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PubMed1985

Clinical and nutritional implications of radiation enteritis.

The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value.

Adult↗
PubMed2006

Optimization of an innovative hollow-fiber process to produce lactose-reduced skim milk.

The research field for applications of lactose hydrolysis has been investigated for several decades. Lactose intolerance, improvement for technical processing of solutions containing lactose, and utilization of lactose in whey are the main topics for development of biotechnological processes. We report here the optimization of a hollow-fiber membrane reactor process for enzymatic lactose hydrolysis. Lactase was circulated abluminally during luminal flow of skim milk. The main problem, the growth of microorganisms in the enzyme solution, was minimized by sterile filtration, ultraviolet irradiation, and temperature adjustment. Based on previous experiments at 23 +/- 2 degrees C, further characterization was carried out at 8 +/- 2 degrees C, 15 +/- 2 degrees C (beta-galactosidase), and 58 +/- 2 degrees C (thermostable beta-glycosidase) varying enzyme activity and flow rates. For a cost-effective process, the parameters 15 +/- 2 degrees C, 240 U/mL of beta-galactosidase, an enzyme solution flow rate of 25 L/h, and a skim milk flow rate of about 9 L/h should be used in order to achieve an aimed productivity of 360 g/(L x h) and to run at conditions for the highest process long-term stability.

Animals↗
PubMed1994

[Quantitative and qualitative determination of lactic acid in fecal filtrate in children].

The authors describe qualitative and quantitative methods for lactic acid assessment in children's feces. A total of 102 children with mainly lactose intolerance were examined. Benedict's test with feces filtrate, lactose tolerance test, and measurements of fecal carbohydrates were used in the diagnostic investigations. Mean lactic acid levels made up (mean +/- m) 33.3 +/- 3.6 mmol/l (6.3 +/- 1.0 in healthy infants on breast feeding and 6.0 +/- 1.3 mmol/l in those on mixed and formula feeding). Fecal carbohydrate levels were normal (below 5 g/l) in 12 infants, but lactic acid levels made up 67.8 +/- 6.1 mmol/l. Qualitative reaction to lactic acid in feces, starting from 44.4 mmol/l, was detected in 27% of infants. Differences in the values of healthy children and those with lactic carbohydrate intolerance were found significant (p < 0.001).

Child↗
PubMed1989

Prophylactic and therapeutic aspects of fermented milk.

Many claims have been made concerning prophylactic and therapeutic effects of fermented bovine milk consumption. Of these, the amelioration of lactose intolerance symptoms in humans and rats due to the reduced lactose level caused by fermentation is convincingly documented and corroborated. In addition, some kinds of fermentation microbes can contribute to lactose digestion in vivo thus augmenting the preingestive fermentative decrease of lactose. Relief of the growth inhibition and the gastrointestinal infection susceptibility due to high dietary lactose levels can also be achieved by fermentation of milk lactose. The hypocholesterolemic activity of fermented milk is apparently related to a similar uncharacterized activity of ordinary milk. Antitumorigenic effects in rats have been reported. Microfloral alterations due to dietary dairy microbes have been reported to retard the development of colon cancer. Purported human longevity effects have not been supported by appropriate data.

Animals↗
PubMed2003

Nutrition in the critically ill patient: part III. Enteral nutrition.

OBJECTIVE: To review the human nutrition in the critically ill patient in a three-part presentation. DATA SOURCES: Articles and published peer-review abstracts and a review of studies reported and identified through a MEDLINE search of the English language literature on enteral nutrition. SUMMARY OF REVIEW: Enteral nutrition is indicated in the critically ill patient when there is an inability to ingest adequate nutrients by mouth and where the gastrointestinal tract is otherwise normal. The commonly used polymeric feeding solutions provide a mixture of nutrients similar to that encountered in the normal diet, usually as an iso-osmolar low residue solution. Because lactose intolerance may be encountered during critical illness, most formulations are lactose free. Special glutamine formulations and immune enhancing enteral formula (e.g. enriched with 3 fatty acids, arginine and ribonucleic acids) have been used in critically ill patients. However there have been few studies to indicate that these diets are of greater benefit compared with normal enteral formulations. The daily nutritional requirements are often not met in critically ill patients largely due to delayed gastric emptying or diarrhoea. Prokinetic agents, special formulations containing fibre and probiotics, have been used in an attempt to improve the tolerance to the formulations, although there have been no comparative studies that allow firm recommendation to be made. In general, a standard enteral solution is usually prescribed first and instilled into the stomach using a fine bore nasogastric tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. CONCLUSIONS: Nutritional requirements for the critically ill patient should be delivered enterally in patients who have a normally functioning gastrointestinal system. A standard formulation is usually prescribed and instilled into the stomach using a fine bore tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. Diarrhoea caused by enteral pathogens may require specific treatment. If pathogens are excluded then fibre and probiotics may be considered. Motility reducing agents (e.g. opiates) may cause abdominal bloating.

Journal Article↗
PubMed1987

Milk consumption, symptom response, and lactose digestion in milk intolerance.

The experience of adverse gastrointestinal symptoms (gas, abdominal pain, and diarrhea) after the oral ingestion of 360 mL whole milk was investigated in 25 adults who claimed to be milk intolerant. The level of customary milk consumption by all subjects was low compared with that of 13 control subjects who denied a history of milk intolerance. After drinking the milk, which was accompanied by a hydrogen breath test, most of the subjects experienced some of their accustomed intestinal discomfort and the degree of intolerance was similar for the nine (36%) who proved to be true lactose-maldigester subjects and the 16 (64%) who had flat hydrogen breath responses, ie, who were classified as lactose-digester subjects. There is a subpopulation of lactose-intolerant milk-rejector individuals that absorbs lactose efficiently and responds to other milk-related factor(s) with the same subjective symptoms and dietary conduct as do true lactose-maldigester individuals.

Adult↗
PubMed1991

Lactose maldigestion and milk intolerance in healthy Greek schoolchildren.

The prevalence of lactose maldigestion in Greek adults is 75% but the age at which the lactase activity starts declining is not known. The prevalences of lactose maldigestion and intolerance were investigated in 150 randomly selected Greek children 5-12 y old by using breath-hydrogen analysis after ingestion of lactose (2 g/kg body wt, maximum 50 g) or 0.240 L of milk. Prevalence of lactose maldigestion increased with age (y = -7.30 + 6.49x, r = 0.88, P = 0.004), being 29.4% and 80.0% at ages 5 and 12 y, respectively. Before testing, the reported prevalences of milk-related symptoms by children with high and low lactose-digestion capacity were 21.1% and 39.7% (chi 2 = 5.96, P = 0.015), respectively. However, the corresponding prevalences of lactose intolerance after ingestion of milk were 7.3% and 8.6% (chi 2 = 0.1, P = 0.72) and only three children had a delta H2 greater than or equal to 20 ppm postprandially. Although intestinal lactase activity declines before age 5 y and many Greek children report milk-related symptoms, true malabsorption and intolerance of lactose after a glass of milk is rarely seen at this age.

Age Factors↗
PubMed1986

Lactose digestion by human jejunal biopsies: the relationship between hydrolysis and absorption.

The relationship between lactose hydrolysis and absorption of released glucose was investigated by determining the kinetics of lactose digestion by jejunal biopsies incubated in vitro. Lactase activity in intact biopsies correlated with conventional assay of tissue homogenates (r = 0.85, p less than 0.001), and glucose uptake from 28 mM lactose was directly proportional to lactase activity (r = 0.95, p less than 0.001) in 21 subjects with normal lactase levels, six with hypolactasia (primary or secondary to coeliac disease) and two with lactose intolerance but normal lactase activity. Kinetic analysis at 0.56-56 mM lactose in five normal subjects showed saturable kinetics for hydrolysis (app Km = 33.9 +/- 2.2 mM; app Vmax = 26.5 +/- 1.1 nmol/min/mg dry weight) but glucose uptake could be fitted to a model either of saturable uptake (app Kt = 47.2 +/- 0.3 mM; app Jmax = 14.1 +/- 0.2 nmol/min/mg) or saturable uptake plus a linear component (app Kt = 21.3 +/- 1.15; app Jmax = 4.59 +/- 0.12; app Kd = 0.093 +/- 0.010 nmol/min/mg/mM). The proportion of glucose taken into the tissue did not significantly exceed 50% of the total released at any lactose concentration suggesting the lack of an efficient capture mechanism for the released glucose. The results suggest that lactose hydrolysis is the rate limiting step in the overall absorption of glucose from lactose in vitro, and that the relationship between hydrolysis and absorption is the same in normal subjects and in hypolactasic subjects.

Adolescent↗
PubMed1994

The possible role of breath methane measurement in detecting carbohydrate malabsorption.

To evaluate the possibility that measurement of breath methane (CH4) enhances the accuracy of breath hydrogen (H2) testing to diagnose carbohydrate malabsorption, breath CH4 concentration of healthy subjects was studied. Fasting breath CH4 concentration measured three times over a 30-minute period in 44 CH4-producing volunteers ranged from 5 to 120 ppm. Fluctuation of breath CH4 excretion exceeded 100% increase over fasting in 1 of 9 subjects who ingested a nonabsorbable, carbohydrate-free solution. Out of 13 subjects who had a false negative breath H2 response to lactulose, 11 had a CH4 percentage increase greater than 100%. In 11 of 32 lactose-intolerant patients with a negative breath H2 test, CH4 percentage increase after lactose challenge was greater than 100%. These data suggested that in methanogenic individuals, breath CH4 measurement might enhance the accuracy of H2 breath testing in detecting carbohydrate malabsorption.

Adult↗
PubMed2002

Milk formulas in acute gastroenteritis and malnutrition: a randomized trial.

OBJECTIVE: To compare three low-lactose milk formulas differing in osmolality and degree of protein hydrolysis in the treatment of diarrhoea and malnutrition in subjects with high rates of lactose intolerance, osmotic diarrhoea and a tropical/environmental enteropathy. METHODS: A randomized double-blind trial of 180 Aboriginal children under 3 years of age admitted with acute diarrhoea and/or malnutrition was carried out. The intervention milk formulas were: (i) De-Lact, a low-osmolality lactose-free formula; (ii) O-Lac, a lactose-free formula; and (iii) Alfaré, a partially hydrolysed formula. Outcome measures were diarrhoeal severity, weight gain, formula palatability and changes in intestinal permeability (L/R ratios). RESULTS: The duration of diarrhoea in days (mean; 95% confidence interval) was significantly longer on Alfaré (8.5; 7.0-10.0) compared to De-Lact (6.1; 5.0-7.2) and O-Lac (6.9; 5.6-8.1; P = 0.04). There were no differences in mean intake between formulas, but palatability of Alfaré was significantly worse (P < 0.01) than the other formulas. Over the trial 5 days, improvement in L/R ratios was significantly greater (P = 0.05) for De-Lact (18.6; 10.6-26.6) than for Alfaré (8.5; 2.1-14.9). Weight gain was not significantly different between the three formulas, except in a malnourished subgroup who had better weight gain on De-Lact (P = 0.05). CONCLUSIONS: In these Aboriginal children with diarrhoea and growth failure, a low osmolality milk was associated with better outcomes and a partially hydrolysed formula with less improvement in mucosal recovery, suggesting that cow's milk protein intolerance is not contributing to greater diarrhoeal severity or enteropathy in Aboriginal children.

Analysis of Variance↗
PubMed1999

Lactitol tolerance in healthy Thai adults.

The hydrogen breath analysis test was performed in healthy Thai adults to determine lactitol tolerance. The study was conducted in 39 individuals (11 males and 28 females) aged 18-41 years. All volunteers agreed to participate in this study after the risks and benefits had been fully explained. Subjects were requested not to consume milk, milk products, or high-vegetable diets for a day and to fast from 10 p.m. of the day preceding the test day. After consumption of the test diet (12 and 20 g of lactose or lactitol, respectively, in 250 mL water), the subjects recorded the severity of symptoms for 24 hours. Breath samples were collected after fasting and after consumption of the test diet at 30 min intervals over the 7-hour study period. Breath samples were analyzed for hydrogen using gas chromatography. After consumption of 12 g lactose, the prevalence of lactose malabsorbers was established. The increment of a peak breath hydrogen level of > or = 20 ppm above the baseline level was used as an indicator of lactose malabsorption. The lactose malabsorbers were further classified as lactose tolerance or lactose intolerance according to the gastrointestinal symptoms observed. All 39 healthy Thai adults could be classified into 3 groups as follows: 9 (23%) lactose absorbers (LA), 15 (38.5%) lactose mal-absorber/tolerance (LMT), and 15 (38.5%) lactose mal-absorber/intolerance (LMI). Using the hydrogen breath test, 67% of the subjects were identified as lactitol intolerance after the consumption of 12 g lactitol. The lactitol intolerance comprised 53.8% of LMI, 34.6% of LMT, and 11.5% of LA. Among all subjects, one third of LA (33%), two thirds of LMT (60%), and 93% of LMI were lactitol intolerant. In addition, gastrointestinal symptoms such as flatulence and abdominal pain were most pronounced in LMI. Diarrhea was also a prominent manifestation after consumption of 12 g lactitol. Therefore, it was finally decided that 20 g lactose or lactitol were not given to LMI because of the risk of gastrointestinal symptoms. After high doses (20 g) of lactose and lactitol consumption, most LMT developed more symptoms than did LA and the main symptom was diarrhea. Consumption of 20 g lactose resulted in fewer symptoms than 20 g lactitol in both LA and LMT. On the basis of the hydrogen breath test, most LA tolerated 12 g lactitol without gastrointestinal symptoms except some flatulence whereas most LMT and LMI did not. Twenty g lactitol was not tolerated by both LA and LMT because there was diarrhea among the subjects, especially in LMT. Although the hydrogen breath analysis test is the best method for identification of lactose malabsorption, it is not the best method to identify lactitol intolerance. A hydrogen concentration of 15 ppm above the baseline level was found to be the best cut-off point to indicate lactitol intolerance although sensitivity was 85% and specificity only 38% in this study. It was further concluded that there is a greater susceptibility to lactitol in human lactose malabsorbers than in lactose absorbers. Our findings might be relevant for the limited use of lactitol in Thailand.

Absorption↗
PubMed1989

Evaluation of infant feeding in acute gastroenteritis.

Sixty-eight bottle-fed babies under 9 months of age with mild acute gastroenteritis were observed to evaluate current feeding regimens following acute gastroenteritis in infancy. All babies were fed for 24 h with a glucose-electrolyte mixture (GEM) and then randomly assigned to either a gradual reintroduction to their normal milk, i.e., slow regrade; immediate return to full-strength formula; or a rapid regrade to a hypoallergenic whey hydrolysate formula. All groups were well matched for age, sex, ethnic origin, nutritional state, and degree of hydration. There was no significance difference in stool frequency or reducing substances, vomiting, and duration of hospital stay between the three groups. Many infants (6/24) refused to take the whey hydrolysate formula, presumably because of unpalatability. Weight gain was more rapid when full-strength milk was given. Clinical relapse developed in 12 (17%) of patients. An enteric pathogen was detected in eight of this group and cow's milk protein intolerance in three (one from each feeding group). No infant had clinically significant lactose intolerance, in marked contrast to previous experience at Queen Elizabeth Hospital. In this group of previously healthy, well-nourished babies with mild acute gastroenteritis, there was no advantage in regrading slowly to milk or a hypoallergenic formula. An immediate return to normal formula 24 h after GEM feeding was well tolerated and simpler for parents.

Acute Disease↗
PubMed1993

[Prevalence of lactose malabsorption in Roman school children. A H2 breath test study using a cow's milk].

The aim of this study was to evaluate the prevalence of lactose malabsorption in a population of 75 (43 males, 32 females) apparently healthy school-children using the H2 breath test with cow's milk. The children, ranging in age from 8 years and 6 months to 15 years and 2 months (mean: 11 years, 7 months) were divided into 2 age groups: Group I (no. = 26): age < 11 years and Group II (no. = 49): age > 11 years. After on overnight fasting, lasting at least 8 hours, samples of expired air were collected at 0 time and at 30-min intervals following the administration of 250 ml cow's milk for a total time of 3 hours. The H2 breath concentration was then measured by gas chromatography (Micro-Lyzer Quintron Instruments Company mod. 12). A net rise of more than 20 ppm H2 was considered as lactose malabsorption. Subjects with symptoms such as excessive flatulence, abdominal pain, or diarrhoea, were considered as lactose intolerant. Two-hundred and 50 ml of cow's milk (12 g of lactose) was considered a more physiological vehicle than the traditional lactose aqueous solution. The examined children, all on free diet, showed a fasting alveolar from 0 to 43 ppm (mean +/- SD = 7.9 +/- 7.6). Sixty-six children out of 70 (93.3%), who completed the test had a total absorption of lactose. Two out of 4 children with lactose malabsorption originated from areas (East Africa and Central America), where a high incidence of this metabolic disorder is a characteristic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Food allergies and food intolerances.

Adverse reactions to foods, aside from those considered toxic, are caused by a particular individual intolerance towards commonly tolerated foods. Intolerance derived from an immunological mechanism is referred to as Food Allergy, the non-immunological form is called Food Intolerance. IgE-mediated food allergy is the most common and dangerous type of adverse food reaction. It is initiated by an impairment of normal Oral Tolerance to food in predisposed individuals (atopic). Food allergy produces respiratory, gastrointestinal, cutaneous and cardiovascular symptoms but often generalized, life-threatening symptoms manifest at a rapid rate-anaphylactic shock. Diagnosis is made using medical history and cutaneous and serological tests but to obtain final confirmation a Double Blind Controlled Food Challenge must be performed. Food intolerances are principally caused by enzymatic defects in the digestive system, as is the case with lactose intolerance, but may also result from pharmacological effects of vasoactive amines present in foods (e.g. Histamine). Prevention and treatment are based on the avoidance of the culprit food.

Food Hypersensitivity↗
PubMed1991

Reversible lactose malabsorption and intolerance in Graves' disease.

Ten patients with untreated Graves' disease underwent tests to determine lactose absorption, liquid gastric emptying, and oral cecal transit time. To determine the influence of thyroid hormone status on lactose absorption, eight of these same patients had repeat studies when rendered euthyroid. Two of these eight patients also underwent studies while transiently hypothyroid. Motility studies were also evaluated in a group of 11 control subjects. Lactose malabsorption occurred in nine patients with Graves' disease. In seven patients who repeated these studies, lactose malabsorption normalized in three, symptoms induced by lactose improved in two and were unchanged in two. However, these latter two patients appeared to have improved symptoms in the transient hypothyroid state. Liquid gastric emptying was significantly faster in untreated patients than controls and treated self-same patients. Transit time was significantly faster in untreated patients than when they were rendered euthyroid. There may be a relationship between altered lactose absorption states and changes in intestinal motility in patients with Graves' disease.

Adult↗
PubMed2005

[Intestinal function tests].

Diagnostic techniques investigating intestinal functions are a main component of gastroenterological diagnostic procedures and are mainly indicated if intestinal motility disturbances or malabsorption syndromes are suspected. H2 breath tests using lactulose or lactitol as substrates measure orocecal transit time. Intestinal manometry allows more detailed analysis of intestinal motility disturbances but is only available at specialized centres. A generalized malabsorption syndrome can be diagnosed by D-xylose test. If it is caused by bacterial overgrowth, the H2 breath test with glucose may be helpful. Lactose intolerance is the most frequently observed intestinal malfunction and affects about 70% of people worldwide. At present, the lactose H2 breath test is the diagnostic procedure of choice to prove lactose malabsorption. Clinically relevant insufficiencies of other intestinal disaccharidases are rare, but may indicate H2 breath tests with specific substrates. Recently developed 13C breath tests using stable, non-radioactive substrates may extend our diagnostic options considerably and may allow more detailed information about intestinal (mal-)functions as a prerequisite for optimized therapy.

Breath Tests↗