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  • Title: Is cow's milk suitable for the dietary supplementation of rural Gambian children? 1. Prevalence of lactose maldigestion.
    Author: Erinoso HO, Hoare S, Spencer S, Lunn PG, Weaver LT.
    Journal: Ann Trop Paediatr; 1992; 12(4):359-65. PubMed ID: 1283664.
    Abstract:
    To define the age-related prevalence of lactose maldigestion (LM), 218 children aged 13-72 months from a rural Gambian village were studied using a lactose breath hydrogen test. There was a significant rise in LM from 21% to 76% between the 2nd and 3rd-5th years of life (p < 0.001). Only eight children had diarrhoea within 2 weeks before the test. Diarrhoea and abdominal discomfort followed in only seven children (3%). There was no difference in mean time of introduction of supplementary diet or cessation of breastfeeding between children aged 12-36 months with lactose digestion and LM. There was a greater proportion of children with normal lactose digestion than with LM in those still receiving breast milk (85% vs 15%), and a greater proportion of LM in the fully weaned group (63% vs 37%) (p < 0.001). There was no relation between weight-for-age or weight-for-height and the ability to digest lactose. The ability to digest lactose is lost in the majority of children during the 2nd year, coincident with the cessation of breastfeeding, but is not a major factor associated with growth failure thereafter. During the dry season in the rural village of Keneba, The Gambia, health workers conducted the lactose breath hydrogen test on 218 children, 13-72 months old, following an overnight fast and ingestion of an aqueous factors solution (2 gm/kg body weight). They also took anthropometric measurements and a 2-week clinical history to determine the age-related prevalence of lactose maldigestion (LM) and to link it to diet, growth, and clinical signs and symptoms of lactose intolerance. Overall LM prevalence stood at 68% . 3-5 year old children were significantly more likely to have LM than 2-year-olds (76% vs. 21%; p .001), coinciding with weaning. Lactose digesters and lactose maldigesters began supplementary feeds and were completely weaned at essentially the same age. Yet, a greater proportion of lactose digesters still consumed breast milk (85% vs. 15%), while a greater proportion of lactose maldigesters were completely weaned (63% vs. 37%) (p .001). LM did not affect weight-for-age or weight-for-height, suggesting that LM does not contribute to childhood growth failure. 8 children suffered from diarrhea during the 2 weeks before the test. 7 children had clinical signs of lactose intolerance (flatus, diarrhea, and/or abdominal cramps). These results led the researchers to recommend that cow's milk should only be given to completely weaned children as a means to supplement carbohydrate, protein, and calcium in areas with high rates of protein energy malnutrition.
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