虽然乳糖酶缺乏和乳糖不耐受并不导致钙吸收不良,但避免或大量减少牛奶和其它乳制品的摄入可以导致钙和维生素D的摄入减少,这可增加骨量减少、骨质疏松和骨折的风险。[69]Di Stefano M, Veneto G, Malservisi S, et al. Lactose malabsorption and intolerance and peak bone mass. Gastroenterology. 2002 Jun;122(7):1793-9.http://www.ncbi.nlm.nih.gov/pubmed/12055586?tool=bestpractice.com[70]Obermayer-Pietsch BM, Bonelli CM, Walter DE, et al. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res. 2004 Jan;19(1):42-7.http://www.ncbi.nlm.nih.gov/pubmed/14753735?tool=bestpractice.com 应鼓励每天固定与其他食物一起摄入 8-12oz (240 mL) 小份牛奶,并增加硬乳酪、酸奶、巧克力奶和富含钙的非乳制品膳食。如果严重乳糖不耐受患者和/或有全身症状的患者不耐受牛奶,可以给予预处理的牛奶、高钙无乳糖配方奶,也可与乳制品一起使用乳糖酶补充剂。[2]Heyman MB; American Academy of Pediatrics, Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006 Sep;118(3):1279-86.http://pediatrics.aappublications.org/content/118/3/1279.longhttp://www.ncbi.nlm.nih.gov/pubmed/16951027?tool=bestpractice.com[64]Greer FR, Krebs NF; American Academy of Pediatrics Committee on Nutrition. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics. 2006 Feb;117(2):578-85.http://pediatrics.aappublications.org/content/117/2/578.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16452385?tool=bestpractice.com 有钙和维生素D摄入减少时,应确保钙和维生素D的监测和补充。[2]Heyman MB; American Academy of Pediatrics, Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006 Sep;118(3):1279-86.http://pediatrics.aappublications.org/content/118/3/1279.longhttp://www.ncbi.nlm.nih.gov/pubmed/16951027?tool=bestpractice.com[54]Suchy FJ, Brannon PM, Carpenter TO, et al. National Institutes of Health Consensus Development Conference: lactose intolerance and health. Ann Intern Med. 2010 Jun 15;152(12):792-6.http://annals.org/aim/fullarticle/745834/national-institutes-health-consensus-development-conference-lactose-intolerance-healthhttp://www.ncbi.nlm.nih.gov/pubmed/20404261?tool=bestpractice.com[64]Greer FR, Krebs NF; American Academy of Pediatrics Committee on Nutrition. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics. 2006 Feb;117(2):578-85.http://pediatrics.aappublications.org/content/117/2/578.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16452385?tool=bestpractice.com[70]Obermayer-Pietsch BM, Bonelli CM, Walter DE, et al. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res. 2004 Jan;19(1):42-7.http://www.ncbi.nlm.nih.gov/pubmed/14753735?tool=bestpractice.com 及时建议和实施以上步骤有助于预防骨质疏松。
Osteoporosis
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