Ingestas de energía y nutrientes recomendadas en la Unión Europea: 2008-2016 / Recommended energy and nutrients intakes in the European Union: 2008-2016

Esta revisión tiene por objeto refl ejar los cambios producidos en la legislación de la Unión Europea y los dictámenes de la Autoridad Europea de Seguridad Alimentaria en relación al etiquetado nutricional de los alimentos, a los valores de referencia de energía, macronutrientes y micronutrientes, y a los niveles máximos de ingesta tolerable. La vigente legislación europea utiliza los valores de referencia para el etiquetado establecidos por el Comité Científico de la Alimentación Humana en 2003. Sería aconsejable una actualización de los mismos a partir de los valores de referencia establecidos por dicha autoridad europea para vitaminas y minerales. Igualmente sería positiva la inclusión de valores de referencia para el etiquetado de ácidos grasos poliinsaturados, fibra alimentaria y colina, y para el etiquetado específicamente referido a niños de 6 a 36 meses. Para vitaminas y minerales sería deseable una revisión de los niveles máximos de ingesta tolerable y el establecimiento de cantidades máximas permitidas en los alimentos enriquecidos y en los complementos alimenticios en la Unión Europea; su ausencia puede representar un peligro de ingesta excesiva e insegura de determinados minerales y vitaminas en algunos grupos de población (AU)

The aim of this document is to reflect the changes happened in the European Union legislation and the opinions of the European Food Safety Authority in relation to the nutritional labeling on food, the reference values for energy, macronutrients and micronutrients, and the tolerable upper safe levels. The European legislation in force uses the labeling reference values established by the Scientific Committee on Food in 2003. There would be advisable an update of them from the reference values for vitamins and minerals established by the European Food Safety Authority. Equally, there would be good to include reference labeling values for polyunsaturated fatty acids, dietary fiber and choline, and specific reference labeling values for children from 6 to 36 months. For vitamins and minerals there would be desirable the revision of tolerable upper safe levels and the establishment of maximum amounts allowed in fortified food and food supplements in the European Union; its absence might represent a risk in some population groups for an excessive and unsafe intake of certain minerals and vitamins (AU)

Aplicação da lipoenxertia nas deformidades craniofaciais: experiência do INTO-RJ / Application of fat grafting in craniofacial deformities: an INTO-RJ experience

INTRODUÇÃO: O enxerto de gordura, atualmente, é usado amplamente na cirurgia plástica estética e reparadora como um preenchimento natural. Na cirurgia crânio-maxilofacial há uma diversidade de pacientes com deformidades congênitas e adquiridas que podem ser muito beneficiados com a lipoenxertia. MÉTODOS: Os pacientes foram submetidos à lipoenxertia para reconstrução e correção de defeitos da face no INTO em 2012 e 2013 utilizando uma técnica padronizada. Nossa avaliação foi clínica e subjetiva, levando em conta a opinião do paciente. Especificamente nos pacientes com enoftalmo tardio secundário à sequela de trauma, realizamos exoftalmometria com o exoftalmômetro de Hertel e tomografia no pré e no pós-operatório para avaliar objetivamente nossos resultados. RESULTADOS: Vinte e dois pacientes receberam tratamento. A maioria foi do gênero feminino (77%). O volume do gordura aplicado variou de 1 ml até 37 ml, com média de 15 ml por sessão. A quantidade de sessões variou de 1 a 4. A lipoenxertia foi usada como tratamento único em apenas 30% dos casos. Fizemos lipoenxertia retrobulbar variando de 6 a 10 ml o volume enxertado, sendo que em um paciente realizamos duas sessões. Houve um ganho de 3 a 7 mm de projeção do globo ocular. Na avaliação tomográfica constatamos também aumento da projeção ocular de 4 mm e 2,2 mm. O resultado clínico foi pobre. CONCLUSÃO: A lipoenxertia é um procedimento simples, barato e reprodutível que deve fazer parte do armamentário do cirurgião plástico e do cirurgião craniofacial. Pode ser uma alternativa nos difíceis casos de enoftalmo tardio.

INTRODUCTION: The fat graft is currently widely used in aesthetic plastic and reconstructive surgery as a natural filler. In cranio-maxillofacial surgery, fat grafting can be very beneficial for patients with various congenital and acquired deformities. METHODS: We included patients who had undergone fat grafting for reconstruction and correction of defects in the face during 2012 and 2013 by using a standard technique. Our assessment was both clinical and subjective, taking into account the patient's opinion. In patients with late enophthalmos secondary to trauma sequelae, we conducted exophthalmometry with an exophthalmometer (Hertel) and preoperative and postoperative CT to objectively evaluate our results. RESULTS: Twenty-two patients were treated. Most were female (77%). The volume of fat grafted varied from 1 ml to 37 ml, with a mean of 15 ml per session. The number of sessions ranged from 1 to 4. Fat grafting was used as a single treatment in only 30% of cases. We performed retrobulbar fat grafting ranging from 6 to 10 ml in volume; in one patient, the grafting was carried out over two sessions. There was a gain of 3 to 7 mm in projection of the eyeball. In tomographic evaluation, an increased eye projection of between 2.2 mm and 4 mm was found. However, the clinical outcome was poor. CONCLUSION: Fat grafting is a simple, inexpensive and reproducible procedure that should be part of the plastic and craniofacial surgeons' inventory. It may be an alternative in difficult cases of late enophthalmos.

Utilização do retalho miocutâneo de grande dorsal, com extensão adiposa, nas reconstruções mamárias: uma opção para preenchimento do polo superior / Use of the myocutaneous latissimus dorsi flap with fat extension in breast reconstruction: an option for filling the upper pole

INTRODUÇÃO: As sequelas de mastectomia se apresentam de formas variadas exigindo, do cirurgião, experiência e criatividade para obter o melhor resultado na reconstrução de uma nova mama. Dentre as dificuldades para que este objetivo seja alcançado, está o desafio de um melhor preenchimento do polo superior da mama. O objetivo deste trabalho é apresentar uma opção terapêutica alternativa para correção do polo superior dentre as técnicas já existentes com este propósito. MÉTODO: A técnica cirúrgica utilizou o retalho de músculo grande dorsal com extensão gordurosa para preenchimento do polo superior da neomama durante sua reconstrução. A técnica descrita foi utilizada em 8 pacientes durante a reconstrução mamária tardia, com idades variando entre 39 e 70 anos. O tamanho desta extensão gordurosa variou entre 4,0 × 10,0 e 7,0 × 13,0 cm. O componente gorduroso do retalho foi avaliado após 3 meses através de ressonância magnética. RESULTADOS: Foram usados implantes mamários que variavam entre 270 e 435 ml. O acompanhamento pós operatório variou entre 3 meses a 1 ano. Ocorreram 2 casos de epidermólise (28%) na junção do retalho cutâneo com a área receptora. Não houve perda ou sofrimento do retalho. Os resultados demonstram clinicamente ou visualmente que a correção da depressão do polo superior da neomama foi alcançada adequadamente, bem como a viabilidade do retalho gorduroso, observada nos exames de imagem (ressonância magnética). CONCLUSÃO: A técnica proposta é uma alternativa adequada para o tratamento da maioria dos casos de reconstrução mamária em que se busca o preenchimento da depressão existente no polo superior da mama.

INTRODUCTION: The sequelae of mastectomy presents in numerous ways, requiring the experience and creativity of the surgeon to achieve the best result in the reconstruction of a new breast. One of the difficulties in achieving this objective is the challenge of adequately filling the upper pole of the breast. The objective of this work was to present an alternative therapeutic option for correction of the upper pole of the neobreast. METHODS: In our surgical technique, a latissimus dorsi muscle flap with fat extension is used for filling the upper pole of the neobreast during its reconstruction. The described technique was used in 8 patients during late breast reconstruction. The patients' ages ranged from 39 and 70 years. The size of the fat extension ranged from 4.0 × 10.0 cm to 7.0 × 13.0 cm. The fat component of the flap was evaluated after 3 months by using magnetic resonance imaging (MRI). RESULTS: Breast implants that varied in volume between 270 and 435 mL were used. The follow-up period after surgery ranged from 3 months to 1 year. Two patients had epidermolysis (28%) at the junction of the cutaneous flap and the receiver area. No graft loss or other complications occurred. Our results demonstrate clinically or visually that correction of the depression in the upper pole of the neobreast was satisfactorily achieved. The viability of the fat flap, as observed on MRI, was adequate. CONCLUSION: The proposed technique is a suitable alternative method for filling the depression in the upper pole of the neobreast in most cases of breast reconstruction.

El ejercicio aeróbico moderado evita la disfunción endotelial y neuronal producida por una dieta rica en grasas en arteria mesentérica de rata / Aerobic exercise training avoids endothelial and neuronal dysfunction produced by a high fat diet in rat mesenteric artery

Objetivo: Determinar si la obesidad inducida por una dieta rica en grasa (HFD) está asociada con modificaciones en las funciones endotelial o neuronal, y los efectos del entrenamiento aeróbico moderado en estos cambios. Materiales y métodos: : Se utilizaron: (i) ratas control (dieta estándar); (ii) ratas alimentadas con una dieta HFD durante ocho semanas, y (iii) ratas HFD sometidas a un entrenamiento aeróbico moderado. Se analizaron las respuestas vasomotoras a acetilcolina (ACh) y estimulación eléctrica (EE), el efecto de L-NAME sobre dichas respuestas, la respuesta vasodilatadora al donante de óxido nítrico (NO) DEA-NO, las liberaciones de NO y de O2.- y la expresión de nNOS y eNOS. Resultados: La ingesta de la dieta HFD disminuyó la respuesta vasodilatadora a ACh e incrementó la respuesta vasoconstrictora a EE. El efecto del L-NAME fue menor en ambos casos en ratas HFD. Las liberaciones de NO endotelial y neuronal fueron disminuidas en ratas HFD. La liberación de O2.- solo aumentó en arterias de ratas HFD con endotelio. La vasodilatación a DEA-NO disminuyó sólo en arterias HFD con endotelio. HFD no modificó la expresión de eNOS, pero disminuyó la expresión de nNOS. Todos estos cambios fueron evitados por el entrenamiento aeróbico moderado. Conclusión: La práctica de ejercicio aeróbico moderado evitó la disfunción de la inervación nitrérgica perivascular y endotelial inducidas por una dieta HFD, evitando el desarrollo de mecanismos que favorecen la hipertensión (AU)

Objective: We investigated whether high-fat diet (HFD)-induced obesity was associated with modifications on endothelial or innervation functions, and the possible effects of aerobic exercise training on these changes. Methods: (i) Control rats (standard diet); (ii) rats fed a HFD for 8 weeks; and (iii) HFD rats submitted to an aerobic exercise training were used. Vasomotor responses to acetylcholine (ACh) and electric field stimulation (EFS), the effect of L-NAME in these responses, vasomotor responses to nitric oxide (NO) donor DEA-NO, NO and O2.- releases, and nNOS and eNOS expression were analysed. Results: : HFD decreased ACh vasodilatation and increased EFS-induced contraction. The effect of L-NAME was lower in both cases in HFD segments. Both endothelial and neuronal NO releases were decreased in HFD. O2.- release was augmented only in endothelium-intact HFD arteries. DEA-NO was decreased only in endothelium- intact segments from HFD. HFD decreased nNOS and did not modify eNOS expressions. All the modifications described were avoided after training. Conclusion: Aerobic exercise training avoided endothelial and nitrergic innervation dysfunction induced by a HFD, thus avoiding the development of mechanisms which lead to hypertension (AU)

Retalho autólogo de grande omento como estrutura cirúrgica de reparo extraperitoneal. Estudo experimental comparativo, pareado e controlado de suas propriedades adaptativas / The autologous greater omental flap as a structure for extraperitoneal surgical repair: a comparative, paired, and controlled experimental study of its adaptive properties

Introdução: O grande omento vem sendo utilizado como estrutura de reparo desde o século XIX e a partir do século XX tem sido descrito, em meio extraperitoneal, para o tratamento de diversas afecções em várias especialidades cirúrgicas. Apesar de amplamente estudado a partir da década de 1960, não há descrição de estudos comparativos sobre o seu retalho em meio extra peritoneal. O objetivo do presente estudo foi analisar as características adaptativas do grande omento em meio extra peritoneal para identificar a real aplicabilidade cirúrgica desta estrutura. Métodos: Estudo experimental comparativo, pareado e controlado de 20 amostras teciduais de ratos (Rattus norvegicus) fêmeas obesas, irmãs da linhagem Sprague- Dawley. De cada animal foram analisados e comparados, macroscopicamente e microscopicamente, através das técnicas de Hematoxilina-eosina (HE) amostras de: (1) omento sem manipulação, (2) omento manipulado intraperitoneal, (3) omento manipulado extraperitoneal e (4) tecido adiposo subcutâneo. Resultados: omento extraperitoneal, macroscopicamente, apresentou uma coloração amarelado mais intenso, semelhante à gordura subcutânea adjacente, com alto grau de contração se comparado ao omento intraperitoneal de controle. Pela técnica de HE, foi identificado alto grau de fibrose e tamanho médio dos adipócitos semelhante ao omento de controle e inferior ao do subcutâneo (p<0,001). Conclusão: O omento extraperitoneal não se mostra capaz de promover regeneração tecidual, uma vez que não foi observado metaplasia à histologia do retalho translocado. Entretanto, pode servir para a correção de pequenas deformidades, para o tratamento de áreas isquêmicas, como estrutura carreadora para a reconstrução cirúrgica e como plataforma germinadora para o desenvolvimento de novos órgãos.

Introduction: The greater omentum was initially used in the repair of gastrointestinal defects in the 19th century; during the 20th century, it has been used extraperitoneally in the treatment of various disorders, in several surgical specialties. Despite the fact that the greater omentum was studies in detail in the 1960s, there are no reported comparative studies concerning the use of omental flaps extraperitoneally. The present study analyzed the adaptive features of the greater omentum in the extraperitoneal space, with the aim of identifying its surgical applicability. Methods: A paired, controlled comparative study was conducted using 20 tissue samples from 5 obese female Sprague-Dawley rats (Rattus norvegicus). The following specimens from each animal were analyzed and compared, macroscopically and microscopically, using the hematoxylin-eosin (HE) technique: (1) omentum without manipulation; (2) intraperitoneally manipulated omentum; (3) extraperitoneally manipulated omentum; and (4) subcutaneous adipose tissue. Results: Macroscopically, the extraperitoneal omentum exhibited a more intense yellowish color and a higher degree of contraction than the control (intraperitoneal) omentum. The extraperitoneal omentum was similar in color to the adjacent subcutaneous adipose tissue. HE staining revealed a high degree of fibrosis and an average adipocyte size, similar to that in the control omentum, but lower than that in subcutaneous adipose tissue (p< 0.001). Conclusion: The results of this study indicate that the extraperitoneal omentum was not able to promote tissue regeneration, as metaplasia of the translocated flap was not observed in the histological analysis. However, this structure may be used to correct small deformities, in the treatment of ischemic areas, as a carrier structure for surgical reconstruction and as a germination platform for the development of new organs.

Análise da lipoenxertia estruturada na redefinição do contorno facial / Analysis of structured fat grafting for redefining facial contours

INTRODUÇÃO: A enxertia de gordura como preenchimento no rejuvenescimento e melhoria do contorno facial vem sendo usada por alguns autores e demonstra um potencial excelente como método de escolha para essa finalidade, uma vez que tem como premissa o princípio básico de corrigir as deformidades com o tecido mais semelhante possível. O objetivo deste trabalho foi avaliar clinicamente a eficiência da enxertia de gordura estruturada na redefinição do contorno facial. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes submetidos a lipoenxertia estruturada para a redefinição do contorno facial, entre 2002 e 2012. A seleção de pacientes incluiu correção de deformidades, assimetrias, harmonização do contorno e aumento da projeção óssea, mas excluiu o rejuvenescimento per se. A avaliação do resultado clínico foi realizada pelo paciente e pelo cirurgião, com auxílio de documentação fotográfica pré e pós-operatória. O resultado clínico foi classificado pelo paciente e cirurgião, empregando escala que variava de 1 a 3: (1) o objetivo não foi alcançado de forma alguma; (2) o objetivo foi alcançado parcialmente; ou (3) o objetivo foi alcançado totalmente. Foi realizado, também, levantamento de prontuários para obtenção dos seguintes dados: idade, alteração ponderal, volume enxertado por área, número de sessões de enxertia realizadas, história de tabagismo e complicações. RESULTADOS: As médias das avaliações do cirurgião e paciente foram, respectivamente, 2,6 ± 0,6 e 2,7 ± 0,5, havendo correlação estatisticamente significante (P < 0,0001). Não foi encontrada relação significativa entre as avaliações e idade, alteração ponderal, volume de enxertia ou tabagismo, com uma única exceção. CONCLUSÕES: A lipoenxertia estruturada demonstrou ser eficiente adjuvante na redefinição do contorno facial e sua eficiência não foi prejudicada por idade, alteração ponderal ou tabagismo. O volume a ser enxertado deve ser adequado às necessidades específicas de cada área.

INTRODUCTION: Fat grafting as a filling method for the rejuvenation and enhancement of facial contours was demonstrated by some authors to be an excellent alternative method for redefining facial contours, based on the premise that the donor tissue used in the correction of the deformities has similar characteristics as the recipient tissue. The objective of the present study was to clinically evaluate the efficiency of structured fat grafting when redefining facial contours. METHODS: A retrospective evaluation was performed in 39 patients who underwent structured fat grafting to redefine their facial contours between 2002 and 2012. The patients selected included those who underwent corrections of deformities, asymmetrical features, contour smoothing, and increased bone projection. Patients who underwent facial contour rejuvenation were excluded. The clinical outcome assessment was performed by the patient and surgeon, with the aid of preoperative and postoperative photographic documentation. The clinical outcome was rated by the patient and surgeon, using a scale ranging from 1 to 3, defined as follows: 1, the objective has not been achieved in any way; 2, the objective was partially achieved; or 3, the objective was fully achieved. In addition, a survey was conducted using the patients' medical charts to obtain the following data: age, weight change, volume grafted by area, number of grafting sessions performed, history of smoking, and complications. RESULTS: The mean surgeon and patient assessment scores were 2.6 ± 0.6 and 2.7 ± 0.5, respectively, with a statistically significant correlation (P < 0.0001). No significant relationship was found between the assessments and age, weight change, graft volume, or smoking habit, with the exception of the cheekbone area. CONCLUSIONS: Structured fat grafting proved to be an efficient adjuvant technique for redefining facial contours, and its efficiency was not affected by age, weight change, or smoking habit. However, the fat volume to be grafted should be adequate for the specific needs of each area.

Fat-soluble vitamins as disease modulators in multiple sclerosis.

BACKGROUND: Fat-soluble vitamins (A, D, E and K) have properties that could be relevant as modulators of disease activity in multiple sclerosis (MS). METHODS: We performed a systematic search on PubMed and Medline up to May 2012, using the search strings 'vitamin A', 'retinol', 'retinal', 'carotenoids', 'vitamin D', 'vitamin E', 'alpha-tocopherol', 'vitamin K' in conjunction with 'multiple sclerosis', 'animal model' and 'experimental autoimmune encephalitis (EAE)'. In addition, the reference lists of the publications identified were examined for further citations of relevance. RESULTS: There is comprehensive evidence from epidemiological, observational, and experimental studies that vitamin D may be beneficial in MS. Results from small-scale clinical studies are inconclusive, and large-scale, adequately powered, randomized, controlled trials are still lacking. For vitamin D, Oxford Centre for Evidence-Based Medicine level 2c evidence exists for a positive therapeutic effect. Evidence from animal models indicates that all the examined fat-soluble vitamins could have potential as modulators of disease activity in MS. For vitamin A and E, level 4 and 5 evidence exists for a modulatory effect in MS; for vitamin K, too few studies have been conducted to indicate an effect in humans. CONCLUSION: Vitamin D is a promising candidate as modulator of disease activity in MS, and controlled studies are currently being conducted. All the fat-soluble vitamins have, however, been demonstrated to be effective in different animal models for the disease, and vitamin A and E have biological properties that could be relevant for MS pathogenesis. Thus, vitamin A and E seem to be promising candidates for future case-control and cohort studies.

Microlipoinjerto autólogo facial intramuscular: descripción de la técnica / Microlipoinjerto autologous facial muscle: description of the art

El microlipoinjerto autólogo facial intramuscular consiste en la inyección de pequeñas alícuotas de grasa en el espacio intramuscular o cerca a los músculos faciales. Preferimos el uso de un sistema cerrado para evitar la contaminación de la grasa. Consiste en muchos detalles técnicos que deben ser escrupulosamente seguidos para obtener un buen resultado cosmético. La evaluación clínica debe ser escrupulosa. El análisis facial debe ser detallado. Procedimiento. Para infiltrar la zona dadora se usó solución anestésica tumescente. La aspiración de la grasa de la zona dadora se realizó únicamente con anestesia local. Para anestesiar el rostro, se empleó bloqueo nervioso más solución tumescente. La grasa a ser inyectada, se mezcló con plasma rico en plaquetas, para asegurar la supervivencia de la grasa. La inyección de la grasa se realizó con cánulas de Coleman. Las partes del rostro que pueden ser inyectadas son la frente, los temporales, la región periocular, la región perioral y el mentón. Se deben seguir escrupulosamente todos los detalles de la técnica para lograr un buen resultado cosmético y evitar las complicaciones. Se pueden realizar procedimientos complementarios como liposucción de carrillos, región submentoniana y cuello. Conclusiones. El microlipoinjerto autólogo facial intramuscular es una herramienta valiosa tanto en cirugía facial cosméticacomo reconstructiva.

Fat autograft muscle injection is the injection of small aliquots of fat in muscle space or near the facial muscles. We prefer to use a closed system to avoid fat contamination. This technique has many technical details that must be thoroughly followed to attain a good cosmetic result. Comprehensive clinical evaluation and facial analysis is mandatory. Procedure. We currently use tumescent anesthetic solution to infuse donor site. Liposuction from the donor site is currently performed under local anesthesia. Facial nerve block facemore tumescent solution, is currently used. Fat to be injected is currently mixed with platelet-rich plasma to ensure the survival of the fat. Fat re-injection is performed with Coleman cannulas. Parts of the face that can be injected are the forehead, temporal, periocular, perioral region, and chin. Careful, detailed technique must be displayed to achieve a good cosmetic result and avoid complications. Complementary procedures such as liposuction of cheeks, submental and neck region can be performed. Conclusions. Facial fat auto graft muscle injection is a valuable tool in both cosmetic and reconstructive facial surgery.

Dietary saturated and monounsaturated fats protect against acute acetaminophen hepatotoxicity by altering fatty acid composition of liver microsomal membrane in rats.

BACKGROUND: Dietary polyunsaturated fats increase liver injury in response to ethanol feeding. We evaluated the effect of dietary corn oil (CO), olive oil (OO), and beef tallow (BT) on fatty acid composition of liver microsomal membrane and acute acetaminophen hepatotoxicity. METHODS: Male Sprague-Dawley rats were fed 15% (wt/wt) CO, OO or BT for 6 weeks. After treatment with acetaminophen (600 mg/kg), samples of plasma and liver were taken for analyses of the fatty acid composition and toxicity. RESULTS: Treatment with acetaminophen significantly elevated levels of plasma GOT and GPT as well as hepatic TBARS but reduced hepatic GSH levels in CO compared to OO and BT groups. Acetaminophen significantly induced protein expression of cytochrome P450 2E1 in the CO group. In comparison with the CO diet, lower levels of linoleic acid, higher levels of oleic acids and therefore much lower ratios of linoleic to oleic acid were detected in rats fed OO and BT diets. CONCLUSIONS: Dietary OO and BT produces similar liver microsomal fatty acid composition and may account for less severe liver injury after acetaminophen treatment compared to animals fed diets with CO rich in linoleic acid. These findings imply that types of dietary fat may be important in the nutritional management of drug-induced hepatotoxicity.

Bovine milk fat enriched in conjugated linoleic and vaccenic acids attenuates allergic dermatitis in mice.

BACKGROUND: Orally administered milk fat enriched in conjugated linoleic acid (CLA) and trans-vaccenic acid (VA) ('enriched milk fat'), produced by supplementing the diet of pasture-fed cows with fish and sunflower oil, has been shown previously to suppress the development of allergic airway disease in mice. OBJECTIVE: To investigate whether topical or oral application of enriched milk fat and its two major fatty acids cis-9, trans-11 CLA (c9,t11-CLA) and VA inhibit allergic dermatitis in mice. METHODS: Allergic dermatitis was induced in C57BL/6 mice by epicutaneous sensitization of tape-stripped skin with ovalbumin (OVA). Enriched milk fat and its two major fatty acids were either topically applied to the OVA-sensitized skin, or orally fed to mice by supplementation of the diet. Blood and skin tissues were collected for analysis after the third skin sensitization. RESULTS: Both topical and oral administration of enriched milk fat and its two major fatty acids led to significant suppression of allergic dermatitis as evidenced by reduced clinical and histological scores of affected skins, infiltration of inflammatory cells, and circulating allergen-specific IgE levels, compared with treatment with normal milk fat or the base control diet. C9,t11-CLA and VA individually inhibited multiple facets of allergic dermatitis when topically applied, and their combination produced a strong additive effect. CONCLUSION AND CLINICAL RELEVANCE: Enriched milk fat, and its two major fatty acids c9,t11-CLA and vaccenic acid attenuate allergic dermatitis in mice.

Consumo y concentraciones séricas de lípidos y proteínas en estudiantes del programa de residencias de la Universidad del Zulia / Intake and serum levels of lipids and proteins in students from the residency program at the Zulia University

Objetivo: Determinar el consumo y las concentraciones séricas de lípidos y proteínas en estudiantes universitarios residentes. Materiales y métodos: La muestra estuvo conformada por 120 estudiantes divididos en grupo de residentes (n = 70) y no residentes (n = 50). Se utilizó recordatorio de 24 horas para determinar el consumo de energía (E), grasas (G) y proteínas (P) y a partir de estos la adecuaciones de nutrientes (%ADE). Se determinaron las concentraciones séricas de triacilglicéridos (TG), colesterol total (CT), proteínas totales (PT). Resultados: En los estudiantes residentes, la E (1.989 ± 702 kcal/día), G (65 ± 21 g/día) y P (85 ± 23 g/día) fueron significativamente menores que en los no residentes (2.721 ± 941 kcal/día, 93 ± 43 g/día y 115 ± 44 g/día, respectivamente) (p < 0,05). En los residentes, el aporte de E y G fue insuficiente (ADE 86% y 85%, respectivamente), pero el de P excedió los requerimientos (ADE 125%). En los estudiantes no residentes, el aporte de energía y macronutrientes excedió los requerimientos. Las concentraciones séricas de TG y CT en ambos grupos fueron normales, pero las PT estaban elevadas en los estudiantes residentes (p < 0,05). Conclusiones: En los residentes, el consumo energético y graso resultó insuficiente y las PT, elevadas, datos que podrían ser útiles para la reformulación de políticas universitarias destinadas a este grupo(AU)

Objective: To determine the consumption and serum levels of lipids and proteins in living college students. Materials and methods: The sample consisted of 120 students divided into groups of residents (n = 70) and non-residents (n = 50). We used 24-hour recall to determine the consumption of energy (E), fat (F) and protein (P) and from them nutritional adequacy (%ADE). We determined the serum levels of triglycerides (TG), total cholesterol (TC), total protein (TP). Results: Resident students, the E (1989 ± 702 kcal/d), G (65 ± 21 g/d) and P (85 ± 23 g/d) were significantly lower than non-residents (2721 ± 941 kcal/d, 93 ± 43 g/d and 115 ± 44 g/d, respectively) (p < 0.05). In residents, the contribution of E and F was insufficient (ADE 86% and 85%, respectively), but the P exceeded requirements (ADE 125%). In the non-resident students, the energy and macronutrient intake exceeded requirements. Serum TG and TC in both groups were normal, but the PT were elevated in resident students (p < 0.05). Conclusions: In the residents, energy and fat intake was insufficient and higher TP, data that could be useful for the reformulation of university policies aimed at this group(AU)

Dieta y ejercicio / Diet and exercise

El tratamiento no farmacológico de la diabetes tipo 2 consiste en medidas precisas y escalonadas en el estilo de vida: alimentación y actividad física. La estrategia nutricional, cuando coexiste obesidad, estriba en la aplicación de una dieta moderadamente hipocalórica que consiga pérdidas modestas de grasa (especialmente visceral), y el mantenimiento de dicha pérdida, conservando la masa magra. El reparto energético entre lípidos, proteínas e hidratos de carbono tiene un margen muy amplio, y debe individualizarse según la edad, la presencia o no de sobrepeso y otras comorbilidades (dislipemia, hipertensión, etc.). En diabéticos tipo 2no obesos el tratamiento es el mismo, pero sin restricción calórica. Estas medidas se acompañarán de un incremento en la actividad física diaria y la recomendación individualizada de ejercicio físico más intenso semanal, por el potente efecto de mejora de la sensibilidad a la insulina y los factores de riesgo cardiovascular asociados. En esta exposición se aportan algunas propuestas de prescripción individualizada de ambos elementos del estilo de vida, basándonos en las evidencias científicas del momento (AU)

Non-pharmacological treatment of type 2diabetes consists of well-defined and progressive lifestyle measures: diet and exercise. In obese diabetic patients, the nutritional strategy consists of a moderatelyhypocaloric diet to achieve modest fat loss(especially visceral fat) and to maintain this loss while conserving lean tissue mass. Calorie distribution among lipids, proteins and carbohydrates has a wide margin and should be individually tailored according to age and the presence or absence of overweight and other comorbidities (dyslipidemia, hypertension etc.). Treatment is the same in non-obese type 2 diabetics, but without calorie restriction. These measures should be accompanied by an increase in daily physical exercise and individualized recommendations for more intense weekly physical activity due to its strong effect on improving insulin sensitivity and associated cardiovascular risk factors. The present article discusses some recommendations for the individualized prescription of both types of lifestyle modification, based on the latest scientific evidence (AU)

The role of glottal gap in predicting aspiration in patients with unilateral vocal paralysis.

Aspiration has been frequently noted among patients suffering from vocal-fold paralysis. The association between a defect of glottal closure and aspiration in patients with unilateral vocal paralysis appears to have been rarely reported. The current study reviews collected data consisting of videotaped flexible nasoendoscopy and stroboscopy for patients with a unilateral vocal-fold paralysis. Mean normalized glottal gap areas for patients suffering vocal paralysis with associated aspiration are significant greater than that for the non-aspiration group. Subsequent to the surgical correction of the glottal gap, all patients recovered well from their earlier aspiration. The investigation of objectively derived data revealed that poor airway protection due to incomplete closure of the vocal fold was the major cause of aspiration for patients suffering unilateral vocal-fold paralysis. Intracordal autologous fat injection can successfully improve the breath control and eliminate aspiration in patients with vocal-fold paralysis.

Papel del azúcar en el tratamiento de la obesidad / No disponible

No disponible

Requerimientos nutricionales del recién nacido pretérmino / Nutritional requeriments of the pretern newborn

Se realiza una revisión y puesta al día de las necesidades nutritivas del recién nacido pretérmino. Se analizan los diversos nutrientes y las recomendaciones de diferentes organismos y publicaciones internacionales, con especial referencia a los ácidos grasos insaturados de cadena larga y su importancia en los niños prematuros. Finalmente, se describe el protocolo que el servicio de Neonatología tiene establecido para la alimentación en estos niños (AU)

Changing profile of parenteral nutrition in pediatric surgery: a 30-year experience at one institute.

BACKGROUND: Due to technical refinements and steady advances in the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients, parenteral nutrition (PN) is now playing an important role in patient management. However, some PN-associated complications, such as catheter-related sepsis (CRS) and cholestasis, continue at high incidence, particularly in neonates. The objective of this study was to investigate the changing profiles of PN over the past 30 years in our department. METHODS: The medical records of 893 children (225 neonates, 245 infants, 261 preschool-age children, and 162 school-age children) who were placed on PN for >7 days in our department were reviewed, and the following data were extracted: birth weight, underlying disease, indications for PN, PN delivery route, type of catheter used, duration of PN, substrate and energy intake, type of amino acid solution used, and incidence of complications including CRS and liver dysfunction. The results were analyzed by dividing the patients into 3 groups according to their basic stages in management of PN and consisted of group 1 (1970 to 1979), group 2 (1980 to 1989), and group 3 (1990 to 1999). The parameters were compared in each group. RESULTS: The total number of patients in each group showed no significant difference; however, the percentage of low birth-weight neonates increased in group 3. In group 1, 85% of PN was administered through the peripheral vein; in group 2, 51.2%; and in group 3, 9.7%. The total calorie and nutrient intake decreased in groups 2 and 3 compared with group 1, particularly regarding fat intake. In groups 1 and 2, commercially available amino acid solution based on the Food and Agriculture Organization/World Health Organization formula was usually used as the nitrogen source, but in group 3, it was changed to an amino acid solution for children. CRS decreased significantly, particularly in neonates, and occurred at a rate of 45.4% in group 1, 10.7% in group 2, and 1.5% in group 3. The incidence of liver dysfunction also showed a decrease: 35.7% in group 1, 22.3% in group 2, and 18.0% in group 3. A multivariate analysis showed a strong relationship between PN-related liver dysfunction and the duration of PN, the presence of infection, and the type of amino acid solution used. CONCLUSIONS: PN via central venous catheters has been regarded as safe and effective treatment in pediatric surgical patients. Over the past 30 years, the incidence of CRS has decreased. However, PN-related liver dysfunction remains a problem, particularly in patients receiving long-term PN.

The evolving role of submucosal injectables for treating internal sphincteric deficiency.

Each of the previously mentioned materials can be used in procedures performed on an outpatient basis using sedation and local anesthesia. Teflon usually requires general anesthesia. None of these materials, however, should be used in acute conditions involving cystitis, urolithiasis, or infection. Table 4 summarizes the postoperative care after a bulking agent injection. There are obvious advantages to using injectable materials for ISD, one of which is that the outpatient procedure is usually done under local anesthesia. It does not have the risks inherent in open surgical procedures like slings or artificial sphincters, and it causes minimal increase of urethral resistance to detrusor-generated micturition force. Such procedures are obviously easier and faster to perform with less cost and rapid recovery followed by a return to regular activity within 48 hours. In conclusion, injection therapy for urinary incontinence is appropriate, but the most effective substance has probably not yet been determined.

Nutriçäo em diabéticos cardiopatas / Nutrition in cardiopath diabetic patients

Desde o Egito antigo a dietoterapia adquire especial importância no tratamento do diabete melito. A evoluçäo dos cuidos dieterápicos aliou-se ao avanço científico dos tratamentos medicamentosos e do conhecimento fisiopatológico da doença. O sucesso da dietoterapia como tratamento único ou coadjuvante no diabete melito depende da realidade patológica, social e econômica dos pacientes. No presente estudo säo discutidos aspectos dietéticos, em terapia nutricional oral e enteral, que auxiliam o controle de pacientes portadores de diabete melito.