O'Keefe S J, O'Keefe E A, Burke E, Roberts P, Lavender R, Kemp T
Nutrition Unit, Groote Schuur Hospital, South Africa.
Am J Clin Nutr. 1991 Jul;54(1):130-5. doi: 10.1093/ajcn/54.1.130.
Fifty malnourished rural African patients were randomly assigned to whole milk (50 g lactose/L), acidified milk (24 g lactose/L), or a commercial lactose-free diet (LFD) as a constant nasogastric infusion for 3 d, starting at 2 L/d and increasing to 3 L/d if tolerated. During the first 2 d mild symptoms of intolerance developed in 63% of patients on whole milk, 37% on acidified milk, and 54% on LFD whereas severe intolerance, necessitating withdrawal, was encountered in 22% receiving whole milk and none receiving LFD. Stool weights and fat excretion on day 3 were greater (P less than 0.02) in the remaining milk-fed patients whereas nitrogen balance remained strongly positive in all three groups. Eighty-seven percent of patients were methane producers, and high excretion rates were associated with better milk tolerance. The results suggest that although undiluted cow milk will not form a suitable tube feed for malnourished African patients, products such as acidified milk may prove cost effective.
50名营养不良的非洲农村患者被随机分为三组，分别接受全脂牛奶（乳糖含量50 g/L）、酸化牛奶（乳糖含量24 g/L）或市售无乳糖饮食（LFD），通过鼻胃管持续输注3天，起始剂量为2 L/d，若能耐受则增加至3 L/d。在头2天，接受全脂牛奶的患者中有63%出现轻度不耐受症状，接受酸化牛奶的患者中这一比例为37%，接受LFD的患者中为54%；而接受全脂牛奶的患者中有22%出现严重不耐受症状，需要停止治疗，接受LFD的患者中则无人出现严重不耐受。第3天，其余接受牛奶喂养的患者粪便重量和脂肪排泄量更大（P<0.02），而三组患者的氮平衡均保持强阳性。87%的患者为甲烷产生者，高排泄率与更好的牛奶耐受性相关。结果表明，尽管未稀释的牛奶不适用于营养不良的非洲患者作为管饲食物，但酸化牛奶等产品可能具有成本效益。
