A review of dairy food intake for improving health among black infants, toddlers, and young children in the US.

Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.

Changes in gut microbiota and lactose intolerance symptoms before and after daily lactose supplementation in individuals with the lactase nonpersistent genotype.

BACKGROUND: Approximately 70%-100% of the Asian adult population is lactase nonpersistent (LNP). The literature shows that many individuals with the LNP-genotype can consume ≤12 g of lactose without experiencing gastrointestinal discomfort. Repetitive consumption of lactose may reduce intolerance symptoms via adaptation of the gut microbiota. OBJECTIVE: This study aimed to assess the effects of daily consumption of incremental lactose doses on microbiota composition and function, and intolerance symptoms. METHODS: Twenty-five healthy adults of Asian origin, carrying the LNP-genotype were included in this 12-wk before and after intervention trial. Participants consumed gradually increasing lactose doses from 3 to 6 g to 12 g twice daily, each daily dose of 6 g, 12 g, or 24 g being provided for 4 consecutive weeks. Participants handed-in repeated stool samples and underwent a 25 g lactose challenge hydrogen breath test (HBT) before and after the 12-wk intervention. Daily gastrointestinal symptoms and total symptom scores (TSSs) during the lactose challenge were recorded. RESULTS: A significant increase from 5.5% ± 7.6% to 10.4% ± 9.6% was observed in Bifidobacterium relative abundance after the intervention (P = 0.009), accompanied by a 2-fold increase (570 ± 269 U/g; P < 0.001) in fecal ß-galactosidase activity compared with baseline (272 ± 158 U/g). A 1.5-fold decrease (incremental area under the curve; P = 0.01) in expired hydrogen was observed during the second HBT (38 ± 35 ppm·min), compared with the baseline HBT (57 ± 38 ppm·min). There was a nonsignificant decrease in TSS (10.6 ± 8.3 before compared with 8.1 ± 7.2 after intervention; P = 0.09). Daily consumption of lactose was well tolerated, with mild to no gastrointestinal complaints reported during the intervention. CONCLUSIONS: Increased levels of Bifidobacterium indicate an adaptation of the gut microbiota upon repetitive consumption of incremental doses of lactose, which was well tolerated as demonstrated by reduced expired hydrogen concentrations during the second 25-g lactose HBT. Bifidobacteria metabolize lactose without gas production thereby potentially reducing intestinal gas formation in the gut of individuals with the LNP-genotype. This increased lactose tolerance possibly lifts the necessity to remove nutrient-rich dairy foods completely from the diet. The trial is registered at the International Clinical Trials Registry Platform: NL9516. The effect of dietary lactose in lactase nonpersistent individuals on gut microbiota.

Does the peroral chromium administration in young Hariana calves reduce the risk of calf diarrhea by ameliorating insulin response, lactose intolerance, antioxidant status, and immune response?

BACKGROUND: The reduction in insulin sensitivity during rumen development may predispose dairy calves towards lactose intolerance, which could be the reason behind neonatal calf diarrhea (NCD). Chromium (Cr) results in a range of effects when fed to ruminants, but most studies have shown improved insulin sensitivity. The aim of this study was to determine the effect of Cr supplementation on insulin sensitivity, lactose intolerance, diarrhoea and antioxidant, and immune response in young Hariana calves. METHODS: A total of 20 milk-fed Hariana calves were randomly assigned to 1 of 2 treatments, each consisted of 10 calves: (1) a control group without supplemental Cr and (2) a 0.15 mg Cr as Cr-picolinate (CrPic)/kg BW0.75 supplemented group (Cr0.15). RESULTS: A more rapid glucose disappearance with unaltered insulin kinetics during intravenous glucose tolerance test (IVGTT) and oral lactose tolerance test (OLTT) indicates greater insulin sensitivity in Cr supplemented calves. Better insulin sensitivity in Cr supplemented calves was further confirmed by higher values of the quantitative insulin sensitivity check index (QUICKI), revised quantitative insulin sensitivity check index (RQUICKI) and insulin receptor substrate-1 (IRS-1) and lower (P < 0.05) values of homeostasis model assessment-insulin resistance (HOMA-IR) and glucose-to-insulin ratio in Cr supplemented calves during IVGTT. Cr supplementation resulted in a lower (P < 0.05) serum cortisol concentration, whereas serum non-esterified fatty acid (NEFA) concentrations during IVGTT did not differ among the groups. The rise in serum glucose concentrations within 2 h post lactose infusion during OLTT peaked at more than twice the basal glucose concentration, therefore calves were not considered as lactose intolerant. Within monthly blood samples, concentrations of serum insulin were similar among treatments, whereas the Cr supplemented group had lower (P < 0.05) serum glucose concentration and glucose-to-insulin ratio compared with the control group. No treatment differences were detected in the biomarkers of antioxidant status and immunity. Serum Cr concentrations were higher (P < 0.05) in Cr supplemented calves while concentrations of other studied minerals were remained unaltered. The incidence, duration of diarrhea, and faecal score were better (P < 0.05) in calves fed on Cr supplemented diet whereas, no treatment effect was observed on average daily gain (ADG). During the study period, no calves died, and no calves were found to have pneumonia, navel or joint disease. CONCLUSION: Feeding a Cr-supplemented diet improved insulin sensitivity and reduced the risk of diarrhoea in milk-fed young calves, but had no or minimal effects on lactose intolerance, antioxidant status, immune response, and growth performance.

The use of probiotics and prebiotics can enable the ingestion of dairy products by lactose intolerant individuals.

OBJECTIVE: To investigate, through a systematic review, the efficiency of the clinical application of probiotic and prebiotic supplements in reducing the symptoms of lactose intolerance (LI). METHODS: This systematic review was conducted without limits for publication time and followed the PRISMA 2020 guidelines. The study was registered at the PROSPERO platform (CRD42022295691). The inclusion criteria were: studies addressing the issue of LI associated with the use of probiotics and prebiotics of any nature; studies performed with adults; randomized, placebo-controlled trials; and open access scientific articles, theses, or dissertations. The studies were retrieved from the following databases: SciELO, PubMed, LILACS, ScienceDirect, and gray literature, with no restrictions imposed regarding the years of publication of the investigations. To document the risk of bias, the RoB 2.0 tool was adopted, and to assess the certainty of the evidence, the GRADE tool was used. RESULTS: A total of 830 studies were found; however, after applying the inclusion and exclusion criteria, only five studies remained. Two studies used the prebiotic GOS (RP-G28) for the treatment of LI and, together, included 462 subjects. The results of these studies showed improvement of LI symptoms during treatment phase and up to 30 days after cessation of GOS use (RP-G28). Three studies used the probiotics Bifidobacterium bifidum 900791, Limosilactobacillus reuteri DSM 17938 (Lactobacillus reuteri), and Lactobacillus acidophilus DDS-1 to evaluate their effects on LI and comprised 117 subjects. The results showed that B. bifidum 900791 did not significantly improve LI symptoms, and only Limosilactobacillus reuteri DSM 17938 showed significant improvement in symptoms and in reduction of expired hydrogen, while Lactobacillus acidophilus DDS-1 showed significant improvement for LI symptoms. The risk of bias for studies on probiotics suggested concerns in all studies, whereas the risk of bias was low in investigations evaluating prebiotics, with only one study classified as concerning. The certainty of evidence was high for the studies using the GOS (RP-G28) prebiotic and low for the probiotics. Pooling for meta-analysis could not be performed due to the lack of similar probiotic strains or lack of common outcomes. CONCLUSION: In summary, the probiotics Limosilactobacillus reuteri DSM 17938 and Lactobacillus acidophilus DDS-1 showed the best results in the management of LI symptoms. The prebiotic GOS (RP-G28) appeared to be more efficient in reducing post-treatment symptoms. However, it is noteworthy that evidence regarding the use of probiotics for the management of LI is considerably scarce; as for prebiotics, data are limited. Studies adopting robust methodologies, especially regarding the complete reporting of data, are therefore warranted.

Benefits of Flavored Lactose-Free Milk for Korean Adults with Lactose Intolerance.

Although lactose-free dairy products for the clinical management of lactose intolerance (LI) are widely available, scientific evidence on their efficacy is still lacking. This study comparatively analyzed the efficacy of flavored lactose-free milk (LFM) and whole milk (WM) in reducing symptoms in South Korean adults with LI. This prospective study was conducted in adults suspected of LI. All screened participants underwent the hydrogen breath test (HBT) using 570 mL of chocolate-flavored WM (20 g of lactose) and responded to a symptom questionnaire. LI was confirmed when the ΔH2 peak exceeded 16 ppm above baseline values and with the occurrence of symptoms after WM consumption. The participants who were diagnosed with LI underwent the HBT again with 570 mL of chocolate-flavored LFM (0 g of lactose), followed by the symptom questionnaire survey after 1 week. After excluding 40 participants who did not meet the diagnostic criteria for LI and 2 who were lost to follow-up, a total of 28 lactose-intolerant individuals were enrolled in the study. The ΔH2 values in the first HBT were significantly higher than those in the second HBT (33.3 ± 21.6 ppm vs. 8.6 ± 6.3 ppm, P < .001). Similarly, there was a significant reduction in the total symptom score in the second HBT (4.18 ± 1.51 vs. 0.61 ± 0.98, P < .001). Flavored LFM is well tolerated in South Korean adults diagnosed with LI based on the HBT and symptom questionnaire results. Therefore, LFM may be a viable alternative to WM.

Healthy Taiwanese Eating Approach (TEA) toward Total Wellbeing and Healthy Longevity.

A healthy dietary pattern review for Asian countries is scarce, which is crucial for guiding healthy eating. We reviewed Taiwanese dietary pattern discovery studies. Included were 19 studies, the majority of which employed dimension reduction methods to find dietary patterns associated with various health conditions. To show what is a high or low intake of foods in Taiwan, we also report the average dietary content and the 25th and 75th percentile values of the adult population for six food groups gathered by the Nutrition and Health Survey in Taiwan, 2017-2020. The healthy Taiwanese dietary approach is cohesive across multiple health outcomes occurring at different ages. It is featured with higher intakes of plant-based foods, aquatic foods, and some beneficial ethnic foods (soy products), drinks (tea), and cooking methods (boiling and steaming); lower intakes of fast foods, fatty and processed meats, sugar, salt rich foods/drinks, and fried foods; but with mixed findings for dairy and egg. Yet, the average Taiwanese person consumed many refined staple foods and livestock, but not sufficient vegetables, fruits, whole grains and roots, beans, and nuts. Dairy consumption remains low. In conclusion, Taiwanese discovery studies point to a mortality-lowering total wellbeing dietary pattern consistent with the current knowledge, which discloses potential benefits of soy product, tea, and boiling and steaming.

Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP).

Epidemiologic data suggest an increased prevalence of pediatric food allergies and intolerances (FAIs) during the last decades. This changing scenario has led to an increase in the overall healthcare costs, due to a growing demand for diagnostic and treatment services. There is the need to establish Evidence-based practices for diagnostic and therapeutic intervention that could  be adopted in the context of public health policies for FAIs are needed.This joint position paper has been prepared by a group of experts in pediatric gastroenterology, allergy and nutrition from the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). The paper is focused on the Diagnostic Therapeutic Care Pathway (DTCP) for pediatric FAIs in Italy.

Switching from the tablet to the powder formulation of levothyroxine corrects severe hypothyroidism in a patient with lactose intolerance.

We describe a case of a 38-year-old woman who, after radioactive iodine therapy for Graves' disease, developed severe hypothyroidism despite receiving a high dose of levothyroxine (L-T4) tablet as replacement therapy. Her thyroid stimulating hormone (TSH) remained to be high despite the dose of L-T4 tablets to 400 µg/day after treatment for hypothyroidism, and the patient complained of general malaise and edema of the legs. Reduced intestinal absorption of L-T4 is the most common cause of failure to achieve the therapeutic target in hypothyroid patients receiving replacement therapy. She was admitted to our hospital for severe hypothyroidism due to resistance to treatment with L-T4 tablet. Our patient was found to have lactose intolerance (LI) by a detailed examination during hospitalization. Therefore, we assumed that LI was impairing intestinal absorption of L-T4 tablet in our patient, leading to severe hypothyroidism. The patient was switched to the powder formulation of L-T4 at the same daily dose, and serum levels of thyroid-stimulating hormone and thyroid hormones normalized. This is the case in which hypothyroidism due to reduced absorption of L-T4 tablet in a patient with LI was resolved by switching to L-T4 powder formulation.

Lactose intolerance in patients with inflammatory bowel diseases and dietary management in prevention of osteoporosis.

Lactose intolerance affects 33% to 75% of the world population and may be associated with various genetic factors. Lactose in the diet can be found in milk and dairy products, which simultaneously constitute the primary sources of calcium. Gut microbiota also influences lactose tolerance. Patients with lactose intolerance often stop consuming milk and dairy products, which may lead to calcium and vitamin deficiency and osteoporosis. Insufficient production of lactase also occurs in patients with diseases of the gastrointestinal tract, such as inflammatory bowel diseases. Moreover, Crohn's disease and ulcerative colitis are risk factors for osteoporosis, and the intake of the proper amount of calcium is an essential element in preventing the decrease of bone mineral density. Diet may prevent the development of osteoporosis, thus, educating patients regarding proper diet should constitute a part of the treatment and prevention process. Patients should consume low-lactose, or lactose-free milk and bacterially fermented dairy products. Additionally, plant milk supplemented by calcium and vitamin D, mineral water with calcium, and certain vegetables also may be good sources of calcium.

Conduct disorder and somatic health in children: a nationwide genetically sensitive study.

BACKGROUND: Conduct disorder (CD), a serious behavioral and emotional disorder in childhood and adolescence, characterized by disruptive behavior and breaking societal rules. Studies have explored the overlap of CD with neurodevelopmental problems (NDP). The somatic health of children with NDP has been investigated; however, the prevalence of these problems in children with CD has not been sufficiently studied. Holistic assessment of children with CD is required for establishing effective treatment strategies. AIMS: (1) Define the prevalence of selected neurological problems (migraine and epilepsy) and gastrointestinal problems (celiac disease, lactose intolerance, diarrhea, and constipation) in a population of twins aged 9 or 12; (2) Compare the prevalence of somatic problems in three subpopulations: (a) children without CD or NDP, (b) children with CD, and (c) children with both CD and NDP; (3) Select twin pairs where at least one child screened positive for CD but not NDP (proband) and map both children's neurological and gastrointestinal problems. METHOD: Telephone interviews with parents of 20,302 twins in a cross-sectional, nationwide, ongoing study. According to their scores on the Autism-Tics, AD/HD, and Comorbidities inventory, screen-positive children were selected and divided into two groups: (1) children with CD Only, (2) children with CD and at least one NDP. RESULTS: Children with CD had an increased prevalence of each neurological and gastrointestinal problem (except celiac disease), and the prevalence of somatic problems was further increased among children with comorbid CD and NDP. The presence of CD (without NDP) increased the odds of constipation for girls and the odds of epilepsy for boys. Girls with CD generally had more coexisting gastrointestinal problems than boys with CD. Female co-twins of probands with CD were strongly affected by gastrointestinal problems. Concordance analyses suggested genetic background factors in neurological and gastrointestinal problems, but no common etiology with CD could be concluded. CONCLUSION: Co-occurring NDP could explain most of the increased prevalence of somatic problems in CD. Our results raise a new perspective on CD in children and adolescents; their CD seems to be linked to a number of other health problems, ranging from neurodevelopmental and psychiatric disorders to somatic complaints.

Nutritional management of lactose intolerance: the importance of diet and food labelling.

Worldwide, 70% of the adult population has limited expression of lactase enzyme with a wide variation among different regions and countries. Lactase deficiency may lead to lactose intolerance (LI). Depending both on the amount of lactose ingested and on the lactase activity, people who suffer from lactose malabsorption might experience numerous gastrointestinal and extra-intestinal symptoms and manifestations. Treatment of LI mainly consists of reducing or eliminating lactose from the diet until the symptoms disappear as well as supplementing lactase, and inducing colon microbiome adaptation by probiotics. Cow's milk is one of the major source of calcium and several other vitamins and minerals. Thus, a complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. Therefore, the dietetic approach has a crucial role in the management of LI patients. Additionally, the use of lactose and milk-derived products in non-dairy products (e.g., baked goods, breakfast cereals, drinks, and processed meat) has become widespread in the modern industry (the so-called "hidden lactose"). In this regard, a strict adherence to the lactose-free diet becomes challenging for LI patients, forced to continuous check of all products and food labels. In fact, lactose-free product labeling is still controversial. Considering that nowadays a specific cut-off value establishing "lactose-free" labeling policy is lacking and that there is no universal law regulating the production and commercialization of "delactosed" products, identification of specific safe and suitable products with a well-recognized lactose-free logo might help consumers. This narrative review aims to identify the dietary management for lactose intolerant people, avoiding symptoms and nutrients deficiencies, helped by the use of specific labelling to guide them to choose the safer product on the market.

Health issues and technological aspects of plant-based alternative milk.

A growing number of consumers opt for plant-based milk substitutes for medical reasons, like cow's milk protein allergy (CMPA), lactose intolerance (LI), or as a lifestyle choice. Plant-based milk substitutes, or plant extracts, are water-soluble extracts of legumes, oilseeds, cereals or pseudocereals that resemble bovine milk in appearance. It is produced by reducing the size of the raw material, extracted in water and subsequently homogenized, being an alternative to cow's milk. They are considered cow's milk replacers due to similar chemical composition and can also be used as a substitute for direct use or in some animal milk-based preparations. On the other hand, these substitutes exhibit different sensory characteristics, stability and nutritional composition from cow's milk. They are manufactured by extracting the raw material in water, separating the liquid, and formulating the final product. Others process like homogenization and thermal treatments are indispensable to improve the suspension and microbiological stabilities of the final product so that can be consumed. However new and advanced non-thermal processing technologies such as ultra-high pressure homogenization and pulsed electric field processing are being researched for tackling the problems related to increase of shelf life, emulsion stability, nutritional completeness and sensory acceptability without the use of high temperatures. Some pre-treatments such as peeling, bleaching or soaking can be performed on the raw material in order to improve the final product. The nutritional properties are influenced by the plant source, processing, and fortification. The addition of other ingredients as sugar, oil and flavorings is done to the plant-based milk substitute to make them more palatable and be more acceptable to consumers. Thus, the aim is to review the main reasons for the consumption of plant-based milk substitute as well as the raw materials used and the technological aspects of its production.

Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer.

Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.

Physicochemical and sensory properties of milk supplemented with lactase microcapsules coated with enteric coating materials.

In this paper, we report the physicochemical and sensory properties of milk supplemented with a powder of microencapsulated lactase. The core material was lactase (ß-galactosidase), the primary coating material was medium-chain triglyceride (MCT), and the secondary (enteric) coating material was either hydroxypropyl methylcellulose phthalate (HPMCP) or shellac, comparing both against market milk as a control. The physicochemical properties of both types of microcapsules were analyzed, including the particle size, zeta potential, and in vitro release behavior. To survey the stability of the microcapsules in milk during storage, we studied the residual lactose content and pH. Furthermore, to determine the properties of milk supplemented with the microcapsules, changes in color and sensory properties were evaluated during storage. The particle sizes (volume-weighted mean; D[4,3]) of the microcapsules coated with HPMCP or shellac were 2,836 and 7,834 nm, respectively, and the zeta potential of the capsules coated with shellac was higher than the zeta potential of those coated with HPMCP. The pH levels of milk supplemented with the lactase microcapsules were similar to those of the control (unsupplemented market milk); however, for milk supplemented with HPMCP-coated microcapsules, the pH was slightly lower. The core material, lactase, was released from the microcapsules during 12-d storage, and 18.82 and 35.09% of lactose was hydrolyzed in the samples for HPMCP- and shellac-coated microcapsules, respectively. The sensory characteristics of milk containing microcapsules coated with HPMCP did not show significant differences from the control, in terms of sweetness or off-taste, until 8 d of storage. However, shellac-coated microcapsules showed significant difference in sweetness and off-taste at d 8 and 6 of storage, respectively. The color of milk containing HPMCP-coated microcapsules did not show a significant difference during storage. However, that containing shellac-coated microcapsules was somewhat higher in color values than others. In particular, it showed significance from 0 to 4 d storage in L* and C* values. In conclusion, a powder of lactase microcapsules coated with HPMCP can be suitable as a supplement for milk.

Shen-ling-bai-zhu-san, a spleen-tonifying Chinese herbal formula, alleviates lactose-induced chronic diarrhea in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Shen-ling-bai-zhu-san (SLBZS) was firstly documented in ancient Chinese medical works "Tai Ping Hui Min He Ji Ju Fang" in Song-dynasty. It has been widely used for treating gastrointestinal disorders such as diarrhea with poor appetite for about 900 years. The present study is to observe the effects of SLBZS on high lactose diet-induced chronic diarrhea. MATERIALS AND METHODS: Rats were subjected to a high lactose diet to induce chronic diarrhea, which were then administrated with SLBZS or smecta. General symptom, body weight, food consumption, water intake and fecal fluid content were recorded every day. The intestinal absorption function was determined by d-xylose uptake assay. The ultrastructures of intestine segments including jejunum, ileum, proximal and distal colon were observed by transmission electron microscopy. Additionally, sodium transport proteins including γ-epithelial sodium channel (ENAC-γ) and sodium/potassium-transporting ATPase subunit alpha-1 (ATP1A1) in distal colon were detected by immunohistochemistry and western blotting. RESULTS: Diarrheal rats produced watery or loose, sticky feces, and presented inactiveness and grouping. A high lactose diet caused a significant decline in body weight, serum d-xylose level as well as food consumption rather than water intake. In contrast, general symptoms were improved to a certain extent and body weight loss was alleviated in the rats treated by SLBZS for one week. Fecal fluid content in diarrheal rats treated by SLBZS presented a gradual decrease trend with about 55% in the end, which was significantly less than the model group with about 81%. Meanwhile, SLBZS significantly improved the serum d-xylose level and reversed abnormal changes of tight junctions and microvilli in intestine. Additionally, SLBZS significantly modulated the abnormal expressions of ENAC-γ and ATP1A1 in distal colon of diarrheal rats. CONCLUSIONS: These findings suggested that SLBZS exhibited ameliorating effects against lactose-induced diarrhea, which might be attributed to its modulations on intestinal absorption function as well as mucosal ultrastructure.

The effects of probiotics in lactose intolerance: A systematic review.

Over 60 percent of the human population has a reduced ability to digest lactose due to low levels of lactase enzyme activity. Probiotics are live bacteria or yeast that supplements the gastrointestinal flora. Studies have shown that probiotics exhibit various health beneficial properties such as improvement of intestinal health, enhancement of the immune responses, and reduction of serum cholesterol. Accumulating evidence has shown that probiotic bacteria in fermented and unfermented milk products can be used to alleviate the clinical symptoms of lactose intolerance (LI). In this systematic review, the effectiveness of probiotics in the treatment of LI was evaluated using 15 randomized double-blind studies. Eight probiotic strains with the greatest number of proven benefits were studied. Results showed varying degrees of efficacy but an overall positive relationship between probiotics and lactose intolerance.

Cárie dentária, perfil salivar, padrão de higiene bucal de crianças com alergia à proteína do leite de vaca ou intolerância à lactose e percepção de pais / Dental caries, salivary profile, oral hygiene standards of children with cow's milk protein allergy or lactose intolerance and parents' perception

A alergia alimentar atualmente é considerada um problema de saúde pública. O objetivo nesta pesquisa foi analisar a prevalência de cárie dentária, o padrão de higiene bucal e o perfil salivar em crianças com alergia à proteína do leite de vaca (APLV) e intolerância à lactose (IL), bem como avaliar o consumo de fórmulas infantis suplementares destas crianças e a percepção de pais de crianças com APLV ou IL. Foi realizado um estudo epidemiológico transversal, com 300 crianças de 5-10 anos de um município da Região Sul do Brasil, nos anos de 2017 e 2018. Foi encaminhado um questionário validado aos responsáveis, sobre o consumo alimentar, doenças pré-existentes, uso de medicamentos e APLV ou IL. As crianças foram submetidas a exames clínicos (índices ceo, CPOD, Necessidade de Tratamento, Mancha Branca e IHOS). Foram coletadas amostras duplicadas de saliva estimuladas de todas as crianças com e sem APLV ou IL em uma outra data, entre 8h e 9h 30min e determinados os parâmetros bioquímicos: fluxo salivar, pH e concentrações de cálcio, fosfato e glicose salivar. Para se testar os índices ceo, CPOD, Mancha Branca, Mancha Ativa, Mancha Inativa, IHOS, pH, fluxo salivar, concentrações de cálcio, fosfato e glicose em relação aos grupos "com e sem APLV ou IL", empregou-se o teste não paramétrico de Mann-Whitney e, para a análise das associações entre as prevalências de cárie, manchas dentárias e higiene bucal entre os grupos, utilizou-se o teste do Qui-quadrado. Realizou-se uma pesquisa qualitativa, com dois grupos focais de pais de crianças com APLV/IL, com a participação de pesquisador/moderador, observador e seis pais em cada grupo, empregando-se roteiro com questões norteadoras. Os discursos foram processados no software IRAMUTEQ e analisados pelas técnicas de Classificação Hierárquica Descendente (CHD), nuvem de palavras e análise de conteúdo. A prevalência de cárie nas crianças com APLV ou IL foi de 67,50% e 60,00%, enquanto para as sem APLV/IL foi 34,37% e 32,80%. O índice ceo médio nos alérgicos ou intolerantes foi 1,75±1,84, significativamente maior que o valor para as crianças sem alergia/intolerância (0,83±1,60) (p<0,001). O índice CPOD médio das crianças com APLV/IL foi de 0,46±1,01, e a população livre de cárie constitui-se de 40 crianças (80,00%), não portadoras de lesões cariosas, perdas dentárias por cárie e restaurações. Em relação à higiene bucal, entre as crianças com APLV/IL, o IHOS médio foi de 2,56±0,48, e no grupo sem alergia/intolerância, 2,31±0,43, e estes resultados podem ser considerados insatisfatórios para ambos os grupos avaliados (p<0,001). As crianças com APLV/IL apresentaram menor fluxo salivar, menor pH, e menores níveis de cálcio e fosfato quando comparadas às não alérgicas/intolerantes (p<0,001). Verificou-se associação significativa entre as manchas brancas e manchas ativas e o alto e moderado consumo de alimentos leite sem lactose e suco de soja (p<0,001). Na avaliação qualitativa, 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. Conclui-se que a cárie dentária na dentição decídua e permanente, o padrão de higiene bucal e o perfil salivar foram associadas a APLV ou IL, e o consumo de diferentes fórmulas infantis suplementares ofereceu maiores chances de ocorrência de lesões cariosas. A percepção dos pais em relação à saúde bucal dos filhos sofre influência dos fatores nutricionais e estigma que a doença apresenta, com relatos de diferentes agravos bucais, e dificuldades de acesso a serviços de saúde com equipes multiprofissionais(AU)

Food allergy is currently considered a public health problem. This study aimed to analyze the prevalence of dental caries, salivary profile and the quality of oral hygiene in children with cow's milk protein allergy (CMPA) and lactose intolerance (LI), as well the consumption of milk-based products and milk derivatives by these patients were investigated and the perception of parents' of children with CMPA or LI. A cross-sectional epidemiological study was undertaken with 300 children aged 5 to 10 years in a town in southern Brazil, in the years 2017 and 2018. A validated questionnaire was sent to those responsible for food consumption, systemic diseases, use of medications and CMPA or LI. The children were submitted to clinical exams (ceo indexes, DMFT, Treatment Needs, White Spot and OHIS). Duplicate samples of saliva were collected from all children with and without CMPA or LI on another date, between 8:00 a.m. and 9:30 a.m. and biochemical parameters were determined: salivary flow, pH and concentrations of calcium, phosphorus and salivary glucose. The Mann-Whitney unbiased test was employed for dmft, DMFT, White Spot, Active Spot, Inactive Spot, OHIS, pH, salivary flow, calcium, phosphorus, and glucose for groups with and without CMPA or LI. The chi-square test was used to analyze the associations (prevalence of caries, dental spots, and oral hygiene) among the groups. A qualitative research was carried out, considering two focal with parents of children with CMPA or LI, with the participation of researcher/moderator, observer and six parents in each group, using a guide with guiding questions. The textual contents were processed in the IRAMUTEQ software and analyzed by the Descending Hierarchical Classification (DHC), word cloud techniques and content analysis. The prevalence of caries in children with CMPA or LI was 67.50% and 60.00%, while for those without CMPA/LI was 34.37% and 32.80%.0% and 60.00%, while for those without APLV / IL it was 34.37% and 32.80%. The mean dmft score in the allergic or intolerant was 1.75±1.84, significantly higher than the value for children without allergy/intolerance (0.83±1.60) (p<0.001). The mean DMFT index of children with CMPA/LI was 0.46±1.01, and the caries-free population consisted of 40 children (80.00%), without carious lesions, dental caries and restorations. Regarding oral hygiene, OHIS mean was 2.56±0.48 among children with CMPA/LI, and in the group without allergy/intolerance, 2.31±0.43, and these results can be considered unsatisfactory for both groups evaluated (p<0,001). Children with CMPA/IL presented lower salivary flow, lower pH, and lower calcium and phosphorus levels when compared to non-allergic/intolerant (p<0.001). There was a significant association between white spots and active spots and the high and moderate consumption of lactose-free milk and soy milk fruit juice (p <0.001). In the qualitative evaluation, six clusters emerged from the multivariate analysis by DHC: (1) Infant Formulas; (2) Oral Health; (3) Nutritional Aspects; (4) Treatment; (5) Stigma of Disease; (6) Health Services. It was concluded that dental caries in the deciduous dentition and permanent dentition, the oral hygiene standards and the salivary profile were associated with CMPA or LI, and the consumption of different supplementary infant formulas offered a greater chance of occurrence of carious lesions. The perception of the parents' in relation to oral health of their children was influenced by the nutritional factors and the stigma that the disease presents, with reports of different oral complaints, and difficulties in accessing health services with multiprofessional teams(AU)

Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives.

Milk is a fundamental component of the diet of every mammal; nevertheless, not every individual can tolerate this kind of food, especially in adulthood. However, lactose intolerance has only been recognized in the last 50 years, and currently, lactose intolerance is defined as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhoea that occur after lactose consumption. Lactose is currently a common disaccharide in human nutrition, both in breastfed infants and in adults, but its digestion requires a specialized enzyme called lactase. The genetically programmed reduction in lactase activity during adulthood affects most of the world's adult population and can cause troublesome digestive symptoms, which may also vary depending on the amount of residual lactase activity; the small bowel transit time; and, especially, the amount of ingested lactose. Several diagnostic tests are currently available for lactose intolerance, but the diagnosis remains challenging. The treatment for lactose intolerance mainly consists of reducing or eliminating the dietetic amount of lactose until the symptoms disappear, but this is hard to achieve, as lactose is present in dairy products and is even commonly used as a food additive. In addition to dietetic restriction of lactose-containing foods, lactase can be administered as an enzymatic food supplement, but its efficacy is still controversial. Recently, probiotics have been proposed for the management of lactose intolerance; certain probiotic strains have shown specific ß-galactosidase activity, thus aiding in the digestion of lactose. The aim of this paper was to review the current knowledge about lactose intolerance and to discuss the potential for the use of specific probiotic strains such as dietary supplements in lactose-intolerant patients.

Dipping probe electrospray ionization/mass spectrometry for direct on-site and low-invasive food analysis.

Rapid, direct, on-site and noninvasive food analysis is strongly needed for quality control of food. To satisfy this demand, the technique of dipping probe electrospray ionization/mass spectrometry (dPESI/MS) was developed. The sample surface was pricked with a fine acupuncture needle and a sample of ∼200 pL was captured at the needle tip. After drying the sample, the needle tip was dipped into the solvent for ∼50 ms and was moved upward. A high-voltage was applied to the needle to generate electrospray when the needle reached the highest position, and mass spectra were measured with a time-of-flight mass spectrometer. For evaluation of the method, the technique was used to analyze foods such as vegetables, salmon flesh, cow's milk, yogurt, and soy-bean milk. The detected major ions for cow's milk and yogurt were [(Lac)n + Ca]2+ with n = 1-6 (where (Lac) is lactose), indicating that Ca2+ is tightly bound by Lac molecules.

One-third of children with lactose intolerance managed to achieve a regular diet at the three-year follow-up point.

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 to 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 of 154 patients (77.3%), and 65 of 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.