Potentially functional lactose-free ice cream with Lacticaseibacillus casei CSL3, ginger, and honey.

AIMS: To develop and characterize a functional lactose-free ice cream with added ginger and honey, evaluate the survival of Lacticaseibacillus casei CSL3 under frozen storage and the simulated gastrointestinal tract (GIT), as well as antioxidant activity and product acceptability. METHODS AND RESULTS: The survival of Lacticaseibacillus casei CSL3 was evaluated for 180 days, under frozen storage, and GIT at 60 days. At 15 days of storage, proximal composition, antioxidant activity, color, pH, acidity, fusion, density, overrun, and sensory analysis were performed. Ice cream was an effective food matrix for maintaining the viability of CSL3, with concentrations > 7 log CFU g- 1 during storage and GIT. In addition, the analysis showed overrun and prebiotic characteristics through high values of antioxidant activity and phenolic compounds, good acceptability, and purchase intention. CONCLUSIONS: The product has satisfactory market potential (acceptance rate of 95.19% and purchase intention rate > 96%), and it could become another means of inserting probiotics in food.

Genotype Prevalence of Lactose Deficiency, Vitamin D Deficiency, and the Vitamin D Receptor in a Chilean Inflammatory Bowel Disease Cohort: Insights from an Observational Study.

Lactose intolerance (LI) and vitamin D deficiency (VDD) have been linked to inflammatory bowel disease (IBD). We conducted an observational study in 192 Chilean IBD patients to investigate the prevalence of a specific gene variant (LCT-13910 CC genotype) associated with LI and the prevalence of VDD/Vitamin D Receptor (VDR) gene variants. Blood samples were analyzed using Illumina's Infinium Global Screening Array. The LCT-13910 CC genotype was found in 61% of IBD patients, similar to Chilean Hispanic controls and lower than Chilean Amerindian controls. The frequency of the LCT-13910-C allele in Chilean IBD patients (0.79) was comparable to the general population and higher than Europeans (0.49). Regarding VDR and VDD variants, in our study, the rs12785878-GG variant was associated with an increased risk of IBD (OR = 2.64, CI = 1.61-4.32; p-value = 0.001). Sixty-one percent of the Chilean IBD cohort have a genetic predisposition to lactose malabsorption, and a significant proportion exhibit genetic variants associated with VDD/VDR. Screening for LI and VDD is crucial in this Latin American IBD population.

Difficulties in Establishing the Adverse Effects of ß-Casomorphin-7 Released from ß-Casein Variants-A Review.

ß-Casomorphin-7 (BCM-7) is a peptide released through the proteolysis of ß-casein (ß-CN), which is considered a bioactive peptide displaying evidence of promoting the binding and activation of the µ-opioid receptor located in various body parts, such as the gastrointestinal tract, the immune system and potentially the central nervous system. The possible effects of BCM-7 on health are a theme rising in popularity due to evidence found in several studies on the modulation of gastrointestinal proinflammatory responses that can trigger digestive symptoms, such as abdominal discomfort. With the advancement of studies, the hypothesis that there is a correlation of the possible effects of BCM-7 with the microbiota-gut-brain axis has been established. However, some studies have suggested the possibility that these adverse effects are restricted to a portion of the population, and the topic is controversial due to the small number of in vivo studies, which makes it difficult to obtain more conclusive results. In addition, a threshold of exposure to BCM-7 has not yet been established to clarify the potential of this peptide to trigger physiological responses at gastrointestinal and systemic levels. The proportion of the population that can be considered more susceptible to the effects of BCM-7 are evidenced in the literature review. The challenges of establishing the adverse effects of BCM-7 are discussed, including the importance of quantifying the BCM-7 release in the different ß-CN genotypes. In summary, the reviewed literature provides plausible indications of the hypothesis of a relationship between ß-CN A1/BCM-7 and adverse health effects; however, there is need for further, especially in vivo studies, to better understand and confirm the physiological effects of this peptide.

[Prevalence of cow´s milk allergy and lactose intolerance among Mexican late adolescents]. / Prevalencia de alergia a la leche de vaca e intolerancia a la lactosa en adolescentes tardíos mexicanos.

OBJECTIVE: To determine the prevalence of cow´s milk allergy and lactose intolerance in a sample of late adolescents. METHODS: Through a population-based study, data corresponding to students with aged 15 to 18 years were analyzed. RESULTS: A total of 1992 adolescents was analized. The prevalence of cow´s milk allergy was 1.4% (95% CI: 0.2% to 0.8%) and the prevalence of lactose intolerance was 0.5% (95% CI: 0.2% to 0.8%). Adolescents with cow´s milk allergy had fewer gastrointestinal symptoms (p = 0.036), but more skin (p < 0.001) and respiratory (p = 0.028) ailments than adolescents with lactose intolerance. CONCLUSIONS: The manifestations associated with cow's milk consumption in late adolescents seem to correspond mainly to cow´s milk allergy than to lactose intolerance.

OBJECTIVO: Determinar la prevalencia de alergia a la proteína de la leche de vaca e intolerancia a la lactosa en una muestra de adolescentes tardíos. MÉTODOS: Estudio transversal con base poblacional, en el que se analizaron los datos de pacientes adolescentes de 15 a 18 años. RESULTADOS: Se registraron 1992 estudiantes. La prevalencia de alergia a la proteína de la leche de vaca fue de 1.4% (IC95%: 0.9% a 2.0%) y de intolerancia a la lactosa de 0.5% (IC95%: 0.2% a 0.8%). Los adolescentes con alergia a la proteína de la leche de vaca tuvieron menos síntomas gastrointestinales (p = 0.036), pero más molestias cutáneas (p < 0.001) y respiratorias (p = 0.028) que los adolescentes con intolerancia a la lactosa. CONCLUSIONES: Las manifestaciones asociadas con el consumo de leche de vaca en adolescentes tardíos corresponden, principalmente, a la alergia de la proteína de la leche de vaca que a la intolerancia a la lactosa.

Leche materna deslactosada con la enzima beta galactosidasa para lactantes intolerantes / Leite materno sem lactose com a enzima beta-galactosidase para lactentes intolerantes / Lactose-free breast milk with the enzyme beta galactosidase for intolerant infants

Introducción: los bebés deben beneficiarse de la leche materna, incluso cuando presentan intolerancia a la lactosa. Por esto, se debe recurrir a la obtención de leche materna deslactosada. Objetivo: analizar el efecto de la enzima beta galactosidasa en la hidrólisis de la lactosa de leche materna madura para bebés clínicamente diagnosticados con intolerancia a la lactosa. Materiales y método: estudio exploratorio, descriptivo y explicativo. El contenido de lactosa se cuantificó desde el inicio hasta el final del tratamiento, controlando temperatura, tiempos y cantidad de enzima ß-galactosidasa adicionada en la leche materna. Se recolectaron 1000 ml de leche materna, obtenidos del Banco de Leche del Hospital General de Medellín (Antioquia, Colombia). Resultados: las muestras donadas se encontraban pasteurizadas y posteriormente fueron sometidas a la acción de la enzima lactasa. Se cuantificó el contenido de lactosa sin la enzima, reportando en promedio 6,34 mg/100 ml ± 0,23. El mayor aporte de lactosa obtenido posterior a la exposición a la enzima (30 minutos) fue de 6,07 mg/ml ± 0,35 (correspondiente a 95 % del contenido inicial), finalizando con un aporte de 0,35 % a una concentración de 0,4 % tras 24 horas, porcentaje que representa 95 % de la hidrólisis total en la leche materna. Conclusiones: en todas las muestras analizadas de diferentes madres se pudo obtener leche materna con bajas concentraciones de lactosa tras 24 horas de haber sido sometidas a la acción de ß-galactosidasa. Lo anterior se establece como una alternativa para los bebés intolerantes a la lactosa, que permitiría no privarlos de todos los beneficios que ofrece este alimento.

Introduction: Babies should benefit from breast milk, even when they are lactose intolerant. For this reason, parents should resort to obtaining lactose-free breast milk. Objective: To examine the effect of the enzyme ß-galactosidase on the hydrolysis of lactose in mature breast milk for babies clinically diagnosed with lactose intolerance. Materials and method: Exploratory, descriptive, and explanatory study. The lactose content was quantified from the beginning to the end of the treatment, controlling variables such as temperature, times, and the amount of ß-galactosidase enzyme added in breast milk. A total of 1000 ml of breast milk were obtained from the milk bank at Hospital General de Medellín (Antioquia, Colombia). Results: Donated samples were first pasteurized and subsequently subjected to the action of the enzyme lactase. The lactose content without the enzyme was quantified, reporting an average of 6.34 mg/100 mL±0.23. The highest contribution of lactose obtained after exposure to the enzyme was 6.07 mg/mL±0.35 (corresponding to 95% of the initial content), at 30 minutes, ending with a contribution of 0.35% at a concentration of 0.4% in 24 hours, percentage that represents 95% of total hydrolysis in breast milk. Conclusions: In all the examined samples from different mothers, it was possible to obtain breast milk with low concentrations of lactose 24 hours after these were exposed to the action of ß-galactosidase. This becomes an alternative for feeding lactose intolerant babies and not deprive them from all the benefits offered by breast milk.

Introdução: os bebês se devem beneficiar do leite materno, mesmo quando tenham intolerância à lactose, razão pela qual se deve recorrer à obtenção de leite materno sem lactose. Objetivo: analisar o efeito da enzima beta-galactosidase na hidrólise da lactose no leite materno maduro para bebês diagnosticados clinicamente com intolerância à lactose. Materiais e método: estudo exploratório, descritivo, explicativo. O teor de lactose foi quantificado do início ao fim do tratamento; temperatura, tempos e quantidade de enzima beta-galactosidase adicionada no leite materno foram controlados; foram coletados 1000ml de leite materno, obtidos no Banco de Leite do Hospital General de Medellín (Antioquia, Colômbia). VResultados: as amostras doadas foram pasteurizadas e posteriormente submetidas à ação da enzima lactase. O teor de lactose sem a enzima foi quantificado, relatando uma média de 6,34mg/100ml±0,23. A maior contribuição de lactose obtida após a exposição à enzima foi de 6,07mg/ml±0,35 (correspondendo a 95% do conteúdo inicial) em 30 minutos, finalizando com uma contribuição de 0,35% na concentração de 0,4% em 24 horas, percentual que representa 95% da hidrólise total no leite materno. Conclusões: em todas as amostras analisadas de diferentes mães, foi possível obter leite materno com baixas concentrações de lactose 24 horas após ser submetido à ação da beta galactosidase, como alternativa para bebês intolerantes à lactose e não os privar de todos os outros benefícios oferecidos por esse alimento ideal.

Intolerancia a la lactosa: mitos y verdades. Actualización / Lactose intolerance: myths and facts. An update

La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.

Lactose is the main carbohydrate present in humanmilk. It is a disaccharide made up of glucoseand galactose. It is produced in the mammaryglands, regardless of maternal diet. In addition toproviding energy, it is the only source of dietarygalactose, necessary for macromolecule synthesis,including oligosaccharides, glycoproteins, andglycolipids. It favors calcium, magnesium, andzinc absorption and retention. Its digestion bylactase and subsequent absorption occurs inthe small intestine. Lactase deficiency may beclassified into congenital primary (very rare),late-onset primary or secondary due to an injuryof the intestine; it may cause intolerance withpain, abdominal distension, abdominal gas, anddiarrhea. In the colon, it may be hydrolyzed bybifidobacteria and lactobacilli. The nutritionalmanagement of intolerance should alwayspreserve breastfeeding. Lactose reduction orelimination should be transient, and eliminatedfood should be replaced with other similar incalorie, protein, mineral, and vitamin content.

Lactose intolerance: myths and facts. An update. / Intolerancia a la lactosa: mitos y verdades. Actualización.

Lactose is the main carbohydrate present in human milk. It is a disaccharide made up of glucose and galactose. It is produced in the mammary glands, regardless of maternal diet. In addition to providing energy, it is the only source of dietary galactose, necessary for macromolecule synthesis, including oligosaccharides, glycoproteins, and glycolipids. It favors calcium, magnesium, and zinc absorption and retention. Its digestion by lactase and subsequent absorption occurs in the small intestine. Lactase deficiency may be classified into congenital primary (very rare), late-onset primary or secondary due to an injury of the intestine; it may cause intolerance with pain, abdominal distension, abdominal gas, and diarrhea. In the colon, it may be hydrolyzed by bifidobacteria and lactobacilli. The nutritional management of intolerance should always preserve breastfeeding. Lactose reduction or elimination should be transient, and eliminated food should be replaced with other similar in calorie, protein, mineral, and vitamin content.

La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.

Extracellular vesicle microRNAs in celiac disease patients under a gluten-free diet, and in lactose intolerant individuals.

BACKGROUND: Celiac disease (CD) is an autoimmune disorder triggered by an abnormal immunological response to gluten ingestion and is associated with deregulated expression of cellular microRNAs (miRNAs) of the gut mucosa. It is frequently misdiagnosed as lactose intolerance (LI) due to symptom resemblance. Microvilli loss may be counteracted by a rigorous gluten-free diet (GFD). AIMS: To identify altered extracellular vesicle miRNAs from plasma among CD patients on GFD (n=34), lactose intolerant individuals on restrictive diet (n=14) and controls (n=23), and to predict biological pathways in which these altered miRNAs may play a part. METHODS: Five different small RNA samples of each group were pooled twice and then screened by new-generation sequencing. Four miRNAs were selected to be quantified by RT-qPCR in the entire sample. RESULTS: The levels of four miRNAs - miR-99b-3p, miR-197-3p, miR-223-3p, and miR-374b-5p - differed between CD patients and controls (P<0.05). Apart from miR-223-3p, all these miRNAs tended to have altered levels also between LI and controls (P<0.10). The results for miR-99b-3p and miR-197-3p between CD and controls were confirmed by RT-qPCR, which also indicated different levels of miR-99b-3p and miR-374b-5p between CD-associated LI and LI (P<0.05). CONCLUSIONS: These miRNAs may have targets that affect cell death, cell communication, adhesion, and inflammation modulation pathways. Hence, altered miRNA levels could be associated with CD-related aspects and gut mucosa recovery.

Intolerância à lactose: diagnóstico clínico laboratorial e genético / Lactose intolerance: clinical and genetic diagnosis

Introdução: A intolerância à lactose é síndrome decorrente da má digestão do dissacarídeo lactose por deficiência da enzima lactase, gerando sintomas principalmente gastrintestinais. Ela envolve 4 causas principais: deficiência congênita de lactase; deficiência de lactase de desenvolvimento; intolerância primária à lactose; e deficiência secundária à lactase. Objetivo: Revisão da apresentação clínica da intolerância à lactose e os principais métodos disponíveis para seu diagnóstico clínico. Método: Revisão narrativa da base de dados PubMed, por meio das palavras-chave "lactose intolerance" e "genetic test" utilizando o descritor boleano and. Foram incluídos somente artigos em língua inglesa e publicados entre os anos de 2017 e 2022, totalizando 8 artigos. Resultado: O diagnóstico de intolerância à lactose relaciona-se com o seu tipo e utiliza-se dos principais métodos: teste oral de tolerância à lactose, teste genético, teste do hidrogênio expirado. Conclusão: Quanto aos métodos de diagnóstico, o teste do hidrogênio expirado é o de escolha, por não ser invasivo, possuir execução fácil e baixo custo. Entretanto, ele não dispensa associação com outras técnicas diagnósticas. O teste genético também é muito útil e sua vantagem é que não há necessidade da realização do teste oral de tolerância.

Introduction: Lactose intolerance is a syndrome resulting from maldigestion of the disaccharide lactose due to lactase enzyme deficiency causing symptoms mainly gastrointestinal. It involves 4 main causes: congenital lactase deficiency; developmental lactase deficiency; primary lactose intolerance; and secondary lactase deficiency. Objective: Review of the clinical presentation of lactose intolerance and the main methods available for its clinical diagnosis. Methods: Literature review in the PubMed database, using the keywords "lactose intolerance" and "genetic test" and using the Boolean data type and. Only articles in English and published between the years 2017 and 2022 were included, totalizing 8 articles. Results: The diagnosis of lactose intolerance is related to its type and uses the main diagnostic tests: oral lactose tolerance, genetic, expired hydrogen. Conclusion: Regarding diagnostic methods, the expired hydrogen test is the one of choice, as it is not invasive, is easy to perform and has low cost. However, it does not dispense association with other diagnostic techniques. Genetic testing is also very usefull and its advantage is that there is no need to use the oral lactose tolerance test.

Tracing the Distribution of European Lactase Persistence Genotypes Along the Americas.

In adulthood, the ability to digest lactose, the main sugar present in milk of mammals, is a phenotype (lactase persistence) observed in historically herder populations, mainly Northern Europeans, Eastern Africans, and Middle Eastern nomads. As the -13910∗T allele in the MCM6 gene is the most well-characterized allele responsible for the lactase persistence phenotype, the -13910C > T (rs4988235) polymorphism is commonly evaluated in lactase persistence studies. Lactase non-persistent adults may develop symptoms of lactose intolerance when consuming dairy products. In the Americas, there is no evidence of the consumption of these products until the arrival of Europeans. However, several American countries' dietary guidelines recommend consuming dairy for adequate human nutrition and health promotion. Considering the extensive use of dairy and the complex ancestry of Pan-American admixed populations, we studied the distribution of -13910C > T lactase persistence genotypes and its flanking haplotypes of European origin in 7,428 individuals from several Pan-American admixed populations. We found that the -13910∗T allele frequency in Pan-American admixed populations is directly correlated with allele frequency of the European sources. Moreover, we did not observe any overrepresentation of European haplotypes in the -13910C > T flanking region, suggesting no selective pressure after admixture in the Americas. Finally, considering the dominant effect of the -13910∗T allele, our results indicate that Pan-American admixed populations are likely to have higher frequency of lactose intolerance, suggesting that general dietary guidelines deserve further evaluation across the continent.

Immobilization of ß-galactosidase from Bacillus licheniformis for application in the dairy industry.

The food industry has developed a wide range of products with reduced lactose to allow people with intolerance to consume dairy products. Although ß-galactosidase has extensive applications in the food, pharma, and biotechnology industries, the enzymes are high-cost catalysts, and their use makes the process costly. Immobilization is a viable strategy for enzyme retention inside a reactor, allowing its reuse and application in continuous processes. Here, we studied the immobilization of ß-galactosidase from Bacillus licheniformis in ion exchange resin. A central composite rotational design (CCRD) was proposed to evaluate the immobilization process in relation to three immobilization solution variables: offered enzyme activity, ionic strength, and pH. The conditions that maximized the response were offered enzyme activity of 953 U, 40 mM ionic strength, and pH 4.0. Subsequently, experiments were performed to provide additional stabilization for biocatalyst, using a buffer solution pH 9.0 at 25 °C for 24 h, and crosslinking with different concentrations of glutaraldehyde. The stabilization step drastically impacted the activity of the immobilized enzyme, and the reticulation with different concentrations of glutaraldehyde showed significant influence on the activity of the immobilized enzyme. In spite of substantially affecting the initial activity of the immobilized enzyme, higher reagent concentrations (3.5 g L-1) were effective for maintaining stability related to the number of cycles of the enzyme immobilized. The ß-galactosidase from Bacillus licheniformis immobilized in Duolite A568 is a promising technique to produce reduced or lactose-free dairy products, as it allows reuse of the biocatalyst, decreasing operational costs.Key Points• Immobilization of ß-galactosidase from Bacillus licheniformis in batch reactor• Influence of buffer pH and ionic concentration and offered enzyme activity on immobilization• Influence of glutaraldehyde on operational stability.

Testes respiratórios não invasivos para o diagnóstico de SBID e intolerância à lactose em pacientes com câncer colorretal e gástrico em tratamento quimioterápico / Noninvasive breath tests for diagnosis of sibo and lactose intolerance in patients on chemotherapy treatment for colorectal and gastric câncer

ABSTRACT BACKGROUND: Worldwide, colorectal cancer (CRC) and gastric cancer (GC) are the third and the fifth most prevalent, respectively. Diarrhea is a common symptom in patients on chemotherapy or radiotherapy treatment and can reduce treatment tolerance. Surgical resections and chemotherapy change the intestinal microbiota that can lead to lactose intolerance, small intestinal bacterial overgrowth (SIBO). OBJECTIVE: The aim of the study was to evaluate the frequency of diarrhea in patients with CRC and GC on chemotherapy with SIBO or intolerance of lactose. METHODS: This is a descriptive and observational study with patients of both sexes, over 18 years old, in treatment in the Gastro-Oncology outpatient clinic of the Federal University of São Paulo. Patients with a confirmed diagnosis of CRC or GC during chemotherapy treatment were included. To detect bacterial overgrowth and lactose intolerance, breath hydrogen test with lactulose and lactose was done. Number and aspects of the evacuations and toxicity degree were collected. For the nutritional assessment, weight and height were performed to calculate the BMI. and the Patient Generated Subjective Global Assessment (PG-SGA). RESULTS: A total of 33 patients were included, 29 with CRC and 3 with GC. Most of them were male (57.57%), mean age of 60.03±10.01 years and in chemotherapy with fluoropyrimidine and oxaliplatin (54.5%). Diarrhea was present in 57.6% and 30.3% had toxicity grade 2. According to the BMI, 78.9% were eutrophics, obese or overweight, but according to PG-SGA, 84.9% had moderate or severe nutritional risk grade. Between patients, 45% had lactose intolerance and 9% SIBO. Diarrhea grade 2-3 was observed in 66.6% of patients with SIBO and 66.7% of that with lactose intolerance. No statistical difference was observed between patients with SIBO or lactose intolerance and grade of diarrhea. CONCLUSION: Diarrhea was a frequent symptom in chemotherapy patients with gastric or colorectal cancer independent of the presence of SIBO or lactose intolerance. Surgery and chemotherapy treatment impacted in the intestinal habit of patients. Diagnosis of other causes of diarrhea may contribute to a better tolerance to treatment and quality of life.

RESUMO CONTEXTO: Mundialmente, o câncer colorretal (CCR) e gástrico (CG) são a terceira e a quinta causa de câncer mais prevalente, respectivamente. A diarreia é um sintoma comum entre os pacientes em quimioterapia ou radioterapia e pode reduzir a tolerância ao tratamento. Quimioterapia e ressecções cirúrgicas causam alterações da microbiota intestinal que podem levar a intolerância à lactose e ao supercrescimento bacteriano do intestino delgado (SBID). OBJETIVO: Avaliar a presença de diarreia nos pacientes com câncer colorretal e gástrico em quimioterapia e a presença de SBID ou intolerância à lactose. MÉTODOS: Foi realizado um estudo descritivo, observacional com pacientes ambulatoriais de ambos os sexos, maiores de 18 anos, em tratamento no ambulatório de gastro-oncologia da Universidade Federal de São Paulo. Foram incluídos pacientes com diagnóstico confirmado de CCR ou CG durante tratamento quimioterápico. Para detectar supercrescimento bacteriano e intolerância à lactose, foram realizados testes respiratórios com lactulose e lactose respectivamente. Número, aspecto das evacuações e grau de toxicidade foram coletados. Para a avaliação nutricional foram aferidos peso e altura para cálculo do IMC e para avaliação do risco nutricional foi realizada a avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP). RESULTADOS: Foram incluídos 33 pacientes, 29 com CCR e 3 com CG. A maioria era do sexo masculino (57,5%) com média de idade 60,03±10,01 anos e em tratamento quimioterápico com fluoropirimidina e oxaliplatina (54,5%). Diarreia foi relatada por 57,6% dos pacientes sendo em 30% grau 2. Pelo IMC, 78,9% apresentavam eutrofia, sobrepeso ou obesidade grau 1, mas pela ASG-PPP 84,9 apresentavam risco nutricional moderado ou severo. Entre os pacientes 9% apresentavam SBID e 45% intolerância à lactose. Diarreia grau 2-3 foi observada em 66,6% daqueles pacientes com SBID e 66,7% dos com intolerância à lactose. Não encontramos diferenças estatísticas entre os pacientes com SBID ou intolerância à lactose e intensidade de diarreia. CONCLUSÃO: Diarreia foi um sintoma frequente entre os pacientes com câncer gástrico ou colorretal em quimioterapia independente da presença de SBID ou intolerância à lactose. Cirurgia e quimioterapia impactaram no hábito intestinal dos pacientes. O diagnóstico de outras causas de diarreia pode contribuir para a melhor tolerância do tratamento e qualidade de vida.

Lack of Association between LCT_rs140433552*CA>del Indel Polymorphism and Lactose Intolerance in a Southern Brazilian Population.

BACKGROUND/AIMS: Polymorphisms in the enhancer of the lactase gene (LCT) are strongly associated with lactase persistence, but not always predictive of the phenotype. We investigated a possible association between the regulatory rs140433552*CA>del variant of LCT and lactose intolerance (LI). METHODS: We genotyped 122 individuals for rs140433552 and rs4988235 (-13910*C>T). RESULTS: Associations of rs140433552*CA>del with LI depend on -13910*C>T. Homozygous individuals for the C-CA haplotype, as well as C-CA+/C individuals, seem more likely to manifest LI (OR 3.33 [95% CI 1.32-8.35], p = 0.011, and OR 3.93 [95% CI 1.61-9.61], p = 0.003, respectively), while homozygous individuals for the T-CA haplotype seem more likely to be lactose tolerant (OR 0.04 [95% CI 0.002-0.70], p = 8 × 10-4). CONCLUSIONS: rs140433552*CA>del is not independently associated with LI.

Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico.

BACKGROUND & AIMS: Gut microbiota are affected by diet and ethnicity, which impacts cognition and hospitalizations in cirrhosis. AIM: Study interactions of diet with microbiota and impact on hospitalizations and cognition in American and Mexican cohorts. METHODS: Controls and age-balanced patients with compensated/decompensated cirrhosis were included and followed for 90-day hospitalizations. A subset underwent minimal hepatic encephalopathy (MHE) testing. Parameters such as dietary, salivary and faecal microbiota (diversity, taxa analysis, cirrhosis dysbiosis ratio CDR:high = good) between/within countries were analysed. Regression analyses for hospitalizations and MHE were performed. RESULTS: In all, 275 age-balanced subjects (133 US [40 Control, 50 Compensated, 43 Decompensated] and 142 Mexican [41 Control, 49 Compensated, 52 Decompensated]) were enrolled. MELD/cirrhosis severity was comparable. Diet showed lower protein and animal fat intake in all decompensated patients, but this was worse in Mexico. Diversity was lower in stool and saliva in decompensated patients, and worse in Mexican cohorts. Prevotellaceae were lower in decompensated cirrhosis, particularly those with lower animal fat/protein consumption across countries. Hospitalizations were higher in Mexico vs the USA (26% vs 14%, P = .04). On regression, Prevotellaceae, Ruminococcaceae and Lachnospiraceae lowered hospitalization risk independent of MELD and ascites. MHE testing was performed in 120 (60/country and 20/subgroup) subjects and MHE rate was similar. MELD and decompensation increased while CDR and Prevotellaceae decreased the risk of MHE. CONCLUSIONS: Changes in diet and microbiota, especially related to animal fat and protein intake and Prevotellaceae, are associated with MHE and hospitalizations in Mexican patients with cirrhosis compared to an American cohort. Nutritional counselling to increase protein intake in cirrhosis could help prevent these hospitalizations.

Association between migraine, constipation and lactose intolerance in adults patients / Associação entre enxaqueca, constipação intestinal e intolerância à lactose em adultos

ABSTRACT BACKGROUND AND OBJECTIVES: Considering the bidirectional connection between intestine and brain, the present study examined the association between migraine, lactose intolerance, and intestinal constipation in patients with status migrainosus. METHODS: This is a cross-sectional retrospective study that included 97 patients aged 20 years or older. The impact of pain was assessed by the Migraine Disability Assessment and the Headache Impact Test-6 questionnaires. The pain intensity was measured by the visual analog scale. Chi-square and Student-t tests were used for the statistical analysis. RESULTS: The sample consisted of 88.7% women, 56.8% overweight, 76.3% sedentary, 32% constipated and 23.7% lactose intolerant. Higher pain intensity (8.9±1.3) and impact pain mean was assessed by the Headache Impact Test-6 (67.6±5.3) and the Migraine Disability Assessment (36.7±26.3) in constipated patients compared to those without constipation. Lactose-intolerant patients presented higher migraine mean time (19.9±14.2) compared to lactose tolerant patients. Constipated and lactose intolerant patients presented higher prevalence of overweight (58.1 and 65.2%) and abdominal obesity (70.0 and 68.2%) compared to non-constipated and lactose tolerant patients, respectively. CONCLUSION: Although were observed in the evaluated sample a considerable prevalence of constipation and lactose intolerance, higher mean scores in the questionnaires used for pain impact and intensity in constipated patients and longer migraine diagnosis time in those with lactose-intolerance, there was no statistical significance in the association between migraine and these two gastrointestinal disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Ao considerar a conexão bidirecional entre intestino e cérebro, o presente estudo avaliou a associação entre enxaqueca, intolerância à lactose e constipação intestinal em pacientes em estado migranoso. MÉTODOS: Trata-se de um estudo transversal e retrospectivo que incluiu 97 pacientes com idade igual ou superior a 20 anos. O impacto da dor foi avaliado pelos questionários: Migraine Disability Assessment e Headache Impact Test-6. A intensidade da dor foi avaliada pela escala analógica visual. Os testes Qui-quadrado e Student-t foram utilizados para análise estatística. RESULTADOS: A amostra foi composta por 88,7% de mulheres, 56,8% com excesso de peso, 76,3% sedentários, 32% constipados e 23,7% intolerantes à lactose. Os constipados apresentaram maiores médias de impacto da dor pelo Headache Impact Test-6 (67,6±5,3) e pelo Migraine Disability Assessment (36,7±26,3) e intensidade da dor (8,9±1,3) do que os não constipados. Os pacientes intolerantes à lactose apresentaram maior média de tempo de enxaqueca (19,9±14,2) em relação aos tolerantes à lactose. Os pacientes constipados apresentaram maiores prevalências de excesso de peso (58,1 e 65,2%) e obesidade abdominal (70,0 e 68,2%) e intolerantes em relação aos sem constipação intestinal e aos tolerantes à lactose, respectivamente. CONCLUSÃO: Embora identificadas prevalências consideráveis de constipação intestinal e intolerância à lactose na amostra avaliada, além de maiores médias de pontuação nos questionários utilizados para impacto e intensidade da dor nos pacientes constipados e de maior tempo de diagnóstico da migrânea nos intolerantes à lactose, não houve significância estatística na associação entre enxaqueca e esses distúrbios gastrointestinais.

Sorvete com extrato hidrossolúvel de arroz: análise físico-química e sensorial / Ice cream made with water-soluble rice extract: physicochemical and sensory analysis

Introdução: Devido ao fato de que muitas pessoas são intolerantes à lactose, novas propostas de preparações dietéticas com bons atributos sensoriais e isentas deste dissacarídeo são necessárias para garantir bem-estar e qualidade de vida para estes indivíduos. Objetivo: desenvolver sorvete com extrato hidrossolúvel de arroz. Método: Foram produzidos sorvetes com 50% e 100% de substituição do leite bovino por extrato hidrossolúvel de arroz em dois sabores (morango e chocolate). Os métodos para o desenvolvimento deste estudo basearam-se na análise físico-química do sorvete, bem como a análise sensorial para definir o nível de aceitação do produto e preferência por parte dos consumidores. Resultados: Os sorvetes de extrato hidrossolúvel de arroz, tanto de chocolate, como de morango obtiveram maiores teores de carboidratos e menores valores energéticos, devido ao fato de ter menor teor de proteína e lipídio, em comparação com o sorvete feito com leite bovino. Obteve-se boa aceitação, sendo que o sorvete de 50% extrato de arroz sabor morango não obteve diferença significativa do sorvete com 100% de leite de bovino, em relação à preferência. Conclusão: Conclui-se que o sorvete com extrato hidrossolúvel de arroz é um produto com boas características nutricionais e tem boa aceitação, podendo ser uma opção para pessoas intolerantes à lactose. (AU)

Introduction: As there are many people with lactose intolerance, new dietary preparations with good sensory aspects and free from this disaccharide need to be proposed, which would ensure these individuals' well-being and quality of life. Purpose: To develop an ice cream made with water-soluble rice extract. Method: Ice creams were produced replacing 50% and 100% of cow milk with water-soluble rice extract, in two flavors (strawberry and chocolate). The methods for developing this study were based on the physicochemical analysis of the ice cream and the sensory analysis, to establish the degree of acceptability of the product, as well as the preference on the part of the consumers. Results: Both the chocolate and the strawberry water-soluble rice extract ice creams had higher carbohydrate content and lower energy values, due to its lower protein and lipid content in comparison with cow milk ice cream. There was good acceptability; particularly, the 50% rice extract strawberry ice cream had no significant difference to the 100% cow milk ice cream, regarding preference. Conclusion: It is concluded that the water-soluble rice extract ice cream is a product with good nutritional characteristics and good acceptability. It can be considered an alternative for people with lactose intolerance. (AU)

Parent's perception of allergic or food-intolerant children in relation to disease / Percepção de pais de crianças alérgicas ou intolerantes alimentares em relação à doença

INTRODUCTION: Cow´s milk protein allergy (CMPA) and lactose intolerance (LI) negatively affect the quality of life of patients and their families. OBJECTIVE: To analyse the perception parents of children with CMPA or LI regarding aspects of health, emphasizing their oral health and the factors involved in the treatment of allergy/food intolerance METHODS: Qualitative research employing focus groups, with a sample of 12 parents of children with CMPA or LI (two groups), including the participation of a researcher/moderator, an observer, and six participants in each group and a plan with guiding questions. Discourses were recorded and transcribed, and textual contents were processed in software IRAMUTEQ and analysed by the descendant hierarchical classification (DHC) technique, content analysis, and word cloud. RESULTS: Six categories were derived from DHC-multivariate analysis: (1) children formula, (2) oral health, (3) nutritional aspects, (4) treatment, (5) disease´s stigma, and (6) health services. The thematic axes were derived from nutritional, assistance, and care categories. Reports of different oral diseases were given by parents regarding food allergy or intolerance in their children, such as frequent caries, teeth spots, pain, and sensitive teeth. CONCLUSION: Parents´ perception of CMPA/LI in their children is affected by nutritional factors and the stigma caused by the disease, with special reference to the importance given to children´s oral health and reports about difficulties in the access to health services with multi-professional teams.

INTRODUÇÃO: A alergia a proteína do leite de vaca (APLV) e intolerância à lactose (IL) afetam negativamente a qualidade de vida de pacientes e seus familiares. OBJETIVO: Analisar a percepção de pais de crianças com APVL ou IL, quanto aos aspectos de saúde, enfatizando sua saúde bucal, bem como, os fatores envolvidos no tratamento da alergia e intolerância alimentar. MÉTODO: Pesquisa qualitativa com emprego da técnica de grupo focal, com uma amostra de 12 pais de crianças com APLV ou IL (dois grupos), incluindo a participação de pesquisador/moderador, observador e seis participantes em cada grupo e um roteiro com questões norteadoras. Os discursos foram gravados e transcritos, os conteúdos textuais foram processados no software IRAMUTEQ e analisados pelas técnicas de Classificação Hierárquica Descendente (CHD), análise de conteúdo e nuvem de palavras. RESULTADOS: Seis clusters emergiram da análise multivariada pela CHD: (1) Fórmulas Infantis; (2) Saúde Bucal; (3) Aspectos Nutricionais; (4) Tratamento; (5) Estigma da Doença; (6) Serviços de Saúde. A partir dos clusters foram identificados três eixos temáticos: nutrição, atenção e assistência. Relatos de diferentes doenças bucais foram dados pelos pais, com relação à alergia ou intolerância alimentar em seus filhos, tais como: cárie frequente, manchas dentárias, dor e dentes sensíveis. CONCLUSÃO: A percepção dos pais de crianças com APLV/IL sofreram influência dos fatores nutricionais e do estigma que a doença apresenta, com especial importância dada para a saúde bucal de seus filhos, e relatos de dificuldades de acesso a serviços de saúde com equipes multiprofissionais.

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting.

Lactose is a unique component of breast milk, many infant formulas and dairy products, and is widely used in pharmaceutical products. In spite of that, its role in human nutrition or lactose intolerance is generally not well-understood. For that reason, a 2-day-long lactose consensus meeting with health care professionals was organized in Mexico to come to a set of statements for which consensus could be gathered. Topics ranging from lactase expression to potential health benefits of lactose were introduced by experts, and that was followed by a discussion on concept statements. Interestingly, lactose does not seem to induce a neurological reward response when consumed. Although lactose digestion is optimal, it supplies galactose for liver glycogen synthesis. In infants, it cannot be ignored that lactose-derived galactose is needed for the synthesis of glycosylated macromolecules. At least beyond infancy, the low glycemic index of lactose might be metabolically beneficial. When lactase expression decreases, lactose maldigestion may lead to lactose intolerance symptoms. In infancy, the temporary replacing of lactose by other carbohydrates is only justified in case of severe intolerance symptoms. In those who show an (epi)genetic decrease or absence of lactase expression, a certain amount (for adults mostly up to 12 g per portion) of lactose can still be consumed. In these cases, lactose shows beneficial intestinal-microbiota-shaping effects. Avoiding lactose-containing products may imply a lower intake of other important nutrients, such as calcium and vitamin B12 from dairy products, as well as an increased intake of less beneficial carbohydrates.

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.

Dairy foods and positive impact on the consumer's health.

The objective of the present chapter was to demonstrate the state of the art in the recent advances in nutritional and functional components of dairy products research. In this chapter, the main mechanisms responsible and essential for a better understanding of nutritional and functional values of the components of milk and dairy products are highlighted. It also includes a discussion about the positive impacts of fermented milk, cheese, butter, ice cream, and dairy desserts components on the consumer's health.