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PubMed2002

The role of fermented milk in complementary feeding of young children: lessons from transition countries.

Probiotic bacteria are used for production of fermented dairy products. The use of probiotic bacteria has the potential to replenish the natural intestinal flora of the body. These bacteria competitively inhibit the growth and colonization of pathogenic bacteria. Breastmilk is the best food for babies, also from a probiotic point of view. Human milk, in fact, contains many substances that stimulate the growth of bifidobacteria in vitro and in the small intestine of infants. Improvement of lactose digestion and avoidance of symptoms of intolerance in lactose malabsorbers are the most profoundly studied health-relevant effects of fermented milk. In fact fermented milks are nutritionally similar to unfermented milk, except that some of lactose is broken down to glucose and galactose. The role of fermented milk in complementary feeding and in particular for the prevention of anaemia is an innovative theme, recently focused. Iron deficiency in infants and young children is widespread and has serious consequences for child health. Prevention of iron deficiency should therefore be given high priority. The too-early introduction of unmodified cow's milk and milk products is an important nutritional risk factors for the development of iron-deficiency anaemia. Fermented milks represent an excellent source of nutrients such as calcium, protein, phosphorus and riboflavin. During the fermentation of milk, lactic acid and other organic acids are produced and these increase the absorption of iron. If fermented milk is consumed at mealtimes, these acids are likely to have a positive effect on the absorption of iron from other foods.

Anemia, Iron-Deficiency↗
PubMed1979

Cows' milk protein-sensitive enteropathy: an important contributing cause of secondary sugar intolerance in young infants with acute infective enteritis.

The effect of cows' milk protein (CMP) on the mucosal disaccharidases was investigated in 23 infants with acute infective enteritis. Jejunal biopsies performed before and after cows' milk provocation were subjected to histological examination and to mucosal disaccharidase enzyme (lactase, sucrase, and maltase) analyses. After milk challenge, changes in mucosal histology were observed in 18 infants, in 17 of them the levels of all 3 mucosal disaccharidases were much reduced. 10 of these infants developed diarrhoea and, in 6, the stools were positive for reducing sugar. It is concluded that CMP has a deleterious effect on the jejunal mucosa of young infants recovering from infective enteritis, so that in the management of young infants with sugar intolerance secondary to infective enteritis, CMP and lactose should be excluded from the diet.

Acute Disease↗
PubMed2001

Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance.

BACKGROUND: The relationship between lactose malabsorption, irritable bowel syndrome and development of intestinal symptoms is unclear, especially when the ingested dose of milk is small. Thus, the role of hydrogen breath testing in the diagnostic work-up of patients with nonspecific intestinal symptoms is still debated. AIMS: To establish the relationship between lactose malabsorption, severe self-reported milk intolerance, irritable bowel syndrome and related symptoms. METHODS: The prevalence of lactose malabsorption was prospectively assessed by means of a hydrogen breath test in 839 patients (503 with irritable bowel syndrome, based on the Rome criteria, regularly consuming milk, and 336 subjects who identified themself as milk intolerant, after an oral load of 25 g lactose). The test was considered "positive" when a hydrogen peak exceeding 20 ppm over baseline values was observed in two or more samples. Attempts were also made to establish whether the predominant presenting symptom (diarrhoea, constipation, alternating diarrhoea and constipation, pain and gaseousness) might be helpful in predicting the outcome of the breath test. RESULTS: The prevalence of a positive breath test was comparable in the two groups (337 patients with irritable bowel syndrome (66.9%) vs 240 patients with milk intolerance (71.4%)). The same holds true for the first peak of hydrogen excretion, total hydrogen output and prevalence of symptoms during, and in the four hours after, the test. The predominant presenting symptom was not useful for predicting outcome of the test either in regular milk users or in milk intolerant subjects. CONCLUSIONS: The almost identical results of the lactose breath test of patients with irritable bowel syndrome and subjects with self-reported milk intolerance suggests that the two conditions overlap to such an extent that the clinical approach should be the same. A lactose breath test should always be included in the diagnostic work-up for irritable bowel syndrome, as fermentation of malabsorbed lactose is likely responsible for triggering symptoms. Conversely, lactase deficiency is probably irrelevant in most subjects not affected by irritable bowel syndrome, within a moderate milk consumption.

Adolescent↗
PubMed1977

Food hypersensitivity allergy or malabsorption.

The terms milk allergy, milk sensitivity, and milk intolerance are used in the medical literature with different meanings. Milk allergy and lactase deficiency to which they are usually referring can be specifically differentiated and diagnosed. A modification of the Rinkel oral test meal can be used to separate these two entities for medical diagnostic accuracy and understanding.

Animals↗
PubMed1984

Prevalence of primary adult lactose malabsorption and awareness of milk intolerance in Italy.

A total of 308 healthy Italian adults (192 females, 116 males; mean age 29.2 yr) were examined using a field version of the lactose tolerance test with breath hydrogen determination. Two geographical groups were formed according to the birth places of the probands' grandparents: 208 subjects from northern Italy (mainly from the regions of Piemonte, Lombardia, and Veneto) and 100 probands from Sicily. Lactose malabsorption was diagnosed in 106 subjects in group "north" (51%) and in 71 subjects in group "Sicily" (71%). Awareness of milk intolerance was more frequent in lactose malabsorbers. The incidence of diarrhea after the test dose of lactose was significantly higher in "aware" lactose malabsorbers, when compared with persons of the same group who had not experienced milk intolerance. The significant difference in lactose malabsorption frequency between northern Italy and Sicily is further evidence of a north-south gradient of lactase gene frequencies in Europe.

Adult↗
PubMed1978

Four cases of long-standing diarrhoea and colic pains cured by fructose-free diet--a pathogenetic discussion.

Four patients with a long history of abdominal swelling, colic pains and diarrhoea were cured by a fructose-free diet. They were all given an oral load of (14C) fructose and their expiratory excretion of 14CO2 was found to be significantly lower than that of control patients with similar symptoms. It is concluded taht the patients cured by a fructose-free diet might have a partial fructose malabsorption.

Adult↗
PubMed2005

Influence of changes in lactase activity and small-intestinal mucosal growth on lactose digestion and absorption in preterm infants.

BACKGROUND: Feeding intolerance (ie, achieving and maintaining full enteral feedings) is a significant problem in preterm infants. A relation exists between feeding intolerance and incomplete lactose digestion. OBJECTIVES: We sought to identify the factors relating to lactose digestion and absorption, lactase activity, and small-intestinal mucosal growth. DESIGN: Lactose digestion and absorption, lactase-specific activity, and lumen-to-mucosa water flux as a measure of small-intestinal mucosal surface area were determined by using the triple-lumen perfusion technique on 2 occasions 3 wk apart in 10 preterm infants (x+/-SEM gestational age: 28.0+/-0.2 wk). RESULTS: Lactose digestion and absorption and lactase activity doubled between studies (P=0.035 and P=0.041, respectively). The change in digestion and absorption was related to lactase activity (P=0.034, R2=0.38). Lactase activity correlated with gestational age at birth (P=0.012, R2=0.51). The number of days of feeding explained 80% of the variability in small-intestinal mucosal surface area (P=0.001). CONCLUSIONS: To our knowledge, this is the first study to measure directly lactose digestion and absorption, lactase activity, and small-intestinal surface area in preterm infants. Changes in lactose absorption relate primarily to lactase activity rather than to mucosal growth. We showed directly a relation between enteral feeding and small-intestinal mucosal growth.

Digestion↗
PubMed1994

Milk tolerance in adults with ulcerative colitis.

OBJECTIVES: There has been concern in the literature and among physicians and patients that milk intolerance may contribute to disease activity in ulcerative colitis. We sought to define whether patients with ulcerative colitis have problems with milk tolerance. METHODS: 1) A questionnaire was administered to a group of gastroenterologists. 2) Consecutive unselected ulcerative colitis patients were administered a questionnaire regarding issues concerning their ingestion and tolerance of milk products. 3) Patients, and age- and ethnically matched controls, underwent lactose hydrogen breath testing at a 50-g dose, and if intolerant, returned for testing at a 12.5-g dose. RESULTS: Eighty percent of responding physicians stated that they recommend avoidance of milk products at some time to their patients. Thirteen of 29 (44%) ulcerative colitis patients were lactose intolerant compared with five of 14 (36%) controls (p = 0.57). Of 11 subjects returning for the 12.5-g test dose, only three (28%) were intolerant. Of 10 ulcerative colitis patients tested during a flare, only two (20%) were intolerant. Nineteen of 28 (66%) patients reduced or eliminated milk products from their diet, but only 10 (45%) of these patients were lactose intolerant. The discordance rate for predicting lactose tolerance status among patients was 35%. By logistic regression analysis, age (p = 0.04) and ethnicity (p = 0.006) were the only variables that were predictive of an abnormal lactose hydrogen breath test. CONCLUSIONS: There are common misperceptions among physicians and patients about lactose intolerance in ulcerative colitis. Lactose intolerance in patients with ulcerative colitis is dependent on their age and ethnicity and not any particular aspects of their disease. The proscription of milk products during flares of disease by many physicians is not supported by this study.

Adult↗
PubMed1992

[Diagnostic and therapeutic problems in Lamblia infections].

A 28-year-old woman complained of chronic diarrhoea of about one year's duration, made worse by taking food. As a lactose tolerance test showed evidence of severe intolerance she was given a lactose-free diet, but this brought no improvement. Duodenal biopsy showed villous atrophy, and in the duodenal juice there were numerous flagellated lamblia. After a single oral dose of 2 g tinidazole the diarrhoea stopped, the lamblia disappeared, and the lactose intolerance and villous atrophy cleared up. Lamblia were also detected in the duodenal juice of a 50-year-old woman, but her infection was much more difficult to treat. Tinidazole (single dose of 2 g), metronidazole (800 mg twice daily for 6 days), ornidazole orally 500 mg twice daily for 10 days and ornidazole intravenously 500 mg twice daily for four days all proved ineffective. However, after a 5-day course of epsilon-9-aminacridine (100 mg three times daily by mouth) the diarrhoea ceased and both vegetative forms and lamblia cysts disappeared. These cases emphasize that lambliasis should be considered as a possible cause of severe chronic diarrhoea even when there is no history of travel abroad and when the symptoms are atypical. Conventional chemotherapeutic agents may be ineffective.

Adult↗
PubMed1980

Comparative tolerance of adolescents of differing ethic backgrounds to lactose-containing and lactose-free dairy drinks. I. Initial experience with a double-blind procedure.

A lactose-free (LF) chocolate dairy drink and one containing 4.5% lactose (LC) were administered randomly in 240- and 480-ml volumes on 4 consecutive mornings under double-blind conditions to 110 healthy teenagers (14 to 19 years old) of differing ethnic backgrounds. Capillary blood glucose analysis after 50 g of oral lactose identified 67 of them as lactose malabsorbers. Neither absorbers nor malabsorbers reported significantly different gastrointestinal symptoms after 240 ml of LC compared with the same amount of LF. However, 17 absorbers and 21 malabsorbers reported symptoms inconsistent with intolerance due to lactose. These subjects had symptoms after LF only, after both LF and LC, or after 240 ml but not 480 ml of LC. After 480 ml of LC, 26 malabsorbers had symptoms, compared to 15 after 480 ml of LF. The prevalence of symptoms after 480 ml of LC, but not after 480 ml of LF, was 7% for absorbers, and 24% for malabsorbers. The results indicate that most of the individuals who reported gastrointestinal symptoms after ingestion of the two beverages did so for reasons other than their lactose content.

Adolescent↗
PubMed1983

Irritable bowel syndrome. Role of lactase deficiency.

In adults with the irritable bowel syndrome who had no history of milk intolerance, the prevalence of lactase deficiency and the value of lactose restriction were determined. Eighty subjects with the irritable bowel syndrome who were white, non-Jewish, and of northern-western European background were screened for lactase deficiency by means of the hydrogen breath test. Lactase deficiency was found in 5 of the 80 subjects with the irritable bowel syndrome and in 6 of the 100 subjects without intestinal symptoms who were of comparable ethnic background. After exclusion of milk from the diet, three of the five subjects with lactase deficiency and the irritable bowel syndrome had partial to complete relief of symptoms for 3 weeks, and two of these had sustained relief for 1 year (one with complete and one with 75% improvement). Lactase deficiency was found to be a relatively uncommon cause of irritable bowel symptoms among non-Jewish whites who are of northern-western European background.

Adult↗