Abaturov Alexandr Ye, Stepanov Yuri M, Nikulina Anna A
State Institution "Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine.
Wiad Lek. 2019;72(1):17-21.
Introduction: Excess lactose in the diet of modern man causes the development of not only lactase deficiency, but it can be a factor that contributes to obesity. The aim: To study associations between obesity and genotype C/C 13910 of lactase gene (LCT) in children, to investigate the effectiveness of treatment using drug exogenous lactase and a low-lactose diet.
Materials and methods: genotyping of lactase gene by real-time polymerase chain reaction, determining the level of lactose maldigestion by hydrogen breath test (HBT), estimating the insulin resistance with the HOMA-IR index in 70 obese children and 40 healthy children 6 - 18 years. Obese children with genotype C/C 13910 and lactose maldigestion (n=40) were randomized in two groups: children from group I (n=20) received an exogenous lactase preparation, and children from group II (n=20) - low-lactose diet.
Results: in obese children, the genotype C/C 13910 is 2 times more often than in healthy children. Obese children with genotype C/C 13910 have a significantly higher value of HBT (32.8-39.8 ppm) compared to healthy children (p<0.05), and an increased value of the HOMA-IR index. After treatment, there was a significant decrease in HBT and the HOMA-IR index in the two comparison groups.
Conclusions: signs of insulin resistance are observed in children with obesity, genotype C/C 13910 and lactose maldigestion. The use of exogenous lactase in the therapy or the administration of a low-lactose diet cause approximately the same decrease in the HOMA-IR index.
引言：现代人类饮食中过量的乳糖不仅会导致乳糖酶缺乏，还可能是导致肥胖的一个因素。目的：研究儿童肥胖与乳糖酶基因（LCT）C/C 13910基因型之间的关联，探讨使用药物外源性乳糖酶和低乳糖饮食治疗的有效性。
材料与方法：采用实时聚合酶链反应对乳糖酶基因进行基因分型，通过氢呼气试验（HBT）测定乳糖消化不良水平，用HOMA-IR指数评估70名肥胖儿童和40名6至18岁健康儿童的胰岛素抵抗。将基因型为C/C 13910且乳糖消化不良的肥胖儿童（n = 40）随机分为两组：第一组（n = 20）儿童接受外源性乳糖酶制剂，第二组（n = 20）儿童接受低乳糖饮食。
结果：肥胖儿童中，C/C 13910基因型的出现频率是健康儿童的2倍。与健康儿童相比，基因型为C/C 13910的肥胖儿童HBT值显著更高（32.8 - 39.8 ppm）（p<0.05），且HOMA-IR指数升高。治疗后，两个比较组的HBT和HOMA-IR指数均显著下降。
结论：肥胖、基因型为C/C 13910且乳糖消化不良的儿童存在胰岛素抵抗迹象。在治疗中使用外源性乳糖酶或给予低乳糖饮食可使HOMA-IR指数下降幅度大致相同。
