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BACKGROUND: Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE: The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS: In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS: Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION: In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.

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ABSTRACT BACKGROUND: Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE: The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS: In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS: Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION: In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.

RESUMO CONTEXTO: A síndrome do intestino irritável é uma condição clínica que cursa com dor, distensão e plenitude abdominal, diarreia, constipação, entre outros sintomas. Gera impacto significativo na qualidade de vida das pessoas acometidas. Sua fisiopatologia é incerta, mas o papel de vários tipos de alimentos está estabelecido na sensibilização intestinal e nas manifestações clínicas. A intolerância aos carboidratos, particularmente a lactose, gera sintomas similares e por vezes indistinguíveis da síndrome do intestino irritável e é uma condição frequente e subdiagnosticada na prática clínica. Está relacionada a deficiências enzimáticas, alterações da microbiota intestinal e mesmo alterações genéticas. O principal exame para o diagnóstico da intolerância à lactose é o teste respiratório, que mede a emissão de hidrogênio produzido apenas por bactérias, após a ingestão do substrato correspondente. OBJETIVO: O presente trabalho tem como objetivo verificar a prevalência de intolerância à lactose em universitários que apresentem sintomas gastrointestinais sugestivos da síndrome do intestino irritável. MÉTODOS: O estudo, caracterizado como do tipo transversal, teve a participação de 124 discentes de medicina que responderam um formulário, a fim de realizar a triagem daqueles com sintomatologia sugestiva. Aqueles com dor abdominal foram encaminhados para o tratamento antiparasitário, a fim de excluir parasitose intestinal como causa secundária. Posteriormente, através do teste respiratório com hidrogênio expirado, foi feito primeiro a pesquisa de supercrescimento bacteriano e caso fosse negativo seria realizado o da intolerância à lactose. Foram considerados com intolerância aqueles que obtiveram uma elevação na concentração de hidrogênio ≥20 ppm acima do nível basal. RESULTADOS: Do total de alunos pesquisados (n=124), 7 foram excluídos por não cumprirem todas as etapas do estudo. A partir dos 117 indivíduos efetivamente incluídos na pesquisa, verificou-se que 8 (6,8%) foram diagnosticados com intolerância a lactose e 2 (1,7%) com supercrescimento bacteriano. A intolerância foi mais frequente nos indivíduos do sexo feminino (75%), faixa etária de 18 a 25 anos (62,5%), cor parda (50%) e do 5º semestre (37,5%). Verificou-se que a presença de pelo menos um sintoma gastrointestinal entre aqueles que possuem intolerância (100%) e os que não possuem (42,2%) foi estatisticamente significativa (P=0,002). Além da própria dor abdominal (100%) (P<0,001), o sintoma gastrointestinal mais recorrente nos discentes intolerantes foi a distensão/flatulência (62,5%) (P=0,026). Em relação aos hábitos de vida e padrão alimentar, não houve diferença estatística entre os indivíduos intolerantes e tolerantes, bem como na frequência de sintomas. Os discentes dos períodos mais avançados da graduação se destacaram por manifestarem com maior constância os sintomas gastrointestinais, porém sem apresentar discrepâncias estatísticas significativas. CONCLUSÃO: Tendo em vista a quantidade da amostra que realizou o teste (n=21), pode-se provar a alta prevalência da intolerância à lactose (6,8%) no meio acadêmico, com as características epidemiológicas compatíveis com a literatura. Assim, foi possível gerar conhecimento para entender, prevenir, diagnosticar, aliviar e tratar os universitários intolerantes, gerando impactos positivos para o bem-estar, melhorando a qualidade de vida desses indivíduos.

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The most common problem limiting milk consumption worldwide is lactose intolerance (LI), which is defined as the experience of gastrointestinal symptoms due to the intake of lactose-containing food. When symptoms ensue the intake of milk, the condition is referred as milk intolerance, and it may or may not be due to LI. The most common cause of LI is primary lactase deficiency which occurs in 30% of Mexican adults when one glass of milk is consumed (12-18 g of lactose). LI occurs in less than 15% of adults after the intake of this dose of lactose. Another cause of lactose intolerance is due to secondary lactase deficiency, which occurs because lactase is reduced due to diseases that affect the intestinal mucosa. Lactose intolerance can be eliminated or significantly reduced by elimination or reduction of the intake of milk and milk containing products. Recent studies demonstrate that when ß-casein-A1 contained in milk is hydrolyzed it produces ß-casomorphine-7 which is an opioid associated with milk intolerance.

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La alimentación a base de soya, se ha relacionado con alteración de la función tiroidea, debido a la presencia de fitoestrógenos en su composición. Es por ello, que el presente estudio tiene como objetivo determinar la función tiroidea en lactantes menores de 6 meses alimentados con fórmula infantil a base de soya. Es un estudio descriptivo, transversal. Se evaluaron 28 lactantes que recibieron fórmula infantil de soya, como única alimentación. Variables utilizadas: edad, sexo, Graffar-Méndez Castellano, motivo de indicación de la fórmula, dilución, onzas diarias ingeridas, determinación de T3-libre y T4-libre y TSH sérico. Para el análisis estadístico se aplicó t de Student para un nivel de significación estadística de p<0,05. Los valores séricos de T3 y T4 libres se mantuvieron dentro de rangos normales. 7% de la muestra mostró valores elevados de TSH, no siendo estadísticamente significativo. No existió relación estadística entre el consumo de fórmula de soya y función tiroidea. Sin embargo, en la muestra estudiadados de los pacientes presentaron aumento de los niveles de TSH, por lo que no se puede descartar la posibilidad de una asociación dado lo limitado de la muestra.

Feeding with soy has been related to alteration of thyroid function. The objective of this study was to determine thyroid functionalism in babies under 6 months of age fed with infantile soy based formula. Descriptive, cross-sectional, non experimental study. Twenty eight babies who received exclusively infantile soy based formula were evaluated. Variables studied were: age, gender, socio-economical level, reason for the prescription of soy formula, dilution, daily ounces, determination of free T3, T4 and TSH. For the statistic analysis, Student’s t test was applied for a statistical significance level of p<0.05. Serum free T3 and T4 were within normal ranges. 7% of the sample showed elevated levels of TSH, with no statistic significance. there was no statistical relationship between consumption of soy formula and thyroid function. However, two patients had increased levels of TSH and therefore, the possibility of an association cannot be ruled out given the small size of the sample.

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Estudos realizados há mais de 10 anos demonstraram que a deficiência ontogenética de lactase é freqüente na população brasileira. Entretanto, esses estudos se basearam no incremento da glicemia após sobrecarga de doses não utilizadas habitualmente na dieta. Atualmente, aceita-se que a avaliação da absorção da lactose com o teste do hidrogênio no ar expirado é mais apropriada que o teste da curva glicêmica. Por outro lado, a enteropatia ambiental sintomática e/ou assintomática constituem um grave problema de saúde pública em grupos populacionais de baixo nível sócio econômico de nosso meio. A ocorrência de sobrecrescimento bacteriano no intestino delgado de crianças com enteropatia ambiental, foi caracterizada em crianças moradoras em favelas. Sobrecrescimento bacteriano no intestino delgado é caracterizado pela presença de bactérias pertencentes à flora colônica no intestino delgado. Objetivando avaliar a freqüência de má absorção de lactose e determinar a ocorrência de sobrecrescimento bacteriano no intestino delgado em crianças escolares, através do teste do H2 no ar expirado, investigaram-se 83 alunos de uma escola localizada na região periférica da cidade de Marília, Estado de São Paulo, após sobrecarga oral de lactose e lactulose. Foram colhidas também amostras de fezes para pesquisa de parasitas. Má absorção de lactose foi observada em 19 (22,9 por cento) escolares e intolerância à lactose em 10 (12,0 por cento). Sobrecrescimento bacteriano no intestino delgado foi identificado pelo teste do H2 no ar expirado em 6 (7,2 por cento) dos 83 escolares. Giardia lambia foi o parasita mais freqüentemente isolado nas fezes dos escolares. A ocorrência de deficiência ontogenética de lactase observada neste grupo de crianças foi semelhante ao relatado para populações caucasianas. Sobrecrescimento bacteriano foi encontrado neste grupo de crianças assintomáticas, podendo refletir as condições desfavoráveis de seu meio ambiente.

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Realizou-se um estudo em dezesseis crianças infectadas verticalmente pelo HIV para avaliar a condiçäo nutricional e verificar a incidência de diarréia, de má-digestäo de lactose e de má-absorçäo de d-xilose. O grupo apresentava média de idade de 15 meses e classificava-se como sintomático segundo o Centers for Disease Control and Prevention (1987). Treze (81 por cento) das crianças eram desnutridas. Os scores-Z médios de estatura para idade (Z E/I) e de peso para estatura (Z P/E) foram de -2,50 + - 1,39 e de -2,46 + - 1,23, respectivamente. A ciercunferência muscular do braço apresentava percentil < 5 em 11 pacientes e a prega cutânea tricipital foi inferior a esse percentil em 10 casos. Diarréia ocorreu em 12 (75 por cento) pacientes...

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Foram estudados prospectivamente 311 lactentes menores de 1 ano de idade, em aleitamento misto ou artificial, hospitalizados por diarréia aguda, com o objetivo de determinar a prevalência de intolerância à lactose e correlacioná-la com faixa etária, estado nutricional, peso de nascimento, estado de hidrataçäo a agente enteropatogênico identificado nas fezes. A admissäo hospitalar, após correçäo dos distúrbios hidroeletrolóticos, todos os pacientes foram realimentados com leite de vaca, tendo sido monitorizados rigorosamente quanto ao surgimento de intolerância alimentar, através da observaçäo clínica de suas manifestaçöes (persistência da diarréia associada à perda de peso, garantida a ingestäo mínima de 100 calorias por quilo por dia, presneça de vômitos incoercíveis, distensäo abdominal associada à presença de substâncias redutoras nas fezes e/ou pH fecal<6 e acidose metabólica associada à distensäo abdominal) e realizaçäo diária de pesquisa de susbstâncias redutoras nas fezes e pH fecal. A taxa de intolerância à lactose encontrada foi de 52,1 por cento (162/311), tendo apresentado associaçäo estatística significativa com idade inferior a 6 meses (P<0,01), com peso de nascimento inferior a 3000 gramas (P<0,01), com desenvolvimento de desidrataçäo durante a evoluçäo da doença (P<0,01) e com infecçäo por sorogrupos de Escherichia coli enteropatogênica clássica (EPEC) (P<0,01). Assim sendo, nestes casos consideramos ser altamente recomendado utilizar fórmula isenta de lactose para a realimentaçäo, evitando-se a persistência do episódio diarréico.

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Three hundred and eleven hospitalized weaned infants with acute diarrhea, all under 12 months of age, were studied in order to evaluate the development of lactose intolerance and its association with age, nutritional status, birth weight, dehydration and enteropathogenic agents identified in fecal samples. After been rehydrated the infants received whole cow' milk assuring the intake of 100 kcal/kg per day. Lactose intolerance was defined according t the following criteria: 1) persistence of diarrhea associated with weight loss during 48 hours, 2) development of vomiting and/or abdominal distention associated with excretion of carbohydrate in feces and/or acids tools, 3) metabolic acidosis associated with abdominal distention at anytime of refeeding period. Lactose intolerance was detected in 52.1% (162/311) of the patients and it was significantly associated with age under 6 months (P < 0.01), birth weight under 3000 grams (P < 0.01), development of dehydration (P < 0.01) and with enteropathogenic Escherichia coli (EPEC) serotypes infection (P < 0.01).

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The main contributions in the knowledge of secondary lactase deficiency in children are reviewed. We present the clinical features of fermentative diarrhea and the current physiopathological issues, diagnostic procedures, and dietetic treatments, related to this diarrhea, as well as a review of the diseases associated with it. Finally, we discuss the epidemiological implications of the deficiency.

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Se revisan los datos publicados sobre la posibilidad de que la mala disgestión de la lactosa del tipo adulto sea de naturaleza hereditaria. Tanto la variabilidad étnica de la frecuencia de esta característica, así como los estudios en gemelos y sobre todo las investigaciones en familias, sugieren que se trata efectivamente de un problema genético. De hecho, los estudios en familias, incluyendo el realizado en México, indican que la mala digestión de lactosa se hereda en forma autosómica recesiva

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Se revisan las contribuciones que han tenido mayor relevancia en el conocimiento de la deficiencia secundaria de lactasa en los niños. Se hace referencia a la identificación de las diarreas fermentativas, a la descripción de sus particularidades clínicas, a la explicación de sus características fisiopatológicas, a los procedimientos para su diagnóstico, y a su manejo dietético. Se mencionan las enfermedades en cuyas manifestaciones clínicas se asocian las del síndrome por deficiencia de lactasa; con base en esta información, se hacen algunos planteamientos acerca de la magnitud y trascendencia epidemiológica de este problema

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La eficacia de las dietas libres de lactosa en forma rutinaria en niños menores de tres años con enfermedad diarreica aguda, en comparación con dietas con lactosa, no ha sido demostrada en forma consistente y significativa a pesar de múltiples estudios realizados. Para determinar si esta diferencia existe, se diseñó un meta-análisis que nos permitió reunir cuantitativamente los resultados de 15 experimentos clínicos controlados, con un total de 1.364 pacientes, seleccionados por su adecuada calidad metodológica, que intentaban responder la hipótesis planteada. Los parámetros evaluados fueron: 1. Duración de la diarrea en días o enhoras medida como la diferencia (tiempo con lactosa-tiempo sin lactosa). 2. Falla terapéutica medida por el RRI (Odds radio: Con lactosa/Sin lactosa). y 3. La ganancia ponderal teniendo en cuenta variación en el peso post-tratamiento respecto al ingreso. El análisis indicó que no hay diferencias estadísticamente significativas en cuanto a la duración de la diarrea en días (0,03 días con IC 95 por ciento -0.4 a +0,3). Sin embargo, al anlizar los estudios que informaron la duración de la diarrea en horas, sugieren que la dieta con lactosa puede incrementar en algunas horas su duración (+12,8 horas con IC 95 por ciento +4,1 a +21,5). En cuanto al análisis por falla terapéutica, sugiere que en conjunto los niños que reciben lactosa tienen un riesgo aproximadamente 2 veces mayor que los que no la reciben (RRI 1,91 con IC 95 por ciento 1,28 a 2,86). Los resultados sugieren que el empleo rutinario de dietas sin lactosa en niños con enfermedad diarreica aguda (EDA) puede producir resultados diferentes según la variable empleada para medir la efectividad. La diferencia obtenida en duración por horas no tiene importancia clínica. La diferencia obtenida en cuanto a falla terapéutica está a favor de la utilización de fórmulas libres de lactosa.

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Lactose intolerance is a recognized complication of some episodes of diarrhoea. Whereas it is of clinical importance in relatively few children with acute diarrhoea it seems to be a more common problem in children presenting with persistent diarrhoea, especially in malnourished children with severe diarrhoea. We describe a recent study which also demonstrated adverse clinical and nutritional consequences in the majority of children with mild but persistent diarrhoea consuming 6 g lactose/kg body weight/d. It is desirable to identify these children who need to reduce their lactose intake in order to limit unnecessary dietary changes which are expensive to implement and/or nutritionally disadvantageous. Admission clinical characteristics were analyzed for their ability to predict clinical outcome in a group of 33 children with persistent diarrhoea taking a lactose-containing diet. The results of tests of stool reducing substances and a lactose breath hydrogen test (LHBT) were analyzed in the same group whose clinical management had been independent of the test results. Eighty-nine percent of children who deteriorated had one of the following characteristics: age < 12 months, weight-for-height less than -2 SD below NCHS norms or fever > 37 degrees C. Children who unequivocally improved while continuing to take lactose could not be selected without the risk of including children who deteriorated. Neither tests of stool reducing substances nor the LBHT improved the predictive value of simple clinical parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

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The author suggests that under certain conditions cultured milk, rather than fluid milk, can be used for infant and child nutrition as well as for school milk programs. Some of the major problems with fluid milk, fresh or reconstituted, are discussed. A review of the literature indicates that the assumption of lactose intolerance among many populations is exaggerated. Inappropriate handling of pasteurized milk very often is responsible for a high bacterial count and organoleptic defects. Such quality defects are more pronounced in countries with a warm climate. The use of polluted water in the reconstitution of milk powder, is probably more often responsible for diarrhea than lactose intolerance. For these reasons it is suggested that under appropriate conditions a cultured milk product such as yogurt or quark, be used for infant and child nutrition. The advantages are: 1) the low pH caused by the high lactic acid content detrimentally affects food spoilage and pathogenic organisms in milk; 2) longer shelf life of the fermented product at ambient temperature; and 3) fermented milk products contain the enzyme lactase which facilitates digestion of residual lactose even after ingestion.

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The degree of which the ability to absorb lactose can be regained after recovery from an acute episode of severe malnutrition is in doubt. Lactase activity was indirectly assessed by means of a standard lactose tolerance test (2 g lactose per kilogram of body weight) in 71 Peruvian Mestizo infants and children (age 5 to 55 months) who had suffered such an episode. All were studied just before discharge after several months of hospital rehabilitation, during which linear growth and weight gain had accelerated and signs of significant malabsorption of other nutrients had disappeared. Only 39% of the total group had a positive test (delta blood glucose greater than 25 mg/dl); there was a decreasing proportion of positive responders with increasing age. No difference in response attributable to type or severity of malnutrition was found. Comparison of the present data with previous data from children in the same community who had never been acutely malnourished suggests that acute malnutrition may hasten the permanent decline of lactase activity normally expected later in life.

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