Dietotherapy in children with obesity associated with adult lactase deficiency
Background. Excess lactose in the infant’s nutrition, especially in combination with adult lactase deficiency (С/C 13910 genotype), promotes the persistence of a chronic inflammatory process associated with the formation of obesity-complicated insulin resistance. Low-lactose dietotherapy reduces insulin resistance, contributes to the immunosuppressive orientation of the immune response due to the absence of lactose-dependent inhibition of galectin 9 — the main ligand of the T-cell apoptosis receptor (Tim-3). The purpose of the study was to evaluate the effectiveness of the low-lactose diet, which was formed using the computer program “Low-lactose diet”, in the treatment of obesity associated with adult lactase deficiency in children aged 6–18 years. Materials and methods. According to the results of the study of polymorphisms of the lactase gene (SNP LCT), out of 80 children aged 6–18 years with obesity, a group of children (n = 38) was isolated with C/C 13910 genotype corresponding to adult lactase deficiency. All children were divided into two clinical groups that did not differ in number (n = 19), age, sex, and the degree of clinical manifestations of lactose malabsorption. All patients received standard therapy for the underlying disease. In addition, a low-lactose diet calculated with the help of the computer program “Low-lactose diet” created by us was prescribed to the children of the main group. The effectiveness of treatment was assessed by anthropometric and metabolic criteria. Results. The mean value of body mass index (BMI) in children of the main and comparison groups at baseline was 98.00 ± 0.52 and 97.00 ± 0.61 percentiles, respectively. After the treatment, there was a significant decrease in BMI in children of both groups (p < 0.05). The mean values of the insulin resistance index (HOMA-IR) in children of the main and comparison groups before treatment were 6.8 ± 0.3 and 5.7 ± 0.9, and after treatment — 4.4 ± 0.3 and 4.3 ± 0.8, respectively. Insulin resistance significantly (p < 0.05) decreased after a six-month treatment only under strict control of the lactose content in the diet, which was carried out using the computer program “Low-lactose diet”. Conclusions. The low-lactose diet calculated with the help of the computer program “Low-lactose diet” improves the effectiveness of obesity treatment in children with C/C 13910 genotype and increases the sensitivity of tissues to insulin, thereby probably preventing the development of complications associated with insulin resistance.
Full Text:PDF (Українська)
Abaturov OE, Nikulina AO. Asociation one-nucleotide polimorphism of the lactase gene in accordance with the insulin resistance of children. Modern medical technologies. 2016; 4 (31): 33-6. (in Ukrainian).
Abaturov OE, Nikulina AO. Asociation one-nucleotide polimorphism of the lactase gene with dislipoproteinemia in obese children. Sovremennaya pediatriya. 2017;2(82):118-21. doi: 10.15574/SP.2017.82.118. (in Ukrainian).
Shadrin OG, Marushko TL, Misnyk VP, Fysun VM, Marushko KR. Challenges of the clinical features and treatment of lactose intolerance in infants. Sovremennaya pediatriya. 2011; 40(6):157-63. (in Ukrainian).
Ekvall Sh, Ekvall VK, editors. Pediatric and adult nutrition in chronic diseases, developmental disabilities, and hereditary metabolic disorders: prevention, assessment, and treatment. 3th ed. New York, NY: Oxford University Press; 2017. 640 p.
Gasbarrini A, Corazza GR, Gasbarrini G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009 Mar 30;29 Suppl 1:1-49. doi: 10.1111/j.1365-2036.2009.03951.x.
Lissner L, Lanfer A, Gwozdz W, et al. Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study. Eur J Epidemiol. 2012;27(9):705-15. doi: 10.1007 / s10654-012-9718-2.
Martin RM, Patel R, Zinovik A, et al. Filter paper blood spot enzyme linked immunoassay for insulin and application in the evaluation of determinants of child insulin resistance. PLoS One. 2012,7(10):e46752. doi: 10.1371/journal.pone.0071315.
Oomizu S, Arikawa T, Niki T, et al. Cell surface galectin-9 expressing Th cells regulate Th17 and Foxp3+ Treg development by galectin-9 secretion. PLoS One. 2012;7(11):e48574. doi: 10.1371/journal.pone.0048574.
Paasela M, Kolho KL, Vaarala O, Honkanen J. Lactose inhibits regulatory T-cell-mediated suppression of effector T-cell interferon-γ and IL-17 production. Br J Nutr. 2014 Dec 14;112(11):1819-25. doi: 10.1017/S0007114514001998.
Pantophlet AJ, Gerrits WJ, Vonk RJ, van den Borne JJ. Substantial replacement of lactose with fat in a high-lactose milk replacer diet increases liver fat accumulation but does not affect insulin sensitivity in veal calves. J Dairy Sci. 2016 Dec;99(12):10022-10032. doi: 10.3168/jds.2016-11524.
Peplies J, Börnhorst C, Günther K et al. Longitudinal associations of lifestyle factors and weight status with insulin resistance (HOMA-IR) in preadolescent children: the large prospective cohort study IDEFICS. Int J Behav Nutr Phys Act. 2016 Sep 2;13(1):97. doi: 10.1186/s12966-016-0424-4.
Storhaug ChL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2017 Oct;2(10):738-746. doi: 10.1016/S2468-1253(17)30154-1.
World Health Organization. Growth reference data for 5-19 years. Geneva: WHO, 2007. Available from: http://www.who.int/growthref/ . Accessed 25 January 2014.
- There are currently no refbacks.
Copyright (c) 2017 CHILD`S HEALTH
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2018