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PubMed1997

Lactose intolerance associated with fractures of weight-bearing bones in Finnish women aged 38-57 years.

Lactose intolerance (LI) often results in decreased calcium intake. To test if long-term low intake of calcium affects bone strength, we examined fracture risks related to LI in women aged 38-57 years. The 11,619 Finnish women aged 47-56 years who responded to the baseline postal inquiry of the Kuopio Osteoporosis Risk Factor and Prevention Study in 1989 formed the study population. In all, 896 women reported LI and 1299 women reported a fracture in 1980-1989. Current intake of dairy calcium was lower in women with LI (570 mg/d) than in the other women (850 mg/d) (p < 0.0001). The fracture risk in general was slightly elevated in women with LI compared with the other women, with an odds ratio (OR) (95% CI) of 1.33 (1.09-1.62). However, the fractures at the three most common sites (wrist, ankle, and rib) were not related to LI. In contrast, fractures at the tibia and metatarsal were strongly related to LI with ORs of 3.31 (1.51-7.24) and 2.84 (1.47-5.50), respectively. The adjusted OR for nonankle lower body fractures combined was 2.15 (1.53-3.04), whereas that for all upper body fractures combined was 1.15 (0.88-1.54). The 10 women with LI and a tibial or metatarsal fracture showed a 19% lower femoral BMD than all the other women in the densitometry subsample of 3222 women (p < 0.001). Long-term premenopausal calcium deficiency differentially affects bones with weight-bearing nonankle bones being at the greatest risk of suffering reduced strength.

Adult↗
PubMed1991

Lactose intolerance and the genetic regulation of intestinal lactase-phlorizin hydrolase.

Lactase-phlorizin hydrolase, which hydrolyzes lactose, the major carbohydrate in milk, plays a critical role in the nutrition of the mammalian neonate. Lactose intolerance in adult humans is common, usually due to low levels of small intestinal lactase. Low lactase levels result from either intestinal injury or (in the majority of the world's adult population) alterations in the genetic expression of lactase. Although the mechanism of decreased lactase levels has been the subject of intensive investigation, no consensus has yet emerged. Recent studies have begun to define the cellular and molecular biology of this enzyme. In animals and humans, a glycosylated precursor is proteolytically cleaved to yield the mature enzyme on the microvillus membrane of the enterocyte, bound to the lipid bilayer only by a hydrophobic anchor sequence. The enzyme hydrolyzes lactose, phlorizin, and glycosylceramides. A decline in lactase specific activity occurs at the time of weaning in most mammalian species; in most humans who have low lactase activity as adults, the decline occurs at approximately 3-5 years of age. In a few human groups, the elevated juvenile level of lactase specific activity persists throughout adulthood. These developmental patterns of lactase expression are most likely regulated at the level of gene transcription.

Animals↗
PubMed1981

Lactose intolerance in North and South Indians.

A multicenter study was carried out in India to determine the incidence of lactose intolerance in healthy volunteers from different parts of the country. The incidence was found to be 66.6% in the subjects from two South Indian centers at Trivandrum and Pondicherry. In contrast, the incidence in the subjects from a North Indian center in New Delhi was much lower, i.e., 27.4% (p less than 0.001). The lower incidence in the North Indian subjects may perhaps be due to the fact that they are descendants of the Aryans who have been dairying for long and are known to be lactose tolerant.

Adolescent↗
PubMed1982

Lactose malabsorption in Greek adults: correlation of small bowel transit time with the severity of lactose intolerance.

Using breath hydrogen analysis after 139 mmol (50 g) oral lactose load, we investigated the prevalence of lactose malabsorption in 200 Greek adults and examined the relationship between symptoms and small bowel transit time. One hundred and fifty subjects had increased breath hydrogen concentrations (greater than 20 ppm) after the lactose load. In these individuals peak breath hydrogen concentration was inversely related to small bowel transit time (r = 0.63, 6 = 6.854, p less than 0.001) and the severity of symptoms decreased with increasing small bowel transit time. Lactose malabsorbers with diarrhoea during the lactose tolerance test had a small bowel transit time of 51 +/- 22 minutes (x +/- SD; n = 90) which was significantly shorter than the small bowel transit time of patients with colicky pain, flatulence, and abdominal distension (74 +/- 30, n = 53; p less than 0.001) and both groups had significantly shorter small bowel transit time than that of asymptomatic malabsorbers (115 +/- 21 n:7; p less than 0.001). When the oral lactose load was reduced to 33 mmol (12 g), the small bowel transit time increased five-fold and the overall incidence of diarrhoea and/or symptoms decreased dramatically. These results indicate that the prevalence of lactase deficiency in Greece may be as high as 75% and suggest that symptom production in lactose malabsorbers is brought about by the rapid passage down the small intestine of the malabsorbed lactose.

Adolescent↗
PubMed2004

Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures.

UNLABELLED: Evidence that genetic disposition for adult lactose intolerance significantly affects calcium intake, bone density, and fractures in postmenopausal women is presented. PCR-based genotyping of lactase gene polymorphisms may complement diagnostic procedures to identify persons at risk for both lactose malabsorption and osteoporosis. INTRODUCTION: Lactase deficiency is a common autosomal recessive condition resulting in decreased intestinal lactose degradation. A -13910 T/C dimorphism (LCT) near the lactase phlorizin hydrolase gene, reported to be strongly associated with adult lactase nonpersistence, may have an impact on calcium supply, bone density, and osteoporotic fractures in the elderly. MATERIALS AND METHODS: We determined LCT genotypes TT, TC, and CC in 258 postmenopausal women using a polymerase chain reaction-based assay. Genotypes were related to milk intolerance, nutritional calcium intake, intestinal calcium absorption, bone mineral density (BMD), and nonvertebral fractures. RESULTS: Twenty-four percent of all women were found to have CC genotypes and genetic lactase deficiency. Age-adjusted BMD at the hip in CC genotypes and at the spine in CC and TC genotypes was reduced by -7% to -11% depending on the site measured (p = 0.04). LCT(T/C-13910) polymorphisms alone accounted for 2-4% of BMD in a multiple regression model. Bone fracture incidence was significantly associated with CC genotypes (p = 0.001). Milk calcium intake was significantly lower (-55%, p = 0.004) and aversion to milk consumption was significantly higher (+166%, p = 0.01) in women with the CC genotype, but there were no differences in overall dietary calcium intake or in intestinal calcium absorption test values. CONCLUSION: The LCT(T/C-13910) polymorphism is associated with subjective milk intolerance, reduced milk calcium intake, and reduced BMD at the hip and the lumbar spine and may predispose to bone fractures. Genetic testing for lactase deficiency may complement indirect methods in the detection of individuals at risk for both lactose malabsorption and osteoporosis.

Age Factors↗
PubMed2001

Irritable bowel syndrome: is the search for lactose intolerance justified?

OBJECTIVES: To determine if confirmation of hypolactasia offers any benefit to the dietary treatment of patients with irritable bowel syndrome (IBS). METHODS: One hundred and twenty-two consecutive IBS patients (37 male, 85 female) were given lactose hydrogen breath tests (LHBT). Those with positive LHBT followed a low lactose diet for 3 weeks. Those improving on the diet were given double-blind, placebo-controlled challenges (DBPCC) with 5 g, 10 g and 15 g of lactose and a placebo, to confirm lactose intolerance. Those who did not respond to the low lactose diet followed either an exclusion or low fibre diet. Symptoms scores were kept prior to the LHBT, 8 h post-LHBT and daily whilst following any dietary change. Patients with negative LHBT returned to clinic and subsequent dietary interventions were recorded. RESULTS: LHBT was positive in 33/122 (27%) IBS patients. Syrr otom scores prior to LHBT were not significantly different between the two groups, but after LHBT the symptoms in the positive group were significantly worse. Twenty-three patients followed a low-lactose diet of which only nine (39%) improved. Six who did not improve followed an exclusion diet, three improved and all were intolerant of milk. Three tried a low fibre diet with two improving. DBPCC were inconclusive. In the negative LHBT group 35 agreed to try a diet and 24 improved (69%). Eight were intolerant of cow's milk. CONCLUSIONS: Use of a low lactose diet was disappointing in IBS patients with lactose malabsorption. Food intolerance was demonstrated in IBS patients with positive or negative LHBT and milk was identified as a problem in both groups. DBPCC were inconclusive. There appears to be little advantage in trying to separate patients who malabsorb lactose from others with IBS.

Adult↗
PubMed1994

Dietary lactose intake, lactose intolerance, and the risk of epithelial ovarian cancer in southern Ontario (Canada).

A case-control study of dietary factors and cancer of the ovary was conducted during 1989-92 in metropolitan Toronto and surrounding areas of southern Ontario, Canada. Four hundred and fifty women aged 35-79 years, with newly diagnosed, histologically verified, primary epithelial ovarian-cancer were interviewed concerning reproduction and diet. Over the same period, 564 randomly-selected population controls, frequency-matched to the cases within three 15-year age groups, also were interviewed. From information obtained by quantitative diet history, average daily macro- and micronutrient intake values were calculated through use of the United States Department of Agriculture Food Composition Databank, which was extended and modified for Canadian items and recipes. Analysis was performed with continuous, unconditional logistic-regression methods, adjusting for age at interview, number of full-term pregnancies, total duration of oral contraceptive use, and total daily caloric intake. Neither reported history of lactose intolerance, nor average daily consumption of lactose or free galactose, were found to be associated with risk of ovarian cancer. Lactose intake or intolerance did not appear to modify the protective effects of parity and oral contraceptive use. Nevertheless, other studies suggest that ovarian galactose metabolism still may have a relationship with risk of ovarian cancer, though more evidence is needed.

Adult↗
PubMed1994

[Abdominal pain in children caused by lactose intolerance. Prospective use of the hydrogen breath test].

OBJECTIVES: We performed the breath hydrogen test in children consulting for abdominal pain in order to determine the minimal quantity of lactose required to prove malabsorption with least patient incomfort and to evaluate the effect of an adapted diet in children with a positive test. METHODS: The breath hydrogen test after lactose intake was performed in 109 children (51 boys, 58 girls, mean age 8.2 + 3.2 years, range 3 to 15) seen for unexplained abdominal pain. All these children had complained of abdominal pain daily for at least 6 months and no other cause could be identified. Children with acute or chronic diarrhoea or constipation were excluded. Nineteen children had been transferred from the surgery unit and 6 had been followed by the psychiatry unit. All these children drank milk regularly. RESULTS: The diagnosis of lactose intolerance was established in 83 children (76.1%) on the basis of a hydrogen peak in the breath after lactose ingestion. One-fourth of the children were of French origin and the others had at least one grandparent who was of Mediterranean or African origin. A lactose-free diet was proposed and led to the disappearance of abdominal pain in 24% and a clear improvement in 32%. CONCLUSION: The breath hydrogen test is a simple non-invasive test which allows a selection of children who could benefit from a lactose-free diet although it cannot be used to predict the effect of diet.

Abdominal Pain↗
PubMed2002

Overcoming the barrier of lactose intolerance to reduce health disparities.

Federal health goals for the public have focused on reducing health disparities that exist between whites and various racial and ethnic groups. Many of the chronic diseases for which African Americans are at greater risk- hypertension, stroke, colon cancer, and obesity-may be exacerbated by a low intake of calcium and/or other dairy-related nutrients. For example, a low intake of dairy food nutrients, such as calcium, potassium, and magnesium, may contribute to the high risk of hypertension seen in African Americans. The Dietary Approaches to Stop Hypertension (DASH) study demonstrated that a low-fat diet rich in fruits and vegetables (8 to 10 servings) and low-fat dairy foods (3 servings) significantly reduced blood pressure-and was twice as effective in African-American participants. Calcium and dairy food consumption is particularly low among African-American, Hispanic, and Asian populations. Average intakes are near the threshold of 600 to 700 mg/day, below which bone loss and hypertension can result. Although lactose intolerance may be partly to blame for the low calcium intakes due to reduced dairy food consumption by minority populations, culturally determined food preferences and dietary practices learned early in life also play a role. The high incidence figures for primary lactose maldigestion among minority groups grossly overestimates the number who will experience intolerance symptoms after drinking a glass of milk with a meal. Randomized, double-blind, controlled clinical trials have demonstrated that by using a few simple dietary strategies, those who maldigest lactose (have low levels of the lactase enzyme) can easily tolerate a dairy-rich diet that meets calcium intake recommendations. Physicians and other health professionals can help their minority patients and the general public understand how to improve calcium nutrition by overcoming the surmountable barrier of lactose intolerance. At the same time they will be helping to reduce the incidence of calcium-related chronic diseases for which minority populations are at high risk.

Asian↗
PubMed1996

Does lactose intolerance predispose to low bone density? A population-based study of perimenopausal Finnish women.

The relationship of lactase malabsorption to osteoporosis is unclear. We examined the relationship of self-reported lactose intolerance (LI) to bone mineral density (BMD) in perimenopausal Finnish women. A random population sample of 2025 women aged 48-59, who underwent spinal and femoral BMD measurement with dual X-ray absorptiometry in Kuopio, Finland during 1989-1991 formed the study population. Out of these women, 162 women reported LI. The mean dairy calcium intake was 558 mg/day in women with LI and 828 mg/day in other women (p < 0.0001). The mean spinal BMDs were 1.097 and 1.129 g/cm2 (-2.8%) (p = 0.016) and the mean femoral BMDs were 0.906 and 0.932 g/cm2 (-2.8%) (p = 0.012) for the LI and other women, respectively. After adjusting for weight, age, years since menopause, and the history of hormone replacement therapy, these differences changed to -2.7% (p = 0.016) for the spinal and -2.4% (p = 0.012) for the femoral BMD, respectively. Dairy calcium intake was an independent determinant of femoral BMD. The addition of calcium intake variables into the multivariate model did not affect the spinal BMD difference, but weakened the femoral BMD difference to -1.9% (p = 0.075). Our results suggest that LI slightly reduces perimenopausal BMD, possibly through reduced calcium intake.

Bone Density↗
PubMed1990

Feeding lactose-intolerant children with a powdered fermented milk.

Fresh yogurt has been proposed as a milk substitute for lactase-deficient patients. We investigated the possibility that a dried, low-fat milk fermented by yogurt microorganisms would be effective. Processing of a fermented milk by spray-drying led to a powder with persistence of lactase activity (11.7 units/g) without storage at 4 degrees C and stable at room temperature (20-23 degrees C). The tolerance and absorption of 10.5 g of lactose in a volume of 150 ml was studied in 25 Gabonese lactase-deficient children aged 5-14 years in the form of a standard humanized milk formula followed 1 week later by the powdered fermented milk formula. Results of the breath hydrogen test showed that in 24 of 25 cases, lactose absorption was normal with a maximal rise of hydrogen over baseline of under 13 ppm after ingestion of the powdered fermented milk. The rise was above 20 ppm in the 25 children with the same load of lactose in the form of the standard formula and one-third had symptoms of lactose intolerance. This powdered fermented milk preparation should be considered as a valid approach in programs of nutritional support targeted to countries with a high prevalence of lactase deficiency.

Adolescent↗
PubMed1998

Peroral gene therapy of lactose intolerance using an adeno-associated virus vector.

Gene therapy is usually reserved for severe and medically refractory disorders because of the toxicity, potential long-term risks and invasiveness of most gene transfer protocols. Here we show that an orally administered adeno-associated viral vector leads to persistent expression of a beta-galactosidase transgene in both gut epithelial and lamina propria cells, and that this approach results in long-term phenotypic recovery in an animal model of lactose intolerance. A gene 'pill' associated with highly efficient and stable gene expression might be a practical and cost-effective strategy for even relatively mild disorders, such as lactase deficiency.

Administration, Oral↗
PubMed1987

[Use of chickpea (Cicer arietinum L.) in non-dairy formulas. II. Nitrogen balance in children with lactose intolerance, fed with a formula based on chickpea and a commercial soybean product].

The nutritive value of chick-pea and soy infant formulas was evaluated. Nitrogen balance was performed in 17 malnourished babies, seven of which were fed with the chick-pea formula, and 10 with the soy commercial formula (Sobee). The percentage of absorption, retention and biological value of the chick-pea formula were 72.4, 26.4 and 35.1, respectively and 69.6, 24.3 and 34.0 in the same order, with the soy formula. Since the nutritional quality of the chick-pea was not different to the commercial soy formula and the diarrhea was better controlled by the former, this formula could be recommended in the treatment of lactating babies with lactose intolerance.

Blood Proteins↗