Association between milk consumption and lactose malabsorption in Indonesian children / 中国当代儿科杂志

OBJECTIVES@#To study the association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years.@*METHODS@#This cross sectional study was conducted in randomly selected presumed healthy children with good nutritional status aged 3-12 years in Central Jakarta, Indonesia (@*RESULTS@#The prevalence of lactose malabsorption in children aged 3-5 years and children aged 6-12 years was 20.8% (15/72) and 35.3% (36/102), respectively. There was no association between milk or milk product consumption and lactose malabsorption (@*CONCLUSIONS@#There is no association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years, suggesting that genetic predisposition may be more important than adaptive mechanisms to lactose consumption.

Análise da intolerância à lactose em alunos com sintomas sugestivos da síndrome do intestino irritável / Analysis of lactose intolerance in students with suggestive symptoms of irritable bowel syndrome

ABSTRACT 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.

RESUMO CONTEXTO: A síndrome do intestino irritável é uma condição clínica que cursa com dor, distensão e plenitude abdominal, diarreia, constipação, entre outros sintomas. Gera impacto significativo na qualidade de vida das pessoas acometidas. Sua fisiopatologia é incerta, mas o papel de vários tipos de alimentos está estabelecido na sensibilização intestinal e nas manifestações clínicas. A intolerância aos carboidratos, particularmente a lactose, gera sintomas similares e por vezes indistinguíveis da síndrome do intestino irritável e é uma condição frequente e subdiagnosticada na prática clínica. Está relacionada a deficiências enzimáticas, alterações da microbiota intestinal e mesmo alterações genéticas. O principal exame para o diagnóstico da intolerância à lactose é o teste respiratório, que mede a emissão de hidrogênio produzido apenas por bactérias, após a ingestão do substrato correspondente. OBJETIVO: O presente trabalho tem como objetivo verificar a prevalência de intolerância à lactose em universitários que apresentem sintomas gastrointestinais sugestivos da síndrome do intestino irritável. MÉTODOS: O estudo, caracterizado como do tipo transversal, teve a participação de 124 discentes de medicina que responderam um formulário, a fim de realizar a triagem daqueles com sintomatologia sugestiva. Aqueles com dor abdominal foram encaminhados para o tratamento antiparasitário, a fim de excluir parasitose intestinal como causa secundária. Posteriormente, através do teste respiratório com hidrogênio expirado, foi feito primeiro a pesquisa de supercrescimento bacteriano e caso fosse negativo seria realizado o da intolerância à lactose. Foram considerados com intolerância aqueles que obtiveram uma elevação na concentração de hidrogênio ≥20 ppm acima do nível basal. RESULTADOS: Do total de alunos pesquisados (n=124), 7 foram excluídos por não cumprirem todas as etapas do estudo. A partir dos 117 indivíduos efetivamente incluídos na pesquisa, verificou-se que 8 (6,8%) foram diagnosticados com intolerância a lactose e 2 (1,7%) com supercrescimento bacteriano. A intolerância foi mais frequente nos indivíduos do sexo feminino (75%), faixa etária de 18 a 25 anos (62,5%), cor parda (50%) e do 5º semestre (37,5%). Verificou-se que a presença de pelo menos um sintoma gastrointestinal entre aqueles que possuem intolerância (100%) e os que não possuem (42,2%) foi estatisticamente significativa (P=0,002). Além da própria dor abdominal (100%) (P<0,001), o sintoma gastrointestinal mais recorrente nos discentes intolerantes foi a distensão/flatulência (62,5%) (P=0,026). Em relação aos hábitos de vida e padrão alimentar, não houve diferença estatística entre os indivíduos intolerantes e tolerantes, bem como na frequência de sintomas. Os discentes dos períodos mais avançados da graduação se destacaram por manifestarem com maior constância os sintomas gastrointestinais, porém sem apresentar discrepâncias estatísticas significativas. CONCLUSÃO: Tendo em vista a quantidade da amostra que realizou o teste (n=21), pode-se provar a alta prevalência da intolerância à lactose (6,8%) no meio acadêmico, com as características epidemiológicas compatíveis com a literatura. Assim, foi possível gerar conhecimento para entender, prevenir, diagnosticar, aliviar e tratar os universitários intolerantes, gerando impactos positivos para o bem-estar, melhorando a qualidade de vida desses indivíduos.

Lactose em alimentos industrializados: avaliação da disponibilidade da informação de quantidade / Lactose in processed foods: evaluating the availability of information regarding its amount

Resumo Indivíduos com intolerância à lactose, doença de alta prevalência, devem controlar o consumo de alimentos com esse dissacarídeo para evitar sintomas gastrointestinais. Como a tolerância é variável à quantidade ingerida, é fundamental a discussão sobre a disponibilização da informação de quantidade de lactose em alimentos industrializados, que atualmente não é obrigatória. O estudo avaliou a disponibilidade da informação sobre a quantidade de lactose por análise dos rótulos de alimentos industrializados, que contivessem leite ou lactose na lista de ingredientes. Em seguida, realizou-se contato com as indústrias de alimentos para solicitação da informação. Foram avaliados 1.209 alimentos, dos quais 1.092 eram tradicionais e 117 diet/light/zero. Apenas 3,1% dos alimentos analisados apresentavam a informação sobre a quantidade de lactose na tabela nutricional dos rótulos. A presença desta informação foi maior no grupo de alimentos diet/light/zero do que nos tradicionais. Além disso, das 156 empresas contatadas, somente 14 informaram a quantidade de lactose contida nos alimentos, 93 responderam a solicitação, porém não disponibilizaram as quantidades, e 49 não responderam. Conclui-se que há baixa disponibilidade da informação sobre a quantidade de lactose em alimentos industrializados.

Abstract Patients with lactose intolerance, a high prevalence disease, should control the intake of food with lactose to avoid gastrointestinal symptoms. Since tolerance depends on the amount of lactose ingested, it is essential to discuss the availability of the amount of lactose information in processed foods, which is currently not mandatory. The study measured the availability of information on the amount of lactose on the labels of processed food that contained milk or lactose in the ingredient list. Then, we contacted the food industry to request this information. We evaluated 1,209 processed foods, of which 1,092 were traditional and 117 were diet/light/zero. Only 3,1% of the analyzed foods provided information on the amount of lactose in the labeled nutrition table. This information was more available in the diet/light/zero food group. Furthermore, of the 156 contacted companies, only 14 reported the amount of lactose contained in foods, 93 answered the request, but have not provided the amounts and 49 did not answer the request. We concluded that there is a low availability of information about the amount of lactose in processed foods.

Caries in children with lactose intolerance and cow's milk protein allergy

Abstract Dental caries in 5-to-8-year-old children with cow's milk protein allergy (CMPA) and lactose intolerance (LI), their treatment needs, and the consumption of milk-based products and milk derivatives by these patients were investigated. A cross-sectional study was undertaken with 200 children in southern Brazil in 2017. The clinical examination was based on the World Health Organization criteria and a questionnaire was sent to parents or legal guardians to collect information on the children's food intake, pre-existing systemic diseases, medication use, and CMPA and LI. Standardization was performed to verify concordance among examiners (kappa = 0.96). Caries prevalence was 67.50% in children with CMPA or LI, but 34.37% in those without these conditions. The mean dmft (decayed, missing, and filled teeth) index in children with CMPA or LI was 1.75 ± 1.84, significantly higher than among non-allergic or lactose-tolerant children (0.83 ± 1.60) (p < 0.001). In children with CMPA or LI, the mean for treatment needs was 1.58 ± 1.50. Lactose-free milk was the most frequently consumed food among allergic/intolerant children (65.00%), with a mean dmft of 2.00 ± 2.08, higher than that obtained for those without CMPA/LI (0.82 ± 0.87), showing no significant difference (p = 0.129). Although dental caries and treatment needs in primary dentition were associated with CMPA or LI, children's intake of replacement foods did not pose any risk for the development of carious lesions. Statistically significant differences were obtained for the prevalence and severity of dental caries. This shows the need for treatment of children with CMPA or LI, who had the worst caries prevalence and severity rates.

Análisis de test de aire espirado en niños con sospecha de intolerancia a la lactosa / Breath tests in children with suspected lactose intolerance

Introducción: Un 70% de la población general presenta intolerancia a la lactosa; sin embargo, no existen estudios epidemiológicos en la población pediátrica chilena afectada por esta condición. Objetivos: Caracterizar una serie clínica de niños que acude a realizarse el test de aire espirado con lactosa para estudio de intolerancia a la lactosa, determinando la frecuencia de intolerancia y malabsorción, síntomas más frecuentes y rendimiento del test dependiendo de su origen. Pacientes y Método: Pacientes menores de 18 años que acudieron a realizarse el test de aire espirado con lactosa al Laboratorio de Gastroenterología de la Pontificia Universidad Católica de Chile, por sospecha clínica de intolerancia a la lactosa. Se consideró malabsorción un aumento ≥ 20 ppm sobre el nivel basal de hidrógeno (H2) o ≥ 34 ppm de H2 y metano (CH4) en conjunto y como intolerancia cuando lo anterior se asoció a la sumatoria de intensidad de síntomas ≥ 7 en el registro. Resultados: Se analizaron 194 pacientes entre 1 y 17 años de edad. De ellos, 102 (53%) pacientes resultaron malabsorbedores y 53 (27%) intolerantes. La frecuencia de intolerancia a la lactosa varió de un 7,1 a un 45,4%, con una mayor frecuencia a edades mayores. Los síntomas más reportados fueron dolor abdominal, meteorismo y borborigmo. Discusión: La malabsorción e intolerancia a lactosa se pueden pesquisar desde los primeros años de vida utilizando el test de aire espirado con lactosa asociado al cuestionario simultáneo de síntomas. Se puede observar un aumento en la frecuencia de intolerancia con la edad, además de una mayor positividad del examen si es solicitado por un gastroenterólogo.

Introduction: Up to 70% of the world population is lactose intolerance. However, there are no epidemiological studies among Chilean pediatric population affected by this condition. Objectives: Clinical characterization of a series of children who underwent the lactose intolerance breath test for lactose intolerance study, establishing intolerance and malabsorption frequencies, the most frequent symptoms, and test performance depending on the origin. Patients and Methods: Patients under 18 years old who took the lactose intolerance breath test in the Gastroenterology Laboratory of the Catholic University of Chile, and who were admitted due to clinically suspected lactose intolerance. Malabsorption was considered when there was as an increase of ≥ 20 ppm above the baseline (H2) or ≥ 34 ppm of H2 and methane (CH4) combined. Intolerance was considered when the above was associated with a symptom intensity score ≥ 7 during registration. Results: The analysis included194 patients aged 1 to17 years of age. Of these, 102 (53%) presented with malabsorption, and 53 (27%) were intolerant. The frequency of lactose intolerance varied from 7.1 to 45.4%, and it occurred more frequently at older ages. The most common reported symptoms were abdominal pain, bloating and rumbling. Discussion: Lactose malabsorption and intolerance can be investigated from the first years of life using the lactose breath test plus a symptom questionnaire. An increase in the frequency of intolerance with age, and a greater number of positive tests, if they were requested by a gastroenterologist, were observed.

Evaluation of lactose and milk intolerance, and bone mineral density in Indian patients with inflammatory bowel disease.

Background. A misconception that milk and lactose intolerance increases disease activity in inflammatory bowel disease leads to the exclusion of dietary dairy products, and patients are at an increased risk of low bone mineral density. Methods. Patients with inflammatory bowel disease (n=45, 19 men and 26 women) and healthy controls were included in this prospective open-label study. As part of exploratory dietary intervention, patients were advised to exclude milk and milk products from diet for the first 7 days and reintroduce at least 250 ml of milk for the next 21 days. Milk and lactose intolerance was assessed in patients and healthy subjects using clinical symptoms and lactose hydrogen breath test, respectively; bone mineral density was assessed in patients using a Hologic QDR 4500A DXA machine. Results. Milk and lactose intolerance was statistically comparable in patients with inflammatory bowel disease (31% and 44%, respectively) and healthy subjects (22% and 27%, respectively). Most of the patients (40%) had excluded dairy products from their diet, and 53% had dietary intake of calcium <200 mg/day. More than 60% of the patients had either osteopenia or osteoporosis. Conclusion. Milk and lactose intolerance in patients with inflammatory bowel disease was not different from that in healthy subjects. The proportion of patients with osteoporosis and osteopenia was high in this population. Hence, patients with inflammatory bowel disease in remission phase may be encouraged to add dairy products in their diet, unless otherwise indicated.

Intolerância à lactose: mudança de paradigmas com a biologia molecular / Lactose intolerance: changing paradigms due to molecular biology

Na maioria dos mamíferos a atividade da enzima lactase diminui na parede intestinal após o desmame, caracterizando a hipolactasia primária que provoca sintomas de intolerância à lactose. A intensidade dos sintomas de distensão, flatulência, dor abdominal e diarreia variam, dependendo da quantidade de lactose ingerida, e aumentam com o passar da idade. A hipolactasia é determinada geneticamente, porém uma mutação ocorreu para que fizesse parte da humanidade tolerar o leite na idade adulta. O diagnóstico é feito por teste de tolerância, empregando a lactose como desafio. Com a descoberta dos finlandeses do polimorfismo associado com a persistência da lactase, principalmente no norte da Europa, o exame genético passou a ser outra ferramenta diagnóstica mais confortável para o intolerante. No Brasil, 43 por cento dos brancos e dos mulatos têm alelo de persistência da lactase, sendo a hipolactasia mais frequente entre os negros e japoneses. Entretanto, na prática clínica indivíduos com hipolactasia podem ser orientados a consumir alguns derivados do leite e alimentos contendo lactose sem apresentar sintomas de intolerância, enquanto que outros terão que fazer restrição de lactose na dieta.

In most mammals, lactase activity declines on the intestinal wall after weaning, characterizing primary hypolactasia that provokes symptoms of lactose intolerance. The intensity of symptoms of distention, flatulence, abdominal pain and diarrhea varies, according to the amount of ingested lactose, and increases with age. Hypolactasia is genetically determined; nonetheless, a mutation occurred that had made a part of mankind tolerate milk in adulthood. Diagnosis is made by a tolerance test, using the lactose challenge. With the discovery made by the Finns of polymorphism associated with lactase persistence, mainly, in Northern Europe, the genetic test was incorporated as a more comfortable diagnostic tool for the intolerant. In Brazil, 43 percent of Caucasian and Mulatto groups have lactase persistence allele, with hipolactasia more frequently found among Blacks and Japanese. However, in clinical practice people with hypolactasia may be advised to consume certain dairy products and food containing lactose without developing intolerance symptoms, whereas others will need a lactose restriction diet.

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

BACKGROUND: The main symptoms of lactose intolerance are bloating, abdominal cramps, increased flatus and loose watery stools. These symptoms are similar to those of irritable bowel syndrome (IBS), which is a prevalent entity in the community. OBJECTIVE: As there was no data available on the prevalence of LI and the correlated factors, this study aimed to determine these correlations and their relation to IBS symptoms in an apparently healthy population in Shiraz, southern Iran. MATERIALS AND METHODS: A survey among 1,978 individuals older than 35 years was conducted in Shiraz, southern Iran, using a questionnaire that consisted of items regarding demographic data, life style, subjective gastrointestinal symptoms of LI and IBS symptoms according to ROME II criteria. RESULTS: A total of 562 subjects reported LI (28.41%). The prevalence was significantly higher in females, in subjects taking NSAIDs or acetaminophen and in cases reporting IBS symptoms. Subjects with LI avoided certain foods and drinks; and in order to relieve their symptoms, they used OTC drugs, herbal medicine or visited a physician. On the other hand, no relation was found between LI and age, smoking or the number of meals per day. CONCLUSIONS: Although we found that individuals with IBS had significantly more subjective LI than those without IBS, in the absence of documented lactose malabsorption, it is hard to tell whether the reported symptoms indeed are those of LI or simply those of IBS. So, a period of dairy product avoidance and/ or requesting a test for lactose malabsorption may be beneficial in this area.

Hypolactasia & lactose intolerance among three ethnic groups in Malaysia.

BACKGROUND & OBJECTIVES: Prevalence of adult-type hypolactasia is known to vary among different countries and in different ethnic populations in the same country. The present study was undertaken to evaluate the prevalence of hypolactasia and lactose intolerance in three different ethnic populations living in similar environmental conditions in Malaysia. The correlation between different symptoms and lactose intolerance test was also studied. METHODS: A total of 300 Malaysian subjects from three different ethnic populations: Malays, Chinese and Indians (100 volunteers in each group, 18-49 yr old working or studying in a University) were included. Urine galactose excretion and gastrointestinal symptoms were measured after lactose intake (50 g). RESULTS: Based on galactose excretion, 88 per cent of the Malays, 91 per cent of the Chinese and 83 per cent of the Indians were hypolactasic. The differences were statistically not significant. When the symptoms were also considered, prevalence of lactose intolerance appeared to be significantly lowest among the Indians. When the subjects were divided into low, middle and high galactose excretion groups some correlation was found between the symptoms and galactose excretion. INTERPRETATION & CONCLUSION: There was no clear association between hypolactasia and gastrointestinal symptoms in all the study groups. However, the lactose intolerance was high in all the study groups indicating the increasing demand for low lactose dairy products in the Asian countries.

Lactose maldigestion in different age groups of north Indians.

Lactase activity with age has been reported in a wide variety of population globally. However, most of these studies in human have ignored to assess age stratified lactose maldigestion. Therefore, the present study was planned to determine lactose maldigestion in different age groups of north Indians adults. Two hundred apparently healthy north Indians (age rage 10-80 years) were subjected to a 50g lactose hydrogen breath test by standard method using a Model 12 Microlyzer from Quintron, USA. The percentage of lactose maldigestion was calculated for different age groups with an interval of 10 years. The results of this study revealed that the frequency of lactose maldigestion did not differ significantly among the age groups. Thus, this study suggests that lactose maldigestion is not associated with age stratification among north Indians.

Utilidad del estudio de las heces para el diagnóstico y manejo de lactantes y prescolares con diarrea aguda / Utility of studying feces for the diagnosis and management of infants and preschool children with acute diarrhea

OBJECTIVE: To analyze the results of a stool work-up protocol in a series of infants and preschoolers with acute diarrhea. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted between April 1999 and March 2000, among 288 children seen at a pediatric office in Guadalajara, Mexico. The mean age (+/-/SD) was 23.1 +/- 13.9 months; 43 were females. Data were collected on demographic and clinical characteristics. The stool work-up consisted of fresh smear and methylene blue and Kinyoun smears, as well as determination of pH and reducing substances. Stool culture was performed in samples with > or = 3 leukocytes/microscopic field and rotavirus antigen detection only in selected cases. Data were analyzed using descriptive statistics, chi 2, odds ratios, and 95 confidence intervals. RESULTS: Enterophatogens () identified were: rotavirus 47.1, Campylobacter jejuni 27.4, Salmonella spp. 5.1, Shigella spp. 4.3, Cryptosporidium parvum 2.8, Giardia lamblia 2.4, Blastocystis hominis 1.4, Entamoeba histolytica 0.7. An OR of 5.7 was obtained for isolation of enteroinvasive bacteria in the presence of fecal leukocytes. Lactose intolerance was detected in 19.1. The frequencies of rotavirus antigen identification and lactose intolerance were significantly higher in infants; the OR for lactose intolerance in infants with rotavirus was 21. Mucus and blood in the stools were associated to enteroinvasive bacteria and Cryptosporidium parvum. CONCLUSIONS: The current stool work-up protocol allowed the identification of enteropathogenic parasites, rotavirus and lactose intolerance in a short period of time. Leukocytes in stools were associated to the isolation of enteroinvasive bacteria. The frequency of agents associated to diarrheal disease was similar to that from other national studies. This stool work-up protocol could be useful as a tool to limit the unnecessary prescription of drugs and to follow universal recommendations for dietary management of these patients.

Absorcion intestinal deficiente de lactosa (AIDL) en una poblacion de ninos mexicanos sanos por medio de la prueba de iones hidrogeno en aire espirado / Lactase defficient intestinal absortion (LDIA) in a population of healthy mexican children through the test of hydorgenion in air breathing

Se estudiaron 100 niños sanos, para determinar si presentaban o no absorción intestinal deficiente de lactosa (AIDL), por medio de la prueba de iones hidrógeno en el aire espirado, que asistieron a la consulta externa del servicio de Gastroenterología del Instituto Nacional de Pediatría de la ciudad de México durante el lapso comprendido entre noviembre de 1993 y febrero de 1994. La prevalencia de AIDL encontrada en este estudio fue del 10 por ciento. No existió una asociación estadisticamente significativa entre la prueba de iones hidrógenos y la determinación de pH y azúcares reductores en heces para el diagnóstico de AIDL.

Nutritional intervention in acute diarrhea: is a lactose-free formula essential?

A prospective study was done to determine the incidence of disaccharide intolerance among 3-36 month-old patients with acute watery diarrhea who were on breast feeding and/or lactose-containing formula. The effect of feeding intervention on the outcome was investigated. Significant disaccharide intolerance was defined as one with (1) biochemical derangements: stool pH < 6.0 (Riedel de Haen pH paper) and reducing substances > or = 0.5 mg% (Clinitest) on two consecutive determinations and (2) clinical evidence: high purging rate (> 10 gm/kg/hour) and reappearance of dehydration and/or weight loss while on a lactose containing milk. Seven of 92 patients (7.8%) had biochemical evidence of disaccharide malabsorption on admission. Subsequent monitoring of the study population showed absence of disaccharide intolerance. Despite a lactose containing formula, a significant (p < 0.05) reduction in stool output from the first to the second day (145.85 +/- 130.26 vs 115.43 +/- 95.65 g/kg admission weight) was noted. Likewise, weight gain from admission to discharge (4.56 +/- 3.44%) was observed. The mean total duration of illness (4.75 +/- 2.84 days) was well within the usual course of five to seven days. This study supports the current recommendation of continued breast feeding and/or use of lactose containing formula during acute watery diarrhea.

Deficiencia de lactasa intestinal en un pueblo Nahua: alternativas para los programas de intervención nutricional en la región / Lactase deficiency in a Nahua group: alternatives of nutritional intervention programs

La entidad conocida como "Deficiencia de lactasa intestinal del tipo adulto" (DLITA) es una condición que se encuentra en más del 70% de la población mundial. Esto significa que entre los grupos portadores de esta característica, una proporción variable de ellos puede experimentar diarrea y otros síntomas gastrointestinales después de ingerir cierta cantidad de leche. No obstante, en muchos países pobres en los que la desnutrición infantil constituye un problema de importancia creciente, cuantiosos recursos se invierten en programas de alimentación basados en el reparto mativo de leche. En este trabajo presentamos los resultados de una encuesta que tuvo como objetivos: 1) Determinar la prevalencia de DLITA en una comunidad indígena, donde la desnutrición afecta a más del 60% de la población preescolar, y 2) Proponer alternativas para los programas de intervención nutricional en la región. De acuerdo al método empleado, de los 110 niños examinados 78% fueron clasificados como no absorbedores y 55% de ellos refirieron episodios de diarrea después de haber ingerido la lactosa. En la parte final de este trabajo se plantean algunas sugerencias, enfocadas a estrategias culturalmente asequibles y que pueden implementarse a corto, mediano y largo plazo en los programas regionales de nutrición comunitaria

Intolerancia a la lactosa, generalidades sobre el diagnóstico y tratamiento / Lactose intolerance. Diagnosis and treatment

Se hacen consideraciones generales sobre la frecuencia de la intolerancia a la lactosa. Se analizan 154 enfermos que tuvieron gastroenteritis e intolerancia a la lactosa observándose que 98% de ellos fueron menores de un año y 53,4% de tres meses de edad. Fue frecuente la desnutrición proteíco calórica avanzada. La evolución de la gastroenteritis fue menor de 15 días en 52,6% de los casos. Se analiza la frecuencia de bacterias enteropatógenas y algunos aspectos del cuadro clínico. Se hacen consideraciones sobre los métodos de diagnóstico que pueden realizarse en nuestro medio, así como la utilidad de la cuantificación del hidrógeno espirado después de una carga de lactosa, señalándose los beneficios de este método. Se hacen consideraciones sobre el tratamiento dietético y se informa sobre el uso de una fórmula alimenticia a base de harina de garbanzo, con la que se observan resultados satisfactorios en el tratamiento de la intolerancia a la lactosa

Estudo da prevalência de intolerância à lactose em uma populaçäo de um hospital geral em Salvador, Bahia / Prevalence of lactose intolerance in a population of a general hospital in Salvador, Bahia

Com a finalidade de investigar a prevalência de intolerância à lactose em uma populaçäo de um Hospital Geral, estudamos 52 pacientes através do teste de tolerância à lactose, teste de tolerância com galactose e glicose, pesquisa de substâncias redutoras nas fezes e pH fecal. Encontramos uma prevalência de 40,3% de indivíduos com intolerância à lactose, havendo concordância entre a intolerância à lactose com a presença de substâncias redutoras nas fezes e a diminuiçäo do pH fecal. A administraçäo dos monossacarídeos correspondentes, a estes pacientes, demonstrou um padräo de curva glicêmica normal, caracterizando assim näo digestäo da lactose e absorçäo normal da glicose e galactose. Todos os pacientes com teste de tolerância à lactose anormal, apresentaram sintomas, sendo o mais freqüente a diarréia, seguido de distensäo abdominal, meteorismo, dor abdominal e náuseas