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PubMed1995

Persistent diarrhea: management in a diarrhea treatment unit.

Five hundred ninety two children (6.0%) were diagnosed as persistent diarrhea (PD) out of a total attendance of 9795 cases in the Diarrhea Training and Treatment Unit (DTU) over a period of 1 year. Most of the cases were initially managed as outpatients on dietary advice and treatment of associated infections. Eighty eight per cent of the cases followed as outpatients from the DTU responded to treatment and only 11.5% of them had to be hospitalized. A total of 49/592 cases (8.3%) required to be hospitalized on account of treatment failure from outpatients and other indications. Clinical spectrum of hospitalized children included severe malnutrition (40.8%), pneumonia (40.8%), urinary tract infection (32.7%), lactose intolerance (32.7%), anemia (28.6%), septicemia (16.3%), dysentery (8.2%) and neck flop due to hypokalemia (4.1%). Dietary management included modifications in the diet already offered to hospitalized patients. Thirty eight children were fed on one of these diets. Of these 13/35 children (37.1%) were successfully managed with lactose reduced diet., 18/22 cases (81.8%) with lactose free diet and only in 2 cases carbohydrate free diet was given. In 3 cases, normal feeding was continued. Eleven cases were too sick to be offered any oral feeding. Eleven of forty nine cases (22.4%) expired. Mortality was highest in infants <6 months (31.6%). The causes of death included severe malnutrition (14.3%), septicemia (14.3%) and pneumonia (12.2%). Screening and treating cases of PD for associated infections like septicemia, pneumonia and urinary tract infection seems to be a key factor which determines morbidity and mortality in these cases. Feeding on a hospital food modified as lactose reduced/free diet can benefit majority of cases with PD and a very small proportion of cases may require carbohydrate free diet.

Age Distribution↗
PubMedDate not supplied

A novel correlation for rapid lactose determination in milk by a cryoscopic technique.

Residual lactose in special milk was systematically determined for people with lactose intolerance by means of a rapid on-line measurement of the cryoscopic point. A proposed cryoscopic procedure was compared to 2 conventional yet highly laborious methods: the enzymatic procedure with spectrophotometric control and the polarimetric method. Several experiments with different mixtures of both semi-skimmed and low-lactose milk were performed. A lineal relationship was found between lactose concentration and freezing point, the analytical equation for which shows a close relationship regarding the 3 methods used. The advantages of the cryoscopic procedure include speed in obtaining results and operational simplicity at a low cost, better monitoring of enzymatic hydrolysis kinetics, and greater control over the production process for delactosed milk. The equation obtained also enables prediction of the lactose percentage in commercial milk by a simple measurement of freezing point.

Animals↗
PubMed1997

[Nutritional physiology of whey and whey components].

Deriving from positive effects of whey drinking cures in antiquity, the Middle Ages and modern time, a review is given on nutritional significance of whey. The proteins are essential components of whey and belong to the proteins with highest biological value because of their amino acid composition. Besides, they show fundamental functional properties, which enable a varied application in foods, dietetic foods and beverages in form of different whey products (powder, protein concentrates and isolates). Whey proteins have found considerable usage in infant's nutrition as whey predominant formulas as well as whey protein hydrolysates in case of cow's milk protein intolerances. A recent field of research are biological active peptide sequences which become effective during digestion and are of importance for secretion of entero hormones as well as for immune enhancing effects. They may contribute to assess the biological value of whey proteins under enlarged points of view and to develop new application forms and areas. It is pointed to further fields of application (e.g. adipositas, gout, kidney insufficiency). Concerning the quantitatively most dominant lactose in whey, it is dealt with its importance for the healthy development of infants (adaptation to the increased lactose content of mother's milk) as well as with lactose intolerance and galactosaemia. In case of mineral salts of whey it is emphasized the high nutrient density of calcium (prophylaxis for osteoporosis), the beneficial Ca:P and Na:K proportions (antihypertensive in case of the last one), the promotion of absorption of mineral salts by lactose, and the high content of iodine. The whey is rich in B-vitamins, which contribute essentially for their satisfaction or requirement in case of a corresponding consumption. To be emphasized is the vitamin B12 in milk and whey, which is the sole source of this indispensable nutrient for blood-formation and cell division in lacto-ovo-vegetarian nutrition. In conclusion, a summarizing dietetics valuation of whey is performed.

Animals↗
PubMed1988

Production of volatile fatty acids as a result of bacterial interactions in the cecum of gnotobiotic rats and chickens fed a lactose-containing diet.

Volatile fatty acid (VFA) productions from lactose and lactate by a Clostridium butyricum and a Veillonella alcalescens strain, alone or in combination with a Lactobacillus acidophilus strain, were determined both in vitro in culture media and in vivo in the ceca of gnotobiotic animals. Gnotobiotic rats, which possess intestinal lactase, and chickens, which are devoid of it, were used. Both animal species were fed a diet containing 4% lactose. The in vitro results showed that the C. butyricum strain fermented lactose and D-lactic acid to butyric and acetic acids, whereas L-lactic acid was not fermented. The V. alcalescens strain did not ferment lactose and fermented L better than D-lactic acid. The in vivo results showed that high VFA concentrations were obtained in the ceca of chickens either disassociated with V. alcalescens or C. butyricum and Lactobacillus strains or monoassociated with C. butyricum. VFA concentrations in the ceca of rats were low, whatever strain the rats harbored. In addition, an antagonistic effect of the C. butyricum strain against the Lactobacillus strain was evidenced both in rats and chickens. It is suggested that the absence of a host lactase makes the chick a good model for lactose intolerance studies in human newborns.

Anaerobiosis↗
PubMed1992

Use of oral tolerance tests to investigate disaccharide digestion in neonatal foals.

Oral tolerance tests were performed on 13 neonatal foals to determine their ability to digest disaccharides on d 1, 3 and 5 postpartum. Foals were assigned randomly to treatments consisting of 20% (wt/vol) solutions of either maltose, lactose, or sucrose, dosed at 1 g/kg of BW, or glucose, dosed at .5 g/kg of BW. After a 2-h fast, an initial blood sample was collected via jugular catheter. Foals were administered the appropriate solution orally, and blood was collected every 15 min for 1 h and then every 30 min for 3 h. Plasma glucose increased after dosing with lactose or glucose but not with sucrose. Plasma glucose concentrations increased slightly on d 3 and 5 in foals dosed with maltose. These findings suggest that although lactose is well digested by neonatal foals, maltose is digested only slightly, and sucrose is not digested by d 5. Results of this experiment indicate that maltose and sucrose would not be suitable for inclusion in artificial diets for foals less than 1 wk old. Oral tolerance tests could be useful for determining the ability of premature or sick foals with lactose intolerance to digest alternate carbohydrate sources.

Animal Feed↗
PubMed2004

[Yoghurt: a probiotic Mediterranean food].

Yoghurt is a traditional Mediterraean food, based on milk and specific living cultures. Most recent research shows that yogurt bacteria are able to survive passage through the human intestine. Yogurt containing viable starter cultures has been shown to improve lactose digestion in lactose-intolerant people. There are indications for a role of live yogurt cultures in modulating the immune system of the consumer. Long-term consumption of live yogurt reduces nasal allergies, particularly in young adults.

Diet, Mediterranean↗
PubMed2002

Irritable bowel syndrome and nonspecific diarrhea in infancy and childhood--relationship with juice carbohydrate malabsorption.

Lactose intolerance and malabsorbed carbohydrate present in some fruitjuice may trigger symptoms commonly seen in irritable bowel syndrome. In a two-site study, 28 subjects 9 months to 18 years old (mean 6.9 +/- 5.9 years) with significant intake of apple juice or pear nectar (> 6 oz a day) with the diagnoses of irritable bowel syndrome, functional abdominal pain, or chronic nonspecific diarrhea were recruited. Breath hydrogen tolerance tests utilizing lactose, sucrose, and apple juice in the amount they typically consumed were positive in 32%, 0%, and 50%, respectively. Subjects were asked to refrain from the ingestion ofjuice for 1 month: 13 of the 28 (46%) subjects improved while 15 (54%) showed no change in their symptoms. In fact, none consuming 6 to 12 oz of apple or pear juice daily improved, 27% of those consuming 12 to 16 oz improved, and 91% of those consuming > 16 oz improved (P < 0.02). Subjects were then given comparable amounts of white grape juice for 1 year. The initial symptoms did not recur in any of the subjects who initially responded to the juice-free diet. Of the 15 subjects who did not respond to the juice-free diet, seven became asymptomatic. Overall, 20 subjects (71%) were asymptomatic, and eight (29%) had no change in their symptoms. Some individuals with irritable bowel syndrome have their symptoms based on their malabsorption of carbohydrates present in apple juice and pear nectar and may improve with adequate choices of fruit juice such as changing to white grape juice.

Adolescent↗
PubMed1999

The widening spectrum of celiac disease.

Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage to the small-intestinal mucosa. Celiac disease is associated with both human leukocyte antigen (HLA) and non-HLA genes and with other immune disorders, notably juvenile diabetes and thyroid disease. The classic sprue syndrome of steatorrhea and malnutrition coupled with multiple deficiency states may be less common than more subtle and often monosymptomatic presentations of the disease. Diverse problems such as dental anomalies, short stature, osteopenic bone disease, lactose intolerance, infertility, and nonspecific abdominal pain among many others may be the only manifestations of celiac disease. The rate at which celiac disease is diagnosed depends on the level of suspicion for the disease. Although diagnosis relies on intestinal biopsy findings, serologic tests are useful as screening tools and as an adjunct to diagnosis. The treatment of celiac disease is lifelong avoidance of dietary gluten. Gluten-free diets are now readily achievable with appropriate professional instruction and community support. Both benign and malignant complications of celiac disease occur but these can often be avoided by early diagnosis and compliance with a gluten-free diet.

Celiac Disease↗
PubMedDate not supplied

Studies on malabsorption in malnourished Pakistani children.

Malnutrition is a common finding in Pakistan especially in children of low socio-economic class. Impairment of digestion and absorption makes the diet inefficient at fulfilling the requirements of the child and leads to malnutrition. Earlier work from this laboratory has shown that feeding a high-protein diet to children suffering from protein-energy malnutrition (PEM) did not improve their condition. In the present study forty-two malnourished children and seventeen control subjects were investigated. They were divided into five groups, i.e. fibrocystic disease of the pancreas (n = 9), coeliac disease (n = 17), lactose intolerance (n = 5), PEM (n = 5) and nonspecific diarrhoea (n = 6) on the basis of history, clinical impression and biochemical findings. They were from 6 months to 12 years of age. The majority of them were suffering from diarrhoea, distension of the abdomen and retardation of growth. All children were physically examined and anthropometric measurements were recorded. Changes in hair in the form of sparseness, dyspigmentation and easy pluckability were observed in all groups. In PEM, 80% of the cases had enlarged livers. All children had reduced weight and height as compared with the control group. Haemoglobin, total protein and serum albumin showed a decrease and the fall was greatest in PEM cases as compared with the control group. The excretion of alpha-amino nitrogen increased in PEM children while hydroxyproline and creatinine levels showed a decrease as compared with the control group. The hydroxyproline index, which signifies the growth rate, was also significantly lower in all groups. Xylose and lactose tolerance tests were performed after an oral dose of xylose or lactose respectively. The xylose concentration after the test dose was reduced with the lowest values in the coeliac disease group as compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Proteins↗
PubMed1988

Reduced intolerance symptoms from lactose consumed during a meal.

Lactose digestion from and tolerance to lactose-containing beverages consumed with food was evaluated in 12 lactase-deficient subjects by breath-hydrogen techniques. Peak hydrogen production after a milk-based food supplement was delayed 2 h as compared with a lactose solution. Addition of a breakfast meal further delayed peak hydrogen production by 1 h. Hydrogen production was significantly lower (p less than 0.03) for the first 4 h after ingestion of the supplement plus meal compared with the supplement alone. Nine subjects experienced intolerance symptoms after consumption of the supplement alone but only three experienced them after consumption of the meal plus supplement. Severity of symptoms was significantly reduced with the ingestion of the supplement compared with an equal lactose load and was further reduced with the consumption of food, presumably due to delayed gastric emptying. Thus, lactose malabsorbers should consume food simultaneously with lactose-containing beverages to reduce intolerance symptoms.

Adult↗
PubMed1987

Medical problems of foreign-born adopted children.

Over 8000 foreign-born children, almost all from third-world countries, are adopted by citizens of the United States each year. Most primary care practitioners do not have enough experience to evaluate and manage their problems efficiently. We reviewed the medical care of the foreign-born adoptees followed up in a single pediatric group practice. The 128 children arrived from one of eight countries in Asia or Latin America at ages ranging from 1 month to 10 years; 57% were female. The median duration of follow-up was 20 months. The most common problems identified included deficient immunizations (37%), intestinal parasites (29%), emotional or behavioral problems (22%), skin diseases (16%), estimated age (12%), scabies and/or lice (10%), and congenital anomales (10%). Twenty-one other classes of problems were identified, including developmental delay, lactose intolerance, vision and hearing deficits, and chronic hepatitis B carrier status. At arrival or within one month, 49% of the children had acute infectious diseases, including upper respiratory tract infection, otitis media, rubeola, varicella, and mumps. Nineteen percent of the children underwent surgical procedures ranging from circumcision to cleft lip-palate repair; 46% of these children were never screened for hepatitis B. Fourteen percent were hospitalized at least once, 5% within the first month after arrival. We developed a simple protocol to screen foreign-born adopted children, allowing rapid identification of treatable problems at the least cost and inconvenience to the family. Thirty-six percent of the families made at least one preadoption visit, permitting an explanation of the protocol and potential problems before the child's arrival.

Adoption↗
PubMed1995

The epidemiology of ovarian cancer.

Ovarian cancer is the second most common cancer of the female reproductive system and the leading cause of death from gynecologic malignancies. In 1995, 26,600 women will be diagnosed with ovarian cancer in the U.S., and 14,500 women will die from the disease. Between 1986-1900, the overall age-adjusted incidence was 14.3/100,000 women; mortality was 7.8/100,000 women. Ovarian cancer, rare before age 40, increases steeply thereafter and peaks at ages 65-75. Incidence and mortality rates are higher among white women than among African-American women. Over the last three decades, ovarian cancer incidence has remained stable in high-risk countries, while an increasing trend has been reported in low-risk countries. Despite recent advancements in treatment, the overall five-year survival rates continues to be low (39%). Over 70% of ovarian tumors are diagnosed when regional or distant involvement has already occurred, causing survival rates to remain stable. The etiology of ovarian cancer is poorly understood. Most studies have focused on the epidemiology of invasive epithelial ovarian tumors, while few have explored the epidemiology of epithelial tumors of low malignant potential and nonepithelial tumors. Factors associated with an increased risk for invasive epithelial ovarian cancer include age, race, nulliparity, family history of ovarian cancer, and history of endometrial or breast cancer. Factors associated with a reduced risk are history of one or more full-term pregnancies, use of oral contraceptives, history of breast feeding, tubal ligation, and hysterectomy. Other factors such as infertility drugs, hormone replacement therapy, age at menarche, age at menopause, dietary factors, lactose intolerance, talc use, coffee and alcohol consumption have been suggested, but their role is still inconclusive.

Female↗
PubMed1983

Persistence of high intestinal lactase activity in Pakistan.

In order to determine the incidence of persistence of high intestinal lactase activity (PLA) in a Pakistani human population, 53 probands belonging to the Punjabi ethnic group were examined using a lactose tolerance test. The incidence of PLA in the sample was found to be 55%, which has been compared with the incidence in other ethnic groups racially or geographically related to the Pakistani population. Various possible explanations for the fairly high incidence of PLA in the Punjabi ethnic group have been discussed.

Adolescent↗
PubMed1995

Effects of active addition of bacterial cultures in fermented milk to patients with chronic bowel discomfort following irradiation.

Radiotherapy is a cornerstone in the treatment of malignancies in the pelvis. Consequently, there is usually exposure of the intestine and especially the lower colon and rectum, with ensuing disturbances in bowel habits at different times following radiotherapy. The main problem is diarrhoea associated with lactose intolerance, bile salt absorption and fat malabsorption. Bacterial contamination has also been described. In the present study we have evaluated the influence of the active administration of specific bacterial cultures in fermented milk, which inhibit the growth of potentially pathogenic micro-organisms, to 40 consecutive patients with chronic alteration in their bowel habits caused by previous radiotherapy of pelvic malignancies. The results suggest that intake of fermented milk products could be of value in decreasing chronic bowel discomfort following radiotherapy of pelvic malignancies. However, a more extensive study is warranted in order to very the significance of the results and to find the optimal product.

Animals↗
PubMed1977

Individual sensitivity to lactose in lactose malabsorption.

The clinical significance of lactose malabsorption and the individual sensitivity to lactose were investigated in 20 patients with verified lactose malabsorption. Thirteen patients were relieved of all symptoms while seven improved only on a lactose-free dth lactose-free milk but following provocation with increasing amounts of lactose, the tendency to diarrhea and abdominal discomfort increased considerably. Three patients experienced discomfort after provocation with only 5 gl lactose. On provocation with increasing amounts of lactose the seven patients who had not recovered also developed increased abdominal discomfort but none of them developed increased tendency to diarrhea. It is concluded that, in addition to lactose malabsorption, these patients must suffer from ittitable colon with tendency to constipation.

Abdomen↗
PubMed1978

Adequacy of endoscopic biopsy specimens for disaccharidase assays.

Intestinal mucosa from 40 patients obtained by fiber-endoscopic biopsy was assayed for disaccharidases to determine suitability of this tissue for assay. The combined specimens from each patient provided 4.7-38.7 mg of tissue, adequate in all instances for duplicate determinations of protein, lactase, sucrase, and maltase. Tissue remained for assays of palatinase in 39 instances, trehalase and cellobiase in 37, and alkaline phosphatase in 22 cases. Twenty-four subjects had normal lactose tolerance tests and normal sucrase/lactase ratios. Thirteen patients with abnormal oral lactose tolerance tests were identified as having a primary low lactase activity on the basis of elevated sucrase/lactase ratios. This ratio was most helpful in making the diagnosis of a primary low lactase, since the mucosal specimens were not obtained from comparable areas. Tissue from three subjects with an abnormally low maltase was unsuitable for diagnosis. Endoscopic biopsy of mucosa appears to be satisfactory for disaccharidase assays in most instances.

Adult↗
PubMed1988

Prediction of lactose malabsorption in referral patients.

Two hundred forty-two patients referred for various gastrointestinal complaints were evaluated for clinical parameters that would predict findings of lactose malabsorption. Breath hydrogen and blood glucose lactose tests were performed after ingestion of 50 g lactose. Presenting complaints, duration of symptoms, and patient demographics such as age, sex, and ethnic heritage were not different between lactose malabsorbers and absorbers as defined by the breath hydrogen lactose test. Food-related symptoms in general and after specific foods such as milk, ice cream, cheese, and yogurt were also similar between groups. Prior to testing, 30% of malabsorbers (N = 161) and 36% of absorbers (N = 81) reported lactose-related symptoms (P = NS). The blood glucose response to lactose was abnormal in 60% of malabsorbers and 15% of absorbers. This study confirmed our impression that it is difficult to predict lactose absorption status by clinical parameters. The majority of our lactose malabsorber patients were unaware of lactose-associated symptoms. Furthermore, symptom assessment, demographics, food history, and blood glucose testing did not predict abnormal hydrogen responses to lactose.

Adult↗