Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway.
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
Lancet Gastroenterol Hepatol. 2017 Oct;2(10):738-746. doi: 10.1016/S2468-1253(17)30154-1. Epub 2017 Jul 7.
Studies have shown wide variation in the prevalence of lactose malabsorption across the world, but no systematic reviews or meta-analyses have recently assessed the prevalence of lactose malabsorption in different geographical areas. We aimed to present an updated systematic review and meta-analysis on the prevalence of lactose malabsorption in adults, by countries and regions, and to assess the variation between different testing methods.
Studies reporting on prevalence of lactose malabsorption and lactase persistence were identified by searching MEDLINE and Embase from database inception to Nov 2, 2016. We evaluated studies presenting lactose malabsorption or lactase persistence prevalence data in adults and children aged 10 years or older, including cross-sectional and prospective studies, using genotyping, hydrogen breath tests, lactose tolerance tests, and other testing methods. We excluded studies in children younger than 10 years, studies using self-reported data, and studies including inpatients and outpatients at gastroenterological wards. Studies were screened by two authors (CLS and SKF) and data values were extracted by two authors (CLS and SKF) independently. The primary outcome was the prevalence of lactose malabsorption. This study is registered with PROSPERO, number CRD42017064802.
We screened 2665 records, and 306 study populations from 116 full-text articles were included (primary sources); data for 144 additional study populations from 59 articles were obtained from review articles, because full-text primary articles could not be obtained (secondary sources). Of the 450 study populations included, 231 were assessed by genotyping, 83 by hydrogen breath tests, 101 by lactose tolerance tests, and 35 by other methods or methods that were not described sufficiently. The studies included 62 910 participants from 89 countries (covering 84% of the world's population). When standardising for country size, the global prevalence estimate of lactose malabsorption was 68% (95% CI 64-72), ranging from 28% (19-37) in western, southern, and northern Europe to 70% (57-83) in the Middle East. When assessing the global prevalence using genotyping data only, the estimate was 74% (69-80), whereas prevalence was 55% (46-65) using lactose tolerance test data, and 57% (46-67) using hydrogen breath test data. Risk of bias was assessed based on ten indicators; 12 of the articles had a score of ten, indicating low risk of bias, 76 had a score of nine, 26 a score of eight, and two articles a score of seven (indicating higher risk of bias). There was substantial heterogeneity between studies within most of the assessed countries.
Lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. Acknowledging regional patterns of lactose malabsorption is important to guide management of gastrointestinal symptoms.
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研究表明，乳糖吸收不良在全球范围内存在广泛差异，但最近没有系统评价或荟萃分析评估不同地理区域乳糖吸收不良的患病率。我们旨在展示一项关于成年人乳糖吸收不良患病率的最新系统评价和荟萃分析，按国家和地区进行划分，并评估不同检测方法之间的差异。
通过检索 MEDLINE 和 Embase 数据库，从数据库建立到 2016 年 11 月 2 日，我们确定了报告乳糖吸收不良和乳糖酶持续性患病率的研究。我们评估了报告成年人乳糖吸收不良或乳糖酶持续性患病率数据的研究，包括横断面和前瞻性研究，使用基因分型、氢呼气试验、乳糖耐量试验和其他检测方法。我们排除了 10 岁以下儿童的研究、使用自我报告数据的研究以及包括胃肠病房住院患者和门诊患者的研究。两位作者（CLS 和 SKF）筛选了研究，并由两位作者（CLS 和 SKF）独立提取数据值。主要结局为乳糖吸收不良的患病率。本研究已在 PROSPERO 注册，编号为 CRD42017064802。
我们筛选了 2665 条记录，从 116 篇全文文章中纳入了 306 个研究人群（主要来源）；从 59 篇综述文章中获得了另外 144 个研究人群的数据，因为无法获得全文主要文章（次要来源）。在 450 个纳入的研究人群中，231 个通过基因分型进行评估，83 个通过氢呼气试验进行评估，101 个通过乳糖耐量试验进行评估，35 个通过其他方法或方法描述不够充分进行评估。这些研究共纳入了来自 89 个国家的 62910 名参与者（覆盖了全球 84%的人口）。按国家规模标准化后，乳糖吸收不良的全球患病率估计为 68%（95%CI 64-72），范围从西欧、南欧和北欧的 28%（19-37）到中东的 70%（57-83）。仅使用基因分型数据评估全球患病率时，估计值为 74%（69-80），而使用乳糖耐量试验数据时患病率为 55%（46-65），使用氢呼气试验数据时患病率为 57%（46-67）。基于十个指标评估了偏倚风险；12 篇文章的得分为 10 分，表明偏倚风险低，76 篇文章得分为 9 分，26 篇文章得分为 8 分，两篇文章得分为 7 分（表明偏倚风险较高）。在大多数评估国家中，研究之间存在很大的异质性。
乳糖吸收不良在世界上大多数地区普遍存在，不同地区之间存在广泛差异，全球约有三分之二的人口存在这种情况。了解乳糖吸收不良的区域性模式对于指导胃肠道症状的管理很重要。
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