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RESUMEN. A fin de conocer la prevalencia de anemia, deficiencias de hierro (DH) y vitamina A y diseñar estrategias de prevención se estudiaron 414 niños/as de 6 a 24 meses de edad, seleccionados aleatoriamente en toda la provincia de Chaco. Se realizó una encuesta y se determinó hemoglobina (Hb), ferritina y retinol plasmáticos. La prevalencia de anemia (Hb < 110 g/L) fue 66,4%, similar en distintos grupos de edad e incluyó a 18% con Hb < 90 g/L. La proporción de estos casos fue menor en niños de 6 a 8 meses de edad (5.1 %) que en los demás (@ 20 %) (P = 0.007). El promedio de Hb fue más alto en los niños de 6 a 8 meses que en el resto, asociándose con menor prevalencia de DH (ferritina < 12 µg/L) (p < 0.000) y no con la edad (F: 0.245 p= 0.8865). La prevalencia de DH, presente en el 36.6% en este grupo de edad, aumentó a 72.9% en los mayores de 18 meses. La prevalencia de anemia fue significativamente más alta en: varones; en nacidos con peso < 3000g; en niños que nunca tomaron suplementos de hierro y en los pobres. La deficiencia de Vitamina A se observó en el 5.1% de los casos. (Retinol < 20 my g /dl) La precocidad con la que aparecen altas prevalencias de anemia y la gravedad de la misma en el segundo año de vida, exigen la aplicación de estrategias para mejorar la nutrición de hierro antes y durante el embarazo, en el período perinatal y los dos primeros años de vida. Estas estrategias deben basarse en el empoderamiento de las comunidades y promover la ligadura oportuna del cordón umbilical.SUMMARY: To determine the prevalence of anemia, and iron (ID) and vitamin A deficiencies aiming at their prevention, 414 children between 6 and 24 months of age, were randomly selected from the whole province of Chaco. A sociodemographic survey was implemented, and hemoglobin (Hb), plasma ferritin and retinol were measured. Anemia prevalence (Hb @ 20 %) (P: 0.007). Mean Hb was also higher in 6 - 8 months old children and was associated with lower prevalence of ID (ferritin

El propósito es conocer las prevalencias de deficiencia de hierro y anemia gestacional, y sus asociaciones con variables sociales y biológicas, en la provincia de Chaco, Argentina, a fin de iniciar un programa de prevención. Se estudiaron 364 embarazadas aleatoriamente seleccionadas en toda la provincia. La hemoglobina (Hb) promedio ± DS descendió progresivamente de 118.4 ±11.0 a 112.1± 11.5 g/L (p = 0.015) entre el 1er y el 3er trimestre gestacional. La prevalencia de anemia (Hb < 110 g/L) fue de 17.4, 26.5 y 35.8% del 1º al 3º. La prevalencia en el 2o trimestre fue 14.% usando Hb Iron deficiency and anemia in pregnant women from Chaco, Argentina. Aiming at their prevention, to determine the prevalence of gestational iron deficiency and anemia, considering access to health care and associations with social and biological variables in the Province of el Chaco, Argentina. 364, randomly selected pregnant women from the whole province participated. Mean Hemoglobin (Hb)± SD dropped progressively from 118.4± 11.0 to 112.1± 11.5 g/L (p = 0.015) between the 1st and the 3rd gestational trimesters. Anemia prevalence (Hb < 110 g/L) was 17.4, 26.5 and 35.8%. From the 1st to the 3rd trimesters. Second trimester prevalence was 14.1% using Hb < 105 g/L as recently suggested. The ferritin geometric mean during the progressive gestational trimesters were 28.9; 16.0 and 11.1 µg/L. 21.7, 40.5 and 60.5% had ferritins

The absorption of a commercial brand of small-particle reduced iron was evaluated in 10 normal subjects. For each subject, the hemoglobin incorporation method was used to measure the true absorption of 60 mg of iron from either ferrous sulfate or ferric ammonium citrate. The iron tolerance test (ITT) was also studied for these two compounds and for reduced iron. This procedure consisted of measuring the area under the curve of plasma iron elevations at specified times for 6 hours, or the peak plasma iron, corrected by the plasma iron disappearance rate obtained from measuring plasma iron at specified times for 4 hours after the slow intravenous injection of 0.4 mg of iron as ferric citrate. Only the ITT was used to measure the absorption of 60 mg of reduced iron. Reference dose iron ascorbate absorption was measured in each subject. The absorption of ferric ammonium citrate and reduced iron was expressed as percent of dose and also as absorption percent of that of ferrous sulfate. Mean % geometric "true absorptions" were 39.0 for reference dose, 10.4 for FeSO4 and 2.4 for ferric ammonium citrate. The later was 23% that of FeSO4. By ITT the mean geometric % absorptions were 7.9, 3.7 and 3.2 for FeSO4, ferric ammonium citrate and reduced iron respectively, or 47 and 41% of that of FeSO4. We propose that the true absorption of the commercial brand of reduced iron tested was 20% that of FeSO4 based on the relation between the ITT results of reduced iron and the ITT and true absorption values of ferric ammonium citrate in relation to FeSO4. The use of this method for measuring absorption of unlabeled iron compounds is discussed.Absorción de hierro reducido comercial no-marcado y de partícula pequeña. Un método para predecir la absorción de compuestos no-marcados de hierro en humanos. La absorción de una forma comercial de hierro reducido de partícula pequeña se evaluó en 10 sujetos normales. La incorporación de hierro radioactivo en la hemoglobina se utilizó en cada sujeto para medir la "absorción verdadera" de 60 mg de hierro proveniente de sulfato ferroso o de citrato férrico amoniacal. La prueba de tolerancia de hierro (ITT) se usó también en cada sujeto para evaluar la absorción de hierro de estos dos compuestos y del hierro reducido no-marcado. Esta prueba consiste en medir el área bajo la curva de hierro plasmático obtenida por mediciones periódicas por 6 horas subsiguientes a la administración oral de los compuestos de hierro o por el valor pico de hierro plasmático corregidos por la constante de desaparición plasmática del hierro obtenida por mediciones seriadas de hierro plasmático por 4 horas después de la administración endovenosa lenta de 0.4 mg de hierro como citrato férrico. Para medir la absorción de 60 mg de hierro reducido se utilizó unicamente la prueba ITT. Se midió también la absorción de una dosis oral de referencia ( 3 mg de ascorbato de hierro) en cada sujeto, por incorporación en la hemoglobina. La absorción del citrato férrico amoniacal y la del hierro reducido se expresaron como porcentaje de la dosis administrada y como porcentaje de la absorción de la misma dosis de sulfato ferroso. El promedio geométrico de la "absorción verdadera" de la dosis de referencia fue de 39.0%, la del sulfato ferroso fue de 10.4% y la del citrato férrico amoniacal fue de 2.4%. Esta última fue 23% la absorción del sulfato ferroso. Por la prueba ITT los promedios geométricos de las absorciones fueron 7.9, 3.7 y 3.2% respectivamente para sulfato ferroso, citrato férrico amoniacal y hierro reducido, o sea 47 y 41% de la absorción del hierro de sulfato ferroso por esta prueba. Proponemos que la "absorción verdadera" de la fuente comercial de hierro reducido estudiada fue de 20 % la absorción del hierro del sulfato ferroso, basados en la relación entre los resultados de la prueba ITT para el hierro reducido y las del ITT y la "absorción verdadera" para el citrato férrico amoniacal, en relación a ambos resultados para el sulfato ferroso. Se discute el uso de este método para medir la absorción de compuestos de hierro no-marcados.

Lead is a ubiquitous and neurotoxic heavy metal particularly harmful to children, who are more susceptible than adults to its toxic effects. The prevalence of lead poisoning and iron deficiency (ID) is high in socioeconomically vulnerable child populations, negatively affecting neurocognitive development in children. Although numerous studies have shown the association between blood lead levels (BLL) and ID, the issue remains controversial. Here, we aimed to identify the association between BLL and iron nutritional status in children. We conducted an analytical cross-sectional study of healthy children aged 1-6 y attending periodic health checks in primary healthcare units from La Plata and its surroundings, Buenos Aires, Argentina, between 2012 and 2017. We performed anthropometric evaluations and determined BLL, hemoglobin (Hb) and serum ferritin levels. Blood lead levels ≥ 5 µg/dL were defined as elevated BLL; ferritin levels < 12 ng/ml were considered ID; Hb levels < 11 g/dL (< 11.5 g/dL for children ≥ 5 y) were defined as anemia. Data were analysed using Mann Whitney test, Student´s t-test, chi-square test and logistic regression. The R package (v. 4.2.2.) was used for the statistical analysis of data. The sample included 392 children (mean age, 2.4 ± 1.4 y; 44.6% females). The prevalence of elevated BLL, ID and anemia was 8.7%, 26.3% and 31.8%, respectively. We found a significant association between elevated BLL and ID (odds ratio [OR], 95% confidence interval [CI]: 3.16 (1.50, 6.63)). The prevalence of elevated BLL was 16.2% and 5.8% in children with and without ID, respectively (p = 0.003). We also found association between elevated BLL and anemia (OR 95% CI: 3.03 (1.49, 6.29)). In conclusion, blood lead levels ≥ 5 µg/dL were significantly associated with ID and anemia in children aged 1-6 years., Competing Interests: Declarations. Ethics Approval: The study protocol was approved by the Institutional Research Review Board of IDIP. The study results were communicated to parents/tutors. Children whose BLL were ≥ 5 g/dL were referred to the Toxicology Service for follow-up. Consent to Participate: Written informed consent was signed by all the participating parents and/or tutors and attested by a witness. Conflict of Interest: The authors declare they have nothing to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

During the first thousand days of life, fetus and infant's nutrition depends on mother's diet. Polyunsaturated fatty acids (PUFA) are important substrates in infant neurogenesis. We related erythrocyte membrane (EM) and breast milk fatty acids (FA) profile in lactating mothers with the EM FA profile in exclusively breastfed infants and evaluated maternal fat consumption. We conducted an observational, cross-sectional analytical study. During the 2016-2019 period, milk and blood samples from adult mothers 90 days post-partum and infant's blood were analysed, and FA were determined by GC. A frequency of consumption survey of fatty acids precursor foods and sources was conducted. The sample included forty-five mother-infant EM and forty-five milk samples donated by the same mothers. A low percentage of DHA (0·14 (0·12-0·2)) was found in milk, consistent with mother's low consumption of DHA-rich foods. A significant positive correlation between infant's EM DHA percentage and milk DHA percentage ( r = 0·39; P value 0·008), as well as between infant's EM ω-3 fatty acids sum and milk DHA percentage ( r = 0·39; P value 0·008), was found. When milk had a DHA percentage greater than or equal to 0·20 %, infants had a significant increase in DHA in their EM. Mother's consumption of DHA precursors and sources was NS. The relation between the DHA percentage distribution found in maternal milk, and the DHA percentage distribution found in infant's and mother's EM was proven in this population. Dietary fatty acid intake is associated with the maternal milk lipid distribution and with mothers' and infant's EM fatty acids percentage.

Background: Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added to tap water while complying with drinking water Argentine regulations., Methods: Tap water samples were collected from the Province of Buenos Aires (Argentina). Physicochemical properties and saturation index were measured. Different incremental concentrations of calcium chloride were added to the experimental aliquots., Results: Baseline water had a mean calcium concentration of 22.00 ± 2.54 mg/L, water hardness of 89.9 ± 6.4 mg/L CaCO 3 , and a saturation index of -1.50 ± 0.11. After the addition of 0.4554 ± 0.0071 g of salt, water hard-ness reached 355.0 ± 7.1 mg/L CaCO 3 , a calcium concentration of 140.50 ± 2.12 mg/L, and a saturation index -0.53 ± 0.02., Conclusions: This study shows that at laboratory level it is feasible to increase calcium concentration of drinking water by adding calcium chloride while complying with national standards. Calcium concentration of drinking tap water could be evaluated and minimum calcium concentration of tap water regulated so as to improve calcium intake in populations with low calcium intake., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Matamoros N et al.)

Objective: To simulate the impact on calcium intake - effectiveness and safety - of fortifying wheat flour with 200, 400 and 500 mg of calcium per 100 g of flour., Design: Secondary analysis of cross-sectional data collected through repeated 24 h dietary recalls using the Iowa State University Intake Modelling, Assessment and Planning Program., Setting: Urban cities in the National Health and Nutrition Survey of Argentina (ENNyS 2018-2019)., Participants: 21 358 participants, including children, adolescents and adults., Results: Most individuals in all age groups reported consuming wheat flour. The prevalence of low calcium intake was above 80 % in individuals older than 9 years. Simulating the fortification of 500 mg of calcium per 100 g of wheat flour showed that the prevalence of low calcium intake could be reduced by more than 40 percentage points in girls and women aged 19 to less than 51 years and boys and men aged 4 to less than 71 years, while it remained above 65 % in older ages. The percentages above the upper intake level remained below 1·5 % in all age groups., Conclusions: Calcium flour fortification could be further explored to improve calcium intake. Subnational simulations could be performed to identify groups that might not be reached by this strategy that could be explored in Argentina. This analysis could be used to advocate for a strategy to fortify wheat flour.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation (control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA., (Sociedad Argentina de Pediatría.)

The aim of this study was to assess the fatty acid (FA) percentage distribution in complex lipids of breast milk from mothers on a low docosahexaenoic acid (DHA) diet. We performed a descriptive, cross-sectional study of milk samples (n = 14) collected 90 days after delivery and analyzed them using gas chromatography, thin-layer chromatography, and the Fiske-Subbarow method. Complex lipid distribution was 40.70 ± 5.11% sphingomyelin (SM), 26.03 ± 5.98% phosphatidylethanolamine (PE), 21.12 ± 2.32% phosphatidylcholine, 7.94 ± 1.96% phosphatidylserine, and 4.22 ± 1.25% phosphatidylinositol. Median DHA and arachidonic acid values were 0.13% (0.12; 0.18) and 0.42% (0.33; 0.53), respectively. Mean FA percentage in SM and PE was as follows: palmitic acid, 34.45 ± 1.94% and 5.38 ± 0.94%; oleic acid, 16.50 ± 4.07% and 9.43 ± 4.05%; linoleic acid, 5.91 ± 4.69% and 9.05 ± 4.5%. DHA was not detectable in SM, but it was found in PE (55.33 ± 14.46). In conclusion, breast milk of mothers on a low DHA diet contained 55% DHA in PE, but no DHA in SM., Competing Interests: The authors report no conflicts of interests., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Dietary calcium intake is low in many countries, particularly in low- and middle-income countries (LMICs). Water is often overlooked as a source of dietary calcium despite it being universally consumed and providing good calcium bioavailability. Our objective was to assess water distribution systems in LMICs and to develop a formula to simulate the contribution of different water sources to calcium availability. We calculated the contribution of drinking water considering different calcium concentration levels to estimate total calcium availability. We consider a country's households' access to drinking water sources and the distribution of the country's population by age and gender. Calcium availability could be increased by an average of 49 mg of calcium per person per day in the 62 countries assessed if calcium in drinking water was considered. In 22 (31%) of the countries studied, 80% of households are supplied by water sources that could increase calcium availability. Improving calcium concentration in water could be considered as a strategy in LMICs to slightly improve calcium availability., (© 2023 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.)

Background: Further investigation is needed to define the impact of long-term pandemic lockdown in children., Objectives: To examine changes in body mass index z-score (zBMI), lifestyle, Health-Related Quality of Life and proportion of overweight or obesity (OW/OB) in 6- to 9-year-old children in Argentina., Methods: Observational study with baseline measurements prior to lockdown and follow-up after eight months of strict restrictive measures (November 2020, first visit, n = 144) and after ten months of partial reopening (September 2021, second visit, n = 108). Anthropometric changes from baseline to first visit in lockdown group (LG) were compared with a historical control group (HCG, n = 134). Follow-up visits included anthropometric measures, lifestyle questionnaire and Pediatric Quality of Life Inventory., Results: Change in zBMI was higher in LG [median, IQR: 0.46 (-0.00; 0.83)] vs HCG [median, IQR: 0.02 (-0.31; 0.27)]; p < 0.001, particularly in children with pre-existing OW/OB. In LG, zBMI was higher at first and second visit vs baseline (p < 0.001) and in second visit vs first visit for boys (p = 0.037) but not for girls. The proportion of children with OW/OB increased from baseline (43.5%) to first (56.5%) and second visit (58.3%) (p = 0.029). Unlike girls, the proportion of boys with OW/OB increased from baseline to first and second visit (p = 0.045). Change in zBMI was higher in children with less healthy habits (p < 0.001)., Conclusions: Weight gain continued to increase in boys when lockdown measurements were eased, although sedentary behaviors decreased and quality of life improved, indicating that the effects of pandemic lockdown could be difficult to reverse., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Infant neurodevelopment is a complex process which may be affected by different events during pregnancy, such as hypertensive disorders of pregnancy (HDP). We conducted a prospective cohort study to compare the prevalence of neurodevelopmental disorders in infants born to mothers with and without HDP at six months of age. Participants attended the Health Observatory of Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" during 2018 and 2019. Infant neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Data were analyzed using Chi-square, Student's t-test and Mann-Whitney test. Of the 132 participating infants, 68 and 64 were born to mothers with and without HDP, respectively. At six months, the prevalence of risk of neurodevelopmental delay was significantly higher in infants born to mothers with than without HDP (27.9% vs. 9.4%; p = 0.008) (odds ratio, 3.71; 95% confidence interval, 1.30; 12.28). In conclusion, infants born to mothers with HDP had three times increased risk of neurodevelopmental delay at six months of age.

Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to drinking water using survival analysis. Methods : We performed the triangle test methodology for samples of water with added calcium using three different calcium salts: calcium chloride, calcium gluconate and calcium lactate. For each salt, a panel of 54 consumers tested seven batches of three water samples. Data were adjusted for chance and sensory threshold was estimated using the survival methodology and a discrimination of 50%. Results : The threshold value estimation for calcium gluconate was 587 ± 131 mg/L of water, corresponding to 25% discrimination, for calcium lactate was 676 ± 186 mg/L, corresponding to 50% discrimination, and for calcium chloride was 291 ± 73 mg/L, corresponding to 50% discrimination. Conclusions : These results show that water with calcium added in different salts and up to a concentration of 500 mg of calcium/L of water is feasible. The calcium salt allowing the highest calcium concentration with the lowest perceived changes in taste was calcium gluconate. Future studies need to explore stability and acceptability over longer periods of time., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Cormick G et al.)

Breast milk is the ideal food for infants and its benefits can be observed in the short and long term. In crisis situations, breastfeeding should be promoted the most because it is one of the most cost-effective interventions aimed at reducing infant morbidity and mortality. In addition to the multiple advantages of breast milk in the mother-child bond and biological and immune properties, the most relevant characteristic of breast milk is that it covers all nutritional needs. When breastfeeding is not possible, the World Health Organization recommends infant formula as the first option. The second option is diluted cow's milk, which entails the risk for nutritional deficiency that should be strictly monitored and timely resolved. When infants are fed with diluted cow's milk, they are mainly at risk for iron, zinc, vitamin A, D, C, and E, amino acid and essential fatty acid deficiency., Competing Interests: The manuscript was written with the help of all authors in an autonomous manner; the company did not interfere with the editorial management or the final article. The authors state that their only relationship with Mead Johnson Nutrition was their participation in conferences and symposiums organized by the company, as in others carried out by other companies., (Sociedad Argentina de Pediatría.)

Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to drinking water using survival analysis. Methods : We performed the triangle test methodology for samples of water with added calcium using three different calcium salts: calcium chloride, calcium gluconate and calcium lactate. For each salt, a panel of 54 consumers tested seven batches of three water samples. Data were adjusted for chance and sensory threshold was estimated using the survival methodology and a discrimination of 50%. Results : The threshold value estimation for calcium gluconate was 587 ± 131 mg/L of water, corresponding to 25% discrimination, for calcium lactate was 676 ± 186 mg/L, corresponding to 50% discrimination, and for calcium chloride was 291 ± 73 mg/L, corresponding to 50% discrimination. Conclusions : These results show that water with calcium added in different salts and up to a concentration of 500 mg of calcium/L of water is feasible. The calcium salt allowing the highest calcium concentration with the lowest perceived changes in taste was calcium gluconate. Future studies need to explore stability and acceptability over longer periods of time., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Cormick G et al.)

Introduction: Wheat flour enrichment is a public health strategy recommended to prevent micronutrient deficiencies, including iron deficiency. The objective of this study was to determine iron content in enriched wheat flour and flour products and their contribution to nutritional recommendations for children., Population and Methods: Observational, analytical, cross-sectional study based on the total diet study method. Enriched wheat flour (as per Law no. 25630) and the most frequently consumed flour products were analyzed. Products were selected using a questionnaire on the frequency of food intake and a 24-hour recall interview with the parents of children aged 6 months to 7 years. Food iron levels were determined based on atomic absorption spectrometry and their contribution to the estimated average requirement was assessed., Results: Enriched flour and flour products showed the expected iron amount, except for French bread and breadcrumbs. The contribution of studied products to iron requirements was 7 % in children aged 6 months to 1 year, 81 % in those aged 1-3 years, and 45 % in those older than 4 years., Conclusions: Except for French bread and breadcrumbs, studied flour and flour products showed the expected enrichment level. The consumption of this type of food does not provide significant amounts of iron to infants, but it does to children older than 1 year., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Objective: To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations., Results: Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, National University of La Plata was 15.8 (SD ± 13.2) mg/L and at the Bone Biology Laboratory of the National University of Rosario was 13.1 (± 10.0) mg/L. Calcium values of samples from supply systems and private wells was similar. Most bottled waters had calcium levels well below 50 mg/L. The intake of one litre of drinking water from Argentina could represent in average between 1.2 and 8.0% of the calcium daily values for an adult.

There is increasing epidemiologic and animal evidence that a low calcium diet increases blood pressure. The aim of this review is to compile the information on the link between low calcium intake and blood pressure. Calcium intake may regulate blood pressure by modifying intracellular calcium in vascular smooth muscle cells and by varying vascular volume through the renin-angiotensin-aldosterone system. Low calcium intake produces a rise of parathyroid gland activity. The parathyroid hormone increases intracellular calcium in vascular smooth muscles resulting in vasoconstriction. Parathyroidectomized animals did not show an increase in blood pressure when fed a low calcium diet as did sham-operated animals. Low calcium intake also increases the synthesis of calcitriol in a direct manner or mediated by parathyroid hormone (PTH). Calcitriol increases intracellular calcium in vascular smooth muscle cells. Both low calcium intake and PTH may stimulate renin release and consequently angiotensin II and aldosterone synthesis. We are willing with this review to promote discussions and contributions to achieve a better understanding of these mechanisms, and if required, the design of future studies.

Docosahexaenoic acid (DHA) is among the main components of synaptosomal membranes and myelin sheaths. Because DHA is essential for child neurodevelopment, breast milk DHA levels should be improved by optimizing maternal nutrition. We determined DHA percentage levels in breast milk of low-income mothers receiving care at the public healthcare sector. We performed a descriptive, cross-sectional study in breast milk samples from 39 exclusively breast-feeding adult mothers with normal fetal and neonatal history. Samples were collected 90 ± 7 days after delivery. Breast milk fatty acid composition was determined by gas chromatography. The cut-off value of DHA was 0.3% of total fatty acids in milk according to recommendations. Median DHA in milk was 0.14% (0.12-0.21). Breast milk DHA levels were lower than the minimum recommended in 92% of samples. The analysis of breast milk samples from low-income exclusively breast-feeding mothers showed that they did not reach the minimum recommended DHA percentage.

Introduction: Vitamin A deficiency (VAD) has been recognized as an important public health problem in developing countries. Preschoolers account for risk groups within vulnerable populations. The objective of this study was to determine the prevalence of VAD and associated factors in a sample of preschoolers., Materials and Methods: Cross-sectional study with children aged 1-6 years receiving social assistance and seen at primary health care centers in the outskirts of the city of La Plata, Buenos Aires. Vitamin A levels were determined by measuring serum retinol with a liquid chromatography; anthropometric parameters and dietary intake were recorded. A multinomial logistic regression model was used to assess the association among outcome measures., Results: Data from 624 children were analyzed. The geometric mean of retinol was 23.8 pg/dL (95 % CI: 23.3-24.3). The prevalence of VAD and the risk for VAD were 24.3 % and 57.4 %, respectively. Retinol levels were significantly lower among boys, low-weight children, and those with low intake (below the first tertile of distribution). The multivariate analysis showed a significant association between VAD and male sex (odds ratio: 1.93; 95 % CI: 1.15-3.24) and between VAD and low intake (odds ratio: 1.48; 95 % CI: 1.15-2.62)., Conclusion: The prevalence of VAD (24.3 %) is a major public health problem in this population. VAD-associated factors were male sex and low vitamin A intake., (Sociedad Argentina de Pediatría.)

Objective: To determine vitamin A content in breast milk and evaluate whether it satisfies the recommendations for infants., Material and Methods: Observational, prospective, cross sectional study. Milk samples were obtained between 30 and 90 days postpartum from mothers seen in public hospitals, and analyzed. Vitamin A concentration was determined by chromatography and its adequacy to the recommended dietary intake. The correlation between outcome measures was analyzed using Spearman's correlation coefficient., Results: A total of 79 mothers participated. Vitamin A concentration in milk samples was 1.80 umol/L (1.36-2.30) and the mean breastfeeding time was 57 days. No significant correlation between breastfeeding days and vitamin A content was observed. In 50% of the samples, vitamin A content did not satisfy the recommendations for infants., Conclusion: Vitamin A content was not enough to satisfy the recommendations in half of the cases., (Sociedad Argentina de Pediatría.)

Introduction: Lead is a toxic metal which, even at low blood levels, can alter normal neurodevelopment in children, so no blood lead level is acceptable. Lead absorption from diet accounts for the highest contribution to blood lead levels in the population who is not exposed to contaminated environments or because of their occupation. The objective of this study was to determine the contribution of diet to lead exposure among children aged 1 to 7 years who attended Hospital de Niños de La Plata for health check-ups., Population and Methods: The study was conducted between June 2015 and May 2016. A questionnaire on the frequency of food intake was administered to 91 children whose average age ± standard deviation was 3.0 ± 1.7 years, and foods included in the analysis were selected based on this questionnaire. Selected foods were purchased from different regional stores. Composite samples were made up of different food groups. Lead levels corresponding to each food group were determined and, finally, the daily intake of lead was estimated for the studied population., Results: The daily intake of lead was 138 µg/day. The food groups with the higher intake rates were processed meat products (15.4%), bakery products (14.8%), milk (12.5%), and meat (11.7%)., Conclusions: Children aged 1 to 7 years attending a public hospital in La Plata have a lead burden from dietary intake of 138 µg/day., (Sociedad Argentina de Pediatría)

Objectives: The prevalence of low weight, normal weight, overweight, and obesity in a sample of Argentinian pregnant women using two reference charts, the Rosso and Mardones (RM) and the Calvo Chart were compared., Methods: A descriptive, cross-sectional, comparative study of data from pregnant women beneficiaries of food aid programs collected in the period 2003-2010 in the province of Buenos Aires, Argentina was performed., Results: Evaluations with the Calvo and RM charts showed statistically significant differences in the prevalence of all nutritional conditions (low weight, 22% vs. 28%; normal weight, 45% vs. 28%; overweight, 21% vs. 15%; obesity, 11% vs. 29%, respectively). Such differences were more marked in normal weight and obese pregnant women., Conclusions: Changes in prevalences as a result of replacing the RM with the Calvo Chart should be borne in mind to avoid misinterpretations about changes in the nutritional condition of pregnant women., (© 2017 Wiley Periodicals, Inc.)

Programming and implementation of health policies for the prevention of overweight and obesity have traditionally focused on the dissemination of specific messages identifying healthy foods and pointing out the importance of physical activity. Despite recurrent efforts, the prevalence of obesity in both adult and children populations continues to rise. The configuration of preventive proposals seems to neglect the more complex reality of the eating phenomenon, whose nature goes beyond its biological basis. Behind the presence of overweight or obesity, there are factors that exceed individual behaviors, which are constituted as elements of social order. This premise is based on the contributions made from several fields such as anthropology, sociology, and social epidemiology, especially over the past thirty years. This study aims to analyze the traditional models of institutional intervention while making visible the importance of a socially-oriented perspective that takes into account context and network analysis to address the problem of childhood overweight and obesity, centered on the food component., (Sociedad Argentina de Pediatría.)

Rationale: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear., Objectives: To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants., Methods: This was a prospective, population-based, cross-sectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model., Measurements and Main Results: A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes., Conclusions: RSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.

Introduction: Lead has neurotoxic effects in children, even at a very low level in blood. The risk factors (RFs) for lead exposure have not been adequately identified in La Plata. The objectives of this study were to determine mean blood lead levels and identify RFs in children aged 1 to 6 years old living in La Plata and the outskirts., Population and Methods: A cross-sectional study was conducted in children who attended primary health care centers for a health check-up. Blood lead levels were determined by atomic absorption spectroscopy, and a socioenvironmental survey was administered to outline RFs. The Mann-Whitney test was used to compare measurements. A multivariate statistical analysis was done to establish the most relevant RFs., Results: A total of 319 children participated (51% were boys); the median (interquartile range) blood lead level was 2.2 pg/dL (1.1-3.6 pg/dL). Significant mean differences in blood lead levels were observed for age≤ 3years old, anemia, pica behavior, overcrowding, dirt floors, and maternal education < 7 years. Age≤ 3years old and pica behavior were both RFs with significant odds ratios (ORs). The OR as adjusted by logistic regression was significant only for age≤ 3years old., Conclusions: The median blood lead level in the studied population was 2.2 pg/dL. The main RFs identified for lead exposure were age≤ 3years old and pica behavior. Other less relevant RFs included anemia, maternal education < 7 years, overcrowding, and dirt floors., (Sociedad Argentina de Pediatría)

Background: There is growing interest in the fatty acid composition of breast milk and substitute formulas used to replace or complement infant breastfeeding., Aim: The aims of this study were to assess the impact of two follow-up infant formulas based on cow milk fat, vegetable oils and different docosahexaenoic (DHA) and arachidonic (ARA) acid content on red blood cell membrane fatty acid composition, and determine the percent saturated fatty acid (SFA) incorporation into the membrane., Study Design: This was a double-blind, randomized, controlled, parallel-group clinical trial. Infants received treatment or control product for at least four months before the age of six months. The control group (n=25) received standard infant formula (FA) and the treatment group (n=24) received the same formula supplemented with higher DHA and ARA content (FB). The reference group (n=47) consisted of normal healthy exclusively breastfed infants., Outcome Measure: Red blood cell membrane fatty acid composition was determined by capillary gas chromatography., Results: Ninety-six infants completed the study (FA, 25; FB, 24; reference, 47). Higher DHA content reflected higher DHA percentage in the red blood cell membrane. Breast milk and FB did not show any significant differences in DHA content. ARA percentage was higher in breastfed infants and palmitic acid percentage was higher in FB- compared with FA-fed infants., Conclusion: DHA and palmitic acid percent distributions were higher in the red blood cell membrane of infants receiving FB. DHA percent distribution was not significantly different in FB-fed and breastfed infants. SFA percent distribution was not significantly different when comparing both formulas with breast milk., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The prevalence of iron deficiency anemia (IDA) is high among infants younger than two years old, especially in disadvantaged populations., Objective: To study certain social and biological determinants associated with IDA in children aged 12 to 23.9 months old in Northeast Argentina in the 2004-2005 period., Methodology: Cross-sectional design. Explanatory outcome measures were organized in three levels: distal (food assistance, unmet basic needs, and head of household with medical coverage), intermediate (breastfeeding, iron supplementation, and iron intake), and proximal (nutritional status, gestational age, birth weight, age, and sex). The association between selected outcome measures and IDA (Hb< 11 g/dL, ferritin < 12 ng/dL, WBCs < 15 000/mL) was assessed using logistic regression models with hierarchical selection of outcome measures., Results: Lack of food assistance (OR: 1.85 [1.14, 3.02]) and inadequate iron intake (OR: 2.60 [1.18, 5.71]) were associated with IDA. The prevalence of anemia was higher with a younger gestational age (OR: 0.89 [0.81, 0.97]) and a younger age in months old (OR: 0.90 [0.84, 0.96])., Conclusions: This study evidences the strong and complex relationship between social determinants and anemia, a disease that is highly prevalent among young children. Food assistance programs may have a protective effect against IDA; consumption of fortified foods may improve iron intake in infants younger than two years old. In addition, emphasis is placed on the need to assess the impact of policies on population health., (Sociedad Argentina de Pediatría.)

Background: Studies in several countries comparing the performance of WHO references and their own national growth standards reported differences that could affect screening and growth monitoring., Aim: To estimate weight and height centiles on a sample of Argentinian children and adolescents and compare selected centiles with WHO and national growth references., Subjects and Methods: A cross-sectional school survey was conducted on 6239 boys and girls aged 5-18. Data were collected between 2005-2009 in Santa Rosa, Argentina. Smoothed weight and height centiles were estimated by the LMS method and compared with WHO 2007 and Argentinian (ARG) growth references., Results: Weight centiles were higher than those of WHO and ARG. Height centiles were above the ARG and below the WHO ones. The greatest differences with ARG were seen before puberty and then declined up to age 18. In contrast, differences with WHO increased from puberty onwards., Conclusion: Compared with the ARG reference, linear growth of these schoolchildren shows a secular acceleration without substantial improvements in the adult height. In relation to WHO, the results suggest that around the adolescent growth spurt differences in linear growth between populations became larger, limiting the clinical usefulness of international growth references in adolescents.

Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning., (Copyright © 2013 Elsevier B.V. All rights reserved.)

We studied the impact of a food supplementation program (Plan Más Vida (PMV)) on the micronutrient nutritional condition of pregnant women from low-income families 1 year after its implementation. The food program provided supplementary diet (wheat and maize--fortified flour, rice or sugar, and fortified soup). We performed a prospective, nonexperimental, cross-sectional study in the province of Buenos Aires, Argentina, evaluating pregnant women at baseline (n = 164) and 1 year after PMV implementation (n = 108). Biochemical tests (hemogram, ferritin, vitamin A, zinc, and folic acid), anthropometric assessments (weight and height), and dietary surveys (24 h recall) were performed at the two study points. One year after PMV implementation, no significant changes in anthropometric values were observed. Folic acid deficiency and the risk of vitamin A deficiency (retinol, 20-30 μg/dl) decreased significantly (35.8 to 6.1 % and 64 to 41 %, respectively; p < 0.000). Anemia and prevalence of iron and zinc deficiency values did not change. Diet survey results showed that although nutrient intake increased significantly, it was still below recommendations. Implementation of the PMV and of the government nutritional strategies had a high impact on the prevalence of folic acid deficiency. We also observed a decrease in the risk of vitamin A deficiency, and no impact on iron and zinc nutritional status. Adherence to the specific fortified food (soup) was not good and intra-family dilution and distribution of food was high.

This study was conducted to evaluate the impact of a food aid program (Plan Más Vida, PMV) on the micronutrient nutritional condition of lactating mothers 1 year after its implementation. The food program provided supplementary diets (wheat- and maize-fortified flour, rice or sugar, and fortified soup) to low-income families from the province of Buenos Aires, Argentina. A prospective, non-experimental study was carried out to evaluate the micronutrient nutritional status of lactating mothers (n = 178 at baseline and n = 151 after 1 year). Biochemical tests (hemoglobin, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height) and dietary surveys (24-h recall) were performed. We found no significant changes in anthropometric values 1 year after the intervention. The risk for vitamin A (retinol 20-30 μg/dl) and folate deficiency significantly decreased 1 year after PMV implementation (56.3 vs. 29.9 and 50.3 vs. 3.4 %, respectively; p < 0.001). Anemia was seen in 25.8 % of lactating mothers at baseline, without statistically significant differences 1 year after (p = 0.439). The nutritional data obtained after assessing the early impact of PMV actions may be useful to provincial health authorities to perform periodic evaluations in the future.

We determined the effect of calcium supplementation on bone mineral density (BMD) and bone mineral content (BMC) and identified predictors of bone mass changes in adolescent mothers 6 months postpartum. A prospective, analytical, clinical study was performed in adolescent mothers (< or = 19 years old; n = 37) from La Plata, Argentina. At 15 days postpartum, mothers were randomly assigned into one of two groups and started with calcium supplementation; one group received dairy products (932 mg Ca; n = 19) and the other calcium citrate tablets (1000 mg calcium/day; n = 18). Weight, height and dietary intake were measured and BMD was determined by DEXA at 15 days (baseline) and 6 months postpartum. BMC, total body BMD and BMD were assessed in lumbar spine, femoral neck, trochanter and total hip. Regression models were used to identify the relationship of total body BMD and BMC with independent variables (calcium supplementation, months of lactation, weight at 6 months, percent weight change, lean mass at 6 months, percent lean mass change, total calcium intake). Results showed that changes in BMD and BMC at the different sites were similar in both groups, and changes in percent body weight and total calcium intake were the main predictive factors. In conclusion, the effect of calcium was similar with either form of supplementation, i.e., dairy products or tablets, and changes in percent body weight and total calcium intake were predictors of total body BMD and BMC changes.

This study was undertaken to evaluate the impact of Plan Más Vida (PMV) on the micronutrient nutritional condition of children aged 1 to 6 years 1 year after PMV implementation. The food program was intended for low-income families from the province of Buenos Aires, Argentina and provided supplementary diets. A prospective, nonexperimental study was carried out. Children (472 at baseline and 474 after 1 year) were divided into two groups (1-2 and 2-6 years of age). Biochemical tests (hemogram, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height), and dietary surveys (24-h recall) were performed. Chronic growth retardation (-2 height/age Z-score) was present in 2.8% and 8.7% of 1-2- and 2-6-year-old children, respectively; 14.4% in the former and 8.8% in the latter group had overweight/obesity. No significant changes were recorded 1 year after PMV implementation. Whereas anemia values decreased (55.3% to 39.1%, p = 0.003) and serum zinc values increased in 1-2-year-old children, the risk for vitamin A deficiency decreased significantly in both age groups. The evaluation of the early impact of PMV actions provided important nutritional data that should be used by provincial health authorities to conduct future evaluations.

Objective: Bone mineral density (BMD) loss has been described in adult women in the 12-month postpartum period. However, little is known about the precise BMD pattern in adolescent mothers. The present study aimed to evaluate BMD in Argentinean adolescent mothers followed up during the 12-month postpartum period., Design: Analytical, prospective clinical trial. BMD and body composition were determined by dual-energy X-ray absorptiometry; bone mineral content (BMC) and BMD were measured in the lumbar spine (L2-L4), femoral neck (FN), femur trochanter (TR), total hip (TH) and total body. Changes in BMD and BMC were analysed using ANOVA for pairwise comparisons. Other comparisons were performed with the paired-sample t test and Wilcoxon test; Pearson's correlation coefficient was used to analyse the relationship among continuous variables., Setting: La Plata, Argentina., Subjects: Adolescent mothers (n 35; 17 years old or less) were recruited within 15 d after delivery. Studies and follow-up were performed at 15 d and 3, 6 and 12 months postpartum., Results: BMD and BMC losses at 3 and 6 months and recovery at 12 months fitted a quadratic curve (ANOVA) at the three sites studied (FN, TH, TR), in total-body BMD (P = 0.000) and BMC (P = 0.038). At hip sites, BMD loss occurred at 3 months (FN, P = 0.000; TR, P = 0.000; TH, P = 0.000) and 6 months (FN, P = 0.000; TR, P = 0.000; TH, P = 0.000) compared with basal values. Percentage BMD loss immediately after delivery up to 6 months was about 5 %., Conclusions: Adolescents showed significant BMD and BMC losses at 6 months postpartum, with an almost total recovery at 12 months in all sites studied.