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La hipolactasia primaria del adulto resulta de la disminución genéticamente programada de la lactasa intestinal después del destete. Se estima que alrededor del 75% de la población adulta en el mundo presentaría es hipolactásica. Objetivo: Determinar la prevalencia de hipolactasia en escolares de la Región Metropolitana y su relación con el consumo de productos lácteos y de calcio. Sujetos y métodos: Se realizó un estudio transversal en una muestra de 326 escolares de 7 a 18 años pertenecientes a 6 establecimientos educacionales de distintos niveles socioeconómicos en Santiago. A cada sujeto se les realizó una prueba de hidrógeno en aire espirado (HBT) con lactosa y se registró la aparición de sintomatología digestiva durante la prueba. También se realizó una encuesta de tendencia de consumo de productos lácteos para determinar la ingesta de calcio. Resultados: 42.3% de los escolares eran hipolactásicos y presentaron una mayor prevalencia de sintomatología digestiva comparado con aquellos sujetos lactasa-persistente(81.9% vs. 70.2%; p=0.019); dicha sintomatología, además, fué más intensa en los hipolactásicos(p

La hipolactasia primaria del adulto resulta de la disminución genéticamente programada de la lactasa intestinal después del destete. Se estima que alrededor del 75% de la población adulta en el mundo presentaría es hipolactásica. Objetivo: Determinar la prevalencia de hipolactasia en escolares de la Región Metropolitana y su relación con el consumo de productos lácteos y de calcio. Sujetos y métodos: Se realizó un estudio transversal en una muestra de 326 escolares de 7 a 18 años pertenecientes a 6 establecimientos educacionales de distintos niveles socioeconómicos en Santiago. A cada sujeto se les realizó una prueba de hidrógeno en aire espirado (HBT) con lactosa y se registró la aparición de sintomatología digestiva durante la prueba. También se realizó una encuesta de tendencia de consumo de productos lácteos para determinar la ingesta de calcio. Resultados: 42.3% de los escolares eran hipolactásicos y presentaron una mayor prevalencia de sintomatología digestiva comparado con aquellos sujetos lactasa-persistente(81.9% vs. 70.2%; p=0.019); dicha sintomatología, además, fué más intensa en los hipolactásicos(p

La transición demográfica y nutricional que vive Chile se ha reflejado en una prevalencia alta y creciente de obesidad y enfermedades crónicas vinculadas a la alimentación. A pesar de los esfuerzos realizados es poco probable cumplir con las metas sanitarias propuestas para el 2010 en cuanto a reducir la obesidad y el sedentarismo. Como parte de sus funciones el Consejo Asesor en Nutrición y Alimentación del Ministerio de Salud ha revisado recientemente y definido las prioridades nacionales en este campo. En la opinión del Consejo los esfuerzos debieran orientarse fundamentalmente a fortalecer la estrategia de intervención nutricional a través del ciclo vital, a mejorar la capacidad institucional del país en el ámbito de los alimentos, a revisar y modernizar la gestión de los programas alimentarios y a desarrollar una alianza estratégica con las empresas productoras de alimentos, sociedades científicas, grupos académicos y con los propios consumidores orientada a promover una mayor oferta y consumo de alimentos saludables y a regular la publicidad en este campo. Para avanzar en la meta propuesta se requiere sin duda de una mayor inversión de recursos públicos y privados fundamentalmente orientados a la promoción de estilos de vida saludable, con especial énfasis en alimentación y actividad física The demographic and nutritional transition in Chile has been reflected by a high and growing prevalence of obesity and chronic illnesses related to nutrition. In spite of the efforts made, it is not likely that the country will comply with the health objectives proposals for 2010 to reduce obesity and sedentary tendencies. As part of their functions the National Health Food and Nutrition Advisory Council has recently checked and defined the national priorities in this area. In the Council's opinion, the efforts should be oriented to strengthen the nutritional intervention strategy through the vital cycle, to improve the institutional capacity of the country as far as food is concerned, to review and modernized feeding programmes and to develop a strategic alliance with food producing companies, scientific societies, academic groups and consumers. These actions are directed to promote a wider and better offer of healthier food and to regulate publicity. In order to advance in these proposals we need a major investment from public and private resources oriented to promote healthier styles of living, with special emphasis on nutrition and physical activity

Uno de los principales mecanismos implicados en las propiedades saludables de los probióticos es su capacidad de mantener la homeostasis de la microbiota intestinal. Este estudio evalúa cómo el consumo de distintas cantidades del probiótico Lactobacillus johnsonii La1 (La1) contribuye en la modulación de las principales poblaciones de la microbiota fecal. Ocho voluntarios asintomáticos participaron en el estudio. Después de un periodo basal, consumieron 100 mL de un producto que contenía 10(8) La1/mL durante la primera semana, 200 mL durante la segunda semana y 500 mL durante la tercera semana. Se obtuvieron muestras de deposición al final de cada uno de estos períodos y luego a los 7 y 14 días de haber terminado el consumo del producto. Las cantidades de lactobacilos excretados fueron determinadas por cultivo en agar MRS y las colonias de La1 fueron confirmadas por ERIC-PCR. Algunas de las principales poblaciones de bacterias fecales fueron evaluadas por hibridación in situ con sondas fluorescentes (FISH) y citometría de flujo. A nivel basal, 18.3% del número total de bacterias fluorescentes detectadas eran F. praunitzii,13.2% Bacteroides, 2.05% Bifidobacterium y 0.95% Lactobacillus. La excreción fecal de La1 aumentó durante el período de consumo pero desapareció después de 14 días de haber terminado el período de ingestión. El consumo de La1 aumentó las poblaciones de Lactobacillus (p=0.056) y Bifidobacterium (p=0.067) que son consideradas como beneficiosas para el huésped mientras que disminuyó aquella de F. prausnitzii (p=0.005), un microorganismo potencialmente patogénico. Las poblaciones bacterianas afectadas volvieron a sus niveles basales durante el periodo post-ingestión. Estos resultados indican que el consumo regular de La1 modula la homeostasis de la microbiota intestinal, lo cual contribuye probablemente a los efectos beneficiosos de este probiótico sobre la salud A basic mechanism implicated in the human health-promoting properties of probiotics is their ability to maintain the homeostasis of the intestinal microbiota. This study evaluates how the ingestion of different amounts of the probiotic Lactobacillus johnsonii La1 (La1) influences the main bacterial populations of the fecal microbiota. Eight asymptomatic volunteers participated in the study. After a basal period, they ingested 100 mL of a product containing 10(8) La1/mL during the first week, 200 mL during the second week and 500 ml during the third week. Fecal samples were obtained at the end of each period and during the 2 weeks post-ingestion. Lactobacilli were determined by culture on MRS agar and La1 colonies were confirmed by ERIC-PCR. The main populations of fecal bacteria were identified by fluorescent probes and flow cytometry. At baseline, 18.3% of the total fluorescent bacteria were F. praunitzii, 13.2% Bacteroides, 2.05% Bifidobacterium and 0.95% Lactobacillus. Fecal excretion of La1 increased during the ingestion period but it was cleared from the stools of the volunteers 2 weeks later. La1 intake increased the populations of Lactobacillus (p=0.056) and Bifidobacterium (p=0.067), which are considered as beneficial for the host, while it decreased those of F. prausnitzii (p=0.005) a potentially pathogenic microorganism. These bacterial populations returned to their baseline levels during the post-ingestion period. The regular intake of a La1-containing product beneficially affects the homeostasis of the human fecal microbiota probably contributing to the health-promoting effects of this probiotic

Background: Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten. Aim: To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood. Patients and methods: 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 compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units. Results: Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p

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Background: Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten. Aim: To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood. Patients and methods: 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 compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units. Results: Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p

La ingestión de probióticos ha sido recientemente propuesta como una posible "herramienta" en el manejo de los individuos colonizados por Helicobacter pylori (Hp). El objetivo de este estudio es evaluar si el consumo regular de un producto comercial con Lactobacillus johnsonii La1 (La1) puede interferir con la colonización gástrica por Hp, y si dicho efecto puede ser mayor a mayor frecuencia de ingestión del producto a lo largo del día. Un primer estudio clínico randomizado de doble ciego se realizó en niños de 6 a 17 años, de una escuela de nivel socioeconómico bajo de Santiago. Los niños determinados como Hp-positivos mediante el test de aire espirado con 13C-urea (13C-UBT) fueron distribuidos en 3 grupos para recibir durante 4 semanas 160 ml diarios de uno de tres productos: 1) uno con La1 vivo, 2) el mismo termizado con La1 muerto o 3) el mismo sin La1 (control). Un segundo 13C-UBT se les realizó al final del período. En el siguiente estudio se reclutaron 11 voluntarios Hp-positivos asintomáticos, que tomaron el producto con La1 vivo cada día y por 2 semanas a razón de 80 ml cada 2 horas de la 8:00h hasta las 22:00h (640 ml en total). Se les realizó un 13C-UBT antes y a 1 y 2 semanas de tomar el producto. Las muestras de aire de ambos estudios se analizaron por espectrometría de masa de relación isotópica y los resultados se expresaron como exceso por mil de 13C por sobre los niveles basales: DOB (‰). En el primer estudio se observó una disminución significativa (p‰‰n the first study, a significant decrease, 11.9% (p

Estudios publicados concluyen que el desarrollo de enfermedades autoinmunes en pacientes celiacos se incrementa al aumentar el tiempo de exposición al gluten y cuanto mayor sea la edad al diagnóstico. 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 inmunológicos endocrinos en pacientes celiacos que cumplen o no la dieta libre de gluten Results of studies published recently have shown that autoimmune phenomena in celiac patients increases with a delayed diagnosis and a more prolonged exposure to gluten. Adolescence is a stage of life in which the gluten-free diet is frequently discontinue. For this reason it is of interest to investigate in this age group the immunological markers of endocrine disturbances in celiac patients depending on whether they have a good compliance to the gluten-free diet

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 cow's milk) and usefulness of a standardized challenge test. Patients and methods: Cross sectional assessment of 49 patients with cow's milk allergy (9 months - 8 years of age), diagnosed at INTA, University of Chile between 1991-2001. Results: All patients had cow's 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 cow's 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 Méd Chile 2003; 131: 275-82).

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 cow's 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 cow's 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 Méd Chile 2003; 131: 25-29)

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 cow's 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 cow's 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 Méd Chile 2003; 131: 25-29)

Predictors to identify infarts who suffer more disease episodes than the average were applied to determine whether they also allow to predct further deterioration of nutricional status, "our groups of infants (group 1: weight/age (W/A) P25 ?50 (NCHS) plus present predictor, n; 20; group 2: W/A. P25 -P50 and absent predictor, n:20; group 3: W/A 2 month survey W/A. ana length/age showed sign'ficant deterioration in croups 1 and 2 Hants fp < 0-05 and p < O.C26, respectively); in contrast, there were no significant differences between groups 1 and 3. .ength increments wee comparable in groups 2 and 4, regardless initial weigh;. The predictor of f-equent diseases allowed to identify those children who, naving a better initial nutritional status, showed deterioration of their W/A throughout the f irst two years of life, but it did not predict nutritional changes among children whose weight was already deteriorated at the begining of the survey.

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.

RESUMEN Se estudiaron 50 lactantes con diarrea de me-nos de 5 dias de evolucion. de los cuales la mitadse realimento con una leche con bajo contenidode lactosa (grupo experimental) y los restantescon una formula lactea en polvo (grupo control),Durante un seguimiento de 2 meses se evaluaron elcurso clinico, los cambios antropometricos y latolerancia a los productos. La evolucion clinica,las etiologi'as y la duration promedio de losepisodios (3,6 ± 1,9 y 3,9 ± 1,9 dias en experi-mentales y controles, respectivamente) fueroncomparables en ambos grupos. No se observe dete-rioro nutricional durante ni despues del episodio.En 2 nifios (8,3%) del grupo control fue necesa-rio administrar la leche sin lactosa para queremitieran los sintomas. La aceptabilidad aambos productos fue satisfactoria. Estos resulta-dos sugieren que la utilization de productos conbajo contenido de lactosa puede ser ventajosa enel manejo ch'nico de lactantes con diarrea aguday evidencia de intolerancia por lactosa.(Palabras claves: diarrea aguda, leche pobre enlactosa, intolerancia a lactosa.)