Intolerancia a la lactosa

Lactose Intolerance in Infants, Children, and Adolescents Melvin B. Heyman and for the Committee on Nutrition Pediatrics 2006;118;1279-1286 DOI: 10.1542/peds.2006-1721

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PEDIATRICS is the official journal of the AmericanAcademy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2006 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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CLINICAL REPORT

Lactose Intolerance in Infants, Children, and Adolescents
Melvin B. Heyman, MD, MPH, for the Committee on Nutrition

Guidance for the Clinician in Rendering Pediatric Care

ABSTRACT The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differencesbetween primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatmentconsists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources ofcalcium or calcium supplements need to be provided.

INTRODUCTION
SIGNIFICANT CHANGES IN our knowledge and approach toward lactose intolerance

have occurred over the past quarter century, since the first statement on lactose intolerance was published by the American Academy of Pediatrics Committee on Nutrition.1 Lactose ingestion in certain susceptible individuals can cause abdominal symptomsthat are variable and can be treated with dietary restriction or enzyme replacement, depending on the amount of lactose consumed and the degree of lactase deficiency. Pediatricians and other pediatric care providers should maintain awareness of the benefits and controversies related to the consumption of dietary milk products and milk-based infant formula. The lactose content of milk ofteninfluences, correctly or not, the ultimate decision about the use or continuation of milk in the diet. Milk and dairy-product avoidance has a negative effect on calcium and vitamin D intake in infants, children, and adolescents. Other nutrients such as protein make dairy products an important source of nutrition for growing children. This revised statement will update the initial statement of 1978 whileincorporating changes from the 1990 supplement2 and current state-of-theart relating to lactose intolerance. Recommendations regarding dietary calcium have been updated recently.3 Lactose, a disaccharide that comprises the monosaccharides glucose and galactose, is the primary carbohydrate found exclusively in mammalian milk. Absorption of lactose requires lactase activity in the small intestinal brushborder to split the bond linking the 2 monosaccharides. A -galactosidase termed “lactase-phlorizin hydrolase” (lactase) accounts for most of the lactase activity in the intestinal

www.pediatrics.org/cgi/doi/10.1542/ peds.2006-1721 doi:10.1542/peds.2006-1721 All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised,...