Estudio nutricional de la composición mineral de los arroces de Calasparra

El arroz es uno de los cereales más consumidos en el mundo, siendo la base de la dieta del 75% de la población mundial. La importancia económica y dietética en torno a la producción y consumo del arroz impulsa el interés por los estudios relacionados con su calidad nutricional. Se busca mantener la calidad de variedades locales, que aún contando con menor rentabilidad productiva, suelen presentar características organolépticas diferenciadoras que hacen que sean valoradas positivamente por los consumidores y están íntimamente asociadas a la actividad agraria y económica de ese área geográfica, como es el caso del arroz Denominación de Origen Calasparra, producido en la vega alta del río Segura (España). El proceso de elaboración del arroz incluye distintas etapas industriales que tienen como finalidad la eliminación total o parcial de su cascarilla, parte del germen y partes externas del pericarpio, dando lugar a las tres principales presentaciones comerciales del arroz: elaborado, semielaborado y descascarillado o integral. Este proceso es fundamental para determinar la calidad del arroz, ya que la eliminación de las partes externas del grano y el tratamiento de pulido ocasionan la pérdida del 75% de la fibra dietética y el 50% de los minerales (entre otros nutrientes), mientras que las formas integrales son las que conservan un mayor contenido nutricional. Es igualmente importante tener en cuenta que la presencia de diferentes componentes de la fibra dietética puede ejercer un efecto negativo en la absorción de minerales, disminuyendo la utilización nutritiva de los mismos. El almidón resistente (RS) es la fracción de almidón que escapa a la digestión en el intestino delgado, se fermenta en el colon, actuando como prebiótico y favoreciendo la reabsorción de minerales en el colon. En la presente tesis Doctoral se estableció como objetivo general el estudio nutricional de la composición mineral de los arroces D.O. Calasparra, crudos y cocidos, la estimación de su disponibilidad mediante la cuantificación de la fracción soluble y la determinación del contenido de fibra dietética total. Para alcanzar el objetivo general se plantean diferentes objetivos específicos. En primer lugar, analizar por espectrofotometría de absorción atómica el contenido mineral y determinar el cómputo mineral en distintos tipos de arroces, tanto crudos como cocinados, en función de la variedad (Bomba y BalillaXSollana), la elaboración (integral, semi-integral o blanco), del paraje y tipo de producción (tradicional o ecológica). En segundo lugar, determinar la solubilidad mineral (Método Miller), como medida de estimación de la disponibilidad de estos minerales. Conocer el efecto del cocinado sobre el contenido de fibra dietética total (FDT), determinada por Método Prosky, y establecer su posible correlación (Pearson) con la solubilidad mineral. Analizar el contenido de amilosa y RS en las distintas muestras de arroz D.O. Calasparra. El perfil mineral en las muestras sin cocinar de arroz D.O. Calasparra estaría constituido por un alto contenido en K y Mg, moderado de Zn y Fe, y bajo de Ca y Na (con dependencia del paraje de cultivo, la variedad y el grado de elaboración de las muestras), presentando un perfil similar al descrito para otros arroces comerciales. El proceso del descascarillado es determinante para el contenido mineral en las muestras, presentando el arroz integral el mayor contenido de minerales frente a los semi-integrales y a los blancos, al estar los minerales distribuidos mayoritariamente en la cascarilla de los cereales. El tipo de cocinado también influye en la concentración final de los minerales, ya que al cocinar permitiendo la absorción completa del agua de cocción, se reabsorben los minerales perdidos por lixiviación, reduciendo el efecto negativo del tratamiento térmico. La disponibilidad mineral, usando el porcentaje de mineral soluble como indicador fue máxima para el K y el Mg, seguidos del Ca, Fe y Zn, siendo superior la solubilidad mineral en las muestras blancas que en las que no habían sufrido el proceso de descascarillado. La influencia del contenido en FDT sobre la solubilidad mineral en las muestras cocidas fue diferente según el caso, en las muestras integrales la solubilidad de Fe y Zn no se ve afectada, debido a la distribución mayoritaria de estos elementos minerales en la cascarilla, mientras que en los arroces elaborados existe una correlación negativa entre FDT y la solubilidad del Mg. No se espera ningún efecto positivo del RS sobre la biodisponibilidad mineral, ya que tras el cocinado el contenido fue muy bajo. The rice is one of the most consumed cereals in the world, being the base of the diet of 75% of the world population. The economic and dietetic importance concerning the production and consumption of the rice stimulates the interest for the studies related to its nutritional quality. We seek to support the quality of local varieties, which still possessing minor productive profitability, are in the habit of presenting distinguishing organoleptic characteristics that are positively valued by the consumers and that are intimately associated with the agrarian and economic activity of that geographical area, since it is the case of the Calasparra Designation of Origin (D.O.) rice, produced in the Segura River high meadow area (Spain). The rice production process includes different industrial stages that take as a purpose the total or partial elimination of his husk, part of the germ and external parts of the pericarp, giving place to three principal commercial presentations of the rice: finished, half-finished and milled or integral. This process is fundamental to determine the quality of the rice, since the removal of the external parts of the grain and the treatment of polishing cause the loss of 75% of the dietetic fibre and 50% of the minerals (amongst other nutrients), whereas the integral ones are those that preserve a higher nutritional content. It is equally important to bear in mind that the presence of different components of the dietetic fibre can carry on a negative effect in the absorption of minerals, lowering its nourishing function. The resistant starch (RS) is the fraction of starch that escapes to the digestion in the small intestine, it ferments in the colon, acting like prebiotic and helping the reabsorption of minerals in the colon. In this PhD Thesis it was established as general aim the nutritional study of the mineral composition of the Calasparra Designation of Origin rice, being raw and boiled, and the estimation of its availability by means of the soluble fraction quantification as well as the content determination of total dietetic fibre. To reach this general aim different specific aims appear. First, to analyse the mineral content by spectrophotometry of atomic absorption and to determine the mineral calculation in different types of rice, both raw and boiled, depending on the variety (Bomba and BalillaXSollana), the production (integral, semi-integral or white), of the growing place and type of production (traditional or ecological). Secondly, to determine the mineral solubility (Miller Method), as estimation measure of the availability of these minerals. To know the effect of cooking on the content of dietetic total fibre (FDT), determined by the Prosky Method, and to establish its possible correlation (Pearson) with the mineral solubility. To analyse the content of amylose and RS in the different samples of Calasparra D.O. rice. The mineral profile in the non-cooked samples of Calasparra D.O. rice would be composed by a high content in K and Mg moderated of Zn and Fe, and low on Ca and Na (with dependence of the place of growing, the variety and the degree of production of the samples), presenting a similar profile to described for other commercial rice varieties. The process of the milling is determinant for the mineral content in the samples, being the brown rice the one with a higher content of minerals versus the semi-integral and the white ones, as the minerals are distributed mostly in the husk of the cereals. The kind of cooking also influences the final concentration of the minerals, since on having cooked allowing the complete absorption of the boiling water, the lost minerals by leaching are re-absorbed, reducing the negative effect of the thermal treatment. The mineral availability, using the percentage of soluble mineral as a sign was the highest for K and Mg, followed by Ca, Fe and Zn, being over the mineral solubility in the white rice samples that in those who had not suffered the process of milling. The influence of the FDT content on the mineral solubility in the boiled samples was different according to the case. In the integral samples the solubility of Fe and Zn does not meet affected, due to the wider distribution of these mineral elements in the husk, whereas in the elaborated rice a negative correlation exists between FDT and the solubility of the Mg. It is not expected any positive effect on the RS related with the mineral bioavailability, since after the cooking one the content was very low

Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care

A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64–81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity