Lactose Malabsorption and Giardiasis in Basotho School Children

Abstract

The prevalence of primary, adult-type, lactose malabsorption was assessed by means of the hydrogen breath test after intake of 360 ml of full cream milk (approximately 18 g lactose) in 96 randomly selected Basotho school children, aged 5-15 years. Of 86 children who did not have diarrhoea in the previous week 82 (85%) were lactose malabsorbers, while 4 (5%) could not be classified because of undetectable hydrogen excretion. Milk intolerance presenting as diarrhoea was significantly (p less than 0.01) more common in children who associated previous abdominal complaints with milk intake and/or did not like milk. A negative hydrogen breath test was significantly (p less than 0.05) more often observed in children who had diarrhoea in the previous week. Giardia was present in 18 (19%) of 93 children. The incidence of giardiasis did not correlate with the presence of lactose malabsorption in children without diarrhoea in the previous week. However, milk intolerance presenting as diarrhoea was significantly (p less than 0.05) more common in children with giardiasis. The findings support the use of physiological quantities of milk in Basotho school children.

Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda

“…While other studies have reported significant association of lactose intolerance with giardiasis [18,19], only one child in the current study was found to have giardiasis and she had no evidence of lactose intolerance. Possibly, this was because of a less sensitive method used (wet stool preparation), as the 'string test' of duodenal contents would have been more preferable.…”

“…In one study, milk intolerance presenting as diarrhoea was significantly more common in children with giardiasis [18]. Similarly, Pettoello and colleagues in Italy concluded that the occurrence of lactose malabsorption of nutritional relevance was common in children suffering or having suffered from giardiasis (45%) [19].…”

Effects of asymptomatic Giardia intestinalis infection on carbohydrate absorption in well-nourished Mexican children.

“…On the other hand, it has been proposed that infection with G. intestinalis interferes between the intestinal brush border enzymes and the disaccharides present in the diet. Therefore, the findings by Tolboom and others, 27 together with the subtle defects in breath hydrogen test results we found in asymptomatic children, suggest that lactose malabsorption may be more likely associated with the lost of lactase caused by diarrhea than the direct effects of Giardia.…”

“…Similar results were found by Gendrel and others, who reported that asymptomatic giardiasis does not increase the frequency of lactose intolerance in well-nourished children. 4 Furthermore, Tolboom and others 27 found that lactose malabsorption does not correlate with the presence of giardiasis, but milk intolerance manifested as diarrhea is more common in children with giardiasis than in healthy subjects. Because of the location of the disaccharidases in the intestinal brush border, any condition that damages its morphology (such as severe diarrhea), will result in a detrimental effect on these enzymes, and thus disaccharides absorption.…”

“…However, few studies have reported the potential effects of moderate or asymptomatic giardiasis on nutrient absorption, and thus the effects on the nutritional status of the host. 4,[25][26][27] For instance, de Morais and others found that asymptomatic giardiasis did not affect the intestinal absorption of iron in children with iron deficiency. 25 We have previously found that mild G. intestinalis infection did not affect energy metabolism (energy intake, basal metabolic rate, and total energy expenditure) in children.…”