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VIII.75 - Lactose Intolerance and Malabsorption

from Part VIII - Major Human Diseases Past and Present

Published online by Cambridge University Press:  28 March 2008

Kenneth F. Kiple
Affiliation:
Bowling Green State University, Ohio
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Summary

Lactose malabsorption describes a physiological situation. It is the basis for lactose intolerance. The inability to digest lactose is a quantitative phenomenon related to the enzyme lactase and its amount and activity in the intestine. Lactose intolerance, then, is a clinical definition. It involves the concept that the individual is unable to tolerate physiologically the lactose present in milk and other dietary products because of an inability to digest the carbohydrate, due to insufficient activity of the lactase enzyme. Intolerance to lactose as a clinical entity has been recognized for some time. Early in this century, Abraham Jacoby hinted at the existence of lactose intolerance in speeches to the American Pediatric Society; later, in 1926, John Howland, in his presidential address to that same organization, was somewhat more explicit when he indicated that many of the infantile diarrheas were the result of a lack of “ferments” necessary for the digestion of carbohydrate (Flatz 1989).

More recently, interest of physicians and nutritionists in the digestion of lactose stimulated reports during the late 1950s. One by A. Holzel and colleagues (1959) reported on a severe diarrhea associated with the ingestion of lactose in two young siblings who, as a consequence, were “failing to thrive.” Another report, by P. Durand (1958), diagnosed two patients with lactose malabsorption and lactosuria. Since then, innumerable articles and reviews have appeared in the world’s literature (Scrimshaw and Murray 1988). Evaluations of that literature may be obtained by consulting G. Semenza and S. Auricchio (1989), G. Flatz (1989), and N. Kretchmer (1971).

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Publisher: Cambridge University Press
Print publication year: 1993

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References

Castillo, R., et al. 1990. Intestinal lactase in the neonatal rat. Journal of Biological Chemistry 265.Google ScholarPubMed
Debongnie, J. C., et al. 1975. Absorption of nitrogen and fat. Archives of the Diseases of Childhood 50.Google Scholar
Durand, P. 1958. Idiopathic lactosuria in a patient with chronic diarrhea and acidosis. Minerva Pediatrica 10.Google Scholar
Flatz, G. 1989. The genetic polymorphism of intestinal lactase activity in adult humans. In The metabolic basis of inherited disease, 6th edition, ed. Scriver, C. R. et al. New York.Google Scholar
Holzel, A., Schwartz, V., and Sutcliff, K. W.. 1959. Defective lactose absorption causing malnutrition in infancy. Lancet 1.Google ScholarPubMed
Kretchmer, N. 1971. [Memorial lecture] Lactose and lactase: A historical perspective. Gastroenterology 61.Google Scholar
Kretchmer, N. 1977. The geography and biology of lactose digestion and malabsorption. Postgraduate Medical Journal 53.Google ScholarPubMed
Lebenthal, E., et al. 1981. Recurrent abdominal pain and lactose absorption in children. Pediatrics 67.Google ScholarPubMed
Quan, R., et al. 1990. Intestinal lactase: Shift in intracellular processing to altered, inactive species in the adult rat. Journal of Biological Chemistry 265.Google ScholarPubMed
Ransome-Kuti, O., et al. 1975. A genetic study of lactose digestion in Nigerian families. Gastroenterology 68.Google ScholarPubMed
Sahi, T. 1974. The inheritance of selective adult-type lactose malabsorption. Scandinavian Journal of Gastroenterology (Supplement 30): 1–73.Google ScholarPubMed
Scrimshaw, N. S., and Murray, E. B.. 1988. The acceptability of milk and milk products in populations with high prevalence of lactose intolerance. American Journal of Clinical Nutrition (Supplement 48(4)): 1083–1147.CrossRefGoogle ScholarPubMed
Semenza, G., and Auricchio, S.. 1989. Small-intestinal disaccharidases. In The metabolic basis of inherited disease, 6th edition, ed. Scriver, C. R. et al. New York.Google Scholar
Simoons, F. J. 1970. Primary adult lactose intolerance and the milking habit: A problem in biologic and cultural interrelations. II. A culture-historical hypothesis. American Journal of Digestive Diseases 15.CrossRefGoogle Scholar
Sunshine, P., and Kretchmer, N.. 1964. Intestinal disaccharidases: Absence in two species of sea lions. Science 144.CrossRefGoogle ScholarPubMed
Wald, A., et al. 1982. Lactose malabsorption in recurrent abdominal pain of childhood. Journal of Pediatrics 100.CrossRefGoogle ScholarPubMed

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