Archivos Latinoamericanos de Nutrición

Del revisor de artículos científicos

Lactancia materna y enfermedades crónicas no transmisibles en la vida adulta

Existe evidencia científica que sugiere que la lactancia materna (LM) tiene beneficios a largo plazo, incluyendo un efecto protector contra la aparición de las enfermedades crónicas no transmisibles (ECNT). Por lo tanto, el objetivo de esta revisión fue identificar la evidencia generada sobre la relación de la LM y el desarrollo de las ECNT en la vida adulta. Se realizó una búsqueda electrónica en PubMed de estudios que evaluaran los efectos a largo plazo de la LM sobre los principales factores de riesgo para las ECNT. Se revisaron artículos publicados hasta agosto de 2014. De 75 artículos revisados, 31 fueron incluidos, los cuales fueron publicados entre los años 2001 y 2014. Algunos de los estudios presentados en esta revisión sugieren que la LM podría tener un rol protector en el desarrollo de las ECNT en la edad adulta o sus factores de riesgo, al igual que los mecanismos biológicos plausibles por los que la leche materna podría actuar. La disminución del riesgo de sobrepeso y obesidad es la que dispone de más evidencia, aunque hay resultados contrarios, al igual que para los factores de riesgo de enfermedad cardiovascular. En el caso de la disminución del riesgo de desarrollar diabetes tipo 2 y estados de inflamación, la evidencia aún es muy escasa. A pesar de que la mayoría de resultados provienen de estudios observacionales, lo que limita establecer causalidad, estos resultados pueden utilizarse para dar apoyo a las políticas y programas de salud relacionados con la promoción de la LM.

Evidence is increasing that breastfeeding beyond its well-established beneficial effects during the breastfeeding period, also confers long-term benefits, particularly in the prevention of risk factors for non-communicable diseases. Therefore, we sought to identify the latest evidence about the benefits of breastfeeding later in life. We searched on PubMed for published studies assessing the effects of breastfeeding on risk factors for non-communicable diseases later in life (cardiovascular risk factors, obesity/overweight, type-2 diabetes and inflammation). Out of 75 references identified, 31 were included in this revision to review the available evidence on long-term benefits of breastfeeding. The search was completed on December 2014. Some of the reviewed studies suggest that breastfeeding may offer protection to develop risk factors for non-communicable diseases later in life, and also have been proposed several mechanisms for a protective effect of breastfeeding against non-communicable diseases. Although there is more evidence of overweight/obesity and cardiovascular disease these is inconclusive. There is a lack of evidence for type-2 diabetes and inflammation, therefore it is difficult to conclude. Although the majority of the studies are observational and this is a limitation to prove causality, the results of this article may provide support to breastfeeding policies.

Capacidad predictiva de los índices antropométricos en la detección de Síndrome Metabólico en adultos chilenos

La presencia de componentes cardiometabólicos condiciona un aumento del riesgo en la aparición de síndrome metabólico y las patologías asociadas. La insulinoresistencia, es probablemente, el mecanismo subyacente a las complicaciones derivadas de este síndrome, donde la acumulación adiposa abdominal se presenta como característica frecuente. El objetivo de este estudio fue determinar la capacidad predictiva de los índices antropométricos estimadores de distribución adiposa central versus el índice de masa corporal en la detección de síndrome metabólico en adultos chilenos. Se realizó un estudio de tipo descriptivo de corte transversal con 229 adultos, cuyos datos fueron obtenidos a través de una fuente de datos secundaria. Estos fueron analizados a través de correlación de Pearson y curva operador receptor estableciendo área bajo la curva. Los resultados mostraron una prevalencia de 58,3% de síndrome metabólico según NCEP-ATP III, donde los índices antropométricos como el índice cintura estatura (0,746), circunferencia de cintura (0,735) e índice de masa corporal (0,722) no presentaron diferencias significativas en la detección de síndrome metabólico. Se estableció mayor correlación de los factores cardiometabólicos con el índice cintura estatura y circunferencia cintura.

The presence of cardiometabolic components conditions the risk increase in the appearance of the metabolic syndrome and the associated pathologies. The insulin resistance is probably the subjacent mechanism to the complications derived from this syndrome, where the abdominal adipose accumulation is a common and frequent characteristic. The purpose of this study was to determine the predictive capability of the anthropometric estimating central adipose distribution indexes against the body mass index in the detection of the metabolic syndrome in Chilean adults. A descriptive crosssectional study was conducted on 229 adults, information obtained through a secondary database. There were analyzed through a Pearson correlation and receiver operating curves determining the area under the curve. The results showed the predominance of 58.3 % of the metabolic syndrome prevailed according to NCEP-ATP III, where the anthropometric indexes such as waist height index (0.746), waist circumference (0.735) and body mass index (0.722) did not show significant differences in the detection of the metabolic syndrome components. It did show a higher correlation of these cardio-metabolic factors with the waist height index and waist circumference.

Predictores maternos del índice de masa corporal del hijo pre-escolar y escolar

El objetivo fue identificar variables maternas predictoras del índice de masa corporal (IMC) del hijo. Se consideraron variables: a) socio-demográficas (edad, escolaridad, ocupación, estado marital e ingreso económico familiar), b) antropométricas (IMC) y c) estrategias de crianza (monitoreo y límites en alimentación, monitoreo y límites de conductas sedentarias, disciplina y control en alimentación). Se realizó un estudio correlacional predictivo con 537 diadas (madre-hijo). Los hijos inscritos en 4 escuelas públicas (2 de nivel pre-escolar y 2 de primaria) fueron seleccionados por muestreo aleatorio probabilístico. Las madres respondieron la Escala Estrategias de Crianza de Alimentación y Actividad, proporcionaron información socio demográfica y se midió peso y talla a cada diada. Los datos se analizaron por correlaciones y análisis de senderos. Se encontró que las madres tenían edad promedio de 34.25 años (DE=6.91), escolaridad 12.40 años (DE=3.36). El 53.3% refirió ser ama de casa y el 46.7% tener trabajo remunerado fuera del hogar. El 38.5% presentó pre-obesidad y el 27.3% algún grado de obesidad. La edad promedio del hijo fue 7.26 años (DE =2.46). El 3.2% presentó bajo peso, el 59.6% peso normal y el 37.2% sobrepeso-obesidad. Se encontró que trabajar fuera del hogar, tener mayor IMC materno, menor control y mayor disciplina en la alimentación son variables predictoras de mayor IMC del hijo. Se recomienda diseñar intervenciones para reducir y tratar el sobrepeso-obesidad infantil considerando los predictores encontrados.

The objective was to identify maternal variables that could be used as predictors of the childs body mass index (BMI). We considered the following variables: a) socio-demographic (age, education, occupation, marital status and family income); b) anthropometric (BMI); and c) upbringing strategies (monitoring and limits for eating habits, monitoring and sedentary behavior limits, discipline and control in feeding. A predictive correlational study was carried out with 537 dyads (motherchild). Children enrolled in 4 public schools (2 for pre-school children and 2 for primary school children) were selected for probabilistic, random sampling. The mothers answered the Feeding and Activity Upbringing Strategies Scale, giving socio-demographic information and the dyads weight and height was measured. The data were analyzed for correlations and path analysis. It was found that the average age of mothers was 34.25 years (SD=6.91), with 12.40 years of education (SD=3.36), 53.3% mentioned that they were housewives and 46.7% had a paid job outside of the home; 38.5% showed pre-OB and 27.3% some degree of OB. The childs average age was 7.26 years (SD=2.46), and 3.2% showed low weight, 59.6% normal weight and 37.2% OW-OB. It was found that working outside the home, having a higher maternal BMI, less control and more discipline in feeding are variables that predict higher BMI in the child. We recommend the design of interventions to reduce and treat the childs OW-OB taking into account the predictors that were found.

Percentile distribution of anthropometric variables in pregnant women

Anthropometric indicators play an important role in the health status assessment of individuals and populations across the different vulnerable groups, due to which it is necessary to ascertain the percentile distribution of the weight, body mass index (BMI), and mid-arm, thigh, and calf circumferences in pregnant women for each week of gestational age. This descriptive and cross-sectional study included 4,481 measurements of anthropometric variables obtained from 745 pregnancies out of 719 subjects aged between 19 and 39 years, who were well-nourished, healthy, without clinical edema in the third trimester, with single pregnancy, and validated gestational age. All evaluations were conducted at the Centro de Atención Nutricional Infantil Antímano, CANIA, from 1998 to 2012. The anthropometric measurements were performed by standardized anthropometrists. Measures of central tendency and dispersion, bivariate correlations, and percentiles 3, 10, 25, 50, 75, 90, and 97 were calculated for each gestational age, between the 8th and 37th weeks of gestation. The number of measurements performed for each studied variable ranged from a minimum of 101 and a maximum of 241 at each gestational week. The BMI and circumference behaviors showed increases as the gestational age advanced. The changes in the variables observed in the 50th percentile between weeks 8 thru 37 were: weight, 10.10 kg; BMI, 4.23 kg/m2; and circumferences (cm): mid-arm, 0.45; calf, 1.60; and thigh, 3.55. The results of this study provide the means to simplify the screening and follow-up of the nutritional status in an accurate manner at any stage of gestation until the 37th week.

Los indicadores antropométricos juegan un papel importante en la evaluación el estado de salud a nivel individual y poblacional en los diferentes grupos vulnerables por lo que resulta necesario conocer la distribución percentilar del peso, índice de masa corporal (IMC) y circunferencias: media del brazo, muslo y pierna, para cada edad gestacional. Estudio descriptivo, de corte transversal, incluyó 4484 mediciones de las variables antropométricas obtenidas de 745 embarazos, provenientes de 719 mujeres, con edades comprendidas entre 19 y 39 años, sanas, eutróficas, sin edema, con embarazo simple y edad gestacional validada, evaluadas en el Centro de Atención Nutricional Infantil Antímano, desde 1998 hasta el 2012. Las mediciones antropométricas fueron realizadas por antropometristas estandarizadas. Se calcularon medidas de tendencia central y de dispersión, así como correlaciones bivariantes y percentiles 3, 10, 25, 50, 75, 90 y 97 para cada edad gestacional, entre las 8 y 37 semanas de gestación. El número de mediciones realizadas para cada variable analizada varió entre 101 y 241 por edad gestacional. El comportamiento del IMC y circunferencias evidenció incrementos a medida que aumenta la edad gestacional. Los cambios referidos al percentil 50 de las variables, de las semanas de gestación 8 a la 37 fueron: peso 10,10 kg; IMC 4,23 Kg/m2; circunferencias (cm): media del brazo 0,45; pierna 1,60; muslo 3,55. Los resultados de este estudio constituyen una herramienta que simplifica la evaluacion inicial y el seguimiento del estado nutricional de manera puntual en cualquier momento de la gestacion hasta las 37 semanas de edad gestacional.

Percentile distribution for anthropometric variables used to estimate body composition in pregnant women

Anthropometric indicators of body composition, reflective of fat and lean compartments in pregnant women, undergo changes throughout gestation. The adequate interpretation of these indicators requires the availability of percentile distribution values for each week of gestational age. The objective was to determine the percentile distribution for subcutaneous skin-fold thicknesses: biceps, triceps, subscapular, mid-thigh, and both arm fat and arm muscle areas for each week of gestational age. This descriptive and cross-sectional study included 4,481 measurements of anthropometric variables obtained from 745 pregnancies out of 719 subjects aged between 19 and 39 years, well-nourished, healthy, without clinical edema, single pregnancy, and validated gestational age. Evaluations were conducted at the Centro de Atención Nutricional Infantil Antímano, between 1998 and 2012. The anthropometric measurements were performed by standardized anthropometrists. Descriptive statistics, bivariant correlations, and percentiles 3, 10, 25, 50, 75, 90, and 97 were calculated for each week of pregnancy between weeks 8 thru 37. The number of measurements performed for each variable studied at each week of gestation ranged between 100 and 236. The behavior of the variables reflecting the fat component showed increases as the gestational age advanced (1.86 cm2), whereas the muscle area showed decreases (-0.02 cm2). The most noticeable variations were seen in the subscapular and mid-thigh skin-fold thicknesses 2.90 mm and 5.0 mm, respectively. The availability of percentile distributions of the anthropometric variables used in the evaluation of body composition for pregnant women per gestational age, contributes to optimizing the nutritional categorization in this population group.

Distribución percentilar de variables antropométricas aplicadas en la estimación de la composición corporal en gestantes adultas. Los indicadores antropométricos de composición corporal que reflejan los compartimientos corporales magro y graso de la gestante se modifican a lo largo de la gestación. Para una interpretación adecuada de los mismos se requeriria disponer de sus valores para cada edad gestacional. El objetivo de la investigación fue determinar la distribución percentilar de los pliegues subcutáneos: bicipital, tricipital, subescapular y muslo, así como las áreas: grasa y muscular en cada semana de gestacion. Estudio descriptivo, de corte transversal, incluyó 4.481 mediciones de las variables antropométricas obtenidas de 745 embarazos, provenientes de 719 mujeres entre 19 y 39 años de edad, sanas, eutróficas, sin edema, con embarazo simple y edad gestacional validada, evaluadas en el Centro de Atención Nutricional Infantil Antímano, entre 1998 y 2012. Las mediciones antropométricas fueron realizadas por antropometristas estandarizadas. Se calcularon descriptivos, correlaciones bivariantes y percentiles 3, 10, 25, 50, 75, 90 y 97 para cada edad gestacional, entre las 8 y 37 semanas de gestación. El número de mediciones para cada variable estudiada en cada edad gestacional varió entre 100 y 236. El comportamiento de las variables que reflejan el componente graso demostró incrementos a medida que aumenta la edad gestacional (1,86 cm2), mientras que el área muscular manifestó decrementos (-0,02 cm2). Los mayores cambios se observaron en los pliegues subescapular 2,90 mm y muslo 5,00 mm. La distribución percentilar de para cada semana de gestación de las variables antropométricas que miden la composición corporal, constituye un aporte a la optimización de la categorización nutricional en este grupo de población.

Aflatoxin M1 in pasteurized, UHT milk and milk powder commercialized in Londrina, Brazil and estimation of exposure

Aflatoxin M1 (AFM1) is found in milk and other excretion products after aflatoxin B1 intake. AFM1 is carcinogenic to humans, and known levels of dairy product contamination is important to understand the risks to which the population is exposed. The occurrence of AFM1 was evaluated in 42 milk samples commercialized in Londrina, Parana State, Brazil and this rate of occurrence was used to estimate this exposure. AFM1 determina tion was ca rried out by ELISA, and was detected in 100 % samples at levels ranging from 0.01 to 0.81 µ g/kg (mean 0.13 µ g/kg). None of the samples p resente d AFM1 above the maximum permitted level by Brazilian Legislation (0.5 µ g/kg for fluid milk and 5 µ g/kg for milk powder). The estimated daily intake (EDI) of AFM1 was evaluated, and the average intake was 0.468 ng/kg body weight (b.w.) for adolescents, 0.384 ng/kg b.w. for adults and 0.559 ng/kg b.w. for the elderly. Values of EDI of AFM1 found in Londrina pose a toxicological risk to the population investigated. To the best of our knowledge, this is the first report on estimat ed AFM1 dietary exposure from Parana, Brazil.

Aflatoxina M1 (AFM1) e encontrada no leite e em outros produtos de excrecao apos o consumo de aflatoxina B1. AFM1 e carcinogenica para humanos, e avaliar os niveis de contaminacao em produtos lacteos e importante para conhecer os riscos aos quais a populacao esta exposta. A ocorrencia de AFM1 foi avaliada em 42 amostras de leite comercializadas em Londrina, Estado do Parana, Brasil, e sua ocorrencia foi utilizada para estimar sua exposicao. A determinacao de AFM1 foi avaliada por ELISA, e foi detectada em 100% das amostras, em niveis variando de 0,01 a 0,81 µ g/kg (media 0,13 µ g kg). Nenhuma das amostras apresentou niveis de AFM1 acima do maximo permitido pela Legislacao brasileira (0,5 µ g/kg para leite fluido e 5 µ g/kg para leite em po). A ingestao diaria estimada (IDE) de AFM1 foi avaliada, e a ingestao media foi de 0,468 ng/kg de peso corporal (p.c.)/dia para adolescentes, 0,384 ng/kg p.c./dia para adultos e 0,559 ng/kg p.c./dia para idosos. Valores de IDE de AFM1 encontrados em Londrina supoem um risco toxicologico para a populacao investigada. Do melhor do nosso conhecimento, este e o primeiro trabalho sobre a exposicao estimada de AFM1 do Parana, Brasil.

Brazilian Food Composition Database (TBCA-USP): Data compilation to serve the public good

O artigo apresenta a evolução da Tabela Brasileira de Composição de Alimentos (TBCA-USP), desde sua criação até sua próxima atualização. Caracteriza a base de dados da TBCA-USP como um bem público e ressalta a importância da compilação de dados de composição de alimentos como atividade de elevada relação custo-benefício. Relata a relevância social das informações de composição de alimentos e a importância dessa base de dados no contexto nacional. Sinaliza estratégias de ampliação e atualização da TBCA-USP.

The article shows the evolution of the Brazilian Food Composition Database (TBCA-USP), since its creation until its next update. The article characterizes the TBCA-USP database like a public good and highlights the importance of the food composition data compilation as a high cost-effective activity. It reports the social relevance of the information about food composition and the importance of this database in the national context. It also indicates extension and update strategies of the TBCA-USP.

Sheep milk: physical-chemical characteristics and microbiological quality

Sheep milk is the third most consumed milk in Brazil. It is much appreciated for its nutritional status and is important for children that have problems with cow milk. Little information is known about the chemical, physical and microbiological composition of sheep milk from South Brazil. Thus, the aim of this study was to describe chemical and microbiological characteristics of sheep milk produced on two rural properties located in southern Brazil (Paraná and Rio Grande do Sul). The chemical composition of sheep milk was 17.32 g/100 g total solids, 5.86 g/100 g total protein, 4.46 g/100 g casein, 1.08 g/100 g whey protein, 7.28 g/100 g fat, 0.93 g/100 g ash, and 3.41 g/100 g lactose. High somatic cell count (1.7x106 cells/mL), total mesophilic bacterias (16.0x106 CFU/mL) and psychrotrophics (5.8x106 CFU/mL) were observed. Growth of Staphylococcus aureus, enterobacteria and coliforms occurred in 100% of the samples, and 45% of the samples showed growth of Escherichia coli. The sheep milk physical-chemical and microbiology parameters are similar to those presented in the literature for other countries but somatic cell count presented high levels.

O leite de ovelha é o terceiro mais consumido no Brasil, e é muito apreciado devido ao seu aspecto nutricional. Pouca informação a respeito da composição química e microbiológica do leite de ovelha no Brasil é conhecida. O objetivo deste trabalho foi caracterizar o leite ovino produzido em duas propriedades rurais localizadas no Sul do Brasil (Paraná e Rio Grande do Sul). A composição química do leite de ovelha foi 17,32 g/100 g de sólidos totais; 5,86 g/100 g de proteína total; 4,46 g/100 g de caseína; 1,08 g/100 g de soro proteico; 7,28 g/100 g de gordura; 0,93 g/100 g de cinzas e 3.41 g/100 g de lactose. Altas contagens de células somáticas (1,7x106 células/mL), bactérias mesófilas (16,0 x106 UFC/mL) e psicrotróficos (5,8x106 UFC/mL) foram observadas. Multiplicação de Staphylococcus aureus, enterobactérias e coliformes ocorreu em 100% das amostras, 45% de amostras apresentou multiplicação de Escherichia coli. Os parâmetros físico-químicos e microbiológicos do leite ovino deste estudo são semelhantes a literatura para outros países, porém, a contagem de células somáticas foi elevada.

La ortorexia: Un nuevo reto para los profesionales de la salud