The allergy to the cow s milk protein affects 2 to 5% from the infantsand its symptoms can vary from minor to life threatening. β-lactoglobulin is the protein fraction more allergenic from the whey. Many processes were developed for the separation and purification of proteins and among them is the ion exchange chromatography. The objective of this work was to obtain the separation of β-lactoglobulin from the whey protein concentrate by ion exchange chromatography, aiming the application in milk formulas. Physical-chemical analysis of the protein concentrate, separation of β- lactoglobulin by ion exchange chromatography, analysis of amino acids profile and of the final amount of β-lactoglobulin in the resulting product and in two hypoallergenic infant formulas were performed. From the results in this study, it is possible to ascertain that it was feasible to separate the protein fractions of β-lactoglobulin by the ion chromatography process.The protein obtained by this process was proven to be a great amino acid source compared to the hypoallergenic infant formulas. / A alergia à proteína do leite de vaca atinge 2 a 5% dos lactentes e desencadeia sintomas que podem variar de leve a risco de vida. A β-lactoglobulina é a fração protéica mais alergênica do soro do leite. Vários processos foram desenvolvidos para a separação e purificação protéica, dentre eles a cromatografia de troca iônica. O objetivo deste trabalho foi realizar a separação da β-lactoglobulina do concentrado protéico do soro do leite através de cromatografia de troca iônica, visando aplicação em fórmulas lácteas. Foram realizadas análises físico-químicas do concentrado protéico, separação da β-lactoglobulina por cromatografia de troca iônica, análise do perfil de aminoácidos e da quantidade final de β-lactoglobulina no produto obtido e em duas fórmulas lácteas hipoalergênicas. A partir dos resultados encontrados no presente estudo, pode-se verificar que foi possível separar a fração protéica de β- lactoglobulina do concentrado protéico do soro do leite através do processo de cromatografia iônica. A proteína obtida através deste processo demonstrou possuir uma ótima fonte de aminoácidos ao ser comparada com as fórmulas lácteas hipoalergênicas.

Esofagite Eosinofílica é uma doença inflamatória crônica restrita ao esôfago e imune mediada por antígenos. Sua prevalência descrita varia desde 0,4%, numa população geral, até 15% em pacientes com sintomas de disfagia. Já se conhece sua associação com doenças atópicas, anafilaxia e alergia alimentar, sendo o leite de vaca um dos principais alimentos envolvidos. Existem relatos recentes de casos em que pacientes foram diagnosticados com esofagite eosinofílica após serem submetidos à imunoterapia oral com o alimento causador de sua alergia alimentar mediada por IgE. Porém, em nenhum destes casos foi avaliado previamente se os mesmos pacientes já não apresentavam eosinofilia esofágica latente e/ou sintomas subjetivos sugestivos da doença. Considerando que, atualmente, um dos tratamentos mais promissores para alergia alimentar é a imunoterapia oral, justificou-se a necessidade de entender se esofagite eosinofílica seria de fato uma complicação do tratamento, ou se seria uma condição pré ou coexistente. Portanto, o objetivo deste trabalho foi avaliar a frequência de eosinofilia esofágica em pacientes com anafilaxia à proteína do leite de vaca. Foram analisados 89 pacientes matriculados no ambulatório de alergia alimentar do HC-FMUSP, com mediana de idade de 8 anos e que apresentavam anafilaxia ao leite de vaca. Todos foram submetidos à endoscopia digestiva alta com biópsias de esôfago, estomago e duodeno. Dados demográficos, comorbidades atópicas, uso de medicações e sintomas gastrointestinais foram analisados e comparados. A frequência de eosinofilia esofágica foi de 38,2% (34 de 89 pacientes). Em 15 dos 34 pacientes com eosinofilia esofágica, foi completada a investigação para esofagite eosinofílica com uso de inibidor de bomba de prótons em dose plena por 8 semanas antes de uma segunda endoscopia. Identificou-se, portanto, cinco pacientes (7,1%) com eosinofilia esofágica responsiva a inibidor de bomba de prótons e 10 pacientes com esofagite eosinofílica (14,2%). No grupo total de pacientes com eosinofilia esofágica (n=34) encontrou-se 29,4% de pacientes com quadro clínico gastrointestinal ausente; 23,5% oligossintomáticos, e apenas 47% com sintomas sugestivos de disfunção esofágica e, destes últimos, nem todos apresentavam sintomas esofágicos persistentes. Pode-se concluir que a frequência de esofagite eosinofílica descrita no grupo estudado foi significativamente superior à estimada na população geral e uma das mais altas descritas em grupos de pacientes com fatores de risco específicos. Também foi observada uma grande parcela de pacientes com eosinofilia esofágica, sendo muitos assintomáticos ou oligossintomáticos, surgindo o questionamento se esta não seria uma doença latente, de início precoce, insidioso e não relacionada diretamente como complicação de tratamentos atuais / Eosinophilic esophagitis is a chronic inflammatory disease, which occurs in the esophagus and is immune mediated by antigens. Its observed prevalence varies between 0.4% in the general population to 15% in patients with dysphagia. Its association with atopic diseases, anaphylaxis and food allergy has already been recognized. Cow\'s milk is one of the main food sources involved. There are recent reports of cases in which patients were diagnosed with eosinophilic esophagitis after being submitted to oral immunotherapy with the food that causes the IgE mediated allergy. However, in none of these cases was it previously determined if the same patients did not already present latent esophageal eosinophilia and/or subjective symptoms suggestive of the disease. Considering that, currently, one of the most promising treatment for food allergy is oral immunotherapy, the need to understand if eosinophilic esophagitis could be a treatment complication, or if it is a coexistent or preexistent condition, is justified. Therefore, the objective of this study was to evaluate esophageal eosinophilia frequency in patients with anaphylaxis to cow\'s milk protein. We analyzed eighty-nine patients registered in the Food Allergy Unit of the HCFMUSP, with a median age of 8 years, who presented cow\'s milk anaphylaxis. All of them were submitted to digestive endoscopy as well as esophagus, stomach, and duodenum biopsies. We also analyzed and compared demographic data, atopic comorbidities, use of medication, and gastrointestinal symptoms. The frequency of esophageal eosinophilia was 38.2% (34 of 89 patients). In 15 of the 34 patients with esophageal eosinophilia, full investigation for the disease was carried out using a proton pump inhibitor at full dose for eight weeks prior to a second endoscopy. From this, five patients (7.1%) had the proton pump inhibitor-responsive esophageal eosinophilia phenotype, and ten patients were diagnosed with eosinophilic esophagitis (14.2%). In the whole group of patients with esophageal eosinophilia (n = 34), it was found 29.4% of patients with an absent gastrointestinal clinical condition, 23.5% were oligosymptomatic, and only 47% had symptoms suggestive of esophagic dysfunction. Of these, not all presented persistent esophagic symptoms. It is possible to conclude that the frequency of eosinophilic esophagitis observed in this group was significantly higher than the estimated for the general population, and one of the highest observed in groups of patients with specific risk factors. A large portion of patients with esophageal eosinophilia were oligosymptomatic or asymptomatic, raising the question if this would not in fact be a latent disease, with a precocious beginning, insidious and not directly related to current treatments complications

I dagsläget överproduceras och överkonsumeras mat, samtidigt slängs 30% av all mat som produceras i världen. Matproduktionen står för en stor del av världens miljöbelastning; främst genom animaliska produkter såsom kött och mejeriprodukter, och därför har ämnet blivit mycket omtalat. I samband med denna debatt har mjölksubstitut introducerats på marknaden. Målet med arbetet var att undersöka hur matbutiker i Stockholm arbetar med svinn och försäljning av mjölk och mjölksubstitut. En jämförelse gjordes mellan Arla Mellanmjölk, Alpro Soya och Alpro Mandeldryck. Datainsamlingsmetoden gjordes dels i kvantitativt format där siffror över försäljning och svinn samlades in, men även i kvalitativt format, i form av intervjuer med sex utvalda matbutiker. Det visade sig att svinnet för Arla Mellanmjölk, Alpro Soya och Alpro Mandeldryck var minimalt med anledning att det alltid finns efterfrågan på dessa produkter och att matbutikerna aktivt arbetar för att hålla svinnet lågt. Detta görs genom att ha ett välkalibrerat automatiskt beställningssystem som tar hand om majoriteten av butikens beställningar in, ha bra kylar i butiken, samt att regelbundet inventera butiken. De produkter som undersöktes ansågs inte behöva exponeras på något speciellt vis då de är basvaror som i princip säljer sig själva. Det är snarare ett problem att mjölksubstituten tar slut från centrallagret emellanåt när efterfrågan blir för stor. Matbutikernas primära mål är att driva ett lönsamt företag och ansträngningarna som görs sker på grund av ekonomiska fördelar. Likväl, även om minskat svinn görs med anledning att inte gå i förlust ekonomiskt blir utfallet detsamma och till fördel för miljön. Konsumenterna verkar tillsynes vara de som har mest makt i att förändra hur matbutikernas verksamhet bedrivs. Genom att välja mjölksubstitut framför mjölk kommer följaktligen miljöbelastningen från mjölkproduktionen att minska. / The food production and consumption today are excessive, while 30% of all produced food in the world goes to waste. Food production has a significant effect on the environment; primarily through animalistic products such as meat and dairy food, it is, therefore, a much-disputed subject. Milk alternatives have, as a reaction to this, been introduced on the market. This project aimed to examine how grocery stores in Stockholm handle food waste and sales of milk and milk alternatives. A comparison was made between Arla semi-skimmed milk, Alpro Soya and Alpro Almond. The data collection methods were both quantitively, as numbers of sales and waste were collected, but also qualitative, with interviews with six selected grocery stores. The food waste for Arla semi-skimmed milk, Alpro Soya and Alpro Almond was minimal as a result of constant demand for these products, and also the grocery stores active work to prevent food waste. This is accomplished through a well calibrated automatic ordering system that controls the majority of the store's orders. Additionally, new refrigerators and continuous inventory are also methods used to minimize the food waste. The grocery stores felt no reason to expose the selected products in any particular way since they are already well-known and gets sold without any effort. It is rather an issue that the demand for the milk substitutes is too high and the central warehouse has no supply. The grocery stores' primary goal is to conduct a profitable business, and when the stores put in an effort, the objective is the economic benefits. Nonetheless, even though the reduced food waste is a product of the grocery stores effort to minimize unnecessary economic losses, the outcome will be the same; a benefit for the environment. The consumers seem to have the most influence on how grocery stores conduct their businesses. By choosing a milk substitute over regular milk, the environmental impact from the production of milk will be reduced.

The WHO Code of Marketing of Breast Milk Substitute is a public health recommendation to reduce preventable causes of infant morbidity and mortality associated with malnutrition. Irresponsible marketing of infant formula in hospitals is a threat to exclusive breastfeeding. Nurses are mandated to support, encourage and protect breastfeeding and to familiarize themselves with their responsibilities under this Code. The researcher explored Geneva nurses' knowledge of the Code and its impact in practice. Eighty seven point seven percent of the participating nurses had poor level of knowledge of the Code. Poor knowledge of the Code impacts on the quality and consistency of information given to mothers in hospitals. Inadvertent violations of the Code were observed among a minority of the respondents: 7.3% indicated that they received gifts; 2.4% received sponsorships to conferences. Training about the Code and its application in counseling is recommended to complement the babyfriendly initiative at hospitals to improve nutrition outcomes. / Health Studies / M.A. (Public Health)

The WHO Code of Marketing of Breast Milk Substitute is a public health recommendation to reduce preventable causes of infant morbidity and mortality associated with malnutrition. Irresponsible marketing of infant formula in hospitals is a threat to exclusive breastfeeding. Nurses are mandated to support, encourage and protect breastfeeding and to familiarize themselves with their responsibilities under this Code. The researcher explored Geneva nurses' knowledge of the Code and its impact in practice. Eighty seven point seven percent of the participating nurses had poor level of knowledge of the Code. Poor knowledge of the Code impacts on the quality and consistency of information given to mothers in hospitals. Inadvertent violations of the Code were observed among a minority of the respondents: 7.3% indicated that they received gifts; 2.4% received sponsorships to conferences. Training about the Code and its application in counseling is recommended to complement the babyfriendly initiative at hospitals to improve nutrition outcomes. / Health Studies / M.A. (Public Health)