Conhecimento de pediatras e nutricionistas sobre o tratamento da alergia ao leite de vaca no lactente

Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.

Health issues and technological aspects of plant-based alternative milk

A growing number of consumers opt for plant-based milk substitutes for medical reasons, like cow's milk protein allergy (CMPA), lactose intolerance (LI), or as a lifestyle choice. Plant-based milk substitutes, or plant extracts, are water-soluble extracts of legumes, oilseeds, cereals or pseudocereals that resemble bovine milk in appearance. It is produced by reducing the size of the raw material, extracted in water and subsequently homogenized, being an alternative to cow's milk. They are considered cow's milk replacers due to similar chemical composition and can also be used as a substitute for direct use or in some animal milk-based preparations. On the other hand, these substitutes exhibit different sensory characteristics, stability and nutritional composition from cow's milk. They are manufactured by extracting the raw material in water, separating the liquid, and formulating the final product. Others process like homogenization and thermal treatments are indispensable to improve the suspension and microbiological stabilities of the final product so that can be consumed. However new and advanced non-thermal processing technologies such as ultra-high pressure homogenization and pulsed electric field processing are being researched for tackling the problems related to increase of shelf life, emulsion stability, nutritional completeness and sensory acceptability without the use of high temperatures. Some pre-treatments such as peeling, bleaching or soaking can be performed on the raw material in order to improve the final product. The nutritional properties are influenced by the plant source, processing, and fortification. The addition of other ingredients as sugar, oil and flavorings is done to the plant-based milk substitute to make them more palatable and be more acceptable to consumers. Thus, the aim is to review the main reasons for the consumption of plant-based milk substitute as well as the raw materials used and the technological aspects of its production.

Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations

The variety of foods and methods of preparation are part of the cultural identity of each population, and thus the main foods that cause symptoms vary among different regions. Due to their increasing frequency, Adverse Reactions to Food (AFR) have been the subject of extensive study, especially in North America and Europe but few studies have been conducted in other areas, especially in populations located in the tropics and subtropics. In this article, we review available information on the epidemiology of food sensitization and food allergies in tropical regions and explore the different epidemiological data considering the major food involved, the underlying immune mechanism and clinical symptoms partners. In addition, we identify the possible limitations and questions that arise from studies conducted in tropical countries, which helps to generate objectives for future research.

Effect of fructo-oligosaccharide supplementation in soya beverage on the intestinal absorption of calcium and iron in newly weaned rats

Studies have shown the positive effects of prebiotics on the intestinal absorption of Ca and Fe. The present study evaluated the effect of fructo-oligosaccharide (FOS) supplementation in soya beverage (SB) on absorption mechanisms of Ca and Fe in recently weaned rats. Male Wistar rats were divided into four groups: lactose-free cows' milk (CM), lactose-free CM with FOS (0·8 g/100 ml) (CMF), SB and soya beverage with FOS (0·8 g/100 ml) (SBF). These rats were euthanised after 1 week of treatment. Organ weight, pH of the caecal content and absorption mechanisms of Ca and Fe were evaluated. The results showed that the weight of the caecal contents increased in the CMF and SBF groups, and the pH of the caecal contents was lower in these groups. The Hb levels of the CMF and SB groups were higher when compared with that of the CM group and lower in relation to the SBF group. The apparent Ca and Fe absorption and apparent Ca retention in the CM group were higher when compared with the SB group, whereas in the CMF group, they were higher in relation to the SBF group. Divalent metal transporter 1 (DMT1) protein expression in the duodenum was higher in the SBF group than in the SB and CMF groups. SB resulted in lower intestinal Ca absorption and higher Hb concentration, despite the lower apparent Fe absorption in relation to CM. Supplementation with FOS provided beneficial effects on Hb and DMT1 protein expression in the duodenum, in addition to improving the absorption process.

[Anaphylaxis related to measles, mumps, and rubella vaccine in Santa Catarina State, Brazil, 2014 and 2015]

The study aimed to describe cases and verify the frequency of anaphylaxis related to measles, mumps, and rubella (MMR) vaccine produced by manufacturer A and to assess associated risk factors. This was a case-control study (1:4) in Santa Catarina State, Brazil, from July 14, 2014, to January 12, 2015, in children from one year to less than five years of age, vaccinated with MMR and reported with anaphylaxis, while the controls were without anaphylaxis. The measure of association was odds ratio (OR) with 95% confidence interval (95%CI), using the chi-square and Fisher's exact tests. Anaphylaxis rates were calculated per doses distributed/administered. Fifteen cases and 60 controls were interviewed in 12 municipalities (counties). Anaphylaxis rates were 2.46 and 5.05 cases per 100,000 doses distributed and administered, respectively. Among the cases of anaphylaxis, eight (53.4%) were males, and among the controls, 36 (60%), with p = 0.64. The bivariate analysis of anaphylaxis and cow's milk protein allergy (CMPA) showed OR = 51.62, with p = 0.00002 and 95%CI: 5.59-476.11. The variables family food allergy, breastfeeding, previous post-vaccine adverse event (PVAE), and simultaneous vaccination were not statistically significant (p = 0.48; p = 1.00; p = 0.49; p = 0.61). Anaphylaxis rates per doses distributed/administered exceeded 1/100,000 doses administered (expected rate). Anaphylaxis and CMPA showed a statistically significant association. No statistically significant associations were found with simultaneous vaccination, breastfeeding, family food allergy, or history of PVAE.

RECOMMENDATIONS

the manufacturer should specify the product's components in the package insert, and children with a history of CMPA should not be vaccinated with this vaccine.

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.

[Knowledge and practice of Brazilian pediatricians concerning gastroesophageal reflux disease in infants]

OBJECTIVE

To assess the knowledge and practice of pediatricians about infants with physiological reflux and gastroesophageal reflux disease.

METHODS

140 pediatricians were interviewed during two scientific events in 2009 and 2010. The questions referred to two clinical cases of infants. One with symptoms of infant regurgitation (physiological reflux) and another with gastroesophageal reflux disease.

RESULTS

Among 140 pediatricians, 11.4% (n=16) and 62.1% (n=87) would require investigation tests, respectively for infant regurgitation (physiological reflux) and gastroesophageal reflux disease. A series of upper gastrointestinal exams would be the first requested with a higher frequency. Medication would be prescribed by 18.6% (n=26) in the case of physiological reflux and 87.1% (n=122) in the case of gastroesophageal reflux disease. Prokinetic drugs would be prescribed more frequently than gastric acid secretion inhibitors. Sleeping position would be recommended by 94.2% (n=132) and 92.9% (n=130) of the respondents, respectively for the case of physiological reflux and gastroesophageal reflux disease; however, about half of the respondents would recommend the prone position. Only 10 (7.1%) of the pediatricians would exclude the cow's milk protein from the infants' diet.

CONCLUSIONS

Approaches different from the international guidelines are often considered appropriate, especially when recommending a different position other than the supine and prescription of medication. In turn, the interviews enable us to infer the right capacity of the pediatricians to distinguish physiologic reflux and gastroesophageal reflux disease correctly.

Dental fluorosis in the primary dentition and intake of manufactured soy-based foods with fluoride

BACKGROUND & AIMS

To identify manufactured soy-based products more recommended by pediatricians and nutritionists; to determine fluoride concentrations in these products; to evaluate children concerning fluorosis in primary teeth and its association with the consumption of soy-based products.

METHODS

Pediatricians and Nutritionists answered a questionnaire about soy-based products they most recommended to children. Fluoride concentrations of the 10 products more cited were analyzed with the ion-specific electrode. Dental fluorosis exams were performed in 315 4-6-year-old children. Dean's Index was used to assess fluorosis. Among the children examined, 26 had lactose intolerance. Their parents answered a questionnaire about children's and family's profile, besides permitting the identification of soy-based products use. Chi-squared and Multivariable Logistic Regression tests were used (p < 0.05).

RESULTS

Fluoride content in the analyzed products ranged from 0.03 to 0.50 μg F(-)/mL. Dental fluorosis was detected in 11% of the children, with very mild and mild degrees. Dental fluorosis in primary teeth was associated with lactose intolerance (p < 0.05), but there was no significant association with the use of manufactured soy-based products.

CONCLUSIONS

Isolated consumption of soy-based products recommended by health professionals to children do not offer risk of dental fluorosis in primary teeth, which had a low prevalence and severity.