Review article: lactose intolerance in clinical practice – myths and realities

Lomer, Miranda; Parkes, Gareth; Sanderson, Jeremy

doi:10.1111/j.1365-2036.2007.03557.x

Cited by 476 publications

(420 citation statements)

References 92 publications

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“…While improving the nutritional profile of the milk meal component, nutrition standards limiting fat content may have had the unintended consequences of decreasing consumption and increasing waste (47,66,67) . With more than half of US children expected to be of Hispanic, Black or Asian decent by 2019 (68) , populations at increased risk for lactose malabsorption and intolerance (69)(70)(71) , offering non-dairy milks may increase acceptability. At the same time, leaders in the field have questioned dairy intake recommendations (72) .…”

Section: Milkmentioning

confidence: 99%

‘It’s just so much waste.’ A qualitative investigation of food waste in a universal free School Breakfast Program

Blondin

Djang

Metayer

et al. 2014

Public Health Nutr.

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Objective: To understand stakeholders' perspectives on food waste in a universal free School Breakfast Program implementing a Breakfast in the Classroom model. Design: Semi-structured focus groups and interviews were conducted with school district stakeholders. Inductive methods were used to code resulting transcripts, from which themes were identified. The analysis provides a thematic analysis of stakeholders' perspectives on food waste in the School Breakfast Program. Setting: Ten elementary schools in a large urban school district implementing a universal free Breakfast in the Classroom model of the US national School Breakfast Program. Subjects: Elementary-school students (n 85), parents (n 86), teachers (n 44), cafeteria managers (n 10) and school principals (n 10). Results: Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and programme-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children's consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food. Conclusions: Stakeholders recognized food waste as a problem, reported myriad contributing factors, and have considered and employed multiple and diverse mitigation strategies. Changes to the menu and/or implementation logistics, as well as efforts to use leftover food productively, may be possible strategies of reducing waste and improving the School Breakfast Program's economic, environmental and nutritional impact. Keywords Food waste National School Breakfast ProgramBreakfast in the Classroom Elementary school Students

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Section: Milkmentioning

confidence: 99%

‘It’s just so much waste.’ A qualitative investigation of food waste in a universal free School Breakfast Program

Blondin

Djang

Metayer

et al. 2014

Public Health Nutr.

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“…Esta fermentação da lactose pela flora bacteriana leva ao aumento do trânsito intestinal e da pressão intracolônica, podendo ocasionar dor abdominal e sensação de inchaço no abdome 63 . A acidificação do conteúdo colônico e o aumento da carga osmótica no íleo e cólon resultante da lactose não absorvida leva à grande secreção de eletrólitos e fluidos, além do aumento do trânsito intestinal, resultando em fezes amolecidas e diarreia 60,64 . Apesar da falta de evidências, alguns autores acreditam que a absorção da lactose nos pacientes com hipolactasia poderia ser favorecida pela sua metabolização pela flora intestinal 56 .…”

Section: Fisiopatologiaunclassified

“…Uma característica importante é que estes indivíduos, mesmo com quadro de diarreia crônica, geralmente não perdem peso 75 . Em alguns casos a motilidade gastrintestinal está diminuída e os indivíduos podem se apresentar com constipação, possivelmente como consequência da produção de metano 64 .…”

Section: Sintomasunclassified

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Intolerância à lactose: mudança de paradigmas com a biologia molecular

Mattar¹,

Mazo²

2010

Rev. Assoc. Med. Bras.

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ResumoNa maioria dos mamíferos a atividade da enzima lactase diminui na parede intestinal após o desmame, caracterizando a hipolactasia primária que provoca sintomas de intolerância à lactose. A intensidade dos sintomas de distensão, flatulência, dor abdominal e diarreia variam, dependendo da quantidade de lactose ingerida, e aumentam com o passar da idade. A hipolactasia é determinada geneticamente, porém uma mutação ocorreu para que fizesse parte da humanidade tolerar o leite na idade adulta. O diagnóstico é feito por teste de tolerância, empregando a lactose como desafio. Com a descoberta dos finlandeses do polimorfismo associado com a persistência da lactase, principalmente no norte da Europa, o exame genético passou a ser outra ferramenta diagnóstica mais confortável para o intolerante. No Brasil, 43% dos brancos e dos mulatos têm alelo de persistência da lactase, sendo a hipolactasia mais frequente entre os negros e japoneses. Entretanto, na prática clínica indivíduos com hipolactasia podem ser orientados a consumir alguns derivados do leite e alimentos contendo lactose sem apresentar sintomas de intolerância, enquanto que outros terão que fazer restrição de lactose na dieta. ConceitoMá absorção ou má digestão de lactose é a diminuição na capacidade de hidrolisar a lactose, que é resultante da hipolactasia. A hipolactasia significa diminuição da atividade de enzima lactase na mucosa do intestino delgado 1 , também denominada recentemente de "lactase não persistente" 2 . O aparecimento de sintomas abdominais por má absorção de lactose caracteriza a intolerância à lactose. A má absorção de lactose nem sempre provoca sintomas de intolerância à lactose 1 . Após o desmame, ocorre uma redução geneticamente programada e irreversível da atividade da lactase na maioria das populações do mundo, cujo mecanismo é desconhecido, resultando em má absorção primária de lactose 3 . Porém, a hipolactasia também pode ser secundária a doenças que causem dano na borda em escova da mucosa do intestino delgado ou que aumentem significativamente o tempo de trânsito intestinal, como nas enterites infecciosas, giardíase 4 , doença celíaca 5 , doença inflamatória intestinal (especialmente doença de Crohn), enterites induzidas por drogas ou radiação, doença diverticular do cólon 6 e anemia (estudo em ratos, mostrando diminuição na expressão gênica) 7 . Diferentemente da hipolactasia primária do adulto, a hipolactasia secundária é transitória e reversível 8 . Enzima lactase-florizina hidrolase da família 1 das glicosil hidrolasesA estrutura primária traduzida da enzima lactase-florizina hidrolase foi deduzida a partir de sequências de cDNA, apresentando 1927 aminoácidos (NP_002290.2-número de acesso no NCBI), sendo que as duas atividades de lactase e florizina hidrolase (glicosilceramidase) se localizam no mesmo polipeptídeo 9 . A estrutura inicial tem peso molecular de 215000 e, após ser processada provavelmente no complexo de Golgi, o peso molecular cai para 160000, se ancorando na membrana da borda em escova do enterócito 10 , poré...

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“…When ingested, lactose is hydrolysed in the small intestine into two monosaccharides (glucose and galactose) that are absorbed via active transport (7) . The hydrolysis of this molecule is catalysed by the enzyme β-galactosidase or lactase, which is present in the brush border of the intestinal villi.…”

Section: Introductionmentioning

confidence: 99%

Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed With Lactose Intolerance Due to Primary Hypolactasia

Francesconi

Machado

Steinwurz

et al. 2016

Arq. Gastroenterol.

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-Background -Primary hypolactasia is a common condition where a reduced lactase activity in the intestinal mucosa is present. The presence of abdominal symptoms due to poor absorption of lactose, which are present in some cases, is a characteristic of lactose intolerance. Objective -Evaluate the efficacy of a product containing exogenous lactase in tablet form compared to a reference product with proven effectiveness in patients with lactose intolerance. Methods -Multicentre, randomized, parallel group, single-blind, comparative non-inferiority study. One hundred twenty-nine (129) adult lactose intolerance patients with hydrogen breath test results consistent with a diagnosis of hypolactasia were randomly assigned to receive the experimental product (Perlatte ® -Eurofarma Laboratórios S.A.) or the reference product (Lactaid ® -McNeilNutritionals, USA) orally (one tablet, three times per day) for 42 consecutive days. Results -Data from 128 patients who actually received the studied treatments were analysed (66 were treated with the experimental product and 62 with the reference product). The two groups presented with similar baseline clinical and demographic data. Mean exhaled hydrogen concentration tested at 90 minutes after the last treatment (Day 42) was significantly lower in the experimental product treated group (17±18 ppm versus 34±47 ppm) in the per protocol population. The difference between the means of the two groups was -17 ppm (95% confidence interval [95% CI]: -31.03; -3.17). The upper limit of the 95% CI did not exceed the a priori non-inferiority limit (7.5 ppm). Secondary efficacy analyses confirmed that the treatments were similar (per protocol and intention to treat population). The tolerability was excellent in both groups, and there were no reports of serious adverse events related to the study treatment. Conclusion -The experimental product was non-inferior to the reference product, indicating that it was an effective replacement therapy for endogenous lactase in lactose intolerance patients. HEADINGS -Lactase. Lactose intolerance. beta-Galactosidase. Clinical trial.

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Review article: lactose intolerance in clinical practice – myths and realities

Cited by 476 publications

References 92 publications

‘It’s just so much waste.’ A qualitative investigation of food waste in a universal free School Breakfast Program

‘It’s just so much waste.’ A qualitative investigation of food waste in a universal free School Breakfast Program

Intolerância à lactose: mudança de paradigmas com a biologia molecular

Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed With Lactose Intolerance Due to Primary Hypolactasia

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