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Frequency of lactose malabsorption among healthy southern and northern Indian populations by genetic analysis and lactose hydrogen breath and tolerance tests^1,2,3

¹ From the Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India (SK and UCG), and Biotools Technologies Pvt Ltd, Banglore, India (JB, PB, and JHP).

² The GI Pathophysiology and Motility Laboratory was supported by the Indian Council of Medical Research, New Delhi, India, through research grant UCG no. 5/4/3-2/2008-NCD-II.

³ Address correspondence to UC Ghoshal, Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India. E-mail: udayghoshal{at}gmail.com.

ABSTRACT

Background: Lactose malabsorption (LM), the inability to break down lactose into glucose and galactose, is due to a deficiency in the small intestinal lactase phlorizin hydrolase (LPH) enzyme. Ethnic and geographic variations of LM are known.

Objective: The aim of this study was to compare the frequency of LM in healthy southern and northern Indian populations.

Design: A total of 153 healthy volunteers (76 from southern and 77 from northern India) were evaluated for LM by using a lactose tolerance test (LTT), a lactose hydrogen breath test (lactose HBT), and polymerase chain reaction–restriction fragment length polymorphism to identify the lactase gene C/T-13910 polymorphism (confirmed by sequencing).

Results: Volunteers from southern and northern India were comparable in age and sex. The LTT result was abnormal in 88.2% of southern Indians and in 66.2% of northern Indians (P = 0.001). The lactose HBT result was abnormal in 78.9% of southern Indians and in 57.1% of northern Indians (P = 0.003). The CC genotype was present in 86.8% and 67.5% (P = 0.002), the CT genotype was present in 13.2% and 26.0% (P = 0.036), and the TT genotype was present in 0% and 6.5% (P = 0.03) of southern and northern Indians, respectively. The frequency of symptoms after the lactose load (47.4% compared with 15.6%; P < 0.001) and peak concentrations of breath hydrogen (88.5 ± 71.9 compared with 55.4 ± 61.9 ppm; P = 0.003), both of which might indicate the degree of lactase deficiency, were higher in southern than in northern Indians.

Conclusion: The frequency and degree of LM is higher in southern than in northern Indian healthy populations because of genetic differences in these populations.

Received for publication April 18, 2009. Accepted for publication October 5, 2009.