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Darma A, Sumitro KR, Jo J, Sitorus N. Lactose Intolerance versus Cow's Milk Allergy in Infants: A Clinical Dilemma. Nutrients 2024; 16:414. [PMID: 38337698 PMCID: PMC10856892 DOI: 10.3390/nu16030414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
Due to its very early introduction, cow's milk is one of the first foods that can cause adverse reactions in human beings. Lactose intolerance (LI) and cow's milk allergy (CMA) are the most common adverse reactions to cow's milk. While LI is due to insufficient small intestinal lactase activity and/or a large quantity of ingested lactose, CMA is an aberrant immune reaction to cow's milk proteins, particularly casein or β-lactoglobulin. However, the clinical manifestations of LI and CMA, particularly their gastrointestinal signs and symptoms, are very similar, which might lead to misdiagnosis or delayed diagnosis as well as nutritional risks due to inappropriate dietary interventions or unnecessary dietary restriction. Formula-fed infants with LI should be treated with formula with reduced or no lactose, while those with CMA should be treated with formula containing extensive hydrolyzed cow's milk protein or amino acids. This review is therefore written to assist clinicians to better understand the pathophysiologies of LI and CMA as well as to recognize the similarities and differences between clinical manifestations of LI and CMA.
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Affiliation(s)
- Andy Darma
- Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia;
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Khadijah Rizky Sumitro
- Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia;
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Juandy Jo
- Department of Biology, Faculty of Science and Technology, Universitas Pelita Harapan, Tangerang 15811, Indonesia;
- Mochtar Riady Institute for Nanotechnology, Tangerang 15811, Indonesia
| | - Nova Sitorus
- Danone Specialized Nutrition Indonesia, Jakarta 12940, Indonesia;
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Fraile-Gutiérrez I, Iglesias S, Acosta N, Revuelta J. Chitosan-based oral hydrogel formulations of β-galactosidase to improve enzyme supplementation therapy for lactose intolerance. Int J Biol Macromol 2024; 255:127755. [PMID: 37935291 DOI: 10.1016/j.ijbiomac.2023.127755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
β-Galactosidase supplementation plays an important role in the life of people with lactose intolerance. However, these formulations are rendered ineffective by the low pH and pepsin in the stomach and pancreatic proteases in the intestine. Therefore, it is necessary to develop oral transport systems for carrying this enzyme in the active form up to the intestine, where the lactose digestion occurs. In this research, a new hydrogel was developed that could potentially be used for enzyme supplement therapy. In this regard, the chitosan-based β-Gal formulations described in the manuscript are an alternative long-acting preparation to the so far available preparations that allow for enzyme protection and mucosal targeting. These hydrogels were prepared from chitosan and polyethylene glycol and contained a covalently immobilized β-galactosidase from Aspergillus oryzae. The β-galactosidase in the hydrogel was protected from degradation in a gastric medium at a pH of 2.5 and retained 75 % of its original activity under subsequent intestinal conditions. In the case of a simulated gastric fluid with a pH of 1.5, a copolymer containing methacrylic acid functional groups was sufficient to protect the hybrid hydrogel from the extremely acidic pH. In addition, the surface of the hydrogel was chemically modified with thiol and amidine groups, which increased the binding to intestinal mucin by 20 % compared with the unmodified hydrogel. These results represent a promising approach for oral transport as a reservoir for β-galactosidase in the small intestine to reduce the symptoms of hypolactasia.
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Affiliation(s)
- Isabel Fraile-Gutiérrez
- BioGlycoChem Group, Departamento de Química Bio-Orgánica, Instituto de Química Orgánica General, CSIC (IQOG-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain; Infiqus, S.L. Instituto de Estudios Biofuncionales - UCM, Paseo Juan XXIII 1, 28040 Madrid, Spain
| | - Susana Iglesias
- BioGlycoChem Group, Departamento de Química Bio-Orgánica, Instituto de Química Orgánica General, CSIC (IQOG-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain
| | - Niuris Acosta
- Infiqus, S.L. Instituto de Estudios Biofuncionales - UCM, Paseo Juan XXIII 1, 28040 Madrid, Spain; Departamento de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain.
| | - Julia Revuelta
- BioGlycoChem Group, Departamento de Química Bio-Orgánica, Instituto de Química Orgánica General, CSIC (IQOG-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain.
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Lizzi M, Sgrazzutti L, Porreca A, Di Filippo P, Cauzzo C, Di Pillo S, Chiarelli F, Attanasi M. Longitudinal prospective anthropometric evaluation in Caucasian prepubertal children with lactose intolerance. Front Pediatr 2023; 11:1219195. [PMID: 37691779 PMCID: PMC10485141 DOI: 10.3389/fped.2023.1219195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The health consequences of lactose intolerance remain unclear. We studied the association of lactose intolerance with growth in children. Methods In this prospective case-control study, we compared Caucasian prepubertal children with lactose intolerance (LI) [n = 30, median age = 7.87 years (3.00-12.75)] to healthy controls [(n = 75, median age = 2.25 years (2.00-7.25)]. A lactose tolerance test was performed for lactose intolerance diagnosis. The gastrointestinal symptom score was administered at baseline and after a lactose-free diet for a median period of 9.0 months [range 5%-95% (6.0-24.0)]. The anthropometric parameters were measured at baseline and follow-up. All the anthropometric data were converted into standard deviation scores (SDS). A linear regression model was used to investigate the association of lactose intolerance with growth parameters. Results We found no difference in height velocity SDS between the LI and control groups [SDS difference (95% CI): 0.52 (-1.86 to 2.90)]. In addition, we found a significant reduction in the clinical score of the LI group after a lactose-free diet [median (5%-95%): 7.5 (4.0-15.0) and 3 (0.0-8.0); p-value <0.001]. Conclusions The LI group exhibited no difference in height velocity compared with the control group. Nonetheless, due to the small sample size, the results on the anthropometric profile of the LI group require careful interpretation. More large-scale studies in the pediatric population are required to better understand the association of LI with anthropometric and metabolic profiles.
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Affiliation(s)
- Mauro Lizzi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
| | - Laura Sgrazzutti
- Department of Pediatrics, San Giacomo Hospital, Castelfranco Veneto, Italy
| | | | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
| | - Chiara Cauzzo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti, Chieti, Italy
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Anatskaya OV, Runov AL, Ponomartsev SV, Vonsky MS, Elmuratov AU, Vinogradov AE. Long-Term Transcriptomic Changes and Cardiomyocyte Hyperpolyploidy after Lactose Intolerance in Neonatal Rats. Int J Mol Sci 2023; 24:ijms24087063. [PMID: 37108224 PMCID: PMC10138443 DOI: 10.3390/ijms24087063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Many cardiovascular diseases originate from growth retardation, inflammation, and malnutrition during early postnatal development. The nature of this phenomenon is not completely understood. Here we aimed to verify the hypothesis that systemic inflammation triggered by neonatal lactose intolerance (NLI) may exert long-term pathologic effects on cardiac developmental programs and cardiomyocyte transcriptome regulation. Using the rat model of NLI triggered by lactase overloading with lactose and the methods of cytophotometry, image analysis, and mRNA-seq, we evaluated cardiomyocyte ploidy, signs of DNA damage, and NLI-associated long-term transcriptomic changes of genes and gene modules that differed qualitatively (i.e., were switched on or switched off) in the experiment vs. the control. Our data indicated that NLI triggers the long-term animal growth retardation, cardiomyocyte hyperpolyploidy, and extensive transcriptomic rearrangements. Many of these rearrangements are known as manifestations of heart pathologies, including DNA and telomere instability, inflammation, fibrosis, and reactivation of fetal gene program. Moreover, bioinformatic analysis identified possible causes of these pathologic traits, including the impaired signaling via thyroid hormone, calcium, and glutathione. We also found transcriptomic manifestations of increased cardiomyocyte polyploidy, such as the induction of gene modules related to open chromatin, e.g., "negative regulation of chromosome organization", "transcription" and "ribosome biogenesis". These findings suggest that ploidy-related epigenetic alterations acquired in the neonatal period permanently rewire gene regulatory networks and alter cardiomyocyte transcriptome. Here we provided first evidence indicating that NLI can be an important trigger of developmental programming of adult cardiovascular disease. The obtained results can help to develop preventive strategies for reducing the NLI-associated adverse effects of inflammation on the developing cardiovascular system.
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Affiliation(s)
| | - Andrey L Runov
- The D.I. Mendeleev All-Russian Institute for Metrology (VNIIM), Moskovsky ave 19, Saint Petersburg 190005, Russia
- Almazov Medical Research Centre, Akkuratova Street 2, Saint Petersburg 197341, Russia
| | | | - Maxim S Vonsky
- The D.I. Mendeleev All-Russian Institute for Metrology (VNIIM), Moskovsky ave 19, Saint Petersburg 190005, Russia
- Almazov Medical Research Centre, Akkuratova Street 2, Saint Petersburg 197341, Russia
| | - Artem U Elmuratov
- Medical Genetics Centre Genotek, Nastavnichesky Alley 17-1-15, Moscow 105120, Russia
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Seidita A, Mansueto P, Giuliano A, Chiavetta M, Soresi M, Carroccio A. Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance. Nutrients 2023; 15:nu15041048. [PMID: 36839406 PMCID: PMC9962554 DOI: 10.3390/nu15041048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
The hypothesis is that inflammatory/allergic conditions should be considered in self-reported milk intolerance (SRMI) patients who test negative and/or are asymptomatic at Lactose Hydrogen Breath Test (LHBT). We analyzed fecal calprotectin (FCP) values in SRMI patients to investigate the frequency of a "positive" intestinal inflammation marker and its correlation with lactose tolerance/intolerance. Data from 329 SRMI patients were retrospectively analyzed; according to the positive/negative results (maldigester/digester) and the presence/absence of symptoms reported during LHBT (intolerant/tolerant), patients were divided into: 'lactose tolerants' (n. 104), 'maldigesters/intolerants' (n. 187), 'digesters/intolerants' (n. 38). FCP values were analyzed in all three subgroups. A percentage of SRMI patients complained of constipation (>15%), extraintestinal symptoms (>30% including anemia), multiple food hypersensitivity (7.6%) and had intraepithelial lymphocytic infiltration at duodenal biopsy (>50%). Over 50.0% showed FCP values above the normal limit. Lactose tolerants and maldigesters/intolerants had higher positivity frequencies (p < 0.0001, for both) and absolute values (p = 0.04, for maldigesters/intolerants) of FCP compared to digesters/intolerants. FCP was not useful to differentiate tolerant from intolerant subjects (AUC 0.58). Our data suggest the existence of an allergic/inflammatory pathogenetic mechanism in a subset of SRMI subjects. FCP results are in keeping with this hypothesis, even if they cannot differentiate lactose tolerant from intolerant patients.
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Affiliation(s)
- Aurelio Seidita
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90120 Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Pasquale Mansueto
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Alessandra Giuliano
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90120 Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Marta Chiavetta
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90120 Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Maurizio Soresi
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonio Carroccio
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90120 Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Fax: +39-091-6552884
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Mofokeng MM, Prinsloo G, Araya HT, Amoo SO, du Plooy CP, Mashela PW. NADES Compounds Identified in Hypoxis hemerocallidea Corms during Dormancy. PLANTS 2022; 11:plants11182387. [PMID: 36145788 PMCID: PMC9503605 DOI: 10.3390/plants11182387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022]
Abstract
Soaking Hypoxis hemerocallidea corms in distilled water improved the propagation and development of cormlets, suggesting the potential leaching-out of inhibitory chemical compounds. To investigate the presence of inhibitory compounds, nuclear magnetic resonance (NMR) spectral data of the leachate from dormant H. hemerocallidea corms were obtained using a 600 MHz 1H-NMR spectrometer. The 1H-NMR analysis led to the identification of choline, succinate, propylene glycol, and lactose, as inhibitory compounds. These four chemical compounds are part of the “Natural Deep Eutectic Solvents” (NADES) that protect plant cells during stress periods, each of which has the potential to inhibit bud growth and development. These compounds are supposedly leached out of the corms during the first rain under natural conditions, possibly accompanied by changes in the ratios of dormancy-breaking phytohormones and inhibitory compounds, to release bud dormancy. The identified chemical compounds heralded a novel frontier in the vegetative propagation of H. hemerocallidea as a medicinal plant, and for its enhanced sustainable uses.
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Affiliation(s)
- Motiki M. Mofokeng
- Agricultural Research Council—Vegetable, Industrial and Medicinal Plants (ARC-VIMP), Private Bag X293, Pretoria 0001, South Africa
- Green Technologies Research Centre, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa
- Correspondence: (M.M.M.); (H.T.A.); (S.O.A.); Tel.: +27-12-808-8000 (M.M.M. & H.T.A. & S.O.A)
| | - Gerhard Prinsloo
- Department of Agriculture and Animal Health, University of South Africa, Private Bag X6, Johannesburg 1710, South Africa
| | - Hintsa T. Araya
- Agricultural Research Council—Vegetable, Industrial and Medicinal Plants (ARC-VIMP), Private Bag X293, Pretoria 0001, South Africa
- Correspondence: (M.M.M.); (H.T.A.); (S.O.A.); Tel.: +27-12-808-8000 (M.M.M. & H.T.A. & S.O.A)
| | - Stephen O. Amoo
- Agricultural Research Council—Vegetable, Industrial and Medicinal Plants (ARC-VIMP), Private Bag X293, Pretoria 0001, South Africa
- Department of Botany and Plant Biotechnology, University of Johannesburg, P.O. Box 524, Auckland Park, Johannesburg 2006, South Africa
- Correspondence: (M.M.M.); (H.T.A.); (S.O.A.); Tel.: +27-12-808-8000 (M.M.M. & H.T.A. & S.O.A)
| | - Christian P. du Plooy
- Agricultural Research Council—Vegetable, Industrial and Medicinal Plants (ARC-VIMP), Private Bag X293, Pretoria 0001, South Africa
| | - Phatu W. Mashela
- Green Technologies Research Centre, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa
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Marabotto E, Ferone D, Sheijani AD, Vera L, Ziola S, Savarino E, Bodini G, Furnari M, Zentilin P, Savarino V, Giusti M, Navarro Rojas FA, Bagnasco M, Albertelli M, Giannini EG. Prevalence of Lactose Intolerance in Patients with Hashimoto Thyroiditis and Impact on LT4 Replacement Dose. Nutrients 2022; 14:nu14153017. [PMID: 35893871 PMCID: PMC9331471 DOI: 10.3390/nu14153017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: to determine lactose intolerance (LI) prevalence in women with Hashimoto’s thyroiditis (HT) and assess the impact of LI on LT4 replacement dose. Methods. consecutive patients with HT underwent Lactose Breath Test and clinical/laboratory data collection. Unrelated gastrointestinal disorders were carefully ruled out. Lactose-free diet and shift to lactose-free LT4 were proposed to patients with LI. Results: we enrolled 58 females (age range, 23−72 years) with diagnosis of HT. In total, 15 patients were euthyroid without treatment, and 43 (74%) euthyroid under LT4 (30 of them with a LT4 formulation containing lactose). Gastrointestinal symptoms were present in 84.5% of patients, with a greater prevalence in change in bowel habits in lactose-intolerant patients (p < 0.0001). The cumulative LT4 dose required did not differ in patients with or without LI. No significant difference in both TSH values and LT4 dose were observed in patients shifted to lactose-free LT4 and diet at 3 and 6 months compared to baseline. Conclusion: the prevalence of LI in patients with HT was 58.6%, not different from global prevalence of LI. In the absence of other gastrointestinal disorders, LI seems not to be a major cause of LT4 malabsorption and does not affect the LT4 required dose in HT patients.
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Affiliation(s)
- Elisa Marabotto
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
| | - Afscin Djahandideh Sheijani
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Lara Vera
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
| | - Sebastiano Ziola
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
| | - Giorgia Bodini
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Patrizia Zentilin
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Vincenzo Savarino
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
| | - Massimo Giusti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
| | - Fabiola Andrea Navarro Rojas
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
| | - Marcello Bagnasco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy; (D.F.); (L.V.); (M.G.); (F.A.N.R.); (M.B.)
- Correspondence:
| | - Edoardo G. Giannini
- Division of Gastroenterology, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.M.); (A.D.S.); (S.Z.); (G.B.); (M.F.); (P.Z.); (V.S.); (E.G.G.)
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Leszkowicz J, Plata-Nazar K, Szlagatys-Sidorkiewicz A. Can Lactose Intolerance Be a Cause of Constipation? A Narrative Review. Nutrients 2022; 14:1785. [PMID: 35565753 PMCID: PMC9105309 DOI: 10.3390/nu14091785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Lactose intolerance and constipation are common in children and impact everyday life, not only for patients but also their families. Both conditions can be comorbid with other diseases or form a part of their clinical presentation, but constipation is not usually associated with lactose intolerance. The typical symptoms of lactose intolerance include abdominal pain, bloating, flatus, diarrhoea, borborygmi, and less frequently nausea and vomiting. In approximately 30% of cases, constipation can be a symptom of lactose intolerance. Constipation is characterized by infrequent bowel movements, hard and/or large stools, painful defecation, and faecal incontinence, and is often accompanied by abdominal pain. This paper provides a narrative review on lactose intolerance, its epidemiology, pathogenesis, the correlation between lactose intolerance and constipation in children, and potential mechanisms of such association.
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Affiliation(s)
- Julia Leszkowicz
- Department of Paediatrics, Gastroenterology, Allergology and Paediatric Nutrition, Faculty of Medicine, Medical University of Gdańsk, Nowe Ogrody 1-6, 80-803 Gdańsk, Poland; (K.P.-N.); (A.S.-S.)
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Chiavelli LUR, Galuch MB, Senes CER, Maia LC, Lopes TAM, Rufato KB, Santos OO, Visentainer JV. Validation of UHPLC-MS/MS Method and Measurement Uncertainty Evaluation for Lactose Quantification in Lactose-Free and Regular UHT Milk. FOOD ANAL METHOD 2022. [DOI: 10.1007/s12161-021-02197-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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World Gastroenterology Organisation Global Guidelines: Diet and the Gut. J Clin Gastroenterol 2022; 56:1-15. [PMID: 34860201 DOI: 10.1097/mcg.0000000000001588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/22/2021] [Indexed: 12/10/2022]
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Prasad A, Kothari N. Cow products: boon to human health and food security. Trop Anim Health Prod 2021; 54:12. [PMID: 34894304 PMCID: PMC8665701 DOI: 10.1007/s11250-021-03014-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023]
Abstract
The world population exceeded 7.8 billion people in 2020 and is predicted to reach 9.9 billion by 2050 as per the current increasing rate of 25%. In view of this, ensuring human health and food security has become an issue of key importance to countries with different degrees of economic development. At the same time, the livestock sector plays a strategic role in improving the economic, environmental, and sociocultural stewardship of any nation. The cow (Bos indicus) has held a distinctive role in human history ever since its domestication because of its valued harvests like dairy products (milk, clarified butter, yogurt, curd, and buttermilk) excreta like dung and urine. These products, except dung, provide all the necessary energy and nutrients to ensure the proper growth and development of the human. They are the source of many bioactive substances, which possess immense pharmacotherapeutic action against various physiological, metabolic and infectious disorders, including COVID-19. The use of urine and dung can be considered a low-cost agricultural practice for farmers and has been extensively used in modern agriculture practices to ensure food security via soil fertility, plant pathogens, and pests. Cow urine mediated synthesized nanomaterial also display distinctive characteristics and novel applications in various fields of science and technology. Thus, this paper aims to provide a comprehensive overview of cow products, describing their biochemical constituents, bioactivities, and their utilization in the area ranging from human welfare to agriculture sustainability. An attempt is also made to present possible applications in bioenergy production and pollution reduction.
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Affiliation(s)
- Arti Prasad
- Laboratory of Public Health Entomology, Department of Zoology, M. L. Sukhadia University, Udaipur, Rajasthan, India
| | - Naresh Kothari
- Laboratory of Public Health Entomology, Department of Zoology, M. L. Sukhadia University, Udaipur, Rajasthan, India.
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Carroccio A, Soresi M, Mantia B, Fayer F, La Blasca F, Seidita A, D’Alcamo A, Florena AM, Tinè C, Garlisi C, Mansueto P. Whole Cow's Milk but Not Lactose Can Induce Symptoms in Patients with Self-Reported Milk Intolerance: Evidence of Cow's Milk Sensitivity in Adults. Nutrients 2021; 13:nu13113833. [PMID: 34836089 PMCID: PMC8621065 DOI: 10.3390/nu13113833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Lactose intolerance is the most frequent food intolerance, but many subjects with self-reported milk intolerance (SRMI) are asymptomatic at lactose hydrogen breath test (LHBT). The aim of this study was to evaluate the frequency of lactose intolerance in SRMI patients and their clinical characteristics. METHODS In a retrospective study, the clinical records of 314 SRMI patients (259 females, mean age: 39.1 ± 13.5 years) were reviewed; 102 patients with irritable bowel syndrome (IBS) served as controls. In a prospective study, 42 SRMI patients, negatives at the LHBT, underwent a double-blind, placebo-controlled (DBPC) whole cow's milk challenge. RESULTS In the retrospective study, only 178 patients (56%) were lactose maldigesters and intolerant at LHBT; 68% of the subjects with SRMI were suffering from IBS; 74% reported dyspepsia (p = 0.0001 vs. IBS controls); and weight loss was recorded in 62 SRMI patients (20%) (p = 0.01 vs. IBS controls). Duodenal histology showed intra-epithelial lymphocytosis in about 60% of cases. In the prospective study, 36 patients (86%) experienced symptoms during the DBPC cow's milk challenge, and only 4 patients (9%) reacted to placebo (p = 0.0001). CONCLUSIONS A percentage of SRMI patients were not suffering from lactose intolerance. DBPC revealed that SRMI patients had clinical reactions when exposed to whole cow's milk.
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Affiliation(s)
- Antonio Carroccio
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90146 Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Fax: +39-091-6552884
| | - Maurizio Soresi
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Beatrice Mantia
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Francesca Fayer
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Francesco La Blasca
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Aurelio Seidita
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Alberto D’Alcamo
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Ada Maria Florena
- Unit of Pathology, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Chiara Tinè
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Chiara Garlisi
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
| | - Pasquale Mansueto
- Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (M.S.); (B.M.); (F.F.); (F.L.B.); (A.S.); (A.D.); (C.T.); (C.G.); (P.M.)
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Purified lactases versus whole-cell lactases-the winner takes it all. Appl Microbiol Biotechnol 2021; 105:4943-4955. [PMID: 34115184 DOI: 10.1007/s00253-021-11388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
Lactose-free dairy products are in great demand worldwide due to the high prevalence of lactose intolerance. To make lactose-free dairy products, commercially available β-galactosidase enzymes, also termed lactases, are used to break down lactose to its constituent monosaccharides, glucose and galactose. In this mini-review, the characteristics of lactase enzymes, their origin, and ways of use are discussed in light of their potential for hydrolyzing lactose. We also discuss whole-cell lactase catalysts, which appear to have great potential in terms of cost reduction and convenience, and which are more natural alternatives to purified enzymes. Lactic acid bacteria (LAB) already used in food fermentations seem to be optimal candidates for whole-cell lactases. However, they have not been industrially exploited yet due to technical hurdles. For whole-cell lactases to be efficient, the lactase enzymes inside the cells must be made available for lactose hydrolysis, and thus, cells need to be permeabilized or disrupted prior to use. Here we review state-of-the-art approaches for disrupting or permeabilizing microorganisms. Lastly, based on recent scientific achievements, we propose a novel, resource-efficient, and low-cost scenario for achieving lactose hydrolysis at a dairy plant using a LAB whole-cell lactase.Key points• Lactases (β-galactosidase) are essential for producing lactose-free dairy products• Novel permeabilization techniques facilitate the use of LAB lactases• Whole-cell lactase catalysts have great potential for reducing costs and resources Graphical abstract.
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Catanzaro R, Sciuto M, Marotta F. Lactose intolerance: An update on its pathogenesis, diagnosis, and treatment. Nutr Res 2021; 89:23-34. [PMID: 33887513 DOI: 10.1016/j.nutres.2021.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
Lactose intolerance has a high prevalence worldwide, ranging between 57% and 65%. It is caused by a reduction or loss of the activity of the intestinal enzyme lactase-phlorizin hydrolase, responsible for the digestion of lactose. This alteration determines an increased osmotic load in the small intestine and the fermentation of lactose by the bacterial flora, which leads to a high production of short-chain fatty acids and gas. This is followed by the onset of abdominal pain, diarrhea, and flatulence. In addition to these problems, it was found that subjects with lactose intolerance have an increased risk of developing various extra-intestinal diseases, including cancers. The diagnosis is essential to undertake an adequate treatment and, for this purpose, different methods have been tested. These include genetic test, hydrogen breath test (HBT), quick lactase test, and lactose tolerance test. HBT is the most used method because it is non-invasive, inexpensive, and highly sensitive and specific, as well as easy to perform. In clinical practice, the other methods are mainly used as HBT integration tests. There are also many therapeutic options. An appropriate intervention concerns the dietetic style, such as the consumption of lactose-free foods, but with nutritional characteristics comparable to dairy products. Other valid choices are represented by the use of exogenous enzymes, probiotics, prebiotics, the selection of milk containing specific types of beta-caseins. This review is intended to illustrate the diagnostic methods currently available and the possible therapeutic options for lactose intolerance.
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Affiliation(s)
- Roberto Catanzaro
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Catania, Italy.
| | - Morena Sciuto
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Catania, Italy.
| | - Francesco Marotta
- ReGenera R&D International for Aging Intervention & San Babila Clinic, Milano, Italy.
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15
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Nakajima S. Kaolin clay intake motivated by lactose ingestion in rats. LEARNING AND MOTIVATION 2021. [DOI: 10.1016/j.lmot.2021.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Porzi M, Burton-Pimentel KJ, Walther B, Vergères G. Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management. Nutrients 2021; 13:nu13051503. [PMID: 33946892 PMCID: PMC8145768 DOI: 10.3390/nu13051503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
Recent discoveries in the “omics” field and the growing focus on preventive health have opened new avenues for personalized nutrition (PN), which is becoming an important theme in the strategic plans of organizations that are active in healthcare, food, and nutrition research. PN holds great potential for individual health optimization, disease management, public health interventions, and product innovation. However, there are still multiple challenges to overcome before PN can be truly embraced by the public and healthcare stakeholders. The diagnosis and management of lactose intolerance (LI), a common condition with a strong inter-individual component, is explored as an interesting example for the potential role of these technologies and the challenges of PN. From the development of genetic and metabolomic LI diagnostic tests that can be carried out in the home, to advances in the understanding of LI pathology and individualized treatment optimization, PN in LI care has shown substantial progress. However, there are still many research gaps to address, including the understanding of epigenetic regulation of lactase expression and how lactose is metabolized by the gut microbiota, in order to achieve better LI detection and effective therapeutic interventions to reverse the potential health consequences of LI.
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Affiliation(s)
- Millie Porzi
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland;
| | - Kathryn J. Burton-Pimentel
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
| | - Barbara Walther
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
| | - Guy Vergères
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
- Correspondence: ; Tel.: +41-58-463-8154
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A New Food Composition Database of Lactose-Free Products Commercialized in Spain: Differences in Nutritional Composition as Compared to Traditional Products. Foods 2021; 10:foods10040851. [PMID: 33919767 PMCID: PMC8070661 DOI: 10.3390/foods10040851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 01/27/2023] Open
Abstract
We developed a new database to evaluate the nutritional composition of lactose-free products from Spain. The database includes dairy products and other products, all of which show the "lactose-free" declaration on their label, accounting for 327 products in total. Of these, 123 are dairy products, 16 are non-dairy products which include a dairy ingredient (5%) and 188 items (57% of the sample) are non-dairy products that do not contain any dairy ingredient. The main subgroups are yogurt (25%), milk (24%), and cheese (17%). Nineteen percent of the compiled products included nutritional claims on their labels. Most lactose-free products did not contain either added sugars or low- or no-calorie sweeteners (58%), while 34% included added sugars and only 6%, sweeteners or a combination of both (2%). We found that 19.5%, mainly within the milk subgroup, were fortified with vitamins A, D, E, K, B9, and B12, P, and Ca. There were no significant differences in the nutritional composition between lactose-free products and traditional products. According to the NOVA classification, 55% of compiled lactose-free products were ultra-processed, and 20% processed. The array of lactose-free products marketed in Spain proves that there are enough, both in quantity and quality, to satisfy the dairy needs of lactose intolerants.
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Katoch GK, Nain N, Kaur S, Rasane P. Lactose Intolerance and Its Dietary Management: An Update. J Am Coll Nutr 2021; 41:424-434. [PMID: 33831336 DOI: 10.1080/07315724.2021.1891587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Milk is the most common food consumed worldwide and is also a major ingredient in the preparation of various dairy products. However, despite the high production and consumption of milk and milk-based products, there is a large percent of the world's population that suffer from allergies to milk solids and lactose intolerance. Lactose intolerance specifically means the inability of the body to breakdown the sugar to its simplest form for assimilation and it is due to the inefficiency or lack of the enzyme in the human body. The most convenient prevention method for the affected population is to avoid milk and milk-based products but this may be a cause of development of other health related issues that result from inadequate nutrient consumption. To help find an alternative to this problem, this study aims at first studying the underlying information on lactose intolerance and then studying plant-based beverages as a possible alternative to milk and milk-based products. Key teaching pointsLactose intolerance specifically means the inability of the body to breakdown the sugar to its simplest form for assimilation and it is due to the inefficiency or lack of the enzyme in the human body.Consumption of probiotics may help relieve the symptoms of lactose intolerance.Soy beverage can be an economical alternative for lactose intolerant populations and has calcium content comparable to bovine milk.Calcium absorption in fortified plant based beverages depends upon type of calcium salt used.
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Affiliation(s)
- Gunjan Kumari Katoch
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Neegam Nain
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
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Di Costanzo M, Biasucci G, Maddalena Y, Di Scala C, De Caro C, Calignano A, Canani RB. Lactose Intolerance in Pediatric Patients and Common Misunderstandings About Cow's Milk Allergy. Pediatr Ann 2021; 50:e178-e185. [PMID: 34039171 DOI: 10.3928/19382359-20210312-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose. Primary lactose intolerance is the most common type of lactose intolerance. It is one of the most common forms of food intolerance and occurs when lactase activity is reduced in the brush border of the small bowel mucosa. People may be lactose intolerant to varying degrees, depending on the severity of these symptoms. When lactose is not digested, it is fermented by gut microbiota, leading to abdominal pain, bloating, flatulence, and diarrhea with a considerable intraindividual and interindividual variability in the severity of clinical manifestations. These gastrointestinal symptoms are similar to cow's milk allergy and could be wrongly labeled as symptoms of "milk allergy." There are important differences between lactose intolerance and cow's milk allergy. Therefore, a better knowledge of these differences could limit misunderstandings in the diagnostic approach and in the management of these conditions. [Pediatr Ann. 2021;50(4):e178-e185.].
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Brandão HCADNTDM, Brandão WAPLNTDM, Mendonça SNTGD, Felsner ML. Bebida fermentada probiótica de extrato de arroz: uma alternativa alimentar aos intolerantes à lactose e aos alérgicos às proteínas do leite bovino e da soja. BRAZILIAN JOURNAL OF FOOD TECHNOLOGY 2021. [DOI: 10.1590/1981-6723.11920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Resumo Consumidores têm demonstrado mais atenção à qualidade e à funcionalidade dos alimentos consumidos em razão do aumento da incidência de doenças inflamatórias intestinais, cardiovasculares, hipertensão arterial, diabetes mellitus II, obesidade, cânceres, principalmente aquelas relacionadas à intolerância à lactose e à alergia às proteínas do leite bovino e da soja. Neste estudo, de forma inédita, foram elaboradas e caracterizadas bebidas probióticas à base de extrato de arroz. As bebidas fermentadas com extrato de arroz (BA) foram desenvolvidas com a inoculação de microrganismos Lactobacillus acidophilus, Streptococcus thermophilus e Bifidobacterium animalis ssp. lactis, adoçadas com diferentes tipos de substratos, como sacarose, glicose e mel, e caracterizadas por análises físico-químicas e microbiológicas. Menos tempo de fermentação (nove horas) foi alcançado com a adição do inóculo SAB 440 (Lactobacillus acidophilus, Streptococcus thermophilus e Bifidobacterium animalis ssp. lactis) e da glicose e mel como substratos nas bebidas de extrato de arroz. Todas as bebidas foram caracterizadas como probióticas porque a contagem de células viáveis foi superior a 106 UFC mL-1. Cabe ressaltar que o valor energético pode se enquadrar como baixo, tendo o conteúdo lipídico sido inferior a 0,03%, o que classifica essas bebidas fermentadas como livres de gordura, de acordo com a legislação brasileira vigente. A funcionalidade de bebidas fermentadas elaboradas pode ser atribuída principalmente à sua característica probiótica. As bebidas desenvolvidas são interessantes para o consumo por pessoas intolerantes à lactose e alérgicas a leite de bovino e soja, pois contêm ingredientes não lácteos.
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Shrestha A, Barnett MPG, Perry JK, Cameron-Smith D, Milan AM. Evaluation of breath, plasma, and urinary markers of lactose malabsorption to diagnose lactase non-persistence following lactose or milk ingestion. BMC Gastroenterol 2020; 20:204. [PMID: 32600320 PMCID: PMC7325051 DOI: 10.1186/s12876-020-01352-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Adult lactase non-persistence (LNP) is due to low lactase expression, resulting in lactose malabsorption (LM). LNP is a genetic trait, but is typically determined by LM markers including breath H2, blood glucose, and urinary galactose after a lactose tolerance test. Known validity of these markers using milk is limited, despite being common practice. Compositional variation, such as β-casein variants, in milk may impact diagnostic efficacy. This study aimed to evaluate the diagnostic accuracy to detect LNP using these commonly measured LM markers after both lactose and milk challenges. Methods Fourty healthy young women were challenged with 50 g lactose then randomized for separate cross-over visits to ingest 750 mL milk (37.5 g lactose) as conventional (both A1 and A2 β-casein) and A1 β-casein-free (a2 Milk™) milk. Blood, breath and urine were collected prior to and up to 3 h following each challenge. The presence of C/T13910 and G/A22018 polymorphisms, determined by restriction fragment length polymorphism, was used as the diagnostic reference for LNP. Results Genetic testing identified 14 out of 40 subjects as having LNP (C/C13910 and G/G22018). All three LM markers (breath H2, plasma glucose and urinary galactose/creatinine) discriminated between lactase persistence (LP) and LNP following lactose challenge with an area under the receiver operating characteristic (ROC) curve (AUC) of 1.00, 0.75 and 0.73, respectively. Plasma glucose and urinary galactose/creatinine were unreliable (AUC < 0.70) after milk ingestion. The specificity of breath H2 remained high (100%) when milk was used, but sensitivity was reduced with conventional (92.9%) and a2 Milk™ (78.6%) compared to lactose (sensitivities adjusted for lactose content). The breath H2 optimal cut-off value was lower with a2 Milk™ (13 ppm) than conventional milk (21 ppm). Using existing literature cut-off values the sensitivity and specificity of breath H2 was greater than plasma glucose to detect LNP following lactose challenge whereas values obtained for urinary galactose/creatinine were lower than the existing literature cut-offs. Conclusion This study showed accurate diagnosis of LNP by breath H2 irrespective of the substrate used, although the diagnostic threshold may vary depending on the lactose substrate or the composition of the milk. Trial registration ACTRN12616001694404. Registered prospectively on December 9, 2016.
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Affiliation(s)
- Aahana Shrestha
- The Liggins Institute, The University of Auckland, Auckland, New Zealand.,The Riddet Institute, Palmerston North, New Zealand
| | - Matthew P G Barnett
- The Riddet Institute, Palmerston North, New Zealand.,Food Nutrition & Health Team, AgResearch Limited, Palmerston North, New Zealand.,The High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Jo K Perry
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - David Cameron-Smith
- The Liggins Institute, The University of Auckland, Auckland, New Zealand.,The Riddet Institute, Palmerston North, New Zealand.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Amber M Milan
- The Liggins Institute, The University of Auckland, Auckland, New Zealand. .,Food Nutrition & Health Team, AgResearch Limited, Palmerston North, New Zealand. .,The High-Value Nutrition National Science Challenge, Auckland, New Zealand.
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Robles L, Priefer R. Lactose Intolerance: What Your Breath Can Tell You. Diagnostics (Basel) 2020; 10:diagnostics10060412. [PMID: 32560312 PMCID: PMC7344825 DOI: 10.3390/diagnostics10060412] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 02/07/2023] Open
Abstract
Lactose intolerance has seen recognized as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhea after the consumption of lactose. Lactose is a common disaccharide found in dairy that requires lactase-phlorizin hydrolase (LPH) to break down into glucose and galactose. A deficiency in this enzyme results in flora bacteria further along in the gastrointestinal tract (GI) tract to metabolize the excess lactose to numerous gases, including H2. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, LPH expression, intestinal flora, and sensitivity of the gastrointestinal tract. Currently, there are several diagnostic tests that investigate the biological mechanism of lactose intolerance such as blood, biopsy, genetic, and breath tests. Due to its relatively low cost, availability, and non-invasiveness, the hydrogen breath test (HBT) has become a popular technology to aid in the diagnosis of many gastroenterological diseases, specifically lactose intolerance. Additionally, while administering the HBT there seems to be a lack of uniform criteria amongst the various studies, with many using their own guidelines, which may in turn cause inconsistency with the analysis of the results. With ever improving nanotechnology, novel approaches to expedite and lower the costs of the HBT has become an area of research with significant advancements.
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Varjú P, Ystad B, Gede N, Hegyi P, Pécsi D, Czimmer J. The role of small intestinal bacterial overgrowth and false positive diagnosis of lactose intolerance in southwest Hungary-A retrospective observational study. PLoS One 2020; 15:e0230784. [PMID: 32384113 PMCID: PMC7209350 DOI: 10.1371/journal.pone.0230784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background Lactose intolerance is a frequent gastrointestinal disease affecting 47% of the Eastern European population. Small intestinal bacterial overgrowth (SIBO) leads to carbohydrate malabsorption and therefore to false results during lactose breath and tolerance tests. Objectives We aimed to assess the prevalence of lactose maldigestion and intolerance in Hungary and to investigate the role of combined diagnostic method and testing for SIBO in reducing false results. Methods We retrospectively analyzed data from 264 adult symptomatic patients who underwent 50g lactose breath and tolerance tests in parallel over a one-year period at our center. A ≥20 ppm elevation of H2 or less than 1.1 mmol/l rise of blood glucose was diagnostic for lactose maldigestion. Patients with maldigestion who had symptoms during the test were defined as lactose intolerant. Patients with an early (≤90 min) significant (≥20 ppm) rise of H2 during lactose and/or lactulose breath tests were determined to have SIBO. Patients with slow/rapid oro-cecal transit and inappropriate preparation before the test were excluded. Results 49.6% of the 264 patients had lactose maldigestion, and 29.5% had lactose intolerance. The most frequent symptom was bloating (22.7%), while 34.8% of the study population and 60% of the symptomatic patients had SIBO. In 9.1% and 9.8% of the patients, the lactose breath and tolerance test alone gave false positive result compared with the combined method. SIBO was present in 75% of the false positives diagnosed with breath test only. Conclusions The prevalence of lactose intolerance is lower in Hungary compared to the Eastern European value (29.5% vs 47%), so it is worth performing a population-based prospective analysis in this area. A combination of lactose breath and tolerance tests and the careful monitoring of results (with early H2 rise, lactulose breath test, etc.) can decrease the false cases caused by e.g. SIBO.
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Affiliation(s)
- Péter Varjú
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Birgit Ystad
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
| | - Dániel Pécsi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - József Czimmer
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- * E-mail:
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Pavlović M, Radlović N, Berenji K, Arsić B, Rokvić Ž. Lactose intolerance in children and adults. MEDICINSKI CASOPIS 2020; 54:105-112. [DOI: 10.5937/mckg54-26370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Lactose is a disaccharide found in milk and dairy products. Children and adults with lactose intolerance are unable to tolerate significant amounts of lactose because of an inadequate amount of the enzyme lactase. The condition occurs in three main types: primary, secondary, and primary adult-type hypolactasia. The use of milk in the diet of these individuals may lead to appearance of the irritable bowel syndrome. In persons with lactose intolerance symptoms include diarrhoea, dominated by abdominal colic, loud peristaltic sounds, increased flatulence and meteorism. A diagnosis of lactose intolerance can usually be made with a careful history, elimination of lactose from the diet, lactose tolerance test, hydrogen breath test and genetic testing. In the absence of appropriate tests in patients with suspected primary adult-type hypolactasia, diagnosis can be made as in patients with food allergy. Treatment is based on the restriction of lactose intake with the use of fermented milk products. However, especially for children, if milk and dairy products are eliminated from the diet, it is important to ensure D vitamin and calcium supplementation.
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25
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Di Costanzo M, Berni Canani R. Lactose Intolerance: Common Misunderstandings. ANNALS OF NUTRITION AND METABOLISM 2019; 73 Suppl 4:30-37. [DOI: 10.1159/000493669] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lactose intolerance primarily refers to a syndrome having different symptoms upon the consumption of foods containing lactose. It is one of the most common form of food intolerance and occurs when lactase activity is reduced in the brush border of the small bowel mucosa. Individuals may be lactose intolerant to varying degrees, depending on the severity of these symptoms. When lactose is not digested, it can be fermented by gut microbiota leading to symptoms of lactose intolerance that include abdominal pain, bloating, flatulence, and diarrhea with a considerable intraindividual and interindividual variability in the severity of clinical manifestations. These gastrointestinal symptoms could be similar to cow’s milk allergy and could be wrongly labeled as symptoms of “milk allergy.” There are important differences between lactose intolerance and cow’s milk allergy; therefore, a better knowledge of these differences could limit misunderstandings in the diagnostic approach and in the management of these conditions.
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Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients 2018; 10:nu10121994. [PMID: 30558337 PMCID: PMC6316316 DOI: 10.3390/nu10121994] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
Lactose intolerance refers to symptoms related to the consumption of lactose-containing dairy foods, which are the most common source for this disaccharide. While four causes are described, the most common is the genetically-determined adult onset lactose maldigestion due to loss of intestinal lactase governed by control of the gene by a 14,000 kb promoter region on chromosome 2. Gastrointestinal symptoms from lactose have expanded to include systemic effects and have also been confounded by other food intolerances or functional gastrointestinal disorders. Partly because lactose maldigestion is often interpreted as lactose intolerance (symptoms), focus of therapy for these symptoms starts with lactose restriction. However, withholding of dairy foods completely is not appropriate due to a more favorable impact on health. Industrial efforts to substitute with plant-based products is not completely successful at this time. This narrative article reviews the complexities of the perception of lactose intolerance, its epidemiology, and pathogenesis. Treatments are discussed, including the inappropriateness of dairy avoidance. In conjunction, effects of dairy products on 19 common diseases are reviewed. Different methods of treatment, lactose-reduced products, plant-based dairy substitutes, adaptation, prebiotics, exogenous lactase, probiotics, and some other dietary interventions are further discussed.
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Affiliation(s)
- Andrew Szilagyi
- Department of Medicine, Division of Gastroenterology, Jewish General Hospital, McGill University School of Medicine, 3755 Cote St Catherine Rd, Room E110, Montreal, QC H3T 1E2, Canada.
| | - Norma Ishayek
- Department of Medicine, Division of Gastroenterology, Jewish General Hospital, McGill University School of Medicine, 3755 Cote St Catherine Rd, Room E110, Montreal, QC H3T 1E2, Canada.
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27
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Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives. Nutrients 2018; 10:nu10111599. [PMID: 30388735 PMCID: PMC6265758 DOI: 10.3390/nu10111599] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022] Open
Abstract
Milk is a fundamental component of the diet of every mammal; nevertheless, not every individual can tolerate this kind of food, especially in adulthood. However, lactose intolerance has only been recognized in the last 50 years, and currently, lactose intolerance is defined as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhoea that occur after lactose consumption. Lactose is currently a common disaccharide in human nutrition, both in breastfed infants and in adults, but its digestion requires a specialized enzyme called lactase. The genetically programmed reduction in lactase activity during adulthood affects most of the world’s adult population and can cause troublesome digestive symptoms, which may also vary depending on the amount of residual lactase activity; the small bowel transit time; and, especially, the amount of ingested lactose. Several diagnostic tests are currently available for lactose intolerance, but the diagnosis remains challenging. The treatment for lactose intolerance mainly consists of reducing or eliminating the dietetic amount of lactose until the symptoms disappear, but this is hard to achieve, as lactose is present in dairy products and is even commonly used as a food additive. In addition to dietetic restriction of lactose-containing foods, lactase can be administered as an enzymatic food supplement, but its efficacy is still controversial. Recently, probiotics have been proposed for the management of lactose intolerance; certain probiotic strains have shown specific β-galactosidase activity, thus aiding in the digestion of lactose. The aim of this paper was to review the current knowledge about lactose intolerance and to discuss the potential for the use of specific probiotic strains such as dietary supplements in lactose-intolerant patients.
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An in-vitro upper gut simulator for assessing continuous gas production: A proof-of-concept using milk digestion. J Funct Foods 2018. [DOI: 10.1016/j.jff.2018.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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29
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Fumery M, Speca S, Langlois A, Davila AM, Dubuquoy C, Grauso M, Martin Mena A, Figeac M, Metzger D, Rousseaux C, Colombel JF, Dubuquoy L, Desreumaux P, Bertin B. Peroxisome proliferator-activated receptor gamma (PPARγ) regulates lactase expression and activity in the gut. EMBO Mol Med 2018; 9:1471-1481. [PMID: 28947679 PMCID: PMC5666307 DOI: 10.15252/emmm.201707795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Lactase (LCT) deficiency affects approximately 75% of the world's adult population and may lead to lactose malabsorption and intolerance. Currently, the regulation of LCT gene expression remains poorly known. Peroxisome proliferator activator receptorγ (PPARγ) is a key player in carbohydrate metabolism. While the intestine is essential for carbohydrate digestion and absorption, the role of PPARγ in enterocyte metabolic functions has been poorly investigated. This study aims at characterizing PPARγ target genes involved in intestinal metabolic functions. In microarray analysis, the LCT gene was the most upregulated by PPARγ agonists in Caco-2 cells. We confirmed that PPARγ agonists were able to increase the expression and activity of LCT both in vitro and in vivo in the proximal small bowel of rodents. The functional response element activated by PPARγ was identified in the promoter of the human LCT gene. PPARγ modulation was able to improve symptoms induced by lactose-enriched diet in weaned rats. Our results demonstrate that PPARγ regulates LCT expression, and suggest that modulating intestinal PPARγ activity might constitute a new therapeutic strategy for lactose malabsorption.
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Affiliation(s)
- Mathurin Fumery
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France.,Service d'Hépatogastroentérologie, Centre Hospitalier Universitaire d'Amiens Université de Picardie Jules Verne, Amiens, France
| | - Silvia Speca
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France
| | - Audrey Langlois
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France
| | - Anne-Marie Davila
- UMR0914, Institut National de la Recherche Agronomique/AgroParisTech, Université Paris-Saclay, Paris, France
| | | | - Marta Grauso
- UMR0914, Institut National de la Recherche Agronomique/AgroParisTech, Université Paris-Saclay, Paris, France
| | - Anthony Martin Mena
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France
| | - Martin Figeac
- Functional and Structural Genomic Platform, Université de Lille, Lille, France
| | - Daniel Metzger
- Institut de Génétique et de Biologie Moléculaire et Cellulaire CNRS, UMR7104/INSERM U964/Université de Strasbourg Collège de France, Paris, France
| | | | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurent Dubuquoy
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France
| | - Pierre Desreumaux
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France.,Inserm, U995, Lille, France.,CHU Lille, Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Claude Huriez, Lille, France
| | - Benjamin Bertin
- U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, Lille, France .,Inserm, U995, Lille, France
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Vorlová L, Prokopová L, Pospíšil J, Tichovský P, Derflerová Brázdová Z, Bogdanovičová K. Dynamics of lactose changes during ripening of Edam cheese. POTRAVINARSTVO 2017. [DOI: 10.5219/685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The published data show that milk and dairy products are an important part of the diet in the European population and the population of North America, where they cover from 20 to 30% of protein, 15% of lipids and about 80% of calcium from food sources. The exclusion of milk and dairy products from human diet due to lactose intolerance (approximately 75% of the global population are lactose malabsorbers) can cause very serious health consequences. From a public health point of view, it is therefore extremely important for diary products to capture all the facts about the fluctuation process or rather reduction of lactose content during dairy production technology. The aim of our study was to determine the lactose in various stages of Edam cheese ripening, to assess its suitability for consumption on the afflicted population. For the determination of lactose (day of production, first, second and sixth month of storage) the reference enzymatic method using the enzymatic set Megazyme International Ireland with a detection limit of 0.00296 g.100 g-1was applied. This set is intended for determination of lactose in samples presented as low-lactose or lactose-free products and is based on the hydrolysis of lactose to D-galactose and D-glucose by the enzyme β-galactosidase. After the subsequent oxidation of galactose, the amount of formed NADH (stoichiometrically related to the amount of lactose contained in the sample) is measured in a spectrophotometer at 340 nm. According to current legislation, the lactose-free product must contain less than 10 mg of lactose per 100 g or 100 mL of the consumed product, while a product that contains up to 1 g of lactose in 100 g or 100 mL of the product consumed is considered as a product with low lactose content. The study results showed that even after one month of storage Edam cheese can be, according to current national and EU legislation, designated as a lactose-free food. This means that the consumer receives a lactose-free product whenever buying this type of cheese.
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31
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Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2:738-746. [PMID: 28690131 DOI: 10.1016/s2468-1253(17)30154-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies have shown wide variation in the prevalence of lactose malabsorption across the world, but no systematic reviews or meta-analyses have recently assessed the prevalence of lactose malabsorption in different geographical areas. We aimed to present an updated systematic review and meta-analysis on the prevalence of lactose malabsorption in adults, by countries and regions, and to assess the variation between different testing methods. METHODS Studies reporting on prevalence of lactose malabsorption and lactase persistence were identified by searching MEDLINE and Embase from database inception to Nov 2, 2016. We evaluated studies presenting lactose malabsorption or lactase persistence prevalence data in adults and children aged 10 years or older, including cross-sectional and prospective studies, using genotyping, hydrogen breath tests, lactose tolerance tests, and other testing methods. We excluded studies in children younger than 10 years, studies using self-reported data, and studies including inpatients and outpatients at gastroenterological wards. Studies were screened by two authors (CLS and SKF) and data values were extracted by two authors (CLS and SKF) independently. The primary outcome was the prevalence of lactose malabsorption. This study is registered with PROSPERO, number CRD42017064802. FINDINGS We screened 2665 records, and 306 study populations from 116 full-text articles were included (primary sources); data for 144 additional study populations from 59 articles were obtained from review articles, because full-text primary articles could not be obtained (secondary sources). Of the 450 study populations included, 231 were assessed by genotyping, 83 by hydrogen breath tests, 101 by lactose tolerance tests, and 35 by other methods or methods that were not described sufficiently. The studies included 62 910 participants from 89 countries (covering 84% of the world's population). When standardising for country size, the global prevalence estimate of lactose malabsorption was 68% (95% CI 64-72), ranging from 28% (19-37) in western, southern, and northern Europe to 70% (57-83) in the Middle East. When assessing the global prevalence using genotyping data only, the estimate was 74% (69-80), whereas prevalence was 55% (46-65) using lactose tolerance test data, and 57% (46-67) using hydrogen breath test data. Risk of bias was assessed based on ten indicators; 12 of the articles had a score of ten, indicating low risk of bias, 76 had a score of nine, 26 a score of eight, and two articles a score of seven (indicating higher risk of bias). There was substantial heterogeneity between studies within most of the assessed countries. INTERPRETATION Lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. Acknowledging regional patterns of lactose malabsorption is important to guide management of gastrointestinal symptoms. FUNDING None.
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Hayman J, Álvarez G, Ceballos FC, Berra TM. The illnesses of Charles Darwin and his children: a lesson in consanguinity. Biol J Linn Soc Lond 2017. [DOI: 10.1093/biolinnean/blw041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Corgneau M, Scher J, Ritie-Pertusa L, Le DTL, Petit J, Nikolova Y, Banon S, Gaiani C. Recent advances on lactose intolerance: Tolerance thresholds and currently available answers. Crit Rev Food Sci Nutr 2017; 57:3344-3356. [DOI: 10.1080/10408398.2015.1123671] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M. Corgneau
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
| | - J. Scher
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
| | | | - D. t. l. Le
- Laboratoires SVM, Muhlbach-sur-Bruche, France
| | - J. Petit
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
| | - Y. Nikolova
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
| | - S. Banon
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
| | - C. Gaiani
- Université de Lorraine, Laboratoire d'Ingénierie des Biomolécules, Vandœuvre-lès-Nancy, France
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Park SH, Chang YW, Kim SJ, Lee MH, Nam JH, Oh CH, Kim JW, Jang JY, Yang JO, Yoo JA, Chung JY. [Efficacy of Lactose-free Milk in Korean Adults with Lactose Intolerance]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 67:22-7. [PMID: 26809628 DOI: 10.4166/kjg.2016.67.1.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Lactose-free milk (LFM) is available for nutrient supply for those with lactose intolerance (LI). However, there are no consistent results of the efficacy of LFM in LI subjects. We aimed to examine the changes of gastrointestinal (GI) symptoms and hydrogen breath test (HBT) values after ingestion of lactose contained milk (LCM) vs. LFM. METHODS From May 2015 to September 2015, thirty-five healthy adults with history of LCM-induced GI symptoms were recruited at a tertiary hospital. For the diagnosis of LI, HBT with LCM 550 mL (lactose 25 g) was performed every 20 minutes for 3 hours. The test was defined as "positive" when H2 peak exceeded 20 ppm above baseline values (ΔH2>20 ppm). When the subjects are diagnosed as LI, the second HBT using LFM 550 mL (lactose 0 g) was performed 7 days later. Subjects were asked to complete a questionnaire about the occurrence and severity of GI symptoms. RESULTS Among a total of 35 subjects, 31 were diagnosed with LI at first visit, and their LCM-related symptoms were abdominal pain (98.6%), borborygmus (96.8%), diarrhea (90.3%), and flatus (87.1%). The ΔH2 value in subjects taking LCM (103.7±66.3ppm) significantly decreased to 6.3±4.9 ppm after ingesting LFM (p<0.0001). There were also significant reduction in total symptom scores and the severity of each symptom when LCM was changed to LFM (p<0.0001). CONCLUSIONS This is the first report that LFM reduce LCM-related GI symptoms and H2 production in Korean adults. LFM can be an effective alternative for LCM in adults with LI.
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Affiliation(s)
- Sun Hee Park
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Woon Chang
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Soo Jung Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Min Hye Lee
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ji Hyeok Nam
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jung-Wook Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin Oh Yang
- Maeil Innovation Center, Maeil Daires Co., Ltd., Pyeongtaek, Korea
| | - Jin Ah Yoo
- Maeil Innovation Center, Maeil Daires Co., Ltd., Pyeongtaek, Korea
| | - Jin Young Chung
- Maeil Innovation Center, Maeil Daires Co., Ltd., Pyeongtaek, Korea
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Marie I, Leroi AM, Gourcerol G, Levesque H, Menard JF, Ducrotte P. Lactose malabsorption in systemic sclerosis. Aliment Pharmacol Ther 2016; 44:1123-1133. [PMID: 27677253 DOI: 10.1111/apt.13810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are no studies on systemic sclerosis (SSc) assessing the relationship between food intake, especially lactose, and gastrointestinal dysfunction. AIM To determine the prevalence of lactose malabsorption, using lactose breath test, in patients with SSc. To evaluate the correlation between lactose malabsorption and gastrointestinal involvement. To predict which SSc patients exhibit lactose malabsorption. METHODS Seventy-seven consecutive Caucasian patients with SSc and 20 control subjects underwent lactose breath test. All patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. RESULTS The prevalence of lactose malabsorption was higher in SSc patients than in controls (44.3% vs. 10%; P = 0.004). We observed a marked correlation between the presence of lactose malabsorption and: higher values of GSS (P < 0.0001); severe oesophageal (P = 0.018) and small intestinal (P = 0.04) motor disorders; and joint involvement (P = 0.019). Furthermore, in SSc patients with symptomatic lactose malabsorption, the median value of GSS of digestive symptoms was lower after initiation of lactose-free diet (P < 0.0001). CONCLUSIONS Our study underscores the fact that lactose malabsorption often occurs in patients with systemic sclerosis. Furthermore, our findings highlight the fact that lactose breath test is a helpful, noninvasive method, by identifying the group of patients with systemic sclerosis with symptomatic lactose malabsorption that may benefit from a reduction in lactose intake.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | - A-M Leroi
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - G Gourcerol
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - H Levesque
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
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Royet JP, Meunier D, Torquet N, Mouly AM, Jiang T. The Neural Bases of Disgust for Cheese: An fMRI Study. Front Hum Neurosci 2016; 10:511. [PMID: 27799903 PMCID: PMC5065955 DOI: 10.3389/fnhum.2016.00511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/27/2016] [Indexed: 01/01/2023] Open
Abstract
The study of food aversion in humans by the induction of illness is ethically unthinkable, and it is difficult to propose a type of food that is disgusting for everybody. However, although cheese is considered edible by most people, it can also be perceived as particularly disgusting to some individuals. As such, the perception of cheese constitutes a good model to study the cerebral processes of food disgust and aversion. In this study, we show that a higher percentage of people are disgusted by cheese than by other types of food. Functional magnetic resonance imaging then reveals that the internal and external globus pallidus and the substantia nigra belonging to the basal ganglia are more activated in participants who dislike or diswant to eat cheese (Anti) than in other participants who like to eat cheese, as revealed following stimulation with cheese odors and pictures. We suggest that the aforementioned basal ganglia structures commonly involved in reward are also involved in the aversive motivated behaviors. Our results further show that the ventral pallidum, a core structure of the reward circuit, is deactivated in Anti subjects stimulated by cheese in the wanting task, highlighting the suppression of motivation-related activation in subjects disgusted by cheese.
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Affiliation(s)
- Jean-Pierre Royet
- Olfaction: From Coding to Memory Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Université de Lyon 1 Lyon, France
| | - David Meunier
- Olfaction: From Coding to Memory Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Université de Lyon 1 Lyon, France
| | - Nicolas Torquet
- Sorbonne Universités, Université Pierre et Marie Curie, Institut de Biologie Paris Seine, UM 119, CNRS, UMR 8246, Neuroscience Paris Seine Paris, France
| | - Anne-Marie Mouly
- Olfaction: From Coding to Memory Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Université de Lyon 1 Lyon, France
| | - Tao Jiang
- Olfaction: From Coding to Memory Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Université de Lyon 1 Lyon, France
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The Physicochemical Optimization and Acceptability of a Cashew Nut-Based Beverage Varying in Mango Juice and Sugar: A Pilot Study. BEVERAGES 2016. [DOI: 10.3390/beverages2030023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Siddiqui I, Ahmed S, Abid S. Update on diagnostic value of breath test in gastrointestinal and liver diseases. World J Gastrointest Pathophysiol 2016; 7:256-265. [PMID: 27574563 PMCID: PMC4981765 DOI: 10.4291/wjgp.v7.i3.256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/22/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
In the field of gastroenterology, breath tests (BTs) are used intermittently as diagnostic tools that allow indirect, non-invasive and relatively less cumbersome evaluation of several disorders by simply quantifying the appearance in exhaled breath of a metabolite of a specific substrate administered. The aim of this review is to have an insight into the principles, methods of analysis and performance parameters of various hydrogen, methane and carbon BTs which are available for diagnosing gastrointestinal disorders such as Helicobacter pylori infection, small intestinal bacterial overgrowth, and carbohydrate malabsorption. Evaluation of gastric emptying is routinely performed by scintigraphy which is however, difficult to perform and not suitable for children and pregnant women, this review has abridged the 13C-octanoic acid test in comparison to scintigraphy and has emphasized on its working protocol and challenges. A new development such as electronic nose test is also highlighted. Moreover we have also explored the limitations and constraints restraining the wide use of these BT. We conclude that breath testing has an enormous potential to be used as a diagnostic modality. In addition it offers distinct advantages over the traditional invasive methods commonly employed.
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Saha M, Parveen I, Shil BC, Saha SK, Banik RK, Majumder M, Salam MU, Islam AN. Lactose Intolerance and Symptom Pattern of Lactose Intolerance among Healthy Volunteers. Euroasian J Hepatogastroenterol 2016; 6:5-7. [PMID: 29201715 PMCID: PMC5578549 DOI: 10.5005/jp-journals-10018-1156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/19/2015] [Indexed: 11/29/2022] Open
Abstract
Aims To see the prevalence of lactose intolerance (LI) and related symptoms following oral lactose challenge in healthy volunteers. Materials and methods Symptoms of abdominal pain, nausea, borborygmi, flatulence, and diarrhea were noted for 24 hours and blood glucose was estimated at 0 hour and 30 minutes after 25 gm oral lactose load to healthy volunteers. Failure to rise blood glucose level ≥ 1.1 mmol/l at 30 minutes after lactose intake from fasting level was taken as lactose malabsorption (LM), i.e., LI. Results A total of 166 volunteers (123 males, 43 females) with a mean age 34.78 ± 11.45 years participated in this study. Lactose intolerance was found among 85.54% (n = 142, M = 104, F = 38). The main symptoms of LI were diarrhea (n = 83, 58.4.0%), borborygmi (n = 81, 57.04%), abdominal pain (n = 35, 24.65%), and flatulence (n = 27, 19.0%). Conclusion Lactose intolerance among healthy adults may be common in Bangladesh. Diarrhea and borborygmi were mostly associated symptoms of LI. How to cite this article Saha M, Parveen I, Shil BC, Saha SK, Banik RK, Majumder M, Salam MU, Nazmul Islam ASM. Lactose Intolerance and Symptom Pattern of Lactose Intolerance among Healthy Volunteers. Euroasian J Hepato-Gastroenterol 2016;6(1):5-7.
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Affiliation(s)
- Madhusudan Saha
- Department of Gastroenterology, North East Medical College, Sylhet, Bangladesh
| | - Irin Parveen
- Department of Gastroenterology, Enam Medical College, Savar, Dhaka, Bangladesh
| | - Bimal Chandra Shil
- Department of Gastroenterology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Shasanka Kumar Saha
- Department of Gastroenterology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Ranjit Kumar Banik
- Department of Gastroenterology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Monojit Majumder
- Department of Biochemistry, MAG Osmani Medical College, Sylhet, Bangladesh
| | - Mahjuba Umme Salam
- Department of Medicine, Sylhet Women's Medical College, Sylhet, Bangladesh
| | - Asm Nazmul Islam
- Department of Gastroenterology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
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40
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Chumpitazi BP, Shulman RJ. Dietary Carbohydrates and Childhood Functional Abdominal Pain. ANNALS OF NUTRITION & METABOLISM 2016; 68 Suppl 1:8-17. [PMID: 27355647 PMCID: PMC4943582 DOI: 10.1159/000445390] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex., USA
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, Tex., USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex., USA
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, Tex., USA
- Children’s Nutrition Research Center, Houston, Tex., USA
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41
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Guo YB, Zhuang KM, Kuang L, Zhan Q, Wang XF, Liu SD. Association between Diet and Lifestyle Habits and Irritable Bowel Syndrome: A Case-Control Study. Gut Liver 2016; 9:649-56. [PMID: 25266811 PMCID: PMC4562783 DOI: 10.5009/gnl13437] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Recent papers have highlighted the role of diet and lifestyle habits in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this association in developing countries. The aim of this study was to evaluate the association between diet and lifestyle habits and IBS. Methods A food frequency and lifestyle habits questionnaire was used to record the diet and lifestyle habits of 78 IBS subjects and 79 healthy subjects. Cross-tabulation analysis and logistic regression were used to reveal any association among lifestyle habits, eating habits, food consumption frequency, and other associated conditions. Results The results from logistic regression analysis indicated that IBS was associated with irregular eating (odds ratio [OR], 3.257), physical inactivity (OR, 3.588), and good quality sleep (OR, 0.132). IBS subjects ate fruit (OR, 3.082) vegetables (OR, 3.778), and legumes (OR, 2.111) and drank tea (OR, 2.221) significantly more frequently than the control subjects. After adjusting for age and sex, irregular eating (OR, 3.963), physical inactivity (OR, 6.297), eating vegetables (OR, 7.904), legumes (OR, 2.674), drinking tea (OR, 3.421) and good quality sleep (OR, 0.054) were independent predictors of IBS. Conclusions This study reveals a possible association between diet and lifestyle habits and IBS.
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Affiliation(s)
- Yu-Bin Guo
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang-Min Zhuang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Kuang
- 2310 S Bentley Ave, Los Angeles, CA, USA
| | - Qiang Zhan
- Department of Gastroenterology, Wuxi People's Hospital affiliated with Nanjing Medical University, Wuxi, China
| | - Xian-Fei Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Si-De Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Diagnosing and Treating Intolerance to Carbohydrates in Children. Nutrients 2016; 8:157. [PMID: 26978392 PMCID: PMC4808885 DOI: 10.3390/nu8030157] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 12/19/2022] Open
Abstract
Intolerance to carbohydrates is relatively common in childhood, but still poorly recognized and managed. Over recent years it has come to the forefront because of progresses in our knowledge on the mechanisms and treatment of these conditions. Children with intolerance to carbohydrates often present with unexplained signs and symptoms. Here, we examine the most up-to-date research on these intolerances, discuss controversies relating to the diagnostic approach, including the role of molecular analysis, and provide new insights into modern management in the pediatric age, including the most recent evidence for correct dietary treatment.
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43
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RANGEL AHDN, SALES DC, URBANO SA, GALVÃO JÚNIOR JGB, ANDRADE NETO JCD, MACÊDO CDS. Lactose intolerance and cow's milk protein allergy. FOOD SCIENCE AND TECHNOLOGY 2016. [DOI: 10.1590/1678-457x.0019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- Anthony K. Campbell
- School of Pharmacy and Pharmaceutical Sciences; Cardiff University; Redwood Building King Edward VII Avenue Cardiff CF10 3NB UK
- Welston Court Science Centre; Milton Pembrokeshire SA70 8PS UK
| | - Stephanie B. Matthews
- School of Pharmacy and Pharmaceutical Sciences; Cardiff University; Redwood Building King Edward VII Avenue Cardiff CF10 3NB UK
- Welston Court Science Centre; Milton Pembrokeshire SA70 8PS UK
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45
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Clinical insights: Understanding the link between nutrition and pressure ulcer prevention. Geriatr Nurs 2015; 36:477-81. [DOI: 10.1016/j.gerinurse.2015.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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McClements DJ, Zou L, Zhang R, Salvia-Trujillo L, Kumosani T, Xiao H. Enhancing Nutraceutical Performance Using Excipient Foods: Designing Food Structures and Compositions to Increase Bioavailability. Compr Rev Food Sci Food Saf 2015. [DOI: 10.1111/1541-4337.12170] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- David Julian McClements
- Biopolymers and Colloids Laboratory, Dept. of Food Science; Univ. of Massachusetts Amherst; Amherst Mass 01003 U.S.A
- Biochemistry Dept., Faculty of Science, Production of Bioproducts for Industrial Applications Research Group and Experimental Biochemistry Unit; King Fahd Medical Research Center, King Abdulaziz Univ; Jeddah Saudi Arabia
| | - Liqiang Zou
- State Key Laboratory of Food Science and Technology; Nanchang Univ; Nanchang, No. 235 Nanjing East Road Nanchang 330047 Jiangxi China
| | - Ruojie Zhang
- State Key Laboratory of Food Science and Technology; Nanchang Univ; Nanchang, No. 235 Nanjing East Road Nanchang 330047 Jiangxi China
| | - Laura Salvia-Trujillo
- State Key Laboratory of Food Science and Technology; Nanchang Univ; Nanchang, No. 235 Nanjing East Road Nanchang 330047 Jiangxi China
| | - Taha Kumosani
- Biochemistry Dept., Faculty of Science, Production of Bioproducts for Industrial Applications Research Group and Experimental Biochemistry Unit; King Fahd Medical Research Center, King Abdulaziz Univ; Jeddah Saudi Arabia
| | - Hang Xiao
- Biopolymers and Colloids Laboratory, Dept. of Food Science; Univ. of Massachusetts Amherst; Amherst Mass 01003 U.S.A
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Houben E, De Preter V, Billen J, Van Ranst M, Verbeke K. Additional Value of CH₄ Measurement in a Combined (13)C/H₂ Lactose Malabsorption Breath Test: A Retrospective Analysis. Nutrients 2015; 7:7469-85. [PMID: 26371034 PMCID: PMC4586543 DOI: 10.3390/nu7095348] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/18/2022] Open
Abstract
The lactose hydrogen breath test is a commonly used, non-invasive method for the detection of lactose malabsorption and is based on an abnormal increase in breath hydrogen (H2) excretion after an oral dose of lactose. We use a combined 13C/H2 lactose breath test that measures breath 13CO2 as a measure of lactose digestion in addition to H2 and that has a better sensitivity and specificity than the standard test. The present retrospective study evaluated the results of 1051 13C/H2 lactose breath tests to assess the impact on the diagnostic accuracy of measuring breath CH4 in addition to H2 and 13CO2. Based on the 13C/H2 breath test, 314 patients were diagnosed with lactase deficiency, 138 with lactose malabsorption or small bowel bacterial overgrowth (SIBO), and 599 with normal lactose digestion. Additional measurement of CH4 further improved the accuracy of the test as 16% subjects with normal lactose digestion and no H2-excretion were found to excrete CH4. These subjects should have been classified as subjects with lactose malabsorption or SIBO. In conclusion, measuring CH4-concentrations has an added value to the 13C/H2 breath test to identify methanogenic subjects with lactose malabsorption or SIBO.
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Affiliation(s)
- Els Houben
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven 3000, Belgium.
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium.
| | - Vicky De Preter
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven 3000, Belgium.
- Group Health and Social Work, University College Leuven-Limburg (UCLL), Leuven 3000, Belgium.
| | - Jaak Billen
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium.
| | - Marc Van Ranst
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium.
- Laboratory of Clinical and Epidemiological Virology, KU Leuven, Leuven 3000, Belgium.
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven 3000, Belgium.
- Leuven Food Science and Nutrition Research Centre (LFoRCe), Leuven 3000, Belgium.
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Amiri M, Diekmann L, von Köckritz-Blickwede M, Naim HY. The Diverse Forms of Lactose Intolerance and the Putative Linkage to Several Cancers. Nutrients 2015; 7:7209-30. [PMID: 26343715 PMCID: PMC4586527 DOI: 10.3390/nu7095332] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/07/2015] [Accepted: 08/21/2015] [Indexed: 12/12/2022] Open
Abstract
Lactase-phlorizin hydrolase (LPH) is a membrane glycoprotein and the only β-galactosidase of the brush border membrane of the intestinal epithelium. Besides active transcription, expression of the active LPH requires different maturation steps of the polypeptide through the secretory pathway, including N- and O-glycosylation, dimerization and proteolytic cleavage steps. The inability to digest lactose due to insufficient lactase activity results in gastrointestinal symptoms known as lactose intolerance. In this review, we will concentrate on the structural and functional features of LPH protein and summarize the cellular and molecular mechanism required for its maturation and trafficking. Then, different types of lactose intolerance are discussed, and the molecular aspects of lactase persistence/non-persistence phenotypes are investigated. Finally, we will review the literature focusing on the lactase persistence/non-persistence populations as a comparative model in order to determine the protective or adverse effects of milk and dairy foods on the incidence of colorectal, ovarian and prostate cancers.
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Affiliation(s)
- Mahdi Amiri
- Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Lena Diekmann
- Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Maren von Köckritz-Blickwede
- Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.
- The Research Center for Emerging Infections and Zoonosis (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Hassan Y Naim
- Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.
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Szilagyi A. Adaptation to Lactose in Lactase Non Persistent People: Effects on Intolerance and the Relationship between Dairy Food Consumption and Evalution of Diseases. Nutrients 2015; 7:6751-79. [PMID: 26287234 PMCID: PMC4555148 DOI: 10.3390/nu7085309] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 02/07/2023] Open
Abstract
Dairy foods contain complex nutrients which interact with the host. Yet, evolution of lactase persistence has divided the human species into those that can or cannot digest lactose in adulthood. Such a ubiquitous trait has differential effects on humanity. The literature is reviewed to explore how the divide affects lactose handling by lactase non persistent persons. There are two basic differences in digesters. Firstly, maldigesters consume less dairy foods, and secondly, excess lactose is digested by colonic microflora. Lactose intolerance in maldigesters may occur with random lactose ingestion. However, lactose intolerance without maldigestion tends to detract from gaining a clear understanding of the mechanisms of symptoms formation and leads to confusion with regards to dairy food consumption. The main consequence of intolerance is withholding dairy foods. However, regular dairy food consumption by lactase non persistent people could lead to colonic adaptation by the microbiome. This process may mimic a prebiotic effect and allows lactase non persistent people to consume more dairy foods enhancing a favorable microbiome. This process then could lead to alterations in outcome of diseases in response to dairy foods in lactose maldigesters. The evidence that lactose is a selective human prebiotic is reviewed and current links between dairy foods and some diseases are discussed within this context. Colonic adaptation has not been adequately studied, especially with modern microbiological techniques.
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Affiliation(s)
- Andrew Szilagyi
- Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University School of Medicine; 3755, Chemin de la Cote-Ste-Catherine Rd, Rm E110, Montreal H3T 1E2, QC, Canada.
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50
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Latorre G, Besa P, Parodi CG, Ferrer V, Azocar L, Quirola M, Villarroel L, Miquel JF, Agosin E, Chianale J. Prevalence of lactose intolerance in Chile: a double-blind placebo study. Digestion 2015; 90:18-26. [PMID: 25096822 DOI: 10.1159/000363229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/28/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Lactase non-persistence (LNP), or primary hypolactasia, is a genetic condition that mediates lactose malabsorption and can cause lactose intolerance. Here we report the prevalence of lactose intolerance in a double-blind placebo study. METHODS The LCT C>T-13910 variant was genotyped by RT-PCR in 121 volunteers and lactose malabsorption was assessed using the hydrogen breath test (HBT) after consuming 25 g of lactose. Lactose intolerance was assessed by scoring symptoms (SS) using a standardized questionnaire following challenge with a lactose solution or saccharose placebo. RESULTS The LNP genotype was observed in 57% of the volunteers, among whom 87% were HBT⁺. In the HBT⁺ group the median SS was 9 and in the HBT⁻ group the median SS was 3 (p < 0.001). No difference was observed in the SS when both groups were challenged with the placebo. The most common symptoms included audible bowel sounds, abdominal pain and meteorism. In the ROC curve analysis, an SS ≥ 6 demonstrated 72% sensitivity and 81% specificity for predicting a positive HBT. To estimate prevalence, lactose intolerance was defined as the presence of an SS ≥ 6 points after subtracting the placebo effect and 34% of the study population met this definition. CONCLUSIONS The LNP genotype was present in more than half of subjects evaluated and the observed prevalence of lactose intolerance was 34%.
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Affiliation(s)
- Gonzalo Latorre
- Medical Student, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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