Complications carentielles suite à l’utilisation de « laits » végétaux, chez des nourrissons de deux mois et demi à 14 mois (quatre cas)

Added Sugar Consumption in Spanish Children (7-12 y) and Nutrient Density of Foods Contributing to Such Consumption: An Observational Study

BACKGROUND

Diets rich in free sugars are associated with an increased risk of obesity. The aim of the present study is to estimate the intake of added sugars in the population of Spanish children and analyze the quality of the foods that contribute to this intake.

METHODS

An observational study was conducted to collect self-reported information on weekly food consumption in 1775 Spanish children (7-12 years). Nutrient contents were obtained from different databases. Two nutritional density indices were constructed taking into account all nutrients provided and compared with two previously described indices.

RESULTS

The average consumption of added sugars in Spanish children was 55.7 ± 1.0 g/day. The products that most contributed to added sugar intake were biscuits (13.3%), cocoa powder (11.1%), sweetened yogurts (9.9%), and dairy desserts (8.6%). Among these, dairy products had considerable nutritional value. Parents' perception of nutritional value was not aligned with the actual nutritional value.

CONCLUSION

The consumption of added sugars was higher than recommended. Public awareness efforts should focus on: (1) the reduction of consumption of low-nutritional quality products containing high amounts of added sugars; (2) the industrial reformulation of most consumed products to reduce sugar content and increase valuable nutrients; and (3) nutritional education.

Cow's Milk in Human Nutrition and the Emergence of Plant-Based Milk Alternatives

Cow's milk is considered a complete food, providing high-quality protein and essential micronutrients, including vitamins and minerals. For medical reasons or as a lifestyle choice, consumers are replacing cow's milk with plant-based milk alternatives (PBMA); some perceive them as healthier alternatives to cow's milk due to their low saturated fatty acid content and no cholesterol content. However, the nutritional composition of PBMA is quite variable between different types and even within, which makes a comparison with cow's milk a complex issue. Furthermore, the consumption of PBMA has been associated with the development of some diseases in infants and children. Meanwhile, the consumption of cow's milk in human health is a controversial issue since it has been associated with a favorable effect in some diseases (such as obesity, type 2 diabetes, and Alzheimer's) and a negative effect in others (such as prostate cancer risk and Parkinson's disease); while in some diseases, there is no consensus in the cow's milk consumption effect. The aim of this review is to make a nutritional comparison of cow's milk with PBMA and to clarify the potential health issues related to their consumption.

MILK Symposium review: The importance of milk and dairy foods in the diets of infants, adolescents, pregnant women, adults, and the elderly

The ongoing increase in life expectancy is not always accompanied by an increase in healthy life span. There is increasing evidence that dietary exposure in early life can substantially affect chronic disease risk in later life. Milk and dairy foods are important suppliers of a range of key nutrients, with some being particularly important at certain life stages. It is now recognized that milk protein can stimulate insulin-like growth factor-1 (IGF-1), essential for longitudinal bone growth and bone mass acquisition in young children, thus reducing the risk of stunting. Low milk consumption during adolescence, particularly by girls, may contribute to suboptimal intake of calcium, magnesium, iodine, and other important nutrients. Given the generally low vitamin D status of European populations, this may have already affected bone development, and any resulting reduced bone strength may become a big issue when the populations are much older. Suboptimal iodine status of many young women has already been reported together with several observational studies showing an association between suboptimal iodine status during pregnancy and reduced cognitive development in the offspring. There is now good evidence that consumption of milk and dairy foods does not lead to an increased risk of cardiovascular diseases and type 2 diabetes. Indeed, some negative associations are seen, notably between yogurt consumption and type 2 diabetes, which should be researched with urgency. Greater emphasis should be placed on reducing malnutrition in the elderly and on dietary approaches to reduce their loss of muscle mass, muscle functionality, and bone strength. Whey protein has been shown to be particularly effective for reducing muscle loss; this needs to be developed to provide simple dietary regimens for the elderly to follow. There is an ongoing, often too simplistic debate about the relative value of animal versus plant food sources for protein in particular. It is important that judgments on the replacement of dairy products with those from plants also include the evidence on relative functionality, which is not expressed in simple nutrient content (e.g., hypotensive and muscle synthesis stimulation effects). Only by considering such functionality will a true comparison be achieved.

Dietary Chloride Deficiency Syndrome: Pathophysiology, History, and Systematic Literature Review

Metabolic alkalosis may develop as a consequence of urinary chloride (and sodium) wasting, excessive loss of salt in the sweat, or intestinal chloride wasting, among other causes. There is also a likely underrecognized association between poor salt intake and the mentioned electrolyte and acid-base abnormality. In patients with excessive loss of salt in the sweat or poor salt intake, the maintenance of metabolic alkalosis is crucially modulated by the chloride-bicarbonate exchanger pendrin located on the renal tubular membrane of type B intercalated cells. In the late 1970s, recommendations were made to decrease the salt content of foods as part of an effort to minimize the tendency towards systemic hypertension. Hence, the baby food industry decided to remove added salt from formula milk. Some weeks later, approximately 200 infants (fed exclusively with formula milks with a chloride content of only 2-4 mmol/L), were admitted with failure to thrive, constipation, food refusal, muscular weakness, and delayed psychomotor development. The laboratory work-up disclosed metabolic alkalosis, hypokalemia, hypochloremia, and a reduced urinary chloride excretion. In all cases, both the clinical and the laboratory features remitted in ≤7 days when the infants were fed on formula milk with a normal chloride content. Since 1982, 13 further publications reported additional cases of dietary chloride depletion. It is therefore concluded that the dietary intake of chloride, which was previously considered a "mendicant" ion, plays a crucial role in acid-base and salt balance.

Lactose intolerance: what is a correct management?

SUMMARY Individuals with Lactose Intolerance (LI) tend to exclude milk from their diet since this behavior seems to relieve the symptoms caused by the disease. However, milk is a food of high nutritional value, and complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. The objective of this review was to evaluate the scientific evidence on the adequate management of patients with LI. This study was carried out from the review of the scientific literature in PubMed and SciELO databases. Complete exclusion of conventional dairy products is not necessary since most individuals with LI can tolerate up to 12 grams of lactose daily in a single dose. Yogurts and cheeses matured for having low amounts of lactose are part of the strategy that allows consumption of dairy products by patients with LI. Currently, there is a diversity of products considered as “milk substitutes” and supplements aimed at individuals with LI. However, these strategies still require better-designed studies.

Improper Use of a Plant-Based Vitamin C-Deficient Beverage Causes Scurvy in an Infant

Scurvy is a rare disease in developed countries. Risk groups include children with restricted diets, mainly patients who are autistic or have cerebral palsy. Furthermore, consumption of plant-based beverages has increased in recent years, especially in developed countries. When plant-based beverages are the exclusive diet in the first year of life and not consumed as a supplement to formula or breastfeeding, it can result in severe nutritional problems. We report a case of scurvy after exclusive intake of almond beverages and almond flour from 2.5 to 11.0 months of life. The patient was referred for pathologic fractures of the femur, irritability, and failure to thrive. He had typical radiologic signs of scurvy, such as osteopenia, cortical thinning, Wimberger ring, Frankel line, fracture, and periosteal reaction. Moreover, his plasmatic vitamin C level was very low. The child was diagnosed with scurvy and was started on vitamin C replacement therapy at a dose of 300 mg per day. Over the following 3 months, his general condition, the pain in the legs, and the radiologic features improved; the plasmatic vitamin C level was normalized; and the child started walking. In summary, this case demonstrates that scurvy is a new and severe complication of improper use of almond drinks in the first year of life. Manufacturers should indicate that these beverages are inappropriate for infants who consume a vitamin C-deficient diet.

[Severe nutritional deficiencies in young infants with inappropriate plant milk consumption]

Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (<20 g/L) and diffuse edema. In the other cases, the nutritional disorders were revealed by a refractory status epilepticus related to severe hypocalcemia (one case), growth arrest of both height and weight secondary to insufficient caloric intake (five cases), and severe cutaneous involvement (one case). Five children had severe iron deficiency anemia (<70 g/L), three children had a very low 25-hydroxy vitamin D level (nutritional rickets), and two had severe hyponatremia (<130 mmoL/L). Milk alternative beverages expose infants to severe nutritional deficiencies. Serious complications can occur. Early, exclusive, and extended use is riskier. These diseases are preventable, and parental education should be provided. Statutory measures forbidding their use in young infants should be organized to slow down the progress of this social trend.