Aspectos nutricionais e buiquímicos da fibrose cística em paciente pediátricos : suplementação com um concentrado protéico do soro do leite bovino enriquecido com TGF- beta e lactoferrina / Nutritional and biochemical aspects of cystic fibrosis in pediatric patients : supplementation with whey protein concentrate enriched with TGF- beta and lactoferrin

Daniela Miotto Bernardi

Cystic fibrosis (CF) is characterized by an intense inflammatory process, pulmonary obstruction, airway infection and gastrointestinal symptoms resulting maldigestion/ malabsorption of nutrients, and as a consequence nutrition is a determinant on the patient`s prognostic. The aims were to evaluate the effect of supplementation with a WPC enriched with TGF-ß and lactoferrin, in pediatric patients with cystic fibrosis. Methods: The study was a randomized, double-blind, placebo controlled, prospective clinical trial of nutritional intervention with four months of duration. Children were recruited from the Pediatric Outpatient Unit, at UNICAMP Clinical Hospital, aged between 3 and 12 years and Shwachman score between moderate and good. The study group started with 45 children, nevertheless, it ended with 28 subjects: 15 of WPC-TGF ß group and 13 of casein group (placebo). Seventeen healthy children were also used as a control group. The supplements (placebo and test) were submitted to centesimal and microbiological analysis. The supplementation was done during four months with three assessments (T0= before starting the supplementation, T1= with two months of supplementation and T2= at the end the 4th months of supplementation) with appraisal of: erythrocyte glutathione concentration, production of reactive oxygen species (ROS) by granulocytes, cytokines (TNF-a, IFN-?, IL-8, IL-6, IL-10) concentration in supernatants from cultures under spontaneous condition, PHA and Bacillus Calmette-Guérin (BCG)-stimulated peripheral blood mononuclear cells, levels of serum TGF-ß2, immunoglobulins (IgA, IgG, IgM and IgE), albumin and prealbumin, salivary IgA, sputum culture, anthropometric measurements and food intake. For statistical analysis, the parametric data were analyzed with T-test and ANOVA and nonparametric data, with Mann-Whitney and Friedman tests. The level of significance was 5%. Results: There was no statistical difference between CF patients and healthy subjects in relation to oxidant and antioxidant system in peripheral blood. The spontaneous production of TNF-a, IL-6, and IL-10, production of IL-6 in response to PHA, TGF-ß2, IgA and IgM in serum and counting white blood cells was increased in CF patients. Furthermore, healthy individuals responded better to secretion of TNF-a in response to BCG stimulation. A low incidence of malnutrition was observed. Supplementation with WPC-TGF ß did not have an influence on concentration of glutathione, immunoglobulins, infection of airways and nutritional status. Regarding GSH although the change was not significant, there was a trend of gradual increase during the supplementation. Furthermore, increased basal stimulation of granulocytes for the production of ROS reduced the production of TNF-a in culture supernatants in response to PHA, slightly reduced the production of IL-10 (T1) in response to PHA and also attenuated the statistical difference existing for TGF-ß2, prior to supplementation, in both groups. The ability to increase the total number of erythrocytes and hemoglobin was attributed to lactoferrin present in the supplement. Conclusion: This study showed that clinically stable CF children could maintain a normal oxidant and antioxidant balance. The high concentrations of TNF-a and IL-6 require a higher production of IL-10, which may have also been responsible for the efficient TH1 response to BCG, expressed by IFN-?. The higher production of IgA and IgM confirm a normal adaptive immune system against bacterial colonization in these patients. It is suggested that supplementation for longer period of children not yet colonized lead to better results than the ours obtained, however, only further study could elucidate such an hypothesis

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