Complications
Although lactase deficiency and lactose intolerance do not predispose to calcium malabsorption, avoidance or significant reduction in intake of milk and other dairy products will lead to reduced calcium and vitamin D intake, which may increase the risk of osteopenia, osteoporosis, and fractures.[5][83] One meta-analysis of Northern European studies found that genetic lactase persistence was associated with significantly higher femoral neck bone mineral density, but not lumbar spine or total hip bone mineral density.[84] Evidence on the association between dairy consumption and fracture risk is inconsistent.[85][86]
Regular daily intake of 8-12 oz (240 mL) of milk in small portions with other foods, increased ingestion of hard cheeses, yoghurts, milk chocolates, and non-dairy diets rich in calcium should be encouraged. When milk is not tolerated in patients with severe intolerance and/or systemic symptoms, pretreated milk, calcium-enriched lactose-free formula milks, and lactase supplements with dairy products should be given.[2][76]
Calcium and vitamin D supplementation is recommended if dietary intake is insufficient.[2][76][87] Many clinicians check serum vitamin D and calcium levels every 6-12 months in all patients who are on low lactose or lactose-free diets for control of lactose intolerance symptoms, although there is a lack of evidence to support this approach.
Timely advice and implementation of the above steps may help to prevent osteoporosis.
Rickets is deficient mineralisation at the growth plate of long bones resulting in growth retardation. It occurs primarily because of a nutritional deficiency of vitamin D, but can be associated with deficiencies of calcium or phosphorus.
Delayed diagnosis and poor control of severe symptomatic lactase deficiency with lactose intolerance due to non-compliance to a lactose-reduced or lactose-free diet may lead to poor nutrition.
More importantly, complete avoidance of dairy products will result in a major reduction in the intake of proteins, calories, vitamin D, and calcium. Complete exclusion of dairy products should be avoided and low-lactose dairy products encouraged. Additionally, consultation with a nutritionist is important to maintain energy, protein, and calcium intake, and help avoid malnutrition.
Growth failure is not common but can happen with complete exclusion of dairy products in growing children, especially if alternative nutrient sources rich in proteins, calories, and calcium are not substituted after consultation with a nutritionist.[88]
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