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PubMed1984

Effect of long-term, peroral administration of sugar alcohols on man.

Certain sugar alcohols (polyols), notably mannitol, sorbitol and xylitol have gained use in food manufacturing for sweetening and technical purposes. These compounds are natural polyols that occur in small amounts in animals and plants. Some sugar alcohols, like xylitol, appear as normal intermediates in the carbohydrate metabolism. Exogenous mannitol, sorbitol and xylitol are metabolized in the human body along pre-existing, physiological pathways. Moderate doses of least xylitol and sorbitol are almost totally absorbed and metabolized, chiefly in the liver cells, thereby eventually contributing to the formation of glucose and liver glycogen. Various slowly absorbed carbohydrates, including sugar alcohols, when taken in orally in large quantities, can give rise to osmotic diarrhea. The available data indicate that the severity of such gastro-intestinal disturbances, induced by large doses of polyols, decrease in the following order: mannitol, sorbitol, xylitol. This osmotic diarrhea resembles that caused by lactose in subjects with restricted or frank lactose intolerance. The quantities of xylitol, for example, required to elicit diarrhea are so high that the consumption of xylitol for dental purposes does not cause any problems in children or adults. Long-term feeding trials and peroral loading experiments on human subjects have been unable to show any clinically significant differences between chronic users of xylitol and comparative human material in factors related to various metabolic functions of the body. These subjects have not shown any delayed or acute reactions which could be distinguished from those caused by the consumption of a sucrose diet. The available clinical data generally suggest that moderate consumption of the above polyols is not harmful to human metabolism.

Absorption↗
PubMed1984

[Biological evaluation, in rats and in humans, of a milk product without lactose, and of a soybean protein formula for use in protein-calorie malnutrition].

Protein quality of a lactose-free milk (LFM) was compared with a soy-protein isolate (SPI) by means of the PER and 24-hour nitrogen balance methods performed with 16 infants with protein-energy malnutrition. PER was 1.19 for the SPI, value which is significantly lower than that of 2.28 obtained for LFM, and 2.71 for casein. Nitrogen absorption of LFM and SPI was 80%. The biological value of both formulas did not differ significantly; however, in six month-old babies or younger with severe malnutrition, nitrogen retention was higher with LFM than with SPI. On the other hand, nitrogen retention was higher in infants 11 and 12 months old with moderate malnutrition fed the SPI formula. The results suggest that both formulas are good alternatives for the treatment of infants with protein-energy malnutrition and lactose intolerance.

Animals↗
PubMedDate not supplied

Gastric emptying of lactose and glucose-galactose in patients with low intestinal lactase activity.

To test the hypothesis that in subjects with low intestinal lactase activity (LLA) lactose solutions leaves the stomach at an abnormally fast rate, we have measured the gastric emptying rate of solutions of lactose and glucose-galactose in patients with LLA (n = 9) and in control subjects with high intestinal lactase levels (n = 7) as proved by the assay of disaccharidases in specimens of intestinal mucosa. The volume of the test meals was 300 ml. Lactose solutions contain 50 g of disaccharide and glucose-galactose solutions contain 25 g of each monosaccharide. The volumes remaining in the stomach at different times after the intragastric instillation of the test meals were estimated by the double sampling test meal. In the control group, minor differences between lactose and glucose-galactose gastric emptying rates was found. By contrast, in LLA patients, the lactose meal left the stomach at a significantly faster rate than the glucose-galactose test meal. These findings support previous evidence obtained in patients with putatively low intestinal lactase activity and are consistent with the view that duodenal osmoreceptors, whose excitation results in inhibition of gastric emptying, lie deeper than the disaccharidases in intestinal mucosa. Thus, incomplete hydrolysis of lactose results in a faster than normal gastric emptying rate of the sugar and this may contribute to the symptoms found in LLA patients after milk ingestion.

Adult↗
PubMed1983

Evolutionary and social aspects of disease.

There are important interactions between disease and organic evolution, between disease and cultural evolution, and between all three. Social behaviour influences disease and is influenced by it. Disease and disease mortality are woven into the complex of behavioural and physiological reactions to the stresses of overpopulation, which act to reduce population size. These principles are illustrated with reference to a number of diseases, including vitamin D imbalance, phenylketonuria, lactose intolerance, malaria, sickle cell anaemia, favism, plague, yellow fever, syphilis, ergot poisoning, kuru, and the sweating sickness.

Agriculture↗
PubMed1980

Intestinal disaccharidase activities and activity ratios in a group of 60 adult German subjects.

Lactase, maltase and sucrase activities were determined in samples of jejunal mucosa obtained by suction biopsy from 60 healthy adult German males. Primary adult hypolactasia ("lactase deficiency") was found in 8 subjects (13%). Maltase:lactase and sucrase:lactase activity ratios were significantly higher in post-weaning hypolactasia than in adult lactase persistence. Sources of variation in disaccharidase activities measured in biopsy tissue homogenates are discussed.

Adult↗
PubMedDate not supplied

[Lactose malabsorption in adult patients at the Hospital das Clínicas de Ribeirão Preto].

A standard oral lactose tolerance test (LTT) was performed in 32 white and 18 non-white hospitalized Brazilian adults. A flat LTT was found in 22 (68,75%) white and in 17 (97,45%) non-white patients indicating a 78% overall rate of lactose malabsorption, Both lactose absorbers and malabsorbers showed a modal milk ingestion of less than a 1 glass/day. Symptoms related to milk consumption or lactose administration were more common among lactose malabsorbers. Estimations of disaccharidase activity in intestinal mucosa specimens obtained by peroral biopsy in 28 patients confirmed a high prevalence of lactose deficiency, and disclosed only one false result, in the patient with a flat LTT and high intestinal lactase levels.

Adolescent↗
PubMed1981

Recurrent abdominal pain and lactose absorption in children.

The association of lactase deficiency with recurrent abdominal pain was investigated. One hundred three white children between the ages of 6 to 14 years with recurrent abdominal pain were evaluated. Sixty-nine underwent lactose tolerance tests and 26 had intestinal biopsies with lactase determinations; 21 of 69 (30.4%) had abnormal lactose tolerance tests and eight of 26 (31%) were lactase deficient. However, 16 of 61 (26.4%) control subjects matched for age and ethnic background exhibited lactase deficiency. Thus, a similar prevalence of lactase deficiency was found in the control and the recurrent abdominal pain groups. Thirty-eight patients with recurrent abdominal pain completed three successive six-week diet trials conducted in a double-blind fashion. An increase above base line value in pain frequency was seen in ten of 21 (48%) lactose malabsorbers and four of 17 (24%) lactose absorbers. After a 12-month milk elimination diet, six of 15 (40%) malabsorbers and five of 13 (38%) absorbers had elimination of their pain. This result compared with improvement occurring in five of 12 (42%) absorbers with recurrent abdominal pain who received a regular diet for one year and suggests that the elimination of lactose will not affect the overall frequency of improvement in recurrent abdominal pain. In addition, the recovery rate from recurrent abdominal pain is similar in both lactose absorbers and nonabsorbers independent of dietary restrictions.

Abdomen↗
PubMed1981

Mucosal function and breath hydrogen excretion: comparative studies in the clinical evaluation of children with nonspecific abdominal complaints.

To evaluate the role of the lactose breath hydrogen test for the detection of lactose malabsorption in children with chronic nonspecific abdominal complaints, breath hydrogen excretion was measured in 131 children with recurrent abdominal pain (n = 75) or chronic nonspecific diarrhea (n = 56) following a lactose load (2 gm/kg; maximum 50 gm). The data were compared to those obtained from lactose tolerance tests (n = 113) and symptom response following a lactose load (n = 109) performed simultaneously with the lactose breath hydrogen test, and with results from small bowel biopsies obtained in 31 children to determine dissacharidase activity and mucosal histology. The results indicate that an increase in breath hydrogen of greater than 10 ppm above base line values (delta ppm) by 120 minutes ("early increase" response) completely discriminates between biopsy-proven isolated lactase-insufficient and lactase-sufficient children. A similar increase after 120 minutes ("late increase" response) is consistent both with normal mucosal function and partial lactase insufficiency due to mucosal injury. Breath hydrogen responses predicted assayed lactase activity in all patients with isolated lactase insufficiency, but were "falsely negative" in four of ten children whose lactase insufficiency was secondary to mucosal injury. In both clinical groups, lactose malabsorbers report significantly more symptoms than absorbers (P less than .001), but neither symptom reports nor tolerance tests are accurate methods for distinguishing lactose malabsorbers from absorbers. Although the lactose breath hydrogen test provides objective documentation of lactose malabsorption, it is equally predictive of assayed lactase activity in all clinical groups.

Abdomen↗
PubMed1980

[Lactase deficiency in the intestinal mucosa. Demonstration by hydrogen detection in the expired air after lactose loading (author's transl)].

Lactose malabsorption can be demonstrated by detecting hydrogen (H2) in the expired air after oral loading with lactose. A comparative study was carried out on 24 subjects. Following an oral loading dose of lactose, the H2 eliminated during expiration was assayed by gas chromatography, and blood galactose levels were measured. The results showed that the test was reliable, well tolerated and reproductible. However, the method does not measure the amounts of lactase present in the intestinal mucosa. The lactose loading test seems to be valuable for studies on lactose and carbohydrate malabsorption.

Adult↗
PubMed1995

Modern management of acute diarrhea and dehydration in children.

Advances in clinical and laboratory knowledge have led to new concepts in the management of acute infectious diarrhea in children. The major advance has been the development of oral rehydration therapy, which is effective for the treatment of diarrhea of any etiology in patients of any age. Optimal management of acute infectious diarrhea includes the following: (1) rapid rehydration (and maintenance of hydration) using an appropriate glucose-based or cereal-based oral rehydration solution; (2) early refeeding with a mixed diet and no interruption of breast feeding; (3) continuation of lactose-containing foods unless clinical signs of lactose intolerance develop, and (4) a staged laboratory evaluation, with the administration of antimicrobial therapy when indicated.

Acute Disease↗
PubMed1995

[Results of the 75selenium homotaurocholic acid retention test (SeHCAT test) in diagnosis of diarrhea].

PATIENTS AND METHOD: For that reason absorption of bile acids was investigated using the 75Se-homotaurocholate (SeHCAT) in 239 patients with diarrhoea. SeHCAT retention time was measured as 7 day retention time in a whole body counter. An intact bile acid absorption (negative SeHCAT test) was confirmed in 23 healthy volunteers within the range of 11 to 50% (mean +/- double standard deviation). RESULTS: In 135 patients with a possible type I bile salt malabsorption the SeHCAT test was positive in 78%, thus indicating bile salt malabsorption. The test is very sensitive detecting bile salt malabsorption in Crohn's disease, identifying ileal disease more precisely than radiology. The SeHCAT test ascertained type II primary bile salt malabsorption in 7 patients, as well as type III bile salt malabsorption in patients (9 out of 28) with cholecystectomy, vagotomy, partial gastrectomy and chronic pancreatitis. In addition, a positive SeHCAT test indicating bile acid malabsorption was found in 5 out of 11 patients with irritable syndrome, diarrhoeic form, and in 4 out of 12 patients with lactose intolerance. CONCLUSION: SeHCAT retention should be measured routinely in patients with chronic diarrhoea for which the cause is not obvious.

Adult↗