Classificação da intolerância à lactose: uma visão geral sobre causas e tratamentos
DOI:
https://doi.org/10.24220/2318-0897v26n3a3812Palabras clave:
Intolerância à lactose. Lactase. Proteínas do leite. Revisão.Resumen
A deficiência total ou parcial da enzima denominada lactase, responsável por hidrolisar em glicose e galactose a lactose presente no leite, é popularmente conhecida como intolerância à lactose. No presente trabalho foram revisadas as causas e tratamentos para intolerância à lactose. Foi realizada uma revisão retrospectiva e integrativa da literatura nas bases SciELO, MedLine e PubMed. A intolerância possui três classificações: primária, secundária e congênita. A intolerância ontogenética à lactose ou hipolactasia primária adulta é a forma mais comum. Já a deficiência secundária consiste em um quadro fisiopatológico que tem como consequência a má absorção de lactose. Por fim, a intolerância congênita à lactose é uma deficiência de herança genética, que acomete recém-nascidos nos primeiros dias de vida. Na hipolactasia, o agravamento surge na vida adulta, justamente com perda da função gradativa da enzima que degrada a lactose. Isso ocorre pelo fato de essa enzima, presente e ativa durante a amamentação em mamífero, perder sua função no início do desmame. Em pacientes não intolerantes, essa mesma enzima passa por um processo de mutação, permanecendo ativa ao longo da vida adulta. O tratamento mais comum para pacientes com intolerância à lactose envolve a retirada total ou parcial do leite e seus derivados, já que a supressão total causa alguns danos à nutrição e à manutenção do organismo.
Descargas
Citas
Ortolani C, Pastorello EA. Food allergies and food intolerances. Best Pract Res Clin Gastroenterol. 2006 [cited 2015 Mar 6];20(3):467-83. Available from: http://www.ncbi.nlm.nih.gov/PubMed/16782524
Walsh J, Meyer R, Shah N, Quekett J, Fox AT. Differentiating milk allergy (IgE and non-IgE mediated) from lactose intolerance: Understanding the underlying mechanisms and presentations. Br J Gen Pract. 2016 [cited 2016 Nov 29];66(649):e609-11. Available from: http://www.ncbi.nlm.nih.gov/PubMed/ 27481986
Lember M. Hypolactasia: A common enzyme deficiency leading to lactose malabsorption and intolerance. Pol Arch Med Wewnętrznej. 2012 [cited 2015 Feb 23];122(Suppl 1):60-4. Available from: http://www.ncbi.nlm.nih.gov/ PubMed/23222197
Gasparin FSR, Carvalho JMT, Araujo SC. Alergia à proteína do leite de vaca versus intolerância à lactose: as diferenças e semelhanças. Saúde Pesq. 2010 [acesso 2015 Mar 6];3(1):107-14. Disponível em: http://periodicos.unicesumar.edu.br/index.php/saudpesq/article/view/1069
Suchy F, Brannon P. NIH consensus development conference statement: Lactose intolerance and health. NIH Consens State Sci Statements. 2010 [cited 2015 Mar 7]; 27(2):1-27. Available from: http://europepmc.org/abstract/ med/20186234
Vandenplas Y. Lactose intolerance. Asia Pac J Clin Nutr. 2015 [cited 2016 Nov 29];24(Suppl 1):S9-13. Available from: http://www.ncbi.nlm.nih.gov/Pub Med/26715083
Berni Canani R, Pezzella V, Amoroso A, Cozzolino T, Di Scala C, Passariello A. Diagnosing and treating intolerance to carbohydrates in children. Nutrients. 2016 [cited 2016 Nov 29];10;8(3):157. Available from: http://www.mdpi.com/2072-6643/8/3/157
Mattar R, Campos Mazo DF, Carrilho FJ. Lactose intolerance: Diagnosis, genetic, and clinical factors. Clin Exp Gastroenterol. 2012 [cited 2015 Mar 6];5:113-21. Available from: http://www.PubMedcentral.nih.gov/articlerender. fcgi?artid=3401057&tool=pmcentrez&rendertype=abstract
Mattar R, Basile-Filho A, Kemp R, Santos JS. Comparison of Quick Lactose Intolerance Test in duodenal biopsies of dyspeptic patients with single nucleotide polymorphism LCT-13910C>T associated with primary hypolactasia/lactase-persistence. Acta Cir Bras. 2013 [cited 2016 Nov 29];28 (Suppl 1):77-82. Available from: http://www.ncbi.nlm.nih.gov/PubMed/ 23381829
Wortmann AC, Simon D, Silveira TR. Análise molecular da hipolactasia primária do tipo adulto: uma nova visão do diagnóstico de um problema antigo e frequente. Rev AMRIGS. 2013;57(4):335-43.
Cardoso AP, Laureano AM, Bulhões AC, Goldani HAS, Oliveira FS, Matte US, et al. Análise molecular de hipolactasia primária: teste implementado no Hospital de Clínicas de Porto Alegre. Rev HCPA. 2008 [acesso 2015 Mar 5];28(Suppl):184. Disponível em: http://www.lume.ufrgs.br/handle/10183/14452
Arroyo MAS. Perspectivas para triagem genética da intolerância à lactose: rastreamento do polimorfismo -13910 C/T, no gene MCM6, em neonatos. [tese]. São José do Rio Preto: Faculdade de Medicina de São José do Rio Preto; 2010 [acesso 2018 Jun 15]. Disponível em: http:// bdtd.famerp.br/handle/tede/74
Ruchkina IN, Fadeeva NA, Parfenov AI, Shcherbakov PL, Gubina AV, Poleva NI, et al. The role of small bowel microflora in the development of secondary lactase deficiency and the possibilities of its treatment with probiotics. Ter Arkh. 2013 [cited 2016 Nov 29];85(2):21-6. Available from: http://www.ncbi.nlm.nih.gov/PubMed/23653934
Usai-Satta P, Scarpa M, Oppia F, Cabras F. Lactose malabsorption and intolerance: What should be the best clinical management? World J Gastrointest Pharmacol Ther. 2012 [cited 2014 Dec 30];3(3):29-33. Available from: http://www.PubMedcentral.nih.gov/articlerender.fcgi?artid=3437438& tool=pmcentrez&rendertype=abstract
Grenov B, Briend A, Sangild PT, Thymann T, Rytter MH, Hother A-L, et al. Undernourished children and milk lactose. Food Nutr Bull. 2016 [cited 2016 Nov 29];37(1):85-99. Available from: http://www.ncbi.nlm.nih.gov/PubMed/ 26893059
Wortmann A, Simon D, Mazzoleni L. Mo1886 molecular analysis of adult type hypolactasia in patients with funcional dyspepsia: Evaluation of five associated single nucleotide. Gastroenterology. 2013 [cited 2016 Nov 29];144(5 Suppl 1):S686. Available from: http://www.gastrojournal.org/ article/S0016-5085(13)62538-X/abstract
Sequeira E, Kaur G, Chintamaneni M. Lactose intolerance: Genetics of lactase polymorphisms, diagnosis and novel therapy. Biomed Rev. 2014 [cited 2016 Nov 29];25:35-44. Available from: http://press.mu-varna.bg/ojs/index.php/bmr/article/view/1046
Tumas R, Cardoso A. Como conceituar, diagnosticar e tratar a intolerância à lactose. Rev Bras Clín Ter. 2008 [acesso 2016 Nov 29];34(1):13-20. Disponível em: http://www.moreirajr.com.br/revistas.asp?id_materia=3697 &fase=imprime
Arola H. Diagnosis of hypolactasia and lactose malabsorption. Scand J Gastroenterol. 1994 [cited 2016 Nov 29];202(Suppl.):26-35. Available from: http://www.ncbi.nlm.nih.gov/PubMed/8042016
Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, et al. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr. 2016 [cited 2016 Nov 29];36(4):917-38. Available from: http://www.ncbi.nlm.nih.gov/PubMed/27890486
Ryan AS, Hay WW. Challenges of infant nutrition research: A commentary. Nutr J. 2016 [cited 2016 Nov 29];15:42. Available from: http://www.ncbi.nlm.nih.gov/PubMed/27103229
Filho DP, Furlan S. Prevalência de intolerância à lactose em função da faixa etária e do sexo: experiência do Laboratório Dona Francisca, Joinville (SC). Rev Saúde Ambient. 2004 [acesso 2016 Nov 29];5(1):24-30. Disponível em: http://antigo.univille.br/arquivos/1572_V5n1Prevalencia.pdf
Berni Canani R, Pezzella V, Amoroso A, Cozzolino T, Di Scala C, Passariello A. Diagnosing and treating intolerance to carbohydrates in children. Nutrients. 2016 [cited 2016 Nov 29];8(3):157. Available from: http://www.ncbi.nlm.nih.gov/PubMed/26978392
Thouvenot É, Camu W. Vitamin D and neurology. Presse Med. 2013 [cited 2016 Nov 29];42(10):1398-404. Available from: http://www.ncbi.nlm.nih.gov/Pub Med/24054766
Sechi G, Sechi E, Fois C, Kumar N. Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev. 2016 [cited 2016 Nov 29];74(5):281-300. Available from: http://www.ncbi.nlm. nih.gov/PubMed/27034475
Harrington LK, Mayberry JF. A re-appraisal of lactose intolerance. Int J Clin Pract. 2008 [cited 2016 Nov 29];62(10):1541-6. Available from: http://www.ncbi.nlm.nih.gov/PubMed/18822024
Teuri U, Vapaatalo H, Korpela R. Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters. Am J Clin Nutr. 1999 May [cited 2016 Nov 29];69(5):973-9. Available from: http://www.ncbi.nlm.nih.gov/PubMed/10232639
Campbell AK, Waud JP, Matthews SB. The molecular basis of lactose intolerance. Sci Prog. 2005 [cited 2016 Nov 29];88(Pt 3):157-202. Available from: http://www.ncbi.nlm.nih.gov/PubMed/16805112
Högenauer C, Hammer HF, Mellitzer K, Renner W, Krejs GJ, Toplak H. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol. 2005 [cited 2015 Feb 23];17(3):371-6. Available from: http://www.ncbi.nlm.nih.gov/PubMed/15716664
Peuhkuri K, Poussa T, Korpela R. Comparison of a portable breath hydrogen analyser (Micro H2) with a Quintron MicroLyzer in measuring lactose maldigestion, and the evaluation of a Micro H2 for diagnosing hypolactasia. Scand J Clin Lab Invest. 1998 [cited 2016 Nov 29];58(3):217-24. Available from: http://www.ncbi.nlm.nih.gov/PubMed/9670345
Cunha MET, Suguimoto HH, Oliveira AN, Sivieri K, Costa MDR. Intolerância à lactose e alternativas tecnológicas lactose. UNOPAR Cient Ciênc Biol Saúde. 2008;10(2):83-8.
Raithel M, Weidenhiller M, Hagel AF-K, Hetterich U, Neurath MF, Konturek PC. The malabsorption of commonly occurring mono and disaccharides: Levels of investigation and differential diagnoses. Dtsch Arztebl Int. 2013 [cited 2016 Nov 29];110(46):775-82. Available from: http://www.ncbi.nlm.nih.gov/PubMed/24300825
Itan Y, Jones BL, Ingram CJE, Swallow DM, Thomas MG. A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evol Biol. 2010 [cited 2015 Feb 16]; 10:36. Available from: http://www.PubMedcentral.nih.gov/articlerender.fcgi?artid=2834688&tool=pmcentrez&rendertype=abstract
Pinto L, Almeida P, Baracho M, Simioni P. O uso de probióticos para o tratamento do quadro de intolerância à lactose. Rev Ciên Inov. 2015 [acesso 2016 nov 29]; 2(1) Disponível em: http://faculdadedeamericana.com.br/revista/index.php/Ciencia_Inovacao/article/view/15/0
Keith JN, Nicholls J, Reed A, Kafer K, Miller GD. The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected. J Natl Med Assoc. 2011 [cited 2016 Nov 29];103(1):36-45. Available from: http://www.ncbi.nlm.nih.gov/PubMed/21329245
Barr R, Levine M, Watkins J. Recurrent abdominal pain of childhood due to lactose intolerance: A prospective study. New Engl J Med. 1979;300:1449-52. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJM1979062 83002602
Vesa TH, Marteau P, Korpela R. Lactose intolerance. J Am Coll Nutr. 2000;19(2):165S-75S.
Misselwitz B, Pohl D, Frühauf H, Fried M, Vavricka SR, Fox M. Lactose malabsorption and intolerance: Pathogenesis, diagnosis and treatment. United Eur Gastroenterol J. 2013 [cited 2014 Dec 14];1(3):151-9. Available from: http://www.PubMedcentral.nih.gov/articlerender.fcgi?artid=4040760 &tool=pmcentrez&rendertype=abstract
Flood M, Kondo M. Toxicity evaluation of a β-galactosidase preparation produced by Penicillium multicolor. Regul Toxicol Pharmacol. 2004 [cited 2016 Nov 29];40(3):281-92. Available from: http://www.sciencedirect.com/ science/article/pii/S0273230004001047
Kapil U, Pradhan R. Integrated Child Development Services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives. Indian J Public Health. 1999 [cited 2016 Nov 29];43(1):21-5. Available from: http://www.ncbi.nlm.nih.gov/Pub Med/11243083
Hall A, Kassa T, Demissie T, Degefie T, Lee S. National survey of the health and nutrition of schoolchildren in Ethiopia. Trop Med Int Heal. 2008;13(12):1518-26. http://dx.doi.org/10.1111/j.1365-3156.2008.02168.x
Sommer A, Davidson FR, Annecy Accords. Assessment and control of vitamin A deficiency: The Annecy Accords. J Nutr. 2002 Sep [cited 2016 Nov 29];132(9 Suppl):2845S-50S. Available from: http://www.ncbi.nlm.nih.gov/PubMed/12221259
Abid Z, Cross AJ, Sinha R. Meat, dairy, and cancer. Am J Clin Nutr. 2014;100(Suppl):386S-93S.
Grance TRS, Serafin PO, Thomaz DMC, Palhares DB. Aditivo homólogo para a alimentação do recém--nascido pré-termo de muito baixo peso. Rev Paul Pediatr. 2015 [acesso 2016 nov 29];33(1):28-33. Disponível em: http://linkinghub.elsevier.com/retrieve/pii/S010305821400032X