Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical Nutrition

Perception of lactose intolerance impairs health-related quality of life

Abstract

Background/Objectives:

Chronic conditions impair perception of well-being. Malabsorption of lactose is the most frequent form of malabsorption and manifests as lactose intolerance. There is a lack of information regarding their impact on self-perception of health. The objective of this study is to determine the subjective impact of self-reported lactose intolerance or objective lactose malabsorption on patient health by using a patient-reported outcome to measure health-related quality of life (HRQOL) and modification of lactose-containing food diet.

Subjects/Methods:

A 3-year prospective, cross-sectional study was performed in patients referred for a lactose hydrogen breath test. Patients were asked about their subjective opinion relative to their lactose tolerance and completed a validated, specific questionnaire to determine symptoms of intolerance during habitual consumption of dairy. A 50-g lactose breath test was then performed. Patients were grouped as absorbers vs malabsorbers and tolerant vs intolerants.

Results:

A total of 580 patients were included (median age 30 years, 419 female). Overall, 324 patients (56%) considered themselves lactose intolerant and that perception was associated with avoidance of dairy consumption (55% vs only 9% of self-defined tolerants). Self-perception of intolerance was associated with lower HRQOL scores (median, 60 vs 70, P<0.01). In contrast, lactose objective malabsorption was not clearly associated with dairy avoidance (41% of malabsorbers avoided dairy vs 31% of absorbers). However, HRQOL scores were also significantly lower in malabsorbers than in absorbers (60 vs 70 respectively, P<0.001).

Conclusions:

Subjective perception of lactose intolerance affects the decision to avoid dairy even more than objective malabsorption. However, both self-perception of lactose intolerance and objective lactose malabsorption are associated with poorer perceived quality of life.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. Casellas F, Aparici A, Casaus M, Rodríguez P . Self-perceived lactose intolerance and lactose breath test in elderly. Eur Geriatr Med 2013; 4: 372–375.

    Article  Google Scholar 

  2. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on lactose thresholds in lactose intolerance and galactosaemia. EFSA J 2010; 8: 1777.

    Article  Google Scholar 

  3. Argüelles-Arias F, Rodríguez Ledo P, Tenías JM, Otero M, Casellas F, Blay Cortés G et al. The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: the SEPD-SEMG national survey. Rev Esp Enferm Dig 2015; 107: 554–558.

    PubMed  Google Scholar 

  4. Iqbal TH, Bradley R, Reilly HM, Lewis KO, Cooper BT . Small intestinal lactase status, frequency distribution of enzyme activity and milk intake in a multi-ethnic population. Clin Nutr 1996; 15: 297–302.

    Article  CAS  Google Scholar 

  5. Gupta SK, Chong SKF, Fitzgerald JF . Disaccharidase activities in children: normal values and comparison based on symptoms and histologic changes. J Pediatr Gastroenterol Nutr 1999; 28: 246–251.

    Article  CAS  Google Scholar 

  6. Suarez FL, Savaiano DA, Levitt MD . A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1–4.

    Article  CAS  Google Scholar 

  7. Casellas F, Aparici A, Casaus M, Rodríguez P, Malagelada JR . Subjective perception of lactose intolerance does not always indicate lactose malabsorption. Clin Gastroenterol Hepatol 2010; 8: 581–586.

    Article  Google Scholar 

  8. Barr SI . Perceived lactose intolerance in adult Canadians: a national survey. Appl Physiol Nutr Metab 2013; 38: 830–835.

    Article  CAS  Google Scholar 

  9. 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; 103: 36–45.

    Article  Google Scholar 

  10. Birge SJ Jr, Keutmann HT, Cuatrecasas P, Whedon GD . Osteoporosis, intestinal lactase deficiency and low dietary calcium intake. N Engl J Med 1967; 276: 445–448.

    Article  CAS  Google Scholar 

  11. Jackson KA, Savaiano DA . Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. J Am Coll Nutr 2001; 20: 198S–207S.

    Article  CAS  Google Scholar 

  12. Dainese R, Casellas F, Mariné-Barjoan E, Vivinus-Nébot M, Schneider SM, Hébuterne X et al. Perception of lactose intolerance in irritable bowel syndrome patients. Eur J GastroenterolHepatol 2014; 26: 1167–1175.

    Article  Google Scholar 

  13. Tomba C, Baldassarri A, Coletta M, Cesana BM, Basilisco G . Is the subjective perception of lactose intolerance influenced by the psychological profile? Aliment Pharmacol Ther 2012; 36: 660–669.

    Article  CAS  Google Scholar 

  14. Zheng X, Chu H, Cong Y, Deng Y, Long Y, Zhu Y et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138–1146.

    Article  CAS  Google Scholar 

  15. Casellas F, Malagelada JR . Applicability of short hydrogen breath test for screening of lactose malabsorption. Dig Dis Sci 2003; 48: 1333–1338.

    Article  CAS  Google Scholar 

  16. Peuhkuri K, Vapaatalo H, Nevala R, Korpela R . Temperature of a test solution influences abdominal symptoms in lactose tolerance tests. Scand J Clin Lab Invest 2000; 60: 75–80.

    Article  CAS  Google Scholar 

  17. Casellas F, Varela E, Aparici A, Casaus M, Rodríguez P . Development, validation and applicability of a symptoms questionnaire for lactose malabsorption screening. Dig Dis Sci 2009; 54: 1059–1065.

    Article  Google Scholar 

  18. Badia W . Transcultural adaptation of health related quality of life measures for its use in Spain. Med Clin 1995; 105: 56–58.

    CAS  Google Scholar 

  19. Yang JF, Fox M, Chu H, Zheng X, Long YQ, Pohl D et al. Four-sample lactose hydrogen breath test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea. World J Gastroenterol 2015; 21: 7563–7570.

    Article  CAS  Google Scholar 

  20. Yang J, Deng Y, Chu H, Cong Y, Zhao J, Pohl D et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262–268.

    Article  Google Scholar 

  21. Yang J, Fox M, Cong Y, Chu H, Zheng X, Long Y et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302–311.

    Article  CAS  Google Scholar 

  22. Petschow B, Doré J, Hibberd P, Dinan T, Reid G, Blaser M et al. Probiotics, prebiotics, and the host microbiome: the science of translation. Ann NY Acad Sci 2013; 1306: 1–17.

    Article  CAS  Google Scholar 

  23. He T, Venema K, Priebe MG, Welling GW, Brummer RJ, Vonk RJ . The role of colonic metabolism in lactose intolerance. Eur J Clin Invest 2008; 38: 541–547.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F Casellas.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Author contributions

FC contributed to study concept and design; acquisition of data; analysis and interpretation of data; and drafting of the manuscript. AA, MJP and PR contributed to acquisition of data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Casellas, F., Aparici, A., Pérez, M. et al. Perception of lactose intolerance impairs health-related quality of life. Eur J Clin Nutr 70, 1068–1072 (2016). https://doi.org/10.1038/ejcn.2016.80

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2016.80

This article is cited by

Search

Quick links