RESUMO
O marketing faz parte do cotidiano, vivenciado por praticamente todos. No entanto, o marketing de fórmulas lácteas é diferente do marketing de itens de uso diário, como xampu, sapatos ou geladeiras. As práticas alimentares das crianças nos primeiros 3 anos de vida afetam profundamente a sua sobrevivência, saúde e desenvolvimento ao longo da vida. A decisão de como alimentamos nossos bebês e crianças deve, portanto, ser baseada nas melhores informações e evidências verdadeiras, influenciadas apenas pelo que é melhor para a criança e os pais e livre de interesses comerciais. Em 1981, a 34ª Assembleia Mundial da Saúde adotou o Código Internacional de Comercialização de Substitutos do Leite Materno (o Código) para regular a comercialização de substitutos do leite materno. Quarenta anos depois, o marketing de fórmula láctea ainda representa um dos riscos mais subestimados para a saúde de bebês e crianças. Aumentar o aleitamento materno poderia prevenir cerca de 800.000 mortes de crianças menores de 5 anos e 20.000 mortes por câncer de mama entre as mães a cada ano. Apesar do Código e das subsequentes resoluções relevantes da Assembleia Mundial da Saúde, as empresas de fórmula láctea continuam a colocar as vendas e os interesses dos acionistas antes da saúde infantil e da população. Este relatório extrai informações de um grande estudo, encomendado pela Organização Mundial da Saúde e pelo Fundo das Nações Unidas para a Infância, realizado ao longo de dois anos. O estudo buscou ouvir diretamente as mulheres e aqueles que as influenciam profissionais de saúde, parceiros, familiares membros e amigos sobre sua exposição e experiência no marketing de fórmula láctea. Oito países foram incluídos Bangladesh, China, México, Marrocos, Nigéria, África do Sul, Reino Unido da Grã-Bretanha e Irlanda do Norte, e Vietnã representativos de países em suas regiões, mas diversos em seus níveis de renda, taxas de aleitamento materno exclusivo e implementação do Código. O estudo foi realizado em populações urbanas onde as tendências e valores sobre as práticas de alimentação infantil são estabelecidas e disseminadas para outras comunidades. O que emerge desta pesquisa é o quadro mais completo até o momento das experiências de mães e profissionais de saúde no marketing fórmula láctea e é profundamente preocupante.
Assuntos
Humanos , Lactente , Aleitamento Materno , Indústria Alimentícia , Saúde da Criança , Marketing , Fórmulas Infantis/efeitos adversosRESUMO
OBJECTIVES: To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition. STUDY DESIGN: In a 36-month prospective cohort study, the occurrence of other atopic manifestations (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E-mediated children with cow's milk allergy (CMA) treated with extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG (EHCF + LGG), rice hydrolyzed formula, soy formula, extensively hydrolyzed whey formula (EHWF), or amino acid-based formula. RESULTS: In total, 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of atopic manifestations was 0.22 (Bonferroni-corrected 95% CI 0.09-0.34) in the EHCF + LGG cohort; 0.52 (0.37-0.67) in the rice hydrolyzed formula cohort; 0.58 (0.43-0.72) in the soy formula cohort; 0.51 (0.36-0.66) in the EHWF cohort; and 0.77 (0.64-0.89) in the amino acid-based formula cohort. The incidence of atopic manifestations in the rice hydrolyzed formula, soy formula, EHWF, and amino acid-based formula cohorts vs the EHCF + LGG cohort was always greater than the prespecified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46-3.86, P < .001) for rice hydrolyzed formula vs EHCF + LGG; 2.62 (1.63-4.22, P < .001) for soy formula vs EHCF + LGG; 2.31 (1.42-3.77, P < .001) for EHWF vs EHCF + LGG; and 3.50 (2.23-5.49, P < .001) for amino acid-based formula vs EHCF + LGG. The 36-month immune tolerance acquisition rate was greater in the EHCF + LGG cohort. CONCLUSIONS: The use of EHCF + LGG for CMA treatment is associated with lower incidence of atopic manifestations and greater rate of immune tolerance acquisition.
Assuntos
Asma/prevenção & controle , Conjuntivite Alérgica/prevenção & controle , Dermatite Atópica/prevenção & controle , Tolerância Imunológica , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Rinite Alérgica/prevenção & controle , Aminoácidos , Asma/epidemiologia , Asma/imunologia , Caseínas , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Conjuntivite Alérgica/imunologia , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Fórmulas Infantis/efeitos adversos , Fórmulas Infantis/química , Fórmulas Infantis/microbiologia , Lacticaseibacillus rhamnosus , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/imunologia , Oryza , Probióticos/uso terapêutico , Estudos Prospectivos , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , Glycine max , Resultado do Tratamento , Soro do LeiteRESUMO
OBJECTIVE: To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk. STUDY DESIGN: We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals. RESULTS: At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections. CONCLUSIONS: Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.
Assuntos
Asma/etiologia , Aleitamento Materno , Fórmulas Infantis/efeitos adversos , Asma/prevenção & controle , Extração de Leite , Canadá , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Proteção , Fatores de RiscoRESUMO
BACKGROUND: Cow's milk protein allergy is the main allergic problem during the first year of life, possibly owing to immune and gastrointestinal systems poor maturation. To prevent allergic reactions, the content and type of proteins in infant formulas resemble those of breast milk. We believe that reactions are due rather to the amount than to the type of protein. OBJECTIVE: To design a new formula with cow's milk that provides the infant with the main nutrients at an affordable cost and with lower risk for the development of allergies. METHODS: Three-phase project: product design, industrial production and ex vivo assay to assess for anemia and type I allergic reaction by CD63 expression in basophils. RESULTS: For every 100 calories, the content of protein was 2.0 g, carbohydrates 7.2 g and fat 0.5 g, which is higher than the indicated maximum value (4.5 g). Microbiologically, it was an innocuous food. CD63 expression was low in 57.1% of the babies and high in 42.9%. CONCLUSION: The new formula did not trigger any allergenic responses and can therefore be supplied to non-atopic infants.
Antecedentes: La alergia a las proteínas de la leche de vaca es el principal problema alérgico durante el primer año de vida, debido a la poca maduración de los sistemas inmunológico y gastrointestinal. Para evitar reacciones alérgicas, el contenido y tipo de proteínas de las fórmulas infantiles se asemejan a los de la leche materna. Conforme un principio de alergología, probablemente las reacciones se deben a la cantidad de proteínas más que al tipo. Objetivo: Diseñar una nueva fórmula con leche de vaca que aporte al lactante los principales nutrientes, a un bajo costo y con menor riesgo de padecer alergias. Métodos: Proyecto realizado en 3 fases: diseño del producto, producción industrial y ensayo ex vivo para evaluar mediante la expresión del CD63 en basófilos la presencia de anemia y reacción alérgica tipo I en lactantes. Resultados: Por cada 100 calorías, el contenido de proteínas fue de 2 g, de carbohidratos de 7.2 g y de grasa de 0.5 g, mayor al valor máximo indicado (4.5 g). Microbiológicamente, la fórmula láctea propuesta se trató de un alimento inocuo. La expresión del CD63 fue baja en 57.1 % de los lactantes y alta en 42.9 %. Conclusión: La nueva fórmula no desencadenó respuesta alergénica, por lo tanto, puede suministrarse a lactantes no atópicos.
Assuntos
Fórmulas Infantis/efeitos adversos , Hipersensibilidade a Leite/etiologia , Leite/efeitos adversos , Animais , Basófilos/química , Bovinos , Carboidratos da Dieta/análise , Gorduras na Dieta/análise , Proteínas Alimentares/análise , Citometria de Fluxo , Aditivos Alimentares , Microbiologia de Alimentos , Hematócrito , Hemoglobinas/análise , Humanos , Lactente , Leite/química , Leite/microbiologia , Valor Nutritivo , Tetraspanina 30/biossínteseRESUMO
Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows' milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows' milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows' milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows' milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future interventions.
Assuntos
Fórmulas Infantis , Interleucina-9/sangue , Interleucinas/sangue , Hipersensibilidade a Leite/dietoterapia , Hidrolisados de Proteína/administração & dosagem , Proteínas de Soja/administração & dosagem , Brasil , Eosinofilia/sangue , Eosinofilia/dietoterapia , Eosinofilia/imunologia , Feminino , Humanos , Lactente , Fórmulas Infantis/efeitos adversos , Interleucina-13/sangue , Interleucina-4/sangue , Masculino , Hipersensibilidade a Leite/sangue , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/imunologia , Estudos Prospectivos , Hidrolisados de Proteína/efeitos adversos , Proteínas de Soja/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Interleucina 22RESUMO
Breastfeeding is the nourishment designed by nature for the newborn and the infant; however its prevalence is nowadays not optimal. The aim of this article is to review the current evidence of the benefits of breastfeeding for children and society, and to elaborate the risks associated with the replacement of lactation with baby formulas. Breastfeeding is a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukaemia, necrotising enterocolitis, celiac disease, and inflammatory bowel disease. It also has a positive impact on neurodevelopment, improving IQ and reducing the risk of attention deficit disorder, and generalised developmental and behavioural disorders. Lactation can decrease the risk of sudden infant deaths syndrome by 36% and prevent 13% of infant mortality worldwide. Breastfeeding result in direct saving on the use of infant formulas and bottles, and indirectly on associated health costs, premature deaths, and quality-adjusted life years, among others. In addition, breastfeeding is environmentally friendly; it does not leave an ecological footprint in its production and consumption. The use of baby formulas and bottles have inherent risks, because they increase the risk of oral diseases, such as mouth breathing, malocclusion, alteration of bite, and tooth decay. Finally, the intestinal microbiota, oxygenation, and thermoregulation of infants are negatively affected by their use.
Assuntos
Aleitamento Materno , Fórmulas Infantis , Feminino , Microbioma Gastrointestinal , Humanos , Lactente , Fórmulas Infantis/efeitos adversos , Saúde do Lactente , Recém-Nascido , Fatores de Proteção , Anos de Vida Ajustados por Qualidade de VidaRESUMO
La lactancia materna (LM) es el alimento diseñado por la naturaleza para el recién nacido y el lactante, sin embargo su prevalencia actual no es la óptima. El objetivo de este artículo es revisar la evidencia actualizada de los beneficios de la LM para el niño y la sociedad, y recordar los riesgos asociados al reemplazo de ésta con fórmulas lácteas. La lactancia ha demostrado ser un factor protector contra distintas enfermedades infectocontagiosas, del espectro atópico y cardiovasculares, así como contra la leucemia, enterocolitis necrotizante, enfermedad celíaca y enfermedades inflamatorias intestinales. Asimismo, tiene un impacto positivo en el neurodesarrollo, mejorando el coeficiente intelectual y pudiendo tener una disminución del riesgo de otras condiciones como el déficit atencional, trastorno generalizado del desarrollo y alteraciones de conducta. La LM puede prevenir un 13% de la mortalidad infantil en el mundo, y disminuye el riesgo de muerte súbita del lactante en un 36%. La lactancia implica un ahorro directo en el uso de fórmulas lácteas y mamaderas, e indirecto en costos de salud asociados, muertes prematuras y años de vida ajustados por calidad, entre otros. Además, es medioambientalmente amigable sin dejar trazas de huella de carbono en su producción y consumo. El uso de fórmulas lácteas y mamaderas tienen riesgos inherentes asociado, aumentan el riesgo de las alteraciones de la cavidad oral, tales como respiración bucal, maloclusión, alteración de la mordida y caries. Por último, la microbiota intestinal, la oxigenación y la termorregulación de los lactantes se ven afectadas negativamente por su uso.
Breastfeeding is the nourishment designed by nature for the newborn and the infant; however its prevalence is nowadays not optimal. The aim of this article is to review the current evidence of the benefits of breastfeeding for children and society, and to elaborate the risks associated with the replacement of lactation with baby formulas. Breastfeeding is a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukaemia, necrotising enterocolitis, celiac disease, and inflammatory bowel disease. It also has a positive impact on neurodevelopment, improving IQ and reducing the risk of attention deficit disorder, and generalised developmental and behavioural disorders. Lactation can decrease the risk of sudden infant deaths syndrome by 36% and prevent 13% of infant mortality worldwide. Breastfeeding result in direct saving on the use of infant formulas and bottles, and indirectly on associated health costs, premature deaths, and quality-adjusted life years, among others. In addition, breastfeeding is environmentally friendly; it does not leave an ecological footprint in its production and consumption. The use of baby formulas and bottles have inherent risks, because they increase the risk of oral diseases, such as mouth breathing, malocclusion, alteration of bite, and tooth decay. Finally, the intestinal microbiota, oxygenation, and thermoregulation of infants are negatively affected by their use.
Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Aleitamento Materno , Fórmulas Infantis/efeitos adversos , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Proteção , Microbioma Gastrointestinal , Saúde do LactenteRESUMO
Health care professionals should become familiar with the follow up of a newborn (NB) growth as well as the techniques and the criteria used in its evaluation. It aimed to evaluate the weight gain of premature newborns at a Neonatal Unit and describe the variables on feeding and types of milk, medications, and gastrointestinal alterations that have been influencing on their weight gain. Exploratory-descriptive study carried out with eighteen premature newborns hospitalized in a maternity of Fortaleza-Ceará-Brazil, from July to August 2005. The data about daily weight, ways and type of feeding, use of medications, gastrointestinal alterations were extracted from patient Ìs records. It was identified that 16 (88.9%) were moderate preterm, and 10 (55.6%) were low birth weight (<2.500g) babies. The findings showed a gain of 20 to 30g of weight per day, which is considered satisfactory; however, it had influences on the nutrition with the use of nutritional supplements and antibiotics. It was concluded that the weight evaluation of premature babies is a strategy to promote health at Neonatal Intensive Care Unit.
Os profissionais de saúde devem se familiarizar com o acompanhamento do crescimento do recém-nascido (RN) e com as técnicas e critérios utilizados em sua avaliação. O presente estudo objetivou avaliar a evolução ponderal dos RN prematuros de uma unidade neonatal, descrever as variáveis via de administração e tipo de leite, terapêutica medicamentosa e alterações gastrintestinais como aspectos influenciadores do ganho ponderal do prematuro. É um estudo exploratório-descritivo realizado com dezoito RNs pré-termo internados em uma maternidade em Fortaleza Ceará - Brasil, de julho a agosto de 2005. Foram extraídos dos prontuários dados do peso diário, tipo e via de alimentação, uso de medicações e alterações gastrintestinais. Identificaram-se dezesseis (88,9%) RNs pré-termo moderados e 10 (55,6%) de baixo peso (<2.500g). Os resultados evidenciaram ganho ponderal diário de 20 a 30g, considerado satisfatório, no entanto, com influências na nutrição, uso de suplementos nutricionais e antibióticos. Concluiu-se que a avaliação ponderal da criança prematura é uma estratégia para promoção da saúde na unidade neonatal.