RESUMO
BACKGROUND: Hydrogen breath tests (HBT) are used to confirm the diagnosis of carbohydrate intolerance or small intestinal bacterial overgrowth (SIBO). OBJECTIVE: Determine the existence of a correlation between the presence and intensity of symptoms experimented by the patient after the ingestion of a carbohydrate load and the test result. MATERIALS AND METHODS: This is an observational, retrospective and analytic study, in which all patients' files from year 2008 to 2014 containing a report of a HBT performed at Hospital San José TEC de Monterrey were revised. Using a visual analogue scale (VAS), the patient reported the intensity of gastrointestinal symptoms during the test. Descriptive statistics were obtained, and exclusively for lactose HBTs, Pearson's correlation coefficient (r) between maximum hydrogen concentration in breath and symptom intensity was calculated. RESULTS: A HBT was performed in 33 patients: 23 with lactose, 5 with fructose, and 5 with lactulose as substrate. Of these, 10, 2, and 5 tests were positive, respectively. For lactose HBTs, the symptom with most sensitivity was flatulence (80%), which also had the greatest likelihood ratio for a positive test (1.73). Diarrhea had the greatest specificity (84.6%). A tendency for positivity was observed when patients presented symptoms. A moderately positive correlation between hydrogen ppm and symptom intensity was found (r=0.427, p=0.023). CONCLUSIONS: A correlation between symptom intensity and test positivity was found in patients with lactose intolerance. The presence of flatulence after lactose loading may be indicative of a positive test.
Assuntos
Intolerância à Frutose/diagnóstico , Hidrogênio/metabolismo , Intolerância à Lactose/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Testes Respiratórios , Criança , Pré-Escolar , Feminino , Flatulência/etiologia , Intolerância à Frutose/metabolismo , Humanos , Lactente , Intolerância à Lactose/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: Lactase nonpersistence (LNP) in humans is a genetically determined trait. This age-dependent decrease of lactase expression is most frequently caused by single nucleotide polymorphisms in the regulatory region of the lactase (LCT) gene. The homozygous LCT-13,910C/C genotype (rs 4988235) predominates in Caucasian adults with LNP, and is useful for its diagnosis in this population. The accuracy of this genetic test (GT) has not been completely established in children or in a Latin-American population. OBJECTIVES: The aim of the study was to determine diagnostic accuracy of GT for LNP in Chilean children using the lactose breath test (BT) as a reference, and to compare diagnostic yield in preschool- (<6 years) and in school-age (≥6 years) children. METHODS: Children referred for BT for diagnosis of lactose malabsorption to the Gastroenterology Laboratory at Clínica Alemana, Santiago, from October 2011 to March 2012 were invited to participate. After informed consent, symptom questionnaires, both historic and post lactose ingestion were completed. H2 and CH4 in expired air and -13,910 C>T single nucleotide polymorphism by polymerase chain reaction, restriction enzyme analysis, and/or Sanger sequencing were determined. GT accuracy was calculated compared to BT as reference method. Diagnostic yield of GT in preschool- and school-age children was compared. RESULTS: Lactose malabsorption was detected by BT in 42 of 60 children (70%). Genotype -13,910C/C was identified in 41 of 60 patients (68%). GT showed 80% sensitivity, 63% specificity, and 74% accuracy for LNP in the preschool population. In school-age children values were higher, 85%, 80%, and 84%, respectively. CONCLUSIONS: GT results were significantly concordant with BT results for hypolactasia detection in Chilean children, particularly in those of age 6 years and older.
Assuntos
Lactase , Intolerância à Lactose/diagnóstico , Adolescente , Testes Respiratórios , Criança , Serviços de Saúde da Criança , Chile , Feminino , Testes Genéticos , Hispânico ou Latino/genética , Humanos , Lactase/genética , Lactase/metabolismo , Intolerância à Lactose/genética , Intolerância à Lactose/metabolismo , Masculino , RNA Mensageiro , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The efficacy of some probiotic strains for the management of lactose intolerance remains to be established. AIM: To evaluate the effects of a 4-week consumption of a probiotic product containing Lactobacillus casei Shirota and Bifidobacterium breve Yakult (10(7)-10(9) CFU of each strain) on symptoms and breath hydrogen exhalation after a lactose load in lactose-intolerant patients and whether the beneficial results persisted after probiotic discontinuation. METHODS: Twenty-seven patients with lactose maldigestion and intolerance participated in this study, which comprised 4 hydrogen breath tests: baseline condition (20 g lactose), after lactase ingestion (9000 FCC units), at the end of 4-week probiotic supplementation, and a follow-up test performed 3 months after probiotic discontinuation. For each test, the area under the breath hydrogen concentration vs time curve (AUC(180 min)) was calculated, and symptom scores were recorded. RESULTS: The probiotic combination significantly reduced symptom scores (P < .01) and breath hydrogen AUC (P = .04) compared with the baseline condition. The comparison with the lactase test showed that symptom scores were similar (P > .05), despite the significantly higher (P = .01) AUC values after probiotic use. In the follow-up test, symptom scores and breath hydrogen AUC values remained similar to those found at the end of probiotic intervention. CONCLUSION: Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.
Assuntos
Bifidobacterium , Lacticaseibacillus casei , Intolerância à Lactose/tratamento farmacológico , Lactose/metabolismo , Probióticos/uso terapêutico , Adulto , Área Sob a Curva , Testes Respiratórios , Suplementos Nutricionais , Digestão , Expiração , Feminino , Humanos , Hidrogênio/metabolismo , Intolerância à Lactose/complicações , Intolerância à Lactose/metabolismo , Masculino , Pessoa de Meia-Idade , Probióticos/administração & dosagemRESUMO
BACKGROUND: The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H(2) breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. METHODS: Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H(2) concentration of 20 ppm over basal. RESULTS: There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p\0.05. In 39% of patients, rise of H(2) occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p\0.05). Symptoms were unrelated to time to 20-ppm change. CONCLUSIONS: An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.
Assuntos
Testes Respiratórios/métodos , Doenças Funcionais do Colo , Hidrogênio , Intestino Delgado , Intolerância à Lactose , Lactose , Dor Abdominal/etiologia , Dor Abdominal/fisiopatologia , Adolescente , Criança , Pré-Escolar , Doenças Funcionais do Colo/etiologia , Doenças Funcionais do Colo/fisiopatologia , Feminino , Motilidade Gastrointestinal , Humanos , Hidrogênio/análise , Hidrogênio/metabolismo , Intestino Delgado/metabolismo , Intestino Delgado/fisiopatologia , Lactose/análise , Lactose/metabolismo , Intolerância à Lactose/complicações , Intolerância à Lactose/diagnóstico , Intolerância à Lactose/metabolismo , Intolerância à Lactose/fisiopatologia , Masculino , Estatística como AssuntoRESUMO
Dietary calcium (Ca) is fundamental to the bone's health. Both the purport and the element bioavailability in the food need to be considered. The purpose of this work was to summarize the factors involved in Ca absorption and point out the sources with higher bioavailability. Ca is mostly absorbed in the jejunum and low pH seems to favor its absorption, which is higher during growth, gestation/lactation and Ca and phosphorus (P) deficiency, and lower with aging. The richest and best-absorbed Ca source is cow's milk and its derivatives. Other foods show high Ca concentrations but variable bioavailability: foods rich in phytates and oxalates show a smaller absorption and carbohydrate-rich foods show higher absorption. Since Ca bioavailability in other animal's milk, soymilk and some vegetables is closer to that in cow's milk, adequate amounts of these foods could be used as an alternative.
Assuntos
Conservadores da Densidade Óssea/farmacocinética , Reabsorção Óssea/metabolismo , Cálcio da Dieta/farmacocinética , Dieta , Absorção Intestinal/fisiologia , Necessidades Nutricionais , Animais , Disponibilidade Biológica , Densidade Óssea/fisiologia , Cálcio/deficiência , Carbonato de Cálcio/metabolismo , Feminino , Humanos , Lactação/metabolismo , Lactose/metabolismo , Intolerância à Lactose/metabolismo , Masculino , Leite/metabolismo , Osteoporose/dietoterapia , Osteoporose/prevenção & controle , Leite de Soja/farmacocinética , Verduras/metabolismoRESUMO
O cálcio (Ca) dietético é fundamental para a saúde óssea. Tanto o teor como a biodisponibilidade do elemento nos alimentos devem ser considerados. Este artigo objetiva sumarizar os fatores envolvidos na absorção e destacar os alimentos com melhor disponibilidade do Ca. Este é absorvido principalmente no jejuno e o pH baixo parece favorecer sua absorção, que é maior no crescimento, na gestação/lactação e na carência de Ca ou fósforo (P), e menor no envelhecimento. As maiores fontes, e com melhor absorção, são os laticínios bovinos. Outros alimentos apresentam concentrações elevadas de Ca, mas com biodisponibilidade variável: os ricos em ácidos oxálico e fítico apresentariam uma menor absorção, enquanto que os ricos em carboidratos teriam uma absorção maior. Por apresentarem uma biodisponibilidade do Ca mais próxima da do leite bovino, o leite de outros animais, o de soja enriquecido e alguns vegetais, em quantidades adequadas, poderiam ser usados como alternativas a este.
Dietary calcium (Ca) is fundamental to the bone's health. Both the purport and the element bioavailability in the food need to be considered. The purpose of this work was to summarize the factors involved in Ca absorption and point out the sources with higher bioavailability. Ca is mostly absorbed in the jejunum and low pH seems to favor its absorption, which is higher during growth, gestation/lactation and Ca and phosphorus (P) deficiency, and lower with aging. The richest and best-absorbed Ca source is cow's milk and its derivatives. Other foods show high Ca concentrations but variable bioavailability: foods rich in phytates and oxalates show a smaller absorption and carbohydrate-rich foods show higher absorption. Since Ca bioavailability in other animal's milk, soymilk and some vegetables is closer to that in cow's milk, adequate amounts of these foods could be used as an alternative.
Assuntos
Humanos , Animais , Masculino , Feminino , Conservadores da Densidade Óssea/farmacocinética , Reabsorção Óssea/metabolismo , Cálcio da Dieta/farmacocinética , Dieta , Absorção Intestinal/fisiologia , Necessidades Nutricionais , Disponibilidade Biológica , Densidade Óssea/fisiologia , Carbonato de Cálcio/metabolismo , Cálcio/deficiência , Lactação/metabolismo , Intolerância à Lactose/metabolismo , Lactose/metabolismo , Leite/metabolismo , Osteoporose/dietoterapia , Osteoporose/prevenção & controle , Leite de Soja/farmacocinética , Verduras/metabolismoRESUMO
El estudio se realizó con la finalidad de determinar el efecto del estado de nutrición en la capacidad de digestión y tolerancia a la lactosa en pacientes hospitalizados que requerían alimentación por sonda. En un diseño controlado doble ciego, se estudiaron 25 pacientes que requerian alimentación por sonda divididos en dos grupos que deferían por su estado de nutrición. Un grupo (PCD) de 10 pacientes con desnutrición: en promedio habían perdido 14.5 ñ 5.4 kg y presentaban 69 ñ 15 por ciento del patrón de referencia de peso la talla. El otro grupo (PSD) fueron 15 pacientes con un estado de nutrición adecuado (peso para talla de 103 ñ 15 por ciento del patrón de referencia). A cada paciente se le administraron en forma cruzada, dos tratamientos: leche intacta (LI) o leche hidrolizada (LH) con > 90 por ciento de lactosa hidrolizada. Se dieron mediante infusión continua a duodeno. Se midió la digestión de lactosa mediante la prueba de análisis de hidrógeno espirado. El grupo PCD excretó 505 ñ 117 ppm. h y el grupo PSD 58 ñ 15 con LI; con la LH fueron 53 ñ 27 y 14 ñ 23 en el mismo orden. El puntaje de síntomas fue de 4.3 ñ 0.7 y 1.5 ñ 0.3 con la LI para PCD y PSD respectivamente, y de 0.5 ñ 0.2 y 0.3 ñ 0.2 con la LH en el mismo orden. La mala digestión (p< 0.0001) y la intolerancia de la lactosa (p< 0.001) fueron considerablemente mayores en los pacientes desnutridos. Concluímos que nuestros resultados sugieren que la desnutrición se acompaña siempre de intolerancia a la lactosa
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Digestão , Hidrogênio/análise , Intolerância à Lactose/metabolismo , Lactose/análise , Ciências da Nutrição , Distúrbios Nutricionais/dietoterapiaRESUMO
É sabido que a lactose é melhor absorvida sob forma de iogurte que de leite, por indivíduos hipolactásicos e que este fenômeno se deve à presença de atividade de beta-galactosidase nos iogurtes, que difere segundo as características dos produtos. Assim, o objetivo deste trabalho foi estudar a absorçao e a tolerância à lactose de alguns iogurtes utilizados em nosso meio. Foram estudados 12 adultos portadores de hipolactasia tipo adulto. Após a confirmaçao diagnóstica, os voluntários foram submetidos a três testes com ingestao de leite e dois tipos de iogurte com diferentes níveis de beta-galactosidase. Esta atividade foi determinada em cada amostra utilizada. A absorçao da lactose foi calculada pela medida do H2 eliminado no ar expirado e a tolerância avaliada por um escore de sintomas referidos pelos participantes. As medianas do incremento de H2 foram de 20 ppm para o leite, 1O.5 para o iogurte X e 5.5 para o iogurte Y. A área sob a curva apresentou mediana de 96O ppm/min no teste com leite, 42Oppm/min com o iogurte X e 27Oppm/min com o iogurte Y. Estes dois dados apresentaram diferenças estatisticamente significativas quando se comparou o leite com cada iogurte e nao significativas comparando-se os dois iogurtes entre si. Os escores de sintomas também foram significantemente diferentes entre o leite e os dois iogurtes e semelhantes entre os iogurtes. Nao se observou associaçao estatisticamente significante entre absorçao e tolerância. No entanto, a maioria dos intolerantes nao absorveu o açúcar. Estes dados indicam que a lactose dos iogurtes foi melhor absorvida e melhor tolerada que a do leite, o que vem sugerir que nossos produtos se assemelham à maioria daqueles da literatura, no que se refere à sua capacidade desdobradora de lactose "in vivo". Apesar das diferenças, medidas "in vitro", entre as atividades de beta-galactosidase, nao houve diferenças significativas de absorçao e tolerância entre os dois iogurtes.
Assuntos
Humanos , Adulto , beta-Galactosidase/metabolismo , Intolerância à Lactose/metabolismo , Lactose/metabolismo , Leite , IogurteRESUMO
It is known that lactose is better absorbed in yogurts than in milk by lactase-deficient individuals. This fact is due to the presence of beta-galactosidase activity in the yogurts, that are different concerning the caracteristics of the products. Thus, the aim of this study was to verify the absorption and tolerance of lactose in some yogurts consumed by our population. We studied 12 hypolactasic adults who, after diagnostic confirmation, were submitted to three breath hydrogen tests after ingestion of milk and two yogurts with different levels of beta-galactosidase. These activities were determined in each sample utilized. The lactose absorption was evaluated by the measurement of H2 eliminated in the expired air and the tolerance was assessed by the symptoms reported by the participants. The medians of the H2 maximum increment were 20 ppm/min for the milk, 10.5 for yogurt X and 5.5 for the yogurt Y. The area under the curve of H2 concentration presented a median of 960 in the test with milk, 420 with yogurt X and 270 with yogurt Y. These results showed statistically significant differences for milk and the two yogurts and similar among the yogurts. The score for symptoms also were different between the milk and the two yogurts and similar among the yogurts. A statistically significant association between absorption and tolerance was not observed, because many tolerant subjects were malabsorbers of lactose. These data show that lactose in yogurts is better absorbed and better tolerated than lactose in milk, suggesting that our products are similar to those of the literature concerning their capacity of hydrolising lactose "in vivo". In spite of the differences found "in vitro" among the beta-galactosidase, there were no significant differences of absorption and tolerance between the two yogurts studied.
Assuntos
Intolerância à Lactose/metabolismo , Lactose/metabolismo , Leite , Iogurte , beta-Galactosidase/metabolismo , Adolescente , Adulto , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of the present study was to determine whether a fermented milk containing Lactobacillus casei and Lactobacillus acidophilus strains isolated from human subjects (CFM) and developed by CERELA (Centro de referencia para Lactobacilos) is better tolerated than regular milk (RM) by subjects with lactase deficiency (< 1 unidad) and lactose intolerance. We studied the digestion of the lactose present in the two milk preparations which were administered to 18 healthy subjects with lactase deficiency and 12 control subjects. Each subject ingested in random sequence on different days, 480 ml CFM, 480 ml RM and 240 ml CFM and 240 ml RM. Breath hydrogen (H2) test was used to measure lactose absorption and orocecal transit time (OCTT). The peak H2 ppm results after 480 ml of CFM were ingested, reached 19.5 +/- 12.1 ppm. The same reading when 480 ml of RM were ingested was 52.6 +/- 31.9 ppm (p < 0.008). The results also showed that 480 ml of CFM delayed OCTT median 111.0 +/- 6.78 min versus 54.0 +/- 5.09 min of RM (p < 0.001) and reduced the development of symptoms (p < 0.08) such as bloating (p < 0.05), borborygmi (p < 0.025) diarrhea (p < 0.05) and abdominal colics (p < 0.05). In spite of the small number of cases studied, it seems justified to conclude that CERELA fermented milk significantly influences lactose digestion and minor development of symptoms in lactase-deficient subjects and lengthens significantly the orocecal transit time compared with regular milk.