Origen de las controversias para limitar el consumo de bebidas y alimentos con fructosa. Revisión sistemática cualitativa

Introducción. La industria del azúcar se ha opuesto a aceptar que sus productos pueden ser la causa raíz principal de la pandemia de enfermedades no transmisibles. Objetivo. Analizar las bases que sustentan las posiciones acerca de limitar el consumo de fructosa que se agrega a bebidas y alimentos industrializados mediante la identificación de conceptos principales en artículos de revisión. Método. Se hizo una búsqueda en PUBMED con los términos ("fructose"[MeSH Terms] OR "fructose"[All Fields]) AND ("diabetes mellitus"[MeSH Terms] OR ("diabetes"[All Fields] AND "mellitus"[All Fields]) OR "diabetes mellitus"[All Fields]) AND ("review"[Publication Type] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields]). Resultados. Se analizaron las consecuencias del consumo de la fructosa en enfermedades no transmisibles como obesidad, resistencia a la insulina, hígado graso, síndrome metabólico, envejecimiento prematuro, hiperuricemia, hipertensión, diabetes, daño renal, enfermedad cardiovascular. Sin aportar datos a favor de la inocuidad de la fructosa agregada a bebidas y alimentos, los autores con conflicto de interés, quienes reciben aportes de la industria del azúcar, desacreditan esos resultados mediante la construcción de falacias. Conclusiones. Las revisiones sistemáticas cuantitativas de autores con conflicto de interés sirven para sustentar posiciones escépticas y poco éticas hacia la evidencia científica.Palabras clave: Enfermedades no transmisibles; Conflicto de interés; Industria de alimentos y bebidas; Revisiones sistemáticas; Falacias.

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

<strong>Introduction:</strong> Several experimental and clinical studies suggest that drugs used in pediatric anesthesia may exert undesirable effects on the developing central nervous system. The objective of this review was to assess the results and conclusions of published studies on long lasting neurodevelopment disorders following exposure to anesthetics in children in a phase of brain immaturity.<br /><strong>Material and Methods:</strong> We performed a literature search in several sources (PubMed, SciELO and Cochrane Library) using the terms ‘Pediatric anesthesia OR Pediatric anesthetic OR Developing brain anesthetic OR Developing brain anesthesia AND behavior disorders’. We selected human studies, referring to long lasting neurodevelopment effects after exposure to anesthetics in the first four years of life.<br /><strong>Results:</strong> Ten retrospective studies met the inclusion criteria. Of these, seven suggest risk of neurobehavioral disorders after exposure of small children to anesthetics, as opposed to the results obtained by the other three.<br /><strong>Discussion:</strong> Although mostly using large databases, the studies found are retrospective, vary in test groups, include sometimes avoidable confounders and some present inaccuracies in the choice of the test and control populations that can compromise the reliability of the results.<br /><strong>Conclusion:</strong> Because of the numerous limitations of the few studies available, the reported results are still deemed insufficient to change current clinical practice. However, although it is undisputable that anesthesia should be provided when needed, regardless of age, the warnings found in literature are worrisome, therefore whenever surgery is unavoidable in small children, alternatives that may help reduce the risks of anesthetic exposure should be sought.<br /><strong>Keywords:</strong> Anesthesia; Anesthetics; Child; Infant; Brain/growth &amp; development; Developmental Disabilities; Cognition Disorders;<br />Review Literature as Topic.