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

Abstract

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.

Vitamin D Levels and Bone Mineral Density in Inborn Errors of Metabolism Requiring Specialised Diets

“…Many studies in literature, including meta-analyses, have evaluated the relationship of 25(OH)D levels and BMD of children with IEM consuming protein-restricted diets (mainly phenylketonuria), and could not detect any significant correlation. [16][17][18][19][20] Moreover, in this study, no significatant relationship was detected between vitamin D levels and BMDs of patients receiving specialised diets.…”

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

“…It has been demonstrated that a daily milk consumption of 245 mL (a cup) is associated with increased body height (0.39 cm, 95% CI 0.29 to 0.48) [37]. Baldan and colleagues [38] evaluated the effect of a lactose-free diet on the phalangeal BMS in 102 LI adolescents compared to that of 102 peers on a normal diet. In particular, the time spent on a lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS.…”

Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake

“…Given the extensive and costly impact of osteoporosis, taking steps throughout life to prevent it is essential to lowering this health burden. As dietary calcium is one of the primary strategies to build and maintain strong and healthy bones, it is critical to ensure adequate calcium intake at each life stage, especially in lactose-intolerant individuals that consume less dietary calcium than their peers [4].…”

“…In adolescents, a study by Baldan et al demonstrated that lactose malabsorbers who substituted regular cow’s milk with lactose-free milk showed no difference in bone mineral status as compared to controls, despite a lower calcium intake [4]. In adults, BMD was found to be lower with lactose maldigestion and lower dairy intakes [71,72,73].…”