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Inhibition of glycolysis and Src/Akt signaling reduces Caveolin-1-enhanced metastasis
(Elsevier, 2024-06-03) Simón, Layla; Torres, Keila; Contreras, Pamela; Diaz-Valdivia, Natalia; Leyton, Lisette; Quest, Andrew F. G.
Metastasis is the leading cause of cancer-related deaths, making the development of novel, more effective therapies imperative to alleviate patient suffering. Metabolic switching is a hallmark of cancer cells that facilitates metastasis. Cancer cells obtain most of their energy and intermediate metabolites, which are required to proliferate and metastasize, through aerobic glycolysis. Previous work from our laboratory has shown that Caveolin-1 (CAV1) expression in cancer cells promotes glycolysis and metastasis. Here, we sought to determine if limiting glycolysis reduced CAV1-enhanced metastasis and to identify the mechanism(s) involved. We evaluated the effects of the glycolysis inhibitor 2-deoxy-D-glucose (2-DG) in metastatic melanoma and breast cancer cell lines expressing or not CAV1. Non-cytotoxic concentrations of 2-DG (1 mM) inhibited the migration of B16-F10 melanoma and MDA-MB-231 breast cancer cells. CAV1-mediated activation of Src/Akt signaling was required for CAV1-enhanced migration and was blocked in the presence of 2-DG. Moreover, inhibition of Akt reduced CAV1-enhanced lung metastasis of B16-F10 cells. Collectively, these findings highlight the importance of CAV1-induced metabolic reprogramming for metastasis and point towards possible therapeutic approaches to prevent metastatic disease by inhibiting glycolysis and Src/Akt signaling.
Phlorotannins: novel orally administrated bioactive compounds that induce mitochondrial dysfunction and oxidative stress in cancer
(MDPI, 2023-09-07) Simón, Layla; Arazo-Rusindo, Migdalia; Quest, Andrew F. G.; Mariotti-Celis, María Salomé
Mitochondrial dysfunction is an interesting therapeutic target to help reduce cancer deaths, and the use of bioactive compounds has emerged as a novel and safe approach to solve this problem. Here, we discuss the information available related to phlorotannins, a type of polyphenol present in brown seaweeds that reportedly functions as antioxidants/pro-oxidants and anti-inflammatory and anti-tumorigenic agents. Specifically, available evidence indicates that dieckol and phloroglucinol promote mitochondrial membrane depolarization and mitochondria-dependent apoptosis. Phlorotannins also reduce pro-tumorigenic, -inflammatory, and -angiogenic signaling mechanisms involving RAS/MAPK/ERK, PI3K/Akt/mTOR, NF-κB, and VEGF. In doing so, they inhibit pathways that favor cancer development and progression. Unfortunately, these compounds are rather labile and, therefore, this review also summarizes approaches permitting the encapsulation of bioactive compounds, like phlorotannins, and their subsequent oral administration as novel and non-invasive therapeutic alternatives for cancer treatment.
Breastfeeding, complementary feeding, physical activity, screen use, and hours of sleep in children under 2 years during lockdown by the COVID-19 pandemic in Chile
(MDPI, 2022-05-30) Bustos-Arriagada, Edson; Etchegaray-Armijo, Karina; Liberona-Ortiz, Ángelo; Duarte-Silva, Lissette
Infants and children are a risk group in terms of developing healthy habits, an important aspect if we consider that many of them were born during the COVID-19 pandemic. Our objective was to evaluate compliance with lifestyle recommendations proposed at the national and international levels in children aged 0 to 23 months during confinement due to the COVID-19 pandemic in Chile. A cross-sectional study was conducted, and 211 online questionnaires were completed with sociodemographic and lifestyle information of children. Our results show high compliance with the recommendations on breastfeeding intake (78.3% and 69.5% in 0–5-month-old and 6–23-month-old children, respectively); age of starting complementary feeding (87.4%); non-consumption of salt and sugar (80.1%), non-caloric sweeteners (90.7%), and sweet and salty snacks (68.9%); and hours of physical activity (66.8%) and sleep (65.4%). However, we observed low compliance with the recommendations on the age of introduction of dinner (58.0%), eggs (23.0%), legumes (39.2%), and fish (35.1%); low consumption of legumes (43.4%) and fish (20.5%); and low compliance with the recommendations on screen use during meals (59.2%) and daily screen hours (41.2%). In conclusion, feeding behavior, physical activity, use of screens, and hours of sleep in children were altered by confinement during the pandemic, harming the development of healthy lifestyles.
Disfunción mitocondrial y estrés oxidativo asociado al trastorno del espectro autista: Una revisión narrativa
(Sociedad Chilena de Nutrición, Bromatología y Toxicología, 2022-02) Etchegaray-Armijo, Karina; Bustos-Arriagada, Edson
El trastorno del espectro autista (TEA) es un conjunto de alteraciones del desarrollo neurológico, deterioro de la interacción social, lenguaje y comunicación, el cual ha aumentado a nivel mundial en los últimos años. El deterioro de esta condición ocurre principalmente a nivel cerebral y actualmente se ha postulado que la disfunción mitocondrial (DM), el aumento del estrés oxidativo y la disminución de la defensa antioxidante conducen a un desequilibrio en la capacidad de contrarrestar los efectos nocivos del estrés oxidativo, como degradación oxidativa de lípidos, proteínas y ADN que puede causar daño en el tejido cerebral, lo que conduce a síntomas clínicos y comportamientos del TEA. La disfunción mitocondrial principalmente puede ocurrir debido a anomalías en la cadena transportadora de electrones, que a su vez induce y aumenta el estrés oxidativo. Por otro lado, el cerebro es sumamente vulnerable al estrés oxidativo, por su alto consumo de oxígeno, su limitada capacidad antioxidante, mayor cantidad de ácidos grasos y hierro. Esta mayor susceptibilidad del cerebro al daño oxidativo destaca la importancia de comprender el papel del estrés oxidativo en las manifestaciones clínicas del TEA. Diversos estudios han observado un aumento de los marcadores de estrés oxidativo y una disminución en las enzimas antioxidantes en el autismo. Por lo tanto, mejorar el estado oxidativo y mantener el equilibrio redox podría mejorar las manifestaciones clínicas del autismo. El presente estudio tiene como objetivo realizar una revisión narrativa sobre estrés oxidativo y disfunción mitocondrial asociado al trastorno del espectro autista.
Pressurized hot liquid extraction with 15% v/v glycerol-water as an effective environment-friendly process to obtain durvillaea incurvata and lessonia spicata phlorotannin extracts with antioxidant and antihyperglycemic potential
(MDPI, 2021-07-10) Erpel, Fernanda; Mariotti-Celis, María Salomé; Parada, Javier; Pedreschi, Franco; Pérez-Correa, José Ricardo
Brown seaweed phlorotannins have shown the potential to promote several health benefits. Durvillaea incurvata and Lessonia spicata—species that are widely distributed in central and southern Chile—were investigated to obtain phlorotannin extracts with antioxidant and antihyperglycemic potential. The use of an environmentally friendly and food-grade glycerol-based pressurized hot liquid extraction (PHLE) process (15% v/v glycerol water) was assessed for the first time to obtain phlorotannins. Multiple effects were analyzed, including the effect of the species, harvesting area (Las Cruces and Niebla), and anatomical part (holdfast, stipe, and frond) on the extracts’ polyphenol content (TPC), antioxidant capacity (AC), and carbohydrate-hydrolyzing enzyme—α-glucosidase and α-amylase—inhibitory activity. Contaminants, such as mannitol, heavy metals (As, Cd, Pb, Hg, and Sn), and 5-hydroxymethylfurfural (HMF), were also determined. The anatomical part used demonstrated a significant impact on the extracts’ TPC and AC, with holdfasts showing the highest values (TPC: 95 ± 24 mg phloroglucinol equivalents/g dry extract; DPPH: 400 ± 140 μmol Trolox equivalents/g dry extract; ORAC: 560 ± 130 μmol TE/g dry extract). Accordingly, holdfast extracts presented the most potent α-glucosidase inhibition, with D. incurvata from Niebla showing an activity equivalent to fifteen times that of acarbose. Only one frond and stipe extract showed significant α-glucosidase inhibitory capacity. No α-amylase inhibition was found in any extract. Although no HMF was detected, potentially hazardous cadmium levels (over the French limit) and substantial mannitol concentrations—reaching up to 50% of the extract dry weight—were found in most seaweed samples and extracts. Therefore, further purification steps are suggested if food or pharmaceutical applications are intended for the seaweed PHLE extracts obtained in this study.
Hot pressurized liquid extraction of polyphenols from the skin and seeds of vitis vinifera L. cv. Negra Criolla Pomace a Peruvian native pisco industry waste
(MDPI, 2021-04-28) Allca-Alca, Erik; León-Calvo, Nilton; Luque-Vilca, Olivia; Martínez-Cifuentes, Maximiliano; Pérez-Correa, José Ricardo; Mariotti-Celis, María Salomé; Human-Castilla, Nils Leander
The pisco industry in Peru generates large amounts of grape pomace, which is a natural source of bioactive compounds with potential nutraceutical applications. Hot pressurized liquid extraction (HPLE) with water-ethanol solvent mixtures (20–60%) at high temperatures (100–160 °C) was applied to recover polyphenols from the skin and seeds of a Peruvian pisco-industry grape-pomace waste. At the same HPLE conditions (60% ethanol, 160 °C), the seed fraction extracts contained ~6 times more total polyphenol and presented ~5 times more antioxidant activity than the extract from the skin fraction. The lowest ethanol concentration (20%) and the highest temperature (160 °C) achieved the highest recovery of flavanols with 163.61 µg/g dw from seeds and 10.37 µg/g dw from skins. The recovery of phenolic acids was maximized at the highest ethanol concentration and temperature with 45.34 µg/g dw from seeds and 6.93 µg/g dw from skins. Flavonols were only recovered from the skin, maximized (17.53 µg/g dw) at 20% of ethanol and the highest temperature. The recovery of specific polyphenols is maximized at specific extraction conditions. These conditions are the same for seed and skin extractions. This alternative method can be used in other agroindustrial wastes in order to recover bioactive compounds with potential applications in the pharmaceutical and food industry.
Multi-response optimal hot pressurized liquid recovery of extractable polyphenols from leaves of maqui (Aristotelia chilensis [Mol.] Stuntz)
(Elsevier, 2021-03-29) Rivera-Tovar, Pamela Raquel; Torres, María Dolores; Camilo, Conrado; Mariotti-Celis, María Salomé; Domínguez, Herminia; Pérez-Correa, José Ricardo
Multi-response optimization of hot pressurized liquid extraction (HPLE) was applied for the first time to obtain maqui (Aristotelia chilensis [Mol.] Stuntz) leaf extracts. The total polyphenol content (TPC), the antioxidant capacity (AC) as well as the total polyphenol purity of the maqui leaf extracts were accurately predicted (RSD < 8%) at the evaluated extraction scales. The optimum HPLE conditions that prioritized TPC and AC equally (OPT1) recovered ~3 times more TPC (205.14 mg GAE/g leaves) than maqui leaf extracts obtained by maceration, while the extract that prioritized purity over TPC and AC presented the highest purity (36.29%) and an EC50 ~3 times lower than currently reported values. It was found by multi-response optimization that maqui leaves and HPLE are among the best natural sources and extraction techniques, respectively, to recover protocatechuic acid, quercetin, and catechin.
Chemical properties of vitis vinifera carménère pomace extracts obtained by hot pressurized liquid extraction, and their inhibitory effect on type 2 diabetes mellitus related enzymes
(MDPI, 2021-03-21) Human-Castilla, Nils Leander; Campos, David; García-Ríos, Diego; Parada, Javier; Martínez-Cifuentes, Maximiliano; Mariotti-Celis, María Salomé; Pérez-Correa, Ricardo
Grape pomace polyphenols inhibit Type 2 Diabetes Mellitus (T2DM)-related enzymes, reinforcing their sustainable recovery to be used as an alternative to the synthetic drug acarbose. Protic co-solvents (ethanol 15% and glycerol 15%) were evaluated in the hot pressurized liquid extraction (HPLE) of Carménère pomace at 90, 120, and 150 °C in order to obtain extracts rich in monomers and oligomers of procyanidins with high antioxidant capacities and inhibitory effects on α-amylase and α-glucosidase. The higher the HPLE temperature (from 90 °C to 150 °C) the higher the total polyphenol content (~79%, ~83%, and ~143% for water-ethanol, water-glycerol and pure water, respectively) and antioxidant capacity of the extracts (Oxygen Radical Absorbance Capacity, ORAC), increased by ~26%, 27% and 13%, while the half maximal inhibitory concentration (IC50) decreased by ~65%, 67%, and 59% for water-ethanol, water-glycerol, and pure water extracts, respectively). Water-glycerol HPLE at 150 and 120 °C recovered the highest amounts of monomers (99, 421, and 112 µg/g dw of phenolic acids, flavanols, and flavonols, respectively) and dimers of procyanidins (65 and 87 µg/g dw of B1 and B2, respectively). At 90 °C, the water-ethanol mixture extracted the highest amounts of procyanidin trimers (13 and 49 µg/g dw of C1 and B2, respectively) and procyanidin tetramers of B2 di-O-gallate (13 µg/g dw). Among the Carménère pomace extracts analyzed in this study, 1000 µg/mL of the water-ethanol extract obtained, at 90 °C, reduced differentially the α-amylase (56%) and α-glucosidase (98%) activities. At the same concentration, acarbose inhibited 56% of α-amylase and 73% of α-glucosidase activities; thus, our grape HPLE extracts can be considered a good inhibitor compared to the synthetic drug.
Adsorption of low molecular weight food relevant polyphenols on cross-linked agarose gel
(Elsevier, 2021-10-25) Rivera-Tovar, Pamela Raquel; Pérez-Manríquez, Javiera; Mariotti-Celis, María Salomé; Escalona, Nestor; Pérez-Correa, José Ricardo
Adsorption of five relevant low molecular weight polyphenols identified in agro-industrial waste extracts (Aristotelia chilensis leaves, Carménère wine pomace, spent coffee grounds, and brewery waste streams) was measured and characterized. SuperoseTM 12 prep grade and between three and six solutions with different water, ethanol, and acetic acid compositions were used as adsorbent and liquid phases. The chosen adsorbent and liquid phases were relevant for designing an adsorption preparative liquid chromatography (APLC) process to isolate these polyphenols. Langmuir and Freundlich models adequately fitted the obtained isothermal equilibrium data. The Freundlich model represented better ferulic acid (FA), kaempferol (KAE), and resveratrol (RSV) adsorptions, while the Langmuir model represented better gallic acid (GA) and catechin (CAT). Different polyphenol/agarose affinities in water-rich liquid phases were observed. From this, a hypothetical elution order was established (KAE < GA < FA < CAT < RSV), which was partially experimentally corroborated (for a mixture of GA, CAT, and RSV) with an APLC system. Lowering the water proportion or increasing the EtOH:HAc ratio in the liquid phase reduced the adsorption of these polyphenols, except for FA. The decrease in adsorption with temperature and the negative values of ΔH indicated that these processes were exothermic. The adsorption of all the polyphenols was governed by physisorption. All the adsorption processes studied were spontaneous and thermodynamically feasible (ΔG < 0). In addition, the polyphenol molecules were less randomly organized (more ordered) at the polyphenol/agarose interface during the adsorption process (ΔS < 0).
Thyme essential oil loaded microspheres for fish fungal infection: microstructure, in vitro dynamic release and antifungal activity
(Taylor & Francis Online, 2020-10-13) Benavides, Sergio; Mariotti-Celis, María Salomé; Paredes, Maria Jose Carolina; Parada, Javier A.; Franco, Wendy V.
Aims: Evaluate the effect of varying the droplet size of microspheres charged with thyme essen tial oil (TEO-MS) on their swelling (Sw), release rate (%RR) and in vitro antifungal activity against Saprolegnia sp. Methods: TEO-MS obtained by ionic gelation were characterised through SEM microscopy and X-ray microtomography. Their Sw and RR% were evaluated at simulated fish-astrointestinal conditions using gravimetric and spectrophotometric techniques. Results: For all evaluated droplet sizes (p 0.05), TEO was heterogeneously distributed inside of the MS and TEO-MS experimented agglomeration and sphericity loss after the drying process. Under gastric conditions, the acid pH (2.9) limited the Sw (50–100%) of TEO-MS, generating a low RR% (14–18%). Contrary, the slightly alkaline intestinal pH (8.1) favoured the Sw ( 3.2 to 3.8 times) and therefore the RR% (42–63%). Conclusions: TEO-MS (5–100 mg/mL) presented antifungal capacity onto Saprolegnia sp. after the simulated fish digestion, being the small droplet size once the most effective.
Functional fermented cherimoya (Annona cherimola Mill.) juice using autochthonous lactic acid bacteria
(Elsevier, 2020-09-07) Isas, Ana Sofía; Mariotti-Celis, María Salomé; Pérez-Correa, José Ricardo; Fuentes, Eduardo; Rodríguez, Lyanne; Palomo, Iván; Mozzo, Fernanda; Van Nieuwenhove, Carina
The biochemical and functional properties of fermented Annona cherimola Mill. (cherimoya) juice using five lactic acid bacteria (LAB) isolated from autochthonous fruits from Northwestern Argentina were studied in this work. Fermentation was carried out at 30 °C for 48 h followed by a 21 day-storage period at 4 °C. The assayed LAB grew well during fermentation (final count of 108 CFU/mL, ΔpH ca. 1 U) and survived after the storage period. All strains consumed fructose and glucose present in cherimoya juice as energy sources, with the consequent synthesis of lactic and/or acetic acids as final metabolic products. However, only two of the five evaluated strains were capable to produce fermented cherimoya juices with a perceptible color change. Due to lactic acid fermentation, a moderate reduction in the total phenolic content (between 13% and 43%) was observed in the majority of the samples, although no change in the antioxidant capacity was detected. The fermented cherimoya juices showed a weak antiplatelet activity when adenosine diphosphate agonist was used. The findings of this study evidenced the potential use of Annona cherimola Mill. fermented juice as a novel matrix for the formulation of stable functional beverages with appealing nutritional and functional properties.
In house validation for the direct determination of 5-hydroxymethyl-2- furfural (HMF) in “dulce de leche''
(Elsevier, 2020-10-01) Barrera, Josefina; Pedreschi, Franco; Gómez, Juan Pablo; Zúñiga, Rommy. Z; Mariotti-Celis, María Salomé
In this work an HPLC-DAD determination method for free and total HMF in “dulce de leche” was developed and validated. The separation was carried out using a mobile phase of acetonitrile-water (4.5:95.5, v/v) on Acclaim™120 C18 (4.6 × 150 mm, 5 μm), at 30 °C and a flow rate of 1 mL/min. The detection was done at 284 nm.The method showed good selectivity and linearity (determination coefficient over 0.999). Low LOD and LOQ values were obtained (19.51 μg/L and 65.05 μg/L respectively). Relative standard deviation (RSD) for repeatability and intermediate precision was <4.12 % and <5.98 % respectively. Recovery rates were between 89.04 % and 91.89 %. In addition, the HMF contents in commercial “dulce de leche” from Chile was reported, ranging from 2.33 to 10.31 mg/kg for free HMF and 314.61–464.98 mg/kg for total HMF.
Vitamin D status and obesity in children from Chile
(Springer Nature, 2021) Pérez-Bravo, Francisco; Duarte, Lissette; Arredondo-Olguín, Miguel; Iñiguez, Germán; Castillo-Valenzuela, Oscar
BACKGROUND: Vitamin D [25(OH)D] is essential for normal bone development and maintenance. Furthermore, its deficiency has been associated with obesity, cardiovascular diseases, insulin resistance, autoimmune diseases, and certain cancers. OBJECTIVE: To determine the incidence of serum 25(OH)D deficiency (<20 ng/ml) among apparently healthy Chilean children (4–14 years old) from three Chilean geographic areas during May–September 2018. MATERIALS AND METHODS: Serum 25(OH)D levels were measured by a competitive protein-binding ELISA assay in 1134 children, and correlations between serum 25(OH)D levels, BMI, and geographic area were calculated. Individuals were grouped according to their serum 25-hydroxyvitamin D levels (ng/ml): severe deficiency: <5; moderate deficiency: 5–10.9; mild deficiency: 11–20.9; insufficiency: 21–29.9 and sufficiency: 30–100. RESULTS: We found 80.4% of children had serum 25(OH)D deficiency, with 1.7% severe, 24.6% moderate, and 54.1% mild. In the three cities, the percentage of serum 25(OH)D deficit was increased when comparing overweight or obesity with a healthy weight. Additionally, an interaction effect was observed between geographic area, nutritional status, and serum 25(OH)D levels using the factorial ANOVA test (p = 0.038). In Antofagasta, there were more overweight children and also a higher percentage of children with VitD deficiency (<30 ng/ml) compared to Santiago or Concepción. CONCLUSION: This study revealed a high prevalence of serum 25(OH)D deficiency in children between 4 and 14 years old in Chile (80.4%) during May–September 2018. Obese and overweight children had the highest prevalence of serum 25(OH)D deficiency.
Feeding behaviour and lifestyle of children and adolescents one year after lockdown by the COVID-19 pandemic in Chile
(MDPI, 2021-11) Bustos-Arriagada, Edson; Fuentealba Urra, Sergio; Etchegaray Armijo, Karina; Quintana Aguirre, Nicolás; Castillo-Valenzuela, Oscar
Lockdown caused by the COVID-19 pandemic may have influenced feeding behaviour and lifestyle in children and adolescents. The purpose of this study was to analyse feeding behaviour and lifestyle in children and adolescents one year after lockdown by the COVID-19 pandemic in Chile. In this cross-sectional study an online survey was implemented in 1083 parents and care- givers regarding their children’s feeding behaviour and lifestyle and sociodemographic background. The results showed that “eat breakfast daily” (89.2%), “not overnight food intake” (69.9%) and “not fast-food intake” (66.0%) were the most frequent reported feeding behaviours, particularly in pre-school children. Respondents declaring healthy feeding behaviours and lifestyle were 23.4 and 23.7%, respectively, with no significant differences by sex. In pre-school children, families with three or fewer members and parents or caregivers with an undergraduate or postgraduate degree reported a significantly better feeding behaviour and lifestyle compared to families with more than three members and parents or caregivers without an undergraduate or postgraduate degree. In conclusion, the pandemic lockdown had a negative impact in lifestyle in children and particularly in adolescents. Healthier feeding behaviour was associated with fewer family members and parents or caregivers with at least an undergraduate degree.
Comportamiento alimentario, suficiencia dietaria y estado nutricional en niños entre 6 a 18 meses
(Sociedad Chilena de Pediatría, 2021) Bustos-Arriagada, Edson; Cádiz, Marcelo; Etchegaray, Karina; Castillo-Valenzuela, Oscar
La alimentación infantil presenta características cualitativas y cuantitativas específicas. La influencia de los padres sobre la ingesta de alimentos es crucial en el desarrollo de hábitos y un adecuado estado nutricional. Objetivo: Evaluar el comportamiento alimentario, las características dietarias y estado nutricional en niños entre 6 a 18 meses. Sujetos y Método: Estudio descriptivo de corte transversal en 199 niños. En una muestra por conveniencia se consignaron datos demográficos y antropométricos para estado nutricional, y antecedentes dietarios, mediante recordatorio de 24 h para el compor- tamiento dietario y la suficiencia alimentaria. Se aplicó t-student y ANOVA de una vía para varia- bles continuas y test chi-cuadrado para categóricas. Resultados: 54,8% mujeres. Estado nutricional: 21,1% sobrepeso y 7,6% obesidad. Un 56,8% de los niños tenían números de comidas acorde su edad. La ingesta promedio de energía fue de 652,9 ± 224,2 calorías diarias. La ingesta de energía y macro- nutrientes fue significativamente mayor en los niños que no consumían leche materna y de 12 a 18 meses. La adecuación energética, lípidos y carbohidratos en las niñas fue significativamente mayor a la de niños. Un 83,1% del consumo de alimentos fueron habituales para este grupo etario. Conclu- sión: En el comportamiento alimentario se encontró que 4 de cada 10 niños presentan números de comidas mayor al sugerido a su edad. En cuanto a la suficiencia dietaría hay una mayor ingesta en los niños con estado nutricional normal, sin LM y entre 12 y 18 meses. A pesar de la alta prevalencia de obesidad, esta fue menor a la observada a nivel nacional.
Evaluación y apoyo nutricional en el paciente pediátrico críticamente enfermo: revisión de la literatura
(Sociedad Chilena de Nutrición Bromatología y Toxicología, 2021) Etchegaray, Karina; Bustos-Arriagada, Edson
Esta revisión se basa en la mejor evidencia actualmente disponible, y en ella se definen las directrices en relación con la evaluación y manejo nutricional en niños críticamente enfermos. Estas directrices incluyen, los criterios para la detección de la malnutrición, tanto por déficit o exceso, así como, se identifican las recomendaciones y consensos de expertos sobre la estimación energética y de macronutrientes, los cuales pueden ser determinantes en prevenir tanto la sobrealimentación como subalimentación. También se señalan las recomendaciones internacionales sobre el momento de inicio del soporte nutricional para que esta sea oportuna, efectiva y segura, eligiendo la vía de alimentación según condición clínica y tipo de patología en función de disminuir el riesgo de morbimortalidad de estos pacientes. A modo general, se sugiere intensificar la investigación científica, con el fin de disponer de mejor evidencia para diseñar protocolos clínicos internacionales y locales para el manejo nutricional del paciente pediátrico críticamente enfermo.

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