Lactose Malabsorption, Calcium Intake, and Bone Mass in Children and Adolescents

Medeiros, Lilian C. da Silva; Lederman, Henrique Manoel; Morais, Mauro Batista de

doi:10.1097/mpg.0b013e3182380604

Cited by 15 publications

(8 citation statements)

References 42 publications

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“…In our study, no significant association was observed between dietary Ca intake and phalangeal BMS, and the BMS was not different in cases and controls, despite the lower Ca intake. These results are in accordance with previous studies [ 41 , 42 ] and in agreement with the findings of a Cochrane review that, in 19 articles including more than 2000 patients, detected only a small and transitory effect of Ca supplementation in healthy children [ 43 ]. The BMS is influenced by several factors (e.g., genetic factors, body weight, physical activity), among which, calcium is an important one.…”

Section: Discussionsupporting

confidence: 93%

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

et al. 2018

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Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow’s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable.

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Section: Discussionsupporting

confidence: 93%

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

et al. 2018

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“…It is suggested that the persistence of lactate activity in certain population groups occurred due to selective pressure on those who depended on dairy products as a source of food. This was due to increasing dependence on pastoral activities in relation to agriculture, as occurred, about 7000 to 9000 years ago, in populations of Northern and Central Europe (35,36) . It is believed that this feeding pattern may have favored the emergence and propagation of dominant genes, arising from mutation, granting persistence to the production and activity of lactate, and constituting an advantage from an evolutionary point of view (36) .…”

Section: Discussionmentioning

confidence: 99%

Analysis of Lactose Intolerance in Students With Suggestive Symptoms of Irritable Bowel Syndrome

Silva

Leite

Rodrigues

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE: The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS: In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS: Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION: In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.

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“…Though some studies have reported an association between calcium intake and bone mineral content (BMC) and BMD in children with LI or cow’s milk allergy[6,8,33], other investigators found no such associations[10,34] in carefully-designed studies that matched the experimental groups’ intake of calcium, milk-derived calcium, milk, cheese, yogurt, ice cream, and calcium density of the diet. The studies that reported associations between calcium intake and BMD did not evaluate the subjects’ vitamin D status[6,8,33].…”

Section: Discussionmentioning

confidence: 99%

Lactose Intolerance: Lack of Evidence for Short Stature or Vitamin D Deficiency in Prepubertal Children

et al. 2013

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BackgroundThe health consequences of lactose intolerance (LI) are unclear.AimsTo investigate the effects of LI on stature and vitamin D status.HypothesesLI subjects will have similar heights and vitamin D status as controls.Subjects and MethodsPrepubertal children of ages 3-12 years with LI (n=38, age 8.61 ± 3.08y, male/female 19/19) were compared to healthy, age- and gender-matched controls (n=49, age 7.95±2.64, male/female 28/21). Inclusion criteria: prepubertal status (boys: testicular volume <3cc; girls: Tanner 1 breasts), diagnosis of LI by hydrogen breath test, and no history of calcium or vitamin D supplementation. Vitamin D deficiency was defined as 25-hydroxyvitamin D [25(OH)D] <50 nmol/L. Gender-adjusted midparental target height (MPTH) z-score was calculated using NCHS data for 18 year-old adults. Data were expressed as mean ± SD.ResultsThere was no significant difference in 25(OH)D between the LI and non-LI subjects (60.1±21.1, vs. 65.4 ± 26.1 nmol/L, p = 0.29). Upon stratification into normal weight (BMI <85th percentile) vs. overweight/obese (BMI ≥85th percentile), the normal weight controls had significantly higher 25(OH)D level than both the normal weight LI children (78.3 ± 32.6 vs. 62.9 ± 23.2, p = 0.025), and the overweight/obese LI children (78.3±32.6 vs. 55.3±16.5, p = 0.004). Secondly, there was no overall difference in height z-score between the LI children and controls. The normal weight LI patients had similar height as normal controls (-0.46 ± 0.89 vs. -0.71 ± 1.67, p = 0.53), while the overweight/obese LI group was taller than the normal weight controls (0.36 ± 1.41 vs. -0.71 ± 1.67, p = 0.049), and of similar height as the overweight/obese controls (0.36 ± 1.41 vs. 0.87 ± 1.45, p = 0.28). MPTH z-score was similar between the groups.ConclusionShort stature and vitamin D deficiency are not features of LI in prepubertal children.

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Lactose Malabsorption, Calcium Intake, and Bone Mass in Children and Adolescents

Abstract: There was no relation among lactose malabsorption and bone densities, bone mineral content, or calcium intake within the present study.

Cited by 15 publications

References 42 publications

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia

Analysis of Lactose Intolerance in Students With Suggestive Symptoms of Irritable Bowel Syndrome

Lactose Intolerance: Lack of Evidence for Short Stature or Vitamin D Deficiency in Prepubertal Children

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