November 27, 2023 • 49 mins
En el programa de hoy estaremos conversando con Adriana Rugeles Estupiñan nutricionista e investigadora de Colombia. En los distintos segmentos conoceremos sobre su trabajo como nutricionista y que le motivó a trabajar en esta área. Hablaremos de la nutrición de los niños con cardiopatías y niños en general. Además de conocer cómo afecta el uso excesivo de azúcares y sodio en los niños. Para finalizar nos contará sobre el desarrollo de la app en la que está colaborando para el seguimiento nutricional en casa para niños con cardiopatías y el papel de la Fundación Cardiovascular de Colombia en esta iniciativa.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Welcome to your heart warrior program,fighting heart disease with genelites. I am
Malta, Rachel Montero, one ofthe hosts of this program, and I
am also the mother of a warriorof heart. I am accompanied in this
interview by Luis satiate the isaman Nava, mothers of some warriors of heart and
Belén Blanton, another warrior of heart. In today' s program we will
(00:30):
be talking with Adriana Cruela, nutritionistand researcher of Colombia in the different segments.
We will know about your work asa nutritionist and what motivated you to
work in this area. We willtalk about the nutrition of children with caldiopathy
and children in general, as wellas how it affects the excessive use of
sugars and sodiums in children. Inconclusion, he will tell us about the
(00:54):
development of the application in which heis collaborating for nutritional monitoring at home for
children with heart disease and the roleof the Cardiovascolar Foundation of Colombia in this
initiative. Welcome to Heart Warriors,Adriana Hello, good afternoon. Thank you
(01:15):
very much for the invitation. Itis an honor to share this special space
with you, mothers of those warriorsand many of you also warriors of heart.
Thank you so much for joining ustonight, Adriana, and I want
you to tell us what motivated youto work on nutrition. Well in general,
(01:40):
nutrition as such allows me to improvethe quality of life of my patients.
It is to recognize in nutrition afundamental key when it comes to addressing
pathologies as important and as complex ascongenital heart disease Thanks to adequate nutritional support,
(02:00):
I have been able to realize thatwe have decreased the mortality of many
children with this pathology. We alsolessen the cost overruns that have this disease
in children. Fortunately, in theCardiovascular Foundation of Colombia we have the possibility
to care for many children of scarceresources. So that' s one of
(02:23):
the biggest motivations to see my kidsget better. This nutritional status and treatment
at the medical level, at theinterdisciplinary level, has a positive effect on
their health. But not only intheir health, but also in their parents
' health. That is, thattranquility that brings your parents, having your
(02:44):
children healthy, being able to seethe continuous progress of your children, how
beautiful, how wonderful. The truththat I love to listen to you is
a super important and fundamental topic,the issue of nutrition in the health of
our children and as much as itcan impact to be able to carry out
(03:15):
this treatment with all these resources fromwhich we can value ourselves and being nutrition
one of the resources, I thinkmost important, that allows us, one
of the most important that allow usto accompany all this situation to the parents
(03:37):
that we have babies, with congenitalcatechies. How important and how nice it
is to be able to share allthis knowledge and for more people to have
this kind of information that is sofundamental. Well, Adriana. I want
you to tell us what studies youneed to have to work in the area
(04:00):
of utrition research. Very well look, since on the basis of being able
to do research in nutrition we haveto have a very solid formation in nutrition
and dietetics. In Colombia, thisis called the undergraduate nutrition and dietetics.
Later, there are different postgraduate degreesthat are highly specialized in master' s
(04:25):
and doctorates, but then these master' s or graduate' s degrees specialize
in an investigative approach and specialize ina medical condition. For example, there
are many who specialize in this pathology, which is congenital heart disease, but
there are different specialties depending on thearea of clinical nutrition already goes all the
(04:47):
specialty ages and depending on each populationgroup, since the study is focused depending
on those needs. Perfect, wonderfuland the subject is a subject of any
age. Or you can specialize inconditions and age, as I told you,
(05:13):
you can specialize in conditions. So, for example, there are eating
behavior disorders, there is an exclusivespecialty of this. We have the specialty
of congenital heart disease. And alreadyin that specialty, because they already cover
all ages depending on the pathology.So if we have at least in Colombia,
the possibility to train at the invertivepostgraduate level in this type of excellent
(05:43):
pathologies. And where you have anoffice, where it is located and to
whom in particular you offer the MiraLuisa service, because currently my work is
carried out mainly in Bucaramanga, Cantander, Colombia, and I offer more than
(06:04):
all nutritional advice in a virtual way, because it is with the intention of
reaching many people, not only outsidemy city, but outside the country.
I also cover all kinds of pathologies, from non- communicable diseases such as
diabetes, it has hiter region oflipidemias, also gastrointestinal diseases such as fatty
(06:26):
liver, cirrhosis, colonitable, gastroesophagealreflux, overweight, oity And I,
practically, because I board all kindsof pregnant populations, mothers, infants,
children under five years of age that, in fact, is one of my
strong ones, because later I willexplain the application precisely is directed for these
(06:47):
minors, but basically on board allkinds of pathologies. Apart from this,
I, therefore, do research,which is one thing in the external consultation,
as such in a clinic, butalso development or research around these issues.
(07:10):
Then it is very feasible for somehealth institution at the level of Colombia
to contact me for data analysis,to analyze a type of patients and based
on that information, we generate knowledge. So what do we do, write
scientific articles, go to congresses andpublish, so, all that information that
(07:30):
is going to be relevant, becausenot only for the scientific community, but
for the general population, who aregoing to have access to this important information
and who are going to help improvethe quality of life of all these children?
Excellent, excellent how interesting. Thatis, any mom who listens to
this podcast and can contact you truthand you, then, do a follow
(07:59):
- up and nutritional accompaniment for anymember. That' s right, Luis.
In fact, then, I willgive a brief description of what is
being done in the consultation. Althoughit' s true, it' s
virtual, but it makes a wholefood nagnessis that means that. A nutritional
survey is done where I can identifythe foods they consume in a twenty-
(08:24):
four- hour reminder to see thatfoods are rejected, that foods can suddenly
affect at the gastrointestinal level. Manythings are identified. Why. Because based
on this we can plan a certaindiet, according to its customs, according
to the diagnosis, so that thisfood is sustainable. It is not the
(08:46):
diet and now, but this isadapting it to be sustainable and more conscious.
Yes, then, that' spractically what we do or what I
do in my consultation with the currentone and more or less adultate an hour,
an hour and a half, dependingon the patient' s diagnosis,
(09:09):
where I also evaluate several, sayvariables from the body mass index, among
other measures that I can evaluate ortake into account for diagnosis. Then of
course, any mommy who is seeingus with pleasure can contact me and I
could do the nutritional consultation and follow- up. Obviously, the controls are
(09:30):
programmed according to the pathology are readgood. Thank you so much. This
content is not intended to replace diagnosticadvice or professional medical treatment. The opinions
expressed in this podcast are not thoseof Horke United Love, but those of
(09:54):
the hosts and guests, and theyintend to generate a debate on issues related
to congenital heart disease. Welcome backI' m white Bethlehem. Before the
(10:15):
break we were talking with Adrian orin his work as an adrian nutritionist,
what would be the main nutrition recommendationsfor a child with heart disease and look
well Belén told you the nutritional managementof a child with heart disease with gene
(10:39):
is a bit complex. It dependson many factors, because the water restriction,
the high caloric requirements, the prevalencethat these children sometimes have to intolerance
of some foods, because it makesthis management change. In addition, because
the hemodynamic impact these children have causesthere to be a slow growth of development.
(11:05):
Let' s say that' sone of the studies and obviously,
experience shows that stunting and development inthese children are very marked. Then we
also suddenly add some orofacial alteration,not motility in the absorption of these nutrients.
(11:26):
He' ll say don' tgive me trouble, Adriana, give
me solutions. Fortunately, then,we have adequate nutrition support to be able
to address all these problems that arisein our children with heart disease, with
people. Then we can start withthe following. Macronutrients, i e,
(11:48):
such as carbohydrates or carbohydrates, proteinsand clean ones. It should be borne
in mind that these children must consumevery high- energy foods, i e
calories energy, so that we canhelp them to progress quickly in their nutritional
state. It turns out that,among all macronutrients, the one that provides
(12:13):
the most energy guess what the fatsare. That' s why we fatten
up easily because children who have thispathology and who are low in weight.
We need to inject it in fat, fat, fat. This will bring
you calories and that will also allowus to increase your weight. So it
is important that you identify that thefatty acids you must consume, the best
(12:37):
so that they can be absorbed,are the long chain or omega three.
It is essential to consume these children' s food, in their diet,
in their nutritional treatment, they willsay well, we can supplement them,
but when they are already bigger,they can be supplemented. But we can
also find it in different sources offood. For example, we have fish.
(13:00):
We can also see it in theseeds and nuts. I don'
t know how many mommys will havelittle kids who still drink milk, i
e, milk formula. Why,Because they are under two years old these
children are It is very important alsoto increase that caloric density and it is
also recommended to incorporate it oily andthe. Another important part is minerals.
(13:24):
They suddenly turn out to tell usabout their children' s experience if they
have suddenly appeared with anemia, thesechildren before surgery or posurgery more than anything
else, they lose blood and itis normal for them to show up.
Then we need to supplement them withiron that helps prevent anemia. And obviously,
(13:48):
because these children with congenital heart diseasehave a higher risk of what the
liver can be. Here, inColombia we get used to eating liver at
least twice a week. Not you, in your countries, the red meats,
the legumes, the leaves of darkgreens such as spinach. Mommies you
(14:09):
can consume, for example, fourmilligrams of iron in just a hundred pieces
of spinach. It' s superimportant. Also a fundamental thing that can
be seen in children is that becauseof the medicines they consume there is an
interaction with the nutrients. So itturns out that these kids start losing magnesium,
they start losing calcium, they startlosing a lot of them, they
(14:33):
get nauseous, they get diarrhea.Yes, then, because of that one
must, then, take into accountthose considerations and offer food that provides them
with these minerals that they are losing. And let' s remember that the
cassium is super important for growth,bone development. Then where we can find
the calcium. Of course, therecomes the other part, because in the
(14:56):
laaths, in the egg, inthe spinach too, but especially in the
milk and the derivatives. But there' s something going on. It turns
out that many children have also seenit in our consultations and there are also
scientific supports where children have problems absorbingnutrients. Among those is just when you
(15:20):
drink dairy, so it turns outthat you have to remove caffeine, which
is the protein from milk. Thenyou can' t give him milk.
They' ll tell me then youwon' t be able to take calcium,
because it only comes from milk andits derivatives. Well, we have
other options, as many of thesechildren do not assimilate milk consumption, as
it can be replaced. We have, for example, vegetable milk, almond
(15:45):
milk and that can be done ina small house. While it is true,
it will not provide the same amountof song, but it is a
way to replace it. Then wecan make an endless number of products derived
from vegetable milk. I don't know all of a sudden you'
ve heard from mole that milk issoy can also be curdled. We can
(16:08):
also get calcium in green leaves,in legumes such as beans, beans,
lentils, in fish. We canalso find calcium in broccoli. So,
not necessarily for those mommies who havetheir kids where they don' t tolerate
milk or its derivatives. Something veryimportant. Moms, while true, these
(16:32):
two minerals, iron and calcium,are deficient in our children. It'
s important not to mix them.It turns out that when you eat foods
with a lot of iron, forexample, the liver, and you eat
something else that contains a lot ofcalcium, because calcium doesn' t let
(16:52):
you absorb iron the way we wantit. If you are antagonists, then
you have to have a recommendation thatI give too. You have to be
very careful when giving foods with alot of iron with calcium, that have
foods together foods that have a lotof calcium, because iron is not going
to be absorbed, yes, sowhat should be given or offered to your
(17:15):
children these foods with a lot ofiron with vitamin C, that is,
with the Basque way. It turnsout that when you eat, for example,
a liver or a piece of meat. They give it to the children
and give it a guava juice orcitrus fruit juice. Whoever wants that iron
the meat is bringing is going toabsorb it in the best way. So
(17:40):
rather accompany those iron products, forgivethose food sources of iron with food sources
of vitamins and yes, then basicallythose are like the general recommendations that,
in fact, that was one ofthe following questions what you were going to
be. But before that it shouldbe noted that there are many children in
(18:03):
our countries who are low- incomeand all that kind of nutrition for them
is too much. People don't have the resources to buy me imagine
a piece of fish or salmon itself. That, at least in my country,
super clear and that' s wherethe problem of all this comes from.
(18:26):
Then, because of course, ifyou have the resources, you can
go to the market, you canbuy that, you can buy the other.
But, for example, what theselow- income people could do for
what they have in their power.They can have fruits, they can have
rice, they can have no rascals, for example, that kind of perfect.
(18:52):
Okay, yeah, sure, youhave to be very creative. Mom.
So, well, what do wehave, Bethlehem tells me, no,
because we have a roz, wehave one and another fruit and we
have beans, then quiet. Itturns out that from there we can also
extract the iron we need. Turnsout there' s something in nutrition that
' s called amino computation. So, when we mix a cereal or flour,
(19:17):
I don' t know what youcall it rice, for example,
and pasta does, you have starch. They mix it with a leguminous,
for example, bean, lentil beans. When you make him a child,
the little one plus that bean,which is all you have, Mommy,
is giving you the piece of meatyou can' t buy. So chevere
(19:38):
is nutrition, to make it.Making this combination between cereal and legume allows
you to contribute, for example,the same iron, which provides two hundred
milliliters in fact, from what givesyou a piece of meat. Yeah,
so imagine, I' ll putit on for you so your baby anemia
(20:03):
is ready. Don' t supposeor children anemias. We' re missing
that important iron. We have thebean with the little rice and remember what
I was saying to vitamin c helpsa lot to absorb that iron. Then
we need that iron to be absurdvery well so that they are children we
don' t fall for anemia.So what do we get from fruit,
because the fruits that bring us vitamins. I know if it' s true,
(20:26):
there are some that contribute more,but whatever you have, then if
you could go and get some lemons, do a lemonade, then what happens
when our children are too exposed tothe use of sodium looks nativity scene.
I think this is not forbidden bysodium, but to everyone that not only
to children with congenital heart disease.To all of us sodium does not bring
(20:51):
anything nor does life lie. But, yeah, because it' s a
mineral and that' s in ourorganism and it' s needed. Obviously,
all in excess. It' swrong, but where is the sodium
in the salt normally? And itturns out that I always say that to
moms why we get so bad habitsfrom childhood, because the child, if
(21:11):
he' s drinking breast milk,right, the breast milk is tasteless,
he didn' t know anything andit turns out that then, when the
child starts with supplementation feeding, thatis, they start feeding him. Oh,
we didn' t throw out thelittle sale because you' re not
going to see anything. Let's not throw him out there,'
cause if I didn' t knowanything about him. I mean, we
don' t depend on sodium,we don' t depend on salt.
(21:33):
So what happens are bad habits thatwe do not really contribute much. And,
on the contrary, this excessive exposureto sodium, because it does,
has negative impacts on our health,especially on the cardiodyescular health of all children
and adults who have congenital heart diseasethat this contributes to liquium retention. If
(21:55):
that increases blood pressure, which obviouslycan be harmful to the heart, then
it is super fundamental to limit theconsumption of foods processed for why, because
there is sodium in canned foods.So, yes, the tuul, the
sardine, but it turns out thatit brings a lot of hatred because it
comes in canned. Yeah, otherthan that, because there' s no
(22:18):
shortage of children in some countries thatgive them the packets these sabritas chips,
because you have sodium stuffed them.Then all that kind of food. There
are products. They have to belimited. An important key for sodium before
reading the labels. Moms, itis important to read food labels in order
(22:41):
to make appropriate decisions, that is, to be able to go and buy
foods or products they have, aslow sodium options whenever possible. Then what
do you have to do? Use, aromatic herbs spices like pepper, curcuma
laurel, for example, in Mexico, a chili to give it flavor will
(23:03):
look very spicy, but good.Yes, trying to use food you try,
cooking our food, but with spices, so that we don' t
have the need for salt and beable to control and run away and run
away from salt to sodium as such, because obviously it can affect the health
(23:23):
of people with heart disease with people, so it' s like my representation
regarding sodium. Tell me when yousay sodium in salt, you mean all
kinds of salts, because now there' s sea salt and salt in the
Himalayas. Another grace realizes everything thatis salt no matter how it is.
(23:48):
It is correct, Yes, ma' am all, especially since with everyone
who has congenital heart disease no confidencein that type of salt Let' s
say it has in different processes,but ultimately it is salt look what you
can not also say about the highsugar exposure for children. I know it
(24:11):
must be fatal, too, butit' s as sharp as sodium.
There are different types of sugars.We have the regular table sugar, but
we also have the fruit sugar andit' s called fruit. Then no
(24:33):
one could eat fruits because they areeating sugars, true why, because they
are fructose. At the end ofthe day, they' re glucose,
fructose as such, so look.The studies indicate the following. We have
a whole scientific support where news ofhigh exposure to good sugar will generate cardiovascular
(24:56):
diseases and other health problems, suchas obesity and overweight in our children,
who may have tooth decay, whichis very common. But we can consume
the sugar that comes from the fruitswithout any inconvenience. Obviously, or,
well, we' re going toeat twenty pounds of fruit in the day,
(25:18):
not that it' s all measured. In fact, there are dietary
recommendations, i e, there aredaily recommendations for this type of products,
let' s say so, orfood. Then it' s not in
that either. Then no. ThenI was told that fruit sugar is not
bad. This one isn' tgoing to eat a lot of fruit,
no, because also that fruit,because it' s going to accumulate in
(25:41):
fat and it can also affect,that' s all in children they'
re going to have other kinds ofproblems. Caria is dental and I also
have to tell you that it hasbeen shown that children are very hyperactive due
to consumption at excessive levels of sugarconsumption and that where they get them from
food processes. So it' snot good for our children to change behavior
(26:04):
and leave aside another type of foodthat really nourishes them by eating foods with
high levels of sugar. What needsto be done is to consume it in
a moderately adrian way. In mycase, my little one has autism.
What would be the recommendation regarding eating, knowing that a child with autism does
(26:27):
not usually eat, because of everything, but also needs to be well nourished
by his heart disease with a genderer. That' s right. Yeah,
look, he' s telling youthat they' re like such specifics.
(26:48):
I mean, for example, I' d have to ask you, I
don' t know if I canget your kid' s nutritional status,
I mean, he' s gotsome kind of, he' s underweight.
Yes, for example, that isessential to be able to give you
as a general recommendation, but well, considering that most need this energy component.
(27:10):
Highly energetic foods, for all Ihave mentioned, that are always tending
to nutrition, to malnutrition. Thenlook is essential entry, explore textures,
colors, presentations that are appetizing foryour child. Almost always children with autism,
(27:36):
as they tend to consume, arevery selective. Then they just want
to eat one thing and it turnsout that they also become undernourished because they
don’ t eat more than that. Then at the beginning, the only
twenty- two. The idea isinsistible to insist on that baby, that
child several times in different ways.I' m telling you an experience.
(27:59):
There was one of the children who, for example, the green color everything
green rejected him. So let's try the little mama to put a
dye on her, change her dye. Then he bought a food coloring that
brings nothing and it turns out thatthe cake, for example, was spinach,
a little spinach dessert that he made, put a blue coloring on it
(28:22):
and the enchanted child ate it.We realized that it rejected the color,
but it wasn' t the taste, it was the color. Then,
in that case, mom is socreative, so creative that they should better
say invent doing everything so that theirchildren can get or consume that food.
(28:45):
There' s something called camouflage food. That' s exactly what I mean
by the example I gave him ofcolors, but there are many also with
the texture, for example, thereare children who what it is like I
started it they suddenly scream not likeit' s very watery. Then start
mixing that puree with something more crushed. Then, for example, the puree
(29:07):
was made an apple puree. Let' s throw a few pieces of chicken
at him and I' ll kickmyself out to see how true we are
about what we are. I callthem moms. There is no need for
this feeding space, especially for thesechildren, to be pleasant, it must
be a positive experience. Yes,because it happens to us too, that
(29:30):
is, how many of us asa child did not give this to us,
they forced us to eat something,and because even Moya did not cry
and scream and everything, and well, in the end she ate it and
it turns out that we do notlike to eat that because we associate it
with that bad experience. Is itlike a trauma we have left to live
those experiences around the food? Then, with more reason, they have to
(29:51):
generate positive experiences around food. There' s something very, very important.
Also take into account. Be veryattentive to signs of intolerance or allergy,
because usually children with last, becausethey will not verbally express what happens to
them. Then we would do somethingwith a mommy and carry like a notebook
(30:17):
where she wrote down the food shegave her child during the week and was
very careful if she had any reaction. Yes, indeed, many of these
foods can also affect behavior. Theyremember sugar, as it turns out that
if you give them foods with alot of sugar, it can also affect
(30:41):
their behavior. It' s thatkind of tips that I' ve seen
that might have worked. Perhaps thereare many things that are not supported on
a scientific level, but it isfrom experience and that I have seen that
has worked out a lot for themommys with the children who have these kinds
of conditions. Thank you very much, Adriana for the warrior advice of the
(31:08):
Heart. It is a presentation byHearth Unite de Glode and is part of
Hogg Packest Network Hoks Deletrea hug Andare the acronyms of Horthy Night, from
glob HORGEI nightd Love is a non- profit organization dedicated to providing resources to
the congenital heart defect community to raise, empower and enrich the lives of members
(31:34):
of our community if you want toaccess free resources belonging to the congenital heart
defect community. Visit our website withGenetal Heart Deffex com for information about hospitals
treating children summer camps for survivors Andmuch more before the break, we were
(32:00):
talking about the nutrition of children withabrianian congenital heart disease. You are collaborating
with the development of an application fornutritional monitoring at home of children with heart
disease. Where the Good Martha initiativecomes from I tell you this fair application
(32:29):
developed in the middle of a pandemic, yes, so that you more or
less get an idea also because itdeveloped. But specifically the initiative arises because
in consultation with parents, the caregiversof these children referred as much concern about
food. After the children discharged them, i e, they left the hospital
(32:51):
from their surgery, went home andhad to wait for their second palliative correction
surgery. So they said but whatwe' re going to give him is
that I' m afraid something willhappen to him and many even got alarmed
by any little thing and took himto the clinic quickly. Yes, then
that was very common in the commondiscourse of these parents. Then they said.
(33:13):
But, this brings to him thearrival of the pandemic, where these
children could not be removed, sincevery often from home, so his appointments
were a little distant. So,because of that concern. We said,
because you have to generate them,you have to develop an application that can
provide these parents from home, becausereliable information, because it is reliable information,
(33:37):
because that application was made among manyprofessionals, that is, there was
the cardiologist, there is the nutritionist, there are different professionals that address this
problem or this disease. Then,in that application, reliable information was designed
and provided, an interactive way forparents, so that it could, so
(34:00):
that it would be easy access alsofor them, those three that generated them
obviously, to not know how tofeed their children at home. Thanks to
this application, and we also sawthat it improved adherence to those nutritional recommendations
given to it from the clinic.Yes, they were then given a whole
series of recommendations, but parents couldstrengthen and reconfirm that information thanks to the
(34:24):
application they had at home. Ithink it' s excellent, because I
really think that all mothers in theworld have the same concern in terms of
and that they can eat that theycan' t eat the And if they
eat a lot of this and ifthey don' t eat from the other.
And especially, when our children withcaldiopathy are not only in the fact
(34:51):
of feeding, but also that theyuse medicines, then we have this pro
where sometimes we have to take careof their diet by kaliopatria. But then
we also come up with other things, because of the food you are having
or because of the medicine you arehaving, which also affects your stomach.
(35:12):
And there I have an experience withmy son that we came up with a
gastritigrosiva that we didn' t knowwhere it came from, but we come
to the conclusion that it was becauseof the use of pyrins. But you
can' t stop taking the pyrins, because it' s important for your
health condition. That is the case, and above all, to be informed,
(35:36):
because to make decisions about food.And precisely the application has crucial information
to make those good decisions, somethingthat I wanted to tell you also a
little bit more in detail about thisapplication, because it is a first how
to say a first design of theapplication. Yes, we were able to
(36:00):
pass as a second stage, becauseof resource issues, because this project was
financed, because the Ministry of Scienceand Technology in Colombia called Science. So
these are projects that go down governmentresources and so we can develop these kinds
of applications. But what was achievedin this first stage. The app,
(36:24):
in fact, is called Baby honAnote, because it' s in the
play store. You can download itpitifully. It' s only for the
Android system, the Android operating system, but it has information, it can
download and it has information like what. A basic information that is the state
(36:45):
one of the modules, the nutritionalstate. Turns out that application you can
put the weight and size of yourchild and vote for a tracking chart and
it allows you to tell you exactlythe diagnosis of your child, for example,
it has low weight, a lowweight example for size and once,
depending on the state of the diagnosis, the nutritional status of the child,
(37:07):
with graph and everything generates specific recommendationsfor your child to gain weight at once.
The app does that. In anothermodule we have complementary power supply.
What happens is that this application wasmade for children under two years of age,
i e that they were starting lappingchildren, i e they were drinking
(37:28):
breast milk or milk formula and theystarted to incorporate their diet after six months.
So this is what we call complementaryfeeding, and this was just one
of the most common doubts. It' s always been one of the very
common doubts about what I' mstarting to give my children to eat I
don' t know what to givethem and how they make you sick and
how they do, so it turnsout that we had children with heart disease
(37:52):
as an infant who were going tostart their complementary feeding. So, because
of that, because of that need, another module is created within the application
that has to do with that supplementaryfeeding information by age. So what are
you going to find when you explorethe application, you' re going to
find food by food groups, byage, what foods are forbidden and one
(38:14):
of the other prescriptions, because that' s also important. Ah well,
you can' t eat egg,but then what can you eat and what
can I prepare with that? Thenthere are also a number of recipes that
can be guided in the mommies sothat they can make them at home and
be able to offer your child whatthey need. And, on the other
hand, we have a notification module, we incorporate vaccination notifications, notifications of
(38:39):
when you have the next appointment withyour pediatrician or your canteologist and also nutrition
status alarms. Then, for example, the mom already put the data to
you and realized that it is lowin weight, comes a series of recommendations
and it turns out that a monthyou have to weigh it back and measure
it and put your eyes and itcomes back and it comes out that the
(39:02):
child is losing weight. So whatthe application does is to send an alarm
of the nutritional status so that you, then, go to the treating doctor
and can explain to him what ishappening and somehow, there you can come
the evolution to the doctor of thatnutritional situation of the child. Well,
we really hope that the opportunity ismade, because nothing else with what you
(39:28):
' re explaining to us from thefirst phase that you say is very general,
it' s not so general,because they' re talking about different
topics and it' s really somethingthat many of us still need sabel.
When it is being explained that itis aimed at younger children, I understand
that a lot of the information thatis there can give an idea even to
(39:51):
all these mothers with older children ofhow to work with food and we really
hope that it will continue that applicationgrowing and that they will follow all the
phases that can follow the funds tocontinue working, because we need it even
I can tell you that in thematter of nutrition and feeding, in the
term of a child with a healthcondition, not specifically the phariopathy any health
(40:16):
condition, I understand that it wouldbe an excellent application because, as I
told you, it gives me theidea of how I will work, how
I will work my child' sfeeding with a health condition, because sometimes
they seem different, but in oneway or another there are times that are
(40:36):
quite similar. In the end ofhow do I have to work this child
with diabetes? It can be assimilatedas I have to work with my child
with caliopathy, this child who isgoing through this process of a cancer condition.
I mean, I understand why you' re explaining to us that this
is open to a general form.That' s right. Yes, it
(41:01):
is more general, because, forexample, we do not yet have the
water restriction that is seen a lotin congenital heart disease, that is,
we have there as the millilites thatshould give the baby when he begins to
consume breast milk. Or we haveno longer been able to land it as
(41:22):
such to the specific disease. Butthis is obviously something we want to do
in a second phase and we hopethat this can be done. And of
course this is an important guideline,because for another type of illness is that
the only fact that they can followtheir child nutritionally, although it is true,
they are very general, they area help while you can go with
(41:44):
your pediatrician, with your nutrient.Yes, with your cardiologist, and they
can give you, obviously, themost detailed information, but at least it
gives you an idea to see whichpath to take while you get close to
the health institution, the health professional, And that' s where you start
what is the role of the CardiovascularFoundation of Colombia, both in the development
(42:07):
of the application and in the pediatrichealth of children with caliopathy in Colombia.
Well, Marta, I have totell you that the Cardiovacular Foundation of Colombia
is one of the most important medicalcomplexes that Colombia has. In fact,
it is one of the most prominentin Latin America. He has an exaggerated
(42:30):
number of accreditations and recognitions in easternColombia. In fact, he was the
best Colombian hospital in cardiology and cardiothoracicsurgery. In fact, it is the
second most prominent in Latin America inthis area. They' re super,
super experts. They have all theprofessionals suitable to be able to address health,
(42:53):
not only at the pediatric level,but also in adults who have these
heart diseases in Colombia. Then therole of the Foundation, apart from telling
them everything it has, what itoffers, that service package, that ecosystem
of integral solutions that the institution has, because apart from them, not only,
(43:15):
because they attend patients. They doeducation and research as such. Thanks
to them it was possible to develop, that is, they provided the support
and resources to carry out the researchproject. Yeah, they' re the
patients we work with, they're their patients, the places, the
(43:37):
area where all the pilot tests weredone. They offered him all the detailed
information. I alone, because Itook care of the nutritional part, but
it was a rather comprehensive work withall the professionals who have extensive experience in
this area and who are part ofthe Cardiovascular Foundation of Colombia. Excuse me
(43:58):
Marta, you know this is veryimportant to me. How would Adriana do
people who are low- income sothe foundation can help them. For example,
you have a child who has acongenic heart disease, but it'
s low- resourced. They cango there to the foundation and take care
(44:23):
of them clearly, yes, ofcourse. Actually, that' s good.
I told them from the beginning thatthey, although it is true,
forgot to tell them it is aprivate institution, but they have agreements with
healthcare providers. So every patient whois sounding up, who has some healthcare
(44:45):
provider here in Colombia and who islow- income, they care for them,
that is definitely yes. In fact, I was telling them at the
beginning that the patients who were incorporatedin that India are all low- resourced,
absolutely everyone, and they have beenprovided with all the services from the
(45:08):
cardiovascular. So, obviously, thereare a number of procedures, but the
normal thing like when you go tohealth insurance, not to make the appointment
that you consult her, first thiswith the general doctor, then you go
to the specialist. He obviously takesall the background with his medical history and
everything that has been done to thegood Adriana patient and what advice you would
(45:31):
give to all mothers in general aboutthe nutrition of their children. I mean,
you said you had to be creative. Well, first of all,
I' d tell the mommys,those moms, those kids' warriors,
(45:51):
warriors who remember that every one oftheir kids is unique. Yes, you
have to have a lot of patience, a lot of love that shows you
that you give them and, rather, do everything for those babies. Then,
in that process always encourage those eatinghabits around a scenario as friendly and
(46:12):
as loving as possible. That works. That works a lot on the kids.
Listen to the signs, the signsof this anxiety of children, the
signs of hunger. They can manifestthemselves in different ways. If so,
little children, those who have alreadyhad are mothers of babies know that,
(46:32):
of course, children have signs andrealize when children are no longer hungry or
on the contrary, they are hungryand weep that kind of thing. It
is important, important to take theminto account in children, because, obviously,
to give them food when they needit, to offer a balanced diet
(46:53):
that is. The idea of feedingchildren is that it is varied, that
includes all kinds of food, thatprioritizes fresh food, natural food, that
everyone is at home, that is, it is a very housework, very
much to prepare their food at home, yes, to always offer them this
(47:13):
type of food. I know theba app said it' s not the
only one. We' ve seena lot of apps too. Then try
to download yourself into those apps,get informed, go to courses, if
necessary, take a cooking course soyou have more ideas, watch YouTube videos
of how food is prepared and doeverything that comes out of your heart.
(47:37):
With much love, then, tooffer the best food and support in this
process to your children, it islike the recommendation that you or. Thank
you Adriana, before you do theshow. Please repeat the name of the
app and also, please repeat whereyou said you have consulted ons and repeat
(47:59):
where they can get you good.The app is called Baby Phone as baby
in cact so baby ok babing hook ya. And so queries can contact
me to my social networks. Inother words, we can schedule a consultation
(48:20):
by zoon wherever it seems to you, since it is more affordable and easier.
So, for example, I cangive you even my email. Yes,
there you can write me that itis to m rugeles arroba gimlay com
and then you can contact me withoutany inconvenience. If you have any concerns.
(48:43):
With pleasure, I' ll belooking after you thanks to Diana.
Thank you very much. Back theshow today thanks to Timarme. So conclude
this episode of warriors and heart.Thank you for listening to us today.
Fruity of this episode, please leavea review of our podcast on our websiw
(49:04):
to Harsta United Club Or and offriendly agreements never give up. Thank you
again for joining us this week.We hope you have been inspired and empowered
to become an advocate of the communityof congenital heart defects that are of the
(49:29):
heart with your hosts Welen Blancton,Geneferking, Guina and Marta Montero. It
is produced monthly and can be heardwherever you have access to Pardcast. The
new episodes are broadcast on the secondSaturday of the month
Welcome to your heart warrior program,fighting heart disease with genelites. I am
Malta, Rachel Montero, one ofthe hosts of this program, and I
am also the mother of a warriorof heart. I am accompanied in this
interview by Luis satiate the isaman Nava, mothers of some warriors of heart and
Belén Blanton, another warrior of heart. In today' s program we will
(00:30):
be talking with Adriana Cruela, nutritionistand researcher of Colombia in the different segments.
We will know about your work asa nutritionist and what motivated you to
work in this area. We willtalk about the nutrition of children with caldiopathy
and children in general, as wellas how it affects the excessive use of
sugars and sodiums in children. Inconclusion, he will tell us about the
(00:54):
development of the application in which heis collaborating for nutritional monitoring at home for
children with heart disease and the roleof the Cardiovascolar Foundation of Colombia in this
initiative. Welcome to Heart Warriors,Adriana Hello, good afternoon. Thank you
(01:15):
very much for the invitation. Itis an honor to share this special space
with you, mothers of those warriorsand many of you also warriors of heart.
Thank you so much for joining ustonight, Adriana, and I want
you to tell us what motivated youto work on nutrition. Well in general,
(01:40):
nutrition as such allows me to improvethe quality of life of my patients.
It is to recognize in nutrition afundamental key when it comes to addressing
pathologies as important and as complex ascongenital heart disease Thanks to adequate nutritional support,
(02:00):
I have been able to realize thatwe have decreased the mortality of many
children with this pathology. We alsolessen the cost overruns that have this disease
in children. Fortunately, in theCardiovascular Foundation of Colombia we have the possibility
to care for many children of scarceresources. So that' s one of
(02:23):
the biggest motivations to see my kidsget better. This nutritional status and treatment
at the medical level, at theinterdisciplinary level, has a positive effect on
their health. But not only intheir health, but also in their parents
' health. That is, thattranquility that brings your parents, having your
(02:44):
children healthy, being able to seethe continuous progress of your children, how
beautiful, how wonderful. The truththat I love to listen to you is
a super important and fundamental topic,the issue of nutrition in the health of
our children and as much as itcan impact to be able to carry out
(03:15):
this treatment with all these resources fromwhich we can value ourselves and being nutrition
one of the resources, I thinkmost important, that allows us, one
of the most important that allow usto accompany all this situation to the parents
(03:37):
that we have babies, with congenitalcatechies. How important and how nice it
is to be able to share allthis knowledge and for more people to have
this kind of information that is sofundamental. Well, Adriana. I want
you to tell us what studies youneed to have to work in the area
(04:00):
of utrition research. Very well look, since on the basis of being able
to do research in nutrition we haveto have a very solid formation in nutrition
and dietetics. In Colombia, thisis called the undergraduate nutrition and dietetics.
Later, there are different postgraduate degreesthat are highly specialized in master' s
(04:25):
and doctorates, but then these master' s or graduate' s degrees specialize
in an investigative approach and specialize ina medical condition. For example, there
are many who specialize in this pathology, which is congenital heart disease, but
there are different specialties depending on thearea of clinical nutrition already goes all the
(04:47):
specialty ages and depending on each populationgroup, since the study is focused depending
on those needs. Perfect, wonderfuland the subject is a subject of any
age. Or you can specialize inconditions and age, as I told you,
(05:13):
you can specialize in conditions. So, for example, there are eating
behavior disorders, there is an exclusivespecialty of this. We have the specialty
of congenital heart disease. And alreadyin that specialty, because they already cover
all ages depending on the pathology.So if we have at least in Colombia,
the possibility to train at the invertivepostgraduate level in this type of excellent
(05:43):
pathologies. And where you have anoffice, where it is located and to
whom in particular you offer the MiraLuisa service, because currently my work is
carried out mainly in Bucaramanga, Cantander, Colombia, and I offer more than
(06:04):
all nutritional advice in a virtual way, because it is with the intention of
reaching many people, not only outsidemy city, but outside the country.
I also cover all kinds of pathologies, from non- communicable diseases such as
diabetes, it has hiter region oflipidemias, also gastrointestinal diseases such as fatty
(06:26):
liver, cirrhosis, colonitable, gastroesophagealreflux, overweight, oity And I,
practically, because I board all kindsof pregnant populations, mothers, infants,
children under five years of age that, in fact, is one of my
strong ones, because later I willexplain the application precisely is directed for these
(06:47):
minors, but basically on board allkinds of pathologies. Apart from this,
I, therefore, do research,which is one thing in the external consultation,
as such in a clinic, butalso development or research around these issues.
(07:10):
Then it is very feasible for somehealth institution at the level of Colombia
to contact me for data analysis,to analyze a type of patients and based
on that information, we generate knowledge. So what do we do, write
scientific articles, go to congresses andpublish, so, all that information that
(07:30):
is going to be relevant, becausenot only for the scientific community, but
for the general population, who aregoing to have access to this important information
and who are going to help improvethe quality of life of all these children?
Excellent, excellent how interesting. Thatis, any mom who listens to
this podcast and can contact you truthand you, then, do a follow
(07:59):
- up and nutritional accompaniment for anymember. That' s right, Luis.
In fact, then, I willgive a brief description of what is
being done in the consultation. Althoughit' s true, it' s
virtual, but it makes a wholefood nagnessis that means that. A nutritional
survey is done where I can identifythe foods they consume in a twenty-
(08:24):
four- hour reminder to see thatfoods are rejected, that foods can suddenly
affect at the gastrointestinal level. Manythings are identified. Why. Because based
on this we can plan a certaindiet, according to its customs, according
to the diagnosis, so that thisfood is sustainable. It is not the
(08:46):
diet and now, but this isadapting it to be sustainable and more conscious.
Yes, then, that' spractically what we do or what I
do in my consultation with the currentone and more or less adultate an hour,
an hour and a half, dependingon the patient' s diagnosis,
(09:09):
where I also evaluate several, sayvariables from the body mass index, among
other measures that I can evaluate ortake into account for diagnosis. Then of
course, any mommy who is seeingus with pleasure can contact me and I
could do the nutritional consultation and follow- up. Obviously, the controls are
(09:30):
programmed according to the pathology are readgood. Thank you so much. This
content is not intended to replace diagnosticadvice or professional medical treatment. The opinions
expressed in this podcast are not thoseof Horke United Love, but those of
(09:54):
the hosts and guests, and theyintend to generate a debate on issues related
to congenital heart disease. Welcome backI' m white Bethlehem. Before the
(10:15):
break we were talking with Adrian orin his work as an adrian nutritionist,
what would be the main nutrition recommendationsfor a child with heart disease and look
well Belén told you the nutritional managementof a child with heart disease with gene
(10:39):
is a bit complex. It dependson many factors, because the water restriction,
the high caloric requirements, the prevalencethat these children sometimes have to intolerance
of some foods, because it makesthis management change. In addition, because
the hemodynamic impact these children have causesthere to be a slow growth of development.
(11:05):
Let' s say that' sone of the studies and obviously,
experience shows that stunting and development inthese children are very marked. Then we
also suddenly add some orofacial alteration,not motility in the absorption of these nutrients.
(11:26):
He' ll say don' tgive me trouble, Adriana, give
me solutions. Fortunately, then,we have adequate nutrition support to be able
to address all these problems that arisein our children with heart disease, with
people. Then we can start withthe following. Macronutrients, i e,
(11:48):
such as carbohydrates or carbohydrates, proteinsand clean ones. It should be borne
in mind that these children must consumevery high- energy foods, i e
calories energy, so that we canhelp them to progress quickly in their nutritional
state. It turns out that,among all macronutrients, the one that provides
(12:13):
the most energy guess what the fatsare. That' s why we fatten
up easily because children who have thispathology and who are low in weight.
We need to inject it in fat, fat, fat. This will bring
you calories and that will also allowus to increase your weight. So it
is important that you identify that thefatty acids you must consume, the best
(12:37):
so that they can be absorbed,are the long chain or omega three.
It is essential to consume these children' s food, in their diet,
in their nutritional treatment, they willsay well, we can supplement them,
but when they are already bigger,they can be supplemented. But we can
also find it in different sources offood. For example, we have fish.
(13:00):
We can also see it in theseeds and nuts. I don'
t know how many mommys will havelittle kids who still drink milk, i
e, milk formula. Why,Because they are under two years old these
children are It is very important alsoto increase that caloric density and it is
also recommended to incorporate it oily andthe. Another important part is minerals.
(13:24):
They suddenly turn out to tell usabout their children' s experience if they
have suddenly appeared with anemia, thesechildren before surgery or posurgery more than anything
else, they lose blood and itis normal for them to show up.
Then we need to supplement them withiron that helps prevent anemia. And obviously,
(13:48):
because these children with congenital heart diseasehave a higher risk of what the
liver can be. Here, inColombia we get used to eating liver at
least twice a week. Not you, in your countries, the red meats,
the legumes, the leaves of darkgreens such as spinach. Mommies you
(14:09):
can consume, for example, fourmilligrams of iron in just a hundred pieces
of spinach. It' s superimportant. Also a fundamental thing that can
be seen in children is that becauseof the medicines they consume there is an
interaction with the nutrients. So itturns out that these kids start losing magnesium,
they start losing calcium, they startlosing a lot of them, they
(14:33):
get nauseous, they get diarrhea.Yes, then, because of that one
must, then, take into accountthose considerations and offer food that provides them
with these minerals that they are losing. And let' s remember that the
cassium is super important for growth,bone development. Then where we can find
the calcium. Of course, therecomes the other part, because in the
(14:56):
laaths, in the egg, inthe spinach too, but especially in the
milk and the derivatives. But there' s something going on. It turns
out that many children have also seenit in our consultations and there are also
scientific supports where children have problems absorbingnutrients. Among those is just when you
(15:20):
drink dairy, so it turns outthat you have to remove caffeine, which
is the protein from milk. Thenyou can' t give him milk.
They' ll tell me then youwon' t be able to take calcium,
because it only comes from milk andits derivatives. Well, we have
other options, as many of thesechildren do not assimilate milk consumption, as
it can be replaced. We have, for example, vegetable milk, almond
(15:45):
milk and that can be done ina small house. While it is true,
it will not provide the same amountof song, but it is a
way to replace it. Then wecan make an endless number of products derived
from vegetable milk. I don't know all of a sudden you'
ve heard from mole that milk issoy can also be curdled. We can
(16:08):
also get calcium in green leaves,in legumes such as beans, beans,
lentils, in fish. We canalso find calcium in broccoli. So,
not necessarily for those mommies who havetheir kids where they don' t tolerate
milk or its derivatives. Something veryimportant. Moms, while true, these
(16:32):
two minerals, iron and calcium,are deficient in our children. It'
s important not to mix them.It turns out that when you eat foods
with a lot of iron, forexample, the liver, and you eat
something else that contains a lot ofcalcium, because calcium doesn' t let
(16:52):
you absorb iron the way we wantit. If you are antagonists, then
you have to have a recommendation thatI give too. You have to be
very careful when giving foods with alot of iron with calcium, that have
foods together foods that have a lotof calcium, because iron is not going
to be absorbed, yes, sowhat should be given or offered to your
(17:15):
children these foods with a lot ofiron with vitamin C, that is,
with the Basque way. It turnsout that when you eat, for example,
a liver or a piece of meat. They give it to the children
and give it a guava juice orcitrus fruit juice. Whoever wants that iron
the meat is bringing is going toabsorb it in the best way. So
(17:40):
rather accompany those iron products, forgivethose food sources of iron with food sources
of vitamins and yes, then basicallythose are like the general recommendations that,
in fact, that was one ofthe following questions what you were going to
be. But before that it shouldbe noted that there are many children in
(18:03):
our countries who are low- incomeand all that kind of nutrition for them
is too much. People don't have the resources to buy me imagine
a piece of fish or salmon itself. That, at least in my country,
super clear and that' s wherethe problem of all this comes from.
(18:26):
Then, because of course, ifyou have the resources, you can
go to the market, you canbuy that, you can buy the other.
But, for example, what theselow- income people could do for
what they have in their power.They can have fruits, they can have
rice, they can have no rascals, for example, that kind of perfect.
(18:52):
Okay, yeah, sure, youhave to be very creative. Mom.
So, well, what do wehave, Bethlehem tells me, no,
because we have a roz, wehave one and another fruit and we
have beans, then quiet. Itturns out that from there we can also
extract the iron we need. Turnsout there' s something in nutrition that
' s called amino computation. So, when we mix a cereal or flour,
(19:17):
I don' t know what youcall it rice, for example,
and pasta does, you have starch. They mix it with a leguminous,
for example, bean, lentil beans. When you make him a child,
the little one plus that bean,which is all you have, Mommy,
is giving you the piece of meatyou can' t buy. So chevere
(19:38):
is nutrition, to make it.Making this combination between cereal and legume allows
you to contribute, for example,the same iron, which provides two hundred
milliliters in fact, from what givesyou a piece of meat. Yeah,
so imagine, I' ll putit on for you so your baby anemia
(20:03):
is ready. Don' t supposeor children anemias. We' re missing
that important iron. We have thebean with the little rice and remember what
I was saying to vitamin c helpsa lot to absorb that iron. Then
we need that iron to be absurdvery well so that they are children we
don' t fall for anemia.So what do we get from fruit,
because the fruits that bring us vitamins. I know if it' s true,
(20:26):
there are some that contribute more,but whatever you have, then if
you could go and get some lemons, do a lemonade, then what happens
when our children are too exposed tothe use of sodium looks nativity scene.
I think this is not forbidden bysodium, but to everyone that not only
to children with congenital heart disease.To all of us sodium does not bring
(20:51):
anything nor does life lie. But, yeah, because it' s a
mineral and that' s in ourorganism and it' s needed. Obviously,
all in excess. It' swrong, but where is the sodium
in the salt normally? And itturns out that I always say that to
moms why we get so bad habitsfrom childhood, because the child, if
(21:11):
he' s drinking breast milk,right, the breast milk is tasteless,
he didn' t know anything andit turns out that then, when the
child starts with supplementation feeding, thatis, they start feeding him. Oh,
we didn' t throw out thelittle sale because you' re not
going to see anything. Let's not throw him out there,'
cause if I didn' t knowanything about him. I mean, we
don' t depend on sodium,we don' t depend on salt.
(21:33):
So what happens are bad habits thatwe do not really contribute much. And,
on the contrary, this excessive exposureto sodium, because it does,
has negative impacts on our health,especially on the cardiodyescular health of all children
and adults who have congenital heart diseasethat this contributes to liquium retention. If
(21:55):
that increases blood pressure, which obviouslycan be harmful to the heart, then
it is super fundamental to limit theconsumption of foods processed for why, because
there is sodium in canned foods.So, yes, the tuul, the
sardine, but it turns out thatit brings a lot of hatred because it
comes in canned. Yeah, otherthan that, because there' s no
(22:18):
shortage of children in some countries thatgive them the packets these sabritas chips,
because you have sodium stuffed them.Then all that kind of food. There
are products. They have to belimited. An important key for sodium before
reading the labels. Moms, itis important to read food labels in order
(22:41):
to make appropriate decisions, that is, to be able to go and buy
foods or products they have, aslow sodium options whenever possible. Then what
do you have to do? Use, aromatic herbs spices like pepper, curcuma
laurel, for example, in Mexico, a chili to give it flavor will
(23:03):
look very spicy, but good.Yes, trying to use food you try,
cooking our food, but with spices, so that we don' t
have the need for salt and beable to control and run away and run
away from salt to sodium as such, because obviously it can affect the health
(23:23):
of people with heart disease with people, so it' s like my representation
regarding sodium. Tell me when yousay sodium in salt, you mean all
kinds of salts, because now there' s sea salt and salt in the
Himalayas. Another grace realizes everything thatis salt no matter how it is.
(23:48):
It is correct, Yes, ma' am all, especially since with everyone
who has congenital heart disease no confidencein that type of salt Let' s
say it has in different processes,but ultimately it is salt look what you
can not also say about the highsugar exposure for children. I know it
(24:11):
must be fatal, too, butit' s as sharp as sodium.
There are different types of sugars.We have the regular table sugar, but
we also have the fruit sugar andit' s called fruit. Then no
(24:33):
one could eat fruits because they areeating sugars, true why, because they
are fructose. At the end ofthe day, they' re glucose,
fructose as such, so look.The studies indicate the following. We have
a whole scientific support where news ofhigh exposure to good sugar will generate cardiovascular
(24:56):
diseases and other health problems, suchas obesity and overweight in our children,
who may have tooth decay, whichis very common. But we can consume
the sugar that comes from the fruitswithout any inconvenience. Obviously, or,
well, we' re going toeat twenty pounds of fruit in the day,
(25:18):
not that it' s all measured. In fact, there are dietary
recommendations, i e, there aredaily recommendations for this type of products,
let' s say so, orfood. Then it' s not in
that either. Then no. ThenI was told that fruit sugar is not
bad. This one isn' tgoing to eat a lot of fruit,
no, because also that fruit,because it' s going to accumulate in
(25:41):
fat and it can also affect,that' s all in children they'
re going to have other kinds ofproblems. Caria is dental and I also
have to tell you that it hasbeen shown that children are very hyperactive due
to consumption at excessive levels of sugarconsumption and that where they get them from
food processes. So it' snot good for our children to change behavior
(26:04):
and leave aside another type of foodthat really nourishes them by eating foods with
high levels of sugar. What needsto be done is to consume it in
a moderately adrian way. In mycase, my little one has autism.
What would be the recommendation regarding eating, knowing that a child with autism does
(26:27):
not usually eat, because of everything, but also needs to be well nourished
by his heart disease with a genderer. That' s right. Yeah,
look, he' s telling youthat they' re like such specifics.
(26:48):
I mean, for example, I' d have to ask you, I
don' t know if I canget your kid' s nutritional status,
I mean, he' s gotsome kind of, he' s underweight.
Yes, for example, that isessential to be able to give you
as a general recommendation, but well, considering that most need this energy component.
(27:10):
Highly energetic foods, for all Ihave mentioned, that are always tending
to nutrition, to malnutrition. Thenlook is essential entry, explore textures,
colors, presentations that are appetizing foryour child. Almost always children with autism,
(27:36):
as they tend to consume, arevery selective. Then they just want
to eat one thing and it turnsout that they also become undernourished because they
don’ t eat more than that. Then at the beginning, the only
twenty- two. The idea isinsistible to insist on that baby, that
child several times in different ways.I' m telling you an experience.
(27:59):
There was one of the children who, for example, the green color everything
green rejected him. So let's try the little mama to put a
dye on her, change her dye. Then he bought a food coloring that
brings nothing and it turns out thatthe cake, for example, was spinach,
a little spinach dessert that he made, put a blue coloring on it
(28:22):
and the enchanted child ate it.We realized that it rejected the color,
but it wasn' t the taste, it was the color. Then,
in that case, mom is socreative, so creative that they should better
say invent doing everything so that theirchildren can get or consume that food.
(28:45):
There' s something called camouflage food. That' s exactly what I mean
by the example I gave him ofcolors, but there are many also with
the texture, for example, thereare children who what it is like I
started it they suddenly scream not likeit' s very watery. Then start
mixing that puree with something more crushed. Then, for example, the puree
(29:07):
was made an apple puree. Let' s throw a few pieces of chicken
at him and I' ll kickmyself out to see how true we are
about what we are. I callthem moms. There is no need for
this feeding space, especially for thesechildren, to be pleasant, it must
be a positive experience. Yes,because it happens to us too, that
(29:30):
is, how many of us asa child did not give this to us,
they forced us to eat something,and because even Moya did not cry
and scream and everything, and well, in the end she ate it and
it turns out that we do notlike to eat that because we associate it
with that bad experience. Is itlike a trauma we have left to live
those experiences around the food? Then, with more reason, they have to
(29:51):
generate positive experiences around food. There' s something very, very important.
Also take into account. Be veryattentive to signs of intolerance or allergy,
because usually children with last, becausethey will not verbally express what happens to
them. Then we would do somethingwith a mommy and carry like a notebook
(30:17):
where she wrote down the food shegave her child during the week and was
very careful if she had any reaction. Yes, indeed, many of these
foods can also affect behavior. Theyremember sugar, as it turns out that
if you give them foods with alot of sugar, it can also affect
(30:41):
their behavior. It' s thatkind of tips that I' ve seen
that might have worked. Perhaps thereare many things that are not supported on
a scientific level, but it isfrom experience and that I have seen that
has worked out a lot for themommys with the children who have these kinds
of conditions. Thank you very much, Adriana for the warrior advice of the
(31:08):
Heart. It is a presentation byHearth Unite de Glode and is part of
Hogg Packest Network Hoks Deletrea hug Andare the acronyms of Horthy Night, from
glob HORGEI nightd Love is a non- profit organization dedicated to providing resources to
the congenital heart defect community to raise, empower and enrich the lives of members
(31:34):
of our community if you want toaccess free resources belonging to the congenital heart
defect community. Visit our website withGenetal Heart Deffex com for information about hospitals
treating children summer camps for survivors Andmuch more before the break, we were
(32:00):
talking about the nutrition of children withabrianian congenital heart disease. You are collaborating
with the development of an application fornutritional monitoring at home of children with heart
disease. Where the Good Martha initiativecomes from I tell you this fair application
(32:29):
developed in the middle of a pandemic, yes, so that you more or
less get an idea also because itdeveloped. But specifically the initiative arises because
in consultation with parents, the caregiversof these children referred as much concern about
food. After the children discharged them, i e, they left the hospital
(32:51):
from their surgery, went home andhad to wait for their second palliative correction
surgery. So they said but whatwe' re going to give him is
that I' m afraid something willhappen to him and many even got alarmed
by any little thing and took himto the clinic quickly. Yes, then
that was very common in the commondiscourse of these parents. Then they said.
(33:13):
But, this brings to him thearrival of the pandemic, where these
children could not be removed, sincevery often from home, so his appointments
were a little distant. So,because of that concern. We said,
because you have to generate them,you have to develop an application that can
provide these parents from home, becausereliable information, because it is reliable information,
(33:37):
because that application was made among manyprofessionals, that is, there was
the cardiologist, there is the nutritionist, there are different professionals that address this
problem or this disease. Then,in that application, reliable information was designed
and provided, an interactive way forparents, so that it could, so
(34:00):
that it would be easy access alsofor them, those three that generated them
obviously, to not know how tofeed their children at home. Thanks to
this application, and we also sawthat it improved adherence to those nutritional recommendations
given to it from the clinic.Yes, they were then given a whole
series of recommendations, but parents couldstrengthen and reconfirm that information thanks to the
(34:24):
application they had at home. Ithink it' s excellent, because I
really think that all mothers in theworld have the same concern in terms of
and that they can eat that theycan' t eat the And if they
eat a lot of this and ifthey don' t eat from the other.
And especially, when our children withcaldiopathy are not only in the fact
(34:51):
of feeding, but also that theyuse medicines, then we have this pro
where sometimes we have to take careof their diet by kaliopatria. But then
we also come up with other things, because of the food you are having
or because of the medicine you arehaving, which also affects your stomach.
(35:12):
And there I have an experience withmy son that we came up with a
gastritigrosiva that we didn' t knowwhere it came from, but we come
to the conclusion that it was becauseof the use of pyrins. But you
can' t stop taking the pyrins, because it' s important for your
health condition. That is the case, and above all, to be informed,
(35:36):
because to make decisions about food.And precisely the application has crucial information
to make those good decisions, somethingthat I wanted to tell you also a
little bit more in detail about thisapplication, because it is a first how
to say a first design of theapplication. Yes, we were able to
(36:00):
pass as a second stage, becauseof resource issues, because this project was
financed, because the Ministry of Scienceand Technology in Colombia called Science. So
these are projects that go down governmentresources and so we can develop these kinds
of applications. But what was achievedin this first stage. The app,
(36:24):
in fact, is called Baby honAnote, because it' s in the
play store. You can download itpitifully. It' s only for the
Android system, the Android operating system, but it has information, it can
download and it has information like what. A basic information that is the state
(36:45):
one of the modules, the nutritionalstate. Turns out that application you can
put the weight and size of yourchild and vote for a tracking chart and
it allows you to tell you exactlythe diagnosis of your child, for example,
it has low weight, a lowweight example for size and once,
depending on the state of the diagnosis, the nutritional status of the child,
(37:07):
with graph and everything generates specific recommendationsfor your child to gain weight at once.
The app does that. In anothermodule we have complementary power supply.
What happens is that this application wasmade for children under two years of age,
i e that they were starting lappingchildren, i e they were drinking
(37:28):
breast milk or milk formula and theystarted to incorporate their diet after six months.
So this is what we call complementaryfeeding, and this was just one
of the most common doubts. It' s always been one of the very
common doubts about what I' mstarting to give my children to eat I
don' t know what to givethem and how they make you sick and
how they do, so it turnsout that we had children with heart disease
(37:52):
as an infant who were going tostart their complementary feeding. So, because
of that, because of that need, another module is created within the application
that has to do with that supplementaryfeeding information by age. So what are
you going to find when you explorethe application, you' re going to
find food by food groups, byage, what foods are forbidden and one
(38:14):
of the other prescriptions, because that' s also important. Ah well,
you can' t eat egg,but then what can you eat and what
can I prepare with that? Thenthere are also a number of recipes that
can be guided in the mommies sothat they can make them at home and
be able to offer your child whatthey need. And, on the other
hand, we have a notification module, we incorporate vaccination notifications, notifications of
(38:39):
when you have the next appointment withyour pediatrician or your canteologist and also nutrition
status alarms. Then, for example, the mom already put the data to
you and realized that it is lowin weight, comes a series of recommendations
and it turns out that a monthyou have to weigh it back and measure
it and put your eyes and itcomes back and it comes out that the
(39:02):
child is losing weight. So whatthe application does is to send an alarm
of the nutritional status so that you, then, go to the treating doctor
and can explain to him what ishappening and somehow, there you can come
the evolution to the doctor of thatnutritional situation of the child. Well,
we really hope that the opportunity ismade, because nothing else with what you
(39:28):
' re explaining to us from thefirst phase that you say is very general,
it' s not so general,because they' re talking about different
topics and it' s really somethingthat many of us still need sabel.
When it is being explained that itis aimed at younger children, I understand
that a lot of the information thatis there can give an idea even to
(39:51):
all these mothers with older children ofhow to work with food and we really
hope that it will continue that applicationgrowing and that they will follow all the
phases that can follow the funds tocontinue working, because we need it even
I can tell you that in thematter of nutrition and feeding, in the
term of a child with a healthcondition, not specifically the phariopathy any health
(40:16):
condition, I understand that it wouldbe an excellent application because, as I
told you, it gives me theidea of how I will work, how
I will work my child' sfeeding with a health condition, because sometimes
they seem different, but in oneway or another there are times that are
(40:36):
quite similar. In the end ofhow do I have to work this child
with diabetes? It can be assimilatedas I have to work with my child
with caliopathy, this child who isgoing through this process of a cancer condition.
I mean, I understand why you' re explaining to us that this
is open to a general form.That' s right. Yes, it
(41:01):
is more general, because, forexample, we do not yet have the
water restriction that is seen a lotin congenital heart disease, that is,
we have there as the millilites thatshould give the baby when he begins to
consume breast milk. Or we haveno longer been able to land it as
(41:22):
such to the specific disease. Butthis is obviously something we want to do
in a second phase and we hopethat this can be done. And of
course this is an important guideline,because for another type of illness is that
the only fact that they can followtheir child nutritionally, although it is true,
they are very general, they area help while you can go with
(41:44):
your pediatrician, with your nutrient.Yes, with your cardiologist, and they
can give you, obviously, themost detailed information, but at least it
gives you an idea to see whichpath to take while you get close to
the health institution, the health professional, And that' s where you start
what is the role of the CardiovascularFoundation of Colombia, both in the development
(42:07):
of the application and in the pediatrichealth of children with caliopathy in Colombia.
Well, Marta, I have totell you that the Cardiovacular Foundation of Colombia
is one of the most important medicalcomplexes that Colombia has. In fact,
it is one of the most prominentin Latin America. He has an exaggerated
(42:30):
number of accreditations and recognitions in easternColombia. In fact, he was the
best Colombian hospital in cardiology and cardiothoracicsurgery. In fact, it is the
second most prominent in Latin America inthis area. They' re super,
super experts. They have all theprofessionals suitable to be able to address health,
(42:53):
not only at the pediatric level,but also in adults who have these
heart diseases in Colombia. Then therole of the Foundation, apart from telling
them everything it has, what itoffers, that service package, that ecosystem
of integral solutions that the institution has, because apart from them, not only,
(43:15):
because they attend patients. They doeducation and research as such. Thanks
to them it was possible to develop, that is, they provided the support
and resources to carry out the researchproject. Yeah, they' re the
patients we work with, they're their patients, the places, the
(43:37):
area where all the pilot tests weredone. They offered him all the detailed
information. I alone, because Itook care of the nutritional part, but
it was a rather comprehensive work withall the professionals who have extensive experience in
this area and who are part ofthe Cardiovascular Foundation of Colombia. Excuse me
(43:58):
Marta, you know this is veryimportant to me. How would Adriana do
people who are low- income sothe foundation can help them. For example,
you have a child who has acongenic heart disease, but it'
s low- resourced. They cango there to the foundation and take care
(44:23):
of them clearly, yes, ofcourse. Actually, that' s good.
I told them from the beginning thatthey, although it is true,
forgot to tell them it is aprivate institution, but they have agreements with
healthcare providers. So every patient whois sounding up, who has some healthcare
(44:45):
provider here in Colombia and who islow- income, they care for them,
that is definitely yes. In fact, I was telling them at the
beginning that the patients who were incorporatedin that India are all low- resourced,
absolutely everyone, and they have beenprovided with all the services from the
(45:08):
cardiovascular. So, obviously, thereare a number of procedures, but the
normal thing like when you go tohealth insurance, not to make the appointment
that you consult her, first thiswith the general doctor, then you go
to the specialist. He obviously takesall the background with his medical history and
everything that has been done to thegood Adriana patient and what advice you would
(45:31):
give to all mothers in general aboutthe nutrition of their children. I mean,
you said you had to be creative. Well, first of all,
I' d tell the mommys,those moms, those kids' warriors,
(45:51):
warriors who remember that every one oftheir kids is unique. Yes, you
have to have a lot of patience, a lot of love that shows you
that you give them and, rather, do everything for those babies. Then,
in that process always encourage those eatinghabits around a scenario as friendly and
(46:12):
as loving as possible. That works. That works a lot on the kids.
Listen to the signs, the signsof this anxiety of children, the
signs of hunger. They can manifestthemselves in different ways. If so,
little children, those who have alreadyhad are mothers of babies know that,
(46:32):
of course, children have signs andrealize when children are no longer hungry or
on the contrary, they are hungryand weep that kind of thing. It
is important, important to take theminto account in children, because, obviously,
to give them food when they needit, to offer a balanced diet
(46:53):
that is. The idea of feedingchildren is that it is varied, that
includes all kinds of food, thatprioritizes fresh food, natural food, that
everyone is at home, that is, it is a very housework, very
much to prepare their food at home, yes, to always offer them this
(47:13):
type of food. I know theba app said it' s not the
only one. We' ve seena lot of apps too. Then try
to download yourself into those apps,get informed, go to courses, if
necessary, take a cooking course soyou have more ideas, watch YouTube videos
of how food is prepared and doeverything that comes out of your heart.
(47:37):
With much love, then, tooffer the best food and support in this
process to your children, it islike the recommendation that you or. Thank
you Adriana, before you do theshow. Please repeat the name of the
app and also, please repeat whereyou said you have consulted ons and repeat
(47:59):
where they can get you good.The app is called Baby Phone as baby
in cact so baby ok babing hook ya. And so queries can contact
me to my social networks. Inother words, we can schedule a consultation
(48:20):
by zoon wherever it seems to you, since it is more affordable and easier.
So, for example, I cangive you even my email. Yes,
there you can write me that itis to m rugeles arroba gimlay com
and then you can contact me withoutany inconvenience. If you have any concerns.
(48:43):
With pleasure, I' ll belooking after you thanks to Diana.
Thank you very much. Back theshow today thanks to Timarme. So conclude
this episode of warriors and heart.Thank you for listening to us today.
Fruity of this episode, please leavea review of our podcast on our websiw
(49:04):
to Harsta United Club Or and offriendly agreements never give up. Thank you
again for joining us this week.We hope you have been inspired and empowered
to become an advocate of the communityof congenital heart defects that are of the
(49:29):
heart with your hosts Welen Blancton,Geneferking, Guina and Marta Montero. It
is produced monthly and can be heardwherever you have access to Pardcast. The
new episodes are broadcast on the secondSaturday of the month
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