<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1135-5727</journal-id>
<journal-title><![CDATA[Revista Española de Salud Pública]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Esp. Salud Publica]]></abbrev-journal-title>
<issn>1135-5727</issn>
<publisher>
<publisher-name><![CDATA[Ministerio de Sanidad]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1135-57272002000200007</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Presencia de residuos y contaminantes en leche humana]]></article-title>
<article-title xml:lang="en"><![CDATA[Waste and pollutants in human milk]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Prado Flores]]></surname>
<given-names><![CDATA[Guadalupe]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carabias Martínez]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="A02"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Gonzalo]]></surname>
<given-names><![CDATA[Encarna]]></given-names>
</name>
<xref ref-type="aff" rid="A02"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrero Hernández]]></surname>
<given-names><![CDATA[Eliseo]]></given-names>
</name>
<xref ref-type="aff" rid="A02"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Universidad Autónoma Metropolitana Departamento de Producción Agrícola y Animal ]]></institution>
<addr-line><![CDATA[Xochimilco ]]></addr-line>
<country>México</country>
</aff>
<aff id="A02">
<institution><![CDATA[,Universidad de Salamanca Facultad de Química Departamento de Química Analítica, Nutrición y Bromatología]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2002</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2002</year>
</pub-date>
<volume>76</volume>
<numero>2</numero>
<fpage>121</fpage>
<lpage>132</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1135-57272002000200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1135-57272002000200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1135-57272002000200007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[La contaminación de la leche humana por xenobióticos es un problema generalizado a nivel mundial, que se ve afectado por las variaciones geográficas, climáticas, culturales y socioeconómicas de cada lugar. Las políticas de salud pública han enfrentado la situación mediante una vigilancia sostenida y legislaciones restrictivas con el objeto de reducir los efectos perjudiciales sobre las poblaciones y el ambiente, sin embargo se registran datos objetivables, sobre todo en los países en desarrollo. En esta revisión se destacan aspectos generales y particulares de los residuos y contaminantes organoclorados, organofosforados, antibióticos, metales pesados, bifenilos policlorados, dioxinas y furanos, valores de sus contenidos, efectos tóxicos estudiados y los límites máximos permitidos por las legislaciones internacionales.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[The contamination of human milk by xenobiotics is a common problem worldwide which is affected by the geographical, climate-related, cultural and socioeconomic variations in each individual location. Public health policies have dealt with this situation by means of ongoing monitoring and restrictive legislation in order to reduce the damaging effects on the populations and the environment, objectivatable data however being recorded particularly in the developing countries. Overall and individual aspects of waste and contaminating oganochlorines, organophosphorates, antibiotics, polychlorate biphenyls, dioxins and furans, their content values, toxic effects studies and the maximum limits permitted under international legislation are highlighted.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Contaminación ambiental]]></kwd>
<kwd lng="es"><![CDATA[Residuos]]></kwd>
<kwd lng="es"><![CDATA[Toxicidad]]></kwd>
<kwd lng="es"><![CDATA[Lactancia]]></kwd>
<kwd lng="en"><![CDATA[Environmental pollution]]></kwd>
<kwd lng="en"><![CDATA[Waste products]]></kwd>
<kwd lng="en"><![CDATA[Toxicity]]></kwd>
<kwd lng="en"><![CDATA[Lactation]]></kwd>
</kwd-group>
</article-meta>
</front><body><![CDATA[   <B>    <P>Colaboraci&oacute;n especial</P>     <P>&nbsp;</P> <FONT SIZE=4>    <P ALIGN="CENTER">Presencia de residuos y contaminantes en leche humana</P> </FONT>    <P>&nbsp;</P>     <P>Guadalupe Prado Flores (1), Rita Carabias Mart&iacute;nez (2), Encarna Rodr&iacute;guez Gonzalo (2) y Eliseo Herrero Hern&aacute;ndez (2).</B>    <BR> <FONT SIZE=2>(1) Departamento de Producci&oacute;n Agr&iacute;cola y Animal. Universidad Aut&oacute;noma Metropolitana-Xochimilco, M&eacute;xico.    <BR> (2) Departamento de Qu&iacute;mica Anal&iacute;tica, Nutrici&oacute;n y Bromatolog&iacute;a, Facultad de Qu&iacute;mica, Universidad de Salamanca, Espa&ntilde;a.</P>     <P>Correspond&ecirc;ncia:    <BR> Guadalupe Prado Flores    ]]></body>
<body><![CDATA[<BR> Depatamento de Producci&oacute;n Agr&iacute;cola y Animal    <BR> Universidad Aut&oacute;noma Metropolitana-Xochimilco    <BR> Calzada del Hueso 1100    <BR> CP 04960 Ciudad de Mexico. M&eacute;xico    <BR> Correo electr&oacute;nico: </FONT><A HREF="mailto:gprado@cueyatl.uam.mx"><FONT SIZE=2>gprado@cueyatl.uam.mx</FONT></A></P>     <P>&nbsp;</P>     <P>&nbsp;</P>     <P><HR></P> <TABLE CELLSPACING=0 BORDER=0 CELLPADDING=2 WIDTH=624> <TR><TD WIDTH="48%" VALIGN="TOP">     <P ALIGN="CENTER"><B>RESUMEN</P> </B>    <P>La contaminaci&oacute;n de la leche humana por xenobi&oacute;ticos es un problema generalizado a nivel mundial, que se ve afectado por las variaciones geogr&aacute;ficas, clim&aacute;ticas, culturales y socioecon&oacute;micas de cada lugar. Las pol&iacute;ticas de salud p&uacute;blica han enfrentado la situaci&oacute;n mediante una vigilancia sostenida y legislaciones restrictivas con el objeto de reducir los efectos perjudiciales sobre las poblaciones y el ambiente, sin embargo se registran datos objetivables, sobre todo en los pa&iacute;ses en desarrollo. En esta revisi&oacute;n se destacan aspectos generales y particulares de los residuos y contaminantes organoclorados, organofosforados, antibi&oacute;ticos, metales pesados, bifenilos policlorados, dioxinas y furanos, valores de sus contenidos, efectos t&oacute;xicos estudiados y los l&iacute;mites m&aacute;ximos permitidos por las legislaciones internacionales.</P> <B>    ]]></body>
<body><![CDATA[<P>Palabras clave: </B>Contaminaci&oacute;n ambiental. Residuos. Toxicidad. Lactancia.</TD> <TD WIDTH="4%" VALIGN="MIDDLE">     <P>&nbsp;</TD> <TD WIDTH="48%" VALIGN="TOP"> <B>    <P ALIGN="CENTER">ABSTRACT</P>     <P ALIGN="CENTER">Waste and pollutants in human milk</P> </B>    <P>The contamination of human milk by xenobiotics is a common problem worldwide which is affected by the geographical, climate-related, cultural and socioeconomic variations in each individual location.</P>     <P>Public health policies have dealt with this situation by means of ongoing monitoring and restrictive legislation in order to reduce the damaging effects on the populations and the environment, objectivatable data however being recorded particularly in the developing countries. Overall and individual aspects of waste and contaminating oganochlorines, organophosphorates, antibiotics, polychlorate biphenyls, dioxins and furans, their content values, toxic effects studies and the maximum limits permitted under international legislation are highlighted.</P> <B>    <P>Key words: </B>Environmental pollution. Waste products. Toxicity. Lactation.</TD> </TR> </TABLE>      <P><HR></P>     <P>&nbsp;</P>     <P>&nbsp;</P> <B>    ]]></body>
<body><![CDATA[<P ALIGN="CENTER">INTRODUCCI&Oacute;N</P> </B>    <P>Por ser la leche humana el alimento id&oacute;neo para el neonato, es fundamental analizar su inocuidad y reconocer numerosos informes que refieren la presencia de residuos y contaminantes en la misma<SUP>1-9</SUP>. Entre las m&uacute;ltiples causas de esta presencia se pueden citar las condiciones actuales del progreso en las actividades agr&iacute;colas y veterinarias, la industrializaci&oacute;n, el aumento de basura y su tratamiento, las explotaciones mineras, el control de plagas y/o enfermedades end&eacute;micas y la cadena productiva de los alimentos. Todo ello y sus interacciones con los factores geogr&aacute;ficos, clim&aacute;ticos y sociales configura un complejo panorama que incide sobre la salud.</P>     <P>Es por eso que las administraciones nacionales e internacionales han hecho referencia muy enf&aacute;tica en el sentido de identificar estos componentes, de cumplimentar y homogeneizar los m&eacute;todos de an&aacute;lisis de los mismos, de estudiar los efectos que pueden hacerse manifiestos en diversos organismos y de generar las estrategias para reducir su uso<SUP>10</SUP>.</P>     <P>En 1971, la Federaci&oacute;n Internacional de Lecher&iacute;a consult&oacute; a los expertos sobre la identidad de los compuestos m&aacute;s peligrosos y prevaleci&oacute; el contenido de los plaguicidas organoclorados en leche y sus derivados; treinta a&ntilde;os despu&eacute;s, su uso ha declinado pero su presencia permanece como, lo demuestra la literatura en el campo. En la actualidad se tiene amplia informaci&oacute;n y definici&oacute;n de los xenobi&oacute;ticos, considerando residuos a los remanentes de plaguicidas y medicamentos de uso veterinario y se reconocen como contaminantes los metales pesados, las micotoxinas, las nitrosaminas, los bifenilos policlorados, y las dioxinas y los furanos policlorados. Los residuos provienen de aplicaciones que tienden a resolver problemas en la producci&oacute;n de los alimentos, ya sea en la protecci&oacute;n de los cultivos, en el control de factores bi&oacute;ticos y abi&oacute;ticos adversos, con fines profil&aacute;cticos, terape&uacute;ticos, o manejo de ectopar&aacute;sitos. Los contaminantes son sustancias presentes de modo no intencional y fuera de control<SUP>11</SUP>.</P>     <P>Los residuos y contaminantes presentes en la leche abarcan los grupos de plaguicidas, antibi&oacute;ticos, sulfonamidas, nitrofuranos, fasciolicidas, metales pesados, micotoxinas, bifenilos policlorados, dibenzo-p-dioxinas y dibenzofuranos policlorados. nitratos nitritos, nitrosaminas, detergentes y desinfectantes. En esta revisi&oacute;n y de este amplio panorama, se seleccionan los derivados m&aacute;s abundantes o los m&aacute;s estudiados por sus efectos perniciosos.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">PLAGUICIDAS ORGANOCLORADOS</P> </B>    <P>Se ha calculado que en los &uacute;ltimos 25 a&ntilde;os se han aplicado 20.000 millones de libras de insecticidas sobre el planeta y de ellos 3 mil millones han sido de DDT<SUP>12</SUP>. Las estad&iacute;sticas han estimado que en M&eacute;xico, en la d&eacute;cada de los 70', el 1% de la producci&oacute;n mundial de DDT fue utilizado en el cultivo de algod&oacute;n<SUP>13</SUP> y que su uso es el mayor en Latinoam&eacute;rica<SUP>14</SUP>. En Uganda en 1996 se emplearon 80 toneladas de DDT/a&ntilde;o, 392 toneladas de dieldr&iacute;n /a&ntilde;o para proteger el pl&aacute;tano y 30 ton/a&ntilde;o en el combate de la mosca ts&eacute;-ts&eacute;<SUP>15</SUP>.</P>     <P>Actualmente ha disminuido su utilizaci&oacute;n gracias a las directrices legislativas de muchos pa&iacute;ses; Canad&aacute; prohibi&oacute; el uso del DDT desde 1969, Suecia en 1970; Espa&ntilde;a en 1977 y Turqu&iacute;a lo restringi&oacute; en 1983<SUP>8</SUP>. La Uni&oacute;n Europea elimin&oacute; el uso del endr&iacute;n mediante la norma 79/117/CEE y 91/188/CEE. Suecia<SUP>9</SUP>, Alemania<SUP>16</SUP> y otros pa&iacute;ses europeos han disminuido entre 9 y 13% las concentraciones de arom&aacute;ticos cada a&ntilde;o a partir de la prohibici&oacute;n de su uso y se ha valorado entre el 11 y el 14% la disminuci&oacute;n de los mencionados compuestos en Canad&aacute; y Estados Unidos<SUP>8</SUP>; sin embargo, pa&iacute;ses de la franja tropical participan activamente en la contaminaci&oacute;n mundial<SUP>17-23</SUP>.</P>     <P>Entre los plaguicidas organoclorados derivados del hexaclorociclohexano (HCH), de los ciclodi&eacute;nicos y los arom&aacute;ticos, el <FONT FACE=Symbol>b</FONT>-HCH, el ep&oacute;xido de heptacloro y el DDE han sido considerados los m&aacute;s persistentes por sus caracter&iacute;sticas moleculares y metab&oacute;licas. Algunos de ellos sufren biotransformaciones dentro de los organismos vivos y se convierten en productos que aumentan su capacidad t&oacute;xica; es el caso de aldr&iacute;n y heptacloro que se convierten en dieldr&iacute;n y en ep&oacute;xido de heptacloro respectivamente; los is&oacute;meros <FONT FACE=Symbol>a</FONT> y <FONT FACE=Symbol>g</FONT>-HCH se transforman en el derivado <FONT FACE=Symbol>b</FONT>-HCH y el DDT se metaboliza formando DDE y DDD, &eacute;stos, a su vez pueden formar derivados metilsulfonados de mayor toxicidad<SUP>24-25</SUP>. Su contenido de cloro les confiere poca polaridad, por lo tanto son insolubles en agua; el DDE manifiesta un log K<SUB>ow</SUB> 5,83<SUP>26</SUP> y no se excreta f&aacute;cilmente por v&iacute;a urinaria sino que se acumula en el tejido adiposo. En la etapa de lactancia se movilizan a la leche y &eacute;sta es la v&iacute;a preferente de eliminaci&oacute;n en los mam&iacute;feros femeninos<SUP>27-31</SUP>.</P>     ]]></body>
<body><![CDATA[<P>Dichas estructuras qu&iacute;micas son muy estables, se degradan poco y por esta raz&oacute;n permanecen intactas por largos per&iacute;odos; se ha calculado que la vida media del dieldr&iacute;n es de 6 a&ntilde;os, para el DDT de 16 a 20 a&ntilde;os en el suelo y en sedimentos de r&iacute;os puede alcanzar 46 a&ntilde;os, motivo por el cual se considera a los organoclorados como persistentes.</P>     <P>Los estudios realizados evidencian que en la leche humana se encuentran los plaguicidas organoclorados y que su contenido se ve influenciado por factores de la madre, como la edad<SUP>32-33</SUP>, origen<SUP>34</SUP>, n&uacute;mero de lactancia<SUP>35-36</SUP>, meses de lactancia<SUP>37-38</SUP> y h&aacute;bitos alimenticios<SUP>39-41</SUP>.</P> <B>    <P>Efectos t&oacute;xicos</P> </B>    <P>Los estudios epidemiol&oacute;gicos y toxicol&oacute;gicos han registrado los efectos siguientes para el DDT: a) Inducci&oacute;n enzim&aacute;tica de las oxidasas microsomales mediadas por el citocromo P450 (CYP)<SUP>42-43</SUP>; b) Aumento de las lipasas, de la transaminasa glut&aacute;mica y bloqueo de la ATPasa; c) Modificaci&oacute;n del metabolismo lip&iacute;dico y transporte de la vitamina A y glucosa; d) Efecto sobre el potencial de acci&oacute;n de los canales de sodio y cloro en neurona, e) Alteraci&oacute;n en la s&iacute;ntesis de hormonas esteroidales<SUP>44-45</SUP>. Tienen efecto sobre el metabolismo hep&aacute;tico, da&ntilde;an el patr&oacute;n renal y las g&oacute;nadas<SUP>10</SUP>. En los sistemas muy oxigenados pueden generar radicales libres de alta reactividad, que son disparadores de peroxidaci&oacute;n de membrana. Las mol&eacute;culas electrof&iacute;licas producidas en su metabolismo se unen f&aacute;cilmente con proteinas y &aacute;cidos nucleicos que son nucleof&iacute;licas y forman aductos<SUP>46</SUP>.</P>     <P>Las manifestaciones macrosc&oacute;picas de los transtornos gen&eacute;ticos o metab&oacute;licos de los xenobi&oacute;ticos clorados son la mutag&eacute;nesis, teratog&eacute;nesis, carcinog&eacute;nesis, neurotoxicidad, alteraciones inmunol&oacute;gicas, as&iacute; como irritabilidad, alergias, problemas de sue&ntilde;o y conductuales<SUP>47-51</SUP>. El DDT es hepatocarcinog&eacute;nico en rat&oacute;n seg&uacute;n datos de la Agencia Internacional de Investigaci&oacute;n en C&aacute;ncer (IARC). Manifiesta cualidades estrog&eacute;nicas y por esta raz&oacute;n se ha vinculado con el c&aacute;ncer mamario dependiente de s&iacute;ntesis hormonal<SUP>52-53</SUP>, con abortos espont&aacute;neos<SUP>54</SUP>, disminuci&oacute;n de la duraci&oacute;n de lactancia<SUP>55</SUP> y bajo peso al nacer<SUP>39</SUP>. Un meta-an&aacute;lisis retrospectivo sobre salud reproductiva analiz&oacute; una poblaci&oacute;n de 14.947 hombres normales en la cual se hicieron estimaciones de actividad esperm&aacute;tica y se le ha vinculado con el aumento de c&aacute;ncer testicular<SUP>45</SUP>. Frente a esta carga de alta agresividad, otros estudios presentan controversia con esas conclusiones<SUP>56-59</SUP>.</P>     <P>El lindano es un agente androg&eacute;nico con efectos mutag&eacute;nicos; en c&eacute;lulas de Leydig de rata inhibe esteroidog&eacute;nesis<SUP>60</SUP> y favorece la peroxidaci&oacute;n de l&iacute;pidos de membrana microsomal y de mitocondria en h&iacute;gado y coraz&oacute;n de <I>Columbia livia</I><SUP>61</SUP>. El dieldr&iacute;n induce hepatocarcinog&eacute;nesis, proliferaci&oacute;n celular y apoptosis en h&iacute;gado de roedores<SUP>62</SUP>. El metoxicloro tiene efectos sobre sistemas reproductivos en desarrollo<SUP>63</SUP>.</P>     <P>Los mencionados disruptores endocrinos han manifestado capacidad de alterar procesos tan vulnerables como la neurog&eacute;nesis, migraci&oacute;n, sinaptog&eacute;nesis, gliog&eacute;nesis y mielinizaci&oacute;n<SUP>64</SUP> en la vida silvestre; han provocado des&oacute;rdenes en la fauna, alterando el equilibrio entre g&eacute;nero de diversos organismos, aumentando las poblaciones femeninas<SUP>65-67</SUP>. Investigaciones recientes han estudiado los puntos cr&iacute;ticos donde estos compuestos pueden participar alterando respuestas de gl&aacute;ndulas sexuales, tiroides y suprarrenales modificando la homeostasis y la funcionalidad de los organismos en procesos como ovulaci&oacute;n<SUP>68</SUP>, desarrollo neuronal<SUP>69</SUP> y metabolismo energ&eacute;tico<SUP>70</SUP>.</P>     <P>En la actualidad, se realizan estudios de residuos organoclorados pr&aacute;cticamente en todo el mundo<SUP>9,16,18,33,57,71-75</SUP> y se ratifica que ni los lugares m&aacute;s rec&oacute;nditos del planeta han escapado a la presencia de estas sustancias. Tambi&eacute;n se ha reconocido que son capaces de cruzar la barrera placentaria e ingresar al torrente circulatorio del feto<SUP>67,76</SUP>. Ya que la leche humana est&aacute; m&aacute;s contaminada que la leche vacuna<SUP>5,77</SUP>, que el calostro registra mayor carga residual que la leche madura<SUP>27,78-79</SUP>, se aprecia que las ventajas nutritivas e inmunol&oacute;gicas de la alimentaci&oacute;n materna sufren un evidente deterioro.</P>     <P>Adicionalmente a la influencia del medio sobre los lactantes, la carga t&oacute;xica se ve aumentada con la presencia de organoclorados persistentes que est&aacute;n espec&iacute;ficamente en la leche humana y que el reci&eacute;n nacido recibe en condici&oacute;n de m&aacute;xima vulnerabilidad ya que sus sistemas desintoxicantes no est&aacute;n maduros.</P>     <P>Ante la peligrosidad de estos xenobi&oacute;ticos, se ha pronunciado la FAO/OMS recomendando que no se sobrepasen las concentraciones de seguridad llamadas l&iacute;mite m&aacute;ximo de residuos, LMR<SUP>11</SUP>, par&aacute;metro vinculado con la leche vacuna o la ingesta diaria admisible, IDA, para la leche humana. En ocasiones las administraciones nacionales regulan sus propios l&iacute;mites, prohibiendo el uso de ciertos compuestos y restringiendo otros. Se presentan en la <A HREF="#tab01">tabla 1</A>, los LMR e IDAs prescritos para la leche por los Organismos de Naciones Unidas.</P>     ]]></body>
<body><![CDATA[<P><A NAME="tab01"></A></P>     <P>&nbsp;</P>     <P ALIGN="CENTER"><IMG SRC="/img/fbpe/resp/v76n2/a07tab01.gif"></P>     
<P>&nbsp;</P> <B>    <P ALIGN="CENTER">PLAGUICIDAS ORGANOFOSFORADOS Y CARBAMATOS</P> </B>    <P>El mayor uso de estas sustancias est&aacute; asociado a la actividad agr&iacute;cola. En 1992, su volumen de importaciones en M&eacute;xico se calcul&oacute; en 60 mil toneladas y en los tres a&ntilde;os siguientes se duplic&oacute;<SUP>80</SUP>. Estos plaguicidas son relativamente poco persistentes y biodegradables, lo que implica que sea necesario aplicarlos con m&aacute;s frecuencia para lograr una protecci&oacute;n eficiente. Los plaguicidas organofosforados provienen de diferentes estructuras qu&iacute;micas, como el parati&oacute;n, que se origina del &aacute;cido fosforoti&oacute;nico o el dicloros del &aacute;cido fosf&oacute;rico.</P>     <P>Su metabolismo se caracteriza por inhibir la acetilcolinesterasa. Esta inhibici&oacute;n producida en el sistema nervioso, propicia una acumulaci&oacute;n de acetilcolina end&oacute;gena, con los consecuentes signos y s&iacute;ntomas que mimetizan los efectos muscar&iacute;nicos y nicot&iacute;nicos del sustrato, as&iacute; como los que la enzima produce. Al no permitir la degradaci&oacute;n de este neurotransmisor el impulso nervioso no se transmite y provoca serias alteraciones<SUP>81-82</SUP>.</P>     <P>Los organofosforados han sido vinculados con diversos s&iacute;ndromes y recientemente con la enfermedad de Parkinson<SUP>83-84</SUP>. La participaci&oacute;n de factores ambientales en la etiolog&iacute;a de este padecimineto fue propuesta a ra&iacute;z del descubrimiento del da&ntilde;o neurol&oacute;gico provocado por la N-metil,4-fenil-1,2,3,6-tetrahidro piridina (MPTP). El hallazgo propici&oacute; un modelo de estudio y la consecuente investigaci&oacute;n epidemiol&oacute;gica ha sugerido que existe una asociaci&oacute;n positiva entre la enfermedad de Parkinson y la exposici&oacute;n a plaguicidas organofosforados.</P>     <P>Se considera que estos compuestos estimulan las enfermedades infecciosas<SUP>85</SUP>, sobre todo del tracto respiratorio y se ha encontrado que la leucemia linfoc&iacute;tica cr&oacute;nica es mayor en sujetos expuestos a plaguicidas organofosforados, especialmente crotoxifos, diclorvos y fampur<SUP>86</SUP> bajo exposiciones agudas, mientras que el conocimiento de los efectos cr&oacute;nico de los plaguicidas organofosforados es muy limitado e igualmente lo son sus efectos a plazos largos.</P>     <P>El metabolismo de los organofosforados sucede en dos procesos b&aacute;sicos: la activaci&oacute;n y la degradaci&oacute;n. En la fase de activaci&oacute;n, los compuestos que en su estado inicial son d&eacute;biles inhibidores de la acetilcolinesterasa son metabolizados por las enzimas microsomales a compuestos intermediarios t&oacute;xicos con elevada actividad sobre la enzima. Estos intermediarios, posteriormente, son sujetos a una degradaci&oacute;n mediante hidr&oacute;lisis y se eliminan como compuestos at&oacute;xicos o menos t&oacute;xicos. Investigadores espa&ntilde;oles<SUP>87-88</SUP> han informado sobre la quiralidad del O-hexil,O-2,5 diclorofenilfosforamidato (HDCP), que es un an&aacute;logo del insecticida metamidofos, el cual causa neuropat&iacute;a en la gallina, evidenciando que la caracter&iacute;stica de quiralidad es decisiva en su toxicidad.</P>     ]]></body>
<body><![CDATA[<P>Los carbamatos son derivados de &eacute;steres del &aacute;cido carb&aacute;mico e inhibidores directos de la acetilcolinesterasa y por lo tanto no requieren del paso de la activaci&oacute;n. Se hidrolizan rompiendo la funci&oacute;n &eacute;ster y se excretan en forma de conjugados<SUP>89</SUP>. Las fuentes de contaminaci&oacute;n de estos plaguicidas son semejantes a las de los organoclorados; algunos de ellos presentan efectos sist&eacute;micos y por esta raz&oacute;n adquieren importancia en el control de larvas de ectopar&aacute;sitos en los animales.</P>     <P>Algunos plaguicidas de este grupo manifiestan una toxicidad superior a la de los organoclorados y pueden aparecer en leche despu&eacute;s de ser ingeridos por v&iacute;a oral, por lo que tiene especial importancia el establecimiento de sus LMR que se presentan en la <A HREF="#tab02">tabla 2</A>.</P>     <P><A NAME="tab02"></A></P>     <P>&nbsp;</P>     <P ALIGN="CENTER"><IMG SRC="/img/fbpe/resp/v76n2/a07tab02.gif"></P>     
<P>&nbsp;</P>     <P>Las principales clases de plaguicidas responsables de envenenamientos agudos en ciertos pa&iacute;ses en desarrollo son los insecticidas organofosforados. En China<SUP>71</SUP> se han calculado 78,8%, en Sri Lanka 69,1% y 53,6% en Malasia. La OMS ha dado datos de 3 millones de envenenamientos agudos por a&ntilde;o, de los cuales 220.000 son mortales; el 99% sucede en pa&iacute;ses en v&iacute;as de desarrollo. En Latinoam&eacute;rica, la mayor&iacute;a de los casos responde a actividades ocupacionales.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">MEDICAMENTOS DE USO VETERINARIO</P> </B>    <P>Despu&eacute;s de la administraci&oacute;n de un tratamiento veterinario aparecen residuos de los productos empleados en los alimentos y por lo tanto en la leche. Los posibles peligros para la salud a causa de estos residuos pueden ser t&oacute;xicos, microbiol&oacute;gicos e inmunopatol&oacute;gicos<SUP>90</SUP>. Se ha demostrado que los residuos de medicamentos o productos qu&iacute;micos empleados pueden presentar efectos como alergias, hipersensibilidad o ser mutag&eacute;nicos, teratog&eacute;nicos y/o carcinog&eacute;nicos.</P>     ]]></body>
<body><![CDATA[<P>Cada vez es mayor el n&uacute;mero de casos en que los medicamentos que son considerados eficaces en un tratamiento dejan de responder repentinamente a las expectativas generadas por una experiencia cl&iacute;nica anterior. La raz&oacute;n de este fen&oacute;meno es la aparici&oacute;n de resistencia a los medicamentos de microorganismos pat&oacute;genos de los animales al hombre<SUP>91-92</SUP>. Muchos microorganismos pat&oacute;genos, como la salmonella, adquieren resistencia m&uacute;ltiple al ser sometidos a bajas concentraciones de antibi&oacute;ticos, lo cual representa un serio peligro potencial para el ser humano. Los cultivos iniciadores empleados en la producci&oacute;n de derivados l&aacute;cteos fermentados, como el queso y yogurt, son extremadamente sensibles a bajas concentraciones de antibi&oacute;ticos en la leche.</P>     <P>Las penicilinas, de las cuales se han identificado cuarenta especies, pertenecen al grupo de los antibi&oacute;ticos betalact&aacute;micos. Unas son naturales y otras son parcial o totalmente sint&eacute;ticas. En el tratamiento de la mastitis se administra la penicilina tanto por v&iacute;a intramamaria como parenteral, ya que algunos casos de mastitis bovina requieren un tratamiento general con f&aacute;rmacos antimicrobianos, en lo que reside otra posibilidad de generar residualidad en la leche. Un ejemplo del grado de afectaci&oacute;n que puede representar el tratamiento con penicilina para el procesamiento industrial refiere que un tratamiento con 200 mg de penicilina G es capaz de contaminar la leche de 8.000 vacas<SUP>93</SUP>.</P>     <P>Las tetraciclinas se llaman antibi&oacute;ticos de amplio espectro porque muestran el amplio rango de actividad antibacteriana de la penicilina, la estreptomicina y el cloranfenicol y, en general, son consideradas como bacteriost&aacute;ticas. Los residuos de las tetraciclinas se registran en la leche en concentraciones relativamente elevadas.</P>     <P>Entre los aminoglic&oacute;sidos, se encuentran la estreptomicina, la gentamicina, la neomicina y su efecto est&aacute; basado en que detienen la s&iacute;ntesis proteica bacteriana y son activos contra especies gram negativas.</P>     <P>El cloranfenicol tiene un gran espectro de actividad contra ricketsias, bacterias gram positivas y gram negativas y es m&aacute;s activo que la penicilina y la estreptomicina. Ha sido usado ampliamente por v&iacute;a oral y parenteral en el tratamiento de infecciones urinarias, mastitis, salmonelosis aguda y otras infecciones resistentes a otros antibi&oacute;ticos. La prohibici&oacute;n de su uso en muchos pa&iacute;ses<SUP>94</SUP> tiene origen en su propiedad de producir en los humanos una reacci&oacute;n adversa fatal, la anemia apl&aacute;stica, aun en concentraciones subterap&eacute;uticas. Por esta raz&oacute;n, su uso ha decrecido notablemente. Algunos valores de concentraci&oacute;n m&aacute;xima de antibi&oacute;ticos permisibles en leche se muestran en la <A HREF="#tab03">tabla 3</A>.</P>     <P><A NAME="tab03"></A></P>     <P>&nbsp;</P>     <P ALIGN="CENTER"><IMG SRC="/img/fbpe/resp/v76n2/a07tab03.gif"></P>     
<P>&nbsp;</P>     <P>Las sulfonamidas y los nitrofuranos son empleados frecuentemente en muchos n&uacute;cleos de productividad lechera y se les encuentra en la leche despu&eacute;s de su aplicaci&oacute;n. Manifiestan igualmente, efectos indeseables a la salud<SUP>93</SUP>.</P>     ]]></body>
<body><![CDATA[<P>&nbsp;</P> <B>    <P ALIGN="CENTER">MICOTOXINAS</P> </B>    <P>Las micotoxinas se definen como metabolitos de los hongos que producen cambios patol&oacute;gicos en el hombre y en los animales. Los efectos biol&oacute;gicos demostrados en animales de laboratorio los muestran como t&oacute;xicos agudos, mutag&eacute;nicos, carcinog&eacute;nicos, teratog&eacute;nicos, alucin&oacute;genos, em&eacute;ticos y estrog&eacute;nicos. Los productos m&aacute;s susceptibles de contaminarse con las micotoxinas son los perecederos. Esta presencia puede originarse en la contaminaci&oacute;n del ganado, como es el caso de la leche donde se encuentra la M<SUB>1</SUB>, el metabolito l&aacute;cteo de la aflatoxina B<SUB>1</SUB>. Las aflatoxinas B<SUB>1</SUB> y B<SUB>2</SUB> son producidas por los hongos <I>Aspergillus flavus y Aspergillus</I> <I>parasiticus.</I> Las aflatoxinas M<SUB>1</SUB> y M<SUB>2</SUB> son los derivados 4-hidroxilados de las B<SUB>1</SUB> y B<SUB>2</SUB> respectivamente<SUP>94</SUP>. Los estudios de toxicidad revelan que las aflatoxinas M<SUB>1</SUB> y M<SUB>2</SUB> tienen una DL<SUB>50</SUB> de 12-16 µg para los animales estudiados, que da&ntilde;an el h&iacute;gado y producen necrosis en los t&uacute;bulos renales. La M<SUB>1</SUB> es letal en ratas macho a una sola dosis de 1,5 mg/kg de peso corporal, manifestando una disociaci&oacute;n de los ribosomas del ret&iacute;culo endopl&aacute;smico rugoso de las c&eacute;lulas de par&eacute;nquima hep&aacute;tico y una proliferaci&oacute;n del ret&iacute;culo endopl&aacute;smico liso.</P>     <P>Estudios hechos en ratas tratadas con 25 µg de M<SUB>1</SUB> por d&iacute;a y bajo entubamiento por 5 d&iacute;as a la semana durante ocho semanas consecutivas, desarrollaron carcinoma hep&aacute;tico en tres animales, mientras que 28 de ellos tuvieron lesiones preneopl&aacute;sicas<SUP>95</SUP>.</P>     <P>Otras micotoxinas estudiadas son la esterigmatocistina, la ocratoxina A, el &aacute;cido ciclopiaz&oacute;nico, el &aacute;cido micofen&oacute;lico y la patulina, todas ellas de alta peligrosidad y producidas por diferentes especies y presentes en variados productos alimenticios; pero es la M<SUB>1</SUB> selectiva de la leche. El registro de sustancias peligrosas o francamente t&oacute;xicas no es exclusivo de la leche; la zearalenona, como el clembuterol y otros muchos compuestos con frecuencia se encuentran en alimentos como carnes, huevo, cereales, oleaginosas etc., lo cual describe un panorama m&aacute;s amplio.</P>     <P>Se ha propuesto un nivel de tolerancia para las aflatoxinas en la leche de 0,05-0,5 <FONT FACE=Symbol>m</FONT>g/kg para adultos, disminuyendo a la mitad para los ni&ntilde;os. Sin embargo, algunos pa&iacute;ses han sido m&aacute;s estrictos; en Dinamarca se estima que la ingesta diaria de M<SUB>1</SUB> es de 0,22 ng/kg de peso/d&iacute;a, lo que significa bajo este modelo dan&eacute;s, la muerte de cinco individuos por un mill&oacute;n de ellos<SUP>4</SUP>.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">BIFENILOS POLICLORADOS</P> </B>    <P>Son sustancias usadas desde 1929 en la industria. Son termoestables, resistentes a la oxidaci&oacute;n, a los &aacute;cidos, a las bases y a otros agentes qu&iacute;micos, insolubles en agua, todo lo cual los hace muy &uacute;tiles en la vida moderna, emple&aacute;ndose como plastificantes, en resinas sint&eacute;ticas, pinturas, barnices, ceras, fluidos hidr&aacute;ulicos, lubricantes en equipos sometidos a presiones extremas, medios de transferencia de calor y en componentes el&eacute;ctricos y electr&oacute;nicos. Tambi&eacute;n se usan con algunos plaguicidas para aumentar su efectividad, como es el caso que 5-25% de bifenilos policlorados (PCBs) adicionados al lindano, lo hacen diez veces m&aacute;s efectivo<SUP>96</SUP>. Las estad&iacute;sticas han se&ntilde;alado que solamente en Estado Unidos se produjeron 1,5 billones de libras de PCBs y Suecia en 1970 import&oacute; 500 toneladas<SUP>97</SUP>. Se les encuentra en organismos y en alimentos en un nivel de biomagnificaci&oacute;n elevada<SUP>39,98</SUP>. Investigadores canadienses revisaron la presencia de organoclorados en El &Aacute;rtico y encontraron que los abor&iacute;genes de Groenlandia, cuya dieta es a base de productos de mam&iacute;feros marinos, tienen la m&aacute;s alta concentraci&oacute;n de PCBs, DDE y clordano. Derivados metilsulfonados de estos policlorobifenilos se han registrado en delfines y focas, de modo que es evidente que los individuos alimentados con estos animales acumulan selectivamente en pulm&oacute;n y &uacute;tero derivados a&uacute;n m&aacute;s toxicos<SUP>24</SUP>. En la leche se les localiza y su fuente primaria es la contaminaci&oacute;n del ganado; otras causas de contaminaci&oacute;n son la pintura en los silos, aceites de desecho y hasta la tinta de empaques de alimentos. Su estructura qu&iacute;mica responde a una alta lipofilicidad y se disuelven en la grasa de la leche, elimin&aacute;ndose por la misma.</P>     <P>En Suecia han estudiado la presencia de los &eacute;teres de los polibromodifenilos (PBDEs) que tienen usos semejantes a los PCBs, habi&eacute;ndoseles en peces, mam&iacute;feros y humanos; su eliminaci&oacute;n es muy lenta y tambi&eacute;n se transfieren por la leche. Su consumo ha aumentado de 0,72 ng/g base lip&iacute;dica en 1984/85 a 4,01 ng/g en 1997<SUP>99,25</SUP>. Su exposici&oacute;n en 30 a&ntilde;os se ha incrementado 6 veces, lo cual ha expresado grave preocupaci&oacute;n en las comunidades cient&iacute;ficas.</P>     ]]></body>
<body><![CDATA[<P>Un informe en Estados Unidos, en 1970, encontr&oacute; niveles promedio de PCBs en quesos de 0,25 mg/kg y 2,27 mg/kg en leche. En Noruega entre 1970 y 1972 hallaron 0,01 a 0,08 mg/kg en mantequilla y en 1973 las muestras de leche suiza analizada no excedieron en promedio 0,01 mg/kg. En mantequilla danesa encontraron 24,7 <FONT FACE=Symbol>m</FONT>g/kg medidos por cromatograf&iacute;a de gases con columnas capilares y las mantequillas de Islandia las encontraron libres de estos compuestos para el per&iacute;odo de 1968 a 1982<SUP>96</SUP>. En Jap&oacute;n detectaron 5,5 ng/g en la leche entera; los ni&ntilde;os alimentados con leche humana ingirieron de 100 a 530 pg/kg equivalentes t&oacute;xicos (TEQ), de los cuales por lo menos el 60% se atribuye a PCBs coplanares<SUP>105</SUP>.</P>     <P>Se asume que el mecanismo de toxicidad es diferente para los miembros de la familia de los PCBs que agrupa 209 compuestos; los m&aacute;s clorados son t&oacute;xicos simplemente por su presencia en los tejidos, los menos clorados, por participar en rutas metab&oacute;licas determinadas y han reconocido derivados metilsulfon&iacute;licos a&uacute;n m&aacute;s t&oacute;xicos que los PCBs originales<SUP>25</SUP>. La toxicidad de los mismos es selectiva de la especie donde se encuentre, probablemente como resultado de diversas estructuras fisiol&oacute;gicas o velocidades metab&oacute;licas y su permanencia en el ambiente es tambi&eacute;n diferente. Por ejemplo el CB-153 tiene una vida media de 17 a&ntilde;os, el CB-118 de 11 a&ntilde;os y los derivados sulfon&iacute;licos MeSO<SUB>2</SUB>-PCBs de 9 a&ntilde;os<SUP>25</SUP>. El estudio global de estas sustancias puede generar confusiones ya que cada uno de los cong&eacute;neres tiene diferencias en diversos comportamientos.</P>     <P>Los efectos nocivos de estas sustancias son edema, dificultad respiratoria, reducci&oacute;n en la ganancia de peso, heridas internas, aumento de tama&ntilde;o del h&iacute;gado, cambios en las caracter&iacute;sticas sexuales. Algunos de estos s&iacute;ntomas se aprecian a concentraciones de 20 mg/kg de PCBs en los alimentos<SUP>2</SUP>. Las enfermedades ocupacionales de trabajadores japoneses expuestos a PCBs se&ntilde;alan hepatocarcinogenicidad y cambios neopl&aacute;sicos<SUP>97,70</SUP> han presentado evidencias de los efectos de cong&eacute;neres de PCBs que afectan el desarrollo cerebral fetal humano, consider&aacute;ndolos disruptores endocrinos. Los metabolitos hidroxilados que se han identificado en la leche de vaca son descritos varias veces m&aacute;s t&oacute;xicos que sus precursores.</P>     <P>Se ha reglamentado la concentraci&oacute;n de PCBs en funci&oacute;n del alto consumo de leche sobre todo de infantes, ni&ntilde;os en crecimiento y personas enfermas y que se pueden presentar intoxicaciones cr&oacute;nicas por su presencia; Ewers en 1987<SUP>96</SUP> encontr&oacute; un m&aacute;ximo nivel de 45 µg por semana en adulto de 70 kg de peso sin efectos notables. La legislaci&oacute;n de la Uni&oacute;n Europea en 1999 adopt&oacute; temporalmente como medida precautoria 0,01 mg/kg de peso corporal para plaguicidas individuales en alimentos para infantes y ni&ntilde;os. Para los m&aacute;s t&oacute;xicos estableci&oacute; 0,0005 mg/kg de peso corporal<SUP>98</SUP>.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">DIBENZO-<I>p</I>-DIOXINAS Y DIBENZOFURANOS POLICLORADOS</P> </B>    <P>Las dioxinas son sustancias altamente t&oacute;xicas y han sido dispersadas en el ambiente en forma indiscriminada. Se les encuentra como impurezas en ciertos compuestos como el «agente naranja» ampliamente usado como herbicida en la guerra de Vietnam o en la industria de sustancias cloradas como en la producci&oacute;n del herbicida 2,4,5T<SUP>99</SUP>. Se forman en peque&ntilde;as cantidades en ciertos procesos de industrias qu&iacute;micas org&aacute;nicas, por el blanqueo de pulpa de papel, producci&oacute;n de aceites pesados, petr&oacute;leo que contiene plomo, industria sider&uacute;rgica y durante la combusti&oacute;n de desperdicios. Se dispersan al ambiente por las part&iacute;culas suspendidas y por el agua.</P>     <P>Se conocen como dioxinas unos 200 compuestos, entre los cuales se halla la m&aacute;s estudiada, la 2,3,7,8-tetraclorodibenzo-<I>p</I>-dioxina (TCDD). Los dibenzofuranos, familia de 135 compuestos, tienen cierta semejanza en la toxicidad con las dioxinas.</P>     <P>El TCDD es la sustancia de mayor grado toxicol&oacute;gico y hay suficiente evidencia de su poder carcinog&eacute;nico, sin embargo tiene un patr&oacute;n de comportamiento que admite confusiones; su toxicidad aguda var&iacute;a con amplios l&iacute;mites en diferentes especies: desde un LD<SUB>50</SUB> de 0,6-2 µg de dibenzo-<I>p</I>-dioxinas/kg de peso corporal en el cobayo hasta 1-5 mg/kg de peso corporal para el h&aacute;mster<SUP>100</SUP>. Adem&aacute;s se le reconocen efectos inmunol&oacute;gicos y reproductivos perniciosos. Petroff y col.<SUP>68</SUP> han estudiado los efectos de este disruptor endocrino y presentan evidencias de cinco sitios donde la TCDD participa, alterando el proceso de ovulaci&oacute;n en roedores. El accidente en Seveso, Italia en 1976, donde una poblaci&oacute;n de 37.000 personas fue expuesta a una dispersi&oacute;n de estos derivados clorados tuvo manifestaciones diversas de efectos mediatos e inmediatos, uno de ellos, el da&ntilde;o a cromosomas. En Austria<SUP>99</SUP> han analizado los efectos de una contaminaci&oacute;n masiva ocurrida en 1970 y han encontrado 29 a&ntilde;os despu&eacute;s, s&iacute;ntomas neurot&oacute;xicos, conductuales y transtornos metab&oacute;licos en la <FONT FACE=Symbol>m</FONT>-glutamil transferasa. Se sabe adem&aacute;s que algunos de sus mecanismos son por la v&iacute;a de los CYP1A1 y CYP1A3<SUP>42</SUP>.</P>     <P>Por tanto, es posible detectar las dioxinas en cualquier parte de la tierra, especialmente en el mar; en los animales marinos y aun en el &Aacute;rtico se les encuentra en bajas cantidades. En el Mar B&aacute;ltico, se encuentran proporciones considerables de ellas y no se puede descartar que las dioxinas en interacci&oacute;n con otras mol&eacute;culas sean responsables de deterioro en los ecosistemas de esa &aacute;rea. Las dioxinas, al contaminar el aire a trav&eacute;s de part&iacute;culas de combusti&oacute;n de materiales que contienen cloro, tambi&eacute;n contaminan los pastos y por esta v&iacute;a, pasan a la leche<SUP>101</SUP>.</P>     ]]></body>
<body><![CDATA[<P>Ya sea por la industria o por ciertas negligencias, las dioxinas contaminan las cadenas alimentarias, su alta persistencia y liposolubilidad favorecen que se acumulen en el tejido adiposo, de ah&iacute; su excreci&oacute;n es muy lenta y se ha estimado su vida media en seis a&ntilde;os. Los lactantes son los organismos m&aacute;s expuestos, sin embargo, el conocimiento de su metabolismo, se conoce poco.</P>     <P>Se les ha detectado en peces en concentraciones desde 0,2 pg/g hasta 460 pg/g en condiciones accidentales<SUP>102</SUP>. En el B&aacute;ltico<SUP>2</SUP> se les registr&oacute; en 6,7-9,0 pg/g. En Europa, entre 1981 y 1987 las muestras de leche de vaca estudiadas, registraron concentraciones de 1,5 pg/g sobre base grasa, expresadas como equivalentes de TCDD, estimadas como elevadas<SUP>109</SUP>, en Estocolmo, Suecia (2000) hallaron 194 pg/g base grasa y 23 pg/g base grasa de furanos<SUP>25</SUP>. Bajo dietas estrictamente vegetarianas, el consumo fue de 0,4 pg/g y se aument&oacute; hasta 63,3 pg/g en la mantequilla<SUP>103</SUP>. En Jap&oacute;n<SUP>104</SUP> el promedio total de equivalentes t&oacute;xicos, TEQ de dioxinas y furanos fue de 0,48 y 0,63 pg/g en leche entera. Los estudios en 1996 han estimado que el 32% del consumo total de dioxinas y furanos proven&iacute;an de la leche<SUP>105</SUP>.</P>     <P>Un grupo de expertos n&oacute;rdicos ha establecido el nivel de 1 ng/kg de peso corporal/d&iacute;a como nivel de no efecto o NOEL y la ingesta semanal tolerable de <FONT FACE=Symbol>&lt;</FONT>35 pg/kg peso corporal/semana de equivalentes de TCDD, en cambio en el Reino Unido se ha establecido como l&iacute;mite 0,7 ng de TEQ/kg de grasa<SUP>106</SUP>.</P>     <P>Se estima que la ingesta de dioxinas en los lactantes puede exceder el valor de la ingesta tolerable semanal (TWI) y se ha comentado con cierta controversia que el organismo humano tiene menos sensibilidad a estos compuestos que otros, menos evolucionados.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">CONCLUSIONES</P> </B>    <P>Realidades sociales, culturales y pol&iacute;ticas est&aacute;n en estrecha relaci&oacute;n con los datos de concentraciones de xenobi&oacute;ticos de riesgo en alimentos de alta vulnerabilidad.</P>     <P>La toxicidad de los xenobi&oacute;ticos HCB, derivados del HCH, del naftaleno, arom&aacute;ticos, as&iacute; como PCBs, dioxinas y furanos expresa mecanismos metab&oacute;licos comunes en las reacciones de fase I, II y III. Respectivamente se ha observado participaci&oacute;n de isoformas del citocromo P450 en hidroxilaciones y epoxidaciones, conjugaci&oacute;n con &aacute;cido glucur&oacute;nico y la formaci&oacute;n de los compuestos metilsulfon&iacute;licos. Resalta la naturaleza electrof&iacute;lica de algunos metabolitos que es capaz de formar aductos mutag&eacute;nicos.</P>     <P>La etiolog&iacute;a de algunas enfermedades se ha vinculado con la exposici&oacute;n a xenobi&oacute;ticos; esto abre procesos de investigaci&oacute;n para conocer mecanismos de acci&oacute;n de los t&oacute;xicos aislados pero sobre todo de las interacciones entre diversas mol&eacute;culas que potencian la acci&oacute;n t&oacute;xica.</P>     <P>Entre las pol&iacute;ticas de regulaci&oacute;n se consideran efectivas la vigilancia sostenida y las normas establecidas por organismos como Codex Alimentarius, la que emiten organismos multinacionales como la Uni&oacute;n Europea as&iacute; como las que dictan los tratados de comercio internacional que estipulan l&iacute;mites estrictos en las transacciones comerciales.</P>     ]]></body>
<body><![CDATA[<P>Algunos pa&iacute;ses en desarrollo no han resuelto problemas de salud p&uacute;blica en referencia a manejo permisible de sustancias de riesgo y por lo tanto hay presencia objetable de residuos y contaminantes en la leche humana. En cambio, pa&iacute;ses desarrollados han abatido las concentraciones de plaguicidas organoclorados pero enfrentan un aumento de otras sustancias que conllevan presumibles riesgos. Las dos corrientes requieren serios esfuerzos y estrategias adecuadas para resolver problema tan acuciante y sin duda estos recursos involucran la educaci&oacute;n ecol&oacute;gica, la investigaci&oacute;n y las pr&aacute;cticas de prevenci&oacute;n.</P>     <P>&nbsp;</P> <B>    <P ALIGN="CENTER">BIBLIOGRAF&Iacute;A</P> </B>    <!-- ref --><P>1. Laug, BP, Kunze, FM, Prickett CS. (1951) Ocurrence of DDT in human fat and milk. 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