Lactase Non-persistence and Lactose Intolerance

Immobilization of enzymes for synergy in polymers to produce lactose free milk

Stabilization of the enzyme lactase is of interest in obtaining lactose-free foods. Optimization of the lactase enzyme activity was investigated using various immobilization methods, including encapsulation, and electrospinning. The physical properties of the immobilized lactase, such as thermal stability, mechanical strength, and resistance to denaturation have been enhanced and evaluated. The activity of the immobilized lactase was compared to that of the free enzyme. Additionally, lactase was examined in combination with glucose oxidase and catalase to reduce feedback inhibition of glucose and the toxicity of H2O2. The core-shell electrospinning technique was employed, wherein lactase was encapsulated within an aqueous core and shielded by a non-biodegradable shell. Electrospinning enhanced the enzyme's stability, reduced diffusion limitations, and improved reusability. The enzyme activity remained stable for four weeks and retained its activity after three months of storage at 4 °C in phosphate-buffered saline (PBS). This approach represents a preliminary investigation into the potential benefits of enzyme synergy.

Consumer behavior and awareness regarding products for food hypersensitivity: trends, motivations, and educational gaps

Background/Objectives

Food hypersensitivity, including allergies and intolerances, represents a significant and growing health challenge. To address this issue effectively, it is essential to implement tailored dietary interventions that can effectively reduce symptoms and improve patients' quality of life. The study aimed to analyze the consumption of specialist products intended for people with food hypersensitivities and to assess knowledge of food allergies and food intolerances.

Methods

The study was conducted from January to May 2021 using an original survey questionnaire that was made available to respondents in electronic form. The study involved 191 people, including 132 women and 59 men.

Results

The analysis showed that the knowledge of respondents about the labeling of products dedicated to people with food allergies and intolerances was generally satisfactory, but significant gaps were found in the knowledge of less common allergens, such as histamine or egg white. In addition, the consumption of products dedicated to food allergies and intolerances was comparable in the groups of diagnosed and healthy people.

Conclusions

Although the general knowledge of consumers about product labels was high, there are significant gaps in knowledge of more specific allergens. Moreover, the results suggest that products dedicated to people with food allergies and intolerances are consumed by both healthy and diagnosed people, which indicates the need for further education in this area.

Food Hypersensitivity: Distinguishing Allergy from Intolerance, Main Characteristics, and Symptoms-A Narrative Review

Background/Objectives: Food hypersensitivity remains an understudied and overlooked subject globally. It is characterized by adverse reactions to dietary substances, potentially triggered by various mechanisms. Food allergy, a subset of food hypersensitivity, denotes an immune response to food proteins categorized into immunoglobulin IgE-mediated or non-IgE-mediated reactions. Conversely, food intolerance, another facet of food hypersensitivity, refers to non-immunological reactions, in which the human body cannot properly digest certain foods or components, leading to gastrointestinal discomfort and other non-immune-related symptoms. The main objective of this study was to determine and differentiate the differences, characteristics, and types of food hypersensitivity. Methods: This study involved a comprehensive review of key research from 1990 onward, including review articles, prospective studies, nested case-control studies, and meta-analyses. Results: Recognizing these differences is essential for healthcare professionals to ensure accurate diagnosis, effective management, and improved patient outcomes, while also aiding dietitians in providing optimal nutritional and dietary guidance. Conclusions: there are big differences between the main characteristics, such as symptoms, complications, and treatments between allergies, and food intolerances. Commonly reported trigger foods include cow milk, gluten, eggs, nuts, and seafood.

Demystifying Carbohydrate Maldigestion: A Clinical Review

Carbohydrate intolerance is a poorly understood and potentially overlooked cause of unexplained gastrointestinal symptoms, particularly among patients with disorders of gut-brain interaction. Symptoms related to carbohydrate intolerance arise from bacterial fermentation of unabsorbed carbohydrates leading to increased gases and osmotic load within the gastrointestinal tract. This mechanism is shared across various carbohydrates, including lactose, sucrose, maltose, fructose, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Primary forms of carbohydrate maldigestion typically affect one specific type of carbohydrate and result from inherited defects in specific brush-border enzymes or transport mechanisms, whereas secondary, or acquired, forms of carbohydrate maldigestion can arise from conditions that affect the structural integrity or function of the pancreas and small intestine. Although confirmation of a disaccharidase deficiency does not imply clinical relevance, obtaining a careful patient history with appropriate use of breath testing, duodenal disaccharidase assay, and response to dietary modification can help identify patients whose symptoms are associated with carbohydrate maldigestion and who may benefit from treatment. Dietary modification remains the cornerstone of therapy for patients with carbohydrate intolerance and should focus on determining the most liberal diet for patients that allows symptom control. Given the complexity and time-consuming nature of this process, clinicians are encouraged to engage the help of dietitians with expertise in the treatment of disorders of gut-brain interaction where available. Enzyme replacement therapy can also be an important adjunct to dietary management, with sacrosidase improving symptoms in sucrase-isomaltase deficiency and helping patients to liberalize their diet.

Trace phospholipid and fatty acid differences between dairy and plant-based milk products by 1H and 31P NMR spectroscopy combined with multivariate statistical analysis

With development of modern food industry, plant-based milk products are widely used to replace dairy products to cook different kinds of food. Due to different origins, it is necessary to assess the nutrition difference between dairy and plant-based milk products. Phospholipids and unsaturated fatty acids, as the important nutrients in cream and butter, were closely related to body development and health. This study developed a rapid determination of phospholipids and double bonds in creams and butters based on 31P NMR and 1H NMR for nutritional difference assessment. Unsupervised principal component analysis and supervised orthogonal least squares discriminant analysis showed marked differences between dairy and plant-based milk products. Eight compounds were screened by variable importance in projection, fold change and P-value. Furthermore, two biomarkers (phosphatidylserine and phosphatidylethanolamine) were identified to distinguish dairy and plant-based milk products. The study demonstrated that 31P NMR has great potential for rapidly distinguishing milk origins.

Determining population structure from k-mer frequencies

Background

Understanding population structure within species provides information on connections among different populations and how they evolve over time. This knowledge is important for studies ranging from evolutionary biology to large-scale variant-trait association studies. Current approaches to determining population structure include model-based approaches, statistical approaches, and distance-based ancestry inference approaches.

Methods

In this work, we identify population structure from DNA sequence data using an alignment-free approach. We use the frequencies of short DNA substrings from across the genome (k-mers) with principal component analysis (PCA). K-mer frequencies can be viewed as a summary statistic of a genome and have the advantage of being easily derived from a genome by counting the number of times a k-mer occurred in a sequence. In contrast, most population structure work employing PCA uses multi-locus genotype data (SNPs, microsatellites, or haplotypes). No genetic assumptions must be met to generate k-mers, whereas current population structure approaches often depend on several genetic assumptions and can require careful selection of ancestry informative markers to identify populations. We compare our k-mer based approach to population structure estimated using SNPs with both empirical and simulated data.

Results

In this work, we show that PCA is able to determine population structure just from the frequency of k-mers found in the genome. The application of PCA and a clustering algorithm to k-mer profiles of genomes provides an easy approach to detecting the number and composition of populations (clusters) present in the dataset. Using simulations, we show that results are at least comparable to population structure estimates using SNPs. When using human genomes from populations identified by the 1000 Genomes Project, the results are better than population structure estimates using SNPs from the same samples, and comparable to those found by a model-based approach using genetic markers from larger numbers of samples.

Conclusions

This study shows that PCA, together with the clustering algorithm, is able to detect population structure from k-mer frequencies and can separate samples of admixed and non-admixed origin. Using k-mer frequencies to determine population structure has the potential to avoid some challenges of existing methods and may even improve on estimates from small samples.

In vitro investigations on the impact of fermented dairy constituents on fecal microbiota composition and fermentation activity

Fermented dairy constitutes a major dietary source and contains lactose as the main carbohydrate and living starter cultures, which can encounter the intestinal microbiota after ingestion. To investigate whether dairy-related nutritional and microbial modulation impacted intestinal microbiota composition and activity, we employed static fecal microbiota fermentations and a dairy model system consisting of lactose and Streptococcus thermophilus wild type and β-galactosidase deletion mutant. In addition, we conducted single-culture validation studies. 16S rRNA gene-based microbial community analysis showed that lactose increased the abundance of Bifidobacteriaceae and Anaerobutyricum and Faecalibacterium spp. The supplied lactose was hydrolyzed within 24 h of fermentation and led to higher expression of community-indigenous β-galactosidases. Targeted protein analysis confirmed that bifidobacteria contributed most β-galactosidases together with other taxa, including Escherichia coli and Anaerobutyricum hallii. Lactose addition led to higher (P < 0.05) levels of butyrate compared to controls, likely due to lactate-based cross-feeding and direct lactose metabolism by butyrate-producing Anaerobutyricum and Faecalibacterium spp. Representatives of both genera used lactose to produce butyrate in single cultures. When supplemented at around 5.5 log cells mL-1, S. thermophilus or its β-galactosidase-negative mutant outnumbered the indigenous Streptococcaceae population at the beginning of fermentation but had no impact on lactose utilization and final short-chain fatty acid profiles.

IMPORTANCE

The consumption of fermented food has been linked to positive health outcomes, possibly due to interactions of food components with the intestinal microbiota. This study brings forward new insights into how major constituents of fermented dairy affect intestinal microbial ecology and activity when supplied together or alone. We provide evidence that lactose availability increased the production of butyrate by fecal microbiota through cross-feeding and did not observe a contribution of starter cultures to lactose metabolism, possibly due to a lack of competitiveness. The methodological setup used in this study can be implemented in future investigations to determine the impact of other fermented foods and their major components on intestinal microbiota composition and activity.

Decrypting the messages in the matrix: The proceedings of a symposium on dairy food matrix science and public health opportunities

Although food matrix research is still in its infancy, there is an emerging understanding of the important role of the food matrix on human nutrition and physiology, as well as for public health. This understanding has largely been propelled forward by research involving different milk and dairy food matrices which has revealed that in addition to their distinct array of nutrients and bioactive compounds, milk and dairy foods also contain complex food matrix microstructures that act as nutrient and bioactive delivery systems that set them apart from the other food groups. Due to these distinct food matrix properties, milk and dairy foods may be uniquely positioned to help Americans meet many of their nutrition and health needs. The aim of this manuscript is to describe the activities and findings from a National Dairy Council-sponsored symposium focused on connecting the science on milk and dairy food matrices with opportunities for improving public health. This proceedings paper summarizes and communicates the symposium presentations and panel discussions, key insights, and next steps to help leverage the evidence on different dairy food matrices (e.g., milk, yogurt, cheese) to develop science-backed strategies to support public health and health equity.

Changes in Nutritional Status Through Low-Lactose Processed Milk Consumption in Korean Adults With Lactose Intolerance

This study was conducted to evaluate changes in hydrogen breath test results and nutritional improvements when Korean adults diagnosed with lactose intolerance consumed processed milk containing approximately 10 g of lactose continuously. Participants consumed 240 mL of intervention food daily for a month and visited the research institute before and after the intervention to undergo nutrient intake survey and hydrogen breath tests. Data from 32 participants, with a mean age of 52.9 years, were analyzed. Hydrogen breath tests showed a significant decrease in hydrogen levels at all but baseline and the first of five 20-minute intervals of expiratory hydrogen concentration measurements. The third and fourth measurements showed the most significant changes (p < 0.001). The gastrointestinal symptoms showed a decreasing trend. Nutrient intake analysis demonstrated significant increases in animal protein (p < 0.001), calcium (p < 0.001), percentage of energy from protein (p = 0.032), vitamin A (p = 0.032), and retinol levels (p = 0.023). Regarding dietary habits, significant improvements were observed in nutritional quotient variables, including nutritional score (p = 0.042) and balance (p = 0.034). This study suggests that the removal of lactose and dairy products is not necessary for individuals with lactose intolerance. Incorporating low-lactose processed milk into their usual diet might be a practical dietary management strategy.

2D-IR spectroscopy of azide-labeled carbohydrates in H2O

Carbohydrates constitute one of the key classes of biomacromolecules, yet vibrational spectroscopic studies involving carbohydrates remain scarce as spectra are highly congested and lack significant marker vibrations. Recently, we introduced and characterized a thiocyanate-labeled glucose [Gasse et al., J. Chem. Phys. 158, 145101 (2023)] demonstrating 2D-IR spectroscopy of carbohydrates using vibrational probes. Here, we build on that work and test azide groups as alternative for studies of carbohydrates to expand the available set of local probes. Many common carbohydrates with different azide labeling positions, such as galactose, glucose, or lactose, are readily available due to their application in click chemistry and hence do not require additional complex synthesis strategies. In this work, we have characterized azide-labeled glucose,, galactose, acetylglucosamine and lactose in water using IR and 2D-IR spectroscopy to test their potential for future applications in studies of carbohydrate-protein interactions. Our findings indicate that their absorption profiles and vibrational dynamics are primarily determined by the labeling position on the ring. However, we also observe additional variations between samples with the same labeling position. Furthermore, we demonstrate that their usage remains feasible at biologically relevant concentrations, highlighting their potential to probe more complex biological processes, i.e., enzymatic catalysis.

Diagnosis of lactose intolerance: concordance between 13910-C/T genotype and lactose tolerance test in a Danish population

The association between the MCM6-13910-C/T polymorphism and lactose intolerance in individuals of European descent is well known. However, the notion that having a single versus a double allelic mutation might influence one's phenotype has been hypothesized. This study investigated whether patients with the three genotypes C/C, C/T, T/T differed in response to a lactose tolerance test (LTT) in a Danish setting. Anonymized data on 603 individuals with results for both genetic test and LTT were investigated. Mean delta glucose values were plotted for the time points of the LTT (0, 15, 30, 45 and 60 min) for the C/C, C/T and T/T genotype, respectively. Further, the agreement between the three genotypes and the diagnostic interpretation of the LTT were examined using a cut-off of > 1.4 mmol/L rise in glucose. In subjects with the C/C genotype, mean glucose delta levels were markedly lower compared to both the C/T and T/T genotypes at all time points. Overall, a difference between mean glucose delta values among the C/T and T/T genotype could not be shown. Using a LTT cut-off of > 1.4 mmol/L, the proportions of lactose intolerant LTT results for each genotype were as follows: 58% among C/C, 5% among C/T, and 7% among T/T. In a Danish healthcare setting, the C/C genotype was on average associated with a smaller glucose response during a LTT when compared to the C/T and T/T genotypes. A marked difference in the LTT response among the C/T and T/T genotype was not observed.

Awareness about Neonatal Lactose Intolerance among Chinese Neonatologists in Outpatient Settings: A Multi-Center Survey

BACKGROUND

This study aimed to identify the specific areas of knowledge gaps regarding lactose intolerance among neonatologists in Chinese outpatient settings as well as to assess the availability of lactose intolerance testing in hospitals.

METHODS

A total of 278 neonatologists in outpatient settings from 144 hospitals were surveyed. To explore the awareness level, diagnosis, and treatment of neonatal lactose intolerance among neonatologists in outpatient settings, a multicenter cross-sectional survey was designed. Descriptive analysis based on frequency and percent distribution was performed for all variables.

RESULTS

Most respondents were senior doctors (256, 92.09%) from general hospitals and maternity/maternal and child health hospitals, had over 10 years of experience, and were dominantly associate chief physicians and chief physicians (211, 75.90%). A significant proportion of the participants (236, 84.89%) believed that neonatal lactose intolerance tends to be overlooked during clinical practice. When the most common symptoms of neonatal lactose intolerance were surveyed, diarrhea was selected by 142 (51.08%) respondents, followed by bloating and milk regurgitation or emesis (71, 25.54%). Other symptoms included unexplained crying (36, 12.85%), stool with milk flap or foam (15, 5.40%), and increased venting (14, 5.04%). Furthermore, the survey results indicated that the most common method for diagnosing neonatal lactose intolerance in the respondents' hospitals was qualitative test for urinary galactose (78, 28.06%). Of the respondents, 137 (49.28%) stated that their hospital could not test for lactose intolerance. For treating lactose intolerance, the neonatologists primarily opted for exogenous lactase rather than lactose-free formula milk.

CONCLUSIONS

This study sheds light on Chinese neonatologists' awareness of neonatal lactose intolerance, revealing some knowledge gaps. The expeditious popularization and conduct of lactose intolerance-related examinations in hospitals will have a positive stimulative effect on the management of lactose intolerance in newborns.

Application of Functional Neurology Therapy in a Lactose-Intolerant Patient

This case report examines the impact of a single session of functional neurology on a 35-year-old female patient diagnosed with lactose intolerance. The patient presented with severe gastrointestinal symptoms, including frequent diarrhea, bloating, and vomiting upon dairy consumption. The intervention aimed to reset dysfunctional neurological programs believed to contribute to her condition. The study utilized a standardized lactose intolerance breath test to measure the hydrogen and methane levels at various intervals before and after treatment. Post-treatment results showed symptomatic relief with the patient reporting normalized bowel movements and the absence of previous symptoms. Despite these improvements, the biochemical markers at higher time points (150 and 175 min) post-treatment remained similar to the pre-treatment values, indicating persistent lactose malabsorption and highlighting the variability of hydrogen measurements. This case report suggests that a single session of functional neurology can significantly alleviate the symptoms of lactose intolerance. However, the preliminary nature of these results underscores the need for further research involving larger sample sizes and long-term follow-up to fully understand the treatment's efficacy and underlying mechanisms.

Global, regional, and national analyses of the burden of colorectal cancer attributable to diet low in milk from 1990 to 2019: longitudinal observational study

Background

Globally, diet low in milk is the third greatest risk factor for colorectal cancer (CRC). However, there has been a lack of detailed worldwide analysis of the burden and trends of CRC attributable to diet low in milk.

Objective

We aim to assess the spatiotemporal trends of CRC-related mortality and disability-adjusted life-years (DALYs) attributable to diet low in milk at the global, regional, and national levels from 1990 to 2019.

Methods

Data of mortality, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CRC attributable to diet low in milk were extracted from the Global Burden of Disease (GBD) 2019 study. The burden of CRC attributable to diet low in milk was estimated using the ASMR and ASDR, while accounting for sex, age, country, and socio-demographic index (SDI). From 1990 to 2019, the estimated annual percentage change (EAPC) was calculated to clarify the temporal trends in the ASMR and ASDR attributable to diet low in milk.

Results

In 2019, there were 166,456 (95% UI = 107,221-226,027) deaths and 3,799,297 (95% UI = 2,457,768-5,124,453) DALYs attributable to diet low in milk, accounting for 15.3 and 15.6% of CRC-related deaths and DALYs in 2019. CRC-related deaths and DALYs attributed to diet low in milk increased by 130.5 and 115.4%, from 1990 to 2019. The burden of CRC attributable to diet low in milk varied notably among regions and nations. High-middle SDI regions had the highest ASDR and ASMR of CRC linked to diet low in milk, while there was a slight downward trend high SDI regions. Among geographical regions, East Asia had the highest number of CRC-related deaths and DALYs attributable to diet low in milk. Notably, the burden of CRC was highest in males and the elderly. With coefficients of -0.36 and -0.36, the EAPC in ASMR and ASDR was significantly inversely correlated with the Human Development Index in 2019.

Conclusion

Globally, the number of CRC deaths attributable to diet low in milk has continued to increase over the last 30 years. Therefore, government and authorities should conduct education campaigns to encourage individuals to increase daily milk intake.

Risk of Bone Fracture on Vegetarian and Vegan Diets

PURPOSE OF REVIEW

Bone fractures can have a devastating effect on health, especially in the elderly, undermining their independence for daily activities, and increasing the risk of comorbidities and mortality. Nutrition is a key factor in maintaining an optimal bone health across the lifespan. The number of people that choose to avoid meat or even all animal products is increasing globally, for a diversity of reasons. Properly planned vegetarian and vegan diets are widely recognized as a healthy dietary pattern, but the long-term impact of these diets on bone health and more specifically risk of bone fractures is less clear. Classic studies have observed a slightly lower bone mineral density in vegetarians but have many limitations, including inadequate adjusting for relevant confounding factors, and cross-sectional design. The aim of this review is to summarize and put into context the current evidence on the effect of vegetarian and vegan diets on bone health, with a focus on fracture risk.

RECENT FINDINGS

In recent years, results from many large prospective studies have emerged, which allowed us to assess the risk of incident bone fractures in vegetarians. In these studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. In many recent prospective cohort studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. At least part of this risk could be due to a lower body mass index and a lower intake of nutrients such as calcium, vitamin D, and protein. Some evidence suggests that combined vitamin D and calcium supplementation and other factors such as consumption of protein-rich foods may attenuate this risk. The eventual deleterious effect of vegetarian diets on bone health should be contextualized and balanced with its benefits, such as lower risk of cardiovascular disease and cancer.

Next generation probiotics: Engineering live biotherapeutics

The population dynamics of the human microbiome have been associated with inflammatory bowel disease, cancer, obesity, autoimmune diseases, and many other human disease states. An emerging paradigm in treatment is the administration of live engineered organisms, also called next-generation probiotics. However, the efficacy of these microbial therapies can be limited by the organism's overall performance in the harsh and nutrient-limited environment of the gut. In this review, we summarize the current state of the art use of bacterial and yeast strains as probiotics, highlight the recent development of genetic tools for engineering new therapeutic functions in these organisms, and report on the latest therapeutic applications of engineered probiotics, including recent clinical trials. We also discuss the supplementation of prebiotics as a method of manipulating the microbiome and improving the overall performance of engineered live biotherapeutics.

A review of dairy food intake for improving health among black children and adolescents in the US

Adequate nutrition during childhood and adolescence is crucial for proper neurological, musculoskeletal, immunological, and cardiometabolic health and development. Yet, disparities among socially underserved racial/ethnic groups in the United States (US) provide significant challenges to achieving adequate nutrition during these years of rapid growth and maturation. For example, Black children and adolescents are at greater risk for having food insecurity, lower-quality diets, obesity, and numerous associated health challenges that result from these disparities compared to their White peers. A growing body of evidence indicates that improving diet quality is critical for improving childhood and adolescent health and well-being, and that the diverse nutritional profile and bioactive compounds found within dairy foods may play multiple roles in promoting proper growth and development during these life stages. Therefore, to support overall health and development among Black youth, greater education and implementation efforts are needed to help this population meet the national dietary recommendations of 2.5 to 3 servings of dairy foods per day. Continuing to fall short of these recommendations puts Black children and adolescents at risk of multiple nutrient inadequacies and health disparities that can have lifelong impacts on disease development, mental health, and quality of life. This review presents the state of knowledge on health disparities and modifiable nutritional strategies involving milk and dairy foods to support the growth and maturation of children and adolescents, with a special focus on Black youth in the US.

The role of dairy food intake for improving health among black Americans across the life continuum: A summary of the evidence

Decades of health data show major health disparities occurring at every life stage between Black and White Americans. These disparities include greater mortality rates among Black mothers and their offspring, higher levels of malnutrition and obesity among Black children and adolescents, and a higher burden of chronic disease and lower life expectancy for Black adults. Although nutrition is only one of many factors that influence human health and well-being across the life continuum, a growing body of research continues to demonstrate that consuming a healthy dietary pattern is one of the most dominant factors associated with increased longevity, improved mental health, improved immunity, and decreased risk for obesity and chronic disease. Unfortunately, large percentages of Black Americans tend to consume inadequate amounts of several essential nutrients such as vitamin A, vitamin D, calcium, and magnesium; and simultaneously consume excessive amounts of fast foods and sugar-sweetened beverages to a greater degree than other racial/ethnic groups. Therefore, strategies that can help improve dietary patterns for Black Americans could make up a major public health opportunity for reducing nutrition-related diseases and health disparities across the life course. A key intervention strategy to improve diet quality among Black Americans is to focus on increasing the intake of nutrient-rich dairy foods, which are significantly underconsumed by most Black Americans. Compared to other food group, dairy foods are some of the most accessible and affordable sources of essential nutrients like vitamin A, D, and B12, calcium, magnesium, potassium, selenium, and zinc in the food supply, as well as being some of the primary sources of several health-promoting bioactive compounds, including polar lipids, bioactive proteins and peptides, oligosaccharides, and live and active cultures in fermented products. Given the complex relationships that many Black Americans have with dairy foods, due to issues with lactose intolerance, and/or negative perceptions about the health effects of dairy foods, there is still a need to examine the role that dairy foods play in the health and well-being of Black Americans of all ages and life stages. Therefore, the National Medical Association and its partners have produced multiple reports on the value of including adequate dairy in the diet of Black Americans. This present summary paper and its associated series of evidence reviews provide an examination of an immense amount of research focused on dairy intake and health outcomes, with an emphasis on evidence-based strategies for improving the health of Black Americans. Overall, the findings and conclusions from this body of research continue to indicate that higher dairy intake is associated with reduced risk for many of the most commonly occurring deficiencies and diseases impacting each life stage, and that Black Americans would receive significantly greater health benefits by increasing their daily dairy intake levels to meet the national recommendations than they would from continuing to fall short of these recommendations. However, these recommendations must be considered with appropriate context and nuance as the intake of different dairy products can have different impacts on health outcomes. For instance, vitamin D fortified dairy products and fermented dairy products like yogurt - which are low in lactose and rich in live and active cultures - tend to show the greatest benefits for improved health. Importantly, there are significant limitations to these research findings for Black Americans, especially as they relate to reproductive and child health, since most of the research on dairy intake and health has failed to include adequate representation of Black populations or to sufficiently address the role of dairy intake during the most vulnerable life stages, such as pregancy, lactation, fetal development, early childhood, and older age. This population and these life stages require considerably more research and policy attention if health equity is ever to be achieved for Black Americans. Sharing and applying the learnings from this summary paper and its associated series of evidence reviews will help inform and empower nutrition and health practitioners to provide more evidence-based dietary recommendations for improving the health and well-being of Black Americans across the life course.

Prebiotic Strategies to Manage Lactose Intolerance Symptoms

Lactose intolerance, which affects about 65-75% of the world's population, is caused by a genetic post-weaning deficiency of lactase, the enzyme required to digest the milk sugar lactose, called lactase non-persistence. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. Genetic variations, namely lactase persistence, allow some individuals to metabolize lactose effectively post-weaning, a trait thought to be an evolutionary adaptation to dairy consumption. Although lactase non-persistence cannot be altered by diet, prebiotic strategies, including the consumption of galactooligosaccharides (GOSs) and possibly low levels of lactose itself, may shift the microbiome and mitigate symptoms of lactose consumption. This review discusses the etiology of lactose intolerance and the efficacy of prebiotic approaches like GOSs and low-dose lactose in symptom management.

Nutritional profile of plant-based dairy alternatives in the Swedish market

The market for plant-based dairy alternatives is growing; therefore, focusing on the nutritional quality of these products is important. This study evaluates the nutritional profile of plant-based alternatives to milk, yoghurt, cheese, cream, ice cream and fat spread in the Swedish market and compares them to corresponding dairy products. The nutritional quality of organic vs non-organic and plain vs flavoured plant-based milk and yoghurt alternatives was also assessed. Nutritional data for 222 plant-based dairy alternatives were collected from the manufacturers' websites, and data for corresponding dairy products were obtained from the Swedish Food Composition Database. Plant-based dairy alternatives had higher fibre content than dairy products, while their protein content was lower, except for soy-based products. The saturated fat content of plant-based dairy alternatives was similar to or lower than dairy products, except for coconut-based yoghurt and plant-fat-based cheese. Their energy content was also similar to or lower than dairy products, except for coconut-based yoghurt, plant-based fat spread and plant-based ice cream, which contained higher energy than yoghurt, blended margarine, and ice cream, respectively. The micronutrient fortification was mainly in plant-based milk, yoghurt, and cheese alternatives; thus, compared to dairy, they had similar or higher vitamins D, B2, and B12 (except in plant-based milk alternatives), calcium and iodine content. Furthermore, organic plant-based milk and yoghurt alternatives had a lower micronutrient content (e.g., vitamins B2 and B12, iodine and calcium) except for vitamin D than non-organic varieties. Flavoured plant-based milk and yoghurt alternatives were higher in energy and total sugar than plain varieties. In summary, plant-based dairy alternatives have nutritional strengths and weaknesses compared to dairy products that should be considered when replacing dairy.

Human adaptations to diet: Biological and cultural coevolution

Modern humans evolved in Africa some 200,000 years ago, and since then, human populations have expanded and diversified to occupy a broad range of habitats and use different subsistence modes. This has resulted in different adaptations, such as differential responses to diseases and different abilities to digest or tolerate certain foods. The shift from a subsistence strategy based on hunting and gathering during the Palaeolithic to a lifestyle based on the consumption of domesticated animals and plants in the Neolithic can be considered one of the most important dietary transitions of Homo sapiens. In this text, we review four examples of gene-culture coevolution: (i) the persistence of the enzyme lactase after weaning, which allows the digestion of milk in adulthood, related to the emergence of dairy farming during the Neolithic; (ii) the population differences in alcohol susceptibility, in particular the ethanol intolerance of Asian populations due to the increased accumulation of the toxic acetaldehyde, related to the spread of rice domestication; (iii) the maintenance of gluten intolerance (celiac disease) with the subsequent reduced fitness of its sufferers, related to the emergence of agriculture and (iv) the considerable variation in the biosynthetic pathway of long-chain polyunsaturated fatty acids in native populations with extreme diets.

Evaluation of a novel stationary phase for the separation of lactose and isomers in lactose-free products using high-performance anion-exchange chromatography coupled with pulsed amperometric detection (HPAEC-PAD)

Lactose intolerance is a widespread condition, which prevents a large number of people from consuming dairy products as a part of their daily diet. It is estimated that an average of 65% of the global population is suffering from lactose intolerance. The global market for 'lactose-free' dairy products is rapidly growing and the criteria for 'lactose-free' labelled products are becoming stricter. To check the lactose contents in these products there is a need for fast, sensitive, and selective analytical method. A method is presented for fast and sensitive determination of lactose and its isomers using High-Performance Anion Exchange Chromatography in combination with Pulsed Amperometric Detection (HPAEC-PAD). The use of a new anion-exchange column, SweetSep™ AEX200, which is a strong anion-exchange column with highly monodisperse 5 µm particles, allowed the separation of all compounds of interest in less than 8 min with high resolution. A variety of dairy products were analyzed to demonstrate the versatility of the method.

Technological and health properties and main challenges in the production of vegetable beverages and dairy analogs

Lactose intolerance affects about 68-70% of the world population and bovine whey protein is associated with allergic reactions, especially in children. Furthermore, many people do not consume dairy-based foods due to the presence of cholesterol and ethical, philosophical and environmental factors, lifestyle choices, and social and religious beliefs. In this context, the market for beverages based on pulses, oilseeds, cereals, pseudocereals and seeds and products that mimic dairy foods showed a significant increase over the years. However, there are still many sensory, nutritional, and technological limitations regarding producing and consuming these products. Thus, to overcome these negative aspects, relatively simple technologies such as germination and fermentation, the addition of ingredients/nutrients and emerging technologies such as ultra-high pressure, pulsed electric field, microwave and ultrasound can be used to improve the product quality. Moreover, consuming plant-based beverages is linked to health benefits, including antioxidant properties and support in the prevention and treatment of disorders and common diseases like hypertension, diabetes, anxiety, and depression. Thus, vegetable-based beverages and their derivatives are viable alternatives and low-cost for replacing dairy foods in most cases.

Refractory Hypothyroidism: Unraveling the Complexities of Diagnosis and Management

INTRODUCTION

Refractory hypothyroidism (RH) represents a challenge in the diagnosis and treatment within the field of thyroidology. It is defined as the inability to achieve disease control despite using levothyroxine (LT4) doses of 1.9 μg/kg/d or higher.

METHODS

A comprehensive review, encompassing 103 articles, was conducted using the Scielo, Scopus, and EMBASE databases, providing an approach to evaluation and diagnosis of this condition.

RESULTS

LT4 disintegrates and dissolves within an acidic gastric environment before being absorbed in the jejunum and ileum. It then extensively binds to serum transporter proteins and undergoes deiodination to yield tri-iodothyronine, the biologically active hormone. There are various nonpathological causes of RH, such as noncompliance with treatment, changes in the brand of LT4, food and drug interferences, as well as pregnancy. Pathological causes include lactose intolerance, Helicobacter pylori infection, giardiasis, among others. The diagnosis of RH involves conducting a thorough medical history and requesting relevant laboratory tests to rule out causes of treatment resistance. The LT4 absorption test allows for the identification of cases of malabsorption. The treatment of RH involves identifying and addressing the underlying causes of noncompliance or malabsorption. In cases of pseudomalabsorption, supervised and weekly administration of LT4 may be considered.

DISCUSSION

Early recognition of RH and correction of its underlying cause are of utmost importance, as this avoids the use of excessive doses of LT4 and prevents cardiovascular and bone complications associated with this condition.

Myths and Facts about Food Intolerance: A Narrative Review

Most adverse reactions to food are patient self-reported and not based on validated tests but nevertheless lead to dietary restrictions, with patients believing that these restrictions will improve their symptoms and quality of life. We aimed to clarify the myths and reality of common food intolerances, giving clinicians a guide on diagnosing and treating these cases. We performed a narrative review of the latest evidence on the widespread food intolerances reported by our patients, giving indications on the clinical presentations, possible tests, and dietary suggestions, and underlining the myths and reality. While lactose intolerance and hereditary fructose intolerance are based on well-defined mechanisms and have validated diagnostic tests, non-coeliac gluten sensitivity and fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intolerance are mainly based on patients' reports. Others, like non-hereditary fructose, sorbitol, and histamine intolerance, still need more evidence and often cause unnecessary dietary restrictions. Finally, the main outcome of the present review is that the medical community should work to reduce the spread of unvalidated tests, the leading cause of the problematic management of our patients.

Pilot study of correlation of selected genetic factors with cribra orbitalia in individuals from a medieval population from Slovakia

OBJECTIVE

The aim of this study is to investigate the potential genetic etiology of cribra orbitalia noted on human skeletal remains.

MATERIALS

We obtained and analyzed ancient DNA of 43 individuals with cribra orbitalia. The analyzed set represented medieval individuals from two cemeteries in western Slovakia, Castle Devín (11th-12th century AD) and Cífer-Pác (8th-9th century AD).

METHODS

We performed a sequence analysis of 5 variants in 3 genes associated with anemia (HBB, G6PD, PKLR), which are the most common pathogenic variants in present day of European populations, and one variant MCM6:c.1917 + 326 C>T (rs4988235) associated with lactose intolerance.

RESULTS

DNA variants associated with anemia were not found in the samples. The allele frequency of MCM6:c.1917 + 326 C was 0.875. This frequency is higher but not statistically significant in individuals displaying cribra orbitalia compared to individuals without the lesion.

SIGNIFICANCE

This study seeks to expand our knowledge of the etiology of cribra orbitalia by exploring the potential association between the lesion and the presence of alleles linked to hereditary anemias and lactose intolerance.

LIMITATIONS

A relatively small set of individuals were analyzed, so an unequivocal conclusion cannot be drawn. Hence, although it is unlikely, a genetic form of anemia caused by rare variants cannot be ruled out.

SUGGESTIONS FOR FURTHER RESEARCH

Genetic research based on larger sample sizes and in more diverse geographical regions.

Taste Responses and Ingestive Behaviors to Ingredients of Fermented Milk in Mice

Fermented milk is consumed worldwide because of its nutritious and healthful qualities. Although it is somewhat sour, causing some to dislike it, few studies have examined taste aspects of its ingredients. Wild-type mice and T1R3-GFP-KO mice lacking sweet/umami receptors were tested with various taste components (sucrose, galactose, lactose, galacto-oligosaccharides, fructo-oligosaccharides, l- and d-lactic acid) using 48 h two-bottle tests and short-term lick tests. d-lactic acid levels were measured after the ingestion of d- or; l-lactic acid or water to evaluate d-lactic acidosis. In wild-type mice, for the sweet ingredients the number of licks increased in a concentration-dependent manner, but avoidance was observed at higher concentrations in 48 h two-bottle tests; the sour ingredients d- and l-lactic acid showed concentration-dependent decreases in preference in both short- and long-term tests. In 48 h two-bottle tests comparing d- and l-lactic acid, wild-type but not T1R3-GFP-KO mice showed higher drinking rates for l-lactic acid. d-lactic acidosis did not occur and thus did not contribute to this preference. These results suggest that intake in short-term lick tests varied by preference for each ingredient, whereas intake variation in long-term lick tests reflects postingestive effects. l-lactic acid may have some palatable taste in addition to sour taste.

Standard vs. Nutrient-Enriched Cow's Milk and Its Impacts on Child Growth: A Systematic Review and Meta-Analysis

Stunting among children indicates malnutrition or undernutrition, hindering their growth and development. This will have negative effects on the overall health of children. This review investigates the effects of different types of cow's milk and their impacts on children's growth. A web-based search of Cochrane, Web of Science, SAGE, and Prospero was carried out using predetermined search/MESH phrases and keywords. The data extraction and analysis were carried out independently by two reviewers, who then double-checked, revised, and discussed any disagreements with a third reviewer. Eight studies met the inclusion criteria and were rated as good (N = 5) and fair quality (N = 3), which were included in the final analysis. The results illustrated that standard cow's milk has more consistent findings than nutrient-enriched cow's milk potentially in assisting children's growth. However, studies on standard cow's milk and child's growth are still lacking for this age group. In addition, there are inconsistent findings between nutrient-enriched cow's milk and children's growth. It is crucial to ensure milk is included in children's diets as per recommended nutrient intake.

The emerging role of nutritional support in the supportive care of pediatric patients undergoing hematopoietic stem cell transplantation

Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) represents a potentially curative strategy for many oncological, hematological, metabolic, and immunological diseases in children. The continuous effort in ameliorating supportive care represents one of the cornerstones in the improvement of outcome in these patients. Nowadays, more than ever nutritional support can be considered a key feature. Oral feeding in the early post-transplant period is severely impaired because of mucositis due to conditioning regimen, characterized by, mainly by vomiting, anorexia, and diarrhea. Gastrointestinal acute graft-versus-host-disease (GvHD), infections and associated treatments, and other medications, such as opioids and calcineurin inhibitors, have also been correlated with decreased oral intake. The consequent reduction in caloric intake combined with the catabolic effect of therapies and transplantation-related complications with consequent extended immobilization, results in a rapid deterioration of nutritional status, which is associated with decreased overall survival and higher complication rates during treatment. Thus, nutritional support during the early post-transplantation period becomes an essential and challenging issue for allo-HSCT recipients. In this context, the role of nutrition in the modulation of the intestinal flora is also emerging as a key player in the pathophysiology of the main complications of HSCT. The pediatric setting is characterized by less evidence, considering the challenge of addressing nutritional needs in this specific population, and many questions are still unanswered. Thus, we perform a narrative review regarding all aspects of nutritional support in pediatric allo-HSCT recipients, addressing the assessment of nutritional status, the relationship between nutritional status and clinical outcomes and the evaluation of the nutritional support, ranging from specific diets to artificial feeding.

Management of Adult Patients with Gastrointestinal Symptoms from Food Hypersensitivity-Narrative Review

The incidence of food hypersensitivity has increased dramatically over the years not only among children but also in adults. Adult patients are usually less suspected of food hypersensitivity symptoms since food allergies are more typical for small children, with a tendency to outgrow the condition. The aim of this article is to increase awareness of hypersensitivity to food symptoms and their diagnosis and treatment possibilities among gastroenterologists and other health care professionals dealing with this type of patient. Symptoms of many gastrointestinal disorders, especially functional, may be driven by different types of mechanisms, and food intolerance or allergy should be considered as a potential cause. This article presents the current understanding of the epidemiology, diagnosis and treatment of immune- and non-immune-mediated food-induced diseases. Diagnosis of food hypersensitivity is based mainly on medical history, different types of sensitivity tests, e.g., hydrogen breath test, specific IgE (sIgE) serum concentration, tissue eosinophil count, skin tests and oral food challenges considered as a "gold standard" for food allergy. Elimination diet and pharmacologic treatment for allergy symptoms are first-line therapies. Eosinophilic gastrointestinal diseases are often caused by non-IgE-mediated food allergies, require endoscopic biopsy samples to confirm diagnosis and proper elimination diet often combined with steroids or proton pump inhibitor agents for treatment. Mast cell activation syndrome (MCAS) derives from pathologic reaction of mast cells with increased tryptase serum level as a marker. Symptoms may occur in the digestive, respiratory, skin, neurologic and cardiovascular system. Treatment is based on histamine type 1, type 2 (H1, H2) receptor antagonists and other mast cell stabilizing agents. Carbohydrate intolerances are the most common type of food hypersensitivity in adult patients, and an elimination diet is effective for reducing symptoms. Food additives hypersensitivity remains difficult to diagnose, but use of a diet low in chemical substances alleviates symptoms and helps to diagnose the triggering factors.

Application of Lactose-Free Whey Protein to Greek Yogurts: Potential Health Benefits and Impact on Rheological Aspects and Sensory Attributes

The application of β-galactosidase in the fermentation of milk enables the acquirement of lower levels of lactose that are tolerated by lactose maldigesters and can reduce the nutritional consequences of avoiding dairy products. The present study evaluated the viability of the fortification of lactose-free prebiotic Greek yogurt formulas with whey protein concentrate (WPC). Two rotational central composite designs (RCCDs) were applied: one to perform the hydrolysis of the whey protein concentrate and another for the yogurt formulations (α = 2 with 2 central points and 4 axial points). Two β-galactosidase enzymes obtained from Kluyveromyces lactis were used. The content of lactose, glucose, galactose, and lactic acid were determined in the WPC, milk (pasteurized and powdered), and yogurts. The three best formulations regarding the attributes’ viscosity, syneresis, firmness, and elasticity were sensorially evaluated by using a nine-point hedonic scale. A microbiological analysis was performed after 48 h of yogurt production. The characterization of the products and the comparison of the results obtained were evaluated using the Student’s T test and the analysis of variance with Tukey’s test (p-values < 0.05). The application of a lactose-free WPC promoted viscosity, firmness, and elasticity. The syneresis was reduced, and whey increased the protein and calcium content. Lactose-free WPC can be used as a partial substitute for skimmed powdered milk in yogurts. The obtained results are encouraging with respect to the production of lactose-free Greek yogurts by the dairy industry.

Cow's milk-induced gastrointestinal disorders: From infancy to adulthood

Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders. Cow's milk protein allergy (CMPA) is the most common food allergy, especially in infancy and childhood, which may persist into adulthood. There are three main types of CMPA; immunoglobulin E (IgE)-mediated CMPA, non-IgE-mediated CMPA, and mixed type. CMPA appears before the first birthday in almost all cases. Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis. CMPA (often non-IgE mediated) can present with symptoms of gastroesophageal reflux, eosinophilic esophagitis, hemorrhagic gastritis, food protein-induced protein-losing enteropathy, and food protein-induced enterocolitis syndrome. Most CMPAs are benign and outgrown during childhood. CMPA is not as common in adults as in children, but when present, it is usually severe with a protracted course. Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose. Lactose intolerance has four typical types: Developmental, congenital, primary, and secondary. Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults. They are also common in inflammatory bowel diseases. Milk consumption may have preventive or promoter effects on cancer development. Milk may also become a source of microbial infection in humans, causing a wide array of diseases, and may help increase the prevalence of antimicrobial resistance. This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.

Optimization of Extraction Process of Polysaccharides MAP-2 from Opuntia Milpa Alta by Response Surface Methodology and Evaluation of Its Potential as α-Glucosidase Inhibitor

The α-glucosidase inhibitors play an important role in blood glucose control in patients with type 2 diabetes. At present, the development of new α-glucosidase inhibitors is an urgent clinical need. Our previous studies have found that the polysaccharide MAP-2 in the cactus Opuntia Milpa Alta has significantly better activity than acarbose (one of the most widely used first-line α-glucosidase inhibitors in clinical practice), but its optimal extraction process parameters and inhibition kinetic characteristics are not clear, and whether it has the potential to become a new α-glucosidase inhibitors is also unclear. In this study, based on previous research, we used the combination of single factor experiments and the response surface method (RSM) to identify the optimal extraction conditions for MAP-2 as follows: solid-liquid ratio 1:4, extraction temperature 90 °C, extraction time 1 h. Under these conditions, the extraction yield of MAP-2 was 3.47 ± 0.062%. When the concentration of MAP-2 was 16 mg/mL, the inhibition rate of α-glucosidase was 91.13 ± 0.62%. In addition, the results of inhibition kinetics showed that the inhibition rate of MAP-2 on α-glucosidase was the highest at pH 7.4 for 30 min, and showed a good dose-effect relationship, which was a reversible competitive inhibition. Meanwhile, we also compared the activities of MAP-2 and acarbose on the side effects of acarbose related enzymes. Compared with acarbose, MAP-2 not only had a better activation effect on lactase, but also inhibited the activity of hyaluronidase, and the activation and inhibition rate were positively correlated with the concentration. However, under the same conditions, the effect of acarbose on hyaluronidase was opposite to that of MAP-2. At low concentration, acarbose had a certain activation effect on lactase, but gradually attained an inhibitory effect with the increase in concentration. In contrast, MAP-2 not only activates lactase activity, improves diarrhea, abdominal distension, and abdominal pain, but also inhibits hyaluronidase activity, to solve the side effects of allergic reactions, suggesting that MAP-2 has the potential to become a novel and effective inhibitor of α-glucosidase with fewer side effects.

The Relationship between Fluid Milk, Water, and 100% Juice and Health Outcomes among Children and Adolescents

Beverages can provide improved nutrient intake and hydration, but also pose concerns related to overnutrition or contamination for children and adolescents who are in a time of critical growth. This narrative review aims to understand the impact of milk, 100% juice, and water consumption on health-related outcomes in youth. The literature review conducted used PubMed, Web of Science, and CABI global. Forty-five research articles met the quality criteria and were included. Health organization and governmental resources were also reviewed to identify current intake and consumption recommendations. All beverages in this review were associated with a variety of desirable and undesirable findings that spanned over 40 different health outcomes. Most studies that assessed milk lacked clear distinction between milk type (flavored vs. unflavored) or fat percentage, making it difficult to understand the impact of milk consumption. The relationship between milk intake and anthropometric-related outcomes were mixed within and across studies. Water was consistently associated with better hydration, while 100% juice and flavored milk intake was associated with more desirable dietary patterns or nutrients that children are currently not consuming adequate amounts of. The implications of these findings were discussed in the context of the National School Lunch Program (NSLP), while considering the impact of issues such as contaminated water and lactose intolerance. This review suggests that water may be an optimal default beverage option in the NSLP to promote hydration and accommodate beverage preferences for those with lactose intolerance.

Circulatory amino acid responses to milk consumption in dairy and lactose intolerant individuals

Background/objectives

Self-reported digestive intolerance to dairy foods is common. As dairy can be an important source of dietary protein, this study aimed to identify whether milk protein digestion is compromised in individuals with digestive intolerance.

Subjects/methods

Adult women (n = 40) were enroled in this double-blinded, randomised cross-over trial, with digestive symptoms characterised using a lactose challenge and self-reported digestive symptom questionnaire. Participants were classified as either lactose intolerant (LI, n = 10), non-lactose dairy intolerant (NLDI, n = 20) or dairy tolerant (DT, n = 10). In a randomised sequence, participants consumed three different kinds of milk (750 ml); conventional milk (CON), a2 Milk™ (A2M), and lactose-free conventional milk (LF-CON). Circulatory plasma amino acid (AA) concentrations were measured at baseline and every 30 min until 3 h post-ingestion.

Results

In all participants across all milk types, plasma AA concentrations (AUC_0-180) increased after milk ingestion with no significant differences in responses observed between milk types or participants (P > 0.05), with the exception of the suppressed lysine response in the DT group following A2M ingestion, relative to the other two groups and milk types (P < 0.05).

Conclusion

Milk protein digestion, as determined by circulatory AAs, is largely unaffected by dairy- and lactose- intolerances.

Bioprospecting Kluyveromyces marxianus as a Robust Host for Industrial Biotechnology

Kluyveromyces marxianus is an emerging non-conventional food-grade yeast that is generally isolated from diverse habitats, like kefir grain, fermented dairy products, sugar industry sewage, plants, and sisal leaves. A unique set of beneficial traits, such as fastest growth, thermotolerance, and broad substrate spectrum (i.e., hemi-cellulose hydrolysates, xylose, l-arabinose, d-mannose, galactose, maltose, sugar syrup molasses, cellobiose, and dairy industry) makes this yeast a particularly attractive host for applications in a variety of food and biotechnology industries. In contrast to Saccharomyces cerevisiae, most of the K. marxianus strains are apparently Crabtree-negative or having aerobic-respiring characteristics, and unlikely to endure aerobic alcoholic fermentation. This is a desirable phenotype for the large-scale biosynthesis of products associated with biomass formation because the formation of ethanol as an undesirable byproduct can be evaded under aerobic conditions. Herein, we discuss the current insight into the potential applications of K. marxianus as a robust yeast cell factory to produce various industrially pertinent enzymes, bioethanol, cell proteins, probiotic, fructose, and fructo-oligosaccharides, and vaccines, with excellent natural features. Moreover, the biotechnological improvement and development of new biotechnological tools, particularly CRISPR-Cas9-assisted precise genome editing in K. marxianus are delineated. Lastly, the ongoing challenges, concluding remarks, and future prospects for expanding the scope of K. marxianus utilization in modern biotechnology, food, feed, and pharmaceutical industries are also thoroughly vetted. In conclusion, it is critical to apprehend knowledge gaps around genes, metabolic pathways, key enzymes, and regulation for gaining a complete insight into the mechanism for producing relevant metabolites by K. marxianus.

Development and Dissolution Study of a β-Galactosidase Containing Drinking Straw

Today, in addition to many different physicochemical and pharmacological properties of the active ingredients and excipients, the developer of a pharmaceutical formulation must take into account several factors during the formulation process in order for the patient to cooperate to use the formulation accurately. One of the innovative solutions in paediatrics may be the use of medicated drinking straws. For our studies, we successfully prepared lactase-containing, rapid disintegration particles by two techniques commonly used in the pharmaceutical industry. The simulation of the usage of the filled straws was presented from a new perspective for the patient by an in vitro method. The effect of the temperature of the liquid used during the administration of the straw and the effect of the frequency during the application on the dissolution rate were investigated. According to our results, in the case of a straw containing rapidly dissolving particles, the temperature of the used liquid and the mode of administration (frequency) play a significant role in the release rate from the composition.

Prevalence of lactose intolerance and malabsorption among children of two ethnic groups from the urban areas of Malaysia and its relation to calcium intake and bone health status

Lactase insufficiency could develop into lactose intolerance (LI) and disrupt the intake of calcium, which is a core nutrient for bone development in children. However, data regarding the prevalence of LI and bone health status (BHS) among Malaysian children are scarcely reported.

PURPOSE

This study aimed to determine the prevalence of LI and lactose malabsorption (LM) in Malay and Chinese children and examine its relationship with calcium intake (CI) and BHS.

METHODS

A total of 400 children participated in this study. The prevalence of lactose tolerance (LT) was assessed using hydrogen breath test, LT test, and visual analogue scales. Assessment of CI was performed using a 24-h dietary recall interview (24-h DR) and food frequency questionnaire (FFQ). Calcaneal broadband ultrasound attenuation (BUA) was measured using a quantitative ultrasonometer.

RESULTS

The prevalence of LI among Chinese children (37%) was significantly higher (p = 0.002) than among Malay children (22.5%). However, 61.5% of Malay and 54.5% of Chinese children were found to have LM. CI of the children fulfilled 30.5% and 33.9% of the Malaysian recommended CI (1300 mg/day) for 24-h DR and FFQ, respectively. The BUA score of Malay children was significantly higher (p < 0.001) than that of Chinese children. However, LT and CI were not correlated with BHS (p > 0.05, respectively).

CONCLUSIONS

LI was diagnosed among Malay and Chinese children. However, the higher prevalence of LM is rather worrying as it could develop to LI. The prevalence possibly has been worsened by insufficient CI. Thus, effective approaches to increase CI are highly needed as bone development occurs rapidly at this age and is important for the attainment of the optimum peak bone mass during late adolescence.

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.

Estimating prevalence of human traits among populations from polygenic risk scores

The genetic basis of phenotypic variation across populations has not been well explained for most traits. Several factors may cause disparities, from variation in environments to divergent population genetic structure. We hypothesized that a population-level polygenic risk score (PRS) can explain phenotypic variation among geographic populations based solely on risk allele frequencies. We applied a population-specific PRS (psPRS) to 26 populations from the 1000 Genomes to four phenotypes: lactase persistence (LP), melanoma, multiple sclerosis (MS) and height. Our models assumed additive genetic architecture among the polymorphisms in the psPRSs, as is convention. Linear psPRSs explained a significant proportion of trait variance ranging from 0.32 for height in men to 0.88 for melanoma. The best models for LP and height were linear, while those for melanoma and MS were nonlinear. As not all variants in a PRS may confer similar, or even any, risk among diverse populations, we also filtered out SNPs to assess whether variance explained was improved using psPRSs with fewer SNPs. Variance explained usually improved with fewer SNPs in the psPRS and was as high as 0.99 for height in men using only 548 of the initial 4208 SNPs. That reducing SNPs improves psPRSs performance may indicate that missing heritability is partially due to complex architecture that does not mandate additivity, undiscovered variants or spurious associations in the databases. We demonstrated that PRS-based analyses can be used across diverse populations and phenotypes for population prediction and that these comparisons can identify the universal risk variants.

The Effects of Milk Supplementation on Bone Health Indices in Adults: A Meta-Analysis of Randomized Controlled Trials

Milk contains a number of bone-beneficial nutrients. However, milk, due to the D-galactose content, might have unfavorable effects on bone health. A meta-analysis of randomized controlled trials (RCTs) was performed to clarify the effects of milk supplementation on bone mineral density (BMD), bone turnover markers [N-terminal telopeptide of type I collagen (NTx), C-terminal telopeptide of type 1 collagen (CTx), osteocalcin, bone alkaline phosphatase (BALP), and procollagen type 1 N-propeptide (P1NP)], and hormonal indices related to bone metabolism [parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], and insulin-like growth factor 1 (IGF-1)] in adults. The PubMed and Web of Science databases were searched. A random-effects model was used to estimate the pooled effect sizes. A total of 20 RCTs were included. The trial duration ranged from 1 mo to 36 mo. Milk supplementation resulted in a small but significant increase in BMD at the hip (+0.004 g/cm2; n = 9 RCTs) and lumbar spine (+0.025 g/cm2; n = 7), but did not significantly affect whole-body BMD (n = 3) and femoral neck BMD (n = 7). Milk supplementation reduced the concentrations of P1NP (-5.20 ng/mL; n = 9), CTx (-0.16 ng/mL; n = 9), and NTx (-8.66 nmol bone collagen equivalents/mmol creatinine; n = 3). The concentrations of osteocalcin (n = 9) and BALP (n = 3) were not affected by milk supplementation. Reduced parathyroid hormone PTH (-1.01 pg/mL; n = 13) concentrations and increased IGF-1 (+1.79 nmol/l; n = 4) concentrations were observed with milk supplementation. 25(OH)D (+3.73 ng/mL; n = 11) concentrations were increased with vitamin-D fortified milk supplementation. The addition of milk to the diet may potentially increase the likelihood of preventing bone loss by restoring bone homeostasis through the modulation of the calcium-vitamin D-PTH axis, bone remodeling rate, and growth hormone/IGF-1 axis.

Association between milk consumption and lactose malabsorption in Indonesian children

OBJECTIVES

To study the association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years.

METHODS

This cross sectional study was conducted in randomly selected presumed healthy children with good nutritional status aged 3-12 years in Central Jakarta, Indonesia (n=174), including 72 children aged 3-5 years and 102 children aged 6-12 years.

RESULTS

The prevalence of lactose malabsorption in children aged 3-5 years and children aged 6-12 years was 20.8% (15/72) and 35.3% (36/102), respectively. There was no association between milk or milk product consumption and lactose malabsorption (P>0.05). In the 51 children with lactose malabsorption, the predominant clinical symptoms were diarrhea (62%), abdominal pain (52%), and nausea (5%) during the hydrogen breath test.

CONCLUSIONS

There is no association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years, suggesting that genetic predisposition may be more important than adaptive mechanisms to lactose consumption.

Calcium and vitamin D intake in allergic versus non-allergic children and corresponding parental attitudes towards dairy products

BACKGROUND

It is hypothesized that parents of children with allergic conditions believe dairy products are potentially harmful to their child.

OBJECTIVES

This study compares the calcium and vitamin D intake of allergic versus non-allergic children and parental beliefs about milk and dairy products.

METHODS

A survey and food-frequency-questionnaire were administered to parents of children between 3 and 13 years, 110 with allergic disease (allergic rhinitis, asthma, food allergy, and/or atopic dermatitis) versus 110 without allergic disease. Calcium and vitamin D intake was calculated from the food-frequency-questionnaire and compared to National Institutes of Health recommendations. Associations between atopy, calcium and vitamin D intake, and beliefs were investigated using Chi-square test (α = 0.05). Distribution across subjects was investigated using Mann-Whitney-U test (α = 0.05).

RESULTS

Fewer allergic (51.8%) versus non-allergic children (77.3%) met the recommended calcium intake (p < 0.001). Both had similar rates of insufficient vitamin D intake: 12.7% allergic and 17.3% non-allergic (p = 0.345). 81.7% of parents of allergic versus 94.0% of non-allergic children believe intake of dairy is important (p = 0.009). 23.7% of parents of allergic versus 8.0% of non-allergic children believe dairy negatively impacts their child (p = 0.003). 19.1% of parents of allergic children (excluding 3 with documented milk allergy) versus 2.0% of non-allergic believe their child is allergic or intolerant to dairy (p < 0.001).

CONCLUSIONS

Children are at risk of insufficient calcium and vitamin D intake. Atopic children may be at increased risk for insufficient intake, due in part to parent's negative beliefs regarding dairy products. Physicians should counsel on the importance of micronutrient intake and how allergic conditions do or do not entail dietary restrictions.