Estudio EPOCA sobre el impacto de los problemas de conducta en niños menores de 12 años y sus familias / Impact of behavioral problems in children under 12 and their families: the EPOCA study

Introducción: El objetivo del estudio EPOCA fue conocer el impacto de los problemas de conducta en el estado de salud y la calidad de vida (CV) de la población pediátrica, así como el tipo de recomendaciones no farmacológicas que realiza el pediatra en este tipo de consultas. Métodos: Estudio multicéntrico y observacional de niños de entre 6 y 12 años de edad, sin patología neurológica y/o psiquiátrica conocida, que acudieron a la consulta del pediatra y refirieron problemas de conducta. Se compararon los datos basales de la muestra con los de población infantil de la Encuesta Nacional de Salud de España (ENSE 2011), los resultados basales frente a los obtenidos al cabo de 3 meses, y también las diferencias a los 3 meses según las medidas recomendadas por el pediatra, en un grupo al que se le recomendó un suplemento alimentario a base de ácidos grasos (AG) omega-3 y otro grupo sin esta recomendación. Resultados: Las puntuaciones basales mostraron que el 67,8% de los participantes presentaban «probables» problemas de salud mental, además de una puntuación menor en la calidad de vida (CV) respecto a la muestra de la ENSE. La CV de los padres también se vio afectada en función de la presencia o no de problemas de conducta en sus hijos. Entre las medidas recomendadas por el pediatra, la complementación con AG omega-3 durante 3 meses se asoció a un porcentaje de mejora significativamente mayor en las puntuaciones de salud mental (el 35,1 vs. 25,5%; p= 0,019), de problemas de conducta (el 40,9 vs. 29,3%; p= 0,017) y de hiperactividad (el 35,9 vs. 24,1%; p= 0,017). La misma tendencia se observó en los resultados sobre «prestar atención» y «sentirse lleno de energía» » (p <0,05; 79,7 ± 103,6 vs. 65,2 ± 98,3, y 20,1 ± 80 vs. 13,3 ± 94,5, respectivamente). Conclusiones: En general, los niños con problemas de conducta presentan un peor estado de salud y una peor CV que los de la población general. La CV de los padres también se ve notablemente afectada por los problemas de conducta de sus hijos. La suplementación de la dieta con AG omega-3 parece tener efectos positivos en distintos factores relacionados con el estado de salud de los niños que refieren problemas de conducta. Las medidas no farmacológicas recomendadas por el pediatra, incluido el uso de un suplemento a base de omega-3, muestran un efecto positivo y sumatorio en la mejoría de tales problemas (AU)

Introduction: The EPOCA study aimed to assess the impact of behavioural problems on health and quality of life (QoL) of pediatric population and to know the non-pharmacological recommendations of pediatrician in such cases. Methods: Observational multicentre study of children aged 6-12 years (without neurological and/or psychiatric diagnosis) whom parents reported behavioral problems during a standard medical visit. Baseline data of EPOCA's participants was compared with those reported for pediatric population of the 2011 Spanish National Health Survey (SNHS). Other analyzes included comparisons of different outcomes at 3-months according to pediatrician recommendations between a group of patients who received dietary supplementation with omega-3 polyunsaturated fatty acids (PUFA) and another group without this recommendation. Results: Baseline scores showed that 67.8% of children were considered with «probable» mental health problems, while a lower score on QoL regarding sample of SNHS was also observed. Parents' QoL also was affected depending on the presence or not of behavioural problems in their progeny. Among the recommendations of pediatricians, supplementation with omega-3 for 3 months was associated with significantly improvements on mental health (35.1 vs. 25.5%; p= 0.019), on behavioral problems (40.9 vs. 29.3%; p= 0.017) and on hyperactivity (35.9 vs. 24.1%; p= 0.017). The same trend was observed on 'paying attention' and 'feel full of energy' (p <0.05; 79.7 ± 103.6 vs. 65.2 ± 98.3, and 20.1 ± 80 vs. 13.3 ± 94.5, respectively). Conclusions: Globally, children with behavioural problems have shown worse scores of health and QoL compared with children of the general population. Parents' QoL was also significantly affected by the behavioral problems of their children. Overall, paediatricians' recommendations, including dietary supplementation with omega-3 PUFA, seems to have positive effects on different factors associated with health in children with behavioral problems (AU)

[The importance of functional ingredients in pediatric milk formulas and cereals]. / La importancia de los ingredientes funcionales en las leches y cereales infantiles.

Feeding during the first months of life has a decisive influence not only in early developmental phases of children but also in their long-term health. Therefore, inclusion of new functional ingredients to pediatric milk formulas is, nowadays, the matter of a number of studies, incorporating day-by-day newer products and more similar to human milk, the gold standard, which contains them in a natural way. Nowadays, technological advances have made possible to obtain these ingredients from animal or vegetal sources for their addition into pediatric milk formulas and cereals. In the present article, the main functional ingredients, such as polyunsaturated fatty acids, palmitate, nucleotides, pre- and probiotic oligosaccharides, carnitine and taurine are reviewed with regards to their nutritional and functional interest in infant feeding. Their incorporation in pediatric foods has been possible after carrying out animal and clinical studies that provide a solid scientific basis which guaranties their proper bioavailability and their efficacy in the newborn. In the future years, thanks to a better understanding of maternal milk composition and to the performance of further studies, it will be possible to add new ingredients that will allow to obtain pediatric milk formulas more and more similar to maternal milk from a nutritional and functional point of view.

La importancia de los ingredientes funcionales en las leches y cereales infantiles / The importance of functional ingredients in pediatric milk formulas and cereals

La alimentación durante los primeros meses de vida tiene una influencia decisiva no sólo en las fases tempranas del desarrollo del niño sino también en su salud a largo plazo. Por ello, la incorporación de nuevos ingredientes funcionales a las leches infantiles es hoy objeto de numerosos estudios, dando cada vez productos más novedosos y semejantes a la leche humana, patrón de oro, que los contiene en forma natural. Hoy día, los avances tecnológicos han permitido la obtención de estos ingredientes a partir de fuentes de tipo animal o vegetal para su adición en leches y cereales infantiles. En el presente estudio se revisa el interés nutricional y funcional de los principales ingredientes funcionales de interés en la alimentación del lactante, como son los ácidos grasos poliinsaturados, b-palmitato, nucleótidos, oligosacáridos con efecto prebiótico, probióticos, carnitina y taurina. Su incorporación en los alimentos infantiles ha sido posible tras la realización de estudios en animales y estudios clínicos que proporcionan una sólida base científica que garantiza tanto su correcta biodisponibilidad como su eficacia en el recién nacido. En el futuro, gracias a un mayor conocimiento de la composición de la leche materna y a la realización de estudios adicionales será posible la incorporación de nuevos ingredientes que permitan la obtención de leches infantiles cada vez más similares a nivel nutricional y funcional a la leche materna (AU)

Feeding during the first months of life has a decisive influence not only in early developmental phases of children but also in their long-term health. Therefore, inclusion of new functional ingredients to pediatric milk formulas is, nowadays, the matter of a number of studies, incorporating day-by-day newer products and more similar to human milk, the gold standard, which contains them in a natural way. Nowadays, technological advances have made possible to obtain these ingredients from animal or vegetal sources for their addition into pediatric milk formulas and cereals. In the present article, the main functional ingredients, such as polyunsaturated fatty acids, palmitate, nucleotides, preand probiotic oligosaccharides, carnitine and taurine are reviewed with regards to their nutritional and functional interest in infant feeding. Their incorporation in pediatric foods has been possible after carrying out animal and clinical studies that provide a solid scientific basis which guaranties their proper bioavailability and their efficacy in the newborn. In the future years, thanks to a better understanding of maternal milk composition and to the performance of further studies, it will be possible to add new ingredients that will allow to obtain pediatric milk formulas more and more similar to maternal milk from a nutritional and functional point of view (AU)

Oligosaccharides: application in infant food.

Oligosaccharides are a complex mixture of approximately 130 compounds present in human milk. It has been shown that human milk oligosaccharides induce an increase in the number of bifidobacteria of colonic flora in breast-fed infants, accompanied with a significant reduction in the number of pathogenic potential bacteria, due to their bifidogenic activity. Complex oligosaccharides have the capacity of inhibiting the binding of pathogens to cell surface because they act as competitive receptors. They are associated with a lower risk of infections and diarrhoea and an improvement of the immune system response. Due to the decrease of the pH intestinal caused by their fermentation, oligosaccharides provoke a reduction of the flora pathogens, an increase of bifidobacteria and an increase of the availability of minerals. In the food industry, simple oligosaccharides such as fructooligosaccharides and galactooligosaccharides are used as bifidogenic oligosaccharides and some infant products contain them in the hope that this might provide some of the benefits attributed to oligosaccharides in human milk. This paper reviews characteristics of oligosaccharides, their beneficial effects and use of oligosaccharides in the food industry. In adults, the benefits of some of the oligosaccharides have been established in several clinical trials, but in infants more fundamental research is needed to establish the metabolic role of these components and the daily intake with bifidogenic activity.