LAKTOZ İNTOLERANSIN PREVALANSI, TEŞHİSİ VE LAKTOZSUZ BESLENME TAVSİYELERİ

Öz

Laktoz, sadece sütte bulunan bir disakkarit olup, emmeyi bıraktıktan sonra çoğu kişide laktozu parçalayan laktaz enziminin sentezi durmakta veya azalmaktadır. Laktoz intolerans olarak bilinen bu durum sütün sindirilememesiyle sonuçlanmakta ve dünyada çok sık görülmektedir. Laktaz geni üzerinde meydana gelen tek nükleotit polimorfizmleri nedeniyle bazı kişilerde laktaz enzimi yaşam boyu sentezlenebilmektedir. Laktaz kalıcılığı olarak adlandırılan bu durumun prevalansı etnik gruplara göre değişmektedir. Laktoz intoleransın teşhisinde çeşitli yöntemler uygulanmasına rağmen, çoğu zaman semptomların gözlenmesi hastalık teşhisi için yeterli olmaktadır. Laktoz intolerans olanlar ömür boyu sürecek laktozsuz bir diyet uygulamalıdır. Süt kalsiyum gibi bazı önemli besin öğeleri açısından zengin bir kaynak olduğu için, laktoz intolerans hastalarının kalsiyum gibi ihtiyaçlarını peynir ve yoğurt gibi laktoz içeriği düşük olan gıdalardan karşılamaları önemlidir. Bu çalışmada, laktoz intolerans hakkında bilgi verilerek, laktoz intoleransın prevalansı ve teşhis yöntemleri ile laktozsuz beslenme üzerinde durulmuştur. Bu çalışma ile laktoz intolerans farkındalığının hem hastalar tarafından hem de gıda endüstrisinin paydaşları tarafından arttırılması hedeflenmektedir.

Anahtar Kelimeler

• Süt,Laktoz intolerans,Laktaz kalıcılığı,Laktozsuz beslenme

THE PREVALENCE AND DIAGNOSTIC METHODS OF LACTOSE INTOLERANCE AND LACTOSE-FREE DIET RECOMMENDATIONS

Abstract

Lactose is a disaccharide found only in milk, and after weaning, the synthesis of lactase, which breaks down lactose, stops or decreases in most individuals. This condition, known as lactose intolerance, results in the inability of the digestion of milk and is very common in the world. Because of the single nucleotide polymorphisms occurring on the lactase gene, the lactase enzyme can be synthesized for life in some individuals. The prevalence of this condition called lactase persistence varies according to ethnic groups. Although there are various methods for the diagnosis of lactose intolerance, observation of symptoms is often sufficient for the diagnosis of the disease. Those who have lactose intolerance should apply a life-long lactose-free diet. Since milk is a rich source of some important nutrients such as calcium, it is important for lactose intolerance patients to meet their needs like calcium from foods with low lactose content such as cheese and yogurt. In this study, information about lactose intolerance was given and lactose intolerance prevalence, diagnosis methods, and lactose-free diet were examined. This study aims to increase the lactose intolerance awareness of both patients and food industry stakeholders.

Keywords

• Milk,Lactose intolerance,Lactase persistence,Lactose-free diet

References

1. Adolfsson, O., Meydani, S.N., Russell, R.M. (2004). Yogurt and gut function. Am J Clin Nutr., 80, 245-56. https://doi.org/10.1093/ajcn/80.2.245
2. Bersaglieri, T., Sabeti, P., Patterson, N., Vanderploeg, T., Schaffner, S., Drake, J., Rhodes, M., Reich, D.E., Hirschhorn, J.N. (2004). Genetic signatures of strong recent positive selection at the lactase gene. The American Journal of Human Genetics, 74(6), 1111-20. https://doi.org/10.1086/421051
3. Brown-Esters, O., Mc Namara, P., Savaiano, D., (2012). Dietary and biological factors influencing lactose intolerance. International Dairy Journal, 22, 98-103. https://doi.org/10.1016/j.idairyj.2011.09.01 Campbell, A.K., Matthews, S.B., Vassel, N., Cox, C.D., Naseem, R., Chaichi, J., Holland, I.B., Green, J., Wann, K.T. (2010). Bacterial metabolic 'toxins': A new mechanism for lactose and food intolerance, and irritable bowel syndrome. Toxicology, 278, 268-276. https://doi.org/10.1016/j.tox.2010.09.0010
4. Campbell, A.K., Waud, J.P., Matthews, S.B. (2005). The molecular basis of lactose intolerance. Science Progress, 88(3), 157-202. https://doi.org/10.3184/003685005783238408
5. Chandan, R.C., Shah, N.P. (2006). Functional Foods and Disease Prevention. Manufacturing Yogurt and Fermented Milks Edited by Ramesh C. Chandan, Blackwell Publishing, 311-325. https://doi.org/10.1002/9780470277812.ch20
6. Cook, C.J. (2014). The role of lactase persistence in precolonial development. Journal of Economic Growth, 19, 369-406. https://doi.org/10.1007/s10887-014-9109-5
7. Corgneau, M., Scher, J., Ritié-Pertusa, L., Le, D.T.L., Petit, J., Nikolova, Y., Banon, S., Gaiani, C. (2015). Recent advances on lactose ıntolerance: Tolerance thresholds and currently available solutions. Critical Reviews in Food Science and Nutrition, 57(15), 3344-3356. https://doi.org/10.1080/10408398.2015.1123671
8. de Vrese, M., Stegelmann, A., Richter, B., Fenselau, S., Laue, C., Schrezenmeir, J. (2001). Probiotics-compensation for lactase insufficiency. The American Journal of Clinical Nutrition, 73(2), 421-29. https://doi.org/10.1093/ajcn/73.2.421s

9. Demirgül, F., Sağdıç, O. (2018). Fermente süt ürünlerinin insan sağlığına etkisi. Avrupa Bilim ve Teknoloji Dergisi, 13, 45-53. https://doi.org/10.31590/ejosat.377798
10. Di Rienzo, T., D'angelo, G., D'aversa, F., Campanale, M.C., Cesario, V., Montalto, M., Gasbarrini, A., Ojetti, V. (2013). Lactose intolerance: from diagnosis to correct management. European Review for Medical and Pharmacological Sciences, 17(Suppl 2), 18-25.
11. Enattah N.S., Jensen, T.G., Nielsen, M., Lewinski, R., Kuokkanen, M., Rasinpera, H., El-Shanti, H., Seo, J.K., Alifrangis, M., Khalil, I.F., Natah, A., Ali, A., Natah, S., Comas, D., Mehdi, S.Q., Groop, L., Vestergaard, E.M., Imtiaz, F., Rashed, M.S., Meyer, B., Troelsen, J., Peltonen L. (2008). Independent introduction of two lactase-persistence alleles into human populations reflects different history of adaptation to milk culture. The American Journal of Human Genetics, 82, 57-72. https://doi.org/10.1016/j.ajhg.2007.09.012
12. Flatz, G., Rotthauwe, H.W. (1973). Lactose nutrition and natural selection. The Lancet, 302(7820), 76-77. https://doi.org/10.1016/S0140-6736(73)93267-4
13. Gaskin, D.J., Ilich, J.Z., (2009). Lactose maldigestion revisited: diagnosis, prevalence in ethnic minorities, and dietary recommendations to overcome it. American Journal of Lifestyle Medicine, 3(3), 212-218. https://doi.org/10.1177/1559827609331555
14. Hertzler, S.R., Savaiano, D.A. (1996). Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. The American Journal of Clinical Nutrition, 64(2), 232-236. https://doi.org/10.1093/ajcn/64.2.232
15. Hertzler, S.R., Savaiano, D.A., Dilk, A., Jackson, K.A., Bhriain, S.N., Suarez, F.L. (2017). Chapter 40 - Nutrient Considerations in Lactose Intolerance. Nutrition in the Prevention and Treatment of Disease, Fourth Edition, 875-892. https://doi.org/10.1016/B978-0-12-802928-2.00040-0
16. Ingram, C.J., Elamin, M.F., Mulcare, C.A., Weale, M.E., Tarekegn, A, T.O., Raga, Bekele, E., Elamin, F.M., Thomas, M.G., Bradman, N., Swallow, D.M. (2007). A novel polymorphism associated with lactose tolerance in Africa: multiple causes for lactase persistence? Human Genetics, 120(6), 779-788. https://doi.org/10.1007/s00439-006-02
17. Ingram, C.J., Mulcare, C.A., Itan, Y., Thomas, M.G., Swallow, D.M. (2009). Lactose digestion and the evolutionary genetics of lactase persistence. Human Genetics, 124(6), 579-591. https://doi.org/10.1007/s00439-008-0593-691-1
18. Itan, Y., Jones, B.L., Ingram, C.J.E., Swallow, D.M., Thomas, M.G. (2010). A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evolutionary Biology, 10, 36. https://doi.org/10.1186/1471-2148-10-36
19. Itan, Y., Powell, A., Beaumont, M.A., Burger, J., Thomas, M.G. (2009). The origins of lactase persistence in Europe. PLoS Computational Biology, 5(8), e1000491. https://doi.org/10.1371/journal.pcbi.1000491
20. Jacobi, A. (1901). Milk-sugar in infant feeding. Transactions of the American Pediatric Society, 13, 150-160.
21. Johnson, A.O., Semenya, J.G., Buchowski, M.S., Enwonwu, C.O., Scrimshaw, N.S. (1993). Adaptation of lactose maldigesters to continued milk intakes. The American Journal of Clinical Nutrition, 58(6), 879-881. https://doi.org/10.1093/ajcn/58.6.879
22. Kuhn, N.J., White, A. (2009). The topography of lactose synthesis. Journal of Mammary Gland Biology and Neoplasia, 14(3), 213-220. https://doi.org/10.1007/s10911-009-9136-6
23. Laland, K.N., Odling-Smee, J., Myles, S. (2010). How culture shaped the human genome: bringing genetics and the human sciences together. Nature Reviews | Genetics, 11, 137-148. https://doi.org/10.1038/nrg2734
24. Lewinsky, R.H., Jensen, T.G., Moller, J., Stensballe, A., Olsen J., Troelsen, J.T. (2005). T-13910 DNA variant associated with lactase persistence interacts with Oct-1 and stimulates lactase promoter activity in vitro. Human Molecular Genetics,14(24), 3945-3953. https://doi.org/10.1093/hmg/ddi418
25. Liebert, A., López, S., Jones, B.L., Montalva, N., Gerbault, P., Lau, W., Thomas, M.G., Bradman, N., Maniatis, N., Swallow, D.M. (2017). World wide distributions of lactase persistence alleles and the complex effects of recombination and selection. Human Genetics, 136, 1445-1453. https://doi.org/10.1007/s00439-017-1847-y
26. Lomer, M.C.E., Parkes, G.C., Sanderson, J.D. (2007). Review article: Lactose intolerance in clinical practice - myts amd realities. Alimentary Pharmacology and Therapeutics, 27(2), 93-103. https://doi.org/10.1111/j.1365-2036.2007.03557.x
27. Mądry, E., Fidler, E., Walkowiak, J. (2010). Lactose intolerance-current state of knowledge. Acta Scientiarum Polonorum Technologia Alimentaria, 9(3), 343-350.
28. Mattar, R., Mazo, D.F.C., Carrilho, F.J. (2012). Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and Experimental Gastroenterology, 5, 113-121. https://doi.org/10.2147/CEG.S32368
29. Matthews, S.B., Waud, J.P., Roberts, A.G., Campbell, A.K. (2005). Systemic lactose intolerance: a new perspective on an old problem. Postgraduate Medical Journal, 81, 167-173.
30. Misselwitz, B., Pohl, D., Frühauf, H., Fried, M., Vavricka, S.R., Fox, M. (2013). Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterology Journal, 1(3), 151-159. https://doi.org/10.1177/2050640613484463 Mulcare, C.A. (2006). The evolution of the lactase persistence phenotype. London: University of London, The Centre for Genetic Anthropology, The Galton Laboratory, Department of Biology, PhD Thesis.
31. Mulcare, C.A., Weale, M.E., Jones, A.L., Connell, B., Zeitlyn, D., Tarekegn, A., Swallow, D.M., Bradman, N., Thomas M.G. (2004). The T allele of a single-nucleotide polymorphism 13.9 kb upstream of the lactase gene (LCT) (C-13.9kbT) does not predict or cause the lactase-persistence phenotype in Africans. American Journal of Human Genetics, 74(6), 1102-1110. https://doi.org/10.1086/421050
32. Silanikove, N., Leitner, G., Merin, U. (2015). The interrelationships between lactose intolerance and the modern dairy industry: global perspectives in evolutional and historical backgrounds. Nutrients, 7, 7312-7331. https://doi.org/10.3390/nu7095340 Swagerty, D.L., Walling, A.D., Klein, R.M. (2002). Lactose intolerance. American Family Physician, 65(9), 1845-1850.
33. Szilagyi, A. (2015). Adaptation to lactose in lactase non persistent people: effects on ıntolerance and the relationship between dairy food consumption and evalution of diseases. Nutrients, 7, 6751-6779. https://doi.org/10.3390/nu7085309
34. Tishkoff, S.A., Reed, F.A., Ranciaro, A., Voight, B.F., Babbitt, C.C., Silveman, J.S., Powell, K., Mortensen, H.M., Hirbo, J.B., Osman, M., Ibrahim, M., Omar, S.A., Lema, G., Nyambo, T.M., Ghori, J., Bumpstead, S., Pritchard, J.K., Wray, G.A., Deloukas, P. (2007). Convergent adaptation of human lactase persistence in Africa and Europe. Nature Genetics, 39(1), 31-40. https://doi.org/10.1038/ng1946
35. Topçu, A., Saldamli, I. (2006). Proteolytical, chemical, textural and sensorial changes during the ripening of Turkish white cheese made of pasteurized cows' milk. International Journal of Food Properties, 9(4), 665-678. https://doi.org/10.1080/10942910500542238
36. Ugidos-Rodriguez, S., Matallana-Gonzalez, M.C., Sanchez-Mata, M.C. (2018). Lactose malabsorption and intolerance: a review. Food & Function, 9(8), 4056-4068. https://doi.org/10.1039/C8FO00555A
37. Vesa, T.H., Marteau, P., Korpela, R. (2000). Lactose intolerance. Journal of the American College of Nutrition, 19:sup2, 165-175. https://doi.org/10.1080/07315724.2000.10718086
38. Yıldırım, D., Özen, H. (2017). Laktoz intoleransı tıbbi beslenme tedavisi olgu sunumu. Beslenme ve Diyet Dergisi, 45(3), 294-297.