Disaccharidase Deficiency in Pediatric Patients with Inflammatory Bowel Disease

Background: Disaccharidase (DS) deficiencies have been reported in pediatric patients with inflammatory bowel disease (IBD), but the relationship between duodenal inflammation and DS deficiency has not been evaluated outside of lactase deficiency. Methods: This study assessed DS levels and DS deficiencies in pediatric IBD patients who underwent endoscopy with assessment of DS activity. Records were reviewed for IBD subtype, pathology findings, and the results of DS analysis. Results: A total of 136 patients were identified. Overall, 89 (65.4%) patients had a diagnosis of Crohn’s disease (CD), 31 (22.8%) patients had a diagnosis of ulcerative colitis (UC), and 16 (11.8%) patients had a diagnosis of indeterminant colitis. Lactase deficiency was identified in 55.9% of patients, followed by maltase deficiency (19.9%), sucrase and palatinase deficiency (14%), and pan-deficiency (12.5%). When analyzing only patients with CD, patients with duodenitis were more likely to exhibit sucrase deficiency, palatinase deficiency, and pan-deficiency with a trend towards maltase deficiency. Conclusions: The most common DS deficiency was lactase deficiency; however, this was not related to duodenal inflammation. Pediatric patients with CD and duodenal inflammation exhibit DS deficiencies, namely, sucrase, palatinase, and pan-deficiency. Dietary adjustments may be warranted temporarily until duodenal inflammation is healed in patients with CD and duodenitis.

LACTOSE INTOLERANCE AND THE IMPORTANCE OF LACTOSE-FREE DAIRY PRODUCTS IN THIS CONDITION (Review)

The paper is a review of the importance of expanding the lactose-free dairy segment to give consumers the opportunity to consume milk and dairy products if they suffer from lactose intolerance. When there is a lactase deficiency in the body, in the small intestine lactose is not hydrolyzed, the volume increases and the fluidity of the intestinal contents increases, allowing lactose to reach the colon where it is fermented by colonic bacteria. Lactose intolerance is a condition that depending on the form developed will show different symptoms and consumers suffering from this disease may ingest amounts between 12-24 g of lactose consumed during a day, taking into account certain recommendations, compared to allergy to milk proteins, where the consumption of dairy products is prohibited. Due to the rich intake of important macro and micronutrients in human nutrition, dairy products cannot be missing from the daily diet. In this context, methods are proposed, in particular ultrafiltration, for obtain free lactose milk that does not affect its composition and properties. Consumers suffering from lactose intolerance should be properly informed about the lactose content in manufactured lactose-free dairy products. This can be done after using highperformance instrumental methods of analysis that can detect the lowest values of lactose content in dairy products.

The role of nutrigenetics in diet personalisation

Nutrigenetics is the field that studies genetic differences in relation to food components. It also examines the risk of food-dependent diseases. The search for genes responsible for disease occurrence is very difficult because the human genome has about 25,000 genes. Association studies are used to identify the relevant genes, and then the presence of polymorphisms is compared with a group of healthy people (control group). Thanks to these tests, it is possible to take an individual approach to the patient and arrange a personalized diet, which results in obtaining the best results. This article focuses on selected diseases including lactase deficiency, celiac disease, phenylketonuria and folate deficiency. In each of these diseases thanks to molecular research, it is possible to detect genetic defects, and then to apply a personalized diet which excludes or provides certain food products. Further development of nutrigenetics in the future will allow even better selection of diets in other disease entities.

What we should know about the carbohydrate component of infant formula

The article is devoted to the discussion of the carbohydrate component of infant formula for feeding healthy and sick children. The role of glycemic and non-glycemic carbohydrates is shown. In addition to lactose, the following glycemic carbohydrates can be used in infant formulas: maltose, sucrose, glucose, glucose syrup, maltodextrins, pretreated starch and gelatinized starch. Resistant oligosaccharides, nonstarch polysaccharides, and resistant modified starches are also used in child nutrition. The composition and amount of lactose, the main carbohydrate of women’s milk, is discussed. The article presents data on the role of galactose, which is conditionally essential for children in the first months of life due to the rapid growth rate of the infant. Information is presented on the lactose breakdown, the importance of enzymes in the digestion and assimilation processes, the prebiotic effects of lactose, and its effect on the absorption of calcium and other minerals. Advantages of lactose include its low glycemic index, as well as its reduced sweetness, which affects the proper development of taste and low risk of dental caries compared to other fermentable sugars. Specific requirements for the carbohydrate composition of low-lactose and lactose-free formulas are discussed because of the often unwarranted increase in the frequency of their use. Evidence is presented using the Cochrane Systematic Review (2018) that reducing or eliminating lactose from infant formulas in infants with infantile colic is not always appropriate. Special low-lactose and lactose-free formulas replace lactose with glucose polymers such as maltodextrin, glucose syrup, and solid glucose syrup, which are produced by hydrolyzing starches (corn, rice, or potato). The article discusses the data on the effect of maltodextrin on the state of the intestinal mucosa, the microbiota of the large intestine and the possible role of this ingredient in the pathogenesis of chronic inflammatory bowel diseases. The results of various studies regarding the effect of maltodextrin on the intestinal microbiota are contradictory. However, special low-lactose or lactose-free products are prescribed in the presence of symptoms of lactase deficiency in an artificially fed baby. It is a major mistake to prescribe lactose-free mixtures on the basis of intact protein or partially hydrolysed ones for secondary lactase deficiency caused by an allergy to cow’s milk proteins. The carbohydrate component of Friso therapeutic hydrolysates contains no maltodextrin, and lactose is partially or completely replaced with glucose syrup.

Algorithm for diagnosing the latent form of celiac disease in adults

The article presents a clinical case of the latent course of celiac disease with diagnosis in the adult period, reflects the role of trigger factors, the features of the clinical course, the formation of concomitant lactase deficiency and the need for all diagnostic stages for diagnosis.

Diagnostic possibilities of lactase deficiency in children with cystic fibrosis

Introduction. Children with cystic fibrosis often have gastrointestinal symptoms despite properly selected primary therapy and pancreatic substitution therapy. A possible reason is lactase deficiency. Aim is to determine the frequency of lactase deficiency in children with cystic fibrosis and the need for appropriate dietary correction of their diets. Materials and methods. In 213 children with cystic fibrosis, during esophagogastroduodenoscopy in biopsies of the small intestinal mucosa 359 rapid tests, «Lactose intolerance quick test” were performed. According to the results of an express test, some patients diagnosed with hypolactasia to determine their tolerance to lactose underwent a glycemic load test with lactose and measured the level of fecal calprotectin to assess the level of faecal calprotectin the degree of chronic intestinal inflammation. Results. Normal lactase activity was observed in 129 (36%) biopsies studied, moderate hypolactasia in 91 (25%) biopsies, severe hypolactasia in 139 (39%) biopsies. In patients with moderate hypolactasia, according to the express test results, 20% confirmed intolerance to lactose as a result of the load test. In patients with severe hypolactasia, 72% were confirmed to be lactose intolerant, according to the results of an express test. There was no correlation between the level of calprotectin and the results of the glycemic load test with lactose. Conclusion. Lactase deficiency is observed in a significant proportion of patients with cystic fibrosis, which may be a consequence of primary adult hypolactasia and chronic intestinal inflammation. In children with cystic fibrosis with dyspeptic symptoms persisted despite correctly prescribed basic therapy and pancreatic enzymes, it is necessary to exclude lactose intolerance and prescribe a low-lactose diet.

Calcium-dependent complications of lactase deficiency in patients with type 2 diabetes mellitus

Objective — to assess the degree of osteodeficiency and probability of osteoporotic fractures in patients with type 2 diabetes mellitus in the absence or presence of lactase deficiency. Materials and methods. All examined patients with type 2 diabetes mellitus were divided into 2 groups depending on the presence/absence of lactase deficiency. In addition to routine examination methods, specific methods were used for diagnosing lactase deficiency, assessing bone mineral density (using dual‑energy X‑ray absorptiometry) and bone quality (ultrasound densitometry), the state of bone remodelling (according to markers of bone resorption and formation), probability of osteoporotic fractures (using FRAX and QFracture calculators), dietary and lifestyle habits were also studied. Results. The changes have been revealed in both processes of bone remodelling — increased bone resorption and insufficient bone formation, and the activity of bone formation, which was the lowest in patients with lactase deficiency and type 2 diabetes mellitus. The results of X‑ray absorptiometry confirmed that osteoporosis was significantly more often in patients with type 2 diabetes mellitus in the presence of lactase deficiency. The use of ultrasonic densitometry confirmed the violation of bone tissue micro architectonics. The indicator of broadband ultrasound attenuation, which reflects the qualitative characteristics of bone tissue, was the lowest in patients with type 2 diabetes mellitus accompanied by lactase deficiency. The probability of osteoporotic fractures according to the results of the assessment with the online calculator FRAX® was higher than the average risk in both groups of patients. No significant difference was established in this indicator between these groups of patients in contrast to the risk calculated with the QFracture instrument — it was the highest in patients with lactase deficiency. Conclusions. The presence of lactase deficiency in patients with type 2 diabetes mellitus can be considered as a factor that contributes to the development of osteodeficiency, deterioration of the quality of bone tissue, imbalance in bone remodelling and an increase in the probability of osteoporotic fractures.

USE OF VARIOUS TYPES OF VEGETABLE RAW MATERIALS IN THE PRODUCTION OF LACTOSE-FREE FOOD PRODUCTS

В последние годы в мире наблюдается тенденция к увеличению потребления безлактозных и низколактозных молочных продуктов, что обусловлено возросшим вниманием к проблеме лактазной недостаточности, характерной для всех возрастных групп населения. Методом анализа тематических источников установлено, что получение новых видов безлактозных продуктов возможно как при применении различных технологических приемов, регулирующих содержание лактозы в готовых молочных продуктах, так и при использовании растительного сырья, альтернативного коровьему молоку. Дана характеристика состава питательных веществ, энергетической и биологической ценности наиболее востребованных видов растительного сырья, используемого при производстве безлактозных продуктов: соевому, кокосовому, рисовому и миндальному молоку. Проанализировано состояние российского рынка безлактозных продуктов. In recent years in the world there has been a tendency to increase the consumption of lactose-free and low-lactose dairy pro- ducts, due to the increased attention to the problem of lactase deficiency, which is characteristic of all age groups of the population. By analyzing thematic sources, it was found that the production of new types of lactose-free products is possible both with the use of various technological methods that regulate the content of lactose in finished dairy products, and with the use of vegetable raw materials, an alternative to cow's milk. Characteristics of the composition of nutrients, energy and biological value of the most popular types of vegetable raw materials used in the production of lactose-free products: soy, coconut, rice and almond milk – are given. The state of the Russian market of lactose-free products is analyzed.

IBS‑like syndromes in clinic of internal diseases: current state of problem

IBS-like syndromes are one of the most important problems in gastroenterology. The clinical picture is identical to that of irritable bowel syndrome can be associated with inflammatory bowel disease, colorectal cancer, celiac disease, food allergy, lactase deficiency enteropathy, non-celiac sensitivity, gluten and other diseases. In this regard, irritable bowel syndrome is a diagnosis of exclusion and always requires a rather complex differential diagnosis to establish the true cause of the disease, conduct adequate therapy and achieve a stable remission. The purpose of the review was to obtain scientific knowledge about IBS-like syndromes and to develop optimal management tactics for these patients. The review demonstrates that the clinical manifestations of IBS are largely nonspecific due to the frequent transition of one form of the disease to another, which creates certain difficulties in making a diagnosis. Timely diagnosis of IBS-like syndromes, often superimposed on the already existing IBS pathology, significantly improves the results of treatment of patients with intestinal symptoms and ensures long-term preservation of remission of the disease.