Lactose malabsorption is a risk factor for decreased bone mineral density in pancreatic insufficient cystic fibrosis patients

Abstract

As decreased bone mineral density (BMD) is a common problem in cystic fibrosis (CF) and milk products may have pivotal dietary role affecting BMD, we aimed to assess the potential influence of adult-type hypolactasia (ATH) and lactose malabsorption (LM) on BMD in adolescent and young adult patients. In 95 CF pancreatic-insufficient patients aged 10-25 years (without liver cirrhosis, steatosis and cholestasis, diabetes mellitus, systemic glucocorticoid therapy), lumbar BMD, the nutritional status, pulmonary function, vitamin D3 concentration, calcium intake and single-nucleotide polymorphism upstream of the lactase gene were assessed. In subjects with the À13910 C/C genotype predisposing to ATH, the presence of LM was determined with the use of a hydrogen-methane breath test (BT). BMD and calcium intake were significantly lower in patients with the C/C genotype (Po0.028 and Po0.043, respectively). The abnormal BMD was stated more frequently in patients with the C/C genotype (Po0.042) and with LM (Po0.007). BMD, daily calcium intake and serum vitamin D concentration were significantly lower in LM subjects than in the other patients (Po0.037, Po0.000004 and Po0.0038, respectively). In logistic regression analysis, the relationship between examined parameters and BMD, was found to be statistically significant (Po0.001). However, only standardized body weight and LM were documented to influence BMD (Po0.025 and Po0.044, respectively). In conclusion, LM seems to be an independent risk factor for decreased BMD in CF patients.

Evaluation of factors related to bone disease in Polish children and adolescents with cystic fibrosis

“…However, the study group included only fourteen patients from 5 to 19 years old. The third study reported reduced bone mineral density in patients with CF between 10 and 25 years old with adult-type hypolactasia and lactose malabsorption, which were confirmed as independent predictors of reduced bone mineral density [23].…”

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

“…Some studies reported that a reduced value of a quantitative ultrasound (QUS) variable, both velocity- and attenuation-based, was associated with a reduced BMS in children with growth problems or disorders affecting bone health [ 11 , 12 , 13 , 14 ]. One study examined the correlation between ATH and bone mineral density (BMD), but their subjects were also affected by cystic fibrosis [ 15 ], and the authors used dual-emission X-ray absorptiometry (DXA) instead of QUS. Our study also provides an overview of Ca intake from different foods that are a source of Ca and vitamin D.…”

Bone mineral density is related to lung function outcomes in young people with cystic fibrosis—A retrospective study

“…An association between BMI and BMD has been noted in the literature previously . This would suggest that increased focus on improving nutritional status in patients with CF would cause bone density to improve accordingly.…”

“…27 An association between BMI and BMD has been noted in the literature previously. 7,28 This would suggest that increased focus on improving nutritional status in patients with CF would cause bone density to improve accordingly. However, a study comparing two cohorts of CF patients, one cohort studied 15 years ago and one cohort in the present day period found that BMI was not significantly different between the two groups.…”