Disaccaridase deficiency in Bolivian children with persistent diarrhea

Abstract

It has been postulated that Amerindian genes favour lactase deficiency in the Latin American infant population, but it is not clear how this phenomenon relates to clinical lactose intolerance. 

Objective: to assess diasaccharidase activities in Aymara or Quechua children admitted for persistent diarrhea and malnutrition and relate these findings to clinical intolerance after recovery. 

Methods: 49% of 42 patients admitted were marasmic while the remaining suffered mixed forms of malnutrition. Median age was 15.7 months (range 3-34). Patients received a lactose free formula until 48 hours prior to discharge, when they were changed to a whole cow´s milk formula. Disaccharidases were measured in jejunal mucosa following Dahlquist´s technique. 

Results: on admission, 64%, 97% and 45% had low lactase, sucrase-isomaltase and maltase activities respectively; at discharge in 59% lactase activity remained low, while sucrase-isomaltase activity increased by 7% and maltase by 7%, but none were intolerant to lactose when challenged with a lactose containing formula prior to discharge. Recovery of lactase activity was significantly better among children with better height/age and weight/age ratios on admission (p < 0.05 y 0.03 respectively). 

Discussion: These results do not support prolonged use of lactose-free formulas in malnourished children of Aymara or Quechua origin with persistent diarrhea.