and its adequacy to the nutritional recommendations for infants. / Contenido de vitamina A en la leche materna madura y su adecuación a las recomendaciones nutricionales en el lactante.

OBJECTIVE: To determine vitamin A content in breast milk and evaluate whether it satisfies the recommendations for infants. MATERIAL AND METHODS: Observational, prospective, cross sectional study. Milk samples were obtained between 30 and 90 days postpartum from mothers seen in public hospitals, and analyzed. Vitamin A concentration was determined by chromatography and its adequacy to the recommended dietary intake. The correlation between outcome measures was analyzed using Spearman's correlation coefficient. RESULTS: A total of 79 mothers participated. Vitamin A concentration in milk samples was 1.80 umol/L (1.36-2.30) and the mean breastfeeding time was 57 days. No significant correlation between breastfeeding days and vitamin A content was observed. In 50% of the samples, vitamin A content did not satisfy the recommendations for infants. CONCLUSION: Vitamin A content was not enough to satisfy the recommendations in half of the cases.

OBJETIVO: Determinar el contenido de vitamina A en la leche materna y evaluar si cubre las recomendaciones para lactantes. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo, de corte transversal. Se analizaron muestras de leche de madres asistidas en el hospital público, obtenidas entre los 30 y los 90 días posparto. Se determinó la concentración de vitamina A por cromatografía y su adecuación a la ingesta dietética recomendada. Se utilizó el coeficiente de Spearman para estudiar la correlación entre variables. RESULTADOS: Participaron 79 madres. La concentración de vitamina A en las leches fue 1,80 µmol/L (1,36-2,30); el tiempo medio de lactancia, de 57 días. No se encontró correlación significativa entre días de lactancia y contenido de vitamina A. El contenido en 50% de las muestras no cubrió las recomendaciones de vitamina A para los lactantes. CONCLUSIÓN: El contenido de vitamina A fue insuficiente para cubrir las recomendaciones en la mitad de los casos.

Lactancia materna exclusiva y su relación con el estado nutricional de vitamina A del binomio madre-hijo / Exclusive breastfeeding and its relationship with the vitamin A nutritional status of the mother-child binomial

INTRODUCCIÓN Las madres en período de lactancia y los lactantes son considerados grupos vulnerables a la deficiencia de vitamina A (DVA). OBJETIVO Conocer la relación entre el estado nutricional de vitamina A en la madre y el lactante alimentado con lactancia materna exclusiva y calcular la adecuación de las leches a las recomendaciones. MÉTODO Estudio observacional, analítico, de corte transversal, en lactantes de 6 meses de edad con lactancia materna exclusiva y sus madres. Se determinó la cantidad de vitamina A en suero y leche por cromatografía líquida. Se calculó la concentración media de retinol y las prevalencias de deficiencias de vitamina A en la madre y el lactante y se establecieron correlaciones entre ellas. Se analizó la adecuación de las leches a las recomendaciones nutricionales de referencia. RESULTADOS Se estudiaron 63 binomios madre-hijo. La concentración media de retinol en suero materno fue 1,84 ± 0,48 µmol /L. Ninguna madre presentó DVA en suero y sólo el 2% riesgo de DVA. La concentración media de retinol en leche fue 1,41 ± 0,80µmol /L y 15,57 µg/g grasa (11,37; 23,98), el 38% de las mujeres presentaron deficiencia de vitamina en leche, y al ajustar por la grasa el 12%. El 67% de las leches no cubren las recomendaciones. En lactantes, la concentración media de retinol en suero fue 1,09 ± 0,25 µmol /L, la prevalencia de DVA 5% y el riesgo de DVA 47,5%. Se encontraron diferencias estadísticamente significativas entre las concentraciones medias de retinol en suero de la madre y del lactante (p=0,0490) y entre los niveles medios de retinol en suero de los lactantes alimentados con leches deficientes y los alimentados con leches no deficientes (p=0,0420). DISCUSIÓN No hubo madres con DVA en suero y sólo el 5 % de los lactantes estaban deficientes. Se encontró asociación entre el estado nutricional en vitamina A en suero y leche de la madre y el del suero del lactante. El 67% de las leches no se adecuaron a las recomendaciones