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PubMedDate not supplied

Lactose malabsorption and intolerance in Uruguayan population by breath hydrogen test (H2).

This study of 200 Uruguayans between 0 and 86 years old was designed to determine the prevalence of lactose malabsorption. Lactose intolerance is defined as a clinical syndrome of abdominal pain, diarrhea, flatulence, and bloating after the ingestion of a standard lactose tolerance test dose (2 g of lactose per kilogram of body weight or 50 g/m2 of body surface area, maximum 50 g in a 20% water solution). Lactose malabsorption refers to the state in which dietary lactose remains unhydrolyzed and subsequently unabsorbed from the gastrointestinal tract; symptoms may or may not result from lactose malabsorption. The technique of breath hydrogen (H2) was used after ingestion of 2 g/kg body weight to a maximum of 50 g in a 20% solution. There was no lactose malabsorption in children younger than 5 years old. The prevalence increases progressively after the age of 5, and in adolescence the percentage of malabsorption is similar to that in adults, who show 65% lactose malabsorption, with 25% asymptomatic and 40% intolerant. In 109 white adults, the prevalence of lactose malabsorption is 63%, with 24% asymptomatic and 39% intolerant. In 11 black adults, lactose malabsorption is 82%, with 27% asymptomatic and 55% intolerant. The difference between white and black adults is statistically significant (p less than 0.05). The H2 test is simple, reliable, noninvasive, and appropriate to study large populations.

Adolescent↗

PubMedDate not supplied

[Assessment of the lactose test and its value in detecting intolerance to milk sugar].

In 109 healthy and sick subjects suffering from diverse affections of the digestive organs the lactase activity in the mucosa of the large intestine was determined and a lactose test set up (1 g of lactose per 1 kg of body weight). In the test the following factors were considered: clinical symptoms, the rate of passage in the intestines (till the appearance of carmine), blood glucose content, pH and sugar in the feces. To appraise the activity of lactase the most accurate indicator in the test appeared to be the estimated degree of the rising blood glucose concentration as against the area of its ascent (23% of erroneous results). Because of a great variability of the test indicators the assessment of the lactase activity by combination of the latter did not increase the total number of correct results. However, in cases when there appeared combinations of indicators most characteristic for different activity of the lactase, the significance of the test results proved much higher (11.5-7% of erroneous results). Since in the lactose tolerance tests it is the total lactase activity, covering the entire surface of the small intestine that is recorded and subject to assessment are also possible changes, adaptive inclusive, of the gastro-intestinal tract motoricity, this test characterizes in the final analysis more correctly the tolerance of food products containing lactic sugar, than does direct determination of the lactase activity.

Humans↗

PubMed1977

The application of the "Lojda" method for intestinal lactase in intestinal biopsies from jaundiced newborn infants.

A new use of the histochemical method for intestinal lactase activity is described. Peroral intestinal biopsies from newborn light-treated infants with diarrhoea were investigated for brush-border lactase. The lactase activity found in these infants by the histochemical method correlated well with the infants ability to hydrolyze lactose judged by lactose tolerance test.

Biopsy↗

PubMed1980

Diagnostic value of sucrose tolerance test in children evaluated by breath hydrogen measurement.

An oral sucrose tolerance test was performed in a group of 103 children, aged between 3 months and 15 years because of episodic diarrhea and/or abdominal pains. Sucrose malabsorption defined as an abnormal increase in expired hydrogen, was found in only 3 children who suffered from congenital sucrase-isomaltase deficiency. This 1% incidence of sucrose malabsorption was lower than the incidence of lactose malabsorption found in this group (33%). Mean rise in blood glucose during the sucrose test was higher (3.4 +/- 1.4 vs. 2.4 +/- 1.2 mmol/l, p less than 0.0001) and the occurrence of false flat blood glucose curves was lower (3% vs. 12.8%, p less than 0.05) than during the lactose test. These findings are consistent with the higher sucrase activity in the small bowel mucosa compared to lactase. In contrast to the lactose tolerance test, sucrose tolerance test should not be used as a screening procedure for secondary disaccharidase deficiency in children.

Adolescent↗

PubMed1985

The frequency of lactase phenotypes in Aymara children.

A total of 122 apparently healthy Bolivian Aymara-mixed children ranging in age from 2 to 12 years were tested for lactose absorption using the standard lactose tolerance test with blood glucose determination. Analysing the sample according to the age of the probands, we found an increased age related frequency of lactose malabsorption showing final percentages of 55% in the 2 to 5 years group, 57.4% in the 6 to 10 years group, and 77.4% in the 11 to 15 years group.

Adolescent↗

PubMed2003

Breath testing to evaluate lactose intolerance in irritable bowel syndrome correlates with lactulose testing and may not reflect true lactose malabsorption.

OBJECTIVES: An increased prevalence of lactose intolerance is seen in irritable bowel syndrome (IBS). Recently, we demonstrated a high prevalence of abnormal lactulose breath test results in IBS suggesting bacterial overgrowth. Because symptoms of lactose intolerance result from bacterial fermentation, the purpose of this study was to determine whether an abnormal lactose breath test is reflective of malabsorption or early presentation to bacteria. METHODS: Subjects with diarrhea-predominant IBS were enrolled. On day 1, subjects underwent a lactulose breath test after an overnight fast. Within 1 wk, subjects returned after fasting for a lactose breath test with simultaneous blood glucose measurements every 15 min to complete a lactose tolerance test (LTT). Symptoms were evaluated 3 h after lactose administration. RESULTS: Twenty subjects completed the study. One subject inadvertently received dextrose through the intravenous and was excluded. Of the remaining 19 subjects, three (16%) had an abnormal LTT suggesting malabsorption. In all, 10 subjects (53%) had an abnormal lactose breath test, 14 (74%) had an abnormal lactulose breath test, and 11 (58%) had symptoms after lactose administration. The agreement with symptoms was moderate (kappa = 0.47) and fair (kappa = 0.24) when compared to the lactose breath test and LTT, respectively. There was a fair correlation between lactose breath test and LTT (kappa = 0.29). However, lactose breath test hydrogen levels >166 ppm were universally predictive of abnormal LTT. Finally, a significant correlation was seen between the hydrogen production on lactose and lactulose breath test (r = 0.56, p = 0.01). CONCLUSIONS: Lactose breath testing in IBS subjects does not seem to reflect malabsorption; it may be an indicator of abnormal lactulose breath test, suggesting bacterial overgrowth.

Adult↗

PubMed1987

Primary adult lactose malabsorption in Italy: regional differences in prevalence and relationship to lactose intolerance and milk consumption.

A study of regional differences in prevalence of primary adult lactose malabsorption in Italy was conducted on 205 subjects. Their origin was determined by their grandparents' birthplace, 89 from northern, 65 from central, and 51 from southern areas of Italy. Lactose malabsorption was diagnosed with standard oral lactose tolerance test and blood glucose determinations. Lactose malabsorbers showed symptoms more frequently than absorbers after the test load of lactose (p less than 0.01) they also reported milk intolerance more frequently (p less than 0.01). Prevalence of lactose malabsorption is significantly lower in the central sample (19%) than in the northern (52%) and southern (41%) samples (p less than 0.01). This finding contrasts with the hypothesis of a continuous increase in frequency of lactose malabsorption from northern to southern Europe and is probably due to the complex genetic history of the Italian population.

Adult↗

PubMed1977

Effects of age on lactose malabsorption in Oklahoma Native Americans as determined by breath H2 analysis.

Breath H2 excretion was used to determine lactose malabsorption in 30 health females and 30 healthy males between the ages of 3 and 64 yr who were at least 7/8 Native American. The test meal consisted of 5 ml reconstituted nonfat dry milk (0.25 g lactose) per kg of body weight. On the basis of breath H2 tests in 15 control subjects with normal oral lactose tolerance tests, a response factor of 20 ppm was selected as the upper limit for lactose absorbers. Of the 60 subjects in the study group, 36 (60%) were classified as lactose malabsorbers since they had a response factor of 20 ppm or greater of breath H2. Only 3 of 20 children (15%) who were under the age of 12 yr were nondigesters of the small lactose dose used in this study. Approximately 82 percent (82.5%) of subjects who were 13 yr and older were lactose malabsorbers. Adolescence appears to be the period in which malabsorption of lactose becomes evident in Native North Americans.

Adolescent↗

PubMed1975

Intolerance of eight ounces of milk in healthy lactose-intolerant teen-agers.

The ability of lactose-intolerant individuals to tolerate 8 ounces of milk was determined in healthy teen-agers. Thirty-two blacks were studied with 50-gm lactose tolerance tests. Nineteen (59%) had a flat blood sugar curve and 13 (39%) also developed bloating, cramps, loose stools, or diarrhea with the test. These latter 13 were defined as lactose-intolerant. Seven of the 13 lactose-intolerant teen-agers (54%) developed abdominal bloating and/or cramps after drinking 8 ounces of milk (half-pint). None had diarrhea. Eight were symptomatic with the equivalent amount of lactose (12 gm) while only one had symptoms with the monosaccharide components of lactose, glucose and galactose. The symptoms with milk and 12 gm of lactose were less severe than with the 50-gm tolerance test. A history of a prior awareness of milk intolerance was obtained from 11 of the 13 lactose-intolerant subjects. At least one half of lactose intolerant teen-agers might be expected to be symptomatic after drinking 8 ounces of milk without other food. Milk intolerance should be considered in the nutritional planning for teen-agers with special attention to members of population groups with a high prevalence of lactose intolerance.

Adolescent↗

PubMed1976

Persistence of high intestinal lactase activity (lactose tolerance) in Afghanistan.

Two hundred and seventy apparently healthy adult subjects from Afghanistan, mainly from the central and eastern parts of the country, were subjected to a lactose tolerance test. The change of blood glucose from the fasting concentration at 20 min after the administration of lactose showed a bimodal distribution. Forty-seven subjects had a rise of blood glucose concentration of more than 1.1 mmol/l and were classified as persistence of high intestinal lactase activity (PHILA), a term which lays emphasis on the fact that high lactase activity in the adult is an unusual state whose prevalence in some populations requires explanation. In the Afghan sample there were no significant differences of the frequency of PHILA in different ethnic groups.

Adult↗

PubMed2000

The prevalence of lactase deficiency and lactose intolerance in Chinese children of different ages.

OBJECTIVE: To determine lactose metabolism and lactase activity in Chinese children of different ages, prevalence of lactase deficiency (LD), and lactose intolerance (LI). METHODS: All 1168 healthy subjects between 3 and 13 years were recruited from schools in four large cities in China. They were screened by a 25 g lactose tolerance test. Some subjects were challenged with 50 g milk powder on different days. Both indicators, the expiratory H2 concentration and intolerance symptoms, were analyzed. RESULTS: LD occurred in 38.5% of children in the 3-5 year age group, and 87% of the 7-8 year and 11-13 year old groups. The age of occurrence for LD may be at 7-8 years among Chinese children. The prevalence of LI among Chinese children was 12.2% at age 3-5 years, 33.1% at age 7-8 years, and 30.5% at age 11-13 years, respectively. CONCLUSION: The results demonstrate that LD is very common in Chinese children from these four cities. LD and LI have a dose dependent response: lactose absorption and symptoms are based on lactase activity. The relationship between breast feeding history (or the history of cow milk intake) and lactase activity among Chinese children has not been established.

Adolescent↗

PubMed1977

Milk and lactose-hydrolyzed milk.

Seven females 18 to 26 years old (mean 23 years) who were lactose malabsorbers as determined by a lactose tolerance test were given two different test meals: 5 ml/kg body weight reconstituted nonfat dry milk and 5 ml/kg body weight reconsituted nonfat dry milk in which 92% of the lactose had been hydrolyzed to glucose and galactose. Lactose malabsorption was determined by the breath H2 test. Tests were done in duplicate for a total of 28 tests. Whether a 3-hr test period of a 5-hr test period was used, the average breath H2 response after the lactose-hydrolyzed nonfat dry milk test meals was significantly lower (P less than 0.002) than the average breath H2 response after the nonfat dry milk test meals. There were significant differences among individual responses (P lless than 0.06 for the 3-hr test period and P less than 0.09 for the 5-hr test period), and no significant differences between duplicate test days.

Adolescent↗

PubMed2006

Comparison of a real-time polymerase chain reaction assay for lactase genetic polymorphism with standard indirect tests for lactose maldigestion.

BACKGROUND & AIMS: There is a discrepancy in outcome between the lactose tolerance and breath hydrogen tests for lactose maldigestion. The availability of a validated genetic test for lactase polymorphism allows a reevaluation of these tests. METHODS: Thirty healthy adults participated in a 50-g lactose challenge test at a university clinic. Blood was drawn for genetic and timed blood glucose testing (2 hours), and breath hydrogen was measured (4.5 hours). Lactase genetic polymorphism was assessed by a real-time polymerase chain reaction assay. Participants completed a diet questionnaire, and symptoms were recorded during the lactose challenge. Sensitivity and specificity were calculated for each indirect test. The 2-way kappa coefficient between these tests was evaluated. Student t test and Wilcoxon rank sum test were used to compare variables. RESULTS: The lactose tolerance test as a standard had an 87.5% sensitivity and 92.7% specificity for genetic status. Only a moderate agreement between lactose tolerance test and breath hydrogen test was observed (2-way kappa coefficient, .53; 95% confidence interval, .22-.83). When genetic status was used as standard, symptoms had a moderate sensitivity and specificity. Lactose tolerance test had very good sensitivity, and the breath test had excellent specificity. CONCLUSIONS: Both indirect tests independently have good to very good sensitivities and specificities for genetic lactase status. The noted disagreement likely reflects variables that affect the tests independently of intestinal lactase status. The value of these tests in the light of the availability of genetic testing is discussed.

Adult↗

PubMed1976

Lactose tolerance in adult Jordanian Arabs.

Lactose tolerance tests were performed in 56 male and female Jordanian Arabs who were permanently resident in the Hashemite Kingdom of Jordan. Forty three had a low rise in blood glucose and 36 had one or more symptoms after oral lactose. Lactose tolerance was not related to sex, age, milk or milk products consumption. The data presented confirm the few existing reports that the majority of Arabs, originating from the Mediterranean basin are hypolactasic and intolerant to lactose.

Adolescent↗

PubMed1983

Congenital lactase deficiency. A clinical study on 16 patients.

There are at least 20 rare autosomal recessive disorders that are excessively common in Finland of which congenital lactase deficiency is one. During the last 17 years we have found 16 cases. In each case the mother noted watery diarrhoea, generally after the first feed of breast milk, and at the latest, by age 10 days. The lactose malabsorption was verified at a mean age of 36 (range 3-90) days, by which time the infants were dehydrated and 15 of them weighed less than at birth (mean weight for age was -2.8 SDs). On a lactose-free elimination diet (a group of 6 on Nutramigen and a group of 10 on soy-based formula) the children caught up in growth. One infant in each group showed allergic symptoms. While the infants were being breast fed their faeces contained 20 to 80 g/l lactose. In 24 peroral lactose tolerance tests, the greatest rise in blood glucose concentration was 0.8 mmol/l. Only 2 patients showed abnormal absorption when tested within a week of lactose elimination, and in each absorption tests became normal during the elimination period. Slight to partial villous atrophy of the jejunum was present in 4 early specimens, but in later ones the mean villous height was normal. The mean height of the epithelial cells was reduced and there were fewer intraepithelial lymphocytes in patients. The lactase activities in jejunal biopsy specimens were lower than in most patients with acquired lactase deficiency, with some overlap. The maltase and sucrase activities were normal.

Female↗

PubMed1986

Distribution of the adult lactase phenotypes in Turkey.

The adult lactase phenotype, lactose absorber or malabsorber, was determined using the lactose tolerance test with breath hydrogen assay in a group of young, healthy, male Turks. Out of a total of 470 subjects, 135 (28.7%) were lactose absorbers and 335 (71.3%) lactose malabsorbers. The frequency of the 'lactase suppression gene' in this population sample was 0.844 (S.D. 0.012). The frequency of lactase suppression in Turkey is intermediate between that in southeast Europe and that in agricultural Arab populations and thus compatible with a genetic cline extending from Europe to southwest Asia.

Adolescent↗

PubMed1976

Lactose intolerance in East Indians of Trinidad.

The incidence of lactose intolerance and by inference intestinal lactase deficiency was investigated by means of the oral lactose tolerance test in 30 East Indians born in Trinidad but of Indian heritage. Twenty showed flat curves (67%) and twenty had cramps and diarrhoea following the lactose load (67%). In India milk consumption is less than in Trinidad. Since all subjects were of the same racial origin the findings are interpreted as suggesting that lactase deficiency among East Indians is inherited on a genetic basis.

Adolescent↗

PubMed1976

Lactose malabsorption in Mexican-American children.

Inability to absorb lactose due to low intestinal lactase is common in many population groups. This study is the first to compare lactose tolerance in 282 Mexican-American (MA) children and 51 Anglo-American (AA) children 2 to 14 years of age with the dietary intake of selected nutrients found in milk. A lactose tolerance test and a 24-hr dietary recall were obtained for each child. Gastrointestinal symptoms were carefully recorded for a 24-hr period following the lactose load. Overall prevalence of lactose malabsorption was 37% in MA children and 8% in AA children, and it increased with age. Number of symptoms occurring in lactose malabsorbers of both ethnic groups also increased with age. Mean protein intake exceeded Recommended Dietary Allowances at all ages for both ethnic groups. Mean consumption of vitamin A, calcium, and energy was below the Recommended Dietary Allowance for MA children. There were no differences in calories, nutrient, or milk intakes between lactose absorbers and malabsorbers, but AA children drank more milk than MA children. Fifteen percent of lactose-absorbing MA, 23% of malabsorbing MA, but no AA children reported having symptoms after drinking milk. There was a significantly greater incidence of lactose intolerance in MA as compared to AA children. This suggests that Mexican-Americans share in the high incidence of primary lactose intolerance characteristic of the majority of the orld's peoples.

Adolescent↗