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PubMed1979

Appropriateness of milk use in international supplementary feeding programs.

Recognition of lactose intolerance, debate over the limitedness of dietary energy and protein in specific settings, and the appreciation for the uniqueness and appropriateness of human milk during the 1st yr of life have prompted reexamination of the use of milk in international feeding programs. Substantial proportions of preschool and school-age children from expected populations are lactose intolerant. However, studies in this county indicate that lactose intolerant preschool and early school-age children can tolerate amounts of milk usually consumed. Older individuals with symptomatic responses to milk also will often have similarly mild symptomatic responses to hydrolyzed lactose milk. Appropriately controlled studies in developing countries are planned or are underway to assess milk tolerance. In feeding programs designed to provide a protein supplement, milk continues to be a very attractive option. The question of how much milk protein must be given and how often it should be provided to make a significant impact on a population's well-being depends on an evaluation of the data base describing protein intakes and needs for specific populations. These types of data for most populations are inadequate.

Adolescent↗
PubMed1977

Lactose tolerance in normal Egyptian infants and children and in protein calorie malnutrition.

Oral lactose tolerance test was performed on a total of 100 cases of normal Egyptian infants and children aged 6 months to 12 years. The same test was performed on 30 cases of protein calorie malnutrition (15 cases of marasmus and 15 cases of kwashiorkor). Detection of sugar and determination of pH were also carried out on all stools passed after the test. Lactose intolerance, as judged by a maximal blood glucose rise of 20 mg. or less and/or stools positive for sugar with a pH less than 6 following lactose ingestion, was observed as follows in normal cases: 12% in the age group 6 months to 2 years, 32% in the age group 2 to 5 years, 32% in the age group 5 to 9 years, and 80% in the age group 9 to 12 years. On the other hand, lactose intolerance was demonstrated in 73.3% of cases suffering from protein malnutrition. The aetiology and practical implications of the present findings of lactose intolerance on normal and malnourished children are discussed.

Child↗
PubMed1990

Breath hydrogen test for assessment of lactose malabsorption following rotavirus gastroenteritis.

Ninety infants and young children with acute gastroenteritis were investigated for lactose malabsorption. Each of them was given an oral lactose load of 2g per kg of body weight after which breath hydrogen excretion was measured, and each was observed for clinical symptoms of lactose intolerance. Only 2 patients, given 2g per kg of lactose, had clinical lactose intolerance. Forty-nine of the 90 patients studied were found to have the rotavirus antigen in their stools. Forty-five of them were found to have an abnormal lactose breath hydrogen test (LBHT). Twenty-three patients with abnormal LBHT were restarted on a diluted lactose-containing formula for oral feeding. They required longer hospitalization (mean 6.7 days, range 3-14 days) and were free of diarrhea in 14 days (mean 7.5 days). Twenty-two patients found to have an abnormal LBHT were given a nonlactose-containing formula (Isomil, Nursoy, Alsoy, ProSobee, or Bebelac FL) when restarted on oral feeding. All patients require less than 5 days of hospitalization and free of diarrhea in 5 days (mean 3.4 days). The difference was statistically significant (p less than 0.05).

Breath Tests↗
PubMed1994

Bone mineral content and dietary calcium intake in children prescribed a low-lactose diet.

Bone density is related to body size and other factors including dietary calcium intake. The purpose of this study was to determine the effect of a low-lactose, low-calcium diet on the bone mineral content (BMC) of prepubertal children with documented lactose intolerance. Radial BMC was determined by single-photon absorptiometry. Dietary intake was assessed by 24-h recall and two 3-day food records, and weight and height were measured. The group of lactose-intolerant children was compared with a group of healthy children of similar age, gender, race, and size and to the prediction equations based on body size from Chan's Utah children. Nineteen children, ages 9.6 +/- 1.9 years, participated in the study. They were relatively short compared with standards (height Z score, -0.30 +/- 0.83). BMC was 0.428 +/- 0.081 g/cm in the study group versus 0.440 +/- 0.116 g/cm in the comparison group (n = 19; p > 0.05). Both the study group and the size-selected comparison group had lower BMC than the Utah children. The diet of the study group was low in calcium: 84% of the Recommended Dietary Allowance in children < 11 years old and 32% in children > 11. Calcium intake was associated (p = 0.03) with BMC in the study group after adjusting for body size. The low-lactose diet resulted in a low calcium intake, and BMC was associated with calcium intake in prepubertal children with lactose intolerance. Evaluation of dietary calcium intake should be considered in this group of patients, with follow-up dietary counseling, calcium supplementation (diet or medication), and bone density assessment when clinically indicated.

Body Height↗
PubMed1998

Human adult-onset lactase decline: an update.

Human adult-onset lactase decline is a biologic feature characteristic of the maturing intestine in the majority of the world's population. The digestion and absorption of lactose, the major carbohydrate in milk and also the main substrate for lactase, is often variable, a consequence of lactase levels, gastric emptying rate, and colonic salvage. Although commercially available "lactase" products alleviate symptoms in many lactose-intolerant people, a greater understanding of this variability in lactose tolerance could lead to interventions that reduce the rate of gastric emptying and/or increase the proliferation of lactose-metabolizing bacteria in the colon, leading to more efficient lactose utilization. Adult-onset lactase decline appears to be a risk factor for developing osteoporosis, owing to avoidance of dairy products or interference of undigested lactose with calcium absorption. Elderly with both adult-onset lactase decline and atrophic gastritis or those undergoing anti-ulcer treatment may have an increased risk of low calcium absorption owing to the lack of gastric acid that facilitates calcium uptake. Thus, lactose-intolerant elders should monitor their calcium nutrition status carefully.

Animals↗
PubMed2000

Effect of a vegetable-protein-rich polymeric diet treatment on body composition and energy metabolism in inactive Crohn's disease.

OBJECTIVE: Since malnutrition and lactose intolerance are frequently reported in Crohn's disease (CD), we evaluated the differences in terms of compliance-to-treatment and nutritional status in inactive CD patients after two different treatments using either a standard polymeric diet or a vegetable-protein-rich and lactose-free diet. STUDY DESIGN: A case-control study. SUBJECTS: Forty CD patients with inactive disease were randomly divided into two groups. Group A (10 men; aged 33.9+/-7.2 years; BMI, 21.8+/-1.7 kg/m2) received a conventional polymeric enteral diet, while group B (10 men; aged 35.6+/-6.8 years; BMI, 21.4+/-1.8 kg/m2) was administered a soy-rich and lactose-free polymeric diet, over a 4-week period. METHODS: All the patients had a clinical and laboratory examination. Body composition was assessed by isotopic dilution and resting metabolic rate (RMR), and substrate oxidation rates were measured by indirect calorimetry. RESULTS: Body weight significantly increased after treatment in both groups (A, P<0.05; and B, P<0.01), as well as fat-free mass (A, P<0.05; and B, P<0.05) and fat mass (A, P<0.05; and B, P<0.01). RMR slightly increased, although it did not reach statistical significance. Treatment did not influence substrate oxidation rates. Group B lactose-intolerant patients reported a greater compliance-to-treatment than those in group A. CONCLUSIONS: This study showed that a polymeric enteral diet rich in vegetable protein and not containing milk protein, eaten at home, with no need for positioning a nasogastric tube, significantly improved body composition in inactive and lactose-intolerant CD patients, with no effect on energy metabolism, suggesting that it could be useful in improving nutritional status in these patients.

Adult↗
PubMed1998

Milk hypersensitivity--key to poorly defined gastrointestinal symptoms in adults.

Lactose intolerance is a common adverse reaction to milk in adults, while milk hypersensitivity is a disorder of infancy. We hypothesized that milk hypersensitivity may cause many unspecific gastrointestinal disorders in adults. Twenty adults were subjected to double-blind, placebo-controlled milk challenge. Phagocyte activity, and Fc gamma and complement receptor expression of phagocytes were assayed, and serum total IgE, milk-specific IgE, and serum reactivity to milk protein were determined. The challenge increased phagocyte activity and complement receptor expression of phagocytes in subjects designated milk-hypersensitive, who had gastrointestinal symptoms from milk ingestion but normal lactose tolerance. The increase was not detected in lactose-intolerant or control subjects. The milk-hypersensitive group was also distinguished from the lactose-intolerant group by enhanced serum reactivity to milk protein. Only two out of nine milk-hypersensitive subjects had detectable milk-specific serum IgE. It is concluded that milk hypersensitivity in adults, occurring as gastrointestinal reactions, may be more common than previously thought.

Adult↗
PubMed1977

Milk consumption by black and by white pupils in two primary schools.

It is heartening to note that relatively well nourished black children in the United States, a number of whom are, in all probability, lactose intolerant and most of whom are destined to become lactose intolerant adults, are able to consume nutritionally valuable quantities of milk with meals and, on the whole, do not report suffering from any abdominal pain or discomfort. It is also encouraging that this population of over two hundred primary school children consumed, on the average, 75 per cent of the 1/2 pt. milk served with lunch, reported drinking an average of three glasses of milk daily, and the vast majority reported liking milk and a number of other dairy products which are important nutrient sources in their diets.

Adolescent↗
PubMed1981

Lactose malabsorption during gastroenteritis, assessed by the hydrogen breath test.

Thirty-eight infants and young children with gastroenteritis were investigated for lactose malabsorption. Each of them was given an oral lactose load of either 0.5 g/kg or 2 g/kg after which breath hydrogen excretion was measured, and each was observed to see if he had clinical symptoms of lactose intolerance. Only one patient, given 2 g/kg lactose, had clinical intolerance. His breath hydrogen excretion however was negative. Three of 18 patients given 0.5 g/kg lactose had positive breath hydrogen tests. None of these was symptomatic. Lactose intolerance in gastroenteritis was rare in our study, and the hydrogen breath test was not an appropriate technique for detecting it.

Breath Tests↗
PubMed1984

Prevalence of primary adult lactose malabsorption in three populations of northern China.

Lactose absorption capacity was examined in 641 apparently healthy adolescents and adults (447 males and 194 females with an average age of 22.9 years and an age range of 16-46 years) using a field version of the lactose tolerance test with breath hydrogen determination. In the total sample, 89 lactose absorbers and 552 lactose malabsorbers were identified. Lactose malabsorption was most frequent in a subgroup of Han (Chinese) from northeastern China (229 of 248 subjects, 92.3%). Among 198 Mongols from Inner Mongolia, there were 174 lactose malabsorbers (87.9%). The frequency of lactose malabsorption was lowest in a group of Kazakhs, traditional herders from the northwestern region of Xinjiang (149 of 195 subjects, 76.4%). Reported symptoms of lactose intolerance were significantly more frequent in lactose malabsorbers. The findings in northern Han are similar to the reported lactose malabsorption frequency in southern (mainly overseas) Chinese, and correspond with the absence of animal milk from traditional Chinese diets. The relatively low prevalence of lactose malabsorption among the Kazakhs suggests that lactose persistence may be frequent in herding pastoralist populations of southwest Asia.

Adolescent↗
PubMed2006

[Clinical studies of pediatric malabsorption syndromes].

Multiple cases with various types of pediatric malabsorption syndromes were evaluated. The clinical manifestations, laboratory findings, pathophysiology, and histopathological descriptions of each patient were analyzed in an effort to clear the pathogenesis of the malabsorption syndromes and the treatments were undertaken. The cases studied, included one patient with cystic fibrosis, two with lactose intolerance with lactosuria (Durand type), one with primary intestinal lymphangiectasia, two with familial hypobetalipoproteinemia, one with Hartnup disease, one with congenital chroride diarrhea, one with acrodermatitis enteropathica, one with intestinal nodular lymphoid hyperplasia (NLH), five with intractable diarrhea of early infancy and four with glycogenosis type Ia. Each case description and outcome is described below: 1. A 15-year-old Japanese boy with cystic fibrosis presented with severe symptoms, including pancreatic insufficiency, bronchiectasis, pneumothorax and hemoptysis. His prognosis was poor. Analysis of the CFTR genes of this patient revealed a homozygous large deletion from intron 16 to 17b. 2. In the sibling case of Durand type lactose intolerance, the subjects'disaccaridase activity of the small bowel, including lactase, were within normal limits. The results of per oral and per intraduodenal lactose tolerance tests confirmed lactosuria in both. These observations suggested, not only an abnormal gastric condition, but also duodenal and intestinal mucosal abnormal permeability of lactose. 3. In the case of primary intestinal lymphangiectasia, the subject had a lymphedematous right arm and hand, a grossly coarsened mucosal pattern of the upper gastrointestinal tract (identified via radiologic examination) and the presence of lymphangiectasia (confirmed via duodenal mucosal biopsy). The major laboratory findings were hypoalbuminemia, decreased immunoglobulin levels and lymphopenia resulting from loss of lymph fluid and protein into the gastro-intestinal tract. 4. In two cases of heterozygous familial hypobetalipoproteinemia, serum total cholesterol and betalipoprotein levels were very low. The subjects presented with symptoms and signs of acanthocytosis and fat malabsorption. Further, one subject had neurological abnormalities such as mental retardation and severe convulsions. Treatment with MCT formula diet corrected the lipid malabsorption. 5. A 5-year-old girl presented with pellagra-like rashes, mental retardation and cerebellar ataxia. An oral tryptophan (Trp) and dipeptide (Trp-Phe) loading test were conducted and the renal clearance of amino acids was also evaluated in this patient and in controls. Following the oral Trp loading test, plasma levels of Trp indicated a lower peak in the case, reaching a maximum at 60 minutes. On the other hand, the oral dipeptide (Trp-Phe) loading test in the Hartnup patient showed the peak Trp plasma level was the same as the control subjects. The renal clearance of neutral amino acids in this case increased to levels 5 to 35 times normal. 6. In the case of congenital chloride diarrhea, the subject had secondary lactose intolerance, dehydration, hyponatremia, hypokalemia, hypochloremia, hyperreninemia and metabolic alkalosis. The chloride content of her fecal fluid was very high. The concentrations were 89-103 mEq/l. In contrast, her urine was chloride-free. The subject's growth and development improved after treatment with lactose free formura and oral replacement of the fecal loses of water, NaCl and KCl. Unfortunately, the patient died of a small bowel intussusception. The kidney histopathological finding was juxtaglomerular hyperplasia by a necropsy. 7. In the case of acrodermatitis enteropathica, the subject had characteristic skin lesions, low serum zinc levels and ALPase activity. An oral ZnSO4 loading test and intestinal mucosal histology by a peroral biopsy were conducted. The serum zinc peak level was 2 hours after the oral ZnSO4 loading test. Infant formula alone could not maintain normal serum zinc ranges. Light microscopic studies of the intestinal villous architecture showed a normal pattern. However, ultrastructual examination of several epithelial cells revealed numerous intracellular vesicles. After zinc therapy, these changes were decreased. The lesions were postulated as the secondary result of zinc deficiency. 8. A 12-year-old girl presented with hypogammaglobulinemia, recurrent infections, chronic diarrhea and intestinal NLH. A barium meal and follow-through examination showed multiple nodules throughout the stomach and intestine. The nodules, all uniform in size, were 2 mm diameter. The barium enema did not show NLH in the colon. Mucosal biopsy of the stomach and jejunum revealed the typical histology of NLH in the lamina propria. Also, achlorhydria was present in this patient and her serum gastrin levels were very high; 315-775 pg/ml. 9. In 4 cases of intractable diarrhea in early infancy (by Avery G B), a jejunal biopsy showed shortening villi and nonspecific enterocolitis. Some patients were found with only low lactase or low lactase and sucrase levels. An electron microscope analysis of the small bowel in 2 cases showed alterations: increased pinocytosis in microvillus membranes and lysosomes by endocytosis of undigested macromolecular substances. I postulated that the stated evidence was causative of this clinical profile. 10. I frequently observed diarrhea as a clinical manifestation in glycogenosis type Ia and lipid malabsorption in one case. The light and electron photomicrographs showed intestinal absorption cells with the glycogen deposits in the inferior devision of nuclei.

Acrodermatitis↗
PubMed1976

Lactose malabsorption in Mexican-American children.

Inability to absorb lactose due to low intestinal lactase is common in many population groups. This study is the first to compare lactose tolerance in 282 Mexican-American (MA) children and 51 Anglo-American (AA) children 2 to 14 years of age with the dietary intake of selected nutrients found in milk. A lactose tolerance test and a 24-hr dietary recall were obtained for each child. Gastrointestinal symptoms were carefully recorded for a 24-hr period following the lactose load. Overall prevalence of lactose malabsorption was 37% in MA children and 8% in AA children, and it increased with age. Number of symptoms occurring in lactose malabsorbers of both ethnic groups also increased with age. Mean protein intake exceeded Recommended Dietary Allowances at all ages for both ethnic groups. Mean consumption of vitamin A, calcium, and energy was below the Recommended Dietary Allowance for MA children. There were no differences in calories, nutrient, or milk intakes between lactose absorbers and malabsorbers, but AA children drank more milk than MA children. Fifteen percent of lactose-absorbing MA, 23% of malabsorbing MA, but no AA children reported having symptoms after drinking milk. There was a significantly greater incidence of lactose intolerance in MA as compared to AA children. This suggests that Mexican-Americans share in the high incidence of primary lactose intolerance characteristic of the majority of the orld's peoples.

Adolescent↗
PubMed1981

Lactose tolerance in lambs with rotavirus diarrhoea.

It has been suggested that lactose malabsorption is an important factor in producing the diarrhoea of acute rotavirus infection. Accordingly, the lactose tolerance of gnotobiotic newborn lambs, infected with lamb rotavirus, has been investigated by clinical studies and tissue enzyme assays. Although lactase activity is low in affected areas of the small intestine, rotavirus infected lambs are not lactose intolerant as assessed by the measurement of reducing substances in the faeces, or by the clinical effects and blood glucose levels after a 5.8 mmol (2 g)/kg lactose load on the second day post-infection. Lactose intolerance could be demonstrated by using extremely high (29.2 mmol (10 g)/kg) doses of lactose, three or four times the normal dietary lactose intake. These experiments suggest that lactose-containing feeds (such as maternal milk) are not necessarily contraindicated in patients or animals with rotavirus diarrhoea.

Animals↗
PubMed2004

[Lactose malabsorption in patients with inflammatory bowel disease without activity: would it be necessary to exclude lactose products in the diet of all patients?].

INTRODUCTION: There are inflammatory bowel disease (IBD) patients avoid lacteal products without evidence of lactose malabsorption, probably because of incorrect patient perceptions and arbitrary advice from physicians and diet books. AIM: To evaluate the prevalence of lactose malabsorption in patients with IBP. METHOD: In 18 patients with Crohńs disease and 24 with ulcerative colitis and 25 controls the prevalence of lactose intolerance, as measured by lactose breath hydrogen tests. RESULTS: Observed deficiencies of absorption of the lactose in 7 (16.6%) patients with IBP and 5 (20%) subjects control. CONCLUSIONS: Not all the patients with IBD are intolerant to the lactose by the suppression of the lacteal produts must not be generalized in the diet of these patients.

Adolescent↗
PubMed2003

Tolerance of symptomatic lactose malabsorbers to lactose in milk chocolate.

OBJECTIVE: To study tolerance to lactose in milk chocolate among symptomatic lactose maldigesters. DESIGN: Randomized cross-over study. SUBJECTS: Twenty-seven adult lactose maldigesters with symptomatic lactose intolerance. METHODS: A 100 g chocolate sample prepared with whole milk (12 g lactose), whole-milk powder (12 g lactose), low-lactose milk powder (2 g lactose) or lactose-free milk powder was eaten after an overnight fast. Gastrointestinal symptoms (flatulence, abdominal bloating, abdominal pain, borgorygmi and nausea) were recorded in a questionnaire during the following 8 h. Bowel movements and stool consistency were also registered during the test day. RESULTS: The numbers of persons reporting different gastrointestinal symptoms or any of the symptoms did not differ significantly after eating the chocolate samples. No statistical differences were found in the estimated strength of the different symptoms or the total strength of all symptoms combined. Differences in the bowel frequency and stool consistency were also non-significant. CONCLUSIONS: Lactose malabsorbers with self-reported lactose intolerence did not differ in their response to milk chocolate samples containing different amounts of lactose.

Cacao↗
PubMed1976

Management of sugar intolerance in children.

Sugar intolerance is a common problem in paediatric practice. The usual type is lactose intolerance following gastroenteritis, but it may also occur in a wide variety of disorders of the small bowel. Diagnosis depends upon identification of reducing substances in the stools. An approach to dietary management of lactose intolerance is given and use of a carbohydrate-free formula in secondary monosaccharide intolerance is described. In each situation, threshold for digestion or absorbtion of carbohydrate is approached gradually from below, and overflow detected by Clinitest stool testing.

Carbohydrate Metabolism↗
PubMed1999

Milk hypersensitivity in young adults.

OBJECTIVE: To estimate the prevalence of milk hypersensitivity in Finnish adults. DESIGN: Cross-sectional study. SUBJECTS: Two hundred men and 206 women aged 27 y randomly recruited from the population register in southwestern Finland. INTERVENTIONS: The subjects were interviewed about their dairy product consumption, abdominal discomfort after dairy product intake and lactose intolerance. From serum samples, serum reactivity to milk protein and milk-specific IgG1, IgG2, IgG3 and IgA were measured. RESULTS: About 20% of the subjects reported abdominal discomfort after dairy product intake, whereas only 6.4% had been diagnosed to have lactose intolerance. The amount of milk consumed correlated well with the serum assay results in subjects reporting abdominal discomfort but not in subjects who were free from these symptoms. Among subjects with no record of dairy product restriction or lactose intolerance, those experiencing abdominal discomfort after dairy product intake had significantly higher serum reactivity to milk protein than those without such discomfort. The concentrations of serum milk-specific antibodies did not differ between these two groups. The prevalence of milk hypersensitivity in this population was estimated to be 3-6%. CONCLUSIONS: Milk hypersensitivity may be as common in adults as in infants. The measurement of serum reactivity to milk protein may prove useful in screening milk hypersensitivity in subjects who have not restricted their dairy product consumption.

Abdominal Pain↗
PubMed1984

Faecal weight, constituents, colonic motility, and lactose tolerance in the irritable bowel syndrome.

Lactose intolerance and faecal characteristics were compared in 16 patients with symptomatic irritable bowel syndrome and in age- and sex-matched controls. Faecal stool weight was increased in the irritable bowel syndrome patients, whereas faecal bile acids, fat, volatile fatty acids, and neutral sterols were not significantly different. No lactose intolerance was found in irritable bowel syndrome subjects. Measurements of colonic motility showed only modest activity for both basal and food-stimulated activity. There was a weak correlation between the concentration of total bile acids, deoxycholic acid, lithocholic acid and the motility index.

Adolescent↗