Yogurt and dietary recommendations for lactose intolerance

La malabsorción de la lactosa se produce por la incapacidad para la digestión del azúcar debido a la disminución de la actividad de la lactasa intestinal tras un desorden primario o secundario a otras patologías. La hipolactasia primaria tipo adulto es un trastorno autosómico recesivo, caracterizado por la pérdida progresiva de lactasa tras el destete, mientras que la secundaria es un trastorno transitorio que se corregirá tras la curación de la patología de base. Para el diagnóstico de la malabsorción a la lactosa destacan los test de hidrógeno y metano espirado tras sobrecarga. En el déficit primario tardío de lactasa puede realizarse el test molecular del polimorfismo de nucleótido simple (SNP C/T-13910). El diagnóstico de la intolerancia precisa de la presencia de sintomatología tras el consumo de lactosa. El tratamiento de la hipolactasia primaria tipo adulto consiste en disminuir la lactosa de la dieta por debajo de la dosis gatillo. Un porcentaje importante de individuos con malabsorción toleran cantidades habituales de consumo y prácticamente el 99% toleran yogur o derivados lácteos fermentados, lo que permite así cubrir las recomendaciones diarias de ingesta de calcio y vitamina D. Además, estrategias nutricionales que reduzcan la carga de lactosa, el tiempo de vaciamiento gástrico y/o el tiempo de tránsito intestinal o que incrementen la actividad lactásica y la compensación colónica van a permitir una mayor tolerancia.Malabsorption to lactose is caused by the inability to digest sugar due to the decrease in the activity of intestinal lactase. Malabsorption may be due to a primary or secondary disorder. Adult type primary hypolactasia is an autosomal recessive disorder, characterized by the progressive loss of lactase after weaning. The secondary hypolactasia is a transitory disorder, which will be corrected after the cure of the basic pathology. For lactose malabsorption diagnosis, the hydrogen and methane exhaled tests after lactose overload stand out and, in the case of the primary adult type, the molecular test of the simple nucleotide polymorphism (SNP C / T-13910). However, the diagnosis of lactose intolerance requires the presence of symptoms after consumption. The treatment of primary adult-type hypolactasia consists in decreasing the lactose in the diet below the trigger dose. A significant percentage of individuals with malabsorption tolerate habitual amounts of consumption. Practically 99% of them tolerate yogurt or fermented dairy products, thus allowing to cover the daily recommendations of calcium and vitamin D intake. In addition, nutritional strategies that reduce the lactose load, gastric emptying time and / or intestinal transit time or increase lactic activity and colonic compensation, will allow a greater tolerance.S

Drug development strategies for the treatment of obesity: how to ensure efficacy, safety, and sustainable weight loss

The prevalence of obesity has increased worldwide, and approximately 25%-35% of the adult population is obese in some countries. The excess of body fat is associated with adverse health consequences. Considering the limited efficacy of diet and exercise in the current obese population and the use of bariatric surgery only for morbid obesity, it appears that drug therapy is the only available method to address the problem on a large scale. Currently, pharmacological obesity treatment options are limited. However, new antiobesity drugs acting through central nervous system pathways or the peripheral adiposity signals and gastrointestinal tract are under clinical development. One of the most promising approaches is the use of peptides that influence the peripheral satiety signals and brain-gut axis such as GLP-1 analogs. However, considering that any antiobesity drug may affect one or several of the systems that control food intake and energy expenditure, it is unlikely that a single pharmacological agent will be effective as a striking obesity treatment. Thus, future strategies to treat obesity will need to be directed at sustainable weight loss to ensure maximal safety. This strategy will probably require the coadministration of medications that act through different mechanisms.Instituto de Salud Carlos IIIXunta de GaliciaFundación Mutua Madrileñ

Clinical Utility of LCT Genotyping in Children with Suspected Functional Gastrointestinal Disorder

Genetic testing is a good predictor of lactase persistence (LP) in specific populations but its clinical utility in children is less clear. We assessed the role of lactose malabsorption in functional gastrointestinal disorders (FGID) in children and the correlation between the lactase non-persistence (LNP) genotype and phenotype, based on exhaled hydrogen and gastrointestinal symptoms, during a hydrogen breath test (HBT). We also evaluate dairy consumption in this sample. We conducted a 10-year cross-sectional study in a cohort of 493 children with suspected FGID defined by Roma IV criteria. Distribution of the C/T-13910 genotype was as follows: CC, 46.0%; TT, 14.4% (LP allele frequency, 34.1%). The phenotype frequencies of lactose malabsorption and intolerance were 36.3% and 41.5%, respectively. We observed a strong correlation between genotype and both lactose malabsorption (Cramér’s V, 0.28) and intolerance (Cramér’s V, 0.54). The frequency of the LNP genotype (p = 0.002) and of malabsorption and intolerance increased with age (p = 0.001 and 0.002, respectively). In 61% of children, evaluated dairy consumption was less than recommended. No association was observed between dairy intake and diagnosis. In conclusion, we found a significant correlation between genotype and phenotype, greater in older children, suggesting that the clinical value of genetic testing increases with ageS

Atlantic diet. Nutrition and gastronomy in Galicia

La dieta de Galicia es el resultado de una conjunción perfecta entre la calidad y la diversidad de los productos de sus tierras y mares y una elaboración sencilla y saludable. A las bondades de los productos gallegos, ya conocidas por los celtas, los romanos o los peregrinos altomedievales, se han sumado las herencias recibidas desde la orilla americana de este océano que compartimos hasta constituir las bases de la llamada dieta atlántica. La alimentación gallega se caracteriza por la abundancia de alimentos de temporada (plantas, frutas, vegetales, patatas, pan y cereales, nueces, castañas, miel y leguminosas), por el elevado consumo de pescados y mariscos y por el moderado consumo de lácteos; por la carne de terneras alimentadas exclusivamente con leche materna y pastos; por el aceite de oliva, por el uso de salsas con baja carga energética y de alta calidad de la grasa y por los postres caseros compuestos principalmente por harina, huevos y frutos secos. La dieta atlántica gallega es saludable, funcional y bioactiva, y, sin duda, junto a un perfil genético beneficioso y unos estilos de vida, una actividad física e inactividad adecuados, favorecidos por nuestro urbanismo –con una población distribuida en pequeños núcleos rurales–, ha contribuido a que tengamos una de las poblaciones más longevas y con una alta calidad de vida. Actualmente, los datos reflejan cifras alarmantes de sobrepeso y obesidad, especialmente en la etapa infantil-juvenil, relacionadas, muy probablemente, entre otros aspectos, con la pérdida de adherencia a nuestra dieta tradicional. De seguir como hasta ahora, los niños y adolescentes gallegos podrían vivir menos que sus abuelos y, además, con más comorbilidades asociadas. Se hace necesario establecer estrategias de promoción para la recuperación y fidelización de nuestra dieta atlántica del noroeste de España.The diet of Galicia is the result of a perfect combination between the quality and diversity of the products of their lands and seas and a simple and healthy elaboration. To the benefits of the Galician products already known by the Celts, the Romans or the Early Medieval pilgrims have been added the inheritances received from the American shore of this ocean that we share, constituting the bases of the Atlantic diet. Galician food is characterized by an abundance of seasonal foods from plants (fruits, vegetables, potatoes, bread and cereals, nuts, chestnuts, honey and legumes), high consumption of fish and shellfish, moderate milk, veal meat fed exclusively with breast milk and pastures, olive oil, use of sauces with low energy load and high-quality fat and homemade desserts composed mainly of flour, eggs and nuts. The Galician Atlantic diet is healthy, functional and bioactive, and without doubt along with a favorable genetic profile, and adequate lifestyles, physical activity and inactivity, favored by our urbanism, with a distribution of the population in small rural areas, has collaborated so that we have one of the longest living populations with a high quality of life. Currently, the data reflect alarming figures of overweight and obesity, especially in the infant-juvenile age, most likely in relation to, among others, the loss of adherence to our traditional diet. To continue as before, Galician children and adolescents could live less than their grandparents, but also with more associated comorbidities. It is necessary to establish strategies to promote recovery and adherence of our Atlantic diet in north-western Spain.S

Los primeros 1000 días: Una oportunidad para reducir la carga de las enfermedades no transmisibles

Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health.El crecimiento y desarrollo de un individuo está determinado desde la etapa embrionaria por su genética y los factores ambientales con los que interactúa. Los riesgos para la salud infantil y adulta pueden programarse durante las etapas fetal-neonatal y esta programación metabólica precoz puede afectar al desarrollo posterior de enfermedades como la obesidad y otras enfermedades no transmisibles (ENT) asociadas. La vida temprana, por la gran plasticidad que la caracteriza, constituye el momento ideal para intervenir y prevenir el riesgo de ENT (ventana de oportunidad). Una nutrición óptima durante los primeros 1000 días, que comprende desde la concepción hasta los dos años, es clave para la salud a lo largo de la vida. El rápido crecimiento y desarrollo del organismo y sus funciones durante el embarazo, la lactancia y el niño de corta edad conlleva requisitos nutricionales específi cos en cada una de estas etapas. La microbiota del tracto gastrointestinal desempeña una labor fundamental en la función y el desarrollo del sistema inmune. Las interacciones entre el hospedador y su microbiota intestinal se consideran factores potenciales en la programación temprana de las funciones intestinales, con una evidencia creciente de que las alteraciones de la colonización bacteriana en el neonato se asocian con un mayor riesgo de enfermedad, incluidas las enfermedades alérgicas. La evidencia científi ca acumulada muestra que los primeros 1000 días son cruciales para alcanzar el mejor desarrollo y salud a largo plazo, y constituyen un periodo estratégico en términos de prevención y salud públicaEsta publicación ha sido promovida y financiada por el Instituto Danon

Effects of a Community-Based Behavioral Intervention with a Traditional Atlantic Diet on Cardiometabolic Risk Markers: A Cluster Randomized Controlled Trial (“The GALIAT Study”)

The Atlantic diet, the traditional dietary pattern in northern Portugal and northwest Spain, has been related to metabolic health and low ischemic heart disease mortality. The Galiat Study is a randomized controlled trial aimed to assess the effects of the Atlantic diet on anthropometric variables, metabolic profile, and nutritional habits. The dietary intervention was conducted in 250 families (720 adults and children) and performed at a primary care center. Over six months, families randomized to the intervention group received educational sessions, cooking classes, written supporting material, and foods that form part of the Atlantic diet, whereas those randomized to the control group followed their habitual lifestyle. 213 families (92.4%) completed the trial. Adults in the intervention group lost weight as opposed to controls who gained weight (adjusted mean difference −1.1 kg, p < 0.001) and total serum cholesterol (adjusted mean difference −5.2 mg/dL, p = 0.004). Significant differences in favor of the intervention were found in other anthropometric variables and low-density lipoprotein cholesterol, but changes in triglycerides, high-density lipoprotein cholesterol, inflammation markers, blood pressure, and glucose metabolism were not observed. A family-based nutritional intervention based on the Atlantic diet showed beneficial effects on adiposity and the lipid profileThis project received funding from the ERDF-Innterconecta for Galicia Program (ITC-20133014 & ITC-20151009), managed by the Centre for the Development of Industrial Technology (CDTI), Spanish Ministry of Economy, Industry and CompetitivenessS

Environmental assessment of menus for toddlers serviced at nursery canteen following the Atlantic diet recommendations

Menus served at public services can be considered as a good opportunity for consumers to demand a service that ensures healthy and environmentally friendly food. It is especially in the sector of nurseries and schools, where these demands make the most sense since they call for the protection of particularly vulnerable population: children. The purpose of this study is to analyze the biweekly menus served at a public Spanish nursery canteen considering the link with the two most recognized environmental indicators: the consumptive water footprint (WF) and the carbon footprint (CF). The WF and CF of the menus vary considerably between menus (619–1359 L·menu−1 and 0.75–2.95 kg CO2eq·menu−1). The assessment has identified non-dairy sources of protein and dairy-based products as the key food categories in all menus. Menus with more meat (mostly beef) and dairy products (mainly cheese) were associated with higher impacts. That is, the average impact of menus with beef is about 2 times greater than the one of all other menus. The distribution and cooking stages presented negligible contributions in terms of greenhouse gases emissions, mainly due to the consumption of local/regional products and low-energy intensive cooking techniques. The most important strategy for reducing environmental impacts is based on reducing the frequency of consumption of beef, so that poultry and lean pork are consumed alternately. This reduction should not compromise the necessary protein intake for toddlers. Attention should also be paid to afternoon snacks that are rich in cold meat and dairy products. Considering these issues, significant reductions in WF and CF indicators could be achieved, up to 550 L·menu−1 and 0.70 kg CO2eq·menu−1. Since eating habits introduced at an early stage are more likely to develop into adult behaviour, children canteen services are an excellent opportunity to promote healthy eating habits in children and their familiesThis research has been partially supported by a project granted by Xunta de Galicia (project ref. ED431F 2016/001 and by a project granted by the Spanish Ministry of Economy and Competitiveness, Proyectos de Investigación en Salud-ISCIII (project ref. PI16/01301). S.G-G. would like to express her gratitude to the Spanish Ministry of Economy and Competitiveness for financial support (Grant reference RYC-2014-14984). S.G.-G., X.E-Ll., G.F. and M.T.M. belong to the Galician Competitive Research Group GRC 2013-032. All these programs are co-funded by Xunta de Galicia and FEDER (EU)S

V232D Mutation in Patients With Cystic Fibrosis: Not So Rare, Not So Mild

The frequency of some Cystic Fibrosis (CF) Transmembrane Conductance Regulator gene (CFTR) mutations varies between populations. Genetic testing during newborn screening (NBS) for CF can identify less common mutations with low clinical expression in childhood and previously considered mild but not fully characterized, such as the mutation p.Val232Asp (c.695T > A). The aim of this study was to describe CF patients with the V232D mutation. We identify CF children with the V232D mutation detected by NBS and compare them with CF adults with this mutation whose diagnosis was prompted by clinical symptoms in the same period. We studied clinical, biochemical, spirometric, and prognostic features in both populations. NBS program tested 276,523 children during a period of 14 years (2003-2017) and identified 54 cases of CF. Six children (11%) had the V232D mutation. Over the same period, 5 adults (age 37.6 ± 16.29 years old) with symptoms of CF and this mutation were also diagnosed. Follow-up duration was mean 10.1 years for adults and mean 6.5 years for children. In the adult group, lung function was impaired at diagnosis in all patients (Forced Expiratory Volume1-FEV1-67.12% ± 13.09) and worsened in children tested during evolution (FEV1first: 113%; FEV1last: 64%). Pancreatic insufficiency was present in adult group, with recurrent pancreatitis in 1 present. Although with less clinical expression in children, V232D is associated with pulmonary and pancreatic involvement during adulthood and CF cannot be considered mild. This mutation is present in 11% of all patients diagnosed with CF in our region. Its inclusion in some NBS programs should be taken into account in order to improve the prognosis of affected children.S

Energy dense salty food consumption frequency is associated with diastolic hypertension in Spanish children

High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well

A clustering approach to analyse the environmental and energetic impacts of Atlantic recipes - A Galician gastronomy case study

The definition of the term gastronomy encompasses both the knowledge of food and its handling, preparation and consumption. Beyond a sense of cultural identity and tradition, gastronomy also represents a pole of tourist attraction. This is the case of Galicia, a region in north-western Spain. Within this framework, local dishes, which include distinctive elements of the Atlantic diet, have gained popularity. This research delves into the sustainability of 60 Galician recipes by performing a hierarchical cluster analysis to study their carbon footprint, the energy return on investment ratio and cost. The life cycle assessment methodology was followed to account for the carbon footprint and the energy return on investment ratio of the recipes. The scope was bounded to the cradle-to-fork phases through the life cycle: production of the ingredients, transport, and meal preparation. The functional unit selected was one serving of a Galician meal. The results suggest that the recipes could be classified into three main groups according to the presence of a greater or lesser amount of animal-based products. Cluster 1 comprises 10 meat recipes. Cluster 2 encompasses 31 recipes rich in fish with some vegetables and moderate consumption of red meat and dairy products. Cluster 3 includes 22 vegetable-based recipes. The higher the portion of animal products in the recipes (mainly red meat), the higher the costs and carbon footprint and the lower the energy return on investment ratio. Conversely, plant-based recipes tend to reduce greenhouse gases emissions and increase cost competitiveness and energy efficiency indicators. Based on this study, the food service could promote eco-labelling that support and certify restaurant menus. This research could also provide transformative climate education for sustainable food for consumers, giving advice to improve food-based dietary guidelines in SpainThe Galiat project received funding from the ERDF-Interconecta for Galicia Program (ITC-20133014 & ITC-20151009), managed by the Centre for the Development of Industrial Technology (CDTI), Spanish Ministry of Economy, Industry and Competitiveness. The authors thank the participating companies that assisted in this study; these include the Belarmino Fernández Iglesias Hostelry School, Bodegas Terras Gauda, Bodegas Pazo de Rivas, Conservas A Rosaleira, Conservas Friscos, Aceites Olei, and Quescrem. C.C.-F. would like to thank the Ministry of Science, Innovation and Universities for financial support (Grant reference FPU 19/06648). C.C-F, S.G.-G., G.F. and M.T.M. belong to the Galician Competitive Research Group (GRC ED431C 2017/29) and to the Cross-disciplinary Research in Environmental Technologies (CRETUS Research Center, ED431E 2018/01). All these programs are co-funded by FEDER (EU)S