Lactase deficiency what tests. Secondary lactase deficiency in adults. Treatment with artificial feeding

Women are very fond of shopping, it improves their mood, allows you to replenish your wardrobe with new and fashionable clothes. Before you buy a dress, skirt, pants or blouse, you need to try them on. It is easier to do this by visiting shops and boutiques. But today, women often buy things in online stores, so they need to know their size exactly.

Women are especially alarmed by European and american sizes, which are significantly different from Russian ones. It is necessary to deal with the markings on clothing labels - digital and alphabetic characteristics.

We have prepared the following reviews:

How to calculate your clothing size correctly

To do this, you need to have an ordinary centimeter tape on hand. You need to know your height, as well as take three measurements - chest, waist and hips. When all the numbers are known, we divide the first and last value by 2. For example, your bust girth is 88 cm, so choose blouses, t-shirts, dresses, shirts in size 44 for yourself. If the measurement of the hips is 92 cm, then look for clothes marked "46" - trousers, leggings, shorts, skirts.

Choose your size carefully

If you bought a thing that fits you, you will wear it for a long time. The product will fit your figure, you will feel comfortable and comfortable in it.

Comparison tables are available at different types women's clothing. It is sewn according to standard standards - jackets, jackets, coats, jackets, sweaters. Dresses, trousers, skirts, jeans also correspond to the main sizes. Carefully approach the choice - and they have their own parameters.

Sales consultants of online stores will help customers in choosing goods. They will choose the size of clothes according to the parameters of your figure. Good luck with your shopping, lovely girls and women!

The main measurements that need to be taken to determine the size of women's clothing are chest (OG), hip (OB) and waist (OT). This refers to taking figure measurements to determine the size in any country. But the combination of these measurements obtained gives a certain size, which has different designations on different continents and in different countries.

In accordance with Russian GOSTs, the sizes of women's clothing are defined as half the size of the chest volume. For example, if the volume of the chest is 92 cm, then this is 46 clothing sizes (92: 2 \u003d 46). At the same time, with a standard figure with a chest volume of 92 cm, the hip volume is 92-96 cm. Therefore, even choosing the size of trousers, which is determined based on the volume of the hips, it is necessary to know the volume of the chest. The table of correspondence between figure parameters and clothing sizes can be viewed in the table:

Table of standards for figure parameters and clothing sizes

Domestic clothing standards are now more or less clear to us. Now we offer to dive deeper into the topic and find out which American clothing sizes and European clothing sizes correspond to ours. After all, probably, there is not a single girl or woman who would wear clothes exclusively from a domestic manufacturer.

It is quite easy to determine your size for clothes that are made according to German standards. To do this, you just need to subtract 6 from the Russian size (and we remember that it is half the chest volume). For example, if the chest volume is 96 cm, then this is 48 Russian size (96: 2 = 48) and 42 European clothing size (48 -6=42). The same clothing standards for women are used in France and Italy.

The English sizing system for women's clothing is completely different. Of course, measurements are also taken and the ratio of the volume of the chest, hips and waist in one size will be the same, regardless of whether the clothes are produced by a Russian or English company. It's about specifically about sizing. Women's sizes in England are between designations 4 and 20. 4 size corresponds to Russian size 42 and European size 36. And the 20th English size is 58 Russian and 52 European.

American clothing sizes usually have a letter designation. There are such American sizes of women's clothing: XXS, XS, S, M, L, XL, XXL, 2XL and 3XL. The letter S is the first letter in the word SMALL (small), M - MIDDLE (medium), L - LARGE (large). Size XXS corresponds to Russian size 42 (36 European), XS - size 44 (38 European) and so on up to 3XL, which corresponds to Russian size 58 (52 European).

Let's move on to such an irreplaceable participant female image like shoes. As one famous Italian actress said: - "The success of a woman in a tight bra and loose shoes." If the first, from the point of view of medicine, can be argued, then everyone will agree that a woman should feel comfortable in shoes. In order to accurately determine your shoe size, you must act in this way. Stand with your foot on a sheet of paper, transfer your body weight to this leg and circle the foot. Then you need to measure the distance between the most protruding point thumb and heels. The same must be done with the second foot. Sometimes, one foot is larger than the other, more often the right one.

Knowing the resulting distance in centimeters, you can easily determine your shoe size. For example, if the foot length is 25 cm, then this corresponds to the 38th Russian shoe size. Women's shoes are usually produced from size 34 (foot length 21.5 cm) to size 42 (foot length 28 cm). The most common are sizes from 36th to 40th. Some sizes in Russia are produced by some companies with half (for example, 39.5). You can see the table of matching the sizes of women's shoes, for example, here.

In Europe and the USA, sizes are indicated differently. In the USA, the Russian 34th size of women's shoes corresponds to the 5th size, and the 42nd - 11.5. In the US and Europe, all sizes are half values, such as 5; 5.5; 6; 6.5 etc. The sizes of women's shoes in the UK differ from American ones by exactly 2. That is, to determine the English size, you need to subtract the number 2 from the American one. So, the smallest size will be the 3rd (Russian 34th), and the largest - 9.5 ( Russian 42nd).

With European sizes, it's a little more difficult with regards to women's shoes. For example, the Russian 34th size corresponds to the 35th European, the Russian 37th European 37.5, and the Russian 39.5 and in Europe is called 39.5. In order to accurately determine the European size of shoes, you can use the table

Table of standards for women's shoe sizes

Table of standard sizes for men's shoes

In any case, all European sizes are "small" in relation to domestic ones.

Lactose deficiency in infants manifests itself in rare cases due to the nature of digestion. Not suitable for these kids. breast milk, and mothers are worried about what they can feed their child and how this intolerance will affect the development of the newborn. If breastfeeding causes your baby to cry, spit up, lose weight, have problems with digestion and stool, you should see a doctor to examine your baby. He will determine if these symptoms are signs of lactose intolerance.

Lactase deficiency is a type of disease that is manifested by a lack of the lactase enzyme, which performs the function of breaking down sugar. And lactose is a disease in which the intestines cannot cope with the digestion of the carbohydrate lactose. Both diseases are characterized by the absence of the enzyme lactase in the intestines of the baby, which breaks down the carbohydrate lactose into two components - glucose and galactose.

Lactose is important for the development of the child, as it gives the baby 40% of the energy he needs, normalizes work needed by the intestines microorganisms and helps the newborn's brain and eyes develop properly. Lactase deficiency does not allow lactose to be absorbed in the intestines of the baby. It leads to deficiency essential substances and energy, as a result of which the development of the child may slow down.

Types of lactose intolerance

There is a congenital and acquired intolerance to this enzyme.

1. Congenital is the absence or decrease in the amount of lactase, so it can often be determined during the first 30 days of a newborn's life.
2. Acquired intolerance is caused by diseases of the digestive system, in which the level of lactase decreases. With proper treatment, it resolves within 60 days.

Reasons for the appearance

1. The most severe form of the disease develops due to a hereditary predisposition, when the baby's body suffers from lactase deficiency and cannot provide enough enzyme due to genetic disorders. This disease It is diagnosed when an increase in the amount of breast milk consumed by a child, which usually occurs at 3-4 weeks of age. With this form of the disease, there is no treatment, and the baby is prescribed special diet and medicines containing lactase.
2. If a child was born prematurely, then there is not enough lactase in his body, since this enzyme begins to be produced in the baby even inside the mother's womb from 6 to 9 months of pregnancy.
3. With the defeat of enterocytes that produce lactase, acquired lactase deficiency develops in the intestine of the newborn. This disease may be due to rotavirus infection, giardiasis, viral or medicinal enteritis.

Symptoms

Symptoms include the following:

• poor appetite;
• sluggish sucking of the breast by the child, accompanied by crying and frequent breaks;
• after feeding, the child spits up, vomiting is possible;
• increased gas formation;
• the baby pulls its legs to the stomach, cries;

Congenital lactase deficiency has the following symptoms:

• frequent colic;
• the presence of flatulence;
• the presence of a frothy greenish watery stool with undigested lumps, which has an unpleasant sour smell, up to 10-12 times a day.

If lactose intolerance is observed for a long time, there may be a lag in the development, growth and weight of the baby.

Diagnostics

For exact definition diagnosis during the examination, it is necessary to pass certain tests.

1. Feces for carbohydrates. This analysis is prescribed to all infants who have symptoms of lactose intolerance. However, such a study does not have accuracy due to the lack of norms and the identification of the type of sugars.
2. Carrying out a coprogram. Responsible for defining advanced level acidity and increased presence of undigested lumps of milk.
3. Breath test. The analysis is aimed at examining the inhaled air when the baby drinks a lactose solution. An elevated hydrogen level resulting from a reaction to bacteria in the gut is the diagnosis.
4. Drinking sugar solution. This analysis, using regular blood sampling to determine the level of glucose, builds a lactose curve. However this method difficult to implement with babies.
5. Biopsy of the intestinal mucosa. This analysis is rarely performed, as it requires anesthesia. It is the most accurate way to determine the disease.

With each diagnostic method, it is necessary to compare the results that the analysis gave with the state and course of the disease. The main study is the reaction of the baby to milk intake. If there are no signs of lactose intolerance, the diagnosis is called into question.

How to treat

Treatment of lactase deficiency is prescribed only by a doctor and after diagnosis. With this disease, when feeding the baby, dairy products are excluded, constant monitoring of changes in his condition is carried out.

1. If the analysis showed a severe course of the disease, instead of breast milk, mothers can offer the child therapeutic lactose-free or soy mixtures that normalize the baby's condition.
2. If the amount of lactase in the baby’s body is reduced, treatment is carried out with special preparations containing this enzyme. A diet is being developed for the mother. Also, a woman should express the anterior portion of milk because the posterior portion contains large quantity lactase.
3. If a child is diagnosed with acquired lactase deficiency, the underlying disease that affects the intestinal mucosa is treated. The disease gradually disappears when the disease is exposed proper treatment and eventually all symptoms disappear.

Food

After the parents passed required analysis, who confirmed lactose intolerance, a diet and specific nutritional methods are prescribed for both mother and baby. The diet consists in the exclusion of this carbohydrate from the diet. First you need to stabilize breast-feeding why the baby needs to be fed with more fat milk. There are several ways:

• expressing foremilk;
• give the baby only one breast;
• try to attach the newborn to the chest in the correct position;
• try to feed more often at night, when milk has a high fat content;
• stop feeding the baby when he comes off the breast.

Moms need to cut out food cow's milk, the protein of which can disrupt the functioning of the intestinal cells of the baby and reduce the formation of lactase. Also, the doctor may exclude other products, which during the study will determine the analysis to identify allergens.

When the disease recedes

If the baby has hereditary lactose intolerance, the child will be prescribed a lactose-free diet for life, adhering to which, he will ease the symptoms of the disease.

Acquired intolerance due to special treatment recedes by the year of life, but in rare cases, the symptoms disappear only by 3 years. To diagnose recovery at the end of treatment, a re-analysis is performed.

So that lactase deficiency does not develop in a severe form, leading to a lag in the growth and development of the child, it is necessary to notice the signs of the disease in the child in time, diagnose and, when the doctor prescribes treatment, strictly adhere to it.

Every fifth child is being treated for lactase deficiency in Russia today. This diagnosis, which a decade and a half ago was considered only a scientific term that has little to do with practice, has now become more than popular. However, pediatricians did not come to a consensus, and therefore it is difficult to find a more controversial and incomprehensible issue regarding the health of infants. The well-known pediatrician and author of books, articles Evgeny Olegovich Komarovsky.

About the problem

Lactase deficiency is the absence or temporary decrease in the body of a special enzyme called "lactase". She can split milk sugar called lactose. When there is little enzyme, milk sugar remains undigested, its fermentation in the intestine begins.

Most often, such a diagnosis is made to children whose age is up to a year. Quite rarely, babies under 6-7 years old suffer from lactase deficiency. After this age, the physiological extinction of the production of the enzyme occurs, since nature does not provide for the consumption of milk by adults. It is extremely rare that the pathology persists in adults, but this is considered to be a variant of the norm, since milk is not an important product for their body.

Lactase deficiency can be congenital, primary. It is also secondary, acquired. Such failure occurs in case of damage to the walls small intestine. This may be the result of an infection (rotavirus, enterovirus), toxic poisoning, severe damage helminthic infestations, allergic reaction for cow protein.

More often than others, premature babies and babies who are overfed and who receive more milk than they can digest suffer from lactase deficiency.

Regarding this diagnosis, modern medicine quite optimistic forecasts: in 99.9% of cases, enzyme deficiency resolves on its own, with the elimination of the causes that caused it.

Doctor Komarovsky about the problem

For adults, lactase deficiency is not a problem, Evgeny Komarovsky believes. Nothing bad will happen if a person simply does not eat dairy products. However, for babies in whom milk is the basis of nutrition, things are somewhat more complicated.

Decreased lactase levels may be genetically determined, says Evgeny Komarovsky. If mom or dad does not tolerate or did not like milk in childhood, then the likelihood of having a baby with a lactase deficiency is quite high.

However, Evgeny Olegovich emphasizes that medicine knows very little of real cases of congenital primary lactase deficiency (30-40). These are really very sick children who do not gain weight, constantly spit up profusely, and suffer from a tummy. The proportion of such cases is about 0.1%.

In all other cases, it was not without the influence of pharmaceutical magnates, who really need to sell lactose-free milk formulas for artificial feeding in large volumes. They cost much more than other food, but parents who have been put in a stalemate are ready to pay as much as they like, so long as the baby lives and develops normally.

In premature babies, lactase deficiency can be explained by the immaturity of the body, they often have transient insufficiency. It passes by itself - as the organs and systems mature. The severity of the disease can be complete or partial.

Evgeny Komarovsky emphasizes that real lactase deficiency is a rather rare case. For this reason, it is not worth stopping breastfeeding and transferring the child to lactose-free sweeps due to suspicions of a lactase enzyme deficiency.

To dispel doubts or confirm the diagnosis that has become so popular recently, Various additional diagnostic methods are used:

• determination of the level of acidity of feces;
• carbohydrate analysis;
• diet tests.

During the tests, under the supervision of a doctor, breastfeeding is temporarily canceled, adapted mixtures.

The child is given only lactose-free or soy mixtures for 2-3 days. With a decrease clinical manifestations diagnosed with lactose intolerance.

In all cases (except for severe congenital ones, which, as already mentioned, occur only in 0.1% of cases), lactase deficiency is purely temporary.

The most common cause of intolerance milk sugar in children - banal overfeeding. Parents try so hard to feed their child that they give him the amount of formula or milk that exceeds all conceivable norms. As a result, a child whose enzymes are normal is diagnosed with lactase deficiency only because his small body cannot break down such a large amount of milk sugar.

Formula-fed babies are the most commonly affected by overfeeding because they make little effort to get bottle-fed.

Babies who suckle breast milk is much more difficult. Sometimes mothers and fathers do not understand what exactly the child wants. The child wants to drink and screams, and they give him food, believing that the baby is hungry. This can also lead to transient lactase deficiency.

Treatment according to Komarovsky

A temporary (transient) lack of the lactase enzyme does not need treatment, says Komarovsky. Enzyme production in the right amount will recover immediately after the cause of the violation is eliminated (the baby will stop overfeeding, they will begin to observe the drinking regimen).

At secondary insufficiency lactase caused by intestinal viral infections, the child is prescribed special drugs. It is advisable to limit food, reduce its volume. Sometimes it is appropriate to start giving your baby probiotics.

A child with a genetically determined lactase deficiency is given lactose-free mixtures for up to six months, and then gently, gradually begin to introduce dairy products into the diet.

A nursing mother should not sound the alarm when she sees greenish liquid feces with sour smell. This is a reason to go to the pediatrician, but not a reason to wean the baby from the breast. Moms should not start to mock themselves. The opinion that maternal nutrition affects the lactose content in milk is nothing more than a myth. Lactose in breast milk always contains the same amount, which does not depend on the gastronomic preferences of the woman, the time of day and the frequency of feeding.

• So that the artificial person does not overeat, you need to give him a mixture from a bottle with a nipple with a small hole. The harder it is for him to suckle, the faster he will feel full. Tem less likely that he eats too much.
• If you are going to reduce the amount of lactose in food, you need to find out which foods contain it the most. The undisputed leader in the percentage of lactose is women's breast milk (7%), cow and goat milk sugar contains approximately the same amount (4.6% and 4.5%, respectively). In the milk of a mare and a donkey, lactose is almost the same as in women's - 6.4%.
• If you have thoughts about acquiring a lactose-free mixture, you should first try giving your child low-lactose Nutrilon and the same Nutrilak.

Dr. Komarovsky will tell more about lactase deficiency in the video below.

Lactase deficiency is a congenital or acquired deficiency in the activity of the lactase enzyme, which causes a violation of the breakdown and absorption of lactose and is manifested by digestive disorders in the form of enzymatic chronic dyspepsia.

Hereditary lactase deficiency is a widespread pathology. So primary lactose intolerance is observed in 100% of American Indians, 80% of Jews, representatives of the Negroid race, indigenous people of the Mediterranean and Asian countries, 5% of residents of Northern and Central Europe.

Clinical manifestations of lactose intolerance occur after consumption of dairy products and, above all, whole milk.

No less widespread is acquired lactase deficiency. Approximately 50% of children with chronic dyspepsia this form of fermentopathy is diagnosed.

Lactase deficiency in children, especially in the first year of life, is an urgent task of pediatrics. This is because lactose is a disaccharide in large numbers contained in milk, which, in turn, serves as the basis of baby food.

Causes and risk factors

Lactose or milk sugar is complex carbohydrate, consisting of two monosaccharide residues, and is one of the main sources of carbohydrates in human nutrition. In the small intestine, under the influence of the enzyme lactase florizin hydrolase (lactase), the lactose molecule is broken down into monosaccharides galactose and glucose, which are absorbed into the systemic circulation through the villous apparatus and distributed throughout the body.

In the future, galactose is used in the process of synthesis of galactolipids necessary for normal development and functioning of the central nervous system, and glucose acts as the main energy resource in the body.

In case of insufficient activity or total absence lactase florizin hydrolase does not break down lactose in the small intestine, and it enters the large intestine unchanged. Here under the influence intestinal microflora fermentation of milk sugar occurs, which is accompanied by increased secretion of water, gas formation, and a decrease in the pH of the intestinal contents.

The development of congenital lactase deficiency is usually caused by a defect in the LCT gene (LAC), localized on the second chromosome and responsible for the synthesis of lactase. Pathology is inherited in an autosomal recessive manner, that is, it is not associated with sex, and for the development of the disease, the child must receive a pathologically altered gene from both the father and mother. At the same time, the parents themselves can only be carriers of the mutated gene and not have any clinical signs lactose intolerance.

If family members have cases of lactose intolerance, medical genetic counseling is recommended for spouses at the stage of pregnancy planning.

With age, lactase activity gradually decreases, which causes some people intolerance to dairy products rich in lactose. In this case, they talk about the development of a constitutional form of lactase deficiency.

Lactase deficiency is more often diagnosed in premature babies. This is due to the fact that lactase activity increases in recent weeks. prenatal development fetus and reaches a maximum by the 39-40th week of gestation.

In some diseases of the small intestine (enteritis, giardiasis, rotavirus and other acute intestinal infections, resection of a section of the intestine), its mucous membrane is damaged, as a result of which lactase secretion is disturbed and lactase deficiency develops.

Forms of the disease

Based on the causes of lactase deficiency in adults and children, it is divided into primary and secondary. The primary forms of the disease include:

• congenital (hereditary) lactase deficiency (hereditary disaccharide intolerance, alactosia);
• transient lactase deficiency in preterm infants;
• hypolactasia of the adult type.

Secondary lactase deficiency is associated with damage to enterocytes caused by pathologies of the small intestine.

According to the nature of the course, transient (transient) and persistent (permanent) lactase deficiency are distinguished.

Depending on the severity enzyme deficiency allocate:

• alactasia - observed against the background of the complete absence of lactase;
• hypolactasia - lactase is synthesized by the cells of the small intestine, but in insufficient quantities or its activity is reduced.

Lesions of the central nervous system in children with lactase deficiency are manifested by a lag in psychomotor development, sleep disorders, irritability, and hyperexcitability.

Symptoms of lactase deficiency

Clinical manifestations of lactose intolerance occur after the consumption of dairy products and, above all, whole milk. The main symptom of lactase deficiency is fermentative diarrhea. The frequency of bowel movements can reach 10-12 times per day. Stools are watery, frothy, with a characteristic sour smell. They are accompanied by pain in the abdomen by type intestinal colic, flatulence . In very rare cases, lactase deficiency in adults and children may not be manifested by diarrhea, but, on the contrary, by constipation.

Source: deteylechenie.ru

In newborns, symptoms of lactase deficiency, in addition to those listed, include frequent regurgitation and skin rashes.

Diagnostics

The preliminary diagnosis of lactase deficiency is based on the characteristic clinical picture. In the future, it needs to be confirmed by the results laboratory research and functional tests.

AT clinical practice The method of diet diagnostics is widely used. The patient is prescribed a lactose-free diet, which leads to the cessation of diarrhea, elimination of flatulence. The introduction of dairy products into the diet contributes to the resumption of the symptoms of the disease. Pay attention to the fact that after a lactose load in the air exhaled by patients, the concentration of methane and hydrogen increases, which can be detected using special laboratory tests.

At infants with lactase deficiency, a decrease in the pH of feces to 5.5 or less is determined, and in adults in feces discover high content lactose.

Lactase deficiency in children is often combined with other pathological conditions(hyperactivity and attention deficit syndrome, vitamin D-deficient rickets, convulsions, muscle hypotension).

Currently, the gold standard for diagnosing lactase deficiency in adults is the determination in a biopsy. small intestine lactase activity. This method has not been found in pediatric practice. wide application due to its invasiveness and complexity.

In primary lactase deficiency, it is indicated to carry out genetic research- lactase genotyping.

Treatment of lactase deficiency

Approach to the treatment of lactase deficiency in patients different ages has certain features. The basic scheme of therapy is based on the following principles:

• diet therapy;
• improving the process of splitting lactose;
• prevention of the development of complications (polymineral and multivitamin deficiency, malnutrition).

Children of the first year of life are shown enzyme replacement therapy, which allows them to keep breastfeeding. If the children are on artificial feeding, they are transferred to nutrition with soy milk or special lactose-free nutritional mixtures.