Lactose Intolerance in Infants, Children, and Adolescents

Abstract

The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided. INTRODUCTIONSIGNIFICANT CHANGES IN our knowledge and approach toward lactose intolerance have occurred over the past quarter century, since the first statement on lactose intolerance was published by the American Academy of Pediatrics Committee on Nutrition. 1 Lactose ingestion in certain susceptible individuals can cause abdominal symptoms that are variable and can be treated with dietary restriction or enzyme replacement, depending on the amount of lactose consumed and the degree of lactase deficiency. Pediatricians and other pediatric care providers should maintain awareness of the benefits and controversies related to the consumption of dietary milk products and milk-based infant formula. The lactose content of milk often influences, correctly or not, the ultimate decision about the use or continuation of milk in the diet. Milk and dairy-product avoidance has a negative effect on calcium and vitamin D intake in infants, children, and adolescents. Other nutrients such as protein make dairy products an important source of nutrition for growing children. This revised statement will update the initial statement of 1978 while incorporating changes from the 1990 supplement 2 and current state-of-theart relating to lactose intolerance. Recommendations regarding dietary calcium have been updated recently. 3 Lactose, a disaccharide that comprises the monosaccharides glucose and galactose, is the primary carbohydrate found exclusively in mammalian milk. Absorption of lactose requires lactase activity in the small intestinal brush border to split the bond linking the 2 monosaccharides. A ␤-galactosidase termed "lactase-phlorizin hydrolase" (lactase) accounts for most of the lactase activity in the intestinal

Perbandingan Efektivitas antara Probiotik Hidup dengan Probiotik Mati pada Anak dengan Malabsorpsi Laktosa

“…2 Probiotik diberikan selama dua minggu karena dari penelitian sebelumnya oleh Arifin dkk 16 dan Kocian dkk 24 menemukan bahwa penggunaan probiotik selama dua minggu meningkatkan toleransi terhadap laktosa dengan menurunkan 95% gejala intoleransi laktosa dan terdapat perubahan 85,7% dari nilai UHN positif ke negatif. Gejala malabsorpsi laktosa yang paling sering muncul sebelum pemberian probiotik (Tabel 2) adalah nyeri perut 55 anak (69,6%) dengan 10 anak (13,9%) mempunyai lebih dari satu gejala.…”

“…2,3 Malabsorpsi laktosa merupakan kondisi paling sering terjadi disebabkan karena kekurangan enzim laktase yang disebabkan adanya kerusakan epitel mukosa usus halus. [4][5][6] Malabsorpsi laktosa dapat didiagnosis berdasarkan gejala intoleransi laktosa (riwayat borborigmic, sering flatus, kembung, mual, muntah, nyeri perut, diare) dan uji hidrogen napas (UHN) >20 part per million (ppm).…”

“…Aktivitas enzim laktase mulai terdeteksi pada bulan ketiga kehamilan dan mencapai puncak pada bayi berusia 2-4 minggu. 2,7 Aktivitas enzim laktase bayi kurang bulan akan sama dengan bayi cukup bulan pada umur 2 minggu jika mendapat ASI dan aktivitasnya bertahan selama menyusui. 7 Adapun tata laksana pada malabsorpsi laktosa maupun intoleransi laktosa yaitu dengan pemberian susu bebas laktosa, yoghurt atau susu fermentasi, probiotik, dan enzim laktase.…”

“…7 Adapun tata laksana pada malabsorpsi laktosa maupun intoleransi laktosa yaitu dengan pemberian susu bebas laktosa, yoghurt atau susu fermentasi, probiotik, dan enzim laktase. 2,4,5,8 Paling sering digunakan untuk mengatasi defisiensi laktase primer dan sekunder yaitu diet rendah laktosa atau bebas laktosa. 4 Probiotik, terutama dari spesies Lactobacillus dan Bifidobacterium yang biasa digunakan pada susu fermentasi dapat mengurangi atau meringankan kondisi malabsorpsi ataupun intoleransi laktosa karena dapat memproduksi antibiotik alamiah yang dapat mengeleminasi berbagai macam kuman patogen gram negatif, meningkatkan aktivitas enzim laktase di usus dan dapat memfermentasi laktosa.…”

Lactose malabsorption is a risk factor for decreased bone mineral density in pancreatic insufficient cystic fibrosis patients

“…14 ATH inherited as an autosomal recessive trait leads to the downregulation of LCT activity in the intestinal mucosa (hypolactasia) and is the main reason of exclusion milk products from the diet worldwide. 15,16 The homozygous form of allelic variant C at position 13910 (C/C À13910 ) upstream of the LCT gene (NM_005915.4:c.1917 þ 326C4T; rs4988235) is strongly associated with ATH, whereas the homo-or heterozygous genotype of T allele (T/T À13910 or C/T À13910 ) results in lactase persistence. 17 LCT activity reduction is a process that occurs progressively over time; hence, to determine the current clinical LCT state, it is necessary to use additional methods like an intestinal biopsy or a non-invasive one, such as hydrogen or hydrogen-methane breath test.…”