Hydrogen and Methane Breath Test in the Diagnosis of Lactose Intolerance.

The hydrogen (H2) breath test is a non-invasive investigation used to diagnose lactose intolerance (LI). Patients with LI may also expire increased amounts of methane (CH4) during a lactose test. The aim of this study is to evaluate the contribution of CH4 measurements. We tested 209 children (1-17 years old) with symptoms suggesting LI with lactose H2 and CH4 breath tests. The result was positive when the H2 excretion exceeded 20 parts per million (ppm) and the CH4 was 10 ppm above the baseline. A clinician, blinded for the results of the breath test, registered the symptoms. Of the patient population, 101/209 (48%) were negative for both H2 and CH4; 96/209 (46%) had a positive H2 breath test result; 31/96 (32%) were also positive for CH4; 12/209 (6%) patients were only positive for CH4. The majority of hydrogen producers showed symptoms, whereas this was only the case in half of the H2-negative CH4 producers. Almost all patients treated with a lactose-poor diet reported significant symptom improvement. These results indicate that CH4 measurements may possibly be of additional value for the diagnosis of LI, since 5.7% of patients were negative for H2 and positive for CH4, and half of them experienced symptoms during the test.

Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management.

Recent discoveries in the "omics" field and the growing focus on preventive health have opened new avenues for personalized nutrition (PN), which is becoming an important theme in the strategic plans of organizations that are active in healthcare, food, and nutrition research. PN holds great potential for individual health optimization, disease management, public health interventions, and product innovation. However, there are still multiple challenges to overcome before PN can be truly embraced by the public and healthcare stakeholders. The diagnosis and management of lactose intolerance (LI), a common condition with a strong inter-individual component, is explored as an interesting example for the potential role of these technologies and the challenges of PN. From the development of genetic and metabolomic LI diagnostic tests that can be carried out in the home, to advances in the understanding of LI pathology and individualized treatment optimization, PN in LI care has shown substantial progress. However, there are still many research gaps to address, including the understanding of epigenetic regulation of lactase expression and how lactose is metabolized by the gut microbiota, in order to achieve better LI detection and effective therapeutic interventions to reverse the potential health consequences of LI.

Lactose intolerance: An update on its pathogenesis, diagnosis, and treatment.

Lactose intolerance has a high prevalence worldwide, ranging between 57% and 65%. It is caused by a reduction or loss of the activity of the intestinal enzyme lactase-phlorizin hydrolase, responsible for the digestion of lactose. This alteration determines an increased osmotic load in the small intestine and the fermentation of lactose by the bacterial flora, which leads to a high production of short-chain fatty acids and gas. This is followed by the onset of abdominal pain, diarrhea, and flatulence. In addition to these problems, it was found that subjects with lactose intolerance have an increased risk of developing various extra-intestinal diseases, including cancers. The diagnosis is essential to undertake an adequate treatment and, for this purpose, different methods have been tested. These include genetic test, hydrogen breath test (HBT), quick lactase test, and lactose tolerance test. HBT is the most used method because it is non-invasive, inexpensive, and highly sensitive and specific, as well as easy to perform. In clinical practice, the other methods are mainly used as HBT integration tests. There are also many therapeutic options. An appropriate intervention concerns the dietetic style, such as the consumption of lactose-free foods, but with nutritional characteristics comparable to dairy products. Other valid choices are represented by the use of exogenous enzymes, probiotics, prebiotics, the selection of milk containing specific types of beta-caseins. This review is intended to illustrate the diagnostic methods currently available and the possible therapeutic options for lactose intolerance.

The self-management work of food hypersensitivity.

BACKGROUND: Food hypersensitivity (FH) has received considerable attention in the scientific community in recent years. However, little attention has been given to the efforts people make to manage their FH. We aimed to explore these efforts by using Normalization Process Theory, which is a conceptual framework formerly used to describe the self-management 'work' of long-term conditions. METHODS: We carried out qualitative individual interviews with 16 women with FH. Transcripts from recorded interviews were analyzed using template analysis. RESULTS: 16 women participated; some had diagnoses from conventional medicine (celiac disease, lactose intolerance, food allergies, irritable bowel syndrome) and some did not. Participants described carrying out several tasks, some of which were time-consuming, to manage their FH. Women who had clarified once and for all what food(s) caused symptoms, described that they could concentrate on carrying out a restricted diet, which could become routine. Conversely, participants who had not achieved such clarification described carrying out tasks to identify what food(s) caused symptoms, and to implement and evaluate a tentative diet. Participants' descriptions also revealed a heightened vigilance when they ate food that others had prepared, and some made efforts to conceal their FH. CONCLUSIONS: Self-management of FH may, like the self-management of other long-term conditions, imply a large workload and burden of treatment. Efforts made to conceal FH may be considered part of this workload, while help in clarifying which food(s) cause symptoms has the potential to reduce the workload.

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders.

Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.

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

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

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

[Myths and fallacies in relation to the consumption of dairy products]. / Mitos y falacias en relación al consumo de productos lácteos.

INTRODUCTION: In recent years the consumption of milk has declined, which could be due to the many myths and fallacies that exist about this food and other dairy products. Affirmations such as: "cow's milk is ideal for calves not humans", "humans are the only animals that drink milk beyond infancy", "milk lead to mucus production or occurrence of asthma" or "milk increases cholesterol levels", among others, are present in many conversations of the general population. However, due to the high nutritional value of dairy products, the elimination/restriction of these foods of our diet, without the existence of circumstances that support it, can have negative repercussions for health. Therefore, it is necessary to dismantle all these myths with scientific arguments.

INTRODUCCIÓN: En los últimos años el consumo de leche ha descendido, lo que podría deberse a los numerosos mitos y falacias que circulan por distintos medios en torno a este alimento y a otros productos lácteos. Afirmaciones como "la leche de vaca es para los terneros, no para los humanos", "somos el único mamífero que sigue tomando leche en la edad adulta", "la leche produce mocos y asma" o "la leche aumenta el colesterol", entre otras, están presentes en muchas conversaciones de la población general. Sin embargo, por su elevado valor nutricional, la eliminación/restricción de estos alimentos de nuestra dieta, sin la existencia de circunstancias que las avalen, puede tener repercusiones negativas para la salud. Por ello, es necesario desmontar todos estos mitos con argumentos científicos.

Effects of Conventional Milk Versus Milk Containing Only A2 ß-Casein on Digestion in Chinese Children: A Randomized Study.

OBJECTIVES: In this study, we hypothesized that replacing conventional milk, which contains A1 and A2 ß-casein proteins, with milk that contains only A2 ß-casein in the diet of dairy or milk-intolerant preschoolers (age 5 to 6 years) would result in reduced gastrointestinal symptoms associated with milk intolerance, and that this would correspond with cognitive improvements. METHODS: This randomized, double-blind, crossover study aimed to compare the effects of 5 days' consumption of conventional milk versus milk containing only A2 ß-casein on gastrointestinal symptoms, as assessed via visual analog scales, average stool frequency and consistency, and serum inflammatory and immune biomarkers in healthy preschoolers with mild-to-moderate milk intolerance. The study also aimed to compare changes in the cognitive behavior of preschoolers, based on Subtle Cognitive Impairment Test scores. RESULTS: Subjects who consumed milk containing only A2 ß-casein had significantly less severe gastrointestinal symptoms as measured by visual analog scales, reduced stool frequency, and improvements in stool consistency, compared with subjects consuming conventional milk. There were significant increases from baseline in serum interleukin-4, immunoglobulins G, E, and G1, and beta-casomorphin-7 coupled to lower glutathione levels, in subjects consuming conventional milk compared with milk containing only A2 ß-casein. Subtle Cognitive Impairment Test analysis showed significant improvements in test accuracy after consumption of milk containing only A2 ß-casein. There were no severe adverse events related to consumption of either milk product. CONCLUSIONS: Replacing conventional milk with milk containing only A2 ß-casein reduced gastrointestinal symptoms associated with milk intolerance in Chinese preschool children, with corresponding improvements in aspects of cognitive performance.

Mitos y falacias en relación al consumo de productos lácteos / Myths and fallacies in relation to the consumption of dairy products

En los últimos años el consumo de leche ha descendido, lo que podría deberse a los numerosos mitos y falacias que circulan por distintos medios en torno a este alimento y a otros productos lácteos. Afirmaciones como "la leche de vaca es para los terneros, no para los humanos", "somos el único mamífero que sigue tomando leche en la edad adulta", "la leche produce mocos y asma" o "la leche aumenta el colesterol", entre otras, están presentes en muchas conversaciones de la población general. Sin embargo, por su elevado valor nutricional, la eliminación/restricción de estos alimentos de nuestra dieta, sin la existencia de circunstancias que las avalen, puede tener repercusiones negativas para la salud. Por ello, es necesario desmontar todos estos mitos con argumentos científicos

In recent years the consumption of milk has declined, which could be due to the many myths and fallacies that exist about this food and other dairy products. Affirmations such as: "cow's milk is ideal for calves not humans", "humans are the only animals that drink milk beyond infancy", "milk lead to mucus production or occurrence of asthma" or "milk increases cholesterol levels", among others, are present in many conversations of the general population. However, due to the high nutritional value of dairy products, the elimination/restriction of these foods of our diet, without the existence of circumstances that support it, can have negative repercussions for health. Therefore, it is necessary to dismantle all these myths with scientific arguments

An Examination of Medically Necessary Diets within the Framework of the Thrifty Food Plan.

The Thrifty Food Plan (TFP) determines the maximum allotment of nutrition assistance for over forty million Americans participating in the Supplemental Nutrition Assistance Program (SNAP). This research recalculates the official TFP allocations using a more straightforward model that minimizes cost subject to nutrient constraints to establish a baseline for adult females and males. We then examine three additional diet plans to evaluate their feasibility under the current SNAP benefit allotment: a diet for lactose intolerance, for persons with type 2 diabetes, and a diet for pregnant women. The first model calculates a diet plan that contains no fluid milk, taking into account that 1 in 4 Americans is lactose intolerant. The second model calculates a diet plan that is lower in carbohydrates (grains and fruits comprise less than 45% of calories), reflecting a recommended diet for a person with type 2 diabetes, approximately 10% of the U.S. population. The third model includes the Institute of Medicine's recommended diet for pregnancy. In each case, total daily cost per individual and allocation across food groups were compared. Our Lactose Intolerance, Type 2 Diabetes, and Pregnancy model for 20-50 year old females all return minimum food costs above the TFP budget allocation. This research demonstrates how the TFP provides an unrealistic assessment of need among 20-50 year old females with relatively common dietary needs. Results indicate that equalizing the TFP budget allocations between men and women would better accommodate the heterogeneous needs of America's poorest individuals.

Lactose-Free Dairy Products: Market Developments, Production, Nutrition and Health Benefits.

Lactose-free dairy is able to provide the essential nutrients present in regular dairy products, like calcium and vitamins, to those that are not able to digest lactose. This product category currently has a wide and growing health appeal to consumers. In recent years, the quality and product variety in the lactose-free dairy segment has been increasing significantly, giving consumers more tempting products to decide from. As a result, lactose-free dairy is now the fastest growing market in the dairy industry. This review discusses the market developments and production possibilities and issues related to the wide variation of lactose-free dairy products that are currently available. Additionally, the health benefits that lactose-free dairy may offer compared to dairy avoidance are illustrated.

Lactose intolerance: what is a correct management?

Individuals with Lactose Intolerance (LI) tend to exclude milk from their diet since this behavior seems to relieve the symptoms caused by the disease. However, milk is a food of high nutritional value, and complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. The objective of this review was to evaluate the scientific evidence on the adequate management of patients with LI. This study was carried out from the review of the scientific literature in PubMed and SciELO databases. Complete exclusion of conventional dairy products is not necessary since most individuals with LI can tolerate up to 12 grams of lactose daily in a single dose. Yogurts and cheeses matured for having low amounts of lactose are part of the strategy that allows consumption of dairy products by patients with LI. Currently, there is a diversity of products considered as "milk substitutes" and supplements aimed at individuals with LI. However, these strategies still require better-designed studies.

Lactose intolerance: what is a correct management?

SUMMARY Individuals with Lactose Intolerance (LI) tend to exclude milk from their diet since this behavior seems to relieve the symptoms caused by the disease. However, milk is a food of high nutritional value, and complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. The objective of this review was to evaluate the scientific evidence on the adequate management of patients with LI. This study was carried out from the review of the scientific literature in PubMed and SciELO databases. Complete exclusion of conventional dairy products is not necessary since most individuals with LI can tolerate up to 12 grams of lactose daily in a single dose. Yogurts and cheeses matured for having low amounts of lactose are part of the strategy that allows consumption of dairy products by patients with LI. Currently, there is a diversity of products considered as "milk substitutes" and supplements aimed at individuals with LI. However, these strategies still require better-designed studies.

RESUMO Os indivíduos com Intolerância à Lactose (IL) tendem a excluir o leite da alimentação, uma vez que essa conduta parece aliviar os sintomas ocasionados pela doença. Entretanto, o leite é um alimento de alto valor nutricional e a exclusão completa dos laticínios pode favorecer o desenvolvimento de doenças ósseas como osteopenia e osteoporose. O objetivo desta revisão foi avaliar as evidências científicas sobre o manejo adequado de pacientes com IL. Este estudo foi realizado a partir da revisão da literatura científica nas bases de dados PubMed e SciELO. A exclusão completa dos produtos lácteos convencionais não é necessária, pois a maior parte dos indivíduos com IL consegue tolerar diariamente até 12 g de lactose em uma única dose. Os iogurtes e queijos maturados, por terem baixa quantidade de lactose, fazem parte da estratégia que garante consumo de produtos lácteos por pacientes com IL. Atualmente existe uma diversidade de produtos considerados "substitutos do leite" e suplementos voltados para os indivíduos com IL, no entanto, essas estratégias ainda requerem estudos mais bem desenhados.

Analysis of lactase in lactose intolerance supplements.

Lactase is the enzyme responsible for the digestion of the disaccharide lactose, and deficiency in this enzyme causes the prevalent medical condition lactose intolerance. Management of lactose intolerance can be achieved through the administration of lactase supplements. Lactase is an appropriate platform for advanced enzymatic study because its medical application is a motivator for student learning. The following is an upper-level biochemistry laboratory sequence that integrates student inquiry and exposure to advanced laboratory techniques. Students investigate three different lactase supplements through experimentation that includes the Bradford assay, SDS-PAGE, continuous and discontinuous kinetic assays, and zymography. Upon completion of this project, students compile their results and conclusions in a scientifically formatted paper comparing supplement protein content and activity. This safe and inexpensive laboratory project enriches student understanding of key biochemical concepts while mirroring work performed in a realistic research setting. © 2018 International Union of Biochemistry and Molecular Biology, 46(6):652-662, 2018.

[Yogurt and dietary recommendations for lactose intolerance]. / El yogur y recomendaciones dietéticas en la intolerancia a la lactosa.

Malabsorption to lactose is caused by the inability to digest sugar due to the decrease in the activity of intestinal lactase. Malabsorption may be due to a primary or secondary disorder. Adult type primary hypolactasia is an autosomal recessive disorder, characterized by the progressive loss of lactase after weaning. The secondary hypolactasia is a transitory disorder, which will be corrected after the cure of the basic pathology. For lactose malabsorption diagnosis, the hydrogen and methane exhaled tests after lactose overload stand out and, in the case of the primary adult type, the molecular test of the simple nucleotide polymorphism (SNP C / T-13910). However, the diagnosis of lactose intolerance requires the presence of symptoms after consumption. The treatment of primary adult-type hypolactasia consists in decreasing the lactose in the diet below the trigger dose. A significant percentage of individuals with malabsorption tolerate habitual amounts of consumption. Practically 99% of them tolerate yogurt or fermented dairy products, thus allowing to cover the daily recommendations of calcium and vitamin D intake. In addition, nutritional strategies that reduce the lactose load, gastric emptying time and / or intestinal transit time or increase lactic activity and colonic compensation, will allow a greater tolerance.

La malabsorción de la lactosa se produce por la incapacidad para la digestión del azúcar debido a la disminución de la actividad de la lactasa intestinal tras un desorden primario o secundario a otras patologías.La hipolactasia primaria tipo adulto es un trastorno autosómico recesivo, caracterizado por la pérdida progresiva de lactasa tras el destete, mientrasque la secundaria es un trastorno transitorio que se corregirá tras la curación de la patología de base. Para el diagnóstico de la malabsorción a la lactosa destacan los test de hidrógeno y metano espirado tras sobrecarga. En el déficit primario tardío de lactasa puede realizarse el test molecular del polimorfismo de nucleótido simple (SNP C/T-13910). El diagnóstico de la intolerancia precisa de la presencia de sintomatología tras el consumo de lactosa.El tratamiento de la hipolactasia primaria tipo adulto consiste en disminuir la lactosa de la dieta por debajo de la dosis gatillo. Un porcentaje importante de individuos con malabsorción toleran cantidades habituales de consumo y prácticamente el 99% toleran yogur o derivados lácteos fermentados, lo que permite así cubrir las recomendaciones diarias de ingesta de calcio y vitamina D. Además, estrategias nutricionales que reduzcan la carga de lactosa, el tiempo de vaciamiento gástrico y/o el tiempo de tránsito intestinal o que incrementen la actividad lactásica y la compensación colónica van a permitir una mayor tolerancia.

El yogur y recomendaciones dietéticas en la intolerancia a la lactosa / Yogurt and dietary recommendations for lactose intolerance

La malabsorción de la lactosa se produce por la incapacidad para la digestión del azúcar debido a la disminución de la actividad de la lactasa intestinal tras un desorden primario o secundario a otras patologías. La hipolactasia primaria tipo adulto es un trastorno autosómico recesivo, caracterizado por la pérdida progresiva de lactasa tras el destete, mientras que la secundaria es un trastorno transitorio que se corregirá tras la curación de la patología de base. Para el diagnóstico de la malabsorción a la lactosa destacan los test de hidrógeno y metano espirado tras sobrecarga. En el déficit primario tardío de lactasa puede realizarse el test molecular del polimorfismo de nucleótido simple (SNP C/T-13910). El diagnóstico de la intolerancia precisa de la presencia de sintomatología tras el consumo de lactosa. El tratamiento de la hipolactasia primaria tipo adulto consiste en disminuir la lactosa de la dieta por debajo de la dosis gatillo. Un porcentaje importante de individuos con malabsorción toleran cantidades habituales de consumo y prácticamente el 99% toleran yogur o derivados lácteos fermentados, lo que permite así cubrir las recomendaciones diarias de ingesta de calcio y vitamina D. Además, estrategias nutricionales que reduzcan la carga de lactosa, el tiempo de vaciamiento gástrico y/o el tiempo de tránsito intestinal o que incrementen la actividad lactásica y la compensación colónica van a permitir una mayor tolerancia

Malabsorption to lactose is caused by the inability to digest sugar due to the decrease in the activity of intestinal lactase. Malabsorption may be due to a primary or secondary disorder. Adult type primary hypolactasia is an autosomal recessive disorder, characterized by the progressive loss of lactase after weaning. The secondary hypolactasia is a transitory disorder, which will be corrected after the cure of the basic pathology. For lactose malabsorption diagnosis, the hydrogen and methane exhaled tests after lactose overload stand out and, in the case of the primary adult type, the molecular test of the simple nucleotide polymorphism (SNP C / T-13910). However, the diagnosis of lactose intolerance requires the presence of symptoms after consumption. The treatment of primary adult-type hypolactasia consists in decreasing the lactose in the diet below the trigger dose. A significant percentage of individuals with malabsorption tolerate habitual amounts of consumption. Practically 99% of them tolerate yogurt or fermented dairy products, thus allowing to cover the daily recommendations of calcium and vitamin D intake. In addition, nutritional strategies that reduce the lactose load, gastric emptying time and / or intestinal transit time or increase lactic activity and colonic compensation, will allow a greater tolerance

Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia.

Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow’s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable.

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.

Gastrointestinal Symptoms and FODMAP Intake of Aged-Care Residents from Christchurch, New Zealand.

Studies on fermentable oligo-, di-, and monosaccharides as well as polyols (FODMAPs) intake in older adults are lacking. This study investigated the relationship between gastrointestinal (GI) symptoms and FODMAPs in aged care residents. The Gastrointestinal Symptom Rating Score questionnaire modified for patients with IBS (GSRS-IBS) was used to identify participants with IBS-like symptoms. Dietary intake was assessed for a subgroup of participants with highest total GSRS-IBS score (symptomatic cases) and age, sex, and level of care matched participants with low total GSRS-IBS score (asymptomatic controls). Seventy-four participants with a mean (SD) age of 86 (6.6) years completed the GSRS-IBS questionnaire and dietary data were collected using food diaries from a subsample of 27 symptomatic and 27 asymptomatic participants. The study found many older adults with functional gut symptoms. There were no differences between the groups for FODMAP intake and no significant relationship was found between FODMAP intake and total GSRS-IBS score. Lactose from milk and milk-based desserts was the biggest FODMAP contributor (16 g/day) and a significant relationship between total FODMAP intake and diarrhoea was found. A larger study sample in future studies is required to better capture symptomatic cases and manipulation of dietary FODMAPs may assist with the management of IBS in the elderly.