Tania Beninga Morais

Enteroaggregative Escherichia coli in infant feeding bottles

1448 Vol 349 • May 17, 1997 aged 62 (SD 19) years old. 4-day prophylaxis with nadroparin increased serum potassium by 5% from 4·06 (0·38) to 4·25 (0·40) mmol/L (p<0·001). The potassium increase was also significant in patients without renal diseases. The highest rise of serum potassium was observed (from 5·11 to 5·70 mmol/L) in an individual in the subgroup with renal failure (creatinine clearance 10–49 mL/min, serum creatinine 108–529 μmol/L). In diabetic patients (HbA1c 6·0–8·4%) potassium increase was marginal, which may be due to the fact that during the 4 days in hospital blood glucose fell under treatment from 7·0–15·5 mmol/L to 5·4–7·6 mmol/L, causing a shift of potassium into intracellular compartments. No correlation was found between age and potassium change. In 11 patients we had the opportunity to measure serum potassium again 3 days after nadroparin withdrawal and found a lower value than when they were on nadroparin in eight of them. We conclude that even the lowest dose of nadroparin used for prophylaxis of thromboembolism increases serum potassium. Potassium should be monitored during the administration of low-molecular-weight heparin at least in patients with concentrations greater than 5 mmol/L.

Excess sodium and insufficient iron content in complementary foods

OBJECTIVES To determine, by chemical analysis, the macronutrient, energy, sodium, and iron contents of homemade foods prepared for infants in two socioeconomic classes in Belém, state of Pará, Brazil. METHODS Cross-sectional study of 78 infants (aged 6 to 18 months) distributed into two groups according to socioeconomic status (high or low). Chemical analyses were performed on samples of homemade complementary foods prepared for each infants lunch. Daily food intake was estimated on the basis of two 24-hour dietary intake recall. RESULTS Chemical analyses showed that the energy content of some food samples was lower than recommended, both in the low socioeconomic status (SES) group (29.8% of samples) and in the high-SES group (43.0%; p = 0.199). The iron content of all samples, regardless of group, was lower than minimum recommended levels (6.0 mg/100 g). On the other hand, excessive sodium levels (200 mg/100 g) were found in 89.2 and 31.7% of samples in the low- and high-SES groups, respectively (p = 0.027). Dietary recalls showed that energy intake exceeded 120% of the Estimated Energy Requirement in 86.5% of infants in the low-SES group and 92.7% of those in the high-SES group (p = 0.483). Lunch and dinner provided 35.2+/-14.6 and 36.4+/-12.0% of daily energy intake in the low- and high-SES groups, respectively (p = 0.692). CONCLUSION Homemade complementary foods for infants were found to be low in iron. A significant portion of samples had excessive sodium content, most frequently those prepared for infants in low-SES status families.

Excesso de sódio e déficit de ferro em alimentos de transição

OBJETIVOS: Determinar, por analise quimica, a composicao nutricional de macronutrientes, energia, sodio e ferro de alimentos preparados no domicilio para lactentes de dois estratos socioeconomicos em Belem (PA). METODOS: Estudo transversal com 78 lactentes (6 a 18 meses) distribuidos em dois grupos com condicao socioeconomica alta ou baixa. Foi realizada analise quimica de amostras de alimentos de transicao preparados no domicilio para o almoco. Foi estimada a ingestao alimentar diaria, com base em dois inqueritos alimentares de 24 horas. RESULTADOS: As analises quimicas revelaram que parcela das amostras dos alimentos apresentava baixo teor de energia em relacao ao recomendado, tanto no estrato socioeconomico baixo (29,8%) como no alto (43,0%; p = 0,199). Todas as amostras analisadas, em ambos os grupos, apresentaram quantidade de ferro abaixo do minimo recomendado (6,0 mg/100 g). Por outro lado, excesso de sodio (200 mg/100 g) foi constatado em 89,2 e 31,7%, respectivamente, das amostras dos grupos de baixo e alto nivel socioeconomico (p = 0,027). De acordo com os inqueritos alimentares, a estimativa da ingestao energetica foi maior que 120% da necessidade media estimada em 86,5% dos lactentes do grupo de nivel socioeconomico baixo e em 92,7% do alto (p = 0,483). O almoco e o jantar forneceram 35,2±14,6 e 36,4±12,0% da energia, respectivamente, nos grupos de baixo e alto nivel socioeconomico (p = 0,692). CONCLUSAO: Alimentos de transicao preparados no domicilio para lactentes apresentaram baixo teor de ferro. Parcela expressiva das amostras apresentou quantidade excessiva de sodio, mais frequentemente nos alimentos preparados para os lactentes de baixo nivel socioeconomico.

Qualidade nutricional e microbiológica de dietas enterais artesanais padronizadas preparadas nas residências de pacientes em terapia nutricional domiciliar

OBJETIVO: Avaliar as propriedades fisico-quimicas, microbiologicas e nutricionais de dietas enterais artesanais padronizadas preparadas nos domicilios de pacientes em terapia nutricional domiciliar. METODOS: Foram desenvolvidas duas formulacoes de dietas enterais (F1=1,2kcal/mL e F2=1,5kcal/mL), elaboradas com maltodextrina (155/155g), concentrado proteico de soro de leite (30/15g) e oleos vegetais (30/60g) dissolvidos em agua (q.s.p.1000mL). Os cuidadores receberam os ingredientes e as medidas padrao e foram orientados quanto ao preparo e as boas praticas de manipulacao. O estudo teve duracao de quatro meses, e amostras das dietas preparadas nos domicilios de 33 pacientes foram coletadas e analisadas no inicio e no final deste periodo. As amostras foram avaliadas quanto a sua adequacao percentual em relacao aos valores prescritos de macronutrientes e energia, bem como aos padroes microbiologicos estabelecidos pela legislacao vigente. RESULTADOS: As dietas formuladas (Formulacao 1/Formulacao 2) apresentaram os seguintes teores de macronutrientes, energia e osmolalidade: agua - 73,5/70,0%; proteina - 4,4/6,0%; lipideo - 4,3/6,6%; carboidrato - 16,9/16,4%; energia - 120/150kcal/100mL; osmolalidade - 440/450mOsm/kg.H2O. As variacoes nas adequacoes percentuais das amostras domiciliares foram menores que 20,0% tanto na primeira quanto na ultima amostragem. As proporcoes de amostras em desacordo com os padroes legais foram significantemente menores nas amostras finais, 24,0% e 36,0% para bacterias mesofilas e coliformes, respectivamente. CONCLUSAO: O preparo das dietas nos domicilios apresentou boa reprodutibilidade; no entanto, a qualidade microbiologica ainda permanece uma questao preocupante, exigindo uma atuacao cuidadosa do profissional de saude nos domicilios.

Nutritional composition, assessed by chemical analyses, of prepared foods available for primary-school children: a comparison of public and private schools.

OBJECTIVE To assess the nutritional quality of prepared foods available to primary-school children. DESIGN Prepared foods available in a public and private school were sampled daily for 4 weeks (a total of forty-five samples) and chemically analysed for protein, fat, carbohydrate, iron, salt and sodium. The results were compared to the nutritional standards for children aged 7-10 years. SETTING Alfenas, south-eastern Brazil. RESULTS The concentration of protein, lipid, iron and sodium and the energy values of the foods at the private school were significantly higher than those at the public school. No differences were seen in the carbohydrate and salt values. The range of macronutrients was more balanced at the public school in relation to fat and protein. Foods at the private school were, in general, energy-dense. At both the public and private school, they provided the minimum energy and iron. Salt content was over twice the maximum amount, and that for sodium was over three times the amount, in both the public and private school. CONCLUSIONS Overall, foods prepared at the public school were better nutritional quality than those at the private school and those offered in public schools in some developed countries. This finding can probably be explained by the fact that a nutritionist, as required by law, was responsible for planning the menus at the public school. However, corrective action is needed to adjust for the wide variability in energy and nutrient content during weekdays and in the sodium content of prepared foods available in both the public and private school.

Determination of Macronutrients, by Chemical Analysis, of Home-Prepared Milk Feeding Bottles and their Contribution to the Energy and Protein Requirements of Infants from High and Low Socioeconomic Classes

Objectives: To determine the macronutrients composition of home-prepared milk feeding bottles, by chemical analysis, and assess their contribution to the energy and protein requirements of children under two years of age from high (HSE) and low (LSE) socioeconomic classes. Methods: 72 samples were analyzed for energy density and protein, fat and carbohydrate content: 41 from the LSE group and 31 from the HSE group. The assessment of the percentages of the energy and protein requirements met by the consumption of the milk bottles was calculated as follows: the energy and protein per 100 mL obtained through chemical analysis were multiplied by the volume consumed at each feeding, then by the number of feedings per day, the results divided by the energy and protein requirements and multiplied by 100. Energy and protein requirements were those recommended by the FAO/WHO/UNU Committee and the Food and Nutrition Board. The children’s weight-for-age index was assessed. Results: Unmodified cow’s milk was largely consumed by both groups. The addition of sugar and other ingredients to the milk was significantly higher in the LSE group. Moisture, protein and fat content were lower in the LSE group, whereas carbohydrate and energy content were higher. The percentages of energy and protein requirements provided by feeding bottles were higher in the LSE group. Children in the LSE group had lower z-scores for weight-for-age. Conclusions: Differences in the preparation practices led to differences in the chemical results. The feeding bottles in the LSE group were high in energy, due to the addition of sugar and cereals to the milk in the bottle. The milk feeding bottles were an important weaning food providing more than 50% and 100% of the children’s energy and protein requirements, respectively. The children’s weight-for-age index was within the normal limits.

[Effect of in-home boiling and refrigeration on bacterial load of pasteurized milk]

OBJECTIVES: To assess the efficacy of in-home boiling of pasteurized milk in reducing the bacterial load and the ability of the refrigeration in preserving the milk after boiling.METHODS: Thirty samples of pasteurized milk bought in São Paulo, Brazil, were submitted to in-home boiling procedure at the laboratory. Portions of samples were taken before and after boiling, and after 2, 4, 6 and 24 hours under refrigeration for microbiological analyses. Methods used were mesophilic bacteria count, and coliforms and Escherichia coli (E.coli) enumeration.RESULTS: No sample presented mesophilic bacteria count above the Brazilian standard for pasteurized milk. E.coli was not recovered from any sample. Ten samples (33%) had coliform bacteria; of these, 3 samples (10%) were above the standard. Mesophilic bacteria count after boiling was significantly lower than before boiling. After 24 hours under refrigeration, mesophilic bacteria count was significantly higher than after boiling. No significant differences were found between the intervals of 2, 4, 6 and 24 hours under refrigeration. Samples before boiling presented significantly higher coliform bacteria. No coliform bacteria were recovered at any time after boiling.CONCLUSIONS: In-home boiling of milk reduced bacterial load, while refrigeration kept bacteria under low counts.

O trabalho sob a ótica das manipuladoras de alimentos de uma unidade hospitalar

OBJETIVO: Analisar as percepcoes acerca da atividade profissional de um grupo de manipuladores de alimentos de um hospital publico. METODOS: A pesquisa, de cunho qualitativo, foi realizada em um servico de nutricao e dietetica de um hospital publico de ensino da Cidade de Sao Paulo. Desenvolveu-se a partir de corpus obtido por tecnica do grupo focal realizada com 15 funcionarias, sendo 8 vinculadas ao lactario e 7 a cozinha dietetica. Os depoimentos foram gravados, transcritos e analisados sob o ponto de vista do conteudo e das representacoes sociais. Posteriormente, a validacao da analise foi realizada com as participantes. A caracterizacao socioeconomica foi realizada com uso de um formulario auto-aplicavel. RESULTADOS: O trabalho e percebido como crucial para a sobrevivencia, porem de grande responsabilidade social, alem de implicar em rotina exaustiva. Alem disso, constitui instância que possibilita apoio e relacionamento entre as trabalhadoras, embora nao lhes proporcione o status que julgam merecer. O trabalho e representado como instância simultânea de sofrimento e apoio; embora importante, tanto para elas mesmas, quanto para o grupo social. Ao mesmo tempo, chefias e os superiores se mostram alheios a todas as dificuldades. CONCLUSAO: Por consequencia, percebe-se que ha necessidade de mudancas na organizacao do trabalho, a fim de reduzir os fatores que ocasionam cansaco, descontentamentos e desânimo nas manipuladoras. Faz-se necessario maior investimento, por parte da chefia do servico, na adocao de estrategias gerenciais mais descentralizadas e participativas, respeitando, na medida do possivel, as opinioes e diferencas individuais, bem como investindo em treinamentos periodicos dos trabalhadores.

Validation and application of a method for the simultaneous absolute quantification of 16 neutral and acidic human milk oligosaccharides by graphitized carbon liquid chromatography – electrospray ionization – mass spectrometry

Human milk oligosaccharides (HMOs) are free glycans naturally present in human milk that act as prebiotics, prevent pathogen binding, modulate the immune system and support brain development in infants. The HMOs composition and concentrations vary significantly among different women mainly because of the direct influence of the Secretor and Lewis phenotypes on HMOs biosynthesis. Analytical methods that can identify the differences in the HMOs composition and concentrations are a fundamental tool in HMOs research. This paper describes a simple HMOs extraction and analysis for the simultaneous and absolute quantification of neutral and acidic HMOs by graphitized carbon liquid chromatography-electrospray ionization-mass spectrometry. This method was validated and applied to analyze HMOs in the human milk obtained from 10 women. This method allows accurate and reliable quantification of HMOs and can be used to determine differences in HMOs concentrations throughout lactation and among women with different Secretor and Lewis phenotypes.

Public Daycare Noncompliance with Prescribed Lunch Menus and Dietary Guidelines

Objective: In Brazil, menus for public child daycare centers (PDC) must be planned by a nutritionist in order to meet the infants’ nutritional needs and to conform to dietary recommendations. Failure to follow them may jeopardize the infants’ health and growth. Therefore, the objectives of this study were to investigate the compliance of actually served lunch menus with the prescribed menus, according to age (7- to 12-month-olds and 13- to 24-month-olds) and whether prescribed and served menus followed the recommended dietary guidelines. Methods: Five PDCs were randomly selected for observation, out of 14 existing in the city of Concordia, Brazil. Data collection was carried out during 6 consecutive weeks in September (fall/winter menus) and October (spring/summer menus) in order to cover the menus representative of the entire year. Results: Of 60 lunches recorded, only 20% of them matched the prescribed ones entirely; none of the lunches served to infants aged 7–12 months did so. Fourteen food items were prescribed 157 times throughout the year. Omission (number of times on menu but not served) was the most frequent form of noncompliance in the younger group: 62.4% (98/157). Foods more frequently omitted by the cooks were beef, pork, chicken, and lentils. Compliance with dietary guidelines was higher in the prescribed menus and in those actually served to the 13- to 24-month-old age group. Conclusions: Infants in the 7- to 12-month-old group may be more vulnerable to nutritional inadequacies because menus served to them were less compliant with the prescribed menus. Dietetics professionals should improve the variety of foods on the menus as well as supervise their execution.