University of Minnesota and Minneapolis Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55471, USA.
Ann Intern Med. 2010 Jun 15;152(12):797-803. doi: 10.7326/0003-4819-152-12-201006150-00241. Epub 2010 Apr 19.
Lactose intolerance resulting in gastrointestinal symptoms is a common health concern. Diagnosis and management of this condition remain unclear.
To assess the maximum tolerable dose of lactose and interventions for reducing symptoms of lactose intolerance among persons with lactose intolerance and malabsorption.
Multiple electronic databases, including MEDLINE and the Cochrane Library, for trials published in English from 1967 through November 2009.
Randomized, controlled trials of individuals with lactose intolerance or malabsorption.
Three investigators independently reviewed articles, extracted data, and assessed study quality.
36 unique randomized studies (26 on lactase- or lactose-hydrolyzed milk supplements, lactose-reduced milk, or tolerable doses of lactose; 7 on probiotics; 2 on incremental lactose administration for colonic adaptation; and 1 on another agent) met inclusion criteria. Moderate-quality evidence indicated that 12 to 15 g of lactose (approximately 1 cup of milk) is well tolerated by most adults. Evidence was insufficient that lactose-reduced solution or milk with a lactose content of 0 to 2 g, compared with greater than 12 g, is effective in reducing symptoms of lactose intolerance. Evidence for probiotics, colonic adaptation, and other agents was also insufficient.
Most studies evaluated persons with lactose malabsorption rather than lactose intolerance. Variation in enrollment criteria, outcome reporting, and the composition and dosing of studied agents precluded pooling of results and limited interpretation.
Most individuals with presumed lactose intolerance or malabsorption can tolerate 12 to 15 g of lactose. Additional studies are needed to determine the effectiveness of lactose intolerance treatment.
乳糖不耐受导致胃肠道症状是一个常见的健康问题。这种情况的诊断和治疗仍不清楚。
评估乳糖不耐受和吸收不良者的乳糖最大耐受剂量和减少乳糖不耐受症状的干预措施。
多个电子数据库，包括 MEDLINE 和 Cochrane 图书馆，检索 1967 年至 2009 年 11 月发表的英文试验。
随机对照试验，纳入乳糖不耐受或吸收不良者。
3 名调查人员独立审查文章、提取数据和评估研究质量。
36 项独特的随机研究（26 项研究乳糖酶或乳糖水解奶补充剂、乳糖降低奶或可耐受乳糖剂量；7 项研究益生菌；2 项研究递增乳糖剂量用于结肠适应；1 项研究其他药物）符合纳入标准。中等质量证据表明，大多数成年人可耐受 12 至 15 克乳糖（约 1 杯牛奶）。与乳糖含量大于 12 克的乳糖降低溶液或牛奶相比，乳糖含量为 0 至 2 克的溶液或牛奶减少乳糖不耐受症状的效果证据不足。益生菌、结肠适应和其他药物的证据也不足。
大多数研究评估的是乳糖吸收不良者，而非乳糖不耐受者。纳入标准、结果报告、研究药物的组成和剂量的差异，导致结果无法合并以及解释受限。
大多数被认为有乳糖不耐受或吸收不良的个体可以耐受 12 至 15 克乳糖。需要进一步研究以确定乳糖不耐受治疗的有效性。
