Sylvia Cruchet M

Prevalencia de hipolactasia en escolares de la Región Metropolitana

La hipolactasia primaria del adulto resulta de la disminucion geneticamente programada de la lactasa intestinal despues del destete. Se estima que alrededor del 75% de la poblacion adulta en el mundo presentaria es hipolactasica. Objetivo: Determinar la prevalencia de hipolactasia en escolares de la Region Metropolitana y su relacion con el consumo de productos lacteos y de calcio. Sujetos y metodos: Se realizo un estudio transversal en una muestra de 326 escolares de 7 a 18 anos pertenecientes a 6 establecimientos educacionales de distintos niveles socioeconomicos en Santiago. A cada sujeto se les realizo una prueba de hidrogeno en aire espirado (HBT) con lactosa y se registro la aparicion de sintomatologia digestiva durante la prueba. Tambien se realizo una encuesta de tendencia de consumo de productos lacteos para determinar la ingesta de calcio. Resultados: 42.3% de los escolares eran hipolactasicos y presentaron una mayor prevalencia de sintomatologia digestiva comparado con aquellos sujetos lactasa-persistente(81.9% vs. 70.2%; p=0.019); dicha sintomatologia, ademas, fue mas intensa en los hipolactasicos(p<0.00). La ingesta de calcio de origen lacteo fue de 492.5±22.5 mg/dia, sin diferencias segun el estado hipolactasico/lactasa-persistente o el nivel socioeconomico de los sujetos. Dicha ingesta cubre solo el 37.9±1.7% de los aportes recomendados de calcio. Conclusiones: la poblacion de escolares estudiada se caracteriza por tener un porcentaje de hipolactasia alta y aportes dietarios de calcio de origen lacteo bajos. Estos datos son de importancia para desarrollar programas destinados a aumentar el consumo de calcio para mejorar la salud osea de la poblacion.

Tiempo de exposición al gluten y marcadores de riesgo de diabetes mellitus insulino dependiente en pacientes celíacos

158 celiac patients were classified as: G1, (n=30 patients)studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliancewith the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten freediet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using mon-key pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units.

Anticuerpos anti-transglutaminasa tisular: ¿una mejor prueba para detectar transgresiones menores de la dieta en pacientes celíacos?

Background: Endomysium antibodies (EMA) do not detect minor dietary transgressions in patients with celiac disease. Aim: To compare the sensitivity and specificity of tissue transglutaminase antibodies (tTGA) and endomysium antibodies (EMA) in biopsy proven celiac patients at the time of diagnosis and during gluten free diet (GFD). Patients and methods: One hundred fifty three subjects were studied: a) 30 healthy controls; b) 9 cases with cows milk allergy; c) 24 celiac patients at time of diagnosis; d) 25 celiac patients adhering to the GFD; e) 65 celiac patients with poor/no adhesion to GFD. EMA and tTGA IgA were measured by immunofluorescence and ELISA, respectively. Results: Sensitivity and specificity were 100% and 97.4% for tTGA, respectively. All patients with cows milk allergy were EMA (-) and 8 of 9 (88.9%) were tTGA (-). In celiac patients not adhering to the GFD, EMA and tTGA positivity were similar (80% and 81,5%, respectively); 95,4% of the subjects tested positive for at least one of them. All patients adhering to GFD were EMA (-) but tTGA were (+) in 28% of them. Conclusions: EMA and tTGA have similar sensitivity and specificity at the time of diagnosis of celiac disease. Positive tTGA in 28% of patients that adhered strictly to the GFD and whose EMA were negative suggest that tTGA may be helpful in detecting minor dietary transgressions and should be further evaluated (Rev Med Chile 2003; 131: 25-29)

Contrapruebas en el diagnóstico y seguimiento de niños con alergia alimentaria

Background: The prevalence of food allergy increased worldwide in the last century. In Chile we became aware of this increase 10-15 years ago, after an epidemiological transition on health. Aim: To assess the most frequent clinical presentations of food allergy, results of circulating immunologlobulins (total IgE, specific IgE and IgG4 against cows milk) and usefulness of a standardized challenge test. Patients and methods: Cross sectional assessment of 49 patients with cows milk allergy (9 months - 8 years of age), diagnosed at INTA, University of Chile between 1991-2001. Results: All patients had cows milk allergy and 37% of them were additionally intolerant to other allergens. Seventy eight percent had digestive symptoms and 84% had non digestive symptoms. The cause of consultation was a non-digestive manifestation in 16% of cases. At least one of the immunoglobulins (total IgE total, specific IgE or IgG4) was over the cut off point in 92% of patients. Between 1990-1995 six patients were diagnosed with cows milk allergy and malabsorption syndrome. Suppression of the specific allergen resulted in disappearance of symptoms in 78% of patients; when a second dietary modification was necessary 87% of cases showed a good response. Thirty five of 56 challenge tests performed were done at home, by relatives, in a non-controlled fashion. All of them were aimed to determine the desensitization of the child. Conclusions: Digestive and non-digestive manifestations were observed in these patients with food allergy. Although not designed to assess laboratory tests, results show that serum immunoglobulin determinations were helpful in guiding diagnosis. Mothers and relatives should be educated to accept diagnostic challenges and avoid carrying out non-controlled challenges (Rev Med Chile 2003; 131: 275-82).

REGULACIÓN DE LA MICROBIOTA INTESTINAL EN VOLUNTARIOS SANOS MEDIANTE EL CONSUMO DE UN PRODUCTO CON EL PROBIÓTICO Lactobacillus johnsonii La1

Resumen es: Uno de los principales mecanismos implicados en las propiedades saludables de los probioticos es su capacidad de mantener la homeostasis de la microbiota...

DIETA LIBRE DE GLUTEN Y DISMINUCIÓN DEL RIESGO DE ASOCIACIÓN DE ENFERMEDADES AUTOINMUNES EN EL PACIENTE CELIACO

Estudios publicados concluyen que el desarrollo de enfermedades autoinmunes en pacientes celiacos se incrementa al aumentar el tiempo de exposicion al gluten y cuanto mayor sea la edad al diagnostico. La adolescencia constituye un periodo de la vida en el cual una dieta libre de gluten frecuentemente se abandona. Por esto es de suma importancia investigar marcadores inmunologicos endocrinos en pacientes celiacos que cumplen o no la dieta libre de gluten

Morbilidad y estado nutricional en lactantes de alto riesgo. Estudio de terreno

Morbidity and nutritional status in children of high risk of morbidity. A field study A predictive model which identifies infanls with four or five times higher morbidity rotes than unselecled populalion, was used to evaluate 108 infants.. 41 of whom lost 10% or more of their weighl/age ratio along a six monlh follow up. Frecuencies and type of diseases did not allow to differenciale patients whose nutrition deteriorated from Ihose in which it did not. The greatest decreases of weigh for age were observed in the second six months of life. In 77.1 % of children weight gain improved after 1 2 months of age, when energetic requirements decrease. Results suggesl that the risk for health of those children may be rather associated with maternal inappropriate practices than lo biological or environmental variables.