Low-fat, lactose-free and leucine-enriched chocolate cow milk prototype: A preliminary study on sensorial acceptability and gastrointestinal complaints following exhaustive exercise.

BACKGROUND: Chocolate milk has gained recent scientific support as a recovery drink. However, it is known that high exercise-demand triggers gastrointestinal discomfort which continues post-exercise, thereby hindering this nutritional strategy. In addition, those who are lactose intolerant cannot benefit from a milk-based beverage. Thus, the aim of this preliminary study was to develop a low-fat, lactose-free, and leucine-enriched chocolate cow milk prototype (CML) representing nutrition-related recommendations for football players, as well as assess athletes' individual subjective outcomes for gastrointestinal complaints and sensorial acceptability in a field-based setting following strenuous team-sport physical demands. METHODS: This study followed a single group and repeated-measured design with 10 football players (23 ± 2 yrs., 74 ± 14 kg, 174 ± 5 cm) who consumed CML following a 90-min football match simulation protocol (FMP). The total CML intake to achieve 0.150 g leucine·kg [BW]·h- 1 occurred in aliquots of 50, 30 and 20% at 0-, 45- and 75-min post-FMP, respectively. Athletes were evaluated by the prevalence, the type and severity (bloating, nausea, flatulence, and gastric reflux) of gastrointestinal complaints and sensorial acceptability (overall perception, appearance, consistency, and flavour) after drinking each aliquot in a 4-h recovery period. RESULTS: The CML showed higher scores for "Product Acceptability Index" (88%) and sensorial acceptability (~ 8 in 9-point hedonic scale). Kendall's W with bootstrapped resample (95%CI) revealed agreement among respondents as "moderate" (overall perception, flavour) to "strong" (appearance, consistency) and with no significant agreement differences between rater response in the timeline analysis (0.57 up to 0.87; p > 0.05). Agresti-Caffo add-4 analysis (95% confidence interval, [95%CI]) revealed no differences in each time-point analysis versus baseline for athletes classified as having severe gastrointestinal symptoms, but confirmed concern with bloating (three athletes showed a transient response at 2-h and only one continued until 3-h; p = 0.051). CONCLUSIONS: These preliminary findings suggest that CML presents good taste and high acceptability by the sampled athletes. Thus, CML may be an alternative sport drink for immediate post-workout supplementation to overcome the energy deficit, offer co-ingested leucine, maintain palatability and adherence including lactose intolerance following a team sport-specific fatigue. TRIAL REGISTRATION: RBR-2vmpz9 , 10/12/2019, retrospectively registered.

Genetic and Oral Tests for the Diagnosis of Lactose Intolerance in Mixed-Ancestry Brazilians with Metabolic Syndrome.

BACKGROUND/AIMS: Metabolic syndrome (MetS) comprises a cluster of physiological and anthropometric abnormalities. MetS has been linked to lactose intolerance (LI). The aim of this study was to compare the sensitivity and specificity to detect LI using 2 different tests: (1) a genetic test and (2) an oral lactose tolerance test (OLTT). METHODS: Two hundred and fifty-four MetS patients, ≥20 years of age, of both genders, were recruited for this comparative study. Nine single nucleotide polymorphisms (SNPs) were selected for genetic investigation: rs182549and rs4988235(both considered "gold standard"); rs56064699; rs148142676; rs562211644; rs59533246; rs3754689; rs2278544,and rs10552864(as potential novel SNPs). Sensitivity and specificity, as well as positive and negative predictive values, were calculated for each genotype using WINPEPI version 11.65. Differences between positive and negative OLTT groups were considered statistically significant when p ≤ 0.05. RESULTS: Among the selected SNPs, only rs182549(p < 0.001) and rs4988235(p < 0.001) gave similar results compared to an OLTT. The sensitivity of both SNPs to detect LI was 87 and 86%, and specificity was 83 and 82.5%, respectively. CONCLUSION: Genetic tests using rs182549and rs4988235SNPs showed high agreement with OLTT. These genetic tests may be a good option to replace OLTT in MetS patients.

[Gastrointestinal and hepatic diseases]. / Enfermedades gastrointestinales y hepáticas.

Diet is considered an important triggering factor for gastrointestinal symptoms whose physiopathology includes not only measurable, inflammatory reactions, but also functional disorders, where no organic effects may be measured or demonstrated. Moreover, the prevalence of the perceived intolerance to certain foods ranges from 20-25% (within the general population) to 50-70% in diseases like irritable bowel syndrome. This intolerance has been observed particularly after the consumption of milk and dairy products, which are frequently considered as causative of gastrointestinal symptoms, thus limiting their ingestion. However, this behavior reduces the dietary sources of calcium and consequently may lead to malnutrition and bone decalcification, amongst other complications. The true dairy intolerance (intestinal lactase deficiency) explains most of the symptoms ensuing their consumption, but the frequency of such alteration on the different gastrointestinal diseases has not been determined. This review focuses on the most frequent gastrointestinal diseases and the existing evidence regarding the alterations and symptoms related to the consumption of milk or dairy products.

Comparison of Quick Lactose Intolerance Test in duodenal biopsies of dyspeptic patients with single nucleotide polymorphism LCT-13910C>T associated with primary hypolactasia/lactase-persistence / Comparação do Teste Quick de Intolerância à Lactose em biópsias duodenais de pacientes dispépticos com polimorfismo de nucleotídeo único LCT-13910C>T associado com hipolactasia primária/lactase persistente

PURPOSE: To analyze the usefulness of Quick Lactose Intolerance Test in relation to the genetic test based on LCT-13910C>T genotypes, previously validated for clinical practice, for primary hypolactasia/lactase-persistence diagnosis. METHODS: Thirty-two dyspeptic patients that underwent upper gastrointestinal endoscopy entered the study. Two postbulbar duodenal biopsies were taken for the Quick test, and gastric antral biopsy for DNA extraction and LCT-13910C>T polymorphism analysis. DNA was also extracted from biopsies after being used in the Quick Test that was kept frozen until extraction. RESULTS: Nine patients with lactase-persistence genotype (LCT-13910CT or LCT-13910TT) had normolactasia, eleven patients with hypolactasia genotype (LCT-13910CC) had severe hypolactasia, and among twelve with mild hypolactasia, except for one that had LCT-13910CT genotype, all the others had hypolactasia genotype. The agreement between genetic test and quick test was high (p<0.0001; Kappa Index 0.92). Most of the patients that reported symptoms with lactose-containing food ingestion had severe hypolactasia (p<0.05). Amplification with good quality PCR product was also obtained with DNA extracted from biopsies previously used in the Quick Test; thus, for the future studies antral gastric biopsies for genetic test would be unnecessary. CONCLUSION: Quick test is highly sensitive and specific for hypolactasia diagnosis and indicated those patients with symptoms of lactose intolerance.(AU)

OBJETIVO: Analisar a aplicabilidade do Teste Quick de Intolerância à Lactose em relação ao teste genético baseado nos genótipos LCT-13910C>T, previamente validado para a prática clínica, para diagnóstico de má digestão primária de lactose/digestão de lactose. MÉTODOS: Trinta e dois pacientes dispépticos submetidos à endoscopia digestiva entraram no estudo. Duas biópsias duodenais pós-bulbares foram empregadas no Teste Quick, e biópsia do antro gástrico para extração de DNA e análise do polimorfismo LCT-13910C>T. DNA também foi extraído de biópsias depois de terem sido usadas no teste Quick, e conservadas congeladas. RESULTADOS: Nove pacientes com genótipo de lactase persistente (LCT-13910CT ou LCT-13910TT) tinham normolactasia, onze pacientes com genótipo de hipolactasia (LCT-13910CC) tinham hipolactasia severa, e entre doze com hipolactasia leve, com exceção de uma que tinha genótipo LCT-13910CT, todos os demais tinham genótipo de hipolactasia. A concordância entre o teste genético e o Quick Teste foi alta (p<0,0001; Índice Kappa=0,92). A maioria dos pacientes que relataram sintomas com ingestão de alimentos com lactose tinham hipolactasia severa (p<0,05). Amplificação com produto de PCR foi obtido com DNA extraído das biópsias usadas no teste Quick; portanto, nos trabalhos futuros seria desnecessário coletar biópsia do antro gástrico para o teste genético. CONCLUSÃO: O Teste Quick é altamente sensível e específico para diagnóstico de hipolactasia e indicou aqueles pacientes com sintomas de intolerância à lactose.(AU)

Is it just lactose intolerance?

Acquired delayed-onset hypolactasia is a common autosomal recessive condition. Cow's milk allergies, conversely, are less common conditions that may manifest with equivalent symptoms and are able to simulate and/or aggravate lactose intolerance. This study was designed to evaluate the contribution of IgE-mediated cow's milk sensitization to the symptomatology of adult patients with lactose-free diet refractory lactose intolerance. Forty-six adult patients with lactose intolerance and persistent symptoms despite a lactose-free diet underwent skin-prick test to investigate cow's milk, goat's milk, and soy protein-specific-IgE. SDS-PAGE immunoblotting was used to investigate the presence of cow's milk protein-specific IgE. The percentage of patients who had skin reactions to whole cow's milk, alpha-lactalbumin, beta-lactoglobulin, caseins, goat's milk, and soy was 69.5, 36.9, 56.5, 56.5%, 54.3, and 50%, respectively. The percentage of patients with immunoblot-detected IgE specific for alpha-lactalbumin, beta-lactoglobulin, caseins, and bovine serum albumin was 21.7, 63, 67.3, and 2.1%, respectively. IgE-mediated sensitization to cow's milk is a frequent comorbidity in subjects with lactose-free diet refractory lactose intolerance and is worth consideration in patients with this condition.

[Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial]. / Digestión deficiente e intolerancia a lactosa en un grupo de enfermos con colitis ulcerativa crónica inespecífica: Ensayo clínico controlado, cruzado y doblemente a ciegas.

INTRODUCTION: Despite the fact that the frequency of hypolactasia and lactose intolerance is similar in both chronic idiopathic ulcerative colitis patients and the general population, the elimination of dairy products from the patient's diet is a habitual recommendation. Hypolactasia is common in Mexico, but its relation to chronic idiopathic ulcerative colitis has not been established. AIMS: To evaluate lactose digestion and lactose intolerance in persons with chronic idiopathic ulcerative colitis. MATERIAL AND METHODS: Thirty-nine patients with confirmed chronic idiopathic ulcerative colitis diagnosis were included in the study (mean: 31 years, range: 15 to 38). Twenty-two patients presented with rectosigmoid involvement and the remaining patients with pancolitis. No patient showed inflammatory activity according to the Truelove-Witts criteria and all consumed dairy products before diagnosis. A prospective, controlled, double-blind, cross-over study was designed. Patients randomly received 12.5 g of lactose or maltose in 250 cc water- each test 72 hours apart - and ydrogen was measured in exhaled air before disaccharide ingestion and then every 30 minutes for 3 hours. Digestion was considered deficient when there was an increase in hydrogen of at least 20 ppm. Symptom intensities were evaluated by Visual Analog Scales before, during, and after the hydrogen test. Differences between the groups were contrasted with the Mann-Whitney U and the Wilcoxon tests. RESULTS: Eighteen patients (46%) presented with deficient lactose digestion. No significant differences were found in the symptoms, extension, or progression of chronic idiopathic ulcerative colitis between patients that could digest and those that could not digest lactose. No patient had symptom exacerbation with the disaccharides used. CONCLUSIONS: Lactose digestion deficiency frequency is similar in subjects with chronic idiopathic ulcerative colitis and in healthy individuals in Mexico. We do not know whether higher doses could have some effect, but symptoms in patients with inactive chronic idiopathic ulcerative colitis were not modified using 12.5 g of lactose/day.

Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients.

BACKGROUND: The efficacy of some probiotic strains for the management of lactose intolerance remains to be established. AIM: To evaluate the effects of a 4-week consumption of a probiotic product containing Lactobacillus casei Shirota and Bifidobacterium breve Yakult (10(7)-10(9) CFU of each strain) on symptoms and breath hydrogen exhalation after a lactose load in lactose-intolerant patients and whether the beneficial results persisted after probiotic discontinuation. METHODS: Twenty-seven patients with lactose maldigestion and intolerance participated in this study, which comprised 4 hydrogen breath tests: baseline condition (20 g lactose), after lactase ingestion (9000 FCC units), at the end of 4-week probiotic supplementation, and a follow-up test performed 3 months after probiotic discontinuation. For each test, the area under the breath hydrogen concentration vs time curve (AUC(180 min)) was calculated, and symptom scores were recorded. RESULTS: The probiotic combination significantly reduced symptom scores (P < .01) and breath hydrogen AUC (P = .04) compared with the baseline condition. The comparison with the lactase test showed that symptom scores were similar (P > .05), despite the significantly higher (P = .01) AUC values after probiotic use. In the follow-up test, symptom scores and breath hydrogen AUC values remained similar to those found at the end of probiotic intervention. CONCLUSION: Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.

Lactulose hydrogen breath test and functional symptoms in pediatric patients.

BACKGROUND: The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H(2) breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. METHODS: Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H(2) concentration of 20 ppm over basal. RESULTS: There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p\0.05. In 39% of patients, rise of H(2) occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p\0.05). Symptoms were unrelated to time to 20-ppm change. CONCLUSIONS: An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.

[Flatulence]. / Flatulencia.

At present physicians focus their medicine studies in well defined illnesses as peptic ulcer, gastric cancer, ulcerative colitis and so on. However, patients reveal their discomfort to us, that is their symptoms or group of symptoms (syndromes). For this reason, our concern for many years has been the study of symptoms and syndromes. In this review we will be looking at the concepts and information gathered with respect to intestinal gases, clinically known as flatulence.

Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans.

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 groups 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 (1) 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.

Intolerancia a lactosa en el niño. Antecedentes / Lactose intolerance in children. A historical review

Se hace una revisión de los primeros trabajos sobre intolerancia a la lactosa en niños con gastroenteritis realizados en México. En 1963 en el Hospital de Pediatría del Centro Médico Nacional del IMSS se investigó la presencia de azúcares reductoras en heces. En 1968 se establecieron pautas para el diagnóstico y tratamiento de la intolerancia a la lactosa en niños con gastroenteritis y se diseñaron fórmulas con harina de soya, carne de pollo y caseinato de calcio para sustituir la fórmula láctea. Se confirmó la utilidad de las cintas y tabletas reactivas y curvas de tolerancia a la lactosa en el diagnóstico de intolerancia a la lactosa en el diagnóstico de intolerancia a los carbohidratos. En 1979 se realizó por primera vez la determinación de hidrógeno espirado como prueba diagnóstica de intolerancia a la lactosa y se realizaron diversos estudios metabólicos, uno de ellos comparando proteínas de soya y garbanzo demostrándose igual valor nutricio. Se comenta sobre las ventajas de las fórmulas lácteas sin lactosa

Avaliaçäo da absorçäo intestinal de açúcares em crianças desnutridas com diarréia aguda / Evaluate intestinal sugar absorption in malnourished children by acute diarrhea

Foram estudadas 18 crianças desnutridas com diarréia aguda e desidrataçäo, idades variando de 4 a 60 meses, com o objetivo de avaliar a absorçäo de açúcares. De acordo com Gomez, 13 (62,3 por cento) eram desnutridas de 1§ grau, quatro (22,2 por cento) de 2§ grau e uma (5,5 por cento) de 3§ grau. Quatorze (77,6 por cento) pacientes apresentaram enteropatógenos nas fezes: bactérias enteropatôgenicas em sete (38,8 por cento), Giardia lamblia em três (16,6 por cento) e rotavirus em quatro (22,2 por cento). Após a estabilizaçäo clínica dos pacientes, foram realizadas provas de absorçäo da D-xilose e lactose, determinaçäo do pH e das substâncias redutoras (SR) das fezes. Dos 18 pacientes, 16 (89,0 por cento) apresentaram as provas de absorçäo alteradas e/ou pH fecal ácido (<6,0)...

[Importance of nutritional status in digestion capacity and lactose tolerance]. / Importancia del estado nutricio en la capacidad de digestión y tolerancia a la lactosa.

The aim of this study is to determine the capacity of undernourished patients to digest and tolerate the lactose in milk administered by tube-feeding. It was a controlled double-blind crossover trial in 25 hospitalized patients who required enteral feeding due to medical reasons. They were divided in two groups differing by nutritional status: 10 patients in Group 1 were malnourished with a mean weight for height of 69% (+/-15% SD) of their ideal one; Group 2 had 15 well nourished patients (mean weight for height of 103 +/- 15%). Each patient received two dietary treatments: intact milk and hydrolyzed milk (> 90% of lactose hydrolyzed). Lactose digestion was measured by the hydrogen breath test. Hydrogen excretion with intact milk was 505 +/- 117 ppm in Group 1 versus 58 +/- 15 ppm in the control group. With hydrolyzed milk, these values were 53 +/- 27 and 14 +/- 23, respectively. The scoring of symptoms after drinking intact milk was 4.3 +/- 0.7 in Group 1 vs 1.5 +/- 0.3 in Group 2, and they were lower with hydrolyzed milk (0.5 +/- 0.2 vs 0.3 +/- 0.2 respectively). The undernourished group had a higher incidence of both lactose maldigestion (p < 0.0001) and lactose intolerance (p < 0.001) than the control group. Our results strongly suggest that undernourishment is accompanied always or almost always by lactose intolerance.

Gastrointestinal dysfunction and disaccharide intolerance in children infected with human immunodeficiency virus.

Because gastrointestinal dysfunction is a major problem in children with human immunodeficiency virus (HIV) infection, we utilized breath hydrogen measurements to determine the relationship between disaccharide malabsorption and gastrointestinal dysfunction in HIV-infected children. We found a strong association between lactose intolerance and persistent diarrheal disease in this population (p less than 0.007, Mann-Whitney U test). We also found evidence of sucrose malabsorption and persistent diarrheal disease in three of the children. Extensive microbiologic evaluations failed to reveal an etiologic agent related to the occurrence of gastrointestinal symptoms. Our findings indicate that disaccharide intolerance is a common occurrence in HIV-infected children with persistent diarrheal disease. Careful attention to dietary intake may be required to ameliorate clinical symptoms and to maintain adequate nutrition.

Persistent diarrhoea in the community. Characteristics and risk factors.

In 58 previously well-nourished patients who were fed cow's milk and who later developed persistent diarrhoea (greater than or equal to 15 days), data obtained during the first 8 days of acute diarrhoea were compared with those of patients whose episodes lasted less than or equal to 8 days. Children with persistent diarrhoea weighted less at birth, passed greater than or equal to 6 stools/day during the first 48 hours, received early treatment with antibiotics. Their milk feedings were stopped during the first 48 hours, they had a past history of digestive diseases and hospitalizations, they were brought in for consultation after 5 days of symptoms and their nutritional status deteriorated more (p less than 0.003, p less than 0.03, p less than 0.0001, p less than 0.0001, p less than 0.0001, p less than 0.002, p less than 0.0001, and p less than 0.03, respectively). Their mothers were significantly younger (p less than 0.0013), had better schooling (p less than 0.037), and fewer children (p less than 0.044), and were separated from the index child during the day more often (p less than 0.056). After persistent diarrhoea was diagnosed, enteropathogens in stools or lactose intolerance or both were demonstrated in 75.9%. Treatment induced remission in all cases. Using logistic regression a predictive model was established which enables us to identify, among patients with acute diarrhoea, those at risk of prolonging their illness.

Ensayo de leche con bajo contenido de lactosa en diarrea aguda / Trial of milk with low-lactose contents in acute diarrhea

Se estudiaron 50 lactantes con diarrea de menos de cinco días de evolución, de los cuales la mitad se realimentó con una leche con bajo contenido de lactosa (grupo experimental) y los restantes con una fórmula láctea en polvo (grupo control). Durante un seguimiento de 2 meses evaluaron el curso clínico, los cambios antropométricos y la tolerancia a los prodctos. La evolución clínica, las etiologías y la duración promedio de los episodios (3,6 + ou - 1,9 y 3,9 + ou - 1,9 días en experimentales y controles, respectivamente) fueron comparables en ambos grupos. No se observó deterioro nutricional durante ni después del episodio. En 2 niños (8,3%) del grupo control fue necesario administrar la leche sin lactosa para que remitieran los sintomas. La aceptabilidad a ambos productos fue satisfactoria. Estos resultados sugieren que la utilización de productos con bajo contenido de lactosapuede ser ventajosa en el manejo clínico de lactantes con diarrea aguda y evidencia de intolerancia por lactosa

[Trial of milk with low-lactose contents in acute diarrhea]. / Ensayo de leche con bajo contenido de lactosa en diarrea aguda.

Fifty infants with acute diarrhea (less than or equal to 5 days of duration) were refed with either a low-lactose formula (experimental group, N = 25) or whole powdered cow's milk (control group, N = 25). During a two-month follow up etiology, clinical course, changes of anthropometric parameters and tolerance to the milk products were evaluated. The etiology of diarrhoea, the mean duration of the episodes (3.6 +/- 1.9 and 3.9 +/- 1.9 days in the experimental and control group, respectively) and the clinical course were comparable in both groups. Nutritional parameters remained unchanged during and after the episode. In two children (8.3%) of the control group stools continued to be liquid, fecal pH was 5 and reducing substances were positive. They had to be refed with the low-lactose product to induce remission of the symptoms. Both products were well tolerated. These findings suggest that availability of low-lactose formulae may be advantageous in the clinical management of infants with acute diarrhea and evidence of lactose intolerance.