Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-03T05:02:47.877Z Has data issue: false hasContentIssue false

Lactose intolerance and bone mass in postmenopausal Italian women

Published online by Cambridge University Press:  09 March 2007

Gino R. Corazza
Affiliation:
Department of Internal Medicine, University of L'Aquila, L'Aquila, Italy
Giuseppe Benati
Affiliation:
Department of Medical Pathology, University of Bologna, Bologna, Italy
Antonio Di Sario
Affiliation:
Department of Medical Pathology, University of Bologna, Bologna, Italy
Carlo Tarozzi
Affiliation:
Division of Nuclear Medicine, Ospedale Maggiore, Bologna, Italy
Alessandra Strocchi
Affiliation:
Department of Medical Pathology, University of Bologna, Bologna, Italy
Mario Passeri
Affiliation:
Department of Medicine, University of Parma, Parma, Italy
Giovanni Gasbarrini
Affiliation:
Department of Medical Pathology, University of Bologna, Bologna, Italy
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Previous studies on the role of lactose malabsorption in the pathogenesis of postmenopausal osteoporosis have yielded conflicting results and further information is needed. To date, all studies have been carried out on populations with a low prevalence of lactose malabsorption and the lactose intestinal absorptive capacity was tested using a non-physiological dose of lactose. In fifty-eight Italian postmenopausal women (mean age 57 (SD 7) years), bone mineral density (BMD) at lumbar spine, H2 breath response after ingestion of 20 g lactose, intensity of symptoms of intolerance after a lactose load and daily Ca intake were evaluated. No differences were found between women with or without a positive H2, breath test with regard to BMD (−1·2 (SD 0·9) ν −0·9 (SD 0·8)) and Ca intake (509 (SD 266) ν 511 (SD 313) mg/d). On the contrary, both BMD and Ca intake were significantly lower in women with lactose malabsorption and symptoms of intolerance (−1·5 (SD 0·7) and 378 (SD 220) mg/d) than in those with malabsorption without symptoms (−0·9 (SD 0·9) and 624 (SD 254) mg/d). Moreover, in lactose malabsorbers Ca intake was correlated inversely with symptom score (rs −0·31, P<0·05) and positively with BMD (rs 0·42, P<0·005). Our results show that in Italian postmenopausal women Ca intake and BMD are not influenced directly by lactose malabsorption; the appearance of symptoms of intolerance seems to influence BMD unfavourably through a reduced Ca intake.

Type
Lactose intolerance and osteoporosis
Copyright
Copyright © The Nutrition Society 1995

References

Alhava, E. M., Jussila, J., Karjalainen, P. & Vuojolahti, P. (1977) Lactose malabsorption and bone mineral content. Acta Medica Scandinavica 201, 281283.CrossRefGoogle ScholarPubMed
Andon, M. B., Smith, K. T., Bracker, M., Sartoris, D., Saltman, P. & Strause, L. (1991) Spinal bone density andcalcium intake in healthy postmenopausal women. American Journal of Clinical Nutrition 54, 927929.CrossRefGoogle Scholar
Angus, R. M., Sambrook, P. N., Pocock, N. A. & Eisman, J. A. (1988) Dietary intake and bone mineral density. Bone Mineral 41, 265277.Google Scholar
Bayless, T. M. (1981) Lactose malabsorption, milk intolerance and symptom awareness in adults. In Lactose Digestion, Clinical and Nutritional Implications, 117123 [PageD. M., D. M., and Bayless, T. M., editors]. Baltimore: Johns Hopkins University Press.Google Scholar
Bell, N. H., Greene, A., Epstein, S., Oexmann, M. J., Show, S. & Shary, J. (1985) Evidence for alteration of the vitamin D-endocrine system in Blacks. Journal of Clinical Investigation 76, 470473.CrossRefGoogle ScholarPubMed
Birge, S. J., Keutmann, H. T., Cuatrecasas, P. & Whedon, G. D. (1967) Osteoporosis, intestinal lactase deficiency and low dietary calcium intake. New England Journal of Medicine 276, 445448.CrossRefGoogle ScholarPubMed
Bond, J. H., Currier, B. E., Buchwald, H. & Levitt, M. D. (1980) Colonic conservation of malabsorbed carbohydrate. Gastroenterology 78, 444447.CrossRefGoogle ScholarPubMed
Bozzani, A., Penagini, R., Velio, G., Camboni, G., Corbellini, A., Quatrini, M., Conte, D. & Bianchi, P. A. (1986) Lactose malabsorption and intolerance in Italians. Clinical implications. Digestive Diseases and Sciences 31, 13131316.CrossRefGoogle ScholarPubMed
Burgio, G. R., Flatz, G., Barbera, C, Patanè, R., Boner, A., Cajozzo, C. & Flatz, S. D. (1984) Prevalence of primary adult lactose malabsorption and awareness of milk intolerance in Italy. American Journal of Clinical Nutrition 39, 100104.CrossRefGoogle ScholarPubMed
Cohn, S. H., Abesamis, C, Yasumara, S., Aloia, J. F., Zanzi, I. & Ellis, K. J. (1977) Comparative skeletal mass and radial bone mineral content in black and white women. Metabolism 26, 171178.CrossRefGoogle ScholarPubMed
Corazza, G. R., Benati, G., Sorge, M., Strocchi, A., Calza, G. & Gasbarrini, G. (1992) β-Galactosidase from Aspergillus niger in adult lactose malabsorption: a double-blind crossover study. Alimentary Pharmacology & Therapeutics 6, 6166.CrossRefGoogle ScholarPubMed
Corazza, G. R., Sorge, M., Strocchi, A., Lattanzi, M. C, Benati, G. & Gasbarrini, G. (1990) Methodology of the H2 breath test. II. Importance of the test duration in the diagnosis of carbohydrate malabsorption. Italian Journal of Gastroenterology 22, 303305.Google ScholarPubMed
Cuatrecasas, P., Lockwood, D. & Caldwell, J. R. (1965) Lactase deficiency in adult: common occurence. Lancet i, 1418.CrossRefGoogle Scholar
Cummings, S. R., Block, G., McHenry, K. & Baron, R. B. (1987) Evaluation of two food frequency methods of measuring dietary calcium intake. American Journal of Epidemiology 126, 796802.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B., Jacques, P. & Shipp, C. (1987) Dietary calcium intake and bone loss from the spine in healthy postmenopausal women. American Journal of Clinical Nutrition 46, 685687.CrossRefGoogle ScholarPubMed
Dempster, D. W. & Lindsay, R. (1993) Pathogenesis of osteoporosis. Lancet 341, 797801.CrossRefGoogle ScholarPubMed
Di Palma, J. A. & Narvaez, R. M. (1988) Prediction of lactose malabsorption in referral patients. Digestive Diseases and Sciences 33, 303307.CrossRefGoogle ScholarPubMed
Ferguson, A. (1990) Food sensitivity or self-deception? New England Journal of Medicine 16, 476478.CrossRefGoogle Scholar
Finkenstedt, G., Skrabal, F., Gasser, R. W. & Braunsteiner, H. (1986) Lactose malabsorption, milk consumption, and fasting blood glucose concentrations in women with idiopathic osteoporosis. British Medical Journal 292, 161162.CrossRefGoogle ScholarPubMed
Gudmand-Höyer, E. & Simony, K. (1977) Individual sensitivity to lactose in lactose malabsorption. Digestive Diseases 22, 177181.CrossRefGoogle ScholarPubMed
Hankin, J. H. (1989) Development of a diet history questionnaire for studies of old persons. American Journal of Clinical Nutrition 50, 11211127.Google Scholar
Härmä, M. & Alhava, E. (1988) Is lactose malabsorption a risk factor in fractures of the elderly? Annales Chirurgiae Gynaecologiae 77, 180183.Google ScholarPubMed
Heaney, R. P., Recker, R. R. & Saville, P. D. (1978) Menopausal changes in calcium balance performance. Journal of Laboratory and Clinical Medicine 92, 953963.Google ScholarPubMed
Horowitz, M., Need, A. G., Philcox, J. C. & Nordin, B. E. C. (1984) Effect of calcium supplementation on urinary hydroxyproline in osteoporotic postmenopausal women. American Journal of Clinical Nutrition 39, 857859.CrossRefGoogle ScholarPubMed
Horowitz, M., Wishart, J., Mundy, L. & Nordin, B. E. C. (1987) Lactose and calcium absorption in postmenopausal osteoporosis. Archives of Internal Medicine 147, 534536.CrossRefGoogle ScholarPubMed
Istituto Italiano della Nutrizione (1983) Tabelle di Composizione Degli Alimenti. Roma: Istituto Italiano della Nutrizione.Google Scholar
Jodry, H., Griessen, M., Courvoisier, B. & Fischer, J. (1987) Incidence de la dèficience en lactase chez les patientes atteintes d'ost`eoporose d'involution et chez les sujets normaux (Incidence of lactase deficiency in osteoporotic patients and healthy subjects). Schweizerische Medizinische Wochenschrift 117, 17361741.Google Scholar
Johnson, A. O., Semenya, J. G., Buchowski, M. S., Enwonwu, C. O. & Scrimshaw, N. S. (1993) Correlation of lactose maladigestion, lactose intolerance, and milk intolerance. American Journal of Clinical Nutrition 57, 399401.CrossRefGoogle Scholar
Johnston, C. C, Melton, L. J., Lindsay, R. & Eddy, D. M. (1989) Clinical indications for bone mass measurement. Journal of Bone and Mineral Research 4 Suppl. 2, 128.Google Scholar
Jones, D. V., Latham, M. C, Kosikowscki, F. W. & Woodward, G. (1976) Symptom response to lactose reduced milk in lactose intolerant adults. American Journal of Clinical Nutrition 29, 633.CrossRefGoogle ScholarPubMed
Kolars, J. C, Levitt, M. D., Aouji, M. & Savaiano, D. A. (1984) Yogurt-an autodigesting source of lactose. New England Journal of Medicine 310, 13.CrossRefGoogle ScholarPubMed
Kotler, D. P., Holt, P. R. & Rosensweig, N. S. (1982) Modification of the breath hydrogen test: increased sensitivity for the detection of the carbohydrate malabsorption. Journal of Laboratory and Clinical Medicine 100, 798805.Google ScholarPubMed
Newcomer, A. D. (1981) Immediate symptomatic and long-term nutritional consequences of hypolactasia. In Lactose Digestion, Clinical and Nutritional Implications, pp. 124133 [Page, D.M. and Bayless, T. M., editors]. Baltimore: Johns Hopkins University Press.Google Scholar
Newcomer, A. D., Hodgson, S. F., McGill, D. B. & Thomas, P. J. (1978 a) Lactase deficiency: prevalence in osteoporosis. Annals of Internal Medicine 89, 218220.CrossRefGoogle ScholarPubMed
Newcomer, A. D., McGill, D. B., Thomas, P. J. & Hofmann, A. F. (1978 b) Tolerance to lactose among lactase-deficient American Indians. Gastroenterology 74, 4446.CrossRefGoogle ScholarPubMed
Payette, H. & Gray-Donald, K. (1991) Dietary intake and biochemical indices of nutritional status in an elderly population, with estimates of the precision of the 7-d food record. American Journal of Clinical Nutrition 54, 478488.CrossRefGoogle Scholar
Perman, J. A., Modler, S. & Obson, A. C. (1981) Role of pH in production of hydrogen from carbohydrate bycolonic bacterial flora. Journal of Clinical Investigation 67, 643650.CrossRefGoogle ScholarPubMed
Richelson, L. S., Wahner, H. W., Melton, L. J. & Riggs, B. L. (1984) Relative contributions of aging and estrogen deficiency to postmenopausal bone loss. New England Journal of Medicine 311, 12731275.CrossRefGoogle ScholarPubMed
Riggs, B. L., Wahner, H. W., Melton, J., Richelson, L. S., Judd, H. L. & O'Fallon, W. M. (1987) Dietary calcium intake and rates of bone loss in women. Journal of Clinical Investigation 80, 979982.CrossRefGoogle ScholarPubMed
Riggs, B. L. & Melton, L.J. (1990) Clinical heterogeneity of involutional osteoporosis: implications for preventive therapy. Journal of Clinical Endocrinology and Metabolism 70, 12291232.CrossRefGoogle ScholarPubMed
Rosado, J. L., Allen, L. H. & Solomons, N. W. (1987) Milk consumption, symptom response, and lactose digestion in milk intolerance. American Journal of Clinical Nutrition 45, 14571460.CrossRefGoogle ScholarPubMed
Rosado, J. L. & Solomons, N. W. (1983) Sensitivity and specificity of the hydrogen breath-analysis test for detecting malabsorption of physiological doses of lactose. Clinical Chemistry 29, 545548.CrossRefGoogle ScholarPubMed
Rosado, J. L., Solomons, N. W., Lisker, R. & Bourges, H. (1984) Enzyme replacement therapy for primary adultlactase deficiency. Gastroenterology 87, 10721082.CrossRefGoogle ScholarPubMed
Saavedra, J. M. & Perman, J. A. (1989) Current concepts in lactose malabsorption and intolerance. Annual Review of Nutrition 9, 475502.CrossRefGoogle ScholarPubMed
Scrimshaw, N. S. & Murray, E. B. (1988) The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. American Journal of Clinical Nutrition 48, 10861098.CrossRefGoogle ScholarPubMed
Seeman, E., Wahner, H. W., Offord, K. P., Kumar, R., Johnson, W. J. & Riggs, B. L. (1982) Differencial effectsof endocrine dysfunction on the axial and appendicular skeleton. Journal of Clinical Investigation 69, 13021309.CrossRefGoogle Scholar
Slemenda, C. W., Christian, J. C, Hui, S., Fitzgerald, J. & Johnston, C. (1991) No evidence for an effect of lactase deficiency on bone mass in pre- or postmenopausal women. Journal of Bone and Mineral Research 6, 13671371.CrossRefGoogle ScholarPubMed
Smith, T. M., Kolars, J. C, Savaiano, D. A. & Levitt, M. D. (1985) Absorption of calcium from milk and yogurt. American Journal of Clinical Nutrition 42, 11971200.CrossRefGoogle ScholarPubMed
Strocchi, A. & Levitt, M. D. (1992) Factors affecting hydrogen production and consumption by human fecal flora: the critical role of hydrogen tension and methanogenesis. Journal of Clinical Investigation 89, 13041311.CrossRefGoogle Scholar
Vigorita, V. J., Lane, J. M., Suda, M. K. & Nelkin, M. (1987) Differences between lactase deficient and non-lactase deficient women with spinal osteoporosis. Clinical Orthopaedics and Related Research 215, 248253.CrossRefGoogle Scholar
Weinstein, R. S. & Bell, N. H. (1988) Diminished rates of bone formation in normal Black adults. New England Journal of Medicine 319, 16981701.CrossRefGoogle ScholarPubMed