Lactose Intolerance In Port Harcourt

 LACTOSE INTOLERANCE IN PORT HARCOURT

ABSTRACT

Lactose intolerance (LI) is a common digestive disorder characterized by the inability to digest lactose, a sugar found in milk and dairy products. Despite its global prevalence, there is a lack of comprehensive research on lactose intolerance in Port Harcourt, Nigeria. This study aims to investigate the prevalence, clinical manifestations, contributing factors, and impact of lactose intolerance in the population of Port Harcourt. A cross-sectional study design will be employed, and data will be collected through survey questionnaires, clinical assessments, and laboratory tests. Data analysis was done using the Statistical Package for Social Sciences (SPSS 21) software. The study included 169 malnourished under-five children. Among those 90 (53.3%) were male with median age of 12 months. The magnitude of LI was 18.3%. Among the study participants highest numbers of LI cases were in the age group of less than 12 months 17(10.1%) followed by 13-24 months 13(7.7%). The factors that show significant association with lactose intolerance on bi-variate logistic analysis were family history of lactose intolerance (P=0.043) and diarrhea (P=0.000). In addition; problems after taking milk (P=0.007), type of therapeutic milk formula (P=0.000), and frequency of stool/24hr (P=0.023) were found to be the independent predictor factors of lactose intolerance in the study population. The magnitude of LI was high in the study setting. Thus it is necessary to give more attention to the proper diagnosis of LI. In addition, similar large-scale studies at the molecular level are required to strengthen the present findings about LI in Nigeria. lactose intolerance; lactase deficiency; carbohydrate malabsorption

 

CHAPTER ONE

General Introduction

• Background

Lactose intolerance is a common digestive disorder characterized by the inability to digest lactose, a sugar found in milk and dairy products. It occurs due to the deficiency of lactase, an enzyme responsible for breaking down lactose into simpler forms that can be easily absorbed by the body. Without sufficient lactase, lactose remains undigested in the gut, leading to various symptoms such as bloating, diarrhea, and abdominal discomfort.

Lactose intolerance affects a significant portion of the global population, and its prevalence varies across different regions and ethnic groups. Lactose intolerance (LI) was first described by Hippocrates around 400 (B.C.) years ago. However, LI has been recognized and diagnosed as a medically important disease only in the past 50 years (1, 2). LI is a pathological condition characterized by the inability to digest a sugar, or lactose due to the absence or insufficient activity of lactase enzyme (β-galactosidase) (3, 4). It could also be described as an intestinal mucosa disorder that incapacitates the digestion of lactose due to the deficiency of lactase enzyme. Lactose is the unique sugar in the milk of mammals. Lactose, the major carbohydrate found in milk and dairy products, is a disaccharide composed of two simple sugars, glucose and galactose joined by a glycosidic linkage as β-galactose 1, 4 glucose (5-7).

The inability to digest lactose, lactose maldigestion, occurs when the concentration of lactase enzyme is reduced in the brush border of the small bowel mucosa. Lactase activity is highest at birth and declines after weaning (4). Lactose malabsorption (LM) or hypolactasia is the most common type of carbohydrate malabsorption and is caused by low lactase levels. Lactose intolerance occurs when the malabsorption causes symptoms (i.e. diarrhea, abdominal discomfort, flatulence, and bloating). Gastrointestinal symptoms after lactose ingestion are known as lactose intolerance (6, 8, 9).

Lactase deficiency (LD) is virtually responsible for lactose malabsorption. LM is indicated when a part of ingested lactose is not hydrolyzed in the small bowel and reaches the colon (6). It is the physiologic problem that manifests as lactose intolerance and is attributable to an imbalance between the amount of ingested lactose and the capacity for lactase to hydrolyze the disaccharide

(5). A blood glucose concentration increasing less than 20 mg/dl, after ingestion of a (50 to 100 g) dose of lactose is evidence of LI (10, 11).

There are different laboratory diagnostic methods for LI including the determination of lactase activity of a jejunal biopsy, lactose tolerance test, hydrogen breath test (HBT), analysis of fecal pH and reducing substances, and genetic studies (9, 12-14).

Lactose intolerance is a prevalent digestive disorder that affects individuals worldwide, including the population of Port Harcourt, Nigeria. Despite the city’s growing population and significant consumption of dairy products, there is a dearth of research on lactose intolerance in this region. This study aims to address this research gap by investigating the prevalence, clinical manifestations, contributing factors, and impact of lactose intolerance in Port Harcourt. The findings of this study will not only enhance our understanding of lactose intolerance in the local population but also provide valuable insights for healthcare professionals, policymakers, and individuals affected by this condition.

1.2 Statement of the problem

Lactose intolerance is a common medical problem, that significantly impacts the lives of affected individuals and has limited treatment options (15). Worldwide, 75% of the population loses the ability to digest lactose (16). However this prevalence of LI is strongly linked to age, ethnicity, use of dairy products in the diet, and the method used for its diagnosis. In populations with a predominance of dairy foods in the diet, particularly northern European people as few as 2% of the population has primary lactase deficiency is common among adults. In contrast, the prevalence of primary lactase deficiency is 50% to 80% in Hispanic people, 60% to 80% in black and Ashkenazi Jewish people, and almost 100% in Asian and American Indian people (5, 9, 12, 17). In the United States, the prevalence is 15% among whites, 53% among Mexican Americans, and 80% in the Black population. The prevalence of primary lactase deficiency is above 50% in Africa (18).

The incidence of secondary lactose intolerance is variable, depending on its underlying etiology. Up to 50% of infants with acute diarrhea have transient lactose intolerance (19). Secondary LD which results as a consequence of injury to the small bowel mucosal brush border due to viral or non-viral intestinal infection is more common in children particularly those in developing countries. In addition, diarrhea is more pronounced in children with secondary LD. Thus secondary LI is noticed as a major risk factor for the incidence of persistent diarrhea, in the children between ages of 1 month and 5 years (20, 21). Moreover, LI is also a risk factor for colorectal cancer since it negatively affects the functioning of the intestines by causing acidification of the lumen, osmotic balance disturbance, and an alteration in intestinal bacteria composition (22).

The prevalence and impact of lactose intolerance in Port Harcourt, Nigeria, have not been extensively studied. Despite being a major city with a growing population and a considerable consumption of dairy products, there is a lack of comprehensive research on lactose intolerance in this region. Understanding the prevalence, clinical manifestations, and factors contributing to lactose intolerance in Port Harcourt is crucial for healthcare professionals, policymakers, and individuals affected by this condition.

• Objectives of the Study

The primary objective of this research is to investigate the prevalence and clinical characteristics of lactose intolerance in the population of Port Harcourt. The specific objectives are as follows:

• To determine the prevalence of lactose intolerance among individuals residing in Port Harcourt.
• To assess the clinical manifestations and severity of lactose intolerance symptoms experienced by affected individuals.
• To explore the factors contributing to lactose intolerance in the study population, including genetic, environmental, and dietary factors.
• To examine the impact of lactose intolerance on the quality of life and dietary habits of affected individuals in Port Harcourt.

1.4 Significance of the Study

This study will provide valuable insights into the prevalence and impact of lactose intolerance in Port Harcourt, Nigeria. The findings will contribute to the existing body of knowledge on lactose intolerance, particularly in an understudied region. The results will be beneficial for healthcare professionals in accurately diagnosing lactose intolerance and implementing appropriate management strategies. Additionally, policymakers can utilize this information to develop public health interventions and strategies for lactose-intolerant individuals. Lastly, individuals affected by lactose intolerance will benefit from increased awareness and understanding of the condition, enabling them to make informed dietary choices and improve their quality of life.

1.5 Scope of the Study

This research will focus specifically on lactose intolerance in the population of Port Harcourt, Nigeria. The study population will comprise of admitted to pediatric units of Selected public hospitals in Port Harcourt from March – to July 2022. The study will include individuals of different age groups and both genders residing in the city. The research will employ a combination of survey questionnaires, clinical assessments, and laboratory tests to collect data on lactose intolerance prevalence, symptoms, and potential contributing factors.

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