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Lactose Intolerance Update
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Lactose Intolerance Update

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (1 March 2019) | Viewed by 142021

Special Issue Editor

Prof. Dr. Dennis Savaiano

E-Mail Website
Guest Editor
Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47906, USA
Interests: prebiotics; biotechnology; human nutrition; milk; dairy; probiotics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue, updating research on lactose and dairy intolerance, provides researchers an opportunity to publish on key controversies related to dairy avoidance, including molecular regulation of intestinal lactase, lactase polymorphisms, beta-casein protein variants, microbiome adaptation to lactose and related compounds, clinical assessment tools, dietary management strategies to keep dairy foods in the diet, dose/response, interaction of lactose intolerance with IBS and other bowel disorders, and a variety of related research issues.

Prof. Dennis A. Savaiano
Guest Editor

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Keywords

  • Lactose intolerance
  • Dairy avoidance
  • Microbiome adaptation
  • Beta casein
  • Intestinal lactase
  • Large bowel microbial lactase
  • Lactase polymorphism

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Published Papers (7 papers)

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Research

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17 pages, 3338 KiB  
Article
Prebiotics for Lactose Intolerance: Variability in Galacto-Oligosaccharide Utilization by Intestinal Lactobacillus rhamnosus
by Jason W. Arnold, Joshua B. Simpson, Jeffery Roach, Jose M. Bruno-Barcena and M. Andrea Azcarate-Peril
Nutrients 2018, 10(10), 1517; https://doi.org/10.3390/nu10101517 - 16 Oct 2018
Cited by 31 | Viewed by 7618
Abstract
Lactose intolerance, characterized by a decrease in host lactase expression, affects approximately 75% of the world population. Galacto-oligosaccharides (GOS) are prebiotics that have been shown to alleviate symptoms of lactose intolerance and to modulate the intestinal microbiota, promoting the growth of beneficial microorganisms. [...] Read more.
Lactose intolerance, characterized by a decrease in host lactase expression, affects approximately 75% of the world population. Galacto-oligosaccharides (GOS) are prebiotics that have been shown to alleviate symptoms of lactose intolerance and to modulate the intestinal microbiota, promoting the growth of beneficial microorganisms. We hypothesized that mechanisms of GOS utilization by intestinal bacteria are variable, impacting efficacy and response, with differences occurring at the strain level. This study aimed to determine the mechanisms by which human-derived Lactobacillus rhamnosus strains metabolize GOS. Genomic comparisons between strains revealed differences in carbohydrate utilization components, including transporters, enzymes for degradation, and transcriptional regulation, despite a high overall sequence identity (>95%) between strains. Physiological and transcriptomics analyses showed distinct differences in carbohydrate metabolism profiles and GOS utilization between strains. A putative operon responsible for GOS utilization was identified and characterized by genetic disruption of the 6-phospho-β-galactosidase, which had a critical role in GOS utilization. Our findings highlight the importance of strain-specific bacterial metabolism in the selection of probiotics and synbiotics to alleviate symptoms of gastrointestinal disorders including lactose intolerance. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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11 pages, 776 KiB  
Article
Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance
by Anish Pillai, Susan Albersheim, Julie Matheson, Vikki Lalari, Sylvia Wei, Sheila M Innis and Rajavel Elango
Nutrients 2018, 10(10), 1433; https://doi.org/10.3390/nu10101433 - 4 Oct 2018
Cited by 14 | Viewed by 5200
Abstract
There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) [...] Read more.
There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) for premature infants at increased risk of feeding intolerance. We prospectively enrolled preterm infants over an 18-month period, for whom a clinical decision had been made to add CPF to human milk due to concerns regarding tolerance of powder HMF. Data on feed tolerance, anthropometry, and serum biochemistry values were recorded. Serious adverse events, such as mortality, necrotizing enterocolitis (NEC), and sepsis, were monitored. A total of 29 babies received CPF fortified milk during the study period. The most common indication for starting CPF was previous intolerance to powder HMF. Feeding intolerance was noted in 4 infants on CPF. The growth velocity of infants was satisfactory (15.9 g/kg/day) after addition of CPF to feeds. The use of CPF as a fortifier in preterm babies considered at increased risk for feed intolerance seems well tolerated and facilitates adequate growth. Under close nutrition monitoring, this provides an additional option for human milk fortification in this challenging subgroup of preterm babies, especially in settings with limited human milk fortifier options. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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Review

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17 pages, 475 KiB  
Review
Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake
by Joanna K. Hodges, Sisi Cao, Dennis P. Cladis and Connie M. Weaver
Nutrients 2019, 11(4), 718; https://doi.org/10.3390/nu11040718 - 28 Mar 2019
Cited by 103 | Viewed by 27082
Abstract
Calcium is an important nutrient with impact upon many biological systems, most notably bone. Ensuring adequate calcium intake throughout the lifespan is essential to building and maintaining bone. Lactose intolerance may predispose individuals to low calcium intake as the number of lactose-free, calcium-rich [...] Read more.
Calcium is an important nutrient with impact upon many biological systems, most notably bone. Ensuring adequate calcium intake throughout the lifespan is essential to building and maintaining bone. Lactose intolerance may predispose individuals to low calcium intake as the number of lactose-free, calcium-rich food sources is limited. In this review, we summarize data from human and animal studies on the influence of lactose and lactase deficiency on calcium absorption and bone health. Based on the available evidence, neither dietary lactose nor lactase deficiency have a significant impact on calcium absorption in adult humans. However, lactose intolerance may lead to reduced bone density and fragility fractures when accompanied by decreased intake or avoidance of dairy. Recently published human trials and meta-analyses suggest a weak but significant association between dairy consumption and bone health, particularly in children. Given the availability of simple dietary approaches to building lactose tolerance and the nutritional deficiencies associated with dairy avoidance, multiple public health organizations recommend that all individuals—including those that are lactose intolerant—consume three servings of dairy per day to ensure adequate nutrient intakes and optimal bone health. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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14 pages, 1439 KiB  
Review
Lactose-Free Dairy Products: Market Developments, Production, Nutrition and Health Benefits
by Peter J. T. Dekker, Damiet Koenders and Maaike J. Bruins
Nutrients 2019, 11(3), 551; https://doi.org/10.3390/nu11030551 - 5 Mar 2019
Cited by 148 | Viewed by 40897
Abstract
Lactose-free dairy is able to provide the essential nutrients present in regular dairy products, like calcium and vitamins, to those that are not able to digest lactose. This product category currently has a wide and growing health appeal to consumers. In recent years, [...] Read more.
Lactose-free dairy is able to provide the essential nutrients present in regular dairy products, like calcium and vitamins, to those that are not able to digest lactose. This product category currently has a wide and growing health appeal to consumers. In recent years, the quality and product variety in the lactose-free dairy segment has been increasing significantly, giving consumers more tempting products to decide from. As a result, lactose-free dairy is now the fastest growing market in the dairy industry. This review discusses the market developments and production possibilities and issues related to the wide variation of lactose-free dairy products that are currently available. Additionally, the health benefits that lactose-free dairy may offer compared to dairy avoidance are illustrated. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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9 pages, 833 KiB  
Review
Congenital Lactase Deficiency: Mutations, Functional and Biochemical Implications, and Future Perspectives
by Dalanda Wanes, Diab M. Husein and Hassan Y. Naim
Nutrients 2019, 11(2), 461; https://doi.org/10.3390/nu11020461 - 22 Feb 2019
Cited by 26 | Viewed by 9562
Abstract
Congenital lactase deficiency (CLD) is a severe autosomal recessive genetic disorder that affects the functional capacity of the intestinal protein lactase-phlorizin hydrolase (LPH). This disorder is diagnosed already during the first few days of the newborn’s life due to the inability to digest [...] Read more.
Congenital lactase deficiency (CLD) is a severe autosomal recessive genetic disorder that affects the functional capacity of the intestinal protein lactase-phlorizin hydrolase (LPH). This disorder is diagnosed already during the first few days of the newborn’s life due to the inability to digest lactose, the main carbohydrate in mammalian milk. The symptoms are similar to those in other carbohydrate malabsorption disorders, such as congenital sucrase-isomaltase deficiency, and include severe osmotic watery diarrhea. CLD is associated with mutations in the translated region of the LPH gene that elicit loss-of-function of LPH. The mutations occur in a homozygote or compound heterozygote pattern of inheritance and comprise missense mutations as well as mutations that lead to complete or partial truncations of crucial domains in LPH, such as those linked to the folding and transport-competence of LPH and to the catalytic domains. Nevertheless, the identification of the mutations in CLD is not paralleled by detailed genotype/protein phenotype analyses that would help unravel potential pathomechanisms underlying this severe disease. Here, we review the current knowledge of CLD mutations and discuss their potential impact on the structural and biosynthetic features of LPH. We also address the question of whether heterozygote carriers can be symptomatic for CLD and whether genetic testing is needed in view of the severity of the disease. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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30 pages, 875 KiB  
Review
Lactose Intolerance, Dairy Avoidance, and Treatment Options
by Andrew Szilagyi and Norma Ishayek
Nutrients 2018, 10(12), 1994; https://doi.org/10.3390/nu10121994 - 15 Dec 2018
Cited by 131 | Viewed by 41984
Abstract
Lactose intolerance refers to symptoms related to the consumption of lactose-containing dairy foods, which are the most common source for this disaccharide. While four causes are described, the most common is the genetically-determined adult onset lactose maldigestion due to loss of intestinal lactase [...] Read more.
Lactose intolerance refers to symptoms related to the consumption of lactose-containing dairy foods, which are the most common source for this disaccharide. While four causes are described, the most common is the genetically-determined adult onset lactose maldigestion due to loss of intestinal lactase governed by control of the gene by a 14,000 kb promoter region on chromosome 2. Gastrointestinal symptoms from lactose have expanded to include systemic effects and have also been confounded by other food intolerances or functional gastrointestinal disorders. Partly because lactose maldigestion is often interpreted as lactose intolerance (symptoms), focus of therapy for these symptoms starts with lactose restriction. However, withholding of dairy foods completely is not appropriate due to a more favorable impact on health. Industrial efforts to substitute with plant-based products is not completely successful at this time. This narrative article reviews the complexities of the perception of lactose intolerance, its epidemiology, and pathogenesis. Treatments are discussed, including the inappropriateness of dairy avoidance. In conjunction, effects of dairy products on 19 common diseases are reviewed. Different methods of treatment, lactose-reduced products, plant-based dairy substitutes, adaptation, prebiotics, exogenous lactase, probiotics, and some other dietary interventions are further discussed. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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12 pages, 222 KiB  
Review
Gender, Age, Race and Lactose Intolerance: Is There Evidence to Support a Differential Symptom Response? A Scoping Review
by Rebecca A Lapides and Dennis A Savaiano
Nutrients 2018, 10(12), 1956; https://doi.org/10.3390/nu10121956 - 11 Dec 2018
Cited by 20 | Viewed by 8432
Abstract
Research evaluating the relationship between lactose intolerance (LI) symptoms and age, gender and race is reviewed. An exhaustive search was conducted on the Google Scholar and PubMed databases. The evidence suggests that women, the elderly or specific racial groups are not more susceptible [...] Read more.
Research evaluating the relationship between lactose intolerance (LI) symptoms and age, gender and race is reviewed. An exhaustive search was conducted on the Google Scholar and PubMed databases. The evidence suggests that women, the elderly or specific racial groups are not more susceptible to LI, but rather dose, body size and genetic differences in lactase non-persistence (LNP) are the primary drivers of intolerance symptoms. Full article
(This article belongs to the Special Issue Lactose Intolerance Update)
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