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Se encontraron diferencias bioqu&#237;micas entre los grupos a las 17 y 52 semanas de edad&#44; con valores de &#225;cido docosahexaenoico &#40;DHA&#41; m&#225;s elevados en el grupo alimentado con f&#243;rmula suplementada&#46; Adem&#225;s&#44; se encontraron diferencias funcionales&#44; como la agudeza visual a las 17 semanas&#44; pero no a las 52 semanas de edad&#46; El segundo estudio se llev&#243; a cabo en reci&#233;n nacidos a t&#233;rmino que se alimentaron con lactancia materna hasta los 4&#8211;6 meses de edad&#44; y posteriormente se aleatoriz&#243; a alimentaci&#243;n con f&#243;rmula convencional o suplementada con LCPUFA hasta el a&#241;o de edad&#46; El resultado mostr&#243; una reducci&#243;n del 50 &#37; del contenido de DHA en eritrocitos de los ni&#241;os alimentados con f&#243;rmula convencional&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">El presente trabajo es un estudio bioqu&#237;mico nuevo&#44; ya que realizamos los an&#225;lisis al nacer y al a&#241;o de edad&#44; 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California&#44; EE&#46;UU&#46;&#41;&#44; utilizando una columna capilar de s&#237;lice fundida SP 2330 &#40;Supelco Inc&#44; Bellefonte&#44; EE&#46;UU&#46;&#41; de 30<span class="elsevierStyleHsp" style=""></span>m de longitud&#44; 0&#44;25<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro interno y 0&#44;20<span class="elsevierStyleHsp" style=""></span>&#956;m de espesor de pel&#237;cula&#46; El tipo de detecci&#243;n utilizada fue ionizaci&#243;n de llama &#40;FID&#41;&#46; La rampa de temperaturas comenzaba manteniendo el horno a 80<span class="elsevierStyleHsp" style=""></span>&#176;C durante 1<span class="elsevierStyleHsp" style=""></span>min&#44; aumentando a 50<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min hasta 140<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; a 5<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min hasta 190<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; esta temperatura se manten&#237;a durante 5<span class="elsevierStyleHsp" style=""></span>min&#46; Finalmente&#44; se aumentaba la temperatura hasta 215<span class="elsevierStyleHsp" style=""></span>&#176;C a 5<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min&#44; y se manten&#237;a durante 15<span class="elsevierStyleHsp" style=""></span>min&#46; La temperatura del inyector y del detector era de 250<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Se utiliz&#243; helio como gas portador a una presi&#243;n de 0&#44;5 bares&#46; La identificaci&#243;n de los &#225;cidos grasos se efectu&#243; por comparaci&#243;n de los tiempos de retenci&#243;n con un patr&#243;n comercial &#40;NuCheck&#44; Elysian&#44; EE&#46;UU&#46;&#41;&#46; La cuantificaci&#243;n se realiz&#243; mediante integraci&#243;n manual&#46; Los resultados se expresaron en valores porcentuales con respecto a la suma total de &#225;cidos grasos&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">An&#225;lisis estad&#237;stico</span><p id="p0035" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; mediante an&#225;lisis de varianza univariante &#40;ANOVA&#41;&#44; con el test de Scheff&#233; para las poblaciones normales&#46; Las poblaciones con distribuci&#243;n no normal para el test Kolmogorov-Smirnov se estudiaron mediante el test de Willcoxon y Mann-Whitney&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Estudio estad&#237;stico</span><p id="p0040" class="elsevierStylePara elsevierViewall">Las diferencias de DHA entre grupos se estudiaron utilizando un modelo general lineal&#46; La homogeneidad de la varianza y la normalidad se establecieron mediante los test de Levene y de Shaphiro-Wilk&#44; respectivamente&#46; Para comparaciones <span class="elsevierStyleItalic">post-hoc</span> se utiliz&#243; el test de Sidak&#46; El an&#225;lisis ANOVA univariante se utiliz&#243; para comparar grupos al nacimiento&#46; Se consider&#243; un valor de p de 0&#44;05 o menor como estad&#237;sticamente significativo&#46; Los an&#225;lisis se realizaron con el programa SPSS&#44; versi&#243;n 10&#46;0 para Windows&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">RESULTADOS</span><p id="p0045" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#t0005">tablas 1&#8211;3</a> muestran los valores basales y finales del perfil de &#225;cidos grasos para los tres grupos&#46; Como se esperaba&#44; no existen diferencias en la situaci&#243;n basal de los &#225;cidos grasos en los tres grupos&#44; ya que todos fueron obtenidos de neonatos sanos al nacimiento&#46; Sin embargo&#44; el grupo A muestra valores de DHA &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41; significativamente mayores que los otros dos grupos al a&#241;o de vida &#40;2&#44;46 &#177; 0&#44;84 frente a 1&#44;80 &#177; 0&#44;48 y 1&#44;89 &#177; 0&#44;75&#59; p &#60; 0&#44;01&#41;&#46; El tipo de alimentaci&#243;n explicaba el 14 &#37; de la variabilidad de DHA&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">Tambi&#233;n podemos observar una reducci&#243;n notable de la concentraci&#243;n de DHA y &#225;cido araquid&#243;nico &#40;AA&#41; entre los neonatos y el primer a&#241;o de vida en los tres grupos&#46; Por lo tanto&#44; el porcentaje de AA y DHA de 0 a 1 a&#241;o de vida desciende de 13&#44;12 &#177; 2&#44;54 a 6&#44;67 &#177; 1&#44;38 &#40;p &#60; 0&#44;001&#41;&#59; y de 4&#44;87 &#177; 1&#44;33 a 2&#44;46 &#177; 0&#44;84 &#40;p &#60; 0&#44;001&#41; en el grupo A&#46; En el grupo B&#44; de 13&#44;20 &#177; 2&#44;26 a 6&#44;27 &#177; 1&#44;25 &#40;p &#60; 0&#44;001&#41; y de 4&#44;12 &#177; 0&#44;87 a 1&#44;80 &#177; 0&#44;49 &#40;p &#60; 0&#44;001&#41;&#46; Finalmente&#44; el grupo C desde 13&#44;12 &#177; 2&#44;80 a 6&#44;34 &#177; 1&#44;12 &#40;p &#60; 0&#44;001&#41; y desde 4&#44;31 &#177; 1&#44;20 a 1&#44;89 &#177; 0&#44;75 &#40;p &#60; 0&#44;001&#41;&#46; No exist&#237;a correlaci&#243;n positiva entre los valores individuales al nacimiento y al primer a&#241;o de vida en ninguno de los grupos estudiados&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">DISCUSI&#211;N</span><p id="p0055" class="elsevierStylePara elsevierViewall">Este trabajo se trata de un estudio bioqu&#237;mico basado en la existencia de una seroteca que contiene muestras pareadas &#40;0&#8211;1 a&#241;os de edad&#41; y datos nutricionales&#44; pero no existe un seguimiento directo de la poblaci&#243;n estudiada&#46; Por esta raz&#243;n&#44; desafortunadamente no poseemos datos auxol&#243;gicos que es la limitaci&#243;n m&#225;s importante de este estudio&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que los tres grupos estudiados &#40;lactancia materna prolongada&#44; media y alimentaci&#243;n con f&#243;rmula artificial&#41;&#44; como se esperaba&#44; comienzan con unos valores de DHA y AA similares &#40;sangre del cord&#243;n umbilical&#41;&#44; y que al a&#241;o de edad&#44; el grupo que sigui&#243; lactancia materna durante m&#225;s de 6 meses presentaba una proporci&#243;n mayor de DHA que los otros dos&#44; cuyos valores no son significativamente diferentes&#46; Adem&#225;s&#44; la disminuci&#243;n de la proporci&#243;n de ambos &#225;cidos grasos desde el nacimiento hasta el primer a&#241;o de edad puede ser considerada fisiol&#243;gica&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Tomando las tres poblaciones como una sola&#44; no existe correlaci&#243;n entre los valores individuales iniciales en el cord&#243;n umbilical y al a&#241;o de edad&#44; lo que indica que los factores ambientales tienen un papel decisivo en el establecimiento de los valores al a&#241;o de edad&#46; Es sorprendente el hecho de que la toma de LCPUFA preformado en la leche materna durante 3&#8211;5 meses no tiene ninguna proyecci&#243;n en los valores al a&#241;o de edad cuando &#233;stos son comparados con los valores de los ni&#241;os alimentados con f&#243;rmula convencional&#46; Este hallazgo se encuentra en aparente controversia con el estudio llevado a cabo en Francia sobre ni&#241;os sanos<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> en los que se encontr&#243; una proyecci&#243;n entre los valores de los &#225;cidos grasos al nacer y los que presentaban a los dos meses de edad &#40;tiempo medio del destete en Francia&#41;&#46; Es posible que el estado de los LCPUFA en el neonato no se proyecte m&#225;s all&#225; del primer trimestre de vida y que&#44; m&#225;s tarde&#44; los factores ambientales &#40;la toma de LCPUFA preformado o no&#41; no parecen ser importantes&#44; como muestra nuestro estudio&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">En cualquier caso&#44; el uso exclusivo de los precursores &#40;&#225;cido linoleico y &#225;cido &#945;-linol&#233;nico&#41; presentes en f&#243;rmula convencional est&#225; aparentemente adaptado para mantener la concentraci&#243;n de n-6 LCPUFA &#40;ya que no existe ninguna diferencia en la concentraci&#243;n de AA entre los grupos a cualquier edad&#41; pero no mantienen los niveles de n-3 LCPUFA&#44; ya que se encuentran diferencias en los niveles de DHA al a&#241;o de edad en el grupo con lactancia prolongada&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">Es dif&#237;cil comparar nuestros resultados con los &#250;nicos estudios funcionales y bioqu&#237;micos encontrados en la bibliograf&#237;a durante este per&#237;odo de vida<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9&#44;</span></a><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11&#44;</span></a><a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> ya que el dise&#241;o es diferente&#46; Estos trabajos incluyen valores de DHA y AA al a&#241;o de edad&#44; pero no al nacer&#44; ya que la aleatorizaci&#243;n de los grupos &#40;f&#243;rmula suplementada con LCPUFA o f&#243;rmula convencional&#41; comienza a las 6 semanas en el primer estudio&#44; y entre los 4 y los 6 meses de edad en el segundo&#44; despu&#233;s de un per&#237;odo de lactancia inicial en todos los casos&#46; Adem&#225;s&#44; el primer estudio bioqu&#237;mico tiene lugar a las 17 semanas&#44; y sus resultados se expresan como concentraciones&#44; mientras que los nuestros lo hacen en porcentaje&#46; Otros estudios&#44; que se ocupan en la evaluaci&#243;n de la agudeza visual o de otros par&#225;metros en ni&#241;os&#44; incluyen la alimentaci&#243;n con f&#243;rmula artificial suplementada con DHA y AA&#44; pero no incluyen valores al nacer&#44; y por tanto&#44; tampoco son comparables<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7&#44;</span></a><a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Nuestros resultados se&#241;alan la necesidad de mantener la toma de DHA preformado durante el primer a&#241;o de vida si deseamos obtener valores m&#225;s elevados al a&#241;o de edad&#46; Dado que es lo que se obtiene con la lactancia materna&#44; debe ser considerado &#243;ptimo&#46; A la vista de los resultados&#44; los pediatras tenemos una raz&#243;n m&#225;s para recomendar la lactancia materna prolongada tanto tiempo como sea posible&#46; La lactancia media de entre 3 a 5 meses&#44; no garantiza el adecuado estatdo de DHA al primer a&#241;o de vida &#40;similar a los valores obtenidos tras lactancia artificial&#41;&#44; probablemente debido a tres causas&#58; <span class="elsevierStyleItalic">1&#46;</span> la toma de DHA preformado cesa al interrumpirse la lactancia&#59; <span class="elsevierStyleItalic">2&#46;</span> es dif&#237;cil sintetizar DHA a partir de su precursor&#44; el &#225;cido &#945;-linol&#233;nico&#44; tanto en animales como en humanos<a class="elsevierStyleCrossRefs" href="#bb0110"><span class="elsevierStyleSup">22&#8211;26</span></a>&#44; y <span class="elsevierStyleItalic">3&#46;</span> la toma de DHA de la dieta est&#225; restringida&#44; ya que las gu&#237;as recientes de la ESPGAN recomiendan la supresi&#243;n del huevo y del pescado durante el primer a&#241;o de vida debido a problemas al&#233;rgicos&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">Por consiguiente&#44; si el destete tiene lugar hacia el quinto mes de vida&#44; la dieta infantil idealmente debe incluir DHA&#44; y puesto que su aporte no es posible por medio del beikost&#44; al estar retardada por las recomendaciones de la ESPGAN&#44; ser&#237;a necesaria la disponibilidad de DHA mediante una formula suplementada tipo 2 &#40;para el segundo semestre de vida&#41;&#46;</p></span></span>"
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            2 => "&#193;cido docosahexaenoico"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Comparar las variaciones de los &#225;cidos grasos poliinsaturados de cadena larga &#40;LCPUFA&#41; al nacer y al a&#241;o de edad en ni&#241;os alimentados con lactancia materna prolongada&#44; lactancia materna de duraci&#243;n media y f&#243;rmula artificial&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Un total de 77 ni&#241;os sanos a t&#233;rmino con alimentaci&#243;n conocida fueron divididos en grupos&#58; el grupo A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>25&#41; hab&#237;a recibido lactancia prolongada &#40;m&#225;s de 6 meses&#41;&#59; el B &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; lactancia media &#40;m&#225;s de 3 meses y menos de 5&#41;&#44; y el C &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; cuyos sujetos fueron alimentados &#250;nicamente con f&#243;rmula artificial&#46; Se midi&#243; la proporci&#243;n de &#225;cidos grasos plasm&#225;ticos al nacer y al primer a&#241;o de vida&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">No existen diferencias en el momento del nacimiento&#46; Sin embargo&#44; hay una disminuci&#243;n significativa de la proporci&#243;n de los principales LCPUFA&#44; &#225;cido docosahexaenoico &#40;DHA&#41; y &#225;cido araquid&#243;nico &#40;AA&#41;&#44; entre el nacimiento y el primer a&#241;o de vida&#46; Al a&#241;o&#44; el porcentaje de DHA var&#237;a significativamente entre el grupo A y los otros dos&#58; 2&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;84 frente a 1&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48 y 1&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1</span>&#46; Al nacer no existen diferencias en el contenido de LCPUFA&#46; <span class="elsevierStyleItalic">2&#46;</span> Se observa una disminuci&#243;n significativa de los principales LCPUFA con la edad&#46; <span class="elsevierStyleItalic">3</span>&#46; El grupo con lactancia materna prolongada posee mayores proporciones de DHA que los otros dos&#46; Por consiguiente&#44; la lactancia durante m&#225;s de 6 meses es necesaria para obtener valores m&#225;s elevados de DHA&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Aim</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Compare the variations of long-chain polyunsaturated fatty acids &#40;LCPUFA&#41; levels at birth and at the first year of age in children on extended breast-feeding&#44; medium term breast-feeding and formula feeding&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">77 healthy term infants divided in three groups&#58; A &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#58; extended breast-feeding &#40;more than 6 months&#41;&#44; B &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#58; medium term breast-feeding &#40;more than 3 and less than 5 months&#41; and C &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#58; exclusive formula feeding&#46; Fatty acids in plasma were measured at birth and at the first year of age&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">There were no differences in the levels at birth&#46; However&#44; there is a significant decrease in the proportion of the main LCPUFA&#44; docosahexaenoic acid &#40;DHA&#41; and arachidonic acid &#40;AA&#41;&#44; between birth and the first year of age&#46; At one year of age&#44; the percentage of DHA in Group A differs significantly between the other two&#58; 2&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;84 vs&#46; 1&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;48 and 1&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1&#46;</span> At birth&#44; there are no differences in LCPUFA&#46; <span class="elsevierStyleItalic">2&#46;</span> A significant decrease in the main LCPUFA is observed with age&#46; <span class="elsevierStyleItalic">3&#46;</span> The extended breast-feeding group shows higher DHA levels than the other two&#46; Therefore&#44; breast-feeding for more than 6 months is required to achieve higher plasma DHA values&#46;</p>"
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          "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Porcentajes de &#225;cido docosahexaenoico &#40;DHA&#41; al nacer &#40;color gris&#41; y al a&#241;o de edad &#40;color blanco&#41; en los tres tipos de alimentaci&#243;n&#58; lactancia materna prolongada &#40;A&#41;&#44; lactancia materna de duraci&#243;n media &#40;B&#41; y f&#243;rmula artificial &#40;C&#41;&#46;</p>"
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192874.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Porcentaje en peso de los &#225;cidos grasos al nacer &#40;basal&#41; y al a&#241;o de vida en los sujetos del grupo A &#40;lactancia prolongada m&#225;s de 6 meses&#41;</p>"
        ]
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      2 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
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            0 => array:2 [
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192872.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Porcentaje en peso de los &#225;cidos grasos al nacer &#40;basal&#41; y al a&#241;o de vida en los sujetos del grupo B &#40;lactancia media entre 3 y 5 meses&#41;</p>"
        ]
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      3 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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            0 => array:2 [
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ORIGINALES
Ácidos grasos n-3 y n-6 en plasma al nacer y al año de edad y relación con el tipo de alimentación
N-3 and N-6 fatty acids in plasma at birth and one year of age and relationship with feeding
P. Sanjurjo Crespo
Autor para correspondencia
labmetabolismo@hcru.osakidetza.net

Dr. P. Sanjurjo Crespo. Departamento de Pediatría. Hospital de Cruces. Plaza de Cruces, s/n. 48903 Barakaldo. Vizcaya. España.
, N. Trebolazabala Quirante, L. Aldámiz-Echevarría Azuara, L. Castaño González, J.A. Prieto Perera, F. Andrade Lodeiro
Departamento de Pediatría. Hospital de Cruces. Barakaldo. Vizcaya. España
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          "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Porcentajes de &#225;cido docosahexaenoico &#40;DHA&#41; al nacer &#40;color gris&#41; y al a&#241;o de edad &#40;color blanco&#41; en los tres tipos de alimentaci&#243;n&#58; lactancia materna prolongada &#40;A&#41;&#44; lactancia materna de duraci&#243;n media &#40;B&#41; y f&#243;rmula artificial &#40;C&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">INTRODUCCI&#211;N</span><p id="p0005" class="elsevierStylePara elsevierViewall">La importancia de los &#225;cidos grasos poliinsaturados de larga cadena &#40;LCPUFA&#41; en la nutrici&#243;n infantil no s&#243;lo se debe al progresivo enriquecimiento del sistema nervioso central en estos &#225;cidos<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; sino tambi&#233;n de la funci&#243;n bioactiva de los eicosanoides&#44; derivados de la familia n-3 y n-6 de los &#225;cidos grasos poliinsaturados de cadena larga &#40;LCPUFA&#41;<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; La controversia nutricional sobre si se debe a&#241;adir o no LCPUFA n-3 y n-6 a la dieta del lactante se est&#225; inclinando hacia la primera opci&#243;n&#46; Esto no s&#243;lo se debe al hecho de que la leche materna los contiene<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a>&#44; sino a que la adici&#243;n de precursores exclusivos en la f&#243;rmula artificial acarrea unos patrones bioqu&#237;micos de membrana &#40;incluyendo el cerebro&#41; diferentes de los de la lactancia materna<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a>&#44; y tambi&#233;n diferencias favorables en su uso en algunos estudios funcionales<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6&#8211;14</span></a>&#46; La conclusi&#243;n podr&#237;a ser que existen diferencias entre una nutrici&#243;n posiblemente inadecuada &#40;uso exclusivo de precursores&#41;&#44; nutrici&#243;n adecuada &#40;uso de f&#243;rmula suplementada con LCPUFA&#41; y nutrici&#243;n &#243;ptima &#40;lactancia materna&#41;&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">La biodisponibilidad de los LCPUFA durante el segundo semestre de vida puede estar comprometida&#44; ya que es com&#250;n la combinaci&#243;n indeseada de que muchos lactantes son alimentados con leche materna durante solamente durante un corto per&#237;odo de tiempo&#44; e inician la alimentaci&#243;n complementaria con alimentos que contengan LCPUFA preformado &#40;huevos&#44; v&#237;sceras&#44; pescado graso&#41; muy tarde&#46; Esto da lugar a una brecha entre los 3 meses y el a&#241;o de vida de ingesta directa de LCPUFA&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">En este sentido&#44; s&#243;lo se han publicado dos estudios bioqu&#237;micos<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9&#44;</span></a><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#46; El primero&#44; realizado en ni&#241;os normales tras 6 semanas de lactancia materna exclusiva&#44; se aleatoriz&#243; en dos grupos con diferente alimentaci&#243;n hasta el primer a&#241;o de vida&#58; f&#243;rmula suplementada con LCPUFA y f&#243;rmula convencional&#46; Se encontraron diferencias bioqu&#237;micas entre los grupos a las 17 y 52 semanas de edad&#44; con valores de &#225;cido docosahexaenoico &#40;DHA&#41; m&#225;s elevados en el grupo alimentado con f&#243;rmula suplementada&#46; Adem&#225;s&#44; se encontraron diferencias funcionales&#44; como la agudeza visual a las 17 semanas&#44; pero no a las 52 semanas de edad&#46; El segundo estudio se llev&#243; a cabo en reci&#233;n nacidos a t&#233;rmino que se alimentaron con lactancia materna hasta los 4&#8211;6 meses de edad&#44; y posteriormente se aleatoriz&#243; a alimentaci&#243;n con f&#243;rmula convencional o suplementada con LCPUFA hasta el a&#241;o de edad&#46; El resultado mostr&#243; una reducci&#243;n del 50 &#37; del contenido de DHA en eritrocitos de los ni&#241;os alimentados con f&#243;rmula convencional&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">El presente trabajo es un estudio bioqu&#237;mico nuevo&#44; ya que realizamos los an&#225;lisis al nacer y al a&#241;o de edad&#44; y se conoce el tipo de alimentaci&#243;n seguida&#46; El objetivo es realizar un estudio sobre la relaci&#243;n entre la lactancia y las estructuras que contienen LCPUFA en este per&#237;odo en que la nutrici&#243;n es tan importante y&#44; sin embargo&#44; se encuentra poco estudiada&#44; es decir&#44; el estado de los LCPUFA en el primer a&#241;o de edad y la correlaci&#243;n individual con los valores al nacimiento&#46; Este trabajo trata tambi&#233;n de conocer si la lactancia materna prolongada es decisiva en los valores plasm&#225;ticos de LCPUFA al a&#241;o de edad&#44; teniendo en cuenta que la toma de otros alimentos que contienen LCPUFA&#44; como pescado&#44; huevos y v&#237;sceras&#44; se ha trasladado m&#225;s all&#225; del a&#241;o de edad&#44; seg&#250;n las recomendaciones de la Sociedad Pediatrica Europea de Gastroenterolog&#237;a y Nutrici&#243;n &#40;ESPGAN&#41;<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">MATERIALES Y M&#201;TODOS</span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Sujetos</span><p id="p0025" class="elsevierStylePara elsevierViewall">La declaraci&#243;n de Helsinki no permite la obtenci&#243;n de muestras de ni&#241;os sanos&#44; de ah&#237; la dificultad de obtenerlas para este tipo de estudios&#46; Nuestras muestras fueron obtenidas merced a la existencia de una seroteca creada para el &#8220;estudio de la etiolog&#237;a de la diabetes mellitus y el tipo de lactancia&#8221; para el que se obtuvieron los permisos y el consentimiento &#233;tico necesarios<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#46; Este banco conten&#237;a muestras de 300 ni&#241;os al nacer y al a&#241;o de vida&#44; y su perfil nutricional era conocido&#59; sin embargo&#44; no se conocen los datos auxol&#243;gicos&#46; Se eligieron 77 muestras que correspond&#237;an a ni&#241;os sanos con historia de gestaci&#243;n normal y un peso adecuado&#44; que puede representar nuestra poblaci&#243;n media&#46; As&#237;&#44; se establecieron tres grupos&#46; El grupo A &#40;n &#61; 25&#41; hab&#237;a recibido lactancia materna prolongada &#40;m&#225;s de 6 meses&#41;&#59; el grupo B&#44; lactancia media &#40;m&#225;s de 3 y menos de 5 meses&#41;&#44; y el grupo C alimentaci&#243;n con f&#243;rmula artificial convencional&#46; Este estudio fue aprobado por el comit&#233; &#233;tico del hospital&#44; y se obtuvo consentimiento informado por escrito de los padres o tutores&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">M&#233;todos</span><p id="p0030" class="elsevierStylePara elsevierViewall">La extracci&#243;n de los l&#237;pidos de las muestras se llev&#243; a cabo con el m&#233;todo de Folch et al<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a>&#46; La reacci&#243;n para la formaci&#243;n de &#233;steres met&#237;licos de los &#225;cidos grasos se realiz&#243; seg&#250;n el m&#233;todo de Lepage y Roy<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&#44; utilizando &#225;cido tridecanoico como patr&#243;n interno&#46; Los &#233;steres met&#237;licos se separaron por medio de un cromat&#243;grafo de gases HP 5890 serie II &#40;Palo Alto&#44; California&#44; EE&#46;UU&#46;&#41;&#44; utilizando una columna capilar de s&#237;lice fundida SP 2330 &#40;Supelco Inc&#44; Bellefonte&#44; EE&#46;UU&#46;&#41; de 30<span class="elsevierStyleHsp" style=""></span>m de longitud&#44; 0&#44;25<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro interno y 0&#44;20<span class="elsevierStyleHsp" style=""></span>&#956;m de espesor de pel&#237;cula&#46; El tipo de detecci&#243;n utilizada fue ionizaci&#243;n de llama &#40;FID&#41;&#46; La rampa de temperaturas comenzaba manteniendo el horno a 80<span class="elsevierStyleHsp" style=""></span>&#176;C durante 1<span class="elsevierStyleHsp" style=""></span>min&#44; aumentando a 50<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min hasta 140<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; a 5<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min hasta 190<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; esta temperatura se manten&#237;a durante 5<span class="elsevierStyleHsp" style=""></span>min&#46; Finalmente&#44; se aumentaba la temperatura hasta 215<span class="elsevierStyleHsp" style=""></span>&#176;C a 5<span class="elsevierStyleHsp" style=""></span>&#176;C&#47;min&#44; y se manten&#237;a durante 15<span class="elsevierStyleHsp" style=""></span>min&#46; La temperatura del inyector y del detector era de 250<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Se utiliz&#243; helio como gas portador a una presi&#243;n de 0&#44;5 bares&#46; La identificaci&#243;n de los &#225;cidos grasos se efectu&#243; por comparaci&#243;n de los tiempos de retenci&#243;n con un patr&#243;n comercial &#40;NuCheck&#44; Elysian&#44; EE&#46;UU&#46;&#41;&#46; La cuantificaci&#243;n se realiz&#243; mediante integraci&#243;n manual&#46; Los resultados se expresaron en valores porcentuales con respecto a la suma total de &#225;cidos grasos&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">An&#225;lisis estad&#237;stico</span><p id="p0035" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; mediante an&#225;lisis de varianza univariante &#40;ANOVA&#41;&#44; con el test de Scheff&#233; para las poblaciones normales&#46; Las poblaciones con distribuci&#243;n no normal para el test Kolmogorov-Smirnov se estudiaron mediante el test de Willcoxon y Mann-Whitney&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Estudio estad&#237;stico</span><p id="p0040" class="elsevierStylePara elsevierViewall">Las diferencias de DHA entre grupos se estudiaron utilizando un modelo general lineal&#46; La homogeneidad de la varianza y la normalidad se establecieron mediante los test de Levene y de Shaphiro-Wilk&#44; respectivamente&#46; Para comparaciones <span class="elsevierStyleItalic">post-hoc</span> se utiliz&#243; el test de Sidak&#46; El an&#225;lisis ANOVA univariante se utiliz&#243; para comparar grupos al nacimiento&#46; Se consider&#243; un valor de p de 0&#44;05 o menor como estad&#237;sticamente significativo&#46; Los an&#225;lisis se realizaron con el programa SPSS&#44; versi&#243;n 10&#46;0 para Windows&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">RESULTADOS</span><p id="p0045" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#t0005">tablas 1&#8211;3</a> muestran los valores basales y finales del perfil de &#225;cidos grasos para los tres grupos&#46; Como se esperaba&#44; no existen diferencias en la situaci&#243;n basal de los &#225;cidos grasos en los tres grupos&#44; ya que todos fueron obtenidos de neonatos sanos al nacimiento&#46; Sin embargo&#44; el grupo A muestra valores de DHA &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41; significativamente mayores que los otros dos grupos al a&#241;o de vida &#40;2&#44;46 &#177; 0&#44;84 frente a 1&#44;80 &#177; 0&#44;48 y 1&#44;89 &#177; 0&#44;75&#59; p &#60; 0&#44;01&#41;&#46; El tipo de alimentaci&#243;n explicaba el 14 &#37; de la variabilidad de DHA&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">Tambi&#233;n podemos observar una reducci&#243;n notable de la concentraci&#243;n de DHA y &#225;cido araquid&#243;nico &#40;AA&#41; entre los neonatos y el primer a&#241;o de vida en los tres grupos&#46; Por lo tanto&#44; el porcentaje de AA y DHA de 0 a 1 a&#241;o de vida desciende de 13&#44;12 &#177; 2&#44;54 a 6&#44;67 &#177; 1&#44;38 &#40;p &#60; 0&#44;001&#41;&#59; y de 4&#44;87 &#177; 1&#44;33 a 2&#44;46 &#177; 0&#44;84 &#40;p &#60; 0&#44;001&#41; en el grupo A&#46; En el grupo B&#44; de 13&#44;20 &#177; 2&#44;26 a 6&#44;27 &#177; 1&#44;25 &#40;p &#60; 0&#44;001&#41; y de 4&#44;12 &#177; 0&#44;87 a 1&#44;80 &#177; 0&#44;49 &#40;p &#60; 0&#44;001&#41;&#46; Finalmente&#44; el grupo C desde 13&#44;12 &#177; 2&#44;80 a 6&#44;34 &#177; 1&#44;12 &#40;p &#60; 0&#44;001&#41; y desde 4&#44;31 &#177; 1&#44;20 a 1&#44;89 &#177; 0&#44;75 &#40;p &#60; 0&#44;001&#41;&#46; No exist&#237;a correlaci&#243;n positiva entre los valores individuales al nacimiento y al primer a&#241;o de vida en ninguno de los grupos estudiados&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">DISCUSI&#211;N</span><p id="p0055" class="elsevierStylePara elsevierViewall">Este trabajo se trata de un estudio bioqu&#237;mico basado en la existencia de una seroteca que contiene muestras pareadas &#40;0&#8211;1 a&#241;os de edad&#41; y datos nutricionales&#44; pero no existe un seguimiento directo de la poblaci&#243;n estudiada&#46; Por esta raz&#243;n&#44; desafortunadamente no poseemos datos auxol&#243;gicos que es la limitaci&#243;n m&#225;s importante de este estudio&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que los tres grupos estudiados &#40;lactancia materna prolongada&#44; media y alimentaci&#243;n con f&#243;rmula artificial&#41;&#44; como se esperaba&#44; comienzan con unos valores de DHA y AA similares &#40;sangre del cord&#243;n umbilical&#41;&#44; y que al a&#241;o de edad&#44; el grupo que sigui&#243; lactancia materna durante m&#225;s de 6 meses presentaba una proporci&#243;n mayor de DHA que los otros dos&#44; cuyos valores no son significativamente diferentes&#46; Adem&#225;s&#44; la disminuci&#243;n de la proporci&#243;n de ambos &#225;cidos grasos desde el nacimiento hasta el primer a&#241;o de edad puede ser considerada fisiol&#243;gica&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Tomando las tres poblaciones como una sola&#44; no existe correlaci&#243;n entre los valores individuales iniciales en el cord&#243;n umbilical y al a&#241;o de edad&#44; lo que indica que los factores ambientales tienen un papel decisivo en el establecimiento de los valores al a&#241;o de edad&#46; Es sorprendente el hecho de que la toma de LCPUFA preformado en la leche materna durante 3&#8211;5 meses no tiene ninguna proyecci&#243;n en los valores al a&#241;o de edad cuando &#233;stos son comparados con los valores de los ni&#241;os alimentados con f&#243;rmula convencional&#46; Este hallazgo se encuentra en aparente controversia con el estudio llevado a cabo en Francia sobre ni&#241;os sanos<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> en los que se encontr&#243; una proyecci&#243;n entre los valores de los &#225;cidos grasos al nacer y los que presentaban a los dos meses de edad &#40;tiempo medio del destete en Francia&#41;&#46; Es posible que el estado de los LCPUFA en el neonato no se proyecte m&#225;s all&#225; del primer trimestre de vida y que&#44; m&#225;s tarde&#44; los factores ambientales &#40;la toma de LCPUFA preformado o no&#41; no parecen ser importantes&#44; como muestra nuestro estudio&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">En cualquier caso&#44; el uso exclusivo de los precursores &#40;&#225;cido linoleico y &#225;cido &#945;-linol&#233;nico&#41; presentes en f&#243;rmula convencional est&#225; aparentemente adaptado para mantener la concentraci&#243;n de n-6 LCPUFA &#40;ya que no existe ninguna diferencia en la concentraci&#243;n de AA entre los grupos a cualquier edad&#41; pero no mantienen los niveles de n-3 LCPUFA&#44; ya que se encuentran diferencias en los niveles de DHA al a&#241;o de edad en el grupo con lactancia prolongada&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">Es dif&#237;cil comparar nuestros resultados con los &#250;nicos estudios funcionales y bioqu&#237;micos encontrados en la bibliograf&#237;a durante este per&#237;odo de vida<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9&#44;</span></a><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11&#44;</span></a><a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> ya que el dise&#241;o es diferente&#46; Estos trabajos incluyen valores de DHA y AA al a&#241;o de edad&#44; pero no al nacer&#44; ya que la aleatorizaci&#243;n de los grupos &#40;f&#243;rmula suplementada con LCPUFA o f&#243;rmula convencional&#41; comienza a las 6 semanas en el primer estudio&#44; y entre los 4 y los 6 meses de edad en el segundo&#44; despu&#233;s de un per&#237;odo de lactancia inicial en todos los casos&#46; Adem&#225;s&#44; el primer estudio bioqu&#237;mico tiene lugar a las 17 semanas&#44; y sus resultados se expresan como concentraciones&#44; mientras que los nuestros lo hacen en porcentaje&#46; Otros estudios&#44; que se ocupan en la evaluaci&#243;n de la agudeza visual o de otros par&#225;metros en ni&#241;os&#44; incluyen la alimentaci&#243;n con f&#243;rmula artificial suplementada con DHA y AA&#44; pero no incluyen valores al nacer&#44; y por tanto&#44; tampoco son comparables<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7&#44;</span></a><a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Nuestros resultados se&#241;alan la necesidad de mantener la toma de DHA preformado durante el primer a&#241;o de vida si deseamos obtener valores m&#225;s elevados al a&#241;o de edad&#46; Dado que es lo que se obtiene con la lactancia materna&#44; debe ser considerado &#243;ptimo&#46; A la vista de los resultados&#44; los pediatras tenemos una raz&#243;n m&#225;s para recomendar la lactancia materna prolongada tanto tiempo como sea posible&#46; La lactancia media de entre 3 a 5 meses&#44; no garantiza el adecuado estatdo de DHA al primer a&#241;o de vida &#40;similar a los valores obtenidos tras lactancia artificial&#41;&#44; probablemente debido a tres causas&#58; <span class="elsevierStyleItalic">1&#46;</span> la toma de DHA preformado cesa al interrumpirse la lactancia&#59; <span class="elsevierStyleItalic">2&#46;</span> es dif&#237;cil sintetizar DHA a partir de su precursor&#44; el &#225;cido &#945;-linol&#233;nico&#44; tanto en animales como en humanos<a class="elsevierStyleCrossRefs" href="#bb0110"><span class="elsevierStyleSup">22&#8211;26</span></a>&#44; y <span class="elsevierStyleItalic">3&#46;</span> la toma de DHA de la dieta est&#225; restringida&#44; ya que las gu&#237;as recientes de la ESPGAN recomiendan la supresi&#243;n del huevo y del pescado durante el primer a&#241;o de vida debido a problemas al&#233;rgicos&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">Por consiguiente&#44; si el destete tiene lugar hacia el quinto mes de vida&#44; la dieta infantil idealmente debe incluir DHA&#44; y puesto que su aporte no es posible por medio del beikost&#44; al estar retardada por las recomendaciones de la ESPGAN&#44; ser&#237;a necesaria la disponibilidad de DHA mediante una formula suplementada tipo 2 &#40;para el segundo semestre de vida&#41;&#46;</p></span></span>"
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          "identificador" => "s0005"
          "titulo" => "INTRODUCCI&#211;N"
        ]
        3 => array:3 [
          "identificador" => "s0010"
          "titulo" => "MATERIALES Y M&#201;TODOS"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "s0015"
              "titulo" => "Sujetos"
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            1 => array:2 [
              "identificador" => "s0020"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "s0025"
              "titulo" => "An&#225;lisis estad&#237;stico"
            ]
            3 => array:2 [
              "identificador" => "s0030"
              "titulo" => "Estudio estad&#237;stico"
            ]
          ]
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        4 => array:2 [
          "identificador" => "s0035"
          "titulo" => "RESULTADOS"
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        5 => array:2 [
          "identificador" => "s0040"
          "titulo" => "DISCUSI&#211;N"
        ]
        6 => array:1 [
          "titulo" => "BIBLIOGRAF&#205;A"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2007-01-31"
    "fechaAceptado" => "2008-02-29"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec94253"
          "palabras" => array:4 [
            0 => "Lactancia materna"
            1 => "Lactancia artificial"
            2 => "&#193;cido docosahexaenoico"
            3 => "&#193;cido araquid&#243;nico"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec94254"
          "palabras" => array:4 [
            0 => "Breast-feeding"
            1 => "Formula feeding"
            2 => "Docosahexaenoic acid"
            3 => "Arachidonic acid"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Comparar las variaciones de los &#225;cidos grasos poliinsaturados de cadena larga &#40;LCPUFA&#41; al nacer y al a&#241;o de edad en ni&#241;os alimentados con lactancia materna prolongada&#44; lactancia materna de duraci&#243;n media y f&#243;rmula artificial&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Un total de 77 ni&#241;os sanos a t&#233;rmino con alimentaci&#243;n conocida fueron divididos en grupos&#58; el grupo A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>25&#41; hab&#237;a recibido lactancia prolongada &#40;m&#225;s de 6 meses&#41;&#59; el B &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; lactancia media &#40;m&#225;s de 3 meses y menos de 5&#41;&#44; y el C &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; cuyos sujetos fueron alimentados &#250;nicamente con f&#243;rmula artificial&#46; Se midi&#243; la proporci&#243;n de &#225;cidos grasos plasm&#225;ticos al nacer y al primer a&#241;o de vida&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">No existen diferencias en el momento del nacimiento&#46; Sin embargo&#44; hay una disminuci&#243;n significativa de la proporci&#243;n de los principales LCPUFA&#44; &#225;cido docosahexaenoico &#40;DHA&#41; y &#225;cido araquid&#243;nico &#40;AA&#41;&#44; entre el nacimiento y el primer a&#241;o de vida&#46; Al a&#241;o&#44; el porcentaje de DHA var&#237;a significativamente entre el grupo A y los otros dos&#58; 2&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;84 frente a 1&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48 y 1&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1</span>&#46; Al nacer no existen diferencias en el contenido de LCPUFA&#46; <span class="elsevierStyleItalic">2&#46;</span> Se observa una disminuci&#243;n significativa de los principales LCPUFA con la edad&#46; <span class="elsevierStyleItalic">3</span>&#46; El grupo con lactancia materna prolongada posee mayores proporciones de DHA que los otros dos&#46; Por consiguiente&#44; la lactancia durante m&#225;s de 6 meses es necesaria para obtener valores m&#225;s elevados de DHA&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Aim</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Compare the variations of long-chain polyunsaturated fatty acids &#40;LCPUFA&#41; levels at birth and at the first year of age in children on extended breast-feeding&#44; medium term breast-feeding and formula feeding&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">77 healthy term infants divided in three groups&#58; A &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#58; extended breast-feeding &#40;more than 6 months&#41;&#44; B &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#58; medium term breast-feeding &#40;more than 3 and less than 5 months&#41; and C &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#58; exclusive formula feeding&#46; Fatty acids in plasma were measured at birth and at the first year of age&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">There were no differences in the levels at birth&#46; However&#44; there is a significant decrease in the proportion of the main LCPUFA&#44; docosahexaenoic acid &#40;DHA&#41; and arachidonic acid &#40;AA&#41;&#44; between birth and the first year of age&#46; At one year of age&#44; the percentage of DHA in Group A differs significantly between the other two&#58; 2&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;84 vs&#46; 1&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;48 and 1&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1&#46;</span> At birth&#44; there are no differences in LCPUFA&#46; <span class="elsevierStyleItalic">2&#46;</span> A significant decrease in the main LCPUFA is observed with age&#46; <span class="elsevierStyleItalic">3&#46;</span> The extended breast-feeding group shows higher DHA levels than the other two&#46; Therefore&#44; breast-feeding for more than 6 months is required to achieve higher plasma DHA values&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Este trabajo ha sido parcialmente financiado por los proyectos RGDM &#40;G03&#47;212&#41; y RCMN &#40;G03&#47;08&#41; del Instituto de Salud Carlos III&#44; Ministerio de Sanidad&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "f0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Porcentajes de &#225;cido docosahexaenoico &#40;DHA&#41; al nacer &#40;color gris&#41; y al a&#241;o de edad &#40;color blanco&#41; en los tres tipos de alimentaci&#243;n&#58; lactancia materna prolongada &#40;A&#41;&#44; lactancia materna de duraci&#243;n media &#40;B&#41; y f&#243;rmula artificial &#40;C&#41;&#46;</p>"
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                  """
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              "imagenFichero" => array:1 [
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        "descripcion" => array:1 [
          "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Porcentaje en peso de los &#225;cidos grasos al nacer &#40;basal&#41; y al a&#241;o de vida en los sujetos del grupo A &#40;lactancia prolongada m&#225;s de 6 meses&#41;</p>"
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      2 => array:7 [
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192872.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Porcentaje en peso de los &#225;cidos grasos al nacer &#40;basal&#41; y al a&#241;o de vida en los sujetos del grupo B &#40;lactancia media entre 3 y 5 meses&#41;</p>"
        ]
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      3 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                            4 => "B&#46;J&#46; Milne"
                            5 => "R&#46; Poulton"
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Información del artículo
ISSN: 16954033
Idioma original: Español
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