Real-life data on the effectiveness of extensively hydrolyzed protein-based formula and amino acid-based formula in regaining weight and height in infants on a cow's milk protein elimination diet.

OBJECTIVE: To compare the effectiveness of extensively hydrolyzed protein-based formula (EHF) or amino acid-based formula (AAF) in reversing the weight and height deficit in infants on a cow's milk protein elimination diet. METHODS: Infants from a retrospective cohort who were fed EHF (n = 17) or AAF (n = 16) for at least 2 months on a cow's milk protein elimination diet were included. The weight and height values recorded in the infants' medical records were obtained. RESULTS: The mean age of the infants at the start of EHF and AAF were 5.8 ± 2.6 and 4.4 ± 2.5 months, respectively (P = 0.061). There was no difference between the groups in terms of the monthly weight gain (373.0 ± 212.2 and 453.1 ± 138.5 g, P = 0.223, respectively, for EHF and AAF), while the monthly increase in height was greater in the group fed with AAF (1.3 ± 0.5 and 1.8 ± 0.6, P = 0.030). A comparison between the difference in the initial z-score and in the oral challenge test of weight-for-age (+0.7 ± 1.2 and +1.3 ± 1.4, P = 0.262, respectively, for the EHF and AAF groups), height-for-age (+0.2 ± 1.1 and +1.2 ± 1.8, P = 0.090), and body mass index (BMI)-for-age (+0.7 ± 1.3 and +0.7 ± 1.5, P = 0.971) did not reveal a statistically significant difference between the groups. Correlation coefficients showed that the greater the initial nutritional deficit, the greater the positive variation between the beginning of each formula and the oral challenge test. CONCLUSION: EHF and AAF provided similar increases in the weight-for-age, height-for-age, and BMI-for-age z-scores in both groups. The monthly increase in height was greater in infants who received AAF.

Real-life data on the effectiveness of extensively hydrolyzed protein-based formula and amino acid–based formula in regaining weight and height in infants on a cow’s milk protein elimination diet

Objective: To compare the effectiveness of extensively hydrolyzed protein-based formula (EHF) or amino acid–based formula (AAF) in reversing the weight and height deficit in infants on a cow’s milk protein elimination diet. Methods: Infants from a retrospective cohort who were fed EHF (n = 17) or AAF (n = 16) for at least 2 months on a cow’s milk protein elimination diet were included. The weight and height values recorded in the infants’ medical records were obtained. Results: The mean age of the infants at the start of EHF and AAF were 5.8 ± 2.6 and 4.4 ± 2.5 months, respectively (P = 0.061). There was no difference between the groups in terms of the monthly weight gain (373.0 ± 212.2 and 453.1 ± 138.5 g, P = 0.223, respectively, for EHF and AAF), while the monthly increase in height was greater in the group fed with AAF (1.3 ± 0.5 and 1.8 ± 0.6, P = 0.030). A comparison between the difference in the initial z-score and in the oral challenge test of weight-for-age (+0.7 ± 1.2 and +1.3 ± 1.4, P = 0.262, respectively, for the EHF and AAF groups), height-for-age (+0.2 ± 1.1 and +1.2 ± 1.8, P = 0.090), and body mass index (BMI)-for-age (+0.7 ± 1.3 and +0.7 ± 1.5, P = 0.971) did not reveal a statistically significant difference between the groups. Correlation coefficients showed that the greater the initial nutritional deficit, the greater the positive variation between the beginning of each formula and the oral challenge test. Conclusion: EHF and AAF provided similar increases in the weight-for-age, height-for-age, and BMI-for-age z-scores in both groups. The monthly increase in height was greater in infants who received AAF (AU)

(In)segurança da rotulagem de alimentos infantis à base de cereais em relação à legislação brasileira vigente / (In)safety of labeling of cereal-based infant foods in relation to current brazilian legislation

Introdução: Os cereais sãoamplamente utilizados na alimentação das crianças. Objetivo: avaliar a composição nutricional e a rotulagem de alimentos infantis à base de cereais, em relação à legislação vigente. Material e Métodos: Estudo transversal, analítico e descritivo que avaliou alimentos à base de cereais, bem como a conformidade da rotulagem em relação à legislação brasileira vigente. Resultados: Avaliaram-se 72 amostras de alimentos: cereal para alimentação infantil; mistura para o preparo de mingaus e farinha de cereais; 100% das amostras apresentaram alguma não conformidade em relação à legislação, incluindo a presença de falso conceito de vantagem e segurança, ilustrações não permitidas, ausência de advertências obrigatórias e ausência da idade mínima para consumo do produto. Nas análises bromatológicas e de rotulagem, o teor de carboidratos de todas as categorias ultrapassou 80% do valor energético total do produto. Os teores de proteínas, lipídios, carboidratos e energia da categoria cereal para alimentação infantil mostraram diferenças significativas, sendo, respectivamente, p=0,015, p<0,001, p=0,013 e p<0,001. A categoria "mistura para preparo de mingaus" também mostrou diferenças significativas para proteínas, lipídios, carboidratos e energia (p<0,001). Na categoria de farinhas de cereais, somente o teor de proteínas apresentou diferença (p=0,05). Conclusão: Considerando o universo amostral do estudo, é possível concluir que mesmo na vigência de legislações específicas, ainda encontramos não conformidades legais na rotulagem de alimentos à base de cereais destinados à alimentação infantil, sendo que esses alimentos apresentam composição nutricional diferente das informações apresentadas em seus rótulos, impactando negativamente a segurança alimentar de crianças.

Introduction: Cereals are widely used in children's nutrition. Objective: to evaluate the nutritional composition and labeling of cereal-based infant foods, in relation to current legislation. Material and Methods: cross-sectional, analytical and descriptive study that evaluated cereal-based foods, as well as labeling compliance with current Brazilian legislation. Results: 72 food samples were evaluated: cereal for baby food; mixture for the preparation of porridge and cereal flour. One hundred percent of the samples showed some non-compliance with the legislation, including the presence of a false concept of advantage and safety, illustrations not allowed, absence of mandatory warnings and, absence of the minimum age for consumption of the product. In bromatological and labeling analyses, the carbohydrate content of all categories exceeded 80% of the total energy value of the product. The protein, lipid, carbohydrate and energy contents of the cereal category for infant feeding showed significant differences, being, respectively, p=0.015, p<0.001, p=0.013 and p<0.001. The mix category for porridge preparation also showed significant differences for proteins, lipids, carbohydrates and energy (p<0.001). In the category of cereal flours, only the protein content showed a difference (p=0.05). Conclusion: considering the sample universe of the study, it is possible to conclude that even in the presence of specific legislation, we still find legal non-conformities in the labeling of cereal-based foods intended for infant feeding, and these foods have a nutritional composition different from the information presented on their labels, negatively impacting children's food safety.

Attitudes and practice of caregivers for cow's milk allergy according to stages of behavior change.

OBJECTIVE: To verify the attitudes and practices of dietary management for cow's milk allergy by caregivers according to the stages of behavior change. METHODS: Observational, cross-sectional study involving 30 caregivers of children with cow's milk allergy who were followed up in a specialized outpatient clinic, from July 2018 to May 2019. Data collection included a structured questionnaire about sociodemographic aspects, social classification and an adapted algorithm to classify the stages of behavior change based on a trans-theoretical model. RESULTS: Most caregivers (26/30) were females aged 20 to 48 years and belonging to social classes C, D and E. Regarding the stages of behavior change for the dietary management of cow's milk allergy according to the model, 80% of the participants (24/30) were in the action stage, while 20% (6/30) were in the maintenance stage. CONCLUSIONS: The attitudes and practices of caregivers for the dietary management of cow's milk allergy are influenced by feelings and emotions that can interfere with communication and the understanding of dietary guidelines; however, these caregivers are in different stages of action and maintenance to change behavior that correspond to their attitudes and practices.

Outcome of food intake and nutritional status after discontinuation of a cow’s-milk-free diet post negative oral food challenge in infants and children

Objective To evaluate the outcome of food intake and nutritional status post discontinuation of a cow’s-milk-free diet after a negative oral food challenge.Methods This was a prospective, uncontrolled study that evaluated food intake and nutritional status of a cohort of 80 infants and children under 5 years of age. Food intake and nutritional status were evaluated on the day of the oral food challenge test and after 30 days. Weight and height were measured on the day of the test and after 30 days.Results The mean age of the patients was 18.7 ± 12.4 months, and 58.7% were male. After discontinuation of the elimination diet, the children showed daily intake increases in (P < 0.001), protein (P < 0.001), carbohydrates (P = 0.042), calcium from foods (P < 0.001), calcium from foods and supplements (P < 0.001), phosphorus (P < 0.001), and vitamin D from foods (P = 0.006). The Z-scores (n = 76) on the day of the oral food challenge test and 30 days after restarting the consumption of cow’s milk were as follows: weight-for-age (P < 0.001) and height-for-age (P < 0.001), respectively.Conclusion Cow’s milk protein in the diet was associated with increased intake of energy, proteins, carbohydrates, calcium, phosphorus, and vitamin D, in addition to an increase in the Z-scores for weight-for-age and height-for-age (aU)

Outcome of food intake and nutritional status after discontinuation of a cow's-milk-free diet post negative oral food challenge in infants and children.

OBJECTIVE: To evaluate the outcome of food intake and nutritional status post discontinuation of a cow's-milk-free diet after a negative oral food challenge. METHODS: This was a prospective, uncontrolled study that evaluated food intake and nutritional status of a cohort of 80 infants and children under 5 years of age. Food intake and nutritional status were evaluated on the day of the oral food challenge test and after 30 days. Weight and height were measured on the day of the test and after 30 days. RESULTS: The mean age of the patients was 18.7 ± 12.4 months, and 58.7% were male. After discontinuation of the elimination diet, the children showed daily intake increases in (P < 0.001), protein (P < 0.001), carbohydrates (P = 0.042), calcium from foods (P < 0.001), calcium from foods and supplements (P < 0.001), phosphorus (P < 0.001), and vitamin D from foods (P = 0.006). The Z-scores (n = 76) on the day of the oral food challenge test and 30 days after restarting the consumption of cow's milk were as follows: weight-for-age (P < 0.001) and height-for-age (P < 0.001), respectively. CONCLUSION: Cow's milk protein in the diet was associated with increased intake of energy, proteins, carbohydrates, calcium, phosphorus, and vitamin D, in addition to an increase in the Z-scores for weight-for-age and height-for-age.

Feeding difficulties in children fed a cows' milk elimination diet.

A cross-sectional study compared feeding difficulties in children aged 2-5 years fed a cows' milk elimination diet due to food allergy with a control group on an unrestricted diet. All data were obtained online. Specific questionnaires evaluated three types of feeding difficulties: avoidant eating, picky eating and feeding problems. The median scores of feeding difficulties in the elimination diet (n 146) and control (n 109) groups were, respectively: picky eating (31 v. 27; P = 0·148), avoidant eating (3 v. 3; P = 0·508) and feeding problems (38 v. 34, P = 0·032). Picky eating was more frequent in the elimination diet (35·4 %) than in the controls (23·3 %; P = 0·042), but no difference was observed for avoidant eating (23·9 % v. 20·4 %, P = 0·508) and feeding problems (32·1 % v. 28·4 %, P = 0·541). Picky eating was associated with lower values of weight-for-age z-scores in both groups. Multivariate analyses identified associations of the three feeding difficulties with previous food refusal and/or inappetence in the elimination diet group. Current constipation and anticipatory gagging were associated with feeding difficulties in both groups. In conclusion, children on an elimination diet presented higher frequency of picky eating and higher scores of feeding problems. Picky eating was associated with lower values of weight-for-age z-scores. Food refusal and/or inappetence as clinical manifestations of food allergy were associated with feeding difficulties at the moment of the survey. Current constipation and anticipatory gagging were associated with picky eating, avoidant eating and feeding problems.

Attitudes and practice of caregivers for cow's milk allergy according to stages of behavior change / Atitudes e práticas de cuidadores sobre a alergia ao leite de vaca segundo os estágios de mudança do comportamento

ABSTRACT Objective: To verify the attitudes and practices of dietary management for cow's milk allergy by caregivers according to the stages of behavior change. Methods: Observational, cross-sectional study involving 30 caregivers of children with cow's milk allergy who were followed up in a specialized outpatient clinic, from July 2018 to May 2019. Data collection included a structured questionnaire about sociodemographic aspects, social classification and an adapted algorithm to classify the stages of behavior change based on a trans-theoretical model. Results: Most caregivers (26/30) were females aged 20 to 48 years and belonging to social classes C, D and E. Regarding the stages of behavior change for the dietary management of cow's milk allergy according to the model, 80% of the participants (24/30) were in the action stage, while 20% (6/30) were in the maintenance stage. Conclusions: The attitudes and practices of caregivers for the dietary management of cow's milk allergy are influenced by feelings and emotions that can interfere with communication and the understanding of dietary guidelines; however, these caregivers are in different stages of action and maintenance to change behavior that correspond to their attitudes and practices.

RESUMO Objetivo: Verificar as atitudes e práticas do manejo dietético da alergia ao leite de vaca por cuidadores segundo os estágios de mudança do comportamento. Métodos: Trata-se de estudo observacional e transversal que contou com 30 cuidadores de crianças com alergia ao leite de vaca, atendidas em ambulatório especializado, no período de julho de 2018 a maio de 2019. A coleta de dados contou com formulário estruturado que incluiu aspectos sociodemográficos, classificação social e algoritmo adaptado para classificar os estágios de mudança do comportamento de acordo com o modelo transteórico. Resultados: A maioria dos cuidadores (26/30) é do sexo feminino, com idade entre 20 e 48 anos e pertence às classes sociais C, D e E. Quanto aos estágios de mudança do comportamento em relação ao manejo dietético da alergia ao leite de vaca, segundo o modelo transteórico, é possível observar que 80% dos participantes (24/30) se encontram no estágio de ação, enquanto 20% (6/30) no estágio de manutenção. Conclusões: As atitudes e práticas de cuidadores de crianças sobre o manejo dietético na alergia ao leite de vaca são influenciadas por sentimentos e emoções que podem interferir na comunicação e no entendimento das orientações dietéticas. Esses cuidadores se encontram em estágios de ação e manutenção em relação à mudança de comportamento correspondentes às suas atitudes e práticas.

Children with brain tumors: a study of nutritional status on hospital admission / Crianças com tumores cerebrais: um estudo do estado nutricional na admissão hospitalar

Objective: to assess the nutritional status of children with brain tumors on hospital admission and to verify whether the nutritional status varies according to the type of tumor. Methods: anthropometric data of 30 children between 2 and 10 years old, of both sexes, with brain tumors and admitted to a hospital in the city of São Paulo, Brazil, were evaluated. Secondary data collection allowed to assess and classify the Z-scores of the body mass index, percentage of adequacy of the triceptal skinfold and the arm muscle circumference, carried out between the years 2004 and 2011. Results: the frequencies of brain tumors were: 33.3% astrocytic, 40% embryonal, 10% of the seal region and 16.6% ependimals. The median age and body mass index Z scores were 5.5 years (4.0 and 7.0) and 0.66 SD (- 1.41 and 0.87), respectively. The median percentage of adequacy of arm muscle circumference was 98% (88.9 and 103.2) and the triceptal skinfold was 83.2% (57.0 and 106.6). As for nutritional status, 21 (70%) of the children were eutrophic; 7 (23.3%) overweight and 2 (6.7%) with malnutrition/wasting showing no significant difference between groups of brain tumors (p = 0.721). The percentages of adequacy of the triceptal skinfold and of the arm muscle circumference also showed no significant difference between the different types of brain tumors (p = 0.865 and p = 0.860, respectively). Conclusion: at the time of hospital admission, the children were in good nutritional status, regardless of the type of brain tumor. (AU)

Objetivo: avaliar o estado nutricional de crianças com tumores cerebrais na admissão hospitalar e verificar se o estado nutricional varia de acordo com o tipo de tumor. Métodos: avaliou-se os dados antropométricos de 30 crianças entre 2 e 10 anos, de ambos os sexos, com tumores cerebrais e admitidas em um hospital na cidade de São Paulo, Brasil. A coleta secundária de dados permitiu avaliar e classificar os escores Z do índice de massa corporal, percentual de adequação da dobra cutânea triceptal e da circunferência muscular do braço, realizados entre os anos de 2004 e 2011. Resultados: as frequências dos tumores cerebrais foram: 33,3% astrocíticos, 40% embrionários, 10% da região selar e 16,6% ependimais. As medianas de idade e dos escores Z do índice de massa corporal foram, respectivamente, 5,5 anos (4,0 e 7,0) e 0,66 DP (- 1,41 e 0,87). A mediana do percentual de adequação da circunferência muscular do braço foi de 98% (88,9 e 103,2) e da dobra cutânea triceptal foi 83,2% (57,0 e 106,6). Quanto ao estado nutricional, 21 (70%) das crianças apresentaramse eutróficas; 7 (23,3%) com excesso de peso e 2 (6,7%) com desnutrição/magreza, não mostrando diferença significante entre os grupos de tumores cerebrais (p=0,721). Os percentuais de adequação da dobra cutânea triceptal e da circunferência muscular do braço também não mostraram diferença significante entre os diferentes tipos de tumores cerebrais (p=0,865 e p=0,860, respectivamente). Conclusão: no momento da admissão hospitalar as crianças se encontravam em bom estado nutricional, independentemente do tipo de tumor cerebral. (AU)

Functional abdominal pain: an integrative review study from a biopsychosocial view / Dor abdominal funcional: um estudo de revisão integrativa do ponto de vista biopsicossocial

ABSTRACT BACKGROUND AND OBJECTIVES: Abdominal pain is one of the most frequent complaints in Pediatric Gastroenterology and may be considered an intricate symptom difficult of immediate differential diagnosis. To perform an integrative review of functional abdominal pain in children. CONTENTS: It included original and empirical national and international articles, between 2006 and 2016, from the Virtual Health Library, Virtual Health Library - Psychology Brazil (BVS-Psi Brazil) and Pubmed databases, in children aged 6 to 10 years old. The descriptors were: functional abdominal pain, children, gastroenterology. The thematic content was analyzed in the categories: etiology, prevalence, diagnosis process, treatment and intervention strategies and evaluation of coping strategies. Thirty-three articles on functional abdominal pain were found. Factors associated with somatization, anxiety, depression and children's bowel habits were highlighted and should be carefully evaluated by health professionals. Parents may negatively influence the treatment when they adopt encouraging, monitoring, and hypervigilance attitudes. CONCLUSION: Behavioral, dietary and pharmacological approaches are widely recommended in the treatment of functional abdominal pain. Regarding the emotional behavior, the psychological approach seems to promote good therapeutic results.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor abdominal é uma das queixas mais frequentes em Gastroenterologia Pediátrica, podendo ser considerada um sintoma intrincado com dificuldade do diagnóstico diferencial imediato. Realizar revisão integrativa sobre dor abdominal funcional em crianças. CONTEÚDO: Incluiu artigos originais e empíricos nacionais e internacionais, entre 2006 e 2016, nas bases de dados Biblioteca Virtual de Saúde, Biblioteca Virtual em Saúde - Psicologia Brasil (BVS-Psi Brasil) e Pubmed, em crianças entre 6 e 10 anos. Os descritores foram: dor abdominal funcional, criança, gastroenterologia. A temática foi analisada nas categorias: etiologia, prevalência, processo de diagnóstico, estratégias de tratamento e avaliação das estratégias de enfrentamento. Foram encontrados 33 artigos sobre dor abdominal funcional. Destacou-se fatores associados à somatização, ansiedade, depressão e hábitos evacuatórios das crianças, que devem ser cuidadosamente avaliados pelos profissionais de saúde. Os pais podem influenciar negativamente o tratamento quando adotam atitudes de encorajamento, monitoramento e hipervigilância. CONCLUSÃO: Abordagens terapêuticas do tipo comportamental, dietética e farmacológica, são amplamente recomendadas no tratamento da dor abdominal funcional. Na vigência de comemorativos do comportamento emocional, a abordagem psicológica parece promover bons resultados terapêuticos.

Knowledge and practice of pediatricians and nutritionists regarding treatment of cow's milk protein allergy in infants / Conhecimento e prática de pediatras e nutricionistas sobre o tratamento da alergia às proteínas do leite de vaca em lactentes

ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow's milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow's milk protein allergy, including goat's milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow's milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow's milk protein allergy.

RESUMO Objetivo Este estudo avaliou o conhecimento e práticas de pediatras e nutricionistas sobre alergia às proteínas do leite de vaca em lactentes, com ênfase em questões relacionadas à dieta de exclusão e ao estado nutricional. Métodos Estudo transversal, descritivo, realizado com uma amostra de conveniência de 204 pediatras e 202 nutricionistas, convidados aleatoriamente em eventos científicos na cidade de São Paulo, de novembro de 2014 a março de 2016. Resultados Entre 1,5% e 21,0% dos entrevistados indicaram produtos inadequados para o tratamento da alergia às proteínas do leite de vaca, incluindo leite de cabra, bebidas ou sucos à base de extrato de soja, fórmula de leite sem lactose e fórmula parcialmente hidrolisada. A recomendação diária de cálcio para crianças entre zero e 36 meses de idade foi corretamente indicada por 27,0% de pediatras e 46,0% de nutricionistas (p=0,001). Além disso, 96,1% dos pediatras e 82,7% dos nutricionistas (p<0,001) forneceram orientação sobre os rótulos dos produtos industrializados. Conclusão Pediatras e nutricionistas apresentam lacunas no conhecimento sobre o tratamento da alergia às proteínas do leite de vaca em lactentes. Estratégias educacionais que aumentam o conhecimento dos profissionais são importantes para o gerenciamento da alergia às proteínas do leite de vaca.

Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen / Má absorção intestinal de frutose associa-se com maior fermentação de lactulose na luz intestinal

Abstract Objective: To study fructose malabsorption in children and adolescents with abdominal pain associated with functional gastrointestinal disorders. As an additional objective, the association between intestinal fructose malabsorption and food intake, including the estimated fructose consumption, weight, height, and lactulose fermentability were also studied. Methods: The study included 31 patients with abdominal pain (11 with functional dyspepsia, 10 with irritable bowel syndrome, and 10 with functional abdominal pain). The hydrogen breath test was used to investigate fructose malabsorption and lactulose fermentation in the intestinal lumen. Food consumption was assessed by food registry. Weight and height were measured. Results: Fructose malabsorption was characterized in 21 (67.7%) patients (nine with irritable bowel syndrome, seven with functional abdominal pain, and five with functional dyspepsia). Intolerance after fructose administration was observed in six (28.6%) of the 21 patients with fructose malabsorption. Fructose malabsorption was associated with higher (p < 0.05) hydrogen production after lactulose ingestion, higher (p < 0.05) energy and carbohydrate consumption, and higher (p < 0.05) body mass index z-score value for age. Median estimates of daily fructose intake by patients with and without fructose malabsorption were, respectively, 16.1 and 10.5 g/day (p = 0.087). Conclusion: Fructose malabsorption is associated with increased lactulose fermentability in the intestinal lumen. Body mass index was higher in patients with fructose malabsorption.

Resumo Objetivo: Pesquisar a má absorção de frutose em crianças e adolescentes com dor abdominal associada com distúrbios funcionais gastrintestinais. Como objetivo adicional, estudou-se a relação entre a má absorção intestinal de frutose e a ingestão alimentar, inclusive a estimativa de consumo de frutose, o peso e a estatura dos pacientes e a capacidade de fermentação de lactulose. Métodos: Foram incluídos 31 pacientes com dor abdominal (11 com dispepsia funcional, 10 com síndrome do intestino irritável e 10 com dor abdominal funcional). O teste de hidrogênio no ar expirado foi usado para pesquisar a má absorção de frutose e a fermentação de lactulose na luz intestinal. O consumo alimentar foi avaliado por registro alimentar. Foram mensurados também o peso e a estatura dos pacientes. Resultados: Má absorção de frutose foi caracterizada em 21 (67,7%) pacientes (nove com síndrome do intestino irritável, sete com dor abdominal funcional e cinco com dispepsia funcional). Intolerância após administração de frutose foi observada em seis (28,6%) dos 21 pacientes com má absorção de frutose. Má absorção de frutose associou-se com maior produção de hidrogênio após ingestão de lactulose (p < 0,05), maior consumo de energia e carboidratos (p < 0,05) e maior valor de escore z de IMC para a idade (p < 0,05). As medianas da estimativa de ingestão diária de frutose pelos pacientes com e sem má absorção de frutose foram, respectivamente, 16,1 e 10,5 g/dia (p = 0,087). Conclusão: Má absorção de frutose associa-se com maior capacidade de fermentação de lactulose na luz intestinal. O índice de massa corporal foi maior nos pacientes com má absorção de frutose.

Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen.

OBJECTIVE: To study fructose malabsorption in children and adolescents with abdominal pain associated with functional gastrointestinal disorders. As an additional objective, the association between intestinal fructose malabsorption and food intake, including the estimated fructose consumption, weight, height, and lactulose fermentability were also studied. METHODS: The study included 31 patients with abdominal pain (11 with functional dyspepsia, 10 with irritable bowel syndrome, and 10 with functional abdominal pain). The hydrogen breath test was used to investigate fructose malabsorption and lactulose fermentation in the intestinal lumen. Food consumption was assessed by food registry. Weight and height were measured. RESULTS: Fructose malabsorption was characterized in 21 (67.7%) patients (nine with irritable bowel syndrome, seven with functional abdominal pain, and five with functional dyspepsia). Intolerance after fructose administration was observed in six (28.6%) of the 21 patients with fructose malabsorption. Fructose malabsorption was associated with higher (p<0.05) hydrogen production after lactulose ingestion, higher (p<0.05) energy and carbohydrate consumption, and higher (p<0.05) body mass index z-score value for age. Median estimates of daily fructose intake by patients with and without fructose malabsorption were, respectively, 16.1 and 10.5g/day (p=0.087). CONCLUSION: Fructose malabsorption is associated with increased lactulose fermentability in the intestinal lumen. Body mass index was higher in patients with fructose malabsorption.

Intestinal absorption of iron and calcium from soy and cow's milk-based infant formulas in weanling rats pups / Absorção intestinal de ferro e cálcio de fórmulas infantis à base de leite de vaca e de soja em filhotes de ratos recém-desmamados

ABSTRACT Objective: This study aimed to compare the intestinal absorption of iron and calcium between soy-based and cow's milk-based infant formulas in weanling rats. Methods: Twenty male Wistar rats, twenty-one days old on the first day of weaning, were used in this experiment, divided in two Groups, one Group was fed soy protein-based infant formula the other, cow's milk protein-based infant formula. During the study period (ten consecutive days) the animals received food and water ad libitum. Hematocrit and hemoglobin were evaluated on the first, fifth, and tenth days by the Wintrobe and cyanomethemoglobin methods. Feces and urine were collected, beginning on the fifth day, for three consecutive days. On the tenth day, hepatic iron content was also analyzed. Hepatic iron as well as fecal and urinary iron and calcium analyses were performed using an atomic absorption spectrophotometer. At thirty-one days of age, the animals were anesthetized with ketamine and xylazine and sacrificed by exsanguination via the vena cava. Results: The final concentration of hemoglobin in the group soy-based infant formula and milk-based infant formula were: 10.3±1.3g/dL and 10.9±1.0g/dL (p=0.310). The apparent absorption of iron and calcium, in that order, were: 73.4±10.2% and 70.2±9.5%; 97.2±0.7% and 97.6±1.0% (p=0.501; p=0.290). The apparent calcium retention was: 88.4% ±2.2 and 88.6±2.6% (p=0.848). Hepatic iron content was: 522.0±121.1mg/g and 527.8±80.5mg/g (p=0.907) . Conclusion: Intestinal iron and calcium absorption from soy-based infant formula is similar to that from milk-based infant formula in weanling rats.

RESUMO Objetivo: Este estudo objetivou comparar a absorção intestinal de ferro e cálcio entre fórmulas infantis à base de leite de vaca e de soja em ratos recém-desmamados. Métodos: Vinte ratos machos Wistar, com 21 dias de vida e no primeiro dia do desmame foram utilizados neste experimento, divididos em dois grupos: um alimentado com fórmula infantil à base de proteína de soja e o outro com fórmula infantil à base de proteína do leite de vaca. Durante o período de estudo (10 dias consecutivos), os ratos receberam dieta e água ad libitum. Hematócrito e hemoglobina foram mensurados no primeiro, quinto e décimo dia pelo método de Wintrobe e da cianometaemoglobina. As fezes e a urina foram recolhidas a partir do quinto dia durante durante três dias consecutivos. No décimo dia, o conteúdo de ferro hepático também foi analisado. O conteúdo de ferro hepático e a análise de ferro e cálcio nas fezes e na urina foram realizados utilizando espectrofotômetro de absorção atômica. Aos 31 dias de vida, os animais foram anestesiados com ketamina e xilasina e sacrificados por exsanguinação da veia vaca. Resultados: A concentração final de hemoglobina no grupo fórmula infantil à base de soja e fórmula infantil à base de leite de vaca foram 10,3±1,3g/dL e 10,9± 1,0g/dL (p=0,310), respectivamente. A absorção aparente de ferro e cálcio foi de: 73,4±10,2% e 70,2±9,5%, para o primeiro grupo; e 97,2±0,7% e 97,6±1,0%, para o segundo (p=0,501; p=0,290). A retenção aparente de cálcio foi: 88,4±2,2% e 88,6±2,6% (p=0,848). O teor de ferro hepático foi: 522,0±121,1µg/g e 527,8±80,5µg/g (p=0,907), respectivamente. Conclusão: A absorção intestinal de ferro e cálcio da fórmula infantil à base de soja é similar à da fórmula infantil à base de leite em ratos recém-desmamados.

Water Load Test in Childhood Functional Abdominal Pain: No Relation to Food Intake and Nutritional Status.

This cross-sectional study evaluates the relations between the water load test in childhood functional gastrointestinal disorders with food intake and nutritional status. Patients with functional dyspepsia required a lower maximum water intake to produce fullness (n = 11, median = 380 mL) than patients with irritable bowel syndrome (n = 10, median = 695 mL) or functional abdominal pain (n = 10, median = 670 mL) (P < 0.05). Among patients who ingested ≤560 mL (n = 17) or >560 mL (n = 14) in the water load test, there was no relation between the maximum drinking capacity and food intake, body mass index, or height.

Effects of soy beverage and soy-based formula on growth, weight, and fecal moisture: experimental study in rats / Efeitos de bebida e de fórmula de soja no crescimento, peso e umidade fecal: estudo experimental em ratos

OBJECTIVE: To compare body growth, weight, and fecal moisture in recently weaned rats fed exclusively on infant soy formula and soy-based beverage. METHODS: Three similar groups were formed (n = 10/group) consisting of weanling Wistar rats, maintained in metabolic cages. One group was fed soy protein-based beverage, another with soy-based infant formula, and another with cow's milk infant formula (control group). Water and diet were offered ad libitum. Body weight and length were measured. Stool was collected for three consecutive days. RESULTS: Weight and length were lower (p = 0.001; p = 0.001) in the groups receiving soy protein-based beverage (73.16 ± 5.74 g; 23.94 ± 1.04 cm) and soy-based formula (71.11 ± 5.84 g; 24.74 ± 0.60 cm) in relation to the group receiving cow's milk formula (84.88 ± 9.75 g; 26.01 ± 0.91 cm). Fresh fecal weight was greater (p < 0.001) in the soy-based beverage (3.44 ± 0.48 g) than in the soy-based formula (0.79 ± 0.20 g) and cow's milk-based formula (0.42 ± 0.17 g). Fecal moisture was higher (p < 0.001) in the group receiving soy protein-based beverage (47.28 ± 9.02%) and soy-based formula (37.21 ± 13.20%) than in the group receiving cow's milk formula (22.71 ± 10.86%). CONCLUSION: The growth of rats fed soy protein-based beverage and soy-based formula was lower than those fed cow's milk-based formula. The soy protein-based beverage resulted in significant increase in fecal weight and moisture. .

OBJETIVO: Comparar o crescimento corporal, o peso e a umidade das fezes de ratos recém-desmamados alimentados exclusivamente com fórmula infantil de soja e com bebida de extrato de soja. MÉTODOS: Constituíram-se três grupos similares (n = 10/grupo) de ratos machos Wistar recém-desmamados, mantidos em gaiolas metabólicas. Um grupo foi alimentado com bebida de extrato de soja, outro com fórmula infantil de soja e o outro com fórmula infantil de leite de vaca (grupo controle). Água e dieta foram oferecidas ad libitum. Foram mensurados o peso e o comprimento corporal. Fezes foram coletadas durante três dias consecutivos. RESULTADOS: Peso e comprimento foram menores (p = 0,001; p = 0,001) nos grupos com bebida de extrato de soja (73,16 ± 5,74 g; 23,94 ± 1,04 cm) e fórmula infantil de soja (71,11 ± 5,84 g; 24,74 ± 0,60 cm) em relação ao grupo de fórmula infantil de leite de vaca (84,88 ± 9,75 g; 26,01 ± 0,91 cm). O peso fresco fecal foi maior (p < 0,001) na bebida de extrato de soja (3,44 ± 0,48 g) do que com as fórmulas infantis de soja (0,79 ± 0,20 g) e de leite de vaca (0,42 ± 0,17 g). A umidade fecal foi maior (p < 0,001) na bebida de extrato de soja (47,28 ± 9,02%) e fórmula infantil de soja (37,21 ± 13,20%) do que na fórmula infantil de leite de vaca (22,71 ± 10,86%). CONCLUSÃO: O crescimento de ratos alimentados com bebida de soja e fórmula infantil de soja foi menor do que os alimentados com fórmula com proteína do leite de vaca. A bebida à base de extrato de soja proporcionou aumento expressivo do peso e da umidade fecal. .

Effects of soy beverage and soy-based formula on growth, weight, and fecal moisture: experimental study in rats.

OBJECTIVE: To compare body growth, weight, and fecal moisture in recently weaned rats fed exclusively on infant soy formula and soy-based beverage. METHODS: Three similar groups were formed (n=10/group) consisting of weanling Wistar rats, maintained in metabolic cages. One group was fed soy protein-based beverage, another with soy-based infant formula, and another with cow's milk infant formula (control group). Water and diet were offered ad libitum. Body weight and length were measured. Stool was collected for three consecutive days. RESULTS: Weight and length were lower (p = 0.001; p = 0.001) in the groups receiving soy protein-based beverage (73.16 ± 5.74 g; 23.94 ± 1.04 cm) and soy-based formula (71.11 ± 5.84 g; 24.74 ± 0.60 cm) in relation to the group receiving cow's milk formula (84.88 ± 9.75 g; 26.01 ± 0.91 cm). Fresh fecal weight was greater (p < 0.001) in the soy-based beverage (3.44 ± 0.48 g) than in the soy-based formula (0.79 ± 0.20 g) and cow's milk-based formula (0.42 ± 0.17 g). Fecal moisture was higher (p < 0.001) in the group receiving soy protein-based beverage (47.28 ± 9.02%) and soy-based formula (37.21 ± 13.20%) than in the group receiving cow's milk formula (22.71 ± 10.86%). CONCLUSION: The growth of rats fed soy protein-based beverage and soy-based formula was lower than those fed cow's milk-based formula. The soy protein-based beverage resulted in significant increase in fecal weight and moisture.

Alergia à Proteína do Leite de Vaca / Allergy to cow´s milk protein

Os autores abordam aspectos atuais da Alergia à Proteína do Leite de Vaca, destacando sua importância e frequência na clínica pediátrica. Procedem a uma revisão dos aspectos clínicos da patologia, em particular a cólica do lactente, refluxo gastroesofágico, proctocolite, constipação crônica, enteropatia e esofagite eosinofílica. Descrevem a rotina diagnóstica e apresentam paradigma para avaliação do paciente com alergia digestiva ao leite de vaca e frisam a importância de uma dieta de exclusão adequada para controle satisfatório do problema...

O leite e derivados na alimentação infantil / Milk and dairy products in infant feeding

Com a instalação da Revolução Industrial, na Inglaterra do século XVIII, o comportamento alimentar infantil sofreu mudanças importantes, à medida que as mulheres que viviam no campo e que amamentavam seus filhos se transferiam para as cidades. No final do século XIX, altas taxas de desnutrição e mortalidade infantil estavam associadas ao declínio do aleitamento materno e ao aumento da utilização de leite animal. Atualmente o leite de vaca é o alimento mais utilizado, universalmente, para substituir o leite materno e geralmente é encontrado nas formas fluida e pó. Entretanto, o leite de vaca integral, fluido ou em pó, não é recomendado para crianças menores de um ano, tendo em vista a evidência científica da inadequação nutricional de sua composição em relação às necessidades do crescimento e desenvolvimento do lactente...

Consumo alimentar de crianças e adolescentes com disfagia decorrente de estenose de esôfago: avaliação com base na pirâmide alimentar brasileira / Food consumption by children and adolescent with dysphagia due to esophageal stricture: assessment based on the Brazilian food guide pyramid

OBJETIVO: Avaliar o consumo alimentar de pacientes com disfagia decorrente de estenose de esôfago, comparando a dieta de consistência líquida com a dieta de consistência pastosa e sólida, com base na Pirâmide Alimentar Brasileira. MÉTODOS: Estudo de corte transversal, no qual foram incluídos consecutivamente 31 pacientes com estenose esofágica, sendo 18 (58,0 por cento) cáustica, 7 (22,6 por cento) pós-cirúrgica, 3 (9,7 por cento) péptica e 3 (9,7 por cento) sem causa definida. Empregou-se o recordatório de 24 horas; os alimentos foram transformados em porções em função dos oito grupos de alimentos, conforme recomendado por Philippi. Utilizou-se o teste Kruskal-Wallis e Exato de Fisher, fixando em 5 por cento o nível de rejeição da hipótese de nulidade. RESULTADOS: A idade variou entre 15 e 176 meses (mediana, 56 meses), sendo 28 crianças e três adolescentes, e 18 do sexo masculino. Vinte e nove pacientes (93,5 por cento) apresentavam disfagia, sendo grave em 34,4 por cento (10/29), moderada em 41,3 por cento (12/29), e leve em 24,1 por cento (7/29). O consumo mediano de porções de cereais, leguminosas, e óleos e gorduras foi menor no grupo com dieta líquida (p<0,005), o qual também apresentou maior proporção de pacientes cujo consumo foi abaixo do proposto pela pirâmide alimentar quando comparado ao grupo com dieta pastosa e sólida, com diferença estatisticamente significante (p<0,05). CONCLUSÃO: O suporte nutricional é de extrema importância no tratamento de pacientes com estenose esofágica, principalmente na disfagia grave, cuja dieta deve ser adaptada à consistência líquida, devido ao risco nutricional que se atribui à limitada ingestão alimentar, e para que o tratamento dietético seja precocemente instituído.

OBJECTIVE: This study assessed food intake by patients with dysphagia due to esophageal stricture and compared liquid, soft and solid diets based on the Brazilian Food guide pyramid. METHODS: This cross-sectional study consecutively included 31 patients with esophageal stricture, of which 18 (58.0 percent) were caustic, 7 (22.6 percent) were postoperative, 3 (9.7 percent) were peptic and 3 (9.7 percent) were of unknown etiology. The 24-hour dietary recall was used and the foods were converted into servings according to the eight food groups, as recommended by Philippi. The Kruskal-Wallis and Fisher's Exact Test were used and the significance level was set at 5 percent. RESULTS: The ages of the patients varied from 15 to 176 months (median: 56 months). There were 28 children and 3 adolescents, of which 28 were males. Twenty-nine patients (93.5 percent) presented dysphagia, of which 34.4 percent (10/29) were severe, 41.3 percent (12/29) were moderate and 24.1 percent (7/29) were mild. The median intake of grain, legume and fat servings was smaller in the liquid diet group (p<0.005). This group also had a significantly greater proportion of patients whose intakes were below those recommended by the food pyramid (p<0.05). CONCLUSION: Nutritional support is extremely important in the treatment of patients with esophageal stricture, especially those with severe dysphagia. These patients need a liquid diet because of the nutritional risk associated with inadequate food intake, which also allows early introduction of the dietary treatment.