LACTOSE INTOLERANCE IN CHILDREN AND ADULTS
Keywords:
lactose intolerance; lactose malapsorption; adult-type lactose intolerance; irritable bowel syndrome
Abstract
Lactose is the 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, is 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 like in patients with food allergy. Treatment is based on the restriction of lactose intake with 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.
References
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28. Simoons FJ. Primary adult lactose intolerance and the milking habit: a problem in biological and cultural interrelationes. Am J Dig Dis 1969; 14: 819-36.
29. McCracken RD. Adult lactose intolerance. JAMA 1970; 213: 2257-60.
30. Enattah NS, Trudeau A, Pimenoff V, et al. Evidence of still-ongoing convergence evolution of the lactase persistence T-13910 alleles in humans. Am J Hum Genet. 2007; 81: 615–25.
31. Diekmann L, Pfeiffer K, Naim HY. Congenital lactose intolerance is triggered by severe mutations on both alleles of the lactase gene. BMC Gastroenterol 2015; 15: 36.
32. Sahi T. Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol Suppl 1994; 202: 7–20.
33. Senewiratne B, Thambipillai S, Perera H. Intestinal lactase deficiency in Ceylon (Sri Lanka). Gastroenterology 1997; 72: 1257-59.
34. Jackson RT, Lathman MC. Lactose malapsorption among Masai children of East Africa. Am J Clin Nutr 1979; 32: 779-82.
35. Law D, Conklin J, Pimentel M. Lactose intolerance and the role of the lactose breath test. Am J Gastroenterol. 2010; 105:1726–28.
36. Fielding JF, Baynes S, Fottrel PJ. The lactose tolerance test and intestinal lactase activiti. Irish Med Sc. 1983; 152: 196-98.
37. Levitt MD, Donaldson RM. Use of respiratory hidrogen (H2) excretion to detect carbohydrate malapsorption. J Lab Clin Med 1970; 75: 937-45.
38. Mattar R, Monteiro MS, Villares CA, Santos AF, Carrilho FJ. Single nucleotide polymorphism C/T-13910, located upstream of the lactase gene, associated with adult-type hypolactasia: validation for clinical practice. Clin Biochem. 2008; 41:628–30.
39. Dahlqvist A. Method for assay of intestinal disaccharidasses. Anal Biochem 1964; 7: 18-25.
40. Burgess EA, Levin B, Mahalanabis D, et al. Hereditary sucrose intolerance: levels of sucrase activity in jejunal mucosa. Arch Dis Child 1964; 39: 431-43.
41. Mattar R, Monteiro MS, Kinoshita da Silva MJ, Carrilho JF. LCT-22018G>A single nucleotide polymorphism is a better predictor of adult-type hypolactasia/lactase persistence in Japanese-Brazilians than LCT-13910C>T. Clinics. 2010; 65: 1399-400.
42. Tishkoff AS, Reed AF, Ranciaro A et al. Convergent adaptation of human lactase persistence in Africa and Europe. Nat Genet. 2007; 39 (1): 31-40.
43. Medeiros LC, Lederman HM, de Morais MB. Lactose malabsorption, calcium intake, and bone mass in children and adolescent s. J Pediatr Gastroenterol Nutr. 2012; 54: 204-9.
44. Ross AC, Taylor CL, Yaktine AL, et al. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
45. Byers KG, Savaino DA. The myth of increased lactose intolerance in African-Americans. J Am Coll Nutr 2005; 24: 569-73.
46. Labayen I, Forga L, Gonzalez A, Lenoir-Wijnkoop I, Nutr R, Martinez JA. Relationship between lactose digestion, gastrointestinal transit time and symptoms in lactose malabsorbers after dairy consumption. Aliment Pharmacol Ther. 2001; 15: 543–9.
47. Škaro V. Genetička predispozicija za nepodnošenje laktoze. Paediatr Croat. 2016; 60: 100-4.
48. Montalto M, Curigliano V, Santoro L, et al. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006; 12: 187–91.
49. De Vrese M, Stegmann A, Richter B, et al. Probiotics-compensation for lactase insufficency. J Am Cl Nutr 2001; 73: 421-9.
50. Adalfsson O, Nikbin Meydani S, Russell R. Yogurt and gut function. Am J Clin Nutr 2004; 80: 245-6.
51. Newcomer AD, Park HSP, O Brien, et al. Response of patients with irritabble bowel syndrome and lactase deficiency using unfermented acidophilus milk. Am J Clin Nutr 1983; 381 : 257-63.
52. Payne DL, Welsh JD, Manion CV, et al. Effectiveness of lactose malapsorption. Am J Clin Nutr 1981; 34 : 2711-55.
53. Wong HB. Rice water in treatment of infantile gastroenetritis. Lancet 1981; 2: 102-3.
54. Molla AM, Sarker SA, Hossein M, et al. Rice-powder alactrolyte solution as oral therapy in diarrhoea due to V. cholerae and E. coli. Lancet 1982; 1: 1317-9.
55. Dahqvist A. Digestion of lactose. In: Delmont J, eds. Milk intolerance and rejection. Masel: Karger, 1983: 11-6.
56. Lybeck-Sörensen K, Vergara Meersohn M, Sonne J, et al. A new type of low-lactose milk. Scand J Gastroenterology 1983; 18: 1063-8.
57. Gilat T, Russo S, Gelman-Malachi E, et al. Lactase in man: a nonadaptibile enzyme. Gastroenterology 1972; 62: 1125-8.
58. Koletzko S, Niggemann B, Arato A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012; 55: 221-9.
2. Radlović N. Nepodnošenje disaharida. Srp Arh Celok Lek 2010; 138:777-82.
3. Auricchio S, Maiuri L. Cellular basis of adult-type hupolactasia. Acta Paediatrica 1994; 83 Suppl 395: 7-14.
4. Campbell A K, Waud J P, Matthews S B. The molecular basis of lactose intolerance. Sci Prog 2005; 88: 157–202.
5. Järvelä I, Enattah NS, Kokkonen J, Varilo T, Savilahti E, Peltonen L. Assigment of locus for congenital lactase deficiency to 2q21, in the vicinity of but separate from the lactase-phlorisin hydrolase gene. Am J Hum Genet 1998; 63: 1078-85.
6. Russo F, De Carne M, Buonsante A, et al. Hypolactasia and metaboloc changes in post-menopausal women. Maturitas 1997; 26: 193-202.
7. Kuokkanen M, Kokkonen J, Enattah NS, et al. Mutations in the translated region of the lactase gene (LCT) underlie congenital lactase deficiency. Am J Hum Genet 2006; 78: 339-44.
8. Enattah NS, Sahi T, Savilahti E, et al. Identification of a variant associatedwith adult-type hypolactasia. Nature genetics 2002; 30: 233-37.
9. Kuokkanen M, Enattah NS, Oksanen A, et al. Transcriptional regulation of the lactase-phlorizin hydrolase gene by polymorphisms associated with adult-type hypolactasia. Gut 2003; 52: 647-52.
10. Röhmann F, Nagano J. Veber die Resorption und die termentative Spaltung der Disaccharide in Dunndarm des ausgewachesenen Hundes. Pflugers Arch Gesamte Physiol Mensch Tiere 1903; 105: 533-9.
11. Fischer JE. Effects of feeding a diet containing lactose upon β-D-galactosidase activity and organ development in the rat digestive tract. Am J Physiol 1957; 188: 49-53.
12. Suchy FJ, Brannon PM, Carpenter TO, et al. National Institutes of Health Consensus Development Conference: lactose intolerance and health. Ann Intern Med. 2010; 152: 792–6.
13. Shepherd SJ, Lomer MC, Gibson PR. Short-chain carbohydrates and functional gastrointestinal disorders. Am Gastroenterol 2013; 108: 707–17.
14. Singh VV, Toskes PP. Small Bowel Bacterial Overgrowth: Presentation, Diagnosis, and Treatment. Curr Treat Options Gastroenterol 2004; 7: 19–28.
15. Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: The role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892–900.
16. Tamm A, Siigur U, Tammur R. Individual short-chain fatty acids and diarrhoea in lactose malabsorbers. Wiss Z Ernst Moritz Arnd Univ 1989; 38: 124-6.
17. Guerin-Ganan C, Popt F. Pattern of metabolism and composition of the fecal microflora in infants 10 to 18 months old from day care centers. J Pediatr Gastroenterology Nutr 1997; 25: 281-9.
18. Cloarec D, Bornet D. Lactase deficiency and lactose intolerance-related symptomps in adult healthy subjects from Western France. Gastroenterol Clin-Biol 1991; 15: 558-93.
19. Mattar R, Mazo D F, Carrilho F J. Lactose intolerance: diagnosis, genetic and clinical factors. Clin Exp Gastroenterol 2012; 5: 113–21.
20. Di Rienzo T, D’Angelo G, D’aversa F, et al. Lactose intolerance: from diagnosis to correct management. Eur Rev Med Pharmacol Sci 2013;17 Suppl 2:18-25.
21. Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intoler¬ance in clinical practice – myths and realities. Aliment Pharmacol Ther. 2008; 27:93–103.
22. Matthews SB, Waud JP, Roberts AG, Campbell AK. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J. 2005; 81:167–73.
23. Berni Canani R, Passariello A, Buccigrossi V, Terrin G, Guarino A. The nutritional modulation of the evolving intestine. J Clin Gastroenterol. 2008; 42(Suppl 3): S197-200.
24. Kuokkanen M, Kokkonen J, Enattah NS, et al. Mutations in the translated region of the lactase gene (LCT) underlie congenital lactase deficiency. Am J Hum Genet. 2006; 78: 339–44.
25. Fazeli W, Kaczmarek S, Kirschstein M, et al. A novel mutation within the lactase gene (LCT): the first report of congenital lactase deficiency diagnosed in Central Europe. BMC Gastroenterol 2015; 15: 90.
26. Guarino A, Albano F, Ashkenazi S, et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. ESPGHAN/ESPID Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe Expert Working Group J Pediatr Gastroenterol Nutr. 2008 ; 46: 619–21.
27. Heyman MB. Lactose intolerance in infants, children, and adolescents. Committee on Nutrition Pediatrics. 2006; 118: 1279–86.
28. Simoons FJ. Primary adult lactose intolerance and the milking habit: a problem in biological and cultural interrelationes. Am J Dig Dis 1969; 14: 819-36.
29. McCracken RD. Adult lactose intolerance. JAMA 1970; 213: 2257-60.
30. Enattah NS, Trudeau A, Pimenoff V, et al. Evidence of still-ongoing convergence evolution of the lactase persistence T-13910 alleles in humans. Am J Hum Genet. 2007; 81: 615–25.
31. Diekmann L, Pfeiffer K, Naim HY. Congenital lactose intolerance is triggered by severe mutations on both alleles of the lactase gene. BMC Gastroenterol 2015; 15: 36.
32. Sahi T. Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol Suppl 1994; 202: 7–20.
33. Senewiratne B, Thambipillai S, Perera H. Intestinal lactase deficiency in Ceylon (Sri Lanka). Gastroenterology 1997; 72: 1257-59.
34. Jackson RT, Lathman MC. Lactose malapsorption among Masai children of East Africa. Am J Clin Nutr 1979; 32: 779-82.
35. Law D, Conklin J, Pimentel M. Lactose intolerance and the role of the lactose breath test. Am J Gastroenterol. 2010; 105:1726–28.
36. Fielding JF, Baynes S, Fottrel PJ. The lactose tolerance test and intestinal lactase activiti. Irish Med Sc. 1983; 152: 196-98.
37. Levitt MD, Donaldson RM. Use of respiratory hidrogen (H2) excretion to detect carbohydrate malapsorption. J Lab Clin Med 1970; 75: 937-45.
38. Mattar R, Monteiro MS, Villares CA, Santos AF, Carrilho FJ. Single nucleotide polymorphism C/T-13910, located upstream of the lactase gene, associated with adult-type hypolactasia: validation for clinical practice. Clin Biochem. 2008; 41:628–30.
39. Dahlqvist A. Method for assay of intestinal disaccharidasses. Anal Biochem 1964; 7: 18-25.
40. Burgess EA, Levin B, Mahalanabis D, et al. Hereditary sucrose intolerance: levels of sucrase activity in jejunal mucosa. Arch Dis Child 1964; 39: 431-43.
41. Mattar R, Monteiro MS, Kinoshita da Silva MJ, Carrilho JF. LCT-22018G>A single nucleotide polymorphism is a better predictor of adult-type hypolactasia/lactase persistence in Japanese-Brazilians than LCT-13910C>T. Clinics. 2010; 65: 1399-400.
42. Tishkoff AS, Reed AF, Ranciaro A et al. Convergent adaptation of human lactase persistence in Africa and Europe. Nat Genet. 2007; 39 (1): 31-40.
43. Medeiros LC, Lederman HM, de Morais MB. Lactose malabsorption, calcium intake, and bone mass in children and adolescent s. J Pediatr Gastroenterol Nutr. 2012; 54: 204-9.
44. Ross AC, Taylor CL, Yaktine AL, et al. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
45. Byers KG, Savaino DA. The myth of increased lactose intolerance in African-Americans. J Am Coll Nutr 2005; 24: 569-73.
46. Labayen I, Forga L, Gonzalez A, Lenoir-Wijnkoop I, Nutr R, Martinez JA. Relationship between lactose digestion, gastrointestinal transit time and symptoms in lactose malabsorbers after dairy consumption. Aliment Pharmacol Ther. 2001; 15: 543–9.
47. Škaro V. Genetička predispozicija za nepodnošenje laktoze. Paediatr Croat. 2016; 60: 100-4.
48. Montalto M, Curigliano V, Santoro L, et al. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006; 12: 187–91.
49. De Vrese M, Stegmann A, Richter B, et al. Probiotics-compensation for lactase insufficency. J Am Cl Nutr 2001; 73: 421-9.
50. Adalfsson O, Nikbin Meydani S, Russell R. Yogurt and gut function. Am J Clin Nutr 2004; 80: 245-6.
51. Newcomer AD, Park HSP, O Brien, et al. Response of patients with irritabble bowel syndrome and lactase deficiency using unfermented acidophilus milk. Am J Clin Nutr 1983; 381 : 257-63.
52. Payne DL, Welsh JD, Manion CV, et al. Effectiveness of lactose malapsorption. Am J Clin Nutr 1981; 34 : 2711-55.
53. Wong HB. Rice water in treatment of infantile gastroenetritis. Lancet 1981; 2: 102-3.
54. Molla AM, Sarker SA, Hossein M, et al. Rice-powder alactrolyte solution as oral therapy in diarrhoea due to V. cholerae and E. coli. Lancet 1982; 1: 1317-9.
55. Dahqvist A. Digestion of lactose. In: Delmont J, eds. Milk intolerance and rejection. Masel: Karger, 1983: 11-6.
56. Lybeck-Sörensen K, Vergara Meersohn M, Sonne J, et al. A new type of low-lactose milk. Scand J Gastroenterology 1983; 18: 1063-8.
57. Gilat T, Russo S, Gelman-Malachi E, et al. Lactase in man: a nonadaptibile enzyme. Gastroenterology 1972; 62: 1125-8.
58. Koletzko S, Niggemann B, Arato A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012; 55: 221-9.