Carroccio A, Montalto G, Cavera G, Notarbatolo A
Istituto di Medicina Interna, Università di Palermo, Italy.
J Am Coll Nutr. 1998 Dec;17(6):631-6. doi: 10.1080/07315724.1998.10718813.
The relationship between lactose-maldigestion, self-reported milk intolerance and gastrointestinal symptoms has not been clearly defined.
To evaluate: a) the prevalence of lactose maldigestion and lactose intolerance in a sample of the general population taken from a rural center; b) the frequency of self-reported milk-intolerance and its correlation with lactose-maldigestion; c) the influence of lactose maldigestion, lactose intolerance and self-reported milk intolerance on dietary habits and consumption of total calories, protein, and calcium.
We studied a randomized sample of the general population in a small center in Sicily. 323 subjects (150 males, 173 females), age range 5 to 85 years (median 44) were included and underwent H2-breath test after 25 g lactose load. The preliminary dietary investigation spanned 7 consecutive days using a printed dietary form and was under the daily control of a team of dietitians.
The dietary investigation was completed in the first part of the study and the results were analyzed for nutrient composition by a computerized database. The subjects were then divided into self-reported milk-intolerants and self-reported milk-tolerants and they underwent H2 breath testing; subjects with H2 concentration >20 ppm over the baseline concentration were considered maldigesters and those with one or more symptoms were classified as intolerants.
104/323 subjects (32.2%) were lactose maldigesters but tolerants, while 13/323 (4%) were lactose maldigesters and intolerants. In each age-class group (pediatric, adult, and elderly subjects) only the lactose maldigester and intolerant subjects showed differences in nutrient intake with a significantly lower daily consumption of milk and a lower calcium intake. 49/323 subjects were self-reported milk-intolerants; of these, 26 (53%) were lactose maldigesters but tolerants, 18 (37%) were lactose digesters and tolerants and only 5 (10%) were lactose maldigesters and intolerants. In the whole group of self-reported milk-intolerants, dietary milk consumption was significantly reduced and calcium intake was lower than in all the other subjects studied (320 mg/day vs. 585 mg/day, p<0.05).
In studies of the general population, the frequency of lactose intolerance is much lower than that of lactose maldigestion. Gastrointestinal symptoms after lactose load in self-reported milk-intolerants are found in only a very low number of these subjects. Furthermore, in these subjects we observed an unnecessary reduction in milk consumption and an insufficient dietary calcium intake.
乳糖消化不良、自我报告的牛奶不耐受与胃肠道症状之间的关系尚未明确界定。
评估：a）从农村中心抽取的普通人群样本中乳糖消化不良和乳糖不耐受的患病率；b）自我报告的牛奶不耐受的频率及其与乳糖消化不良的相关性；c）乳糖消化不良、乳糖不耐受和自我报告的牛奶不耐受对饮食习惯以及总热量、蛋白质和钙摄入量的影响。
我们研究了西西里岛一个小中心普通人群的随机样本。纳入了323名受试者（150名男性，173名女性），年龄范围为5至85岁（中位数44岁），在摄入25克乳糖后进行了氢气呼气试验。初步饮食调查使用印刷的饮食表格连续进行7天，并由一组营养师每日监督。
饮食调查在研究的第一部分完成，结果通过计算机化数据库分析营养成分。然后将受试者分为自我报告的牛奶不耐受者和自我报告的牛奶耐受者，并进行氢气呼气试验；氢气浓度超过基线浓度>20 ppm的受试者被视为消化不良者，有一项或多项症状的受试者被归类为不耐受者。
104/323名受试者（32.2%）为乳糖消化不良但耐受者，而13/323名（4%）为乳糖消化不良且不耐受者。在每个年龄组（儿童、成人和老年受试者）中，只有乳糖消化不良且不耐受的受试者在营养摄入方面存在差异，牛奶日消费量显著较低，钙摄入量也较低。49/323名受试者自我报告为牛奶不耐受者；其中，26名（53%）为乳糖消化不良但耐受者，18名（37%）为乳糖消化良好且耐受者，只有5名（10%）为乳糖消化不良且不耐受者。在整个自我报告的牛奶不耐受者组中，饮食中的牛奶消费量显著减少，钙摄入量低于所有其他研究对象（320毫克/天对585毫克/天，p<0.05）。
在普通人群研究中，乳糖不耐受的发生率远低于乳糖消化不良。自我报告的牛奶不耐受者在乳糖负荷后出现胃肠道症状的人数极少。此外，在这些受试者中，我们观察到牛奶消费量不必要的减少以及饮食钙摄入量不足。
