lvrachЛечащий ВрачLechaschi Vrach1560-51752687-1181lvrach-449Research ArticleСтатьиЛактазная недостаточность: происхождение и пути коррекцииLactase insufficiency: ethiology and approaches to correctionБельмерС. В.BelmerS. V.belmersv@mail.ruГБОУ ВПО РНИМУ им. Н. И. Пирогова МЗ РФRussian Federation201823062021024141Copyright © Бельмер С.В., 20212021Бельмер С.В.Belmer S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/449

Рассмотрена проблема лактазной недостаточности у детей, подходы к коррекции первичной и вторичной лактазной недостаточности. Даются рекомендации по питанию детей грудного возраста с учетом особенностей вскармливания, а также детей старше 1 года и взрослых.

The problem of lactase insufficiency correction in children was considered, as well as approaches to primary and secondary lactase insufficiency. The guidelines on nutrition for infants, considering the characteristics of feeding were given, as well as for children over one year old and adults. 

ДетиКоллоквиумГастроэнтерологияГепатологияЛактозаЛактазаЛактазная недостаточностьНизколактозная диетаchildrenlactoselactaselactase insufficiencylow-lactose dietReferencesBeja-Pereira A., Luikart G., England P. R. et al. Gene-culture coevolution between cattle milk protein genes and human lactase genes // Nat Genet. 2003; 35: 311–313.Beja-Pereira A., Luikart G., England P. R. et al. Gene-culture coevolution between cattle milk protein genes and human lactase genes // Nat Genet. 2003; 35: 311–313.Boll W., Wagner P., Mantei N. Structure of the chromosomal gene and cDNAs coding for lactase-phlorizin hydrolase in humans with adult-type hypolactasia or persistence of lactase // Am J Hum Genet. 1991; 48: 889–890.Boll W., Wagner P., Mantei N. Structure of the chromosomal gene and cDNAs coding for lactase-phlorizin hydrolase in humans with adult-type hypolactasia or persistence of lactase // Am J Hum Genet. 1991; 48: 889–890.Cavalli-Sforza L. L. Analytic review: some current problems of human population genetics // Am J Hum Genet. 1973; 25: 82–104.Cavalli-Sforza L. L. Analytic review: some current problems of human population genetics // Am J Hum Genet. 1973; 25: 82–104.Chapman T. M., Plosker G. L., Figgitt D. P. VSL#3 probiotic mixture: a review of its use in chronic inflammatory bowel diseases // Drugs. 2006; 66 (10): 1371–1287.Chapman T. M., Plosker G. L., Figgitt D. P. VSL#3 probiotic mixture: a review of its use in chronic inflammatory bowel diseases // Drugs. 2006; 66 (10): 1371–1287.Coelho M., Luiselli D., Bertorelle G. et al. Microsatellite variation and evolution of human lactase persistence // Hum Genet. 2005; 117: 329–339.Coelho M., Luiselli D., Bertorelle G. et al. Microsatellite variation and evolution of human lactase persistence // Hum Genet. 2005; 117: 329–339.Enattah N. S., Sahi T., Savilahti E., Terwilliger J. D., Peltonen L., J?verl? I. Identifiation of a variant associated with adult-type hypolactasia // Nat Genet. 2002; 30: 233–237.Enattah N. S., Sahi T., Savilahti E., Terwilliger J. D., Peltonen L., J?verl? I. Identifiation of a variant associated with adult-type hypolactasia // Nat Genet. 2002; 30: 233–237.Evershed R. P., Payne S., Sherratt A. G., Copley M. S., Coolidge J., Urem-Kotsu D., Kotsakis K., Ozdogan M., Ozdogan A. E., Nieuwenhuyse O. et al. Earliest date for milk use in the Near East and southeastern Europe linked to cattle herding // Nature. 2008, 455, 528–531.Evershed R. P., Payne S., Sherratt A. G., Copley M. S., Coolidge J., Urem-Kotsu D., Kotsakis K., Ozdogan M., Ozdogan A. E., Nieuwenhuyse O. et al. Earliest date for milk use in the Near East and southeastern Europe linked to cattle herding // Nature. 2008, 455, 528–531.Gerosa J., Skoet J. Milk Availability: Trends in Production and Demand and Medium-Term Outlook. Available online: www.fao.org/docrep/015/an450 e/an450 e00.pdf (accessed on 26 May 2015). ESA Working paper No. 12–01 February 2012.Gerosa J., Skoet J. Milk Availability: Trends in Production and Demand and Medium-Term Outlook. Available online: www.fao.org/docrep/015/an450 e/an450 e00.pdf (accessed on 26 May 2015). ESA Working paper No. 12–01 February 2012.Global Consumption of Dairy Products. Canadian Dairy Information Centre. Available online: http://www.dairyinfo.gc.ca/index_e.php?s1=dff-fcil&s2=cons&s3=consglo (accessed on 26 May 2015).Global Consumption of Dairy Products. Canadian Dairy Information Centre. Available online: http://www.dairyinfo.gc.ca/index_e.php?s1=dff-fcil&s2=cons&s3=consglo (accessed on 26 May 2015).He T., Priebe M. G., Zhong Y., Huang C., Harmsen H. J. et al. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects // J Appl Microbiol. 2008, 104: 595–604.He T., Priebe M. G., Zhong Y., Huang C., Harmsen H. J. et al. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects // J Appl Microbiol. 2008, 104: 595–604.International Dairy Federation (IDF). World Dairy Situation 2014; Bulletin No. 476/2014; IDF: Brussels, Belgium, 2014.International Dairy Federation (IDF). World Dairy Situation 2014; Bulletin No. 476/2014; IDF: Brussels, Belgium, 2014.Kretchmer N. Lactose and lactase // Sci Am. 1972; 227: 71–78.Kretchmer N. Lactose and lactase // Sci Am. 1972; 227: 71–78.Leonardi M., Gerbault P., Thomas M. G., Burger J. The evolution of lactase persistence in Europe. A synthesis of archaeological and geneticгрудного вскармливания evidence // Int. Dairy J. 2012, 22, 88–97.Leonardi M., Gerbault P., Thomas M. G., Burger J. The evolution of lactase persistence in Europe. A synthesis of archaeological and geneticгрудного вскармливания evidence // Int. Dairy J. 2012, 22, 88–97.Lokki A. I., J?rvel? I., Israelsson E., Maiga B., Troye-Blomberg M., Dolo A., Doumbo O. K., Meri S., Holmberg V. Lactase persistence genotypes and malaria susceptibility in Fulani of Mali // Malar J. 2011, Jan 14; 10: 9.Lokki A. I., J?rvel? I., Israelsson E., Maiga B., Troye-Blomberg M., Dolo A., Doumbo O. K., Meri S., Holmberg V. Lactase persistence genotypes and malaria susceptibility in Fulani of Mali // Malar J. 2011, Jan 14; 10: 9.Lomer M. C., Parkes G. C., Sanderson J. D. Review article: lactose intolerance in clinical practice — myths and realities // Aliment Pharmacol Ther. 2008, Jan 15; 27 (2): 93–103.Lomer M. C., Parkes G. C., Sanderson J. D. Review article: lactose intolerance in clinical practice — myths and realities // Aliment Pharmacol Ther. 2008, Jan 15; 27 (2): 93–103.Malmstr?m H., Linderholm A., Lid?n K., Stor? J., Molnar P., Holmlund G., Jakobsson M., G?therstr?m A. High frequency of lactose intolerance in a prehistoric hunter-gatherer population in northern Europe // BMC Evol. Biol. 2010, 10, 89, I.Malmstr?m H., Linderholm A., Lid?n K., Stor? J., Molnar P., Holmlund G., Jakobsson M., G?therstr?m A. High frequency of lactose intolerance in a prehistoric hunter-gatherer population in northern Europe // BMC Evol. Biol. 2010, 10, 89, I.Mattar R., Monteiro M. S., Silva J. M. K., Carrilho F. J. LCT-22018 G.A single nucleotide polymorphism is a better predictor of adult-type hypolactasia/lactase persistence in Japanese-Brazilians than LCT-13910 C.T // Clinics (S?o Paulo). 2010; 65: 1399–1400.Mattar R., Monteiro M. S., Silva J. M. K., Carrilho F. J. LCT-22018 G.A single nucleotide polymorphism is a better predictor of adult-type hypolactasia/lactase persistence in Japanese-Brazilians than LCT-13910 C.T // Clinics (S?o Paulo). 2010; 65: 1399–1400.Montes R. G., Bayless T. M., Saavedra J. M., Perman J. A. Effect of milks inoculated with Lactobacillus acidophilus or a yogurt starter culture in lactose-maldigesting children // J Dairy Sci. 1995, 78: 1657–1664.Montes R. G., Bayless T. M., Saavedra J. M., Perman J. A. Effect of milks inoculated with Lactobacillus acidophilus or a yogurt starter culture in lactose-maldigesting children // J Dairy Sci. 1995, 78: 1657–1664.Nei M., Saitou N. Genetic relationship of human populations and ethnic differences in reaction to drugs and food // Prog Clin Biol Res. 1986; 214: 21–37.Nei M., Saitou N. Genetic relationship of human populations and ethnic differences in reaction to drugs and food // Prog Clin Biol Res. 1986; 214: 21–37.Ozdemir O., Mete E., Catal F., Ozol D. Food intolerances and eosinophilic esophagitis in childhood // Dig Dis Sci. 2009; 54: 8–14.Ozdemir O., Mete E., Catal F., Ozol D. Food intolerances and eosinophilic esophagitis in childhood // Dig Dis Sci. 2009; 54: 8–14.Ranciaro A., Campbell M. C., Hirbo J. B., Ko W.-Y., Froment A., Anagnostou P., Kotze M. J., Ibrahim M., Nyambo T., Omar S. A. et al. Genetic origins of lactase persistence and the spread of pastoralism in Africa // Am. J. Hum. Genet. 2014, 94, 496–510.Ranciaro A., Campbell M. C., Hirbo J. B., Ko W.-Y., Froment A., Anagnostou P., Kotze M. J., Ibrahim M., Nyambo T., Omar S. A. et al. Genetic origins of lactase persistence and the spread of pastoralism in Africa // Am. J. Hum. Genet. 2014, 94, 496–510.Rasinper? H., Savilahti E., Enattah N. S. et al. A genetic test which can be used to diagnose adult-type hypolactasia in children // Gut. 2004; 53: 1571–1576.Rasinper? H., Savilahti E., Enattah N. S. et al. A genetic test which can be used to diagnose adult-type hypolactasia in children // Gut. 2004; 53: 1571–1576.Salque M., Bogucki P. I., Pyzel J., Sobkowiak-Tabaka I., Grygiel R., Szmyt M., Evershed R. P. Earliest evidence for cheese making in the sixth millennium BC in northern Europe // Nature. 2013, 493, 522–525.Salque M., Bogucki P. I., Pyzel J., Sobkowiak-Tabaka I., Grygiel R., Szmyt M., Evershed R. P. Earliest evidence for cheese making in the sixth millennium BC in northern Europe // Nature. 2013, 493, 522–525.Savaiano D. A., Abou El Anouar A., Smith D. E., Levitt M. D. Lactose malabsorption from yogurt, pasteurized yogurt, sweet acidophilus milk, and cultured milk in lactase-deficient individuals // Am J Clin Nutr. 1984, 40: 1219–1223.Savaiano D. A., Abou El Anouar A., Smith D. E., Levitt M. D. Lactose malabsorption from yogurt, pasteurized yogurt, sweet acidophilus milk, and cultured milk in lactase-deficient individuals // Am J Clin Nutr. 1984, 40: 1219–1223.Sherratt A. The secondary exploitation of animals in the Old World // World Archaeol. 1983, 15, 90–104.Sherratt A. The secondary exploitation of animals in the Old World // World Archaeol. 1983, 15, 90–104.Silanikove N., Leitner G., Merin U., Prosser C. G. Recent advances in exploiting goat’s milk: Quality, safety and production aspects // Small Ruminant Res. 2010, 89, 110–124.Silanikove N., Leitner G., Merin U., Prosser C. G. Recent advances in exploiting goat’s milk: Quality, safety and production aspects // Small Ruminant Res. 2010, 89, 110–124.Simoons F. J. Primary adult lactose intolerance and the milking habit: a problem in biologic and cultural interrelations: II. A culture historical hypothesis // Am J Dig Dis. 1970; 15: 695–710.Simoons F. J. Primary adult lactose intolerance and the milking habit: a problem in biologic and cultural interrelations: II. A culture historical hypothesis // Am J Dig Dis. 1970; 15: 695–710.Szilagyi A. Adaptation to Lactose in Lactase Non Persistent People: Effects on Intolerance and the Relationship between Dairy Food Consumption and Evalution of Diseases // Nutrients. 2015 Aug 13; 7 (8): 6751–6779.Szilagyi A. Adaptation to Lactose in Lactase Non Persistent People: Effects on Intolerance and the Relationship between Dairy Food Consumption and Evalution of Diseases // Nutrients. 2015 Aug 13; 7 (8): 6751–6779.Troelsen J. T. Adult-type hypolactasia and regulation of lactase expression // Biochim Biophys Acta. 2005; 1723: 19–32.Troelsen J. T. Adult-type hypolactasia and regulation of lactase expression // Biochim Biophys Acta. 2005; 1723: 19–32.U. S. Food and Drug Administration — Problems Digesting Dairy Products? Available online: http://www.fda.gov/forconsumers/consumerupdates/ucm094550.htm#intolerance (accessed on 26 May 2015).U. S. Food and Drug Administration — Problems Digesting Dairy Products? Available online: http://www.fda.gov/forconsumers/consumerupdates/ucm094550.htm#intolerance (accessed on 26 May 2015).Xu L., Sun H., Zhang X. et al. The –22018 A allele matches the lactase persistence phenotype in northern Chinese populations // Scand J Gastroenterol. 2010; 45: 168–174.Xu L., Sun H., Zhang X. et al. The –22018 A allele matches the lactase persistence phenotype in northern Chinese populations // Scand J Gastroenterol. 2010; 45: 168–174.Zecca L., Mesonero J. E., Stutz A. et al. Intestinal lactase-phlorizin hydrolase (LPH): the two catalytic sites; the role of the pancreas in pro-LPH maturation // FEBS Lett. 1998; 435: 225–228.Zecca L., Mesonero J. E., Stutz A. et al. Intestinal lactase-phlorizin hydrolase (LPH): the two catalytic sites; the role of the pancreas in pro-LPH maturation // FEBS Lett. 1998; 435: 225–228.Zecca L., Mesonero J. E., Stutz A. et al. Intestinal lactase-phlorizin hydrolase (LPH): the two catalytic sites; the role of the pancreas in pro-LPH maturation // FEBS Lett. 1998; 435: 225–228.Zecca L., Mesonero J. E., Stutz A. et al. Intestinal lactase-phlorizin hydrolase (LPH): the two catalytic sites; the role of the pancreas in pro-LPH maturation // FEBS Lett. 1998; 435: 225–228.Данилов М. Б. Активность ?-галактозидазы микроорганизмов, используемых в производстве молочных продуктов // Хранение и переработка сельхозсырья. 2001. № 7. С. 30–31.Данилов М. Б. Активность ?-галактозидазы микроорганизмов, используемых в производстве молочных продуктов // Хранение и переработка сельхозсырья. 2001. № 7. С. 30–31.Мngram C. J., Liebert A., Swallow D. M. Population Genetics of Lactase Persistence and Lactose Intolerance; John Wiley & Sons, Inc.: Hoboken, NJ, USA, 2012.Мngram C. J., Liebert A., Swallow D. M. Population Genetics of Lactase Persistence and Lactose Intolerance; John Wiley & Sons, Inc.: Hoboken, NJ, USA, 2012.Мухина Ю. Г., Чубарова А. И., Гераськина В. П., Бельмер С. В., Гасилина Т. В., Боровик Т. Э., Рославцева Е. А., Скворцова В. А., Яцык Г. В. Рабочий протокол по диагностике и лечению лактазной недостаточности у детей // Вопр. дет. диет. 2016; 14 (1): 64–69.Мухина Ю. Г., Чубарова А. И., Гераськина В. П., Бельмер С. В., Гасилина Т. В., Боровик Т. Э., Рославцева Е. А., Скворцова В. А., Яцык Г. В. Рабочий протокол по диагностике и лечению лактазной недостаточности у детей // Вопр. дет. диет. 2016; 14 (1): 64–69.Рипелиус К., Двинский Б. М. Максилакт — ферментная обработка молока решает проблему непереносимости лактозы // Молочная промышленность. 1995. № 5. С. 23–24.Рипелиус К., Двинский Б. М. Максилакт — ферментная обработка молока решает проблему непереносимости лактозы // Молочная промышленность. 1995. № 5. С. 23–24.

The authors declare that there are no conflicts of interest present.