Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake

Predictors of maternal hypocalcemia among pregnant women attending at a tertiary referral hospital in Tanzania: a cross-sectional study

BACKGROUND

Hypocalcemia is a problem among pregnant women mainly caused by pregnancy physiology, and poor dietary calcium intake, especially in African countries due to low socio-economic status. Worldwide, the prevalence of hypocalcemia varies from 25.5 to 70.6%. This study was designed to determine the prevalence of maternal hypocalcemia and its predictors among pregnant women attending Bugando Medical Centre, a tertiary referral hospital in Mwanza, Tanzania.

METHODS

This was a cross-sectional study. Socio-demographic, clinical and laboratory data were collected using a standardized, pre-tested, and coded questionnaire, and laboratory form. Venous blood was taken for laboratory investigation to measure the serum calcium level. Data were entered into a computer using Microsoft Excel 2013, and analyzed using STATA version 15. We used univariate logistic regression followed by multivariate logistic regression models to determine the predictors of maternal hypocalcemia. Predictors with a p-value of less than 0.05 were considered statistically significant.

RESULTS

A total of 651 pregnant women were enrolled. Their mean age was 29.5 ± 5.6 years, and the majority, 79.7% (519/651) aged less than 35 years. The prevalence of maternal hypocalcemia was 23.2% (151/651) [95% CI 20.0% - 26.4%]. The independent predictors of maternal hypocalcemia were multiple pregnancy (OR 11.8; 95% CI 5.1-27.5; p-value ˂0.001), previous history of preeclampsia-eclampsia (PE-E) (OR 2.1; 95% CI 1.1-4.1; p-value 0.028), lack of calcium supplementation during antenatal visits (OR 11.8; 95% CI 2.4-57.8; p-value 0.002), number of antenatal visits less than 4 (OR 1.8; 95% CI 1.1 - 2.9; p-value 0.013), residing in rural (OR 2.8; 95% CI 1.5-5.4; p-value 0.002), and use of MgSO4 and/or Calcium channel blocker (CCB) (OR 18.6; 95% CI [6.1-57.0]; p-value ˂0.001).

CONCLUSION

We found that one out of five pregnant women had maternal hypocalcemia. The independent predictors of maternal hypocalcemia were, having multiple pregnancies, previous history of PE-E, lack of calcium supplementation during antenatal visits, having less than 4 antenatal visits, residing in rural areas and use of MgSO4 and/or Calcium channel blocker. Routine screening for maternal hypocalcemia during antenatal clinic visits, routine calcium supplementation during antenatal visits should be strictly adhered, and education on nutrition regarding calcium-rich food should be emphasized.

Strategies for preventing bone loss in populations with insufficient calcium and vitamin D intake

Calcium and vitamin D are essential nutrients for maintaining skeletal health, yet deficiencies in these nutrients are particularly widespread in regions such as Asia and Africa. Inadequate intake of these nutrients in these areas has been associated with diminished bone integrity and a rising incidence of osteoporosis. This review examines the underlying mechanisms of bone loss driven by calcium and vitamin D deficiencies, emphasizing their crucial roles in bone metabolism. It also presents strategies to improve nutrient intake, such as fortification of staple foods and supplementation, along with lifestyle modifications including increased physical activity, sun exposure, and dietary education, to prevent bone loss effectively. Special consideration is given to vulnerable populations, including older adults, individuals with limited sun exposure, and those with dietary restrictions, who are at higher risk of deficiency. The review further evaluates public health strategies, including government-initiated fortification and educational programs, as essential measures for tackling widespread nutrient deficiencies. Lastly, it explores future avenues for addressing calcium and vitamin D deficiencies, including the potential role of digital health tools, personalized nutrition, and innovative public health policies to alleviate the global burden of bone-related diseases.

Association between long-term exercise with different osteogenic index, dietary patterns, body composition, biological factors, and bone mineral density in female elite masters athletes

This study evaluated the association between long-term exercise with different osteogenic index, dietary patterns, body composition, biological factors, and bone mineral density (BMD) in 199 female elite masters athletes endurance athletes (EA), speed-power athletes (SPA), and throwing athletes (TA). Bone parameters in the distal (dis) and proximal (prox) parts of the forearm were measured by densitometry. Body compositions were analyzed using bioelectrical impedance analysis. Biological factors and lifetime bone fracture status were rated via face-to-face interviews. Dietary patterns and usual dietary intake were assessed using a semiquantitative NHANES Food Frequency Questionnaire. In female elite masters athletes the main parameters affecting BMD dis were age at menopause (small effect: η² = 0.03), number of fractures (small effect: η² = 0.05), number of dairy products per day (small effect: η² = 0.05), type of dietary pattern (small effect: η² = 0.04) and sport competition, type by OI (small effect: η² = 0.03). BMD prox was affected by age at menarche (medium effect: η² = 0.096), age at menopause (large effect: η² = 0.12), past fractures (small effect: η² = 0.02), dairy product (large effect: η² = 0.13), type of dietary pattern (small effect: η² = 0.04) and sports competition (medium effect: η² = 0.06). In both groups of women, EA and SPA dietary pattern with high intake of fruit, vegetables, dairy products, whole grains, poultry, fish, nuts, and legumes had a greater mean BMD. In contrast, in the TA group dietary pattern with lactose-free, and gluten-free determined higher mean BMD. Late menarche determined higher mean BMD in all groups of women, especially in TA. Physical activity helps maintain bone mineralization during aging. The long-term effects of athletic training, especially exercises such as throwing, have been confirmed in these studies. It is therefore worth considering popularizing these exercises for healthy aging.

Alternative biological functions of lactose: a narrative review

Lactose, commonly known as "milk sugar," offers various health benefits beyond its role as an energy source. As a precursor for essential molecules, lactose impacts calcium absorption, has low cariogenicity, affects satiety, enhances athletic performance, and potentially functions as a prebiotic for gut health. However, not all individuals can digest lactose, with a minority of the population exhibiting gastrointestinal symptoms after its consumption. The ability to digest lactose during adulthood is a genetically conferred trait known as lactase persistence, which is also likely affected by epigenetic alterations and other endogenous factors. In the present review, we highlight the multifaceted health effects of lactose, including its impact on calcium absorption, its low cariogenicity, its role in satiety control, its ability to enhance athletic performance, and its potential benefits as a prebiotic for gut health. Since these benefits are inherently dependent on lactose intake trends and the digestion capacity of populations, we also present the latest available information on the current trends in lactose consumption around the world. Overall, the gathered evidence suggests that moderate lactose consumption is recommended, as it can foster multiple lifelong health benefits.

Development and evaluation of interpretable machine learning regressors for predicting femoral neck bone mineral density in elderly men using NHANES data

Osteoporotic femoral neck fractures (OFNFs) pose a significant orthopedic challenge in the elderly population, accounting for up to 40% of all osteoporotic fractures and leading to considerable health deterioration and increased mortality. In addressing the critical need for early identification of osteoporosis through routine screening of femoral neck bone mineral density (FNBMD), this study developed a user-friendly prediction model aimed at men aged 50 years and older, a demographic often overlooked in osteoporosis screening. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), the study involved outlier detection and handling, missing value imputation via the K nearest neighbor (KNN) algorithm, and data normalization and encoding. The dataset was split into training and test sets with a 7:3 ratio, followed by feature screening through the least absolute shrinkage and selection operator (LASSO) and the Boruta algorithm. Eight different machine learning algorithms were then employed to construct predictive models, with their performance evaluated through a comprehensive metric suite. The random forest regressor (RFR) emerged as the most effective model, characterized by key predictors such as age, body mass index (BMI), poverty income ratio (PIR), serum calcium, and race, achieving a coefficient of determination (R²) of 0.218 and maintaining robustness in sensitivity analyses. Notably, excluding race from the model resulted in sustained high performance, underscoring the model's adaptability. Interpretations using Shapley additive explanations (SHAP) highlighted the influence of each feature on FNBMD. These findings indicate that our predictive model effectively aids in the early detection of osteoporosis, potentially reducing the incidence of OFNFs in this high-risk population.

Decrease in Facial Bone Density with Aging and Maintenance Effect of Calcium Maltobionate Ingestion in Japanese Adult Women: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Trial

BACKGROUND/OBJECTIVES

Facial bone density, including the jawbone, declines earlier than that of the lumbar spine and calcaneus. Calcium maltobionate is reported to mitigate bone resorption and maintain bone density of the lumbar spine in post-menopausal women, but its effects on facial bone density remain understudied. Therefore, this study compared variations in facial bone mineral density with variations in calcaneal bone mineral density and bone resorption markers among healthy women, examining differences between pre- and post-menopause and the effects of continuous calcium maltobionate intake.

METHODS

This randomized, double-blind, placebo-controlled, parallel-group trial involved 48 healthy Japanese women aged 30-69 years, divided into two groups. The test food group received tablets containing calcium maltobionate, while the placebo group received tablets containing a maltose and calcium carbonate mixture for 24 weeks. Calcaneal and facial bone densities were measured pre- and post-intervention in both groups.

RESULTS

Post-intervention calcaneal bone mineral density and bone resorption marker deoxypyridinoline (DPD) showed no statistical difference between groups in pre-menopausal women. However, in post-menopausal women, the test food group exhibited significantly higher calcaneal bone density and lower DPD levels compared with the placebo group. Facial bone mineral density increased significantly in the test food group compared with the placebo group in post-menopausal participants, with similar trends observed in pre-menopausal participants.

CONCLUSIONS

Facial bone mineral density could serve as a useful indicator for monitoring bone health from middle age onward. Moreover, continuous calcium maltobionate intake appears to mitigate bone density decline in pre- and post-menopausal women, contributing to osteoporosis prevention (UMIN-CTR ID: 000046391).

Correlations between in vitro gastrointestinal digestion of β-galactosidase/carboxymethylchitosan-silica dosage powder and its physicochemical properties

Oral administration of β-galactosidase, which alleviate lactose intolerance symptoms, is challenging due to its instability throughout the gastrointestinal tract. The objective of this work was to make correlations between the in-vitro digestion and chemical characteristics of a β-galactosidase/carboxymethylchitosan-silica biocatalyst powder. This was obtained by a one-pot silica gel route assisted by carboxymethyl chitosan, using maltose as lyoprotectant. The chemical characterization allowed to understand as was modulated the calcium incorporation, through electrostatic interactions and as maltose protects the enzyme from agglomeration, by vitrification and formation of hydrogen bonds. The formulated biocatalyst could be a complement of silicon and calcium, in turn, it preserves 96 % and 63 % of the enzymatic activity compared with the biocatalyst control (without simulated digestion), in the gastric and intestinal phases, respectively. This activity was even greater than that observed in the commercial products evaluated in these phases. Likewise, the biocatalyst obtained retained its activity after 12 months of storage at 25 °C and it did not present cytotoxicity in cells derived from human colon epithelial mucosa (NCM460) under the conditions and concentrations evaluated. These results make this biocatalyst in an excellent candidate for release of this enzyme. Therefore, it could be useful for lactose-intolerant people.

From Genomics to Metabolomics: Molecular Insights into Osteoporosis for Enhanced Diagnostic and Therapeutic Approaches

Osteoporosis (OP) is a prevalent skeletal disorder characterized by decreased bone mineral density (BMD) and increased fracture risk. The advancements in omics technologies-genomics, transcriptomics, proteomics, and metabolomics-have provided significant insights into the molecular mechanisms driving OP. These technologies offer critical perspectives on genetic predispositions, gene expression regulation, protein signatures, and metabolic alterations, enabling the identification of novel biomarkers for diagnosis and therapeutic targets. This review underscores the potential of these multi-omics approaches to bridge the gap between basic research and clinical applications, paving the way for precision medicine in OP management. By integrating these technologies, researchers can contribute to improved diagnostics, preventative strategies, and treatments for patients suffering from OP and related conditions.

Finger millet (Eleusine coracana L.): from staple to superfood-a comprehensive review on nutritional, bioactive, industrial, and climate resilience potential

MAIN CONCLUSION

This review discusses the Finger millet's rich nutritional profile, bioactive potential, and industrial applications, combined with its climate resilience, which make it a promising crop for enhancing food security and promoting sustainable agriculture. This review also highlights its significant potential to address malnutrition and mitigate climate change impacts. The emergence of Finger millet from "poor man's staple food" to "a nutrient rich cereal" has encouraged the need to explore this crop at a wider scale. It is a highly significant crop due to its rich nutritional and bioactive profile, diverse biological activities, and promising industrial applications, along with the high climate resilience. This comprehensive review evaluates its nutritional composition by comparing favorably with other cereals and millets and emphasizing its potential to address malnutrition and enhance food security. Furthermore, it explores the phytochemical/bioactive potential and strategies to enhance their bioavailability followed biological activities of Finger millet by highlighting its various health-promoting properties. The review also discusses industrial potential of finger millet including its role in nutraceutical and functional food production, as well as bioenergy generation. In addition, role of Finger millet as a climate-resilient crop; specifically, the available genetic resources and identification of genes and quantitative trait loci (QTLs) associated with major stress tolerance traits have also been discussed. By providing a comprehensive synthesis of existing knowledge, this study offers valuable insights for researchers, policymakers, and stakeholders engaged in efforts to promote sustainable agriculture, enhance food and nutrition security, and mitigate the impacts of climate change.

New insights into dairy management and the prevention and treatment of osteoporosis: The shift from single nutrient to dairy matrix effects-A review

Dairy is recognized as a good source of calcium, which is important for preventing osteoporosis. However, the relationship between milk and bone health is more complex than just calcium supplementation. It is unwise to focus solely on observing the effects of a single nutrient. Lactose, proteins, and vitamins in milk, as well as fatty acids, oligosaccharides, and exosomes, all work together with calcium to enhance its bioavailability and utilization efficiency through various mechanisms. We evaluate the roles of dairy nutrients and active ingredients in maintaining bone homeostasis from the perspective of the dairy matrix effects. Special attention is given to threshold effects, synergistic effects, and associations with the gut-bone axis. We also summarize the associations between probiotic/prebiotic milk, low-fat/high-fat milk, lactose-free milk, and fortified milk with a reduced risk of osteoporosis and discuss the potential benefits and controversies of these dairy products. Moreover, we examine the role of dairy products in increasing peak bone mass during adolescence and reducing bone loss in old age. It provides a theoretical reference for the use of dairy products in the accurate prevention and management of osteoporosis and related chronic diseases and offers personalized dietary recommendations for bone health in different populations.

The joint effects of physical activity and sleep duration on risk of osteoporosis in Taiwanese adult population: The Taiwan Biobank Study

Most studies investigating the association between physical activity and osteoporosis prevention only focused on specific types of physical activity. This study's evidence regarding the combined effects or interaction of sleep duration and physical activity. The findings emphasize the role of sleep duration and physical activity in association with osteoporosis.

PURPOSE

The associations between physical activity, sleep duration, and prevalent osteoporosis in Taiwanese adults were studied in this cross-sectional study.

METHODS

The Taiwan Biobank enrolled a community-based cohort of ~ 120,000 volunteers (as of April 30, 2020) between 30 and 76 years of age with no history of cancer. Amongst, bone mineral density (BMD) measures by dual-energy X-ray absorptiometry (DXA) were available in 22,402 participants. After excluding individuals who had no complete data of BMI (n = 23), MET score (n = 207), T-score (n = 8,826), and sleep duration (n = 16), 13,330 subjects were included as the primary cohort. Univariate and multivariable regression analyses were performed to determine the associations between the presence of osteoporosis, physical activity level, sleep duration, and other variables.

RESULTS

The results showed that after adjustment, subjects with physical activity < 20 METs/week and ≥ 20 METs/week (aOR = 1.017 and 0.767, respectively) were associated with risk of osteoporosis than those with zero MET. The odds of osteoporosis were not significantly lower in subjects who slept for ≥ 8 h/day (aOR = 0.934,p=0.266). In addition, compared to short sleepers with no physical activity, adults with increased physical activity ≥ 20 METs/week and sleep ≥ 8 h/day had a significantly lowest likelihood of osteoporosis (aOR = 0.702). Those with medium physical activity (< 20 METs/week) plus average sleep duration (6.5-8 h/day) did not have significant higher odds of osteoporosis (aOR = 1.129,p=0.151).

CONCLUSION

The findings emphasize the joint role of sleep duration and physical activity in association with osteoporosis. Adults with high physical activity plus high sleep hours have the highest BMD and lowest risk of osteoporosis.

Epileptic seizures and abnormal tooth development as primary presentation of pseudohypoparathyroidism type 1B

Pseudohypoparathyroidism (PHP) is a rare genetic disorder characterised by a non-functioning PTH. Usually, the diagnosis is made following (symptomatic) hypocalcaemia. We describe a case in which epileptic seizures and abnormalities in dental development were the main clinical manifestation of PHP type 1B. This case demonstrates the importance of screening for hypocalcaemia in patients with de novo epileptic seizures. In addition, antiepileptic medications themselves may interfere with calcium-phosphate metabolism, causing or aggravating a hypocalcaemia as well. By correcting the calcium level, a resolution of these symptoms could be obtained.

Cow's Milk: A Benefit for Human Health? Omics Tools and Precision Nutrition for Lactose Intolerance Management

Cow's milk (CM) is a healthy food consumed worldwide by individuals of all ages. Unfortunately, "lactase-deficient" individuals cannot digest milk's main carbohydrate, lactose, depriving themselves of highly beneficial milk proteins like casein, lactoalbumin, and lactoglobulin due to lactose intolerance (LI), while other individuals develop allergies specifically against these proteins (CMPA). The management of these conditions differs, and an inappropriate diagnosis or treatment may have significant implications for the patients, especially if they are infants or very young children, resulting in unnecessary dietary restrictions or avoidable adverse reactions. Omics technologies play a pivotal role in elucidating the intricate interactions between nutrients and the human body, spanning from genetic factors to the microbiota profile and metabolites. This comprehensive approach enables the precise delineation and identification of distinct cohorts of individuals with specific dietary requirements, so that tailored nutrition strategies can be developed. This is what is called personalized nutrition or precision nutrition (PN), the area of nutrition that focuses on the effects of nutrients on the genome, proteome, and metabolome, promoting well-being and health, preventing diseases, reducing chronic disease incidence, and increasing life expectancy. Here, we report the opinion of the scientific community proposing to replace the "one size fits all" approach with tailor-made nutrition programs, designed by integrating nutrigenomic data together with clinical parameters and microbiota profiles, taking into account the individual lactose tolerance threshold and needs in terms of specific nutrients intake. This customized approach could help LI patients to improve their quality of life, overcoming depression or anxiety often resulting from the individual perception of this condition as different from a normal state.

A systematic review and meta-analysis of diet and nutrient intake in adults with irritable bowel syndrome

BACKGROUND

Numerous individual and environmental factors including diet may play an important role in the pathophysiology of irritable bowel syndrome (IBS). It is unclear to what degree dietary intake is affected in individuals with IBS. We aimed to perform a systematic review and meta-analysis to summarize dietary intake of adults with IBS and to compare dietary intake between adults with IBS and non-IBS controls.

METHODS

Ovid MEDLINE, Embase, Cochrane, CINAHL, and Scopus were searched through February 2023 for clinical trials and observational studies measuring usual diet in adults with IBS. Pooled weighted averages were estimated for total energy, macronutrient, and micronutrient data. Mean differences (MD) in nutrient intake were estimated for adults with IBS versus non-IBS controls using a random effects model. Heterogeneity was assessed by the inconsistency index (I2).

KEY RESULTS

Sixty-three full-text articles were included in the review of which 29 studies included both IBS and control subjects. Nutrients not meeting the recommended intake level for any dietary reference values in the IBS population were fiber and vitamin D. Meta-regression by female proportion was positively correlated with total fat intake and negatively correlated with carbohydrate intake. Comparisons between participants with IBS and controls showed significantly lower fiber intake in participants with IBS with high heterogeneity (MD: -1.8; 95% CI: -3.0, -0.6; I2 = 85%).

CONCLUSIONS AND INFERENCES

This review suggests that fiber and vitamin D intake is suboptimal in IBS; however, overall dietary intake does not appear to be comprised. Causes and consequences of reduced fiber in IBS deserve further study. Results of this systematic review and meta-analysis suggest that fiber and vitamin D intake is suboptimal in IBS. However, overall intake of other macro- and micronutrients does not appear to be compromised. Causes and consequences of reduced fiber and Vitamin D intake in IBS deserve further study.

Exploring the diverse applications of Carbohydrate macromolecules in food, pharmaceutical, and environmental technologies

Carbohydrates are a class of macromolecules that has significant potential across several domains, including the organisation of genetic material, provision of structural support, and facilitation of defence mechanisms against invasion. Their molecular diversity enables a vast array of essential functions, such as energy storage, immunological signalling, and the modification of food texture and consistency. Due to their rheological characteristics, solubility, sweetness, hygroscopicity, ability to prevent crystallization, flavour encapsulation, and coating capabilities, carbohydrates are useful in food products. Carbohydrates hold potential for the future of therapeutic development due to their important role in sustained drug release, drug targeting, immune antigens, and adjuvants. Bio-based packaging provides an emerging phase of materials that offer biodegradability and biocompatibility, serving as a substitute for traditional non-biodegradable polymers used as coatings on paper. Blending polyhydroxyalkanoates (PHA) with carbohydrate biopolymers, such as starch, cellulose, polylactic acid, etc., reduces the undesirable qualities of PHA, such as crystallinity and brittleness, and enhances the PHA's properties in addition to minimizing manufacturing costs. Carbohydrate-based biopolymeric nanoparticles are a viable and cost-effective way to boost agricultural yields, which is crucial for the increasing global population. The use of biopolymeric nanoparticles derived from carbohydrates is a potential and economically viable approach to enhance the quality and quantity of agricultural harvests, which is of utmost importance given the developing global population. The carbohydrate biopolymers may play in plant protection against pathogenic fungi by inhibiting spore germination and mycelial growth, may act as effective elicitors inducing the plant immune system to cope with pathogens. Furthermore, they can be utilised as carriers in controlled-release formulations of agrochemicals or other active ingredients, offering an alternative approach to conventional fungicides. It is expected that this review provides an extensive summary of the application of carbohydrates in the realms of food, pharmaceuticals, and environment.

The Importance of Nutrition in Menopause and Perimenopause-A Review

Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.

Nutritional and functional insight into novel probiotic lycopene-soy milk by genome edited Bacillus subtilis

Nutritional and functional soy-based milk gains growing attention globally in food industry. However, its poor sensorial attributes, single flavor, and limited substance variety become critical issues in displaying balanced nutrition and multifunction for health. Herein, a novel probiotic lycopene-soy milk was developed by genome edited Bacillus subtilis harboring lycopene biosynthesis cassette with efficient lycopene production of 25.73 ± 1.57 mg/g DCW. Further investigation displayed desirable pH, reducing sugar, protein, total phenolic content and isoflavone for achieved milk than conventional soy milk, implying it with well-balanced nutritional quality. Notably, achieved milk exhibited stronger antioxidant capacity and higher isoflavone bioavailability for functionality. Moreover, it possessed significantly high scores for taste, appearance, and overall acceptability, suggesting its excellent sensorial attributes. To our delight, it is the first time to fortify soy-milk with probiotic and lycopene by genome edited B. subtilis to explore additive effect on improving nutritional value and functionality for food application.

Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis

PURPOSE OF REVIEW

We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications.

RECENT FINDINGS

Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.

Lactose malabsorption and intolerance: What is the correct management in older adults?

Lactose malabsorption is a very common condition due to intestinal lactase deficiency. Post weaning, a genetically programmed and irreversible reduction of lactase activity occurs in the majority of the world's population. Lactose malabsorption does not necessarily result in gastrointestinal symptoms, i.e. lactose intolerance, which occurs in approximately one third of those with lactase deficiency. In the absence of well-established guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Mainly in particular categories, such as the older adults, the approach to lactose malabsorption may deserve careful considerations. Milk and dairy products are an important supply of a wide range of nutrients that contribute to meet the nutritional needs in different life stages. Dietary composition can significantly impact the mechanisms leading to age-related loss of bone mineral density, skeletal muscle mass or function and overall risk of sarcopenia. Moreover, in the latest years, different lines of evidence have highlighted an association between dairy intake and prevention of chronic diseases as well as all-cause mortality. The aim of this opinion paper is to provide an overview of lactose malabsorption and intolerance in the older adults and their implications in clinical practice.

Plant-based alternative proteins-are they nutritionally more advantageous?

BACKGROUND

The transition towards sustainable nutrition as well as the exploration of alternative sources of protein have been at the forefront of thinking in the 21st century. However, further research is required to ascertain if a diet composed of alternative plant-based proteins has similar nutritional advantages to a plant-based diet. This study aims to model the replacement of a diet consisting of animal-based proteins with plant-based alternatives (PBA), in a group of Asians.

METHODS

A 4-day food record was collected from 50 individuals residing in Singapore and nutrient profiles were generated for each individual. Food records were analysed, and meat, dairy, and seafood ingredients were substituted gram-for-gram with their PBA. The original and replaced nutrient profiles were compared against each other and the differences in macro and micronutrients were analysed.

RESULTS

A significant increase in carbohydrates, dietary fibre, as well as in micronutrients such as sodium and calcium was observed. Conversely, there was a significant decreased intake in overall energy, protein and fat (p < 0.005).

CONCLUSIONS

The significant nutritional impact of substituting animal-based proteins for PBA may present benefits for bone health and individuals on a caloric restriction diet. However, higher sodium levels may be undesirable for individuals with cardiovascular conditions and hypertension, and the low bioavailability of iron in plant-based sources may present issues for iron deficient populations. Bearing some of these key findings in mind, researchers and manufacturers need to consider these when developing alternative protein products to meet consumer demands for palatable and nutritious plant-based products.

How Many Hungarian Consumers Choose Lactose- and Gluten-Free Food Products Even When They Do Not Necessarily Need to?

The popularity of "free-from" food products (FFFPs), which exclude several ingredients such as lactose, gluten, or sugar, is increasing globally. However, experts agree that avoiding these ingredients without medical reasons can lead to nutritional deficiencies. A representative consumer survey was conducted in Hungary (n = 1002); it focused on behaviors related to FFFPs, particularly lactose- and gluten-free products. This study revealed that consumers often consider "free-from" claims during shopping. Lactose- and gluten-free foods were popular, even among those without specific dietary needs. A distinct "free-from consumer group" (7.8% of the sample, predominantly women) was identified, who consume both lactose- and gluten-free foods frequently. However, only 15.4% of the group had medical reasons for their preference, such as lactose intolerance or gluten sensitivity. The majority (75.6%) chose these products without medical justification, relying on self-diagnosis, through the involvement of family members, or the belief that they were healthier. This consumer group accounts for nearly 6% of Hungary's adult population, exceeding 470,000 individuals. Extrapolating these figures to other European countries suggests that 25-30 million EU citizens might be in a similar situation, highlighting the need for improved health education and awareness-raising campaigns to prevent imbalanced nutrition and foster the recognition and treatment of real health problems.

Analysis of Eight Types of Plant-based Milk Alternatives from the United States Market for Target Minerals and Trace Elements

A wide variety of commercial plant-based foods that are marketed and sold as alternatives for milk (plant-based milk alternatives or PBMAs) are available to consumers. In this study, PBMAs from the United States (n=85) were subjected to analysis for target minerals (magnesium, phosphorus, selenium, and zinc) to compare their variability across PBMA types, brands, and production lots. Samples were also screened for the environmental contaminant elements arsenic, cadmium, and lead. The eight PBMA types sampled were produced from almond, cashew, coconut, hemp, oat, pea, rice, and soy. Elemental analysis was conducted using microwave-assisted acid digestion followed by inductively coupled plasma-mass spectrometry. The results showed that pea PBMAs contained the highest mean amounts of phosphorus, selenium, and zinc, while soy PBMAs were highest in magnesium. Mean amounts of minerals were lower than those found in milk for the majority of PBMA types. There was significant variation (P<0.05) in amounts of minerals across the majority of product brands. The amounts of phosphorus and magnesium varied across production lots (P<0.05), but the absolute value of these differences was low. Total arsenic was highest in rice PBMAs; amounts of cadmium and lead across PBMAs were generally found at low or non-quantifiable amounts. These results underscore the importance of generating analytical data on the elemental composition of products within the rapidly growing category of PBMA.

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

Importance

Nearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data.

Objective

To estimate medical expenditures among US youth across all BMI categories along with sex and age groups.

Design, Setting, Participants

This cross-sectional study used IQVIA's ambulatory electronic medical records (AEMR) data set linked with IQVIA's PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits.

Exposure

BMI categories.

Main Outcomes and Measures

Total medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions.

Results

The sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively.

Conclusions and Relevance

The study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

Genetic Predisposition to Primary Lactose Intolerance Does Not Influence Dairy Intake and Health-Related Quality of Life in Romanian Children: A Hospital-Based Cross-Sectional Study

BACKGROUND

Primary lactose intolerance (PLI) is characterized by the inability to digest lactose. Homozygotes for the lactase gene polymorphisms (CC or GG) are considered to be genetically predisposed to PLI. Still, symptoms may only be present later in life. The evidence supporting a link between PLI, dairy intake, and quality of life (QoL) is limited in children.

AIM

This study investigates the link between LCT polymorphisms and suggestive symptoms and the influence of the genetic predisposition to PLI on dairy intake and QoL in Romanian children.

MATERIALS AND METHODS

We recruited consecutive children evaluated in our ambulatory clinic. We asked all participants to complete a visual-analog symptoms scale, a dairy intake, and a QoL questionnaire. We used strip genotyping to identify genetic predisposition to PLI.

RESULTS

51.7% of children had a CC genotype, and 34.5% also had a GG genotype. Most children reported no or mild symptoms. Dairy intake and QoL were similar across study groups.

CONCLUSIONS

Our study shows that genetic predisposition does not necessarily assume the presence of specific symptoms. Genetic predisposition to PLI did not lead to dairy avoidance, nor did it negatively influence our children's QoL.

A Comprehensive Look at the -13910 C>T LCT Gene Polymorphism as a Molecular Marker for Vitamin D and Calcium Levels in Young Adults in Central and Eastern Europe: A Preliminary Study

Intolerance to dairy products resulting from the abnormal digestion of milk sugar (lactose) is a common cause of human gastrointestinal disorders. The aim of this study was to show that the -13910 C>T LCT gene polymorphism, together with genotypes of selected VDR gene polymorphisms and diet and nutritional status parameters, can impact the prevalence of vitamin D and calcium deficiency in young adults. This study was conducted on a group of 63 people, which comprised 21 individuals with primary adult lactase deficiency, and a control group of 42 individuals with no hypolactasia. The LCT and VDR gene genotypes were assessed using PCR restriction fragment length polymorphism (PCR-RFLP) analysis. A validated HPLC method was used to determine serum concentrations of 25(OH)D₂ and 25(OH)D₃. Atomic absorption spectrometry was used to determine calcium levels. Their diets (self-reported 7-day estimated food record), estimated calcium intakes based on the ADOS-Ca questionnaire and basic anthropometric parameters were assessed. The CC genotype associated with hypolactasia was found in 33.3% of the subjects. The presence of the CC variant of the LCT gene polymorphism in the study group of young Polish adults was found to be associated with significantly lower milk (134.7 ± 66.7 g/d vs. 342.5 ± 176 g/d; p = 0.012) and dairy product consumption (78.50 ± 36.2 g/d vs. 216.3 ± 102 g/d; p = 0.008) compared with lactase persistence. At the same time, people with adult-type primary intolerance were found to have statistically significant lower serum levels of vitamin D and calcium (p < 0.05). There was a higher chance of vitamin D and calcium deficiency and a lower intake in the group exhibiting lactase non-persistence (OR > 1). The AA variant of the VDR gene's BsmI polymorphism present in people with hypolactasia may further contribute to an increased risk of vitamin D deficiency. Exclusion of lactose from the diet, combined with impaired vitamin D metabolism, may also lead to inhibited calcium absorption by the body. Further research should be carried out on a larger group of subjects to clarify the relationship between lactase activity and vitamin D and calcium levels in young adults.

Lactase deficiency in Russia: multiethnic genetic study

BACKGROUND

Lactase persistence-the ability to digest lactose through adulthood-is closely related to evolutionary adaptations and has affected many populations since the beginning of cattle breeding. Nevertheless, the contrast initial phenotype, lactase non-persistence or adult lactase deficiency, is still observed in large numbers of people worldwide.

METHODS

We performed a multiethnic genetic study of lactase deficiency on 24,439 people, the largest in Russia to date. The percent of each population group was estimated according to the local ancestry inference results. Additionally, we calculated frequencies of rs4988235 GG genotype in Russian regions using the information of current location and birthplace data from the client's questionnaire.

RESULTS

The attained results show that among all studied population groups, the frequency of GG genotype in rs4988235 is higher than the average in the European populations. In particular, the prevalence of lactase deficiency genotype in the East Slavs group was 42.8% (95% CI: 42.1-43.4%). We also investigated the regional prevalence of lactase deficiency based on the current place of residence.

CONCLUSIONS

Our study emphasizes the significance of genetic testing for diagnostics, i.e., specifically for lactose intolerance parameter, as well as the scale of the problem of lactase deficiency in Russia which needs to be addressed by the healthcare and food sectors.

Variability in Macro- and Micronutrients of 15 Rarely Researched Microalgae

Microalgae have enormous potential for human nutrition, yet the European Commission has authorized the consumption of only eleven species. Strains of fifteen rarely researched microalgae from two kingdoms were screened regarding their nutritional profile and value for human health in two cultivation phases. Contents of protein, fiber, lipids, fatty acids, minerals, trace elements and heavy metals were determined. In the growth phase, microalgae accumulated more arginine, histidine, ornithine, pure and crude protein, Mg, Mn, Fe and Zn and less Ni, Mo and I₂ compared to the stationary phase. Higher contents of total fat, C14:0, C14:1_n5, C16:1_n7, C20:4_n6, C20:5_n3 and also As were observed in microalgae from the chromista kingdom in comparison to microalgae from the plantae kingdom (p < 0.05). Conversely, the latter had higher contents of C20:0, C20:1_n9 and C18:3_n3 as well as Ca and Pb (p < 0.05). More precisely, Chrysotila carterae appeared to have great potential for human nutrition because of its high nutrient contents such as fibers, carotenoids, C20:6_n3, Mg, Ca, Mn, Fe, Se, Zn, Ni, Mo and I₂. In summary, microalgae may contribute to a large variety of nutrients, yet the contents differ between kingdoms, cultivation phases and also species.

A critical review of the recent concept of artificial mechanical uterus design in relation to the maternal microbiome: An Update to past researches

The microbiome in the female reproductive tract plays an essential role in immune modulation and reproductive health. However, various microbes become established during pregnancy, the balance of which plays a crucial role in embryonic development and healthy births. The contribution of disturbances in the microbiome profile to embryo health is poorly understood. A better understanding of the relationship between reproductive outcomes and the vaginal microbiota is needed to optimize the chances of healthy births. In this regards, microbiome dysbiosis refers to conditions in which the pathways of communication and balance within the normal microbiome are imbalanced due to the intrusion of pathogenic microorganisms into the reproductive system. This review summarizes the current state of knowledge on the natural human microbiome, with a focus on the natural uterine microbiome, mother-to-child transmission, dysbiosis, and the pattern of microbial change in pregnancy and parturition, and reviews the effects of artificial uterus probiotics during pregnancy. These effects can be studied in the sterile environment of an artificial uterus, and microbes with potential probiotic activity can be studied as a possible therapeutic approach. The artificial uterus is a technological device or biobag used as an incubator, allowing extracorporeal pregnancy. Establishing beneficial microbial communities within the artificial womb using probiotic species could modulate the immune system of both the fetus and the mother. The artificial womb could be used to select the best strains of probiotic species to fight infection with specific pathogens. Questions about the interactions and stability of the most appropriate probiotics, as well as dosage and duration of treatment, need to be answered before probiotics can be a clinical treatment in human pregnancy.

Lower calcium and iron intake in adolescent gymnasts: A case of concern for youth sports nutrition

OBJECTIVES

Diet is important for the appropriate development and maturation of young amateur athletes. The aim of this study was to determine whether young gymnasts were consuming adequate amounts of nutrients, particularly calcium and iron.

METHODS

This cross-sectional survey was conducted in Portugal's Almada and Lisbon regions in 2020. To determine if participants' diet was adequate, weight, height, and skinfold measurements were taken. Dietary consumption was examined using two 24-h recalls. We collected data from 66 participants (60% females, 12-18 y of age), of whom 82% had normal weight and 39% had ideal body fat.

RESULTS

The daily total energy intake (TEI) was1605 ± 601 kcal. Of the TEI, 19%, 31%, and 50% were comprised of protein, fat, and carbohydrates, respectively. The most often consumed protein sources were poultry and ultra-processed meat products (52% and 45%, respectively). The average daily consumption of calcium and iron was 626 ± 293 and 9 ± 3 mg, respectively. Only 2 of the 66 participants had calcium intake within recommended levels, and 1of 5 had iron intake within recommended levels, the percentage of which was lower in girls than boys (7.5% versus 38.5%, P < 0.05).

CONCLUSIONS

Despite having a sufficient macronutrient distribution, Portuguese gymnasts consume a high amount of ultra-processed items and a low amount of calcium and iron. The low proportion of female gymnasts with adequate iron consumption is cause for worry in sports nutrition.

Market Basket Survey of the Micronutrients Vitamin A, Vitamin D, Calcium, and Potassium in Eight Types of Commercial Plant-Based Milk Alternatives from United States Markets

We performed a market basket survey of plant-based milk alternatives (PBMAs) from the US market for vitamin A, vitamin D, calcium, and potassium to identify the amount and variability of these micronutrients across various PBMAs. The PBMA types included in this analysis were almond, cashew, coconut, hemp, oat, pea, rice, and soy (n=90 total product units). Analyses for vitamin A (as retinyl palmitate), vitamin D2/D3, and minerals were performed using high-performance liquid chromatography, liquid chromatography-tandem mass spectrometry, and inductively coupled plasma-mass spectrometry, respectively. A majority of PBMA types had significant differences (P<0.05) in the amounts of target micronutrients across brands. The coefficient of variation (%CV) for micronutrient concentrations within one lot of a single brand ranged from 4.1-42.2% for vitamin A, 1.5-44.1% for vitamin D, 1.7%-37.6% for calcium, and 0.7%-39.0% for potassium. The variability of these micronutrients should be taken into account when considering the nutritional value of PBMAs.

Systems biology of human aging: A Fibonacci time series model

Fractals are everywhere in nature, particularly at the interfaces where matter or energy must be transferred, since they maximize surface area while minimizing energy losses. Temporal fractals have been well studied at micro scales in human biology, but have received comparatively little attention at broader macro scales. In this paper, we describe a fractal time series model of human aging from a systems biology perspective. This model examines how intrinsic aging rates are shaped by entropy and Fibonacci fractal dynamics, with implications for the emergence of key life cycle traits. This proposition is supported by research findings. The finding of an intrinsic aging rate rooted in Fibonacci fractal dynamics represents a new predictive paradigm in evolutionary biology.

A rescue diet raises the plasma calcium concentration and ameliorates rheumatoid arthritis in mice: Role of CaSR-mediated inhibition of osteoclastogenesis

Calcium modulates bone cell recruitment, differentiation, and function by binding to the calcium-sensing receptor (CaSR). However, the function of CaSR induced by high extracellular calcium (Ca²⁺ _e ) in the regulation of osteoclast formation in rheumatoid arthritis (RA) remains unknown. Here, we used TNFα-transgenic (TNF^TG ) RA mice and their wildtype (WT) littermates fed a normal or a rescue diet (high calcium, high phosphorus, and high lactose diet, termed rescue diet) to compare their joint bone phenotypes. In comparison to TNF^TG mice fed the normal diet, articular bone volume and cartilage area are increased, whereas inflamed area, eroded surface, TRAP⁺ surface, and osteoclast-related genes expression are decreased in TNF^TG mice fed the rescue diet. Besides, TNF^TG mice fed the rescue diet were found to exhibit more CaSR⁺ area and less NFATc1⁺ /TRAP⁺ area. Furthermore, at normal Ca²⁺ _e concentrations, osteoclast precursors (OCPs) from TNF^TG mice formed more osteoclasts than OCPs from WT mice, but the number of osteoclasts gradually decreased when the Ca²⁺ _e concentration increased. Meanwhile, the expression of CaSR increased responding to a high level of Ca²⁺ _e , whereas the expression of NF-κB/NFATc1 signaling molecules decreased. At last, the knockdown of CaSR blocked the inhibition of osteoclast differentiation attributed to high Ca²⁺ _e . Taken together, our findings indicate that high Ca²⁺ _e inhibits osteoclast differentiation in RA mice partially through the CaSR/NF-κB/NFATc1 pathway.

Effects of Calcium Lactate-Enriched Pumpkin on Calcium Status in Ovariectomized Rats

This study aimed to evaluate the effects of enriched pumpkin on calcium status in ovariectomized rats. The study was conducted in sixty female Wistar rats, which were divided into six groups: a group fed a standard diet (C) and five ovariectomized groups fed a standard diet (OVX_C) or a diet with calcium lactate (CaL), with calcium lactate-enriched pumpkin (P_CaL), with calcium lactate and alendronate (CaL_B), or with calcium lactate-enriched pumpkin with alendronate (P_CaL_B). After 12 weeks of the intervention, the rats were sacrificed, and their blood and tissues were collected. The calcium concentrations in serum and in tissues were measured using flame atomic absorption spectrometry (AAS). Serum concentrations of procollagen type-1 amino-terminal propeptide (PINP), parathyroid hormone PTH, estrogen (ES), and osteocalcin (OC) were determined with enzyme-linked immunosorbent assay (ELISA). It was found that enriched pumpkin increased the calcium level in the kidneys (194.13 ± 41.01 mg) compared to the C (87.88 ± 12.42 mg) and OVX_C (79.29 ± 7.66 mg) groups. The addition of alendronate increased the calcium level in the femurs (267.63 ± 23.63 mg) and more than six times in the kidneys (541.33 ± 62.91 mg) compared to the OVX_C group (234.53 ± 21.67 mg and 87.88 ± 12.42 mg, respectively). We found that the CaL, P_CaL, and CaL_B groups had significantly lower PINP serum concentrations (4.45 ± 0.82 ng/mL, 4.14 ± 0.69 ng/mL, and 3.77 ± 0.33 ng/mL) and higher PTH serum levels (3.39 ± 0.54 ng/dL, 3.38 ± 0.57 ng/dL, and 3.47 ± 0.28 ng/dL) than the OVX_C group (4.69 ± 0.82 ng/mL and 2.59 ± 0.45 ng/dL, respectively). In conclusion, pumpkin enriched with calcium lactate affects calcium status and normalizes PINP and PTH serum levels in ovariectomized rats. Diet with enriched pumpkin and alendronate increase calcium concentration in the femur. Enriched pumpkin causes calcium to accumulate in the kidneys of ovariectomized rats; alendronate significantly exacerbates this effect.

Adherence to Lifestyle Recommendations for Bone Health in Older Adults with and without Osteoporosis: Cross-Sectional Results of the OUTDOOR ACTIVE Study

Sustaining good bone health into older age is key for preventing osteoporosis. Bone health is associated with several lifestyle factors. This study investigates older adults' adherence to bone health-promoting lifestyle recommendations dependent on osteoporosis status. Cross-sectional data of 1610 community-dwelling older adults (65-75 years) residing in Bremen, Germany (53.4% female) were included. The Osteoporosis Self-Assessment Tool and self-reported osteoporosis diagnosis were used to classify participants by osteoporosis status (low risk, high risk, diagnosis). Adherence to bone health recommendations regarding calcium and vitamin D intake, sun exposure, alcohol consumption, resistance/weight-bearing exercise, and physical activity were assessed. Descriptive statistics were applied, stratified by sex and osteoporosis status. A total of 91 women (10.6%) and 15 men (2.0%) reported an osteoporosis diagnosis, 457 women (43.2%) and 311 men (41.4%) were classified as having a high risk, and 311 women (36.2%) and 425 men (56.6%) as having a low risk. Adherence to bone health recommendations was high for calcium intake (93.3-100.0%), vitamin D intake (77.8-93.3%), and sun exposure (86.7-97.7%). Lower adherence was observed regarding resistance/weight-bearing exercise (36.3-54.4%), physical activity (14.3-57.7%), and alcohol consumption (40.0-72.4%). In conclusion, tailored prevention strategies are needed that focus on older adults with an osteoporosis diagnosis or who are at high risk.

Lactose: Characteristics, Food and Drug-Related Applications, and Its Possible Substitutions in Meeting the Needs of People with Lactose Intolerance

The recent growing interest in lactose intolerance has resulted in the proliferation of lactose-free products by food manufacturing companies. Since updated papers about lactose and its uses are missing, the main purpose of this review is to investigate this sugar comprehensively. Firstly, its chemical and physical characteristics were studied, following its employment in the food and drug industries. The positive and negative health-related effects of lactose are reported, focusing on the condition of lactose intolerance, for which an adequate lactose-free diet has to be followed to avoid symptoms that impairs quality of life. Considering that EU legislation on lactose-free product labelling is still controversial, suitable options for producing and identifying lactose-free products are suggested, in order to meet lactose-intolerant people’s needs.

The Glycemic Response to Infant Formulas: A Randomized Clinical Trial

Background: Commercial infant formulas attempt to imitate human milk’s unique composition. However, lactose-free and milk protein-free formulas are often chosen due to medical reasons or personal preferences. The aim of this study was to determine the glycemic and insulinemic indices of a variety of infant formulas. Methods: We conducted a three-arm, randomized, double-blind, crossover study. Participants were 25–40-year-old healthy adults. Three commercial infant formulas (cow’s milk protein-based [“standard”], soy protein-based, and lactose-free) were randomly given to each participant. Glycemic and insulinemic responses were determined and compared between the three formulas. Results: Twenty subjects were enrolled (11 females/9 males, mean age 32.8 ± 2.9 years). No significant difference was found in the glycemic index between the three formulas (21.5, 29.1, and 21.5 for the standard, soy protein-based, and lactose-free formulas, respectively, p = 0.21). However, maximal glucose levels were significantly higher for the soy protein-based formula compared to both the standard and lactose-free formulas (111.5 compared to 101.8 and 105.8 mg/dL, respectively, p = 0.001). Conclusion: Cow’s milk protein-based, soy protein-based, and lactose-free formulas have a similar glycemic index. However, soy protein-based formula produced a significantly higher increase in postprandial glucose levels. The implication and biological significance of these results have yet to be determined.

Evolution of Milk Consumption and Its Psychological Determinants: A Mini-Review

The consumption of lactose-free products and in particular lactose-free milk is increasing worldwide. Although many studies claim that this dietary trend is mainly determined by the number of lactose intolerant people that is growing, others state that most of them self-report an intolerance that has not been diagnosed by medical tests. However, many researchers reported that the consumption of lactose-free milk may put the consumers' health at risk especially when the subjects are not intolerant. Consequently, understanding this new dietary trend considering its main determinants it is necessary to generate educational and intervention campaigns useful to guide people toward healthier and more adequate eating styles. For these reasons we conducted a narrative mini review to summarize the factors contributing to the consumption of lactose-free milk as an alternative to cow's milk, exploring intrinsic and extrinsic product characteristics, biological and physiological, as well as psychological, situational and socio-cultural factors. This narrative mini-review shows that there are six categories of factors that affect the consumption of lactose-free milk. In particular, the intrinsic aspects linked to the product and the socio-demographic characteristics of the consumer are the most explored. On the contrary, situational and socio-cultural factors are the least studied. Finally, this study argues that there are too few studies that investigates the emotional, identity and social aspects underlying these food choices, suggesting the development of future research that investigate the implicit consumer subjective levers to decipher lactose-free milk consumptions.

Lactose Malabsorption and Presumed Related Disorders: A Review of Current Evidence

Background. Lactose malabsorption (LM) is a frequent clinical problem associated with several digestive and extra-digestive diseases. The aim of this manuscript was to clarify the real clinical impact of LM on these disorders. Methods. A literature search for digestive and extra-digestive disorders related to LM was carried out using PubMed, Medline and Cochrane. Results. A transient lactase deficiency is present in celiac disease (CD) on a normal diet. The persistence of symptoms in CD on a gluten-free diet may be instead, in part, attributed to a primary LM. Similar circumstances are present in inflammatory bowel diseases (IBD), in which LM can be responsible for a part of persistent symptoms in IBD on clinical remission. LM and irritable bowel syndrome (IBS) are instead independent conditions. On the other hand, a lactose-restricted diet may be useful for some IBS patients. A reduced lactose intake can lead to low bone mass and limited risk of fragility fractures. Finally, the absorption of levothyroxine could be conditioned by LM. Conclusions. LM can be responsible for persistent symptoms in CD and IBD. The association with IBS seems to be casual. Bone mass and levothyroxine absorption can be affected by LM.

Associations between dietary advice on modified fibre and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy

OBJECTIVES

A variety of non-evidence-based dietary advice on modified fibre and lactose intakes are provided to patients undergoing pelvic radiotherapy to counteract treatment-related bowel symptoms. More knowledge on the nutritional consequences of such advice is needed. This study aimed to explore how advice on modified fibre and lactose intakes during pelvic radiotherapy was associated with nutrient intakes amongst patients with prostate cancer.

METHODS

A total of 77 Swedish men who underwent radiotherapy (50/2 Gy + boost 20-30 Gy) in 2009-2014 due to prostate cancer were given dietary advice at radiotherapy onset (baseline) and at 4 and 8 weeks after radiotherapy onset, to modify their fibre and lactose intakes. At baseline, the participants completed a food frequency questionnaire (FFQ) and a 24-h dietary recall. At 4 and 8 weeks, the participants completed the FFQ and a 4-day estimated food record.Fibre and lactose intakes were measured by intake scores calculated from the FFQs. Multiple linear regression models were used to analyse associations between intake scores and fibre- and lactose-related nutrients.

RESULTS

In adjusted analyses, there were few significant associations between dietary advice on modified fibre and lactose intakes and observed intakes of fibre- and lactose-related nutrients. A more modified lactose intake was thus associated with a lower intake of calcium (P = 0.041), whilst a more modified fibre intake was associated with a higher value for the change in intake of vitamin C (P = 0.016).

CONCLUSIONS

Dietary advice on modified fibre and lactose intake was in most cases not significantly associated with altered nutrient intakes, rather the energy and nutrient intakes were mostly stable during the pelvic radiotherapy. More research is needed on the nutritional consequences of dietary advice on modified fibre and lactose intakes to reach consensus on if they should continue to be provided in the clinic.

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The structure of nutrition of Russian students as a risk factor for the development of nutritional diseases

The paper analyzes the literature data on the peculiarities of nutrition of students studying in higher educational institutions of various regions of Russia, and the risks of developing food-related diseases. They are largely associated with the adaptation of students to study at a university, the lack of self-organization skills and a lack of  knowledge in matters of rational nutrition. The actual nutrition of  students, on the one hand, is characterized by a lack of macronutrients and micronutrients intake, on the other hand, by excessive consumption of substances that contribute to the development of obesity. The results of numerous studies show a general pattern of unbalanced nutrition of students in terms of the ratio of saturated and polyunsaturated fatty acids, insufficient consumption of dietary fiber, full-fledged proteins, and  excessive intake of simple carbohydrates. Dietary fiber deficiency can  lead to changes in the composition of the microbiocenosis of the digestive tract, a deficiency of omega-3 fatty acids, and consequently, the imbalance of fatty acid composition of the blood cell membrane. 20–40 % of Russian students show signs of severe hypovitaminosis, especially calciferol, which is caused not only by its deficiency in the diet, but also by physical, geographical, climatic and seasonal factors. The analysis of the content of the main minerals in students shows a sufficient content of calcium in the body, an excess of sodium and a lack of magnesium, potassium and  iron, which is due to both the composition of the food consumed and the peculiarities of the accumulation and excretion of these ions. An analysis of the actual nutrition of students shows the need for counseling young people, especially in the first years of study. The introduction of an educational program on optimal nutrition is possible through the practice of curatorial work during the adaptation of the first-year students to student’s life. 

Renal Contributions to Age-Related Changes in Mineral Metabolism

Aging results in a general decline in function in most systems. This is particularly true with respect to the skeleton and renal systems, impacting mineral homeostasis. Calcium and phosphate regulation requires tight coordination among the intestine, bone, parathyroid gland, and kidney. The role of the intestine is to absorb calcium and phosphate from the diet. The bone stores or releases calcium and phosphate depending on the body's needs. In response to low plasma ionized calcium concentration, the parathyroid gland produces parathyroid hormone, which modulates bone turnover. The kidney reabsorbs or excretes the minerals and serves as the final regulator of plasma concentration. Many hormones are involved in this process in addition to parathyroid hormone, including fibroblast growth factor 23 produced by the bone and calcitriol synthesized by the kidney. Sclerostin, calcitonin, osteoprotegerin, and receptor activator of nuclear factor‐κB ligand also contribute to tissue‐specific regulation. Changes in the function of organs due to aging or disease can perturb this balance. During aging, the intestine cannot absorb calcium efficiently due to decreased expression of key proteins. In the bone, the balance between bone formation and bone resorption tends toward the latter in older individuals. The kidney may not filter blood as efficiently in the later decades of life, and the expression of certain proteins necessary for mineral homeostasis declines with age. These changes often lead to dysregulation of organismal mineral homeostasis. This review will focus on how mineral homeostasis is impacted by aging with a particular emphasis on the kidney's role in this process. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Dairy product consumption reduces cardiovascular mortality: results after 8 year follow-up of ELSA-Brasil

PURPOSE

To investigate whether the consumption of dairy products and their subgroups is associated with the risk of death from cardiovascular disease (CVD) after 8-year follow-up, and verify if dairy products predict changes in high-sensitivity C-reactive protein (hs-CRP) between two follow-up visits of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

Prospective study with 6671 participants without CVD at baseline. Consumption in grams/day of total dairy, full-fat and low-fat dairy, fermented dairy, and milk was obtained through a food frequency questionnaire and categorized into sex-specific quartiles. Cox regression and linear mixed-effect models were used to estimate associations of dairy products intake with death from CVD and changes in hs-CRP levels, respectively.

RESULTS

After adjustments, individuals in the 3rd and 4th quartiles of total dairy consumption presented, respectively, 62% (HR 0.38; 95% CI 0.15-0.99) and 64% (HR 0.36; 95% CI 0.14-0.94) lower hazards of death from CVD compared to the 1st quartile. Also, participants in the 4th quartile of milk consumption had 66% (HR 0.34; 95% CI 0.14-0.86) lower hazard to die from CVD, but only the 2nd quartile of full-fat dairy consumption indicated a lower hazard to die from CVD (HR 0.30; 95% CI 0.10-0.92). No association was observed between low-fat or fermented dairy products and cardiovascular mortality. Consumption of total dairy and their subgroups did not predict changes in hs-CRP levels after 4-year follow-up.

CONCLUSION

Results suggest beneficial effects of total dairy and milk, but only low-to-moderate full-fat dairy consumption, on the risk of death from CVD. Assuming true effects, public policies should encourage the consumption of dairy products, especially milk.

Hypocalcemia and Vitamin D Deficiency in Children with Inflammatory Bowel Diseases and Lactose Intolerance

Background: A diet restricted in dairy products can cause calcium and vitamin D deficiency and, secondarily, lead to malnutrition and low bone mass. The aim of the study was to determine the incidence hypocalcemia and vitamin D deficiency in children with inflammatory bowel diseases and lactose intolerance (LI). Material and Methods: A total of 107 patients were enrolled to the study (mean age 14.07 ± 3.58 years; 46.7% boys): 43 with Crohn’s disease (CD), 31 with ulcerative colitis (UC), and 33 with functional abdominal pain (AP-FGID). Hydrogen breath test with lactose and laboratory tests to assess the calcium-phosphate metabolism were performed in all patients. The results of densitometry were interpreted in 37 IBD patients. Results: LI was diagnosed in 23.2% patients with CD, 22.6% with UC, and 21.2% children with AP-FGID, (p = 0.9). Moreover, 9.5% patients with CD, in 21.4% with UC, and in 51.5% with AP-FGID had optimal concentration of 25(OH)D (p = 0.0002). Hypocalcemia was diagnosed in 21% of patients with CD, 16.1% with UC patients, AP-FGID patients had normal calcium levels (p = 0.02). There was no difference in concentrations of total calcium, phosphorus, and 25(OH)D between patients on low-lactose diet and normal diet (p > 0.05). BMD Z-score ≤ −1 SD was obtained by 12 CD patients (48%), and 6 with UC (50%). Conclusion: The use of a low-lactose diet in the course of lactose intolerance in children with inflammatory bowel diseases has no effect on the incidence of calcium-phosphate disorders and reduced bone mineral density.

[Efficacy and safety of lactase additive in preterm infants with lactose intolerance: a prospective randomized controlled trial]

OBJECTIVE

To study the efficacy and safety of lactase additive in improving lactose intolerance in preterm infants.

METHODS

A total of 60 preterm infants with lactose intolerance who were admitted to the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2019 were randomly divided into a lactase treatment group and a control group, with 30 infants in each group. The infants in the lactase treatment group were given 4 drops of lactase additive (180 mg) added into preterm formula or breast milk, and those in the control group were given placebo, oral administration of probiotics (live combined Bifidobacterium, Lactobacillus and Enterococcus powder) at half an hour after feeding (1 g each time, twice a day), and clockwise abdominal massage around the belly button at 1 hour after feeding for 15 minutes each time, 3 times a day. Fecal pH, fecal reducing sugar, growth indicators, symptoms of lactose intolerance, and laboratory markers were measured at the end of the first and second weeks after intervention.

RESULTS

Finally 29 infants in the lactase treatment group and 26 infants in the control group completed the trial. At the end of the first week after intervention, compared with the control group, the lactase treatment group had significantly lower frequency of daily milk vomiting and gastric retention amount (P < 0.05) and a significantly higher proportion of infants with fecal pH > 5.0 (P < 0.05). At the end of the second week after intervention, compared with the control group, the lactase treatment group had significantly lower frequency of daily milk vomiting and 24-hour abdominal circumference difference (P < 0.05) and a significantly higher proportion of infants with the absence of gastric retention, fecal pH > 5.0, or negative reducing sugar in feces (P < 0.05). No adverse reactions associated with the lactase additive or probiotics were observed during the trial.

CONCLUSIONS

Lactase additive can safely and effectively improve the clinical symptoms caused by lactose intolerance in preterm infants.

Determination of Carbohydrates in Lactose-Free Dairy Products to Support Food Labelling

Milk and its derivatives are the basis of human nutrition since childhood. Given their importance within a balanced diet, the determination of carbohydrates in milk and its derivatives is fundamental for two reasons: one of alimentary origin related to intolerances and the other one of technological origin, especially for PDO (Protected Designation of Origin) products. The dietetic approach, including lactose-free products, has a crucial role in the management of lactose intolerance, but labelling and compositional rules indicating the absence or reduced presence of lactose in food are currently not harmonised at Union level. Considering the above-mentioned issues and the absence of official methods for the determination of low sugar concentrations, we propose a new and simple IC-HRMS method to detect carbohydrates in milk and different lactose-free derivatives, which can allow the definition of concentration limits useful to characterise products suitable for specific dietary regimes.

The Effect of Space Travel on Bone Metabolism: Considerations on Today's Major Challenges and Advances in Pharmacology

Microgravity-induced bone loss is currently a significant and unresolved health risk for space travelers, as it raises the likelihood for irreversible changes that weaken skeletal integrity and the incremental onset of fracture injuries and renal stone formation. Another issue related to bone tissue homeostasis in microgravity is its capacity to regenerate following fractures due to weakening of the tissue and accidental events during the accomplishment of particularly dangerous tasks. Today, several pharmacological and non-pharmacological countermeasures to this problem have been proposed, including physical exercise, diet supplements and administration of antiresorptive or anabolic drugs. However, each class of pharmacological agents presents several limitations as their prolonged and repeated employment is not exempt from the onset of serious side effects, which limit their use within a well-defined range of time. In this review, we will focus on the various countermeasures currently in place or proposed to address bone loss in conditions of microgravity, analyzing in detail the advantages and disadvantages of each option from a pharmacological point of view. Finally, we take stock of the situation in the currently available literature concerning bone loss and fracture healing processes. We try to understand which are the critical points and challenges that need to be addressed to reach innovative and targeted therapies to be used both in space missions and on Earth.

The Effects of Empowerment Education on Daily Dairy Intake in Community-Dwelling of Older Asian Women

A scarcity in the intake of dairy products in older women begets a wide range of musculoskeletal problems, especially osteoporosis. However, dairy products are often not consumed in sufficient quantities in Eastern societies. This study used empowerment education to improve daily dairy intake in 68 older Asian women in the community through a quasi-experimental study design. The 34 participants in the experimental group took part in empowerment education programs that included lectures, sharing sessions, situation dramas, and cooking activities, for two hours per week for 6 weeks. The 34 participants in the control group had no interventions. The generalized estimating equation was used to evaluate the intervention’s effectiveness. The test was conducted for the two groups at 1 and 12 weeks after the completion of the lessons. We used daily dairy intake self-efficacy, intention, and behavior scale to measure the outcome. The change in the experimental group’s daily dairy intake self-efficacy and intention score at post-1 week and post-12 weeks was higher compared to the control group, but the dairy intake behavior was only changed at post-12 weeks. The empowerment education was effective in encouraging older women to change their dairy intake behavior and improved their dairy intake self-efficacy and intentions.