RESUMO Contexto: O papel dos alimentos lácteos na doença inflamatória intestinal (DII) tem sido controverso e é discutível se os pacientes com DII devem ou não evitar leite e laticínios, bem como a relação entre esses alimentos e sintomas nesta população. Objetivo: Estudo transversal multicêntrico foi projetado para avaliar se é realmente necessário privar os pacientes com DII do consumo desta classe de alimentos. Métodos: Um estudo multicêntrico com 12 centros de referência em gastroenterologia de quatro países foi projetado para avaliar sintomas gastrointestinais após o consumo de alimentos lácteos em todos os ambulatórios de DII durante seis meses e comparar pacientes tratados nos mesmos centros sem DII. Resultados: No total, foram incluídos 1888 casos (872 pacientes com DII e 1016 casos sem DII. 56,6% dos participantes eram do sexo feminino com idade média de 40,1 anos. 79,8% dos participantes eram caucasianos e originalmente eram cidadãos de 10 países. A prevalência relativa de DII foi maior em africanos e indianos e a prevalência mais frequente de intolerância a alimentos lácteos observada nos asiáticos. Entre os pacientes com DII, 571 casos foram diagnosticados como colite ulcerativa e 189 participantes como doença de Crohn. A duração média do diagnóstico como DII foi de 6,8 anos (de 2 meses a 35 anos). Os sintomas de gastrointestinais mais prevalentes após o consumo de todos os alimentos lácteos foram inchaço e dor abdominal. No total, a intolerância aos alimentos lácteos e a deficiência de lactase foi mais prevalente entre os pacientes com DII em comparação com os casos sem DII (65,5% vs 46,1%, P=0,0001). A taxa de queixas gastrointestinais entre os pacientes com DII que não tinham histórico familiar de deficiência de lactase, histórico de sensibilidade alimentar ou ambos foram de 59,91%, 52,87% e 50,33% respectivamente e semelhantes aos casos sem DII (P=0,68, 0,98 e 0,99, respectivamente). Conclusão: A taxa de intolerância de alimentos lácteos entre pacientes com DII sem histórico familiar de deficiência de lactase ou histórico de sensibilidade alimentar é semelhante aos casos sem DII e provavelmente não há razão para privá-los dessa importante fonte de cálcio dietético, vitamina D e outros nutrientes.

ABSTRACT Background: The role of dairy foods in inflammatory bowel disease (IBD) has been controversial and it is debatable if patients with IBD should avoid milk and dairy products or not, as well as the relationship between these foods and symptoms among those population. Objective: This multi centric cross-sectional study designed to evaluate if it is really necessary to deprive IBD patients from consumption of dairy foods. Methods: A multicenter study with 12 gastroenterology referral centers in four countries was designed to evaluate gastrointestinal (GI) symptoms after consumption of dairy foods from all outpatients with IBD during 6 months and to compare patients treated at the same centers without IBD (non IBD cases). Results: Overall 1888 cases included (872 IBD patients and 1016 non IBD cases). 56.6% of participants were female with average age of 40.1 years. Racially 79.8% participants were Caucasians and originally they were citizens of 10 countries. Relative prevalence of IBD was higher in Africans and Indians and the most frequent prevalence of dairy foods intolerance was seen in Asians. Among IBD patients, 571 cases diagnosed as ulcerative colitis and 189 participants as Crohn’s disease. Average duration of diagnosis as IBD was 6.8 years (from 2 months to 35 years). The most prevalent GI symptoms after consumption of all the dairy foods were bloating and abdominal pain. Totally, intolerance of dairy foods and lactase deficiency was more prevalent among IBD patients in comparison with non IBD cases (65.5% vs 46.1%, P=0.0001). But the rate of GI complains among IBD patients who had not any family history of lactase deficiency, history of food sensitivity or both were 59.91%, 52.87% & 50.33% respectively and similar to non IBD cases (P=0.68, 0.98 & 0.99 respectively). Conclusion: The rate of dairy foods intolerance among IBD patients without family history of lactase deficiency or history of food sensitivity is similar to non IBD cases and probably there is no reason to deprive them from this important source of dietary calcium, vitamin D and other nutrients.

OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R² = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R² = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.

OBJETIVO: Examinar la relación entre los hábitos alimentarios y el grado de actividad física (AF) por un lado y el índice de masa corporal por el otro, así como las asociaciones entre esas variables en la población infantil. MÉTODOS: Se seleccionó una muestra representativa de 21 111 escolares de 6-18 años mediante técnicas de muestreo aleatorio multietápico por conglomerados en 23 provincias de la República Islámica del Irán. La AF y los hábitos alimentarios se evaluaron mediante cuestionarios validados autoadministrados. RESULTADOS: La frecuencia de consumo de frutas y verduras, productos lácteos y refrigerios (salados, grasos o dulces) fue similar, de aproximadamente dos veces al día. El tipo de grasa consumido con más frecuencia eran las grasas sólidas hidrogenadas (73,8% de las familias). El nivel de AF fue significativamente mayor entre los varones que entre las muchachas, en los residentes en zonas rurales que en los de zonas urbanas, y en los alumnos de nivel medio que en los alumnos de instituto. Entre los chicos, la frecuencia de consumo de verduras y proteínas vegetales (R² = 0,46), y entre las chicas la frecuencia de consumo de productos lácteos y fruta, así como un nivel alto de AF, estaban inversamente relacionados, de forma significativa, con el IMC (R² = 0,57). Entre los chicos, la baja frecuencia de consumo de fruta, el tiempo invertido en alguna AF y el gasto energético estaban relacionados sensiblemente con el exceso de peso. Al controlar las covariables, se observó que los niveles de AF estaban relacionados de forma significativa con la frecuencia de consumo de todos los grupos de alimentos. CONCLUSIÓN: Los modos de vida poco saludables predisponen a los jóvenes iraníes a sufrir enfermedades crónicas más adelante en la vida. La relación entre los hábitos alimentarios y el nivel de AF es un aspecto a considerar a la hora de estudiar los beneficios para la salud asociados a esos factores.

OBJECTIF: Étudier la relation entre les pratiques en matière alimentation et d'activité physique et l'indice de masse corporelle (IMC), ainsi que les associations de ces pratiques parmi les enfants. MÉTHODES: Un échantillon représentatif randomisé, composé de 21 111 élèves âgés de 6 à 18 ans, a été sélectionné par une procédure de sondage en grappe à plusieurs degrés dans 23 provinces de la République Islamique d'Iran. Les pratiques en matière d'activité physique et d'alimentation ont été évaluées par des questionnaires validés auto-administrés. RÉSULTATS: Les fréquences de consommation de fruits et légumes, de produits laitiers et d'en-cas (salés, gras ou sucrés) étaient similaires et de deux fois par jour environ. Les matières grasses les plus fréquemment consommées étaient des matières grasses solides hydrogénées (consommées par 73,8 % des familles). Le niveau d'activité physique était nettement plus élevé chez les garçons que chez les filles, chez les ruraux que chez les urbains et chez les étudiants de cycle intermédiaire que chez les étudiants de l'enseignement supérieur. Chez les garçons, la fréquence de consommation de légumes et de protéines végétales (R² = 0,46); et chez les filles, la fréquence de consommation de produits laitiers et de fruits, ainsi que la pratique d'une activité physique intensive, présentaient une corrélation inverse significative avec l'indice de masse corporelle (R² = 0,57). Chez les garçons, la fréquence de consommation de fruits, le temps consacré à l'activité physique et les dépenses énergétiques; et chez les filles, le temps consacré à l'activité physique et les dépenses énergétiques, étaient significativement corrélés avec le poids. Les autres cofacteurs étant maintenus constants, les niveaux d'activité physique étaient significativement corrélés avec la fréquence de consommation de l'ensemble des groupes d'aliments. CONCLUSION: La pratique de modes de vie nuisibles à la santé a augmenté la prédisposition des jeunes Iraniens aux maladies chroniques à un stade ultérieur de la vie. Lorsqu'on examine les bénéfices pour la santé de l'activité physique et de comportements alimentaires sains, les interactions entre ces deux facteurs doivent être prises en compte.