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Lactose Intolerance: An Unnecessary Risk for Low Bone Density
Abstract
The potential for lactose intolerance causes 25-50 million Americans and an unknown number of people around the world to avoid milk. Milk avoidance is a significant risk factor for low bone density. Individuals who avoid milk, due to intolerance or learned aversion, consume significantly less calcium and have poorer bone health and probable higher risk of osteoporosis. Lactose intolerance is easily managed by: (1) regular consumption of milk that adapts the colon bacteria and facilitates digestion of lactose; (2) consumption of yogurts and cheeses and other dairy foods low in lactose; consumption of dairy foods with meals to slow transit and maximize digestion, and use of lactose-digestive aids. As dairying spreads around the world to new markets and dairy foods become the dominant source of calcium in these markets, the potential for lactose intolerance will grow. Management of lactose intolerance globally will require both education and product development.
... Bone mass is also decreased by the use of glucocorticosteroids, which directly cause osteoblast dysfunction and accelerate osteoblast apoptosis and reducing calcium absorption from the gastrointestinal tract and increasing renal calcium excretion (stimulating parathyroid hormone release in the parathyroid glands) [2]. Puberty (Tanner stages 2, 3, 4) has been shown to be the most sensitive period in which glucocorticoid use may lead to irreversible bone loss [2,3]. ...
... In addition, dairy products are also a source of protein, phosphorus, potassium, and vitamins A, D, B2 (riboflavin), and B12 (cobalamin) [5]. Multiple observational studies show that consumers who avoid milk have lower bone mineral density (BMD) and a 2.7-fold higher risk of bone fractures in pre-pubertal children compared to individuals with higher milk consumption [3,[6][7][8]. ...
... Disturbances in the parameters of calcium and phosphate metabolism can be reflected in disturbances in bone mineralization [7]. Both IBD alone and the dairy-restricted diet are considered risk factors for bone mineralization disorder [2,3,7]. In the analyzed group of patients, the results of bone mineral density measurements in lactose-intolerant patients on a low-lactose/lactose-free diet were similar to those obtained in lactose-tolerant patients and not on an elimination diet. ...
Background:
A diet restricted in dairy products can cause calcium and vitamin D deficiency and, secondarily, lead to malnutrition and low bone mass. The aim of the study was to determine the incidence hypocalcemia and vitamin D deficiency in children with inflammatory bowel diseases and lactose intolerance (LI).
Material and methods:
A total of 107 patients were enrolled to the study (mean age 14.07 ± 3.58 years; 46.7% boys): 43 with Crohn's disease (CD), 31 with ulcerative colitis (UC), and 33 with functional abdominal pain (AP-FGID). Hydrogen breath test with lactose and laboratory tests to assess the calcium-phosphate metabolism were performed in all patients. The results of densitometry were interpreted in 37 IBD patients.
Results:
LI was diagnosed in 23.2% patients with CD, 22.6% with UC, and 21.2% children with AP-FGID, (p = 0.9). Moreover, 9.5% patients with CD, in 21.4% with UC, and in 51.5% with AP-FGID had optimal concentration of 25(OH)D (p = 0.0002). Hypocalcemia was diagnosed in 21% of patients with CD, 16.1% with UC patients, AP-FGID patients had normal calcium levels (p = 0.02). There was no difference in concentrations of total calcium, phosphorus, and 25(OH)D between patients on low-lactose diet and normal diet (p > 0.05). BMD Z-score ≤ -1 SD was obtained by 12 CD patients (48%), and 6 with UC (50%).
Conclusion:
The use of a low-lactose diet in the course of lactose intolerance in children with inflammatory bowel diseases has no effect on the incidence of calcium-phosphate disorders and reduced bone mineral density.
... O declínio nos níveis de lactase é progressivo durante a infância e a adolescência, havendo um aumento nas taxas de má-absorção de acordo com a idade 7,8 . Nos casos em que a má-absorção de lactose avança para o estágio de Intolerância à Lactose (IL), os indivíduos portadores apresentam uma série de reações adversas após ingestão de leite e de seus derivados: diarreia, flatulência, náusea, dor e distensão abdominal 9,10 . A presença dessas reações pode levar a um menor consumo de leite e de derivados e, consequentemente, a uma ingestão insuficiente de cálcio, predispondo seus portadores a maiores riscos para o desenvolvimento da osteoporose 10,11 . ...
... Nos casos em que a má-absorção de lactose avança para o estágio de Intolerância à Lactose (IL), os indivíduos portadores apresentam uma série de reações adversas após ingestão de leite e de seus derivados: diarreia, flatulência, náusea, dor e distensão abdominal 9,10 . A presença dessas reações pode levar a um menor consumo de leite e de derivados e, consequentemente, a uma ingestão insuficiente de cálcio, predispondo seus portadores a maiores riscos para o desenvolvimento da osteoporose 10,11 . ...
... O acúmulo de lactose no intestino induz à fermentação por microrganismos intestinais, o que resulta na formação de gases como metano, dióxido de carbono e hidrogênio, que são responsáveis pela flatulência, distensão e dor abdominal, sintomas característicos da IL. Além disso, a presença de lactose não absorvida no lúmen intestinal aumenta a pressão osmótica, retendo água e aumentando o trânsito intestinal, o que resulta em fezes amolecidas e diarreia, podendo levar a uma absorção comprometida de cálcio 17 e à utilização do cálcio ósseo para a manutenção desse mineral no sangue e dos níveis de cálcio neural 10 . ...
Objective This study compared the calcium intake and bone mineral density of adult women with lactose intolerance with those of their counterparts without the condition. Methods Sixty adult women aged 20 to 40 years were divided into two groups: 30 diagnosed with lactose intolerance and 30 without the condition. Calcium intake was assessed by three 24-hour recalls and bone mineral density of the femur was determined by dual energy x-ray absorptiometry. Results The bone mineral density of the femoral neck (M=0.86, SD=0.13g/cm(2) versus M=0.77, SD=0.12g/cm(2)) and femoral total (M=1.14, SD=0.14g/cm(2) versus M=1.06, SD=0.12g/cm(2)) were lower (p<0.05) for the lactose-intolerant group than for the control, but there was no significant difference for the bone density of the entire body (M=1.14, SD=0.15g/cm(2) versus M=1.08, SD=0.09g/cm(2), p>0.05). Also, calcium intake was lower for the lactose intolerant than for the control group (M=250.5, SD=111.7mg/day(-1) versus M=659.7, SD=316.1mg/day(-1), p<0.05). Conclusion The results of this study suggest that the onset of intolerance symptoms may influence bone mineral density due to low calcium intake.
... The management of lactose intolerance includes a lactose-restricted diet and replacement therapy by substitute enzymes (5). Lactase deficiency is wide-ranging and patients often tolerate varying amounts of lactose without significant symptoms (6,7). For example, a restricted diet is only necessary for a limited period of time in transient lactase deficiency (8). ...
... Out of 154 patients with positive breath tests, 96 (62.3%) were still on restrictive diet at follow up, while the others had returned to a regular diet. The median duration (IQR) of the restrictive diet in patients that had returned to regular diet at follow up was three (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) months. In the positive group, we found a negative correlation between age and the total quality of life score (r= -0.22, p=0.006) as well as the consumption of dairy products (r= -0.21, p = 0.008). ...
Aim:
This study described outcomes following treatment for lactose intolerance, which is common in children.
Methods:
The medical records of children aged 6-18 years who underwent lactose hydrogen breath testing at Dana-Dwek Children's Hospital, Tel Aviv, Israel, from August 2012-August 2014 were analysed. We compared 154 children with gastrointestinal symptoms and positive lactose hydrogen breath tests to 49 children with negative test results.
Results:
Of the 154 children in the study group, 89 (57.8%) were advised to follow a lactose restricted diet, 32 (20.8%) were advised to avoid lactose completely, 18 (11.7%) were instructed to use substitute enzymes and 15 (9.7%) did not receive specific recommendations. Only 11 patients (7.1%) received recommendations to add calcium-rich foods or calcium supplements to their diet. Lactose reintroduction was attempted in 119/154 patients (77.3%), and 65/154 (42.2%) experienced clinical relapses. At the final follow up of 3.3 years, 62.3% of the study children were still observing a restricted diet. Older children and those who were symptomatic during lactose hydrogen breath testing were more likely to be on a prolonged restricted diet.
Conclusion:
Our long-term follow up of lactose intolerant children showed that only a third were able to achieve a regular diet. This article is protected by copyright. All rights reserved.
... Nevertheless, milk is calcium and nutrient-rich food and an important part of a healthy diet (6). Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). ...
... Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). Some studies have suggested that the prevalence of lactose intoler-ance is a global issue. ...
... Nevertheless, milk is calcium and nutrient-rich food and an important part of a healthy diet (6). Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). ...
... Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). Some studies have suggested that the prevalence of lactose intoler-ance is a global issue. ...
Lactose intolerance is a common disorder affecting an individual’s ability to digest lactose present in milk or any food product. Lactose intolerance is caused by the deficiency of β-galactosidase (lactase) in the digestive tract. Diagnosis of lactose intolerance is not so simple and straightforward clinically. Many biochemical and genetic tests have been developed for the determination of lactose intolerance. Several case reports indicate wherein subjects have self-diagnosed being lactose intolerant. There is an emerging link of this disorder with human gene polymorphism, where genetic basis has been used as a diagnostic tool. The high prevalence of this condition among children and adults has compelled the production of lactose-free foods. Additionally, external enzyme supplementation has been looked at as an alternative protective mechanism in lactose intolerant subjects. This review highlights the genetic variants of lactase polymorphism and theranostic (therapeutic and diagnostic) strategies for lactose intolerance.
... Besides large interindividual variability, even within single ethnic groups, it is also characterised by the weak association between symptoms and diagnosis, mostly based on breath test assessment of hydrogen produced by fermentation of undigested lactose by colonic bacteria (19,20). Consequently, most individuals presumed to be affected prefer to avoid milk and milk-containing products by self-selection, with a consequent low intake of calcium and the possible untoward consequences on bone health, starting even from adolescence (21,22). In revising the matter of the definition of lactose threshold in lactose tolerance, the European Food Safety Authority recently issued a document emphasising that lactose tolerance varies widely in individuals with (presumed or real) lactose maldigestion (23). ...
... Individuals need to adapt their lactose consumption to their individual tolerance. Recent recommendations (22) to address lactose intolerance point out the beneficial effects of regular milk consumption that may adapt colon bacteria, thus facilitating the digestion of lactose; the consumption of yogurts and cheeses, mildly lower in lactose but displaying lactase activity (particularly yogurts and fermented products) at lower temperature, further aiding lactose digestion within the gastrointestinal tract; the consumption of dairy foods with meals to slow transit and maximise digestion; the use of milks with low lactose content, that is, with lactose already split by enzymatic intervention. The use of lactose-digestive aids has also been advocated, but they are expensive and their use is scarcely evidence based. ...
Discussions and debates have recently emerged on the potential positive and negative effects of cow's milk in the paediatric community, also under the pressure of public opinion. The negative effects of cow's-milk consumption seem to be limited to iron status up to 9 to 12 months; then no negative effects are observed, provided that cow's milk, up to a maximum daily intake of 500 mL, is adequately complemented with iron-enriched foods. Lactose intolerance can be easily managed and up to 250 mL/day of milk can be consumed. Allergy to cow's-milk proteins is usually transient. Atopic children may independently be at risk for poor growth, and the contribution of dairy nutrients to their diet should be considered. The connection of cow's milk to autistic spectrum disorders is lacking, and even a cause-effect relation with type 1 diabetes mellitus has not been established because many factors may concur. Although it is true that cow's milk stimulates insulin-like growth factor-1 and may affect linear growth, association with chronic degenerative, noncommunicable diseases has not been established. Finally, fat-reduced milk, if needed, should be considered after 24 to 36 months. Cow's milk represents a major source of high nutritional quality protein as well as of calcium. Moreover, it has growth-promoting effects independent of specific compounds. Its protein and fat composition, together with the micronutrient content, is suggestive of a functional food, whose positive effects are emphasised by regular consumption, particularly under conditions of diets poor in some limiting nutrients, although in industrialised countries cow's milk's optimal daily intake should be around 500 mL, adequately complemented with other relevant nutrients.
... In a lowlactose diet, patients should avoid the consumption of certain foods such as milk, yogurt, butter, cheese, cream, ice cream, and packaged foods (Facioni, Raspini, Pivari, Dogliotti, & Cena, 2020). It should be noted that restricting especially milk and dairy products will cause a decrease in the intake of some nutrients such as calcium, potassium, B vitamins, and protein (Savaiano, 2011). This is a significant risk for the development of osteoporosis in IBS patients (Vernia et al., 2014;Casellas et al., 2018). ...
Irritable bowel syndrome (IBS) is one of the most common chronic functional disorders among gastrointestinal system diseases. IBS, which has a high prevalence worldwide, negatively affects the quality of life of patients. The mechanisms that are effective in the development of IBS has not clearly been defined. However, its mechanism is thought to be multifactorial. IBS is characterized by certain symptoms, such as abdominal pain, diarrhea, constipation, flatulence, and indigestion. Nevertheless, these symptoms aren’t specific to IBS and can often be confused with lactose intolerance (LI) symptoms. On the other hand, the probability of having LI at the same time is quite high in IBS patients. IBS patients restrict lactose-containing foods, especially milk and dairy products, due to the thought that they trigger their symptoms, and thus calcium deficiency may occur as a result. Due to insufficient calcium intake for a long time, the risk of osteoporosis and osteoporotic fractures becomes an important problem. In line with all these factors, this review aims to examine osteoporosis that may develop due to the presence of LI in IBS patients and to make nutritional recommendations.
... El manejo de IL podría llevarnos a reducir o incluso evitar el consumo de productos lácteos, pero debemos tener presente que estos son alimentos de la base de la pirámide alimentaria saludable y que se recomienda sean de consumo diario. Constituyen una importante fuente de calcio, potasio, proteínas de alta calidad y vitaminas B y D, por lo que su falta en la dieta podría poner en riesgo el aporte de estos nutrientes, aumentando también el riesgo de morbilidades como el deterioro de la densidad mineral ósea (osteoporosis y fracturas óseas) (12,13,(38)(39)(40)(41) . Por ello, se debe promocionar en estos pacientes la ingesta de alimentos ricos en calcio, así como establecer medidas para asegurar la más adecuada ingesta láctea posible. ...
Anales de Microbiota, Probióticos & Prebióticos (2021). Volumen 2, Número 1, pp. 56-60.
... Lactose intolerance is an inability to digest lactose (LI) due to deficiency of lactase or β-galactosidase enzyme in the small intestine (Harrington et al. 2008). In lactose intolerance, undigested lactose in the colon could be fermented by some gut bacteria, producing acid and gas, leading to the development of lactose intolerance symptoms (Horner et al. 2011;Savaiano et al. 2011). Probiotic bacteria provide health benefits to the host gut, like protection from pathogen colonization, restoration of the gut microbiome composition, and prevention of gastrointestinal disorders (Matthews et al. 2005;Heyman 2006;Gayathri and Vasudha 2018). ...
The gut of human beings is inhabited by a diverse group of microorganisms, around trillions, which makes it a new essential endocrine organ and shows a symbiotic connection with a host, and they metabolize the food ingested and produce diverse bioactive and dietary compounds. This may include organic acids, bacteriocins, and short-chain fatty acids, which provide potential to impact on physiological and pathological conditions of the host and maintain homeostasis. In recent times, due to rapid advancement in technology, our understanding about microbiome has also expanded. The modulation of the microbiome leads to disturbance in homeostasis, which causes imbalance and leads to dysbiosis, and the gut barrier integrity gets disturbed and immunological reaction leads to inflammation. This chapter reviews the current insights on various diseases and gastroenterological disorders associated with the modulation of the gut microbiome and how probiotics help in maintaining the healthy gut with intact gut barrier by regulating the expression of tight junction proteins, perhaps leading to good human health.
... Management of LI typically consists of reducing, or even avoiding, the consumption of dairy products [16,17]. However, because dairy products constitute a high-quality source of calcium, potassium, protein, and vitamin B and D, avoidance of these foods can increase the risk of morbidity, including bone fracture, osteoporosis, and nutrient deficiencies [18][19][20]. The most preferred and reliable treatment option involves the consumption of lactose-free dairy products. ...
Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of which is impaired due to a deficiency in the lactase enzyme. These clinical signs can be modified by several factors, including lactose dose, residual lactase expression, concurrent ingestion of other dietary components, gut-transit time, and enteric microbiome composition. In many of individuals with lactose malabsorption, clinical signs may be absent after consumption of normal amounts of milk or, in particular, dairy products (yogurt and cheese), which contain lactose partially digested by live bacteria. The intestinal microbiota can be modulated by biotic supplementation, which may alleviate the signs and symptoms of LI. This systematic review summarizes the available evidence on the influence of prebiotics and probiotics on lactase deficiency and LI. The literature search was conducted using the MEDLINE (via PUBMED) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included randomized controlled trials. For each study selected, the risk of bias was assessed following the Cochrane Collaboration methodology. Our findings showed varying degrees of efficacy but an overall positive relationship between probiotics and LI in relation to specific strains and concentrations. Limitations regarding the wide heterogeneity between the studies included in this review should be taken into account. Only one study examined the benefits of prebiotic supplementation and LI. So further clinical trials are needed in order to gather more evidence.
La microbiota intestinal ejerce un papel fundamental en la regulación de la motilidad intestinal afectando al tiempo de tránsito, la frecuencia y consistencia de las deposiciones.
Estudios recientes han demostrado cambios en la composición y funcionalidad de la microbiota intestinal de pacientes con estreñimiento y motilidad intestinal limitada. En este
artículo se describen los mecanismos de acción e impacto que puede ejercer el consumo de prebióticos y probióticos en la prevención y tratamiento del estreñimiento y la motilidad
intestinal de distintos grupos poblacionales.
Milk and dairy food consumption can lead to a range of adverse clinical symptoms, the best known of which is lactose intolerance (LI). LI is defined as experiencing gastrointestinal symptoms following the ingestion of lactose. While LI is often caused by a genetically determined reduction of lactase production in adulthood, it is important to note that other causes exist. In addition, adverse gastrointestinal and other symptoms following milk and dairy food consumption may not necessarily be the result of LI. Despite our deeper understanding of food sensitivities and their overlap with irritable bowel syndrome, misattribution of gastrointestinal symptoms to lactose ingestion in self-reporting lactose-intolerant individuals remains common. In this chapter we discuss the complexities of lactose-related and lactose-independent adverse gastrointestinal and other symptoms associated with milk and dairy food consumption as well as the nutritional consequences of dairy food avoidance.
The aim of this study was to verify the effect of physical activity level on bone mineral density (BMD) in pre-menopausal women with lactose intolerance. Sixty women was engaged in this study (age: 31.9±6.9 years) and were initially separated into two groups: 30 women with lactose intolerance (LI) and 30 controls (C). The groups were further subdivided into less and more active using the median of weekly total energy expenditure, estimated by the International Physical Activity Questionnaire (IPAQ-long version). The LI diagnosis was confirmed by lactose intolerance test (oral lactose overload with monitoring of blood glucose and associated clinical manifestations). BMD was assessed by dual energy X-ray absorptiometry (DXA). As expected, physical activity score was higher in both groups for women classified as more active (p>0.05). The BMD at hip and pelvis was lower in LI than in C group (p<0.05). In addition, there was a tendency for a lower BMD in L2, L4, femoral neck and total hip for LI compared to C group (p<0.10). However, there was no main effect of physical activity level or interaction for the BMD at any other bone sites (p<0.10). The LI group had lower (p<0.05) absolute free-fat mass, independently of physical activity level. Therefore, the results of the present study suggest that LI reduces BMD in pre-menopausal women and this reduction is independent of physical activity level.
Calcium’s importance in health and disease is clear when listing its multiple roles in the body, which include building strong bones and teeth, vascular calcification, muscle function, hormonal regulation and maintaining a normal heartbeat. This book will examine these roles and will also cover areas such as chemical analysis, sources of calcium based on geography, influence of Vitamin D, hypercalcemia and the effects of dietary calcium.
This edited volume will pool knowledge across scientific disciplines in a way that increases its applicability to a wide range of audiences and fills the gap identified in providing comprehensive synopses of food substances. Chemists, analytical scientists, forensic scientists, food scientists, as well as course lecturers and university librarians, will all benefit from this title.
Lactose is a widely distributed disaccharide in the diet and pharmaceutical industries. It is the sugar from the milk of mammals. The loss of intestinal lactase activity with age is frequent. It varies between ethnic and genetic conditions, and may cause its malabsorption. It may also be secondary to intestinal mucosal damage and, rarely, to congenital deficiency. Malabsorption does not necessarily imply clinical intolerance, with gastrointestinal symptoms after its ingestion. The exclusion of lactose from the diet produces clinical improvement but it could lead to a defect in the recommended daily intake of other nutrients such as calcium. It can be reintroduced into the diet but there is an individual clinical threshold of tolerance.
Cow' milk is a main food in human nutrition, even beyond the weaning period, at least in Causasian population. In the last few years, through the web or other non-conventional information technologies some negative ideas on the intake of cow's milk have arisen. Mostly they are aprioristic positions with little scientific evidence. In this paper we will review the role on cow's milk intake in the development of ferropenic anemia, the causes of lactose intolerance or the prevalence of cow's milk allergy beyond infancy. Some voices have pointed a disputable role of cow's milk in the development of metabolic syndrome or other chronic non-transmissible diseases. Even autistic disorders or mucous production have being associated with the intake of cow's milk. Strengthnesses and weaknesses of these arguments will be reviewed. Some practical points will be set at the end of the papers.
Nutrition plays an important role in skeletal health throughout the life cycle. This chapter addresses evidence-based nutrition recommendations that can be used to promote skeletal health. Maintaining bone health is a significant concern in the USA; healthful lifestyle is an opportunity to promote bone health. The total diet or overall pattern of food consumed is the most important focus of healthy eating (Freeland-Graves and Nitzke, J Acad Nutr Diet 113:307–317, 2013). A healthful dietary pattern is associated with prevention of chronic diseases as well promoting skeletal health.
The Surgeon General’s report on bone health and osteoporosis recommendations include consuming recommended amounts of calcium and vitamin D, maintaining a healthful body weight, and being physically active, along with minimizing the risk of falls (USDHHS Surgeon General, 2004).
Meeting calcium recommendations and weight bearing physical activity build strong bones, optimizes bone mass, and may reduce the risk of osteoporosis later in life. Nutrition counseling using the Nutrition Care Process is an effective structure for tailoring evidenced-based recommendations to an individual’s unique needs in the prevention, treatment, and maintenance of health and quality of life into old age.
Lactose is a widely distributed disaccharide in the diet and pharmaceutical industries. It is the sugar from the milk of mammals. The loss of intestinal lactase activity with age is frequent. It varies between ethnic and genetic conditions, and may cause its malabsorption. It may also be secondary to intestinal mucosal damage and, rarely, to congenital deficiency. Malabsorption does not necessarily imply clinical intolerance, with gastrointestinal symptoms after its ingestion. The exclusion of lactose from the diet produces clinical improvement but it could lead to a defect in the recommended daily intake of other nutrients such as calcium. It can be reintroduced into the diet but there is an individual clinical threshold of tolerance.
BACKGROUND AND OBJECTIVES: Studies evaluating the
prevalence of celiac disease and lactose intolerance in patients
with inflammatory bowel diseases are scarce and have produced
conflicting results. The recognition of the association of these
diseases has clinical relevance because its symptoms are similar
and may hamper the clinical management of these patients. The
objective of this study was to estimate the prevalence of lactose
malabsorption and positivity for serological markers of celiac disease
in inflammatory bowel diseases patients. METHODS: A
cross-sectional observational study that included adult patients
with inflammatory bowel diseases followed up between April and
December, 2011. The laboratory results were extracted from medical
records. Patients were compared according to the type of
inflammatory bowel diseases and the presence of lactose malabsorption
in the oral lactose tolerance test. RESULTS: Fifty-four
subjects were included, 56% females, mean age 34.6 ± 13.4 years.
Regarding the inflammatory bowel diseases diagnosis, ulcerative
colitis was observed in 30 patients and Crohn’s disease in
24 individuals. None of the included subjects presented with positive
serological markers for celiac disease (anti-endomysial and/
or anti-transglutaminase antibodies). Evidences of lactose malabsorption
were observed in 50% of the sample and were associated
with lower mean age at inflammatory bowel diseases diagnosis.
CONCLUSION: In this study, none of the included subjects
exhibited serological evidence of celiac disease. The prevalence
of lactose malabsorption was similar to that described for the general
population, and it was not related to variables specifically
related to inflammatory bowel diseases. These findings suggest
that the lactose malabsorption in these individuals is most likely
related to primary lactase deficiency than secondary to pathological
changes of the digestive tract.
ABSTRACT
OBJECTIVE: This study compared the calcium intake and bone mineral density of adult women with lactose intolerance with those of their counterparts without the condition.
METHODS: Sixty adult women aged 20 to 40 years were divided into two groups: 30 diagnosed with lactose intolerance and 30 without the condition. Calcium intake was assessed by three 24hour recalls and bone mineral density of the femur was determined by dual energy xray absorptiometry.
RESULTS: The bone mineral density of the femoral neck (M=0.86, SD=0.13g/cm² versus M=0.77, SD=0.12g/cm²) and femoral total (M=1.14, SD=0.14g/cm² versus M=1.06, SD=0.12g/cm²) were lower (p<0.05) for the lactoseintolerant group than for the control, but there was no significant difference for the bone density of the entire body (M=1.14, SD=0.15g/cm² versus M=1.08, SD=0.09g/cm², p>0.05). Also, calcium intake was lower for the lactose intolerant than for the control group (M=250.5, SD=111.7mg/day-1 versus M=659.7, SD=316.1mg/day-1, p<0.05).
CONCLUSION: The results of this study suggest that the onset of intolerance symptoms may influence bone mineral density due to low calcium intake.
Indexing terms: Lactase. Milk. Bone and bones. Malabsorption sindromes.
The endogenous β-galactosidase expressed in intestinal microbes is demonstrated to help humans in lactose usage, and treatment associated with the promotion of beneficial microorganism in the gut is correlated with lactose tolerance. From this point, a kind of recombinant live β-galactosidase delivery system using food-grade protein expression techniques and selected probiotics as vehicle was promoted by us for the purpose of application in lactose intolerance subjects. Previously, a recombinant Lactococcus lactis MG1363 strain expressing food-grade β-galactosidase, the L. lactis MG1363/FGZW, was successfully constructed and evaluated in vitro. This study was conducted to in vivo evaluate its efficacy on alleviating lactose intolerance symptoms in post-weaning Balb/c mice, which were orally administered with 1 × 10(6) CFU or 1 × 10(8) CFU of L. lactis MG1363/FGZW daily for 4 weeks before lactose challenge. In comparison with naïve mice, the mice administered with L. lactis MG1363/FGZW showed significant alleviation of diarrhea symptoms in less total feces weight within 6 h post-challenge and suppressed intestinal motility after lactose challenge, although there was no significant increase of β-galactosidase activity in small intestine. The alleviation also correlated with higher species abundance, more Bifidobacterium colonization, and stronger colonization resistance in mice intestinal microflora. Therefore, this recombinant L. lactis strain effectively alleviated diarrhea symptom induced by lactose uptake in lactose intolerance model mice with the probable mechanism of promotion of lactic acid bacteria to differentiate and predominantly colonize in gut microbial community, thus making it a promising probiotic for lactose intolerance subjects.
Lactose tolerance tests were performed in 33 women with osteoporosis and 33 control women matched for age. A questionnaire was used to elicit any history of milk intolerance and the subjects' daily intake of calcium derived from milk and dairy products. Eleven patients and four controls gave a history of milk intolerance (p less than 0.01); 13 patients had lactose malabsorption compared with four controls (p less than 0.01). The daily intake of calcium derived from milk was significantly lower in patients (125 (SEM 20) mg v 252 (43) mg; p less than 0.05). Curves of blood glucose concentrations during the lactose tolerance test in subjects with lactose malabsorption were significantly flatter in patients than controls (p less than 0.05). The fasting blood glucose concentration was higher (5.44 (0.17) mmol/l (98 (3) mg/100 ml) in the patients than the controls (4.88 (0.11) mmol/l (88 (2) mg/100 ml); p less than 0.05), although body weight was significantly lower (61.6 (2.2) kg v 66.3 (1.6) kg; p less than 0.05). Absorption of lactose is significantly impaired in women with "idiopathic" osteoporosis; this combined with low consumption of milk and a subclinical disorder of glucose metabolism may be a major factor in the development of idiopathic osteoporosis in women.
Previous studies on the role of lactose malabsorption in the pathogenesis of postmenopausal osteoporosis have yielded conflicting results and further information is needed. To date, all studies have been carried out on populations with a low prevalence of lactose malabsorption and the lactose intestinal absorptive capacity was tested using a non-physiological dose of lactose. In fifty-eight Italian postmenopausal women (mean age 57 (SD 7) years), bone mineral density (BMD) at lumbar spine, H2 breath response after ingestion of 20 g lactose, intensity of symptoms of intolerance after a lactose load and daily Ca intake were evaluated. No differences were found between women with or without a positive H2 breath test with regard to BMD (-1.2 (SD 0.9) v. -0.9 (SD 0.8)) and Ca intake (509 (SD 266) v. 511 (SD 313) mg/d). On the contrary, both BMD and Ca intake were significantly lower in women with lactose malabsorption and symptoms of intolerance (-1.5 (SD 0.7) and 378 (SD 220) mg/d) than in those with malabsorption without symptoms (-0.9 (SD 0.9) and 624 (SD 254) mg/d). Moreover, in lactose malabsorbers Ca intake was correlated inversely with symptom score (rs -0.31, P < 0.05) and positively with BMD (rs 0.42, P < 0.005). Our results show that in Italian postmenopausal women Ca intake and BMD are not influenced directly by lactose malabsorption; the appearance of symptoms of intolerance seems to influence BMD unfavourably through a reduced Ca intake.
The relationship between lactose maldigestion, lactose intolerance, and calcium intake in premenopausal African American women is unknown.
To determine how intolerance of lactose and dairy products affects intake of calcium in lactose maldigesting premenopausal African American women.
Dietary intake of calcium was assessed in 50 premenopausal lactose maldigesting African American women as determined by the breath hydrogen test. Twenty-six women were lactose intolerant and 24 were lactose tolerant by self-reports.
The average intake of calcium in lactose maldigesting and intolerant women was significantly lower than in lactose tolerant women (388 +/- 150 mg/day vs. 763 +/- 333 mg/day, p < 0.0001, t test). Neither group reached the newly established Dietary Reference Intake (DRI) for calcium (1,000 mg/day). Major source of dietary calcium in lactose tolerant women were milk and dairy products (45%), and mixed foods containing calcium from non-dairy sources (30%). In lactose intolerant women, 46% of calcium was from mixed foods and only 12% was from milk and dairy products. Lactose intolerant women had higher body mass index (BMI) than lactose tolerant women (p = 0.008, t test), and calcium intake was negatively associated with BMI (R2 = 0.470).
In African American premenopausal women, lactose tolerance facilitates the dietary intake of calcium when compared with their lactose intolerant counterparts. Low calcium intake is associated with higher BMI.
Race and sex differences in the effect of diet on bone mineral density (BMD) at the hip in the elderly are unknown.
This study related cross-sectional nutrient and dairy product consumption to hip BMD in white and black men and women aged >60 y and evaluated the influence of nutrient and dairy product consumption on changes in BMD in a white cohort participating in a calcium, vitamin D, or placebo trial.
The Health Habits and History Questionnaire was used in 289 white women and 116 white men who participated in the trial and in 265 black women and 75 black men to predict total hip and femoral neck BMD or changes in BMD.
Blacks had higher calcium intakes than did whites (700 and 654 mg/d, respectively; P = 0.0094), and men had higher calcium intakes than did women (735 and 655 mg/d, respectively; P = 0.0007). For men, the correlation between total hip BMD and dairy calcium intake after adjustment for age, race, and weight was 0.23 (P < 0.005); this relation was not significant in women (r = 0.02, P = 0.12). Similar results were found for femoral neck BMD. In the longitudinal study, calcium supplementation reduced bone loss from the total hip and femoral neck in those who consumed <1.5 servings of dairy products/d and were <72 y old.
Cross-sectional results indicated that higher dairy product consumption is associated with greater hip BMD in men, but not in women. Calcium supplementation protected both men and women from bone loss in the longitudinal study of whites.
Dietary calcium is critical for the development of the human skeleton and likely plays an important role in the prevention of osteoporosis. Dairy products provide approximately three-fourths of calcium consumed in the diet and are the most concentrated sources of this essential nutrient. One obstacle that likely interferes with calcium consumption among many ethnic soups is lactose maldigestion The real or perceived occurrence of intolerance symptoms after dairy food consumption may cause maldigesters to avoid dairy products. Several investigators have observed a relationship between lactose maldigestion, dietary calcium and osteoporosis in Caucasian populations. Research on ethnically diverse populations is necessary to better understand how lactose maldigestion influences the risk for osteoporosis. Low calcium intakes, a greater than previously thought potential for low bone density and extensive lactose maldigestion among Hispanic-American and Asian-American populations may create an elevated risk for osteoporosis. Dietary management strategies for lactose maldigesters to increase calcium consumption include consuming (I) dairy foods with meals, (2) yogurts, (3) calcium-fortified foods, (4) using lactose digestive aids and (5) including dairy foods daily in the diet to enhance colonic metabolism of lactose.
A national probability sample in their 60s (32%), 70s (38%), and 80s (30%) completed a telephone survey (N = 475). Subjective measures indicated that perceived milk intolerance occurred more often in Blacks vs. Whites (35% vs. 17%) and women vs. men (21% vs. 10%). Compared to milk tolerant individuals, milk intolerant individuals were more likely to “not try at all” to consume enough calcium (46% vs. 31%), and more likely to avoid milk during adolescence (30% vs. 15%) and currently (56% vs. 23%). Milk intolerant elders appear at risk for low calcium intakes because of their long history of milk avoidance and lack of concern about consuming enough calcium as adults.
Calcium intake is one of a number of factors that affect peak bone mass. Low bone mass is related to increased incidence of osteoporotic fractures. Data from the USDA 1987-88 Nationwide Food Consumption Survey were used to determine populations most at risk of less than optimal calcium intake and food sources of calcium intake. Mean per capita daily consumption of calcium for the total U.S. population was 737 mg and varied by region of the country, household income, ethnic group, sex, and age. For most groups of females, intake was substantially less than the RDA. About 50% of total dietary calcium was supplied by milk and milk products. Milk and cheese used as ingredients in meat, grain, and vegetable mixtures contributed another 20% of dietary calcium. The remaining 30% of calcium was provided by grains and grain products, meat, poultry, fish, vegetables, fruits, eggs, legumes, nuts, and seeds.
This paper examines the evidence that connects calcium intake and vitamin D status to bone fragility, hypertension, colon cancer, and breast cancer. Human calcium physiology, with an intestinal absorptive barrier and inefficient conservation, reflects the abundance of calcium in the primordial human food supply. The calcium intake of stone-age adults is estimated at 50 to 75 mmol/d, three to five times the median calcium intake of present-day U.S. adults. Long-term calcium restriction and/or insufficient vitamin D may promote the development of bone fragility, high blood pressure, colon cancer, and breast cancer in susceptible individuals. Conversely, improvement in calcium intake and/or in vitamin D status may help to prevent these serious health problems. At least 12 intervention studies have established the skeletal benefit of increased calcium intake among women in the late postmenopause. Other reports suggest that adequate calcium may protect against salt-sensitive and pregnancy-associated hypertension. High intakes of both dietary calcium and vitamin D are associated with reduced development of precancerous changes in colonic mucosa. Preliminary findings also suggest that vitamin D has a protective effect against breast cancer.
Bone density is related to body size and other factors including dietary calcium intake. The purpose of this study was to determine the effect of a low-lactose, low-calcium diet on the bone mineral content (BMC) of prepubertal children with documented lactose intolerance. Radial BMC was determined by single-photon absorptiometry. Dietary intake was assessed by 24-h recall and two 3-day food records, and weight and height were measured. The group of lactose-intolerant children was compared with a group of healthy children of similar age, gender, race, and size and to the prediction equations based on body size from Chan's Utah children. Nineteen children, ages 9.6 +/- 1.9 years, participated in the study. They were relatively short compared with standards (height Z score, -0.30 +/- 0.83). BMC was 0.428 +/- 0.081 g/cm in the study group versus 0.440 +/- 0.116 g/cm in the comparison group (n = 19; p > 0.05). Both the study group and the size-selected comparison group had lower BMC than the Utah children. The diet of the study group was low in calcium: 84% of the Recommended Dietary Allowance in children < 11 years old and 32% in children > 11. Calcium intake was associated (p = 0.03) with BMC in the study group after adjusting for body size. The low-lactose diet resulted in a low calcium intake, and BMC was associated with calcium intake in prepubertal children with lactose intolerance. Evaluation of dietary calcium intake should be considered in this group of patients, with follow-up dietary counseling, calcium supplementation (diet or medication), and bone density assessment when clinically indicated.
This study examined the feasibility of increasing food-derived calcium to 1500 mg/d and the impact of this change on plasma lipids and nutrient consumption in hypertensive (n = 130) and normotensive (n = 196) participants. Three interventions were applied in a randomized, parallel, placebo-controlled fashion: 1) counseling to increase dietary calcium through food consumption to 1500 mg/d (n = 106), 2) a 1000-mg/d calcium supplement (n = 109), or 3) placebo (n = 111). Plasma lipids were measured before and after 12 wk of intervention whereas nutrient intake was monitored throughout the study. At baseline, hypertensive patients reported lower intakes of carbohydrates, calcium, magnesium, phosphorus, potassium, iron, vitamin D, thiamin, and riboflavin (all P < 0.05). They also had lower HDL (P = 0.014) and higher LDL (P < 0.05) compared with normotensive subjects. During intervention, calcium, magnesium, phosphorus, potassium, thiamin, riboflavin, and vitamins C and D increased (P < 0.01) in the group receiving food calcium but not in the placebo or supplement groups. No changes occurred in plasma lipids or lipoproteins after 12 wk of intervention.
Intervention strategies aimed at reducing the prevalence of nutrition-related diseases, including designing nutrition policies and nutrition education and assistance programs, require effective monitoring of what Americans are eating. Nutrient reference data from the third National Health and Nutrition Examination Survey provide essential information to achieve these goals. Mean and median iron intakes were adequate in males of all race-ethnic groups but were generally low in females and young children. Mean and median calcium intakes were also higher in males than in females and were lower than recommendations in adolescents and in women of all ages. Mean sodium intakes for all age, sex, and race-ethnic groups exceeded the minimum requirements of healthy persons and were higher in non-Hispanic black children and adolescents than in non-Hispanic white and Mexican American children and adolescents. Mean fiber intakes also did not meet recommendations in most subgroups and were higher in Mexican American adults followed by non-Hispanic white adults and non-Hispanic black adults. Further research is planned to compare the food sources of energy and nutrients consumed by different population groups in NHANES III to similar results from earlier nation surveys. NHANES III, Phase 2 (1991-94) recalls were collected using the same dietary method as those collected in Phase 1 (1988-91), and other analyses will compare findings from both phases of NHANES III.
Lactose malabsorption per se is not associated with alterations of bone mineral density (BMD) or calcium intake, but when intolerance symptoms are present a lower calcium intake and reduction of BMD values are evident. The purpose of this study was to evaluate whether lactose intolerance interferes with the achievement of an adequate peak bone mass in young adults.
Of 103 enrolled healthy subjects, 55 proved to be lactose malabsorbers with H(2) breath test after lactose administration, and 29 of them experienced intolerance symptoms (diarrhea, abdominal pain, bloating, flatulence). Lumbar and femoral BMD by dual-energy X-ray absorptiometry was measured, and calcium intake and biochemical indices of bone and mineral metabolism were evaluated.
Lumbar and femoral BMD, calcium intake, and mineral metabolism did not differ between malabsorbers and absorbers, although among malabsorbers, intolerant subjects showed significant alterations of all these parameters in comparison with tolerant subjects. A strict correlation was evident between BMD values and both severity of symptoms and calcium intake and between calcium intake and severity of symptoms.
Lactose intolerance prevents the achievement of an adequate peak bone mass and may, therefore, predispose to severe osteoporosis.
The purpose of the present study was to determine differences, if any, in bone mineral density, the risk of fracture, and clinical behavior in patients with lactose intolerance investigated by hydrogen breath test.
The study population (n = 218; age, mean +/- SD, 58.2 +/- 11.5 years) consisted of 103 healthy individuals negative hydrogen breath test (Delta H2 0-20 ppm; group I), and 115 individuals with evidence of lactose intolerance according to the hydrogen breath test (Delta H2 > 20 ppm), of whom 40 individuals had test results of 20 ppm < Delta H2 < 59 ppm (group II). The remaining 75 individuals were strongly positive on the hydrogen breath test (Delta H2 > 60 ppm; group III). The entire study population was measured for bone mineral density in the nondominant forearm and in the vertebra (quantitative computed tomography [qCT]). Radiographs of the spine were studied for fractures.
In healthy individuals, bone mineral density in the vertebra assessed by qCT (mean +/- SD, 111.2 +/- 31 mg/cc) did not significantly differ between those with mild (qCT, mean +/- SD, 109.8 +/- 35 mg/cc) and those with severe (qCT, mean +/- SD, 107.7 +/- 36 mg/cc) lactose intolerance. Lactose-intolerant individuals had more vertebral fractures per patient when compared with those with mild lactose intolerance or controls ( P < 0.05). Considering vertebral and self-reported non-vertebral fractures, no statistically significant differences were found. In the entire group, the overall occurrences of fracture in the presence of lactose intolerance and in controls were comparable after correction for age and body mass index (BMI).
Individuals with lactose intolerance verified by the hydrogen breath test appear not to be at risk for accelerated bone loss. Nevertheless, a relationship between vertebral fractures and an apparent lactose intolerance cannot be excluded, as a few individuals with severe lactose intolerance had a large number of vertebral fractures.
This study was designed to quantify the impact of dairy foods on nutrient intakes in the United States.
Data were from 17959 respondents to the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII). Statistical analyses Nutrient intakes were quantified by quartile of dairy food intake. Also, dairy intakes were compared in people who met vs did not meet intake recommendations for select nutrients. Finally, the direct contribution of dairy foods/ingredients to calcium and lipid intakes was determined. SAS and SUDAAN software were used. Data were weighted. Energy intake was a covariable in regression models.
Intake of all micronutrients examined, except vitamin C, was higher with increasing quartile of total dairy and milk intake, controlling for energy intake. Calcium was the only micronutrient positively associated with cheese intake. Fat intake either did not differ or was lower among people in quartile 2, 3, or 4 vs quartile 1 of total dairy and milk intake, whereas fat was higher as quartile of cheese intake increased. Dietary cholesterol was lower as intakes of any of the dairy categories increased; the opposite was true for saturated fat. Dairy foods/ingredients directly contributed an average of 51% of dietary calcium, 19% of total fat, 32% of saturated fat, and 22% of cholesterol.
Total dairy and milk intakes were associated with higher micronutrient intakes without adverse impact on fat or dietary cholesterol. Results reinforce the strong nutritional profile of dairy-rich diets, although results with saturated fat and with cheese suggest that it would be useful to modify product composition and/or eating patterns to optimize nutritional contributions of dairy products.
In the United States, approximately three fourths of African-Americans have the potential for symptoms of lactose intolerance because lactose digestion depends on the presence of the enzyme lactase-phlorizin hydrolase which is reduced by up to 90-95% in individuals with lactase nonpersistence. The 'African-American diet' is more likely to be low in a variety of vitamins and minerals, including calcium. African-Americans consume low amounts of dairy foods and do not meet recommended intakes of a variety of vitamins and minerals, including calcium. Low intake of calcium and other nutrients put African-Americans at an increased risk for chronic diseases. The 2005 Dietary Guidelines recommend consuming three servings of dairy foods per day to ensure adequate calcium intake, among other nutrients, and the National Medical Association has recently published a similar recommendation of three to four servings of dairy per day for the African-American population. Research has shown that lactose maldigesters, including African-American maldigesters, can consume at least one cup (8 oz) of milk without experiencing symptoms, and that tolerance can be improved by consuming the milk with a meal, choosing yogurt or hard cheeses, or using products that aid in the digestion of lactose such as lactase supplements or lactose-reduced milks.
Lactose intolerance (LI) is a common enzymatic insufficiency, manifesting by poor tolerance of dairy products, leading to low calcium intake and poor calcium absorption from dairy products. These changes might lead to an impairment of bone metabolism [1].
To evaluate the impact of LI on quantitative bone parameters in axial and appendicular skeletal sites. To assess the impact of calcium intake from dairy and non-dairy nutritional sources, calcium regulating hormones and bone turnover on quantitative bone parameters in LI patients.
We evaluated calcium intake and bone status in sixty-six patients with LI, 49 women and 17 men, aged 20 to 78. Bone mass was assessed at the lumbar spine (LS), total hip (TH) and femoral neck (FN) by dual-energy x-ray absorptiometry (DEXA) and at the radius, tibia, phalanx by quantitative ultrasound. Serum calcium, albumin, inorganic phosphate, calcium regulating hormones and markers of bone turnover were evaluated.
Total daily calcium intake was below the recommended by the American Dietetic Association [2] in all study participants (mean 692 mg/day +/- 162). Elevated level of urinary deoxypyridinoline crosslinks (DPD) was observed in 63 (96%) patients and was negatively correlated with total daily calcium intake (r = -0.998, p = 0.025) and with nondairy calcium intake (r = -0.34, p = 0.015). Parathyroid hormone (PTH) level in the upper third of normal range (45-65 ng/L) was observed in 11 (17%) patients. Parathyroid hormone (PTH) was inversely correlated with total calcium intake (r = -0.4, p = 0.001), dairy calcium intake (r = -0.83, p = 0.05), non-dairy calcium intake (r = -0.29, p = 0.043), 25OHD(3) serum level (r = -0.3, p = 0.007) and positively correlated with bone turnover markers (deoxypyridinoline crosslinks [DPD], r = 0.36, p = 0.01 and bone specific alkaline phosphatase [BSAP] r = 0.36, p = 0.01). Decrease in quantitative bone parameters compared to age-matched controls was observed in the axial and in the appendicular skeleton in men and in postmenopausal women: mean z-score for LS -0.87 +/- 0.22 and -1.32 +/- 0.65, p = 0.004 and 0.015, tibia -1.15 +/- 0.53 and -0.44 +/- 0.044, p < 0.001 and 0.27, phalanx -0.98 +/- 0.22 and -0.52 +/- 0.98, p < 0.001. We observed decrease in bone mass in patients with serum PTH in the upper tertile of normal range in the FN (z-score -0.57 +/- 0.6 versus -0.03 +/- 0.9, p = 0.025), TH (-0.51 +/- 0.96 versus 0.04 +/- 0.9, p = 0.05) and radius (-1.84 +/- 0.27 versus -0.07 +/- 1.61, p = 0.025, respectively). z-scores in FN and TH positively correlated with serum 25OHD(3) level (r = 0.31, 0.29; p = 0.014, 0.019). In postmenopausal women serum 25OHD(3) level correlated also with LS z-scores (r = 0.52, p = 0.004); FN and TH z-scores negatively correlated with DPD level (r = -0.51, p = 0.02 and r = -0.55, p = 0.04).
LI state may lead to increased bone turnover and decreased bone mass especially in men and postmenopausal women. Impaired vitamin D status and low calcium intake may be deleterious to bone in this condition.
The purpose of this study was to determine associations among lactose maldigestion status, perceived milk intolerance, dietary calcium intake, and bone mineral content in early adolescent girls.
Subjects were 291 girls who participated in a substudy of the multiple-site project Adequate Calcium Today. Lactose maldigestion status was determined with hydrogen breath testing, and questionnaires were used to assess perceived milk intolerance. Dietary calcium intake was estimated from a semiquantitative food frequency questionnaire. Anthropometric and dual-energy x-ray absorptiometric measurements (total body, spine L2-L4, total hip, and hip femoral neck) were standardized across sites.
Of the 230 girls who completed breath hydrogen testing, 65 were Asian, 76 were Hispanic, and 89 were non-Hispanic white. A total of 100 girls experienced increases in breath hydrogen levels of >20 ppm and were classified as lactose maldigesters. Of the 246 participants who completed useable perceived milk intolerance questionnaires, 47 considered themselves to be milk intolerant. Of the 47 girls self-reporting perceived milk intolerance, 40 completed breath hydrogen testing and 22 were not maldigesters. Girls with perceived milk intolerance consumed an average of 212 mg of total food calcium per day less than girls without perceived milk intolerance. Spinal bone mineral content was significantly lower in the girls with perceived milk intolerance, compared with the girls without perceived milk intolerance. When girls with lactose maldigestion were compared with girls without lactose maldigestion, there were no significant differences in calcium intake or bone measures.
These results suggest that, starting as early as 10 years of age, self-imposed restriction of dairy foods because of perceived milk intolerance is associated with lower spinal bone mineral content values. The long-term influence of these behaviors may contribute to later risk for osteoporosis.
To compare reported dairy/calcium intake with intake recommendations and examination of food sources and fat levels of dairy intake in the National Health and Nutrition Examination Survey 1999-2002.
Dietary, anthropometric, and sociodemographic data for 2- to 18-year-olds (n = 7716) were evaluated to compare intakes of dairy (MyPyramid) and calcium (Adequate Intake [AI]) recommendations. US Department of Agriculture food codes were used to identify mutually exclusive food groups of dairy-contributing foods, which were ranked in descending order proportional to total intake. Complex sample survey Student t tests were used to determine statistical significance among intakes in 4 age groups and between reported and recommended intakes.
Dairy consumption was not significantly different among age groups, but only 2- to 3-year-olds met the MyPyramid recommendation. Calcium intake was significantly different among age groups, and 2- to 8-year-olds met the AI. Intake of flavored milk ranged from 9% to 18%. More than half of the milk consumed by 2- to 3-year-olds was whole milk, and, with the exception of yogurt consumption in 2- to 3-year-olds, children choose to consume more of the highest-fat varieties of cheese, yogurt, ice cream, and dairy-based toppings.
Dairy and calcium intakes are inadequate in 4- to 18-year-olds. Most children consume the high-fat varieties of milk and dairy products. Focusing nutrition guidance efforts on increasing the intake of the low-fat dairy products, with special emphasis on increasing calcium intake in school-age children and adolescents through flavored low-fat milk products, may be beneficial.
Advanced Data from Vital and Health Statistics No. 258. Hyattsville, National Center for Health Statistics
Advanced Data from Vital and Health Statistics No. 258. Hyattsville, National
Center for Health Statistics, 1994.
19 Federation of American Societies for Experimental Biology (FASEB), Life
Sciences Research Office: Third Report on Nutrition Monitoring in the United
States: Executive Summary. Washington, US Government Printing Office,
1995.